Category Archives: MCQS

Pharmacology 1-30 FMGE MCQs


1.Which drug name is not a generic name?


B. Valium

C. Ipratropium

D. Hyoscine

2.Which of the following is not a pharmacokinetic property of a drug?

A. Metabolism

B. Protein-binding

C. Absorption

D. Receptor-binding

3. Sodium hydrogen carbonate is sold as a drug under various names such as alkali, baking soda, uracol, and sodium bicarbonate. Which of the following is considered a proprietary name for this substance?

A. Uracol

B. Sodium bicarbonate

C. Sodium hydrogen carbonate

D. Baking soda

4. Drugs are often protein-bound in the bloodstream. What is the principal protein that does this best?

A. Fibrinogen

B. Albumin

C. Haemoglobin

D. Gamma globulin

5. Natural vitamin E is usually given in gelatine capsules dissolved in soybean oil. Which word would best described the property of vitamin E in this process?

A. Lipophobic

B. Hydrophilic

C. Lipophilic

D. Hydroxylation

6. The principal site of drug metabolism is the:

A. kidneys

B. stomach

C. colon

D. liver

7. The most efficient absorption of a drug takes place in the ileum if the drug is:

A. non-ionised at a pH of ~6

B. a weak base

C. ionised at a pH of ~8

D. a weak acid

8. What is the basic mechanism of action of an osmotic diuretic such as urea?

A. Physical

B. Chemical

C. Enzyme inhibition

D. Receptor activation

9. A drug administered to a person produced a blood concentration of 900 ng/L after 3 hours. After a further 5 hours the concentration had fallen to 300 ng/L. What is the approximate half-life of this drug assuming zero kinetics?

A. 5 hours

B. 3 hours

C. 4.5 hours

D. 3.5 hours

10. Morphine and pentazocine both act upon similar receptors in the central nervous system and produce analgesia. If pentazocine is given to a morphine addict it may produce withdrawal symptoms. What kind of action does pentazocine have at opioid receptors?

A. A full antagonist action

B. A partial agonist action

C. A full agonist action

D. An inhibitor action

11. Which of these drugs is a potent enzyme inhibitor in the liver?

A. Famotidine

B. Nizatidine

C. Ranitidine

D. Cimetidine

12. Under what conditions is it most important to store sodium nitroprusside?

A. Protected from heat

B. Protected from moisture

C. Protected from cold

D. Protected from light

13. It is possible to refer to a medication using different names. Which type of name is best to use in clinical practice?

A. The medication’s trade name.

B. The medication’s proprietary name.

C. The medication’s chemical name.

D. The medication’s generic name.

14. A drug’s margin of safety is the dose range which places it:

A. above both the minimum effective concentration (mec) and maximum safe concentration (msc)

B. below the maximum safe concentration (msc) and above the minimum effective concentration (mec)

C. above the maximum safe concentration (msc) and below the minimum effective concentration (mec)

D. below both the maximum safe concentration (msc) and minimum effective concentration (mec)

15. Blood cell lysis is associated with which type of hypersensitivity reaction?




D. I

16. Placental drug transfer is affected by the drug’s:

A. molecular size only

B. affinity for plasma proteins only

C. concentration gradient across the placenta only

D. all of the above affect placental drug transfer

17. In reference to the use of medicines in pregnancy, a category X drug is described as a medicine:

A. where animal studies may be inadequate, but there is no evidence of foetal damage

B. that has no proven harmful effects on the foetus

C. have a high risk of causing irreversible damage to the foetus

D. where the harmful effects on the foetus may be reversible

18. A slow acetylator administered a drug metabolised in this way may warrant:

A. an increase in drug dosage

B. a decrease in drug dosage

C. no special considerations in their care

D. more frequent dosage

19. Parenteral drug absorption in a person with congestive cardiac failure might be expected to result in:

A. higher blood concentration and a lower concentration at the injection site

B. lower blood concentration and a higher concentration at the injection site

C. higher blood concentration and a higher concentration at the injection site

D. lower blood concentration and a lower concentration at the injection site

20. Which of the following physiological states would be expected to result in higher plasma levels if the drug was hydrophilic?

A. When taking the drug with food

B. Diuresis

C. An increase in gut peristalsis

D. In hepatic disorders

21. Which of the following statements is applicable when administering a drug to a paediatric client?

A. Involve the parents in the procedure

B. In order to gain the child’s co-operation tell the child that injections don’t hurt.

C. Prepare the medications in front of the child.

D. Avoid the oral route when giving a drug to a young child.

22. Generally, the most reliable indicator for paediatric dose calculations is:

A. age

B. bodyweight

C. sex

D. body surface area

23. Why is it important to assess the number of medications an elderly client is taking?

A. Solely to minimise drug interactions

B. Solely to minimise adverse drug reactions

C. Only because the person may be seeing a number of doctors who do not communicate with each other about the drugs they have prescribed

D. All of the above

24. Which of the following factors would not be expected to contribute to compliance with drug treatment in the elderly?

A. Individualised medication education

B. Complicated drug regimens

C. Use of a dosette box

D. Thorough assessment of clients

25. If aspirin is administered together with warfarin, what is the most likely outcome with respect to protein binding?

A. There will be more unbound (free) form of the warfarin available, leading to a decreased bleeding tendency.

B. There will be more bound form of the warfarin available, leading to an increased bleeding tendency.

C. There will be more bound form of the warfarin available, leading to a decreased bleeding tendency.

D. There will be more free (or unbound) form of the warfarin available, leading to increased bleeding tendency.

26. Which of the following is not a type of phase I metabolism?

A. Removal or addition of an active molecule group on a drug.

B. Conjugation of a drug with a polar molecule to render the product soluble for excretion.

C. Oxidation of a drug.

D. Reduction and hydrolysis of a drug.

27. _______ medications have a larger volume of distribution in neonates and young infants compared with adults and therefore require a larger dose to reach therapeutic levels.

A. highly protein bound

B. hydrophilic and lipophilic

C. hydrophilic

D. lipophilic

28. In which state are drugs more likely to be well absorbed?

A. Polar

B. Un-ionised

C. Charged

D. Hydrophilic

29. In a case of poisoning, a drug with which apparent volume of distribution would be most effectively cleared from the body by haemodialysis?

A. 50 L/kg

B. 0.57 L/kg

C. 0.04 L/kg

D. 3 L/kg

30. The parameters that contribute to determining the drug half-life are:

A. clearance and apparent volumegggof distribution

B. apparent volume of distribution and plasma drug concentration

C. loading dose and clearance

D. frequency of administration and plasma drug concentration



Question 21: All the following are correct about radiological evaluation of a patient with Cushing’s syndrome except

1. Adrenal CT scan distinguishes adrenal cortical hyperplasia from an adrenal tumor

2. CT of sella tursica is diagnostic when a pituitary tumor is present

3. MRI of the adrenals may distinguish adrenal adenoma from carcinoma

4. Petrosal sinus sampling is the best way to distinguish tumor from an ectopic ACTH producing tumor

Question 22: Most physiological treatment of duodenal ulcer is

1. Highly selective vagotomy

2. Antrectomy

3. Vagotomy & gastrojejunostomy

4. Gastrojejunostomy

Question 23: A 30 year old male was brought to the casualty following a road traffic accident. His physical examination revealed that his right lower limb was short, internally rotated, and flexed and adducted at the hip. The most likely diagnosis is

1. Posterior dislocation of hip

2. Central Fracture dislocation of hip

3. Trochanteric fracture

4. Fracture neck of femur

Question 24: Incontinence in urinary tract infection is

1. False

2. True

3. Stress

4. Urge

Question 25: Inversion injury of foot is associated with damage to all the following except 1.

