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Question 1
Correct
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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: 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
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Question 2
Correct
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Which of the following drug classes may cause bronchoconstriction:
Your Answer: Beta-blockers
Explanation:Beta-blockers, including those considered to be cardioselective, should usually be avoided in patients with a history of asthma, bronchospasm or a history of obstructive airways disease. However, when there is no alternative, a cardioselective beta-blocker can be given to these patients with caution and under specialist supervision. In such cases the risk of inducing bronchospasm should be appreciated and appropriate precautions taken.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 3
Incorrect
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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: GABA reuptake inhibitor
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 4
Correct
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Regarding antacids, which of the following statements is CORRECT:
Your Answer: Antacids are contraindicated in hypophosphataemia.
Explanation:Antacids are contraindicated in hypophosphataemia. Liquid preparations are more effective than tablet preparations. Magnesium-containing antacids tend to be laxative whereas aluminium-containing antacids tend to be constipating. Antacids are best taken when symptoms occur or are expected, usually between meals and at bedtime. Antacids should preferably not be taken at the same time as other drugs since they may impair absorption.
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 5
Correct
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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: 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 6
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 7
Correct
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Which of the following infections is vancomycin most likely prescribed for?
Your 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 8
Incorrect
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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: Insulin
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 9
Incorrect
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Regarding antimuscarinic antispasmodics, which of the following statements is CORRECT:
Your Answer: Hyoscine butylbromide is a very effective antispasmodic.
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 10
Incorrect
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A 60-year-old patient had a sudden onset of palpitations and shortness of breath. He had a history of poorly controlled hypertension and ischemic heart disease. His ECG also shows atrial fibrillation. Based on the patient’s condition, which pharmacologic cardioversion would be best to use?
Your Answer: Propafenone
Correct Answer: Amiodarone
Explanation:Chemical cardioversion, or pharmacologic cardioversion, is the treatment of abnormal heart rhythms using drugs.
Flecainide and propafenone are examples of drugs used as chemical cardioverters.
However, given the situation of the patient, these drugs are contraindicated for his ischaemic heart disease. Amiodarone is also an antiarrhythmic drug and is the best choice for this situation.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 11
Incorrect
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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: Hypophosphatemia
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 12
Incorrect
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A 40-year-old man has been admitted for alcohol detoxification. You are asked to review the patient's treatment chart and notice that he has been prescribed Pabrinex by one of your colleagues.
Out of the following, which vitamin is not found in Pabrinex?Your Answer: Vitamin B3
Correct Answer: Vitamin B12
Explanation:Pabrinex is indicated in patients that require rapid therapy for severe depletion or malabsorption of water-soluble vitamins B and C, particularly in alcoholism detoxification.
Pabrinex has the following:
1. Thiamine (vitamin B1)
2. Riboflavin (vitamin B2)
3. Nicotinamide (Vitamin B3, niacin and nicotinic acid)
4. Pyridoxine (vitamin B6)
5. Ascorbic acid (vitamin C)
6. GlucoseSuspected or established Wernicke’s encephalopathy is treated by intravenous infusion of Pabrinex/ The dose is 2-3 pairs three times a day for three to five days, followed by one pair once daily for an additional three to five days or for as long as improvement continues.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pharmacology
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Question 13
Incorrect
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Which of the following drugs used in the management of hyperkalaemia does not affect serum potassium levels:
Your Answer: Sodium bicarbonate
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 14
Correct
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An elderly female has a bacterial infection and you are asked to prescribe an antibiotic to her. This antibiotic is a nucleic acid synthesis inhibitor.
Which of the following antimicrobial drugs will be prescribed to this patient?Your Answer: Metronidazole
Explanation:Metronidazole and the other 5-nitroimidazole agents inhibit nucleic acid synthesis by forming toxic free radical metabolites in the bacterial cell that damage DNA.
Vancomycin inhibits cell wall peptidoglycan formation by binding the D-Ala-D-Ala portion of cell wall precursors.
Erythromycin inhibits protein synthesis and blocks translocation by binding to the 23S rRNA of the 50S ribosomal subunit.
Chloramphenicol blocks peptidyl transferase at 50S ribosomal subunit.
Gentamicin, an aminoglycoside antibiotic, acts by binding to the 30S subunit of the bacterial ribosome inhibiting the binding of aminoacyl-tRNA and thus preventing initiation of protein synthesis.
An overview of the different mechanisms of action of the various types of antimicrobial agents is shown below:
1. Inhibition of cell wall synthesis
– Penicillins
– Cephalosporins
– Vancomycin
2. Disruption of cell membrane function
– Polymyxins
– Nystatin
– Amphotericin B
3. Inhibition of protein synthesis
– Macrolides
– Aminoglycosides
– Tetracyclines
– Chloramphenicol
4. Inhibition of nucleic acid synthesis
– Quinolones
– Trimethoprim
– 5-nitroimidazoles
– Rifampicin
5. Anti-metabolic activity
– Sulphonamides
– Isoniazid -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 15
Incorrect
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Regarding the partial pressure of gases, which of the following statements is INCORRECT:
Your Answer: The partial pressure of a gas in the atmosphere is determined by the fractional concentration of that gas.
