GENERAL PRACTITIONER EXAM KIT-75

GENERAL PRACTITIONER EXAM

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  1. Unanswered
  2. Answered
  3. Review
  1. Question 1 of 100
    1. Question
    1 points

    A 60-year-old male has a six year history of hypertension for which he is receiving candesartan, amlodipine, bendrofluamethiazide and aliskiren.
    Which of the following best describes the mechanism of action of aliskiren?

    Correct

    Incorrect

    Explanation:
    Aliskiren is a direct renin inhibitor and represents the first new class of drug available in over a decade for the treatment of hypertension. Renin has long been recognised as a possible site for blockade of the-renin-angiotensin-aldosterone system (RAS) because it prevents conversion of angiotensinogen to angiotensin I and is a rate-limiting step in the RAS cascade. Aliskiren binds to the active site of the renin molecule, blocking angiotensinogen cleavage, thus preventing the formation of angiotensin I. Clinical studies have demonstrated at least equivalent blood pressure lowering efficacy compared with existing drugs with a favorable side effect profile.
  2. Question 2 of 100
    2. Question
    1 points

    A 35-year-old male is treated for an acute exacerbation of ulcerative colitis. Six weeks post-discharge, he is re-admitted with sepsis and labs show pancytopenia. What drug is responsible?

    Correct

    Incorrect

    Explanation:
    The answer could be either azathioprine or mesalazine as both cause a pancytopenia although azathioprine in the more common cause. Hence it is a tore up but one would have to go for azathioprine.
  3. Question 3 of 100
    3. Question
    1 points

    Lead poisoning:

    Correct

    Incorrect

    Explanation:
    Lead can also be absorbed through the skin and by inhalation.
    Associated with iron deficiency & a microcytic anaemia. Most common GI symptoms are abdominal colic and constipation.
  4. Question 4 of 100
    4. Question
    1 points

    Which of the following is a metabolic effect of Exenatide?

    Correct

    Incorrect

    Explanation:

    Exenetide mimics the effect of the gut hormone GLP-1 (glucagons-like peptide 1) and has favouable effects on the metabolism of individuals with diabetes mellitus.
    Exenetide suppresses appetite, inhibits glucose production in the liver, slows gastric emptying and stimulates insulin release.
    It does not increase insulin sensitivity which is achieved by drugs such as metformin and the glitazones.

    • Stimulates insulin release.
    • Inhibits glucose production by the liver
    • Slow gastric emptying
    • Suppresses appetite.
  5. Question 5 of 100
    5. Question
    1 points

    Which of the following compounds is the toxic metabolite that accumulates during Paracetamol overdose and is reduced by treatment with N-acetylcysteine?

    Correct

    Incorrect

    Explanation:
    Paracetamol is predominantly metabolized to glucuronide and sulphate conjugates, which are excreted in the urine. Hepatotoxicity is related to the conversion of a small proportion of the ingested dose to N-acetyl-p-benzoquinoneimine. In therapeutic doses N-acetyl-p-benzoquinoneimine is detoxified by conjugation with glutathione in the liver, but once the protective intracellular glutathione stores are depleted hepatic and renal damage may ensue. NAC and Methionine replenishes glutathione stores in the liver and may also act through its Sulphhydryl (-SH) group as a direct reducing agent.
  6. Question 6 of 100
    6. Question
    1 points

    Which of the following antiemetics functions as a cholinergic muscarinic antagonist?

    Correct

    Incorrect

    Explanation:
    Scopolamine is named after the genus Scopolia. The name “hyoscine” is from the scientific name for henbane, Hyoscyamus niger. It acts as a competitive antagonist at muscarinic acetylcholine receptors; it is thus classified as an anticholinergic or as an anti-muscarinic drug.
  7. Question 7 of 100
    7. Question
    1 points

    A 33 year old woman has a history of general anxiety disorder.
    She is most likely to develop physical dependence to which of the following medications?

    Correct

    Incorrect

    Explanation:

    Generalized anxiety disorder is characterized by excessive, almost daily anxiety and worry for ≥6 months about many activities or events. The cause is unknown, although it commonly coexists in people who have alcohol abuse, major depression, or panic disorder. Diagnosis is based on history and physical examination. Treatment is psychotherapy, drug therapy, or both.
    Certain antidepressants, including SSRIs are effective but typically only after being taken for at least a few weeks. Benzodiazepines (eg Diazepam) in small to moderate doses are also often and more rapidly effective, although sustained use usually causes physical dependence.

  8. Question 8 of 100
    8. Question
    1 points

    A 21 year old man is admitted to a psychiatric ward for stabilization of an acute episode of psychosis. He has been started on an antidepressant, an antipsychotic, and has required additional medications on several occasions for agitation. He develops a sustained muscular contraction involving his left neck muscles, with associated pain and distress on the fifth day of his hospitalization. Out of the following which is most likely responsible for it?

    Correct

    Incorrect

    Explanation:
    This patient is experiencing neuroleptic-induced acute dystonia. About 10% of patients experience dystonia as an adverse effect of antipsychotics, usually within the first few days of treatment. Dystonia can involve the neck (torticollis), the jaw, the tongue, the eyes, other specific muscle groups, and the entire body. Dystonias are most common with high potency conventional antipsychotics, such as haloperidol. Pseudoparkinsonism and akathisia are other forms of acute extrapyramidal side effects.
  9. Question 9 of 100
    9. Question
    1 points

    A male patient with bipolar disorder is being treated with lithium. Which one of the following is the most likely side effect of this therapy?

    Correct

    Incorrect

    Explanation:
    Lithium is used as a mood stabilizer in bipolar disease and can be used as monotherapy, especially when the depression is mild. A well- recognized side effect lithium is hypothyroidism. It is recommended that TSH be monitored in patients treated with lithium. Hyperparathyroidism, but not hypoparathyroidism, has been reported, but it is not common as hypothyroidism. Nephrogenic diabetes insipidus has been reported only rarely. Hypoaldosteronism is not a side effect of lithium.
  10. Question 10 of 100
    10. Question
    1 points

    An 80 year old man, resident of a nursing home has developed symptoms of depression including withdrawal and sadness. The staff also reports that he doesn´t want to leave his room, and often expresses a desire to stay in bed all day. After performing an appropriate evaluation and recommending non-pharmacologic interventions, you also decide that pharmacologic treatment is indicated. The most appropriate antidepressant is

    Correct

    Incorrect

    Explanation:
    Amitriptyline, doxepin, MAO inhibitors, and clomipramine should be avoided in nursing-home patients. SSRIs are the most appropriate first-line pharmacologic treatment for depression in nursing-home residents. Other classes of non-tricyclic antidepressant may be effective and appropriate, but the evidence for this is not as good as the evidence for SSRIs.
  11. Question 11 of 100
    11. Question
    1 points

    A 77 year old man presents with progressive tremors that had been there over the past 2 years. The tremor interferes with everyday habits. No other medical problem is present. He abstains from alcohol and tobacco products. Physical examination is remarkable for an action tremor of the upper extremities and a head tremor. No rigidity or gait disorder is noted. Which of the following is most appropriate as initial drug therapy for this problem?

    Correct

    Incorrect

    Explanation:
    Essential tremor is the most likely cause of a disabling action tremor in this age group. A resting tremor, rigidity, and other associated problems are seen with Parkinson´s disease. Propranolol and primidone are the agents of choice. Alprazolam may have beneficical effects, but it is not a first-line agent because of the risk of sedation and habituation. Clonazepam has not been found to be effective in this disorder. Low doses of theophylline have been found to be somewhat beneficial, but it is considered a second-line agent for essential tremor. Selective Beta-blockers such as metoprolol are not as effective as propranolol.
  12. Question 12 of 100
    12. Question
    1 points

    A 25 year old male is brought to the emergency department by his family because he says that he is being followed by gangsters and that they are going to kill him. Temperature is 37.8°C (100.0°F), pulse is 110/min and blood pressure is 160/95 mmHg. His pupils are dilated. The remainder of the physical examination is normal. The family states that he has a history of drug abuse. The drug that most likely caused this reaction is

    Correct

    Incorrect

    Explanation:

    This patient shows symptoms of paranoia and sympathetic stimulation. Common symptoms of cocaine use include the classic ones associated with sympathetic stimulation, such as tachycardia, hypertension, mydriasis, and sweating. Paranoia, suspiciousness, and psychosis may occur with prolonged use.
    Although at low levels alcohol induces some behavioral stimulation, it is a CNS depressant. Occasionally chronic alcohol use induces paranoia, but dementia and memory loss are more common symptoms.
    Diazepam, sold under the trade name Valium, is commonly prescribed as an anti-anxiety drug or muscle relaxant, and does not produce the symptoms noted. Heroin, like most opioids, is also a CNS depressant, and symptoms associated with its use include drowsiness, slurred speech, memory impairment, occasional perceptual disturbances, and pinpoint pupils.

  13. Question 13 of 100
    13. Question
    1 points

    Propranolol cannot be used in

    Correct

    Incorrect

    Explanation:
    Propranolol is a beta blocker used to treat chest pain (angina), high blood pressure, irregular heartbeats, migraine headaches, tremors and anxiety. Beta-blockers can cause hypoglycemia or hyperglycemia. Also, beta-blockers can blunt some of the body´s responses to hypoglycemia such as rapid heart rate, thus making it difficult for patients to recognize (and treat) hypoglycemic reactions.
  14. Question 14 of 100
    14. Question
    1 points

    A 61-year-old lady has osteoporosis. She takes alendronate. By what mechanism does this drug function against osteoporosis?

    Correct

    Incorrect

    Explanation:

    Osteoclasts are responsible for bone resorption therefore by reducing the efficacy of osteoclasts bone turnover is reduced.
    Bisphosphonates licensed for the prevention and treatment of osteoporosis include alendronate, risedronate and ibandronate. The bisphosphonates zoledronate and pamidronate are used for the treatment of metastatic bone disease and short-term management of hypercalcemia.

  15. Question 15 of 100
    15. Question
    1 points

    Which of the following drugs lower blood sugar by interfering with intestinal absorption of complex carbohydrates but does not affect fasting blood sugar?

    Correct

    Incorrect

    Explanation:
    Acarbose is an alpha-glucosidase inhibitor which interferes with intestinal absorption of complex carbohydrates and thus lowers the glucose load absorbed in the body. They inhibit α-glucosidase, an enzyme necessary for the conversion of complex starches, oligosaccharides, and disaccharides to the monosaccharides that can be transported out of the intestinal lumen and into the bloodstream. As a result of slowed absorption, postprandial hyperglycemia is reduced. These drugs lack an effect on fasting blood sugar. Metformin is a biguanide which works by decreasing hepatic glucose production by 30% and increasing glucose utilization in skeletal muscle. In one large study metformin lowered the fasting blood glucose level by an average of 52 mg/ dl. NPH insulin is long- acting and remains in the body eight to twelve hours after injection. Type II diabetics who take NPH insulin simply relieve their pancreas of the need to produce that amount of insulin during the day. It can now cope with the extra glucose coming in. Sulfonylureas work by binding to a sulfonylurea receptor on the pancreatic islet cell and thus facilitate insulin secretion. Regular insulin works in half an hour to one hour, and lowers the blood glucose by increasing glucose uptake in cells.
  16. Question 16 of 100
    16. Question
    1 points

    A 36 year old man is brought to the Emergency Department unconscious. He is warm and sweaty. His heart rate is 52 bpm; his BP is 90/60. His pupils are constricted, his eyes are teary, and he is drooling. You assume he is suffering from a toxidrome. Which of the following antidote would you give him?

