PC1 EX1 Practice Questions

JT is a 25-year-old female who reports to your clinic with complaints of UTI. After further assessment, you find out she's only taking multi-vitamins (MVI) including calcium and iron. Which of the following antibiotics for UTI may not get fully absorbed due to chelation with the MVI?

A: Bactrim DS

B: Cipro

C: Metronidazole

D: Rocephin

E: Macrobid

B: Cipro

A 65-year-old male patient presents to the emergency department with symptoms of a potential stroke. PMH: TIA, HTN, Hyperlipidemia, T2DM, GERD, and Osteoarthritis. The medical resident asks your view on the potential for an interaction between clopidogrel and omeprazole inducing a stroke. What is the best pharmacologic mechanism for this potential interaction?

A: Omeprazole induces the metabolism of clopidogrel, resulting in partially decreased activity of Clopidogrel

B: Clopidogrel requires an acidic environment for optimal absorption; omeprazole would increase pH and therefore decrease clopidogrel absorption and potential effectiveness

C: Clopidogrel conversion to its active metabolite may be inhibited by omeprazole, resulting in potentially decreased clopidogrel effectiveness

D: Omeprazole inhibits the metabolism of clopidogrel, resulting in a potentially increased risk of bleeding by clopidogrel

C: Clopidogrel conversion to its active metabolite may be inhibited by omeprazole, resulting in potentially decreased clopidogrel effectiveness

It is October. LL is a 35 y/o female 30 weeks pregnant with no known drug allergies and no significant past medical history. She is up-to-date on all her routine childhood and adult immunizations, however has not yet received any seasonal immunizations this year. She comes to your pharmacy inquiring about which immunizations she is eligible to receive. Which of the following is appropriate to administer to LL today?

A: Tenivac®

B: Adacel®

C: Flumist®

D: Arexvy®

E: Varivax®

B: Adacel®

BL is a 19-year-old female with past medical history of sickle cell disease. She is up-to-date on all childhood immunizations. Her adult immunization history consists only of Prevnar20® (received November 2024). She has not received any other routinely recommended adult immunizations. Based upon her chronic condition, which of the following vaccines is most appropriate for her to receive?

A: Beyfortus® and Priorix®

B: Abrysvo® and M-M-R II®

C: Penbraya® and Hiberix®

D: Havrix® and Daptacel®

E: Synagis® and Tenivac®

C: Penbraya® and Hiberix®

A patient was brought to ER after being found minimally responsive and confused at home. She spoke about increasing her Motrin to 4 pills, about 4 times a day for severe back pain over the last month. She vaguely recalls or remembers the last 24 hours due to being so lethargic. Past Medical History: Hypertension, Diabetes, Acid Reflux, Stage 3 chronic kidney disease, and past back surgery 9 years ago. Last serum creatinine 1.8 mg/dl was taken 30 days ago. Physical Examination: Vitals: BP 109/66 mmHg; HR 115/min; RR 34/min; Temp 98.9 C; On room air O2 Sat=93% Height 5’2” Weight 182 lbs Labs- Serum: Na+ 141, K+ 6.1, Cl- 115, HCO3- 10, BUN 80, Creatinine 3.1 mg/dl, Glucose 89 ABG: pH 7.2, pCO2 29 mmHg, patient SpO2 96% on BiPAP in the ER Choose the cause of the patient's current kidney injury listed below.

A: Uremia

B: Pre-Renal Azotemia

C: Intrinsic Azotemia

D: Post-Renal Azotemia

E: Renal Failure

B: Pre-Renal Azotemia

A patient was brought to ER after being found minimally responsive and confused at home. She spoke about increasing her Motrin to 4 pills, about 4 times a day for severe back pain over the last month.

She vaguely recalls or remembers the last 24 hours due to being so lethargic. Past Medical History: Hypertension, Diabetes, Acid Reflux, Stage 3 chronic kidney disease, and past back surgery 9 years ago. Last serum creatinine 1.8 mg/dl was taken 30 days ago. Medication Profile: Aspirin, Diovan, Furosemide, TUMS, Jardiance, Motrin. Obtunded, tachycardic, tachypneic and the patient was taken to the ER. Physical Examination: Vitals: BP 109/66 mmHg; HR 115/min; RR 34/min; Temp 98.9 C; On room air O2 Sat=93% Labs- Serum: Na+ 141, K+ 6.1, Cl- 115, HCO3-

10, BUN 80, Creatinine 3.1 mg/dl, Glucose 89 ABG: pH 7.2, pCO2 29 mmHg, patient SpO2 96% on BiPAP in the ER Which of the following factors in the Patients Medical History and Medication profile is most likely the cause of

her current complication? SELECT ALL THAT APPLY

A: Jardiance

B: Mortrin

C: Stage 3 CKD

D: Furosemide

E: TUMs (Calcium Carbonate)

