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Below is the complete model paper for the 20th batch. It follows the same format as the previous 18th and 19th batch papers and contains 60 multiple‐choice questions. Each question is followed by its correct answer and a brief explanation (reasoning) outlining the rationale behind the answer.

Clinical Sciences Stream Examination 1 – Model Paper for 20th Batch

Questions 1–15 (Part A – Selected Topics)

1. Dermatology A 12‐year‐old boy presents with a chronic, pruritic rash predominantly in the flexural areas. Which of the following is NOT a recommended management option for atopic dermatitis? A. Regular use of emollients B. Topical corticosteroids during flare‐ups C. Avoidance of known triggers D. Routine use of systemic antibiotics E. Topical calcineurin inhibitors

Correct Answer: D Reasoning: Atopic dermatitis is managed with moisturizers, topical anti‐inflammatory agents, and trigger avoidance. Systemic antibiotics are reserved for secondary bacterial infection only.

2. Infectious Diseases (Dengue) A 10‐year‐old child with dengue fever develops persistent vomiting, restlessness, and hypotension. Which clinical feature best suggests progression to dengue shock syndrome? A. High platelet count B. Narrow pulse pressure C. Elevated liver enzymes D. Diffuse rash E. Absence of fever

Correct Answer: B Reasoning: A narrowed pulse pressure indicates significant intravascular volume depletion—a key marker of impending shock in dengue.

3. Cardiology A 55‐year‐old male with chest pain and ECG changes consistent with an anterior myocardial infarction is managed in hospital. On day 3, he develops hypotension, a new holosystolic murmur, and pulmonary edema. Which complication is most likely? A. Ventricular septal rupture B. Papillary muscle rupture causing acute mitral regurgitation C. Free wall rupture D. Pericardial effusion E. Dressler syndrome

Correct Answer: B Reasoning: Acute mitral regurgitation due to papillary muscle rupture commonly presents with these findings a few days after an MI.

4. Gastroenterology A 45‐year‐old woman presents with chronic right upper quadrant pain, intermittent jaundice, and pruritus. Which investigation is the most appropriate initial test to evaluate for cholangiocarcinoma? A. Abdominal ultrasound B. CT scan C. Endoscopic Retrograde Cholangiopancreatography (ERCP) D. Magnetic Resonance Cholangiopancreatography (MRCP) E. Liver biopsy

Correct Answer: D Reasoning: MRCP is a non‐invasive imaging modality that provides excellent visualization of the biliary tree, making it the preferred initial investigation.

5. Endocrinology A 30‐year‐old woman presents with weight gain, irregular menstrual cycles, and hirsutism. Laboratory evaluation reveals elevated free testosterone and insulin resistance. What is the most likely diagnosis? A. Cushing’s syndrome B. Hypothyroidism C. Polycystic Ovary Syndrome (PCOS) D. Congenital adrenal hyperplasia E. Androgen‐secreting tumor

Correct Answer: C Reasoning: PCOS is common in reproductive‐aged women and is characterized by menstrual irregularity, hyperandrogenism, and insulin resistance.

6. Nephrology A 65‐year‐old man with multiple myeloma presents with worsening renal function. Which of the following is most commonly responsible for renal impairment in multiple myeloma? A. Hypercalcemia B. Cast nephropathy C. Light chain deposition D. Amyloidosis E. Dehydration

Correct Answer: B Reasoning: Cast nephropathy (myeloma kidney) is the leading cause of renal impairment in multiple myeloma due to precipitation of light chains within the tubules.

7. Pulmonology A 60‐year‐old heavy smoker presents with progressive dyspnea and a chronic cough. Chest X‑ray shows hyperlucent lung fields with flattened diaphragms. What is the most likely diagnosis? A. Chronic bronchitis B. Emphysema C. Bronchiectasis D. Interstitial lung disease E. Asthma

Correct Answer: B Reasoning: Emphysema, common in long‐term smokers, shows characteristic radiographic features such as hyperlucency and diaphragm flattening.

