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معهد البحوث الطبية

Medical Research Institute

Pharmacology Department Semester: spring

PhD Degree Academic year: 2019/2020

Course title: Clinical Pharmacology & therapeutics II Time allowed: 180 minutes

Course code: 1704801 Date: 11 / 7/ 2020

Final Exam Total marks: 75

THE EXAM CONSISTS OF “2” QUESTIONS IN “26” PAGES

Question no.1: (59 marks, 0.5 mark each)

Select the ONE lettered answer that is BEST in each of the following statements:

1. In shock

(a) Vasoconstriction of vital organs causes further increase in blood pressure

(b) There is release of mediators like epinephrine and norepinephrin (c)

Hypoperfusion of heart and brain leads to failure of these organs (d)

Mortality is high even with optimal treatment

2. In shock:

(a) Hypovolemia may be caused directly by bleeding

(b) Hypovolemia may be caused indirectly by movement of extracellular fluid

intracellularly

(c) Various insults can be the underlying cause including fever and diabetes (d)

Irradiation can be one case of precipitating shock

3. In class Ia antiarrhythmic drugs:

(a) Quinidine and procainamide are the most drugs used in this class

(b) Disopramide resembles quinidine including its atropine-like effect (c)

Disopramide has more negative inotropic action than quinidine.

(d) Disopramide is more likely to cause hypersensitivity reactions than quinidine

4. Class I antiarrhythmic drugs:

(a) Activate sodium channels by binding to sites in the α-subunit

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(b) Increase the maximum rate of polarization in phase 0

(c) Bind to channels most strongly when they are either in the open or refractory state

(d) Activation of sodium cannels happens slowly

5. Emergency treatment of serious dysrhythmias includes:

(a) Propranolol

(b) Lidocaine

(c) Verapamil

(d) Electrical cardioversiom

6. Circulating drugs that may bring about cardiac arrhythmia include:

(a) Antiarrhythmics

(b) Parasympatholytics

(c) Anesthetics

(d) Opioids

7. Signs and symptoms of arrhythmia may include the following EXCEPT:

(a) Dizziness or collapse because of a poor blood supply to the brain

(b) Shortness of breath because of poor oxygenation

(c) Angina associated with a poor coronary circulation and/or

(d) Decreased cardiac workload arising from a bradycardia and weakness

8. Amiodarone as antiarrhythmic agent

(a) Has long t½ of 10 to 100 days and accumulates in the body during repeated dosing

(b) An i.v loading dose is usually given in a peripheral vein

(c) Causes phlebitis if given in a central vein

(d) Used mainly to treat bradyarrhthmias

9. Side defects of amiodarone include the following, except:

(a) Renal insufficiency

(b) Grey/bluish coloration of the skin

(c) Pulmonary fibrosis

(d) Thyroid abnormalities connected to high iodine content

10. Mechanism of action of mediators that promote smooth vasodilatation in shock

includes

(a) Activation of ATP-sensitive Ca++ channels in vascular muscles

(b) Relative increased secretion of antidiuretic hormone

(c) Increased synthesis of nitric oxide

(d) Relative deficiency of adrenalin secretion due to inhibition of synthesis by adrenal

gland

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11. The following are used to treat hypovolemic shock, except:

(a) Adrenaline can be life saving

(b) Blocking or neutralizing endotoxins , interleukins and tumor necrosis factor

(c) Supporting the circulation with vasoactive drugs designed to optimize flow to vital

organs (d) Volume replacement therapy by i.v. fluids to correct hypovolemia

12. Which of the following is not a property of the antiarrhythic Flicainamide? (a)

Is short acting antiarrhthnic administered i.v.

(b) May increase the incidence of sudden death after myocardial infarction

(c) Its main use of is in prophylaxis against paroxysmal atrial fibrillation (d)

Clinical uses include recurrent tachyarrythmias

13. Emergency treatment of serious dysrhythmias include:

(a) Propranolol

(b) Lidocaine

(c) Verapamil

(d) Electrical cardioversion

14. Which of the following conditions cannot cause shock?

(a) Hemorrhage

(b) Malignancy

(c) Anaphylaxis

(d) Myocardial infarction

15. In the physiological response to hypovolemia, which of the following is not correct?

(a) Vasodilatation of vital organs favors their perfusion

(b) Vasodilatation of certain organs causes reduction in blood pressure

(c) Tissue hypoxia is a serious problem

(d) Vasodilatation of vital organs prevents rapid deterioration of clinical condition

16. Which of the following is not true for patients with established shock?

(a) Have profound and inappropriate vasodilatation in non-essential organs

(b) Vasodilatation is non-essential organs could be easily corrected by vasoconstrictors

(c) Hypoperfusion leads to multiple organ failure

(d) Correcting hypotension is an essential step in treatment

17. Which of the following is not found in shock?

(a) There is release of mediators which promote hypotension

(b) The released mediators cause capillary dilatation

(c) There is leaking of blood in interstitial tissue

(d) The released mediators include histamine, nitric oxide and prostaglandins

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18. The mechanisms of action of mediators promoting vasodilatation in shock include the

following, except:

