Primary MCQs-July2008

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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 |

Pharmacology

Unclassified Pharmacology

A few repeats:

  • MB 37
  • PS06

General Pharmacology

GP19 Which of the following has it's action related to a ligand gated ion channel?

A. Metoclopramide

B. Phenylephrine

C. Morphine

D. Salbutamol

E. Vecuronium


What is K elimination constant- units


Quantal dose response curves:

A. Can be used to determine potency

B. Can be used to determine efficacy

C. Can be used to determine therapeutic index

D. Can be used to deteremine the 50% effective response

E.


Chemoreceptor Trigger Zone (inaccurately remebered)

A. Not affected by drugs that cannor cross blood brain barrier ( I remembered it as: CTZ is inside blood brain barrier)

B. Receives multiple synaptic, csf and blood inputs

C. Contains dopamine and 5HT3 receptors

D. Affected by copper

E. Affected by CSF & Blood borne substance


GP31 Which of the following is not a ligand gated receptor:

A. nicotinic Ach receptor

B. alpha 2 adrenergic receptor

C. 5HT3 receptor

D. ?


Liver metabolism

A. Phase 1 – more water soluble

B. Phase 2


Something about 3 compartment kinetics

A. Effect site part of central compartment

B. Large peripheral compartment increase elimination half life


If a drug have a hepatic extraction ratio 0.7 and oral ansoprtion 0.3. What is the drug bioavailability

A. 0.09


In Healthy Elderly which is true

A. Increase vd of water soluble drug

B. Increase vd of lipid soluble drug

C. Increase lean body mass

D. Unchanged renal clearance

E. Decrease clearance of perfusion dependent drugs


Dopamine receptor

A. All G protein coupled

B. D2 via Gs

C.

Inhalational Anaesthetics

(repeat) Which of the following causes least decrease in SVR

A. Isoflurane

B. Sevoflurane

C. Desflurane

D. Enflurane

E. Halothane


Compare and contrast Isoflurane, Desflurane, Sevoflurane

A. Iso largest MW

B. Iso largest SVP

C. Iso no formation of carbon monoxide

D. All three increase CBF

E. All three uses variable bypass vapouriser


Factors decrease MAC

A. Pregnancy

B. Hypothyroid

C. Female

D. Obesity


Which of these have no effect on speed of induction of volatile

A. Obesity

B. Age

C. Cardiac output

D. paCO2

IV Anaesthetics

(repeat) Propofol

A. Faster blood/brain equilibration than Thiopentone


Ketamine

A. Is chemically related to Phencyclidine

B.

C. Is a competitive antagonist at NMDA receptors

D.

E. Is antagonised by Mg2+


(repeat) Which benzodiazepine has the longest terminal elimination half time?

A. diazepam

B. temazepam

C. lorazepam

D. oxazepam

E. flunitrazepam


(repeat) Propofol clearance is :

A. significantly decreased in liver failure

B. decreased in pregnancy

C. significantly increased in neonates

D. significantly decreased in renal failure

E. Unchanged in the elderly


Once commenced on an infusion, propofol bottle must be discarded after:

A. 6hrs

B. 12 hours

C. 16 hours

D. 24 hours

E. 30 hours

(12, 24 and 30 were definitely options) Not sure about the other two. a was definately 6hrs


The component that emulsifies propofol is:

A. Soy oil

B. Glycerol

C. Sodium metabilsulphite

D. Egg lecithin

E. ??


Propofol clearance is :

A. significantly decreased in liver failure

B. ncreased/decreased in pregnancy

C. significantly increased in neonates

D. significantly decreased in renal failure

E. Unchanged in the elderly


CVS effects of thiopentone compared to propofol

A. thiopentone is a direct negative inotrope

B. thiopentone causes a greater drop in BP (or cardiac depression)

C. thiopentone doesn't cause tachycardia

D. propofol causes greater decrease in venous return

E. propofol causes greater decrease in SVR


Thiopentone

A. thiopentone shoter onset of duration than methohexital

B. thiopentone all inactive metabolite

C. water soluble at physiological pH

D. larger vd than propofol


Midazolam

A. Less lipophilic than lorazepam

B. Formulation alkaline

C. Degradated o dismethylation

D. N demethylation


Which drug have No antiemetic activity

A. Etomidate

B. Propofol

C. Benzodiazepine

Local Anaesthetics

(newish) Adrenaline added to local anaesthetic at 1:200 000. The concentration is:

A: 50 mcg/ml

B: 5 mcg/ml

C: 0.1 mcg/ml (etc)


(repeat) Bupivacine 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


Bupivacine 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


Bupivacaine 0.5% 20mls given intravascularly over 30 sec in a 30 yo pregnant woman of 60kg. Most likey effects:

