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  • Question 1 - Which patient with acute ischaemic stroke is a candidate for neurosurgical intervention? ...

    Incorrect

    • Which patient with acute ischaemic stroke is a candidate for neurosurgical intervention?

      Your Answer: Neurosurgery is not indicated in ischaemic stroke

      Correct Answer: A 50-year-old with infarction of 60% of the middle cerebral artery (MCA) territory

      Explanation:

      Guidelines for Decompressive Hemicraniectomy in Large Cerebral Infarctions

      Current clinical guidelines recommend that patients under 60 years of age with large cerebral infarctions in the middle cerebral artery (MCA) territory should be considered for decompressive hemicraniectomy. This procedure involves removing part of the skull to reduce intracranial pressure and should be done within 48 hours of the stroke. Eligibility for the surgery is based on clinical and radiological evidence of a stroke affecting the MCA territory, radiological evidence that more than 50% or 145 cm3 of the MCA territory is involved, and being classified as having a moderate to severe stroke according to the National Institute of Health stroke scale.

      In addition to large cerebral infarctions in the MCA territory, other indications for neurosurgical intervention in acute ischemic stroke include a massive cerebellar infarction or evidence of hydrocephalus or brainstem compression. It is important for healthcare professionals to be aware of these guidelines and indications for neurosurgical intervention in order to provide the best possible care for stroke patients. Proper and timely intervention can greatly improve outcomes and quality of life for stroke survivors.

    • This question is part of the following fields:

      • Pharmacology
      23.2
      Seconds
  • Question 2 - A young adult with a history of psychosis and mood disorder is experiencing...

    Correct

    • A young adult with a history of psychosis and mood disorder is experiencing frequent urination and is ultimately diagnosed with diabetes insipidus. Which medication is the probable culprit?

      Your Answer: Lithium

      Explanation:

      Common Side Effects of Lithium

      Lithium is a medication that is commonly used to treat bipolar disorder. However, it can also cause a number of side effects. One of the most common side effects is gastrointestinal disturbance, which can include nausea, vomiting, and diarrhea. Another common side effect is fine tremor, which can affect the hands and fingers. Weight gain and oedema (swelling) are also possible side effects of lithium.

      In addition, lithium can cause goitre, which is an enlargement of the thyroid gland. If taken in excess, it can also lead to blurred vision, ataxia (loss of coordination), drowsiness, and coarse tremor. One of the more unique side effects of lithium is that it causes antidiuretic hormone (ADH) resistance, which can lead to the production of large volumes of dilute urine. Overall, while lithium can be an effective treatment for bipolar disorder, it is important to be aware of these potential side effects.

    • This question is part of the following fields:

      • Pharmacology
      9
      Seconds
  • Question 3 - A 15-year-old girl arrives at the Emergency Department after ingesting a handful of...

    Incorrect

    • A 15-year-old girl arrives at the Emergency Department after ingesting a handful of her father's anxiety medication. He takes lorazepam 1 mg TID for generalized anxiety disorder which has not responded well to other treatments.

      She has consumed 8 mg lorazepam and is now unresponsive, with a respiratory rate of eight per minute and oxygen saturation of 90% on room air.

      The patient does not react to verbal stimuli, but responds to a painful sternal rub and attempts to push the examiner's hand away.

      Given that the half-life of lorazepam is approximately 10-20 hours, how long will it take for the medication to be eliminated from her system?

      Your Answer: 120 hours

      Correct Answer: 200 hours

      Explanation:

      Clonazepam and Flumazenil in Benzodiazepine Overdose

      Conventionally, a drug is considered to be eliminated from the system after four or five half-lives, leaving only a small fraction of the original amount. However, this does not necessarily mean that the drug’s clinical effects have disappeared. For instance, a person who has taken clonazepam, a potent benzodiazepine used to treat certain seizure disorders, may still feel relatively alert even after only one half-life has passed.

      Clonazepam is a long-acting benzodiazepine that is approximately 20 times more potent than diazepam. In cases of benzodiazepine overdose, flumazenil may be a useful antidote. Flumazenil is particularly effective in uncomplicated cases of benzodiazepine overdose, and it works by reversing the effects of benzodiazepines on the central nervous system. Therefore, it may be considered as a treatment option for individuals who have taken an excessive amount of clonazepam or other benzodiazepines.

    • This question is part of the following fields:

      • Pharmacology
      43.6
      Seconds
  • Question 4 - A 42-year-old woman with rheumatoid arthritis is currently taking methotrexate, folic acid, Adcal-D3,...

    Incorrect

    • A 42-year-old woman with rheumatoid arthritis is currently taking methotrexate, folic acid, Adcal-D3, ibuprofen, and paracetamol. She visits the GP clinic complaining of a sore throat. Upon examination, her tonsils are enlarged with pus, she has tender cervical lymphadenopathy, and a fever of 38.5°C. She does not have a cough. What course of action would you suggest for her management plan?

      Your Answer: Admit the patient to hospital as an emergency with suspected neutropenic sepsis

      Correct Answer: Send an urgent venous blood sample for full blood count and commence benzylpenicillin 500 mg QDS for 10 days

      Explanation:

      Methotrexate and Tonsillitis: Differential Diagnosis and Treatment

      Methotrexate therapy can lead to a rare but serious complication known as marrow failure, which can manifest as fever and sore throat. However, in cases where there are clear signs of tonsillitis, such as in this patient, it is more likely to be the cause of the symptoms. To confirm the diagnosis, a full blood count is necessary to rule out marrow failure.

      In this case, the patient meets the Centor criteria for antibiotic treatment of sore throat, which includes the presence of anterior cervical adenopathy, tonsillar exudates, fever, and absence of cough. A score of four or higher suggests that the tonsillitis is more likely to be bacterial in origin, making treatment with antibiotics reasonable.

      While marrow failure is a serious complication, admitting the patient to the hospital as an emergency would not be a reasonable use of resources in this case. Instead, the focus should be on treating the tonsillitis and monitoring the patient for any signs of worsening symptoms or complications.

    • This question is part of the following fields:

      • Pharmacology
      24.2
      Seconds
  • Question 5 - A 20-year-old woman arrives at the Emergency Department experiencing an asthma attack. Normally,...

    Incorrect

    • A 20-year-old woman arrives at the Emergency Department experiencing an asthma attack. Normally, her asthma is well managed with a salbutamol inhaler taken twice daily. Due to recent work-related stress, a friend offered her a propranolol pill to alleviate her symptoms. What type of drug interaction is this indicative of?

      Your Answer: Synergistic

      Correct Answer: Antagonism

      Explanation:

      Beta Blockers and Beta Agonists: Opposing Effects

      Beta blockers like propranolol are commonly used to treat anxiety by slowing down the heart rate through beta-adrenoceptor blockade. However, this drug is not recommended for asthmatics as it can cause bronchoconstriction. On the other hand, salbutamol is a beta-adrenoceptor agonist that works by relaxing the airway muscles and is commonly used to treat asthma.

      The effects of these two drugs are opposing, making them an example of an antagonistic reaction. While beta blockers slow down the heart rate and constrict the airways, beta agonists like salbutamol do the opposite by increasing heart rate and relaxing the airway muscles. It is important to note that these drugs should not be used together as they can cancel out each other’s effects and lead to potentially harmful outcomes.

    • This question is part of the following fields:

      • Pharmacology
      17.2
      Seconds
  • Question 6 - A patient is being treated for a pneumonia. She is given 200 mg...

    Correct

    • A patient is being treated for a pneumonia. She is given 200 mg of an antibiotic. The concentration of the drug in her bloodstream is measured at 5 mg/L.

      What is the volume of distribution of this drug?

      Your Answer: 40 L

      Explanation:

      Volume of Distribution

      The volume of distribution is a measure of the volume required to achieve a specific concentration of a drug in the plasma. For instance, if 200 mg of a drug is administered and the concentration in the plasma is 5 mg/L, this is equivalent to dissolving the drug in 40 L of fluid. However, the volume of distribution varies depending on the drug’s properties, such as its affinity for proteins or fats. In general, a volume of distribution that is ten times greater than the average total plasma volume suggests that the drug is primarily bound to tissues or fat rather than being freely available in the plasma. This information is crucial when determining the appropriate loading doses for certain medications, particularly those used to treat epilepsy. To summarize, the volume of distribution is essential for optimizing drug dosing and ensuring effective treatment.

    • This question is part of the following fields:

      • Pharmacology
      33.8
      Seconds
  • Question 7 - A patient in his 50s with heart failure is prescribed a diuretic by...

    Correct

    • A patient in his 50s with heart failure is prescribed a diuretic by his GP and subsequently develops gynaecomastia. Which specific agent is most likely responsible for this adverse effect?

      Your Answer: Spironolactone

      Explanation:

      Drugs that may cause side effects and the role of Spironolactone

      There are several drugs that may cause side effects, including cimetidine, oestrogens, digoxin, and ketoconazole. These drugs can affect the body in different ways, leading to various symptoms. For instance, cimetidine may cause confusion, while oestrogens may cause breast tenderness. Digoxin may cause nausea and vomiting, and ketoconazole may cause liver problems.