(a) Increased synthesis of nitric oxide

(b) Activation of ATP-sensitive Ca+2 channels in vascular smooth muscle

(c) Relative deficiency of antidiuretic hormone

(d) Increased synthesis of NO

19. Treatment of hypovolemic shock includes:

(a) Supporting the circulation with mixtures of vasoactive drugs

(b) Antagonists which block interleukins and inducible nitric oxide synthase

(c) Volume replacement is useful with hypovolemia

(d) Adrenaline can be life-saving

20. Propranolol as antiarrhythmic is not suitable for clinical use in:

(a) Reduction of mortality following myocardial infarction

(b) Prevention of recurrence of tachyarrhythmia provoked by increased sympathetic

activity

(c) Recommended for use in patients with bronchial asthma (d) Prevention of

paroxysmal fibrillation

21. Lidocaine in the treatment of dysrhythmia

(a) Is given by i.v. infusion immediately following MI to prevent ventricular dysrhythia

(b) In certain cases may be administered orally

(c) Its plasma t1/2 is 20 hours but may be accelerated if hepatic blood flow is increased

(d) Its main adverse effect is paralysis od respiratory muscles

22. Satolol has the following properties, except:

(a) More effective than amiodarone in preventing chronic malignant tachyarrhythmia

(b) Is valuable in patients whom β-adrenoceptor antagonists are not contraindicated

(c) Suppresses ventricular ectopic beats and short runs of ventricular tachycardia

(d) Prolongs the cardiac action potential and slows the outward potassium current

23. The following are properties of verapamil in the treatment of dysrhythmia, except

(a) Intravenous preparations are preferred

(b) Is subject to extensive first-pass if given orally

(c) Displaces digoxin from tissue binding sites and reduces its renal elimination if

coadministered

(d) Is ineffective and dangerous in ventricular dysrhythmias

24. The properties of adenosine as antiarrhythmic includes:

(a) It has largely replaced verapamil for this purpose because it is safer

(b) The effects of a bolus dose of adenosine last only 2-3 hours

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(c) The vasodilator and antiplatelet drug Dipyridamole blocks adenosine receptors and

inhibits the action of i.v. adenosine.

(d) Theophylline and other xanthine alkaloids potentiate adenosine and prolongs its

adverse effects

25. Digoxin has the following antiarrhhythmic properties except:

(a) Has a role in the management of atrial tachyarrhythmia., in the presence of congestive

heart failure

(b) Effects of digoxin are decreased by hyperkalemia, hypocalcemia and thyrotoxicosis

(c) Digoxin inhibits conduction through the AV node and thus protects the ventricles from

rapid atrial rhythms

(d) Non-cardiac side effects include anorexia, nausea & vomiting, fatigue, confusion,

abnormal color vision (excess yellow-green

26. A 63-year old man was admitted to the emergency department because of a 12-

hour history of dyspnea,and bradycardia.He was taking propranolol, captopril

furosemide, and amiloride because of previous myocardial infarction, as well as

ibuprofen for osteoarthritis.Physical examination showed the patient was in

respiratory distress with the following signs:blood pressure 150/86 mm Hg;

heart rate 40 bpm; respirations 20/min.Which of the following substances was

most likely increased in the patient’s serum?

(a) Sodium (b)

Calcium

(c) Glucose

(d) Potassium

27. All of the following agents may be associated with hypokalemia, EXCEPT:

(a) Hydrochlorothiazide

(b) Furosemide (c) Amiloride

(d) Indapamide

28. Diuretic that may be used to treat epilepsy, and open angle glaucoma

(a) Acetazolamide (Diamox)

(b) Chlorothiazide (Diuril)

(c) Bumetanide (Bumex)

(d) Metolazone (Zaroxolyn)

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29. Chlorothiazides can produce which one of the following actions :

(a) Hyperkalemia

(b) Hyperuricemia

(c) Hypoglycemia in diabetic patients

(d) Hypocalcemia

30. A 75-year-old woman with hypertension is being treated with a thiazide. Her blood

pressure was read at 120/75 mm Hg. After several months on the medication, she

complains of being tired and weak. An analysis of the blood indicates low values of

which of the following?

(a) Calcium

(b) Glucose

(c) Potassium

(d) Sodium

31. A 55-year –old male with kidney stones has been placed on a diuretic to decrease

calcium excretion. After a few weeks, he develops an attack of gout. Which diuretic

was he taking?

(a) Furosemide

(b) Hydrochlorothiazide

(c) Spironolactone

(d) Triamterine

32. A group of athletes is planning a mountain climbing trip. Which of the following drugs

would be appropriate for them to take to prevent mountain sickness?

(a) A thiazide diuretic

(b) An anticholinergic

(c) A carbonic anhydrase inhibitor

(d) A β- blocker

33. An alcoholic male with hepatic cirrhosis. To control ascites and oedema, he is

prescribed which one of the following?

(a) Hydrochlorothiazide

(b) Acetazolamide

(c) Spironolactone

(d) Mannitol

34. A 69-year old man was recently diagnosed with severe cardiac failure and the

physician started treatment with propranolol, captopril, and digoxin.Diuretic

therapy was also included.Which of the following pairs of diuretics would have been

most appropriate for this patient ?

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(a) Hydrochlorothiazide and spironolactone

(b) Furosemide and spironolactone

(c) Triamterene and acetazolamide

(d) Furosemide and mannitol

35. A 32-year-old woman suffering from idiopathic hypercalciuria was diagnosed with a

large stone in the right renal pelvis. She was scheduled for surgical removal of the

calculus. Which of the following drugs would be appropriate for the patient to

prevent new stone production

(a) Acetazolamide

(b) Furosemide

(c) Hydrochlorothiazide

(d) Triamterene

36. A 65-year-old patient was scheduled for surgery to remove a brain tumour. Which of

the following drugs would be given before and after surgery to prevent increased

intracranial pressure

(a) Hydrochlorothiazide

(b) Mannitol

(c) Triamterine

(d) Propranolol

37. A 64-year-old woman suffering from stage C heart failure had her diuretic

medication changed because of a serious allergic reaction to furosemide. Which of

the following diuretics was most likely prescribed?

