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Q1
Which nerve supplies sensory innervation to the lateral aspect of the sole of the foot?
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Q2
Which of the following arteries is the main blood supply to the nasolacrimal duct?
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D
Q3
During embryonic development, the midgut loop herniates into the umbilical cord at which week?
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Q4
A 55-year-old man presents with exertional dyspnea and peripheral edema. Echocardiography shows a left ventricular ejection fraction of 30% with dilated cardiomyopathy. Which of the following neurohormonal mechanisms primarily contributes to the progression of his heart failure?
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Q5
A 30-year-old woman on loop diuretics develops hypokalemia. Which renal segment is primarily responsible for the potassium loss?
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Q6
The primary fate of dietary fat after digestion is:
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Q7
A chronic alcoholic presents with elevated transaminases. Which pattern of AST and ALT is most typical for alcoholic liver disease?
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D
Q8
A drug exhibits time-dependent inhibition of its metabolizing enzyme. The greatest decrease in drug exposure will occur:
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Q9
Which of the following is a key component of the STOPP/START criteria used for medication review in older adults?
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Q10
A patient with chronic kidney disease requires a blood transfusion. To prevent iron overload and transfusion reactions, which blood component is most appropriate for correcting anemia in this patient?
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Q11
Which of the following is the gold standard test for diagnosing acute leukemia?
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D
Q12
Which of the following mediators is released by mast cells during type I hypersensitivity?
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D
Q13
Under Nepali law, 'brain death' is defined by which legislation?
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D
Q14
According to Nepalese forensic practice, the viscera preserved for chemical analysis should be stored in:
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D
Q15
In a patient with newly diagnosed atrial fibrillation, which of the following is the recommended initial strategy to reduce stroke risk?
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D
Q16
Which of the following is the most sensitive laboratory test for early detection of chronic kidney disease in a diabetic patient?
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D
Q17
The preferred initial ART regimen for a treatment-naΓ―ve adult HIV patient in Nepal (per NAC guidelines) is:
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D
Q18
Which laboratory finding is characteristic of intravascular hemolysis?
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D
Q19
Which of the following is the recommended target mean arterial pressure (MAP) in septic shock according to Surviving Sepsis Campaign 2021 guidelines?
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D
Q20
In a patient with a 3 cm hepatic lesion that shows arterial phase hyperenhancement and portal venous washout on triphasic CT, what is the most likely diagnosis?
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D
Q21
Which imaging modality is the best first-line investigation for a suspected ureteric stone measuring less than 5 mm?
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D
Q22
Which of the following is NOT a component of the ABCD rule for scar assessment?
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D
Q23
Which of the following is the most appropriate management for a patient presenting with Cord Prolapse during the second stage of labor?
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D
Q24
What is the most common side effect associated with the use of the Levonorgestrel-releasing intrauterine system (LNG-IUS)?
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Q25
What is the recommended dose of Vitamin K1 given intramuscularly to a term neonate to prevent Hemorrhagic Disease of the Newborn?
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D
Q26
A 9-month-old child presents with high fever, cough, coryza, conjunctivitis, and a maculopapular rash. The most likely diagnosis is:
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Q27
A 40-year-old male presents with a 2-week history of progressive proptosis, pain, and decreased vision. Imaging shows an enhancing mass in the orbital apex involving the optic canal. The most likely diagnosis is:
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Q28
A 30-year-old woman presents with a painful swelling over the lateral aspect of the ankle after an inversion injury. Examination reveals a firm, tender mass that becomes more prominent with ankle dorsiflexion. Which structure is most likely involved?
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D
Q29
Which of the following medications is used as an aversive agent in the treatment of alcohol dependence?
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D
Q30
The 'ground glass' appearance on a CT scan most commonly suggests which of the following?
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D
Q31
In a disaster scenario, the principle of 'do the greatest good for the greatest number' refers to which ethical concept?
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Q32
Under the National Immunization Program, the Pentavalent vaccine provides protection against which five diseases?
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D
Q33
Rifampin, a potent CYP3A4 inducer, is most likely to decrease the plasma concentration of which co-administered drug?
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D
Q34
Which cranial nerve is responsible for the pupillary light reflex?
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D
Q35
Which of the following describes the 'glucose-fatty acid cycle' (Randle cycle)?
