NRE 6 AUGUST 2023

NRE 6 AUGUST 2023

1. Patients present with a sudden onset of cough, shortness of breath (SOB), and dyspnea. The medical officer
suspects seasonal allergies. Which component is raised in the complete blood count (CBC)?
A. Neutrophils
B. Lymphocytes
C. Monocytes
D. Eosinophils

Correct Answer: E. Eosinophils

Explanation:

When thinking about sudden onset of cough, shortness of breath and dyspnea differential diagnosis of asthma
should be kept in a mind which is type 1 hypersensitivity reaction also called an allergic reaction. Eosinophils are
a type of white blood cell that is associated with allergic reactions and certain respiratory conditions, including
seasonal allergies. An elevated eosinophil count in a complete blood count (CBC) may indicate an allergic
response, such as in the case of a patient with sudden onset cough, shortness of breath (SOB), and dyspnea due
to seasonal allergies.

2. A young boy is presenting with a hyper trophic scar. However, the wound healing has progressed beyond the
margins of the initial injury and has not regressed. What is this condition?
A. Cicatrix
B. Keloid
C. Callus
D. Granulation tissue
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Correct Answer: B. Keloid Explanation:

A keloid is a type of abnormal scar tissue that forms at the site of an injury or wound. Unlike normal scars
(cicatrices), keloids extend beyond the original boundaries of the wound and do not regress over time. They can
be raised, thickened, and may even cause discomfort or itching. In this scenario, since the wound healing has
extended beyond the injury margin and has not regressed, the correct answer is "B. Keloid."

3. While playing cricket, a boy was hit by a ball on the left ear pinna, resulting in swelling. The Rinne test was
negative on the right side but positive on the left side. Blood has accumulated in the external tympanic
membrane, leading to hearing loss on the affected side. How should this condition be managed?
A. Clean the blood and send home.
B. Clean the blood with suction and give antibiotics.
C. Clean the blood and give oral antibiotics.
D. Clean the blood and give IV antibiotics.

Correct Answer: B. Clean the blood with suction and give antibiotics.
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Explanation:

The scenario describes a traumatic injury to the ear with blood accumulation in the external tympanic
membrane and hearing loss. Given the severity of the injury and the potential risk of infection, option B is the
most appropriate. Cleaning the blood with suction helps remove debris and clots that might affect healing.
Antibiotics are necessary to prevent or manage potential infection. The combination of cleaning the blood and
administering antibiotics through option B addresses both the immediate management of the injury and the
prevention of complications.

4. Urgent tracheostomy is required in:

A. Diphtheria
B. Foreign body (FB) in the esophagus
C. Acute bronchitis
D. Esophageal stricture

Correct Answer: A. Diphtheria

• Explanation:

Diphtheria is a bacterial infection that can lead to the formation of a thick pseudo membrane in the throat,
which can block the airway and lead to breathing difficulties. In severe cases, when the airway is compromised
and conventional methods of maintaining the airway are inadequate, a tracheostomy may be urgently required
to establish a secure airway. Tracheostomy may be performed to bypass the obstructed upper airway and
ensure proper ventilation in cases of severe diphtheria. The other options listed (B, C, D) do not typically
necessitate urgent tracheostomy as the primary intervention.

Definition: a permanent or temporary opening (stoma) in the cervical trachea created through a
surgical incision below the cricoid cartilage
Indications
For emergency indications, same as for cricothyroidotomy

• Long-term mechanical ventilation (> 3 weeks)

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5. The injury pattern resembling a bird's foot is observed in which of the following situations?

A. Car accident
B. Bird attack
C. Explosive
D. Injury by thorn

Correct Answer: C. Explosive

• Explanation: CAR accident

The bird foot pattern injury is typically seen in cases of explosive trauma. When an explosive device detonates,
it can create a pattern of injuries that radiates outward in a manner resembling the splayed appearance of a
bird's foot. This distinct injury pattern is often indicative of explosive-related trauma. The other options (A, B, D)
are less likely to result in this specific pattern of injury.

6. What is the mechanism of action of activated charcoal?

A. Hydrolysis
B. Dilution
C. Absorption
D. Neutralization

Correct Answer: C. Absorption

Explanation: The primary mechanism of action of activated charcoal is absorption. Activated charcoal is a
highly porous substance that has the ability to bind to and adsorb a wide range of substances, including toxins,
chemicals, and drugs, onto its surface. Once ingested, activated charcoal can adsorb harmful substances in the
gastrointestinal tract, preventing their absorption into the bloodstream and facilitating their elimination from
the body. This property makes activated charcoal useful in cases of certain poisonings and overdoses. The
other options (A, B, D) do not accurately describe the main mechanism of action of activated charcoal. Use as
a antidot in

7. Active labor has been ongoing for 2 hours, and the fetus is in a brow presentation. How should this situation be
managed?

A. Wait for cephalic conversion

B. Cord prophylaxis
C. Perform a cesarean section
D. Physically rotate the face

Correct Answer: A. Wait for cephalic conversion

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Explanation:

In a brow presentation, the fetus's head is partially extended, which can make the birth process more
challenging. However, brow presentations can often convert to a more favorable cephalic (head-first)
presentation during labor. It is advisable to wait for some time to see if the fetus naturally changes its position
before considering more invasive interventions like a cesarean section. The other options (B, C, D) do not
necessarily address the specific situation of a brow presentation.

8. What are the side effects of insulin?

A. Hypoglycemia
B. Hyperglycemia
C. Hypercalcemia
D. Hyperkalemia

Correct Answer: A. Hypoglycemia

Explanation: Insulin is a hormone used to manage blood sugar levels in individuals with diabetes. One of the
potential side effects of insulin therapy is hypoglycemia, which is a condition characterized by low blood sugar
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levels. Insulin helps lower blood sugar, but if too much insulin is administered or if a person does not eat
enough after taking insulin, it can lead to hypoglycemia. The other options (B, C, D) are not directly associated
with the side effects of insulin.

9. A baby is delivered by a diabetic mother at 40 weeks of gestation. How should the investigation be conducted?

A. Complete Blood Count (CBC)

B. Blood Glucose
C. Serum Potassium
D. Serum Bicarbonate"

Correct Answer: B. Blood Glucose

Explanation: In the case of a baby delivered by a diabetic mother, it is important to investigate the blood
glucose levels of both the mother and the baby. Infants born to diabetic mothers are at risk of hypoglycemia
(low blood sugar) due to their exposure to high levels of maternal glucose during pregnancy. Monitoring blood
glucose levels helps assess and manage the baby's blood sugar levels after birth. The other options (A, C, D)
are not directly related to the specific concern of diabetes and its potential impact on the baby.

10. How should hypovolemic shock be managed?

A. Oral antibiotics
B. High-dose steroids
C. Nebulized bronchodilators
D. Intravenous fluids

Correct Answer. D. Intravenous fluids

Explanation: The correct management for hypovolemic shock involves administering intravenous (IV) fluids to
rapidly restore blood volume and stabilize the patient. IV fluids help compensate for the loss of blood or fluids
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and improve circulatory function.

11. A 2-year-old child experiences bloating during milk intake, but the symptoms are relieved afterward. What is
the likely cause of these symptoms?

A. Lactase deficiency
B. Pyloric stenosis
C. Intestinal atresia
D. Amylase deficiency

Correct Answer: A. Lactase deficiency

Explanation: The symptoms of bloating during milk intake and relief afterward are suggestive of lactase
deficiency or lactose intolerance. Lactase deficiency occurs when the body lacks sufficient lactase, the enzyme
needed to properly digest lactose, which is the sugar found in milk and dairy products. As a result, undigested
lactose can cause gastrointestinal symptoms such as bloating, gas, and discomfort. The symptoms improving
after milk consumption ceases or subsides may indicate lactose intolerance as the underlying cause.

12. Which vitamin deficiency could potentially lead to bleeding from the baby's cord?
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A. Vitamin K
B. Vitamin K
C. Vitamin K
D. Vitamin K

Correct Answer: A. Vitamin K

Explanation: Bleeding from the baby's cord could be due to a deficiency in Vitamin K. Vitamin K is crucial
for blood clotting, and its deficiency can result in bleeding issues. Vitamin K is important for blood
clotting, and newborns have relatively low levels of this vitamin at birth. This is because vitamin K doesn't
cross the placenta very effectively, and the newborn's gut is not yet fully colonized with the bacteria
needed to produce vitamin K. As a result, newborns are at risk of bleeding disorders due to vitamin K
deficiency.

To counteract this, it's common for newborns to receive a vitamin K injection shortly after birth. This
injection helps boost the baby's vitamin K levels and reduces the risk of bleeding, particularly in the first
weeks of life. This practice has become standard in many healthcare systems to ensure the well-being of
newborns.

13. Which of the following is a side effect of Fluoroquinolones?

A. Redman syndrome
B. Renal tubular acidosis
C. Leucopenia
D. Tendinopathy

Correct Answer: D. Tendinopathy

Explanation:
Following are the side effects of fluoroquinolones.
• GI upset
• Neurological symptoms like mild headache and dizziness
• Hyperglycemia/hypoglycemia
• QT prolongation
• Skin rash
• Superinfection
• In children: potential damage to growing cartilage → reversible arthropathy
• Muscle ache, leg cramps, tendinitis, tendon rupture, especially of the Achilles tendon (the risk of
tendon rupture is higher for individuals over 60 years of age and for individuals on steroid therapy)

14. An abortion or miscarriage is referred to when the fetus dies inside the womb:
A. Before 20 weeks
B. After 20 weeks
C. Before 28 weeks
D. After 28 weeks

Correct answer: A
Explanation: An abortion or miscarriage is typically referred to when the fetus dies inside the womb before
reaching 20 weeks of gestation. After this point, if the fetus dies inside the womb, it is generally considered a
stillbirth rather than a miscarriage.
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15. Among the following options, the car accident that leads to the most fatal condition is:
A. Multiple rib fractures
B. Flail chest
C. Tension pneumothorax
D. Spontaneous pneumothorax

Correct Answer: C. Tension pneumothorax

Explanation:
Tension pneumothorax is a life-threatening condition that occurs when air accumulates in the pleural space
(the space between the lung and chest wall), leading to lung collapse and increased pressure in the chest. This
pressure can compress the heart and major blood vessels, severely impairing blood circulation and causing
shock. Tension pneumothorax requires immediate medical intervention to relieve the pressure and restore
proper lung function.

16. In a car accident, the following combination of symptoms indicates:

• Hyperresonance on percussion
• Hypotension
• Decreased heart sounds (Jugular Venous Distention - JVC)
• Absence of normal breath sounds
Options:
A. Cardiac Tamponade
B. Tension pneumothorax
C. Hemothorax
D. None of the above

Correct Answer. B. Tension pneumothorax

Explanation: Based on the symptoms described (hyperresonance on percussion, hypotension, JVC decrease,
and absence of normal breath sounds), the most fitting answer is B. Tension pneumothorax. This condition
encompasses all the described symptoms, indicating that it is likely the result of the car accident scenario.
Tension pneumothorax occurs when air accumulates in the pleural space, leading to lung collapse and
increased pressure in the chest. This can result in decreased cardiac output due to compression of the heart
and great vessels, leading to hypotension and JVC. Hyperresonance on percussion and absence of normal
breath sounds can also occur due to lung collapse. Tension pneumothorax is a life-threatening emergency that
requires immediate medical intervention to relieve pressure and restore lung function and circulation.
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17. A 16-year-old boy presenting with diarrhea and exhibiting pear-shaped binucleated structures on microscopic
examination should be treated with:

A. Metronidazole
B. Cyclosporine
C. Quinoline
D. Ciprofloxacin

Correct Answer: A. Metronidazole

Explanation: The scenario describes a 16-year-old boy with diarrhea and the presence of pear-shaped
binucleated structures on microscopic examination. Based on these findings, we need to identify the
appropriate treatment option. Metronidazole is an antibiotic that is effective against various protozoal
infections, including Giardia lamblia, which can present with pear-shaped binucleated trophozoites.
Metronidazole is a common choice for treating Giardia infections and is a suitable option based on the
presented symptoms.

18. A taxi driver who has an allergy causing recurring sneezing can use the following for relief:
A. Montelukast
B. Albuterol
C. Diphenhydramine
D. Mast cell stimulants

Correct Answer: C. Diphenhydramine

Explanation: The scenario describes a taxi driver with an allergy leading to repetitive sneezing. The goal is to
identify a suitable solution for alleviating the symptoms. Diphenhydramine is an antihistamine that can
provide relief from allergy symptoms like sneezing, itching, and runny nose. It is commonly used to manage
various allergic reactions.

19. The urine capacity of an adult bladder is:

A. 400 ml
B. 600 ml
C. 300 ml
D. 200 ml
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Correct Answer: B. 600 ml
Explanation: Generally, the average urine capacity of an adult bladder falls within the range of approximately
400 to 600 milliliters. Therefore, the most suitable choice from the given options is B. 600 ml.