1. Lateral malleolus

2. Base of 5th metatarsal bone

3. Sustentaculum tali

4. Extensor digitorum brevis

Question 26: A man aged 60 yrs has h/o IHD and atherosclerosis. He presents with abdominal pain and maroon stools, likely diagnosis is

1. Acute intestinal obstruction

2. Acute mesenteric ischemia

3. Peritonitis

4. Appendicitis

Question 27: An anterolateral corodotomy relieving pain in right leg is effective because it interrupts the:

1. Left dorsal column

2. Left ventral spinothalmic tract

3. Left lateral spinothalmic tract

4. Right lateral spinothalmic tract

Question 28: Thickness of stomach in ultrasound is

1. 2mm

2. 5mm

3. 7mm

4. 10mm

Question 29: A 27 year old man presents with a left testicular tumor with a 10 cm retroperitoneal lymph node mass. The treatment of choice is

1. Radiotherapy

2. Immunotherapy with interferon and interleukins

3. Left high inguinal orchiectomy plus chemotherapy

4. Chemotherapy alone

Question 30: Sympathectomy is indicated in all the following conditions except

1. Ischaemic ulcers

2. Anhidrosis

3. Intermittent claudication

4. Acrocyanosis

Question 31: Most common cause of acute pancreatitis is

1. Gall stone

2. Alcohol

3. Trauma

4. Cyst

Question 32: True intracavernous aneurysms present with

1. Ophthalmological problems

2. Headache

3. Nasal intonation of voice

4. Vomiting

Question 33: Littre’s hernia includes

1. Meckel’s diverticulum

2. Intestinal margins

3. Umblicus

4. Omentum

Question 34: The commonest site for congenital “Arachnoid cyst” is

1. Sylvian fissure

2. Cerebello-pontine angle

3. Cerebello-pontine angle

4. Cerebellar vermis

Question 35: A post thyroidectomy patient presents with tingling and perioral paresthesia. Serum calcium level was 7 mg/dL. Which of the following is the best line of management

1. Oral vitamin D3

2. Oral vitamin D3 with calcium

3. I.V.calcium gluconate

4. Observation

Question 36: In which of the following conditions is paradoxical respiration observed

1. Stove-in chest

2. Flail chest

3. Pneumothorax

4. Haemopneumothorax

Question 37: Which one of the following radio-isotopes is commonly used as a source for external beam radiotherapy in the treatment of cancer patients

1. Strontium-89

2. Radium-226

3. Cobalt-59

4. Cobalt-60

Question 38: Shepherd crook deformity is seen in

1. Osteopetrosis

2. Fibrous dysplasia

3. Rheumatoid arthritis

4. Osteoarthritis

Question 39: Fraying and cupping of metaphyses of long bones in an child does not occur in

1. Rickets

2. Lead poisoning

3. Metaphyseal dysplasia

4. Hypophosphatasia

Question 40: “CSF Rhinorrhoea” may occur because of all except

1. Trauma

2. Chronically Raised Intracranial pressure

3. Acoustic tumor

4. Pituitary surgery


Try to Solve them n Post your Answers through Comment.  I’ll Post Answers Tomorrow in Comment Section.

Question 11: The Hunterian Ligature operation is performed for

1. Varicose veins

2. Arteriovenous fistulae

3. Aneurysm

4. Acute ischemia

Question 12: The most common malignancy after cholecystectomy is of

1. Colon

2. Stomach

3. Pancreas

4. Ileum

Question 13: All the following indicates early gastric cancer except

1. Involvement of mucosa

2. Involvement of mucosa and submucosa

3. Involvement of mucosa, submucosa and muscularis

4. Involvement of mucosa, submucosa and adjacent lymph nodes

Question 14: Trans-cranial Doppler Ultrasonography(TCD) uses all of the following windows except

1. Trans-temporal

2. Trans-orbital

3. Foramen magnum

4. Trans-frontal

Question 15: In a motor vehicle accident the seat belt leads to following EXPECTED

1. Reduced incidence of severe thoracic injury

2. Occurrence of small intestine and mesenteric injury

3. Increased severity of decelerating head injury

4. Trauma to major intra abdominal

Question 16: After appendicectomy, fecal fistula may be due to

1. Crohn’s disease

2. Ulcerative colitis

3. TB

4. Amebic colitis

Question 17: In a patient having heavy dense bones, penetration is best achieved by

1. Increase in mA

2. Increase in kVp

3. Increased exposure time

4. Increased developing time

Question 18: Which type of hypospadias does not need any treatment

1. Galndular

2. Coronal

3. Penile

4. Peno-scrotal

Question 19: On her third of hospitalization, a 70 year old woman who is being treated for acute cholecystitis develops increased pain and tenderness in the right upper quadrant with a palpable mass. Her temperature rises to 104 F and her BP falls to 80/60.Heametamesis and malena ensue and petechiae are noted. Laboratory studies reveal thrombocytopenia, prolonged PT, and decreased fibrinogen level. The most important step in the correction of this patients coagulopathy

1. Administration of heparin

2. Administration of fresh frozen plasma

3. Administration of Epsilon amino caproic acid

4. Exploratory laparotomy

Question 20: The treatment modality of achalasia which has the maximum probability of causing a recurrence is

1. Pneumatic dilatation

2. Laparoscopic myotomy

3. Botulinum toxin

4. Open surgical myotomy


Question 1: A patient presented with a 3.5 cms size lymph node enlargement, which was hard and presented in submandibular region. Examination of the head and neck did not yield any lesion. The next investigation to be done

1. CXR

2. Triple endoscopy

3. Supravital staining of oral mucosa

4. Laryngoscopy

Question 2: A 50-year old male. Working as a hotel cook, has four dependent family members. He has been diagnosed with an early stage squamous cell cancer of anal canal. He has more than 60% chances of cure. The best treatment option is

1. Abdomino-perineal resection

2. Combined surgery and radiotherapy

3. Combined chemotherapy and radiotherapy

4. Chemotherapy alone

Question 3: A patient on same evening after thyroidectomy has swelling and difficulty breathing. Next step of management will be

