Primary MCQs-Feb 2007

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Primary Physiology Black Bank | Primary Pharmacology Black Bank

Primary exam on 26 Feb 2007


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

Fluid & electrolytes

FE08 Hartmann's solution contains

A. Sodium 151 mmol/L

B. Potassium 2 mmol/L

C. Calcium 3 mmol/L

D. Magnesium 5 mmol/L

E. Chloride 151 mmol/L


FE04 ECG change with hyperkalaemia:

A. Long PR

B. Wide QRS

C. Long QT

D. ST elevation

E. ST depression

Respiratory Physiology

RE25 The partial pressure of oxygen in dry air (in mmHg) at atmospheric pressure.

A. 149

B. 153

C. 159

D. 163


RE70 The anatomical dead space is increased by:

A. Intubation

B. Chin tuck position

C. Moving from supine to erect

D. Moving from sitting to semi-recumbent

E. Bronchospasm


What gives with the phasic response question to 8 hours of hypoxia without any CO2 correction? (It refers to the Ventilatory Response to Isocapnoeic Hypoxia)

A. monophasic

B. biphasic

C. triphasic early>late

D. triphasic early<late

E. triphasic early=late



Chemoreceptors.

A. Aortic bodies are principally responsible for the changes in respiratory drive

B. Type 1 cells are in contact with the glossopharyngeal nerve

C. Type 2 cells are responsible for respiratory changes

D.

E. ?


RE71The VO2 max for a sedentary 40 year old male is about?

A. 3ml/kg/min

B. 11ml/kg/min

C. 40ml/kg/min

D. 90ml/kg/min

E. 250ml/kg/min

Acid-base physiology

AD19 Which of the following is a 'strong ion'?

A. PO4

B. SO4

C. Cl

D. Albumin

E. Propyl geline

AD20 During infusion of hydrochloric acid (HCl), which contributes most to buffering? (repeated MCQ)

A. Phosphate buffer

B. Bicarbonate buffer

C. Intracellular buffers

D. Proteins (?intracellular proteins)

E. None of the above


AD21 Which of the following sets of values are measured directly by ABG machine

A. pCO2, paO2, pH

B. paCO2, HCO3, pH

C. paCO2, base excess, paO2

D. Something with base excess

E. Something with HCO3

CVS physiology

Which one about ECG is correct?

A. The standard limb leads are bipolar

B. Lead 1 negative electrode to R arm

C Lead 2 negative electrode to R arm

D. Lead 3 negative electrode to R arm

E. When lead 1, 2 and 3 are connected correctly potential is zero


I: is a leadobtained between a negative electrode placed on the right arm and a positive electrode placed on the left arm

II: is a lead obtained between a negative electrode placed on the right arm and a positive electrode placed on the left foot

III: is a lead obtained between a negative electrode placed on the left arm and a positive electrode placed on the left foot


Regarding the ECG leads, which is not true?

A. The standard limb leads are bipolar

B. Lead 1 negative electrode to R arm

C Lead 2 negative electrode to R arm

D. Lead 3 negative electrode to R arm

E. When lead 1, 2 and 3 are connected correctly potential is zero

(I'm sure I misread this question as there was only one stem like that) (This is also how I remember the question - the first stem should have NOT in the question)


CV82Which of the following is not a cardiac channel/current

A. voltage gated Na channel

B. voltage gated Ca channel

C. Inward rectifying current

D. Delayed rectifier

E. Transient inward K+ current


Peripheral baroreceptors

A.

B. 8-10 seconds for response

C.

D.

E. Glomus cells have direct neural input to glossopharyngeal nerve

Renal physiology

KD43

Which of the following results in decreased K+ excretion?

A. prolonged vomiting

B. metabolic acidosis

C. normal saline infusion

D. Aldosterone

E. Renal failure

GI physiology

Blood & immunology

BL21 HLA is expressed

A. on antigen presenting cells
B. T-cells
C. B-cells
D. Red cells
E. All nucleated cells.

Option E was almost all nucleated cells - slight alteration from previous similar question.


