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Question 1
Incorrect
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A 62-year-old man complains of chest pain and goes to the emergency room. You diagnose him with an acute coronary syndrome and prescribe enoxaparin as part of his treatment plan.
Enoxaparin inactivates which of the following?Your Answer: Antithrombin III
Correct Answer: Thrombin
Explanation:Enoxaparin is a low molecular weight heparin (LMWH) that works in the same way as heparin by binding to and activating the enzyme inhibitor antithrombin III. Antithrombin III inactivates thrombin by forming a 1:1 complex with it. Factor Xa and a few other clotting proteases are also inhibited by the heparin-antithrombin III complex.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 2
Correct
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A 22-year-old with a history of brittle asthma is brought to the ED by her partner. She is wheezing and very short of breath and her condition is deteriorating rapidly. Following a series of nebulisations, hydrocortisone and IV magnesium sulphate, she is taken to resus and the intensive care team is called to review her. She is severely hypoxic and confused and a decision is made to intubate her.
Which of these drugs is ideal as an induction agent in this patient?Your Answer: Ketamine
Explanation:Only about 2% of asthma attacks requires intubation and most severe cases are managed with non-invasive ventilation techniques.
Though life-saving in the crashing asthmatic, intubation in asthmatic patients is associated with significant morbidity and mortality and is risky. Indications for intubation in asthmatic patients include:
Severe hypoxia
Altered mental state
Respiratory or cardiac arrest
Failure to respond to medicationsKetamine (1-2 mg/kg) is the preferred induction agent. It has bronchodilatory properties and does not cause hypotension.
Propofol poses a risk of hypotension but can also be used.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 3
Correct
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Which of the following is a contraindication for aspirin?
Your Answer: Children under 16 years
Explanation:Aspirin contraindications include: hypersensitivity to NSAIDs; asthma, rhinitis, and nasal polyps; and usage in children or teens.
There is little evidence of allergic cross-reactivity for salicylates. However, due to similarities in chemical structure and/or pharmacologic activities, the possibility of cross-sensitivity cannot be completely ruled out. -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 4
Correct
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The patients listed below have had wounds or injuries and were treated as described in a local walk-in clinic.
Which of the following patients has had adequate tetanus protection?Your Answer: 80-year-old diabetic, a rusty nail went through his shoe and into his foot when walking in the woods, uncertain of vaccination history - receives vaccination and immunoglobulin
Explanation:25-year-old receives immunoglobulin and vaccination after cutting her hand on a drinking glass and not knowing her vaccination history.
Because this is not a tetanus-prone wound, immunoglobulin is not recommended. Because you can’t be sure about her vaccination history, now is the best time to start a tetanus vaccination course to ensure coverage later in life. The first vaccination should be administered at the time of presentation; the patient’s own GP should then review the patient’s vaccination history and schedule the rest of the course as needed.
8-year-old whose hand was cut with a kitchen knife, received her first round of vaccinations as a baby and a booster at the age of four – receives vaccination:
The tetanus vaccinations for this child are up to date, and the next booster should not be given too soon. Immunoglobulin is not required because this is not a tetanus-prone wound.80-year-old diabetic, a rusty nail went through his shoe and into his foot while walking in the woods, and he was uncertain of his vaccination history – he received vaccination and immunoglobulin:
A tetanus vaccination course may not have been completed by an 80-year-old UK resident (the vaccination was introduced in 1961). The vaccination should be given at a walk-in clinic, and the patient’s own GP should be contacted to confirm vaccination history and to schedule the rest of the course as needed. Because this is a tetanus-prone wound (puncture wound and potential soil contact), immunoglobulin would be recommended in a patient with incomplete tetanus vaccinations.A 28-year-old Polish man cuts his leg while working in the garden, the wound is heavily contaminated with soil, and his vaccination history is unknown – he receives vaccination:
In a patient with an unknown vaccination history, this is a tetanus-prone wound. In this case, the best course of action would be to administer both the vaccination and immunoglobulin at the walk-in clinic, then contact the patient’s own GP to check his or her vaccination history and schedule the rest of the course as needed.30-year-old with a large amount of devitalized tissue in the torso from an electrical burn – has had all vaccinations, so no need for vaccination or immunoglobulin:
Because this is a high-risk tetanus wound (with a lot of devitalized tissue), even if the patient has had a full course of vaccinations in the past, immunoglobulin is recommended. There is no need for any additional vaccinations. -
This question is part of the following fields:
- Immunological Products & Vaccines
- Pharmacology
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Question 5
Correct
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ACE inhibitors are indicated for all of the following EXCEPT for:
Your Answer: Angina
Explanation:ACE inhibitors have many uses and are generally well tolerated. They are indicated for:
- Heart failure
- Hypertension
- Diabetic nephropathy
- Secondary prevention of cardiovascular events
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 6
Correct
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A young male has presented to you with respiratory depression and small pupils on examination. You diagnose opioid overdose and immediately start therapy with Naloxone.
Which of the following statements is TRUE regarding naloxone?Your Answer: It can be given by a continuous infusion if repeated doses are required
Explanation:Naloxone is a short-acting, specific antagonist of mu(μ)-opioid receptors. It is used to reverse the effects of opioid toxicity.
It can be given by a continuous infusion if repeated doses are required and the infusion rate is adjusted according to the vital signs. Initially, the infusion rate can be set at 60% of the initial resuscitative IV dose per hour.
Naloxone has a shorter duration of action (6-24 hours) than most opioids and so close monitoring according to the respiratory rate and depth of coma and repeated injections are necessary. When repeated doses are needed in opioid addicts, naloxone administration may precipitate a withdrawal syndrome with abdominal cramps, nausea and diarrhoea, but these usually settle within 2 hours.
An initial dose of 0.4 to 2 mg can be given intravenously and can be repeated at 2 to 3-minute intervals to a maximum of 10mg.
If the intravenous route is inaccessible, naloxone can be administered via an IO line, subcutaneously (SQ), IM, or via the intranasal (IN) route.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 7
Correct
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You're in resus with a 69-year-old woman who is very sick. You decide to contact the intensive care outreach team because she appears to be in septic shock. They decide to start a dobutamine infusion as soon as they arrive.
Which of the following statements about dobutamine is correct?Your Answer: It may be infused via a peripheral line
Explanation:Dobutamine is a synthetic isoprenaline derivative that is used to provide inotropic support to patients with low cardiac output caused by septic shock, myocardial infarction, or other cardiac conditions.
Dobutamine is a sympathomimetic drug that stimulates beta-1 adrenergic receptors in the heart to produce its primary effect. As a result, it has inotropic properties that increase cardiac contractility and output. It also has a small amount of alpha1- and beta-2-adrenergic activity.
It is infused intravenously after being diluted to a volume of at least 50 ml in a suitable crystalloid solution. The dose is titrated to response and ranges from 0.5 to 40 g/kg/min. Extravasation-induced skin necrosis is uncommon, and dobutamine can be administered through a peripheral line.
At doses below 10 g/kg/min, side effects are rare, but at higher doses, they can include:
Nausea and vomiting
Tachycardia
Dysrhythmias
Angina
Hypertension
Headache -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 8
Correct
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Which of the following is NOT an adverse effect associated with warfarin therapy:
Your Answer: Neutropenia
Explanation:Adverse effects of warfarin:
The most common adverse effect of warfarin is bleedingOther common adverse effects of warfarin include nausea, vomiting, diarrhoea, jaundice, hepatic dysfunction, pancreatitis, pyrexia, alopecia, purpura, and rash
Skin necrosis is a rare but serious adverse effect of warfarin; treatment with warfarin should be stopped if warfarin related skin necrosis is suspected
Calciphylaxis is a rare, but a very serious condition that causes vascular calcification and cutaneous necrosis
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 9
Correct
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You plan to use plain 1% lidocaine for a ring block on a finger that needs suturing.
Which SINGLE statement regarding the use of 1% lidocaine, in this case, is true?Your Answer: Lidocaine works by blocking fast voltage-gated sodium channels
Explanation:Lidocaine is a tertiary amine that is primarily used as a local anaesthetic but can also be used intravenously in the treatment of ventricular dysrhythmias.
Lidocaine works as a local anaesthetic by diffusing in its uncharged base form through neural sheaths and the axonal membrane to the internal surface of the cell membrane sodium channels. Here it alters signal conduction by blocking the fast voltage-gated sodium channels. With sufficient blockage, the membrane of the postsynaptic neuron will not depolarise and will be unable to transmit an action potential, thereby preventing the transmission of pain signals.
Each 1 ml of plain 1% lidocaine solution contains 10 mg of lidocaine hydrochloride. The maximum safe dose of plain lidocaine is 3 mg/kg. When administered with adrenaline 1:200,000, the maximum safe dose is 7 mg/kg. Because of the risk of vasoconstriction and tissue necrosis, lidocaine should not be used in combination with adrenaline in extremities such as fingers, toes, and the nose.
The half-life of lidocaine is 1.5-2 hours. Its onset of action is rapid within a few minutes, and it has a duration of action of 30-60 minutes when used alone. Its duration of action is prolonged by co-administration with adrenaline (about 90 minutes).
Lidocaine tends to cause vasodilatation when used locally. This is believed to be due mainly to the inhibition of action potentials via sodium channel blocking in vasoconstrictor sympathetic nerves. -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 10
Correct
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Which of the following local anaesthetics has the longest duration of action:
Your Answer: Bupivacaine
Explanation:Bupivacaine has a longer duration of action than the other local anaesthetics, up to 8 hours when used for nerve blocks. It has a slow onset, taking up to 30 minutes for full effect. It is often used in lumbar epidural blockade and is particularly suitable for continuous epidural analgesia in labour, or for postoperative pain relief. It is the principal drug used for spinal anaesthesia.
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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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An 82 year old man taking warfarin as a maintenance medication comes in to your clinic because of an infection. Which antibiotic is the safest choice for this patient?
Your Answer: Cefalexin
Explanation:Alterations in the international normalized ratio (INR) brought about by the concurrent use of antibiotics and warfarin may result in either excessive clotting or excessive bleeding if they are deemed to have a high risk for interaction. As such, there should be careful consideration of the class of antibiotic to be used.
Antibiotics from the following drug classes should generally be avoided as they have a high risk for interaction with warfarin, possible enhancing the anticoagulant effects of warfarin resulting in bleeding: Fluoroquinolones (e.g. ciprofloxacin, levofloxacin), Macrolides (e.g. clarithromycin, erythromycin, azithromycin), Nitroimidazoles (e.g. metronidazole), Sulphonamides (e.g. co-trimoxazole, a combination of trimethoprim and sulfamethoxazole), Trimethoprim, Tetracyclines (e.g. doxycycline).
Low risk antibiotics that have low risk for interaction with warfarin includes cephalexin, from the cephalosporin class, and clindamycin which is a lincomycin.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 12
Correct
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A 23-year-old student presents to the emergency department with a terrible headache, photophobia, and a fever. On her lower limbs, you see a non-blanching purpuric rash. In the department, a lumbar puncture is conducted. What do you think you'll notice on Gram stain:
Your Answer: Gram negative diplococci
Explanation:Bacterial meningitis and septicaemia are most commonly caused by meningococcal bacteria. The Gram-negative diplococci Neisseria Meningitidis causes meningitis. Gram stain and culture of CSF identify the etiologic organism, N meningitidis. In bacterial meningitis, Gram stain is positive in 70-90% of untreated cases, and culture results are positive in as many as 80% of cases.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 13
Correct
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Following the administration of a medication for a heart condition, a 69-year-old man develops hypothyroidism.
Which of the following drugs is most likely to be the cause?Your Answer: Amiodarone
Explanation:Amiodarone has a chemical structure that is similar to that of thyroxine and can bind to the nuclear thyroid receptor. It can cause both hypothyroidism and hyperthyroidism, though hypothyroidism is far more common, with 5-10% of patients suffering from it.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 14
Correct
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The patients listed below have been diagnosed with a variety of ailments.
In which of the following situations would aspirin be an effective treatment option?Your Answer: A 36-year-old with an acute migraine (dose of 900-1000 mg)
Explanation:A study published in the Cochrane Database of Systematic Reviews in 2010 found that a single 1000-mg dose of aspirin is effective in treating acute migraine. It was discovered that 24 percent of aspirin users were pain-free after two hours, compared to 11 percent of placebo users. Because the BNF recommends a maximum dose of 900 mg for analgesia and most non-proprietary aspirin comes in a dose of 300 mg, a dose of 900 mg is frequently prescribed in the UK.
Because aspirin is not recommended for children under the age of 16 due to the risk of Reye’s syndrome, it would be inappropriate to give it to the 12-year-old with the viral URTI.
For uncomplicated dental pain, aspirin is an acceptable option, but not for patients who are taking warfarin. The combination of aspirin’s antiplatelet action and warfarin’s anticoagulation properties puts the patient at high risk of bleeding. Furthermore, aspirin can deplete the therapeutic levels of warfarin by displacing it from plasma proteins. It would be better to use another NSAID or analgesic.
In gout, aspirin should be avoided because it reduces urate clearance in the urine and interferes with the action of uricosuric agents. Naproxen, diclofenac, and indomethacin are better options.
Although aspirin is useful for inflammatory pains, the dose of aspirin required for an adequate analgesic effect in severe pain is associated with significant side effects. Naproxen would be a better first-line treatment option.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 15
Correct
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A 59-year-old man presents to the emergency room with chest pain. He was recently released from the hospital after receiving abciximab during coronary angioplasty.
Which of the following is abciximab (ReoPro) mechanism of action?Your Answer: Antagonism of the glycoprotein IIb/IIIa receptor
Explanation:Abciximab (ReoPro) is a glycoprotein IIb/IIIa receptor antagonist that is a chimeric monoclonal antibody. It is primarily used during and after coronary artery procedures such as angioplasty to inhibit platelet aggregation.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 16
Correct
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An ambulance transports a 37-year-old woman who is having a seizure. She is moved to resuscitation and given a benzodiazepine dose, which quickly ends the seizure. You later learn that she has epilepsy and is usually treated with carbamazepine to control her seizures.
What is carbamazepine's main mechanism of action?Your Answer: Sodium channel blocker
Explanation:Carbamazepine is primarily used to treat epilepsy, and it is effective for both focal and generalised seizures. It is not, however, effective in the treatment of absence or myoclonic seizures. It’s also commonly used to treat neuropathic pain, as well as a second-line treatment for bipolar disorder and as a supplement for acute alcohol withdrawal.
Carbamazepine works as a sodium channel blocker that preferentially binds to voltage-gated sodium channels in their inactive state. This prevents an action potential from firing repeatedly and continuously.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 17
Incorrect
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Regarding inflammatory bowel disease, acute mild to moderate disease of the rectum or rectosigmoid should be treated initially with:
Your Answer: Oral aminosalicylate
Correct Answer: Local aminosalicylate
Explanation:Acute mild to moderate disease affecting the rectum (proctitis) or the rectosigmoid is treated initially with local application of an aminosalicylate; alternatively, a local corticosteroid can be used but it is less effective. A combination of a local aminosalicylate and a local corticosteroid can be used for proctitis that does not respond to a local aminosalicylate alone.
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 18
Correct
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A 58-year-old male has cellulitis of his left leg. Because he is allergic to penicillin, you start him on erythromycin.
What is erythromycin's mechanism of action?Your Answer: Inhibition of protein synthesis
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.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 19
Incorrect
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Which of the following has the most potent glucocorticoid effect:
Your Answer: Fludrocortisone
Correct Answer: Dexamethasone
Explanation:Dexamethasone and betamethasone have the most potent glucocorticoid (anti-inflammatory) effect.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 20
Incorrect
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You've been summoned to a young man in the resus area who is experiencing an SVT. You decide to use adenosine after trying several vagal manoeuvres without success.
Which of the following is the correct adenosine mechanism of action?Your Answer: Inhibits the Na/K ATPase in cardiac myocytes
Correct Answer: Opens K + channels in the heart
Explanation:The purine nucleoside adenosine is used to diagnose and treat paroxysmal supraventricular tachycardia. Adenosine works by stimulating A1-adenosine receptors and opening potassium channels that are sensitive to acetylcholine. This causes the atrioventricular (AV) node’s cell membrane to become hyperpolarized, slowing conduction by inhibiting calcium channels.
Patients who have had a heart transplant are extremely sensitive to the effects of adenosine and should start with a lower dose of 3 mg, then 6 mg, and finally 12 mg.Dipyridamole potentiates the effects of adenosine, so it should be used with caution in patients who are taking it.
The use of adenosine is contraindicated in the following situations:
Asthma
COPD (chronic obstructive pulmonary disease)
Decompensated heart failure
Long QT syndrome
AV block in the second or third degree
Sinusitis is a condition in which the sinuses become (unless pacemaker fitted)
Hypotension that is severe -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 21
Incorrect
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Which of the following is first-line for management of status epilepticus:
Your Answer: Intramuscular diazepam
Correct Answer: Intravenous lorazepam
Explanation:First-line treatment is with intravenous lorazepam if available. Intravenous diazepam is effective but it carries a high risk of thrombophlebitis so should only be used if intravenous lorazepam is not immediately available. Absorption of diazepam from intramuscular injection or from suppositories is too slow for treatment of status epilepticus. When facilities for resuscitation are not immediately available or if unable to secure immediate intravenous access, diazepam can be administered as a rectal solution or midazolam oromucosal solution can be given into the buccal cavity.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 22
Incorrect
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Regarding ciprofloxacin, which of the following statements is INCORRECT:
Your Answer: Common side effects include diarrhoea, dizziness, headache, nausea and vomiting.
Correct Answer: Ciprofloxacin decreases plasma concentrations of theophylline.
Explanation:Ciprofloxacin increases plasma concentrations of theophylline. There is an increased risk of convulsions when quinolones are given with NSAIDs or theophylline. There is an increased risk of tendon damage when quinolones are given with corticosteroids. Quinolones are known to increase the QT-interval and should not be taken with concomitantly with other drugs that are known to cause QT-interval prolongation. There is an increased risk of myopathy when erythromycin or clarithromycin are taken with simvastatin or atorvastatin.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 23
Incorrect
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Which of the following best describes the therapeutic effect of calcium gluconate when used in treatment for hyperkalaemia:
Your Answer: Increases intracellular uptake of K+ via Na-K ATP pump
Correct Answer: Reduces cardiac cell membrane excitability
Explanation:Calcium resonium is an ion-exchange resin that exchanges sodium for potassium as it passes through the intestine, leading to excretion of potassium from the body. Salbutamol and insulin act to increase intracellular uptake of K+ via Na-K ATP pump. Sodium bicarbonate acts to correct acidosis and thus promotes intracellular uptake of K+. Calcium gluconate acts to protect the cardiac membrane and has no effect on serum K+ levels.
