Download VNSGU MBBS RAN 2106000102020101 Pharmacology Paper I January2023 Question Paper

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RAN-2106000102020101

II^nd M.B.B.S. Examination January - 2023

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Department of Pharmacology, (Paper -I)

[ Time: 3 Hours ] [ Total Marks: 100

? : / Instructions

(1) ? ? ? ? ? ? ? ?.

Fill up strictly the details of signs on your answer book

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Name of the Examination:

II^nd M.B.B.S.

Name of the Subject:

Department of Pharmacology, (Paper -I)

(2) Encircle the single most appropriate answer.

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(3) Each question carries one mark and there is no negative marking.

(4) Overwriting is not allowed.

Q.1 Multiple Choice Questions (MCQs) [Marks 20]

1. All of the following statements for COX-2 are correct EXCEPT:
   1. Induced at the site of inflammation
   2. Activation of COX-2 leads to ulcer protective effect on gastric mucosa

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   3. It is constitutionally expressed on some cell surfaces
   4. It is utilized in generation of eicosanoids with a ring structure
2. Which of the following drug is commonly used in narcoanalysis?
   1. Atropine sulfate
   2. Scopolamine hydrochloride

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   3. Phenobarbitone
   4. Morphine
3. For which of the following drugs a warning is written: 'To be sold by retail on the prescription of registered medical practitioner only'.
   1. Schedule C
   2. Schedule X

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   3. Schedule Y
   4. Schedule H
4. Antihistaminics used for motion sickness is :
   1. Cetirizine
   2. Meclizine

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   3. Diphenhydramine
   4. Fexofenadine
5. The sympathetic and parasympathetic systems exert functionally opposite influences on the following parameters except:
   1. Heart rate
   2. Atrial refractory period

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   3. Pupil diameter
   4. Intestinal motility
6. Gastric lavage is contraindicated in :
   1. Salicylate poisoning
   2. Organophosphate poisoning

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   3. Kerosene poisoning
   4. Morphine poisoning
7. Regarding efficacy and potency of a drug all are true EXCEPT :
   1. In a clinical setup, efficacy is more important than potency
   2. In the log dose response curve, the height of the curve corresponds with efficacy

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   3. ED₅₀ of the drug corresponds to the efficacy
   4. Drugs that produce similar pharmacological effect can have different levels of efficacy
8. Tachyphylaxis is seen after use of:
   1. Tamoxifen
   2. Ephedrine

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   3. Morphine
   4. Chlorpromazine
9. Correctly matched pair of heavy metal and its respective chelating agent is :
   1. Iron - BAL
   2. Mercury - Calcium disodium edetate

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   3. Copper - d-penicillamine
   4. Arsenic - Desferioxamine
10. Caution is advised for the use of Aspirin in which of the following group of patients:
    1. In diabetics - can cause hyperglycaemia
    2. In children with viral disease - risk of acute renal failure

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    3. In gout - can increase serum uric acid levels
    4. In pregnancy- risk of teratogenicity
11. Timolol eye drops are preferred over pilocarpine eye drops by glaucoma patients because :
    1. Timolol is more effective than pilocarpine
    2. Timolol acts by enhancing uveo-scleral outflow

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    3. Timolol produces less ocular side effects
    4. There are no contraindications to timolol
12. Use of morphine in preanaesthetic medication:
    1. Is routine except in the presence of contraindications
    2. Is restricted to patients being anaesthetised with ether

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    3. Should be made only in combination with atropine
    4. Is restricted mostly to patients in pain preoperatively
13. A drug competes with ACh for receptors at the motor end plate affect skeletal muscle as it
    1. produces uncontrolled muscle spasms
    2. causes the muscles to contract and be unable to relax

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    3. causes muscles to relax and be unable to contract
    4. makes the muscles more excitable
14. Transdermal drug delivery systems offer the following advantages EXCEPT:
    1. Produces high peak plasma concentration of the drug
    2. Produces smooth and non-fluctuating plasma concentration of the drug

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    3. Minimises inter-individual variations in the achieved plasma drug concentration
    4. Avoids hepatic first-pass metabolism of the drug
15. Therapeutic index is an assessment of:
    1. Potency of drug
    2. Onset of action

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    3. Duration of action
    4. Margin of safety
16. All of the following statements for flumazenil are true EXCEPT :
    1. It is a specific antagonist of benzodiazepines
    2. It may be used to treat barbiturate poisoning

