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Q1
During a thyroidectomy, the surgeon accidentally ligates an artery that provides the primary blood supply to the posterior aspect of the thyroid gland. Which artery is this?
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Q2
A 50-year-old woman presents with a fractured neck of the femur following a minor fall. Which arterial structure is at greatest risk of injury in this scenario?
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Q3
In the adrenal medulla, which neurotransmitter is synthesized and stored in secretory granules of chromaffin cells?
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Q4
During the 4th week of development, the embryonic disc undergoes folding. Which process is primarily responsible for the formation of the C-shaped curvature of the embryo?
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Q5
Acute hyperventilation leads to which primary acid-base disturbance?
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Q6
Which of the following best describes the role of the myelin sheath in saltatory conduction?
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Q7
Which enzyme is responsible for the conversion of pyruvate to oxaloacetate, providing a critical entry point for gluconeogenesis?
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Q8
A patient's serum chemistry: Na 140 mEq/L, Cl 100 mEq/L, HCO3- 18 mEq/L. What is the anion gap?
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Q9
A patient with chronic schizophrenia presents with extrapyramidal symptoms, specifically acute dystonia. Which of the following medications is most effective for the immediate reversal of these symptoms?
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Q10
A patient with chronic heart failure and chronic kidney disease develops a dry cough while on an ACE inhibitor. Which alternative drug provides similar renoprotective benefits?
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Q11
Prolonged ischemia leads to hypoxic cell injury mainly by depletion of which high-energy molecule, causing failure of ion pumps?
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Q12
A peripheral blood smear in megaloblastic anemia due to vitamin B12 deficiency typically shows:
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Q13
A 50-year-old female with hypothyroidism has an elevated TSH. Which of the following laboratory patterns is most consistent with primary hypothyroidism?
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Q14
What is the drug of choice for visceral leishmaniasis (kala-azar) in Nepal according to national guidelines?
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Q15
A 45-year-old man with a history of anaphylaxis to peanuts receives an epinephrine autoinjector. Which immunological mechanism does epinephrine counteract during an anaphylactic reaction?
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Q16
A screening test has sensitivity 90% and specificity 80%. If the disease prevalence in the screened population is 10%, what is the approximate positive predictive value (PPV)?
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Q17
The National Cancer Control Programme of Nepal recommends screening for which cancer in women aged 30 - 45 years?
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Q18
Which of the following is the most appropriate method to assess household indoor air pollution from biomass cooking fuels?
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Q19
Regarding HIV status confidentiality in Nepal, which statement is true?
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Q20
Which of the following heavy metal poisonings is most associated with a line dermatitis along the gum margins and Mees' lines on the nails?
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Q21
A patient with type 1 diabetes presents with polyuria, vomiting, Kussmaul respirations and abdominal pain. Which serum electrolyte abnormality is most likely?
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Q22
A patient with a history of atrial fibrillation presents with an acute right-sided weakness. Which anticoagulant is preferred for secondary stroke prevention in this setting?
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Q23
Which of the following is the most appropriate long-term prophylaxis for a patient with recurrent urticaria due to chronic spontaneous urticaria?
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Q24
A 28-year-old male presents with acute cocaine intoxication, chest pain, and hypertension (BP 180/110 mmHg). Which medication should be avoided in his acute management?
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Q25
A 38-year-old woman presents with a 2 cm solitary thyroid nodule that is solid on ultrasound, hypoechoic, with irregular margins, and a fine-needle aspiration report of Bethesda category V. What is the most appropriate next step?
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Q26
A 70-year-old man presents with a pulsatile neck mass and a bruit on auscultation. Duplex ultrasonography shows a 75 % stenosis of the left internal carotid artery. What is the recommended surgical management?
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Q27
During the intrapartum period, which fetal monitoring method is recommended for low-risk pregnancies in Nepalese primary health centers?
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Q28
Which of the following drugs is contraindicated for the treatment of hyperemesis gravidarum?
