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Question 1
Correct
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What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?
Your 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.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 2
Incorrect
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A 22-year-old with a history of brittle asthma is brought to the ED by her partner. She is wheezing and very short of breath and her condition is deteriorating rapidly. Following a series of nebulisations, hydrocortisone and IV magnesium sulphate, she is taken to resus and the intensive care team is called to review her. She is severely hypoxic and confused and a decision is made to intubate her.
Which of these drugs is ideal as an induction agent in this patient?Your Answer:
Correct Answer: Ketamine
Explanation:Only about 2% of asthma attacks requires intubation and most severe cases are managed with non-invasive ventilation techniques.
Though life-saving in the crashing asthmatic, intubation in asthmatic patients is associated with significant morbidity and mortality and is risky. Indications for intubation in asthmatic patients include:
Severe hypoxia
Altered mental state
Respiratory or cardiac arrest
Failure to respond to medicationsKetamine (1-2 mg/kg) is the preferred induction agent. It has bronchodilatory properties and does not cause hypotension.
Propofol poses a risk of hypotension but can also be used.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 3
Incorrect
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Regarding the UK routine childhood immunisation schedule which of the following vaccines is given at 3 months:
Your Answer:
Correct Answer: Rotavirus
Explanation:At 3 months the following vaccines are given:
Diphtheria, tetanus, pertussis, polio, Hib and hepatitis B (2nd dose)
Pneumococcal (13 serotypes)
Rotavirus (2nd dose) -
This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
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Question 4
Incorrect
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Regarding the UK routine childhood immunisation schedule which of the following vaccines is NOT given at 4 months:
Your Answer:
Correct Answer: Rotavirus
Explanation:At 4 months the following vaccines are given:
Diphtheria, tetanus, pertussis, polio, Hib and hepatitis B (3rd dose)
Meningococcal group B (2nd dose) -
This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
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Question 5
Incorrect
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The patient is a 66-year-old woman who has troublesome bilateral ankle swelling. This has been happening since she began taking a new antihypertensive medication a few weeks ago.
Which of the following medications is most likely to be the cause of this adverse reaction?Your Answer:
Correct Answer: Amlodipine
Explanation:Amlodipine is a calcium-channel blocker that is frequently used to treat hypertension. Ankle swelling is a very common side effect of calcium-channel blockers, and it occurs quite frequently.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 6
Incorrect
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You intend to suture a hand wound with plain 1 percent lidocaine.
In 1 mL of plain 1 percent lidocaine solution, how much lidocaine hydrochloride is there?Your Answer:
Correct Answer: 10 mg lidocaine hydrochloride
Explanation:10 mg of lidocaine hydrochloride is contained in each 1 mL of plain 1 percent lidocaine solution.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 7
Incorrect
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Nitrous oxide is associated with which of the following adverse effects:
Your Answer:
Correct Answer: Megaloblastic anaemia
Explanation:Exposure to nitrous oxide for prolonged periods, either by continuous or by intermittent administration, may result in megaloblastic anaemia as a result of interference with the action of vitamin B12; neurological toxic effects can occur without preceding overt haematological changes. Depression of white cell formation may also occur.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 8
Incorrect
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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
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Question 9
Incorrect
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A patient presents with an acute severe asthma attack. Following a poor response to his initial salbutamol nebuliser, you administer a further nebuliser that this time also contains ipratropium bromide.
After what time period would you expect the maximum effect of the ipratropium bromide to occur? Select ONE answer only.Your Answer:
Correct Answer: 30 -60 minutes
Explanation:Ipratropium bromide is an antimuscarinic drug used in the management of acute asthma and COPD. It can provide short-term relief in chronic asthma, but short-acting β2agonists act more quickly and are preferred.
The BTS guidelines recommend that nebulised ipratropium bromide (0.5 mg 4-6 hourly) can be added to β2agonist treatment for patients with acute severe or life-threatening asthma or those with a poor initial response to β2 agonist therapy.
The aerosol inhalation of ipratropium can be used for short-term relief in mild chronic obstructive pulmonary disease in patients who are not already using a long-acting antimuscarinic drug (e.g. tiotropium).Its maximum effect occurs 30-60 minutes after use; its duration of action is 3-6 hours, and bronchodilation can usually be maintained with treatment three times per day.
The commonest side effect of ipratropium bromide is dry mouth. It can also trigger acute closed-angle glaucoma in susceptible patients. Tremor is commonly seen with β2agonists but not with antimuscarinics. Ipratropium bromide should be used with caution in: Men with prostatic hyperplasia and bladder-outflow obstruction (worsened urinary retention has been reported in elderly men), People with chronic kidney disease (CKD) stages 3 and above (because of the risk of drug toxicity), People with angle-closure glaucoma (nebulised mist of antimuscarinic drugs can precipitate or worsen acute angle-closure glaucoma) -
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 10
Incorrect
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Bendoflumethiazide may cause all of the following electrolyte imbalances EXCEPT for:
Your Answer:
Correct Answer: Hypocalcaemia
Explanation:Common side effects of thiazide diuretics include:
Excessive diuresis, postural hypotension, dehydration, renal impairment
Acid-base and electrolyte imbalance
Hypokalaemia, hyponatraemia, hypomagnesaemia, hypercalcaemia, hypochloraemic alkalosis
Metabolic imbalance
Hyperuricaemia and gout
Impaired glucose tolerance and hyperglycaemia
Altered plasma-lipid concentrations
Mild gastrointestinal disturbances -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 11
Incorrect
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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.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 12
Incorrect
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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 hypertensionThe 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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Question 13
Incorrect
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Which of the following corticosteroids has the most potent mineralocorticoid effect:
Your Answer:
Correct Answer: Fludrocortisone
Explanation:Fludrocortisone has the most potent mineralocorticosteroid activity, making it ideal for mineralocorticoid replacement in adrenal insufficiency.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 14
Incorrect
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A 52-year-old patient requires procedural sedation for DC cardioversion of atrial fibrillation. You plan on using propofol as the sedative agent.
Propofol works as a result of action on what type of receptor? Select ONE answer only.Your Answer:
Correct Answer: Gamma-aminobutyric acid (GABA)
Explanation:Propofol (2,6-diisopropylphenol) is a short-acting phenol derivative that is primarily used for the induction of anaesthesia.
Its mechanism of action is unclear but is thought to act by potentiating the inhibitory neurotransmitters GABA and glycine, which enhances spinal inhibition during anaesthesia.
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
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Question 15
Incorrect
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Question 16
Incorrect
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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
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Question 17
Incorrect
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A 50-year-old man presents with signs and symptoms of an anaphylactic reaction. His GP had recently given him a new medication.
Which one of these is the most likely medication responsible for the drug-induced anaphylactic reaction?
Your Answer:
Correct Answer: Penicillin
Explanation:The most common cause of drug-induced anaphylaxis is penicillin.
