Primary MCQs-Aug2014

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Introduction

  • This page contains MCQs that were on the 11th August 2014 MCQ exam.
  • Thank you for your efforts in remembering MCQs and posting them here.
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Remembered MCQs

14B-1. An ABG given pH of 7.42, reduced bicarbonate, reduced CO2 (exact numbers not recalled).

A. altitude
B. COPD
C. metabolic acidosis
D. hyperventilation
E. prolonged vomiting


14B-2. If the pH of a solution changes from 7.4 to 7.1 what is happening to the hydrogen ion concentration?

A. Decrease by approximately 75%
B. Increase by approximately 150%
C. Increase by approximately 100%
D. Increase by approximately 20%
E. No increase due to the effect of a buffer


14B-3 The H+ production by body metabolism that has to be excreted by the kidney to prevent acidosis is?

A. 32nmol
B. 32mmol
C. 0.68mmol
D. 6.8mmol
E. 68mmol


14B-4 The last part of the heart to depolarise after atrial depolarisation:

A. Left apex of endocardium
B. LV base
C. RV base
D. Left apex epicardium
E. Right apex endocardium


14B-5 When comparing radial artery and aortic waveforms

A. Aortic wave has higher systolic pressure
B. Aortic wave has lower systolic pressure
C. Aortic wave has higher mean arterial pressure
D. Radial wave has bigger incisura
E. Radial wave occurs earlier


14B-6 ECG changes with digoxin toxicity:

A. shortened PR interval
B. prolonged QRS duration
C. ST depression
D. Prolonged QT interval


14B-7 During infusion of an acidic solution (Hydrochloric acid) which contributes most to buffering?

A. phosphate buffer
B. bicarbonate buffer
C. intracellular buffer
D. plasma proteins
E. haemoglobin


14B-10 In Torsades de Pointes:

A. More likely in bradycardia in susceptible individuals
B. Preferred treatment: amiodarone infusion protocol
C. ?
D. ?
E. ?


14B-11. During raised intrathoracic period of Valsalva manoeuvre:

A. Decreased heart rate
B. Systemic vascular resistance (SVR) is decreased
C. Decreased preload
D. ?


14B-16 Hypokalaemia will result in

A. Prolonged QRS duration
B. Prolonged QT interval
C. Peaked T wave
D. Hyperpolarisation of cell membrane
E. Shortened PR interval


14B-17 Long term response to hypertension is via alteration of

A. Aldosterone system
B. Smooth muscle relaxation
C. Renin angiotensin system
D. Capillary fluid shifts
E. Renal-Body response mechanism


14B-18 During pneumoperitoneum, what does not occur

A. low CO
B. increased BP
C. increased HR
D. increased Pulm vascular resistance
E. increased SvO2


14B-19 Regarding the Resting Membrane Potential (RMP) of the nerve cell:

A. K+ ions Nernst Potential I -70mV (definitely said -70mV not -90mV)
B. Na+ ion Nernst Potential -61mV
C. Is temperature dependent
D. The conductance ratio of Na:K is about 500 fold


14B-20 H2-agonism causes all of the following EXCEPT:

A. Bronchospasm
B. Vascular SM contraction
C. Increased contractility
D. Platelet activation
E. Increased gastric acid secretion


14B-21 Which of the following devices are most commonly used in breath-to-breath analysis of O2 in anaesthetic breathing circuits:

A. The Paramagnetic oxygen analyser
B. Clarke electrode
C. Fuel cell
D. Gas chromatography
E. Mass Spectroscopy


14B-22 Waveforms found in the PAWP trace are: (? repeat) – (not the CVC/RA trace)

A. All of a, v, c.
B. a, v but not c
C. a,c but not v
D. ?


14B-23 Paramagnetic O2 analysers using N2 filled spheres are:

A. used in anaesthetic machines
B. not used because they are too bulky
C. not used because they require frequent calibration
D. something else


14B-24 Thirst is stimulated by

A. reduction in volume
B. ANP
C. increased osmolarity sensed by posterior pituitary
D. Angiotensin II inhibiting the subfornical organ


14B-25 In the normal term neonate liver which of the following is true

A. produces concentrations of clotting factors similar to adults
B. normal bilirubin conjugation compared with infant
C. increased protein production compared with infant
D. decreased ability to utilise amino acids for protein synthesis