BL34 Bilirubin

A. is only produced from the breakdown of haemoglobin
B. free bilirubin is bound to albumin for transport to liver
C. is produced in the reticuloendothelial system
D. is conjugated in the liver and then secreted into the bloodstream
E. ?

answer: B see http://en.wikipedia.org/wiki/Bilirubin

Endocrine & metabolic physiology

??


Neurophysiology

Which is not an effect of stimulation at Beta-2 receptors

A. tachycardia

B. lipolysis

C. glycolysos

D. bronchodilatation

E. something obvious - i think it was bladder wall relaxation

F. uterine relaxation

Answer: A Sympathetic effects on the heart are mediated by B1 receptors

Unsure if B2 receptors effect glycolysis B2 stimulation does increase glycogenolysis and lipolysis

Bronchodilation, bladder wall relaxation and uterine relation are all effects of B2 stimulation

answer: B. see Ganong p227-228 b: via beta1/beta3. A is right. c: should be glycogenolysis then is right.

The answer is C - Glycolysis is NOT an effect of stimulation at beta-2 receptors. (Glycolysis is the breakdown of glucose to pyruvate or lactate --> occurs in all cells independent of sympathetic or parasympathetic stimulation). B1 and B2 both cause tachycardia is according to both Ganong and Goodman and Gilman (though G&G clarify further by stating it is B1>B2) Table 6-1 in G&G as well as table 13-2 in ganong have a good summary. Lipolysis is mediated by a1, b1,2,3 and inhibited by a2.


NU11Which of the following is an excitatory neurotransmitter

A. Glycine

B. Glutamate

C. Gamma amino butyric acid

D. Serotonin

E. Dopamine

Physiology of muscle & NMJ

Maternal, foetal & neonatal physiology

Apnoea in neonates caused by 100% O2 indicates

A. Some retinal protective reflex

B. Immature central oxygen chemoreceptors (it said this)

C. Tonic drive by peripheral chemo receptors

D.

E.


C Tonic drive page 234 Nunn 6th Ed

Clinical measurement

CM36 Which of the following is NOT a base SI unit

A. metre

B. ampere

C. candela (A unit for luminosity - how bright! or NOT!)

D. kelvin

E. Newton


Regarding humidity

A. Ratio of water vapour present to total water vapour required to fully saturate air

B. Absolute humidity is vapour volume per unit volume of air

C. Relative humidity is volume of water vapour divided by/over volume of water vapour capacity

D. Absolutely humidity is 44gm3 at 20 degrees C

E. Relative humidity is ratio of water vapour present to water vapour required to fully saturate the same volume of air at the same temperature


  • A - Definition of relative humidity (Davis)
  • B - no it isn't
  • C - Water vapour capacity is a little dodgy
  • D - 100% saturated air at 20oC is 17gm3, 37oC is 44gm3
  • E - Relative humidity = mass of water in given volume : mass required to saturate at given volume (Davis pg 127 fifth ed)



Which is true regarding the Clarke electrode?

A. Has a Ag/AgCl cathode and a platinum anode

B. Can measure pO2 in both gas and blood sample

C. Uses a 0.6V polarising current


A The Ag/AgCl is the anode not cathode

B correct page 205 davis 5th edition

C The polarizing current is variously described as 0.6, 0.7, 0.75 V. Who knows?


What best describes relative humidity (two different but similar questions)

A. vapour content over vapour capacity

B. saturated vapour pressure

C. can't remember the other options

D. All questions started with "Ratio" of this and that

E. ?

Pharmacology

General pharmacology

GP05 LD50 is:

A. median lethal dose

B. determined in phase I clinical trials

C. dose causing death in 50% of animals within 1hr

D. ...

E. ...


Which of the following does NOT decrease ACh release from presynaptic terminal

A. aminoglycosides

B. magnesium

C. acetylcholine

D. isoflurane

E. ?


C Acetylcholin has a presynaptic positive feedback effect (Katzung 10th ed pg 424)


GP28 A drug has hepatic extraction ratio of 0.7 and is 30% abosorbed, what is the bioavailability

A. 0.3

B. 0.7

C. 0.21

D. 0.09

E. 0.03


GP51Which is an antagonist at the NMDA receptor?

