Professional Documents
Culture Documents
Answer Key in Pharmacology Pink Pacop
Answer Key in Pharmacology Pink Pacop
1. Two dose-response curve response plotted on the same graph showed sigmoid curves having
the same slope and height. T curve is located to the right of the A curve. Which of the following
statements is/are correct regarding curves A an:
a. PGD2
b. PGI2
c. PGE1
d. PGE2
e. PGF2-alpha
228. Which of the following effects is caused by Prostacylin?
a. Bronchoconstriction
b. Vasoldilation of the blood vessels
c. Inhibition of gastric acid secretion
d. Contraction of the uterus
e. Inhibition of renin secretion
229. What is the primary indication of the prostaglandin analogue Latanoprost?
a. Management of glaucoma
b. Smooth muscle relaxant in erectile dysfunction
c. Abortifacient
d. Inhibition of platelet aggregation
e. Vasoconstrictor in episodes of hypertension
230. Which of the following statement correctly describes the effects of glucocorticosteroids in
eicosanoid synthesis?
I. Dexamethasone inhibits the expression of the COX-2 gene
II. Glucocorticosteroids inhibit the synthesis of annexins leading to decreased activity of
Phospholipase C
III. Glucocorticosteroids stimulates the syntheis of lipocortins which inhibit the activity of
Phospholipase A2
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
231. Which of the following drugs classified as NSAIDs inhibit/s the COX-1 more than the
COX-2 isozymes?
a. Indomethacin
b. Ibuprofen
c. Mefenamic acid
d. Naproxen
e. Celecoxib
232. Which of the following drugs classified as NSAIDs inhibit/s the COX-2 morre than the
COX-1 isozymes?
a. Indomethacin
b. Ibuprofen
c. Mefenamic acid
d. Naproxen
e. Celecoxib
233. Which of the following statement/s is correctly describe/s the pharmacokinetics of
Aspirin?
I. Aspirin can be absorbed in the stomach and the small intestines in the hydrolyzed form
II. Elimination of aspirin can be best descrined as following a Michaelis-Menten kinetics
III. Acidification of the urine facilitates renal elimination of Salicylates
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
234. Which of the following mechanisms may play a role of anti-inflammatory effect of Aspirin?
I. Decreased synthesis of prostaglandins
II. Inhibition of neutrophil migration and adherence
III. Stabilize iysosomes of neutrophils
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
235. At what usual adult dose of aspirin is its anti-inflammatory effect observed?
a. 0.3-2.4g/day
b. <0.6-4g/day
c. 3.2-4g/day
d. <0.325g/day
e. At all dose range
236. What is the principal mechanism which can explain anti-pyretic effect of Aspirin?
a. Peripheral reduction in the levels of prostaglandins
b. Peripheral vasodilation
c. Inhibition of prostaglandin syntheis at subcortical sites
d. Inhibtion of CNS response to interleukin-1
e. Activation of the thermoregulatory sweat glands
237. Which of the following statements is/are correct regarding the anti-platelet aggregation
effect of Aspirin?
I. Discontinuation of Aspirin immediatel rrestores platelet aggregation in matter of 1-2 days
II. The mechanism involves irreversible actylation of the cyclooxygenase enzyme in
platelets
III. The effect is clinically significant in all dose ranges for Aspirin
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
238. Which of the following statements must be considered with regard to the effect of Aspirin
aand other NSAIDs on the gastric mucosa?
I. The risk of GI intolerance can be reduced if Aspirin or any other NSAIDs is taken with
meals
II. With Aspirin, the risk of erosive gastritis is obsereved only when Aspirin is given at doses
>0.325g/day
III. Gastric irritation is most prominent among NSAIDs that inhibit COX-1 more than COX-2
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
239. Which of the following drug is currently considered as the preferred drug to prevent
erosive gastritis in patient at risk of developing this side effect when NSAIDs have to be given to
the patient?
a. Omeprazole
b. Ranitidine
c. Sucralfate
d. Telenzepine
e. Misoprostol
240. In salicylate poisoning, serum salicylate levels of 50-80mg/dL can present with which of
the following clinical findings?
I. Hyperthermia
II. Respiratpry alkalosis
III. Tinnitus and Vertigo
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
241. A25-years old male ingested an unidentified number of Aspirin tablets. He presents with
the following findings: Responsive to verbal stimulation, BP=110/60, Body Temperature=39.5’C,
ABGs: pH=6.9, HCO3=7meq/L, pCO2 -29 mmHg; dry oral mucosa, absent axillary sweating.
What serum salicylate level is consistent with these findings?
a. 50-80mg/dL
b. 80-110mg/dL
c. 110-160mg/dL
d. 160-190mg/dL
e. >190mg/dL
242. A number of the NSAIDs cannot be given to patients with Gouty Arthritis as these may
precipitate an acute attack of gout or induce uric acid stone formation. Which of the following
NSAIDs should no be given to patient with gout?
a. Tolmetin
b. Ibuprofen
c. Indomethacin
d. Diclofenac
e. Mefenamic acid
243. Which of the following NSAIDs with minimal anti-inflammatory activity is/are primarily
indicated as analgesic especially in the management of post-operative pain?
I. Diclofenac
II. Ketorolac
III. Etodolac
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
244. All the know NSAIDs are weak acids. Which of the following drugs is the only exception?
a. Piroxicam
b. Sulindac
c. Nabumetone
d. Ketorolac
e. Tolmetin
245. Which of the following statement/s is/are correct regarding Mefenamic Acid, a popular
NSAID?
I. It is more toxic than Aspirin
II. The drug should not be used for more than 1 week
III. It should not be given to children
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
246. What is the most important toxicity associated with pyrazolone derivatives like
Phenylbutazone which necessitated the withdrawal of a number of these drugs from the market?
a. Hepatoxicity
b. Hematologic toxicities
c. Nephrotoxicity
d. Gastric ulceration
e. Stevens-johnson syndrome
247. Which of the following NSAIDs is most useful as an analgesic and has been used
successfully to replace morphine in some situation involving mild to moderate post surgical pain?
When used with an opioid, it may decrease the opioid requirement by as much as 25-50%.
a. Naproxen
b. Ketorolac
c. Tenoxicam
d. Diclofenac
e. Mefenamic acid
248. What is the primary advantage od drugs like Celecoxib and etericoxib?
a. Less incidence of gastric irritation or ulceration
b. Less incidence of nephrotoxicity
c. Less incidence of hematologic toxicities
d. Minimal risk of causing worsening hypertension
e. Less likelihood of inhibiting platelet aggregation
249. A number of drugs classified as specificCOX-2 inhibitors like Rofecoxib (Vioxx) have
been withdrawn from the market or are marketed with “black box” warning. What is the primary
reason for such actions to be taken against these drugs?
a. They are associated with severe agranulocytosis
b. They cause severe irreversible hepatic necrosis
c. They increase the risk of bleeding in patient on Warfarin
d. They increase the risk of thrombosis and cardiac deaths
e. They cause worsening of DM and Hypertension
250. Which of the following agents is currently used as the first-line DMARDs in the
management of Rheumatoid Arthritis?
a. Hydroxychloroquine
b. Auranofin
c. Penicillamine
d. Azathioprine
e. Methotrexate
251. When the methotrexate is used for the management of rheumatoid arthitis, what is the
usual maintenance dosing regimen given to patients?
a. 150mg OD
b. 15mg OD
c. 15mg once a week
d. 150mg BID
e. 15mg BID
252. Which of the following statement/s is/are correct regarding the drug Methotrexate when
used for rheumatoid arthritis?
I. The primary mechanism of action involves inhibition of AICAR
(aminomidazolecarboxamide) transformylase and thymydylate synthase
II. Toxicity of the drug may be minimized with the use of Leucovorin
III. The drug is contraindicated in pregnancy
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
253. Which of the following statements is/are correct regarding the drug acetaminophen?
I. It is a weak inhibitor of COX-1 and COC-2 isozymes in peripheral tissues
II. It has significant anti-inflammatory activity
III. It is equivalent to Aspirin as analgesic and anti-pyretic
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
254. Which of the following agent is most useful in the management of acetaminophen
poisoning?
a. N-acetylcysteine
b. S-carboxymethylcysteine
c. Dantrolene
d. Atropine
e. Sodium Bicarbonate
255. Which of the following condition when present may increase of formation of the toxic
intermediate N-acetyl-p-iminobenzoquinone with regular doses of acteminophen?
I. Patient with viral hepatitis
II. Patients on warfarin therapy
III. Chronic alcoholics
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
256. Which of the following drugs used for gout produces its effect by inhibiting the enzyme
xanthine oxide
a. Allopurinol
b. Colchicine
c. Indomethacin
d. Probenecid
e. Sulfinpyrazone
257. Which of the following drugs used for gout produces its effect by inhibiting the synthesis
of microtubules?
a. Allopurinol
b. Colchicine
c. Indomethacin
d. Probenecid
e. Sulfinpyrazone
258. Which of the following is/are appropriate indication/s of Allopurinol?
I. In the management of chronic tophaceous gout
II. In preventing massive uricosuria in patients to be given chemotherapeutic agents for
acute leukemia
III. In patients with recurrent renal urate stones
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
259. In the management of acute gouty attack, which of the following statement/s is/are
correct?
I. Uricosuric agent are given at the onset of acute attack to reduce the duration of the
episode
II. Indomethacin is preffered for the management of the pain of an acute attack
III. Colchine relieves the pain and inflammation of an acute attack in 12-24 hours
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
260. Which of the following groups can relax the brochial smooth muscles and are primarily
used as bronchodilators in bronchial asthma?
I. Methylxanthines
II. Beta-2 agonists
III. Anticholinergic agents
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
261. In the management of bronchial asthma, which of the following medications
is/areconsidered as controller medications?
I. Low-dose inhaled glucocorticosteroids
II. Short-acting beta-2 agonists
III. Long-acting inhaled beta-2 agonists
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
262. Which of the following advice should you give to a patient with bronchial asthma
regarding the use of medications for his condition based on the current recommendations?
