mcq answers 2018 - frcaheadstart.org · 5.#the#context>sensitive#half#life: a)...
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Multiple Choice Answers
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1. Atrial natriuretic factors (ANF)
a) Simulate aldosterone secretion F
b) Increase in chronic congestive cardiac failure D
c) Decrease the absorption of sodium from the loop of Henle F
d) Are rapidly cleared by the liver T
e) Cause vasodilatation T
2. Mast cells:
a) Originate from precursor cells in the bone marrow T
b) Contain heparin T
c) Have IgE receptors on their outer membranes T
d) Release TNF-‐a as part of an antibody-‐antigen reaction F
e) Are not usually found in peripheral tissue F
3. In patients with Wolff-‐Parkinson-‐White syndrome
a) Broad complex tachycardia is commoner than narrow complex tachycardia F
b) Digoxin is a useful anti-‐arrhythmic F
c) Patients with AF and rapid ventricular response rates have a poor prognosis T
d) Associated septal defects are common F
e) I.V. verapamil is the drug of choice to treat tachycardia F
4. Cannon “a” waves occur in the venous pulse in
a) Atrial flutter F
b) Ventricular tachycardia T
c) Complete atrioventricular block T
d) Junctional tachycardia T
e) Mobitz type 1 second degree atrioventricular block T
5. The context-‐sensitive half life:
a) Depends on the concentration of drug in plasma when the infusion is stopped F
b) Of alfentanil is always shorter than that of propofol F
c) Increases linearly in proportion to the duration of the infusion F
d) Is the inverse of the rate constant for excretion time F
e) Of a drug can never exceed its elimination half-‐time T
6. The following are true of the cerebral circulation
a) Hypoxaemia increases cerebral blood flow T
b) Blood flow increases proportionally to haematocrit F
c) Moderate hyperventilation does not have a significant effect F
d) Cerebral blood flow remains unchanged during moderate changes in T
blood pressure
e) Cerebral blood flow is independent of the temperature of the brain F
7. In the transfusion of blood components
a) The plasma K+ of stored blood can be up to 30mmol/L T
b) Levels of coagulation factors V and VIII are still 50% normal at 7 days F
in stored blood
c) Red blood cell viability is 35 days as a SAG-‐M preparation T
d) Red blood cell viability is defined as 50% survival 12hrs after transfusion F
e) SAG-‐M blood has a haematocrit of approximately 0.45 F
8. Polyuria
a) In nephrogenic diabetes insipidus is due to reduced secretion of ADH F
b) Occurring in diabetes insipidus may disappear if CCF supervenes T
c) In chronic renal failure with uraemia is partly due to an osmotic diuresis T
d) Due to excessive water intake is secondary to a rise in glomerular filtration F
e) Occurs in K+ depletion because of suppression of ADH release F
9. Gabapentin
a) Is not metabolised and is excreted unchanged in the urine T
b) Activates GABAB receptors F
c) Activates KATP channels F
d) Binds to voltage-‐gated calcium channels T
e) Commonly causes emesis F
10. Antibiotic prophylaxis is currently recommended for patients with structural cardiac defects undergoing
a) Dental procedures F
b) Upper gastrointestinal endoscopy F
c) Bronchoscopy F
d) Body piercing F
e) Tattooing F
11. In sepsis
a) Tumour Necrosis Factor (TNF) is a pivotal cytokine and high levels T
are associated with a poor outcome
b) Low levels of circulating TNF receptors are associated with a poor outcome F
c) High mobility group protein (HMG-‐B1) is an important cytokine produced F
early in sepsis
d) Disseminated intravascular coagulation (DIC) is associated with high F
levels of protein C, anti-‐thrombin III and high platelet counts
e) The inflammatory response can be easily controlled and manipulated F
