GENERAL PRACTITIONER EXAM
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Question 1 of 12
1. Question
1 pointsA 21 year old healthy student presents to discuss contraception options. She is in a monogamous relationship with her boyfriend for 2 years and would like a prescription for oral contraceptive pills. Her BP is 110/70 mm Hg. She says that she does not want to get pregnant and is curious about the availability of medications to induce abortion. Which eicosanoid is available as a vaginal suppository to induce abortion?
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Explanation:
PGE2 is available clinically as dinoprostone. It can be used to induce abortion, evacuate a missed abortion, or treat a benign hydatidiform mole. LTA4 is the first leukotriene produced by the lipoxygenase pathway. PGD2 causes both vasodilatation and vasoconstriction, depending on the vascular bed. PGF2, which is also vasoactive, increases cardiac output, constricts bronchial smooth muscle, initiates uterine contractions, and causes contraction of gastrointestinal longitudinal muscle. PGG2 and PGH2 are unstable and are isomerized to form PGD2, PGE2, or PGF2. Note that both PGG2 and PGH2 do not have any known physiologic effects of importance.
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Question 2 of 12
2. Question
1 pointsA 66 year old man has experienced several transient ischemic attacks over the past few months. The decision is made to treat him medically. Which medication would be most appropriate for his therapy?
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Explanation:
Although treatment of transient ischemic attacks (actually prophylaxis against stroke) remains a controversial area, you should be aware of current recommendations. Daily aspirin therapy has been shown in prospective, randomized studies to reduce the incidence of stroke and death in patients with transient ischemic attacks. If alternative therapy is needed, either because the patient cannot tolerate aspirin or because aspirin therapy has failed, the antiplatelet agent ticlopidine can be used. Anticoagulation with Coumadin does not decrease the risk of stroke and death but does increase the risk of intracerebral hemorrhage. Despite the antiplatelet activity of dipyridamole, therapeutic trials have not shown efficacy in the prophylaxis of stroke. Anticoagulation with heparin does not decrease the risk of stroke and death but does increase the risk of intracerebral hemorrhage. Despite the antiplatelet activity of sulfinpyrazone, therapeutic trials have not shown efficacy in the prophylaxis of stroke. -
Question 3 of 12
3. Question
1 pointsA 74 year old pharmacist presents to the emergency department because of chest pain and shortness of breath. She has a history of hypertension. She takes an aspirin daily and a diuretic that “acts at the distal tubule of the nephron.” Diuretic name cannot be recalled. Considering her description, which is the likely diuretic?
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Explanation:
The thiazide diuretics (e.g., hydrochlorothiazide, chlorothiazide, benzthiazide) promote diuresis by inhibiting reabsorption of NaCl, primarily in the early distal tubule. Ethacrynic acid and furosemide are loop diuretics. They act by inhibiting electrolyte reabsorption in the thick ascending loop of Henle. If you didn´t know where these agents act, but did know that they both belong to the same class of diuretics, you could have eliminated them as possibilities since there can´t be more than one correct answer choice. Mannitol is an osmotic diuretic. It is freely filtered at the glomerulus and is not reabsorbed. Its primary action occurs at the proximal tubule. Spironolactone is a potassium-sparing diuretic. It acts on the collecting tubule to inhibit the reabsorption of Na+ and the secretion of K+. Spironolactone is a structural analog of aldosterone that binds to its receptor. (Triamterene and amiloride are also potassium sparing diuretics but are not aldosterone antagonists.) -
Question 4 of 12
4. Question
1 pointsWhich is the commonest cause of Hypomagnesemia?
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Question 5 of 12
5. Question
1 pointsWhich of the following reactions is involved in the metabolism of paracetamol under normal conditions?
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Explanation:
Paracetamol is conjugated to glucuronic acid and sulphate under normal conditions.
In overdose these processes become saturated and the drug is then conjugated with glutathione.
If the glutathione supply is depleted then a toxic metabolite is formed. -
Question 6 of 12
6. Question
1 pointsYou are asked to advice on analgesia for a 45-year-old woman with acute intermittent porphyria who has undergone wisdom teeth extraction. Which of the following drugs is safe for use in her treatment?
