Professional Documents
Culture Documents
2. Desflurane:
a) is a fluorinated methylisopropyl ether
b) boils at 23 degrees C
c) is safe to use in patients with malignant hyperpyrexia
d) stimulates the sympathetic system when inspired concentration is suddenly increased
e) prolongs the duration of muscle relaxants
FTFTT
5. Action potentials:
a) are all or none signals of about 100 mV in amplitude
b) are generated by leakage of K+ down their concentration gradient
c) are normally conducted antidromically
d) summate at high frequencies
e) depend on the size of the stimulus
5.TFFFF
8. Atropine:
a) may cause bradycardia
b) dilates the pupil in premedicant dose
c) has a shorter duration of action than glycopyrrolate
d) increases the physiological dead space
e) has both muscarinic and nicotinic effects
8.TTTTF
1
9.FFTTT
15. The following trigger the secretion of antidiuretic hormone from the posterior hypothalamus:
a) a 5% reduction in extracellular fluid
b) chronic renal failure
c) anxiety
d) supine position
e) head injury
15.FFTFT
2
d) is proportional to half life
e) is dependent on the elimination rate constant
18.TFTTF
21. The following antibiotics have good activity against anaerobic bacteria:
a) vancomycin
b) aztreonam
c) metronidazole
d) imipenem
e) trimethoprim
21.FFTTF
22. Flumazenil:
a) may induce panic attacks in susceptible patients
b) has anticonvulsant activity in patients with epilepsy
c) has a long duration of action
d) may cause nausea and vomiting
e) has inverse agonist action at benzodiazepine receptors
22.TFFTF
24. Osmolality:
a) is the number of osmotically active particles per litre of solvent
b) of urine is similar to that of plasma in chronic renal failure
c) may be estimated by formula 2X(Na+K) + Blood sug + BUN
d) is measured by amount of depression of the freezing point
e) is a part of colloid oncotic pressure
24.FTFTF
3
b) results in the oxyhaemoglobin curve shifting to the left
c) poisoning can be reliably detected by pulse oximetry
d) levels in normal non-smokers is 10-15%
e) concentration in circle is increased during desflurane anaesthesia
27.FTFFT
ANSWERS
1.FFTTT ; 2.FTFTT ; 3.TFFTF ; 4.FFTFT ; 5.TFFFF ; 6.FTFTT ; 7.TTFTT ; ; 8.TTTTF ;9.FFTTT ; 10.TTTFT ; 11.FTFTF
; 12.TTFTT ; 13.TFFTF ; 14.TFTTF ; 15.FFTFT ; 16.FTTTF ; 17.FFFFT ; 18.TFTTF ; 19.TTFFT ; 20.TTFTT ;
21.FFTTF ; 22.TFFTF ; 23.TTFFF ; 24.FTFTF ; 25.TFTTF ; 26.TTTTF ; 27.FTFFT ; 28.TFTTF ; 29.TTFFT ; 30.TTTFT ;
4
1. P50:
a) is normally 5.5 kPa
b) is increased at high altitude
c) is an indicator of the position of the oxygen dissociation curve
d) is increased in foetal blood
e) is increased in banked red blood cells
1.FTTFF (decreased 2-3DPG in banked RBCs causes a LEFT shift of curve and therefore DECREASED P50)
4. Lung compliance:
a) is normally 0.2 L/cm H2O
b) is decreased with loss of pulmonary surfactant
c) is increased in emphysema
d) is decreased after induction of general anaesthesia
e) is different at the apices and bases of lungs
4.TTTTT
5
d) the diffusing capacity of the lung for carbon monoxide is decreased in emphysema
e) FEV1 and PEFR can be used to assess the reversibility of airway obstruction
9.TTTFT (Lung compliance increases in emphysema because of the less elastic lung tissue)
6
a) must cross the blood-brain barrier to be effective
b) include agents which are selective dopamine D1 receptor antagonists
c) include histamine H1 receptor agonists
d) are ineffective orally
e) include propofol
18.FFFFT (most do in fact cross the BBB and act directly on the Vomiting Centre but the CTZ is outside the BBB and
DA and 5HT3 blockers antgonise these NTs peripherally)
24. Baroreceptors:
a) in the carotid sinus are innervated by the vagus nerve
b) are stretch receptors
c) reset the threshold for firing in chronic hypertension
d) are made less sensitive by volatile agents
e) also respond to the changes in blood pH and PaCO2
24.FTTTF
26. Asystole:
a) occurs in about 25% of hospital patients
