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  • Question 1 - All of the following are indications for beta-blockers EXCEPT for: ...

    Correct

    • All of the following are indications for beta-blockers EXCEPT for:

      Your Answer: Raynaud's disease

      Explanation:

      Beta-blockers are contraindicated in Raynaud’s syndrome.
      Beta-blockers may be indicated in:
      Hypertension
      Pheochromocytoma (only with an alpha-blocker)
      Angina
      Secondary prevention after ACS
      Arrhythmias including atrial fibrillation
      Heart failure
      Thyrotoxicosis
      Anxiety
      Prophylaxis of migraine
      Essential tremor
      Glaucoma

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      27.4
      Seconds

  • Question 2 - Regarding antiemetics, which of the following statements is INCORRECT: ...

    Correct

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

      Your Answer: Of the antiemetics, cyclizine is most commonly associated with acute dystonic reactions.

      Explanation:

      Cyclizine acts by inhibiting histamine pathways and cholinergic pathways involved in transmission from the vestibular apparatus to the vomiting centre. Metoclopramide is a dopamine-receptor antagonist which acts both peripherally in the GI tract and centrally within the chemoreceptor trigger zone. Prochlorperazine is a dopamine-D2 receptor antagonist and acts centrally by blocking the chemoreceptor trigger zone. Metoclopramide and prochlorperazine are both commonly associated with extrapyramidal effects, such as acute dystonic reaction. Cyclizine may rarely cause extrapyramidal effects.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      43.2
      Seconds

  • Question 3 - Regarding penicillin antibiotics, which of the following statements is CORRECT: ...

    Correct

    • Regarding penicillin antibiotics, which of the following statements is CORRECT:

      Your Answer: Patients with a history of atopy are at higher risk of hypersensitivity reactions.

      Explanation:

      Allergic reactions to penicillins occur in 1 – 10% of exposed individuals; anaphylactic reactions occur in fewer than 0.05% of treated patients. Patients with a history of atopic allergy are at higher risk of anaphylactic reactions to penicillins. Patients with a history of anaphylaxis, urticaria, or rash immediately after penicillin use should not receive a penicillin or other beta-lactam antibiotics; about 0.5 – 6.5 % of penicillin-sensitive patients will also be allergic to the cephalosporins.

      Patients with a history of a more minor rash (i.e. non-confluent, non-pruritic rash restricted to a small area of the body) or delayed reaction (rash occurring more than 72 hours after penicillin administration), may not be truly allergic and may be considered for penicillin or beta-lactam treatment in severe infection (although possibility of allergy should be borne in mind). Other beta-lactam antibiotics (including cephalosporins) can be used in these patients.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      64.3
      Seconds

  • Question 4 - All of the following are indications for beta-blockers EXCEPT for: ...

    Correct

    • All of the following are indications for beta-blockers EXCEPT for:

      Your Answer: Prinzmetal's angina

      Explanation:

      Beta-blockers are contraindicated in Prinzmetal’s angina.Beta-blockers may be indicated in:HypertensionPheochromocytoma (only with an alpha-blocker)AnginaSecondary prevention after ACSArrhythmias including atrial fibrillationHeart failureThyrotoxicosisAnxietyProphylaxis of migraineEssential tremorGlaucoma

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      48.4
      Seconds

  • Question 5 - The patient is a 66-year-old woman who has troublesome bilateral ankle swelling. This...

    Incorrect

    • The patient is a 66-year-old woman who has troublesome bilateral ankle swelling. This has been happening since she began taking a new antihypertensive medication a few weeks ago.

      Which of the following medications is most likely to be the cause of this adverse reaction?

      Your Answer: Atenolol

      Correct Answer: Amlodipine

      Explanation:

      Amlodipine is a calcium-channel blocker that is frequently used to treat hypertension. Ankle swelling is a very common side effect of calcium-channel blockers, and it occurs quite frequently.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      44.8
      Seconds

  • Question 6 - A 45-year-old man, a known case of epilepsy, visits his neurologist with complaints...

    Correct

    • A 45-year-old man, a known case of epilepsy, visits his neurologist with complaints of red, swollen gums.

      Which of the following medications is most likely responsible for his symptoms?

      Your Answer: Phenytoin

      Explanation:

      Phenytoin is a commonly used antiepileptic drug. A well-recognized side-effect of phenytoin is gingival enlargement and occurs in about 50% of patients receiving phenytoin. It is believed that reduced folate levels may cause this, and evidence suggests that folic acid supplementation may help prevent this in patients starting phenytoin.

      As evidence suggests, drug-induced gingival enlargement may also improve by substituting with other anticonvulsant drugs and reinforcing a good oral hygiene regimen. Surgical excision of hyperplastic gingiva is often necessary to correct the aesthetic and functional impairment associated with this condition to manage it successfully.

      Phenytoin is also the only anticonvulsant therapy associated with the development of Dupuytren’s contracture.
      Other side effects are:
      1. Ataxia
      2. Drug-induced lupus
      3. Hirsutism
      4. Pruritic rash
      5. Megaloblastic anaemia
      6. Nystagmus

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      28.4
      Seconds

  • Question 7 - The triage nurse asks if you will prescribe a dose of codeine phosphate...

