MCQ

1. Regarding two compartment pharmacokinetics: a) a drug is always removed from the peripheral compartment b) the central compartment is blood volume c) a drug with a high volume of distribution is likely to be lipophillic d) a drug can have a short duration of action while being eliminated very slowly e) most anaesthetic drugs are modelled well with a two-compartment model 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

3. Regarding the use of suxamethonium: a) bradycardia is a complication b) phase II block occurs more commonly with neonates c) prolonged duration of action may be seen in around one patient in 40 d) can raise the serum potassium by 0.5 mmol/ L e) dose required is lower in small children
4. Concerning electroencephalography (EEG): a) voltages are in the range of 10-100 millivolts b) spontaneous EEG activity is lost when the body temperature drops below 25 degrees C c) b waves are enhanced by sedatives d) d waves only occur in brain injury e) q waves occur at a frequency of 4-7 Hz 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 6. Conduction velocity of a nerve impulse: a) is greater in C fibres than in group A fibres b) is greater in large diameter nerve fibres c) is greater in unmyelinated nerve fibres because of saltatory conduction d) can be as fast as 120 m/s in human nerve fibres e) is decreased in hypothermia 7. Regarding drug metabolism by cytochrome P450 isoenzymes: a) cytochrome P450 makes up 1% of total liver proteins b) the most important enzyme is CYP3A4

c) the system is responsible for most of the reductive metabolism in humans d) volatile anaesthetics are metabolised by CYP2E1 e) some isoenzymes are inhibited strongly by erythromycin

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
9. In the pulmonary circulation: a) capillary hydrostatic pressure is about 25 mmHg b) 50% of the cardiac output goes to the pulmonary circulation in the foetus c) angiotensin is broken down d) bradykinin is inactivated e) hypoxia causes vasoconstriction 10. Regarding local anaesthetic agents (LA): a) the potency of LAs is proportional to their lipid solubility b) the duration of action is dependent on protein binding c) agents with low pKa have a faster onset of action d) all local anaesthetics are vasodilators e) the depth of local anaesthetic block is increased by increasing the dose 11. Cisatracurium besylate: a) is a mixture of three stereoisomers b) in equipotent doses has a similar duration of action to vecuronium c) is less potent than atracurium d) undergoes more Hoffmans degradation than atracurium e) in equipotent doses has a similar onset time to atracurium 12. If an electric current is fed through the body: a) risk of injury is largely dependent upon the current flow b) antistatic shoes provide good protection due to their high resistance c) high frequencies are more dangerous than low frequencies d) ventricular fibrillation occurs at a lower current in patients with dysrhythmias e) a tingling sensation is felt at a current strength of 1 mA 13. The countercurrent concentrating mechanism in the kidney: a) depends on active transport of sodium and chloride out of the ascending loop of Henle b) allows an osmolality of 1200 mosmoles/kg in distal tubules c) occurs predominantly in the cortical nephrons d) relies on the free movement of water and electrolytes across the walls of the vasa recta e) depends on a low concentration of urea in the medullary interstitium 14. The adverse effects of NSAIDs on the kidney: a) are reversible in normal kidneys b) are not dose related c) are mediated by inhibition of PGI2 synthesis d) may cause acute interstitial nephritis e) are counteracted by the use of ACE inhibitors

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 16. Concerning the measurement of oxygen: a) an oxygen electrode should be calibrated at zero and in room air b) oxygen tension in a liquid can be measured with a Clark electrode c) a polarographic electrode can be used in vivo d) oxygen measurement in a gas mixture makes use of the magnetic property of oxygen e) a fuel cell has a rapid response to change in oxygen concentration 17. Drug clearance: a) is the amount of drug removed from plasma in unit time b) is proportional to half-life c) is low in lipid-soluble drugs d) occurs only in the liver and kidney e) is calculated by dividing the dose of drug given by area under plasma concentration-time curve 18. The volume of distribution of a drug: a) is low if the drug is highly protein bound b) can be calculated by multiplying half-life by natural logarithm of 2 c) is relatively low for muscle relaxants d) is proportional to half life e) is dependent on the elimination rate constant 19. Concerning composition of body fluids: a) plasma constitutes a quarter of extracellular fluid (ECF) volume b) ECF volume may be grossly depleted in intestinal obstruction c) the protein content of interstitial fluid is higher compared with intracellular fluid (ICF) and plasma d) the ratio of ECF/ICF volume is smaller in infants and children e) the normal osmolality of plasma is 280 mosmoles/kg 20. Aldosterone causes: a) a decrease in urine sodium concentration b) weight gain c) decreased serum chloride level d) increased extracellular fluid volume e) increased K+ excretion 21. The following antibiotics have good activity against anaerobic bacteria: a) vancomycin b) aztreonam c) metronidazole d) imipenem e) trimethoprim

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
23. Concerning the blood brain barrier (BBB): a) it is virtually impermeable to ions and proteins b) it breaks down around brain infarcts c) a rise in serum albumin by 20 g/L will draw more H2O across the BBB than a rise in serum Na+ by 5 mmol/L d) when damaged, cytotoxic brain oedema results e) mannitol crosses the BBB easily 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 25. ABO compatibility is essential for transfusion of: a) SAGM blood b) haemoglobin solutions c) cryoprecipitates d) FFP e) platelets 26. The following increase during pregnancy: a) plasma volume b) fibrinogen c) gastric emptying time d) glucose tolerance e) arterial PaCO2 27. Carbon monoxide: a) binds to haemoglobin with 100 times the affinity of oxygen 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 28. Resting potential across the nerve membrane: a) depends largely on the ratio of K+ inside and outside the cell b) is positive inside with respect to outside c) is of the order of 0.06 volt

d) decreases in magnitude during prolonged hypoxia e) is greater the larger the diameter of the nerve fibre 29. Activation of NMDA receptors: a) is important in learning and memory b) can result in neuronal damage c) is involved in the development of opioid tolerance d) causes opening of the chloride channel e) may increase the intensity of pain 30. Bacteria develop resistance to antibiotics: a) by changing permeability of porin channels in cell wall b) by producing enzymes to inactivate antibiotics c) by altering target sites (DNA gyrase and topoisomerase) for antibiotics d) by active extrusion of antibiotic once it enter the cell e) easily in presence of necrotic tissue 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

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 2. The work of breathing: a) is inversely related to lung compliance b) increases during exercise c) normally requires 15% of total body oxygen consumption d) is increased when the subject breathes heliox instead of room air e) is calculated by integration of a pressure/volume loop 3. Alveolar - arterial oxygen difference (A-a DO2): a) is normally 2-3 kPa while breathing room air b) is increased under anaesthesia due to increased V/Q mismatch c) is decreased in one lung ventilation d) is increased in the presence of right to left intracardiac shunts e) is decreased in severe exercise 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 5. An arterial blood sample has the following values: pH 7.25, PCO2 4 kPa, PO2 8 kPa, base excess -5.6 mmol/L, standard bicarbonate 20 mmol/L These could result from: a) an intracardiac left to right shunt b) Acute respiratory distress syndrome c) chronic obstructive airways disease d) aspirin overdose e) diabetic ketoacidosis 6. The Magill (Mapleson A) breathing system: a) is the most efficient system for spontaneously breathing patients b) will work with minimal rebreathing at a fresh gas flow of 70% of minute volume c) makes scavenging of exhaled gases easier d) co-axial version is the Lack system e) is also efficient during controlled ventilation 7. The respiratory centre in the brain stem receives input from: a) the aortic and carotid bodies b) bronchiolar stretch receptors via vagal afferents c) oxygen-sensitive chemoreceptors in the medulla d) receptors which respond to the hydrogen ion concentration in the cerebrospinal fluid e) mechanoreceptors of the larynx 8. The carotid bodies:

a) b) c) d)

have cells which respond only to decrease in PaO2 have the highest blood flow (ml/unit weight) in the body maximally stimulate the respiratory centre between 4-8 kPa increase the respiratory drive when mean arterial pressure decreases below 70 mmHg

9. Concerning pulmonary function tests: a) FEV1 is low in small airway disease b) FEV1 is also effort dependent c) The flow-volume loop can indentify the source of airway obstruction 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 10. Mixed venous oxygen saturation: a) is normally between 65-80% b) is essential in calculations of shunt and oxygen extraction ratio c) is increased in hypothermia d) is decreased in low cardiac output states and in thyrotoxicosis e) can be continuously monitored with an oximetric Swan Ganz catheter 11. With a decrease in body temperature: a) P50 and PaCO2 are decreased b) pH is increased c) arrhythmias are increasingly common at temperatures below 30 degrees C d) blood becomes more viscous e) the EEG becomes isoelectric at about 20 degrees C 12. Concerning the pharmacokinetics of inhalational agents: a) agents with a high blood:gas partition co-efficient will keep alveolar to inspired gas (FA/FI) ratio low b) alveolar partial pressure rises faster in adults than in children c) high cardiac output slows the rate of rise of alveolar partial pressure (FA) d) diffusion hypoxia is due to the second gas effect e) the second gas effect slows the rate of rise of alveolar partial pressure (FA)

13. The following statements regarding inhalational agents are correct: a) the blood gas partition co-efficient of desflurane is 0.42 b) desflurane can cause sympathetic stimulation c) sevoflurane can degrade to compound A in soda lime d) desflurane is suitable for inhalational induction e) desflurane can be used in halothane vaporiser
14. Nitrous oxide (N2O): a) has a blood:gas partition coefficient of 0.47 b) is 34 times less soluble than N2 c) may be associated with postoperative hearing loss d) inactivates methionine synthetase after prolonged administration e) when inhaled at 66% can double a pneumothorax in 10 minutes 15. The speed of induction with inhalational agents:

a) is quicker in patients with very high functional reserve capacity b) is quicker if the agent is very soluble in blood c) is slower in the presence of right to left shunt d) is unchanged in the presence of left to right shunt with normal systemic flow e) is quicker when used with nitrous oxide 16. With reference to the skeletal muscle myofilaments: a) actin is the major constituent of thin filaments b) myosin and tropomyosin combine to form the thick filaments c) troponin is a constituent of thin filaments d) tropomyosin prevents the interaction between actin and myosin in the resting state e) troponin C has 4 calcium binding sites 17. The following receptors are part of a ligand-gated ion channel: a) opioid m receptor b) muscarinic cholinoceptors c) nicotinic cholinoceptors d) GABA A receptor e) GABA B receptor 18. Drugs with anti-emetic activity: 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 19. Concerning the rate of diffusion of a gas: a) it is a result of the random movement of the gas molecules b) it is proportional to the tension gradient c) it depends upon the gas temperature d) it is inversely related to the square root of the gas density at constant temperature e) carbon dioxide diffuses more rapidly than oxygen 20. Concerning the use of lasers: a) most lasers use light of wavelengths in the visible and infrared spectrum b) the CO2 laser is strongly absorbed by water, blood and tissues c) the Nd-Yag laser is absorbed mostly by pigments d) nitrous oxide should be avoided during the use of a laser near the airway e) endotracheal tube cuffs should be inflated with saline or water 21. Concerning pacemakers: a) AOO is a fixed rate type of pacemaker b) VVI is the most common type of synchronous pacemaker c) failure to capture is never seen with hyperkalaemia d) unipolar electrocautery is prefered in patients with a pacemaker e) the ground plate of the electrocautery should be placed as far as possible from the pacemaker 22. Regarding defibrillation:

a) the greater the time interval between onset of ventricular fibrillation and defibrillation, the less the success of defibrillation b) 5-40 joules should be applied to the heart if the chest is open c) paddles should be of 13 cm in diameter in adults d) defibrillation is most effective when the electric shock is delivered during inspiration e) the myocardium is refractory to defibrillation in hypothermia 23. Regarding acid-base balance: a) chronic obstructive airways disease patients have high serum bicarbonate levels b) the normal anion gap is 20-25 mmol/L c) mixed venous pH is always lower than arterial pH d) the pKa for bicarbonate buffer is 6.1 e) kidneys cannot produce urine with a pH <4.4 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 25. Ablation of the stellate ganglion causes: a) dilatation of the ipsilateral pupil b) vasodilatation of the ipsilateral arm c) posteral hypotension d) loss of consensual light reflex e) loss of ipsilateral lacrimation 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 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 27. Regarding coronary blood flow: a) subendocardium is more vulnerable to ischaemia than epicardium b) adenosine and dipyridamole are coronary vasodilators c) myocardial oxygen consumption and coronary blood flow bear a linear relationship d) coronary blood flow may be improved by slowing the heart rate e) the normal myocardial oxygen extraction ratio is 70% 28. The following are true of local anaesthetic toxicity: a) as plasma levels gradually rise, cardiotoxicity is an early likely event b) lidocaine toxicity causes its earliest symptoms at levels of 5 mg/ml c) profound vasodilatation is the mechanism of hypotension d) emergency treatment involves treating convulsions and administering antiarrhythmic agents