The second commonest cause are NSAIDs. Other drugs associated with anaphylaxis are ACE inhibitors and aspirin.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 18
Incorrect
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In the treatment of hypertensive episodes in pheochromocytoma, which of the following medication types is administered as first-line management:
Your Answer:
Correct Answer: Alpha-blockers
Explanation:The first line of management in controlling blood pressure and preventing intraoperative hypertensive crises is to use a combination of alpha and beta-adrenergic inhibition. In phaeochromocytoma, alpha-blockers are used to treat hypertensive episodes in the short term. Tachycardia can be managed by the careful addition of a beta-blocker, preferably a cardioselective beta-blocker, once alpha blockade has been established. Long term management of pheochromocytoma involves surgery.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 19
Incorrect
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Which of the following is a contraindication to the use of opioid analgesics:
Your Answer:
Correct Answer: Raised intracranial pressure
Explanation:Opioids should be avoided in people who have:
A risk of paralytic ileus (opioids reduce gastric motility)
Acute respiratory depressionAn acute exacerbation of asthma (opioids can aggravate bronchoconstriction as a result of histamine release)
Conditions associated with increased intracranial pressure including head injury (opioids can interfere with pupillary response making neurological assessment difficult and may cause retention of carbon dioxide aggravating the increased intracranial pressure) -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 20
Incorrect
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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.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 21
Incorrect
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Which of these is NOT a lithium side effect:
Your Answer:
Correct Answer: Peptic ulcer disease
Explanation:Adverse Effects of lithium Include
Leucocytosis (most patients)
Polyuria/polydipsia (30-50%)
Dry mouth (20-50%)
Hand tremor (45% initially, 10% after 1 year of treatment)
Confusion (40%)
Decreased memory (40%)
Headache (40%)
Muscle weakness (30% initially, 1% after 1 year of treatment)
Electrocardiographic (ECG) changes (20-30%)
Nausea, vomiting, diarrhoea (10-30% initially, 1-10% after 1-2 years of treatment)
Hyperreflexia (15%)
Muscle twitch (15%)
Vertigo (15%)
Extrapyramidal symptoms, goitre (5%)
Hypothyroidism (1-4%)
Acne (1%)
Hair thinning (1%) -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 22
Incorrect
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Following an injury sustained during a rugby match, a 16-year-old boy is brought to the Emergency Department by his mother. His forearm appears to be deformed, and you believe he has a distal radius fracture. A numerical rating scale is used to assess his pain, and the triage nurse informs you that he is in moderate pain.'
The RCEM guidance recommends which of the following analgesics for the treatment of moderate pain in a child of this age?Your Answer:
Correct Answer: Oral codeine phosphate 1 mg/kg
Explanation:According to a 2018 audit conducted by the Royal College of Emergency Medicine (RCEM), the standard of care for children presenting to EDs with fractured limbs has deteriorated, with most patients waiting longer than ever before for pain relief. More than one-tenth of the children who came in with significant pain from a limb fracture received no pain relief at all.
For all patients, including children, the Agency for Health Care Policy and Research (AHCPR) in the United States recommends using the ABCs of pain management:
A – Ask about pain regularly. Assess pain systematically.
B – Believe the patient and family in their reports of pain and what relieves it.
C – Choose pain control options appropriate for the patient, family, and setting.
D – Deliver interventions in a timely, logical, coordinated fashion.
E – Empower patients and their families. Enable patients to control their course to the greatest extent possible.The RCEM guidelines recommend assessing a child’s pain within 15 minutes of arrival. This is a fundamental requirement. For the assessment of pain in children, a variety of rating scales are available; which one is used depends on the child’s age and ability to use the scale. These are some of them:
Faces of Wong-Baker Scale for assessing pain
Scale of numerical evaluation
The behavioural scale is a scale that measures how people behave.The RCEM has provided the following visual guide:
The RCEM has established the following guidelines for when patients in severe pain should receive appropriate analgesia:
100% within 60 minutes of arrival or triage, whichever is earliest
75% within 30 minutes of arrival or triage, whichever is earliest
50% within 20 minutes of arrival or triage, whichever is earliest -
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 23
Incorrect
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A 62-year-old woman is brought to the Emergency Department as she is acutely unwell. Her attendants inform you that she was recently started on lithium as a mood stabilizer.
You instantly send a blood sample to check for lithium levels.
What is the usual therapeutic range for lithium?Your Answer:
Correct Answer: 0.4-0.8 mmol/l
Explanation:Lithium is the drug of choice for recurrent bipolar illness but should be carefully monitored as it has a very low therapeutic index. The normal therapeutic range is 0.4-0.8 mmol/l.
The lower end of the range is usually the target for the elderly and as maintenance therapy. Toxicity is usually seen at levels >1.5 mmol/l. Samples should be taken 12 hours after the dose, and levels should be checked one week after starting therapy and one week after every change in dosage.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 24
Incorrect
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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.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 25
Incorrect
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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.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 26
Incorrect
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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 K2. If there is clinically significant bleeding
an intravenous dose of 250-300 mcg/kgActivated 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
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Question 27
Incorrect
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Regarding benzylpenicillin, which of the following statements is CORRECT:
Your Answer:
Correct Answer: If meningococcal disease is suspected, benzylpenicillin should be given before transfer to hospital.
Explanation:Benzylpenicillin (although inactivated by bacterial beta-lactamases) is effective for many streptococcal (including pneumococcal), gonococcal, and meningococcal infections and also for anthrax, diphtheria, gas gangrene, leptospirosis, and treatment of Lyme disease. If meningococcal disease (meningitis with non-blanching rash or meningococcal septicaemia) is suspected, benzylpenicillin should be given before transfer to hospital, so long as this does not delay the transfer; benzylpenicillin is no longer the drug of first choice for pneumococcal meningitis. Although benzylpenicillin is effective in the treatment of tetanus, metronidazole is preferred. Benzylpenicillin is inactivated by gastric acid and absorption from the gastrointestinal tract is poor and therefore it must be given by injection.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 28
Incorrect
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A 45-year-old woman presents with persistent palpitations for the past two days. She has a good haemodynamic balance. An ECG is performed, which reveals that she has atrial flutter. The patient is examined by a cardiology registrar, who recommends using a 'rate control' strategy while she waits for cardioversion.
Which of the drugs listed below is the best fit for this strategy?Your Answer:
Correct Answer: Bisoprolol
Explanation:In atrial flutter, ventricular rate control is usually used as a stopgap measure until sinus rhythm can be restored. A beta-blocker (such as bisoprolol), diltiazem, or verapamil can be used to lower the heart rate.
Electrical cardioversion, pharmacological cardioversion, or catheter ablation can all be used to restore sinus rhythm. Cardioversion should not be attempted until the patient has been fully anticoagulated for at least three weeks if the duration of atrial flutter is unknown or has lasted for more than 48 hours. Emergency electrical cardioversion is the treatment of choice when there is an acute presentation with haemodynamic compromise. For the treatment of recurrent atrial flutter, catheter ablation is preferred.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 29
Incorrect
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Which of the following lifestyle changes is not likely to improve symptoms of gastro-oesophageal reflux disease (GORD):
Your Answer:
Correct Answer: Lowering the head of the bed
Explanation:The following approaches have some benefit in adult patients with reflux:
Weight loss or weight management for individuals who are overweight
Head of bed elevation is important for individuals with nocturnal or laryngeal symptoms, but its value for other situations is unclear.
The following lifestyle approaches also are used frequently. There is some evidence that these lifestyle changes improve laboratory measures of reflux (such as lower oesophageal sphincter pressure).
Dietary modification – A practical approach is to avoid a core group of reflux-inducing foods, including chocolate, peppermint, and alcohol, which may reduce lower oesophageal sphincter pressure. Acidic beverages, including colas with caffeine and orange juice also may exacerbate symptoms.
Avoiding the supine position soon after eating.
Promotion of salivation by either chewing gum or using oral lozenges. Salivation neutralizes refluxed acid, thereby increasing the rate of oesophageal acid clearance.
Avoidance of tobacco (including passive exposure to tobacco smoke) and alcohol. Nicotine and alcohol reduce lower oesophageal sphincter pressure, and smoking also diminishes salivation. -
This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 30
Incorrect
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All of the following predisposes to lithium toxicity in patients taking long-term therapy EXCEPT:
Your Answer:
Correct Answer: Hypernatraemia
Explanation:A common complication of long term lithium therapy results in most cases of lithium intoxication. It is caused by reduced excretion of the drug which can be due to several factors including deterioration of renal function, dehydration, hyponatraemia, infections, and co-administration of diuretics or NSAIDs or other drugs that may interact.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 31
Incorrect
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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
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Question 32
Incorrect
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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
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Question 33
Incorrect
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Which of the following is NOT one of insulin's actions:
Your Answer:
Correct Answer: Increased gluconeogenesis
Explanation:Insulin has a number of effects on glucose metabolism, including:
Inhibition of glycogenolysis and gluconeogenesis
Increased glucose transport into fat and muscle
Increased glycolysis in fat and muscle
Stimulation of glycogen synthesis
By inhibiting gluconeogenesis, insulin maintains the availability of amino acids as substrates for protein synthesis. Thus, insulin supports protein synthesis through direct and indirect mechanisms. -
This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 34
Incorrect
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An elderly female has a bacterial infection and you are asked to prescribe an antibiotic to her. This antibiotic is a nucleic acid synthesis inhibitor.