I. Oral bambuterol must be taken on PRN basis for acute exacerbations of bronchial
asthma
II. Inhalation of salbutamol for acute relief of attack mest be used for not more than three
times a day
III. He must adequately gargle about 5x after each use Fluticasone inhaler
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
263. Which of the following drugs for bronchial asthma can be given subcutaneously during
acute episodes of bronchospasm?
a. Salnutamol
b. Isoproterenol
c. Terbutaline
d. Budesonide
e. Theophylline
264. Which of the following mechanisms may explain the actions of methylxanthines in
bronchial asthma?
I. May inhibit the late phase allergic reaction occuring about 2-8hours after an acute attack
II. May inhibit the enzyme phosphodiesterase leading to an increase in the levels of cAMP
III. May antagonize the action of Adenosine
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
265. Which of the following statements describe/s the clinical use of Theophylline?
I. May reduce the nocturnal attack of bronchial asthma when given as sustained-release
preparation
II. May improve response to high dose inhaledd beta-2 agonists when given intravenously
concurrently with beta-2 agonists during acute exacerbation of asthma
III. May improve contratility of the diaphragm improving ventilatory response to hypoxia
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
266. Which of the following statements is an important consideration regarding the toxicities
and side effects of Theophylline?
a. Toxicities and side effects do not occur as long as the serum levels of Theophylline do
not exceed 20mg/L
b. Adults, neonates, and young infants have faster clearance of Theophylline than children
c. Clearance may be decreased with inhibition of hepatic enzymes among chronic smokers
d. Seizures and arrythmias are more common when serum levels exceed 40mg/L
e. Hepatic dysfunction does not alter significantly the clearance of Theophylline and can
thus be safely used for patients with liver disease
267. Which of the following statements describe the use of anti-cholinergic agents in COPD
and bronchial asthma?
I. They can be safely given at high doses by inhalations to saturate the muscarinic
receptors
II. Available agents are tertiary ammonium compunds
III. They are more effective than beta-2 agonists in bronchial asthma but less effective in
COPD
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
268. What is the mechanism of action of Nedocromil?
a. Increase outward potassium conductance leading to hyperpolarization of mast cell
membrane
b. Increase inward chloride conductance leading to hyperpolarization of mast cell
membrane
c. Increase inward sodium conductance leading to depolarization of mast cell membrane
d. Increase outward calcium conductance leading to repolarization of mast cell membrane
e. Increase inward potassium conductaance leading to depolarization of mast cell
membrane
269. What is the mechanism of action of Zafirlukast and Montelukast?
a. Pharmacologic antagonism of Luekotriene D4 action
b. Pharmacologic antagonism of Leukotriene C4 action
c. Inhibition of the enzyme 5-lipoxygenase
d. Inhibition of citokine release by macrophages
e. Inhibition of Histamine-1 receptors
270. Which of the following agents has/have experimental effect as bronchodilator/s?
I. Omalizumab
II. Nifedipine
III. Nitric oxide
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
271. Which of the following correctly describes the action of cromolyn sodium?
a. Induces relaxation of bronchial smooth muscles
b. Blocks the degranulation of mast cells
c. Inhibits release of cytokines by inflammatory cells
d. Inhibits binding of IgE to mast cell membrane
e. Inhibits degradation of cGMP
272. Which of the following effects observe with acute or chronic use of opioids like morphine
can be attributed to stimulatio of the mu-receptors?
I. Respiratory depression
II. Psychosis
III. Miosis
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
273. Which of the following statement correctly describe the mechanism of action of the
opioids?
I. They mimic the action of endogenous opioid peptides
II. The stimulate the release of endogenous opioid peptides
III. They bind to receptors like the mu, kappa, and delta
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
274. Which of the following is an opioid receptor that is responsible for inducing analgesia
most especially among women?
a. Kappa
b. Delta
c. Alpha
d. Epsilon
e. Mu
275. Tolerance is an expected consequence with chronic use of most of the available opioids.
Which of the following effects of opioids is tolerance NOT observed?
a. Respiratory depression
b. Analgesia
c. Euphoria
d. Constipation
e. Sedation
276. Which of the following statements regarding the development of tolerance to opioids
is/are correct?
I. Develops in 2-3 weeks of continuous use especially when large doses are used over short
intervals
II. Gross-tolerance develops among predominantly kappa-receptor full agonists
III. Partial agonists induce cross-tolerance with strong agonists and antagonists
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
277. A 45-year old male admitted for severe chest painwas diagnosed with AMI. He was
being given morphine 2mg IV for relief of the chest pain. Which of the following is/are important
findings that must be observed as expected consequence/s of the use of Morphine?
I. Tachycardia
II. Hypotension
III. Vasospasm
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
278. Which of the following opioids is not associated with biliary colic and thus can be used
for severe pain associated with this condition?
a. Morphine
b. Pentazocine
c. Fentanyl
d. Meperidine
e. Codeine
279. Abstinence syndrome is a rebound effect characterized by rhinorrhea, lacrimation,
yawning, chills, gooseflesh, hyperventilation, and hostility observed in which of the following
situations?
I. Abrupt withdrawal of an opioid agonist in a patient taking the drug chronically
II. In a newborn of a mother illicitly taking heroin during her pregnancy
III. Administration of Nalbuphine on a patient chronically on morphine
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
280. Which of the following oral doses of morphine is quivalent to 10mg of an IV dose?
a. 200mg
b. 180mg
c. 100mg
d. 40mg
e. 10mg
281. Diacetylmorphine is the chemical name of which of the following opioids?
a. Apomorphine
b. Morphine
c. Heroin
d. Codeine
e. Meperidine
282. Tramadol is weak mu-receptor agonist that does not require as S2 license for
dispensing. It is a synthetic analogue ofwhich of the following opiates/opioids?
a. Codeine
b. Thebaine
c. Morphine
d. Meperidine
e. Diphenoxylate
283. Which of the listed opioid below is along the recommended drugs for the management of
acute pulmonary edema?
a. Nalbuphine
b. Codeine
c. Morphine
d. Meperidine
e. Apomorphine
284. What is the primary mechanism involved in the utility of opioids in the management of
acute pulmonary edema?
a. Induction of osmotic diiuresis of edema fluuids
b. Peripheral vasodilation reducing venous return
c. Decreased cardiac inotropism
d. Improved mobilization of edema fluid by osmosis
e. Increased glumerolar filtration rate
285. Which of the following is/are possible therapeutic classification/s for available opiates
and opioids?
I. Cough supressants
II. Emetics
III. Analgesics
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
286. What is the main reason why atropine is always given with diphenoxylate (lomotil)?
a. The anticholinergic after-effects with Atropine discourages abuse of Diphenoxylate
b. The anti-motility effect of Atroppine augments the constipating effect of Diphenoxylate
c. Atropine minimizes the respiratory depression expected with Diphenoxylate
d. Atropine reduces the absorption and systemic toxicity of Diphenoxylate
e. Atropine inhibits the hepatic metabolism of diphenoxylate effectively reducing the dose
requuired for diarrhea
287. What is the primary indication for the drug methadone?
a. Analgesic substitute for Morphine
b. Antitussive substitute for Codeine
c. Weaning off patients addicted to Heroin or Morphine
d. Management of biliary colic
e. Anesthetic premedication
288. Which of the following agents is a strong full agonist of opioid receptors
a. Hydromorphone
b. Hydrocodone
c. Codeine
d. Propoxyphene
e. Pentazocine
289. Which of the following agents is classified as a partial agonist of opioid receptors?
a. Meperidine
b. Methadone
c. Levallorphan
d. Fentanyl
e. Nalbuphine
290. Which of the following agents is/are classified as opioid antagonist/s?
I. Nalorphine
II. Naloxone
III. Naltrexone
a. Meperidine
b. Methadone
c. Levallorphan
d. Fentanyl
e. Nalbuphine
291. Which of the following anticoagulant is produced by recombinant DNA technology from
the gene that encodes the natural anticoagulant derived from medicinal leeches?
a. Dicumarol
b. Hirudin
c. Lepirudin
d. Heparin
e. Dalteparin
292. What is the primary indication of the anticoagulant derived from medicinal leeches or its
recombinant form?
a. Anticoagulation when necessary during pregnancy
b. When initiatin anticoagulation therapy in patient requiring chronic anticoagulation
c. Treatment of and prophylaxis against pulmonary thromboembolism
d. Management of thrombosis associated with heparin-induced thrombocytopenia
e. In patients with AMI or unstable angina pectoris
293. What is the mechanism of action of regular heparin?
a. Activates antithrombin III which in turn inactivates a number of activated clotting factors
b. Activation of plasminogen to plasmin leading to destruction of fibrin and fibrinogen
c. Inhibits the reductive activation of vitamin K epoxide to the hydroquinone form
d. Inhibits activvation of prothrombin to thrombin
e. Mimics the action of epsilon-aminocaproic acid
294. The activity of regular heparin when given intravenously is best monitored atleast every
6 hours for the first 24 hours of therapy using what parameter?
a. Protime
b. Platelet count
c. Clot reaction time
d. Activated partial thromboplastin time
e. Bleeding time
295. When regular heparin is used subcutaneously, which of the followinh statements is
correct?
a. There is no need to monitor activity in most cases
b. Monitoring of activity must be done on a weekly instead of daily basis
c. Monitoring must be done using aPTT
d. Monitoring of activity must be done regularly using the PT value
e. Monitoring of activity must be done using the platelet count
296. Which of the following agents must be classified as a low molecular weight heparin?
a. Enoxaparin
b. Regular heparin
c. Warfarin
d. Hirudin
e. Phenindione
297. Which of the following parameters must be measured when a patient on low molecular
weight heparin develops bleeding that may be associated with therapy?
a. aPTT
b. Prothrombin time
c. Factor X assay
d. Factor IX assay
e. Bleeding time
298. Bleeding associated with the use of regular heparin is best managed with which of the
following interventions?
a. Immediate stopping of therapy
b. Administration of Tranexamic acid
c. Administration of vitamin K
d. Administration of protamine sulfate and stopping therapy
e. Lowering of the current dose without stopping therapy
299. What is the primary drawback with phenprocoumon that limit its clinical use in the
management of thrombosis?
