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  • Question 1 - A 20-year-old boy took almost 25 tablets of paracetamol almost 4 hours ago....

    Incorrect

    • A 20-year-old boy took almost 25 tablets of paracetamol almost 4 hours ago. The boy is healthy and has no known comorbid or drug history.

      Out of the following metabolic pathways, which one is primarily responsible for the toxic effects of paracetamol?

      Your Answer:

      Correct Answer: N-hydroxylation

      Explanation:

      Paracetamol is predominantly metabolized in the liver by three main metabolic pathways:
      1. Glucuronidation (45-55%)
      2. Sulphate conjugation (30-35%)
      3. N-hydroxylation via the hepatic cytochrome P450 enzyme system (10-15%)

      Cytochrome P450 enzymes catalyse the oxidation of acetaminophen to the reactive metabolite N-acetyl-p-benzoquinoneimine (NAPQI). NAPQI primarily contributes to the toxic effects of acetaminophen. NAPQI is an intermediate metabolite that is further metabolized by fast conjugation with glutathione. The conjugated metabolite is then excreted in the urine as mercapturic acid. High doses of acetaminophen (overdoses) can lead to hepatic necrosis due to depleting glutathione and high binding levels of reactive metabolite (NAPQI) to important parts of liver cells.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      7
      Seconds
  • Question 2 - Which of the following side effects would you least associated with ciprofloxacin: ...

    Incorrect

    • Which of the following side effects would you least associated with ciprofloxacin:

      Your Answer:

      Correct Answer: Folate deficiency

      Explanation:

      Common side effects include diarrhoea, dizziness, headache, nausea and vomiting.
      Other adverse effects include: Tendon damage (including rupture), Seizures (in patients with and without epilepsy), QT-interval prolongation, Photosensitivity and Antibiotic-associated colitis

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds
  • Question 3 - A young male has presented to the Emergency Department with a sudden onset...

    Incorrect

    • A young male has presented to the Emergency Department with a sudden onset of severe palpitations, shortness of breath, and chest pain. A 12-lead ECG is recorded, and it shows a narrow complex tachycardia that points to a diagnosis of supraventricular tachycardia.

      Vagal manoeuvres are attempted but are unsuccessful in eliminating the arrhythmia. The next action plan is to use a drug to revert to sinus rhythm.

      Out of the following, which is the first-line treatment for supraventricular tachycardia?

      Your Answer:

      Correct Answer: Adenosine

      Explanation:

      Paroxysmal supraventricular tachycardia is an intermittent tachycardia (HR > 100 bpm) and has the following characteristics:
      1. Sudden onset/offset (Contrast with sinus tachycardia)
      2. Electrical activity originates above the ventricle (Contrast with ventricular tachycardia)
      3. Produces narrow QRS complex (<120ms) The most common cause of PSVT is Atrioventricular nodal re-entrant tachycardia (AVNRT), most common in young women with a mean age onset of 32 years old. There are recurrent episodes of palpitations, and most of the episodes spontaneously. Sometimes, some vagal manoeuvres are required:
      1. Valsalva manoeuvre
      2. immersing the face in ice-cold water
      3. carotid sinus massage.

      If PSVT keeps persisting or is causing severe symptoms, the treatment of choice is intravenous adenosine. The patient’s ECG should be continuously monitored throughout the treatment.

      The recommended doses in adults are as follows:
      – Initial dose of adenosine is 6 mg by rapid IV bolus
      – If unsuccessful, give another dose of adenosine 12 mg by rapid IV bolus
      – If unsuccessful, give a further dose of adenosine 12 mg by rapid IV bolus
      The latest ALS guidelines advocate 18 mg for the third dose, whereas the BNF/NICE guidelines advocate 12 mg.

      If adenosine fails or is contraindicated, intravenous verapamil can be used as an alternative, but it should be avoided in patients recently treated with beta-blockers.

      Synchronized electrical cardioversion will be necessary with signs of hemodynamic instability or if drug treatment has failed to restore sinus rhythm.
      Recurrent episodes of paroxysmal supraventricular tachycardia can be treated by catheter ablation or prevented with drugs such as flecainide, sotalol, diltiazem, or verapamil.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 4 - Swelling of the lips, tongue, and face is observed in a 59-year-old African-American...

    Incorrect

    • Swelling of the lips, tongue, and face is observed in a 59-year-old African-American woman. In the emergency room, she is given intramuscular adrenaline, but her symptoms do not improve. Her GP recently started her on a new medication.

      Which of the following drugs is most likely to have caused her symptoms?

      Your Answer:

      Correct Answer: Ramipril

      Explanation:

      Angiotensin-converting enzyme (ACE) inhibitors are the most common cause of drug-induced angioedema in the United Kingdom and the United States, owing to their widespread use.

      Angioedema is caused by ACE inhibitors in 0.1 to 0.7 percent of patients, with data indicating a persistent and relatively constant risk year after year. People of African descent have a five-fold higher chance of contracting the disease.

      Swelling of the lips, tongue, or face is the most common symptom, but another symptom is episodic abdominal pain due to intestinal angioedema. Itching and urticaria are noticeably absent.

      The mechanism appears to be activated complement or other pro-inflammatory cytokines like prostaglandins and histamine, which cause rapid vasodilation and oedema.

      Other medications that are less frequently linked to angioedema include:
      Angiotensin-receptor blockers (ARBs)
      Nonsteroidal anti-inflammatory drugs (NSAIDs)
      Bupropion (e.g. Zyban and Wellbutrin)
      Beta-lactam antibiotics
      Statins
      Proton pump inhibitors

      The majority of these reactions are minor and can be treated by stopping the drug and prescribing antihistamines.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 5 - Normal human immunoglobulin is mostly used to protect against which of the following...

    Incorrect

    • Normal human immunoglobulin is mostly used to protect against which of the following infectious diseases?

      Your Answer:

      Correct Answer: Measles and hepatitis A

      Explanation:

      Immune globulin IM is indicated for prophylaxis following exposure
      to hepatitis A, to prevent or modify measles (rubeola) in a
      susceptible person exposed fewer than 6 days previously,
      for susceptible household contacts of measles patients,
      particularly contacts <1 year and pregnant women without
      evidence of immunity, and to modify rubella in exposed pregnant
      women who will not consider a therapeutic abortion.

    • This question is part of the following fields:

      • Immunoglobulins And Vaccines
      • Pharmacology
      0
      Seconds
  • Question 6 - What is the primary mode of action of Enoxaparin? ...

    Incorrect

    • What is the primary mode of action of Enoxaparin?

      Your Answer:

      Correct Answer: Inhibits factor Xa

      Explanation:

      Heparin acts as an anticoagulant by enhancing the inhibition rate of clotting proteases by antithrombin III impairing normal haemostasis and inhibition of factor Xa. Low molecular weight heparins have a small effect on the activated partial thromboplastin time and strongly inhibit factor Xa. Enoxaparin is derived from porcine heparin that undergoes benzylation followed by alkaline depolymerization.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds
  • Question 7 - The functional residual capacity (FRC) will be decreased in which of the following:...

    Incorrect

    • The functional residual capacity (FRC) will be decreased in which of the following:

      Your Answer:

      Correct Answer: Pulmonary fibrosis

      Explanation:

      Factors decreasing FRC:
      Restrictive ventilatory defects e.g. pulmonary fibrosis
      Posture – lying supine
      Increased intra-abdominal pressure (e.g. obesity, pregnancy, ascites)
      Reduced muscle tone of diaphragm e.g. muscle relaxants in anaesthesia, neuromuscular disease

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      0
      Seconds
  • Question 8 - A 32-year-old female is diagnosed case of bipolar disorder and is on medication....

    Incorrect

    • A 32-year-old female is diagnosed case of bipolar disorder and is on medication. She presents to her psychiatric team with symptoms of severe depression. She is currently taking Lithium.

      Out of the following, which is TRUE regarding lithium?

      Your Answer:

      Correct Answer: It commonly causes a tremor

      Explanation:

      Lithium is the drug of choice for bipolar disorders but is commonly associated with side effects and toxicity.

      Fine hand tremor is very commonly seen and reported in as many as 50% of patients during the first week of therapy with Lithium. The tremor tends to reduce with time and is only present in around 5% of patients taking the medication two years or longer. Lithium tremors are more common with older age, presumably due to the additive effects of age-related essential tremors.

      Option The normal therapeutic range is 2.0-2.5 mmol/l: Lithium should be carefully monitored as it has a very low therapeutic index. The normal therapeutic range is 0.4-0.8 mmol/l. Levels should be checked one week after starting therapy and one week after every change in dosage. (Option Levels should be checked one month after starting therapy)

      Option It can induce hyperthyroidism: Lithium has a known effect on thyroid function. Lithium decreases the production of T4 and T3 and commonly causes hypothyroidism. More rarely, lithium causes hyperthyroidism due to thyroiditis.

      Option It can induce diabetes mellitus: Lithium can induce nephrogenic diabetes insipidus but not diabetes mellitus.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 9 - Adenosine is primarily indicated for which of the following: ...

    Incorrect

    • Adenosine is primarily indicated for which of the following:

      Your Answer:

      Correct Answer: Paroxysmal supraventricular tachycardia

      Explanation:

      Adenosine is usually the treatment of choice for terminating paroxysmal supraventricular tachycardia including those associated with accessory conduction pathways e.g. Wolff-Parkinson-White syndrome.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
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  • Question 10 - What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?...

    Incorrect

    • What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?

      Your Answer:

      Correct Answer: 10 ml of 1 in 10,000 adrenaline solution

      Explanation:

      Ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) are referred to as shockable rhythm.

      IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be administered after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter for a shockable rhythm.

      For a non-shockable rhythm, 1 mg IV adrenaline should be administered as soon as IV access is obtained, and then every 3 – 5 minutes/after alternate shocks thereafter.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds
  • Question 11 - Regarding hypertensive crises, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding hypertensive crises, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: In a hypertensive emergency, blood pressure should be reduced by 20 - 25% within 2 hours.

      Explanation:

      A hypertensive emergency is defined as severe hypertension (blood pressure ≥ 180/110 mmHg) with acute damage to the target organs. Prompt treatment with intravenous antihypertensive therapy is generally required; over the first few minutes or within 2 hours, blood pressure should be reduced by 20 – 25%. Severe hypertension without acute target organ damage is defined as hypertensive urgency.; blood pressure should be reduced gradually over 24 – 48 hours with oral antihypertensive therapy. If blood pressure is reduced too quickly in the management of hypertensive crises, there is a risk of reduced organ perfusion leading to cerebral infarction, blindness, deterioration in renal function, and myocardial ischaemia.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds
  • Question 12 - Which of the following statements is correct regarding gentamicin? ...

    Incorrect

    • Which of the following statements is correct regarding gentamicin?

      Your Answer:

      Correct Answer: Gentamicin is ineffective against anaerobic bacteria.

      Explanation:

      Gentamicin is the aminoglycoside of choice in the UK and is a parenterally administered, broad spectrum antibiotic typically used for moderate to severe gram negative infections. However, it is inactive against anaerobes. There is poor activity against haemolytic streptococci and pneumococci. It is usually given in conjunction with a penicillin or metronidazole (or both) when used for the blind treatment of undiagnosed serious infections. Nephrotoxicity and ototoxicity are the main toxic effects due to damage to the vestibulocochlear nerve (CN VIII).

      It is contraindicated in myasthenia gravis and should be used with great care in renal disease as it may result in accumulation and a higher risk of toxic side effects.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds
  • Question 13 - Regarding ampicillin, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding ampicillin, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Ampicillin may cause a widespread maculopapular rash in a patient with glandular fever.

      Explanation:

      Ampicillin is a broad-spectrum antibiotic, active against certain Gram-positive and Gram-negative organisms but is inactivated by penicillinases (similar to amoxicillin in spectrum). Ampicillin is associated with high levels of resistance, therefore it is often not appropriate for blind treatment of infection. It is principally indicated for the treatment of exacerbations of chronic bronchitis and middle ear infections, both of which may be due to Streptococcus pneumoniae and H. influenzae, and for urinary tract infections.

      Maculopapular rashes commonly occur with ampicillin (and amoxicillin) but are not usually related to true penicillin allergy. They almost always occur in patients with glandular fever; thus broad-spectrum penicillins should not be used for blind treatment of a sore throat. The risk of rash is also increased in patients with acute or chronic lymphocytic leukaemia or in cytomegalovirus infection.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
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  • Question 14 - You are reviewing a patient in the Emergency Department brought in by the...

    Incorrect

    • You are reviewing a patient in the Emergency Department brought in by the ambulance team from a burning building. After examination, you decide to intubate the patient due to laryngeal oedema. The induction agent you are planning to use is propofol.

      Which one of the following statements about this medicine is TRUE?

      Your Answer:

      Correct Answer: It decreases cardiac output by approximately 20%

      Explanation:

      Propofol is a short-acting anaesthetic that is thought to work by potentiating GABA and glycine. It induces anterograde amnesia and anaesthetic effects and is used to induce anaesthesia, outpatient surgeries and preoperative sedation. The dose for induction of anaesthesia is 1.5-2.5mg/kg. The dose for maintenance of anaesthesia is 4-12 mg/kg/hour. Following intravenous injection, propofol acts within 30 seconds and its duration of action is 5-10 minutes.

      Propofol produces a 15-25% decrease in blood pressure and systemic vascular resistance without a compensatory increase in heart rate. It is negatively inotropic and decreases cardiac output by approximately 20%.

      The main side effects of propofol are:
      Pain on injection (in up to 30%)
      Hypotension
      Transient apnoea
      Hyperventilation
      Coughing and hiccough
      Headache
      Thrombosis and phlebitis

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
      Seconds
  • Question 15 - Lidocaine's mechanism of action as a local aesthetic is as follows: ...

