University of Thi-Qar Time: 2 hours

‫ز‬
College of Pharmacy Stage: Fifth Year/ second Semester

Dept. of pharmacology and Subject: applied therapeutics II

toxicology
Date: 11 / 4 / 2023

Mid-term examination / second semester / 2022-2023

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1. . A 26-year-old woman asked her family physician for a hormonal contraceptive. She
refused other methods of contraception. Past history of the woman indicated disseminated
intravascular coagulation that followed an abortion due to placental abruptio. Which of the
following would be the most appropriate hormonal contraceptive preparation for this
woman?
A. Diethylstilbestrol.
B. Ethinyl estradiol and levonorgestrel.
C. Levonorgestrel.
D. Ethinyl estradiol and norethindrone

2. A 39-year-old obese woman was admitted to the hospital because of a severe pain in her
right calf. Medical history included chronic bronchial asthma, currently treated with inhaled
albuterol, and mild type II diabetes, currently treated with chlorpropamide and metformin.
She had been taking combined oral contraceptives for 2 years. Physical examination showed
a red, swollen, and tender right calf. A duplex ultrasonography confirmed the diagnosis of
deep venous thrombosis. Which of the following drugs most likely caused the patient's
disorder?
A. Metformin.
B. Ethinyl estradiol.
C. Chlorpropamide.
D. Albuterol
3. A 20-year-old woman started using a hormonal contraceptive with a monophasic
combination of ethinyl estradiol and norethindrone. The primary contraceptive mechanism
of action of this contraceptive preparation most likely includes decreased secretion of a
hormone from which of the following organs or tissues?
A. Hypothalamus.
B. Ovary.
C. Posterior pituitary.
D. Endometrium.
4. The following points related with the transdermal contraceptives, Except :
A. It is as effective as CHCs in women weighing less than 100 kg.
B. The patch should be applied to the neck.
C. The patch should be replaced every week for 3 weeks.
D. The patch should be applied at the beginning of the menstrual cycle.
5. Which of the following points unrelated with emergency contraception:
A. Emergency Contraception is used to prevent unintended pregnancy after unprotected
or inadequately protected sexual intercourse.
B. progestin-only and progesterone receptor modulator products are recommended as
first-line emergency contraception options.
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 C. should be given within (7 days) of unprotected intercourse.
D. Common adverse effects of emergency contraception include nausea, vomiting, and
irregular bleeding .
6. Which of the following points related with injectable progestins side effects:
A. menstrual irregularity.
B. reduced bone mineral density.
C. Weight loss.
D. A and b are true.
7. All about vaginal contraceptive sponge is true except:
A. available over the counter and contains nonoxynol-9 .
B. provides protection for 48 hours.
C. After intercourse, the sponge must be left in place for at least 6 hours before removal.
D. It should not be reused after removal.
8. A.M 40 years old female in the terminal stages of carcinoma. Her current medication
paroxetine 20 mg daily, tamoxifen 20 mg daily, co-domal 2 tablets and diazepam 2 mg . but
A.M Still complaining of pain. About tamoxifen is not true:
A. It has both estrogenic and antiestrogenic properties.
B. reduce estrogens by blocking peripheral conversion from an androgenic precursor.
C. It increases the risks of stroke.
D. preferred second agent when metastases are present in premenopausal women.
9. The following related with breast cancer clinical presentation(for primary and locally
advanced stage), Except:
A. Bone pain.
B. A painless mass.
C. unilaterally mass.
D. prominent skin edema.
10. Which of the following points is correct regarding biologic or targeted therapy:
A. Can be used as adjuvant with chemotherapy is indicated in patients with early stage, HER2-
positive breast cancer.
B. These drugs can be Cardiotoxic.
C. These drugs are the choice to hormone receptor–positive metastases.
D. These drugs benefits in patients with HER2-positive MBC.
11. Which of the followings is true about Aromatase inhibitors (AIs):
A. first line therapy in premenopausal women.
B. blocking peripheral conversion from an androgenic precursor.
C. AIs increase circulating and target organ estrogens.
D. None of above is true.
12. The goal of neoadjuvant chemotherapy in locally advanced breast cancer is cure
A. True .
B. False.
13. All points regarding the Early stage of breast cancer is true :
A. Carcinoma in situ or disease that has not invaded the basement membrane.
B. Small primary invasive tumor without lymph node involvement.
C. Involvement of regional lymph nodes.
D. All above is true.

