ABSTRACT
NSAID-induced bleeding d. Ibuprofen is less likely to cause serious gastrointestinal side effects
than diclofenac
2. Adenosine a. This has a half-life of approximately 10 min b. It is a naturally occurring purine nucleoside c. It is useful in the management of supraventricular and ventricular
arrhythmias d. It is the drug of choice to cardiovert patients with tachycardias
related to Wolff-Parkinson-White syndrome
3. Mannitol a. This should be given to all patients with head injury and a
reduced GCS b. It is a loop diuretic similar in action to furosemide c. It decreases cerebral blood flow by reducing blood viscosity and
microcirculatory resistance d. It may produce renal failure or hypotension if given in large doses
4. b Blockers a. They are all water soluble b. They should never be used in patients with diabetes c. They are used in the treatment of heart failure, migraine and
hypothyroidism d. They should never be used in combination with digoxin
5. Regarding some of the b blockers a. Propranolol is a non-selective b blocker with a half-life of
3-6 hours b. Esmolol has a rapid onset of action and short half-life, and is
useful in the treatment of ventricular arrhythmias c. Sotalol is not recommended for the treatment of angina or
hypertension d. Labetalol has an arterial vasodilating action
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6. a. Renin is released from the juxtaglomerular apparatus in the
kidney b. Renin acts on angiotensin I, converting it into angiotensin II c. Angiotensin II is a powerful vasoconstrictor of arterioles d. Angiotensin-converting enzyme is found primarily in the blood
vessels of the lungs
7. ACE inhibitors such as captopril and enalapril a. These are useful in the treatment of hypertension, heart failure
and angina b. They should not be used in patients with renal artery stenosis
or hypokalaemia c. They may cause cough due probably to a potentiation of the
action of bradykinin d. They may cause first-dose hypotension, especially in those on
diuretics
8. In the treatment of angina a. The main aim is to reduce the work of the heart and therefore its
oxygen demand b. Glyceryl trinitrate (GTN) acts by producing nitrous oxide (N2O),
which causes peripheral vasodilatation in the venous system c. Patients on longer-acting nitrates may develop tolerance that
can be reduced by introducing a nitrate-free period of 4-8 hours each day
d. GTN should be avoided in patients with aortic regurgitation
9. Calcium channel blockers a. These act only on one site and therefore have a limited
therapeutic use b. They block L-type voltage-sensitive channels in arteriolar
smooth muscle c. They cause vasoconstriction and increase preload d. They can all be safely used with b blockers
10. Regarding treatment of cardiac arrest a. Sodium bicarbonate is indicated in all causes of cardiac arrest
where the arterial pH is ,7 b. Regardless of pH, sodium bicarbonate should be given in
cardiac arrest associated with hyperkalaemia or tricyclic antidepressant overdose
c. Calcium should be given during resuscitation from pulseless electrical activity (PEA) if it is thought to be caused by hypocalcaemia, overdose of calcium channel-blocking drugs or hypokalaemia
d. The initial dose of calcium chloride when indicated is 10 mL 10%, which is 6.8 mmol Ca2þ
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11. Regarding a. Aspirin has been shown to reduce mortality in patients who have
had a myocardial infarction b. Aspirin reduces platelet aggregation by an inhibition of
thromboxane A2 formation c. Clopidogrel has a synergistic action when given with aspirin d. Clopidogrel should be given to all patients presenting with chest
pain
12. Thrombolytics in acute myocardial infarction a. These should not be given to patients over the age of 75 b. They inhibit the formation of plasmin c. They are not useful unless given within 30 min of the patient
arriving in the emergency department d. The risk of haemorrhagic stroke is approximately 10%
13. b2 Agonists (such as salbutamol) a. These may be given orally, subcutaneously, intravenously or by
inhalation b. They may cause hyperkalaemia and should therefore be used with
caution in patients on spironolactone c. They act by causing smooth muscle relaxation via an increase in
intracellular cAMP d. They may commonly cause adverse effects such as fine tremor,
tachycardia and hypotension
14. Ipratropium bromide a. This is an anticholinergic agent b. It is a derivative of atropine and has a maximum effect between 30
and 60 min c. Side effects include dry mouth, urinary retention and tachycardia d. It may interact with warfarin and cause lengthening of the INR
15. Benzodiazepines a. These act on NMDA receptors and cause an increase in
intracellular calcium b. They may be the first-line treatment for seizures c. They are useful in the management of acute anxiety and should be
considered for the long-term treatment of patients with sleep disturbance
d. Their effects are reversed by naloxone
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16. the related side effects a. Histamine receptors causing drowsiness and sedation b. Dopamine receptors causing dystonia and dyskinesia c. a-Adrenoreceptors causing hypertension d. Muscarinic receptors causing dry mouth, blurred vision and
constipation
17. Regarding vomiting a. Emesis is coordinated by the vomiting centre, which is located in
the pons b. The chemoreceptor trigger zone contains both dopamine
receptors and 5HT3 receptors c. The use of metoclopramide is not recommended in males d. Cyclizine has its antiemetic effect by the blockade of dopamine
receptors
18. Morphine a. This exerts many of its analgesic effects via actions at m
receptors b. In high doses it causes respiratory depression and mydriasis c. It should never be used as pain relief in patients who are addicted
to heroin d. It can cause itching and flushing of the skin due to histamine
release
19. Regarding antiepileptic medication a. Phenytoin probably achieves its action via blockade of Kþ
channels b. Phenytoin is metabolised via a first-order process and is
therefore safe in increased doses c. Sodium valproate should be avoided, if possible, in pregnant
women d. Carbamazepine and phenytoin may exacerbate porphyria
20. Penicillins a. These are not useful agents in the treatment of Gram-positive
infections b. They are bacteriostatic c. They act in the DNA of the bacterial cell d. They all may be given orally or intravenously
21. Tetracyclines a. These are usually the antibiotic of choice in urethritis, Q fever and
Lyme disease b. They should not be used in children under the age of 12 years c. They are often given intravenously in severe infections d. They act by inhibiting bacterial protein synthesis
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22. The a. These are usually given orally b. They are most active against Gram-negative bacteria and are
often used in life-threatening infections c. They should not be given to patients with renal dysfunction d. They require regular monitoring of serum levels to prevent
toxicity
23. The following are all used in the initial treatment of tuberculosis a. Isoniazid b. Ribavirin c. Pyridoxine d. Ethambutol
24. Which of the following infections are correctly paired with an appropriate antibiotic? a. Meningitis: cefotaxime b. Lower urinary tract infection: ciprofloxacin c. Gonorrhoea: ciprofloxacin d. Typhoid fever: benzylpenicillin
25. Insulin a. This is secreted by the a cells of the islets of Langerhans in the
pancreas b. It causes a rise in serum potassium c. It stimulates synthesis of glycogen by the liver d. It increases breakdown of lipids
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1a. F 1b. F 1c. F 1d. T Adverse effects from NSAIDs (non-steroidal anti-inflammatory drugs) are common, especially as they are often given for long periods of time to elderly patients. NSAIDs inhibit cyclooxygenase and decrease the production of prostaglandins, which are protective, via a decrease in gastric acid secretion. Although eradicating H. pylori may help reduce the overall risk of ulceration in those starting long-term NSAID treatment that have dyspepsia or a history of ulceration, it is unlikely to reduce the risk of NSAID-induced bleeding or ulceration in those already on NSAIDs. Ibuprofen is the NSAID associated with the lowest risk of bleeding.