1. Open immediately

2. Intubate oro tracheally

3. Wait and watch

4. Oxygen by mask

Question 4: Most common cause of aneurysm of abdominal aorta is

1. Trauma

2. Atherosclerosis

3. Syphilis

4. Cysitic medial necrosis

Question 5: Post cricoid carcinoma of the oesophagus are best treated by

1. Radiotherapy

2. Total oesophagectomy

3. Pharyngolaryngectomy with gastric transposition

4. Intubation through growth

Question 6: Pitutary region can be best viewed by

1. Plain AP view

2. Caldwell

3. Townes

4. Basal view

Question 7: Isotope selectively concentrated in abscess cavities

1. Gallium

2. Technetium

3. Selenium

4. Chromium

Question 8: Neural tube defects occur during gestational age

1. 18-22 days

2. 26-30 days

3. 22-26 days

4. 30-34 days

Question 9: The muscle pair which rotates radius without flexion and extension at arm is

1. Pronator quadratus and pronator teres

2. Supinator and Anconeus

3. Bachioradialis and brachialis

4. Triceps and Biceps brachii

Question 10: A lady presents with a history of fracture radius, which was put on plaster of paris cast for 4 weeks. After that she developed swelling of hands with shiny skin. What is the most likely diagnosis

1. Rupture of extensor policis longus tendon

2. Myositis ossificans

3. Reflex sympathetic dystrophy

4. Malunion

SURGERY MOST COMMON  FMGE QUESTIONS, Try to Solve them n Post your Answers through Comment.

   I’ll Post Answers Tomorrow…

55 Mcq’s with Explanations & Imp. Points

Click to Download: 55 Mcq’s n Imp Points Pdf File

1. All of the following muscles are composite muscles except:
a. Pectineus
b. Rectus femoris
c. Adductor magnus
d. Biceps femoris
The pectineus is supplied by the femoral nerve and the accessory Obturator nerve (L3). also receives a branch from the Obturator nerve. adductor magnus and biceps femoris have a dual nerve supply.

2. All of the following are digastric muscles, except:
a. Muscle fibers in the ligament of Trietz
b. Omohyoid
c. Occipitofrontalis
d. Sternocleidomastoid
The sternocleidomastoid takes origin by two heads and is not a digastric muscle

3. In the lungs bronchial arteries supply the bronchopulmonary tree:
a. Till the tertiary bronchus
b. Till segmental bronchi
c. Till respiratory bronchiole
d. Till alveolar sacs
The arteries supply as far as the respiratory bronchioles. Tissues which do not have close access to atmospheric oxygen are supplied by the bronchial arteries.

4. The skin overlying the region where a venous cutdown is made to access the great saphenous vein is supplied by:
a. Femoral nerve
b. Sural nerve
c. Tibial nerve
d. Superficial peroneal nerve
The skin is supplied by the saphenous nerve which is a branch of the femoral nerve.

5. Which of the following is the correct order of pathway for a sperm:
a. Straight tubules- rete testis- efferent tubules
b. Rete testis- efferent tubules- straight tubules
c. Efferent tubules- rete testis- straight tubules
d. Straight tubules- efferent tubules- rete testis
Straight tubules are seminiferous tubules. The sperm passes through the rete testis to reach the efferent tubules (ductules).

6. Which of the following veins is found in relation to the paraduodenal fossa:
a. Inferior mesenteric vein
b. Middle colic vein
c. Left colic vein
d. Splenic vein

7. The artery to the ductus deferns is a branch of:
• Inferior epigastric artery
• Superior epigastric artery
• Superior vesical artery
• Cremasteric artery
An artery supplying a visceral structure is always a branch of another visceral artery to some related viscera. Here only the superior vesical artery is a visceral artery and the rest all the parietal (supply the structures in the abdominal wall).

8. Tributary of the cavernous sinus includes all of the following except:
• Superior petrosal sinus
• Inferior petrosal sinus
• Superficial middle cerebral vein
• Deep middle cerebral vein
Deep middle cerebral vein forms the basal vein. The basal veins join the great cerebral vein and finally drain into the straight sinus.

9. All of the following statements about diploic veins are true, except:
• Develop around 8 weeks of gestation
• These have no valves
• Present in cranial bones
• Have a thin wall lined by a single layer of endothelium
The diploic veins are absent at birth and appear at 2 years of age.
10. Which of the following bones do not contribute to the formation of the nasal septum:
• Sphenoid
• Lacrimal
• Palatine
• Ethmoid
Mainly formed by the vomer and the ethmoid with small contributions from the palatine and sphenoid bones.

11. All of the following cranial nerves contain somatic efferents except:
• Facial nerve
• Oculomotor nerve
• Trochlear nerve
• Abducent nerve
Facial nerve contains no somatic efferent fibers as it supplies only the muscles derived from the branchial arches. It does not supply any muscle derived from the somites.

12. Facial colliculus is seen in the:
• Midbrain
• Pons
• Medulla
• Interpeduncular fossa
Facial colliculus is seen on the posterior aspect of the pons in the floor of the fourth ventricle.

13. Which is the nucleus of masseteric reflex:
• Superior sensory nucleus of the trigeminal nerve
• Spinal nucleus of trigeminal nerve
• Mesencephalic nucleus of trigeminal nerve
• Dorsal nucleus of vagus nerve
Proprioceptive impulses from the masticatory muscles are conveyed through the mesencephalic nucleus of the trigeminal nerve. The neurons are unique in being the only primary sensory neurons with cell bodies in the CNS. The masseteric reflex or the jaw jerk is the only supraspinal monosynaptic reflex and the mesencephalic nucleus is a relay station for the same.

14. Primordial germ cells are derived from:
• Ectoderm
• Mesoderm
• Endoderm
• Mesodermal sinus
Technically, the primordial germ cells are derived from the epiblast long before the establishment of the three germ layers. There is a difference between where they are first seen and from where they are derived. Well they are definitely first seen in the endoderm.
15. Movements of pronation and supination occurs in all the following joints except:
• Superior radio ulnar joint
• Middle radio ulnar joint
• Inferior radio ulnar joint
• Radio carpal joint
these movements take place only between the radius and the ulna. Rotatory movements are not possible at the wrist joint.

16. About posterior cruciate ligament- true statement is:
• Attached to the lateral femoral condyle
• Intrasynovial
• Prevents posterior dislocation of tibia
• Relaxed in full flexion
The posterior cruciate ligament is attached anteriorly to the medial femoral condyle and posteriorly to the upper surface of tibia. It prevents the posterior dislocation of tibia on the femur. everything is taut during extension.

17. Structures that pass from thorax to abdomen behind the diaphragm are all except:
• Azygous vein
• Aorta
• Thoracic duct
• Greater splanchnic nerve
Technically all the structures passing through the aortic hiatus are posterior to the diaphragm. The greater splanchnic nerves pierce the diaphragm to reach the abdominal cavity.

18. Most common site of Morgagni hernia is:
• Left anterior
• Right posterior
• Right anterior
• Left posterior
These are Subcostosternal hernias through a defect in the anterior diaphragm. Most commonly occurs on the right side.