    Incorrect

    • Lidocaine's mechanism of action as a local aesthetic is as follows:

      Your Answer:

      Correct Answer: Blocks influx of Na+ through voltage-gated Na+ channels

      Explanation:

      Local anaesthetics prevent generation/conduction of nerve impulses by reducing sodium permeability and increasing action potential threshold; inhibits depolarization, which results in blockade of conduction

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
      Seconds
  • Question 16 - A 4-year-old girl is rushed to the Emergency Department by her grandparents after...

    Incorrect

    • A 4-year-old girl is rushed to the Emergency Department by her grandparents after swallowing some of her grandfather's Warfarin tablets. On further questioning, it turns out that she took 5 of his 3 mg tablets which he needs to take due to a history of atrial fibrillation. The child appears healthy well-oriented in time, place and person, and has normal vitals.

      What is the threshold dose of Warfarin that needs to be ingested for there to be a risk of anticoagulation?

      Your Answer:

      Correct Answer: 0.5 mg/kg

      Explanation:

      The clinical effects of Warfarin occur after a dose of greater than 0.5 mg/kg, and they will be observable 8-10 hours after consumption of the drug. The antidote used for Warfarin is Vitamin K.

      1. In low-risk cases with no apparent bleeding:
      an oral dose of 10 mg vitamin K

      2. If there is clinically significant bleeding
      an intravenous dose of 250-300 mcg/kg

      Activated charcoal:
      in cases of warfarin ingestion
      binds to it and reduces the absorption of warfarin
      the ingestion must have occurred within the last hour
      There is, however, rarely a need for the use of activated charcoal because vitamin K is such as safe and effective antidote.

      Clotting studies, including an INR, can be performed, but small children who have ingested warfarin do not require INRs or follow up if they have been treated with 10 mg vitamin K. This dose of vitamin will completely reverse the anticoagulative effects of warfarin.

      Perform INR if any of the following are present:
      1. Delayed presentation (>6 hours)
      2. Patients with symptoms or signs of anticoagulation
      3. Possible massive ingestion

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
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  • Question 17 - Which of the following bacteria is a rod-shaped, oxidase-positive, opportunistic gram-negative bacteria that...

    Incorrect

    • Which of the following bacteria is a rod-shaped, oxidase-positive, opportunistic gram-negative bacteria that can cause a catheter-related urinary tract infection (UTI)?

      Your Answer:

      Correct Answer: Pseudomonas aeruginosa

      Explanation:

      Listeria monocytogenes is a gram-positive bacteria that does not produce spores.

      Staphylococcus aureus is a gram-positive bacteria, while Candida albicans is a gram-positive yeast with a single bud.

      Among the choices, gram-negative bacteria include only Klebsiella pneumoniae and Pseudomonas aeruginosa.

      Pseudomonas aeruginosa is an oxidase-positive bacterium, while Klebsiella pneumoniae is an oxidase-negative bacterium.

      P. aeruginosa can cause urinary tract infections (UTIs) and is spread through poor hygiene or contaminated medical equipment or devices, such as catheters that haven’t been fully sterilized.

    • This question is part of the following fields:

      • Infections
      • Microbiology
      0
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  • Question 18 - Following a phone call from the microbiology consultant, you evaluate a patient who...

    Incorrect

    • Following a phone call from the microbiology consultant, you evaluate a patient who has been diagnosed with urinary sepsis. Following the results of the blood cultures, he recommends that you add gentamicin to the patient's antibiotic treatment.

      Gentamicin produces its pharmacological effect by binding to which of the following? 

      Your Answer:

      Correct Answer: The 30S subunit of the bacterial ribosome

      Explanation:

      Antibiotics with aminoglycosides, such as gentamicin, bind to the 30S subunit of the bacterial ribosome and prevent aminoacyl-tRNA from binding, preventing protein synthesis.

      They also cause mRNA misreading, resulting in the production of non-functional proteins. This last mechanism is unique to aminoglycosides, and it may explain why they are bactericidal rather than bacteriostatic, as other protein synthesis inhibitors are.

      Patients with myasthenia gravis should avoid aminoglycosides since they can disrupt neuromuscular transmission. They cross the placenta and are linked to poisoning of the 8th cranial nerve in the foetus, as well as permanent bilateral deafness.

      It is possible that they will cause deafness, although this is not a contraindication. In individuals with renal impairment, serum aminoglycoside concentrations should be closely monitored, but this is still not considered a contraindication.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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  • Question 19 - For a tachyarrhythmia caused by shock, which of the following is the first-line...

    Incorrect

    • For a tachyarrhythmia caused by shock, which of the following is the first-line treatment:

      Your Answer:

      Correct Answer: Synchronised DC shock

      Explanation:

      If there are any adverse symptoms, immediate cardioversion with synchronized DC shock is recommended. If cardioversion fails to stop the arrhythmia and the symptoms persist, amiodarone 300 mg IV over 10–20 minutes should be administered before attempting another cardioversion. The loading dosage of amiodarone is followed by a 24-hour infusion of 900 mg administered into a large vein.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
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  • Question 20 - Despite taking the oral contraceptive pill, a 29-year-old woman becomes pregnant. During a...

    Incorrect

    • Despite taking the oral contraceptive pill, a 29-year-old woman becomes pregnant. During a medication review, you discover that she is epileptic and that her antiepileptic therapy has recently been changed.

      Which of the following antiepileptics is most likely to impair the oral contraceptive pill's effectiveness?

      Your Answer:

      Correct Answer: Carbamazepine

      Explanation:

      The metabolism of ethinyl oestradiol and progestogens has been shown to be increased by enzyme-inducing antiepileptics. The oral contraceptive pill (OCP) is less effective in preventing pregnancy as a result of this increased breakdown.

      Antiepileptic drugs that induce enzymes include:
      Carbamazepine
      Phenytoin
      Phenobarbital
      Topiramate

      Antiepileptics that do not induce enzymes are unlikely to affect contraception. Non-enzyme-inducing anticonvulsants include the following:
      Clonazepam
      Gabapentin
      Levetiracetam
      Piracetam
      Sodium valproate is a type of valproate that is used to

      Lamotrigine is an antiepileptic drug that does not cause the production of enzymes. It does, however, require special consideration, unlike other non-enzyme-inducing antiepileptics. The OCP does not appear to affect epilepsy directly, but it does appear to lower lamotrigine levels in the blood. This could result in a loss of seizure control and the occurrence of seizures.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
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  • Question 21 - An 11-year-old presented to a GP with a history of headache, neck stiffness...

    Incorrect

    • An 11-year-old presented to a GP with a history of headache, neck stiffness and photophobia. On examination, HR is 122, BP is 87/42, RR is 28, SaO 2 is 95%, temperature is 39.4 o C. There is a recent petechial rash on legs and arms. The GP administered a dose of antibiotics in the prehospital setting before transferring to the Emergency Department.

      Which of these would the GP have administered?

      Your Answer:

      Correct Answer: IM benzylpenicillin 600 mg

      Explanation:

      General Practitioners are advised to give a single injection of benzylpenicillin by intravenous or intramuscular injection before transferring the patient urgently to the ED when bacterial meningitis is suspected.

      The recommended doses are:
      Infants under 1 year: 300 mg
      Children ages 1 to 9 years: 600 mg
      Children aged 10 years and over: 1.2g
      Adults: 1.2g

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
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  • Question 22 - What is the mechanism of action of penicillin antibiotics: ...

    Incorrect

    • What is the mechanism of action of penicillin antibiotics:

      Your Answer:

      Correct Answer: Inhibition of bacterial cell wall synthesis

      Explanation:

      Penicillins and the other ß-lactam antibiotics are bactericidal. They produce their antimicrobial action by preventing cross-linkage between the linear peptidoglycan polymer chains that make up the bacterial cell wall. They, therefore, inhibit cell wall synthesis.
      The integrity of the ß-lactam ring is essential for antimicrobial activity. Many bacteria (including most Staphylococci) are resistant to benzylpenicillin and phenoxymethylpenicillin because they produce enzymes (penicillinases, ß-lactamases) that open the ß-lactam ring.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
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  • Question 23 - Disease specific immunoglobulin is available for all of the following infectious diseases EXCEPT...

    Incorrect

    • Disease specific immunoglobulin is available for all of the following infectious diseases EXCEPT for:

      Your Answer:

      Correct Answer: Hepatitis A

      Explanation:

      Disease specific immunoglobulins are available for:
      hepatitis B
      rabies
      tetanus
      varicella-zoster
      Normal immunoglobulin can be used to confer protection against hepatitis A.

    • This question is part of the following fields:

      • Immunoglobulins And Vaccines
      • Pharmacology
      0
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  • Question 24 - A 60-year-old man with insulin-controlled diabetes mellitus asks you about how his ability...

    Incorrect

    • A 60-year-old man with insulin-controlled diabetes mellitus asks you about how his ability to drive is affected. He owns a car as well as a motorcycle.

      Which of the following statements about driving with diabetes under insulin control is correct?

      Your Answer:

      Correct Answer: He must monitor his blood glucose levels every 2 hours whilst driving

      Explanation:

      The DVLA sends a detailed information sheet about their licence and driving to all drivers with diabetes mellitus. The primary danger of driving while diabetic is hypoglycaemia.

      The DVLA must be notified of the following diabetic patients:
      All of the drivers are on insulin. (Licenses are being reviewed more frequently.)
      Those who are at high risk of hypoglycaemia and have had more than one episode of severe hypoglycaemia in the previous year. (Severe hypoglycaemia is defined as requiring the assistance of another person to manage.)
      Those who are unaware of their hypoglycaemia
      Anyone who has ever been in a car accident due to hypoglycaemia
      Anyone with diabetic retinopathy who needs laser treatment (to both eyes or to a second eye if sight only in one eye)
      Patients with diabetes complications that impair their ability to drive.

      To drive, drivers with insulin-treated diabetes must meet the following requirements:
      They need to be aware of hypoglycaemia.
      They must not have had more than one episode of hypoglycaemia in the previous 12 months that necessitated the assistance of another person.
      They must check their blood glucose levels no later than 2 hours before the first journey.
      While driving, they must check their blood glucose levels every two hours.
      The visual acuity and visual field standards must be met.

      Any significant changes in their condition must be reported to the DVLA. Furthermore, on days when they are not driving, group 2 licence holders must test their blood glucose twice daily using a metre that can store three months’ worth of readings.

      In addition to this advice, the DVLA also offers the following advice to diabetic patients:
      When taking tablets that have the potential to cause hypoglycaemia (such as sulfonylureas and glinides), monitoring may be necessary if there has been more than one episode of severe hypoglycaemia.
      Drivers must show good control and be able to recognise hypoglycaemia.
      Verify that your vision meets the required standard.

      If a patient feels hypoglycaemic or has a blood glucose level of less than 4.0 mmol/L, they should not drive. Driving should not be resumed until blood glucose levels have returned to normal, which should take 45 minutes.

      If there are any warning signs, patients should carry rapidly absorbed sugar in their vehicle and stop, turn off the ignition, and eat it.

      If resuscitation is required, a card stating which medications they are taking should be carried.

      If hypoglycaemia causes an accident, a diabetic driver may be charged with driving under the influence of drugs.

    • This question is part of the following fields:

      • Endocrine Pharmacology
      • Pharmacology
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  • Question 25 - Regarding antimuscarinic antispasmodics, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding antimuscarinic antispasmodics, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: They are contraindicated in paralytic ileus.

      Explanation:

      Antimuscarinics are contraindicated in paralytic ileus. Antimuscarinics reduce intestinal motility by blocking muscarinic acetylcholine receptors and relaxing smooth muscle. Hyoscine butylbromide is advocated as a gastrointestinal antispasmodic, but it is poorly absorbed and thus has limited clinical utility. Antimuscarinics cause a reduction in bronchial secretions (they can be used to this effect in palliative patients). Antispasmodics are occasionally of value in treating abdominal cramp associated with diarrhoea but they should not be used for primary treatment. Antispasmodics should be avoided in young children with gastroenteritis because they are rarely effective and have troublesome side effects.

    • This question is part of the following fields:

      • Gastrointestinal
      • Pharmacology
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  • Question 26 - A 64-year-old man presents with an acute episode of gout. He has a...

    Incorrect

    • A 64-year-old man presents with an acute episode of gout. He has a history of chronic heart failure and hypertension. His current medications include ramipril and furosemide.
      Which of the following statements regarding the treatment of gout is true? Select ONE answer only.

      Your Answer:

      Correct Answer: Colchicine has a role in prophylactic treatment

      Explanation:

      In the absence of any contra-indications, high-dose NSAIDs are the first-line treatment for acute gout. Naproxen 750 mg as a stat dose followed by 250 mg TDS is a commonly used and effective regime.
      Aspirin should not be used in gout as it reduces the urinary clearance of urate and interferes with the action of uricosuric agents. Naproxen, Diclofenac or Indomethacin are more appropriate choices.
      Allopurinol is used prophylactically, preventing future attacks by reducing serum uric acid levels. It should not be started in the acute phase as it increases the severity and duration of symptoms.
      Colchicine acts on the neutrophils, binding to tubulin to prevent neutrophil migration into the joint. It is as effective as NSAIDs in relieving acute attacks. It also has a role in prophylactic treatment if Allopurinol is not tolerated.
      NSAIDs are contra-indicated in heart failure as they can cause fluid retention and congestive cardiac failure. Colchicine is the preferred treatment in patients with heart failure or those who are intolerant of NSAIDs.

    • This question is part of the following fields:

      • Musculoskeletal Pharmacology
      • Pharmacology
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  • Question 27 - You review a 46-year-old woman who has recently been prescribed antibiotics for a...

