Multi-Choice Questions: Analgesia Toxicology and Antibiotics
David Lang
Q1: All of the following may cause seizures directly or indirectly
A: Tramadol
B: M3G
C: M6G
D: Hydromorphone
E: Flumazenil
Q2: The following opiate with the least intrinsic activity is.
A: Propoxyphene
B: Alfentanil
C: Codeine
D: Nefopam
E: Meperidine
Q3: Regarding spinal pain transmission and the opiates one is false.
A: Pre-synaptic terminals have mu, delta and kappa receptors.
B: Binding mu receptors on post-synaptic terminal opens K+ channels.
C: Decrease in Ca++ influx pre-synaptically can be mediated by opiate
D: Opiates affect afferent pain transmission but also efferent pain
E: NMDA blockade increases tolerance to opiates.
Q4: Complications related to COX-2 inhibitors include.
A: Gastrointestinal bleeding.
B: Renal failure.
C: Increase in adverse cardiovascular events.
D: Sulphur allergy.
E: All of the above.
Q5: Medication with anti-inflammatory properties in gout include all
A: Prednisone
B: Colchicine
C: Tolmetin
D: Indomethacin
E: Celecoxib
Q6: Diet supplementation with fish eicosapentaenoic acid
A: Decreases inflammation by elevating vitamin D levels.
B: Is not as efficient as NSAIDs at reducing inflammation.
C: Is a saturated fatty acid.
D: Forms eicosanoids several orders less potent than usual.
E: Effects have not been clinically studied.
Q7: Regarding carbon monoxide one is false.
A: It is readily formed by incomplete combustion of carbon.
B: The fetus is protected by the maternal circulation from toxic
C: The hemoglobin affinity is 220 times that of oxygen.
D: The half life is 5 hours and 20 mins breathing air.
E: Smokers can exibit carboxyhemoglobin levels of 5-10 per cent.
Q8: Bio-accumulation is a feature of which substance.
A: Carbamates.
B: Organophosphates.
C: Ozone.
D: Mercury.
E: None of the above.
Q9: Chelation therapy for heavy metal poisoning.
A: Chelation for lead has little compelling evidence in the
asymptomatic individual.
B: Deferoxamine therapy increases susceptibility to Yersinia
enterocolitica infection.
C: Chelation therapy is useful in cadmium intoxication.
D: Peanut allergy is a contraindication to the use of intramuscular
E: L-Penicillamine frequently causes pyridoxine deficiency.
Q10: A primarily bacteriostatic antibiotic is.
A: Metronidazole
B: Chloramphenicol
C: Penicillin
D: Vancomycin
E: Gentamicin
Q11: If penicillin together with tetracycline is tested for synergy and
is found in combination to achieve MIC at 3mg/L of penicillin and 3mg/L of
tetracycline compared to a MIC of 0.5mg/L for each drug on its own then the FIC
index is.
A: 3
B: 6
C: 9
D: 12
E: 1/6
Q12: For Question 11 one of the following statements is false.
A: Damage to the bacteria at two sites simultaneously has not enhanced
B: Antibiotics displaying indifference of effect approach a FIC index
of 2.
C: Antibiotics displaying similar action without synergy approach FIC
index of 1.
D: Synergy is an increase in expected effect above the sum of individual
antibiotic effects  had
they been acting alone.
E: Synergy is seen at greater than or equal to 4.
Q13: Cefoxitin and Piperacillin interact in the following way to
achieve antagonism.
A: Induction of enzymatic inactivation by beta-lactamase for some
B: Competitive inhibition at PBPs.
C: Cidal inhibition by static agent.
D: Achieve high levels of synergy.
E: Are not available in Australasia
and are irrelevant.
Q14: All the penicillins need dose adjustment in renal failure except.
A: Penicillin G
B: Dicloxacillin
C: Amoxicillin/ Clavulanate
D: Ticarcillin
E: Penicillin V
Q15: For cross reaction/ hypersensitivity one of the following is
A: Penicillins/ Monobactams no cross reactivity.