19. Structure that does not cross the midline is:
• Left gonadal vein
• Left renal vein
• Left brachiocephalic vein
• Hemiazygous vein
All the veins of the left side cross the midline to join the veins on the right side, directly or indirectly, because the left drainage channel to the heart (the left horn of sinus venosus) disappears during development. The left gonadal vein drains into the left renal vein and thus does not physically cross the midline.

20. Portosystemic shunt is not seen in
• Liver
• Spleen
• Anorectum
• Gastroesophageal
Portosystemic shunt is primarily seen in the structures derived from or related to the gastrointestinal tract. Spleen develops outside the gastrointestinal system

21. Injury to the male urethra below the perineal membrane causes urine to accumulate in:
• Superficial perineal pouch
• Deep perineal pouch
• Space of retzius
• Pouch of douglas
Superficial perineal pouch is superficial to the perineal membrane.

22. All are true about the trigone of the urinary bladder except:
• Mucosa is loosely attached to the underlying musculature
• Mucosa is smooth
• It is lined by transitional epithelium
• It is derived from the absorbed part of the mesonephric duct
Mucosa is never loosely attached to the underlying mucosa anywhere in the body. the efficient expansion of the bladder is due to the transitional epithelium and not due to a loosely attached mucosa.

23. Supports of the uterus are all except:
• Uterosacral ligament
• Broad ligament
• Mackenrodt’s ligament
• Levator ani
Broad ligament is just a fold of peritoneum.

24. Posterior communicating artery is a branch of:
• Internal carotid
• External carotid
• Middle cerebral
• Posterior superior cerebellar
Posterior communicating artery is a branch of the cerebral part of internal carotid artery.

25. Which of the following is not a branch of cavernous segment of the internal carotid artery
• Cavernous branch
• Inferior hypophyseal artery
• Meningeal branch
• Ophthalmic branch
The Ophthalmic artery is a branch from the cavernous part.

26. Difference between typical cervical and thoracic vertebra:
• Has a triangular body
• Has foramen transversarium
• Superior articular facet directed backwards and upwards
• Has a large vertebral body
Foramen transversarium is a feature unique to the cervical vertebrae.

27. Which part of the vertebral canal will show secondary curves with concavity backwards:
• Cervical
• Thoracic
• Sacral
• Coccyx
The two secondary curves are the lumbar and the cervical curves. Both are convex anteriorly.

28. Which of the following has an intra articular tendon:
• Sartorius
• Semitendinosus
• Anconeus
• Popliteus
The tendon of popliteus is enclosed by the knee joint capsule.

29. Which of the following is not a sign of stellate ganglion block:
• Miosis
• Exophthalmos
• Nasal congestion
• Conjunctival redness
Obviously, exophthalmos. The enophthalmos that is seen is because of the ptosis. There is no true retraction of the eyeball into the orbital cavity.

30. A 43 year old woman came with a large abscess in the middle of the right posterior triangle of the neck. The physician incised and drained the abscess. Five days later the patient noticed that she could not extend her right hand above her head to brush her hair. Which of the following are the signs and symptoms of additional harm:
• Damage to scalenus medius
• Injury to suprascapular nerve
• Cut to spinal part of accessory nerve
• Spread of infection to the shoulder joint
The trapezius and the Serratus anterior are responsible for overhead abduction. Trapezius is supplied by the spinal part of accessory nerve which lies in the posterior triangle of the neck.

31. Middle meningeal artery is a direct branch of:
• External carotid artery
• Internal maxillary artery
• Superficial temporal artery
• Middle cerebral artery
It is a direct branch of the first part of the maxillary artery.

32. In adults, the spinal cord normally ends at:
• Lower border of L1
• Lower border of L3
• Lower border of S1
• Lower border of L5
In adults it is the lower border of L1.

33. Lymphatic drainage of the cervix occurs by all of the following lymph nodes except:
• Parametrial lymph nodes
• Deep inguinal lymph nodes
• Obturator lymph nodes
• External iliac lymph nodes
The superficial inguinal nodes receive lymphatics from the uterus but not the deep inguinal nodes.

34. All of the following are the components of the white pulp of spleen except:
• Periarteriolar lymphoid sheath
• B cells
• Antigen presenting cells
• Vascular sinus
The vascular sinuses represent the red pulp.

35. Polar bodies are formed during:
• Spermatogenesis
• Organogenesis
• Oogenesis
• Morphogenesis

36. The carpal tunnel contains all of the following important structures except:
• Median nerve
• Flexor pollicis longus
• Flexor carpi radialis
• Flexor digitorum superficialis
The flexor carpi radialis is superficial to the flexor retinaculum.

37. The femoral ring is bounded by the following structures except:
• Femoral vein
• Inguinal ligament
• Femoral artery
• Lacunar ligament
The femoral ring is the entrance to the femoral canal. The femoral vein lies medial to the femoral canal and the femoral artery lies lateral to the vein.

38. While doing thoracocentesis, it is advisable to introduce needle along:
• Upper border of the rib
• Lower border of the rib
• In the center of the intercostal space
• In the anterior part of the intercostal space
The lower border of the ribs contains the neurovascular bundle.

39. Benign prostatic hypertrophy results in obstruction of the urinary tract. The specific condition is associated with enlargement of the:
• Entire prostate gland
• Lateral lobes
• Median lobe
• Posterior lobe
The median lobe of the prostate is classically described as enlarged during BPH.

40. Prostatic urethra is characterized by all of the following features, except that it:
• Is the widest and most dilatable part
• Presents a concavity posteriorly
• Lies closer to anterior surface of prostate
• Receives prostatic ductules along its posterior wall
The posterior wall of the prostatic urethra is convex anteriorly. the convexity is known as the urethral crest.

41. All of the following statements regarding vas deferns are true except:
• The terminal part is dilated to form ampulla
• It crosses ureter in the region of ischial spine
• It passes lateral to the inferior epigastric artery at the deep inguinal ring
• It is separated from the base of the bladder by the peritoneum
There is no peritoneum between the base of the bladder and the vas deferns.

42. The following groups of lymph nodes receive lymphatics from the uterus except:
• External iliac
• Internalilliac
• Superficial inguinal
• Deep inguinal
The deep inguinal nodes do not receive lymphatics from the uterus.

43. In an adult male, on per rectal examination, the following structures can be felt anteriorly except:
• Internal illiac lymph nodes
• Bulb of the penis
• Prostate
• Seminal vesicle when enlarged
The internal iliac nodes are at the level of the sigmoid colon. they can be felt posteriorly, if enlarged.

44. All of the following are branches of the external carotid artery except:
• Superior thyroid artery
• Anterior ethmoidal artery
• Occipital artery
• Posterior auricular artery
Anterior ethmoidal artery is not a branch from the external carotid artery.

45. Paralysis of 3rd, 4th, 6th nerves with involvement of the ophthalmic division of the 5th nerve, localizes the lesion to:
• Cavernous sinus
• Apex of the orbit
• Brainstem
• Base of the skull
All these nerves are in relation to the cavernous sinus.

