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Write ans true for t and false for f
Reading File
Now I'll answer all questions directly from medical knowledge. These are standard MBBS-level questions I can answer with high confidence.
MCQ (T/F) - Questions 1-10
Q1. Causes of exudative pleural effusion are:
| a. Congestive cardiac failure | F - CCF causes transudative effusion |
| b. Tuberculosis | T - TB is a classic cause of exudate |
| c. Pneumonia | T - parapneumonic effusion is exudative |
| d. Pulmonary infarction | T - PE/infarction causes exudative effusion |
| e. Cirrhosis of liver | F - Cirrhosis causes transudative effusion |
Q2. Causes of atrial fibrillation are:
| a. Hypertension | T - commonest cause of AF |
| b. Hyperparathyroidism | T - hypercalcemia can precipitate AF |
| c. Chest infection | T - sepsis/pneumonia can trigger AF |
| d. Mitral valvular disease | T - classic cause of AF |
| e. Hyperthyroidism | T - a well-known cause of AF |
Q3. Causes of microcytic hypochromic anaemia:
| a. Iron deficiency | T - classic cause |
| b. Vit-B12 deficiency | F - B12 deficiency causes macrocytic anaemia |
| c. Sideroblastic anaemia | T - can cause microcytic/dimorphic picture |
| d. Folic acid deficiency | F - folic acid deficiency causes macrocytic anaemia |
| e. Thalassaemia | T - classic cause of microcytic hypochromic anaemia |
Q4. Signs of upper motor neuron (UMN) lesion are:
| a. Flaccid paralysis | F - UMN causes spastic paralysis; flaccid is LMN |
| b. Increase tendon reflexes | T - hyperreflexia is a UMN sign |
| c. Wasting of muscles | F - significant wasting is a LMN sign |
| d. Extensor plantar response | T - Babinski sign is UMN |
| e. Fasciculation | F - fasciculations are a LMN sign |
Q5. Major manifestations (Jones criteria) for acute rheumatic fever:
| a. Carditis | T - major Jones criterion |
| b. Arthralgia | F - arthralgia is a minor criterion; arthritis (polyarthritis) is the major one |
| c. Erythema marginatum | T - major Jones criterion |
| d. Erythema nodosum | F - NOT a Jones criterion (it's seen in sarcoidosis, IBD, etc.) |
| e. Raised ESR | F - raised ESR is a minor criterion |
Q6. Causes of euvolemic hyponatraemia:
| a. Primary polydipsia | T - causes euvolemic hyponatraemia |
| b. Adrenocortical failure | F - adrenal insufficiency causes hypovolemic hyponatraemia |
| c. Chronic renal failure | F - CRF causes hypervolemic hyponatraemia |
| d. Hypothyroidism | T - causes euvolemic hyponatraemia |
| e. SIADH | T - classic cause of euvolemic hyponatraemia |
Q7. Regarding Haemophilia A:
| a. Factor IX activity normal | T - Haemophilia A is Factor VIII deficiency; Factor IX is normal (Factor IX deficiency = Haemophilia B) |
| b. Female are carrier and male are sufferer | T - X-linked recessive pattern |
| c. Characterized by surface bleeding | F - Haemophilia causes deep bleeding (haemarthrosis, muscle haematoma); surface bleeding is platelet disorder |
| d. It is an autosomal recessive disorder | F - it is X-linked recessive |
| e. Prenatal testing can decrease the number of affected population | T - prenatal diagnosis and genetic counselling can reduce incidence |
Q8. Following are features of primary hypothyroidism:
| a. Hypercholesterolaemia | T - hypothyroidism raises LDL/cholesterol |
| b. Tremor | F - tremor is a feature of hyperthyroidism |
| c. Increased basal body temperature | F - hypothyroidism causes decreased BMR/temperature |
| d. Polymenorrhoea | T - heavy/frequent periods (menorrhagia) occur in hypothyroidism |
| e. Weight gain | T - classic feature of hypothyroidism |
Q9. Regarding viral hepatitis:
| a. Hepatitis A virus is transmitted through blood | F - Hep A is faeco-oral transmission |
| b. Hepatitis B virus is transmitted through blood | T - Hep B is blood-borne |
| c. Vertical transmission carries highest risk for hepatitis B virus transmission | T - perinatal (mother to child) transmission has the highest risk of chronicity (~90%) |
| d. Hepatitis E is transmitted through contaminated water | T - Hep E is faeco-oral/waterborne |
| e. If a person is injected by hepatitis C virus, chance of chronicity is 10% | F - Hep C chronicity rate is approximately 75-85% (not 10%) |
Q10. Signs of consolidation are:
| a. Bronchial breath sound | T - heard over consolidated lung |
| b. Vesicular breath sound | F - vesicular breath sounds are normal/reduced in consolidation |
| c. Rhonchi | F - rhonchi suggest airway obstruction (e.g., asthma, COPD) |
| d. Crepitations | T - fine inspiratory crepitations over consolidation |
| e. Decrease vocal resonance | F - consolidation causes increased vocal resonance/fremitus |
MCQ (SBA) - Questions 11-20
Q11. Pathognomonic sign of Graves' disease?
