Dipiro 9th MCQ
Dipiro 9th MCQ
E. Clarithromycin
E. Atropine
Chapter 3 - Hypertension
Use the following scenario for the next two questions: A 78-year-old man has a past medical
history of hypertension for10 years. His BP today is 158/72 mm Hg (156/70 mm Hg when
repeated), heart rate is 60 beats/min, serum creatinine is 1.2 mg/dL, and potassium is 4.3
mEq/L. He is currently on lisinopril 40 mg daily and verapamil SR 240 mg daily, weighs 73
kg, is 70″ tall, smokes one pack cigarettes daily, and consumes two to three ethanol-
containing drinks weekly.
Use the following scenario for the next two questions: A 37-year-old woman has a BP
measurement of 190/120 mm Hg when she first arrives for a routine physical examination by
a medical assistant. She has no previous history of hypertension, and the only other time she
had been seen by her primary care physician, her BP was 120/80 mm Hg. She is extensively
interviewed and examined, and has no signs of acute or chronic hypertension-associated
target-organ damage. Her physician measures her BP again 20 minutes later, and it is 142/92
mm Hg (140/90 mm Hg when repeated). Based on her most recent fasting lipid panel, her
Framingham risk score is 1%.
3) Which of the following is the most accurate clinical assessment of her present situation?
A. Prehypertension
B. Elevated blood pressure
C. Stage 1 hypertension
D. White coat hypertension
4) Which of the following is the most appropriate BP goal in this patient?
A. <120/80 mm Hg
B. <130/80 mm Hg
C. <140/80 mm Hg
D. <140/90 mm Hg
Use the following scenario for the next two questions: A 60-year-old woman with
hypertension and heart failure with preserved ejection fracture is seen 2 months after
experiencing an acute myocardial infarction. She also has a history of dyslipidemia. Her
present BP is 130/84 mm Hg (132/82 mm Hg when repeated) and her heart rate is 60
beats/min. Her serum creatinine is 1.1 mg/dL, serum potassium is 3.5 mEq/L, and spot
urinalysis shows 20 mg albumin/g creatinine. She currently has no peripheral or pulmonary
edema. She is taking furosemide 40 mg twice daily, carvedilol 25 mg twice daily, enalapril 20
mg twice daily, and pravastatin 20 mg daily.
5) Which of the following medical conditions is/are a compelling indication(s) for the use of
carvedilol in this patient?
A. Heart failure
B. Recent MI
C. Chronic kidney disease
D. Dyslipidemia
6) Which of the following statements is most appropriate to include when counseling this
patient regarding her antihypertensive therapy?
A. It will be possible to stop enalapril once your BP is at goal.
B. If you experience depression, stop taking carvedilol.
C. Long-term benefits of these medications are a reduced risk of CV events.
D. If you experience dry cough, stop taking lisinopril because this can lead to
angioedema.
7) Which of the following statements is/are true regarding ARBs in the treatment of
hypertension?
A. ARBs are first-line agents because they lower BP and lower risk of CV events.
B. The ALLHAT study showed that nonfatal MI and coronary heart disease are reduced
more with ARB therapy than with amlodipine or chlorthalidone.
C. ARBs are preferred over ACE inhibitors in patients with chronic kidney disease.
D. An ACE inhibitor should be added to ARB therapy in patients with hypertension who
are not yet at their BP goal value.
8) Which of the following is true regarding prehypertension?
A. All patients with BP values greater than 120/80 mm Hg are classified as
prehypertension.
B. Guidelines recommend lifestyle modifications in all patients with prehypertension.
C. Less than 50% of patients with prehypertension develop hypertension within their
lifetime.
D. Patients with prehypertension have equal CV risk compared to patients with normal
BP values.
Use the following case for the next two questions: A 70-year-old woman with hypertension
and type 2 diabetes has been on hydrochlorothiazide 25 mg daily and diltiazem extended
release 240 mg daily for 6 years. She was on lisinopril several years ago, but it was stopped
due to a dry cough. She was first diagnosed with hypertension when her blood pressure was
180/82 mm Hg. Today, her blood pressure is 158/78 mm Hg (160/76 mm Hg when repeated)
and her heart rate is 100 beats/min. Her urinalysis shows 100 mg albuminuria/24 hours,
serum creatinine is 1.6 mg/dL, potassium is 4.1 mEq/L, weight is 75 kg, and height is 66″.
Her only complaint is headache.
9) Which of the following is/are routine monitoring parameters for her antihypertensive drug
therapy?
A. Heart rate
B. Serum potassium, sodium, and magnesium
C. Serum creatinine and BUN
D. All of the above
10) Losartan 50 mg daily is added to her regimen. Four weeks later, her BP is 146/82 and
148/80 mm Hg, serum creatinine is 1.9 mg/dL, and potassium has increased to 4.4 mEq/L.
Which of the following is the most appropriate option to treat this patient’s hypertension?
A. Increase losartan to 100 mg daily.
B. Increase hydrochlorothiazide to 50 mg daily.
C. Add spironolactone 25 mg daily.
D. Decrease losartan to 25 mg daily.
11) Which of the following is true regarding the use of arterial vasodilators (hydralazine or
minoxidil) in the treatment of hypertension?
A. Severe bradycardia occurs when they are used in combination with a β-blocker.
B. Both can cause severe rebound hypertension when stopped abruptly.
C. Both are poorly tolerated because of anticholinergic side effects.
D. Both should be given in combination with a diuretic and a β-blocker.
12) A 65-year-old woman with type 2 diabetes, hypertension, osteoporosis, and atrial
fibrillation has a BP of 150/96 mm Hg (150/90 mm Hg when repeated), heart rate of 68
beats/min, potassium of 3.2 mEq/L, and a serum creatinine of 2.3 mg/dL. She reports an
allergy to hydrochlorothiazide (severe gout). Presently, she is on diltiazem CD 360 mg daily.
Which of the following drug regimens would be the most appropriate to add to her regimen?
A. Chlorthalidone 12.5 mg daily
B. Amlodipine 5 mg daily
C. Atenolol 25 mg daily
D. Valsartan 160 mg daily
13) Which of the following is preferred as add-on therapy for a patient who is post-MI (1
month ago) with a BP of 146/88 mm Hg (144/86 mm Hg when repeated) while treated with
metoprolol succinate 200 mg daily?
A. Chlorthalidone
B. Verapamil
C. Amlodipine
D. Lisinopril
14) Which of the following is preferred as initial antihypertensive therapy for a 63-year-old
woman who is diagnosed with hypertension and has a history of ischemic stroke (6 months
ago), with a BP of 186/108 mm Hg (184/106 mm Hg when repeated)?
A. A thiazide diuretic with an ACE inhibitor
B. A thiazide diuretic with a nonselective β-blocker
C. A thiazide diuretic alone
D. An ACE inhibitor with an ARB
15) A 52-year-old man has a past history of chronic stable angina and hypertension. He is
experiencing ischemic chest pain twice weekly while being treated with atenolol 100 mg
daily. His BP is 146/90 mm Hg (144/92 mm Hg when repeated), and heart rate is 58
beats/min. Which of the following is the most appropriate agent to add in this patient?
A. Lisinopril 20 mg daily
B. Diltiazem SR 180 mg daily
C. Amlodipine 5 mg daily
D. Irbesartan 150 mg daily
Use the following case for the next three questions: A 69-year-old woman with a history of
angioedema (from lisinopril), hypertension, and type 2 diabetes is currently receiving
hydrochlorothiazide 25 mg daily and carvedilol 25 mg twice daily. Today her blood pressure
is 138/82 mm Hg (138/84 mm Hg when repeated) and heart rate is 56 beats/min. Urinalysis
shows 400 mg albumin/24 hours, serum creatinine is 1.2 mg/dL, potassium is 3.8 mEq/dL,
weight is 90 kg, and height is 65″. She complains of heartburn, a dry cough, constipation, and
fatigue when she exercises. She normally exercises three times per week, and follows a
DASH eating plan.
16) Which of her complaints is most likely from one of her antihypertensive medications?
A. Heartburn
B. Dry cough
C. Constipation
D. Fatigue
17) Which of the following is the most appropriate modification to her regimen?
A. Decrease carvedilol to 12.5 mg twice daily and add enalapril.
B. Decrease carvedilol to 12.5 mg twice daily and add valsartan.
C. Replace hydrochlorothiazide with spironolactone and felodipine.
D. Replace carvedilol with valsartan.
18) The patient reports takes several nonprescription medications including aspirin 81 mg
daily, a multivitamin daily, acetaminophen, and loratadine. She asks you if these are safe to
take because of her hypertension. Which of the following is the most appropriate response?
A. You should stop taking these until you have discussed this with your primary care
physician.
B. Acetaminophen can increase your blood pressure; you should use naproxen instead.
C. Loratadine can increase your blood pressure; you should use it only if needed.
D. These medications are generally safe to use in patients with hypertension.
19) A 55-year-old man with hypertension and no other chronic medical problems is currently
treated with hydrochlorothiazide 50 mg daily, irbesartan 300 mg daily, carvedilol 25 mg
twice daily, and amlodipine 10 mg daily. His BP is 144/96 mm Hg (146/94 mm Hg when
repeated). He is adherent with all of these medications. Serum creatinine is 1.2 mg/dL,
potassium is 4.2 mEq/L, and all other laboratory values are normal. Which of the following is
the most appropriate to add to his regimen?
A. Terazosin 2 mg daily
B. Spironolactone 25 mg daily
C. Clonidine 0.1 mg twice daily
D. Chlorthalidone 12.5 mg daily
20) A patient with newly diagnosed hypertension asks you for advice on how to increase
potassium as a lifestyle modification to lower BP. Which of the following is/are appropriate
recommendations?
A. Increase your dietary intake of potassium-rich foods.
B. Start using nonprescription potassium supplements.
C. Ask your physician to prescribe prescription-strength potassium chloride.
A 58-year-old white male with a 2-year history of heart failure secondary to an MI returns to
the clinic for a routine followup. He continues to have fatigue and dyspnea on minimal
exertion. His serum electrolytes, creatinine clearance, and other labs are within normal limits.
His LVEF by echo is 35%. His cardiovascular drug regimen is unchanged over the previous 3
months except that digoxin was started 1 month ago. His current digoxin plasma
concentration is 1.6 ng/mL (2 nmol/L) collected approximately 18 hours after his previous
dose.
D. Spironolactone 25 mg daily
The next two questions refer to the following case: A 58-year-old male with a history of
ischemic cardiomyopathy presents to a clinic with orthopnea, dyspnea with minimal exertion,
3+ pitting edema, fatigue, anorexia, nausea, and early satiety.