29. The following statements about acetylcholine are true: a) its synthesis requires ATP b) it is broken down by choline acetyltransferase in the synaptic cleft c) it is broken down to acetic acid and choline d) it is released only by preganglionic fibres in the autonomic nervous system e) it acts by diffusing through channels in the postsynaptic membrane
30. The dinamap non-invasive blood pressure monitor: a) uses a double cuff oscillotonometric system b) needs to be at the same level as the patient c) is accurate even when an abnormal rhythm is present d) gives a more accurate measure of the diastolic than systolic pressure e) is more accurate than a manual oscillotonometer

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 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

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
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

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 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
6. In an awake upright spontaneously breathing patient: a) ventilation per unit lung volume is smallest at the apex of lungs b) basal alveoli are smaller c) basal alveoli expand more than apical alveoli during inspiration d) pleural pressure is less negative at the base of the lungs 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 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 9. In a normal healthy man at rest in the supine position: a) left ventricular end-diastolic volume is about 20 ml b) the first heart sound coincides with the onset of ventricular systole c) cardiac output is approximately 75 ml/beat 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 10. The rate of diffusion of a gas (Ficks Law) across a membrane: a) is directly proportional to the area b) is directly proportional to the partial pressure gradient c) is inversely proportional to thickness of the membrane d) is directly proportional to molecular weight e) is inversely proportional to the density of the gas 11. Third generation beta-adrenergic blockers: a) include celiprolol and dilevalol b) block the beta-1 receptors c) stimulate beta-2 receptors d) appear well tolerated in asthmatics e) may reduce juxtaglomerular renin release by beta-1 blockade 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 13. Concerning the ABO blood groups: a) a person of group O is a universal recipient b) a person of group B always has anti-A agglutinins in his plasma c) in an incompatible blood transfusion reaction, donor cells are lysed by recipient antibodies d) disseminated intravascular coagulation may be a clue to mismatched transfusion e) a saline cross-matching takes 10 minutes to perform 14. Aspirin at the therapeutic dose: a) inactivates the platelet cyclo-oxygenase system temporarily b) causes sweating by a direct action on the post-ganglionic nerves c) acts in fever to reset the central thermostat d) will not antagonise the hyperthermia of exercise e) does not alter the requirement of heparin for anticoagulation 15. Oral anti-coagulant treatment:

a) may be teratogenic in early pregnancy b) can cause haemorrhagic foetal death in the third trimester c) precludes breast feeding d) predisposes to particular hazards in patients undergoing prostatectomy e) is best withdrawn 5 days before elective surgery 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

17. Regarding blood transfusions: a) they may result in hypercalcaemia b) in an emergency, it is safe to give O+ blood to an O-ve patient c) they are contraindicated in head injury d) they may result in consumption coagulopathy e) when rapid will often cause hyperthermia
18. The haemoglobin oxygen dissociation curve is moved to the left by: a) ascending to 6000 feet over 24 hours b) carbon monoxide c) frozen red cells d) bovine haemoglobin e) anaemia 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 20. Enzyme induction: a) occurs in both hepatic and extrahepatic tissues b) develops within 5 days of administration of an inducing agent c) is usually brought about by lipid-insoluble substances with a short half-life d) enables the body to adapt to varying exposure to foreign compounds e) can be a cause of loss of anticoagulant control 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

22. Third generation cephalosporins: a) in general are active against gram +ve cocci b) in general are active against Escherichia coli, Klebsiella and Proteus mirabilis c) may be nephrotoxic in combination with aminoglycosides d) may have disulfiram like action e) is the drug of choice for prophylaxis against bacterial endocarditis 23. Compared with intracellular fluid, extracellular fluid has: a) a greater osmolarity b) a higher protein concentration c) a lower chloride ion concentration d) a lower hydrogen ion concentration e) a lower potassium ion concentration 24. With reference to the normal human heart: a) the most rapidly conducting fibres in the heart are the Purkinje fibres b) the last part of the ventricle to be activated is the apex c) the duration of an action potential in a ventricular muscle fibre is about the same as in a skeletal muscle fibre d) the T wave of the ECG occurs at the beginning of the absolute refractory period of the ventricle e) left axis deviation leads to abnormally large R wave in Standard Limb Lead I

25. Concerning dopamine receptors: a) D1 receptors are present in renal and mesenteric blood vessels b) D1 receptors in renal tubules may induce natriuresis c) D1 receptor stimulation may lead to renin release d) D2 receptors are present in the nigrostriatal pathway e) fenoldapam selectively acts on D1 receptors
26. Pulmonary vascular resistance a) is increased at high altitude b) is decreased by a low pH c) can be measured using a flow-directed balloon catheter d) is increased by isoprenaline e) is decreased by 5-HT 27. A plasma sodium concentration of 120 mmol/L may be a consequence of: a) Conns syndrome b) prolonged unconsciousness c) analgesic-induced nephropathy d) diabetes insipidus e) acutely decreased renal blood flow 28. Factors determining urinary sodium loss include: a) plasma sodium concentration b) glomerular filtration rate c) circulating renin levels d) distal tubular fluid anion concentration e) plasma hydrogen ion concentration

29. Atrial natriuretic peptide (ANP): a) is released via coronary sinus b) is a potent vasodilator c) improves renal blood flow d) increases the glomerular filteration rate e) may augment the release of antidiuretic hormone
30. Excitatory amino acids: a) include aspartate and glutamate b) act on NMDA, kainate and quisqualate receptors c) may induce uncontrolled sodium and calcium influx to the cell d) can be antagonised by ketamine e) may potentiate pain transmission

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 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 3. Regarding pH and ionic dissociation: a) a weak acid will be 1000 times more ionised at a pH of 7 than at a pH of 4 b) a strong alkali will have a high pH c) the pH is inversely proportional to the hydrogen ion concentration d) a pH of 7.7 corresponds to a hydrogen ion concentration of 20 nmol/ L e) in the adult, there is a hundred fold range of H+ concentration that is compatible with life 4. Regarding 5-hydroxytryptamine (5-HT): a) it is synthesised from L-tryptophan in the enterochromaffin cells b) it is metabolised to hydroxyindole acetic acid c) it causes bronchospasm and vasodilatation by interacting with 5HT-2 receptors d) a 5HT-3 antagonist is a good anti-emetic e) it may have a platelet aggregating effect 5. Rocuronium: a) is an aminosteroid b) is stable in aqueous solution c) undergoes principally hepatic elimination d) can provide intubating conditions within 60 seconds e) does not release histamine 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 7. S(+) ketamine compared with R(-) ketamine: a) is 3-4 times more potent b) is associated with less incidence of emergence reaction c) is a better analgesic d) has a faster recovery e) has a higher affinity for NMDA receptors 8. Concerning the physiology of the stomach: a) acid secretion in response to hypoglycaemia is mediated by gastrin b) gastric emptying is quickened by sympathetic stimulation c) acid secretion is mediated by H2, M1 and gastrin receptors d) gastric pH is normally around 2-3 e) acidity is reduced by proton pump inhibitors

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 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 12. Longer term adjustments to altitude hypoxia include: a) hyperventilation b) kidneys slowly lose bicarbonate c) increased serum level of erythropoietin d) increased number of mitochondria e) heart rate remains elevated 13. Concerning patterns of stimulation for monitoring of neuromuscular junction: a) 100 Hz tetanic stimulation is commonly used b) frequency of train of four is 2 Hz c) first response of train of four is equivalent to single twitch response d) train of ratio of 0.7 corresponds to 100% recovery of single twitch e) double burst stimulation consists of two short tetanic stimulations separated by 750 ms 14. Non-depolarising muscle relaxants: a) demonstrate fade due to their presynaptic action b) may not show post-tetanic facilitation c) with large dose may block the diaphragm first before adductor pollicis d) have onset defined as time from administration to abolition of response to single twitch 15. The sequence of events in muscle contraction: a) action potential depolarises the T-tubules b) depolarisation of T-tubules release calcium from sarcoplasmic reticulum c) calcium binds to the troponin-tropomyosin complex d) actin combines with myosin ATP leading to cross-bridge activation e) calcium moves back into the sarcoplasmic reticulum by passive transport 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 18. Regarding the pharmacokinetics of volatile agents: a) blood/gas partition coefficient of desflurane is 0.69 b) sevoflurane can be used for inhalational induction in adults c) inspired concentration influences the rate at which alveolar concentration is attained d) alveolar concentration during recovery decreases more slowly after prolonged anaesthesia 19. Breathing (reservoir) bags: a) are designed to distend enormously when subjected to pressures above 50-60 mmHg b) are of optimal size that fits neatly in one hand c) prevent wastage of fresh gas flow during expiratory pause d) provide a rough visual assessment of volume of ventilation e) act as a reservoir because anaesthetic machine can not provide the peak inspiratory flow required in normal respiration 20. Regarding breathing systems used in anaesthesia: a) Magill system is most efficient for spontaneously breathing patients even at a fresh gas flow (FGF) of 70% of minute ventilation b) D, E and F systems are all T pieces c) Bain system requires a FGF of 50-60 ml/kg during spontaneous breathing d) the rate of change of vapour concentration in circle system depends on circle system volume, the FGF rate and net gas uptake e) Magill system is inefficient during controlled ventilation because much of the gases are vented via pop-off valve 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 22. The following are statements about acetylcholine: a) its synthesis requires ATP b) it is broken down in the synaptic cleft by choline acetyltransferase c) it is broken down to acetic acid and choline d) it is released only by preganglionic autonomic fibres e) it acts by diffusing through channels in the postsynaptic membrane 23. The velocity of conduction of a nerve action potential:

a) is inversely proportional to the cross-sectional area of the axon b) is faster in a myelinated fibre than in a non-myelinated fibre of the same diameter c) is decreased by cooling the nerve d) may be 200-250 ms in the fastest conducting mammalian fibres e) is decreased by disease which attack the myelin sheath 24. An excitatory post-synaptic potential (EPSP): a) is itself propagated by the post-synaptic cell b) comprises depolarisation of the membrane to zero, transient reversal of potential and then repolarisation c) is related in amplitude to the concentration of the initiating transmitter at the presynaptic membrane d) may summate both temporally and spatially with other EPSPs e) is reduced in amplitude by drugs which block the post-synaptic receptors for the transmitter substance 25. C fibres transmitting pain sensation: a) conduct at an average velocity of 2 metres/second b) conduct temperature sensation c) terminate in laminae 2 and 3 of the dorsal horn d) are the sole nociceptive afferents from viscera in the chest and abdomen 26. Concerning CNS physiology: a) the dominant cerebral hemisphere is most commonly the left b) REM sleep occurs for about 25% of the time during normal sleep in adults c) the dominant cerebral hemisphere is always on the right in left-handed individuals d) REM sleep is associated with a marked increase in muscle tone e) Neuromuscular block reduces the amplitude of somatosensory evoked potential 27. In the myocardium: a) a rise in extracellular K+ brings resting the membrane potential towards threshold b) a rise in extracellular K+ increases the membrane permeability to K+ c) hypokalaemia results in reduced ventricular action potential duration d) the slope of depolarisation (dp/dt) affects the contractility of ventricular muscle fibres e) a rise in extracellular Na+ increases membrane resting potential 28. Fibrinogen depletion: a) is diagnostic of disseminated intravascular coagulation b) occurs as a consequence of increased fibrinolysis c) should be treated by administration of cryoprecipitate d) may be a consequence of vitamin K deficiency e) occurs more commonly in men than in women 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 30. Concerning absorption of carbon dioxide in breathing systems:

a) soda lime granules are sized 4-8 mesh b) baralyme contains calcium hydroxide in addition to barium hydroxide c) soda lime produces more compound A during low fresh gas flow d) dry soda lime absorbs more carbon dioxide e) carbon dioxide first reacts with sodium and potassium hydroxide of soda lime

