SELF ASSESSMENT - Questions

Dr Rebecca Appleboam and Dr Ed Hammond

Question 1

The following statements about suxamethonium are true

1. It is the muscle relaxant most frequently implicated in allergic reactions
2. It is metabolised to two molecules of acetylcholine by the action of plasma pseudocholinesterase
3. The rise in intraocular pressure caused by its administration lasts for up to half an hour
4. It may cause a bradycardia due to stimulation of nicotinic receptors
5. The Phase II block seen after repeated administration or infusion is reliably reversed using neostigmine

Question 2

The following statements are true about digoxin

1. 75% of the oral dose is absorbed
2. 50% is bound to plasma proteins
3. Most is excreted unchanged in the urine
4. Hyperkalaemia may cause raised serum levels of digoxin
5. Toxicity may result in complete heart block

Question 3

According to the Hagen-Poiseuille equation

1. Flow varies inversely with the fourth power of the radius
2. Flow varies inversely with fluid density
3. Flow varies directly with pressure difference between the ends of the vessel
4. Haematocrit is likely to inversely affect blood flow
5. If the radius of a vessel is doubled, resistance will fall to less than 50% of its previous value.

Question 4

Diastolic filling of the left ventricle

1. Is aided by a modest tachycardia when the left ventricle is hypertrophied
2. Occurs mainly in later diastole, including the time of atrial systole
3. Active relaxation is improved by sympathetic stimulation in the setting of a steady heart rate
4. Is most commonly disturbed by hypertensive cardiac disease
5. Can be represented by a constant of ventricular stiffness

Question 5

Sevoflurane

1. Is a hexafluoroisopropyl fluromethyl ether
2. Undergoes minimal biotransformation in the liver to produce inorganic fluoride ions
3. Releases carbon monoxide when in contact with sodalime
4. Has a lower SVP than isoflurane
5. Has a blood:gas partition coefficient approximately half that of isoflurane

Question 6

Rocuronium

1. Is more potent than vecuronium
2. Is chemically related to vecuronium
3. In suitable doses produces good intubating conditions in 60-90's
4. Has a longer elimination half time than vecuronium
5. Possesses active metabolites

Question 7

The following are likely to cause serious complications during pregnancy

1. Mitral stenosis
2. Secundum atrial septal defect
3. Ventricular septal defect with normal pulmonary artery pressure
4. Isolated aortic regurgitation
5. Primary pulmonary hypertension

Question 8

Pulmonary hypertension

1. Causes wide splitting of S2
2. Is a cause of the Graham-Steele murmur
3. Can cause peripheral cyanosis
4. Is a cause of atrial fibrillation
5. Causes giant a waves in the JVP

Question 9

Respiratory failure

1. PaCO₂ is <8.0 kPa by definition
2. Lactic acidosis may occur
3. Is always due to pre-existing lung disease
4. Should always be treated with 100% oxygen
5. Is a recognised complication of diphtheria

Question 10

A small pupil is characteristic of

1. IIIrd nerve palsy
2. Horner's syndrome
3. Tabes dorsalis
4. Optic neuritis
5. Holmes-Adie pupil

Question 11

Regarding the physiology of glucose control

1. A protein meal stimulates glucagon release
2. A protein meal stimulates insulin release
3. Somatostatin infusion induces hypoglycaemia
4. Insulin-like growth factor-I (ILGF-I) secretion by the liver is stimulated by insulin
5. Ketone body synthesis is stimulated by insulin

Question 12

In paracetamol overdose

1. The toxic metabolite is N-acetyl-P-benzoquinonimine
2. Decreased conscious level is common on admission
3. A paracetamol level above 200 ng/L at 4 hours after ingestion requires treatment with acetylcysteine
4. Those taking enzyme-inducing drugs are at increased risk
5. After a severe overdose the patient should not take paracetamol again, even in normal therapeutic doses

Question 13

Albumin

1. Has a biological half life of 20 days
2. Has a molecular weight of 65,000 Daltons
3. Analbuminaemia presents with severe peripheral oedema
4. 60 % of the extracellular albumin is in the plasma compartment
5. Plasma levels vary with posture

Question 14

Pressure can be measured with the following

1. Aneroid gauge
2. Bourdon gauge
3. Rayleigh refractometer
4. Raman gauge
5. Displacement of a flexible diaphragm

Question 15

The following are true regarding breathing systems

1. The Bain circuit is an example of a Mapleson A system
2. The Bain circuit is more efficient than the Lack circuit during spontaneous breathing
3. In the Bain circuit, fresh gas flow occurs through the outer tube
4. During spontaneous breathing, the Lack circuit requires a fresh gas flow rate of twice the alveolar minute ventilation to prevent rebreathing
5. The Lack circuit may be used to ventilate the patient's lungs with the Penlon Nuffield 200 ventilator

Question 16

Adverse drug reactions

1. Most commonly affect the cardiovascular and respiratory systems
2. Are uncommon in patients taking digoxin and diuretics
3. Often affect the gastrointestinal tract and skin
4. Are particularly likely to occur in females over 60 years old
5. Cause up to 3% of admissions to acute medical wards

Question 17

The following are natural precursors of adrenaline

1. Noradrenaline
2. Glycine
3. Tyrosine
4. Phenylalanine
5. Dobutamine

Question 18

Warfarin

1. Prevents the carboxylation of vitamin K
2. Interferes with the synthesis of clotting factors II, V, X and XII
3. Has an anticoagulant effect delayed by about 12 hours following the first dose
4. Is teratogenic
5. Is excreted in the urine

Question 19

The following poisons are matched to the appropriate therapy

1. Carbon monoxide - hyperbaric oxygen
2. Organophosphates - atropine and pralidoxime
3. Beta-blocker - phentolamine
4. Methanol - ethanol
5. Tricyclic antidepressants - phenytoin

Question 20

Gastrointestinal motility is affected by

1. 5HT3 antagonists
2. Metoclopramide
3. H2 receptor blockers
4. Neostigmine
5. Opioids via the chemoreceptor trigger zone

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