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  • Question 1 - You're examining a 58-year-old male who has cellulitis in his left leg. Because...

    Incorrect

    • 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 is renally excreted

      Correct 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
      20.1
      Seconds
  • Question 2 - Which of the following is NOT a typical feature of lithium toxicity: ...

    Correct

    • Which of the following is NOT a typical feature of lithium toxicity:

      Your Answer: Miosis

      Explanation:

      Features of toxicity include:
      Increasing gastrointestinal disturbances (vomiting, diarrhoea, anorexia)
      Visual disturbances
      Polyuria and incontinence
      Muscle weakness and tremor
      Tinnitus
      CNS disturbances (dizziness, confusion and drowsiness increasing to lack of coordination, restlessness, stupor)
      Abnormal reflexes and myoclonus
      Hypernatraemia
      With severe overdosage (serum-lithium concentration > 2 mmol/L) seizures, cardiac arrhythmias (including sinoatrial block, bradycardia and first-degree heart block), blood pressure changes, electrolyte imbalance, circulatory failure, renal failure, coma and sudden death may occur.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      7.2
      Seconds
  • Question 3 - Dexamethasone would be most useful for which of the following conditions: ...

    Correct

    • Dexamethasone would be most useful for which of the following conditions:

      Your Answer: Raised intracranial pressure secondary to malignancy

      Explanation:

      Dexamethasone has a very high glucocorticoid activity in conjunction with insignificant mineralocorticoid activity. This makes it particularly suitable for high-dose therapy in conditions where fluid retention would be a disadvantage such as in the management of raised intracranial pressure or cerebral oedema secondary to malignancy. Dexamethasone also has a long duration of action and this, coupled with its lack of mineralocorticoid action makes it particularly suitable for suppression of corticotropin secretion in congenital adrenal hyperplasia. In most individuals a single dose of dexamethasone at night, is sufficient to inhibit corticotropin secretion for 24 hours. This is the basis of the ‘overnight dexamethasone suppression test’ for diagnosing Cushing’s syndrome.

    • This question is part of the following fields:

      • Endocrine
      • Pharmacology
      14.7
      Seconds
  • Question 4 - A 60-year-old female has a past medical history of diverticular disease. She now...

    Correct

    • A 60-year-old female has a past medical history of diverticular disease. She 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, after administering this treatment, the patient develops a side-effect to the medication.

      What side-effect of using hyoscine butyl bromide is she MOST likely to develop out of the following?

      Your Answer: Dry mouth

      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 side-effects:
      1. Constipation
      2. Dizziness
      3. Drowsiness
      4. Dry mouth
      5. Dyspepsia
      6. Flushing
      7. Headache
      8. Nausea and vomiting
      9. Palpitations
      10. Skin reactions
      11. Tachycardia
      12. Urinary disorders
      13. Disorders of vision

    • This question is part of the following fields:

      • Gastrointestinal Pharmacology
      • Pharmacology
      23.8
      Seconds
  • Question 5 - A 5-year-old girl presents in a paediatric clinic with symptoms of viral gastroenteritis....

    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: To prevent dehydration, a child with diarrhoea should drink 200 ml of ORT after each loose stool

      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 salts

      Current 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
      76
      Seconds
  • Question 6 - Regarding dynamic compression of the airways, which of the following statements is CORRECT:...

    Incorrect

    • Regarding dynamic compression of the airways, which of the following statements is CORRECT:

      Your Answer: It is brought about by reflex activation of sympathetic nerves.

      Correct 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.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      25.3
      Seconds
  • Question 7 - Which of the following best describes the mechanism of action of aspirin: ...

    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.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      15
      Seconds
  • Question 8 - The triage nurse asks if you will prescribe a dose of codeine phosphate...

    Correct

    • 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.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      25.4
      Seconds
  • Question 9 - An 85-year-old woman is brought in from her nursing home. She arrives in...

    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: Distal 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 Acid

      Loop 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
      23.9
      Seconds
  • Question 10 - Severe vomiting and diarrhoea were reported by a 25-year-old man. He's dehydrated and...

    Incorrect

    • Severe vomiting and diarrhoea were reported by a 25-year-old man. He's dehydrated and needs intravenous fluids to rehydrate. You give him cyclizine as part of his treatment.

      What is cyclizine's main mechanism of action?

      Your Answer: Dopamine receptor antagonism

      Correct Answer: Antihistamine action

      Explanation:

      Cyclizine is a piperazine derivative that functions as an antihistamine (H1-receptor antagonist). To prevent nausea and vomiting, it is thought to act on the chemoreceptor trigger zone (CTZ) and the labyrinthine apparatus. It has a lower antimuscarinic effect as well.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      30.3
      Seconds
  • Question 11 - Glucagon may be used as an antidote for overdose with which of the...

