[PHARMA] LE 3 – Probability Sampling by Romey

1.Mucosal erosion and ulceration occur when the defensive factors of the Gl tract are overwhelmed. Which of the following is NOT a defensive factor?\ A. Decreased blood flow\ B. Presence of the restitution process\ C. Increased mucus and bicarbonate secretion\ D. Increased prostaglandin secretion\

A. Decreased blood flow\

2.Which of the following defense mechanisms of the gastroduodenal mucosa against acid and pepsin is CORRECT?\ A. Areas of injured epithelium are slowly repaired by restitution\ B. Mucosal prostaglandins decrease bicarbonate and mucus secretion\ C. Epithelial cell-to-cell tight junctions allow back-diffusion of pepsin\ D. Blood flow carries bicarbonate and nutrients to surface cells\

D. Blood flow carries bicarbonate and nutrients to surface cells\

3.Which of the following statements on the physiology of acid secretion is INCORRECT?\ A. Gastrin released into the blood from antral G cells binds to parietal cell receptors\ B. The major effect of gastrin on acid secretion is mediated directly through parietal cell stimulation\ C. Acetylcholine directly stimulates the parietal cell\ D. Enterochromaffin-like cells have receptors for acetylcholine and gastrin that stimulate histamine release\

B. The major effect of gastrin on acid secretion is mediated directly through parietal cell stimulation\

6.Which of the following statements is TRUE?\ A. Gastric ulcer has a high risk of carcinoma formation\ B. Peppermint and chocolate are GERD trigger foods\ C. Duodenal ulcer pain decreases with meals and leads to weight gain\ D. NSAIDs decrease PGl2, leading to decreased gastric mucosal protection\

C. Duodenal ulcer pain decreases with meals and leads to weight gain\

7.A 12-year-old girl was prescribed an antacid by her pediatrician for epigastric pain. Three days later she complains of constipation. Which antacid is most likely responsible?\ A. Aluminum hydroxide\ B. Calcium carbonate\ C. Magnesium hydroxide\ D. Sodium bicarbonate\

A. Aluminum hydroxide\

10.A medical student is given an antacid for epigastric pain. Which statement about antacids is INCORRECT?\ A. Calcium carbonate is more soluble than sodium bicarbonate\ B. Calcium carbonate may cause belching\ C. Unabsorbed magnesium salts may cause osmotic diarrhea\ D. Excessive calcium carbonate with calcium-containing dairy products may cause milk-alkali syndrome\

A. Calcium carbonate is more soluble than sodium bicarbonate\

14.Acid-neutralizing capacity of antacids varies depending on all of the following EXCEPT:\ A. Rate of reaction with acid\ B. Rate of gastric emptying\ C. Rate of dissolution\ D. Degree of water and acid solubility\

D. Degree of water and acid solubility\

9.Which of the following statements about sodium bicarbonate is INCORRECT?\ A. Sodium chloride absorption exacerbates fluid retention\ B. Unreacted alkali causes gastric distention\ C. May cause metabolic alkalosis in high doses\ D. Special precaution is needed in renal failure\

B. Unreacted alkali causes gastric distention\

11.Which antacid is correctly paired with its potential adverse effect?\ A. Magnesium hydroxide: hypophosphatemia and osteodystrophy\ B. Magnesium hydroxide: hyporeflexia\ C. Aluminum hydroxide: milk-alkali syndrome\ D. Calcium carbonate: chelates and increases the effectiveness of tetracycline\

B. Magnesium hydroxide: hyporeflexia\

18.Which statement about drug interactions of antacids is INCORRECT?\ A. An antacid must not be given within 2 hours of a fluoroquinolone\ B. Solubility of a weakly basic drug is altered when taken with an antacid\ C. Absorption of a drug is increased after binding with an antacid\ D. Alkaline pH alters the solubility of other drugs\

C. Absorption of a drug is increased after binding with an antacid\

3.Which antacid should you AVOID in a patient with heart failure, hypertension and renal insufficiency?\ A. Calcium carbonate\ B. Magnesium hydroxide\ C. Aluminum hydroxide\ D. Sodium bicarbonate\

D. Sodium bicarbonate\

12.Which agent for acid-peptic disease does NOT cause belching from carbon-dioxide production?\ A. Magnesium hydroxide\ B. Calcium carbonate\ C. Sodium bicarbonate\ D. All of the choices do not cause belching\