    Incorrect

    • You review a 46-year-old woman who has recently been prescribed antibiotics for a urinary tract infection. She suffers from COPD and is currently prescribed salbutamol and Seretide inhalers, and Phyllocontin continus. Since starting the antibiotics, she has been experiencing nausea, vomiting and abdominal pain.
      Which of the following antibiotics is she MOST LIKELY to have been prescribed for her UTI? Select ONE answer only .

      Your Answer:

      Correct Answer: Ciprofloxacin

      Explanation:

      Phyllocontin continus contains aminophylline (a mixture of theophylline and ethylenediamine), a bronchodilator used in the management of COPD and asthma.
      This patient is exhibiting symptoms of theophylline toxicity, which may have been triggered by the prescription of the antibiotic. Quinolone antibiotics, such as ciprofloxacin and levofloxacin, and macrolide antibiotics, such as erythromycin, increase the plasma concentration of theophyllines and can lead to toxicity.
      The drugs that commonly affect the half-life and the plasma concentration of theophylline are summarised in the table below:
      Drugs increasing plasma concentration of theophylline
      Drugs decreasing plasma concentration of theophylline
      Calcium channel blockers, e.g. Verapamil
      Cimetidine
      Fluconazole
      Macrolides, e.g. erythromycin
      Quinolones, e.g. ciprofloxacin
      Methotrexate
      Barbiturates
      Carbamazepine
      Phenobarbitol
      Phenytoin (and fosphenytoin)
      Rifampicin
      St. John’s wort

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
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  • Question 28 - A 32-year-old woman with a history of bipolar disorder exhibits lithium toxicity symptoms.

    Which...

    Incorrect

    • A 32-year-old woman with a history of bipolar disorder exhibits lithium toxicity symptoms.

      Which of the following is the MOST LIKELY feature to be present?

      Your Answer:

      Correct Answer: Clonus

      Explanation:

      Lithium toxicity manifests itself in the following ways:
      Ataxia
      Clonus
      Coma
      Confusion
      Convulsions
      Diarrhoea
      Increased muscle tone
      Nausea and vomiting
      Nephrogenic diabetes insipidus
      Renal failure
      Tremor

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      0
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  • Question 29 - Regarding inhaled corticosteroids, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding inhaled corticosteroids, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: Lower doses of inhaled corticosteroids may be required in smokers.

      Explanation:

      Current and previous smoking reduces the effectiveness of inhaled corticosteroids and higher doses may be necessary.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      0
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  • Question 30 - Which of the following presentations is NOT consistent with the diagnosis of anaphylaxis...

    Incorrect

    • Which of the following presentations is NOT consistent with the diagnosis of anaphylaxis following exposure to a known allergen:

      Your Answer:

      Correct Answer: Generalised urticaria and angioedema alone

      Explanation:

      Anaphylaxis is characterised by sudden onset and rapidly developing, life-threatening airway, breathing and circulation problems associated with skin and/or mucosal changes. Reactions can vary greatly, from hypotension alone, to reactions with predominantly asthmatic features, to cardiac/respiratory arrest. Skin or mucosal changes may be absent or subtle in up to 20% of cases but skin or mucosal changes alone are not a sign of an anaphylactic reaction.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
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  • Question 31 - A 61-year-old patient experiences a spontaneous rupture of his Achilles tendon following a...

    Incorrect

    • A 61-year-old patient experiences a spontaneous rupture of his Achilles tendon following a course of antibiotics

      Which of the antibiotics listed below is MOST likely to be the cause? 

      Your Answer:

      Correct Answer: Ciprofloxacin

      Explanation:

      Tendinopathy and spontaneous tendon rupture are caused by fluoroquinolones, which are an uncommon but well-known cause. Tendon problems caused by fluoroquinolones are expected to affect 15 to 20 people per 100,000. Patients over the age of 60 are most likely to develop them.

      It usually affects the Achilles tendon, but it has also been described in cases involving the quadriceps, peroneus brevis, extensor pollicis longus, long head of biceps brachii, and rotator cuff tendons. The exact aetiology is uncertain, although the fluoroquinolone medication is thought to obstruct collagen activity and/or cut off blood supply to the tendon.

      Other factors linked to tendon rupture spontaneously include:
      Gout
      Treatment with corticosteroids
      Hypercholesterolaemia
      Long-term dialysis
      Kidney transplant
      Rheumatoid arthritis 

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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  • Question 32 - A 65-year-old man presents with a red, hot, swollen great toe. A diagnosis...

    Incorrect

    • A 65-year-old man presents with a red, hot, swollen great toe. A diagnosis of acute gout is made. His past medical history includes heart failure and type 2 diabetes mellitus.
      Which of the following is the most appropriate medication to use in the treatment of his gout? Select ONE answer only.

      Your Answer:

      Correct Answer: Colchicine

      Explanation:

      In the absence of any contra-indications, high-dose NSAIDs are the first-line treatment for acute gout. Naproxen 750 mg as a stat dose followed by 250 mg TDS is a commonly used and effective regime.
      Aspirin should not be used in gout as it reduces the urinary clearance of urate and interferes with the action of uricosuric agents. Naproxen, Diclofenac or Indomethacin are more appropriate choices.
      Allopurinol is used prophylactically, preventing future attacks by reducing serum uric acid levels. It should not be started in the acute phase as it increases the severity and duration of symptoms.
      Colchicine acts on the neutrophils, binding to tubulin to prevent neutrophil migration into the joint. It is as effective as NSAIDs in relieving acute attacks. It also has a role in prophylactic treatment if Allopurinol is not tolerated.
      NSAIDs are contra-indicated in heart failure as they can cause fluid retention and congestive cardiac failure. Colchicine is the preferred treatment in patients with heart failure or those who are intolerant of NSAIDs.

    • This question is part of the following fields:

      • Musculoskeletal Pharmacology
      • Pharmacology
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  • Question 33 - Which of the following is an action of glucagon: ...

    Incorrect

    • Which of the following is an action of glucagon:

      Your Answer:

      Correct Answer: Stimulates glycogenolysis

      Explanation:

      Glucagon is a peptide hormone that is produced and secreted by alpha cells of the islets of Langerhans, which are located in the endocrine portion of the pancreas. The main physiological role of glucagon is to stimulate hepatic glucose output, thereby leading to increases in glycaemia. It provides the major counter-regulatory mechanism to insulin in maintaining glucose homeostasis.
      Hypoglycaemia is the principal stimulus for the secretion of glucagon but may also be used as an antidote in beta-blocker overdose and in anaphylaxis in patients on beta-blockers that fail to respond to adrenaline.
      Glucagon then causes:
      Glycogenolysis
      Gluconeogenesis
      Lipolysis in adipose tissue
      The secretion of glucagon is also stimulated by:
      Adrenaline
      Cholecystokinin
      Arginine
      Alanine
      Acetylcholine
      The secretion of glucagon is inhibited by:
      Insulin
      Somatostatin
      Increased free fatty acids
      Increased urea production

      Glycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released by this process is used to form ATP and NADH. Glycolysis is inhibited by glucagon, and glycolysis and gluconeogenesis are reciprocally regulated so that when one cell pathway is activated, the other is inactive and vice versa.

      Glucagon has a minor effect of enhancing lipolysis in adipose tissue. Lipolysis is the breakdown of lipids and involves the hydrolysis of triglycerides into glycerol and free fatty acids. It makes fatty acids available for oxidation.

    • This question is part of the following fields:

      • Endocrine
      • Pharmacology
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  • Question 34 - A 40-year-old man complains of pain and redness in his lower thigh due...

    Incorrect

    • A 40-year-old man complains of pain and redness in his lower thigh due to an insect bite. He was diagnosed with cellulitis. Select the first-line antibiotic for cellulitis.

      Your Answer:

      Correct Answer: Flucloxacillin

      Explanation:

      Cellulitis is most commonly caused by bacteria from the group Aß-hemolytic streptococcus.

      Cellulitis can be caused by animal bites. For uncomplicated cellulitis, flucloxacillin is the first-line antibiotic. Because it is beta-lactamase stable, it is efficient against Staphylococcus aureus.

    • This question is part of the following fields:

      • Infections
      • Microbiology
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  • Question 35 - You review a sick patient in resus who has been prescribed mannitol as...

    Incorrect

    • You review a sick patient in resus who has been prescribed mannitol as part of his treatment protocol.
      Which SINGLE statement regarding mannitol is true?

      Your Answer:

      Correct Answer: It is irritant to veins and causes phlebitis

      Explanation:

      Mannitol is a low molecular weight compound and is therefore freely filtered at the glomerulus and is not reabsorbed. It, therefore, increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain barrier (BBB).
      Mannitol is primarily used to reduce the pressure and volume of cerebrospinal fluid (CSF). It decreases the volume of CSF by:
      Decreasing the rate of CSF formation,and;
      Withdrawing extracellular fluid from the brain across the BBB
      Other uses of mannitol include:
      Short-term management of glaucoma
      Treatment of rhabdomyolysis
      Preserve renal function in peri-operative jaundiced patients
      To initiate diuresis in transplanted kidneys
      Bowel preparation prior to colorectal procedures
      The recommended dose of mannitol for the reduction of CSF pressure/cerebral oedema is 0.25-2g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.
      Circulatory overload and rebound increases in intracranial pressure may occur following the use of mannitol. It is irritant to tissues and veins and can cause inflammation and phlebitis.
      Mannitol causes an expansion of the extracellular fluid space, which may worsen congestive cardiac failure. Contraindications to the use of mannitol include:
      Anuria
      Intracranial bleeding (except during craniotomy)
      Severe cardiac failure
      Severe dehydration
      Severe pulmonary oedema

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 36 - A 56-year-old female visits her cardiologist complaining of a condition that has started...

    Incorrect

    • A 56-year-old female visits her cardiologist complaining of a condition that has started since he started her on amiodarone for atrial arrhythmia. The cardiologist recognised that she is experiencing a side effect of amiodarone.

      Which one of the following conditions will this woman NOT have?

      Your Answer:

      Correct Answer: Xanthopsia

      Explanation:

      Amiodarone is a class III potassium channel blocker used to treat multiple types of arrhythmias.

      Side effects include:
      1. pulmonary fibrosis
      2. blue discolouration of the skin
      3. phototoxicity
      4. corneal deposits
      5. hepatic necrosis
      6. thyroid dysfunction
      7. sleep disturbances
      8. peripheral neuropathy.

      Xanthopsia is a condition where the patient complains of seeing yellow lines and is seen in digoxin overdose.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 37 - The functional residual capacity (FRC) will be increased in which of the following:...

    Incorrect

    • The functional residual capacity (FRC) will be increased in which of the following:

      Your Answer:

      Correct Answer: Emphysema

      Explanation:

      Factors increasing FRC:
      Emphysema
      Air trapping in asthma
      Ageing (due to loss of elastic properties)
      Increasing height of patient

    • This question is part of the following fields:

      • Physiology
      • Respiratory
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  • Question 38 - You examine a 79-year-old woman who has had hypertension and atrial fibrillation in...

    Incorrect

    • You examine a 79-year-old woman who has had hypertension and atrial fibrillation in the past. Her most recent blood tests show that she has severe renal impairment.

      Which medication adjustments should you make in this patient's case?

      Your Answer:

      Correct Answer: Reduce dose of digoxin

      Explanation:

      Digoxin is excreted through the kidneys, and impaired renal function can lead to elevated digoxin levels and toxicity.
      The patient’s digoxin dose should be reduced in this case, and their digoxin level and electrolytes should be closely monitored.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
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  • Question 39 - A 30-year-old patient has a mild exacerbation of his asthma. His steroid inhaler...

    Incorrect

    • A 30-year-old patient has a mild exacerbation of his asthma. His steroid inhaler ran out a couple of weeks ago, and he has not replaced it.

      Which of these statements describes the mechanism of action of corticosteroids in asthma?

      Your Answer:

      Correct Answer: Reduction of bronchial inflammation

      Explanation:

      Inhaled corticosteroids suppresses airway inflammation seen in asthma by downregulating pro-inflammatory proteins.
      They also appear to reverse components of asthma-induced structural changes (airway remodelling), including increased vascularity of the bronchial wall.
      Corticosteroids reduces the number of inflammatory cells (eosinophils, T lymphocytes, mast cells, and dendritic cells) in the airways.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
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  • Question 40 - The patients listed below have had wounds or injuries and were treated as...

    Incorrect

    • The patients listed below have had wounds or injuries and were treated as described in a local walk-in clinic.

      Which of the following patients has had adequate tetanus protection?

      Your Answer:

      Correct Answer: 80-year-old diabetic, a rusty nail went through his shoe and into his foot when walking in the woods, uncertain of vaccination history - receives vaccination and immunoglobulin

      Explanation:

      25-year-old receives immunoglobulin and vaccination after cutting her hand on a drinking glass and not knowing her vaccination history.

      Because this is not a tetanus-prone wound, immunoglobulin is not recommended. Because you can’t be sure about her vaccination history, now is the best time to start a tetanus vaccination course to ensure coverage later in life. The first vaccination should be administered at the time of presentation; the patient’s own GP should then review the patient’s vaccination history and schedule the rest of the course as needed.

      8-year-old whose hand was cut with a kitchen knife, received her first round of vaccinations as a baby and a booster at the age of four – receives vaccination:
      The tetanus vaccinations for this child are up to date, and the next booster should not be given too soon. Immunoglobulin is not required because this is not a tetanus-prone wound.

      80-year-old diabetic, a rusty nail went through his shoe and into his foot while walking in the woods, and he was uncertain of his vaccination history – he received vaccination and immunoglobulin:
      A tetanus vaccination course may not have been completed by an 80-year-old UK resident (the vaccination was introduced in 1961). The vaccination should be given at a walk-in clinic, and the patient’s own GP should be contacted to confirm vaccination history and to schedule the rest of the course as needed. Because this is a tetanus-prone wound (puncture wound and potential soil contact), immunoglobulin would be recommended in a patient with incomplete tetanus vaccinations.