      One drug that can help maintain plasma potassium levels is Spironolactone. It acts as an aldosterone antagonist, which means it blocks the effects of aldosterone, a hormone that regulates sodium and potassium levels in the body. By blocking aldosterone, Spironolactone helps to maintain a balance of potassium in the blood. This is important because too much or too little potassium can cause serious health problems, such as irregular heartbeats or muscle weakness. Therefore, Spironolactone is often prescribed to people with conditions such as heart failure, liver disease, or high blood pressure.

    • This question is part of the following fields:

      • Pharmacology
      7.8
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  • Question 8 - Which of the following drug/receptor interactions accurately describes steroid hormones? ...

    Correct

    • Which of the following drug/receptor interactions accurately describes steroid hormones?

      Your Answer: Tamoxifen – Oestrogen antagonist

      Explanation:

      Examples of Agonist and Antagonist Hormones

      Agonist and antagonist hormones are two types of hormones that have opposite effects on the body. Agonist hormones bind to specific receptors in the body and activate them, while antagonist hormones bind to the same receptors but block their activation. This can have a variety of effects on the body, depending on the specific hormone and receptor involved.

      Examples of agonist hormones include glucocorticoids like prednisolone, dexamethasone, and hydrocortisone, which are used to treat inflammation and autoimmune disorders. These hormones bind to glucocorticoid receptors and activate them, reducing inflammation and suppressing the immune system.

      On the other hand, mifepristone is an antagonist hormone that blocks the effects of glucocorticoids. It is used to terminate pregnancies and to treat conditions like Cushing’s syndrome, which is caused by an excess of glucocorticoids in the body.

      Another example of an agonist hormone is fludrocortisone, a mineralocorticoid that is used to treat conditions like Addison’s disease, which is caused by a deficiency of mineralocorticoids. Fludrocortisone binds to mineralocorticoid receptors and activates them, helping to regulate salt and water balance in the body.

      In contrast, spironolactone is an antagonist hormone that blocks the effects of mineralocorticoids. It is used to treat conditions like high blood pressure and heart failure, which can be caused by excess mineralocorticoid activity.

      Other examples of agonist and antagonist hormones include oestrogen and tamoxifen, which are used to treat breast cancer, and progesterone and danazol, which are used to treat menstrual disorders and endometriosis. the effects of these hormones and their receptors is important for developing effective treatments for a variety of conditions.

    • This question is part of the following fields:

      • Pharmacology
      19.4
      Seconds
  • Question 9 - Which statement about voltage gated ion channels (VGIC) is accurate? ...

    Correct

    • Which statement about voltage gated ion channels (VGIC) is accurate?

      Your Answer: Each subunit has six transmembrane spanning domains (S1-S6)

      Explanation:

      Voltage Gated Ion Channels

      Voltage gated ion channels (VGICs) are composed of four subunits, each containing six transmembrane domains (S1-S6). The S4 domain is believed to be the voltage sensor, as every other residue is charged. The channel of calcium and sodium VGICs is formed by a single peptide, while the potassium receptor channel is made up of four separate peptides, indicating that it is evolutionarily more primitive. The sodium VGIC is targeted by local anesthetics. In summary, VGICs are essential for the proper functioning of cells and play a crucial role in the transmission of electrical signals in the nervous system.

    • This question is part of the following fields:

      • Pharmacology
      23.8
      Seconds
  • Question 10 - How can this question be restated? ...

    Incorrect

    • How can this question be restated?

      Your Answer: 5HT3 receptor is a g protein coupled receptor

      Correct Answer: NMDA receptors are ligand gated ion channels

      Explanation:

      Different Types of Receptors in the Body

      There are various types of receptors in the body that play important roles in different physiological processes. One type of receptor is the 5HT3 receptor, which is a ligand gated ion channel. This means that it opens and closes in response to the binding of a specific ligand, allowing ions to flow in and out of the cell. Another type of receptor is the aldosterone receptor, which is a steroid receptor. This receptor binds to the hormone aldosterone and regulates the body’s electrolyte balance.

      The β2 adrenoreceptor is another type of receptor, which is a g protein coupled receptor. This receptor is activated by the hormone adrenaline and plays a role in regulating heart rate and bronchodilation. Finally, the insulin receptor is a tyrosine receptor kinase. This receptor is activated by the hormone insulin and plays a crucial role in regulating glucose metabolism in the body. the different types of receptors in the body is important for how different physiological processes are regulated.

    • This question is part of the following fields:

      • Pharmacology
      23.9
      Seconds
  • Question 11 - As an investigator, you will be participating in a clinical trial of a...

    Correct

    • As an investigator, you will be participating in a clinical trial of a new antihypertensive agent. The drug has already been tested on healthy volunteers, but this trial will be the first to involve patients. The aim of the trial is to determine the optimal dosage for therapy, which will be used in future studies. Are you ready to take part in this clinical trial?

      Your Answer: Phase 2 study

      Explanation:

      Phases of Clinical Trials

      Clinical trials are conducted in several phases to determine the safety and efficacy of a new drug. The first phase, known as phase 1, involves testing the drug on healthy volunteers to determine its safety. In phase 2, the drug is tested on patients across a range of doses to establish the most effective dose with respect to clinical efficacy and adverse events. The third phase, known as phase 3, involves expanding the number of patients to confirm the drug’s efficacy and adverse event profile. This phase is conducted prior to registration. Finally, in phase 4, the drug is tested post-marketing to support clinical endpoints for reimbursement or to support marketing messages. These phases are crucial in determining the safety and efficacy of a new drug before it is made available to the public.

    • This question is part of the following fields:

      • Pharmacology
      15.2
      Seconds
  • Question 12 - A 50-year-old male is referred by his GP for an endoscopy due to...

    Incorrect

    • A 50-year-old male is referred by his GP for an endoscopy due to recurrent indigestion. During the procedure, a small duodenal ulcer is discovered and Helicobacter pylori is found to be present. What is the recommended treatment for this patient?

      Your Answer: Bismuth alone

      Correct Answer: Omeprazole, metronidazole and clarithromycin

      Explanation:

      Helicobacter pylori and Peptic Ulceration

      The bacterium Helicobacter pylori, which is classified as a gram-negative curved rod, has been linked to the development of peptic ulceration by inhibiting the healing process. In fact, up to 90% of patients with duodenal ulceration and 70% of cases of peptic ulceration may be infected with Helicobacter. To treat this infection, therapy should focus on acid suppression and eradication of the bacterium. Triple therapy, which involves a proton pump inhibitor like omeprazole along with two antibiotics (amoxicillin/clarithromycin plus metronidazole), has been found to be the most effective treatment. This therapy should be administered for one week, with proton pump therapy continuing thereafter.

    • This question is part of the following fields:

      • Pharmacology
      49.3
      Seconds
  • Question 13 - A previously healthy 95-year-old individual with a history of hypertension arrives at the...

    Correct

    • A previously healthy 95-year-old individual with a history of hypertension arrives at the Emergency department with dysphasia and right-sided hemiplegia. A CT scan is performed urgently 2 hours after the symptoms began, revealing a left hemisphere cerebral infarction. What is the time frame for administering alteplase in the treatment of this patient?

      Your Answer: 4.5 hours

      Explanation:

      Guidelines for Thrombolysis in Stroke Patients

      According to the guidelines set by The Royal College of Physicians, thrombolysis with alteplase can be administered within three hours from the onset of stroke symptoms, regardless of the patient’s age, as long as a haemorrhagic stroke is ruled out and there are no contraindications to thrombolysis. However, in patients under the age of 80 years, alteplase can be given up to 4.5 hours from the onset of stroke, and in some cases, up to 6 hours. It is important to note that the benefits of thrombolysis decrease over time.

      The guidelines emphasize the importance of timely administration of thrombolysis to maximize its benefits. However, the decision to administer thrombolysis should be made after careful consideration of the patient’s medical history, contraindications, and the potential risks and benefits of the treatment. It is also important to rule out haemorrhagic stroke before administering thrombolysis, as it can worsen the condition and lead to complications. Overall, the guidelines provide a framework for the safe and effective use of thrombolysis in stroke patients.

    • This question is part of the following fields:

      • Pharmacology
      13.1
      Seconds
  • Question 14 - A 30-year-old expectant mother complains of feeling tired. During the examination, her nail...

    Incorrect

    • A 30-year-old expectant mother complains of feeling tired. During the examination, her nail beds and conjunctiva appear pale, and her haemoglobin level is below 98 g/L, indicating significant anaemia. What is the recommended amount of dietary iron that pregnant women should consume?

      Your Answer: 5 mg

      Correct Answer: 15 mg

      Explanation:

      Anaemia in Pregnancy

      During pregnancy, anaemia is a common occurrence due to various factors such as reduced absorption, fetal demand, and expansion of plasma volume. As the pregnancy progresses, maternal iron stores tend to become depleted. Although cessation of menstruation prevents iron loss, it is not enough to compensate for the additional fetal requirements. To address this, it is recommended that pregnant women consume 15 mg of dietary iron per day.