26. BL10. Which of the following are vitamin K dependent?

A. von Wilebrand factor (vWF)
B. Protein C
C. Factor V
D. Factor XII
E. Antithrombin III


27. 14B-27. Two hours after the start of fast which of the following is true

A. glucagon levels elevated
B. insulin levels elevated
C. ketogenesis
D. proteolysis


28. 14B-28 In thromboelastography (TEG):

A. A angle represents (something incorrect)
B. Beta angle represents (something incorrect)
C. ?
D. Maximum Amplitude (MA. reflect the strength of the clot which is dependent on platelet number and function
E. measures all aspects of clot formation from initial thrombin activation to thrombolysis


29. 14B-29. The liver produces all of the following EXCEPT:

A. von Willebrand factor
B. Albumin
C. Antithrombin III
D. Fibrin
E. ?


30. 14B-30. Which of the following is TRUE about tissue macrophages:

A. half life <24 hours
B. derived from circulating monocytes
C. in the liver they are called histiocytes
D. not found in the brain
E. ?


31-36. not recalled


14B-37. The waveform in an awake adult at rest with eyes closed and mind wandering:

A. alpha
B. beta
C. theta
D. delta
E. mixture of alpha and beta


14B-38. C fibres that transmit peripheral nociceptive signals synapse in the dorsal horn of the spinal cord at:

A. laminae I and II
B. laminae I and IV
C. laminae III and IV
D. laminae IV and V
E. laminae V and VI


14B-39. Glucose produced from glycogen:

A. stores can last for 8 hours at normal activity levels
B. stimulated by cGMP-linked glucagon receptor
C. under the control of glucose-6-phosphatase
D. stimulated by insulin via tyrosine kinase
E. occurs in the mitochondria of skeletal muscle


14B-40 Which is not true: 32g O2 and CO2 44g

A. Occupy the same volume
B. Have the same number of particles in 1 mole
C. Have the same density
D. Have the same viscosity


14B-41 Factors causing quickest rise in metabolic rate

A. Skeletal muscle activity
B. Cardiac muscle activity
C. Increased lipid metabolism
D. Increased carbohydrate metabolism


14B-42 Optimal damping for a measurement system is D:

A. 1.0
B. 0.64
C. 0.5
D. 0.32
E. 0.13


14B-43 One mole of nitrous oxide and one mole of carbon dioxide:

A. Have the same mass
B. Each contain the same number of molecules in one mole
C. Occupy the same volume at standard temperature and pressure
D. Have the same density
E. Have the same viscosity


14B-44 All of the following are derived SI units EXCEPT: (repeat)

A. Joules
B. Litres
C. Pascal
D. Ampere
E. Newton


14B-45 Regarding renal blood flow:

A. Renal nerves come from the sympathetic nervous system
B. Innervated by the vagus via the hypogastric nerve
C. Innervated by the vagus via...
D. All noradrenergic fibres end in close proximity to the juxtaglomerular apparatus or renal tubules
E. Autoregulated between a MAP of 40 - 120 mmHg


14B-46. Regarding the juxtaglomerular apparatus:

A. Has both sympathetic and parasympathetic supply
B. ?
C. ?
D. Juxtaglomerular cells lie in the afferent arterioles
E. Macula densa cells are in the thick ascending loop of Henle


47. ?

48. ?


14B-49 With maximal secretion of ADH, the highest proportion of water reabsorption occurs in the:

(or: In the presence of vasopressin, most filtered water is reabsorbed in:)
A. proximal convoluted tubule
B. loop of Henle
C. distal convoluted tubule
D. cortical collecting duct
E. medullary collecting duct


14B-50 The highest reduction in renal resistance occurs at:

A. renal artery
B. afferent and efferent arterioles
C. peritubular capillaries
D. ?


14B-51 ADH secretion affect:

A. V1A receptors in smooth vascular muscle
B. aquaporin 2 receptors
C. ?
D. ?


52-60 ??


