lgh-anaesthesia

PHARMACOLOGY 

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) have cells which respond only to decrease in PaO₂
b) have the highest blood flow (ml/unit weight) in the body
c)  maximally stimulate the respiratory centre between 4-8 kPa
d) 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 RBC’s 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 NT’s 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 (Fick’s 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) Conn’s 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 Starling’s 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 infant’s:

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 HPO₄^2- when HCO₃^-  is consumed
c) H⁺ excreted into the tubular fluid reacts with NH₃ when HPO₄^2- 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 Reynold’s 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) Stefan’s 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-Breuer’s 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 half–life can be used for any drug
e) about 94% of a drug is cleared from the body in four half-lives 

5. First-order processes:

a) apply to enzyme-mediated reactions
b) are characterised by high rates of reaction when the concentrations of reacting substances are high, and vice verse
c) can properly be described in terms of t1/2
d) are involved in the elimination of most drugs
e) change to zero-order kinetic at very high drug doses 

6. Regarding drug clearance by the body:

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

7. 5-HT:

a) is synthesised from tyrosine by enterochromaffin cells of the gastrointestinal tract
b) is also an endogenous neurotransmitter in the brain
c) is metabolised by monoamine oxidase to hydroxyindole acetic acid
d) is degraded to a great extent by pulmonary endothelial cells
e) can cause vasoconstriction and increased gastrointestinal motility 

8. Concerning metabolism of following drugs: 

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

9. Regarding arterial blood gas analysis:

a) hydrogen, oxygen and CO₂ electrodes measure at 37 degrees C
b) PaO₂ read by gas analyser would be higher than patient’s PaO₂ at 32 degrees C
c) the pH of the blood rises by 0.015 units per 10 degrees C decrease in body temperature
d) the alpha-stat approach is to keep uncorrected PaCO₂ and pH at normal levels
e) PaCO₂ of a patient at 30 degrees C will be lower than that at body temperature 

10. Regarding fibrinolysis:

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

11. Adenosine:

a) is an endogenous nucleoside and a metabolite of high energy phosphates
b) has a half-life of 8-10 seconds
c) has a negative inotropic effect
d) can cause severe bradycardia
e) has cellular protective effects during hypoxia or ischaemia 

12. Breathing out against a closed glottis:

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

13. Regarding anaesthesia in a hyperbaric chamber: 

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

14. The natural frequency of direct pressure measuring systems (desirable > 30 Hz) would be higher in  presence of:

a) a wide bore cannula
b) a very long catheter
c) a wider catheter
d) a less compliant catheter
e) multiple three way stopcocks 

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

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

16. Insulin secretion:

a) is about 1 U/hour in the basal state
b) is increased 5-10 times following ingestion of food
c) is increased by glucagon
d) is depressed in starvation
e) is increased in the perioperative period 

17. Adenyl cyclase:

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

18. Concerning bilirubin:

a) conjugated bilirubin is water soluble
b) a conjugated bilirubin of 20 mmol/L in a neonate will cause brain damage
c) the serum-conjugated bilirubin is increased in haemolysis
d) barbiturates may be used to treat hyperbilirubinaemia
e) urinary urobilinogen excretion is decreased in obstructive jaundice 

19. Regarding arterial blood pressure waveform:

a) initial upstroke reflects the inotropic component of the left ventricle
b) systolic and diastolic portion can be separated by dicrotic notch
c) systolic peak is higher in radial artery than that in the aorta
d) dicrotic notch is more pronounced in children
e) area under the pressure waveform represents stroke volume 

20. Motility of the gastrointestinal tract is increased by:

a) vagal blockade
b) mechanical obstruction
c) stimulation of splanchnic nerves
d) blockade of ventral roots near subarachnoid space below level of T4
e) neostigmine

21. Pulmonary arterial occlusion pressure  will be greater than left ventricular end-diastolic pressure in the presence of:

a) severe mitral stenosis
b) positive end-expiratory pressure
c) left atrial myxoma
d) stiff left ventricle
e) premature closure of mitral valve 

22. Starvation causes: 

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

23. Regarding isomerism of the anaesthetic drugs:

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

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

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

25. Central venous pressure is greater than pulmonary arterial occlusion pressure in:

a) right ventricular failure
b) pulmonary embolism
c) chronic lung disease
d) pulmonary hypertension
e) acute pulmonary regurgitation

26. The following statements are true regarding these new drugs:

a) fenoldopam, a D1 agonist, is used for treating hypertensive emergencies
b) bambuterol is a prodrug, converted to terbutaline in the body
c) nicorandil, a potassium channel activator, reduces both preload and afterload
d) nimodipine is a cerebral vasodilator
e) nabilone, a synthetic cannabinoid, is used as an anti-emetic during cancer chemotherapy 

27. Regarding the loop of Henle:

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

28. Concerning renal function:

a) when the glomerular filtration rate is reduced by 75%, serum creatinine begins to rise
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 patient’s dentures should be removed

20. In normal pregnancy at term:

a) the maternal haemoglobin content is increased
b) the lung volume is increased
c) tidal volume is increased
d) the cardiac output is increased by 10-20%
e) glomerular filtration rate may be increased by up to 80%

21. Aortocaval compression in the pregnant patient:

a) may produce hypotension
b) will only occur in the supine posture
c) will only occur in patients with epidural or spinal anaesthesia
d) may present solely as foetal distress
e) IV ephedrine is the initial treatment of choice

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

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

23. Infusions of sodium nitroprusside:

a) do not interfere with autoregulation of cerebral blood flow
b) result in cyanide toxicity if the dose exceeds 1 mcg/kg given over 3 hours
c) cause an increase in renin secretion
d) reduce cerebral oxygen consumption
e) should be protected from light

24. A highly ionised drug:

a) is well absorbed from the intestine
b) is excreted mainly by the kidney
c) crosses the placental barrier easily
d) is reabsorbed from the renal tubules
e) is highly protein bound

25. Nitric oxide:

a) is beneficial in reducing pulmonary vascular resistance
b) is available as compressed gas in cylinders
c) side-effects are related to metabolic by-products
d) is useful in treating methaemoglobinaemia
e) in therapeutic concentrations can cause brain damage

26. Regarding drug pharmacokinetics:

a) Vd represents the apparent volume available in the body for drug distribution
b) CL reflects the ability of the body to eliminate the drug
c) the terminal half-life of a drug is not dependent on Vd and CL
d) the Vd of muscle relaxants is localised to the plasma and extracellular fluid
e) Vd can never be greater than total body water

27. Regarding anaesthetic breathing systems:

a) rebreathing does not occur in Mapleson D during controlled ventilation
b) with a fresh gas flow (FGF) <1.5 L, volatile concentration in breathing system may be higher than the dial setting of the vaporiser
c) in circle system with a FGF <1 L (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 Bain’s co-axial system during spontaneous ventilation
e) dead space gas is preserved in Magill system during spontaneous ventilation

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

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

1. Albumin:

a) has a molecular weight of 69,000, with a strong negative charge on its surface
b) is synthesised by hepatocytes at a rate of 9-12 g/day in a healthy adult
c) generates oncotic pressure because of its high molecular weight
d) has a degradation half-life of 18 days
e) can be present in the urine in individuals on prolonged standing

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 HCO₃^-

4. Regarding diuretics:

a) ethanol inhibits antidiuretic hormone secretion
b) theophylline increases the sodium content of urine
c) acetozolamide increases the sodium content of urine
d) spironolactone can cause hyponatraemia
e) frusemide leads to increased K⁺ secretion in the distal tubule

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) Boyle’s 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) Poiseuille’s 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 Reynold’s 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 Boyle’s 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