    Correct

    Incorrect

    Explanation:
    This patient is presenting with classic signs and symptoms of toxicity with a cholinergic drug. The antidote for this is with an anticholinergic drug such as atropine. Atropine will raise the heart rate and reverse the other effects of this toxidrome.
  17. Question 17 of 100
    17. Question
    1 points

    Cyanide toxicity results from which of the following?

    Correct

    Incorrect

    Explanation:
  18. Question 18 of 100
    18. Question
    1 points

    Cyanide toxicity results from which of the following?

    Correct

    Incorrect

    Explanation:
    Cyanide inhibits the electron transport chain, thereby blocking the metabolic activity of the cell. It does not alter coagulability. Any anemia it may produce is not involved in cyanide´s principal toxicity. Cyanide is not associated with arrhythmias or dehydration as mechanisms of toxicity.
  19. Question 19 of 100
    19. Question
    1 points

    Pharmacological agent that is NOT associated with exacerbations of systemic lupus erythematosus in susceptible individuals is

    Correct

    Incorrect

    Explanation:
    Methotrexate is often used in the management of lupus. All of the other drugs have been implicated in drug induced lupus.
  20. Question 20 of 100
    20. Question
    1 points

    A 25 year old female attempts suicide by taking an overdose of diazepam. She is rushed to the emergency department, where the attending physician will most likely administer which treatment?

    Correct

    Incorrect

    Explanation:

    Flumazenil is an antagonist at the benzodiazepine receptor. It has no effect on other CNS depressants, such as barbiturates or alcohol.
    Acetylcysteine is the drug of choice for treatment of overdose of acetaminophen, the active ingredient in Tylenol. Atropine is a muscarinic antagonist used in cases of acetylcholinesterase inhibitor overdose. Bicarbonate infusions may be given to alkalinize the urine and enhance the excretion of acidic drugs (e.g., aspirin). CaNa2 EDTA is used as a chelator in lead poisoning.

  21. Question 21 of 100
    21. Question
    1 points

    A 65 year old man with Parkinson is diagnosed with clinical depression. What agent would be most effective in helping to alleviate the signs and symptoms associated with Parkinson disease and his depression?

    Correct

    Incorrect

    Explanation:
    Parkinson disease is a condition caused by dopamine depletion secondary to the degeneration of the dopaminergic nigrostriatal system, leading to an imbalance of dopamine and acetylcholine. Treatment is directed at restoring the balance between these two neurotransmitters by either replacing dopamine or blocking the effect of acetycholine with anticholinergic agents. Therefore, an agent with strong anticholinergic side effects would help to alleviate some of the signs and symptoms of Parkinson disease. Amitriptyline is a tricyclic antidepressant that has very strong anticholinergic properties. In general, most of the tricyclic antidepressants have strong anticholinergic properties. Citalopram and sertraline are both selective serotonin reuptake inhibitors (SSRIs) with very few, if any, anticholinergic properties. Nefazodone is a phenylpiperazine antidepressant with very few anticholinergic properties. Venlafaxine is a phenylethylamine antidepressant with very few anticholinergic properties.
  22. Question 22 of 100
    22. Question
    1 points

    A 19 year old girl is brought to the ER after a crush injury. She develops reddish urine and her creatinine rises from 1.0 to 4.0 mg/dL. She also develops edema globally. A diuretic should be prescribed to alleviate the edema and minimize damage to kidneys from her myoglobinemia. Which diuretic that is contraindicated in this case?

    Correct

    Incorrect

    Explanation:
    Spironolactone, a potassium-sparing diuretic, is contraindicated in renal failure. It blocks the effects of endogenous mineralocorticoids, leading to the excretion of salt and water and increasing the retention of C and H. This patient has developed acute renal failure secondary to the myoglobinuria of crush injury. Presumably, this patient will also have hyperkalemia as the crushed cells of the injured tissue release potassium. Stunned by the acute injury the kidneys cannot accommodate the increased potassium load. As a result, serum potassium increases. A diuretic that spares potassium will only exacerbate the elevated serum potassium. Hyperkalemia can lead to arrhythmia, which can be fatal. Acetazolamide could be used in this case. This drug inhibits carbonic anhydrase and works in the proximal tubule. The effectiveness of this diuretic is limited by the presence of HCO3-. Fortunately alkalinization of the urine using HCO3- aids in the treatment of myoglobinuria. Thus, this diuretic would be particularly effective in this case. Furosemide could be used in this case. A loop diuretic furosemide inhibits the Na/K/Cl “megatransporter” in the thick ascending loop on Henle. Due to this mechanism, furosemide can induce massive diuresis. Hydrochlorothiazide inhibits the reabsorption of NaCl in the early distal tubuie. Its use could be appropriate in this scenario. Mannitol, an osmotic diuretic, could be used in this case. While it is contraindicated in anuria, this patient continues to have urine output.
  23. Question 23 of 100
    23. Question
    1 points

    A 66 year old man develops a vesicular rash localized to a narrow circumferential band on one side his chest. The rash is very painful and the vesicles are confluent, with some ulceration. Rest of the examination is not significant. What would be the most appropriate course of therapy?

    Correct

    Incorrect

    Explanation:
    This patient has shingles, the recurrent form of herpes zoster infection, which is usually (except in the case of immunosuppressed patients) confined to a single dermatome. Isolated vesicles may be seen outside the dermatome. The primary herpes zoster infection precedes the development of shingles by years or decades. In patients with shingles, acyclovir, famciclovir, and valacyclovir are approved for use but the improved pharmacodynamics of famciclovir and valacyclovir make them the preferred drugs for varicella zoster virus. Doxepin is approved for use in the topical treatment of eczematous dermatitis (atopic dermatitis, eczema, or lichen simplex chronicus). This agent is not indicated for use in patients with shingles. Foscarnet or phosphonoformic acid, is approved for use in immunosuppressed patients suffering from cytomegalovirus infections. It inhibits the viral DNA polymerase by mimicking the pyrophosphate portion of nucleoside triphosphates. The Oka strain live attenuated vaccine for varicella zoster virus (VZV) is administered during childhood on the same schedule as the MMR vaccine. It is effective as a prophylactic treatment even after exposure to VZV and may be used to limit the onset of shingles in the elderly, but would not be effective once the shingles outbreak has occurred. Pooled immune globulin or varicella zoster immunoglobulin (VZIg) may be given to immunosuppressed patients susceptible to severe disease but would not be effective as a therapy for patients already suffering from active infections.
  24. Question 24 of 100
    24. Question
    1 points

    During phase I clinical trials pharmacokinetic parameters of a new antimicrobial agent are being determined. Recently it has been determined that the half life of this new agent is 9 hours. One subject had an adverse reaction and the drug was immediately discontinued. How much time will it take for plasma drug level to reach approximately 6% of steady state levels?

    Correct

    Incorrect

    Explanation:
    The rule of thumb is that the levels decrease by half every half-life. Therefore, 50% will remain after one half-life, 25% will remain after two half-lives, 12.5%will remain after three half-lives, and 6.245% will remain after four half-lives. The half-life of this drug is 9 hours, so it will reach approximately 6% of steady state levels in 36 hours.
  25. Question 25 of 100
    25. Question
    1 points

    A patient with total cholesterol of 272 mg/dL and LDL level of 210 mg/dL. is prescribed a drug that inhibits the formation of VLDL by the liver. Which symptoms will this patient likely experience from this drug?

    Correct

    Incorrect

    Explanation:

    Niacin or vitamin B3, is an agent that results in the following physiologic changes: LDL reductions tend to occur in 5-7 days with the maximal effect seen in 3-5 weeks; triglycerides and VLDL are reduced by 20%to 40% in 1-4 days and HDL levels can increase by 20%. This agent is indicated as adjunctive therapy in patients with elevated cholesterol and triglycerides when diet and other nondrug therapies are inadequate. The most common adverse effect of this agent is generalized flushing with a sensation of warmth, especially in the facial area. This reaction maybe so severe in some patients that they discontinue therapy. Aspirin can be helpful in alleviating this symptom. Other common adverse effects include hepatotoxicity, tachycardia, hypoalbuminemia, hyperglycemia, nausea, vomiting, hyperuricemia, glucose intolerance, pruritus, peptic ulcer disease, and dry skin.

  26. Question 26 of 100
    26. Question
    1 points

    A 64 year old man has precordial chest pain that is often precipitated by stress or exertion and is generally relieved quickly by rest and/or nitrates. ECG shows evidence of ischemia during stress testing. Angiography shows narrowing of several major heart vessels. Which drug would likely worsen his angina?

    Correct

    Incorrect

    Explanation:
    The patient meets the criteria for exertional angina: precordial chest pain precipitated by stress or exertion and generally quickly relieved by rest and/or nitrates. The beta adrenergic blocking agents prevent angina by decreasing myocardial oxygen requirements during exertion and stress through the reduction of heart rate, myocardial contractility, and blood pressure. Beta blockers are the only antianginal agents that have been proven to prolong life in patients with coronary disease and are considered to be first line agents in the treatment of chronic angina. Beta blockers with intrinsic sympathomimetic activity (acebutolol and pindolol) are generally not recommended for patients with angina because they may exacerbate the angina in some patients.
  27. Question 27 of 100
    27. Question
    1 points

    A 27 year old HIV positive female has of vaginal discharge, profound vaginal itching as well as the appearance of multiple clear vesicles on her external labia. Smear reveals several multinucleated giant cells with nuclear homogenization and Cowdry type A bodies. What treatment would recommend for use in this patient?

    Correct

    Incorrect

    Explanation:
    In this question the student must first make the correct diagnosis and then choose the most appropriate treatment measure. With respect to the diagnosis the cytopathic effect of a virus is often the key to determining the type of infection that is present. Infection by the herpes simplex virus is recognized by nuclear C homogenization (ground glass nuclei), intranuclear inclusions (Cowdry type A bodies), and the formation of multinucleated cells. The herpes simplex (HSV) type 2 virus is considered to be a sexually transmitted viral disease. When infected, the disease will manifest itself with the appearance of vesicles that ulcerate and cause burning, itching, and pain. Although the lesions heal on their own, the virus will have recurrent patterns of dormancy and remitting infections. Although there are two medications used to treat HSV infections listed as answer choices (acyclovir and valacyclovir), only one of these agents can be safely used in the treatment of this patient´s infection. Acyclovir is indicated for the treatment of initial and recurrent mucosal and cutaneous infections caused by HSV (Types 1 and 2) in immunocompromised and non-immunocompromised patients. Valacyclovir is not indicated for use in immunocompromised patients since it has been associated with the development of thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. These reactions have occurred in immunocompromised patients and have resulted in death. The combination of amphotericin B + flucytosine is used in the treatment of Cryptococcus neoformans infections. Fluconazole is primarily used in the treatment of Candida infections, which are the most common type of fungal infections in HIV infected patients. Pentamidine is indicated for the treatment of Pneumocystis carinii infections.
  28. Question 28 of 100
    28. Question
    1 points

    The agent prescribed to a 29 year old male for CML is a cell cycle S phase specific antimetabolite. Side effects include myelosuppression and hyperuricemia. If the neoplastic cells delete the gene encoding HGPRT, they will become resistant to this drug. The antineoplastic agent for the treatment is which one of the following?

