Module 8 - Combined Questions with 4 answers

What adverse effect is most concerning when starting metformin (Biguanide) in a patient with eGFR 28 mL/min?

A. Hypoglycemia

B. Lactic acidosis

C. Renal failure

D. Hyperglycemia

Lactic acidosis.

Key Rationale: Metformin (Biguanide) has a black box warning (BBW) for lactic acidosis, especially when eGFR <30 mL/min due to reduced renal clearance leading to drug accumulation.

Predicted MCQ Trap: Confusing with hypoglycemia; trap is choosing renal failure alone without specifying lactic acidosis as the primary concern.

Which insulin starts working within 15 minutes and lasts 3-5 hours, taken before meals? A. Regular insulin B. NPH insulin C. Lispro D. Glargine

Lispro (Rapid-acting insulin). Key Rationale: Rapid-acting insulins like lispro have a quick onset (15-30 min) and short duration, ideal for mealtime bolus to control postprandial glucose spikes. Predicted MCQ Trap: Mistaking with short-acting regular insulin (onset 30-60 min); trap is selecting NPH for rapid control.

What explains shakiness and sweating mid-morning after insulin injection? A. Hyperglycemia B. Hypoglycemia C. Infection D. Allergic reaction

Hypoglycemia at insulin peak effect. Key Rationale: Symptoms like shakiness and sweating indicate hypoglycemia, which peaks at the insulin's maximum activity time. Predicted MCQ Trap: Attributing to hyperglycemia; trap is choosing infection without glucose context.

How to avoid injection site complications in insulin users? A. Massage site B. Rotate injection sites C. Clean site only D. Use same site

Rotate injection sites systematically. Key Rationale: Systematic rotation prevents lipodystrophy, fibrosis, and erratic absorption from repeated use of the same site. Predicted MCQ Trap: Suggesting massage; trap is ignoring rotation for cleaning only.

What is likely if an insulin pump site shows localized swelling after 6 days without site change? A. Infection B. Allergic reaction C. Lipodystrophy D. Hematoma

Lipodystrophy (due to poor site rotation). Key Rationale: Prolonged use of the same site leads to tissue changes like swelling or atrophy from insulin deposition. Predicted MCQ Trap: Confusing with infection; trap is selecting allergy without rotation history.

What interaction causes fatigue, nausea, and elevated lactate in a patient on metformin (Biguanide) who drinks alcohol? A. Gastrointestinal upset B. Hypoglycemia C. Lactic acidosis D. Hepatotoxicity

Lactic acidosis. Key Rationale: Alcohol impairs lactate clearance, exacerbating metformin (Biguanide)'s risk of lactic acidosis. Predicted MCQ Trap: Choosing GI upset; trap is missing lactate elevation as key indicator.

Which lab should be monitored before continuing metformin (Biguanide) in a patient scheduled for contrast CT? A. Serum lactate B. eGFR C. Blood glucose D. Liver enzymes

eGFR. Key Rationale: Contrast can impair renal function; eGFR ensures safe metformin (Biguanide) use to prevent lactic acidosis. Predicted MCQ Trap: Selecting lactate; trap is focusing on post-contrast without baseline renal check.

Why might glyburide (Sulfonylurea) become less effective over time despite adherence? A. Non-adherence B. Insulin resistance C. Beta-cell fatigue D. Drug metabolism

Beta-cell fatigue. Key Rationale: Progressive pancreatic beta-cell dysfunction in T2DM reduces sulfonylurea responsiveness over time. Predicted MCQ Trap: Attributing to resistance; trap is choosing non-adherence without beta-cell context.

How should levothyroxine (Thyroid hormone) be taken for best absorption? A. With meals B. At bedtime C. On an empty stomach D. With calcium

On an empty stomach in the morning, 30-60 minutes before food. Key Rationale: Food, especially calcium-rich, interferes with absorption; fasting optimizes bioavailability. Predicted MCQ Trap: Suggesting with food; trap is ignoring timing for convenience.

What interaction affects levothyroxine (Thyroid hormone) absorption when starting calcium carbonate (Mineral supplement)? A. Enhanced absorption B. Reduced metabolism C. Calcium inhibition D. Increased clearance

Calcium inhibits levothyroxine absorption when taken together. Key Rationale: Calcium binds levothyroxine (Thyroid hormone) in the gut, reducing uptake; separate by 4 hours. Predicted MCQ Trap: Thinking it enhances; trap is confusing with iron interaction.