Which of the following antimicrobial drugs will be prescribed to this patient?Your Answer:
Correct Answer: Metronidazole
Explanation:Metronidazole and the other 5-nitroimidazole agents inhibit nucleic acid synthesis by forming toxic free radical metabolites in the bacterial cell that damage DNA.
Vancomycin inhibits cell wall peptidoglycan formation by binding the D-Ala-D-Ala portion of cell wall precursors.
Erythromycin inhibits protein synthesis and blocks translocation by binding to the 23S rRNA of the 50S ribosomal subunit.
Chloramphenicol blocks peptidyl transferase at 50S ribosomal subunit.
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.
An overview of the different mechanisms of action of the various types of antimicrobial agents is shown below:
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 35
Incorrect
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At which opioid receptors do opioid analgesics act primarily?
Your Answer:
Correct Answer: Mu
Explanation:Opioid receptors are widely distributed throughout the central nervous system. Opioid analgesics mimic endogenous opioid peptides by causing prolonged activation of these receptors, mainly the mu(μ)-receptors which are the most highly concentrated in brain areas involved in nociception.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 36
Incorrect
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A 40-year-old man has been admitted for alcohol detoxification. You are asked to review the patient's treatment chart and notice that he has been prescribed Pabrinex by one of your colleagues.
Out of the following, which vitamin is not found in Pabrinex?Your Answer:
Correct Answer: Vitamin B12
Explanation:Pabrinex is indicated in patients that require rapid therapy for severe depletion or malabsorption of water-soluble vitamins B and C, particularly in alcoholism detoxification.
Pabrinex has the following:
1. Thiamine (vitamin B1)
2. Riboflavin (vitamin B2)
3. Nicotinamide (Vitamin B3, niacin and nicotinic acid)
4. Pyridoxine (vitamin B6)
5. Ascorbic acid (vitamin C)
6. GlucoseSuspected or established Wernicke’s encephalopathy is treated by intravenous infusion of Pabrinex/ The dose is 2-3 pairs three times a day for three to five days, followed by one pair once daily for an additional three to five days or for as long as improvement continues.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pharmacology
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Question 37
Incorrect
-
Nifedipine commonly causes which of the following adverse effects?
Your Answer:
Correct Answer: Ankle oedema
Explanation:Most common adverse effects of Nifedipine include:
Peripheral oedema (10-30%)
Dizziness (23-27%)
Flushing (23-27%)
Headache (10-23%)
Heartburn (11%)
Nausea (11%) -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 38
Incorrect
-
Amoxicillin is used first line for all of the following infections EXCEPT for:
Your Answer:
Correct Answer: Cellulitis
Explanation: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). Flucloxacillin is used first line for acute cellulitis.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 39
Incorrect
-
Question 40
Incorrect
-
Haemoptysis, weight loss, and night sweats are symptoms of a patient. You believe you've been diagnosed with tuberculosis. He works at an asylum seeker hostel, but due to a contraindication, he did not receive a BCG vaccination when he first started there.
Which of the following patient groups would the BCG vaccine be safe to administer?Your Answer:
Correct Answer: The patient is asplenic
Explanation:In patients with asplenia, all vaccines, whether live or inactivated, are recommended.
Anaphylaxis following any vaccination is a contraindication to receiving that vaccine again.
The BCG vaccine is a live vaccine. The following situations are generally contraindicated for live vaccinations:
Pregnancy
HIV infection can be asymptomatic or symptomatic.
If it’s been less than three weeks since the last live vaccine (although two live vaccinations can be given together at different sites of the body)
Other illnesses that wreak havoc on the immune system
Malignancies of the blood -
This question is part of the following fields:
- Immunological Products & Vaccines
- Pharmacology
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Question 41
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
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 42
Incorrect
-
A 7-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 non-blanching rash on legs and arms. The GP administered a dose of antibiotics before transferring child to the Emergency Department.
Which of these is the most appropriate antibiotic to administer in this scenario from the choices available?
Your Answer:
Correct Answer: Give IM benzylpenicillin 600 mg
Explanation:Meningococcal septicaemia should be suspected in a child with a non-blanching rash especially in the presence of:
An ill-looking child
Neck stiffness
Lesions larger than 2 mm in diameter (purpura)
Capillary refill time of>3 secondsThe index child is very sick and shows signs of septic shock. In the prehospital setting, a single dose of benzylpenicillin should be given immediately. The correct dose for this childs age is IM benzylpenicillin 600 mg.
The recommended doses of benzylpenicillin according to age are:
Infants <1 year of age: IM or IV benzylpenicillin 300 mg
Children 1 to 9 years of age: IM or IV benzylpenicillin 600mg
Children and adults 10 years or older: IM or IV benzylpenicillin 1.2g -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 43
Incorrect
-
Which of the following intravenous induction drugs results in the highest drop in blood pressure:
Your Answer:
Correct Answer: Propofol
Explanation:Propofol’s most frequent side effect is hypotension, which affects 17% of paediatric patients and 26% of adults. This is attributable to systemic vasodilation as well as a decrease in preload and afterload. Propofol has a little negative inotropic impact as well. The drop in blood pressure is dosage-dependent and is more noticeable in the elderly, thus this should be expected.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 44
Incorrect
-
A 65-year-old female presents to the Emergency Department with complaints of chest pain pointing to angina. A dose of glyceryl trinitrate (GTN) was administered, rapidly resolving her symptoms. Unfortunately, she develops a side-effect of the drug.
Which one of the following is the side effect she is most likely to have developed?Your Answer:
Correct Answer: Flushing
Explanation:Angina pectoris is the most common symptom of ischemic heart disease and presents with chest pain relieved by rest and nitro-glycerine.
Nitrates are the first-line treatment to relieve chest pain caused by angina. The commonly used nitrates are:
1. Glyceryl trinitrate
2. Isosorbide dinitrateSide effects to nitrate therapy are common especially
The most common side effects are:
1. Headaches
2. Feeling dizzy, weak, or tired
3. Nausea
4. FlushingThe serious but less likely to occur side effects are:
1. Methemoglobinemia (rare)
2. Syncope
3. Prolonged bleeding time
4. Exfoliative dermatitis
5. Unstable angina
6. Rebound hypertension
7. ThrombocytopeniaDry eyes, bradycardia, and metabolic acidosis have not been reported.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 45
Incorrect
-
A young farmer who is caught under farm machinery and suffering from a major crush injury is taken to the emergency department and requires a quick induction sequence. In this type of injury, which of the following anaesthetic medicines should be avoided?