B: Mortrin

C: Stage 3 CKD

D: Furosemide

(same patient as 5,6) Which of the following treatments listed below is most likely to manage her current Potassium Status? SELECT ALL THAT APPLY

A: IV KCL 20 MEq over 2 hours by PICC Line

B: Human Regular Insulin

C: IV Dextrose

D: Sodium Zirconium Cyclosilicate (Lokelma)

E: Magnesium Citrate

B: Human Regular Insulin

C: IV Dextrose

D: Sodium Zirconium Cyclosilicate (Lokelma)

(SAME PT) serum creatinine 1.8 mg/dl was taken 30 days ago. Medication Profile: Aspirin, Diovan, Furosemide, TUMS, Jardiance, Motrin EMS was called because the patient was semi-comatose (obtunded), tachycardic, tachypneic and the patient was taken to the ER. Physical Examination: Vitals: BP 109/66 mmHg; HR 115/min; RR 34/min; Temp 98.9 C; On room air O2 Sat=93% Height 5’2” Weight 182 lbs In the EMS Van before ER presentation, the Patient develops hypotension (BP falls to 90/59), HR increase to 120 beats/min. Labs- Serum: Na+ 141, K+ 6.1, Cl-115, HCO3- 10, BUN 80, Creatinine 3.1 mg/dl, Glucose 89 ABG: pH 7.2, pCO2 29 mmHg, patient SpO2 96% on BiPAP in the ER, Which of the following best describes the patient's current Fluid Volume Serum Osm Status on ER admission?

A: Hypervolemic Acute Renal Failure

B: Isovolemic SIADH

C: Hypovolemic Cardiogenic Shock

D: Hypovolemic Septic Shock

E: Acute Volume Overload

C: Hypovolemic Cardiogenic Shock

P.P. is a 58-year-old male white male, US postman and a clinic patient with a history of hypertension and today he was newly diagnosed with type 2 diabetes mellitus. He denies a Past Social History of alcohol use but he does smoke cigarettes (1 pack/day). His current medications included Metoprolol 50 mg/day and a multivitamin. At his 2 week follow-up appointment, his BP is 153/95 mm Hg. A 24-hour urine collection reveals 0.4 g of albumin present in his urine. A recent SCr is 1.7 mg/dL. His GFR collection is 58 mL/minute. Assuming that the nonpharmacologic life style approaches have been maximized. Which one of the following therapeutic interventions is best for P.P. to limit the progression towards chronic kidney disease?

A: Add Nifedipine

B: Add Diltiazem

C: Add Lisinopril

D: Add HCTZ

E: Add Sodium Citrate

C: Add Lisinopril

A 67-year-old, 70 kg, man admitted to the intensive care unit (ICU) for sepsis was recently diagnosed with Hyponatremia from syndrome of inappropriate antidiuresis. His serum sodium acutely fell from 135 mEq to 115 mEq/L during the past 3 days, and he recently developed 2 seizures secondary to this problem. Calculate his Sodium Deficit (Na) using a desired (Na) of (125) and the mEq of Sodium that should administer over the next 24 hours.

A: 77 mEq of Na over 24 hours

B: 154 mEq of Na over 24 hours

C: 308 mEq of Na over 24 hours

D: 420 mEq of Na over 24 hours

E: 700 mEq of Na over 24 hour

D: 420 mEq of Na over 24 hours

Which of the following treatment interventions listed below would most likely be used as a Cardioprotective agent to prevent Heart Block in severe Potassium imbalances?

A: IV KCL 10 mEq over 1 hour by PICC Line

B: Sevelamer (Renvela) 800 mg orally 3 times a day with meals

C: IV Calcium Gluconate 1-2 grams over slow IV push

D: IV Sodium Bicarbonate 50 mEq in 1 Liter of 0.45 NaCl

E: Sodium polystyrene sulfonate 25–50 g

C: IV Calcium Gluconate 1-2 grams over slow IV push

A 49-year-old man (weight 65 kg) is admitted to the ICU from surgery after a 6 hour Renal Transplant surgery procedure. His serum laboratory values are as follows: sodium 145 mEq/L, potassium 2.8 mEq/L, chloride 98 mEq/L, HCO3 28 mEq/L, BUN 14 mg/dL, SCr 0.9 mg/dL, calcium 8.9 mg/dL, phosphorus 1.9 mg/dL, magnesium 1.4mg/dL, and albumin 3 g/dL. Ph= 7.44, PaCO2 42%, PaO2 92% on room air Vital Signs- BP-115/75, HR- 110, Tmax- 99.5, RR- 12 breaths/min Select which Acid-Base disorder listed below best describes this patient's status?

A: Metabolic Acidosis with Compensated Respiratory Alkalosis

B: Metabolic Alkalosis with Compensated Respiratory Acidosis

C: Metabolic Acidosis with Partially Compensated Respiratory Alkalosis

D: Metabolic Alkalosis with Uncompensated Respiratory Acidosis

E: Respiratory Acidosis with partially Compensated Metabolic Alkalosis

B: Metabolic Alkalosis with Compensated Respiratory Acidosis

TJ is a 22-year-old female with sickle cell disease. She is up to date on childhood immunizations but hasn’t received any vaccines in adulthood. Which of the following vaccinations are indicated due to her condition?

