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  • Question 1 - A 7-year-old presented to a GP with a history of headache, neck stiffness...

    Correct

    • 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: 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 seconds

      The 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
      5
      Seconds

  • Question 2 - Regarding inhaled corticosteroids, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer:

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

      Explanation:

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

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      0
      Seconds

  • Question 3 - A 34-year-old man arrives at the department befuddled. He has a history of...

    Incorrect

    • A 34-year-old man arrives at the department befuddled. He has a history of schizophrenia and is on an antipsychotic medication, but he can't recall what it's called.

      Which of the following statements about antipsychotic drug side effects is correct?

      Your Answer:

      Correct Answer: Haloperidol is the most common causative antipsychotic drug

      Explanation:

      Extrapyramidal side effects are most common with piperazine phenothiazines (fluphenazine, prochlorperazine, and trifluoperazine) and butyrophenones (fluphenazine, prochlorperazine, and trifluoperazine) (benperidol and haloperidol). The most common causative antipsychotic drug is haloperidol.

      Tardive dyskinesia (rhythmic, involuntary movements of the tongue, face, and jaw) is most commonly associated with long-term or high-dose treatment. It is the most serious form of extrapyramidal symptoms because withdrawal of the causative drug may make it irreversible, and treatment is usually ineffective.

      Dystonia (abnormal facial and body movements) is more common in children and young adults, and it usually shows up after only a few doses. Procyclidine 5 mg IV or benzatropine 2 mg IV as a bolus can be used to treat acute dystonia.

      An unpleasant feeling of restlessness characterises akathisia. The inability to initiate movement is known as akinesia.

      Renal impairment causes increased cerebral sensitivity, so lower doses should be used.

      In elderly patients with dementia-related psychosis who are treated with haloperidol, there is an increased risk of death. This appears to be due to a higher risk of heart attacks and infections like pneumonia.

      The following are some of the antipsychotic drugs’ contraindications:
      Reduced level of consciousness/coma
      Depression of the central nervous system
      Phaeochromocytoma

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 4 - Nifedipine commonly causes which of the following adverse effects? ...

    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
      0
      Seconds

  • Question 5 - What is the recommended dosing regime for amiodarone in the treatment of a...

    Incorrect

    • What is the recommended dosing regime for amiodarone in the treatment of a stable regular broad-complex tachycardia:

      Your Answer:

      Correct Answer: 300 mg IV over 10 - 60 minutes, followed by an IV infusion of 900 mg over the next 24 hours

      Explanation:

      A ventricular tachycardia (or broad-complex tachycardia of uncertain origin) should be treated with amiodarone 300 mg IV over 10 – 60 min, followed by an infusion of 900 mg over the next 24 hours.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 6 - Which of the following drugs used in the management of hyperkalaemia does not...

    Incorrect

    • Which of the following drugs used in the management of hyperkalaemia does not affect serum potassium levels:

      Your Answer:

      Correct Answer: Calcium gluconate

      Explanation:

      Calcium gluconate is given to antagonise cardiac cell membrane excitability to reduce the risk of arrhythmias. It has no effect on serum potassium levels unlike the alternative drugs listed above.

    • This question is part of the following fields:

      • Fluids And Electrolytes
      • Pharmacology
      0
      Seconds

  • Question 7 - Which of the following is NOT a typical electrolyte disturbance caused by furosemide:...

    Incorrect

    • Which of the following is NOT a typical electrolyte disturbance caused by furosemide:

      Your Answer:

      Correct Answer: Hypercalcaemia

      Explanation:

      Adverse effects of loop diuretics include:
      Mild gastrointestinal disturbances, pancreatitis and hepatic encephalopathy
      Hyperglycaemia
      Acute urinary retention
      Water and electrolyte imbalance
      Hyponatraemia, hypocalcaemia, hypokalaemia, hypomagnesaemia, hypochloraemiaHypotension, hypovolaemia, dehydration, and venous thromboembolism
      Metabolic alkalosis
      Hyperuricaemia
      Blood disorders (bone marrow suppression, thrombocytopenia, and leucopenia)
      Visual disturbance, tinnitus and deafness
      Hypersensitivity reactions

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 8 - Regarding alteplase, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer:

      Correct Answer: Alteplase is commonly associated with hypotensive effects.

      Explanation:

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

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 9 - A 60-year-old patient had a sudden onset of palpitations and shortness of breath....

    Incorrect

    • A 60-year-old patient had a sudden onset of palpitations and shortness of breath. He had a history of poorly controlled hypertension and ischemic heart disease. His ECG also shows atrial fibrillation. Based on the patient’s condition, which pharmacologic cardioversion would be best to use?