A. Magnesium hydroxide\

19.Magnesium hydroxide is associated with which side effect?\ A. Placental crossing\ B. Constipation\ C. Vitamin B12 malabsorption\ D. Diarrhea\

D. Diarrhea\

13.Which of the following statements is TRUE?\ A. Calcium carbonate may cause metabolic acidosis\ B. Sodium bicarbonate may be taken together with iron\ C. Belching can occur after intake of Maalox\ D. Sodium bicarbonate added to gastric acid forms carbon dioxide and sodium chloride\

D. Sodium bicarbonate added to gastric acid forms carbon dioxide and sodium chloride\

15.A single 156-mEq dose of antacid given 1 hour after a meal neutralizes gastric acid for up to how long?\ A. 1 hour\ B. 4 hours\ C. 2 hours\ D. 6 hours\

C. 2 hours\

16.Which drug class used for peptic ulcer disease and gastritis is most commonly sold over the counter?\ A. Prostaglandin analogs\ B. H2-receptor antagonists\ C. Antacids\ D. All of the above\

C. Antacids\

21.A 27-year-old medical student has GERD with infrequent heartburn (fewer than three times a week). Which statement best justifies your pharmacologic choice?\ A. A PPI is preferred because of superior acid inhibition\ B. An antacid is preferred because it provides rapid neutralization\ C. H2-receptor antagonist effect is short-lived but faster in onset\ D. H2-receptor antagonists give faster relief than antacids\

B. An antacid is preferred because it provides rapid neutralization\

29.Which statement about the mechanism of adverse effects after long-term or high-dose cimetidine is FALSE?\ A. May lead to impotence at high doses\ B. Decreases serum prolactin levels\ C. Inhibits binding of dihydrotestosterone to androgen receptors\ D. Inhibits the metabolism of estradiol\

B. Decreases serum prolactin levels\

30.A 30-year-old woman with severe epigastric pain is prescribed an H2 antagonist. What should the doctor consider before prescribing?\ A. H2 antagonists do not cross the placenta\ B. H2 antagonists block cardiac H2 receptors, causing tachycardia\ C. H2 antagonists compete with procainamide for renal tubular secretion\ D. Rapid H2-antagonist infusion may cause hypertension\

C. H2 antagonists compete with procainamide for renal tubular secretion\

31.Which statement about H2 antagonists is INCORRECT?\ A. Provide acid inhibition in erosive esophagitis but are inferior to PPIs\ B. Provide effective ulcer healing for uncomplicated gastric ulcer\ C. Can be taken prophylactically before meals, twice daily, for frequent heartburn\ D. Used in treating acute peptic ulcer caused by Helicobacter pylori\

D. Used in treating acute peptic ulcer caused by Helicobacter pylori\

32.Which statement about the adverse effects of H2-receptor antagonists is NOT TRUE?\ A. They cross the placenta, so they are given only when absolutely necessary\ B. They can block cardiac H2 receptors and cause bradycardia\ C. They are secreted in breast milk and may affect nursing infants\ D. They do not cross the blood-brain barrier\

D. They do not cross the blood-brain barrier\

24.Which H2-receptor antagonist has had limited clinical use because it interferes with multiple hepatic CYP450 pathways, causing numerous drug interactions and prolonging the half-life of co-ingested drugs?\ A. Cimetidine\ B. Nizatidine\ C. Famotidine\ D. Ranitidine\

A. Cimetidine\

27.You plan to give an H2-receptor antagonist to a 30-year-old with chest discomfort after coffee. Which pharmacokinetic statement about H2 antagonists is INCORRECT?\ A. In the elderly, drug clearance declines by up to 50%\ B. H2 antagonists are cleared via renal tubular secretion\ C. H2 antagonists are absorbed in the intestine\ D. Famotidine has little first-pass effect in the liver compared with nizatidine\

D. Famotidine has little first-pass effect in the liver compared with nizatidine\

28.When prescribing ranitidine to a 40-year-old woman with dyspepsia, which pharmacodynamic principle applies?\ A. Ranitidine binds to both H1 and H2 receptors\ B. Ranitidine increases the volume of gastric secretion\ C. Ranitidine suppresses basal and meal-stimulated acid secretion\ D. Ranitidine increases pepsin concentration\