Select all that apply.

A. PPSV23

B. PCV20

C. Hiberix (Hib)

D. MenACWY

E. Varivax

Answer: A, C, D

Rationale: Sickle cell patients are functionally asplenic → ↑ risk for encapsulated organisms (Strep pneumo, H. flu, N. meningitidis). PCV13 or PCV20 followed by PPSV23, Hib, and MenACWY are all indicated.

A 28-year-old female taking combined oral contraceptives reports starting St. John’s Wort for depression. What is the most likely clinical outcome of this combination?

A. Increased risk of thromboembolism

B. Decreased contraceptive efficacy due to CYP3A4 induction

C. Increased serum estrogen levels

D. No significant interaction

Answer: B

Rationale: St. John’s Wort is a strong CYP3A4 inducer → ↓ estrogen/progestin levels → risk of breakthrough bleeding & pregnancy.

Which of the following statins has the highest risk of adverse effects when used concurrently with verapamil?

A. Pravastatin

B. Rosuvastatin

C. Simvastatin

D. Pitavastatin

Answer: C

Rationale: Verapamil inhibits CYP3A4 → ↑ simvastatin levels → risk of myopathy/rhabdo. Simvastatin dose should be limited or avoided.

A 64-year-old male is taking gemfibrozil for elevated triglycerides. His PCP is considering adding simvastatin. What is the primary concern with this combination?

A. Pancreatitis

B. Elevated uric acid

C. Severe hypotension

D. Rhabdomyolysis

Answer: D

Rationale: Gemfibrozil + statins (esp. simvastatin) → ↑ risk of rhabdo due to inhibition of statin metabolism.

A patient with chronic hyponatremia (Na = 116 mEq/L) is corrected too rapidly with hypertonic saline. Which life-threatening condition is most likely to occur?

A. SIADH

B. Central pontine myelinolysis

C. Cerebral edema

D. Hypernatremic encephalopathy

B. Central pontine myelinolysis

Rationale: Rapid correction of chronic hyponatremia (>8-10 mEq/day) → ODS/central pontine myelinolysis → irreversible neuro damage.

A patient taking tamoxifen is also on paroxetine for anxiety. What is the main concern with this drug combination?

A. Increased hot flashes

B. Decreased effect of tamoxifen due to CYP2D6 inhibition

C. Worsening depression

D. Increased clotting risk

B. Decreased effect of tamoxifen due to CYP2D6 inhibition

Rationale: Paroxetine is a strong CYP2D6 inhibitor → ↓ conversion of tamoxifen to active metabolite (endoxifen) → ↓ efficacy.

Which of the following would be appropriate adjunctive therapies to manage hyperkalemia in a patient with ESRD who is receiving epoetin alfa? SATA

A. Sodium zirconium cyclosilicate (Lokelma)

B. Calcium gluconate

C. Epoetin alfa

D. IV Dextrose + InsulinE. Lactated Ringer’s

A. Sodium zirconium cyclosilicate (Lokelma)

B. Calcium gluconate

D. IV Dextrose + InsulinE. Lactated Ringer’s

Rationale: ESRD impairs K+ excretion. Lokelma binds K+ in the gut. Ca gluconate stabilizes cardiac membrane. Insulin + dextrose shifts K+ intracellularly. Procrit treats anemia, not K+.

Tolvaptan is most appropriate in the management of which of the following conditions?

A. Hyperkalemia

B. SIADH with symptomatic hyponatremia

C. Acute kidney injury

D. Diabetic ketoacidosis

B. SIADH with symptomatic hyponatremia

Rationale: Tolvaptan is a vasopressin V2 receptor antagonist → promotes free water excretion without affecting Na+ → useful in hyponatremia from SIADH.

A 70-year-old man presents with muscle weakness and ECG changes. K+ is 2.1 mEq/L. What are appropriate initial treatments?

Select all that apply.

A. Calcium gluconate

B. IV sodium bicarbonate

C. Albuterol

D. IV insulin + dextrose

E. Oral sodium polystyrene sulfonate

B. IV sodium bicarbonate

C. Albuterol

D. IV insulin + dextrose

Rationale: For hypokalemia: insulin + dextrose, albuterol, and IV NaHCO3 (if metabolic acidosis present) help shift K+ into cells. Calcium gluconate is for hyperkalemia. Kayexalate is for hyperkalemia too.

other exam content:

-practice case in class

-discussion post that was done

-Novavax 2 doses 14 days to be effective

-2 vaccines in same day requirement chart

-brand names for all vaccines

-shingrix CD4 count 50 chart

-when to give different pneumo vaccines

-pregancy vaccines + weeks range

-when to avoid live vaccines