b) is likely to follow bradycardia associated with mobitz type II AV block
c) only rarely follows ventricular fibrillation
7
d) when unresponsive to high dose adrenaline (5 mg) should be treated by external pacing
e) may respond to precordial thump after basic life support
26.FTFFF
ANSWERS
1.FTTFF (decreased 2-3DPG in banked RBCs causes a LEFT shift of curve and therefore DECREASED P50)
2.TTFFT
3.TTFTF
4.TTTTT
5.FTFTT
6.TTFTF
7.TTFTT
8.FTTT
9.TTTFT (Lung compliance increases in emphysema because of the less elastic lung tissue)
10.TTTTT
11.TFTTT
12.TFTFF (2nd gas effect SPEEDS UP the rate of rise of alveolar pp of the inhalational agent)
13.TTTFF
14.TFTTT
15.FFTTT
16.TFTTT
17.FFTTF
18.FFFFT (most do in fact cross the BBB and act directly on the Vomiting Centre but the CTZ is outside the BBB and
DA and 5HT3 blockers antgonise these NTs peripherally)
19.TTFFT
20.TTTTT
21.TTFFT
22.TTTFT
23.TFTTT
24.FTTTF
25.FTFFT
26.FTFFF
27.TTTTT
28.FTTF
29.TFTFF
30.FFFFF
8
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
1.TTTFT a)see p.680, Kumar and Clark: fall in ECF osmolality causes H2O to move into cells.
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
2.TTTTF
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
3.FTTTT a) most texts quote max MW of 40,000 d) in high doses, PT is prolonged.
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
4.FTTFT c) hence use with caution in glaucoma.
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
5.TTFTF
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
7.TTFTT
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
8.FTTTF
9
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
9.FTTTT
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
12.TTTTF
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
16.FTFFF
18. The haemoglobin oxygen dissociation curve is moved to the left by:
10
a) ascending to 6000 feet over 24 hours
b) carbon monoxide
c) frozen red cells
d) bovine haemoglobin
e) anaemia
18.FTTTF
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
19.TTTTT
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
21.TTTFT
11
26.TFTFF
ANSWERS
1.TTTFT a)see p.680, Kumar and Clark: fall in ECF osmolality causes H2O to move into cells.
2.TTTTF
3.FTTTT a) most texts quote max MW of 40,000 d) in high doses, PT is prolonged.
4.FTTFT c) hence use with caution in glaucoma.
5.TTFTF
6.TTTT
7.TTFTT
8.FTTTF
9.FTTTT
10.TTTFF
11.TTTTT
12.TTTTF
13.FTTTF
14.FFTTT
15.TTFTF
16.FTFFF
17.FTFTF
18.FTTTF
19.TTTTT
20.TFFTT
21.TTTFT
22.TTTTF
23.FFFTT
24.TFFFF
25.TTTTT
26.TFTFF
27.FFTFF
28.TTTTF
29.FTTTF
30.TTTTT
12
1. Severe hyperkalaemia is suggested by:
a) absent p waves in the ECG
b) chronic ACE inhibitor intake
c) decreased serum bicarbonate level
d) suxamethonium administration in immediate burn
e) aldosterone deficiency
2. Glycine:
a) is a non-essential amino acid
b) can be used as an irrigating solution in transurethral resection of the prostate
c) acts as an inhibitory neurotransmitter in the spinal cord
d) toxicity can cause permanent blindness
e) solution is highly ionised
6. Propofol:
a) is insoluble in water
b) is bound to albumin up to 97-98%
c) reduces sodium channel opening times in neuronal membranes
d) is isotonic
e) does not cause tachycardia
9. The ratio of intravascular hydrostatic pressure to colloid hydrostatic pressure (according to Starlings Forces)
is greater:
a) in splanchnic capillaries than in renal glomerular capillaries
b) than normal in hepatic failure
c) than normal in haemorrhagic shock
d) than normal in capillaries where the oedema is due to venous obstruction
e) in systemic than in pulmonary capillaries
10. The effects of moving from sea level to an altitude of 5000 m include:
a) increased alveolar ventilation due to central chemoreceptor stimulation
b) increased blood bicarbonate level
c) reduced exercise tolerance
d) alveolar PO2 nearly reaches PO2 of air
e) increased plasma volume
13