C. Ranitidine suppresses basal and meal-stimulated acid secretion\

40.Which statement about PPIs is INCORRECT?\ A. PPIs have a long duration of action\ B. PPIs inhibit fasting and meal-stimulated acid secretion\ C. PPIs inhibit 50% of 24-hour acid secretion\ D. PPIs are concentrated and activated near their site of action\

C. PPIs inhibit 50% of 24-hour acid secretion\

43.What should you tell a patient before prescribing a PPI?\ A. Take it after meals\ B. It may be taken with warfarin\ C. It takes effect immediately\ D. Three to four days are required for full acid-inhibition effect\

D. Three to four days are required for full acid-inhibition effect\

38.Which is the most accurate description of omeprazole's therapeutic mechanism?\ A. Irreversible inactivation of H

K-ATPase\ B. Activation of prostaglandin receptors\ C. Inhibition of H2 histamine receptors\ D. Inhibition of bacterial protein synthesis\

46.Proton pump inhibitors reduce the absorption of the following EXCEPT:\ A. Non-heme iron\ B. Potassium\ C. Vitamin B12\ D. Magnesium\

B. Potassium\

47.Which of the following is NOT an adverse effect of PPIs?\ A. Vitamin B12 malabsorption\ B. Low magnesium absorption\ C. Low calcium absorption\ D. Folic acid malabsorption\

D. Folic acid malabsorption\

52.Which PPI has the least significant drug interactions (and is preferred in a patient on clopidogrel)?\ A. Pantoprazole\ B. Esomeprazole\ C. Omeprazole\ D. Lansoprazole\

A. Pantoprazole\

53.Omeprazole inhibits the metabolism of the following drugs EXCEPT:\ A. Warfarin\ B. Phenytoin\ C. Heparin\ D. Diazepam\

C. Heparin\

54.Which is the best drug for Zollinger-Ellison syndrome?\ A. Lansoprazole\ B. Maalox\ C. Misoprostol\ D. Bismuth\

A. Lansoprazole\

39.Omeprazole is a substituted benzimidazole that blocks H

K-ATPase. Which statement about it is FALSE?\ A. Inactive prodrug\ B. Substituted benzimidazole that resembles ranitidine (H2RAS)\ C. Hydrophilic\ D. Weak base\

41.Which agent reduces both fasting and meal-stimulated acid secretion for 24 hours?\ A. Ranitidine\ B. Sodium bicarbonate\ C. Sucralfate\ D. Omeprazole\

D. Omeprazole\

45.A 20-year-old man has acid-reflux symptoms. What should you consider when prescribing a PPI?\ A. Capsule formulations may be used in children with dysphagia by mixing with apple juice\ B. After the first dose, all proton pumps are inactivated\ C. PPIs must be given after meals for rapid acid inhibition\ D. PPIs have a long serum half-life\

A. Capsule formulations may be used in children with dysphagia by mixing with apple juice\

48.A woman on long-term pantoprazole tests positive for Clostridioides difficile. What contributed most to the infection?\ A. Altered intestinal mucosa\ B. Intact epithelium\ C. Prolonged use of antibiotics\ D. Decreased gastric acid\

D. Decreased gastric acid\

49.A pregnant woman on long-term omeprazole presents with a low-impact fracture. Most likely cause?\ A. Direct inhibition of osteoblast activity\ B. Increased parathyroid hormone secretion\ C. Decreased calcium absorption\ D. Increased bone vascularization\

C. Decreased calcium absorption\

59.Which statement about sucralfate is TRUE?\ A. It breaks down into sucrose sulfate and an aluminum salt\ B. It forms a viscous paste in alkaline solution\ C. It is given 1 g four times daily on a full stomach\ D. It binds negatively charged proteins in the ulcer base\

A. It breaks down into sucrose sulfate and an aluminum salt\

63.A 30-year-old man with an NSAID-induced ulcer is prescribed misoprostol. Which statement is correct?\ A. It stimulates mucus and bicarbonate secretion\ B. It decreases intestinal motility and uterine tone\ C. It decreases mucosal blood flow\ D. It increases histamine-stimulated CAMP to cause modest acid inhibition\

A. It stimulates mucus and bicarbonate secretion\

64.Which of the following describes the pharmacokinetics of a prostaglandin analog (misoprostol)?\ A. Excreted in feces\ B. Rapidly absorbed\ C. Requires dose reduction in hepatic insufficiency\ D. Serum half-life is more than 30 minutes\