(a) Spironolactone

(b) Triamterene

(c) Ethacrynic acid

(d) Indapamide

38. A 63-year-old woman was brought to the emergency department. Her past medical

history was significant for bone metastases from breast cancer.Her serum values

were Na 148 mEq/L (136-145 mEq/L); Ca 19.2 mg/dl (8.5-10.5 mg/dl).An IV saline

infusion was started and a diuretic was given. Which of the following diuretics was

most likely administered?

(a) Acetazolamide

(b) Hydroclorothiazide

(c) Furosemide

(d) Amiloride

39. A 60-year-old man was admitted to the hospital because of weakness, polydipsia

(excessive thirst), polyuria over the last 2 weeks. Blood pressure 136/95 mm Hg,

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heart rate 80 bpm, respirations 13/ min. K+ 3.1 mEq/L (normal 3.5-5 ); aldosterone

45 ng/dl (normal 7-30). CT scan showed bilateral adrenal hyperplasia.Which of the

following drugs are included in the therapeutic regimen of this patient

(a) Hydrochlorothiazide

(b) Mannitol

(c) Spironolactone

(d) Furosemide

40. A 66-year-old woman suffering from systolic cardiac failure was brought to

department because of sudden onset of dyspnea, cyanosis, tachypnea,

restlessness. Cough with pink tinged sputum, pulse 120 bpm.Blood pressure

80/45 and rales audible at lung bases. Which of the following drugs was mostly

included in the immediate treatment of the patient

(a) Amiloride

(b) Mannitol

(c) Furosemide

(d) Metoprolol

41. Digoxin has the following pharmacological effects

(a) Increased cardiac output without increasing oxygen consumption

(b) Negative inotropic effect

(c) Positive chronotropic effect

(d) All of the above

42. A 73-year old man complained to his physician of increasing fatigue and shortness of

breath that was often worse at night. He also noticed that his feet were getting

swollen. Blood pressure 150/90, respirations 17/min. On examination, mild pitting

edema was seen on the legs. ECG showed a second degree atrioventricular block.his

physician diagnosed cardiac failure and prescribed therapy.Which of the following

drugs would be contraindicated for this patient?

(a) Captopril

(b) Losartan

(c) Digoxin

(d) Furosemide

43. To treat cardiac arrhythmias due to toxicity by digoxin

(a) Correction of hypokalemia by oral potassium or potassium-sparing diuretics

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(b) Specific anti-arrhythmic drugs like lidocaine

(c) Quinidine is contraindicated because it may increase digoxin level in plasma (d) All

of the above

44. A 57-year old woman suffering from persistent atrial flutter started a treatment with

digoxin.Which of the following cardiac actions most likely occurred during the

therapy?

(a) Increased end systolic volume

(b) Decreased cardiac automaticity

(c) Decreased heart rate

(d) Increased atrial refractory period

45. The inotropic action of cardiac glycosides is due to

(a) Inhibition of membrane bound Na+,K+-ATPase (Na+, K+-pump)

(b) Stimulation of sympathetic activity

(c) Inhibition of parasympathetic activity

(d) Increase of potassium entry into the cardiac cell

46. A 61-year old man recently diagnosed with stage C heart failure was admitted to the

hospital for evaluation. A treatment that included digoxin was started. Which of the

following cardiovascular parameters did digoxin most likely increased? (a) Heart

rate

(b) Oxygen consumption of the heart

(c) Total peripheral resistance

(d) Stroke volume

47. Digoxin in CHF patients with edema causes diuresis, because

(a) It improves blood circulation

(b) It has a direct effect on the glomeruli in the kidney

(c) It inhibits the antidiuretic hormone

(d) Only (a) and (b) are correct

48. A 63-year old woman recently diagnosed with systolic heart failure started a

treatment with furosemide and captopril.Plasma levels of which of the following

pairs of compounds were most likely increased after administration of captopril?

(a) Vasopressin and sodium

(b) Norepinephrine and angiotensin II

(c) Bradykinin and angiotensin I

(d) Angiotensin III and prostaglandins

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49. Which one of the following is most likely to contribute to the arrhythmogenic effect of

digoxin

(a) Increased vagal discharge

(b) Increased serum calcium level

(c) Increased extracellular potassium

(d) Decreased sympathetic discharge

50. Compensatory increases in heart rate and renin release that occur in heart failure

may be alleviated by which of the following drugs?

(a) Milrinone

(b) Digoxin

(c) Dobutamine

(d) Metoprolol

51. Which of the following are the drugs of choice for long-term control in patients

with any degree of persistent asthma?

A. Inhaled β2 agonists

B. Methylxanthines

C. Inhaled corticosteroids

D. Cromolyn and nedocromil

E. Inhaled Ipratropium

52. Which of the following can be used for quick relief of an acute asthma attack?

A. Salmeterol inhaler

B. Formoterol inhaler

C. Salbutamol (albuterol) inhaler

D. Inhaled corticosteroids

E. An inhaler contains a combination of formoterol and fluticasone

53. Which of the following statements is not true regarding the short acting β2-

agonists (SABA)?