B: Vancomycin: release of histamine.
C: Penicillins/ Cephalosporin 20% cross reactivity.
D: Penicillins/ Carbapenems 50% cross reactivity.
E: Penicillin/ Erythromycin no cross reactivity.
Q16: The best CSF penetration of the beta lactam containing antibiotics
is achieved by.
A: Cefotaxime
B: Ceftriaxone
C: Meropenem
D: Penicillin G
E: Aztreonam
Q16: Chloramphenicol has the following features except one.
A: In doses above 50mg/kg/d in infants may cause grey baby syndrome.
B: It is an inhibiter of microsomal enzymes.
C: It binds reversibly to the 50s subunit inhibiting protein synthesis.

D: It penetrates virtually every tissue to near serum levels.
E: Agranulocytosis is idiosyncratic, 1: 24-40,000 cases and tends to be
Q18: A lactone ring is a feature of all the following drugs except:
A: Erythromycin
B: Clindamycin
C: Amphotericin B
D: Clarithromycin
E: Ivermectin
Q19: MLS Resistance will give resistance to all the following
antibiotics except.
A: Quinupristin/ Dalfopristin
B: Linezolid
C: Roxithromycin
D: Clindamycin
E: Lincomycin.
Q20: Sulphonamide antibiotics.
A: Do not affect mammalian cells as they rely on exogenous folate.
B: Act as PABA analogues inhibiting Dihydrofolate reductase.
C: Gain synergy from other folate metabolic pathway inhibitors acting
at alternat sites.
D: Have activity against protozoa, fungi and bacterial species.
E: Share hypersensitivity with COX2 inhibitors/ carbonic anhydrase
inhibitors/ loop diuretics and oral hypoglycaemic agents.
Q21: Fluoroquinolones exibit all the following except.
A: Risk of tendinitis and arthropathy.
B: QTc prolongation worsened by erythromycin administration.
C: Resistance arising with 1: 10 to the 7-9 due to point mutations.
D: Act via inhibition of topoisomerase II and IV
E: The newest agents including moxifloxacin have improved pseudomonal
Q22: With the anti-Tubercular drugs the following associations are true
A: Rifampcin: yellow staining of soft contact lenses.
B: Pyrazinamide: taken up by phagocytes and more active in this acidic
C: Streptomycin: well tolerated orally and given as fourth agent
pending sensitivity.
D: Isoniazid: inhibition of mycolic acid production in cell wall.
E: Ethambutol: red green colour blindness.
Q23: One of the following is true for the imidazoles vs the triazoles.
A: The triazoles are more specific for fungal p450
B: The imidazoles are less toxic parenteral.
C: Fluconazole has poor CSF penetration due to insolubility in water.
D: Both these medications act to activate p450 digestion of fungal cell
E: Flucytosine is a close relative with similar action.
Q24: The neucleotide-like antivirals include all except.
A: acyclovir
B: ganciclovir
C: zidovudine
D: lamivudine
E: nevirapine
Q25: The most generally active of the following antimicrobials is.
A: Sodium hypochlorite
B: Phenols
C: Alcohols
D: Chlorhexidine
E: Sodium bicarbonate
Q26: You are treating a patient with P.falciparum form rural Thailand and
you are primarily worried about.
A: The residency status of your patient.
B: The risk of catching malaria.
C: Mefloquine induced psychosis.
D: Multi- drug resistance.
E: Difficulty clearing the liver of hypnozoites.
Q27: Agents used in the treatment of P jiroveci include all except.
A: Oxygen
B: Pentamidine
C: Co-trimoxazole
D: Atovaquone
E: Ciprofloxacin
Q28: Albendazole shares a similar mechanism of action with.
A: piperazines
B: opiates
C: colchicine
D: ivermectin
E: praziquantel

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