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Question 1
Correct
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A 56-year-old female presents at the hospital with a diabetic foot ulcer that has become infected. She has a longstanding history of type 2 diabetes mellitus and diabetic polyneuropathy. She has trouble controlling her blood sugar levels, and recently, she was converted to a new insulin regimen that includes intermediate-acting insulin.
Out of the following, which one is the intermediate-acting insulin?Your Answer: Isophane insulin
Explanation:Insulin is used mainly in type 1 diabetes, where the pancreas makes no insulin and can sometimes be prescribed in type 1 diabetes. There are different types of insulin categorized by their onset of action:
1. Intermediate-acting insulins (isophane insulin NPH):
– intermediate duration of action, designed to mimic the effect of endogenous basal insulin
– starts their action in 1 to 4 hours
– peaks in 4 to 8 hours
– dosing is usually twice a day and helps maintain blood sugar throughout the day
– Isophane insulin is a suspension of insulin with protamine2. Short-acting insulins (regular insulin)
– starts the action in 30 to 40 minutes
– peaks in 90 to 120 minutes
– duration of action is 6 to 8 hours
– taken before meals, and food is necessary within 30 minutes after its administration to avoid hypoglycaemia3. Long-acting insulins (glargine, detemir, degludec)
– start action in 1 to 2 hours
– plateau effect over 12 to 24 hours
– Dosing is usually during the night-time after meals. Their long duration of action helps in reducing the frequency of dosing throughout the day.4. Rapid-acting insulins (lispro, aspart, glulisine)
– start their action in 5 to 15 minutes
– peak in 30 minutes
– The duration of action is 3 to 5 hours
– generally used before meals and always used along with short-acting or long-acting insulins to control sugar levels throughout the day. -
This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 2
Correct
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All of the following are indications for beta-blockers EXCEPT for:
Your Answer: Raynaud's disease
Explanation:Beta-blockers are contraindicated in Raynaud’s syndrome.
Beta-blockers may be indicated in:
Hypertension
Pheochromocytoma (only with an alpha-blocker)
Angina
Secondary prevention after ACS
Arrhythmias including atrial fibrillation
Heart failure
Thyrotoxicosis
Anxiety
Prophylaxis of migraine
Essential tremor
Glaucoma -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 3
Correct
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Flucloxacillin is used first line for all of the following infections EXCEPT for:
Your Answer: Otitis media
Explanation:Flucloxacillin is used first line for treatment of widespread impetigo infection, cellulitis, mastitis, osteomyelitis, septic arthritis, severe erysipelas, severe/spreading otitis externa and infective endocarditis caused by staphylococci. Amoxicillin is first line for acute otitis media.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 4
Correct
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Regarding amoxicillin, which of the following statements is INCORRECT:
Your 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.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 5
Correct
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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: 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 6
Correct
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What is the mechanism of action of penicillin antibiotics:
Your 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 7
Correct
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Regarding ampicillin, which of the following statements is CORRECT:
Your Answer: Ampicillin may cause a widespread maculopapular rash in a patient with glandular fever.
Explanation:Ampicillin is a broad-spectrum antibiotic, active against certain Gram-positive and Gram-negative organisms but is inactivated by penicillinases (similar to amoxicillin in spectrum). Ampicillin is associated with high levels of resistance, therefore it is often not appropriate for blind treatment of infection. It is principally indicated for the treatment of exacerbations of chronic bronchitis and middle ear infections, both of which may be due to Streptococcus pneumoniae and H. influenzae, and for urinary tract infections.
Maculopapular rashes commonly occur with ampicillin (and amoxicillin) but are not usually related to true penicillin allergy. They almost always occur in patients with glandular fever; thus broad-spectrum penicillins should not be used for blind treatment of a sore throat. The risk of rash is also increased 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 8
Correct
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A 72 year old man is brought to ED by ambulance with sudden onset chest pain, palpitations and shortness of breath. His HR is 160 bpm and BP 90/65. ECG demonstrates new-onset fast atrial fibrillation. Which of the following is the first-line treatment option in this case:
Your Answer: Synchronised DC cardioversion
Explanation:All patients with adverse features suggesting life-threatening haemodynamic instability (shock, syncope, heart failure, myocardial ischaemia) caused by new onset atrial fibrillation should undergo emergency electrical cardioversion with synchronised DC shock without delaying to achieve anticoagulation.
