← Combined Technical (NG)
Past Questions — 2026
The most common cause of intradialytic hypotension is:
A)
Sepsis
B)
Acute myocardial infarction
C)
Autonomic neuropathy
D)
Excessive ultrafiltration
Intradialytic hypotension (IDH) occurs when the rate of fluid removal from the blood exceeds the rate at which fluid shifts from the interstitial space into the intravascular compartment.
1. Why 'd' is correct: Excessive ultrafiltration is the most common cause of IDH. When the ultrafiltration rate is too high (often due to excessive interdialytic weight gain or inaccurate dry weight assessment), the plasma volume drops faster than the body can compensate, leading to a drop in blood pressure.
2. Why other options are incorrect:
- Sepsis (a): While sepsis can cause hypotension due to systemic vasodilation and shock, it is an acute complication rather than the most common cause of hypotension specifically during dialysis.
- Acute myocardial infarction (b): This can cause cardiogenic shock and hypotension, but it is a rare event compared to the frequency of fluid-removal-related hypotension.
- Autonomic neuropathy (c): This is a predisposing factor (common in diabetic patients) that impairs the body's ability to compensate for fluid loss, but it is not the primary cause of the hypotension itself.
Maximum allowable endotoxin level in dialysis water is:
A)
<0.1 EU/mL
B)
<0.20 EU/mL
C)
<0.25 EU/mL
D)
0.5 EU/mL
According to the standards set by the Association for the Advancement of Medical Instrumentation (AAMI) and the ISO guidelines for hemodialysis water quality, the maximum allowable endotoxin level for dialysis water is <0.25 EU/mL.
1. Why Option (c) is correct: The standard limit for water used in hemodialysis is strictly maintained at less than 0.25 Endotoxin Units per milliliter (EU/mL) to prevent pyrogenic reactions and systemic inflammation in patients.
2. Why other options are incorrect:
- Option (a) <0.1 EU/mL is the standard for 'Ultrapure' water (used in Hemodiafiltration), which is a higher grade of purity than standard dialysis water.
- Option (b) <0.20 EU/mL is not a recognized standard threshold for general dialysis water.
- Option (d) 0.5 EU/mL exceeds the safety limit and would be considered contaminated, posing a risk of pyrogenic reactions.
Which government initiative focuses on water conservation in India?
A)
Swachh Bharat Abhiyan
B)
Jal Shakti Abhiyan
C)
Make in India
D)
Digital India
The correct option is 'Jal Shakti Abhiyan' because it is a campaign launched by the Government of India specifically for water conservation and water security, focusing on rainwater harvesting, recharge of aquifers, and renovation of traditional water bodies.
Other options are incorrect because:
- Swachh Bharat Abhiyan (a) focuses on sanitation and cleanliness (Open Defecation Free India).
- Digital India (d) focuses on transforming India into a digitally empowered society and knowledge economy.
- Make in India (c) is an initiative to encourage companies to manufacture their products in India to boost the economy and employment.
Which of the following is NOT a typical finding in Chronic Kidney Disease?
A)
Broad casts in urinary sediment
B)
Kidneys reduced in size bilaterally
C)
Persistent increase in serum sodium levels
D)
Persistent rise in serum creatinine levels
The correct option is (c) because Chronic Kidney Disease (CKD) typically leads to a deficit in the kidney's ability to excrete water and sodium, often resulting in hyponatremia (low serum sodium) due to water retention or dilution, rather than a persistent increase in serum sodium levels.
Other options are typical findings in CKD:
- (a) Broad casts: These are formed in dilated tubules of damaged kidneys and are a hallmark of end-stage renal disease.
- (b) Kidneys reduced in size: Chronic inflammation and fibrosis lead to atrophy and shrinkage of the kidneys (except in specific cases like diabetic nephropathy or polycystic kidney disease).
- (d) Persistent rise in serum creatinine: As the Glomerular Filtration Rate (GFR) declines permanently, creatinine clearance decreases, leading to a steady rise in serum creatinine levels.
Dialysis disequilibrium syndrome is primarily due to:
A)
Rapid removal of sodium
B)
Rapid potassium removal
C)
Rapid urea removal causing cerebral edema
D)
Inadequate removal of urea
Dialysis Disequilibrium Syndrome (DDS) occurs when urea is removed from the blood more rapidly than it can diffuse out of the brain cells. This creates an osmotic gradient where the blood becomes hypotonic relative to the brain tissue, drawing water into the brain cells and resulting in cerebral edema. This typically occurs during the first few sessions of dialysis in patients with very high blood urea nitrogen (BUN) levels.
