Primary MCQs-Feb2008

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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 |


Physiology

Unclassified Physiology

Add to this section if don't have time to classify & organise
your remembered MCQs


General physiology

BP08 In regards to voltage gated Na+ channels:

A. Giant squid axons used to study as they only contain Na+ channels

B. Blocked from the inside by tetrodotoxin

C. ?

D. ?

E. ?


BP09 Which is incorrect regarding the Kreb’s cycle:

A. Acetyl-coA is metabolized to CO2 & H+

B. ?

C. Oxaloacetate is recycled

D. 12 ATP is generated

E. Cycle is continous during anaerobic metabolism but at slower rate


BP10 Cytochrome c oxidase catalyses *new*

A. O2 + 2H+ -> H2O

B. ?

C. ?

D. H+ + HCO3- -> H2CO3

E. None of the above

(Think this may have actually been asking about cytochrome a3)


BP11 In regards to the Na+/K+ ATPase *new*

A. Three K+ out for every two Na+ pumped in

B. Stimulated by Ouabain

C.3ATP broken down to ADP and P for every 3Na+ pumped in

D.is inhibited by high extracellular concentrations of Na+

E. an electrogenic pump


Fluid & electrolytes

FE33 Hyponatraemia is usually due to:

A. Excess lipids

B. Excess glucose

C. Free water deficit

D. Excess protein

E. Free water excess


FE30 [Jul07] [Feb08] Infusion of 40ml/kg of 0.9% saline solution will cause:

A. Hypochloraemic metabolic acidosis.

B. Hypochloraemic metabolic alkalosis.

C. Hyperchloraemic metabolic acidosis.

D. Hyperchloraemic metabolic alkalosis.

E. No acid base disturbance.


Feb08: Remembered as:

An infusion of 40mls/kg of Normal Saline would cause

A. Metabolic alkalosis

B. Mixed repiratory and metabolic acidosis

C. Metabolic acidosis

D. No change

E. ?


Acid-base physiology

AD10 [Apr01] [Jul04] [Feb08] A patient is draining 1 litre of fluid per day from a pancreatic fistula while maintaining normal volume status. The most likely acid-base disorder is:

A. Hyperchloraemic metabolic acidosis

B. Hypochloraemic metabolic acidosis

C. Metabolic acidosis with normal chloride

D. Hyperchloraemic metabolic alkalosis

E. Hypochloraemic metabolic alkalosis


AD18 [Feb06] [Feb08] Calculation of Base Excess

A. ? related to Henderson Hasselbalch equation

B. Assumes a PCO2 of 40mmHg

C. ?

D. ?

E. ?


AD22 [Feb08] Person with these blood gas results: pH 7.33 CO2 58 HCO3 33

A. Acclimitization after several weeks at altitude

B. Person with chronic pulmonary disease

C. Diabetic ketoacidosis

D. Hyperventilation

E. Prolonged vomiting


AD23 [Feb08] Person with these blood gas results: pH 7.53 pCO2 27 HCO3 22

A. Acclimitization after several weeks at altitude

B. Person with chronic pulmonary disease

C. Diabetic ketoacidosis

D. Hyperventilation

E. Prolonged vomiting


Respiratory Physiology

  • new*

RE Hypoxic Pulmonary Vasoconstriction follows a biphasic response. The time taken to maximal vasoconstriction in the Initial phase of HPV is:

A. 1-2 minutes
B. 5-10 minutes
C. 30-40 minutes
D. 1-2 hours
E. (hours?)

Answer: A

Actually Nunn states is rapid in ONSET with maximal response after 5-10 mins, then rapid decrease to previous level- followed by slow sustained rise to plateau after 40 mins p101-102 Nunn 5th


  • new*

RE In regards to CO2

A.
B.
C. The exchange of Cl for the inwards movt of HCO3 results from the buffering of CO2 in the red blood cell.
D.
E. CO2 uptake in the peripheries results in an increased haematocrit

Answer: C Disagree: the exchange is HCO3 out for CL in. I think E is correct- Brandis page 6


  • new*

RE If breathing air, what is PAO2 at 8,828m (atm pr = 248mmHg) when PACO2 is 20mmHg?

a) 10
b) 17
c) 27
d) 32
e) 42

ANSWER:21%*(248-47)=44 PAO2= 44-20/0.8-2=17 answer: B


RE In normal patient, which has the highest PCO2 value?

a) dead space gas
b) ideal alveolar gas
c) end tidal
d) mixed expiratory
e) ?

