Primary MCQs-Feb 2006

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Primary Physiology Black Bank | Primary Pharmacology Black Bank

MCQs remembered from Exam held on 20 Feb 2006


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

General physiology

BP07 NEW Q

Tight junctions between cells:

A. impermeable to water and solutes

B. involved in active transport

C. permeable to water and solutes

D. permeability is NOT under hormonal control

E. permeable to large compounds (or something else wrong)


Fluid & electrolytes

FE01 REPEAT Q Add: option C "absent P waves"


FE14 REPEAT

The ion present in the lowest concentrations in the cell:

(same options as previously - calcium only correct answer)


FE29 NEW Diffusion across semipermeable membrane:

A. is inversely proportional to thickness

B. is proportional to molecular weight

C. ?


Acid-base physiology

AD17 REPEAT

Set of blood gases with high pH, high HCO3 and high CO2. Options:

A. Metabolic acidosis

B. Acclimatisation to altitude

C. COAD

D. ?

E. Prolonged vomiting


AD18 NEW

Base excess calculation from

A. when PaCO2 is 40 mm Hg

B. difference of measured HCO3 from standard HCO3

C. lower with higher HCO3

D. is an indicator of cellular buffers

E. is negative when pH greater than 7.40


Respiratory physiology

RE41 option:

"pulmonary and CNS toxicity MAY be seen at 100% O2 at 1 atm >48 hours"


RE63 NEW Q Anatomical dead space

A. measured by carbon monoxide inhalation

B. 2ml/kg in average adult.

C. ?


RE64 NEW

With regard to dead space:

A. Bohr equation can be used for anatomical dead space

B. Nitrogen washout can be used for alveolar dead space

C. Physiological dead space calculated from end-tidal CO2

D. Physiological dead space can be calculated from end-tidal CO2 and alveolar CO2.


RE66 A-a gradient is increased with (I think there were 2 very similar questions about a widened A-a gradient)

A. atelectasis

B. venous admixture

C. Hypoventilation

D. reduced cardiac output

E. increased diffusion distance for oxygen


RE66b A-a gradient of 50mmHg in a patient breathing room air is most likely due to (stem definitely correct):


RE With regard to physiological dead space

A. Increased with atelectasis

B. Dependent on anatomical dead space

C. ?


RE65 NEW

Regarding the work of lungs in breathing:

A. ?

B. Most work is to overcome airway resistance

C. Increased by increasing respiratory rate (i think)

D. ?

E. Work done is determined by integral of pressure volume loop


CVS physiology

CV A strange question on the main determinant of blood pressure in chronic hypertensives (or the abnormal control system in chornic hypertensives)? Can't recall options but they were something like:

A. Renin-angiotensin system

B. Renal-blood flow mechanism

C. Tubuloglomerular feedback

D. Glomerulotubular balance

E. Starling's forces

(B was definitely there, the others may be falsely recalled)


CV28 Slowest conduction velocity is found in:

A. AV node

B. Purkinje fibres

C. ventricular muscle

D. ?


CV Coarctation of aorta

A. higher vascular resistance in lower body

B. cardiac output is 1.5 times normal

C. flow in all tissues is normal

D. Baroreceptor reflexes are inactivated

E. ?BP in upper and lower limbs equal

F. Flow to upper and lower limbs are equal


CV In a resting healthy adult, order of A-v oxygen difference from highest to lowest:

A. heart > liver > skeletal muscle > skin > kidney

B. heart > skeletal muscle > liver > kidney > skin

C. heart > liver > skeletal muscle > kidney > skin

D. liver > heart > skeletal muscle.

E. heart > skeletal muscle > liver > skin > kidneys (which is correct going by ganong page 615 - table)


CV53 All of the following are baroreceptors EXCEPT:

A. Carotid sinus

B. Carotid body

C. Aortic arch

D. Atrium

E. Walls of great veins


CV Effect of exercise:

A. systolic BP decreases

B. pulsepressure widens

C diastolic BP decreases

D. diastolic pressure increases

E. ?pulse pressure narrows (maybe wrong)


CV Effect of ageing (normally):

A. pulse pressure widens

B. diastolic increases

C. increased aortic compliance

D. increased rate of ventricular filling in diastole

E. heart rate increases (?? not sure if this is right option - but another incorrect answer I think)


CV The organ most UNLIKLEY to demonstrate an increase in blood flow in response to decreased capillary partial pressure of oxygen?

