1) A pansystolic murmur developing within the first 24 hours does not require further investigation.
2) Dipyridamole therapy reduces reinfarction within the first year.
3) Heparin is beneficial if given with streptokinase.
4) Prophylactic lignocaine given in the first 48 hours is effective in preventing ventricular fibrillation
5) Treatment with a dihydropyridine calcium antagonist is associated with increased cardiovascular mortality.
2- A 30 year old male presented with a paranoid psychosis accompanied by visual hallucinations which resolved over the next three days. Which one of the following is the most likely diagnosis?
1) Alcohol withdrawal.
2) Diazepam dependence.
3) Fluoxetine overdose.
4) Heroin withdrawal.
5) Smoking cannabis.
3- Which ONE of the following oncerning Insulin is correct?
1) acts via a similar mechanism as steroid receptors
2) causes an increased glucose-protein transport on the endoplasmic reticulum
3) can be detected in the lymph
4) interacts with the nuclear membrane
5) is synthesised in the alpha cells of islets of Langerhans
4- In which of the following circumstances would the treatment of anaemia with erythropeitin still be expected to be effective?
1) Aluminium toxicity
2) Folate deficiency
3) Hyperkalaemia
4) Infection
5) Iron deficiency
5- A 70-year-old male is referred by his GP for management of recently diagnosed congestive heart failure. The patient has a history of poorly controlled hypertension. Over the last three months he has been aware of deteriorating shortness of breath, fatigue, and orthopnea. Over the last month he had been commenced on Digoxin (62.5 micrograms daily), Frusemide (80 mg daily), and amiloride 10 mg. On examination he has a pulse of 96 bpm regular, a blood pressure of 132/88 mmHg. His JVP was not raised, he had some scattered bibasal crackles on auscultation with a displaced apex beat in the anterior axillary line, 6th intercostal space. Auscultation of the heart revealed no murmurs and he had peripheral oedema to the mid tibia. Investigations showed:
electrolytes normal serum urea concentration 17 mmol/l (NR 2-8 mmol/l) creatinine 175 micromol/l (NR 55-110) Serum digoxin 0.7 ng/mL {therapeutic: 1.0-2.0}
One month previously his urea had been 11 mmol/l and creatinine 110 micromol/l. An ECG reveals left ventricular hypertrophy and Chest X-ray shows cardiomegaly and calcified aorta.
What is the most appropriate next step in management?
1) Add an ACE inhibitor to the current regimen
2) Add atenolol at a dose of 25mg daily
3) Increase digoxin to 0.25 mg daily
4) Increase frusemide to 80 mg twice daily
5) Maintain on current therapy.
6- Which one of the following drugs works by inhibiting the tumour necrosis factor?
1) cyclosporin
2) infliximab
3) methotrexate
4) montelukast
5) sulphasalazine
7- Which of the following is NOT associated with hyponatraemia and hyperkalaemia?
1) Acute hypoadrenalism
2) Carbenoxolone therapy
3) Co-Amilofruse therapy
4) Congestive cardiac failure.
5) Type IV renal tubular acidosis
8- A 70 year old male was receiving amiodarone 200 mg daily for intermittent atrial fibrillation. However, he was aware of tiredness and lethargy. He appeared clinically euthyroid with no palpable goitre. Investigations revealed:
Serum free T4 23pmol/L (9-26)
Serum total T3 0.8 nmol/L (0.9-2.8)
Serum TSH 8.2 mU/L (<5)
Which of the following statements would explain these results?
1) Abnormal thyroxine binding globulin
2) Amiodarone-induced hypothyroidism
3) 'sick euthyroid' syndrome
4) Spontaneous hypothyroidism
5) TSH secreting pituitary adenoma
9- There is presently no known effective treatment for a chronic disease. A new treatment is known to be effective in animal models and shows promise in short-term studies in patients. There is some theoretical concerns regarding possible hepato- and bone marrow toxicity although thus far, no toxicity have been observed in studies.
What is the most appropriate next step in the drug's development?
1) A case control study
2) No further studies should be done and drug development should be stopped
3) An open study
4) A randomised double blind placebo controlled study
5) A randomised single blind placebo controlled study
10- A 51-year-old female is referred by her GP over concerns about osteoporosis. She had a hysterectomy and oophorectomy because of uterine fibroids one year ago, after which she developed hot flushes that now have stopped. Her elderly mother recently fractured the neck of her femur and the patient is worried about the possibility that she too will fracture her hip later in life. She is otherwise well, is a non-smoker drinks about 5 units of alcohol weekly and has a healthy diet.
Examination reveals a fit thin female with a BMI of 18, her blood pressure is 122/88mmHg and breast examination is normal. Which of the following would you recommend for her?
