Primary MCQs-February 2014

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Primary Physiology Black Bank | Primary Pharmacology Black Bank

This page contains MCQs that were on the 24 February 2014 exam.

Primary MCQ papers

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1. AD29 The following ABG is suggestive of:

pH 7.56, HCO3 46, pC02 58
A. Mountain Climber after several weeks at altitude
B. Chronic Pulmonary Disease
C. Diabetic Coma
D. 5 Mins Hyperventilation
E. Prolonged vomiting

2. AD30 If the pH of a solution changes from 7.4 to 7.1 what is happening to the H+ 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

3. AD31 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

4. AD32 In blood gas analysis the base excess:

A. Is directly measured:\
B. Assumes a pCO2 of 40mmhg
C. Assesses respiratory acid base status
D. Is the same as plasma bicarbonate
E. Is independent of blood haemoglobin level

5. FE41 What is true for Magnesium?

A. normal plasma level is 1.1 - 2.2
B. slows sinoatrial conduction
C. increases uterine tone
D. is a diuretic
E. is a direct respiratory depressant

6. 14A-6 ADH secretion is increased

A. only when there is a 10% increase in plasma osmolality
B. decrease in extravascular volume
C. nausea and vomiting
D. alcohol
E. with a change in position from standing to supine

7. 14A-7 In the kidney, which of the following substances is NOT under hormonal control?

A. Calcium
B. Potassium
C. Phosphate
D. Sodium
E. Sulphate

8. 14A-8 In a 70kg trained athlete at rest.

A. 02 Consumption is 350mls/min
B. AV difference of 5ml/min
C. Cardiac output 7L/min
D. Stroke volume is 70mls
E. End-systolic volume is 70mls

9. CV27 The last part of the heart to depolarise after atrial depolarisation:

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

10. 14A-10 Regarding cutaneous circulation, all of the following are true EXCEPT:

A. AV anastomoses do not exhibit basal tone
B. It is supplied by the sympathetic and parasympathetic nervous system
C. Neural input is more important than metabolic control
D. There is a countercurrent exchange in the extremities
E. I can't remember but I'm pretty sure it was True

11. 14A-11 Vagal stimulation causes

A. Increase conduction time
B. Increase atrial myocardial conduction
C. Decreased Atrial Ventricular nodal conduction
D. Decreased left peak intraventricular pressures

12. 14A-12 During normal inspiration

A. Increased CVP
B. Increased RAP
C. Increased Intrathoracic Pressure
D. SVC blood flow doubles
E. Decreased pulmonary vascular resistance

13. 14A-13 With IPPV the predominant decrease in CO is due to?

B. ↓VR
C. Impaired RV function
D. ↓LV distensibility
E. ↑LV afterload

14. 14A-14 In response to exercises.

A. AV oxygen difference increases to 20mls/dl
B. MAP increases from 90-140mmhg
C. O2 consumption increases up to a maximum of 500%
D. Stroke volume increases linearly up to 120mls
E. Peripheral vascular resistance falls by greater than half.

15. 14A-15 Large Elastic Arteries

A. Act as hydraulic conductors to increase flow during diastole
B. Compliance increases with advancing age
C. Smaller increases in diameter with increase age
D. Equal flow in the pulmonary and systemic circulation

16. 14A-16 Regarding the splanchnic circulation

A. There is a countercurrent exchange mechanism in the intestinal villi
B. Includes blood flow to the gut, liver, kidney, spleen and adrenal gland
C. Cholecystokinin decreases blood flow
D. Parasympathetic stimulation causes vasoconstriction
E. Portal vein PO2 increases during a meal

17. 14A-17 The following are cardiovascular changes in the elderly.

A. Increased compliance of ventricles
B. Fibrosis of AV NODE.
C. Unchanged stroke volume.
D. Impaired baroreceptors.
E. Increased resting heart rate.

18. CV92 When comparing radial artery and aorta waveforms.

A. Aorta has higher systolic.
B. Aorta has lower systolic.
C. Aorta has higher MAP.
D. Radial has bigger incisura.
E. Radial occurs earlier.

