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  • Question 1 - A 45-year-old male is brought to the emergency department after being found collapsed,...

    Incorrect

    • A 45-year-old male is brought to the emergency department after being found collapsed, outside a nightclub. The ER team found an empty bottle of amyl nitrate in his pocket. The patient is hypoxic with an O2 saturation of 84% and is confused. Which of the following is the best treatment for this patient?

      Your Answer: Intubation

      Correct Answer: Methylene blue

      Explanation:

      The best treatment for the patient in question would be methylene blue.The most probable diagnosis in this patient is methemoglobinemia due to the ingestion of amyl nitrate.Amyl nitrate promotes the formation of methaemoglobin, which avidly conserves oxygen and leads to decreased tissue oxygen saturations. Treatment of choice includes methylene blue and vitamin C.Adverse effects:Benign side effects include green or blue discoloration of urine and patients should be forewarned. Significant side effects are based on methylene blue, itself, being an oxidizing agent and an inhibitor of monoamine oxidase A (MAO-A). As an oxidizing agent, methylene blue can actually precipitate methemoglobinemia or haemolysis in high doses or when ineffectively reduced. Methylene blue administration in a patient taking a serotonergic agents may predispose to serotonin syndrome.Note: Although methylene blue administration is controversial in the setting of G6PD-deficiency due to reduced levels of NADPH, it is not contraindicated and should be administered cautiously and judiciously.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      78.6
      Seconds

  • Question 2 - A 40-year-old patient under treatment for gout gave a history of progressive weakness...

    Incorrect

    • A 40-year-old patient under treatment for gout gave a history of progressive weakness of his limbs over 2 months. He noticed that it was particularly difficult for him to get up from the toilet seat and to get out of his car. He also felt some tingling and numbness of his toes at night, which was distressing. He was taking several medications which included Ibuprofen, perindopril, colchicine, vitamin supplements, and indapamide.On examination his pulse was 85/min, blood pressure was 140/90 mmHg and fundi revealed arteriovenous nipping. He had proximal lower limb weakness of 4/5 and absent ankle reflexes. Plantar reflexes were upgoing on both sides. His serum creatinine phosphokinase level was normal.What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Colchicine toxicity

      Explanation:

      The given clinical scenario is suggestive of myo-neuropathy and is most likely to be caused by colchicine toxicity. It gives rise to subacute proximal muscle weakness and on occasions can lead to an acute necrotizing myopathy. Creatine phosphokinase may be normal or may be elevated.Weakness resolves when the drug is discontinued but the neuropathic features remain.Death is usually a result of respiratory depression and cardiovascular collapse.Treatment is symptomatic and supportive, and the treatment for colchicine poisoning includes lavage and measures to prevent shock.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      0
      Seconds

  • Question 3 - A 30-year-old male is brought to the emergency department following his collapse in...

    Incorrect

    • A 30-year-old male is brought to the emergency department following his collapse in a night club. His friends who accompanied him admit that, of recent, he has been using increasing amounts of cocaine. Which among the following is commonly associated with cocaine overdose?

      Your Answer:

      Correct Answer: Metabolic acidosis

      Explanation:

      Metabolic acidosis is associated with cocaine overdose. In overdose, cocaine leads to agitation, tachycardia, hypertension, sweating, hallucinations, and finally convulsions. Metabolic acidosis, hyperthermia, rhabdomyolysis, and ventricular arrhythmias also occur.Chronic use may be associated with premature coronary artery disease, dilated cardiomyopathy, and increased risk of cerebral haemorrhage.There are 3 stages for acute cocaine toxicity:Stage I: CNS symptoms of headache, vertigo, pseudo hallucinations, hyperthermia, hypertension. Stage II: increased deep tendon reflexes, tachypnoea, irregular breathing, hypertension.Stage III: Areflexia, coma, fixed and dilated pupils, hypotension, ventricular fibrillation, apnoea, and respiratory failure.Treatment:- Airway, breathing, and circulation to be secured. The patient’s fever should be managed, and one should rule out hypoglycaemia as a cause of the neuropsychiatric symptoms. – Cardiovascular toxicity and agitation are best-treated first-line with benzodiazepines to decrease CNS sympathetic outflow.- The mixed beta/alpha blocker labetalol is safe and effective for treating concomitant cocaine-induced hypertension and tachycardia.- Non-dihydropyridine calcium channels blockers such as diltiazem and verapamil have been shown to reduce hypertension reliably, but not tachycardia. – Dihydropyridine agents such as nifedipine should be avoided, as reflex tachycardia may occur. – The alpha-blocker phentolamine has been recommended but only treats alpha-mediated hypertension and not tachycardia.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      0
      Seconds