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 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 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 3. Low molecular weight heparins:

a) have a molecular weight <10,000 daltons b) inhibit activated factors IX, X, XI, XII c) include tinzaparin, dalteparin and enoxaparin d) are not effective in deep-vein thrombosis prophylaxis in once-daily regimen e) do not bind to thrombin and antithrombin III simultaneously 4. The following drugs have antiplatelet activity: a) epoprostenol b) calcium heparin c) hydroxyethyl starch d) dipyridamole e) remifentanil 5. Compared with that of a normal adult, the newborn infants: a) kidneys have less ability to excrete a concentrated urine b) blood-brain barrier is less permeable to bilirubin c) heat regulation is more efficient because of its ability to metabolise brown fat d) blood has a greater affinity for oxygen at low oxygen pressures e) carbohydrate reserve is greater 6. Concerning acid-base balance: a) standard bicarbonate is lower than actual bicarbonate in a chronic obstructive airways disease (COAD) patient b) metabolic alkalosis is seen with prolonged use of loop diuretics c) standard bicarbonate is low in metabolic acidosis d) about 70% of carbon dioxide is transported in plasma as bicarbonate e) the ratio of HCO3/CO2 may be normal in a stable COAD patient 7. The following statements are true regarding cardiovascular physiology: a) atrial systole contributes to 25% of ventricular filling b) pericardial effusion decreases end-diastolic volume c) coronary blood flow is about 5% of the cardiac output at rest d) the pressure-volume loop consists of isovolumetric contraction, ejection, isovolumetric relaxation and rapid ventricular filling e) LVdP/dTmax is dependent on changes in preload 8. In the human heart: a) end-systolic left ventricular volume is dependent on the afterload b) left ventricular static compliance is reduced in myocardial ischaemia c) ejection fraction is the ratio of stroke volume to end-diastolic volume d) the second heart sound coincides with end of the T wave in the ECG e) pulmonary artery occlusion pressure reflects the left ventricular end-diastolic pressure 9. When measuring arterial blood pressure with a sphygmomanometer: a) cuff width should be 20% greater than the arm diameter b) a mercury column manometer may be used at an angle of up to 25 degrees from vertical c) a common source of error is blockage of the air vent d) there are five Korotkoff phases e) use of a finger to detect return of pulsation is highly inaccurate 10. In the human thyroid gland:

a) iodide ions from the plasma enter the follicle cells by passive diffusion b) T4 and T3 bind to the receptors in nuclei c) thyroxine, once synthesised, is then coupled to thyroglobulin until released d) a greater proportion of tri-iodothyronine is formed when iodine is deficient e) thyroid hormones increase the number and affinity of beta-receptors in the myocardium 11. Regarding aldosterone: a) it increases the amount of Na+-K+ ATPase in the target cells b) it reduces the sodium content of the sweat c) it increases the acidity of the urine d) it increases the potassium content of the urine e) basal secretion is normal even after hypophysectomy 12. Regarding insulin: a) its release is increased by the sulphonylurea type of hypoglycaemic drugs b) it has a half-life of 5 minutes in the circulation c) it increases the number of glucose transporters in the plasma membrane d) secretion is reduced by surgical stress response e) it is normally secreted at a rate of about 40-50 U/day 13. The following statements about end-tidal CO2 are true: a) normal variation in barometric pressure at sea level is unlikely to influence end-tidal CO2 b) rebreathing can raise end-tidal CO2 if the minute ventilation remains unchanged c) a decrease in cardiac output decreases the end-tidal CO2 d) discontinuation of N2O at the end of anaesthesia may transiently reduce the end-tidal CO2 e) shunt has less of an impact on end-tidal CO2 in contrast to O2 14. A high level of calcium in the blood: a) is associated with an increased excitability of muscle and nerve cells b) may result from chronic renal failure c) may result from excessive vitamin D ingestion d) is seen after accidental hyperparathyroidectomy e) is seen following injection of gland extracts from the anterior pituitary 15. Cardiac muscle contraction: a) develops greater tension when initial fibre length is reduced b) occurs with a greater velocity of shortening when the load on the muscle is small c) develops variable force depending on the frequency of contractions d) reaches its peak at the end of the repolarisation phase of the action potential e) occurs in a graded manner due to fibre recruitment 16. PaCO2-EtCO2 gradient: a) is up to 0.7 kPa in patients without significant disease b) increases in venous air embolism c) is greater in high frequency ventilation d) is greater in high V/Q areas of the lungs e) is greater in patients with rapid respiratory rates 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 18. Which of the following are true: 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 19. The capnograph trace: a) plots CO2 on the X-axis versus time on the Y-axis b) elevated phase I is due to rebreathing of CO2 c) a flattened upstroke of phase II represents slow exhalation secondary to obstruction d) phase III shows a flat curve with a slight upstroke e) undulations in phase III may be due to cardiac oscillations 20. In the adult human: a) albumin is synthesised only in the liver b) elevated serum lactate dehydrogenase is a good indicator of liver damage c) plasma urea concentration may be low in hepatic failure d) plasma fibrinogen is synthesised in the liver e) the pressure in portal vein is normally about 2 kPa 21. Regarding suxamethonium myalgia: a) it is more common in women b) it commonly occurs in day case patients c) a rise in plasma creatinine phosphokinase and myoglobin is related to the severity of muscle pain d) the severity of muscle pain is related to strength of muscle fasciculations e) intravenous lidocaine before suxamethonium may completely abolish the muscle pain 22. Regarding the renin-angiotensin-aldosterone mechanism: a) renin is secreted by the juxtaglomerular apparatus b) the physiological role of aldosterone is to maintain plasma volume and plasma sodium levels c) angiotensin II maintains the tone of the efferent arterioles of the glomeruli d) angiotensin II is the primary factor determining plasma aldosterone levels e) beta- blockers inhibit renin release 23. According to European Guidelines for Basic Life Support: a) when the pulse is absent, the first thing to do is to go and telephone for help b) the recovery position should be adopted when patient is unconscious and breathing through a clear airway c) ventricular fibrillation is the commonest primary cause of cardiac arrest d) early defibrillation is the most important determinant of success in ventricular fibrillation e) the peripheral venous route is preferred because CPR can continue and cannulation is rapid 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 25. Concerning the renal buffering mechanism: a) H+ excreted into the tubular fluid reacts with HCO3- in the tubular fluid b) H+ excreted into tubular fluid combines with HPO42- when HCO3- is consumed c) H+ excreted into the tubular fluid reacts with NH3 when HPO42- is consumed d) the phosphate and ammonia buffers are more utilised than HCO3 in metabolic acidosis e) an increased amount of HCO3- is added to blood in respiratory acidosis 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 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 28. Regarding mivacurium: a) it releases more histamine than atracurium in equipotent doses b) it is broken down by plasma cholinesterase as rapidly as suxamethonium c) it is a bisquaternary benzylisoquinolinium compound d) 10% of a bolus dose is excreted in the urine over 24 hours e) at an equipotent dose it has a similar onset of action to pancuronium 29. Pulmonary vascular resistance: a) is normally 150-250 dyne.sec/cm5 b) when raised decreases the left ventricular pre-load c) is increased at an arterial PO2 of 6 kPa d) is increased by application of positive end-expiratory pressure e) is decreased by nitric oxide inhalation 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). 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 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 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 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 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 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 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 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 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 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 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 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 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 16. Gastric acid secretion is increased by: a) anticholinergic drugs b) histamine c) vagal stimulation d) gastrin e) sucralfate 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 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 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 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 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 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 23. The following affect protein binding: a) pKa b) pH c) molecular weight d) binding site availability e) lipid solubility 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 25. The following drugs have greater than 50% bioavailability after oral administration: a) warfarin b) propranolol c) atenolol d) lidocaine e) morphine 26. Lower oesophageal sphincter pressure is decreased by: a) opiates b) metoclopramide c) atropine

d) gastrin e) dopamine 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 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.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) 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 2. Concerning gastric secretion in a normal adult: a) the lowest pH obtainable in the stomach is about 4.5 b) histamine receptors in the stomach can be pharmacologically stimulated without affecting those in the lungs c) pentagastrin injection can cause a maximal secretion of acid in the stomach d) excessive secretion is prevented by an effect originating in the antral receptors e) gastrin comes mainly from cells in the fundus of the stomach 3. The resistance of the airways: a) is not constant in a given subject b) depends on the pressure drop across the airways c) is expressed as cm H2O/L/s d) is greater in turbulent flow than in laminar flow e) is directly proportional to the density of the gases 4. In a normal man breathing quietly at rest: a) carbon dioxide in alveolar air is about twice that in room air b) carbon dioxide in mixed venous blood is greater than in alveolar air c) water vapour in alveolar air is less than half that of alveolar carbon dioxide d) oxygen in expired air is greater than that in alveolar air e) the amount of nitrogen expired is equal to that inspired 5. A shift of the oxygen dissociation curve to the right: a) occurs in the pulmonary capillaries b) is favoured by a rise in temperature c) favours the passage of oxygen from blood to tissues d) occurs when fetal blood is replaced by adult blood e) occurs in stored blood 6. Concerning glomerular filtration: a) glomerular filtration is a type of ultrafiltration b) glomerular filtrate has the same composition as lymph c) blood in the efferent arterioles is more viscous than that in afferent arterioles d) glomerular filtration rate (GFR) is directly proportional to systemic arterial pressure e) tubular function is more important than GFR in determining the rate of urine production 7. Concerning local anaesthetics: a) they are absorbed more rapidly after intercostal block than after caudal administration b) in the foetus they are able to cross the placenta as readily as from the mother c) they are weak acids

d) those which are esters are rapidly metabolised by liver enzymes e) pKa is the pH at which more than half of a local anaesthetic exists in non-ionised form 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 9. Regarding peri-arrest administration of drugs: a) during ventricular fibrillation, IV access should be established before DC shock is administered b) the peripheral venous route is prefered because CPR can continue and cannulation is rapid c) central venous administration delivers drugs more rapidly than peripheral with a 20 ml push d) in adults, doses of drug for endotracheal administration should be 5 times the IV dose e) in children, intraosseous drugs should be given when the IV route cannot be established within 90 seconds 10. With reference to adjustments in exercise: a) an increase in muscle blood flow begins after the first half minute of exercise b) cerebral blood flow rises if the exercise causes systolic arterial blood pressure to rise c) body temperature may rise measurably d) lymph flow from the exercising muscle increases e) visceral blood flow decreases 11. During intra-uterine life: a) all the foetal blood returning from the placenta flows directly into the inferior vena cava b) foetal blood carries more oxygen than maternal blood at a low PO2 c) umbilical venous blood has a PO2 of 4-5 kPa d) blood on the right side of the foetal heart is slightly better oxygenated than that on the left side e) pulmonary vascular resistance is higher than after birth 12. The rotameters: a) are variable orifice flowmeters b) produce a variable pressure drop across the bobbin c) produce laminar flow at low flow rates d) produce laminar flow at high flow rates e) are accurate to within +/- 0.5% 13. Cardiac output obtained by the thermodilution technique can be accurate: a) in the presence of right-sided valvular diseases b) in the presence of left to right intracardiac shunt c) in dysrhythmias d) in the presence of rapid volume infusions e) if the tip of pulmonary artery catheter is completely wedged 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 15. Regarding carbon dioxide: a) a rise in PaCO2 may not increase cerebral blood flow b) PaCO2 greater than 13 kPa could depress the respiratory centre c) hypercarbia will increase pulmonary vascular resistance d) chronic hypercarbia results in renal retention of bicarbonate e) bicarbonate diffuses more quickly than CO2 across the blood-brain barrier 16. Myocardial contractility: a) is the degree of inotropic state of heart independent of preload, afterload or heart rate b) determines the rate of development of ventricular pressure (dp/dt) c) can be estimated by ventricular pressure-volume loops d) is reduced by hypocalcaemia e) accounts for approximately 90% of total myocardial oxygen consumption 17. The features of non-depolarising blockade include: a) fasciculation b) sustained response to tetanic stimulation c) presence of post-tetanic potentiation d) small rapidly moving muscles are blocked first e) more than 90% of the receptors must be blocked by the relaxant for optimal relaxation 18. Non-depolarising relaxants: a) can cross the blood-brain barrier b) may affect the smooth muscles 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 19. Concerning the chemoreceptors involved in the control of breathing: a) central chemoreceptors are located on the ventral surface of the medulla b) raised cerebrospinal fluid hydrogen ion concentration can stimulate central chemoreceptors c) increased ventilation due to raised arterial PaCO2 is mediated through both central and peripheral chemoreceptors d) denervation of carotid and aortic bodies can abolish the ventilatory response to hypoxia e) peripheral chemoreceptors mediate the ventilatory response to acidaemia 20. Which of the following are competitive antagonists: a) morphine and naltrexone b) histamine and perphenazine c) phenobarbitone and propofol d) acetyl choline and cisatracurium e) aspartate and ketamine 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 22. The following drugs cross the placenta: a) midazolam b) remifentnil c) propofol d) sevoflurane e) ropivacaine 23. A loading or priming dose: a) is smaller than the maintenance dose b) is equal to the amount of drug which is eliminated in a dose interval c) is unnecessary for benzylpenicillin (t 1/2 30 min) d) is necessary if a rapid onset of digoxin (t 1/2 36-48 hours) is required e) is given with the objective of quickly achieving the desired plasma concentration 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 25. Regarding interactions between drugs: a) with steep dose-response curves they are unlikely to be harmful b) with small therapeutic ratios they are unlikely to be harmful c) they are described as summation if the effects of two drugs with the same action are additive d) they are described as potentiation if the action of one drug increases the effect of another e) the effect of two drugs with similar action is greater in synergism than would have been expected from summation 26. Alteration of urine pH: a) with probenecid reduces elimination of penicillin and can be therapeutically useful b) can significantly affect the elimination of drugs which do not possess ionisable chemical groups c) is valuable in overdose with barbiturates d) with alkali is useful in detecting amphetamine addicts since it increases urinary excretion of the drug e) is of major importance in the management of pethidine overdose 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 28. Regarding diffusion:

a) the rate of diffusion of a substance across a membrane is proportional to its concentration gradient b) the diffusion across the alveolo-capillary membrane is measured using carbon monoxide c) the rate of the diffusion of a gas is proportional to its tension gradient d) pneumonectomy approximately halves the diffusing capacity e) the rate of diffusion of a gas is inversely proportional to the square root of its molecular weight 29. The following are idiosyncratic reactions: a) haemolysis after exposure to NSAIDs in patients with glucose-6-phosphate deficiency b) prolonged apnoea after suxamethonium due to abnormal pseudocholinesterase c) malignant hyperpyrexia after halothane d) acute porphyria following induction with thiopentone e) sulphonamide toxicity in slow acetylators 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