A. All patients with asthma should be prescribed a SABA inhaler

B. Can be used as a sole therapeutic agent for patients with persistent asthma

C. Can be used for exercise-induced bronchospasm.

D. Have both bronchodilator and anti-inflammatory effects

E. Both (B) and (D)

F. Both (C) and (D)

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54. Which of the following statements is not true regarding the leukotriene

modifiers?

A. are useful for treatment of asthma in patients who are poorly controlled by

conventional therapy

B. Used as alternatives for patients experience adverse effects secondary to

corticosteroid treatment.

C. Can be used in situations where immediate bronchodilation is required.

D. Leukotriene receptor antagonists can be used for the prevention of

exerciseinduced bronchospasm.

E. Zileuton is a selective and specific inhibitor of 5-lipoxygenase enzyme.

55. Which of the following drugs is called a mast cell stabilizer?

A. Omalizumab

B. Montelukast

C. Cromolyn

D. Zileuton

E. Ipratropium

56. Which of the following anti-asthmatic drugs that act via blocking the vagally

mediated contraction of airway smooth muscle and mucus secretion?

A. Inhaled salbutamol

B. Inhaled fluticasone

C. Inhaled Ipratropium

D. Inhaled nedocromil

E. Inhaled cromolyn

57. Which of the following anti-asthmatic drugs is an immunomodulatory drug that

selectively binds to human immunoglobulin E (IgE)?

A. Omalizumab

B. Montelukast

C. Cromolyn

D. Montelukast

E. Ipratropium

58. A 23-year-old woman is using an albuterol (Salbutamol) inhaler for frequent

acute episodes of asthma and complains of symptoms that she ascribes to the

albuterol.

Which of the following is not a recognized action of albuterol?

A. Diuretic effect

B. Tachycardia

C. Skeletal muscle tremors

D. Palpitations

E. None of the above

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59. A 10-year-old child has severe asthma and was hospitalized 5 times between the

ages of 7 and 9. He is now receiving outpatient medications that have greatly

reduced the frequency of severe attacks. Which of the following is most likely to

make a growth defect in this child when used daily over long periods for severe

asthma?

a. Albuterol by aerosol

b. Beclomethasone by aerosol

c. Cromolyn by inhaler

d. Prednisone by mouth

e. Theophylline in long-acting oral form

60. The only steroid that can be safely used orally in pregnant women with bronchial

asthma.

a. Prednisone.

b. Prednisolone.

c. Dexamethasone.

d. Ciclesonide.

e. Fluticasone

61. Which of the following statements best describe the term soft steroid?

a. An inhaled corticosteroid which is metabolized by enzymes in the lungs.

b. It has an increased risk of toxicity from systemic absorption when given

inhalationally.

c. Ciclesonide is an example.

d. Both (a) and (c) are correct.

e. All of the above.

62. A mast cell stabilizer that is used for patients with multiple disorders (atopic

dermatitis, perennial rhinitis, conjunctivitis etc.) as it has antihistaminic action

apart from mast cell stabilizing property.

a. cromolyn sodium.

b. nedocromil.

c. ketotifen.

d. ketoprufen.

e. zafirlukast.

63. Which of the following statements doesn’t describe COPD?

a. A disease state characterized by a reversible airflow limitation

b. The airflow limitation is usually progressive.

c. Abnormal inflammatory response of the lungs to noxious particles or gases.

d. Progressive respiratory diseases like emphysema and chronic bronchitis.

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64. Which of the following clinical features can diagnose chronic bronchitis?

a. Chronic cough with sputum production for 6 consecutive months.

b. Chronic or recurrent cough with sputum production on most days for at least

3 months of the year during at least 2 consecutive years, in the absence of

other diseases recognized to cause sputum production.

c. Nonproductive cough.

d. Abnormal enlargement of the air spaces distal to the terminal bronchioles.

65. Which of the following best describes the pattern of inflammation in COPD?

a. Similar pattern of inflammation as asthma.

b. Milder inflammation than asthma.

c. An exaggerated inflammatory response with an increase in certain

inflammatory cells with the release of inflammatory mediators and

cytokines.

d. Shows a good response to corticosteroids.

66. The emphysematous destruction of the alveoli may be caused by………

a. Decreased production/activity of proteinases.

b. Increased production/activity of antiproteinases.

c. Decreased production/activity of antiproteinases.

d. Increased α1-antitrypsin activity.

67. Oxidative stress seen in COPD can cause all of the following except

a. Damaging the intracellular matrix, oxidizing biological molecules.

b. Causing cell destruction and promoting histone acetylation.

c. Decreases the activity of antiproteinases.

d. Increases responsiveness to corticosteroids.

68. Which of the following statements is true regarding the management of COPD?

a. Easily controlled on a daily basis of treatment.

b. Lung function is fully reversible upon using bronchodilator.

c. Drug treatment can only relieve symptoms and smoking cessation is the

only management strategy proven to slow progression of COPD.

d. The inhaled corticosteroids are the drugs of choice for long-term control in

COPD patients.

69. Which of the following statements is true regarding the use of bronchodilator in

COPD?

a. COPD patients respond similarly to β2-agonists as asthmatic patients.

b. The inhaled β2-agonists is not preferred as it causes severe side effects.

c. Ipratropium has a more rapid onset of action and a more prolonged

bronchodilator effect compared with standard β2-agonists.