8. Neurology A 70‐year‐old man with hypertension suddenly develops a severe headache and loses consciousness. A CT scan reveals subarachnoid hemorrhage. What is the most common non‐traumatic cause? A. Traumatic injury B. Ruptured saccular (berry) aneurysm C. Arteriovenous malformation D. Hypertensive hemorrhage E. Cavernous hemangioma

Correct Answer: B Reasoning: In non‐traumatic subarachnoid hemorrhage, rupture of a berry aneurysm is the most frequent cause.

9. Obstetrics/Gynecology A 28‐year‐old pregnant woman presents with acute right lower quadrant pain and fever. Ultrasound shows an enlarged, non‐compressible appendix. What is the most appropriate management? A. Conservative management with antibiotics B. Laparoscopic appendectomy C. Open appendectomy D. Delayed surgery after delivery E. Endoscopic drainage

Correct Answer: B Reasoning: Laparoscopic appendectomy is considered safe during pregnancy and is the treatment of choice for acute appendicitis.

10. Pediatrics A 2‐year‐old child presents with fever, cough, and difficulty breathing. On examination, there are intercostal retractions and crackles in the right lower lung field. What is the most appropriate initial management? A. Supportive care with hydration B. Oral antibiotics for community‐acquired pneumonia C. Nebulized bronchodilators D. Immediate intubation E. High‐dose intravenous steroids

Correct Answer: B Reasoning: Bacterial community‐acquired pneumonia in children is generally managed with oral antibiotics along with supportive care.

11. Trauma A 25‐year‐old male involved in a road traffic accident presents with multiple fractures and signs of hemorrhagic shock. What is the most important initial management step? A. Immediate surgical fixation B. Intravenous fluid resuscitation C. Administration of analgesics D. CT scan evaluation E. Applying tourniquets to all injured limbs

Correct Answer: B Reasoning: Restoration of intravascular volume via IV fluid resuscitation is the priority in hemorrhagic shock.

12. Psychiatry A 35‐year‐old man has experienced low mood, anhedonia, and feelings of worthlessness for 2 months. Which is the first‐line treatment? A. Electroconvulsive therapy B. Selective serotonin reuptake inhibitors (SSRIs) C. Tricyclic antidepressants D. Antipsychotics E. Mood stabilizers

Correct Answer: B Reasoning: SSRIs are first‑line in treating major depressive disorder due to their efficacy and favorable side‐effect profile.

13. Hematology A 50‐year‐old woman presents with easy bruising and petechiae. Laboratory tests show isolated thrombocytopenia with a normal coagulation profile. What is the most likely diagnosis? A. Hemophilia B. Idiopathic thrombocytopenic purpura (ITP) C. Disseminated intravascular coagulation (DIC) D. Von Willebrand disease E. Thrombotic thrombocytopenic purpura (TTP)

Correct Answer: B Reasoning: ITP typically presents with isolated thrombocytopenia and mucocutaneous bleeding, with normal clotting studies.

14. Infectious Diseases (Tuberculosis in HIV) A 40‐year‐old man with HIV presents with chronic cough, weight loss, and night sweats. His sputum smear is negative for acid‐fast bacilli. Which test is most appropriate next? A. Repeat sputum smear B. Sputum culture for Mycobacterium tuberculosis C. Chest CT scan D. GeneXpert MTB/RIF assay E. Bronchoscopy with lavage

Correct Answer: D Reasoning: The GeneXpert MTB/RIF assay is both sensitive and rapid for detecting TB (and rifampicin resistance) in HIV‐infected patients.

15. Orthopedics A 60‐year‐old woman with known osteoporosis presents with sudden onset back pain after a minor fall. X‑ray reveals a compression fracture of the thoracic spine. What is the most appropriate initial management? A. Prolonged bed rest for 6 weeks B. Early mobilization with bracing C. Surgical vertebroplasty D. High‐dose steroids E. Immediate physical therapy without bracing

Correct Answer: B Reasoning: Early mobilization with appropriate bracing helps prevent deconditioning and promotes healing in osteoporotic compression fractures.