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Q29
A 28-year-old woman presents with secondary amenorrhea for 6 months and infertility. Her serum FSH is 30 IU/L, LH is 25 IU/L, and estradiol is low. Which of the following is the most likely diagnosis?
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Q30
A newborn is born at 38 weeks gestation, weighing 2.3 kg, with a temperature of 35.5°C. Which measure is most effective to prevent hypothermia in this infant?
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Q31
A 4-month-old infant is exclusively breastfed but shows pallor and lethargy. Laboratory tests reveal hemoglobin 9 g/dL. What is the most likely cause?
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Q32
A 2-year-old child with diabetic ketoacidosis (DKA) presents with a blood glucose of 350 mg/dL and severe dehydration. What is the initial fluid of choice?
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Q33
What is the most appropriate surgical technique for a mature cataract in a typical Nepalese setting?
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Q34
A 50-year-old male with hypertension presents with recurrent anterior epistaxis. On examination, the nasal vestibule shows telangiectatic vessels. Which of the following is the most likely associated systemic condition?
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Q35
A 45-year-old man presents with a slowly enlarging, pearly nodule with telangiectasias on the lower lip. What is the most likely diagnosis?
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Q36
A 45-year-old woman presents with knee pain and swelling after repetitive movement. Arthroscopy reveals a loose disc fragment in the medial compartment. Which diagnosis is most likely?
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Q37
Which drug is most effective for reversing neuromuscular blockade caused by non-depolarizing agents in the operating theatre?
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Q38
In a forensic autopsy, which finding would most strongly suggest that death occurred while the heart was still beating?
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Q39
During a sudden choking episode, an adult loses consciousness. What is the next step in management?
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Q40
A 22-year-old woman undergoing breast surgery under general anesthesia receives nitrous oxide and sevoflurane. Which of the following is the most likely cause of postoperative nausea and vomiting in this patient?
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Q41
Which hormone is primarily responsible for decreasing serum calcium levels?
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Q42
A 35-year-old woman on oral contraceptive pills is prescribed phenytoin for seizure control. She subsequently reports missed periods and an unplanned pregnancy. What is the most likely mechanism of this interaction?
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Q43
A 14-year-old girl is brought for examination after alleged sexual assault. The most important medicolegal consideration is:
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Q44
A patient on category I DOTS therapy for pulmonary TB develops jaundice with serum bilirubin 5 mg/dl and transaminases 10× ULN at 6 weeks of treatment. Which is the most appropriate next step?
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Q45
According to the IMCI protocol, the first-line oral antibiotic for a child with non-severe pneumonia (fast breathing only) is:
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Q46
Loss of taste sensation from the posterior one-third of the tongue is caused by injury to which cranial nerve?
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Q47
In a healthy adult male, what proportion of total body water is intracellular?
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Q48
Which cell type is primarily responsible for the production of antithrombin III?
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Q49
A 34-year-old woman with a suspected mitochondrial myopathy has a heteroplasmic point mutation in the mitochondrial tRNA^Leu(UUR) gene. Which of the following statements best describes the concept of heteroplasmy?
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Q50
Which of the following best describes the 'Loading Dose' of a drug?
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Q51
Which histologic feature is characteristic of hypersensitivity pneumonitis (extrinsic allergic alveolitis)?
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Q52
Which of the following statements regarding 'Pasteurization' is correct?
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Q53
The infant mortality rate (IMR) in a district is reported as 38 per 1,000 live births. If there were 2,500 live births in a year, how many infant deaths occurred?
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Q54
In a focus group discussion conducted to explore community perceptions of a new vaccine, the moderator's role is to:
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Q55
A patient with chronic liver disease develops flapping tremor, altered sensorium, and asterixis after a large upper GI bleed. Serum ammonia is elevated. The first-line agent to reduce ammonia production from the gut is:
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Q56
Which of the following is NOT a contraindication to insertion of a copper IUD?
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Q57
A 6-month-old infant is found to have recurrent seizures, severe developmental delay, and a "happy puppet" facial appearance. Molecular testing shows a loss-of-function mutation in the maternally derived UBE3A gene. Which syndrome does this represent?
