Nepal Medical Council Licensing Examination (NMCLE) PQA
Here’s a collection of Nepal Medical Council Licensing Examination (NMCLE) practice MCQs covering key subjects like Medicine, Surgery, Pediatrics, Gynecology & Obstetrics, and Community Medicine. Each question includes the correct answer and an explanation.
Medicine
1. A 45-year-old male with chronic alcoholism presents with confusion, ataxia, and ophthalmoplegia. What is the most likely diagnosis?
A) Wernicke’s encephalopathy
B) Hepatic encephalopathy
C) Korsakoff syndrome
D) Alcohol withdrawal delirium
Answer: A) Wernicke’s encephalopathy
Explanation: Wernicke’s encephalopathy is caused by thiamine (vitamin B1) deficiency and is characterized by the classic triad of confusion, ataxia, and ophthalmoplegia.
2. Which of the following is the most common cause of community-acquired pneumonia?
A) Klebsiella pneumoniae
B) Streptococcus pneumoniae
C) Mycoplasma pneumoniae
D) Haemophilus influenzae
Answer: B) Streptococcus pneumoniae
Explanation: S. pneumoniae is the most common bacterial cause of community-acquired pneumonia, presenting with fever, cough, pleuritic chest pain, and lobar consolidation on chest X-ray.
Surgery
3. A patient presents with sudden, severe epigastric pain radiating to the back. Serum lipase is elevated. What is the likely diagnosis?
A) Peptic ulcer disease
B) Acute pancreatitis
C) Acute cholecystitis
D) Perforated duodenal ulcer
Answer: B) Acute pancreatitis
Explanation: Acute pancreatitis presents with epigastric pain radiating to the back and elevated serum lipase/amylase. Common causes include gallstones and alcohol consumption.
4. A 65-year-old male presents with painless hematuria. What is the most likely diagnosis?
A) Bladder cancer
B) Urinary tract infection
C) Benign prostatic hyperplasia
D) Nephrolithiasis
Answer: A) Bladder cancer
Explanation: Painless hematuria is the most common presenting symptom of bladder cancer, especially in older patients with a history of smoking.
Pediatrics
5. A newborn presents with persistent vomiting, dehydration, and hyperkalemia. Which condition should be suspected?
A) Pyloric stenosis
B) Congenital adrenal hyperplasia
C) Hirschsprung disease
D) Intussusception
Answer: B) Congenital adrenal hyperplasia
Explanation: 21-hydroxylase deficiency in congenital adrenal hyperplasia leads to salt-wasting, dehydration, hyperkalemia, and hypotension due to aldosterone deficiency.
6. A 5-year-old child presents with fever, conjunctivitis, rash, and cervical lymphadenopathy. What is the most likely diagnosis?
A) Scarlet fever
B) Measles
C) Kawasaki disease
D) Rubella
Answer: C) Kawasaki disease
Explanation: Kawasaki disease is an acute vasculitis in children characterized by fever, conjunctivitis, rash, cervical lymphadenopathy, and risk of coronary aneurysms.
Gynecology & Obstetrics
7. A 32-year-old pregnant woman presents with painless vaginal bleeding in her third trimester. What is the most likely diagnosis?
A) Placenta previa
B) Placental abruption
C) Uterine rupture
D) Vasa previa
Answer: A) Placenta previa
Explanation: Placenta previa presents with painless vaginal bleeding in the third trimester due to implantation of the placenta over the cervical os.
8. Which of the following is the best method to confirm ovulation?
A) Basal body temperature charting
B) Serum progesterone on day 21
C) Urinary LH surge detection
D) Endometrial biopsy
Answer: B) Serum progesterone on day 21
Explanation: A mid-luteal phase serum progesterone level above 3 ng/mL confirms ovulation.
Community Medicine
9. The best indicator of overall health status of a community is:
A) Crude birth rate
B) Infant mortality rate
C) Life expectancy
D) Maternal mortality rate
Answer: B) Infant mortality rate
Explanation: Infant mortality rate (IMR) reflects the overall health and healthcare quality of a community as it is affected by nutrition, sanitation, and maternal health.
10. Which of the following vaccines is a live attenuated vaccine?
A) Hepatitis B
B) DPT
C) OPV (Oral Polio Vaccine)
D) Tetanus toxoid
Answer: C) OPV (Oral Polio Vaccine)
Explanation: OPV contains live attenuated poliovirus strains, which provide mucosal immunity.
Medicine
11. A 60-year-old male with a history of smoking presents with hemoptysis, weight loss, and a mass in the right upper lung. What is the most likely diagnosis?