11. An environmental temperature of 40 degrees C:
a) is thermoneutral if there is a strong wind
b) leads to vasodilatation of skin vessels
c) results in heat stroke if the relative humidity is 100%
d) causes the body to sweat with a lower sodium concentration
e) is appropriate for people in training for heat adaptation
16. Morphine:
a) 10-30% of oral morphine reaches the systemic circulation
b) has a terminal half-life of approximately 3 hours
c) has morphine-3-glucoronide as principal metabolite
d) morphine-6-glucoronide has no analgesic effect
e) increases the secretion of antidiuretic hormone
17. Amiodarone:
a) blocks the potassium channels
b) prolongs the refractory period of myocardium and entire conducting tissues
c) has a elimination half-life of approximately 28 days
d) may result in pulmonary fibrosis on prolonged use
e) may cause hypothyroidism
14
21. A typical motoneurone:
a) innervates only one skeletal muscle cell
b) has a myelinated axon
c) would have its cell body only in the ventral horn of the spinal cord
d) might itself receive an input directly from Ia afferent fibres in the spinal cord
e) would be stimulated by application of glycine to its cell body
29. Insulin:
a) is secreted by the alpha cells of the pancreas
b) is anabolic
c) has a circulating half-life of 5 minutes
d) shows increased secretion during surgery
e) can be used for rapid control of hyperkalaemia
15
ANSWERS
1.TTTFT ; 2.TTTFF ; 3.TTFTF ; 4.TTTTT ; 5.TTTTT ; 6.TTTTT ; 7.TTTTT ; 8.TFTTT ; 9.FTFTT ; 10.FFTFF
11.FTTTT ; 12.TTTTT ; 13.TTTTT ; 14.TFTT ; 15.TTTTF ; 16.TTTFT ; 17.TTTTT ; 18.FTTT ; 19.FFTTT ; 20.TTFTF
21.FTTTF ; 22.TFTFF ; 23.FTTFT ; 24.FTTTT ; 25.FTTF; 26.TTFFF ; 27.TTTTF ; 28.FTTFF ; 29.FTTFT ; 30.TTTFT
16
1. 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
1.FTTTF
2. 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
2.TFTTT
17
d) there are five Korotkoff phases
e) use of a finger to detect return of pulsation is highly inaccurate
9.TFTTF
17. In a normal resting man, a fall in heart rate would be expected to occur following:
a) increased carotid sinus pressure
b) increased right atrial pressure
c) application of pressure to the eyeball
d) the release of a Valsalva manoeuvre
e) inspiration
17.TTTTF
18
a) the [H+] electrode relies for its action on the hydrogen ion sensitivity of a glass electrode
b) A CO2 electrode is, in principle, a modified [H+] electrode
c) The [H+] electrode requires no temperature compensation
d) CO2 may be measured by an infrared absorption spectrometer
e) N2O may be measured by an infrared absorption spectrometer
18.TTFTT
24. Adenosine:
a) is composed of adenine and d-ribose
b) causes depression of cardiac contractility by binding to adenosine A1 receptors
c) mediates vasodilatation by binding to low affinity adenosine A2 receptors
d) is used in diagnosis of supraventricular arrhythmias
e) blocks re-entry circuits for its antiarrhythmic effects
24.TTTTT
26. Total body oxygen consumption can be measured by the following methods:
a) oxygen loss from a closed breathing system
b) subtraction of expired from inspired volume of oxygen
c) ventilated hood technique
d) multiplying cardiac output by arterial-mixed venous oxygen content difference
e) tissue PO2 electrodes
26.TTTTF
19
27. Pulmonary surfactant:
a) is produced by type II pneumocytes
b) is a mixture of phospholipids and proteins
c) prevents transudation of fluid from the blood into the alveoli
d) lies in a monomolecular layer
e) lowers surface tension to a large extent in a small alveolus
27.TTTTT
ANSWERS
1.FTTTF ; 2.TFTTT ; 3.TTTFT ; 4.TTTTF ; 5.TFFTF ; 6.TTTTT ; 7.TTTTT ; 8.TTTTT ; 9.TFTTF ; 10 FTTTT
11.TTTTT ; 12.TTTTT ; 13.TTTTT ; 14.FFTFT ;15.FFTFF ; 16.TTTTT ; 17.TTTTF ; 18.TTFTT ; 19.FTTTT ; 20.TFTTT
21.TTFFF ; 22.TTTTT ; 23.FTTTT ; 24.TTTTT ; 25.TTTTT ; 26.TTTTF ; 27.TTTTT ; 28.TFTTT
29.FTTTT (A: is false, range quoted is 25-125 dyn.sec/cm5 in A-Z, Fundamentals and Oxford Handbook of critical care).
