IVMS ANS Autonomic Nervous System Review Test 2


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IVMS ANS Autonomic Nervous System Review Test 2

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IVMS ANS Autonomic Nervous System Review Test 2

  1. 1. IVMS ANS Autonomic Nervous System Review Test 2Directions: Each of the numbered items or incomplete statements in this section is followed byanswers or by completions of the statement. Select the ONE lettered answer or completion thatis BEST in each case.1. Botulinum toxin causes paralysis byA. Inhibiting choline acetyltransferaseB. Blocking transport of choline into neuronsC. Blocking release of acetylcholine from storage vesiclesD. Inhibiting acetylcholinesteraseE. Blocking the synapse at ganglia2. Which of the following neurotransmitters interacts with guanethidine?A. AcetylcholineB. EpinephrineC. DopamineD. NorepinephrineE. Serotonin3. What is the mechanism of action of cocaine?A. Propagation of action of norepinephrine by inhibiting its active transport from the synapseB. Oxidative deamination of norepinephrine in nerve terminals and the effector cellsC. Inhibition of metabolism of norepinephrine in nerve terminalsD. Potentiation of tyrosine hydroxylase, the rate-limiting enzyme in the synthesis ofnorepinephrineE. Promotion of release of norepinephrine from adrenergic nerve endings4. What intracellular effect does albuterol, a β2-agonist, produce?A. Allows passage of sodium through a ligand-gated ion channelB. Activates Gs-protein, resulting in stimulation of adenylyl cyclaseC. Activates Gq-protein, resulting in increase of phosphatidylinositol and calcium mobilizationD. Activates Gi-protein, resulting in inhibition of adenylyl cyclaseE. Binds to µ-receptors in the specific areas of the brain5. What class of medications does methacholine belong to?A. Nicotinic blockersB. α-AgonistsC. β1-BlockersD. β2-BlockersE. Muscarinic agonistsAutonomic Nervous Review Test 2 Page 1MarcImhotep Cray, M.D. 06-09-2012
  2. 2. 6. A 38-year-old farmer is brought to the ER by his wife with symptoms of sudden difficultybreathing, sweatiness, and anxiety. He was spraying insecticide when this happened. It hasbeen 25 minutes since the symptoms started. Patient is emergently intubated and givenatropine and another medication that acts to reactivate acetylcholinesterase. What medication isit?A. PhysostigmineB. PropranololC. PralidoximeD. PhenylephrineE. Pancuronium7. Oxybutynin works byA. Inhibiting acetylcholinesterase at muscarinic and nicotinic receptorsB. Causing a neuromuscular blockadeC. Antagonizing α1-adrenoceptorsD. Binding to muscarinic receptorsE. Activating β2-adrenoceptors8. A 78-year-old male with Parkinsons disease experiences worsening of his symptoms. He isalready taking levodopa. Since the disease is characterized by degeneration of dopaminergicneurons, leading to the lack of inhibition of cholinergic neurons, the addition of which medicationis likely to help alleviate the patients symptoms?A. BenztropineB. ReserpineC. DoxazocinD. TimololE. Tubocurarine9. A 66-year-old female with a long history of heavy smoking presents to her doctor withcomplaints of shortness of breath and chronic coughing that has been present for about 2 yearsand has been worsening in frequency. The doctor decides to prescribe a bronchodilator agentthat has minimal cardiac side effects, since the patient also has an extensive cardiac history.Which medication did the doctor likely prescribe?A. AlbuterolB. PrazosinC. AtenololD. IpratropiumE. PseudoephedrineAutonomic Nervous Review Test 2 Page 2MarcImhotep Cray, M.D. 06-09-2012
  3. 3. 10. From the list below, choose the depolarizing neuromuscular blocker most likely to be used in“rapid sequence intubation,” a procedure that is done when the stomach contents have a highrisk of refluxing and causing aspiration.A. BaclofenB. SuccinylcholineC. NeostigmineD. HomatropineE. Pralidoxime11. Ephedra (ephedrine) causes increased blood pressure byA. Indirect action on cholinergic receptorsB. Blockade of adrenergic receptorsC. Stimulation of release of epinephrineD. Inhibition of reuptake of catecholaminesE. Direct action on dopamine receptors12. A 34-year-old carpenter presents to the ER after an accident in which he inadvertentlychopped off the tip his index finger. He is taken to the OR for reattachment of the digit, and aftersedation, a local anesthetic is administered around the site of the injury. The local anestheticused in the procedure did not contain any epinephrine, as it usually does for most surgicalprocedures. The reason for this isA. Epinephrine causes increased blood loss during delicate surgeryB. Epinephrine causes swelling of the tissues, making surgery more challengingC. Epinephrine is contraindicated in emergency surgeryD. Epinephrine causes vasoconstriction, which can lead to vascular ischemia in digitsE. Epinephrine can cause hypotension when administered with sedative agents13. A 7-year-old boy is brought in by his parents for complaints of hyperactivity at school. He isalso inattentive and impulsive at home. After a detailed interview, the physician decides to givethe boy amphetamine-containing medication for presumed attention hyperactivity disorder.AmphetamineA. Inhibits epinephrine reuptakeB. Indirectly acts on norepinephrine receptorsC. Blocks effects of norepinephrineD. Directly acts on cholinoreceptorsE. Inhibits serotonin reuptake14. Which of the following medications is used to prevent premature labor?A. TamsulosinB. CevimelineC. AtracuriumD. TolterodineE. TerbutalineA. BronchospasmB. Postural hypotensionC. Heart failureD. SedationE. Drug abuseAutonomic Nervous Review Test 2 Page 3MarcImhotep Cray, M.D. 06-09-2012