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This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
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Question 24
Correct
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The following all cause a left shift in the oxygen dissociation curve EXCEPT for:
Your Answer: Decrease in pH
Explanation:An increased affinity of haemoglobin for oxygen, shown by a left shift in the oxygen dissociation curve, is caused in the lungs by a rise in pH, a fall in PCO2,a decrease in temperature and a decrease in 2,3 -DPG. Carbon monoxide (CO) binds 240 times more strongly than O2to haemoglobin and by occupying O2-binding sites, reduces oxygen capacity. CO also increases oxygen affinity, shifting the oxygen haemoglobin curve to the left and making O2release to tissues more difficult.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 25
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 26
Incorrect
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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: Colon
Correct Answer: Oral cavity
Explanation:Streptococci that are alpha-haemolytic, such as Streptococcus viridans, are major components of the flora in the oral cavity.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 27
Correct
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A 25-year-old female arrives at the emergency room with a severe case of asthma. When she doesn't seem to be improving after initial treatment, you decide to start an aminophylline infusion.
From the options below, which is Aminophylline's main mechanism of action?Your Answer: Phosphodiesterase inhibition
Explanation:Theophylline and Ethylenediamine are combined in a 2:1 ratio to form Aminophylline. Its solubility is improved by the addition of Ethylenediamine. It has a lower potency and a shorter duration of action than Theophylline.
It is used to treat the following conditions:
Heart failure
It is used to treat the following conditions:
COPD
BradycardiasAminophylline has the following properties:
Phosphodiesterase inhibitor that increases intracellular cAMP and relaxes smooth muscle in the bronchial airways and pulmonary blood vessels.
Mast cell stabilization is achieved by using a non-selective adenosine receptor antagonist.
It has slight positive inotropic and chronotropic effects, increasing cardiac output and decreasing systemic vascular resistance, lowering arterial blood pressure. It has been used historically in the treatment of refractory heart failure and is indicated by the current ALS guidelines as a substitute treatment for bradycardia.The daily oral dose for adults is 900 mg, divided into 2-3 doses. For severe asthma or COPD, a loading dosage of 5 mg/kg over 10-20 minutes is given, followed by a continuous infusion of 0.5 mg/kg/hour. The therapeutic range is small (10-20 microgram/ml), hence assessments of aminophylline plasma concentrations are useful during long-term treatment.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 28
Correct
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A 34-year-old man arrives at the department befuddled. He has a history of schizophrenia and is on an antipsychotic medication, but he can't recall what it's called.
Which of the following statements about antipsychotic drug side effects is correct?Your Answer: Haloperidol is the most common causative antipsychotic drug
Explanation:Extrapyramidal side effects are most common with piperazine phenothiazines (fluphenazine, prochlorperazine, and trifluoperazine) and butyrophenones (fluphenazine, prochlorperazine, and trifluoperazine) (benperidol and haloperidol). The most common causative antipsychotic drug is haloperidol.
Tardive dyskinesia (rhythmic, involuntary movements of the tongue, face, and jaw) is most commonly associated with long-term or high-dose treatment. It is the most serious form of extrapyramidal symptoms because withdrawal of the causative drug may make it irreversible, and treatment is usually ineffective.
Dystonia (abnormal facial and body movements) is more common in children and young adults, and it usually shows up after only a few doses. Procyclidine 5 mg IV or benzatropine 2 mg IV as a bolus can be used to treat acute dystonia.
An unpleasant feeling of restlessness characterises akathisia. The inability to initiate movement is known as akinesia.
Renal impairment causes increased cerebral sensitivity, so lower doses should be used.
In elderly patients with dementia-related psychosis who are treated with haloperidol, there is an increased risk of death. This appears to be due to a higher risk of heart attacks and infections like pneumonia.
The following are some of the antipsychotic drugs’ contraindications:
Reduced level of consciousness/coma
Depression of the central nervous system
Phaeochromocytoma -
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 29
Incorrect
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Regarding pressures and airflow during the normal breathing cycle, which of the following statements is INCORRECT:
Your Answer: During expiration both intrapleural pressure and alveolar pressure rise.
Correct Answer: Negative intrapleural pressure causes dynamic compression of the airways.
Explanation:Dynamic compression occurs during forced expiration, when as the expiratory muscles contract, 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).
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 30
Incorrect
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An 80-year-old female complains of chest pain characteristic of angina. A dose of glyceryl trinitrate (GTN) is administered that resolves the chest pain rapidly.
Which ONE of the following is released on the initial metabolism of GTN?Your Answer: Cyclic AMP
Correct Answer: Nitrite ions
Explanation:Angina pectoris is the most common symptom of ischemic heart disease and presents with chest pain relieved by rest and nitro-glycerine.
Nitrates are the first-line treatment to relieve chest pain caused by angina. The commonly used nitrates are:
1. Glyceryl trinitrate
2. Isosorbide dinitrateThe nitrate drugs are metabolized in the following steps:
1. Release Nitrite ions (NO2-), which are then converted to nitric oxide (NO) within cells.
2. NO activates guanylyl cyclase, which causes an increase in the intracellular concentration of cyclic guanosine-monophosphate (cGMP) in vascular smooth muscle cells.
3. Relaxation of vascular smooth muscle.Although nitrates are potent coronary vasodilators, their principal benefit in the management of angina results from a predominant mechanism of venous dilation:
– Bigger veins hold more blood
– Takes blood away from the left ventricle
– Lowers LVEDV (preload), LA pressure
– Less pulmonary oedema → improved dyspnoea -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 31
Incorrect
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A 64-year-old man presents with an acute episode of gout. He has a history of chronic heart failure and hypertension. His current medications include ramipril and furosemide.
Which of the following statements regarding the treatment of gout is true? Select ONE answer only.Your Answer: NSAIDs are the treatment of choice for patients with a history of heart failure
Correct Answer: Colchicine has a role in prophylactic treatment
Explanation:In the absence of any contra-indications, high-dose NSAIDs are the first-line treatment for acute gout. Naproxen 750 mg as a stat dose followed by 250 mg TDS is a commonly used and effective regime.
Aspirin should not be used in gout as it reduces the urinary clearance of urate and interferes with the action of uricosuric agents. Naproxen, Diclofenac or Indomethacin are more appropriate choices.
Allopurinol is used prophylactically, preventing future attacks by reducing serum uric acid levels. It should not be started in the acute phase as it increases the severity and duration of symptoms.
Colchicine acts on the neutrophils, binding to tubulin to prevent neutrophil migration into the joint. It is as effective as NSAIDs in relieving acute attacks. It also has a role in prophylactic treatment if Allopurinol is not tolerated.
NSAIDs are contra-indicated in heart failure as they can cause fluid retention and congestive cardiac failure. Colchicine is the preferred treatment in patients with heart failure or those who are intolerant of NSAIDs. -
This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 32
Incorrect
-
A 52-year-old patient requires procedural sedation for DC cardioversion of atrial fibrillation. You plan on using propofol as the sedative agent.
Propofol works as a result of action on what type of receptor? Select ONE answer only.Your Answer: Serotonin
Correct Answer: Gamma-aminobutyric acid (GABA)
Explanation:Propofol (2,6-diisopropylphenol) is a short-acting phenol derivative that is primarily used for the induction of anaesthesia.
Its mechanism of action is unclear but is thought to act by potentiating the inhibitory neurotransmitters GABA and glycine, which enhances spinal inhibition during anaesthesia.
The dose for induction of anaesthesia is 1.5-2.5mg/kg. The dose for maintenance of anaesthesia is 4-12 mg/kg/hour. Following intravenous injection, propofol acts within 30 seconds and its duration of action is 5-10 minutes.
Propofol produces a 15-25% decrease in blood pressure and systemic vascular resistance without a compensatory increase in heart rate. It is negatively inotropic and decreases cardiac output by approximately 20%.
The main side effects of propofol are:
Pain on injection (in up to 30%)
Hypotension
Transient apnoea
Hyperventilation
Coughing and hiccough
Headache
Thrombosis and phlebitis -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 33
Incorrect
-
Which of the following lifestyle changes is not likely to improve symptoms of gastro-oesophageal reflux disease (GORD):
Your Answer: Weight loss
Correct Answer: Lowering the head of the bed
Explanation:The following approaches have some benefit in adult patients with reflux:
Weight loss or weight management for individuals who are overweight
Head of bed elevation is important for individuals with nocturnal or laryngeal symptoms, but its value for other situations is unclear.
The following lifestyle approaches also are used frequently. There is some evidence that these lifestyle changes improve laboratory measures of reflux (such as lower oesophageal sphincter pressure).
Dietary modification – A practical approach is to avoid a core group of reflux-inducing foods, including chocolate, peppermint, and alcohol, which may reduce lower oesophageal sphincter pressure. Acidic beverages, including colas with caffeine and orange juice also may exacerbate symptoms.
Avoiding the supine position soon after eating.
Promotion of salivation by either chewing gum or using oral lozenges. Salivation neutralizes refluxed acid, thereby increasing the rate of oesophageal acid clearance.
Avoidance of tobacco (including passive exposure to tobacco smoke) and alcohol. Nicotine and alcohol reduce lower oesophageal sphincter pressure, and smoking also diminishes salivation. -
This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 34
Incorrect
-
Compliance is greater in all but which one of the following:
Your Answer: The lung volume at functional residual capacity
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.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 35
Incorrect
-
A 28-year-old woman in her second trimester is diagnosed with a psychiatric illness. She is started on treatment with a drug. The treatment results in her baby being born with poor tone, feeding problems, hypothyroidism, and a goitre
Out of the following, which drug is most likely responsible for the baby's condition?Your Answer: Amitriptyline
Correct Answer: Lithium
Explanation:In pregnancy and postpartum, lithium is an effective treatment for relapse prevention in bipolar disorder. However, lithium has also been associated with risks during pregnancy for both the mother and the unborn child. Recent large studies have confirmed the association between first-trimester lithium exposure and an increased risk of congenital malformations.
Lithium levels need to be monitored more frequently throughout pregnancy and the postnatal period.
If given in the 1st-trimester, lithium is associated with a risk of fetal cardiac malformations, such as Ebstein’s anomaly.
If given in the 2nd and 3rd-trimesters, there is a risk of the following:
1. hypotonia
2. lethargy
3. feeding problems
4. hypothyroidism
5. goitre
6. nephrogenic diabetes insipidus in the neonate -
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 36
Correct
-
A 62-year-old woman is brought to the Emergency Department as she is acutely unwell. Her attendants inform you that she was recently started on lithium as a mood stabilizer.
You instantly send a blood sample to check for lithium levels.
What is the usual therapeutic range for lithium?Your Answer: 0.4-0.8 mmol/l
Explanation:Lithium is the drug of choice for recurrent bipolar illness but should be carefully monitored as it has a very low therapeutic index. The normal therapeutic range is 0.4-0.8 mmol/l.
The lower end of the range is usually the target for the elderly and as maintenance therapy. Toxicity is usually seen at levels >1.5 mmol/l. Samples should be taken 12 hours after the dose, and levels should be checked one week after starting therapy and one week after every change in dosage.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 37
Incorrect
-
The primary mechanism of action of ketamine is:
Your Answer: Gamma-aminobutyric acid (GABA)-receptor agonist
Correct Answer: N-methyl-D-aspartate (NMDA)-receptor antagonist
Explanation:Ketamine is a non-competitive antagonist of the calcium-ion channel in the NMDA (N-methyl-D-aspartate) 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).
Overdose may lead to panic attacks and aggressive behaviour; rarely seizures, increased ICP, and cardiac arrest
Very similar in chemical makeup to PCP (phencyclidine), but it is shorter acting and less toxic
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 38
Incorrect
-
Which of the following is NOT an effect of benzodiazepines:
Your Answer: Hypnotic effect
Correct 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 39
Incorrect
-
In a ward round, you come across a patient's treatment chart prescribed an antibiotic to fight his infection. This antibiotic disrupts cell membrane function.
Which of the following antimicrobial drugs is prescribed to this patient?Your Answer: Flucloxacillin
Correct Answer: Nystatin
Explanation:Nystatin binds ergosterol (unique to the fungi cell membrane) and forms membrane pores that allow K+ leakage, acidification, and subsequent death of the fungus.
Vancomycin inhibits cell wall peptidoglycan formation by binding the D-Ala-D-Ala portion of cell wall precursors.
Flucloxacillin inhibits the synthesis of bacterial cell walls. It inhibits cross-linkage between the linear peptidoglycan polymer chains that make up a major component of the cell wall of Gram-positive bacteria.
Trimethoprim inhibits bacterial dihydrofolate reductase.
Isoniazid decreases the synthesis of mycolic acids in mycobacteria.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 40
Incorrect
-
Antispasmodic drugs are primarily indicated in which of the following conditions:
Your Answer: Bowel obstruction
Correct Answer: Irritable bowel syndrome
Explanation:Antispasmodics, such as antimuscarinics, may be used in the management of irritable bowel syndrome. Other antispasmodics used include direct-acting smooth muscle relaxants such as mebeverine, alverine, and peppermint oil. Antispasmodics are contraindicated in bowel obstruction and severe inflammatory bowel disease. Antispasmodics are occasionally of value in treating abdominal cramp associated with diarrhoea but they should not be used for primary treatment. Antispasmodics should be avoided in young children with gastroenteritis because they are rarely effective and have troublesome side effects. Antimuscarinics are contraindicated in urinary retention.
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 41
Incorrect
-
A 58-year-old man with a long history of poorly controlled hypertension complains of a headache and vision blurring today. In triage, his blood pressure is 210/192 mmHg. A CT head scan is scheduled to rule out the possibility of an intracranial haemorrhage. You make the diagnosis of hypertensive encephalopathy and rush the patient to reus to begin blood pressure-lowering treatment. He has a history of brittle asthma, for which he has been admitted to the hospital twice in the last year.
Which of the following is the patient's preferred drug treatment?Your Answer: Glyceryl trinitrate
Correct Answer: Nicardipine
Explanation:End-organ damage (e.g. encephalopathy, intracranial haemorrhage, acute myocardial infarction or ischaemia, dissection, pulmonary oedema, nephropathy, eclampsia, papilledema, and/or angiopathic haemolytic anaemia) characterises a hypertensive emergency (also known as ‘accelerated hypertension’ or malignant hypertension’ It’s a life-threatening condition that necessitates rapid blood pressure reduction to avoid end-organ damage and a negative outcome.
Hypertensive encephalopathy is a syndrome that includes headaches, seizures, visual changes, and other neurologic symptoms in people who have high blood pressure. It is reversible if treated quickly, but it can progress to coma and death if not treated properly.
Any patient with suspected hypertensive encephalopathy should have an urgent CT scan to rule out an intracranial haemorrhage, as rapid blood pressure reduction could be dangerous in these circumstances.
The drug of choice is labetalol, which reduces blood pressure steadily and consistently without compromising cerebral blood flow.
An initial reduction of approximately 25% in mean arterial pressure (MAP) over an hour should be aimed for, followed by a further controlled MAP reduction over the next 24 hours. In patients who are unable to take beta-blockers, nicardipine can be used as a substitute. -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 42
Incorrect
-
All of the following cause bronchoconstriction, EXCEPT for:
Your Answer: Stimulation of irritant receptors
Correct Answer: Adrenaline
Explanation:Factors causing bronchoconstriction:
- Via muscarinic receptors
- Parasympathetic stimulation
- Stimulation of irritant receptors
- Inflammatory mediators e.g. histamine, prostaglandins, leukotrienes
- Beta-blockers
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 43
Incorrect
-
A young pregnant woman is in the late stages of her pregnancy. She is administered a drug that results in her newborn being born with respiratory depression. The baby also suffers from neonatal withdrawal syndrome.
Out of the following, which drug is most likely responsible for the baby's condition?Your Answer: Heparin
Correct Answer: Diazepam
Explanation:Benzodiazepines are used as a first-line treatment in breaking seizures and in status epilepticus as they are rapid-acting.
Use of benzodiazepines in the late third-trimester or exposure during labour is associated with great risks to the foetus/neonate. Babies can exhibit either floppy infant syndrome, or marked neonatal withdrawal symptoms. Symptoms vary from mild sedation, hypotonia, and reluctance to suck, to apnoeic spells, cyanosis, and impaired metabolic responses to cold stress. These symptoms have been reported to persist for periods from hours to months after birth.
They also cross into breast milk and should be used with caution in breastfeeding mothers
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 44
Incorrect
-
Salbutamol should be used with caution in patients with which of the following:
Your Answer: Prostatic hyperplasia
Correct Answer: Susceptibility to QT-interval prolongation
Explanation:Beta-2 agonists should be used with caution in people with:
Cardiovascular disease, including arrhythmias and hypertension (beta-2 agonists may cause an increased risk of arrhythmias and significant changes to blood pressure and heart rate)
Diabetes(risk of hyperglycaemia and ketoacidosis, especially with intravenous use)
Hyperthyroidism(beta-2 agonists may stimulate thyroid activity)
Hypokalaemia(potentially serious hypokalaemia may result from beta-2 agonist therapy; this effect may be potentiated in severe asthma by concomitant treatment with theophylline, corticosteroids, diuretics and by hypoxia)
Susceptibility to QT-interval prolongation
Convulsive disorders -
This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 45
Incorrect
-
An unrelated medical condition brings a 28-year-old asthmatic man to the Emergency Department. When you look over his meds, you notice that he is taking Theophylline to help with his asthma.
Which of the following medicines should you NOT prescribe?Your Answer: Cefalexin
Correct Answer: Ciprofloxacin
Explanation:Ciprofloxacin is a cytochrome P450 enzyme inhibitor that raises theophylline levels in the blood. As a result, co-prescribing theophylline should be avoided.
The medicines that typically impact theophylline’s half-life and plasma concentration are listed in the table below:
Drugs that increase the levels of theophylline in the blood
Drugs that lower theophylline levels in the blood
Calcium channel blockers e.g. Verapamil
Fluconazole
Cimetidine
Quinolones, e.g. ciprofloxacin
Methotrexate
Barbiturates
Carbamazepine
Phenobarbital
Macrolides, e.g. erythromycin
Phenytoin (and fosphenytoin)
Rifampicin
St. John’s wort -
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 46
Incorrect
-
A patient allergic to penicillin and with marked cellulitis presents and you decide to start him on erythromycin.
Which statement about macrolide antibiotics is true?