      A 28-year-old Polish man cuts his leg while working in the garden, the wound is heavily contaminated with soil, and his vaccination history is unknown – he receives vaccination:
      In a patient with an unknown vaccination history, this is a tetanus-prone wound. In this case, the best course of action would be to administer both the vaccination and immunoglobulin at the walk-in clinic, then contact the patient’s own GP to check his or her vaccination history and schedule the rest of the course as needed.

      30-year-old with a large amount of devitalized tissue in the torso from an electrical burn – has had all vaccinations, so no need for vaccination or immunoglobulin:
      Because this is a high-risk tetanus wound (with a lot of devitalized tissue), even if the patient has had a full course of vaccinations in the past, immunoglobulin is recommended. There is no need for any additional vaccinations.

    • This question is part of the following fields:

      • Immunological Products & Vaccines
      • Pharmacology
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  • Question 41 - You've been summoned to a young man in the resus area who is...

    Incorrect

    • You've been summoned to a young man in the resus area who is experiencing an SVT. You decide to use adenosine after trying several vagal manoeuvres without success.

      Which of the following is the correct adenosine mechanism of action?

      Your Answer:

      Correct Answer: Opens K + channels in the heart

      Explanation:

      The purine nucleoside adenosine is used to diagnose and treat paroxysmal supraventricular tachycardia. Adenosine works by stimulating A1-adenosine receptors and opening potassium channels that are sensitive to acetylcholine. This causes the atrioventricular (AV) node’s cell membrane to become hyperpolarized, slowing conduction by inhibiting calcium channels.
      Patients who have had a heart transplant are extremely sensitive to the effects of adenosine and should start with a lower dose of 3 mg, then 6 mg, and finally 12 mg.

      Dipyridamole potentiates the effects of adenosine, so it should be used with caution in patients who are taking it.

      The use of adenosine is contraindicated in the following situations:
      Asthma
      COPD (chronic obstructive pulmonary disease)
      Decompensated heart failure 
      Long QT syndrome
      AV block in the second or third degree
      Sinusitis is a condition in which the sinuses become (unless pacemaker fitted)
      Hypotension that is severe

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 42 - Which of the following does NOT predispose to digoxin toxicity in a patient...

    Incorrect

    • Which of the following does NOT predispose to digoxin toxicity in a patient taking digoxin:

      Your Answer:

      Correct Answer: Hyponatraemia

      Explanation:

      Hypoxia, hypercalcaemia, hypokalaemia and hypomagnesaemia predispose to digoxin toxicity. Care should also be taken in the elderly who are particularly susceptible to digoxin toxicity. Hypokalaemia may be precipitated by use of diuretics. Although hyponatremia can result in the development of other pathological disturbances, it does not potentiate digoxin toxicity.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
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  • Question 43 - Regarding paracetamol, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding paracetamol, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: It has anti-pyretic action.

      Explanation:

      Paracetamol is a non-opioid analgesic, similar in efficacy to aspirin, with antipyretic properties but no anti-inflammatory properties. It is well absorbed orally and does not cause gastric irritation. Paracetamol is a suitable first-line choice for most people with mild-to-moderate pain, and for combination therapy.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      0
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  • Question 44 - Which of the following is an adverse effect of carbamazepine: ...

    Incorrect

    • Which of the following is an adverse effect of carbamazepine:

      Your Answer:

      Correct Answer: Aplastic anaemia

      Explanation:

      Common adverse effects include nausea and vomiting, sedation, dizziness, headache, blurred vision and ataxia. These adverse effects are dose related and are most common at the start of treatment.
      Other adverse effects include:
      Allergic skin reactions (and rarely, more serious dermatological conditions)
      Hyponatraemia (avoid concomitant use with diuretics)
      Leucopenia, thrombocytopenia and other blood disorders including aplastic anaemia
      Hepatic impairment

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      0
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  • Question 45 - All of the following cause bronchodilation, EXCEPT for: ...

    Incorrect

    • All of the following cause bronchodilation, EXCEPT for:

      Your Answer:

      Correct Answer: Stimulation of irritant receptors

      Explanation:

      Factors causing bronchodilation: Via beta2-adrenoceptors
      Sympathetic stimulation:
      Adrenaline (epinephrine)
      Beta2-adrenergic agonists e.g. salbutamol
      Anticholinergic and muscarinic antagonists e.g. ipratropium

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      0
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  • Question 46 - An 82 year old man taking warfarin as a maintenance medication comes in...

    Incorrect

    • An 82 year old man taking warfarin as a maintenance medication comes in to your clinic because of an infection. Which antibiotic is the safest choice for this patient?

      Your Answer:

      Correct Answer: Cefalexin

      Explanation:

      Alterations in the international normalized ratio (INR) brought about by the concurrent use of antibiotics and warfarin may result in either excessive clotting or excessive bleeding if they are deemed to have a high risk for interaction. As such, there should be careful consideration of the class of antibiotic to be used.

      Antibiotics from the following drug classes should generally be avoided as they have a high risk for interaction with warfarin, possible enhancing the anticoagulant effects of warfarin resulting in bleeding: Fluoroquinolones (e.g. ciprofloxacin, levofloxacin), Macrolides (e.g. clarithromycin, erythromycin, azithromycin), Nitroimidazoles (e.g. metronidazole), Sulphonamides (e.g. co-trimoxazole, a combination of trimethoprim and sulfamethoxazole), Trimethoprim, Tetracyclines (e.g. doxycycline).

      Low risk antibiotics that have low risk for interaction with warfarin includes cephalexin, from the cephalosporin class, and clindamycin which is a lincomycin.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
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  • Question 47 - Which of the following is a common adverse effect of glucagon: ...

    Incorrect

    • Which of the following is a common adverse effect of glucagon:

      Your Answer:

      Correct Answer: Nausea

      Explanation:

      Adverse effects include:
      Common: Nausea
      Uncommon: Vomiting
      Rare: Abdominal pain, hypertension, hypotension, tachycardia

    • This question is part of the following fields:

      • Endocrine
      • Pharmacology
      0
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  • Question 48 - Regarding macrolide antibiotics, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding macrolide antibiotics, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Macrolides are first line for treatment of whooping cough.

      Explanation:

      A macrolide antibiotic is recommended first line for whooping cough (if onset of cough is within the previous 21 days)
      Prescribe clarithromycin for infants less than 1 month of age.
      Prescribe azithromycin or clarithromycin for children aged 1 month or older, and non-pregnant adults.
      Prescribe erythromycin for pregnant women.
      Macrolides interfere with bacterial protein synthesis and are mainly active against Gram-positive organisms. They have a similar antibacterial spectrum to penicillin and are thus a useful alternative in penicillin-allergic patients. Erythromycin is commonly associated with gastrointestinal upset.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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  • Question 49 - Captopril should not be used if you have any of the following conditions:...

    Incorrect

    • Captopril should not be used if you have any of the following conditions:

      Your Answer:

      Correct Answer: Renal artery stenosis

      Explanation:

      Contraindications indications of Captopril include:
      – Bilateral renal artery stenosis
      – Hypersensitivity to ACE inhibitors
      – Anuria
      – History of ACEI-induced angioedema
      – Hereditary or idiopathic angioedema
      – Co-administration of Neprilysin inhibitors (e.g., sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hours of switching to or from sacubitril/valsartan.
      If ACE inhibitors are used, they should be initiated only under specialist supervision and renal function should be monitored regularly. ACE inhibitors should also be used with particular caution in patients who may have undiagnosed and clinically silent renovascular disease. This includes patients with peripheral vascular disease or those with severe generalised atherosclerosis.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 50 - You review a 34-year-old man with lower back pain and plan to prescribe...

    Incorrect

    • You review a 34-year-old man with lower back pain and plan to prescribe him ibuprofen and codeine phosphate. His only past medical history of note is depression, for which he takes fluoxetine.
      Which of the following scenarios would prompt you to consider the co-prescription of a PPI for gastro-protection? Select ONE answer only.

      Your Answer:

      Correct Answer: Co-prescription of fluoxetine

      Explanation:

      Patients at risk of gastro-intestinal ulceration (including the elderly) who need NSAID treatment should receive gastroprotective treatment. The current recommendations by NICE suggest that gastro-protection should be considered if patients have ≥1 of the following:
      Using maximum recommended dose of an NSAID
      Aged 65 or older
      History of peptic ulcer or GI bleeding
      Concomitant use of medications that increase risk:
      Low dose aspirin
      Anticoagulants
      Corticosteroids
      Anti-depressants including SSRIs and SNRIs
      Requirements for prolonged NSAID usage:
      Patients with OA or RA at any age
      Long-term back pain if older than 45
      It is suggested that if required, either omeprazole 20 mg daily or lansoprazole 15-30 mg daily should be the PPIs of choice.
      This patient is on 400 mg of ibuprofen TDS, but the maximum recommended dose of ibuprofen is 2.4 g daily. Co-prescription of codeine, raised BMI, and a family history of peptic ulceration would also not prompt gastro-protection.

    • This question is part of the following fields:

      • Musculoskeletal Pharmacology
      • Pharmacology
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  • Question 51 - Regarding alteplase, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding alteplase, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: Alteplase is commonly associated with hypotensive effects.

      Explanation:

      Alteplase is a recombinant tissue-type plasminogen activator (tPA), a naturally occurring fibrin-specific enzyme that has selectivity for activation of fibrin-bound plasminogen. It has a short half-life of 3 – 4  minutes and must be given by continuous intravenous infusion but is not associated with antigenic or hypotensive effects, and can be used in patients when recent streptococcal infections or recent use of streptokinase contraindicates the use of streptokinase.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
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  • Question 52 - Which of the following antibiotics may be used for malaria prophylaxis: ...

    Incorrect

    • Which of the following antibiotics may be used for malaria prophylaxis:

      Your Answer:

      Correct Answer: Doxycycline

      Explanation:

      Doxycycline may be used for malaria prophylaxis and as an adjunct to quinine in the treatment of Plasmodium falciparum malaria.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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  • Question 53 - You're evaluating a 37-year-old woman who is 12 weeks pregnant. She has experienced...

    Incorrect

    • You're evaluating a 37-year-old woman who is 12 weeks pregnant. She has experienced vaginal bleeding.

      Which of the following anti-D statements is correct?

      Your Answer:

      Correct Answer: Routine antenatal prophylaxis is recommended for RhD negative women at 28 and 34 weeks

      Explanation:

      Anti-D is an IgG antibody that targets the antigen Rhesus D (RhD). Plasma from rhesus-negative donors who have been immunised against the anti-D-antigen is used to make anti-D immunoglobulin.

      Only RhD negative women are given Anti-D Ig. Women who are RhD negative do not have the RhD antigen on their RBC. If a foetus has the RhD antigen (i.e. is RhD positive) and the mother is exposed to foetal blood, she may develop antibodies to RhD that pass through the placenta and attack foetal red cells (resulting in newborn haemolytic disease). Anti-D is given to bind and neutralise foetal red cells in the maternal circulation before an immune response is triggered. In the event of a sensitising event, 500 IU Anti-D Ig should be administered intramuscularly.

      The following are examples of potentially sensitising events:
      Birth
      Haemorrhage during pregnancy
      Miscarriage
      Ectopic pregnancy
      Death within the womb
      Amniocentesis
      Chorionic villus sampling
      Trauma to the abdomen

      The sooner anti-D is given in the event of a sensitising event, the better; however, it is most effective within 72 hours, and the BNF states that it is still likely to have some benefit if given outside of this time frame.

      At 28 and 34 weeks, RhD negative women should receive routine antenatal prophylaxis. This is regardless of whether they have previously received Anti-D for a sensitising event during the same pregnancy.

      Prophylactic anti-D is not necessary before 12 weeks gestation, as confirmed by scan, in uncomplicated miscarriage (where the uterus is not instrumented), or mild, painless vaginal bleeding, as the risk of foeto-maternal haemorrhage (FMH) is negligible. In cases of therapeutic termination of pregnancy, whether by surgical or medical means, 250 IU of prophylactic anti-D immunoglobulin should be given to confirmed RhD negative women who are not known to be RhD sensitised.

    • This question is part of the following fields:

      • Immunological Products & Vaccines
      • Pharmacology
      0
      Seconds
  • Question 54 - Naloxone is a reversal agent for which of the following groups of drugs:...

    Incorrect

    • Naloxone is a reversal agent for which of the following groups of drugs:

      Your Answer:

      Correct Answer: Opioids

      Explanation:

      Naloxone is a specific antagonist of mu(μ)-opioid receptors, the specific antidote for opioid overdose and will reverse respiratory depression and coma if given at sufficient dosage. The initial dose is usually 0.8 mg (2 mL) intravenously (the dose range suggested by BNF is 0.4-2 mg). It can also be given by intramuscular injection if the intravenous route is not feasible.
      As naloxone has a shorter duration of action than most opioids, close monitoring and repeated injections are necessary according to the respiratory rate and depth of coma. The dose is generally repeated every 2-3 minutes to a maximum of 10 mg. When repeated doses are needed, naloxone may be given by a continuous infusion adjusted according to the vital signs. Initially, the infusion rate can be set at 60% of the initial resuscitative IV dose per hour.
      In opioid addicts, naloxone administration may precipitate a withdrawal syndrome with abdominal cramps, nausea and diarrhoea, but these usually settle within 2 hours.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
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  • Question 55 - You're taking a history of a 59-year-old banker who has had heartburn in...

    Incorrect

    • You're taking a history of a 59-year-old banker who has had heartburn in the past.

      Which of the following information about antacids is correct?

      Your Answer:

      Correct Answer: Magnesium carbonate can reduce the absorption of drugs taken at the same time

      Explanation:

      Antacids such as aluminium hydroxide and magnesium carbonate are commonly used. They’re both water-insoluble and can reduce the absorption of drugs taken together. Allow at least 1-2 hours between taking these antacids and any other medications.