How does pregnancy affect levothyroxine (Thyroid hormone) dosing in hypothyroid women? A. Decreases dose B. No change C. Increases dose D. Stops therapy

Increases requirements due to increased thyroid-binding globulin (TBG). Key Rationale: Pregnancy elevates TBG, binding more thyroid hormone and necessitating higher doses. Predicted MCQ Trap: Decreasing dose; trap is missing physiologic changes.

Why start levothyroxine (Thyroid hormone) at lower doses in elderly patients? A. Reduced absorption B. Risk of ischemia C. Decreased metabolism D. Renal impairment

Higher risk of myocardial ischemia with increased metabolism; start low to avoid cardiac issues. Key Rationale: Elderly have reduced cardiac reserve; rapid metabolic increase can precipitate ischemia. Predicted MCQ Trap: For absorption; trap is ignoring age-related risks.

What is propranolol (Beta-blocker)'s main role in symptomatic hyperthyroidism? A. Suppresses thyroid hormone B. Controls adrenergic symptoms C. Reduces iodine uptake D. Inhibits conversion

Controls adrenergic symptoms like tremor and tachycardia. Key Rationale: Blocks beta-adrenergic effects of excess thyroid hormone without altering hormone levels. Predicted MCQ Trap: Thyroid suppression; trap is confusing with antithyroid drugs.

What black box warning is illustrated when a toddler shows signs of testosterone gel exposure? A. Overdose risk B. Secondary exposure C. Allergic reaction D. Hepatotoxicity

Secondary exposure risk. Key Rationale: Testosterone (Androgen) gel can transfer via skin contact, causing virilization in children (BBW). Predicted MCQ Trap: Overdose; trap is missing transfer mechanism.

What is the main concern when prescribing sildenafil (PDE-5 inhibitor) to a patient on isosorbide mononitrate (Nitrate)? A. Priapism B. Vision loss C. Severe hypotension D. Arrhythmia

Severe hypotension/syncope due to interaction between PDE-5 inhibitors and nitrates (absolute contraindication). Key Rationale: Both vasodilate via NO pathway, causing profound drop in BP. Predicted MCQ Trap: Vision loss; trap is choosing priapism over hypotension.

What causes delayed sildenafil (PDE-5 inhibitor) effectiveness when taken after a large meal? A. Increased metabolism B. High-fat meal delay C. Reduced clearance D. Enzyme induction

High-fat meals delay absorption, reducing effectiveness. Key Rationale: Fat slows gastric emptying and drug absorption. Predicted MCQ Trap: Metabolism; trap is ignoring meal timing.

How does tamsulosin (Alpha-1 blocker) improve urinary flow in BPH without shrinking the prostate? A. Shrinks prostate B. Relaxes smooth muscle C. Increases urine output D. Inhibits DHT

Relaxes bladder neck and prostate smooth muscles (alpha-1 blocker effect). Key Rationale: Targets alpha-1 receptors for symptomatic relief without affecting prostate volume. Predicted MCQ Trap: Shrinkage; trap is confusing with 5-ARIs.

How long does finasteride (5-alpha reductase inhibitor) take to reduce prostate size and symptoms? A. Days B. Weeks C. Months D. Years

Several months. Key Rationale: Inhibits DHT production, leading to gradual prostate atrophy and symptom improvement. Predicted MCQ Trap: Immediate; trap is selecting weeks over months.

What administration mistake likely caused heartburn and swallowing difficulty with alendronate (Bisphosphonate)? A. Taking with food B. Lying down after dose C. Small water volume D. Evening dosing

Lying down after dose (Increases risk of esophagitis). Key Rationale: Must remain upright 30 min to prevent reflux and esophageal irritation. Predicted MCQ Trap: Empty stomach; trap is missing posture.

Which osteoporosis medication is contraindicated in patients with Barrett's esophagus? A. Denosumab B. Alendronate C. Raloxifene D. Teriparatide

Alendronate (Bisphosphonate). Key Rationale: Bisphosphonates irritate esophagus; contraindicated in disorders like Barrett's. Predicted MCQ Trap: Denosumab; trap is choosing injectables.

What adverse effect is associated with denosumab (RANKL inhibitor) use? A. Hypocalcemia B. Infections C. Osteonecrosis D. Fracture risk

Increased risk of infections, including skin and dental abscesses. Key Rationale: Inhibits osteoclasts but may suppress immune function. Predicted MCQ Trap: Hypocalcemia; trap is focusing on bone over infection.