Your Answer: They act by binding to the 30S subunit of the bacterial ribosome
Correct Answer: They are actively concentrated within leukocytes
Explanation:Macrolide antibiotics are bacteriostatic.
They act by binding to the 50S subunit of the bacterial ribosome inhibit protein synthesis.
Macrolide antibiotics are actively concentrated within leukocytes, because of this, they are transported into the site of infection.
Macrolide antibiotics are not effective in meningitis as they do not penetrate the central nervous system well.
They are mainly against Gram-positive organisms and can be used as an alternative in patients with penicillin allergy.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 47
Incorrect
-
Bendoflumethiazide may cause all of the following electrolyte imbalances EXCEPT for:
Your Answer: Hypokalaemia
Correct Answer: Hypocalcaemia
Explanation:Common side effects of thiazide diuretics include:
Excessive diuresis, postural hypotension, dehydration, renal impairment
Acid-base and electrolyte imbalance
Hypokalaemia, hyponatraemia, hypomagnesaemia, hypercalcaemia, hypochloraemic alkalosis
Metabolic imbalance
Hyperuricaemia and gout
Impaired glucose tolerance and hyperglycaemia
Altered plasma-lipid concentrations
Mild gastrointestinal disturbances -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 48
Correct
-
A 78-year-old woman visits the emergency room with dizziness and nausea. She claims that her doctor gave her cinnarizine two days prior, but that it didn't seem to help.
Cinnarizine's mechanism of action is which of the following?Your Answer: Antihistamine action
Explanation:Cinnarizine is a piperazine derivative with an antihistamine effect that makes it anti-emetic. Motion sickness and vestibular disorders, such as Méniéres disease, are the most common conditions for which it is prescribed.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 49
Incorrect
-
Regarding antiemetics, which of the following statements is INCORRECT:
Your Answer: Metoclopramide acts directly on the gastrointestinal tract.
Correct Answer: Of the antiemetics, cyclizine is most commonly associated with acute dystonic reactions.
Explanation:Cyclizine acts by inhibiting histamine pathways and cholinergic pathways involved in transmission from the vestibular apparatus to the vomiting centre. Metoclopramide is a dopamine-receptor antagonist which acts both peripherally in the GI tract and centrally within the chemoreceptor trigger zone. Prochlorperazine is a dopamine-D2 receptor antagonist and acts centrally by blocking the chemoreceptor trigger zone. Metoclopramide and prochlorperazine are both commonly associated with extrapyramidal effects, such as acute dystonic reaction. Cyclizine may rarely cause extrapyramidal effects.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 50
Incorrect
-
Flumazenil is a reversal agent for which of the following groups of drugs:
Your Answer: Barbiturates
Correct 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 51
Incorrect
-
A 46-year-old male who is suffering from a chest infection. You decide to start giving the patient antibiotics, however he is allergic to penicillin. You consult with one of your co-workers about the best choice of antibiotic to give.
From the following choices, which is considered an example of bacteriostatic antibiotic?
Your Answer: Ceftriaxone
Correct Answer: Trimethoprim
Explanation:Antibiotics that are bactericidal kill bacteria, while antibiotics that are bacteriostatic limit their growth or reproduction. The antibiotics grouped into these two classes are summarized in the table below:
Bactericidal antibiotics
Bacteriostatic antibioticsVancomycin
Metronidazole
Fluoroquinolone, such as ciprofloxacin
Penicillins, such as benzylpenicillin
Cephalosporin, such as ceftriaxone
Co-trimoxazole
Tetracyclines, such as doxycycline
Macrolides, such as erythromycin
Sulphonamides, such as sulfamethoxazole
Clindamycin
Trimethoprim
Chloramphenicol -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 52
Incorrect
-
Regarding macrolide antibiotics, which of the following statements is CORRECT:
Your Answer: They can not be given to penicillin-allergic patients.
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
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Question 53
Incorrect
-
The patient is a 66-year-old woman who has troublesome bilateral ankle swelling. This has been happening since she began taking a new antihypertensive medication a few weeks ago.
Which of the following medications is most likely to be the cause of this adverse reaction?Your Answer: Losartan
Correct Answer: Amlodipine
Explanation:Amlodipine is a calcium-channel blocker that is frequently used to treat hypertension. Ankle swelling is a very common side effect of calcium-channel blockers, and it occurs quite frequently.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 54
Incorrect
-
Which of the following drugs used in the management of hyperkalaemia does not affect serum potassium levels:
Your Answer: Salbutamol
Correct Answer: Calcium gluconate
Explanation:Calcium gluconate is given to antagonise cardiac cell membrane excitability to reduce the risk of arrhythmias. It has no effect on serum potassium levels unlike the alternative drugs listed above.
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This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
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Question 55
Incorrect
-
Which of the following is NOT an adverse effect of amitriptyline:
Your Answer: QT-interval prolongation
Correct Answer: Hypokalaemia
Explanation:Adverse effects include:
Antimuscarinic effects: Dry mouth, Blurred vision, Constipation, Urinary retention, Sedation, Confusion
Cardiovascular effects: Heart block, Arrhythmias, Tachycardia, Postural hypotension, QT-interval prolongation, Hepatic impairment, Narrow-angle glaucoma -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 56
Correct
-
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 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 secondsThe 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
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Question 57
Incorrect
-
A young 20-year-old boy is a known case of type I diabetes mellitus. Today, he presents with polyuria, polydipsia, and abdominal pain in the emergency department. His blood sugar is drawn, which is markedly elevated to 7 mmol/L. Quick ABGs are drawn, which show metabolic acidosis. You diagnose the patient to be suffering from diabetic ketoacidosis (DKA) and immediately commence its treatment protocol in which insulin is also administered.
Out of the following, which parameter is MOST likely to change due to initiating insulin?Your Answer: Magnesium
Correct Answer: Potassium
Explanation:Diabetes ketoacidosis is an acute complication of diabetes mellitus. Insulin is administered to achieve euglycemia, and crystalloids or colloidal solution is administered to achieve euvolemia and euelectrolytaemia.
Potassium levels severely fluctuate during the treatment of DKA, hypokalaemia being more common. Insulin promotes the cell to take up potassium from the extracellular space via increased sodium-potassium pump activity.
It is important to monitor potassium levels during the treatment of DKA regularly. It is widely suggested that the normal saline shall be used for initial resuscitation, and once the potassium level is retrieved, the patient can be started on potassium replacement should the serum potassium level be between 3.3 and 4.5 mmol/L
If potassium levels fall below 3.3 mmol/l, insulin administration may need to be interrupted to correct the hypokalaemia. -
This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 58
Correct
-
Which of the following does NOT predispose to digoxin toxicity in a patient taking digoxin:
Your Answer: Hyponatraemia
Explanation:Hypoxia, hypercalcaemia, hypokalaemia and hypomagnesaemia predispose to digoxin toxicity. Care should also be taken in the elderly who are particularly susceptible to digoxin toxicity. Hypokalaemia may be precipitated by use of diuretics. Although hyponatremia can result in the development of other pathological disturbances, it does not potentiate digoxin toxicity.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 59
Incorrect
-
In the treatment of hypertensive episodes in pheochromocytoma, which of the following medication types is administered as first-line management:
Your Answer: ACE inhibitors
Correct Answer: Alpha-blockers
Explanation:The first line of management in controlling blood pressure and preventing intraoperative hypertensive crises is to use a combination of alpha and beta-adrenergic inhibition. In phaeochromocytoma, alpha-blockers are used to treat hypertensive episodes in the short term. Tachycardia can be managed by the careful addition of a beta-blocker, preferably a cardioselective beta-blocker, once alpha blockade has been established. Long term management of pheochromocytoma involves surgery.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 60
Incorrect
-
Regarding the foetal oxygen-haemoglobin dissociation curve, which of the following statements is CORRECT:
Your Answer: The foetus has a lower haemoglobin concentration than that of the mother.
Correct Answer: The HbF dissociation curve lies to the left of that for HbA.
Explanation:Foetal haemoglobin (HbF) has a higher affinity for oxygen than adult haemoglobin (HbA) because it’s gamma chains bind 2,3-DPG less avidly than beta chains of HbA. The HbF dissociation curve lies to the left of that for HbA. In the placenta PCO2moves from the foetal to the maternal circulation, shifting the maternal curve further right and the foetal curve further left (the double Bohr effect). The higher affinity of HbF relative to HbA helps transfer oxygen from mother to foetus. Therefore even through blood returning from the placenta to the foetus in the umbilical vein has a PO2of only about 4 kPa, its saturation is 70%. Oxygen transport in the foetus is also helped by a high Hb of about 170 – 180 g/L.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 61
Incorrect
-
Regarding ACE inhibitors, which of the following statements is CORRECT:
Your Answer: ACE inhibitors are used first line for hypertension in pregnancy.
Correct Answer: Angiotensin-II receptor blockers are a useful alternative in patients who cannot tolerate ACE-inhibitors due a persistent cough.
Explanation:ACE inhibitors should be used with caution in patients of Afro-Caribbean descent who may respond less well; calcium channel blockers are first line for hypertension in these patients. ACE inhibitors have a role in the management of diabetic nephropathy. ACE inhibitors are contraindicated in pregnant women. ACE inhibitors inhibit the breakdown of bradykinin; this is the cause of the persistent dry cough. Blocking ACE also diminishes the breakdown of the potent vasodilator bradykinin which is the cause of the persistent dry cough. Angiotensin-II receptor blockers do not have this effect, therefore they are useful alternative for patients who have to discontinue an ACE inhibitor because of persistent cough.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 62
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: Paracetamol
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
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Question 63
Incorrect
-
You examine a 43-year-old woman who was referred to you by a friend. She suffers from a variety of medical conditions and takes a variety of medications, including amitriptyline.
Which of the following is NOT a contraindication to amitriptyline treatment?Your Answer: Manic phase of bipolar affective disorder
Correct Answer: Breastfeeding
Explanation:Amitriptyline is a tricyclic antidepressant (TCA) that is most commonly used to treat depression, but it can also be used to treat anxiety disorders, chronic pain, and attention deficit hyperactivity disorder (ADHD). It inhibits reuptake, raising serotonin and noradrenaline levels while also inhibiting acetylcholine action.
TCAs have a number of drawbacks, including:
Acute Porphyria
Arrhythmias
During bipolar disorder’s manic phase
Heart block
After a myocardial infarction, there is an immediate recovery period.TCA levels in breast milk are too low to be harmful, and use can be continued while breastfeeding.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 64
Correct
-
Regarding loop diuretics, which of the following statements is INCORRECT:
Your Answer: The risk of hypokalaemia is greater with loop diuretics than with an equipotent dose of a thiazide diuretic.
Explanation:Hypokalaemia can occur with both thiazide and loop diuretics. The risk of hypokalaemia depends on the duration of action as well as the potency and is thus greater with thiazides than with an equipotent dose of a loop diuretic. Hypokalaemia is dangerous in severe cardiovascular disease and in patients also being treated with cardiac glycosides. Often the use of potassium-sparing diuretics avoids the need to take potassium supplements. In hepatic failure, hypokalaemia caused by diuretics can precipitate encephalopathy, particularly in alcoholic cirrhosis.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 65
Correct
-
Regarding inhaled corticosteroids, which of the following statements is INCORRECT:
Your Answer: Lower doses of inhaled corticosteroids may be required in smokers.
Explanation:Current and previous smoking reduces the effectiveness of inhaled corticosteroids and higher doses may be necessary.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 66
Incorrect
-
A young farmer who is caught under farm machinery and suffering from a major crush injury is taken to the emergency department and requires a quick induction sequence. In this type of injury, which of the following anaesthetic medicines should be avoided?
Your Answer: Etomidate
Correct Answer: Suxamethonium
Explanation:Suxamethonium is a neuromuscular blocker. It is contraindicated in patients who have experienced massive trauma, hyperkalemic, or burn injuries.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 67
Incorrect
-
Which of the following is NOT a common side effect of amiodarone:
Your Answer: Pulmonary fibrosis
Correct Answer: Blue/green teeth discolouration
Explanation:Common side effects of amiodarone include: Bradycardia, Nausea and vomiting, Thyroid disorders – hypothyroidism and hyperthyroidism, Persistent slate grey skin discoloration, Photosensitivity, Pulmonary toxicity (including pneumonitis and fibrosis), Hepatotoxicity, Corneal microdeposits (sometimes with night glare), Peripheral neuropathy and Sleep disorders.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 68
Incorrect
-
At which opioid receptors do opioid analgesics act primarily?
Your Answer: Kappa
Correct Answer: Mu
Explanation:Opioid receptors are widely distributed throughout the central nervous system. Opioid analgesics mimic endogenous opioid peptides by causing prolonged activation of these receptors, mainly the mu(μ)-receptors which are the most highly concentrated in brain areas involved in nociception.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 69
Incorrect
-
A 39-year-old man who is suffering from a bacterial infection require antibiotic treatment. You need to figure out which antibiotic is most suitable. Listed below are antimicrobial drugs.
Which one is a nucleic acid synthesis inhibitor?
Your Answer: Gentamicin
Correct Answer: Ciprofloxacin
Explanation:Ciprofloxacin and other quinolone antibiotics work by blocking DNA gyrase, an enzyme that compresses bacterial DNA into supercoils, as well as a type II topoisomerase, which is required for bacterial DNA separation. As a result, they prevent nucleic acid synthesis.
The following is a summary of the many modes of action of various types of antimicrobial agents:Action Mechanisms- Examples:
Cell wall production is inhibited
Vancomycin
Vancomycin
CephalosporinsThe function of the cell membrane is disrupted
Nystatin
Polymyxins
Amphotericin BInhibition of protein synthesis
Chloramphenicol
Macrolides
Aminoglycosides
TetracyclinesNucleic acid synthesis inhibition
Quinolones
Trimethoprim
Rifampicin
5-nitroimidazoles
Sulphonamides
Anti-metabolic activity
Isoniazid -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 70
Incorrect
-
A critically ill 48-year-old individual appears with symptoms and signs of an anaphylactic reaction.
In an allergic reaction, which of the following is an absolute contraindication to the injection of adrenaline?Your Answer: Second stage of labour
Correct Answer: None of the other options
Explanation:Even if the following relevant contraindications exist, adrenaline can be given in life-threatening anaphylactic reactions:
Coronary artery disease (CAD)
Coronary artery disease (CAD) Second stage of labour
Hypertension that is uncontrolled
Severe Ventricular arrhythmias -
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 71
Correct
-
In the treatment of bradyarrhythmias with adverse characteristics or risk of asystole, what is the initial suggested dose of atropine?
Your Answer: 500 micrograms
Explanation:Atropine 500 mcg IV bolus should be administered if there are any adverse features or risk of asystole. If the reaction is not adequate, repeat the steps every 3 to 5 minutes up to a maximum dose of 3 mg. In the case of acute myocardial ischemia or myocardial infarction, atropine should be taken with caution since the increased heart rate may aggravate the ischemia or increase the size of the infarct.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 72
Incorrect
-
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 50S subunit of the bacterial ribosome
Correct 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.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 73
Incorrect
-
Which of the following medications can block the effect of adrenaline?
Your Answer: Alpha-blockers
Correct Answer: Beta-blockers
Explanation:Beta-blockers may reduce the response to adrenaline in the treatment of anaphylactic reactions.
Noncardioselective beta-blockers in particular can antagonize the broncho dilating and cardio stimulatory effects of adrenaline by blocking beta-2 adrenergic receptors in the smooth muscles of the bronchial tree and in the heart muscles.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 74
Correct
-
Which of the following medications may lessen warfarin's anticoagulant effect:
Your Answer: Phenytoin
Explanation:Phenytoin will decrease the level or effect of warfarin by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
Metronidazole will increase the level or effect of warfarin by affecting hepatic enzyme CYP2C9/10 metabolism.
NSAIDs, when given with Warfarin, increase anticoagulation. -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 75
Correct
-
Calcium-channel blockers can be divided into two categories: dihydropyridines and non-dihydropyridines. The basic chemical structure of these two classes differs, as does their relative selectivity for cardiac versus vascular L-type calcium channels. The phenylalkylamine class and the benzothiazepine class are two subgroups of non-dihydropyridines.
A phenylalkylamine calcium-channel blocker is, for example, which of the following?Your Answer: Verapamil
Explanation:Calcium-channel blockers, also known as calcium antagonists, stop calcium from entering cells through the L-type calcium channel. This causes vascular smooth muscle in vessel walls to relax, resulting in a decrease in peripheral vascular resistance.
They can be used for a variety of things, including:
Hypertension
Angina
Atrial fibrillation
MigraineCalcium-channel blockers can be divided into two categories: dihydropyridines and non-dihydropyridines. The basic chemical structure of these two classes differs, as does their relative selectivity for cardiac versus vascular L-type calcium channels.
Dihydropyridines have a high vascular selectivity and lower systemic vascular resistance and blood pressure. As a result, they’re frequently used to treat hypertension. Modified release formulations are also used to treat angina, but their powerful systemic vasodilator and pressure-lowering effects can cause reflex cardiac stimulation, resulting in increased inotropy and tachycardia, which can counteract the beneficial effects of reduced afterload on myocardial oxygen demand.
The suffix -dpine distinguishes dihydropyridines from other pyridines. Examples of dihydropyridines that are commonly prescribed include:
Amlodipine
Felodipine
Nifedipine
NimodipineThe phenylalkylamine class and the benzothiazepine class are two subgroups of non-dihydropyridines.
Phenylalkylamines are less effective as systemic vasodilators because they are relatively selective for the myocardium. This group of drugs lowers myocardial oxygen demand and reverses coronary vasospasm, making them useful in the treatment of angina. They are also occasionally used to treat arrhythmias. A phenylalkylamine calcium-channel blocker like verapamil is an example.
In terms of selectivity for vascular calcium channels, benzothiazepines fall somewhere between dihydropyridines and phenylalkylamines. They can lower arterial pressure without producing the same level of reflex cardiac stimulation as dihydropyridines because they have both cardiac depressant and vasodilator effects. Diltiazem is the only benzothiazepine currently in clinical use.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 76
Incorrect
-
Regarding dynamic compression of the airways, which of the following statements is CORRECT:
Your Answer: It does not occur in normal expiration, because the intrapleural pressure is positive throughout.
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.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 77
Incorrect
-
Which of the following is NOT a common side effect of antihistamines:
Your Answer: Urinary retention
Correct Answer: Tremor
Explanation:Common side effects of antihistamines may include:
Anticholinergic effects (blurred vision, dry mouth, urinary retention)
Headache
Gastrointestinal disturbances
Psychomotor impairment (sedation, dizziness and loss of appetite)
These side effects are significantly reduced with second-generation agents. -
This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 78
Correct
-
Aldin is a 24-year-old male patient who arrives at the emergency department diagnosed with psittacosis based on his symptoms and history of being a pigeon enthusiast. Which of the following is the causative bacteria of psittacosis?