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Q58
A 30-year-old man presents with multiple small, flesh-colored papules each having a central umbilicated core on his forearms and trunk, some of which regress spontaneously. What is the most likely diagnosis?
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Q59
Which inhalational anesthetic has the lowest blood/gas partition coefficient, providing the fastest emergence from anesthesia?
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Q60
A patient develops serum-sickness-like symptoms ten days after antitoxin administration. Which hypersensitivity type is responsible?
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Q61
At what age is the first dose of rotavirus vaccine administered under Nepal's Expanded Programme on Immunization (EPI)?
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Q62
A woman delivers vaginally and the placenta fails to separate after gentle cord traction. The uterus is firm and the patient is stable. What is the next best step?
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Q63
At what age is the Japanese encephalitis vaccine administered in Nepal?
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Q64
A 22-year-old female presents with progressive fatigue, hair loss and a pale appearance. Laboratory results: Hb 9.5 g/dL, MCV 115 fL, serum vitamin B12 80 pg/mL (normal 200-900), serum folate 12 ng/mL (normal >4). Which of the following is the most appropriate initial therapy?
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Q65
A 35-year-old patient presents with suspected methanol poisoning. Laboratory findings show a severe anion gap metabolic acidosis and visual disturbances. Which of the following is the preferred antidote for this condition?
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Q66
Which of the following is the most appropriate immediate management for a patient presenting with a ruptured abdominal aortic aneurysm (AAA) and hemodynamic instability?
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Q67
A 30-year-old pregnant woman with known antiphospholipid syndrome presents at 10 weeks gestation. Which prophylactic therapy should be started to reduce the risk of recurrent miscarriage?
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Q68
Which description best reflects the pattern of linear growth velocity during the first year of life?
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Q69
Which clinical scenario is most likely to impair the ventilatory response to hypoxemia?
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Q70
Metaplasia is best defined as:
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Q71
A 7-kg infant with acute gastroenteritis presents with moderate dehydration. According to the WHO Plan C, what is the total volume of isotonic crystalloid to be given in the first hour?
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Q72
A 28-year-old woman with schizophrenia on clozapine presents with sore throat, fever, and leukopenia (WBC 2.0 ×10⁹/L). What is the most appropriate next step?
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Q73
A 48-year-old man undergoes intramedullary nailing for a femoral shaft fracture. Post-operatively, he complains of thigh pain aggravated by weight bearing and a sensation of "clicking" in the hip. Which complication is most likely?
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Q74
Blood cultures from a patient with intra-abdominal infection grow gram-positive cocci that are catalase negative, grow in 6.5% NaCl, and are bile-esculin positive. Which organism is most likely?
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Q75
A 70-year-old man on entecavir for chronic hepatitis B develops proximal muscle pain. Which antiviral agent is most likely responsible?
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Q76
In IMCI classification, a child aged 18 months with a respiratory rate of 55 breaths per minute is considered to have which condition?
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Q77
A 55-year-old man with long-standing diabetes presents with a chronic ulcer over the posterior heel, foul-smelling discharge, and exposed bone. Radiographs reveal a sequestrum surrounded by new bone formation. Which condition best describes his bone pathology?
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Q78
A 42-year-old woman with Graves disease desires fertility preservation and is awaiting definitive therapy. Which surgical option is preferred?
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Q79
The cerebellar dentate nucleus is located in which lobe of the cerebellum?
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Q80
Which of the following is NOT a component of the 'Rational Use of Medicines' as defined by the WHO?
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Q81
A body recovered from a fire shows 'Heat Hematoma' in the extradural space. How can this be distinguished from a traumatic extradural hemorrhage?
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Q82
A 32-year-old woman at 34 weeks' gestation presents with a blood pressure of 160/110 mmHg and severe proteinuria. During admission, she develops a generalized tonic-clonic seizure. After the loading dose of magnesium sulfate, what is the most appropriate maintenance dose to prevent recurrent seizures?
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Q83
The ileocecal valve is located between which two segments of the gut?