20. During a tour of Murree, while sharing a room, experiencing nighttime itching can be attributed to:
A. Atopic dermatitis
B. Erythema
C. Eczema
D. Scabies

Correct Answer: D. Scabies

Explanation:
Scabies is a highly contagious skin infestation caused by mites. It results in intense itching, especially at night,
due to the mites burrowing into the skin to lay eggs. This option also aligns with the provided symptoms.
Scabies is particularly known for causing intense itching at night due to the mites' activity. If scabies is
suspected, it's crucial to seek medical attention for proper diagnosis and treatment to prevent further spread.

21. The treatment for scabies includes the following options:

A. Fluconazole
B. 5% Permethrin
C. Ivermectin
D. Topical steroids

Correct Answer: 5% Permethrin

Explanation: Permethrin is a common and effective treatment for scabies. It is a topical medication that kills
the mites and their eggs. Ivermectin is an oral medication that can be used to treat scabies, particularly in
cases where topical treatments are not effective. It helps kill the mites. Permethrin is a commonly
recommended topical treatment, while Ivermectin is used in cases where oral treatment is preferred or
necessary. The choice between the two depends on factors such as the severity of the infestation, patient
preferences, and any contraindications.
Permethrin acts via blocking the deactivation of Na+ channels leading to uncontrollable depolarization of
neuronal membranes that results in seizures and ultimately paralysis and death of the parasite while
ivermectin paralyses parasite by:
• Enhancing γ-aminobutyric acid (GABA)-mediated neurotransmission
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• Binding to muscle glutamate-gated chloride ion channels → cell hyperpolarization

22. Immediate treatment for burns includes the following options:

A. Antiseptic dressing
B. IV fluids
C. IV antibiotics
D. IV analgesics

Correct Answer: B. IV fluids

Explanation:
Burn injuries can lead to fluid loss and dehydration. IV fluids are crucial for maintaining hydration and
electrolyte balance. According to ATLS protocol the circulation should be managed first and fluid resuscitation
is the first step in the management of burn patients.

23. Light sleep is associated with which waves?

A. Alpha
B. Beta
C. Delta
D. Theta

Correct Answer: D. Theta waves

Explanation: Delta waves are slow brainwaves that are prominent during deep sleep. They are most closely
associated with the restorative stages of sleep. Light sleep is not typically characterized by alpha or beta
waves; rather, it is more often associated with the presence of theta waves.
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24. Which sound is associated with interstitial lung disease?

A. Crepitations (Crackles)
B. Pleural rub
C. Bronchial sound
D. Rhonchi

Correct Answer: A. Crepitations (Crackles)

Explanation: Crepitations, also known as crackles, are abnormal lung sounds that can be heard during
inspiration or expiration. They are often indicative of fluid or inflammation in the lungs and can be a sign of
interstitial lung disease. Based on the options provided, the most appropriate choice for the sound associated
with interstitial lung disease is A. Crepitations (Crackles). Crackles are often heard in conditions that involve
lung tissue changes, such as fibrosis, which is a hallmark of interstitial lung disease. If crackles are present on
auscultation, it can raise suspicion for this type of lung pathology and warrant further evaluation and diagnosis
by a healthcare professional.

25. Respiratory support is indicated when the Glasgow Coma Scale (GCS) is around:
A. 11
B. 10
C. 8
D. 9

Correct Answer: C. 8
Explanation:
In trauma, a Glasgow Coma Scale score (GCS) of 8 or less indicates a need for endotracheal intubation. The
underlying assumption is that any patient who has a GCS of ≤8 is unable to protect their own airway and so is
at risk of aspiration, whereas any patient with a GCS of >8 has intact airway reflexes and so is able to protect
their own airway. Some advocate a similar approach for other causes of decreased consciousness; however,
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the loss of airway reflexes and risk of aspiration cannot be reliably predicted using the GCS alone.

26. At 10 weeks of gestation, the presence of blue-greenish discharge with a foul smell is most likely caused by:
A. Trichomonas
B. E. coli
C. Gonococcus
D. Pseudomonas

Correct Answer: A. Trichomonas

Explanation: Trichomoniasis is a sexually transmitted infection that can cause a frothy, greenish-yellow
discharge with a foul odor.
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27. At 36 weeks of gestation, painless bleeding with a normal fetal status persisting for the last hour is most likely
indicative of:
A. Placenta previa
B. Placental abruption
C. Vasa previa
D. Placenta increta

Correct Answer: A. Placenta previa

Explanation: Placenta previa is a condition where the placenta covers part or all of the cervix. Its clinical
features include:
• Sudden, painless, bright red vaginal bleeding
• Usually occurs during the 3rd trimester (before rupture of the membranes)
• Initial bleeding episodes are often self-limited and recur during the onset of labor
• Soft, nontender uterus
• Usually, no fetal distres

28. A young patient who recently underwent a dental procedure is now experiencing high-grade fever, drowsiness,
vomiting, seizures, papilledema, and focal neurological deficits (FNDs). Nuchal rigidity is absent, and there is no
history of travel to a mosquito-prevalent area. The doctor suspects a ring-enhancing lesion. This is most likely
indicative of:
A. Cerebral malaria
B. Meningitis
C. Encephalitis
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D. Brain abscess

Correct Answer: Brain abscess

Explanation:
Based on the symptoms presented (fever, drowsiness, vomiting, seizures, papilledema, focal neurological
deficits, and a suspected ring-enhancing lesion) and the absence of nuchal rigidity and travel history to a
mosquito-prevalent area, the most suitable answer is D. Brain abscess.
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29. In hepatitis, which component raised specifically specifies liver injury?

A. LDH
B. Gamma globulin
C. Alpha-fetoprotein
D. ALT

Correct Answer: D. ALT

Explanation: Based on the options provided, the most appropriate answer for a component that is raised
specifically to indicate liver injury in hepatitis is D. ALT (Alanine Aminotransferase). Elevated ALT levels are a
reliable indicator of liver cell damage or injury, making it a valuable diagnostic tool for assessing liver health
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and function. LDH (Lactate Dehydrogenase): LDH is an enzyme that can be elevated in various conditions,
including liver injury. However, it is not specific to the liver and can also be elevated in other tissues.

30. In chronic HCV patients presenting with hematemesis, which complication could be a potential cause?
A. Esophageal varices
B. Mallory-Weiss tear
C. Gastric tumor
D. Duodenal ulcer

Correct Answer: A. Esophageal varices

Explanation:
Esophageal varices are enlarged and swollen veins in the lower part of the esophagus. Chronic liver disease,
including HCV, can lead to portal hypertension and the development of varices. Ruptured varices can cause
severe bleeding, leading to hematemesis. Based on the options provided, the most suitable answer for a
complication that could lead to hematemesis in chronic HCV patients is A. Esophageal varices. Chronic HCV
can lead to liver cirrhosis and portal hypertension, which are risk factors for the development of esophageal
varices. Ruptured varices can result in significant bleeding and hematemesis, making it a common and serious
complication in patients with chronic liver disease, including chronic HCV.

31. Drooping of the eyelids is caused by which type of bite?

A. Spider bite
B. Snake bite
C. Scorpion sting
D. Tick-borne bite

Correct Answer: C. Scorpion sting

Explanation:
Based on the options provided, the most suitable answer for a bite that can cause drooping of the eyelids is C.
Scorpion sting. Certain scorpion venoms contain neurotoxins that can affect muscle function, including the
muscles responsible for eyelid movement. While this symptom is not exclusive to scorpion stings, it is a
potential effect of scorpion envenomation.

32. Metabolic alkalosis is a disturbance characterized by:

A. Gain of H+ (hydrogen ions)
B. Absorption of HCO3- (bicarbonate ions)
C. Retention of CO2 (carbon dioxide)
D. Loss of CO2 (carbon dioxide)

Correct Answer: B. Absorption of HCO3- (bicarbonate ions)

Explanation:
Based on the options provided, the most appropriate answer for the disturbance associated with metabolic
alkalosis is B. Absorption of HCO3- (bicarbonate ions). Metabolic alkalosis occurs when there is an excess of
bicarbonate ions in the blood, leading to an increase in pH. This can result from conditions such as excessive
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vomiting, use of diuretics, or excessive ingestion of bicarbonate-containing substances. The increase in
bicarbonate ions shifts the body's acid-base balance towards alkalinity.

33. Vision loss in preschool-age children can be attributed to:

A. Vitamin A deficiency
B. Rubella infection
C. Congenital cataract
D. Trauma

Correct Answer: C. Congenital cataract

Explanation:
Based on the options provided, the most appropriate answer for a cause of vision loss specifically in
preschool-age children is C. Congenital cataract which is a clouding of the lens of the eye present at birth. This
condition can lead to visual impairment or loss in early childhood and should be promptly evaluated and
treated by a medical professional. Vitamin A deficiency can leads to vision problems, including night blindness
and other visual impairments, especially in young children. However, it may not be the most common cause of
vision loss specifically in the preschool age group.

34. Following a myocardial infarction (MI), the primary cause of shock is typically related to:
A. Right ventricle problems
B. Aortic valve problem
C. Left ventricle hypertrophy
D. Enlarged right atrium (RA)

Correct Answer: A. Right ventricle problems

Explanation:

Right ventricle dysfunction can lead to a condition called "right ventricular failure" or "right-sided heart
failure." This can cause shock due to reduced blood flow and cardiac output, particularly in the setting of
certain types of heart attacks. Based on the options provided, the most appropriate answer for the primary
cause of shock following a myocardial infarction is A. Right ventricle problems. In some cases, an MI can
damage the right ventricle, leading to decreased cardiac output and potential shock. It's important to note
that the severity and specific features of the heart attack, as well as the individual's overall cardiovascular
health, can influence the development of shock and its underlying causes.

35. The best measure to assess preload is:

A. End-diastolic volume (EDV)
B. Mean arterial pressure (MAP)
C. Wedge pressure
D. Right ventricular pressure
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Correct Answer: A. End-diastolic volume (EDV)
Explanation: EDV represents the volume of blood in the heart at the end of diastole, right before contraction.
It is a direct indicator of preload and the amount of blood available for ejection during systole.

36. In myocardial infarction (MI), elevation of CK-MB typically occurs during the following time frame:
A. 3 to 7 hours
B. 12 to 24 hours
C. 3 to 7 days
D. 3 to 10 days

Correct Answer: B. 12 to 24 hours

Explanation: CK-MB elevation within 12 to 24 hours after an MI is a more typical time frame for detecting an
increase in this enzyme. It reflects the damage to cardiac tissue and is commonly used as a diagnostic marker
for MI.

37. Typhoid fever is associated with which of the following manifestations?

A. Erythema nodosum
B. Rose spots
C. Bitot spots
D. Roth spots

Correct Answer: B. Rose spots

Explanation:
Rose spots are a specific skin manifestation of typhoid fever. They are small, pink or red, raised spots that
appear on the abdomen and chest.
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38. Which antihypertensive is associated with cough?

A. ACE inhibitor (ACE I)
B. Beta blocker
C. Calcium channel blocker (CCB)
D. Diuretic

Correct Answer: A. ACE inhibitor (ACE I)

Explanation:
ACE inhibitors are known to be associated with a side effect known as ACE inhibitor-induced cough. The cough
is often dry and persistent, and it occurs due to the accumulation of bradykinin, a substance that can irritate
the airways. Following are the adverse effects of ACE inhibitors:

39. The cause of delayed split S2 is related to:

A. Delayed closing of the aorta
B. Delayed closing of the pulmonary trunk
C. Mitral stenosis
D. Ventricular septal defect (VSD)

Correct Answer: B. Delayed closing of the pulmonary trunk

Explanation:
A delayed closing of the pulmonary trunk (pulmonary valve) can contribute to a delayed split S2 sound. This
occurs when the pulmonary valve closes slightly later than usual relative to the aortic valve closure.
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40. What is the compression ratio per minute for BSL (Basic Life Support) and ACLS (Advanced Cardiovascular Life
Support)?
A. 60
B. 80
C. 100
D. 140

Correct Answer: C. 100

Explanation: The guidelines for CPR are the following:
Place the heel of your hand on the centre of the person's chest, then place the palm of your other hand on top
and press down by 5 to 6cm (2 to 2.5 inches) at a steady rate of 100 to 120 compressions a minute. After
every 30 chest compressions, give 2 rescue breaths.