Your Answer: Chlamydia psittaci
Explanation:Chlamydia psittaci is a microorganism that is commonly found in birds.
These bacteria can infect people and cause psittacosis. Psittacosis is an infectious disease that may cause high fever and pneumonia associated with headaches, altered mental state, and hepatosplenomegaly.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 79
Incorrect
-
Which of the following statements is correct with regards to heparin-induced thrombocytopaenia (HIT)?
Your Answer: Further anticoagulation should be avoided until HIT has resolved.
Correct Answer: HIT typically develops 5-10 days after starting heparin.
Explanation:Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder caused by antibodies that recognize complexes of platelet factor 4 (PF4) and heparin. HIT is frequently considered in the differential diagnosis of thrombocytopenia occurring in patients on heparin therapy. HIT is a challenging diagnosis because of routine heparin use in hospitalized patients, the common occurrence of thrombocytopenia. The process of heparin dependent IgG antibodies binding to heparin/platelet factor 4 complexes activates platelets and produces a hypercoagulable state. This syndrome typically develops 5-10 days (range 4-15 days) after heparin is commenced. It can occur with unfractionated heparin, low molecular weight heparin, or, rarely, fondaparinux. The diagnosis of HIT requires the combination of a compatible clinical picture and laboratory confirmation of the presence of heparin dependent platelet activating HIT antibodies. Discontinuation of heparin alone or initiation of a vitamin K antagonist alone like warfarin, is not sufficient to stop the development of thrombosis in patients with acute HIT. If there is moderate clinical suspicion for HIT, all sources of heparin must be discontinued and there must be consideration of anticoagulant treatment with a non-heparin drug.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 80
Incorrect
-
Which of the following intravenous induction drugs results in the highest drop in blood pressure:
Your Answer: Midazolam
Correct Answer: Propofol
Explanation:Propofol’s most frequent side effect is hypotension, which affects 17% of paediatric patients and 26% of adults. This is attributable to systemic vasodilation as well as a decrease in preload and afterload. Propofol has a little negative inotropic impact as well. The drop in blood pressure is dosage-dependent and is more noticeable in the elderly, thus this should be expected.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 81
Incorrect
-
You are about to give an antimuscarinic agent to a 55 year-old male patient. Which of the following conditions will make you with stop the administration, since it is a contraindication to antimuscarinic agents?
Your Answer: Hypothyroidism
Correct Answer: Prostatic enlargement
Explanation:Antimuscarinic medications may impair the contractility of bladder smooth muscle, resulting in acute urine retention in men with BPH, and should be avoided or used with caution.
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 82
Correct
-
The mechanism of action of abciximab is by:
Your Answer: Blocking the binding of fibrinogen to GPIIb/IIIa receptor sites
Explanation:Abciximab is a glycoprotein IIb/IIIa inhibitors and prevents platelet aggregation by blocking the binding of fibrinogen to receptors on platelets.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 83
Incorrect
-
In patients who are not at risk of hypercapnic respiratory failure but are requiring oxygen, the oxygen saturations should be maintained at which of the following?
Your Answer:
Correct Answer: 94 - 98%
Explanation:Oxygen saturation should be 94 – 98% in most acutely ill patients with a normal or low arterial carbon dioxide (PaCO2). In some clinical situations, however, like cardiac arrest and carbon monoxide poisoning, it is more appropriate to aim for the highest possible oxygen saturation until the patient is stable.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 84
Incorrect
-
A 22-year-old man comes to the emergency department with a human bite injury to his hand received from a punch during a fight 3 hours earlier outside a bar. On closer inspection, you discover bite marks on his first and second knuckles. Which of the following is the best treatment option for this patient:
Your Answer:
Correct Answer: Oral co-amoxiclav for 7 days
Explanation:Even if there is no evidence of infection, prophylactic antibiotics should be administered for all human bite wounds that are less than 72 hours old. The first-line therapy is 7 days of co-amoxiclav. In penicillin-allergic people, metronidazole + doxycycline is an option. Streptococcus spp., Staphylococcus aureus, Haemophilus spp., Eikenella corrodens, Bacteroides spp., and other anaerobes are the most prevalent organisms found in human bites.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 85
Incorrect
-
You're a member of the cardiac arrest team, and you're helping to resuscitate an elderly gentleman who had collapsed at home. The team leader requests that you administer an adrenaline shot.
Which of the following statements about adrenaline is FALSE?Your Answer:
Correct Answer: The IM dose in anaphylaxis is 1 ml of 1:1000
Explanation:Adrenaline (epinephrine) is a sympathomimetic amine that binds to alpha- and beta-adrenergic receptors and acts as an agonist. It is active at both alpha and beta receptors in roughly equal amounts.
When taken orally, it becomes inactive. Subcutaneous absorption is slower than intramuscular absorption. In cardiac arrest, it is well absorbed from the tracheal mucosa and can be given through an endotracheal tube.
At the adrenergic synapse, catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO) metabolise it primarily. The inactive products are then passed through the kidneys and excreted in the urine.
In adult cardiac arrest, the IV dose is 1 mg, which is equal to 10 ml of 1:10000 or 1 ml of 1:1000. In anaphylaxis, the IM dose is 0.5 ml of 1:1000. (500 mcg).
In open-angle glaucoma, adrenaline causes mydriasis and lowers pressure.
Adrenaline is used in cardiopulmonary resuscitation, the treatment of severe croup, and the emergency management of acute allergic and anaphylactic reactions (as a nebuliser solution).
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 86
Incorrect
-
A 67-year-old woman arrives at the Emergency Department with chest pain. Flecainide is one of the medications she is taking.
Which of the following statements about flecainide mechanism of action is correct?Your Answer:
Correct Answer: Blocks Na+ channels in the heart
Explanation:Flecainide is an antiarrhythmic drug of class Ic that works by blocking the Nav1.5 sodium channel in the heart, prolonging the cardiac action potential and slowing cardiac impulse conduction. It has a significant impact on accessory pathway conduction, particularly retrograde conduction, and significantly reduces ventricular ectopic foci.
Many different arrhythmias can be treated with flecainide, including:
Pre-excitation syndromes (e.g. Wolff-Parkinson-White)
Acute atrial arrhythmias
Ventricular arrhythmias
Chronic neuropathic painThe use of flecainide is contraindicated in the following situations:
Abnormal left ventricular function
Atrial conduction defects (unless pacing rescue available)
Bundle branch block (unless pacing rescue available)
Distal block (unless pacing rescue available)
Haemodynamically significant valvular heart disease
Heart failure
History of myocardial infarction
Long-standing atrial fibrillation where conversion to sinus rhythm not attempted
Second-degree or greater AV block (unless pacing rescue available)
Sinus node dysfunction (unless pacing rescue available)Flecainide should only be used in people who don’t have a structural heart problem. The CAST trial found a significant increase in sudden cardiac death and all-cause mortality in patients with an ejection fraction of less than 40% after a myocardial infarction, where it tended to be pro-arrhythmic.
Anti-arrhythmic drugs have a limited and ineffective role in the treatment of atrial flutter. It’s important to keep in mind that flecainide shouldn’t be used by itself to treat atrial flutter. When used alone, there is a risk of inducing 1:1 atrioventricular conduction, which results in an increase in ventricular rate that is paradoxical. As a result, it should be used in conjunction with a beta-blocker or a calcium channel blocker with a rate-limiting effect.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 87
Incorrect
-
Regarding airway resistance, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Airway resistance is predominantly determined by the radius of the airway as described by Poiseuille's law.
Explanation:Flow through airways is described by Darcy’s law which states that flow is directly proportional to the mouth-alveolar pressure gradient and inversely proportional to airway resistance. Airway resistance is primarily determined by the airway radius according to Poiseuille’s law, and whether the flow is laminar or turbulent. Parasympathetic stimulation causes bronchoconstriction and sympathetic stimulation causes bronchodilation, but mediated by beta2-adrenoceptors. Muscarinic antagonists e.g. ipratropium bromide cause bronchodilation.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 88
Incorrect
-
Which of the following is an action of glucagon:
Your Answer:
Correct Answer: Stimulates glycogenolysis
Explanation:Glucagon is a peptide hormone that is produced and secreted by alpha cells of the islets of Langerhans, which are located in the endocrine portion of the pancreas. The main physiological role of glucagon is to stimulate hepatic glucose output, thereby leading to increases in glycaemia. It provides the major counter-regulatory mechanism to insulin in maintaining glucose homeostasis.
Hypoglycaemia is the principal stimulus for the secretion of glucagon but may also be used as an antidote in beta-blocker overdose and in anaphylaxis in patients on beta-blockers that fail to respond to adrenaline.
Glucagon then causes:
Glycogenolysis
Gluconeogenesis
Lipolysis in adipose tissue
The secretion of glucagon is also stimulated by:
Adrenaline
Cholecystokinin
Arginine
Alanine
Acetylcholine
The secretion of glucagon is inhibited by:
Insulin
Somatostatin
Increased free fatty acids
Increased urea productionGlycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released by this process is used to form ATP and NADH. Glycolysis is inhibited by glucagon, and glycolysis and gluconeogenesis are reciprocally regulated so that when one cell pathway is activated, the other is inactive and vice versa.
Glucagon has a minor effect of enhancing lipolysis in adipose tissue. Lipolysis is the breakdown of lipids and involves the hydrolysis of triglycerides into glycerol and free fatty acids. It makes fatty acids available for oxidation.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 89
Incorrect
-
Which of the following is NOT a contraindication to the use of diazepam:
Your Answer:
Correct Answer: Acute alcohol withdrawal
Explanation:Benzodiazepines are used to treat symptoms in patients with acute alcohol withdrawal syndrome.
Benzodiazepines are contraindicated in:
Respiratory depression
Marked neuromuscular respiratory weakness, such as unstable myasthenia gravis
Obstructive sleep apnoea syndrome (symptoms may be aggravated)
Severe hepatic impairment (the elimination half-life of diazepam may be prolonged; increased risk of coma)
Phobic or obsessional states, chronic psychosis or hyperkinesis (paradoxical reactions may occur). -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 90
Incorrect
-
A 52-year-old female visits the Emergency Department complaining of an acute worsening of her asthma symptoms. A detailed history reveals that she took one of her brother's heart pills without a prescription as she was experiencing palpitations and thought it would cure her. Her shortness of breath was suddenly exacerbated after ingesting this medicine.
Which one of the following medications has this woman most likely consumed?Your Answer:
Correct Answer: Propranolol
Explanation:Propranolol, like other non-selective beta-blockers, is contraindicated in patients with asthma. These drugs can cause acute bronchospasm, therefore worsening symptoms, especially in high doses. However, there has been some recent evidence that long-term use of selective beta-blockers in mild or moderate asthma patients can be safe.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 91
Incorrect
-
A 67-year-old female is admitted under your care with the complaint of shortness of breath and massive pedal oedema. There are fine crepitations up to the mid zones on both lung fields on chest auscultation. When questioned about her medication, she doesn't remember everything she takes but knows that there is a tablet to get rid of excess water.
Out of the following medications, which one increases the osmolality of the filtrate in the glomerulus and the tubule, creating an osmotic effect?Your Answer:
Correct Answer: Mannitol
Explanation:Mannitol is an osmotic diuretic that stops the absorption of water throughout the tubule, thus increasing the osmolality of both glomerular and tubular fluid. It is used to:
1. decrease intraocular pressure in glaucoma
2. decrease intracerebral pressure
3. oliguria.Furosemide is a loop diuretic that inhibits the Na/K/2Cl transported in the ascending limb of the Loop of Henle.
Bendroflumethiazide is a thiazide diuretic which inhibits the Na/Cl transporter.
Spironolactone is a potassium-sparing diuretic that acts as an aldosterone receptor antagonist.
Acetazolamide is a carbonic anhydrase inhibitor.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 92
Incorrect
-
A patient is currently taking is glyceryl trinitrate among other chronic medications. Which of the following side effects is he LEAST likely to develop?
Your Answer:
Correct Answer: Syncope
Explanation:Nitrates are used in the treatment of angina pectoris and the prevention of myocardial ischaemia. Commonly used examples of nitrates are glyceryl trinitrate and isosorbide dinitrate. Unwanted effects, however, are common and can limit therapy, particularly when angina is severe or when patients are unusually sensitive to the effects of nitrates.
The following are common or very common side effects of nitrates:
- Arrhythmias
- Asthenia
- Cerebral ischaemia
- Dizziness
- Drowsiness
- Flushing
- Headache
- Hypotension
- Nausea and vomiting
- Diarrhoea, syncope and cyanosis can occur, but these are rare side effects.
Dry eyes, bradycardia and metabolic acidosis have not been reported.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 93
Incorrect
-
In which of the following cases is intravenous phenytoin contraindicated?
Your Answer:
Correct Answer: Second degree heart block
Explanation:Phenytoin Contraindications include:
Hypersensitivity
Sinus bradycardia
Sinoatrial block
Second and third degree A-V block
Adams-Stokes syndrome
Concurrent use with delavirdine
History of prior acute hepatotoxicity attributable to phenytoin -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 94
Incorrect
-
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:
Correct Answer: Age under 12 years
Explanation:Codeine phosphate is a mild opiate that can be used to treat mild to moderate pain when other pain relievers like paracetamol or ibuprofen have failed. It can also be used to treat diarrhoea and coughs that are dry or painful.
The use of all opioids is contraindicated for the following reasons:
Respiratory depression (acute)
Patients who are comatose
Head injury (opioid analgesics impair pupillary responses, which are crucial for neurological evaluation)
Intracranial pressure has risen (opioid analgesics interfere with pupillary responses vital for neurological assessment)
There’s a chance you’ll get paralytic ileus.The use of codeine phosphate is contraindicated in the following situations:
Because of the significant risk of respiratory side effects in children under the age of 12, it is not recommended for children under the age of 12.Patients of any age who have been identified as ultra-rapid codeine metabolizers (CYP2D6 ultra-rapid metabolizers)
Because codeine can pass through breast milk to the baby and because mothers’ ability to metabolise codeine varies greatly, it is especially dangerous in breastfeeding mothers.
If other painkillers, such as paracetamol or ibuprofen, fail to relieve acute moderate pain in children over the age of 12, codeine should be used. In children with obstructive sleep apnoea who received codeine after tonsillectomy or adenoidectomy, a significant risk of serious and life-threatening adverse reactions has been identified.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 95
Incorrect
-
Question 96
Incorrect
-
Regarding co-amoxiclav, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: Clavulanic acid acts to inhibit cross-linking of bacterial peptidoglycan polymers.
Explanation:Co-amoxiclav consists of amoxicillin with the beta-lactamase inhibitor clavulanic acid. Clavulanic acid itself has no significant antibacterial activity but, by inactivating beta-lactamases, it makes the combination active against beta-lactamase-producing bacteria that are resistant to amoxicillin.The most common adverse effects of co-amoxiclav include nausea, vomiting, skin rash and diarrhoea. Pseudomembranous colitis should be considered if a person develops severe diarrhoea during or after treatment with co-amoxiclav. Cholestatic jaundice can occur either during or shortly after the use of co-amoxiclav. An epidemiological study has shown that the risk of acute liver toxicity was about 6 times greater with co-amoxiclav than with amoxicillin. Cholestatic jaundice is more common in patients above the age of 65 years and in men; these reactions have only rarely been reported in children. Jaundice is usually self-limiting and very rarely fatal.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 97
Incorrect
-
Following the administration of a drug that was started a few months earlier, a patient presents with features of peripheral neuropathy.
Which of the following drugs is most likely to cause peripheral neuropathy?
Your Answer:
Correct Answer: Isoniazid
Explanation:Isoniazid, a first-line agent for the treatment of tuberculosis, has the commonest side effect of peripheral neuropathy. It occurs in up to 20% of patients taking the drug at a dose > 6 mg/kg daily.
Isoniazid combines with pyridoxine (vitamin B6) to form hydrazone, which is excreted in the urine. This causes a deficiency of biologically active pyridoxine leading to peripheral neuropathy.
Peripheral neuropathy of isoniazid is prevented by the co-administration of pyridoxine at a dose of 10 mg for each 100 mg of isoniazid given.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 98
Incorrect
-
You're evaluating a 37-year-old woman who is 12 weeks pregnant. She has experienced vaginal bleeding.
Which of the following anti-D statements is correct?Your Answer:
Correct Answer: Routine antenatal prophylaxis is recommended for RhD negative women at 28 and 34 weeks
Explanation:Anti-D is an IgG antibody that targets the antigen Rhesus D (RhD). Plasma from rhesus-negative donors who have been immunised against the anti-D-antigen is used to make anti-D immunoglobulin.
Only RhD negative women are given Anti-D Ig. Women who are RhD negative do not have the RhD antigen on their RBC. If a foetus has the RhD antigen (i.e. is RhD positive) and the mother is exposed to foetal blood, she may develop antibodies to RhD that pass through the placenta and attack foetal red cells (resulting in newborn haemolytic disease). Anti-D is given to bind and neutralise foetal red cells in the maternal circulation before an immune response is triggered. In the event of a sensitising event, 500 IU Anti-D Ig should be administered intramuscularly.
The following are examples of potentially sensitising events:
Birth
Haemorrhage during pregnancy
Miscarriage
Ectopic pregnancy
Death within the womb
Amniocentesis
Chorionic villus sampling
Trauma to the abdomenThe sooner anti-D is given in the event of a sensitising event, the better; however, it is most effective within 72 hours, and the BNF states that it is still likely to have some benefit if given outside of this time frame.
At 28 and 34 weeks, RhD negative women should receive routine antenatal prophylaxis. This is regardless of whether they have previously received Anti-D for a sensitising event during the same pregnancy.
Prophylactic anti-D is not necessary before 12 weeks gestation, as confirmed by scan, in uncomplicated miscarriage (where the uterus is not instrumented), or mild, painless vaginal bleeding, as the risk of foeto-maternal haemorrhage (FMH) is negligible. In cases of therapeutic termination of pregnancy, whether by surgical or medical means, 250 IU of prophylactic anti-D immunoglobulin should be given to confirmed RhD negative women who are not known to be RhD sensitised.