Questions 16–60 (Additional Topics)

16. Infectious Diseases (Urinary Tract Infection) A 68‐year‐old man presents with dysuria and frequency. He is febrile and his urine culture grows Escherichia coli. Which of the following is the best initial antibiotic choice in the elderly? A. Nitrofurantoin B. Amoxicillin C. Ciprofloxacin D. Trimethoprim‐sulfamethoxazole E. Intravenous ceftriaxone

Correct Answer: C Reasoning: Fluoroquinolones such as ciprofloxacin provide broad-spectrum coverage and are effective in complicated UTIs in the elderly.

17. Gastroenterology (Acute Pancreatitis) A 45‐year‐old man with a history of alcohol abuse presents with severe epigastric pain radiating to the back and vomiting. Which of the following is the most appropriate initial management? A. Immediate ERCP B. Aggressive IV fluid resuscitation C. High‐dose analgesia only D. Urgent surgical intervention E. Oral feeding with a low-fat diet

Correct Answer: B Reasoning: Early aggressive IV fluid resuscitation is critical in acute pancreatitis to prevent hypovolemia and organ failure.

18. Endocrinology (Myxedema Coma) A 70‐year‐old woman with a history of hypothyroidism is found unresponsive with hypothermia and bradycardia. Which is the most appropriate initial treatment? A. High‑dose oral levothyroxine B. Intravenous levothyroxine C. Intravenous glucocorticoids and IV levothyroxine D. Supportive care only E. Radioiodine therapy

Correct Answer: C Reasoning: Myxedema coma is a medical emergency managed with IV levothyroxine along with glucocorticoids to support adrenal function.

19. Neurology (Acute Ischemic Stroke) A 65‐year‐old man presents within 2 hours of sudden onset right‐sided weakness and slurred speech. Which intervention is most time‑sensitive? A. Aspirin administration B. Intravenous thrombolysis (rtPA) C. Immediate CT angiography D. Mechanical thrombectomy E. High‑dose statin therapy

Correct Answer: B Reasoning: Intravenous thrombolysis is indicated within a narrow therapeutic window in acute ischemic stroke and can significantly improve outcomes.

20. Cardiology (Arrhythmia) A 72‐year‐old man presents with palpitations and lightheadedness. ECG reveals atrial fibrillation with rapid ventricular response. Which is the most appropriate rate‑control medication? A. Intravenous amiodarone B. Oral beta‑blockers C. Intravenous digoxin D. Oral calcium channel blockers E. Oral anticoagulants

Correct Answer: B Reasoning: Beta‑blockers are effective for rate control in atrial fibrillation and are typically used as first‑line agents in this setting.

21. Pulmonology (Asthma Exacerbation) A 25‐year‐old known asthmatic presents with acute wheezing, dyspnea, and accessory muscle use. What is the first‑line management? A. High‑dose inhaled corticosteroids alone B. Nebulized short‑acting beta‑agonists C. Oral theophylline D. Intravenous magnesium sulfate E. Systemic antibiotics

Correct Answer: B Reasoning: Nebulized short‑acting beta‑agonists (SABAs) provide rapid bronchodilation and are the mainstay of acute asthma exacerbation management.

22. Rheumatology (Rheumatoid Arthritis) A 42‐year‐old woman presents with symmetric joint pain and morning stiffness lasting over 1 hour. Which medication is used as a disease‑modifying agent? A. Ibuprofen B. Methotrexate C. Prednisolone D. Acetaminophen E. Naproxen

Correct Answer: B Reasoning: Methotrexate is the first‑line disease‑modifying antirheumatic drug (DMARD) used in rheumatoid arthritis.

