MBBS Therapeutic Assessment 9 December 2000

ONE MARK WILL BE AWARED FOR EACH CORRECT ANSWER AND ONE MARK WILL BE DEDUCTED FOR EACH WRONG ANSWER. NO MARKS WILL BE DEDUCTED FOR UNATTEMPTED QUESTIONS

Indicate whether the statements given below are true (T) or false (F) by shading the appropriate circles on the answer card.

1.	A 60-year-old man presented with peritonitis and at laparotomy was found to have a perforation to a tumor. In the management of peritonitis:

a.	benzylpenicillin is preferred to metronidazole because it has broader coverage against anaerobes including Bacteroides fragilis. F
b.	gentamicin may be included in the antimicrobial regimen because it is effective against most of the members of the Enterobacteriaecae family. T
c.	a third generation cephalosporin, like ceftriaxone, may be used as it should cover most of the aerobic gram-negative bacili. T
d.	cefriaxone has adequate coverage against anaerobes including Bacteroides fragilis. F

2.	In the management of peritonitis due to a perforated colon the antimicrobial regimen that is administered is dependent on factors such as:

a.	history of drug allergies. T
b.	renal function if metronidazole is used. F
c.	liver function if an aminoglycoside is to be used. F
d.	immune status. T

3.	In the choice of antibiotics for the treatment of peritonitis secondary to a perforated colon the following statements are true:

a.	the infection is polymicrobial. T
b.	an antifungal drug should be included in the treatment regimen. F
c.	antimicrobial treatment alone without surgical intervention is appropriate. T
d.	antimicrobial therapy should cover members of the Enterobactericae family and anaerboes. T

4.	In the management of a patient with a severe asthmatic attack:

a.	inhaled salbutamol is given for immediate relief. T
b.	intravenous steroids may be initiated at the same time. T
c.	intravenous aminophylline should be given as a rapid bolus. F
d.	subcutaneous adrenaline is effective in relieving bronchospasm but is seldom used because of cardiovascular side effects. T

5.	In the long-term management of asthma:

a.	the drug that is prescribed depends on the frequency of the asthmatic attacks. T
b.	oral theophylline should not be used. F
c.	oral steroid is the drug of choice. F
d.	inhaled salbutamol is sued to prevent asthmatic attacks. T

6.	The following statements describe the adverse reactions of drugs used in the management of asthma:

a.	pharyngeal candidiasis is associated with inhaled salbutamol. F
b.	increased risk of infection is associated with oral steroids. T
c.	salbutamol may cause tachycardia. T
d.	theophylline may cause arrhythmias. T

7.	The following drug(s) can be used in the initial management of patients who suffer from depression and insomnia:

a.	combination of benzodiazepines and flluoxetine. T
b.	amitriptyline alone. T
c.	fluoxetine alone. F
d.	benzodiazepine alone. F

8.	In the management of elderly depressed patients:

a.	tricyclic antidepressants are most suitable.
b.	mood elevating effect is immediately detected. F
c.	paroxetine causes less anticholinergic effects than amitriptyline. T
d.	SSRIs are more efficacious than TCAs. F

9.	In the management of patients with psychotic depression:

a.	combination of haloperidol and antidepressant may be used. T
b.	combination of clozapine and antidepressant may be used. F
c.	electro-convulsive therapy may be used. T
d.	moclobemide amy be used. F

10.	In the management of an obese diabetic:

a.	diet and exercise should first be prescribed. T
b.	metformin may be given for the first two months to help the patient to lose weight. T
c.	tolbutamide and metformin should be given together at the first visit. F
d.	chlorpropamide is a better choice than glibenclamide because it is more potent. F

11.	In the obese type II diabetic patient who does not respond to diet and metformin:

a.	poor drug compliance may be a factor. T
b.	there may be inadequate circulating insulin levels. T
c.	caloric intake may have to be reduced. T
d.	insulin should be introduced. F

12.	The following drugs have antibacterial action against Helicobacter pylori infection:

a.	tetracycline. T
b.	metronidazole. T
c.	bismuth subsalicylate. T
d.	ranitidine. F

13.	Interactions may occur between the following drugs:

a.	sucralfate and omeprazole. T
b.	antacids and tetracycline. T
c.	omeprazole and warfarin. T
d.	antacids and digoxin. T

14.	In patients who have a peptic ulcer in the absence of Helicobacter pylori infection, the following drugs may help to heal the ulcer:

a.	omeprazole. T
b.	cimetidine. T
c.	aspirin. F
d.	clarithromycin. F

15. 	In the management of idiopathic hypertension:

a.	one should focus upon managing the blood pressure and not be distracted by concurrent problems, such as hyperlipidaemia. F
b.	lack of compliance with medication is usually not a problem. F
c.	the therapeutic aim is to reduce the blood pressure down to 120 / 80 mmHg. F
d.	reduction of blood pressure is associated with a lowering of cardiovascular risk. T

16.	The following are true of these antihypertensive drugs:

a.	hydrochlorothiazide may be used for managing mild hypertension. T
b.	losartan is just as reliable to produce dry cough as captopril. F
c.	nifedipine is able to produce smooth control of blood pressure over 24 hours. F
d.	atenolol is extensively metabolized by the liver. F

17.	In the management of idiopathic hypertension:

a.	the major therapeutic endpoint is to reduce the risk of cardiovascular related morbidity and mortality.
b.	non-pharmacological methods may be as important as pharmacological ones. T
c.	it is important to try and achieve blood pressure lowering effects that are widely different between the beginning and end of the dosage interval. F
d.	it is important to exclude the effect of white coat hypertension. T

18.	In the management of pain following abdominal surgery:

a.	patient controlled analgesia is able to provide smooth pain control over a 24-hour period. T
b.	NSAIDs are usually adequate. F
c.	intramuscular morphine often induces nausea and vomiting. T
d.	adequate analgesia has been shown to hasten the recovery process. T

19.	In managing pain associated with late-stage cancer:

a.	opioid analgesics should not be used. F
b.	anti-depressant drugs may reduce the need for analgesics. T
c.	one should aim to provide at least 8 hours of pain free sleep per day. T
d.	non-pharmacological methods are ineffective F.

20.	The following are true of these analgesics:

a.	opioid analgesics may produce respiratory depression even at therapeutic doses. F
b.	morphine has a high first pass metabolism. T
c.	morphine should never be administered orally. F
d.	buprenorphine may be administered sublingually. T