20
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
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
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
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
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
21
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
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
22
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
25. The following drugs have greater than 50% bioavailability after oral administration:
a) warfarin
b) propranolol
c) atenolol
d) lidocaine
e) morphine
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
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
ANSWERS
1.TTTTT ; 2.TTTTT ; 3.FFTTT ; 4.TTFTF ; 5.TFTTT
6.TTFFF d)[H+] 36-46 nm/L [Na+] 135-145 mmol/l. Body concerned more with [H+] than [Na+]
7.TTTFF ; 8.TTFTT ; 9.FTFFT ; 10.TTFFT ; 11.FTTTF ; 12.TFTTF d)See West pg 53
13.TTFFT ; 14.FTTTT ; 15.FTFTF ; 16.FTTTF ; 17.FTTTT ; 18.TFTTT ;19.FFTFF ;20.TFFFF
21.FFTTF
22.TFFTF e) This is voltage mediated and no energy per se is needed the ions flow because the membrane is
depolarised.
23
23.FTFTT d) competition for binding sites is competitive and can alter unbound fraction of each (Peck+Williams)
24.TTFTT
25.TFFFF c) 45% bioavailability in Calvey+Williams, QBASE, Peck+W BUT 50% in Fundamentals of Anaesthesia e)
only 25% reaches systemic circulation
26.TFTFT
27.TFFT
28.TFTFT
29.TTTTT e) all the above are true and are listed in Fundamentals pg 533 (old edition)
24
1. The following result in an increase in physiological dead space:
a) positive end-expiratory pressure
b) venous air embolism
c) hypotension
d) pregnancy
e) obesity
1.TTTTF d) Increased by up to 45% (Fundamentals of Anaesthesia)
8. With reference to the mechanical events in the cardiac cycle in a normal adult human:
a) the left ventricle ejects more blood per beat than the right ventricle
b) the mitral valve opens when the left atrial pressure exceeds the left ventricular pressure
c) during strenuous work, the left ventricular end-diastolic volume may be double that at rest
d) the pulmonary valve opens when the right ventricular pressure reaches 20-25 mmHg
e) during diastole, the left ventricular pressure is about 70 mmHg
8.FTFFF
25
9.FTTFT
14. If about 500 ml of isotonic saline were to be infused into a healthy adult, the consequences would include:
a) increase in cardiac stroke volume
b) increase in flow of lymph from peripheral tissues
c) increase in renin secretion by the kidney
d) increase in cerebral blood flow
e) equal distribution of the excess volume between intracellular and extracellular compartments
14.TTFFF
26
c) are needed at values of 2-3 times their ED95 for endotracheal intubation
d) can cross tbe placenta
e) are highly ionised at physiological pH
18.TFTTT a) and d) a small amount can cross the bbb/placenta
21. Midazolam:
a) is an anticonvulsant
b) is lipid soluble at physiological pH
c) has no active metabolites
d) has an elimination half-life of 2-4 hours
e) can be administered as nasal drops for premedication
21.TTFTT
24. Bioavailability:
a) is indicated by the area under the plasma concentration-time curve
b) of a drug which is injected intravenously must be less than 100%
c) may be reduced by destruction of drug in the gut
d) may be reduced by metabolism of drug in the liver
e) is greater by sublingual route than enteral route
24.TFTTT
27
27. 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
27.FTTFF
30. 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
30.FFTFF
ANSWERS
1.TTTTF d) Increased by up to 45% (Fundamentals of Anaesthesia)
2.FTTTF ; 3.TTTTT ; 4.FTFTF ; 5.FTTTF ; 6.TFTFT ; 7.TFFFF ; 8.FTFFF ; 9.FTTFT ; 10.FFTTT ; 11.FTTTT