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This question is part of the following fields:
- Immunological Products & Vaccines
- Pharmacology
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Question 99
Incorrect
-
Which of the following is NOT a pharmacological effect of beta-blockers:
Your Answer:
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 automaticityEye:
Reduce intraocular pressureRespiratory system:
Cause bronchoconstriction -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 100
Incorrect
-
Regarding antihistamines, which of the following statements is CORRECT:
Your Answer:
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.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 101
Incorrect
-
Mannitol is primarily indicated for which of the following:
Your Answer:
Correct Answer: Cerebral oedema
Explanation:Mannitol is an osmotic diuretic that can be used to treat cerebral oedema and raised intraocular pressure. Mannitol is a low molecular weight compound and is, therefore, freely filtered at the glomerulus and is not reabsorbed. It, therefore, increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain-barrier (BBB).
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 102
Incorrect
-
A 36 year old man who is overweight with a history of gout, presents to emergency room with an acutely painful big toe which is red, hot and swollen. However, he is apyrexic and otherwise systemically well. He has been diagnosed with acute gout. The most appropriate first line treatment for him is which of the following?
Your Answer:
Correct Answer: NSAIDs
Explanation:The first line treatment for acute gout includes NSAIDs like diclofenac, indomethacin or naproxen. In patients in whom NSAIDs are contraindicated, not tolerated or ineffective, colchicine is an alternative. In those who cannot tolerate or who are resistant to NSAIDs and colchicine, oral or parenteral corticosteroids are an effective alternative. In acute monoarticular gout, intra-articular injection of a corticosteroid can be used occasionally. In acute gout. allopurinol is not used in the actual treatment, but its use should be continued during an acute attack if the patient is already established on long term therapy.
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This question is part of the following fields:
- Musculoskeletal
- Pharmacology
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Question 103
Incorrect
-
Which of the following is a contraindication to using nitrous oxide:
Your Answer:
Correct 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 104
Incorrect
-
A 4-year-old girl is rushed to the Emergency Department by her grandparents after swallowing some of her grandfather's Warfarin tablets. On further questioning, it turns out that she took 5 of his 3 mg tablets which he needs to take due to a history of atrial fibrillation. The child appears healthy well-oriented in time, place and person, and has normal vitals.
What is the threshold dose of Warfarin that needs to be ingested for there to be a risk of anticoagulation?Your Answer:
Correct Answer: 0.5 mg/kg
Explanation:The clinical effects of Warfarin occur after a dose of greater than 0.5 mg/kg, and they will be observable 8-10 hours after consumption of the drug. The antidote used for Warfarin is Vitamin K.
1. In low-risk cases with no apparent bleeding:
an oral dose of 10 mg vitamin K2. If there is clinically significant bleeding
an intravenous dose of 250-300 mcg/kgActivated charcoal:
in cases of warfarin ingestion
binds to it and reduces the absorption of warfarin
the ingestion must have occurred within the last hour
There is, however, rarely a need for the use of activated charcoal because vitamin K is such as safe and effective antidote.Clotting studies, including an INR, can be performed, but small children who have ingested warfarin do not require INRs or follow up if they have been treated with 10 mg vitamin K. This dose of vitamin will completely reverse the anticoagulative effects of warfarin.
Perform INR if any of the following are present:
1. Delayed presentation (>6 hours)
2. Patients with symptoms or signs of anticoagulation
3. Possible massive ingestion -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 105
Incorrect
-
Which of the following is NOT a mineralocorticoid effect of corticosteroids:
Your Answer:
Correct Answer: Hyperglycaemia
Explanation:Mineralocorticoid side effects include:hypertensionsodium retentionwater retention and oedemapotassium losscalcium loss
Glucocorticoid side effects include:weight gainhyperglycaemia and diabetesosteoporosis and osteoporotic fracturesmuscle wasting (proximal myopathy)peptic ulceration and perforationpsychiatric reactions -
This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 106
Incorrect
-
For which of the following class of drugs can neostigmine be used as a reversal agent?
Your Answer:
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 107
Incorrect
-
All of the following are indications for beta-blockers EXCEPT for:
Your Answer:
Correct Answer: Prinzmetal's angina
Explanation:Beta-blockers are contraindicated in Prinzmetal’s angina.Beta-blockers may be indicated in:HypertensionPheochromocytoma (only with an alpha-blocker)AnginaSecondary prevention after ACSArrhythmias including atrial fibrillationHeart failureThyrotoxicosisAnxietyProphylaxis of migraineEssential tremorGlaucoma
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 108
Incorrect
-
On ambulatory blood pressure monitoring, a 48-year-old Caucasian man has an average BP reading of 152/96 mmHg (ABPM).
Which of the following would be the patient's first-line drug treatment?Your Answer:
Correct Answer: Ramipril
Explanation:An ambulatory blood pressure reading of >150/95 is classified as stage 2 hypertension, according to the NICE care pathway for hypertension, and the patient should be treated with an antihypertensive drug.
A calcium-channel blocker, such as amlodipine, would be the most appropriate medication for a 48-year-old Afro-Caribbean man.
An ACE inhibitor, such as ramipril, or a low-cost angiotensin-II receptor blocker (ARB), such as losartan, would be the most appropriate medication for a 48-year-old Caucasian man.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 109
Incorrect
-
A 55-year-old female is urgently rushed into the Emergency Department as she complains of chest pain that is worse on breathing, shortness of breath, palpitations, and haemoptysis.
She undergoes a CT pulmonary angiogram, which reveals a large pulmonary embolus. She is immediately started on heparin and shifted to the acute medical ward.
Which of the following statements is true regarding heparin?Your Answer:
Correct Answer: It activates antithrombin III
Explanation:Heparin is a polymer of glycosaminoglycan. It occurs naturally and is found in mast cells. Clinically, it is used in two forms:
1. Unfractionated: widely varying polymer chain lengths
2. Low molecular weight: Smaller polymers onlyHeparin works by binding to and activating the enzyme inhibitor antithrombin III. Antithrombin III inactivates thrombin (factor IIa) by forming a 1:1 complex with thrombin. The heparin-antithrombin III complex also inhibits factor Xa and some other proteases involved with clotting. The heparin-ATIII complex can also inactivate IX, XI, XII, and plasmin.
Heparin is not thrombolytic or fibrinolytic. It prevents the progression of existing clots by inhibiting further clotting. The lysis of existing clots relies on endogenous thrombolytics.
Heparin is used for:
1. Prevention and treatment of venous thromboembolism
2. Treatment of disseminated intravascular coagulation
3. Treatment of fat embolism
4. Priming of haemodialysis and cardiopulmonary bypass machinesThere is no evidence that heparin is superior to low-molecular-weight heparins in preventing mortality from thrombosis.
Vitamin K is used to reverse the effects of warfarin but not heparin. For heparin, protamine sulphate is used to counteract its effects.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 110
Incorrect
-
Glucagon may be used as an antidote for overdose with which of the following:
Your Answer:
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 productionGlycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released by this process is used to form ATP and NADH. Glycolysis is inhibited by glucagon, and glycolysis and gluconeogenesis are reciprocally regulated so that when one cell pathway is activated, the other is inactive and vice versa.
Glucagon has a minor effect of enhancing lipolysis in adipose tissue. Lipolysis is the breakdown of lipids and involves the hydrolysis of triglycerides into glycerol and free fatty acids. It makes fatty acids available for oxidation.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 111
Incorrect
-
Regarding nitrous oxide, which of the following statements is CORRECT:
Your Answer:
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 112
Incorrect
-
Which of the following is NOT a notifiable disease:
Your Answer:
Correct Answer: HIV
Explanation:HIV mainly infects CD4+ T helper cells. Viral replication results in progressive T-cell depletion and impaired cell-mediated immunity with subsequent secondary opportunistic infections and increased risk of malignancy. B-cell function is also reduced as a result of lack of T-cell stimulation.
HIV is not a notifiable disease. -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 113
Incorrect
-
You suspect an anaphylactic reaction in a patient who is hypotensive, with trouble breathing after eating peanuts. Which of the following diagnostic tests will confirm this?
Your Answer:
Correct Answer: Mast cell tryptase
Explanation:The concentration of serum tryptase rises in anaphylaxis and anaphylactoid responses.
Because tryptase is a significant component of mast cell granules, mast cell degranulation causes elevated tryptase levels in the blood.
Although tryptase levels are not always high during anaphylaxis, it is considered a particular marker.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 114
Incorrect
-
What is the recommended dosing regime for amiodarone in the treatment of a stable regular broad-complex tachycardia:
Your Answer:
Correct Answer: 300 mg IV over 10 - 60 minutes, followed by an IV infusion of 900 mg over the next 24 hours
Explanation:A ventricular tachycardia (or broad-complex tachycardia of uncertain origin) should be treated with amiodarone 300 mg IV over 10 – 60 min, followed by an infusion of 900 mg over the next 24 hours.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 115
Incorrect
-
Which of the following best describes digoxin:
Your Answer:
Correct Answer: A positive inotrope and negative chronotrope
Explanation:Digoxin is a cardiac glycoside used in the treatment of atrial fibrillation and flutter, and congestive cardiac failure. It acts by inhibiting the membrane Na/K ATPase in cardiac myocytes. This raises intracellular sodium concentration and increases intracellular calcium availability indirectly via Na/Ca exchange. The increase in intracellular calcium levels causes an increases the force of myocardial contraction (positive inotrope), and slows the heart rate (negative chronotrope).
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 116
Incorrect
-
All of the following cause bronchodilation, EXCEPT for:
Your Answer:
Correct Answer: Stimulation of irritant receptors
Explanation:Factors causing bronchodilation: Via beta2-adrenoceptors
Sympathetic stimulation:
Adrenaline (epinephrine)
Beta2-adrenergic agonists e.g. salbutamol
Anticholinergic and muscarinic antagonists e.g. ipratropium -
This question is part of the following fields:
- Physiology
- Respiratory
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Question 117
Incorrect
-
After collapsing in his nursing home, a 70-year-old man is brought into the ER. He has diabetes mellitus and is on medication for it. An RBS of 2.0 mmol/L (3.9-5.5 mmol/L) is recorded in the ER.
Out of the following, which medication for diabetes mellitus is LEAST likely responsible for his hypoglycaemic episode?Your Answer:
Correct Answer: Metformin
Explanation:Metformin is a biguanide used as the first-line to treat type 2 diabetes mellitus. It has a good reputation as it has an extremely low risk of causing hypoglycaemia compared to the other agents for diabetes. It does not affect the insulin secreted by the pancreas or increase insulin levels. Toxicity with metformin can, however, cause lactic acidosis with associated hypoglycaemia.
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This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 118
Incorrect
-
A young female was diagnosed with a urinary tract infection and was sent home with medications. However, after 48 hours of discharge, she returned to the hospital because there had been no relief from her symptoms. The urine sensitivity test report is still unavailable. Fresh blood tests were sent, and her estimated GFR is calculated to be >60 ml/minute.
She was prescribed nitrofurantoin 100 mg modified-release orally twice a day for two days.
Out of the following, which antibiotic is most appropriate to be prescribed to this patient?Your Answer:
Correct Answer: Fosfomycin
Explanation:The NICE guidelines for women with lower UTIs who are not pregnant are:
1. Consider prescribing a different antibiotic if symptoms do not improve within 48 hours or worsen at any time
2. If the urine culture and susceptibility test results are available, review the choice of antibiotic according to the results and change the antibiotic accordingly if symptoms are not improving or bacteria is resistant to the prescribed antibioticThe first choice of antibiotics for non-pregnant women aged 16 years and over is:
1. Nitrofurantoin
100 mg modified-release PO BD for 3 days – if eGFR >45 ml/minute
2. Trimethoprim
200 mg PO BD for three daysThe second-choice (no improvement in lower UTI symptoms on first-choice for at least 48 hours, or when first-choice is not suitable) are:
1. Nitrofurantoin
100 mg modified-release PO BD for three days – if eGFR >45 ml/minute
2. Pivmecillinam
400 mg PO initial dose, then 200 mg PO TDS for three days
3. Fosfomycin 3 g single sachet dose -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 119
Incorrect
-
What is the main mechanism of action of dobutamine as an inotropic sympathomimetic:
Your Answer:
Correct Answer: Beta1-receptor agonist
Explanation:Dobutamine directly stimulates the beta1-adrenergic receptors in the heart and increases contractility and cardiac output with little effect on the rate. In addition action on beta2-receptors causes vasodilation.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 120
Incorrect
-
A 23 year old student presents to ED with a widespread maculopapular rash. She recently had a sore throat and was started on a course of antibiotics. The most likely antibiotic that she was prescribed is:
Your Answer:
Correct Answer: Amoxicillin
Explanation:Maculopapular rashes are commonly seen with ampicillin and amoxicillin. However they are not usually related to true penicillin allergy. Very often, they occur in patients with glandular fever and so, broad-spectrum penicillins should not be used blindly, for management and treatment of a sore throat. There is also an increased risk of rash in patients with acute or chronic lymphocytic leukaemia or in cytomegalovirus infection.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 121
Incorrect
-
Regarding drug interactions with erythromycin, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: Erythromycin decreases plasma levels of warfarin.
Explanation:Erythromycin and clarithromycin inhibit cytochrome P450-mediated metabolism of warfarin, phenytoin and carbamazepine and may lead to accumulation of these drugs. There is an increased risk of myopathy (due to cytochrome P450 enzyme CYP3A4 inhibition) if erythromycin or clarithromycin is taken with atorvastatin or simvastatin. Erythromycin increases plasma concentrations of theophylline, and theophylline may also reduce absorption of oral erythromycin. All macrolides can prolong the QT-interval and concomitant use of drugs that prolong the QT interval is not recommended.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 122
Incorrect
-
A 22-year-old woman is brought in by ambulance from her GP surgery with suspected meningitis. She has been given a dose of benzylpenicillin already.
What is the mechanism of action of benzylpenicillin? Select ONE answer only.Your Answer:
Correct Answer: Inhibition of cell wall synthesis
Explanation:Penicillins and the other ß-lactam antibiotics are bactericidal. They produce their antimicrobial action by preventing cross-linkage between the linear peptidoglycan polymer chains that make up the bacterial cell wall. They, therefore, inhibit cell wall synthesis.
An overview of the different mechanisms of action of the various types of antimicrobial agents is shown below:
Mechanism of action
Examples
Inhibition of cell wall synthesis
Penicillins
Cephalosporins
Vancomycin
Disruption of cell membrane function
Polymyxins
Nystatin
Amphotericin B
Inhibition of protein synthesis
Macrolides
Aminoglycosides
Tetracyclines
Chloramphenicol
Inhibition of nucleic acid synthesis
Quinolones
Trimethoprim
5-nitroimidazoles
Rifampicin
Anti-metabolic activity
Sulfonamides
Isoniazid -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 123
Incorrect
-
A 40-year-old man complains of pain and redness in his lower thigh due to an insect bite. He was diagnosed with cellulitis. Select the first-line antibiotic for cellulitis.
Your Answer:
Correct Answer: Flucloxacillin
Explanation:Cellulitis is most commonly caused by bacteria from the group Aß-hemolytic streptococcus.
Cellulitis can be caused by animal bites. For uncomplicated cellulitis, flucloxacillin is the first-line antibiotic. Because it is beta-lactamase stable, it is efficient against Staphylococcus aureus.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 124
Incorrect
-
A 29-year-old man is diagnosed with a severe case of asthma.
In the treatment of acute asthma in adults, which of the following is NOT recommended?Your Answer:
Correct Answer: Nebulised magnesium
Explanation:There is no evidence to support the use of nebulized magnesium sulphate in the treatment of adults at this time.
In adults with acute asthma, the following medication dosages are recommended:
By using an oxygen-driven nebuliser, you can get 5 milligrams of salbutamol.
500 mcg ipratropium bromide in an oxygen-driven nebuliser
Oral prednisolone 40-50 mg
100 mg hydrocortisone intravenous
1.2-2 g magnesium sulphate IV over 20 minutes
When inhaled treatment is ineffective, intravenous salbutamol (250 mcg IV slowly) may be explored (e.g. a patient receiving bag-mask ventilation).Following senior counsel, current ALS recommendations propose that IV aminophylline be explored in severe or life-threatening asthma. If utilized, a loading dose of 5 mg/kg should be administered over 20 minutes, then a 500-700 mcg/kg/hour infusion should be given. To avoid toxicity, serum theophylline levels should be kept below 20 mcg/ml.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 125
Incorrect
-
A 25-year-old patient requires procedural sedation for reduction of an open fracture of his tibia and fibula. You plan on using ketamine as the sedative agent.
Ketamine works as a result of action on what type of receptor? Select ONE answer only.Your Answer:
Correct Answer: N-methyl-D-aspartate (NMDA)
Explanation:Ketamine is the only anaesthetic agent available that has analgesic, hypnotic, and amnesic properties. When used correctly it is a very useful and versatile drug.
Ketamine acts by non-competitive antagonism of the NMDA receptor Ca2+ channel pore and also inhibits NMDA receptor activity by interaction with the phencyclidine binding site.
Ketamine can be used intravenously and intramuscularly. The intramuscular dose is 10 mg/kg, and when used by this route, it acts within 2-8 minutes and has a duration of action of 10-20 minutes. The intravenous dose is 1.5-2 mg/kg administered over a period of 60 seconds. When used intravenously, it acts within 30 seconds and has a duration of action of 5-10 minutes. Ketamine is also effective when administered orally, rectally, and nasally.
Ketamine causes tachycardia, an increase in blood pressure, central venous pressure, and cardiac output, secondary to an increase in sympathetic tone. Baroreceptor function is well maintained, and arrhythmias are uncommon.
The main disadvantage to the use of ketamine is the high incidence of hallucinations, nightmares, and other transient psychotic effects. These can be reduced by the co-administration of a benzodiazepine, such as diazepam or midazolam.
The main side effects of ketamine are:
Nausea and vomiting
Hypertension
Nystagmus
Diplopia
Rash -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 126
Incorrect
-
In the resus area of your Emergency Department, you are called to a VF cardiac arrest.
During an adult VF arrest, which of the following points should be treated with adrenaline?Your Answer:
Correct Answer: After the 3 rd shock, once chest compressions have been resumed
Explanation:In non-shockable (PEA/asystole) cardiac arrests, adrenaline should be given as soon as circulatory access is gained. The dose is 1 mg via IV or IO (10 mL of 1:10,000 or 1 mL of 1:1000).
Once chest compressions have been resumed after the third shock in a shockable (Vf/pVT) cardiac arrest, adrenaline should be administered. The dosage is one milligram (10 mL of 1:10,000 or 1 mL of 1:1000)
It should be given every 3-5 minutes after that (i.e. alternate loops) and without interrupting chest compressions.
