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General Primary MCQ 10

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

2. Regarding protein binding of drugs in the plasma:

a) highly protein bound drugs have a longer biological half-life

b) protein binding is markedly different in arterial and venous blood
c) free drug concentration is not altered in hypoalbuminaemic states
d) alpha-1 acid glycoprotein principally binds to basic drugs
e) the greater the protein binding, the lesser the volume of distribution

3. Alprostadil (PGE 1) and Epoprostenol (PGI2):

a) are principally metabolised in the lungs

b) dilate ductus arteriosus to increase pulmonary blood flow in neonates
c) inhibit platelet aggregation
d) improve oxygenation in ARDS patients when used by the nebulised route
e) do not cause apnoea in neonates

4. The following statements about drug half-life are correct:

a) the half-life of a drug is shorter than its time constant

b) drugs given by infusion without a bolus reach a steady state in five half-lives
c) the extent of drug distribution into the total body water or extracellular fluid is unlikely to affect t1/2
d) context-sensitive half–life can be used for any drug
e) about 94% of a drug is cleared from the body in four half-lives

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

6. Regarding drug clearance by the body:

a) this only refers to elimination by the kidney

b) this refers to the volume of plasma cleared of the drug in unit time
c) it cannot exceed the glomerular filtration rate
d) it is dependent on its volume of distribution
e) hepatic clearance is expressed as extraction ratio

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

8. Concerning metabolism of following drugs:

a) lidocaine is metabolised to monoethylglycinexylidide (MEGX) in the liver

b) lithium is almost entirely excreted unchanged by the kidney
c) gentamicin is metabolised in the liver and excreted in the bile
d) chlorpromazine is degraded via microsomal oxidative metabolism in the liver
e) levodopa crosses the blood-brain barrier and is then converted to dopamine

9. Regarding arterial blood gas analysis:

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a) hydrogen, oxygen and CO2 electrodes measure at 37 degrees C

b) PaO2 read by gas analyser would be higher than patient’s PaO2 at 32 degrees C
c) the pH of the blood rises by 0.015 units per 10 degrees C decrease in body temperature
d) the alpha-stat approach is to keep uncorrected PaCO2 and pH at normal levels
e) PaCO2 of a patient at 30 degrees C will be lower than that at body temperature

10. Regarding fibrinolysis:

a) streptokinase converts plasminogen to plasmin

b) tranexamic acid is a potent inhibitor of plasmin
c) aprotinin has antiplasmin activity
d) urokinase is a plasminogen activator
e) rT-PA converts plasminogen to plasmin

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

12. Breathing out against a closed glottis:

a) raises intra-tracheal pressure

b) there is no change in the heart rate
c) right ventricular output is increased
d) LV output initially rises and then falls
e) systolic pressure falls then rises

13. Regarding anaesthesia in a hyperbaric chamber:

a) 0.4% isoflurane at 3 atmospheres will produce a similar depth of anaesthesia to that produced by 1.2%
isoflurane at sea level
b) rotameters may read falsely high due to an increase in gas density
c) air can be used to elicit a loss of resistance of epidural space
d) endotracheal tube cuffs should be inflated with saline
e) the risk of oxygen toxicity is higher with high FIO2

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

15. On ascent to 6000 metres (1/2 ambient pressure):

a) respiratory minute volume is increased

b) plasma pH is increased initially
c) the urine is alkaline
d) hypoxia occurs
e) cerebral blood flow is increased

16. Insulin secretion:

a) is about 1 U/hour in the basal state

b) is increased 5-10 times following ingestion of food
c) is increased by glucagon
d) is depressed in starvation
e) is increased in the perioperative period

17. Adenyl cyclase:

a) catalyses the conversion of ATP to cyclic AMP

b) is linked to stimulatory and inhibitory G proteins
c) is decreased by aminophylline
d) release is triggered by cyclic AMP
e) is an integral part of beta-adrenergic receptors

18. Concerning bilirubin:

a) conjugated bilirubin is water soluble

b) a conjugated bilirubin of 20 mmol/L in a neonate will cause brain damage
c) the serum-conjugated bilirubin is increased in haemolysis

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d) barbiturates may be used to treat hyperbilirubinaemia

e) urinary urobilinogen excretion is decreased in obstructive jaundice

19. Regarding arterial blood pressure waveform:

a) initial upstroke reflects the inotropic component of the left ventricle

b) systolic and diastolic portion can be separated by dicrotic notch
c) systolic peak is higher in radial artery than that in the aorta
d) dicrotic notch is more pronounced in children
e) area under the pressure waveform represents stroke volume

20. Motility of the gastrointestinal tract is increased by:

a) vagal blockade
b) mechanical obstruction
c) stimulation of splanchnic nerves
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

22. Starvation causes:

a) increase in plasma glucose

b) increase in urinary nitrogen excretion
c) increase in plasma ketone bodies
d) increase in glucose utilisation by the brain
e) a metabolic alkalosis

23. Regarding isomerism of the anaesthetic drugs:

a) propofol and sevoflurane are achiral compounds

b) ropivacaine, rocuronium and cisatracurium are single stereoisomers
c) bupivacaine and ketamine are racemic compounds
d) atracurium and mivacurium have more than two stereoisomers
e) there is no pharmacodynamic diference between R and S enantiomers

24. In a normal subject, the resting PaCO2 depends on:

a) cardiac output
b) alveolar ventilation
c) transfer factor
d) carbon dioxide production
e) activity of medullary chemoreceptors

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

27. Regarding the loop of Henle:

a) the descending limb is permeable to water

b) the filterate becomes hypertonic as it goes down the descending limb
c) the ascending limb of loop is virtually impermeable to water
d) about 15% of filtered water is absorbed in the loop of Henle
e) the thick ascending limb has a higher amount of Na-K ATPase than any other part of the renal tubule

28. Concerning renal function:

a) when the glomerular filtration rate is reduced by 75%, serum creatinine begins to rise

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b) urine osmolality reflects the tubular function

c) urinary sodium <20 mmol/L indicates hypovolaemia
d) fractional excretion of sodium is greater than normal in acute tubular necrosis

29. Regarding sodium excretion by the kidney:

a) 96-99% of filtered sodium is absorbed by the renal tubule

b) fractional excretion of sodium is increased with a salty diet intake
c) brain natriuretic peptide increases renal sodium excretion
d) dopamine decreases the renal sodium excretion
e) most of the filtered sodium is reabsorbed with chloride in renal tubules

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
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

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