a. Ist metabolism to a hepatotoxic metabolite
b. Ita long half-life
c. Its prominent gastrointestinal side effects
d. Its high degree of protein binding
e. The long delay in its onset of action
300. Warfarin exerts its effect primarily by inhibiting the gamma-carboxylation of the
glutamate residues of which of the following clotting factors?
a. IXa,Xa, XIa, XIIIa
b. IIa, VIIa, IXa, Xa
c. II, VII, IX, X
d. IX, X, XI, XIII
e. I, II, V, VII
301. When warfarin is used as anticoagulant, the achievement of a maximal
hypothrombinemic effect is expected to be delayed. What is the primary reason for this delay in
warfarin effect?
a. The presence of preformed clotting factors in the plasma which have biiologic half-lives 6
to 60 hours
b. The high degree of protein binding which dela entry of the drug into its biologic site of
action
c. The delay of activation of precursor clotting factors due to high levels of activation-
inhibitors
d. The ability of warfarin to induce its own metabolism which delays achievement of
therapeutic levels by days
e. The ability of warfarin to interfere with the assay done to measure its activity
302. Cutaneous necrosis which can develop during the frist few weeks of therapy is expected
with warfarin due to which of the following mechanisms?
a. Idiosyncratic and paradoxical increase in the rate of synthesis of a number of clotting
factors
b. Earlier decline in the circulating levels of natural anticoagulants causing predominance of
procoagulant clotting factors
c. Intrinsic thrombogenic property of warfarin molecules
d. Direct reduction in tissue perfusion as a consequence of the allergic property of warfarin
e. Hypotensive effective of warfarin which reditributes blood flow to critical sites in the body
303. What is the recommended target protime INR for patients who need warfarin and have
prosthetic heart valves?
a. 1-3
b. 2-3
c. 3-4
d. 4-5
e. 5-6
304. A patient on warfarin for the last 4 weeks for DVT has a PT INR of 4 but without
evidence of bleeding. What is the most appropriate intervention?
a. No intervention as within target INR range
b. Reduction of the dose by atleast half
c. Adimintration of vitamin K
d. Adminitration of protamine sulfate
e. Administration of tranexamic acid
305. Which of the following drugs or conditions can increase the activity of warfarin by
affecting the drug’s absorption, distribution, and elimination?
a. Cimetidine
b. Rifampicin
change to vegetarian diet
c. The presence of hepatic disease
d. Concurrent use of heparin
306. What interaction is present with concominant use of warfarin and the pyrazolone
NSAIDs?
I. Inhibition of urinary excretion of warfarin
II. Inhibition of the oxidative metabolism of S-Warfarin
III. Displacement of Warfarin from its protein binding
a. I only
b. II only
c. I and III
d. II and III
e. I, II, and III
307. Which of the following correctly describes the mechanism of action of fibrinolytic agents?
a. Directly catalyze the proteolysis of fobrin and fibrinogen
b. Inhibit the action of thrombin by preventing its binding to fibrin and fibrinogen
c. Activate plasminogen to plasmin, a serine protease that catalyzes breakdown of fibrin
and fibrinogen
d. Inhibit activation of fibrinogen by proteolysis of thrombin
e. Activate the endogenous anti coagulants protein C and protein S
308. Which of the following is classified as a thrombolytic agent?
a. Reteplase
b. Warfarin
c. Argatroban
d. Bivalirudin
e. Lepirudin
309. Which of the following statements is/are correct regarding the use of thrombolytic agents in
myocardial infarction?
I. Best response is seen if the drug is given within 24 hours from onset of symptoms
310. Which of the following agents is associated with formation of antibodies that can cause development
of allergic reaction with subsequent exposure to the drug?
b. Streptokinase e. Tenecteplase
c. Alteplase
311. Which of the following mechanisms may lead to inhibition of platelet aggregation?
312. Which of the following mechanisms correctly describes the mechanism of action of aspirin as an
inhibitor of platelet aggregation?
313. Which of the following agents requires weekly WBC monitoring within the first 3 months of treatment
due to a risk of causing leukopenia?
A. Cilostazol C. abciximab
B. Dipyridamole D. Clopidogrel
E.Ticlodipine
314. Which of the following agents is associated with development of thrombotic thrombocytopenic
purpura?
A. Aspirin D. Eptifibatide
B. Ticlodipine E. Cilostazol
C. Tirobifan
315. Which of the following agents is classified as an inhibitor of glycoprotein IIb/IIIa and is useful in
patients with acute coronary syndrome and those undergoing percutaneous coronary intervention?
A. Clopidogrel D. Cilostazol
B. Ticlodipine E. Urokinase
C. Abciximab
316. What is the most important adverse effect of Dipyridamole when given to patients with ischemic
heart disease?
318. Which of the following agents primarily cause lowering of the VLDL and is thus useful for
hypertiglyceridemia?
A. Niacinamide D. Probucol
B. Fenofibrate E. Cholestyramine
C. Simvastatin
319. Which of the following is consistent with the action of the drug Colestipol?
II. Increases uptake of LDL and IDL with up-regulation of LDL receptors in the liver
B. Serves as ligand for the nuclear transcription called peroxisome proliferators-activated receptor alpha
D. Inhibits the reuptake of bile acids leading to loss of negative feedback on the alpha-hydroxylase
enzyme
321. Which of the following is/are important monitoring considerations in a patient receivimg Simvastatin?
322. Patients on Statins are generally advised to take the medication at night. What is the basis for this?
A. Maximal absorption occurs at night D. Minimize Syncopal attacks with the first dose of statins
B. Maximal cholesterol de-novo synthesis occurs at nightE. LDL release occurs at night
333. Statins are generally best taken at night. Which of the following statins is night dosing unnecessary?
A. Lovastatin D. Pravastatin
B. Simvastatin E. Fluvastatin
C. Atorvastatin
C. Simvastatin + Gemfibrozil
325. Therapy with HMGCoA reductase inhibitors is associated with Rhabdomyolysis and myositis. These
complications which can lead to acute tubular necrosis and renal failure have been reported to be
augmented with co-administration of which drugs.
326. Which of the following drugs is associated with cutaneous vasodilation and warmth sensation after
an initial dose which may be reduced with the use of 300mg dose Aspirin taken an hour before the dose?
A. Niacin D. Cholestyramine
B. Fenofibrate E. Probucol
C. Atorvastatin
327. Which of the following drugs can be bind to molecular components of the macromolecular complex
of GABA-A receptor –chloride channel present in neuronal membranes in the CNS?
I. Diazepam
II. Zolpidem
III. Phenobarbital
328. Which of the following statements correctly describes the mechanism of action of the anxiolytic drug
Buspirone?
A. Selective binding to the BZ-1 receptor in the brain D. Inhibitor of MAO enzyme
B. Antagonist of alpha receptors in the brain E. Antagonist of the BZ-1 receptor in the brain
329. Which of the following benzodiazepines is a prodrug that is hydrolyzed to the active metabolite
Nordiazepam in the stomach?
A. Alprazolam D. Diazepam
B. Chlordiazepoxide E. Lorazepam
C. Chlorazepate
331. Which of the following Benzodiazepines has the shortest half-life and a rapid onset of action?
A. Lorazepam
B. Triazolam
C. Oxazepam
D. Diazepam
E. Prazepam
332. Which of the following agents is absolutely contraindicated in patients with disorder associated with
porphyrin such as acute intermittent porphyria, vanegate porphyria, and symptomatic porphyria?
A. Chlordiazepoxide
B. Diazepam
C. Zolpodem
D. Phenobarbital
E. Buspirone
333. Which of the following agents is associated with significant anterogade amnestic effect which is
advantageous in a number of medical and surgical procedures that may discomfort to the patient?
A. Midazolam
B. Zolpidem
C. Buspirone
D. Phenobarbital
E. Thiopental
334. What is the rationale behind the use of long-acting benzodiazepine like chlordiazepoxide and
diazepam in the management of alcohol withdrawal?
335. Which of the following agents may be expected to have an additive CNS depressants effect with the
sedative hypnotics like benzodiazepines when taken simultaneously?
I.Opioid analgesics
II. Phenothiazines
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
336. Which of the following patients may be expected to have an increased sensitivity to sedative-
hypnotics leading to higher incidence of adverse effects or toxicity?
I. Young women
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
337. Which of the following statements correctly describes the pharmacokinetics of Phenytoin?
D. A first order kinetics of metabolism is observed with Phenytoin at low and high blood levels
E. Phenytoin is not significantly Protein bound so drug displacement interaction is not a major concern
II. At high concentrations, it also inhibits the release of Serotonin and Norepinephrine
III. At therapeutic concentrations, Phenytoin inhibits the generation of repetitive action potentials
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
339. Which of the following findings in a patient taking Phenytoin would warrant reduction in the dose?
A. Gingival Hyperplasia
B. Nystagmus
C. Osteomalacia
D. Ataxia
E. Hirsutism
340. Autoinduction of the metabolism is a phenomenon that leads to decrease in the usual half-life of a
given drug that the dose adjustments must be made within the first month of therapy to ensure
therapeutic drug levels are reached, and reduction of dosage must be made once metabolism has
stabilized. Such is seen with which of the following drugs?
A. Carbamazepine
B. Phenytoin
C. Phenobarbital
D. Valproic acid
E. Primidone
341. Which of the following drugs for seizures is metabolized to yield Phenobarbital?
A. Lamotrigine
B. Vigabatrin
C. Primidone
D. Topimarate
E. Felbamate
342. When Phenytoin is given intravenously, what is the maximum rate by which drug can be
administered?
A. 10mg/min
B. 20mg/min
C. 30mg/min
D. 40mg/min
E. 50mg/min
343. Which of the following statements is/are correct regarding intravenous Phenytoin?
I. Cardiotoxicity is partly due to Propylene Glycol
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
344. Which of the following statements is/are correct regarding the toxicity profile and the management of
overdose of most drugs used for treatments of seizures?
345. What is the most common side effect seen with the use of carbamazepine which requires adjustment
in the dose of the drug?
A. Diplopia D. Vomiting
B. Drowsiness E. Leukopenia
C. Hyponatremia
346. What is the preferred drug for the management of pure absence seizures?
A. Phenobarbital
B. Valproic acid
C. Phenytoin
D. Ethosuximide
E. Lamotrigine
347. Which of the following agent is associated with the idiosyncratic hepatotoxicity when given for the treatment of seizure
in children less than 2 years of age and in patients with multiple medications?
