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Question 1
Correct
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You're evaluating a 37-year-old woman who is 12 weeks pregnant. She has experienced vaginal bleeding.
Which of the following anti-D statements is correct?Your Answer: Routine antenatal prophylaxis is recommended for RhD negative women at 28 and 34 weeks
Explanation:Anti-D is an IgG antibody that targets the antigen Rhesus D (RhD). Plasma from rhesus-negative donors who have been immunised against the anti-D-antigen is used to make anti-D immunoglobulin.
Only RhD negative women are given Anti-D Ig. Women who are RhD negative do not have the RhD antigen on their RBC. If a foetus has the RhD antigen (i.e. is RhD positive) and the mother is exposed to foetal blood, she may develop antibodies to RhD that pass through the placenta and attack foetal red cells (resulting in newborn haemolytic disease). Anti-D is given to bind and neutralise foetal red cells in the maternal circulation before an immune response is triggered. In the event of a sensitising event, 500 IU Anti-D Ig should be administered intramuscularly.
The following are examples of potentially sensitising events:
Birth
Haemorrhage during pregnancy
Miscarriage
Ectopic pregnancy
Death within the womb
Amniocentesis
Chorionic villus sampling
Trauma to the abdomenThe sooner anti-D is given in the event of a sensitising event, the better; however, it is most effective within 72 hours, and the BNF states that it is still likely to have some benefit if given outside of this time frame.
At 28 and 34 weeks, RhD negative women should receive routine antenatal prophylaxis. This is regardless of whether they have previously received Anti-D for a sensitising event during the same pregnancy.
Prophylactic anti-D is not necessary before 12 weeks gestation, as confirmed by scan, in uncomplicated miscarriage (where the uterus is not instrumented), or mild, painless vaginal bleeding, as the risk of foeto-maternal haemorrhage (FMH) is negligible. In cases of therapeutic termination of pregnancy, whether by surgical or medical means, 250 IU of prophylactic anti-D immunoglobulin should be given to confirmed RhD negative women who are not known to be RhD sensitised.
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This question is part of the following fields:
- Immunological Products & Vaccines
- Pharmacology
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Question 2
Incorrect
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Which of the following has the most potent glucocorticoid effect:
Your Answer: Fludrocortisone
Correct Answer: Dexamethasone
Explanation:Dexamethasone and betamethasone have the most potent glucocorticoid (anti-inflammatory) effect.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 3
Correct
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Following a bee sting, a 8-year old boy was transported to resus with symptoms and signs of an anaphylactic reaction. You decide to administer adrenaline IM stat. What is the recommended dose of intramuscular adrenaline?
Your Answer: 0.3 mL of 1:1000
Explanation:Anaphylaxis is a type I hypersensitivity reaction that is severe and life-threatening. It is marked by the fast onset of life-threatening airway and/or circulatory issues, which are generally accompanied by skin and mucosal abnormalities. When an antigen attaches to specific IgE immunoglobulins on mast cells, degranulation and the release of inflammatory mediators takes place (e.g. histamine, prostaglandins, and leukotrienes).
The most important medicine for treating anaphylactic responses is adrenaline. It decreases oedema and reverses peripheral vasodilation as an alpha-adrenergic receptor agonist. Its beta-adrenergic effects widen the bronchial airways, enhance the force of cardiac contraction, and inhibit the release of histamine and leukotriene. The first medicine to be given is adrenaline, and the IM route is optimal for most people.
In anaphylaxis, age-related dosages of IM adrenaline are:
150 mcg (0.15 mL of 1:1000) for a child under 6 years
300 mcg (0.3 mL of 1:1000) for a child aged 6 to 12 years
500 mcg (0.5 mL of 1:1000) for children aged 12 and above
500 mcg for adults (0.5 mL of 1:1000) -
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 4
Correct
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You are reviewing a patient in the Emergency Department brought in by the ambulance team from a burning building. After examination, you decide to intubate the patient due to laryngeal oedema. The induction agent you are planning to use is propofol.
Which one of the following statements about this medicine is TRUE?Your Answer: It decreases cardiac output by approximately 20%
Explanation:Propofol is a short-acting anaesthetic that is thought to work by potentiating GABA and glycine. It induces anterograde amnesia and anaesthetic effects and is used to induce anaesthesia, outpatient surgeries and preoperative sedation. The dose for induction of anaesthesia is 1.5-2.5mg/kg. The dose for maintenance of anaesthesia is 4-12 mg/kg/hour. Following intravenous injection, propofol acts within 30 seconds and its duration of action is 5-10 minutes.
Propofol produces a 15-25% decrease in blood pressure and systemic vascular resistance without a compensatory increase in heart rate. It is negatively inotropic and decreases cardiac output by approximately 20%.
The main side effects of propofol are:
Pain on injection (in up to 30%)
Hypotension
Transient apnoea
Hyperventilation
Coughing and hiccough
Headache
Thrombosis and phlebitis -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 5
Correct
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Glucagon may be used as an antidote for overdose with which of the following:
Your Answer: Beta blockers
Explanation:Glucagon is a peptide hormone that is produced and secreted by alpha cells of the islets of Langerhans, which are located in the endocrine portion of the pancreas. The main physiological role of glucagon is to stimulate hepatic glucose output, thereby leading to increases in glycaemia. It provides the major counter-regulatory mechanism to insulin in maintaining glucose homeostasis.
Hypoglycaemia is the principal stimulus for the secretion of glucagon but may also be used as an antidote in beta-blocker overdose and in anaphylaxis in patients on beta-blockers that fail to respond to adrenaline.
Glucagon then causes:
Glycogenolysis
Gluconeogenesis
Lipolysis in adipose tissue
The secretion of glucagon is also stimulated by:
Adrenaline
Cholecystokinin
Arginine
Alanine
Acetylcholine
The secretion of glucagon is inhibited by:
Insulin
Somatostatin
Increased free fatty acids
Increased urea productionGlycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released by this process is used to form ATP and NADH. Glycolysis is inhibited by glucagon, and glycolysis and gluconeogenesis are reciprocally regulated so that when one cell pathway is activated, the other is inactive and vice versa.
Glucagon has a minor effect of enhancing lipolysis in adipose tissue. Lipolysis is the breakdown of lipids and involves the hydrolysis of triglycerides into glycerol and free fatty acids. It makes fatty acids available for oxidation.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 6
Correct
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Which of the following drug classes may cause bronchoconstriction:
Your Answer: Beta-blockers
Explanation:Beta-blockers, including those considered to be cardioselective, should usually be avoided in patients with a history of asthma, bronchospasm or a history of obstructive airways disease. However, when there is no alternative, a cardioselective beta-blocker can be given to these patients with caution and under specialist supervision. In such cases the risk of inducing bronchospasm should be appreciated and appropriate precautions taken.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 7
Correct
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Regarding codeine, which of the following statements is INCORRECT:
Your Answer: There is a reduced risk of toxicity in patients who are ultra-rapid metabolisers of codeine.
Explanation:Codeine phosphate is a weak opioid and can be used for the relief of mild to moderate pain where other painkillers such as paracetamol or ibuprofen have proved ineffective.Codeine is metabolised to morphine which is responsible for its therapeutic effects. Codeine 240 mg is approximately equivalent to 30 mg of morphine. The capacity to metabolise codeine can vary considerably between individuals; there is a marked increase in morphine toxicity in people who are ultra rapid metabolisers, and reduced therapeutic effect in poor codeine metabolisers. Codeine is contraindicated in patients of any age who are known to be ultra-rapid metabolisers of codeine (CYP2D6 ultra-rapid metabolisers).Codeine is also contraindicated in children under 12, and in children of any age who undergo the removal of tonsils or adenoids for the treatment of obstructive sleep apnoea due to reports of morphine toxicity.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 8
Correct
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A patient who is taking ramipril for high blood pressure complains of a dry persistent cough. What is the mechanism of cough in ACE inhibitor therapy:
Your Answer: Decreased bradykinin breakdown
Explanation:Blocking ACE also diminishes the breakdown of the potent vasodilator bradykinin which is the cause of the persistent dry cough. Angiotensin-II receptor blockers do not have this effect, therefore they are useful alternative for patients who have to discontinue an ACE inhibitor because of persistent cough.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 9
Correct
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A 6-year-old child with a few itchy honey crusted sores on her left cheek is brought in by her mother. Following a thorough examination of the child, you diagnose impetigo and recommend a course of topical fusidic acid.
Fusidic acid's mode of action is which of the following?Your Answer: Inhibition of protein synthesis
Explanation:By binding EF-G-GDP, fusidic acid prevents both peptide translocation and ribosome disassembly, which slows protein synthesis. Because it has a novel structure and mechanism of action, it is unlikely to cause cross-resistance with existing antibiotics.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 10
Correct
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Regarding calcium channel blockers, which of the following statements is CORRECT:
Your Answer: Calcium channel blockers inhibit L-type voltage-sensitive calcium channels in arterial smooth muscle causing vasodilation.
Explanation:Calcium channel blockers inhibit L-type voltage-sensitive calcium channels in arterial smooth muscle, causing relaxation and vasodilation (reduction in peripheral vascular resistance). They also block calcium channels within the myocardium and conducting tissues of the heart which produces a negative inotropic effect by reducing calcium influx during the plateau phase of the action potential.
They have a variety of uses, including:
Hypertension
Angina
Atrial fibrillation
Migraine
Calcium channel blockers have been found to be moderately useful in the prevention of migraines. The best evidence is for this is with verapamil. This may be due to the prevention of the arteriolar constriction that is associated with migraine. They are commonly used for this elsewhere in the world but are not currently licensed for this use in the UK.
The following are common side effects of all calcium-channel blockers:
Abdominal pain
Dizziness
Drowsiness
Flushing
Headache
Nausea and vomiting
Palpitations
Peripheral oedema
Skin reactions
Tachycardia
Verapamil is highly negatively inotropic and reduces cardiac output, slows the heart rate and may impair atrioventricular conduction. It may precipitate heart failure, exacerbate conduction disorders, and cause hypotension at high doses and should not be used with beta-blockers. Nifedipine has less myocardial effects than verapamil and has no antiarrhythmic properties but has more influence on the vessels. Nimodipine is used solely for the prevention and treatment of vascular spasm following aneurysmal subarachnoid haemorrhage. -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 11
Correct
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A 18 year old with known asthma presents himself to ED with acute breathlessness and wheeze for the past 20 minutes. On examination he is tachypneic and tachycardic. His oxygen saturations are 96% on air. What is the first line treatment for acute asthma:
Your Answer: Salbutamol
Explanation:High-dose inhaled short-acting beta2-agonists are the first line treatment for acute asthma(salbutamol or terbutaline). Oxygen should only been given to hypoxaemic patients (to maintain oxygen saturations of 94 – 98%). A pressurised metered dose inhaler with spacer device is preferred in patients with moderate to severe asthma (4 puffs initially, followed by 2 puffs every 2 minutes according to response, up to 10 puffs, whole process repeated every 10 – 20 minutes if necessary). The oxygen-driven nebuliser route is recommended for patients with life-threatening features or poorly responsive severe asthma (salbutamol 5 mg at 15 – 30 minute intervals). Continuous nebulisation should be considered in patients with severe acute asthma that is poorly responsive to initial bolus dose (salbutamol at 5 – 10 mg/hour) The intravenous route should be reserved for those in whom inhaled therapy cannot be used reliably.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 12
Correct
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A 58-year-old man with a long history of poorly controlled hypertension complains of a headache and vision blurring today. In triage, his blood pressure is 210/192 mmHg. A CT head scan is scheduled to rule out the possibility of an intracranial haemorrhage. You make the diagnosis of hypertensive encephalopathy and rush the patient to reus to begin blood pressure-lowering treatment. He has a history of brittle asthma, for which he has been admitted to the hospital twice in the last year.
Which of the following is the patient's preferred drug treatment?Your Answer: Nicardipine
Explanation:End-organ damage (e.g. encephalopathy, intracranial haemorrhage, acute myocardial infarction or ischaemia, dissection, pulmonary oedema, nephropathy, eclampsia, papilledema, and/or angiopathic haemolytic anaemia) characterises a hypertensive emergency (also known as ‘accelerated hypertension’ or malignant hypertension’ It’s a life-threatening condition that necessitates rapid blood pressure reduction to avoid end-organ damage and a negative outcome.
Hypertensive encephalopathy is a syndrome that includes headaches, seizures, visual changes, and other neurologic symptoms in people who have high blood pressure. It is reversible if treated quickly, but it can progress to coma and death if not treated properly.
Any patient with suspected hypertensive encephalopathy should have an urgent CT scan to rule out an intracranial haemorrhage, as rapid blood pressure reduction could be dangerous in these circumstances.
The drug of choice is labetalol, which reduces blood pressure steadily and consistently without compromising cerebral blood flow.
An initial reduction of approximately 25% in mean arterial pressure (MAP) over an hour should be aimed for, followed by a further controlled MAP reduction over the next 24 hours. In patients who are unable to take beta-blockers, nicardipine can be used as a substitute. -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 13
Correct
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A 78-year-old man develops renal impairment and hearing loss after inpatient management for sepsis.
Which of these antibiotics is most likely to have been used?Your Answer: Gentamicin
Explanation:Gentamicin, an aminoglycoside antibiotic, acts by binding to the 30S subunit of the bacterial ribosome inhibiting the binding of aminoacyl-tRNA, and thus prevents initiation of protein synthesis.
Two of its most notable side effects are reversible nephrotoxicity(caused by the inhibition of protein synthesis in renal cells, which causes acute tubular necrosis) and hearing loss (caused by damage to the vestibular apparatus of the inner ear).
Both side effects are dose-related and occur commonly in the elderly.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 14
Correct
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In which of the following cases is intravenous phenytoin contraindicated?
Your Answer: Second degree heart block
Explanation:Phenytoin Contraindications include:
Hypersensitivity
Sinus bradycardia
Sinoatrial block
Second and third degree A-V block
Adams-Stokes syndrome
Concurrent use with delavirdine
History of prior acute hepatotoxicity attributable to phenytoin -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 15
Incorrect
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An ambulance transports a 72-year-old woman to the Emergency Department. She is confused, has been vomiting and having stomach pains. Digoxin is one of her medications.
Which of the following claims about digoxin is correct?Your Answer: It is the first-line drug in the treatment of persistent and permanent atrial fibrillation
Correct Answer: Therapeutic plasma levels are between 1.0-1.5 nmol/l
Explanation:Digoxin is a cardiac glycoside that is used to treat atrial fibrillation and flutter, as well as congestive heart failure. In cardiac myocytes, it works by inhibiting the membrane Na/K ATPase. Through Na/Ca exchange, this raises intracellular sodium concentration and indirectly increases intracellular calcium availability. Increased intracellular calcium levels have both a positive inotropic and negative chronotropic effect.
Digoxin therapeutic plasma levels are typically between 1.0 and 1.5 nmol/l, though higher concentrations may be required, and the value varies between laboratories. At concentrations greater than 2 nmol/l, the risk of toxicity increases dramatically.
In patients with normal renal function, digoxin has a long plasma half-life of 36 to 48 hours. This can take up to 5 days in patients with impaired renal function.
Hypokalaemia, rather than hyperkalaemia, has been shown to increase the risk of digoxin toxicity.
In the treatment of persistent and permanent atrial fibrillation, digoxin is no longer widely used. Beta-blockers, also known as rate-limiting calcium channel blockers, are now the first-line treatment for this condition.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 16
Correct
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A 65-year-old man presents with a red, hot, swollen great toe. A diagnosis of acute gout is made. His past medical history includes heart failure and type 2 diabetes mellitus.
Which of the following is the most appropriate medication to use in the treatment of his gout? Select ONE answer only.Your Answer: Colchicine
Explanation:In the absence of any contra-indications, high-dose NSAIDs are the first-line treatment for acute gout. Naproxen 750 mg as a stat dose followed by 250 mg TDS is a commonly used and effective regime.
Aspirin should not be used in gout as it reduces the urinary clearance of urate and interferes with the action of uricosuric agents. Naproxen, Diclofenac or Indomethacin are more appropriate choices.
Allopurinol is used prophylactically, preventing future attacks by reducing serum uric acid levels. It should not be started in the acute phase as it increases the severity and duration of symptoms.
Colchicine acts on the neutrophils, binding to tubulin to prevent neutrophil migration into the joint. It is as effective as NSAIDs in relieving acute attacks. It also has a role in prophylactic treatment if Allopurinol is not tolerated.
NSAIDs are contra-indicated in heart failure as they can cause fluid retention and congestive cardiac failure. Colchicine is the preferred treatment in patients with heart failure or those who are intolerant of NSAIDs. -
This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 17
Correct
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A patient presents to ED with heartburn for which they already take regular antacids. Which of the following drugs can be affected if taken with antacids:
Your Answer: Digoxin
Explanation:Antacids should preferably not be taken at the same time as other drugs since they may affect absorption. When antacids are taken with acidic drugs (e.g. digoxin, phenytoin, chlorpromazine, isoniazid) they cause the absorption of the acidic drugs to be decreased, which causes low blood concentrations of the drugs, which ultimately results in reduced effects of the drugs. Antacids taken with drugs such as pseudoephedrine and levodopa increase absorption of the drugs and can cause toxicity/adverse events due to increased blood levels of the drugs. Antacids that contain magnesium trisilicate and magnesium hydroxide when taken with some other medications (such as tetracycline) will bind to the drugs, and reduce their absorption and effects.
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 18
Correct
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What is the primary mode of action of Enoxaparin?
Your Answer: Inhibits factor Xa
Explanation:Heparin acts as an anticoagulant by enhancing the inhibition rate of clotting proteases by antithrombin III impairing normal haemostasis and inhibition of factor Xa. Low molecular weight heparins have a small effect on the activated partial thromboplastin time and strongly inhibit factor Xa. Enoxaparin is derived from porcine heparin that undergoes benzylation followed by alkaline depolymerization.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 19
Correct
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Regarding antihistamines, which of the following statements is CORRECT:
Your Answer: Elderly patients and children are more susceptible to side effects.
Explanation:Elderly patients and children are more susceptible to side effects. Antihistamines are competitive inhibitors at the H1-receptor. The newer antihistamines e.g. cetirizine cause less sedation and psychomotor impairment than the older antihistamines because they are much less lipid soluble and penetrate the blood brain barrier only to a slight extent. Antihistamines are used as a second line adjunct to adrenaline in anaphylaxis.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 20
Correct
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A 30-year-old patient has a mild exacerbation of his asthma. His steroid inhaler ran out a couple of weeks ago, and he has not replaced it.
Which of these statements describes the mechanism of action of corticosteroids in asthma?
Your Answer: Reduction of bronchial inflammation
Explanation:Inhaled corticosteroids suppresses airway inflammation seen in asthma by downregulating pro-inflammatory proteins.
They also appear to reverse components of asthma-induced structural changes (airway remodelling), including increased vascularity of the bronchial wall.
Corticosteroids reduces the number of inflammatory cells (eosinophils, T lymphocytes, mast cells, and dendritic cells) in the airways. -
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 21
Correct
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Which of the following statements is correct regarding paracetamol?
Your Answer: Liver damage peaks 3 to 4 days after paracetamol ingestion.
Explanation:The maximum daily dose of paracetamol in an adult is 4 grams. Doses greater than this can lead to hepatotoxicity and, less frequently, acute kidney injury. Early symptoms of paracetamol toxicity include nausea, vomiting, and abdominal pain, and usually settle within 24 hours. Symptoms of liver damage include right subcostal pain and tenderness, and this peaks 3 to 4 days after paracetamol ingestion. Other signs of hepatic toxicity include encephalopathy, bleeding, hypoglycaemia, and cerebral oedema.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 22
Correct
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Which of the following statements about propofol is TRUE:
Your Answer: Propofol has some antiemetic action.
Explanation:Propofol has some antiemetic properties. It’s for this reason that it’s used to treat postoperative nausea and vomiting. Propofol is mostly processed in the liver, with the kidneys excreting just around 1% of it unaltered. Propofol, unlike thiopental, does not produce tissue necrosis when it is extravasated. Propofol lowers intracranial pressure via lowering brain metabolic rate and cerebral blood flow. Propofol is thought to be safe for people with bronchial asthma and chronic obstructive pulmonary disease.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 23
Correct
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A 62-year-old man complains of chest pain and goes to the emergency room. You diagnose him with an acute coronary syndrome and prescribe enoxaparin as part of his treatment plan.
Enoxaparin inactivates which of the following?Your Answer: Thrombin
Explanation:Enoxaparin is a low molecular weight heparin (LMWH) that works in the same way as heparin by binding to and activating the enzyme inhibitor antithrombin III. Antithrombin III inactivates thrombin by forming a 1:1 complex with it. Factor Xa and a few other clotting proteases are also inhibited by the heparin-antithrombin III complex.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 24
Correct
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Which of the following is NOT a side effect of phenytoin:
Your Answer: Ototoxicity
Explanation:Adverse effects of phenytoin include:
Nausea and vomiting
Drowsiness, lethargy, and loss of concentration
Headache, dizziness, tremor, nystagmus and ataxia
Gum enlargement or overgrowth
Coarsening of facial features, acne and hirsutism
Skin rashes
Blood disorders -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 25
Correct
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Question 26
Correct
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A 22-year-old presents with acute severe asthma. He takes a drug prescribed by her GP but cannot recall the name and is receiving regular salbutamol nebulisers. His current potassium level is 2.8 mmol/l.