What is the black box warning for raloxifene (SERM) in patients with prior DVT or PE? A. Stroke risk B. Venous thromboembolism C. Hepatotoxicity D. Malignancy

Venous thromboembolism risk (BBW for clotting risk). Key Rationale: Estrogenic effects increase coagulation factors. Predicted MCQ Trap: Stroke only; trap is missing VTE specificity.

What is a known complication of long-term prednisone (Glucocorticoid) use? A. Adrenal insufficiency B. Osteoporosis C. Hypoglycemia D. Hypertension

Osteoporosis and increased fracture risk. Key Rationale: Suppresses bone formation and increases resorption. Predicted MCQ Trap: Adrenal insufficiency; trap is chronic vs. acute.

Is tapering needed after a 4-day prednisone (Glucocorticoid) 40 mg course for asthma flare? A. Always taper B. No taper needed C. Taper if elderly D. Taper if high dose

No taper required for short courses under 2 weeks. Key Rationale: Short duration doesn't suppress HPA axis significantly. Predicted MCQ Trap: Always taper; trap is overgeneralizing.

What explains low morning cortisol and suppressed ACTH in a patient on chronic high-dose prednisone (Glucocorticoid)? A. Primary adrenal failure B. HPA axis suppression C. Pituitary tumor D. Acute stress

HPA axis suppression due to chronic steroid use. Key Rationale: Exogenous steroids feedback inhibit ACTH and cortisol production. Predicted MCQ Trap: Primary adrenal; trap is missing exogenous cause.

Why avoid methotrexate (DMARD) in RA patients with stage 3 CKD? A. Hepatotoxicity B. Drug accumulation C. Infection risk D. Bone marrow suppression

Risk of drug accumulation and toxicity due to reduced renal clearance. Key Rationale: Primarily renally excreted; CKD leads to toxicity. Predicted MCQ Trap: Hepatotoxicity; trap is ignoring renal.

Why is TB screening required before starting infliximab (TNF-alpha inhibitor)? A. Hepatitis reactivation B. TB reactivation C. Malignancy risk D. Fungal infection

BBW for latent TB reactivation with TNF-alpha inhibitors. Key Rationale: TNF blockade impairs granuloma maintenance, reactivating TB. Predicted MCQ Trap: Hepatitis; trap is missing TB specificity.

What black box warning should a patient on leflunomide (DMARD) be aware of? A. Infection risk B. Hepatotoxicity and teratogenicity C. Malignancy D. Renal toxicity

Hepatotoxicity and teratogenicity. Key Rationale: Inhibits pyrimidine synthesis; toxic to liver and fetus. Predicted MCQ Trap: Infection; trap is confusing with biologics.

What black box warnings apply to TNF inhibitors like adalimumab (TNF-alpha inhibitor)? A. Hepatotoxicity B. Infections and malignancy C. QT prolongation D. Lactic acidosis

Increased risk of serious infections and malignancy. Key Rationale: Immune suppression heightens risks. Predicted MCQ Trap: Hepatotoxicity; trap is non-specific.

Why is baseline ECG done before starting hydroxychloroquine (Antimalarial)? A. Retinopathy risk B. QT prolongation C. Hepatotoxicity D. Myopathy

Risk of QT prolongation, especially with other QT-prolonging drugs. Key Rationale: Can cause arrhythmias; baseline assesses risk. Predicted MCQ Trap: Retinopathy; trap is ocular vs. cardiac.

What nutritional deficiency should be monitored with orlistat (Lipase inhibitor) use? A. Vitamin B12 B. Fat-soluble vitamins (ADEK) C. Iron D. Calcium

Fat-soluble vitamin (ADEK) deficiency due to fat absorption blockade. Key Rationale: Inhibits lipase, reducing fat and vitamin absorption. Predicted MCQ Trap: Water-soluble; trap is missing fat link.

Why is liraglutide (GLP-1 RA) contraindicated in patients with family history of medullary thyroid carcinoma? A. Pancreatitis risk B. Thyroid cancer risk C. Hypoglycemia D. Renal failure

BBW for increased risk of thyroid cancer. Key Rationale: Rodent studies show C-cell tumors; contraindicated in MTC/MEN2. Predicted MCQ Trap: Pancreatitis; trap is confusing risks.