      It is important to routinely assess haemoglobin levels throughout each pregnancy. If haemoglobin levels are found to be less than 110 g/L, investigations and management should begin promptly. By monitoring haemoglobin levels and ensuring adequate iron intake, the risk of anaemia during pregnancy can be reduced, promoting better health outcomes for both the mother and the developing fetus.

    • This question is part of the following fields:

      • Pharmacology
      15
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  • Question 15 - A 45-year-old man with epilepsy has been prescribed carbamazepine. As time passes, the...

    Incorrect

    • A 45-year-old man with epilepsy has been prescribed carbamazepine. As time passes, the dosage of carbamazepine required by him has been gradually increasing. He only takes paracetamol occasionally and no other medications. What type of drug reaction is this indicative of?

      Your Answer: Inhibition of metabolism

      Correct Answer: Induction of metabolism

      Explanation:

      Medications and their effects on metabolism

      Some medications can affect the metabolism of other drugs. For instance, carbamazepine is a medication that induces liver enzymes, which can increase the metabolism of certain drugs that rely on those pathways. It is worth noting that carbamazepine is an auto-inducer, meaning that the amount of carbamazepine required can increase over time. This can lead to changes in the dosage required to achieve the desired therapeutic effect. Therefore, it is important to monitor patients who are taking carbamazepine or any other medication that can affect the metabolism of other drugs. By doing so, healthcare providers can ensure that patients receive the appropriate dosage of medication to achieve the desired therapeutic effect.

    • This question is part of the following fields:

      • Pharmacology
      20.7
      Seconds
  • Question 16 - What is a true statement about the way local anaesthetics work during minor...

    Incorrect

    • What is a true statement about the way local anaesthetics work during minor surgical procedures?

      Your Answer: The sodium ligand gated ion channel is the target of local anaesthetics

      Correct Answer: Adrenaline is sometimes co-administered to prolong the local action of local anaesthetics

      Explanation:

      Lidocaine and Procaine Target VGIC in Sensory Neurons

      Lidocaine and procaine are two drugs that target voltage-gated ion channels (VGIC) in sensory neurons. These drugs are particularly effective against sensory neurons with small diameters, low myelination, and low conduction velocity, such as C and Ad fibers. In contrast, large motor neurons with Aß fibers are less affected by these drugs.

      VGIC have three states: closed, transiently open, and inactivated. Lidocaine binds preferentially to the inactivated state of VGIC and stabilizes it. This mechanism of action is known as use dependence, which means that the drug is more effective when the neuron is firing rapidly.

      Overall, lidocaine and procaine are useful drugs for treating pain and other sensory disorders by targeting VGIC in sensory neurons. Their selective action on inactivated VGIC and use dependence make them effective and safe for clinical use.

    • This question is part of the following fields:

      • Pharmacology
      32.2
      Seconds
  • Question 17 - These thyroid function tests were obtained on a 55-year-old female who has recently...

    Correct

    • These thyroid function tests were obtained on a 55-year-old female who has recently been treated for hypertension:
      Free T4 28.5 pmol/L (9.8-23.1)
      TSH <0.02 mU/L (0.35-5.5)
      Free T3 10.8 pmol/L (3.5-6.5)
      She now presents with typical symptoms of hyperthyroidism.
      Which medication is likely to have caused this?

      Your Answer: Amiodarone

      Explanation:

      Amiodarone and its Effects on Thyroid Function

      Amiodarone is a medication that can have an impact on thyroid function, resulting in both hypo- and hyperthyroidism. This is due to the high iodine content in the drug, which contributes to its antiarrhythmic effects. Atenolol, on the other hand, is a beta blocker that is commonly used to treat thyrotoxicosis. Warfarin is another medication that is used to treat atrial fibrillation.

      There are two types of thyrotoxicosis that can be caused by amiodarone. Type 1 results in excess thyroxine synthesis, while type 2 leads to the release of excess thyroxine but normal levels of synthesis. It is important for healthcare professionals to monitor thyroid function in patients taking amiodarone and adjust treatment as necessary to prevent complications.

    • This question is part of the following fields:

      • Pharmacology
      19.2
      Seconds
  • Question 18 - You are managing a pediatric patient with a multidrug resistant chest infection in...

    Incorrect

    • You are managing a pediatric patient with a multidrug resistant chest infection in the pediatric intensive care unit and are consulting with the pediatric infectious disease specialist regarding the antibiotics that have been administered. All of the following antibiotics inhibit protein synthesis in the bacterial ribosome except for which one?

      Your Answer: Doxycycline

      Correct Answer: Cefuroxime

      Explanation:

      Mechanisms of Action of Antibiotics

      Antibiotics are drugs that are used to treat bacterial infections. They work by targeting specific components of the bacterial cell, which can either kill the bacteria or stop them from multiplying. Cefuroxime is a second generation cephalosporin that inhibits cell wall synthesis, making it bactericidal. Chloramphenicol and clindamycin, on the other hand, bind to the 50S subunit of the bacterial ribosome, which prevents protein synthesis and is bacteriostatic. Aminoglycosides like gentamicin and tetracyclines such as doxycycline act on the 30S subunit, which disrupts protein synthesis and is bactericidal. the mechanisms of action of antibiotics is important in selecting the appropriate drug for a specific bacterial infection.

    • This question is part of the following fields:

      • Pharmacology
      15.4
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  • Question 19 - A 20-year old woman arrives at the Emergency department after a night out...

    Correct

    • A 20-year old woman arrives at the Emergency department after a night out with her friends. According to her friends, she has been talking to herself about nonsensical things and appears agitated and restless. During the examination, it is noted that her reflexes are heightened and an electrocardiogram (ECG) reveals ventricular ectopics. What type of substance abuse is suspected in this case?

      Your Answer: Ecstasy

      Explanation:

      Ecstasy Overdose

      Ecstasy, also known as MDMA, is a drug that stimulates the central nervous system. It can cause increased alertness, euphoria, extroverted behavior, and rapid speech. People who take ecstasy may also experience a lack of desire to eat or sleep, tremors, dilated pupils, tachycardia, and hypertension. However, more severe intoxication can lead to excitability, agitation, paranoid delusions, hallucinations, hypertonia, and hyperreflexia. In some cases, convulsions, rhabdomyolysis, hyperthermia, and cardiac arrhythmias may also develop.

      Severe cases of MDMA poisoning can result in hyperthermia, disseminated intravascular coagulation, rhabdomyolysis, acute renal failure, hyponatremia, and even hepatic damage. In rare cases, amphetamine poisoning may lead to intracerebral and subarachnoid hemorrhage and acute cardiomyopathy, which can be fatal. Chronic amphetamine users may also experience hyperthyroxinemia.

    • This question is part of the following fields:

      • Pharmacology
      17.8
      Seconds
  • Question 20 - A 57-year-old man arrives at the Emergency Department in a confused and unresponsive...

    Correct

    • A 57-year-old man arrives at the Emergency Department in a confused and unresponsive state. He had been given diazepam for his back spasms and had consumed half a bottle of wine during dinner. What type of drug reaction is this indicative of?

      Your Answer: Synergistic

      Explanation:

      Benzodiazepines and Ethanol Combination Leads to Excessive Sedation

      The combination of benzodiazepines and ethanol can result in excessive sedation due to their shared action on GABA receptors, which leads to generalised neuroinhibitory effects. Both substances have a calming effect on the brain, and when taken together, they can intensify each other’s effects, leading to a dangerous level of sedation. This is likely the reason why the gentleman in question experienced excessive sedation. It is important to note that combining benzodiazepines and ethanol can be extremely dangerous and should be avoided.

    • This question is part of the following fields:

      • Pharmacology
      17.3
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  • Question 21 - A patient in his 50s with type 2 diabetes mellitus visits the clinic...

    Incorrect

    • A patient in his 50s with type 2 diabetes mellitus visits the clinic with an HbA1c of 68 mmol/mol. All recent blood tests are normal except for an eGFR of 54 mls/min/1.73 m2. The patient, who has a BMI of 29 kg/m2 and works as a heavy goods vehicle driver, is already taking the maximum tolerated doses of metformin and gliclazide and is trying to modify his diet and exercise habits. He has no other health conditions. What medication could be added to improve his glycemic control?

      Your Answer: Pioglitazone

      Correct Answer: Sitagliptin

      Explanation:

      Choosing the Right Medication for a Diabetic Patient

      When selecting a medication for a diabetic patient, it is important to consider their occupation and any driving restrictions. Insulin may not be the best option in this case. Liraglutide is only recommended for overweight patients or those who would benefit from weight loss, and it is not suitable for patients with an eGFR less than 60 mls/min/1.73 m2. Nateglinide has not been approved by NICE, and pioglitazone has been associated with various health risks.

      Therefore, sitagliptin is the most appropriate choice. While it may cause headaches and weight gain, it promotes insulin release and may require a reduction in the dose of gliclazide to avoid hypoglycemia. However, it should be used with caution in patients with renal failure. By considering the patient’s individual circumstances and medical history, healthcare professionals can make informed decisions about the most suitable medication for their diabetic patients.

