The most rapidly acting nondepolarizing neuromuscular blocking agent which can be used as an alternative to succinylcholine for tracheal intubation is: A. Rocuronium B. Pancuronium C. Doxacurium D. Pipecuronium

The most rapidly acting nondepolarizing neuromuscular blocking agent which can be used as an alternative to succinylcholine for tracheal intubation is:
A. Rocuronium
B. Pancuronium
C. Doxacurium
D. Pipecuronium
by

1 Answer

Answer :

A. Rocuronium
by

Related questions

Select the skeletal muscle relaxant that is commonly used for endotracheal intubation despite causing histamine release, K+ efflux from muscles and cardiovascular changes: A. Pipecuroniun B. Succinylcholine C. Pancuronium D. Cisatracurium

Description : Select the skeletal muscle relaxant that is commonly used for endotracheal intubation despite causing histamine release, K+ efflux from muscles and cardiovascular changes: A. Pipecuroniun B. Succinylcholine C. Pancuronium D. Cisatracurium

Last Answer : B. Succinylcholine

Succinylcholine is the preferred muscle relaxant for tracheal intubation because: A. It produces rapid and complete paralysis of respiratory muscles with quick recovery B. It does not alter heart rate or blood pressure C. It does not cause histamine release D. It does not produce postoperative muscle soreness

Description : Succinylcholine is the preferred muscle relaxant for tracheal intubation because: A. It produces rapid and complete paralysis of respiratory muscles with quick recovery B. It does not alter heart rate or ... C. It does not cause histamine release D. It does not produce postoperative muscle soreness

Last Answer : A. It produces rapid and complete paralysis of respiratory muscles with quick recovery

The neuromuscular blocker that does not need reversal of action by neostigmine at the end of the operation is: A. d-Tubocurarine B. Doxacurium C. Pipecuronium D. Mivacurium

Description : The neuromuscular blocker that does not need reversal of action by neostigmine at the end of the operation is: A. d-Tubocurarine B. Doxacurium C. Pipecuronium D. Mivacurium

Last Answer : D. Mivacurium

CHOOSE THE MOST APPROPRIATE RESPONSE 23.1 Which of the following drugs is a nondepolarizing neuromuscular blocker: A. Succinylcholine B. Vecuronium C. Decamethonium D. Dantrolene sodium

Description : CHOOSE THE MOST APPROPRIATE RESPONSE 23.1 Which of the following drugs is a nondepolarizing neuromuscular blocker: A. Succinylcholine B. Vecuronium C. Decamethonium D. Dantrolene sodium

Last Answer : B. Vecuronium

ostoperative muscle soreness may be a side effect of the following neuromuscular blocker: A. d-tubocurarine B. Succinylcholine C. Pancuronium D. Atracurium

Description : ostoperative muscle soreness may be a side effect of the following neuromuscular blocker: A. d-tubocurarine B. Succinylcholine C. Pancuronium D. Atracurium

Last Answer : B. Succinylcholine

Which of the following drugs undergoes ‘Hofmann’ elimination: A. Succinylcholine B. Pancuronium C. Vecuronium

Description : Which of the following drugs undergoes ‘Hofmann’ elimination: A. Succinylcholine B. Pancuronium C. Vecuronium

Last Answer : D. Atracurium

Diazepam is used as a muscle relaxant for: A. Deep intra-abdominal operation B. Tracheal intubation C. Tetanus D. Diagnosis of myasthenia gravis

Description : Diazepam is used as a muscle relaxant for: A. Deep intra-abdominal operation B. Tracheal intubation C. Tetanus D. Diagnosis of myasthenia gravis

Last Answer : C. Tetanus

Which of the following is applicable to mivacurium: A. It undergoes Hoffmann elimination B. It is the shortest acting nondepolarizing neuromuscular blocker C. It is excreted unchanged by kidney D. It does not cause histamine release

Description : Which of the following is applicable to mivacurium: A. It undergoes Hoffmann elimination B. It is the shortest acting nondepolarizing neuromuscular blocker C. It is excreted unchanged by kidney D. It does not cause histamine release

Last Answer : B. It is the shortest acting nondepolarizing neuromuscular blocker

Choose the correct statement about long acting calcium channel blocking drugs as antihypertensives: A. They are the most effective drugs in suppressing hypertensive left ventricular hypertrophy B. They are as effective as diuretics or β blockers in reducing cardiovascular/total mortality C. They compromise quality of life more than β blockers D. They have no beneficial effect in hypertensive/diabetic nephropath