14B-61 Hypoxia pulmonary vasoconstriction

A. is solely mediated by alveolar pO2
B. requires neural connections to the lung
C. is not affected by NO and PGI2
D. in prolonged hypoxia shows a biphasic response at 40 minutes
E. is due to smooth muscle contraction in pulmonary veins


14B-62 Decreased FRC during anaesthesia

A. reduces to 24-28% supine
B. partially due to increased distribution of blood from periphery to intra thoracic vessels
C. due to reduced cross sectional area of the chest wall
D. related to loss of end expiratory diaphragm tone
E. greater due to muscle relaxation


14B-63 ABG from an anaesthetised relaxed patient with FiO2 0.4 and PiO2 285mmHg

pH 7.4
pCO2 40 mmHg
pO2 144 mmHg
A. normal A-a gradient expected with anaesthesia
B. patient is 99 years old
C. 20% virtual shunt
D. reduced ventilation to regions of the lung with high V/Q ratios
E. increased dead space due to ETT and LMA


14B-64 A question on: What symptoms to expect in severe hypercapnoea/hypercarbia?

A. Hypertension
B. Hypotension
C. intracellular acidosis
D. ?


14B-65 A question on the oxygen content of blood with Hb 140g/l and pO₂ 100 mmHg

A. reported content was 20.3 ml/dl at pH 7.4 and temperature 37C
B. 18.3 mls
C. ?
D. ?
E. other answers contained a variety of different contents at varying temps and pH

(use CaO2 equation here)?


66. not recalled


14B-67 Turbulent flow is less likely with:

A. Decreased viscosity
B. Increased temperature
C. Increased radius
D. Reynold's number greater than 2000
E. Bifurcation of airway


14B-68 At 33°C core body temp:

A. Metabolic rate decreased by 15%
B. Decreased HR
C. Isoelectric EEG
D. Isoelectric ECG
E. Platelets retain normal function


69-72. (not recalled)


14B-73 What is an adverse effect of stopping a beta-blocker peri-operatively? (or: ... stopping on admission to hospital?)

A. Myocardial infarction
B. Hypoglycaemia
C. Premature labour (?uterine contractions)
D. Bronchospasm
E. ?


14B-74 Which statement is true regarding the following beta-blockers:

A. Esmolol and carvedilol are B1 selective
B. Sotalol and metoprolol are class III anti-arrhythmics
C. Esmolol and ...?... have membrane stabilising properties
D. Propanolol and metoprolol have half-lives of 4-6 hours
E. ?


14B-75 What is the most common side-effect of ondansetron

A. Headache
B. Nausea
C. Hypotension
D. QT prolongation
E. ?


76-78. ??


14B-79 Regarding use of Intralipid for reversal of systemic toxicity of Local Anaesthetics

A. "Lipid Sink" effect is due to trapping of an aqueous drug in an aqueous medium
B. Propofol can be used as a substitute if Intralipid is not available
C. A loading dose of 2.5ml/kg of 10% intralipid is used
D. An infusion of 0.25ml/kg/min 20% intralipid can be started after the bolus if required
E. Reversal effect is only due to the lipid sink


14B-80 When GTN is used during acute myocardial ischaemia

A. effect is mainly via cGMP mediated venodilation and decreased ventricular wall tension
B. Phosphodiesterase inhibitors such as sildenafil decreased the effectiveness
C. it may precipitate coronary steal
D. ?
E. causes reversal of hypoxic pulmonary vasoconstriction via cAMP


14B-81 The side effects of an organophosphate overdose differ from those of a neostigmine overdose in that they include:

A. Bradycardia
B. Meiosis
C. Seizures
D. Diarrhoea
E. Bronchoconstriction


14B-82 Which of the following is the most harmful effect of Atropine in children ? (repeat)

A. Hypotension
B. Tachycardia
C. Hyperthermia
D. Hypertension


14B-83 Dabigatran

A. Has oral bioavailability of 80%
B. Has a half life of 8-12 hours
C. Requires a 75% dose reduction in renal failure
D. ?


14B-84 Prothrombinex:

A. Contains coagulation factors II, V, VII, IX, X
B. Immediately reverses heparin
C. Is always administered with Vitamin K
D. ?


85-87. ??


14B-88 What additives are in an ampoule of thiopentone:

A. Sodium carbonate and N2
B. Sodium bicarbonate and N2
C. Sodium carbonate and CO2
D. ?
E. ?


14B-89 Which drug is NOT a racemic mixture

A. Lignocaine
B. Enflurane
C. Isoflurane
D. Bupivacaine
E. ?


90. ??


