Which of the following drugs is a mixed agonist-antagonist type of opioid analgesic?

a. Buprenorphine
b. Fentanyl
c. Morphine
d. Pentazocine
e. Pethidine

A patient has developed an irritating dry cough for which he is prescribed an opioid. However after a
week he comes back with the complaint of constipation, though the cough has been relieved. Which of
the following opioids was he most likely prescribed?
a. Buprenorphine
b. Codeine
c. Morphine
d. Pentazocine
e. Pethidine

A patient is brought to the emergency intoxicated and in aggressive state with abnormal disinhibited
behavior. His vision is blurred and his breath has characteristic formaldehyde like smell. Which of the
following drugs he has most likely abused?
a. Cocaine
b. Ethanol
c. Heroin
d. Methanol
e. Phenobarbitone

Which of the following is an early sign of toxicity with lithium in the initial days of therapy?
a. Constipation
b. Hypertension, hemorrhage
c. Insomnia, headache
d. Nausea, tremors
e. Weight loss

Most of the antidepressants act by increasing the aminergic transmission in the areas of brain concerned
with mood. Which one of the following mechanisms is unlikely to be involved in the mode of their
antidepressant effect?

a. Blockade of dopamine D2 receptor

Which one of the following antipsychotic drugs on long term use causes ocular toxicity?
a. Droperidol
b. Fluphenthixol
c. Haloperidol
d. Olanzapine
e. Thioridazine
Which of the following antipsychotic drugs has weak D2 blocking but potent 5HT2 blocking activity, is
beneficial for both positive and negative symptoms of schizophrenia and produces agranulocytosis on
long term use?
a. Clozapine
b. Haloperidol
c. Loxapine
d. Pimozide
e. Penfluridol
A 50-year-old patient with Parkinsonism presents with swollen feet. They are red, tender and very
painful. These symptoms would abate within a few days if the patient stops taking:
a. Amantadine
b. Bromocriptine
c. Carbidopa
d. Levodopa
e. Selegiline
The primary mechanism of action of local anesthetics involves the blockade of which of the following ion
channels?
a. Activated, ligand gated Ca+2 channels
b. Activated, voltage gated Ca+2 channels
c. Inactivated, voltage gated Na+ channels
d. Inactivated, ligand gated K+ channels
e. Resting voltage gated K+ channels
A 14 year old boy complains of burning pain due to multiple superficial skin abrasions after a motorcycle
accident. Which of the following local anesthetic would be appropriate for this boy?
a. Benzocaine
b. Bupivacaine
c. Cocaine
d. Prilocaine
e. Procaine
Which of the following drugs / drug groups is preferred for long term treatment of severe anxiety
disorders with intermittent panic attacks?
a. Beta blockers
b. Buspirone
c. Phenothiazine
d. SSRIs
e. TCAs
Which of the following mechanism of action is responsible for the therapeutic effect of the triptan class of
drugs in migraine?
a. Antagonism at α-adrenoceptors
b. Antagonism at dopamine receptors
c. Antagonism at serotonin 5-HT2 receptors
d. Direct inhibition of substances P receptors in the vasculature
e. Stimulation of serotonin 5-HT1D receptors
A 35-years-old woman with a history of migraine reports to her physician that the last time she used her
medicine to stop an acute attack, she felt numbness and tingling in her extremities and blanching and
cyanosis of her fingers. Which one of the following medications did she take?
a. Dihydroergotamine
b. Methysergide
c. Naproxen
d. Sumatriptan
e. Tramadol
A 28 years old lady with a history of epilepsy gives birth to a newborn having cleft lip with cleft palate
and congenital cardiac problems. Which of the following antiepileptic drugs is responsible for these
adverse effects and was most likely taken by the mother during pregnancy?
a. Carbamazepine
b. Diazepam
c. Ethosuxemide
d. Phenytoin
e. Valproic acid
A known case of epilepsy presents to the emergency department with status epilepticus. Which one of the
following antiepileptics can be prescribed to the patient in the management of this acute attack?
a. Clonazepam
b. Carbamazepine
c. Ethosuximide
d. Lamotrigine
e. Lorazepam
An intravenous bolus dose of thiopental leads to loss of consciousness within 10-15 seconds. If no further
drugs are administered, the patient regains consciousness in just a few minutes, the reason for this is that
thiopental undergoes:
a. Exhalation rapidly through the lungs
b. Fast tubular secretion by the kidneys
c. Fast hepatic glucuronide conjugation
d. Redistribution to adipose tissues
e. Secretion in the bile
Which of the following intravenous anesthetic agents is associated emergence phenomenon characterized
by a high incidence of disorientation, sensory /perceptual illusions and vivid dreams during recovery from
anesthesia?
a. Diazepam
b. Fentanyl
c. Ketamine
d. Midazolam
e. Thiopental
A six year old child is prepared for elective urology surgery under general anesthesia. He refuses to allow
the anesthesiologist on IV access, so the physician decides to give him inhalational anesthetic. Which one
of the following will be the best inhalational agent of choice for induction of anesthesia in the child?
a. Chloroform
b. Desflurane
c. Methoxy flurane
d. Isoflurane
e. Sevoflurane
Which of the following is a correct statement about flumazenil?
a. It has no CNS effect of its own but blocks the depressant effect of barbiturates
b. It has no CNS effect of its own but blocks the depressant effects of bzds and barbiturates
c. It has no CNS effect of its own but blocks the depressant effect of diazepam
d. It is a CNS depressant but blocks the action of diazepam
e. It is a CNS stimulant used as an antidote for benzodiazepine poisoning
Benzodiazepines differ from barbiturates in all of the following aspects except:
a. Muscle relaxant effect is not blocked by flumazenil
b. They do not induced microsomal enzyme
c. They have lower abuse liability
d. They have a steeper dose response curve
e. They have wider therapeutic index
Genetic polymorphisms in certain hepatic enzymes involved in drug metabolism are established to be
responsible for variation in analgesic response to:
a. Buprinorphine
b. Codeine
c. Fentanyl
d. Methadone
e. Tramadol
Although fentanyl or one of its congeners is usually administered in the early stages of general anesthesia,
it is likely that the patient will receive an injection of morphine in the late phase. The rationale for
switching to morphine is that the drug has:
a. A longer duration of action
b. Greater analgesic efficacy
c. More of a ceiling effect and less tendency to cause respiratory failure
d. Mu opioid receptor agonist activity whereas fentanyl is a selective kappa agonist
e. The advantage of being completely reversed by nalaxone
Intellectual disability, microcephaly and underdevelopment of midface region in an infant is associated
with chronic heavy maternal use during pregnancy of which of the following?
a. Cocaine
b. Diazepam
c. Ethanol
d. Heroin
e. Methylenedioxymethamphetamine (MDMA)
After ingestion of a meal that included cheese and red wine, a patient taking phenelzine experienced an
increase in blood pressure to 190/130 mmHg for which he had to be taken to emergency department. The
most likely explanation for this untoward effect is that phenelzine:
a. Acts to release tyramine from foods
b. Inhibits storage of catecholamines in vesicles
c. Inhibits the metabolism of catecholamines
d. Is an activator of tyrosine hydroxylase
e. Promotes the release of norepinephrine from sympathetic nerve endings
A 35 years old woman who has never been pregnant suffers from pain, discomfort and mood depression
at the time of menses each month. She may benefit from the use of this selective serotonine reuptake
inhibitor in the form that can be taken once weekly?
a: Amoxapine
b. Bupropion
c. Citalopram
d. Fluoxetine
e: Tranylcypromine
The reason why clozapine causes less extrapyramidal dysfunction than haloperidol when used in
schizophrenia is that in the CNS, clozapine
a. Activates GABA receptors
b. Blocks dopamine release
c. Has greater antagonism at muscarinic receptors
d. Has a low affinity for dopamine D2 receptors
e. Is an alpha receptor antagonist
A 55 years old patient with glaucoma, BPH and chronic constipation is having symptoms of psychosis.
Which of the following drugs will be most suitable for him while taking his co morbidities in
consideration?
a. Chlorpromazine
b. Flupenthixol
c. Haloperidol
d. Promethazine
e. Thioridazine
Lidocaine is commonly used as a local anesthetic. If a patient mistakenly receives a toxic dose of
lidocaine intravenously the patient is likely to exhibit:

a. Cardiovascular stimulation
b. Excessive salivation, mydriasis and diarrhea
c. Hyperthermia and hypertension
d. No effects immediately but then delayed massive hepatocellular damage
e. Seizures and coma
A 30 years old man is brought to emergency with complaints of chest pain after consuming an illicit
substance at a party. ECG shows ventricular fibrillation. A primary survey of the patient shows perforated
nasal septum. Which one of the following drugs was abused by the patient?
a. Cocaine
b. Gamma Hydoxybutyric Acid (GHB)
c. Lysergic Acid Diethylamide (LSD)
d. Marijuana
e. Phencyclidine
A patient of chronic wide angle glaucoma develops parkinson’s disease for which he is prescribed an
antiparkinsonean drug. However after a week he comes back with signs and symptoms of an acute attack
of glaucoma. Which of the following antiparkinsonean drugs was he most likely given?
a. Amantadine
b. Benztropine
c. Bromocriptine
d. Selegeline
e. Tolcapone
A patient has been diagnosed with Parkinson’s disease and is prescribed levodopa for it. He is told that he
may experience “on off phenomenon” after some weeks or months of therapy with the drug. He asks you
to explain this phenomenon, you most probably reply by saying that it is:
a. Decreased duration of clinical response with decreased doses and increased clinical response with
increased doses
b. Feeling depressed sometimes and sometimes in a better mood
c. Fluctuation of clinical response independent of dose
d. Loss of vision for sometime followed by regaining vision
e. Periods of hyperkinesia alternating with periods of bradykinesia
A 24 years old man with a history of partial seizures has been treated with valproic acid, however it is not
fully effective and his neurologist prescribes another drug approved for adjuvant use in partial seizures.
Unfortunately the patient develops a toxic epidermal necrolysis. The second drug prescribed was?
a. Diazepam
b. Ethosuxemide
c. Felbamate
d. Lamotrigine
e. Phenobarbital
Which of the following IV general anesthetics is a cerebral vasoconstrictor and thereby decreases cerebral
blood flow making this drug most useful in the management of patients with space occupying intracranial
lesions?
a. Etomidate
b. Ketamine
c. Midazolam
d. Propofol
e. Thiopentone
All of the following are merits of Halothane except?
a. Causes bronchodilation, useful in asthmatics
b. Does not increase intracranial pressure
c. Has fruity odour, preferred in children
d. Less postop nausea and vomiting
e. Non irritant, non inflammable
Which of the following statements regarding the barbiturates is accurate?
a. Abstinence syndrome is more severe during withdrawal from phenobarbitone than secobarbitone
b. Alkalinization of the urine accelerates the elimination of phenobarbitone
c. Barbiturates may increase the half lives of drugs metabolized by the liver
d. Compared to barbiturates benzodiazepines exhibit a steeper dose response relationship
e. Respiratory depression caused by barbiturate overdosage can be reversed by flumazenil