Applied Therapeutics/Mid Term Exam

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Select one correct answer (45 marks)

Breakthrough bleeding or spotting (inter-menstrual bleeding) may 1 point

continue for more than 3 months in women using combined oral

contraceptive, to reduce this types of bleeding: *

Use alternative method of contraception

Use formula with more estrogen dose

Decrease the dose of both estrogen & progestin

Use formula with same estrogen dose & more progestin

Which category of patients is most likely to experience weight gain due to 1 point
second-generation antipsychotic therapy? *

Children and adolescents

Middle-aged adults

Older adults (age greater than 65)

Young adults

Dystonia is one of the life threatening EPS, it is: * 1 point

May be present even with low initial doses of FGAs

Amantadine can be used as prophylactic medications when using high-potency FGAs

Relief usually occurs within 1 to 2 hours of IM diazepam injection

More commonly occur in younger male patients

In addition to the central obesity, facial rounding (moon face) findings in 1 point
Cushing syndrome, other findings may include the following, Except: *

Some patients develop cushing-induced osteoporosis

Increase gonadal function

Elevated blood pressure

Glucose intolerance
Steroidogenic inhibitor that limited to be used for patients with emergency 1 point
acute hypercortisolemia is: *

Ketoconazole

Aminoglutethimide

Etomidate

Metyrapone

Subclinical hyperthyroidism can be diagnosed by: * 1 point

Normal TSH and elevated T4 or T3

Low or undetectable and normal T4 or T3

Low or undetectable TSH and elevated T4 or T3

Elevated of both TSH and T4 or T3

The following are healthy risk for women taking contraceptive pill, EXCEPT: 1 point
*

Higher chances of acquiring sexually transmitted diseases such as gonorrhea.

Increased vaginal discharge and susceptibility to vaginitis.

Elevated LDL and low HDL levels.

Benign uterus tumors which can eventually be serious.

Amphetamine-induced schizophrenic symptoms like disturbed behavior 1 point
patterns by its action to: *

Increasing production of norepinepherine

Increasing levels of Cortisol

Blocking the brain's dopamine receptor sites and so reducing dopamine activity

Increasing brain dopamine activity

Second generation antipsychotics may increase risk of the following 1 point

except: *

Akathisia

Weight gain

Diabetes mellitus

Hyperlipidemia

SGAs may increase risk of the following except: * 1 point

Weight gain

Hyperlipidemia

Akathisia

Diabetes mellitus
All the following statements about raloxifene are true, except: * 1 point

Considered a curative treatment for osteoporosis

Not associated with uterine bleeding

Reduce vasomotor symptoms in perimenopausal women

Antagonize estrogen effects on breast & endometrium

The evidence that dopamine plays an important role in schizophrenia 1 point

stems from: *

All of them

Findings that amphetamines work by increasing dopamine and high doses can cause
schizophrenia-like symptoms

Findings that antipsychotic medication acts by reducing dopamine

Findings that giving too much synthetic dopamine (L-DOPA) to patients with
Parkinson's disease produces schizophrenic-like symptoms.

Which of the following drugs acts as a glucocorticoid receptor antagonist? 1 point

Mifepristone.

Mitotane.

Spironolactone.

Aminoglutethimide.
All the following statements are related to myxedema coma, Except: * 1 point

Mortality rates reaches 60% to 70% of cases

manifested from hypothermia to delirium and coma

Liothyronine (synthetic T3) is uncommon to be used

Immediate and aggressive therapy are required

Schizophrenic patients may acquire neuroleptic malignant syndrome with 1 point

the use of antipsychotics, which described by the following, except: *

Reported usually with the SGAs, including clozapine

Patients need supportive care but discontinue of antipsychotics is not necessary

Associated with elevated levels of liver enzymes and creatine kinase

Bromocriptine reduces rigidity, fever, or CK levels in up to 94% of patients

The treatment of choice for bilateral adrenal hyperplasia-dependent 1 point

aldosteronism is: *

Angiotensin receptor blockers.

Spironolactone.

Partial adrenalectomy.

Mifepristone.
Advantages of combination contraceptive pill use include: * 1 point

Safety with women over 35 who are cigarette smokers.

Nearly 100 % effectiveness if used properly.

Protection against sexually transmitted diseases.

All of them

Low level of estrogen at menopause may lead to the following, except: * 1 point

Increase the risk of osteoporosis

Endometrium become thin and dry

Menstrual cycles shorten or lengthen

Skin and nail become thicker

Potassium iodide is available as Lugol’s solution, the false statement is: * 1 point

Should be used following the use of antithyroid drugs to reach euthyroid state

The solution contain 6.3 mg of iodide per drop

Should be administered 6 to 8 weeks preoperatively

Used to prepare a patient for surgery to decrease vascularity of the gland

For women with cardiovascular risk; the regimen of hormonal replacement 1 point
therapy should be: *

Estrogen continuously + Mirena IUS

4 weeks estrogen + 12 days progesterone

continuous use of both hormons

70 days estrogen + 14 days progesterone

Schizophrenia is a particular type of psychosis, associated with the 1 point

following, Except: *

It occurs earlier in women than in men

Has a strong genetic component

The incidence is about equal between sexes

Affects people during late adolescence or early adulthood

The front line treatment for schizophrenia is: * 1 point

Cognitive behavioral therapy (CBT)

Stress management training

Antipsychotic medication

Social skills training

The drug of choice for treatment of congenital adrenal hyperplasia 1 point
resulting fluid imbalance is; *

Fludrocortisone.

Hydrocortisone.