Which drug is least likely to have caused his hypokalaemia?
Your Answer: Spironolactone
Explanation:Serious hypokalaemia can occur in severe asthma and the effect can be potentiated by concomitant treatment with theophyllines like aminophylline, corticosteroids, thiazide and loop diuretics, and hypoxia. Plasma-potassium concentration should be monitored in severe asthma.
Spironolactone, a potassium-sparing diuretic, is not likely to have contributed to patients hypokalaemia.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 27
Correct
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At which opioid receptors do opioid analgesics act primarily?
Your Answer: Mu
Explanation:Opioid receptors are widely distributed throughout the central nervous system. Opioid analgesics mimic endogenous opioid peptides by causing prolonged activation of these receptors, mainly the mu(μ)-receptors which are the most highly concentrated in brain areas involved in nociception.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 28
Correct
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Which of the following is NOT a common side effect of adenosine:
Your Answer: Yellow vision
Explanation:Common side effects of adenosine include:
Apprehension
Dizziness, flushing, headache, nausea, dyspnoea
Angina (discontinue)
AV block, sinus pause and arrhythmia (discontinue if asystole or severe bradycardia occur) -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 29
Correct
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Regarding V/Q mismatch, which of the following statements is CORRECT:
Your Answer: In a true shunt, increasing inspired oxygen has no effect on improving hypoxaemia.
Explanation:Both ventilation and perfusion increase towards the lung base, because of the effects of gravity, but the gravitational effects are greater on perfusion than ventilation and therefore there is a regional variation in V/Q ratio from lung apex (high V/Q) to lung base (low V/Q). In a pure shunt, there is normal perfusion but absent ventilation and the V/Q ratio = 0. In a true shunt increasing oxygen fraction has no effect because the oxygen-enriched air fails to reach the shunted blood. An increased A-a gradient is seen in V/Q mismatch.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 30
Correct
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The second generation antihistamine, cetirizine is a less-sedating antihistamine than the older antihistamine, chlorphenamine because:
Your Answer: It is less lipid-soluble so less able to cross the blood brain barrier.
Explanation:All older antihistamines such as chlorphenamine cause sedation. The newer antihistamines e.g. cetirizine cause less sedation and psychomotor impairment than the older antihistamines because they are much less lipid soluble and penetrate the blood brain barrier only to a slight extent.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 31
Correct
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Question 32
Incorrect
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A 22-year-old woman comes in with an asthmatic flare. Salbutamol is her only regular medication.
What is the dosage per inhalation of a standard metered dose salbutamol inhaler?Your Answer: 200 micrograms
Correct Answer: 100 micrograms
Explanation:The dose of a conventional metered dose inhaler is 100 micrograms per metered inhalation.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 33
Correct
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You plan to use plain 1% lidocaine for a ring block on a finger that needs suturing.
Which SINGLE statement regarding the use of 1% lidocaine, in this case, is true?Your Answer: Lidocaine works by blocking fast voltage-gated sodium channels
Explanation:Lidocaine is a tertiary amine that is primarily used as a local anaesthetic but can also be used intravenously in the treatment of ventricular dysrhythmias.
Lidocaine works as a local anaesthetic by diffusing in its uncharged base form through neural sheaths and the axonal membrane to the internal surface of the cell membrane sodium channels. Here it alters signal conduction by blocking the fast voltage-gated sodium channels. With sufficient blockage, the membrane of the postsynaptic neuron will not depolarise and will be unable to transmit an action potential, thereby preventing the transmission of pain signals.
Each 1 ml of plain 1% lidocaine solution contains 10 mg of lidocaine hydrochloride. The maximum safe dose of plain lidocaine is 3 mg/kg. When administered with adrenaline 1:200,000, the maximum safe dose is 7 mg/kg. Because of the risk of vasoconstriction and tissue necrosis, lidocaine should not be used in combination with adrenaline in extremities such as fingers, toes, and the nose.
The half-life of lidocaine is 1.5-2 hours. Its onset of action is rapid within a few minutes, and it has a duration of action of 30-60 minutes when used alone. Its duration of action is prolonged by co-administration with adrenaline (about 90 minutes).
Lidocaine tends to cause vasodilatation when used locally. This is believed to be due mainly to the inhibition of action potentials via sodium channel blocking in vasoconstrictor sympathetic nerves. -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 34
Correct
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You examine a 43-year-old woman who was referred to you by a friend. She suffers from a variety of medical conditions and takes a variety of medications, including amitriptyline.
Which of the following is NOT a contraindication to amitriptyline treatment?Your Answer: Breastfeeding
Explanation:Amitriptyline is a tricyclic antidepressant (TCA) that is most commonly used to treat depression, but it can also be used to treat anxiety disorders, chronic pain, and attention deficit hyperactivity disorder (ADHD). It inhibits reuptake, raising serotonin and noradrenaline levels while also inhibiting acetylcholine action.
TCAs have a number of drawbacks, including:
Acute Porphyria
Arrhythmias
During bipolar disorder’s manic phase
Heart block
After a myocardial infarction, there is an immediate recovery period.TCA levels in breast milk are too low to be harmful, and use can be continued while breastfeeding.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 35
Correct
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Which of the following is NOT a common effect of etomidate:
Your Answer: Significant hypotension
Explanation:Etomidate causes less hypotension than thiopental sodium and propofol during induction. However, it is associated with a high incidence of extraneous muscle movements, which can be minimised by an opioid analgesic or a short-acting benzodiazepine given prior to induction. Pain on injection is common and there is a high rate of thrombophlebitis in the postoperative period. Postoperative nausea and vomiting commonly occur. Etomidate suppresses adrenocortical function, particularly during continuous administration, and it should not be used for maintenance of anaesthesia. It should be used with caution in patients with underlying adrenal insufficiency, for example, those with sepsis.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 36
Correct
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The triage nurse asks if you will prescribe a dose of codeine phosphate for a patient who is in a lot of pain. You discover that you are unable to prescribe it due to a contra-indication after evaluating the patient.
The use of codeine phosphate is contraindicated in which of the following situations?Your Answer: Age under 12 years
Explanation:Codeine phosphate is a mild opiate that can be used to treat mild to moderate pain when other pain relievers like paracetamol or ibuprofen have failed. It can also be used to treat diarrhoea and coughs that are dry or painful.
The use of all opioids is contraindicated for the following reasons:
Respiratory depression (acute)
Patients who are comatose
Head injury (opioid analgesics impair pupillary responses, which are crucial for neurological evaluation)
Intracranial pressure has risen (opioid analgesics interfere with pupillary responses vital for neurological assessment)
There’s a chance you’ll get paralytic ileus.The use of codeine phosphate is contraindicated in the following situations:
Because of the significant risk of respiratory side effects in children under the age of 12, it is not recommended for children under the age of 12.Patients of any age who have been identified as ultra-rapid codeine metabolizers (CYP2D6 ultra-rapid metabolizers)
Because codeine can pass through breast milk to the baby and because mothers’ ability to metabolise codeine varies greatly, it is especially dangerous in breastfeeding mothers.
If other painkillers, such as paracetamol or ibuprofen, fail to relieve acute moderate pain in children over the age of 12, codeine should be used. In children with obstructive sleep apnoea who received codeine after tonsillectomy or adenoidectomy, a significant risk of serious and life-threatening adverse reactions has been identified.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 37
Correct
-
Which of the following statements is correct regarding the partial pressure of oxygen during respiration?
Your Answer: Exhaled PO 2 > Alveolar PO 2
Explanation:Because of humidification, inspired PO2 in the airways is less than inhaled PO2.
Because of gas exchange, alveolar PO2 is less than inhaled or inspired PO2.
Because of mixing with anatomical dead space (air that has not taken part in gas exchange, exhaled PO2 is greater than alveolar O2, and therefore that has relatively higher PO2 on the way out, but is less than inhaled or inspired PO2.
Typical values for a resting young healthy male (in kPa) are shown below:
-Inhaled air: PO221.2, PCO20.0
-Inspired air in airways (after humidification): PO219.9, PCO20.0
-Alveolar air (after equilibrium with pulmonary capillaries): PO213.3, PCO25.3
-Exhaled air (after mixing with anatomical dead space air): PO215.5, PCO24.3 -
This question is part of the following fields:
- Physiology
- Respiratory
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Question 38
Correct
-
Which of the following is caused by an alpha-1 antitrypsin deficiency?
Your Answer: Early onset emphysema
Explanation:Mucus contains chemicals such as alpha-1-antitrypsin, lysozyme, and IgA that protect the airway from pathogens and damaging proteases released from dead bacteria and immune cells. Early-onset emphysema results from a genetic deficit of alpha-1-antitrypsin, which is caused by unregulated protease activity in the lungs, which results in the degradation of elastin in the alveoli.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 39
Correct
-
A 25-year-old patient requires procedural sedation for reduction of an open fracture of his tibia and fibula. You plan on using ketamine as the sedative agent.
Ketamine works as a result of action on what type of receptor? Select ONE answer only.Your Answer: N-methyl-D-aspartate (NMDA)
Explanation:Ketamine is the only anaesthetic agent available that has analgesic, hypnotic, and amnesic properties. When used correctly it is a very useful and versatile drug.
Ketamine acts by non-competitive antagonism of the NMDA receptor Ca2+ channel pore and also inhibits NMDA receptor activity by interaction with the phencyclidine binding site.
Ketamine can be used intravenously and intramuscularly. The intramuscular dose is 10 mg/kg, and when used by this route, it acts within 2-8 minutes and has a duration of action of 10-20 minutes. The intravenous dose is 1.5-2 mg/kg administered over a period of 60 seconds. When used intravenously, it acts within 30 seconds and has a duration of action of 5-10 minutes. Ketamine is also effective when administered orally, rectally, and nasally.
Ketamine causes tachycardia, an increase in blood pressure, central venous pressure, and cardiac output, secondary to an increase in sympathetic tone. Baroreceptor function is well maintained, and arrhythmias are uncommon.
The main disadvantage to the use of ketamine is the high incidence of hallucinations, nightmares, and other transient psychotic effects. These can be reduced by the co-administration of a benzodiazepine, such as diazepam or midazolam.
The main side effects of ketamine are:
Nausea and vomiting
Hypertension
Nystagmus
Diplopia
Rash -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 40
Correct
-
Salbutamol should be used with caution in patients with which of the following:
Your Answer: Susceptibility to QT-interval prolongation
Explanation:Beta-2 agonists should be used with caution in people with:
Cardiovascular disease, including arrhythmias and hypertension (beta-2 agonists may cause an increased risk of arrhythmias and significant changes to blood pressure and heart rate)
Diabetes(risk of hyperglycaemia and ketoacidosis, especially with intravenous use)
Hyperthyroidism(beta-2 agonists may stimulate thyroid activity)
Hypokalaemia(potentially serious hypokalaemia may result from beta-2 agonist therapy; this effect may be potentiated in severe asthma by concomitant treatment with theophylline, corticosteroids, diuretics and by hypoxia)
Susceptibility to QT-interval prolongation
Convulsive disorders -
This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 41
Incorrect
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Which of the following does NOT predispose to digoxin toxicity in a patient taking digoxin:
Your Answer: Hypercalcaemia
Correct Answer: Hyponatraemia
Explanation:Hypoxia, hypercalcaemia, hypokalaemia and hypomagnesaemia predispose to digoxin toxicity. Care should also be taken in the elderly who are particularly susceptible to digoxin toxicity. Hypokalaemia may be precipitated by use of diuretics. Although hyponatremia can result in the development of other pathological disturbances, it does not potentiate digoxin toxicity.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 42
Correct
-
Cefotaxime (or ceftriaxone) is used first line for which of the following infections:
Your Answer: Blind treatment of suspected bacterial meningitis
Explanation:Cefotaxime (or ceftriaxone) are indicated first line in:
– Blind treatment of meningitis in patients > 3 months (with amoxicillin if patient > 50 years)
– Meningitis caused by meningococci
– Meningitis caused by pneumococci
– Meningitis caused by H. influenzae
– Severe or invasive salmonellosis
– Typhoid fever
– Gonorrhoea
– Gonococcal arthritis
– Haemophilus influenzae epiglottitis -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 43
Correct
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A patient with pronounced tremor, muscle contractions, muscle spasms, and slowness of movement is brought in by his family. He has a long history of mental health issues for which he is currently treated with a variety of medications.
Which of the medications listed below is most likely to be the cause of these side effects?Your Answer: Haloperidol
Explanation:Acute dyskinesias and dystonic reactions, tardive dyskinesia (rhythmic, involuntary movements of the tongue, face, and jaw), Parkinsonism (tremor, bradykinesia, and rigidity), akinesia, akathisia, and neuroleptic malignant syndrome are all examples of extrapyramidal side effects. They are caused by dopamine depletion or blockade in the basal ganglia; this lack of dopamine frequently mimics idiopathic extrapyramidal pathologies.
The first-generation antipsychotics, which are strong dopamine D2 receptor antagonists, are the drugs most commonly associated with extrapyramidal side effects. Haloperidol and fluphenazine are the two drugs in this class that are most commonly associated with extrapyramidal side effects. Extrapyramidal adverse effects are less common in second-generation antipsychotics (e.g., olanzapine) than in first-generation antipsychotics.
Other drugs are linked to extrapyramidal symptoms as well, but at a lower rate. Some antidepressants, lithium, various anticonvulsants, antiemetics, and, in rare cases, oral contraceptive agents are among them.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 44
Correct
-
All of the following statements regarding metronidazole are correct except:
Your Answer: Metronidazole reduces the anticoagulant effect of warfarin.
Explanation:The anticoagulant effect of warfarin is enhanced by metronidazole. If use of both cannot be avoided, one must consider appropriately reducing the warfarin dosage. With alcohol, metronidazole can cause a disulfiram-like reaction, with symptoms like flushing, headaches, dizziness, tachypnoea and tachycardia, nausea and vomiting. The common side effects of metronidazole include a metallic taste and gastrointestinal irritation, in particular nausea and vomiting. These side effects are more common at higher doses. This drug has high activity against anaerobic bacteria and protozoa, and is well absorbed orally. For severe infections, the intravenous route is normally reserved.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 45
Correct
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In adult advanced life support, which of the following best describes the correct administration of adrenaline for a non-shockable rhythm:
Your Answer: Give 1 mg of adrenaline as soon as intravenous access is achieved and every 3 - 5 minutes thereafter
Explanation:IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be given after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 46
Correct
-
The most common complication of paracetamol overdose is:
Your Answer: Hepatic failure
Explanation:The maximum daily dose of paracetamol in an adult is 4 grams. Doses greater than this can lead to hepatotoxicity and, less frequently, acute kidney injury. Early symptoms of paracetamol toxicity include nausea, vomiting, and abdominal pain, and usually settle within 24 hours. Symptoms of liver damage include right subcostal pain and tenderness, and this peaks 3 to 4 days after paracetamol ingestion. Other signs of hepatic toxicity include encephalopathy, bleeding, hypoglycaemia, and cerebral oedema.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 47
Correct
-
Regarding the foetal oxygen-haemoglobin dissociation curve, which of the following statements is CORRECT:
Your Answer: The HbF dissociation curve lies to the left of that for HbA.
Explanation:Foetal haemoglobin (HbF) has a higher affinity for oxygen than adult haemoglobin (HbA) because it’s gamma chains bind 2,3-DPG less avidly than beta chains of HbA. The HbF dissociation curve lies to the left of that for HbA. In the placenta PCO2moves from the foetal to the maternal circulation, shifting the maternal curve further right and the foetal curve further left (the double Bohr effect). The higher affinity of HbF relative to HbA helps transfer oxygen from mother to foetus. Therefore even through blood returning from the placenta to the foetus in the umbilical vein has a PO2of only about 4 kPa, its saturation is 70%. Oxygen transport in the foetus is also helped by a high Hb of about 170 – 180 g/L.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 48
Correct
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You have been called to review a patient and his management in the resuscitation room. A very sick patient has been started on mannitol in his treatment protocol.
Out of the following, what is NOT an FDA-recognized indication for the use of mannitol?
Your Answer: Congestive cardiac failure
Explanation:Mannitol is the most widely used osmotic diuretic that is most commonly used to reduce cerebral oedema and intracranial pressure.
Mannitol has four FDA approved uses clinically:
1. Reduction of intracranial pressure and brain mass
2. reduce intraocular pressure if this is not achievable by other means
3. promote diuresis for acute renal failure to prevent or treat the oliguric phase before irreversible damage
4. promote diuresis to promote the excretion of toxic substances, materials, and metabolitesIt can be used in rhabdomyolysis-induced renal failure, especially in crush injuries. Mannitol reduces osmotic swelling and oedema in the injured muscle cells and helps restore skeletal muscle function.
It is a low molecular weight compound and can be freely filtered at the glomerulus and not reabsorbed. This way increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain barrier (BBB).
Mannitol causes an expansion of the extracellular fluid space, which may worsen congestive cardiac failure. Contraindications to the use of mannitol include:
1. Anuria due to renal disease
2. Acute intracranial bleeding (except during craniotomy)
3. Severe cardiac failure
4. Severe dehydration
5. Severe pulmonary oedema or congestion
6. Known hypersensitivity to mannitol -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 49
Correct
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Despite taking the oral contraceptive pill, a 29-year-old woman becomes pregnant. During a medication review, you discover that she is epileptic and that her antiepileptic therapy has recently been changed.
Which of the following antiepileptics is most likely to impair the oral contraceptive pill's effectiveness?Your Answer: Carbamazepine
Explanation:The metabolism of ethinyl oestradiol and progestogens has been shown to be increased by enzyme-inducing antiepileptics. The oral contraceptive pill (OCP) is less effective in preventing pregnancy as a result of this increased breakdown.
Antiepileptic drugs that induce enzymes include:
Carbamazepine
Phenytoin
Phenobarbital
TopiramateAntiepileptics that do not induce enzymes are unlikely to affect contraception. Non-enzyme-inducing anticonvulsants include the following:
Clonazepam
Gabapentin
Levetiracetam
Piracetam
Sodium valproate is a type of valproate that is used toLamotrigine is an antiepileptic drug that does not cause the production of enzymes. It does, however, require special consideration, unlike other non-enzyme-inducing antiepileptics. The OCP does not appear to affect epilepsy directly, but it does appear to lower lamotrigine levels in the blood. This could result in a loss of seizure control and the occurrence of seizures.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 50
Correct
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A 7-days-old neonate is taken to the emergency department. She's pyretic, lethargic, and unresponsive, and her fontanelle has bulged. Antibiotics are started, and a lumbar puncture reveals Gram-negative rods. Which pathogen is most likely to be the cause:
Your Answer: Escherichia coli
Explanation:Among neonates, group B streptococci (GBS) are the most commonly identified causes of bacterial meningitis, implicated in roughly 50% of all cases. Escherichia coli(Gram-negative rods) accounts for another 20%. Thus, the identification and treatment of maternal genitourinary infections is an important prevention strategy.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 51
Incorrect
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A patient presents with severe vomiting. They take a maintenance dose of 12.5 mg of prednisolone daily for their COPD. They are unable to swallow or keep down tablets at present, and you plan on converting them to IV hydrocortisone.
What dose of hydrocortisone is equivalent to this dose of prednisolone? Select ONE answer only.Your Answer: 25 mg
Correct Answer: 50 mg
Explanation:Prednisolone is four times more potent than hydrocortisone, and therefore, a dose of 12.5 mg would be equivalent to 50 mg of hydrocortisone.
The following table summarises the relative potency of the main corticosteroids compared with hydrocortisone:
Corticosteroid
Potency relative to hydrocortisone
Prednisolone
4 times more potent
Triamcinolone
5 times more potent
Methylprednisolone
5 times more potent
Dexamethasone
25 times more potent -
This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 52
Correct
-
A young female was diagnosed with a urinary tract infection and was sent home with medications. However, after 48 hours of discharge, she returned to the hospital because there had been no relief from her symptoms. She is pregnant in her second trimester.
The urine sensitivity test report is still unavailable. Fresh blood tests were sent, and her estimated GFR is calculated to be >60 ml/minute.
She was prescribed nitrofurantoin 100 mg modified-release orally twice a day for two days.