Your Answer:
Correct Answer: Suxamethonium
Explanation:Suxamethonium is a neuromuscular blocker. It is contraindicated in patients who have experienced massive trauma, hyperkalemic, or burn injuries.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 46
Incorrect
-
Which of the following best describes the mechanism of action of aspirin:
Your Answer:
Correct Answer: Cyclo-oxygenase (COX) inhibitor
Explanation:Aspirin is a non-steroidal anti-inflammatory drug (NSAID). Aspirin irreversibly inhibits cyclooxygenase (COX) enzymes and the resulting inhibition of prostaglandin synthesis results in analgesic, antipyretic and to a lesser extent anti-inflammatory actions.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 47
Incorrect
-
When treating diabetic ketoacidosis (DKA), glucose should be given together with insulin as soon as the blood glucose concentration falls below 14 mmol/L in the form of:
Your Answer:
Correct Answer: 10% glucose intravenous infusion at a rate of 125 mL/hour
Explanation:In addition to the sodium chloride 0.9 percent infusion, glucose 10% should be given intravenously (into a large vein with a large-gauge needle) at a rate of 125 mL/hour once blood glucose concentration falls below 14 mmol/litre.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 48
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
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Question 49
Incorrect
-
A 18 year old with known asthma presents himself to ED with acute breathlessness and wheeze for the past 20 minutes. On examination he is tachypneic and tachycardic. His oxygen saturations are 96% on air. What is the first line treatment for acute asthma:
Your Answer:
Correct Answer: Salbutamol
Explanation:High-dose inhaled short-acting beta2-agonists are the first line treatment for acute asthma(salbutamol or terbutaline). Oxygen should only been given to hypoxaemic patients (to maintain oxygen saturations of 94 – 98%). A pressurised metered dose inhaler with spacer device is preferred in patients with moderate to severe asthma (4 puffs initially, followed by 2 puffs every 2 minutes according to response, up to 10 puffs, whole process repeated every 10 – 20 minutes if necessary). The oxygen-driven nebuliser route is recommended for patients with life-threatening features or poorly responsive severe asthma (salbutamol 5 mg at 15 – 30 minute intervals). Continuous nebulisation should be considered in patients with severe acute asthma that is poorly responsive to initial bolus dose (salbutamol at 5 – 10 mg/hour) The intravenous route should be reserved for those in whom inhaled therapy cannot be used reliably.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 50
Incorrect
-
A 33 year old lady with a known nut allergy was having dinner at a Thai restaurant. She suddenly complained of lip and tongue swelling and difficulty breathing and is brought to ED by ambulance with suspected anaphylaxis. She received intramuscular adrenaline in the ambulance.
The most appropriate doses of the second line treatments for anaphylaxis are which of the following?Your Answer:
Correct Answer: 10 mg chlorphenamine and 200 mg hydrocortisone
Explanation:Second line drugs to reduce the severity and duration of anaphylactic symptoms are intravenous or intramuscular chlorpheniramine and hydrocortisone. The recommended dose is 10 mg chlorpheniramine and 200 mg hydrocortisone in adults.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 51
Incorrect
-
A 72-year-old man has a past medical history of diverticular disease. He now presents in the clinic with crampy abdominal pain. The nurse at the triage suggests prescribing hyoscine butyl bromide to help relieve the abdominal pain. However, you do not agree with this medication, as you can see on his chart that the patient has several other comorbidities.
Out of the following, what is NOT a contraindication to using hyoscine butyl bromide?Your Answer:
Correct Answer: Prostatic hyperplasia
Explanation:Hyoscine butylbromide is an antispasmodic drug that blocks muscarinic receptors and reduces intestinal motility. It is used for gastrointestinal and genitourinary smooth muscle spasms and symptomatic relief of IBS.
It has the following contraindications:
1. Closed-angle glaucoma
2. Gastrointestinal obstruction
3. Intestinal atony
4. Paralytic ileus
5. Toxic megacolon
6. Severe ulcerative colitis
7. Significant bladder outflow obstruction
8. Urinary retention
9. Myasthenia gravisUse cautiously in the following conditions:
1. Acute myocardial infarction (in adults)
2. Arrhythmias (may be worsened)
3. Autonomic neuropathy
4. Hypertension
5. Cardiac insufficiency (due to association with tachycardia)
6. Congestive cardiac failure (maybe worsened)
7. Cardiac surgery (due to association with tachycardia)
8. Gastro-oesophageal reflux disease
9. Ulcerative colitis
10. Prostatic hyperplasia
11. Use in children (increased risk of side effects) -
This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
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Question 52
Incorrect
-
A 28-year-old patient who has been in a car accident needs to be intubated using a rapid sequence induction. As an induction agent, you intend to use etomidate.
Etomidate works by interacting with which type of receptor?Your Answer:
Correct Answer: Gamma-aminobutyric acid (GABA)
Explanation:Etomidate is a carboxylated imidazole derivative with a short half-life that is primarily used to induce anaesthesia.
It is thought to modulate fast inhibitory synaptic transmission in the central nervous system by acting on GABA type A receptors.
The dose for anaesthesia induction is 0.3 mg/kg. Etomidate takes 10-65 seconds to take effect after an intravenous injection, and it lasts 6-8 minutes. With repeated administration, the effects are non-cumulative.The relative cardiovascular stability of etomidate is noteworthy. During induction, it causes less hypotension than thiopental sodium and propofol. It’s also linked to a quick recovery without the hangover.
Etomidate is a strong steroidogenesis inhibitor. The drug inhibits the enzymes responsible for adrenal 11 beta-hydroxylase and cholesterol cleavage, resulting in a decrease in cortisol and aldosterone synthesis for up to 24 hours after administration. It should not be used to maintain anaesthesia because of the adrenocortical suppression.
Other side effects associated with etomidate use include:
Vomiting and nausea
The injection causes pain (in up to 50 percent )
Phlebitis and thrombosis of the veins
Heart block and arrhythmias
Hyperventilation
Apnoea and respiratory depression
It has the potential to cause both hypo- and hypertension.
Critically ill patients have a higher mortality rate. -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 53
Incorrect
-
Which of the following is first-line for management of status epilepticus:
Your Answer:
Correct Answer: Intravenous lorazepam
Explanation:First-line treatment is with intravenous lorazepam if available. Intravenous diazepam is effective but it carries a high risk of thrombophlebitis so should only be used if intravenous lorazepam is not immediately available. Absorption of diazepam from intramuscular injection or from suppositories is too slow for treatment of status epilepticus. When facilities for resuscitation are not immediately available or if unable to secure immediate intravenous access, diazepam can be administered as a rectal solution or midazolam oromucosal solution can be given into the buccal cavity.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 54
Incorrect
-
After eating a peanut, a 24-year-old lady develops an anaphylactic reaction.
Which of the following should be the first step to manage the situation?Â
Your Answer:
Correct Answer: Administer IM adrenaline
Explanation:The most important medicine for treating anaphylactic responses is adrenaline. It decreases oedema and reverses peripheral vasodilation as an alpha-adrenergic receptor agonist. Its beta-adrenergic effects widen the bronchial airways, enhance the force of cardiac contraction, and inhibit the release of histamine and leukotriene. The first medicine to be given is adrenaline, and the IM route is optimal for most people.
In anaphylaxis, age-related dosages of IM adrenaline are given:
150 mcg (0.15 mL of 1:1000)Â for children under the age of sixÂ
 300 mcg (0.3 mL of 1:1000) for a child aged 6 to 12 yearsÂ
500 mcg (0.5 mL of 1:1000) for children aged 12 and above
500 mcg (0.5 mL of 1:1000) for adults -
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 55
Incorrect
-
Which of the following best describes the correct administration of adrenaline for a shockable rhythm in adult advanced life support?
Your Answer:
Correct Answer: Give 1 mg of adrenaline after the third shock and every 3 - 5 minutes thereafter
Explanation:The correct administration of IV adrenaline 1 mg (10 mL of 1:10,000 solution) is that it should be given after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 56
Incorrect
-
Lidocaine's antiarrhythmic mode of action is as follows:
Your Answer:
Correct Answer: Blocks inactivated Na+ channels
Explanation:Lidocaine is a class 1B antidysrhythmic; combines with fast Na channels and thereby inhibits recovery after repolarization, resulting in decreasing myocardial excitability and conduction velocity. However, in ischaemic areas, where anoxia causes depolarisation and arrhythmogenic activity, many Na+ channels are inactivated and therefore susceptible to lidocaine.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 57
Incorrect
-
A 63-year-old man complains of chest pain and syncope on occasion. His heart rate is 37 beats per minute, and he has a second-degree heart block, according to his rhythm strip.
