Chapter: Analgesics-Toxicology
1.

Regarding paraquat poisoning

A. The interval between ingestion and death is usually hours because of immediate pulmonary toxicity
B. Mechanism of action involves single electron oxidation of the herbicide to free radical species
C. Probable human lethal dosage is 50-500mg/kg
D. Oxygen high flow stops the pulmonary lesions occurring
E. Paraquat doesn’t affect hepatic or renal functions
Answer» C. Probable human lethal dosage is 50-500mg/kg
2.

Regarding NSAIDs

A. Piroxicam has a half life of >50 hours
B. Aspirin reversibly inhibits COX
C. Diclofenac is a selective COX1 inhibitor
D. Indomethacin is relatively free of adverse side effects
E. Ibuprofen is predominantly excreted unchanged in the urine
Answer» A. Piroxicam has a half life of >50 hours
3.

Regarding paracetamol (acetaminophen)

A. Less than 5% is excreted unchanged
B. Acetaminophen has no anti-inflammatory properties
C. The half life of paracetamol is 2-3 hours
D. Haemolytic anaemia has rarely been noted with paracetamol
E. All of the above are true
Answer» E. All of the above are true
4.

Regarding lead toxicity

A. Lead can induce an anaemia that is macrocytic
B. Young children absorb about 10% of ingested inorganic lead
C. Lead induced peripheral neuropathy often involves upper limb extensors resulting in wrist drop
D. High dose organic lead poisoning usually results in severe pneumonitis
E. All patients with elevated blood lead levels should have chelation treatment whether symptomatic or not
Answer» C. Lead induced peripheral neuropathy often involves upper limb extensors resulting in wrist drop
5.

Regarding agents used to treat gout

A. As little as 8mg of colchicine taken over 24 hours may be fatal
B. Allopurinol is a xanthine oxidase stimulator
C. Probenecid is an organic alkaline substance
D. Colchicine may precipitate acute attacks of gout
E. Aspirin is effective against gout as it inhibits urate crystal phagocytosis
Answer» A. As little as 8mg of colchicine taken over 24 hours may be fatal
6.

All of the following may be seen in organophosphate poisoning EXCEPT

A. Salivation
B. Tachycardia
C. Fibrillation of muscle fibres
D. Bronchospasm
E. Vomiting
Answer» B. Tachycardia
7.

Regarding aspirin

A. The average anti-inflammatory dose of aspirin is 0.6g up to 4 hourly
B. Aspirin’s main side effect at usual doses is rash
C. Aspirin’s antiplatelet effect lasts 8 – 10 days
D. At low toxic doses – respiratory acidosis may occur
E. Aspirin has a pka of 4.5
Answer» C. Aspirin’s antiplatelet effect lasts 8 – 10 days
8.

The main mechanism of action of colchicine is

A. Inhibition of polymorphonuclear leucocytes
B. Inhibition of synoviocyte phagocytosis
C. Reduced formation of leukotriene D4
D. Inhibition of mononuclear phagocytes
E. Decreasing the body pool of urate
Answer» A. Inhibition of polymorphonuclear leucocytes
9.

Aspirin inhibits all of the following EXCEPT

A. Cyclo oxygenase
B. Recurrent miscarriages
C. Protacyclin synthesis
D. Kallikrein system
E. Lipo oxygenase
Answer» E. Lipo oxygenase
10.

Acetaminophen (paracetamol) can undergo all of the following biotransformation reactions EXCEPT

A. Deamination
B. N-oxidation
C. Glucuronidation
D. Sulphation
E. Glutathione conjugation
Answer» A. Deamination
11.

Aspirin

A. Is hydrolysed to acetone and salicylate
B. Exhibits first order kinetics with elimination in low doses
C. Is mostly conjugated by the liver and excreted in the bile
D. Reversibly blocks the cyclooxygenase enzyme
E. Causes an immediate doubling of bleeding time
Answer» B. Exhibits first order kinetics with elimination in low doses
12.

