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  • Question 1 - A 28-year-old patient who has been in a car accident needs to be...

    Incorrect

    • A 28-year-old patient who has been in a car accident needs to be intubated using a rapid sequence induction. As an induction agent, you intend to use etomidate.

      Etomidate works by interacting with which type of receptor?

      Your Answer: N-methyl-D-aspartate (NMDA)

      Correct Answer: Gamma-aminobutyric acid (GABA)

      Explanation:

      Etomidate is a carboxylated imidazole derivative with a short half-life that is primarily used to induce anaesthesia.

      It is thought to modulate fast inhibitory synaptic transmission in the central nervous system by acting on GABA type A receptors.
      The dose for anaesthesia induction is 0.3 mg/kg. Etomidate takes 10-65 seconds to take effect after an intravenous injection, and it lasts 6-8 minutes. With repeated administration, the effects are non-cumulative.

      The relative cardiovascular stability of etomidate is noteworthy. During induction, it causes less hypotension than thiopental sodium and propofol. It’s also linked to a quick recovery without the hangover.

      Etomidate is a strong steroidogenesis inhibitor. The drug inhibits the enzymes responsible for adrenal 11 beta-hydroxylase and cholesterol cleavage, resulting in a decrease in cortisol and aldosterone synthesis for up to 24 hours after administration. It should not be used to maintain anaesthesia because of the adrenocortical suppression.

      Other side effects associated with etomidate use include:
      Vomiting and nausea
      The injection causes pain (in up to 50 percent )
      Phlebitis and thrombosis of the veins
      Heart block and arrhythmias
      Hyperventilation
      Apnoea and respiratory depression
      It has the potential to cause both hypo- and hypertension.
      Critically ill patients have a higher mortality rate.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      21.2
      Seconds

  • Question 2 - You review a patient with urinary sepsis and decide to start her...

    Incorrect

    • You review a patient with urinary sepsis and decide to start her on gentamicin.

      Which statement about gentamicin is true?

      Your Answer: It acts by binding to the 50S subunit

      Correct Answer: Ototoxicity is a dose-related effect

      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.

      Gentamicin is given by injection because it is NOT absorbed orally.

      It is excreted in the kidneys by glomerular filtration

      Gentamicin is not to be used for the treatment of Neisseria meningitidis, Neisseria gonorrhoea, or Legionella pneumophila.There is a risk of patient going into shock from lipid A endotoxin release.

      Two of its most notable side effects are hearing loss reversible nephrotoxicity and which are both dose-related and levels should be monitored in patients.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      21.2
      Seconds

  • Question 3 - A 34-year-old male presents to the Emergency Department with the complaint of palpitations...

    Correct

    • A 34-year-old male presents to the Emergency Department with the complaint of palpitations and difficulty breathing, which started suddenly half an hour ago. His ECG shows findings of supraventricular tachycardia. You attempt vagal manoeuvres but cannot convert them back to sinus rhythm. Therefore, drug therapy is necessary to terminate the arrhythmia. Adenosine cannot be used in this patient because of a contra-indication listed in his medical record.

      Which one of the conditions listed below would be a contraindication in this case?

      Your Answer: Asthma

      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.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      51
      Seconds

  • Question 4 - Regarding codeine, which of the following statements is INCORRECT: ...

    Correct

    • 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.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      19.4
      Seconds

  • Question 5 - A patient who is taking ramipril for high blood pressure complains of a...

    Incorrect

    • 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: Increased mast cell degranulation

      Correct 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.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      27.8
      Seconds

  • Question 6 - Which of the following is NOT a pharmacological effect of beta-blockers: ...

    Incorrect

    • Which of the following is NOT a pharmacological effect of beta-blockers:

      Your Answer: Reduced intraocular pressure

      Correct Answer: Reduced AV conduction time

      Explanation:

      Effects of beta-blockers:
      Cardiovascular system:
      Reduce blood pressure
      Reduce heart rate, contractility and cardiac output
      Increase AV conduction time, refractoriness and suppress automaticity

      Eye:
      Reduce intraocular pressure

      Respiratory system:
      Cause bronchoconstriction

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      20.5
      Seconds

  • Question 7 - Regarding paracetamol, which of the following statements is CORRECT: ...

    Correct

    • Regarding paracetamol, which of the following statements is CORRECT:

      Your Answer: It has anti-pyretic action.