Incorrect options:
- Option (a) and (b): While sodium and potassium levels are managed during dialysis, their rapid removal does not cause the specific osmotic shift in the brain associated with DDS.
- Option (d): Inadequate removal of urea would maintain the osmotic balance; it is the *rapid* removal (the steep drop in serum urea) that triggers the syndrome.
Among the following options, what is the most common cause of acute kidney injury in pregnancy?
A)
Thrombotic Thrombocytopenic Purpura
B)
Pre-eclampsia
C)
HELLP syndrome
D)
Acute fatty liver of pregnancy
Pre-eclampsia is the most common cause of acute kidney injury (AKI) in pregnancy. It leads to renal dysfunction primarily through glomerular endotheliosis, which causes a decrease in the glomerular filtration rate (GFR) and proteinuria. While other options can cause renal failure, they are significantly less frequent. HELLP syndrome (c) is often considered a severe manifestation of pre-eclampsia but is less common as a standalone primary cause of AKI. Thrombotic Thrombocytopenic Purpura (a) and Acute Fatty Liver of Pregnancy (d) are rare, life-threatening emergencies that can lead to AKI, but their incidence is much lower than that of pre-eclampsia.
The most common bone disease in CKD is:
A)
Osteoporosis
B)
Osteomalacia
C)
Paget disease
D)
Secondary hyperparathyroidism
The correct option is Secondary Hyperparathyroidism (SHPT). In Chronic Kidney Disease (CKD), the kidneys fail to excrete phosphate and cannot activate Vitamin D (calcitriol). This leads to hypocalcemia and hyperphosphatemia, which chronically stimulate the parathyroid glands to secrete Parathyroid Hormone (PTH) to maintain calcium levels. This process is the hallmark of CKD-Mineral and Bone Disorder (CKD-MBD) and is the most common bone-related pathology in these patients.
Why other options are incorrect:
- Osteoporosis (a): While common in the general elderly population, it is not the primary or most characteristic bone disease specifically caused by the pathophysiology of CKD.
- Osteomalacia (b): This refers to defective mineralization of the bone matrix (often due to Vitamin D deficiency). While it can occur in CKD, it is less common than the systemic hyperparathyroidism that drives renal osteodystrophy.
- Paget disease (c): This is a localized disorder of bone remodeling caused by overactive osteoclasts and osteoblasts; it is not related to kidney function or CKD.
In starvation, the body first uses:
A)
Protein
B)
Glycogen
C)
Fat
D)
Vitamins
During the initial stages of starvation, the body first utilizes glycogen stored in the liver and skeletal muscles. Glycogenolysis (the breakdown of glycogen into glucose) occurs to maintain blood glucose levels and provide immediate energy to the brain and muscles.
Why other options are incorrect:
- Fat (c): Once glycogen stores are depleted (usually within 12-24 hours), the body shifts to lipolysis, breaking down fats into fatty acids and ketones for energy.
- Protein (a): Protein breakdown (gluconeogenesis from amino acids) occurs primarily after glycogen is exhausted and as a last resort to preserve vital organ function.
- Vitamins (d): Vitamins are micronutrients used as cofactors for enzymes; they are not used as a primary fuel source for energy.
What does the term Azotaemia mean?
A)
Elevated level of nitrogenous waste products in the blood
B)
Elevated level of uric acid in the blood
C)
Elevated level of adenosine de-aminase level in the blood
D)
Elevated level of chylomicrons in the blood
Azotaemia (or azotemia) is derived from the Greek words 'azotos' (nitrogenous) and 'haima' (blood). It refers to the medical condition characterized by an abnormal accumulation of nitrogen-containing waste products—specifically urea, creatinine, and other nitrogenous compounds—in the blood, typically resulting from kidney dysfunction.
Why other options are incorrect:
- Option b: While elevated uric acid (hyperuricemia) is a type of nitrogenous waste increase, azotaemia is a broader term encompassing urea and creatinine, not just uric acid.
- Option c: Adenosine deaminase is an enzyme involved in immune function; its elevation is not termed azotaemia.
- Option d: Elevated chylomicrons (lipids) in the blood is referred to as hyperlipidemia or hyperchylomicronemia, not azotaemia.
Which fat is considered “good” fat for heart health?