41. Which condition is influenced by the head of the pancreas in the case of cancer?
A. CBD stone obstruction
B. Jaundice
C. Liver cirrhosis
D. Constipation

Correct Answer: B. Jaundice

Explanation: Jaundice, characterized by yellowing of the skin and eyes, can result from obstruction of the bile
duct due to cancer in the head of the pancreas. When cancer obstructs the CBD, it can lead to a backup of bile,
causing jaundice.
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42. In the case of a mother with diabetes and a baby exhibiting convulsions and lethargy after delivery, which test
would be ordered?
A. Serum electrolytes
B. Serum calcium
C. Serum glucose
D. Serum potassium (K)

Correct Answer: Serum glucose

Explanation: In the case of a baby delivered by a diabetic mother, it is important to investigate the blood
glucose levels of both the mother and the baby. Infants born to diabetic mothers are at risk of hypoglycemia
(low blood sugar) due to their exposure to high levels of maternal glucose during pregnancy. Monitoring blood
glucose levels helps assess and manage the baby's blood sugar levels after birth.

43. What is the duration of tourniquet application in hours during hand surgery?
A. 1 hour
B. 2 hours
C. 3 hours
D. 4 hours

Correct Answer: A. 1 hour

Explanation: Tourniquet application for 1 hour may be a reasonable duration for hand surgery. Prolonged
tourniquet application can lead to complications, so the duration is typically limited.

44. Which is the preferred vein for CABG (Coronary Artery Bypass Graft) surgery?
A. Great saphenous vein
B. Femoral vein
C. Iliac vein
D. Axillary vein

Correct Answer: A. Great saphenous vein

Explanation: The great saphenous vein, located in the leg, is one of the most commonly used veins for CABG
surgery. It is often harvested and used to create grafts that bypass blocked coronary arteries. This vein is often
chosen for its suitability, accessibility, and ability to provide a graft for coronary artery bypass.

45. In a patient with a history of past malaria, which option is used for malaria eradication?
A. Primaquine
B. Quinine
C. Artesunate and Lumefantrine
D. Doxycycline

Correct Answer: A. Primaquine

Explanation:
Primaquine is an antimalarial medication used to treat and prevent relapses of certain types of malaria,
particularly Plasmodium vivax and Plasmodium ovale. It targets the liver stage of the parasite's life cycle and
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helps prevent the reactivation of the disease.

46. In the case of a humerus diaphysis fracture, which nerve is at risk of damage?
A. Radial nerve
B. Axillary nerve
C. Brachial nerve
D. Ulnar nerve

Correct Answer: A. Radial nerve

Explanation: Based on the options provided and the context of a humerus diaphysis fracture, the most
appropriate answer for the nerve at risk of damage is A. Radial nerve. Fractures in the midshaft region of the
humerus can potentially affect the radial nerve, leading to complications such as wrist drop and weakness in
wrist and finger extension.

47. After a shoulder dislocation, which nerve is responsible for the loss of sensation in the shoulder area?
A. Axillary nerve
B. Brachial plexus
C. Ulnar nerve
D. Musculocutaneous nerve

Correct Answer: A. Axillary nerve

Explanation:
The axillary nerve innervates the deltoid muscle and the skin over the lateral shoulder. Damage to the axillary
nerve can result in loss of sensation in the deltoid region. Based on the options provided and the context of a
shoulder dislocation, the most suitable answer for the nerve responsible for the loss of sensation in the
shoulder area is A. Axillary nerve. A shoulder dislocation can potentially injure the axillary nerve, leading to
sensory deficits in the shoulder region.

48. A Siachen soldier at a height of 20,000 feet is experiencing malaise and fatigue. What is the recommended
descent in feet?
A. 100 feet descent
B. 2000 feet descent
C. 200 feet descent
D. 300 feet descent

Correct Answer: B. 2000 feet descent

 NRE 6 AUGUST 2023
Explanation:
Based on the options provided, the most suitable answer for the recommended descent in feet to alleviate
symptoms of malaise and fatigue at high altitude is B. 2000 feet descent. Rapid descent to a lower altitude is a
key strategy for managing altitude sickness. Rest of options doesn’t provide symptomatic relief.

49. In a case where allergies worsen during winter, which process is activated?
A. Mast cell degranulation
B. Bronchitis
C. Bronchiectasis
D. Emphysema

Correct Answer: A. Mast cell degranulation

Explanation:
Allergic reactions involve the release of histamines and other chemicals from mast cells, leading to various
symptoms. Mast cell degranulation is a common mechanism in allergic responses. Based on the options
provided and the context of allergies worsening during winter, the most suitable answer for the activated
process is A. Mast cell degranulation. During winter, individuals with allergies may experience symptoms such
as sneezing, runny nose, and itchy eyes due to exposure to indoor allergens like dust mites, mold, and pet
dander. These allergens can trigger mast cell degranulation and the release of histamines, leading to allergy
symptoms.

50. For a first-time mother with a baby diagnosed with Down syndrome at 15 weeks of gestation, how can
screening for Down syndrome be conducted for a second baby?
A. Amniocentesis
B. Quad screen
C. Ultrasound
D. Beta-hCG (BhcG) test

Correct Answer: B. Quad screen

Explanation:
The quad screen is a blood test that measures four substances (alpha-fetoprotein, hCG, estriol, and inhibin-A)
to assess the risk of chromosomal abnormalities, including Down syndrome. It is a screening test and not
diagnostic. Based on the options provided and the context of screening for Down syndrome in a second baby,
the most suitable answer for screening is B. Quad screen. The quad screen is a non-invasive blood test that
 NRE 6 AUGUST 2023
assesses the risk of Down syndrome and other chromosomal abnormalities.

51. Which metabolic fuel is utilized for generating glucose in severe starvation?
A. Amino acids
B. Fat
C. Glycogen
D. Lipoproteins

Correct Answer: A. Amino acids

Explanation:
During severe starvation, the body can break down proteins (amino acids) from muscle tissue to generate
glucose through a process called gluconeogenesis. Based on the options provided, the most suitable answer
for the metabolic fuel utilized for generating glucose in severe starvation is A. Amino acids. During periods of
prolonged fasting or severe caloric restriction, the body may rely on amino acids from muscle tissue to
maintain blood glucose levels and provide energy for essential functions. This process is part of the body's
 NRE 6 AUGUST 2023
survival mechanisms during times of nutrient scarcity.

52. What does vomiting cause?

A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Respiratory acidosis

Correct Answer: A. Metabolic alkalosis

Explanation:
Based on the options provided and the context of vomiting, the most suitable answer for the effect of
vomiting is A. Metabolic alkalosis. The loss of stomach acid through vomiting can disrupt the body's acid-base
balance, resulting in a tendency toward alkalinity. It's important to note that vomiting can have various effects
on the body, including electrolyte imbalances, dehydration, and changes in acid-base balance.

53. Which of the following vaccines is known to cause serious side effects such as encephalitis once administered
to an infant?
A. BCG
B. HBV
C. Measles
D. Pertussis

Correct Answer: C. Measles

Explanation:
The measles vaccine is an important immunization to prevent measles, which is a highly contagious viral
illness. In very rare cases, the measles vaccine has been associated with a condition called vaccine-associated
encephalitis, but the risk is extremely low.
 NRE 6 AUGUST 2023
54. What is considered fast respiration in a 2-year-old child?
A. Greater than 20 breaths per minute
B. Greater than 30 breaths per minute
C. Greater than 40 breaths per minute
D. Greater than 50 breaths per minute

Correct Answer:C. Greater than 40 breaths per minute

Explanation:

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 NRE 6 AUGUST 2023
55. In a young female involved in a road traffic accident (RTA) with distant abdominal injury, normal respiration,
SpO2 of 88%, hypotension, and increased pulse rate, which immediate action should be taken?
A. IV fluids
B. Dextrose
C. Chest intubation
D. Tracheostomy

Correct Answer: A. IV fluids

Explanation:
Based on the options provided and the clinical scenario, the most suitable answer for the immediate action is
A. IV fluids according to ACLS protocol. Hypotension and increased pulse rate suggest the possibility of
hypovolemia, which should be addressed promptly with intravenous fluids to stabilize the patient's condition.
Once the patient's hemodynamic status is stabilized, further assessment and management can be pursued as
needed.

56. In a patient with hepatic failure who gradually develops hepatic encephalopathy, which compound's
deterioration is responsible?
A. Creatinine
B. Glutamine
C. Urea
D. Infectious agents

Correct Answer: B. Glutamine

Explanation:
Based on the options provided and the context of hepatic failure and hepatic encephalopathy, the most
suitable answer for the compound responsible for deterioration is B. Glutamine. In the setting of hepatic
failure, ammonia buildup can lead to increased glutamine levels in the brain, contributing to the neurological
symptoms that are characteristic of hepatic encephalopathy. Management of hepatic encephalopathy often
 NRE 6 AUGUST 2023
involves addressing ammonia levels through dietary modifications, medications, and interventions to support
liver function.

57. What is the half-life of platelets?

A. 8-10 hours
B. 3-4 days
C. 7-10 days
D. 14-21 days

Correct answer: C. 7-10 days

Explanation:
Platelets are anuclear, granulated cells about 2 to 4 µm in diameter derived from bone marrow
megakaryocytes. Normal half-life of platelets is 7 to 10 days.

58. What does a blue-greenish discharge from a wound indicate?

A. Staphylococcus aureus
B. Pseudomonas
C. E. coli
D. Candida albicans

Correct Answer: B. Pseudomonas

Explanation:
Pseudomonas aeruginosa is a bacterium known to produce a blue-green pigment, which can result in a blue-
greenish discharge from a wound. Pseudomonas infections are often associated with water-related
environments and compromised immune systems. The blue-green pigment produced by Pseudomonas
aeruginosa can result in a distinct coloration of wound discharge.

59. When does secondary hemorrhage occur?

A. Within 6 hours of surgery
B. Within 24 hours of surgery
C. 7-14 days after surgery
D. 3 weeks after surgery

Correct Answer: C. 7-14 days after surgery

Explanation:
Based on the options provided and the context of secondary hemorrhage, the most suitable answer is C. 7-14
days after surgery. Secondary hemorrhage is often related to factors such as wound infection, delayed wound
 NRE 6 AUGUST 2023
healing, or disruption of healing tissue. While bleeding can occur at various times post-surgery, the specified
timeframe of 7-14 days is more consistent with the occurrence of secondary hemorrhage.

60. What is the most common site for pressure sores in a bedridden patient?
A. Sacrum
B. Greater trochanter
C. Occiput
D. Ischial tuberosity

Correct Answer: A. Sacrum

Explanation:
Based on the options provided and the context of pressure sores in bedridden patients, the most suitable
answer is A. Sacrum. The sacral area is particularly vulnerable to pressure sores due to the pressure exerted
on it when a person is lying down for extended periods without repositioning. Proper skin care, frequent
position changes, and the use of supportive devices can help prevent pressure sores in bedridden patients.

61. What is the most appropriate diagnosis for a 50-year-old female patient with an 8-hour history of severe
abdominal pain? The pain initially was peri-umbilical but shifted to the right iliac fossa. Rovsing's sign is positive,
and she has rebound tenderness in the right iliac fossa.
A. Appendicitis
B. Right ureteric colic
C. Ectopic pregnancy
D. Perforated duodenal ulcer

Correct Answer: A. Appendicitis

Explanation:
The patient's symptoms, including the shift of pain to the right iliac fossa, positive Rovsing's sign, and rebound
tenderness, are consistent with the clinical picture of appendicitis. This condition involves inflammation of the
appendix, often requiring surgical intervention. Following are the symptoms of acute appendicitis:
 NRE 6 AUGUST 2023

62. What is the cause of diarrhea in a 30-year-old male who presented with profuse diarrhea and vomiting,
appearing toxic and dehydrated? He had dinner at a function where multiple meat dishes were served 3 hours
earlier.
A. Cholera
B. E. coli
C. Shigellosis
D. Staph aureus toxin

Correct Answer: D. Staph aureus toxin

Explanation:
Staphylococcus aureus bacteria can produce toxins that cause food poisoning, resulting in symptoms such as
nausea, vomiting, abdominal cramps, and diarrhea. Based on the options provided and the clinical
presentation, the most suitable answer is D. Staph aureus toxin. The patient's symptoms of profuse diarrhea,
vomiting, rapid onset, and consumption of meat dishes are highly suggestive of Staph aureus toxin-mediated
food poisoning. This type of foodborne illness is known for its quick onset of symptoms after consuming
 NRE 6 AUGUST 2023
contaminated food typically within 6 hours.

63. Which characteristics are associated with transverse myelitis?

A. Sensory only
B. Motor sensory, autonomic dysfunction
C. Asymmetry defect
D. Motor neurological defect

Correct Answer: B. Motor sensory, autonomic dysfunction

Explanation:
Based on the options provided and the characteristics of transverse myelitis, the most suitable answer is B.
Motor sensory, autonomic dysfunction. Transverse myelitis is characterized by a combination of motor and
sensory deficits, along with possible autonomic dysfunction.
Idiopathic transverse myelitis
• Immune-mediated destruction of spinal cord
Pathophysiology • Often postinfectious (molecular mimicry)

• Bilateral motor weakness, classically early flaccid (LMN) progressing to

late spastic (UMN)
• Bilateral sensory dysfunction (all somatosensory systems)
Clinical features
• Distinct sensory level
• Autonomic dysfunction (bowel &/or bladder)

• MRI of spine: no compressive lesion, T2 hyperintensity

Diagnosis • Lumbar puncture: ↑ WBCs, ↑ IgG index

• High-dose intravenous glucocorticoids

Treatment • Plasmapheresis

LMN = lower motor neuron; UMN = upper motor neuron; WBCs = white blood cells.

