FRCA pdf Qs

Question 1

The liver:

a) receives most of its oxygen supply from the portal vein
b) has its highest oxygen tension at the centre of a lobule
c) produces heparin
d) has a normal portal venous pressure of greater than 20 mmHg
e) receives approximately 25% of the cardiac output

Answer 1

TFTFT

Question 2

Skeletal muscle blood flow:

a) increases with noradrenaline
b) receives 50% of the cardiac output at rest
c) may cease during isometric contraction
d) increases with rhythmic contraction
e) increases with adrenaline

Answer 2

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Question 3

In thermoregulation:

a) respiratory heat loss is insignificant under normal conditions
b) brown fat is an important source of heat production in neonates
c) shivering is due to impulses conducted via autonomic efferents
d) peripheral vasoconstriction increases heat production
e) sweating is mediated by sympathetic cholinergic neurones

Answer 3

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Question 4

Adrenaline:

a) is synthesized by demethylation of noradrenaline
b) increases coronary blood flow
c) increases free fatty acids in the blood
d) mobilizes glycogen stores from the liver
e) is metabolized in the plasma by monoamine oxidase

Answer 4

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Question 5

Glucagon:

a) is a positive inotrope
b) is produced by the beta cells of the pancreas
c) stimulates production of free fatty acids in the blood
d) release is increased in starvation
e) stimulates glycogen synthesis

Answer 5

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Question 6

Total plasma calcium:

a) increases with phosphate
b) increases with a rise in albumin
c) changes its degree of ionisation with pH changes
d) is decreased in osteoporosis
e) is affected by vitamin D

Answer 6

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Question 7

There is increased intestinal motility with:

a) increased intraluminal pressure
b) anticholinesterase drugs
c) sympathetic block to T4
d) stimulation of the splanchnic nerves
e) increased circulating adrenaline

Answer 7

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Question 8

A healthy adult breathing an FIO2 of 0.1 will:

a) have a decreased cardiac output
b) have a normal PaO2
c) have a changed alveolar PCO2
d) have an unchanged respiratory rate
e) initially have a fall in pH

Answer 8

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Question 9

Acetylcholine is a neurotransmitter at:

a) sweat glands
b) the adrenal medulla
c) the parotid gland
d) parasympathetic ganglia
e) the neuromuscular junction

Answer 9

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Question 10

Insulin:

a) has the same effect on blood sugar as growth hormone
b) inhibits entry of potassium into cells
c) facilitates protein anabolism
d) increases deposition of fats
e) secretion is affected by catecholamines

Answer 10

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Question 11

The following affect gastric emptying:

a) diamorphine
b) diazepam
c) metoclopramide
d) cisapride
e) omeprazole

Answer 11

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Question 12

Chlorpromazine

a) can cause dystonic reactions
b) antagonises apomorphine-induced vomiting
c) is a dopamine antagonist at the chemoreceptor trigger zone
d) is a weak alpha-adrenergic agonist
e) undergoes extensive first-pass metabolism

Answer 12

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Question 13

Alfentanil

a) is less lipid soluble than fentanyl
b) relaxes the sphincter of Oddi
c) has active metabolites
d) has a large volume of distribution
e) causes analgesia without sedation

Answer 13

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Question 14

Folic acid metabolism is impaired by:

a) nitrous oxide
b) sodium nitroprusside
c) sulphonamides
d) penicillin
e) trimethoprim

Answer 14

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Question 15

Significant agonist activity at opioid receptors occurs with:

a) clonidine
b) pentazocine
c) buprenorphine
d) ketamine (Ketamine has antagonist activity at µ opioid receptors, but agonist activity at d and ? receptors)
e) naloxone

Answer 15

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Question 16

The following drugs are mainly eliminated from the body by hepatic metabolism:

a) isoflurane
b) morphine
c) atracurium
d) suxamethonium
e) dopamine

Answer 16

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Question 17

The following have an elimination half-life of greater than 24 hours: a) diazepam

b) midazolam
c) methadone
d) gelofusine
e) hydroxyethyl starch

Answer 17

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Question 18

Phenytoin:

a) shows first-order elimination kinetics
b) induces enzymes
c) causes hypotension
d) causes vitamin B2 deficiency
e) has a half-life of about 4 hours

Answer 18

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Question 19

L-dopa:

a) is more lipid soluble than dopamine
b) may produce postural hypotension
c) may cause nausea
d) may cause abnormal movements
e) is ineffective via the oral route

Answer 19

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Question 20

Toxicity from hyperbaric oxygen therapy can cause:

a) painful joints
b) pulmonary oedema
c) acute tubular necrosis
d) convulsions
e) bradycardia