The next two questions refer to the following case: A 57-year-old African American male
with ischemic cardiomyopathy (ejection fraction [EF] 25% [0.25]) presenting to the
emergency department (ED) with an acute heart failure (HF) exacerbation. His vital signs
include BP 103/77 mm Hg, HR 92 bpm, RR 23 rpm, and O2 sat 91% (0.91) on 4 L by nasal
cannula. Physical examination reveals jugular venous distension (JVD), crackles at bases,
ascites, and trace bilateral lower extremity edema. He admits to a 10 lb (4.5 kg) weight gain
in the past 2 weeks since his metoprolol dose was increased and reports strict adherence to
both dietary restrictions and medications. In the ED, he has already received furosemide 160
mg IV × 1 dose with minimal response in urine output. Pertinent labs include potassium 5.1
mEq/L (5.1 mmol/L), brain natriuretic peptide (BNP) 950 pg/mL (275 pmol/L), blood urea
nitrogen (BUN) 41 mg/dL (14.6 mmol/L), and serum creatinine (SCr) 2.2 mg/dL (194
µmol/L) (baseline). The patient’s medications on admission include lisinopril 10 mg daily,
metoprolol XL 150 mg daily, and furosemide 120 mg twice daily.
The next three questions refer to the following case: A 63-year-old female with hypertensive
cardiomyopathy (EF 30–35% [0.30 – 0.35]) presents with a chief complaint of “always
feeling tired.” Her daughter reported that the patient’s exercise tolerance has recently
significantly declined despite strict adherence to a low sodium diet and currently prescribed
medications that include enalapril 7.5 mg twice daily, carvedilol 12.5 mg twice daily,
furosemide 80 mg twice daily, and digoxin 0.125 mg daily. Vital signs include BP 92/57 mm
Hg, HR 95 bpm, (mild orthostasis), and RR 16 rpm. On physical examination, she has no
findings consistent with fluid overload. Laboratory analysis reveals sodium 135 mEq/L (135
mmol/L), potassium 4.9 mEq/L (4.9 mmol/L), BUN 45 mg/dL (16.1 mmol/L), and SCr 2.2
mg/dL (194 µmol/L) (baseline BUN/SCr 27/1.1 [SI: 9.6/97]). Upon further questioning, the
patient does admit to occasional dizziness.
7) Which one of the following clinical categories best describes this patient?
A. Warm and dry
B. Warm and wet
C. Cold and dry
D. Cold and wet
8) Which of the following laboratory parameters would assist with confirming the fluid status
of this patient?
A. C-reactive protein
B. Brain natriuretic peptide
C. Serum albumin
D. Hemoglobin
9) Which one of the following is the optimal initial intervention for this patient?
A. Change furosemide to 80 mg IV twice daily
B. Hold furosemide and initiate cautious hydration with IV fluids
C. Hold carvedilol and initiate dobutamine at 2 mcg/kg/min
D. Increase carvedilol to 25 mg by mouth twice daily
10) Which one of the following are appropriate initial therapies for this patient?
A. Furosemide 80 mg IV twice daily
B. Furosemide 80 mg IV twice daily plus nesiritide 0.01 mcg/kg/min
C. Furosemide 20 mg/h IV continuous infusion
D. Nesiritide 0.01 mcg/kg/min IV continuous infusion
11) Once this patient’s volume status is optimized, his CI and SVR have not changed
substantially, and his vital signs and oral heart failure medications remain essentially
unchanged with the exception of his diuretic dose. Which of the following therapies are now
appropriate to manage this patient’s ADHF?
A. Nitroprusside 0.01 mcg/kg/min IV continuous infusion
B. Enalaprilat 2.5 mg IV every 6 hours
C. Dobutamine 2 mcg/kg/min IV continuous infusion
B. False
D. ASA
1) You are following a patient who is receiving chronic oral amiodarone. Which of the
following statements regarding monitoring of drug-induced toxicities is correct?
I. Thyroid function tests should be monitored every 3 months.
II. Pulmonary function tests should be monitored on an annual basis.
III. Liver function tests should be monitored every 6 months.
A. I only
B. III only
C. I and II only
D. II and III only
E. I, II, and III
2) Which of the following electrophysiologic properties does propafenone possess?
A. Vaughan-Williams class III only
B. Vaughan-Williams class Ib only
C. Vaughan-Williams class Ic and II
D. Vaughan-Williams class Ia and IV
3) The class Ic antiarrhythmics, such as flecainide, slow conduction velocity through sodium-
dependent tissue the most at normal heart rates. The reason for this is that flecainide does
which of the following?
A. It has “slow on/off” kinetics for the sodium channel.
B. It has “fast on/off” kinetics for the sodium channel.
C. It has rate-dependent effects in blocking the sodium channel.
D. It blocks the sodium channel primarily in the inactivated state.
4) You are asked to see a patient with new-onset AF, a rapid ventricular response (HR = 179
beats/min), and thyrotoxicosis. Currently, his only symptoms are weakness and palpitations.
Which of the following do you suggest as initial therapy?
A. IV digoxin to control his ventricular rate
B. IV ibutilide to restore sinus rhythm
C. IV esmolol to control his ventricular rate
D. IV amiodarone to control his ventricular rate
5) A 56-year-old woman with a PMH of HF (LVEF = 30%) and paroxysmal AF is receiving
the following medications: digoxin 0.25 mg by mouth daily (last digoxin level 1.1 ng/mL [1.4
nmol/L]), warfarin 6 mg by mouth daily (INR 2 to 3 for the past 4 weeks), enalapril 10 mg by
mouth twice daily, furosemide 40 mg by mouth daily, and metoprolol XL 50 mg by mouth
daily. The physician would like to attempt to restore and maintain sinus rhythm with oral
amiodarone. Which of the following recommendations should you make regarding the
management of this patient?
I. To avoid the drug interactions, use flecainide instead of amiodarone.
II. Decrease the warfarin dose to 4 mg by mouth daily.
III.Decrease the digoxin dose to 0.125 mg by mouth daily
A. I only
B. III only
C. I and II only
D. II and III only
E. I, II, and III
6) Based on the results of the AFFIRM, RACE, STAF, PIAF, and HOT-CAFE trials, which
of the following statements regarding the initial management of a patient with AF iscorrect?
A. It would be reasonable to initially use a “rate-control” strategy with digoxin,
nondihydropyridine calcium blockers, and/or β-blockers.
B. It would be reasonable to initially use a “rhythm-control” strategy with low-dose
amiodarone in order to maintain sinus rhythm.
C. It would be reasonable to initially use a “rhythm-control” strategy with sotalol in
order to maintain sinus rhythm.
D. It would be reasonable to initially use a “rate-control” strategy with low-dose
amiodarone.
7) A 54-year-old man (5′9″, 175 lb [175 cm, 79.5 kg]) presents to the emergency department
complaining of worsening palpitations, shortness of breath, and fatigue. He has a history of
MI (5 months ago), HF (LVEF = 25% [≤0.25]), paroxysmal AF, and pulmonary fibrosis
secondary to amiodarone (occurred 1 year ago). His current medications include aspirin,
lisinopril, furosemide, carvedilol, atorvastatin, digoxin, and warfarin. His vitals are BP
115/70 mm Hg and HR 72 beats/min. Pertinent labs include SCr 1.3 mg/dL (115 µmol/L),
digoxin 0.6 ng/mL (0.8 nmol/L), and INR 2.6. His ECG reveals: AF, HR 70 beats/min, and
QT interval 400 milliseconds. He undergoes successful electrical cardioversion and is now in
sinus rhythm. The plan is to start chronic antiarrhythmic therapy to maintain him in sinus
rhythm. Which of the following antiarrhythmic drugs would be most appropriate to maintain
him in sinus rhythm?
A. Amiodarone
B. Dofetilide
C. Flecainide
D. Sotalol
8) Which of the following drugs would be most appropriate to restore sinus rhythm in a
patient with AV nodal reentry or orthodromic AV reentry?
A. Adenosine
B. Procainamide
C. Lidocaine
D. Digoxin
9) A 19-year-old woman with a history of WPW syndrome is seen in the emergency room.
She has no other medical problems or known heart disease. Her current ECG shows a wide
QRS tachycardia (irregular) (HR = 178 beats/min). Her BP is stable and she does not feel
syncopal. Which of the following agents would be the most appropriate to administer to this
patient at this time?
A. IV adenosine
B. IV verapamil
C. IV procainamide
D. IV lidocaine
10) A 79-year-old man with a past medical history of hypertension and dyslipidemia presents
to clinic complaining of dizziness and palpitations that have been occurring for the past 2 to 3
days. An ECG reveals that he is in AF (HR = 120 beats/min). Which of the following drug
regimens would be most appropriate for stroke prevention in this patient?
A. Aspirin 325 mg by mouth daily.
B. Warfarin (titrated to an INR of 2 to 3).
C. Low-dose warfarin (titrated to an INR 1.2 to 1.5) and aspirin 325 mg by mouth daily.
D. This patient does not need antithrombotic therapy and should be cardioverted
immediately.
11) Which of the following is not consistent with the clinical profile of drug-induced torsade
de pointes?
A. Females are at higher risk.
B. It usually occurs within several days of initiating the offending agent.
C. It is always dose related (i.e., large doses = higher risk).
D. It often occurs in association with underlying heart disease and electrolyte
abnormalities.
12) Which of the following statements regarding the results of clinical trials performed with
oral antithrombotic agents in patients with AF is correct?
A. Bleeding was less likely to occur with dabigatran 75 mg by mouth twice daily than
warfarin in the RE-LY trial.
B. Warfarin was superior to dabigatran 150 mg by mouth twice daily in preventing
stroke or systemic embolism in the RE-LY trial.
C. Rivaroxaban was noninferior to aspirin in preventing stroke or systemic embolism in
the ROCKET-AF trial.
D. Stroke or systemic embolism was significantly reduced with apixaban compared with
aspirin in the AVERROES trial.
13) A patient suffers a cardiac arrest and was successfully resuscitated at the local airport by
an automated external defibrillator. He is transported to your hospital and admitted to the
coronary care unit. His cardiac enzymes are markedly elevated and demonstrate that he had
an MI. Which of the following would be the most appropriate chronic treatment strategy for
this patient?
A. Implantable cardioverter-defibrillator
B. Empiric oral amiodarone
C. Revascularization (if possible) and then chronic oral metoprolol
D. Electrophysiologic testing to see if the patient has sustained ventricular tachycardia or
fibrillation
14) A 65-year-old man has a history of MI (6 months ago; current EF = 25% [0.25]) and
recurrent sustained ventricular tachycardia. During his electrophysiologic study, he
experienced inducible sustained ventricular tachycardia (rate = 240 beats/min) that caused
him to pass out. Which of the following would be the most appropriate treatment for this
patient’s arrhythmia?
A. Radio-frequency ablation of the Kent bundle
B. Implantable cardioverter-defibrillator
C. Chronic sotalol therapy
D. No therapy at present—close followup only
15) A 55-year-old woman with a history of AF is admitted for pharmacologic cardioversion.
In the coronary care unit, she is given 2 mg of IV ibutilide that terminates the AF. However,
shortly thereafter, she suffers several long episodes of polymorphic ventricular tachycardia
with a prolonged QT interval during sinus rhythm. Which of the following would be the most
appropriate treatment for this arrhythmia?
A. IV epinephrine 1 mg
B. IV amiodarone 300 mg
C. IV lidocaine 100 mg
D. IV magnesium 2 g
1) Mr. Jones is a healthy 37-year-old man who presents to the medical office complaining of
swelling and pain in his left calf. Three days ago Mr. Jones participated in a softball game
and was involved in a collision at home plate. The pain is localized in the left calf. The left
calf measures 16 cm and the right calf measures 15 cm. There is no edema present. Mr. Jones
is 5 ft 11 in (180 cm) tall and weighs 100 kg. Which of the following strategies would be the
most appropriate in the initial management for Mr. Jones?