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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've been summoned to a young man in the resus area who has an SVT. You decide to use adenosine after trying several vagal manoeuvres without success.
The use of adenosine is not contraindicated in which of the following situations?Your Answer: Concurrent use of a beta-blocker
Explanation:The use of a beta-blocker at the same time increases the risk of myocardial depression, but it is not a contraindication.
The use of adenosine is contraindicated in the following situations:
Asthma
COPD (chronic obstructive pulmonary disease)
Decompensated heart failureÂ
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 10
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Question 11
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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: 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 12
Correct
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Ipratropium bromide should be used with caution in patients with which of the following conditions:
Your Answer: Prostatic hyperplasia
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
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Question 13
Correct
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A 61-year-old man complains of crushing chest pain that radiates to his left arm and jaw. An ECG is taken, and the lateral leads show extensive ST depression. His blood pressure is currently 190/123 mmHg, and as part of his treatment, you intend to begin drug therapy to lower it.
Which of the following is the INITIAL drug treatment for this patient's BP reduction?Your Answer: Glyceryl trinitrate
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 presence of cardiac ischaemia, hypertensive emergencies require immediate treatment to prevent myocardial infarction.
Similarly, if myonecrosis occurs in the presence of an existing infarction, prompt treatment is required to prevent further myonecrosis. When thrombolysis is used as the primary reperfusion therapy for acute myocardial infarction, blood pressure control is especially important.
An intravenous nitrate is the drug of choice in this situation (e.g. GTN). These have a dual purpose in that they can help patients with ischaemic chest pain manage their symptoms. Because lowering blood pressure with nitrates isn’t always enough to achieve optimal results, intravenous beta-blockers are frequently used as a supplement. For this, intravenous atenolol and metoprolol are commonly used.
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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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A 55-year-old male diabetic patient presents to the Emergency Room complaining of severe chest pain. His medical record shows that he had coronary angioplasty one week ago, during which he was administered abciximab.
Which of the following haematological diseases has a similar mechanism of action to this drug?Your Answer: Glanzmann’s thrombasthenia
Explanation:Abciximab is glycoprotein IIb/IIIa receptor antagonist that decreases aggregation of platelets by prevent their cross-linking. In Glanzmann’s thrombasthenia there are low levels of these same receptors leading to decreased bridging of platelets as fibrinogen cannot attach. There is increased bleeding time both in this disease and when there is use of abciximab.
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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 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. She is pregnant in her second trimester.
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: Cefalexin
Explanation:The NICE guidelines for pregnant women with lower UTIs are:
1. Prescribe an antibiotic immediately, taking into account the previous urine culture and susceptibility results or avoiding past antibiotics that may have caused resistance
2. Obtain a midstream urine sample before starting antibiotics and send for urine culture and susceptibility
– Review the choice of antibiotic when the results are available
– change the antibiotic according to susceptibility results if the bacteria are resistant, using a narrow-spectrum antibiotic wherever possibleThe first choice of antibiotics for pregnant women aged 12 years and over is:
1. Nitrofurantoin
100 mg modified-release PO BD for 3 days – if eGFR >45 ml/minuteThe 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. Amoxicillin
500 mg PO TDS for seven days (ONLY if culture results available and susceptible)
2. Cefalexin
500 mg BD for seven days
Alternative second-choices – consult local microbiologist, choose antibiotics based on culture and sensitivity results -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 16
Correct
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A 5-year-old girl presents in a paediatric clinic with symptoms of viral gastroenteritis. You encourage the mother to treat the child at home with oral rehydration therapy (ORT), e.g. dioralyte.
Out of the following, which statement is FALSE regarding the use of ORT in the management of gastroenteritis?Your Answer: ORT is sugar-free
Explanation:One of the major complications of gastroenteritis is dehydration. Choosing the correct fluid replacement therapy is essential according to a patient’s hydration status.
