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  • Question 1 - Which of the following is NOT a benefit of low molecular weight heparin...

    Correct

    • Which of the following is NOT a benefit of low molecular weight heparin (LMWH) over unfractionated heparin therapy:

      Your 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

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      26.4
      Seconds
  • Question 2 - A young farmer who is caught under farm machinery and suffering from a...

    Correct

    • 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: Suxamethonium

      Explanation:

      Suxamethonium is a neuromuscular blocker. It is contraindicated in patients who have experienced massive trauma, hyperkalemic, or burn injuries.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      11.9
      Seconds
  • Question 3 - What is the mechanism of action of cetirizine: ...

    Correct

    • What is the mechanism of action of cetirizine:

      Your Answer: H1-receptor antagonist

      Explanation:

      Cetirizine is a competitive inhibitor at the H1-receptor (an antihistamine).

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      11.3
      Seconds
  • Question 4 - You contact the intensive care outreach team to inquire about a severely hypotensive...

    Incorrect

    • You contact the intensive care outreach team to inquire about a severely hypotensive resuscitated patient. They make the decision to start a dopamine infusion.

      Dopamine primarily has which of the following effects at high doses (>15 g/kg/min)?

      Your Answer: Beta-adrenergic stimulation

      Correct Answer: Alpha-adrenergic stimulation

      Explanation:

      Dopamine is a catecholamine that occurs naturally and is used to treat low cardiac output, septic shock, and renal failure. It is both adrenaline and noradrenaline’s immediate precursor.

      Dopamine acts on D1 and D2 dopamine receptors in the renal, mesenteric, and coronary beds at low doses (1-5 g/kg/min). Dopamine causes a significant decrease in renal vascular resistance and an increase in renal blood flow at these doses. Within this dose range, it is also involved in central modulation of behaviour and movement.

      Dopamine stimulates beta- and alpha-adrenergic receptors directly and indirectly at higher doses. Beta-stimulation predominates at a rate of 5-10 g/kg/min, resulting in a positive inotropic effect that increases cardiac output and coronary blood flow. Alpha-stimulation predominates at infusion rates greater than 15 g/kg/min, resulting in peripheral vasoconstriction and an increase in venous return and systolic blood pressure.

      Because clearance varies greatly in critically ill patients, plasma concentrations cannot be predicted reliably from infusion rates.
      Dopamine is given as an intravenous infusion, and because extravasation can cause tissue necrosis and sloughing, a central line is usually used (especially at higher doses >240 g/min). In an emergency, however, dopamine can be administered through a large vein (cephalic or basilic) while a central line is being prepared. Alkaline intravenous solutions inactivate it, so sodium bicarbonate should not be infused with it.

      The following are the most common dopamine side effects:
      Nausea and vomiting
      Tachycardia
      Dysrhythmias
      Angina
      Hypertension

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      22.1
      Seconds
  • Question 5 - A 68-year-old female has presented to the Emergency Department with chest pain, palpitations,...

    Correct

    • A 68-year-old female has presented to the Emergency Department with chest pain, palpitations, and breathlessness complaints. On ECG, she is diagnosed with ventricular arrhythmia and is administered lidocaine.

      Which of the following is the correct mechanism of action of lidocaine?

      Your Answer: Blocks Na+ channels in the heart

      Explanation:

      Lidocaine is a tertiary amide local anaesthetic and also a class IV antiarrhythmic.

      Like other local anaesthetics, lidocaine works on the voltage-gated sodium ion channel on the nerve cell membranes. It works in the following steps:
      1. diffuses through neural sheaths and the axonal membrane into the axoplasm
      2. binds fast voltage-gated Na+ channels in the neuronal cell membrane and inactivates them
      3. 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

      The same principle applies to Lidocaine’s actions in the heart as it blocks the sodium channels in the conduction system and the myocardium. This raises the threshold for depolarizing, making it less likely for the heart to initiate or conduct any action potential that can cause arrhythmia.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      22.9
      Seconds
  • Question 6 - A 23 year old woman has noticed her skin seems to have a...