A. Obtain a compression ultrasound of the left lower extremity to rule out DVT.
B. Order a D-dimer to rule out DVT.
C. Order a D-dimer and obtain a compression ultrasound of the left lower extremity to
rule out DVT.
D. Administer 5,000 units of unfractionated heparin IV and obtain a compression
ultrasound of the lower extremity as soon as possible.
2) Which of the following patients would be at greatest risk for developing a DVT in the next
month?
A. A 23-year-old male admitted to the ICU in diabetic ketoacidosis with mental status
changes
B. A 59-year-old male with three-vessel coronary artery disease who smokes two packs
of cigarettes per day
C. A 46-year-old female undergoing an abdominal hysterectomy due to irregular
menses
D. A 78-year-old obese female with severe osteoarthritis for the past 15 years who will
have an elective knee replacement tomorrow
3) Which of the signs or symptoms listed below are the least consistent with the diagnosis of
DVT?
A. The examiner feels a palpable cord in the patient’s right leg.
B. The patient’s right and left ankles are very swollen.
C. The patient complains of pain in the right leg when flexing the right foot.
D. The patient’s left leg appears red and feels hot.
4) Three months of anticoagulation would be the best choice to minimize the risk of recurrent
VTE in which of the following circumstances?
A. A 56-year-old man with diabetes who had a DVT following hip replacement surgery
B. A 62-year-old woman receiving chemotherapy for colon cancer who had a DVT
following a long car trip
C. A 42-year-old man with heterozygous factor V Leiden and prothrombin 20210
mutation who had an idiopathic PE
D. A 75-year-old woman who had a recurrent episode of DVT 4 years after completing 3
months of anticoagulation for a DVT that complicated knee replacement surgery
5) Which of the following statements best describes the use of graduated compression
stockings for VTE prophylaxis following surgery?
A. Compression stockings are a relatively expensive strategy.
B. Compression stockings are poorly tolerated by the majority of patients.
C. Compression stockings are an acceptable strategy for the patients at high risk for
bleeding.
D. Compression stockings should not be used in combination with anticoagulant drugs.
6) Which of the following statements best describes warfarin?
A. Warfarin interferes with the production of protein C in the liver.
B. Warfarin should never be used in combination with other anticoagulant drugs.
C. Although it has a long half-life, warfarin produces its anticoagulation effect rapidly.
D. Warfarin is effective for the long-term treatment of VTE but is not useful for VTE
prophylaxis.
7) Low-dose unfractionated heparin (5,000 units subcutaneously every 12 hours) would be
the best choice to prevent VTE for which of following patients?
A. A 77-year-old male receiving a hip fracture repair following an automobile accident
B. A 42-year-old female undergoing an abdominal hysterectomy for ovarian cancer
C. A 51-year-old male with benign prostatic hyperplasia and undergoing an abdominal
prostatectomy
D. A 28-year-old female with a history of recurrent DVT undergoing bowel resection
surgery for severe Crohn’s disease
8) Which of the following statements best describes the low-molecular-weight heparins
(LMWHs)?
A. The LMWHs are direct inhibitors of thrombin formation.
B. The LMWHs are preferred in patients with a history of heparin-induced
thrombocytopenia.
C. The LMWHs are poorly absorbed following subcutaneous administration.
D. The LMWHs are a preferred option for treating VTE in pregnant women.
9) Which of the following statements best describes unfractionated heparin (UFH)?
A. UFH molecules with fewer than 18 saccharide units possess no anticoagulant
activity.
B. UFH should be given in significantly lower doses to patients with liver disease.
C. UFH is rapidly and completely absorbed when administered subcutaneously in doses
of 5,000 units or less.
D. UFH produces an unpredictable anticoagulant response.
10) Which of the following individuals would be the best candidate for outpatient DVT
treatment?
A. A 64-year-old male who uses insulin to control his diabetes
B. A 44-year-old female with a recent history of IV drug abuse
C. A 92-year-old male with severe rheumatoid arthritis–limited social support
D. A 53-year-old female who complains of leg pain, swelling, and shortness of breath
11) In addition to starting warfarin therapy, which of the following would be the
best initial acute treatment choice for a 57-year-old, 180-kg male who has a proximal DVT
and no other comorbid conditions?
A. Enoxaparin 150 mg subcutaneously twice daily
B. Rivaroxaban 20 mg orally once daily
C. Fondaparinux 10 mg subcutaneously once daily
D. Enoxaparin 360 mg subcutaneously once daily
12) A 71-year-old female taking warfarin for the past 2 months for a DVT following a hip
replacement surgery comes to clinic today. The patient’s INR is 6.4. Her vital signs are
stable, she has no complaints, she is fully ambulatory, and there is no evidence of bleeding.
Which of following interventions would be the best management strategy at this point in
time?
A. Omit the next two doses of warfarin and recheck INR in 3 days.
B. Administer vitamin K 2.5 mg orally, omit next dose of warfarin, and recheck INR in
7 days.
C. Administer clotting factor concentrates, omit next dose of warfarin, and recheck INR
in 24 hours.
D. Administer vitamin K 1.25 mg orally, omit the next dose of warfarin, and recheck
INR in 24 hours.
13) Which of the following individuals would be at the greatest risk for bleeding if given
warfarin therapy?
A. An 81-year-old woman with frequent tonic–clonic seizures who had neurosurgery last
week
B. A 54-year-old man with well-controlled high blood pressure who enjoys cross-
country skiing on weekends
C. A 74-year-old woman with poorly controlled diabetes mellitus type 2 who drinks one
glass of wine with dinner
D. A 42-year-old man with coronary artery disease who takes aspirin 81 mg daily and
who participates in a daily exercise program at the gym
14) Ms. Smith is a 67-year-old female who has had recurrent DVT and has been taking
warfarin for the past 3 years. Her last six INR values have been within her goal range. Today,
the patient’s INR is 1.2. Which of the following would be the best explanation for the low
INR?
A. Ms. Smith forgot her dose of warfarin this morning.
B. Ms. Smith drank tomato and carrot juice for breakfast this morning.
C. Ms. Smith ate a large spinach salad for dinner day before yesterday.
D. Ms. Smith finished a 10-day course of trimethoprim for a urinary tract infection
yesterday.
15) A patient is initiating dalteparin subcutaneously and warfarin orally for the treatment of
DVT on an outpatient basis. Which of the following laboratory monitoring plans is best to
determine response and toxicity to this drug treatment regimen?
A. Measure platelet count, aPTT, and INR daily.
B. Measure INR in 2 days and platelet count in 7 days.
C. Measure INR in 12 hours, aPTT in 4 days, and hemoglobin in 30 days.
D. Measure clotting time, serum creatinine, and liver function tests every 3 days.
Chapter 10 - Stroke
1) An 84-year-old Asian male is admitted to the hospital 4 hours after experiencing the onset
of right-sided weakness and difficulty with speech. He has a past medical history of
hypertension for 10 years.
Which of the following acute therapies has been shown to improve long-term outcome in a
patient like the one presented above?
A. Aspirin
B. Subcutaneous heparin
C. Enoxaparin
D. tPA
2) Which of the following antiplatelet medications is associated with a high incidence of
headache?
A. Warfarin
B. Aspirin
C. Clopidogrel
D. Aspirin + dipyridamole
E. Unfractionated heparin
3) Which of the following characteristics make(s) a stroke patient ineligible for IV
thrombolysis?
A. Hemorrhage seen on CT of the head
B. Blood pressure >195/100
C. Time of onset >3 hours
D. A and B
E. A, B, and C
4) A 52-year-old African American female was brought to the emergency room after falling
in the kitchen. The event was witnessed by her husband. She arrived at the ER 60 minutes
after the onset of symptoms. She has a history of hypertension for 20 years, and
hypothyroidism.
Based on the data above, is the patient eligible for thrombolytic therapy with t-PA?
A. Yes
B. No
5) Which characteristic(s) of the patient described in Question #4 has/have been shown
to independently increase her risk of developing a symptomatic intracerebral hemorrhage
after t-PA?
A. Systolic blood pressure >170 mm Hg
B. Negative CT
C. African American
D. Severe stroke (NIHSS >20)
E. B and D
6) Which of the following is the most common cause of acute neurologic deterioration of an
ischemic stroke patient in the first 3 days after the event?
A. Pulmonary embolism
B. Pneumonia
C. Cerebral edema
D. Recurrent ischemia
E. Dementia
7) Which of the following statements is true regarding clopidogrel?
A. It is an ADP receptor antagonist and prevents platelet activation.
B. Its antiplatelet effect is maximal within 60 minutes of oral administration of 75 mg.
C. It causes slightly more GI bleeding than ASA 325 mg/daily.
D. It is maximally effective when administered with ASA for secondary stroke
prevention.
8) Which of the following patients may be a candidate for carotid endarterectomy?
A. An 80-year-old man with a history of TIA and 70% stenosis of the symptomatic
internal carotid artery (ICA).
B. A 46-year-old woman with coronary artery disease and peripheral vascular disease,
no history of TIA or stroke, with 45% stenosis of the L ICA and occlusion of the R ICA.
C. A patient with atrial fibrillation and intolerance to warfarin.
D. A 65-year-old man with a history of weakness on the R that lasted less than 10
minutes. He has 40% stenosis of his L ICA and 60% of his R ICA.
9) What is the target level of anticoagulation for a patient with atrial fibrillation who has
recently experienced a minor stroke?
A. PT = 1.5 − 2.5 × control
B. INR = 1.8 − 2.5
C. INR = 2.5
D. PT = 2.5 − 3.5 × control
10) Choose the correct statement for the use of ERDP-ASA.
A. Dose is usually ERDP 50 mg/ASA 25 mg twice daily.
B. First choice in the primary prevention of TIAs.
C. First-line therapy for secondary prevention of noncardioembolic stroke.
D. Side effects occur rarely.
11) Which of the following categories would best describe a 78-year-old man with atrial
fibrillation, poor left ventricular function, hypertension, and a TIA history?
A. Moderate risk for stroke
B. Low risk for stroke
C. High risk for stroke
D. No risk for stroke
E. Unable to determine due to lack of information
12) When should dabigatran be considered in patients who have had an ischemic stroke?
A. If atrial fibrillation and inability to afford warfarin therapy
B. If atrial fibrillation and age >80 years
C. If cardioembolic stroke and history of recent intracranial hemorrhage
D. If atrial fibrillation and poor adherence with warfarin
13) Pharmacogenetic testing for CYP2C9 polymorphisms may be helpful in:
A. Adjusting doses of clopidogrel
B. Initial dosing of clopidogrel
C. Choosing antiplatelet therapy for noncardioembolic stroke
D. Initial dose selection of warfarin
14) Thrombolytic therapy of acute ischemic stroke is indicated:
A. Prior to arrival in the ER
B. Only with streptokinase
C. If initiated within at least 4.5 hours of the acute event
D. If CT scan is positive for acute hyperintensity
15) Anticoagulation therapy for all TIA patients is generally acceptable now that clinical
trials have shown it to be safe and effective.