A) Tuberculosis
B) Bronchiectasis
C) Lung cancer
D) Pulmonary embolism
Answer: C) Lung cancer
Explanation: A lung mass, weight loss, and hemoptysis in a chronic smoker are highly suggestive of lung cancer, particularly squamous cell carcinoma.
12. A patient with chronic liver disease presents with altered sensorium and asterixis. Which of the following should be given first?
A) Lactulose
B) Rifaximin
C) Intravenous fluids
D) Vitamin K
Answer: A) Lactulose
Explanation: Lactulose reduces ammonia absorption in hepatic encephalopathy, improving mental status.
Surgery
13. Which of the following is the most common site of colorectal cancer?
A) Ascending colon
B) Transverse colon
C) Sigmoid colon
D) Cecum
Answer: C) Sigmoid colon
Explanation: The sigmoid colon is the most common site for colorectal cancer, often presenting with a change in bowel habits and occult blood loss.
14. A patient presents with acute right lower quadrant pain, fever, and tenderness at McBurney’s point. What is the best initial step in management?
A) IV antibiotics and observation
B) Abdominal ultrasound
C) CT abdomen
D) Immediate laparotomy
Answer: C) CT abdomen
Explanation: CT abdomen is the most sensitive imaging test for appendicitis. If confirmed, appendectomy is the definitive treatment.
Pediatrics
15. A neonate presents with delayed passage of meconium for more than 48 hours. What is the most likely cause?
A) Cystic fibrosis
B) Hirschsprung disease
C) Meconium ileus
D) Neonatal sepsis
Answer: B) Hirschsprung disease
Explanation: Hirschsprung disease results from the absence of ganglion cells in the distal colon, leading to functional obstruction.
16. A child presents with a “barking” cough, inspiratory stridor, and hoarseness. What is the most likely diagnosis?
A) Epiglottitis
B) Croup (Laryngotracheobronchitis)
C) Foreign body aspiration
D) Bronchiolitis
Answer: B) Croup (Laryngotracheobronchitis)
Explanation: Croup is caused by parainfluenza virus and presents with a barking cough, inspiratory stridor, and hoarseness due to subglottic airway inflammation.
Gynecology & Obstetrics
17. A woman at 34 weeks of gestation presents with severe hypertension (160/110 mmHg) and proteinuria. What is the best next step?
A) Oral antihypertensives
B) Magnesium sulfate
C) Delivery of the fetus
D) Bed rest and observation
Answer: C) Delivery of the fetus
Explanation: Severe preeclampsia at 34 weeks requires immediate delivery to prevent maternal and fetal complications.
18. The best method for emergency contraception within 72 hours of unprotected intercourse is:
A) Copper intrauterine device (IUD)
B) Levonorgestrel pill
C) Ulipristal acetate
D) Mifepristone
Answer: B) Levonorgestrel pill
Explanation: Levonorgestrel (Plan B) is the most commonly used emergency contraceptive within 72 hours of unprotected sex.
Community Medicine
19. Herd immunity is least effective for which of the following diseases?
A) Measles
B) Polio
C) Tetanus
D) Influenza
Answer: C) Tetanus
Explanation: Tetanus is caused by Clostridium tetani spores in the environment, making herd immunity ineffective as it is not transmitted from person to person.
20. The most reliable indicator of malnutrition in children under five years is:
A) Weight-for-age
B) Height-for-age
C) Mid-upper arm circumference
D) Weight-for-height
Answer: D) Weight-for-height
Explanation: Weight-for-height best reflects acute malnutrition and is used in WHO guidelines for assessing wasting in children.
Pharmacology
21. Which of the following drugs is a beta-lactamase inhibitor?
A) Amoxicillin
B) Ceftriaxone
C) Clavulanic acid
D) Vancomycin
Answer: C) Clavulanic acid
Explanation: Clavulanic acid is a beta-lactamase inhibitor that protects beta-lactam antibiotics (e.g., amoxicillin) from enzymatic degradation.
22. The antidote for organophosphate poisoning is:
A) Atropine and pralidoxime
B) Naloxone
C) Flumazenil
D) Vitamin K
Answer: A) Atropine and pralidoxime
Explanation: Organophosphates inhibit acetylcholinesterase, leading to cholinergic toxicity. Atropine blocks muscarinic effects, while pralidoxime reactivates acetylcholinesterase.
Pathology
23. Which of the following findings is characteristic of iron deficiency anemia?
A) Hypersegmented neutrophils
B) Target cells
C) Microcytic hypochromic RBCs
D) Schistocytes
Answer: C) Microcytic hypochromic RBCs
Explanation: Iron deficiency anemia presents with microcytic, hypochromic red blood cells due to impaired hemoglobin synthesis.