1) Bisphosphonates
2) Calcitonin
3) Combined Oestrogen and progesterone therapy
4) Unopposed Oestrogen therapy
5) Vitamin D
</>2" style="display: none;"> 11- Which of the following may be responsible for an acute relapse of Systemic Lupus rythematosus in a 38 year old female?
1) hydralazine therapy
2) Pregnancy
3) Progesterone only contraceptive pill
4) Salmeterol therapy
5) Winter holiday in Lapland
12- Which of the following drugs is most likely to cause systemic lupuslike syndrome?
1) baclofen
2) isoniazid
3) methotrexate
4) procainamide
5) sulphasalazine
13- Which of the following reactions is involved in the metabolism of paracetamol under normal conditions?
1) cytochrome p450 dependent oxidation
2) hydrolysis
3) conjugation to glucuronic acid
4) conjugation to glutathione
5) acetylation
14- An 85 year old woman presented with bilateral osteoarthritis of the knees. She had no history of previous gastrointestinal disease. Which of the following is the most appropriate initial treatment for her?
1) Celecoxib
2) Naproxen
3) Dihydrocodeine
4) Paracetamol
5) Topical diclofenac.
15- A 24 year old man presented twelve hours after an overdose of dihydrocodeine 1.2 g and paracetamol 30 g. He had pinpoint pupils, a Glasgow Coma Scale score of 14 and a blood pressure of 100/60 mmHg. Which one of the following is the most appropriate management?
1) 500ml of 10% glucose intravenously over four hours.
2) Intravenous Flumazenil.
3) Intravenous Naloxone.
4) Intravenous N-acetylcysteine.
5) Oral activated charcoal.
16- A youth worker, aged 40, presents to Accident and Emergency with vomiting. On detailed questioning, he admits to having taken 36 paracetamol tablets 2 hours previously. He is vomiting profusely with a BP of 90/60. Which of the following measures would be most appropriate?
1) Paracetamol levels
2) oral methionone
3) IV N-acetyl cysteine
4) IV fluids
5) Coagulation screen
17- An 18-year-old woman is admitted after taking drugs at a night-club. Which of the following features suggest she had taken Ecstasy (MDMA)?
1) A pyrexia of 40oC
2) hypernatraemia
3) hypokalaemia
4) metabolic acidosis
5) respiratory depression
18- A 67 year old man presents with sudden onset atrial fibrillation (ventricular rate of 150/minute). His serum creatinine concentration was 250 umol/L (70-110). What is the main factor that determines the choice of loading dose of digoxin in this patient?
1) Absorption
2) Apparent volume of distribution
3) Lipid solubility
4) Plasma half-life
5) Renal clearance
19- A 30-year-old man presents with a history of transient loss of consciousness and palpitations. His ECG shows ventricular tachycardia.
Which of the following treatments should be avoided?
1) adenosine
2) amiodarone
3) DC cardioversion
4) flecainide
5) verapamil
20- A 58-year-old man has a history of obesity, gastro-oesophageal reflux disease, low back pain and IHD. He presents with large, itchy wheals over the trunk and limbs and a sensation of tightness in the throat. Which one of the following drugs is the most likely to have triggered this skin eruption?
1) aspirin
2) GTN (nitrate) spray
3) omeprazole
4) paracetamol
5) simvastatin
</>3" style="display: none;"> 21- A 43 year old woman with atopic dermatitis (atopic eczema) presented with an acute generalized exacerbation of her disease. She was admitted to hospital but failed to improve with emollients, topical betamethasone-17-valerate and oral antihistamine. Which one of the following drugs is the most appropriate treatment?
1) Acitretin
2) Amoxycillin
3) Ciclosporin
4) Colchicine
5) Dapsone
22- A 30-year-old man presents to the Accident and Emergency Department with a history of drug overdose. He is known to be repeatedly admitted with similar episodes of self-harm. On this occaision he is drowsy and has prominent hypersalivation. Which of the following agents, found on his person, is the likely cause?
1) Chlormethiazole
2) Cocaine
3) Dothiepin
4) L-dopa
5) Solvent cannister
23- Which of the following is a contraindication to immunisation?
1) Infantile eczema requiring topical steroids.
2) Oral poliomyelitis vaccine to a child on oral steroids.
3) A history of prolonged jaundice.
4) A child with congenital adrenal hyperplasia on oral cortisone.
5) A child with cerebral palsy.
24- In which of the following cases would the level of the second drug (or its effect) become elevated by adding the first?
1) Erythromycin : theophylline
2) Phenytoin : ethynoloestrodial
3) Ranitidine : cortiocosteroid
4) Rifampicin : warfarin
5) Valproate : phenobarbitone
25- Which of the following is true concerning oral hypoglycaemic agents?