23. Dermatology (Psoriasis) A 35‐year‐old man with well‑demarcated erythematous plaques and silvery scales on the extensor surfaces is diagnosed with psoriasis. Which treatment option is most appropriate for moderate disease? A. Topical emollients only B. Topical corticosteroids combined with vitamin D analogs C. Systemic methotrexate as first‑line D. Oral antibiotics E. Ultraviolet light therapy only

Correct Answer: B Reasoning: Combination therapy with topical corticosteroids and vitamin D analogs is effective in managing moderate psoriasis.

24. Hematology (Anemia Work-Up) A 50‐year‐old woman presents with fatigue and pallor. Laboratory studies reveal microcytic hypochromic anemia. Which is the most appropriate next step? A. Bone marrow biopsy B. Iron studies C. Serum vitamin B12 levels D. Direct antiglobulin test E. Fecal occult blood testing

Correct Answer: B Reasoning: Iron studies help to evaluate iron deficiency, the most common cause of microcytic anemia.

25. Nephrology (Glomerulonephritis) A 30‐year‐old man presents with cola‑colored urine, edema, and hypertension. Laboratory tests reveal red blood cell casts. What is the most likely diagnosis? A. Nephrotic syndrome B. Acute glomerulonephritis C. Urinary tract infection D. Renal tubular acidosis E. Diabetic nephropathy

Correct Answer: B Reasoning: The presence of red blood cell casts, hematuria, and hypertension strongly suggests acute glomerulonephritis.

26. Obstetrics (Pre‑eclampsia) A 32‐year‐old primigravida at 34 weeks’ gestation presents with hypertension and proteinuria. Which of the following is the most appropriate management? A. Immediate delivery regardless of gestational age B. Magnesium sulfate for seizure prophylaxis and close monitoring C. High‑dose corticosteroids D. No treatment is necessary E. Oral antihypertensives only

Correct Answer: B Reasoning: In pre‑eclampsia, magnesium sulfate is used for seizure prophylaxis and maternal stabilization while monitoring for indications for delivery.

27. Pediatrics (Bronchiolitis) A 9‑month‑old infant presents with a low‑grade fever, cough, and respiratory distress with wheezing. Which is the best initial management? A. Nebulized beta‑agonists B. Supportive care with hydration and oxygen C. Systemic corticosteroids D. Oral antibiotics E. Hospitalization for IV fluids

Correct Answer: B Reasoning: Bronchiolitis is managed supportively with oxygen and hydration; routine use of bronchodilators is not recommended.

28. Orthopedics (Fracture Management) A 28‑year‑old man sustains a mid‑shaft fracture of the tibia in a road traffic accident. Which is the appropriate initial management step? A. Immediate open reduction and internal fixation B. Splinting and immobilization with subsequent surgical evaluation C. High‑dose analgesia only D. Immediate traction E. Early weight‑bearing exercises

Correct Answer: B Reasoning: Initial stabilization with splinting followed by definitive management (which may include surgical fixation) is the standard approach for tibial fractures.

29. ENT (Acute Otitis Media) A 4‑year‑old child presents with fever and ear pain. Otoscopic examination reveals a bulging, erythematous tympanic membrane. What is the best initial management? A. Immediate myringotomy B. High‑dose systemic steroids C. Oral amoxicillin D. Topical antibiotic drops E. Observation without treatment

Correct Answer: C Reasoning: Acute otitis media in children is typically managed with oral amoxicillin, especially when symptoms are moderate to severe.

30. Urology (Benign Prostatic Hyperplasia) A 65‑year‑old man presents with hesitancy, weak urinary stream, and nocturia. Which investigation is most useful to assess the severity of benign prostatic hyperplasia? A. Serum prostate‑specific antigen (PSA) B. Digital rectal examination C. Uroflowmetry D. Transrectal ultrasound E. Cystoscopy

Correct Answer: C Reasoning: Uroflowmetry objectively measures urine flow rate and is useful in assessing the severity of lower urinary tract symptoms in BPH.