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D
Q36
Elevated serum IgE in a child with atopic dermatitis is most closely associated with a mutation in which gene?
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D
Q37
In Nepal, the principle of 'autonomy' in medical ethics primarily focuses on:
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Q38
A patient presents with seizures, hyperthermia, and rhabdomyolysis after ingestion of a plant used traditionally as a stimulant. Which toxin is most likely involved?
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D
Q39
A 50-year-old diabetic patient presents with a foot ulcer. He has diminished ankle reflexes and decreased vibration sense. Which of the following is the most appropriate first-line pharmacological therapy for his neuropathic pain?
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D
Q40
The most common cause of death in patients with severe dengue is:
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Q41
A 55-year-old man presents with progressive dysphagia to solids and liquids, weight loss, and regurgitation of undigested food. Barium swallow shows a dilated esophagus with a bird's beak appearance. What is the most likely underlying pathophysiology?
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Q42
A 70-year-old woman with postmenopausal bleeding has a 1.2 cm posterior wall fibroid. The most appropriate management is?
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Q43
A 60-year-old woman with a displaced intra-articular radius fracture and dorsal angulation of 20Β° is best treated with:
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Q44
A 60-year-old male presents with widespread tense bullae on an erythematous base, primarily on the abdomen and thighs. He does not have oral involvement. What is the most likely diagnosis?
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D
Q45
During a refugee camp outbreak of cholera, which environmental modification is most effective at reducing disease spread within 48 hours?
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D
Q46
During moderate-intensity exercise, skeletal muscle glucose uptake occurs mainly via which mechanism?
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D
Q47
Which of the following is the correct sequence of events in the Renin-Angiotensin-Aldosterone System (RAAS) activation?
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Q48
A 35-year-old male presents with metabolic acidosis. His serum electrolytes are NaβΊ 140 mmol/L, Clβ» 100 mmol/L, HCOββ» 12 mmol/L. What is the anion gap, and which condition is most likely to cause an increased anion gap?
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Q49
Which of the following mechanisms contributes most to the development of the 'deck-of-cards' appearance of the liver in congestive cardiac failure?
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D
Q50
When prescribing a new antibiotic for suspected bacterial meningitis in a 12-year-old child, which principle of stepwise empirical therapy is most important to balance efficacy and toxicity?
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Q51
A 45-year-old male with chronic heart failure (ejection fraction 35 %) is being evaluated for disease severity. Which of the following biomarkers is most reliable for assessing the severity and guiding management?
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D
Q52
In sickle cell disease, which complication is the most common cause of sudden death in adults?
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D
Q53
The most common organism isolated from tubo-ovarian abscesses in Nepalese women is:
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D
Q54
A term infant exhibits a flat nasal bridge, low-set ears, a single palpebral fissure and a large ventricular septal defect. Which chromosomal anomaly is most likely?
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Q55
At what age range is the 'rolling over' motor milestone typically achieved?
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Q56
A 5-day-old neonate presents with sudden cyanosis after feeding. The most likely diagnosis is:
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Q57
Which psychometric tool is most commonly used in Nepal to screen for post-traumatic stress disorder in the clinical setting?
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D
Q58
The vertebral level of the transpyloric plane corresponds to which major abdominal organ's neck?
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D
Q59
Within Nepal's PMTCT (Prevention of Mother-to-Child Transmission) programme, which antiretroviral drug is administered to the newborn within 72 hours of birth for prophylaxis?
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Q60
Which hormone directly increases renal tubular reabsorption of calcium?
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D
Q61
A 52-year-old man with a history of chronic alcohol use presents with jaundice. His serum bilirubin is 8 mg/dl (direct 6 mg/dl) and alkaline phosphatase is 110 IU/L (reference 30-120). Which pattern of liver injury does this most likely represent?
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Q62
Following an abdominal trauma, a patient develops a sudden increase in intra-abdominal pressure, decreased urine output, and difficulty ventilating the patient. What is the most definitive management for this condition?
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Q63
In a patient with a history of severe hypertension, which of the following induction agents is most likely to cause the least hemodynamic instability?
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Q64
Which ventilator strategy is recommended as the initial mode for a patient with acute respiratory distress syndrome to reduce ventilator-induced lung injury?
