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Question 1
Correct
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Flumazenil is a reversal agent for which of the following groups of drugs:
Your Answer: Benzodiazepines
Explanation:Flumazenil is a benzodiazepine antagonist used for the reversal of the sedative effects of benzodiazepines after anaesthesia, sedation and similar procedures.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 2
Incorrect
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Which of the following is NOT a common side effect of diazepam:
Your Answer: Muscle weakness
Correct Answer: Bradycardia
Explanation:Adverse effects include:
Drowsiness and lightheadedness
Confusion and ataxia (especially in the elderly), amnesia, muscle weakness
Headache, vertigo, tremor, dysarthria, hypotension, decreased libido, erectile dysfunction, gynaecomastia, urinary retention
Paradoxical effects such as talkativeness, excitement, irritability, aggression, anti-social behaviour, and suicidal ideation
Withdrawal symptoms, for example anxiety, depression, anorexia, impaired concentration, insomnia, abdominal cramps, palpitations, tremor, tinnitus and perceptual disturbances
Tolerance and dependence (people who use benzodiazepines longer term can develop tolerance and eventual dependence) -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 3
Correct
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Which of the following is NOT a common effect of etomidate:
Your Answer: Significant hypotension
Explanation:Etomidate causes less hypotension than thiopental sodium and propofol during induction. However, it is associated with a high incidence of extraneous muscle movements, which can be minimised by an opioid analgesic or a short-acting benzodiazepine given prior to induction. Pain on injection is common and there is a high rate of thrombophlebitis in the postoperative period. Postoperative nausea and vomiting commonly occur. Etomidate suppresses adrenocortical function, particularly during continuous administration, and it should not be used for maintenance of anaesthesia. It should be used with caution in patients with underlying adrenal insufficiency, for example, those with sepsis.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 4
Incorrect
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You are reviewing a patient in the Emergency Department brought in by the ambulance team from a burning building. After examination, you decide to intubate the patient due to laryngeal oedema. The induction agent you are planning to use is propofol.
Which one of the following statements about this medicine is TRUE?Your Answer: It is thought to work by inhibiting GABA and glycine
Correct Answer: It decreases cardiac output by approximately 20%
Explanation:Propofol is a short-acting anaesthetic that is thought to work by potentiating GABA and glycine. It induces anterograde amnesia and anaesthetic effects and is used to induce anaesthesia, outpatient surgeries and preoperative sedation. The dose for induction of anaesthesia is 1.5-2.5mg/kg. The dose for maintenance of anaesthesia is 4-12 mg/kg/hour. Following intravenous injection, propofol acts within 30 seconds and its duration of action is 5-10 minutes.
Propofol produces a 15-25% decrease in blood pressure and systemic vascular resistance without a compensatory increase in heart rate. It is negatively inotropic and decreases cardiac output by approximately 20%.
The main side effects of propofol are:
Pain on injection (in up to 30%)
Hypotension
Transient apnoea
Hyperventilation
Coughing and hiccough
Headache
Thrombosis and phlebitis -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 5
Incorrect
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Approximately how long is the duration of a lidocaine block (when given with adrenaline):
Your Answer: 30 minutes
Correct Answer: 90 minutes
Explanation:Lidocaine is a tertiary amine that is primarily used as a local anaesthetic but can also be used intravenously in the treatment of ventricular dysrhythmias.
Lidocaine works as a local anaesthetic by diffusing in its uncharged base form through neural sheaths and the axonal membrane to the internal surface of the cell membrane sodium channels. Here it alters signal conduction by blocking the fast voltage-gated sodium channels. With sufficient blockage, the membrane of the postsynaptic neuron will not depolarise and will be unable to transmit an action potential, thereby preventing the transmission of pain signals.
Each 1 ml of plain 1% lidocaine solution contains 10 mg of lidocaine hydrochloride. The maximum safe dose of plain lidocaine is 3 mg/kg. When administered with adrenaline 1:200,000, the maximum safe dose is 7 mg/kg. Because of the risk of vasoconstriction and tissue necrosis, lidocaine should not be used in combination with adrenaline in extremities such as fingers, toes, and the nose.
The half-life of lidocaine is 1.5-2 hours. Its onset of action is rapid within a few minutes, and it has a duration of action of 30-60 minutes when used alone. Its duration of action is prolonged by co-administration with adrenaline (about 90 minutes).