Which of the following would be the most appropriate next step in his management, according to the ALS bradycardia algorithm?Your Answer:
Correct Answer: Give atropine 500 mcg
Explanation:Atropine is used to treat bradycardia (sinus, atrial, or nodal) or AV block when the patient’s haemodynamic condition is compromised by the bradycardia.
If any of the following adverse features are present, the ALS bradycardia algorithm recommends a dose of atropine 500 mcg IV:
Shock
Syncope
Myocardial ischemia
Insufficiency of the heartIf this does not work, give additional 500 mcg doses at 3-5 minute intervals until a maximum dose of 3 mg is reached. The heart rate can be slowed paradoxically if the dose is higher than 3 mg.
The ALS bradycardia algorithm also suggests the following interim measures:
Transcutaneous pacing
Isoprenaline infusion 5 mcg/min
Adrenaline infusion 2-10 mcg/minutes
Alternative drugs (aminophylline, dopamine, glucagon, glycopyrrolate) -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 58
Incorrect
-
An elderly female with a diagnosed psychiatric illness was prescribed prochlorperazine for her complaints of dizziness and nausea. Two days later, she returned to the clinic with no improvement in the symptoms.
Which one of the following is the mechanism of action of prochlorperazine?Your Answer:
Correct Answer: Dopamine receptor antagonism
Explanation:Prochlorperazine is a phenothiazine drug as it is categorized as a first-generation antipsychotic. It mainly blocks the D2 (dopamine 2) receptors in the brain. Along with dopamine, it also blocks histaminergic, cholinergic, and noradrenergic receptors.
It exerts its antiemetic effect via dopamine (D2) receptor antagonist. It is used to treat nausea and vomiting of various causes, including labyrinthine disorders.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 59
Incorrect
-
When treating diabetic ketoacidosis (DKA), which of the following should be given if the systolic blood pressure is initially less than 90 mmHg:
Your Answer:
Correct Answer: 500 mL sodium chloride 0.9% intravenous infusion over 10 - 15 minutes
Explanation:If SBP is less than 90 mmHg , 500 mL sodium chloride 0.9 percent should be administered intravenously over 10–15 minutes, and repeated if SBP remains less than 90 mmHg. When SBP is greater than 90 mmHg, sodium chloride infusion must be maintained at a rate that replaces the deficit.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 60
Incorrect
-
A patient presents with a cough, productive of green sputum and fever. He was commenced on antibiotics 4 days earlier, but his condition has worsened. There is a documented history of penicillin allergy, and the GP prescribed erythromycin.
Erythromycin exert its pharmacological effect by binding to?
Your Answer:
Correct Answer: The 50S subunit of the bacterial ribosome
Explanation:Macrolides are bacteriostatic antibiotics. They act by binding to the 50S subunit of the bacterial ribosome and inhibit translocation, therefore, inhibiting protein synthesis.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 61
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.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 62
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.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 63
Incorrect
-
Which of the following is NOT a typical side effect of digoxin:
Your Answer:
Correct Answer: Hypokalaemia
Explanation:Digoxin does not cause hypokalaemia, but hypokalaemia does potentiate digoxin toxicity. The adverse effects of digoxin are frequently due to its narrow therapeutic window and include:
Cardiac adverse effects – Sinoatrial and atrioventricular block, Premature ventricular contractions, PR prolongation and ST-segment depression
Nausea, vomiting and diarrhoea
Blurred or yellow vision
CNS effects – weakness, dizziness, confusion, apathy, malaise, headache, depression, psychosis
Thrombocytopenia and agranulocytosis (rare)
Gynaecomastia in men in prolonged administration -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 64
Incorrect
-
An unrelated medical condition brings a 28-year-old asthmatic man to the Emergency Department. When you look over his meds, you notice that he is taking Theophylline to help with his asthma.
Which of the following medicines should you NOT prescribe?Your Answer:
Correct Answer: Ciprofloxacin
Explanation:Ciprofloxacin is a cytochrome P450 enzyme inhibitor that raises theophylline levels in the blood. As a result, co-prescribing theophylline should be avoided.
The medicines that typically impact theophylline’s half-life and plasma concentration are listed in the table below:
Drugs that increase the levels of theophylline in the blood
Drugs that lower theophylline levels in the blood
Calcium channel blockers e.g. Verapamil
Fluconazole
Cimetidine
Quinolones, e.g. ciprofloxacin
Methotrexate
Barbiturates
Carbamazepine
Phenobarbital
Macrolides, e.g. erythromycin
Phenytoin (and fosphenytoin)
Rifampicin
St. John’s wort -
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 65
Incorrect
-
What is the main mechanism of action of flecainide:
Your Answer:
Correct Answer: Blocks Na+ channels
Explanation:Flecainide inhibits the transmembrane influx of extracellular Na+ ions via fast channels on cardiac tissues resulting in a decrease in rate of depolarisation of the action potential, prolonging the PR and QRS intervals. At high concentrations, it exerts inhibitory effects on slow Ca2+ channels, accompanied by moderate negative inotropic effect.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 66
Incorrect
-
A 22-year-old presents with acute severe asthma. He takes a drug prescribed by her GP but cannot recall the name and is receiving regular salbutamol nebulisers. His current potassium level is 2.8 mmol/l.
Which drug is least likely to have caused his hypokalaemia?
Your Answer:
Correct Answer: Spironolactone
Explanation:Serious hypokalaemia can occur in severe asthma and the effect can be potentiated by concomitant treatment with theophyllines like aminophylline, corticosteroids, thiazide and loop diuretics, and hypoxia. Plasma-potassium concentration should be monitored in severe asthma.
Spironolactone, a potassium-sparing diuretic, is not likely to have contributed to patients hypokalaemia.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 67
Incorrect
-
A 72 year old man is brought to ED by ambulance with sudden onset chest pain, palpitations and shortness of breath. His HR is 160 bpm and BP 90/65. ECG demonstrates new-onset fast atrial fibrillation. Which of the following is the first-line treatment option in this case:
Your Answer:
Correct Answer: Synchronised DC cardioversion
Explanation:All patients with adverse features suggesting life-threatening haemodynamic instability (shock, syncope, heart failure, myocardial ischaemia) caused by new onset atrial fibrillation should undergo emergency electrical cardioversion with synchronised DC shock without delaying to achieve anticoagulation.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
-
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Question 68
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
-
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Question 69
Incorrect
-
Which of the following is the primary indication for loop diuretics?
Your Answer:
Correct Answer: Acute pulmonary oedema
Explanation:Loop diuretics have long been the cornerstone of pulmonary oedema treatment, with furosemide being the most commonly used of these drugs. Premedication with drugs that decrease preload (e.g., nitro-glycerine [NTG]) and afterload (e.g., angiotensin-converting enzyme [ACE] inhibitors) before the administration of loop diuretics can prevent adverse hemodynamic changes.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
-
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Question 70
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?Â
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
-
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Question 71
Incorrect
-
Question 72
Incorrect
-
Which of these drugs may reduce the efficacy of contraception?
Your Answer:
Correct Answer: Carbamazepine
Explanation:Antiepileptic medications such as carbamazepine (Tegretol), topiramate (Topamax), and phenytoin (Dilantin) are widely known for reducing the contraceptive effectiveness of OCPs.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 73
Incorrect
-
A patient presents to ED with heartburn for which they already take regular antacids. Which of the following drugs can be affected if taken with antacids:
Your Answer:
Correct Answer: Digoxin
Explanation:Antacids should preferably not be taken at the same time as other drugs since they may affect absorption. When antacids are taken with acidic drugs (e.g. digoxin, phenytoin, chlorpromazine, isoniazid) they cause the absorption of the acidic drugs to be decreased, which causes low blood concentrations of the drugs, which ultimately results in reduced effects of the drugs. Antacids taken with drugs such as pseudoephedrine and levodopa increase absorption of the drugs and can cause toxicity/adverse events due to increased blood levels of the drugs. Antacids that contain magnesium trisilicate and magnesium hydroxide when taken with some other medications (such as tetracycline) will bind to the drugs, and reduce their absorption and effects.