46. The superior oblique muscle is supplied by:
• 3rd cranial nerve
• 4th cranial nerve
• 5th cranial nerve
• 6th cranial nerve
SO4, LR6

47. The following statements concerning chorda tympani nerve are true except that it:
• Carries secretomotor fibers to submandibular gland
• Joins lingual nerve in the infratemporal fossa
• Is a branch of the facial nerve
• Contains postganglionic parasympathetic fibers
The nerve contains preganglionic parasympathetic and taste fibers.

48. The type of joint between sacrum and the coccyx is a:
• Symphysis
• Synostosis
• Synchondrosis
• Syndesmosis
It is secondary cartilaginous joint also known as a symphysis

49. All of the following physiological processes occur during the growth at the Epiphyseal plate except:
• Proliferation and hypertrophy
• Calcification and ossification
• Vasculogenesis and erosion
• Replacement of red bone marrow with yellow marrow
Bone marrow is not present in the Epiphyseal plate.

50. Barr body is found in the following phase of the cell cycle:
• Interphase
• Metaphase
• GI phase
• Telophase
A Barr body is only seen during periods of inactivity.


51. A patient with bilirubin value of 8 mg/dl and serum creatinine of 1.9 mg/dl is planned for surgery. What is the muscle relaxant of choice in this patient?
A. Vecuronium
B. Pancuronium
C. Atracurium
D. Rocuronium
Ans: C.

52. A 25 year old overweight female was given fentanyl-pancuronium anesthesia for surgery. After surgery and extubation she was observed to have limited movement of the upper body and chest wall in the recovery room. She was conscious and alert but voluntary respiratory effort was limited. Her blood pressure and heart rate were normal. The likely diagnosis is:
A. Incomplete reversal of pancuronium
B. Pulmonary embolism
C. Fentanyl induced chest wall rigidity
D. Respiratory depression
Ans A.

53. All of the following statements about neuromuscular blockage produced by succinylcholine are true, except:
A. No fade on train of four stimulation
B. Fade on tetanic stimulation
C. No post tetanic facilitation
D. Train of four ratio > 0.4
Ans: B.

54. A 27 year old female was brought to emergency department for acute abdominal pain following which she was shifted to the operation theatre for laparotomy. A speedy intubation was performed but after the intubation, breath sounds were observed to be decreased on the left side and a high end trial CO2 was recorded. The likely diagnosis is:
A. Endotracheal tube blockage
B. Bronchospasm
C. Esophageal intubation
D. Endobronchial intubation
Ans: D.

Important Points:

Aneurysms Important Points

1. The Most common type of true aneurysm is fusiform type.
2. Most common Site: Arterial Aneurysm is Infra renal part of abdominal aorta
3. Popliteal Aneurysms are most common peripheral aneurysms
4. The Most common site for dissecting aneurysms is Ascending aorta
MC AAA (Abdominal aortic aneurysm is Atherosclerosis
True aneurysm tht involve all 3 layes. Present wd Large,Pulsatil mass above the umbilicus.
Once Rupture it present a Classic “Pain-Hypotension-Mass triad” Radiating pain acute sever Constant abdomen to back…..
Medical treatment strict control Bp….
Surgical is definitive treatment… >5.5
Radiology: CT scan…
Cirsoid aneurysmd are common in superficial temporal artery
Berry Aneurysm occur Circle of willis
Anterior Cerebral artery Most common
Rupture in Subarachnoid Hemorrhage (severe pain headache wrost in my life) Most common SAH Trauma Radiology: NCCT scan…. III Cranial Nerve (Optic N) Involve….
Polycystic Kidney disease also present Berry Aneurysm
Micro Aneurysm seen in DM & HTN
Mycotic Aneurysms are seen in Bacterial Infections
Aortic Dissecting Aneurysms due to degeneration of tunica media. Occur in Marfans syndrome (Chromosome 15) also present AR (aortic regurgitation, Ectopic lense Upper temporal lense detachment Retinal detachment) and HTN
Syphilitic Aneurysms or luetic aneurysms involve ascending aorta
Pseudo-aneurysm femoral artery( External iliac artery continuation) follow trauma usually……..

Arterial Diseases

Burgers Disease (Thromoangitis Obliterans)
1. Affects Small and Medium Sized Arteries….
2. Affect young <40years if > 40years then Atherosclerosis…..
3. Ankle index pressure is low here..
4. Smokers
5. Coldness and Numbness of toes is the 1st sign
6. Xanithol nicotinate is used for treatment
7. Lumbar sympathetectomy is done…
8. Martorells sign is (+)ve…..
For Raynauds Disease: affects arterioles. Features are: Blanching, Dusky cyanosis, Red engorgement. (White, Blue & RED)
Butchers thigh is due to injury to femoral artery in femoral triangle….
Lerieches syndrome is due to aortoiliac occlusion..

DVT (Deep vein Thrombosis) – 2011 Sep FMGE, Many Questions on this topic.

• Earliest sign is rise in Temperature.
• Occurs less frequently in upper extremity than lower Extremity
• Heparin is used for DVT prophylaxis
• Most Important Consequences of this disorder are Pulmonary embolism and chronic venous insufficiency
• DVT of the Iliac, femoral or popliteal viens is suggested by unilateral leg swelling warmth, erythema, Pain….
• The Non Invasive test used most often to diagnosis DVT is Duplex Venous USG….
Sign DVT….
1. Holmans sign – Forced Dorsiflexion of ankle causes Pain in Calf
2. Mosses sign – Pain in Calf on squeezing calf muscle
3. Pratts sign – lateral squeezing calf muscle cause pain
4. Phlergma alba dolens – swollen leg (whitish) with edema and blanching
5. Phlegm cerulae dolens – Painful (blue) leg


1. Which of the following about atherosclerosis is true?
A. Intake of unsaturated fatty acid associated with decreased risk
B. Thoracic aorta involvement is more severe than abdominal aorta involvement
C. Extent of lesion in veins is same as that in arteries
D. Hypercholesterolemia does not always increase the risk of atherosclerosis perse
A. Intake of unsaturated fatty acid associated with decreased risk
Ref- Harrison 17th edition page no.2429
· Atherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol.
· It is a syndrome affecting arterial blood vessels, a chronic inflammatory response in the walls of arteries, caused largely by the accumulation of macrophage white blood cells and promoted by low-density lipoproteins without adequate removal of fats and cholesterol from the macrophages by functional high density lipoproteins (HDL),
· It is commonly referred to as a hardening or furring of the arteries.
· It is caused by the formation of multiple plaques within the arteries.
The athermanous plaque is divided into three distinct components:
1. The atheroma which is the nodular accumulation of a soft, flaky, yellowish material at the center of large plaques, composed of macrophages nearest the lumen of the artery
2. Underlying areas of cholesterol crystals
3. Calcification at the outer base of older/more advanced lesions.
Role of PUFA
· "N-3 polyunsaturated fatty acids (n-3 PUFAs) are present in high concentration in fish and in flax seeds.
· The most widely used n-3 PUFAs for the treatment of hyperlipidernias are the two active molecules in fish oil: eicosapentanoic acid (EPA) and decohexanoic acid (DHA).
· N-3 PUFAs have been concentrated into tablets and decrease fasting triglycerides in doses of 3–4 g/d.
· Fish oils can result in an increase in plasma LDL-C levels in some patients.
· Fish oil supplements can be used in combination with fibrates, niacin, or statins to treat hypertriglyceridemia. In general, fish oils are well tolerated and appear to be safe, at least at doses up to 3–4 g.
· Although fish oil administration is associated with a prolongation in the bleeding time, no increase in bleeding has been seen in clinical trials.
· A lower dose of omega 3 (about 1 g) has been associated with reduction in cardiovascular events in CHD patients and is used by some clinicians for this purpose."

