PrimMCQ-Pharmacology-Feb2013

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OLD Syllabus Pharm MCQ February 2013

Primary Physiology Black Bank | Primary Pharmacology Black Bank


Contents

Primary MCQ papers

Feb06 | Jul06 | Feb07 | Jul07 | Feb08 | Jul08 | Mar09 | Jul09 | Mar10 | Jul10 |

Feb11 | Aug11 | Feb12 | Jul12(Physiol) | Jul12(Pharm) | Feb13(Physiol) | Feb13(Pharm) | Feb13(NewExam) | Sep13 | Feb14 |

Aug14 | Feb15 | Aug15 | Feb16 | Aug16 |



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Unclassified

(repeat) which of the following is an NMDA receptor antagonist

a) Dextropropoxephene
b) Dexphenylephrine
c) Dexamphetamine
d) Dextromethorphan
e) Dexmedetomidine


Patients who develop ?periph neuropathy with isoniazid are likely to have a reaction with

c) sulfonamides
d) aspirin


Aspirin causes

a) bronchospasm due to leukotrienes


Clopidogrel

a) inhibits ADP Rc on PLT

General Pharmacology

All have high first pass metabolism except:

a) Metoclopramide
b) Propranolol
c) Midazolam
d) Lignocaine
e) GTN


What is true of isomerism?

a) S-methadone has more analgesic potency than R-methadone
b) S-ketamine is less toxic than R-ketamine
c) etc...

(Can't recall exact answer options, but I recall the wrong naming systems being used for many of them, i.e. R- and S- instead of l- and d-, etc).

(alternative) isomers

A. s-bupivicaine vs levobupivicaine
B. (made up isomers of lignocaine)
C. methadone
D. R ketamine 4x sedating as S ketamine


With regards to rectal administration:

a) Absorption from low in the rectum (i.e. below the dentate line) completely bypasses the liver - surely this isn't in the rectum?
b)
c) The upper part of the rectum has good absorption due to extensive anastamoses between the superior and inferior haemorrhoidal arteries. (definitely said arteries)'
d) better absorbed in upper than lower rectum

Inhalational Agents

Contaminants in N2O include:

a) NO2
b) NO
c) N2
d) ammonia
e) All of the above


Isoflurane:

a) 0.2% to hexafluoroisopropanol
b) 2% to trifluoroacetic acid
c) 0.2% via CYP2E1
d) 0.2% in the kidneys
e) None of the above


With regards to nitric oxide:

a)
b)
c) Causes pulmonary hypertension in the newborn
d)
e) Easily titratable intravenous agent


Which of the following increase the effect of ?volatile anaesthetics/?sevoflurane? (I thought this was one of the two sequential questions asked in opposite effect direction regarding NMDRs and specificially cisatracurium)

a) Phenytoin
b) Hypomagnesaemia
c) Hypocalcaemia
d) Hyperkalaemia


One MAC of isoflurane at normocarbia causes:

a) ?
b) ?
c) Decreased oxygen tension in the internal jugular vein
d) Increased ICP
e) Decreased CSF production


Concerns regarding the use of nitrous oxide in anaesthesia do NOT include:

a) Something about subacute degeneration of the spinal cord
b) Cardiovascular disease due to elevated homocysteine levels
c) Teratogenicity for female operating theatre staff members
d) ??


Recovery from volataile anaesthesia

A - can be described graphically from the rate of decline of FA/FI
B
C
D - can be affected by altering fresh gas flows
E

Intravenous Anaesthetic Agents

IV31 Percentage of thiopentone dose remaining in the brain FIVE minutes after a bolus dose: (definitely 5 not 30 mins as previously recalled/asked)

a) 0.2%
b) 0.5%
c) 20%
d) 35%
e) 50%


IV32 Addition of sodium carbonate to thiopentone:

A - Confers a yellow colour
B - Increases lipophilicity??
C - provides CO2
D -
E - Bacteriostatic


(alt) NaCO3 in thiopentone

A. decrease pH
B. decrease solubility
C. CO2
D. bacteriostatic


IV33 With regards to the structure of barbiturate drugs:

A.
B. Oxygen substitution at the 1- position increases ?half-life
C. Phenol substitution at the 5- position increases anticonvulsant activity
D. ?


