3RD SHIFTING MOCK EXAM PHARMA

A pregnant woman was exposed to a synthetic non-steroidal estrogen that is banned because it can cause vaginal adenocarcinoma in female fetuses. Which drug is described?

A. Ethinyl estradiol

B. Diethylstilbestrol

C. Estriol

D. Mestranol

B. Diethylstilbestrol

A pregnant patient is monitored through repeated maternal urinary estrogen assay to assess fetal well-being. Which estrogen is being measured?

A. Estradiol

B. Estriol

C. Estrone

D. Mestranol

B. Estriol

Which progestin is designed to have impeded androgenic activity and is less likely to worsen acne and hirsutism?

A. Levonorgestrel

B. Norethindrone

C. Medroxyprogesterone

D. Desogestrel

D. Desogestrel

A woman taking oral contraceptive pills develops migraine with neurologic symptoms. Which is the best next step?

A. Discontinue treatment

B. Increase estrogen dose

C. Switch to androgenic progestin

D. Add Danazol

A. Discontinue treatment

Which adverse effect of oral contraceptive pills is mainly associated with estrogen rather than progestin?

A. Hirsutism

B. Breakthrough bleeding

C. Venous thromboembolism

D. Acne

C. Venous thromboembolism

A patient taking oral contraceptive pills is started on rifampin. Which outcome is most likely?

A. Increased estrogen effect

B. Decreased OCP efficacy

C. Immediate ovarian cancer risk

D. Increased lactation

B. Decreased OCP efficacy

A postmenopausal woman with osteoporosis needs a SERM that has estrogenic effects on bone and lipids but does not stimulate breast or endometrium. Which is DOC?

A. Tamoxifen

B. Raloxifene

C. Clomiphene

D. Fulvestrant

B. Raloxifene

A breast cancer patient resistant to tamoxifen is treated with a pure estrogen receptor antagonist with no agonist activity. Which drug is used?

A. Letrozole

B. Fulvestrant

C. Raloxifene

D. Clomiphene

B. Fulvestrant

A woman with tamoxifen-resistant breast tumor receives a selective non-steroidal aromatase inhibitor. Which drug fits best?

A. Fulvestrant

B. Raloxifene

C. Letrozole

D. Mifepristone

C. Letrozole

A patient is given an anti-progestin that strongly binds progesterone and glucocorticoid receptors and is used to terminate early pregnancy. Which drug is this?

A. Danazol

B. Mifepristone

C. Raloxifene

D. Clomiphene

B. Mifepristone

A patient with endometriosis is treated with a weak progestational, androgenic, and glucocorticoid drug that suppresses ovarian function. Which adverse fetal concern is important?

A. Neural tube defect

B. Vaginal adenocarcinoma only

C. Urogenital abnormalities

D. Cleft palate only

C. Urogenital abnormalities

A woman develops postpartum hemorrhage. Which uterotonic directly stimulates uterine smooth muscle contraction and can be given IM or IV?

A. Oxytocin

B. Isoxsuprine

C. Atosiban

D. Terbutaline

A. Oxytocin

A pregnant patient with threatened abortion at less than 3 months is treated with a direct-acting tocolytic listed as DOC in the file. Which drug is used?

A. Oxytocin

B. Isoxsuprine

C. Methylergonovine

D. Misoprostol

B. Isoxsuprine

A preeclamptic patient develops convulsions. Which drug is DOC for convulsions only?

A. Methyldopa

B. Magnesium sulfate

C. Oxytocin

D. Misoprostol

B. Magnesium sulfate

Which androgen is the most potent androgen in the prostate, skin, and seminal vesicles?

A. Dihydrotestosterone

B. DHEA

C. Testosterone

D. Androstenedione

A. Dihydrotestosterone

A patient with BPH receives a drug that inhibits 5α-reductase and decreases DHT formation. Which drug is used?

A. Flutamide

B. Finasteride

C. Abiraterone

D. Ketoconazole

B. Finasteride

A man with metastatic prostate cancer receives a drug that inhibits 17α-hydroxylase and blocks androgen synthesis. Which drug is this?