12.TFTFF ; 13.FFFFF ; 14.TTFFF ; 15.FTTTF
16.FTTTT a) by definition, contractility is for a GIVEN preload and afterload, i.e. it must affect it. Ganong states changes in
rate or rhythm can also affect the myocardial contractility
17.FFTTT ; 18.TFTTT a) and d) a small amount can cross the bbb/placenta
19.TTTTT ; 20.TTFTT ; 21.TTFTT ; 22.TTTTT ; 23.FFTTT ; 24.TFTTT ; 25.FFTTT ; 26.FFTFF ; 27.FTTFF ; 28.TTTTT
29.TTTTT ; 30.FFTFF
28
1. Angiotensin II has a role in maintenance of effective circulatory volume by the following mechanisms:
a) increasing thirst
b) increased antidiuretic hormone release from posterior pituitary
c) systemic vasoconstriction
d) increased aldosterone release
e) increased proximal tubular sodium reabsorption
2. Adenosine triphosphate:
a) is synthesised when the skeletal muscle contracts
b) contains two energy rich phosphate bonds
c) is an integral part of the flavoprotein-cytochrome system
d) is only produced during the aerobic, not anaerobic, catabolism of glucose
e) is hydrolysed enzymically during the operation of the sodium pump
6. Concerning pain:
a) transmission occurs in the lateral spinothalamic tracts
b) it may be modulated at a spinal level by endorphinergic interneurones
c) it is modified at a spinal level by descending fibres from the periaqueductal grey matter of the mid-brain
d) fibres from the frontal cortex inhibit thalamic interpretation of pain
e) surgery of the cerebral cortex is not associated with pain
7. Gas chromatography:
a) depends on the partition of a substance between two phases, one stationary and one moving
b) the stationary phase is an inert solid material that packs the column
c) a specific detector is needed at the end of the column
d) a particular gas can be identified by its specific profile
e) the amount of a particular gas is calibrated against accurately known samples
9. Concerning flow:
a) if Reynolds number exceeds 1000, turbulent flow is likely to be present
b) the critical velocity at which laminar flow changes to turbulent flow varies only with the gas involved
c) helium reduces the density of inspired gases and therefore the likelihood of turbulent flow within the respiratory
system
d) turbulent flow within blood vessels is only detectable by invasive techniques
e) endotracheal tube adaptors (e.g. Magill) are specifically designed to avoid turbulent flow
10. The effects of opioids at a desired CNS receptor site depend on:
a) route of administration
b) volume of distribution
c) ionisation and protein binding
d) cerebral blood flow
e) permeability of blood-brain barrier
29
11. Concerning the opioids used in the perioperative period:
a) the volume of distribution of fentanyl is greater than that of morphine
b) at physiological pH morphine is more ionised than alfentanil
c) morphine is more protein bound than fentanyl
d) fentanyl penetrates the blood-brain barrier more quickly than morphine
e) pethidine has a metabolite with epileptogenic potency
19. The weight of gas dissolved in a liquid at constant ambient pressure at equilibrium depends on:
a) temperature of the liquid
b) partial pressure of the gas
c) the diffusion coefficient
d) solubility of the gas in the liquid
e) critical temperature of the gas
30
21. Concerning electromagnetic radiation:
a) it includes visible light
b) infrared radiation only occurs from objects that are hotter than the environment
c) Stefans law defines the heat radiated from a black body and includes a term of the fourth power of the absolute
temperature of the body
d) obeys the inverse square law
e) includes ultrasound
28. Warfarin:
a) competes with vitamin K
b) displaces phenylbutazone from plasma protein binding sites