  • Question 4 - Which among the following antihypertensives is centrally acting? ...

    Incorrect

    • Which among the following antihypertensives is centrally acting?

      Your Answer:

      Correct Answer: Moxonidine

      Explanation:

      Moxonidine and alpha-methyl dopa are centrally acting antihypertensives and modify blood pressure through modifying sympathetic activity.Other options:Verapamil is a calcium antagonist.Minoxidil and hydralazine are both vasodilators.Phenoxybenzamine is an alpha-blocker.Adverse effects:Dry mouth and somnolence were the most frequently reported adverse events, followed by headache, dizziness, nausea and allergic skin reactions.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      0
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  • Question 5 - Organophosphates, such as Sarin, have been used as chemical-warfare agents by terrorists. Which...

    Incorrect

    • Organophosphates, such as Sarin, have been used as chemical-warfare agents by terrorists. Which of the following statements is true concerning organophosphate poisoning?

      Your Answer:

      Correct Answer: Atropine is useful in the management of organophosphate poisoning

      Explanation:

      The principal action of organophosphates is the inhibition of acetylcholinesterase’s, therefore leading to the accumulation of acetylcholine at muscarinic receptors (miosis, hypersalivation, sweating, diarrhoea, excessive bronchial secretions), nicotinic receptors (muscle fasciculations and tremor) and in the central nervous system (anxiety, loss of memory, headache, coma). Removal from the source of the organophosphate, adequate decontamination, supplemental oxygen and atropine are the initial treatment measures. Pralidoxime, an activator of cholinesterase, should be given to all symptomatic patients.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      0
      Seconds

  • Question 6 - Which one of the following features is least recognised in long-term lithium use?...

    Incorrect

    • Which one of the following features is least recognised in long-term lithium use?

      Your Answer:

      Correct Answer: Alopecia

      Explanation:

      All the above side-effects, with the exception of alopecia, may be seen in patients taking lithium.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
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  • Question 7 - What is the mechanism of action of sumatriptan? ...

    Incorrect

    • What is the mechanism of action of sumatriptan?

      Your Answer:

      Correct Answer: 5-HT1 agonist

      Explanation:

      Triptans are specific 5-HT1 agonists used in the acute treatment of migraine. They are generally used as first-line therapy in combination with an NSAID or paracetamol.

      Sumatriptan acts as an agonist on 5-HT1B/1D receptors by inducing vasoconstriction in the basilar artery and blood vessels within the dura mater. The drug reduces peripheral nociception either by selective cranial vasoconstriction or by affecting trigeminovascular nerves.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      0
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  • Question 8 - A 50-year-old farmer, under treatment for depression, presents to the emergency department following...

    Incorrect

    • A 50-year-old farmer, under treatment for depression, presents to the emergency department following an intentional overdose of an unidentified substance. On examination, he was found to be bradycardic, hypotensive, hyper-salivating, and disoriented. On ocular examination, his pupils were found to be miotic. What is the most likely substance he ingested?

