MED2107: Final Exam Questions With
Verified Answers
Which one of the following is the primary neurotransmitter agent normally
released in the sinoatrial node of the heart in response to a blood pressure
increase?
(A) Acetylcholine
(B) Dopamine
(C) Epinephrine
(D) Glutamate
(E) Norepinephrine - ANSWER (A) Acetylcholine
When blood pressure increases, the parasympathetic system is activated and
heart rate decreases. Acetylcholine is the transmitter at parasympathetic nerve
endings innervating the sinus node (nerve endings of the vagus nerve). The
answer is A.
Full activation of the parasympathetic nerves is likely to produce which of the
following effects?
(A) Bronchodilation
(B) Decreased intestinal motility
(C) Increased thermoregulatory sweating
(D) Increased pupillary constrictor tone (miosis)
(E) Increased heart rate (tachycardia) - ANSWER (D) Increased pupillary
constrictor tone (miosis)
Parasympathetic nerve discharge causes bronchial and intestinal smooth
muscle contraction and bradycardia. Thermoregulatory (eccrine) sweat glands
are innervated by sympathetic cholinergic fibers, not parasympathetic. The
pupillary constrictor muscle is under parasympathetic cholinergic control. The
answer is D.
Which one of the following is the primary neurotransmitter agent normally
released in the sinoatrial node of the heart in response to a blood pressure
increase?
(A) Acetylcholine
(B) Dopamine
(C) Epinephrine
(D) Glutamate
(E) Norepinephrine - ANSWER (A) Acetylcholine
,When blood pressure increases, the parasympathetic system is activated and
heart rate decreases. Acetylcholine is the transmitter at parasympathetic nerve
endings innervating the sinus node (nerve endings of the vagus nerve). The
answer is A.
Which of the following correctly describes Atropine?
(A) It is a selective antimuscarinic agent
(B) It can be used as an antidote for cholinesterase inhibitor toxicity
(C) It is water-soluble
(D) It does not cause sedation - ANSWER (B) It can be used as an antidote for
cholinesterase inhibitor toxicity
Atropine is a non-selective antimuscarinic agent and is lipid-soluble. The answer
is B.
A crop duster pilot has been accidentally exposed to a high concentration of a
highly toxic agricultural organophosphate insecticide. If untreated, the cause of
death from such exposure would probably be
(A) Cardiac arrhythmia
(B) Gastrointestinal bleeding
(C) Heart failure
(D) Hypotension
(E) Respiratory failure - ANSWER (E) Respiratory failure
Respiratory failure, from neuromuscular paralysis or CNS depression, is the
most important cause of acute deaths in cholinesterase inhibitor toxicity. The
answer is E.
If a child has signs of anaphylaxis, what is the treatment of choice?
(A) Diphenhydramine (an antihistamine)
(B) Ephedrine
(C) Epinephrine
(D) Isoproterenol
(E) Methylprednisolone (a corticosteroid) - ANSWER (C) Epinephrine
The treatment of anaphylaxis requires a powerful physiological antagonist with
the ability to cause rapid bronchodilation (beta2 effect), and vasoconstriction
(alpha effect). Epinephrine is the most effective agent with these properties and
is considered the drug of choice if the diagnosis is definite. Antihistamines and
corticosteroids are sometimes used as supplementary agents, but the prompt
parenteral use of epinephrine is mandatory. The answer is C.
Your 30-year-old patient has moderately severe new onset asthma, and you
prescribe a highly selective beta 2 agonist inhaler to be used when needed. In
considering the possible drug effects in this patient, you would note that beta 2
stimulants frequently cause
, (A) Direct stimulation of renin release
(B) Hypoglycemia
(C) Itching due to increased GMP (cyclic guanine monophosphate) in mast cells
(D) Skeletal muscle tremor
(E) Vasodilation in the skin - ANSWER (D) Skeletal muscle tremor
Tremor is a common beta 2 effect. Blood vessels in the skin have almost
exclusively alpha (vasoconstrictor) receptors. Stimulation of renin release is a
beta 1 effect. Beta2 agonists cause hyperglycemia and have little effect on
cGMP. The answer is D.
A 27-year-old compulsive drug user injected a drug he thought was
methamphetamine, but he has not developed any signs of methamphetamine
action. He has been admitted to the emergency department and antimuscarinic
drug overdose is suspected. Probable signs of atropine overdose include which
one of the following?
(A) Gastrointestinal smooth muscle cramping
(B) Increased heart rate
(C) Increased gastric secretion
(D) Pupillary constriction
(E) Urinary frequency - ANSWER (B) Increased heart rate
Tachycardia is a characteristic atropine overdose effect. Bradycardia is
sometimes observed after small doses. None of the other choices are typical of
atropine or methamphetamine overdose. The answer is B.
A patient presents at the emergency department with threatened anaphylaxis.
Respiratory obstruction appears likely if she is not treated immediately. Her past
medical history includes hypertension, for which she is receiving an
adrenoceptor blocker. The emergency physician plans to use epinephrine to
treat her anaphylactic reaction. Which of the following effects of epinephrine
would be blocked by prazosin but not by metoprolol?
(A) Cardiac stimulation
(B) Increase of cAMP (cyclic adenosine monophosphate) in fat cells
(C) Mydriasis
(D) Relaxation of bronchial smooth muscle
(E) Relaxation of the uterus - ANSWER (C) Mydriasis
Mydriasis caused by contraction of the pupillary dilator radial smooth muscle is
mediated by alpha receptors. All the other effects listed are mediated by beta
receptors. The answer is C.
Clinical studies have shown that adrenoceptor blockers have many useful
effects in patients.
However, a number of drug toxicities have been documented. Adverse effects
that limit the use of adrenoceptor blockers include which one of the following?