B. Rapidly absorbed\

68.Which statement describes bismuth compounds?\ A. Causes gastrointestinal bleeding\ B. Rapid renal excretion\ C. Binds enterotoxin for treating traveler's diarrhea\ D. Rapid dissociation within the intestine for absorption of salicylate\

C. Binds enterotoxin for treating traveler's diarrhea\

69.All of the following are adverse effects of bismuth compounds EXCEPT:\ A. Darkening of the tongue and blackening of stools\ B. High doses can lead to salicylate toxicity\ C. Should be avoided in patients with liver failure\ D. Prolonged use can lead to encephalopathy\

C. Should be avoided in patients with liver failure\

58.What best describes the mechanism of action of sucralfate?\ A. Inhibits H

K-ATPase to reduce gastric acid secretion\ B. Neutralizes gastric acid via aluminum hydroxide\ C. Negatively charged sucrose sulfate binds positively charged proteins at the ulcer base, forming a protective barrier and stimulating prostaglandin and bicarbonate secretion\ D. Is rapidly absorbed to enhance mucosal blood flow and epithelial regeneration\

60.Which drug is commonly used in ICU patients to reduce the incidence of Gl bleeding from stress-related mucosal injury, with a lower nosocomial-pneumonia risk than acid suppressors?\ A. Sucralfate\ B. Ranitidine\ C. Magnesium hydroxide\ D. Esomeprazole\

A. Sucralfate\

61.Sucralfate binds to the base of ulcers for up to how long?\ A. 2 hours\ B. 24 hours\ C. 30 minutes\ D. 6 hours\

D. 6 hours\

62.An elderly woman with severe rheumatoid arthritis has multiple gastric ulcers on EGD. She refuses to stop NSAIDs and fears the cardiovascular toxicity of COX-2 inhibitors. What is reasonable to prescribe?\ A. Omeprazole\ B. Misoprostol\ C. Metronidazole\ D. Magnesium hydroxide\

B. Misoprostol\

70.Which drug used in acid-peptic disease causes blackening of stools?\ A. Cimetidine\ B. Pantoprazole\ C. Calcium carbonate\ D. Bismuth subsalicylate\

D. Bismuth subsalicylate\

33.What is the standard length of a GERD treatment course with a PPI?\ A. 8 weeks\ B. 4 weeks\ C. 2 weeks\ D. 6 weeks\

A. 8 weeks\

85.Which lifestyle measure has the best evidence for improving GERD symptoms in an overweight patient?\ A. Avoiding all spicy food\ B. Sleeping flat without pillows\ C. Drinking milk at bedtime\ D. Weight loss\

D. Weight loss\

86.A patient with typical reflux has taken a PPI for several weeks before a normal-looking endoscopy. Most likely explanation for the absence of erosions?\ A. The patient does not have GERD\ B. The PPI caused hypergastrinemia that masks erosions\ C. Drug therapy may have already healed the erosive lesions\ D. Endoscopy is the gold standard and cannot miss GERD\

C. Drug therapy may have already healed the erosive lesions\

93.Which is a correct combination of drugs to eradicate Helicobacter pylori?\ A. PPI, metronidazole, amoxicillin, clarithromycin\ B. PPI, bismuth subsalicylate, tetracycline, metronidazole\ C. PPI, bismuth, clarithromycin, metronidazole\ D. PPI, bismuth, amoxicillin, tetracycline\

B. PPI, bismuth subsalicylate, tetracycline, metronidazole\

104.A 35-year-old alcoholic man has multiple gastric ulcers with H. pylori. Which statement about the role of the PPI is TRUE?\ A. PPIs have antimicrobial properties against the causative agent\ B. PPIs increase the minimal inhibitory concentration of amoxicillin\ C. Prolonged PPI use may increase absorption of oral cyanocobalamin\ D. Triple therapy is PPI + amoxicillin or clarithromycin + bismuth subsalicylate\

A. PPIs have antimicrobial properties against the causative agent\

100.A 55-year-old diabetic has melena and a 2-cm ulcer on EGD; H. pylori positive. She has a penicillin allergy and NO prior macrolide use. Appropriate eradication strategy?\ A. Levofloxacin with metronidazole\ B. Sequential therapy\ C. Hybrid therapy\ D. Clarithromycin with metronidazole (plus PPI)\

D. Clarithromycin with metronidazole (plus PPI)\

105.A coated tongue is a typical finding in which infection?\ A. C. difficile infection\ B. Enteric fever\ C. Shigellosis\ D. Amoebiasis\