14. Methods for cancer prevention, all true except:

A. Vaccination such as with hepatitis B vaccine.
B. Smoking cessation for reduce lung cancer risk.
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 C. Minimizing sun exposure, using sunscreens, wearing protective clothing and
sunglasses.
D. Use antineoplastic medications such as Tamoxifen for prostate cancer prevention.
E. B and C.

15. Regarding metastasis, all true except:

A. Metastasis is a growth of the same cancer cell found at some distance from the primary
tumor site.
B. When metastasis founded that is sign of poor prognosis.
C. The most of treatment considered as palliative.
D. The usual metastatic sites for solid tumors are the brain, bone, lung, and liver.
E. Non of above.
16. When cancer arises from glandular tissue is called:
A-Carcinoma. B- Sarcoma. C- Lipoma. D-Adenocarcinoma.
17. Chemotherapy in general prefers to use more than one agent due to:
A- To produce synergistic effect and overcome resistance cases.
B- To overcome some economic problems.
C- To reduce drug drug interaction problem.
D- All of above.
18. Chemotherapy may be given to help control the symptoms of an incurable cancer:
A-Adjuvant Therapy. B-Neoadjuvant Therapy. C- Palliative therapy.
D- None of above.
19. Chemotherapeutic agent may cause myelosuppression:
A- Vinca alkaloids such as vinblastine. B- Antibiotics such as Bleomycin.
C- Folate Antagonists like Methotrexate. D- B and C. E- A and C.

20. Other possible causes that must be ruled out before confirm diagnosis of chemotherapy
induced nausea and vomiting:
A- Opioid intolerance. B- Brain metastases.
C- Vestibular dysfunction. D- All of above.
21. W.D. is a 55-year-old female with acute lymphocytic leukemia. Her cycle of treatment
include cyclophosphamide, vinblastine and dexamethasone. The counseling of clinical
pharmacist about treatment suggested adding Mesna to regimen. What is the reason behind
adding mesna to treatment regimen?
A- To get more efficacy of treatment regimen.
B- To reduce toxicity associated with treatment.
C- To get more symptoms control.
D- All of above.
22. A drugs indicated for prevention chemotherapy induced nausea and vomiting:
A- palonosetron. B- aprepitant. C- dexamethasone. D- metoclopramide.
E- All of above. F-All of above except D. G- All of above except C and D.
23. Nonpharmacological measures to prevent mucositis:
A-brushing with a soft-bristled toothbrush at least twice daily, flossing, bland rinses, and
saliva substitutes.
B- Using prophylactic antibiotics.
C- Administration oral Palifermin for total 6 doses (3 before and 3 after cycle).
D- All of above .
24. A 50-year-old woman is receiving adjuvant chemotherapy for stage II breast cancer. She
received her third cycle of AC (doxorubicin and cyclophosphamide) 10 days ago. Her CBC
today includes WBC 600 cells/mm3 , segmented neutrophils 60%, band neutrophils 10%,
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 monocytes 12%, basophils 8%, and eosinophils 10%. She is afebrile.From above case,
Which best represents this patient’s ANC?
A. 600 cells/mm3 . B. 360 cells/mm3 . C. 240 cells/mm3 . D. 420 cells/mm3
.
25. From your previous answer, given this ANC, which statement is most appropriate?
A. The patient should be initiated on Colony-stimulating factors.
B. The patient should begin prophylactic treatment with a quinolone antibiotic or trimethoprim/
sulfamethoxazole.
C. The patient, who is neutropenic, should be monitored closely for signs and symptoms of
infection.
D. The patient should be received empiric antibiotics and amphotericin B.
26. Regarding Filgrastim :
A-Stimulate the maturation and differentiation of neutrophil precursors.
B- The prophylactic use of these agents decreases days of hospitalization and use of empiric
antibiotics by shortening the duration of severe neutropenia (defined as ANC < 500/µL).
C- Primary used as biosimilar products to get more potency.
D- A and C. E- A and B. F- All of above.
27. Regarding pharmacologic therapy for Hemorrhagic cystitis :
A-Direct instillation of alum into the bladder using catheter.
B- Systemic Tranexamic acid or hyperbaric oxygen.
C-Antispasmodic agents such as oxybutynin 5 mg by mouth two to three times daily may be
used for bladder spasms.
D- All of above are true. E- A and C.
28. Incidence of gram-positive to gram-negative organisms isolated in bloodstream infections
(BSI) in cancer patients were 60% to 40%.