    Incorrect

    • A 23 year old woman has noticed her skin seems to have a yellow tinge and presents to the emergency room. On examination she is found to have jaundice and mild splenomegaly, and blood tests show that her Hb is 79 g/L. She only takes one regular medication. The medication that is most likely to cause haemolytic anaemia is:

      Your Answer: Gabapentin

      Correct Answer: Mefenamic acid

      Explanation:

      Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) that is used short-term (7 days or less) to treat mild to moderate pain in adults and children who are at least 14 years old. Mefenamic acid is also used to treat menstrual pain. It has only minor anti-inflammatory properties and has occasionally been associated with diarrhoea and haemolytic anaemia. If these occur, treatment should be discontinued.

    • This question is part of the following fields:

      • Musculoskeletal
      • Pharmacology
      38.6
      Seconds
  • Question 7 - A 45-old woman is on several medications and being treated for epilepsy and...

    Incorrect

    • A 45-old woman is on several medications and being treated for epilepsy and bipolar disorder. In the ward rounds, you are asked to examine her in detail and discover she has a noticeable tremor. You believe that one of her medications may be responsible for this new onset tremor.

      Which of the following medications is least likely to be responsible for this tremor?

      Your Answer: Lithium

      Correct Answer: Carbamazepine

      Explanation:

      The only medication that does not commonly cause tremors is carbamazepine.

      The other drugs present with the following types of tremors as a side effect to their usage:
      1. Sodium valproate – Postural tremor is most common, but a resting tremor can also occur. Approximately 25% of patients taking sodium valproate are found to develop a tremor within 12 months of starting therapy.
      2. Lithium – fine hand tremor is very commonly seen and reported in as many as 50% of patients during the first week of therapy. The tremor tends to reduce with time and is only present in around 5% of patients taking the medication two years or longer.
      3. Atypical antipsychotics, such as olanzapine and quetiapine – tremor and limb shakiness.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      18.2
      Seconds
  • Question 8 - A 62-year-old woman is brought to the Emergency Department as she is acutely...

    Incorrect

    • 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: 0.2-0.4 mmol/l

      Correct 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.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      35.2
      Seconds
  • Question 9 - A 15-year-old girl took 20 tablets of paracetamol almost 4 hours ago after...

    Incorrect

    • A 15-year-old girl took 20 tablets of paracetamol almost 4 hours ago after her mother for refused to provide her permission for her to go on a girl's trip. The girl is healthy and has no known comorbidities or drug history. Which one of the following is TRUE regarding paracetamol?

      Your Answer: It is primarily metabolised via the cytochrome p450 enzyme system

      Correct Answer: It is excreted renally

      Explanation:

      Acetaminophen is an acetanilide derivative and is a widely used non-prescription analgesic and antipyretic medication for mild-to-moderate pain and fever.

      The route of elimination: Paracetamol is metabolised extensively in the liver and excreted in the urine mainly as inactive glucuronide and sulfate conjugates, <5% is excreted as free (unconjugated) acetaminophen, and >90% of the dose administered is excreted within 24 hours.

      It is thought to work by selectively inhibiting COX-1 receptors in the brain and spinal cord: It is categorized by the FDA as an NSAID as it is believed to selectively inhibit cyclo-oxygenase 3 (COX-3) receptors in the brain and spinal cord.

      COX-3 is a unique variant of the more known COX-1 and COX-2. It is responsible for the production of prostaglandins in central areas, which sensitizes free nerve endings to the chemical mediators of pain. Therefore, by selectively inhibiting COX-3, paracetamol effectively reduces pain sensation by increasing the pain threshold.

      Toxicity is primarily due to glutathione production: Acetaminophen metabolism by the CYP2E1 pathway releases a toxic metabolite known as 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.

      Acetaminophen can be administered orally, rectally, or intravenously. It is predominantly metabolized in the liver, and the elimination half-life is 1-3 hours after a therapeutic dose. But maybe greater than 12 hours after an overdose.

      It is primarily metabolized via the cytochrome p450 enzyme system: It 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%)

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      19.1
      Seconds
  • Question 10 - Which of the following statements is correct regarding paracetamol? ...

    Incorrect

    • Which of the following statements is correct regarding paracetamol?