24. Reed-Sternberg cells are characteristic of:
A) Non-Hodgkin’s lymphoma
B) Hodgkin’s lymphoma
C) Multiple myeloma
D) Burkitt’s lymphoma
Answer: B) Hodgkin’s lymphoma
Explanation: Hodgkin’s lymphoma is diagnosed by the presence of Reed-Sternberg cells on lymph node biopsy.
Microbiology
25. Which of the following bacteria is a common cause of nosocomial pneumonia?
A) Streptococcus pneumoniae
B) Pseudomonas aeruginosa
C) Mycoplasma pneumoniae
D) Legionella pneumophila
Answer: B) Pseudomonas aeruginosa
Explanation: Pseudomonas aeruginosa is a common cause of hospital-acquired pneumonia, especially in ventilated patients.
26. The causative agent of gas gangrene is:
A) Clostridium perfringens
B) Staphylococcus aureus
C) Streptococcus pyogenes
D) Bacillus anthracis
Answer: A) Clostridium perfringens
Explanation: Clostridium perfringens produces alpha toxin, causing gas gangrene with crepitus in tissues due to gas production.
Medicine
27. Which of the following is the first-line treatment for hypertensive emergency?
A) Labetalol
B) Nifedipine
C) Clonidine
D) Enalapril
Answer: A) Labetalol
Explanation: Labetalol is a first-line IV antihypertensive for hypertensive emergency due to its combined alpha and beta-blocking effects.
28. A patient with long-standing diabetes presents with nephrotic-range proteinuria. What is the most likely cause?
A) Focal segmental glomerulosclerosis
B) Membranous nephropathy
C) Diabetic nephropathy
D) IgA nephropathy
Answer: C) Diabetic nephropathy
Explanation: Diabetic nephropathy is the leading cause of nephrotic syndrome in adults, with characteristic nodular glomerulosclerosis (Kimmelstiel-Wilson nodules).
Surgery
29. A 25-year-old man presents with severe testicular pain, absent cremasteric reflex, and high-riding testis. What is the most likely diagnosis?
A) Epididymitis
B) Testicular torsion
C) Hydrocele
D) Varicocele
Answer: B) Testicular torsion
Explanation: Testicular torsion is a urological emergency requiring immediate surgical detorsion to prevent ischemic necrosis.
30. A trauma patient presents with distended neck veins, hypotension, and muffled heart sounds. What is the most likely diagnosis?
A) Tension pneumothorax
B) Cardiac tamponade
C) Hemothorax
D) Aortic dissection
Answer: B) Cardiac tamponade
Explanation: Beck’s triad (hypotension, muffled heart sounds, and distended neck veins) is characteristic of cardiac tamponade.
Pediatrics
31. The most common cause of neonatal sepsis in Nepal is:
A) Group B Streptococcus
B) Escherichia coli
C) Staphylococcus aureus
D) Klebsiella pneumoniae
Answer: D) Klebsiella pneumoniae
Explanation: In South Asian settings, Klebsiella is a leading cause of neonatal sepsis, often linked to hospital-acquired infections.
32. A child presents with wheezing, nasal polyps, and recurrent sinus infections. Which genetic disorder should be suspected?
A) Cystic fibrosis
B) Kartagener syndrome
C) Asthma
D) Bronchopulmonary dysplasia
Answer: A) Cystic fibrosis
Explanation: Cystic fibrosis presents with respiratory symptoms, nasal polyps, and pancreatic insufficiency due to CFTR gene mutation.
Gynecology & Obstetrics
33. The most common cause of postpartum hemorrhage is:
A) Uterine atony
B) Retained placenta
C) Genital tract trauma
D) Coagulopathy
Answer: A) Uterine atony
Explanation: Uterine atony is the most frequent cause of postpartum hemorrhage, treated with uterotonic agents like oxytocin.
34. A 26-year-old woman with primary infertility is found to have bilateral enlarged ovaries with multiple cysts. Which is the most likely diagnosis?
A) Polycystic ovary syndrome (PCOS)
B) Endometriosis
C) Premature ovarian failure
D) Ovarian cancer
Answer: A) Polycystic ovary syndrome (PCOS)
Explanation: PCOS presents with oligomenorrhea, infertility, hirsutism, and polycystic ovaries on ultrasound.