Correct Answer: At high altitude, the oxygen fraction is reduced.
Explanation:At altitude, the oxygen fraction is unaltered but the barometric pressure and thus partial pressure of oxygen is reduced.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 16
Correct
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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: 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 17
Incorrect
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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 67-year-old on warfarin with dental pain
Correct 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 18
Incorrect
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A 68-year-old man is being treated with digoxin for atrial fibrillation. When serum digoxin levels are above the therapeutic range, he is at highest risk for developing digoxin toxicity if he also develops which of the following?
Your Answer: Hypophosphataemia
Correct Answer: Hypokalaemia
Explanation:Predisposing factors for digoxin toxicity include hypoxia, hypercalcaemia, hypokalaemia and hypomagnesaemia There should also be care taken in the elderly who are particularly susceptible to digoxin toxicity. Hypokalaemia may be precipitated by use of diuretics. Hyponatremia can result in the development of other pathological disturbances, but it does not make digoxin toxicity worse.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 19
Incorrect
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Regarding V/Q mismatch, which of the following statements is CORRECT:
Your Answer: In a pure shunt, the V/Q ratio = ∞.
Correct Answer: In a true shunt, increasing inspired oxygen has no effect on improving hypoxaemia.
Explanation:Both ventilation and perfusion increase towards the lung base, because of the effects of gravity, but the gravitational effects are greater on perfusion than ventilation and therefore there is a regional variation in V/Q ratio from lung apex (high V/Q) to lung base (low V/Q). In a pure shunt, there is normal perfusion but absent ventilation and the V/Q ratio = 0. In a true shunt increasing oxygen fraction has no effect because the oxygen-enriched air fails to reach the shunted blood. An increased A-a gradient is seen in V/Q mismatch.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 20
Incorrect
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Which of the following is NOT an indication for a H1 receptor antihistamine:
Your Answer:
Correct Answer: Gastroesophageal reflux disease
Explanation:Antihistamines are competitive inhibitors at the H1-receptor (in contrast to H2 receptor antagonists used to decrease gastric acid secretion in gastroesophageal reflux disease).
Indications:
Allergic rhinitis and conjunctivitis
Urticarial rashes, pruritus, insect bites and stings
Angioedema
Anaphylaxis (second line adjunct to adrenaline)
Nausea/vomiting and prevention of motion sickness
Insomnia -
This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 21
Incorrect
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A 68-year-old man has a very fast heartbeat' and is out of breath. He has had a heart transplant in the past. His electrocardiogram reveals supraventricular tachycardia.
Which of the following is the most appropriate adenosine dose for him to receive as a first dose?Your Answer:
Correct Answer: Adenosine 3 mg IV
Explanation:A rapid IV bolus of adenosine is given, followed by a saline flush. The standard adult dose is 6 mg, followed by 12 mg if necessary, and then another 12 mg bolus every 1-2 minutes until an effect is seen.
Patients who have had a heart transplant, on the other hand, 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.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 22
Incorrect
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An elderly patient presents to ED following a fall after feeling light headed when standing up. You are reviewing his medication and note that he is taking a high dose of furosemide. Loop diuretics act primarily at which of the following sites in the nephron:
Your Answer:
Correct Answer: Thick ascending limb
Explanation:Loop diuretics inhibit the Na+/K+/2Cl- symporter on the luminal membrane in the thick ascending limb of the loop of Henle, thus preventing reabsorption of NaCl and water. These agents reduce reabsorption of Cl- and Na+ and increase Ca2+ excretion and loss of K+ and Mg2+.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 23
Incorrect
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Carbamazepine is contraindicated in which of the following:
Your Answer:
Correct Answer: Atrioventricular block
Explanation:Carbamazepine is contraindicated in:
– People with known hypersensitivity to carbamazepine or structurally related drugs
– People with atrioventricular block (may suppress AV conduction and ventricular automaticity)
– People with a history of bone marrow depression (risk of agranulocytosis and aplastic anaemia)
– People with a history of acute porphyrias
– People taking a monoamine oxidase inhibitor (risk of serotonin syndrome) -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 24
Incorrect
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Due to severe palpitations, a 28-year-old woman is transported to the Emergency Department by ambulance. Her heart rate is 180 beats per minute, and the rhythm strip shows supraventricular tachycardia. You intend to give adenosine.
Which of the following is NOT a contraindication for adenosine use?Your Answer:
Correct Answer: History of heart transplant
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 severeIt has a half-life of less than 10 seconds and acts quickly within that time frame. The actions last between 10 and 20 seconds.
