Practice Test

Which of the following describe the mechanism of action of proton pump inhibitors (PPIs)?

1. Coating of the ulcer

2. Increase bicarbonate secretion in the stomach

3. Decrease gastric acid production

4. Inhibit the H+/K+ ATPase in gastric parietal cells

A. all of the above
B. only 4
C. only 1 and 3
D. 1, 2, and 3
E. 2 and 4

B

H2 receptor antagonists work by:

1. Competitively inhibiting histamine at H2 receptors

2. Directly blocking the H+/K+ ATPase pump (acid secretion)

3. Reduced pepsin

4. Reducing nocturnal acid secretion

A. all of the above
B. only 4
C. only 1 and 3
D. 1, 2, and 3
E. 2 and 4

C

Which of the following drugs belong to the H2 receptor antagonist class?

1. Ranitidine

2. Famotidine

3. Cimetidine

4. Omeprazole

A. all of the above
B. only 4
C. only 1 and 3
D. 1, 2, and 3
E. 2 and 4

D

Which of the following are potential adverse effects of cimetidine, a competitive H2 receptor antagonist?

1. Gynecomastia

2. Inhibition of CYPP450

3. Decreased sperm count

4. Increased gastric motility

A. all of the above
B. only 4
C. only 1 and 3
D. 1, 2, and 3
E. 2 and 4

D

Misoprostol is used to prevent NSAID-induced ulcers because:

1. It increases mucus, bicarbonate, and blood flow

2. It inhibits gastric acid secretion

3. It is a prostaglandin E1 analog

4. It directly neutralizes stomach acid

A. all of the above
B. only 4
C. only 1 and 3
D. 1, 2, and 3
E. 2 and 4

D

Which of the following correctly describe sucralfate?

1. Bacteriostatic

2. Forms a protective barrier over ulcers

3. Main side effect is diarrhea due to Ca²⁺ uptake

4. Potassium (KSOS) coats the ulcer directly

A. all of the above
B. only 4
C. only 1 and 3
D. 1, 2, and 3
E. 2 and 4

E

Bismuth subsalicylate is used for:

1. Prevents growth of H. pylori (bacteriostatic)

2. Neutralization of stomach acid by increasing prostaglandin release

3. Antidiarrheal properties

4. Anti-inflammatory effects

A. all of the above
B. only 4
C. only 1 and 3
D. 1, 2, and 3
E. 2 and 4

C

Which of the following best describes the mechanism of action of alkylating agents such as cyclophosphamide?

1. They mimic purine and pyrimidine bases.

2. They inhibit topoisomerase enzymes.

3. They interfere with microtubule formation.

4. They cross-link DNA strands by transferring alkyl groups to guanines, preventing replication
   A. all of the above
   B. only 4
   C. only 1 and 3
   D. 1, 2, and 3
   E. 2 and 4

B

Which of the following side effects is commonly associated with topoisomerase inhibitors like etoposide?

1. Secondary malignancy

2. Myelosuppression

3. Nausea

4. Peripheral neuropathy
   A. all of the above
   B. only 4
   C. only 1 and 3
   D. 1, 2, and 3
   E. 2 and 4

D

Which of the following best describes the mechanisms of action of antimetabolites (5-flouracil and methotrexate)?

1. They incorporate into DNA and cause strand breaks by blocking thymidylate synthase.

2. They induce oxidative stress in rapidly dividing cells.

3. They inhibit enzymes involved in purine synthesis (DHFR).

4. They interfere with microtubule function.
   A. all of the above
   B. only 4
   C. only 1 and 3
   D. 1, 2, and 3
   E. 2 and 4

C

Which of the following drugs belong to the taxane class?

1. Paclitaxel

2. Vincristine

3. Docetaxel

4. Etoposide
   A. all of the above
   B. only 4
   C. only 1 and 3
   D. 1, 2, and 3
   E. 2 and 4

C

Which of the following are mechanisms of resistance to chemotherapy?