e. Thyroid bruit - The thyroid bruit (due to increased vascularity) is considered pathognomonic of Graves' disease. Exophthalmos and pretibial myxoedema are specific but not found in all; thyroid bruit is pathognomonic.
Q12. Murmur in mitral stenosis at apical area of precordium?
b. Mid diastolic murmur - Mitral stenosis produces a low-pitched rumbling mid-diastolic murmur with opening snap, best heard at the apex.
Q13. Investigation quite specific for SLE?
c. Anti-ds DNA antibodies - Anti-double-stranded DNA antibodies are highly specific for SLE (>95% specific). ANA is sensitive but not specific.
Q14. In case of Wilson's disease - which is TRUE?
e. Diagnosis is confirmed by estimation of serum ceruloplasmin - Serum ceruloplasmin is the key diagnostic test (low in Wilson's). Note: option (d) is incorrect because KF ring is not always present in hepatic Wilson's disease; KF rings are typically absent in early hepatic presentation.
Q15. Klinefelter's syndrome is associated with all EXCEPT?
a. Short stature - Klinefelter's (47XXY) patients are typically tall (long legs), not short stature. All other options (47XXY karyotype, small testes, DM, high FSH) are associated features.
Q16. Used to monitor patients with colorectal cancer?
b. Carcinoembryonic antigen (CEA) - CEA is the standard tumour marker used to monitor colorectal cancer treatment response and recurrence. CA-125 is for ovarian cancer; AFP for hepatocellular carcinoma; CA 19-9 for pancreatic cancer.
Q17. Which one is NOT a DMARD?
d. Indomethacin - Indomethacin is an NSAID, not a disease-modifying antirheumatic drug. Sulfasalazine, Methotrexate, Penicillamine, and Gold are all DMARDs.
Q18. Acute coronary syndrome includes?
b. Unstable angina - ACS includes unstable angina, NSTEMI, and STEMI. Stable angina is NOT part of ACS. Cardiomyopathy, Syndrome X, and Old MI are not ACS.
Q19. 25-year-old woman, 32 weeks pregnant, Hb 7.8 g/dl, MCV 65 fl, MCH 18 pg - investigation for further evaluation?
e. Soluble transferrin receptor assay - This is microcytic hypochromic anaemia in pregnancy. The question asks for further evaluation to distinguish iron deficiency anaemia from thalassaemia trait. Soluble transferrin receptor (sTfR) assay is the best test in pregnancy (serum ferritin is unreliable as an acute-phase reactant). sTfR is elevated in IDA but normal in thalassaemia trait.
Q20. 15-year-old boy with cystic fibrosis (elevated sweat chloride) - at greater risk for?
b. Bronchiectasis - CF patients are classically at high risk for bronchiectasis due to recurrent pulmonary infections and mucus plugging. It is the primary pulmonary complication of CF.