Which diabetes drug should be avoided in a patient with eGFR 25 mL/min due to risk of lactic acidosis? A. Canagliflozin B. Metformin C. Glipizide D. Liraglutide

Metformin (Biguanide) — BBW for lactic acidosis, especially with renal impairment (eGFR <30). Key Rationale: Renal clearance impaired, leading to accumulation. Predicted MCQ Trap: SGLT2i; trap is renal benefit vs. risk.

Which insulin has the fastest onset for rapid post-meal glucose control? A. Aspart B. Lispro C. Regular insulin D. NPH

Lispro (Rapid-acting insulin) — onset 15-30 mins, ideal for post-meal coverage. Key Rationale: Mimics physiologic insulin response. Predicted MCQ Trap: Aspart vs. lispro; trap is similar onsets.

In a T2DM patient who drinks alcohol daily, which drug has the greatest lactic acidosis risk? A. Sulfonylureas B. Metformin C. SGLT2 inhibitors D. Insulin

Metformin (Biguanide) — alcohol increases lactic acidosis risk with metformin. Key Rationale: Both impair lactate metabolism. Predicted MCQ Trap: Sulfonylureas; trap is hypoglycemia vs. acidosis.

Which insulin is most likely responsible for nocturnal hypoglycemia? A. Glargine B. NPH C. Lispro D. Detemir

NPH (Intermediate-acting insulin) — peaks 6-14 hours, increasing nocturnal hypoglycemia. Key Rationale: Peak timing aligns with sleep. Predicted MCQ Trap: Long-acting; trap is flat profile.

Which diabetes drug causes hypoglycemia masked by beta blockers? A. Metformin B. Glipizide C. Sitagliptin D. Canagliflozin

Glipizide (Sulfonylurea) — hypoglycemia risk; beta blockers mask adrenergic symptoms. Key Rationale: Blocks sympathetic signs like tachycardia. Predicted MCQ Trap: Metformin; trap is non-hypoglycemic.

Which diabetes drug carries a black box warning for heart failure exacerbation? A. SGLT2 inhibitors B. Pioglitazone C. Metformin D. Insulin

Pioglitazone (TZD) — BBW for fluid retention worsening heart failure. Key Rationale: PPAR-gamma activation causes edema. Predicted MCQ Trap: SGLT2i; trap is benefit vs. risk.

Which drug is associated with acute pancreatitis in a patient on DPP-4 inhibitors? A. Liraglutide B. Sitagliptin C. Metformin D. Glimepiride

Sitagliptin (DPP-4 inhibitor) — linked to acute pancreatitis. Key Rationale: Inhibits DPP-4, potentially inflaming pancreas. Predicted MCQ Trap: GLP-1; trap is similar mechanisms.

Which drug is strongly associated with Fournier's gangrene (perineal infection)? A. Metformin B. Canagliflozin C. Insulin D. Antibiotics

Canagliflozin (SGLT2 inhibitor) — BBW for rare but serious Fournier's gangrene. Key Rationale: Glucosuria promotes infections. Predicted MCQ Trap: Antibiotics; trap is cause vs. treatment.

Which diabetes drug is contraindicated with a family history of medullary thyroid carcinoma? A. Semaglutide B. Liraglutide C. Metformin D. Sitagliptin

Liraglutide (GLP-1 RA) — contraindicated in MTC history. Key Rationale: Animal data on thyroid tumors. Predicted MCQ Trap: Semaglutide; trap is class-wide.

Which hypothyroidism medication must be taken on an empty stomach? A. Propylthiouracil B. Levothyroxine C. Methimazole D. Liothyronine

Levothyroxine (Thyroid hormone) — take 30-60 mins before meals to ensure absorption. Key Rationale: Food reduces bioavailability. Predicted MCQ Trap: With food; trap is convenience.

Which hypothyroid drug dose needs increase during pregnancy? A. Methimazole B. Levothyroxine C. Propylthiouracil D. No change

Levothyroxine (Thyroid hormone) — pregnancy increases thyroid-binding globulin, requiring dose adjustment. Key Rationale: Maintains euthyroidism. Predicted MCQ Trap: Decrease; trap is misunderstanding.

Which thyroid drug has a BBW against use for weight loss in euthyroid patients? A. Liothyronine B. Levothyroxine C. Methimazole D. Propylthiouracil

Levothyroxine (Thyroid hormone) — can cause life-threatening toxicity if used for weight loss. Key Rationale: Hyperthyroidism risks. Predicted MCQ Trap: Off-label; trap is safety.