1. Increased drug efflux via P-glycoprotein

2. Increased DNA repair

3. Enhanced hydrolase activity

4. Decreased cell permeability
   A. all of the above
   B. only 4
   C. only 1 and 3
   D. 1, 2, and 3
   E. 2 and 4

A

Which of the following drugs are classified as topoisomerase inhibitors/DNA unwinding enzymes?

1. Podophyllin

2. Camptothecin

3. Doxorubicin

4. Bleomycin
   A. all of the above
   B. only 4
   C. only 1 and 3
   D. 1, 2, and 3
   E. 2 and 4

D

Which of the following chemotherapy agents are associated with neurotoxicity?

1. Vincristine

2. Cisplatin

3. Taxol

4. Oxaliplatin
   A. all of the above
   B. only 4
   C. only 1 and 3
   D. 1, 2, and 3
   E. 2 and 4

C

Which of the following best describes the action of platinum-based chemotherapy drugs?

1. They act as microtubule stabilizers.

2. They inhibit dihydrofolate reductase.

3. They interfere with RNA transcription.

4. They generate kinks in DNA
   A. all of the above
   B. only 4
   C. only 1 and 3
   D. 1, 2, and 3
   E. 2 and 4

B

Which of the following best describes the mechanism of action of β-lactam antibiotics?

A) They inhibit bacterial cell wall synthesis.

B) They bind to the 50S ribosomal subunit.

C) They are primarily bacteriostatic.

D) They disrupt bacterial DNA replication.

E) They inhibit folic acid metabolism.

A

Fluoroquinolones exert their antibacterial effect by:

A) Inhibiting the 30S ribosomal subunit.
B) Disrupting bacterial protein synthesis.
C) Interfering with folic acid metabolism.
D) Blocking bacterial RNA polymerase.
E) Inhibiting DNA gyrase and topoisomerase IV.

E

Macrolides function by:

A) Inhibiting bacterial cell wall synthesis

B) Binding to the 30S ribosomal subunit

C) Binding to the 50S ribosomal subunit

D) Disrupting DNA synthesis

E) Blocking bacterial folic acid metabolism

C

Which of the following is a mechanism of resistance against β-lactam antibiotics?

A) Increased efflux pump activity

B) Methylation of the 50S ribosomal subunit

C) Production of β-lactamases

D) Phosphorylation of the antibiotic

E) Altered DNA gyrase

C

Vancomycin is primarily used to treat infections caused by ____. It does this by preventing the transfer of sugar-pentapeptide.

A) Gram-negative bacteria

B) Anaerobic bacteria

C) Mycobacteria

D) Gram-positive bacteria

E) Spirochetes

D

Which of the following bacterial shapes is described as spherical?

A) Bacilli (gram +)

B) Spirochetes (gram -)

C) Cocci (gram -)

D) Vibrio

E) Filamentous

C

What is the primary difference between Gram-positive and Gram-negative bacteria in terms of cell wall structure?

A) Gram-positive bacteria have an outer membrane, while Gram-negative bacteria do not

B) Gram-positive bacteria have a thicker peptidoglycan layer and gram-negative bacteria have an outer membrane

C) Gram-negative bacteria lack peptidoglycan in their cell wall

D) Gram-positive bacteria have lipopolysaccharides (LPS) in their outer membrane

E) Gram-negative bacteria have a thick peptidoglycan layer

B

During Gram staining, what happens if you forget to use ethanol or acetone (decolorizer)?

A) Both Gram-positive and Gram-negative bacteria will appear pink

B) Both Gram-positive and Gram-negative bacteria will appear purple

C) Gram-positive bacteria will appear pink, and Gram-negative bacteria will appear purple

D) Gram-positive bacteria will appear colorless

E) Gram-negative bacteria will appear purple, and Gram-positive bacteria will appear colorless

B

Which of the following is a distinguishing feature of Gram-negative bacteria?

A) Presence of teichoic acids

B) Thick peptidoglycan layer

C) Outer membrane containing lipopolysaccharides (LPS)

D) Absence of a periplasmic space

E) Ability to retain crystal violet after ethanol washing

C

Which antibiotic is more effective against Gram (+) bacteria due to its mechanism of action on peptidoglycan synthesis?