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d. Inhaled anticholinergic drugs reverse the vagal tone which is the major

reversible component and have a significant bronchodilator effect.

70. Which of the following combination inhalational bronchodilator products can

reduce the need of frequent dosing for COPD patient?

a. A combination of albuterol and ipratropium

b. A combination of formoterol and tiotropium.

c. A combination of terbutaline and ipratropium

d. A combination of terbutaline and salbutamol.

71. Which of the following statements is NOT true regarding the use of antibiotics in

COPD?

a. Should be used on a regular basis in the management of COPD patients.

b. Should be used during acute exacerbations of COPD.

c. Should be used if the patient exhibits increased dyspnea

d. Should be used if the patient exhibits increased sputum volume, and sputum

purulence

72. Which of the following statements describes the mechanism of action of

salbutamol?

a. Stimulating β2-adrenoceptors increasing cyclic adenosine monophosphate

(cAMP).

b. Blocking β2-adrenoceptors decreasing cyclic adenosine monophosphate

(cAMP).

c. Increasing cyclic adenosine monophosphate (cAMP) causing

dephosphorylation of a cascade of enzymes.

d. Inhibiting adenylyl cyclase via inhibitory G-proteins.

73. Regarding the use of corticosteroid and theophylline in COPD patients; which of

the following statements is true?

a. Corticosteroids are the first line therapy for COPD patients.

b. Theophylline should never be combined with corticosteroids as it could

increases its toxicity and decreases its responsiveness.

c. Children clear theophylline slower than adults and thus require lower dose.

d. Low dose theophylline could be able to reverse the decrease in histone

deacetylase activity associated with oxidative stress and may be of benefit

in reversing corticosteroid resistance.

74. In patients with inherited AAT deficiency–associated emphysema, treatment

focuses on all of the following except

a. Reduction of risk factors such as smoking

b. Symptomatic treatment with bronchodilators.

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c. Augmentation therapy with replacement α1-antitrypsin.

d. Augmentation therapy with replacement neutrophil elastase.

75. Which of the following statements are NOT correct regarding long acting β2

agonists LABA?

a. The use of LABA monotherapy as an asthma controller medication in

patient with persistent asthma.

b. LABAs are considered to be useful adjunctive therapy for attaining asthma

control.

c. Should be considered when COPD patients demonstrate a frequent need for

short-acting agents (with frequent and persistent symptoms).

d. Should not be used for quick relief of an acute asthma attack.

76. Which of the following drugs is the bronchodilator of choice in asthmatic or

COPD patients on propranolol (β blocker) therapy?

a. Albuterol.

b. Ipratropium.

c. Formoterol.

d. Terbutaline.

77. With which of the following receptors theophylline has an antagonistic

interaction?

a. Histamine receptor s

b. Bradykinin receptors

c. Adenosine receptors

d. Imidazoline receptors

78. Which of the following statements is NOT true regarding COPD?

a. It is initially diagnosed in adults over the age of 40.

b. 99% of COPD patients are due to a genetic disorder.

c. Aggravations are caused by respiratory tract infections such as pneumonia

and the flu.

d. Tobacco smoking is the most important and dominant risk factor in the

development of COPD.

79. Treatment of acute exacerbations of COPD may include all of the following

except

a. Intensification of bronchodilator therapy.

b. A short course of systemic corticosteroids.

c. The use of the proper antimicrobial therapy.

d. A single dose of pneumococcal vaccine and annual influenza vaccinations.

80. To which of the following inhalers the xerostomia and bitter taste are related?

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a. Inhaled salbutamol.

b. Inhaled corticosteroids.

c. Inhaled ipratropium.

d. Inhaled formoterol.

81. Which enzyme is inhibited by aminophylline?

a. Monoamine oxidase.

b. Alcohol dehydrogenase

c. Phosphodiesterase

d. Cytochrome P 450

82. Which of the following is a suitable agent for hypertensive patient with gouty

arthritis?

a. Loop Diuretic.

b. Thiazide Diuretic.

c. Thiazide like Diuretic.

d. The angiotensin receptor blocker; Losartan.

83. COX-2 selective agents e.g. Etoricoxib can be used for treatment of acute gout

but it is not recommended for the routine use due to………….. A.

The high risk of developing gastro-intestinal bleeding.

B. The high risk of developing acute renal failure

C. The increased risk of cardiovascular thromboembolic events.

D. All of the above.

E. None of the above

84. Which of the following anti-gout medications acts via inhibition of microtubule

assembly causing mitotic arrest in neutrophils with subsequent inhibition of

monosodium urate crystal-induced leucocyte migration and release of

inflammatory mediators e.g. IL-1β? A. Indomethacin

B. Allopurinol

C. Colchicine

D. Probencid

E. Anakinra

85. An IL-1 receptor antagonist approved for the management of signs and

symptoms of rheumatoid arthritis and has been shown to reduce the pain and

inflammation of gout.

a. Anakinra

b. Omalizumab.

c. Canakinumab.

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d. Pegloticase

86. A monoclonal antibody approved for treatment of a number of

autoinflammatory diseases as it can neutralize the activity of human IL-1β,

leading to inhibition of IL-1β signaling and suppression of inflammation.

a. Rilonacept

b. Omalizumab.

c. Canakinumab.

d. infliximab

87. A soluble receptor that binds to IL-1α and β inhibiting their action.

a. Rilonacept

b. Omalizumab.

c. Canakinumab.

d. Anakinra

88. All of the following about benzbromarone and sulphinpyrazone are true except

A. They increase uric acid excretion primarily by inhibiting post-secretory tubular

absorption of uric acid from filtered urate in the kidney.