A. Spironolactone

B. Finasteride

C. Abiraterone

D. Cyproterone acetate

C. Abiraterone

Which anti-androgen can cause reversible gynecomastia by increasing the estradiol-testosterone ratio?

A. Ketoconazole

B. Dutasteride

C. Nilutamide

D. Finasteride

A. Ketoconazole

Which statement about male contraception is TRUE?

A. No fully effective and safe oral male contraceptive currently exists

B. Gossypol is widely used because it is very safe

C. Testosterone plus danazol is superior to testosterone alone

D. Oral progestin alone causes 100% azoospermia

A. No fully effective and safe oral male contraceptive currently exists

A patient under anesthesia is delirious, excited, amnestic, with irregular respiration and enhanced reflexes. Which stage of anesthesia is this?

A. Stage 1 analgesia

B. Stage 3 surgical anesthesia

C. Stage 4 medullary depression

D. Stage 2 disinhibition

D. Stage 2 disinhibition

A patient under anesthesia develops severe respiratory and cardiovascular depression requiring ventilatory and pharmacologic support. Which stage is this?

A. Stage 1

B. Stage 2

C. Stage 3

D. Stage 4

D. Stage 4

Which IV anesthetic produces dissociative anesthesia through NMDA receptor antagonism?

A. Propofol

B. Etomidate

C. Ketamine

D. Midazolam

C. Ketamine

A trauma patient needs anesthesia but has hypotension and poor cardiac reserve. Which IV anesthetic is preferred for cardiovascular stability but may suppress adrenal steroid synthesis?

A. Thiopental

B. Propofol

C. Methohexital

D. Etomidate

D. Etomidate

A patient is induced with an IV anesthetic that has antiemetic activity but commonly causes hypotension, bradycardia, apnea, and pain on injection. Which drug is this?

A. Ketamine

B. Etomidate

C. Propofol

D. Midazolam

C. Propofol

A patient receives an IV anesthetic that increases BP, HR, and cardiac output and is useful in reactive airway disease because it preserves respiratory drive. Which drug is this?

A. Propofol

B. Etomidate

C. Ketamine

D. Thiopental

C. Ketamine

A patient receives conscious sedation with a benzodiazepine and becomes oversedated. Which antagonist reverses the benzodiazepine effect?

A. Flumazenil

B. Naloxone

C. Dantrolene

D. Physostigmine

A. Flumazenil

Which inhaled anesthetic has the highest MAC and is not sufficient for surgical anesthesia alone?

A. Halothane

B. Sevoflurane

C. Nitrous oxide

D. Desflurane

C. Nitrous oxide

Which inhaled anesthetic has the lowest MAC and is therefore highly potent, but is associated with halothane hepatitis and catecholamine sensitization?

A. Halothane

B. Nitrous oxide

C. Desflurane

D. Xenon

A. Halothane

A child needs mask induction. Which inhaled anesthetic has a sweet odor, rapid induction, and minimal airway irritation?

A. Sevoflurane

B. Desflurane

C. Isoflurane

D. Enflurane

A. Sevoflurane

A patient with bowel obstruction should avoid which anesthetic because it expands closed gas spaces?

A. Halothane

B. Sevoflurane

C. Nitrous oxide

D. Propofol

C. Nitrous oxide

A patient exposed to volatile anesthetic and succinylcholine develops rigidity, hyperthermia, hypercapnia, hyperkalemia, and acidosis. Which drug treats this condition?

A. Flumazenil

B. Dantrolene

C. Naloxone

D. Midazolam

B. Dantrolene

Which premonitory sign may occur before malignant hyperthermia becomes fully developed?

A. Miosis

B. Masseter rigidity

C. Diarrhea

D. Hypoglycemia

B. Masseter rigidity

Which inhaled anesthetic is very rapid but pungent and can cause coughing or laryngospasm, making it poor for mask induction?