    Correct

    Incorrect

    Explanation:
    Mercaptopurine is a purine metabolite that inhibits purine biosynthesis. Mercaptopurine is activated following conversion to a nucleoside triphosphate by hypoxanthine/guanine phosphoribosyl transferase (HGPRT). Allopurinol, which inhibits xanthine oxidase, is often given to patients undergoing cancer chemotherapy to reduce the synthesis of uric acid. However, because mercaptopurine is metabolized by xanthine oxidase, allopurinol elevates mercaptopurine levels. Hepatotoxicity is another toxicity associated with long term use of mercaptopurine. Anastrozole is an estrogen antagonist used to treat breast cancer. Busulfan is also used to treat chronic myeloid leukemia and can cause myelosuppression. However, busulfan is an alkylating agent and its effectiveness would not be affected by levels of HGPRT. Carmustine, which is also an alkylating agent that can cause prolonged myelosuppression, is used to treat brain tumors, myeloma, and lymphomas. Cisplatin is a platinum compound that forms metabolites that bind and crosslink DNA strands. Cisplatin is less likely to cause myelosuppression compared to other anticancer drugs. Below is a table that summarizes modes of resistance to antineoplastic medications.
  29. Question 29 of 100
    29. Question
    1 points

    A 45 year old man presents with severe pneumonia. He recently returned from a business trip, and has a history of smoking and alcohol use. CXR shows extensive consolidation affecting portions of each lung lobe. Culture on charcoal yeast extract medium grows out a small gram negative bacterium. Which antibiotic is the most appropriate treatment?

    Correct

    Incorrect

    Explanation:
    This patient has Legionnaires disease, an acute, and sometimes fatal, pneumonia. It is caused by Legionella pneumophila, a facultative intracellular parasite that can be grown on charcoal yeast agar; erythromycin is the treatment of choice. Legionella is acquired from inhaling an infectious aerosol produced from sources such as air conditioning systems of large buildings (e.g., hotels) or respiratory therapy equipment. Legionnaires disease affects men more often than women, and is more common in individuals older than 40. The disease is more severe in smokers, alcoholics, diabetics, and immunosuppressed patients.
    Ceftriaxone is a third-generation cephalosporin. It is a broad-spectrum antibiotic and is the drug of choice for Neisseria gonorrhoeae infections. Chloramphenicol is a broad-spectrum antibiotic that is rarely used in the U.S. because of the risk of aplastic anemia, a rare but fatal side effect. In developing nations, it is the drug of choice for typhoid fever. Clindamycin is a broad-spectrum antibiotic active against gram-positive cocci and anaerobic bacteria. It is the most common agent associated with antibiotic induced pseudomembranous colitis due to Clostridium difficile. Metronidazole is active against many obligate anaerobes, certain protozoa (Amoeba, Trichomonas, Giardia), and Helicobacter pylori. It is also used to treat pseudomembranous colitis due to Clostridium difficile infection.
  30. Question 30 of 100
    30. Question
    1 points

    A 48 year old alcoholic has 2 days of severe worsening pain with redness and swelling of his first metatarsophalangeal joint. No history of injury or trauma is present. He is afebrile with no other symptoms. The most appropriate therapy is

    Correct

    Incorrect

    Explanation:
    This patient is experiencing an acute attack of gout. The association of gout with alcoholism is well documented. Gout is caused by overproduction or underexcretion of uric acid. Precipitation of sodium urate (uric acid is ionized at body pH) in joint fluid causes an acute inflammatory synovitis with synovial edema and leukocytic infiltrate. It usually affects the joints of the lower extremity, most commonly, the large toe. Formation of tophi (orate deposits surrounded by inflammatory cells, including foreign body giant cells) is pathognomonic. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin, can be used in the treatment of acute gout. They are as efficacious as colchicine and less toxic. Allopurinol is an anti-gout drug indicated for the treatment of chronic gout. Allopurinol functions to inhibit the enzyme xanthine oxidase, which results in decreased production of uric acid from its immediate precursor, xanthine. It lowers both serum and urinary concentrations of uric acid. Colestipol is a bile acid sequestrant that is useful in lowering cholesterol levels in familial hyperlipidemias. It is not used for the treatment of gout. Pravastatin is a hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitor useful in the treatment of familial hyperlipidemias. It is not used for the treatment of gout. Probenecid is indicated for the treatment of chronic gout. Probenecid inhibits uric add reabsorption and therefore increases the urinary excretion of uric acid.
  31. Question 31 of 100
    31. Question
    1 points

    A 77-year-old man is agitated and confused. He has small pupils, a heart rate of 50 bpm, and is frothing at the mouth. What is the most likely poison?

    Correct

    Incorrect

    Explanation:
    The patient has cholinergic features with a relative bradycardia, small pupils and increased salivation. This is highly suggestive of organophosphorus poisoning which is an anti-cholinesterase, thus prolonging the effects of acetylcholine.
    The effects of organophosphate poisoning are recalled using the mnemonic SLUDGEM (Salivation, Lacrimation, Urination, Defecation, Gastrointestinal motility, Emesis, miosis)These side effects occur because of the excess acetylcholine that results from blocking acetylcholinesterase. In addition, bronchospasm, blurred vision and bradycardia may result.An additional mnemonic is DUMBELLS: Diarrhea, Urination, Miosis, Bradycardia, Bronchoconstriction, Emesis, Lacrimation, Salivation, Sweating, Secretion.
    Paraquat is associated with nausea, vomiting and diarrhea with ulceration.
    Creosote is petroleum based substance and would not have such an effect.
    Glyphosate herbicides produce nausea, vomiting and diarrhea with a caustic effect in the mouth.
    Pyrethroid is an insecticide and poisoning is rare but associated with coma, convulsions and pulmonary edema.
  32. Question 32 of 100
    32. Question
    1 points

    A middle lady presents with cervical and inguinal lymphadenopathy. She is also experiencing pins and needles in a glove and stocking distribution, and has gum hypertrophy. She has a previous history of epilepsy and is on regular medication. Which of the following drugs is most likely to cause her symptoms?

    Correct

    Incorrect

    Explanation:

    Recognized side effects of phenytoin include

    • Drowsiness
    • Ataxia
    • Confusion
    • Blurred vision
    • Dizziness
    • Nystagmus
    • Permanent cerebellar ataxia
    • Peripheral neuropathy
    • Rashes
    • Gum hypertrophy
    • Thickening of the facial features
    • Lymhadenopathy
    • Chorea
    • Sleep disturbance

    Remarkable side effects of other anti-epileptic drugs are:

    • Drowsiness
    • Blurred vision
    • Dizziness
    • Leukopaenia
    • SIADH and rash (carbamazepine)
    • Liver toxicity (sodium valproate)
    • Severe rash (lamotrigine)
    • Retinal damage (vigabatrin)
    • Aplastic anaemia (felbamate).
  33. Question 33 of 100
    33. Question
    1 points

    A 61-year-old with idiopathic Parkinson´s disease has motor oscillations and on-off periods. She had received Co-beneldopa for 5-years. 
    Selegiline was added to her treatment. Which one of the following enzymes does Selegiline act on to cause this adjuvant action?

    Correct

    Incorrect

    Explanation:
    Selegiline is a MAO-B inhibitor.
  34. Question 34 of 100
    34. Question
    1 points

    Which of the following anti-microbials is associated with prolongation of the QT interval?

    Correct

    Incorrect

    Explanation:
    The macrolides are associated with a prolongation of the QT interval. Quinine also causes it.
  35. Question 35 of 100
    35. Question
    1 points

    A 40-year-old male has chest pain, confusion and agitation after taking a recreational drug. He is confused, has a temperature of 38.3°C and a blood pressure of 190/102 mmHg. Which of the following drugs has he taken?

    Correct

    Incorrect

    Explanation:

    In this scenario, the young male presents with confusion and agitation following drug abuse.
    The most likely agent is cocaine.
    Through central effects, cocaine induces sweating, pyrexia and also adrenergic mediated hypertension.
    It may also be responsible for coronary and cerebral artery spasm causing infarction.

  36. Question 36 of 100
    36. Question
    1 points

    A 70-year-old lady with mitral valve disease and atrial fibrillation is taking warfarin. Lately her INR has fallen and the dose of warfarin has had to be increased. Which of the following new treatments may account for this change?

    Correct

    Incorrect

    Explanation:

    The metabolism of warfarin has been increased since it is becoming less effective.
    St´ John wort is an enzyme inducer. The other drugs are enzyme inhibitors.

  37. Question 37 of 100
    37. Question
    1 points

    A lady aged 35 years comes to the office for a Papanicolaou (Pap) test, On a review-of-system checklist, she checks ´yes´ to depressive symptoms, insomnia, and anxiety. On asking, she admits to feeling depressed for about 4 months, after a recent job change. She is not suicidal. On further questioning, she admits that she repeatedly checks her locks and constantly worries about cleanliness; this is her life time routine, but finds it very time- consuming. Which one of the following drugs is the best choice for this patient?

    Correct

    Incorrect

    Explanation:
    The patient most likely has obsessive compulsive disorder (OCD) with a depressive episode, SSRIs are most frequently used. Risperidone and clonazepam are considered second line drugs and are used as augmentation drugs when there is a partial response to an SSRI. There is no evidence that clorazepate or imipramine is effective in OCD.
  38. Question 38 of 100
    38. Question
    1 points

    A 35 year old man is under your treatment for anxiety, panic disorder, and a history of alcoholism. He has been abstinent from alcohol for 6 years. The greatest risk of physical dependence is associated with which of the following?

    Correct

    Incorrect

    Explanation:
    Alprazolam is a benzodiazepine. It is capable of producing physical dependence, and the risk is substantially elevated in a patient with a history of alcohol dependence. Imipramine is a tricyclic drug and does not carry a risk of physical addiction or dependence. Buspirone is in the azapirone class. It does not produce sedation or euphoria. There is no withdrawal syndrome or dependence. Propranolol is a Beta-blocker and may be useful for controlling somatic symptoms of anxiety. While Beta-blockers are not addictive, abrupt withdrawal may be hazardous due to potential cardiovascular side effects. Phenelzine is an MAO inhibitor. Physical dependence is not a problem with this drug class.
  39. Question 39 of 100
    39. Question
    1 points

    Typical antipsychotic drugs act by which of the following mechanism?

    Correct

    Incorrect

    Explanation:

    Typical antipsychotic medications include haloperidol, chlorpromazine and thioridazine. Their mechanism of action is they block the dopamine (D2) receptors. They treat positive symptoms like hallucination or delusions.
    Atypical antipsychotics include risperdione and clozapine. They work by blocking both D2 and serotonin (5-HT) receptors. They treat both positive and negative symptoms.

  40. Question 40 of 100
    40. Question
    1 points

    A major advantage of second- generation (atypical) antipsychotics compared with first-generation antipsychotics is

    Correct

    Incorrect

    Explanation:
    A recent expert consensus panel endorsed the use of second-generation antipsychotics rather than first-generation drugs. Tardive dyskinesia is much less common with the use of second-generation antipsychotics. Several of the second-generation drugs require monitoring for major side effects, however. For example, clozapine, shown by studies to be the most efficacious of the new class, causes granulocytopenia or agranulocytosis, requiring weekly and later biweekly monitoring of blood counts. Both classes have depot formulations for intramuscular administration every 2-4 weeks. Oral dosing of drugs from both classes varies from l to 3 times daily. First-generation antipsychotics cost less than second-generation drugs.
    		 