B. Enteric fever\

106.Which medication can act as BOTH empiric and definitive therapy for salmonellosis (typhoid)?\ A. Oral ciprofloxacin\ B. Oral azithromycin\ C. IV ceftriaxone\ D. IV azithromycin\ E. All of these\

B. Oral azithromycin\

108.A 20-year-old has 2 days of fever, abdominal pain and bloody diarrhea. Stool shows gram-negative, NON-motile, facultatively anaerobic, non-spore-forming rods. First-line medication?\ A. Vancomycin\ B. Ceftriaxone\ C. Ciprofloxacin\ D. Metronidazole\

C. Ciprofloxacin\

119.Which drug can be used for C. difficile infection when first-line agents cannot be obtained?\ A. Azithromycin\ B. Ceftriaxone\ C. Clindamycin\ D. Metronidazole\

D. Metronidazole\

114.Which infection requires a luminal agent for proper eradication?\ A. Shigellosis\ B. C. difficile infection\ C. Typhoid fever\ D. Amoebiasis\

D. Amoebiasis\

118.A 45-year-old woman treated with ampicillin-sulbactam for aspiration pneumonia develops watery diarrhea, fever and pain. Colonoscopy shows yellow-white pseudomembranes. What will you prescribe?\ A. Oral metronidazole alone\ B. Intravenous metronidazole alone\ C. Intravenous vancomycin alone\ D. Oral ciprofloxacin alone\ E. Oral vancomycin alone\

E. Oral vancomycin alone\

123.Indiscriminate antibiotic use is associated with which infection?\ A. Shigellosis\ B. Amoebiasis\ C. Salmonellosis\ D. C. difficile infection\

D. C. difficile infection\

126.A 55-year-old woman with type 1 diabetes for 40 years has severe bloating and abdominal distress after meals. What can you give to relieve her symptoms?\ A. Sucralfate\ B. Loperamide\ C. Cimetidine\ D. Metoclopramide\

D. Metoclopramide\

124.What is the mechanism of action of metoclopramide?\ A. α-adrenoceptor antagonist\ B. Serotonin 5-HT4-receptor agonist only\ C. Muscarinic cholinoceptor antagonist\ D. Dopamine D2-receptor antagonist\

D. Dopamine D2-receptor antagonist\

128.An elderly patient develops irreversible tardive dyskinesia and other extrapyramidal effects from a Gl drug. Which is the likely culprit?\ A. Ondansetron\ B. Domperidone\ C. Loperamide\ D. Metoclopramide\

D. Metoclopramide\

129.Why does domperidone have a lower risk of tardive dyskinesia than metoclopramide, yet still work as an antiemetic?\ A. It is a partial dopamine agonist\ B. It poorly crosses the blood-brain barrier, while the CTZ lies outside the BBB\ C. It is a 5-HT3 antagonist\ D. It has strong anticholinergic activity\

B. It poorly crosses the blood-brain barrier, while the CTZ lies outside the BBB\

130.Which drug acts CENTRALLY as a gut motility agent?\ A. Metoclopramide\ B. Colestipol\ C. Octreotide\ D. Diphenoxylate\

A. Metoclopramide\

140.An elderly man with multiple medical problems develops worsening constipation while hospitalized for cellulitis. Which laxative is appropriate, and why?\ A. A stool softener such as lactulose given rectally\ B. Ondansetron\ C. Psyllium, because it is a bulk-forming laxative good for chronic constipation\ D. Docusate\

C. Psyllium, because it is a bulk-forming laxative good for chronic constipation\

142.Which laxatives are indigestible hydrophilic colloids that absorb water, forming a bulky emollient gel that distends the colon and promotes peristalsis?\ A. Psyllium\ B. Polyethylene glycol\ C. Lactulose\ D. Glycerin suppository\

A. Psyllium\

143.Which laxative acts as a stool softener by permitting water and lipids to penetrate the stool?\ A. Docusate\ B. Polycarbophil\ C. Psyllium\ D. Bisacodyl\

A. Docusate\

144.Which of the following laxatives (as keyed) will cause severe lipid pneumonitis?\ A. Psyllium\ B. Glycerin suppository\ C. Polycarbophil\ D. Methylcellulose\

B. Glycerin suppository\

170.Which antidiarrheal is a somatostatin analog marketed to inhibit the effects of Gl endocrine tumors?\ A. Polycarbophil\ B. Diphenoxylate\ C. Loperamide\ D. Octreotide\

