Primary MCQs-Feb2015

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This page contains MCQs from the 23 February 2015 exam.
Please help by adding comments/references etc to the pages for each MCQ
Remember up to one-third of the MCQs on the next MCQ paper
  will be from this listing, so well worth the effort to research 
  these ones.

MCQs

15A-10 Factors that increase coronary blood flow:

A - hypoxia
B - aortic systolic blood pressure
C - hyperthyroidism
D - aortic compliance


15A-11 Cardiogenic shock is caused by:

A - Arrhythmia
B - Decreased stroke volume
C - Decreased arteriolar pressure
D - Decreased venous pressure


15A-22 Na/K ATPase

A. Is electrogenic
B. Is impaired by low extracellular ECF conc
C. 3 ATP used for each 3 na pumped
D. 3 K+ in for 2 Na+ out


15A-23 Nernst potential:

A electrical ?neutrality
B chemical equilibrium across membrane
C at which k out? Is greater than k in
D at which na out? Is greater than na in
E at which cl/ca? In? Is greater than out


15A-24 Best way to measure breath by breath oxygen

A Paramagnetic analyser
B. Fuel Cell
C. Clarke Electrode
D. Sniff test
E. Hot wire anemometer


15A-29 Haemoglobin structure is

A. Two porphyrin rings with 2 Fe3+ ions
B. Four porphyrin rings with 4x Fe3+ ions
C. Two porphyrin rings qith 2x Fe 2+ ions
D. Four porphyrin rings with 4x Fe3+ ions
E. Two porphyrin rings with 4 x Fe 2+ ions


15A-30 The FRC in a child is:

A. 20ml/kg
B. 30ml/kg
C. 40ml/kg
D. 50ml/kg


15A-37. Cerebral blood flow

A: Indirectly proportional to glucose
B: Increases with neuronal activity
C: Equals mean arterial pressure minus intracranial pressure
D: Equals 30% of cardiac output
E: Increases with increased age


38. 15A-38. Compared to plasma, cerebrospinal fluid (CSF) composition:

A: Lower K
B: Higher Na
C: Higher osmolality
D: Lower chloride
E: Higher HCO3-


39. 15A-39. Skeletal muscle action potential:

A: Potassium efflux before peak depolarisation
B: Resting membrane potential -80mV
C: Na channels open at -30mV
D: ?
E: ?


44. CM36: Which is NOT a derived SI unit:

A. Joule
B. Litre
C. Pascal
D. Ampere
E. Newton


50. 15A-50. Which of these is most completely re-absorbed in the kidneys

A. Albumin
B. Glucose
C. Calcium
D. Potassium
E. Sodium


51. 15A-51. For a substance to have greater clearance than Inulin:

A: It must be completely filtered at glomerulus
B: Must be secreted in the tubules
C: Must be completely re-absorbed
D: should be lipid soluble
E: ?


52. 15A-52 In a patient with significant hypovolaemia and ?increased osmolality:

A: ?Decreased ?sodium reabsorption at distal tubule & collecting duct
B: ?Increased ?water reabsorption at proximal tubule
C: ?Increased ?water reabsorption at ascending loop of henle
D: Increased water permeability of collecting duct
E: None of the above

Note: I can’t remember whether options said increase or decrease water or sodium, but I think ive got the locations right.


15A-53 Increased Erythropoeitin with:

A: Acidosis
B: something about Haem dependent proteins?
C:
D:
E:


15A-55 The minimum pH that the urine can create is

A: 3.0
B: 3.5
C: 4.0
D: 4.5
E: 5.0


15A-56 Which of the following decrease secretion of potassium in the distal convoluted tubule

A. Acidosis
B. IV Saline
C. Aldosterone
D. Vasopressin
E. Carbonic anhydrase inhibitors


15A-57 Regarding peripheral chemoreceptors:

A. their blood flow is 3x their metabolic rate
B. Something about response rate
C. Type 1 fibres are in contact with glossopharyngeal nerve
D. Type 2 fibres are ..?..
E. Aortic body is responsible for most respiratory responses


15A-64. Peripheral chemoreceptors:

A. Respond to decreased O2 saturation
B. Respond to increased arterial pH
C. Respond to decreased arterial CO2 tension
D. Nonlinear increase with arterial oxygen tension
E. Slow response to changes in arterial carbon dioxide tension


15A-58 Severe hypercapnia is most likely to be associated with...