      Because it reduces gastrointestinal phosphate absorption, aluminium hydroxide can also be used to treat hyperphosphatemia in patients with renal failure.

      Magnesium carbonate has a laxative effect, whereas aluminium hydroxide has a constipating effect.

    • This question is part of the following fields:

      • Gastrointestinal Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 56 - Approximately how long is the duration of a lidocaine block (when given with...

    Incorrect

    • Approximately how long is the duration of a lidocaine block (when given with adrenaline):

      Your Answer:

      Correct Answer: 90 minutes

      Explanation:

      Lidocaine is a tertiary amine that is primarily used as a local anaesthetic but can also be used intravenously in the treatment of ventricular dysrhythmias.
      Lidocaine works as a local anaesthetic by diffusing in its uncharged base form through neural sheaths and the axonal membrane to the internal surface of the cell membrane sodium channels. Here it alters signal conduction by blocking the fast voltage-gated sodium channels. With sufficient blockage, the membrane of the postsynaptic neuron will not depolarise and will be unable to transmit an action potential, thereby preventing the transmission of pain signals.
      Each 1 ml of plain 1% lidocaine solution contains 10 mg of lidocaine hydrochloride. The maximum safe dose of plain lidocaine is 3 mg/kg. When administered with adrenaline 1:200,000, the maximum safe dose is 7 mg/kg. Because of the risk of vasoconstriction and tissue necrosis, lidocaine should not be used in combination with adrenaline in extremities such as fingers, toes, and the nose.
      The half-life of lidocaine is 1.5-2 hours. Its onset of action is rapid within a few minutes, and it has a duration of action of 30-60 minutes when used alone. Its duration of action is prolonged by co-administration with adrenaline (about 90 minutes).
      Lidocaine tends to cause vasodilatation when used locally. This is believed to be due mainly to the inhibition of action potentials via sodium channel blocking in vasoconstrictor sympathetic nerves.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
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  • Question 57 - A 60-year-old male presents to the genitourinary clinic with dysuria and urinary frequency...

    Incorrect

    • A 60-year-old male presents to the genitourinary clinic with dysuria and urinary frequency complaints. He has a past medical history of benign prostate enlargement, for which he has been taking tamsulosin.

      There is blood, protein, leucocytes, and nitrites on a urine dipstick. Fresh blood tests were sent, and his estimated GFR is calculated to be >60 ml/minute.

      A urinary tract infection (UTI) diagnosis is made, and he is prescribed antibiotics.

      Out of the following, which antibiotic is most appropriate to be prescribed to this patient?

      Your Answer:

      Correct Answer: Nitrofurantoin

      Explanation:

      The NICE guidelines for men with lower UTIs are:
      1. Prescribe an antibiotic immediately, taking into account the previous urine culture and susceptibility results or avoiding antibiotics used previously that may have caused resistance
      2. Obtain a midstream urine sample before starting antibiotics and send for urine culture and susceptibility
      – Review the choice of antibiotic when the results are available AND
      – change the antibiotic according to susceptibility results if the bacteria are resistant and symptoms are not improving, using a narrow-spectrum antibiotic wherever possible

      The first choice of antibiotics for men with lower UTIs is:
      1. Trimethoprim
      200 mg PO BD for seven days
      2. Nitrofurantoin
      100 mg modified-release PO BD for 3 days – if eGFR >45 ml/minute

      In men whose symptoms have not responded to a first-choice antibiotic, alternative diagnoses (such as acute pyelonephritis or acute prostatitis) should be considered. Second-choice antibiotics should be based on recent culture and susceptibility results.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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  • Question 58 - You're in resus with a 69-year-old woman who is very sick. You decide...

    Incorrect

    • You're in resus with a 69-year-old woman who is very sick. You decide to contact the intensive care outreach team because she appears to be in septic shock. They decide to start a dobutamine infusion as soon as they arrive.

      Which of the following statements about dobutamine is correct?

      Your Answer:

      Correct Answer: It may be infused via a peripheral line

      Explanation:

      Dobutamine is a synthetic isoprenaline derivative that is used to provide inotropic support to patients with low cardiac output caused by septic shock, myocardial infarction, or other cardiac conditions.

      Dobutamine is a sympathomimetic drug that stimulates beta-1 adrenergic receptors in the heart to produce its primary effect. As a result, it has inotropic properties that increase cardiac contractility and output. It also has a small amount of alpha1- and beta-2-adrenergic activity.

      It is infused intravenously after being diluted to a volume of at least 50 ml in a suitable crystalloid solution. The dose is titrated to response and ranges from 0.5 to 40 g/kg/min. Extravasation-induced skin necrosis is uncommon, and dobutamine can be administered through a peripheral line.

      At doses below 10 g/kg/min, side effects are rare, but at higher doses, they can include:
      Nausea and vomiting
      Tachycardia
      Dysrhythmias
      Angina
      Hypertension
      Headache

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 59 - An elderly patient presents to ED following a fall after feeling light headed...

    Incorrect

    • An elderly patient presents to ED following a fall after feeling light headed when standing up. You are reviewing his medication and note that he is taking a high dose of furosemide. Loop diuretics act primarily at which of the following sites in the nephron:

      Your Answer:

      Correct Answer: Thick ascending limb

      Explanation:

      Loop diuretics inhibit the Na+/K+/2Cl- symporter on the luminal membrane in the thick ascending limb of the loop of Henle, thus preventing reabsorption of NaCl and water. These agents reduce reabsorption of Cl- and Na+ and increase Ca2+ excretion and loss of K+ and Mg2+.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds
  • Question 60 - A young pregnant woman is in the late stages of her pregnancy. She...

    Incorrect

    • A young pregnant woman is in the late stages of her pregnancy. She is administered a drug that results in her newborn being born with respiratory depression. The baby also suffers from neonatal withdrawal syndrome.

      Out of the following, which drug is most likely responsible for the baby's condition?

      Your Answer:

      Correct Answer: Diazepam

      Explanation:

      Benzodiazepines are used as a first-line treatment in breaking seizures and in status epilepticus as they are rapid-acting.

      Use of benzodiazepines in the late third-trimester or exposure during labour is associated with great risks to the foetus/neonate. Babies can exhibit either floppy infant syndrome, or marked neonatal withdrawal symptoms. Symptoms vary from mild sedation, hypotonia, and reluctance to suck, to apnoeic spells, cyanosis, and impaired metabolic responses to cold stress. These symptoms have been reported to persist for periods from hours to months after birth.

      They also cross into breast milk and should be used with caution in breastfeeding mothers

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
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  • Question 61 - You're examining a 58-year-old male who has cellulitis in his left leg. Because...

    Incorrect

    • You're examining a 58-year-old male who has cellulitis in his left leg. Because he is allergic to penicillin, you start him on erythromycin.

      Which of the following statements about erythromycin is correct?

      Your Answer:

      Correct Answer: It can be used to treat Legionnaire’s disease

      Explanation:

      Bacteriostatic antibiotics include erythromycin and other macrolide antibiotics. They work by attaching to the bacterial ribosome’s 50S subunit, preventing translocation and thereby protein synthesis. Macrolide antibiotics are actively concentrated inside leukocytes and delivered to the infection site as a result.

      Erythromycin is an orally active antibiotic that can also be given intravenously. It is metabolized in the liver and eliminated in the bile and has a biological half-life of 1.5 hours.

      It has a similar antibacterial spectrum to benzylpenicillin (i.e., a narrow spectrum, primarily against Gram-positive pathogens) and can be used as a penicillin substitute in people who are allergic to penicillin.
      Erythromycin is unsuccessful in the treatment of meningitis because it does not penetrate the central nervous system well enough. It is efficient against a variety of unusual pathogens, unlike penicillin.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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  • Question 62 - A 73-year-old woman arrives at the emergency department 48 hours after being discharged from...

    Incorrect

    • A 73-year-old woman arrives at the emergency department 48 hours after being discharged from the hospital after a two-week stay for sepsis treatment. She has fever, productive cough with thick green sputum, and shortness of breath. An X-ray shows left lower lobe pneumonia. Which of the bacteria listed below is more likely to be the causative agent:

      Your Answer:

      Correct Answer: Pseudomonas aeruginosa

      Explanation:

      Hospital-acquired pneumonia (HAP), or nosocomial pneumonia, is a lower respiratory infection that was not incubating at the time of hospital admission and that presents clinically 2 or more days after hospitalization. Pneumonia that presents sooner should be regarded as community­ acquired pneumonia. VAP refers to nosocomial pneumonia that develops among patients on ventilators. Ventilator-associated pneumonia (VAP) is defined as pneumonia that presents more than 48 hours after endotracheal intubation.

      Common bacteria involved in hospital-acquired pneumonia (HAP) include the following [10] :
      Pseudomonas Aeruginosa
      Staphylococcus aureus, including methicillin-susceptible S aureus (MSSA) and methicillin-resistant S aureus (MRSA)
      Klebsiella pneumoniae
      Escherichia coli

    • This question is part of the following fields:

      • Infections
      • Microbiology
      0
      Seconds
  • Question 63 - Regarding oral rehydration therapy, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding oral rehydration therapy, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: Oral rehydration solutions should be slightly hyperosmolar.

      Explanation:

      Oral rehydration therapy (ORT) is a fluid replacement strategy used to prevent or treat dehydration. It is less invasive than other strategies for fluid replacement and has successfully lowered the mortality rate of diarrhoea in developing countries. Oral rehydration solutions should be slightly hypo-osmolar (about 250 mmol/litre) to prevent the possible induction of osmotic diarrhoea.
      ORT contains glucose (e.g. 90 mmol/L in dioralyte). The addition of glucose improves sodium and water absorption in the bowel and prevents hypoglycaemia. It also contains essential mineral salts.
      Current NICE guidance recommends that 50 ml/kg is given over 4 hours for the treatment of mild dehydration.
      Once rehydrated, a child should continue with their usual daily fluid intake plus 200 ml ORT after each loose stool. In an infant, give ORT at 1-1.5 x the normal feed volume and in an adult, give 200-400 ml after each loose stool.

    • This question is part of the following fields:

      • Fluids And Electrolytes
      • Pharmacology
      0
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  • Question 64 - A 66-year-old female who is a known case of atrial fibrillation comes to...

    Incorrect

    • A 66-year-old female who is a known case of atrial fibrillation comes to the Emergency Department with the complaint of fever and vomiting for the past two days. When her medical chart is reviewed, you see that she takes Warfarin for her arrhythmia.

      Which ONE of the following medications cannot be prescribed to this patient?

      Your Answer:

      Correct Answer: Ibuprofen

      Explanation:

      Like other non-steroidal anti-inflammatory drugs, Ibuprofen cannot be given with Warfarin as it would increase the bleeding risk of this patient.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 65 - Which of the following side effects is most likely caused by erythromycin: ...

    Incorrect

    • Which of the following side effects is most likely caused by erythromycin:

      Your Answer:

      Correct Answer: QT - prolongation

      Explanation:

      The side effects of erythromycin include abdominal pain, anaphylaxis,
      cholestatic hepatitis, confusion,
      diarrhoea, dyspepsia, fever, flatulence, hallucinations, hearing loss,
      headache, hypertrophic pyloric stenosis, hypotension, Interstitial
      nephritis, mild allergic reactions, nausea, nervous system effects,
      including seizures, pain, pruritus, pseudomembranous colitis,
      QT prolongation, rash, skin eruptions, tinnitus, urticaria,
      ventricular arrhythmias, ventricular tachycardia, vertigo, vomiting

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds
  • Question 66 - A 25-year-old patient requires procedural sedation for reduction of an open fracture of...

    Incorrect

    • A 25-year-old patient requires procedural sedation for reduction of an open fracture of his tibia and fibula. You plan on using ketamine as the sedative agent.
      Ketamine works as a result of action on what type of receptor? Select ONE answer only.

      Your Answer:

      Correct Answer: N-methyl-D-aspartate (NMDA)

      Explanation:

      Ketamine is the only anaesthetic agent available that has analgesic, hypnotic, and amnesic properties. When used correctly it is a very useful and versatile drug.
      Ketamine acts by non-competitive antagonism of the NMDA receptor Ca2+ channel pore and also inhibits NMDA receptor activity by interaction with the phencyclidine binding site.
      Ketamine can be used intravenously and intramuscularly. The intramuscular dose is 10 mg/kg, and when used by this route, it acts within 2-8 minutes and has a duration of action of 10-20 minutes. The intravenous dose is 1.5-2 mg/kg administered over a period of 60 seconds. When used intravenously, it acts within 30 seconds and has a duration of action of 5-10 minutes. Ketamine is also effective when administered orally, rectally, and nasally.
      Ketamine causes tachycardia, an increase in blood pressure, central venous pressure, and cardiac output, secondary to an increase in sympathetic tone. Baroreceptor function is well maintained, and arrhythmias are uncommon.
      The main disadvantage to the use of ketamine is the high incidence of hallucinations, nightmares, and other transient psychotic effects. These can be reduced by the co-administration of a benzodiazepine, such as diazepam or midazolam.
      The main side effects of ketamine are:
      Nausea and vomiting
      Hypertension
      Nystagmus
      Diplopia
      Rash

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
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  • Question 67 - An ambulance transports a 37-year-old woman who is having a seizure. She is...

    Incorrect

    • An ambulance transports a 37-year-old woman who is having a seizure. She is moved to resuscitation and given a benzodiazepine dose, which quickly ends the seizure. You later learn that she has epilepsy and is usually treated with carbamazepine to control her seizures.

      What is carbamazepine's main mechanism of action?

      Your Answer:

      Correct Answer: Sodium channel blocker

      Explanation:

      Carbamazepine is primarily used to treat epilepsy, and it is effective for both focal and generalised seizures. It is not, however, effective in the treatment of absence or myoclonic seizures. It’s also commonly used to treat neuropathic pain, as well as a second-line treatment for bipolar disorder and as a supplement for acute alcohol withdrawal.