in clinical practice
12. Complement activation via the classical pathway
a) Starts with component C3 F
b) Results in osmotic cell lysis T
c) Is normally controlled by multiple serum inhibitors T
d) May be induced by cardiopulmonary bypass F
e) Generates anaphylotoxins T
13. Patients who may have ingested large amounts of paracetamol
a) May benefit from administration of activated charcoal T
b) Will have a poor prognosis if their prothrombin time is > 100 secs T
c) Will not benefit from N-‐acetylcysteine administration if it is given >16hrs F
after the paracetamol ingestion
d) Have a good prognosis if liver enzymes e.g. ALT do not increase markedly F within 24hrs of admission
e) Should avoid alcohol for at least 6 months after recovery F
14. Myasthenia gravis
a) Is a disease of the presynaptic terminal of the neuromuscular junction F
b) Is usually associated with anti-‐acetylcholine receptor antibodies T
c) Commonly presents with sensory symptoms F
d) Patients are sensitive to depolarising neuromuscular blocking agents T
e) Plasma exchange is a useful long-‐term treatment F
15. During one lung ventilation
a) Hypercarbia is inevitable F
b) The PaO2 decreases due to reflex pulmonary vasoconstriction F
c) Hypercarbia can be prevented by clamping the branch pulmonary F
d) CPAP applied to the unventilated lung may increase the PaO2 T
e) PEEP applied to the ventilated lung may decrease the PaO2 T
16. A patient with a congenital diaphragmatic hernia
a) Always presents before 4 weeks of age F
b) Requires surgery within 24hrs of admission F
c) Has at least one hypoplastic lung T
d) Usually has a normal heart T
e) May benefit from exogenous surfactant F
17. Acclimatisation to an altitude of 5,000 metres usually results in an increased:
a) Red cell concentration of 2,3 dihydrophoglycerate T
b) Bicarbonate concentration in the cerebrospinal fluid F
c) Diffusing capacity for carbon monoxide T
d) Blood viscosity T
e) Cardiac output at rest F
18. With regards to the anatomy of the autonomic nervous system
a) Sympathetic outflow arises from T1-‐L2 T
b) Sympathetic outflow has ganglia within the target organ/tissue F
c) Parasympathetic system has a cranial outflow only F
d) Parasympathetic outflow is from cranial nerves 1,7, 9 and 10 F
e) Preganglionic sympathetic nerve fibres are myelinated T
19. The APGAR score
a) Was developed by paediatrician as a neonatal outcome tool F
b) Should be performed at 1 and 10 minutes after birth F
c) Includes an assessment of muscle tone T
d) Has a maximum score of 10 T
e) Scores are from 0-‐3 for each parameter F
20. The following are recognised associations
a) Thrombocytosis and chronic myeloid leukaemia T
b) Beta thalassaemia major and raised total body iron T
c) Aplastic anaemia and Down’s syndrome F
d) Multiple myeloma and gout T
e) Polycythaemia and renal carcinoma T
21. Primary hyperparathyroidism is associated with
a) Renal calculi T
b) Ectopic calcification T
c) Increased serum phosphate F
d) An increase in serum alkaline phosphatase T
e) Peptic ulceration T
22. A urine specific gravity of 1.030 is compatible with
a) Diabetes insipidus F
b) Pre-‐renal failure T
c) Dehydration T
d) Normal renal function T
e) Chronic renal failure F
23. During hepatic surgery
a) Hepatic metastases from bowel tumour are not an indication for hepatic surgery F
b) Veno-‐venous bypass preserves renal function worse than cross clamping of the Finferior vena cava
c) Atracurium is preferable to vecuronium T
d) Disseminated intravascular coagulation is diagnosed by reduction in the platelet F count
e) Clinically apparent hypocalcaemia often occurs F
24. Inotropes
a) Adrenaline may only be administered centrally F
b) The half life of adrenaline is 2-‐5 minutes T
c) Sodium bicarbonate inactivates adrenaline F