    • This question is part of the following fields:

      • Pharmacology
      21.3
      Seconds
  • Question 22 - A disheveled woman is brought to the Emergency Department with constricted pupils, a...

    Correct

    • A disheveled woman is brought to the Emergency Department with constricted pupils, a respiratory rate of eight per minute and an oxygen saturation of 84% on room air. Her heart rate is 60 beats per minute and her blood pressure is 110/70. The medical team recognizes her as a frequent drug user in the area. She is placed in a supine position and given high-flow oxygen, but her respiratory rate remains at eight per minute and her oxygen saturation only improves to 86%.

      What is the most appropriate medication to administer in this situation?

      Your Answer: Naloxone

      Explanation:

      Treatment for Opiate-Induced Respiratory Depression

      When a patient displays respiratory depression and mild bradycardia, it is likely due to opiate use. In such cases, the opiate antagonist naloxone is the most effective treatment. Naloxone has a rapid onset of action and can immediately reverse the effects of opiates. However, it is important to note that the half-life of naloxone is shorter than that of opiates, so patients must be monitored to prevent them from leaving prematurely.

      Flumazenil is used to treat uncomplicated benzodiazepine overdose, while pralidoxime is used in organophosphate poisoning. However, in cases of opiate-induced respiratory depression, naloxone is the drug of choice. It is important to be aware that opiate abusers may become angry and aggressive when their high is suddenly reversed. Therefore, a slow infusion of naloxone may be necessary to ensure adequate oxygenation without completely reversing the effects of the opiates. Overall, naloxone is a highly effective treatment for opiate-induced respiratory depression.

    • This question is part of the following fields:

      • Pharmacology
      9.8
      Seconds
  • Question 23 - The following result is obtained on a 48-year-old male who is admitted with...

    Correct

    • The following result is obtained on a 48-year-old male who is admitted with acute onset chest pain:
      Serum Cholesterol 7.3 mmol/L (<5.2)
      He has a strong family history of ischaemic heart disease.
      What abnormalities might be expected upon examination of this man?

      Your Answer: Tendon nodules

      Explanation:

      Familial Hypercholesterolaemia and its Manifestations

      Familial hypercholesterolaemia is a condition characterized by high levels of cholesterol in the blood. This condition is often indicated by the deposition of cholesterol in various parts of the body. The history of the patient suggests that they may be suffering from familial hypercholesterolaemia. The deposition of cholesterol can be observed around the corneal arcus, around the eye itself (xanthelasma), and in tendons such as achilles, knuckles or triceps tendons (tendon xanthomas).

      While dietary and lifestyle modifications are recommended, they are usually not enough to manage the condition. High dose lifelong statin therapy is often necessary to control the levels of cholesterol in the blood. It is important to seek medical attention and follow the recommended treatment plan to prevent further complications associated with familial hypercholesterolaemia. The National Institute for Health and Care Excellence (NICE) recommends the use of statin therapy in conjunction with lifestyle modifications for the management of familial hypercholesterolaemia.

    • This question is part of the following fields:

      • Pharmacology
      14.5
      Seconds
  • Question 24 - Which statement about agonists and antagonists is accurate? ...

    Correct

    • Which statement about agonists and antagonists is accurate?

      Your Answer: A partial agonist has affinity but reduced efficacy

      Explanation:

      Affinity and Efficacy in Pharmacology

      In pharmacology, the terms affinity and efficacy are used to describe the relationship between a drug and its target receptor. Affinity refers to the strength of the binding between the drug and the receptor, while efficacy refers to the ability of the drug to activate the receptor and produce a response.

      An agonist is a drug that binds to a receptor and activates it, producing a response. An agonist has both high affinity and high efficacy, meaning it binds strongly to the receptor and produces a strong response.

      An antagonist, on the other hand, binds to the receptor but does not activate it, blocking the action of other agonists. An antagonist has high affinity but no efficacy, meaning it binds strongly to the receptor but does not produce a response.

      A partial agonist is a drug that binds to the receptor and produces a response, but the response is weaker than that produced by a full agonist. A partial agonist has high affinity but reduced efficacy, meaning it binds strongly to the receptor but produces a weaker response.

      the concepts of affinity and efficacy is important in drug development and in the effects of drugs on the body. By manipulating these properties, researchers can develop drugs that selectively target specific receptors and produce desired effects with minimal side effects.

    • This question is part of the following fields:

      • Pharmacology
      33.4
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  • Question 25 - A 50-year-old patient who had a kidney transplant two years ago is currently...

    Incorrect

    • A 50-year-old patient who had a kidney transplant two years ago is currently taking ciclosporin. However, due to a manufacturing issue, the patient cannot obtain their prescribed medication, Sandimmune, for the next five days. What should be done in this situation?

      Your Answer: Advise him that cyclosporine has a long half life and that he can safely wait until his usual formulation is back in stock without taking Capimune, but provide additional protection with high dose oral prednisolone during this period

      Correct Answer: Switch him to another formulation and monitor his renal function, ciclosporin level and blood pressure whilst the changeover is being made

      Explanation:

      Ciclosporin is an immunosuppressant used to prevent graft rejection and treat various conditions. Different formulations have varying pharmacokinetic properties, so it is important to prescribe by brand and monitor patients closely when switching formulations. Consultation with a renal unit is recommended before switching therapy.

    • This question is part of the following fields:

      • Pharmacology
      30.1
      Seconds
  • Question 26 - Following the administration of lorazepam to a severely agitated senior patient, the nursing...

    Incorrect

    • Following the administration of lorazepam to a severely agitated senior patient, the nursing staff contacts you to report a decrease in respiratory rate and the patient's unresponsiveness. What medication would be suitable for reversing the adverse effects of this drug?

      Your Answer: Protamine

      Correct Answer: Flumazenil

      Explanation:

      Reversing the Effects of Benzodiazepines

      Benzodiazepines work by binding to GABA receptors in the central nervous system, which enhances the calming and sleep-inducing effects of this neurotransmitter. However, these effects can be reversed by administering flumazenil. On the other hand, naloxone is used to counteract the effects of opiate overdose, while protamine is used to reverse the effects of excessive heparinization.

      In the case of benzodiazepine overdose, it is important to ensure that the patient is receiving adequate ventilation. Additionally, administering flumazenil through a bag valve mask can help to reverse the effects of the drug. By doing so, the patient’s breathing and consciousness can be restored to normal levels. Proper management of benzodiazepine overdose is crucial in preventing serious complications and ensuring the patient’s safety.

    • This question is part of the following fields:

      • Pharmacology
      12.5
      Seconds
  • Question 27 - A 55-year-old male patient complains of sudden chest pain and is being evaluated...

    Correct

    • A 55-year-old male patient complains of sudden chest pain and is being evaluated for acute coronary syndrome. Upon fasting, his serum cholesterol level was found to be 7.1 mmol/L (<5.2). What is the best initial course of action for managing this patient?

      Your Answer: Statin therapy

      Explanation:

      Statin Therapy for Hypercholesterolemia in Acute Coronary Syndrome

      Hypercholesterolemia is a common condition in patients with acute coronary syndrome. The initial treatment approach for such patients is statin therapy, which includes drugs like simvastatin, atorvastatin, and rosuvastatin. Statins have been proven to reduce mortality in both primary and secondary prevention studies. The target cholesterol concentration for patients with hypercholesterolemia and acute coronary syndrome is less than 5 mmol/L.

      According to NICE guidance, statins should be used more widely in conjunction with a QRISK2 score to stratify risk. This will help prevent cardiovascular disease and improve patient outcomes. The guidance recommends that statins be used in patients with a 10% or greater risk of developing cardiovascular disease within the next 10 years. By using statins in conjunction with risk stratification, healthcare professionals can provide more targeted and effective treatment for patients with hypercholesterolemia and acute coronary syndrome.

    • This question is part of the following fields:

      • Pharmacology
      10.3
      Seconds
  • Question 28 - A 70-year-old male presents with two episodes of haemetemesis. He has a medical...

    Incorrect

    • A 70-year-old male presents with two episodes of haemetemesis. He has a medical history of ischaemic heart disease (IHD) and is currently on medication. What is the probable reason for his condition?

      Your Answer: Gastritis

      Correct Answer: Peptic ulceration

      Explanation:

      The effects of different medications on renal tubular acidosis (RTA) are significant. RTA is a condition that affects the kidneys’ ability to regulate acid-base balance in the body. Various medications can cause RTA through different mechanisms.

      Spironolactone, for instance, is a direct antagonist of aldosterone, a hormone that regulates sodium and potassium levels in the body. By blocking aldosterone, spironolactone can lead to hyperkalemia (high potassium levels) and a reduction in serum bicarbonate, which is a type of RTA known as type 4.