A. Sevoflurane

B. Halothane

C. Desflurane

D. Nitrous oxide

C. Desflurane

Which inhaled anesthetic can provoke seizure-like EEG activity at high doses and has fluoride-related nephrotoxicity?

A. Sevoflurane

B. Desflurane

C. Xenon

D. Enflurane

D. Enflurane

A patient receives a sedative that resembles physiologic sleep, has analgesia through spinal α2 receptors, and produces minimal respiratory depression. Which drug is this?

A. Dexmedetomidine

B. Propofol

C. Thiopental

D. Ketamine

A. Dexmedetomidine

Which IV anesthetic is a barbiturate that decreases cerebral blood flow, volume, and ICP but should be avoided in acute intermittent porphyria?

A. Propofol

B. Ketamine

C. Thiopental

D. Fospropofol

C. Thiopental

Which local anesthetic is the exception because it has intrinsic sympathomimetic action by inhibiting norepinephrine reuptake?

A. Lidocaine

B. Bupivacaine

C. Cocaine

D. Procaine

C. Cocaine

Local anesthetics primarily block which channel to prevent impulse propagation?

A. Calcium channel

B. Chloride channel

C. Potassium channel

D. Voltage-dependent sodium channel

D. Voltage-dependent sodium channel

Which statement about local anesthetic action is NOT TRUE?

A. Uncharged form enters the axon

B. Esters are mainly metabolized by the liver

C. Charged form blocks the sodium channel

D. Vasoconstrictors prolong action

B. Esters are mainly metabolized by the liver

A patient with liver dysfunction has increased risk of toxicity from which group of local anesthetics?

A. Esters

B. Amides

C. Gaseous anesthetics only

D. Nondepolarizing blockers only

B. Amides

Which local anesthetic has the fastest onset according to the file?

A. Articaine

B. Procaine

C. Tetracaine

D. Bupivacaine

A. Articaine

A patient receiving epidural anesthesia develops hypotension due to blockade of autonomic fibers. Which complication explains this?

A. Direct renal failure

B. GABA toxicity

C. CYP inhibition

D. Autonomic blockade

D. Autonomic blockade

Which nerve fibers are generally blocked first by local anesthetics?

A. Large unmyelinated fibers

B. Large motor fibers

C. Small diameter fibers

D. Deep core fibers only

C. Small diameter fibers

A patient receives aspirin for inflammatory pain. Which statement best describes its COX action?

A. Irreversible COX inhibition

B. Weak CNS COX inhibition only

C. Selective COX-2 blockade only

D. NMDA receptor blockade

A. Irreversible COX inhibition

A child with fever is given paracetamol. Which toxic metabolite is responsible for liver injury in overdose?

A. Morphine-6-glucuronide

B. Leukotriene B4

C. Acetaldehyde

D. NAPB

D. NAPB

A patient with acute gout attack is given an old DOC that binds tubulin and inhibits microtubule polymerization, phagocytosis, and LTB4. Which drug is this?

A. Allopurinol

B. Colchicine

C. Febuxostat

D. Pegloticase

B. Colchicine

Which drug is DOC for chronic gout and prevention of tumor lysis syndrome by irreversibly inhibiting xanthine oxidase?

A. Probenecid

B. Colchicine

C. Pegloticase

D. Allopurinol

D. Allopurinol

A patient with chronic refractory gout and tophi receives a recombinant urate oxidase that converts uric acid to allantoin. Which serious reaction should be watched for?

A. Gray baby syndrome

B. Ototoxicity

C. Serotonin syndrome

D. Anaphylaxis

D. Anaphylaxis

Which drug is a mixed opioid-nonopioid analgesic that is a μ-receptor agonist and inhibits serotonin/norepinephrine reuptake?

A. Tramadol

B. Ketorolac

C. Morphine

D. Colchicine

A. Tramadol

A post-operative patient receives a neuromuscular blocker and develops hyperkalemia, myalgia, and increased intragastric pressure from fasciculations. Which drug caused this?