Because of the short half-life of the drug, any side effects are usually only temporary. These are some of them:
a feeling of impending doom
Flushing of the face
Dyspnoea
Uncomfortable chest
Tastes metallic -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 25
Incorrect
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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 26
Incorrect
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A 63 year old lady presents to ED with a persistent cough and red currant jelly sputum. She has a history of chronic alcohol abuse and has an X-ray which demonstrates a cavitating pneumonia. The most likely causative pathogen is:
Your Answer:
Correct Answer: Klebsiella pneumoniae
Explanation:One of the results of Klebsiella pneumoniae is pneumonia that is usually a very severe infection. It is characterised by thick, bloody sputum (red currant jelly sputum), and is associated with complications like lung abscess, cavitation, necrosis, empyema and pleural effusions.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 27
Incorrect
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A patient who was put on low molecular weight heparin for suspected DVT and was scheduled for an ultrasound after the weekend, arrives at the emergency department with significant hematemesis. Which of the following medications can be used as a heparin reversal agent:
Your Answer:
Correct Answer: Protamine sulfate
Explanation:The management of bleeding in a patient receiving heparin depends upon the location and severity of bleeding, the underlying thromboembolic risk, and the current aPTT (for heparin) or anti-factor Xa activity (for LMW heparin). As an example, a patient with minor skin bleeding in the setting of a mechanical heart valve (high thromboembolic risk) and a therapeutic aPTT may continue heparin therapy, whereas a patient with major intracerebral bleeding in the setting of venous thromboembolism several months prior who is receiving heparin bridging perioperatively may require immediate heparin discontinuation and reversal with protamine sulphate. If haemorrhage occurs it is usually sufficient to withdraw unfractionated or low molecular weight heparin, but if rapid reversal of the effects of the heparin is required, protamine sulphate is a specific antidote (but only partially reverses the effects of low molecular weight heparins). Clinician judgment and early involvement of the appropriate consulting specialists is advised.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 28
Incorrect
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What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?
Your Answer:
Correct Answer: 10 ml of 1 in 10,000 adrenaline solution
Explanation:Ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) are referred to as shockable rhythm.
IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be administered after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter for a shockable rhythm.
For a non-shockable rhythm, 1 mg IV adrenaline should be administered as soon as IV access is obtained, and then every 3 – 5 minutes/after alternate shocks thereafter.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 29
Incorrect
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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:
Correct 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 30
Incorrect
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A 39-year-old man with a long history of depression presents after intentionally overdoing his heart medication. Verapamil immediate-release 240 mg is the tablet he takes for this condition, he says. He took the pills about 30 minutes ago, but his wife discovered him right away and rushed him to the emergency room.
Which of the following is a verapamil toxicity?Your Answer:
Correct Answer: Negative inotropy
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 following summarises the toxicity of calcium-channel blockers:
Cardiac effects
Vascular smooth muscle tone affects
Metabolic effects
Excessive negative inotropy: myocardial depression
Negative chronotropy: sinus bradycardia
Negative dromotropy: atrioventricular node blockade
Decreased afterload
Systemic hypotension
Coronary vasodilation
Hypoinsulinaemia
Calcium channel blocker-induced insulin resistance -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 31
Incorrect
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Which of the following local anaesthetics has the longest duration of action:
Your Answer:
Correct 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 32
Incorrect
-
Which of the following side effects is most likely caused by erythromycin:
Your Answer:
Correct Answer: QT - prolongation
Explanation:The side effects of erythromycin include abdominal pain, anaphylaxis,
cholestatic hepatitis, confusion,
diarrhoea, dyspepsia, fever, flatulence, hallucinations, hearing loss,
headache, hypertrophic pyloric stenosis, hypotension, Interstitial
nephritis, mild allergic reactions, nausea, nervous system effects,
including seizures, pain, pruritus, pseudomembranous colitis,
QT prolongation, rash, skin eruptions, tinnitus, urticaria,
ventricular arrhythmias, ventricular tachycardia, vertigo, vomiting -
This question is part of the following fields:
- Infections
- Pharmacology
-
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Question 33
Incorrect
-
A 50-year-old man presents with signs and symptoms of an anaphylactic reaction. His GP had recently given him a new medication.
Which one of these is the most likely medication responsible for the drug-induced anaphylactic reaction?
Your Answer:
Correct Answer: Penicillin
Explanation:The most common cause of drug-induced anaphylaxis is penicillin.
The second commonest cause are NSAIDs. Other drugs associated with anaphylaxis are ACE inhibitors and aspirin.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 34
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 35
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 36
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:
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
-
-
Question 37
Incorrect
-
Which of the following best describes the mechanism of action of aspirin:
Your Answer:
Correct Answer: Cyclo-oxygenase (COX) inhibitor
Explanation:Aspirin is a non-steroidal anti-inflammatory drug (NSAID). Aspirin irreversibly inhibits cyclooxygenase (COX) enzymes and the resulting inhibition of prostaglandin synthesis results in analgesic, antipyretic and to a lesser extent anti-inflammatory actions.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
-
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Question 38
Incorrect
-
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:
Correct 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 39
Incorrect
-
Streptococcus viridans has developed subacute bacterial endocarditis in your patient. Which of the following locations is most likely to be the organism's origin?
Your Answer:
Correct Answer: Oral cavity
Explanation:Streptococci that are alpha-haemolytic, such as Streptococcus viridans, are major components of the flora in the oral cavity.