64. Which of the following tests are predictive for ischemia of coronary arteries?
A. HIDA scan
B. Iodine 131
C. Thallium scan
D. DEXA scan
 NRE 6 AUGUST 2023
Correct Answer: C. Thallium scan
Explanation:
A thallium scan, also known as myocardial perfusion imaging, is a nuclear medicine test used to assess blood
flow to the heart muscle. It involves injecting a radioactive tracer (usually thallium-201) and then imaging the
heart to detect areas of reduced blood flow, which may indicate ischemia. This test can help assess the
presence and severity of coronary artery disease and guide further management.

65. What investigation should be done next for a 38-year-old female who presented with low hemoglobin (Hb), low
mean corpuscular volume (MCV), low mean corpuscular hemoglobin (MCH), and low mean corpuscular
hemoglobin concentration (MCHC)?
A. Serum ferritin
B. Serum folate
C. Serum B-12
D. Reticulocyte count

Correct Answer: A. Serum ferritin

Explanation:
The question focuses on identifying the appropriate investigation to determine the underlying cause of the
patient's anemia, characterized by low Hb, low MCV, low MCH, and low MCHC. The anemia is most likely due
to decrease iron stores that results in iron deficiency anemia. Low serum ferritin levels may indicate iron
deficiency anemia, which is characterized by microcytic (low MCV) and hypochromic (low MCH, low MCHC)
red blood cells. Thus, serum ferritin levels can help confirm or rule out iron deficiency as the underlying cause.

66. What is the diagnosis for a 61-year-old female who presented with fever, anxiety, agitation, palpitations,
marked muscle weakness, and diarrhea? Examination reveals a goiter and atrial fibrillation with a ventricular
rate of 135/min. On urine exam, protein is positive, RBCs are positive, and WBCs are positive. TFTs exam shows
low TSH of 0.5 μIU/L.
A. Hypothyroidism
B. Pheochromocytoma
C. Thyroid storm
D. UTI (Urinary Tract Infection)

Correct Answer: C. Thyroid storm

Explanation:
Thyroid storm, also known as thyrotoxic crisis, is a life-threatening condition caused by excessive release of
thyroid hormones. It can present with fever, agitation, palpitations, muscle weakness, and other symptoms.
The presence of atrial fibrillation, marked muscle weakness, and low TSH levels (indicative of
 NRE 6 AUGUST 2023
hyperthyroidism). Thyroid storm is a severe manifestation of hyperthyroidism that requires prompt medical
intervention to manage the excess thyroid hormone release and associated symptoms.
Clinical features of thyroid storm
• Thyroid or nonthyroidal surgery
Precipitating • Acute illness (eg, trauma, infection), childbirth
factors • Acute iodine load (eg, iodine contrast)

• Fever as high as 40-41.1 C (104-106 F)

• Tachycardia, hypertension, congestive heart failure, cardiac arrhythmias
(eg, atrial fibrillation)
Clinical
• Agitation, delirium, seizure, coma
presentation
• Goiter, lid lag, tremor, warm & moist skin
• Nausea, vomiting, diarrhea, jaundice

• β blocker (eg, propranolol) to ↓ adrenergic manifestations

• PTU followed by iodine solution (SSKI) to ↓ hormone synthesis &
release
Treatment • Glucocorticoids (eg, hydrocortisone) to ↓ peripheral T4 to T3 conversion
& improve vasomotor stability
• Identify trigger & treat, supportive care

PTU = propylthiouracil; SSKI = potassium iodide; T3 = triiodothyronine; T4 = thyroxine.

67. What disorder is marked by gradual deterioration of mental capacity along with memory impairment and
confusion?
A. Alzheimer's disease
B. Cerebral palsy
C. Tourette syndrome
D. Motor neuron disease

Correct Answer: A. Alzheimer's disease

Explanation:
Based on the options provided and the specific symptoms described, the most suitable answer is A.
Alzheimer's disease. This disorder is characterized by the gradual deterioration of mental capacity, memory
impairment, and confusion, which are classic hallmarks of the disease. Alzheimer's disease is a progressive
condition that affects a person's ability to think, remember, and perform everyday tasks, and it is one of the
most well-known forms of dementia.
Clinical features of Alzheimer disease
• Anterograde memory loss (ie, immediate recall affected, distant memories
preserved)
Early • Visuospatial deficits (eg, lost in own neighborhood)
findings • Language difficulties (eg, difficulty finding words)
• Cognitive impairment with progressive decline
 NRE 6 AUGUST 2023
• Neuropsychiatric (eg, hallucinations, wandering)
• Dyspraxia (eg, difficulty performing learned motor tasks)
• Lack of insight regarding deficits
Late
• Noncognitive neurologic deficits (eg, pyramidal & extrapyramidal motor,
findings
myoclonus, seizures)
• Urinary incontinence

Anterograde amnesia: A person cannot remember new information but can remember events from before the
onset of amnesia. Retrograde amnesia: A person can remember new information but cannot remember
events from before the onset of amnesia. Dissociative amnesia: A person may forget specific events or time
periods
68. In a 3-year-old with coarse facial features, protruding tongue, and umbilical hernia, along with apparent mental
retardation, which hormone deficiency is likely responsible?
A. Cortisol
B. Insulin
C. Somatostatin
D. Thyroxine (Thyroxin)

Correct Answer: D. Thyroxine (Thyroxin)

Explanation:
Based on the options provided and the clinical presentation described, the most suitable answer is D.
Thyroxine (Thyroxin). The symptoms of coarse facial features, protruding tongue, umbilical hernia, and mental
retardation are characteristic of congenital hypothyroidism, which is caused by deficient production of thyroid
hormones during early development. This condition is commonly known as congenital hypothyroidism also
known as cretinism.
Congenital hypothyroidism
• Usually asymptomatic at birth (rarely causes delayed meconium passage)
• After maternal thyroxine wanes (weeks to months)
o Lethargy, poor feeding
o Enlarged fontanelle
Clinical
o Protruding tongue, puffy face, umbilical hernia
manifestations
o Constipation
o Prolonged jaundice
o Dry skin

• ↑ TSH & ↓ free thyroxine levels

Diagnosis • Newborn screening

• Levothyroxine*
Treatment

• No deficits if treatment started in neonatal period

• Untreated disease is associated with neurocognitive dysfunction (eg,
Prognosis
↓ intelligence quotient)

*Avoid coadministration with soy products, iron, or calcium.

NRE 6 AUGUST 2023
 NRE 6 AUGUST 2023
69. Which tumor spreads by the hematogenous route?
A. Lung cancer
B. Sarcoma
C. Fibroma
D. Ovarian cancer

Correct Answer: B. Sarcoma

Explanation:
Sarcomas are a group of tumors that originate in connective tissues, such as bones, muscles, and soft tissues.
Some sarcomas can spread hematogenously, especially to the lungs and liver. Based on the options provided
and the characteristics of tumor spread, the most suitable answer is B. Sarcoma. Sarcomas, especially high-
grade and aggressive types, have a greater tendency to spread hematogenously to distant sites, including the
lungs.

70. In a 45-year-old male with chronic hepatitis C, a 3cm space-occupying lesion is found in the right lobe of the
liver. What is the tumor marker?
A. AFP (Alpha-fetoprotein)
B. PSA (Prostate-specific antigen)
C. CEA (Carcinoembryonic antigen)
D. CA123 (Cancer antigen 125)

Correct Answer: A. AFP (Alpha-fetoprotein)

Explanation:
Based on the options provided and the clinical scenario of a space-occupying lesion in the liver of a patient
with chronic hepatitis C, the most suitable answer is A. AFP (Alpha-fetoprotein). Elevated AFP levels in this
context could suggest the presence of hepatocellular carcinoma (HCC), a type of liver cancer commonly
associated with chronic liver diseases like hepatitis C.

71. In a young female with episodic breathlessness, cough, wheezing, and chest tightness worsening in the spring
season, what is the pathological mechanism responsible?
A. Permanent enlargement of distal air spaces
B. Mast cell activation
C. Excessive loss of elastin
D. Alpha-1 antitrypsin deficiency
 NRE 6 AUGUST 2023
Correct Answer: B. Mast cell activation
Explanation:
Mast cell activation is a key mechanism in allergic reactions and asthma. Episodic breathlessness, cough,
wheezing, and chest tightness that worsen in specific seasons (such as spring) are characteristic of allergic
asthma, where allergen exposure triggers mast cell activation and subsequent airway inflammation.

72. In a 20-year-old male who suffered from acute viral hepatitis, which type of cells attack infected cells?
A. B-lymphocytes
B. Macrophages
C. Monocytes
D. Natural killer cells

Correct Answer: D. Natural killer cells

Explanation:
Natural killer (NK) cells are a type of lymphocyte that plays a crucial role in the innate immune response by
directly attacking and killing infected cells, as well as tumor cells. They are known for their ability to recognize
and destroy abnormal or infected cells. During acute viral infections, including hepatitis, natural killer cells are
important for recognizing and eliminating infected liver cells. They play a role in controlling viral replication
and preventing the spread of infection.

73. In myasthenia gravis, the disorder originates from which area?

A. Anterior horn cell
B. Neuromuscular junction
C. Peripheral cells
D. Posterior horn
 NRE 6 AUGUST 2023
Correct Answer: B. Neuromuscular junction
Explanation:
Based on the options provided and the nature of myasthenia gravis, the most suitable answer is B.
Neuromuscular junction. Myasthenia gravis is characterized by dysfunction at the neuromuscular junction,
where nerve impulses fail to properly transmit signals to muscle cells due to the presence of autoantibodies
against acetylcholine receptors. This leads to muscle weakness and fatigue in affected individuals.
Myasthenia gravis
• Fluctuating & fatigable proximal muscle weakness:
o Ocular (eg, diplopia, ptosis)
Clinical
o Bulbar (eg, dysphagia, dysarthria)
presentation
o Respiratory (myasthenic crisis)

• Medications: antibiotics (eg, fluoroquinolones,

aminoglycosides), neuromuscular blocking agents, cardiac
Causes of medications (eg, BBs), MgSO4, penicillamine
exacerbations • Physiologic stress: pregnancy/childbirth, surgery
(especially thymectomy), infection

• Ice pack test (bedside), AChR-Ab (highly specific)

Diagnosis • CT scan of chest (thymoma)

• AChE inhibitors (eg, pyridostigmine) ± immunotherapy

(eg, corticosteroids, azathioprine)
Treatment
• Thymectomy

AChE = acetylcholinesterase; AChR-Ab = acetylcholine receptor antibodies;

BBs = beta blockers; MgSO4 = magnesium sulfate.

74. A worker presents with accidental exposure of the eye to battery acid. What should be the immediate step to
take?
A. Take history (hx)
B. Check visual activity
C. General physical examination (GPE)
D. Copious irrigation of the eye

Correct Answer: D. Copious irrigation of the eye

Explanation:
Battery acid exposure to the eye is a serious emergency that requires immediate and thorough irrigation of
the affected eye with copious amounts of water or a sterile saline solution. Prompt irrigation helps dilute and
remove the corrosive substance from the eye, minimizing potential damage and reducing the risk of severe
injury.

75. For histological diagnosis in the thyroid, which investigation is performed?

A. FNAC (Fine Needle Aspiration Cytology)
B. Incision biopsy
C. Excision biopsy
 NRE 6 AUGUST 2023
D. Trucut biopsy

Correct Answer: A. FNAC (Fine Needle Aspiration Cytology)

Explanation:
FNAC is a minimally invasive procedure where a thin needle is used to extract a sample of cells from a thyroid
nodule or mass. The cells are then examined under a microscope to determine if they are benign (non-
cancerous) or malignant (cancerous). FNAC is often the initial investigation of choice for thyroid nodules. FNAC
is a widely used procedure that provides valuable information about the nature of thyroid nodules and helps
guide further management decisions.