      Carbamazepine works as a sodium channel blocker that preferentially binds to voltage-gated sodium channels in their inactive state. This prevents an action potential from firing repeatedly and continuously.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      0
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  • Question 68 - Which of the following has the most potent glucocorticoid effect: ...

    Incorrect

    • Which of the following has the most potent glucocorticoid effect:

      Your Answer:

      Correct Answer: Dexamethasone

      Explanation:

      Dexamethasone and betamethasone have the most potent glucocorticoid (anti-inflammatory) effect.

    • This question is part of the following fields:

      • Endocrine
      • Pharmacology
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  • Question 69 - Herpes simplex encephalitis has a predilection for which of the following sites: ...

    Incorrect

    • Herpes simplex encephalitis has a predilection for which of the following sites:

      Your Answer:

      Correct Answer: Temporal lobe

      Explanation:

      Herpes simplex virus is the most common cause of infective encephalitis and has a predilection for the temporal lobes. Herpes simplex is transmitted through direct contact. It invades skin locally producing skin vesicles by its cytolytic activity.

    • This question is part of the following fields:

      • Infections
      • Microbiology
      0
      Seconds
  • Question 70 - Which of the following is NOT a typical feature of benzodiazepine toxicity: ...

    Incorrect

    • Which of the following is NOT a typical feature of benzodiazepine toxicity:

      Your Answer:

      Correct Answer: Hyperventilation

      Explanation:

      Features of benzodiazepine toxicity include: drowsiness, ataxia, dysarthria, nystagmus, occasionally respiratory depression and coma

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
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  • Question 71 - The patient is a 61-year-old man with severe central chest pain. An acute...

    Incorrect

    • The patient is a 61-year-old man with severe central chest pain. An acute myocardial infarction is revealed by his ECG. Clopidogrel is one of the medications he takes as part of his treatment.

      Clopidogrel's direct mechanism of action is which of the following?

      Your Answer:

      Correct Answer: Inhibition of platelet ADP receptors

      Explanation:

      Clopidogrel, a thienopyridine derivative, prevents platelet aggregation and cross-linking by the protein fibrin by inhibiting the ADP receptor on platelet cell membranes (inhibits binding of ADP to its platelet receptor (P2Y12 ADP-receptor).

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
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  • Question 72 - A young male has presented to you with respiratory depression and small pupils...

    Incorrect

    • A young male has presented to you with respiratory depression and small pupils on examination. You diagnose opioid overdose and immediately start therapy with Naloxone.

      Which of the following statements is TRUE regarding naloxone?

      Your Answer:

      Correct Answer: It can be given by a continuous infusion if repeated doses are required

      Explanation:

      Naloxone is a short-acting, specific antagonist of mu(μ)-opioid receptors. It is used to reverse the effects of opioid toxicity.

      It can be given by a continuous infusion if repeated doses are required and the infusion rate is adjusted according to the vital signs. Initially, the infusion rate can be set at 60% of the initial resuscitative IV dose per hour.

      Naloxone has a shorter duration of action (6-24 hours) than most opioids and so close monitoring according to the respiratory rate and depth of coma and repeated injections are necessary. When repeated doses are needed in opioid addicts, naloxone administration may precipitate a withdrawal syndrome with abdominal cramps, nausea and diarrhoea, but these usually settle within 2 hours.

      An initial dose of 0.4 to 2 mg can be given intravenously and can be repeated at 2 to 3-minute intervals to a maximum of 10mg.

      If the intravenous route is inaccessible, naloxone can be administered via an IO line, subcutaneously (SQ), IM, or via the intranasal (IN) route.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
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  • Question 73 - You need to give your patient antibiotics, so you call microbiology for some advice.

    Of...

    Incorrect

    • You need to give your patient antibiotics, so you call microbiology for some advice.

      Of the following antibacterial drugs, which of them is a protein synthesis inhibitor?

      Your Answer:

      Correct Answer: Erythromycin

      Explanation:

      Bacteriostatic antibiotics include erythromycin and other macrolides. They work by attaching to the bacterial ribosome’s 50S subunit, preventing translocation and, as a result, inhibit protein synthesis. Macrolide antibiotics are actively concentrated inside leukocytes and delivered into the infection site as a result.

      Action Mechanisms- Examples:

      Cell wall production is inhibited
      Vancomycin
      Vancomycin
      Cephalosporins

      The function of the cell membrane is disrupted
      Nystatin
      Polymyxins
      Amphotericin B

      Inhibition of protein synthesis
      Chloramphenicol
      Macrolides
      Aminoglycosides
      Tetracyclines

      Nucleic acid synthesis inhibition
      Quinolones
      Trimethoprim
      Rifampicin
      5-nitroimidazoles
      Sulphonamides
      Anti-metabolic activity
      Isoniazid

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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  • Question 74 - Which of the following side effects is more common of etomidate than other...

    Incorrect

    • Which of the following side effects is more common of etomidate than other intravenous induction agents:

      Your Answer:

      Correct Answer: Extraneous muscle movements

      Explanation:

      Etomidate is associated with a high incidence of extraneous muscle movements, which can be minimised by an opioid analgesic or a short-acting benzodiazepine given prior to induction. Etomidate causes less hypotension than thiopental sodium and propofol during induction. Etomidate is associated with rapid recovery without a hangover effect. The rate of respiratory depression and tachycardia is not higher in etomidate.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
      Seconds
  • Question 75 - Which of the following medications can block the effect of adrenaline? ...

    Incorrect

    • Which of the following medications can block the effect of adrenaline?

      Your Answer:

      Correct Answer: Beta-blockers

      Explanation:

      Beta-blockers may reduce the response to adrenaline in the treatment of anaphylactic reactions.

      Noncardioselective beta-blockers in particular can antagonize the broncho dilating and cardio stimulatory effects of adrenaline by blocking beta-2 adrenergic receptors in the smooth muscles of the bronchial tree and in the heart muscles.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      0
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  • Question 76 - Regarding NSAIDs, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding NSAIDs, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Diclofenac is contraindicated in people with ischaemic heart disease.

      Explanation:

      Due to their increased risk of cardiovascular adverse events, coxibs and diclofenac are contraindicated in people with ischaemic heart disease, cerebrovascular disease, peripheral arterial disease and mild, moderate, or severe heart failure. Other NSAIDs are only contraindicated in people with severe heart failure. Selective inhibition of COX-2 is associated with less gastrointestinal intolerance. In single doses NSAIDs have analgesic activity comparable to that of paracetamol, therefore given their side effect profile, paracetamol is preferred, particularly in the elderly. Pain relief starts soon after taking the first dose and a full analgesic effect should normally be obtained within a week, whereas an anti-inflammatory effect may not be achieved (or may not be clinically assessable) for up to 3 weeks. Mefenamic acid has only very mild anti-inflammatory properties.

    • This question is part of the following fields:

      • Musculoskeletal
      • Pharmacology
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  • Question 77 - A 27-year-old man was sent to the emergency department by ambulance with suspected...

    Incorrect

    • A 27-year-old man was sent to the emergency department by ambulance with suspected anaphylaxis. What is the best first-line treatment for this patient?

      Your Answer:

      Correct Answer: 500 micrograms of adrenaline intramuscularly

      Explanation:

      Anaphylaxis is the sudden onset of systemic hypersensitivity due to IgE-mediated chemical release from mast cells and basophils.

      If anaphylaxis is suspected, 500 micrograms of adrenaline should be administered promptly (0.5 ml of 1:1000 solution).

      In anaphylaxis, the intramuscular route is the most immediate approach; the optimal site is the anterolateral aspect of the middle part of the thigh.

      Intravenous adrenaline should only be given by people who are well-versed in the use and titration of vasopressors in their routine clinical practice.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
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  • Question 78 - You examine a 73-year-old patient who is experiencing a worsening of his chronic...

    Incorrect

    • You examine a 73-year-old patient who is experiencing a worsening of his chronic heart failure. Bumetanide was recently prescribed for him.

      Which of the following statements about bumetanide is correct?

      Your Answer:

      Correct Answer: It has better intestinal absorption than furosemide

      Explanation:

      Bumetanide is a loop diuretic that inhibits sodium, chloride, and potassium reabsorption by acting on the Na.K.2Cl co-transporter in the ascending loop of Henlé. This reduces the osmotic gradient that forces water out of the collecting duct system and prevents the formation of a hypertonic renal medulla. This has a strong diuretic effect on the body.

      It’s primarily used in patients with heart failure who aren’t responding to high doses of furosemide. Bumetanide and furosemide differ primarily in terms of bioavailability and pharmacodynamic potency.

      In the intestine, furosemide is only partially absorbed, with a bioavailability of 40-50 percent. Bumetanide, on the other hand, is almost completely absorbed in the intestine and has a bioavailability of about 80%. Bumetanide is 40 times more potent than furosemide, and one milligram is roughly equivalent to 40 milligrams of furosemide.

      Bumetanide also lowers the concentration of neuronal chloride, making GABA’s action more depolarizing. In the neonatal period, it is being studied as an antiepileptic.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 79 - All of the following statements regarding metronidazole are correct except: ...

    Incorrect

    • All of the following statements regarding metronidazole are correct except:

      Your Answer:

      Correct Answer: Metronidazole reduces the anticoagulant effect of warfarin.

      Explanation:

      The anticoagulant effect of warfarin is enhanced by metronidazole. If use of both cannot be avoided, one must consider appropriately reducing the warfarin dosage. With alcohol, metronidazole can cause a disulfiram-like reaction, with symptoms like flushing, headaches, dizziness, tachypnoea and tachycardia, nausea and vomiting. The common side effects of metronidazole include a metallic taste and gastrointestinal irritation, in particular nausea and vomiting. These side effects are more common at higher doses. This drug has high activity against anaerobic bacteria and protozoa, and is well absorbed orally. For severe infections, the intravenous route is normally reserved.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds
  • Question 80 - Fusidic acid is primarily indicated for infections caused by which of the following...

    Incorrect

    • Fusidic acid is primarily indicated for infections caused by which of the following microorganisms:

      Your Answer:

      Correct Answer: Staphylococcal infections

      Explanation:

      Fusidic acid is a narrow spectrum antibiotic used for staphylococcal infections, primarily topically for minor staphylococcal skin (impetigo) or eye infection. It is sometimes used orally for penicillin-resistant staphylococcal infection, including osteomyelitis or endocarditis, in combination with other antibacterials.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
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  • Question 81 - An ambulance transports a 23-year-old woman who has taken a witnessed overdose of...

    Incorrect

    • An ambulance transports a 23-year-old woman who has taken a witnessed overdose of her mother's diazepam tablets. She has no significant medical history and does not take any medications on a regular basis.

      In this case, what is the SINGLE MOST APPROPRIATE FIRST DRUG TREATMENT?

      Your Answer:

      Correct Answer: Flumazenil IV 200 μg

      Explanation:

      Flumazenil is a benzodiazepine antagonist that can be helpful in some overdose situations. It works quickly (in less than a minute), but the effects are fleeting, lasting less than an hour. The dose is 200 micrograms every 1-2 minutes with a maximum dose of 3 milligrams per hour.

      Flumazenil should be avoided by patients who are addicted to benzodiazepines or who take tricyclic antidepressants because it can cause withdrawal symptoms. It can cause seizures or cardiac arrest in these situations.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      0
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  • Question 82 - A 59-year-old man presents to the emergency room with chest pain. The cardiology...

    Incorrect

    • A 59-year-old man presents to the emergency room with chest pain. The cardiology team recently discharged him. He underwent a procedure and was given several medications, including abciximab, during his stay.

      Which of the following statements about abciximab is correct?

      Your Answer:

      Correct Answer: The platelet count should be checked 2-4 hours after starting treatment

      Explanation:

      Abciximab (ReoPro) is a glycoprotein IIb/IIIa receptor antagonist that is a chimeric monoclonal antibody. It is primarily used during and after coronary artery procedures such as angioplasty to inhibit platelet aggregation.

      It’s approved for use as a supplement to heparin and aspirin in high-risk patients undergoing percutaneous transluminal coronary intervention to prevent ischaemic complications. Only one dose of abciximab should be given (to avoid additional risk of thrombocytopenia).

      Before using, it is recommended that baseline prothrombin time, activated clotting time, activated partial thromboplastin time, platelet count, haemoglobin, and haematocrit be measured. 12 and 24 hours after starting treatment, haemoglobin and haematocrit should be measured again, as should platelet count 2-4 hours and 24 hours after starting treatment.
      When used for high-risk patients undergoing angioplasty, the EPIC trial(link is external)found that abciximab reduced the risk of death, myocardial infarction, repeat angioplasty, bypass surgery, and balloon pump insertion.

      The use of abciximab is contraindicated in the following situations:
      Internal bleeding is present.
      Within the last two months, you’ve had major surgery, intracranial surgery, or trauma.
      Stroke in the previous two years
      Intracranial tumour
      Aneurysm or arteriovenous malformation
      Haemorrhagic diathesis is a type of haemorrhagic diathesis.
      Vasculitis
      Retinopathy caused by hypertension

      The following are some of the most common abciximab side effects:
      Manifestations of bleeding
      Bradycardia
      Back ache
      Pain in the chest
      Vomiting and nausea
      Pain at the puncture site
      Thrombocytopenia

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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      Seconds
  • Question 83 - During her pregnancy, a 28-year-old lady was given an antibiotic. The neonate was...

    Incorrect

    • During her pregnancy, a 28-year-old lady was given an antibiotic. The neonate was prematurely born with cyanosis and ashen grey coloured skin as a result of this. Other symptoms were hypotonia, low blood pressure, and poor feeding.

      From the  following antibiotics, which one is most likely to cause this side effect? 