      Your Answer:

      Correct Answer: An organophosphate insecticide

      Explanation:

      The farmer has most likely ingested an organophosphate insecticide.Organophosphorus compounds are used widely as:• Insecticides – Malathion, parathion, diazinon, dichlorvos• Nerve gases – Soman, sarin, tabun, VX• Ophthalmic agents – Echothiophate• Antihelmintics – Trichlorfon• Herbicides – merphos• Industrial chemical (plasticizer) – Tricresyl phosphateSigns and symptoms of Organophosphorus Poisoning (OPP) can be classified as:• Muscarinic effects:o Cardiovascular – Bradycardia, hypotensiono Respiratory – Rhinorrhoea, bronchorrhea, bronchospasm, cough, severe respiratory distresso Gastrointestinal – Hypersalivation, nausea and vomiting, abdominal pain, diarrhoea, faecal incontinenceo Genitourinary – Incontinenceo Ocular – Blurred vision, miosiso Glands – Increased lacrimation, diaphoresis• Nicotinic effects:o Muscle fasciculation, weakness, cramping, diaphragmatic failure, and autonomic side effects include: hypertension, tachycardia, and mydriasis.• Central nervous system (CNS) effects:o Anxiety, emotional lability, restlessness, confusion, ataxia, tremors, seizures, coma, apnoeaMainstay Treatment:• Decontamination• Securing Airway, Breathing and Circulation• Atropine• Pralidoxime• Benzodiazepines

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      0
      Seconds

  • Question 9 - What is the mechanism of action of sildenafil citrate? ...

    Incorrect

    • What is the mechanism of action of sildenafil citrate?

      Your Answer:

      Correct Answer: Inhibition of phosphodiesterase V

      Explanation:

      Sildenafil citrate (Viagra) is the first oral drug to be widely approved for the treatment of erectile dysfunction. It is a potent and selective inhibitor of type-V phosphodiesterase, the primary form of the enzyme found in human penile erectile tissue, thereby preventing the breakdown of cyclic guanosine monophosphate (cGMP), the intracellular second messenger of nitric oxide.Uses:It is used for the treatment of erectile dysfunction, idiopathic pulmonary hypertension, premature ejaculation, high altitude illness, penile rehabilitation after radical prostatectomy, angina pectoris, and lower urinary tract symptoms.Adverse effects:Mild headache, flushing, dyspepsia, cyanopsia, back pain, and myalgias – due to a high concentration of PDE11 enzyme in skeletal muscle, which shows significant cross-reactivity with the use of tadalafil.It can also cause hypotension, dizziness, and rhinitis.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      0
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  • Question 10 - What is the rationale concerning the use of sodium cromoglycate in the prophylaxis...

    Incorrect

    • What is the rationale concerning the use of sodium cromoglycate in the prophylaxis of bronchial asthma?

      Your Answer:

      Correct Answer: Inhibition of mast-cell degranulation

      Explanation:

      Sodium cromoglycate principally acts by inhibiting the degranulation of mast cells triggered by the interaction of antigen and IgE. The inhibitory effect on mast cells appears to be cell-type specific since cromoglycate has little inhibitory effect on mediator release from human basophils.Thus, it inhibits the release of histamine, leukotrienes, and slow-reacting substance of anaphylaxis from mast cells by inhibiting degranulation following exposure to reactive antigens.Adverse effects include cough, flushing, palpitation, chest pain, nasal congestion, nausea, fatigue, migraine, etc.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      0
      Seconds

  • Question 11 - Which of the following enzymes are involved in Phase I drug metabolism? ...

    Incorrect

    • Which of the following enzymes are involved in Phase I drug metabolism?

      Your Answer:

      Correct Answer: Alcohol dehydrogenase

      Explanation:

      Drug metabolism can be broadly classified into:Phase I (functionalization) reactions: also termed non-synthetic reactions, they include oxidation, reduction, hydrolysis, cyclization and de-cyclization. The most common and vital reactions are oxidation reactions. (Of the given enzymes only Alcohol dehydrogenase is involved in phase I drug metabolism. Succinate dehydrogenase, is a vital enzyme involved in the Kreb’s cycle and the mitochondrial electron transport chain). They are mainly catalysed by Cytochrome P-450 enzyme.Phase II (conjugation) reactions: occur following phase I reactions, they include reactions: glucuronidation and sulphate conjugation, etc. They are mostly catalysed by UDP-glucuronosyltransferase enzyme. Other phase II enzymes include: sulfotransferases, N-acetyltransferases, glutathione S-transferases and methyltransferases.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      0
      Seconds

  • Question 12 - A 30-year-old female presents with a 4-day history of diarrhoea and vomiting. She...