A)
Trans fat
B)
Saturated fat
C)
Unsaturated fat
D)
Hydrogenated fat
Unsaturated fats (found in olive oil, nuts, and fish) are considered 'good' fats because they help reduce LDL (bad) cholesterol levels in the blood, thereby lowering the risk of heart disease and stroke. In contrast, Saturated fats (option b) can raise total cholesterol if consumed in excess, and Trans fats (option a) and Hydrogenated fats (option d)—which are often the same thing—are the most harmful as they simultaneously raise LDL and lower HDL (good) cholesterol, significantly increasing cardiovascular risk.
Which of the following plays an important role in delaying renal replacement therapy?
A)
Water
B)
Diet
C)
Beverages
D)
All of the above
Dietary management is a cornerstone in the conservative treatment of Chronic Kidney Disease (CKD) to delay the onset of Renal Replacement Therapy (RRT) such as dialysis or transplant. By restricting the intake of potassium, phosphorus, and sodium, and managing protein intake (low-protein diets), the workload on the kidneys is reduced, and the accumulation of uremic toxins is slowed.
While water (a) and beverages (c) are part of fluid management, they are subsets of overall dietary and nutritional guidelines. 'Diet' is the comprehensive term that encompasses protein restriction, electrolyte control, and fluid management, making it the most accurate and complete answer. Therefore, option 'b' is the primary driver in delaying RRT.
Maximum allowable bacterial count in dialysis water (AAMI standard) is:
A)
<50 CFU/mL
B)
<100 CFU/mL
C)
<200 CFU/mL
D)
<0.25 CFU/mL
According to the Association for the Advancement of Medical Instrumentation (AAMI) standards for dialysis water quality, the maximum allowable bacterial count for water used in hemodialysis is <100 colony-forming units per milliliter (CFU/mL). This limit is set to minimize the risk of pyrogenic reactions and systemic infections in patients.
- Option (a) <50 CFU/mL is more stringent than the standard AAMI requirement for general dialysis water.
- Option (c) <200 CFU/mL exceeds the safety threshold established by AAMI.
- Option (d) <0.25 CFU/mL refers to the standard for 'ultrapure' water (often used in CAPD or specific high-purity settings), not the general AAMI standard for dialysis water.
What are the general principles to be followed in AVF monitoring by physical examination?
A)
feel, look, listen
B)
look, listen, feel
C)
listen, look, feel
D)
None of the above
In the clinical assessment of an Arteriovenous Fistula (AVF), the standard sequence of physical examination follows the general medical diagnostic order: Look, Listen, and Feel.
1. **Look (Inspection):** The clinician first inspects the site for signs of infection, redness, swelling, aneurysms, or skin changes.
2. **Listen (Auscultation):** The clinician uses a stethoscope to listen for the characteristic 'bruit' (whooshing sound), which indicates the patency of the fistula.
3. **Feel (Palpation):** The clinician feels for the 'thrill' (vibration), which confirms blood flow. Palpation is often done last or in conjunction with auscultation to avoid altering the flow or causing discomfort before the initial visual assessment.
Options 'a' and 'c' are incorrect because they deviate from the standard clinical sequence of 'Inspection $\rightarrow$ Auscultation $\rightarrow$ Palpation' used in vascular access monitoring.
EDTA (Ethylenediaminetetraacetic acid) tubes are used for:
A)
Blood culture
B)
Coagulation tests
C)
Complete blood count
D)
Glucose test
EDTA (Ethylenediaminetetraacetic acid) is a powerful anticoagulant that works by chelating calcium ions, which are essential for the blood clotting cascade. It is the gold standard for a Complete Blood Count (CBC) because it preserves the morphology of blood cells and prevents platelet aggregation.
Incorrect options:
- a) Blood culture: Requires sterile tubes/bottles without anticoagulants to allow for the growth of microorganisms.
- b) Coagulation tests: Require Sodium Citrate (light blue top) tubes, as EDTA interferes with the clotting factors needed for these tests.
- d) Glucose test: Requires Fluoride (grey top) tubes to inhibit glycolysis (the breakdown of glucose by red blood cells).
All are clinical parameters to assess adequacy of dialysis, EXCEPT:
A)
Electrolytes in target range
B)
Adequate urine output
C)
No uremic symptoms
D)
Optimal dry weight
The adequacy of dialysis is assessed by whether the treatment effectively replaces the lost functions of the kidney to maintain homeostasis and eliminate toxins.