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 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 3. The blood-brain barrier: a) anatomically, is at the arachnoid villi b) is less permeable in the neonate c) results in the total exclusion of many certain from the brain d) results in very low catecholamine levels in the brain and spinal cord e) is functionally similar to a cell membrane 4. Sodium reabsorption in the nephron is: a) greater in the distal than in the proximal convoluted tubule b) only achieved in exchange for potassium excretion c) the only major energy consuming activity of the kidney d) the main object of the countercurrent multiplier system e) dependent on the glomerular filtration rate as well as aldosterone 5. The carotid body chemoreceptors: a) are stimulated by a fall in arterial oxygen tension b) are inhibited by a fall in arterial pH c) produce reflex peripheral vasoconstriction d) are responsible for increased ventilation in a patient with carbon monoxide poisoning e) have a very high tissue blood flow 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 8. Concerning electrical safety:

a) when touching faulty apparatus with wet hands, skin impedance is increased and current flow greater than normal b) electrical shock is not a risk with potential below 24 V AC or 50 V DC c) the modern diathermy earthing plate is not connected directly with earth d) microshock may lead to ventricular fibrillation via an intracardiac catheter with currents in excess of 150 microamps e) leakage currents are induced voltages in other circuits resulting from an alternating mains current 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 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 12. Tachyphylaxis occurs during treatment with: a) ephedrine b) trimetaphan c) suxamethonium d) noradrenaline e) sodium nitroprusside 13. A plot of pressure against volume: a) allows compliance to be measured b) may show hysteresis c) allows a direct measurement of airway resistance d) is usually plotted on a semi-logarithmic paper e) allows an estimate to be made of respiratory work 14. Concerning protamine: a) it is a basic protein b) 1 mg antagonises 100 mg heparin c) it is a myocardial stimulant d) it is contraindicated in hepatic failure e) it is 60% protein bound

15. Vasoconstrictor agents with little or no positive inotropic effect include: a) adrenaline b) methoxamine c) isoprenaline d) dobutamine e) metaraminol 16. Opioid-induced bradycardia: a) is not seen with pethidine b) is due to stimulation of central vagal nuclei c) is not seen in patients undergone bilateral vagotomy d) is due to a direct effect of some of the opioids on the SA node e) is more commonly seen when used with vecuronium in the intraoperative period 17. Causes of the anticoagulant effect of a massive blood transfusion includes: a) deficient factor V and VIII b) inactive platelets c) microaggregates d) cold e) vitamin K availability 18. the oxyhaemogloin dissociation curve is: a) a curve relating quantity of oxygen combining with haemoglobin to the partial pressure of oxygen in the gas with which the blood is equilibrated b) the dissociation constant of oxygen c) a reflection of the efficiency of oxygen transport d) the same shape and position for haemoglobin A and myoglobin e) only of sigmoid shape in vivo. 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 20. Concerning opioid-induced muscle rigidity: a) it is commonly seen with very high doses of opioids b) it is more commonly seen with concomitant use of nitrous oxide c) it is often seen in young patients d) it can be reversed by naloxone e) it is seen only in chest wall muscles 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

22. Concerning the intracellular fluid: a) it is approximately twice the volume of the extracellular fluid b) the volume can be measured directly c) it is freely interchangeable with other body fluid compartments d) it contains approximately 150 mEq/L potassium e) it is a fairly constant fraction of all tissues 23. Concerning hypersensitivity: a) type I immediate hypersensitivity involves IgE b) antigen excess in type III produces the Arthus reaction c) delayed hypersensitivity is cell mediated d) type II hypersensitivity binds complement e) cell mediated hypersensitivity involves complement 24. The following are side-effects of suxamethonium: a) anaphylaxis b) masseter muscle rigidity c) raised intraocular pressure d) raised intragastric pressure e) myoglobinuria 25. These are true in the SI system of measurement: a) the basic unit of mass is the gram b) pico is the prefix denoting 10-12 c) the Hertz is the derived unit of frequency d) it is still allowable to use temperature on the Celsius scale e) the unit of time in the metric and SI unit system are the same 26. With increasing altitude: a) the concentration of oxygen in the atmosphere falls b) the atmospheric pressure decreases exponentially c) water will boil at a temperature of less than 100 degrees C d) PaCO2 will decrease at first e) acetazolamide can reduce the incidence of pulmonary oedema 27. The physiological dead space: a) increases with induction of anaesthesia b) decreases during controlled ventilation c) increases with a short inspiration time d) increases with the use of positive end-expiratory pressure 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 29. In man, atropine causes:

a) secretion of antidiuretic hormone b) an initial bradycardia c) relaxation of uterine muscle d) relaxation of ureteric muscle e) mydriasis 30. Concerning metabolism: a) skeletal muscles at rest utilise free fatty acids (FFA) as the energy source b) the mechanical efficiency of skeletal muscles is greater during isotonic contraction than isometric contraction c) the amount of ATP generated from FFA varies with their size d) th deamination of amino acids results in urea synthesis by the liver e) phosphoryl creatine is an energy store for skeletal muscles for ATP synthesis

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 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 2. Regarding intracranial pressure (ICP) monitoring:

a) ventricular catheter is the gold standard for monitoring of ICP b) in infants, ICP can be monitored by placing a transducer over anterior fontanelle c) the normal ICP waveform is like a miniature CVP waveform d) cerebral blood flow is zero when mean arterial blood pressure is same as ICP e) ventricular catheter does not allow compliance testing 3. Regarding temperature monitoring: a) infrared thermometers use the frequency of electromagnetic radiation of the emitting object b) thermistors measure temperature-sensitive electrical resisitance c) liquid crystal is used for measurement of skin surface temperature d) skin surface temperature corresponds to core temperature following induction of anaesthesia e) core-peripheral temperature gradient is a measure of tissue perfusion 4. PaCO2 - PEtCO2 difference is smaller in: a) ventilation with large tidal volumes b) third trimester of pregnancy c) exercise d) chronic obstructive airways disease patients ventilated with low respiratory rate compared with ventilation with a high rate e) infants and neonates without known lung disease 5. Regarding control of breathing: a) cerebrospinal fluid has a very poor buffering capacity for a given change in pH compared with blood b) carotid and aortic bodies start firing non-linearly when PaO2 falls below 13 kPa c) stretch receptors in airways are an integral part of Hering-Breuers reflex d) epithelial receptors in the larynx can precipitate laryngospasm e) J receptors are activated by pulmonary capillary engorgement 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 9. Concerning allergic reactions:

a) released histamine has a half-life of 2.5 minutes b) plasma tryptase level is increased during the reaction c) tryptase is a marker of drug-induced allergic reaction d) methylhistamine level is decreased in urine during an allergic reaction e) a skin-prick test to identify the suspected agent brings the sensitised lymphocytes to the skin surface 10. The following statements are correct: a) SI unit of pressure is mmHg b) atmospheric pressure at sea level is about 100 kPa c) a central venous pressure of 7.5 mmHg is equivalent to 10 cm H2O 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 13. Nitrous oxide: a) is stored as a liquid b) is a gas above a temperature of 36 degrees C c) cylinders should have a filling ratio of 0.65-0.75 d) content in a cylinder is always reflected from its pressure gauge e) cylinder when full has a pressure of about 50 atmospheres 14. Closing volume: a) is larger than functional reserve capacity b) may be determined by single breath N2 curve following a deep breath of oxygen c) is high in young children and decreases progressively with advancing age d) if high, may be responsible for arterial hypoxaemia e) is unaffected by bronchomotor tone 15. Regarding haemodynamic changes seen following the Valsalva manoeuvre: a) the rise in mean arterial blood pressure (MAP) in phase I is due to the rise in intrathoracic pressure b) in phase II, decreased venous return is responsible for the drop in MAP c) MAP increases in phase III due to the rise in heart rate and vasoconstriction d) MAP returns to normal in phase IV e) these changes are present even in autonomic dysfunction 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 17. Hypophysectomy will result in: a) depressed thyroid function b) osteoporosis and generalised wasting c) the secretion of adrenal glucocorticoid and sex hormones to a low level d) diabetes insipidus e) normal aldosterone secretion 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 19. Sympathetic stimulation affects carbohydrate metabolism because: a) adrenaline increases liver glycogenolysis b) sympathetic nerves to the pancreas regulate insulin release c) peripheral tissues require adrenaline to take up glucose d) insulin cannot act on the liver in the absence of adrenaline e) none of the above 20. Regarding work of breathing: a) inspiring a low tidal volume at a higher rate reduces the elastic component of work of breathing b) work of breathing is increased at high inspiratory flow c) the viscous component of work of breathing is increased in the presence of stiff lungs 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 21. Gastric emptying: a) can be measured by using radioactive substances b) may be measured by repeated X-rays after a barium meal c) can be measured by naso-gastric aspiration of the residues d) is commonly measured by paracetamol uptake e) time is delayed by intravenous erythromycin 22. One or more prostaglandins: a) are peptides found in prostatic secretions b) dilate the bronchial smooth muscles c) dilate the afferent arterioles in the glomeruli d) raise the intracranial pressure e) affect platelet function 23. Regarding endorphins:

a) they are short chain peptides b) there is a homogenous population of receptors for them c) they are present in the brain but not the spinal cord d) concentrations are decreased by exercise e) may be antagonised by naloxone 24. Both bradykinin and histamine: a) are direct vasodilators b) increase capillary permeability c) stimulate the secretion of gastric acid d) cause pain when applied to a blister base e) cause vasodilatation in the axon reflex 25. Prostaglandins are: a) not naturally occurring substances b) used to induce abortion and labour c) metabolised in the pulmonary circulation d) modulators of histamine and bradykinin action in pain e) involved in protecting the gastric mucosa from hydrochloric acid 26. Normal values in the newborn include: a) blood volume of 110 ml/kg b) arterial blood pressure of 80/60 mmHg c) resting heart rate of 160-180 bpm d) PaO2 of 6 kPa e) HbF of 40% 27. Regarding thyroid hormones: a) they sensitise the myocardium to catecholamines b) they lower the plasma cholesterol c) they increase the formation of messenger RNAs d) reverse T3 may be active in some cells e) iodine is absorbed from the gastrointestinal tract in ionised form 28. Regarding antiarrhythmic drugs: a) amiodarone enhances repolarisation b) flecainide has no effect on repolarisation c) magnesium is not useful in AF and torsades de pointes d) adenosine can differentiate supraventricular from ventricular arrhythmias e) beta-blockers increase K+ permeability and decrease the rate of firing in the SA node 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

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

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 (PGE1) 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 halflife 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: a) hydrogen, oxygen and CO2 electrodes measure at 37 degrees C b) PaO2 read by gas analyser would be higher than patients 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 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 enddiastolic 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 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 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: 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 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 patients 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 (N2O: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 Bains 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: 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

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

Art1.