A) Vancomycin

B) Polymyxins

C) Tetracyclines

D) Fluoroquinolones

E) Sulfonamides

A

Which of the following antibiotic sensitivity tests involves placing antibiotic-impregnated discs on an agar plate?

A) Broth dilution test

B) E-test

C) Kirby-Bauer disk diffusion test

D) PCR-based resistance test

E) MIC determination

C

In the Kirby-Bauer disk diffusion test, what does a large zone of inhibition around an antibiotic disc indicate?

A) The bacteria are highly resistant to the antibiotic

B) The antibiotic is ineffective against the bacteria

C) The bacteria are sensitive to the antibiotic

D) The bacteria are Gram-positive

E) The antibiotic has no effect on bacterial protein synthesis

C

What does the minimum inhibitory concentration (MIC) of an antibiotic represent?

A) The lowest concentration of an antibiotic that inhibits visible bacterial growth

B) The highest concentration of an antibiotic required to kill bacteria

C) The concentration of an antibiotic at which bacteria develop resistance

D) The amount of antibiotic needed to stain bacteria for identification

E) The average antibiotic concentration found in human blood

A

What are examples of folate synthesis inhibitors?

A) trimethoprim and fluroquinolone

B) penicillin and vancomycin

C) macrolides and aminoglycosides

D) isoniazid and pyrazinamide

E) trimethoprim and sulfamethoxazole

E

What are examples of cell wall synthesis inhibitors?

A) trimethoprim and fluroquinolone

B) penicillin and vancomycin

C) macrolides and aminoglycosides

D) isoniazid and pyrazinamide

E) trimethoprim and sulfamethoxazole

B

What are examples of protein synthesis inhibitors?

A) trimethoprim and fluroquinolone

B) penicillin and vancomycin

C) macrolides and aminoglycosides

D) isoniazid and pyrazinamide

E) trimethoprim and sulfamethoxazole

C

What are examples of anti-mycobacterials?

A) trimethoprim and fluroquinolone

B) penicillin and vancomycin

C) macrolides and aminoglycosides

D) isoniazid and pyrazinamide

E) trimethoprim and sulfamethoxazole

D

What are the main side effects of aminoglycosides?

1. seizure

2. nephrotoxicity

3. rashes

4. ototoxicity

   A. all of the above
   B. only 4
   C. only 1 and 3
   D. 1, 2, and 3
   E. 2 and 4

E

Which of the following is the most potent endogenous opioid peptide?

A) Endorphins

B) Enkephalins

C) Dynorphins

D) Nociceptin

C

Which opioid receptor subtype is primarily responsible for the analgesic effects of most clinically used opioids?
A) Mu (μ)
B) Delta (δ)
C) Kappa (κ)
D) Sigma (σ)

A

What is the mechanism of action of opioid analgesics at the cellular level?
A) Activation of adenylyl cyclase
B) Opening of calcium channels
C) Inhibition of potassium efflux
D) Inhibition of firing afferent neurons and GABAergic descending pain pathway

D

Which of the following opioids is a partial agonist at the μ-opioid receptor?

A) Morphine

B) Fentanyl

C) Buprenorphine

D) Methadone

C

Which adverse effect of opioids is least likely to develop tolerance over time?

A) Respiratory depression

B) Analgesia

C) Constipation

D) Euphoria

C

What is the role of naloxone in opioid overdose management?

A) Opioid receptor partial agonist

B) Opioid receptor agonist

C) Opioid receptor antagonist

D) Dopamine reuptake inhibitor

C

Which of the following is NOT a typical sign of opioid withdrawal?

A) Diarrhea

B) Mydriasis

C) Piloerection

D) Bradycardia

D

Which synthetic opioid is most associated with high potency and high risk of respiratory depression, especially in combination with other CNS depressants?

A) Morphine

B) Fentanyl

C) Hydrocodone

D) Codeine

B

Which of the following best defines a biologic drug as distinct from a small molecule drug?