Oral rehydration therapy (ORT) refers to the restitution of water and electrolyte deficits in dehydrated patients using an oral rehydration salt (ORS) solution. It is a fluid replacement strategy that is less invasive than other strategies for fluid replacement and has successfully lowered the mortality rate of diarrhoea in developing countries.
Some characteristics of Oral rehydration solutions are:
– slightly hypo-osmolar (about 250 mmol/litre) to prevent the possible induction of osmotic diarrhoea.
– contain glucose (e.g. 90 mmol/L in dioralyte). The addition of glucose improves sodium and water absorption in the bowel and prevents hypoglycaemia.
– also contains essential mineral saltsCurrent NICE guidance recommends that 50 ml/kg is given over 4 hours to treat mild dehydration.
Once rehydrated, a child should continue with their usual daily fluid intake plus 200 ml ORT after each loose stool. In an infant, give ORT at 1-1.5 x the normal feed volume and in an adult, give 200-400 ml after each loose stool. -
This question is part of the following fields:
- Fluids & Electrolytes
- Pharmacology
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Question 17
Correct
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Regarding pressures and airflow during the normal breathing cycle, which of the following statements is INCORRECT:
Your 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 18
Correct
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During the second and third trimesters of her pregnancy, a 36-year-old woman is given a drug to treat a medical condition. The foetus has developed hypoperfusion and the oligohydramnios sequence as a result of this.
Which of the following drugs is most likely to be the cause of these side effects?Your Answer: Ramipril
Explanation:Hypoperfusion, renal failure, and the oligohydramnios sequence are all linked to ACE inhibitor use in the second and third trimesters.
The oligohydramnios sequence refers to a foetus’ or neonate’s atypical physical appearance as a result of oligohydramnios in the uterus. It’s also linked to aortic arch obstructive malformations and patent ductus arteriosus.
The inhibitory effects on the renin-angiotensin-aldosterone system appear to be the cause of these defects. To avoid these risks, ACE inhibitors should be stopped before the second trimester.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 19
Correct
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Which of the following is first-line for management of status epilepticus:
Your 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 20
Correct
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You examine a 73-year-old patient who is experiencing a worsening of his chronic heart failure. Bumetanide was recently prescribed for him.
Which of the following statements about bumetanide is correct?Your Answer: It has better intestinal absorption than furosemide
Explanation:Bumetanide is a loop diuretic that inhibits sodium, chloride, and potassium reabsorption by acting on the Na.K.2Cl co-transporter in the ascending loop of Henlé. This reduces the osmotic gradient that forces water out of the collecting duct system and prevents the formation of a hypertonic renal medulla. This has a strong diuretic effect on the body.
It’s primarily used in patients with heart failure who aren’t responding to high doses of furosemide. Bumetanide and furosemide differ primarily in terms of bioavailability and pharmacodynamic potency.
In the intestine, furosemide is only partially absorbed, with a bioavailability of 40-50 percent. Bumetanide, on the other hand, is almost completely absorbed in the intestine and has a bioavailability of about 80%. Bumetanide is 40 times more potent than furosemide, and one milligram is roughly equivalent to 40 milligrams of furosemide.
Bumetanide also lowers the concentration of neuronal chloride, making GABA’s action more depolarizing. In the neonatal period, it is being studied as an antiepileptic.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 21
Correct
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Which of the following is a well recognised adverse effect of prochlorperazine:
Your Answer: Acute dystonic reaction
Explanation:Adverse actions include anticholinergic effects such as drowsiness, dry mouth, and blurred vision, extrapyramidal effects, and postural hypotension. Phenothiazines can all induce acute dystonic reactions such as facial and skeletal muscle spasms and oculogyric crises; children (especially girls, young women, and those under 10 kg) are particularly susceptible.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 22
Correct
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Which of the following is NOT an effect of benzodiazepines:
Your Answer: Analgesic effect
Explanation:Benzodiazepines are gamma-aminobutyric acid (GABA) receptor agonists which enhance inhibitory synaptic transmission throughout the central nervous system, with sedative, hypnotic, anxiolytic, anticonvulsant, amnesic and muscle relaxant properties.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 23
Correct
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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: 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 24
Correct
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Regarding flucloxacillin, which of the following statements is CORRECT:
Your Answer: It is resistant to bacterial beta-lactamases.