1. Why 'b' is correct: Urine output is a measure of residual renal function, not a measure of dialysis adequacy. A patient can have zero urine output (anuric) but still have perfectly adequate dialysis, or have high urine output but inadequate dialysis. Therefore, urine output is not a parameter used to assess if the dialysis process itself is sufficient.
2. Why other options are incorrect:
- 'a' (Electrolytes): Maintaining electrolytes (like potassium and phosphorus) within target ranges is a primary clinical goal of dialysis.
- 'c' (No uremic symptoms): The absence of uremic symptoms (e.g., nausea, pruritus, encephalopathy) is a key clinical indicator that the dialysis dose is sufficient to clear uremic toxins.
- 'd' (Optimal dry weight): Achieving and maintaining the optimal dry weight (absence of fluid overload/edema) indicates that the ultrafiltration component of dialysis is adequate.
Recommended drugs for thrombolysis of hemodialysis catheter :
A)
Alteplase
B)
Urokinase
C)
Heparin
D)
Both (a) and (b)
Thrombolysis of a hemodialysis catheter involves the use of fibrinolytic agents to dissolve an existing blood clot (thrombus) blocking the lumen.
1. **Alteplase (a)**: A recombinant tissue plasminogen activator (rtPA) that is highly specific for fibrin and is widely used and recommended for catheter declotting due to its efficacy.
2. **Urokinase (b)**: A plasminogen activator that is also frequently used for the thrombolysis of dialysis catheters, often as a more cost-effective alternative to Alteplase.
3. **Heparin (c)**: This is an anticoagulant, not a thrombolytic. While it is used to *prevent* the formation of clots (prophylaxis) or to prevent further extension of a clot, it cannot dissolve an existing thrombus.
Since both Alteplase and Urokinase are recommended pharmacological agents for the active lysis of clots in hemodialysis catheters, option (d) is the correct choice.
Glomerular disease increases permeability to:
A)
Urea
B)
Creatinine
C)
Proteins
D)
Phosphate
The glomerular filtration barrier (consisting of fenestrated endothelium, glomerular basement membrane, and podocytes) acts as a size and charge selective filter. Under normal conditions, it prevents large molecules and negatively charged proteins (like albumin) from entering the filtrate. In glomerular disease (e.g., glomerulonephritis or nephrotic syndrome), this barrier is damaged, increasing permeability to proteins, leading to proteinuria. Urea, creatinine, and phosphate are small molecules that are already freely filtered by a healthy glomerulus; therefore, glomerular disease does not 'increase' their permeability, but rather typically decreases their clearance due to a drop in the overall glomerular filtration rate (GFR).
Advantages of high flux membrane are:
A)
Better middle molecular clearance
B)
High resistance
C)
Back filtration
D)
All of the above
High-flux membranes are designed with larger pore sizes compared to low-flux membranes, which allows for the following:
1. Why 'a' is correct: The larger pores facilitate the removal of larger solute molecules (middle molecules), such as $\beta_2$-microglobulin, leading to better middle molecular clearance. This is the primary clinical advantage of high-flux dialysis.
2. Why 'b' is incorrect: High-flux membranes have lower hydraulic resistance to allow higher filtration rates, not high resistance.
3. Why 'c' is incorrect: Back filtration (the movement of fluid from the dialysate back into the blood) is actually a potential complication or a characteristic of high-flux membranes (due to the high permeability), not an 'advantage'.
4. Why 'd' is incorrect: Since options 'b' and 'c' are not advantages, 'All of the above' cannot be correct.
Immediate management of intradialytic hypotension includes all except:
A)
Trendelenburg position
B)
Reduction or stopping of ultrafiltration
C)
Boluses of normal saline 100 ml or more
D)
Reduction in blood flow rate
Intradialytic hypotension (IDH) occurs when fluid removal (ultrafiltration) exceeds the plasma refill rate from the interstitial space.
1. Why Option 'd' is correct: Reduction in blood flow rate (BFR) does not address the underlying cause of hypotension (volume depletion) and may actually decrease the efficiency of the dialysis session. It is not a standard immediate management step for IDH.
2. Why other options are incorrect (as they are standard management):
- Option 'a' (Trendelenburg position): This is a first-line maneuver to increase venous return to the heart and improve cerebral perfusion.
- Option 'b' (Reduction or stopping of ultrafiltration): This is the most critical immediate step to stop further fluid loss and stabilize blood pressure.
- Option 'c' (Boluses of normal saline): Administering isotonic saline helps restore intravascular volume quickly to treat the hypotensive episode.