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Q65
A 24-year-old woman presents with primary amenorrhea and a blind-ending vagina. Ultrasound reveals a uterus is present. What is the most likely diagnosis?
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Q66
What is the primary purpose of using a wound protector during laparoscopic surgery?
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Q67
When a registered medical practitioner discovers unconsciousness in a colleague during a public training session, which legal duty arises under Nepal's professional conduct codes?
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Q68
A 35-year-old patient with systemic lupus erythematosus (SLE) presents with worsening proteinuria and hematuria. A renal biopsy shows 'wire-loop' lesions. Which WHO/ISN class of lupus nephritis does this represent?
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Q69
A 45-year-old man is evaluated for unexplained thrombocytosis (platelet count 720,000/Β΅L). Peripheral smear shows large mature platelets, and the leukocyte alkaline phosphatase (LAP) score is elevated. Which condition is most consistent with these findings?
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Q70
A 15-month-old child presents with fever, conjunctivitis, bilateral non-purulent conjunctival injection, strawberry tongue, and edema of the hands and feet. The child has had fever for 6 days. What is the most appropriate immediate management to prevent coronary artery aneurysms?
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Q71
The nucleus that receives olfactory sensory input directly from the olfactory bulb and projects to the piriform cortex is the ____.
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Q72
Which serum parameter is the most reliable indicator of hepatic synthetic function?
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Q73
The recommended prophylactic platelet transfusion threshold for a stable adult with chemotherapy-induced thrombocytopenia is:
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Q74
Which immunoglobulin is primarily responsible for crossing the placenta to provide passive immunity to the fetus?
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D
Q75
Which of the following is the most common extra-intestinal manifestation of inflammatory bowel disease?
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D
Q76
Which of the following HIV-associated opportunistic infections is characterized by a 'ground-glass' appearance on High-Resolution CT (HRCT) of the chest and is common in patients with CD4 < 200?
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D
Q77
Which thyroid malignancy accounts for the largest proportion of all thyroid cancers?
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Q78
A 5-year-old child has a greasy, yellow-white scaling rash on the scalp, nasolabial folds and diaper area, sparing the diaper skin. Which condition is most likely?
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Q79
The National Safe Motherhood Programme in Nepal recommends a minimum of how many antenatal care (ANC) visits for a pregnant woman?
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Q80
Which of the following occurs during the repolarization phase of a neuronal action potential?
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Q81
In eukaryotic DNA replication, which enzyme is primarily responsible for removing RNA primers generated during lagging-strand synthesis?
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Q82
A 25-year-old man presents with recurrent epistaxis and hemoptysis. Renal biopsy reveals linear IgG deposition along glomerular basement membranes. The target antigen is the non-collagenous domain of which collagen type?
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Q83
A 34-year-old woman with systemic lupus erythematosus presents with a photosensitive rash over the cheeks and nasal bridge, oral ulcers, and arthralgia. Which immunologic finding is most specific for SLE diagnosis?
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Q84
A 30-year-old man is diagnosed with type 1 diabetes mellitus and is found to have microalbuminuria on routine screening. Which of the following interventions is most likely to delay progression of diabetic nephropathy?
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D
Q85
Which vestibular disorder is the most prevalent cause of vertigo in elderly individuals?
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Q86
According to Nepal's National Tuberculosis Control Program, what is the treatment outcome definition for a patient who completed treatment but did not have negative smear results in the last month?
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Q87
The pineal gland develops from which part of the neural tube?
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Q88
A 6-month-old infant presents with failure to thrive, developmental delay, and cherry-red spots on ophthalmologic examination. Laboratory studies show elevated transaminases and hepatomegaly. Which macromolecule accumulation is pathognomonic for this condition?
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Q89
A 55-year-old man with known cirrhosis presents with ascites and new-onset confusion. Which is the first-line pharmacologic agent for managing hepatic encephalopathy?
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Q90
In a patient with a full-thickness lower eyelid defect involving the tarsal plate after tumor excision, the reconstructive technique that best restores structural support and mucosal lining is:
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Q91
An 85-year-old man is admitted after being involved in a road traffic accident. He undergoes surgery for a splenic rupture. After seven hours, he becomes hypotensive and febrile. He rapidly develops disseminated intravascular coagulation. Which of the following is the most likely diagnosis?