Community Medicine
35. The most effective method of tuberculosis control in a community is:
A) Mass BCG vaccination
B) DOTS therapy
C) Isolation of TB patients
D) Regular screening of the population
Answer: B) DOTS therapy
Explanation: Directly Observed Treatment, Short-course (DOTS) ensures compliance and reduces TB transmission.
36. The primary vector for dengue fever is:
A) Anopheles mosquito
B) Culex mosquito
C) Aedes mosquito
D) Phlebotomus sandfly
Answer: C) Aedes mosquito
Explanation: Aedes aegypti transmits dengue virus and breeds in stagnant water.
Pharmacology
37. Which of the following drugs causes ototoxicity?
A) Ciprofloxacin
B) Amikacin
C) Doxycycline
D) Rifampicin
Answer: B) Amikacin
Explanation: Aminoglycosides (e.g., amikacin, gentamicin) can cause ototoxicity and nephrotoxicity.
38. Which medication is contraindicated in pregnancy?
A) Metformin
B) Methotrexate
C) Labetalol
D) Nifedipine
Answer: B) Methotrexate
Explanation: Methotrexate is teratogenic and contraindicated in pregnancy due to its antifolate effects.
Pathology
39. Which marker is most specific for myocardial infarction?
A) CK-MB
B) Troponin I
C) Myoglobin
D) LDH
Answer: B) Troponin I
Explanation: Troponin I is highly specific and remains elevated for up to 7–10 days after myocardial infarction.
40. Which of the following conditions is associated with Bence Jones proteins?
A) Multiple myeloma
B) Hodgkin’s lymphoma
C) Chronic lymphocytic leukemia
D) Waldenström macroglobulinemia
Answer: A) Multiple myeloma
Explanation: Bence Jones proteins (light chains) are found in the urine of multiple myeloma patients.
Microbiology
41. The most common cause of bacterial meningitis in adults is:
A) Neisseria meningitidis
B) Streptococcus pneumoniae
C) Haemophilus influenzae
D) Listeria monocytogenes
Answer: B) Streptococcus pneumoniae
Explanation: S. pneumoniae is the leading cause of bacterial meningitis in adults and the elderly.
42. Which of the following causes gas gangrene?
A) Clostridium perfringens
B) Staphylococcus aureus
C) Streptococcus pyogenes
D) Bacillus anthracis
Answer: A) Clostridium perfringens
Explanation: Clostridium perfringens produces alpha toxin, leading to gas gangrene with tissue necrosis.
Miscellaneous Clinical Scenarios
43. A patient presents with burning pain in the epigastric region, which improves with meals. What is the most likely diagnosis?
A) Duodenal ulcer
B) Gastric ulcer
C) GERD
D) Zollinger-Ellison syndrome
Answer: A) Duodenal ulcer
Explanation: Duodenal ulcers improve with meals and are commonly caused by H. pylori infection.
44. A 60-year-old male with a history of smoking has a productive cough for more than 3 months for the past 2 years. What is the most likely diagnosis?
A) Chronic bronchitis
B) Emphysema
C) Bronchiectasis
D) Tuberculosis
Answer: A) Chronic bronchitis
Explanation: Chronic bronchitis is diagnosed when cough with sputum persists for at least 3 months in 2 consecutive years.
Medicine
45. A 65-year-old man with a history of COPD presents with increasing dyspnea, wheezing, and use of accessory muscles. What is the first-line treatment?
A) IV antibiotics
B) Nebulized salbutamol and ipratropium
C) IV corticosteroids
D) Non-invasive ventilation
Answer: B) Nebulized salbutamol and ipratropium
Explanation: Bronchodilators (beta-agonists and anticholinergics) are the first-line treatment for COPD exacerbation.
46. The most common cause of secondary hypertension is:
A) Primary hyperaldosteronism
B) Renal artery stenosis
C) Pheochromocytoma
D) Cushing’s syndrome
Answer: B) Renal artery stenosis
Explanation: Renal artery stenosis causes hypertension by activating the renin-angiotensin-aldosterone system.
Surgery
47. A patient with blunt abdominal trauma presents with hypotension, tachycardia, and absent bowel sounds. What is the most likely diagnosis?
A) Splenic rupture
B) Liver laceration
C) Intestinal perforation
D) Pancreatic injury
Answer: A) Splenic rupture
Explanation: The spleen is the most commonly injured organ in blunt trauma, leading to hypovolemic shock.
48. The first-line investigation for a suspected aortic dissection is:
A) Chest X-ray
B) CT angiography
C) MRI
D) Echocardiography
Answer: B) CT angiography
Explanation: CT angiography provides rapid and accurate diagnosis of aortic dissection.