Serum TSH levels should be obtained, along with a thyroid ultrasound, to determine nodule size and
sonographic features. Certain sonographic features (eg, microcalcifications, irregular margins, internal
vascularity) carry a much higher risk of malignancy than others (eg, cystic or spongiform lesions). Thyroid
nodules >1 cm with these high-risk sonographic features—and all noncystic thyroid nodules >2 cm—should
undergo FNA.
76. A patient presented with carpopedal spasm, seizure and a positive Chvostek sign. Which intravenous (IV)
treatment should be administered?
A. Calcium gluconate
B. Sodium Bicarbonate
C. Potassium Chloride
D. Phosphate
 NRE 6 AUGUST 2023
Correct Answer: A. Calcium gluconate
Explanation:

77. Which one of the following vaccines is recommended at birth?

A. BCG (Bacillus Calmette-Guérin)
B. DPT (Diphtheria, Pertussis, Tetanus)
C. Measles
D. Rotavirus vaccine

Correct Answer: A. BCG (Bacillus Calmette-Guérin)

Explanation:
Based on the options provided and the recommended vaccination schedule, the most suitable answer is A.
BCG (Bacillus Calmette-Guérin). The BCG vaccine is often given at birth to provide early protection against
 NRE 6 AUGUST 2023
tuberculosis in areas with a high prevalence of the disease.

78. A 6-month-old child was brought by his mother to the ER with the first episode of generalized seizures and
fever for the last 2 days. On examination, the temperature is 101°F with bulging anterior fontanelle and marked
irritability. What is the investigation of choice?
A. Blood CP (Complete Blood Count)
B. Blood culture
C. Blood sugar random
D. Lumbar puncture

Correct Answer: D. Lumbar puncture

Explanation:
The presentation of fever, seizures, and a bulging anterior fontanelle raises concerns about possible central
nervous system (CNS) infection, such as meningitis. A lumbar puncture is the investigation of choice in this
scenario to obtain cerebrospinal fluid (CSF) for analysis, which can help diagnose or rule out CNS infection and
guide appropriate treatment.

79. A 2-year-old boy presents with a sudden onset of weakness of the left lower limb following an episode of
febrile illness. On examination, tone, power, and reflexes in the affected limb are diminished. He has not
received regular vaccines. The rest of the systemic exam is unremarkable. What is the most likely diagnosis?
A. Encephalitis
B. Guillain-Barré Syndrome (GBS)
C. Poliomyelitis
D. Transverse Myelitis

Correct Answer: C. Poliomyelitis

Explanation:
Poliomyelitis (polio) is a viral infection that can cause paralysis and weakness, primarily affecting the motor
neurons of the spinal cord. The sudden onset of weakness and diminished reflexes in the left lower limb
following a febrile illness could be consistent with polio. While polio has become rare due to widespread
vaccination efforts, it remains a possible consideration in regions like Pakistan and Afghanistan where the
disease is not fully eradicated.
 NRE 6 AUGUST 2023

80. A patient comes to you with pain, redness, and photophobia in the right eye. Examination shows circum-
corneal congestion. Which condition is most likely?
A. Blepharitis
B. Uveitis
C. Bacterial conjunctivitis
D. Orbital cellulitis

Correct Answer: B. Uveitis

Explanation:

Uveitis is inflammation of the uvea, the middle layer of the eye. It can cause symptoms such as pain, redness,
photophobia, and blurred vision. Circum-corneal congestion can be a feature of uveitis. Following are the
clinical features of uveitis:
 NRE 6 AUGUST 2023

81. Which of the following is contraindicated for lumbar puncture?

A. Irritability
B. Encephalitis
C. High-grade fever
D. Papilledema

Correct Answer: D. Papilledema

Explanation:
Papilledema refers to swelling of the optic nerve head due to increased intracranial pressure. Lumbar
puncture may be contraindicated in the presence of papilledema, as it can potentially lead to further increases
in intracranial pressure and herniation.

82. A middle-aged man presents with monoarthritis of the knee joint with effusion. What is the most appropriate
diagnostic procedure in this case?
A. Arthroscopy with synovial biopsy
B. Aspiration of joint fluid
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C. Plain MRI of the knee joint
D. USG knee

Correct Answer: B. Aspiration of joint fluid

Explanation:
Aspiration of joint fluid (arthrocentesis) is a common diagnostic procedure used to obtain a sample of synovial
fluid from the joint. It can help identify the underlying cause of the monoarthritis, such as infection,
inflammation, or crystal deposition. This procedure can provide important diagnostic information to guide
further management.

83. A 6-month-old infant is diagnosed with scabies. What is the treatment of choice?
A. 10% sulfur in petrolatum
B. Topical 5% permethrin
C. Oral ivermectin
D. Antibiotic

Correct Answer: B. Topical 5% permethrin

Explanation:
Topical permethrin is considered the treatment of choice for scabies, including in infants. It is safe and
effective when used as directed and is often preferred for young children. In addition, oral Ivermectin is
contraindicated in children with weight less than 15kg or age less than 2 year.

84. Extra-pyramidal side effects of antipsychotics include:

A. Diarrhea
B. Vomiting
C. Dystonia
D. Dizziness
Correct Answer: C. Dystonia
Explanation:

Based on the options provided and the concept of extra-pyramidal side effects, the most suitable answer is C.
Dystonia. It's important to note that EPS can include various movement-related symptoms such as dystonia,
akathisia, parkinsonism, and tardive dyskinesia. Dystonia is characterized by involuntary muscle contractions
resulting in abnormal postures or movements. It is a known EPS associated with antipsychotic use.

85. What is the compression rate for both BLS and ACLS in a child?
A. 60/min
B. 80/min
C. 100/min
D. 120/min
 NRE 6 AUGUST 2023
Correct Answer: C. 100/min
Explanation:
100/min is a commonly recommended compression rate for child CPR in both BLS and ACLS guidelines.

86. A tract connecting an intestine to the skin is:

A. Sinus
B. Fistula
C. Duct
D. Cleft

Correct Answer: B. Fistula

Explanation:
A fistula is an abnormal connection or passage between two organs or spaces that do not normally connect. In
this case, an intestinal fistula would involve a tract connecting the intestine to the skin.

87. In an asthmatic baby, which drug, when used for prolonged periods, can lead to side effects?
A. Prednisolone
B. Albuterol
C. Salbuterol
D. Montelukast

Correct Answer: A. Prednisolone

Explanation:
Asthma is a chronic respiratory condition that often requires long-term management with medications.
Prednisolone is a corticosteroid medication used to reduce inflammation in the airways. Prolonged use of
corticosteroids, especially at high doses, can lead to various side effects, including growth suppression, bone
thinning (osteoporosis), and adrenal gland suppression.
 NRE 6 AUGUST 2023
88. In lung carcinoma, what is the most frequent symptom?
A. Cough
B. Dyspnea
C. Hemoptysis
D. Fever

Correct Answer: Cough

Explanation:
Lung carcinoma, also known as lung cancer, can present with a variety of symptoms. Cough is a common
symptom in lung carcinoma, especially if the tumor is located near the airways. It can be persistent and may
involve coughing up blood or sputum.

89. In a child with glomerulonephritis, which condition is most likely?

A. PSGN (Post-Streptococcal Glomerulonephritis)
B. MCD (Minimal Change Disease)
C. Alport Syndrome
D. IgA Nephropathy

Correct Answer: PSGN (Post-Streptococcal Glomerulonephritis)

Explanation:

PSGN is a type of glomerulonephritis that occurs after a streptococcal infection, such as strep throat. It is more
common in children and typically follows a recent infection.
Acute poststreptococcal glomerulonephritis
• Several weeks after GAS infection (eg, pharyngitis, impetigo)
• GBM immune complex deposition
Pathophysiology
• Complement component C3 & CH50 accumulation

• Can be asymptomatic
• If symptomatic:
o Gross hematuria (tea- or cola-colored urine)
Clinical features
o Edema (periorbital, generalized)
o Hypertension
 NRE 6 AUGUST 2023
• Urinalysis: + protein, + blood, ± RBC casts
• Serum:
o ↑ Creatinine
Laboratory
o ↓ C3 & CH50
findings
o Possible ↓ C4
o Positive streptozyme test*

• Supportive care
• Volume overload: loop diuretics
Management • Hypertension: ± additional antihypertensives
• Refractory cases: hemodialysis

• Complete recovery in a few weeks in children

Prognosis • Adults more likely to develop chronic kidney disease

*Streptozyme tests: antistreptolysin O, anti-DNAse B, antihyaluronidase, anti–nicotinamide adenine

dinucleotidase, antistreptokinase.

GAS = group A Streptococcus; GBM = glomerular basement membrane; RBC = red blood cell.

90. In older people, what is the most common site for diverticulitis?
A. Sigmoid
B. Transverse
C. Small intestine
D. Iliac

Correct Answer: A. Sigmoid

Explanation:
Diverticulitis refers to inflammation or infection of small pouches (diverticula) that can develop in the walls of
the digestive tract, most commonly in the large intestine. The sigmoid colon is the most common site for
diverticulitis, particularly in older individuals. Diverticula often form in the sigmoid colon due to increased
 NRE 6 AUGUST 2023
pressure and weakening of the colon wall.

91. When should facial sutures be removed?

A. After 5 days
B. After 2 days
C. After 4 days
D. After 10 days

Answer: A. After 5 days

Explanation:
Sutures, also known as stitches, are used to close wounds or incisions after surgery or injury. The timing for
suture removal depends on various factors, including the location of the sutures and the healing process. In
the case of facial sutures, the removal timeline can vary. Suture removal after 5 days is a common timeframe
for many facial sutures, depending on the type of wound and the healthcare provider's assessment.

92. In a case of cholera with feeble pulse and systolic blood pressure of 80 mmHg, what is the most appropriate
treatment?
A. IV rehydration
B. Antibiotics
C. Antiviral
D. Analgesics
Correct Answer: A. IV rehydration
Explanation:
Cholera is a severe diarrheal disease caused by the bacterium Vibrio cholerae. It can lead to rapid and severe
dehydration, which can result in a feeble pulse and low blood pressure. IV rehydration: IV (intravenous)
rehydration is the cornerstone of treatment for cholera. Rapid and aggressive fluid replacement is crucial to
 NRE 6 AUGUST 2023
restore electrolyte balance and prevent shock due to severe dehydration.

93. The thyroid isthmus is located in front of which cartilage?

A. Tracheal cartilage
B. Cricoid cartilage
C. Hyoid bone
D. Epiglottis

Correct Answer: A. Tracheal cartilage

Explanation:
The thyroid isthmus is a narrow band of tissue that connects the two lobes of the thyroid gland, which is
located in the neck. The thyroid isthmus is situated in front of the tracheal cartilage, specifically the second
and third tracheal rings.

94. What is responsible for the milky appearance of plasma after a fatty meal?
A. Chylomicron
B. HDL (High-Density Lipoprotein)
C. LDL (Low-Density Lipoprotein)
D. VLDL (Very-Low-Density Lipoprotein)

Correct Answer: Chylomicron

Explanation:
After consuming a fatty meal, the digestive system processes dietary fats into lipoproteins for transport in the
bloodstream. Chylomicrons are lipoproteins that transport dietary triglycerides from the intestines to various
tissues. They are responsible for the milky appearance of plasma after a fatty meal. They transport dietary fats
(triglycerides) from the intestines to the bloodstream for distribution to various tissues in the body.

95. In a child with high-grade fever, dysphagia, and swollen tonsils, which antibiotic is given?
A. Co-amoxiclav
B. Gentamicin Injection
C. Metronidazole
D. Aztreonam

Correct Answer: A. Co-amoxiclav

Explanation:
Tonsillitis, characterized by symptoms such as high-grade fever, sore throat, and swollen tonsils, is often
caused by bacterial infections. Co-amoxiclav is a combination antibiotic that includes amoxicillin and clavulanic
acid. It is commonly prescribed for bacterial infections, including tonsillitis. Co-amoxiclav is effective against a
broad spectrum of bacteria and is often used in the treatment of tonsillitis.

96. What is the cause of conductive hearing loss?

A. Streptomycin
B. Gentamicin
C. Otosclerosis
 NRE 6 AUGUST 2023
D. Meniere disease

Correct Answer: C. Otosclerosis

Explanation:
Conductive hearing loss occurs when there is a problem in the outer or middle ear that prevents sound from
being conducted effectively to the inner ear. Otosclerosis is a condition in which abnormal bone growth
affects the movement of the stapes bone in the middle ear. This can result in conductive hearing loss by
interfering with the transmission of sound vibrations to the inner ear.
Otosclerosis
• Younger (early to mid-30s) Caucasian patients
• More common in women
Epidemiology
• Autosomal dominant with incomplete penetrance

• Imbalance of bone resorption & deposition → stiffening of stapes

Pathophysiology

• Progressive conductive hearing loss

• Paradoxical improvement in speech discrimination in noisy
Clinical
environments
manifestations
• ± Reddish hue behind tympanic membrane

• Amplification (eg, hearing aids)

Management • Surgery (eg, stapes reconstruction)

97. How is ectopic pregnancy confirmed?

A. Scan + raised β-HCG (beta human chorionic gonadotropin)
B. Scan + UPT (urine pregnancy test)
C. UPT + β-HCG (beta human chorionic gonadotropin)
D. UPT + Dilation and Curettage

Correct Answer: A. Scan + raised β-HCG (beta human chorionic gonadotropin)

 NRE 6 AUGUST 2023
Explanation:

Ectopic pregnancy is a condition in which a fertilized egg implants and develops outside the uterus, typically in
the fallopian tube. It is important to confirm ectopic pregnancy promptly for appropriate management.
Among the options provided, the most appropriate approach to confirm ectopic pregnancy is A. Scan + raised
β-HCG. This approach combines ultrasound imaging with the assessment of β-HCG levels to detect and locate
the ectopic pregnancy accurately. Early diagnosis and intervention are crucial for managing ectopic pregnancy
and preventing complications.