CO2 come from blood, the most CO2 close to blood level is the highest. Answer: C Hmmmm Doesn't the CO2 in the alveoli have a higher PO2 than the end tidal which is always going to be a bit less than the ideal? (the ideal gas is still mixed with some well ventilated but underperfused alveoli) (page 157 Nunn 5th ed) I think answer is B

I Agree the answer is B. See Nunn Ed 6 pg 156 Fig 10.7 for some useful numbers. See also Nunn page 128: "Ideal alveolar PCO2 is approximately equal to PaCO2". Pg 157: "End expiratory CO2 will be lower than than that of alveoli that are perfused".


  • new*

RE Which of the following would occur within 30mins of ascent to extremely high altitude

A.Increased respiratory rate to completely restore PaO2 to normal
B. Decreased cardiac output
C. Respiratory acidosis
D. increased levels of 2,3 DPG
E. pulmonary edema

Answer: E can try it yourself, take some Dex with you.And a oxygen bottle. How fast does 2,3 DPG rise??

"Extremely High Altitude is 5500M or higher" A: false - hyperventilation can't COMPLETELY restore normal PaO2 B: false - Increased Cardiac output for 2-4 days C: false - Respiratory ALKALOSIS because of hyperventilation initially, but really corrected to allow further hyperventilation. Takes hours to days D: "Likely the best answer." Less O2 available = need to lower unbinding threshold = need for more 2,3 DPG. You can make this pretty fast, as fast as the Leubering-Rapoport shunt can go actually (as long as you have no organophosphate poisoning) so I guess in 30 mins you could increase 2,3 DPG a bit, push the O2 dissociation curve L a bit and offload a bit more O2 peripherally. That would be nice. E: false - This takes hours to days.


RE73 During normal tidal ventilation

A. Intrapleural pressures between -5 & -8mmHg
B. Alveolar pressures between -2 & +2 cmH2O
C. Tracheal flow is sinusoidal
D. Peak flow is 5L/s
E. ?intrapleural pressure curve is sinusoidal


Respiratory rate affects compliance due to:

a)
b)
c)alveoli having different time constants
d)Compression of airways
e)

Answer: c

CVS physiology

  • new

CV All are ion channels in the cardiac muscle except

a) Voltage gated Ca-Channel

b) Delayed rectifying K-channel

c) Inwardly rectifying K-channel

d) Transient inward K-Channel

e) Voltage gated Na-Channel


  • repeat*

ANSWER: D ->K goes out not in

CV In regards to ECG calibration and speed.

A. 1mV/cm at speed 50mm/sec

B. 1mV/1cm at speed 25mm/sec

C. 1mV/0.5cm at speed 25mm/sec

other options were mixes of the above

  • REPEAT*
ANSWER B

CV Which organs have the highest O2 extraction per unit weight?

A. Heart>liver>kidney>skin

B. Liver>skin>kidney>heart

C. Kidney>Liver>Heart>Skin

D. Heart>liver>kidney>skin

E. Heart>Liver>Skin>Kidney

(There were actually two answers exactly the same!)

  • REPEAT*

answer:E

I can't see a correct answer. From Ganong Ed21 Table 32-1: O2 consumption in ml/100g/min: Heart 9.7, Kidneys 6.0, Liver 2.0, Skin 0.3

It's not asking about O2 consumption, it's asking about extraction ratio. Kidneys have blood flow far in excess of their O2 requirements. Heart has highest extraction ration of all organs (55-65% (Brandis)). Therefore E is the correct answer


CV Which is the least likely to show autorhythmicity? (comment: I think stem was saying slowest autorythmicity)

a) AV node

b) HIS bundle

c) SA node

d) Atrial muscle

e) Ventricular muscle

  • repeat*

ANSWER: E

CV Which CVS change is not true regarding normal aging process

a) Decreasing HR

b) Increasing diastolic pressure

c) ?Increased heart compliance

d) ?increased peripheral resistance

e) ?