Description : Choose the correct statement about long acting calcium channel blocking drugs as antihypertensives: A. They are the most effective drugs in suppressing hypertensive left ventricular hypertrophy B. They ... more than β blockers D. They have no beneficial effect in hypertensive/diabetic nephropath

Last Answer : B. They are as effective as diuretics or β blockers in reducing cardiovascular/total mortality

Which of the following is a long acting neuroleptic having specific antidopaminergic action, but little adrenergic or cholinergic blocking activity: A. Triflupromazine B. Thioridazine C. Clozapine D. Pimozide

Description : Which of the following is a long acting neuroleptic having specific antidopaminergic action, but little adrenergic or cholinergic blocking activity: A. Triflupromazine B. Thioridazine C. Clozapine D. Pimozide

Last Answer : D. Pimozide

The following antibiotic accentuates the nuromuscular blockade produced by pancuronium: A. Streptomycin B. Erythromycin C. Penicillin G D. Chloramphenicol

Description : The following antibiotic accentuates the nuromuscular blockade produced by pancuronium: A. Streptomycin B. Erythromycin C. Penicillin G D. Chloramphenicol

Last Answer : A. Streptomycin

Pancuronium differs from tubocurarine in that: A. It is a depolarizing blocker B. Its action is not reversed by neostigmine C. It can cause rise in BP on rapid I.V. injection D. It causes marked histamine release

Description : Pancuronium differs from tubocurarine in that: A. It is a depolarizing blocker B. Its action is not reversed by neostigmine C. It can cause rise in BP on rapid I.V. injection D. It causes marked histamine release

Last Answer : C. It can cause rise in BP on rapid I.V. injection

Among all cardiac glycosides, digoxin is the most commonly used, because: A. It is the most potent and fastest acting glycoside B. It has the highest and most consistent oral bioavailability C. It is the longest acting and the safest glycoside D. It has intermediate plasma half life so that dose adjustments are possible every 2-3 days and toxicity abates rather rapidly after discontinuatio

Description : Among all cardiac glycosides, digoxin is the most commonly used, because: A. It is the most potent and fastest acting glycoside B. It has the highest and most consistent oral ... so that dose adjustments are possible every 2-3 days and toxicity abates rather rapidly after discontinuatio

Last Answer : D. It has intermediate plasma half life so that dose adjustments are possible every 2-3 days and toxicity abates rather rapidly after discontinuatio

The following statement is correct about buspirone: A. It interacts with benzodiazepine receptor as an inverse agonist B. It is a rapidly acting anxiolytic, good for panic states C. It produces physical dependence and suppresses barbiturate withdrawal syndrome D. It has anxiolytic but no anticonvulsant or muscle relaxant propert

Description : The following statement is correct about buspirone: A. It interacts with benzodiazepine receptor as an inverse agonist B. It is a rapidly acting anxiolytic, good for panic states C. ... suppresses barbiturate withdrawal syndrome D. It has anxiolytic but no anticonvulsant or muscle relaxant propert

Last Answer : D. It has anxiolytic but no anticonvulsant or muscle relaxant property

Select the muscle relaxant that is used to control spasticity associated with upper motor neurone paralysis: A. Vecuronium B. Succinylcholine C. Chlorzoxazone D. Baclofen

Description : Select the muscle relaxant that is used to control spasticity associated with upper motor neurone paralysis: A. Vecuronium B. Succinylcholine C. Chlorzoxazone D. Baclofen

Last Answer : D. Baclofen

Succinylcholine produces spastic paralysis in: A. Rabbits B. Frogs C. Birds D. Patients with atypical pseudocholinesterase

Description : Succinylcholine produces spastic paralysis in: A. Rabbits B. Frogs C. Birds D. Patients with atypical pseudocholinesterase

Last Answer : C. Birds

Chloramphenicol inhibits bacterial protein synthesis by: A. Binding to 30S ribosome and inhibiting attachment of aminoacyl tRNA B. Binding to 50S ribosome and preventing peptide bond formation C. Binding to 50S ribosome and blocking translocation of peptide chain D. Binding to both 30S and 50S ribosome and inducing misreading of mRNA code