A. Rocuronium

B. Pancuronium

C. Succinylcholine

D. Cisatracurium

C. Succinylcholine

A patient receiving pancuronium develops tachycardia. Which mechanism explains this adverse effect?

A. Histamine release only

B. Vagolytic action

C. NMDA antagonism

D. Glycine receptor activation

B. Vagolytic action

Which neuromuscular blocker has minimal cardiovascular effect and belongs to the isoquinoline nondepolarizing group?

A. Tubocurarine

B. Pancuronium

C. Cisatracurium

D. Succinylcholine

C. Cisatracurium

Which interaction increases risk of malignant hyperthermia?

A. Benzodiazepine + opioid

B. Lidocaine + epinephrine

C. Succinylcholine + inhaled anesthetic

D. Procaine + plasma cholinesterase

C. Succinylcholine + inhaled anesthetic

A patient receiving nondepolarizing neuromuscular blocker develops excessive blockade after aminoglycoside therapy. What is the mechanism?

A. Increased dopamine release

B. Increased GABA-A current

C. Direct RYR1 activation

D. Blockade of P-type calcium channels

D. Blockade of P-type calcium channels

Which drug reverses nondepolarizing neuromuscular blockade by increasing acetylcholine at the neuromuscular junction?

A. Anticholinesterase

B. Succinylcholine

C. Dantrolene

D. Ketamine

A. Anticholinesterase

Which drug is used as a premedication in anesthesia and is a benzodiazepine?

A. Atropine

B. Promethazine

C. Diazepam

D. Rocuronium

A. Diazepam

A patient with insomnia is prescribed a Z-drug that acts on benzodiazepine receptors but has less effect on sleep stages. Which drug fits this group?

A. Zolpidem

B. Lithium

C. Haloperidol

D. Clozapine

A. Zolpidem

A patient with benzodiazepine overdose is treated with the specific antagonist. Which drug is given?

A. Naloxone

B. Dantrolene

C. Physostigmine

D. Flumazenil

D. Flumazenil

A patient on benzodiazepines should avoid alcohol because of what major interaction?

A. Antagonism of sedation

B. Increased renal elimination

C. Decreased GABA effect

D. Additive CNS depression

D. Additive CNS depression

A patient taking a short-acting sedative-hypnotic abruptly stops the drug and develops anxiety, tremors, hyperreflexia, and seizures. What is this?

A. Withdrawal syndrome

B. Neuroleptic malignant syndrome

C. Serotonin syndrome

D. Malignant hyperthermia

A. Withdrawal syndrome

A psychotic patient with hallucinations is treated with a typical antipsychotic that strongly blocks D2 receptors. Which adverse effect is most expected?

A. Renal stones

B. Platelet inhibition

C. Hyperthyroidism

D. Extrapyramidal symptoms

D. Extrapyramidal symptoms

A patient on antipsychotic therapy develops fever, muscle rigidity, autonomic instability, and altered mental status. Which diagnosis is most likely?

A. Neuroleptic malignant syndrome

B. Serotonin syndrome

C. Malignant hyperthermia

D. Cholinergic crisis

A. Neuroleptic malignant syndrome

Which antipsychotic is associated with agranulocytosis and therefore needs regular CBC monitoring?

A. Haloperidol

B. Risperidone

C. Olanzapine

D. Clozapine

D. Clozapine

A patient with bipolar disorder is started on lithium. Which adverse effect must be monitored?

A. Ototoxicity

B. Hypocalcemia

C. Visual halos

D. Nephrogenic diabetes insipidus

D. Nephrogenic diabetes insipidus

Which antimanic drug is teratogenic and classically associated with Ebstein anomaly?

A. Valproate

B. Carbamazepine

C. Lamotrigine

D. Lithium

D. Lithium

A patient with depression and neuropathic pain is prescribed a drug that inhibits serotonin and norepinephrine reuptake. Which class is this?

A. SSRI

B. MAOI

C. SNRI

D. TCA only

C. SNRI

A patient on antidepressants develops hyperthermia, diarrhea, mydriasis, tremor, and clonus. Which syndrome is this?