14B-91 The log-dose response curve for a partial agonist looks like

A.  ?
B. like the curve for a full agonist with an antagonist
C.  ?
D.  ?


14B-92 Consider two opioids X and Y in the following graph:

2 Sigmoid curves with:
x axis plasma conc in mcg/L
(equally spaced for values 2, 4, 8, 16, 32, 64),
y axis % effect with ED50 at 4 for X and 16 for Y
(No mention of 'log' for x-axis but equal spacing indicates this)

What percentage of receptors need to be occupied for a maximum effect of opioid X?

A. 10%
B. 25%
C. 50%
D. 75%
E. 100%


14B-93 IV Magnesium 20mmol administered IV pre induction of anaesthesia. Which of the following will NOT be seen (new I think )

A. prolongation/latency of vecuronium block
B. effect on inhalational alkylating agents
C. effect on inhalational other agents
D. decrease in seizure threshold with propofol
E. uterine relaxation


14B-94 A drug which is a weak base with a pKa of 8.6

A. Will be rapidly absorbed
B. Is mostly ionised in plasma
C. ?
D. ?


14B-95 Transdermal drug delivery

A. Avoids first pass metabolism
B. Something about water soluble
C. Is quick
D. ?
E. ?


14B-96 Drugs interactions that inhibit

A. Cimetidine and warfarin
B. Phenytoin and ?
C. Carbimazole and  ?
D. Thiopentone and ?
E. Rifampicin and metoprolol


14B-97 When calculating a loading dose prior to infusion of a drug, what factors are NOT considered:

A. Vd
B. Leo
C. Toxicity and side effects
D. Plasma concentration
E. Context sensitive half time


14B-98 Neonatal drug delivery:

A. Increase aminoglycoside dose due to increased ECF
B. Have increase PB when compared with adult
C. ?
D. ?


14B-99 When considering tolerance:

A. May be due to decreased BA
B. Is not present without dependence
C. With opioids it is due to up-regulation of receptors
D. ?


14B-100 Serotonin syndrome:

A. Idiosyncratic and unpredictable
B. Occurs when an increased dose of a single drug is taken, or when normal doses of different drugs are taken in combination
C. Would occur with a MAOI and an SNRI
D. Onset of muscle rigidity and hyperthermia within minutes
E. Treated with doses of dantrolene similar to that used to treat MH


14B-101 After a long surgical case it is noted on ABG that the patient's carboxyhaemoblogin level has gone up. This could be because:

A. CO2 absorbent doesn't have enough sodium hydroxide (NaOH)
B. Sevoflurane used instead of desflurane
C. CO2 absorbent is dry
D. CO2 absorbent doesn't have enough potassium hydroxide (KOH)
E. ?


14B-102 Which of the following has no effect on MAC:

A. Anticholinesterases
B. Local anaesthetics
C. Gender
D. Ethanol
E. Another option that dose effect MAC


14B-103 Which of the following has no effect (or: the least effect) on the ventilatory response to hypoxaemia in the setting of normocapnoea?

A. Nitrous oxide
B. Isoflurane
C. Desflurane
D. Halothane
E. Sevoflurane


14B-104 Which inhalational agent is most likely to cause renal damage?

A. Sevoflurane (… ? something about compound A)
B. Desflurane
C. Methoxyflurane
D. Damage is not linked to duration of exposure (??)


14B-105 Impurities associated with nitrous oxide:

A. Nitric oxide
B. Ammonia
C. NO2
D. N2
E. All of the above


14B-106 Which organ has no lymphatic vessels?

A. Brain
B. Stomach
C. Kidney
D. Heart
E. Lung


14B-107 An ideal property of neuromuscular blocking drug for rapid sequence induction is:

A. ?
B. Low potency
C. ?
D. Organ-independent elimination
E. ?


14B-108 Macula densa cells are:

A. Baroreceptors
B. Osmoreceptors
C. ? (Some other wrong answer)
D. Chemoreceptors
E. In the proximal thick ascending limb


109 ?

110 ?

111 ?


14B-112 A complication of IV infusion of 8.4% NaHCO3 is:

A. hypotonicity
B. intracellular acidosis
C. ionised hypercalcaemia
D. rebound acidosis
E. ?


14B-113 Local anaesthetic solutions are prepared with dilute hydrochloric acid because:

A. bacteriostatic
B. more water soluble at acidic pH.
C. ?
D. ?
E. ?


14B-114 Which is a (?concentrated?) amide local anaesthetic?