  4. 4. 15. What significant side effect of terazosin should the doctor warn a 69-year-old patient about?A. BronchospasmB. Postural hypotensionC. Heart failureD. SedationE. Drug abuse16. A floor nurse pages you about a patient who is having a chest pain. You order anelectrocardiogram and rush to see the patient. He describes the pain as tight pressure and isdemonstrably sweating and gasping for air. The ECG comes back with acute ST-segmentelevations in inferior leads, and you diagnose a myocardial infarction. You start giving thepatient oxygen and give him sublingual nitroglycerin and morphine for pain. You also give himanother medication, which you have read may prolong his survival in this dire situation. Whatclass of medication is it?A. β-BlockerB. α-AgonistC. Muscarinic agonistD. Neuromuscular blockerE. Dopamine agonist17. A 35-year-old female presents to your office for a regular check-up. Her only complaint isrecurrent migraine headaches, which have increased in frequency over the years. Onexamination, her blood pressure is elevated at 150/70. You decide to start her onantihypertensive therapy that is also used for prophylaxis of migraines. Which medication is it?A. ClonidineB. PrazosinC. HydrochlorothiazideD. PropranololE. Verapamil18. In contrast to propranolol, metoprololA. Is used for the management of hypertensionB. Has greater selectivity for β2-adrenoceptorsC. May be beneficial for the acute treatment of migraine headacheD. Is less likely to precipitate bronchoconstriction in patients with asthma19. Intravenous administration of epinephrine to a patient results in a severe decrease indiastolic pressure and an increase in cardiac output. Which of the following drugs might thepatient have previously taken that could account for this unexpected effect?A. PropanololB. AtropineC. PhenylephrineD. Prazosin20. Which of the following drugs is used to diagnose myasthenia gravis?A. AtropineB. NeostigmineC. BethanecholD. EdrophoniumE. PralidoximeAutonomic Nervous Review Test 2 Page 4MarcImhotep Cray, M.D. 06-09-2012
  5. 5. 21. Pilocarpine reduces intraocular pressure in patients with glaucoma because itA. Activates nicotinic cholinoceptorsB. Activates muscarinic cholinoceptorsC. Selectively inhibits peripheral activity of sympathetic gangliaD. Inhibits acetylcholinesterase22. Prolonged apnea may occur following administration of succinylcholine to a patient with ahereditary deficiency of which of the following enzymes?A. Glucose-6-phosphate dehydrogenaseB. Plasma cholinesteraseC. Monoamine oxidaseD. Cytochrome P4503AE. Acetylcholinesterase23. Dantrolene is the drug of choice to treat malignant hyperthermia caused by succinylcholinebecause dantroleneA. Blocks Ca2 release from sarcoplasmic reticulumB. Induces contraction of skeletal muscleC. Increases the rate of succinylcholine metabolismD. Inhibits succinylcholine binding to nicotinic receptorsE. Acts centrally to reduce fever24. A drug that acts at prejunctional α2-adrenoceptors and is used to treat hypertension isA. ClonidineB. MethoxamineC. MetaproterenolD. DobutamineE. Dopamine25. Drug X causes an increase in blood pressure and a decrease in heart rate whenadministered to a patient intravenously. If an antagonist at ganglionic nicotinic receptors isadministered first, drug X causes an increase in blood pressure and an increase in heart rate.Drug X most likely isA. PropranololB. NorepinephrineC. IsoproterenolD. TerbutalineE. Curare26. Poisoning with an insecticide containing an acetylcholinesterase inhibitor is best managedby administration of which one of the following agents?A. PhysostigmineB. BethanecholC. PropranololD. PilocarpineE. AtropineAutonomic Nervous Review Test 2 Page 5MarcImhotep Cray, M.D. 06-09-2012
  6. 6. 27. Receptor actions of acetylcholine are mimicked by nicotine at which one of the followingsites?A. Adrenal medullary chromaffin cellsB. Urinary bladder smooth muscle cellsC. Iris circular (constrictor) muscleD. Heart sinoatrial pacemaker cells28. Muscarinic cholinoceptor agonists may cause vasodilation through the release of endothelialA. HistamineB. NorepinephrineC. AcetylcholineD. Nitric oxide29. Emergency treatment of acute heart failure is best managed with which of the followingdrugs?A. MetaproterenolB. PhenylephrineC. DobutamineD. NorepinephrineE. Isoproterenol30. Which one of the following agents, when applied topically to the eye, would cause bothmydriasis and cycloplegia?A. PhenylephrineB. CarbacholC. PrazosinD. Atropine31. Neostigmine would be expected to reverse which one of the following conditions?A. Paralysis of skeletal muscle induced by a competitive, nondepolarizing muscle relaxantB. Paralysis of skeletal muscle induced by a depolarizing muscle relaxantC. Cardiac slowing induced by stimulation of the vagus nerveD. Miosis induced by bright light32. The direct cardiac effects of dobutamine would be blocked by which one of the followingagents?A. PrazosinB. MetoprololC. ClonidineD. IsoproterenolAutonomic Nervous Review Test 2 Page 6MarcImhotep Cray, M.D. 06-09-2012
  7. 7. 33. Topical application of timolol to the eye would be expected to induce which of the following?A. MiosisB. MydriasisC. Decreased formation of aqueous humorD. Increased outflow of aqueous humor34. Phenylephrine is used to treat patients with nasal mucosa stuffiness because it causesvasoconstriction. It does this byA. Blocking nicotinic cholinoceptorsB. Blocking β-adrenoceptorsC. Stimulating α-adrenoceptorsD. Stimulating muscarinic cholinoceptorsAutonomic Nervous Review Test 2 Page 7MarcImhotep Cray, M.D. 06-09-2012