  • REPAET*

ANSWER: BEST ANSWER: C B also wrong, the question ask about normal aging process,which diastolic BP can be decrease. not talking about diastolic hypertension.

Renal physiology

  • new

KD Which is an action of aldosterone on principal cells?

a) K resorption

b) H+ secretion

c) Na resorption

d) Bicarbonate secretion?

e) Chloride resorption?

Answer C: Aldosterone causes K+ secretion and Na+ absorption from principal cells. Also H+ secretion from intercalated cells (from Peter Watt's notes)

GI physiology

  • new*

GI Functions of Liver DOES NOT include

a) synthesis of immunogloubins

b) Synthesis of clotting factors

c) Conjugation of bilirubin

d) ?cholesterol

e) Inactivations of steroids

Answer A: The immunoglobulins are produced by plasma cells of the bone marrow, spleen, lymph nodes and gut. (Power and Kam p 258)

  • new*

GI The following CHO is absorbed in the small intestine:

a) glucose

b) sucrose

c) hexose

d) trehalose

e) lactose

Answer A: The three monosaccharide products of carbohydrate digestion - glucose, galactose and fructose are absorbed by the small intestine. (Boron p 952)

Blood & immunology

  • new*

BL Plasmin cleaves all the following except

a) II

b) V

c) VII

d) VIII

e) XII


Plasmin cleaves F2,5,8,10,12 fib, activated by t-PA, u-PA AND F12a , inactivated by PAI-1 and alfa 2 -AP. answer: c


  • new*

BL Regarding the complement system

a) aids innate immunity

b) aids ?cellular/humoral/acquired immunity

c) bacterial mannose triggers alternate pathway

d) requires b-cells for activation

e) answer: B. Disagree. It's part of the INNATE system.

  • new

BL26 Regarding Fe and haemoglobin:

A. ?
B. 69% stored in Hb
C. Hb has 4heme groups each containing porphyrin and ferric iron
D. ?
E.

answer: B. 65-70% in Hb, 25-30% in liver as ferritin, total 3-4 g (Brandis table p 199)

C is also correct.C is wrong.Fe is in ferrous form.

Endocrine & metabolic physiology

  • new*

ED Patient with following results: Na 122, K 6.7 Cl 80. Which is correct?

a) hyperaldosteronism

b) adrenal insufficiency

c) DKA

d) Diabetes insipidus

e) Water Toxicity

B http://en.wikipedia.org/wiki/Addison%27s_disease#Addisonian_crisis

Why is this not DKA? I suspect that DKA and Addison's disease may have similar Na, K and Cl with glucose being the major difference (high in DKA, low in Addison's)


  • new

ED Patient with core temperature of 33C under anaesthesia

a) decreased metabolic rate by 15%

b) Decreased HR

c) Decreased CO2 and Increased O2?

d)

e) Platelet function preserved

Neurophysiology

  • new*

NU In Cerebrospinal Fluid there is:

A. higher concentration of sodium

B. higer concentration of protein

C. lower concentration of potassium

D. lower concentration of chloride

E. higher osmolarity

Answer: C. K is lower, Cl is higher, protein is lower. (Brandis p 224). Not sure about Na and osmolality. I am assuming they are the same as plasma as they are not mentioned as differences in Brandis

    CSF               Plasma

Na+ 141 145 K+ 3 4.5 Ca2+ 1.15 2.5 Mg2+ 1.12 0.8 Cl- 124 108 HCO3- 21-25 21-25 PCO2 50 40 pH 7.3 7.4 Protein 20mg/dl 6g/dl Glucose 3.5 4.5 Tonicity 285 mOsmol/Kg 285 mOsmol/Kg


  • new

NU Regarding the (?sympathetic) autonomic system, which is true?

a)

b) Postganglionic sympathetic fibres secrete noradrenaline to sweat glands

c) Sympathetic preganglionic fibres originate from T1 to L2/3

d) Some preganglgionic sympathetic fibres enter the gray communicans to enter spinal & visceral nerves

e) The adrenal glands are similar to modified preganglionic nerve cells

Some POSTganglgionic sympathetic fibres enter the gray communicans to enter spinal & visceral nerves. The adrenal glands are similar to modified POSTganglionic nerve cells C is correct I think, but Ganong states that B is as well pg 228 22nd ed so???