B. Used as second-line agents in patients who are urate under-excreters.

C. Used as second-line agents in patients who are urate over-producers.

D. Should be avoided in patients with urate nephropathy.

E. Patients receiving these agents are required to maintain an adequate fluid intake to

prevent urate precipitation

89. Which of the following anti-gout medications is most likely to increase serum

concentrations of conventional doses of methotrexate, a weak acid that is

primarily cleared in the urine (a renally excreted anionic drug)?

A. Indomethacin

B. Allopurinol

C. Colchicine

D. Febuxostat

E. Probenecid

Questions 90 and 91. A 52-year-old woman presented with intense pain, warmth, and

redness in the first toe on her left foot. Examination of fluid withdrawn from the

inflamed joint revealed crystals of uric acid.

90. In the treatment of this woman’s acute attack of gout, a high dose of colchicine

will reduce the pain and inflammation but will results in severe diarrhea. Thus,

many

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physicians prefer to treat acute gout with another medication which is……………..

A. Allopurinol

B. Indomethacin

C. Benzbromarone

D. Rasburicase

E. Aspirin

91. Over the next 7 months, the patient had 2 more attacks of acute gout. Her serum

concentration of uric acid was elevated. The decision was made to put her on

chronic drug therapy to try to prevent subsequent attacks. Which of the following

drugs could

be used to decrease this woman’s rate of production of uric acid?

A. Allopurinol

B. Aspirin

C. Colchicine

D. Hydroxychloroquine

E. Probenecid

92. Regarding the Unfractionated heparin (UFH); which of the following statements

is incorrect?

A. Unfractionated heparin (UFH) is a heterogeneous mixture of sulfated

glycosaminoglycans of variable lengths and pharmacologic properties.

B. The UFH could inhibit blood coagulation through direct inhibition of the activity

of several clotting factors like factors IXa, Xa, XIIa, and thrombin (IIa).

C. The anticoagulant effect of UFH is mediated through a specific pentasaccharide

sequence on the heparin molecule that binds to antithrombin, provoking a

conformational change.

D. The UFH-antithrombin complex is 100 to 1,000 times more potent as an

anticoagulant than antithrombin alone.

Anticoagulan

t drug

19

93. The following figure indicate the mechanism of anticoagulant action of ……..

A. Fondaparinux.

B. Unfractionated Heparin

C. Low-molecular-weight heparin; Enoxaparin.

D. Warfarin.

E. The Hirudin analogue; Bivalirudin

Questions 94-97. A 67-year-old woman presents with pain in her left thigh muscle.

Duplex ultrasonography indicates the presence of deep vein thrombosis (DVT) in the

affected limb.

94. The decision was made to treat this woman with enoxaparin. Relative to

unfractionated heparin (UFH), enoxaparin has the following are characteristics

except

A. A more predictable anticoagulation dose response when given SC.

B. They are approximately one-third the molecular weight of UFH.

C. They have shorter biological half-lives requires more frequent dosing.

D. They are associated with lower incidence of thrombocytopenia.

E. Less need for routine laboratory monitoring to guide dosing.

95. During the next week, the patient was started on warfarin and her heparin was

discontinued. Two months later, she returned after a severe nosebleed.

Laboratory analysis revealed an INR (international normalized ratio) of 7.0 (INR

20

value in such a warfarin-treated patient should be 2.0–3.0). What is the possible

intervention required to prevent severe hemorrhage?

A. The warfarin should be discontinued and this patient should be treated immediately

with protamine.

B. The warfarin should be discontinued and this patient should be treated immediately

with Vitamin K1 (phytophenadione).

C. The warfarin should be discontinued and this patient should be treated immediately

with aspirin or clopidogril.

D. A fibrinolytic agent like alteplase should be indicated.

96. Regarding the hemorrhagic complication of warfarin, which of the following

concurrent therapies could be responsible for this condition?

A. Phenobarbital.

B. Rifampicin.

C. Cimetidine.

D. Carbamazepine.

97. By which of the following mechanisms could the drug in question 96 increases the

risk of bleeding?

A. Inhibition of hepatic cytochrome P450.

B. Induction of hepatic cytochrome P450.

C. Inhibition of platelet aggregation.

D. Displacing warfarin from plasma albumin.

98. Which of the following drugs could be indicated as an anticoagulant for patients

with inherited or acquired deficiency of antithrombin III?

A. Enoxaparin.

B. Fondaparinux.

C. Unfractionated heparin.

D. Hirudin analogues include lepirudin , bivalirudin.

E. Aspirin.

99. Regarding the heparin-induced thrombocytopenia (HIT); which of the following

statements is incorrect?

A. It occurs in two forms in which the second type of thrombocytopenia is immune

mediated often results in much more profound decreases in platelet count and an

increased risk of thromboembolism.

B. The LMWHs could be indicated in individuals who had previously developed

thrombocytopenia after UFH.

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C. If the platelet count falls by 50% and/or the patient develops new thrombosis or

skin allergy during the treatment period, heparin-induced thrombocytopenia (HIT)

should be considered

D. If HIT is strongly suspected or confirmed, heparin should be stopped and an

alternative agent such as the direct thrombin inhibitor argatroban is indicated.