      Your Answer:

      Correct Answer: Amiodarone

      Explanation:

      Chemical cardioversion, or pharmacologic cardioversion, is the treatment of abnormal heart rhythms using drugs.

      Flecainide and propafenone are examples of drugs used as chemical cardioverters.

      However, given the situation of the patient, these drugs are contraindicated for his ischaemic heart disease. Amiodarone is also an antiarrhythmic drug and is the best choice for this situation.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 10 - Which of the following is NOT one of insulin's actions: ...

    Incorrect

    • 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
      0
      Seconds

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

    Incorrect

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

      Your Answer:

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

      Explanation:

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

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 12 - Which of the following is NOT a benefit of low molecular weight heparin...

    Incorrect

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

      Your Answer:

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

      Explanation:

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

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 13 - Which of the following best describes the therapeutic effect of calcium gluconate when used...

    Incorrect

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

      Your Answer:

      Correct Answer: Reduces cardiac cell membrane excitability

      Explanation:

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

    • This question is part of the following fields:

      • Fluids And Electrolytes
      • Pharmacology
      0
      Seconds

  • Question 14 - You plan to use plain 1% lidocaine for a ring block on a...

    Incorrect

    • You plan to use plain 1% lidocaine for a ring block on a finger that needs suturing.
      Which SINGLE statement regarding the use of 1% lidocaine, in this case, is true?

      Your Answer:

      Correct Answer: Lidocaine works by blocking fast voltage-gated sodium channels

      Explanation:

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

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
      Seconds

  • Question 15 - Which of the following is a contraindication for aspirin? ...

    Incorrect

    • Which of the following is a contraindication for aspirin?

      Your Answer:

      Correct Answer: Children under 16 years

      Explanation:

      Aspirin contraindications include: hypersensitivity to NSAIDs; asthma, rhinitis, and nasal polyps; and usage in children or teens.
      There is little evidence of allergic cross-reactivity for salicylates. However, due to similarities in chemical structure and/or pharmacologic activities, the possibility of cross-sensitivity cannot be completely ruled out.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      0
      Seconds

  • Question 16 - A 20-year-old boy took almost 25 tablets of paracetamol almost 4 hours ago....

    Incorrect

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

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

      Your Answer:

      Correct Answer: N-hydroxylation

      Explanation:

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

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

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 17 - After what time period should intravenous phenytoin be used as second-line treatment of...

    Incorrect

    • After what time period should intravenous phenytoin be used as second-line treatment of status epilepticus?

      Your Answer:

      Correct Answer: 25 minutes

      Explanation:

      If seizures recur or fail to respond after initial treatment with benzodiazepines within 25 minutes of onset, phenytoin sodium, fosphenytoin sodium, or phenobarbital sodium should be used.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      0
      Seconds

  • Question 18 - A 56-year-old female presents at the hospital with a diabetic foot ulcer that...

    Incorrect

    • A 56-year-old female presents at the hospital with a diabetic foot ulcer that has become infected. She has a longstanding history of type 2 diabetes mellitus and diabetic polyneuropathy. She has trouble controlling her blood sugar levels, and recently, she was converted to a new insulin regimen that includes intermediate-acting insulin.

      Out of the following, which one is the intermediate-acting insulin?

      Your Answer:

      Correct Answer: Isophane insulin

      Explanation:

      Insulin is used mainly in type 1 diabetes, where the pancreas makes no insulin and can sometimes be prescribed in type 1 diabetes. There are different types of insulin categorized by their onset of action:

      1. Intermediate-acting insulins (isophane insulin NPH):
      – intermediate duration of action, designed to mimic the effect of endogenous basal insulin
      – starts their action in 1 to 4 hours
      – peaks in 4 to 8 hours
      – dosing is usually twice a day and helps maintain blood sugar throughout the day
      – Isophane insulin is a suspension of insulin with protamine

      2. Short-acting insulins (regular insulin)
      – starts the action in 30 to 40 minutes
      – peaks in 90 to 120 minutes
      – duration of action is 6 to 8 hours
      – taken before meals, and food is necessary within 30 minutes after its administration to avoid hypoglycaemia

      3. Long-acting insulins (glargine, detemir, degludec)
      – start action in 1 to 2 hours
      – plateau effect over 12 to 24 hours
      – Dosing is usually during the night-time after meals. Their long duration of action helps in reducing the frequency of dosing throughout the day.

      4. Rapid-acting insulins (lispro, aspart, glulisine)
      – start their action in 5 to 15 minutes
      – peak in 30 minutes
      – The duration of action is 3 to 5 hours
      – generally used before meals and always used along with short-acting or long-acting insulins to control sugar levels throughout the day.