d) Noradrenaline is a part alpha agonist F
e) Noradrenaline may cause a contractile effect on the gravid uterus F
25. During carotid endarterectomy
a) Hypotension is required to prevent rupture of the carotid artery at the time of F application of the clamp
b) Reflex bradycardia as well as tachycardia maybe seen T
c) Stump pressure of >50mmHg is a reliable predictor of adequate CBF F
d) Carbon dioxide should be moderately increased (6.1-‐6.65) to allow better F
perfusion of the brain
e) EEG is a sensitive method to detect cerebral ischaemia F
26. Methicillin resistant Staphlococcus Aureus (MRSA)
a) Is a gram positive aerobic rod F
b) Is associated with excess mortality in critical care patient T
c) May be assumed to be eradicated after 3 clear swabs for infection T
control purposes
d) Eradication of carriage is with mupirocin nasal ointment and T
octenisan baths
e) In the UK 10% of staph aureus is methicillin resistant F
27. Are the following statements regarding renal replacement therapy true or false
a) Prostacyclin when used as an anticoagulant can reduced the MAP by 15mmHg T
b) RRT has an established role in septic shock with normal renal function F
c) Protein bound drugs are not easily removed by CRRT T
d) The hospital mortality of patients with AKI on RRT is approximately 60% T
e) CRRT can aid feeding by improving fluid management T
28. Delirium in the intensive care
a) Affects 24-‐46% of ventilated patients F
b) Predisposing factors include male gender and severity of illness T
c) Patients with delirium are 2-‐3 times more likely to die T
d) May be managed with benzodiazepines F
e) May be managed with olanzapine T
29. Which of the following statements regarding H1N1 viral pneumonitis is correct?
a) Fever may be absent in 30% of patients T
b) Studies show oseltaivir is well absorbed enterically in critically ill patients T
c) Myocarditis and pericarditis is common F
d) Inhaled Zanamivir is recommended in critically ill patients F
e) High dose systemic steroids are recommended in hypoxic patients with F
respiratory failure
30. The epidural space
a) Has the anterior longitudinal ligament as its anterior boundary F
b) Has the largest posterior venous plexus generally at the lumbar level F
c) Is bound laterally by the pedicle of the vertebra and the intervertebral foramen T
d) In an adult has spinal cord and dural sac ending at L1 and S2 levels respectively T
e) In the thoracic region is wider than the lumbar epidural space F
31. Pin-‐index systems on cylinders
a) Is present in cylinders of all sizes F
b) Is a fail-‐safe method for preventing misconnection F
c) Is 2&5 for oxygen and 3&5 for nitrous oxide T
d) The pin is present on the valve block and matching holes on the yoke F
of the anaesthetic machine
e) Bodok seal provides a gas tight joint between the valve and yoke of the T
anaesthetic machine
32. The following statements are true:
a) The axial length in myopic individuals is less than 25mm F
b) The lateral orbital walls are parallel to each other F
c) The axis of the orbit is parallel to the axis of the globe F
d) Tenon’s capsule is a relatively thick membrane F
e) The inferior orbital vein passes through the inferior orbital fissure to drain T
into cavernous sinus
33. Maxillary nerve block at pterygopalatine fossa causes anaesthesia of:
a) Upper molar T
b) Lower molar F
c) Soft palate T
d) Anterior 2/3rd of tongue F
e) Conjunctiva F
34. The alveolar gas equation:
a) Relates alveolar concentration of oxygen to inspired oxygen concentration, T alveolar carbon dioxide concentration and respiratory exchange ratio
b) Predicts a negative PAO2 at low PiO2 T
c) Utilises Avogadro’s law F
d) Can show linear or non-‐linear relation depending on quantities allowed to T