19. CD10 ECG changes with digoxin toxicity:

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

20. 14A-20 Systemic blood pressure is determined by

A. Arterial compliance and blood volume

21. 14A-21 The resting membrane potential

A. is temperature dependent??

22. FE06 The Gibbs Donnan Effect:

A. Explains distribution of charge between intra and extravascular space
B. Explains distribution in charge between intra and extracellular space
C. Explains differences in ionic concentration gradients
D. Explains the distributions of plasma proteins across cell membranes
E. Explains the distribution of all proteins across cell membranes

23. 14A-23 With regard to Doppler estimation of cardiac output, which of the following parameters is not required?

A. Haematocrit
B. Aortic Cross section area
C. Velocity of red cells
D. Time taken for ejection
E. Heart rate

14A-24 to 14A-26 ?not recalled

27. 14A-27 Closure of the ductus arteriosus is due to

A. Left to right shunt
B. O2 dependent smooth muscle contraction
C. Increased aortic pressure

28. 14A-28 Bile:

A. Is produced in the gall bladder
B. Is hypertonic
C. Contains fat soluble vitamins
D. Is alkalotic

29. 14A-29 At birth chlidren A RhD negative have high titres to:

A. A antigens
B. B antigens
C. A and RhD antigens
D. B and RhD antigens
E. none of the above

30. BL10 Which of these are vitamin K dependent clotting factors

A. Protein C
B. Factor VIII
C. Factor X
D. vWF
E. Factor V

31. 14A-31 Which of the following is true about TISSUE macrophages

A. They last only 24 hours
B. They are derived from circulating lymphocytes

14A-32 ?not recalled

33. 14A-33 What is true regarding nerve action potentials?

A. Sodium channels open at -80 mV
B. Potassium efflux begins prior to maximum depolarisation
C. Sodium channels return to resting state at -30 mV
D. Potassium channels have resting, activated, and inactivated states
E. Potassium channels undergo a 500-1000-fold change in conductance with repolarisation

34. 14A-34 Skeletal muscle intrafusal fibres:

A. Are shorter than extrafusal fibres
B. Contain contractile elements
C. Have no motor innervation
D. Are in series with extrafusal fibres
E. Detect changes in muscle tension

?Alternative recall of 14A-34 - Very similar

35. 14A-35 Intrafusal muscle fibres...

A. Have contractile mechanisms
B. Are the same length as extrafusal fibres
C. Are connected in series to extrafusal fibres
D. Provide information about muscle tension

36. 14A-36 Action potential in a skeletal muscle...

A. Repolarisation begins before Na channels close
B. Threshold potential -30mV
C. Channels close 15mV??

37. 14A-37 Compare sympathetic and parasympathetic system.

A. PNS the length of the fibres relatively short, postganglionic fibres lying within close proximately of the organs.

38. 14A-38 With regards to Cerebral Blood Flow

A. Increased blood flow with increased neuronal activity
B. depends on MAP and ICP
C. increased plasma glucose level
D. no option of increased partial pressure of CO2(as per previous)

39. 14A-39 The equilibrium potential for any particular ion

A. occurs when there is no net movement of the ion
B. occurs when its intracellular fluid concentration equals its extracellular fluid concentration
C. There was something about intracellular anions in this Q - I think it said is caused by intracellular anions

40. NU15 CSF, with respect to plasma

A. higher K+
B. lower Na+
C. higher protein
D. ??HCO3-

41. 14A-41 Trace elements integral in the action of Lactate dehydrogenase, carbonic anhydrase and many other enzymes?

A. cobalt
B. copper
C. magnesium
D. manganese
E. zinc

42. 14A-42 What has the greatest immediate effect on metabolic rate?