    Incorrect

    • Glucagon may be used as an antidote for overdose with which of the following:

      Your Answer: Calcium channel blockers

      Correct 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 production

      Glycolysis 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.

    • This question is part of the following fields:

      • Endocrine
      • Pharmacology
      13.3
      Seconds
  • Question 12 - A 22-year-old woman comes in with an asthmatic flare. Salbutamol is her only regular...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
      16.2
      Seconds
  • Question 13 - A young male has presented to the Emergency Department with a sudden onset...

    Correct

    • 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: 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
      16.3
      Seconds
  • Question 14 - You're a member of the cardiac arrest team, and you're helping to resuscitate...

    Correct

    • 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: 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).

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      29.8
      Seconds
  • Question 15 - Regarding fibrinolytics, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding fibrinolytics, which of the following statements is INCORRECT:

      Your Answer: Reteplase is a genetically engineered form of human tPA.

      Correct Answer: Fibrinolytic drugs act as thrombolytics by directly degrading the fibrin mesh and so breaking up thrombi.

      Explanation:

      Fibrinolytic drugs act as thrombolytics by activating plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      32.3
      Seconds
  • Question 16 - Which of the following is caused by an alpha-1 antitrypsin deficiency? ...

    Incorrect

    • Which of the following is caused by an alpha-1 antitrypsin deficiency?

      Your Answer: Cystic fibrosis

      Correct 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.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      5.2
      Seconds
  • Question 17 - Compliance is greater in all but which one of the following: ...

    Correct

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

      Your 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
      44.3
      Seconds
  • Question 18 - A 32-year-old female is diagnosed case of bipolar disorder and is on medication....

    Incorrect

    • A 32-year-old female is diagnosed case of bipolar disorder and is on medication. She presents to her psychiatric team with symptoms of severe depression. She is currently taking Lithium.

      Out of the following, which is TRUE regarding lithium?

      Your Answer: The normal therapeutic range is 2.0-2.5 mmol/l

      Correct Answer: It commonly causes a tremor

      Explanation:

      Lithium is the drug of choice for bipolar disorders but is commonly associated with side effects and toxicity.

      Fine hand tremor is very commonly seen and reported in as many as 50% of patients during the first week of therapy with Lithium. The tremor tends to reduce with time and is only present in around 5% of patients taking the medication two years or longer. Lithium tremors are more common with older age, presumably due to the additive effects of age-related essential tremors.

      Option The normal therapeutic range is 2.0-2.5 mmol/l: Lithium should be carefully monitored as it has a very low therapeutic index. The normal therapeutic range is 0.4-0.8 mmol/l. Levels should be checked one week after starting therapy and one week after every change in dosage. (Option Levels should be checked one month after starting therapy)

      Option It can induce hyperthyroidism: Lithium has a known effect on thyroid function. Lithium decreases the production of T4 and T3 and commonly causes hypothyroidism. More rarely, lithium causes hyperthyroidism due to thyroiditis.

      Option It can induce diabetes mellitus: Lithium can induce nephrogenic diabetes insipidus but not diabetes mellitus.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      23.9
      Seconds
  • Question 19 - Which of the following is NOT a typical feature of benzodiazepine toxicity: ...

    Correct

    • Which of the following is NOT a typical feature of benzodiazepine toxicity:

      Your Answer: Hyperventilation

      Explanation:

      Features of benzodiazepine toxicity include: drowsiness, ataxia, dysarthria, nystagmus, occasionally respiratory depression and coma

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      8.4
      Seconds
  • Question 20 - Which of the following is NOT a common effect of etomidate: ...

    Incorrect

    • Which of the following is NOT a common effect of etomidate:

      Your Answer: Pain on injection

      Correct 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.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      12.7
      Seconds
  • Question 21 - In adult basic life support, chest compressions should be performed at which of...

    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.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      7.6
      Seconds
  • Question 22 - A 67-year-old woman complains of general malaise, nausea, and vomiting. She is perplexed...

    Incorrect

    • A 67-year-old woman complains of general malaise, nausea, and vomiting. She is perplexed and declares that everything 'looks yellow.' Her potassium level is 6.8 mmol/l, according to a blood test.

      Which of the drugs listed below is most likely to be the cause of her symptoms?

      Your Answer: Phenytoin

      Correct Answer: Digoxin

      Explanation:

      Because digoxin has a narrow therapeutic index, it can cause toxicity both during long-term therapy and after an overdose. Even when the serum digoxin concentration is within the therapeutic range, it can happen.

      Acute digoxin toxicity usually manifests itself within 2-4 hours of an overdose, with serum levels peaking around 6 hours after ingestion and life-threatening cardiovascular complications following 8-12 hours.

      Chronic digoxin toxicity is most common in the elderly or those with impaired renal function, and it is often caused by a coexisting illness. The clinical signs and symptoms usually appear gradually over days to weeks.