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 2. The following statements are correct: a) thromboxane A2 is principally produced by the endothelial cells b) prostacyclin is produced in large amounts by the platelets c) aspirin irreversibly inhibits cyclooxygenase both in platelets and endothelial cells d) nitric oxide activates soluble guanylyl cyclase in smooth muscle e) endothelins are polypeptides with half-lives of less than a minute 3. Regarding renal physiology: a) when the rate of flow through tubule increases, the glomerular filtration rate (GFR) in the same nephron decreases b) when GFR increases, the solute reabsorption in the tubule also increases c) for each H+ secreted in the renal tubule, one Na+ and one HCO3- enter the interstitial fluid d) more H+ is secreted in the proximal tubule than in the distal tubule e) urine becomes more acidic in presence of low plasma HCO34. 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 5. Pulmonary vascular resistance is: a) increased by low alveolar PO2 b) decreased by prostacyclin c) decreased by isoprenaline d) increased by adrenaline e) increased by metabolic and respiratory acidosis

6. Regarding the drugs acting on the autonomic nervous system: a) methyldopa forms false transmitters b) bretylium prevents norepinephrine release c) yohimbine blocks alpha-2 adrenergic receptors d) mivazerol is an alpha-2 agonist e) clonidine has analgesic action 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 8. Regarding gastric acid secretion: a) when acid production is increased after a meal, urine may be less acidic b) parietal cells have H+,K+-ATPase proton pumps c) activity of the proton pump is determined by the level of cAMP in parietal cells d) parietal cells have H2, M1 and gastrin receptors e) prostaglandins inhibit the activity of proton pumps 9. Regarding the measurement of body temperature: a) electrical resistance of platinum increases with rises in temperature b) thermistor is a metal oxide whose resistance drops with rises in temperature c) copper and constanton are used for the Seeback effect in thermocouple d) infrared thermometer is increasingly used for measuring tympanic membrane temperature e) the triple point of water is at 273.160 Kelvin 10. In the pulmonary circulation: a) serotonin is almost completely removed by a single pass b) bradykinin is degraded by angiotensin-converting enzyme c) histamine is unaffected during its passage d) resistance is decreased by hypoxia e) oxygen saturation is higher in pulmonary veins than bronchial veins 11. At high altitude (e.g. 6000 m): a) barometric pressure is about half atmospheric b) FIO2 is 0.21 c) the saturated vapour pressure of water is 6.3 kPa at 37 degrees C d) the boiling point of water would be low e) hypoxia predominates the ventilatory drive 12. Regarding the opioids used in the perioperative period: a) papaveretum has a morphine content up to 70% b) codeine has a higher oral bioavaibility than morphine c) pethidine crosses the blood-brain barrier more rapidly than morphine d) sufentanil is 5-10 times as potent as fentanyl e) the metabolism of remifentanil is affected by concomitant administration of anticholinesterases 13. The output of a variable bypass vaporiser can be influenced by:

a) rate of fresh gas flow b) temperature inside the vaporiser c) back pressure during intermittent positive pressure ventilation d) composition of carrier gases e) filling halothane vaporiser with enflurane 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 15. Functional residual capacity: a) increases in obstructive airways disease b) decreases in term pregnancy c) is increased by application of positive end-expiratory pressure d) is lower in morbidly obese patients e) is not altered after induction of anaesthesia with sevoflurane 16. The following are analgesic substances: a) bradykinin b) histamine c) 5-hydroxytryptamine d) substance-P e) calcitonin gene-related peptide (CGRP) 17. Pulse pressure: a) depends on left ventricular stroke volume b) increases with increase in the velocity of blood flow c) depends on the compliance of the arterial tree d) is higher in peripheral arteries than that in the aorta e) is low in high cardiac output states 18. Pancuronium: a) is a synthetic steroid b) releases a large amount of histamine c) causes noradrenaline release at nerve endings d) can cause ganglion blockade e) has a duration of action of 45-60 minutes 19. Regarding anaesthetic gases: a) nitrous oxide can be liquified at 50 atmospheres at room temperature b) nitrogen can cause surgical anaesthesia at 12 atmospheres c) a half empty oxygen cylinder has a pressure of about 68 atmospheres d) oxygen is stored for hospital supply in liquid form at -150 degrees C e) Boyles Law does not apply to anaesthetic gases due to van der Waals attraction between the molecules 20. Regarding the neuromuscular junction:

a) the junctional cleft is about 50-60 nm across b) the postjunctional membrane is thrown into folds c) the acetylcholine receptor has five protein subunits d) two alpha subunits of the acetylcholine receptor have to be activated for the channel to open e) acetylcholine is synthesised from choline and acetic acid 21. Packed red blood cells: a) one bag contains 220 ml of red cells and 80 ml of plasma b) has a packed cell volume of 0.65-0.75 c) cause fewer febrile transfusion reactions d) contain a negligible amount of platelets and white cells e) can have saline, adenine, glucose and mannitol (SAGM) added as an additive solution 22. Regarding cerebral blood flow: a) the brain receives 15% of cardiac output b) cerebral blood flow rises by 4% for each mm rise in PaCO2 c) volatile anaesthetics increase cerebral blood flow d) volatile anaesthetics can impair the autoregulation of cerebral blood flow e) cerebral blood flow is relatively constant for cerebral perfusion pressures between 50-150 mmHg 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 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 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 26. Which of the following are partial agonists at opioid receptors: a) nalbuphine b) nalorphine c) naloxone d) buprenorphine e) meptazinol 27. Enflurane:

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 28. Regarding gas or liquid flow: a) in laminar flow, flow is determined by the pressure gradient divided by resistance b) in laminar flow system, resistance is constant and independent of flow c) resistance increases with flow in turbulent flow d) Poiseuilles law does not apply in turbulent flow e) flow through an orifice is always turbulent 29. Regarding fluid flow: a) flow is laminar in tubes that are very long compared with their diameter b) flow is turbulent when Reynolds number is < 2000 c) flow through an orifice is influenced by the fluid or gas density d) velocity is higher and pressure is lower at the point of constriction in a tube e) at low haematocrit, blood flow is better in blood vessels 30. Regarding physics applied to anaesthesia: a) the mass of a gas that dissolves in a liquid is proportional to its partial pressure b) a tube whose radius exceeds its length is called an orifice c) bipolar cautery does not need a dispersive ground plate electrode d) in unipolar cautery, if the dispersive pad is not in proper contact with the skin, burn can occur around the ECG electrode e) gases do not obey Boyles law at temperatures at which they approach their point of liquefaction BONUS QUESTION Regarding pain transmission: a) ad fibres are myelinated while C fibres are unmyelinated b) visceral pain is carried by unmyelinated sympathetic fibres c) sharp pain is transmitted by Ad fibres while dull aching pain is transmitted by C fibres d) lamina II of the dorsal horn has inhibitory interneurones which modulate pain transmission e) besides pain, Ad- and C fibres also carry touch and temperature sensation

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

1. The carotid bodies: a) have a low blood flow per gram of tissue b) contain baroreceptors c) respond to changes in pH d) respond to small changes in PaO2 e) are located on the external carotid arteries 2. The following are examples of active transport: a) sodium extrusion from cells b) water reabsorption from the proximal convoluted tubule c) potassium excretion in the distal convoluted tubule d) glucose absorption from the gut c) water reabsorption in the loop of Henle 3. Growth hormone and insulin have opposite effects on: a) carbohydrate uptake by muscle b) catabolism of fat c) synthesis of fat d) synthesis of protein e) somatic growth 4. Stimulation of the tenth cranial nerve causes: a) slowing of A-V conduction b) constriction of coronary vessels c) increased secretion of gastric acid d) miosis e) relaxation of the pylorus 5. An increase in sympathetic stimulation to the heart causes:

a) a fall in diastolic time b) a fall in dP/dt c) an increase in stroke volume d) dilation of the coronary vasculature e) an increase in myocardial oxygen consumption 6. If oxygen is added to inspired air to increase its partial pressure from 20 kPa (150 mmHg) to 60 kPa (450 mmHg): a) dissolved oxygen will increase approximately three-fold b) the oxygen content of the blood will increase approximately three-fold c) the PaN2 will remain the same d) the PaO2 will increase approximately three-fold e) hypercarbia will be prevented 7. Pulmonary vascular resistance is increased by: a) serotonin b) hypocarbia c) hypoxia d) a fall in pH e) adrenaline 8. On changing from the upright to the supine position: a) baroreceptor activity decreases b) leg vein pressure is reduced c) the blood volume in the pulmonary circulation falls d) stroke volume increases e) renin activity increases 9. The fall in urine output associated with major trauma may be caused by: a) haemorrhage b) a rise in antidiuretic hormone activity c) a fall in aldosterone activity d) an increase in the level of circulating catecholamines e) a rise in corticosteroid output 10. In the foetal circulation before birth: a) the PO2 is higher in the ductus venosus than in the ductus arteriosus b) blood can go from the right atrium to the aorta without passing through the left atrium and ventricle c) the PO2 in the aortic arch is higher than in the descending aorta d) blood flowing through the foramen ovale comes principally from the superior vena cava e) blood passes through the ductus arteriosus because of the high pulmonary vascular resistance 11. In the central venous pressure waveform: a) the a wave occurs after ventricular systole b) the v wave is caused by atrial contraction c) the a wave is absent in atrial fibrillation d) the a wave corresponds with closure of the aortic valve e) the v wave occurs during diastole 12. Renin activity is increased by:

a) an increase in circulating adrenaline b) hypotension c) increased sodium ingestion d) an increase in aldosterone output e) hypovolaemia 13. Acute antagonism of beta adrenergic receptors causes: a) hyperglycaemia b) peripheral vasodilatation c) suppression of uterine contractility d) pupillary dilatation e) a reduction in cardiac output 14. Unilateral transection of dorsal nerve roots C3-T2 produces: a) motor paralysis b) loss of sensation c) loss of reflexes d) loss of sympathetic and sudomotor tone e) hypotonia 15. The rate of gastric emptying is: a) delayed by fat in the duodenum b) delayed by secretin c) delayed by fat in the oesophagus d) enhanced by alcohol e) independent of volume and type of food ingested 16. An increase in aldosterone production occurs in response to: a) ingestion of sodium chloride b) an increase in blood volume c) an increased intake of potassium d) angiotensin II e) trauma 17. Cerebrospinal fluid: a) is the main source of brain nutrition b) is mainly produced by active secretion from the choroid plexus c) contains virtually no glucose d) pH changes rapidly in response to changes in plasma pH e) pressure increases with jugular venous obstruction 18. Carbonic anhydrase is found at high concentration in: a) plasma b) red blood cells c) renal tubular cells d) gastric parietal cells e) cardiac muscle cells 19. The Hb-oxygen dissociation curve shifts to the right in:

a) acute hypoxia b) stored blood c) metabolic acidosis d) respiratory alkalosis e) hypothermia 20. The functional residual capacity: a) is increased in the obese b) is approximately 10% higher in men than in women c) falls with general anaesthesia d) increases on changing from the supine to the standing position e) falls with increasing age ANSWERS 1. FFTFF 2. TFTTF 3. TTTFF 4. TFTFT 5. TFTTT 6. TFFTF 7. TFTTF 8. FTFTF 9. TTFTT 10. TTTFT 11. FFTFT 12. TTFFT 13 FFFFT 14. FTTFF 15. TTFFF 16. FFTTT 17. FTFFT 18. FTTTF 19. FFTFF 20. FTTTT 1. In calculating the shunt fraction, the following need to be measured or estimated: a) mixed venous oxygen content b) pulmonary end-capillary oxygen content c) arterial oxygen content d) alveolar partial pressure of oxygen e) haemoglobin concentration 2. Pulse pressure increases with an increase in: a) stroke volume b) left ventricular end-diastolic volume c) arterial partial pressure of oxygen d) systemic vascular resistance e) blood viscosity 3. Acute untreated haemorrhagic shock in a patient will lead to: a) an increase in physiological dead-space b) an increase in the arterio-venous PCO2 difference c) a fall in the pulmonary vascular volume d) an increase in antidiuretic hormone secretion e) an increase in plasma bicarbonate concentration

4. An increase in aldosterone secretion follows: a) a sodium chloride load b) a rise in blood volume c) an increase in oral potassium absorption d) trauma c) an increase in production of angiotensin II 5. Stimulation of alpha-adrenergic receptors will cause: a) vasoconstriction of the coronary arteries b) increased tone in the bladder neck muscle c) increased platelet aggregation d) lipolysis e) bronchodilation

ANSWERS 1.TTTTT 2.TTFFF 3.TFTTF 4.FFTTT 5.TTTFF 6. In the normal adult heart: a) mitral valve closure occurs before tricuspid valve closure b) pulmonary valve closure occurs before aortic valve closure c) there is isometric contraction of the left ventricle after the aortic valve opens d) atrial contraction is of more importance to ventricular filling if the heart rate increases e) the aortic valve cusps are immobile during ventricular filling 7. Resistance to laminar flow in a vessel is: a) proportional to wall thickness b) inversely proportional to the fourth power of the radius c) proportional to length d) independent of haematocrit e) proportional to the pressure drop 8. Autoregulatory mechanisms used in hypovolaemia include: a) an increase in precapillary sphincter tone b) an increase in capillary hydrostatic pressure c) a decrease in baroreceptor activity d) stimulation of the juxtaglomerular apparatus e) an increase in angiotensin II 9. Myocardial contractility is increased by: a) catecholamines b) an increase in heart rate c) an increase in fibre length d) an increase in parasympathetic nervous system activity e) calcium ions 10. The carotid sinuses:

a) have stretch receptors in their walls b) give afferent impulses via the glossopharyngeal nerve c) stimulate the respiratory centre d) contain chemoreceptors e) stimulate the vasomotor centre ANSWERS 6.TFFTT 7.FTTFF 8.TTTTT 9.TTTFT 10.TTFFT 11. The following cause a decrease in the arterial partial pressure of oxygen: a) anaemia b) carbon monoxide c) hyperventilation d) a rise in physiological dead-space e) old age 12. Iron absorption is dependent on: a) total body vitamin C b) HCl in the stomach c) an intact colonic mucosa d) total body iron e) erythropoietin levels in the blood 13. If a normal person hyperventilates for 2 hours to an arterial PCO2 of 4 kPa: a) the cerebral blood flow decreases b) the standard bicarbonate decreases c) the Hb-oxygen dissociation curve shifts to the left d) the ionised calcium concentration decreases e) the plasma bicarbonate increases 14. Hypoglycaemia may result from: a) excessive insulin secretion b) alpha-adrenergic stimulation c) beta-adrenergic stimulation d) glucagon secretion e) hypothermia 15. Ingested lipid: a) is important in prostaglandin synthesis b) increases in the faeces with a decrease in bile secretion c) is absorbed via the intestinal lymphatics d) is mainly in the form of triglycerides e) can be used as a source of ATP production ANSWERS

11.FFFFT 12.FTFTF 13.TFTTF 14.TFTFF 15.TTTTT 16. The following may be found in normal adult venous blood: a) 3% carboxyhaemoglobin b) 5% methaemoglobin c) 70% oxyhaemoglobin d) 2% free haemoglobin e) 2% fetal haemoglobin 17. In normal human lungs: a) a low PO2 produces pulmonary vasodilatation b) beta-2 agonists cause bronchoconstriction c) pulmonary vascular resistance is increased by serotonin d) pulmonary vascular resistance is decreased by histamine e) pulmonary vascular resistance is decreased by noradrenaline 18. The normal response to surgery includes: a) a decrease in urine volume b) a decrease in the urinary excretion of sodium c) a decrease in plasma cortisol level d) an increase in the urinary excretion of nitrogen e) an increase in the urinary excretion of potassium 19. Capillary permeability is increased by: a) bradykinin b) adrenaline c) calcium d) vasopressin c) histamine 20. Expected changes in a patient with a phaeochromocytoma include: a) a decreased haematocrit b) a decreased total blood volume c) a decreased serum sodium concentration d) an abnormal glucose tolerance test e) a reduced metabolic rate ANSWERS 16.TFTFF 17.FFTFF 18.TTFTT 19.TFFFT 20.FTFTF

A1.