    Incorrect

    • A 30-year-old female presents with a 4-day history of diarrhoea and vomiting. She has been unable to keep fluids down for 4 days and has been treated with metoclopramide. She develops a dystonic reaction. What is the most appropriate treatment for this woman?

      Your Answer:

      Correct Answer: Benztropine

      Explanation:

      Acute dystonic reactions (extrapyramidal symptoms) such as spasmodic torticollis, trismus, and oculogyric crises can occur following the administration of metoclopramide or stemetil and thus, neither is recommended for the treatment of nausea in young women.

      Such reactions respond well to treatment with benztropine or procyclidine.

      – Benztropine: It is an anticholinergic medication with significant CNS penetration. A single dose of benztropine 1 to 2 mg IV followed by 1 to 2 mg p.o twice a day for up to 7 days to prevent a recurrence. Subsequently, both the offending agent and those from the same group should be avoided.

      – Alternatively, diphenhydramine can be used intravenously (up to a dose of 50mg) or intramuscularly followed by p.o therapy every 6 hours for 1 to 2 to prevent a recurrence.- Second-line therapy with IV benzodiazepines is reserved for those patients who do not respond to anticholinergics.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      0
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  • Question 13 - A 50-year-old man is admitted with nausea and excessive drowsiness after taking an...

    Incorrect

    • A 50-year-old man is admitted with nausea and excessive drowsiness after taking an antihistamine tablet with grapefruit juice. Which of the following liver enzyme systems is affected by grapefruit juice causing the given side effect?

      Your Answer:

      Correct Answer: Cytochrome p450 3A4

      Explanation:

      The cytochrome p450 3A4 enzyme system in the liver is affected by grapefruit juice. Patients taking antihistamines should be advised to avoid drinking grapefruit juice. This is because constituents of grapefruit juice such as naringin and bergamottin inhibit CYP3A4 in the liver, particularly at high doses, leading to decreased drug elimination via hepatic metabolism and can increase potential drug toxicities. Inhibition of this enzyme system leads to reduced metabolism of antihistamines leading to an increased incidence of side effects like excessive drowsiness and nausea as in this patient.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      0
      Seconds

  • Question 14 - Where is the site of action of spironolactone? ...

    Incorrect

    • Where is the site of action of spironolactone?

      Your Answer:

      Correct Answer: Distal convoluted tubule

      Explanation:

      Spironolactone is an aldosterone antagonist which acts in the distal convoluted tubule. It is a potassium-sparing diuretic that prevents the body from absorbing too much salt and keeps the potassium levels from getting too low. Spironolactone is used to treat heart failure, high blood pressure (hypertension), or hypokalaemia (low potassium levels in the blood).

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      0
      Seconds

  • Question 15 - A 70-year-old male with advanced COPD currently on treatment with salbutamol (as required)...

    Incorrect

    • A 70-year-old male with advanced COPD currently on treatment with salbutamol (as required) presents for review. After a complete history and examination, you conclude that he requires to be stepped up in his inhalational therapy. The decision to add tiotropium bromide to his regime was taken. Which of the following best describe the mechanism of action of tiotropium?

      Your Answer:

      Correct Answer: It is a long-acting anticholinergic agent

      Explanation:

      Tiotropium is a specific long-acting antimuscarinic agent indicated as maintenance therapy for patients with COPD (chronic obstructive pulmonary disease). It should be used cautiously in patients with narrow-angle glaucoma, prostatic hyperplasia or bladder neck obstruction.The most frequently encountered adverse effects of tiotropium include pharyngitis, bronchitis, sinusitis, dry mouth, cough, and headaches. Paradoxical bronchospasm may also occur as a rare side-effect. Dry mouth occurs in up to 14% of patients taking tiotropium, in keeping with its anticholinergic profile. Rarer side-effects include tachycardia, blurred vision, urinary retention, and constipation.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      0
      Seconds

  • Question 16 - A 22-year-old university student is admitted after taking drugs at a night club....