A. True
B. False
Chapter 11 - Hyperlipidemia
1) Which one of the following is the best choice for the treatment of type I (Fredrickson-
Levy-Lees classification) hyperlipidemia?
A. Rosuvastatin
B. Colestipol
C. Ezetimibe
D. Lovastatin
E. Dietary fat restriction
2) In the recently reported ARBITER 6-HALTS study, the risk of major cardiovascular
events was reported to be 5% in the ezetimibe + state group compared with 1% in the niacin
+ statin group. What is the NNT for the niacin + statin group?
A. 5
B. 25
C. 37
D. 53
E. 81
3) Based on the National Cholesterol Education Program Adult Treatment Panel III
definitions, what is defined as an HDL level that is low?
A. <40 mg/dL
B. 60 mg/dL
C. 130 mg/dL
D. 160 mg/dL
E. 190 mg/dL
4) Based on the National Cholesterol Education Program Adult Treatment Panel III
definitions, what is the target LDL cholesterol in all patients?
A. <100 mg/dL
B. <130 mg/dL
C. <160 mg/dL
D. <190 mg/dL
5) All of the following are considered to be CHD risk equivalents except:
A. Asthma
B. Diabetes
C. Symptomatic carotid artery disease
D. Peripheral arterial disease
E. Abdominal aortic aneurysm
6) All of the following are considered to be traditional risk factors except (slide 56):
A. Cigarette smoking
B. Hypertension
C. HDL cholesterol >60 mg/dL
D. Males ≥45 years old
E. Family history of premature CHD
7) A patient presents with a total cholesterol of 245 mg/dL, an HDL of 35 mg/dL, and
triglycerides of 350 mg/dL. What is the non-HDL concentration?
A. 105 mg/dL
B. 140 mg/dL
C. 210 mg/dL
D. 240 mg/dL
E. 545 mg/dL
8) Which one of the following has the mechanism of action of upregulating LDL receptors
and interfering with the synthesis of cholesterol?
A. Niacin
B. Fibrates
C. Bile acid binding resins
D. Statins
E. Cholesterol absorption inhibition
9) Which category of drug therapy can raise HDL the most?
A. Niacin
B. Fibrates
C. Bile acid binding resins
D. Statins
E. Cholesterol absorption inhibition
10) Which one of the following states is the most potent LDL-lowering drug?
A. Lovastatin
B. Pravastatin
C. Rosuvastatin
D. Simvastatin
E. Fluvastatin
11) What is the most common adverse effect of niacin?
A. Constipation
B. Flatulence
C. Cholelithiasis
D. Pulmonary edema
E. Flushing
12) Which one of the following is a risk factor for the development of myositis with
gemfibrozil?
A. Gender
B. Combination therapy with a statin
C. Routine exercise
D. High ambient temperature
E. Time of administration
D. Pentoxifylline
Chapter 15 - Asthma
1) Which of the following asthma therapies has been shown to result in reduced death and
hospitalizations for patients with asthma?
A. Inhaled corticosteroids
B. Cromolyn
C. Leukotriene modifiers
D. Long-acting β-agonists
2) Which of the following is the reason for the boxed warning in long-acting inhaled β2-
agonist FDA labeling?
A. Their slow onset makes them ineffective in acute asthma exacerbations.
B. They cause prolongation of the QTc interval increasing the risk of cardiac
arrhythmias.
C. They are associated with an increased risk of asthma deaths when prescribed as
monotherapy.
D. They result in increased severe exacerbations when used in combination with inhaled
corticosteroids.
3) Which of the following statements is true concerning the use of inhaled corticosteroids in
children with mild persistent asthma?
A. Inhaled corticosteroids are no more effective than cromolyn or montelukast.
B. Inhaled corticosteroids are more effective than alternatives but are not recommended
for safety reasons.
C. Inhaled corticosteroids are the most effective controller but may decrease growth in
children up to 1 cm.
D. Inhaled corticosteroids do not reduce severe exacerbations that can result in
hospitalization and ED visits.
4) Which of the following is true regarding the use of peak flow monitoring for patients with
asthma?
A. Peak flow monitoring has been demonstrated to improve outcomes in patients with
asthma.
B. Peak flow monitoring may be useful for patients who are poor perceivers of airway
obstruction.
C. Peak flow monitoring is superior to symptom monitoring only.
D. Peak flow monitoring is no longer recommended in the management of asthma as it is
ineffective in improving outcomes.
5) One of your adult patients with severe persistent asthma was prescribed two inhalations of
budesonide/formoterol 80/4.5 twice a day 3 months ago in addition to as-needed albuterol. He
states that the new therapy has made a significant difference in his well-being and that he has
never felt better. On questioning him, he states that he continues to occasionally awaken at
night, although only one time per week, and that he did require a 7-day burst of prednisone
for an upper respiratory tract infection last month so “is in to refill his prescription.” He only
has symptoms two to three times per week, but they always respond to albuterol. The
physician monitoring this patient should:
A. Continue with current therapy, as the patient is improving.
B. Consider increasing the regimen to budesonide/formoterol 160/4.5.
C. Consider adding regular inhaled ipratropium bromide.
D. Consider adding montelukast.
6) In the initial development of a disease management program for asthma in your managed
care organization, the primary focus should be:
A. The provision of an extensive patient education program
B. Ensuring all patients do home monitoring of peak flows
C. Ensuring that only the least expensive asthma controller therapies are prescribed
D. Limiting the frequency of patient consultation with asthma specialists
7) A 70-kg female arrives at the emergency department with an acute exacerbation of asthma.
A peak flow measurement was obtained and the results are 30% of the predicted value.
Oxygen by nasal canula has been started. Which of the following is appropriate initial drug
therapy?
A. Albuterol 2.5 to 10 mg by nebulization every 20 minutes
B. Albuterol 2.5 to 10 mg and ipratropium bromide 0.5 mg by nebulization every 20
minutes
C. Albuterol 2.5 to 10 mg by nebulization every 20 minutes and corticosteroids (e.g.,
prednisone, prednisolone, methylprednisolone) 30 to 45 mg by mouth every 6 hours
D. Albuterol 2.5 to 10 mg and ipratropium bromide 0.5 mg by nebulization every 20
minutes and corticosteroids (e.g., prednisone, prednisolone, methylprednisolone) 30 mg twice
a day by mouth
8) In providing patient education, which of the following has been shown to result in reduced
emergency care utilization due to asthma?
A. Teaching about the pathophysiology of asthma
B. Teaching self-management skills
C. Teaching inhaler administration technique
D. Teaching about the pharmacology of the drugs
9) Which of the following is the primary long-term controller medication for a 5-year-old
female with moderate persistent asthma?
A. Salmeterol twice daily
B. Fluticasone propionate twice daily
C. Sustained-release theophylline twice daily
D. Montelukast once daily
10) Which of the following statements regarding short-acting inhaled β2-agonists is the most
correct?
A. Regular use of short-acting inhaled β2-agonists worsens asthma, and increases its
morbidity.
B. Regular use of short-acting inhaled β2-agonists increases the risk of death and near
death from asthma.
C. Short-acting inhaled β2-agonists should be used on an as-needed basis only, so their
use can be used as an outcome measure of control.
D. Regular use of short-acting inhaled β2-agonists produces tolerance so that patients
will not respond during acute exacerbations.
11) A 3-year-old child is diagnosed with mild persistent asthma. Which of the following is
the preferred initial therapy?
A. As-needed inhaled albuterol only
B. 5-mg chewable montelukast tablet every evening plus as-needed inhaled albuterol
C. 20-mg nebulized cromolyn three times daily plus as-needed inhaled albuterol
D. 0.5-mg nebulized budesonide once daily plus as-needed inhaled albuterol
12) A 22-year-old female, diagnosed with moderate persistent asthma, goes to her pharmacy
to pick up her prescription for fluticasone/salmeterol (100/50) combination. She has
dispensed the medication in a dry powder inhaler called a Diskus, which she has never used
before. Which of the following is the appropriate way for her to use this device?
A. Dispense the dose of medication, place lips around the mouthpiece, exhale into the
device, inhale steadily and deeply, hold breath for 10 seconds, and breathe out slowly.
B. Shake the device, dispense the dose of medication, place lips around mouth piece,
breathe in steadily and deeply, hold breath for 10 seconds, and breathe out slowly.
C. Shake the device, dispense the dose of medication, place lips around mouth piece,
exhale into the device, inhale steadily and deeply, hold breath for 10 seconds, and breathe out
slowly.
D. Dispense the dose of medication, place lips around mouthpiece, inhale forcefully and
deeply, hold breath for 10 seconds, and breathe out slowly.
13) A 14-year-old basketball player is diagnosed with exercise-induced bronchospasm. The
most appropriate therapy for him would be:
A. Begin ciclesonide once daily.
B. Begin two inhalations of albuterol prior to exercise.
C. Begin two inhalations of ipratropium bromide prior to exercise.
D. Begin 5 mg of montelukast 2 hours prior to exercise.
14) Regarding the use of nebulizers versus metered-dose inhalers plus valved holding
chambers (MDI + VHC) for administering medication, which of the following statements is
the most accurate?
A. The MDI + VHC provides more effective delivery than nebulizers, particularly in
young children.
B. The MDI + VHC and nebulizers provide similar benefits even in patients in the
emergency department.
C. The MDI + VHC delivery system is more cost-effective than nebulizers for
administering albuterol.
D. The MDI + VHC is the only effective way for delivering inhaled corticosteroids to
young children.
15) The best rationale for using inhaled corticosteroids as primary therapy for persistent
asthma is:
A. ICSs have no adverse effects so their safety profile exceeds other therapies.
B. The primary pathologic finding in asthma is airway inflammation, particularly with
eosinophils and T lymphocytes.
C. Inhaled corticosteroids are required to prevent the downregulation and tolerance of
the β2-adrenergic receptors.
D. ICSs work rapidly giving the patients positive feedback, thus encouraging adherence
for long-term use.
E. C and D
Chapter 20 - Peptic Ulcer Disease
D. Azathioprine
E. Sulfation
Chapter 25 - Pancreatitis
1) Which of the following etiologies of acute pancreatitis is the most common in the United
States?
A. Gallstones
B. Medications
C. Alcohol
D. ERCP
2) Which of the following medications has a probable association as a cause of acute
pancreatitis?
A. Pravastatin
B. Opiates
C. Lamivudine
D. Bactrim
3) Which of the following is correct concerning the course of acute pancreatitis?
A. About half of patients have a severe course with a mortality rate over 30%.
B. The gold standard for identifying patients at risk for a severe course is serum lipase.
C. There is no role for CECT in the diagnosis or staging of acute pancreatitis.
D. Scoring systems combine multiple factors to predict the clinical course of acute
pancreatitis.
4) Which of the following is correct regarding fluid replacement in acute pancreatitis?
A. Patients at risk for renal or cardiovascular complications should be fluid restricted.
B. Fluid and electrolyte requirements are minimal in patients with mild disease.
C. The prognosis of patients often depends on the adequacy of volume restoration.
D. Sequestered fluid in the peritoneal or retroperitoneal space should not be replaced.
5) Which of the following is the best nutrition therapy for a patient with severe acute
pancreatitis whose pain has improved and bowel sounds are normal?