1) Acarbose promotes insulin secretion in response to meals
2) Chlorpropamide induces liver enzymes
3) Glibenclamide is excreted unchanged by the kidney
4) Gliclazide inhibits gluconeogenesis
5) Metformin inhibits hepatic gluconeogenesis
26- A 44 year old male with Child's grade C cirrhosis presented with haematemesis. Which one of the following drugs, administered intravenously, would be the most appropriate, immediate, treatment?
1) Isosorbide dinitrate.
2) Omeprazole.
3) Propranolol
4) Somatostatin
5) Tranexamic acid.
27- A 25 year old male homosexual is admitted with dyspnoea and weight loss of 2 months duration. He is diagnosed with Pneumocystis pneumoniae due to AIDS. Which of the following concerning Pneumocystis pneumonia is true?
1) May have an extra pulmonary presentation
2) is always associated with X-ray changes
3) is caused by a bacterium
4) elevated serum antibodies to P. carinii helpful diagnostically
5) is best treated with intravenous pentamidine
28- A 68-year-old lady with mitral valve disease and atrial fibrillation is taking warfarin. Lately her INR has fallen and the dose of warfarin has had to be increased. Which of the following new treatments may account for this change?
1) Allopurinol
2) Amiodarone
3) Clarithromycin
4) Sertraline
5) St John's wort
29- You are an occupational health physician and have been asked by an anxious employee about contraindications to pertussis immunisation. Which of the following is a contraindication?
1) Eczema
2) Cow's milk protein intolerance.
3) Fever to 39.5°C following the first dose.
4) Redness of >2.5cm at the injection site after the first dose.
5) Hydrocephalus
30 - Which of the following is true regarding the action of Clopidogrel?
1) It inhibits cyclo-oxygenase
2) It is an ADP receptor antagonist
3) It is a glycoprotein IIb/IIIa inhibitor
4) It is a selective factor Xa inhibitor
5) It is Hydroxymethyl Coenzyme A inhibitor
</>4" style="display: none;"> 31- A 2 week old male child is brought to casualty by his concerned parents with diarrhoea and vomiting. He is the first child of a young couple. Examination reveals few features besides obvious dehydration. He is noted to have a penile length of 3.5cms. Which of the following is the most appropriate inital treatment for this patient?
1) Cow's milk allergy is the most likely diagnosis
2) gluten-enteropathy should be excluded
3) Requires urgent treatment with oral steroids
4) Requires urgent treatment with IV normal saline
5) Rota virus gastroenteritis is the most likely diagnosis
32- A 75 year old man was admitted after been found collapsed in a garden shed surrounded by a number of empty containers. On clinical examination the patient had small pupils, a heart rate of 50 beats per minute, and was frothing at the mouth. What is the most likely diagnosis?
1) Creosote poisoning.
2) Glyphosate poisoning.
3) Organophosphorus poisoning.
4) Paraquat poisoning.
5) Pyrethroid poisoning.
33- Which of the following is a true of cutaneous anthrax?
1) causes a black eschar which overlies pus
2) lesions are usually painful and tender
3) lesions are associated with marked oedema
4) Mortality is approximately 20% despite antibiotic therapy
5) Is very likely to occur in subjects exposed to anthrax spores
34- A young woman has acne and is taking oral medication. She develops polyarthritis and raised liver enzyme tests. Investigations show AST 95 413 ALT 170 bilirubin 16
antinuclear antibodies strongly positive at 1/640, negative at 1/20
Which of the following drugs is she most likely to have been prescribed?
1) erythromycin
2) isotretinoin
3) minocycline
4) oxytetracycline
5) trimethoprim
35- A 74-year-old man with a thirty year history of psoriasis presented with generalised erythroderma of 3 days duration. Examination reveals him to be shivering but otherwise is well. He was treated as an inpatient with emollients and attention to fluid replacement and temperature control but failed to improve after five days. What is the most appropriate next treatment?
1) Oral hydroxychloroquine
2) Oral methotrexate
3) Oral prednisolone
4) Topical coal tar
5) Topical dithranol
36- A previously fit, 30-year-old female presents with a four day history of intractable pruritus and urticaria. What is the most appropriate initial management?
1) Chlorpheniramine
2) Prednisolone
3) Ranitidine
4) Topical hydrocortisone
5) topical mepyramine
37- Cannabinoids. Which is the incorrect statement?
1) Bioavailability after oral administration is about 16%
2) Inhibit eicosanoid synthesis
3) Lower intraocular pressure
4) Naloxone blocks the antinociceptive actions of cannabinoids
5) 9-tetrahydrocannabinol is an active constituent of the resin
38- With which of the following is hyperprolactinaemia associated?