A. carbohydrate metabolism
B. fat metabolism
C. skeletal muscle activity
D. hepatic enzyme activity

43. CM44 Gas flow is less likely turbulent if

A. Gas viscosity less
B. Gas temp increased
C. Tube radius increased
D. Reynolds > 2000
E. Tube has bifurcation

44. CM36 All are SI derived except

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

45. 14A-45 The affect of ADH in the kidney

A. Aquaporin insertion on the basolateral membrane
B. cause constriction of extraglomerular mesangial cells?
C. Act on V1A receptors / V2A receptors

46. 14A-46 Renal blood flow in a 70kg man is

A. 600 – 650 ml/kidney/min

47. 14A-47 In kidney, Bicarbonate

A. Is not filtered
B. Appears in urine at all times
C. Only appears in urine when plasma HCO3 conc > 32 mmol/L
D. Reabsorption increased with increased GFR
E. Reabsorption increased in DCT

48. 14A-48 Renal structure most vulnerable to Hypoxic injury

A. Glomerulus
E. Collecting Ducts

49. 14A-49 Regarding control of Renal blood flow

A. is predominantly SNS to the kidney
B. is predominately PNS to the kidney
C. PNS from the Vagus via the hypogastric nerve
D. Noradrenaline acts on the JG and tubular cells
E. Autoregulation between 40 – 140mmHg

50. 14A-50 Glucose handling by the kidney

A. Freely filtered
B. Passively reabsorbed
C. Linked to Potassium ions reabsorption
D. Equal amounts reabsorbed in all cell
E. Only reabsorbed in hypoglycaemia

51. 14A-51 The regulation of GFR is not influenced by

A. Juxtaglomerular apparatus
B. Mean arterial pressure
C. afferent arteriole
D. efferent arteriole
E. macula densa

52. 14A-52 The Juxtaglomerular apparatus

Totally forgot options…

53. 14A-53 Renal clearance

A. inulin as its MW ~70kDa
B. reduced GFR results in reduced creatinine clearance
C. PAH excreted less than inulin
D. inulin underestimates GFR
E. exercise is associated with a ↓creatinine clearance

54. 14A-54 Renal water reabsorption occurs predominantly by

A. osmosis
B. active transport
C. facilitated diffusion
D. secondary active transport
E. paracelllular diffusion

55-58 ?not recalled

59. 14A-59 32g of O2 occupies 22.4L. What does 44g of CO2 occupy?

A. 22.4L
B. Plus other wrong answers

60. 14A-60 The barometric pressure of air is 247mmHg. What is the pressure of oxygen in moist inspired air?

A. 42mmHg
B. Various other numbers.

61. 14A-61 What percentage of venous admixture is an increase in FiO2 unable to compensate for?

A. 15%
B. 25%
C. 35%
D. 45%
E. 55%

62. (not recalled - thought to be a repeat)

63. 14A-63 Most O2 in the blood is carried:

A. Dissolved in plasma
B. As carbamino compounds in RBCs
C. As carbamino compounds in plasma
D. As HCO3 in RBCs
E. As HCO3 in plasma

64. Not Recalled

65. 14A-65 With constant O2 consumption PvO2 ↑s with

A. alkalosis
B. ↓2,3 DPG
C. ↓temp
D. hypercapnoea
E. none of the above

66. 14A-66 Closing volume

A. is measured from a single breath N2 washout
B. 20% of VC at 65yrs of age
C. is in ?? of small airways disease
D. is measured when upper airways close
E. no change with posture

67. ?not recalled

68. 14A-68 Breathing heliox with decrease?

A. minute ventilation
B. mixed CO2

71. 14A-71 The major heat production in an adult

A. skeletal muscle activity
B. NaKATPase activity
C. thyroid hormone activity
D. catecholamine activity
E. specific dynamic action of food

72. 14A-72 The effects of digoxin include

A. centrally mediated vagotonic activity
B. ↓pacemaker ectopic activity
C. ↑myocardial K
D. ↓myocardial Ca
E. inhibit Ca/Na exchanger

73. 14A-73 Lignocaine as an antiarrythmic is more likely to worsen cardiac failure because of?

A. Negative inotropy
B. Decreased volume of distribution and Clearance in Cardiac Failure (T)
C. Slows AV conduction
D. Causes Torsades de Pointes

74. 14A-74 Phenoxybenzamine

A. Does not cross the BBB
B. Good absorption with predictable OBA
C. Inhibits post synaptic a1 > a2
D. alpha block is not prolonged
E. causes bradycardia at high doses

75-76. ?not recalled

77. 14A-77 Metoclopramide:

A. antagonises the actions of acetylcholine
B. decreases gastric acid secretions
C. Is a Dopamine Antagonist
D. Does not cross the Blood Brain Barrier
E. Does not cross the Placenta

78. 14A-78 Nitric Oxide:

A. Is scavenged by Red Blood Cells
B. Is therapeutic in concentrations of 0.06-0.23 ppm
C. Is administered with Oxygen as a carrier gas to enable delivery of accurate concentrations

79-88. ?not recalled

89. 14A-89 Which drug is not presented as a racemic mixture?