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 74
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.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 75
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.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 76
Incorrect
-
A 45-year-old man, a known case of epilepsy, visits his neurologist with complaints of red, swollen gums.
Which of the following medications is most likely responsible for his symptoms?Your Answer:
Correct Answer: Phenytoin
Explanation:Phenytoin is a commonly used antiepileptic drug. A well-recognized side-effect of phenytoin is gingival enlargement and occurs in about 50% of patients receiving phenytoin. It is believed that reduced folate levels may cause this, and evidence suggests that folic acid supplementation may help prevent this in patients starting phenytoin.
As evidence suggests, drug-induced gingival enlargement may also improve by substituting with other anticonvulsant drugs and reinforcing a good oral hygiene regimen. Surgical excision of hyperplastic gingiva is often necessary to correct the aesthetic and functional impairment associated with this condition to manage it successfully.
Phenytoin is also the only anticonvulsant therapy associated with the development of Dupuytren’s contracture.
Other side effects are:
1. Ataxia
2. Drug-induced lupus
3. Hirsutism
4. Pruritic rash
5. Megaloblastic anaemia
6. Nystagmus -
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 77
Incorrect
-
Which of the following is NOT an adverse effect associated with warfarin therapy:
Your Answer:
Correct Answer: Neutropenia
Explanation:Adverse effects of warfarin:
The most common adverse effect of warfarin is bleedingOther common adverse effects of warfarin include nausea, vomiting, diarrhoea, jaundice, hepatic dysfunction, pancreatitis, pyrexia, alopecia, purpura, and rash
Skin necrosis is a rare but serious adverse effect of warfarin; treatment with warfarin should be stopped if warfarin related skin necrosis is suspected
Calciphylaxis is a rare, but a very serious condition that causes vascular calcification and cutaneous necrosis
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 78
Incorrect
-
Regarding airway resistance, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Airway resistance is predominantly determined by the radius of the airway as described by Poiseuille's law.
Explanation:Flow through airways is described by Darcy’s law which states that flow is directly proportional to the mouth-alveolar pressure gradient and inversely proportional to airway resistance. Airway resistance is primarily determined by the airway radius according to Poiseuille’s law, and whether the flow is laminar or turbulent. Parasympathetic stimulation causes bronchoconstriction and sympathetic stimulation causes bronchodilation, but mediated by beta2-adrenoceptors. Muscarinic antagonists e.g. ipratropium bromide cause bronchodilation.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 79
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.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 80
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.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 81
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 possibleThe 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/minuteIn 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.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 82
Incorrect
-
A 60-year-old female has a past medical history of diverticular disease. She now presents in the clinic with crampy abdominal pain. The nurse at the triage suggests prescribing hyoscine butyl bromide to help relieve the abdominal pain. However, after administering this treatment, the patient develops a side-effect to the medication.
What side-effect of using hyoscine butyl bromide is she MOST likely to develop out of the following?Your Answer:
Correct Answer: Dry mouth
Explanation:Hyoscine butylbromide is an antispasmodic drug that blocks muscarinic receptors and reduces intestinal motility. It is used for gastrointestinal and genitourinary smooth muscle spasms and symptomatic relief of IBS.
It has the following side-effects:
1. Constipation
2. Dizziness
3. Drowsiness
4. Dry mouth
5. Dyspepsia
6. Flushing
7. Headache
8. Nausea and vomiting
9. Palpitations
10. Skin reactions
11. Tachycardia
12. Urinary disorders
13. Disorders of vision -
This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
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Question 83
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.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 84
Incorrect
-
You examine a 72-year-old man who has recently begun bumetanide treatment for worsening heart failure.
Which of these statements about bumetanide is correct?Your Answer:
Correct Answer: It has better intestinal absorption than furosemide
Explanation:Bumetanide is a loop diuretic that is used to treat congestive heart failure. It is frequently used in patients who have failed to respond to high doses of furosemide.
It has a potency of about 40 times that of furosemide, with a 1 mg dose being roughly equivalent to a 40 mg dose of furosemide.
Seizures are not known to be triggered by bumetanide. In fact, it lowers the concentration of neuronal chloride, making GABA’s action more depolarizing, and it’s currently being tested as an antiepileptic in the neonatal period.It takes effect after 1 hour of oral administration, and diuresis takes 6 hours to complete.
Bumetanide absorbs much better in the intestine than furosemide. Because it has a higher bioavailability than furosemide, it is commonly used in patients with gut oedema.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 85
Incorrect
-
Which of the following best describes digoxin:
Your Answer:
Correct Answer: A positive inotrope and negative chronotrope
Explanation:Digoxin is a cardiac glycoside used in the treatment of atrial fibrillation and flutter, and congestive cardiac failure. It acts by inhibiting the membrane Na/K ATPase in cardiac myocytes. This raises intracellular sodium concentration and increases intracellular calcium availability indirectly via Na/Ca exchange. The increase in intracellular calcium levels causes an increases the force of myocardial contraction (positive inotrope), and slows the heart rate (negative chronotrope).
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 86
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
Vancomycin2) Disruption of cell membrane function
Polymyxins
Nystatin
Amphotericin B3) Inhibition of protein synthesis
Macrolides
Aminoglycosides
Tetracyclines
Chloramphenicol4) Inhibition of nucleic acid synthesis
Quinolones
Trimethoprim
5-nitroimidazoles
Rifampicin5) Anti-metabolic activity
Sulphonamides
Isoniazid -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 87
Incorrect
-
Which of the following conditions require IV Lidocaine administration?
Your Answer:
Correct Answer: Refractory ventricular fibrillation in cardiac arrest
Explanation:IV Lidocaine is indicated in Ventricular Arrhythmias or Pulseless Ventricular Tachycardia (after defibrillation, attempted CPR, and vasopressor administration)
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 88
Incorrect
-
Which of the following is NOT an adverse effect of amitriptyline:
Your Answer:
Correct Answer: Hypokalaemia
Explanation:Adverse effects include:
Antimuscarinic effects: Dry mouth, Blurred vision, Constipation, Urinary retention, Sedation, Confusion
Cardiovascular effects: Heart block, Arrhythmias, Tachycardia, Postural hypotension, QT-interval prolongation, Hepatic impairment, Narrow-angle glaucoma -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 89
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.
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This question is part of the following fields:
- Musculoskeletal
- Pharmacology
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Question 90
Incorrect
-
Which of the following statements about lithium treatment is FALSE:
Your Answer:
Correct Answer: Concomitant treatment with NSAIDs decreases serum-lithium concentration.
Explanation:Lithium levels are raised by NSAIDs because renal clearance is reduced. Lithium is a small ion (74 Daltons) with no protein or tissue binding and is therefore amenable to haemodialysis. Lithium is freely distributed throughout total body water with a volume of distribution between 0.6 to 0.9 L/kg, although the volume may be smaller in the elderly, who have less lean body mass and less total body water. Steady-state serum levels are typically reached within five days at the usual oral dose of 1200 to 1800 mg/day. The half-life for lithium is approximately 18 hours in adults and 36 hours in the elderly.