      Type 4 RTA can also occur in people with diabetes mellitus due to scarring associated with diabetic nephropathy. Metformin, a medication commonly used to treat diabetes, can cause lactic acidosis, a condition where there is an excess of lactic acid in the blood. Pioglitazone, another diabetes medication, can cause salt and water retention and may also be associated with bladder tumors.

      Ramipril, a medication used to treat high blood pressure and heart failure, can also cause hyperkalemia, but this is not related to direct aldosterone antagonism. Healthcare providers must be aware of the effects of different medications on RTA to ensure proper management and treatment of this condition.

    • This question is part of the following fields:

      • Pharmacology
      19
      Seconds
  • Question 29 - A 67-year-old man with a history of renal impairment and severe osteoporosis has...

    Incorrect

    • A 67-year-old man with a history of renal impairment and severe osteoporosis has come in with a worsening of his chronic lower back pain. Upon examination, an L4 wedge fracture was discovered on a lumbar spine x-ray. What medication is recommended for pain management?

      Your Answer: Naproxen

      Correct Answer: Paracetamol

      Explanation:

      Medications and Renal Impairment

      When it comes to renal impairment, it is important to be cautious with certain medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided as they can worsen renal impairment. This is because renal prostaglandins, which control the rate of blood flow into the kidney, are impaired by NSAIDs. As a result, renal blood flow is reduced, exacerbating the impairment.

      On the other hand, morphine can be used in renal impairment, but it should be used with caution. While it is an effective pain reliever, its excretion is reduced in individuals with renal impairment, which can lead to a buildup of the drug in the body. Therefore, paracetamol is typically the first line of treatment for pain relief in individuals with renal impairment, with morphine used only as necessary.

    • This question is part of the following fields:

      • Pharmacology
      11.6
      Seconds
  • Question 30 - Which diabetes medication is the least likely to cause weight gain? ...

    Incorrect

    • Which diabetes medication is the least likely to cause weight gain?

      Your Answer: Gliclazide

      Correct Answer: Exenatide

      Explanation:

      Exenatide and its Benefits for Overweight Patients

      Exenatide is a medication that mimics the effects of GLP-1, a hormone released by the gut in response to food intake. This hormone triggers insulin secretion in the pancreatic beta-cells, which makes GLP-1 mimetics like exenatide effective in stimulating insulin release. Additionally, exenatide is associated with weight loss, making it a good choice for patients who are significantly overweight.

      According to NICE guidelines, exenatide should be used in patients with a BMI exceeding 35 kg/m2 or in those with significant weight-related comorbidity, even if their BMI is less than 35 kg/m2. After six months of therapy, exenatide should only be continued if the patient’s HbA1c has fallen by 11 mmol/mol and their weight has decreased by 3%.

      However, exenatide does have some side effects, including nausea and vomiting. It should also be avoided in patients with renal failure, impaired liver function, and gastroparesis. On the other hand, other diabetes medications like gliptins, glitazones, and sulphonylureas are associated with significant weight gain, while repaglinide may result in minimal or no weight gain.

      Overall, exenatide is a promising option for overweight patients with diabetes, as it not only stimulates insulin release but also promotes weight loss.

    • This question is part of the following fields:

      • Pharmacology
      7.4
      Seconds
  • Question 31 - Which statement about steroid receptors is accurate? ...

    Incorrect

    • Which statement about steroid receptors is accurate?

      Your Answer: Receptors have a transmembrane spanning domain

      Correct Answer: Receptors have a DNA binding domain

      Explanation:

      Steroid Receptors

      Steroid receptors are composed of three main domains: ligand binding, DNA binding, and transcription activation. These receptors are typically found in the cytoplasm and are only translocated to the nucleus after binding with a ligand. However, the oestrogen receptor is an exception to this rule, as it is constitutively found in the nucleus.

      In summary, steroid receptors are essential for the regulation of gene expression. They are composed of three domains and are typically found in the cytoplasm. However, the oestrogen receptor is an exception to this rule, as it is always found in the nucleus. the function of steroid receptors is crucial for developing treatments for various diseases.

    • This question is part of the following fields:

      • Pharmacology
      16.3
      Seconds
  • Question 32 - Which statement about receptor tyrosine kinases is accurate? ...

    Incorrect

    • Which statement about receptor tyrosine kinases is accurate?

      Your Answer: The glutamate NMDA receptor is an example of a receptor tyrosine kinase

      Correct Answer: Dimerisation of receptors is usually involved in activation

      Explanation:

      Receptor Binding and Activation

      Substances such as insulin, epidermal growth factor (EGF), and platelet-derived growth factor (PDGF) can bind to receptors in the body. These receptors have four domains: ligand binding, transmembrane, catalytic, and autophosphorylation domains. When an agonist binds to the receptor, it causes a change in shape, which leads to phosphorylation. This process activates the receptor and triggers a response in the body.

    • This question is part of the following fields:

      • Pharmacology
      14.8
      Seconds
  • Question 33 - A 45-year-old male is undergoing treatment for ischaemic heart disease. He has recently...

    Incorrect

    • A 45-year-old male is undergoing treatment for ischaemic heart disease. He has recently reported experiencing cold peripheries. What medication could be causing this symptom?

      Your Answer: Thiazide diuretic

      Correct Answer: Beta-blocker

      Explanation:

      Causes of Cold Peripheries

      Beta-blockers are known to cause cold peripheries due to their ability to constrict the superficial vessels. This constriction leads to a decrease in blood flow to the extremities, resulting in a feeling of coldness. In addition to beta-blockers, other factors can also contribute to cold peripheries. Bronchospasm, which is a narrowing of the airways in the lungs, can also cause coldness in the extremities. This is because the body redirects blood flow away from the extremities and towards the lungs to help with breathing. Finally, fatigue can also cause cold peripheries as the body’s energy levels decrease, leading to a decrease in blood flow to the extremities. Overall, there are several factors that can contribute to cold peripheries, and it is important to identify the underlying cause in order to provide appropriate treatment.

    • This question is part of the following fields:

      • Pharmacology
      15.2
      Seconds
  • Question 34 - A 68-year-old male with a three year history of type 2 diabetes complains...

    Correct

    • A 68-year-old male with a three year history of type 2 diabetes complains of feeling dizzy, sweaty and confused. Upon checking his glucose levels, it is found that he is experiencing hypoglycaemia which is resolved with a glucose drink. Which medication is the most probable cause of this hypoglycaemic episode?

      Your Answer: Glibenclamide

      Explanation:

      Mechanisms of Hypoglycaemia in Sulphonylurea Therapies

      Sulphonylurea therapies, including gliclazide, glimepiride, and glibenclamide, are known to cause hypoglycaemia. This is due to their ability to increase pancreatic insulin secretion, which can lead to a drop in blood glucose levels. On the other hand, metformin and pioglitazone work differently to control blood glucose levels. Metformin reduces the amount of glucose produced by the liver, while pioglitazone improves the body’s sensitivity to insulin. Neither of these medications typically causes hypoglycaemia.

      Overall, it is important for healthcare providers to be aware of the potential for hypoglycaemia when prescribing sulphonylurea therapies and to monitor patients closely for any signs or symptoms of low blood glucose levels. Additionally, patients should be educated on the importance of monitoring their blood glucose levels regularly and seeking medical attention if they experience any symptoms of hypoglycaemia.

    • This question is part of the following fields:

      • Pharmacology
      27.2
      Seconds
  • Question 35 - A teenage girl is given a prescription for an antibiotic by her doctor,...

    Correct

    • A teenage girl is given a prescription for an antibiotic by her doctor, but she comes back after two days, reporting that she is developing a rash on her face and arms that gets worse when exposed to sunlight. What drug reaction is likely causing this photosensitive rash?

      Your Answer: Doxycycline

      Explanation:

      Common Side Effects of Tetracyclines

      Tetracyclines are a class of antibiotics that are commonly used to treat bacterial infections. However, they are also known to cause several side effects. Nausea and vomiting are among the most common side effects of tetracyclines. Additionally, patients may develop a photosensitive rash, which can be triggered by exposure to sunlight. Dental hypoplasia is another potential side effect of tetracyclines, which is why they are not recommended for use in children, pregnant or breastfeeding women. Finally, tetracyclines have been associated with idiopathic intracranial hypertension, a condition that causes increased pressure inside the skull.

      It is important to note that photosensitivity can also be caused by other antibiotics, such as quinolones and sulphonamides. Patients who experience any of these side effects should contact their healthcare provider immediately. In some cases, the dosage or type of antibiotic may need to be adjusted to minimize these side effects. Overall, while tetracyclines can be effective in treating bacterial infections, patients should be aware of the potential side effects and discuss any concerns with their healthcare provider.

    • This question is part of the following fields:

      • Pharmacology
      13.2
      Seconds
  • Question 36 - A 25-year-old office worker arrives at the Emergency Department complaining of headaches due...

    Correct

    • A 25-year-old office worker arrives at the Emergency Department complaining of headaches due to work-related stress. She took two paracetamol earlier today, but when it didn't help, she took two aspirin. However, she developed an itchy rash on her face and is experiencing breathing difficulties. What type of drug reaction is this indicative of?