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This question is part of the following fields:
- Infections
- Microbiology
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-
Question 40
Incorrect
-
Which of the following is a contraindication to the use of opioid analgesics:
Your Answer:
Correct Answer: Raised intracranial pressure
Explanation:Opioids should be avoided in people who have:
A risk of paralytic ileus (opioids reduce gastric motility)
Acute respiratory depressionAn acute exacerbation of asthma (opioids can aggravate bronchoconstriction as a result of histamine release)
Conditions associated with increased intracranial pressure including head injury (opioids can interfere with pupillary response making neurological assessment difficult and may cause retention of carbon dioxide aggravating the increased intracranial pressure) -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
-
-
Question 41
Incorrect
-
Which of the following corticosteroids has the most potent mineralocorticoid effect:
Your Answer:
Correct Answer: Fludrocortisone
Explanation:Fludrocortisone has the most potent mineralocorticosteroid activity, making it ideal for mineralocorticoid replacement in adrenal insufficiency.
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This question is part of the following fields:
- Endocrine
- Pharmacology
-
-
Question 42
Incorrect
-
A 35-year-old woman has complaints of nausea, abdominal pain and dark urine. On examination, you notice she has jaundice. She tells you she recently started a new medication.
Which drug is NOT likely to cause cholestatic jaundice out of the following?Your Answer:
Correct Answer: Isoniazid
Explanation:Isoniazid is an antibiotic used in the treatment of tuberculosis. It can cause acute, dose-dependent, hepatitis but is not a recognised cause of cholestatic jaundice.
The drugs that cause cholestatic jaundice are the following:
1. Nitrofurantoin
2. Erythromycin
3. Cephalosporins
4. Verapamil
5. NSAIDs
6. ACE inhibitors
7. Tricyclic antidepressants
8. Phenytoin
9. Azathioprine
10. Carbamazepine
11. Oral contraceptive pills
12. Diazepam
13. Ketoconazole
14. Tamoxifen -
This question is part of the following fields:
- Infections
- Pharmacology
-
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Question 43
Incorrect
-
The most common complication of paracetamol overdose is:
Your Answer:
Correct Answer: Hepatic failure
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.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
-
-
Question 44
Incorrect
-
Question 45
Incorrect
-
A 60-year-old male presents to the genitourinary clinic with dysuria and urinary frequency complaints. He has a past medical history of benign prostate enlargement, for which he has been taking tamsulosin. There is blood, protein, leucocytes, and nitrites on a urine dipstick. Fresh blood tests were sent, and his estimated GFR is calculated to be >60 ml/minute. A urinary tract infection (UTI) diagnosis is made, and he is prescribed antibiotics. Out of the following, which antibiotic is most appropriate to be prescribed to this patient?
Your Answer:
Correct Answer: Ciprofloxacin
Explanation:URINARY TRACT INFECTIONS IN ADULT MEN
Symptomatic urinary tract infections are much less common in men than in women, and all UTIs
in men are considered complicated UTIs. Men with UTIs should be evaluated for predisposing or
causative factors.Uncomplicated cystitis
- Fosfomycin, oral, 3 g as a single dose.
If fosfomycin is unavailable:
- Nitrofurantoin, oral, 100 mg 6 hourly for 5 days.
Do not use nitrofurantoin or fosfomycin if there is any suspicion of early pyelonephritis as they do
not achieve adequate renal tissue levels.
If there are any factors precluding the use of the above agents, then a beta-lactam should be used.
Options include:
Cefixime 200 mg PO 12 hourly for 7 days
OR
Cefpodoxime 100 mg PO 12 hourly for 7 daysComplicated cystitis
Adults- Ciprofloxacin 500 mg PO 12 hourly
OR - Levofloxacin 750 mg PO once daily
Empiric antibiotic therapy should be changed based upon the bacteria isolated and its
antimicrobial susceptibility.
Treat for a total of 7–14 days -
This question is part of the following fields:
- Infections
- Pharmacology
-
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Question 46
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
-
-
Question 47
Incorrect
-
Question 48
Incorrect
-
Regarding gas exchange at the alveolar-capillary membrane, which of the following statements is CORRECT:
Your Answer:
Correct Answer: The rate of diffusion in lungs can be estimated by measuring the diffusing capacity of the lungs for carbon monoxide.
Explanation:Gas exchange between alveolar air and blood in the pulmonary capillaries takes place by diffusion across the alveolar-capillary membrane. Diffusion occurs from an area of high partial pressure to an area of low partial pressure, thus the driving force for diffusion is the alveolar-capillary partial pressure gradient. Diffusion occurs across a membrane and is therefore governed by Fick’s law. Although CO2is larger than O2, it is is much more soluble and diffuses 20 times more rapidly. The diffusing capacity for oxygen (DLO2) cannot be measured directly but the rate of diffusion in the lungs can be estimated by measuring the diffusing capacity of the lungs for carbon monoxide (DLCO).
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This question is part of the following fields:
- Physiology
- Respiratory
-
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Question 49
Incorrect
-
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:
Correct 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 50
Incorrect
-
Carbamazepine is indicated for all of the following EXCEPT for:
Your Answer:
Correct Answer: Myoclonic seizures
Explanation:Carbamazepine is a drug of choice for simple and complex focal seizures and is a first-line treatment option for generalised tonic-clonic seizures. It is also used in trigeminal neuralgia and diabetic neuropathy. Carbamazepine may exacerbate tonic, atonic, myoclonic and absence seizures and is therefore not recommended if these seizures are present.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 51
Incorrect
-
Which of the following statements is correct regarding the partial pressure of oxygen during respiration?
