General 3

Question 1

1. Hyponatraemia:
   a) may increase intracellular fluid volume
   b) may be seen in syndrome of Inappropriate antidiuretic hormone
   c) may increase the secretion of atrial natriuretic peptide
   d) may increase the plasma osmolality
   e) of acute onset may be associated with cerebral oedema

Answer 1

1.TTTFT a)see p.680, Kumar and Clark: fall in ECF osmolality causes H2O to move into cells.

Question 2

2. Adrenaline:
   a) can be nebulised
   b) is a bronchodilator
   c) may elevate the blood sugar
   d) has an almost equal effect on both alpha- and beta-adrenergic receptors
   e) tracheal administration of adrenaline should be used even in presence of IV access during cardiopulmonary resuscitation

Answer 2

2.TTTTF

Question 3

3. Heparin:
   a) has a molecular weight between 3,000-60,000 daltons
   b) acts by binding to antithrombin III
   c) has antiplatelet activity
   d) prolongs the prothrombin time
   e) has a shorter duration of action than low molecular weight heparin

Answer 3

3.FTTTT a) most texts quote max MW of 40,000 d) in high doses, PT is prolonged.

Question 4

4. Glycopyrrolate:
   a) can act at central cholinergic receptors
   b) can increase the physiological dead space
   c) can dilate the pupil
   d) is equally effective when given orally
   e) is five times more potent as an antisialagogue than atropine

Answer 4

4.FTTFT c) hence use with caution in glaucoma.

Question 5

5. Isoprenaline:
   a) can be given by mouth
   b) is absorbed from the sublingual route
   c) causes complete heart block
   d) has more beta than alpha effect on the heart
   e) antagonises the action of phentolamine

Answer 5

5.TTFTF

Question 6

6. In an awake upright spontaneously breathing patient:
   a) ventilation per unit lung volume is smallest at the apex of lungs
   b) basal alveoli are smaller
   c) basal alveoli expand more than apical alveoli during inspiration
   d) pleural pressure is less negative at the base of the lungs

Answer 6

6.TTTT

Question 7

7. Regarding nitrates:
   a) they are nitric oxide donors
   b) they increase the level of intracellular cyclic GMP
   c) they have an onset of action faster than that of sodium nitroprusside
   d) they may cause methaemoglobinaemia
   e) tolerance may develop

Answer 7

7.TTFTT

Question 8

8. Ephedrine:
   a) shows tachyphylaxis due to downregulation of beta receptors
   b) readily crosses the blood-brain barrier
   c) releases noradrenaline at sympathetic nerve endings
   d) has both alpha and beta effects
   e) reduces placental blood flow

Answer 8

8.FTTTF

Question 9

9. In a normal healthy man at rest in the supine position:
   a) left ventricular end-diastolic volume is about 20 ml
   b) the first heart sound coincides with the onset of ventricular systole
   c) cardiac output is approximately 75 ml/beat
   d) left ventricular end-diastolic pressure is about 5 mmHg
   e) the second heart sound coincides with the end of the T wave of the ECG

Answer 9

9.FTTTT

Question 10

10. The rate of diffusion of a gas (Fick’s Law) across a membrane:
    a) is directly proportional to the area
    b) is directly proportional to the partial pressure gradient
    c) is inversely proportional to thickness of the membrane
    d) is directly proportional to molecular weight
    e) is inversely proportional to the density of the gas

Answer 10

10.TTTFF

Question 11

11. Third generation beta-adrenergic blockers:
    a) include celiprolol and dilevalol
    b) block the beta-1 receptors
    c) stimulate beta-2 receptors
    d) appear well tolerated in asthmatics
    e) may reduce juxtaglomerular renin release by beta-1 blockade

Answer 11

11.TTTTT

Question 12

12. Methaemoglobinaemia:
    a) may be caused by prilocaine
    b) may be beneficial in cyanide toxicity
    c) is effectively treated by methylene blue
    d) will not change the partial pressure of oxygen in blood
    e) is seen in carbon monoxide poisoning

Answer 12

12.TTTTF

Question 13

13. Concerning the ABO blood groups:
    a) a person of group O is a universal recipient
    b) a person of group B always has anti-A agglutinins in his plasma
    c) in an incompatible blood transfusion reaction, donor cells are lysed by recipient antibodies
    d) disseminated intravascular coagulation may be a clue to mismatched transfusion
    e) a saline cross-matching takes 10 minutes to perform

Answer 13

13.FTTTF

Question 14

14. Aspirin at the therapeutic dose:
    a) inactivates the platelet cyclo-oxygenase system temporarily
    b) causes sweating by a direct action on the post-ganglionic nerves
    c) acts in fever to reset the central thermostat
    d) will not antagonise the hyperthermia of exercise
    e) does not alter the requirement of heparin for anticoagulation

Answer 14

14.FFTTT

Question 15

15. Oral anti-coagulant treatment:
    a) may be teratogenic in early pregnancy
    b) can cause haemorrhagic foetal death in the third trimester
    c) precludes breast feeding
    d) predisposes to particular hazards in patients undergoing prostatectomy
    e) is best withdrawn 5 days before elective surgery