A. Liver

B. Skeletal muscle

C. heart

D. Kidneys

E. Lung


CV Regarding pressure volume loop of heart:

A. contractility is demonstrated by end systolic point

B. afterload is determined by end diastolic volume

C. ventricular diastolic elastance curve is change in pressure / change in volume in diastole

D. end systolic pressure volume relationship gives guide of afterload

E. aortic valve closes at diastolic blood pressure

(very poorly worded question that will surely be scrapped)


CV Which of the following are not produced by vascular endothelium?

A. thromboxane

B. Endothelin

C. prostacyclin

D. NO

E. something else that i think was produced by endothelium


CV Regarding blood flow in capillaries:

A. increases as diameter decreases

B. is a newtonian fluid

C. increases as viscosity decreases

D. something wrong

E. something wrong

Renal physiology

KD35 NEW

The amount of H+ filtered by the kidney per day:

A. 3.6 mmol

B. 36 nmol

C. 0.68 mmol

D. 6.8 mmol

E. 68 mmol


KD11 REPEAT

??stem

A. Max urine osmolality 1200mosmol/kg

B. Min urine osmolality 100mosmol/Kg

C. Minimum osmolality = 20mOsmol/kg


KD36 Regarding water reabsorption in the collecting tubules:

A. depend on aldosterone levels

B. collecting tubules able to reabsorb 60-70% of water

C. depends on renin levels

D. loops of henle are ONLY located in the renal medulla (may be from another question)


KD37 Regarding the Loop of Henle:

A. active transport of na into tubules

B. active transport of cl out of tubules

C. active transport of k into tubules

D. permeable to water

E. something else wrong


KD38 Glycosuria is most likely to occur with:

A. increased GFR and increased blood glucose level

B. decreased GFR and increased blood glucose level

C. decreased GFR and decreased blood glucose level

D. increased GFR and decreased blood glucose level

E. no change to GFR and increased blood glucose level.


KD What is the minimum pH of urine that the kidney can generate:

A. 3.0

B. 3.5

C. 4.0

D. 4.5

E. 5.0


GI physiology

GI The oesophagus is normally:

A. Closed at top end

B. Closed at bottom end

C. Closed at both ends

D. Opened at both ends

E. ?


GI Calcium absorption from the GIT:

A. Is by facilitated diffusion mostly in proximal lower intestine

B. Is by a carrier protein on mucosal surface

C. 10-20% is absorbed

D. ?mostly from stomach

E. (Dont know - i think wrong though)

Blood & immunology

BL07 Antithrombin 3 inactivates which of the following clotting factors:

A. factor XII

B. factor XI

C. factor IX

D. factor II

E. all of the above


BL A negative recipient. Which donor blood would you choose?

A. O+

B. A+

C. AB+

D. AB-

E. O-


BL Most cytokines are:

A. hormones

B. prostaglandins

C. aptens

D. proteins

E. ?


Endocrine & metabolic physiology

ED Glycogen phosphorylase activity:

A. present in all cells

B. increased in liver and muscle due to adrenaline

C. increased in liver and muscle due to glucagon

D. carnitine increases the transport of FFAs into the mitochondria.

E. Chylomicrons are synthesised in microsomes in the mitochondria.


ED Hormone sensitive lipase ...

A. glucagon

B. Lipoprotein lipase stimulates the breakdown of triglycerides to glycerol and fatty acids

C. ??carnotene, and fatty acids being transported into mitochondria (short and medium chain FA's?)

D. ?Mitochondria is site of FA synthesis?

E. ?Adipose cells site of chylomicron synthesis


ED Beta 2 receptor stimulation causes:

A. reduced pancreatic islet cell hormone release

B. coronary vasodilatation

C. tachycardia

D. reduced renin synthesis

E. reduced aldosterone synthesis


ED Diabetes insipidus untreated for 4 hours results in

A. Na 130, K 4.0, Osmol 280mosml/L

B. Na 130, K.3.5, Osmol 300mosml/L

C. Na 140, K 4.5, Osmol 320mosm/L

D. Na 155, K 3.0, Osmol 320mosm/L

E. Na 155, K 3.5, Osmol 280mosm/L


ED An anaesthetised patient has reduced ability to produce heat due to:

A. vasodilatation

B. decreased activity of nak-atpase

C. reduced skeletal muscle tone

D. ?


Neurophysiology

NU Which of the following neurotransmitters is excitatory?