Your Answer:
Correct Answer: Exhaled PO 2 > Alveolar PO 2
Explanation:Because of humidification, inspired PO2 in the airways is less than inhaled PO2.
Because of gas exchange, alveolar PO2 is less than inhaled or inspired PO2.
Because of mixing with anatomical dead space (air that has not taken part in gas exchange, exhaled PO2 is greater than alveolar O2, and therefore that has relatively higher PO2 on the way out, but is less than inhaled or inspired PO2.
Typical values for a resting young healthy male (in kPa) are shown below:
-Inhaled air: PO221.2, PCO20.0
-Inspired air in airways (after humidification): PO219.9, PCO20.0
-Alveolar air (after equilibrium with pulmonary capillaries): PO213.3, PCO25.3
-Exhaled air (after mixing with anatomical dead space air): PO215.5, PCO24.3 -
This question is part of the following fields:
- Physiology
- Respiratory
-
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Question 52
Incorrect
-
Digoxin is predominantly used for which of the following:
Your Answer:
Correct Answer: Rate control in persistent and permanent atrial fibrillation
Explanation:Digoxin is most useful for controlling the ventricular response in persistent and permanent atrial fibrillation and atrial flutter. Digoxin is usually only effective for controlling the ventricular rate at rest, and should therefore only be used as monotherapy in predominantly sedentary patients with non-paroxysmal atrial fibrillation. It is now rarely used for rapid control of heart rate, as even with intravenous administration, response may take many hours. Digoxin is reserved for patients with worsening or severe heart failure due to left ventricular systolic dysfunction refractory to combination therapy with first-line agents. Digoxin is contraindicated in supraventricular arrhythmias associated with accessory conduction pathways e.g. Wolff-Parkinson-White syndrome.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 53
Incorrect
-
Which of the following is NOT a typical side effect of opioid analgesics:
Your Answer:
Correct Answer: Diarrhoea
Explanation:All opioids have the potential to cause:
Gastrointestinal effects – Nausea, vomiting, constipation, difficulty with micturition (urinary retention), biliary spasm
Central nervous system effects – Sedation, euphoria, respiratory depression, miosis
Cardiovascular effects – Peripheral vasodilation, postural hypotension
Dependence and tolerance -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
-
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Question 54
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:
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
-
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Question 55
Incorrect
-
In patients requiring oxygen, who are at risk of hypercapnic respiratory failure, oxygen saturations should be maintained at:
Your Answer:
Correct Answer: 88 - 92%
Explanation:A lower target of 88 – 92% oxygen saturation is indicated for patients at risk of hypercapnic respiratory failure e.g. patients with COPD. Until blood gases can be measured, initial oxygen should be given using a controlled concentration of 28% or less, titrated towards the SpO2 of 88 – 92%. The aim is to provide the patient with enough oxygen to achieve an acceptable arterial oxygen tension without worsening carbon dioxide retention and respiratory acidosis.
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This question is part of the following fields:
- Pharmacology
- Respiratory
-
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Question 56
Incorrect
-
Which of the following is NOT one of insulin's actions:
Your Answer:
Correct Answer: Increased gluconeogenesis
Explanation:Insulin has a number of effects on glucose metabolism, including:
Inhibition of glycogenolysis and gluconeogenesis
Increased glucose transport into fat and muscle
Increased glycolysis in fat and muscle
Stimulation of glycogen synthesis
By inhibiting gluconeogenesis, insulin maintains the availability of amino acids as substrates for protein synthesis. Thus, insulin supports protein synthesis through direct and indirect mechanisms. -
This question is part of the following fields:
- Endocrine
- Pharmacology
-
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Question 57
Incorrect
-
Regarding the foetal oxygen-haemoglobin dissociation curve, which of the following statements is CORRECT:
Your Answer:
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 58
Incorrect
-
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:
Correct 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.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
-
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Question 59
Incorrect
-
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:
Correct 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 60
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:
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.
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This question is part of the following fields:
- Musculoskeletal
- Pharmacology
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Question 61
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 62
Incorrect
-
After collapsing at home, a 62-year-old man is transported in an ambulance. He is now awake, but he is experiencing palpitations and chest pain. He is rushed to resuscitation and placed on a cardiac monitor, which reveals ventricular tachycardia. An amiodarone infusion is set up.
Which of these statements about amiodarone is correct?Your Answer:
Correct Answer: It is expressed in breast milk
Explanation:Antiarrhythmic drug amiodarone is used to treat both ventricular and atrial arrhythmias. It’s a class III antiarrhythmic that works by prolonging the repolarization phase of the cardiac action potential, where potassium permeability is normally high and calcium permeability is low.
Dronedarone is sometimes used instead of amiodarone in certain situations. Although amiodarone is more effective than dronedarone, dronedarone has fewer side effects.
Grapefruit juice inhibits the metabolism of amiodarone.