Description : Chloramphenicol inhibits bacterial protein synthesis by: A. Binding to 30S ribosome and inhibiting attachment of aminoacyl tRNA B. Binding to 50S ribosome and preventing peptide bond formation C. Binding to ... chain D. Binding to both 30S and 50S ribosome and inducing misreading of mRNA code

Last Answer : B. Binding to 50S ribosome and preventing peptide bond formation

Cisapride enhances gastrointestinal motility by: A. Activating serotonin 5-HT4 receptor B. Activating muscarinic M3 receptor C. Blocking dopamine D2 receptor D. All of the above

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Last Answer : A. Activating serotonin 5-HT4 receptor

Which antiemetic selectively blocks levodopa induced vomiting without blocking its antiparkinsonian action: A. Metoclopramide B. Cisapride C. Domperidone D. Ondansetron

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Last Answer : C. Domperidone

Amiloride inhibits K+ excretion in the distal tubules and collecting ducts by blocking: A. Electrogenic K+ channels B. Electrogenic Na+ channels C. Nonelectrogenic Na+-Cl– symport D. H+K+ATPase

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Last Answer : B. Electrogenic Na+ channels

Nonsteroidal antiinflammatory drugs reduce the diuretic action of furosemide by: A. Preventing prostaglandin mediated intrarenal haemodynamic actions B. Blocking the action in ascending limb of loop of Henle. C. Enhancing salt and water reabsorption in distal tubule D. Increasing aldosterone secretion

Description : Nonsteroidal antiinflammatory drugs reduce the diuretic action of furosemide by: A. Preventing prostaglandin mediated intrarenal haemodynamic actions B. Blocking the action in ascending limb of loop ... C. Enhancing salt and water reabsorption in distal tubule D. Increasing aldosterone secretion

Last Answer : A. Preventing prostaglandin mediated intrarenal haemodynamic actions

Choose the correct statement(s) about dofetilide: A. It is a pure class III antiarrhythmic B. It has no adrenergic/cholinergic receptor blocking property C. It selectively depresses the rapid component of delayed rectifier K+ current in myocardial fibres D. All of the above

Description : Choose the correct statement(s) about dofetilide: A. It is a pure class III antiarrhythmic B. It has no adrenergic/cholinergic receptor blocking property C. It selectively depresses the rapid component of delayed rectifier K+ current in myocardial fibres D. All of the above

Last Answer : D. All of the above

The following is true of propafenone except: A. It is a weak Na+ channel blocker B. It markedly delays recovery of myocardial Na+ channels C. It has additional β-adrenergic blocking property D. It slows anterograde as well as retrograde conduction in the WPW bypass tract

Description : The following is true of propafenone except: A. It is a weak Na+ channel blocker B. It markedly delays recovery of myocardial Na+ channels C. It has additional β-adrenergic blocking property D. It slows anterograde as well as retrograde conduction in the WPW bypass tract

Last Answer : A. It is a weak Na+ channel blocker

Procainamide differs from quinidine in the following respect(s): A. It does not cause paradoxical tachycardia B. It has no α adrenergic blocking activity C. It has little antivagal action D. Both ‘B’ and ‘C’ are corre

Description : Procainamide differs from quinidine in the following respect(s): A. It does not cause paradoxical tachycardia B. It has no α adrenergic blocking activity C. It has little antivagal action D. Both ‘B’ and ‘C’ are corre

Last Answer : D. Both ‘B’ and ‘C’ are correct

Procainamide differs from quinidine in the following respect(s): A. It does not cause paradoxical tachycardia B. It has no α adrenergic blocking activity C. It has little antivagal action D. Both ‘B’ and ‘C’ are correct

Description : Procainamide differs from quinidine in the following respect(s): A. It does not cause paradoxical tachycardia B. It has no α adrenergic blocking activity C. It has little antivagal action D. Both ‘B’ and ‘C’ are correct

Last Answer : D. Both ‘B’ and ‘C’ are correct

The following drug claimed to have a therapeutic effect in senile dementia has α adrenergic blocking activity: A. Piracetam B. Pyritinol C. Codergocrine D. Methylphenidate

Description : The following drug claimed to have a therapeutic effect in senile dementia has α adrenergic blocking activity: A. Piracetam B. Pyritinol C. Codergocrine D. Methylphenidate