2. A girl presented with severe hyperkalemia and peaked T waves on ECG. Most rapid way to decreased serum potassium level?
A. Calcium gluconate IV B. Oral resins
C. Insulin + glucose D. Sodium bicarbonate
Ans C. Insulin + glucose
Ref-.Harrison 17th e/p.284.
Hyperkalemia is treated by following ways.
1. Injection calcium gluconate – It stabilizes cardiac membrane and thus prevent arrhythmia. It does not reduce serum potassium level. It is usually given when serum potassium level are very high.
2. Injection dextrose insulin drip – It is the most widely used method to reduce serum potassium level. It is the fastest method to reduce potassium level.
3. Beta 2 agonist – Like salbutamol & Albuterol can also reduce serum potassium level.
4. Potassium chelating resin – They are used orally, usually for long term use, they prevent serum potassium level to rise. Resins are slow acting used in chronic hyper kalemia
5. Dialysis
6. Injection NahCO3 – It is used to treat severe acidosis when PH is below 7.1. Acidosis is usually associated with hyperkalemia so when we treat by NahCO3, potassium level also falls. But please note NahCO3 is not used to treat hyperkalemia as such!!!
Treatment for urgent control of hyperkalemia.
Modality Onset Duration
Calcium Gluconate 0-5 minutes 1 hour
Sodium Bicarbonate 15-30 minutes 1-2 hour
Insulin 15-60 minutes 4-6 hours
Albuterol 15-30 minutes 2-4 hours

3. A 9 yr old girl has difficulty in combing hairs and climbing upstairs since 6 / months. She has Gower’s sign positive and maculopapular rash over metacarphalangeal joints. What should be the next appropriate investigation to be done?
a. ESR b. RA factor
c. Creatine kinase d. Electromyography
Ans. C. Creatine kinase
Ref. Harrison ed.17th pg no.2700
In the question, as the patient is not able to comb her hair and is unable to climb up stairs it means she is suffering most likely with proximal myopathy. She also has skin lesion over the metacarphalangeal joints, she probably has dermatomyositis & the skin lesion seem to be Gottron’s sign.
The clinically suspected diagnosis of PM, DM, or IBM is confirmed by examining the serum muscle enzymes, EMG findings, and muscle biopsy (Table 383-2).
Table 383-2 (Harrison ed.17th ) Criteria for Diagnosis of Inflammatory Myopathies
Criterion Definite Probable Dermatomyositis Inclusion Body Myositis
Myopathic muscle weaknessa Yes Yes Yesb Yes; slow onset, early involvement of distal muscles, frequent falls
Electromyographic findings Myopathic Myopathic Myopathic Myopathic with mixed potentials
Muscle enzymes Elevated (up to 50-fold) Elevated (up to 50-fold) Elevated (up to 50-fold) or normal Elevated (up to 10-fold) or normal
Muscle biopsy findings "Primary" inflammation with the CD8/MHC-I complex and no vacuoles Ubiquitous MCH-I expression but minimal inflammation and no vacuoles Perifascicular, perimysial, or perivascular infiltrates, perifascicular atrophy Primary inflammation with CD8/MHC-I complex; vacuolated fibers with -amyloid deposits; cytochrome oxygenase–negative fibers; signs of chronic myopathy
Rash or calcinosis Absent Absent Present Absent
· ESR & RA factor would not directly help in establishing the diagnosis of inflammatory myopathy Needle
· EMG shows myopathic potentials characterized by short-duration, low-amplitude polyphasic units on voluntary activation and increased spontaneous activity with fibrillations, complex repetitive discharges, and positive sharp waves.
· These EMG findings are not diagnostic of an inflammatory myopathy but are useful to identify the presence of active or chronic myopathy and to exclude neurogenic disorders.
· Muscle biopsy is the definitive test for establishing the diagnosis of inflammatory myopathy and for excluding other neuromuscular diseases.
Hereditary Myopathies
Muscular dystrophy refers to a group of hereditary progressive diseases each within unique phenotypic and genetic features. (Table 382-5, 382-6, 382-7)
Table 382-5 (Harrison ed.17th) Progressive Muscular Dystrophies
Type Inheritance Onset Age Clinical Features Other Organ Systems Involved
Duchenne XR Before 5 years Progressive weakness of girdle musclesUnable to walk after age 12Progressive kyphoscoliosisRespiratory failure in 2d or 3d decade CardiomyopathyMental impairment
Becker XR Early childhood to adult Progressive weakness of girdle musclesAble to walk after age 15Respiratory failure may develop by 4th decade Cardiomyopathy
Limb-girdle AD/AR Early childhood to early adult Slow progressive weakness of shoulder and hip girdle muscles ± Cardiomyopathy
Emery-Dreifuss XR/AD Childhood to adult Elbow contractures, humeral and peroneal weakness Cardiomyopathy
Congenital AR At birth or within first few months Hypotonia, contractures, delayed milestonesProgression to respiratory failure in some; static course in others CNS abnormalities (hypomyelination, malformation)Eye abnormalities
Myotonica (DM1, DM2) AD Usually 2d decadeMay be infancy if mother affected (DM1 only) Slowly progressive weakness of face, shoulder girdle, and foot dorsiflexionPreferential proximal weakness in DM2 Cardiac conduction defectsMental impairmentCataractsFrontal baldnessGonadal atrophy
Facioscapulohumeral AD Before age 20 Slowly progressive weakness of face, shoulder girdle, and foot dorsiflexion DeafnessCoats’ (eye) disease
Oculopharyngeal AD 5th to 6th decade Slowly progressive weakness of extraocular, pharyngeal, and limb muscles —
aTwo forms of myotonic dystrophy, DM1 and DM2, have been identified. Many features overlap (see text).Abbreviations: XR, X-linked recessive; AD, autosomal dominant; AR, autosomal recessive; CNS, central nervous system.
The most sensitive enzyme is CK, which in active disease can be elevated as much as 50-fold. Although the CK level usually parallels disease activity, it can be normal in some patients with active IBM or DM, especially when associated with a connective tissue disease. The CK is always elevated in patients with active PM. Along with the CK, the serum glutamic-oxaloacetic and glutamate pyruvate transaminases, lactate dehydrogenase, and aldolase may be elevated.
EMG findings are not diagnostic of an inflammatory myopathy but are useful to identify the presence of active or chronic myopathy and to exclude neurogenic disorders .