The plasma half-life of amiodarone is very long, ranging from 2 weeks to 5 months. The half-life is about 2 months on average.
Because amiodarone is excreted in breast milk, it should be avoided by breastfeeding mothers. -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 63
Incorrect
-
Which of the following statements is INCORRECT. Fick's law tells us that the rate of diffusion of a gas across a membrane increases as:
Your Answer:
Correct Answer: the partial pressure gradient decreases.
Explanation:Fick’s law tells us that the rate of diffusion of a gas increases:
the larger the surface area involved in gas exchange
the greater the partial pressure gradient across the membrane
the thinner the membrane
the more soluble the gas in the membrane
the lower the molecular weight of the gas -
This question is part of the following fields:
- Physiology
- Respiratory
-
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Question 64
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 65
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 66
Incorrect
-
Which of the following types of food is most commonly implicated in anaphylactic reactions:
Your Answer:
Correct Answer: Nuts
Explanation:Anaphylaxis can be triggered by any of a very broad range of triggers, but those most commonly identified include food, drugs, latex and venom. Of foods, nuts are the most common cause; muscle relaxants, antibiotics, NSAIDs and aspirin are the most commonly implicated drugs. Food is the commonest trigger in children and drugs the commonest in adults. A significant number of cases are idiopathic. Most reactions occur over several minutes; rarely, reactions may be slower in onset. The speed of onset of the reaction depends on the trigger e.g. intravenous medications will cause a more rapid onset than stings which in turn will cause a more rapid onset than ingestion of food.
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This question is part of the following fields:
- Pharmacology
- Respiratory
-
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Question 67
Incorrect
-
One of your patients is undergoing resuscitation and is in septic shock. The intensive care outreach team arrives to assess them and determines that a dobutamine infusion should be started.
Which of the following receptors does dobutamine primarily affect?Your Answer:
Correct Answer: Beta-1 receptors
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.
A summary of the mechanism and effects of different inotropic agents is shown below:
Inotrope
Mechanism
Effects
Adrenaline (epinephrine)
Beta-1 and -2 agonist at increasing doses;
Alpha-agonist at high doses
Increased cardiac output;
Vasoconstriction at higher doses
Noradrenaline (norepinephrine)
Mainly alpha-agonist;
Beta-1 and -2 agonist at increasing doses
Vasoconstriction;
Some increased cardiac output
Dopamine
Dopamine agonist at low doses;
Beta-1 and -2 agonist at increasing doses;
Alpha-agonist at high doses
Increased cardiac output;
Vasoconstriction at higher doses
Dobutamine
Mainly beta-1 agonist
Increased cardiac output -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 68
Incorrect
-
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:
Correct 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 69
Incorrect
-
A patient presents with increased breathlessness and worsening of his chronic cough and. He has a chronic lung disorder and is on long-term oxygen therapy (LTOT). Which of these is an indication for LTOT?
Your Answer:
Correct Answer: A non-smoker with COPD and a PaO2 of 7.5 kPa when stable with secondary polycythaemia
Explanation:Long-term administration of oxygen, usually at least 15 hours daily, improves survival in COPD patients who have severe hypoxaemia.
Long-term oxygen therapy should be considered in:
A non-smoker with COPD and a PaO2<7.3 kPa when stable
A non-smoker with COPD and PaO27.3–8 kPa when stable and with secondary polycythaemia, peripheral oedema, or evidence of pulmonary hypertension
Severe chronic asthma with PaO2<7.3 kPa or persistent disabling breathlessness
A patient with Interstitial lung disease with PaO2<8 kPa and in patients with PaO2>8 kPa with disabling dyspnoea
A patient with cystic fibrosis when PaO2<7.3 kPa or if PaO27.3–8 kPa in the presence of secondary polycythaemia, nocturnal hypoxaemia, pulmonary hypertension, or peripheral oedema
Pulmonary hypertension, without parenchymal lung involvement when PaO2<8 kPa
Neuromuscular or skeletal disorders, after specialist assessment
Obstructive sleep apnoea despite continuous positive airways pressure therapy, after specialist assessment
Pulmonary malignancy or other terminal disease with disabling dyspnoea
Heart failure with daytime PaO2<7.3 kPa when breathing air or with nocturnal hypoxaemia
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 70
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 71
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 72
Incorrect
-
Regarding gas exchange at the alveolar-capillary membrane, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Transfer of oxygen is usually perfusion-limited.
Explanation:Gas exchange between alveolar air and blood in the pulmonary capillaries takes place by diffusion across the alveolar-capillary membrane. Diffusion occurs from an area of high partial pressure to an area of low partial pressure, thus the driving force for diffusion is the alveolar-capillary partial pressure gradient. Diffusion occurs until equilibrium is reached, but random movement of particles continues to occur and this is known as dynamic equilibrium. The diffusing capacity for oxygen (DLO2) cannot be measured directly but the rate of diffusion in the lungs can be estimated by measuring the diffusing capacity of the lungs for carbon monoxide (DLCO), not by measuring total lung capacity. The rate of transfer of a gas may be diffusion or perfusion limited; carbon monoxide transfer is diffusion-limited, oxygen transfer is usually perfusion-limited.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 73
Incorrect
-
You review a patient with a history of Addison’s disease. He takes 100 mg of hydrocortisone per day to control this.