      Explanation:

      Paracetamol is a non-opioid analgesic, similar in efficacy to aspirin, with antipyretic properties but no anti-inflammatory properties. It is well absorbed orally and does not cause gastric irritation. Paracetamol is a suitable first-line choice for most people with mild-to-moderate pain, and for combination therapy.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      9.2
      Seconds

  • Question 8 - Compliance is greater in all but which one of the following: ...

    Incorrect

    • Compliance is greater in all but which one of the following:

      Your Answer: Elderly

      Correct Answer: Pulmonary oedema

      Explanation:

      Compliance changes at different lung volumes. Initially at lower lung volumes the compliance of the lung is poor and greater pressure change is required to cause a change in volume. This occurs if the lungs become collapsed for a period of time. At functional residual capacity (FRC) compliance is optimal since the elastic recoil of the lung tending towards collapse is balanced by the tendency of the chest wall to spring outwards. At higher lung volumes the compliance of the lung again becomes less as the lung becomes stiffer. At all volumes, the base of the lung has a greater compliance than the apex. Patients with emphysema have increased compliance. Compliance is affected by a person’s age, sex and height.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      24
      Seconds

  • Question 9 - You're called to a cardiac arrest in your Emergency Department resuscitation area. The...

    Correct

    • You're called to a cardiac arrest in your Emergency Department resuscitation area. The rhythm strip is shown in the diagram below. Defibrillation has already been attempted three times on the patient. You intended to administer amiodarone, but your department has informed you that it is not available. In these circumstances, if amiodarone is not available, which of the following drugs is recommended by the ALS guidelines? Ventricular fibrillation

      Your Answer: Lidocaine

      Explanation:

      If amiodarone is unavailable in VF/pVT arrests, lidocaine at a dose of 1 mg/kg can be used instead, according to the latest ALS guidelines. If amiodarone has already been given, no lidocaine should be given.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      21.9
      Seconds

  • Question 10 - Regarding the management of gout, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding the management of gout, which of the following statements is CORRECT:

      Your Answer: Ibuprofen is the NSAID of choice in treating acute gout.

      Correct Answer: Allopurinol may cause an acute attack of gout when first started.

      Explanation:

      Allopurinol is a treatment for the prevention of gout. The initiation of treatment may precipitate an acute attack, and should be covered with an NSAID or colchicine, continued for at least one month after the hyperuricaemia has been corrected. Colchicine is not indicated for long term prevention of gout. NSAIDs are first line for acute gout; colchicine is an alternative in whom NSAIDs are contraindicated, not tolerated or ineffective (including in people taking anticoagulants). Ibuprofen is not recommended for acute gout, given it has only weak anti-inflammatory properties; naproxen, diclofenac or indometacin are indicated instead.

    • This question is part of the following fields:

      • Musculoskeletal
      • Pharmacology
      20.2
      Seconds

  • Question 11 - Regarding macrolide antibiotics, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding macrolide antibiotics, which of the following statements is CORRECT:

      Your Answer: There are mainly active against Gram-negative organisms.

      Correct 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
      88.2
      Seconds

  • Question 12 - Co-amoxiclav is used first line for which of the following indications: ...

    Correct

    • Co-amoxiclav is used first line for which of the following indications:

      Your Answer: Animal bite

      Explanation:

      Co-amoxiclav is used first line for infected and prophylaxis of infection in animal and human bites.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      9.7
      Seconds

  • Question 13 - You are attending to a patient that has presented with a severe headache...

    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
      42.7
      Seconds

  • Question 14 - Hartmann's solution contains how much sodium: ...

    Incorrect

    • Hartmann's solution contains how much sodium:

      Your Answer: 126 mmol/L

      Correct Answer: 131 mmol/L

      Explanation:

      Hartmann’s solution (compound sodium lactate) contains: Na+131 mmol/L, K+5 mmol/L, HCO3-29 mmol/L (as lactate), Cl-111 mmol/L, Ca2+2 mmol/L. It can be used instead of isotonic sodium chloride solution during or after surgery, or in the initial management of the injured or wounded; it may reduce the risk of hyperchloraemic acidosis.

    • This question is part of the following fields:

      • Fluids And Electrolytes
      • Pharmacology
      4.9
      Seconds

  • Question 15 - A 7-year-old presented to a GP with a history of headache, neck stiffness...

