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General Primary MCQ 6

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 NH 4 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

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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:

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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:

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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)

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