Answer 20

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Question 21

In a patient with a low cardiac output, the following are true of inhalational anaesthetic agents:

a) a lower inspired anaesthetic concentration will be required to induce anaesthesia
b) it would take longer to reach a given depth of surgical anaesthesia
c) the rate at which alveolar approaches inspired anaesthetic concentrations is faster
d) a higher inspired anaesthetic concentration is required to reach the same brain anaesthetic concentration
e) there will be no change in the inspired anaesthetic concentration to achieve the same depth of anaesthesia

Answer 21

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Question 22

The rate of induction using an inhalational technique is directly related to:

a) the rate at which alveolar approaches the inspired fractional anaesthetic concentration
b) the blood-gas solubility coefficient
c) the inspired fractional anaesthetic concentration
d) the alveolar ventilation
e) right or left shunt

Answer 22

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Question 23

In the unconscious patient:

a) absence of radial pulse indicates a cardiac arrest
b) chest movement indicates breathing is present
c) dilated pupils indicate brain damage has occurred
d) the airway should be checked for obstruction
e) the patient’s dentures should be removed

Answer 23

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Question 24

In normal pregnancy at term:

a) the maternal haemoglobin content is increased
b) the lung volume is increased
c) tidal volume is increased
d) the cardiac output is increased by 10-20%
e) glomerular filtration rate may be increased by up to 80%

Answer 24

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Question 25

Aortocaval compression in the pregnant patient:

a) may produce hypotension
b) will only occur in the supine posture
c) will only occur in patients with epidural or spinal anaesthesia
d) may present solely as foetal distress
e) IV ephedrine is the initial treatment of choice

Answer 25

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Question 26

The following cause an increase in cerebral blood flow:

a) dexamethasone
b) isoflurane
c) glyceryl trinitrate
d) ketamine
e) nitrous oxide

Answer 26

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Question 27

Infusions of sodium nitroprusside:

a) do not interfere with autoregulation of cerebral blood flow
b) result in cyanide toxicity if the dose exceeds 1 mcg/kg given over 3 hours
c) cause an increase in renin secretion
d) reduce cerebral oxygen consumption
e) should be protected from light

Answer 27

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Question 28

A highly ionised drug:

a) is well absorbed from the intestine
b) is excreted mainly by the kidney
c) crosses the placental barrier easily
d) is reabsorbed from the renal tubules
e) is highly protein bound

Answer 28

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Question 29

Nitric oxide:

a) is beneficial in reducing pulmonary vascular resistance
b) is available as compressed gas in cylinders
c) side-effects are related to metabolic by-products
d) is useful in treating methaemoglobinaemia
e) in therapeutic concentrations can cause brain damage

Answer 29

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Question 30

Regarding drug pharmacokinetics:

a) Vd represents the apparent volume available in the body for drug distribution
b) CL reflects the ability of the body to eliminate the drug
c) the terminal half-life of a drug is not dependent on Vd and CL
d) the Vd of muscle relaxants is localised to the plasma and extracellular fluid
e) Vd can never be greater than total body water

Answer 30

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Question 31

Regarding anaesthetic breathing systems:

a) rebreathing does not occur in Mapleson D during controlled ventilation
b) with a fresh gas flow (FGF) <1.5 L, volatile concentration in breathing system may be higher than the dial setting of the vaporiser
c) in circle system with a FGF <1 L (N2O:O2=66:34), FIO2 in the circle may increase over time
d) a FGF of 3 times the minute volume may be needed to prevent rebreathing in Bain’s co-axial system during spontaneous ventilation
e) dead space gas is preserved in Magill system during spontaneous ventilation

Answer 31

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Question 32

The volume of distribution of a drug is not altered by:

a) age
b) increased extracellular fluid volume
c) pregnancy
d) renal failure
e) cardiac failure

Answer 32

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Question 33

Regarding pharmacokinetics:

a) terminal half-life provides a guide to frequency of drug administration
b) for IV drugs, loading dose=CpXVd and rate of infusion = CpxCl, where Cp is the desired plasma concentration
c) terminal half-life is not related to the duration of action in case of IV barbiturates
d) diazepam has a high oral bioavailability
e) cimetidine appears to increase the bioavailability of propranolol

Answer 33

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Question 34

Regarding central venous pressure monitoring:

a) the tip of the catheter must be in the right atrium
b) cannon a waves are seen in presence of junctional rhythm
c) y descent is due to opening of the tricuspid valve
d) x descent occurs during ventricular systole
e) a wave corresponds with QRS complex in ECG

Answer 34

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Question 35

Adrenaline:

a) should be administered every 3 minutes during CPR
b) is principally released in postsynaptic sympathetic nerve endings
c) differs from noradrenaline by having an extra methyl group
d) is commonly used with local anaesthetics at a concentration of 1:80,000
e) d-adrenaline is 50-100 times less potent than l-adrenaline