Lidocaine tends to cause vasodilatation when used locally. This is believed to be due mainly to the inhibition of action potentials via sodium channel blocking in vasoconstrictor sympathetic nerves. -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 6
Incorrect
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Regarding nitrous oxide, which of the following statements is CORRECT:
Your Answer: Prolonged or repeated exposure may result in a microcytic anaemia.
Correct Answer: Nitrous oxide may be used for maintenance of anaesthesia where its use allows reduced dosage of other agents.
Explanation:For anaesthesia, nitrous oxide is commonly used in a concentration of around 50 – 66% in oxygen in association with other inhalation or intravenous agents. Nitrous oxide cannot be used as the sole anaesthetic agent due to lack of potency, but is useful as part of a combination of drugs since it allows reduction in dosage of other agents. Exposure to nitrous oxide for prolonged periods, either by continuous or by intermittent administration, may result in megaloblastic anaemia as a result of interference with the action of vitamin B12. Nitrous oxide increases cerebral blood flow and should be avoided in patients with, or at risk of, raised intracranial pressure. Nitrous oxide may be administered by any trained personnel experienced in its use.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 7
Incorrect
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For which of the following class of drugs can neostigmine be used as a reversal agent?
Your Answer: Depolarising muscle relaxants
Correct Answer: Non-depolarising muscle relaxants
Explanation:Neostigmine is used specifically for reversal of nondepolarizing (competitive) blockade and is anticholinesterase. It acts within one minute of intravenous injection, and the effects last for 20 to 30 minutes. After this time period, a second dose may then be necessary.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 8
Correct
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Thiopental sodium is contraindicated in which of the following:
Your Answer: Acute intermittent porphyrias
Explanation:Barbiturates induce hepatic enzymes. The enzyme gamma aminolevulinic acid synthetase, which produces porphyrins, can be induced and in susceptible patients an attack of acute intermittent porphyria can occur. Thiopental is absolutely contraindicated in these patients.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 9
Correct
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You intend to suture a hand wound with plain 1 percent lidocaine.
In 1 mL of plain 1 percent lidocaine solution, how much lidocaine hydrochloride is there?Your Answer: 10 mg lidocaine hydrochloride
Explanation:10 mg of lidocaine hydrochloride is contained in each 1 mL of plain 1 percent lidocaine solution.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 10
Correct
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In the United Kingdom, which of the following is the most often used intravenous aesthetic:
Your Answer: Propofol
Explanation:In the United Kingdom, propofol is the most widely used intravenous anaesthetic. In adults and children, it can be used to induce or maintain anaesthesia, although it is not commonly used in newborns. It can also be used to sedate individuals in intensive care and for sedation during operations.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 11
Correct
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Which of the following is a contraindication to using nitrous oxide:
Your Answer: Raised intracranial pressure
Explanation:Nitrous oxide should not be utilized in patients with an air-containing confined area because it diffuses into these spaces, causing a rise in pressure. This includes circumstances like pneumothorax, intracranial air after a head injury, imprisoned air from a recent undersea dive, a recent intraocular gas injection, or intestinal blockage. Nitrous oxide increases cerebral blood flow and should be avoided in individuals who have or are at risk of having high intracranial pressure.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 12
Correct
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Nitrous oxide is associated with which of the following adverse effects:
Your Answer: Megaloblastic anaemia
Explanation:Exposure to nitrous oxide for prolonged periods, either by continuous or by intermittent administration, may result in megaloblastic anaemia as a result of interference with the action of vitamin B12; neurological toxic effects can occur without preceding overt haematological changes. Depression of white cell formation may also occur.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 13
Correct
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Your consultant decides to use ketamine for a patient requiring procedural sedation in the Emergency Department. At what receptor does ketamine primarily act:
Your Answer: NMDA receptor
Explanation:In contrast to most other anaesthetic agents, ketamine is a NMDA (N-methyl-D-aspartate) receptor antagonist. It is a non-competitive antagonist of the calcium-ion channel in the NMDA receptor. It further inhibits the NMDA-receptor by binding to its phencyclidine binding site. Ketamine also acts at other receptors as an opioid receptor agonist (analgesic effects), as an muscarinic anticholinergic receptor antagonist (antimuscarinic effects) and by blocking fast sodium channels (local anaesthetic effect).