Verified Answers
Which one of the following is the primary neurotransmitter agent normally
released in the sinoatrial node of the heart in response to a blood pressure
increase?
(A) Acetylcholine
(B) Dopamine
(C) Epinephrine
(D) Glutamate
(E) Norepinephrine - ANSWER (A) Acetylcholine
When blood pressure increases, the parasympathetic system is activated and
heart rate decreases. Acetylcholine is the transmitter at parasympathetic nerve
endings innervating the sinus node (nerve endings of the vagus nerve). The
answer is A.
Full activation of the parasympathetic nerves is likely to produce which of the
following effects?
(A) Bronchodilation
(B) Decreased intestinal motility
(C) Increased thermoregulatory sweating
(D) Increased pupillary constrictor tone (miosis)
(E) Increased heart rate (tachycardia) - ANSWER (D) Increased pupillary
constrictor tone (miosis)
Parasympathetic nerve discharge causes bronchial and intestinal smooth
muscle contraction and bradycardia. Thermoregulatory (eccrine) sweat glands
are innervated by sympathetic cholinergic fibers, not parasympathetic. The
pupillary constrictor muscle is under parasympathetic cholinergic control. The
answer is D.
Which one of the following is the primary neurotransmitter agent normally
released in the sinoatrial node of the heart in response to a blood pressure
increase?
(A) Acetylcholine
(B) Dopamine
(C) Epinephrine
(D) Glutamate
(E) Norepinephrine - ANSWER (A) Acetylcholine
,When blood pressure increases, the parasympathetic system is activated and
heart rate decreases. Acetylcholine is the transmitter at parasympathetic nerve
endings innervating the sinus node (nerve endings of the vagus nerve). The
answer is A.
Which of the following correctly describes Atropine?
(A) It is a selective antimuscarinic agent
(B) It can be used as an antidote for cholinesterase inhibitor toxicity
(C) It is water-soluble
(D) It does not cause sedation - ANSWER (B) It can be used as an antidote for
cholinesterase inhibitor toxicity
Atropine is a non-selective antimuscarinic agent and is lipid-soluble. The answer
is B.
A crop duster pilot has been accidentally exposed to a high concentration of a
highly toxic agricultural organophosphate insecticide. If untreated, the cause of
death from such exposure would probably be
(A) Cardiac arrhythmia
(B) Gastrointestinal bleeding
(C) Heart failure
(D) Hypotension
(E) Respiratory failure - ANSWER (E) Respiratory failure
Respiratory failure, from neuromuscular paralysis or CNS depression, is the
most important cause of acute deaths in cholinesterase inhibitor toxicity. The
answer is E.
If a child has signs of anaphylaxis, what is the treatment of choice?
(A) Diphenhydramine (an antihistamine)
(B) Ephedrine
(C) Epinephrine
(D) Isoproterenol
(E) Methylprednisolone (a corticosteroid) - ANSWER (C) Epinephrine
The treatment of anaphylaxis requires a powerful physiological antagonist with
the ability to cause rapid bronchodilation (beta2 effect), and vasoconstriction
(alpha effect). Epinephrine is the most effective agent with these properties and
is considered the drug of choice if the diagnosis is definite. Antihistamines and
corticosteroids are sometimes used as supplementary agents, but the prompt
parenteral use of epinephrine is mandatory. The answer is C.
Your 30-year-old patient has moderately severe new onset asthma, and you
prescribe a highly selective beta 2 agonist inhaler to be used when needed. In
considering the possible drug effects in this patient, you would note that beta 2
stimulants frequently cause
, (A) Direct stimulation of renin release
(B) Hypoglycemia
(C) Itching due to increased GMP (cyclic guanine monophosphate) in mast cells
(D) Skeletal muscle tremor
(E) Vasodilation in the skin - ANSWER (D) Skeletal muscle tremor
Tremor is a common beta 2 effect. Blood vessels in the skin have almost
exclusively alpha (vasoconstrictor) receptors. Stimulation of renin release is a
beta 1 effect. Beta2 agonists cause hyperglycemia and have little effect on
cGMP. The answer is D.
A 27-year-old compulsive drug user injected a drug he thought was
methamphetamine, but he has not developed any signs of methamphetamine
action. He has been admitted to the emergency department and antimuscarinic
drug overdose is suspected. Probable signs of atropine overdose include which
one of the following?
(A) Gastrointestinal smooth muscle cramping
(B) Increased heart rate
(C) Increased gastric secretion
(D) Pupillary constriction
(E) Urinary frequency - ANSWER (B) Increased heart rate
Tachycardia is a characteristic atropine overdose effect. Bradycardia is
sometimes observed after small doses. None of the other choices are typical of
atropine or methamphetamine overdose. The answer is B.
A patient presents at the emergency department with threatened anaphylaxis.
Respiratory obstruction appears likely if she is not treated immediately. Her past
medical history includes hypertension, for which she is receiving an
adrenoceptor blocker. The emergency physician plans to use epinephrine to
treat her anaphylactic reaction. Which of the following effects of epinephrine
would be blocked by prazosin but not by metoprolol?
(A) Cardiac stimulation
(B) Increase of cAMP (cyclic adenosine monophosphate) in fat cells
(C) Mydriasis
(D) Relaxation of bronchial smooth muscle
(E) Relaxation of the uterus - ANSWER (C) Mydriasis
Mydriasis caused by contraction of the pupillary dilator radial smooth muscle is
mediated by alpha receptors. All the other effects listed are mediated by beta
receptors. The answer is C.
Clinical studies have shown that adrenoceptor blockers have many useful
effects in patients.
However, a number of drug toxicities have been documented. Adverse effects
that limit the use of adrenoceptor blockers include which one of the following?
