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General Primary MCQ 11

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

2. The following drugs are excreted largely unchanged by the kidney:

a) lidocaine
b) morphine
c) propofol
d) levo-bupivacaine
e) vecuronium

3. The following statements are true about the flow of gases:

a) gas flow is proportional to fourth power of the radius in laminar flow

b) resistance is directly proportional to length of a tube
c) a gas with low density is likely to develop turbulent flow
d) flow is not dependent on viscosity in laminar flow
e) flow is inversely proportional to the square root of pressure in turbulent flow

4. The following are correct:

a) t1/2 = k/0.693
b) CL= k.Vd
c) CL = 0.693 x Vd / t1/2
d) pH = pKa + log [base/acid]
e) I x Css = CL
where I = infusion rate, Css = plasma concentration at steady state, CL = clearance

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

7. Regarding the pharmacokinetics of opioid analgesics:

a) bioavailabilty of most of the opioids given by the oral route is about 75-85%
b) highly water soluble opioids have a rapid onset of action
c) the duration of action of opioids is related to their terminal half-lives
d) they have flow-dependent hepatic clearance
e) morphine has a terminal half-life similar to fentanyl

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

9. The following statements regarding the pharmacodynamics of opioids are true:

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a) naloxone is more effective at mu receptors than at other opioid receptors

b) unchanged diamorphine has no affinity for opioid receptors
c) pethidine penetrates the blood-brain barrier quicker than morphine
d) pethidine may be used safely in patients receiving monoamine oxidase inhibitors
e) the duration of action of remifentanil is prolonged by concomitant administration of anticholinesterase
drugs

10. Non-selective beta-blockers have the following side-effects:

a) bronchospasm
b) increased uterine tone
c) hypoglycaemia
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

13. Regarding partial opioid agonists:

a) partial agonists are agonists at m but antagonists at k receptors

b) buprenorphine has low intrinsic activity at m receptors
c) partial agonists show a plateau or ceiling effect in their dose-response curve
d) nalbuphine is equipotent with morphine
e) buprenorphine is longer acting due to its strong receptor affinity

14. When using a nerve stimulator to monitor neuromuscular blockade:

a) a minimum of 30 seconds must be left between train of four (T-O-F) stimuli

b) tetanic fade suggests inadequate reversal of blockade
c) recovery of 25% single twitch height is the same as return of 1st twitch of T-O-F
d) depolarising block does not alter the T-O-F ratio
e) ability to raise the head for 5 seconds corresponds to 50% twitch height recovery

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

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d) the alveolar ventilation

e) right or left shunt

19. 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

20. 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%

21. 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

22. The following cause an increase in cerebral blood flow:

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

23. 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

24. 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

25. 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

26. 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

27. 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 (N 2O: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

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

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

29. 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

30. Regarding drug metabolism:

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

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