A. Increased catecholamines
B. Increased urine output
C. Increased myocardial contractility
D. ?...
E. ?...


15A-59 In which form is the majority of CO2 carried in blood?

A. Carbamino groups bound to proteins
B. Carbamino groups bound to haemoglobin
C. Dissolved in plasma
D. Bicarbonate in red blood cells
E. Bicarbonate in plasma


15A-60 Which respiratory parameter cannot be obtained using spirometry?

A. Tidal volume
B. Vital capacity
C. Inspiratory capacity
D. Residual volume
E. Expiratory reserve capacity


15A-61 In IPPV and PEEP, what changes would you expect:

A. Change in a systolic parameter
B. Change in a diastolic parameter
C. On echocardiography you would notice a left shift in inter ventricular septum
D. a few other wrong answers...


62. 15A-62 PEEP leads to

A. ?
B. ?


63. 15A-63 Mixed venous PO2 would be due to:

A. West Zone 3
B. ?
C. ?

A few wrong answers. Rest of options were not a simple rearrangement of Fick's principle! random ones


65. CM44 Turbulent flow is LESS likely with

A. Decreased viscosity
B. Increased temperature
C. Reynold number > 2000
D. Bifurcation
E. Increased radius


66. 15A-66 Regarding muscles of respiration

A: Diaphragm moves 1 cm in normal breathing
B: Diaphragm can be an accessory muscle of expiration
C: Internal intercostal muscles are inspiratory
D: 50% of normal breathing is due to intercostals
E: SCM is an accessory muscle of inspiration that acts by raising the first rib


70. RE82 Airway Resistance:

A: Decreases with decreasing viscosity
B: Increases with increasing lung volume
C: The pressure between the alveoli and mouth divided by flow (?exact wording)
D:
E: Mediated by α receptors


Q71: MF18 Thermoneutral Zone:

A: Range of body temperatures which occur with exercise
B: Range of peripheral temperatures which occur with no energy expenditure
C: Range of environmental temperatures where metabolic rate is minimal
D: Range of metabolic rates over which…
E: Range of core temperatures over which…


15A-72. Brown fat metabolism:

A. Metabolism is autonomically mediated
B. Mediates its effects by insulation of neck vessels
C. ?
D. Produces heat by uncoupling of oxidative phosphorylation outside of the mitochondria
E. Results in the production of large amounts of ATP and heat


15A-73: Amiodarone:

A. Half life 24-36 hrs
B. act on cardiac K+ channels
C. Doesn't cause hypotension when given IV
D. ?


15A-74: Adenosine and amiodarone:

A. Both class 3 anti-arrythmics
B. both cause bronchospasm & tachycardia
C. Half life 10 secs & 10 hrs respectively
D. Slow AV conduction & prolong pr interval
E. Both used for treatment of svt & vt


15A-75: Ceasing metoprolol preoperatively can cause:

A. myocardial ischaemia
B. bradycardia
C. premature labour
D. hypoglycaemia
E. bronchospasm


15A-76 Esmolol:

A. metabolized by plasma esterase
B. long effect time
C. more lipid soluble than propranolol
D. onset of peak effect
E. ?


15A-77 Dexamethasone:

A. short acting
B. naturally occurring
C. no mineralocorticoid activity
D. glucocorticoid


MD76 Ondansetron most common side effects

A. headache
B. constipation
C. sedation
D. hypotension
E. extra pyramidal side effects


15A-79 Which drug is contraindicated in Pre eclampsia

A Methyldopa
B Labetalol
C Hydralazine
D Perindopril
E Clonidine


15A-80 Adminstration of clonidine can cause

A. Tachycardia
B. ?
C. Transient Hypertension
D Seizures
E. Delirium


15A-85 Regarding adverse/side effects of Clonidine

A: Hypotensive side effect is exacerbated by tricyclic antidepressants (TCAs)
B: Tachycardia
C: Excess salivation
D: Sudden cessation causes hypertensive crisis
E. ?