A) Biologics are synthesized via chemical reactions.

B) Biologics are generally orally bioavailable due to their stability.

C) Biologics are large, complex molecules produced by living systems.

D) Biologics cannot be used to treat chronic conditions.

E) Biologics typically have faster renal elimination than small molecules.

C

Which factor most significantly complicates the manufacturing of biologics compared to small molecules?

A) High oral bioavailability of biologics

B) Strict reproducibility of chemical synthesis

C) Low specificity of biologic targeting

D) Inability to perform quality control on biologics

E) Need for complex living systems to produce active compounds

E

What is the primary reason biologics are usually administered via injection rather than orally?

A) They are too lipophilic to be absorbed in the gut

B) They are unstable in the gastrointestinal tract

C) Their mechanism of action requires hepatic metabolism

D) They cannot cross the blood-brain barrier

E) Oral administration reduces their immunogenicity

B

Which of the following components is most characteristic of a monoclonal antibody (mAb) biologic?

A) A single amino acid chain with low specificity

B) A variable region that binds a specific antigen

C) A carbohydrate backbone with multiple side chains

D) An active site mimicking an enzyme

E) A steroidal ring structure providing stability

B

Regarding biosimilars, which statement is most accurate?

A) They are chemically identical to their reference biologics.

B) They require no clinical testing due to structural similarity.

C) They can be substituted for the reference biologic without physician approval.

D) They are highly similar to the reference product with no clinically meaningful differences.

E) They are generic versions approved via the same pathway as small molecules.

D

Which term describes the ability of a biologic to activate an immune response, potentially reducing its efficacy?

A) Bioavailability

B) Pharmacodynamics

C) Immunogenicity

D) Specificity

E) Solubility

C

Which of the following best explains the target specificity of monoclonal antibodies used as biologics?

A) Their ability to interact with multiple receptors simultaneously

B) Their non-specific lipid solubility

C) The unique antigen-binding site formed by their variable region

D) Their high rate of renal excretion

E) Their mimicry of natural steroid hormones

C

What distinguishes a chimeric monoclonal antibody from a humanized monoclonal antibody?

A) Chimeric antibodies contain only human sequences

B) Chimeric antibodies contain non-human variable regions and human constant regions

C) Humanized antibodies contain more non-human sequences than chimeric ones

D) Humanized antibodies are made entirely in mice

E) Chimeric antibodies are more likely to evade immune detection

B

Which of the following best describes the role of biologics in the treatment of autoimmune diseases?

A) They block specific immune mediators to reduce pathological immune activity

B) They mimic cytokines to enhance inflammation

C) They activate T-cell responses to eliminate infections

D) They promote B-cell proliferation to generate antibodies

E) They act as vaccines to prevent autoimmunity

A

Which of the following best explains the anti-inflammatory mechanism of NSAIDs?

A) Inhibition of phospholipase A2, preventing arachidonic acid release

B) Blockade of histamine receptors, reducing vascular permeability

C) Inhibition of cyclooxygenase enzymes, decreasing prostaglandin synthesis

D) Suppression of neutrophil chemotaxis via TNF-α antagonism

E) Inhibition of leukotriene synthesis through lipoxygenase blockade

C

What is a key pharmacological distinction between non-selective NSAIDs and COX-2 selective inhibitors?

A) Only non-selective NSAIDs reduce fever

B) COX-2 inhibitors inhibit platelet aggregation more than non-selective NSAIDs

C) Non-selective NSAIDs have a higher risk of cardiovascular events than COX-2 inhibitors

D) Non-selective NSAIDs inhibit both COX-1 and COX-2, while COX-2 inhibitors spare COX-1

E) COX-2 inhibitors do not affect renal prostaglandin synthesis

D

Which adverse effect is most closely associated with chronic NSAID use due to COX-1 inhibition?

A) Hypertension
B) Peptic ulceration
C) Hepatotoxicity
D) Bronchospasm
E) Thrombocytopenia

B

Which NSAID can be used in acute gout and rheumatoid arthritis treatment?