Out of the following, which antibiotic is most appropriate to be prescribed to this patient?Your Answer: Cefalexin
Explanation:The NICE guidelines for pregnant women with lower UTIs are:
1. Prescribe an antibiotic immediately, taking into account the previous urine culture and susceptibility results or avoiding past antibiotics that may have caused resistance
2. Obtain a midstream urine sample before starting antibiotics and send for urine culture and susceptibility
– Review the choice of antibiotic when the results are available
– change the antibiotic according to susceptibility results if the bacteria are resistant, using a narrow-spectrum antibiotic wherever possibleThe first choice of antibiotics for pregnant women aged 12 years and over is:
1. Nitrofurantoin
100 mg modified-release PO BD for 3 days – if eGFR >45 ml/minuteThe second-choice (no improvement in lower UTI symptoms on first-choice for at least 48 hours, or when first-choice is not suitable) are:
1. Amoxicillin
500 mg PO TDS for seven days (ONLY if culture results available and susceptible)
2. Cefalexin
500 mg BD for seven days
Alternative second-choices – consult local microbiologist, choose antibiotics based on culture and sensitivity results -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 53
Correct
-
When treating diabetic ketoacidosis (DKA), which of the following should be given if the systolic blood pressure is initially less than 90 mmHg:
Your Answer: 500 mL sodium chloride 0.9% intravenous infusion over 10 - 15 minutes
Explanation:If SBP is less than 90 mmHg , 500 mL sodium chloride 0.9 percent should be administered intravenously over 10–15 minutes, and repeated if SBP remains less than 90 mmHg. When SBP is greater than 90 mmHg, sodium chloride infusion must be maintained at a rate that replaces the deficit.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 54
Correct
-
A 39-year-old man with a long history of depression presents after intentionally overdoing his heart medication. Verapamil immediate-release 240 mg is the tablet he takes for this condition, he says. He took the pills about 30 minutes ago, but his wife discovered him right away and rushed him to the emergency room.
At the moment, he is completely symptom-free. When it comes to this type of overdose, how long does it usually take for symptoms to appear?Your Answer: 1-2 hours
Explanation:Overdosing on calcium-channel blockers should always be taken seriously and regarded as potentially fatal. Verapamil and diltiazem are the two most lethal calcium channel blockers in overdose. These work by binding the alpha-1 subunit of L-type calcium channels, preventing calcium from entering the cell. In cardiac myocytes, vascular smooth muscle cells, and islet beta-cells, these channels play an important role.
>10 tablets of verapamil (160 mg or 240 mg immediate or sustained-release capsules) or diltiazem can cause serious toxicity (180 mg, 240 mg or 360 mg immediate or sustained-release capsules)
In children, 1-2 tablets of verapamil or diltiazem (immediate or sustained-release)
Symptoms usually appear within 1-2 hours of ingestion with standard preparations. However, with slow-release preparations, significant toxicity may take 12-16 hours to manifest, with peak effects occurring after 24 hours.
The following are the main clinical features of calcium-channel blocker overdose:
Nausea and vomiting
Hypotension
Bradycardia and first-degree heart block
Myocardial ischaemia and stroke
Renal failure
Pulmonary oedema
HyperglycaemiaThe following are some of the most important bedside investigations to conduct:
Blood glucose
ECG
Arterial blood gas
Other investigations that can be helpful include
Urea & electrolytes
Chest X-ray (pulmonary oedema)
Echocardiography -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 55
Correct
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The patient is a 66-year-old woman who has troublesome bilateral ankle swelling. This has been happening since she began taking a new antihypertensive medication a few weeks ago.
Which of the following medications is most likely to be the cause of this adverse reaction?Your Answer: Amlodipine
Explanation:Amlodipine is a calcium-channel blocker that is frequently used to treat hypertension. Ankle swelling is a very common side effect of calcium-channel blockers, and it occurs quite frequently.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 56
Correct
-
A 55-year-old woman with mild dyspepsia seeks advice from her pharmacist on how to deal with her symptoms. In the first instance, the pharmacist advises her to take an over-the-counter antacid. She buys an antacid that contains aluminium hydroxide, which relieves her symptoms but has a negative side effect.
She's most likely to have developed which of the following side effects?Your Answer: Constipation
Explanation:Aluminium hydroxide is a common antacid that is used to treat ulcer dyspepsia and non-erosive gastro-oesophageal reflux disease.
When antacids containing aluminium salts are given to patients with renal impairment, there is a risk of accumulation and aluminium toxicity. If renal function is normal, aluminium accumulation does not appear to be a risk.
Because it reduces gastrointestinal phosphate absorption, aluminium hydroxide can also be used to treat hyperphosphatemia in patients with renal failure.
Magnesium-based antacids are generally laxative, whereas aluminium-based antacids can be constipating. Renal impairment, angioedema, and anaphylaxis are not significantly increased.
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This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
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Question 57
Correct
-
Flumazenil is a reversal agent for which of the following groups of drugs:
Your Answer: Benzodiazepines
Explanation:Flumazenil is a benzodiazepine antagonist used for the reversal of the sedative effects of benzodiazepines after anaesthesia, sedation and similar procedures.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 58
Correct
-
Carbamazepine is indicated for all of the following EXCEPT for:
Your Answer: Myoclonic seizures
Explanation:Carbamazepine is a drug of choice for simple and complex focal seizures and is a first-line treatment option for generalised tonic-clonic seizures. It is also used in trigeminal neuralgia and diabetic neuropathy. Carbamazepine may exacerbate tonic, atonic, myoclonic and absence seizures and is therefore not recommended if these seizures are present.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 59
Correct
-
The mechanism of action of abciximab is by:
Your Answer: Blocking the binding of fibrinogen to GPIIb/IIIa receptor sites
Explanation:Abciximab is a glycoprotein IIb/IIIa inhibitors and prevents platelet aggregation by blocking the binding of fibrinogen to receptors on platelets.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 60
Correct
-
A patient presents with acute severe asthma. Her initial salbutamol nebulization produced a poor response and you administer another nebuliser with ipratropium bromide added on.
Which statement about ipratropium bromide is true?Your Answer: It can trigger acute closed-angle glaucoma
Explanation:Ipratropium bromide is an antimuscarinic drug. It is used in the management of acute asthma and COPD.
It provides short-term relief in chronic asthma. Short-acting β2agonists are preferred and act more quickly.
The commonest side effect of ipratropium bromide is dry mouth. Tremor is commonly seen with β2agonists.
It can trigger acute closed-angle glaucoma in patients that are susceptible.
First-line treatment for moderate asthma attacks is short-acting β2agonists.
The BTS guidelines recommend that nebulised ipratropium bromide (0.5 mg 4-6 hourly) be added to β2agonist treatment in patients with a poor initial response to β2agonist therapy or with acute severe or life-threatening asthma.
Its duration of action is 3-6 hours, maximum effect occurs 30-60 minutes after use, and bronchodilation can be maintained with three times per day dosing.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 61
Correct
-
What is the main mechanism of action of dopamine as an inotropic sympathomimetic:
Your Answer: Beta1-receptor agonist
Explanation:Dopamine is a neurotransmitter and a metabolic precursor of the catecholamines. It acts on beta1-receptors in cardiac muscle increasing cardiac contractility, and increases renal perfusion by stimulating dopamine receptors in the renal vasculature. This is of benefit in cardiogenic shock where deterioration of renal function is common.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 62
Correct
-
What is the recommended dosing regime for amiodarone in the treatment of a stable regular broad-complex tachycardia:
Your Answer: 300 mg IV over 10 - 60 minutes, followed by an IV infusion of 900 mg over the next 24 hours
Explanation:A ventricular tachycardia (or broad-complex tachycardia of uncertain origin) should be treated with amiodarone 300 mg IV over 10 – 60 min, followed by an infusion of 900 mg over the next 24 hours.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 63
Incorrect
-
A 15-year-old girl took 20 tablets of paracetamol almost 4 hours ago after her mother for refused to provide her permission for her to go on a girl's trip. The girl is healthy and has no known comorbidities or drug history. Which one of the following is TRUE regarding paracetamol?
Your Answer: It is thought to work by selectively inhibiting COX-1 receptors in the brain and spinal cord
Correct Answer: It is excreted renally
Explanation:Acetaminophen is an acetanilide derivative and is a widely used non-prescription analgesic and antipyretic medication for mild-to-moderate pain and fever.
The route of elimination: Paracetamol is metabolised extensively in the liver and excreted in the urine mainly as inactive glucuronide and sulfate conjugates, <5% is excreted as free (unconjugated) acetaminophen, and >90% of the dose administered is excreted within 24 hours.
It is thought to work by selectively inhibiting COX-1 receptors in the brain and spinal cord: It is categorized by the FDA as an NSAID as it is believed to selectively inhibit cyclo-oxygenase 3 (COX-3) receptors in the brain and spinal cord.
COX-3 is a unique variant of the more known COX-1 and COX-2. It is responsible for the production of prostaglandins in central areas, which sensitizes free nerve endings to the chemical mediators of pain. Therefore, by selectively inhibiting COX-3, paracetamol effectively reduces pain sensation by increasing the pain threshold.
Toxicity is primarily due to glutathione production: Acetaminophen metabolism by the CYP2E1 pathway releases a toxic metabolite known as N-acetyl-p-benzoquinoneimine (NAPQI). NAPQI primarily contributes to the toxic effects of acetaminophen. NAPQI is an intermediate metabolite that is further metabolized by fast conjugation with glutathione. The conjugated metabolite is then excreted in the urine as mercapturic acid. High doses of acetaminophen (overdoses) can lead to hepatic necrosis due to depleting glutathione and high binding levels of reactive metabolite (NAPQI) to important parts of liver cells.
Acetaminophen can be administered orally, rectally, or intravenously. It is predominantly metabolized in the liver, and the elimination half-life is 1-3 hours after a therapeutic dose. But maybe greater than 12 hours after an overdose.
It is primarily metabolized via the cytochrome p450 enzyme system: It is predominantly metabolized in the liver by three main metabolic pathways:
1. Glucuronidation (45-55%)
2. Sulphate conjugation (30-35%)
3. N-hydroxylation via the hepatic cytochrome p450 enzyme system (10-15%) -
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 64
Correct
-
A known epileptic is transported in status epilepticus by ambulance. On the way to the hospital, she took some diazepam.
Which of the following statements about diazepam is correct?Your Answer: It crosses into breast milk
Explanation:Diazepam boosts GABA’s effects, giving it sedative, hypnotic, anxiolytic, anticonvulsant, and muscle-relaxing properties. It can be administered orally, rectally, or intravenously.
With a half-life of 20-100 hours, it is a long-acting benzodiazepine. Midazolam, oxazepam, and alprazolam are examples of short-acting benzodiazepines with a half-life of less than 12 hours (Xanax).
If used in the presence of hepatic impairment, benzodiazepines can cause coma. If treatment is necessary, benzodiazepines with shorter half-lives should be used in lower doses. Diazepam is a sedative that crosses into breast milk and should be avoided by breastfeeding mothers.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 65
Correct
-
Which of the following best describes the mechanism of action of aspirin:
Your Answer: Cyclo-oxygenase (COX) inhibitor
Explanation:Aspirin is a non-steroidal anti-inflammatory drug (NSAID). Aspirin irreversibly inhibits cyclooxygenase (COX) enzymes and the resulting inhibition of prostaglandin synthesis results in analgesic, antipyretic and to a lesser extent anti-inflammatory actions.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 66
Correct
-
All of the following cause bronchodilation, EXCEPT for:
Your Answer: Stimulation of irritant receptors
Explanation:Factors causing bronchodilation: Via beta2-adrenoceptors
Sympathetic stimulation:
Adrenaline (epinephrine)
Beta2-adrenergic agonists e.g. salbutamol
Anticholinergic and muscarinic antagonists e.g. ipratropium -
This question is part of the following fields:
- Physiology
- Respiratory
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Question 67
Correct
-
What is the most common application of Nitrates?
Your Answer: Angina
Explanation:In patients with exertional stable angina, nitrates improve exercise tolerance, time to onset of angina, and ST-segment depression during exercise testing. In combination with beta-blockers or calcium channel blockers, nitrates produce greater anti-anginal and anti-ischemic effects.
While they act as vasodilators, coronary vasodilators, and modest arteriolar dilators, the primary anti ischemic effect of nitrates is to decrease myocardial oxygen demand by producing systemic vasodilation more than coronary vasodilation. This systemic vasodilation reduces left ventricular systolic wall stress. -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 68
Correct
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What is nimodipine used predominantly in the treatment of?
Your Answer: Prevention and treatment of vascular spasm following subarachnoid haemorrhage
Explanation:Nimodipine is a smooth muscle relaxant that is related to nifedipine, but the effects preferentially act on cerebral arteries. It is exclusively used for the prevention and treatment of vascular spasm after an aneurysmal subarachnoid haemorrhage.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 69
Correct
-
What is the main mechanism of action of cyclizine:
Your Answer: Histamine-H1 antagonist
Explanation:Antihistamines e.g. cyclizine, are effective against nausea and vomiting caused by many different conditions, including motion sickness and vertigo. These agents act by inhibiting histamine pathways, and cholinergic pathways involved in transmission from the vestibular apparatus to the vomiting centre. There is no evidence that any one antihistamine is superior to another but their duration of action and incidence of adverse effects differ. Adverse effects include drowsiness and antimuscarinic effects such as blurred vision, dry mouth, urinary retention, constipation and confusion.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 70
Correct
-
A 35-year-old woman has complaints of nausea, abdominal pain and dark urine. On examination, you notice she has jaundice. She tells you she recently started a new medication.
Which drug is NOT likely to cause cholestatic jaundice out of the following?Your Answer: Isoniazid
Explanation:Isoniazid is an antibiotic used in the treatment of tuberculosis. It can cause acute, dose-dependent, hepatitis but is not a recognised cause of cholestatic jaundice.
The drugs that cause cholestatic jaundice are the following:
1. Nitrofurantoin
2. Erythromycin
3. Cephalosporins
4. Verapamil
5. NSAIDs
6. ACE inhibitors
7. Tricyclic antidepressants
8. Phenytoin
9. Azathioprine
10. Carbamazepine
11. Oral contraceptive pills
12. Diazepam
13. Ketoconazole
14. Tamoxifen -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 71
Correct
-
Intravenous glucose solutions are typically used in the treatment of all of the following situations except:
Your Answer: Hypokalaemia
Explanation:In hypokalaemia, initial potassium replacement therapy should not involve glucose infusions, as glucose may cause a further decrease in the plasma-potassium concentration. Glucose infusions are used for the other indications like diabetic ketoacidosis, hypoglycaemia, routine fluid maintenance in patients who are nil by mouth (very important in children), and in hyperkalaemia.
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This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
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Question 72
Correct
-
A 52-year-old patient requires procedural sedation for DC cardioversion of atrial fibrillation. You plan on using propofol as the sedative agent.
Propofol works as a result of action on what type of receptor? Select ONE answer only.Your Answer: Gamma-aminobutyric acid (GABA)
Explanation:Propofol (2,6-diisopropylphenol) is a short-acting phenol derivative that is primarily used for the induction of anaesthesia.
Its mechanism of action is unclear but is thought to act by potentiating the inhibitory neurotransmitters GABA and glycine, which enhances spinal inhibition during anaesthesia.
The dose for induction of anaesthesia is 1.5-2.5mg/kg. The dose for maintenance of anaesthesia is 4-12 mg/kg/hour. Following intravenous injection, propofol acts within 30 seconds and its duration of action is 5-10 minutes.
Propofol produces a 15-25% decrease in blood pressure and systemic vascular resistance without a compensatory increase in heart rate. It is negatively inotropic and decreases cardiac output by approximately 20%.
The main side effects of propofol are:
Pain on injection (in up to 30%)
Hypotension
Transient apnoea
Hyperventilation
Coughing and hiccough
Headache
Thrombosis and phlebitis -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 73
Correct
-
You are about to give an antimuscarinic agent to a 55 year-old male patient. Which of the following conditions will make you with stop the administration, since it is a contraindication to antimuscarinic agents?
Your Answer: Prostatic enlargement
Explanation:Antimuscarinic medications may impair the contractility of bladder smooth muscle, resulting in acute urine retention in men with BPH, and should be avoided or used with caution.
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 74
Correct
-
Calcium-channel blockers can be divided into two categories: dihydropyridines and non-dihydropyridines. The basic chemical structure of these two classes differs, as does their relative selectivity for cardiac versus vascular L-type calcium channels. The phenylalkylamine class and the benzothiazepine class are two subgroups of non-dihydropyridines.
A phenylalkylamine calcium-channel blocker is, for example, which of the following?Your Answer: Verapamil
Explanation:Calcium-channel blockers, also known as calcium antagonists, stop calcium from entering cells through the L-type calcium channel. This causes vascular smooth muscle in vessel walls to relax, resulting in a decrease in peripheral vascular resistance.
They can be used for a variety of things, including:
Hypertension
Angina
Atrial fibrillation
MigraineCalcium-channel blockers can be divided into two categories: dihydropyridines and non-dihydropyridines. The basic chemical structure of these two classes differs, as does their relative selectivity for cardiac versus vascular L-type calcium channels.
Dihydropyridines have a high vascular selectivity and lower systemic vascular resistance and blood pressure. As a result, they’re frequently used to treat hypertension. Modified release formulations are also used to treat angina, but their powerful systemic vasodilator and pressure-lowering effects can cause reflex cardiac stimulation, resulting in increased inotropy and tachycardia, which can counteract the beneficial effects of reduced afterload on myocardial oxygen demand.
The suffix -dpine distinguishes dihydropyridines from other pyridines. Examples of dihydropyridines that are commonly prescribed include:
Amlodipine
Felodipine
Nifedipine
NimodipineThe phenylalkylamine class and the benzothiazepine class are two subgroups of non-dihydropyridines.
Phenylalkylamines are less effective as systemic vasodilators because they are relatively selective for the myocardium. This group of drugs lowers myocardial oxygen demand and reverses coronary vasospasm, making them useful in the treatment of angina. They are also occasionally used to treat arrhythmias. A phenylalkylamine calcium-channel blocker like verapamil is an example.
In terms of selectivity for vascular calcium channels, benzothiazepines fall somewhere between dihydropyridines and phenylalkylamines. They can lower arterial pressure without producing the same level of reflex cardiac stimulation as dihydropyridines because they have both cardiac depressant and vasodilator effects. Diltiazem is the only benzothiazepine currently in clinical use.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 75
Correct
-
A 78-year-old woman visits the emergency room with dizziness and nausea. She claims that her doctor gave her cinnarizine two days prior, but that it didn't seem to help.
Cinnarizine's mechanism of action is which of the following?Your Answer: Antihistamine action
Explanation:Cinnarizine is a piperazine derivative with an antihistamine effect that makes it anti-emetic. Motion sickness and vestibular disorders, such as Méniéres disease, are the most common conditions for which it is prescribed.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 76
Correct
-
Regarding the management of diabetic ketoacidosis (DKA), insulin should initially be given:
Your Answer: At a concentration of 1 unit/mL at a fixed rate of 0.1 units/kg/hour
Explanation:An intravenous insulin infusion should be started at a concentration of 1 unit/mL, at a fixed rate of 0.1 units/kg/hour. Established subcutaneous long-acting insulin therapy should be continued concomitantly. Blood ketone and blood glucose concentrations should be checked hourly and the insulin infusion rate adjusted accordingly. Blood ketone concentration should fall by at least 0.5 mmol/litre/hour and blood glucose concentration should fall by at least 3 mmol/litre/hour.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 77
Correct
-
For a tachyarrhythmia caused by hypovolaemic shock, which of the following is the first-line treatment:
Your Answer: Synchronised DC shock
Explanation:If there are any adverse symptoms, immediate cardioversion with synchronized DC shock is recommended. If cardioversion fails to stop the arrhythmia and the symptoms persist, amiodarone 300 mg IV over 10–20 minutes should be administered before attempting another cardioversion. The loading dosage of amiodarone is followed by a 24-hour infusion of 900 mg administered into a large vein.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 78
Correct
-
A 62-year-old woman is brought to the Emergency Department as she is acutely unwell. Her attendants inform you that she was recently started on lithium as a mood stabilizer.
You instantly send a blood sample to check for lithium levels.
What is the usual therapeutic range for lithium?Your Answer: 0.4-0.8 mmol/l
Explanation:Lithium is the drug of choice for recurrent bipolar illness but should be carefully monitored as it has a very low therapeutic index. The normal therapeutic range is 0.4-0.8 mmol/l.
The lower end of the range is usually the target for the elderly and as maintenance therapy. Toxicity is usually seen at levels >1.5 mmol/l. Samples should be taken 12 hours after the dose, and levels should be checked one week after starting therapy and one week after every change in dosage.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 79
Correct
-
A 28-year-old woman in her second trimester is diagnosed with a psychiatric illness. She is started on treatment with a drug. The treatment results in her baby being born with poor tone, feeding problems, hypothyroidism, and a goitre
Out of the following, which drug is most likely responsible for the baby's condition?Your Answer: Lithium
Explanation:In pregnancy and postpartum, lithium is an effective treatment for relapse prevention in bipolar disorder. However, lithium has also been associated with risks during pregnancy for both the mother and the unborn child. Recent large studies have confirmed the association between first-trimester lithium exposure and an increased risk of congenital malformations.
Lithium levels need to be monitored more frequently throughout pregnancy and the postnatal period.
If given in the 1st-trimester, lithium is associated with a risk of fetal cardiac malformations, such as Ebstein’s anomaly.
If given in the 2nd and 3rd-trimesters, there is a risk of the following:
1. hypotonia
2. lethargy
3. feeding problems
4. hypothyroidism
5. goitre
6. nephrogenic diabetes insipidus in the neonate -
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 80
Correct
-
You're examining a 58-year-old male who has cellulitis in his left leg. Because he is allergic to penicillin, you start him on erythromycin.
Which of the following statements about erythromycin is correct?Your Answer: It can be used to treat Legionnaire’s disease
Explanation:Bacteriostatic antibiotics include erythromycin and other macrolide antibiotics. They work by attaching to the bacterial ribosome’s 50S subunit, preventing translocation and thereby protein synthesis. Macrolide antibiotics are actively concentrated inside leukocytes and delivered to the infection site as a result.