      Your Answer: Paracetamol overdose is most commonly complicated by renal failure.

      Correct Answer: Liver damage peaks 3 to 4 days after paracetamol ingestion.

      Explanation:

      The maximum daily dose of paracetamol in an adult is 4 grams. Doses greater than this can lead to hepatotoxicity and, less frequently, acute kidney injury. Early symptoms of paracetamol toxicity include nausea, vomiting, and abdominal pain, and usually settle within 24 hours. Symptoms of liver damage include right subcostal pain and tenderness, and this peaks 3 to 4 days after paracetamol ingestion. Other signs of hepatic toxicity include encephalopathy, bleeding, hypoglycaemia, and cerebral oedema.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      90.5
      Seconds
  • Question 11 - Regarding calcium channel blockers, which of the following statements is CORRECT: ...

    Correct

    • Regarding calcium channel blockers, which of the following statements is CORRECT:

      Your Answer: Calcium channel blockers inhibit L-type voltage-sensitive calcium channels in arterial smooth muscle causing vasodilation.

      Explanation:

      Calcium channel blockers inhibit L-type voltage-sensitive calcium channels in arterial smooth muscle, causing relaxation and vasodilation (reduction in peripheral vascular resistance). They also block calcium channels within the myocardium and conducting tissues of the heart which produces a negative inotropic effect by reducing calcium influx during the plateau phase of the action potential.
      They have a variety of uses, including:
      Hypertension
      Angina
      Atrial fibrillation
      Migraine
      Calcium channel blockers have been found to be moderately useful in the prevention of migraines. The best evidence is for this is with verapamil. This may be due to the prevention of the arteriolar constriction that is associated with migraine. They are commonly used for this elsewhere in the world but are not currently licensed for this use in the UK.
      The following are common side effects of all calcium-channel blockers:
      Abdominal pain
      Dizziness
      Drowsiness
      Flushing
      Headache
      Nausea and vomiting
      Palpitations
      Peripheral oedema
      Skin reactions
      Tachycardia
      Verapamil is highly negatively inotropic and reduces cardiac output, slows the heart rate and may impair atrioventricular conduction. It may precipitate heart failure, exacerbate conduction disorders, and cause hypotension at high doses and should not be used with beta-blockers. Nifedipine has less myocardial effects than verapamil and has no antiarrhythmic properties but has more influence on the vessels. Nimodipine is used solely for the prevention and treatment of vascular spasm following aneurysmal subarachnoid haemorrhage.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      108.7
      Seconds
  • Question 12 - You examine a 72-year-old man who has recently begun bumetanide treatment for worsening...

    Incorrect

    • You examine a 72-year-old man who has recently begun bumetanide treatment for worsening heart failure.

      Which of these statements about bumetanide is correct?

      Your Answer: It acts within 30 minutes of oral administration

      Correct Answer: It has better intestinal absorption than furosemide

      Explanation:

      Bumetanide is a loop diuretic that is used to treat congestive heart failure. It is frequently used in patients who have failed to respond to high doses of furosemide.

      It has a potency of about 40 times that of furosemide, with a 1 mg dose being roughly equivalent to a 40 mg dose of furosemide.
      Seizures are not known to be triggered by bumetanide. In fact, it lowers the concentration of neuronal chloride, making GABA’s action more depolarizing, and it’s currently being tested as an antiepileptic in the neonatal period.

      It takes effect after 1 hour of oral administration, and diuresis takes 6 hours to complete.

      Bumetanide absorbs much better in the intestine than furosemide. Because it has a higher bioavailability than furosemide, it is commonly used in patients with gut oedema.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      123.4
      Seconds
  • Question 13 - Regarding nitrous oxide, which of the following statements is CORRECT: ...

    Correct

    • Regarding nitrous oxide, which of the following statements is CORRECT:

      Your 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.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      128.7
      Seconds
  • Question 14 - What is the recommended dosing regime for amiodarone in the treatment of a...

    Correct

    • What is the recommended dosing regime for amiodarone in the treatment of a stable regular broad-complex tachycardia:

      Your 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.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      63
      Seconds
  • Question 15 - Compliance is greater in all but which one of the following: ...