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Q92
Which bacterium is primarily responsible for initiating root caries?
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Q93
A 40-year-old male presents after a motorcycle crash with a closed fracture of the distal tibia and fibula. The injury is at the level of the ankle joint with a transverse fibular fracture 1 cm proximal to the plafond and associated medial clear space widening. According to the Danis-Weber classification, this injury is most consistent with:
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Q94
Which of the following post-translational modifications is known to regulate protein degradation by targeting proteins to the proteasome?
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Q95
A 65-year-old farmer is found dead with a bottle of white crystalline powder nearby. Post-mortem toxicology reveals elevated serum copper and signs of pulmonary fibrosis. Which metal is implicated?
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Q96
The number needed to screen (NNS) is defined as:
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Q97
Which regional anaesthesia technique provides postoperative analgesia after hip arthroplasty with minimal motor block?
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Q98
Which of the following is the most appropriate indication for using a vacuum extractor during the second stage of labor?
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Q99
A 25-year-old male is brought to the emergency department unconscious following a road traffic accident. There is no next-of-kin available, and immediate life-saving surgery is required. Under the principle of 'Doctrine of Necessity' in medical law, the surgeon can proceed because:
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Q100
A 48-year-old man presents with episodic headaches, sweating, and palpitations. His blood pressure is 180/110 mmHg. Laboratory tests show elevated 24-hour urinary metanephrines. Which of the following is the most appropriate medication to administer before performing surgery for this condition?
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Q101
During a surgical procedure, the sudden onset of tachycardia, hypotension, and increased end-tidal CO2 in a patient under general anesthesia most likely indicates:
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Q102
A drug is characterized by a high hepatic extraction ratio. According to the Well-Stirred Model, the systemic clearance of this drug is primarily determined by which of the following?
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Q103
A patient on unfractionated heparin therapy develops a sudden drop in platelet count. Which laboratory test is most appropriate to confirm heparin-induced thrombocytopenia (HIT)?
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Q104
In a disaster setting, which of the following personal protective equipment (PPE) items is considered the minimum requirement for a first responder entering a zone contaminated with unknown chemical agents?
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Q105
The inguinal region bounded by the rectus abdominis (medially), the external oblique (laterally), the inguinal ligament (inferiorly) and the transversus abdominis (posteriorly) is known as
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Q106
A 48-year-old female presents with recurrent episodes of right upper quadrant pain and nausea. Ultrasound shows multiple gallstones but no gallbladder wall thickening. She is diagnosed with biliary colic. Which of the following is the most appropriate definitive treatment to prevent recurrence?
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Q107
Variable decelerations with deep >60 bpm drop persist despite maternal repositioning. What is the next immediate intervention?
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Q108
A 6-year-old with tetralogy of Fallot presents with sudden cyanosis and SpOβ 70 % on room air. The immediate therapeutic step is:
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Q109
A 10-month-old child presents with a high fever and a barking cough. Which vaccine component protects against this disease in Nepal?
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Q110
Aldosterone most directly increases sodium reabsorption in which nephron segment?
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Q111
Which of the following blood group combinations is most likely to lead to a severe hemolytic transfusion reaction if an incompatible unit of packed red blood cells is administered?
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Q112
Which test is used to diagnose type I hypersensitivity in vivo by producing a wheal-and-flare response after intradermal allergen application?
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Q113
When documenting a case of suspected strangulation, the 'dissection of the neck' should be performed as:
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Q114
A 35-year-old male with untreated HIV infection (CD4 80 cells/Β΅L) presents with fever, cough, and diffuse bilateral interstitial infiltrates on chest X-ray. Sputum culture grows a yeast that forms a characteristic "bowl-shaped" colony. Which drug regimen is the treatment of choice?
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Q115
A 48-year-old woman with rheumatoid arthritis has normocytic anemia. Iron studies show low serum iron, low total iron-binding capacity, and ferritin within the normal-high range. Which pattern best describes this anemia?
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D
Q116
A 50-year-old woman with a history of ischemic heart disease desires contraception. Combined oral contraceptives are classified as which Medical Eligibility Category for this condition?