IV33 barbiturates

A. S/O substitution ->- shorter duration of action
B. methyl at 1 -->
C. ethyl at 1 --> invol movements
D. short alkyl chains at 5 --> anticonvulsant
E. phenyl chains at 5 -->


IV34 Propofol clearance (There were two questions on it - can't recall both so I've put what I can recall from them together)

a) Decreased in hepatic failure
b) Decreased in renal failure
c) Increased in children
d) Decreased in cirrhosis
e) reduced clearance in pregnancy


IV35 Ketamine:

A decreases ICP / CBF
B acts via opioid receptors
C decreases salivation
D airway reflexes
E ?

Local Anaesthetic Agents

Potency in peripheral nerve block:

a) Prilocaine > lignocaine > bupivacaine > ropivacaine
b) Lignocaine > prilocaine > ropivacaine > bupivacaine
c) Ropivacaine > bup > ligno > prilo
d) Bupivacaine > rop > ligno > prilo
e) Levobupivacaine > ropivacaine > ligno > prilo


i recall this (with some confidence) as Potency of LAs for peripheral nerve blockade

A - prilocaine = lignocaine > bupivacaine > ropivacaine
B - bupivacaine = Ropivacaine > lignocaine > prilocaine
C - bupivacaine > ropivacaine > lignocaine > prilocaine
D - ropivacaine > bupivacaine > lignocaine > prilocaine
E - levobupivacaine > ropivacaine > lignocaine > prilocaine

(recall same as above) potency of local anaesthetic highest to lowest

A bupivicaine = ropivicaine > lignocaine > prilocaine
B bupivicane > ropivicaine > lignocaine > prilocaine
C ropivicaine > bup > lig > pril
D levobupivicaine > ropivicaine > lignocaine > prilocaine


clonidine in nerve block

a - activion via Aδ and C fibres
b - has no analgesic properties

Major Analgesics and Opioids

An 84 year old woman with a morphine PCA is found unresponsive 24 hours post back surgery. The likely cause is:

A - Morphine-3-glucuronide
B - Morphine-6-glucuronide
C -


Paracetamol:

C - Metabolised to N-acetyl-P-benzoquinonimine and subsequently conjugated to glutathione


Aspirin:

A - Reversibly inhibits platelet activity
B - Causes metabolic alkalosis in overdose


COX-2 inhibitors

a) less GIH
b) similar side effects


Pethidine effects:

A - convulsant or CNs stimluation
B - less nausea than with morphine

Morphine vs fentanyl longer duration of action after bolus due to:

A - slower elimination halflife
B - higher lipid solubility of fentanyl

Naltrexone:

A - partial agonist
B - only reliably reverses opioids?
C - well absorbed into portal vein
D -
E -

Clonidine in periph nerve block

A. inhibits A + C fibres
B. supraspinal adrenergic effect
C. supraspinal adrenergic effect
D. no effect

Cardiovascular

Phenotolamine:

A - selecitve α1
B - covalently binds receptor
C - ?hypertension
D - increases cardiac output
E - selectiveα2


Stopping a patient's beta-blockers on admission to hospital may cause:

A - myocardial ischaemia
B - Bradycardia??
C - Premature labour
D -
E - Hypoglycaemia


First line agent used in ventricular fibrillation:

a) Lignocaine
b) Amiodarone
c) Adrenaline
d) Vasopressin
e) Magnesium

also recalled as:

First line agent for VF

A - Amiodarone
B - Lignocaine
C - Adrenaline
D - something else
E - sotalol


Vasopressin not useful in?

A - prolonged CPR
B - variceal haemorrhage
C - nephrogentic diabetes insipidus
D - anaphylaxis (refractory or long lasting)
E - severe Sepsis


The best sign that a patient is adequately treated with phenoxybenzamine is:

a) Patient complains of a stuffy nose
b) Postural hypotension
c) The blood pressure is stabilized
d) and
e) Things that sounded like adverse effects


Which agent does NOT rely on cAMP to produce its effect?

a) Digoxin
b) Milrinone
c) Noradrenaline
d) ...