c) blocks prothrombin synthesis
d) is contraindicated in malignant hypertension
e) prevents normal fibrinolysis
31
ANSWERS
1.TTTTT ; 2.FFFFT ; 3.FFTFT ; 4.FFFFT ; 5.TFTFT ; 6.TTTTT ; 7.TFTFT ; 8.FTTTT ; 9.FFTFF ; 10.TTTTT ;
11.TTFTT ;12.TTTTT ;13.TTFFT; 14.TFFFF; 15.FTFFT ; 16.TTTTT ; 17.TTTFF ; 18.TFTFF ; 19.TTFTF ; 20.TFFFF
; 21.TFTTF ; 22.TFFTF ; 23.TFTTF ; 24.TTTTT; 25.FTTTT ; 26.FTTTT ; 27.TFTT ; 28.TTTTF ; 29.FTFTT ;
30.TTTTT
32
1. Ideal volatile agent should have:
a) analgesic properties
b) high oil:gas partition coefficient
c) low blood:gas partition coefficient
d) boiling point less than 20 degrees C
e) low molecular weight
6. Dopamine:
a) does not cross the blood-brain barrier
b) causes renal vasodilatation via DA1 receptors
c) inhibits prolactin release
d) may cause nausea and vomiting via DA2 receptors
e) increases atrioventricular conduction
7. Glyceryl trinitrate:
a) dilates both resistance and capacitance vessels
b) is a nitric oxide donor
c) may cause cyanide toxicity
d) can cause reflex tachycardia
e) in combination with adrenaline can be used in low cardiac output conditions
8. Sodium nitroprusside:
a) reduces both preload and afterload
b) can decompose if the infusion bag is not wrapped by aluminium foil
c) molecule has five cyanide groups
d) combines with haemoglobin to produce cyanmethaemoglobin
e) toxicity can be associated with increase in mixed venous oxygen saturation
33
d) laminar flow in a blood vessel has the greatest flow rate at the centre of the blood vessel
e) flow is proportional to the square root of the pressure difference in turbulent flow
11. Verapamil:
a) prolongs A-V nodal refractoriness
b) undergoes extensive first-pass hepatic extraction on oral administration
c) is a useful antiarrhythmic agent in cases of recent myocardial infarction
d) is contraindicated in Wolff-Parkinson-White syndrome
e) is also useful for ventricular arrhythmias
12. The electrolyte and acid-base imbalance seen in end-stage renal failure includes:
a) metabolic alkalosis
b) a fall in serum magnesium
c) a rise in serum phosphate
d) a rise in serum calcium
e) a fall in serum potassium
16. Propofol:
a) has a pH of 7.0-8.5
b) is insoluble in water
c) is twice as potent as thiopentone
d) can be given as an infusion because its terminal half-life is less than 30 minutes
e) may change the colour of urine due to propofol glucuronide
18. Pneumotachograph:
a) lumen is broken up to a large number of smaller tubes
b) has a sensitive differential pressure transducer across the resistor
c) output is affected by the gas viscosity
d) may give an erroneous reading in the presence of condensed water vapour
e) works on the principle of Poiseuille's Law
34
d) low respiratory rate reduces the viscous component of work of breathing
e) patients naturally adopt a respiratory pattern which ensures the lowest work of breathing
29. Regarding the passage of glomerular filtrate through the renal tubules:
a) the thick ascending limb of the loop of Henle dilutes the filtrate by its powerful sodium pumps
b) the osmolality of the filtrate at the tip of loop of Henle is about 1200 mosm/L
c) the distal tubule is normally impermeable to water
d) glucose is absent in the filtrate in the loop of Henle
e) sodium concentration in the descending limb of the loop of Henle is the same as that in the proximal convoluted
tubule
35
ANSWERS
1.TTTFF
2.TTFTF
3.TTTTF
4.TTTTT
5.TTTTT
6.TTTTT
7.TTFTT
8.TTTTT
9.TTTFT
10.FTTTT
11.TTFTF
12.FFTFF
13.TTTFT
14.FTFTF
15.TTTTF
16.TTTFT
17.TFTTT
18.TTTTT
19.TFFFF (alpha 2 inhibits insulin release, beta 2 increases insulin release)
20.TTFTT
21.TTTTF
22.FTTFT
23.FFFFT
24.TTFTF
25.FTTTT
26.FTTFF
27.TTTFT
28.FTFTF (amiodarone slows repolarisation).