31. Surgery (Acute Appendicitis) A 22‑year‑old man presents with periumbilical pain that migrates to the right lower quadrant, accompanied by fever and nausea. What is the next best step? A. Laparoscopic appendectomy B. CT scan of the abdomen C. Abdominal ultrasound D. Conservative management with antibiotics E. Discharge with painkillers

Correct Answer: A Reasoning: Clinical diagnosis of appendicitis in a young patient is often confirmed by imaging if needed; however, prompt laparoscopic appendectomy is the definitive treatment.

32. Infectious Diseases (HIV Management) A 30‑year‑old man is newly diagnosed with HIV. Which of the following is the recommended first‑line treatment strategy? A. Monotherapy with a nucleoside reverse transcriptase inhibitor B. Combination antiretroviral therapy (cART) C. Protease inhibitor monotherapy D. Interferon therapy E. Delayed treatment until symptoms develop

Correct Answer: B Reasoning: Combination antiretroviral therapy (cART) is the standard of care in HIV management to reduce viral load and prevent resistance.

33. Gastroenterology (Cirrhosis Complication) A 55‑year‑old man with a history of chronic alcohol use presents with ascites and peripheral edema. Which investigation is most useful to assess for portal hypertension? A. Liver biopsy B. Abdominal ultrasound with Doppler C. Serum albumin measurement D. CT scan of the abdomen E. Endoscopy

Correct Answer: B Reasoning: An ultrasound with Doppler assessment helps evaluate portal blood flow and is useful in assessing portal hypertension in cirrhosis.

34. Pulmonology (Pleural Effusion) A 60‑year‑old woman presents with dyspnea and pleuritic chest pain. Chest X‑ray shows a unilateral pleural effusion. Which investigation is most appropriate to determine its etiology? A. Thoracentesis with fluid analysis B. Repeat chest X‑ray in 24 hours C. CT scan of the chest D. Bronchoscopy E. Pulmonary function tests

Correct Answer: A Reasoning: Thoracentesis with biochemical, cytological, and microbiological analysis of the pleural fluid is key to diagnosing the cause of an effusion.

35. Neurology (Seizure Management) A 28‑year‑old woman presents with a first‑time generalized tonic‑clonic seizure. Which investigation is most appropriate in the initial evaluation? A. Lumbar puncture B. Electroencephalogram (EEG) C. Brain MRI D. Serum electrolytes and glucose E. PET scan

Correct Answer: D Reasoning: Acute metabolic disturbances (electrolytes, blood glucose) should be assessed in any first‑time seizure before further neuroimaging.

36. Endocrinology (Diabetic Ketoacidosis) A 22‑year‑old man with type 1 diabetes presents with polyuria, polydipsia, and rapid breathing. Laboratory evaluation reveals metabolic acidosis, ketonemia, and hyperglycemia. What is the most appropriate initial management? A. Oral hypoglycemic agents B. Intravenous insulin and fluid resuscitation C. Subcutaneous insulin only D. High‑dose corticosteroids E. Immediate dialysis

Correct Answer: B Reasoning: DKA is managed with aggressive IV fluid replacement and insulin therapy to correct metabolic derangements and reverse ketosis.

37. Cardiology (Heart Failure Management) A 65‑year‑old man with a history of ischemic heart disease presents with dyspnea on exertion and orthopnea. His ejection fraction is 35%. Which medication has been proven to reduce mortality in systolic heart failure? A. Digoxin B. ACE inhibitors C. Calcium channel blockers D. Nitrates E. Loop diuretics

Correct Answer: B Reasoning: ACE inhibitors improve survival and are a cornerstone in the management of systolic heart failure.

38. Gastroenterology (Acute Gastrointestinal Bleed) A 60‑year‑old woman presents with melena and symptomatic anemia. Which investigation should be performed first to localize the source of bleeding? A. Colonoscopy B. Upper GI endoscopy C. CT angiography D. Capsule endoscopy E. Abdominal ultrasound

Correct Answer: B Reasoning: In melena, an upper GI endoscopy is the investigation of choice to localize and treat the bleeding source.