Which drug causes virilization in toddlers after skin contact? A. Oral testosterone B. Testosterone gel C. Estrogen cream D. Steroid inhaler

Testosterone (Androgen) — secondary exposure can cause virilization (BBW). Key Rationale: Topical transfer. Predicted MCQ Trap: Oral; trap is route.

Which drug is contraindicated with nitrates for erectile dysfunction due to hypotension risk? A. Tadalafil B. Vardenafil C. Alprostadil D. Testosterone

Vardenafil (PDE5 inhibitor) — life-threatening hypotension with nitrates. Key Rationale: Synergistic vasodilation. Predicted MCQ Trap: Tadalafil; trap is duration.

Which drug improves urine flow in BPH without changing prostate size? A. Finasteride B. Tamsulosin C. Dutasteride D. Terazosin

Tamsulosin (Selective alpha-1 blocker) — relaxes bladder neck smooth muscle. Key Rationale: Symptomatic relief. Predicted MCQ Trap: Finasteride; trap is size reduction.

Which osteoporosis drug requires taking with a full glass of water while standing? A. Denosumab B. Alendronate C. Teriparatide D. Raloxifene

Alendronate (Bisphosphonate) — prevents esophagitis by proper administration. Key Rationale: Reduces irritation. Predicted MCQ Trap: Lying down; trap is error.

Which osteoporosis drug is contraindicated in women with a history of PE? A. Alendronate B. Raloxifene C. Denosumab D. Teriparatide

Raloxifene (SERM) — BBW for increased VTE/stroke risk. Key Rationale: Procoagulant effects. Predicted MCQ Trap: Estrogen; trap is similar.

Which drug can cause dental abscess and hypocalcemia in osteoporosis? A. Alendronate B. Denosumab C. Raloxifene D. Teriparatide

Denosumab (RANKL inhibitor) — may cause infections and hypocalcemia. Key Rationale: Bone turnover suppression. Predicted MCQ Trap: Bisphosphonates; trap is ONJ.

Which osteoporosis drug can cause dizziness and hypotension after injection? A. Alendronate B. Denosumab C. Teriparatide D. Raloxifene

Teriparatide (PTH analog) — orthostatic hypotension risk. Key Rationale: Vasodilation side effect. Predicted MCQ Trap: Denosumab; trap is injection.

Which drug is implicated in osteonecrosis of the jaw after dental work? A. Prednisone B. Alendronate C. Denosumab D. Teriparatide

Alendronate (Bisphosphonate) — linked to osteonecrosis of the jaw, especially post dental procedures. Key Rationale: Inhibits bone healing. Predicted MCQ Trap: Steroids; trap is similar risk.

Which RA drug causes bone marrow suppression and elevated liver enzymes? A. Leflunomide B. Methotrexate C. Adalimumab D. Etanercept

Methotrexate (DMARD) — BBW for bone marrow suppression and hepatotoxicity. Key Rationale: Folate antagonist. Predicted MCQ Trap: Leflunomide; trap is similar.

Which DMARD is contraindicated in CKD stage 4 due to renal excretion? A. Etanercept B. Methotrexate C. Adalimumab D. Hydroxychloroquine

Methotrexate (DMARD) — renally excreted, contraindicated in advanced CKD. Key Rationale: Toxicity accumulation. Predicted MCQ Trap: Biologics; trap is route.

Which RA drug requires TB screening before starting therapy? A. Methotrexate B. Etanercept C. Leflunomide D. Hydroxychloroquine

Etanercept (TNF inhibitor) — BBW for TB reactivation. Key Rationale: Immune suppression. Predicted MCQ Trap: Methotrexate; trap is non-biologic.

Which RA drug has BBWs for hepatotoxicity and teratogenicity in women of childbearing age? A. Adalimumab B. Leflunomide C. Etanercept D. Methotrexate

Leflunomide (DMARD) — hepatotoxic and teratogenic BBW. Key Rationale: Long half-life. Predicted MCQ Trap: Washout; trap is management.

Which TNF inhibitor carries a BBW for serious infections and lymphoma? A. Methotrexate B. Infliximab C. Leflunomide D. Hydroxychloroquine

Infliximab (TNF-alpha inhibitor) — BBW for infections and malignancy risks. Key Rationale: Broad immunosuppression. Predicted MCQ Trap: All; trap is class.

Which drug requires slow tapering after 8 weeks due to HPA axis suppression? A. Prednisone B. Alendronate C. Metformin D. Lispro

Prednisone (Glucocorticoid) — taper to avoid adrenal insufficiency. Key Rationale: Restores axis. Predicted MCQ Trap: Short course; trap is duration.