A. Gabapentin
B. Valproic acid
C. Phenytoin
D. Primidone
E. Topimarate
348. Which of the following agents is currently the preferred drug for the initial management of Status Epilepticus?
A. Lorazepam
B. Diazepam
C. Phenobarbital
D. Phenytoin
E. Valproic acid
349. Which of the following drugs used or seizure disorders is most commonly associated with cosmetic changes making
the drug desirable to used among adolescents, school-age children, and women?
A. Lamotrigine
B. gabapentin
C. Phenobarbital
D. Phenytoin
E. Valproic acid
350. A 50 year old male with Generalized Tonic-clonic seizure was initially given Carbamazepine as maintenance therapy.
He however developed adverse response to drug in form of Stevens-Johnsons syndrome. Which of the following agents
may be safed to used as an alternative treatment for the seizure?
I. Valproic acid
II. Phenytoin
III. Phenobarbital
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
351. Which of the following drugs classified as diuretics maybe useful in epileptic women who have seizures exacerbations
at the time of menses?
A. Hydrochlorothiazide
B. Metolazone
C. Acetazolamide
D. Chlorthalidone
E. Torsemide
352. Which of the following correctly describes the clinical used of Carbidopa in the therapy of parkinsonism?
A. I only
B. II only
C. I and III
D. II and III
E. I,II and III
354. Female patients with Pituitary tumor and manifesting with amenorrhea and galactorrhea are initially manage with
Bromocriptine. What is the mechanism of Bromocriptine in this condition?
355. During the maintenance therapy with Levodopa, patients are advsed to take the drug on an empty stomach. Why is
this advice given?
A. To minimize the risk of aspiration in as much as the drug can cause nausea and vomiting
B. Oral bioavailability of the drug is reduced as Levodopa can be found to food particles in the GIT
C. Bile acids released in response to food can interfere with the absorption of the drug
D. Large neutral amino acids in food interfere with the drugs’ transport acroos the blood brain barrier
E. Food can induce expression of DOPA decarboxylase which can limit the drugs CNS bioavailability
356. Which of the following drugs is most useful in controlling the bradykinesia of Parkinsonism?
A. Levodopa
B. Bromocriptine
c. Amantadine
D. Selegiline
E. Entacapone
357. Retroperitoneal fibrosis is an observed complication seen with drugs that belong to what class of agents?
A. Antiviral agents
B. Tropane Alkaloids
C. Ergot alkaloids
D. Ethanolamine Anti-histamines
E. Dopamine Agonist
358. Livedo Reticularis, a vascular cutaneous reaction characterized by a reddish-purple, fish net- patterm mottling of the
Upper/Lower extremities, is a side effect associated with which of the following agents?
A. amantadine
B. Di[henhydramine
C. Levodopa
D. Pramipexole
E. Selegiline
C A COMT inhibitor
360. The so-called “wearing-off” phenomenon encountered with the use of Levodopa-Carbidopa combination in
Parkinsonism is partly due to the formation of which metabolite which can compete with the transport of Levodopa across
the blood brain barrier?
A. alpha-methyldopamine
B. alpha-methylnorepinephrine
C. alpha-methyldopa
D. 3-O – methyldopa
E. 3-0- methyldopamine
361.Which of the currently available inhalation anesthetic is the most potent based in the minimum Alveolar concentration?
A. Halothane
B. Desflurane
C. Nitrous Oxide
D. Sevoflurane
E. Enflurane
362. Based on recent studies what is currently considered as the most probable explanation for the action inhalation
anesthetic?
A. Interaction with the molecular components of the GABA-A receptor
B. Interaction and interference with the activity of the fast inward sodium channels
363. Which of the following inhalational anesthetics sensitizes the myocardium to cathecolamines which can lead to
ventricular arryhtmia when symphatomimetic drugs are co-currently administered?
A. Sevoflurane
B. Isoflurane
C. Desflurane]
D. Halothane
E. Nitrous Oxide
364. Which of the following inhalational anesthetics associated with potentially severe and Life-threatening hepatitis?
A. Sevoflurane
B Isoflurane
C. Desflurane
D. Halothane
E. Nitrous Oxide
365. Malignant Hyperthermia which may developed in susceptible individuals exposed to i9nhalational anesthetic is
appropriately treated with which of the following agents?
A. Diazepam
B. Baclofen
C. Dantrolene
D, Thiamylal
E. Haloperidol
366. Which of the following drugs combination provide a state called Neurolepanesthesia?
367. Which of the following statement is correct regarding the use of a combination of the least potent Nitrous oxide with a
second inhalation anesthetic?
I. Reduction in the risk of the myocardial depression at a given depth of anesthesia compared to the more potent
anesthetic given alone
II. Facilitation of metabolism of the more potent anesthetic which may increase the risk of nephrotoxicity
III. Reduction in the anesthetic requirement fot he more potane anesthetic due to a second gas effect.
A. I only
B. II only
C. I and III
D. II and III
E. I. II and III
368. What is responsible for the very short duration and very rapid onset of effect of the so-called Ultra short acting
barbiturates?
369. which of the following intravenous agents can only be used to induced anesthesias but not to maintain anesthesia?
I. Propofol
II. Thiopental
III. Ketamine
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
370. Which of the following anesthetic is associated with a Dissociative state characterized by catatonia, amnesia, and
analgesia with or without actual loss of consciousness?
A. Propofol
B. Thiopental
C. Midazolam
D. Ketamine
E. Nitrous Oxide
371. Which of the following characteristics is consistent with the drug Propofol?
III. Post-operative nausea and vomiting is minimal due to its anti-emetic effect
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
372. What is the common mechanism of action of the Local anesthetics when given in their usual doses?
A. Inhibition of Ligand gated sodium channel
373. Which of the following Local anesthetics is hydrolyzed to Para-amino benzoic acid?
A. Cocaine
B. Isobucaine
C. Lidocaine
D. Bupivacaine
E. Tetracaine
374. Allergic reaction is most likely to occur with which of the following agents?
A. Isobucaine
B. Prilocaine
C. Procaine
D. Lidocaine
E. Mepivacaine
375. Which of the following local anesthetics is a substrate for metabolic degradation by the enzyme butyrylcholinesterase?
A. Chlorprocaine
B. Etidocaine
C. Ropivacaine
D. Lidocaine
E. Bupivacaine
376. Which of the following agents is considered to be the most neurotoxic when given as a spinal anesthetics causing a
transient reticular irritation?
A. Procaine
B. Lidocaine
C. Bupivacaine
D. Mepivacaine
E.Prilocaine
377. Cardiotoxocity manifesting as a electromechanical dissociation, cardiovascular collapse and death, is a complication
of therapy most commonly seen with which of the following local anesthetics?
A. Mepivacaine
B. Ropivacaine
C. Lidocaine
D. Procaine
E. Bupivacaine
378. When large doses of a local anesthetic must be administered, the risk of developing seizures can be significantly
reduced with the used of which of the following agents as pre-medication?
A. Midazolam
B. Thiopental
C. Succinyl choline
D. Propofol
E. Diphenhydramine
379.Which of the following Local anesthetics can predisposed to the development of methemoglobinemia when given in
large doses during regional anesthesia?
A. Procaine
B. Lidocaine
C. Cocaine
D. Tetracaine
E. Prilocaine
380. Which of the following metabolites of local anesthetics when formed in the body in significant amounts can cause
oxidation of the iron in hemoglobin in the ferric form?
A. Glycinexylidide
B. Ortho-toluidine
D. Benzoic acid
E. Demethylamine
381. Which of the following anti-psychotics drug groups primarily inhibit the Dopamine-2 receptors in the brain?
I. Phenothiazines
II. Dibenzodiazepines
III. Butyrophenones
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
382. In terms of potency, which of the drugs listed below is expected to be the most potent?
A. Trifluorophenazine
B. Thioridazine
C. Piperacetazine
D. trifluopromazine
E. Chlorpromazine
383. The Anti-psychotic drug Clozapine belongs to what chemical class of agents?
A. Dibenzoxazepine
B. Dibenzodiazepine
C. Benzisoxazole
D. Fluorobenzyindole
E. Thienobenzodiazepine
384. Which of the following agents is expected to produce the effects and side effects comparable to Haloperidol?
a. Mesoridazine
B. Chlorprothixene
C. Thiothixene
D. Promazine
E. Fluphenazine
385. Anticholinergic effect manifesting as loss of accommodation, difficulty in urination, constipation, and a toxic
confusional state is most commonly observed with which of the following drugs?
A. Haloperidol
B. Sertindole
C. Chlopromazine
D. Loxapine
E. Chlorpropthixene
386. Dystoinic reactions such as an oculogyric crisis and pseudoparkinsonism such as tremors are side-effects most likely
to be seen in patients taking which of the following medications?
A. Thioridazine
B. Chlorpromazine
C. Loxapine
D. Trifluphenazine
E. Molindone
387. Neuroleptic malignant syndrome which resembles malignant hyperthermia is more commonly seen with which of the
following agents?
A. Mesoridazine
B. Promazine
C. Loxapine
D. Haloperidol
E. Sertindole
388. Which of the following drugs for psychosis is most commonly associated with prolongation of QT interval on ECG
which can lead to fatal arrhythmias?
A. Thioridazine
B. Mesoridazine
C. Haloperidol
D. Clozapine
E. Loxapine
389. Which of the following drugs when given to patients will necessitate weekly WBC monitoring for the first 6 months of
therapy and every 3 weeks thereafter due to its propensity to cause agranulocytosis?
A. thioridazine
B.Chlopromazine
C. Loxapine
D. Clozapine
E. Molindone
390. Which of the following agents is most likely to cause deposits in the retina which can lead to blindness necessitating a
baseline and regular ophthalmologic examination when administered?
A. Thioridazine
B. Chlorpromazine
C. Loxapine
D. Trifluphenzaine
E. Molindone
391. Weight gain is expected complication of therapy with all the clinically useful antipsychotics. One of the drugs listed
below, however does not produce this side effect. What is this drug?
