General 6

Question 1

1. Concerning the spectrum of electromagnetic radiation:

a) the visible spectrum spreads from 390 nm to 750 nm
b) X-rays and gamma rays are ionising radiations
c) the CO2 laser gives infrared radiation
d) ultraviolet rays are non-ionising
e) wavelength is inversely related to frequency

Answer 1

1.TTTTT

Question 2

2. Halothane:

a) has a marked arrhythmogenic potential compared with other currently used volatiles
b) is a racemic mixture of optical isomers
c) has a minimal alveolar concentration of 0.29 in 70% of nitrous oxide
d) is metabolised to the greatest extent amongst currently available agents
e) sensitises the myocardium to endogenous or exogenous catecholamines

Answer 2

2.TTTTT

Question 3

3. For intravenous anaesthetic agents:

a) the end point of induction of anaesthesia is loss of the eyelash reflex
b) the clearance is their rate of excretion
c) lower doses will be required for induction in hypovolaemic patients
d) the effects on the CNS. depend on their degree of ionisation
e) their non-protein bound fraction increase in liver and renal diseases

Answer 3

3.FFTTT

Question 4

4. Enflurane:

a) is less potent than isoflurane
b) causes convulsive EEG pattern when used at high concentration in the presence of hypocapnia
c) decreases intracranial pressure
d) impairs the autoregulation
e) does not affect cerebral blood flow

Answer 4

4.TTFTF

Question 5

5. Ketamine:

a) has marked analgesic properties mediated by its binding to NMDA receptors
b) causes a fall in cardiac output and a rise in heart rate
c) is contraindicated in patients with raised intracerebral pressure
d) has active metabolites
e) causes postoperative dreaming and hallucinations which are less frequent in children

Answer 5

5.TFTTT

Question 6

6. With regard to acids and bases:

a) acids can be considered as H+ ion donors
b) water can act as both an acid and a base
c) pH is log 10 [H+]
d) physiological systems control Na+ concentration within more closely defined limits than H+ concentration
e) lactic acidosis is a normal `anion-gap’ acidosis

Answer 6

6.TTFFF d)[H+] 36-46 nm/L [Na+] 135-145 mmol/l. Body concerned more with [H+] than [Na+]

Question 7

7. The following characteristics of a drug intended to be given by infusion are desirable:

a) short elimination half-life
b) high rate of plasma clearance
c) low cost
d) low aqueous solubility
e) administration via a central vein

Answer 7

7.TTTFF

Question 8

8. The effects of acidosis may include:

a) increased minute ventilation
b) shift of the oxygen dissociation curve due to the Bohr effect
c) negative inotropism due to higher calcium levels
d) hyperkalaemia
e) increased NH4 excretion

Answer 8

8.TTFTT

Question 9

9. Concerning buffers:

a) buffers are least efficient when half dissociated
b) carbonic anhydrase is an important component of the physiological buffering system
c) phosphate is an important extracellular buffer
d) oxygenated haemoglobin is a more powerful physiological buffer than deoxygenated haemoglobin
e) the imidazole ring structure of haemoglobin is the site of H+ exchange for physiological buffering

Answer 9

9.FTFFT

Question 10

10. A competitive antagonist:

a) combines with the same receptor as the agonist drug
b) shifts the log dose-response curve for the agonist to the right
c) depresses the maximum obtainable response of the agonist
d) may affect the affinity of the agonist for its receptors
e) need not have a close structural similarity to the agonist

Answer 10

10.TTFFT

Question 11

11. Concerning body fluid compartments:

a) water constitutes 70% of the total body weight
b) plasma constitutes a quarter of the extracellular fluid (ECF) volume
c) sucrose can be used to measure the ECF volume
d) the interstitial fluid volume for a 70 kg man is approximately 9 litres
e) The ECF/intracellular fluid volume ratio is smaller in infants and children than it is in adults

Answer 11

11.FTTTF

Question 12

12. When the ventilation/perfusion ratio of a lung unit increases:

a) the alveolar PO2 rises
b) the alveolar CO2 rises
c) end capillary PO2 increases
d) arterial PO2 increases
e) hypoxic pulmonary vasoconstriction will compensate for any change in gas exchange

Answer 12

12.TFTTF d)See West pg 53

Question 13

13. In the type I immune reaction in man:

a) the antibody is always IgE
b) an antigen-antibody reaction occurs on the surface of mast cells
c) most of the clinical manifestations are due to the release of kinins from mast cells
d) anaphylaxis occurs only in atopic individuals
e) bronchoconstriction may follow inhalation of reagin