Regarding NSAIDs

A. At high doses diclofenac demonstrates zero order kinetics
B. Aspirin is a reversible inhibitor of cyclooxygenase
C. Aspirin at doses of <2g/day reduces uric acid levels
D. All NSAIDs can be found in synovial fluid after repeated dosing
E. Use of ibuprofen and aspirin together increases the anti inflammatory effect
Answer» D. All NSAIDs can be found in synovial fluid after repeated dosing
13.

The metabolic pathway of detoxification that becomes increasingly important in paracetamol toxicity is

A. Conjugation with glucuronide
B. Oxidation
C. Reduction
D. Cytochrome p-450 dependent glutathione conjugation
E. Methylation
Answer» D. Cytochrome p-450 dependent glutathione conjugation
14.

Which of the following NSAIDs has a t1/2 of about 1 hour

A. Diclofenac
B. Naproxen
C. Piroxicam
D. Indomethacin
E. Ibuprofen
Answer» A. Diclofenac
15.

Which of the following symptoms of aspirin toxicity occurs at plasma salicylate concentrations of 100mg/dl?

A. Tinnitus
B. Vasomotor collapse
C. Metabolic acidosis
D. Gastric intolerance
E. Renal failure
Answer» C. Metabolic acidosis
16.

All of the following drugs can cause a wide anion gap metabolic acidosis EXCEPT

A. Lithium
B. Methanol
C. Cyanide
D. Salicylates
E. Isoniazid
Answer» A. Lithium
17.

Which of the following drug overdoses may be amenable to the elimination technique of haemodialysis

A. Calcium channel blockers
B. Benzodiazepines
C. Valproate
D. Quinidine
E. Opioids
Answer» C. Valproate
18.

Which of the following antidote – drug pairings is INCORRECT

A. Acetaminophen → n-acetyl cysteine
B. β blockers → glucagon
C. Opioids → naloxone
D. Benzodiazepines → Flumazenil
E. Tricyclic antidepressants → physostigmine
Answer» E. Tricyclic antidepressants → physostigmine
19.

Regarding carbon monoxide poisoning

A. CO has an affinity for Hb that is about 2000 times that of oxygen
B. Hyperbaric oxygen is indicated as a treatment for all patients with CO Hb levels >20%
C. The average concentration of CO in the atmosphere is about 0.1ppm
D. With room air at 1atm the elimination half time of CO is about 80 minutes
E. The foetus is resistant to the effects of CO exposure
Answer» C. The average concentration of CO in the atmosphere is about 0.1ppm
20.

“Erethism” is seen in which of the following intoxications

A. Lead
B. Mercury
C. Arsine gas
D. Penicillamine
E. Arsenic
Answer» B. Mercury
21.

All of the following are NSAIDs EXCEPT

A. Sulindac
B. Piroxicam
C. Gemfibrozil
D. Ketorolac
E. Diflunisal
Answer» C. Gemfibrozil
22.

Drugs which enhance other drug metabolism include all of the following EXCEPT

A. Rifampicin
B. Ketoconazole
C. Phenobarbital
D. Griseofulvin
E. Phenytoin
Answer» B. Ketoconazole
23.

Which of the following has a high extraction ratio

A. Trimethoprim
B. Valproic acid
C. Lignocaine
D. Metronidazole
E. Diazepam
Answer» C. Lignocaine
24.

Heparin and protamine used together is an example of

A. Physiologic antagonism
B. Chemical antagonism
C. Partial agonism
D. Irreversible antagonism
E. Agonal agonism
Answer» B. Chemical antagonism
25.

The half life of a drug with a Vd of 200ml/70kg and clearance of 10ℓ/hr/70kg is

A. 10 hours
B. 14 hours
C. 20 hours
D. 40 hours
E. Indeterminate
Answer» B. 14 hours
Chapter: Antibiotics
26.

All of the following are true regarding penicillins EXCEPT

A. Most penicillins only cross the blood brain barrier when the meninges are inflamed.
B. Penicillins don’t require dosage adjustment in renal failure
C. Penicillins inhibit cross linkage of peptidoglycans in the cell wall
D. Piperacillin is a penicillin active against pseudomonas
E. Only about 5 to 10% of people with a past history of penicillin allergy have a reaction on re exposure
Answer» B. Penicillins don’t require dosage adjustment in renal failure
27.