    Incorrect

    • A 22-year-old university student is admitted after taking drugs at a night club. Which of the following features suggest she had taken ecstasy (MDMA)?

      Your Answer:

      Correct Answer: A pyrexia of 40°C

      Explanation:

      MDMA commonly known as ecstasy or molly, is a psychoactive drug primarily used as a recreational drug. The desired effects include altered sensations, increased energy, empathy, and pleasure. Features of MDMA abuse include hyponatraemia, tachycardia, hyperventilation, and hyperthermia.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      0
      Seconds

  • Question 17 - A 30-year-old woman is admitted for drainage of an abscess in her left...

    Incorrect

    • A 30-year-old woman is admitted for drainage of an abscess in her left forearm. She has revealed that she was regular heroin user and has stopped for the past few days. Clinical signs are pointing towards opioid withdrawal. What is the next step in managing this patient?

      Your Answer:

      Correct Answer: Give her 10 mg of methadone syrup and wait 60 min to determine its effect

      Explanation:

      The next step in managing this patient is to give 10 mg and continue administering in 10 mg increments each hour until symptoms are under control.Methadone alleviates opioid withdrawal symptoms and reduces cravings. Methadone is useful for detoxification from longer-acting opioids such as morphine or methadone itself.Methadone should be used with caution if the patient has:Respiratory deficiencyAcute alcohol dependenceHead injuryTreatment with monoamine oxidase inhibitors (MAOIs)Ulcerating colitis or Crohn’s diseaseSevere hepatic impairmentThe dose must be reviewed on a daily basis and adjusted based upon how well the symptoms are controlled and the presence of side effects. The greater the dose of opioids used by the patient, the greater the dose of methadone required to control withdrawal symptoms. To avoid the risk of overdose in the first days of treatment The recommended dosing of methadone is 30mg in two doses of 15mg morning and evening.It is important to note that a methadone dose equivalent to what the patient reports they are taking should never be given. It is rare to need more than 40 mg per 24 hours: beware of overdosing which can lead to respiratory arrest.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
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  • Question 18 - Which one of the following antibiotics is safest to use in pregnancy? ...

    Incorrect

    • Which one of the following antibiotics is safest to use in pregnancy?

      Your Answer:

      Correct Answer: Erythromycin

      Explanation:

      Antibiotics that should be avoided in pregnancy are included in the mnemonic: Countless SAFe Moms Take Really Good Care -Clarithromycin, Sulphonamides, Aminoglycosides, Fluoroquinolones, Metronidazole, Tetracyclines, Ribavirin, Griseofulvin, Chloramphenicol

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      0
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  • Question 19 - Treatment of an acute attack of gout with allopurinol may result in which...

    Incorrect

    • Treatment of an acute attack of gout with allopurinol may result in which of the following?

      Your Answer:

      Correct Answer: Exacerbation and prolongation of the attack

      Explanation:

      Initiation of allopurinol treatment during an attack can exacerbate and prolong the episode. Thus treatment should be delayed until the attack resolves.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      0
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  • Question 20 - Which of the following statements is false regarding the bioavailability of a drug?...

    Incorrect

    • Which of the following statements is false regarding the bioavailability of a drug?

      Your Answer:

      Correct Answer: The bioavailability of a drug given orally is often affected by the degree of renal elimination

      Explanation:

      Renal elimination of a drug has no role in altering the bioavailability of a drug.The bioavailability of a drug is the proportion of the drug which reaches systemic circulation. Mathematically, bioavailability is the AUCoral/AUCiv x 100%, where AUC = area under the concentration-time curve following a single (oral or iv) dose. Other options are true:By definition, the bioavailability of a drug given intravenously is 100%.Drugs given orally that undergo high pre-systemic (first-pass) metabolism in the liver or gut wall have a low bioavailability e.g. lidocaine. Bioavailability is also affected by the degree of absorption from the gut and this can change depending on gut motility and administration of other drugs.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      0
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  • Question 21 - A 35-year-old woman under treatment for long-term epilepsy with valproate presented with complaints...