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Explanation:
Many drugs may induce acute porphyric crises, thus great care must be taken when prescribing for patients with acute porphyria. Drugs unsafe for use in acute porphyria include barbiturates, tricyclic antidepressants, MAOIs, amphetamines, anabolic steroids, hormone replacement therapy, benzodiazepines, diuretics, captopril, cephalosporins, erythromycin, isoniazid, sulphonamides, sulphonylureas, Theophylline, antihistamines, nifedipine, verapamil, amiodarone and simvastatin.
Ibuprofen is safe for use in acute intermittent porphyria, but diclofenac should be avoided. -
Question 7 of 12
7. Question
1 pointsA 25-year-old female who has previously suffered with severe depression presents with secondary amenorrhea. She is found to have a Prolactin of 650mU/L (normal 50-350).Which of the drugs which she takes may cause this?
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Explanation:
Antipsychotic medications are known to elevate prolactin levels, due to dopamine antagonist effects.
Sertraline is not though to exert dopamine antagonist effects and thus does not result in hyperprolactinaemia.
The other medications on her list have not been associated with hyperprolactinaemia. -
Question 8 of 12
8. Question
1 points: A 43-year-old man presents with gingival hypertrophy. Which of his cardiac medications is likely to be responsible?
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Explanation:
Gingival enlargement may also be associated with the administration of three different classes of drugs, all producing a similar response:
- Anticonvulsants (such as phenytoin, phenobarbital, lamotrigine, valproate, vigabatrin, ethosuximide, topiramate and primidone)
- Calcium channel blockers, such as nifedipine, amlodipine, and verapamil. The dihydropyridine derivative isradipidine can replace nifedipine and does not induce gingival overgrowth.
- Ciclosporin, an immunosuppresant.
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Question 9 of 12
9. Question
1 pointsWhich of the following drugs interacts with cranberry juice?
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Explanation:
The answer is warfarin. Cranberry juice has been recognized to be responsible for a deranged INR, it being postulated that it inhibits cytochrome p450. -
Question 10 of 12
10. Question
1 pointsA man of age 28 year is brought to the emergency department because he has been vomiting for the past 24 hours. He has used prochlorperazine suppositories for relief of nausea and vomiting. Severe muscle spasms are now present in his neck. On physical examination there is sustained spasm of the sternocleidomastoid and trapezius muscles with twisting of his head to the right. The most appropriate medication at this time is which of the following?
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Explanation:
The trick to this question is recognizing that that prochlorperazine is a directive of the antipsychotic medications (neuroleptics) such as chlorpromazine, thioridazine, and fluphenazine. Thus, it is capable of causing similar dystonic reactions, including sustained twisting of the head to the right (torticollis), impaired breathing (laryngospasm), and eyes deviated up, down, or sideways (oculogyric crisis). Diphenhydramine, 25-50 mg given intramuscularly, will relieve the symptoms of a dystonic reaction. -
Question 11 of 12
11. Question
1 pointsA lady aged 52 year had a history of recurrent major depressive disorder and is currently on a maintenance dose of an antidepressant. She has been well for the past 2 years. Now she complains to her psychiatrist about her decreased ability to reach orgasm. The medication most likely responsible for her anorgasmia is
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Explanation:
Paroxetine, along with other selective serotonin reuptake inhibitors, can cause decreased libido and difficulties reaching orgasm. In studies the incidence of these side effects was 1% to 2% in patients on paroxetine, compared with those on placebo. -
Question 12 of 12
12. Question
1 pointsVarenicline is an agent used in the treatment of smokers to help them quit. Which of the following best describes its mechanism of action?
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Explanation:
There are now many therapies that have been investigated for use in smoking cessation. Newer drugs are becoming available that have been specifically developed for smoking cessation. Varenicline is one of them.
Nicotine is a stimulant and releases dopamine in the brain that leads to addictive effects of smoking. Its effects can be replaced in other ways using nicotine replacement therapy and this reduces the addiction to cigarette smoking.
Bupropion (Zyban) reduces the neuronal uptake of dopamine, serotonin and norepinephrine.
Clonidine, a second line agent in smoking cessation because of its side effects, is an α2-noradrenergic agonist that suppresses sympathetic activity.
Nortriptyline is a tricyclic antidepressant with mostly noradrenergic properties and is an agent that appears to be effective. Varenicline is a non-nicotine drug that is a partial agonist of the alpha-4-beta-2 nicotinic receptor.