Which drug commonly causes vertebral fractures with chronic use? A. Metformin B. Prednisone C. Levothyroxine D. Tamsulosin

Prednisone (Glucocorticoid) — chronic steroids cause osteoporosis and fractures. Key Rationale: Bone loss. Predicted MCQ Trap: Acute; trap is time.

Which weight loss drug causes oily stools and vitamin ADEK deficiency? A. Phentermine B. Orlistat C. Liraglutide D. Naltrexone/Bupropion

Orlistat (Lipase inhibitor) — reduces fat absorption causing steatorrhea and vitamin deficiency. Key Rationale: Non-systemic. Predicted MCQ Trap: Stimulants; trap is mechanism.

Which weight loss drug is contraindicated in malabsorption and liver impairment? A. Phentermine B. Orlistat C. Liraglutide D. Naltrexone/Bupropion

Orlistat (Lipase inhibitor) — contraindicated due to GI side effects and liver metabolism. Key Rationale: Exacerbates conditions. Predicted MCQ Trap: Systemic; trap is absorption.

Which weight loss drug has a BBW for suicidal ideation in young adults? A. Orlistat B. Phentermine/Topiramate C. Naltrexone/Bupropion D. Liraglutide

Naltrexone/Bupropion (Opioid antagonist/antidepressant) — BBW for suicidality especially in youth. Key Rationale: CNS effects. Predicted MCQ Trap: Bupropion alone; trap is combo.

Which weight loss drug is contraindicated in pregnancy and glaucoma? A. Orlistat B. Phentermine/Topiramate C. Liraglutide D. Naltrexone/Bupropion

Phentermine/Topiramate (Sympathomimetic/carbonic anhydrase inhibitor) — contraindicated in pregnancy and glaucoma. Key Rationale: Fetal harm and IOP increase. Predicted MCQ Trap: Orlistat; trap is safety.

Which GLP-1 receptor agonist weight-loss drug is contraindicated with family history of MTC? A. Liraglutide B. Semaglutide C. Dulaglutide D. Metformin

Semaglutide (GLP-1 RA) — BBW contraindicated in MTC or MEN2 history. Key Rationale: Thyroid risk. Predicted MCQ Trap: Liraglutide; trap is class.

Which drug provides glucose control and renal protection in a 58-year-old male with T2DM, ASCVD, and CKD? A. Metformin B. Canagliflozin C. Glipizide D. Insulin

Canagliflozin (SGLT2 inhibitor). Key Rationale: Cardiorenal benefits in trials. Predicted MCQ Trap: Metformin; trap is renal contraindication.

Best diabetes medication choice for a 67-year-old female with T2DM and obesity concerned about weight gain? A. Glipizide B. Liraglutide C. Pioglitazone D. NPH insulin

Liraglutide (GLP-1 receptor agonist). Key Rationale: Promotes weight loss. Predicted MCQ Trap: Sulfonylurea; trap is weight gain.

Most appropriate medication for a 72-year-old male with BPH and orthostatic hypotension? A. Terazosin B. Tamsulosin C. Finasteride D. Doxazosin

Tamsulosin (Selective alpha-1 blocker). Key Rationale: Selective to avoid systemic hypotension. Predicted MCQ Trap: Non-selective; trap is BP drop.

Which diabetes drug commonly causes genital fungal infections? A. Metformin B. Dapagliflozin C. Glipizide D. Sitagliptin

Dapagliflozin (SGLT2 inhibitor). Key Rationale: Glucosuria fosters yeast. Predicted MCQ Trap: UTI only; trap is fungal vs. bacterial.

Medication that reduces fat absorption for a 40-year-old with obesity? A. Phentermine B. Orlistat C. Liraglutide D. Naltrexone/Bupropion

Orlistat (Lipase inhibitor). Key Rationale: Blocks dietary fat. Predicted MCQ Trap: Systemic; trap is GI focus.

Drug likely causing lactic acidosis in a 51-year-old female with T2DM and severe renal impairment? A. Alcohol B. Metformin C. SGLT2 inhibitors D. Insulin

Metformin (Biguanide). Key Rationale: Accumulation in CKD. Predicted MCQ Trap: Alcohol alone; trap is drug.

Which osteoporosis drug is contraindicated if patient cannot sit upright for 30 minutes? A. Denosumab B. Alendronate C. Teriparatide D. Raloxifene

Alendronate (Bisphosphonate). Key Rationale: Esophagitis risk. Predicted MCQ Trap: Injectable; trap is oral.