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    3. It is given intravenously
    4. It acts on same site on GABA channels where benzodiazepines bind
17. When is Ketamine NOT preferred as an anaesthetic agent ?
    1. Glaucoma
    2. Emergency conditions with full stomach

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    3. Short surgeries in asthmatic patients
    4. For dissociative anaesthesia
18. Drug of choice for alcohol withdrawal is:
    1. Chlordiazepoxide
    2. Disulfiram

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    3. Naltrexone
    4. Diazepam
19. The most vulnerable period of pregnancy for the causation of foetal malformations due to drugs is:
    1. 18-55 days of gestation
    2. 56-84 days of gestation

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    3. Second trimester
    4. 36 weeks onwards
20. In drug metabolism, hepatic cytochrome P-450 (CYP-450) system is responsible for:
    1. Phase I reactions
    2. Phase II reactions

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    3. Both (a) and (b)
    4. Converting hydrophilic metabolites to lipophilic metabolites

Instructions:

(1) Answers should be precise and to the point.

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(2) Give examples and figures if needed.

(3) First 20 mins have been allotted to solve multiple choice questions.

SECTION I

Q. 2 Answer in brief [any five] : [3×5=15]

1. First order versus zero order kinetics.

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2. Explain microsomal enzyme inhibition with suitable examples.
3. Write differences between neostigmine and physostigmine.
4. Short note on "Placebo".
5. Write in brief therapeutic uses and adverse effects of selective COX-2 inhibitors.
6. Define drug antagonism. Mention its types with suitable examples.

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Q.3 Write short notes [any three] : [5×3=15]

1. Enumerate various drugs for glaucoma. Discuss the pharmacotherapy for angle closure glaucoma.
2. Classify ß - blocker drugs. Discuss their therapeutic uses and adverse effect profile.
3. Describe the concept of potency and efficacy of drugs with suitable examples and graphs.
4. Mention various atropine substitutes and/or derivatives. Describe their clinical uses.

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Q.4 Case based questions : [10×1=10]

A 36-year-old female presented to the rheumatology department with chief complaints of pain, swelling and morning stiffness of small joints of both hands along with increased fatigue in the last 3-4 months. Her physical examination and laboratory investigations were suggestive of rheumatoid arthritis. She was prescribed tablet methotrexate 15 mg once a week for two months and tablet aceclofenac 100 mg once a day for one month for her condition.

Answer the following questions :

1. Explain the rationale behind prescribing the above-mentioned drugs for initial episode. What are the main adverse effects to be anticipated in this patient?
2. Mention the precautions to be taken while the patient is on these medications. [2+1+2]

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3. Classify disease modifying anti-rheumatoid drugs. [2]
4. What is the pharmacological basis of prescribing corticosteroids during the course of the disease? [3]

SECTION II

Q.5 Answer in brief [any five] : [3×5=15]

1. Explain in brief "Pharmacovigilance".

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2. Typical versus atypical antipsychotic agents.
3. Short note of management of methanol poisoning.
4. Enlist agents used in spinal anaesthesia along with complications of spinal anaesthesia.
5. Name two mucolytic agents. Explain briefly role of mucolytic in the treatment of cough.
6. Write a note on pre-anaesthetic medications along with its uses.

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Q. 6 Write short notes [any three] : [5×3=15]

1. Mention various neuromuscular blocking agents. Explain the difference between non-depolarizing and depolarizing block. Write any two therapeutic uses of succinylcholine.
2. Enumerate various anti-epileptic agents. Explain the pharmacological basis of phenytoin in grand mal epilepsy. Describe drug-drug interactions of phenytoin.
3. Phases of clinical trial.
4. Classify anti-asthmatic drugs. Discuss the treatment for acute attack of bronchial asthma.

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Q. 7 Case based questions : [10×1=10]

A 50-year-old male patient presents to the medicine out-patient department with tremors at rest in one hand, difficulty in initiating movements, mask like face, defective posture and gait along with dementia. After a thorough clinical and central nervous system examination, he was diagnosed as a case of parkinson's disease. The clinician prescribed a combination of levodopa 100 mg and carbidopa 10 mg orally once daily for one month. The patient was asked to visit for follow-up after a month.

Answer the following questions :

1. Explain the rationale for prescribing a fixed dose combination of levodopa + carbidopa.
2. Discuss the consequences of initial as well as prolonged levodopa therapy. [2+2]

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3. Classify the drugs prescribed for parkinsonism. [2]
4. What is drug induced parkinsonism? How will you treat such a case? [2]
5. Mention recent developments in the treatment of parkinsonism. [2]

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