Systemic vasoconstriction is caused by the alpha-adrenergic effects of adrenaline, which raises coronary and cerebral perfusion pressures.Adrenaline’s beta-adrenergic effects are inotropic (increased myocardial contractility) and chronotropic (increased heart rate), and they can increase coronary and cerebral blood flow. However, concomitant increases in myocardial oxygen consumption and ectopic ventricular arrhythmias (especially in the absence of acidaemia), transient hypoxemia due to pulmonary arteriovenous shunting, impaired microcirculation, and increased post-cardiac arrest myocardial dysfunction may offset these benefits.
Although there is no evidence of long-term benefit from its use in cardiac arrest, the improved short-term survival reported in some studies justifies its use.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 127
Incorrect
-
An elderly female with a diagnosed psychiatric illness was prescribed prochlorperazine for her complaints of dizziness and nausea. Two days later, she returned to the clinic with no improvement in the symptoms.
Which one of the following is the mechanism of action of prochlorperazine?Your Answer:
Correct Answer: Dopamine receptor antagonism
Explanation:Prochlorperazine is a phenothiazine drug as it is categorized as a first-generation antipsychotic. It mainly blocks the D2 (dopamine 2) receptors in the brain. Along with dopamine, it also blocks histaminergic, cholinergic, and noradrenergic receptors.
It exerts its antiemetic effect via dopamine (D2) receptor antagonist. It is used to treat nausea and vomiting of various causes, including labyrinthine disorders.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 128
Incorrect
-
Which of the following bacteria is a rod-shaped, oxidase-positive, opportunistic gram-negative bacteria that can cause a catheter-related urinary tract infection (UTI)?
Your Answer:
Correct Answer: Pseudomonas aeruginosa
Explanation:Listeria monocytogenes is a gram-positive bacteria that does not produce spores.
Staphylococcus aureus is a gram-positive bacteria, while Candida albicans is a gram-positive yeast with a single bud.
Among the choices, gram-negative bacteria include only Klebsiella pneumoniae and Pseudomonas aeruginosa.
Pseudomonas aeruginosa is an oxidase-positive bacterium, while Klebsiella pneumoniae is an oxidase-negative bacterium.
P. aeruginosa can cause urinary tract infections (UTIs) and is spread through poor hygiene or contaminated medical equipment or devices, such as catheters that haven’t been fully sterilized.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 129
Incorrect
-
Which of the following infections is vancomycin most likely prescribed for?
Your Answer:
Correct Answer: Clostridium difficile colitis
Explanation:125 mg PO q6hr for 10 days is indicated for treatment of Clostridium difficile (C. difficile)-associated diarrhoea
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 130
Incorrect
-
Nifedipine commonly causes which of the following adverse effects?
Your Answer:
Correct Answer: Ankle oedema
Explanation:Most common adverse effects of Nifedipine include:
Peripheral oedema (10-30%)
Dizziness (23-27%)
Flushing (23-27%)
Headache (10-23%)
Heartburn (11%)
Nausea (11%) -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 131
Incorrect
-
The patient is a 78-year-old woman who has recently developed left-sided hemiplegia. A CT head scan is performed, and the diagnosis of an ischaemic stroke is confirmed. Her blood pressure is currently very high, with the most recent measurement being 196/124 mmHg, according to the nurse in charge. While you wait for the stroke team to review her, she asks you to prescribe something to help lower the patient's blood pressure.
Which of the following is the best drug treatment for this patient's BP reduction?Your Answer:
Correct Answer: Labetalol
Explanation:End-organ damage (e.g. encephalopathy, intracranial haemorrhage, acute myocardial infarction or ischaemia, dissection, pulmonary oedema, nephropathy, eclampsia, papilledema, and/or angiopathic haemolytic anaemia) characterises a hypertensive emergency (also known as ‘accelerated hypertension’ or malignant hypertension’ It’s a life-threatening condition that necessitates rapid blood pressure reduction to avoid end-organ damage and a negative outcome.
In the setting of a stroke syndrome (i.e., in the presence of focal neurological deficits), hypertensive emergencies usually necessitate a slower and more controlled blood pressure reduction than in other situations. Rapid reduction of MAP in the presence of an ischaemic stroke can compromise blood flow, leading to further ischaemia and worsening of the neurological deficit. In this situation, intravenous labetalol is the drug of choice for lowering blood pressure.
Significantly elevated blood pressure (>185/110 mmHg) is a contraindication to thrombolysis, but there is some evidence for controlling blood pressure before thrombolysis in exceptional circumstances, when it is only slightly above this threshold.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 132
Incorrect
-
Which of the following statements is correct regarding gentamicin?
Your Answer:
Correct Answer: Gentamicin is ineffective against anaerobic bacteria.
Explanation:Gentamicin is the aminoglycoside of choice and is a parenterally administered, broad spectrum antibiotic typically used for moderate to severe gram negative infections. However, it is inactive against anaerobes. There is poor activity against haemolytic streptococci and pneumococci. It is usually given in conjunction with a penicillin or metronidazole (or both) when used for the blind treatment of undiagnosed serious infections. Nephrotoxicity and ototoxicity are the main toxic effects due to damage to the vestibulocochlear nerve (CN VIII).
It is contraindicated in myasthenia gravis and should be used with great care in renal disease as it may result in accumulation and a higher risk of toxic side effects.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 133
Incorrect
-
The QRS duration of a broad-complex tachyarrhythmia is:
Your Answer:
Correct Answer: Greater than or equal to 0.12 s
Explanation:It’s a broad-complex tachycardia if the QRS duration is 0.12 seconds or more. It’s a narrow-complex tachycardia if the QRS complex is shorter than 0.12 seconds. The QRS duration should be examined if the patient with tachyarrhythmia is stable.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 134
Incorrect
-
Dysuria and urinary frequency are symptoms of a 29-year-old woman. A urine dipstick is used to detect the presence of blood, protein, leucocytes, and nitrites in the urine. You diagnose a urinary tract infection and give antibiotics to the patient.
In the United Kingdom, which of the following antibiotics has the highest percentage of E.coli resistance?Your Answer:
Correct Answer: Trimethoprim
Explanation:In the United Kingdom, antibiotic resistance is becoming a significant factor in the treatment of urinary tract infections and pyelonephritis. E. coli (the main causative organism of both urinary tract infections and acute pyelonephritis) resistance to the following antibiotics in laboratory-processed urine specimens is:
30.3 percent trimethoprim (varies by area from 27.1 to 33.4 percent )
19.8 percent co-amoxiclav (varies by area from 10.8 to 30.7 percent )
Ciprofloxacin (Cipro): 10.6% (varies by area from 7.8 to 13.7 percent )
Cefalexin has a concentration of 9.9%. (varies by area from 8.1 to 11.4 percent ) -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 135
Incorrect
-
What is the mechanism of action of penicillin antibiotics:
Your Answer:
Correct Answer: Inhibition of bacterial cell wall synthesis
Explanation:Penicillins and the other ß-lactam antibiotics are bactericidal. They produce their antimicrobial action by preventing cross-linkage between the linear peptidoglycan polymer chains that make up the bacterial cell wall. They, therefore, inhibit cell wall synthesis.
The integrity of the ß-lactam ring is essential for antimicrobial activity. Many bacteria (including most Staphylococci) are resistant to benzylpenicillin and phenoxymethylpenicillin because they produce enzymes (penicillinases, ß-lactamases) that open the ß-lactam ring. -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 136
Incorrect
-
Which of the following is NOT a typical feature of benzodiazepine toxicity:
Your Answer:
Correct Answer: Hyperventilation
Explanation:Features of benzodiazepine toxicity include: drowsiness, ataxia, dysarthria, nystagmus, occasionally respiratory depression and coma
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 137
Incorrect
-
A patient presents to ED with heartburn for which they already take regular antacids. Which of the following drugs can be affected if taken with antacids:
Your Answer:
Correct Answer: Digoxin
Explanation:Antacids should preferably not be taken at the same time as other drugs since they may affect absorption. When antacids are taken with acidic drugs (e.g. digoxin, phenytoin, chlorpromazine, isoniazid) they cause the absorption of the acidic drugs to be decreased, which causes low blood concentrations of the drugs, which ultimately results in reduced effects of the drugs. Antacids taken with drugs such as pseudoephedrine and levodopa increase absorption of the drugs and can cause toxicity/adverse events due to increased blood levels of the drugs. Antacids that contain magnesium trisilicate and magnesium hydroxide when taken with some other medications (such as tetracycline) will bind to the drugs, and reduce their absorption and effects.
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 138
Incorrect
-
In a patient with an ongoing seizure, after what time period should treatment be commenced?
Your Answer:
Correct Answer: 5 minutes
Explanation:Immediate emergency care and treatment should be given to children, young people and adults who have prolonged or repeated convulsive seizures.
Prolonged seizures last 5 minutes or more.
Repeated seizures refer to 3 or more seizures in an hour. -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 139
Incorrect
-
You need to give your patient antibiotics, so you call microbiology for some advice.
Of the following antibacterial drugs, which of them is a protein synthesis inhibitor?
Your Answer:
Correct Answer: Erythromycin
Explanation:Bacteriostatic antibiotics include erythromycin and other macrolides. They work by attaching to the bacterial ribosome’s 50S subunit, preventing translocation and, as a result, inhibit protein synthesis. Macrolide antibiotics are actively concentrated inside leukocytes and delivered into the infection site as a result.
Action Mechanisms- Examples:
Cell wall production is inhibited
Vancomycin
Vancomycin
CephalosporinsThe function of the cell membrane is disrupted
Nystatin
Polymyxins
Amphotericin BInhibition of protein synthesis
Chloramphenicol
Macrolides
Aminoglycosides
TetracyclinesNucleic acid synthesis inhibition
Quinolones
Trimethoprim
Rifampicin
5-nitroimidazoles
Sulphonamides
Anti-metabolic activity
Isoniazid -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 140
Incorrect
-
All of the following statements are correct regarding the management of acute asthma in adults except:
Your Answer:
Correct Answer: Intravenous aminophylline has been shown to result in significant additional bronchodilation compared to standard care.
Explanation:There usually isn’t any additional bronchodilation with intravenous (IV) aminophylline compared to standard care with inhaled bronchodilators and steroids. IV aminophylline may cause side effects such as arrhythmias and vomiting. However, some additional benefit may be gained in patients with near-fatal asthma or life-threatening asthma with a poor response to initial therapy (5 mg/kg loading dose over 20 minutes unless on maintenance oral therapy, then continuous infusion of 0.5 – 0.7 mg/kg/hr).
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 141
Incorrect
-
Regarding the management of gout, which of the following statements is CORRECT:
Your Answer:
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.
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This question is part of the following fields:
- Musculoskeletal
- Pharmacology
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Question 142
Incorrect
-
Adenosine has a half-life of approximately:
Your Answer:
Correct Answer: 8 - 10 seconds
Explanation:Adenosine stimulates A1-adenosine receptors and opens acetylcholine sensitive K+ channels, increasing K+ efflux. This hyperpolarises the cell membrane in the atrioventricular node and, by inhibiting the calcium channels, slows conduction in the AVN. As it has a very short duration of action (half-life only about 8 – 10 seconds), most side effects are short lived.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 143
Incorrect
-
After collapsing at home, a 75-year-old man is transported in an ambulance. He is now awake, but he is experiencing palpitations and chest pain. He is transported to resuscitation and placed on a cardiac monitor, which indicates that he is in VT. An amiodarone infusion is set up.
Which of the following statements about amiodarone side effects is correct?Your Answer:
Correct Answer: It can cause jaundice
Explanation:Amiodarone has a lot of potential toxic side effects, so it’s important to get a full clinical evaluation before starting treatment with it.
The following are some of the most common amiodarone side effects:
Arrhythmias
Corneal microdeposits
Hepatic disorders
Hyperthyroidism
Hypothyroidism
Hepatic disorders and jaundice
Nausea
Peripheral neuropathy
Respiratory disorders (including lung fibrosis)
Sleep disturbance
Skin reactions
QT prolongationAmiodarone can cause optic neuritis, which is a very rare side effect. If this happens, the amiodarone should be stopped right away because it poses a risk of blindness.
Most people who take amiodarone develop corneal microdeposits, which go away once the medication is stopped and rarely cause vision problems.
Amiodarone has a chemical structure that is similar to that of thyroxine and can bind to the nuclear thyroid receptor. It can cause both hypothyroidism and hyperthyroidism, though hypothyroidism is far more common, with 5-10% of patients suffering from it.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 144
Incorrect
-
On which of the following types of receptors does loperamide act?
Your Answer:
Correct Answer: Opioid receptors
Explanation:Loperamide inhibits acetylcholine release from the myenteric plexus acts by action on opioid mu-receptors, and this then reduces bowel motility. The intestinal transit time is increased, thereby facilitating water reabsorption.
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 145
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:
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
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Question 146
Incorrect
-
Disease specific immunoglobulin is available for all of the following infectious diseases EXCEPT for:
Your Answer:
Correct Answer: Hepatitis A
Explanation:Disease specific immunoglobulins are available for:
hepatitis B
rabies
tetanus
varicella-zoster
Normal immunoglobulin can be used to confer protection against hepatitis A. -
This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
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Question 147
Incorrect
-
The patient is a 61-year-old man with severe central chest pain. An acute myocardial infarction is revealed by his ECG. Clopidogrel is one of the medications he takes as part of his treatment.
Clopidogrel's direct mechanism of action is which of the following?Your Answer:
Correct Answer: Inhibition of platelet ADP receptors
Explanation:Clopidogrel, a thienopyridine derivative, prevents platelet aggregation and cross-linking by the protein fibrin by inhibiting the ADP receptor on platelet cell membranes (inhibits binding of ADP to its platelet receptor (P2Y12 ADP-receptor).
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 148
Incorrect
-
What is the primary mode of action of Enoxaparin?
Your Answer:
Correct Answer: Inhibits factor Xa
Explanation:Heparin acts as an anticoagulant by enhancing the inhibition rate of clotting proteases by antithrombin III impairing normal haemostasis and inhibition of factor Xa. Low molecular weight heparins have a small effect on the activated partial thromboplastin time and strongly inhibit factor Xa. Enoxaparin is derived from porcine heparin that undergoes benzylation followed by alkaline depolymerization.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 149
Incorrect
-
A 52-year-old woman visits her local pharmacy to get medication to help with mild dyspepsia symptoms. The pharmacist on duty suggests she uses an over-the-counter antacid. She purchases an antacid that contains magnesium carbonate, which relieves her symptoms, but she unfortunately also develops a side effect.
Out of the following, which side effect is she MOST likely to develop after using the antacid?Your Answer:
Correct Answer: Diarrhoea
Explanation:Magnesium carbonate is an over the counter antacid commonly used to relieve symptoms in ulcer dyspepsia and non-erosive gastro-oesophageal reflux.
Antacids containing magnesium also tend to work as a laxative, while the antacids with aluminium may cause constipation. There is no significant increased risk of anaphylaxis, hepatotoxicity or renal impairment.
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This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
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Question 150
Incorrect
-
In adult basic life support, chest compressions should be performed at which of the following rates:
Your Answer:
Correct Answer: 100 - 120 per minute
Explanation:Chest compressions should be performed at a rate of 100 – 120 per minute.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 151
Incorrect
-
A 6-year-old child with a few itchy honey crusted sores on her left cheek is brought in by her mother. Following a thorough examination of the child, you diagnose impetigo and recommend a course of topical fusidic acid.
Fusidic acid's mode of action is which of the following?Your Answer:
Correct Answer: Inhibition of protein synthesis
Explanation:By binding EF-G-GDP, fusidic acid prevents both peptide translocation and ribosome disassembly, which slows protein synthesis. Because it has a novel structure and mechanism of action, it is unlikely to cause cross-resistance with existing antibiotics.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 152
Incorrect
-
A 72-year-old man has a past medical history of diverticular disease. He now presents in the clinic with crampy abdominal pain. The nurse at the triage suggests prescribing hyoscine butyl bromide to help relieve the abdominal pain. However, you do not agree with this medication, as you can see on his chart that the patient has several other comorbidities.
Out of the following, what is NOT a contraindication to using hyoscine butyl bromide?Your Answer:
Correct Answer: Prostatic hyperplasia
Explanation:Hyoscine butylbromide is an antispasmodic drug that blocks muscarinic receptors and reduces intestinal motility. It is used for gastrointestinal and genitourinary smooth muscle spasms and symptomatic relief of IBS.
It has the following contraindications:
1. Closed-angle glaucoma
2. Gastrointestinal obstruction
3. Intestinal atony
4. Paralytic ileus
5. Toxic megacolon
6. Severe ulcerative colitis
7. Significant bladder outflow obstruction
8. Urinary retention
9. Myasthenia gravisUse cautiously in the following conditions:
1. Acute myocardial infarction (in adults)
2. Arrhythmias (may be worsened)
3. Autonomic neuropathy
4. Hypertension
5. Cardiac insufficiency (due to association with tachycardia)
6. Congestive cardiac failure (maybe worsened)
7. Cardiac surgery (due to association with tachycardia)
8. Gastro-oesophageal reflux disease
9. Ulcerative colitis
10. Prostatic hyperplasia
11. Use in children (increased risk of side effects) -
This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
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Question 153
Incorrect
-
What is the mechanism of action of captopril:
Your Answer:
Correct Answer: Angiotensin-converting enzyme inhibitor
Explanation:Captopril is an angiotensin-converting enzyme (ACE) inhibitor, which inhibits the conversion of angiotensin I to angiotensin II.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 154
Incorrect
-
A 22-year-old presents with acute severe asthma. He takes a drug prescribed by her GP but cannot recall the name and is receiving regular salbutamol nebulisers. His current potassium level is 2.8 mmol/l.
Which drug is least likely to have caused his hypokalaemia?
Your Answer:
Correct Answer: Spironolactone
Explanation:Serious hypokalaemia can occur in severe asthma and the effect can be potentiated by concomitant treatment with theophyllines like aminophylline, corticosteroids, thiazide and loop diuretics, and hypoxia. Plasma-potassium concentration should be monitored in severe asthma.
Spironolactone, a potassium-sparing diuretic, is not likely to have contributed to patients hypokalaemia.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 155
Incorrect
-
A 4-year-old child has been convulsing for 20 minutes. She has received two doses of lorazepam. She takes phenytoin for maintenance therapy, and you draw up a phenobarbitone infusion.