Opinion: Kam Pg 58 Preganglionic sympathetic fibers originate from T1-L2/3 Kam 328 Sweat glands are innervated by cholinergic sympathetic fibers


  • New

NU EEG waves of a person moving from a hyperexcitable state to sleep would be

A theta -> alpha -> beta -> delta

B

C

D

E

B-E different order of the same four http://en.wikipedia.org/wiki/Sleep#Stages_of_sleep

Physiology of muscle & NMJ

  • new

MU Smooth muscle differs from skeletal muscle

a) they have a longer latency

b) cannot produce as high a peak force

c) cannot sustain as long a contraction

d) ? have longer sarcomeres

e)none of the above

"REPEAT: ANSWER E" <-- WHAT??? Answer is A! "This latent period is about 50 times as great for smooth muscle as for skeletal muscle contraction" Guyton pp99 11Ed

  • new

MU Microscopy of a striated (?skeletal) muscle

a)

b)

c) Z-discs intersect fibrils?

d)

e) http://en.wikipedia.org/wiki/Sarcomere

Maternal, foetal & neonatal physiology

  • new*

MF During pregnancy, O2 consumption increases by 16-20%. This is due to

A. effects of progesterone

B. evident by 20 weeks gestation

C. due to fetoplacental unit

D. unrelated to muscle work

E. ? hypercarbia


  • new*

MF Pregnant woman at term has a spinal block to T4 on sensory testing. She is unable to generate an effective cough because:

A. laryngeal edema

B. cephalad movement of uterus after 20 weeks gestation causes a decrease in ERV (?)

C. phrenic nerve block

D. Block of lower intercostal muscles

E.


MF Breathing 100% O2 may cause apnoea in the neonate. This is due to (I’m unsure of exact options)

a) optic nerve protective reflex

b) immature peripheral chemoreceptors

c) immature central O2 receptors.

d) Tonic discharge of peripheral receptors

Clinical measurement

  • new

CM Which of these is LEAST likely to affect CO measurement by thermodilution?

a) ...rapid injection?

b) Injection during inspiratory phase

c) Incorrect volume of injectate

d) Temperature of injectate very close to body temperature

e) ?

useful reference http://www.ncbi.nlm.nih.gov/pubmed/6352195


  • repeat*

CM In regards to clarke electrode

A. has a platinum annode and Ag/AgCl cathode

B.

C. measures O2 content of both gas and blood samples

D. requires 0.6 amp current

Pharmacology

Unclassified Pharmacology

General pharmacology

Which of the following is not a ligand gated receptor:

a)nicotinic Ach receptor

b)alpha 2 adrenergic receptor

c)HT3 receptor

d)?

IV anaesthetics

Propofol clearance is :

a)significantly decreased in liver failure

b)increased/decreased in pregnancy

c)significantly increased in neonates

d)significantly decreased in renal failure

e)Unchanged in the elderly


Thiopentone compared to propofol has:

a)shorter effect site equilibrium time

b)?

c)?

d)?


PS06 Which benzodiazepine has the LONGEST terminal elimination half time?

A. diazepam

B. temazepam

C. lorazepam

D. oxazepam


Local anaesthetics

Bupivacaine has pka of 8.1, What is its pH when ratio of ionised to unionised fraction is 100:1?

a) 6.1

b) 5.1

c) 10.1

d) 6.5

pH = pKa + log B/BH+ ..... pH = 8.1 + log 1/100 .... pH = 6.1


Which of the following is an amide local anaesthetic:

a)dibucaine

b)cocaine

c)procaine

d)amethocaine

e) Procainamide (I think)

  • if (e) was procaine a ester LA then the straight forward answer is (a) dibucaine. as it stands both (a) and (e) seem to be amide LAs

