A 28-year-old pregnant nurse presents with progressive shortness of breath. She had rheumatic fever as a child and was advised to take long-term penicillin, which she refused. Examination reveals left atrial hypertrophy and elevated pulmonary capillary wedge pressure, consistent with mitral stenosis due to her history of rheumatic fever.

1. 1. A 28-year young staff Nurse presents with progressive dyspnea in 2nd
trimester of her 1st
pregnancy. She had rheumatic fever at
the age of 10 and her family physician advised long acting penicillin for rest of her life, which she refused. A thorough work-up
revealed left atrial hypertrophy and raised pulmonary capillary wedge pressure. Which one of the following conditions is
responsible for her presentation?
A. Aortic Stenosis
B. Mitral Stenosis
C. Pulmonary Stenosis
D. Aortic Regurgitation
E. Tricuspid Regurgitation

2. 2. During OSPE, a final year medical student was asked to auscultate aortic valve. She will place her stethoscope in one of the
following intercostal spaces along sternal margin:
A. 2nd
on the right
B. 2nd
on the left
C. 3rd
on the right
D. 3rd
on the left
E. 4th
on the right

3. 3. A 45-year old hypertensive smoker presents in ER with severe left sided chest pain radiating to left shoulder. ECG revealed
ischemic changes in chest leads. Perfusion scan revealed impaired arterial supply to posterior third of interventricular septum.
Occlusion of one of the following arteries is most likely cause of his presentation:
A. Right marginal
B. Left coronary
C. Right coronary
D. Anterior interventricular
E. Posterior interventricular

4. 4. A patient of ischemic heart disease presented in ER with complete heart block. The most probable site of pathology is:
A. Crista terminalis
B. SA node
C. AV node
D. Bundle of His
E. Moderator band

5. 5. A 20-year old female in her third trimester of pregnancy presents with dyspnea and dysphagia. Barium Swallow revealed
esophageal compression in midthorax. One of the following structures is responsible for this esophageal compression:
A. Thoracic Aorta
B. Right Atrium
C. Right Ventricle
D. Left Atrium
E. Left Ventricle

6. 6. An 18-year old boy during a street fight suffered a stab wound in the left 5th
intercostal space in mid claviclular line. The structure
most likely be injured is:
A. Arch of aorta
B. Left auricle
C. Pulmonary trunk
D. Left ventricle
E. Left atrium

7. 7. A 4-year old boy presented in OPD with blue discoloration of lips and nails, and clubbing. Chest X-ray showed enlarged right
ventricle. These findings are consistent with which one of the following:
A. Atrial Septal defect
B. Patent ductus artreosus
C. Coarctation of aorta
D. Mitral valve regurgitation
E. Fallot’s tetrology

8. 8. Ayela Malik, a first year medical student was studying the blood supply of heart on a specimen. While studying the venous
drainage of heart, she found that one of the following veins did not open into the coronary sinus:
A. Great cardiac
B. Middle cardiac
C. Small cardiac
D. Anterior cardiac
E. Posterior vein of left ventricle

9. 9. The membranous interventricular septum during early cardiac development is derived from:
A. Septum primum
B. Septum secondum
C. Septum spurium
D. Endocardial cushions
E. Ventricular ingrowth

10. 10. A unique and distinguishing characteristic feature of cardiac muscle is the:
A. T tubule
B. Myofibril
C. Sarcoplasmic reticulum
D. Intercalated disk
E. Cross striations

11. 11. An adult male presented with H/O hypertension. On examination there was notable difference in blood pressure in upper and
lower limbs along with radio-femoral delay. These findings are typical of:
A. Atrial septal defect
B. Patent ductus arteriosus
C. Coarctation of aorta
D. Tetralogy of Fallot
E. Pulmonary stenosis

12. 12. A 45-year old hypertensive smoker presented in ER with severe left sided chest pain radiating to the left shoulder. ECG revealed
changes in all anterior leads. Perfusion scan revealed impaired arterial supply to anterior 2/3 of interventricular septum including
sternocostal surface of left ventricle. Occlusion of which one of the following arteries is most likely cause of this presentation:
A. Diagonal
B. Left coronary
C. Obtuse marginal
D. Circumflex
E. Left anterior descending

13. 13. Which of the following is the least likely part of the specialized conduction system of the heart?
A. SA node.
B. AV node.
C. Myocardial cells
D. Purkinje fibers
E. Bundle of His