A. Dexamethasone

B. Dextropropoxyphene

C. Dexmedetomidine

D. Dextromethorphan

E. Dexmethamphetamine


With regards to diffusion through a membrane:

A. Directly proportional to thickness

B. Inversely proportional to thickness

C. Inversely proportional to Surface area

D. Inversely proportional to concentration difference

E. Directly proportional to molecular size


All exist as racemic mixtures except

A. thiopentone

B. lignocaine

C. bupivacaine

D. isoflurane

E. enflurane


G Proteins

A. Alpha subunit unit has GTPase activity

B. Has seven transmembrane subunits

C. G protein RECEPTOR hsa three subunits

D.

A Yes (google) B The G protein coupled *Receptor* has 7 transmembrane subunits


All are second messengers except

A. Nitric Oxide

B. Ca++

C. cAMP

D. cGMP

E. G proteins

A NO is a primary ligand (wikipedia) and cGMP is its second messenger. I disagree - Nitric Oxide is a second messanger (even your wikipedia source says so). G-Proteins are transducers NOT second messengers - IP3 and DAG are the second messengers

When giving a loading dose prior to an infusion the following is not taken into consideration.

A. Volume of distribution.

B. Context sensitive half time.

C. ?Keo


Which of these is a constituent of Ringer's lactate?

A. 150mmol/L Na.

B. 150mmol/L K.

C.

Inhalational anaesthetics

IN MAC can be considered as

A. measure of median effective dose

B. ?

C. ?

D. ?

E. ?


IN02c Nitrous oxide at 70%

A. 99% equilibrium at 3 min

B. about 10L uptake within first 3 min

C. reduces muscle blood flow by 30%

D. decrease cerebral autoregulation by 70%

E. ...


IN35 Which of the following regarding nitrous oxide and Xenon is true?

A. Xenon limited by cost

B. Xenon is less lipid soluble than nitrous

C. Nitrous and Xenon have MAC of > 100% and < 100% respectively

D. Nitrous/both will induce surgical anaesthesia

E. Both are synthesised from readily available chemicals

Comment: I think the stem was which is FALSE?


Anaesthetic preconditioning:

A. Greater that 1 MAC isoflurane required

B. Related to effects of adenosine

C. Related to K+ ATP channels

D. ?

E. ?

Stupid question: Anaesthetic preconditioning CEACCP Feb 2010 - Adenosine and K-ATP channels BOTH thought to be involved.

Regarding Isoflurane metabolism:

A. 0.02%

B. O.2% by CYT P450 2E1.

IV anaesthetics

IV Thiopentone vs Propofol

A. tachycardia is less with thiopentone

B. SVR decrease is more with propofol

C. ?

D. ?

E. ?


IV After an IV bolus of thiopentone, amount remaining in brain after 30min is

A. 0.2%

B. 0.5%

C. 1%

D. 10%

E. 30%

(*SPOILER ALERT): According to stoelting Ed 3 p.115, the correct figure is "as little as 10%" at 30 min)

Local anaesthetics

LA Order of potency of local anaesthetics:

A. Bupivacaine > levobupivacaine > Ropivacaine > Lignocaine

B. Bupivacaine = levobupivacaine > Ropivacaine > Ligoncaine

C. Ropivacaine> Levobupivacaine > Bupivacaine> lignocaine.

D.

E.

(Barash states LA potency for bupiv=ropiv both 3.6, Stoelting also states levo=bupiv=ropiv, all 4)

Lignocaine has pKa of 7.9, the percentage ionised at pH 6.9 is

A.

B. 11%

C. 50%

D. 91%

E. 99%

Muscle relaxants & antagonists

Malignant hyperthermia is not associated with:

A. Hyperthermia

B. DIC

C. Resistance to relaxants

D. Respiratory acidosis

Opioids

Opioid receptors:

A. Mu, kappa and delta receptors are found in all laminae in dorsal horn

B.

C.