      Your Answer: Idiosyncratic

      Explanation:

      Idiosyncratic Reaction to Medication

      A person’s idiosyncratic reaction to medication is a peculiar response that is not expected from the drug’s mode of action. In this case, a woman is experiencing an allergic reaction to either aspirin or paracetamol. The fact that she is having difficulty breathing is a serious symptom that requires urgent treatment. It is important to note that not all allergic reactions are the same, and some can be life-threatening. Therefore, it is crucial to seek medical attention immediately if any unusual symptoms occur after taking medication.

    • This question is part of the following fields:

      • Pharmacology
      27
      Seconds
  • Question 37 - What is a true characteristic of G protein coupled receptors and their involvement...

    Correct

    • What is a true characteristic of G protein coupled receptors and their involvement in biological processes?

      Your Answer: GPCRs interact with G proteins through their third intracellular loop

      Explanation:

      G Protein Coupled Receptors and Their Role in Signal Transduction

      G protein coupled receptors are present in various systems of the body, including opioid and adrenaline binding. These receptors consist of seven transmembrane domains and are encoded by approximately 7% of the human genome. When an agonist binds to a G protein coupled receptor, it causes a change in the conformation of the linked G protein through the third intracellular loop and C tail. This change leads to the transmission of messages using second messengers like cAMP, ADP, and phosphokinase.

      In summary, G protein coupled receptors play a crucial role in signal transduction in the body. They are involved in the binding of various substances and cause a conformational change in the linked G protein, leading to the transmission of messages through second messengers. the function of these receptors is essential in developing drugs that target them and can be used to treat various diseases.

    • This question is part of the following fields:

      • Pharmacology
      9.8
      Seconds
  • Question 38 - You are creating a medication schedule for a patient with chronic renal failure...

    Incorrect

    • You are creating a medication schedule for a patient with chronic renal failure who is elderly. Which medication may require a dosage modification due to the reduced renal clearance?

      Your Answer: Warfarin

      Correct Answer: Morphine sulphate

      Explanation:

      Opioid Use in Patients with Abnormal Renal Function

      Patients with abnormal renal function should have their opioid doses reduced due to the prolonged duration of action. However, it is important to note that the initial loading dose may need to be greater in these patients to achieve the desired drug effect. This is because patients with chronic renal failure have an increased volume of distribution, which can affect drug concentration in the plasma. Despite the need for a higher initial dose, subsequent doses should be reduced to account for poor drug clearance. It is important to monitor patients closely and adjust doses as needed to avoid adverse effects. None of the other agents typically require caution in patients with abnormal renal function.

    • This question is part of the following fields:

      • Pharmacology
      14.5
      Seconds
  • Question 39 - A 65-year-old man is undergoing his yearly check-up for his type 2 diabetes....

    Incorrect

    • A 65-year-old man is undergoing his yearly check-up for his type 2 diabetes. He is currently being evaluated for macroscopic haematuria.

      Which medication for diabetes should be avoided in this case?

      Your Answer: Glibenclamide

      Correct Answer: Pioglitazone

      Explanation:

      Safety Concerns Surrounding Glitazones

      The glitazones, which include pioglitazone and rosiglitazone, have been associated with safety concerns. Rosiglitazone has been removed from use due to an increased risk of myocardial infarction in patients taking the drug. Pioglitazone is still in use, but there are concerns about an increased risk of cardiac failure, myocardial infarction, pneumonia, and fracture risk in patients taking the drug.

      Additionally, the European Medicines Agency has advised that there is an increased risk of bladder cancer when taking pioglitazone. Although the risk is small, it should not be used in patients with a history of the disease, who have unexplained macroscopic haematuria, or are at a high risk of developing bladder cancer.

      These safety concerns make glitazones less popular than some of the other new diabetes drugs. The European Medicines Agency advises that pioglitazone should only be used when other antidiabetes agents are not suitable. It is important for healthcare professionals to carefully consider the risks and benefits of glitazones before prescribing them to patients with diabetes.

    • This question is part of the following fields:

      • Pharmacology
      26.6
      Seconds
  • Question 40 - A 67-year-old woman complains of muscle aches and pains. She has a medical...

    Incorrect

    • A 67-year-old woman complains of muscle aches and pains. She has a medical history of ischaemic heart disease, which has been treated recently. What medication is the most probable cause of her symptoms?

      Your Answer: ACE inhibitors

      Correct Answer: Statins

      Explanation:

      The Benefits and Risks of Statin Therapy

      Statins are medications used to lower lipid levels in the body, which can significantly reduce the risk of cardiovascular disease. However, one common side effect of this treatment is myalgia, or muscle pain. This side effect can be worsened by certain medications, such as macrolides and fibrates, as well as by hypothyroidism. While myalgia is generally not life-threatening, it can be uncomfortable and may lead some patients to discontinue statin therapy.

      In rare cases, statin therapy can lead to a potentially lethal condition called rhabdomyolysis. This occurs when there is severe muscle infiltration and destruction, which can cause renal failure. While this side effect is rare, it is important for patients to be aware of the potential risks associated with statin therapy and to report any unusual symptoms to their healthcare provider. Overall, the benefits of statin therapy in reducing cardiovascular risk generally outweigh the risks, but it is important for patients to work closely with their healthcare provider to monitor for any potential side effects.

    • This question is part of the following fields:

      • Pharmacology
      9.8
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  • Question 41 - You are administering lidocaine to numb the skin of a young patient before...

    Incorrect

    • You are administering lidocaine to numb the skin of a young patient before a minor procedure. What is a true statement about this medication?

      Your Answer: Can be safely administered with adrenaline in ring blocks

      Correct Answer: Can be used to treat ventricular tachycardia

      Explanation:

      Lidocaine: Characteristics and Uses

      Lidocaine is a medication that is quickly broken down by the liver, making it unsuitable for oral administration. Its effects last for only 20 minutes, but this can be extended to approximately 90 minutes when combined with the vasoconstrictor adrenaline. However, this combination should not be used in areas where there is a risk of ischaemia.

      Lidocaine is a potent antiarrhythmic drug that falls under class I, as it prolongs the action potential. It can be used to treat ventricular tachycardia, although it is not included in the ALS algorithm and should only be administered by a specialist.

    • This question is part of the following fields:

      • Pharmacology
      22.8
      Seconds
  • Question 42 - A 24-year-old man with asthma is brought to the emergency department due to...

    Correct

    • A 24-year-old man with asthma is brought to the emergency department due to shortness of breath. He has been experiencing a worsening cough with thick yellow phlegm for the past three days. He regularly uses a beclomethasone inhaler and salbutamol inhaler as needed.

      Upon assessment, the patient's heart rate is 166 bpm, blood pressure is 113/65 mmHg, oxygen saturation is 91%, and respiratory rate is 29. He is only able to speak in broken sentences.

      Which of the following therapies is most likely to exacerbate his asthma?

      Your Answer: Bisoprolol

      Explanation:

      Treatment for Acute Asthma Attack

      When a person experiences an acute asthma attack, the first and most important treatment is to administer oxygen. This is followed by nebulised salbutamol to dilate the airways, oral steroids, and appropriate antibiotics if the productive cough is due to a chest infection. However, the use of the beta blocker bisoprolol to reduce the heart rate would be inappropriate.

      Salbutamol works by targeting beta-2 adrenoceptors, which causes the bronchi to dilate. However, cardiac muscle also has beta adrenoceptors, which can cause an increased heart rate. In this case, the patient is likely tachycardic due to increased work of breathing and salbutamol administered on the way to the hospital. Bisoprolol, on the other hand, is a beta antagonist that counteracts these effects by causing a reduction in heart rate and smooth muscle constriction, which would constrict the bronchi. This is the opposite of the desired effect and can worsen the patient’s condition. Therefore, it is important to avoid using bisoprolol in the treatment of acute asthma attacks.

    • This question is part of the following fields:

      • Pharmacology
      14.2
      Seconds
  • Question 43 - β-adrenergic receptor antagonists, like propranolol, are commonly prescribed in medical practice. In which...

    Correct

    • β-adrenergic receptor antagonists, like propranolol, are commonly prescribed in medical practice. In which of the following conditions are β-adrenergic receptor antagonists not recommended for use in elderly patients?

      Your Answer: Asthma

      Explanation:

      Beta Blockers and Asthma

      Beta blockers are commonly used to treat various cardiovascular diseases due to their negative chronotropic and inotropic effects. However, they can be detrimental to individuals with asthma. This is because beta blockers antagonize beta-2 receptors, which can lead to bronchoconstriction and trigger asthma attacks. As a result, beta blockers are not recommended as a treatment for asthma. It is important for healthcare providers to be aware of this potential adverse effect and to consider alternative medications for patients with asthma who require cardiovascular treatment. Proper management of both conditions is crucial to ensure optimal health outcomes for patients.

    • This question is part of the following fields:

      • Pharmacology
      10.7
      Seconds
  • Question 44 - As a third year medical student in an outpatient department with a dermatology...