A. Enteral nutrition via the nasogastric route
B. Enteral nutrition via the nasojejunal route
C. Total parenteral nutrition
D. Combined enteral and parenteral nutrition
6) Which of the following is correct with respect to the use of opioid analgesics for pain
associated with acute pancreatitis?
A. Avoid agents that cause spasm of the sphincter of Oddi.
B. Morphine can be used first line.
C. Synthetic opioids are the preferred agents.
D. Meperidine is the agent of choice.
7) Which is of the following is correct regarding studies evaluating the use of prophylactic
antibiotics in acute pancreatitis?
A. No benefit has been demonstrated with their use in mild disease.
B. Studies using carbapenems show a decrease in pancreatic infection.
C. The largest studies demonstrate the greatest benefit.
D. Studies enrolling patients without necrosis show a decrease in mortality.
8) Which of the following pathogenic mechanisms for the development of chronic
pancreatitis results in fatty degeneration of the pancreas secondary to lipid accumulation due
to the presence of metabolites of alcohol?
A. Toxic-metabolic
B. Oxidative stress
C. Periductular necrosis
D. Ductal obstruction
9) Which of the following is most indicative of chronic pancreatitis?
A. Serum trypsinogen of 10 ng/mL (mcg/L)
B. Fecal elastase of 400 mcg/g stool
C. Weight loss
D. Watery diarrhea
10) Which of the following is the best recommendation for a 47-year-old man with chronic
pancreatitis who smokes and still has steatorrhea despite maximum pancreatic enzyme
supplementation?
A. Begin an antisecretory agent and medium-chain triglyceride supplementation.
B. Quit smoking and begin medium-chain triglyceride supplementation.
C. Begin an antisecretory agent, quit smoking, and reduce fat intake to 0.5 g/kg/day.
D. Begin alternative enzyme supplement and reduce fat intake to 0.5 g/kg/day.
11) Which of the following is the best therapy for treating pain from chronic pancreatitis in a
51-year-old woman with a past medical history of a bleeding gastric ulcer who is no longer
getting relief from acetaminophen 650 mg orally four times daily?
A. Fentanyl 25 mcg/h transdermal patch every 72 hours
B. Hydrocodone/acetaminophen 5/500 mg orally four times daily
C. Ibuprofen 400 mg orally three times daily
D. Tramadol 50 mg orally four times daily
12) Which of the following patients with chronic pancreatitis is the best candidate for
pancreatic enzyme supplementation?
A. Steatorrhea with persistent weight loss
B. Steatorrhea without weight loss
C. Fecal fat estimation of 2 g/day
D. Worsening pain despite opioids
13) Which of the following pancreatic enzyme supplements would likely provide the largest
amount of active lipase to the duodenum at a rate similar to that of chyme from the stomach?
A. Minitablets
B. Enteric-coated beads
C. Minimicrospheres
D. Microspheres with bicarbonate buffer
14) Which of the following is the best option for a patient with persistent steatorrhea who has
not gained weight despite receiving the maximum dose of minimicrosphere enzyme
supplements administered during meals?
A. Change to microspheres.
B. Add an antisecretory agent.
C. Administer supplements before meals.
D. Administer supplements with applesauce.
15) Which of the following should regularly be assessed in a patient receiving opioids for
pain associated with chronic pancreatitis?
A. Steatorrhea
B. Weight loss
C. Respiratory depression
D. Constipation
E. Cefepime
D. Doxercalciferol
Chapter 32 - Glomerulonephritis
1) In a patient with nephrotic syndrome, which of the following is/are commonly observed
characteristic(s)?
A. Proteinuria
B. Edema
C. Hyperlipidemia
D. Hypercoagulable state
E. All of the above
2) Which of the following is/are expected to reduce proteinuria when used for patients with
glomerulonephritis?
A. Angiotensin-converting enzyme (ACE) inhibitors
B. Angiotensin II receptor blockers
C. Nonsteroidal anti-inflammatory agents
D. A and B only
E. A, B, and C are expected to reduce proteinuria
3) Which of the following parameters is often used to assess the risk for progressive decline
of renal function in patients with glomerulonephritis?
A. Edema
B. Proteinuria
C. Hyperlipidemia
D. Coagulopathy
E. Hematuria
4) Which of the following is the optimal target blood pressure in patients with glomerular
disease with GFR <60 mL/min or albuminuria >300 mg/day?
A. 130/80 mmHg
B. 130/90 mmHg
C. 140/80 mmHg
D. 140/90 mmHg
E. 140/70 mmHg
5) Anticoagulation therapy for thrombosis prophylaxis may be considered for patients with
which of the following glomerular diseases?
A. Minimal-change nephropathy
B. Focal segmental glomerulonephritis
C. Membranous nephropathy
D. Immunoglobulin A nephropathy
E. Membranoproliferative glomerulonephritis
6) In pediatric patients presenting with nephrotic syndrome, which of the following
glomerular disease is likely?
A. Minimal-change nephropathy
B. Focal segmental glomerulonephritis
C. Immunoglobulin A nephropathy
D. Membranous nephropathy
E. Membranoproliferative glomerulonephritis
7) Which of the following agents is often used as first-line therapy for inducing remission in
patients with recently diagnosed minimal-change nephropathy?
A. Steroid
B. Cyclosporine
C. Azathioprine
D. Cyclophosphamide
E. Mycophenolate mofetil
8) Which of the following is correct regarding the use of cyclosporine for the treatment of
minimal-change nephropathy?
A. Cyclosporine is often effective in inducing remission during relapse
B. Cyclosporine is useful for patients who are steroid dependent
C. The disease-free period is not often sustained after therapy discontinuation
D. A and B only
E. A, B, and C are correct
9) Which of the following are risk factors associated with rapid renal function decline in
patients with focal segmental glomerulonephritis?
A. Severe proteinuria
B. High serum creatinine concentration at initial diagnosis
C. Initial steroid resistance
D. Only A and B are correct
E. A, B, and C are correct
10) Which of the following has been shown by meta-analysis to reduce proteinuria in patients
with IgA nephropathy?
A. Corticosteroids
B. Cytotoxic agents
C. Fish oil
D. Antiplatelet agents
E. Phenytoin
11) A patient with IgA nephropathy who has normal renal function, isolated microhematuria,
and proteinuria less than 1 g/day should be:
A. Observed closely without specific treatment
B. Given fish oil
C. Given steroid treatment
D. Given cytotoxic agents
E. Given mycophenolate mofetil
12) Which of the following is/are commonly considered when selecting the optimal treatment
for patients with lupus nephritis?
A. Disease activity according to pathologic findings
B. Duration of symptoms
C. Extent of proteinuria
D. A and B only
E. A, B, and C
13) Which of the following is considered to be protective against the onset of lupus nephritis,
relapse of the disease, as well as the development of ESRD and venous thrombosis?
A. Steroid
B. Cytotoxic agent
C. Cyclosporine
D. Mycophenolate mofetil
E. Hydroxychloroquine
14) Annual eye examination for possible retinal toxicity should be conducted for patients
receiving which of the following therapy?
A. Fish oil
B. Cytotoxic agent
C. Cyclosporine
D. Mycophenolate mofetil
E. Hydroxychloroquine
15) Which of the following treatments is/are appropriate for poststreptococcal
glomerulonephritis?
A. Antibiotic to reduce severity of disease
B. Antibiotic to prevent the spread of infection to family members
C. Fish oil to prevent renal damage
D. A and B only
E. A, B, and C
Glucose 93mg/dL; Uosm 395 mOsm/kg; UNa 29mEq/L; SNa =120mEq/L; SCl =89mEq/L;
TCO2 =17mEq/L
Calcium 6.9mg/L; albumin 2g/L; SK =2.4mEq/L; BUN = 23mg/L; SCr =0.8mg/dL
In corresponding SI units:
Glucose 5.2; Uosm 395; UNa 29; SNa =120; SCl =89; TCO2 =17
Calcium 1.73; albumin 20; SK = 2.4; BUN = 8.2; SCr =71
D. Tolvaptan
Questions 1 to 3
A 23-year-old man was found to be apneic and unresponsive in the surgery ward following
reconstructive knee surgery. Three hours ago, his nurse had reprogrammed his
hydromorphone patient-controlled analgesia (PCA) because he was complaining that he could
not get enough pain relief when he pressed the PCA button. While he is being assessed and
resuscitated, and administered a dose of naloxone 10 mg IV × 1, an arterial blood gas sample
was taken, revealing the following: pH 7.08, Pco2 80 mm Hg (10.6 kPa), HCO3 23 mEq/L (23
mmol/L). His most recent serum labs demonstrated: Na 130 mEq/L (130 mmol/L), Cl 111
mEq/L (111 mmol/L), and TCO2 23 mEq/L (23 mmol/L).
Questions 4 to 8
A 68-year-old man (weight = 70 kg; height = 69 inches [175 cm]) who recently took
antibiotics for a skin infection presents with 10 episodes of watery diarrhea per day for the
last 5 days. His most recent ABG is: pH 7.30, Pco2 34 mm Hg (4.5 kPa), HCO3 17 mEq/L (17
mmol/L), and his Po2 80 mm Hg (10.6 kPa) and his most recent serum labs demonstrate: Na
135 mEq/L (135 mmol/L), Cl 114 mEq/L (114 mmol/L), and TCO2 17 mEq/L (17 mmol/L).
Questions 9 to 11
A 31-year-old man presents with lethargy, weakness, labored respiration, and confusion. He
has had diabetes for 15 years, and has been suffering from the “intestinal flu” for a day or so,
for which he has been avoiding food to help prevent further vomiting and “make his stomach
ache go away”. Since he stopped eating, he thought that it would be a good idea to stop taking
his insulin. When seen in the emergency department his urine dipped positive for both
glucose and ketones and his breath had a strange sweet, fruity smell. The following arterial
blood gas data were obtained: pH 7.27, Pco2 23 mm Hg (3.1 kPa), and HCO3 10 mEq/L (10
mmol/L). His most recent serum chemistries are as follows: Na 132 mEq/L (132 mmol/L), Cl
83 mEq/L (83 mmol/L), K 4.9 mEq/L (4.9 mmol/L), and glucose 345 mg/dL (19.1 mmol/L).
Questions 12 to 15
12) Acid–base disturbances in renal failure present as __________ initially due to impaired
ammoniagenesis, but progress to __________ as retention of phosphates and sulfates
increases.
A. Metabolic alkalosis; metabolic acidosis
B. Chloride-responsive metabolic alkalosis; chloride-unresponsive metabolic alkalosis
C. Metabolic acidosis; metabolic alkalosis
D. Hyperchloremic metabolic acidosis; high anion gap metabolic acidosis
E. Chloride-unresponsive metabolic alkalosis; chloride-responsive metabolic alkalosis
13) Which of the following statements is false regarding respiratory acidosis?