      The following are characteristics of digoxin toxicity:
      Nausea and vomiting
      Diarrhoea
      Abdominal pain
      Confusion
      Tachyarrhythmias or bradyarrhythmias
      Xanthopsia (yellow-green vision)
      Hyperkalaemia (early sign of significant toxicity)

      Some precipitating factors are as follows:
      Elderly patients
      Renal failure
      Myocardial ischaemia
      Hypokalaemia
      Hypomagnesaemia
      Hypercalcaemia
      Hypernatraemia
      Acidosis
      Hypothyroidism
      Spironolactone
      Amiodarone
      Quinidine
      Verapamil
      Diltiazem

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      25.9
      Seconds
  • Question 23 - Regarding propofol, which of the following statements is INCORRECT: ...

    Correct

    • Regarding propofol, which of the following statements is INCORRECT:

      Your Answer: A lower induction dose of propofol is required in children.

      Explanation:

      Elderly patients have a reduced volume of distribution and slower clearance of the drug. They are therefore more sensitive to the effects of propofol and the drug wears off more slowly. They need less of the drug, which should be injected slowly, monitoring its effect on the patient. The opposite is true in children, who need larger doses of propofol. This is particularly so in children under three years of age. Propofol is not recommended for induction of anaesthesia in children under one month of age or for maintenance of anaesthesia in children under three years old.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      51.8
      Seconds
  • Question 24 - Which of the following side effects is more common of etomidate than other...

    Incorrect

    • Which of the following side effects is more common of etomidate than other intravenous induction agents:

      Your Answer: Tachycardia

      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.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      23.5
      Seconds
  • Question 25 - 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
      55.5
      Seconds
  • Question 26 - A 50-year-old man has recently been on antibiotics for a chest infection. He...

    Incorrect

    • A 50-year-old man has recently been on antibiotics for a chest infection. He suffers from COPD and is currently on Seretide inhalers, salbutamol, and Phyllocontin continus. Since commencing the antibiotics, he has developed nausea, vomiting and abdominal pain.

      Which of the following antibiotics has he MOST LIKELY been on for his chest infection?

      Your Answer: Co-amoxiclav

      Correct Answer: Erythromycin

      Explanation:

      Phyllocontin continues contains aminophylline, a bronchodilator used in the management of asthma and COPD.

      The index patient is exhibiting symptoms of theophylline toxicity. This may have been triggered by the antibiotic he took. Macrolide antibiotics, like erythromycin and quinolone antibiotics, like ciprofloxacin and levofloxacin, increases the plasma concentration of theophyllines and can lead to toxicity.

      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
      16.7
      Seconds
  • Question 27 - Which of the following is NOT a typical side effect of opioid analgesics:...

    Correct

    • Which of the following is NOT a typical side effect of opioid analgesics:

      Your Answer: Diarrhoea

      Explanation:

      All opioids have the potential to cause:
      Gastrointestinal effects – Nausea, vomiting, constipation, difficulty with micturition (urinary retention), biliary spasm
      Central nervous system effects – Sedation, euphoria, respiratory depression, miosis
      Cardiovascular effects – Peripheral vasodilation, postural hypotension
      Dependence and tolerance

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      12.1
      Seconds
  • Question 28 - Which of the following is NOT a notifiable disease: ...

    Correct

    • Which of the following is NOT a notifiable disease:

      Your Answer: Chickenpox

      Explanation:

      Chickenpox is not a notifiable disease.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      8.2
      Seconds
  • Question 29 - Disease specific immunoglobulin is available for all of the following infectious diseases EXCEPT...

    Correct

    • Disease specific immunoglobulin is available for all of the following infectious diseases EXCEPT for:

      Your 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
      7.7
      Seconds
  • Question 30 - Streptococcus viridans has developed subacute bacterial endocarditis in your patient. Which of the...

    Incorrect

    • Streptococcus viridans has developed subacute bacterial endocarditis in your patient. Which of the following locations is most likely to be the organism's origin?

      Your Answer:

      Correct Answer: Oral cavity

      Explanation:

      Streptococci that are alpha-haemolytic, such as Streptococcus viridans, are major components of the flora in the oral cavity.

    • This question is part of the following fields:

      • Infections
      • Microbiology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Infections (2/3) 67%
Pharmacology (14/26) 54%
Central Nervous System (3/3) 100%
Endocrine (1/2) 50%
Gastrointestinal Pharmacology (1/1) 100%
Fluids & Electrolytes (0/1) 0%
Physiology (1/3) 33%
Respiratory (1/3) 33%
CNS Pharmacology (1/3) 33%
Cardiovascular Pharmacology (2/4) 50%
Respiratory Pharmacology (0/2) 0%
Cardiovascular (1/2) 50%
Anaesthesia (2/4) 50%
Immunoglobulins And Vaccines (1/1) 100%
Passmed