Erythromycin is an orally active antibiotic that can also be given intravenously. It is metabolized in the liver and eliminated in the bile and has a biological half-life of 1.5 hours.
It has a similar antibacterial spectrum to benzylpenicillin (i.e., a narrow spectrum, primarily against Gram-positive pathogens) and can be used as a penicillin substitute in people who are allergic to penicillin.
Erythromycin is unsuccessful in the treatment of meningitis because it does not penetrate the central nervous system well enough. It is efficient against a variety of unusual pathogens, unlike penicillin. -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 81
Incorrect
-
A 72-year-old man has a past medical history of diverticular disease. He now presents in the clinic with crampy abdominal pain. The nurse at the triage suggests prescribing hyoscine butyl bromide to help relieve the abdominal pain. However, you do not agree with this medication, as you can see on his chart that the patient has several other comorbidities.
Out of the following, what is NOT a contraindication to using hyoscine butyl bromide?Your Answer: Severe ulcerative colitis
Correct Answer: Prostatic hyperplasia
Explanation:Hyoscine butylbromide is an antispasmodic drug that blocks muscarinic receptors and reduces intestinal motility. It is used for gastrointestinal and genitourinary smooth muscle spasms and symptomatic relief of IBS.
It has the following contraindications:
1. Closed-angle glaucoma
2. Gastrointestinal obstruction
3. Intestinal atony
4. Paralytic ileus
5. Toxic megacolon
6. Severe ulcerative colitis
7. Significant bladder outflow obstruction
8. Urinary retention
9. Myasthenia gravisUse cautiously in the following conditions:
1. Acute myocardial infarction (in adults)
2. Arrhythmias (may be worsened)
3. Autonomic neuropathy
4. Hypertension
5. Cardiac insufficiency (due to association with tachycardia)
6. Congestive cardiac failure (maybe worsened)
7. Cardiac surgery (due to association with tachycardia)
8. Gastro-oesophageal reflux disease
9. Ulcerative colitis
10. Prostatic hyperplasia
11. Use in children (increased risk of side effects) -
This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
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Question 82
Correct
-
A 59-year-old man presents to the emergency room with chest pain. He was recently released from the hospital after receiving abciximab during coronary angioplasty.
Which of the following is abciximab (ReoPro) mechanism of action?Your Answer: Antagonism of the glycoprotein IIb/IIIa receptor
Explanation:Abciximab (ReoPro) is a glycoprotein IIb/IIIa receptor antagonist that is a chimeric monoclonal antibody. It is primarily used during and after coronary artery procedures such as angioplasty to inhibit platelet aggregation.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
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Question 83
Correct
-
A patient presents with an acute severe asthma attack. Following a poor response to his initial salbutamol nebuliser, you administer a further nebuliser that this time also contains ipratropium bromide.
After what time period would you expect the maximum effect of the ipratropium bromide to occur? Select ONE answer only.Your Answer: 30 -60 minutes
Explanation:Ipratropium bromide is an antimuscarinic drug used in the management of acute asthma and COPD. It can provide short-term relief in chronic asthma, but short-acting β2agonists act more quickly and are preferred.
The BTS guidelines recommend that nebulised ipratropium bromide (0.5 mg 4-6 hourly) can be added to β2agonist treatment for patients with acute severe or life-threatening asthma or those with a poor initial response to β2 agonist therapy.
The aerosol inhalation of ipratropium can be used for short-term relief in mild chronic obstructive pulmonary disease in patients who are not already using a long-acting antimuscarinic drug (e.g. tiotropium).Its maximum effect occurs 30-60 minutes after use; its duration of action is 3-6 hours, and bronchodilation can usually be maintained with treatment three times per day.
The commonest side effect of ipratropium bromide is dry mouth. It can also trigger acute closed-angle glaucoma in susceptible patients. Tremor is commonly seen with β2agonists but not with antimuscarinics. Ipratropium bromide should be used with caution in: Men with prostatic hyperplasia and bladder-outflow obstruction (worsened urinary retention has been reported in elderly men), People with chronic kidney disease (CKD) stages 3 and above (because of the risk of drug toxicity), People with angle-closure glaucoma (nebulised mist of antimuscarinic drugs can precipitate or worsen acute angle-closure glaucoma) -
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 84
Correct
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Question 85
Incorrect
-
In a ward round, you come across a patient's treatment chart prescribed an antibiotic to fight his infection. This antibiotic disrupts cell membrane function.
Which of the following antimicrobial drugs is prescribed to this patient?Your Answer: Trimethoprim
Correct Answer: Nystatin
Explanation:Nystatin binds ergosterol (unique to the fungi cell membrane) and forms membrane pores that allow K+ leakage, acidification, and subsequent death of the fungus.
Vancomycin inhibits cell wall peptidoglycan formation by binding the D-Ala-D-Ala portion of cell wall precursors.
Flucloxacillin inhibits the synthesis of bacterial cell walls. It inhibits cross-linkage between the linear peptidoglycan polymer chains that make up a major component of the cell wall of Gram-positive bacteria.
Trimethoprim inhibits bacterial dihydrofolate reductase.
Isoniazid decreases the synthesis of mycolic acids in mycobacteria.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 86
Correct
-
You contact the intensive care outreach team to inquire about a severely hypotensive resuscitated patient. They make the decision to start a dopamine infusion.
Dopamine primarily has which of the following effects at high doses (>15 g/kg/min)?Your Answer: Alpha-adrenergic stimulation
Explanation:Dopamine is a catecholamine that occurs naturally and is used to treat low cardiac output, septic shock, and renal failure. It is both adrenaline and noradrenaline’s immediate precursor.
Dopamine acts on D1 and D2 dopamine receptors in the renal, mesenteric, and coronary beds at low doses (1-5 g/kg/min). Dopamine causes a significant decrease in renal vascular resistance and an increase in renal blood flow at these doses. Within this dose range, it is also involved in central modulation of behaviour and movement.
Dopamine stimulates beta- and alpha-adrenergic receptors directly and indirectly at higher doses. Beta-stimulation predominates at a rate of 5-10 g/kg/min, resulting in a positive inotropic effect that increases cardiac output and coronary blood flow. Alpha-stimulation predominates at infusion rates greater than 15 g/kg/min, resulting in peripheral vasoconstriction and an increase in venous return and systolic blood pressure.
Because clearance varies greatly in critically ill patients, plasma concentrations cannot be predicted reliably from infusion rates.
Dopamine is given as an intravenous infusion, and because extravasation can cause tissue necrosis and sloughing, a central line is usually used (especially at higher doses >240 g/min). In an emergency, however, dopamine can be administered through a large vein (cephalic or basilic) while a central line is being prepared. Alkaline intravenous solutions inactivate it, so sodium bicarbonate should not be infused with it.The following are the most common dopamine side effects:
Nausea and vomiting
Tachycardia
Dysrhythmias
Angina
Hypertension -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 87
Correct
-
Regarding aspirin at analgesic doses, which of the following statements is CORRECT:
Your Answer: It is contraindicated in patients with severe heart failure.
Explanation:Aspirin (at analgesic doses) is contraindicated in severe heart failure. Aspirin irreversibly inhibits cyclooxygenase (COX) enzymes resulting in decreased production of prostaglandins (which can lead to irritation of the gastric mucosa). The analgesic dose is greater than the antiplatelet dose, and taken orally it has a duration of action of about 4 hours. Clinical features of salicylate toxicity in overdose include hyperventilation, tinnitus, deafness, vasodilatation, and sweating.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 88
Correct
-
Stimulation of J receptors located on alveolar and bronchial walls results in all of the following EXCEPT for:
Your Answer: Tachycardia
Explanation:Juxtapulmonary or ‘J’ receptors are located on alveolar and bronchial walls close to the capillaries. Their afferents are small unmyelinated C-fibres or myelinated nerves in the vagus nerve. Activation causes depression of somatic and visceral activity by producing apnoea or rapid shallow breathing, a fall in heart rate and blood pressure, laryngeal constriction and relaxation of skeletal muscles via spinal neurones. J receptors are stimulated by increased alveolar wall fluid, pulmonary congestion and oedema, microembolism and inflammatory mediators. J receptors are thought to be involved in the sensation of dyspnoea in lung disease.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 89
Correct
-
In the Emergency Department, a 35-year-old woman actively seizing is brought in. She is quickly shifted into the resuscitation room and is administered a dose of benzodiazepine. The seizure is quickly terminated.
Once the patient is stable, she tells you she is a known case of epilepsy and takes phenytoin to control it.
Which of the following is the primary mechanism of action of phenytoin?Your Answer: Sodium channel blocker
Explanation:Phenytoin is in the anticonvulsants class of drugs and is used in the management and treatment of the following:
1. epilepsy
2. generalized tonic-clonic seizures
3. complex partial seizures
4. status epilepticus.It works by inactivating the voltage-gated sodium channels responsible for increasing the action potential. It is non-specific and targets almost all voltage-gated sodium channel subtypes. More specifically, phenytoin prevents seizures by inhibiting the positive feedback loop that results in neuronal propagation of high-frequency action potentials.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 90
Correct
-
A 72 year old man is brought to ED by ambulance with sudden onset chest pain, palpitations and shortness of breath. His HR is 160 bpm and BP 90/65. ECG demonstrates new-onset fast atrial fibrillation. Which of the following is the first-line treatment option in this case:
Your Answer: Synchronised DC cardioversion
Explanation:All patients with adverse features suggesting life-threatening haemodynamic instability (shock, syncope, heart failure, myocardial ischaemia) caused by new onset atrial fibrillation should undergo emergency electrical cardioversion with synchronised DC shock without delaying to achieve anticoagulation.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 91
Correct
-
Which of the following is NOT a contraindication to treatment with aspirin at analgesic doses:
Your Answer: Myasthenia gravis
Explanation:Aspirin (at analgesic doses) is contraindicated in:
People with a history of true hypersensitivity to aspirin or salicylates (symptoms of hypersensitivity to aspirin or salicylates include bronchospasm, urticaria, angioedema, and vasomotor rhinitis)
People with active or previous peptic ulceration
People with haemophilia or another bleeding disorder
Children younger than 16 years of age (risk of Reye’s syndrome)
People with severe cardiac failure
People with severe hepatic impairment
People with severe renal impairmentN.B. Owing to an association with Reye’s syndrome, aspirin-containing preparations should not be given to children under 16 years, unless specifically indicated, e.g. for Kawasaki disease.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 92
Correct
-
You examine a 72-year-old man who has recently begun bumetanide treatment for worsening heart failure.
Which of these statements about bumetanide is correct?Your Answer: It has better intestinal absorption than furosemide
Explanation:Bumetanide is a loop diuretic that is used to treat congestive heart failure. It is frequently used in patients who have failed to respond to high doses of furosemide.
It has a potency of about 40 times that of furosemide, with a 1 mg dose being roughly equivalent to a 40 mg dose of furosemide.
Seizures are not known to be triggered by bumetanide. In fact, it lowers the concentration of neuronal chloride, making GABA’s action more depolarizing, and it’s currently being tested as an antiepileptic in the neonatal period.It takes effect after 1 hour of oral administration, and diuresis takes 6 hours to complete.
Bumetanide absorbs much better in the intestine than furosemide. Because it has a higher bioavailability than furosemide, it is commonly used in patients with gut oedema.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 93
Correct
-
Swelling of the lips, tongue, and face is observed in a 59-year-old African-American woman. In the emergency room, she is given intramuscular adrenaline, but her symptoms do not improve. Her GP recently started her on a new medication.
Which of the following drugs is most likely to have caused her symptoms?Your Answer: Ramipril
Explanation:Angiotensin-converting enzyme (ACE) inhibitors are the most common cause of drug-induced angioedema in the United Kingdom and the United States, owing to their widespread use.
Angioedema is caused by ACE inhibitors in 0.1 to 0.7 percent of patients, with data indicating a persistent and relatively constant risk year after year. People of African descent have a five-fold higher chance of contracting the disease.
Swelling of the lips, tongue, or face is the most common symptom, but another symptom is episodic abdominal pain due to intestinal angioedema. Itching and urticaria are noticeably absent.
The mechanism appears to be activated complement or other pro-inflammatory cytokines like prostaglandins and histamine, which cause rapid vasodilation and oedema.
Other medications that are less frequently linked to angioedema include:
Angiotensin-receptor blockers (ARBs)
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Bupropion (e.g. Zyban and Wellbutrin)
Beta-lactam antibiotics
Statins
Proton pump inhibitorsThe majority of these reactions are minor and can be treated by stopping the drug and prescribing antihistamines.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 94
Correct
-
For which of the following class of drugs can neostigmine be used as a reversal agent?
Your Answer: Non-depolarising muscle relaxants
Explanation:Neostigmine is used specifically for reversal of nondepolarizing (competitive) blockade and is anticholinesterase. It acts within one minute of intravenous injection, and the effects last for 20 to 30 minutes. After this time period, a second dose may then be necessary.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 95
Correct
-
A 23-year-old female has been prescribed a medication in the first trimester of pregnancy due to a life-threatening medical problem. After delivery, the foetus is found to have nasal hypoplasia, stippling of his bones and atrophy of bilateral optic discs along with growth retardation.
Which ONE of the following drugs has this woman most likely received?Your Answer: Warfarin
Explanation:Warfarin is teratogenic and can cause a host of abnormalities in the growing foetus. These include hypoplasia of the nasal bridge, stippling of the epiphyses, multiple ophthalmic complications, growth retardation, pectus carinatum, atrial septal defect, ventriculomegaly and a patent ductus arteriosus.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 96
Correct
-
Which of the following is NOT an adverse effect of amitriptyline:
Your Answer: Hypokalaemia
Explanation:Adverse effects include:
Antimuscarinic effects: Dry mouth, Blurred vision, Constipation, Urinary retention, Sedation, Confusion
Cardiovascular effects: Heart block, Arrhythmias, Tachycardia, Postural hypotension, QT-interval prolongation, Hepatic impairment, Narrow-angle glaucoma -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 97
Correct
-
Which of the following is NOT an indication for a H1 receptor antihistamine:
Your Answer: Gastroesophageal reflux disease
Explanation:Antihistamines are competitive inhibitors at the H1-receptor (in contrast to H2 receptor antagonists used to decrease gastric acid secretion in gastroesophageal reflux disease).
Indications:
Allergic rhinitis and conjunctivitis
Urticarial rashes, pruritus, insect bites and stings
Angioedema
Anaphylaxis (second line adjunct to adrenaline)
Nausea/vomiting and prevention of motion sickness
Insomnia -
This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 98
Correct
-
In adult basic life support, chest compressions should be performed at which of the following rates:
Your Answer: 100 - 120 per minute
Explanation:Chest compressions should be performed at a rate of 100 – 120 per minute.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 99
Correct
-
Herpes simplex encephalitis has a predilection for which of the following sites:
Your Answer: Temporal lobe
Explanation:Herpes simplex virus is the most common cause of infective encephalitis and has a predilection for the temporal lobes. Herpes simplex is transmitted through direct contact. It invades skin locally producing skin vesicles by its cytolytic activity.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 100
Correct
-
Which of the following is a well recognised adverse effect of prochlorperazine:
Your Answer: Acute dystonic reaction
Explanation:Adverse actions include anticholinergic effects such as drowsiness, dry mouth, and blurred vision, extrapyramidal effects, and postural hypotension. Phenothiazines can all induce acute dystonic reactions such as facial and skeletal muscle spasms and oculogyric crises; children (especially girls, young women, and those under 10 kg) are particularly susceptible.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 101
Correct
-
Nifedipine commonly causes which of the following adverse effects?
Your Answer: Ankle oedema
Explanation:Most common adverse effects of Nifedipine include:
Peripheral oedema (10-30%)
Dizziness (23-27%)
Flushing (23-27%)
Headache (10-23%)
Heartburn (11%)
Nausea (11%) -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 102
Incorrect
-
Before a patient is discharged, you are asked to review them. He is a 59-year-old man who was seen with epigastric pain that has since subsided, and he will be seen by his GP in the coming days. He's been hearing a lot about aspirin lately and wants to learn more about it.
Which of the following statements about aspirin's mechanism of action is correct?Your Answer: Inhibition of factor VII
Correct Answer: Inhibition of cyclo-oxygenase
Explanation:Aspirin works by inhibiting cyclo-oxygenase in an irreversible manner, resulting in a decrease in prostaglandin and thromboxane production. As a result, platelet activation and aggregation are reduced.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 103
Incorrect
-
A 40-year-old man complains of pain and redness in his lower thigh due to an insect bite. He was diagnosed with cellulitis. Select the first-line antibiotic for cellulitis.
Your Answer: Amoxicillin
Correct Answer: Flucloxacillin
Explanation:Cellulitis is most commonly caused by bacteria from the group Aß-hemolytic streptococcus.
Cellulitis can be caused by animal bites. For uncomplicated cellulitis, flucloxacillin is the first-line antibiotic. Because it is beta-lactamase stable, it is efficient against Staphylococcus aureus.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 104
Incorrect
-
Due to severe palpitations, a 28-year-old woman is transported to the Emergency Department by ambulance. Her heart rate is 180 beats per minute, and the rhythm strip shows supraventricular tachycardia. You intend to give adenosine.
Which of the following is NOT a contraindication for adenosine use?Your Answer: 2 nd -degree heart block
Correct Answer: History of heart transplant
Explanation:The purine nucleoside adenosine is used to diagnose and treat paroxysmal supraventricular tachycardia. Adenosine works by stimulating A1-adenosine receptors and opening potassium channels that are sensitive to acetylcholine. This causes the atrioventricular (AV) node’s cell membrane to become hyperpolarized, slowing conduction by inhibiting calcium channels.
Patients who have had a heart transplant are extremely sensitive to the effects of adenosine and should start with a lower dose of 3 mg, then 6 mg, and finally 12 mg. Dipyridamole potentiates the effects of adenosine, so it should be used with caution in patients who are taking it.
The use of adenosine is contraindicated in the following situations:
Asthma
COPD (chronic obstructive pulmonary disease)
Decompensated heart failureÂ
Long QTÂ syndrome
AV block in the second or third degree
Sinusitis is a condition in which the sinuses become (unless pacemaker fitted)
Hypotension that is severeIt has a half-life of less than 10 seconds and acts quickly within that time frame. The actions last between 10 and 20 seconds.
Because of the short half-life of the drug, any side effects are usually only temporary. These are some of them:
a feeling of impending doom
Flushing of the face
Dyspnoea
Uncomfortable chest
Tastes metallic -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 105
Incorrect
-
The patient is a 61-year-old man with severe central chest pain. An acute myocardial infarction is revealed by his ECG. Clopidogrel is one of the medications he takes as part of his treatment.
Clopidogrel's direct mechanism of action is which of the following?Your Answer: Inhibition of the synthesis of clotting factors II, VII, IX and X
Correct Answer: Inhibition of platelet ADP receptors
Explanation:Clopidogrel, a thienopyridine derivative, prevents platelet aggregation and cross-linking by the protein fibrin by inhibiting the ADP receptor on platelet cell membranes (inhibits binding of ADP to its platelet receptor (P2Y12 ADP-receptor).
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 106
Incorrect
-
A 73-year-old woman arrives at the emergency department 48 hours after being discharged from the hospital after a two-week stay for sepsis treatment. She has fever, productive cough with thick green sputum, and shortness of breath. An X-ray shows left lower lobe pneumonia. Which of the bacteria listed below is more likely to be the causative agent:
Your Answer: Streptococcus pneumoniae
Correct Answer: Pseudomonas aeruginosa
Explanation:Hospital-acquired pneumonia (HAP), or nosocomial pneumonia, is a lower respiratory infection that was not incubating at the time of hospital admission and that presents clinically 2 or more days after hospitalization. Pneumonia that presents sooner should be regarded as community acquired pneumonia. VAP refers to nosocomial pneumonia that develops among patients on ventilators. Ventilator-associated pneumonia (VAP) is defined as pneumonia that presents more than 48 hours after endotracheal intubation.
Common bacteria involved in hospital-acquired pneumonia (HAP) include the following [10] :
Pseudomonas Aeruginosa
Staphylococcus aureus, including methicillin-susceptible S aureus (MSSA) and methicillin-resistant S aureus (MRSA)
Klebsiella pneumoniae
Escherichia coli -
This question is part of the following fields:
- Infections
- Microbiology
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Question 107
Incorrect
-
A 70-year-old patient presents with a chronic digoxin overdose. She has vomited several times, is extremely tired, and her vision 'appears yellow,' according to her.
Which of the following is a reason for this patient's use of Digifab?Your Answer: Heart rate of 40 bpm
Correct Answer: Coexistent renal failure
Explanation:An antidote for digoxin overdose is digoxin-specific antibody (Digifab). It’s a lyophilized preparation of digoxin-immune ovine Fab immunoglobulin fragments that’s sterile, purified, and lyophilized. These fragments were extracted from the blood of healthy sheep that had been immunised with a digoxin derivative called digoxin-dicarboxymethoxylamine (DDMA), a digoxin analogue that contains the functionally important cyclopentaperhydrophenanthrene:lactone ring moiety coupled to keyhole limpet hemocyanin (KLH).