Explanation:Flucloxacillin is unique in that it is beta-lactamase stable and it can be used in infections caused by beta-lactamase producing staphylococci e.g. S. aureus. It is acid-stable and can therefore be given by mouth as well as by injection. It is used first line for treatment of widespread impetigo infection, cellulitis, mastitis, osteomyelitis, septic arthritis, severe erysipelas, severe/spreading otitis externa and infective endocarditis caused by staphylococci. The most common adverse effects of flucloxacillin include nausea, vomiting, skin rash, and diarrhoea. Cholestatic jaundice and hepatitis may occur very rarely, up to two months after treatment with flucloxacillin has been stopped. Administration for more than 2 weeks and increasing age are risk factors. First line treatment of animal and human bites is co-amoxiclav.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 25
Correct
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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: 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 26
Correct
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Normal human immunoglobulin is mostly used to protect against which of the following infectious diseases?
Your Answer: Measles and hepatitis A
Explanation:Immune globulin IM is indicated for prophylaxis following exposure
to hepatitis A, to prevent or modify measles (rubeola) in a
susceptible person exposed fewer than 6 days previously,
for susceptible household contacts of measles patients,
particularly contacts <1 year and pregnant women without
evidence of immunity, and to modify rubella in exposed pregnant
women who will not consider a therapeutic abortion. -
This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
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Question 27
Correct
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A 53 year old women presents to the emergency room with a chronic cough. The pulmonary receptors likely to be involved in causing her cough are:
Your Answer: Irritant receptors
Explanation:Throughout the airways, there are irritant receptors which are located between epithelial cells which are made of rapidly adapting afferent myelinated fibres in the vagus nerve. A cough is as a result of receptor stimulation located in the trachea, hyperpnoea is as a result of receptor stimulation in the lower airway. Stimulation may also result in reflex bronchial and laryngeal constriction. Many factors can stimulate irritant receptors. These include irritant gases, smoke and dust, airway deformation, pulmonary congestion, rapid inflation/deflation and inflammation. Deep augmented breaths or sighs seen every 5 – 20 minutes at rest are due to stimulation of these irritant receptors. This reverses the slow lung collapse that occurs in quiet breathing.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 28
Correct
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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: 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 29
Correct
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A 63-year-old man complains of chest pain and syncope on occasion. His heart rate is 37 beats per minute, and he has a second-degree heart block, according to his rhythm strip.
Which of the following would be the most appropriate next step in his management, according to the ALS bradycardia algorithm?Your Answer: Give atropine 500 mcg
Explanation:Atropine is used to treat bradycardia (sinus, atrial, or nodal) or AV block when the patient’s haemodynamic condition is compromised by the bradycardia.
If any of the following adverse features are present, the ALS bradycardia algorithm recommends a dose of atropine 500 mcg IV:
Shock
Syncope
Myocardial ischemia
Insufficiency of the heartIf this does not work, give additional 500 mcg doses at 3-5 minute intervals until a maximum dose of 3 mg is reached. The heart rate can be slowed paradoxically if the dose is higher than 3 mg.
The ALS bradycardia algorithm also suggests the following interim measures:
Transcutaneous pacing
Isoprenaline infusion 5 mcg/min
Adrenaline infusion 2-10 mcg/minutes
Alternative drugs (aminophylline, dopamine, glucagon, glycopyrrolate) -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 30
Correct
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A 30-year-old woman presents with a history of fever and sore throat. On examination, there is tonsillar exudate and cervical lymphadenopathy and a diagnosis of tonsillitis is made. A course of penicillin is prescribed.
What is the mechanism of action of penicillin?
Your Answer: Inhibition of cell wall synthesis
Explanation:Penicillin is bactericidal and produces its antimicrobial action by preventing cross-linkage between the linear peptidoglycan polymer chains that make up the bacterial cell wall. This action inhibits cell wall synthesis.
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This question is part of the following fields:
- Infections
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