Flutamide.

Dexamethasone.

Which type of contraceptive pill is considered acceptable for the first six 1 point
weeks after birth when breastfeeding? *

High estrogen pills

Triphasic contraceptive pills

Combination contraceptive pills

Progestin-only pills

The following statements about radioactive iodine –I 131 in management of 1 point

thyrotoxicosis are true, Except: *

Safe to be used in pregnancy

Indicated for toxic multinodular goiter

Compatible combination with B-blocker

Agent of choice for Graves’ disease

Persist symptoms for at least 6 months with at least one month of the 1 point
following may confirm the diagnosis of schizophrenia *

Criterion B

Delusions

Criterion A

Catatonic behavior

Tibolone, as a hormonal replacement therapy, characterized by: except: * 1 point

Estrogenic effects are weak, but it cause monthly bleeding

Has protective effect against osteoporosis

Synthetic steroid with estrogenic, progestogenic, & androgenic effects

Androgenic action tend to increase libido

All the following statements about combined oral contraceptive users are 1 point
true, EXCEPT: *

Switching to pills with less estrogen or progestin may alleviate the headache

Ischemic stroke is more likely to occur in combined oral contraceptive users with
history of classic migraine (with aura)

Women with severe headache should discontinue combined oral contraceptive use

Headache cannot occur during the placebo week

Aldosterone is synthesized in the: * 1 point

Zona reticularis

zona glomerulosa

Zona fasciculata.

Medulla

High dose of bromocriptine (>25 mg daily) as a treatment of acromegaly 1 point

may produce: *

Shortening the required duration of treatment

Do not show any additional benefits in the reducing GH level

Delay the progression of the abnormal morphological features

None of them

Typical antipsychotic drugs are classified to low- or high-potency 1 point

according to: *

All of them

Clinical effectiveness

Adverse effect profile Weight gain

Origin of the drug

Combined oral contraceptive users may contribute to thromboembolic 1 point
events by several mechamisms, including: *

All of them

Decrease the activity of antithrombin III

May increase clotting factors formulation (VII, X, XII)

With long term use; increase platelets count & platelets aggregation

Dopamine- serotonin–stabilizing agent, has a low risk of most forms of 1 point

EPS, but high incidence of akathisia: *

Aripiprazole

Risperidone

Ziprasidone

Olanzapine

Alternate-day therapy with systemic glucocorticoids: * 1 point

Should be the initial regimen for most patients.

Is equally effective as compared to daily therapy.

Can be problematic in children because the dosing may need to be changed

frequently.

Theoretically minimizes hypothalamic-pituitary-adrenal axis suppression.

Which of the following factors are not associated with better recovery in 1 point
schizophrenia? *

Having a diet full of fresh fruit and vegetables

Being female

Having a high level of education

Early intervention at illness onset

Which of the following is not a cause of primary hypothyroidism” * 1 point

Decrease thyroid hormone sensitivity

Iodine deficiency

Viral infection

Hashimoto’s thyroiditis

In a 45-year-old male patient with cushingoid habitus, elevated serum and 1 point
urinary cortisol, very low serum ACTH, the most likely diagnosis would be
Cushing's syndrome secondary to: *

Adrenal carcinoma.

Pituitary adenoma.

Adrenal adenoma.

Ectopic ACTH production.

Treatment of choice for both ACTH-dependent & independent Cushing 1 point
syndrome is: *

Transsphenoidal resection of the pituitary tumor

Laparoscopic adrenalectomy

Pituitary irradiation preceded by steroidogenic inhibitors

Pituitary irradiation

Glucocorticoids regulate their own secretion by inhibiting the pituitary 1 point

secretion of: *

Melanocyte-stimulating hormone.

Adrenocorticotropic hormone.

Renin.

corticotropin-releasing hormone.

The therapeutic options for 30 y. o male diagnosed with acromegaly 1 point

include all, Except: *

Dopamine agonists

Dexamethasone

Somatostatin analog

Growth hormone receptor antagonist

Therapeutic options for patient with myxedema coma include; * 1 point

Immediate and aggressive therapy with IV bolus levothyroxine, 300 to 500 mcg.

Glucocorticoid therapy with IV hydrocortisone 100 mg every 8 hours is recommended

until coexisting adrenal suppression is excluded.

Initial treatment with IV liothyronine (synthetic T3) or a combination of both hormones

is advocated because of impaired conversion of T4 to T3.

All of them

Thionamides are potent antithyroid drugs, can block thyroid hormone 1 point
synthesis. One of the following is not true about thionamides: *

Usual initial doses include methimazole 30 to 60 mg daily given in three divided doses

The dose increased weekly because the endogenously produced T4 will reach a new
steady-state concentration in this interval.

Expected improvement in symptoms occur within 4 to 8weeks

Major adverse effects include agranulocytosis and aplastic anemia

Which of the following are not included in the DSM criteria for 1 point
schizophrenia? *

Catastrophic thinking

Delusions

Hallucinations

Disorganized speech
 Patients who will be taking glucocorticoids long term should be warned 1 point
about all the following Except: *

That patients may need to decrease dose during times of increased stress.

That weight gain and insomnia often occur when starting treatment.

That chronic use can lead to osteoporosis and glaucoma for which they must be
monitored.

That patients should wear medical identification stating that they are on chronic
steroid therapy.

A delusion involving thought broadcasting involves the individual believing 1 point

that: *

Their thoughts are escaping their mind and can be read by others

That everyday events have special relevance to them

They have a special purpose in life.

They are being persecuted or harassed

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