A. Serotonin syndrome

B. Neuroleptic malignant syndrome

C. Anticholinergic toxicity

D. Malignant hyperthermia

A. Serotonin syndrome

A patient with depression is started on an SSRI and later complains of delayed ejaculation and decreased libido. Which adverse effect is being tested?

A. Hypertensive crisis

B. Sexual dysfunction

C. Agranulocytosis

D. Pulmonary fibrosis

B. Sexual dysfunction

A depressed patient taking an MAOI eats aged cheese and develops severe hypertension. Which adverse effect is this?

A. Serotonin withdrawal

B. Tyramine-induced hypertensive crisis

C. Nephrogenic diabetes insipidus

D. Dopamine blockade

B. Tyramine-induced hypertensive crisis

A patient taking a TCA develops dry mouth, constipation, urinary retention, blurred vision, and tachycardia. Which adverse effect group is present?

A. Nephrotoxic effects

B. Anticholinergic effects

C. Pure extrapyramidal effects

D. Ototoxic effects

B. Anticholinergic effects

A patient with Parkinson disease is treated with a dopamine precursor that crosses the blood-brain barrier. Which drug is used?

A. Pramipexole

B. Selegiline

C. Levodopa

D. Benztropine

C. Levodopa

Levodopa is combined with carbidopa mainly to:

A. Increase peripheral dopamine formation

B. Block COMT only

C. Block dopamine receptors

D. Decrease peripheral metabolism of levodopa

D. Decrease peripheral metabolism of levodopa

A Parkinson patient is given a dopamine agonist that can cause impulse control problems and hallucinations. Which drug fits?

A. Entacapone

B. Pramipexole

C. Benztropine

D. Amantadine

B. Pramipexole

Which Parkinson drug is an MAO-B inhibitor that decreases dopamine breakdown in the brain?

A. Tolcapone

B. Selegiline

C. Carbidopa

D. Trihexyphenidyl

B. Selegiline

Which Parkinson drug is a COMT inhibitor used as adjunct to levodopa?

A. Entacapone

B. Benztropine

C. Amantadine

D. Bromocriptine

A. Entacapone

A Parkinson patient with tremor and rigidity receives an antimuscarinic drug. Which drug is this?

A. Levodopa

B. Selegiline

C. Entacapone

D. Benztropine

D. Benztropine

A Huntington disease patient has choreiform movements due to excess dopaminergic activity. Which drug that depletes monoamines can be used?

A. Tetrabenazine

B. Levodopa

C. Pramipexole

D. Carbidopa

A. Tetrabenazine

Which statement about oral contraceptives is NOT TRUE?

A. They suppress ovulation

B. They increase risk of ovarian cancer

C. They may reduce dysmenorrhea

D. They may cause chloasma

B. They increase risk of ovarian cancer

A woman taking progestin-only pills complains of irregular bleeding. What is the most common problem with progestin-only agents?

A. Vaginal cancer in fetus

B. Severe hypocalcemia

C. Breakthrough bleeding

D. Malignant hyperthermia

C. Breakthrough bleeding

A patient on OCP develops chloasma. This adverse effect is best described as:

A. Breast enlargement only

B. Deep vein thrombosis only

C. Increased face pigmentation

D. Ototoxicity

C. Increased face pigmentation

Which drug is an oxytocin receptor antagonist formerly used as a tocolytic but removed due to cardiovascular adverse effects?

A. Terbutaline

B. Atosiban

C. Isoxsuprine

D. Methylergonovine

B. Atosiban

Which anti-estrogen is used as an ovulation-inducing agent because it competitively inhibits endogenous estrogens?

A. Raloxifene

B. Fulvestrant

C. Clomiphene

D. Exemestane

C. Clomiphene

Which drug is a steroidal irreversible aromatase inhibitor used in advanced breast cancer?