The liver:

a) receives most of its oxygen supply from the portal vein b) has its highest oxygen tension at the centre of a lobule c) produces heparin d) has a normal portal venous pressure of greater than 20 mmHg e) receives approximately 25% of the cardiac output 2. Skeletal muscle blood flow: a) increases with noradrenaline b) receives 50% of the cardiac output at rest c) may cease during isometric contraction d) increases with rhythmic contraction e) increases with adrenaline 3. In thermoregulation: a) respiratory heat loss is insignificant under normal conditions b) brown fat is an important source of heat production in neonates c) shivering is due to impulses conducted via autonomic efferents d) peripheral vasoconstriction increases heat production e) sweating is mediated by sympathetic cholinergic neurones 4. Adrenaline: a) is synthesized by demethylation of noradrenaline b) increases coronary blood flow c) increases free fatty acids in the blood d) mobilizes glycogen stores from the liver e) is metabolized in the plasma by monoamine oxidase 5. Glucagon: a) is a positive inotrope b) is produced by the beta cells of the pancreas c) stimulates production of free fatty acids in the blood d) release is increased in starvation e) stimulates glycogen synthesis

ANSWERS 1.TFTFT 2.FFTTT 3.TTFFT (fundamentals of anaesthesia, 2nd edition page 446) 4.FTTTF 5.TFTTF
r6.

Surfactant:

a) is a mucopolypeptide b) causes a decrease in surface tension c) results in the same surface tension for different sized alveoli d) causes an increase in compliance e) production is reduced after a prolonged reduction in pulmonary blood flow 7. Sinus arrhythmia:

a) produces a lengthening of the P-R interval b) produces a lengthening of the R-R interval c) is maximal with breath holding d) is more marked during exercise e) is more marked in 70 year olds than in 20 year olds 8. A pressure-volume curve can be used for measuring: a) the work of breathing b) functional residual capacity c) anatomical dead space d) compliance e) respiratory quotient 9. The absolute refractory period for cardiac muscle is: a) as long as the entire action potential b) the period when no further action potential can be stimulated c) twice the length of the S-T interval d) as long as the mechanical contraction e) shorter for pacemaker tissue than for normal cardiac muscle 10. In a young normal adult: a) the glomerular filtration rate is approximately 125 ml/min b) the 24 hour urine creatinine content is approximately 800 mg c) urine specific gravity is always less than 1000 d) renal blood flow is approximately 20% of cardiac output e) over 50% of water reabsorption from the glomerular filtrate occurs in the collecting ducts

ANSWERS 6.FTFTT 7.FTFFF 8.TFFTF 9.FTFFT 10.TFFTF 11. Total plasma calcium: a) increases with phosphate b) increases with a rise in albumin, c) changes its degree of ionisation with pH changes d) is decreased in osteoporosis e) is affected by vitamin D 12. There is increased intestinal motility with: a) increased intraluminal pressure b) anticholinesterase drugs c) sympathetic block to T4 d) stimulation of the splanchnic nerves e) increased circulating adrenaline 13. A healthy adult breathing an FIO2 of 0.1 will:

a) have a decreased cardiac output b) have a normal PaO2 c) have a changed alveolar PCO2 d) have an unchanged respiratory rate e) initially have a fall in pH 14. Acetylcholine is a neurotransmitter at: a) sweat glands b) the adrenal medulla c) the parotid gland d) parasympathetic ganglia e) the neuromuscular junction 15. Insulin: a) has the same effect on blood sugar as growth hormone b) inhibits entry of potassium into cells c) facilitates protein anabolism d) increases deposition of fats e) secretion is affected by catecholamines

ANSWERS 11.FTTFT 12.TTTFF 13.FFTFF 14.TTTTT 15.FFTTT

ti16.

In a normal resting subject, a bradycardia would be expected following:

a) an increase in carotid sinus pressure b) an increase in right atrial pressure c) application of pressure to the eyeball d) the release of a Valsalva manoevre e) inspiration 17. The velocity of conduction of a nerve action potential: a) is inversely related to the cross-sectional area of the axon b) is faster in a myelinated fibre than in an unmyelinated one c) is decreased by cooling the nerve d) can exceed 100 m/s in humans e) is highest in pre-ganglionic autonomic fibres 18. The placenta: a) transports glucose from maternal to foetal blood by facilitated diffusion b) can synthesize glycogen c) actively transports oxygen from maternal to foetal blood d) allows protein molecules to pass from maternal to foetal blood by pinocytosis e) secretes oestradiol 19. Oxytocin:

a) stimulates production of milk b) stimulates ejection of milk c) release is stimulated by dilatation of the cervix d) is synthesized in the anterior pituitary e) produces more powerful uterine contraction in the presence of progesterone 20. Aldosterone: a) production increases with a fall in plasma osmolality b) production decreases with a fall in blood volume c) production decreases with a rise in plasma renin level d) increases urinary potassium excretion e) may be produced by tumours of the adrenal cortex

ANSWERS 16.TFTTF 17.FTTTF 18.TFFFT 19.FTTFF 20.FFFTT 1. Adrenaline a) is secreted by the adrenal cortex b) decreases systemic vascular resistance at low doses c) decreases pulmonary vascular resistance d) constricts the pupil e) acts only at beta-1 receptors 2. A typical mammalian motor neurone: a) innervates only one skeletal muscle cell b) is myelinated c) has its cell body in the ventral (anterior) horn of the spinal cord d) might receive an input directly from Group Ia afferent fibres in the spinal cord e) would be stimulated by application of glycine to its cell body 3. The vagus nerve: a) has little direct effect on the strength of ventricular contraction b) contains afferent and efferent fibres c) contains parasympathetic post-ganglionic fibres d) contains fibres which regulate gastric acid secretion e) has a role in bladder emptying 4. Vital capacity: a) is the volume of air expired from full inspiration to full expiration b) increases gradually with age in adults c) is greater in men than in women of similar age and height d) is equal to the sum of the inspiratory and expiratory reserve volumes e) may be measured by spirometry 5. Hyperventilation in a normal subject for 24 hours will produce a:

a) fall in PaCO2 b) rise in PaCO2 c) rise in ionised calcium d) fall in cerebrospinal fluid bicarbonate e) rise in plasma bicarbonate

ANSWERS 1.FTTFF 2.FTTTF 3.TTFTF 4.TFTFT 5.TFFFF

cl6.

The blood-brain barrier:

a) results in certain molecules in the blood taking longer to equilibrate with tissue fluid in the brain than with tissue fluid elsewhere b) permits CO2 to pass freely c) is more permeable to water-soluble substances than fat-soluble substances d) is more permeable in neonates than in adults e) is readily crossed by dopamine 7. A reflex action: a) may be carried out by skeletal, smooth or cardiac muscle or by glands b) is not influenced by higher centres in the brain c) results from activity in at least two central nervous synapses in series d) may involve simultaneous contraction of some skeletal muscles and relaxation of others e) can be monosynaptic or polysynaptic 8. Platelets: a) are produced in the bone marrow b) increase in number after tissue damage c) have a small nucleus d) alter their shape when they make contact with collagen e) are activated by ADP and thrombin 9. The pressure: a) drop across the major veins is similar to that across the major arteries b) drop across the hepatic portal bed is similar to that across the splenic vascular bed c) in the hepatic portal vein is higher than that in the inferior vena cava d) drop across the vascular bed in the foot is greater when standing than when lying down e) drop across the pulmonary circulation is the same as across the systemic circulation 10. Athletes differ from normal individuals in having: a) a higher resting cardiac output b) a higher resting heart rate c) a decreased muscle mass d) a higher maximum oxygen consumption e) increased muscular efficiency at high blood lactate levels

ANSWERS 6.TTFTF 7.TFFTT 8.TTFTT 9.FFTFF 10.FFFTT

eD.

Stimulation of the parasympathetic nervous system:

a) increases the heart rate b) decreases the rate of gastric emptying c) dilates the pupil d) causes vasoconstriction e) causes contraction of the detrusor muscle in the bladder 2. Pregnancy at term is associated with a: a) 20% decrease in red cell mass b) rise in cardiac output c) fall in PaCO2 d) fall in haematocrit e) low protein-bound iodine 3. The P5O is: a) the oxygen saturation when the arterial partial pressure of oxygen is 50 mmHg b) the arterial oxygen tension when haemoglobin is 50% saturated c) an indicator of the position of the oxygen dissociation curve d) raised in foetal blood e) lowered in chronic anaemia 4. In a healthy adult human heart the: a) left ventricular end-systolic volume is approximately 30 ml b) first heart sound coincides with the onset of ventricular systole c) stroke volume is approximately 70 ml d) left ventricular end-diastolic pressure is about 50 mmHg e) second heart sound is caused by closure of the aortic and pulmonary valves 5. Renin: a) is released from granules in the juxtaglomerular cells of the afferent arteriole b) levels in the blood increase in response to a fall in plasma sodium concentration c) levels in the blood decrease when renal perfusion is decreased d) release is enhanced by angiotensin II e) release is inhibited by antidiuretic hormone

ANSWERS 1.FFFFT 2.FTTTF 3.FTTFF

4.TTTFT 5.TTFFT
a1.

The following are secreted from the adrenal cortex:

a) testosterone b) aldosterone c) angiotensin d) noradrenaline e) deoxycorticosterone 2. Aldosterone: a) secretion increases in response to a fall in blood volume b) is a polypeptide c) produces an increase in renal arterial pressure d) produces a fall in urine volume e) increases the reabsorption of sodium 3. Cerebrospinal fluid: a) is actively secreted by the choroid plexus b) is the major nutrition source of the brain c) has the same pH as arterial blood d) contains virtually no glucose e) has a higher chloride level than plasma 4. Red blood cell production: a) increases during acclimatisation to altitude b) can occur in the spleen c) is dependent on normal gastric secretory activity d) is stimulated by hypercarbia e) is dependent on ervthropoietin 5. Bile: a) salts contribute to the solubility of cholesterol in the bile b) contains bilirubin mainly in the unconjugated form c) contributes more than pancreatic secretion to the neutralisation of acid from the stomach d) becomes more alkaline following concentration in the gall bladder e) is produced at a rate of approximately 2000 ml/day ANSWERS 1.FTFFT 2.TFTFT 3.TFFFT 4.TTTFT 5.TFFFF
te1.

Carbonic anhydrase plays a role in the:

a) production of HCl by the parietal cells of the stomach b) secretion of hydrogen ions from the fluid in the renal tubules

c) passage of CO2 from the pulmonary capillaries to the alveoli d) secretion of bicarbonate by the pancreas e) production of red blood cells 2. In a patient with severe hypovolaemia, the: a) physiological dead-space increases b) arterio-venous oxygen difference decreases c) alveolar-arterial oxygen difference increases d) minute volume increases e) arterial PCO2 increases 3. The group A antigen: a) is present on the red cells of a group A patient b) may occur in the saliva of a group A patient c) is transmitted as an autosomal recessive characteristic d) is more common than the group B antigen e) is the most common cause of haemolytic disease of the newborn 4. The action of noradrenaline maybe terminated by: a) monoamine oxidase in the nerve terminal b) catechol-O-methyltransferase in the liver c) catechol-O-methyltransferase in the nerve terminal d) dopa decarboxylase in the nerve terminal e) neuronal reuptake 5. An increase in the 2.3-DPG concentration in red blood cells occurs in: a) anaemia b) acclimatisation to altitude c) stored blood d) trained athletes e) cyanotic heart disease ANSWERS 1.TTFFF 2.TFTTF 3.TTFTF 4.TTFFT 5.TTFFT
:21.