4. 14 yrs old girl on exposure to cold has pallor of extremities followed by pain and cyanosis. In later ages of life she is prone to develop?
B. Scleroderma
C Rheumatoid arthritis
D. Histiocytosis
Ans. B. Scleroderma
Ref-Harrison ed.17th pg no.2101
· "Raynaud’s phenomenon, defined as episodic vasoconstriction in the fingers and toes, develops in virtually every patient with Systemic sclerosis. In some, episodes may also affect the tip of the nose and earlobes.

5· Attacks are triggered by
a. Exposure to cold
b. Decrease in temperature
c. Emotional stress
d. Using vibration tools
· In colder climates, patients commonly experience an increase in the frequency and severity of episodes during the winter months.
Table 243-1 Classification of Raynaud’s Phenomenon
Primary or idiopathic Raynaud’s phenomenon: Raynaud’s disease
Secondary Raynaud’s phenomenon
1. Collagen vascular diseases: scleroderma, systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, polymyositis
2. Arterial occlusive diseases: atherosclerosis of the extremities, thromboangiitis obliterans, acute arterial occlusion, thoracic outlet syndrome
3. Pulmonary hypertension
4. Neurologic disorders: intervertebral disk disease, syringomyelia, spinal cord tumors, stroke, poliomyelitis, carpal tunnel syndrome
5. Blood dyscrasias: cold agglutinins, cryoglobulinemia, cryofibrinogenemia, myeloproliferative disorders, Waldenström’s macroglobulinemia
6. Trauma: vibration injury, hammer hand syndrome, electric shock, cold injury, typing, piano playing
7. Drugs: ergot derivatives, methysergide, Beta-adrenergic receptor blockers, bleomycin, vinblastine, cisplatin
· Typical attacks start with pallor, followed by cyanosis of variable duration. Eventually erythema develops spontaneously or with rewarming of the digit.
· The progression of the three color phases reflects the underlying pathogenic mechanisms of vasoconstriction, ischemia, and reperfusion.
· Some patients with Raynaud’s phenomenon may experience only pallor or cyanosis."
· In a patient of Raynaud’s phenomena all arteries (like radial, brachial, popliteal, dorsalis pedis) are normally palpable.
Recent Advances:
· Recently a new drug, Bosentan, which is a endothelin receptor blocking drug has been approve for the treatment of Raynaud’s phenomenon.
· Extra Edge: Bosentan has also approved for the treatment of primary pulmonary arterial hypertension

5. Berry aneurysm – Defect lies in
A. Degeneration of internal elastic lamina
B. Deposition of mucoid material in media
C. Defect in muscular layer
D. Disturbance in vessel wall
Ans. C. Defect in muscular layer
Ref- Harrison 17th, Page 1727
· Saccular (Berry) aneurysms occur at the bifurcations of the large to medium-sized intracranial arteries; rupture is into the subarachnoid space in the basal cisterns and often into the parenchyma of the adjacent brain.
· Approximately 85% of aneurysms occur in the anterior circulation, mostly on the circle of Willis. About 20% of patients have multiple aneurysms, many at mirror sites bilaterally.
· As an aneurysm develops, it typically forms a neck with a dome. The length of the neck and the size of the dome vary greatly and are factors that are important in planning neurosurgical obliteration or endovascular embolization.
· The arterial internal elastic lamina disappears at the base of the neck.
· The media thins, and connective tissue replaces smooth-muscle cells. At the site of rupture (most often the dome) the wall thins, and the tear that allows bleeding is often £0.5 mm long.
· Aneurysm size and site are important in predicting risk of rupture.
· Those >7 mm in diameter and those at the top of the basilar artery and at the origin of the posterior communicating artery are at greater risk of rupture.

6. In which cotrimoxazole not use in treatment?
B. Prostatitis
C. Chancroid
D. Typhoid
Ans. C. Chancroid
Uses of cotrimoxazole
· Pneumocystis pneumonia
· Toxoplasmosis and nocardiosis
· Acute exacerbations of chronic bronchitis and infections of the urinary tract where there is good rationale for use
· Acute otitis media in children where there is good rationale
Specific indications for its use include:
Being an antibiotic, co-trimoxazole does not have any activity against HIV itself, but it is often prescribed to immunocompromised patients as Pneumocystis jirovecii pneumonia prophylaxis.
· Infections caused by Listeria monocytogenes, Nocardia spp., Stenotrophomonas maltophilia (Zanthomonas maltophilia)
· Staphylococcus saprophyticus infections presenting as urinary tract infection or cystitis
· Melioidosis
· Shigellosis
· Whipple’s Disease
· Traveler’s Diarrhea
· Typhoid
· Isosporiasis
· Prophylaxis of cerebral toxoplasmosis in HIV patients
· Cyclospora cayetanensis
Chronic bacterial prostatitis treatment
· Chronic bacterial prostatitis treatment is with long-term antibiotics, up to eight weeks, with ciprofloxacin, sulfa drugs [for example, sulfamethoxazole and trimethoprim or erythromycin
· Chancroid – Treatment regimens may include the following: azithromycin, ceftriaxone, ciprofloxacin and erythromycin base
· Typhoid fever –
a. Ciprofloxacin is the most frequently used drug.
b. Ceftriaxone, an intramuscular injection medication, is an alternative
c. Ampicillin and trimethoprim-sulfamethoxazole are frequently prescribed antibiotics.

7. Thrombotic event is seen in all of following except
D. Heparin induced thrombocytopenia
Ans. C.ITP
Ref- .Harrison 17th edition Page 367
Table 59-3 Risk Factors for Thrombosis
Venous Venous and Arterial
Inherited Inherited
Factor V Leiden Homocystinuria
Prothrombin G20210A Dysfibrinogenemia
Antithrombin deficiency
Protein C deficiency Mixed (Inherited and acquired)
Protein S deficiency Hyperhomocysteinemia
Elevated FVIII
Acquired Malignancy
Age Antiphospholipid antibody syndrome
Previous thrombosis Hormonal therapy
Immobilization Polycythemia vera
Major surgery Essential thrombocythemia
Pregnancy & puerperium Paroxysmal nocturnal hemoglobinuria
Hospitalization Thrombotic thrombocytopenic purpura
Obesity Heparin-induced thrombocytopenia
Infection Disseminated intravascular coagulation
APC resistance, non genetic
Elevated factor II, IX, XI
Elevated TAFI levels
Low levels of TFPI
a Unknown whether risk is inherited or acquired.
Note: APC, activated protein C; TAFI, thrombin-activatable fibrinolysis inhibitor; TFPI, tissue factor pathway inhibitor