Answer 13

13.TTFFT

Question 14

14. When a patient is using a monoamine oxidase inhibitor, the following drugs should be avoided:

a) halothane
b) pethidine
c) adrenaline
d) dopexamine
e) phenylephrine

Answer 14

14.FTTTT

Question 15

15. The following statements about diuretics are correct:

a) amiloride causes hyperuricaemia
b) thiazides improve carbohydrate tolerance
c) loop diuretics reduce renal calcium loss
d) loop diuretics potentiate nephrotoxicity of cephalosporins
e) thiazides may prevent renal colic in patients with idiopathic hypercalcaemia

Answer 15

15.FTFTF

Question 16

16. Gastric acid secretion is increased by:

a) anticholinergic drugs
b) histamine
c) vagal stimulation
d) gastrin
e) sucralfate

Answer 16

16.FTTTF

Question 17

17. Renal clearance of drugs can:

a) involve zero order kinetics
b) involve active secretion
c) occur by filtration
d) be affected by lipid solubility
e) depend on protein binding

Answer 17

17.FTTTT

Question 18

18. Peripheral nerve stimulators:

a) should have an ability to generate 60-70 mA of current
b) should be capable of delivering an impulse longer than 0.5 ms
c) should be able to deliver monophasic and rectangular wave impulse
d) should be able to deliver supramaximal stimuli
e) should be used on the healthy side in hemiplegic patients

Answer 18

18.TFTTT

Question 19

19. The following are impermeable to water:

a) ascending vasa recta
b) descending vasa recta
c) ascending loop of Henle
d) descending loop of Henle
e) proximal convoluted tubule

Answer 19

19.FFTFF

Question 20

20. A highly ionised drug:

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

Answer 20

20.TFFFF

Question 21

21. A more rapid induction of anaesthesia will occur using an inhalational agent if:

a) the agent is highly soluble in blood
b) the patient has a low cardiac output
c) the patient is breathing 5% carbon dioxide
d) the agent has a low blood/gas solubility coefficient
e) a low flow circle system is used

Answer 21

21.FFTTF

Question 22

22. Examples of active transport include:

a) hydrogen ion secretion from parietal cells
b) endocrine gland secretion of hormones
c) Na+ and K+ movement across nerve membranes
d) glucose reabsorption in the proximal tubule
e) voltage dependent Ca++ entry into myocardial cells

Answer 22

22.TFFTF e) This is voltage mediated and no energy per se is needed – the ions flow because the membrane is depolarised.

Question 23

23. The following affect protein binding:

a) pKa
b) pH
c) molecular weight
d) binding site availability
e) lipid solubility

Answer 23

23.FTFTT d) competition for binding sites is competitive and can alter unbound fraction of each” (Peck+Williams)

Question 24

24. In first order kinetics:

a) the rate of excretion is proportional to the concentration of the drug present in the body at any time
b) the plasma level decay is exponential
c) excretion must be purely renal
d) excretion must not be affected by administration of another drug
e) 95% of the drug is eliminated in about three time constants

Answer 24

24.TTFTT

Question 25

25. The following drugs have greater than 50% bioavailability after oral administration:

a) warfarin
b) propranolol
c) atenolol
d) lidocaine
e) morphine

Answer 25

25.TFFFF c) 45% bioavailability in Calvey+Williams, QBASE, Peck+W BUT 50% in Fundamentals of Anaesthesia e) only 25% reaches systemic circulation

Question 26

26. Lower oesophageal sphincter pressure is decreased by:

a) opiates
b) metoclopramide
c) atropine
d) gastrin
e) dopamine

Answer 26

26.TFTFT

Question 27

27. Ingested lipids:

a) are mainly triglycerides
b) cannot be used to produce energy for cell metabolism
c) are broken down in the duodenum
d) are transported as chylomicrons from the gut to the liver

Answer 27

27.TFFT

Question 28

28. Lidocaine:

a) has a pKa of 7.7 at 37 degrees C
b) is more potent than ropivacaine
c) is less effective orally as an antidysrhythmic because of its high first-pass metabolism
d) is an acid
e) can cause epileptiform fits

Answer 28

28.TFTFT

Question 29

29. The factors affecting the rate of transport of a drug across the placenta are:

a) the degree of ionisation
b) the degree of protein binding
c) placental blood flow
d) the pK of the drug
e) the lipid solubility of the drug

Answer 29

29.TTTTT e) all the above are true and are listed in Fundamentals pg 533 (old edition)