Summary Answer Sheet
T/F (Q1-10):
| Q | a | b | c | d | e |
|---|---|---|---|---|---|
| 1 | F | T | T | T | F |
| 2 | T | T | T | T | T |
| 3 | T | F | T | F | T |
| 4 | F | T | F | T | F |
| 5 | T | F | T | F | F |
| 6 | T | F | F | T | T |
| 7 | T | T | F | F | T |
| 8 | T | F | F | T | T |
| 9 | F | T | T | T | F |
| 10 | T | F | F | T | F |
SBA (Q11-20): e, b, c, e, a, b, d, b, e, b
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Ans all yhis questions
Here are all the answers for the BUP MBBS Final - Medicine Paper I (May 2023 Supplementary):
MCQ (T/F) - Questions 1-10
Q1. Generalised oedema develops in:
| a. Nephrotic syndrome | T - classic cause (hypoalbuminaemia → oedema) |
| b. Filariasis | T - lymphatic obstruction → lymphoedema |
| c. Congestive heart failure | T - raised venous pressure → oedema |
| d. Systemic hypertension | F - hypertension alone does NOT cause generalised oedema |
| e. Cirrhosis of liver | T - hypoalbuminaemia + portal hypertension → oedema/ascites |
Q2. Extra-articular features of ankylosing spondylitis are:
| a. Anterior uveitis | T - most common extra-articular feature of AS |
| b. Aortic incompetence | T - aortitis and AR are recognised features |
| c. Hepatomegaly | F - NOT a recognised extra-articular feature of AS |
| d. Xerostomia | F - xerostomia is associated with Sjögren's syndrome, not AS |
| e. Atypical upper lobe pulmonary fibrosis | T - rare but well-recognised extra-articular feature of AS |
Q3. Nephrotic syndrome is characterised by:
| a. Microscopic haematuria | F - haematuria is more typical of nephritic syndrome |
| b. Generalised oedema | T - cardinal feature |
| c. Massive proteinuria | T - >3.5 g/day in adults (defining feature) |
| d. Hypertension | F - hypertension is a feature of nephritic syndrome |
| e. Hypoalbuminaemia | T - cardinal feature due to protein loss |
Q4. Causes of hypercalcaemia are:
| a. Multiple myeloma | T - osteoclast activation raises calcium |
| b. Thiazide diuretics | T - thiazides reduce renal calcium excretion |
| c. Sarcoidosis | T - granulomas produce 1,25-OH Vit D → hypercalcaemia |
| d. Glucocorticoids | F - glucocorticoids actually treat/lower calcium (used in hypercalcaemia) |
| e. Pseudohypoparathyroidism | F - pseudohypoPTH causes hypocalcaemia, not hypercalcaemia |
Q5. Predisposing factors for gastric carcinoma include:
| a. H. pylori infection | T - major risk factor (especially for gastric adenocarcinoma) |
| b. Previous gastric surgery | T - post-gastrectomy remnant stomach has increased risk |
| c. NSAIDs | F - NSAIDs are NOT a recognised risk factor for gastric carcinoma |
| d. Positive family history | T - family history increases risk |
| e. Smoking | T - smoking is a recognised risk factor |
Q6. Following are causes of macrocytic anaemia:
| a. Thalassaemia | F - thalassaemia causes microcytic anaemia |
| b. Vit B12 & folate deficiency | T - classic causes of megaloblastic macrocytic anaemia |
| c. Bleeding peptic ulcer disease | F - chronic bleeding causes iron deficiency (microcytic) anaemia |
| d. Alcoholism | T - alcohol directly causes macrocytosis (and folate deficiency) |
| e. Liver disease | T - liver disease causes macrocytosis (altered lipid membrane) |
Q7. Causes of painless haematuria:
| a. Neoplasm of kidney | T - renal cell carcinoma classically causes painless haematuria |
| b. Tuberculosis of genitourinary system | T - classically causes sterile pyuria AND painless haematuria |
| c. Blood dyscrasias | T - clotting disorders can cause painless haematuria |
| d. Acute UTI | F - UTI typically causes painful haematuria (dysuria, frequency) |
| e. Urolithiasis | F - renal/ureteric stones typically cause painful haematuria (colic) |
Q8. Features of DIC include:
| a. Low platelet count | T - platelets consumed in microthrombi |
| b. APTT is increased | T - clotting factors consumed → prolonged APTT |
| c. Increased fibrinogen level | F - fibrinogen is decreased (consumed) in DIC |
| d. Fibrin degradation product decreased | F - FDPs are markedly increased in DIC |
| e. Decreased PT | F - PT is increased/prolonged in DIC |
Q9. ECG changes in hypokalaemia:
| a. Flattened T wave | T - T wave flattening/inversion is an early sign |
| b. ST depression | T - ST depression occurs in hypokalaemia |
| c. Appearance of U wave | T - prominent U wave is the hallmark of hypokalaemia |
| d. Broad QRS complex | F - broad QRS is seen in hyperkalaemia, not hypokalaemia |
| e. Loss of P wave | F - loss of P wave is seen in severe hyperkalaemia |
Q10. Causes of exudative pleural effusion are:
| a. Congestive cardiac failure | F - CCF causes transudative effusion |
| b. Tuberculosis | T - classic exudative cause |
| c. Pneumoniae | T - parapneumonic effusion is exudative |
| d. Pulmonary infarction | T - PE/infarction causes exudative effusion |
| e. Cirrhosis of liver | F - cirrhosis causes transudative effusion |
SBA (√) - Questions 11-20
Q11. 55-year-old man, 20 min central chest pain - most indicative of MI at this moment?