Digifab has a higher affinity for digoxin than digoxin does for its sodium pump receptor, which is thought to be the site of its therapeutic and toxic effects. When given to a patient who is intoxicated, Digifab binds to digoxin molecules, lowering free digoxin levels and shifting the equilibrium away from binding to receptors, reducing cardio-toxic effects. The kidney and reticuloendothelial system then clear the Fab-digoxin complexes.
The following summarises the indications for Digifab in acute and chronic digoxin toxicity:
Acute digoxin toxicity
Chronic digoxin toxicity
Cardiac arrest
Life-threatening arrhythmia
Potassium level > 5 mmol/l
>10 mg digoxin ingested (adult)
>4 mg digoxin ingested (child)
Digoxin level > 12 ng/ml
Cardiac arrest
Life-threatening arrhythmia
Significant gastrointestinal symptoms
Symptoms of digoxin toxicity -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 108
Incorrect
-
You investigated a patient with a chest infection and want to start antibiotics right away. The patient says they she can't take cephalosporins when you ask about allergies.
Choose the 'second-generation' cephalosporin from the following choices?Your Answer: Cefalexin
Correct Answer: Cefuroxime
Explanation:Cephalosporins of the first generation include cephalexin, cefradine, and cefadroxil. Urinary tract infections, respiratory tract infections, otitis media, and skin and soft-tissue infections are all treated with them.
Second-generation cephalosporins include cefuroxime, cefaclor, and cefoxitin. These cephalosporins are less vulnerable to beta-lactamase inactivation than the ‘first-generation’ cephalosporins. As a result, they’re effective against germs that are resistant to other antibiotics, and they’re especially effective against Haemophilus influenzae.
Cephalosporins of the third generation include cefotaxime, ceftazidime, and ceftriaxone. They are more effective against Gram-negative bacteria than second generation’ cephalosporins. They are, however, less effective against Gram-positive bacteria such Staphylococcus aureus than second-generation cephalosporins.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 109
Correct
-
A patient who is a known case of rheumatoid arthritis presents to the clinic as his grandson was recently diagnosed with chickenpox. His grandson spent the weekend with her, and he was in close contact with him. He takes 50 mg of prednisolone once daily and has been for the past six months. There is no history of chickenpox.
Out of the following, which is TRUE regarding the next plan of action for her care?Your Answer: She should receive prophylactic varicella-zoster Immunoglobulin (VZIG)
Explanation:Varicella-zoster immunoglobulin (VZIG) is indicated for post exposure prevention and treatment of varicella. It is recommended as prophylaxis for high-risk patients with no known immunity (i.e. no known previous chickenpox) who have had a significant exposure to varicella-zoster (considered >4 hours close contact).
The high-risk groups are:
1. Neonates
2. Pregnant women
3. The immunocompromised (e.g. cancer, immunosuppressive therapies)
4. Those on high dose steroids (children on more than 2 mg/kg/day for more than 14 days, or adults on 40 mg/day for more than a week)This patient is at high risk of developing adrenal insufficiency and may need a temporary increase in her steroid dose during infection or stress. It would be inappropriate to stop or wean down her dose of prednisolone and can cause side effects.
Since he is on steroids without immunity for chickenpox, he is at risk of developing severe varicella infection, with possible complications including pneumonia, hepatitis and DIC.
If he develops a varicella infection, he will need to be admitted and require a specialist review and intravenous Acyclovir.
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This question is part of the following fields:
- Immunological Products & Vaccines
- Pharmacology
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Question 110
Incorrect
-
Regarding ACE inhibitors, which of the following statements is CORRECT:
Your Answer: They are recommended first line treatment for hypertension in patients of Afro-Caribbean descent.
Correct Answer: Angiotensin-II receptor blockers are a useful alternative in patients who cannot tolerate ACE-inhibitors due a persistent cough.
Explanation:ACE inhibitors should be used with caution in patients of Afro-Caribbean descent who may respond less well; calcium channel blockers are first line for hypertension in these patients. ACE inhibitors have a role in the management of diabetic nephropathy. ACE inhibitors are contraindicated in pregnant women. ACE inhibitors inhibit the breakdown of bradykinin; this is the cause of the persistent dry cough. Blocking ACE also diminishes the breakdown of the potent vasodilator bradykinin which is the cause of the persistent dry cough. Angiotensin-II receptor blockers do not have this effect, therefore they are useful alternative for patients who have to discontinue an ACE inhibitor because of persistent cough.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 111
Incorrect
-
Disease specific immunoglobulin is available for all of the following infectious diseases EXCEPT for:
Your Answer: Hepatitis B
Correct Answer: Hepatitis A
Explanation:Disease specific immunoglobulins are available for:
hepatitis B
rabies
tetanus
varicella-zoster
Normal immunoglobulin can be used to confer protection against hepatitis A. -
This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
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Question 112
Incorrect
-
Regarding NSAIDs, which of the following statements is CORRECT:
Your Answer: The anti-inflammatory effect is usually apparent after 24 hours.
Correct Answer: Diclofenac is contraindicated in people with ischaemic heart disease.
Explanation:Due to their increased risk of cardiovascular adverse events, coxibs and diclofenac are contraindicated in people with ischaemic heart disease, cerebrovascular disease, peripheral arterial disease and mild, moderate, or severe heart failure. Other NSAIDs are only contraindicated in people with severe heart failure. Selective inhibition of COX-2 is associated with less gastrointestinal intolerance. In single doses NSAIDs have analgesic activity comparable to that of paracetamol, therefore given their side effect profile, paracetamol is preferred, particularly in the elderly. Pain relief starts soon after taking the first dose and a full analgesic effect should normally be obtained within a week, whereas an anti-inflammatory effect may not be achieved (or may not be clinically assessable) for up to 3 weeks. Mefenamic acid has only very mild anti-inflammatory properties.
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This question is part of the following fields:
- Musculoskeletal
- Pharmacology
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Question 113
Incorrect
-
A 55-year-old female is urgently rushed into the Emergency Department as she complains of chest pain that is worse on breathing, shortness of breath, palpitations, and haemoptysis.
She undergoes a CT pulmonary angiogram, which reveals a large pulmonary embolus. She is immediately started on heparin and shifted to the acute medical ward.
Which of the following statements is true regarding heparin?Your Answer: It inhibits clotting factors II, VII, IX and X
Correct Answer: It activates antithrombin III
Explanation:Heparin is a polymer of glycosaminoglycan. It occurs naturally and is found in mast cells. Clinically, it is used in two forms:
1. Unfractionated: widely varying polymer chain lengths
2. Low molecular weight: Smaller polymers onlyHeparin works by binding to and activating the enzyme inhibitor antithrombin III. Antithrombin III inactivates thrombin (factor IIa) by forming a 1:1 complex with thrombin. The heparin-antithrombin III complex also inhibits factor Xa and some other proteases involved with clotting. The heparin-ATIII complex can also inactivate IX, XI, XII, and plasmin.
Heparin is not thrombolytic or fibrinolytic. It prevents the progression of existing clots by inhibiting further clotting. The lysis of existing clots relies on endogenous thrombolytics.
Heparin is used for:
1. Prevention and treatment of venous thromboembolism
2. Treatment of disseminated intravascular coagulation
3. Treatment of fat embolism
4. Priming of haemodialysis and cardiopulmonary bypass machinesThere is no evidence that heparin is superior to low-molecular-weight heparins in preventing mortality from thrombosis.
Vitamin K is used to reverse the effects of warfarin but not heparin. For heparin, protamine sulphate is used to counteract its effects.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 114
Incorrect
-
A 25-year-old female arrives at the emergency room with a severe case of asthma. When she doesn't seem to be improving after initial treatment, you decide to start an aminophylline infusion.
From the options below, which is Aminophylline's main mechanism of action?Your Answer: Alpha receptor antagonism
Correct Answer: Phosphodiesterase inhibition
Explanation:Theophylline and Ethylenediamine are combined in a 2:1 ratio to form Aminophylline. Its solubility is improved by the addition of Ethylenediamine. It has a lower potency and a shorter duration of action than Theophylline.
It is used to treat the following conditions:
Heart failure
It is used to treat the following conditions:
COPD
BradycardiasAminophylline has the following properties:
Phosphodiesterase inhibitor that increases intracellular cAMP and relaxes smooth muscle in the bronchial airways and pulmonary blood vessels.
Mast cell stabilization is achieved by using a non-selective adenosine receptor antagonist.
It has slight positive inotropic and chronotropic effects, increasing cardiac output and decreasing systemic vascular resistance, lowering arterial blood pressure. It has been used historically in the treatment of refractory heart failure and is indicated by the current ALS guidelines as a substitute treatment for bradycardia.The daily oral dose for adults is 900 mg, divided into 2-3 doses. For severe asthma or COPD, a loading dosage of 5 mg/kg over 10-20 minutes is given, followed by a continuous infusion of 0.5 mg/kg/hour. The therapeutic range is small (10-20 microgram/ml), hence assessments of aminophylline plasma concentrations are useful during long-term treatment.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 115
Incorrect
-
Regarding airway resistance, which of the following statements is INCORRECT:
Your Answer: Flow through airways is inversely proportional to airway resistance.
Correct Answer: In the lower respiratory tract, airway resistance is mostly determined by the smallest bronchioles.
Explanation:Airway resistance is primarily determined by the airway radius according to Poiseuille’s law, and whether the flow is laminar or turbulent. The major site of airway resistance is the medium-sized bronchi. The smallest airways would seem to offer the highest resistance, but they do not because of their branching parallel arrangement.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 116
Incorrect
-
Which of the following side effects is more common of etomidate than other intravenous induction agents:
Your Answer: Hypotension
Correct Answer: Extraneous muscle movements
Explanation:Etomidate is associated with a high incidence of extraneous muscle movements, which can be minimised by an opioid analgesic or a short-acting benzodiazepine given prior to induction. Etomidate causes less hypotension than thiopental sodium and propofol during induction. Etomidate is associated with rapid recovery without a hangover effect. The rate of respiratory depression and tachycardia is not higher in etomidate.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 117
Incorrect
-
A 22-year-old woman is brought in by ambulance from her GP surgery with suspected meningitis. She has been given a dose of benzylpenicillin already.
What is the mechanism of action of benzylpenicillin? Select ONE answer only.Your Answer: Inhibition of protein synthesis
Correct Answer: Inhibition of cell wall synthesis
Explanation:Penicillins and the other ß-lactam antibiotics are bactericidal. They produce their antimicrobial action by preventing cross-linkage between the linear peptidoglycan polymer chains that make up the bacterial cell wall. They, therefore, inhibit cell wall synthesis.
An overview of the different mechanisms of action of the various types of antimicrobial agents is shown below:
Mechanism of action
Examples
Inhibition of cell wall synthesis
Penicillins
Cephalosporins
Vancomycin
Disruption of cell membrane function
Polymyxins
Nystatin
Amphotericin B
Inhibition of protein synthesis
Macrolides
Aminoglycosides
Tetracyclines
Chloramphenicol
Inhibition of nucleic acid synthesis
Quinolones
Trimethoprim
5-nitroimidazoles
Rifampicin
Anti-metabolic activity
Sulfonamides
Isoniazid -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 118
Incorrect
-
A 32-year-old asthmatic patient on theophylline as part of her asthma management presents to the Emergency Department with an unrelated medical condition.
Which of these drugs should be avoided?Your Answer: Metronidazole
Correct Answer: Clarithromycin
Explanation:Macrolide antibiotics (e.g. clarithromycin and erythromycin) are cytochrome P450 enzyme inhibitors. They increase blood levels of theophylline leading to hypokalaemia, and potentially increasing the risk of Torsades de pointes when they are prescribed together.
Co-prescription with theophylline should be avoided.
Factors that enhance theophylline clearance include cigarette smoking, carbamazepine, phenobarbital, phenytoin, primidone, and rifampin.
Medications that inhibit clearance include ethanol, ciprofloxacin, erythromycin, verapamil, propranolol, ticlopidine, tacrine, allopurinol, and cimetidine. -
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 119
Correct
-
A 72-year-old woman presents to your clinic with worsening oedema. She has ischaemic heart disease and heart failure. You decide to add a loop diuretic to her current drug regime to control the oedema. Which of the following is a contraindication to using a loop diuretic?
Your Answer: Anuria
Explanation:Loop diuretics are drugs used to manage and treat fluid overload associated with CHF, liver cirrhosis, and renal disease. The drugs commonly used are:
- Furosemide
- Bumetanide
- Torsemide
- Ethacrynic Acid
Loop diuretics inhibit the Na-K-Cl pump in the ascending loop of Henle, resulting in salt-water excretion. This relieves congestion and reduces oedema.
The contra-indications to the use of loop diuretics are:
1. Anuria
2. Comatose and precomatose states associated with liver cirrhosis
3. Renal failure due to nephrotoxic or hepatotoxic drugs
4. Severe hypokalaemia
5. Severe hyponatremia
6. History of hypersensitivity to furosemide, bumetanide, or torsemide (or sulphonamides)The following conditions or states are not contraindications, but loop diuretics needs to be used cautiously in these conditions:
1. Diabetes (but hyperglycaemia less likely than with thiazides)
2. Gout
3. Hypotension (correct before initiation of treatment)
4. Hypovolaemia (Correct before initiation of treatment) -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 120
Incorrect
-
Adenosine has a half-life of approximately:
Your Answer: 6 - 8 hours
Correct Answer: 8 - 10 seconds
Explanation:Adenosine stimulates A1-adenosine receptors and opens acetylcholine sensitive K+ channels, increasing K+ efflux. This hyperpolarises the cell membrane in the atrioventricular node and, by inhibiting the calcium channels, slows conduction in the AVN. As it has a very short duration of action (half-life only about 8 – 10 seconds), most side effects are short lived.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 121
Correct
-
A 33 year old lady with a known nut allergy was having dinner at a Thai restaurant. She suddenly complained of lip and tongue swelling and difficulty breathing and is brought to ED by ambulance with suspected anaphylaxis. She received intramuscular adrenaline in the ambulance.
The most appropriate doses of the second line treatments for anaphylaxis are which of the following?Your Answer: 10 mg chlorphenamine and 200 mg hydrocortisone
Explanation:Second line drugs to reduce the severity and duration of anaphylactic symptoms are intravenous or intramuscular chlorpheniramine and hydrocortisone. The recommended dose is 10 mg chlorpheniramine and 200 mg hydrocortisone in adults.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 122
Incorrect
-
Which of the following best characterizes the correct administration of amiodarone for a shockable rhythm in adults on advanced life support:
Your Answer: Give 300 mg IV amiodarone after the first shock
Correct Answer: Give 300 mg IV amiodarone after 3 shocks
Explanation:After three shocks, 300 mg IV amiodarone should be administered. After five defibrillation attempts, a further dose of 150 mg IV amiodarone may be considered. If amiodarone is not available, lidocaine may be used as a substitute, but it should not be given if amiodarone has previously been administered.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 123
Incorrect
-
You've been summoned to a young man in the resus area who is experiencing an SVT. You decide to use adenosine after trying several vagal manoeuvres without success.
Which of the following is the correct adenosine mechanism of action?Your Answer: Prolongs phase 3 of cardiac action potential
Correct Answer: Opens K + channels in the heart
Explanation:The purine nucleoside adenosine is used to diagnose and treat paroxysmal supraventricular tachycardia. Adenosine works by stimulating A1-adenosine receptors and opening potassium channels that are sensitive to acetylcholine. This causes the atrioventricular (AV) node’s cell membrane to become hyperpolarized, slowing conduction by inhibiting calcium channels.
Patients who have had a heart transplant are extremely sensitive to the effects of adenosine and should start with a lower dose of 3 mg, then 6 mg, and finally 12 mg.Dipyridamole potentiates the effects of adenosine, so it should be used with caution in patients who are taking it.
The use of adenosine is contraindicated in the following situations:
Asthma
COPD (chronic obstructive pulmonary disease)
Decompensated heart failureÂ
Long QT syndrome
AV block in the second or third degree
Sinusitis is a condition in which the sinuses become (unless pacemaker fitted)
Hypotension that is severe -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
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Question 124
Incorrect
-
Regarding amoxicillin, which of the following statements is INCORRECT:
Your Answer: It has a similar antibacterial spectrum to ampicillin.
Correct Answer: It is used first line for bacterial tonsillitis.
Explanation:Amoxicillin is a derivative of ampicillin and has a similar antibacterial spectrum. It is better absorbed than ampicillin when given orally, producing higher plasma and tissue concentrations; unlike ampicillin, absorption is not affected by the presence of food in the stomach.
The adverse effects of amoxicillin are mainly gastrointestinal and mild and include nausea, vomiting and diarrhoea. Amoxicillin is used first line for low to moderate severity community acquired pneumonia, exacerbations of chronic bronchitis, for acute otitis media, for acute sinusitis, for oral infections/dental abscess, for Listeria meningitis (in combination with another antibiotic), for infective endocarditis (in combination with another antibiotic) and for H. Pylori eradication (in combination with metronidazole/clarithromycin and a PPI).
Penicillin V is used first line for bacterial tonsillitis; amoxicillin should be avoided in blind treatment of a sore throat as there is a high risk of a rash if glandular fever is present.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 125
Incorrect
-
You intend to suture a hand wound with plain 1 percent lidocaine.
In 1 mL of plain 1 percent lidocaine solution, how much lidocaine hydrochloride is there?Your Answer: 100 mcg lidocaine hydrochloride
Correct Answer: 10 mg lidocaine hydrochloride
Explanation:10 mg of lidocaine hydrochloride is contained in each 1 mL of plain 1 percent lidocaine solution.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 126
Incorrect
-
Your consultant decides to use ketamine for a patient requiring procedural sedation in the Emergency Department. At what receptor does ketamine primarily act:
Your Answer: Mu-opioid receptor
Correct Answer: NMDA receptor
Explanation:In contrast to most other anaesthetic agents, ketamine is a NMDA (N-methyl-D-aspartate) receptor antagonist. It is a non-competitive antagonist of the calcium-ion channel in the NMDA receptor. It further inhibits the NMDA-receptor by binding to its phencyclidine binding site. Ketamine also acts at other receptors as an opioid receptor agonist (analgesic effects), as an muscarinic anticholinergic receptor antagonist (antimuscarinic effects) and by blocking fast sodium channels (local anaesthetic effect).
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
-
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Question 127
Correct
-
A 14-year-old female is brought to the Emergency Room by her mother after a fall from a tree in which she injured her elbow. An elbow fracture is suspected based on the examination findings, and she is given Entonox for analgesia as her elbow is set in a cast.
Which one of the following statements regarding this drug is true?Your Answer: It can cause inhibition of vitamin B12 synthesis
Explanation:Entonox is a mixture of 50% Oxygen and 50% nitrous oxide and is given in an inhaled form as a quick form of analgesia. Entonox causes non-competitive inhibition of NMDA (N-methyl-D-aspartate) receptors, which are a subtype of the glutamate receptor.
It is stored in blue and white cylinders and administered via a pressure regulator and demand valve. The administration of this medicine reduces pain and anxiety in paediatric and dental procedures ands during labour.
Effects are apparent after 20 seconds, and peak action occurs after 3 to 5 minutes as it is a drug with a rapid onset and the patient will also recover rapidly from its effects. Entonox is widely used as it does not accumulate in the body and does not cause many side effects. However, a notable side effect is the inhibition of Vitamin B12 synthesis.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 128
Incorrect
-
In a VF arrest, a 6-year-old child is brought to your Emergency Department resuscitation area. He weighs 16 kilogrammes. He's had three DC shocks, but he's still in VF and doesn't have an output.
What amiodarone dose should he get now, according to the most recent APLS guidelines?Your Answer: 96 mg
Correct Answer: 80 mg
Explanation:In a shockable (Vf/pVT) paediatric cardiac arrest, amiodarone should be administered after the third and fifth shocks. The dose is 5 mg/kg (maximum 300 mg) and should be administered over a three-minute period. If at all possible, administration via a central line is recommended.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 129
Incorrect
-
Regarding ciprofloxacin, which of the following statements is INCORRECT:
Your Answer: Ciprofloxacin is particularly active against Gram-negative bacteria.
Correct Answer: Ciprofloxacin decreases plasma concentrations of theophylline.
Explanation:Ciprofloxacin increases plasma concentrations of theophylline. There is an increased risk of convulsions when quinolones are given with NSAIDs or theophylline. There is an increased risk of tendon damage when quinolones are given with corticosteroids. Quinolones are known to increase the QT-interval and should not be taken with concomitantly with other drugs that are known to cause QT-interval prolongation. There is an increased risk of myopathy when erythromycin or clarithromycin are taken with simvastatin or atorvastatin.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 130
Incorrect
-
In patients requiring oxygen, who are at risk of hypercapnic respiratory failure, oxygen saturations should be maintained at:
Your Answer: 94 - 98%
Correct Answer: 88 - 92%
Explanation:A lower target of 88 – 92% oxygen saturation is indicated for patients at risk of hypercapnic respiratory failure e.g. patients with COPD. Until blood gases can be measured, initial oxygen should be given using a controlled concentration of 28% or less, titrated towards the SpO2 of 88 – 92%. The aim is to provide the patient with enough oxygen to achieve an acceptable arterial oxygen tension without worsening carbon dioxide retention and respiratory acidosis.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 131
Correct
-
A 61-year-old patient experiences a spontaneous rupture of his Achilles tendon following a course of antibiotics
Which of the antibiotics listed below is MOSTÂ likely to be the cause?ÂYour Answer: Ciprofloxacin
Explanation:Tendinopathy and spontaneous tendon rupture are caused by fluoroquinolones, which are an uncommon but well-known cause. Tendon problems caused by fluoroquinolones are expected to affect 15 to 20 people per 100,000. Patients over the age of 60 are most likely to develop them.