    Incorrect

    • As a third year medical student in an outpatient department with a dermatology consultant, you are evaluating a 27-year-old patient who is unresponsive to current hyperhidrosis treatment. The consultant suggests starting botox injections to prevent sweating. Can you explain the mechanism of action of botulinum toxin at the neuromuscular junction?

      Your Answer: Blocks acetylcholine receptors on postsynaptic membrane

      Correct Answer: Inhibits vesicles containing acetylcholine binding to presynaptic membrane

      Explanation:

      Botulinum Toxin and its Mechanism of Action

      Botulinum toxin is becoming increasingly popular in the medical field for treating various conditions such as cervical dystonia and achalasia. The toxin works by binding to the presynaptic cleft on the neurotransmitter and forming a complex with the attached receptor. This complex then invaginates the plasma membrane of the presynaptic cleft around the attached toxin. Once inside the cell, the toxin cleaves an important cytoplasmic protein that is required for efficient binding of the vesicles containing acetylcholine to the presynaptic membrane. This prevents the release of acetylcholine across the neurotransmitter.

      It is important to note that the blockage of Ca2+ channels on the presynaptic membrane occurs in Lambert-Eaton syndrome, which is associated with small cell carcinoma of the lung and is a paraneoplastic syndrome. However, this is not related to the mechanism of action of botulinum toxin.

      The effects of botox typically last for two to six months. Once complete denervation has occurred, the synapse produces new axonal terminals which bind to the motor end plate in a process called neurofibrillary sprouting. This allows for interrupted release of acetylcholine. Overall, botulinum toxin is a powerful tool in the medical field for treating various conditions by preventing the release of acetylcholine across the neurotransmitter.

    • This question is part of the following fields:

      • Pharmacology
      21.5
      Seconds
  • Question 45 - A 40-year-old woman comes to the clinic with complaints of pain and swelling...

    Correct

    • A 40-year-old woman comes to the clinic with complaints of pain and swelling in her right calf. Upon further examination, it is confirmed that she has a deep vein thrombosis. Can any of the medications she is currently taking be a contributing factor to this condition?

      Your Answer: Combined oral contraceptive pill

      Explanation:

      Thromboembolic Risk and Oral Contraceptives

      The use of combined oral contraceptives (OCP) is known to increase the risk of thromboembolism. This is due to the estrogen component of the pill, which promotes a pro-thrombotic environment. However, the risk of thromboembolism on the OCP is only about five times higher than normal, which is significantly lower than the risk during pregnancy, which is six to ten times higher. On the other hand, there is no clear evidence of an increased risk of thromboembolism associated with the use of progesterone-only contraceptive pills (mini pill). It is important for women to discuss their individual risk factors with their healthcare provider before starting any form of hormonal contraception.

    • This question is part of the following fields:

      • Pharmacology
      8.1
      Seconds
  • Question 46 - What is the rate of elimination of phenytoin based on its zero-order kinetics?...

    Incorrect

    • What is the rate of elimination of phenytoin based on its zero-order kinetics?

      Your Answer: Proportional to the plasma concentration

      Correct Answer: Constant regardless of the plasma concentration

      Explanation:

      Zero-Order Kinetics in Drugs

      Zero-order kinetics is a term used to describe the rate of elimination of certain drugs, such as ethanol, phenytoin, and aspirin. In these drugs, the rate of elimination remains constant and is not dependent on the concentration of the drug in the plasma. This means that even if the concentration of the drug in the plasma increases, the rate of elimination remains the same.

      However, this also means that if the metabolism capacity of the body is overwhelmed, the plasma levels of these drugs can rapidly increase, leading to an overdose. This is particularly dangerous in drugs with zero-order kinetics, as the rate of elimination cannot be increased to compensate for the overdose. Therefore, it is important to understand the pharmacokinetics of drugs and their elimination rates to prevent such incidents.

      In summary, zero-order kinetics in drugs means that the rate of elimination is constant and not dependent on plasma concentration. This can lead to dangerous situations if the metabolism capacity is overwhelmed, as the rate of elimination cannot be increased to compensate for an overdose. the pharmacokinetics of drugs is crucial in preventing such incidents.

    • This question is part of the following fields:

      • Pharmacology
      11.7
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  • Question 47 - A young adult female arrives at the Emergency Department after ingesting 18 paracetamol...

    Incorrect

    • A young adult female arrives at the Emergency Department after ingesting 18 paracetamol tablets in a moment of impulsivity during a disagreement with her partner. It has been six hours since she took the tablets and her paracetamol levels are measured, indicating the need for treatment. The patient is initiated on N-acetylcysteine. What is the mechanism of action of this medication?

      Your Answer: Absorbs paracetamol from the bloodstream

      Correct Answer: Replaces compounds used in paracetamol metabolism

      Explanation:

      Paracetamol Metabolism and Toxicity

      Paracetamol is metabolised in two ways. The first mechanism involves conjugation with glucuronic acid, resulting in a safe metabolite that can be excreted. However, there is a limit to how much paracetamol can be metabolised this way. The second mechanism is used when a large amount of paracetamol is taken. In this case, paracetamol is oxidised to a toxic metabolite called N-acetyl-p-benzoquinone. This metabolite can cause liver and kidney necrosis if glutathione supplies are exhausted.

      Glutathione is responsible for making the toxic metabolite safe. However, when glutathione supplies are depleted, the toxic metabolite can cause damage to the liver and kidneys. N-acetylcysteine is a protective agent that increases the rate of glutathione synthesis. Therefore, it can help prevent liver and kidney damage caused by the toxic metabolite of paracetamol.

    • This question is part of the following fields:

      • Pharmacology
      12.4
      Seconds
  • Question 48 - An 80-year-old man is brought to the Emergency Department by his physician due...

    Incorrect

    • An 80-year-old man is brought to the Emergency Department by his physician due to sudden confusion. The patient had been treated for a chest infection with clarithromycin recently. He has a history of atrial fibrillation and is taking warfarin as an anticoagulant. Due to his confusion, it is challenging to obtain a detailed medical history from him. However, his blood tests reveal a significantly low haemoglobin level of 56 g/L (115-160). What type of drug reaction is this indicative of?

      Your Answer: Antagonism

      Correct Answer: Inhibition of metabolism

      Explanation:

      Drug Interaction Causing Bleeding and Confusion

      This patient’s symptoms are a classic example of a drug interaction between clarithromycin and warfarin. While there are many medications that can interact with warfarin, antibiotics are particularly known for affecting its effectiveness. In this case, clarithromycin has inhibited the metabolism of warfarin, causing it to become more potent. As a result, the patient has experienced bleeding, most likely in the gastrointestinal tract, which has led to confusion.

      Further investigation is necessary to ensure that there is not an underlying issue, such as colon cancer, that has been unmasked by this drug interaction. It is important for healthcare providers to be aware of potential drug interactions and to monitor patients closely for any adverse effects. By doing so, they can help prevent complications and ensure that patients receive the best possible care.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 49 - Which statement regarding ligand gated ion channels (LGIC) is accurate? ...

    Incorrect

    • Which statement regarding ligand gated ion channels (LGIC) is accurate?

      Your Answer: Channel ion selectivity is dependent upon pore size

      Correct Answer: Agonist recognition and ion channel are intrinsic to a single protein complex

      Explanation:

      Ligand Gated Ion Channels: A Brief Overview

      Ligand gated ion channels (LGICs) are protein complexes that have both agonist recognition and ion channel functions. These functions are intrinsic to a single protein complex, which is usually pentameric in nature. For example, the nicotinic acetylcholine receptor (nAChR) is composed of a2ßδγ subunits. Each monomer of the LGIC has four transmembrane domains (TMSD) labeled M1-M4. The M2 domain forms a putative alpha-helix within the membrane.

      LGICs typically have a charged entrance that plays a role in ion selectivity. For instance, the nAChR has a negatively charged entrance that attracts Na and K ions. This selectivity is crucial for the proper functioning of the LGIC. the structure and function of LGICs is important for developing drugs that target these channels. By targeting LGICs, researchers can develop drugs that modulate the activity of these channels, which can have therapeutic benefits for a variety of diseases.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 50 - A 70-year-old female complains of abdominal pain and melaena. She has a medical...

    Incorrect

    • A 70-year-old female complains of abdominal pain and melaena. She has a medical history of hypertension, type 2 diabetes, and right knee osteoarthritis. Which medication could be causing her symptoms?

      Your Answer: Tramadol

      Correct Answer: Diclofenac

      Explanation:

      Causes of Peptic Ulceration and the Role of Medications

      Peptic ulceration is a condition that can cause acute gastrointestinal (GI) blood loss. One of the common causes of peptic ulceration is the reduction in the production of protective mucous in the stomach, which exposes the stomach epithelium to acid. This can be a consequence of using non-steroidal anti-inflammatory drugs (NSAIDs) such as diclofenac, which is commonly used in the treatment of osteoarthritis. Steroids are also known to contribute to peptic ulceration.