In normal cerebrospinal fluid, the:

a) chloride concentration is higher than in blood b) glucose concentration is the same as in plasma c) PCO2 is higher than in mixed venous blood d) pH is the same as in arterial blood e) bicarbonate concentration is the same as in arterial blood 2. When breathing out against a closed glottis, the:

a) intratracheal pressure rises b) heart rate slows transiently c) right ventricular output increases d) left ventricular output has a sustained increase e) systolic arterial pressure falls then rises 3. Changing position from standing to supine: a) increases stroke volume b) increases baroreceptor activity c) increases the pulmonary blood volume d) decreases leg vein pressure e) decreases the heart rate 4. Vagal stimulation produces: a) a fall in heart rate b) an increase in atrial contractility c) an increase in ventricular contractility d) slowing of A-V conduction e) a fall in stroke volume 5. The following are representative of myocardial afterload: a) mean aortic pressure b) mean pulmonary artery pressure c) left ventricular end-diastolic volume d) left ventricular end-diastolic pressure e) the rate of rise of left ventricular pressure ANSWERS 1.TFTFF 2.TTFFF 3.TTTTT 4.TFFTT 5.TTFFF

ArticleDate:20060518 Si1.

On ascending to an altitude of 6000m, changes include:

a) an increase in minute volume b) an initial increase in plasma pH c) a rise in urine pH d) a fall in arterial PO2 e) an increase in cerebral blood flow 2. Transferrin is: a) involved in iron uptake by the gut mucosa b) involved in iron transport across the gut mucosa c) involved in iron transport to muscle d) involved in iron transport to storage sites e) normally only 35% saturated with iron

3. Breathing 100% oxygen at atmospheric pressure for a prolonged period causes: a) retrosternal pain b) dizziness c) auditory disturbances d) convulsions e) atelectasis 4. The following transfusions will lead to agglutination:

a) b) c) d) e)

Donor B AB B O AB

Recipient O A AB AB O

5. Chemoreceptors in the arterial system: a) have a higher rate of oxygen consumption per gram than brain tissue b) respond to changes in oxygen tension and not content c) respond to changes in pH d) conduct afferent information via the glossopharyngeal and vagus nerves e) are found in the carotid sinus ANSWERS 1.TTTTF 2.FFTTT 3.TFFFT 4.TTFFT 5.FTTTF 1. In the healthy heart, an increase in stroke volume is seen with an increase in: a) dP/dT b) aortic systolic pressure c) left ventricular end-diastolic volume d) left ventricular end-systolic pressure e) heart rate 2. The a-wave of the central venous pressure waveform: a) is caused by atrial contraction b) is not seen in atrial fibrillation c) is caused by atrial filling during ventricular contraction d) decreases with inspiration e) is followed by the v-wave 3. In the electrocardiogram, the: a) P-R interval is equivalent to the A-V nodal conduction time b) T-wave is equivalent to ventricular repolarisation c) Q-T interval is equivalent to the duration of ventricular contraction d) U-wave represents sinoatrial node repolarisation e) duration of a normal P-wave is 0.2 seconds

4. Ptosis results from: a) parasympathetic block b) sympathetic block c) facial nerve block d) trigeminal nerve block e) oculomotor nerve block 5. The following are precursors of adrenaline: a) tyrosine b) phenylalanine c) noradrenaline d) dopamine e) isoprenaline

ANSWERS 1.TFTFF 2.TTFFF 3.TTTFF 4.FTTFT 5.TTTTF

te1.

The following lead to an increase in insulin secretion:

a) glucagon b) adrenaline c) growth hormone d) starvation e) major trauma 2. Adenyl cyclase: a) increases the conversion of ATP to cyclic AMP b) is closely linked to alpha- and beta-adrenergic receptors c) is inhibited by aminophylline d) release is triggered by cyclic AMP e) acts at a mitochondrial level 3. Surfactant: a) contains phospholipids b) prevents oedema formation in the alveolar wall c) reduces surface tension by approximately 30% d) produces a monomolecular layer e) stabilises the size of an alveolus 4. The oxyhaemoglobin dissociation curve is shifted to the left by: a) an increase in arterial PCO2 b) acidosis c) chronic anaemia d) carbon monoxide

e) a fall in temperature 5. In the adult, growth hormone stimulates: a) glucose uptake into cells b) calcium absorption from the gut c) protein synthesis d) fat synthesis e) bone growth ANSWERS 1.TFTFT 2.TTFFF 3.TTFFT 4.FFFTT 5.FFTFT
S1.

In the electrocardiogram at a heart rate of 80 per minute:

a) the PR interval should be less than 0.2 s and greater than 0.12 s b) the QRS complex should last less than 0.02 s c) the T wave is normally greater than 1 mV d) there will be an interval of 0.75 s between the end of one complex and the beginning of the next e) the T wave is ventricular repolarisation 2. Fibrinogen degradation products are natural anticoagulants interfering with: a) polymerisation of the fibrin monomer b) platelet aggregation c) thrombin activity d) serum calcium concentrations e) intrinsic pathway activation 3. Atropine: a) has no effect on acetylcholine production or destruction b) dilates cutaneous blood vessels c) is a parasympathetic depressant d) stimulates the respiratory centre e) increases intraocular pressure 4. In the cardiac cycle: a) left ventricular volume is maximal at the end of atrial systole b) the mitral valve closes by contraction of the papillary muscles c) the left ventricular pressure is maximal just before the aortic valve opens d) the ejection fraction is about 85% e) the dicrotic notch is due to rebound of the aortic valve 5. Pulmonary vascular resistance: a) is increased in chronic hypoxia b) has a value approximately one-sixth that of the systemic circulation c) can be measured using a flow-directed balloon catheter with a thermistor tip d) is increased by isoprenaline e) is decreased by 5-hydroxytryptamine (5-HT)

6. Dopamine: a) increases cardiac output b) in high doses causes peripheral vasodilatation c) increases renal blood flow d) increases ventricular excitability e) increases splanchnic blood flow 7. The following are true of alpha-adrenoceptor blocking agents: a) they increase blood flow in normal skin and muscle b) they cause drowsiness c) the clinically useful drugs are competitive antagonists d) they have only alpha 1- blocking activity e) they are chronotropic agents 8. In the normal cardiac cycle: a) the period of ventricular systole is equal to the Q-T interval b) the duration of the QRS complex depends on the heart rate c) the PR interval is less than 0.22 s d) ejection occurs throughout systole c) the R-R interval may vary 9. The oxygen carrying capacity of the blood is: a) the maximum quantity of oxygen that will combine with 100 ml of whole blood b) the ratio between oxygen uptake and oxygen usage c) independent of the haemoglobin concentration d) the oxygen physically dissolved in blood c) normally of the order of 15 ml per 100 ml whole blood 10. Captropril: a) increases the rate of breakdown of angiotensin II b) inhibits the breakdown of bradykinin c) may cause an increase in plasma potassium d) can safely be given in large doses in hypertensive crisis e) urine should be checked regularly for proteinuria 11. The following are isotonic with plasma: a) 1.2% sodium bicarbonate b) 5% dextrose c) 0.9 molar NaCl d) Hartmann's solution (Ringer-Lactate) e) human plasma protein fraction (5% human albumin solution) 12. When measuring arterial blood pressure using a sphygmomanometer cuff: a) if the cuff is too small for the arm, the pressure will tend to read high b) accuracy is increased by leaving the cuff slightly inflated between readings c) the slower the deflation, the more accurate the reading d) a mercury column has a low frequency response e) diastolic pressure agrees more accurately with direct measurement than will systolic pressure 13. Sympathetic innervation of blood vessels:

a) is mediated by alpha-adrenoceptors b) is mediated locally by noradrenaline c) implies that sympathectomy induces vasodilation d) increases flow independent of vessel diameter e) induces vasodilation in response to cold and haemorrhage 14. Venous return to the heart is decreased by: a) the Valsalva manoeuvre b) exercise c) paralysis of skeletal muscles d) femoral arteriovenous fistula c) rapid infusion of blood 15. The following are important in physiological limitation of blood clotting: a) removal of activated clotting factors by the liver b) prostacyclin c) protein C d) a factor released from the endothelial cells e) fibrinogen 16. Heart rate is slowed by: a) amphetamine b) atropine c) propranalol d) dobutamine e) nifedipine 17. Using propranolol to treat hypertension: a) may exacerbate asthma b) often produces postural hypotension c) is contraindicated in patients with high plasma renin levels d) may precipitate cardiac failure in susceptible patients e) should be avoided in a patient with Raynaud's phenomenon 18. Cardiac output may be measured by: a) thermodilution b) electromagnetic flow meter c) Doppler ultrasound d) limb plethysmography e) ballistocardiography 19. In pulse oximetry: a) the theoretical basis is Stefan's law b) calibration is against known in vitro standards c) carboxyhaemoglobin does not affect readings d) accuracy at readings above 90% saturation is to within 0.1% e) pulse amplitude is a good indicator of cardiac output 20. The coronary blood flow:

a) is about 500 ml/min at rest b) supplies muscle that takes up 40 ml oxygen per minute at rest c) is altered directly by vagal activity d) ceases in systole e) is autoregulated

ANSWERS 1.TFFFT 2.TTTFF 3.TTTFT 4.TFFFT 5.TTFFF 6.TFTTT 7.TFFFF 8.TFTFT 9.TFFFF 10.FTTFF 11.TTTTT 12.TFFTF 13.TTTFF 14.TFTFF 15.FTTTF 16.FFTFF 17.TFFTT 18.TTTFT 19.FFFFF 20.FTTFT
ection: Article 0060214

1. Cimetidine: a) lowers plasma creatinine b) prolongs the prothrombin time c) hastens gastric emptying d) may potentiate the action of warfarin e) may impair cardiac conduction 2. Acute intermittent porphyria: a) is exacerbated by digoxin b) is precipitated by sulphonamides c) is precipitated by ethyl alcohol d) is treated by parenteral lidocaine e) contraindicates the use of thiopentone 3. The following are features of digoxin toxicity: a) headache b) nausea c) abdominal pain d) convulsions e) coupled beats 4. Lidocaine can cause:

a) sedation b) convulsions c) slowed A-V conduction d) prolongation of the cardiac action potential e) shortening of the refractory phase 5. Features of severe aspirin overdose include: a) tinnitus b) metabolic acidosis c) a reduction in the platelet count d) haemolysis e) hyperventilation 6. Atropine antagonises the action of: a) some of the effects of morphine b) acetylcholine at the neuromuscular junction c) acetylcholine at sweat glands d) trimetaphan at the autonomic ganglia e) pilocarpine on the pupil 7. Toxic effects of sodium nitroprusside: a) are not related to dose b) are due to cyanide ions c) are due to thiocyanate d) are due to liver rhodanese e) may be treated with vitamin B12 8. Pethidine: a) causes less miosis than morphine b) is metabolised to active substances with analgesic properties c) has a longer duration of action than morphine d) possesses atropine-like activity e) has some local anaesthetic activity 9. The following are useful in the suppression of ventricular ectopic beats: a) digoxin b) amiodarone c) mexiletine d) verapamil e) bretylium 10. The following act directly on vascular smooth muscle by altering calcium transport: a) nicardipine b) sodium nitroprusside c) hydralazine d) bendrofluazide c) dantrolene 11. Metoclopramide:

a) has an action on gastric emptying opposed by atropine b) causes prolactin release c) is a phenothiazine d) lowers the blood glucose e) is a dopamine antagonist 12. Otoxicity can follow the administration of: a) ethacrynic acid b) gentamicin c) frusemide d) cefuroxime e) streptomycin 13. Poisoning by organophosphorus compounds causes: a) increased bronchial secretions b) constipation c) miosis d) tetanus e) tachycardia 14. Phenobarbitone: a) is used in the treatment of grand mal epilepsy b) may aggravate petit mal epilepsy c) can produce skin rashes d) is rapidly metabolised e) has its effects terminated by redistribution 15. Testosterone derivatives are: a) androgenic b) diabetogenic c) progestogenic d) anabolic e) carcinogenic 16. Buprenorphine: a) causes little nausea and vomiting b) has a respiratory depressant action antagonised by naloxone c) is mostly metabolised in the liver d) may cause withdrawal symptoms in morphine addicts e) must be given parenterally 17. The following should not be discontinued abruptly: a) cimetidine b) propranolol c) clonidine d) amiodarone e) digoxin 18. Sulphonylureas:

a) are used in maturity-onset diabetes b) can cause hypoglycaemia c) are suitable for the treatment of ketoacidosis d) are an effective treatment for hyperglycaemia following total pancreatectomy e) can cause lactic acidosis 19. Hyoscine: a) causes tachycardia b) causes sedation c) causes mydriasis d) is an antiemetic e) has a weaker antisialagogue effect than atropine 20. Salbutamol can cause: a) tremor b) an increase in uterine contractility c) a worsening of intermittent claudication d) hypokalaemia e) tachycardia ANSWERS 1. FFFTT 2. FTTFT 3. TTTTT 4. TTTFT 5. TTFFT 6. FFTFT 7. TTFFF 8. FTFTT 9. FTTFT 10. TTTFF 11. TTFFT 12. TTTFT 13. TFTFF 14. TTTFF 15. TTFTT 16. FFTTF 17. FTTFF 18. TTFFF 19. TTTTF 20. TFFTT 1. Dopamine: a) may produce ventricular arrhythmias b) increases mesenteric blood flow at high doses c) crosses the blood-brain barrier d) is synthesised from L-dopa e) is inactivated in alkaline solution 2. The following increase the amount of calcium in cardiac muscle: a) halothane b) adrenaline c) diltiazem d) nifedipine e) trimetaphan