It usually affects the Achilles tendon, but it has also been described in cases involving the quadriceps, peroneus brevis, extensor pollicis longus, long head of biceps brachii, and rotator cuff tendons. The exact aetiology is uncertain, although the fluoroquinolone medication is thought to obstruct collagen activity and/or cut off blood supply to the tendon.
Other factors linked to tendon rupture spontaneously include:
Gout
Treatment with corticosteroids
Hypercholesterolaemia
Long-term dialysis
Kidney transplant
Rheumatoid arthritis -
This question is part of the following fields:
- Infections
- Pharmacology
-
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Question 132
Incorrect
-
Which of the following statements is incorrect regarding potassium replacement?
Your Answer: Compensation for potassium loss is particularly necessary in patients in whom secondary hyperaldosteronism occurs.
Correct Answer: Oral potassium supplements are often required for patients taking spironolactone.
Explanation:It is very seldom that potassium supplements are required with the small doses of diuretics given to treat hypertension. Potassium-sparing diuretics like spironolactone (rather than potassium supplements), are recommended for hypokalaemia prevention when diuretics are given to eliminate oedema, such as furosemide or the thiazides.
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This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
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Question 133
Incorrect
-
For which of the following infections is phenoxymethylpenicillin (penicillin V) primarily used?
Your Answer: Infective endocarditis
Correct Answer: Streptococcal tonsillitis
Explanation:Phenoxymethylpenicillin (penicillin V) is less active than benzylpenicillin but both have similar antibacterial spectrum. Because penicillin V is gastric-acid stable, it is suitable for oral administration, but should not be used for serious infections as absorption can be unpredictable and plasma concentrations can be variable.
Its uses are:
1. mainly for respiratory tract infections in children
2. for streptococcal tonsillitis
3. for continuing treatment after one or more injections of benzylpenicillin when clinical response has begun.
4. for prophylaxis against streptococcal infections following rheumatic fever and against pneumococcal infections following splenectomy or in sickle-cell disease.It should not be used for meningococcal or gonococcal infections.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 134
Incorrect
-
In a ward round, you come across a patient's treatment chart prescribed an antibiotic to fight his infection. This antibiotic is an inhibitor of cell wall synthesis.
Which of the following antimicrobial drugs is prescribed to this patient?Your Answer: Tetracycline
Correct Answer: Benzylpenicillin
Explanation:Penicillins and cephalosporins are the major antibiotics that inhibit bacterial cell wall synthesis. They inactivate transpeptidases that help cross-link peptidoglycans in cell walls.
Isoniazid decreases the synthesis of mycolic acids in mycobacterium.
Clarithromycin binds to the 50S subunit of ribosomes and inhibits protein synthesis.
Metronidazole and the other 5-nitroimidazole agents inhibit nucleic acid synthesis by forming toxic free radical metabolites in the bacterial cell that damage DNA.
Tetracycline bind to 30S and prevent attachment of aminoacyl-tRNA.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 135
Incorrect
-
A young male has presented to the Emergency Department with a sudden onset of severe palpitations, shortness of breath, and chest pain. A 12-lead ECG is recorded, and it shows a narrow complex tachycardia that points to a diagnosis of supraventricular tachycardia.
Vagal manoeuvres are attempted but are unsuccessful in eliminating the arrhythmia. The next action plan is to use a drug to revert to sinus rhythm.
Out of the following, which is the first-line treatment for supraventricular tachycardia?Your Answer: Diltiazem
Correct Answer: Adenosine
Explanation:Paroxysmal supraventricular tachycardia is an intermittent tachycardia (HR > 100 bpm) and has the following characteristics:
1. Sudden onset/offset (Contrast with sinus tachycardia)
2. Electrical activity originates above the ventricle (Contrast with ventricular tachycardia)
3. Produces narrow QRS complex (<120ms) The most common cause of PSVT is Atrioventricular nodal re-entrant tachycardia (AVNRT), most common in young women with a mean age onset of 32 years old. There are recurrent episodes of palpitations, and most of the episodes spontaneously. Sometimes, some vagal manoeuvres are required:
1. Valsalva manoeuvre
2. immersing the face in ice-cold water
3. carotid sinus massage.If PSVT keeps persisting or is causing severe symptoms, the treatment of choice is intravenous adenosine. The patient’s ECG should be continuously monitored throughout the treatment.
The recommended doses in adults are as follows:
– Initial dose of adenosine is 6 mg by rapid IV bolus
– If unsuccessful, give another dose of adenosine 12 mg by rapid IV bolus
– If unsuccessful, give a further dose of adenosine 12 mg by rapid IV bolus
The latest ALS guidelines advocate 18 mg for the third dose, whereas the BNF/NICE guidelines advocate 12 mg.If adenosine fails or is contraindicated, intravenous verapamil can be used as an alternative, but it should be avoided in patients recently treated with beta-blockers.
Synchronized electrical cardioversion will be necessary with signs of hemodynamic instability or if drug treatment has failed to restore sinus rhythm.
Recurrent episodes of paroxysmal supraventricular tachycardia can be treated by catheter ablation or prevented with drugs such as flecainide, sotalol, diltiazem, or verapamil. -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 136
Correct
-
Which of the following is NOT a typical side effect of thiopental sodium:
Your Answer: Seizures
Explanation:Extravasation of thiopental during injection can lead to tissue damage. Accidental intra-arterial injection causes vasospasm and may lead to thrombosis and tissue necrosis. Other side effects include involuntary muscle movements on induction, cough and laryngospasm, arrhythmias, hypotension, headache and hypersensitivity reactions. Thiopental sodium has anticonvulsant properties and does not cause seizures.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 137
Incorrect
-
What is the mechanism of action of captopril:
Your Answer: Inhibition of inactivated Na+ channels
Correct Answer: Angiotensin-converting enzyme inhibitor
Explanation:Captopril is an angiotensin-converting enzyme (ACE) inhibitor, which inhibits the conversion of angiotensin I to angiotensin II.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 138
Incorrect
-
The patients listed below have had wounds or injuries and were treated as described in a local walk-in clinic.
Which of the following patients has had adequate tetanus protection?Your Answer: 28-year-old man from Poland, cuts leg whilst working in garden, wound heavily contaminated with soil, uncertain of vaccination history – receives vaccination
Correct Answer: 80-year-old diabetic, a rusty nail went through his shoe and into his foot when walking in the woods, uncertain of vaccination history - receives vaccination and immunoglobulin
Explanation:25-year-old receives immunoglobulin and vaccination after cutting her hand on a drinking glass and not knowing her vaccination history.
Because this is not a tetanus-prone wound, immunoglobulin is not recommended. Because you can’t be sure about her vaccination history, now is the best time to start a tetanus vaccination course to ensure coverage later in life. The first vaccination should be administered at the time of presentation; the patient’s own GP should then review the patient’s vaccination history and schedule the rest of the course as needed.
8-year-old whose hand was cut with a kitchen knife, received her first round of vaccinations as a baby and a booster at the age of four – receives vaccination:
The tetanus vaccinations for this child are up to date, and the next booster should not be given too soon. Immunoglobulin is not required because this is not a tetanus-prone wound.80-year-old diabetic, a rusty nail went through his shoe and into his foot while walking in the woods, and he was uncertain of his vaccination history – he received vaccination and immunoglobulin:
A tetanus vaccination course may not have been completed by an 80-year-old UK resident (the vaccination was introduced in 1961). The vaccination should be given at a walk-in clinic, and the patient’s own GP should be contacted to confirm vaccination history and to schedule the rest of the course as needed. Because this is a tetanus-prone wound (puncture wound and potential soil contact), immunoglobulin would be recommended in a patient with incomplete tetanus vaccinations.A 28-year-old Polish man cuts his leg while working in the garden, the wound is heavily contaminated with soil, and his vaccination history is unknown – he receives vaccination:
In a patient with an unknown vaccination history, this is a tetanus-prone wound. In this case, the best course of action would be to administer both the vaccination and immunoglobulin at the walk-in clinic, then contact the patient’s own GP to check his or her vaccination history and schedule the rest of the course as needed.30-year-old with a large amount of devitalized tissue in the torso from an electrical burn – has had all vaccinations, so no need for vaccination or immunoglobulin:
Because this is a high-risk tetanus wound (with a lot of devitalized tissue), even if the patient has had a full course of vaccinations in the past, immunoglobulin is recommended. There is no need for any additional vaccinations. -
This question is part of the following fields:
- Immunological Products & Vaccines
- Pharmacology
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Question 139
Incorrect
-
Digoxin is contraindicated in all of the following EXCEPT for:
Your Answer: Hypertrophic cardiomyopathy
Correct Answer: Asthma
Explanation:Digoxin is contraindicated in:Supraventricular arrhythmias associated with accessory conduction pathways e.g. Wolff-Parkinson-White syndromeVentricular tachycardia or fibrillationHeart conduction problems e.g. second degree or intermittent complete heart blockHypertrophic cardiomyopathy (unless concomitant atrial fibrillation and heart failure but should be used with caution)
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 140
Incorrect
-
Which of the following statements is correct with regards to heparin-induced thrombocytopaenia (HIT)?
Your Answer: HIT typically presents with features of haemorrhage.
Correct Answer: HIT typically develops 5-10 days after starting heparin.
Explanation:Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder caused by antibodies that recognize complexes of platelet factor 4 (PF4) and heparin. HIT is frequently considered in the differential diagnosis of thrombocytopenia occurring in patients on heparin therapy. HIT is a challenging diagnosis because of routine heparin use in hospitalized patients, the common occurrence of thrombocytopenia. The process of heparin dependent IgG antibodies binding to heparin/platelet factor 4 complexes activates platelets and produces a hypercoagulable state. This syndrome typically develops 5-10 days (range 4-15 days) after heparin is commenced. It can occur with unfractionated heparin, low molecular weight heparin, or, rarely, fondaparinux. The diagnosis of HIT requires the combination of a compatible clinical picture and laboratory confirmation of the presence of heparin dependent platelet activating HIT antibodies. Discontinuation of heparin alone or initiation of a vitamin K antagonist alone like warfarin, is not sufficient to stop the development of thrombosis in patients with acute HIT. If there is moderate clinical suspicion for HIT, all sources of heparin must be discontinued and there must be consideration of anticoagulant treatment with a non-heparin drug.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 141
Incorrect
-
On which of the following types of receptors does loperamide act?
Your Answer: Muscarinic receptors
Correct Answer: Opioid receptors
Explanation:Loperamide inhibits acetylcholine release from the myenteric plexus acts by action on opioid mu-receptors, and this then reduces bowel motility. The intestinal transit time is increased, thereby facilitating water reabsorption.
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 142
Incorrect
-
After collapsing in his nursing home, a 70-year-old man is brought into the ER. He has diabetes mellitus and is on medication for it. An RBS of 2.0 mmol/L (3.9-5.5 mmol/L) is recorded in the ER.
Out of the following, which medication for diabetes mellitus is LEAST likely responsible for his hypoglycaemic episode?Your Answer: Novomix 30
Correct Answer: Metformin
Explanation:Metformin is a biguanide used as the first-line to treat type 2 diabetes mellitus. It has a good reputation as it has an extremely low risk of causing hypoglycaemia compared to the other agents for diabetes. It does not affect the insulin secreted by the pancreas or increase insulin levels. Toxicity with metformin can, however, cause lactic acidosis with associated hypoglycaemia.
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This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 143
Correct
-
Which of the following is an example of a vaccine produced by recombinant DNA technology:
Your Answer: Hepatitis B
Explanation:Hepatitis B vaccines are prepared from the viral surface antigen. The recombinant vaccine is now the most widely used vaccine and induces a sufficient antibody response in 90% of individuals.
Indications for hepatitis B vaccination include:
All health care professional’s
Other professions with occupational risks (foster carers, staff of custodial institutions, morticians etc)
Babies of mothers with hepatitis B during pregnancy
Close family contacts of a case or carrier
IV drug abusers
Individuals with haemophilia
Individuals with chronic renal failure
Sex workers and individuals with frequently changing sexual partners
The vaccine should be stored between 2 and 8 degrees C as freezing destroys its efficacy. The vaccine is administered intramuscularly, either into the deltoid region (preferred) or anterolateral thigh. The buttock should be avoided as it reduces the efficacy of the vaccine.
The standard regime is to give 3 doses of the vaccine, the 1stand 2ndone month apart and the 2ndand 3rdsix months apart. Antibody titres should be tested 2 to 4 months after the primary course.
A peak titre above 100 mIU/ml is regarded as a good response and implies long-term immunity. A peak titre between 10-100 mIU/ml is regarded as a low response and a peak titre of less than 10mIU/ml is regarded as a poor response.
There is no substantiated association between hepatitis B vaccination and Guillain-Barre syndrome. -
This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
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Question 144
Incorrect
-
You proceed to administer lorazepam intravenously to a 21-year-old patient with status epilepticus. Which of the following best describes lorazepam's action?
Your Answer: Inhibits effect of NMDA
Correct Answer: Potentiates effect of GABA
Explanation:Lorazepam is a type of benzodiazepine.
Benzodiazepines are gamma-aminobutyric acid (GABA) receptor agonists with sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant characteristics that promote inhibitory synaptic transmission across the central nervous system.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 145
Incorrect
-
You're a member of the cardiac arrest team, and you're helping to resuscitate an elderly gentleman who had collapsed at home. The team leader requests that you administer an adrenaline shot.
Which of the following statements about adrenaline is FALSE?Your Answer: It may be administered via an endotracheal tube
Correct Answer: The IM dose in anaphylaxis is 1 ml of 1:1000
Explanation:Adrenaline (epinephrine) is a sympathomimetic amine that binds to alpha- and beta-adrenergic receptors and acts as an agonist. It is active at both alpha and beta receptors in roughly equal amounts.
When taken orally, it becomes inactive. Subcutaneous absorption is slower than intramuscular absorption. In cardiac arrest, it is well absorbed from the tracheal mucosa and can be given through an endotracheal tube.
At the adrenergic synapse, catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO) metabolise it primarily. The inactive products are then passed through the kidneys and excreted in the urine.
In adult cardiac arrest, the IV dose is 1 mg, which is equal to 10 ml of 1:10000 or 1 ml of 1:1000. In anaphylaxis, the IM dose is 0.5 ml of 1:1000. (500 mcg).
In open-angle glaucoma, adrenaline causes mydriasis and lowers pressure.
Adrenaline is used in cardiopulmonary resuscitation, the treatment of severe croup, and the emergency management of acute allergic and anaphylactic reactions (as a nebuliser solution).
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 146
Incorrect
-
A young male has presented to you with respiratory depression and small pupils on examination. You diagnose opioid overdose and immediately start therapy with Naloxone.
Which of the following statements is TRUE regarding naloxone?Your Answer: It has a longer duration of action than most opioids
Correct Answer: It can be given by a continuous infusion if repeated doses are required
Explanation:Naloxone is a short-acting, specific antagonist of mu(μ)-opioid receptors. It is used to reverse the effects of opioid toxicity.
It can be given by a continuous infusion if repeated doses are required and the infusion rate is adjusted according to the vital signs. Initially, the infusion rate can be set at 60% of the initial resuscitative IV dose per hour.
Naloxone has a shorter duration of action (6-24 hours) than most opioids and so close monitoring according to the respiratory rate and depth of coma and repeated injections are necessary. When repeated doses are needed in opioid addicts, naloxone administration may precipitate a withdrawal syndrome with abdominal cramps, nausea and diarrhoea, but these usually settle within 2 hours.
An initial dose of 0.4 to 2 mg can be given intravenously and can be repeated at 2 to 3-minute intervals to a maximum of 10mg.
If the intravenous route is inaccessible, naloxone can be administered via an IO line, subcutaneously (SQ), IM, or via the intranasal (IN) route.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 147
Incorrect
-
Which of the following is the primary indication for loop diuretics?
Your Answer: Cerebral oedema
Correct Answer: Acute pulmonary oedema
Explanation:Loop diuretics have long been the cornerstone of pulmonary oedema treatment, with furosemide being the most commonly used of these drugs. Premedication with drugs that decrease preload (e.g., nitro-glycerine [NTG]) and afterload (e.g., angiotensin-converting enzyme [ACE] inhibitors) before the administration of loop diuretics can prevent adverse hemodynamic changes.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 148
Incorrect
-
A patient who was put on low molecular weight heparin for suspected DVT and was scheduled for an ultrasound after the weekend, arrives at the emergency department with significant hematemesis. Which of the following medications can be used as a heparin reversal agent:
Your Answer: Idarucizumab
Correct Answer: Protamine sulfate
Explanation:The management of bleeding in a patient receiving heparin depends upon the location and severity of bleeding, the underlying thromboembolic risk, and the current aPTT (for heparin) or anti-factor Xa activity (for LMW heparin). As an example, a patient with minor skin bleeding in the setting of a mechanical heart valve (high thromboembolic risk) and a therapeutic aPTT may continue heparin therapy, whereas a patient with major intracerebral bleeding in the setting of venous thromboembolism several months prior who is receiving heparin bridging perioperatively may require immediate heparin discontinuation and reversal with protamine sulphate. If haemorrhage occurs it is usually sufficient to withdraw unfractionated or low molecular weight heparin, but if rapid reversal of the effects of the heparin is required, protamine sulphate is a specific antidote (but only partially reverses the effects of low molecular weight heparins). Clinician judgment and early involvement of the appropriate consulting specialists is advised.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 149
Incorrect
-
You review a patient with a history of Addison’s disease. He takes 100 mg of hydrocortisone per day to control this.
What dose of prednisolone is equivalent to this dose of hydrocortisone? Select ONE answer only.Your Answer: 12.5 mg
Correct Answer: 25 mg
Explanation:Prednisolone is four times more potent than hydrocortisone, and therefore, a dose of 25 mg would be equivalent to 100 mg of hydrocortisone.
The following table summarises the relative potency of the main corticosteroids compared with hydrocortisone:
Corticosteroid
Potency relative to hydrocortisone
Prednisolone
4 times more potent
Triamcinolone
5 times more potent
Methylprednisolone
5 times more potent
Dexamethasone
25 times more potent -
This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 150
Incorrect
-
Aldin is a 24-year-old male patient who arrives at the emergency department diagnosed with psittacosis based on his symptoms and history of being a pigeon enthusiast. Which of the following is the causative bacteria of psittacosis?
Your Answer: Legionella pneumophila
Correct Answer: Chlamydia psittaci
Explanation:Chlamydia psittaci is a microorganism that is commonly found in birds.
These bacteria can infect people and cause psittacosis. Psittacosis is an infectious disease that may cause high fever and pneumonia associated with headaches, altered mental state, and hepatosplenomegaly.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 151
Incorrect
-
An 82-year-old woman was brought in an ambulance to the Emergency Department with a 1-hour history of left-sided weakness and dysphasia.
A CT scan is performed, and primary intracerebral haemorrhage is excluded as a possible cause. She is prepared for thrombolysis when her blood pressure is recorded at 200/115 mmHg.
Out of the following, which step would be the most appropriate as the next step in her management?Your Answer: Ramipril 5 mg PO
Correct Answer: Labetalol 10 mg IV
Explanation:A patient suffering from acute ischemic stroke can commonly present with hypertensive emergencies. Thrombolytic therapy is contraindicated in a patient with:
1. Systolic blood pressure greater than 185 mmHg
2. Diastolic blood pressure greater than 110 mmHgBut delaying thrombolytic therapy is associated with increased morbidity in patients with acute ischemic stroke.
Managing high blood pressure in acute ischemic stroke requires a slower and more controlled reduction in BP. In the presence of an ischaemic stroke, rapid reduction of MAP can compromise blood flow, causing further ischemia and worsening of the neurological deficit.
Intravenous labetalol is the agent of choice. The dose is 10 mg IV over 1-2 minutes. This dose can be repeated, or an infusion can be set up that runs at 2-8 mg/minute. Thrombolysis can be performed once the blood pressure is brought down to less than 180/105 mmHg.
A nitrate infusion (for example, Isoket) can be used as an alternative in patients with contraindications to the use of beta-blockers (e.g., asthma, heart block, cardiac failure).
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 152
Incorrect
-
A 64-year-old man presents with an acute episode of gout. He has a history of chronic heart failure and hypertension. His current medications include ramipril and furosemide.
Which of the following statements regarding the treatment of gout is true? Select ONE answer only.Your Answer: Febuxostat is an effective treatment for acute gout
Correct Answer: Colchicine has a role in prophylactic treatment
Explanation:In the absence of any contra-indications, high-dose NSAIDs are the first-line treatment for acute gout. Naproxen 750 mg as a stat dose followed by 250 mg TDS is a commonly used and effective regime.
