Pharmacology | Set 2

1. Regarding local anaesthetics (LA)

A. Lignocaine is metabolised in the liver faster than any of the other amide LA

B. Allergies to amide Las are more common than with the ester Las

C. Prilocaine is the most cardiotoxic LA

D. Cocaine is an amide LA which is often used as a drug of abuse

E. The +1/2 of lignocaine may be increased 3-4 fold in a patient with severe liver disease

Correct : E. The +1/2 of lignocaine may be increased 3-4 fold in a patient with severe liver disease

2. Regarding nondepolarising muscle relaxants

A. Jaw and eye muscles are paralysed before the limb and trunk muscles

B. Rocuronium is the most potent nondepolarising skeletal muscle relaxant

C. Atracurium is a steroid derivative

D. Vecuronium blocks cardiac muscarinic receptors, thus inducing moderate increase in heart rate

E. The nondepolarising agents produce a non-surmountable blockade

Correct : A. Jaw and eye muscles are paralysed before the limb and trunk muscles

3. The skeletal muscle relaxant with the longest duration of action is

4. Which of the following DOES NOT increase the susceptibility of a nerve fibre to conduction blockade by a local anaesthetic

A. Small diameter

B. Myelination

C. Location in the periphery of a nerve

D. High firing rate

E. Short action potential duration

Correct : E. Short action potential duration

5. Diuretics

A. Work to lower BP initially by decreasing peripheral vascular resistance

B. Thiazide diuretics are potassium sparing

C. Are effective in lowering Bp by 20 – 25 mmHg in most patients

D. BP response to thiazides continues to increase at doses greater than usual therapeutic dose.

E. Diuretics may impair glucose tolerance

Correct : E. Diuretics may impair glucose tolerance

6. Methyl dopa

A. Lowers the heart rate and cardiac output more than clonidine does

B. Causes reduction in renal vascular resistance

C. Has minimal CNS side effects

D. Has 80% bioavailability

E. Usual therapeutic dose is about 1 – 2 mg/day

Correct : B. Causes reduction in renal vascular resistance

7. Propranolol

A. Is a B1 specific blocker

B. Causes prominent postural hypotension

C. Inhibits the stimulation of renin production by catecholamines

D. Has a half life of 12 hours

E. Has no effect on plasma lipids

Correct : C. Inhibits the stimulation of renin production by catecholamines

8. Hydralazine

A. Dilates veins but not arterioles

B. Is contraindicated in the treatment of preeclampsia

C. Can cause an SLE type syndrome in up to 10 – 20% of patients

D. Causes orthostatic hypotension in many cases

E. Is extremely useful as a single agent in treatment of hypertension

Correct : C. Can cause an SLE type syndrome in up to 10 – 20% of patients

9. Which of the following drug’s metabolism characteristics are bimodally distributed in the population?

10. The ACE inhibitors

A. Inhibit peptidyl dipeptidase thus preventing the inactivation of bradykinin

B. Captopril is a prodrug

C. Are to be used with caution in patients with IHD as reflex sympathetic activation occurs secondary to the hypotensive effects of the ACE inhibitors

D. Have no role in treating the normotensive diabetic patients

E. Are useful antihypertensive agents in late pregnancy

Correct : A. Inhibit peptidyl dipeptidase thus preventing the inactivation of bradykinin

11. The following drugs when combined with ACE inhibitors may produce troublesome problems EXCEPT

12. The nitrates

A. Have an antianginal effect via vasodilation of arterioles only

B. Serve to increase preload

C. Have a direct effect on cardiac muscle to cause a decrease in anginal symptoms

D. All have high oral bioavailability

E. Are contraindicated in the presence of increased intracranial pressure

Correct : E. Are contraindicated in the presence of increased intracranial pressure