1) Cabergoline therapy
2) Depression
3) Fluoxetine therapy
4) Hyperthyroidism
5) Sheehan's syndrome
39- A 35 year old woman with alcoholic cirrhosis is admitted with deteriorating encephalopathy and abdominal discomfort. An ascitic tap revealed a polymorphonuclear cell count of 350 cells per mm3. Which of the following is the most appropriate therapy?
1) Intravenous amoxicillin
2) Intravenous cefotaxime
3) Intravenous metronidazole
4) Oral neomycin
5) Oral norfloxacin
40- Which of the following is a feature of Vancomycin-resistant enterococci?
1) cause resistant infective diarrhoea
2) produce an enzyme that inactivates vancomycin
3) may be found in healthy community volunteers not recently hospitalized
4) high dose ampicillin is the treatment of choice
5) are commonly vancomycin-dependent
</>5" style="display: none;"> 41- Which one of the following is a recognised treatment option in poisoning?
1) ethanol for isopropyl alcohol poisoning
2) glucagon for cocaine poisoning
3) methylene blue for cyanide poisoning
4) N-acetylcysteine in paraquat poisoning
5) pralidoxime in sarin (nerve gas) poisoning
42- A 78 year old female is referred by her GP with high blood pressure. Over the last three months her blood pressure is noted to be around 180/80 mmHg. She has a body mass index of 25.5kg/m2, is a nonsmoker. There are no features to suggest a secondary cause for her hypertension.
Which of the following is the most appropriate treatment for her blood pressure?
1) Alpha-Blocker
2) Angiotensin Converting Enzyme (ACE) Inhibitor
3) Angiotensin Blocker
4) Beta-blocker
5) Calcium channel blocker
43- A 56 year old male with left ventricular systolic dysfunction was dyspnoeic on climbing stairs but not at rest. The patient was commenced on ramipril and frusemide. Which one of the following drugs would improve the patient's prognosis?
1) Amiodarone
2) Amlodipine
3) Bisoprolol
4) Digoxin
5) Nitrate therapy
44- A 70 year old female is admitted 12 hours after taking an overdose of aspirin. Investigations revealed: Serum sodium 138 mmol/L (137-144), Serum potassium 5.9 mmol/L (3.5-4.9), Serum bicarbonate 14 mmol/L (20-28), Serum urea 18.1 mmol/L (2.5-7.5), Serum creatinine 238 umol/L (60-110), Serum salicylate 1120 mg/L (8 mmol/L). What is the most appropriate treatment of this patient?
1) Haemodialysis
2) Haemofiltration
3) Intravenous sodium bicarbonate.
4) Peritoneal dialysis.
5) Urine alkalinization.
45- A 40-year-old man attending a routing screening has a blood pressure of 166/100 mmHg. Two weeks later his blood pressure was 150/90 mmHg. He does not smoke. He drinks 35 units alcohol / week. His body mass index (BMI) is 30 kg/m2 (20 - 25). What is the best management strategy?
1) amlodipine
2) atenolol
3) bendrofluazide
4) enalapril
5) lifestyle advice
46- In a chronic disease which has no known effective treatment, a new treatment is known to be effective in animal models and shows promise in short-term studies in patients. There are some theoretical concerns about toxicity involving liver and bone marrow although no cases have been observed in studies so far. What is the most appropriate next step in the drug's development?
1) case control study
2) No further studies should be done and drug development should be stopped
3) open study
4) randomised double blind placebo controlled study
5) randomised single blind placebo controlled study
47- Which of the following compounds has a vasodilating effect?
1) Antidiuretic hormone
2) Calcitonin
3) Endothelin
4) Renin
5) Somatostatin
48- In malignant hyperpyrexia:
1) A mortality rate of 20% may be expected
2) Elevation of serum creatine kinase and myoglobinuria is diagnostic
3) Muscle biopsy may be histologically normal
4) The only available specific treatment is sodium dantrolene, which has a neutral pH
5) The predisposing gene is thought to be on chromosome 9
49- Which of the following anti-microbials is associated with prolongation of the QT interval?
1) Co-amoxiclav
2) Gentamicin
3) Cefuroxime
4) Erythromycin
5) Isoniazid
50- A study has been designed to investigate whether a certain drug plus physiotherapy treatment is better than drug treatment alone in the management of rheumatoid arthritis. After randomizing the patients a small proportion of the drug plus physiotherapy group decide to drop out of the study or omit some treatment sessions specified in the research protocol. What is the correct way of analysing the subsequent data?