A. Isoflurane
B. Enflurane
C. Lignocaine
D. Bupivicaine
E. Methadone

90. 14A-90 Emax Refers to?

A. Efficacy
B. Affinity
C. Potency
D. Lethal Dose
E. Toxic Dose

91. 14A-91 According to receptor theory

A. irreversible antagonists bind to all spare recpetors
B. Competitive antagonists have no intrisic activity
C. Partial agonists have decreased affinity
D. Spare receptors do not relate to sensitivity of drug binding
E. Kd is the ratio of bound drug to recpetor: unbound drug to receptor

92. 14A-92 All are second messengers EXCEPT

A. IP3
C. G proteins

93. 14A-93 How does NO exert its effect:

A. diffuses across
B. extra cellular receptor
C. intracellular

94-105. ?nor recalled

106. 14A-106 Enflurane & isoflurane

A. enantiomers
B. diasteriomers
C. structural isomers
D. optical isomers

107. 14A-107 After 20mins induction with 66% nitrous & 1.2% sevoflurane, at surgical incision there is a 5% chance of?

A. opening eyes
B. movement (withdrawal reflex)
C. purposeful movement
D. ↑HR
E. awareness

108. 14A-108 Which agent undergoes the LEAST metabolism?

A. sevoflurane
B. desflurane
C. isoflurane
D. nitrous oxide
E. xenon

109. 14A-109 Ketamine:

A. direct alpha- & beta- adrenoreceptor receptor agonist
B. direct sympathetic ganglia stimulation
C. competitive NDMA antagonist
D. commonly causes histamine release
E. negative ionotrope.

110. 14A-110 Ketamine is not commonly used as an IV infusion because:

A. at (high dose, can't remember specific number) does not cause adequate anaesthesia
B. half-life greater than 80 minutes not suitable for infusion
C. H20 soluble
D. 30% emergence phenomena
E. provides analgesia, but not adequate anaesthesia

111. 14A-111 Propofol infusion for maintenance of anaesthesia is superior to Thiopentone because?

A. Higher effect site equilibration
B. Shorter t1/2β
C. Higher clearance
D. Higher Plasma Protein Binding

112. 14A-112 Following a bolus of Sodium Thiopentone

A. uptake to effect site is maximal at 90 seconds
B. Rapidly redistributed to fat
C. Equilibrates with skeletal muscle in 5-10 mins

Also recalled as: Thiopentone redistribution came up

?Something about peak concentration in the brain at 90 seconds?

113-115. ?not recalled

116. 14A-116 Ropivocaine

A. Pure R isomer
B. Isomer of bupivacaine
C. Causes more motor blockade than Bupivocaine
D. More cardiotoxic than Bupivocaine
E. Similar physicochemical properties to Bupivocaine

117. 14A-117 local anaesthetc prepared as Hydrochloride because

A. More stable in solution
B. More water soluble in acidic pH
C. Make solution isotonic
D. Shows tautomerism
E. Bacteriostatic

118. 14A-118 Which is a concentrated Amide LA

A. Dibucaine
B. Procaine
C. Tertracaine
D. procainomide

119. 14A-119 Seizures after Bupivicaine

A. ? Prolonged
B. Treated with lignocaine
C. Treated with phenytoin
D. Preceeded by drowsiness
E. Associated with hyperventilation

120. 14A-120 Treatment of endocarditis with Vancomycin

A. Gram positive and negative bacteria
B. Not as good as penicillin for methicillin sensitive staphyloccus
C. Suitable for oral outpatient Rx
D. Can be dialysed with renal failure
E. (? All/none of the above)

121-122. ?not recalled

123. 14A-123 Poorly recalled – with regard to midazolam.

A. one option referred to its tautomerism and a specific pH it would open

124. 14A-124 Poorly recalled - on side effects of dantrolene.