Last Answer : C. Codergocrine

Strychnine produces convulsions by: A. Stimulating NMDA receptors B. Facilitating the excitatory transmitter glutamate C. Blocking the inhibitory transmitter GABA D. Blocking the inhibitory transmitter glycine

Description : Strychnine produces convulsions by: A. Stimulating NMDA receptors B. Facilitating the excitatory transmitter glutamate C. Blocking the inhibitory transmitter GABA D. Blocking the inhibitory transmitter glycine

Last Answer : D. Blocking the inhibitory transmitter glycine

The following is a tetracyclic antidepressant that has additional dopamine blocking and neuroleptic properties, as well as greater propensity to cause seizures in overdose: A. Amoxapine B. Doxepin C. Dothiepin D. Trazodone

Description : The following is a tetracyclic antidepressant that has additional dopamine blocking and neuroleptic properties, as well as greater propensity to cause seizures in overdose: A. Amoxapine B. Doxepin C. Dothiepin D. Trazodone

Last Answer : A. Amoxapine

Olanzapine has the following features except: A. It is an antipsychotic drug with weak D2 receptor blocking action B. It has potent 5-HT2 blocking and antimuscarinic actions C. It lowers seizure threshold D. It produces prominent extrapyramidal side effects

Description : Olanzapine has the following features except: A. It is an antipsychotic drug with weak D2 receptor blocking action B. It has potent 5-HT2 blocking and antimuscarinic actions C. It lowers seizure threshold D. It produces prominent extrapyramidal side effects

Last Answer : D. It produces prominent extrapyramidal side effect

The following antipsychotic drug has weak dopamine D2 but additional 5-HT2 blocking activity and benefits both positive and negative symptoms of schizophrenia: A. Loxapine B. Clozapine C. Pimozide D. Penfluridol

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Last Answer : B. Clozapin

What is true of risperidone: A. It is an atypical neuroleptic which produces few extrapyramidal side effects B. It has combined dopamine D2 and 5-HT2 receptor blocking activity C. It does not cause hyperprolactinemia D. Both 'A' and 'B' are correct

Description : What is true of risperidone: A. It is an atypical neuroleptic which produces few extrapyramidal side effects B. It has combined dopamine D2 and 5-HT2 receptor blocking activity C. It does not cause hyperprolactinemia D. Both 'A' and 'B' are correct

Last Answer : D. Both 'A' and 'B' are correct

Compared to other antipsychotic drugs, the distinctive feature of penfluridol is: A. Very long duration of action B. Weak dopamine D2 blocking activity C. Lack of extrapyramidal side effects D. Additional 5-HT2 receptor blocking activity

Description : Compared to other antipsychotic drugs, the distinctive feature of penfluridol is: A. Very long duration of action B. Weak dopamine D2 blocking activity C. Lack of extrapyramidal side effects D. Additional 5-HT2 receptor blocking activity

Last Answer : A. Very long duration of action

Choose the correct statement about lamotrigine: A. It is a dopaminergic agonist used in parkinsonism B. It acts by blocking NMDA-type of glutamate receptors C. It is a broad spectrum antiepileptic drug D. It suppresses tonic-clonic seizures, but worsens absence seizures

Description : Choose the correct statement about lamotrigine: A. It is a dopaminergic agonist used in parkinsonism B. It acts by blocking NMDA-type of glutamate receptors C. It is a broad spectrum antiepileptic drug D. It suppresses tonic-clonic seizures, but worsens absence seizures

Last Answer : C. It is a broad spectrum antiepileptic drug

e primary mechanism by which general anaesthetics produce their action is: A. Affecting receptor operated ion channels in cerebral neurones B. Blocking voltage sensitive Na+ channels in neuronal membrane C. Depressing metabolic activity of cerebral neurones D. Blocking production of high energy phosphates in the brain

Description : e primary mechanism by which general anaesthetics produce their action is: A. Affecting receptor operated ion channels in cerebral neurones B. Blocking voltage sensitive Na+ channels in neuronal ... activity of cerebral neurones D. Blocking production of high energy phosphates in the brain

Last Answer : A. Affecting receptor operated ion channels in cerebral neurones

Local anaesthetics block nerve conduction by: A. Blocking all cation channels in the neuronal membrane B. Hyperpolarizing the neuronal membrane C. Interfering with depolarization of the neuronal membrane D. Both ‘B’ and ‘C’ are correct