  41. Question 41 of 100
    41. Question
    1 points

    All are neuropsychological effects of hallucinogens, except

    Correct

    Incorrect

    Explanation:
    Hallucinogens can produce physiological effects including elevated heart rate, increased blood pressure, and dilated pupils. These drugs are often unpredictable and a user may experience different effects compared to other users or past usage. Users often experience changes in perception, thought, and mood.
  42. Question 42 of 100
    42. Question
    1 points

    The primary mechanism of sucralfate in gastroesophageal reflux disease (GERD) is which of the following?

    Correct

    Incorrect

    Explanation:

    Omeprazole inhibits the hydrogen-potassium ATPase pump inhibitor and is a potent suppressor of acid production. Cimetidine is a histamine2 receptor antagonist and also decreases acid production. Sucralfate offers local mucosal protection. Metronidazole is part of a multiple drug therapy aimed at the eradication of Helicobacter pylori, which has been demonstrated in peptic ulcer disease. Antacids chemically neutralize acid.

  43. Question 43 of 100
    43. Question
    1 points

    What is the drug of choice in preventing meningococcal infections?

    Correct

    Incorrect

    Explanation:
    Rifampin is the drug of choice in prophylaxis against outbreaks of meningococcal meningitis. The other drugs are not routinely used for prophylaxis.
  44. Question 44 of 100
    44. Question
    1 points

    Antihypertensive agent that is most likely to cause hyperkalemia is which one of the following?

    Correct

    Incorrect

    Explanation:
    Captopril is the antihypertensive agent to most likely cause hyperkalemia.
  45. Question 45 of 100
    45. Question
    1 points

    A 62 year old woman being treated with cytotoxic drugs develops fever of 40°C (104°C) and a gram positive alpha hemolytic coccus is cultured from her blood in 6.5% NaCl on bile/esculin agar. Agent is vancomycin resistant according to Kirby Bauer antibiotic sensitivity test. The mechanism of vancomycin resistance in this infectious agent is

    Correct

    Incorrect

    Explanation:
    The antibiotic properly of vancomycin depends upon its ability to bind D-ALA-D-ALA, which is vital in the synthesis of peptidoglycan peptide bridges. Vancomycin resistant enterococci insteadutilize lactic acid in their peptide bonds, and thus are resistant to the action of vancomycin. Enzymatic deactivation of antibiotics is a common mode of resistance to aminoglycosides, chloramphenicol, and sulfonamides. The most common chemical modifications are acetylation, adenylation, and phosphorylation. Penicillin that has penetrated the cell membrane acts by binding to penicillin binding proteins (PBPs). PBPs are transpeptidases and carboxypeptidases that function in production of the bridges within the peptidoglycan molecule. Penicillin resistance may be conferred through altered PBP affinity or number. Vancomycin resistance does not depend on PBPs. β-lactamase is a bacterial enzyme that inactivates some of the penicillins and cephalosporins, but has no activity on vancomycin. Modified ribosomes with decreased antibiotic affinity confer resistance to protein synthesis inhibiting antibiotics, including tetracycline, minocycline, doxycycline, and the macrolide antibiotics. Vancomycin is not a protein synthesis inhibiting antibiotic.
  46. Question 46 of 100
    46. Question
    1 points

    A 28 year old female presents with urinary frequency, urgency, and burning on urination. Fever is absent. Urinalysis indicates the presence of pyuria and bacteriuria. The patient is prescribed an antibiotic and is informed that the use of antacids could lead to a therapeutic failure. The patient most likely prescribed which one of the following?

    Correct

    Incorrect

    Explanation:
    Uncomplicated cystitis can be treated with any of the agents listed in this question. Ofloxacin is a fluoroquinolone that will have a dramatic decrease in bioavailability when taken with antacids, secondary to the binding of the two medications in the intestinal tract. The fluoroquinolones are commonly used to treat upper and lower respiratory infections as well as genitourinary tract infections. The bioavailability of the other agents is not affected nearly as much as the fluoroquinolones when taken with antacids. Ampicillin is a penicillin antibiotic used to treat a variety of Infections caused by gram negative and gram positive organisms, as well as anaerobic infections. Cephalexin is a first generation cephalosporin commonly used to treat skin infections as well as urinary tract infections. Loracarbef is a second generation cephalosporin used to treat lower respiratory tract, intra-abdominal, skin, and bone infections caused by gram negative, gram positive, and anaerobic bacteria. Trimethoprim sulfamethoxazole is a “sulfa” antibiotic primarily used to treat urinary tract infections and acne.
  47. Question 47 of 100
    47. Question
    1 points

    A firefighter was burned over 60% of his body. He is rushed to the ER and during the surgery the anesthesiologist notices tall peaked T waves and prolongation of the PR interval, accompanied by progressive widening of the QRS complex so that it appears to merge with the T waves. He goes into ventricular fibrillation then asystole, and cannot be resuscitated. What is most likely responsible for this patient´s ECG changes?

    Correct

    Incorrect

    Explanation:
    The electrocardiogram strongly suggests that this patient is suffering from hyperkalemia. Hyperkalemia is a potentially life-threatening complication of succinylcholine. Because succinylcholine is a depolarizing skeletal muscle relaxant, during prolonged muscle depolarization the muscle can release substantial amounts of K+ Patients with burns, extensive soft tissue injuries, spinal cord injury, or muscular dystrophies are at great risk of succinylcholine induced hyperkalemia, and succinylcholine should be either avoided or used with extreme caution. In hyperkalemia, the ECG may show peaked T waves, widened QRS, and biphasic QRS-T complexes. Atracurium and tubocurarine are nondepolarizing skeletal muscle relaxants and do not increase the risk of hyperkalemia. Baclofen is a spasmolytic and would not be used in a surgical setting. Cyclobenzaprine is used to relieve acute temporary muscle spasm that is caused by strain or local trauma. It would never be used as a skeletal muscle relaxant in a surgical setting.
  48. Question 48 of 100
    48. Question
    1 points

    A female attempts suicide by ingesting 25 tables of extra strength acetaminophen. She is rushed to the emergency room. The medication that will most likely to be administered to this patient is which one of the following?

    Correct

    Incorrect

    Explanation:
    Acetylcysteine (N -acetylcysteine) is the antidote for acetaminophen overdose. Atropine is a muscarinic receptor antagonist used in the treatment of cholinesterase inhibitor poisoning. Penicillamine is a chelating agent used to treat poisoning with copper, lead, arsenic, and gold. Pralidoxime is an acetylcholinesterase reactivating agent that is used in organophosphorus cholinesterase inhibitor poisoning. Protamine is used for heparin overdose. Protamine is a basic peptide that binds heparin to form a stable complex devoid of anticoagulant activity.
  49. Question 49 of 100
    49. Question
    1 points

    Drug acting on the kidney has been shown to increase urine flow rate. Following diagram shows the effects on renal excretion. Which one of the following is most likely blocked by the drug?

    Correct

    Incorrect

    Explanation:

    The net effects of vasopressin are mediated by its interaction with the three types of receptors, V1a, V1b, and V2.V2 receptors are primarily located in the principle cells of the renal collecting duct system, as well as on epithelial cells in the thick ascending limb and on vascular endothelial cells. The drug is blocking vasopressin type 2 (V2) receptors in the collecting duct, because it is increasing the free water clearance (C-H2O) without affecting sodium or potassium excretion. Due to the addition of aquaporins towards the apical membrane of the principal cells of the collecting duct, there is increased water permeability. This new class of drugs is actually used to increase plasma sodium in certain patients with SIADH or congestive heart failure. Carbonic anhydrase inhibitors such as acetazolamide, increase sodium and potassium excretion with no effect on C-H2O. Mineralocorticoid receptor antagonists such as spironolactone are potassium sparing diuretics. Therefore, they increase sodium excretion and decrease potassium excretion. Thiazide type diuretics inhibit the Na Cl- cotransporter in the distal tubule. They increase sodium and potassium excretion. Also, since they inhibit the dilution of the urine, they decrease CH2O. Loop diuretics inhibit the Na+ -K+ -2Cl- cotransporter in the thick ascending limb. They increase sodium and potassium excretion. Since the thick ascending limb is involved in generating the medullary gradient and diluting the urine, it could have variable effects on the CH2O.

  50. Question 50 of 100
    50. Question
    1 points

    A 68 year old man diagnosed with supraventricular tachycardia is given a medication that blocks potassium channels, prolongs repolarization, widens the QRS, and prolongs the QT interval. Which medication was most likely prescribed?

    Correct

    Incorrect

    Explanation:
    This question is essentially asking for the mechanism of action of the patient´s medication. Amiodarone is a class III (with IA properties as well) antiarrhythmic that blocks potassium channels, prolongs repolarization, widens the QRS, and prolongs the QT interval, possibly resulting in torsades. Amiodarone is used in the treatment of refractory ventricular tachycardia and supraventricular tachycardia, and in the prevention of ventricular tachycardia and ventricular fibrillation. Lidocaine is a class IB antiarrhythmic indicated for the treatment of ventricular tachycardia. This agent blocks sodium channels and shortens the action potential duration. Propranolol is a beta-receptor blocking agent and class II antiarrhythmic that decreases automaticity and prolongs atrioventricular conduction and refractoriness. It is indicated for the treatment of supraventricular tachycardia. Quinidine is a class IA antiarrhythmic used in the treatment of ventricular tachycardia and supraventricular tachycardia, and in the prevention of ventricular fibrillation and symptomatic ventricular premature beats. It blocks sodium channels, slows the rate of rise of the action potential, and prolongs its duration. It also prolongs the QT interval. Verapamil is a calcium channel blocker and a class IV agent. It decreases automaticity and slows atrioventricular conduction. This agent is indicated for the treatment of supraventricular tachycardias.
  51. Question 51 of 100
    51. Question
    1 points

    A 55 year old man has epigastric pain that occurs at regular intervals daily partially relieved by antacids and food. Upper endoscopy reveals an ulcer in the first part of duodenum. Spiral shaped, motile, oxidase positive and catalase positive rods with multiple flagella atone pole are cultured from the lesion. The most effective treatment is

    Correct

    Incorrect

    Explanation:
    The gross specimen shows a typical peptic ulcer of the first portion of the duodenum. The great majority of these ulcers are associated with chronic Helicobacter pylori infection, which plays a pathologic role. H. pylori is a spiral shaped gram negative rod that has many characteristics in common with Campylobacter, such as multiple flagella at one pole and active motility. H. pylori is oxidase positive, catalase positive, and is a strong producer of urease. Eradication of H. pylori is necessary not only for rapid healing of active ulcers, but also to prevent future recurrence. Therefore, drugs that eradicate this gram-negative bacillus are used for treatment of active peptic ulcer disease. Proton pump inhibitors (omeprazole or lansoprazole) are also useful for treating peptic ulcer disease. This treatment must be combined with at least one of the antibiotics (usually two) that are effective against H. pylori. Clarithromycin is usually used in combination with either metronidazole or amoxicillin. Aluminum or magnesium-containing antacids are probably the most common over the counter medications used by patients with peptic ulcers and gastroesophageal reflux for prompt relief of epigastric pain and discomfort, These drugs are no longer recommended as first line agents for treatment of peptic disease nor do they have anti- H. pylori activity. H2-receptor blocking agents including cimetidine, famotidine, and ranitidine are not effective in eradicating H. pylori infection. However, they provide rapid symptomatic relief and promote ulcer healing. Prostaglandin analogs (e.g. misoprostol) are used exclusively as prophylactic agents to prevent NSAID induced ulcers, not as a standard treatment of peptic ulcers. These drugs act by stimulating mucus and bicarbonate production. Sucralfate forms a protective mucosal barrier. It is effective for treatment of duodenal ulcers to a degree comparable to H2 receptor blocking agents. However, it has no antibacterial activity against H. pylori.
  52. Question 52 of 100
    52. Question
    1 points
    The effects of a drug on aldosterone secretion and blood pressure are shown in the figure below. The identity of the drug is most likely which of the following?
    Correct

    Incorrect

    Explanation:

    The drug is lowering blood pressure and increasing aldosterone secretion. Furosemide, a loop diuretic, lowers blood pressure and increases activity of the renin-angiotensin-aldosterone system through a baroreceptor-mediated increase in sympathetic input to the renin-secreting granular cells. The increased angiotensin II stimulates aldosterone secretion from the adrenal cortex. Atenolol is a selective receptor antagonist. An important mechanism of its blood pressure lowering effect is suppression of renin secretion from the granular cells. As a result of decreased angiotensin II levels, aldosterone secretion is decreased. Captopril is an ACE inhibitor. Therefore, its blood pressure lowering effects are mediated through decreased synthesis of angiotensin II and aldosterone. Clonidine, an alpha 2 selective agonist, decreases sympathetic tone. As a result, there is suppression of the renin-angiotensin-aldosterone system. Losartan blocks angiotensin II receptors. As a result, blood pressure decreases, in part from the decreased aldosterone secretion.