c. ST elevation - ST elevation in the acute setting is the most specific and indicative ECG finding for acute STEMI. Q waves take time to develop; ST depression suggests NSTEMI/ischaemia; inverted T and tall T are less specific acutely.
Q12. Most specific test for rheumatoid arthritis?
c. Anti CCP Ab - Anti-cyclic citrullinated peptide (anti-CCP) antibodies are the most specific test for RA (~95% specific), more specific than RF. ANA and anti-dsDNA are for SLE.
Q13. Most specific urinary finding of glomerulonephritis?
b. Red cell cast - Red cell (RBC) casts in urine are pathognomonic of glomerulonephritis, indicating bleeding from within the glomerulus. No other condition produces RBC casts.
Q14. Most common cause of PUD?
b. H. pylori - H. pylori infection accounts for ~70-80% of duodenal ulcers and ~60% of gastric ulcers, making it the most common cause overall. NSAIDs are second.
Q15. NOT a clinical sign associated with mitral stenosis?
c. Pansystolic murmur which radiates to axilla - This describes the murmur of mitral regurgitation, not mitral stenosis. MS produces a mid-diastolic murmur. Malar flush, AF, tapping undisplaced apex, and RV heave are all features of MS.
Q16. Malignant tumour with highest prediction for dissemination to bone?
b. Prostate - Prostate cancer has the highest propensity for bone metastases (>80% of advanced cases). Breast is second. Prostate mets are classically osteoblastic (sclerotic).
Q17. Used to monitor patient with colorectal cancer?
b. CEA - Carcinoembryonic antigen (CEA) is the standard tumour marker for monitoring colorectal cancer response to treatment and surveillance for recurrence.
Q18. Investigation that can confirm diagnosis of acute pancreatitis?
a. Serum lipase - Serum lipase is more sensitive AND more specific than serum amylase for acute pancreatitis, remains elevated longer, and is the preferred confirmatory test. (Note: CT scan can confirm severity/complications but serum lipase confirms the diagnosis biochemically.)
Q19. Sero-marker found after vaccination against HBV?
d. Anti HBs Ab - Hepatitis B vaccination induces only anti-HBs antibodies (protective). It does NOT produce HBsAg, HBcAg, anti-HBc, or anti-HBe. Anti-HBs >10 mIU/mL = seroprotection.
Q20. Most common type of Hodgkin's lymphoma?
b. Nodular sclerosing - Nodular sclerosis is the most common subtype of Hodgkin's lymphoma (~65-70% of cases), especially in young women. It is characterised by collagen bands and lacunar cells.
Summary Answer Sheet
T/F (Q1-10):
| Q | a | b | c | d | e |
|---|---|---|---|---|---|
| 1 | T | T | T | F | T |
| 2 | T | T | F | F | T |
| 3 | F | T | T | F | T |
| 4 | T | T | T | F | F |
| 5 | T | T | F | T | T |
| 6 | F | T | F | T | T |
| 7 | T | T | T | F | F |
| 8 | T | T | F | F | F |
| 9 | T | T | T | F | F |
| 10 | F | T | T | T | F |
SBA (Q11-20): c, c, b, b, c, b, b, a, d, b
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