    Incorrect

    • A 35-year-old woman under treatment for long-term epilepsy with valproate presented with complaints of excessive weight gain. She is consuming oral contraceptive pills.Which among the following is the best alternative to valproate for treating long-term epilepsy?

      Your Answer:

      Correct Answer: Lamotrigine

      Explanation:

      Among the given anti-epileptics the best drug that can be given in this patient is lamotrigine.Topiramate, carbamazepine, phenytoin, and phenobarbital are all hepatic enzyme inducers and are associated with decreased effectiveness of the oral contraceptive (OCP) due to acceleration of the metabolism of oestrogens and progestogens.If she is planning on pregnancy then registry studies suggest that lamotrigine would also be the best choice.Other hepatic enzyme inducers include rifampicin, spironolactone, griseofulvin, etc.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      0
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  • Question 22 - A 45-year-old woman has been diagnosed with T1N1M1 malignancy in the left breast,...

    Incorrect

    • A 45-year-old woman has been diagnosed with T1N1M1 malignancy in the left breast, with metastases detectable in the lower thoracic vertebrae and the left lung. Before the initiation of treatment of this patient with trastuzumab, which is the most important investigation to perform?

      Your Answer:

      Correct Answer: Echo

      Explanation:

      Before the initiation of trastuzumab, an echocardiography is a must to rule out any pre-existing cardiac abnormalities as trastuzumab is cardiotoxic.Trastuzumab (Herceptin) is a monoclonal antibody directed against the HER2/neu receptor. It is used mainly in metastatic breast cancer although some patients with early disease are now also given trastuzumab.Adverse effects include:Flu-like symptoms and diarrhoea are common.Cardiotoxicity: – Risk increases when anthracyclines are used concomitantly. – Trastuzumab-induced cardiac dysfunctions are regarded as less severe and largely reversible because primary cardiomyocyte do not show ultrastructure changes unlike those associated with anthracycline-induced cardiotoxicity. – Primary myocyte injury does not occur in patients who were treated with trastuzumab.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
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  • Question 23 - A 33-year-old electrical technician presents following an overdose. Anticholinergic syndrome is suspected. Which...

    Incorrect

    • A 33-year-old electrical technician presents following an overdose. Anticholinergic syndrome is suspected. Which of the following is true?

      Your Answer:

      Correct Answer: Mydriasis occurs

      Explanation:

      Anticholinergic syndrome occurs following overdose with drugs that have prominent anticholinergic activity including tricyclic antidepressants, antihistamines and atropine. Features include dry, warm, flushed skin, urinary retention, tachycardia, mydriasis (dilated pupils) and agitation.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
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  • Question 24 - A 25-year-old female presents to the emergency department with severe breathlessness and tinnitus....

    Incorrect

    • A 25-year-old female presents to the emergency department with severe breathlessness and tinnitus. She is under treatment for asthma and depression with albuterol and amitriptyline respectively.On examination, she seems agitated with a BP of 100/44, a pulse rate of 112 bpm, a respiratory rate of 30 cycles/min, and a temperature of 37.8'C.An arterial blood gas performed reveals:pH: 7.48 (7.36 – 7.44)pO2: 11.2 kPa (11.3 – 12.6 kPa)pCO2: 1.9 kPa (4.7 – 6.0 kPa)Bicarbonate: 13 mmol/l (20 – 28 mmol/L)What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Salicylate poisoning

      Explanation:

      The blood gas analysis provided above is suggestive of a mixed respiratory alkalosis and metabolic acidosis characteristic of salicylate overdose.Pathophysiology:The direct stimulation of the cerebral medulla causes hyperventilation and respiratory alkalosis.As it is metabolized, it causes an uncoupling of oxidative phosphorylation in the mitochondria. Lactate levels then increase due to the increase in anaerobic metabolism. This, along with a slight contribution from the salicylate metabolites result in metabolic acidosis.Tinnitus is characteristic and salicylate ototoxicity may produce deafness. Other neurological sequelae include encephalopathy and agitation, seizures and CNS depression and coma. Cardiovascular complications include tachycardia, hypotension, and dysrhythmias (VT, VF, and asystole).