    Incorrect

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

      Your Answer: Elderly

      Correct Answer: Pulmonary oedema

      Explanation:

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

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      12.1
      Seconds
  • Question 16 - A 52-year-old patient requires procedural sedation for DC cardioversion of atrial fibrillation. You...

    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: N-methyl-D-aspartate (NMDA)

      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
      15.9
      Seconds
  • Question 17 - Which of the following is NOT a pharmacological effect of beta-blockers: ...

    Correct

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

      Your Answer: Reduced AV conduction time

      Explanation:

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

      Eye:
      Reduce intraocular pressure

      Respiratory system:
      Cause bronchoconstriction

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      8
      Seconds
  • Question 18 - Amoxicillin is used first line for all of the following infections EXCEPT for:...

    Correct

    • Amoxicillin is used first line for all of the following infections EXCEPT for:

      Your Answer: Cellulitis

      Explanation:

      Amoxicillin is used first line for low to moderate severity community acquired pneumonia, exacerbations of chronic bronchitis, for acute otitis media, for acute sinusitis, for oral infections/dental abscess, for Listeria meningitis (in combination with another antibiotic), for infective endocarditis (in combination with another antibiotic) and for H. Pylori eradication (in combination with metronidazole/clarithromycin and a PPI). Flucloxacillin is used first line for acute cellulitis.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      13.5
      Seconds
  • Question 19 - In the United Kingdom, which of the following is the most often used...

    Incorrect

    • In the United Kingdom, which of the following is the most often used intravenous aesthetic:

      Your Answer: Ketamine

      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.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      20.9
      Seconds
  • Question 20 - EMLA cream is a topical local anaesthetic containing which of the following: ...

    Incorrect

    • EMLA cream is a topical local anaesthetic containing which of the following:

      Your Answer: 2.5% lidocaine

      Correct Answer: 50/50 mixture 2.5% lidocaine and 2.5% prilocaine

      Explanation:

      EMLA cream, an effective topical local anaesthetic, is a 50/50 mixture of 2.5% prilocaine and 2.5% lidocaine.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      15.6
      Seconds
  • Question 21 - What is the main mechanism of action of dopamine as an inotropic sympathomimetic: ...

    Correct

    • What is the main mechanism of action of dopamine as an inotropic sympathomimetic:

      Your Answer: Beta1-receptor agonist

      Explanation:

      Dopamine is a neurotransmitter and a metabolic precursor of the catecholamines. It acts on beta1-receptors in cardiac muscle increasing cardiac contractility, and increases renal perfusion by stimulating dopamine receptors in the renal vasculature. This is of benefit in cardiogenic shock where deterioration of renal function is common.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      24.6
      Seconds
  • Question 22 - Regarding airway resistance, which of the following statements is CORRECT: ...

    Correct

    • Regarding airway resistance, which of the following statements is CORRECT:

      Your 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.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      53.4
      Seconds
  • Question 23 - A 6-year-old child with a few itchy honey crusted sores on her left...

    Correct

    • 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: 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.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      26.3
      Seconds
  • Question 24 - Captopril should not be used if you have any of the following conditions:...

    Correct

    • Captopril should not be used if you have any of the following conditions:

      Your Answer: Renal artery stenosis

      Explanation:

      Contraindications indications of Captopril include:
      – Bilateral renal artery stenosis
      – Hypersensitivity to ACE inhibitors
      – Anuria
      – History of ACEI-induced angioedema
      – Hereditary or idiopathic angioedema
      – Co-administration of Neprilysin inhibitors (e.g., sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hours of switching to or from sacubitril/valsartan.
      If ACE inhibitors are used, they should be initiated only under specialist supervision and renal function should be monitored regularly. ACE inhibitors should also be used with particular caution in patients who may have undiagnosed and clinically silent renovascular disease. This includes patients with peripheral vascular disease or those with severe generalised atherosclerosis.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      35.3
      Seconds
  • Question 25 - Regarding amoxicillin, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer: It is used first line for acute otitis media.

      Correct Answer: It is used first line for bacterial tonsillitis.