  53. Question 53 of 100
    53. Question
    1 points

    A 73 year old male with a history of mitral valve replacement is currently on an oral anticoagulant. His prothrombin time is monitored on a regular basis. 7 days after starting an oral antibiotic he develops hematuria. Which drug is most likely responsible for this new symptom?

    Correct

    Incorrect

    Explanation:
    Warfarin is the oral anticoagulant the patient was most likely taking. This drug is commonly prescribed for patients with atrial fibrillation to prevent the formation of atrial thrombi as well as prevention of thrombus formation in a variety of other situations, such as prosthetic valves. Warfarin increases prothrombin time (PT), because it interferes with the synthesis of the vitamin K dependent clotting factors of the liver (II, VII, IX, and X) and therefore necessitates regular monitoring of the PT. Clarithromycin, like other macrolides, binds to the 50S subunit of the 70S ribosome, thereby blocking RNA mediated bacterial protein synthesis. It inhibits hepatic enzymes, including those that metabolize warfarin. Consequently, coadministration of warfarin and clarithromycin results in enhanced warfarin activity, producing pronounced anticoagulation and hematuria. Amoxicillin, a penicillin, and cefaclor, a cephalosporin, are both beta lactam antibiotics. Although these agents may increase the patient´s PT at very high doses, at standard oral doses, this effect is unlikely. The most likely cause of the patient´s increased PT is the macrolide antibiotic, clarithromycin. Rifampin is a potent hepatic enzyme inducer. Therefore, this agent would be expected to decrease the blood level of warfarin by increasing its metabolism. Tetracycline is unlikely to affect the patient´s prothrombin time.
  54. Question 54 of 100
    54. Question
    1 points

    A 56 year old woman with a history of food allergies presents with whole body itching and welts on her torso. She ate some Thai food with a peanut sauce base, and the patient is allergic to peanuts. She denies any difficulty breathing, and her blood pressure is 120/70 mm Hg. Respiratory exam is normal. She is given Diphenhydramine. What change will occur as a result of administering Diphenhydramine?

    Correct

    Incorrect

    Explanation:
    H1 antihistamines, such as diphenhydramine, are effective in treating the symptoms of seasonal rhinitis and conjunctivitis because they decrease these histamine- mediated responses. The H1 receptor is widely distributed in the smooth muscle and is involved in the type I hypersensitivity reactions, e.g., allergies, anaphylaxis. H1 receptors increase IP3 and DAG; therefore, H1 antagonists lead to decreased IP3 and DAG. The effects of histamine can also be reduced with physiologic antagonists (e.g., epinephrine, which bronchodilates, constricts blood vessels, and decreases swelling) and degranulation inhibitors (e.g., cromolyn and nedocromil, which decrease the degranulation of mast cells resulting from the immunologic effects triggered by antigen-IgE interaction). Activation of H2 receptors leads to an increase in cAMP levels.
  55. Question 55 of 100
    55. Question
    1 points

    A newborn infant is diagnosed with pulmonary atresia. To prevent severe cyanosis, the patency of the ductus arteriosus must be maintained. Which drug can artificially prolong the patency of the ductus arteriosus in this child?

    Correct

    Incorrect

    Explanation:
    The ductus arteriosus is an arterial channel connecting the aorta with the pulmonary trunk during intrauterine life. Closure of this embryonal vessel occurs in the first few days after birth. Patency of the ductus is maintained by prostaglandins, more specifically prostaglandin E. Alprostadil is prostaglandin E1. Nonsteroidal anti-inflammatory drugs (NSAIDS), such as indomethacin promote closure of this structure since NSAIDs inhibit prostaglandin synthesis. Betamethasone, a glucocorticoid, can accelerate pulmonary maturation and stimulate production of surfactant when given to the mother prior to delivery of premature infants, but does not affect the ductus arteriosus. Insulin inhibits surfactant production but has no effect on the ductus arteriosus. Oxytocin is a hypothalamic hormone that stimulates contraction of smooth muscle in the uterus and mammary glands. It has no effect on the ductus arteriosus.
  56. Question 56 of 100
    56. Question
    1 points

    A 71 year old man has chronic heartburn. It is painful for him to bend over, and he sleeps on a wedge shaped pillow to try to reduce the burning sensation. The medication that would be the most efficacious in reducing his symptoms is

    Correct

    Incorrect

    Explanation:
    Omeprazole is an irreversible inhibitor of H+/K+/ATPase of the parietal cell. It is used in the treatment of peptic ulcer disease, reflux esophagitis, and Zollinger Ellison syndrome. Omeprazole can reduce daily gastric acid secretion by more than 95%. This drug is of particular value to patients who do not respond sufficiently to H2 antagonists. Because of the profound reduction in gastric acid secretion, patients can develop modest hypergastrinemia. In laboratory rats, the increased gastrin causes hyperplasia of oxyntic mucosal cells and carcinoid tumors. Although there has been concern that the hyperplasia could also occur in humans, this has not been substantiated to date. Bisacodyl is a stimulant laxative. Cimetidine is an H2-receptor antagonist that would block histamine induced acid secretion. It is not as efficacious as omeprazole. Magnesium hydroxide is an antacid. It would help relieve the heartburn but would not be as efficacious as omeprazole. Promethazine, a dopamine-receptor antagonist, is an antiemetic.
  57. Question 57 of 100
    57. Question
    1 points

    A 31 year old female with a history of tonic clonic seizures complains of double vision, thickened gums, and growth of facial hair since starting a new drug. Which anticonvulsant medication is most likely responsible for her symptoms?

    Correct

    Incorrect

    Explanation:
    Diplopia, gingival hyperplasia, and hirsutism are classic side effects of phenytoin. Other side effects include nystagmus, sedation, ataxia, and enzyme induction. Phenytoin is used in the treatment of grand mal and tonic-clonic seizures. It is not used for absence seizures. Carbamazepine does produce diplopia, but not the other symptoms in this vignette. It can also produce ataxia, enzyme induction, and blood dyscrasias. It is useful in tonic clonic and partial seizures and in tic douloureux. Ethosuximide causes gastrointestinal distress, headache, and lethargy. It is used exclusively for absence seizures. Phenobarbital is used for grand mal and partial seizures. It causes sedation, enzyme induction, and dependence. Valproic acid causes gastrointestinal distress, hepatotoxicity and inhibition of drug metabolism. It can be used for all seizure types but is particularly useful in myoclonic and petit mal seizures.
  58. Question 58 of 100
    58. Question
    1 points
    Two alpha adrenergic antagonists (Drugs X and Y) decrease blood pressure by the same amount after IV administration at the following doses:
    Drug X: 120 mg
    Drug Y: 15 mg
    This scenario implies that Drug X
    Correct

    Incorrect

    Explanation:
    Both drugs produce exactly the same effect, but Drug Y achieved the blood pressure response with one eighth the dosage of Drug X. This means that Drug X is 8 times less potent than Drug Y. A high therapeutic index means that the drug is relatively safe. However, the safety of a drug is not necessarily related to its potency. Differences in bioavailability between these two drugs cannot be determined because both of these drugs were administered intravenously. Bioavailability is the fraction of a (typically orally administered) drug that reaches the systemic circulation. Bioavailability is by definition (100%) when drugs are administered intravenously. The half-life is the amount of time it takes for the concentration of a drug to fall to 50% of a previous measurement. There is no information provided to determine the half-lives of these drugs.
    Efficacy, which is a measurement of the drug´s maximal response, is given by the maximal height of the dose response curve. At these doses, each drug produced the same effect, but there is no information provided to determine what the maximal effect of each drug would be. In addition, potency and efficacy are not related.
  59. Question 59 of 100
    59. Question
    1 points

    A 25 year old male underwent treatment for Hodgkin lymphoma 1 year ago. He presents with increasing dyspnea and cough. Exam is remarkable for rales bilaterally. Arterial blood gases show hypoxia, and bilateral pulmonary infiltrates are seen on CXR. Which agent most likely produced these side effects?

    Correct

    Incorrect

    Explanation:
    Pulmonary toxicity (characterized by interstitial pneumonitis that may progress to pulmonary fibrosis) is a dose related complication seen with the administration of bleomycin, an antibiotic chemotherapeutic agent. Other agents associated with pulmonary toxicity include methotrexate and busulfan. Cyclophosphamide is an alkylating agent used in the treatment of numerous cancers (e.g., breast, testicular), leukemia, and Hodgkin lymphoma. It is also used as a conditioning agent for bone marrow transplant. Hemorrhagic cystitis, which can be severe and even fatal, can develop. The mechanism is thought to be secondary to irritation from the toxic cyclophosphamide metabolite acrolein. Doxorubicin is an antibiotic chemotherapeutic that acts by intercalating between DNA and inducing DNA strand breaks via topoisomerase II. Irreversible cardiotoxicity is an important adverse reaction. This includes EKG changes and congestive heart failure. Etoposide interferes with topoisomerase, inducing DNA strand breaks, and is used to treat testicular and lung cancers. Adverse reactions include stomatitis, erythema, and bone marrow suppression. 5-Fluorouracil is an S/G1 phase-specific antimetabolite that is a widely used antineoplastic agent used systemically to treat solid tumors and topically to treat skin cancers. Adverse reactions include alopecia, bone marrow suppression, dermatitis, stomatitis, and gastrointestinal distress.
  60. Question 60 of 100
    60. Question
    1 points

    A pilot working for a major commercial airline suffers from hay fever. The medication that would be most suitable for the pilot during working hours is which one of the following?

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    Incorrect

    Explanation:
    Fexofenadine, which belongs to the piperidine drug class, is the only drug listed that does not cross the blood-brain barrier and therefore does not cause sedation (a bad thing for someone flying an airplane). Other drugs from the same class include cetirizine and levocabastine. Terfenadine and astemizole were also members of this second generation of antihistamines but have since been removed from the U.S. market because their metabolism was easily inhibited (by ketoconazole, itraconazole, macrolide antibiotics, and even by grapefruit juice), resulting in high concentrations that could lead to a lethal arrhythmia (torsade de pointes). All the other choices have some degree of sedation as a side effect and therefore would not be recommended for someone who is flying an airplane or operating any kind of machinery.
  61. Question 61 of 100
    61. Question
    1 points

    Which of the following best describes the pharmacological actions of Ondansetron?