      Your Answer:

      Correct Answer: Chloramphenicol

      Explanation:

      Grey baby syndrome is a rare but causes significant adverse effect caused by the build-up of chloramphenicol in neonates (particularly preterm babies).

      The following are the main characteristics of ‘grey baby syndrome’:

      Skin that is ashy grey in colour.
      Feeding problems
      Vomiting
      Cyanosis
      Hypotension
      Hypothermia
      Hypotonia
      Collapse of the cardiovascular system
      Distension of the abdomen
      trouble breathing

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds
  • Question 84 - Which of the following is NOT a typical feature of lithium toxicity: ...

    Incorrect

    • Which of the following is NOT a typical feature of lithium toxicity:

      Your Answer:

      Correct Answer: Miosis

      Explanation:

      Features of toxicity include:
      Increasing gastrointestinal disturbances (vomiting, diarrhoea, anorexia)
      Visual disturbances
      Polyuria and incontinence
      Muscle weakness and tremor
      Tinnitus
      CNS disturbances (dizziness, confusion and drowsiness increasing to lack of coordination, restlessness, stupor)
      Abnormal reflexes and myoclonus
      Hypernatraemia
      With severe overdosage (serum-lithium concentration > 2 mmol/L) seizures, cardiac arrhythmias (including sinoatrial block, bradycardia and first-degree heart block), blood pressure changes, electrolyte imbalance, circulatory failure, renal failure, coma and sudden death may occur.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      0
      Seconds
  • Question 85 - A 28-year-old asthmatic patient is seen in the Emergency Department following an acute...

    Incorrect

    • A 28-year-old asthmatic patient is seen in the Emergency Department following an acute exacerbation. His symptoms start to improve when your consultant gives him a high dose of IV aminophylline.

      Which of the following is correct mechanism of action of aminophylline ?

      Your Answer:

      Correct Answer: Inhibition of phosphodiesterase

      Explanation:

      Aminophylline has the following properties:
      Phosphodiesterase inhibitor that increases intracellular cAMP and relaxes smooth muscle in the bronchial airways and pulmonary blood vessels.
      Mast cell stabilization is achieved by using a non-selective adenosine receptor antagonist.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
      0
      Seconds
  • Question 86 - A 58-year-old male has cellulitis of his left leg. Because he is allergic to...

    Incorrect

    • A 58-year-old male has cellulitis of his left leg. Because he is allergic to penicillin, you start him on erythromycin.

      What is erythromycin's mechanism of action?

      Your Answer:

      Correct Answer: Inhibition of protein synthesis

      Explanation:

      Bacteriostatic antibiotics include erythromycin and other macrolide antibiotics. They work by attaching to the bacterial ribosome’s 50S subunit, preventing translocation and thereby protein synthesis. Macrolide antibiotics are actively concentrated inside leukocytes and delivered to the infection site as a result.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds
  • Question 87 - All of the following cause bronchoconstriction, EXCEPT for: ...

    Incorrect

    • All of the following cause bronchoconstriction, EXCEPT for:

      Your Answer:

      Correct Answer: Adrenaline

      Explanation:

      Factors causing bronchoconstriction:Via muscarinic receptorsParasympathetic stimulationStimulation of irritant receptorsInflammatory mediators e.g. histamine, prostaglandins, leukotrienesBeta-blockers

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      0
      Seconds
  • Question 88 - After collapsing at home, a 62-year-old man is transported in an ambulance. He...

    Incorrect

    • After collapsing at home, a 62-year-old man is transported in an ambulance. He is now awake, but he is experiencing palpitations and chest pain. He is rushed to resuscitation and placed on a cardiac monitor, which reveals ventricular tachycardia. An amiodarone infusion is set up.

      Which of these statements about amiodarone is correct?

      Your Answer:

      Correct Answer: It is expressed in breast milk

      Explanation:

      Antiarrhythmic drug amiodarone is used to treat both ventricular and atrial arrhythmias. It’s a class III antiarrhythmic that works by prolonging the repolarization phase of the cardiac action potential, where potassium permeability is normally high and calcium permeability is low.

      Dronedarone is sometimes used instead of amiodarone in certain situations. Although amiodarone is more effective than dronedarone, dronedarone has fewer side effects.

      Grapefruit juice inhibits the metabolism of amiodarone.

      The plasma half-life of amiodarone is very long, ranging from 2 weeks to 5 months. The half-life is about 2 months on average.
      Because amiodarone is excreted in breast milk, it should be avoided by breastfeeding mothers.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 89 - A 34-year-old male presents to the Emergency Department with the complaint of palpitations...

    Incorrect

    • A 34-year-old male presents to the Emergency Department with the complaint of palpitations and difficulty breathing, which started suddenly half an hour ago. His ECG shows findings of supraventricular tachycardia. You attempt vagal manoeuvres but cannot convert them back to sinus rhythm. Therefore, drug therapy is necessary to terminate the arrhythmia. Adenosine cannot be used in this patient because of a contra-indication listed in his medical record.

      Which one of the conditions listed below would be a contraindication in this case?

      Your Answer:

      Correct Answer: Asthma

      Explanation:

      Entonox is a mixture of 50% Oxygen and 50% nitrous oxide and is given in an inhaled form as a quick form of analgesia. Entonox causes non-competitive inhibition of NMDA (N-methyl-D-aspartate) receptors, which are a subtype of the glutamate receptor.

      It is stored in blue and white cylinders and administered via a pressure regulator and demand valve. The administration of this medicine reduces pain and anxiety in paediatric and dental procedures ands during labour.

      Effects are apparent after 20 seconds, and peak action occurs after 3 to 5 minutes as it is a drug with a rapid onset and the patient will also recover rapidly from its effects. Entonox is widely used as it does not accumulate in the body and does not cause many side effects. However, a notable side effect is the inhibition of Vitamin B12 synthesis.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
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  • Question 90 - In a ward round, you come across a patient's treatment chart prescribed an...

    Incorrect

    • In a ward round, you come across a patient's treatment chart prescribed an antibiotic to fight his infection. This antibiotic is a protein synthesis inhibitor.

      Which of the following antimicrobial drugs is prescribed to this patient?

      Your Answer:

      Correct Answer: Gentamicin

      Explanation:

      Gentamicin, an aminoglycoside antibiotic, acts by binding to the 30S subunit of the bacterial ribosome inhibiting the binding of aminoacyl-tRNA and thus preventing initiation of protein synthesis.

      Vancomycin inhibits cell wall peptidoglycan formation by binding the D-Ala-D-Ala portion of cell wall precursors.

      Penicillins and cephalosporins are the major antibiotics that inhibit bacterial cell wall synthesis. They inactivate transpeptidases that help cross-link peptidoglycans in cell walls.

      Metronidazole and the other 5-nitroimidazole agents inhibit nucleic acid synthesis by forming toxic free radical metabolites in the bacterial cell that damage DNA.

      Ciprofloxacin inhibits prokaryotic enzymes topoisomerase II (DNA gyrase) and topoisomerase IV.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
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  • Question 91 - A 63 year old lady presents to ED with a persistent cough and...

    Incorrect

    • A 63 year old lady presents to ED with a persistent cough and red currant jelly sputum. She has a history of chronic alcohol abuse and has an X-ray which demonstrates a cavitating pneumonia. The most likely causative pathogen is:

      Your Answer:

      Correct Answer: Klebsiella pneumoniae

      Explanation:

      One of the results of Klebsiella pneumoniae is pneumonia that is usually a very severe infection. It is characterised by thick, bloody sputum (red currant jelly sputum), and is associated with complications like lung abscess, cavitation, necrosis, empyema and pleural effusions.

    • This question is part of the following fields:

      • Infections
      • Microbiology
      0
      Seconds
  • Question 92 - Regarding dynamic compression of the airways, which of the following statements is CORRECT:...

    Incorrect

    • Regarding dynamic compression of the airways, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: It occurs during forced expiration.

      Explanation:

      Dynamic compression occurs because as the expiratory muscles contract during forced expiration, all the structures within the lungs, including the airways, are compressed by the positive intrapleural pressure. Consequently the smaller airways collapse before the alveoli empty completely and some air remains within the lungs (the residual volume). Physiologically this is important as a completely deflated lung with collapsed alveoli requires significantly more energy to inflate. Dynamic compression does not occur in normal expiration because the intrapleural pressure is negative throughout the whole cycle.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      0
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  • Question 93 - Regarding inflammatory bowel disease, acute mild to moderate disease of the rectum or...

    Incorrect

    • Regarding inflammatory bowel disease, acute mild to moderate disease of the rectum or rectosigmoid should be treated initially with:

      Your Answer:

      Correct Answer: Local aminosalicylate

      Explanation:

      Acute mild to moderate disease affecting the rectum (proctitis) or the rectosigmoid is treated initially with local application of an aminosalicylate; alternatively, a local corticosteroid can be used but it is less effective. A combination of a local aminosalicylate and a local corticosteroid can be used for proctitis that does not respond to a local aminosalicylate alone.

    • This question is part of the following fields:

      • Gastrointestinal
      • Pharmacology
      0
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  • Question 94 - A 50-year-old woman has an anaphylactic reaction following accidental ingestion peanuts at a...

    Incorrect

    • A 50-year-old woman has an anaphylactic reaction following accidental ingestion peanuts at a restaurant. She is a known hypertensive on atenolol 50 mg daily and BP is well controlled. She is also on amlodipine 5 mg daily. Two doses of IM adrenaline has been given without improvement.

      Which medication may prove helpful in this patient?

      Your Answer:

      Correct Answer: IM Glucagon

      Explanation:

      Resistant to the effects of adrenaline in anaphylaxis is seen in patients taking beta-blockers.

      Glucagon can be used to overcome the effects of the beta-blockade if initial doses of adrenaline are unsuccessful in patients taking beta-blockers.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
      0
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  • Question 95 - A 78-year-old man develops renal impairment and hearing loss after inpatient management...

    Incorrect

    • A 78-year-old man develops renal impairment and hearing loss after inpatient management for sepsis.

      Which of these antibiotics is most likely to have been used?

      Your Answer:

      Correct Answer: Gentamicin

      Explanation:

      Gentamicin, an aminoglycoside antibiotic, acts by binding to the 30S subunit of the bacterial ribosome inhibiting the binding of aminoacyl-tRNA, and thus prevents initiation of protein synthesis.

      Two of its most notable side effects are reversible nephrotoxicity(caused by the inhibition of protein synthesis in renal cells, which causes acute tubular necrosis) and hearing loss (caused by damage to the vestibular apparatus of the inner ear).

      Both side effects are dose-related and occur commonly in the elderly.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
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  • Question 96 - Regarding antacids, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding antacids, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Antacids should not be taken at the same time as other drugs as they impair absorption.

      Explanation:

      Antacids should preferably not be taken at the same time as other drugs since they may impair absorption. Antacids act by neutralising stomach acid. They are used for symptomatic relief in dyspepsia, but are not first line for proven peptic ulcer disease where antisecretory drugs have a better healing effect. Magnesium-containing antacids tend to be laxative whereas aluminium-containing antacids tend to be constipating. Antacids are contraindicated in hypophosphataemia.

    • This question is part of the following fields:

      • Gastrointestinal
      • Pharmacology
      0
      Seconds
  • Question 97 - Regarding the partial pressure of gases, which of the following statements is INCORRECT:...

    Incorrect

    • Regarding the partial pressure of gases, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: At high altitude, the oxygen fraction is reduced.

      Explanation:

      At altitude, the oxygen fraction is unaltered but the barometric pressure and thus partial pressure of oxygen is reduced.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      0
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  • Question 98 - Regarding amoxicillin, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding amoxicillin, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: It is used first line for bacterial tonsillitis.

      Explanation:

      Amoxicillin is a derivative of ampicillin and has a similar antibacterial spectrum. It is better absorbed than ampicillin when given orally, producing higher plasma and tissue concentrations; unlike ampicillin, absorption is not affected by the presence of food in the stomach.

      The adverse effects of amoxicillin are mainly gastrointestinal and mild and include nausea, vomiting and diarrhoea. Amoxicillin is used first line for low to moderate severity community acquired pneumonia, exacerbations of chronic bronchitis, for acute otitis media, for acute sinusitis, for oral infections/dental abscess, for Listeria meningitis (in combination with another antibiotic), for infective endocarditis (in combination with another antibiotic) and for H. Pylori eradication (in combination with metronidazole/clarithromycin and a PPI).

      Penicillin V is used first line for bacterial tonsillitis; amoxicillin should be avoided in blind treatment of a sore throat as there is a high risk of a rash if glandular fever is present.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
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  • Question 99 - You're called to a cardiac arrest in your Emergency Department resuscitation area. The...

    Incorrect

    • You're called to a cardiac arrest in your Emergency Department resuscitation area. The rhythm strip is shown in the diagram below. Defibrillation has already been attempted three times on the patient. You intended to administer amiodarone, but your department has informed you that it is not available.

      In these circumstances, if amiodarone is not available, which of the following drugs is recommended by the ALS guidelines?

      Your Answer:

      Correct Answer: Lidocaine

      Explanation:

      If amiodarone is unavailable in VF/pVT arrests, lidocaine at a dose of 1 mg/kg can be used instead, according to the latest ALS guidelines. If amiodarone has already been given, no lidocaine should be given.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 100 - Which of the following drugs decreases plasma-theophylline levels: ...

    Incorrect

    • Which of the following drugs decreases plasma-theophylline levels:

      Your Answer:

      Correct Answer: Carbamazepine

      Explanation:

      Examples of enzyme-inhibiting drugs (raise plasma theophylline level):
      Erythromycin
      Clarithromycin
      Ciprofloxacin
      Fluconazole
      Verapamil
      Allopurinol
      Cimetidine
      Examples of enzyme-inducing drugs (lower plasma theophylline level):
      Primidone
      Phenobarbital
      Carbamazepine
      Phenytoin
      Ritonavir
      Rifampicin
      St John’s Wort

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      0
      Seconds
  • Question 101 - A patient who shows symptoms of infection and is admitted under supervision of...