8. A patient develops sudden palpitation with HR 150 / min, regular. What could be the cause?

b. Sinus tachycardia
c. Ventricular tachycardia
d. Atrial flutter with block
Ans. A. PSVT
Paroxysmal supraventricular tachycardia (PSVT) is an occasional rapid heart rate.
i. PSVT can be initiated in the SA node, In the atria, in the atrial conduction pathways, or other areas.
ii. PSVT can occur with digitalis toxicity and conditions such as Wolff-Parkinson-White syndrome.
iii. The condition occurs most often in young people and infants.
The following increase risk for PSVT:
i. Alcohol use
ii. Caffeine use
iii. Illicit drug use
iv. Smoking
i. Anxiety
ii. Chest tightness
iii. Palpitations (a sensation of feeling the heart beat)
iv. Rapid pulse
v. Shortness of breath
vi. Polyuric
vii. Dizziness
viii. Fainting
Note: Symptoms may start and stop suddenly, and can last for a few minutes or several hours. A PSVT lasting more than half of the day is considered an incessant PSVT.
Signs and tests
· A physical examination during a PSVT episode will show a rapid heart rate.
· The heart rate may be 150 to 250 beats per minute (bpm). In children, the heart rate tends to be very high. There may be signs of poor blood circulation such as lightheadedness. Between episodes of PSVT, the heart rate is normal (60 to 100 bpm).
· An ECG during symptoms shows PSVT.
· An electrophysiology study (EPS) is often necessary for an accurate diagnosis and to recommend the best treatment.
The Valsalva maneuver can be used to interrupt the fast heartbeat.
Emergency treatment of PSVT may include:
1. Medicines through a vein, including adenosine and verapamil.
2. Other medications may be used, such as procainamide, beta-blockers, and propafenone.
3. Electrical cardioversion, the use of electric shock to restore a rapid heartbeat back to normal.
Long-term treatment of PSVT may include:
1. Daily medications such as propafenone, flecainide, moricizine, sotalol, and amiodarone.
2. Pacemakers to override the fast heartbeat; very occasionally used in children with PSVT who have not responded to any other treatment.
3. Radiofrequency catheter ablation; currently the treatment of choice for most PSVTs.
The main complication is an increased risk of heart failure.

9. Where pulsatile liver and ascites is found
a. TR
b. Critical pulmonary stenosis
c. MR
d. MS
Ans. A. TR
Ref: Harrison, 17th edition page 1479
· The clinical features of TR result primarily from systemic venous congestion and reduction of CO.
· With the onset of TR in patients with pulmonary hypertension, symptoms of pulmonary congestion diminish, but the clinical manifestations of right-sided heart failure become intensified.
· The neck veins are distended with prominent v waves and rapid y descents, marked hepatomegaly, ascites, pleural effusions, edema, systolic pulsations of the liver, and a positive hepatojugular reflux.
· A prominent RV pulsation along the left parasternal region and a blowing holosystolic murmur along the lower left sternal margin, which may be intensified during inspiration and reduced during expiration or the strain of the Valsalva maneuver (Carvallo’s sign), are characteristic findings;
· AF is usually present.

10. ln renal cell carcinoma which is not associated
a. Polycythemia
b. Amyloidosis
c. Cushing syndrome
d. Malignant hypertension
Ans. C. Cushing syndrome
Ref-Harrison 17th/e p.2254,592.
· The presenting signs and symptoms include hematuria, abdominal pain, and a flank or abdominal mass.
· This classic triad occurs in 10–20% of patients. Other symptoms are fever, weight loss, anemia, and a varicocele (Table 90-4).
· The tumor can also be found incidentally on a radiograph. Widespread use of radiologic cross-sectional imaging procedures (CT, ultrasound, MRI) contributes to earlier detection, including incidental renal masses detected during evaluation for other medical conditions.
· The increasing number of incidentally discovered low-stage tumors has contributed to an improved 5-year survival for patients with renal cell carcinoma and increased use of nephron-sparing surgery (partial nephrectomy).
· A spectrum of paraneoplastic syndromes has been associated with these malignancies, including erythrocytosis, hypercalcemia, nonmetastatic hepatic dysfunction (Stauffer syndrome), and acquired dysfibrinogenemia.
· Erythrocytosis is noted at presentation in only about 3% of patients. Anemia, a sign of advanced disease, is more common.
Table 90-4 Signs and Symptoms in Patients with Renal Cell Cancer
Presenting Sign or Symptom Incidence, %
Classic triad: hematuria, flank pain, flank mass 10-20
Hematuria 40
Flank pain 40
Palpable mass 25
Weight loss 33
Anemia 33
Fever 20
Hypertension 20
Abnormal liver function 15
Hypercalcemia 5
Erythrocytosis 3
Neuromyopathy 3
Amyloidosis 2
Increased erythrocyte sedimentation rate 55

12. Reperfusion is useful for
a. Stunt myocardium
b. Hibernating myocardium
c. Non ischemic viable myocardium
d. Mixed ischemic myocardium
Ans. B. Hibernating myocardium
· "LV dysfunction can be due to non contractile or hypo contractile segments that are viable but are chronically ischemic (hibernating myocardium).
· As a consequence of chronic reduction in myocardial blood flow these segments down regulate their contractile function.
· These can be detected by using consequence of chronic reduction in myocardial blood flow these segments down regulate their contractile function.
· These can be detected by using radionuclide scans of myocardial perfusion and metabolism, PET, CMR imaging, or delayed scanning with thallium-20 I; or by improvement of regional functional impairment, provoked by low-dose dobutamine.
· " In such patients, revascularization improves myocardial blood flow, can return function, and can improve survival."
· Stunned myocardium can be differentiated from hibernating myocardium by three clinical parameters, namely, LV wall motion, myocardial perfusion, and myocardial metabolism.
· Stunned myocardium has abnormal wall motion that tends to normalize in response to inotrope and postextrasystolic potentiation.
· Perfusion is adequate and metabolism is also adequate. Hibernating myocardium also has abnormal wall motion, which normalizes after nitrates, inotrope, post extrasystolic potentiation (PESP), PTCA, or CABG.
· Myocardial perfusion is reduced but can be reversed with PTCA or CABG and metabolism is adequate.
Extra Edge: Recent Advances:
Following are the methods to reperfuse the myocardium
a. Thrombolytic therapy
b. Mechanical method :
ii. Stent
iii. Rotablator
c. Coronary artery bypass graft (CABG)

13. Positive hepatojugular reflux is found in all of the following conditions except?
a. Tricuspid regurgitation
b. Right heart failure
c. Decreased after load
d. Increased pulmonary capillary bed pressure
Ans. C. Decreased after load
Ref: Harrison, 17th edition, page 1384
· In patients suspected of having right ventricular failure who have a normal CVP at rest, the abdominojugular reflux test may be helpful.
· The palm of the examiner’s hand is placed over the abdomen, and firm pressure is applied for 10 s or more. In normal persons, this maneuver does not alter the jugular venous pressure significantly, but when right heart function is impaired, the upper level of venous pulsation usually increases.
· A positive abdominojugular test is best defined as an increase in JVP during 10 s of firm midabdominal compression followed by a rapid drop in pressure of 4 cm blood on release of the compression.
Extra Edge:
a. The most common cause of a positive test is right-sided heart failure secondary to elevated left heart filling pressures.
b. Increase after load is associated with LVF. That is why ACEI are used in the treatment of LVF (To reduce after load)

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