Muscle relaxants & antagonists

Which neuromuscular blocking agent is the least metabolised:

A) Vecuronium

B) Rocuronium

C) Cisatracurium

D) Atracurium

E) Pancuronium

Assuming that we could count hoffman and non-specific esteratic degradation as "metabolism" then the answer must be E) Panc. Steroidal NDMB with liver de-acetylation. Slow onset, longer duration of action than Vec. That's my best guess.


what antagonises the effect of neostigimine on its reversal of neuromuscular blockade

a)hyperkalaemia

b)hypomagnemesaemia

c)respiratory acidosis

d)metabolic acidosis

e)respiratory alkalosis


ED95 for neuromuscular blockade means:

a)dose where twitch is reduced by 95%

b)dose where twitch is reduced to 95%

c)dose where 95% of the population is paralysed

d)?

Opioids

A bolus dose of morphine has a longer duration of action compared with fentanyl (repeat)

a)larger volume of distribution

b)less lipid solubility

c)longer elimination half time


Opioid receptors:

a)found in all lamina of dorsal horn of spinal cord

b)opiods with only delta agonist activity doesn't have analgesic property

Cardiovascular drugs

CD Atenolol:

a) has higher lipid solubility than propanolol

b) is a nonselective beta blocker

c)

d)

Atenolol is a cardioselective beta blocker that is less lipid soluble than propanolol (source: Goodman & Gilman)

Miscellaneous drugs

Hyoscine can:

A) Cause post op confusion in the elderly

B) Cause nausea and vomiting

C) Has a Quartenary Nitrogen

D) ?Is related to Atropine


GP37 Which of the following causes reversible inhibition of platelet function?

A. aspirin

B. heparin

C. warfarin

D. diclofenac

E. clopidogrel


Which following drug is not a serotonin receptor antagonist?

a)sumatriptan

b)clozapine

c)ketanserin

d)ondasetron

As written here, both A) and B) are possible answers. Sumatriptan is a 5HT AGONIST, and Clozapine a partial 5HT AGONIST. Must be remembered wrong?


Regarding antibacterial agents, which of the following is true?

a) Isopropyl alcohol is sporicidal

b) chlorhexidine is antibacterial in 1 minute

c) povidone iodine is antibacterial in 1 minute

d) chlorhexidine is neutralised by skin moisturises

e) Isopropyl alcohol is able to penetrate proteins


  • Isopropyl alcohol cannot be used to sterilise instruments because it is NOT sporicidal and cannot penetrate proteins
  • Povidine iodine 90% in 90 seconds
  • Chlorhexidine "fast onset" and can be neutralised by mosturisers


Metoclopramide:

A. Able to reverse opiod induced delayed emptying of the stomach

B. Is a H1 antagonist

C. Causes constipation

D. Increases lower oesophageal sphincter tone

E. ?

Regarding metformin and glimepiride:

a)both don't have therapeutic effects above what insulin offers

b)metformin is renally metabolised whereas glimepiride is metabolised totally by the liver

c)obesity is a problem side effect

d)both cause metabolic acidosis


Which of the following anticonvulsants work by modifying GABA transmission?

A. lamotrigine

B. vigabatrin

C. phenytoin

D. ethosuximide

E.

  • im going for viGABAtrin!


Which of the following produces contractions in uterine muscle?

a)PGE2

b)beta blockers

c)PGF2alpha

d)magnesium

  • PGE2 :dinoprostone used for inducing labour

Different question to above:

BL02 Which one causes bronchodilation?

A. PGE2

B-E. some other stems which were all constrictors

(NOTE: This seems to be BL02 from the Physiology MCQs though recorded here as a Pharm MCQ (??). Anyone got any other information? In the meantime temporarily code as BL02) Definitely in the pharm paper, only did the pharm paper this sitting!!!

Statistics and Drug Trials

Only 2 stats questions in the whole paper

Repeat regarding central mean theory...


General comments/opinions about the paper

I thought it was a fair paper, nothing too unexpected.

Not many repeat MCQ's.

Some typographical errors in the paper, which may unfortunately alter some answers.


i thought there was at least 50% repeats!

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