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Q84
During the third week, the primitive streak regresses. Which of the following structures is a direct derivative of the node (Hensen's node) located at the anterior end of the primitive streak?
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Q85
A 30-year-old woman presents with recurrent infections and poor wound healing. She is found to be deficient in a vitamin that is a cofactor for the enzyme glutathione peroxidase. Which vitamin is this?
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Q86
Which of the following is the primary intracellular buffer system responsible for maintaining pH within the cells?
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Q87
During surgery for a solid ovarian mass, frozen-section diagnosis suggests a Brenner tumor. What is the most typical clinical presentation of this tumor?
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Q88
The "first 1000 days" concept in nutrition emphasizes interventions during which periods?
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Q89
A patient presents after a fireworks injury with periorbital swelling, palpable crepitus and decreasing visual acuity. Which immediate bedside procedure is indicated to relieve suspected orbital compartment syndrome?
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Q90
In the context of tumor angiogenesis, which molecule is most directly responsible for increasing vascular permeability and promoting new vessel formation?
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Q91
A district in Nepal reports high prevalence of dental and skeletal fluorosis due to natural fluoride in groundwater. What is the most appropriate preventive measure?
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Q92
What is the recommended storage condition for vaginal washings collected for DNA analysis in a sexual assault case?
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Q93
A woman undergoes a low transverse cesarean section. According to NMC recommendations, which LMWH regimen is appropriate for VTE prophylaxis in a patient immobilized postoperatively?
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Q94
What is the recommended storage temperature range for the pneumococcal conjugate vaccine (PCV) used in Nepal?
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Q95
The primary force driving lymph formation from interstitial fluid is:
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Q96
Which corneal layer provides the majority of the cornea's tensile strength?
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Q97
A sample of urine for culture and sensitivity is collected but cannot be processed for 6 hours. What is the most appropriate action to prevent the overgrowth of commensals?
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Q98
Which of the following histologic changes is most typical of celiac disease?
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Q99
Which antimalarial combination is the first-line drug for uncomplicated Plasmodium falciparum malaria in Nepal?
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Q100
A newborn is found to have a low free T4 with a normal TSH level. Which cause of congenital hypothyroidism is most common in Nepal?
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Q101
A 55-year-old man presents 6 hours after ingesting 30 g of acetaminophen. His serum ALT is still normal. Which antidote should be given promptly?
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Q102
During a community health needs assessment, investigators classify households into wealth quintiles based on asset ownership. This is an example of:
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Q103
A 70-year-old man with COPD reports worsening dyspnea, increased purulent sputum, and fever. Chest X-ray reveals a new right-lower-lobe infiltrate. Which antibiotic is appropriate for empiric treatment of this COPD exacerbation with suspected pneumonia?
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Q104
A 62-year-old patient with known cirrhosis presents with ascites and an enlarging umbilical hernia. The hernia becomes tender and the overlying skin shows a bluish discoloration. Which of the following is the most appropriate next step?
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Q105
Which primary skin lesion is defined as a flat, non-palpable change in skin colour measuring less than 1 cm in diameter?
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Q106
Libman-Sacks endocarditis, seen in systemic lupus erythematosus, is characterized by:
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Q107
In the management of a Gustilo-Anderson type IIIB open tibial fracture, which component is mandatory during the initial surgical debridement?
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Q108
In a sanitation intervention, the term "accessibility" refers to?
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Q109
A 12-year-old presents with sore throat after a fish bone is felt in the tonsillar area, but there is no airway compromise. What is the most appropriate management?
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Q110
In a 42-year-old patient with a 1.5 cm papillary thyroid carcinoma and no clinical lymphadenopathy, which surgical approach to the central neck is most appropriate?
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Q111
A 45-year-old man is receiving treatment for a severe infection with a aminoglycoside antibiotic. He complains of dizziness and a 'ringing' sensation in his ears. What is the mechanism of this toxicity?
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Q112
A 9-month-old infant presents with a cough, a respiratory rate of 58 breaths/min, no chest indrawing, and can feed normally. According to IMCI, how should this child be classified?