Ciprofloxacin

A. Is a defluorinated analogue of nalidixic acid
B. Inhibits tropoisomerases 2 and 3
C. Has no gram positive cover
D. Has a bioavailability of 30%
E. May cause an arthropathy
Answer» E. May cause an arthropathy
28.

Resistance to B lactams

A. Can be due to an efflux pump
B. Is most commonly due to modification of the target PBPs
C. Does not involve penetration of drug to target PBPs
D. Infers resistance only to penicillinc
E. Can involve up to 5 different B lactamases
Answer» A. Can be due to an efflux pump
29.

Macrolides

A. Have enhanced activity at acidic pH
B. Have little activity against legionella
C. Have half lives which increase in patients with anuria
D. Induce cytochrome p450 enzymes
E. Are contraindicated in neonates
Answer» C. Have half lives which increase in patients with anuria
30.

Flucloxacillin

A. Is ineffective against streptococci
B. Is active against enterococci and anaerobes
C. Blocks transpeptidation and inhibits peptidoglycan synthesis
D. Is poorly absorbed orally
E. Has excellent penetration into CNS and prostate
Answer» C. Blocks transpeptidation and inhibits peptidoglycan synthesis
31.

All of the following inhibit nucleic acid synthesis EXCEPT

A. Norfloxacillin
B. Chloramphenicol
C. Trimethoprim
D. Rifampicin
E. Sulfasalazine
Answer» B. Chloramphenicol
32.

Which of the following is a second generation cephalosporin?

A. Cefaclor
B. Ceftazidime
C. Cephalexin
D. Cefotaxime
E. Cephalothin
Answer» A. Cefaclor
33.

Regarding the pharmacokinetics of the tetracyclines

A. Tetracyclines are 40 to 80 % bound by serum proteins
B. Absorption is enhanced by coadministration of antacids
C. Tetracyclines cross the blood brain barrier easily
D. Doxycycline is excreted predominantly by the kidney
E. Demeclocyline is a short acting tetracycline drug
Answer» A. Tetracyclines are 40 to 80 % bound by serum proteins
34.

All of the following are recognized adverse effects of isoniazid EXCEPT

A. Hepatitis
B. Peripheral neuropathy
C. Retrobulbar neuritis
D. Decreased phenytoin metabolism – increased phenytoin blood levels / toxicity
E. CNS toxicity
Answer» C. Retrobulbar neuritis
35.

Vancomycin

A. 90% of vancomycin is excreted by glomerular filtration
B. Inhibits proteinsynthesis in bacteria
C. Is bactericidal against gram negative bacilli
D. Is well absorbed from the GIT
E. One adverse reaction to infusions of vancomycin is the “blue man” syndrome
Answer» A. 90% of vancomycin is excreted by glomerular filtration
36.

Regarding mechanisms of antiviral drug action

A. blockage of viral uncoating is caused by rifampicin
B. Zidovudine is a protease inhibitor
C. Amantidine blocks viral DNA packaging and assembly
D. Indinavir is a reverse transcriptase inhibitor
E. Acyclovir inhibits viral DNA synthesis
Answer» E. Acyclovir inhibits viral DNA synthesis
37.

Regarding toxicity of antibiotics

A. Enamel dysplasia is common with aminoglycosides
B. Gray baby syndrome occurs with rifampicin use
C. Haemolytic anaemias can occur with sulphonamide use
D. Nephritis is the most common adverse reaction with isoniazid
E. Disulfiram like reaction can occur with macrolides
Answer» C. Haemolytic anaemias can occur with sulphonamide use
38.

Chloramphenicol

A. Does not penetrate the blood brain barrier
B. Must be administered parenterally
C. Can be safely used in premature infants
D. Can cause depression of bone marrow function
E. Can cause discoloration of developing teeth when given to children
Answer» D. Can cause depression of bone marrow function
39.

Spironolactone

A. Has a steroid structure
B. Is a partial agonist
C. Promotes sodium retention
D. Increases potassium loss
E. Is a loop diuretic
Answer» A. Has a steroid structure
40.

Which of the following drugs cause diuresis by the mechanisms indicated?