100. By which of the following mechanisms; protamine sulfate could reverse the

excessive anticoagulant action of heparin?

A. Acts as a pharmacological antagonist that binds to the same binding site on

antithrombin inhibiting the binding of heparin.

B. Acts as a functional or physiological antagonist that enhance blood coagulation

and thus oppose heparin action.

C. Acts as a chemical antagonist; being a highly basic, positively charged peptide it

combines with negatively charged heparin and forms a stable complex devoid of

anticoagulant activity.

D. Acts as a pharmacokinetic antagonist that induces the liver metabolizing enzymes

responsible for heparin metabolism.

101. If a patient undergoes a percutaneous coronary angiography procedure and

placement of a stent in a coronary blood vessel, she may be given eptifibatide to

prevent platelet-induced occlusion of coronary stents. Which of the following

most accurately describes the mechanism of eptifibatide anticlotting action?

A. Activation of antithrombin III

B. inhibit the enzyme vitamin K epoxide reductase, thereby blocking hepatic

synthesis of the active, reduced form of vitamin K (needed

for carboxylation of coagulation factors

C. Inhibition of thromboxane production

D. Irreversible inhibition of platelet ADP receptors

E. Reversible inhibition of glycoprotein IIb/IIIa receptors

102. Which of the following drugs is considered a Non-vitamin K antagonists oral

anticoagulants (NOACs)?

A. Warfarin.

B. Enoxaparin.

C. Dabigatran (Pradaxa)

D. phenindione

103. Regarding the anticoagulant warfarin; which of the following statements is true?

A. It could be indicated alone from the beginning (as a sole treatment) as it has a rapid

onset of anticoagulation.

22

B. The warfarin effect is terminated rapidly and thus requires more frequent dosing to

achieve a successful anticoagulation

C. Warfarin has no direct effect on previously circulating clotting factors or

previously formed thrombi.

D. Never to be combined with UFH or LMWH.

104. As compared to warfarin; which of the following statements regarding the direct

factor Xa inhibitors (rivaroxaban (Xarelto), apixaban (Eliquis)) is incorrect?

A. They have a rapid onset which reduces need for "bridging" with a parenteral

anticoagulant,

B. They don't require frequent monitoring or re-dosing whilst having few strong drug

interactions and no food interactions.

C. They have longer elimination half-life and higher risk of intra cranial bleeding.

D. They lack the adequate experience required for dosage adjustment in special

patient populations e.g. obese patients or those with renal impairment.

105. Which of the following antiplatelet drugs exert its action through inhibiting the

synthesis or activity of specific mediators of platelet aggregation?

A. clopidogrel.

B. Aspirin

C. abciximab,

D. eptifibatide.

E. Both (A and B).

F. both (C and D)

106. Which of the following regarding the antiplatelet action of aspirin is incorrect?

A. Low doses of aspirin have been found to selectively inhibit the synthesis of

prostacyclin without having as much effect on TXA2.

B. The dosage of aspirin used to inhibit platelet aggregation is usually lower than that

used for other pharmacologic effects.

C. Aspirin inhibits platelet aggregation for the life of the platelet and effectively

reduces platelet aggregation when administered once a day or every other day. D.

Aspirin irreversibly inhibits cyclooxygenase enzyme.

107. As compared to other ADP blockers; ticagrelor has the following special

properties except

A. Due to the reversibility of its action; this ADP blocker may be used as an

antiplatelet in patients about to undergo surgery.

B. Ticagrelor does not require activation and appears to exert antiplatelet effect more

rapidly.

23

C. Beneficial for CYP2C19 poor metabolizers

D. It is a prodrugs that is metabolized to active antiplatelet metabolites by CYP2C19.

108. Which of the following ADP blockers can cause severe neutopeneia and thus

largely replaced by other agents?

A. clopidogrel

B. prasugrel

C. ticagrelor D. ticlopidine.

109. Which of the following antiplatelet medication inhibits the final common

pathway in platelet aggregation which is the cross-linking of platelets by

fibrinogen?

A. Aspirin.

B. The phosphodiesterase inhibitor; Dipyridamole

C. The ADP blocker; ticagrelor.

D. The glycoprotein IIb/IIIa antagonists; abciximab

Questions 110–114. A 23-year-old pregnant woman is referred by her obstetrician for

evaluation of anemia. She is in her fourth month of pregnancy and has no history of

anemia; her grandfather had pernicious anemia. Her hemoglobin is 10 g/dL (normal,

12–16 g/dL).

110. The type of anemia of the patient’s grandfather is most probably caused by

deficiency of what of the following?

A. Erythropoietin

B. Folic acid

C. Intrinsic factor

D. Iron

E. ferritin

111. If this woman has macrocytic anemia, an increased serum concentration of

transferrin, and a normal serum concentration of vitamin B12, the most likely

cause of her anemia is deficiency of which of the following?

A. Cobalamin

B. Erythropoietin

C. Folic acid

D. Intrinsic factor

E. Iron

112. If the patient in Question 112 had the deficiency identified, her infant would have

a higher than normal risk of which of the following?

(A) Cardiac abnormality

24

(B) Congenital neutropenia

(C) Kidney damage

(D) Limb deformity

(E) Low birth weight for gestational age and Neural tube defect.

113. If the laboratory data for this pregnant patient indicate that she does not have

macrocytic anemia but rather microcytic anemia. Optimal treatment of normocytic

or mild microcytic anemia associated with pregnancy uses which of the following?