Pediatrics
49. A child presents with recurrent infections, absent thymic shadow on chest X-ray, and hypocalcemia. What is the likely diagnosis?
A) DiGeorge syndrome
B) SCID (Severe Combined Immunodeficiency)
C) Wiskott-Aldrich syndrome
D) Ataxia-telangiectasia
Answer: A) DiGeorge syndrome
Explanation: DiGeorge syndrome (22q11 deletion) leads to thymic aplasia, recurrent infections, and hypocalcemia due to parathyroid dysfunction.
50. A 2-month-old baby presents with projectile, non-bilious vomiting and a palpable olive-shaped mass in the epigastrium. What is the most likely diagnosis?
A) Pyloric stenosis
B) Duodenal atresia
C) Gastroesophageal reflux
D) Hirschsprung disease
Answer: A) Pyloric stenosis
Explanation: Pyloric stenosis causes hypertrophy of the pylorus, leading to projectile vomiting and metabolic alkalosis.
Gynecology & Obstetrics
51. A woman at 32 weeks gestation presents with painless vaginal bleeding. What is the most likely cause?
A) Placenta previa
B) Abruptio placentae
C) Uterine rupture
D) Cervical insufficiency
Answer: A) Placenta previa
Explanation: Placenta previa presents with painless vaginal bleeding in the third trimester.
52. A pregnant woman at 36 weeks has severe pruritus without rash, elevated bile acids, and abnormal liver function tests. What is the likely diagnosis?
A) Intrahepatic cholestasis of pregnancy
B) Acute fatty liver of pregnancy
C) HELLP syndrome
D) Preeclampsia
Answer: A) Intrahepatic cholestasis of pregnancy
Explanation: Intrahepatic cholestasis of pregnancy causes pruritus and elevated bile acids, increasing the risk of fetal complications.
Community Medicine
53. Which of the following vaccines is given at birth according to the National Immunization Schedule?
A) BCG, Hepatitis B, OPV-0
B) DPT, Hib, Hepatitis B
C) OPV, Rotavirus, Measles
D) PCV, IPV, DPT
Answer: A) BCG, Hepatitis B, OPV-0
Explanation: These vaccines protect against tuberculosis, hepatitis B, and polio.
54. The most effective way to prevent mother-to-child transmission of HIV is:
A) Antiretroviral therapy during pregnancy
B) Exclusive breastfeeding
C) Neonatal prophylaxis alone
D) Early weaning
Answer: A) Antiretroviral therapy during pregnancy
Explanation: ART reduces viral load and significantly lowers the risk of transmission.
Pharmacology
55. A patient on warfarin develops a life-threatening bleeding episode. What is the best immediate treatment?
A) Fresh frozen plasma
B) Vitamin K
C) Tranexamic acid
D) Desmopressin
Answer: A) Fresh frozen plasma
Explanation: Fresh frozen plasma provides clotting factors for rapid warfarin reversal in emergencies.
56. Which of the following drugs is used for the treatment of acute gout?
A) Allopurinol
B) Colchicine
C) Probenecid
D) Febuxostat
Answer: B) Colchicine
Explanation: Colchicine reduces inflammation in acute gout attacks but does not lower uric acid levels.
Pathology
57. Which of the following is a tumor suppressor gene?
A) HER2
B) BRCA1
C) EGFR
D) KRAS
Answer: B) BRCA1
Explanation: BRCA1 is a tumor suppressor gene linked to breast and ovarian cancer.
58. A patient with leukemia has Auer rods in the blood smear. What is the most likely diagnosis?
A) Acute myeloid leukemia (AML)
B) Chronic myeloid leukemia (CML)
C) Acute lymphoblastic leukemia (ALL)
D) Chronic lymphocytic leukemia (CLL)
Answer: A) Acute myeloid leukemia (AML)
Explanation: Auer rods are specific for AML, particularly in promyelocytic leukemia.
Microbiology
59. The causative agent of tetanus is:
A) Clostridium tetani
B) Clostridium botulinum
C) Clostridium difficile
D) Clostridium perfringens
Answer: A) Clostridium tetani
Explanation: Clostridium tetani produces tetanospasmin, causing muscle spasms.
60. A 30-year-old man presents with fever, jaundice, and dark urine. His blood test is positive for HBsAg and anti-HBc IgM. What is the diagnosis?
A) Acute Hepatitis B infection
B) Chronic Hepatitis B infection
C) Resolved Hepatitis B infection
D) Hepatitis C infection
Answer: A) Acute Hepatitis B infection
Explanation: HBsAg and anti-HBc IgM indicate an acute hepatitis B infection.