Lithium is excreted almost entirely by the kidneys and is handled in a manner similar to sodium. Lithium is freely filtered but over 60 percent is then reabsorbed by the proximal tubules. -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 91
Incorrect
-
A patient who is taking ramipril for high blood pressure complains of a dry persistent cough. What is the mechanism of cough in ACE inhibitor therapy:
Your Answer:
Correct Answer: Decreased bradykinin breakdown
Explanation:Blocking ACE also diminishes the breakdown of the potent vasodilator bradykinin which is the cause of the persistent dry cough. Angiotensin-II receptor blockers do not have this effect, therefore they are useful alternative for patients who have to discontinue an ACE inhibitor because of persistent cough.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 92
Incorrect
-
Carbamazepine is indicated for all of the following EXCEPT for:
Your Answer:
Correct Answer: Myoclonic seizures
Explanation:Carbamazepine is a drug of choice for simple and complex focal seizures and is a first-line treatment option for generalised tonic-clonic seizures. It is also used in trigeminal neuralgia and diabetic neuropathy. Carbamazepine may exacerbate tonic, atonic, myoclonic and absence seizures and is therefore not recommended if these seizures are present.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 93
Incorrect
-
Hartmann's solution contains how much sodium:
Your Answer:
Correct Answer: 131 mmol/L
Explanation:Hartmann’s solution (compound sodium lactate) contains: Na+131 mmol/L, K+5 mmol/L, HCO3-29 mmol/L (as lactate), Cl-111 mmol/L, Ca2+2 mmol/L. It can be used instead of isotonic sodium chloride solution during or after surgery, or in the initial management of the injured or wounded; it may reduce the risk of hyperchloraemic acidosis.
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This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
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Question 94
Incorrect
-
A 52-year-old woman visits her local pharmacy to get medication to help with mild dyspepsia symptoms. The pharmacist on duty suggests she uses an over-the-counter antacid. She purchases an antacid that contains magnesium carbonate, which relieves her symptoms, but she unfortunately also develops a side effect.
Out of the following, which side effect is she MOST likely to develop after using the antacid?Your Answer:
Correct Answer: Diarrhoea
Explanation:Magnesium carbonate is an over the counter antacid commonly used to relieve symptoms in ulcer dyspepsia and non-erosive gastro-oesophageal reflux.
Antacids containing magnesium also tend to work as a laxative, while the antacids with aluminium may cause constipation. There is no significant increased risk of anaphylaxis, hepatotoxicity or renal impairment.
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This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
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Question 95
Incorrect
-
A 28-year-old woman in her second trimester is diagnosed with a psychiatric illness. She is started on treatment with a drug. The treatment results in her baby being born with poor tone, feeding problems, hypothyroidism, and a goitre
Out of the following, which drug is most likely responsible for the baby's condition?Your Answer:
Correct Answer: Lithium
Explanation:In pregnancy and postpartum, lithium is an effective treatment for relapse prevention in bipolar disorder. However, lithium has also been associated with risks during pregnancy for both the mother and the unborn child. Recent large studies have confirmed the association between first-trimester lithium exposure and an increased risk of congenital malformations.
Lithium levels need to be monitored more frequently throughout pregnancy and the postnatal period.
If given in the 1st-trimester, lithium is associated with a risk of fetal cardiac malformations, such as Ebstein’s anomaly.
If given in the 2nd and 3rd-trimesters, there is a risk of the following:
1. hypotonia
2. lethargy
3. feeding problems
4. hypothyroidism
5. goitre
6. nephrogenic diabetes insipidus in the neonate -
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 96
Incorrect
-
Co-amoxiclav is used first line for which of the following indications:
Your Answer:
Correct Answer: Animal bite
Explanation:Co-amoxiclav is used first line for infected and prophylaxis of infection in animal and human bites.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 97
Incorrect
-
A young boy is carried by his friends to the Emergency Department in an unconscious state. He is quickly moved into the resuscitation room.
He was at a party with friends and has injected heroin. On examination, his GCS is 6/15, and he has bilateral pinpoint pupils and a very low respiratory rate of 6 breaths per minute.
Which of the following is the first-line treatment for this patient?Your Answer:
Correct Answer: Naloxone 0.8 mg IV
Explanation:Heroin is injected into the veins and is the most commonly abused drug. Acute intoxication with opioid overuse is the most common cause of death by drug overdose.
The clinical features of opioid overdose are:
1. Decreased respiratory rate
2. Reduced conscious level or coma
3. Decreased bowel sounds
4. Miotic (constricted) pupils
5. Cyanosis
6. Hypotension
7. Seizures
8. Non-cardiogenic pulmonary oedema (with IV heroin usage)The main cause of death secondary to opioid overdose is respiratory depression, which usually occurs within 1 hour of the overdose. Vomiting is also common, and aspiration can occur.
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 with repeated injections is 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.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 98
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.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 99
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
CephalosporinsThe function of the cell membrane is disrupted
Nystatin
Polymyxins
Amphotericin BInhibition of protein synthesis
Chloramphenicol
Macrolides
Aminoglycosides
TetracyclinesNucleic 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 100
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 abdomenThe 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.
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This question is part of the following fields:
- Immunological Products & Vaccines
- Pharmacology
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Question 101
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
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Question 102
Incorrect
-
After returning from Thailand two days ago, a 61-year-old man presents to the department with severe diarrhoea and vomiting. He has a history of hypertension and takes an ACE inhibitor to treat it.
Which of the following statements about angiotensin-converting enzyme inhibitors is correct?Your Answer:
Correct Answer: They have been shown to reduce mortality in heart failure
Explanation:Angiotensin-converting enzyme (ACE) inhibitors prevent angiotensin I from being converted to angiotensin II. Angiotensin II has a variety of effects:
Sympathetic activity has increased.
Vasoconstriction in the arteries
Secretion of Vasopressin
Secretion of aldosteroneThe increase in systemic blood pressure is caused by arteriolar vasoconstriction. Vasopressin stimulates water reabsorption in the kidneys as well as the thirst sensation. In the distal convoluted tubules and collecting ducts, aldosterone causes the reabsorption of sodium and water from the urine in exchange for potassium secretion. As a result, ACE inhibitors lower systemic blood pressure while also causing hyperkalaemia.
Angiotensin-converting enzyme inhibitors (ACE inhibitors) are used in a variety of clinical settings, including heart failure. According to a meta-analysis, ACE inhibitors reduce death, MI, and overall admission in patients with heart failure by 28%.
ACE inhibitors are also used in the following clinical settings:
Hypertension
Chronic kidney disease
Diabetic nephropathyÂ
Following a myocardial infarctionIn the presence of renal artery stenosis, ACE inhibitors are contraindicated because they can cause or exacerbate renal failure.
The most common side effect of ACE inhibitors is a dry cough caused by increased bradykinin production. There is, however, no known link to fibrosis of the lungs. -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 103
Incorrect
-
A 68-year-old man is being treated with digoxin for atrial fibrillation. When serum digoxin levels are above the therapeutic range, he is at highest risk for developing digoxin toxicity if he also develops which of the following?
Your Answer:
Correct Answer: Hypokalaemia
Explanation:Predisposing factors for digoxin toxicity include hypoxia, hypercalcaemia, hypokalaemia and hypomagnesaemia There should also be care taken in the elderly who are particularly susceptible to digoxin toxicity. Hypokalaemia may be precipitated by use of diuretics. Hyponatremia can result in the development of other pathological disturbances, but it does not make digoxin toxicity worse.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 104
Incorrect
-
Digoxin is contraindicated in all of the following EXCEPT for:
Your Answer:
Correct Answer: Asthma
Explanation:Digoxin is contraindicated in:Supraventricular arrhythmias associated with accessory conduction pathways e.g. Wolff-Parkinson-White syndromeVentricular tachycardia or fibrillationHeart conduction problems e.g. second degree or intermittent complete heart blockHypertrophic cardiomyopathy (unless concomitant atrial fibrillation and heart failure but should be used with caution)
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 105
Incorrect
-
The risk of renal impairment in a patient on ACE inhibitor therapy is increased by concomitant treatment with which of the following drug classes:
Your Answer:
Correct Answer: NSAIDs
Explanation:Concomitant treatment with NSAIDs increases the risk of renal damage, and with potassium-sparing diuretics (or potassium-containing salt substitutes) increases the risk of hyperkalaemia. Hyperkalaemia and other side effects of ACE inhibitors are more common in the elderly and in those with impaired renal function and the dose may need to be reduced.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 106
Incorrect
-
Ipratropium bromide should be used with caution in patients with which of the following conditions:
Your Answer:
Correct Answer: Prostatic hyperplasia
Explanation:Ipratropium bromide is an antimuscarinic drug used in the management of acute asthma and COPD. It can provide short-term relief in chronic asthma, but short-acting β2agonists act more quickly and are preferred.