A. Exemestane

B. Letrozole

C. Tamoxifen

D. Fulvestrant

A. Exemestane

A man with BPH and male pattern baldness is treated with a 5α-reductase inhibitor. Which fetal adverse effect is a major pregnancy warning?

A. Neural tube defect

B. Hypospadias in male fetus

C. Vaginal adenocarcinoma

D. Cleft palate only

B. Hypospadias in male fetus

Which androgen receptor antagonist is often combined with a GnRH analog to reduce tumor flare in metastatic prostate cancer?

A. Finasteride

B. Ketoconazole

C. Spironolactone

D. Bicalutamide

D. Bicalutamide

Which experimental male contraceptive was abandoned because of hypokalemia that could cause transient paralysis?

A. Testosterone enanthate

B. Levonorgestrel

C. Danazol

D. Gossypol

D. Gossypol

Which anesthetic has no analgesia, causes profound hypotension, and is commonly used for rapid IV induction?

A. Propofol

B. Ketamine

C. Nitrous oxide

D. Dexmedetomidine

A. Propofol

A patient receiving fospropofol during monitored anesthesia care reports perianal paresthesia. What is fospropofol?

A. NMDA antagonist

B. Opioid agonist

C. Barbiturate

D. Water-soluble propofol prodrug

D. Water-soluble propofol prodrug

Which IV anesthetic may activate epileptic foci and is useful for electroconvulsive therapy?

A. Methohexital

B. Etomidate

C. Ketamine

D. Propofol

A. Methohexital

A patient receiving opioids as part of anesthesia develops respiratory depression. Which antagonist reverses opioid effect?

A. Flumazenil

B. Dantrolene

C. Physostigmine

D. Naloxone

D. Naloxone

Which opioid is rapidly metabolized by tissue and blood esterases, allowing fast recovery?

A. Morphine

B. Fentanyl

C. Remifentanil

D. Meperidine

C. Remifentanil

Which local anesthetic has intrinsic mood elevation from CNS dopamine/amine effects, separate from its local anesthetic action?

A. Procaine

B. Bupivacaine

C. Cocaine

D. Tetracaine

C. Cocaine

Which statement about local anesthetics is TRUE?

A. Lipid solubility increases potency

B. Esters are metabolized mainly by liver CYP enzymes

C. Vasoconstrictors shorten duration

D. Large fibers always block first

A. Lipid solubility increases potency

A patient receives a long-acting local anesthetic with high protein binding. Which toxicity risk increases if another drug displaces it from protein binding?

A. Systemic local anesthetic toxicity

B. Decreased anesthetic effect only

C. Immediate opioid withdrawal

D. Hypercalcemia

A. Systemic local anesthetic toxicity

Which NSAID is used short-term for moderate to severe acute pain but has risk of GI bleeding, renal damage, and increased bleeding time?

A. Paracetamol

B. Ketorolac

C. Colchicine

D. Allopurinol

B. Ketorolac

Which anti-gout drug is contraindicated in asymptomatic hyperuricemia and may cause hemolytic anemia in G6PD deficiency?

A. Probenecid

B. Colchicine

C. Pegloticase

D. Allopurinol

C. Pegloticase

Which drug is DOH-approved alternative to colchicine mentioned under uricosurics?

A. Allopurinol

B. Febuxostat

C. Ketorolac

D. Peperomia pellucida

D. Peperomia pellucida

A surgical patient needs rapid tracheal intubation with a depolarizing neuromuscular blocker. Which drug has duration of action less than 8 minutes?

A. Rocuronium

B. Cisatracurium

C. Succinylcholine

D. Pancuronium

C. Succinylcholine

Which neuromuscular blocker is a steroid nondepolarizing agent with moderate muscarinic block and vagolytic tachycardia?

A. Atracurium

B. Vecuronium

C. Mivacurium

D. Pancuronium

D. Pancuronium

Which adverse effect is commonly associated with nondepolarizing neuromuscular blockers due to histamine release?

A. Seizure-like EEG

B. Hypotension

C. Hyperglycemia

D. Cyanide toxicity

B. Hypotension