(alt): Which agent does act via cAMP

A - Digoxin
B - Dopamine
C - Dopexamine
D - Isoprenaline
E - Glucagon

(alt): Which of the following are not cAMP dependent

A. digoxin
B. dobutamine
C. dopexamine
D. isoprenaline
E. glucagon


Amiodarone:

a) May cause pulmonary infiltrates
b) Structurally resembles thyroxine
c) Increases the refractory period of action potential
d) Antagonist at both alpha and beta adrenoreceptors


Sodium nitroprusside toxicity

a)
b)
c) Treated with ... to help eliminate methaemoglobin ??
d) Treated with nitrates
e) Treated with sodium thiosulphate

Muscle Relaxants and Antagonists

Action of cistracturium is improved / decreased by

A - pheytoin
B - hypo / er magnesaemia
C - hypo/er calcaemia
D - lithium
E - suxamethonium


(alt): Cis-atracurium effect potentiated with

A. phenytoin
B low Mg
C high Ca
D. ?


Muscle relaxant potentiated

A - hypermagnesaemia
B - hyperkalaemia
C - hypercalcaemia
D - ?
E - respiratory acidosis


Mivacurium

A. no histamine release
B. onset 2-3min after 2 x ED95
C. ?


Anticholinergics / Antimuscarinics

Physostigmine antagonizes (or "reverses"):

a) Sedative effects of opioids
b) Analgesic effects of opioids
c) Sedative effects of phenothiazines
d) ?...
e) Analgesic effects of ketamine


(alt) physostigmine has no effect on

A. sedatory effects of opioids
B. analgesic effects of opioids
C. phenothiazines
D. TCA
E. analgesic effects of ketamine


Treatment of central anticholinergic syndrome includes:

a) Atropine
b) Benztropine
c) Physostigmine
d) Pralidoxime
e) Pyridostigmine

Antiemetics

Somebody gave a little old lady a 1mg IV bolus of granisetron. Possible adverse effects include:

A. Oculogyric crisis
B. Hypotension
C. QT prolongation
D. Histamine Release
E. ?abdo pain and diarrhoea (this may be from different MCQ

Psychotherapeutic Drugs

PS08b Flumazenil:

A. ?
B. ?
C. Predictably reverses the respiratory depression caused by benzodiazepine overdose
D. ?
E. ?

Side effects of L-dopa do NOT include:

A. Psychiatric abnormalities
B. Cardiac arrhythmias
C. Hypertension
D. Involuntary movements
E. Nausea and vomiting


Statistics and Clinical Trials

NOTE: Statistics are not part of the new Syllabus

What is an example of descriptive statistics?

a) Student's t-test
b) Chi-square
c) Correlation
d) Power analysis
e) Coefficient of Variance


Sensitivity is:

a) The probability of returning a positive result where the disease in question exists
b) The ability to detect a significant difference
c) ...Something suggestive of a positive likelihood ratio
d) ...Something suggestive of a negative likelihood ratio
e) The probability of returning a negative result when the disease in question is NOT present


Endocrine Drugs

A 30 year old woman presented to hospital with severe thyrotoxicosis. What would be the best agent to use to treat her condition? (OR what would work the fastest?)

a) Carbimazole
b) Neomercazole
c) Propylthiouracil
d) Beta-blocker?? - wishful thinking IM afraid, the drug an anaesthetist would be most likely to give was not listed
D - iodide - Lugols solution
E) Radioactive iodine


Miscellaneous Drugs

What is true of colloids?

A - They include Hartmann's solution and gelofusine
B - 4% albumin can only be stored at room temperature for 1 month
C - All are synthetic
D - The plasma expanding effect of Gelofusin lasts for 6 to 8 hours
E - Dextran 40 improves microcirculatory flow


Mannitol

A. sugar and not metabolised
B. decreases urinary pH
C. increases GFR
D. ?
E. ?


A 70 year old man was given gentamicin 2mg/kg prior to undergoing a TURP. Possible adverse effects include:

A. Vestibular toxicity
B. ?Cardiac arrhythmia
C. Perioral paraesthesia
D. Something else which seemed like overkill
E. Renal cortical necrosis


Warfarin:

A -  ?
B -  ?
C - Reduces activity of Protein C (definitely reduces activity not reduces levels of)
D - Half life of 14 hrs
E - Large volume of distribution due to high level of protein binding (definitely that wording)


A 27 year old woman was given ergometrine IV to prevent (?treat) PPH. Possible side effects include:

a) cerebrovascular accident
b) Hypotension
c) Bronchospasm
d) Massive histamine release
e) uterine atony


The most common side effect of proton pump inhibitors include:

A - ?Tinnitus
B - Dry, non-productive cough
C - Nausea and abdominal pain
D ?
E - Visual disturbances
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