Which ED drug is contraindicated in a patient using nitrates? A. Alprostadil B. Sildenafil C. Testosterone D. Tamsulosin

Sildenafil (PDE5 inhibitor). Key Rationale: Hypotension. Predicted MCQ Trap: All; trap is class.

Testosterone therapy route avoiding secondary skin exposure in transgender man? A. Testosterone gel B. Injectable testosterone C. Oral testosterone D. Transdermal patch

Injectable testosterone (Androgen). Key Rationale: No topical transfer. Predicted MCQ Trap: Gel; trap is risk.

DMARD most likely causing interstitial lung disease in RA patient? A. Adalimumab B. Methotrexate C. Etanercept D. Leflunomide

Methotrexate (DMARD). Key Rationale: Pulmonary toxicity. Predicted MCQ Trap: TNF; trap is infection.

Drug improving insulin sensitivity in a 33-year-old with PCOS? A. Oral contraceptives B. Metformin C. Pioglitazone D. Insulin

Metformin (Biguanide). Key Rationale: Off-label for PCOS. Predicted MCQ Trap: OCP; trap is indication.

Ideal drug for BPH with small prostate and no BP lowering effect? A. Finasteride B. Tamsulosin C. Terazosin D. Dutasteride

Tamsulosin (Selective alpha-1 blocker). Key Rationale: Symptom relief. Predicted MCQ Trap: 5-ARI; trap is size.

Osteoporosis drug to avoid in patient with previous VTE? A. Alendronate B. Raloxifene C. Denosumab D. Teriparatide

Raloxifene (SERM). Key Rationale: Clotting risk. Predicted MCQ Trap: Bisphosphonate; trap is no VTE.

Diabetes medication class most likely causing nausea and injection site reactions? A. Insulin B. GLP-1 receptor agonists C. SGLT2 inhibitors D. Sulfonylureas

GLP-1 receptor agonists. Key Rationale: GI and local effects. Predicted MCQ Trap: Insulin; trap is hypo.

Which diabetes med may cause hypoglycemia when started with allopurinol? A. Metformin B. Glimepiride C. Sitagliptin D. Canagliflozin

Glimepiride (Sulfonylurea). Key Rationale: Interaction increases levels. Predicted MCQ Trap: Metformin; trap is no hypo.

Weight loss med likely increasing INR in patient on warfarin? A. Orlistat B. Phentermine C. Liraglutide D. Naltrexone/Bupropion

Phentermine (Sympathomimetic). Key Rationale: Potential interaction. Predicted MCQ Trap: Orlistat; trap is vitamin K.

Drug that can reverse corticosteroid-induced osteoporosis? A. Alendronate B. Teriparatide C. Denosumab D. Raloxifene

Teriparatide (PTH analog). Key Rationale: Anabolic effect. Predicted MCQ Trap: Bisphosphonate; trap is antiresorptive.

Weight loss medication to avoid in patient with history of pancreatitis? A. Orlistat B. Liraglutide C. Phentermine D. Naltrexone/Bupropion

Liraglutide (GLP-1 receptor agonist). Key Rationale: Pancreatitis risk. Predicted MCQ Trap: Orlistat; trap is GI.

RA medication to stop when planning pregnancy within a year? A. Adalimumab B. Methotrexate C. Etanercept D. Hydroxychloroquine

Methotrexate (DMARD). Key Rationale: Teratogenic. Predicted MCQ Trap: Biologics; trap is variable.

Weekly injectable for T2DM that promotes weight loss and appetite suppression? A. Semaglutide B. Dulaglutide C. Liraglutide D. Insulin glargine

Dulaglutide (GLP-1 receptor agonist). Key Rationale: Weekly dosing. Predicted MCQ Trap: Semaglutide; trap is frequency.

Insulin providing basal coverage lasting over 24 hours? A. Lispro B. NPH C. Glargine U-300 D. Detemir

Glargine U-300 (Long-acting insulin). Key Rationale: Extended duration. Predicted MCQ Trap: Detemir; trap is shorter.

Oral diabetic drug class avoiding hypoglycemia risk seen with sulfonylureas? A. Metformin B. DPP-4 inhibitors C. SGLT2 inhibitors D. TZDs

DPP-4 inhibitors. Key Rationale: Glucose-dependent. Predicted MCQ Trap: Metformin; trap is similar.