A. Ethanol – by preventing the reabsorption of sodium from renal tubular fluid
B. Digoxin – by inhibiting release of ADH
C. Dopamine – by inhibiting active transport of chloride over the entire length of the descending limb of the loop of Henle
D. Frusemide – by inhibiting carbonic anhydrase
E. Chlorothiazide – by inhibiting active sodium transport in the ascending limb of the loop of Henle
Answer» E. Chlorothiazide – by inhibiting active sodium transport in the ascending limb of the loop of Henle
41.

All of the following antibiotics bind to the 50S subunit of the ribosome thereby inhibiting proteinsynthesis EXCEPT

A. Chloramphenicol
B. Erythromycin
C. Linezolid
D. Doxycycline
E. Clindamycin
Answer» D. Doxycycline
42.

Pharmacokinetics of doxycycline

A. 20% bound by serum proteins
B. 60-70% absorption after oral administration
C. Absorption is impaired by divalent cations, Al3+, and antacids
D. Widely distributed especially into the CSF
E. Is eliminated via renal mechanisms
Answer» C. Absorption is impaired by divalent cations, Al3+, and antacids
43.

Which of the following inhibits DNA gyrase?

A. Penicillin
B. Trimethoprim
C. Chloramphenicol
D. Ciprofloxacin
E. Gentamicin
Answer» D. Ciprofloxacin
44.

Resistance to Penicillin and other β lactams is due to

A. Modification of target PBPs
B. Impaired penetration of drug to target PBPs
C. Presence of an efflux pump
D. Inactivation of antibiotics by β lactamase
E. All of the above
Answer» E. All of the above
45.

All of the following are recognised adverse effects of isoniazid EXCEPT

A. Hepatitis
B. Peripheral neuropathy
C. Retrobulbar neuritis
D. ↓ Phenytoin metabolism → ↑ Phenytoin blood levels and toxicity
E. CNS toxicity
Answer» C. Retrobulbar neuritis
46.

Regarding fluoroquinolones

A. Ciprofloxacin is ineffective in the treatment of gonococcus
B. Norfloxacin and Ciprofloxacin are predominantly faecally excreted
C. Norfloxacin and Ciprofloxacin have long half lives (12 hours)
D. They have poor oral bioavailability
E. May damage growing cartilage in children less than 18 years of age
Answer» E. May damage growing cartilage in children less than 18 years of age
47.

Vancomycin

A. Is never orally administered as it is poorly absorbed from the GIT
B. Binds to the 30S unit on the ribosome and inhibits protein synthesis
C. 60% of vancomycin is excreted by glomerular filtration
D. Parenteral vancomycin is commonly used for treatment of infections caused by methicillin susceptible staphylococci
E. Adverse reactions to vancomycin are encountered in about 10% of patients
Answer» E. Adverse reactions to vancomycin are encountered in about 10% of patients
48.

Regarding the “azole” group of antifungals

A. Fluconazole has low water solubility
B. Ketoconazole may be given IV/PO
C. Itraconazole undergoes renal elimination
D. Clotrimazole is the treatment of choice for systemic candidiasis – given orally
E. They work by reduction of ergosterol synthesis by inhibition of fungal cytochrome P450 enzymes
Answer» E. They work by reduction of ergosterol synthesis by inhibition of fungal cytochrome P450 enzymes
49.

The fluoroquinolones

A. May be administered to patients with severe campylobacter infection
B. Work by inhibiting dihydrofolate reductase
C. Have little effect against gram positive organisms
D. Are heavily metabolised in the liver
E. Are safe to give to breast feeding mothers
Answer» A. May be administered to patients with severe campylobacter infection
50.

Clindamycin

A. Inhibits bacterial cell wall synthesis
B. Is often used for prophylaxis of endocarditis in patients with Valvular disease who are undergoing dental procedures
C. Penetrates through BBB into CSF well
D. Works well against enterococci and gram negative aerobic organisms
E. Is 10% protein bound
Answer» B. Is often used for prophylaxis of endocarditis in patients with Valvular disease who are undergoing dental procedures
51.

Which of the following is a second generation cephalosporin?