15A-86 Spironolactone:

A: K sparing effect by potentiating/agonisim of aldosterone/receptors
B: PO, its theraputic effect is complete in/by 24 hours
C: K sparing effect agonised?/antagonised by NSAIDs
D: Causes increased K movement across luminal membrane
E: Risk of HYPERkalaemia with B blockers


15A-87 Metformin:

A: Causes hypoglycaemia
B: Excreted unchanged
C: Lactic acidosis: incidence 50 per 1000 patient years (this was the wording - good luck!)
D: Decreases hepatic gluconeogenesis
E. ?


15A-91. With regards to volatile agents and nephrotoxicity:

A. Increased risk with enflurane only
B. Increased risk with Sevoflurane
C. Increased risk with Desflurane
D. Increased risk with Methoxyflurane
E. None of the above


15A-92 For maximal effect of drug “x” what percent of receptors need to be occupied?

Graph of 2 opioids with x-axis= log dose
and y axis = intrinsic efficacy
(drug "x” is higher potency thus
sigmoid curve to left of drug "y”).]
a. 10%
b. 25%
c. 50%
d. 75%
e. 100%


15A-97 Which of these drugs crosses the blood brain barrier? ( repeat)

A. Propranolol
B. ?
C. ?

15A-98 Which of these drug features is least desirable in a drug infusion?

A. short half life
B. not reliant on liver metabolism
C. high therapeutic ratio


15A-99 Which of these devices is used to measure oxygen in a breathing system?

A. Paramagnetic oxygen analyser
B. ?


15A-102. [Repeat] regarding morphine metabolism:

A. Decreased hepatic conjugation
B. ?

15A-103. The interaction of these two drugs is mediated by serotonin:

a. Tramadol and imipramine
b. Moclobemide and morphine
c. [[Pethidine] and tranalcipramine
d. Fluvoxamine and ondansetron
e. Fentanyl and chlorpromazine

Also remembered as:

15A-x22 Which drug combination has an interaction involving Serotonin (I don’t think that’s the right wording)

A. Morphine and ?
B. Tramadol and ?some TCA/SSRI
C. Cisapride and ?
D. ?
E. ?


15A-109 Dexmetomidine:

A. Is opioid sparing

B. Is a non selective alpha 2 agonist
C. Is an indirect sympathomimetic
D. Its context sensitive half time is independent of the length of infusion




15A-110 Propofol:

A. Has fast redistribution from peripheral to central compartment
B. Decreases liver blood flow so decreases its own metabolism
C. ?
D. ?


15A-111. Barbiturates

A. Protein binding parallels lipid solubility hence ? oxybarbiturates are more protein bound/lipid soluble
B. Aspirin will decrease protein binding of thiopentone
C. Uremia does not effect thiopentone
D. ?
E.


15A-112 Ketamine is not commonly used as a sole drug infusion for TIVA because:

A: It has insufficient hypnotic effect for general anaesthesia
B: It provides insufficient analgesic effect
C: Approximately 30% of patients can experience emergence phenomena
D: An infusion of 0.5mg/kg/hr is insufficient to maintain unawareness
E: ?


15A-113 Propofol is preferable to thiopentone for use as an infusion for TIVA because:

A: propofol is less lipid soluble
B: propofol has a shorter elimination half life
C: propofol has a higher clearance
D: propofol has a smaller volume of distribution
E: propofol T1/2 keo is shorter


15A-114 Ketamine:

A: reduces cerebral blood flow
B: causes direct myocardial depression
C: causes bronchoconstriction
D: reduces pharyngeal secretions
E: is a competitive antagonist at NMDA receptors


15A-115 Adminstration of 8.4% Na HCO3 can cause (repeat )

A. ?
B. ?
C. Intracellular acidosis


15A-117 Which is an ester local anaesthetic

A Dibucaine
B Mepivacaine
C Tetracaine
D Etidocaine


15A-118 EMLA is a local anaesthetic solution that

a. Consists of a mixture of local anaesthetics that are water soluble above room temperature
b. Consists of a base and its respective local anaesthetics in an emulsion
c. 20% ionisation of prilocaine and lignocaine
d. causes vasodilation
e. should not be left on longer than 1 hour


15A-119. A dose of bupivacaine is inadvertantly injected into the caudal vein during a caudal anaesthetic in a two week old neonate. The increased risk of toxicity compared to the adult is primarily due to:

a. Increased permeability of the blood/brain barrier
b. decreased hepatic clearance
c. decreased volume of distribution
d. decreased alpha1 acid-glycoprotein
e. respiratory acidosis


15A-120 Which combination is correct with regards to chemotherapeutic agents and their effects?