    Correct

    • The triage nurse asks if you will prescribe a dose of codeine phosphate for a patient who is in a lot of pain. You discover that you are unable to prescribe it due to a contra-indication after evaluating the patient.

      The use of codeine phosphate is contraindicated in which of the following situations?

      Your Answer: Age under 12 years

      Explanation:

      Codeine phosphate is a mild opiate that can be used to treat mild to moderate pain when other pain relievers like paracetamol or ibuprofen have failed. It can also be used to treat diarrhoea and coughs that are dry or painful.

      The use of all opioids is contraindicated for the following reasons:
      Respiratory depression (acute)
      Patients who are comatose
      Head injury (opioid analgesics impair pupillary responses, which are crucial for neurological evaluation)
      Intracranial pressure has risen (opioid analgesics interfere with pupillary responses vital for neurological assessment)
      There’s a chance you’ll get paralytic ileus.

      The use of codeine phosphate is contraindicated in the following situations:
      Because of the significant risk of respiratory side effects in children under the age of 12, it is not recommended for children under the age of 12.

      Patients of any age who have been identified as ultra-rapid codeine metabolizers (CYP2D6 ultra-rapid metabolizers)

      Because codeine can pass through breast milk to the baby and because mothers’ ability to metabolise codeine varies greatly, it is especially dangerous in breastfeeding mothers.

      If other painkillers, such as paracetamol or ibuprofen, fail to relieve acute moderate pain in children over the age of 12, codeine should be used. In children with obstructive sleep apnoea who received codeine after tonsillectomy or adenoidectomy, a significant risk of serious and life-threatening adverse reactions has been identified.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      22.6
      Seconds

  • Question 8 - What is the appropriate dose of 1:1000 adrenaline solution for a 15-year-old patient...

    Correct

    • What is the appropriate dose of 1:1000 adrenaline solution for a 15-year-old patient with suspected anaphylactic shock?

      Your Answer: 500 micrograms intramuscularly

      Explanation:

      1: 1000 Adrenaline solution dosage for children above the age of 12 and adults, including pregnant women (over 50 kg) is 0.50 mL, which is equivalent to 500 mcg of adrenaline.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      25
      Seconds

  • Question 9 - Which of the following is NOT a common effect of etomidate: ...

    Correct

    • Which of the following is NOT a common effect of etomidate:

      Your Answer: Significant hypotension

      Explanation:

      Etomidate causes less hypotension than thiopental sodium and propofol during induction. However, it is associated with a high incidence of extraneous muscle movements, which can be minimised by an opioid analgesic or a short-acting benzodiazepine given prior to induction. Pain on injection is common and there is a high rate of thrombophlebitis in the postoperative period. Postoperative nausea and vomiting commonly occur. Etomidate suppresses adrenocortical function, particularly during continuous administration, and it should not be used for maintenance of anaesthesia. It should be used with caution in patients with underlying adrenal insufficiency, for example, those with sepsis.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      20.7
      Seconds

  • Question 10 - A 46-year-old male who is suffering from a chest infection. You decide to start giving...

    Incorrect

    • A 46-year-old male who is suffering from a chest infection. You decide to start giving the patient antibiotics, however he is allergic to penicillin. You consult with one of your co-workers about the best choice of antibiotic to give.

      From the following choices, which is considered an example of bacteriostatic antibiotic?

      Your Answer: Ciprofloxacin

      Correct Answer: Trimethoprim

      Explanation:

      Antibiotics that are bactericidal kill bacteria, while antibiotics that are bacteriostatic limit their growth or reproduction. The antibiotics grouped into these two classes are summarized in the table below:

      Bactericidal antibiotics
      Bacteriostatic antibiotics

      Vancomycin
      Metronidazole
      Fluoroquinolone, such as ciprofloxacin
      Penicillins, such as benzylpenicillin
      Cephalosporin, such as ceftriaxone
      Co-trimoxazole
      Tetracyclines, such as doxycycline
      Macrolides, such as erythromycin
      Sulphonamides, such as sulfamethoxazole
      Clindamycin
      Trimethoprim
      Chloramphenicol

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      45.1
      Seconds

  • Question 11 - Captopril should not be used if you have any of the following conditions:...

    Incorrect

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

      Your Answer: Asthma

      Correct Answer: Renal artery stenosis

      Explanation:

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

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      19.2
      Seconds

  • Question 12 - What is the main mechanism of action of dopamine as an inotropic sympathomimetic: ...

    Correct

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

      Your Answer: Beta1-receptor agonist

      Explanation:

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

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      6.3
      Seconds

  • Question 13 - You examine a 72-year-old man who has recently begun bumetanide treatment for worsening...

    Correct

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

      Which of these statements about bumetanide is correct?

      Your Answer: It has better intestinal absorption than furosemide

      Explanation:

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

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

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

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

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      26.3
      Seconds

  • Question 14 - Digoxin is predominantly used for which of the following: ...