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    Incorrect

    Explanation:
    Ondansteron is a selective 5-HT3 antagonist both centrally and peripherally and as such potent antiemetic.
  62. Question 62 of 100
    62. Question
    1 points

    Which of the following is NOT associated with hyponatraemia and hyperkalaemia?

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    Incorrect

    Explanation:
    Carbenoxolone therapy may be associated with hypokalaemia and salt retention due to pseudohypoaldosteronism through inhibition of the enzyme 11 beta Hydroxysteroid dehydrogenase. Type IV renal tubular acidosis is associated with hyporeninaemic hypoaldosteronism and both hyponatraemia and hyperkalaemia can occur. Hypoadrenalism is associated with hyperkalaemia and hyponatraemia as is Cardiac failure, hepatic and renal failure. Co-amilofruse the combination of amiloride and fursemide may also produce this biochemical picture.
  63. Question 63 of 100
    63. Question
    1 points

    Which of the following are centrally acting antihypertensive therapy?

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    Incorrect

    Explanation:
    Moxonidine and alpha-methyle dopa are centrally acting antihypertensives and modify blood pressure through central action modifying sympathetic activity. Verapamil is a calcium antagonist, minoxidil and hydralazine both vasodilators and phenoxybenzamine an alpha blocker.
  64. Question 64 of 100
    64. Question
    1 points

    A 50 year old lady has a three year history of sero-positive erosive rheumatoid arthritis. She has recently started methotrexate therapy. What agent she should be receiving in conjunction with methotrexate?

    Correct

    Incorrect

    Explanation:
    Methotrexate is a chemotherapeutic agent as well as being an immunosuppressant used as a DMARD. It acts through inhibition of dehydrofolate reductase thus depleting folate concentrations. To reduce the impact of folate deficiency, a dose of 5mg of folic acid weekly is recommended in conjunction with methotrexate taking the agent at least two days prior to commencing the methotrexate taking the agent at least two days prior to commencing the methotrexate. Its action in arthritides is not entirely understood but may relate to both anti-inflammatory as well as immunomodulation. Some local variation may exist regarding dose and frequently of folate therapy. Please be aware of your local guidelines.
  65. Question 65 of 100
    65. Question
    1 points

    A 52 year old lady with a history of paroxysmal atrial fibrillation has been successfully treated for depression with sertraline (zoloft). However, she has persistent insomnia, and a 10-day trial of zolpidem (Ambien) has yielded minimal improvement. What would be the most appropriate addition to her current medication?

    Correct

    Incorrect

    Explanation:
    Trazodone has been found useful for its sedative and hypnotic effects, and is often used in combination with another antidepressant. Benzodiazepines are not recommended for long-term use. Zaleplon is more short-acting than zolpiden and therefore would not be more effective. Amitriptyline could be used for its antidepressant and sedative effects, but its chronotropic side effects make it less preferable for someone with a disposition to cardiac arrhythmia.
  66. Question 66 of 100
    66. Question
    1 points

    The benzodiazepines that has the shortest elimination half life in the body is

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    Incorrect

    Explanation:
    Triazolam has the shortest half life of any benzodiazepine at 3 hours. Alprazolam (Xanax) has a half life of 12 hours. Lorazepam (Ativan) has a life 14 hours. Diazepam (Valium) has a half life of 43 hours.
  67. Question 67 of 100
    67. Question
    1 points

    A patient presents to the ER with drug overdose. He has fever, tachycardia, dilated pupils a blood pressure of 220/110 mmHg. What is the most likely cause?

    Correct

    Incorrect

    Explanation:
    Because cocaine is a very short acting drug, heavy users may inject it or smoke it 10 to 15 min. This repetition produces toxic effects, such as tachycardia, hypertension, mydriasis, muscle twitching, sleeplessness, and extreme nervousness.
  68. Question 68 of 100
    68. Question
    1 points

    All of the following are associated with hyponatremia, EXCEPT

    Correct

    Incorrect

    Explanation:
    Penicillin does not cause hyponatremia. All of the other agents, clofibrate (A), oxytocin (B), nonsteroidal anti-inflammatory drugs (D), and acetaminophen (E) have been implicated in the production of hyponatremia.
  69. Question 69 of 100
    69. Question
    1 points

    Barbiturate toxicity is attributable to which of the following mechanism?

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    Incorrect

    Explanation:

    The action of barbiturates as GABA receptor agonists is responsible for the central nervous system depression seen with toxicity. The other choices are not involved in barbiturate activity.
  70. Question 70 of 100
    70. Question
    1 points

    Which diuretic works at the loop of Henle?

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    Incorrect

    Explanation:
    Acetozolamide (A) works at the proximal tubule and prevents bicarbonate reabsorption, which can cause a metabolic acidosis (furosemide and thiazides may cause a metabolic alkalosis). Furosemide (C) works at the ascending loop of Henle and may be ototoxic (the other choices are not commonly ototoxic). Thiazide diuretics (B) work at the distal convoluted tubule and can cause hyperuricemia. Spironolactone (D) is a K+ sparing diuretic that works at the distal tubule and collecting duct (the other diuretics are more likely to cause hypokalemia).
  71. Question 71 of 100
    71. Question
    1 points

    All of the following can cause hypercalcemia, EXCEPT

    Correct

    Incorrect

    Explanation:
    Digoxin does not lead to hypercalcemia. Ingestion of vitamin A, thiazide, lithium, or estrogens can all lead to hypercalcemia when sufficient quantities are consumed.
  72. Question 72 of 100
    72. Question
    1 points

    A potassium sparing diuretic is which one of the following?

    Correct

    Incorrect

    Explanation:
    Acetozolamide works at the proximal tubule and prevents HCO3- reabsorption, which can cause a metabolic acidosis (furosemide and thiazides may cause a metabolic alkalosis). Furosemide works at the ascending loop of Henle and may be ototoxic (the other choices are not commonly ototoxic). Thiazide diuretics work at the distal convoluted tubule and can cause hyperuricemia. Spironolactone is a K+ sparing diuretic that works at the distal tubule and collecting duct (the other diuretics are more likely to cause hypokalemia).
  73. Question 73 of 100
    73. Question
    1 points

    ECG of a 72 year old woman with a history of congestive heart disease reveals the presence of atrial fibrillation. What drug would be most likely prescribed to decrease the conduction through the AV node?

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    Incorrect

    Explanation:
    The effect of digoxin on the myocardium is dose related and involves both a direct and indirect action on the cardiac muscle. The indirect actions involve a vagomimetic action, which decreases the conduction rate through the atrioventricular node (AV node), an, a depression of the sinoatrial node. Digoxin is indicated for the treatment of atrial fibrillation; especially when the ventricular rate is elevated. Digoxin is also indicated for the treatment of congestive heart failure and atrial flutter, although electrical cardioversion is often the treatment of choice for atrial flutter. Beta blockers and calcium channel blockers are other conventional choices for atrial arrhythmia. Atropine is an anticholinergic agent that has been used in the treatment of atrioventricular heart block to increase conduction through the AV node when increased vagal tone is a major factor in the conduction defect. Lidocaine is an antiarrhythmic agent indicated for the treatment of ventricular arrhythmias. Lidocaine has a variable effect on AV node conduction. For the most part, conduction through the AV node remains unchanged. Procainamide is a class IA antiarrhythmic agent indicated for the treatment of ventricular arrhythmias. It often causes AV node conduction to be slightly increased. Quinidine is indicated for the conversion of atria fibrillation/flutter. However, quinidine exerts an indirect anticholinergic effect that will decrease vagal tone and may facilitate conduction in the AV node.
  74. Question 74 of 100
    74. Question
    1 points

    A 58 year old man has a 10 year history of hypertension. Labs reveal that the plasma renin activity 3-4 times higher than normal. Losartan is prescribed. After its administration, which would be expected to increase in this patient?

    Correct

    Incorrect

    Explanation:
    Losartan competitively inhibits angiotensin II at the ATI receptor. Angiotensin II is the most powerful sodium retaining hormone of the body. The effects of angiotensin II can be attributed to (1) direct stimulation of sodium reabsorption in the proximal and distal tubules of the kidney; (2) stimulation of aldosterone secretion which is another sodium retaining hormone: and (3) constriction of the efferent arterioles in the kidney which increases peritubular colloid osmotic pressure thereby enhancing reabsorption of salt and water from the proximal tubule. Therefore, when the effects of angiotensin II are blocked with losartan, the ability of the kidneys to excrete sodium increases greatly. Because angiotensin II normally stimulates aldosteronesecretion, losartan decreases plasma aldosterone levels. The decrease in arterial pressure caused by losartan (because of its effect to increase the loss of salt and water) should also decrease the total peripheral resistance by an autoregulatory mechanism. That is when arterial pressure is lowered, the arterioles dilate which maintains blood flow at a constant level in the peripheral tissues. Overstretching of the two atria, usually as a result of increased blood volume causes atrial natriuretic peptide to be released into the blood. Because losartan increases the ability of the kidneys to excrete sodium (and therefore water), the blood volume should decrease and the plasma levels of atrial natriuretic peptide should decrease. Angiotensin II is a potent vasoconstrictor. Blocking its effects with losartan would be expected to decrease total peripheral resistance.
  75. Question 75 of 100
    75. Question
    1 points

    A patient being diagnosed with bulimia and depression is started an antidepressant by an inexperienced physician. Over the course of a few weeks of treatment, the dose is gradually increased. He develops seizures and is brought to the emergency department. The antidepressant that this patient was most likely taking is which one of the following?

    Correct

    Incorrect

    Explanation:
    Bupropion is an antidepressant that is contraindicated in patients with no current or prior diagnosis of bulimia or anorexia nervosa because a higher incidence of seizures has been noted in these patients secondary to metabolic disturbances. Even in less sensitive patients, doses above 300-450 mg increase the risk of seizures so that the incidence is approximately 0.4%. Buspirone is antianxiety agent that is mostly used in conjunction with antidepressants for the treatment of comorbid depression and anxiety. It is not used for bulimia nervosa. Seizure is an extremely rare side effect that has been described in pre marketing trials. Fluoxetine is the only antidepressant currently approved for the treatment of bulimia nervosa. In pre-marketing trials, an increased risk for seizures has not been observed in patients treated with fluoxetine as compared with those treated with placebo. Mirtazapine is an antidepressant indicated for the treatment of depression, but it is not officially approved for the treatment of bulimia nervosa. In pre- marketing trials, 1 of 2796 patients experienced seizure. No trials were conducted in patients with a history of seizures, but caution should be exercised. Sertraline belongs to the SSRIs and can be used to treat depression. However, it is not formally indicated for the treatment of bulimia nervosa. In pre-marketing trials, a few cases of seizure were reported in patients with a previous history of seizure but not in the general population. Therefore, caution should be exercised if there is a history of seizure.
  76. Question 76 of 100
    76. Question
    1 points

    During 1960s, dentists at psychiatric institutions for children noted an unusual presentation of gingival overgrowth in many epileptic patients. Most had severe convulsive seizures that would last for more than half an hour at a time. Though some conjectured an association between generalized seizures and gingival epithelial overgrowth, the dental findings were later attributed to the common use of some medications for epilepsy. The molecular mechanism of this drug associated with this unusual phenomenon is most similar to the mechanism of which cardiovascular drug?