Radiology
61. A “ground-glass appearance” on chest X-ray is characteristic of:
A) Pneumocystis pneumonia
B) Tuberculosis
C) Pulmonary embolism
D) COPD
Answer: A) Pneumocystis pneumonia
Explanation: Pneumocystis jirovecii causes a diffuse ground-glass appearance in immunocompromised patients.
62. A “double bubble sign” on abdominal X-ray in a newborn suggests:
A) Duodenal atresia
B) Intussusception
C) Pyloric stenosis
D) Hirschsprung disease
Answer: A) Duodenal atresia
Explanation: Duodenal atresia is associated with Down syndrome and presents with the double bubble sign.
Medicine
63. A 45-year-old man presents with exertional chest pain that is relieved by rest. What is the most likely diagnosis?
A) Stable angina
B) Unstable angina
C) Myocardial infarction
D) Pericarditis
Answer: A) Stable angina
Explanation: Stable angina is chest pain triggered by exertion and relieved by rest or nitroglycerin.
64. Which of the following is a major Duke criterion for infective endocarditis?
A) Fever ≥ 38°C
B) Janeway lesions
C) Positive blood culture
D) Roth spots
Answer: C) Positive blood culture
Explanation: Major Duke criteria include positive blood cultures and echocardiographic evidence of endocarditis.
Surgery
65. A 35-year-old male presents with a non-healing ulcer on the sole of his foot with a punched-out appearance. What is the most likely diagnosis?
A) Diabetic foot ulcer
B) Arterial ulcer
C) Venous ulcer
D) Pressure ulcer
Answer: B) Arterial ulcer
Explanation: Arterial ulcers have a punched-out appearance and occur in areas of poor circulation.
66. The most common type of hernia in both males and females is:
A) Direct inguinal hernia
B) Indirect inguinal hernia
C) Femoral hernia
D) Umbilical hernia
Answer: B) Indirect inguinal hernia
Explanation: Indirect inguinal hernias follow the inguinal canal and are more common in both sexes.
Pediatrics
67. A child presents with cough, coryza, conjunctivitis, and Koplik spots. What is the likely diagnosis?
A) Measles
B) Rubella
C) Scarlet fever
D) Mumps
Answer: A) Measles
Explanation: Koplik spots are pathognomonic for measles.
68. Which congenital heart defect is most commonly associated with Down syndrome?
A) Atrial septal defect (ASD)
B) Ventricular septal defect (VSD)
C) Tetralogy of Fallot
D) Atrioventricular septal defect (AVSD)
Answer: D) Atrioventricular septal defect (AVSD)
Explanation: AVSD is the most common congenital heart defect in Down syndrome.
Gynecology & Obstetrics
69. A pregnant woman at 30 weeks presents with a sudden onset of painful vaginal bleeding. What is the most likely cause?
A) Placenta previa
B) Abruptio placentae
C) Vasa previa
D) Uterine rupture
Answer: B) Abruptio placentae
Explanation: Abruptio placentae presents with painful vaginal bleeding due to premature placental separation.
70. Which of the following is a risk factor for ectopic pregnancy?
A) Multiparity
B) Endometriosis
C) Smoking
D) Both B and C
Answer: D) Both B and C
Explanation: Endometriosis and smoking increase the risk of ectopic pregnancy.
Community Medicine
71. Which measure best represents the central tendency of a skewed distribution?
A) Mean
B) Median
C) Mode
D) Standard deviation
Answer: B) Median
Explanation: The median is the best measure of central tendency for skewed distributions.
72. What is the target of the Sustainable Development Goal (SDG) related to maternal mortality?
A) Reduce maternal mortality to < 50 per 100,000 live births
B) Reduce maternal mortality to < 70 per 100,000 live births
C) Reduce maternal mortality to < 100 per 100,000 live births
D) Reduce maternal mortality to < 150 per 100,000 live births
Answer: B) Reduce maternal mortality to < 70 per 100,000 live births
Explanation: The SDG target aims to reduce maternal mortality below 70 per 100,000 live births.
Pharmacology
73. Which antihypertensive is contraindicated in pregnancy?
A) Methyldopa
B) Labetalol
C) ACE inhibitors
D) Nifedipine
Answer: C) ACE inhibitors
Explanation: ACE inhibitors can cause fetal renal damage and should be avoided in pregnancy.
74. Which of the following drugs is a selective serotonin reuptake inhibitor (SSRI)?
A) Amitriptyline
B) Fluoxetine
C) Diazepam
D) Haloperidol
Answer: B) Fluoxetine
Explanation: Fluoxetine is an SSRI used to treat depression and anxiety disorders.