    Incorrect

    • A patient who shows symptoms of infection and is admitted under supervision of the medical team. The organism which caused this, is a Gram-negative bacterium, according to the culture. A penicillin therapy is suggested by the microbiologist.

      Which of the penicillins listed below is the most effective against Gram-negative bacteria? 

      Your Answer:

      Correct Answer: Amoxicillin

      Explanation:

      Amoxicillin and Ampicillin are more hydrophilic (broad-spectrum) penicillins than benzylpenicillin and phenoxymethylpenicillin. Because they may penetrate through gaps in the outer phospholipid membrane, they are effective against Gram-negative bacteria. Amoxicillin and Ampicillin are resistant to penicillinase-producing microbes.

      Community-acquired pneumonia, otitis media, sinusitis, oral infections, and urinary tract infections are among the most prevalent conditions for which they are prescribed. The normal adult oral dose of Amoxicillin is 500 mg three times/day, which can be increased to 1 g three times/day if necessary. Ampicillin is given to adults in doses of 0.5-1 g every 6 hours.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
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  • Question 102 - Following the administration of a medication for a heart condition, a 69-year-old man...

    Incorrect

    • Following the administration of a medication for a heart condition, a 69-year-old man develops hypothyroidism.

      Which of the following drugs is most likely to be the cause?

      Your Answer:

      Correct Answer: Amiodarone

      Explanation:

      Amiodarone has a chemical structure that is similar to that of thyroxine and can bind to the nuclear thyroid receptor. It can cause both hypothyroidism and hyperthyroidism, though hypothyroidism is far more common, with 5-10% of patients suffering from it.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 103 - Adenosine has a half-life of approximately: ...

    Incorrect

    • Adenosine has a half-life of approximately:

      Your Answer:

      Correct Answer: 8 - 10 seconds

      Explanation:

      Adenosine stimulates A1-adenosine receptors and opens acetylcholine sensitive K+ channels, increasing K+ efflux. This hyperpolarises the cell membrane in the atrioventricular node and, by inhibiting the calcium channels, slows conduction in the AVN. As it has a very short duration of action (half-life only about 8 – 10 seconds), most side effects are short lived.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
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  • Question 104 - Which of the following is an example of a vaccine produced by recombinant...

    Incorrect

    • Which of the following is an example of a vaccine produced by recombinant DNA technology:

      Your Answer:

      Correct Answer: Hepatitis B

      Explanation:

      Hepatitis B vaccines are prepared from the viral surface antigen. The recombinant vaccine is now the most widely used vaccine and induces a sufficient antibody response in 90% of individuals.
      Indications for hepatitis B vaccination include:
      All health care professional’s working in the UK
      Other professions with occupational risks (foster carers, staff of custodial institutions, morticians etc)
      Babies of mothers with hepatitis B during pregnancy
      Close family contacts of a case or carrier
      IV drug abusers
      Individuals with haemophilia
      Individuals with chronic renal failure
      Sex workers and individuals with frequently changing sexual partners
      The vaccine should be stored between 2 and 8 degrees C as freezing destroys its efficacy. The vaccine is administered intramuscularly, either into the deltoid region (preferred) or anterolateral thigh. The buttock should be avoided as it reduces the efficacy of the vaccine.
      The standard regime is to give 3 doses of the vaccine, the 1stand 2ndone month apart and the 2ndand 3rdsix months apart. Antibody titres should be tested 2 to 4 months after the primary course.
      A peak titre above 100 mIU/ml is regarded as a good response and implies long-term immunity. A peak titre between 10-100 mIU/ml is regarded as a low response and a peak titre of less than 10mIU/ml is regarded as a poor response.
      There is no substantiated association between hepatitis B vaccination and Guillain-Barre syndrome.

    • This question is part of the following fields:

      • Immunoglobulins And Vaccines
      • Pharmacology
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  • Question 105 - Which of the following statements is correct regarding anti-D immunoglobulin? ...

    Incorrect

    • Which of the following statements is correct regarding anti-D immunoglobulin?

      Your Answer:

      Correct Answer: It is administered as part of routine antenatal care for rhesus-negative mothers.

      Explanation:

      In all non-sensitised pregnant women who are RhD-negative, it is recommended that routine antenatal anti-D prophylaxis is offered. Even if there is previous anti-D prophylaxis, use of routine antenatal anti-D prophylaxis should be given for a sensitising event early in the same pregnancy. Postpartum anti-D prophylaxis should also be given even if there has been previous routine antenatal anti-D prophylaxis or antenatal anti-D prophylaxis for a sensitising event in the same pregnancy.

    • This question is part of the following fields:

      • Immunoglobulins And Vaccines
      • Pharmacology
      0
      Seconds
  • Question 106 - After collapsing in his nursing home, a 70-year-old man is brought into the...

    Incorrect

    • After collapsing in his nursing home, a 70-year-old man is brought into the ER. He has diabetes mellitus and is on medication for it. An RBS of 2.0 mmol/L (3.9-5.5 mmol/L) is recorded in the ER.

      Out of the following, which medication for diabetes mellitus is LEAST likely responsible for his hypoglycaemic episode?

      Your Answer:

      Correct Answer: Metformin

      Explanation:

      Metformin is a biguanide used as the first-line to treat type 2 diabetes mellitus. It has a good reputation as it has an extremely low risk of causing hypoglycaemia compared to the other agents for diabetes. It does not affect the insulin secreted by the pancreas or increase insulin levels. Toxicity with metformin can, however, cause lactic acidosis with associated hypoglycaemia.

    • This question is part of the following fields:

      • Endocrine Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 107 - Which of the following statements about propofol is TRUE: ...

    Incorrect

    • Which of the following statements about propofol is TRUE:

      Your Answer:

      Correct Answer: Propofol has some antiemetic action.

      Explanation:

      Propofol has some antiemetic properties. It’s for this reason that it’s used to treat postoperative nausea and vomiting. Propofol is mostly processed in the liver, with the kidneys excreting just around 1% of it unaltered. Propofol, unlike thiopental, does not produce tissue necrosis when it is extravasated. Propofol lowers intracranial pressure via lowering brain metabolic rate and cerebral blood flow. Propofol is thought to be safe for people with bronchial asthma and chronic obstructive pulmonary disease.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
      Seconds
  • Question 108 - Atracurium is used as a muscle relaxant during endotracheal intubation. This drug’s mechanism...

    Incorrect

    • Atracurium is used as a muscle relaxant during endotracheal intubation. This drug’s mechanism of action is best described by which of the following?

      Your Answer:

      Correct Answer: Nicotinic acetylcholine receptor antagonist

      Explanation:

      Atracurium is a non-depolarizing neuromuscular blocker that is used to help with intubation and controlled ventilation by causing muscle relaxation and paralysis.

      At the neuromuscular junction’s post-synaptic membrane, atracurium competes with acetylcholine for nicotinic (N2) receptor binding sites. This prevents the receptors from being stimulated by acetylcholine.

      Muscle paralysis occurs gradually due to the competitive blockade.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
      Seconds
  • Question 109 - What is the direct mechanism of action of digoxin as a positive inotrope:...

    Incorrect

    • What is the direct mechanism of action of digoxin as a positive inotrope:

      Your Answer:

      Correct Answer: Inhibition of Na+/K+ ATPase pump

      Explanation:

      Digoxin directly inhibits membrane Na+/K+ ATPase, which is responsible for Na+/K+ exchange across the myocyte cell membrane. This increases intracellular Na+ and produces a secondary increase in intracellular Ca2+ that increases the force of myocardial contraction. The increase in intracellular Ca2+ occurs because the decreased Na+ gradient across the membrane reduces the extrusion of Ca2+ by the Na+/Ca2+ exchanger that normally occurs during diastole. Digoxin and K+ ions compete for the receptor on the outside of the muscle cell membrane, and so the effects of digoxin may be dangerously increased in hypokalaemia.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds
  • Question 110 - You examine a 48-year-old woman's blood results and notice that her glucose level...

    Incorrect

    • You examine a 48-year-old woman's blood results and notice that her glucose level is elevated. When you tell her about it, she tells you that her doctor recently ran some tests and discovered that she has impaired glucose tolerance.

      Which of the following medications has not been linked to a reduction in glucose tolerance?

      Your Answer:

      Correct Answer: Amlodipine

      Explanation:

      The following drugs have been linked to impaired glucose tolerance:
      Thiazide diuretics, e.g. Bendroflumethiazide
      Loop diuretics, e.g. furosemide
      Steroids, e.g. prednisolone
      Beta-blockers, e.g. atenolol

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 111 - A 78-year-old woman visits the emergency room with dizziness and nausea. She claims...

    Incorrect

    • A 78-year-old woman visits the emergency room with dizziness and nausea. She claims that her doctor gave her cinnarizine two days prior, but that it didn't seem to help.

      Cinnarizine's mechanism of action is which of the following?

      Your Answer:

      Correct Answer: Antihistamine action

      Explanation:

      Cinnarizine is a piperazine derivative with an antihistamine effect that makes it anti-emetic. Motion sickness and vestibular disorders, such as Méniéres disease, are the most common conditions for which it is prescribed.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 112 - Which of the following is NOT a benefit of low molecular weight heparin...

    Incorrect

    • Which of the following is NOT a benefit of low molecular weight heparin (LMWH) over unfractionated heparin therapy:

      Your Answer:

      Correct Answer: Its effects can be rapidly and completely reversed with protamine sulfate.

      Explanation:

      Advantages of LMWHGreater ability to inhibit factor Xa directly, interacting less with platelets and so may have a lesser tendency to cause bleedingGreater bioavailability and longer half-life in plasma making once daily subcutaneous administration possibleMore predictable dose response avoiding the need for routine anticoagulant monitoringLower associated risk of heparin-induced thrombocytopenia or of osteoporosis

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds
  • Question 113 - You examine a 43-year-old woman who was referred to you by a friend....

    Incorrect

    • You examine a 43-year-old woman who was referred to you by a friend. She suffers from a variety of medical conditions and takes a variety of medications, including amitriptyline.

      Which of the following is NOT a contraindication to amitriptyline treatment?

      Your Answer:

      Correct Answer: Breastfeeding

      Explanation:

      Amitriptyline is a tricyclic antidepressant (TCA) that is most commonly used to treat depression, but it can also be used to treat anxiety disorders, chronic pain, and attention deficit hyperactivity disorder (ADHD). It inhibits reuptake, raising serotonin and noradrenaline levels while also inhibiting acetylcholine action.

      TCAs have a number of drawbacks, including:
      Acute Porphyria
      Arrhythmias
      During bipolar disorder’s manic phase
      Heart block
      After a myocardial infarction, there is an immediate recovery period.

      TCA levels in breast milk are too low to be harmful, and use can be continued while breastfeeding.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 114 - Regarding fibrinolytics, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding fibrinolytics, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: Fibrinolytic drugs act as thrombolytics by directly degrading the fibrin mesh and so breaking up thrombi.

      Explanation:

      Fibrinolytic drugs act as thrombolytics by activating plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 115 - A 6-year-old child with a few itchy honey crusted sores on her left...

    Incorrect

    • A 6-year-old child with a few itchy honey crusted sores on her left cheek is brought in by her mother. Following a thorough examination of the child, you diagnose impetigo and recommend a course of topical fusidic acid.

      Fusidic acid's mode of action is which of the following?

      Your Answer:

      Correct Answer: Inhibition of protein synthesis

      Explanation:

      By binding EF-G-GDP, fusidic acid prevents both peptide translocation and ribosome disassembly, which slows protein synthesis. Because it has a novel structure and mechanism of action, it is unlikely to cause cross-resistance with existing antibiotics.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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  • Question 116 - You're currently treating an infection in a patient and trying to figure out...

    Incorrect

    • You're currently treating an infection in a patient and trying to figure out which antibiotic would be best.

      Which of the following antimicrobial drugs inhibits the formation of cell walls?

      Your Answer:

      Correct Answer: Cefuroxime

      Explanation:

      Cefuroxime and other cephalosporin antibiotics are bactericidal ß-lactam antibiotics. They work similarly to penicillins in that they prevent cross-linking between the linear peptidoglycan polymer chains that make up the bacterial cell wall. As a result, they prevent the formation of cell walls.
      The following is a summary of the various mechanisms of action of various types of antimicrobial agents:

      1) Inhibition of cell wall synthesis
      Penicillins
      Cephalosporins
      Vancomycin

      2) Disruption of cell membrane function
      Polymyxins
      Nystatin
      Amphotericin B

      3) Inhibition of protein synthesis
      Macrolides
      Aminoglycosides
      Tetracyclines
      Chloramphenicol

      4) Inhibition of nucleic acid synthesis
      Quinolones
      Trimethoprim
      5-nitroimidazoles
      Rifampicin

      5) Anti-metabolic activity
      Sulphonamides
      Isoniazid

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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  • Question 117 - Which of the following best describes the therapeutic effect of calcium gluconate when used...

    Incorrect

    • Which of the following best describes the therapeutic effect of calcium gluconate when used in treatment for hyperkalaemia:

      Your Answer:

      Correct Answer: Reduces cardiac cell membrane excitability

      Explanation:

      Calcium resonium is an ion-exchange resin that exchanges sodium for potassium as it passes through the intestine, leading to excretion of potassium from the body. Salbutamol and insulin act to increase intracellular uptake of K+ via Na-K ATP pump. Sodium bicarbonate acts to correct acidosis and thus promotes intracellular uptake of K+. Calcium gluconate acts to protect the cardiac membrane and has no effect on serum K+ levels.

    • This question is part of the following fields:

      • Fluids And Electrolytes
      • Pharmacology
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