Aspirin should not be used in gout as it reduces the urinary clearance of urate and interferes with the action of uricosuric agents. Naproxen, Diclofenac or Indomethacin are more appropriate choices.
Allopurinol is used prophylactically, preventing future attacks by reducing serum uric acid levels. It should not be started in the acute phase as it increases the severity and duration of symptoms.
Colchicine acts on the neutrophils, binding to tubulin to prevent neutrophil migration into the joint. It is as effective as NSAIDs in relieving acute attacks. It also has a role in prophylactic treatment if Allopurinol is not tolerated.
NSAIDs are contra-indicated in heart failure as they can cause fluid retention and congestive cardiac failure. Colchicine is the preferred treatment in patients with heart failure or those who are intolerant of NSAIDs. -
This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 153
Incorrect
-
Which of the following is NOT a typical feature of benzodiazepine toxicity:
Your Answer: Ataxia
Correct Answer: Hyperventilation
Explanation:Features of benzodiazepine toxicity include: drowsiness, ataxia, dysarthria, nystagmus, occasionally respiratory depression and coma
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 154
Incorrect
-
An 80-year-old female complains of chest pain characteristic of angina. A dose of glyceryl trinitrate (GTN) is administered that resolves the chest pain rapidly.
Which ONE of the following is released on the initial metabolism of GTN?Your Answer: Nitric oxide
Correct Answer: Nitrite ions
Explanation:Angina pectoris is the most common symptom of ischemic heart disease and presents with chest pain relieved by rest and nitro-glycerine.
Nitrates are the first-line treatment to relieve chest pain caused by angina. The commonly used nitrates are:
1. Glyceryl trinitrate
2. Isosorbide dinitrateThe nitrate drugs are metabolized in the following steps:
1. Release Nitrite ions (NO2-), which are then converted to nitric oxide (NO) within cells.
2. NO activates guanylyl cyclase, which causes an increase in the intracellular concentration of cyclic guanosine-monophosphate (cGMP) in vascular smooth muscle cells.
3. Relaxation of vascular smooth muscle.Although nitrates are potent coronary vasodilators, their principal benefit in the management of angina results from a predominant mechanism of venous dilation:
– Bigger veins hold more blood
– Takes blood away from the left ventricle
– Lowers LVEDV (preload), LA pressure
– Less pulmonary oedema → improved dyspnoea -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 155
Incorrect
-
A 5-year-old girl presents in a paediatric clinic with symptoms of viral gastroenteritis. You encourage the mother to treat the child at home with oral rehydration therapy (ORT), e.g. dioralyte.
Out of the following, which statement is FALSE regarding the use of ORT in the management of gastroenteritis?Your Answer: 50 ml/kg given over 4 hours is recommended for the treatment of mild dehydration
Correct Answer: ORT is sugar-free
Explanation:One of the major complications of gastroenteritis is dehydration. Choosing the correct fluid replacement therapy is essential according to a patient’s hydration status.
Oral rehydration therapy (ORT) refers to the restitution of water and electrolyte deficits in dehydrated patients using an oral rehydration salt (ORS) solution. It is a fluid replacement strategy that is less invasive than other strategies for fluid replacement and has successfully lowered the mortality rate of diarrhoea in developing countries.
Some characteristics of Oral rehydration solutions are:
– slightly hypo-osmolar (about 250 mmol/litre) to prevent the possible induction of osmotic diarrhoea.
– contain glucose (e.g. 90 mmol/L in dioralyte). The addition of glucose improves sodium and water absorption in the bowel and prevents hypoglycaemia.
– also contains essential mineral saltsCurrent NICE guidance recommends that 50 ml/kg is given over 4 hours to treat mild dehydration.
Once rehydrated, a child should continue with their usual daily fluid intake plus 200 ml ORT after each loose stool. In an infant, give ORT at 1-1.5 x the normal feed volume and in an adult, give 200-400 ml after each loose stool. -
This question is part of the following fields:
- Fluids & Electrolytes
- Pharmacology
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Question 156
Correct
-
You're in resus with a 69-year-old woman who is very sick. You decide to contact the intensive care outreach team because she appears to be in septic shock. They decide to start a dobutamine infusion as soon as they arrive.
Which of the following statements about dobutamine is correct?Your Answer: It may be infused via a peripheral line
Explanation:Dobutamine is a synthetic isoprenaline derivative that is used to provide inotropic support to patients with low cardiac output caused by septic shock, myocardial infarction, or other cardiac conditions.
Dobutamine is a sympathomimetic drug that stimulates beta-1 adrenergic receptors in the heart to produce its primary effect. As a result, it has inotropic properties that increase cardiac contractility and output. It also has a small amount of alpha1- and beta-2-adrenergic activity.
It is infused intravenously after being diluted to a volume of at least 50 ml in a suitable crystalloid solution. The dose is titrated to response and ranges from 0.5 to 40 g/kg/min. Extravasation-induced skin necrosis is uncommon, and dobutamine can be administered through a peripheral line.
At doses below 10 g/kg/min, side effects are rare, but at higher doses, they can include:
Nausea and vomiting
Tachycardia
Dysrhythmias
Angina
Hypertension
Headache -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 157
Incorrect
-
A 60-year-old male presents to the genitourinary clinic with dysuria and urinary frequency complaints. He has a past medical history of benign prostate enlargement, for which he has been taking tamsulosin. There is blood, protein, leucocytes, and nitrites on a urine dipstick. Fresh blood tests were sent, and his estimated GFR is calculated to be >60 ml/minute. A urinary tract infection (UTI) diagnosis is made, and he is prescribed antibiotics. Out of the following, which antibiotic is most appropriate to be prescribed to this patient?
Your Answer: Cefalexin
Correct Answer: Ciprofloxacin
Explanation:URINARY TRACT INFECTIONS IN ADULT MEN
Symptomatic urinary tract infections are much less common in men than in women, and all UTIs
in men are considered complicated UTIs. Men with UTIs should be evaluated for predisposing or
causative factors.Uncomplicated cystitis
- Fosfomycin, oral, 3 g as a single dose.
If fosfomycin is unavailable:
- Nitrofurantoin, oral, 100 mg 6 hourly for 5 days.
Do not use nitrofurantoin or fosfomycin if there is any suspicion of early pyelonephritis as they do
not achieve adequate renal tissue levels.
If there are any factors precluding the use of the above agents, then a beta-lactam should be used.
Options include:
Cefixime 200 mg PO 12 hourly for 7 days
OR
Cefpodoxime 100 mg PO 12 hourly for 7 daysComplicated cystitis
Adults- Ciprofloxacin 500 mg PO 12 hourly
OR - Levofloxacin 750 mg PO once daily
Empiric antibiotic therapy should be changed based upon the bacteria isolated and its
antimicrobial susceptibility.
Treat for a total of 7–14 days -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 158
Incorrect
-
What is the main mechanism of action of dobutamine as an inotropic sympathomimetic:
Your Answer: Dopamine receptor agonist
Correct Answer: Beta1-receptor agonist
Explanation:Dobutamine directly stimulates the beta1-adrenergic receptors in the heart and increases contractility and cardiac output with little effect on the rate. In addition action on beta2-receptors causes vasodilation.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 159
Incorrect
-
You're taking a history of a 59-year-old banker who has had heartburn in the past.
Which of the following information about antacids is correct?Your Answer: Magnesium carbonate tends to cause constipation
Correct Answer: Magnesium carbonate can reduce the absorption of drugs taken at the same time
Explanation:Antacids such as aluminium hydroxide and magnesium carbonate are commonly used. They’re both water-insoluble and can reduce the absorption of drugs taken together. Allow at least 1-2 hours between taking these antacids and any other medications.
Because it reduces gastrointestinal phosphate absorption, aluminium hydroxide can also be used to treat hyperphosphatemia in patients with renal failure.
Magnesium carbonate has a laxative effect, whereas aluminium hydroxide has a constipating effect.
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This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
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Question 160
Incorrect
-
A 39-year-old man with a long history of depression presents after intentionally overdoing his heart medication. Verapamil immediate-release 240 mg is the tablet he takes for this condition, he says. He took the pills about 30 minutes ago, but his wife discovered him right away and rushed him to the emergency room.
Which of the following is a verapamil toxicity?Your Answer: Increased afterload
Correct Answer: Negative inotropy
Explanation:Overdosing on calcium-channel blockers should always be taken seriously and regarded as potentially fatal. Verapamil and diltiazem are the two most lethal calcium-channel blockers in overdose. These work by binding the alpha-1 subunit of L-type calcium channels, preventing calcium from entering the cell. In cardiac myocytes, vascular smooth muscle cells, and islet beta-cells, these channels play an important role.
The following summarises the toxicity of calcium-channel blockers:
Cardiac effects
Vascular smooth muscle tone affects
Metabolic effects
Excessive negative inotropy: myocardial depression
Negative chronotropy: sinus bradycardia
Negative dromotropy: atrioventricular node blockade
Decreased afterload
Systemic hypotension
Coronary vasodilation
Hypoinsulinaemia
Calcium channel blocker-induced insulin resistance -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 161
Incorrect
-
An 85-year-old woman is brought in from her nursing home. She arrives in the Emergency Department and appears confused. The staff member from the nursing home accompanying her informs you that she takes a water tablet.
From her past medical history and records, you deduce that the water tablet is a loop diuretic.
Which of the following parts of a nephron does a loop diuretic act on?Your Answer: Proximal convoluted tubule
Correct Answer: Ascending loop of Henlé
Explanation:Loop diuretics are drugs used to manage and treat fluid overload associated with CHF, liver cirrhosis, and renal disease. The drugs commonly used are:
Furosemide
Bumetanide
Torsemide
Ethacrynic AcidLoop diuretics act on the apical membrane of the thick ascending loop of Henle and inhibit the Na-K-Cl cotransporter. This blocks the reabsorption of sodium and chloride and results in salt-water excretion. This relieves congestion and reduces oedema.
Other diuretics act on the following part of the nephron:
1. Thiazide diuretics – Na/Cl co-transporter in the distal convoluted tubule
2. Osmotic diuretics – PCT and the loop of Henle
3. Aldosterone antagonists – distal convoluted tubule
4. Carbonic anhydrase inhibitors – inhibit the carbonic anhydrase and act on proximal tubular cells -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 162
Incorrect
-
Regarding flucloxacillin, which of the following statements is CORRECT:
Your Answer: It is used first line for infected animal bites.
Correct Answer: It is resistant to bacterial beta-lactamases.
Explanation:Flucloxacillin is unique in that it is beta-lactamase stable and it can be used in infections caused by beta-lactamase producing staphylococci e.g. S. aureus. It is acid-stable and can therefore be given by mouth as well as by injection. It is used first line for treatment of widespread impetigo infection, cellulitis, mastitis, osteomyelitis, septic arthritis, severe erysipelas, severe/spreading otitis externa and infective endocarditis caused by staphylococci. The most common adverse effects of flucloxacillin include nausea, vomiting, skin rash, and diarrhoea. Cholestatic jaundice and hepatitis may occur very rarely, up to two months after treatment with flucloxacillin has been stopped. Administration for more than 2 weeks and increasing age are risk factors. First line treatment of animal and human bites is co-amoxiclav.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 163
Incorrect
-
Which of the following statements is INCORRECT. Fick's law tells us that the rate of diffusion of a gas across a membrane increases as:
Your Answer: the membrane surface area increases.
Correct Answer: the partial pressure gradient decreases.
Explanation:Fick’s law tells us that the rate of diffusion of a gas increases:
the larger the surface area involved in gas exchange
the greater the partial pressure gradient across the membrane
the thinner the membrane
the more soluble the gas in the membrane
the lower the molecular weight of the gas -
This question is part of the following fields:
- Physiology
- Respiratory
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Question 164
Incorrect
-
A 40-year-old man has been admitted for alcohol detoxification. You are asked to review the patient's treatment chart and notice that he has been prescribed Pabrinex by one of your colleagues.
Out of the following, which vitamin is not found in Pabrinex?Your Answer: Vitamin B6
Correct Answer: Vitamin B12
Explanation:Pabrinex is indicated in patients that require rapid therapy for severe depletion or malabsorption of water-soluble vitamins B and C, particularly in alcoholism detoxification.
Pabrinex has the following:
1. Thiamine (vitamin B1)
2. Riboflavin (vitamin B2)
3. Nicotinamide (Vitamin B3, niacin and nicotinic acid)
4. Pyridoxine (vitamin B6)
5. Ascorbic acid (vitamin C)
6. GlucoseSuspected or established Wernicke’s encephalopathy is treated by intravenous infusion of Pabrinex/ The dose is 2-3 pairs three times a day for three to five days, followed by one pair once daily for an additional three to five days or for as long as improvement continues.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pharmacology
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Question 165
Incorrect
-
In the United Kingdom, which of the following is the most often used intravenous aesthetic:
Your Answer: Midazolam
Correct Answer: Propofol
Explanation:In the United Kingdom, propofol is the most widely used intravenous anaesthetic. In adults and children, it can be used to induce or maintain anaesthesia, although it is not commonly used in newborns. It can also be used to sedate individuals in intensive care and for sedation during operations.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 166
Incorrect
-
A 40-year-old man who has a history of asthma arrives at the emergency department complaining of palpitations that have been going on for 5 days. Which of the following beta-blockers is the safest for an asthmatic patient?
Your Answer: Carvedilol
Correct Answer: Atenolol
Explanation:Atenolol is a beta blocker, which is a type of medication that works by preventing certain natural substances in the body, such as epinephrine, from acting on the heart and blood vessels.
This effect reduces heart rate, blood pressure, and cardiac strain. Atenolol, bisoprolol fumarate, metoprolol tartrate, nebivolol, and (to a lesser extent) acebutolol have a lower action on beta2 (bronchial) receptors and are thus cardio selective but not cardiac specific.
They have a lower effect on airway resistance, although they are not without this adverse effect.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 167
Correct
-
A 72-year-old man presents with chest pain that is characteristic of angina. You administer a dose of glyceryl trinitrate (GTN), which rapidly resolved his symptoms. Unfortunately, he also develops an unpleasant side effect.
Which of the following side effects is he most likely to have developed? Select ONE answer only.Your Answer: Headache
Explanation:Nitrates are used in the treatment of angina pectoris and the prevention of myocardial ischaemia. Commonly used examples of nitrates are glyceryl trinitrate and isosorbide dinitrate. Unwanted effects, however, are common and can limit therapy, particularly when angina is severe or when patients are unusually sensitive to the effects of nitrates.
The following are common or very common side effects of nitrates
Arrhythmias
Asthenia
Cerebral ischaemia
Dizziness
Drowsiness
Flushing
Headache
Hypotension
Nausea and vomiting
Diarrhoea, syncope and cyanosis can occur, but these are rare side effects. Dry eyes, bradycardia and metabolic acidosis have not been reported. -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 168
Incorrect
-
Regarding aciclovir, which of the following statements is INCORRECT:
Your Answer: Aciclovir acts to inhibit viral DNA synthesis.
Correct Answer: Aciclovir eradicates herpes simplex virus from the body.
Explanation:Aciclovir is active against herpesviruses but does not eradicate latent virus.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 169
Incorrect
-
Which of the following is NOT a benefit of low molecular weight heparin (LMWH) over unfractionated heparin therapy:
Your Answer: It has less interaction with platelet function.
Correct Answer: Its effects can be rapidly and completely reversed with protamine sulfate.
Explanation:Advantages of LMWHGreater ability to inhibit factor Xa directly, interacting less with platelets and so may have a lesser tendency to cause bleedingGreater bioavailability and longer half-life in plasma making once daily subcutaneous administration possibleMore predictable dose response avoiding the need for routine anticoagulant monitoringLower associated risk of heparin-induced thrombocytopenia or of osteoporosis
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 170
Incorrect
-
A young female was diagnosed with a urinary tract infection and was sent home with medications. However, after 48 hours of discharge, she returned to the hospital because there had been no relief from her symptoms. The urine sensitivity test report is still unavailable. Fresh blood tests were sent, and her estimated GFR is calculated to be >60 ml/minute.
She was prescribed nitrofurantoin 100 mg modified-release orally twice a day for two days.
Out of the following, which antibiotic is most appropriate to be prescribed to this patient?Your Answer: Ciprofloxacin
Correct Answer: Fosfomycin
Explanation:The NICE guidelines for women with lower UTIs who are not pregnant are:
1. Consider prescribing a different antibiotic if symptoms do not improve within 48 hours or worsen at any time
2. If the urine culture and susceptibility test results are available, review the choice of antibiotic according to the results and change the antibiotic accordingly if symptoms are not improving or bacteria is resistant to the prescribed antibioticThe first choice of antibiotics for non-pregnant women aged 16 years and over is:
1. Nitrofurantoin
100 mg modified-release PO BD for 3 days – if eGFR >45 ml/minute
2. Trimethoprim
200 mg PO BD for three daysThe second-choice (no improvement in lower UTI symptoms on first-choice for at least 48 hours, or when first-choice is not suitable) are:
1. Nitrofurantoin
100 mg modified-release PO BD for three days – if eGFR >45 ml/minute
2. Pivmecillinam
400 mg PO initial dose, then 200 mg PO TDS for three days
3. Fosfomycin 3 g single sachet dose -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 171
Correct
-
You review a sick patient in resus who has been prescribed mannitol as part of his treatment protocol.
Which SINGLE statement regarding mannitol is true?Your Answer: It is irritant to veins and causes phlebitis
Explanation:Mannitol is a low molecular weight compound and is therefore freely filtered at the glomerulus and is not reabsorbed. It, therefore, increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain barrier (BBB).
Mannitol is primarily used to reduce the pressure and volume of cerebrospinal fluid (CSF). It decreases the volume of CSF by:
Decreasing the rate of CSF formation,and;
Withdrawing extracellular fluid from the brain across the BBB
Other uses of mannitol include:
Short-term management of glaucoma
Treatment of rhabdomyolysis
Preserve renal function in peri-operative jaundiced patients
To initiate diuresis in transplanted kidneys
Bowel preparation prior to colorectal procedures
The recommended dose of mannitol for the reduction of CSF pressure/cerebral oedema is 0.25-2g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.
Circulatory overload and rebound increases in intracranial pressure may occur following the use of mannitol. It is irritant to tissues and veins and can cause inflammation and phlebitis.
Mannitol causes an expansion of the extracellular fluid space, which may worsen congestive cardiac failure. Contraindications to the use of mannitol include:
Anuria
Intracranial bleeding (except during craniotomy)
Severe cardiac failure
Severe dehydration
Severe pulmonary oedema -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 172
Incorrect
-
A 52-year-old woman visits her local pharmacy to get medication to help with mild dyspepsia symptoms. The pharmacist on duty suggests she uses an over-the-counter antacid. She purchases an antacid that contains magnesium carbonate, which relieves her symptoms, but she unfortunately also develops a side effect.
Out of the following, which side effect is she MOST likely to develop after using the antacid?Your Answer: Constipation
Correct Answer: Diarrhoea
Explanation:Magnesium carbonate is an over the counter antacid commonly used to relieve symptoms in ulcer dyspepsia and non-erosive gastro-oesophageal reflux.
Antacids containing magnesium also tend to work as a laxative, while the antacids with aluminium may cause constipation. There is no significant increased risk of anaphylaxis, hepatotoxicity or renal impairment.
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This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
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Question 173
Incorrect
-
Doxycycline is indicated first line for treatment of which of the following infections:
Your Answer: Bacterial vaginosis
Correct Answer: Chlamydia
Explanation:Doxycycline may be used first line for chlamydia, pelvic inflammatory disease (with metronidazole and ceftriaxone), acute bacterial sinusitis, exacerbation of chronic bronchitis, moderate-severity community acquired pneumonia and high-severity community acquired pneumonia (with benzylpenicillin).
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 174
Correct
-
Thiopental sodium is contraindicated in which of the following:
Your Answer: Acute intermittent porphyrias
Explanation:Barbiturates induce hepatic enzymes. The enzyme gamma aminolevulinic acid synthetase, which produces porphyrins, can be induced and in susceptible patients an attack of acute intermittent porphyria can occur. Thiopental is absolutely contraindicated in these patients.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 175
Correct
-
You are attending to a patient that has presented with a severe headache in the Emergency Department. The patient has signs of cerebral oedema and raised intracranial pressure.
You discuss the case with the on-call neurology registrar and decide to prescribe Mannitol. The nurse assisting you asks you to reconsider this management plan as she suspects the patient has a contraindication to Mannitol.
Out of the following, what is a contraindication to mannitol?Your Answer: Severe cardiac failure
Explanation:Mannitol is the most widely used osmotic diuretic that is most commonly used to reduce cerebral oedema and intracranial pressure.
It is recommended to use mannitol for the reduction of CSF pressure/cerebral oedema in a dose of 0.25-2 g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.Mannitol has several contraindications and some of them are listed below:
1. Anuria due to renal disease
2. Acute intracranial bleeding (except during craniotomy)
3. Severe cardiac failure
4. Severe dehydration
5. Severe pulmonary oedema or congestion
6. Known hypersensitivity to mannitol -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 176
Incorrect
-
Regarding benzodiazepines, which of the following statements is INCORRECT:
Your Answer: Lorazepam produces more prolonged sedation than temazepam and it has marked amnesic effects.