A. Ceftazidime
B. Cephalothin
C. Cefotaxime
D. Cefaclor
E. Cephalexin
Answer» D. Cefaclor
52.

The cephalosporin with the highest activity against gram positive cocci is

A. Cefaclor
B. Cephalothin
C. Cefuroxime
D. Cefepime
E. Cefotaxime
Answer» B. Cephalothin
53.

Regarding the penicillins

A. Penicillin ix excreted into breast milk to levels 3-15% of those present in the serum
B. Absorption of amoxyl is impaired by food
C. Benzathine penicillin is given PO
D. Penicillins are 90% excreted by glomerular filtration
E. Dosage of nafcillin should be adjusted in the presence of renal failure
Answer» A. Penicillin ix excreted into breast milk to levels 3-15% of those present in the serum
54.

Rifampicin

A. Inhibits hepatic microsomal enzymes
B. Inhibits DNA synthesis
C. Is bactericidal for mycobacteria
D. Is not appreciably protein bound
E. Is predominantly excreted unchanged in the urine
Answer» C. Is bactericidal for mycobacteria
55.

Regarding resistance to antibiotics

A. Penicillinases cannot inactivate cephalosporins
B. Macrolides can be inactivated by transferases
C. Mutation of aminoglycoside binding site is its main mechanism of resistance
D. Tetracycline resistance is a marker for multidrug resistance
E. Resistance to antibiotics is rarely plasmid encoded
Answer» C. Mutation of aminoglycoside binding site is its main mechanism of resistance
56.

Concerning toxicity of antibiotics

A. Enamel dysplasia is common with aminoglycosides
B. Grey Baby Syndrome occurs with rifampicin use
C. A disulfiram like reaction can occur with macrolides
D. Haemolytic anaemias can occur with sulphonamide use
E. Nephritis is the most common adverse reaction with isoniazid
Answer» D. Haemolytic anaemias can occur with sulphonamide use
57.

Which of the following is considered to be bacteriostatic?

A. Penicillin
B. Chloramphenicol
C. Ciprofloxacin
D. Cefoxitin
E. Tobramycin
Answer» B. Chloramphenicol
58.

Half life of amphotericin B is

A. 2 seconds
B. 20 minutes
C. 2 hours
D. 2 weeks
E. 2 months
Answer» D. 2 weeks
59.

Regarding antiseptic agents – all of the following are true EXCEPT

A. Sodium hypochlorite is an effective antiseptic for intact skin
B. Potassium permanganase is an effective bactericidal agent
C. Formaldehyde may be used to disinfect instruments
D. Chlorhexidine is active against gram positive cocci
E. Ethanol is an effective skin antiseptic because it denatures microbial proteins
Answer» A. Sodium hypochlorite is an effective antiseptic for intact skin
60.

Ciprofloxacin

A. Is a defluorinated analogue of nalidixic acid
B. Inhibits tropoisomerases 2 and 3
C. Has no gram positive cover
D. Has bioavailability of 30%
E. May cause an arthropathy
Answer» D. Has bioavailability of 30%
61.

Aminoglycosides

A. Have a β lactam ring
B. Can produce neuromuscular blockade
C. Are DNA gyrase inhibitors
D. Normally reach high CSF concentrations
E. Have good oral absorption but high first pass metabolism
Answer» B. Can produce neuromuscular blockade
62.

Ribosomal resistance occurs with

A. Sulphonamides
B. Penicillin
C. Fluoroquinolones
D. Macrolides
E. Trimethoprim
Answer» D. Macrolides
63.

Regarding antivirals

A. Delvindine is a nucleoside reverse transcriptase inhibitor (NRTI)
B. Zidovudine (AZT) is a non nucleoside reverse transcriptase inhibitor (NNRTI)
C. NRTIs activate HIV-1 reverse transcriptase
D. Abacavir is a protease inhibitor
E. NRTIs require intracytoplasmic activation to the triphosphate form
Answer» E. NRTIs require intracytoplasmic activation to the triphosphate form
64.

All of the following are true regarding metronidazole EXCEPT

A. It is used to treat giardia
B. It causes a metallic taste in the mouth
C. It inhibits alcohol dehydrogenase
D. It is used to treat gardnerella
E. It is useful against trichomonoas vaginalis
Answer» C. It inhibits alcohol dehydrogenase
Chapter: CNS Drugs
65.