14. 14. Which of the following vessels has the largest effect on total peripheral resistance?
A. Arteries
B. Arterioles
C. Veins.
D. Venules
E. Capillaries

15. 15. Atherosclerosis of the anterior interventricular branch of left coronary artery causes dysfunction of ventricular and papillary
muscles resulting in a systolic murmur. Where will you place the stethoscope to hear this murmur?
A. Left 5th ICS at the apex
B. Right 2nd ICS at sternal edge
C. Left 4th ICS at left sternal edge
D. Left 2nd ICS at sternal edge
E. Right 4th ICS at sternal edge

16. 16. The ventricles are completely depolarized during which phase of the ECG?
a. PR interval
b. QRS complex
c. QT interval
d. ST segment
e. T wave

17. 17. Which of the following ECG manifestation suggest intra-ventricular conduction block:
a. Inversion of P wave
b. Inversion of T wave
c. Prolongation of QRS
d. Prolongation of P-R interval
e. Prolongation of Q-T interval

18. 18. The strength of contraction of cardiac muscle depends to a great extent on the concentration of calcium ions in:
a. Sarcoplasmic reticulum
b. T- tubules
c. Extracellular fluid
d. Intracellular fluid
e. Rough endoplasmic reticulum

19. 19. One of the following structures is located in the posterior mediastinum and empties into the superior vena cava:
a. Azygos vein
b. Brachiocephalic artery.
c. Left brachiocephalic vein
d. Right brachiocephalic vein
e. Thoracic duct

20. 20. Ten minutes after undergoing liver biopsy, a patient develops moderately severe pain on the tip of right shoulder. Which one of
the following nerve mediates this pain
a. Axillary.
b. Intercostobrachial
c. Right phrenic
d. Right sympathetic chain.
e. Right vagus.

21. 21. Structure arching over root of right lung is
a. Azygos vein
b. Right phrenic nerve
c. Right vagus nerve.
d. Aortic arch.
e. Esophagus.

22. 22. Which one of the following costal cartilages does not articulate directly with the body of sternum
a. 1
st
b. 2
nd
c. 3
rd
d. 4
th
e. 5
th

23. 23. Which structure accompanies esophagus while passing through esophageal opening of diaphragm
a. Rt phrenic nerve
b. Ant. and post. trunks of vagus
c. Left phrenic nerve
d. Greater splanchnic nerve
e. Subcostal nerve

24. 24. The muscle which primarily increases the anteroposterior diameter of thoracic cage is
a. Sternocleidomastoid
b. Scalenes anterior
c. Internal intercostal
d. External intercostal
e. Diaphragm

25. 25. Structures winding around the root of left bronchus is
a. Aortic arch
b. Azygos vein
c. Vagus nerve
d. Recurrent laryngeal nerve
e. Esophagus.

26. 26. While draining a pleural effusion, the reason behind putting the needle above the upper border of lower rib is to avoid injury to
a. Intercostal nerve
b. Intercostal artery
c. Intercostal vein
d. Neurovascular bundle
e. Long thoracic nerve.

27. 27. Pain felt by patient during thoracocentesis is carried along
a. Intercostal nerve
b. Greater splanchnic nerve
c. Phrenic nerve
d. Subcostal nerve
e. Vagal nerve

28. 28. A 20 year old female in her third trimester of pregnancy presents with dyspnea and dysphagia. Barium Swallow revealed
esophageal compression in midthorax. Which of following structures may be responsible for this esophageal compression?
a. Thoracic Aorta
b. Right Atrium
c. Right Ventricle
d. Left Atrium
e. Left Ventricle

29. 29. In Hemopericardium, extravasated blood collects between:
a. Fibrous & Parietal Pericardium
b. Parietal & Visceral Pericardium
c. Visceral Pericardium & Myocardium
d. Fibrous & Visceral Pericardium
e. Parietal pericardium & Myocardium

30. 30. A female inhales peanut while laughing. The foreign body would lodge most likely in segmental bronchus of one of the
followings Bronchopulmonary segments?
a. Right superior apical
b. Right inferior apical
c. Left superior apical
d. Left inferior apical
e. Left inferior lingular

31. 31. A middle aged man received iatrogenic injury to left phrenic nerve during operation for tumor at root of neck. His chest
radiograph will show the affected dome of diaphragm as:
a. Raised
b. Depressed
c. Flattened
d. Unchanged
e. Shifted