Correct Answer: Diazepam is a short-acting benzodiazepine.
Explanation:Diazepam is used to produce mild sedation with amnesia. It is a long-acting drug with active metabolites and a second period of drowsiness can occur several hours after its administration. Midazolam is a water-soluble benzodiazepine that is often used in preference to intravenous diazepam; recovery is faster than from diazepam, but may be significantly longer in the elderly, in patients with a low cardiac output, or after repeated dosing. Midazolam is associated with profound sedation when high doses are given intravenously or when it is used with certain other drugs.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 177
Incorrect
-
Which of the following is NOT a common side effect of antihistamines:
Your Answer: Dry mouth
Correct Answer: Tremor
Explanation:Common side effects of antihistamines may include:
Anticholinergic effects (blurred vision, dry mouth, urinary retention)
Headache
Gastrointestinal disturbances
Psychomotor impairment (sedation, dizziness and loss of appetite)
These side effects are significantly reduced with second-generation agents. -
This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 178
Incorrect
-
An 82 year old man taking warfarin as a maintenance medication comes in to your clinic because of an infection. Which antibiotic is the safest choice for this patient?
Your Answer: Co-trimodazole
Correct Answer: Cefalexin
Explanation:Alterations in the international normalized ratio (INR) brought about by the concurrent use of antibiotics and warfarin may result in either excessive clotting or excessive bleeding if they are deemed to have a high risk for interaction. As such, there should be careful consideration of the class of antibiotic to be used.
Antibiotics from the following drug classes should generally be avoided as they have a high risk for interaction with warfarin, possible enhancing the anticoagulant effects of warfarin resulting in bleeding: Fluoroquinolones (e.g. ciprofloxacin, levofloxacin), Macrolides (e.g. clarithromycin, erythromycin, azithromycin), Nitroimidazoles (e.g. metronidazole), Sulphonamides (e.g. co-trimoxazole, a combination of trimethoprim and sulfamethoxazole), Trimethoprim, Tetracyclines (e.g. doxycycline).
Low risk antibiotics that have low risk for interaction with warfarin includes cephalexin, from the cephalosporin class, and clindamycin which is a lincomycin.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 179
Incorrect
-
As part of his angina treatment, a 68-year-old man is prescribed a beta blocker. He starts having nightmares and has trouble sleeping soon after starting the beta-blocker.
Which of the beta blockers listed below is the most likely to be in his system?Your Answer: Sotalol
Correct Answer: Propranolol
Explanation:The beta-adrenoceptors in the heart, peripheral vasculature, bronchi, pancreas, and liver are blocked by beta-adrenoceptor blocking drugs (beta blockers).
Beta blockers come in a wide range of strengths, with the choice largely determined by the disease being treated and the patient’s unique circumstances. The intrinsic sympathomimetic activity, lipid solubility, duration of action, and cardioselectivity of beta blockers all differ.
Some beta blockers are lipid (lipophilic) soluble, while others are water soluble (hydrophilic). Drugs that are more lipid-soluble are absorbed faster from the gut, undergo more first-pass metabolism, and are eliminated faster. They’re also more likely to get into the brain and cause central effects like insomnia and nightmares. Propranolol, pindolol, labetalol, and metoprolol are examples of lipid-soluble beta blockers. Beta blockers that are water-soluble are less likely to enter the brain and are more resistant to first-pass metabolism. They are excreted by the kidneys, and in renal impairment, dosage reduction is frequently required. Atenolol, nadolol, celiprolol, and sotalol are examples of water-soluble beta blockers.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 180
Incorrect
-
An 80-year-old male has presented with chest pain characteristic of angina pectoris. Before initiating treatment with Glyceryl nitrate, you examine the patient and find a murmur. The patient reveals that he has a heart valve disorder, and you immediately put a hold on the GTN order.
Which of the following valve disorders is an absolute contraindication to the use of GTN?Your Answer: Tricuspid regurgitation
Correct Answer: Mitral stenosis
Explanation:Angina pectoris is the most common symptom of ischemic heart disease and presents with chest pain relieved by rest and nitro-glycerine.
Nitrates are the first-line treatment to relieve chest pain caused by angina. The commonly used nitrates are:
1. Nitro-glycerine (NTG) – angina pectoris (treatment/prophylaxis), acute coronary syndrome, heart failure, hypertension
2. Isosorbide mononitrate (ISMN) – chronic angina pectoris (treatment)
3. Isosorbide dinitrate (ISDN) – angina pectoris (treatment/prophylaxis)The nitrate drugs cause vasodilation via the action of nitric oxide.
The contraindications to the use of nitrate are the following:
1. Allergy to nitrates
2. Concomitant use of phosphodiesterases (PDE) inhibitors such as tadalafil and sildenafil
3. Right ventricular infarction
4. Hypertrophic cardiomyopathy
5. Cardiac tamponade
6. Constrictive pericarditis
7. Hypotensive conditions
8. Hypovolaemia
9. Marked anaemia
10. Mitral stenosis
11. Raised intracranial pressure due to cerebral haemorrhage or head trauma
12. Toxic pulmonary oedema -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 181
Incorrect
-
What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?
Your Answer: 10 ml of 1 in 1000 adrenaline solution
Correct Answer: 10 ml of 1 in 10,000 adrenaline solution
Explanation:Ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) are referred to as shockable rhythm.
IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be administered after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter for a shockable rhythm.
For a non-shockable rhythm, 1 mg IV adrenaline should be administered as soon as IV access is obtained, and then every 3 – 5 minutes/after alternate shocks thereafter.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 182
Correct
-
Regarding antacids, which of the following statements is CORRECT:
Your Answer: Antacids should not be taken at the same time as other drugs as they impair absorption.
Explanation:Antacids should preferably not be taken at the same time as other drugs since they may impair absorption. Antacids act by neutralising stomach acid. They are used for symptomatic relief in dyspepsia, but are not first line for proven peptic ulcer disease where antisecretory drugs have a better healing effect. Magnesium-containing antacids tend to be laxative whereas aluminium-containing antacids tend to be constipating. Antacids are contraindicated in hypophosphataemia.
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 183
Incorrect
-
What is the mechanism of action of penicillin antibiotics:
Your Answer: Inhibition of bacterial nucleic acid synthesis
Correct Answer: Inhibition of bacterial cell wall synthesis
Explanation:Penicillins and the other ß-lactam antibiotics are bactericidal. They produce their antimicrobial action by preventing cross-linkage between the linear peptidoglycan polymer chains that make up the bacterial cell wall. They, therefore, inhibit cell wall synthesis.
The integrity of the ß-lactam ring is essential for antimicrobial activity. Many bacteria (including most Staphylococci) are resistant to benzylpenicillin and phenoxymethylpenicillin because they produce enzymes (penicillinases, ß-lactamases) that open the ß-lactam ring. -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 184
Incorrect
-
An elderly female with a diagnosed psychiatric illness was prescribed prochlorperazine for her complaints of dizziness and nausea. Two days later, she returned to the clinic with no improvement in the symptoms.
Which one of the following is the mechanism of action of prochlorperazine?Your Answer: Neurokinin receptor antagonism
Correct Answer: Dopamine receptor antagonism
Explanation:Prochlorperazine is a phenothiazine drug as it is categorized as a first-generation antipsychotic. It mainly blocks the D2 (dopamine 2) receptors in the brain. Along with dopamine, it also blocks histaminergic, cholinergic, and noradrenergic receptors.
It exerts its antiemetic effect via dopamine (D2) receptor antagonist. It is used to treat nausea and vomiting of various causes, including labyrinthine disorders.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 185
Correct
-
Regarding inflammatory bowel disease, acute mild to moderate disease of the rectum or rectosigmoid should be treated initially with:
Your Answer: Local aminosalicylate
Explanation:Acute mild to moderate disease affecting the rectum (proctitis) or the rectosigmoid is treated initially with local application of an aminosalicylate; alternatively, a local corticosteroid can be used but it is less effective. A combination of a local aminosalicylate and a local corticosteroid can be used for proctitis that does not respond to a local aminosalicylate alone.
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 186
Correct
-
Which of the following types of food is most commonly implicated in anaphylactic reactions:
Your Answer: Nuts
Explanation:Anaphylaxis can be triggered by any of a very broad range of triggers, but those most commonly identified include food, drugs, latex and venom. Of foods, nuts are the most common cause; muscle relaxants, antibiotics, NSAIDs and aspirin are the most commonly implicated drugs. Food is the commonest trigger in children and drugs the commonest in adults. A significant number of cases are idiopathic. Most reactions occur over several minutes; rarely, reactions may be slower in onset. The speed of onset of the reaction depends on the trigger e.g. intravenous medications will cause a more rapid onset than stings which in turn will cause a more rapid onset than ingestion of food.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 187
Incorrect
-
You review a 34-year-old man with lower back pain and plan to prescribe him ibuprofen and codeine phosphate. His only past medical history of note is depression, for which he takes fluoxetine.
Which of the following scenarios would prompt you to consider the co-prescription of a PPI for gastro-protection? Select ONE answer only.Your Answer: Family history of peptic ulcer
Correct Answer: Co-prescription of fluoxetine
Explanation:Patients at risk of gastro-intestinal ulceration (including the elderly) who need NSAID treatment should receive gastroprotective treatment. The current recommendations by NICE suggest that gastro-protection should be considered if patients have ≥1 of the following:
Using maximum recommended dose of an NSAID
Aged 65 or older
History of peptic ulcer or GI bleeding
Concomitant use of medications that increase risk:
Low dose aspirin
Anticoagulants
Corticosteroids
Anti-depressants including SSRIs and SNRIs
Requirements for prolonged NSAID usage:
Patients with OA or RA at any age
Long-term back pain if older than 45
It is suggested that if required, either omeprazole 20 mg daily or lansoprazole 15-30 mg daily should be the PPIs of choice.
This patient is on 400 mg of ibuprofen TDS, but the maximum recommended dose of ibuprofen is 2.4 g daily. Co-prescription of codeine, raised BMI, and a family history of peptic ulceration would also not prompt gastro-protection. -
This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 188
Correct
-
Which of the following side effects is most likely caused by erythromycin:
Your Answer: QT - prolongation
Explanation:The side effects of erythromycin include abdominal pain, anaphylaxis,
cholestatic hepatitis, confusion,
diarrhoea, dyspepsia, fever, flatulence, hallucinations, hearing loss,
headache, hypertrophic pyloric stenosis, hypotension, Interstitial
nephritis, mild allergic reactions, nausea, nervous system effects,
including seizures, pain, pruritus, pseudomembranous colitis,
QT prolongation, rash, skin eruptions, tinnitus, urticaria,
ventricular arrhythmias, ventricular tachycardia, vertigo, vomiting -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 189
Incorrect
-
A young 20-year-old boy is a known case of type I diabetes mellitus. Today, he presents with polyuria, polydipsia, and abdominal pain in the emergency department. His blood sugar is drawn, which is markedly elevated to 7 mmol/L. Quick ABGs are drawn, which show metabolic acidosis. You diagnose the patient to be suffering from diabetic ketoacidosis (DKA) and immediately commence its treatment protocol in which insulin is also administered.
Out of the following, which parameter is MOST likely to change due to initiating insulin?Your Answer: Magnesium
Correct Answer: Potassium
Explanation:Diabetes ketoacidosis is an acute complication of diabetes mellitus. Insulin is administered to achieve euglycemia, and crystalloids or colloidal solution is administered to achieve euvolemia and euelectrolytaemia.
Potassium levels severely fluctuate during the treatment of DKA, hypokalaemia being more common. Insulin promotes the cell to take up potassium from the extracellular space via increased sodium-potassium pump activity.
It is important to monitor potassium levels during the treatment of DKA regularly. It is widely suggested that the normal saline shall be used for initial resuscitation, and once the potassium level is retrieved, the patient can be started on potassium replacement should the serum potassium level be between 3.3 and 4.5 mmol/L
If potassium levels fall below 3.3 mmol/l, insulin administration may need to be interrupted to correct the hypokalaemia. -
This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 190
Correct
-
Regarding benzylpenicillin, which of the following statements is CORRECT:
Your Answer: If meningococcal disease is suspected, benzylpenicillin should be given before transfer to hospital.
Explanation:Benzylpenicillin (although inactivated by bacterial beta-lactamases) is effective for many streptococcal (including pneumococcal), gonococcal, and meningococcal infections and also for anthrax, diphtheria, gas gangrene, leptospirosis, and treatment of Lyme disease. If meningococcal disease (meningitis with non-blanching rash or meningococcal septicaemia) is suspected, benzylpenicillin should be given before transfer to hospital, so long as this does not delay the transfer; benzylpenicillin is no longer the drug of first choice for pneumococcal meningitis. Although benzylpenicillin is effective in the treatment of tetanus, metronidazole is preferred. Benzylpenicillin is inactivated by gastric acid and absorption from the gastrointestinal tract is poor and therefore it must be given by injection.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 191
Incorrect
-
A 58-year-old man with a long history of depression presents with a deliberate overdose of verapamil tablets, which he is prescribed for a heart condition.
What is verapamil's mechanism of action?Your Answer: N-type calcium channel blockade
Correct Answer: L-type calcium channel blockade
Explanation:Overdosing on calcium-channel blockers should always be taken seriously and regarded as potentially fatal. Verapamil and diltiazem are the two most lethal calcium channel blockers in overdose. These work by binding the alpha-1 subunit of L-type calcium channels, preventing calcium from entering the cell. In cardiac myocytes, vascular smooth muscle cells, and islet beta-cells, these channels play an important role.
The standard ABC approach should be used to resuscitate all patients as needed. If life-threatening toxicity is expected, intubation and ventilation should be considered early on. If hypotension and shock are developing, early invasive blood pressure monitoring is recommended.
The primary goal of specific treatments is to support the cardiovascular system. These are some of them:
1. Fluid resuscitation: Give up to 20 mL of crystalloid per kilogramme of body weight.
2. Calcium supplementation
This can be a good way to raise blood pressure and heart rate temporarily.
via central venous access: 10% calcium gluconate 60 mL IV (0.6-1.0 mL/kg in children) or 10% calcium chloride 20 mL IV (0.2 mL/kg in children)
Boluses can be given up to three times in a row.
To keep serum calcium >2.0 mEq/L, consider a calcium infusion.3. Atropine: 0.6 mg every 2 minutes up to 1.8 mg is an option, but it is often ineffective.
4. HIET (high-dose insulin-euglycemic therapy):
The role of HIET in the step-by-step management of cardiovascular toxicity has changed.5. Vasoactive infusions:
This was once thought to be a last-ditch measure, but it is now widely recommended that it be used sooner rather than later.
Insulin with a short half-life 50 mL of 50 percent glucose IV bolus plus 1 U/kg bolus (unless marked hyperglycaemia present)
Short-acting insulin/dextrose infusions should be continued.
Glucose should be checked every 20 minutes for the first hour, then hourly after that.
Regularly check potassium levels and replace if they fall below 2.5 mmol/L.
Titrate catecholamines to effect (inotropy and chronotropy); options include dopamine, adrenaline, and/or noradrenaline infusions.6. Sodium bicarbonate: Use 50-100 mEq sodium bicarbonate (0.5-1.0 mEq/kg in children) in cases where a severe metabolic acidosis develops.
7. Cardiac pacing: It can be difficult to achieve electrical capture, and it may not improve overall perfusion.
Bypass AV blockade with ventricular pacing, which is usually done at a rate of less than 60 beats per minute.8. Intralipid transport
Calcium channel blockers are lipid-soluble agents, so they should be used in refractory cases. -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 192
Incorrect
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For the treatment of his atrial fibrillation, a 59-year-old man is about to begin taking warfarin. He also takes a number of other medications.
Which of the following medications will enhance warfarin's effects?Your Answer: Phenobarbital
Correct Answer: Erythromycin
Explanation:Many medications, including warfarin, require cytochrome P450 enzymes for their metabolism. When co-prescribing cytochrome p450 enzyme inducers and inhibitors with warfarin, it’s critical to be cautious.
Inhibitors of the cytochrome p450 enzyme potentiate the effects of warfarin, resulting in a higher INR. To remember the most commonly encountered cytochrome p450 enzyme inhibitors, use the mnemonic O DEVICES:
O– Omeprazole
D– Disulfiram
E– Erythromycin (And other macrolide antibiotics)
V– Valproate (sodium valproate)
I– Isoniazid
C– Ciprofloxacin
E– Ethanol (acute ingestion)
S- Sulphonamides -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 193
Correct
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All of the following are indications for beta-blockers EXCEPT for:
Your Answer: Prinzmetal's angina
Explanation:Beta-blockers are contraindicated in Prinzmetal’s angina.Beta-blockers may be indicated in:HypertensionPheochromocytoma (only with an alpha-blocker)AnginaSecondary prevention after ACSArrhythmias including atrial fibrillationHeart failureThyrotoxicosisAnxietyProphylaxis of migraineEssential tremorGlaucoma
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 194
Incorrect
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All of the following statements are correct regarding the management of acute asthma in adults except:
Your Answer: Routine prescription of antibiotics is not indicated for patients with acute asthma.
Correct Answer: Intravenous aminophylline has been shown to result in significant additional bronchodilation compared to standard care.
Explanation:There usually isn’t any additional bronchodilation with intravenous (IV) aminophylline compared to standard care with inhaled bronchodilators and steroids. IV aminophylline may cause side effects such as arrhythmias and vomiting. However, some additional benefit may be gained in patients with near-fatal asthma or life-threatening asthma with a poor response to initial therapy (5 mg/kg loading dose over 20 minutes unless on maintenance oral therapy, then continuous infusion of 0.5 – 0.7 mg/kg/hr).
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 195
Incorrect
-
For the treatment of his atrial fibrillation, a 67-year-old man is about to begin taking warfarin. He also takes a number of other medications.
Which of the following medications will prevent warfarin from working?Your Answer: Clarithromycin
Correct Answer: Phenytoin
Explanation:Many medications, including warfarin, require cytochrome P450 enzymes for their metabolism. When co-prescribing cytochrome p450 enzyme inducers and inhibitors with warfarin, it’s critical to be cautious.
Inhibitors of the cytochrome p450 enzyme inhibit the effects of warfarin, resulting in a lower INR. To remember the most commonly encountered cytochrome p450 enzyme inducers, use the mnemonic PC BRASS:
P– Phenytoin
C– Carbamazepine
B– Barbiturates
R– Rifampicin
A– Alcohol (chronic ingestion)
S– Sulphonylureas
S– Smoking -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 196
Correct
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Regarding dynamic compression of the airways, which of the following statements is CORRECT:
Your Answer: It occurs during forced expiration.
Explanation:Dynamic compression occurs because as the expiratory muscles contract during forced expiration, all the structures within the lungs, including the airways, are compressed by the positive intrapleural pressure. Consequently the smaller airways collapse before the alveoli empty completely and some air remains within the lungs (the residual volume). Physiologically this is important as a completely deflated lung with collapsed alveoli requires significantly more energy to inflate. Dynamic compression does not occur in normal expiration because the intrapleural pressure is negative throughout the whole cycle.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 197
Incorrect
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Adenosine is primarily indicated for which of the following:
Your Answer: Bradyarrhythmias
Correct Answer: Paroxysmal supraventricular tachycardia
Explanation:Adenosine is usually the treatment of choice for terminating paroxysmal supraventricular tachycardia including those associated with accessory conduction pathways e.g. Wolff-Parkinson-White syndrome.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 198
Correct
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A critically ill 48-year-old individual appears with symptoms and signs of an anaphylactic reaction.
In an allergic reaction, which of the following is an absolute contraindication to the injection of adrenaline?Your Answer: None of the other options
Explanation:Even if the following relevant contraindications exist, adrenaline can be given in life-threatening anaphylactic reactions:
Coronary artery disease (CAD)Â
Coronary artery disease (CAD)Â Second stage of labour
Hypertension that is uncontrolled
Severe Ventricular arrhythmias -
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 199
Correct
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Regarding macrolide antibiotics, which of the following statements is CORRECT:
Your Answer: Macrolides are first line for treatment of whooping cough.
Explanation:A macrolide antibiotic is recommended first line for whooping cough (if onset of cough is within the previous 21 days)
Prescribe clarithromycin for infants less than 1 month of age.
Prescribe azithromycin or clarithromycin for children aged 1 month or older, and non-pregnant adults.
Prescribe erythromycin for pregnant women.
Macrolides interfere with bacterial protein synthesis and are mainly active against Gram-positive organisms. They have a similar antibacterial spectrum to penicillin and are thus a useful alternative in penicillin-allergic patients. Erythromycin is commonly associated with gastrointestinal upset. -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 200
Incorrect
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A 68-year-old man is being treated with digoxin for atrial fibrillation. When serum digoxin levels are above the therapeutic range, he is at highest risk for developing digoxin toxicity if he also develops which of the following?
Your Answer:
Correct Answer: Hypokalaemia
Explanation:Predisposing factors for digoxin toxicity include hypoxia, hypercalcaemia, hypokalaemia and hypomagnesaemia There should also be care taken in the elderly who are particularly susceptible to digoxin toxicity. Hypokalaemia may be precipitated by use of diuretics. Hyponatremia can result in the development of other pathological disturbances, but it does not make digoxin toxicity worse.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