39. Infectious Diseases (Malaria) A 35‑year‑old man returning from a malaria‑endemic region presents with fever, chills, and rigors. Which diagnostic test is most appropriate for confirmation? A. Rapid diagnostic test (RDT) for malaria B. Chest X‑ray C. Blood culture D. Urinalysis E. Lumbar puncture

Correct Answer: A Reasoning: Rapid diagnostic tests for malaria allow prompt diagnosis and treatment, particularly in travelers from endemic regions.

40. Pediatrics (Congenital Heart Disease) A 3‑month‑old infant is noted to have a murmur and failure to thrive. Echocardiography reveals a large ventricular septal defect (VSD). What is the most appropriate management initially? A. Immediate surgical repair B. Medical management with diuretics and afterload reduction C. Balloon septostomy D. No treatment needed E. Cardiac catheterization

Correct Answer: B Reasoning: Medical management using diuretics and afterload reduction is first‑line therapy for symptomatic VSD in infancy to reduce pulmonary overcirculation until surgical repair is indicated.

41. Rheumatology (Systemic Lupus Erythematosus) A 27‑year‑old woman presents with joint pain, photosensitive rash, and oral ulcers. Which serologic test is most sensitive for SLE? A. Anti-double stranded DNA antibody B. Anti-Smith antibody C. Antinuclear antibody (ANA) D. Rheumatoid factor E. C-reactive protein

Correct Answer: C Reasoning: A positive ANA is highly sensitive for SLE and is typically used as a screening test, though it is not specific.

42. Dermatology (Acne Vulgaris) A 19‑year‑old man presents with inflammatory papules and pustules on the face and upper back. Which is the most appropriate initial treatment for moderate acne? A. Topical retinoids combined with benzoyl peroxide B. Oral isotretinoin as first‑line C. Systemic antibiotics alone D. Topical corticosteroids E. Laser therapy

Correct Answer: A Reasoning: For moderate acne, a combination of topical retinoids and benzoyl peroxide is effective in reducing inflammation and preventing comedone formation.

43. Neurology (Multiple Sclerosis) A 32‑year‑old woman presents with intermittent episodes of visual loss, limb numbness, and balance problems. MRI shows demyelinating plaques. Which is the most appropriate initial treatment for an acute relapse? A. Oral prednisone B. High‑dose intravenous methylprednisolone C. Interferon beta therapy D. Plasmapheresis E. Symptomatic management only

Correct Answer: B Reasoning: High‑dose IV methylprednisolone is the standard treatment for acute relapses in multiple sclerosis to hasten recovery.

44. Hematology (Acute Leukemia) A 45‑year‑old man presents with fatigue, fever, and bleeding gums. His complete blood count shows pancytopenia with circulating blasts. What is the next appropriate investigation? A. Peripheral blood smear only B. Bone marrow biopsy and aspiration C. Coagulation studies D. Lymph node biopsy E. Serum LDH level

Correct Answer: B Reasoning: A bone marrow biopsy and aspiration are required to confirm the diagnosis and subtype of acute leukemia.

45. Urology (Renal Colic) A 38‑year‑old man presents with severe, colicky flank pain radiating to the groin. Non-contrast CT of the abdomen reveals a 5‑mm ureteric stone. What is the most appropriate management? A. Immediate surgical removal B. Conservative management with hydration, analgesia, and medical expulsive therapy C. Extracorporeal shock wave lithotripsy (ESWL) as first‑line D. Ureteroscopy E. Percutaneous nephrolithotomy

Correct Answer: B Reasoning: A 5‑mm stone is likely to pass spontaneously; management with hydration, analgesia, and alpha‑blockers (medical expulsive therapy) is appropriate.

46. Orthopedics (Hip Fracture in the Elderly) A 78‑year‑old woman falls at home and is diagnosed with an intracapsular neck of femur fracture. What is the preferred management? A. Conservative treatment with bed rest B. Early surgical intervention with hemi‑arthroplasty C. External fixation D. Intramedullary nailing E. High‑dose analgesia only

Correct Answer: B Reasoning: Early surgical intervention with hemi‑arthroplasty is recommended to allow early mobilization and reduce morbidity in elderly patients with femoral neck fractures.