Answer 35

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Question 36

Low molecular weight heparins:

a) have a molecular weight <10,000 daltons
b) inhibit activated factors IX, X, XI, XII
c) include tinzaparin, dalteparin and enoxaparin
d) are not effective in deep-vein thrombosis prophylaxis in once-daily regimen
e) do not bind to thrombin and antithrombin III simultaneously

Answer 36

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Question 37

The following drugs have antiplatelet activity:

a) epoprostenol
b) calcium heparin
c) hydroxyethyl starch
d) dipyridamole
e) remifentanil

Answer 37

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Question 38

Compared with that of a normal adult, the newborn infant’s:

a) kidneys have less ability to excrete a concentrated urine
b) blood-brain barrier is less permeable to bilirubin
c) heat regulation is more efficient because of its ability to metabolise brown fat
d) blood has a greater affinity for oxygen at low oxygen pressures
e) carbohydrate reserve is greater

Answer 38

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Question 39

Concerning acid-base balance:

a) standard bicarbonate is lower than actual bicarbonate in a chronic obstructive airways disease (COAD) patient
b) metabolic alkalosis is seen with prolonged use of loop diuretics
c) standard bicarbonate is low in metabolic acidosis
d) about 70% of carbon dioxide is transported in plasma as bicarbonate
e) the ratio of HCO3/CO2 may be normal in a stable COAD patient

Answer 39

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Question 40

The following statements are true regarding cardiovascular physiology:

a) atrial systole contributes to 25% of ventricular filling
b) pericardial effusion decreases end-diastolic volume
c) coronary blood flow is about 5% of the cardiac output at rest
d) the pressure-volume loop consists of isovolumetric contraction, ejection, isovolumetric relaxation and rapid ventricular filling
e) LVdP/dTmax is dependent on changes in preload

Answer 40

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Question 41

In the human heart:

a) end-systolic left ventricular volume is dependent on the afterload
b) left ventricular static compliance is reduced in myocardial ischaemia
c) ejection fraction is the ratio of stroke volume to end-diastolic volume
d) the second heart sound coincides with end of the T wave in the ECG
e) pulmonary artery occlusion pressure reflects the left ventricular end-diastolic pressure

Answer 41

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Question 42

When measuring arterial blood pressure with a sphygmomanometer:

a) cuff width should be 20% greater than the arm diameter
b) a mercury column manometer may be used at an angle of up to 25 degrees from vertical
c) a common source of error is blockage of the air vent
d) there are five Korotkoff phases
e) use of a finger to detect return of pulsation is highly inaccurate

Answer 42

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Question 43

In the human thyroid gland:

a) iodide ions from the plasma enter the follicle cells by passive diffusion
b) T4 and T3 bind to the receptors in nuclei
c) thyroxine, once synthesised, is then coupled to thyroglobulin until released
d) a greater proportion of tri-iodothyronine is formed when iodine is deficient
e) thyroid hormones increase the number and affinity of beta-receptors in the myocardium

Answer 43

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Question 44

Regarding aldosterone:

a) it increases the amount of Na+ -K + ATPase in the target cells
b) it reduces the sodium content of the sweat
c) it increases the acidity of the urine
d) it increases the potassium content of the urine
e) basal secretion is normal even after hypophysectomy

Answer 44

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Question 45

Regarding insulin:

a) its release is increased by the sulphonylurea type of hypoglycaemic drugs
b) it has a half-life of 5 minutes in the circulation
c) it increases the number of glucose transporters in the plasma membrane
d) secretion is reduced by surgical stress response
e) it is normally secreted at a rate of about 40-50 U/day

Answer 45

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Question 46

Elderly patients show increased response to standard drug dosage and an increased incidence of adverse drug reactions because they have:

a) increased lean body mass
b) reduced renal and hepatic function
c) reduced blood flow to vital organs
d) better nutrition
e) less efficient homeostatic mechanisms

Answer 46

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Question 47

Regarding diffusion:

a) the rate of diffusion of a substance across a membrane is proportional to its concentration gradient
b) the diffusion across the alveolo-capillary membrane is measured using carbon monoxide
c) the rate of the diffusion of a gas is proportional to its tension gradient
d) pneumonectomy approximately halves the diffusing capacity
e) the rate of diffusion of a gas is inversely proportional to the square root of its molecular weight

Answer 47

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Question 48

The following are idiosyncratic reactions:

a) haemolysis after exposure to NSAIDs in patients with glucose-6-phosphate deficiency
b) prolonged apnoea after suxamethonium due to abnormal pseudocholinesterase
c) malignant hyperpyrexia after halothane
d) acute porphyria following induction with thiopentone
e) sulphonamide toxicity in slow acetylators

Answer 48

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Question 49

Phenytoin:

a) plasma half-life is the same at all plasma concentrations
b) is subject only to first-order kinetics
c) enhances its own metabolism
d) is unlikely to cause drug interactions in a patient taking other medications
e) has a remarkably small range of adverse effects

Answer 49

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