D. Octreotide\

171.After ileal resection, a patient has diarrhea from unabsorbed fecal bile acids. Which antidiarrheal will you prescribe?\ A. Octreotide\ B. Domperidone\ C. Cholestyramine\ D. Loperamide\

C. Cholestyramine\

155.Which antidiarrheal is a non-prescription opioid agonist that does not cross the blood-brain barrier and has no analgesic properties or addiction potential?\ A. Lubiprostone\ B. Loperamide\ C. Octreotide\ D. Alvimopan\

B. Loperamide\

158.A 34-year-old comes to clinic with diarrhea. Which drug should you NOT give?\ A. Cholestyramine\ B. Glycerin suppository\ C. Loperamide\ D. Diphenoxylate\

B. Glycerin suppository\

163.A 21-year-old on medication for IBS takes 30 tablets in a suicide attempt. He is confused and tachycardic (HR 120), with dilated pupils, dry skin, hypoactive bowel sounds and a full bladder. Which drug did he overdose on?\ A. Docusate\ B. Ondansetron\ C. Hyoscyamine\ D. Octreotide\

C. Hyoscyamine\

164.Which highly potent, selective 5-HT3 antagonist is approved for women with severe diarrhea-predominant IBS?\ A. Hyoscyamine\ B. Octreotide\ C. Polycarbophil\ D. Alosetron\

D. Alosetron\

166.A patient on drug therapy for Crohn's disease develops headache, anorexia, fever, rash, agranulocytosis, hypersensitivity pneumonitis and worsening colitis. Most likely drug?\ A. Sulfasalazine\ B. Cyclosporine\ C. Methotrexate\ D. Budesonide\

A. Sulfasalazine\

169.An elderly man has 3 months of watery diarrhea, hypokalemia, achlorhydria and elevated VIP from a pancreatic islet tumor (VIPoma). Best agent for his symptoms?\ A. Sulfasalazine\ B. Bismuth\ C. Octreotide\ D. Glucagon\

C. Octreotide\

176.A 54-year-old receiving emetogenic chemotherapy vomits repeatedly during sessions. Which drug should be included in her regimen?\ A. Cimetidine\ B. Bromocriptine\ C. Ondansetron\ D. Cetirizine\

C. Ondansetron\

181.Which 5-HT3 antagonist has the highest propensity for life-threatening QT prolongation and torsades?\ A. Granisetron\ B. Ondansetron\ C. Dolasetron\ D. Palonosetron\

C. Dolasetron\

184.Which drug is most effective for motion sickness?\ A. Ondansetron\ B. Aprepitant\ C. Metoclopramide\ D. Scopolamine\

D. Scopolamine\

200.A hypertensive woman on losartan discovers she is pregnant. Why must she stop it?\ A. They are safe; no change needed.\ B. ACE inhibitors

ARBs cause fetal renal damage, oligohydramnios and hypocalvaria (2nd-3rd trimester)\ C. They cause gray baby syndrome\ D. They cause phocomelia\

217.A newborn has transposition of the great vessels. Which drug maintains ductus arteriosus patency until surgery?\ A. Prednisone\ B. Leukotriene antagonist\ C. Alprostadil\ D. Aspirin\

C. Alprostadil\

234.Which is the most significant (most clinically important) pharmacokinetic change with aging?\ A. Increased hepatic Phase II conjugation\ B. Decreased renal clearance\ C. Decreased gastric absorption\ D. Increased plasma albumin\

B. Decreased renal clearance\

236.In geriatric patients, decreased total body water affects HYDROPHILIC drugs (digoxin, aminoglycosides, ethanol) how?\ A. Faster renal clearance\ B. Increased volume of distribution\ C. Decreased volume of distribution -> higher plasma concentration -> reduce the loading dose\ D. No change\

C. Decreased volume of distribution -> higher plasma concentration -> reduce the loading dose\

246.According to the Beers Criteria, which drug class is most strongly associated with anticholinergic effects, delirium, falls and fractures in older adults?\ A. SSRIS\ B. ACE inhibitors\ C. Tricyclic antidepressants\ D. Statins\

C. Tricyclic antidepressants\

249.An elderly man on a diuretic develops urinary frequency and is started on oxybutynin for 'overactive bladder'. He becomes confused and constipated. This sequence is an example of:\ A. A drug holiday\ B. Intelligent non-compliance\ C. A prescribing cascade\ D. Therapeutic duplication\