47. Obstetrics (Postpartum Hemorrhage) A 30‑year‑old woman, 2 hours postpartum, develops heavy vaginal bleeding with hypotension. What is the first‑line management? A. Uterine massage and oxytocin infusion B. Immediate hysterectomy C. Uterine artery embolization D. High‑dose misoprostol only E. Blood transfusion alone

Correct Answer: A Reasoning: Immediate uterine massage and oxytocin infusion are the first‑line interventions to control postpartum hemorrhage due to uterine atony.

48. Endocrinology (Adrenal Crisis) A 40‑year‑old woman with known Addison’s disease presents with severe hypotension, vomiting, and confusion. What is the most critical initial management? A. Oral hydrocortisone B. Intravenous saline and hydrocortisone C. Fludrocortisone only D. High‑dose insulin E. Intravenous glucagon

Correct Answer: B Reasoning: Adrenal crisis is life‑threatening and requires prompt IV fluid resuscitation and hydrocortisone administration.

49. Infectious Diseases (Community-Acquired Pneumonia) A 50‑year‑old man with a history of smoking presents with fever, productive cough, and pleuritic chest pain. Chest X‑ray shows a lobar consolidation. What is the most appropriate initial antibiotic? A. Oral amoxicillin‑clavulanate B. Intravenous vancomycin C. Oral azithromycin D. Intravenous ceftriaxone E. No antibiotic is needed

Correct Answer: A Reasoning: For community‑acquired pneumonia in an adult with risk factors, a beta‑lactam plus a macrolide (or amoxicillin‑clavulanate) is generally recommended.

50. Gastroenterology (Peptic Ulcer Disease) A 45‑year‑old woman presents with epigastric pain that improves with food. Endoscopy reveals a duodenal ulcer. Which is the most appropriate management? A. High‑dose proton pump inhibitor (PPI) with Helicobacter pylori eradication therapy B. Surgical resection C. Oral antacids alone D. Long‑term H2 receptor blockers only E. Immediate endoscopic therapy

Correct Answer: A Reasoning: The first‑line treatment for duodenal ulcers involves PPI therapy combined with H. pylori eradication if indicated.

51. Cardiology (Atrial Fibrillation Management) A 68‑year‑old woman with newly diagnosed atrial fibrillation and a CHA₂DS₂‑VASc score of 3 is evaluated for stroke prevention. Which is the best next step? A. No treatment needed B. Start aspirin C. Start an oral anticoagulant D. Start rate‑control therapy only E. Immediate electrical cardioversion

Correct Answer: C Reasoning: In atrial fibrillation with a CHA₂DS₂‑VASc score of ≥2, oral anticoagulation is recommended to reduce stroke risk.

52. Pulmonology (COPD Exacerbation) A 70‑year‑old man with known COPD presents with increased dyspnea, cough, and purulent sputum. What is the most appropriate management for a moderate exacerbation? A. High‑flow oxygen only B. Oral corticosteroids and antibiotics C. Immediate mechanical ventilation D. Nebulized bronchodilators only E. Intravenous antibiotics only

Correct Answer: B Reasoning: For a moderate COPD exacerbation, a combination of oral corticosteroids, nebulized bronchodilators, and antibiotics (if bacterial infection is suspected) is recommended.

53. Neurology (Migraine Management) A 29‑year‑old woman presents with recurrent unilateral throbbing headaches associated with nausea and photophobia. What is the most appropriate acute management? A. High‑dose beta blockers B. Sumatriptan C. Prophylactic anticonvulsants D. Daily aspirin E. Intravenous magnesium sulfate

Correct Answer: B Reasoning: Triptans (such as sumatriptan) are first‑line acute treatment for moderate‑to‑severe migraines.