    Incorrect

    • Digoxin is predominantly used for which of the following:

      Your Answer: Rate control in paroxysmal atrial fibrillation

      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.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      70.9
      Seconds

  • Question 15 - Which of the following best describes the therapeutic effect of calcium gluconate when used...

    Correct

    • Which of the following best describes the therapeutic effect of calcium gluconate when used in treatment for hyperkalaemia:

      Your Answer: Reduces cardiac cell membrane excitability

      Explanation:

      Calcium resonium is an ion-exchange resin that exchanges sodium for potassium as it passes through the intestine, leading to excretion of potassium from the body. Salbutamol and insulin act to increase intracellular uptake of K+ via Na-K ATP pump. Sodium bicarbonate acts to correct acidosis and thus promotes intracellular uptake of K+. Calcium gluconate acts to protect the cardiac membrane and has no effect on serum K+ levels.

    • This question is part of the following fields:

      • Fluids And Electrolytes
      • Pharmacology
      61.9
      Seconds

  • Question 16 - Following the administration of a drug that was started a few months earlier,...

    Correct

    • Following the administration of a drug that was started a few months earlier, a patient presents with features of peripheral neuropathy.

      Which of the following drugs is most likely to cause peripheral neuropathy?

      Your Answer: Isoniazid

      Explanation:

      Isoniazid, a first-line agent for the treatment of tuberculosis, has the commonest side effect of peripheral neuropathy. It occurs in up to 20% of patients taking the drug at a dose > 6 mg/kg daily.

      Isoniazid combines with pyridoxine (vitamin B6) to form hydrazone, which is excreted in the urine. This causes a deficiency of biologically active pyridoxine leading to peripheral neuropathy.

      Peripheral neuropathy of isoniazid is prevented by the co-administration of pyridoxine at a dose of 10 mg for each 100 mg of isoniazid given.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      10.9
      Seconds

  • Question 17 - Regarding antacids, which of the following statements is CORRECT: ...

    Correct

    • Regarding antacids, which of the following statements is CORRECT:

      Your Answer: Antacids should not be taken at the same time as other drugs as they impair absorption.

      Explanation:

      Antacids should preferably not be taken at the same time as other drugs since they may impair absorption. Antacids act by neutralising stomach acid. They are used for symptomatic relief in dyspepsia, but are not first line for proven peptic ulcer disease where antisecretory drugs have a better healing effect. Magnesium-containing antacids tend to be laxative whereas aluminium-containing antacids tend to be constipating. Antacids are contraindicated in hypophosphataemia.

    • This question is part of the following fields:

      • Gastrointestinal
      • Pharmacology
      20.1
      Seconds

  • Question 18 - In the treatment of hypertensive episodes in pheochromocytoma, which of the following medication...

    Correct

    • In the treatment of hypertensive episodes in pheochromocytoma, which of the following medication types is administered as first-line management:

      Your Answer: Alpha-blockers

      Explanation:

      The first line of management in controlling blood pressure and preventing intraoperative hypertensive crises is to use a combination of alpha and beta-adrenergic inhibition. In phaeochromocytoma, alpha-blockers are used to treat hypertensive episodes in the short term. Tachycardia can be managed by the careful addition of a beta-blocker, preferably a cardioselective beta-blocker, once alpha blockade has been established. Long term management of pheochromocytoma involves surgery.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      13.1
      Seconds

  • Question 19 - A 30-year-old woman presents with a history of fever and sore throat. On...

    Correct

    • A 30-year-old woman presents with a history of fever and sore throat. On examination, there is tonsillar exudate and cervical lymphadenopathy and a diagnosis of tonsillitis is made. A course of penicillin is prescribed.

      What is the mechanism of action of penicillin?

      Your Answer: Inhibition of cell wall synthesis

      Explanation:

      Penicillin is bactericidal and produces its antimicrobial action by preventing cross-linkage between the linear peptidoglycan polymer chains that make up the bacterial cell wall. This action inhibits cell wall synthesis.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      29.8
      Seconds

  • Question 20 - You're currently treating an infection in a patient and trying to figure out...

    Incorrect

    • You're currently treating an infection in a patient and trying to figure out which antibiotic would be best.

      Which of the following antimicrobial drugs inhibits the formation of cell walls?

      Your Answer: Doxycycline

      Correct Answer: Cefuroxime

      Explanation:

      Cefuroxime and other cephalosporin antibiotics are bactericidal ß-lactam antibiotics. They work similarly to penicillins in that they prevent cross-linking between the linear peptidoglycan polymer chains that make up the bacterial cell wall. As a result, they prevent the formation of cell walls.
      The following is a summary of the various mechanisms of action of various types of antimicrobial agents:

      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
      46.9
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular (4/6) 67%
Pharmacology (15/20) 75%
Central Nervous System (1/1) 100%
Infections (3/5) 60%
Cardiovascular Pharmacology (1/2) 50%
CNS Pharmacology (2/2) 100%
Respiratory (1/1) 100%
Anaesthesia (1/1) 100%
Fluids And Electrolytes (1/1) 100%
Gastrointestinal (1/1) 100%
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