A. Doxorubicon - pulmonary fibrosis
B. Bleomycin - cardiomyopathy
C. Cisplatin - pseudocholinesterase deficiency
D. Cyclophosphamide - monamine oxidase inhibition
E. Vincristine - peripheral neuropathy


ALT Version: 

Regarding chemotherapy drugs and side effects:


A. Doxirubicin - interstitial fibrosis


:B. Cisplatin - pseudocholinesterase deficinecy


C. Cyclopsorin - MAO deificency

D. Vincristine - peripheral neuropathy

E. Bleomycin - cardiomyopathy


15A-124 Suxamethoniums mechanism of action

A: Inactivation of voltage gated sodium channels leading to prolonged depolarisation
B: Open channel block
C: Non depolarising block
D: Inactivation of Calcium channels


125. PS07 Fluoxetine mechanism of action

A: Noradernaline reuptake inhibition
B: Serotonin reuptake inhibition
C: Monoamine oxidase inhibition


126. 15A-126 During propofol Tiva which of the following will increase cerebral blood flow

A: Ketamine
B: Isoflurane
C: Opioids
D: Dexmedetomidine


127. 15A-127 With respect to Midazolam:

A: Less lipophilic than lorazepam
B: Has an Alkaline pH in the ampoule
C: Metabolised by demethylation (etc etc)
D: Has significant first pass metabolism
E: Is water soluble at physiological pH


15A-128 During total intravenous anaesthesia (TIVA), which drug is most likely to increase cerebral blood flow?

A: Ketamine (definitely ketamine)
B: Dopamine
C: Propranolol (may have been another drug starting with ‘p’ )
D: Edrophonium
E: Suxamethonium
(Note: This one seemed to have similar options to GP06, but is asking something quite different to GP06.)


15A-129 Which drugs cross the blood brain barrier?

A: A . . . (some drug starting with the letter ‘a’)
B: Alprazolam
C: Amiloride
D: Amoxycillin
E: Azithromycin


15A-130: Acetyl-salycylic acid (aspirin):

A. Causes a reversible inhibition of cyclo-oxygenase (COX-1)
B. Has a duration of action which is directly related to plasma half-life
C. Acts on gastric mucosa COX but not platelet COX
D. In toxic doses uncouples oxidative phosphorylation in skeletal muscle
E. Is poorly absorbed by the stomach


15A-131: Critical factors that affect drug transfer across the placenta and cause teratogenic effects include all EXCEPT:

a. physiochemical properties
b. rate of transfer across placenta
c. distribution characteristics of fetal tissue
d. maternal age at conception
e. stage of fetal and placental development at time of drug administration


15A-132: Administration of oxytocics for uterine atony post C-section

a. oxytocin causes hypotension due to negative intotropy
b. ergometrine causes ischaemia (myocardial) via coronary steel
c. something about adrenaline
d. PGE2 causes severe hypertension
e. PGF2 causes bronchoconstriction


15A-133. Alfentanil elimination half life is prolonged in:

A. hypoalbuminaemia
B. administration of erythromycin
C. caucasian children
D. renal failure
E. slow acetylators


15A-134: A metabolite of pethidine, norpethidine:

a. half-life is reduced compared to pethidine
b. is a CNS stimulant
c. has more analgesic effect than pethidine
d. ?
e. ?