Regarding antipsychotics as a group

A. Metabolites are important to the action of these drugs
B. Haloperidol has a higher systemic availability than thioridazine or chlorpromazine
C. Elimination half lives of these drugs range between 3 – 6 hours
D. This group of drugs generally has short clinical duration of action
E. Clozipine is a member of the dihydroindolone group
Answer» B. Haloperidol has a higher systemic availability than thioridazine or chlorpromazine
66.

Which of the following antipsychotics (in excess dose) is responsible for cardiac arrhythmias?

A. Chlorpromazine
B. Clozapine
C. Thioridazine
D. Haloperidol
E. Thiothixene
Answer» C. Thioridazine
67.

Plasma lithium levels (assuming no change in daily lithium dose) may become toxic in the presence of all of the following EXCEPT

A. Pregnancy
B. Use of thiazides
C. Dehydration
D. Use of some non-steroidal anti-inflammatory drugs
E. Post partum state
Answer» A. Pregnancy
68.

Regarding pharmacokinetics of antidepressants

A. Most are highly protein bound
B. Fluoxetine is poorly absorbed
C. Tricyclics are predominantly excreted unchanged in the urine
D. Plasma half lives of antidepressants are mostly less than 10 hours
E. The half life of the older MAOIs is helpful in governing doses
Answer» A. Most are highly protein bound
69.

Which of the following drugs is potentially dangerous in a single drug overdose

A. Moclobemide
B. Paroxetine
C. Sertraline
D. Trazodone
E. Amoxapine
Answer» E. Amoxapine
70.

Which of the following drugs is 99% protein bound in plasma

A. Gentamicin
B. Theophylline
C. Carbamazepine
D. Atenolol
E. Diazepam
Answer» E. Diazepam
71.

Which of the following drugs is contraindicated (absolutely) in a patient with porphyria

A. Zolpidem
B. Chloral hydrate
C. Buspirone
D. Phenobarbitone
E. Diazepam
Answer» D. Phenobarbitone
72.

Regarding local anaesthetic agents

A. Lignocaine is also an antiarrhythmic of the Vaughan Williams classification group 1A
B. At normal pH the larger fraction of local anaesthetic in the body fluids will be in the unchanged form
C. Bupivacaine may cause an apparent cyanosis in some patients
D. The duration of action of procaine will be increased in the presence of liver disease
E. Local anaesthetic agents block conduction in small myelinated axons prior to blockade of other axons
Answer» E. Local anaesthetic agents block conduction in small myelinated axons prior to blockade of other axons
73.

Regarding IV anaesthetic agents

A. Ketamine is the induction agent of choice in a head injured patient
B. Propofol has a slow offset of action
C. Etomidate causes hypotension more commonly than thiopentone
D. Ideal agents for neuroleptanalgesia are fentanyl and droperidol
E. Thiopentone is metabolised at a rate of 40-50% per hour in humans following a single dose
Answer» D. Ideal agents for neuroleptanalgesia are fentanyl and droperidol
74.

Suxamethonium

A. Is a non-depolarising neuromuscular blocking agent
B. Is contraindicated in all eye operations
C. Stimulates cardiac muscarinic receptors and autonomic ganglia
D. Its action is directly terminated by the action of plasma cholinesterase
E. Should not be administered to patients with burns >24 hours old because of its hypercalcaemic effect
Answer» C. Stimulates cardiac muscarinic receptors and autonomic ganglia
75.

Inhalational anaesthetics

A. Enflurane is proconvulsant
B. Isoflurane is the inhalational agent of choice in patients with active IHD
C. Nitrous oxide is a useful adjunct to volatile anaesthetic use in women in the first trimester of pregnancy
D. Halothane has a MAC value of 75% making it less potent than desflurane
E. Desflurane is extensively metabolised via the liver
Answer» A. Enflurane is proconvulsant
76.

Phenytoin

A. Is 20-30% bound to albumin
B. Is the drug treatment of choice in absence seizures
C. Undergoes flow limited elimination
D. Steady state mean plasma concentrations varies disproportionately with the dose
E. Preferentially binds to activated state sodium channels
Answer» D. Steady state mean plasma concentrations varies disproportionately with the dose
77.