A-The causes of this shift from Gram-negative to positive are attributed to the widespread
use of central venous catheters.
B- The shift related to use quinolone as prophylactic antibiotics.
C- Vancomycin is added to overcome this shifting in infection causative M.O.
A- All of above.

29. Which of the following points related with pharmacological treatment of perimenopause and
menopause:
A- menopausal hormone therapy
B- Estradiol
C- Ethinyl estradiol
D- Dehydroepiandrosterone
E- All are correct

30. Which of the following points related with dysmenorrhea symptoms:

A. Symptoms often begin immediately after ovulation and can last until the
end of menstruation
B. Pain in the lower abdomen and low back pain
C. Pain radiating down the legs
D. A and C only.
E. A, B, and C are correct

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 31. The following points related with dysmenorrhea treatment, Except:
A- ibuprofen and naproxen are the highly used NSAIDs
B- desired treatment outcomes is reduction of pelvic pain
C- exercise may reduce dysmenorrhea by reducing pelvic blood flow and stimulating the
release of beta-endorphins
D- estrogen-only agents diminish dysmenorrhea by reducing or eliminating menses over time
E- C and D are incorrect .

32. The following points related with anovulatory uterine bleeding, Except:
A- it is irregular menstrual bleeding from the endometrium
B- it is the most common form of noncyclic uterine bleeding
C- when ovary fails to secrete progesterone is the main factor for incidence of
this problem
D- the desired outcome of the treatment is to stop chronic bleeding
E- estrogen is the recommended treatment.
33.Which of the following points related with amenorrhea:
A- it is the absence of menstruation during the female during the reproductive
ages
B- polycystic ovary syndrome is the main cause for secondary amenorrhea
C- using low dose for long time of oral contraceptive can cause amenorrhea
D- estrogen treatment is the recommended type for both primary and
secondary amenorrhea
E- All are correct
34. The following points related with dysmenorrhea, Except:
A- is a rare reported menstrual complaint among women
B- women with primary dysmenorrhea have abnormal contractions of the
uterus due to a chemical imbalance in the body
C- a direct relationship exists between primary dysmenorrhea and elevated
level of arachidonic acid
D- endometriosis is one of the causes of primary type
E- A and D are incorrect
35. Which of the following points related with dysmenorrhea:
A- is pelvic pain, generally described as painful cramping
B- occurs during or just prior to menstruation
C- primary dysmenorrhea occurs with normal pelvic anatomy and physiology
D- secondary dysmenorrhea this type is due to some physical cause
E- All are correct
36. Which of the following points related with symptoms of perimenopause and
menopause:
A- hot flushes and night sweats
B- sleep disturbances, depression, and anxiety
C- urogenital atrophy and metabolic changes
D- Only A and C are correct
E- A, B, and C are correct
37. Which of the following points related with non-pharmacological treatment of
perimenopause and menopause:
A- lowering the room temperature
B- non-estrogenic vaginal creams
C- combined hormonal contraceptives
D- A and B only
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 E- A and C only