15A-134. Regarding pethidine's metabolite, norpethidine:

A. elimination half-life is shorter than pethidine
B. stimulates the CNS
C. analgesic effect twice that of pethidine
D. responsible for most of the analgesia of pethidine
E. not excreted in the urine


15A-135. Buprenorphine

A. henbane derivative
B. low lipid solubility
C. high Mu affinity
D. little first pass metabolism
E. less potent than morphine


15A-136 Pharmacokinetics of fentanyl is most affected by:

A. Variability in age
B. Renal disease
C. Type of surgery
D. ?
E. Liver flood flow/disease


15A-137 The context sensitive half-time of alfentanil in a 37yo woman undergoing a 4 hour operation would be closest to:

A. 4 minutes
B. 10 minutes
C. 30 minutes
D. 60 minutes
E. 120 minutes


15A-138 Regarding paracetamol toxicity:

A. Occurs with dose of over 10-12 grams
B. Treatment is based on levels measured 1-2 hours after ingestion
C. ?
D. ?
E. Best treated by ??sulphur/sulfanyl compound (can't recall)

Alt Version: 15A-138. With regards to paracetamol which of the following is true?

A. Oral bioavailability is 40-60%
B. Analgesic activity is not impaired by concomitant administration and use of granisetron
C. early signs of toxicity are presents after 8-10g ingestion
D. Paracetamol concentrations are reliable for prognosis and treatment within 1-2 hours of ingestion
E. Treatment is with the use of sulphydryl-group donors


15A-139B. With regards to opioid metabolism which of the following is true?

A. Primarily reductive hepatic metabolism of phenylpiperidine derivatives
B. Morphine, tramadol, and hydromorphone are metabolised to active metabolites
C. Codeine, oxycodone and tramadol are metabolised by CYP2D6 to active metabolites
D. Pethidine, tramadol and oxycodone have metabolites with seizure-like activity
E. ?


15A-139: Which is not a catecholamine?

A. Adrenaline
B. Dopamine
C. Isoprenaline
D. Dobutamine
E. Phenylephrine


15A-140 ->see 15A-80 same MCQ


15A-142 The following are complications of oxygen therapy EXCEPT:



A. CO2 narcosis

B. seizures with partial pressures administered over 1,000 mmHg
C. haemorrhagic pulmonary interstitial oedema

D. fibrolental hypoplasia
E absorption atelectasis


15A-143 The following are all found in the epidural space EXCEPT:

A. anterior venous plexus
B. posterior venous plexus
C. fat
D. connective tissue
E. anterior vertebral artery


15A-145 Bronchial artery supplies:

A. Provide a low pressure flow to lung parenchyma
B. Provide blood to all bronchioles down to the respiratory bronchioles
C. Are branches from the intercostal arteries
D. Provides blood supply to both visceral and parietal pleura
E. Provides supply to some lung parenchyma


15A-146 Disinfection:

A removal of micro-organisms and unwanted matter from contaminated materials
B prevention of microbial contamination
C complete destruction of all microorganisms including spores
D inactivation of non-sporing organisms using thermal or chemical means
E Occurs before decontamination and sterilisation


15A-147 Oxygen flush on Anaesthetic machine:

A It has the flow of 15-30 L/ min and the same rate of volatile agent adjusted for
B It has the flow of 15-30 L/ min with no volatile agent
C It has the flow of 45-60 L/min and the same rate of volatile agent adjusted for
D It has the flow of 45-60 L/ min with no volatile agent
E None of the above

OR->

a. Supplies 15-30L/min oxygen; with dialled concentration of volatile
b. Supples 15-30L/min oxygen; with no volatile
c. Supplies 35-70L/min oxygen; with dialled concentration of volatile
d. Supplies 35-70L/min oxygen; with no volatile
e. None of the above


15A-148 Lowest level of microshock for VF

A. 1 microamp
B. 10 microamp
C. 100 microamp
D. 1 mA
E. 10 mA


15A-149 Scavenging ... :

a. Downstream pressures are limited between -2 and -10 cmH2O
b. Tubing is 22mm in diameter
c. ?
d. Decreases the risk of intra-operative fires
e. Disposal system can be active or passive

ALT: Scavenge

A. Must have high and low pressure relieving devices on the interface
B. Disposal can be active or passive
C. Tubing 22mm
D.
E.