98. What is the common site of osteosarcoma?

A. Knee
B. Hip
C. Spine
D. Skull

Correct Answer: A. Knee

 NRE 6 AUGUST 2023
Explanation:

Osteosarcoma is a type of bone cancer that primarily affects the bone tissue. It commonly occurs in certain
locations within the body. Osteosarcoma frequently occurs around the knee joint, especially in the metaphysis
of the long bones, such as the distal femur and proximal tibia.

99. What is a painless mass on the back side of the wrist?

A. Sebaceous cyst
B. Lipoma
C. Ganglion cyst
D. Bursitis

Correct Answer: C. Ganglion cyst

Explanation:
A painless mass on the back side of the wrist can be caused by various conditions. A ganglion cyst is a fluid-
filled lump that commonly occurs near joints or tendons, such as on the back of the wrist. It is usually painless
but may cause discomfort or limit movement if it presses on a nearby nerve.
Ganglion cyst
• Mucoid degeneration of periarticular tissue
• Herniation of connective tissue from joint capsule, tendon sheath, bursae
Pathophysiology
• Filled with clear/gelatinous fluid

• Wrist (most common), dorsal foot, knee

• Rubbery, round, well-circumscribed cystic nodule
Presentation
• Transillumination positive

• Observation for asymptomatic cysts

• Needle aspiration (recurrence common)
Treatment
• Surgical excision

• Most resolve spontaneously

Prognosis
 NRE 6 AUGUST 2023
100.An elderly patient presents with a painless swelling in the groin area that increases on coughing, and the ring
occlusion test is positive. What is the likely diagnosis?
A. Direct hernia
B. Indirect hernia
C. Femoral hernia
D. Lipoma

Correct Answer: A. Direct hernia

Explanation:

The clinical presentation of a painless swelling in the groin area that increases on coughing suggests a hernia,
which is a protrusion of an organ or tissue through an opening or weak spot in the abdominal wall. A direct
hernia occurs through a weakness in the abdominal wall in the region of the inguinal (groin) canal. It may
cause a swelling that increases on coughing, but the ring occlusion test is negative. An indirect hernia occurs
when a portion of the intestine or other abdominal tissue pushes through the internal inguinal ring. It typically
presents as a swelling that increases on coughing, and the ring occlusion test is positive. In ring occlusion test
pressure is applied with the thumb on the marked point to occlude the deep inguinal ring and patient is asked
to cough. If the swelling appeared than it is positive in case of direct hernia. However, if swelling doesn’t
appear it is negative in case of indirect hernia.

101.What is the likely cause of painless per rectal bleeding in a child?

A) Perianal Fistula
B) Perianal abscess
C) Hemorrhoid
D) Meckel diverticulum

Correct Answer: D) Meckel diverticulum

Explanation:
 NRE 6 AUGUST 2023
Meckel’s diverticulum is a true diverticulum arising from the terminal ileum and is the result of persistence of
the vitello-intestinal duct. The lifetime risks of complications from Meckel’s diverticulum includes bleeding,
diverticulitis, and intussusception. The risk of bleeding is more common in children in than adults and is due to
the presence of ectopic gastric mucosa causing ulceration.
Meckel diverticulum
• Persistent vitelline (omphalomesenteric) duct
• Often contains ectopic gastric mucosa → intestinal ulceration &
Pathogenesis
bleeding

Rule of 2s:

• Presentation often by age 2 (but can occur at any age)

Epidemiology
• Usually <2 inches long
• Location within 2 feet of ileocecal valve

• May be asymptomatic (incidental finding)

• Painless rectal bleeding ± iron deficiency anemia
• Acute abdominal pain due to complications:
Clinical
o Intussusception (recurrent, atypical)
presentation
o Diverticulitis (mimics appendicitis)
o Bowel obstruction, perforation (peritoneal signs)

• Technetium-99m pertechnetate (Meckel) scan detects gastric mucosa

Diagnosis

102.Which medication lowers intraocular pressure (IOP) during acute congestive glaucoma?
A) Pilocarpine
B) Timolol
C) Mannitol
D) Latanoprost

Correct Answer: C) Mannitol

Explanation:
 NRE 6 AUGUST 2023

A patient has acute angle-closure glaucoma (ACG) presenting with headache, ocular
pain, nausea, and decreased visual acuity. ACG is characterized by narrowing or
closure of the anterior chamber angle, leading to decreased aqueous outflow and
elevated intraocular pressure (IOP). Examination findings include conjunctival
injection; corneal edema; palpable firmness of the eyeball; and a fixed, mid-dilated
pupil. The diagnosis is confirmed by gonioscopy to visualize the corneal angle and/or
tonometry to measure IOP.
Initial management is directed at rapidly lowering IOP. Combination therapy with
multiple topical agents is recommended; a typical regimen includes timolol (which
reduces aqueous production), apraclonidine (which decreases aqueous production
and increases outflow), and pilocarpine (which causes ciliary muscle contraction to
open the trabecular meshwork at the corneal angle) eye drops. In addition, oral or
intravenous acetazolamide is recommended to rapidly reduce further production of
aqueous humor. Subsequently, laser iridotomy can facilitate aqueous outflow and
provide definitive management
 NRE 6 AUGUST 2023
103.A 30-year-old man experiences indigestion, flatulence, and bloating after consuming milk. Avoiding these
products relieves his symptoms. This condition is caused by an individual's inability to digest which of the
following:
A) Fructose
B) Lactose
C) Maltose
D) Mannose

Correct Answer: B) Lactose

Explanation:
The symptoms described, such as indigestion, flatulence, and bloating after consuming milk, suggest a possible
intolerance to a specific component of milk. Lactose intolerance is the inability to digest lactose, a sugar found
in milk and dairy products. People with lactose intolerance lack the enzyme lactase needed to break down
lactose, leading to gastrointestinal symptoms such as indigestion, bloating, and flatulence when consuming
lactose-containing foods.

104.What is an indication for immediate cholecystectomy?

A) Obstructive jaundice
B) Pigment stones
C) Mucocele of gallbladder
D) Emphysematous cholecystitis

Correct Answer: D) Emphysematous cholecystitis

Explanations:
Cholecystectomy is the surgical removal of the gallbladder and is indicated for various conditions related to
gallbladder disease. Immediate cholecystectomy is often indicated in the following situations:
• Acute cholecystitis (inflammation of the gallbladder)
• Gangrenous or perforated gallbladder
• Emphysematous cholecystitis (gas-forming infection of the gallbladder)
• Biliary pancreatitis (inflammation of the pancreas due to gallstones)
• Gallstone ileus (intestinal obstruction due to a gallstone)
• Severe symptoms that do not respond to conservative management

Emphysematous cholecystitis
• Diabetes mellitus
• Vascular compromise
Risk factors
• Immunosuppression

• Fever, right upper quadrant pain, nausea/vomiting

Clinical
• Crepitus in abdominal wall adjacent to gallbladder
presentation

• Air-fluid levels in gallbladder, gas in gallbladder wall

• Cultures with gas-forming Clostridium, Escherichia coli
Diagnosis
• Unconjugated hyperbilirubinemia, mildly elevated aminotransferases

Treatment • Emergency cholecystectomy

 NRE 6 AUGUST 2023
• Broad-spectrum antibiotics with Clostridium coverage (eg, piperacillin-
tazobactam)

105.What is a compound fracture?

A) Is present if there are more than two fracture fragments
B) Is present if laceration of mucous membrane connects with fracture hematoma exposing bone
C) Is a fracture which is associated with nerve injury
D) Is a fracture which is associated with arterial injury

Correct Answer: B) Is present if laceration of mucous membrane connects with fracture hematoma exposing
bone
Explanation:
A compound fracture, also known as an open fracture, is a type of fracture where the broken bone is exposed
to the external environment through the overlying skin. Among the options provided, the correct definition of
a compound fracture is B) Is present if laceration of mucous membrane connects with fracture hematoma
exposing bone.

106.Which nerve exits from the stylomastoid foramen?

A) Facial nerve
B) Trigeminal nerve
C) Hypoglossal nerve
D) Glossopharyngeal nerve

Correct Answer: A) Facial nerve

Explanation:
The stylomastoid foramen is a small opening located on the temporal bone of the skull. The facial nerve
(cranial nerve VII) exits from the stylomastoid foramen. It is responsible for controlling the muscles of facial
expression and transmitting taste sensation from the anterior two-thirds of the tongue.

107.In a patient with pontine hemorrhage and pinpoint pupils, which artery is likely damaged?
A) Anterior cerebral artery
B) Basilar artery
C) Middle cerebral artery
D) Posterior inferior cerebellar artery

Answer: B) Basilar artery

Explanation:
Pontine hemorrhage refers to bleeding within the pons, which is part of the brainstem. The presence of
pinpoint pupils (also known as "pinpoint" or "miotic" pupils) is a neurological sign that suggests damage to
certain structures in the brainstem. The basilar artery supplies blood to the brainstem, including the pons.
Damage to the basilar artery can result in pontine hemorrhage and may lead to pinpoint pupils.
Pontine lesions lead to extreme bilateral miosis (<1 mm), with preservation of the pupillary light reflex, which
is very hard to perceive. Pinpoint pupils due to pontine hemorrhages may result from sympathetic pathway
 NRE 6 AUGUST 2023
lesions and irritation of parasympathetic pathways

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108.A woman presenting with abdominal pain, fever, weight loss, tender nodules on shin, tender iliac fossa, vague
right mass, and mouth ulcers, along with a history of on and off bloody diarrhea, is likely to be diagnosed with:
A) Crohn's disease
B) Ulcerative colitis
C) Diverticulitis
D) Ileocecal tuberculosis

Answer: A) Crohn's disease

Explanation:
The symptoms and clinical presentation described are suggestive of an inflammatory bowel disease (IBD).
Crohn's disease is a type of IBD that can affect any part of the gastrointestinal tract. It commonly presents
with abdominal pain, fever, weight loss, mouth ulcers, and diarrhea. The presence of tender nodules on the
shin (erythema nodosum) and a vague right mass are consistent with Crohn's disease. Crohn's disease can also
involve the ileocecal region.
Inflammatory bowel disease subtype characteristics
Crohn disease Ulcerative colitis
• Anywhere mouth to anus (mostly
ileum & colon) • Rectum (always) & colon
Involvement • Perianal disease with rectal sparing • Continuous lesions
• Skip lesions
 NRE 6 AUGUST 2023
• Noncaseating granulomas • No granulomas
Microscopy

• Transmural inflammation • Mucosal & submucosal

Gross • Linear mucosal ulcerations inflammation
findings • Cobblestoning, creeping fat • Pseudopolyps

• Abdominal pain (varying

• Abdominal pain (often RLQ)
Clinical locations)
• Watery diarrhea (bloody if colitis)
manifestations • Bloody diarrhea

• Fistulae, abscesses
Intestinal • Toxic megacolon
• Strictures (bowel obstruction)
complications

RLQ = right lower quadrant.

109.A 60-year-old individual with difficulty in reading a newspaper and blurred vision likely has:
A) Hypermetropia (Hyperopia)
B) Macular degeneration
C) Myopia (Nearsightedness)
D) Presbyopia

Correct Answer: D) Presbyopia

Explanation:
The symptoms described suggest changes in visual acuity that often occur with age. Presbyopia is an age-
related condition where the natural lens of the eye loses its flexibility, leading to difficulty focusing on close
objects. This condition is known to cause difficulty in reading small print or performing close-up tasks, which
aligns with the symptoms described.

110.An 8-year-old boy with a habit of scratching his nose frequently is found to have a bleed seen on the nose upon
examination.
A) Little area
B) Bridge area
C) Nostril area
D) Upper area

Correct Answer; A) Little area

Explanation:
The description suggests that the bleeding seen on the nose is a result of the boy's habit of scratching.
"Little area" likely refers to a small or localized portion of the nose. It contains Kiesselbach plexus which is
 NRE 6 AUGUST 2023
an anastomosis of four arteries (anterior ethmoidal artery, sphenopalatine artery, greater palatine artery,
and superior labial artery) located in the anteroinferior portion of the nasal septum (Little area).