29.TTFTT
10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
36
1. Regarding drug administration:
a) the sublingual route avoids first-pass inactivation in the liver
b) suppositories expose the drug to first-pass metabolism
c) distribution of nebulised drug in the respiratory tree depends on the particle size
d) highly water soluble drugs are administered by the transdermal route
e) drugs given by the oral route should have a very high extraction ratio
5. First-order processes:
a) apply to enzyme-mediated reactions
b) are characterised by high rates of reaction when the concentrations of reacting substances are high, and vice verse
c) can properly be described in terms of t1/2
d) are involved in the elimination of most drugs
e) change to zero-order kinetic at very high drug doses
7. 5-HT:
a) is synthesised from tyrosine by enterochromaffin cells of the gastrointestinal tract
b) is also an endogenous neurotransmitter in the brain
c) is metabolised by monoamine oxidase to hydroxyindole acetic acid
d) is degraded to a great extent by pulmonary endothelial cells
e) can cause vasoconstriction and increased gastrointestinal motility
37
11. Adenosine:
a) is an endogenous nucleoside and a metabolite of high energy phosphates
b) has a half-life of 8-10 seconds
c) has a negative inotropic effect
d) can cause severe bradycardia
e) has cellular protective effects during hypoxia or ischaemia
14. The natural frequency of direct pressure measuring systems (desirable > 30 Hz) would be higher in presence
of:
a) a wide bore cannula
b) a very long catheter
c) a wider catheter
d) a less compliant catheter
e) multiple three way stopcocks
38
d) blockade of ventral roots near subarachnoid space below level of T4
e) neostigmine
21. Pulmonary arterial occlusion pressure will be greater than left ventricular end-diastolic pressure in the
presence of:
a) severe mitral stenosis
b) positive end-expiratory pressure
c) left atrial myxoma
d) stiff left ventricle
e) premature closure of mitral valve
25. Central venous pressure is greater than pulmonary arterial occlusion pressure in:
a) right ventricular failure
b) pulmonary embolism
c) chronic lung disease
d) pulmonary hypertension
e) acute pulmonary regurgitation
26. The following statements are true regarding these new drugs:
a) fenoldopam, a D1 agonist, is used for treating hypertensive emergencies
b) bambuterol is a prodrug, converted to terbutaline in the body
c) nicorandil, a potassium channel activator, reduces both preload and afterload
d) nimodipine is a cerebral vasodilator
e) nabilone, a synthetic cannabinoid, is used as an anti-emetic during cancer chemotherapy
30. Blood urea nitrogen is an unreliable measure of renal dysfunction as it is increased in:
a) gastrintestinal haemorrhage
b) dehydration
c) excessive protein intake
39
d) end-stage liver disease
e) omission of essential amino acids from diet
ANSWERS
1.TFTFF
2.TFFTT
3.FTTTF
4.TTFFT
5.TTFTT
6.FTFTT (Cl= k. Vd)
7.FTTTT
8.TTFTT
9.TTTTT
10.TTTTT
11.TTTTT
12.TFFFF
13.TTFTT
14.TFTTF
15.TTTTT
16.TTTTF
17.TTFFT
18.TFFTF
19.TTTTT
20.FTFFT
21.TFTFF (see A-Z, with PEEP, LVEDP>PAWP)
22.FTTFF
23.TTTTF
24.TTTTT
25.TTTTT
26.TTTTT
27.TTTTT
28.TTTT
29.TTTFT
30.TTTFT
40
1. Factors which affect the peak effect of intravenous anaesthetics include:
a) dose administered
b) volume of distribution
c) hepatic clearance
d) rate of injection
e) cardiac output
5. Ketamine:
a) is an imidazole derivative
b) has also antanalgesic effect
c) is contraindicated rectally
d) has no active metabolites
e) probably has no effect on intracranial pressure
6. The following statements are true regarding the opioids used in the perioperative period:
a) morphine may raise plasma histamine
b) pethidine does not alter the heart rate
c) pethidine is more of a myocardial depressant than morphine
d) sufentanil may not cause truncal rigidity in high doses
e) opioid-induced bradycardia is rare in patients undergoing bilateral vagotomy
8. Methohexitone:
a) is an oxybarbiturate
b) may cause pain on injection
c) is a methylated hexobarbitone
d) is safer in asthma than thiopentone
e) has a shorter half life than propofol
41
d) decreased peripheral blood flow
e) urinary retention
11. The following influence the rate of absorption of a drug given intramuscularly:
a) pka
b) pH
c) blood flow to the muscle
d) site of injection
e) pharmaceutical formulation
12. Clonidine:
a) is an alpha-1 adrenoceptor agonist
b) reduces catecholamine release in the body