A. cocaine
B. dibucaine
C. procaine
D. tetracaine
E. procainamide


14B-115 Which of the following is NOT a racemic agent?

A. levobupivacaine
B. ropivacaine
C. lignocaine
D. ? halothane
E. ?


116. ?


14B-117 Cephazolin

A. is a third generation cephalosporin
B. doesn’t penetrate the blood brain barrier so cannot be used for neurosurgery
C. only covers gram-positive cocci
D. is a potent bactericidal agent
E. do not require dose adjustment in renal impairment


14B-118 Co-adminstration of which of these drugs are likely to decrease action / and duration of the non-depolarising neuromuscular blockers?

A. Aminoglycosides
B. Volatile ethers
C. Volatile alkanes
D. Aminopyridines
E. ?


14B-119 Pre treatment with dantrolene causes:

A.  ?
B. Ileus
C. Muscle weakness
D. Contraction


14B-120 Atracurium metabolism

A. ?
B. Hoffman degradation solely dependent on pH
C. Ester hydrolysis independent of plasma cholinesterase
D. Acetylcholinesterase


14B-120b (Too similar to above Q so assumed to be same remembered differently)

Atracurium:
A. has active metabolites
B. metabolism is affected by pseudocholinesterase deficiency
C. metabolism is only affected by temperature
D. metabolism is largely via ester hydrolysis
E. is organ dependent

(Q similar to MB22)

121. ?


14B-122 Post-tetanic facilitation:

A. is used to assess residual paralysis
B. 50Hz stimulation followed by 2Hz twitches
C. can be used every 2 minutes
D. used to assess a deep level of neuromuscular blockade
E. 20Hz stimulation followed by 5Hz twitches


123. MB06d Which drug does NOT potentiate the action of non-depolarising neuromuscular blockers by inhibiting the action of acetylcholinesterase?

A. Cyclophosphamide
B. Magnesium
C. Metoclopramide
D. Frusemide
E. Phenytoin


124. 14B-124- PS21 Regarding monoamine oxidase inhibitors:

A. Selegeline is a MAO A for Parkinsons
B. The early MAOIs reversibly inhibit MAO A and MAO B
C. Promote uptake tyrosine in the GI tract
D. Moclobemide is a MAO- B with fewer side effects


14B-124B (Must be same Q as above remembered slightly differently)

Which is true regarding MAO inhibitors
A. Moclobemide is a MAO-A inhibitor
B. Older agents are reversible MAO-A and MAO-B inhibitors
C. MAO inhibitors increase tyramine uptake by inhibiting GIT MAO
D. Selegiline is a MAO-A inhibitor


125. PS07 The anti-depressant fluoxetine:

A. Inhibits Noradrenaline uptake
B. Inhibits presynaptic serotonin uptake
C. Has more sedative properties than tricyclics
D. Is a dopamine.....???


126. 14B-126 Midazolam:

A. Less lipophilic than lorazepam
B. Has an Alkaline pH in the ampule
C. Metabolism by demethylation
D. Has significant first pass metabolism
E. Is water soluble at physiological pH


127-144 ??


14B-146 Which automatically stops current flow when saline drips on to a powerboard

A. Line isolation monitor
B. Residual current device
C. Isolated transformer
D. Equipotential earthing


14B-147-NP06- Which of the following are branches of the Aorta

A. coronary
B. brachiocephalic
C. right carotid
D. right subclavian
E. inferior thyroid


14B-148 CM42 There is a unidirectional valve in:

A. Mapleson A circuit
B. Mapleson B circuit
C. Mapleson C circuit
D. Mapleson D circuit
E. No Mapleson circuit


14B-149 A patient is anaesthetised with 50% oxygen, 50% nitrous oxide and 1% sevoflurane for a tracheostomy. When the surgeon cut into the trachea with diathermy, the ETT catches fire. In this case the nitrous oxide is acting as:

A. fuel
B. oxidising agent
C. smothering agent by ...?...
D. secondary ignition source by increasing conductivity of the gas mixture
E. Smothering agent by increasing the distance between oxygen molecules


14B-150 A substance with a HIGH Specific Heat Capacity:

A. Has high thermal energy for its temperature
B. Is a poor conductor
C. Is a poor insulator
D. Can have a large amount of heat energy added to it to yield a resultant per unit temperature change
E. ?
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