      On the other hand, tramadol, an opiate, does not increase the risk of GI ulceration. It is important to be aware of the potential side effects of medications and to discuss any concerns with a healthcare provider. By doing so, patients can receive appropriate treatment while minimizing the risk of adverse effects.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 51 - A 70-year-old female complains of abdominal pain and melaena. She has a medical...

    Correct

    • A 70-year-old female complains of abdominal pain and melaena. She has a medical history of hypertension, type 2 diabetes, and right knee osteoarthritis. Which medication could be causing her symptoms?

      Your Answer: Diclofenac

      Explanation:

      Causes of Peptic Ulceration and the Role of Medications

      Peptic ulceration is a condition that can cause acute gastrointestinal (GI) blood loss. One of the common causes of peptic ulceration is the reduction in the production of protective mucous in the stomach, which exposes the stomach epithelium to acid. This can be a consequence of using non-steroidal anti-inflammatory drugs (NSAIDs) such as diclofenac, which is commonly used in the treatment of osteoarthritis. Steroids are also known to contribute to peptic ulceration.

      On the other hand, tramadol, an opiate, does not increase the risk of GI ulceration. It is important to be aware of the potential side effects of medications and to discuss any concerns with a healthcare provider. By doing so, patients can receive appropriate treatment while minimizing the risk of adverse effects.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 52 - You are seeking participants for a study of a novel anti-diabetic medication. The...

    Correct

    • You are seeking participants for a study of a novel anti-diabetic medication. The trial excludes patients with a glomerular filtration rate (GFR) below 60 ml/min and requires individuals with a diabetes duration of no more than three years. What is accurate regarding this clinical study?

      Your Answer: All patients have to be given, understand and sign their informed consent

      Explanation:

      Informed Consent in Clinical Trials

      Clinical trials are conducted to test the safety and efficacy of new investigational agents. Before a patient can participate in a clinical trial, they must be given informed consent. This process involves detailing the potential benefits, risks, and adverse events associated with the investigational therapy. The patient must sign the informed consent form before beginning the therapy.

      All clinical trials must adhere to the declaration of Helsinki, which outlines ethical principles for medical research involving human subjects. Patients can only receive reasonable expenses for participating in a clinical trial, and not a premium. Clinical trial waivers are not acceptable, and entry into a study is based on both potential efficacy and safety.

      In summary, informed consent is a crucial aspect of clinical trials. It ensures that patients are fully aware of the potential risks and benefits of the investigational therapy before they begin treatment. Adherence to ethical principles and guidelines is also essential to ensure the safety and well-being of study participants.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 53 - A 65-year-old male patient is started on azathioprine treatment by a gastroenterologist for...

    Incorrect

    • A 65-year-old male patient is started on azathioprine treatment by a gastroenterologist for Crohn's disease. After six months of treatment, you receive a request from the gastroenterology department to assist with monitoring his treatment.
      What is the current recommended protocol for monitoring patients on long-term azathioprine therapy?
      Note:
      FBC - Full blood count
      LFT - Liver function tests
      U&E - Urea and electrolytes.

      Your Answer: FBC every 6 months, U&E and LFT every 12 months

      Correct Answer: FBC, LFT and U&E every three months

      Explanation:

      Azathioprine: A Cytotoxic Agent for Severe Refractory Eczema and Other Conditions

      Azathioprine is a cytotoxic drug that is converted to mercaptopurine, which acts as a purine analogue that inhibits DNA synthesis. It is used off-label for severe refractory eczema, post-transplant, and in patients with rheumatoid arthritis and inflammatory bowel disease. However, bone marrow suppression and hepatotoxicity are serious and well-known complications of azathioprine therapy. Other side effects include nausea, vomiting, and skin eruptions. Patients with low levels of the enzyme thiopurine methyltransferase (TPMT), which metabolizes azathioprine, are at increased risk of toxicity, and their enzyme activity is often measured before starting treatment.

      To minimize the risk of complications, current guidelines from the British Association of Dermatologists and the British National Formulary recommend monitoring full blood count (FBC), liver function tests (LFT), and urea and electrolytes (U&E) every three months once patients are established on azathioprine treatment. By following these guidelines, healthcare providers can ensure that patients receive the benefits of azathioprine while minimizing the risk of adverse effects.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 54 - A 65-year-old male patient complains of a persistent cough that has been bothering...

    Correct

    • A 65-year-old male patient complains of a persistent cough that has been bothering him for the past three months. He has a medical history of hypertension and type 2 diabetes, which he manages with medication. Which of the following drugs is the most probable cause of his cough?

      Your Answer: ACE inhibitors

      Explanation:

      ACE Inhibitors and Coughing: the Mechanism

      Angiotensin-converting enzyme (ACE) inhibitors are known to cause coughing in almost a third of the people who use them. However, angiotensin blockers, which have similar benefits to ACE inhibitors, do not cause coughing and are often prescribed to patients who cannot tolerate ACE inhibitors. The reason behind this difference lies in the mechanism of action of these drugs. ACE inhibitors lead to the accumulation of bradykinin in the bronchial tissue, which triggers coughing. On the other hand, angiotensin blockers do not affect bradykinin levels and hence do not cause coughing. this mechanism is crucial in selecting the right medication for patients who are intolerant to ACE inhibitors.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 55 - What is the term used to describe a drug that binds to the...

    Correct

    • What is the term used to describe a drug that binds to the same receptor as an agonist but is unable to produce a comparable effect even with increasing doses?

      Your Answer: Partial agonist

      Explanation:

      Agonists, Antagonists, and Partial Agonists

      Agonists, antagonists, and partial agonists are terms used to describe drugs that interact with receptors in the body. Competitive antagonists work by binding to the same receptor site as the agonist, preventing it from binding and producing its effect. However, increasing the concentration of the agonist can overcome this effect.

      Allosteric drugs, on the other hand, act at a site separate from the receptor site of the agonist. This can either enhance or inhibit the effect of the agonist. Partial agonists, like buprenorphine, produce a weaker effect than a full agonist. When combined with a full agonist, like morphine, the overall effect is decreased, leading to poor pain control.

      the differences between agonists, antagonists, and partial agonists is important in the development and use of drugs for various medical conditions. By targeting specific receptors in the body, these drugs can produce a desired effect or block unwanted effects. Proper dosing and combination of these drugs can lead to effective treatment and management of various conditions.

    • This question is part of the following fields:

      • Pharmacology
      16.9
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  • Question 56 - A 32-year-old female patient complains of a disrupted menstrual cycle, decreased libido, and...

    Correct

    • A 32-year-old female patient complains of a disrupted menstrual cycle, decreased libido, and lactation despite never being pregnant. Upon blood testing, she is found to have elevated serum prolactin levels. Which medication is associated with causing hyperprolactinemia?

      Your Answer: Cimetidine

      Explanation:

      Hyperprolactinaemia in Women

      Hyperprolactinaemia is a condition that affects women and is characterized by an excess of prolactin hormone in the body. This condition can present with various symptoms, including anovulatory infertility, reduced menstruation, production of breast milk, reduced libido, and vaginal dryness. The condition is caused by either disinhibition of the anterior pituitary or excess production due to a pituitary tumor. A serum prolactin concentration greater than 5000 mIU/L suggests a pituitary adenoma.

      Moreover, hyperprolactinaemia can also be caused by certain prescription medications, including antihistamines, butyrophenones, cimetidine, methyldopa, metoclopramide, and phenothiazines. These medications are strongly associated with the condition and can lead to an increase in prolactin levels in the body.

      It is important to understand the symptoms and causes of hyperprolactinaemia in women to seek appropriate medical attention and treatment. With proper diagnosis and management, women can effectively manage this condition and improve their quality of life.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 57 - A 55-year-old man with uncontrolled type 2 diabetes is hospitalized and presents with...

    Correct

    • A 55-year-old man with uncontrolled type 2 diabetes is hospitalized and presents with elevated inflammatory markers, metabolic acidosis, leukocytosis, and an amylase level of 3480 U/L. Which medication is the probable cause?

      Your Answer: Exenatide

      Explanation:

      Exenatide and Pancreatitis: A Review of the Evidence

      Exenatide is a medication that mimics the effects of the hormone GLP-1, which triggers insulin secretion in response to food intake. However, there is a rare but concerning association between exenatide and acute pancreatitis. A recent case-control study found that patients taking GLP-1 mimetics like exenatide had a higher risk of developing pancreatitis compared to those taking other diabetes drugs. As a result, patients starting on exenatide should be informed about the symptoms of pancreatitis and monitored closely for abdominal pain.

      While there is some controversy surrounding the association between gliptins and pancreatitis, the British National Formulary recommends discontinuing sitagliptin if acute pancreatitis is suspected. It is important to note that lactic acidosis, a potential side effect of metformin, should not be confused with pancreatitis, which is characterized by elevated levels of amylase. Overall, healthcare providers should be aware of the potential risk of pancreatitis in patients taking exenatide and other GLP-1 mimetics, and take appropriate precautions to monitor and manage this condition.

    • This question is part of the following fields:

      • Pharmacology
      26.3
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SESSION STATS - PERFORMANCE PER SPECIALTY

Pharmacology (27/57) 47%
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