A. Respiratory acidosis can occur in a patient having an acute exacerbation of chronic
obstructive pulmonary disease
B. Respiratory acidosis is a primary increase in Pco2 resulting in a decreased pH
C. The Pco2 is the primary stimulus to breathe in a patient with end-stage chronic
obstructive pulmonary disease, who is managed at home with oxygen therapy
D. Renal bicarbonate reabsorption is an expected response to respiratory acidosis
E. None of the above are false
14) Which of the following therapies would be most likely administered to a patient with a
sodium chloride-resistant metabolic alkalosis?
A. Arginine monohydrochloride
B. Shohl’s solution
C. Ammonium chloride
D. IV hydrochloric acid
E. Spironolactone
15) Which of the following would not be considered a viable treatment option for a patient
with a life-threatening acute metabolic acidosis (plasma bicarbonate of 8 mEq/L [8 mmol/L]
and pH <7.20)?
A. Hemodialysis
B. Sodium bicarbonate
C. Tromethamine (THAM)
D. Sodium acetate
4) In clinical situations similar to KP’s, what should patients and families be counseled about
expectations from their AD therapy?
A. Drug therapy will usually halt the progression of the disease
B. The risk of adverse events with drug therapy outweighs the benefit in mild disease, so
drug therapy should be delayed until the disease is moderately severe.
C. The time to reach significant functional decline may be delayed, but the disease will
continue to progress
D. Memory noticeably improves for most patients when therapy is initiated
5) The most common Aricept® adverse event that KP and his wife should be counseled about
is:
A. Elevated blood pressure
B. Agitation
C. Hyperglycemia
D. Nausea, diarrhea, or vomiting
6) KP had a Mini-Mental Status Examination (MMSE) score of 21 at the time of diagnosis.
Would it be considered appropriate to add memantine to his drug regimen at this time?
A. Yes, since he is in the moderate stage of AD
B. Yes, since he is unlikely to respond to Aricept®
C. No, since he is in the mild stage of AD
D. No, since memantine should not be added to cholinesterase inhibitor therapy
7) What is the preferred initial treatment for agitation in AD?
A. Antidepressants
B. Antipsychotics
C. Benzodiazepines
D. Nonpharmacological behavioral interventions
8) How frequently should KP’s donepezil therapy be monitored at a follow-up visit with the
prescriber?
A. Weekly until efficacy is demonstrated and then monthly
B. Monthly until side effects are manageable and then every 6 months
C. Two to three months after starting therapy and then every 6 months unless significant
changes in cognition, function, or behavior arise
D. Annually unless significant side effects arise
9) Which of the following drugs or drug combinations has NOT been shown to be effective
therapy for patients in LR’s stage of AD?
A. Donepezil 10 mg every night at bedtime + Rivastigmine 6 mg twice daily
B. Donepezil 10 mg every night at bedtime
C. Memantine 10 mg twice daily
D. Donepezil 10 mg every night at bedtime + Memantine 5 mg twice daily
10) LR’s husband asks about using Tylenol PM® to help his wife with falling asleep. What
recommendations should you give LR concerning the use of Tylenol PM®?
A. Tylenol PM® is preferred over prescription medications to treat insomnia in
Alzheimer’s patients
B. Tylenol PM® may enhance the effects of cholinesterase inhibitors, so concurrent use
should be avoided
C. Tylenol PM® should be avoided because there is a pharmacokinetic drug interaction
between diphenhydramine and cholinesterase inhibitors
D. Tylenol PM® should be avoided because diphenhydramine may worsen cognitive
function
D. Dalfampridine
Chapter 40 - Epilepsy
1) In the pharmacoresistant epilepsy patient which factor(s) best defines QOL:
A. Seizure freedom
B. Addressing anxiety and/or depression
C. Patient being employed
D. A decrease in seizure frequency
E. Both B and D
2) Nonpharmacologic therapy of the epilepsy patient can involve all of the following in the
appropriate patient except:
A. Temporal lobe surgery
B. Low glycemic index diet treatment
C. Acupuncture
D. Vagal nerve stimulator
E. Extratemporal lobe surgery
3) Which antiepileptic drug’s (AED’s) serum level is most affected by the pregnancy state?
A. Levetiracetam
B. Lamotrigine
C. Phenytoin
D. Carbamazepine
E. Lacosamide
4) Which AED is most likely to associated with polycystic ovary syndrome?
A. Vigabatrin
B. Primidone
C. Phenytoin
D. Zonisamide
E. Valproic acid
5) Which item is of no value in the workup of a person who presents to the emergency room
with a first time generalized tonic–clonic (GTC) seizure?
A. Serum glucose
B. Serum creatinine
C. 30 minute electroencephalogram (EEG)
D. Serum prolactin level
E. All are useful
6) Which AED should not be effective in the treatment of absence epilepsy?
A. Phenytoin
B. Valproic acid
C. Ethosuximide
D. Carbamazepine
E. Both A and D are correct
7) Which AED has the longest elimination half-life?
A. Lacosamide
B. Oxcarbazepine
C. Tiagabine
D. Clobazam
E. Topiramate
8) Which AED is not used for refractory complex partial seizures?
A. Vigabatrin
B. Lacosamide
C. Levetiracetam
D. Valproic acid
E. Rufinamide
9) Which AED is not considered a controlled substance?
A. Felbamate
B. Clobazam
C. Pregabalin
D. Lacosamide
E. Phenobarbital
10) Mr. H. has a history of calcium phosphate kidney stones and is allergic to sulfa. Which is
the worst choice of AED to use in the treatment of Mr. H’s partial seizures?
A. Topiramate
B. Lacosamide
C. Zonisamide
D. Carbamazepine
E. Oxcarbazepine
11) Which AED is more likely to cause speech or language problems?
A. Valproic acid
B. Tiagabine
C. Phenytoin
D. Topiramate
E. None are correct
12) Which patient is most likely going to have successful discontinuation of his AED(s)?
A. Patient with a seizure-free period for 1 to 2 years
B. An onset of seizures after 35 years of age
C. Seizure control within 1 year of onset
D. Patient with complex partial seizures as opposed to GTC seizures
E. Patient with an abnormal EEG only when he is asleep
13) In a patient taking an older enzyme inducer AED, which form of birth-control
does not need a back-up method to avoid pregnancy:
A. Transdermal contraceptive patch
B. Emergency contraceptive pill
C. Medroxyprogesterone depot injection
D. Hormone-releasing intrauterine device system
E. Both C and D
14) Which AED has saturable GI absorption and therefore should not be given in large doses
all at once:
A. Gabapentin
B. Tiagabine
C. Pregabalin
D. Lacosamide
E. None are correct
15) Which statement is false?
A. GTC seizures are always associated with loss of consciousness
B. Complex partial seizures can involve sensory or focal motor features
C. Absence seizures can be almost nondetectable
D. The interictal period is a period where the patient is delirious
An 8-year-old boy is brought by an ambulance to the ER. His mother says he had
fallen to the ground and began twitching and jerking both arms and legs. The
jerking lasted for about 2 to 3 minutes, after which he would wake up, but have no
memory of the event. This pattern of events recurred for what seemed like an hour
before the ambulance arrived. His mother said he had a fever with upper
respiratory tract symptoms a day or two ago. She relayed he does not have epilepsy
but does have asthma. He takes Flonase (fluticasone), Singular (montelukast) daily,
and albuterol as needed. As you are taking the history, the child begins to convulse
again.
A 57-year-old (wt 85 kg) man with a history of complex partial seizures (2 per
month) presents to the ER because of a “long” seizure at home that was at least
partly witnessed by his wife. He was given lorazepam and is now seizure free. He
chronically received Carbatrol 600 mg twice a day and Keppra 1,500 mg twice a
day. All chemistries, including liver function test and CBC, are normal.
Chapter 50 - Schizophrenia
1) Which of the following is the most accurate statement regarding the
potential etiology of schizophrenia?
A. Developmental delays in children who later develop schizophrenia indicate
that schizophrenia is clearly a developmental disorder.
B. Genetics studies suggest a Mendelian genetic relationship for developing
schizophrenia.
C. PET studies indicate that schizophrenia is a degenerative brain disorder.
D. Schizophrenia shows characteristics of both a developmental and a
degenerative disorder.
5) Which of the following most accurately reflects the initial workup (i.e.,
evaluation) of a patient suspected of having schizophrenia?
A. Mental status examination, physical examination, neurologic examination,
social history, laboratory workup, and PET scan
B. Mental status examination, physical examination, neurologic examination,
social history, laboratory workup, and MRI scan
C. Mental status examination, physical examination, neurologic examination,
social history, family history, and a CSF homovanillic acid (HVA) level
D. Mental status examination, physical examination, neurologic examination,
family history, laboratory workup, and a CSF 5-hydroxyindolacetic acid (5-HIAA)
level
E. Mental status examination, physical examination, neurologic examination,
family history, social history, and laboratory workup
10) The rapid on, rapid off theory of atypicality is best associated with which
of the following antipsychotics?
A. Aripiprazole
B. Olanzapine
C. Quetiapine
D. Risperidone
E. Ziprasidone
A. Trazodone
B. Flurazepam
C. Cognitive therapy
D. Zolpidem
E. Sleep hygiene
2) Mrs D, a 35-year-old female, complains of difficulty with sleep onset for more
than 6 weeks. She has appropriately tried sleep hygiene therapy, but that has not
worked. The plan is to initiate medication therapy. If the patient has no
contraindications, and no medical causes for these sleep difficulties, which of the
following therapies would you start with?
A. Amitriptyline
B. Fluoxetine
C. Doxepin
D. Citalopram
E. Zolpidem
3) A 42-year-old female who recently lost her husband tells you that she is not
sleeping at night. After questioning her further, you determine that she does not
have depression or substance abuse. What would you recommend?
4) A 27-year-old female has trouble with waking up in the middle of the night.
Which of the following is least likely to be effective for her if taken at bedtime?
A. Zaleplon
B. Temazepam
C. Zolpidem CR
D. Estazolam
5) What is the best way to avoid tolerance and dependence in this patient?
6) A 28-year-old female has a chief complaint of insomnia occurring for the last 5
months. She just graduated from pharmacy school, and she spends the evening
worrying if she has made a mistake during her busy days at work. All other
psychiatric and medical conditions have been ruled out. How would you approach
treating this patient?
C. Recommend an approach that would include education concerning good sleep hygiene,
supportive therapy, and trazodone as an adjunct if needed.
D. Take modafinil prior to going to work to help him stay awake overnight.
A. Temazepam
B. Amitriptyline
C. Ramelteon
D. Levothyroxine
10) DB is a 58-year-old male with obstructive sleep apnea and daytime sleepiness.
What is the best therapy for him?
A. Tracheostomy
B. Modafinil
C. Uvulopalatopharyngoplasty
D. Oral appliances
11) Sleep apnea can lead to all of the following sequelae except?
A. Depression
B. Stroke
C. Hypertension
D. REM parasomnias
12) Which of the following is the standard of treatment for daytime sleepiness
associated with narcolepsy?
A. Methamphetamine
B. Modafinil
C. Zolpidem
D. Imipramine
13) Which of the following is the most effective treatment for cataplexy associated
with narcolepsy?
A. Methamphetamine
B. Medroxyprogesterone acetate
C. Modafinil
D. Sodium oxybate
15) Which of the following would be the correct recommendation for a patient with
obsessive-compulsive disorder and restless legs syndrome who has difficulty
falling asleep due to his RLS?