c) is a commonly used antihypertensive agent
d) is contraindicated via the epidural route
e) does not alter the minimal alveolar concentration of volatile agents
15. Naloxone:
a) is a pure antagonist
b) does not produce antanalgesic effects in naive subjects
c) has a terminal half-life of 2.5 hours
d) can be used orally
e) completely reverses the side effects of buprenorphine
16. Enoximone:
a) selectively inhibits phosphodiesterase type III isoenzyme
b) should be used with caution in hypotensive patients
c) is routinely administered by IV bolus
d) improves cardiac index
e) does not cause thrombocytopenia
17. 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
18. 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
42
d) the cardiac output is increased by 10-20%
e) glomerular filtration rate may be increased by up to 80%
43
a) liver converts water-soluble to lipid-soluble drugs
b) oral opioids have a negligible first-pass effect
c) thiopentone in the dose used for induction will induce the hepatic enzymes
d) anticonvulsants have little effect on hepatic microsomal enzymes
e) metronidazole appears to induce hepatic microsomal enzymes
ANSWERS
1.TFFTT
2.FFFFF
3.TTFFF (Parbrook, flow is directly proportional to the square root of pressure in turbulent flow)
4.FTTTF
5.FFFFF
6TFTFT
7.FFFTT
8.TTTFF
9.TTTFF
10.TTTTF
11.FFTTT
12.FTFFF
13.FTTTT
14.FTFTF
15.TFTFF
16.TFFTF
17.FFTFT
18.TTTTF
19.FFFTT
20.TFTFF
21.TFFTF
22.FTTTT
23.FFTFT
24.FFFFF
25.TTFFF
26.TTFTF
27.FFFTT
28.FFFFF
29.TTTTT
30.FFFFF
44
1. Albumin:
a) has a molecular weight of 69,000, with a strong negative charge on its surface
b) is synthesised by hepatocytes at a rate of 9-12 g/day in a healthy adult
c) generates oncotic pressure because of its high molecular weight
d) has a degradation half-life of 18 days
e) can be present in the urine in individuals on prolonged standing
1.TTFTT
4. Regarding diuretics:
a) ethanol inhibits antidiuretic hormone secretion
b) theophylline increases the sodium content of urine
c) acetozolamide increases the sodium content of urine
d) spironolactone can cause hyponatraemia
e) frusemide leads to increased K+ secretion in the distal tubule
4.TTTTT
7. Esmolol:
a) is a beta-1 selective blocker
b) has an elimination half-life of 9 minutes
c) is metabolised by plasma pseudocholinesterase
d) may cause hypotension
e) is useful in the management of supraventricular arrhythmias
7.TTFTT
45
d) infrared thermometer is increasingly used for measuring tympanic membrane temperature
e) the triple point of water is at 273.160 Kelvin
9.TTTTT
14. Naloxone:
a) is a derivative of oxymorphone
b) has a reverse agonist effect
c) can cause pulmonary oedema
d) has a duration of effective antagonism of 30-45 minutes
e) has an antanalgesic effect in individuals not given opioids
14.TFTTT
18. Pancuronium:
a) is a synthetic steroid
b) releases a large amount of histamine
46
c) causes noradrenaline release at nerve endings
d) can cause ganglion blockade
e) has a duration of action of 45-60 minutes
18.TFTFT
23. Glucagon:
a) plasma level is increased in cirrhosis of the liver
b) is an inotrope
c) causes glycogenolysis in liver but not in muscle
d) secretion is inhibited by propanolol
e) can cause hyperkalaemia
23.TTTTT
24. Midazolam:
a) has a half-life of less than 2 hours
b) is water soluble at a pH 4
c) has an active metabolite
d) can have a prolonged effect if given with erythromycin
e) can be given by the intranasal route
24.TTTTT
25. Ketamine:
a) raises the plasma noradrenaline level
b) can cause unpleasant side-effects in adults for 24 hours after administration
c) is a depressant to denervated cardiac muscle
d) produces a loss of consciousness in one arm-brain circulation time
e) is a bronchdilator
25.TTTFT
27. Enflurane:
47
a) is a halogenated hydrocarbon with an oil:gas partition coefficient of 98
b) when metabolised is converted to form inorganic flouride ions
c) at high concentration can cause seizures when associated with low PaCO2
d) depresses hypoxic pulmonary vasoconstriction
e) depresses uterine tone and contractility
27.FTTTT (enflurane is a halogenated methylether)
48
BONUS QUESTION
ANSWERS
1.TTFTT
2.FFTTT
3.TTTTT
4.TTTTT
5.TTTTT
6.TTTTT
7.TTFTT
8.TTTTT
9.TTTTT
10.TTTFT
11.TTTTT
12.TTTTF
13.TTTTT
14.TFTTT
15.TTTTF
16.TTTTT
17.TTTTF
18.TFTFT
19.TTTTT
20.TTTTF
21.FTTTT
22.TTTTT
23.TTTTT
24.TTTTT
25.TTTFT
26.TTFTT
27.FTTTT (enflurane is a halogenated methylether)
28.TTTTF
29.TFTTT
30.TTTTT
BONUS QUESTION.TTTTT
49