A. one option was regarding skeletal muscle fatigue

125. 14A-125 Side effects of suxamethonium:

A. Hypotension is secondary to histamine release
B. Bradycardia
C. Hypertension
D. Tachycardia
E. All of the above

126. 14A-126 Pre-treatment with dantrolene:

A. action on smooth muscle
B. decreased cardiac myofibril contraction
C. generalised muscle weakness

127-128. ?not recalled

129. PS07 Fluoxetine

A. Inhibits acetylcholine
B. Inhibits dopamine reuptake
C. Inhibits presynaptic uptake of serotonin
D. Increases noradrenaline uptake

130. 14A-130 The CNS effects of cocaine are.

A. Noradrenaline reuptake inhibition
B. Increases dopamine reuptake
C. Acts directly on dopamine receptors
D. No effect of cerebral vasculature

131. 14A-131 Aspirin is:

A. COX2 selective
B. bronchospasm from leukotrienes
C. cytochrome 2D6 metabolism
D. ?

140. 14A-140 Which agent does act via cAMP

A. Digoxin
B. Dopamine / dopexamine / dobutamine
C. Isoprenaline
D. Glucagon

141. NP03 The epidural space does NOT contain:

A. Fat
B. connective tissue
C. the anterior venous plexus
D. the posterior venous plexus
E. the posterior spinal artery

142. 14A-142 A substance above critical temperature:

A. exists as a solid, liquid and gas
B. exists as a liquid and gas
C. exists as a liquid and vapour
D. the latent heat of vapourisation will be zero
E. pressure does not relate to volume

143. 14A-143 Which automatically stops current when saline drips on to a powerboard:

A. Line isolation monitor
B. residual current device
C. isolated transformer
D. equipotential earthing

144. 14A-144 With respect to ventricular phase 1 repolarisation:

A. it is not as pronounced in purkinje fibers
B. it is due to intracellular potassium current
C. it is due to opening inward ion current?
D. it is not as pronounced in endocardial fibers
E. Is due to transient outward rectifying current

145. 14A-145 Production of toxic metabolites when nitric oxide is administered is greatest when:

E. administered with 80% O2
f) it is administered above 40ppm?

146. 14A-146 Almost pure beta adrenoreceptor action occurs with:

E. isoprenaline
f) Noradrenaline
g) Adrenaline
h) angiotensin 2
i) glucagon

147. 14A-147 The coaxial Bain circuit is a modification of the Mapleson:

A. A
B. B
C. C
D. D
E. E

148. 14A-148 A mobile phone is:

A. class 1 equipment
B. class 2 equipment
C. class 3 equipment
D. cardiac protected equipment
E. body protected equipment

149. NP02 The SVC is formed by the formation of:

A. the R brachiocephalic and L subclavian
B. the R brachiocephalic and L IJV
C. the L brachiocephalic and azygos vein
D. the R brachiocephalic and L brachiocephalic
E. another option of 2 veins

150. 14A-150 A pericardial effusion post insertion of a CVC is at decreased risk if the tip of the CVC is at:

A. the angle of Louis
B. the transverse sinus
C. the oblique sinus
D. T6 vertebra
E. tricuspid valve


Some questions on Thiopentone’s protein binding:

A Aspirin increase the free fraction of thiopentone

The following is not a second messenger (repeat)

A G-proteins
B ... some second messengers Ca, No, ...

Reason for adding HCl to local anaesthetics include

A. Improve solubility

Something about naltrexone..

Which agent does act via cAMP

A – some sympathomimetics
B – Dopamine / dopexamine / dobutamine
C - Digoxin
D - Isoprenaline
E - Glucagon

Factors affecting ?prolonging muscle relaxation


Something about beta blockers with sympathomimetic activity


The following volatiles increase ICP


Which is an amide LA

A. Procainamide
B. Procaine
C. ?Amethocaine / cocaine
D. Tetracaine
E. Dibucaine

Renal nervous innervations is mainly from


Something about the quicker offset of propofol vs thiopentone

A larger clearance
B shorter context sensitive plasma elimination (not called CSHT)

Noradrenalins action is first offset / terminated by

C Reputake into the nerve terminus
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