111.Growth hormone increases:

A) Exercise
B) Hyperglycemia
C) Obesity
D) Aging

Correct Answer: A) Exercise

Explanation:
Growth hormone (GH) is a hormone produced by the pituitary gland that plays a crucial role in growth, cell
repair, and metabolism. One of the factors that can stimulate the release of growth hormone is exercise.
Physical activity, especially high-intensity exercise, can lead to an increase in growth hormone secretion. This
hormone promotes tissue growth, protein synthesis, and fat metabolism, which are beneficial effects of
 NRE 6 AUGUST 2023
exercise.

112.Tingling and numbness sensation in the thenar region may be due to:
A) Median nerve damage
B) Axillary nerve damage
C) Brachial nerve damage
D) Radial nerve damage

Correct Answer: A) Median nerve damage

Explanation:

Tingling and numbness sensations in the thenar region, which is the area on the palm of the hand near the
thumb, can be indicative of nerve involvement. The median nerve supplies the muscles and skin of the thenar
eminence. Damage to the median nerve can lead to symptoms such as tingling and numbness in this region, as
 NRE 6 AUGUST 2023
seen in carpal tunnel syndrome.

Carpal tunnel syndrome

• Obesity
• Pregnancy
• Diabetes
Risk factors • Hypothyroidism
• Rheumatoid arthritis
• End-stage renal disease/hemodialysis

• Pain & paresthesia in median nerve distribution (first 3½

digits)
• Positive Phalen test & Tinel sign
Clinical presentation
• Severe disease: weakness of thumb abduction & opposition,
atrophy of thenar eminence

• Nerve conduction studies

Confirmatory test

• Wrist splinting
• Glucocorticoid injection
Treatment
• Surgery for severe or refractory symptoms

113.A patient with a dog bite and no history of vaccination in the past 10 years requires the following next steps in
addition to first aid:
A) TT (Tetanus Toxoid)
B) Immunoglobulin (Rabies Immunoglobulin)
C) Immunoglobulin plus TT
D) None of these

Correct Answer: C) Immunoglobulin plus TT

 NRE 6 AUGUST 2023
Explanation:

114.A patient who underwent an appendectomy 4 days ago is now presenting with purulent discharge at the
incision site. This is most likely indicative of:
A) Surgical site infection
B) Appendicular abscess
C) Peritonitis
D) Adenitis

Correct Answer: A) Surgical site infection

Explanation:
After surgery, especially abdominal surgery like an appendectomy, it's important to monitor for signs of
infection or complications. This is a common complication after surgery especially with its one week.
Symptoms may include pain, redness, swelling, warmth, and purulent discharge at the incision site.
Appendicular abscess may be considered but duration of 4 days make it less likely.
 NRE 6 AUGUST 2023

115.The best method for obtaining a urine specimen is:

A) Midstream
B) By Catheter
C) Percutaneous catheterization
D) By urethra

Correct Answer: A) Midstream

Explanation:
When obtaining a urine specimen, the method used depends on the clinical situation and the purpose of the
test. This method involves collecting urine midstream during the act of voiding. It helps reduce contamination
and is often used for routine urine tests.

116.In a case of hematuria, lumbar mass, and pain, the most appropriate imaging study to further evaluate the
condition is:
A) CT with IV contrast
B) IV pyelogram
C) Oral contrast
D) US (ultrasound)

Correct Answer: A) CT with IV contrast

 NRE 6 AUGUST 2023
Explanation:

RCC is classically associated with the triad of flank pain, hematuria, and a
palpable abdominal mass, <10% of patients have all 3 of these symptoms.
Patients with suspected RCC usually require abdominal CT with and without contrast
for further evaluation followed by staging imaging (eg, CT chest)
Adults age >40 who have painless hematuria require prompt investigation for bladder
cancer when no evidence of infection (eg, dysuria, pyuria, bacteriuria), GN (eg, RBC
casts, dysmorphic RBCs), or nephrolith are present. The gold-standard initial test is
urinary cystoscopy, which allows direct visualization of the bladder wall and biopsy of
suspicious masses. Abdominal CT is then generally necessary for staging.

117.In a case of a building fall with blood at the urethral meatus, pubic bone fracture, and inability to pass urine, the
most likely diagnosis is:
A) Urethral injury
B) Bladder injury
C) Crushing injury
D) Kidney injury

Correct Answer: A) Urethral injury

 NRE 6 AUGUST 2023
Explanation: uretheral injury

118.A middle-aged man with a frequent history of heartburn presents with generalized abdominal pain while
undergoing treatment for osteoarthritis. On examination, there is tenderness and rigidity. X-ray reveals gas
under the diaphragm. The most likely cause is:
A) Peptic ulcer perforation
B) Typhoid perforation
C) Cirrhosis
 NRE 6 AUGUST 2023
D) Pericarditis

Correct Answer: A) Peptic ulcer perforation

Explanation:

Gas under the diaphragm on X-ray is a characteristic finding in cases of perforated viscus. Based on the
symptoms described (heartburn, abdominal pain, tenderness, rigidity, gas under the diaphragm), the most
likely cause is A) Peptic ulcer perforation. Peptic ulcers can lead to perforation, allowing gas to escape into the
abdominal cavity and cause free gas under the diaphragm

119.Lower limb amputation is followed by complications with crepitations. The reason is:
A. Gas gangrene
B. Secondary hemorrhage
C. Pseudomonas Infection
D. Chlamydia Infection

Correct Answer: A. Gas Gangrene

Explanation:
Subcutaneous bacterial invasion may lead to cellulitis or, in the case of Clostridium
perfringens, gas gangrene with myonecrosis. However, cellulitis is typically
characterized by skin warmth and gas gangrene is characterized by crepitus
Gas gangrene is a serious and potentially life-threatening infection caused by certain types of bacteria, most
commonly Clostridium species. This infection produces gas within tissues, leading to the characteristic
 NRE 6 AUGUST 2023
crepitations (crackling sound) when the affected area is touched or manipulated. Gas gangrene can develop
after surgical procedures, including amputations, if bacteria contaminate the surgical site.
120.Premenstrual cycle pain and lower abdominal discomfort, along with mood changes, are commonly associated
with the:
A. Follicular phase
B. Mid-ovulatory phase
C. Luteal phase
D. Menstruation

Correct Answer: C. luteal phase

Explanation:
Premenstrual syndrome
(PMS) is the most common physical manifestations of PMS are bloating, fatigue, headaches, hot flashes, and
breast tenderness. Affective symptoms may include anxiety, mood swings, difficulty concentrating, decreased
libido, and irritability.A symptom diary over 2 menstrual cycles should demonstrate recurrence of symptoms
during the luteal phase (1-2 weeks prior to menses) and resolution during the follicular phase (onset of
menses or a few days thereafter)
If the symptom pattern is consistent with the luteal phase of the menstrual cycle, selective serotonin reuptake
inhibitors are the first-line treatment and can be given daily or limited to only the luteal phase. Combined
(estrogen/progestin) oral contraceptives are another treatment option and work by causing anovulation
Premenstrual syndrome (PMS) refers to a collection of physical and emotional symptoms that many
individuals experience in the days leading up to their menstrual period. These symptoms can include lower
abdominal discomfort, pain, bloating, breast tenderness, and mood changes such as irritability, anxiety, and
mood swings.

Premenstrual syndrome and

premenstrual dysphoric disorder

• Symptoms occur during luteal phase
• Physical: bloating, fatigue, headaches, hot flashes, breast tenderness
Clinical
• Affective: anxiety, irritability, mood swings, decreased interest; more severe in
features
premenstrual dysphoric disorder

• Symptom/menstrual diary
Evaluation

• Selective serotonin reuptake inhibitor

Treatment

121.Thick white vaginal discharge is seen in:

A. Candidiasis
B. Bacterial vaginosis
C. Pelvic inflammatory disease
D. Trichomoniasis

Correct Answer: A. Candidiasis

Explanation:
 NRE 6 AUGUST 2023
Thick white vaginal discharge is a common symptom of candidiasis, which is a fungal infection caused by an
overgrowth of Candida species, typically Candida albicans. This type of discharge is often described as "cottage
cheese-like" in appearance and may be accompanied by itching, redness, and irritation of the vaginal area.

Bacterial vaginosis, on the other hand, is characterized by a thin, grayish-white discharge with a distinct "fishy"
odor. Trichomoniasis is associated with a frothy, greenish-yellow vaginal discharge that may be accompanied
by itching and discomfort. Pelvic inflammatory disease (PID) may cause a variety of symptoms, including pelvic
pain, fever, and foul-smelling vaginal discharge, but it is not specifically associated with a thick white
discharge.

122.What is the recommended treatment for status asthmaticus?

A. Nebulization with beta2 agonist.
B. Nebulization with beta agonist and additional medication.
C. Testing nebulized albuterol and clenil, along with ventilation.
D. None of these.

Correct Answer: B. Nebulization with beta agonist and additional medication

Explanation:
Severe asthma exacerbation requires SABAs, ipratropium nebulizer,
and systemic corticosteroids. Adding ipratropium to SABAs may cause
greater bronchodilation than either agent alone and is recommended during
emergency department care of severe exacerbations. Systemic
glucocorticoids (oral or intravenous) increase the rate of symptomatic
improvement, but their beneficial effects are not clinically apparent for
 NRE 6 AUGUST 2023
several hours after administration. Additional bronchodilation with a onetime infusion of IV magnesium sulfate
is also recommended

Features of respiratory failure in acute asthma

• Absent/minimal wheezing (poor air movement → silent chest)
• Accessory muscle use
Clinical features
• Altered mental status

• ABG*: poor ventilation (↑ PaCO2 & ↓ pH), poor oxygenation (↓ PaO2)

• Lactate: transient ↑ due to muscle WOB (type A) &/or β-agonist–
Laboratory
induced (type B)
findings
• K+: transient ↓ due to β-agonist &/or respiratory alkalosis

• Nebulized albuterol & ipratropium, IV corticosteroids ± IV magnesium

• Short trial (<2 hr) of NIPPV
Management
• Low threshold for intubation & invasive mechanical ventilation

*Impending respiratory failure: ↑↑ respiratory effort to maintain normal/borderline PaCO2 & pH.

ABG = arterial blood gases; IV = intravenous; NIPPV = noninvasive positive pressure ventilation;
WOB = work of breathing.

123.What is the cause of Type 1 diabetes in a child?

 NRE 6 AUGUST 2023
A. Decreased glucose uptake by peripheral tissues.
B. High serum potassium (k).
C. High insulin levels.
D. Autoimmune T-cell–mediated destruction of β cell

Correct Answer: D. Autoimmune T-cell–mediated destruction of β cell

Explanation:

124.How should an older patient with sigmoid colon cancer (Ca) be diagnosed?

A. Proctosigmoidoscopy plus biopsy.

B. ESR (Erythrocyte Sedimentation Rate).
C. CYTOSCOPY
D. Ultrasound (US).

Correct Answer: A. Proctosigmoidoscopy plus biopsy.

Explanation:

Sigmoid colon cancer (colorectal cancer) is typically diagnosed through a combination of imaging and tissue
biopsy. In this context, a proctosigmoidoscopy, which is a procedure used to examine the lower part of the
colon and rectum, can provide direct visualization of the tumor and adjacent tissues. A biopsy can be taken
during this procedure to confirm the diagnosis by examining the tissue sample under a microscope. This
approach allows for accurate staging and determination of the type and extent of the cancer.

125.A 5-year-old boy presents with pancytopenia, petechial rash, and hypocellular bone marrow. What is the most
likely diagnosis?
A. Aplastic Anemia.
B. Acute Lymphoblastic Leukemia (ALL).
C. Acute Myeloid Leukemia (AML).
D. Chronic Lymphocytic Leukemia (CLL).

Correct Answer: A. Aplastic Anemia.

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Explanation:APLASTIC ANEMIA is a

Aplastic anemia is a condition characterized by bone marrow failure, resulting in a reduction in the
production of all blood cell types (pancytopenia). The hypocellular bone marrow means that the bone marrow
is not producing enough blood cells. The petechial rash may occur due to a low platelet count, which is a
common feature of aplastic anemia. This condition can lead to anemia (low red blood cells), leukopenia (low
white blood cells), and thrombocytopenia (low platelets).

126.What is the primary cause of tennis elbow?

A. Extensor carpi ulnaris.

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B. Extensor carpi radialis.
C. Flexor carpi ulnaris.
D. Flexor carpi radialis.

Correct Answer: B. Extensor carpi radialis.

Explanation: Tennis elbow, also known as lateral epicondylitis, is a painful condition that occurs due to
overuse and strain of the forearm muscles and tendons that attach to the lateral epicondyle of the humerus
(the bony bump on the outer part of the elbow). The extensor carpi radialis brevis tendon, which attaches to
the lateral epicondyle, is the primary tendon involved in tennis elbow. Repetitive motions involving the wrist
and forearm, such as gripping and twisting activities, can lead to microtears and inflammation in this tendon,
resulting in the characteristic pain on the outer part of the elbow.