A. Thioridazine
B. Chlorpromazine
C. Loxapine
D. Trifluphenazine
E. Molindone
392. Tardive dyskinesia is considered as the most important unwanted effect of antipsychotic agents. What is considered
as the mechanism of development of this condition?
I. Dopamine receptor block
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
393. Which of the following drugs is most commonly associated with seizures?
A. Thioridazine
B. Chlorpromazine
C. Loxapine
D. Trifluphenazine
E. Molindone
394. Poisonings with antipsychotics are rarely fatal. Which of the following agents is associated with a higher incidence of
fatal poisoning?
A. Mesoridazine
B. Chlorpromazine
C. Trifluphenazine
D. Haloperidol
E. Molindone
395. What is the most common side effect associated with the used of tricyclic antidepressants?
A. Sedation
B. Tachycardia
C. Weight gain
D. Orthostatic hypotension
E. Anticholinergic effect
396. Which of the following agents is classified as a tricyclic antidepressant or 1 st generation anti-depressants?
A. Bupropion
B Trazodone
C.Desipramine
D. Amoxapine
E. Mirtazepine
397.Which of the following is/are advantage/s of the SSRI’s compared to the rest of the drugs used for depression?
I. Lesser lethality with overdose
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
398. A psychiatric patient on medications develops tremor, thyroid enlargement, and leukocytosis. The drug he is taking is
most likely
A. Chlorpromazine
B. Lithium
C. Desipramine
D. Fluoxetine
E. Haloperidol
399. Serotonin syndrome which resembles malignant hyperthermia in symptomatology occurs when SSRI’s like Fluoxetine
and Sertraline are given concurrently with
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
400. MAO-A is the amine oxidase primarily responsible for the metabolism of Norepinephrine, Serotonin, and tyramine,
while MAO-B is the specific for the metabolism of Dopamine. Which of the following agents is a selective reversible MAO-A
inhibitor whose advantage is a lesser risk of causing hypertensive crisis with tyramine foods?
A. Selegiline
B. Nefazodone
C. Moclobemide
D. Trazodone
E. Imipramine
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
402. Imipramine has been found to be useful in the treatment of nocturnal enuresis ( bed wetting). This clinical use
explained by which of the following effects of the drug?
C. Anticholinergic effects
D. Sedating effect
403. Which of the following findings is/are consistent with the poisoning of antipsychotic drugs?
I. Hypotension
II. Hypothermia
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
404. Which of the following agents interventions is/are appropriate in the management of poisoning with the Phenothiazine
antipsychotic?
405. Which of the following agents are avoided in patients taking Tranylcypromine?
I. Ephedrine
II. Phenylpropanolamine
III. Levodopa
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
406. Which of the following agents can produce the so-called serotonin syndrome when given to a patient already on
Phenelzine?
I. Venlafaxine
II. Buspirone
III. Fluoxetine
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
407.Which of the following side-effects of Lithium can be seen even in usual doses thus by itself is NOT considered a sign
of Lithium toxicity ?
B. Polyuria
C. hyperreflexia
D. Confusion
E. ataxia
408. Which of the following may be considered as mechanism/s of effect of Beta lactam antibiotics?
III. Binding to the so-called PBPs and related proteins in the cell membrane
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
I. Their effect is attributed to their ability to inhibit the enzyme dihydrofolate reductase
II. As sine agents, they are bacteriostatic but are bactericidal when given with Trimethoprim
III. They can cause hemolytic anemia if given to G6PD deficient individuals
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
411. Which of the following may be an expected complication with the use of Aminoglycosides?
I. Neuromuscular blockade
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
412. Which of the following agents is most effective against nosocomial infection with Pseudomonas aeruginosa?
A. Clarithromycin
B. Ceftazidime
C. Amikacin
D. Imipenem
E. Metronidazole
413. Which of the following drugs can be given orally to treat infections caused by Peudomonas aeruginosa?
A. Ciprofloxacin
B. Ceftazidime
C. Piperacillin
D. Clindamycin
E. Azithromycin
414. Which of the following agents can be safely used for a pregnant women with urinary tract infection?
A. Cotrimixazole
B. Ampicillin
C. Norfloxacin
D. Doxycycline
E. Chloramphenicol
415. Which of the following statements correctly describes the properties of Aminoglycosides?
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
416.Which of the following agents can penetrate inflamed meninges in sufficient concentration to be usedful for meningitis?
A. Amikacin
B. Tobramycin
C. Chloramphenicol
D. Aztreonam
E. Gentamicin
417. Which of the following agents has acivity against anaerobic organisms against most protozoan infection?
A. Clindamycin
B. Metronidazole
C. Chloramphenicol
E. Doxycycline
418. Which of the following drugs attacks plasmodiain exoerythrocytic stages and is an effective prophylactic agent against
Plasmodium vivax and Plasmodium ovale?
A. Quinine
B. Chloroquine
C. Primaquine
D. Sulfadoxine
E. Pyrimethamine
A. Clindamycin
B. Erythromycin
C. Chloramphenicol
D. Doxycycline
E. Ciprofloxacin
420.Which of the following agents exhibit a primary concentration dependent bactericidal activity wherein the rate and
extent of killing increases with increasing concentrations of drug?
A. Amikacin
B. Vancomycin
C. Clindamycin
D. Ceftriaxone
E. Piperacillin
421.Among patients with renal impairment, the dose of antibiotics must be adjusted according to the creatinine clearance.
Which of the following drugs does not require such adjustment in dosing for patients with decreased creatinine clearance?
A. Imipenem
B. Penicillin G
C. Nafcillin
D. Ceftazidime
E. Cefuroxime
422. Which of the following agents requires adjustment or may even have to be avoided in patients with hepatic
impairment?
I. Erythromycin
II. Metronidazole
III. Clindamycin
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
423. Which of the following agents is contraindicated in patients less than 18 years of age and pregnant patients due to its
adverse effects on cartilage development?
A. Sulfamethoxazole
B. Ethambutol
C. Chloramphenicol
D. Doxycycline
E. Ciprofloxacin
424. Which of the following antibiotics is contraindicated in children less than 9 years of age and in pregnant patients due
to the risk of permanent staining of teeth and enamel dysplasia in children?
A. Sulfamethoxazole
B. Ethambutol
C. Chloramphenicol
D. Doxycycline
E. Ciprofloxacin
425.Which of the following agents may predispose the neonate premature babies to kernicterus when given to this subset
of patients?
A. Sulfamethoxazole
B. Ethambutol
C. Chloramphenicol
D. Doxycycline
E. Ciprofloxacin
426. What is the primary role of agents such as Tazobactam amd Sulbactam in antibacterial therapy?
427.Which of the following antibiotic combinations is associated with clinically significant antimicrobial antagonism which
has been reported to cause higher rate of mortality in patients given this combination compared to patients receiving any of
the agent singly?
A. Penicillins + Cephalosporin
B. Penicillin + aminoglycoside
C. Erythromycin + aminoglycoside
D. Penicillin + Chloramphenicol
E. Erythromycin + Doxycycline
428.Which of the following is the preferred empiric treatment for patients suspected or proved to have sysytemic fungal
infection of any etiology?
A. Itraconazole
B. Amphotericin B
C. Fluconazole
D. Flucytosine
E. Ketoconazole
429. The activity of Penicillin G is defined units. How many units does each milligram of crystalline sodium penicillin G
contain?
A. 1
B. 58
C. 180
D. 1600
E. 2600
430. The absorption of most oral penicillins is impaired by food. An exception to this is:
A. Ampicillin
B. Amoxicillin
C. Penicillin
D. Penicillin G
E. Oxacillin
431. Which of the following organism is/are susceptible to Penicillin G, making the drug the drug of choice in the treatment
of the infection caused by this/these organism?
I. Treponema pallidum
II.Pneumococcus
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
432. The so-called Isoxazolyl penicillins are primarily indicated for the treatment of infection caused by what organism?
A. Staphylococcus aureus
B. Bacteroides fragilis
C. Escherichia coli
D. Haemophilus influenzae
E. Streptococcus peumoniae
433. Penicillins classified as ureido penicillins have extended spectrum of activity against gram-negative bacteria
compared to the natural and other semisynthetic penicillins. Which of the following organism are the ureido penicillins
effective against?
I. Enterococci
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
434. Which of the following antibiotics belong to the ureido penicillin class of agents?
A. Carbenicillin
B. Ticarcillin
C. Peparicillin
D. Bacampicillin
E. Pivampicillin
435. Which of the following agents is a first generation cephalosporin that is given intravenously?
A. Cefazolin
B. Cephalexin
C. Cephadrine
D. Cefadroxil
E. Cephapirin
436. The second generation cephalosporin includes the Cephamycins. What is the distinctive advantage of the
cephamycin over the rest of the second generation cephalosporin?
437. Which of the following second generation cephalosporins can be given orally and parenterally?
A. Cefaclor
B. Cefuroxime axetil
C. Cefotetan
D. Cefprozil
E. Cefoxitin
438. Which of the following agents belong the cephalosporins group called cephamycins?
A. Cefamandole
B. Cefprozil
C. Cefoxitin
D. Loracarbef
E. Cefaclor
439. Which of the following third generation cephalosporins have activity against Pseudomonas aeruginosa?
I. Ceftriaxone
II. Ceftazidime
III. Cefoperazone
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
A. Cefepime
B. Cefotaxime
C. Cefoperazone
D. Cefixime
E. Moxolactam
441. Which of the following cephalosporin is/are associated with Disulfiram-effect when alcohol is taken by patients who
are on this/these antibiotics?
I. Cefotetan
II. Ceftazidime
III. Cefamandole
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
442. Which of the following cephalosporins is associated with hypoprothrombinema and has increased risk of bleeding
disorders?
A. Cefoperazone
B. Cefoxitin
C. Cefuroxime
D. Ceftriaxone
E. Cefotaxime
443. Which of the following agents is considered as first line drug in the management of neisseria gonorrhea infection?
A. Ceftriaxone
B .Cefuroxime
C.Penicillin G
D. Amoxicillin
E. Trimethoprim-Sulfamethoxazole
A. Moxolactam
B. Aztreonam
C. Meropenem
D. Loracarbef
E. Ticarcillin
446. Which of the following antibacterial agents primarily work by inhibiting cell wall synthesis?
I.Polymyxin B
II. Vancomycin
III. Streptpgramins
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
447. Which of the following agents primarily work by inhibiting aminoacyl translocation and blocking the formation of
initiation complexes?