A) Indomethacin

B) Naproxen

C) Celecoxib

D) Ibuprofen

E) Ketorolac

B

Why do NSAIDs potentially exacerbate hypertension and renal impairment?

A) They decrease aldosterone levels

B) They inhibit prostaglandin-mediated afferent arteriole vasodilation

C) They cause direct glomerular toxicity

D) They increase sodium excretion via the loop of Henle

E) They stimulate ADH release

B

Which of the following best explains aspirin’s cardioprotective effect?

A) COX-2 inhibition increases endothelial prostacyclin synthesis

B) It irreversibly inhibits COX-1 in platelets, reducing thromboxane A2 production

C) It increases NO production, leading to vasodilation

D) It reduces LDL oxidation by scavenging free radicals

E) It competitively inhibits P2Y12 receptors on platelets

B

In which of the following conditions is the use of NSAIDs generally contraindicated due to increased risk of bronchospasm?

A) Asthma with nasal polyps

B) Rheumatoid arthritis

C) Acute gout

D) Osteoarthritis

E) Chronic kidney disease

A

Which of the following best describes the primary therapeutic goal of DMARDs in autoimmune diseases like rheumatoid arthritis?

A) Rapid analgesia through prostaglandin inhibition

B) Symptom control through peripheral nerve blockade

C) Suppression of inflammatory cytokines to prevent joint destruction

D) Enhancement of synovial fluid production

E) Immediate reversal of autoimmune pathology

C

Which of the following DMARDs is a folate analog that inhibits dihydroorotate dehydrogenase, thus decreasing ribonucleotide synthesis ?

A) Leflunomide

B) Hydroxychloroquine

C) Methotrexate

D) Sulfasalazine

E) Azathioprine

A

What is a major toxicity concern with methotrexate therapy that requires regular monitoring?

A) Retinal damage

B) Hepatotoxicity

C) Bone marrow hyperplasia

D) Pulmonary hypertension

E) Nephrolithiasis

B

Which of the following statements correctly contrasts conventional synthetic DMARDs and biologic DMARDs?

A) Biologics are less specific and more toxic than synthetic DMARDs

B) Synthetic DMARDs directly neutralize cytokines

C) Biologics are usually administered orally, unlike synthetic DMARDs

D) Synthetic DMARDs require refrigeration and are administered subcutaneously

E) Biologic DMARDs target specific immune mediators like TNF-α

E

What step(s) are apart of making biologic monoclonal therapies?

1. Collect spleen cells of mice

2. Fuse spleen cells with cancer (myeloma) cells

3. Cells fuse and divide

4. Harvest the antibodies produced from the fused cells

A. all of the above
B. only 4
C. only 1 and 3
D. 1, 2, and 3
E. 2 and 4

A

How many variable regions (CDRs) are on a single antibody that has 2 antigen receptors?

A. 9

B. 11

C. 8

D. 10

E. 12

E

What is an example of an all human monoclonal antibody?

a) bevacizumab

b) adalimumab

c) pasotuxizumab

d) raceizumab

e) fuvaxizumab

B

What is TRUE regarding the anti-rheumatic biologic “adalimumab” (Humira)?

1. white blood cell increase

2. inhibits production of IL-17

3. always completely irradicates psoriasis

4. used for psoriasis

A. all of the above
B. only 4
C. only 1 and 3
D. 1, 2, and 3
E. 2 and 4

E

Which biologic(s) are used as anti-PD-1/anti-cancer biologics because they target PD-1 to stop the loop of T-cell deactivation and therefore inhibit stimulation of PD-L1 by PD-1?

1. nivolumab

2. adalimumab

3. pembrolizumab

4. exixumab

A. all of the above
B. only 4
C. only 1 and 3
D. 1, 2, and 3
E. 2 and 4

C

What are the correct mechanism(s) of taking steroids as anti-inflammatory drugs?