3. The following can be used safely in a patient on a monoamine oxidase inhibitor: a) morphine b) pethidine c) noradrenaline d) amphetamine e) adrenaline 4. Hyoscine hydrobromide causes: a) antiemesis b) somnolence c) pupillary dilatation d) tachycardia followed by bradycardia e) extrapyramidal symptoms 5. Clonidine: a) is an alpha-2 receptor agonist b) is a dopamine antagonist c) causes tachycardia d) inhibits salivation e) reduces the minimum alveolar concentration of halothane

ANSWERS 1.TTFTT 2.FTFFF 3.TFTFT 4.TTTTF 5.TFFTT 6. Hydralazine: a) is metabolised by acetylation b) is destroyed by plasma cholinesterase c) can cause a lupus-like syndrome d) stimulates the baroreceptor reflex e) is contraindicated in pregnancy 7. The following are prodrugs: a) suxamethonium b) diamorphine c) captopril d) paracetamol e) enalapril 8. The following drugs penetrate the blood-brain barrier: a) physostigmine b) dopamine c) propranolol d) glycopyrrolate e) noradrenaline 9. Naloxone: a) is an agonist at kappa receptors

b) is an antagonist at mu receptors c) reverses ventilatory depression due to morphine d) may precipitate opiate withdrawal symptoms e) may cause pulmonary oedema 10. The following are precursors of adrenaline: a) tyrosine b) phenylalanine c) dopamine d) isoprenaline e) noradrenaline

ANSWERS 6.TFTTF 7.FTFFT 8.TFTFF 9.FTTTT 10.TTTFT

Art11.

The following affect gastric emptying:

a) diamorphine b) diazepam, c) metoclopramide d) cisapride e) omeprazole 12. Chlorpromazine: a) can cause dystonic reactions b) antagonises apomorphine-induced vomiting c) is a dopamine antagonist at the chemoreceptor trigger zone d) is a weak alpha-adrenergic agonist e) undergoes extensive first-pass metabolism 13. Alfentanil: a) is less lipid soluble than fentanyl b) relaxes the sphincter of Oddi c) has active metabolites d) has a large volume of distribution e) causes analgesia without sedation 14. Folic acid metabolism is impaired by: a) nitrous oxide b) sodium nitroprusside c) sulphonamides d) penicillin e) trimethoprim 15. Significant agonist activity at opioid receptors occurs with:

a) clonidine b) pentazocine c) buprenorphine d) ketamine (Ketamine has antagonist activity at opioid receptors, but agonist activity at d and ? receptors) e) naloxone

ANSWERS 11.TFTTF 12.TTTFT 13.TFFFF 14.TFTFT 15.FTTFF

ic16.

Drug clearance by the body:

a) only refers to elimination by the kidney b) refers to the volume of blood cleared of the drug in unit time c) cannot exceed the glomerular filtration rate d) may be influenced by renal tubular secretion e) is the same as creatinine clearance 17. Dopexamine: a) causes arterial vasoconstriction b) is an agonist at dopaminergic D1 and D2 receptors c) increases the force of myocardial contraction d) increases renal blood flow e) causes arrhythmias 18. Sodium valproate: a) is effective in grand mal epilepsy b) is effective in petit mal epilepsy c) is safe in patients with liver disease d) should not be given to children e) increases brain concentrations of gamma-amino butyric acid (GABA) 19. The Chi-squared test: a) is used to compare the frequencies of occurrence b) requires the standard error of the mean to be calculated c) does not require a knowledge of the number of degrees of freedom d) should not be used for data with small groups e) does not involve the null hypothesis 20. A placebo effect: a) may occur in either treatment or control groups b) occurs only in mentally ill patients c) is likely to occur repeatedly in placebo reactors d) can occur in up to 35% of patients

e) is not seen in double-blind trials

ANSWERS 16.FTFTF 17.FTTTT 18.TTFFT 19.TFFTF 20.TFTTF

l1.

The following act by blocking cholinergic receptors:

a) trimetaphan b) hexamethonium c) ouabain d) benzhexol e) physostigmine 2. Esmolol: a) has a negative inotropic effect b) has no intrinsic sympathomimetic activity c) causes a dose-dependent fall in heart rate d) increases airways resistance e) may prolong the duration of action of suxamethonium 3. Enflurane: a) is a halogenated methyl-ethyl ether b) has a blood/gas solubility coefficient of 1.43 c) lowers intracranial pressure d) increases the tone of the pregnant uterus e) causes a decrease in systemic vascular resistance 4. Morphine: a) causes histamine release b) has no active metabolites c) undergoes extensive first-pass hepatic metabolism d) has an elimination half-life of 3-4 hours e) may be antagonised by pentazocine 5. Uterine tone is: a) increased by ketamine b) decreased by halothane c) increased by beta-2 antagonists d) unaffected by suxamethonium e) decreased by nifedipine

ANSWERS

1.TTFTF 2.TTTTT 3.TFFFT 4.TFTTT 5.TTTTT

e6.

Aspirin overdose causes:

a) thrombocytopenia b) coma c) metabolic acidosis d) jaundice e) pulmonary oedema

7. Non-depolarising neuromuscular blockers are potentiated by: a) lithium b) diazepam c) trimetaphan d) magnesium e) suxamethonium 8. Atropine: a) crosses the blood-brain barrier b) can cause an initial bradycardia c) increases the rate of gastric emptying d) increases conduction through the AV node e) produces bronchoconstriction 9. Hepatotoxicity has been associated with: a) diethyl ether b) chloroform c) cyclopropane d) enflurane e) halothane 10. The anticoagulant effect of warfarin: a) is exerted directly on the blood b) is slow in onset c) can be reversed by vitamin K d) is potentiated by phenylbutazone c) is potentlated by barbiturates

ANSWERS 6.FTTFT (HYPOTHROMBINAEMIA AND INHIBITION OF PLATELET AGGREGATION, BUT NOT THROMBOCYTOPENIA) 7.TFTTT 8.TTFTF

9.FTFTT 10.FTTTF
D11.

The following may be used in the treatment of digoxin toxicity:

a) propranolol b) lidocaine c) phenytoin d) calcium e) potassium 12. Dobutamine: a) is structurally similar to isoprenaline b) activates adenyl cyclase c) has a selective action on beta-1 adrenoreceptors d) has a half-life of 2 minutes e) increases the left ventricular end-diastolic pressure 13. Organophosphorus anticholinesterases: a) have an irreversible action b) phosphorylate cholinesterase c) can have their action reversed in the early stages by atropine d) are readily absorbed through the skin 14. The following factors encourage passage of a substance across the cell membrane: a) high lipid solubility b) low concentration gradient c) high molecular weight d) negative hydrostatic pressure e) high degree of ionisation 15. Amitriptyline in overdose causes: a) cardiac arrhythmias b) hypotension c) restlessness d) metabolic acidosis e) jaundice

ANSWERS 11.TTTFT 12.TTFTF 13.TTTT 14.TFFFF 15.TTTTF 16. Low plasma cholinesterase activity: a) is related to the patient's blood group

b) has no effect on the action of decamethonium c) occurs with organophosphorus poisoning d) prolongs the action of esmolol e) occurs in malnutrition 17. Sulphonylureas: a) acts by increasing insulin release b) tends to produce weight loss c) is suitable for use in pregnancy d) is effective in correcting ketoacidosis e) can produce hypoglycaemia 18. Side-effects of hydralazine include: a) tachycardia b) impotence c) constipation d) systemic lupus erythematosus e) bronchoconstriction 19. The following are measures of scatter in statistical analysis: a) mean b) standard error of the mean c) standard deviation d) range e) p of less than 0.5 20. Statistical tests are used to: a) eliminate observer bias b) eliminate placebo effect c) show that results are true d) show that the results did not occur by chance e) show that the results are clinically significant

ANSWERS 16.FFTTT 17.TFFFT 18.TFFTF 19.FTTTF 20.FFFTF

a1.

Nifedipine:

a) causes tachycardia b) causes tremor c) causes hypoglycaemia d) can be given sublingually e) dilates skeletal muscle arterioles 2. Tetracycline: a) may be hepatotoxic in large doses b) is extensively metabolised

c) is contraindicated in pregnancy d) potentiates non-depolarising muscle relaxants e) absorption is decreased by magnesium trisilicate 3. Neostigmine: a) is eliminated entirely by the liver b) causes foetal bradycardia when given to a pregnant woman c) causes miosis d) is a quaternary ammonium compound 4. The following drugs readily cross the placenta: a) atracurium b) lidocaine c) bupivacaine d) neostigmine e) propranolol 5. In acute intermittent porphyria, the following, drugs may be safely used: a) etomidate b) ketamine c) midazolam d) pethidine e) cotrimoxazole ANSWERS 1.TTFTT 2.TTTTT 3.FFTT 4.FTFFT 5.FFTTF

Arti6.

The following drugs are mainly eliminated from the body by hepatic metabolism:

a) isoflurane b) morphine c) atracurium d) suxamethonium e) dopamine 7. The following have an elimination half-life of greater than 24 hours: a) diazepam b) midazolam c) methadone d) gelofusine e) hydroxyethyl starch 8. Phenytoin:

a) shows first-order elimination kinetics b) induces enzymes c) causes hypotension d) causes vitamin B2 deficiency e) has a half-life of about 4 hours 9. L-dopa: a) is more lipid soluble than dopamine b) may produce postural hypotension c) may cause nausea d) may cause abnormal movements e) is ineffective via the oral route 10. Toxicity from hyperbaric oxygen therapy can cause: a) painful joints b) pulmonary oedema c) acute tubular necrosis d) convulsions e) bradycardia

ANSWERS 6.FTFFF 7.TFTFT 8.TTTFF 9.TTTTF 1 11. Atropine: a) increases gut motility b) is a mixture of d- and l-isomers c) is equipotent with hyoscine d) can cause bradycardia e) crosses the blood-brain barrier 12. Beclomethasone: a) can be given by aerosol inhaler b) can cause candidiasis c) is a fludrocortisone d) increases the circulating cortisol concentration e) is a bronchodilator 13. Dopamine receptor antagonists: a) increase heart rate b) are antiemetics c) cause hypertension d) cause extrapyramidal side-effects e) increase lower oesophageal sphincter tone 14. The volume of stomach contents is reduced by:

a) sodium citrate b) metoclopramide c) cimetidine d) atropine e) pyridostigmine 15. The following drugs relax the pregnant uterus: a) salbutamol b) propranolol c) noradrenaline d) acetylcholine e) dopamine ANSWERS 11.FTFTT 12.TTFFT 13.FTFTT 14.FTTFT 15.TFFFF

ArticleDate:20040629 SiteSection: Article

0.FTFTF

16. Carbonic anhydrase inhibitors: a) cause an alkaline urine to be produced b) cause a metabolic acidosis c) are more effective when given continuously than when given intermittently d) may lead to the formation of renal calculi e) cause the intraocular pressure to rise 17. Osmotic diuretics: a) are only effective if completely reabsorbed from the renal tubule b) reduce intracranial pressure primarily by inducing a diuresis c) produce a urine flow limited by glomerular filtration rate d) can lead to pulmonary oedema if renal function is impaired e) have a molecular weight of between 40,000 and 65,000 daltons 18. The following are ethers: a) sevoflurane b) halothane c) desflurane d) trichlorethylene e) enflurane 19. Warfarin: a) has a rapid onset of action

b) is readily excreted in the urine c) is antagonised by salicylates d) is potentiated by metronidazole e) is antagonised by barbiturates 20. Salbutamol: a) is a beta-1 selective adrenoreceptor agonist b) acts on the lung only when given by the inhalational route c) reduces the forced expiratory volume in asthmatics d) produces vasodilatation in skeletal muscle e) can produce hypokalaemia ANSWERS 16.TTFTF 17.FFFTF 18.TFTFT 19.FFFTT 20.FFFTT

cleDate:20060214 te:20051021 ArticleDate:20051021 ArticleDate:20051101 SiteSection: Article icleDate:20050220