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Q117
The most appropriate reconstruction for a 5 cm wide, 2 cm deep, full-thickness scalp defect with exposed calvarium is:
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D
Q118
Which of the following is the most sensitive early biochemical marker of vitamin B12 deficiency?
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D
Q119
A 30-year-old man with epilepsy is on phenobarbital and requires treatment for tuberculosis. Which anti-tubercular drug is most likely to reduce phenobarbital levels?
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Q120
An 8-cm pancreatic pseudocyst located in the tail of the pancreas is causing increasing abdominal girth. The most appropriate therapeutic approach is:
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Q121
A 28-year-old female presents with unilateral painless ptosis, miosis, anhidrosis and facial flushing when exposed to cold. Which syndrome does this presentation suggest?
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D
Q122
According to KDIGO recommendations, at what age should screening for intracranial aneurysms be considered in patients with autosomal dominant polycystic kidney disease (ADPKD) who have a positive family history?
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Q123
Which laboratory finding most strongly suggests early acute kidney injury in a septic patient?
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Q124
A 30-year-old male is brought to the clinic with a history of 'strange' beliefs, including the idea that he can predict the future and that he can communicate with spirits. He has odd speech patterns and eccentric dress but does not have full-blown delusions or hallucinations. What is the most likely diagnosis?
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Q125
Parafollicular (C) cells of the thyroid gland originate from which embryonic structure?
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D
Q126
Which neuromuscular blocking agent is most appropriate for rapid sequence induction in a patient with end-stage renal disease?
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D
Q127
What is the primary focus of Nepal's National Oral Health Programme?
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D
Q128
A 60-year-old woman develops progressive gait difficulty, urinary urgency, and magnetic gait. MRI shows ventriculomegaly with enlarged subarachnoid spaces but no cortical atrophy. Which disorder best explains these findings?
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D
Q129
A patient presents with a hypertensive emergency and a systolic BP above 200 mmHg. Which intravenous agent provides the most rapid reduction?
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D
Q130
A 32-year-old woman with severe pre-eclampsia at 39 weeks gestation has a blood pressure of 165/110 mmHg and proteinuria. Which medication is indicated for seizure prophylaxis?
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D
Q131
A medical practitioner in Nepal fails to provide timely treatment in an emergency, resulting in a preventable death. Under current law, which liability applies?
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Q132
Platelet-activating factor (PAF) contributes to anaphylaxis primarily by:
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Q133
Which of the following vitamins, if deficient in a child, is most likely to cause 'bitot spots' and follicular hyperkeratosis?
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D
Q134
A 58-year-old man with hepatic cirrhosis is prescribed a drug that has a high hepatic extraction ratio. Which pharmacokinetic parameter will most likely be altered in this patient?
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Q135
A 55-year-old man with COPD reports worsening dyspnea and wheezing, using his short-acting beta-agonist inhaler more than four times daily. According to GOLD guidelines, what is the recommended step-up therapy?
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D
Q136
Following total thyroidectomy for a 1.2-cm papillary thyroid carcinoma without extrathyroidal extension, which postoperative therapy is recommended?
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D
Q137
The short delay between arrival of an action potential at a skeletal-muscle fiber and the onset of contraction is primarily attributable to which step?
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D
Q138
During a medicolegal autopsy of a suspected drowning case, which finding is most supportive of pulmonary aspiration?
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D
Q139
A 30-year-old man develops a diffuse, erythematous, scarlatiniform rash 2 days after starting amoxicillin for sinusitis. He also has fever and a sandpaper-like texture of the skin. Which of the following is the most likely diagnosis?
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D
Q140
A researcher wants to deliver a therapeutic gene of 7 kb to non-dividing cells using a viral vector. Which vector is most suitable?
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Q141
A 28-year-old patient presents with suspected Hemophilia A. The laboratory results show a prolonged aPTT and a normal PT. Which of the following assays is most appropriate to confirm the specific factor deficiency?
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D
Q142
In the management of acute organophosphate poisoning, which of the following medications is used specifically to reverse the nicotinic effects, such as muscle fasciculations and respiratory paralysis?
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D
Q143
During an acute variceal hemorrhage, which endoscopic modality is considered the first-line therapy to achieve hemostasis?
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D
Q144
A patient presents with 'scanning speech', intention tremor, and ataxia. These signs are most characteristic of a lesion in which part of the cerebellum?