    Correct

    Incorrect

    Explanation:

    Gingival hyperplasia is a side effect associated with the chronic use of phenytoin, which is commonly employed in patients undergoing the generalized convulsive status epilepticus that is described in this example. Although the etiology of this drug induced overgrowth remains unclear, some risk factors such as gingivitis due to poor oral hygiene or the presence of dental plaque that; may provide a reservoir for the accumulation of phenytoin, have been suggested. Approximately 50% of patients on phenytoin will develop significant gingival hyperplasia. It is sometimes used to reverse digitalis induced arrhythmias. Tocainide, lidocaine, and mexiletine are another example of a class 1B antiarrhythmic, which block sodium channels in the heart. Other common medications that have been associated with gingival hyperplasia are nifedipine and cyclosporine. Captopril is an ACE inhibitor used for treating hypertension and congestive heart failure. It has no effects on Na+ channels. Digoxin acts by inhibiting the Na+ /K+ -ATPase on cell membranes, not Na+ channels themselves.

  77. Question 77 of 100
    77. Question
    1 points

    A 30 year old pregnant woman is told by her obstetrician to avoid taking aspirin. Use of aspirin is contraindicated, especially during the last part of pregnancy, because aspirin affects which hematologic parameters?

    Correct

    Incorrect

    Explanation:
    Aspirin irreversibly acetylates platelet cyclooxygenase, thereby inactivating this enzyme and preventing the production of thromboxane A2. In this manner, aspirin therapy interferes with secondary aggregation. The result is a prolonged bleeding time related to platelet dysfunction rather than to dysfunction of the coagulation process, as would be implied by prolongation of the activated partial thromboplastin time, prothrombin time, or thromboplastin time. The platelet count is not affected by aspirin.
  78. Question 78 of 100
    78. Question
    1 points

    A 66 year old man with palpitations and fatigue is diagnosed with atrial fibrillation and treated with digoxin. Later his serum digoxin levels are found to be above the therapeutic range. He is at highest risk for developing digoxin toxicity if he also develops which abnormality?

    Correct

    Incorrect

    Explanation:
    Digoxin is a cardiac glycoside indicated for the treatment of congestive heart failure, atrial fibrillation and atrial flutter. The therapeutic drug serum levels for digoxin are 0.5-2.2 ng/mL. Toxicity typically occurs when digoxin levels are greater than 2.5 ng/mL; if the patient is hypokalemic; however toxicity can occur at any therapeutic concentration. Hypokalemia sensitizes the myocardium to digoxin and may reduce the positive inotropic effects of the medication. Other signs and symptoms of digoxin toxicity include nausea vomiting anorexia and appearance of yellow green halos in the visual field as well as the development of cardiac arrhythmias. Although hyponatremia and hypophosphatemia can result in the development of other pathological disturbances they do not potentiate digoxin toxicity. Vitamin B12 deficiency is associated with the development of pernicious anemia. Vitamin K deficiency is associated with the development of clotting disorders. Vitamin K deficiency also can potentiate warfarin toxicity.
  79. Question 79 of 100
    79. Question
    1 points

    A 66 year old man diagnosed with metabolic syndrome is prescribed a medication that decreases blood glucose, decreases triglycerides, decreases C-reactive protein levels, increases HDL cholesterol levels and, in some patients, lowers blood pressure. He was most likely prescribed which drug?

    Correct

    Incorrect

    Explanation:
    As one can see from the table, the thiazolidinedione class of medications provides all of the therapeutic outcomes listed in the question stem.
    Therapeutic Benefits Provided by Selected Drug Classes when Used in Metabolic
    Medication class Triglycerides HDL Cholesterol C. Reactive Protein Glucose Level Blood Pressure
    ACE Inhibitors – – +/- Kidney benefits-no effect on glucose levels Decrease
    Angiotensin II receptor antagonists – – +/- Kidney benefits-no effect on glucose levels Decrease
    Niacin Decrease Increase – increase –
    Statins Decrease Increase Decrease – –
    Thiazolidinediones Decrease Increase Decrease Decrease +/-
  80. Question 80 of 100
    80. Question
    1 points

    After a seizure a patient is brought to the ER. His mother describes a sudden loss of consciousness associated with a tonic contraction of muscles and total loss of postural control. The patient has a series of rhythmic contractions of all four limbs in the ER. What is the most appropriate pharmacotherapy?

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    Incorrect

    Explanation:
    The patient is presenting with signs and symptoms of status epilepticus. Initially, there is a sudden loss of consciousness associated with a tonic contraction of muscles and total loss of postural control. The patient usually falls to the floor in an opisthotonic posture, often sustaining injury. Next, there is a series of rhythmic contractions of all four limbs. Unlike the classic “tonic clonic” seizure, in which there is a gradual return to consciousness with cessation of the seizure activity, patients with status epilepticus will present without recovery of consciousness or cessation of seizure activity. Since this is a medical emergency associated with 20% mortality, therapeutic intervention is needed to immediately stop the seizure activity. Lorazepam or diazepam, both benzodiazepines, are considered the initial drugs of choice in patients with status epilepticus. In addition to benzodiazepines, phenytoin (or fosphenytoin) can be administered for long term seizure control. Carbamazepine is indicated for the long term treatment and prevention of tonic clonic, focal, and complex partial seizures. Ethosuximide is indicated for the treatment and prevention of absence seizures. Phenytoin is an antiepileptic agent indicated for the treatment and prevention of tonic-clonic, focal, and psychomotor seizures. It can be given to a patient in status epilepticus if the patient does not improve with benzodiazepines. Valproic acid is indicated for the treatment and prevention of tonic-clonic, myoclonic, absence, and atypical absence seizures.
  81. Question 81 of 100
    81. Question
    1 points

    A 68 year old male is has fever, chills, and a productive cough for four days. Exam shows a quite ill male with blood pressure of 110/70 mm Hg, heart rate of 102/min, respiratory rate of 24/min, and temperature of 38.7°C (101 .7°F). There is dullness to percussion, and decreased breath sound over the left lung base. Sputum Gram´s stain reveals abundant neutrophils, a few epithelial cells, and numerous gram-positive diplococci. The antibiotic that would be the most appropriate choice for empiric therapy of his infection is

    Correct

    Incorrect

    Explanation:
    Streptococcus pneumoniae (pneumococcus) is classified as a gram positive diplococcus. It is the most likely organism causing this man´s pneumonia, based on the clinical presentation as well as the Gram´s stain results. Given this patient´s age and symptoms, intravenous antibiotics should be given in a hospital setting. Despite the occurrence of resistance of pneumococcus to penicillin, this is still the antibiotic of choice for empiric treatment of this organism. Ceftazidime, a third generation cephalosporin with antipseudomonal activity, is less effective than first generation cephalosporins or other third generation cephalosporins (e.g., ceftriaxone) against gram-positive cocci. Ciprofloxacin is a fluoroquinolone with activity against gram negative-organisms. It is not reliably effective against the pneumococci. Erythromycin is useful for a variety of organisms, but there is a high level of macrolide resistance among community-acquired pneumococci. Trimethoprim sulfamethoxazole is useful for many urinary tract pathogens, Pneumocystis carinii, Salmonella and Serratia but pneumococci show a significant amount of resistance to the combination.
  82. Question 82 of 100
    82. Question
    1 points

    A 58 year old male is diagnosed with a small pulmonary embolism. He is admitted to the hospital and started on heparin therapy. The anticoagulant effect of this drug would be most appropriately associated by which laboratory value?

    Correct

    Incorrect

    Explanation:
    Heparin, an anticoagulant that accelerates the activity of antithrombin III, thereby inactivating thrombin, is often administered to .individuals diagnosed with acute embolism or thrombosis by continuous IV infusion at a rate sufficient to raise the activated partial thromboplastin time (aPTT) to 1.5-2 times the control value. The aPTT measures the intrinsic system and common pathway, which is affected by factors XII, XI, IX, VIII, X, VI, prothrombin and fibrinogen. In other words, the anticoagulant effect of heparin should be continually monitored to ensure that the patient´s aPTT does not exceed 1.5 to 2 times the control value. If the control aPTT value is exceeded, the risk for internal bleeding can increase substantially. The bleeding time is a measure of platelet function and correlates well with the propensity to bleed. The normal bleeding time (BT) is 2.5 to 10 minutes and measures the interaction between platelets and the subendothelium. The BT can be prolonged in thrombocytopenia as well as abnormal platelet function in patients with von Willebrand disease, liver disease, and uremia, and in patients receiving aspirin and NSAIDs. A complete blood count is a measure of all the cell components contained in the blood, e.g., the numbers of white blood cells, red blood cells, and platelets. Both the international normalized ratio (INR) and prothrombin time (PT) are used to monitor the anticoagulant effect of coumarin anticoagulants, such as warfarin. Coumarin anticoagulants are dosed to raise the PT to 1.5 to 3.5 times the control value. However, the thromboplastins used to monitor PT values vary among institutions, leading to different control values and subsequently different levels of anticoagulation for a given patient. In other words, there is no absolute consistency for PT values taken at two different hospitals. Therefore, INR values are commonly used because the INR at one institution will relate to that at another.
  83. Question 83 of 100
    83. Question
    1 points

    A woman aged 54 years complains of a rapid heart rate and dry mouth. According to her the symptoms occur in the morning after taking her medication. Which drug is most likely the cause of these symptoms?

    Correct

    Incorrect

    Explanation:
    Tachycardia refers to a rapid beating of the heart and usually applies to rates greater than 100 per minute. Xerostomia means dryness of the mouth, resulting from diminished or arrested secretion. Both tachycardia and dry mouth are common side effects of medications that possess anticholinergic properties. Of the medications listed, only doxepin possesses anticholinergic properties. Doxepin is a tricyclic antidepressant primarily used to treat clinical depression. It is also used to treat psychoneurotic anxiety and depressive reactions, as well as mixed symptoms of anxiety and depression. Captopril is an angiotensin converting enzyme (ACE) inhibitor used to treat hypertension and congestive heart failure. Although it is not associated with the development of xerostomia or tachycardia, it is known to cause angioedema, hyperkalemia, and chronic cough. Conjugated estrogens and medroxyprogesterone, a progestin, are used together to help prevent the signs and symptoms associated with menopause. The most common side effects of these agents are nausea and vomiting. Note: estrogens are also associated with the development of clotting disorders, as well as endometrial hyperplasia. Naproxen is a non-steroidal anti-inflammatory drug indicated for the treatment of mild to moderate pain. The most common side effect of naproxen is gastrointestinal irritation.
  84. Question 84 of 100
    84. Question
    1 points

    A 42 year old man previously had an allergic reaction to bupivacaine. Which local anesthetic should be avoided in this patient?

    Correct

    Incorrect

    Explanation:
    Bupivacaine is an amide-type local anesthetic, and allergic reactions to local anesthetics tend to cross-react only within groups (ester type cross reacts with ester-type and amide-type cross-reacts with amide type). The only example in the answer choices of an amide type local anesthetic which would be metabolized by hepatic amidases, is lidocaine. Other members of this group include mepivacaine, etidocaine, and prilocaine. Benzocaine, cocaine, procaine, and tetracaine are all ester type local anesthetics, which can be metabolized by plasma cholinesterases and hepatic esterases. They will usually not cross-react with antibodies produced to an amide anesthetic.
  85. Question 85 of 100
    85. Question
    1 points

    A 51 year old man has signs and symptoms of amyotrophic lateral sclerosis. Which drug would likely prolong the survival of this patient?