Pathology
75. The Reed-Sternberg cell is a characteristic finding of:
A) Non-Hodgkin lymphoma
B) Hodgkin lymphoma
C) Multiple myeloma
D) Chronic lymphocytic leukemia
Answer: B) Hodgkin lymphoma
Explanation: Reed-Sternberg cells are diagnostic of Hodgkin lymphoma.
76. A 55-year-old man with chronic alcohol use presents with macrocytic anemia. What is the likely deficiency?
A) Iron
B) Vitamin B12
C) Folic acid
D) Copper
Answer: C) Folic acid
Explanation: Alcoholism commonly leads to folic acid deficiency and macrocytic anemia.
Microbiology
77. The causative organism of diphtheria is:
A) Bordetella pertussis
B) Corynebacterium diphtheriae
C) Streptococcus pyogenes
D) Haemophilus influenzae
Answer: B) Corynebacterium diphtheriae
Explanation: Corynebacterium diphtheriae produces a toxin that causes pseudomembrane formation in the throat.
78. The most common cause of viral gastroenteritis in children is:
A) Rotavirus
B) Norovirus
C) Adenovirus
D) Astrovirus
Answer: A) Rotavirus
Explanation: Rotavirus is the leading cause of viral gastroenteritis in children.
Psychiatry
79. A patient presents with persistent fear of social interactions and avoidance of public speaking. What is the likely diagnosis?
A) Generalized anxiety disorder
B) Social anxiety disorder
C) Panic disorder
D) Agoraphobia
Answer: B) Social anxiety disorder
Explanation: Social anxiety disorder involves excessive fear of social situations.
80. Which neurotransmitter is most involved in schizophrenia?
A) Serotonin
B) Dopamine
C) Norepinephrine
D) Acetylcholine
Answer: B) Dopamine
Explanation: Dopamine hyperactivity is implicated in schizophrenia.
Dermatology
81. The Koebner phenomenon is seen in:
A) Psoriasis
B) Lichen planus
C) Vitiligo
D) All of the above
Answer: D) All of the above
Explanation: Koebnerization refers to new lesions appearing at sites of trauma in these conditions.
82. Which bacterial infection causes honey-colored crusts in children?
A) Erysipelas
B) Impetigo
C) Cellulitis
D) Scabies
Answer: B) Impetigo
Explanation: Impetigo is a superficial skin infection caused by Staphylococcus aureus or Streptococcus pyogenes.
Medicine
83. A 60-year-old man presents with dyspnea, orthopnea, and bilateral basal crepitations. What is the most likely diagnosis?
A) Chronic obstructive pulmonary disease (COPD)
B) Congestive heart failure (CHF)
C) Pulmonary embolism
D) Pneumonia
Answer: B) Congestive heart failure (CHF)
Explanation: Orthopnea and basal crepitations suggest pulmonary congestion due to left-sided heart failure.
84. Which electrolyte imbalance is most commonly seen in Addison’s disease?
A) Hypernatremia and hypokalemia
B) Hyponatremia and hyperkalemia
C) Hypernatremia and hyperkalemia
D) Hyponatremia and hypokalemia
Answer: B) Hyponatremia and hyperkalemia
Explanation: Addison’s disease leads to aldosterone deficiency, causing sodium loss and potassium retention.
Surgery
85. A 70-year-old man with a history of smoking presents with painless hematuria. What is the most likely diagnosis?
A) Renal cell carcinoma
B) Bladder cancer
C) Prostatitis
D) Urolithiasis
Answer: B) Bladder cancer
Explanation: Painless hematuria is the hallmark of bladder cancer, especially in smokers.
86. The most common cause of acute mesenteric ischemia is:
A) Atherosclerosis
B) Embolism from the heart
C) Venous thrombosis
D) Hypotension
Answer: B) Embolism from the heart
Explanation: Atrial fibrillation can lead to embolism, causing mesenteric ischemia.
Pediatrics
87. A newborn presents with a scaphoid abdomen and severe respiratory distress. What is the most likely diagnosis?
A) Diaphragmatic hernia
B) Esophageal atresia
C) Meconium aspiration
D) Hyaline membrane disease
Answer: A) Diaphragmatic hernia
Explanation: A scaphoid abdomen and respiratory distress suggest diaphragmatic hernia with lung compression.
88. The most common cause of meningitis in neonates is:
A) Streptococcus pneumoniae
B) Neisseria meningitidis
C) Group B Streptococcus
D) Listeria monocytogenes
Answer: C) Group B Streptococcus
Explanation: Group B Streptococcus is the leading cause of neonatal meningitis.
