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Question 1
Correct
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Regarding local anaesthetics, which of the following statements is INCORRECT:
Your Answer: Adrenaline should be used in digital nerve blocks to create a bloodless field.
Explanation:It is not advisable to give adrenaline/epinephrine with a local anaesthetic injection in digits or appendages because of the risk of ischaemic necrosis.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 2
Correct
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In the emergency room, a 28-year-old woman complains of wobbly and slurred speech, is unable to do the heel-shin test, and has nystagmus. The following signs are most likely related to damage to which of the following areas:
Your Answer: Cerebellum
Explanation:Cerebellar injury causes delayed and disorganized motions. When walking, people with cerebellar abnormalities sway and stagger. Damage to the cerebellum can cause asynergia, the inability to judge distance and when to stop, dysmetria, the inability to perform rapid alternating movements or adiadochokinesia, movement tremors, staggering, wide-based walking or ataxic gait, a proclivity to fall, weak muscles or hypotonia, slurred speech or ataxic dysarthria, and abnormal eye movements or nystagmus.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 3
Incorrect
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A 60-year-old man comes to your department with complaints of epigastric pain. There is a history of rheumatoid arthritis and he has been taking ibuprofen 200 mg TDS for the last 2 weeks.The following scenarios would prompt you to consider the co-prescription of a PPI for gastroprotection with NSAIDs EXCEPT?
Your Answer: Short-term prescribing in a patient aged 67
Correct Answer: Long-term use for chronic back pain in a patient aged 30
Explanation:The current recommendations by NICE suggest that gastro-protection should be considered if patients have ≥1 of the following:Aged 65 or older- Using maximum recommended dose of an NSAID- History of peptic ulcer or GI bleeding- Concomitant use of: antidepressants like SSRIs and SNRIs, Corticosteroids, anticoagulants and low dose aspirin- Long-term NSAID usage for: long-term back pain if older than 45 and patients with OA or RA at any ageThe maximum recommended dose of ibuprofen is 2.4 g daily and this patient is on 400 mg of ibuprofen TDS.
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This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 4
Correct
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An elderly patient presents to ED following a fall after feeling light headed when standing up. You are reviewing his medication and note that he is taking a high dose of furosemide. Loop diuretics act primarily at which of the following sites in the nephron:
Your Answer: Thick ascending limb
Explanation:Loop diuretics inhibit the Na+/K+/2Cl- symporter on the luminal membrane in the thick ascending limb of the loop of Henle, thus preventing reabsorption of NaCl and water. These agents reduce reabsorption of Cl- and Na+ and increase Ca2+ excretion and loss of K+ and Mg2+.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 5
Correct
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A 22-year-old woman comes in with an asthmatic flare. Salbutamol is her only regular medication.What is the dosage per inhalation of a standard metered dose salbutamol inhaler?
Your Answer: 100 micrograms
Explanation:The dose of a conventional metered dose inhaler is 100 micrograms per metered inhalation.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 6
Correct
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What is the primary function of the mitochondria?
Your Answer: The production of the cell's supply of chemical energy
Explanation:The mitochondria is responsible for the production of the cell’s supply of chemical energy. It does this by using molecular oxygen, sugar and small fatty acid molecules to generate adenosine triphosphate (ATP) by a process ss known as oxidative phosphorylation. An enzyme called ATP synthase is required. Transcription of ribosomal RNA occurs in the nucleolusProduction of messenger RNA occur in the nucleusProduction of lysosome occurs in the Golgi apparatusThe post-translational processing of newly made proteins occurs in the endoplasmic reticulum
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This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
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Question 7
Incorrect
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A 52-year-old female visits the Emergency Department complaining of an acute worsening of her asthma symptoms. A detailed history reveals that she took one of her brother's heart pills without a prescription as she was experiencing palpitations and thought it would cure her. Her shortness of breath was suddenly exacerbated after ingesting this medicine. Which one of the following medications has this woman most likely consumed?
Your Answer:
Correct Answer: Propranolol
Explanation:Propranolol, like other non-selective beta-blockers, is contraindicated in patients with asthma. These drugs can cause acute bronchospasm, therefore worsening symptoms, especially in high doses. However, there has been some recent evidence that long-term use of selective beta-blockers in mild or moderate asthma patients can be safe.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 8
Incorrect
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A 15-year-old girl took almost 20 tablets of paracetamol almost 4 hours ago to show anger towards her mother for denying permission to go on a girl's trip. The girl is healthy and has no known comorbids or drug history. Which one of the following is TRUE regarding paracetamol?
Your Answer:
Correct Answer: It is excreted renally
Explanation:Acetaminophen is an acetanilide derivative and is a widely used non-prescription analgesic and antipyretic medication for mild-to-moderate pain and fever.The route of elimination: Metabolites are mainly excreted in the urine. 90% of the dose administered is excreted within 24 hours. It is thought to work by selectively inhibiting COX-1 receptors in the brain and spinal cord: It is categorized by the FDA as an NSAID as it is believed to selectively inhibit cyclo-oxygenase 3 (COX-3) receptors in the brain and spinal cord. COX-3 is a unique variant of the more known COX-1 and COX-2. It is responsible for the production of prostaglandins in central areas, which sensitizes free nerve endings to the chemical mediators of pain. Therefore, by selectively inhibiting COX-3, paracetamol effectively reduces pain sensation by increasing the pain threshold.Toxicity is primarily due to glutathione production: Acetaminophen metabolism by the CYP2E1 pathway releases a toxic metabolite known as 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.It has a half-life of 6-8 hours: Acetaminophen can be administered orally, rectally, or intravenously. It is predominantly metabolized in the liver, and the elimination half-life is 1-3 hours after a therapeutic dose. But maybe greater than 12 hours after an overdose.It is primarily metabolized via the cytochrome p450 enzyme system: It 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%)
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 9
Incorrect
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A 38-year-old woman is investigated for Addison's disease. She had low blood pressure, weakness, weight loss, and skin discoloration. An adrenocorticotropic hormone (ACTH) stimulation test is scheduled as part of her treatment.Which of the following statements about ACTH is correct?
Your Answer:
Correct Answer: It is released in response to the release of CRH
Explanation:The anterior pituitary gland produces and secretes a peptide hormone called adrenocorticotropic hormone (ACTH) (adenohypophysis). It is secreted in response to the hypothalamus’s secretion of the hormone corticotropin-releasing hormone (CRH).ACTH promotes cortisol secretion via binding to cell surface ACTH receptors in the zona fasciculata of the adrenal cortex.ACTH also promotes the production of beta-endorphin, which is a precursor to melanocyte-releasing hormone (MRH).
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 10
Incorrect
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Compression of this nerve can cause weakness in the left leg while walking and thigh adduction weakness at the hip joint.
Your Answer:
Correct Answer: Obturator nerve
Explanation:The obturator nerve is a sensory and motor nerve that emerges from the lumbar plexus and innervates the thigh. This nerve supplies motor innervation to the medial compartment of the thigh, making it necessary for thigh adduction.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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SESSION STATS - PERFORMANCE PER SPECIALTY