vary or be fixed
d) Include respiratory exchange ratio which is equal to VO2/VCO2 F
35. Agglutination will occur if the following donor blood is given to the following recipients
a) Group O to group AB F
b) Group A to group O T
c) Group AB to group A T
d) Group A to group AB F
e) Group O to group A F
36. Vasopressin
a) Has a normal plasma level of <4ng/ml F
b) Is produced in the magnocellular neurones and released from the T
posterior pituitary
c) Release is inhibited by hypoxia, acidosis, hypercapnoea and pain F
d) Has lesser affinity for oxytocin type receptor as oxytocin F
e) Acts on V2 receptors predominantly located in the distal tuble and T
collecting ducts to regulate Osmolality
37. Phaeochromocytoma
a) Tumours arising from chromaffin cells in the adrenal medulla T
b) Tumour secretes only noradrenaline F
c) Sustained hypotension is a common presenting feature F
d) Hypoglycaemia is a common feature F
e) Diagnosis is confirmed by measuring catecholamine metabolites in 24-‐hr T
urine collection
38. Regarding DystrophiaMyotonica, the following are true:
a) Has X-‐linked inheritance F
b) Suxamethonium should be avoided T
c) Regional anaesthesia prevents muscle contraction F
d) Is a non-‐progressive disease F
e) Can develop bulbar palsy T
39. The following are true of nerves
a) Pain and temperature sensation are transmitted via A-‐delta and B-‐fibres F
b) Somatic motor nerves are B-‐fibres F
c) Post ganglionic sympathetic nerves are C-‐fibres T
d) Touch sensation is transmitted by A beta fibres T
e) Preganglionic autonomic nerves are B-‐fibres T
40. The following are appropriate for cerebrospinal fluid
a) Protein 400mg/L T
b) Glucose 6mmol/L F
c) Chloride 80mmol/L F
d) Pressure 8cmH2O T
e) Less than 5 lymphocytes per mm3 T
41. Concerning clinical trials
a) Phase II studies are usually conducted on healthy volunteers F
b) Placebo drugs are physiologically inert F
c) The commonest criticism of negative trials is a type II error T
d) Cross over studies require fewer patients than group comparisons T
e) Visual analogue scales are unreliable F
42. The following produce haemolysis in patients with G6PD (Glucose-‐6 Phosphate Dehydrogenase) deficiency:
a) Primaquine T
b) Penicillin F
c) Tetracycline F
d) Infectious haemolysis T
e) Nitrofurantoin T
43. Following massive haemorrhage
a) A platelet count of <50/10-‐9/L may occur after loss of 2 circulating T
blood volumes T
b) A fibrinogen concentration of fibrinogen <1g/L should be treated F
with 1 pooled unit of fibrinogen concentrate per 25kg body weight
c) Thromboelastometry may reveal fibrinolysis that is best treated F
with an infusion of aprotinin
d) Uncontrolled bleeding can be successfully treated with human F
recombinant factor VII when the fibrinogen concentration is low
e) Blood product usage may be reduced by near patient testing using T thromboelastometry
44. In the stomach
a) Gastric distension leads to increased acid secretion T
b) Parietal cells are mainly situated around the pylorus T
c) Chief cells secrete gastrin F
d) Pepsinogen and HCL are secreted by the parietal cells F
e) Pepsinogen secretion is increased by vagal stimulation T
45. Concerning bilirubin and its metabolism
a) Bilirubin is produced in macrophages by reduction of biliverdin T
b) Bilirubin is transported to the liver in un-‐combined form F
c) 10% of bilirubin entering hepatocytes undergoes sulphonation T
d) 50% of urobilinogen absorbed from the gut is renally excreted F
e) In biliary obstruction conjugated bilirubin will not appear in the urine F
46. Baroreceptors
a) Are not found in pulmonary vessels F
b) Play a key role in the long term control of arterial blood pressure F
c) In the carotid sinus are less sensitive than those in the aortic arch F