A. tinnitus and sinus tachy

B. grand mal seizure and hypotension

C. focal seizures and atrial ectopics

D. muscle twitches and AV block

E. confusion and something else


Bupivacaine

A. Toxicity probably due to sodium channel blockade in the heart

B. More toxic as evident by higher cc:cns ratio


Cocaine

A. Direct sympathetic activity

B. Strong central dopamine activity

C. Vasodilatation


Levobupivacaine and ropivacaine

A. Levo- L isomer, ropi R isomer

B. Levo hydrophilic portion confert greater potency

C. Levo hydrophobic portion confer greater potency

D. Levo amide links confer greater potency

Muscle relaxants & antagonists

(repeat) 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


Anticholinergic syndrome treated with:

A. Atropine

B. Pyridostigmine

C. Physostigmine

D. Neostigmine

E. Edrophonium


(new) In regards to AntiChE

A. Pyridostigmine has a tertiary amine

B. Onset of Edrophonium is longer than Neostigmine

C.

D.

E.


(repeat) Sarin gas

A. Causes dry, red skin

B. Anticholinergic treatment contraindicated with tachycardia

C. Pralidoxime reverse sarin gas effect by blocking the binding site receptor

D. Causes muscle fasciculation and paralysis

E. Central cholinergic syndrome

F. Physostigmine


Central anticholinesterase syndrome can be treated with: (Not sure about the "incorrect" answers, but physostigmine was definitely there

A. Pralidoxime

B. Pyridostigmine

C. Atropine

D. Glycopyrrolate

E. Physostigmine


Something similar to:

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


(Something about) Suxamethonium & plasma cholinesterase

A. Neostigmine

B. Metoclopramide

C. Procaine


2ED 95% duration till back of 25% twitch height is 12 min

A. Mivacurium

B. Suxamethonium


Which of these prolonged action of suxamethonium without interaction with plasma cholinesterase

A. Metoclopramide

B. Neostigmine

C. Chemotherapeutic

D. Magnesium


Phase 1 block

A. Initially associated with increase sodium channel permeability

B. Act by blocking the nicotinic channel


Anticholinesterase

A. Neostigmine is shorter acting than pyridostigmine

B. Edrophonium is slower onset than neostigmine

C. Edrophonium act via carbamylated enzyme

D. Pyridostigmine is a tertiary anticholinesterase

E. Quaternary anti cholinesterase have larger vd than neuromuscular blocking drug


Suxamethonium

A. Cause orbital muscle fasciculation, hence contraindicated in all ocular surgery

B. In patient with end staged renal failure the increase in potassium is not significantly more than normal patient

C. Dibucaine number higher associated with more prolong blockade

Opioids/Analgesia

Fentanyl in a dose of 30mcg/kg which is FALSE (not remembered accurately)

A. Will cause hypotension

B. Will decrease MAC by 80%

C. Decreased sympathetic output


Regarding routes of administration

A. NSAIDs as effective and with less side effects PR vs PO

B. NSAIDs are ineffective applied topically for soft tissue pain

C. morphine SC is as effective and better tolerated than IM

D. continuous opiate infusions are safe and easy to use for nursing staff

E. ?all routes of admin for NSAIDs have same side effects?


Paracetamol

A. Toxic metabolite is inactivated by conjugation with glucuronide

B. Toxic dose is 10times clinical dose

C. Analgesia, anti-inflammatory, anti pyretic


Tramadol in regards to serotonin effect- is true

A. Direct agonist

B. Partial agonist

C. Indirect agonist

D. 5HT antagonist


Serotonin syndrome

A. Encephalopathy

B. Hypotensive

C. Myocardial depression


In neonate

A. Morphine increase clearance because of higher liver blood flow

B.

Cardiovascular drugs

Question about Clonidine


Metaraminol

A. Direct alpha and beta action

B. Indirect alpha action

C. Indirect alpha and beta action


CD50 (new) Which of the following has the highest oral bioavailability

A. Metoprolol

B. Esmolol

C. Labetalol

D. Atenolol

E. Carvedilol

(F. Propanolol)


(new) Esmolol and Sotalol both have

A. Are both class III anti-arrhythmics

B. Both have 90% bioavailbility

C. Prolong QT causing torsades des pointes

D. Depress SA node and prolong AV

E. Decrease refractory period

(F. Increase effective refractory period of avn but increasing action potential)


Question about NO MOA


(new) Nitrous Oxide:

A. Inhibits methionine synthetase

B. Decreases homo-cysteine levels

C. Increases s-adenyl-methionine levels

D. A and B

E. B and C


Most important contraindication for beta blockers

A. Asthma

B. Stable Heart Failure

C. First line treatment in phaeochromocytoma

D. Hypertension in Diabetes

E. Treat ischaemic heart disease in diabetic with peripheral vascular disease


ACEi

A. Contraindicated in heart failure

B. Preferred method of treating hypertension in diabetics

C. Something about oedema


ACEi

A. Administer as prodrug to minimize cough

B. Direct decrease sympathetic outflow

C. Can cause ARF

D. Hypokalaemia


CD50 The beta blocker with the greatest bioavailability is:

A. Atenolol

B. Metoprolol

C. Sotalol

D. Labetalol

E. Carvedilol


Witnessed VF with defibrilator immediately available

A. biphasic 200J/360J/360J

B. biphasic 200J/200J/200J

C. monophasic 200J/360J/360J

D. biphasic 200J/200J/360J

E. monophasic 200J/200J/200J


CD52 Acetazolamide

A. maximum increase in urine pH 8 hours after oral dose

B. maximum safe dose causes complete absence of HCO3 reabsorption

C. maximum safe dose decreases HCO3 reabsorption (?to) 45%

D. causes hypochloremic acidosis

E. is a K sparing diuretic


(Remembered as)

A. Unconscious with atrial ectopic

B. Seizure and heart block

C. Hypotension and heart block

D. Respiratory depression


Milrinone- true except

A. Phosphodiasterase 3 inhibitor

B. In chronic CCF, increase mortality

C. Less thrombocytopenia than amirone

D. Loading dose 50mcg/kg then 0.5mcg/kg/min

E. Infusion limited by hypertension and tachycardia


Digoxin

A. Inhibit Na-K ATPase by binding to K protein

B.



Glucagons

A. Work via beta receptor in the heart

B. Stimulate catecholamine release

C. Depress insulin release from pancrease

D. Not effective in chronic hypoglycaemia


First sign of phenytoin toxicity

A. Respiratory depression

B. Nystagmus

C. Seizure

D. Coma


Phenylepherine (can cause?)

A. Mydriasis

B. hyperthermia


Adenosine

A. Depress SAN

B. Work on potassium channel to cause increase in effective period for all excitable tissue

C. Potentiate by caffeine

Miscellaneous

Warfarin

A. Depends on the time to produce new clotting factors for onset

B. Is clinically used as a racemic mixture

C. Does not cross the placenta

D. Only the R-isomer is effective (or R isomer more potent than S)

E. Inhibits prothrombin


Metoclopramide


A. Is a dopamine agonist

B. Derivative benzamide

C.

D.

E. Increases gastric emptying thorugh it's effect on H1 receptors


Regarding antiseptics

A. isopropol alcohol is sporicidal

B. isopropol alcohol penetrates protein containing organisms

C. povidine iodine is bactericidal within one minute

D. chlorhexidine is bactericidal within one minute

E. chlorhexidine is inactivated by moisterisers


Clopidogrel- is true

A. Irreversible altered the ADP receptor

B. Inactive metabolites

Statistics

Power analysis take into account the following except

A. No of patient

B. 95% CI

C. Alpha error

D. Effect size

E. Variance


(repeat) Central limit theorem (not accurately remembered)

A. In a large sample the means will approach a normal distribution

B. Something about confidence intervals

C.

D.

E.

Physiology

FROM JULY 2008

Unclassified Physiology

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


General physiology

Fluid & electrolytes

FE09 Osmotic pressure of ECF is

A. 300 mosmol/L
B. 20 mmHg ???
C. 5900 mmHg
D. ?
E. ??

Acid-base physiology

  • NEW*

pH 6.96 - pCO2 23 - HCO3 5

This ABG is consistent with

A. ?
B. ?
C. diabetic coma
D. ?
E. prolonged vomiting


  • Repeat* Pancreatic fistula with output of 1L per day and normovolaemia

a. ?

b. ?

c. hyperchloraemic metabolic acidosis

d. hypochloraemic metabolic alkalosis

e. ?

Respiratory Physiology

Resp01 Functional residual capacity

a. decreases with age

b. increases in pregnancy

c. decreases in obesity

d. ?

e. ?


Resp02 New* Rate of PaCO2 rise in breath-holding

A. 1 mmHg/min

B. 2 mmHg/min

C. 4 mmHg/min

D. 8 mmHg/min

E. 16 mmHg/min

Nunn's Ed 6 pg 160 ....pC02 rises at 3-6 mmHg/min. Hence C best answer


In asthmatics (? poorly remembered? something about dead space)

... anatomical deadspace is reduced


Transmural pressure

a. is greater at the apex

b. ?

c. ?

d. ?

e. ?