1) Assume the patients have withdrawn their consent
2) Exclude these patients from all analysis
3) Extend the trial recruitment to make up the numbers
4) Include these patient outcomes in the drug plus physiotherapy group
5) Interview the patients and report their group separately
</>6" style="display: none;"> 51- Useful therapy for improving fertility in Polycystic ovarian syndrome include
1) Cyproterone acetate
2) Ethinyl oestradiol
3) Metformin
4) Glibenclamide
5) Spironolactone
52- A 45 year old male type 1 diabetic with a number of complex diabetic gastrointestinal complications is noted to have a PR interval of 0.18s, a QRS duration of 0.1s and a QT interval of 0.48s on routine ECG. Which of the following drugs may be responsible?
1) Cisapride
2) Octreotide
3) Co-trimoxazole
4) Domperidone
5) Cimetidine
53- Which of the following is true of radioactive iodine (131I) therapy?
1) Causes hypothyroidism in 90% of treated patients within 3 months
2) Causes a deterioration in ophthalmopathy in patients with Graves disease
3) Is associated with a subsequently increased risk of infertility
4) Is associated with an increased risk of thyroid lymphoma
5) Is the preferred treatment in amiodarone induced thyrotoxicosis
54- Erythropoietin therapy causes
1) Benign intracranial hypertension
2) Myositis
3) Hypotension
4) Seizures
5) Osteoporosis
55- Which of the following is a feature of Vancomycin-resistant enterococci?
1) cause resistant infective diarrhoea
2) produce an enzyme that inactivates vancomycin
3) may be found in healthy community volunteers not recently hospitalized
4) high dose ampicillin is the treatment of choice
5) are commonly vancomycin-dependent
56- Oral therapy with which of the following may cause galactorrhoea?
1) Bromocriptine
2) Cabergoline
3) Spironolactone
4) Cimetidine
5) Domperidone
57- Which of the following is currently recommended as the drug of choice in treating refractory ventricular fibrillation or pulseless ventricular tacchycardia?
1) Adenosine
2) Amiodarone
3) Bretyllium
4) Lignocaine
5) Magnesium
58- A 55 year old man presents with gynaecomastia while receiving treatment for Heart failure.
Which of the following drugs is most likely to be the cause of his gynaecomastia?
1) Amiloride
2) Carvedilol
3) Frusemide
4) Omeprazole
5) Ramipril
59- An elderly man with a history of asthma, congestive heart failure, and peptic ulcer disease is admitted with bronchospasm and rapid atrial fibrillation. He recieves frequent nebulised salbutamol and IV digoxin loading, his regular medications are continued. 24 hours after admission his serum potassium is noted to be 2.8 mmol/l. Which of his medications is most likely to have caused this abnormality.
1) Digoxin
2) ACE inhibitor
3) Salbutamol
4) Ranitidine
5) Spironolactone
60- A 24-year-old man presents with a headache that has been present for nine months. He has headache almost every day, mainly frontal, sometimes with nausea. Current medication includes paracetamol, brufen and codeine with only transient relief of symptoms. He has a history of depression. Examination was normal.
What is the most likely diagnosis?
1) analgesic misuse headache
2) cluster headache
3) frontal brain tumour
4) headache due to depression
5) migraine
</>7" style="display: none;"> 61- A 68 year old woman was admitted to hospital with evidence of biventricular cardiac failure. On examination her pulse was 100 beats per minute (sinus rhythm), and her blood pressure was 140/60 mmHg. She had haemorrhages in both fundi. Her condition improved after
intravenous diuretics.
Investigations revealed:
haemoglobin 5.6 g/dl (11.5 – 16.5)
haematocrit 0.19 (0.36 – 0.47)
MCV 118 fl (80 – 96)
MCH 33.0 pg (28 – 32)
WCC 3.4 x 109/L (4 – 11)
platelet count 95 x 109/L (150 – 400)
What is the next most appropriate step in management?
1) blood transfusion
2) bone marrow aspiration
3) intramuscular vitamin B12 alone
4) intramuscular vitamin B12 and oral folic acid together
5) oral folic acid alone
62- With regard to poisoning / overdose:
1) Phenobarbitone causes a metabolic acidosis
2) Ethylene glycol causes a metabolic alkalosis and renal failure
3) Aspirin causes acidosis due to hypoventilation
4) Methanol causes a metabolic acidosis with an increased anion gap
5) Chlormethiazole causes hyperthermia and hypertension
63- Which of the following is NOT associated with hyponatraemia and hyperkalaemia?
1) Acute hypoadrenalism
2) Carbenoxolone therapy
3) Co-Amilofruse therapy
4) Congestive cardiac failure.
5) Type IV renal tubular acidosis
64- A 55-year-old woman was found to have ++ glycosuria and had a maternal history of Type II diabetes mellitus. She was a smoker of 20 cigarettes per day. Examination reveals no specific abnormalities apart from a BMI of 30. Blood pressure was 132/88 mmHg.
Investigations reveal:
serum creatinine 80 µmol/L (60 – 110)
plasma glucose (fasting) 11.3 mmol/L (3.0 – 6.0)
total serum cholesterol 5.5 mmol/L (<5.2)
HDL cholesterol 1.4 mmol/L (>1.55)
What is most likely to improve her life expectancy?
1) Metformin 500 mg bd
2) Ramipril 10 mg daily
3) Simvastatin 10 mg daily
4) Stopping smoking
5) Weight loss to achieve a BMI of 25
65- Baclofen
1) acts directly on skeletal muscle
2) causes rhabdomyolysis
3) reduces cerebral but not spinal spasticity
4) cause hallucinations when withdrawn
5) reduce Ca2+ release from sarcoplasmic reticulum
66- Which one of the following is correct regarding long-acting beta-2 agonists?
1) Can be used to prevent activity-induced symptoms without anti-inflammatory therapy.
2) Become less effective over time (tolerance).
3) Are beneficial in acute viral croup.
4) Protect against allergen challenge for up to 48 hours.
5) Should not be used in association with erythromycin.
67- A 50-year-old lady suffers with migraine. She smokes 20 cigarettes a day. She has found that paracetamol 1 g was not always effective in relieving her pain. Which of the following factors is the most likely to account for this problem?
1) altered volume of distribution
2) delayed gastric emptying
3) first pass metabolism
4) hepatic enzyme induction
5) reduced gut blood flow
68- In the treatment of osteoporosis, which of the following best describe the drug Raloxifene?
1) A Bisphosphonate
2) A Calcium Receptor Modulator
3) An Estrogen
4) A PTH receptor agonist
5) A Selective Estrogen Receptor Modulator
69- In which of the following have randomised controlled trials shown that long-term oxygen therapy (LTOT) reduces mortality?
1) Asthma
2) Cor pulmonale due to chronic airflow obstruction
3) Cryptogenic fibrosing alveolitis
4) Cystic fibrosis
5) Pulmonary sarcoidosis
70- A firm 2 to 3 cm mass is palpable in the upper outer quadrant of the right breast of a 52-year-old woman. There are no palpable axillary lymph nodes. A lumpectomy with axillary node dissection is performed and the breast lesion is found to have positive immunohistochemical staining for HER2/neu (c-erb B2). Staining for oestrogen and progesterone receptors is negative. Which of the following additional treatment options is most appropriate, based upon these findings?
1) Radical mastectomy
2) St John's wort
3) Tamoxifen
4) Trastuzumab
5) Vancomycin
</>8" style="display: none;"> 71- Which of the following is the oral hypoglycaemic agent Rosiglitazone?
1) A Perixisome Proliferator Activating Receptor (PPAR)-alpha agonist
2) A Peroxisome Proliferator Activating Receptor (PPAR)-gamma agonist
3) A Sulphonylurea
4) A Biguanide
5) An alpha-Glucosidase inhibitor
72- Which of the following is true concerning oral hypoglycaemic agents?
1) Acarbose promotes insulin secretion in response to meals
2) Chlorpropamide induces liver enzymes
3) Glibenclamide is excreted unchanged by the kidney
4) Gliclazide inhibits gluconeogenesis
5) Metformin inhibits hepatic gluconeogenesis
73- The following are the causes of drug induced hepatitis except:
1) Isoniazid
2) Amiodarone
3) Pyrazinamide
4) Ethambutol
5) Methyldopa
74- A 21 year old female with epilepsy is well controlled on sodium valproate 600mg bd and had been taking oral contraceptives for three years. She presented to her general practitioner 12 weeks pregnant. Which of the following is correct?
1) An alternative anticonvulsant should be used in place of sodium valproate
2) Interaction of sodium valproate with the oral contraceptive increased the risk of pregnancy
3) The dose of sodium valproate should be increased
4) There is an increased risk of a neural tube defect in her fetus
5) She is at increased risk of anaemia in pregnancy
75- Which of the following antiarrhythmic drugs may be used in the treatment of long QT syndrome?
1) Amiodarone
2) Atenolol
3) Flecainide
4) Propofanone
5) Sotalol
76- A new drug is being studied to find the most appropriate dose in a dose response study. Small doses of the drug lead to a linear increase in serum drug concentration. At higher doses there is an exponential rise in serum drug concentration. Which of the following best describes the pharmacokinetic properties of this new drug?
1) first order kinetics
2) first pass effect
3) long plasma half life
4) saturation kinetics
5) zero order kinetics
77- Which of the following concerning the conjugation of bilirubin is correct?
1) is catalysed by a glucuronyl transferase
2) occurs in the Kupfer cells of the liver
3) is increased by valproate
4) is inhibited by rifampicin
5) is impaired in Dubin-Johnson syndrome
78-Which of the following doses of prednisolone is equivalent in its glucocorticoid potency to 20mg of hydrocortisone.
1) 2 mg
2) 5 mg
3) 10 mg
4) 15 mg
5) 20 mg
79- A 33 year old epileptic female presents with visual problems. Examination reveals a constriction of visual fields to confrontation. Which of the following may be responsible for her visual deterioration?
1) Vigabatrin
2) Lamotrigine
3) Gabapentin
4) Phenytoin
5) Sodium Valproate
80- A 2 week old male child is brought to casualty by his concerned parents with diarrhoea and vomiting. He is the first child of a young couple. Examination reveals few features besides obvious dehydration. He is noted to have a penile length of 3.5cms. Which of the following is the most appropriate inital treatment for this patient?
1) Cow's milk allergy is the most likely diagnosis
2) gluten-enteropathy should be excluded
3) Requires urgent treatment with oral steroids
4) Requires urgent treatment with IV normal saline
5) Rota virus gastroenteritis is the most likely diagnosis
</>9" style="display: none;"> 81- Which of the following statements concering the treatment of acute myocardial infarction is correct?
1) A pansystolic murmur developing within the first 24 hours does not require further investigation.
2) Dipyridamole therapy reduces reinfarction within the first year.
3) Heparin is beneficial if given with streptokinase.
4) Prophylactic lignocaine given in the first 48 hours is effective in preventing ventricular fibrillation
5) Treatment with a dihydropyridine calcium antagonist is associated with increased cardiovascular mortality.
82- A 67 year old man presents with sudden onset atrial fibrillation (ventricular rate of 150/minute). His serum creatinine concentration was 250 umol/L (70-110). What is the main factor that determines the choice of loading dose of digoxin in this patient?
1) Absorption
2) Apparent volume of distribution
3) Lipid solubility
4) Plasma half-life
5) Renal clearance
83- Folic acid metabolism can be affected by
1) tetracycline
2) pyrimethamine
3) vitamin B12
4) penicillin
5) brufen
84- Which ONE statement is true regarding the treatment of iron deficiency anaemia:
1) iron is absorbed in the distal jejunum
2) absorption of iron is increased by ascorbic acid
3) sustained release iron is a useful way of giving larger doses
4) ferrous sulphate 200mg has less elemental iron than the same dose of ferrous gluconate
5) parenteral iron is indicated when the anaemia responds slowly to oral iron
85- Which of the following concerning Pityriasis rosea is correct?
1) It is due to a fungal infection
2) It is characterised by flat scaly patches
3) It is frequently associated with oro-genital itching
4) May be preceded by intense itching
5) Tends to recur after apparent cure
86- A 76-year-old with a recent history of cerebral haemorrhage is admitted with a cough, worsening breathlessness and right pleuritic chest pain. He is also mildly pyrexial. His ventilation-perfusion scan reveals several areas of ventilation/perfusion mismatches. What is the most appropriate line of management?
1) aspirin therapy
2) antibiotics
3) inferior vena cava filter
4) low molecular weight heparin treatment
5) warfarin treatment
87- A 70 year old male was receiving amiodarone 200 mg daily for intermittent atrial fibrillation. However, he was aware of tiredness and lethargy. He appeared clinically euthyroid with no palpable goitre.
Investigations revealed:
Serum free T4 23pmol/L (9-26)
Serum total T3 0.8 nmol/L (0.9-2.8)
Serum TSH 8.2 mU/L (<5)
Which of the following statements would explain these results?
1) Abnormal thyroxine binding globulin
2) Amiodarone-induced hypothyroidism
3) 'sick euthyroid' syndrome
4) Spontaneous hypothyroidism
5) TSH secreting pituitary adenoma
88- 56 year old male with left ventricular systolic dysfunction was dyspnoeic on climbing stairs but not at rest. The patient was commenced on ramipril and frusemide. Which one of the following drugs would improve the patient's prognosis?
1) Amiodarone
2) Amlodipine
3) Bisoprolol
4) Digoxin
5) Nitrate therapy
89- A 60-year-old man with a past history of controlled hypertension presents with acute onset weakness of his left arm, that resolved over 12 hours. He had suffered two similar episodes over the last three months. Examination reveals a blood pressure of 132/82 mmHg and he is in atrial fibrillation with a ventricular rate of 85 per minute. CT brain scan is normal.
What is the most appropriate management?
1) amiodarone
2) aspirin
3) digoxin
4) dipyridamole
5) warfarin
90- A 45 year old female presents with a 6 month history of exertional dyspnoea and is diagnosed with pulmonary fibrosis. Over the last one year she has received a variety of medications. Which of the following drugs could be responsible?
1) Dexamethasone
2) Ibuprofen
3) nalidixic acid
4) penicillamine
5) sulphasalazine
</>10" style="display: none;"> 91- Which statement is true regarding Gabapentin?
1) is a potent hepatic enzyme inducer
2) side effects typically include visual field defects with long-term use
3) therapy is best monitored through measuring plasma concentrations
4) is of particular value as monotherapy in absence attacks (petit mal)
5) requires dose adjustment in renal disease
92- Which of the following relate to Dopa-decarboxylase inhibitors?
1) enhance the effect of levodopa on the substantia nigra
2) reduce the extracerebral complications of L-dopa therapy
3) have anticholinergic activity
4) should not be given in combination with dopamine agonists
5) prevent L-dopa associated dyskinesias
93- The antibiotic combination Quinipristin and Dalfopristin are
1) effective against resistant mycobacterium TB.
2) indicated in subjects with chronic renal impairment.
3) particularly effective in the treatment of pseudomonas infection in Cystic fibrosis.
4) administered orally.
5) Effective against multi-resistant Staph Aureus
94- A 60-year-old Chinese man has been started on quinine for leg cramps by his General Practitioner. He presents, a week later, with 5 days of darkened urine and 2 days of increasing breathlessness, back pain and fatigue. Investigations show a haemoglobin of 7.0 g/dl and raised reticulocyte count. Which of the following best explain this drug reaction?
1) autoimmune haemolytic anaemia
2) glucose-6-phosphate dehydrogenase deficiency
3) hereditary spherocytosis
4) pyruvate kinase deficiency
5) sickle cell disease
95- An 18-year-old woman is admitted after taking drugs at a night-club. Which of the following features suggest she had taken Ecstasy (MDMA)?
1) A pyrexia of 40°C
2) hypernatraemia
3) hypokalaemia
4) metabolic acidosis
5) respiratory depression
96- A 65-year-old was advised to start oral digoxin at a dose of 250 µg daily. His physician explained that the full effect of this treatment would not be apparent for at least a week. Which one of the following pharmacokinetic variables did the physician use to give this explanation?
1) bioavailablity
2) half-life
3) plasma protein binding
4) renal clearance
5) volume of distribution
97- A 70-year-old male is referred by his GP for management of recently diagnosed congestive heart failure. The patient has a history of poorly controlled hypertension. Over the last three months he has been aware of deteriorating shortness of breath, fatigue, and orthopnea. Over the last month he had been commenced on Digoxin (62.5 micrograms daily), Frusemide (80 mg daily), and amiloride 10 mg. On examination he has a pulse of 96 bpm regular, a blood pressure of 132/88 mmHg. His JVP was not raised, he had some scattered bibasal crackles on auscultation with a displaced apex beat in the anterior axillary line, 6th intercostal space. Auscultation of the heart revealed no murmurs and he had peripheral oedema to the mid tibia.
Investigations showed:
electrolytes normal
serum urea concentration 17 mmol/l (NR 2-8 mmol/l)
creatinine 175 micromol/l (NR 55-110)
Serum digoxin 0.7 ng/mL {therapeutic: 1.0-2.0}
One month previously his urea had been 11 mmol/l and creatinine 110 micromol/l. An ECG reveals left ventricular hypertrophy and Chest X-ray shows cardiomegaly and calcified aorta.
What is the most appropriate next step in management?
1) Add an ACE inhibitor to the current regimen
2) Add atenolol at a dose of 25mg daily
3) Increase digoxin to 0.25 mg daily
4) Increase frusemide to 80 mg twice daily
5) Maintain on current therapy.
98- A 19 year old female presents with acute breathlessness. She has had asthma for approximately 3 years and recently commenced new therapy. Which agent may be responsible for this exacerbation?
1) Salmeterol
2) Theophylline
3) Beclomethasone
4) Ipratropium bromide
5) Monteleukast
99- The anticonvulsant Levetiracetecam
1) Is used as monotherapy for the treatment of generalised convulsions
2) Acts via the GABA receptor
3) Is associated with induction of hepatic cytochrome p450 enzymes
4) Is well absorbed via the oral route
5) Is associated with increased plasma concentrations of sodium valproate
100- A 40-year-old man attending a routing screening has a blood pressure of 166/100 mmHg. Two weeks later his blood pressure was 150/90 mmHg. He does not smoke. He drinks 35 units alcohol / week.
His body mass index (BMI) is 30 kg/m2 (20 - 25). What is the best management strategy?
1) amlodipine
2) atenolol
3) bendrofluazide
4) enalapril
5) lifestyle advice
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