The BTS guidelines recommend that nebulised ipratropium bromide (0.5 mg 4-6 hourly) can be added to β2agonist treatment for patients with acute severe or life-threatening asthma or those with a poor initial response to β2 agonist therapy.
The aerosol inhalation of ipratropium can be used for short-term relief in mild chronic obstructive pulmonary disease in patients who are not already using a long-acting antimuscarinic drug (e.g. tiotropium).Its maximum effect occurs 30-60 minutes after use; its duration of action is 3-6 hours, and bronchodilation can usually be maintained with treatment three times per day.
The commonest side effect of ipratropium bromide is dry mouth. It can also trigger acute closed-angle glaucoma in susceptible patients. Tremor is commonly seen with β2agonists but not with antimuscarinics. Ipratropium bromide should be used with caution in: Men with prostatic hyperplasia and bladder-outflow obstruction (worsened urinary retention has been reported in elderly men), People with chronic kidney disease (CKD) stages 3 and above (because of the risk of drug toxicity), People with angle-closure glaucoma (nebulised mist of antimuscarinic drugs can precipitate or worsen acute angle-closure glaucoma) -
This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 107
Incorrect
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Intravenous glucose solutions are typically used in the treatment of all of the following situations except:
Your Answer:
Correct Answer: Hypokalaemia
Explanation:In hypokalaemia, initial potassium replacement therapy should not involve glucose infusions, as glucose may cause a further decrease in the plasma-potassium concentration. Glucose infusions are used for the other indications like diabetic ketoacidosis, hypoglycaemia, routine fluid maintenance in patients who are nil by mouth (very important in children), and in hyperkalaemia.
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This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
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Question 108
Incorrect
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A young 20-year-old boy is a known case of type I diabetes mellitus. Today, he presents with polyuria, polydipsia, and abdominal pain in the emergency department. His blood sugar is drawn, which is markedly elevated to 7 mmol/L. Quick ABGs are drawn, which show metabolic acidosis. You diagnose the patient to be suffering from diabetic ketoacidosis (DKA) and immediately commence its treatment protocol in which insulin is also administered.
Out of the following, which parameter is MOST likely to change due to initiating insulin?Your Answer:
Correct Answer: Potassium
Explanation:Diabetes ketoacidosis is an acute complication of diabetes mellitus. Insulin is administered to achieve euglycemia, and crystalloids or colloidal solution is administered to achieve euvolemia and euelectrolytaemia.
Potassium levels severely fluctuate during the treatment of DKA, hypokalaemia being more common. Insulin promotes the cell to take up potassium from the extracellular space via increased sodium-potassium pump activity.
It is important to monitor potassium levels during the treatment of DKA regularly. It is widely suggested that the normal saline shall be used for initial resuscitation, and once the potassium level is retrieved, the patient can be started on potassium replacement should the serum potassium level be between 3.3 and 4.5 mmol/L
If potassium levels fall below 3.3 mmol/l, insulin administration may need to be interrupted to correct the hypokalaemia. -
This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 109
Incorrect
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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
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 110
Incorrect
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Which of the following is NOT a common side effect of amiodarone:
Your Answer:
Correct Answer: Blue/green teeth discolouration
Explanation:Common side effects of amiodarone include: Bradycardia, Nausea and vomiting, Thyroid disorders – hypothyroidism and hyperthyroidism, Persistent slate grey skin discoloration, Photosensitivity, Pulmonary toxicity (including pneumonitis and fibrosis), Hepatotoxicity, Corneal microdeposits (sometimes with night glare), Peripheral neuropathy and Sleep disorders.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 111
Incorrect
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A 5-year-old girl is brought into the Paediatric ER for acute seizures. She has been convulsing for the past 18 minutes now and was already two doses of lorazepam in the ambulance. Now, you prepare a phenytoin infusion to abolish the seizures.
According to the APLS algorithm, what dose of phenytoin is advised for a convulsing child at this stage?Your Answer:
Correct Answer: 20 mg/kg over 20 minutes
Explanation:Advanced paediatric life support (APLS) recommends phenytoin as the first choice for second-line anticonvulsant in a patient that continues to seize ten minutes after the second dose of the first-line anticonvulsant (benzodiazepine). (step 3 of the APLS algorithm)
The recommended dose of phenytoin infusion is up at 20 mg/kg over 20 minutes. If the patient has already taken phenytoin as maintenance therapy or is allergic to phenytoin, then a phenobarbitone infusion should be set up at 20 mg/kg over 30-60 minutes.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 112
Incorrect
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Which of the following is NOT a common side effect of adenosine:
Your Answer:
Correct Answer: Yellow vision
Explanation:Common side effects of adenosine include:
Apprehension
Dizziness, flushing, headache, nausea, dyspnoea
Angina (discontinue)
AV block, sinus pause and arrhythmia (discontinue if asystole or severe bradycardia occur) -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 113
Incorrect
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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.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 114
Incorrect
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All of the following statements are correct regarding the management of acute asthma in adults except:
Your Answer:
Correct Answer: Intravenous aminophylline has been shown to result in significant additional bronchodilation compared to standard care.
Explanation:There usually isn’t any additional bronchodilation with intravenous (IV) aminophylline compared to standard care with inhaled bronchodilators and steroids. IV aminophylline may cause side effects such as arrhythmias and vomiting. However, some additional benefit may be gained in patients with near-fatal asthma or life-threatening asthma with a poor response to initial therapy (5 mg/kg loading dose over 20 minutes unless on maintenance oral therapy, then continuous infusion of 0.5 – 0.7 mg/kg/hr).
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 115
Incorrect
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Glucagon may be used as an antidote for overdose with which of the following:
Your Answer:
Correct Answer: Beta blockers
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 productionGlycolysis 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.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 116
Incorrect
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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
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 117
Incorrect
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Which of the following statements is correct with regards to heparin-induced thrombocytopaenia (HIT)?
Your Answer:
Correct Answer: HIT typically develops 5-10 days after starting heparin.
Explanation:Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder caused by antibodies that recognize complexes of platelet factor 4 (PF4) and heparin. HIT is frequently considered in the differential diagnosis of thrombocytopenia occurring in patients on heparin therapy. HIT is a challenging diagnosis because of routine heparin use in hospitalized patients, the common occurrence of thrombocytopenia. The process of heparin dependent IgG antibodies binding to heparin/platelet factor 4 complexes activates platelets and produces a hypercoagulable state. This syndrome typically develops 5-10 days (range 4-15 days) after heparin is commenced. It can occur with unfractionated heparin, low molecular weight heparin, or, rarely, fondaparinux. The diagnosis of HIT requires the combination of a compatible clinical picture and laboratory confirmation of the presence of heparin dependent platelet activating HIT antibodies. Discontinuation of heparin alone or initiation of a vitamin K antagonist alone like warfarin, is not sufficient to stop the development of thrombosis in patients with acute HIT. If there is moderate clinical suspicion for HIT, all sources of heparin must be discontinued and there must be consideration of anticoagulant treatment with a non-heparin drug.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 118
Incorrect
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Which of the following is NOT a typical side effect of opioid analgesics:
Your Answer:
Correct Answer: Diarrhoea
Explanation:All opioids have the potential to cause:
Gastrointestinal effects – Nausea, vomiting, constipation, difficulty with micturition (urinary retention), biliary spasm
Central nervous system effects – Sedation, euphoria, respiratory depression, miosis
Cardiovascular effects – Peripheral vasodilation, postural hypotension
Dependence and tolerance -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 119
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