Lateral epicondylitis
• Repetitive, forceful overuse of wrist & digit extensors
Pathophysiology • Angiofibroblastic tendinosis of extensor tendons at lateral epicondyle

• Insidious pain; onset weeks to months

Clinical • Pain 1 cm distal to lateral epicondyle
presentation • Pain elicited by resisted wrist extension & passive wrist flexion

• Diagnosis based on clinical presentation

• Musculoskeletal ultrasound for doubtful cases
Management • Initial treatment: activity modification, counterforce bracing/strap
• Refractory symptoms: short-term NSAIDs, corticosteroid injection, surgery

NSAIDs = nonsteroidal anti-inflammatory drugs.

127.What is the term for the amount of hemoglobin per 100 ml of blood?

A. MHC (Mean Hemoglobin Concentration).

B. MCHC (Mean Corpuscular Hemoglobin Concentration).
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C. Hematocrit (Hct) or Hematocratic Index.
D. Reticulocyte.

Correct Answer: B. MCHC (Mean Corpuscular Hemoglobin Concentration).

Explanation: MCHC stands for Mean Corpuscular Hemoglobin Concentration. It represents the average
concentration of hemoglobin in a given volume of packed red blood cells. MCHC is typically expressed as a
percentage or in grams per deciliter (g/dL) and is used as a measure of the concentration of hemoglobin
within red blood cells. It provides information about the color and hemoglobin content of individual red
blood cells.

128.What dietary approach is recommended for individuals with liver cirrhosis?

A. Low protein.
B. High protein.
C. Low fiber.
D. High fiber.

Correct Answer: B. High protein.

Explanation: Individuals with liver cirrhosis often require a diet that includes an adequate intake of high-
quality protein. Protein is important for maintaining muscle mass, supporting immune function, and
preventing malnutrition. Liver cirrhosis can lead to protein deficiency due to impaired protein synthesis by
the damaged liver. Therefore, a diet containing sufficient high-quality protein helps prevent protein
malnutrition and muscle wasting.

129.Warfarin has caused gum bleeding. Which lab test should be ordered to assess the effects of warfarin?

A. PT (Prothrombin Time).
B. PTT (Partial Thromboplastin Time).
C. BT (Bleeding Time).
D. OC (Osmotic Fragility Test).
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Correct Answer: A. PT (Prothrombin Time).

Explanation:

Warfarin is an anticoagulant medication that interferes with the production of certain clotting factors in the
blood. To assess the effects of warfarin and its impact on the clotting cascade, the Prothrombin Time (PT) is
commonly used. PT measures the time it takes for blood to clot and is used to monitor the effects of
medications like warfarin. If the PT is prolonged, it indicates that the blood's ability to clot is compromised,
which can lead to bleeding tendencies, such as gum bleeding.

130.A 35-year-old individual with a family history of breast cancer is seeking advice for screening. What is the
recommended approach?

A. Mammography every year.

B. Reassurance.
C. Self-examination.
D. MRI every year.

Correct Answer: D. MRI every year.

Explanation:
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131.What are the characteristic findings on arterial blood gas (ABG) analysis for type 2 respiratory failure?

A. Hyperoxemia.
B. Hypocarbia.
C. Hypercarbia.
D. Normoxia.

Correct Answer: C. Hypercarbia.

Explanation: Definition: In Type 2 respiratory failure, there's a failure to effectively remove carbon dioxide
from the blood, resulting in high levels of carbon dioxide (hypercapnia).
Cause: It often arises from conditions that impair the respiratory drive or the ability of the lungs to adequately
expel carbon dioxide, such as chronic obstructive pulmonary disease (COPD), neuromuscular disorders, or
severe asthma.
Oxygen: Oxygen levels in the blood may be low (hypoxemia) due to ventilation-perfusion imbalances caused
by inefficient breathing.
Clinical Signs: Slow and shallow breathing, confusion, drowsiness, and signs of increased work of breathing.
Type 1 respiratory failure primarily involves inadequate oxygenation, while Type 2 respiratory failure
involves ineffective carbon dioxide elimination. Both types can have serious health implications and require
medical attention to address the underlying causes and provide appropriate respiratory support.
Type 1 respiratory failure: Inadequate oxygen exchange, low blood oxygen. Common in conditions affecting
oxygenation.
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Type 2 respiratory failure: Poor carbon dioxide removal, high blood carbon dioxide. Linked to conditions
impairing lung function or respiratory drive.
132.Isoniazid causing peripheral neuropathy is prevented by which drug?

A. Niacin.
B. Pyridoxine.
C. B3.
D. Vitamin A.

Correct Answer: B. Pyridoxine (Vitamin B6).

Explanation:

Isoniazid (INH) is a medication commonly used in the treatment of tuberculosis. However, it can cause
peripheral neuropathy as a side effect, particularly due to its potential to deplete the body of Vitamin B6
(pyridoxine). Vitamin B6 is essential for maintaining nerve health and function.

Supplementing with pyridoxine (Vitamin B6) can help prevent or alleviate the peripheral neuropathy
associated with isoniazid therapy. Therefore, option B, Pyridoxine, is the correct answer.

133.A man is brought to the emergency room after an accident. His heart rate is 100 beats per minute, and his
blood pressure is 90/80 mmHg. Which fluid should be administered?
A. Ringer's lactate.
B. Normal saline.
C. 5% dextrose (D5W).
D. None of the above.

Correct Answer: A. Ringer's lactate.

Refrence kaplan surgery,NLE MOCK TEST REPEATED MCQ

134.The most sensitive and widely acceptable indicator of health status among the options provided is:
A. Infant Mortality rate (IMR)
B. Under 5 mortality rate
C. Maternal mortality rate
D. Crude mortality rate

Correct Answer: B. Under 5 mortality rate

Explanation:
The Under 5 mortality rate (also known as Under-5 child mortality rate or U5MR) is a crucial indicator of the
overall health and well-being of a population, particularly in terms of child health. It represents the
probability of a child dying before reaching the age of 5 years per 1,000 live births. This indicator takes into
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account child deaths from all causes and is sensitive to changes in health conditions, healthcare access, and
socioeconomic factors.

While each of the indicators listed (IMR, Under 5 mortality rate, Maternal mortality rate, Crude mortality rate)
provides valuable insights into different aspects of health and mortality, the Under 5 mortality rate is often
considered a sensitive measure that reflects the health status of children and the overall progress in
healthcare and social development within a population.

135.A soldier participating in a prolonged parade develops decreased urine output, elevated serum creatinine, and
hematuria on urine analysis, but red blood cell casts are absent on microscopy. What is the likely diagnosis?
A. Rhabdomyolysis
B. Sickle cell disease
C. Systemic lupus erythematosus
D. Alport syndrome

Correct Answer: A. Rhabdomyolysis

Explanation:
Rhabdomyolysis results from excessive skeletal muscle breakdown following injury or intense exertion. It
causes myoglobinuria, which appears grossly similar to hematuria and is mistakenly detected as blood on
urinalysis. However, it is not true hematuria and no red blood cells are present on urine microscopy.
Rhabdomyolysis is a condition characterized by the breakdown of muscle tissue, leading to the release of
myoglobin and other muscle cell components into the bloodstream. Myoglobin can cause kidney damage and
result in acute kidney injury (AKI), leading to decreased urine output and elevated serum creatinine levels.
Hematuria (blood in the urine) can occur as a result of myoglobin-induced kidney injury.

The absence of red blood cell (RBC) casts on urine microscopy is a key distinguishing factor. RBC casts are
typically seen in glomerulonephritis and other forms of renal damage, but they are not present in
rhabdomyolysis.Prolonged physical exertion, such as participating in a prolonged parade, can lead to muscle
breakdown and rhabdomyolysis, especially in hot and strenuous conditions. Treatment involves addressing
the underlying cause, aggressive fluid hydration to prevent kidney damage, and monitoring kidney function.

136.The most appropriate initial pulmonary investigation by a thoracic surgeon before surgery is:
A. Chest X-ray
B. HRCT
C. D-Dimer
D. Ultrasound

Correct Answer: A. Chest X-ray

Explanation: Chest X-ray is the initial modality for thoracic surgeons before proceeding for surgery.

137.What is triple therapy for H. Pylori infection?

A. Lansoprazole + Amoxicillin + Clarithromycin
B. Metronidazole + Paromomycin + Ceftriaxone
C. Amoxicillin + Paromomycin + Ceftriaxone
D. Doxycycline + Paromomycin + Ceftriaxone

Correct Answer: A. Lansoprazole + Amoxicillin + Clarithromycin

Explanation:
Triple therapy for H. pylori infection typically consists of a proton pump inhibitor (PPI) such as lansoprazole,
along with two antibiotics: amoxicillin and clarithromycin. This combination aims to target and eradicate the
Helicobacter pylori bacteria, which is associated with stomach ulcers and gastritis. The PPI helps reduce
stomach acid production, which creates a more favorable environment for the antibiotics to work effectively
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against the bacteria. This triple therapy regimen is a common and effective treatment approach for H. pylori
infection.

138.A 20-year old girl presented in gynae clinic with complain of irregular menstrual cycle for one year followed by
amenorrhoea of 3 months. On examination she is obese, has oily skin and mildly excessive hair growth on upper
lip and chin. Her genitalia is well estrogonized. Her serum prolactin is borderline raised and random blood sugar
is 200mg%. Serum FSH and LH are within normal range. Ultrasound shows multiple cysts in both ovaries of small
size. The most likely diagnosis is:
A. Diabetes mellitus
B. Polycystic ovarian syndrome
C. Premature ovarian failure
D. Hyperthyroidism

Correct Answer: B. Polycystic ovarian syndrome

Explanation:
Explanation: Polycystic Ovarian Syndrome
Clinical features: Menstrual irregularities, oligomenorrhea, infertility, menorrhagia, hirsutism, acne,
acanthosis nigricans.
Diagnosis: Rotterdam criteria (anovulation, polycystic ovary on USG, testosterone increased.)
Treatment; combined oral contraceptive pills, metformin, Weight loss, surgical treatments (ovarian drilling,
laser, electrolysis.)
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139.The drug of choice (DOC) for a child with petit mal seizures is:
A. Valproate
B. Ethosuximide
C. Phenytoin
D. Carbamazepine

Correct Answer: B. Ethosuximide

Explanation:
Ethosuximide is the drug of choice (DOC) for the treatment of absence seizures, also known as petit mal
seizures. Absence seizures are a type of generalized seizure characterized by brief episodes of staring and
temporary loss of awareness.

140.What is recommended age for biopsy given a women have abnormal menstrual bleeding?
A. <35
B. >35
C. >50
D. ≥45

Answer: D. ≥45
Explanation:
Endometrial biopsy indications
• Abnormal uterine bleeding
Age >45 • Postmenopausal bleeding

Abnormal uterine bleeding PLUS:

• Unopposed estrogen (obesity, anovulation)

Age <45
• Failed medical management
• Lynch syndrome (hereditary nonpolyposis colorectal cancer)

• Atypical glandular cells on Pap test

Age >35

141.The hormone that causes ovulation is:

A. FSH
B. LH
C. Estrogen
D. Progesterone

Answer: B. LH
Explanation:
Ovulation is a key event in the menstrual cycle of a woman's reproductive system. It involves the release of a
mature egg (ovum) from the ovary, which is then available for fertilization by sperm. The surge of
luteinizing hormone (LH) triggers ovulation.

LH is produced by the anterior pituitary gland in response to increasing levels of another hormone called
estrogen, which is primarily secreted by the ovaries. During the menstrual cycle, estrogen levels rise in the first
half of the cycle, leading to the development of the egg-containing follicles in the ovary. As the dominant
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follicle matures, it produces increasing amounts of estrogen. When estrogen levels reach a certain
threshold, it triggers a surge in LH secretion. This LH surge is the hormonal signal that triggers the release of
the mature egg from the ovary, leading to ovulation.

142.Mood swings during the menstrual cycle are most commonly associated with the:
A. Follicular phase
B. Mid-ovulatory phase
C. Secretory phase
D. Luteal phase

Correct Answer. D. Luteal phase

Explanation:
The menstrual cycle consists of several distinct phases, including the follicular phase, ovulatory phase, luteal
phase, and menstrual phase. The luteal phase, which occurs after ovulation and before menstruation, is often
linked to mood swings, irritability, and emotional changes.
During the luteal phase, the corpus luteum (the structure that forms from the follicle after ovulation)
produces progesterone in preparation for a potential pregnancy. While progesterone plays a vital role in
maintaining the uterine lining and supporting pregnancy, its effects on the central nervous system can also
lead to mood changes and irritability in some individuals. This is sometimes referred to as premenstrual
syndrome (PMS) or premenstrual dysphoric disorder (PMDD).
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