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Q145
A 28-year-old woman with known sickle cell disease presents with acute chest pain, dyspnea, and a new infiltrate on chest X-ray. Laboratory studies show a hemoglobin of 6.5 g/dL and a reticulocyte count of 12%. Which blood component should be administered to improve oxygen-carrying capacity while minimizing the risk of alloimmunization?
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D
Q146
In microsurgical free tissue transfer, which mismatch is most likely to cause thrombosis?
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D
Q147
A 22-year-old woman is diagnosed with acute salpingitis. She is not pregnant. Which antibiotic regimen is recommended as first-line treatment in Nepal?
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Q148
A 30-year-old woman at 34 weeks gestation presents with fever, chills, uterine tenderness, and foul-smelling vaginal discharge. She is in preterm labor. Which intervention is most effective in reducing neonatal morbidity in this setting?
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D
Q149
Which ethical principle best justifies allocating limited ventilators to patients with the highest likelihood of survival during a pandemic surge?
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D
Q150
Which artery is the main source of blood for the adductor (medial) group of the thigh?
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D
Q151
A 70-year-old patient with severe sepsis develops oliguria despite fluid resuscitation. Which laboratory parameter is the earliest indicator of acute kidney injury in this setting?
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Q152
A patient with a suspected aortic dissection is being managed. The most critical goal in the initial medical management of a Stanford Type A dissection is:
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Q153
The principle of justice in Nepal's medical ethics guidelines most strongly emphasizes:
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Q154
A 45-year-old man on maintenance hemodialysis develops sudden dyspnea, chest pain, and hypotension during a dialysis session. What is the most likely cause?
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D
Q155
Which complication of atherosclerosis is most likely to cause sudden cardiac death?
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D
Q156
Which new cadre was introduced by Nepal's National Mental Health Programme to deliver community mental health services?
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Q157
A 50-year-old patient undergoes a cholecystectomy. During the operation, the surgeon identifies the cystic artery. From which artery does the cystic artery most commonly originate?
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Q158
A 22-year-old woman at 12 weeks gestation has a pre-pregnancy BMI of 18 kg/mΒ². According to Nepal ANC recommendations, the ideal total weight gain for her pregnancy is:
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Q159
In the context of the Expanded Programme on Immunization (EPI) in Nepal, which of the following is an absolute contraindication to the administration of the BCG vaccine?
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D
Q160
A 45-year-old patient with mechanical mitral valve replacement requires anticoagulation. Which agent has a specific reversal agent available for emergency surgery or life-threatening bleeding?
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D
Q161
In a firearm injury, which internal finding most directly indicates the bullet's trajectory?
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Q162
In the management of severe acute malnutrition (SAM), which of the following is the most critical initial step to prevent mortality during the stabilization phase?
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D
Q163
On MRI, T2* gradient-echo sequences are primarily employed to detect which type of abnormality?
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Q164
In the hapten concept of drug-induced hypersensitivity, the drug becomes immunogenic by:
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Q165
Which of the following best describes the primary mechanism by which the NaβΊ/KβΊ ATPase maintains low intracellular NaβΊ concentration?
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Q166
In the proximal tubule, which transporter is chiefly responsible for reclaiming filtered bicarbonate?
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D
Q167
During the process of lipolysis, which enzyme is responsible for the final step of releasing the last fatty acid from the glycerol backbone?
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D
Q168
A patient is administered a drug that follows Michaelis-Menten kinetics. As the plasma concentration increases and approaches the maximum rate of metabolism (Vmax), the order of elimination shifts from:
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D
Q169
A 32-year-old man with chronic low back pain and morning stiffness >1 hour improves with exercise. Plain radiographs of the sacroiliac joints show bilateral grade 2 sacroiliitis. Which imaging modality is most sensitive for detecting early inflammatory changes before radiographic sacroiliitis?
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Q170
Which preoperative preparation is essential for a patient undergoing adrenalectomy for pheochromocytoma to prevent intra-operative hypertensive crises?
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Q171
A patient is diagnosed with a lesion in the cerebellum, specifically the vermis. Which of the following clinical findings is most characteristic of this physiological deficit?
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D
Q172
Which of the following is the first-line management for a term neonate with blood glucose of 30 mg/dL who is symptomatic?