    • This question is part of the following fields:

      • Endocrine Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 19 - Which of the following side effects has limited the use of etomidate as...

    Incorrect

    • Which of the following side effects has limited the use of etomidate as an intravenous induction agent:

      Your Answer:

      Correct Answer: Adrenocortical suppression

      Explanation:

      Etomidate causes the least cardiovascular depression of the intravenous induction agents, with only a small reduction in the cardiac output and blood pressure. In the past, etomidate was widely used to induce anaesthesia in the shocked, elderly or cardiovascularly unstable patient. However, more recently it has become less popular as a single induction dose blocks the normal stress-induced increase in adrenal cortisol production for 4 – 8 hours, and up to 24 hours in elderly and debilitated patients. Although no increase in mortality has been identified following a single dose during induction of anaesthesia, the use of etomidate has declined due to a perceived potential morbidity.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
      Seconds

  • Question 20 - You suspect an anaphylactic reaction in a patient who is hypotensive, with trouble...

    Incorrect

    • You suspect an anaphylactic reaction in a patient who is hypotensive, with trouble breathing after eating peanuts. Which of the following diagnostic tests will confirm this?

      Your Answer:

      Correct Answer: Mast cell tryptase

      Explanation:

      The concentration of serum tryptase rises in anaphylaxis and anaphylactoid responses.

      Because tryptase is a significant component of mast cell granules, mast cell degranulation causes elevated tryptase levels in the blood.

      Although tryptase levels are not always high during anaphylaxis, it is considered a particular marker.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      0
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  • Question 21 - As part of his angina treatment, a 68-year-old man is prescribed a beta...

    Incorrect

    • As part of his angina treatment, a 68-year-old man is prescribed a beta blocker. He starts having nightmares and has trouble sleeping soon after starting the beta-blocker.

      Which of the beta blockers listed below is the most likely to be in his system?

      Your Answer:

      Correct Answer: Propranolol

      Explanation:

      The beta-adrenoceptors in the heart, peripheral vasculature, bronchi, pancreas, and liver are blocked by beta-adrenoceptor blocking drugs (beta blockers).

      Beta blockers come in a wide range of strengths, with the choice largely determined by the disease being treated and the patient’s unique circumstances. The intrinsic sympathomimetic activity, lipid solubility, duration of action, and cardioselectivity of beta blockers all differ.

      Some beta blockers are lipid (lipophilic) soluble, while others are water soluble (hydrophilic). Drugs that are more lipid-soluble are absorbed faster from the gut, undergo more first-pass metabolism, and are eliminated faster. They’re also more likely to get into the brain and cause central effects like insomnia and nightmares. Propranolol, pindolol, labetalol, and metoprolol are examples of lipid-soluble beta blockers. Beta blockers that are water-soluble are less likely to enter the brain and are more resistant to first-pass metabolism. They are excreted by the kidneys, and in renal impairment, dosage reduction is frequently required. Atenolol, nadolol, celiprolol, and sotalol are examples of water-soluble beta blockers.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 22 - Which of the following is NOT a side effect of phenytoin: ...

    Incorrect

    • Which of the following is NOT a side effect of phenytoin:

      Your Answer:

      Correct Answer: Ototoxicity

      Explanation:

      Adverse effects of phenytoin include:
      Nausea and vomiting
      Drowsiness, lethargy, and loss of concentration
      Headache, dizziness, tremor, nystagmus and ataxia
      Gum enlargement or overgrowth
      Coarsening of facial features, acne and hirsutism
      Skin rashes
      Blood disorders

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      0
      Seconds

  • Question 23 - You are attending to a patient that has presented with a severe headache...

    Incorrect

    • You are attending to a patient that has presented with a severe headache in the Emergency Department. The patient has signs of cerebral oedema and raised intracranial pressure.

      You discuss the case with the on-call neurology registrar and decide to prescribe Mannitol. The nurse assisting you asks you to reconsider this management plan as she suspects the patient has a contraindication to Mannitol.

      Out of the following, what is a contraindication to mannitol?

      Your Answer:

      Correct Answer: Severe cardiac failure

      Explanation:

      Mannitol is the most widely used osmotic diuretic that is most commonly used to reduce cerebral oedema and intracranial pressure.
      It is recommended to use mannitol for the reduction of CSF pressure/cerebral oedema in a dose of 0.25-2 g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.