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    Incorrect

    Explanation:

    This patient has amyotrophic lateral sclerosis (ALS), a disorder of lower motor neurons (located in the ventral horn) and the upper motor neurons (corticospinal neurons). The disorder is characterized by rapidly progressive weakness, muscle atrophy and fasciculations, spasticity, dysarthria, dysphagia, and respiratory compromise. Riluzole is an agent with complex actions in the nervous system and is prescribed to extend the survival of patients and/or the time until tracheostomy. ALS may involve excitotoxicity to neurons caused by glutamate. Riluzole is a glutamate release inhibitor, glutamate receptor blocker, as well as a sodium channel blocker. The most useful agent for the symptomatic treatment of spasticity of ALS is baclofen, a GABA-B agonist.
    Clonazepam, a benzodiazepine, is an effective antispasmodic, but may contribute to respirators depression in patients with advanced ALS. Dantrolene acts directly on skeletal muscle fibers impairing calcium release from the sarcoplasmic reticulum. Because it can worsen muscle weakness, it is not used in ALS to treat spasticity. Tizanidine is an agonist of alpha-2 adrenergic receptors in the CNS and increases presynaptic inhibition of motor neurons. Therefore, it can be used to treat spasticity in ALS patients.

  86. Question 86 of 100
    86. Question
    1 points

    A 48 year old overweight female presents with symptoms of cholelithiasis. If the physician decides on medical treatment, which would be the most appropriate agent?

    Correct

    Incorrect

    Explanation:
    This patient has symptomatic cholelithiasis. Biliary pain is characterized by infrequent episodes of steady severe pain in the epigastrium or right upper quadrant with radiation to the right scapula. The diagnosis is generally confirmed with ultrasound. Ursodiol, or ursodeoxycholic acid, is a primary bile acid that acts by reducing cholesterol secretion into bile, and is effective in dissolving, cholesterol gallstones in some patients. Used alone, it may take months to years to be hilly effective, and may not produce a full therapeutic response in all patients. It can be combined with sonic lithotripsy to dissolve gallstone fragments. Laparoscopic cholescystectomy may also be used in patients who are surgical candidates. Diphenoxylate is used in combination with atropine to treat diarrhea. Infliximab is a monoclonal antibody to TNF-α that is used in Crohn disease. Octreotide is a synthetic somatostatin analog used to treat diarrhea in a variety of endocrine disorders such as carcinoid syndrome, gastrinoma, and glucagonoma. It is also used to treat variceal bleeding and acromegaly. Omeprazole is an inhibitor of the H+/K+ pump that is used to decrease gastric acid secretion.
  87. Question 87 of 100
    87. Question
    1 points

    A diabetic male aged 55 years is brought to the emergency department in an unresponsive state. Lab values are: PCO2: 19 mm Hg, Bicarbonate: 11mEq/L, pH: 6.9. The most appropriate immediate treatment for this patient is

    Correct

    Incorrect

    Explanation:
    This patient is in a diabetic ketoacidotic coma. The goals in treating such a patient are to increase the rate of glucose utilization by insulin dependent tissues, to reverse ketonemia and acidosis, and to replenish fluids.
    Treatment with bicarbonate would result in only a transient elevation of pH. Oral hypoglycemic agents are commonly prescribed for the maintenance of patients with type 2 diabetes and would not be appropriate in an acute setting. Since this is a life threatening condition, monitoring the patient without treatment is unacceptable.
  88. Question 88 of 100
    88. Question
    1 points

    A 48 year old man has acute pain in his big toe. Investigations reveal a uric acid level of 10 mg/dL. He is started on a drug (Drug A). After the resolution of the acute attack, he is started on a second medication (Drug B). Drug B decreases both the serum and urine levels of uric acid. Which one is Drug B?

    Correct

    Incorrect

    Explanation:
    This is a simple drug mechanism question made somewhat more difficult by the additional information presented in the stem. First, the diagnosis of gout should have been easily made. (Other “classic clues” for gout include negatively bireftingent needle shaped crystals and the presence of tophi.) The only crucial information in the question is that Drug 2 decreases uric acid in both the serum and the urine. Allopurinol inhibits the formation of uric acid by blocking the conversion of hypoxanthine to xanthine and xanthine to uric acid by xanthine oxidase (allopurinol is an analog of hypoxanthine). If uric acid synthesis is decreased, you would expect to see a decrease in both the serum and urine levels. Note that allopurinol is used in the treatment of severe hyperuricemia, whether or not it is related to gout. Also note that in acute attacks of gout, therapy with allopurinol should be delayed until after the acute episode has resolved and the patient is on maintenance doses of colchicine (probably Drug A in this vignette). Colchicine works by interfering with microtubule polymerization, thereby preventing granulocyte migration to the inflammatory site and decreasing metabolic and phagocytic activity of granulocytes. Colchicine has no effect on uric acid levels and is not an analgesic. Colchicine is used to treat acute attacks of gout and is also given prophylactically to prevent recurrent episodes. Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) that works by inhibiting both cyclooxygenase and the motility of polymorphonuclear leukocytes. Although indomethacin can be used in the treatment of acute gout, it affects neither the serum nor the urine levels of uric acid. Both probenecid and sulfinpyrazone increase urinary excretion of uric acid (uricosuric). As such, you would expect increased, not decreased, urine levels of uric acid in patients taking either drug (serum levels would be decreased).
  89. Question 89 of 100
    89. Question
    1 points

    A 65 year old male presents with difficulty in micturition. He is diagnosed with benign Prostatic hyperplasia and is started on finasteride. Which hormone production would be selectively inhibited?

    Correct

    Incorrect

    Explanation:
    Finasteride is a 5 alpha-reductase inhibitor and inhibits the conversion of testosterone to the active DHT.
  90. Question 90 of 100
    90. Question
    1 points

    A 55 year old man is receiving treatment with Imatinib for chronic myeloid leukaemia. What is the mechanism of action of Imatinib?

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    Incorrect

    Explanation:
    Imatinib is an inhibitor of tyrosine kinase and is used in the treatment of conditions such as CML and GIST tumours. It inhibits TK on abl proto-oncogene, c-kit and the PDGF-R. In CML, the Philadelphia chromosome leads to a fusion protein of abl with bcr (breakpoint cluster region), termed bcr-ab1. As this is now a continuously active tyrosine kinase, imatinib is used to decrease bcr-abl activity.
  91. Question 91 of 100
    91. Question
    1 points

    Which of the following is true of radioactive iodine (131I) therapy?

    Correct

    Incorrect

    Explanation:

    RAI is associated with the induction of hypothyroidism in the majority of subjects by three months (70%) with 10% failing at the first dose at about 18 months.
    It may precipitate deterioration in ophthalmopathy in patients with Graves.
    There is no evidence of either increased risk of infertility or lymphoma after RAI with evidence suggesting that it is quite safe.
    Withdrawing amiodarone is the preferred treatment in amiodarone induced thyrotoxicosis and often the iodine uptake would be low in these patients making 131I therapy unhelpful.

  92. Question 92 of 100
    92. Question
    1 points

    A farmer, on treatment for depression is admitted acutely 1 hour following an intentional overdose of an unidentified substance. On examination he is bradycardic, hypotensive, disorientated, hypersalivating, and has small pupils. He has most likely ingested:

    Correct

    Incorrect

    Explanation:
    Hypersalivation and miosis are the specific clues to acetycholine overactivity. Occupational access to organophosphate insecticides. Pupils tend to be dilated with TCA OD. Paracetamol, cyanide and paraquat shouldn´t affect pupils.
  93. Question 93 of 100
    93. Question
    1 points

    A 64-year-old female presents with dry mouth of 3 months duration. She is taking medication for hypertension, stress incontinence and reflux esophagitis. Which of the following may be responsible for her dry mouth?

    Correct

    Incorrect

    Explanation:
    Oxybutinin is an effective treatment for detrussor instability and is a parasympathetic muscarinic antagonist. Consequently dry mouth is a problem in up to 70%of cases. Bendroflumethiazide, the thiazide diuretic, at a dose of 2.5 mg per day is not associated with dry mouth.
  94. Question 94 of 100
    94. Question
    1 points

    A 36 year old lady, who is on antipsychotic medication, develops stiffness in her arms and neck. Which of the following side affects of medication she have?

    Correct

    Incorrect

    Explanation:

    The side effects of antipsychotic medications are as follows:
    Dystonia: sustained contraction of muscles, twisting postures and may be visible only when the patient is moving. Neck and arm muscles are most commonly affected.
    Parkinsonism: involves tremor, increased muscle tone, bradykinesia or akinesia, drooling, postural instability, loss of spontaneity, micrographia, and seborrhea.
    Akathisia: motor restlessness accompanied by a feeling of inner restlessness (sometimes described as anxiety), an urge to move, and an inability to sit; still, patients may pace or continuously move their feet and legs.
    Tardive dyskinesia: hyperkinesia, involuntary body movements most often of the muscles of the face, mouth, and tongue.
    Lethargy: Physical and mental weakness.

  95. Question 95 of 100
    95. Question
    1 points

    Which of the following anti-depressants is least likely to cause drug interactions?

    Correct

    Incorrect

    Explanation:
    Like all drugs, SSRIs have significant side effects, including inhibition of the cytochrome P-430 system. However, citalopram is least likely to inhibit this system, making it a preferred SSRI for patients taking multiple medications for other illnesses.
  96. Question 96 of 100
    96. Question
    1 points

    An 81 year old chronic schizophrenic, who is heavily taking medications presents to you with constant, involuntary chewing motions and repetitive movements of his legs. The most likely diagnosis is

    Correct

    Incorrect

    Explanation:
    The patient has classic signs of tardive dyskinesia. Repetitive movement of the mouth and legs is caused by antipsychotic agents such as phenothiazides and haloperidol. Neuroleptic malignant syndrome consists of fever autonomic dysfunction, and movement disorder. Acute dystonia involves twisting of the next, trunk, and limbs into uncomfortable positions. Huntington´s disease causes choreic movements, which are flowing, not repetitive. Oculogyric crisis involves the eyes.
  97. Question 97 of 100
    97. Question
    1 points

    True regarding Raloxifene (Evista)

    Correct

    Incorrect

    Explanation:
    Raloxifene is a selective estrogen-receptor modulator. It was initially approved by the FDA just to treat osteoporosis because it increases bone density. It does not stimulate either endometrium or breast tissue. It does lower both LDL and total cholesterol. However, it can actually cause hot flashes, and is therefore not useful for managing menopausal symptoms.
  98. Question 98 of 100
    98. Question
    1 points

    A 17-year-old boy is being treated for rhabdomyosarcoma with doxorubicin. Which one of the following drug toxicities is associated with the use of this drug?

    Correct

    Incorrect

    Explanation:
    Doxorubicin and the other anthracycline antibiotic, daunomycine, have the distinct adverse effect of causing cardiac toxicity, resulting in cardiomyopathy.
  99. Question 99 of 100
    99. Question
    1 points

    The treatment of choice for opiate poisoning is

    Correct

    Incorrect

    Explanation:
    The synthetic opiate analog, Naloxone, is the treatment of choice for opiate poisoning. Tannic acid is used for gastric Lavage along KMnO4 in strychnine poisoning and flumazenil is antidote for benzodiazepines overdose. None of the other agents are useful.
  100. Question 100 of 100
    100. Question
    1 points

    Which one of the following antibiotics is contraindicated for use in patients suffering from myasthenia gravis?

    Correct

    Incorrect

    Explanation:
    Aminoglycosides possess certain intrinsic nicotinic neuromuscular junction blocking activity. As a result, the effect of antibodies binding to acetylcholine receptors (as seen in myasthenia gravis) is accentuated, often rendering MG patients taking aminoglycosides paralyzed. None of the other drugs have neuromuscular junction blocking potential and, hence, are safe for use in myasthenia gravis patients.

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