D. Drugs with solely delta agonism have no analgesic properties

E.

Cardiovascular drugs

CD Regarding pharmacologic management of ventricular fibrillation:

A. epinephrine at 100mcg/kg improves outcomes in in hospital arrest

B. vasopressin improves cardiac and coronary perfusion by action at V1 receptors

C. Lignocaine 1.5mg/kg is first line

D. Amiodarone increases risk of Torsades

E.


CD Which is not a side effect of amiodarone?

A. cardiomyopathy

B. thyrotoxicosis

C. corneal microdeposits

D. pulmonary fibrosis

E. photodermatitis


CD51 Dexmedetomidine (repeated)

A. MAC sparing for isoflurane by maximal 30%

B. can cause bradycardia & sinus arrest

C. increases CBF

D. ...

E. ...


CD24 Example of a beta-1 selective antagonist with a plamsa half life of 6-7 hours and renal elimination (repeated)

A. propranolol

B. metoprolol

C. esmolol

D. ....

E. atenolol


CD10 ECG changes associated with digoxin at therapeutic levels (repeated)

A. shortened PR interval

B. prolonged PR interval

C. ST segment changes

D. Peaked T- waves

E. ?


CD Which is NOT a side effect of non-selective beta blockade

A. urinary retention

B. bronchospasm

C. hyperglycaemia

D. Hyperkalaemia

E. ?


CD Milrinone:

A. increased cAMP ?

B. alpha 1 adrenergic receptors ???

C. mechanism of action is a cAMP dependent rise in intracellular calcium

D. ?increases myocardial oxygen demand

E.


CD Thiazide diuretics are not associated with-

A. Hyperglycaemia.

B. Hypermagnesmia

C. Hyperuricaemia.

D. Hyponatraemia.

E. Hypokalaemia.


B Correct (see Goodman and Gilman)

Miscellaneous drugs

Which one of the following is true about aminoglycosides?

A. Does NOT cause ototoxicity

B. Does NOT cause nephrotoxcity

C. Does NOT potential NMJ blockers

D. Contraindicated in Myasthenia gravis

E. Is NOT highly protein bound


Which one of the following is NOT true about aminoglycosides:

A. Do cause ototoxicity

B. Do cause nephrotoxicity

C. Are highly protein bound

D. Contraindicated in Myaesthenia gravis

E. Potentiate NMJ blockade


Which of the following drugs does NOT reduce uterine tone (repeat MCQ):

A. magnesium sulphate

B. isoprenaline

C. indomethacin

D. Nitrates

E. phenytoin


With regard to oxgygen (repeat of July 06)

A. causes pulmonary toxicity at less than 100kPa

B. medical grade is 95% pure

C. the only gas that ignite a glowing splint

D. some CNS toxicity at 100kPa

E. produced by hydrolysis on commercial level?


With regard to drug administration in a neonate (repeat July 06)

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 second week

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


Which of the following antiemetics does not easily cross the blood brain barrier?

A. Metoclopramide

B. Ondansetron

C. Domperidone

D. Prochlorperazine

E. Droperidol

Which of these anticonvulsants acts on the GABA Receptor.

A. Ethosuccimide.

B. Carbamezipine.

C. Vigabatrin.

D. Lamotrigine.

E. Phenytoin.


MD60 Which of the following is a non particulate antacid

A. Aluminium

B. Sodium citrate

C. Magnesium

D. Cimetidine

E. ?

Statistics and Drug Trials

A drug that has reached a stage 2 trial:

A. Can be used in a clinically in a teaching hospital

B. Has not had pharmacokinetic data determined

C. Is to be trialled on the target population

D. Has not yet been tested on humans

E. ?

Myles and Gin pg 137 Selected clinical investigations in patients for whom the drug is intended establishing dose response curves, efficacy and further safety(!).


SP21 Which is true linear regression:

A. Line goes through origin

B. Can be used for categorical data

C. Calculated by method of least squares

D. X and Y axis interchangeable

E. ?

Standard error-

A. Difference between population mean and sample mean

Unclassified MCQs

General comments about the paper

?

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