15A-150 Bipolar diathermy:

A. Not a cause of intra-operative fires
B. Same current density as monopolar at the active electrode.
C. Cannot be used for cutting.
D. Associated with surgical fires.
E. Doesn’t work when immersed in blood.


Numbers not remembered



15A-x1 Carotid sinus massage is used in SVT to:

A. Increase vagal outflow to the SA node
B. Decreased sympathetic stimulation to the SA node
C. Increased vagal outflow to the AV node
D. Decrease sympathetic stimulation to the AV node
E.?


15A-x2 Oxygen therapy causes (? repeat)

A. Causes pulmonary haemorrhage and odema
B. Seizures at > 1000mmHg
C. CO2 narcosis
D. Absorption atelectasis
E. Retrolental fibroplasia


NP07 Spinal arteries

A. There is NO anastomosis between the anterior and posterior spinal arteries
B. Arteries enter the cord at T10-L1
C. Arteries enter via the lamina foramina
D. Anterior spinal artery travels on the right side

E. ?

Alt version: NP07 Regarding spinal cord blood flow:

A: Anterior and posterior spinal arteries do NOT anastomose in the spinal cord
B: Anterior spinal artery enters at T2-L1
C: Anterior spinal artery is derived from the right side
D: Arteries enter from the laminae forminae
E:


15A-x4 With a propofol TIVA, which would increase cerebral blood flow

A. Desflurane
B. Ketamine

C. ?
D.
E.


15A-x5 The juxtaglomerular apparatus (repeat)

A. Macula densa is located in the PROXIMAL ascending loop

B. Granular cells are in the wall of the afferent arteriole
C. Mesangial cells are inside Bowman's capsule
D. ?
E.


15A-x6 The likelihood of gas flow being less turbulent: (repeat)

A. Increased radius
B. Reynolds number > 2000
C. Increased temperature

D.
E.


15A-x7 Sugammadex causes effective reversal of

A. Rocuronium

B. Vecuronium

C. Rocuronium and Vecuronium
D. Rocuronium, vecuronium and pancuronium

E. None of the above


15A-x8 Avoiding ACE-I in pregnant

A. ??


15A-x9 Suxamethonium and procaine - pseudocholinesterase deficiency

A. ??


15A-x10 Teratogenicity not affected by maternal age of conception

A. ??


15A-x11 Difference between skeletal, cardiac and smooth muscles?

A. ??


15A-x12 Arterial blood gas:

pH 7.54
pCO2 27
HCO3 22

Which ONE of the following explains these ABG results:

A: Altitude for several weeks
B: Hyperventilation for 5 minutes
C: DKA
D: Prolonged vomiting
E: ?


15A-x13 Extracellular osmotic pressure

A: 25mmHg
B: 5600mmHg
C. ?
D: 280 mOsm/L
E: None of the above


15A-x14 Airway surgery fire. O2 and N2O being used. N2O is the: (repeat)

A: Fuel
B: Oxidiser
C: Ignitor
D: ?
E: ?


15A-x15 Antidiuretic hormone (ADH). H2O absorption is greatest in:

A: Proximal tubule
B: Distal tubule
C: Loop of Henle
D. ?
E. ?


15A-x17 Peripheral chemoreceptors respond to:

A: pH
B: pO2
C: pCO2


15A-x18 In a patient with significant hypovolaemia and ?increased osmolality:

A: ?Decreased ?sodium reabsorption at distal tubule & collecting duct

B: ?Increased ?water reabsorption at proximal tubule

C: ?Increased ?water reabsorption at ascending loop of henle
D: Increased water permeability of collecting duct
E: None of the above

Note: I cannot remember whether options said increase or decrease water or sodium, but I think I've got the locations right


15A-x19 In the first 2 hours of fasting:

A: Insulin is increased
B: Glucagon is increased
C: ?
D:
E:


15A-x20 A partial agonist:

A: Looks the same as a full agonist with reversible antagonist on a graded dose-response curve
B: ?
C:
D:
E:


15A-x21 Fluoxetine:

A. serotonin reuptake inhibitor
B. noradrenaline reuptake inhibitor
C. ? dopamine something
D. ? both Ser & NA reuptake inhibitor
E. ?



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