A. Aminoglycosides
B. Chloramphenicol
C. Linezolid
D. Tetracyclines
E. Macrolides
448. Which of the following drugs reversibly binds to the 30S subunit of the bacterial ribosome and inhibits the peptidyl
transferase step of the protein synthesis?
A. Aminoglycosides
B. Chloramphenicol
C. Linezolid
D. Tetracyclines
E. Macrolides
449. Which of the following agents reversibly binds to the 30S subunits of the bacterial ribosome blocking the binding of
aminoacyl-tRNA to the acceptor site on the mRNA-ribosome complex?
A. Aminoglycosides
B. Chloramphenicol
C. Linezolid
D. Tetracyclines
E. Macrolides
450. (MISSING)
451. Which of the following agents inhibits protein synthesis by binding at the 23S ribosomal RNA and preventing the
formation of ribosome complex that initiates protein snthesis?
A. Aminoglycosides
B. Chloramphenicol
C. Linezolid
D. Tetracyclines
E. Macrolides
452. The mechanism of action of Clindamycin is similar to the mechanism of action of which of the following agents?
A. Aminoglycosides
B. Chloramphenicol
C. Linezolid
D. Tetracyclines
E. Macrolides
453. Which of the following statements correctly describes the properties of the drugs Minocycline and Doxycycline?
II. Their absorption is not impaired by divalent cations like calcium and magnesium
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
454. Which of the following tetracyclines is the drug of choice when tetracyclines are needed in a patient with renal
insufficiency??
A. Oxytetracycline
B. Chlortetracycline
C. Methacycline
D. Doxycyclie
E. Minocycline
455. Which of the following macrolides can inhibit cytochrome P450 enzymes can cause an increase in the serum
concentrations of drugs like theophylline and warfarin?
I. Erythromycin
II. Azithromycin
III. Clarithromycin
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
A. Erythromycin base
B. Erythromycin ethylsuccinate
C. Erythromycin estolate
D. Erythromycin lactobionate
E. Erythromycin stearate
B. Antiprotozoal agent
D. Management of SIADH
458. Which of the following is/are clinical indication/s for the drug Clindmycin?
III. Prophylaxis of endocarditis in patients with valvular heart disease undergoing dental procedures
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
459. Which of the following may be considered as indication for the streptogramin combination Quinupristin-Dalfopristin?
I. Treatment of MRSA
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
460. Which of the following statements correctly describes the characteristics of Aminoglycosides?
II. May be given both orally and parenterally for systemic activity
III. Readily penetrate the blood brain barrier reaching adequate concentrations in the CSF
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
461. Which of the following drugs may enhance toxicity of Aminoglycosides if given with the latter concurrently to a patient?
I.Penicillin G
II. Furosemide
III. Vancomycin
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
462. Which of the following Aminoglycosides as the most ototoxic in terms of tis side-effect on the cochlear apparatus?
A. Neomycin
B. Amikacin
C. Streptomycin
D. Tobramycin
E. Netilmicin
463. Which of the following Aminoglycosides is considered as the most vestibulotoxic?
A. Neomycin
B. Amikacin
C. Streptomycin
D. Tobramycin
E. Netilmicin
A. Neomycin
B. Amikacin
C. Streptomycin
D. Tobramycin
E. Netilmicin
465. Which of the following disease-causing organism is/are the aminoglycosides most useful either assingle agents or in
combinations?
I. Mycobacterium tuberculosis
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
466. Which of the following agents is given with the Sulfonamides for its synergistic effect with the latter or inhibiting folic
acid synthesis in protozoal cells than mammalian or bacterial cells?
A. Pyrimethamine
B. Trimethoprim
C. Silver
D. Mafenide
E. Salicylic acid
468. A patient receiving sulfadiazine 4 grams per day may benefit with co-administration of which of the following agents as
preventive therapy of sulfadiazine-related complications?
I. Sodium bicarbonate
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
469. Which of the following drugs given for tuberculosis is/are bactericidal in activity at the usual dose given for TB?
I. Ethambutol
II. Rifampicin
III. Isoniazid
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
470. A 3 year old boy is diagnosed with primary tuberculosis infection. The appropriate anti-TB regimen for the child may
include which of the following agents?
I. Ethambutol
II. Rifampicin
III. Isoniazid
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
471. Which of the following drugs given for tuberculosis is metabolized by the liver enzyme N-acetyltransferase whose
expression is genetically determined may vary in different populations?
A. Isoniazid
B. Rifampicin
C. Ethambutol
D. Pyrazinamide
E. Streptomycin
472. Which of the following TB drugs is given only during the intensive phase of therapy?
A. Isoniazid
B. Rifampicin
C. Ethambutol
D. Pyrazinamide
E. Streptomycin
473. What is the acceptable dose for isoniazid in the treatment of TB?
A. 1 mg/kg/day
B.5mg/k/day
C. 10mg/k/day
D. 15mg/k/day
E.20mg/k/day
A. 1 mg/kg/day
B.5mg/k/day
C. 10mg/k/day
D. 15mg/k/day
E.20mg/k/day
475. Which of the following agents may be considred as useful 2 nd line agents for TB?
I. Kanamycin
II. Amikacin
III. Ciprofloxacin
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
476. Which of the following agents given for tuberculosis may provoke an attack of acute gouty arthritis?
A. Isoniazid
B. Rifampicin
C. Ethambutol
D. Pyrazinamide
E. Streptomycin
477. Which of the following drugs has been historically associated with the development of Creutzfeldt-Jakob disease, a
fatal neurodegenerative disease caused by prions?
E. Cortisol
478. Ocreotide is a drug used for the treatment of such conditions as acromegaly, gastrinoma, and glucagonoma. What
hormone is ocreotide an analog of?
A. Somatostatin
B. Growth hormone
C. Prolactin
D. Oxytocin
E. Dopamine
479. Which of the following correctly describes the nomal physiologic hormone release?
I. GnRH is released continuously by the hypothalamus to induce secretion of FSH and LH by the pituitary
II. ACTH release occurs in pulses that peak iin the early morning hours and after meals
III. The release of cortisol is constant throughout the day maintaining a level that varies little with meals
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
482. Which of the following statements correctly describes the thyroid hormones?
III. Hypothyroidism increases the clearance of both hormones leading to an decrease in their half-lives
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
483. Which of the following agents may interfere with the absorption of levothyroxine that patient must be advised on the
proper interval of intake with this/these agents?
I. Sucralfate
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
484. A 43 year old female who works in a hospital was admitted for tachycardia, palpitations and weight loss. Her T4 was
elevated with suppresses TSH but her thyroid scan showed a normal-sized gland with normal iodine uptake. Which of the
following should be suspected?
E. Hypothyroidism
485. A patient is receiving 50mg of Propylthiouracil three times a day. If the plan is to shift her medication to methimazole,
what dose of methimazole should you recommended?
A. 5 mg once daily
B. 15 mg once daily
C. 30 mg once daily
D. 45 mg once daily
E. 60 mg once daily
486. In monitoring response to therapy with methimazole, which of the following findings taken 3 months after initiating
therapy best indicates good response to therapy?
A. a normal TSH
B. a normal T4
487. Which of the following describes the mechanism of action of the thioamides for the management of hyperthyroidism?
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
488. Which of the following interventions may be appropriate to monitor or treat thionamide-associated agranulocytosis?
II. Monitoring the WBC is necessary for the first three months of therapy
III. Switching of therapy from one thionamide to another may reverse the effect
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
489. Which of the following cautions must be observed when iodides are given to treat hypothyroidism?
III. Iodides are the preffered drugs for chronic therapy during pregnancy
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
I. beta-blockers can inhibit the peroxidase-catalyzed reaction in the synthesis of thyroid hormones
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
491. Which of the following statements correctly describes the thyroid hormone replacement therapy?
I. Infants and children with congenital hypothyroidism require higher dose per kilogram body weight than adults
II. Steady state levels of thyroxine takes about 6-8 weeks to achieve after initiating therapy
III. Older adults and those with long-standing disease must be started on lower than usual dose of levothyroxine
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
492. A 20-year old female is receiving Hydrocortisone 20 mg IV three times a day. If the plan is to discharge the patient
with an equivalent dose of Oral Prednisone, what dose of Prednisone will you recommend?
A. 5 mg once a day
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
495. Which of the following drugs or drug combinations is appropriate maintenance therapy for patient with primary adrenal
insufficiency?
A. Hydrocortisone + Fludrocortisone
B. Dexamethasone + Hydrocortisone
C. Hydrocortisone
D. Prednisone
E. Betamethasone
496. Which of the following is/ are appropriate indications for using Glucocorticosteroids?
I. In mothers who may have premature labor and delivery before 34 weeks of gestation
II. In patients with secondary pulmonary tuberculosis prior to initiation of antitubercular therapy
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
497. In patients on glucocorticoid therapy, which of the following monitoring plans sould be initiated?
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
498. Which of the following statements is/are correct regarding adrenal suppression as a complication of therapy with
glucocorticosteroids?
I. It is expected to occur when glucocorticosteroids therapy is extended beyond 2 weeks
II. Dosage reduction when the therapy is to stopped must be done very slowly when the dose reaches replacement levels
III. Patients must receive supplementary therapy at times of stress like surgery or trauma
IV. Recovery of the hypothalamic-pituitary-adrenal axis is rapid after discontinuing chronic use of Dexamethasone
V. Treatment with ACTH reduces the time required for the return of normal adrenal function
A. I and III
B. II and IV
C. I, II and III
D. I, III and V
E. I, II ,III, IV and V
499. Which of the following glucocorticosteroids is employed in the work-up of patients with Cushing’s Syndrome to
diagnose the most probable etiology of the condition?