38.Which one of the SERMs should not be used for woman

with history of endometrial hyperplasia:
A. Raloxifene
B. Ospemifene
C. Bazedoxifene
D. Tamoxifen
E. All of them should be avoided.
39. Diagnosis of menopause should may involvedetermination of the
following, except:
A. Medical history and physical examination
B. Assessment of ovarianfunction
C. Increase FSH concentration up to 40 IU/L
D. Decrease LH concentration less than normal
E. 12 consecutive months of amenorrhea
40. Post-menopause women with one or more of the following medical
conditions are absolutely Contraindicated for hormonal replacement therapy, except:
A. Active deep vein thrombosis, pulmonary embolism, or a history
of these conditions
B. history of ovarian cancer.
C. history of breast cancer.
D. Liver disease.
E- undiagnosed abnormal genital tract.

41. The major risk factors associated with dysmenorrhea are the following, except:
A. Menarche prior to age12.
B. Obesity.
C. Age less than 30 years
D. Smoking.
E. Irregular menses.

42.For CML all the following true except

A. Median age of diagnosis 65 y
B. 50% are asymptomatic.
C. Philadelphia chromosome result from translocation between chromosome 9,21
D. Fluorescence in situ hybridization (FISH) detects and monitors BCR-ABL gene.
E. BCR-ABL (<0.1%) is associated with long term disease control.

43. for Tyrosine kinase inhibitor, all true except

A. Ponatinib can overcome the T315 mutation.
B. Ponatinib increases serious arterial thrombosis and prolongs QT interval in ECG.
C. Pleural effusion associated with use of nilotinib.
D. Hydroxyurea is not curative for CML.
E. Allogenic hematopoietic stem cell transplant is the only curative for CML.

44. For tyrosine kinase inhibitors all true except

A. Imatinib and bosutinib take with food, while nilotinib on empty stomach
B. Imatinib safely use with acetaminophen.
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 C. All TKI are CYP450 substrate.
D. Omacetaxine sub cut injection TKI used for two or more TKIs resistance.
E. Omacetaxine used for T3151 mutation.

45. For CLL all the following true except

A. CLL most common type of leukemia in adult
B. Median age 70 y
C. 50% are asymptomatic.
D. Asymptomatic early stage CLL observed without treatment until evidence of disease
progression.
E. Patient with del (17 p) or TP53 mutation have good response to therapy.

46.For CLL all the following are true except

A. Current treatments of CLL are not curative.
B. Allogenic hematopoietic stem cell transplant for younger patients with aggressive disease
who have failed prior therapy.
C. Monoclonal antibodies (anti-CD20) used as monotherapy.
D. Infusion reactions are common side effects of monoclonal antibodies.
E. Reactivation of hepatitis B virus is a concern for patients on anti-CD 20 therapy.

47.For small molecule inhibitors in CLL all the following true except
A. These therapies have improved the median overall survival of CLL.
B. Ibrutinib is a BTK inhibitor used as first line therapy for all patients.
C. Acalabrutinib (BTK inhibitors) increased risk of atrial fibrillation
D. Idelatisib inhibits phosphatidylinositol 3 kinase.
E.Venetoclax inhibit B cell lymphoma 2 protein and many cause tumor lysis syndrome

48.For acute leukemia, all the following are true except

A. The average age of diagnosis for ALL is about 63y.
B. Ifosfamide , cyclophosphamide and Eloposide linked to an increase risk of AML
C. Immunophenotyping by flow cytometry has an important role in the diagnosis of leukemia.
D. Gum hypertrophy indicative of AML M4 and M5 sub type
E. Failure to obtain morphologic bone marrow remission by day 28 is very adverse prognostic
sign.