1. Lipoprotein A promotes arachidonic acid production, which promotes prostaglandin production → decreased inflammation

2. Lipoprotein A blocks arachidonic acid, which inhibits prostaglandin production → decreased inflammation

3. Glucocorticoids promote NF-KB, inhibiting transcription of TNF or IL-1 → decreased inflammation

4. Glucocorticoids inhibit NF-KB, inhibiting transcription of TNF or IL-1 → decreased inflammation

A. all of the above
B. only 4
C. only 1 and 3
D. 1, 2, and 3
E. 2 and 4

E

Which DMARD increases the pH of lysosomes to affect the inflammation cycle by inhibiting Ca²⁺ signaling for T cell activation?

a) methotrexate

b) hydroxychloroquine

c) cyclosporin

d) azathioprine

e) colchicine

B

What side effect cause the NSAID, Vioxx, to be removed from the market?

a) profuse sweating

b) myocardial infraction

c) piloerectors

d) increased blood pressure

e) heart failure

B

Which chemotherapy drug has a side effect of cardiotoxicity due to the free radical peroxidation of heart tissue?

a) doxorubicin

b) methotrexate

c) 5-flouricile

d) leflunomide

e) vincristine

A

Which drugs target ER+ breast cancer?

1. tamoxifen

2. anastrozole

3. anthracyclines

4. camptothecin

A. all of the above
B. only 4
C. only 1 and 3
D. 1, 2, and 3
E. 2 and 4

D

Parietal cells:

a) produce and secrete acid

b) produce pepsinogen, the inactive precursor of pepsin

c) produce gastrin

d) produce mucous and bicarbonate

A

Chief cells:

a) produce and secrete acid

b) produce pepsinogen, the inactive precursor of pepsin

c) produce gastrin

d) produce mucous and bicarbonate

B

Enteroendocrine cells:

a) produce and secrete acid

b) produce pepsinogen, the inactive precursor of pepsin

c) produce gastrin

d) produce mucous and bicarbonate

C

Surface mucous cells:

a) produce and secrete acid

b) produce pepsinogen, the inactive precursor of pepsin

c) produce gastrin

d) produce mucous and bicarbonate

D

Which drugs for the treatment of peptic ulcers are dopaminergic antagonists, causing faster digestion? These drugs can have parkinson’s-like side effects due to increased acetylcholine and dopamine.

1. Bismuth

2. Domperidone

3. Misoprostol

4. Metoclopramide

A. all of the above
B. only 4
C. only 1 and 3
D. 1, 2, and 3
E. 2 and 4

E

Long term treatment with steroids can cause an overproduction ACTH. This can cause a disease categorized by “moon face” and susceptibility to infection due to immune suppression. What is the name of this disease?

a) Addison’s disease

b) Cushing’s disease

c) Albert’s disease

d) Catherine’s disease

e) None of the above

B

Leflunomide increases the effectiveness of methotrexate when given together.

a) True

b) False

A

What is the main toxicity / side effect associated with chemotherapeutics?

a) alopecia

b) weight loss

c) myelosuppression

d) nausea

e) fatigue

C

What is the one exception to opioid side effects because it has high anti-cholinergic activity? This drug is not used as an anti-diarrheal or antitussive and it causes tachycardia.

a) naloxone

b) demerol

c) naltrexone

d) fentanyl

e) meperidine

E

Which opioid is a competitive antagonist for the Mu receptor in the CNS? It has no oral bioavailability and must be given by injection or inhalation.

a) naloxone

b) demerol

c) naltrexone

d) fentanyl

e) meperidine

A

What do aminoglycosides like gentamicin and tobramycin mainly target? They work through a concentration-dependent bactericidal mechanism.

A) Gram-negative bacteria

B) Anaerobic bacteria

C) Mycobacteria

D) Gram-positive bacteria

E) Spirochetes

A

What are macrolides like azithromycin, clarithromycin, and erythromycin indicated for?

1. Upper respiratory tract infections

2. Peptic ulcer disease

3. Chlamydia

4. Many gram + and few gram - bacteria

A. all of the above
B. only 4
C. only 1 and 3
D. 1, 2, and 3
E. 2 and 4

A