Drugs of abuse can be extremely dangerous in the wrong hands! Which of the following is correct

A. Ketamine is structurally related to psilocybin
B. LSD acts on various 5 HT receptor subtypes to produce its mind altering effects
C. Marijuana causes mydriasis and conjunctival infection
D. Cocaine has a long plasma half life
E. Amphetamine like drugs cause marked stimulation of appetite
Answer» B. LSD acts on various 5 HT receptor subtypes to produce its mind altering effects
78.

Flumazenil

A. Is cleared renally
B. Predictably reverses benzodiazepine induced respiratory depression
C. Antagonises CNS effects of opioids
D. Can precipitate seizures in mixed overdose
E. Has a half life of around 10 hours
Answer» D. Can precipitate seizures in mixed overdose
79.

Regarding non-depolarising muscle relaxants

A. Pancuronium is eliminated via the kidney
B. Roacuronium is an isoquinolone derivative
C. Roacuronium undergoes Hoffman elimination
D. Vecuronium is eliminated predominantly via the kidney
E. Atracurium is eliminated via plasma pseudocholinesterase
Answer» A. Pancuronium is eliminated via the kidney
80.

Which of the following is a direct serotonin agonist

A. Fluoxetine
B. Amitriptylline
C. Moclobemide
D. Ondansetron
E. Sumatriptan
Answer» E. Sumatriptan
81.

The opiate associated with seizures when given in high doses to patients with renal failure is

A. Morphine
B. Pethidine
C. Methadone
D. Fentanyl
E. Codeine
Answer» B. Pethidine
82.

Ethanol

A. Is lipid soluble
B. Is metabolised by the MEOS system at blood concentrations below 100mg/dl
C. Is a vasodilator
D. The most frequent neurological abnormality in chronic alcoholism is asymmetrical peripheral nerve injury specific to hands and feet
E. Alcohol is estimated to be responsible for approximately 10% of cases of hypertension
Answer» C. Is a vasodilator
83.

Which of the following local anaesthetic agents is an ester

A. Bupivacaine
B. Ropivacaine
C. Prilocaine
D. Procaine
E. Lignocaine
Answer» D. Procaine
84.

Regarding temazepam – all of the following are true EXCEPT

A. It produces inactive metabolites
B. It induces enzymes only to a minimal extent
C. It causes less hangover than nitrazepam
D. It causes rebound insomnia
E. It increases REM sleep
Answer» E. It increases REM sleep
85.

Regarding the antiepileptic drugs

A. Lorazepam has documented efficacy against absence seizures
B. Phenytoin is able to stimulate its own metabolism by enzyme induction
C. Valproate has a large Vd (>500l/70kg)
D. The most common dose related adverse effects of Carbamazepine are ataxia and diplopia
E. Vigabatrin works by sodium channel blockade
Answer» D. The most common dose related adverse effects of Carbamazepine are ataxia and diplopia
86.

Benzodiazepines

A. Increase the duration of GABA gated chloride channel openings
B. Will depress (in high doses) the CNS to the point known as stage 3 of general anaesthesia
C. Bind to GABAβ receptors
D. Have extensive cardiodepressant effects in doses used to cause hypnosis
E. Decrease the duration of stage 2 NREM sleep
Answer» B. Will depress (in high doses) the CNS to the point known as stage 3 of general anaesthesia
87.

Regarding drugs used in Parkinson’s disease

A. Bromocriptine is the first line drug to treat Parkinson’s disease in psychotic patients
B. 80-90% of a single dose of Levodopa enters the brain unaltered
C. Patients taking Selesiline to treat Parkinson’s disease are limited in what they can eat because of the tyranine reaction phenomenon
D. Amantadine has anti Parkinsonian effects and is administered at a dose of 100mg bd
E. Anti muscarinic drugs are of benefit in elimination of bradykinesia in Parkinson’s
Answer» D. Amantadine has anti Parkinsonian effects and is administered at a dose of 100mg bd
88.