A. Glycine

B. GABA

C. Glutamate

D. Dopamine

E. Serotonin


Physiology of muscle & NMJ

There were 2 questions like this:

MU Cardiac muscle differs from skeletal muscle by:

A. slow ca channels

B. fast na channels

C. presence of striations

D. wrong

E. wrong


MU Cardiac muscle is similar to skeletal muscle in terms of:

A. presence of striations

B. slow ca channels

C. same conduction velocity

D. both -90mV resting memb potential

E. ?


MU Smooth muscle vs skeletal muscle

A. more mitochondria

B. same conduction velocity (i think)

C. increased action:myosin ratio (seemed to be the only correct answer)

D. ?

E. ?


Maternal, foetal & neonatal physiology

MF Pregnancy is associated with 15-20% increase in oxygen consumption. This is due to:

A. foetal oxygen consumption

B. not related to skeletal muscle activity

C. progesterone

D. Present from 20 weeks gestation

E. ?


MF The O2 saturation of Hb in the fetus is highest in

A. Umbilical Artery

B. Umbilical Vein

C. IVC

D. Pulmonary vein

E. Left ventricle


Clinical measurement

CM Which of the following is NOT a base SI unit:

A. Candela

B. Ampere

C. Kilogram

D. Degree celcius

E. Second


CM Regarding flow:

A. Laminar in small tubles

B. Resistance in series - resistance is the sum of resistances in series

C. Resistance in parallel - resistance is the sum of the reciprocal of resistances

D. velocity increases as diameter decreases

E. ?

Pharmacology

General pharmacology

GP. Which only act at G protein coupled receptors

A. acetylcholine

B. histamine

C. glutamate

D. glycine


GP. Regarding the management of poisoning. In what order would you perform the following:

  • 1. minimise absorption, increase excretion
  • 2. ensure safety of health workers
  • 3. manage airway, B, C
  • 4. treat pharmacologic and toxicological effects

A. 1,2,3,4

B. 2,3,1,4

C. 2,3,4,1

D. 4,3,2,1

E. 4,2,3,1

Did they intend the word organophosphorous to be there? - It wasnt there


GP. Weak base with pka 8.9, what is percent ionised at pH 7.9?

A. 10%

B. 20%

C. 90%

D. 99%

Inhalational anaesthetics

IN  ?? increased sympathetic discharge is likely if increased %absorption of sevoflurane ?? (might have been an option to one of the volatile questions


IN. Uptake of inhaled anaesthetics is not affected by

A. age

B. MAC

C. concentration of agent

D. solubility of agent

E. cardiac output


IN. MAC what is true

A. not affected by changes in sodium

B. not affected by changes in potassium

C. not affected by pregnancy

D. affected by age 40-80


IN Which is true?

A. MAC of Des greater than sevo

B. Sevoflurane is more rapidly excreted than iso despite having a larger tissue/blood partition coefficient

IV anaesthetics

IV. Proprofol:

A. substituted isopropylphenol

B. 20% egg phosphatide

C. 80% protein bound

D. causes histamine release


IV. Midazolam:

A. two glycine binding sites on GABA receptor

B. acts at Gaba B receptors

C. stimulates chloride channel opening at GABA B

D. agonist at mu opioid receptors


IV. What has the largest volume of distribution?

A. thiopentone

B. propofol

C. dexemedetomidine

D. midazolam

E. ?


IV. Which agent has no antiemetic effects

A. propfol

B. midazolam

C. scopolamine

D. etomidate

E. ?


IV -. Thiopentone:

A. faster onset with acidosis or

B. predominantly ionised in acidotic environment

C. mostly bound to albumin after injection

D. ?

Local anaesthetics

LA Cocaine effects...

A. Cocaine toxicity is similar to amphetamine toxicity

B. Central effects are due to noradrenaline

C. Vasodilator

D. Maximal effect within 5 minutes

E. ?


Muscle relaxants & antagonists

MB Which drug is likely to have prolonged duration in pseudocholinesterase deficiency:

A. Mivacurium

B. Cocaine

C. Procaine

D. Esmolol

E. Remifentanil


MB. Non-depolarising neuromuscular block prolonged with

A. [[Phenytoin}}

B. Hypomagnesemia

C. Respiratory acidosis

D. Hyperkalaemia

E. ?


MB Which drugs do not cause prolongation of blockade by inhibiting calcium channel on nerve terminal?

A. Aminoglycosides

B. Frusemide

C. Ca blockers

D. Volatiles

E. Magnesium


MB Edrophonium question (repeat)

A. Has quicker onset than neostigmine

B. Has shorter half life than neostigmine

C. Is a tertiary amine (all options same as previous)

D. ?


MB Pyridostigmine:

A. is a tertiary amine

B. ?

C. ?

D. ?

E. May improve symptoms of myaesthenia gravis


Opioids

OP Remifentanil

A. is metabolised by red cell esterases

B.

C.

D.