(A) A high-fiber diet

(B) Erythropoietin injections

(C) Ferrous sulfate tablets

(D) Folic acid supplements

(E) Hydroxocobalamin injections

114. If this pregnant female has a child that accidently took her medication indicated

in question 115 and developed toxicity in the form of gastro-intestinal haemorrage,

cardiovascular collapse, hepatic and neurotoxicity. Which of the following agents is

used to treat this toxicity? A. Desferrioxamine.

B. Cyanocobolamine.

C. Pyridoxine.

D. Iron dextran

E. IL-11; oprelvekin

115. Which of the following is most likely to be required by a 5-year-old boy with

chronic renal insufficiency to correct his anemia?

(A) Cyanocobalamin

(B) Deferoxamine

(C) Erythropoietin

(D) Filgrastim (G-CSF)

(E) Oprelvekin (IL-11)

116. In a patient who requires filgrastim (G-CSF) after being treated with anticancer

drugs, the therapeutic objective is to prevent which of the following?

a. Allergic reactions

b. Cancer recurrence

c. Excessive bleeding

d. Hypoxia

e. Systemic infection

117. After undergoing surgery for breast cancer, a 53-year-old woman is scheduled

to receive 4 cycles of cancer chemotherapy. Her first cycle was complicated by severe

25

chemotherapy-induced thrombocytopenia. During the second cycle of chemotherapy,

it would be appropriate to consider treating this patient with which of the following?

a. Darbepoetin alpha

b. Filgrastim (G-CSF)

c. Iron dextran

d. Oprelvekin (IL-11)

e. Vitamin B12

118. Which of the following types of anemias could be caused by certain drugs (e.g.

alkylating agents, such as cyclophosphamide) predictably if given in sufficient dose as

an idiosyncratic type B adverse reaction?

A. Megaloblastic anemia.

B. Aplastic anemia.

C. Pernicious anemia.

D. G6PD deficiency anemia.

Question no. 2: State if the following statements is true or false.

(16 marks, 1mark each)

119. A prescription of antibiotics like quinolones or sulphonamides should be indicated

immediately for patients with G6PD deficiency if any infection is suspected. A. true.

B. false.

120. The megaloblastic anemia of vitamin B 12 deficiency can be partially corrected

by ingestion of large amounts of folic acid.

A. true.

B. false

121. Ulcerative colitis is an autoimmune transmural inflammatory condition of the

GIT that is confined to the rectum and colon. A.

true.

B. false.

122. Both infliximab and adalimumab are monoclonal antibodies that are directed

against interferon-γ and could be useful in moderate to severe active disease and

steroid-dependent or fistulizing disease but the cost far exceeds that of other regimens.

A. true.

B. false.

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123. Mesalamine products (such as Pentasa or Asacol) that release mesalamine in the

small bowel may be more effective than sulfasalazine for ileal involvement. On the

other hand Sulfasalazine is more effective when Crohn’s disease involves the colon.

A. true.

B. false. 124. Cyclosporine and corticosteroids are highly recommended for treatment of mild

Crohn’s disease and also helpful in maintaining remission. A.

true.

B. false.

125. 5-ASA (the 5 amino salicylic acid) is the constituent responsible for the

antiinflammatory action of sulfasalazine and also responsible for its adverse effects

profile (folate deficiency, agranulocytosis and anemia). A. true.

B. False.

126. Patients receiving azathioprine and allopurinol concomitantly should double the

usual dose of azathioprine as allopurinol induces the hepatic enzymes responsible for

its metabolism. A. true.

B. false.

127. Patients with moderate to severe IBD are often malnourished and require

supplementation with vitamin B12, zinc, folate, and iron. Patients who have severe

disease may require a course of parenteral nutrition. Probiotic formulas have been

effective in maintaining remission in ulcerative colitis. A. true.

B. false.

128. The anti-gout medication; colchicine is also helpful in reducing the attacks of the

auto-inflammatory disease; Familial Mediterranean Fever. However, it is associated

with rapid development of amyloidosis and subsequent organ damage on chronic use.

A. true.

B. false.

129. The anti-inflammatory effect of colchicine in FMF has traditionally been thought

to result from microtubule disruption in neutrophils, which prevents their migration

in response to chemotactic factors. Moreover, it has been shown to alter the

distribution of cell adhesion molecules on neutrophils and endothelial cells, thereby

reducing neutrophil transmigration.

A. true.

B. false.

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130. The diarrhea and abdominal cramps that developed during colchicine treatment

could be minimized by splitting the dose or starting at a low dose and increasing it

gradually.

A. true.

B. false. 131. It is highly recommended to increase colchicine doses during attacks of FMF to

suppress an acute attack.

A. true.

B. false.

132. Protracted febrile myalgia syndrome (PFMS) is a very rare but severe

manifestation of FMF that does not respond to NSAIDs but could be suppressed by

1 mg/kg Prednisone at for up to 6 weeks. IL-1 inhibitors; Anakinra

and canakinumab could also be helpful. A. true.

B. false.

133. Dipyridamole, a coronary vasodilator, is employed prophylactically to treat

angina pectoris. Due to its effective antiplatelet action; it could be used alone to

prevent and treat arterial thromboembolic disorders.

A. True.

B. False.

134. the most appropriate time to measure serum urate for monitoring purposes in

patients with gout is once the attack has been developed.

A. True.

B. False.

GOOD LUCK