A patient complains of post op muscle pain. This is most likely to be due to

A. Suxamethonium
B. Propofol
C. Isoflurane
D. Atracurium
E. Ketamine
Answer» A. Suxamethonium
89.

Lithium

A. Has rapid onset of action
B. Is partially renally excreted
C. Has no neurological side effects
D. Has no contraindications to be given in conjunction with NSAIDS
E. Is contraindicated in sick sinus syndrome
Answer» E. Is contraindicated in sick sinus syndrome
90.

With respect to opioid receptors

A. Fentanyl works predominantly at the kappa receptors
B. Both U and delta receptors contribute to respiratory depression
C. Methadone is used for heroin withdrawal because its actions are predominantly at the delta receptors
D. Opioid receptors are coupled to a tyrosine kinase mechanism of action
E. Physical dependence and tolerance is caused by the rapid disintegration of receptors
Answer» B. Both U and delta receptors contribute to respiratory depression
91.

Lignocaine

A. Penetrates the axon in its changed form
B. Is more potent than bupivacaine
C. Has higher affinity for activated than resting sodium channels
D. Is a weak acid
E. Blocks voltage gated sodium channels at their extracellular end
Answer» C. Has higher affinity for activated than resting sodium channels
92.

Regarding adverse effects of propofol

A. Post op vomiting is common
B. Hypertension is a complication
C. Severe acidosis can occur with its use in paediatric respiratory infections
D. It is positively inotropic
E. Tremor is a common side effect
Answer» C. Severe acidosis can occur with its use in paediatric respiratory infections
93.

Regarding inhaled anaesthetics

A. They reduce MAP in direct proportion to their alveolar concentration
B. Nitrous oxide has a relatively low MAC
C. Halogenated agents have a lower brain:blood partition coefficient
D. Nitrous oxide causes a decrease in tidal volume and an increase in respiratory rate
E. They decrease the metabolic rate in the brain by decreasing cerebral blood flow
Answer» A. They reduce MAP in direct proportion to their alveolar concentration
94.

Local anaesthetic agents

A. Are primarily K+ channel blockers
B. Prevent repolarisation of the membrane
C. Can be used with a vasodilator to prolong local action
D. Activity is enhanced by high extracellular K+ concentration
E. Activity is enhanced by high extracellular Ca2+
Answer» D. Activity is enhanced by high extracellular K+ concentration
95.

Which of the following side effects for given drugs is wrong

A. Phenytoin – gum hypertrophy
B. Ethosuximide – hirsuitism
C. Phenobarbital – enzyme induction
D. Carbamazepine – ataxia
E. Valproate – idiosyncratic hepatic toxicity
Answer» B. Ethosuximide – hirsuitism
96.

The main side effect of benztropine is

A. Miosis
B. Confusion
C. Diarrhoea
D. GIT haemorrhage
E. Bronchorrhoea
Answer» B. Confusion
97.

Thiopentone

A. Is not lipid soluble
B. Can be used IM or IV to induce anaesthesia
C. Has good analgesic properties
D. Can cause convulsive movements
E. Anaesthetic action is terminated by redistribution from CNS to other highly vascularised tissues
Answer» E. Anaesthetic action is terminated by redistribution from CNS to other highly vascularised tissues
98.

Nitrous oxide

A. Can be used with O2 as a carrier gas for halothane
B. Has poor analgesic properties
C. Forms a vapour which is explosive
D. Sensitises the heart to the action of catecholamines
E. Is an effective agent for inducing anaesthesia
Answer» A. Can be used with O2 as a carrier gas for halothane
99.

Codeine

A. Is more potent than fentanyl
B. Frequently causes diarrhoea
C. Is used to treat nausea caused by morphine
D. Occurs in foxglove plants
E. Depresses the cough reflex
Answer» E. Depresses the cough reflex
100.

Regarding GABA: all the following are true EXCEPT

A. Receptor blockers have anticonvulsant activity
B. Is found in high concentrations in the basal ganglia
C. Concentrations in the basal ganglia are abnormally low in Huntington’s chorea
D. Metabolism is inhibited by sodium valproate
E. Receptors are sensitive to the activity of benzodiazepines
Answer» A. Receptor blockers have anticonvulsant activity
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