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 14
Correct
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Which of the following is NOT an effect of benzodiazepines:
Your Answer: Analgesic effect
Explanation:Benzodiazepines are gamma-aminobutyric acid (GABA) receptor agonists which enhance inhibitory synaptic transmission throughout the central nervous system, with sedative, hypnotic, anxiolytic, anticonvulsant, amnesic and muscle relaxant properties.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 15
Incorrect
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Which of the following statements about propofol is TRUE:
Your Answer: If accidentally injected outside a vein it can cause tissue necrosis.
Correct Answer: Propofol has some antiemetic action.
Explanation:Propofol has some antiemetic properties. It’s for this reason that it’s used to treat postoperative nausea and vomiting. Propofol is mostly processed in the liver, with the kidneys excreting just around 1% of it unaltered. Propofol, unlike thiopental, does not produce tissue necrosis when it is extravasated. Propofol lowers intracranial pressure via lowering brain metabolic rate and cerebral blood flow. Propofol is thought to be safe for people with bronchial asthma and chronic obstructive pulmonary disease.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 16
Correct
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Which of the following side effects has limited the use of etomidate as an intravenous induction agent:
Your Answer: Adrenocortical suppression
Explanation:Etomidate causes the least cardiovascular depression of the intravenous induction agents, with only a small reduction in the cardiac output and blood pressure. In the past, etomidate was widely used to induce anaesthesia in the shocked, elderly or cardiovascularly unstable patient. However, more recently it has become less popular as a single induction dose blocks the normal stress-induced increase in adrenal cortisol production for 4 – 8 hours, and up to 24 hours in elderly and debilitated patients. Although no increase in mortality has been identified following a single dose during induction of anaesthesia, the use of etomidate has declined due to a perceived potential morbidity.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 17
Correct
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Regarding local anaesthetics, which of the following statements is INCORRECT:
Your Answer: Adrenaline should be used in digital nerve blocks to create a bloodless field.
Explanation:It is not advisable to give adrenaline/epinephrine with a local anaesthetic injection in digits or appendages because of the risk of ischaemic necrosis.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 18
Correct
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In relation to ketamine, which of the following statements is TRUE:
Your Answer: It is usually associated with tachycardia, increased blood pressure and increased cardiac output.
Explanation:Ketamine has hypnotic, analgesic and local anaesthetic properties. Major adverse effects include Hypertension, Increased cardiac output, Increased ICP, Tachycardia, Tonic-clonic movements, Visual hallucinations and Vivid dreams.
Ketamine is mostly utilized in paediatric anaesthesia, especially when repeated dosing is necessary (such as for serial burns dressings). Ketamine has little effect on respiratory drive, and protective airway reflexes are unaffected. Ketamine is also a bronchial smooth muscle relaxant, hence it plays a unique function in the treatment of severe asthma. -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 19
Correct
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A 34-year-old male is brought into the Emergency Department by the paramedics after a road traffic accident. After a quick triage, you establish that he will need to be intubated, and you ask for some ketamine to be prepared.
Which one of the following options regarding this drug is true?Your Answer: It is the only anaesthetic agent available that has analgesic, hypnotic, and amnesic properties
Explanation:Ketamine is a dissociative anaesthetic with analgesic, amnesic, and hypnotic effects. It is the only anaesthetic agent which causes all three of these effects.
Ketamine exerts its action by non-competitive antagonism at the NMDA (N-methyl-D-aspartate) receptor. Due to its analgesic property, Ketamine is given so that patients do not retain memories of short term procedures. Ketamine is used for the induction and maintenance of anaesthesia in general surgery and for treating burn wounds, battlefield injuries, and children who cannot tolerate other anaesthetic or analgesic agents.
It can be given by both intravenous and intramuscular routes. Ketamine causes cardiac stimulation by increasing the sympathetic tone. The major side effect is increased intracranial pressure as an increase in the sympathetic tone causes vasoconstriction and an increase in the MAP.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 20
Correct
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Lidocaine's mechanism of action as a local aesthetic is as follows:
Your Answer: Blocks influx of Na+ through voltage-gated Na+ channels
Explanation:Local anaesthetics prevent generation/conduction of nerve impulses by reducing sodium permeability and increasing action potential threshold; inhibits depolarization, which results in blockade of conduction
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