49.All the following true foe acute leukemia except

A. Remission is absence of all clinical evidence of leukemia with the restoration of normal
hematopoiesis.
B. Lymphadenopathy is commonly seen in ALL.
C. Minimal residual disease (MRD) less than 0.01% appears to be associated with poor
outcome.
D. For ALL induction of remission, Dexamethasone better than prednisolone because of its
longest half-life and better CNS penetration
E. For ALL improved outcome is associated with increasing 6 mercaptopurine dose.

50.For Acute leukemia all the following true except

A. Leukemic invasive of CNS is an almost universal event in acute leukemia.
B. Common extra medullary sites of relapse include the CNS and testicles.
C. Blinatumomab approved for ph. negative relapsed or refractory ALL.
D. Nelarabine is used in patient with relapsed or refractory T-lineage ALL.
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E. Treatment of relapsed ALL includes chemotherapy or hematopoietic stem cell transplant.

51- the following points related with pathophysiology of schizophrenia except

A. Genetic predisposition
B. Obstetric complication
C-Increase in oxygen level
D. Increased neuronal pruning.
E-Dopamine receptor defect.
52- The following points related with positive symptoms of schizophrenia, except
A.delusions
B. Disorganized speech
C. Hallucinations
D. Flat effect
E. Illusion

53- comorbid psychiatric and medical disorder which related with schizophrenia include
A. Anxiety disorders
B. Substance abuse
C. Respiratory disorders
D. Cardiovascular disorders
E. All are correct.

54- Goals of treating schizophrenia patient are the following except

A. Palliate target symptoms.
B. Integrate the patient back into the community.
C. Prevent relapse of the disease.
D. Maintaining psychosocial functioning and productivity within the current level.
E. Avoid side effects.

55-Which of the following points related with pharmacological treatment of schizophrenia

A. Rispreidone injection is more effective than oral risperidone in preventing relapse.
B. In stage 3, clozapine monotherapy is recommended.
C. Use of SGAs during the first acute episode results in greater treatment retention and relapse
prevention compared to FGAs.
D. Only C is correct.
E. A, B and C are correct.

56. the following points related with extrapyramidal side effect of schizophrenia treatment except
A. Dystonia’s which are very short tonic muscle contractions
b-Pseudo-Parkinsonism
D. Neuroleptic malignant syndrome (NMS) occurs in 0.5%-1 % of patients taking FGAs.
D. Orthostatic hypotension
E.poikilothermia

57. For schizophrenia, all the following true except

A. Delusion
B. Catatonia
C. Alogia
D. Continuous symptoms that persist for at least 6 weeks
E. Anhedonia
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58.For resistant schizophrenia
A. Haloperidol
B-Aripiprazole
C-Clozapine
D-Olanzapine
E-Chlorpromazine

59. For schizophrenia, all the following true except

A. Galactorrhea, gynecomastia, and decreased libido are more common with first generation
antipsychotics.
B. Dopamine agonists are treatment of choice for hyperprolactinemia caused by antipsychotics.
C. Weight gain common with antipsychotics
D. Olanzapine and clozapine have a higher risk of causing new onset diabetes.
E. Orthostatic hypotension is greatest with low potency first generation antipsychotics.

60. For schizophrenia, all the following true except

A.Olanzapine. clozapine and quetiapine have the highest risk for dyslipidemia.
B. Exacerbation of narrow angle glaucoma can occur with antipsychotics.
C. Haloperidol should be avoided in pregnant with schizophrenia.
D-Clozapine, chlorpromazine and olanzapine have high risk for neutropenia.
E. Urinary hesitancy and retention are common in men with BPH using low potency first
generation antipsychotics.

Good luck

Lectures of subject: Head of department:

Dr.Ryadh khayoon Dr.layth jabbar.

Dr.Alyaa AbdAlrazaq

Dr.Makarm M.Ali

Dr.Abbas khazaal.

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