54. Surgery (Acute Cholecystitis) A 50‑year‑old woman presents with right upper quadrant pain, fever, and a positive Murphy’s sign. Ultrasound confirms acute cholecystitis. What is the most appropriate initial management? A. Immediate open cholecystectomy B. Conservative management with IV antibiotics and supportive care C. Laparoscopic cholecystectomy after initial stabilization D. Endoscopic retrograde cholangiopancreatography (ERCP) E. Percutaneous cholecystostomy only

Correct Answer: C Reasoning: Patients with acute cholecystitis are initially stabilized with IV antibiotics and then managed with early laparoscopic cholecystectomy.

55. Psychiatry (Acute Psychosis) A 30‑year‑old man presents to the emergency department with sudden onset of disorganized behavior, hallucinations, and agitation. What is the most appropriate immediate management? A. Oral benzodiazepines B. Intramuscular antipsychotic medication C. Immediate electroconvulsive therapy D. Observation only E. Outpatient follow‑up

Correct Answer: B Reasoning: In acute psychosis with agitation, IM antipsychotics are used for rapid control of symptoms.

56. Rheumatology (Gout) A 55‑year‑old man presents with acute onset of severe pain, redness, and swelling of the first metatarsophalangeal joint. What is the most appropriate initial treatment? A. Allopurinol B. Colchicine C. High‑dose aspirin D. Urate‑lowering therapy only after the attack resolves E. Antibiotics

Correct Answer: B Reasoning: Colchicine is effective when initiated early in an acute gout attack to reduce inflammation.

57. Pediatrics (Febrile Seizure) A 2‑year‑old child presents with a brief generalized seizure during a febrile illness. Which of the following is the best management? A. Routine antiepileptic drug therapy B. Reassurance and management of fever C. Immediate lumbar puncture D. MRI of the brain E. Prophylactic anticonvulsants

Correct Answer: B Reasoning: Simple febrile seizures are benign; the management is supportive with fever control and reassurance.

58. Obstetrics (Preterm Labor) A 28‑year‑old woman at 32 weeks’ gestation presents with regular uterine contractions and cervical change. Which is the most appropriate management to delay delivery? A. Immediate delivery B. Tocolytic therapy with magnesium sulfate C. Administration of tocolytics (e.g., nifedipine) and corticosteroids for fetal lung maturity D. Bed rest only E. High‑dose oxytocin

Correct Answer: C Reasoning: In preterm labor, tocolytics combined with corticosteroids help delay delivery and promote fetal lung maturity.

59. Neurology (Intracerebral Hemorrhage) A 60‑year‑old hypertensive man presents with sudden onset headache, vomiting, and neurological deficits. CT scan reveals an intracerebral hemorrhage. What is the most critical initial management step? A. Immediate surgical evacuation B. Blood pressure control and supportive care C. Intravenous thrombolysis D. High‑dose corticosteroids E. Oral anticoagulants

Correct Answer: B Reasoning: Management of intracerebral hemorrhage focuses on controlling blood pressure and supportive care to minimize further bleeding.

60. Cardiology (ST-Elevation Myocardial Infarction) A 58‑year‑old man presents with crushing chest pain, diaphoresis, and ST‑elevations on ECG. What is the most appropriate next step in management? A. Immediate coronary angiography and primary percutaneous coronary intervention (PCI) B. Oral beta blockers only C. Thrombolytic therapy if PCI is unavailable within the recommended window D. Intravenous nitrates only E. High‑dose statin therapy

Correct Answer: A Reasoning: For STEMI, the preferred treatment is immediate primary PCI. If PCI is not available within the recommended timeframe, thrombolytic therapy is considered.

End of Model Paper

This comprehensive paper—comprising 60 questions covering dermatology, infectious diseases, cardiology, gastroenterology, endocrinology, nephrology, pulmonology, neurology, obstetrics/gynecology, pediatrics, trauma, psychiatry, hematology, rheumatology, surgery, and urology—serves as a robust revision tool. The provided answers and explanations aim to enhance clinical reasoning and guide your preparation for examinations.