What dose of prednisolone is equivalent to this dose of hydrocortisone? Select ONE answer only.Your Answer:
Correct Answer: 25 mg
Explanation:Prednisolone is four times more potent than hydrocortisone, and therefore, a dose of 25 mg would be equivalent to 100 mg of hydrocortisone.
The following table summarises the relative potency of the main corticosteroids compared with hydrocortisone:
Corticosteroid
Potency relative to hydrocortisone
Prednisolone
4 times more potent
Triamcinolone
5 times more potent
Methylprednisolone
5 times more potent
Dexamethasone
25 times more potent -
This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 74
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 75
Incorrect
-
Regarding dynamic compression of the airways, which of the following statements is CORRECT:
Your Answer:
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 76
Incorrect
-
You intend to suture a hand wound with plain 1 percent lidocaine.
In 1 mL of plain 1 percent lidocaine solution, how much lidocaine hydrochloride is there?Your Answer:
Correct Answer: 10 mg lidocaine hydrochloride
Explanation:10 mg of lidocaine hydrochloride is contained in each 1 mL of plain 1 percent lidocaine solution.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 77
Incorrect
-
Which of the following is an adverse effect of carbamazepine:
Your Answer:
Correct Answer: Aplastic anaemia
Explanation:Common adverse effects include nausea and vomiting, sedation, dizziness, headache, blurred vision and ataxia. These adverse effects are dose related and are most common at the start of treatment.
Other adverse effects include:
Allergic skin reactions (and rarely, more serious dermatological conditions)
Hyponatraemia (avoid concomitant use with diuretics)
Leucopenia, thrombocytopenia and other blood disorders including aplastic anaemia
Hepatic impairment -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 78
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 79
Incorrect
-
Which of the following is an example of a vaccine produced by recombinant DNA technology:
Your Answer:
Correct Answer: Hepatitis B
Explanation:Hepatitis B vaccines are prepared from the viral surface antigen. The recombinant vaccine is now the most widely used vaccine and induces a sufficient antibody response in 90% of individuals.
Indications for hepatitis B vaccination include:
All health care professional’s
Other professions with occupational risks (foster carers, staff of custodial institutions, morticians etc)
Babies of mothers with hepatitis B during pregnancy
Close family contacts of a case or carrier
IV drug abusers
Individuals with haemophilia
Individuals with chronic renal failure
Sex workers and individuals with frequently changing sexual partners
The vaccine should be stored between 2 and 8 degrees C as freezing destroys its efficacy. The vaccine is administered intramuscularly, either into the deltoid region (preferred) or anterolateral thigh. The buttock should be avoided as it reduces the efficacy of the vaccine.
The standard regime is to give 3 doses of the vaccine, the 1stand 2ndone month apart and the 2ndand 3rdsix months apart. Antibody titres should be tested 2 to 4 months after the primary course.
A peak titre above 100 mIU/ml is regarded as a good response and implies long-term immunity. A peak titre between 10-100 mIU/ml is regarded as a low response and a peak titre of less than 10mIU/ml is regarded as a poor response.
There is no substantiated association between hepatitis B vaccination and Guillain-Barre syndrome. -
This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
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Question 80
Incorrect
-
A 32-year-old asthmatic patient on theophylline as part of her asthma management presents to the Emergency Department with an unrelated medical condition.
Which of these drugs should be avoided?Your Answer:
Correct Answer: Clarithromycin
Explanation:Macrolide antibiotics (e.g. clarithromycin and erythromycin) are cytochrome P450 enzyme inhibitors. They increase blood levels of theophylline leading to hypokalaemia, and potentially increasing the risk of Torsades de pointes when they are prescribed together.
Co-prescription with theophylline should be avoided.
Factors that enhance theophylline clearance include cigarette smoking, carbamazepine, phenobarbital, phenytoin, primidone, and rifampin.
Medications that inhibit clearance include ethanol, ciprofloxacin, erythromycin, verapamil, propranolol, ticlopidine, tacrine, allopurinol, and cimetidine. -
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 81
Incorrect
-
An 80-year-old male has presented with chest pain characteristic of angina pectoris. Before initiating treatment with Glyceryl nitrate, you examine the patient and find a murmur. The patient reveals that he has a heart valve disorder, and you immediately put a hold on the GTN order.
Which of the following valve disorders is an absolute contraindication to the use of GTN?Your Answer:
Correct Answer: Mitral stenosis
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. Nitro-glycerine (NTG) – angina pectoris (treatment/prophylaxis), acute coronary syndrome, heart failure, hypertension
2. Isosorbide mononitrate (ISMN) – chronic angina pectoris (treatment)
3. Isosorbide dinitrate (ISDN) – angina pectoris (treatment/prophylaxis)The nitrate drugs cause vasodilation via the action of nitric oxide.