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
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  • Question 25 - A 55-year-old diabetic male presents with a feeling of generally being unwell. He...

    Incorrect

    • A 55-year-old diabetic male presents with a feeling of generally being unwell. He also has a history of atrial fibrillation and epilepsy. His main complaint is a blue tinge to his vision. Which one of his medications is most likely to be responsible?

      Your Answer:

      Correct Answer: Sildenafil

      Explanation:

      Blue tinge of vision/cyanopsia is caused due to the intake of sildenafil citrate.Sildenafil citrate (Viagra) is the first oral drug to be widely approved for the treatment of erectile dysfunction. It is a potent and selective inhibitor of type-V phosphodiesterase, the primary form of the enzyme found in human penile erectile tissue, thereby preventing the breakdown of cyclic guanosine monophosphate (cGMP), the intracellular second messenger of nitric oxide.Uses:It is used for the treatment of erectile dysfunction, idiopathic pulmonary hypertension, premature ejaculation, high altitude illness, penile rehabilitation after radical prostatectomy, angina pectoris, and lower urinary tract symptoms.Adverse effects:Mild headache, flushing, dyspepsia, cyanopsia, back pain, and myalgias – due to a high concentration of PDE11 enzyme in skeletal muscle, which shows significant cross-reactivity with the use of tadalafil.It can also cause hypotension, dizziness, and rhinitis.Note: Xanthopsia (yellow-green vision) may occur secondary to treatment with digoxin.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
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  • Question 26 - A 78-year-old male with long-standing Alzheimer's disease is being reviewed in your clinic....

    Incorrect

    • A 78-year-old male with long-standing Alzheimer's disease is being reviewed in your clinic. Which among the following is true regarding memantine, a drug which has been approved for the management of dementia?

      Your Answer:

      Correct Answer: It is an NMDA-receptor antagonist

      Explanation:

      Memantine is an antagonist of the NMDA (N-Methyl-D-Aspartate)-receptor subtype of glutamate receptor. It is used to slow the neurotoxicity thought to be involved in Alzheimer’s disease and other neurodegenerative diseases.

      Drug interactions:

      • When given concomitantly with other NMDA-receptor antagonists (e.g., ketamine, amantadine) there is increased risk of psychosis.
      • Dopamine agonists, L-dopa, and anticholinergics enhance effects of memantine.
      • Antispasmodics (e.g., baclofen) enhance effects, as memantine has some antispasmodic effects.
      • Drugs excreted by cationic transporters in the kidney (e.g. quinine, cimetidine, ranitidine) reduce excretion.
      • Common adverse effects include dizziness, headache, confusion, diarrhoea, and constipation.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
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  • Question 27 - A 50-year-old male was under treatment for bipolar disease. He was brought to...

    Incorrect

    • A 50-year-old male was under treatment for bipolar disease. He was brought to the emergency department as he had become increasingly confused over the past two days. He had vomiting and diarrhoea. He was also consuming and passing a lot of water.On examination, he was disoriented. He had vertical nystagmus and was ataxic.What two investigations are likely to lead to the correct diagnosis?

      Your Answer:

      Correct Answer: Desmopressin test and serum lithium level

      Explanation:

      Desmopressin test (done to differentiate nephrogenic diabetes insipidus from central diabetes insipidus), and serum lithium levels can together confirm a diagnosis of lithium-induced nephrogenic diabetes insipidus.Bipolar disease is most often managed with mood stabilizers like lithium. This patient develops gastrointestinal symptoms followed by an acute confusional state associated with polyuria and polydipsia. These symptoms are suggestive of diabetes insipidus.In a case where these symptoms occur in a bipolar patient under treatment, lithium-induced nephrogenic diabetes insipidus should be considered as the most probable cause.Lithium intoxication can present with symptoms of nausea, vomiting, mental dullness, action tremor, weakness, ataxia, slurred speech, blurred vision, dizziness, especially vertical nystagmus and stupor or coma. Diffuse myoclonic twitching and nephrogenic diabetes insipidus can also occur. Such a clinical syndrome occurs above the serum level of lithium of 1.5–2.0 mEq/L.Management: – Correcting electrolyte abnormalities in patients with acute disease is critical and often life-saving.- Treatment should be initiated with parenteral fluids to replete hypovolemia (normal saline at 200-250 mL/h), followed by administration of hypotonic fluid (0.5% normal saline). – On the restoration of the volume status of the patient forced diuresis should be initiated by the administration of parenteral furosemide or bumetanide accompanied by continued intravenous hypotonic fluid administration to maintain volume status.- Polyuria is managed with hydrochlorothiazide combined with amiloride, acetazolamide.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
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  • Question 28 - A 75-year-old man has presented to the clinic with a complaint of disturbed...

    Incorrect

    • A 75-year-old man has presented to the clinic with a complaint of disturbed sleep. The physician has prescribed temazepam. Which of the following best describes the mechanism of action of this drug?

      Your Answer:

      Correct Answer: Enhances the effect of gamma-aminobutyric acid

      Explanation:

      Temazepam is an orally available benzodiazepine used in the therapy of insomnia. The soporific activity of the benzodiazepines is mediated by their ability to enhance gamma-aminobutyric acid (GABA) mediated inhibition of synaptic transmission through binding to the GABA-A receptor.The recommended initial dose for insomnia is 7.5 mg before bedtime, increasing as needed to a maximum dose of 30 mg. The most common side effects of temazepam are dose-related and include daytime drowsiness, lethargy, ataxia, dysarthria, and dizziness.Tolerance develops to these side effects, but tolerance may also develop to the effects on insomnia.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
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  • Question 29 - β-blockers are used in the treatment of angina because they have which one...

    Incorrect

    • β-blockers are used in the treatment of angina because they have which one of the following properties?

      Your Answer:

      Correct Answer: Decrease the heart rate and myocardial contractility

      Explanation:

      The cardiovascular effects of β-adrenoceptor block result from reduction of the sympathetic drive which includes reduced heart rate (automaticity) and reduced myocardial contractility (rate of rise of pressure in the ventricle). This will lead to reduced cardiac output and an overall fall in oxygen consumption.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
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  • Question 30 - An 81-year-old male presented to the emergency department following a fall at home....

    Incorrect

    • An 81-year-old male presented to the emergency department following a fall at home. He was diagnosed with osteoporosis about five years ago. He presently complains of significant low back pain. A lumbar spine X-ray was suggestive of a fractured lumbar vertebra. A subsequent MRI scan of the lumbosacral spine revealed a new L3 burst fracture with no evidence of cord compression. A neurosurgical consult was sought and conservative management was planned accordingly in the form of pain control, physiotherapy, and mobilization (as allowed by the pain). He also has been diagnosed with chronic renal disease (stage IV) with a creatinine clearance of 21ml/min, he was started on a Buprenorphine patch. Which of the following opioids would be safest to use for his breakthrough pain?

      Your Answer:

      Correct Answer: Oxycodone

      Explanation:

      Oxycodone is a safer opioid to use in patients with moderate to end-stage renal failure.Active metabolites of morphine accumulate in renal failure which means that long-term use is contraindicated in patients with moderate/severe renal failure. These toxic metabolites can accumulate causing toxicity and risk overdose. Oxycodone is mainly metabolised in the liver and thus safer to use in patients with moderate to end-stage renal failure with dose reductions.Adverse effects:Constipation is the most common overall side effect. Others include: asthenia, dizziness, dry mouth, headache, nausea, pruritus, etc. Medications in renal failure:Drugs to be avoided in patients with renal failureAntibiotics: tetracycline, nitrofurantoinNSAIDsLithiumMetforminDrugs that require dose adjustment:Most antibiotics including penicillin, cephalosporins, vancomycin, gentamicin, streptomycinDigoxin, atenololMethotrexateSulphonylureasFurosemideOpioidsRelatively safe drugs:Antibiotics: erythromycin, rifampicinDiazepamWarfarin

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
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