Gynecology & Obstetrics
89. A 28-year-old woman presents with lower abdominal pain and cervical motion tenderness. What is the likely diagnosis?
A) Ectopic pregnancy
B) Pelvic inflammatory disease (PID)
C) Ovarian cyst rupture
D) Endometriosis
Answer: B) Pelvic inflammatory disease (PID)
Explanation: Cervical motion tenderness is a key feature of PID.
90. A pregnant woman at 37 weeks presents with hypertension, proteinuria, and edema. What is the most likely diagnosis?
A) Gestational hypertension
B) Preeclampsia
C) Eclampsia
D) HELLP syndrome
Answer: B) Preeclampsia
Explanation: Preeclampsia is diagnosed with new-onset hypertension and proteinuria after 20 weeks.
Community Medicine
91. Herd immunity is least effective in preventing which disease?
A) Measles
B) Influenza
C) Tetanus
D) Polio
Answer: C) Tetanus
Explanation: Tetanus is not spread from person to person, so herd immunity is ineffective.
92. Which test is used to assess the efficiency of chlorine in drinking water?
A) Methylene blue test
B) Orthotolidine test
C) Phenol red test
D) Voges-Proskauer test
Answer: B) Orthotolidine test
Explanation: The orthotolidine test measures residual chlorine in water.
Pharmacology
93. Which drug is used to treat anaphylaxis?
A) Hydrocortisone
B) Epinephrine
C) Diphenhydramine
D) Salbutamol
Answer: B) Epinephrine
Explanation: Epinephrine is the first-line treatment for anaphylaxis.
94. Which antibiotic is contraindicated in pregnancy due to its teratogenic effects?
A) Penicillin
B) Cephalosporins
C) Tetracyclines
D) Macrolides
Answer: C) Tetracyclines
Explanation: Tetracyclines cause dental discoloration and should be avoided in pregnancy.
Pathology
95. A patient has a Bence-Jones protein in the urine. What is the likely diagnosis?
A) Multiple myeloma
B) Waldenström’s macroglobulinemia
C) Chronic lymphocytic leukemia
D) Hodgkin lymphoma
Answer: A) Multiple myeloma
Explanation: Bence-Jones proteins are light chains found in multiple myeloma.
96. Which of the following conditions is associated with a “starry sky” appearance on histology?
A) Burkitt lymphoma
B) Hodgkin lymphoma
C) Multiple myeloma
D) Chronic myeloid leukemia
Answer: A) Burkitt lymphoma
Explanation: Burkitt lymphoma shows a “starry sky” pattern due to tingible body macrophages.
Microbiology
97. The most common cause of community-acquired pneumonia is:
A) Streptococcus pneumoniae
B) Klebsiella pneumoniae
C) Mycoplasma pneumoniae
D) Staphylococcus aureus
Answer: A) Streptococcus pneumoniae
Explanation: S. pneumoniae is the leading cause of pneumonia in all age groups.
98. A 25-year-old female presents with frothy vaginal discharge and a fishy odor. The likely cause is:
A) Candida albicans
B) Trichomonas vaginalis
C) Gardnerella vaginalis
D) Neisseria gonorrhoeae
Answer: B) Trichomonas vaginalis
Explanation: Trichomoniasis causes frothy, malodorous vaginal discharge.
Ophthalmology
99. The most common cause of blindness worldwide is:
A) Cataract
B) Glaucoma
C) Diabetic retinopathy
D) Age-related macular degeneration
Answer: A) Cataract
Explanation: Cataracts are the leading cause of reversible blindness globally.
ENT
100. The most common cause of otitis media in children is:
A) Streptococcus pneumoniae
B) Haemophilus influenzae
C) Moraxella catarrhalis
D) Pseudomonas aeruginosa
Answer: A) Streptococcus pneumoniae
Explanation: S. pneumoniae is the most common bacterial cause of acute otitis media.
Emergency Medicine
101. The initial treatment for a tension pneumothorax is:
A) Needle decompression
B) Chest X-ray
C) Intubation
D) IV antibiotics
Answer: A) Needle decompression
Explanation: Immediate needle decompression in the 2nd intercostal space relieves pressure.
102. A patient presents with severe bradycardia (HR = 30 bpm) and hypotension. What is the first-line treatment?
A) Atropine
B) Amiodarone
C) Adenosine
D) Lidocaine
Answer: A) Atropine
Explanation: Atropine increases heart rate by blocking vagal stimulation.