      Mannitol has several contraindications and some of them are listed below:
      1. Anuria due to renal disease
      2. Acute intracranial bleeding (except during craniotomy)
      3. Severe cardiac failure
      4. Severe dehydration
      5. Severe pulmonary oedema or congestion
      6. Known hypersensitivity to mannitol

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
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  • Question 24 - Regarding gentamicin, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer:

      Correct Answer: Gentamicin typically causes acute glomerulonephritis in toxicity.

      Explanation:

      Gentamicin is the aminoglycoside of choice in the UK and is used widely for the treatment of serious infections. It has a broad spectrum but is inactive against anaerobes and has poor activity against haemolytic streptococci and pneumococci. When used for the blind therapy of undiagnosed serious infections it is usually given in conjunction with a penicillin or metronidazole (or both). The main toxic effects are nephrotoxicity and ototoxicity due to damage to the vestibulocochlear nerve (CN VIII).

      Gentamicin is contraindicated in myasthenia gravis and should be used with caution in renal disease which may result in accumulation and a greater risk of toxic side effects.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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  • Question 25 - A 40-year-old man who has a history of asthma arrives at the emergency...

    Incorrect

    • A 40-year-old man who has a history of asthma arrives at the emergency department complaining of palpitations that have been going on for 5 days. Which of the following beta-blockers is the safest for an asthmatic patient?

      Your Answer:

      Correct Answer: Atenolol

      Explanation:

      Atenolol is a beta blocker, which is a type of medication that works by preventing certain natural substances in the body, such as epinephrine, from acting on the heart and blood vessels.

      This effect reduces heart rate, blood pressure, and cardiac strain. Atenolol, bisoprolol fumarate, metoprolol tartrate, nebivolol, and (to a lesser extent) acebutolol have a lower action on beta2 (bronchial) receptors and are thus cardio selective but not cardiac specific.

      They have a lower effect on airway resistance, although they are not without this adverse effect.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 26 - A patient who was put on low molecular weight heparin for suspected DVT...

    Incorrect

    • A patient who was put on low molecular weight heparin for suspected DVT and was scheduled for an ultrasound after the weekend, arrives at the emergency department with significant hematemesis. Which of the following medications can be used as a heparin reversal agent:

      Your Answer:

      Correct Answer: Protamine sulfate

      Explanation:

      The management of bleeding in a patient receiving heparin depends upon the location and severity of bleeding, the underlying thromboembolic risk, and the current aPTT (for heparin) or anti-factor Xa activity (for LMW heparin). As an example, a patient with minor skin bleeding in the setting of a mechanical heart valve (high thromboembolic risk) and a therapeutic aPTT may continue heparin therapy, whereas a patient with major intracerebral bleeding in the setting of venous thromboembolism several months prior who is receiving heparin bridging perioperatively may require immediate heparin discontinuation and reversal with protamine sulphate. If haemorrhage occurs it is usually sufficient to withdraw unfractionated or low molecular weight heparin, but if rapid reversal of the effects of the heparin is required, protamine sulphate is a specific antidote (but only partially reverses the effects of low molecular weight heparins). Clinician judgment and early involvement of the appropriate consulting specialists is advised.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 27 - You proceed to administer lorazepam intravenously to a 21-year-old patient with status epilepticus....

    Incorrect

    • You proceed to administer lorazepam intravenously to a 21-year-old patient with status epilepticus. Which of the following best describes lorazepam's action?

      Your Answer:

      Correct Answer: Potentiates effect of GABA

      Explanation:

      Lorazepam is a type of benzodiazepine.

      Benzodiazepines are gamma-aminobutyric acid (GABA) receptor agonists with sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant characteristics that promote inhibitory synaptic transmission across the central nervous system.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
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  • Question 28 - The patients listed below have had wounds or injuries and were treated as...

    Incorrect

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

      Which of the following patients has had adequate tetanus protection?

      Your Answer:

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

      Explanation:

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

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

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

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

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

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

    • This question is part of the following fields:

      • Immunological Products & Vaccines
      • Pharmacology
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  • Question 29 - A young 20-year-old boy is a known case of type I diabetes mellitus....

    Incorrect

    • 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 30 - Regarding nitrous oxide, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding nitrous oxide, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Nitrous oxide may be used for maintenance of anaesthesia where its use allows reduced dosage of other agents.

      Explanation:

      For anaesthesia, nitrous oxide is commonly used in a concentration of around 50 – 66% in oxygen in association with other inhalation or intravenous agents. Nitrous oxide cannot be used as the sole anaesthetic agent due to lack of potency, but is useful as part of a combination of drugs since it allows reduction in dosage of other agents. 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. Nitrous oxide increases cerebral blood flow and should be avoided in patients with, or at risk of, raised intracranial pressure. Nitrous oxide may be administered by any trained personnel experienced in its use.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
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