Nunn's Ed 6 pg 29 .... A is correct


  • New* Rate of PaCO2 rise in breath-holding

A. 1 mmHg/min

B. 2 mmHg/min

C. 4 mmHg/min

D. 8 mmHg/min

E. 16 mmHg/min

CVS physiology

ECG

A. ?
B. ?
C. QT interval proportional to HR
D. PR interval is atrial depolarisation to ventricular depolarisation
E. ?


  • Repeat* Hyperkalaemia causes

A. increased QT interval B. absence of P waves C. ST depression D. inverted T waves E. ?


ED21 Endothelin

A. is produced by vascular smooth muscle
B. is not found in the brain
C. cause vasodilation
D. released with vascular stretch
E. ?


  • REPEAT* Reynold's number is not affected by

a. velocity

b. diameter

c. density

d. length

e. viscosity

Renal physiology

RP01 Maximal urine pH

A. 3.0

B. 3.5

C. 4.0

D. 4.5

E. 5.0


  • new* Renal oxygen consumption

a. Is greater in the medulla than the cortex

b. ?

c. is greater than the brain per unit weight

d. ?

e. is 25ml/100g/min (whatever the correct units were)

Both A and C are correct. Reference for A, Ganong Ed 21 pg 708 and for C, Ganong Ed 21 pg 615


  • Repeat* Glycosuria is most likely to occur with

a. increase GFR and increase blood glucose concentration

b. increase GFR and decrease blood glucose concentration

c. ?

d. ?

e. ?

GI physiology

Blood & immunology

  • Repeat* Haemoglobin

a. is a large metalloprotein with a molecular weight of 169500 daltons (? can't remember if it was kDa or Da)

b. ?

c. accounts for 65-70% of total iron body stores

d. is always bound to 2,3 DPG

e. contains 4 protoporphyrin rings with 1 ferrous ion


FFP

a. does not contain factors V and VIII

b. Must be crossmatched

c. does not contain albumin

d. Contains an anticoagulant

e. does not contribute to colloid osmotic pressure


Actcois of complement (it said 'ACTCOIS' i'm guessing it meant actions)

a. phagocytosis

b. ?vasodilation

c. ?

d.

e.

Endocrine & metabolic physiology

  • NEW* The citric acid cycle does NOT produce

a. CO2

b. H+

c. NADH

d. FADH2

e. NAD


The last reaction in the electron transport chain is

a. ?

b. ?

c. 1/2 O2 + 2H+ --> H2O

d. ?

e. ?

  • Repeat* Basal metabolic rate is measured how many hours after the last meal?

a. 1 hour

b. 6 hours

c. 8 hours

d. 12 hours

e. 24 hours


  • New* Initial temperature drop under anaethesia is due to:

a. Opening of AV shunts in the skin (or something like that)

b. radiation to the theatre

c. conduction to the operating table

d. evaporation from the skin

e. ???

Neurophysiology

  • NEW* The EEG in a person with eyes closed and mind wandering would be

a. beta waves

b. theta waves

c. delta waves

d. alpha waves

e. beta and alpha waves


  • NEW* CSF

a. is reabsorbed by the choroid plexus

b. turnover rate of 6 times per day

c. is produced at 4ml/hr

d. is actively secreted

e. reabsorption is inversely proportional to CSF pressure


  • NEW* In woman in active labour

a. epidural pressure is decreased

b. CSF volume increased (??? not sure but it was something to do with CSF)

c. Gastric emptying is decreased

d. ?

e. ?


  • REPEAT* EEG changes with sleep

a. ?

b. ?

c. ?

d. beta > alpha > theta > delta

e. ?


  • New* Itch is transmitted via

a. Aalpha

b. ?Abeta

c. Adelta

d. B fibers

e. C fibers


  • Repeat* Sharp pain due to injury is transmitted by

a. Myelinated Aalpha

b. Unmyelinated Adelta

c. Fibers which carry impulses at the rate of 15m/s

d. Fibres which synapsy in the anterior horn and travel via spinothalamic tract

e. ?

Physiology of muscle & NMJ

  • NEW* Question on smooth muscle

a. ?

b. ?

c. ? No troponin in smooth muscle. contraction is mediated by calcium binding to calmodulin

d. ?

e. Something about the Fenn effect?

Maternal, foetal & neonatal physiology

Clinical measurement

  • NEW* Regarding invasive pressure monitoring

a. Systems with natural frequency of 5Hz will have a decrease in MAP

b. Overdamped will have decrease in MAP

c. Underdamped will have decrease in MAP

d. Underdamped will have decrease in diastolic BP

e. overdamped will have increase in systolic BP

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