to pulsatile pressure
d) May send afferents to the medulla via fibres in the vagus T
e) Increase their impulse frequency if BP decreases acutely F
47. Division of the sciatic nerve at the level of the ischial tuberosity is followed by:
a) Complete anaesthesia of the leg below the knee F
b) Loss of the ankle jerk T
c) Foot drop T
d) Paralysis of the hip adductors F
e) Paralysis of the rectus femoris F
48. The following problems are commonly seen in a quadriplegic patient 3-‐5 days after spinal cord trauma to C7
a) Hypotension T
b) Adductor spasm of the legs F
c) Increased resistance to suxamethonium F
d) Deep vein thrombosis F
e) Distended bladder T
49. Rocuronium
a) Competitively inhibits acetylchonine (ACh) binding to post-‐junctional T
nicotinic ACh receptors
b) Blocks Ach receptor channels for periods of about 1 sec F
c) Interacts with pre-‐synaptic nicotinic cholinergic Ach receptors T
causing a reduction in Ach release from motor nerve terminals
d) Clearance has no significant effect on its duration of action F
e) Has a relatively short onset time because it has a relatively low potency T
50. Clinically significant right to let shunting may occur in a normal 2-‐week old neonate:
a) Through a ductus venosus F
b) Through an arterial duct F
c) Through a foramen ovale F
d) Who is made severely hypoxic T
e) Who is made severely hypocarbic F
51. Drugs of a hepatic extraction ratio >0.5 include:
a) Morphine T
b) Buprenorphine T
c) Propofol T
d) Aspirin F
e) Warfarin T
52. In a neonate with a tracheo-‐oesophageal fistula
a) An oesophageal tube should be placed prior to surgery T
b) The most likely lesion involves a fistula to the distal oesophagus T
c) Associated congenital lesions rarely involve the heart F
d) After intubation the bevel of the endotracheal tube should face F
posteriorly
e) A gastrectomy should be performed prior to thoracic repair F
53. Complications of patients fed enteral nutrition include:
a) Sinusitis F
b) Pneumomediastinum F
c) Pneumonitis T
d) Diarrhoea T
e) Hypomagnesaemia T
54. Median nerve
a) Lateral to brachial artery in the cubital fossa F
b) Supplies 3 and 4 lumbricals F
c) Sensory on hypothenar eminence F
d) Supplies abductor pollicis brevis T
e) Lies deep to the flexor retinaculum T
55. Gestational diabetes mellitus
a) Affects about 14% of all pregnant women F
b) Never precedes type 1 DM F
c) Does not affect fetal prognosis F
d) Never requires treatment with insulin F
e) Is more common in women >35 years old T
56. Which of the following suggests a diagnosis of pre-‐renal failure in an oliguric patient
a) Urine specific gravity > 1.018 T
b) No urinary sedimentation F
c) Urinary Na > 20mmol/L F
d) Urine : plasma creatinine ratio > 20 F
e) Urine osmolality of 280 mosm/Kg F
57. Pulmonary hypertension has the following features
a) Pulmonary systolic pressure must be above 40mmHg F
b) Calcium blockers can reduce the pressure T
c) RBBB is a common feature of the ECG T
d) Primary disease is more common in males F
e) May follow COPD T
58. Acute tetanus due to clostridium tetani
a) Is treated with human tetanus immunoglobulin T
b) Is diagnosed by culture of clostridium F
c) May cause paralysis and need artificial ventilation T
d) Usually gets worse for 10 days following onset T
e) Beta blockers are used to treat sympathetic over activity T
59. Weil’s disease
a) Is treated with doxycycline, erythromycin and penicillin F
b) Transmitted in the urine of livestock and rats to human water supplies T
c) Caused by leptospira which are aerobic gram positive bacilis T
d) Mortality is 50% T
e) Causes vasulitis affecting all major organ systems T
60. The following drugs are bound to alpha-‐1-‐acid glycoprotein
a) Phenytoin F
b) Ibuprofen F
c) Lidocaine T
d) Warfarin T
e) Sulphonamides T