A. Hydrocortisone
B. Prednisone
C. Cortisone
D. Fludprednisolone
E. Dexamethasone
501. The transport of glucose that is facilitated by insulin is mediated by which of the following transporters?
A. GLUT1
B. GLUT2
C. GLUT3
D. GLUT4
E. GLUT 5
502. What is the primary advantage of Insulin Lispro compared to regular Insulin?
C. It is less immunogenic
503. Which of the following new insulin preparations has a characteristics release pattern that shows no peak and a
plateau serum insulin level that is maintained for about 24 hours?
A. Insulin Glargine
B. Insulin Lispro
C. insulin Aspart
D. Ultralente Insulin
E. NPH Insulin
504. Which of the following statements is/are correct regarding Lente Insulin?
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
505. A 50 year old male patient with Type2 Diabetes mellitus is maintained for the last 7 days on subcutaneous Isophane
Insulin at 20 units and 10 units pre-supper. For the last three days, his capillary blood glucose levels have been
consistently showing the following values: 190 mg% (prebreakfast), 118mg% (2hr-post lunch), and 110 mg% (presupper).
What recommendation will you make regarding his therapy?
A. Increase his pre-breakfast insulin to 24 units while maintaining his pre-supper Insulin at 10 units
B. Increase his pre-breakfast Insulin to 24 units and his pre-supper Insulin to 12 units
C. Maintain his pre-breakfast and pre-supper Insulin doses give Insulin Lispro 4 units pre-breakfast
D. Maintain his pre-breakfast insulin at 20 units while increase his pre-supper insulin to 12 units
E. No change in the insulin doses as all values are within the acceptable range
506. A 50 year old male patient with type2 diabetes mellitus is maintain for the last 7 days of subcutaneous Isophane
Insulin at 20 Units pre-breakfast and 10 units pre-supper. For the last three days, his capillary blood glucose levels have
been consistently showing the following values: 110mg% ( pre-breakfast), 218mg% (2 hour post breakfast), 110 mg% (2
hour post lunch), and 110 mg% ( pre-supper). What recommendation will you make regarding his therapy?
A. Increase his pre-breakfast insulin to 24 units while maintaining his pre-supper insulin at 10 units
B. Increase his pre-breakfast insulin to 24 units and his pre-supper insulin to 12 units
C. Maintain his pre-breakfast and pre-supper insulin doses but give insulin lispro 4 units pre-breakfast
D. Maintain his pre-breakfast insulin at 20 units while increase his pre-supper insulin to 12 units
E. No change in the insulin doses as all values are withih the acceptable range
507. Immune insulin resistance is said to be due to production of low levels of what type of insulin antibodies?
A. IgA
B. IgD
C. IgE
D. IgG
E. IgM
508. Which of the following oral anti-diabetic drugs is/are known to induce hypoglycemia among diabetic and euglycemic
individuals?
I. Sulfonylureas
II. Biguanides
III. Meglitinides
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
509. Which of the following antidiabetic drugs produced control of blood sugar by promoting directly or indirectly the
release of insulin by the remaining functional beta cells of the pancreas?
I. Meglitinides
II. Biguanides
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
510. Which of the following antidiabetic drugs has the longest half-life?
A. Chlorpropramide
B. Tolazamide
C. Tolbutamide
D. Glyburide
E. Glimepiride
511. What is the recommended clinical use of Repaglinide in the management of Diabetes mellitus?
B. Rosiglitazone
C. Nateglinide
D. Metformin
E. Acarbose
513. In which individuals should Biguanides be avoided as part of therapy for DM because of increased risk of lactic
acidosis?
I. Chronic alcoholics
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
514. Which of the following drugs is involved in regulating the genes involved in lipid and glucose metabolism and adiposite
differentiation by acting as ligand of the PPAR-gamma, thus useful for the managing Insulin resistance?
A. Metformin
B. Repaglinitide
C. Acarbose
D. Tolazamide
E. Rosiglitazone
515. Which of the following drugs may be given to type 1 DM patients as a combination therapy with Insulin?
A. Voglibose
B. Repaglinide
C. Nateglinide
D. Chlorpropamide
E. Glyburide
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
517. Which of the following is the common complication associated with the alpha-glucosidase inhibitors?
A. Cardiac arrhythmia
B. Flatulence
D. Hepatotoxicity
E. Interstitial Nephritis
518. Which of the following is the most common problem encountered in female patients using Progestin only oral
contraceptive pills?
A. Mastalgia
B. Breakthrough bleeding
C.Increase in pigmentation
D. Hirsutism
E. hypertension
519. The risk of stroke is especially increase when oral contraceptives are given to which subpopulation of patients?
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
520. Which of the following drugs is recommended prophylaxis for travelers in malaria endemic areas with known
chloroquine-resistant strains of Plasmodium falciparum?
I. Primaquine
II. Mefloquine
III. Atovaquone-proguanil
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
521. Although the clinical value of resistance reversal is not established, there are certain drugs that have been shown to
reverse chloroquine-resistance in malaria. Which of the following is an exemple of resistance reversing drugs?
A. Verapamil
B. Propranolol
C. Calcium gluconate
D. Primaquine
E. Diphenhydramine
522. Which of the following is the preferred treatment of malaria caused by Plasmodium vivax or Plasmodium ovale?
A. Clindamycin
B. Doxycycline
C. Fansidar
D. Halofantrine
E. Chloroquine
523. What is the treatment of choice for the management of severe falciparum malaria?
A. Chloroquine phosphate
B. Quinidine gluconate
C. Artemether
D. Artesunate
E. Doxycycline
524. Which of the following agents may be useful for eradicating a carrier state of Entamoeba histolytica?
I. Metronidazole
III. Iodoquinol
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
525. Which of the following agents is considered as the standard drug for the initial management of Pneumocystis jiroveci
(carinii) pneumonia in patients with AIDS?
A. Cotrimoxazole
B. Pentamidine
C. Doxycycline
D. Meronidazole
E. Emetine
526. filariasis an infection which can lead to Lymphatic obstructive disease is caused by Wuchreria bancrofti and Brugia
malayi. Eradication of microfilaria can be accomplished by the use of which of the following agents?
A. Praziquantel
B. Diethycarabamazine citrate
C. Niclosamide
D. Albendazole
E. Metronidazole
527. What is the probable mechanism of action of Mebendazole, A broad spectrum anthelmintic agent for Ascariasis,
Trichuriasis, and hookworm infection?
E. Increases permeability of the nematode cell membrane to calcium resulting to paralysis and death
528. Which of the following agents is considered as the drug of choice for most cestodal and trematodal infection?
A. Praziquantel
B. Mebendazole
C. Niclosamide
D. Albendazole
E. Metronidazole
529. Which of the following antineoplastic agents is considered as cell cycle specific agent in terms of its action on cancer
cells?
A. Dactinomycin
B. Daunorubicin
C. Vincristine
D. Cisplatin
E. Mechlorethamine
530. Exemestane is a steroidal hormone agent that binds to and irreversibly inactivate aromatase enzyme. What is the
clinical use of the agent?
C. Choriocarcinoma
D. Breast cancer
E. Colorectal cancer
531. Which of the following correctly provides the sequence of symptoms associated with carbon monoxide poisoning?
532. Which of the following statements regarding carbon monoxide poisoning is/are correct?
I. The brain and the heart are the most affected organ
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
533. The ability of a chemical agent to cause injury in a given situation or setting is called?
A. Hazard
B. Risk
C. Exposure
D. Toxicity
E. Threshold
A. Sulfur oxides
B. Nitrogen oxides
C. Hydrocarbons
D. Carbon monoxide
E. Ozone
535. Which of the following aliphatic hydrocarbons is considered as the most hepatotoxic?
A. Carbon monoxide
B. Chloroform
C. Trichloroethylene
D. Tetrachloroethylene
E. Methyl chloroform
A. CNS Stimulation
B. CNS depression
D. Peripheral neuropathy
E. Leukemia
537. Which of the following is considered as the most significant serious toxic effect of chronic exposure to benzene?
A. Hepatotoxicity
B. Nephrotoxicity
C. Peripheral neuropathy
E. Cardiotoxicity
538. What is considered as the most common cause of industrial lead poisoning?
A. Absorption of Lead via the gastric mucosa
539. Which of the following factors predisposed to increased intestinal lead absorption?
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
540. Which of the following statements is/are correct regarding the pharmacokinetics of lead?
I. Lead can cross the placenta and pose a potential hazard to fetus
II. Adults have greater degree of absorption of ingested lead than young children
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
541. In developing a fetus as well as in a young child, what is considered as the most sensitive target organ for Lead’s
toxic effect?
B. Kidneys
D. Gastrointestinal tract
542. What is the primary repository site of lead in the body of an adult containing about 90% of the total body lead burden?
A. Liver
B. Bone
C. Brain
D. Gastrointestinal tract
543. Which of the following chelating agents may be useful in the different phases of management of inorganic lead
poisoning?
II. Succimer
III. Dimercaprol
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
544. A patient presenting with encephalopathy, abdominal colic, hemolytic anemia and an elevated liver enzymes several
days after exposure to large amounts of a metallic poison may be suffering from what poisoning?
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
545. Which of the following effects correctly describe the mechanism of action of arsenic as a poison?
A. Inhibits generation of ATP by binding to cytochrome oxidase system in the electron transport chain
B. Inhibits effective oxygen delivery by oxidizing the hemoglobin iron form ferrous to ferric
C. Inhibits the enzyme activity by binding to the Sulfhydryl groups in the enzyme
A. Lead
B. Mercury
C. Iron
D. Copper
E. Arsenic
547. Chronic excessive exposure to this metal can lead to deposition in various organs and tissues causing the
development of conditions such secondary Diabetes mellitus, restrictive cardiomyopathy, and hepatic failure
A. Lead
B. Mercury
C. Iron
D. Copper
E. Arsenic
548. Erethism, a behavioral pattern characterized by change in mood from shyness, withdrawal and depression with
explosive anger or blushing, is seen as a manifestation of metal poisoning. It can be seen with other findings such as
tremors progressing to choreiform movements of limbs and gingivostomatitis. Which of the following metals may be
responsible for these manifestations?
A. Lead
B. Mercury
C. Iron
D. Copper
E. Arsenic
549. The findings of congestive cardiomyopathy, pulmonary edema (cardiogenic and non-cardiogenic), pancytopenia with
basophilic stippling of erythrocytes, and ascending sensorimotor peripheral neuropathy with acute exposure, and the
appearance of Aldrich-mees lines months after the acute exposure are consistent with poisoning with which of the following
metals?