13. Regarding Calcium channel blockers

A. Calcium channel blockers are not bound to plasma proteins

B. Nifedipine has less vascular potency than verapamil

C. Felodipine has been shown to inhibit insulin release in humans

D. Diltiazem has a plasma half life of 3 – 4 hours

E. Verapamil has high affinity for cerebral blood vessels thus decreasing vasospasm post subarachnoid haemorrhage

Correct : D. Diltiazem has a plasma half life of 3 – 4 hours

14. Which of the following calcium channel blockers is excreted predominantly in the faeces?

15. Which of the following calcium channel blockers has the longest plasma half life?

16. The following include major actions of digoxin on cardiac electrical functions EXCEPT

A. Decreased PR interval on ECG

B. Decreased conduction velocity at the AV node

C. Increased automaticity of the atrial muscle

D. Decreased effective refractory period in purkinje system/ventricles

E. Bigeminy can be induced by digoxin

Correct : A. Decreased PR interval on ECG

17. Which of the following increases the risk of digoxin induced arrhythmias?

18. Digoxin

A. Is poorly lipid soluble

B. Is extensively metabolized

C. Has a half life in the body of 40 hours

D. Has minimal GI toxicity

E. Is 80% bound to plasma proteins

Correct : C. Has a half life in the body of 40 hours

19. Drugs which may increase digoxin effect include all of the following EXCEPT

20. Which of the following drugs has the smallest volume of distribution?

21. Which is the most common organism causing community acquired pneumonia?

22. which organism causing pneumonia has an increased association with COPD

23. Which organism causing pneumonia has an increased incidence in IV drug users and those post-influenza?

24. Which drug/s should be used in adult mild-mod. Community acquired pneumonia?

25. Which drug regimen is suggested for severe community acquired pneumonia initially?

A. benzyl penicillin and gentamicin and erythromycin

B. benzyl penicillin and gentamicin

C. ceftriaxone and gentamicin

D. gentamicin and erythromycin

E. flucloxacillin and gentamicin

Correct : A. benzyl penicillin and gentamicin and erythromycin

26. Which bug makes up 50% of hospital acquired pneumonia?

27. What is the largest size spontaneous primary pneumothorax that can be managaed without aspiration or thoracostomy?

28. In which sort of pneumoathorax is aspiration likely to be most successful?

29. What if the role of aspiration in traumatic pneumothoraces?

A. there is no role

B. first line management in small pneumathoraces only

C. it should be tried in all pneumathoraces as long as there is no respiratory compromise

D. it can be repeated twice before thoracostomy tube is considered

E. none of the above

Correct : A. there is no role

31. Which is not a biochemical feature of transudative pleural effusions?

A. protein<30g/l

B. pleural protein:serum protein <0.5

C. pleural LDH : seurm LDH < 0.6

D. pleural glucose< serum glucose

E. none of the above are biochemical features

Correct : D. pleural glucose< serum glucose

32. Which of the list below is not the cause of an exudative pleural effusion?

33. Which of the list below is not a cause of a transudative pleural effusion?

35. Which statement is false about haemoptysis?

A. massive haemoptysis is greater than 600ml in 24 hours

B. a CXR is normal in about 25 % of cases

C. in any four cases, one is likely to be due to nonteuberculous infection, one due to neoplasia, one due to rarer causes and one idiopathic

D. in massive hemoptysis the pt should be nursed bleeding lung up

E. if possible a double lumen tube should be reserved for post brochoscopy as a rigid bronchoscope cannot be passed down it

Correct : D. in massive hemoptysis the pt should be nursed bleeding lung up

36. Which drug/intervention is of no proven benefit in management of acute severe asthma in adults?

37. As a generalization, at what PEFR should someone be admitted?

A. PEFR<25% pretreatment and <40% posttreatment

B. PEFR<10% pretreatment and <20% posttreatment

C. PEFR<40% pretreatment and <60% posttreatment

D. PEFR<50% pretreatment and <70% posttreatment

E. PEFR is of no value in this decision

Correct : A. PEFR<25% pretreatment and <40% posttreatment

38. Which statement is false?

A. Ipratropium is of definite proven benefit in asthma when used with B agonists

B. Ketamine is the intubation agent of choise but in ongoing therapy in acute asthma no benefit has yet been proven in the few studies done

C. Oral steroids are as effective as parenteral steroids

D. Aminophylline may have a role in acute treatment in children but not in adults

E. No studies have been done to see whether adrenaine is better than parenteral salbutamol

Correct : A. Ipratropium is of definite proven benefit in asthma when used with B agonists

39. Which is FALSE regarding CPAP in acute asthma?

A. it decreases the work of breathing

B. it causes bronchodilation and decreases airway resistance

C. it improves gas exchange if used alone in severe asthma

D. it may be an effective alternative to ETT when maximal pharmacotherapy is used

E. it reduces the cardiovascular impact of changes in pressures caused by asthma

Correct : C. it improves gas exchange if used alone in severe asthma

40. Which drug/intervention is rarely used acutely in the acute setting of exacerbation of COAD?

41. Which statement is incorrect regarding the acute management of exacerbation of COAD?

A. support for the widespread use of steroids is limited

B. support for the use of salbutamol combined with ipratropium is limited

C. B agonists are widely used assuming the possiblility of a small reversible component to the airflow obstruction

D. Support for the widespread use of CPAP and BiPAP is minimal

E. Theophylline is rarely used acutely

Correct : D. Support for the widespread use of CPAP and BiPAP is minimal

42. Regarding pulmonary emboli, which statement is correct?

A. a normal Aa gradient excludes a PE

B. a paO2>80 excludes a PE

C. a normal CXR excludes a PE

D. anticoagulation reduces mortality from PE from 30% to 10%

E. all of the above are correct

Correct : D. anticoagulation reduces mortality from PE from 30% to 10%

43. With regards to PE which statement is CORRECT?

A. embolectomy has a better outcome than thrombolysis in massive PE

B. streptokinase is more effective with lower side effects than tPA in massive PE

C. LMWH is probably as effective as unfractionated heparin

D. TOE is sensitive for peripheral emboli

E. Spiral CT angiography is better at detecting peripheral clots than central

Correct : C. LMWH is probably as effective as unfractionated heparin

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