E. has active metabolites that are hydrolysed to inactive metabolites


OP Naloxone:

A. selective mu antagonist only

B. intrinsic activity when given alone

C. mu, kappa, delta activity is equal

D. causes APO

E. half life 6-8 hours


OP Tramadol:

A. prevents reuptake of serotonin and noradrenalin

B. ?

C. ?


OP Opioids

A. spinal receptors exist for mu and delta but not kappa

B. mu receptors found in all lamina of dorsal horn

C. those with only delta agonist activity are not analgesic

D. tramadol, codeine and oxycodone metabolised by cyp2d6 to active metabolites

E. tramadol, hydromorphone and codeine have active metabolites

F. morphine-3-glucuronide is very potent at mu receptors


OP. Which ONE of the following is true?

A. oxycodone, codeine and tramadol result in metabolites that are active

B. tramadol, morphine and hydromorphone have active metabolites

C. ?


OP. Opioids

A. phenylpiperidinies are predominately metabolised by reduction in the liver

B. ?

C. ?


OP. Regarding tolerance to clinical use of opioids

A. Cross tolerance is complete for all opioids

B. Mechanism may be Phosphorylation of receptors and internalisation

C. Physical dependence is not a problem

D. psychological dependence does not always occur

E. ?

Cardiovascular drugs

CD Regarding esmolol:

A. is metabolised by red cell esterases

B. half life something?

C. intrinsic sympathomimentic

D. (no option about not being a membrane stabiliser)

E. ?


CD. Phenylephrine and metaraminol

A. are resistant to metabolism by COMT

B. have both indirect and direct effects

C. have only direct effects

D. ?


CD. Digoxin:

A. inhibits Na+/Ca2+ exchange

B. has a central effect on vagal nuclei

C. Increases atrial refractoriness

D. ?


CD Phentolamine:

A. Selective alpha-1 antagonist

B. Causes bradycardia

D. Causes increased cardiac output

E. Selective alpha 2 antagonist


CD Dexmedetomidine:

A. MAC sparing for isoflurane by maximal 30%

B. Causes bradycardia and sinus arrest

C. ?


Miscellaneous drugs

MD With regard to drug administration in neonate,

A. Aminoglycosides need to be given in higher relative dose because proportion of water is greater

B. Concentration of free/unbound drug is lower

C. Highly protein bound reduces serum bilirubin

D. Renal clearance is higher in first few days of life compared with the 2nd week

E. Prenatal maternal drug administration has no effect on neonatal drug metabolism


MD. Which drugs increase gastric emptying?

A. Omeprazole

B. Domperidone

C. Prochlorperazine

D. Atropine

E. Midazolam


MD. Metoclopramide

A. Substituted benzamide

B. Phenothiazine

c. Half life of: 2 hours


MD. Dexemedetomidine

A. Increases CBF

B. Decrease MAC of isoflurane up to maximum of 30%

C. May cause bradycardia and sinus arrest

D. ?


MD. Warfarin:

A. Is a racemic mixture

B. R isomer is more potent than S isomer

C. Doesn't cross placenta

D. Onset of action depends on speed of synthesis of coagulation factors


MD. Clopidogrel has its effects by:

A. Binding to GP2b3a receptor

B. Inhibits uptake and binding of ADP

C. Binds to ADP receptor preventing activity

D. Plasma levels elevated for about 7 days after ceasing


MD. PGI2 and PGE2 causes all except

A. Hypotension

B. Abdomial pain

C. Fever

D. Nausea and vomiting

E. Bronchoconstriction


MD. Salbutamol:

A. ?? Myosin light chain kinase


MD. Aspirin:

A. Uncouples oxidative phosphorylation in skeletal muscle in overdose.

B. plasma levels elevated for about 7 days after ceasing.

C. something about increasing excretion by changing urine pH

D. half life of 6 hours or something


MD. Phenytoin, which is not true?

A. actions on Ca2+ channels

B. actions on GABA channels

C. direct action on membranes

D. actions on Na+ channels


MD20 Which of the following causes irreversible cardiotoxicity?

A. Vincristine

B. Bleomycin

C. Asparaginase

D. Danorubicin


MD Oxytocin

A. t1/2 of 5 min

B. Strong antidiuretic effect

C. ?

Statistics

SP02 Standard error of the mean:

A. variability of samples

B. The difference between the sample mean and the population mean.

C. ?

D. ?


SP01 Tests involving ranking of data:

A. Are preferred when normal distribution cannot be confirmed

B. Include chi squared test

C. something about having more power (but not in those exact words)

D. (?? Have more power than parametric tests)


Can't remember which

??

General comments about the paper

  • "very few MCQ questions in physiology were repeated or slightly altered, most questions were brand new"

. . It seems after the recent successes of >90% passing both physiol and pharm MCQs, the examiners have really dug deep to try and reduce those percentages. got a real shock on the day. not what everyone said it would be like!

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