What dose of phenobarbitone is advised in the treatment of the convulsing child that reaches that stage of the APLS algorithm? Select ONE answer only.Your Answer:
Correct Answer: 20 mg/kg over 30-60 minutes
Explanation:If a convulsing child reaches step 3 of the APLS algorithm, then a phenytoin infusion should be set up at 20 mg/kg over 20 minutes. If they are already taken phenytoin as maintenance therapy, then a phenobarbitone infusion should be set up at 20 mg/kg over 30-60 minutes.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 156
Incorrect
-
Intravenous glucose solutions are typically used in the treatment of all of the following situations except:
Your Answer:
Correct Answer: Hypokalaemia
Explanation:In hypokalaemia, initial potassium replacement therapy should not involve glucose infusions, as glucose may cause a further decrease in the plasma-potassium concentration. Glucose infusions are used for the other indications like diabetic ketoacidosis, hypoglycaemia, routine fluid maintenance in patients who are nil by mouth (very important in children), and in hyperkalaemia.
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This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
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Question 157
Incorrect
-
What is the direct mechanism of action of digoxin as a positive inotrope:
Your Answer:
Correct Answer: Inhibition of Na+/K+ ATPase pump
Explanation:Digoxin directly inhibits membrane Na+/K+ ATPase, which is responsible for Na+/K+ exchange across the myocyte cell membrane. This increases intracellular Na+ and produces a secondary increase in intracellular Ca2+ that increases the force of myocardial contraction. The increase in intracellular Ca2+ occurs because the decreased Na+ gradient across the membrane reduces the extrusion of Ca2+ by the Na+/Ca2+ exchanger that normally occurs during diastole. Digoxin and K+ ions compete for the receptor on the outside of the muscle cell membrane, and so the effects of digoxin may be dangerously increased in hypokalaemia.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 158
Incorrect
-
A 59-year-old man presents to the emergency room with chest pain. The cardiology team recently discharged him. He underwent a procedure and was given several medications, including abciximab, during his stay. Which of the following statements about abciximab is correct?
Your Answer:
Correct Answer: It is a glycoprotein IIa/IIIb receptor antagonist
Explanation:Abciximab (ReoPro) is a glycoprotein IIb/IIIa receptor antagonist that is a chimeric monoclonal antibody. It is primarily used during and after coronary artery procedures such as angioplasty to inhibit platelet aggregation.
It’s approved for use as a supplement to heparin and aspirin in high-risk patients undergoing percutaneous transluminal coronary intervention to prevent ischaemic complications. Only one dose of abciximab should be given (to avoid additional risk of thrombocytopenia).
Before using, it is recommended that baseline prothrombin time, activated clotting time, activated partial thromboplastin time, platelet count, haemoglobin, and haematocrit be measured. 12 and 24 hours after starting treatment, haemoglobin and haematocrit should be measured again, as should platelet count 2-4 hours and 24 hours after starting treatment.
When used for high-risk patients undergoing angioplasty, the EPIC trial(link is external)found that abciximab reduced the risk of death, myocardial infarction, repeat angioplasty, bypass surgery, and balloon pump insertion.The use of abciximab is contraindicated in the following situations:
Internal bleeding is present.
Within the last two months, you’ve had major surgery, intracranial surgery, or trauma.
Stroke in the previous two years
Intracranial tumour
Aneurysm or arteriovenous malformation
Haemorrhagic diathesis is a type of haemorrhagic diathesis.
Vasculitis
Retinopathy caused by hypertensionThe following are some of the most common abciximab side effects:
Manifestations of bleeding
Bradycardia
Back ache
Pain in the chest
Vomiting and nausea
Pain at the puncture site
Thrombocytopenia -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 159
Incorrect
-
The functional residual capacity (FRC) will be decreased in which of the following:
Your Answer:
Correct Answer: Pulmonary fibrosis
Explanation:Factors decreasing FRC:
Restrictive ventilatory defects e.g. pulmonary fibrosis
Posture – lying supine
Increased intra-abdominal pressure (e.g. obesity, pregnancy, ascites)
Reduced muscle tone of diaphragm e.g. muscle relaxants in anaesthesia, neuromuscular disease -
This question is part of the following fields:
- Physiology
- Respiratory
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Question 160
Incorrect
-
A known epileptic is transported in status epilepticus by ambulance. On the way to the hospital, she took some diazepam.
Which of the following statements about diazepam is correct?Your Answer:
Correct Answer: It crosses into breast milk
Explanation:Diazepam boosts GABA’s effects, giving it sedative, hypnotic, anxiolytic, anticonvulsant, and muscle-relaxing properties. It can be administered orally, rectally, or intravenously.
With a half-life of 20-100 hours, it is a long-acting benzodiazepine. Midazolam, oxazepam, and alprazolam are examples of short-acting benzodiazepines with a half-life of less than 12 hours (Xanax).
If used in the presence of hepatic impairment, benzodiazepines can cause coma. If treatment is necessary, benzodiazepines with shorter half-lives should be used in lower doses. Diazepam is a sedative that crosses into breast milk and should be avoided by breastfeeding mothers.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 161
Incorrect
-
A GP is considering prescribing a non-steroidal anti-inflammatory (NSAID) for pain relief for a patient with a knee injury
Which of these statements about NSAIDs is NOT true?Your Answer:
Correct Answer: Side effects are less commonly seen with indomethacin than naproxen
Explanation:Most NSAIDs act as non-selective inhibitors of the enzyme cyclo-oxygenase (COX). They inhibit both COX-1 and COX-2 isoenzymes.
Only about 60% of patients will respond to any given NSAID.
It can take 21 days of treatment for a clinically appreciable reduction in inflammation to be apparent. If no improvement is seen after 21 days, the NSAID should be changed.
The use of NSAIDs in the 3rd trimester of pregnancy is associated with the following risks: delayed onset of labour, premature closure of ductus arteriosus and foetal kernicterus.
Side effects are lowest in Ibuprofen and highest in indomethacin. so side effects are more commonly seen with indomethacin than naproxen.
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This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 162
Incorrect
-
You review a sick patient in resus who has been prescribed mannitol as part of his treatment protocol.
Which SINGLE statement regarding mannitol is true?Your Answer:
Correct Answer: It is irritant to veins and causes phlebitis
Explanation:Mannitol is a low molecular weight compound and is therefore freely filtered at the glomerulus and is not reabsorbed. It, therefore, increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain barrier (BBB).
Mannitol is primarily used to reduce the pressure and volume of cerebrospinal fluid (CSF). It decreases the volume of CSF by:
Decreasing the rate of CSF formation,and;
Withdrawing extracellular fluid from the brain across the BBB
Other uses of mannitol include:
Short-term management of glaucoma
Treatment of rhabdomyolysis
Preserve renal function in peri-operative jaundiced patients
To initiate diuresis in transplanted kidneys
Bowel preparation prior to colorectal procedures
The recommended dose of mannitol for the reduction of CSF pressure/cerebral oedema is 0.25-2g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.
Circulatory overload and rebound increases in intracranial pressure may occur following the use of mannitol. It is irritant to tissues and veins and can cause inflammation and phlebitis.
Mannitol causes an expansion of the extracellular fluid space, which may worsen congestive cardiac failure. Contraindications to the use of mannitol include:
Anuria
Intracranial bleeding (except during craniotomy)
Severe cardiac failure
Severe dehydration
Severe pulmonary oedema -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 163
Incorrect
-
In the United Kingdom, which of the following is the most often used intravenous aesthetic:
Your Answer:
Correct Answer: Propofol
Explanation:In the United Kingdom, propofol is the most widely used intravenous anaesthetic. In adults and children, it can be used to induce or maintain anaesthesia, although it is not commonly used in newborns. It can also be used to sedate individuals in intensive care and for sedation during operations.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 164
Incorrect
-
Regarding antimuscarinic antispasmodics, which of the following statements is CORRECT:
Your Answer:
Correct Answer: They are contraindicated in paralytic ileus.
Explanation:Antimuscarinics are contraindicated in paralytic ileus. Antimuscarinics reduce intestinal motility by blocking muscarinic acetylcholine receptors and relaxing smooth muscle. Hyoscine butylbromide is advocated as a gastrointestinal antispasmodic, but it is poorly absorbed and thus has limited clinical utility. Antimuscarinics cause a reduction in bronchial secretions (they can be used to this effect in palliative patients). Antispasmodics are occasionally of value in treating abdominal cramp associated with diarrhoea but they should not be used for primary treatment. Antispasmodics should be avoided in young children with gastroenteritis because they are rarely effective and have troublesome side effects.
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 165
Incorrect
-
A young boy is carried by his friends to the Emergency Department in an unconscious state. He is quickly moved into the resuscitation room.
He was at a party with friends and has injected heroin. On examination, his GCS is 6/15, and he has bilateral pinpoint pupils and a very low respiratory rate of 6 breaths per minute.
Which of the following is the first-line treatment for this patient?Your Answer:
Correct Answer: Naloxone 0.8 mg IV
Explanation:Heroin is injected into the veins and is the most commonly abused drug. Acute intoxication with opioid overuse is the most common cause of death by drug overdose.
The clinical features of opioid overdose are:
1. Decreased respiratory rate
2. Reduced conscious level or coma
3. Decreased bowel sounds
4. Miotic (constricted) pupils
5. Cyanosis
6. Hypotension
7. Seizures
8. Non-cardiogenic pulmonary oedema (with IV heroin usage)The main cause of death secondary to opioid overdose is respiratory depression, which usually occurs within 1 hour of the overdose. Vomiting is also common, and aspiration can occur.
Naloxone is a short-acting, specific antagonist of mu(μ)-opioid receptors. It is used to reverse the effects of opioid toxicity.
It can be given by a continuous infusion if repeated doses are required and the infusion rate is adjusted according to the vital signs. Initially, the infusion rate can be set at 60% of the initial resuscitative IV dose per hour.
Naloxone has a shorter duration of action (6-24 hours) than most opioids, and so close monitoring according to the respiratory rate and depth of coma with repeated injections is necessary. When repeated doses are needed in opioid addicts, naloxone administration may precipitate a withdrawal syndrome with abdominal cramps, nausea and diarrhoea, but these usually settle within 2 hours.
An initial dose of 0.4 to 2 mg can be given intravenously and can be repeated at 2 to 3-minute intervals to a maximum of 10mg.
If the intravenous route is inaccessible, naloxone can be administered via an IO line, subcutaneously (SQ), IM, or via the intranasal (IN) route.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 166
Incorrect
-
You review a 46-year-old woman who has recently been prescribed antibiotics for a urinary tract infection. She suffers from COPD and is currently prescribed salbutamol and Seretide inhalers, and Phyllocontin continus. Since starting the antibiotics, she has been experiencing nausea, vomiting and abdominal pain.
Which of the following antibiotics is she MOST LIKELY to have been prescribed for her UTI? Select ONE answer only .Your Answer:
Correct Answer: Ciprofloxacin
Explanation:Phyllocontin continus contains aminophylline (a mixture of theophylline and ethylenediamine), a bronchodilator used in the management of COPD and asthma.
This patient is exhibiting symptoms of theophylline toxicity, which may have been triggered by the prescription of the antibiotic. Quinolone antibiotics, such as ciprofloxacin and levofloxacin, and macrolide antibiotics, such as erythromycin, increase the plasma concentration of theophyllines and can lead to toxicity.
The drugs that commonly affect the half-life and the plasma concentration of theophylline are summarised in the table below:
Drugs increasing plasma concentration of theophylline
Drugs decreasing plasma concentration of theophylline
Calcium channel blockers, e.g. Verapamil
Cimetidine
Fluconazole
Macrolides, e.g. erythromycin
Quinolones, e.g. ciprofloxacin
Methotrexate
Barbiturates
Carbamazepine
Phenobarbitol
Phenytoin (and fosphenytoin)
Rifampicin
St. John’s wort -
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 167
Incorrect
-
A 20-year-old boy took almost 25 tablets of paracetamol almost 4 hours ago. The boy is healthy and has no known comorbid or drug history.
Out of the following metabolic pathways, which one is primarily responsible for the toxic effects of paracetamol?Your Answer:
Correct Answer: N-hydroxylation
Explanation:Paracetamol is predominantly metabolized in the liver by three main metabolic pathways:
1. Glucuronidation (45-55%)
2. Sulphate conjugation (30-35%)
3. N-hydroxylation via the hepatic cytochrome P450 enzyme system (10-15%)Cytochrome P450 enzymes catalyse the oxidation of acetaminophen to the reactive metabolite N-acetyl-p-benzoquinoneimine (NAPQI). NAPQI primarily contributes to the toxic effects of acetaminophen. NAPQI is an intermediate metabolite that is further metabolized by fast conjugation with glutathione. The conjugated metabolite is then excreted in the urine as mercapturic acid. High doses of acetaminophen (overdoses) can lead to hepatic necrosis due to depleting glutathione and high binding levels of reactive metabolite (NAPQI) to important parts of liver cells.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 168
Incorrect
-
A 58-year-old man with a long history of depression presents with a deliberate overdose of verapamil tablets, which he is prescribed for a heart condition.
What is verapamil's mechanism of action?Your Answer:
Correct Answer: L-type calcium channel blockade
Explanation:Overdosing on calcium-channel blockers should always be taken seriously and regarded as potentially fatal. Verapamil and diltiazem are the two most lethal calcium channel blockers in overdose. These work by binding the alpha-1 subunit of L-type calcium channels, preventing calcium from entering the cell. In cardiac myocytes, vascular smooth muscle cells, and islet beta-cells, these channels play an important role.
The standard ABC approach should be used to resuscitate all patients as needed. If life-threatening toxicity is expected, intubation and ventilation should be considered early on. If hypotension and shock are developing, early invasive blood pressure monitoring is recommended.
The primary goal of specific treatments is to support the cardiovascular system. These are some of them:
1. Fluid resuscitation: Give up to 20 mL of crystalloid per kilogramme of body weight.
2. Calcium supplementation
This can be a good way to raise blood pressure and heart rate temporarily.
via central venous access: 10% calcium gluconate 60 mL IV (0.6-1.0 mL/kg in children) or 10% calcium chloride 20 mL IV (0.2 mL/kg in children)
Boluses can be given up to three times in a row.
To keep serum calcium >2.0 mEq/L, consider a calcium infusion.3. Atropine: 0.6 mg every 2 minutes up to 1.8 mg is an option, but it is often ineffective.
4. HIET (high-dose insulin-euglycemic therapy):
The role of HIET in the step-by-step management of cardiovascular toxicity has changed.5. Vasoactive infusions:
This was once thought to be a last-ditch measure, but it is now widely recommended that it be used sooner rather than later.
Insulin with a short half-life 50 mL of 50 percent glucose IV bolus plus 1 U/kg bolus (unless marked hyperglycaemia present)
Short-acting insulin/dextrose infusions should be continued.
Glucose should be checked every 20 minutes for the first hour, then hourly after that.
Regularly check potassium levels and replace if they fall below 2.5 mmol/L.
Titrate catecholamines to effect (inotropy and chronotropy); options include dopamine, adrenaline, and/or noradrenaline infusions.6. Sodium bicarbonate: Use 50-100 mEq sodium bicarbonate (0.5-1.0 mEq/kg in children) in cases where a severe metabolic acidosis develops.
7. Cardiac pacing: It can be difficult to achieve electrical capture, and it may not improve overall perfusion.
Bypass AV blockade with ventricular pacing, which is usually done at a rate of less than 60 beats per minute.8. Intralipid transport
Calcium channel blockers are lipid-soluble agents, so they should be used in refractory cases. -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 169
Incorrect
-
Which of the following side effects is more common of etomidate than other intravenous induction agents:
Your Answer:
Correct Answer: Extraneous muscle movements
Explanation:Etomidate is associated with a high incidence of extraneous muscle movements, which can be minimised by an opioid analgesic or a short-acting benzodiazepine given prior to induction. Etomidate causes less hypotension than thiopental sodium and propofol during induction. Etomidate is associated with rapid recovery without a hangover effect. The rate of respiratory depression and tachycardia is not higher in etomidate.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 170
Incorrect
-
The functional residual capacity (FRC) will be increased in which of the following:
Your Answer:
Correct Answer: Emphysema
Explanation:Factors increasing FRC:
Emphysema
Air trapping in asthma
Ageing (due to loss of elastic properties)
Increasing height of patient -
This question is part of the following fields:
- Physiology
- Respiratory
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Question 171
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:
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
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Question 172
Incorrect
-
A 44-year-old man with an acute episode of gout presents to you and you discuss treatment plan with him.
Which one of these statements concerning the treatment of acute gout is true?Your Answer:
Correct Answer: A common first-line treatment is Naproxen as a stat dose of 750 mg followed by 250 mg TDS
Explanation:High-dose NSAIDs are the first-line treatment for acute gout. In the absence of any contraindications, Naproxen 750 mg as a stat dose followed by 250 mg TDS is commonly used.
Aspirin is contraindicated in gout. It reduces the urinary clearance of urate and also interferes with the action of uricosuric agents.
Colchicine is preferred in patients with heart failure or in those who are intolerant of NSAIDs. It is as effective as NSAIDs in relieving acute attacks.
Colchicine acts on the neutrophils, binding to tubulin to prevent neutrophil migration into the joint. Where Allopurinol is not tolerated, it has a role in prophylactic treatment of gout.
Allopurinol should not be started in the acute phase of gout as it increases the severity and duration of symptoms. It is used as a prophylaxis in preventing future attacks and acts by reducing serum uric acid levels.
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This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 173
Incorrect
-
You review a 56-year-old man who has recently been prescribed antibiotics for a chest infection. He suffers from COPD and is currently prescribed salbutamol and Seretide inhalers, and Phyllocontin continus. Since starting the antibiotics, he has been experiencing nausea, vomiting and abdominal pain.
Which of the following antibiotics is he MOST LIKELY to have been prescribed for his chest infection? Select ONE answer only .Your Answer:
Correct Answer: Levofloxacin
Explanation:Phyllocontin continus contains aminophylline (a mixture of theophylline and ethylenediamine), a bronchodilator used in the management of COPD and asthma.
This patient is exhibiting symptoms of theophylline toxicity, which may have been triggered by the prescription of the antibiotic. Quinolone antibiotics, such as ciprofloxacin and levofloxacin, and macrolide antibiotics, such as erythromycin, increase the plasma concentration of theophyllines and can lead to toxicity.
The drugs that commonly affect the half-life and the plasma concentration of theophylline are summarised in the table below:
Drugs increasing plasma concentration of theophylline
Drugs decreasing plasma concentration of theophylline
Calcium channel blockers, e.g. Verapamil
Cimetidine
Fluconazole
Macrolides, e.g. erythromycin
Quinolones, e.g. ciprofloxacin
Methotrexate
Barbiturates
Carbamazepine
Phenobarbitol
Phenytoin (and fosphenytoin)
Rifampicin
St. John’s wort -
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 174
Incorrect
-
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:
Correct Answer: Constipation
Explanation:Aluminium hydroxide is a common antacid that is used to treat ulcer dyspepsia and non-erosive gastro-oesophageal reflux disease.