Answer 15

15.TTFTF

Question 16

16. Haemaccel:
    a) is a derivative of starch
    b) has an average molecular weight of 35,000 daltons
    c) is equally distributed throughout the extracellular fluid
    d) has a half life of 8 hours
    e) is hypotonic

Answer 16

16.FTFFF

Question 17

17. Regarding blood transfusions:
    a) they may result in hypercalcaemia
    b) in an emergency, it is safe to give O+ blood to an O-ve patient
    c) they are contraindicated in head injury
    d) they may result in consumption coagulopathy
    e) when rapid will often cause hyperthermia

Answer 17

17.FTFTF

Question 18

18. The haemoglobin oxygen dissociation curve is moved to the left by:
    a) ascending to 6000 feet over 24 hours
    b) carbon monoxide
    c) frozen red cells
    d) bovine haemoglobin
    e) anaemia

Answer 18

18.FTTTF

Question 19

19. Amiodarone:
    a) prolongs the action potential duration in the SA node
    b) prolongs repolarisation in the AV node
    c) may cause photosensitivity
    d) may have effect on thyroid function on long-term treatment
    e) slows conduction velocity in His-Purkinjee system

Answer 19

19.TTTTT

Question 20

20. Enzyme induction:
    a) occurs in both hepatic and extrahepatic tissues
    b) develops within 5 days of administration of an inducing agent
    c) is usually brought about by lipid-insoluble substances with a short half-life
    d) enables the body to adapt to varying exposure to foreign compounds
    e) can be a cause of loss of anticoagulant control

Answer 20

20.TFFTT

Question 21

21. Pulmonary artery wedge pressure will be greater than left ventricular end diastolic pressure in the following situations:
    a) presence of mitral valve prosthesis
    b) positive end-expiratory pressure during mechanical ventilation
    c) catheter tip in Zone I
    d) non-compliant left ventricle
    e) mitral stenosis

Answer 21

21.TTTFT

Question 22

22. Third generation cephalosporins:
    a) in general are active against gram +ve cocci
    b) in general are active against Escherichia coli, Klebsiella and Proteus mirabilis
    c) may be nephrotoxic in combination with aminoglycosides
    d) may have disulfiram like action
    e) is the drug of choice for prophylaxis against bacterial endocarditis

Answer 22

22.TTTTF

Question 23

23. Compared with intracellular fluid, extracellular fluid has:
    a) a greater osmolarity
    b) a higher protein concentration
    c) a lower chloride ion concentration
    d) a lower hydrogen ion concentration
    e) a lower potassium ion concentration

Answer 23

23.FFFTT

Question 24

24. With reference to the normal human heart:
    a) the most rapidly conducting fibres in the heart are the Purkinje fibres
    b) the last part of the ventricle to be activated is the apex
    c) the duration of an action potential in a ventricular muscle fibre is about the same as in a skeletal muscle fibre
    d) the T wave of the ECG occurs at the beginning of the absolute refractory period of the ventricle
    e) left axis deviation leads to abnormally large R wave in Standard Limb Lead I

Answer 24

24.TFFFF

Question 25

25. Concerning dopamine receptors:
    a) D1 receptors are present in renal and mesenteric blood vessels
    b) D1 receptors in renal tubules may induce natriuresis
    c) D1 receptor stimulation may lead to renin release
    d) D2 receptors are present in the nigrostriatal pathway
    e) fenoldapam selectively acts on D1 receptors

Answer 25

25.TTTTT

Question 26

26. Pulmonary vascular resistance
    a) is increased at high altitude
    b) is decreased by a low pH
    c) can be measured using a flow-directed balloon catheter
    d) is increased by isoprenaline
    e) is decreased by 5-HT

Answer 26

26.TFTFF

Question 27

27. A plasma sodium concentration of 120 mmol/L may be a consequence of:
    a) Conn’s syndrome
    b) prolonged unconsciousness
    c) analgesic-induced nephropathy
    d) diabetes insipidus
    e) acutely decreased renal blood flow

Answer 27

27.FFTFF

Question 28

28. Factors determining urinary sodium loss include:
    a) plasma sodium concentration
    b) glomerular filtration rate
    c) circulating renin levels
    d) distal tubular fluid anion concentration
    e) plasma hydrogen ion concentration

Answer 28

28.TTTTF

Question 29

29. Atrial natriuretic peptide (ANP):
    a) is released via coronary sinus
    b) is a potent vasodilator
    c) improves renal blood flow
    d) increases the glomerular filteration rate
    e) may augment the release of antidiuretic hormone

Answer 29

29.FTTTF

Question 30

30. Excitatory amino acids:
    a) include aspartate and glutamate
    b) act on NMDA, kainate and quisqualate receptors
    c) may induce uncontrolled sodium and calcium influx to the cell
    d) can be antagonised by ketamine
    e) may potentiate pain transmission

Answer 30

30.TTTTT