A. Zolpidem
B. Doxepin
C. Ropinirole
D. Pramipexole
Chapter 62 - Contraception
1) A healthy woman who is 3 weeks postpartum and breast-feeding seeks
contraception. She would like to have another child in 1 year. Which of the
following is the preferred method of contraception?
A. Combined oral contraceptive
B. Progestin-only oral contraceptive
C. Depo-medroxyprogesterone acetate
D. Transdermal contraceptive
2) A 32-year-old woman comes to the pharmacy to pick up her prescription for
norgestimate/ethinyl estradiol (Ortho-Cyclen). She complains of nausea and
headaches since starting her oral contraceptive 5 months ago. What do you
recommend?
A. Call her physician to change her prescription to another oral contraceptive with less
estrogen
B. Call her physician to change her prescription to another oral contraceptive with less
progestin
C. Buy a home pregnancy test to rule out pregnancy
D. Wait another 1 to 2 months to see if symptoms improve
3) A 33-year-old nonobese woman wants to discuss her contraceptive options. She
is married with two children and does not desire to have additional children. Her
medical history includes hypertension and migraines with aura. Which one of the
following is the best approach to hormonal contraception for this patient?
A. Ortho Cyclen (combined oral contraceptive)
B. Implanon (implantable contraceptive)
C. Ortho Evra (transdermal patch)
D. Nuvaring (vaginal contraceptive)
4) An 18-year-old woman with a seizure disorder seeks contraception today. She is
taking carbamazepine. Which of the following contraceptive methods would be
most appropriate?
A. Combined oral contraceptive (with 35 mcg of ethinyl estradiol)
B. Depo-medroxyprogesterone acetate
C. Transdermal contraceptive
D. Progestin-only oral contraceptive
5) A 23-year-old frantic woman comes to the pharmacy asking for advice. She had
sexual intercourse last night and her partner’s condom broke. She states she has a
past medical history of type 2 diabetes and hypothyroidism. What do you
recommend?
A. Purchase a home pregnancy test
B. Buy levonorgestrel-containing emergency contraception at the pharmacy
C. Make an appointment with her physician to discuss emergency contraception
D. Do nothing and reassure her that she is not likely to get pregnant
6) A 22-year-old woman has been using Depo-Provera for the past year. She comes
to the office for her quarterly injection (her last injection was 13 weeks ago). The
nurse asks you about the administration of Depo-Provera, and you recommend that
she:
A. Have the patient wait until her next menses before receiving the injection
B. Return to the office next week for her injection
C. Give the injection today but use a second method of contraception for the next cycle
D. Obtain a pregnancy test and if negative give the injection today
7) In which of the following situations would it be inappropriate to recommend
combined oral contraceptives?
A. Sickle-cell disease
B. Hypertension treated with a diuretic and an average blood pressure of 172/92 mm Hg
C. History of migraines without aura in women less than 35 year of age
D. Dyslipidemia without coronary artery disease treated to goal LDL with a statin
8) Which one of the following is a noncontraceptive benefit of oral contraceptives?
A. Prevention of sexually transmitted diseases
B. Decreased risk of cervical cancer
C. Decrease in serum triglycerides
D. Decreased risk of endometrial and ovarian cancers
9) LR is a 27-year-old woman who started on a low dose combined oral
contraceptive containing 20 mcg ethinyl estradiol (EE) 2 months ago. She went out
of town for the weekend and missed two doses of her medication. It is the third
week of her cycle. She is now asking for your opinion on how she should handle
the situation. What would be the most appropriate response?
A. Take an active tablet as soon as possible (two tablets on that day) and then continue
taking tablets daily, 1 each day. No additional contraceptive protection is recommended
B. Take an active tablet as soon as possible (two tablets on that day) and then continue
taking tablets daily, 1 each day. Use condoms or abstain from sex until tablets have been
taken for 7 days in a row. Finish the active tablets in the current pack and start a new pack the
next day (i.e., do not take the seven inactive tablets).
C. Discard the current pack, allow bleeding to occur and then restart a new pack, taking
1 tablet each day. Use condoms or abstain from sex until the new pill pack has been taken for
7 days in a row
D. Take an active tablet as soon as possible (two tablets on that day) and then continue
taking tablets daily, 1 each day. Use condoms or abstain from sex until tablets have been
taken for 7 days in a row
10) KR is a 39-year-old nonsmoking female with a history of migraines with aura.
She has two children with no immediate plans for others. She is obese and weighs
115 kg. What contraceptive method would be the best option?
A. Levonorgestrel IUD (Mirena)
B. Progestin implant (Implanon)
C. Combined oral contraceptive
D. Vaginal ring contraceptive
11) The most clinically useful indicator of approaching ovulation is:
A. Estrogen surge
B. LH surge
C. Progesterone drop
D. Corpus luteum degeneration
12) A 36-year-old patient who is fairly nonadherent to medications and has never
been on hormonal contraception in the past is requesting contraception. She is a
smoker. What would be the most appropriate recommendation?
A. Nuvaring (vaginal contraceptive)
B. Ortho-Cyclen (combined oral contraceptive)
C. Injectable depo-medroxyprogesterone
D. Micronor (progestin-only pill)
13) Use of the vaginal contraceptive ring would be most appropriate in which of
the following women?
A. 30-year-old woman with hypothyroidism
B. 38-year-old woman who smokes one-pack-per-day
C. 36-year-old woman with migraines
D. 39-year-old woman with obesity
14) AT is a 26-year-old female with a history significant for depression,
dysmenorrhea, and smoking. She is not currently using hormonal contraception.
She and her boyfriend were on a cruise and did not use a condom and had
unprotected sexual intercourse 5 days ago. What is the best recommendation?
A. Buy levonorgestrel-containing emergency contraception at the pharmacy
B. Buy a home pregnancy test
C. Inform her there is no emergency contraception option for her particular situation
D. Call her clinician with a recommendation for a verbal order for ulipristal emergency
contraception
15) A 25-year-old single, nulliparous, nonsmoking female with no significant
medical history wants an easy, highly effective, and quickly reversible
contraceptive method. What would you recommend?
A. Combined oral contraceptive
B. Progestin implant (Implanon)
C. Depo-medroxyprogesterone acetate
D. Progestin-only oral contraceptive
Chapter 64 - Endometriosis
1) JH is a 35-year-old obese (BMI >30 kg/m2) woman with a history of two
uncomplicated births via spontaneous vaginal delivery. She reports menarche at
age 13 and menstrual cycles of approximately 25 days. She breast-fed each child
for approximately 10 months. Based on these data, which of the following
characteristics confers increased risk of endometriosis in JH?
A. Age of menarche
B. Body mass index
C. Duration of lactation
D. Length of menstrual cycle
E. Multiple deliveries
2) Which of the following is a proposed theory for why endometrial tissue is found
outside the uterus in women with endometriosis?
I. Differentiation of stem cells from bone marrow into endometrial-like tissues
II. Malignant and uncontrolled division of abnormal cells in the peritoneal cavity
III. Retrograde flow of menstrual tissue through the fallopian tubes
A. III only
B. I and II only
C. I and III only
D. II and III only
E. I, II, and III
3) Which of the following accurately describes findings in patients with pain
caused by endometriosis?
A. Low levels of prostaglandins
B. Elevated levels of substance P
C. Increased density of nerve fibers is found near endometrial lesions
D. Correlation between size and location of endometrial lesions and severity of pain
E. Decreased concentrations of tumor necrosis factor-α and interleukins 1, 6, and 8
4) Which of the following mechanisms may lead to infertility in women with
endometriosis?
I. Inflammatory cytokines in peritoneal fluid induce sperm DNA damage.
II. Hormone dysregulation leads to decreased ovarian reserve.
III. Anatomic abnormalities physically block fallopian tubes.
A. III only
B. I and II
C. I and III
D. II and III
E. I, II, and III
5) CK is a 50-year-old female who has suffered from endometriosis since age 16.
Over the years, she has experienced both pain and infertility, and she and her
husband selected to adopt two children 10 years ago. Her last surgical treatment
was 4 years ago, and she presents again today with moderate-to-severe pain. What
are the most appropriate treatment goals for CK based on these data?
I. Preserve fertility.
II. Preserve ovarian function.
III. Relieve pain.
A. III only
B. II only
C. I and III only
D. II and III only
E. I, II, and III
6) KS is a 15-year-old female who presents to her family practitioner for followup
after presenting with severe menstrual pain 6 months prior. At that time, she was
prescribed a low-dose combined oral contraceptive pill continuously. Today, KS
reports that her pain has not improved. Based on this information, which of the
following options is most appropriate at this time?
A. Change current oral contraceptive to cyclic dosing.
B. Switch therapy to the levonorgestrel intrauterine system.
C. Switch therapy to subcutaneous leuprolide.
D. Add ibuprofen during menstrual cycles.
E. Refer for laparoscopic evaluation.
7) Which of the following medical therapies is considered a drug treatment of first
choice for endometriosis?
A. Anastrozole (oral)
B. Danazol (vaginal)
C. Depot medroxyprogesterone (subcutaneous)
D. Nafarelin (nasal spray)
E. Naproxen (oral)
8) Which of the following side effects is common to the GnRH agonists, aromatase
inhibitors, and depot medroxyprogesterone?
A. Bone mineral density loss
B. Breakthrough bleeding
C. Hirsuitism
D. Hot flashes
E. Nausea/vomiting
9) What characteristic would preclude use of combined oral contraceptive pills to
treat endometriosis pain in a woman over age 35 due to increased risk of serious
side effects?
A. Diabetes
B. Hypertension
C. Seizure medications
D. Tension headaches
E. Tobacco use
10) Which of the following statements is true regarding add-back therapy?
A. Add-back therapy prevents hot flashes and bone loss.
B. Add-back therapy always includes an estrogen and progestin.
C. Add-back therapy is likely to stimulate new endometrial growth.
D. Add-back therapy is only started after 12 months of GnRH agonist therapy.
E. Add-back therapy dosing is similar to the hormonal doses used in contraception.
11) A 22-year-old female with endometriosis prefers to try a “natural and
alternative” approach to treating her pain before proceeding with traditional
medical therapies. Which of the following options has data to support its
effectiveness?
A. Acupuncture
B. Calcium supplementation
C. Cognitive behavioral therapy
D. Increased salmon in diet
E. Vitamin D supplementation
12) RH is a 21-year-old, unmarried, college student with severe endometriosis pain
that has been unresponsive to 6 months treatment with depot medroxyprogesterone.
Her PMH also includes seasonal allergic rhinitis, asthma, migraine with aura, and
allergy to aspirin products. Her medications include loratadine 10 mg by mouth
daily, fluticasone/salmeterol 100/50 one puff twice a day, albuterol HFA two puffs
every 6 hours as needed, and sumatriptan 50 mg by mouth as needed. RH has good
prescription drug insurance that covers all commonly utilized endometriosis
treatments. In addition to discontinuation of the depot medroxyprogesterone, which
of the following treatment recommendations would be best for RH based on the
information given?