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Q113
The optic nerve is surrounded by which meningeal layers as it extends from the eye to the optic chiasm?
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Q114
During each hydrolytic cycle of the Na⁺/K⁺-ATPase, how many ions are transported across the membrane?
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Q115
Active hepatitis B infection with a high viral load is considered an absolute contraindication for a living kidney donor. Which of the following is the most appropriate reason?
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Q116
During a cover test for suspected esotropia, the uncovered eye moves in which direction?
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Q117
A 5-year-old child with symptomatic bradycardia (heart rate 45/min) after a vagal episode requires immediate pharmacologic intervention. Which agent is the first-line drug of choice?
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Q118
In a clinical trial the absolute risk reduction (ARR) for a new drug is 0.04. What is the number needed to treat (NNT) to prevent one adverse event?
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Q119
Which of the following is a characteristic of a 'pedicled flap' as opposed to a 'free flap'?
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Q120
A patient on chronic loop diuretic therapy is most likely to develop which electrolyte disturbance?
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Q121
A victim of a physical assault presents with a 'crescentic' or 'half-moon' shaped abrasion on the shoulder. This specific pattern of injury is most commonly associated with:
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Q122
In fluoroscopy-guided interventional procedures, which protective device is placed on the patient's abdomen to reduce radiation dose to the gonads?
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Q123
A 45-year-old man with uncontrolled diabetes presents with purulent nasal discharge, facial pain, periorbital edema and ophthalmoplegia. What is the most likely causative organism?
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Q124
A non-pregnant woman presents with frothy, yellow-green vaginal discharge and motile flagellated organisms on wet mount. According to NMC guidelines, which therapy is first-line?
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Q125
Following a penetrating eye injury, which systemic antibiotic should be given prophylactically to prevent endophthalmitis?
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Q126
A patient with chronic kidney disease (CKD) is being treated for hyperphosphatemia. Which of the following phosphate binders is a non-calcium based agent that prevents the risk of hypercalcemia?
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Q127
A microbiology laboratory uses the 'Double-disk synergy test' to detect the production of which enzyme in Enterobacteriaceae?
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Q128
Which of the following is a mandatory component of the medicolegal report for a sexual assault case in Nepal?
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Q129
Which vaccine is scheduled as a single-dose booster at 12 months of age in Nepal's routine immunization program?
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Q130
During sustained isometric handgrip exercise, which of the following changes in cardiovascular parameters is most prominent?
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Q131
Langhans-type giant cells are pathognomonic for which form of granulomatous disease caused by intracellular infectious agents?
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Q132
According to the National Safe Motherhood Programme, the use of Misoprostol is recommended for the prevention of postpartum hemorrhage (PPH) specifically in which setting?
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Q133
A 6-month-old infant develops severe hypoglycemia, hyperammonemia, and ketosis after a short fasting period. Which enzyme deficiency is most likely responsible?
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Q134
A 9-month-old infant is brought for a check-up. The physician notes the child can sit without support and has started to creep. Which of the following fine motor milestones should the child ideally have achieved by this age?
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Q135
A district health office plans to estimate anemia prevalence among pregnant women by sampling 10,000 women. Which sampling strategy is likely to give the most representative estimate?
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Q136
A 60-year-old diabetic patient complains of exertional chest discomfort but has no resting ECG changes. What is the first-line pharmacologic therapy while awaiting further evaluation?
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Q137
Which laboratory pattern is typical of megaloblastic anemia due to folate deficiency?
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Q138
A 30-year-old woman presents with a butterfly rash on her face and joint pain. Laboratory tests show low C3 and C4 complement levels. This pattern of complement consumption is most indicative of:
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Q139
Nail pitting is most commonly associated with which dermatologic disease?
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Q140
For a sex‑cord stromal tumor suspected intra‑operatively, which immunohistochemical marker best confirms a granulosa cell tumor?
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MBBS Licensing Exam preparation SET 2
140 multiple-choice questions · 140 questions · 3 hours · Bachelor-level licensing
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