    Incorrect

    • A 7-year-old presented to a GP with a history of headache, neck stiffness and photophobia. On examination, HR is 122, BP is 87/42, RR is 28, SaO 2 is 95%, temperature is 39.4 o C. There is a recent non-blanching rash on legs and arms. The GP administered a dose of antibiotics before transferring child to the Emergency Department.

      Which of these is the most appropriate antibiotic to administer in this scenario from the choices available?

      Your Answer: Give oral penicillin V 500 mg

      Correct Answer: Give IM benzylpenicillin 600 mg

      Explanation:

      Meningococcal septicaemia should be suspected in a child with a non-blanching rash especially in the presence of:
      An ill-looking child
      Neck stiffness
      Lesions larger than 2 mm in diameter (purpura)
      Capillary refill time of>3 seconds

      The index child is very sick and shows signs of septic shock. In the prehospital setting, a single dose of benzylpenicillin should be given immediately. The correct dose for this childs age is IM benzylpenicillin 600 mg.

      The recommended doses of benzylpenicillin according to age are:
      Infants <1 year of age: IM or IV benzylpenicillin 300 mg
      Children 1 to 9 years of age: IM or IV benzylpenicillin 600mg
      Children and adults 10 years or older: IM or IV benzylpenicillin 1.2g

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      31.6
      Seconds

  • Question 16 - What is the main mechanism of action of dopamine as an inotropic sympathomimetic: ...

    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.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      21.1
      Seconds

  • Question 17 - Regarding antihistamines, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding antihistamines, which of the following statements is CORRECT:

      Your Answer: Antihistamines act on H2 receptors.

      Correct 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.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      17.2
      Seconds

  • Question 18 - Following a phone call from the microbiology consultant, you evaluate a patient who...

    Correct

    • Following a phone call from the microbiology consultant, you evaluate a patient who has been diagnosed with urinary sepsis. Following the results of the blood cultures, he recommends that you add gentamicin to the patient's antibiotic treatment.

      Gentamicin produces its pharmacological effect by binding to which of the following?

      Your Answer: The 30S subunit of the bacterial ribosome

      Explanation:

      Antibiotics with aminoglycosides, such as gentamicin, bind to the 30S subunit of the bacterial ribosome and prevent aminoacyl-tRNA from binding, preventing protein synthesis.

      They also cause mRNA misreading, resulting in the production of non-functional proteins. This last mechanism is unique to aminoglycosides, and it may explain why they are bactericidal rather than bacteriostatic, as other protein synthesis inhibitors are.

      Patients with myasthenia gravis should avoid aminoglycosides since they can disrupt neuromuscular transmission. They cross the placenta and are linked to poisoning of the 8th cranial nerve in the foetus, as well as permanent bilateral deafness.

      It is possible that they will cause deafness, although this is not a contraindication. In individuals with renal impairment, serum aminoglycoside concentrations should be closely monitored, but this is still not considered a contraindication.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      18.1
      Seconds

  • Question 19 - A 55-year-old woman with mild dyspepsia seeks advice from her pharmacist on how...

    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.

    • This question is part of the following fields:

      • Gastrointestinal Pharmacology
      • Pharmacology
      24.6
      Seconds

  • Question 20 - You examine a 48-year-old woman's blood results and notice that her glucose level...

    Incorrect

    • You examine a 48-year-old woman's blood results and notice that her glucose level is elevated. When you tell her about it, she tells you that her doctor recently ran some tests and discovered that she has impaired glucose tolerance.

      Which of the following medications has not been linked to a reduction in glucose tolerance?

      Your Answer: Prednisolone

      Correct Answer: Amlodipine

      Explanation:

      The following drugs have been linked to impaired glucose tolerance:
      Thiazide diuretics, e.g. Bendroflumethiazide
      Loop diuretics, e.g. furosemide
      Steroids, e.g. prednisolone
      Beta-blockers, e.g. atenolol

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      24.5
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Anaesthesia (0/1) 0%
Pharmacology (9/19) 47%
Infections (2/5) 40%
Cardiovascular Pharmacology (3/4) 75%
Central Nervous System (2/2) 100%
Cardiovascular (1/3) 33%
Physiology (0/1) 0%
Respiratory (0/2) 0%
Musculoskeletal (0/1) 0%
Fluids And Electrolytes (0/1) 0%
Gastrointestinal Pharmacology (1/1) 100%
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