Description : Local anaesthetics block nerve conduction by: A. Blocking all cation channels in the neuronal membrane B. Hyperpolarizing the neuronal membrane C. Interfering with depolarization of the neuronal membrane D. Both ‘B’ and ‘C’ are correct

Last Answer : C. Interfering with depolarization of the neuronal membrane

Neuromuscular blocking drugs do not produce central actions because: A. They do not cross the blood-brain barrier B. Nicotinic receptors are not present in the brain C. They are sequestrated in the periphery by tight binding to the skeletal muscles D. They do not ionise at the brain pH

Description : Neuromuscular blocking drugs do not produce central actions because: A. They do not cross the blood-brain barrier B. Nicotinic receptors are not present in the brain C. They are sequestrated in the periphery by tight binding to the skeletal muscles D. They do not ionise at the brain pH

Last Answer : A. They do not cross the blood-brain barrier

Finasteride acts by: A. Blocking testosterone receptors in the prostate gland B. Reducing testosterone secretion from testes C. Reducing LH secretion from pituitary D. Lowering circulating as well as prostatic dihydrotestosterone concentration

Description : Finasteride acts by: A. Blocking testosterone receptors in the prostate gland B. Reducing testosterone secretion from testes C. Reducing LH secretion from pituitary D. Lowering circulating as well as prostatic dihydrotestosterone concentration

Last Answer : D. Lowering circulating as well as prostatic dihydrotestosterone concentration

Labetalol differs from propranolol in that: A. It has additional α1 blocking property B. It is a selective β1 blocker C. It does not undergo first pass metabolism D. All of the above

Description : Labetalol differs from propranolol in that: A. It has additional α1 blocking property B. It is a selective β1 blocker C. It does not undergo first pass metabolism D. All of the above

Last Answer : A. It has additional α1 blocking property

Labetalol has: A. More potent β adrenergic blocking than α blocking activity B. More potent α adrenergic blocking than β blocking activity C. Equal α and β adrenergic blocking activity D. β1 agonistic activity in addition to α and β adrenergic blockade

Description : Labetalol has: A. More potent β adrenergic blocking than α blocking activity B. More potent α adrenergic blocking than β blocking activity C. Equal α and β adrenergic blocking activity D. β1 agonistic activity in addition to α and β adrenergic blockade

Last Answer : A. More potent β adrenergic blocking than α blocking activity

Adrenergic neurone blocking drugs: A. Block the action of adrenaline on neuronal α2 adrenoceptors B. Block both α and β adrenoceptor mediated effects of injected adrenaline C. Do not block any effect of injected adrenaline D. Do not block the effects of sympathetic nerve

Description : Adrenergic neurone blocking drugs: A. Block the action of adrenaline on neuronal α2 adrenoceptors B. Block both α and β adrenoceptor mediated effects of injected adrenaline C. Do not block any effect of injected adrenaline D. Do not block the effects of sympathetic nerve

Last Answer : C. Do not block any effect of injected adrenaline

Ganglion blocking drugs are no longer used in therapeutics because: A. They have few and weak pharmacological actions B. They produce many side effects C. They are inactive by oral route D. They have short duration of action

Description : Ganglion blocking drugs are no longer used in therapeutics because: A. They have few and weak pharmacological actions B. They produce many side effects C. They are inactive by oral route D. They have short duration of action

Last Answer : A. They have potent antiovulatory action of their own

Ergotamine relieves migraine by: A. Blocking vascular α adrenergic receptors B. Blocking vascular 5-HT2 receptors C. Dilating cranial arterio-venous shunt channels D. Constricting cranial vessels and reducing perivascular neurogenic inflammation

Description : Ergotamine relieves migraine by: A. Blocking vascular α adrenergic receptors B. Blocking vascular 5-HT2 receptors C. Dilating cranial arterio-venous shunt channels D. Constricting cranial vessels and reducing perivascular neurogenic inflammation

Last Answer : D. Constricting cranial vessels and reducing perivascular neurogenic inflammation

Labetalol differs from propranolol in that: A. It has additional α1 blocking property B. It is a selective β1 blocker C. It does not undergo first pass metabolism D. All of the above