A. Start oral danazol.
B. Start letrozole, estradiol, and norethindrone.
C. Start leuprolide, norethindrone, and oxycodone.
D. Start a low-dose combined oral contraceptive pill.
E. Refer for laparoscopy, followed by retreatment with depot medroxyprogesterone.
13) TJ is a 65-year-old female who has suffered from endometriosis for most of her
life. Five years ago, she underwent hysterectomy with preservation of her ovaries.
Prior to that surgery, she had not had a menstrual cycle in 8 months time. Today,
TJ again presents with pelvic pain that is assessed to be due to relapsing
endometriosis. Her PMH is also positive for hypertension, hyperthyroidism, and
osteoporosis. Her medications include lisinopril 10 mg orally daily, amlodipine 5
mg orally daily, levothyroxine 75 mcg orally daily, alendronate 70 mg orally
weekly, and calcium/vitamin D supplementation. Which of the following therapies
is most reasonable to recommend at this time?
A. Anastrozole
B. Depot medroxyprogesterone
C. Goserelin
D. Naproxen
E. Surgical removal of ovaries
14) JW, a 34-year-old female with endometriosis, just underwent conservative
laparoscopic surgery 2 months ago in an attempt to improve her fertility. She has
not yet achieved pregnancy. What is the most logical next step in JW’s treatment
plan?
A. Start dietary therapy.
B. Start a GnRH agonist.
C. Start contraceptive ring.
D. Continue watchful waiting.
E. Start assisted reproductive efforts.
15) Which of the following monitoring plans is most appropriate for a patient
receiving oral danazol for endometriosis pain?
A. Degree of pain relief at 6 months and liver function tests every 3 months
B. Degree of pain relief at 3 months and serum cholesterol every 6 months
C. Degree of pain relief at 3 months and bone mineral density scan at 1 year
D. Degree of pain relief at 2 months and bone mineral density scan at 6 months
E. Degree of pain relief at 2 months, liver function tests every 3 months, and serum
cholesterol every 3 months
Results Reporter
Chapter 71 - Osteoarthritis
1) Risk factors for the development of osteoarthritis (OA) include:
A. Smoking
B. Participation in running
C. Being underweight
D. Advanced age
E. B and D
2) Patient education for OA, such as programs in which volunteers regularly
contact patients
A. Has not yet been demonstrated to provide benefit to OA patients
B. Is too expensive to recommend for general use by OA patients
C. Should emphasize the “wear and tear” nature of OA as part of the educational
message
D. Has been shown to improve pain and functional status of OA patients
E. All of the above
3) MMPs (matrix metalloproteinases)
A. Are naturally occurring chemokines that work primarily by recruiting neutrophils and
macrophages to the inflamed synovium
B. Help trigger degradation of articular cartilage by cleaving peptide bonds in
proteoglycans
C. Are stimulated by TIMPs (tissue inhibitors of metalloproteinases)
D. Must be activated before they can ease the pain of OA
E. B and C
4) Which of the following are required for an accurate and appropriate diagnosis of
OA?
A. Patient history and physical exam
B. Patient history, physical exam, and radiologic evaluation
C. Physical examination and magnetic resonance imaging
D. Patient history, physical exam, and positive response to pharmacologic treatment
E. Any of the above is accurate and appropriate
5) Acetaminophen
A. Is recommended as an appropriate initial treatment in OA
B. Should be given on a scheduled basis for optimal pain control
C. Can be associated with hepatotoxicity at doses below 4 g per day
D. Provides mild analgesia
E. All of the above
6) Traditional, nonselective NSAIDs
A. Block access of arachidonic acid to both COX-1 and COX-2 enzymes
B. Promote platelet aggregation through blockade of COX-2 activity
C. Promote prostaglandin and bicarbonate production in gastric mucosa through
blockade of COX-2 activity
D. Counteract renal vasoconstriction by promoting formation of renal prostaglandins
E. Are antiinflammatory at low doses and analgesic at higher doses
7) NSAIDs:
A. Are associated with thousands of serious or life-threatening GI adverse events every
year
B. Provide superior relief of OA pain in some individuals
C. Will usually produce symptoms of dyspepsia or abdominal discomfort as a prelude to
serious GI adverse events
D. Should be consistently monitored by serum levels when used in antiinflammatory
doses
E. A and B
8) NSAIDs:
A. Are recommended as an alternative to acetaminophen for controlling inflammation
associated with OA
B. Provide pain relief by the inhibition of prostaglandins
C. Provide cardioprotective effects similar to aspirin
D. Increase renal blood flow, causing sodium and potassium excretion
E. B and C
9) Celecoxib, a COX-2 selective inhibitor:
A. Blocks the COX-2 enzyme with little or no inhibition of COX-1
B. Is more effective at relieving pain than nonselective NSAIDs
C. Is much safer to use in patients with compromised circulatory function
D. Carries a manufacturer’s warning against use in sulfa allergic patients
E. A and D
10) Intraarticular corticosteroids:
A. Have no role in OA, as this disease does not have any inflammatory component
B. Are recommended as maintenance therapy for patients who cannot tolerate NSAIDs
and who have severe OA
C. Can be administered up to 12 times per year for the treatment of severe OA pain
D. Are associated with hyperglycemia in patients without diabetes mellitus
E. Should not be used for the treatment of hip OA
11) Hyaluronate injectable material:
A. Is made using recombinant technology
B. Provides a long-term increase in viscosity of synovial fluid
C. Is a low-cost pharmacologic therapy
D. Is highly effective when compared to placebo vehicle injections
E. Is less effective than intraarticular corticosteroids
12) Recommended treatment options for OA patients who have failed
acetaminophen include:
A. Nonselective NSAIDs used at analgesic doses, if the patient is not at high risk for GI
bleeding
B. Nonselective NSAIDs with an H2 antagonist to prevent GI bleeding in the high-risk
patient
C. COX-2–selective inhibitors with sucralfate in the high-risk patient
D. COX-2–selective inhibitors with misoprostol in the high-risk patient
E. None of the above
13) Knee replacement surgery should be considered in the patient with OA if:
A. The patient prefers not to try oral medications such as acetaminophen
B. There is significant disability and interference with daily functioning
C. The patient refuses treatment with low-dose NSAIDs
D. The patient is at high risk for NSAID-related GI bleeding
E. The patient does not respond to topical therapy with NSAIDs
14) Topical capsaicin therapy for the treatment of OA pain:
A. Produces systemic adverse effects
B. Provides therapeutic results within 48 hours
C. Is most effective when used on an as-needed basis
D. Must be used four times daily for best results
E. Is most appropriate for the treatment of hand OA
15) A patient with a history of which of the following is best suited to opioid
analgesic therapy for their OA symptoms?
A. Alcoholism
B. Small bowel obstruction
C. Traumatic fall on home stairs
D. Myocardial infarction
E. Poor adherence to medications
Chapter 75 - Glaucoma
1) Assessment of primary open-angle glaucoma includes:
A. Increased intraocular pressure
B. Loss of visual fields
C. Glaucomatous changes of the optic disc and nerve fiber layer
D. B and C
E. A, B, and C
2) The objective of drug therapy of open-angle glaucoma is to:
A. Reduce intraocular pressure to the normal range
B. Restore visual field to normal
C. Halt progression of visual field loss
D. A and C
E. A, B, and C
3) Aqueous humor is produced by the:
A. Trabecular meshwork
B. Iris
C. Schlemm’s canal
D. Ciliary body
E. None of the above
4) Increased intraocular pressure observed in the majority of primary open-angle
glaucoma is the result of:
A. Increased aqueous humor production
B. Increased resistance to flow through the pupil
C. Blockage of the trabecular meshwork by the iris
D. Increased resistance to outflow through the trabecular meshwork
E. None of the above
5) Drug therapies used in glaucoma reduce intraocular pressure by:
A. Reduction of aqueous production by the ciliary body
B. Increased outflow of aqueous humor through the trabecular meshwork and/or
uveoscleral pathway
C. Induction of miosis
D. A and B only
E. A and C only
6) Glaucoma medications that reduce intraocular pressure by increasing
uveoscleral outflow include:
A. β-blockers and carbonic anhydrase inhibitors
B. Cholinergics
C. Prostaglandin analogs and α2 agonists
D. A and C
E. A and B
7) First-line agents for the treatment of open-angle glaucoma usually include:
A. Cholinesterase inhibitors
B. Combination of timolol and brimonidine
C. Prostaglandin analogs
D. Oral carbonic anhydrase inhibitors
E. Pilocarpine
8) Use of nasolacrimal occlusion or eyelid closure following application of topical
glaucoma medications is potentially beneficial for:
A. Only patients experiencing inadequate response to therapy
B. Only patients experiencing systemic adverse effects
C. All patients
D. Only patients with significant local side effects
E. Only patients who have difficulty administering medications
9) Side effects associated with prostaglandin F2a analogs include:
A. Pigmentary changes of the iris
B. Miosis
C. Bronchospasm
D. Decreased blood pressure
E. A and D
10) Appropriate therapeutic approaches to a 67-year-old white female with no
family history of glaucoma and an intraocular pressure of 26 mm Hg in both eyes
with normal visual fields and optic disc findings include:
A. Initiate therapy with pilocarpine 4% one drop in each eye four times daily
B. Trabeculectomy
C. Initiate therapy with 0.5% timolol one drop in each eye twice daily
D. Adjunctive therapy to reduce intraocular pressure aggressively
E. Monitor for signs of glaucoma only after assessing glaucoma risk factors
11) Differences between available ophthalmic β-blocking agents are:
A. β1-specificity
B. Intrinsic sympathomimetic activity
C. Available dosage forms
D. Frequency of local and systemic side effects
E. All of the above
12) Side effects associated with ophthalmic β-blockers include:
A. Reduced exercise capacity
B. Bronchospasm
C. Heart block
D. Psychosis
E. All of the above
13) Topical carbonic anhydrase inhibitors reduce intraocular pressure by:
A. Increased trabecular outflow
B. Increased uveoscleral outflow
C. Induction of miosis
D. Reduced aqueous production
E. Increased serum osmolarity
14) Caution should be used when administering the following medications to
patients being treated for open-angle glaucoma:
A. Systemic agents with anticholinergic effects
B. Topical parasympathomimetics
C. Topical corticosteroids
D. Systemic monoamine oxidase inhibitors
E. None of the above
15) The following statement(s) regarding the drug therapy of open-angle glaucoma
is (are) true:
A. Reduction of a high intraocular pressure in a patient with glaucoma to normal always
results in a halt of visual field loss
B. Patients with normal intraocular pressures and with early glaucomatous field loss may
not be left untreated and should be observed for disease progression
C. Reduction of intraocular pressure below normal provides no benefit to patients with
glaucoma and normal intraocular pressure
D. B and C only
E. A and C only
Chapter 78 - Psoriasis
1) The overall incidence of psoriasis in North America and Europe is
approximately
A. 0.2%
B. 2%
C. 12%
D. 20%
2) Which of the following drugs may precipitate new-onset psoriasis?
A. Corticosteroids
B. Azathioprine
C. β-adrenergic blocker
D. Thiazide diuretics
3) Which of the following drugs may exacerbate preexisting psoriasis?
A. β-adrenergic blocker
B. Lithium
C. Nonsteroidal antiinflammatory drugs
D. All of the above
4) