Case 1 Questions 1-17

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Question 1

What are the properties of the tunica adventitia in arteries?

  1. Endothelium and basal lamina
  2. Low subendothelial connective tissue
  3. Smooth muscle and no fibroblasts
  4. Thick connective tissue layer and high collagen
  5. Thick connective tissue layer and low collagen

The correct answer is option d. Thick connective tissue layer and high collagen

d is correct as as the tunica adventicia connects the blood vessels to the surroundings
a. Endothelium and basal laina is what the tunica intima connect
b. the tunica adventicia has a large amount of connective tissue
c. There is less smooth muscle in the tunica adventicia
e. Thre is a high amount of collagen in the tunica adventicia

Question 2

Why do large arteries have more elastic tissue?

  1. Helps reduce speed of blood flow
  2. Helps to increases blood transfer
  3. Helps maintain pressure without damaging blood vessel
  4. Helps blood vessel to constrict and dilate
  5. Helps to regenerate damaged blood vessels to increase blood flow

The correct answer is option c. Helps maintain pressure without damaging blood vessel

c is correct as the elastic recoil helps maintain pressure in diastole
a. Incorrect as the elastic increases blood flow in diastole, not decrease the flow
b. Incorrect as arteries are not involved in blood transfer, this is more the role of capillaries
d. Smooth muscle is involved in constriction and dilation, not the elastic tissue
e. Fibroblasts are more likely to regenerate blood vessels, not the connective tissues

Question 3

How are capillaries adapted to their function of gas exchange?

  1. High velocity and low surface area
  2. High velocity and high surface area
  3. Medium velocity and medium surface area
  4. Low velocity and low surface area
  5. Low velocity and high surface area

The correct answer is option e. Low velocity and high surface area

e. correct as lower velocity increases time for diffusion and high surface areas increases are for diffusion to take place at
a. Incorrect as the high velocity and low surface area would decrease the efficency of gas exchange
b. Incorrect as the higher velocity would decrease diffusion efficency
c. This wouldn’t make the diffusion as efficent as possible so is incorrect
d. The low surface area would decrease the efficency of diffusion

Question 4

How do baroreceptors cause an decrease in BP?

  1. Increased stretch in blood vessel —> Central control area —> vasodilation
  2. Increased stretch in blood vessel —> Central control area —> vasoconstriction
  3. Decreased stretch in blood vessel —> Central control area —> vasodilation
  4. Decreased stretch in blood vessel —> Central control area —> vasoconstriction
  5. Increased chemical stimulus —> Central control area —> vasodilation

The correct answer is option a. Increased stretch in blood vessel —> Central control area —> vasodilation

a is correct as the strech detects increased blood pressure and vasodilation is a compensatory for decreasing blood pressure
b. Incorrect as vasoconstriction would increase blood pressure
c. Incorrect as decreased strech would cause vasoconstriction not vasodilation
d. Incorrect as vasoconstriction would cause an increase in blood pressure
e. Incorrect as increased chemical stimulus would not cause vasodilation

Question 5

What clotting factors are Vitamin K dependent?

  1. 1, 2, 3, 4
  2. 4, 7, 9, 10
  3. 4, 9, 10, 11
  4. 8, 9, 11, 12
  5. 7, 8, 9, 19

The correct answer is option c. 4, 9, 10, 11

Correct Answer as these clotting factors need Vit K to form
a. Incorrect as factor 3 and 4 are not vitamin K dependant
b. Incorrect as factor 4 is not vitamin K dependant
d. Incorrect as factor 8 and 12 are not vitamin K dependant
e. Incorrect as factor 8 is not vitamin K dependant

Question 6

Where are baroreceptors located?

  1. Adrenal gland
  2. Carotid sinus
  3. Lungs
  4. Medulla oblongata
  5. Pituitary gland

The correct answer is option b. Carotid sinus

b is correct as the peripberal barorecptors are found in the carotid sinus’
a. Incorrect as this is the site of the formation of many hormones such as the catecholamines and androgens
c. Incorrect this is the site of gas exchange and the ACE enzyme
d. The medulla oblongata is the location of connecting the spinal cord and the brain together
e. The pituitary gland is the location of hormone release, not detection of blood pressure

Question 7

What is a QRISK score?

  1. 1 year risk of MI
  2. 5 year risk of MI
  3. 5 year risk of developing CVD event
  4. 10 year risk of developing CVD event
  5. 20 year risk of developing CVD event

The correct answer is option d. 10 year risk of developing CVD event

d is correct as as the qRISK is for CVD risk
a. The qRISK is not just for MI but also strokes and other cardiovascular diseases
b. The qRISK is for risk of all CVD risk, not just MIs
c. qRISK sees the 10 year risk, not the 5 year risk
e. The qRISK sees the 10 year risk, not the 20 year risk

Question 8

What is stage 2 hypertension?

  1. BP under 140 systolic
  2. BP between 140-159/80-99
  3. BP between 140-159/90-99
  4. BP between 160-179/100-119
  5. BP above 180 systolic or 120 diastolic

The correct answer is option d. BP between 160-179/100-119

Correct as the stage 2 is between 160-179/100-119 in clinic readings
a. This is not hypertension
b. This is systolic stage 1 hypertension and normal diastolic ranges
c. This is stage 1 hypertension
d. This is stage 3 hypertension

Question 9

What is the mechanism of action of Losartan?