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D
Q173
In a patient with suspected dengue infection, which laboratory test provides the earliest detection of the virus during the first 5 days of illness?
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D
Q174
A physician who neglects to report a death arising from professional negligence may be prosecuted for which of the following?
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D
Q175
Urine microscopy in a 30-year-old with acute kidney injury shows numerous eosinophils (Hansel stain positive). Which condition is strongly suggested?
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D
Q176
The reconstructive ladder in plastic surgery includes all of the following steps EXCEPT:
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Q177
In primary open-angle glaucoma, which structural parameter measured by spectral-domain OCT shows the earliest change?
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Q178
A 22-year-old female experiences episodic, intensely pruritic wheals that last less than 24 hours, appear spontaneously, and are triggered by stress and certain foods. There are no systemic symptoms. Which of the following is the most appropriate initial management?
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D
Q179
The fornix is composed mainly of fibers projecting from which structure?
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Q180
A 30-year-old male presents after a high-speed motor vehicle collision. He is hypotensive, and FAST demonstrates free fluid in the Morison's pouch. His hemoglobin is 7 g/dL after 2 L crystalloid infusion. Which intervention is the most appropriate next step?
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Q181
A 30-year-old woman has postpartum haemorrhage after a vaginal delivery. The uterus is boggy and continues to bleed despite oxytocin infusion. Which of the following is the next appropriate step before proceeding to laparotomy?
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Q182
A 60-year-old male with osteopenia sustains a distal radius fracture with 25Β° dorsal angulation and 5 mm stepoff of the articular surface. What is the most appropriate definitive treatment?
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D
Q183
Which of the following is a validated screening tool for postpartum depression used in Nepal's primary health care?
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D
Q184
A patient develops a severe skin reaction (Stevens-Johnson Syndrome) after taking carbamazepine. This reaction is most likely due to:
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D
Q185
Which of the following is the most sensitive clinical sign for the early detection of abdominal compartment syndrome in a critically ill trauma patient?
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D
Q186
A deficiency of which copper-containing plasma protein is commonly observed in Wilson disease and reflects impaired hepatic copper export?
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D
Q187
A 40-year-old male presents with exertional dyspnea and a loud, diastolic decrescendo murmur heard best at the apex with the patient leaning forward. Which of the following is the most likely diagnosis?
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D
Q188
In the management of septic arthritis due to Staphylococcus aureus, which antibiotic is recommended for intravenous therapy with a loading dose of 15 mg/kg followed by maintenance 10 mg/kg q12 h?
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D
Q189
During a thoracic surgery, the surgeon notes that the thoracic duct empties into the venous system at a specific junction. Into which venous angle does the thoracic duct drain?
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Q190
Which laboratory parameter best distinguishes thrombotic thrombocytopenic purpura from hemolytic uremic syndrome?
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D
Q191
What is the WHO and Nepal recommended duration of exclusive breastfeeding for infants?
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D
Q192
In a patient with suspected pulmonary embolism, which CT finding represents the "polo mint sign"?
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D
Q193
The 'Safe Zone' for injecting intramuscular medication in the gluteal region is the upper outer quadrant to avoid which nerve?
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Q194
What is the most potent physiological stimulus for renin release from juxtaglomerular cells?
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Q195
At 48 hours of life, what total serum bilirubin level in a term infant warrants consideration of exchange transfusion?
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D
Q196
A focal lesion of the ventral posterolateral (VPL) nucleus of the thalamus would most likely cause loss of which sensory modality on the contralateral side of the body?
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D
Q197
In a patient with chronic kidney disease stage 4 with hypertension, which drug is considered first-line due to its renoprotective properties?
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Q198
Which technique in breast reconstruction is most likely to produce a natural-appearing outcome?
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Q199
A 2-day-old infant born to a mother with chorioamnionitis is febrile (38.8Β°C) and lethargic. Which antibiotic regimen is recommended for empiric treatment of neonatal sepsis in this setting?
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D
Q200
Which of the following hormones directly stimulates calcium reabsorption in the thick ascending limb of Henle?
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D
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MD/MS Post-Graduate Entrance Exam preparation SET 2
200 multiple-choice questions Β· 200 questions Β· 3 hours Β· Masters entrance exam
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