The contraindications to the use of nitrate are the following:
1. Allergy to nitrates
2. Concomitant use of phosphodiesterases (PDE) inhibitors such as tadalafil and sildenafil
3. Right ventricular infarction
4. Hypertrophic cardiomyopathy
5. Cardiac tamponade
6. Constrictive pericarditis
7. Hypotensive conditions
8. Hypovolaemia
9. Marked anaemia
10. Mitral stenosis
11. Raised intracranial pressure due to cerebral haemorrhage or head trauma
12. Toxic pulmonary oedema -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 82
Incorrect
-
A 45-year-old woman presents with persistent palpitations for the past two days. She has a good haemodynamic balance. An ECG is performed, which reveals that she has atrial flutter. The patient is examined by a cardiology registrar, who recommends using a 'rate control' strategy while she waits for cardioversion.
Which of the drugs listed below is the best fit for this strategy?Your Answer:
Correct Answer: Bisoprolol
Explanation:In atrial flutter, ventricular rate control is usually used as a stopgap measure until sinus rhythm can be restored. A beta-blocker (such as bisoprolol), diltiazem, or verapamil can be used to lower the heart rate.
Electrical cardioversion, pharmacological cardioversion, or catheter ablation can all be used to restore sinus rhythm. Cardioversion should not be attempted until the patient has been fully anticoagulated for at least three weeks if the duration of atrial flutter is unknown or has lasted for more than 48 hours. Emergency electrical cardioversion is the treatment of choice when there is an acute presentation with haemodynamic compromise. For the treatment of recurrent atrial flutter, catheter ablation is preferred.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 83
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 84
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 85
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 86
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:
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 87
Incorrect
-
You review a patient with urinary sepsis and decide to start her on gentamicin.
Which statement about gentamicin is true?
Your Answer:
Correct Answer: Ototoxicity is a dose-related effect
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.
Gentamicin is given by injection because it is NOT absorbed orally.
It is excreted in the kidneys by glomerular filtration
Gentamicin is not to be used for the treatment of Neisseria meningitidis, Neisseria gonorrhoea, or Legionella pneumophila.There is a risk of patient going into shock from lipid A endotoxin release.
Two of its most notable side effects are hearing loss reversible nephrotoxicity and which are both dose-related and levels should be monitored in patients.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 88
Incorrect
-
Which of the following is NOT a common effect of etomidate:
Your Answer:
Correct Answer: Significant hypotension
Explanation:Etomidate causes less hypotension than thiopental sodium and propofol during induction. However, it is associated with a high incidence of extraneous muscle movements, which can be minimised by an opioid analgesic or a short-acting benzodiazepine given prior to induction. Pain on injection is common and there is a high rate of thrombophlebitis in the postoperative period. Postoperative nausea and vomiting commonly occur. Etomidate suppresses adrenocortical function, particularly during continuous administration, and it should not be used for maintenance of anaesthesia. It should be used with caution in patients with underlying adrenal insufficiency, for example, those with sepsis.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 89
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 90
Incorrect
-
Which of the following statements about lithium treatment is FALSE:
Your Answer:
Correct Answer: Concomitant treatment with NSAIDs decreases serum-lithium concentration.
Explanation:Lithium levels are raised by NSAIDs because renal clearance is reduced. Lithium is a small ion (74 Daltons) with no protein or tissue binding and is therefore amenable to haemodialysis. Lithium is freely distributed throughout total body water with a volume of distribution between 0.6 to 0.9 L/kg, although the volume may be smaller in the elderly, who have less lean body mass and less total body water. Steady-state serum levels are typically reached within five days at the usual oral dose of 1200 to 1800 mg/day. The half-life for lithium is approximately 18 hours in adults and 36 hours in the elderly.
Lithium is excreted almost entirely by the kidneys and is handled in a manner similar to sodium. Lithium is freely filtered but over 60 percent is then reabsorbed by the proximal tubules. -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 91
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 92
Incorrect
-
Which of the following is NOT an adverse effect associated with warfarin therapy:
Your Answer:
Correct 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 93
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 94
Incorrect
-
Which of the following medications can block the effect of adrenaline?
Your Answer:
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 95
Incorrect
-
Regarding calcium channel blockers, which of the following statements is CORRECT:
Your Answer:
Correct 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
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Question 96
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 97
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
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 98
Incorrect
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Hartmann's solution contains how much sodium:
Your Answer:
Correct Answer: 131 mmol/L
Explanation:Hartmann’s solution (compound sodium lactate) contains: Na+131 mmol/L, K+5 mmol/L, HCO3-29 mmol/L (as lactate), Cl-111 mmol/L, Ca2+2 mmol/L. It can be used instead of isotonic sodium chloride solution during or after surgery, or in the initial management of the injured or wounded; it may reduce the risk of hyperchloraemic acidosis.
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This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
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Question 99
Incorrect
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Nitrous oxide is associated with which of the following adverse effects:
Your Answer:
Correct Answer: Megaloblastic anaemia
Explanation:Exposure to nitrous oxide for prolonged periods, either by continuous or by intermittent administration, may result in megaloblastic anaemia as a result of interference with the action of vitamin B12; neurological toxic effects can occur without preceding overt haematological changes. Depression of white cell formation may also occur.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 100
Incorrect
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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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SESSION STATS - PERFORMANCE PER SPECIALTY