Long-acting testosterone formulation preferred by a 65-year-old male? A. Testosterone gel B. Injectable testosterone C. Implantable pellet D. Transdermal patch

Implantable pellet (Androgen). Key Rationale: Long duration. Predicted MCQ Trap: Injection; trap is preference.

Weight loss medication to avoid in patient with obesity and uncontrolled hypertension? A. Orlistat B. Bupropion/Naltrexone C. Liraglutide D. Phentermine

Bupropion/Naltrexone (Antidepressant/opioid antagonist). Key Rationale: BP increase. Predicted MCQ Trap: Phentermine; trap is similar.

Best anabolic bone therapy for osteoporosis on long-term steroids? A. Alendronate B. Teriparatide C. Denosumab D. Raloxifene

Teriparatide (PTH analog). Key Rationale: Builds bone. Predicted MCQ Trap: Denosumab; trap is inhibition.

Diabetes medication causing multiple UTIs and weight loss? A. Metformin B. Canagliflozin C. Glipizide D. Liraglutide

Canagliflozin (SGLT2 inhibitor). Key Rationale: Glucosuria and diuresis. Predicted MCQ Trap: GLP-1; trap is nausea.

Key adverse effect to monitor in patient on methotrexate (DMARD) for RA? A. Renal toxicity B. Liver toxicity C. Hypoglycemia D. Infection

Liver toxicity. Key Rationale: Hepatotoxic potential. Predicted MCQ Trap: Renal; trap is primary.

Drug causing disabling joint pain in T2DM patient on DPP-4 inhibitor? A. Sitagliptin B. Saxagliptin C. Metformin D. Canagliflozin

Saxagliptin (DPP-4 inhibitor). Key Rationale: Arthralgia risk. Predicted MCQ Trap: Sitagliptin; trap is class.

Drug class associated with jaw necrosis in osteoporosis patients? A. SERMs B. Bisphosphonates C. RANKL inhibitors D. PTH analogs

Bisphosphonates. Key Rationale: ONJ from healing impairment. Predicted MCQ Trap: Denosumab; trap is similar.

Insulin best for pre-meal coverage in Type 1 diabetes basal-bolus regimen? A. Regular insulin B. Lispro C. NPH D. Glargine

Lispro (Rapid-acting insulin). Key Rationale: Rapid onset. Predicted MCQ Trap: Regular; trap is slower.

Infection-related contraindication to rule out before infliximab (TNF-alpha inhibitor) therapy? A. Hepatitis B B. Tuberculosis C. HIV D. Fungal infection

Tuberculosis (TB). Key Rationale: Reactivation risk. Predicted MCQ Trap: HBV; trap is viral vs. bacterial.

Osteoporosis drug suitable for postmenopausal woman with hot flashes and breast cancer history? A. Estrogen B. Raloxifene C. Alendronate D. Denosumab

Raloxifene (SERM). Key Rationale: Estrogen agonist/antagonist. Predicted MCQ Trap: HRT; trap is cancer risk.

Which drug should never be combined with nitrates due to risk of fatal hypotension? A. Tadalafil B. Sildenafil C. Alprostadil D. Testosterone

Sildenafil (PDE5 inhibitor): Contraindicated with nitrates because it can cause life-threatening hypotension. Key Rationale: NO synergy. Predicted MCQ Trap: Tadalafil; trap is all PDE5.

Which diabetic drug must be avoided with gemfibrozil due to high hypoglycemia risk? A. Nateglinide B. Repaglinide C. Metformin D. Sitagliptin

Repaglinide (Meglitinide): Gemfibrozil inhibits metabolism leading to severe hypoglycemia. Key Rationale: CYP inhibition. Predicted MCQ Trap: Nateglinide; trap is similar.

What serious interaction occurs when MAOIs are combined with phentermine? A. Serotonin syndrome B. Hypertensive crisis C. Hypoglycemia D. Seizures

Hypertensive crisis: MAOIs + stimulants can cause dangerous blood pressure spikes. Key Rationale: Catecholamine excess. Predicted MCQ Trap: Serotonin; trap is syndrome.

Which combination significantly increases lactic acidosis risk? A. Metformin + contrast B. Metformin + alcohol C. SGLT2 + alcohol D. Insulin + alcohol

Metformin (Biguanide) + alcohol: increases lactic acidosis risk especially in renal impairment. Key Rationale: Lactate impairment. Predicted MCQ Trap: Contrast; trap is similar.