A. Lead
B. Mercury
C. Iron
D. Copper
E. Arsenic
550. Chronic exposure with this metal has been linked with malignancies of the lung, skin, and the urinary bladder even at
doses not high enough to cause either acute or chronic toxicities. Which toxic chronic exposures on the hand, important
findings include a “raindrop” pattern of hyperpigmentation and hyperkeratosis of the palms and soloes,and a stocking-glove
pattern of sensorimotor neuropathy?
A. Lead
B. Mercury
C. Iron
D. Copper
E. Arsenic
551. Which of the following manifestations is most consistent with acute overdose of Iron, particularly in children?
A. Hemorrhagic gastroenteritis
E. Acute Gingivostomatitis
552. Which of the following is/are correct indications for the use of Dimercaprol?
III. Combination treatment with edentate calcium disodium for severe lead poisoning
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
553. Penicillamine, as a chelating agent, is primarily used for the treatment of poisoning with which of the following
metals?
A. Lead
B. Mercury
C. Iron
D. Copper
E. Arsenic
554. Deferoxamine is primarily indicated for the treatment of poisoning with which of the following metals?
A. Lead
B. Mercury
C. Iron
D. Copper
E. Arsenic
555. Hemodialysis as an intervention for poisoning is indicated for which of the following drugs?
A. Morphine
B. Digoxin
C. Diazepam
D. Propranolol
E. Ethylene glycol
556. The use of activated charcoal as a means of eliminating a drug taken in overdose is applicable for which of the
following drugs?
A. Carbamazepine
B. Ethanol
C. Ferrous sulfate
D. Lithium carbonate
E. Potassium chloride
557. Following a non-accidental ingestion of Acetaminophen tablets, what minimum serum acetaminophen level taken 4
hours after ingestion will indicate a high risk of liver injury?
A. > 10mg/ml
B. > 50mg/L
C. > 1000mg/L
E. >2000mg/L
558. In the management of Quinidine-like cadiotoxicity associated with an overdose of a tricyclic antidepressant, which of
the following is the most useful intervention?
A. Physostigmine
B. Lidocaine
C. Quinidine
D. Sodium bicarbonate
E. Magnesium sulfate
559. Seizures as a manifestation of poisoning can be seen as a common component of the toxidrome of which of the
following drugs?
I. Atropine
II. Methampethamine
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
560. Which of the following agents can cause a state of drunkenness followed a day later by severe anioin gap metabolic
acidosis?
A. Ethylene glycol
B. Ethanol
C. Gamma-hydroxybutyrate
D. Lorazepam
E. Diazepam
561. The volume of Distribution of a drug may determine the efficacy of hemodialysis or hemoperfusion as a means of
facilitating elimination of the drug from the body. Which of the following drugs or drug groups have a high volume of
distribution which makes hemodialysis ineffective therapeutic option in cases of poisoning?
I. Antipsychotics
II. Antidepressants
III. Antimalarials
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
562. Constriction of pupils (miosis) is seen with poisoning or overdoses with which of the following agents?
A. Opoids
B. Tropane alkaloids
C. Amphetamines
D. LSD
E. Cocaine
563. Which of the following agents can cause a high anion gapmetabolic acidosis?
I. Methanol
II. Ethanol
III. Metformin
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
A. Propranolol
B. Sodium bicarbonate
C. Epinephrine
D. Calcium gluconate
E. Naloxone
565. Which of the following is most appropriate treatment for the management of cardiac manifestations of theophylline or
Caffeine overdose?
A. Verapamil
B. Esmolol
C. Digoxin
D. Magnesium sulfate
E. Adenosine
566. Which of the following agents is most useful for the management of acetaminophen toxicity?
A. S-carboxymethylcysteine
B. N-acetylcysteine
C.Atropine
D. Ethanol
E. Oxygen
567. Which of the following agents may be useful for the treatment of poisoning due to methanol?
I .Ethanol
II. Glucagon
III. Fomepizole
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
568. Which of the following agents may be useful for the treatment of ethylene glycol poisoning?
I .Ethanol
II. Glucagon
III. Fomepizole
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
569. Royal jelly, a popular nutritional supplement form honeybee has been reported to cause which of the following
adverse effects?
A. Hepatotoxicity
B. CNS depression
C. CNS stimulation
D. Anaphylaxis
E. Hemorrhagic gastritis
570. Ginkgo biloba is a common additive in a number of nutritional supplements. Which subset of patients should be
cautioned against the use ginkgo-containing products?
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
571. Ginseng (Panax ginseng) is a popular additive in nutritional supplement due to its ability to improve physical and
mental performance. Which subset/s of patients must be advised regarding the potential adverse effect of Ginseng on their
disease or when taken concurrently with their medications?
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
572. Delayed neurotoxicity associated with exposure to organophosphate characterized by polyneuropathy, paralysis and
axonal degeneration has been attributed to what effect of these toxicants?
573. Which of the following statements is/are correct regarding the toxicology of the carbamate insecticides?
I. Inhibition of the cholinesterase enzyme is reversed easily with the use of pralidoxime
III. They are considered as persistent toxicants with great impact in the environment
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
574. Which of the following mechanisms explains the toxicity of the chlorinated hydrocarbon insecticides like DDT?
575.Toxidromes of poisoning with chlorinated hydrocarbons primarily consists of which of the following manifestations?
A. CNS stimulation
B. CNS depression
E. Hepatic failure
576. Which of the following agents is/are considered as botanical insecticide/s (derived from botanical sources)?
I. Nicotine
II. Rotenone
III. Pyrethrum
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
577. What is the minimum fatal dose of nicotine, equivalent to 2 sticks of cigarettes?
A. 10mg
B. 20 mg
C. 40mg
D. 80 mg
E. 160 mg
578. Which of the following findings is/are consistent with acute nicotine toxicity?
I. Hypertension
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
579. Which of the following describe/s the appropriate management of acute nicotine toxicity?
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
580. Paraquat is described as having a toxicity rating of 4. What are the probable human lethal dosages with this rating?
D. 5-50mg/kg body wt
581. Parathion has a toxicity rating of 6. What are the probable human lethal dosages with this rating?
D. 5-50mg/kg body wt
A.1
B. 2
C. 5
D. 5
E. 6
583. Which of the following toxicants is known to accumulate slowly in the lungs by an active process and causes lung
edema, alveolitis, and progressive pulmonary fibrosis days to weeks after an exposure?
A. Paraquat
B. Scopolamine
C. Parathion
D. Dioxin
E. Nicotine
584.Yusho disease documented in Japan in the 1960’s is associated with exposure to which of the following toxicants?
A.Polychlorinated biphenyls
B. Paraquat
C. Nicotine
D. Aconite
E. Mercury
A. inhalation
B. Dermal exposure
C. Ingestion
D. Ophthalmic
E. Bites
586. In the initial treatment of poisoning at home, which of the following instructions is correct to give regarding inducing
vomiting as an initial intervention?
C. For children, less than 1 year old, use one tablespoonful of Ipecac followed by a glassful of water
D. If the patient does not vomit with Ipecac, use salt water or mustard as an alternative
E. If the patient does not vomit with Ipecac, try other techniques like tickling the back of the throat of your finger
587. Which of the following situations will contraindicate induction of vomiting as an intervention in cases of poisoning?
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
588. Hyperbaric oxygen supplementation may be necessary intervention if no response is seen with 100% oxygen
supplementation in cases of poisoning with which of the following toxicants?
I. carbon monoxide
II. Nitrobenzene
III. Cyanide
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
589. Milk may be used to dilute ingested toxicants. Which of the following ingested poisons may be manage initially by the
administration of milk?
I. Hypochlorite
III. Fluoride
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
590. Alteration of pH can alter renal elimination of certain toxins. Which of the following toxicants may be safely eliminated
by either acidification or alkalinization of urine?
I. Phencyclidine
II. Salicylates
III. Amphetamines
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
591. Which of the following rugs may be useful to manage complication of exposures to nitrogen oxides and nitrobenzene?
A. Methylene blue
B. Ethanol
C. Calcium gluconate
D. Activated charcoal
E. Penicillamine
592. Toxidrome consisting of CNS depression followed by severe metabolic acidosis, blindness with initial “snowstorm-like”
visual disturbance, and coma is most consistent with which of the following toxicants?
A. Nitrates
B. Warfarin
C. Ethanol
D. Methanol
E. Ethylene glycol
593. The manifestations of oxalate poisoning are best managed with which of the following antidotes?
A. Calcium gluconate
B. Fomepizole
C. Glucagon
D. Sodium bicarbonate
E. Atropine
594. A 20 year old male patient is admitted after ingesting 20 tablets of 300mg Isoniazid tablet. Which of the following
statements is/are correct regarding the management of this patient?
595. Historically, a “universal antidote” was employed in the management of poisoning. Recent studies have shown that
the two of the components of this so-called universal antidote have no significant efficacy. What are the components of this
so-called “universal antidote”?
596. Which of the following interventions is/are applicable in cases of acute opioid overdose?
I. Activated charcoal dose not have a role in the management of opoid poisoning
III. If respiratory depression develops, 2mg of naloxone is administered and may be repeated as necessary
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
597. A patient is given physostigmine to manage poisoning with anti-muscarinic agent. Which of the following is/are
possible complications of therapy with physostigmine?
I. Cholinergic crisis
II. Seizures
III. Asystole
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
598. In the management of Mercury Poisoning, which of the following is/are important considerations?
I. dimercaprol is not used for elemental and organic mercury poisoning as the drug may redistribute mercury from tissues
to brain
II. Chelation from unithiol may diminished nephrotoxicity that may result from acute exposure to inorganic mercury
III. In acute exposure, the efficacy of chelation therapy diminishes with time since exposure
A. I only
B. II only
C. I and III
D. II and III
E. I, II and III
A. Dimercaprol
B. Succimer
C. D-dimethylcysteine
D. unithiol
E. Deferoxamine
600. What is the mechanism of action of Glucagon that makes the drug useful for the management of overdoses or
poisoning with drugs that directly inhibit myocardial contractility?
f.