      Explanation:

      Amoxicillin is a derivative of ampicillin and has a similar antibacterial spectrum. It is better absorbed than ampicillin when given orally, producing higher plasma and tissue concentrations; unlike ampicillin, absorption is not affected by the presence of food in the stomach.

      The adverse effects of amoxicillin are mainly gastrointestinal and mild and include nausea, vomiting and diarrhoea. Amoxicillin is used first line for low to moderate severity community acquired pneumonia, exacerbations of chronic bronchitis, for acute otitis media, for acute sinusitis, for oral infections/dental abscess, for Listeria meningitis (in combination with another antibiotic), for infective endocarditis (in combination with another antibiotic) and for H. Pylori eradication (in combination with metronidazole/clarithromycin and a PPI).

      Penicillin V is used first line for bacterial tonsillitis; amoxicillin should be avoided in blind treatment of a sore throat as there is a high risk of a rash if glandular fever is present.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      60
      Seconds
  • Question 26 - What is the main mechanism of action of cyclizine: ...

    Incorrect

    • What is the main mechanism of action of cyclizine:

      Your Answer: Histamine-H2 antagonist

      Correct Answer: Histamine-H1 antagonist

      Explanation:

      Antihistamines e.g. cyclizine, are effective against nausea and vomiting caused by many different conditions, including motion sickness and vertigo. These agents act by inhibiting histamine pathways, and cholinergic pathways involved in transmission from the vestibular apparatus to the vomiting centre. There is no evidence that any one antihistamine is superior to another but their duration of action and incidence of adverse effects differ. Adverse effects include drowsiness and antimuscarinic effects such as blurred vision, dry mouth, urinary retention, constipation and confusion.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      11.9
      Seconds
  • Question 27 - A 20-year-old asthmatic patient's symptoms is deteriorating and patient is moved to the...

    Correct

    • A 20-year-old asthmatic patient's symptoms is deteriorating and patient is moved to the resuscitation area of the Emergency Department. A loading dose of IV aminophylline is administered and her symptoms begin to improve. You are asked to check her theophylline levels after an appropriate time period.

      How long should you wait before taking her blood sample be taken?

      Your Answer: 4-6 hours

      Explanation:

      Plasma theophylline concentration is usually measured five days after starting oral treatment and three days after each dose adjustment.

      A blood sample to check theophylline concentration should usually be taken after 4-6 hours if an IV dose of aminophylline was given.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
      33.8
      Seconds
  • Question 28 - A young male has presented to you with respiratory depression and small pupils...

    Correct

    • 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.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      204.9
      Seconds
  • Question 29 - You're taking a history of a 59-year-old banker who has had heartburn in...

    Correct

    • You're taking a history of a 59-year-old banker who has had heartburn in the past.

      Which of the following information about antacids is correct?

      Your Answer: Magnesium carbonate can reduce the absorption of drugs taken at the same time

      Explanation:

      Antacids such as aluminium hydroxide and magnesium carbonate are commonly used. They’re both water-insoluble and can reduce the absorption of drugs taken together. Allow at least 1-2 hours between taking these antacids and any other medications.

      Because it reduces gastrointestinal phosphate absorption, aluminium hydroxide can also be used to treat hyperphosphatemia in patients with renal failure.

      Magnesium carbonate has a laxative effect, whereas aluminium hydroxide has a constipating effect.

    • This question is part of the following fields:

      • Gastrointestinal Pharmacology
      • Pharmacology
      108
      Seconds
  • Question 30 - Which of the following medications can block the effect of adrenaline? ...

    Correct

    • Which of the following medications can block the effect of adrenaline?

      Your 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.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      7.8
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular (6/6) 100%
Pharmacology (16/28) 57%
Anaesthesia (2/5) 40%
Respiratory (3/4) 75%
Cardiovascular Pharmacology (1/3) 33%
Musculoskeletal (0/1) 0%
CNS Pharmacology (1/4) 25%
Central Nervous System (0/2) 0%
Physiology (1/2) 50%
Infections (2/3) 67%
Respiratory Pharmacology (1/1) 100%
Gastrointestinal Pharmacology (1/1) 100%
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