Description : Labetalol differs from propranolol in that: A. It has additional α1 blocking property B. It is a selective β1 blocker C. It does not undergo first pass metabolism D. All of the above

Last Answer : A. It has additional α1 blocking property

Adrenergic neurone blocking drugs: A. Block the action of adrenaline on neuronal α2 adrenoceptors B. Block both α and β adrenoceptor mediated effects of injected adrenaline C. Do not block any effect of injected adrenaline D. Do not block the effects of sympathetic nerve stimulation

Description : Adrenergic neurone blocking drugs: A. Block the action of adrenaline on neuronal α2 adrenoceptors B. Block both α and β adrenoceptor mediated effects of injected adrenaline C. Do not block any effect of injected adrenaline D. Do not block the effects of sympathetic nerve stimulation

Last Answer : C. Do not block any effect of injected adrenaline

Ganglion blocking drugs are no longer used in therapeutics because: A. They have few and weak pharmacological actions B. They produce many side effects C. They are inactive by oral route D. They have short duration of action

Description : Ganglion blocking drugs are no longer used in therapeutics because: A. They have few and weak pharmacological actions B. They produce many side effects C. They are inactive by oral route D. They have short duration of action

Last Answer : B. They produce many side effects

The quarternary analogues of belladonna alkaloids are preferred over the natural alkaloids for antisecretory/ antispasmodic indications because: A. They have additional nicotinic receptor blocking activity B. They are incompletely absorbed after oral administration C. They are devoid of CNS and ocular effects D. Dose to dose they are more potent than atropine

Description : The quarternary analogues of belladonna alkaloids are preferred over the natural alkaloids for antisecretory/ antispasmodic indications because: A. They have additional nicotinic receptor blocking activity B. They are ... of CNS and ocular effects D. Dose to dose they are more potent than atropine

Last Answer : C. They are devoid of CNS and ocular effects

Diethyl carbamazine citrate has the following action in filariasis: A. Rapidly kills adult filarial worms and stops production of microfilariae B. Kills circulating microfilariae C. Kills microfilariae present in nodules and serous fluids D. Promotes phagocytosis of circulating microfilariae

Description : Diethyl carbamazine citrate has the following action in filariasis: A. Rapidly kills adult filarial worms and stops production of microfilariae B. Kills circulating microfilariae C. Kills microfilariae present in nodules and serous fluids D. Promotes phagocytosis of circulating microfilariae

Last Answer : D. Promotes phagocytosis of circulating microfilaria

Metronidazole is selectively active against anaerobic organisms because: A. Aerobes have an active transport mechanism to pump it out of their cell B. Only anaerobes reduce it to generate the reactive nitro radical C. It is rapidly inactivated in the presence of oxygen D. It binds to DNA of anaerobes with high affinity

Description : Metronidazole is selectively active against anaerobic organisms because: A. Aerobes have an active transport mechanism to pump it out of their cell B. Only anaerobes reduce it to generate the reactive ... inactivated in the presence of oxygen D. It binds to DNA of anaerobes with high affinity

Last Answer : B. Only anaerobes reduce it to generate the reactive nitro radical

Choose the antimalarial drug effective against multidrug resistant P. falciparum, which rapidly terminates an attack of malarial fever, but has a short duration of action, so that recrudescence is common: A. Proguanil B. Mefloquine C. Amodiaquine D. Artemisinin

Description : Choose the antimalarial drug effective against multidrug resistant P. falciparum, which rapidly terminates an attack of malarial fever, but has a short duration of action, so that recrudescence is common: A. Proguanil B. Mefloquine C. Amodiaquine D. Artemisinin

Last Answer : D. Artemisinin

In a patient of pulmonary tuberculosis, pyrazinamide is most active on the following subpopulation of tubercle bacilli: A. Rapidly multiplying bacilli located on cavity walls B. Slow growing bacilli within macrophages and at sites showing inflammatory response C. Intermittently multiplying bacilli within caseous material D. Dormant bacilli

Description : In a patient of pulmonary tuberculosis, pyrazinamide is most active on the following subpopulation of tubercle bacilli: A. Rapidly multiplying bacilli located on cavity walls B. Slow ... showing inflammatory response C. Intermittently multiplying bacilli within caseous material D. Dormant bacilli

Last Answer : B. Slow growing bacilli within macrophages and at sites showing inflammatory response