The most common acute complication during hemodialysis is:
A)
Dialyzer reaction
B)
Hypotension
C)
Hemolysis
D)
Air embolism
1. Why Hypotension is correct: Intradialytic hypotension (IDH) is the most frequent acute complication encountered during hemodialysis. It primarily occurs due to the rapid removal of fluid (ultrafiltration) exceeding the rate at which plasma can refill the intravascular space from the interstitial compartment, leading to a drop in blood pressure.
2. Why other options are incorrect:
- Dialyzer reaction: While reactions to the membrane material (e.g., first-use syndrome) can occur, they are relatively uncommon with modern synthetic membranes.
- Hemolysis: This is a serious but rare complication, usually caused by severe technical errors such as improper blood pump speed or air in the circuit.
- Air embolism: This is a life-threatening emergency but is extremely rare due to the use of venous bubble traps and air detectors in modern dialysis machines.
In India, the full form of THOTA Act is:
A)
Transplantation of Human Organs and Tissues Act
B)
Transplantation of Heart and Organs technical Act
C)
Tissue Human Organ Transfer Act
D)
Transplantation Hospitals and Organ Trade Act
The correct full form of the THOTA Act is the 'Transplantation of Human Organs and Tissues Act'. This legislation is designed to regulate the removal, storage, and transplantation of human organs and tissues for therapeutic purposes and to prevent commercial dealings in human organs.
- Option (b) is incorrect because it specifies 'Heart' and 'technical Act', which is too narrow and inaccurate.
- Option (c) is incorrect as it rearranges the terms into 'Tissue Human Organ Transfer Act', which is not the legal title.
- Option (d) is incorrect because it refers to 'Hospitals and Organ Trade', whereas the act is focused on the legal process of 'Transplantation' and the prohibition of trade.
What is basal metabolic rate (BMR)?
A)
Energy used during exercise
B)
Energy used for digestion
C)
Energy used at rest for basic body functions
D)
Total energy intake per day
Basal Metabolic Rate (BMR) is the minimum amount of energy (calories) required to keep the body functioning while at complete rest. This includes vital processes such as breathing, blood circulation, cell production, and temperature regulation.
Incorrect options:
- Option (a) refers to 'Active Metabolic Rate' or physical activity energy expenditure.
- Option (b) refers to the 'Thermic Effect of Food' (TEF), which is the energy used to process nutrients.
- Option (d) refers to 'Total Daily Energy Intake' or caloric intake, which is the amount of energy consumed, not the rate at which it is burned by the body.
Which factor mainly influences food habits through traditions and customs?
A)
Economic
B)
Cultural
C)
Psychological
D)
Environmental
The correct option is 'Cultural' because traditions, customs, beliefs, and social norms are the core components of a culture. Cultural factors dictate what is considered edible, how food is prepared, and the rituals associated with eating within a specific community.
Other options are incorrect because:
- Economic factors (a) relate to affordability and income levels.
- Psychological factors (c) relate to individual emotions, cravings, and mental states.
- Environmental factors (d) relate to geography, climate, and the natural availability of food sources.
Which of the following is a complete protein?
A)
Wheat
B)
Rice
C)
Egg
D)
Corn
A complete protein is a dietary protein that contains all nine essential amino acids that the human body cannot synthesize on its own.
1. **Why Egg is correct:** Eggs are considered a high-quality complete protein because they provide all essential amino acids in the proportions required by the human body.
2. **Why others are incorrect:** Rice, Wheat, and Corn are plant-based proteins (cereals/grains). Most grains are incomplete proteins because they are deficient in one or more essential amino acids (for example, most cereals are limiting in lysine).
The position used in a cardiac bed is:
A)
Sim’s position
B)
Fowler’s or high fowler’s position
C)
Knee-chest position
D)
Prone position
The correct option is Fowler's or high Fowler's position. In cardiac care (such as for patients with heart failure or myocardial infarction), this upright position (45-90 degrees) is used because it allows for maximum chest expansion, decreases venous return to the heart (reducing preload), and eases the work of breathing by allowing the diaphragm to drop, thereby reducing cardiac workload and dyspnea.
Incorrect options:
- Sim’s position: A semi-prone position used primarily for rectal examinations or administering enemas.
- Prone position: Lying flat on the stomach, which would severely restrict chest expansion and increase cardiac strain.
- Knee-chest position: Used primarily for gynecological or rectal examinations, not for cardiac stability.