  1. alpha1-adrenoceptor antagonists
  2. beta-adrenoceptor antagonists
  3. Blocking of angiotensin receptors
  4. Calcium Channel blockers
  5. Inhibits the conversion of Angiotensin I to Angiotensin II

The correct answer is option c. Blocking of angiotensin receptors

c is correct as Losartan is a ARB so will block the angiotensin receptors
a. This is the MOA of alpha blockers
b. This is the MOA of beta blockers
d. This is the MOA of CCBs such as amlodipine
e. This is the mechanism of ACE inhibitors, not ARBs

Question 10

What is a contraindication of lisinopril?

  1. Bradycardia
  2. Bronchospasm
  3. Hypokalaemia
  4. Hyponatraemia
  5. Renal failure

The correct answer is option e. Renal failure

e is correct as renal faliure as there is an increased risk of hyperkalaemia
a. Incorrect as this is not an ACE inhibitor contraindication
b. Incorrect as bronchospasm is not a contraindication of ACE inhibitors
c. Incorrect as hypokalaemia isnt a contraindication of ACE inhibitors
d. Incorrect as the hyponatraemia is not a contraindication of an ACE inhibitor

Question 11

What is the first line hypertension drug for a 60 year old African man?

  1. Amlodipine
  2. Atenolol
  3. Bisoprolol
  4. Candesartan
  5. Metformin

The correct answer is option a. Amlodipine

a is correct as a CCB is first line in patients of afrocarribean descent
b. Incorrect as beta blockers are not first line for patients of afrocarribean descent
c. Incorrect as beta blockers are not first line treatment of hypertension
d. Incorrect as ARBs are not first line treatment in hypertension for patients of afrocarribean descent
e. Incorrect as metformin is not used as treatment for hypertension, but for T2DM

Question 12

A 50 year old man who has been on antihypertensives for 2 weeks starts complaining about a dry cough. What medication is causing this side effect?

  1. Amlodipine
  2. Atorvastatin
  3. Lisinopril
  4. Losartan
  5. Spironolactone

The correct answer is option c. Lisinopril

c. ACE inhibitors have common side effect of a dry cough
a. Amlodipine does not have a dry cough as a common side effect
b. Atorvastatin does not have a dry cough as a common side effect
d. Losartan does not have a dry cough as a common side effect
e. Spironolactone does not have a dry cough as a common side effect

Question 13

Which statement defines volume of distribution?

  1. The distribution between a drug A and drug B
  2. The distribution between a drug and a set standard
  3. The distribution of a drug between plasma and the rest of the body
  4. The distribution of a drug between absorption and excretion
  5. The distribution of a drug metabolism

The correct answer is option c. The distribution of a drug between plasma and the rest of the body

c is the correct definition of volume of distribution
a. Incorrect as this is not the correct definition, but more a comparison
b. This is more a comparison, not the Vd
d. This would be the steady state calculations
e. This is more the defition of the metabolism rate

Question 14

What is the half life in first order kinetics?

  1. No half life
  2. Half life is constant
  3. Half life doubles each time
  4. Half life triples each time
  5. Half life increases 4 times each time

The correct answer is option b. Half life is constant

b. is correct as the half life is constant
a. Incorrect as first order kinetics have a constant half life
c. Incorrect as first order kinetics have a constant half lifea. Incorrect as first order kinetics have a constant half life
d. Incorrect as first order kinetics have a constant half life
e. Incorrect as first order kinetics have a constant half life

Question 15

What occurs to the rate of metabolism in zero order kinetics?

  1. No rate of metabolism
  2. Rate of metabolism is constant
  3. Rate of metabolism is proportional to drug concentration
  4. Rate of metabolism is inversely proportional to drug concentration
  5. Rate of metabolism is exponentially proportional to drug concentration

The correct answer is option b. Rate of metabolism is constant

Correct Answer as 0 order is independant of drug concentration
a. Incorrect as the drug is still metabolised
c. Incorrect as the metabolism is not proportional, but independant instead
d. The drug metabolism is not inversely proportional, but independant
e. The drug metabolism is not expionentially proportional

Question 16

What is the Volume of distribution for paracetamol when t1/2 is 2s and Dose is 3mg and C0 is 4 mg/L?

  1. Vd = 0.33 g
  2. Vd = 0.375 L
  3. Vd = 0.5 L
  4. Vd = 0.67 g
  5. Vd = 0.75 L

The correct answer is option e. Vd = 0.75 L

e is correct as Vd is calculated by Dose divided by C0
a. Is incorrect as you do not use Half life
b. Incorrect as you do not use half life
c. Incorrect as you dont use half life
d. Incorrect as you dont use half life

Question 17

Why are loading doses given?

  1. To reduce the drug plasma concentration
  2. To ensure the therapeutic concentration is achieved rapidly
  3. To ensure the half life does not change
  4. To ensure the rate of metabolism is constant
  5. To prevent overdose

The correct answer is option b. To ensure the therapeutic concentration is achieved rapidly

b is correct as loading doses are to increase speed of theraputic effects
a. A is incorrect as loading dose would increase the plasma concentration
c. The half life is not dependant on the loading dose given
d. This is only true if there is 0 order metabolism
e. Loading doses increase the risk of overdosing, not decreasing the risk