C. A prescribing cascade\

255.An elderly patient with dementia, lost to follow-up after starting treatment, now has visual hallucinations (seeing deceased relatives). Most likely culprit?\ A. Donepezil\ B. Galantamine\ C. Memantine\ D. Rivastigmine\

C. Memantine\

259.Which factors lower the threshold for digoxin toxicity in the elderly, and which atypical toxicities should you watch for?\ A. Hypokalemia, hypomagnesemia, hypoxemia, coronary atherosclerosis; delirium, visual changes, endocrine effects\ B. Hyperkalemia only; rash\ C. Hypercalcemia only; diarrhea\ D. No special factors; only arrhythmias\

A. Hypokalemia, hypomagnesemia, hypoxemia, coronary atherosclerosis; delirium, visual changes, endocrine effects\

AM1.A 65-year-old man had a percutaneous nephrostomy in India and took ciprofloxacin x 7 days. Two weeks later: confusion, dysuria, chills, BP 90

50, T 38.5C WBC 24,000, ^ lactate, pyuria with 4+ bacteria. Which organism do the cultures most likely grow?\ A. ESBL-producing E. coli\ B. Methicillin-susceptible S. aureus\ C. Ampicillin-susceptible E. faecalis\ D. Candida albicans\

AM2.In the same patient, which initial empiric regimen is correct while resuscitating and checking the nephrostomy?\ A. Repeat oral ciprofloxacin\ B. Nitrofurantoin\ C. Meropenem + vancomycin\ D. Ceftriaxone alone\

C. Meropenem + vancomycin\

AM3.Drug of choice for surgical prophylaxis in most cardiac, thoracic, vascular, orthopedic and biliary procedures:\ A. Vancomycin\ B. Cefazolin\ C. Meropenem\ D. Ceftriaxone\

B. Cefazolin\

AM4.When should parenteral surgical prophylaxis be given, and for how long?\ A. At skin closure; continue 5-7 days\ B. 24 h before surgery; continue until discharge\ C. Only if the wound becomes infected\ D. Within 60 min before incision; ideally a single dose\

D. Within 60 min before incision; ideally a single dose\

AM5.A wound with acute non-purulent inflammation, a major break in technique and spillage from a hollow organ is classified as:

A. Clean (MIC)

B. fT>MIC

C. AUC24/MIC

D. MBC

B. fT>MIC

AM10.Current vancomycin dosing targets which parameter, with renal monitoring?\ A. Trough level alone\ B. fT > MIC\ C. Cmax

MIC\ D. 24-h AUC

AM11.The minimum inhibitory concentration (MIC) is best described as:\ A. Lowest concentration that kills 99.9% of organisms\ B. Peak serum concentration after a dose\ C. Lowest concentration preventing visible growth\ D. Zone of inhibition in mm\

C. Lowest concentration preventing visible growth\

AM12.Which statement about Kirby-Bauer disk diffusion is INCORRECT?\ A. Zone sizes can be compared directly between different antibiotics\ B. Larger zone = greater susceptibility\ C. Each organism-drug pair has its own breakpoint\ D. Result is reported as S, I or R\

A. Zone sizes can be compared directly between different antibiotics\

AM13.Bactericidal therapy is considered absolutely required in all EXCEPT:\ A. Uncomplicated cellulitis in an immunocompetent host\ B. Infective endocarditis\ C. Bacterial meningitis\ D. Infection in a neutropenic patient\

A. Uncomplicated cellulitis in an immunocompetent host\

AM14.Which is a bacteriostatic agent?\ A. Vancomycin\ B. Daptomycin\ C. Linezolid\ D. Gentamicin\

C. Linezolid\

AM15.TMP-SMZ is synergistic by which mechanism?\ A. Inhibition of enzymatic inactivation\ B. Blockade of sequential steps (folate pathway)\ C. Enhanced uptake of the second drug\ D. Induction of B-lactamase\

B. Blockade of sequential steps (folate pathway)\

AM16.Penicillin + aminoglycoside for enterococcal endocarditis works because:\ A. Both block sequential folate steps\ B. The aminoglycoside inhibits B-lactamase\ C. Penicillin induces porin loss\ D. The cell-wall agent increases aminoglycoside uptake\

D. The cell-wall agent increases aminoglycoside uptake\