When antacids containing aluminium salts are given to patients with renal impairment, there is a risk of accumulation and aluminium toxicity. If renal function is normal, aluminium accumulation does not appear to be a risk.
Because it reduces gastrointestinal phosphate absorption, aluminium hydroxide can also be used to treat hyperphosphatemia in patients with renal failure.
Magnesium-based antacids are generally laxative, whereas aluminium-based antacids can be constipating. Renal impairment, angioedema, and anaphylaxis are not significantly increased.
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This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
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Question 175
Incorrect
-
For which of the following infections is phenoxymethylpenicillin (penicillin V) primarily used?
Your Answer:
Correct Answer: Streptococcal tonsillitis
Explanation:Phenoxymethylpenicillin (penicillin V) is less active than benzylpenicillin but both have similar antibacterial spectrum. Because penicillin V is gastric-acid stable, it is suitable for oral administration, but should not be used for serious infections as absorption can be unpredictable and plasma concentrations can be variable.
Its uses are:
1. mainly for respiratory tract infections in children
2. for streptococcal tonsillitis
3. for continuing treatment after one or more injections of benzylpenicillin when clinical response has begun.
4. for prophylaxis against streptococcal infections following rheumatic fever and against pneumococcal infections following splenectomy or in sickle-cell disease.It should not be used for meningococcal or gonococcal infections.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 176
Incorrect
-
Which of the following statements about propofol is TRUE:
Your Answer:
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 177
Incorrect
-
In relation to ketamine, which of the following statements is TRUE:
Your Answer:
Correct 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 178
Incorrect
-
A 78-year-old man develops renal impairment and hearing loss after inpatient management for sepsis.
Which of these antibiotics is most likely to have been used?Your Answer:
Correct Answer: Gentamicin
Explanation:Gentamicin, an aminoglycoside antibiotic, acts by binding to the 30S subunit of the bacterial ribosome inhibiting the binding of aminoacyl-tRNA, and thus prevents initiation of protein synthesis.
Two of its most notable side effects are reversible nephrotoxicity(caused by the inhibition of protein synthesis in renal cells, which causes acute tubular necrosis) and hearing loss (caused by damage to the vestibular apparatus of the inner ear).
Both side effects are dose-related and occur commonly in the elderly.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 179
Incorrect
-
Question 180
Incorrect
-
Which of the following is NOT a common side effect of diazepam:
Your Answer:
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 181
Incorrect
-
During her pregnancy, a 28-year-old lady was given an antibiotic. The neonate is born with bilateral deafness as a result of this.
From the following antibiotics, which one is most likely to cause this side effect?Your Answer:
Correct Answer: Gentamicin
Explanation:Aminoglycosides cross the placenta and are linked to poisoning of the 8th cranial nerve in the foetus, as well as permanent bilateral deafness.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 182
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:
Correct Answer: 100 micrograms
Explanation:The dose of a conventional metered dose inhaler is 100 micrograms per metered inhalation.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 183
Incorrect
-
A 70-year-old patient presents with a chronic digoxin overdose. She has vomited several times, is extremely tired, and her vision 'appears yellow,' according to her.
Which of the following is a reason for this patient's use of Digifab?Your Answer:
Correct Answer: Coexistent renal failure
Explanation:An antidote for digoxin overdose is digoxin-specific antibody (Digifab). It’s a lyophilized preparation of digoxin-immune ovine Fab immunoglobulin fragments that’s sterile, purified, and lyophilized. These fragments were extracted from the blood of healthy sheep that had been immunised with a digoxin derivative called digoxin-dicarboxymethoxylamine (DDMA), a digoxin analogue that contains the functionally important cyclopentaperhydrophenanthrene:lactone ring moiety coupled to keyhole limpet hemocyanin (KLH).
Digifab has a higher affinity for digoxin than digoxin does for its sodium pump receptor, which is thought to be the site of its therapeutic and toxic effects. When given to a patient who is intoxicated, Digifab binds to digoxin molecules, lowering free digoxin levels and shifting the equilibrium away from binding to receptors, reducing cardio-toxic effects. The kidney and reticuloendothelial system then clear the Fab-digoxin complexes.
The following summarises the indications for Digifab in acute and chronic digoxin toxicity:
Acute digoxin toxicity
Chronic digoxin toxicity
Cardiac arrest
Life-threatening arrhythmia
Potassium level > 5 mmol/l
>10 mg digoxin ingested (adult)
>4 mg digoxin ingested (child)
Digoxin level > 12 ng/ml
Cardiac arrest
Life-threatening arrhythmia
Significant gastrointestinal symptoms
Symptoms of digoxin toxicity -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 184
Incorrect
-
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:
Correct 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.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 185
Incorrect
-
In the Emergency Department, a 35-year-old woman actively seizing is brought in. She is quickly shifted into the resuscitation room and is administered a dose of benzodiazepine. The seizure is quickly terminated.
Once the patient is stable, she tells you she is a known case of epilepsy and takes phenytoin to control it.
Which of the following is the primary mechanism of action of phenytoin?Your Answer:
Correct Answer: Sodium channel blocker
Explanation:Phenytoin is in the anticonvulsants class of drugs and is used in the management and treatment of the following:
1. epilepsy
2. generalized tonic-clonic seizures
3. complex partial seizures
4. status epilepticus.It works by inactivating the voltage-gated sodium channels responsible for increasing the action potential. It is non-specific and targets almost all voltage-gated sodium channel subtypes. More specifically, phenytoin prevents seizures by inhibiting the positive feedback loop that results in neuronal propagation of high-frequency action potentials.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 186
Incorrect
-
A 40-year-old man who has a history of asthma arrives at the emergency department complaining of palpitations that have been going on for 5 days. Which of the following beta-blockers is the safest for an asthmatic patient?
Your Answer:
Correct Answer: Atenolol
Explanation:Atenolol is a beta blocker, which is a type of medication that works by preventing certain natural substances in the body, such as epinephrine, from acting on the heart and blood vessels.
This effect reduces heart rate, blood pressure, and cardiac strain. Atenolol, bisoprolol fumarate, metoprolol tartrate, nebivolol, and (to a lesser extent) acebutolol have a lower action on beta2 (bronchial) receptors and are thus cardio selective but not cardiac specific.
They have a lower effect on airway resistance, although they are not without this adverse effect.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 187
Incorrect
-
You examine a 50-year-old female who has a swollen, painful right big toe. She has a history of gout, and this discomfort is identical to prior relapses, according to her. She is currently taking 200 mg of allopurinol per day and has been for the last year. This is her second round of acute gout within this time period. She has no prior medical history to speak of and does not take any other medications. She doesn't have any known drug allergies.
Which of the following management options is the SINGLE MOST APPROPRIATE?Your Answer:
Correct Answer: Continue with the allopurinol and commence naproxen
Explanation:Allopurinol should not be started during an acute gout episode because it can both prolong and trigger another acute attack. Allopurinol should be continued in patients who are currently taking it, and acute attacks should be treated as usual with NSAIDs or colchicine, as needed.
Non-steroidal anti-inflammatory medications (NSAIDs), such as naproxen, are the first-line treatment for acute gout attacks. Colchicine can be used in situations where NSAIDs are contraindicated, such as in patients with hypertension or those who have had a history of peptic ulcer disease. Because there is no reason for this patient to avoid NSAIDs, naproxen would be the medicine of choice from the list above.
It would be reasonable to titrate up the allopurinol dose once the acute episode has subsided, targeting <6 mg/dl (<360 µmol/l) plasma urate levels .
Febuxostat (Uloric) is a drug that can be used instead of allopurinol to treat persistent gout. -
This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 188
Incorrect
-
You examine a 34-year-old lady with symptoms that are consistent with acute sinusitis. You're thinking about giving her doxycycline for treatment.
What is doxycycline's mechanism of action?Your Answer:
Correct Answer: Inhibition of protein synthesis
Explanation:Doxycycline and other tetracycline antibiotics attach to the 30S subunit of the bacterial ribosome, preventing aminoacyl-tRNA binding and so protein synthesis beginning.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 189
Incorrect
-
A 66-year-old female who is a known case of atrial fibrillation comes to the Emergency Department with the complaint of fever and vomiting for the past two days. When her medical chart is reviewed, you see that she takes Warfarin for her arrhythmia.
Which ONE of the following medications cannot be prescribed to this patient?Your Answer:
Correct Answer: Ibuprofen
Explanation:Like other non-steroidal anti-inflammatory drugs, Ibuprofen cannot be given with Warfarin as it would increase the bleeding risk of this patient.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 190
Incorrect
-
After collapsing in his nursing home, a 70-year-old man is brought into the ER. He is a known case of diabetes mellitus and is on medication for it. An RBS of 2.5 mmol/L (3.9-5.5 mmol/L) is recorded in the ER.
Out of the following, which medication for diabetes mellitus is MOST likely responsible for his hypoglycaemic episode?Your Answer:
Correct Answer: Pioglitazone
Explanation:Pioglitazone is used to treat type 2 diabetes mellitus. It selectively stimulates the nuclear receptor peroxisome proliferator-activated receptor gamma (PPAR-γ) and to a lesser extent PPAR-α.
Of the medications mentioned in this question, only pioglitazone is a recognized cause of hypoglycaemia.
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This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 191
Incorrect
-
A 55-year-old female is urgently rushed into the Emergency Department as she complains of chest pain that is worse on breathing, shortness of breath, palpitations, and haemoptysis.
She undergoes a CT pulmonary angiogram, which reveals a large pulmonary embolus. She is immediately started on heparin and shifted to the acute medical ward.
Which of the following does heparin activate?Your Answer:
Correct Answer: Antithrombin III
Explanation:Heparin works by binding to and activating the enzyme inhibitor antithrombin III.
Antithrombin III inactivates thrombin (factor IIa) by forming a 1:1 complex with thrombin. The heparin-antithrombin III complex also inhibits factor Xa and some other proteases involved with clotting. The heparin-ATIII complex can also inactivate IX, XI, XII, and plasmin.
Heparin is a polymer of glycosaminoglycan. It occurs naturally and is found in mast cells. Clinically, it is used in two forms:
1. Unfractionated: widely varying polymer chain lengths
2. Low molecular weight: Smaller polymers onlyHeparin is not thrombolytic or fibrinolytic. It prevents the progression of existing clots by inhibiting further clotting. The lysis of existing clots relies on endogenous thrombolytics.
Heparin is used for:
1. Prevention and treatment of venous thromboembolism
2. Treatment of disseminated intravascular coagulation
3. Treatment of fat embolism
4. Priming of haemodialysis and cardiopulmonary bypass machines -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 192
Incorrect
-
A patient presents with an acute severe asthma attack. Following a poor response to his initial salbutamol nebuliser, you administer a further nebuliser that this time also contains ipratropium bromide.
After what time period would you expect the maximum effect of the ipratropium bromide to occur? Select ONE answer only.Your Answer:
Correct Answer: 30 -60 minutes
Explanation:Ipratropium bromide is an antimuscarinic drug used in the management of acute asthma and COPD. It can provide short-term relief in chronic asthma, but short-acting β2agonists act more quickly and are preferred.
The BTS guidelines recommend that nebulised ipratropium bromide (0.5 mg 4-6 hourly) can be added to β2agonist treatment for patients with acute severe or life-threatening asthma or those with a poor initial response to β2 agonist therapy.
The aerosol inhalation of ipratropium can be used for short-term relief in mild chronic obstructive pulmonary disease in patients who are not already using a long-acting antimuscarinic drug (e.g. tiotropium).Its maximum effect occurs 30-60 minutes after use; its duration of action is 3-6 hours, and bronchodilation can usually be maintained with treatment three times per day.
The commonest side effect of ipratropium bromide is dry mouth. It can also trigger acute closed-angle glaucoma in susceptible patients. Tremor is commonly seen with β2agonists but not with antimuscarinics. Ipratropium bromide should be used with caution in: Men with prostatic hyperplasia and bladder-outflow obstruction (worsened urinary retention has been reported in elderly men), People with chronic kidney disease (CKD) stages 3 and above (because of the risk of drug toxicity), People with angle-closure glaucoma (nebulised mist of antimuscarinic drugs can precipitate or worsen acute angle-closure glaucoma) -
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 193
Incorrect
-
A 72-year-old woman presents to your clinic with worsening oedema. She has ischaemic heart disease and heart failure. You decide to add a loop diuretic to her current drug regime to control the oedema. Which of the following is a contraindication to using a loop diuretic?
Your Answer:
Correct Answer: Anuria
Explanation:Loop diuretics are drugs used to manage and treat fluid overload associated with CHF, liver cirrhosis, and renal disease. The drugs commonly used are:
- Furosemide
- Bumetanide
- Torsemide
- Ethacrynic Acid
Loop diuretics inhibit the Na-K-Cl pump in the ascending loop of Henle, resulting in salt-water excretion. This relieves congestion and reduces oedema.
The contra-indications to the use of loop diuretics are:
1. Anuria
2. Comatose and precomatose states associated with liver cirrhosis
3. Renal failure due to nephrotoxic or hepatotoxic drugs
4. Severe hypokalaemia
5. Severe hyponatremia
6. History of hypersensitivity to furosemide, bumetanide, or torsemide (or sulphonamides)The following conditions or states are not contraindications, but loop diuretics needs to be used cautiously in these conditions:
1. Diabetes (but hyperglycaemia less likely than with thiazides)
2. Gout
3. Hypotension (correct before initiation of treatment)
4. Hypovolaemia (Correct before initiation of treatment) -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 194
Incorrect
-
A 10-year-old girl presents with polyuria, polydipsia, and stomach pain. She has a history of type I diabetes mellitus. On blood gas analysis, she has metabolic acidosis. Diabetic ketoacidosis (DKA) is diagnosed, and therapy is initiated. She becomes increasingly confused when intravenous fluids and insulin are administered.
Which electrolyte imbalance is the MOST likely reason of the increased confusion
Your Answer:
Correct Answer: Hyponatraemia
Explanation:Because of the shift of water from the intracellular to the extracellular compartment as a result of hyperglycaemia and increased plasma osmolality, dilutional hyponatraemia is common in diabetic ketoacidosis (DKA).
If intravenous fluids are not delivered with caution, hyponatraemia might worsen, which can lead to increased degrees of disorientation. Hyponatraemia has also been linked to an increased risk of cerebral oedema, especially if blood glucose levels drop too quickly following treatment.
Headache, recurrence of vomiting, irritability, Glasgow Coma Scale score, inappropriate heart rate slowing, and rising blood pressure are the most common causes of death in paediatric DKA, and children should be monitored for the symptoms mentioned above. To prevent this from developing, s low osmolarity normalization, attention to glucose and salt levels, as well as hydration over 48 hours, is necessary.
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This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 195
Incorrect
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Compliance is decreased by all but which one of the following:
Your Answer:
Correct Answer: Aging
Explanation:Factors increasing compliance:
Old age
EmphysemaFactors decreasing compliance:
Pulmonary fibrosis
Pulmonary oedema
Atelectasis
Extremes of lung volumes (at higher lung volumes the compliance of the lung becomes less as the lung becomes stiffer) -
This question is part of the following fields:
- Physiology
- Respiratory
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Question 196
Incorrect
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A 5-year-old girl is brought into the Paediatric ER for acute seizures. She has been convulsing for the past 18 minutes now and was already two doses of lorazepam in the ambulance. Now, you prepare a phenytoin infusion to abolish the seizures.
According to the APLS algorithm, what dose of phenytoin is advised for a convulsing child at this stage?Your Answer:
Correct Answer: 20 mg/kg over 20 minutes
Explanation:Advanced paediatric life support (APLS) recommends phenytoin as the first choice for second-line anticonvulsant in a patient that continues to seize ten minutes after the second dose of the first-line anticonvulsant (benzodiazepine). (step 3 of the APLS algorithm)
The recommended dose of phenytoin infusion is up at 20 mg/kg over 20 minutes. If the patient has already taken phenytoin as maintenance therapy or is allergic to phenytoin, then a phenobarbitone infusion should be set up at 20 mg/kg over 30-60 minutes.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 197
Incorrect
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Which of the following is NOT a benefit of low molecular weight heparin (LMWH) over unfractionated heparin therapy:
Your Answer:
Correct Answer: Its effects can be rapidly and completely reversed with protamine sulfate.
Explanation:Advantages of LMWHGreater ability to inhibit factor Xa directly, interacting less with platelets and so may have a lesser tendency to cause bleedingGreater bioavailability and longer half-life in plasma making once daily subcutaneous administration possibleMore predictable dose response avoiding the need for routine anticoagulant monitoringLower associated risk of heparin-induced thrombocytopenia or of osteoporosis
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 198
Incorrect
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After what time period should intravenous phenytoin be used as second-line treatment of status epilepticus?
Your Answer:
Correct Answer: 25 minutes
Explanation:If seizures recur or fail to respond after initial treatment with benzodiazepines within 25 minutes of onset, phenytoin sodium, fosphenytoin sodium, or phenobarbital sodium should be used.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 199
Incorrect
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An ambulance transports a 23-year-old woman who has taken a witnessed overdose of her mother's diazepam tablets. She has no significant medical history and does not take any medications on a regular basis.
In this case, what is the SINGLE MOST APPROPRIATE FIRST DRUG TREATMENT?Your Answer:
Correct Answer: Flumazenil IV 200 μg
Explanation:Flumazenil is a benzodiazepine antagonist that can be helpful in some overdose situations. It works quickly (in less than a minute), but the effects are fleeting, lasting less than an hour. The dose is 200 micrograms every 1-2 minutes with a maximum dose of 3 milligrams per hour.
Flumazenil should be avoided by patients who are addicted to benzodiazepines or who take tricyclic antidepressants because it can cause withdrawal symptoms. It can cause seizures or cardiac arrest in these situations.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 200
Incorrect
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What is the main mechanism of action of dopamine as an inotropic sympathomimetic:
Your Answer:
Correct Answer: Beta1-receptor agonist
Explanation:Dopamine is a neurotransmitter and a metabolic precursor of the catecholamines. It acts on beta1-receptors in cardiac muscle increasing cardiac contractility, and increases renal perfusion by stimulating dopamine receptors in the renal vasculature. This is of benefit in cardiogenic shock where deterioration of renal function is common.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
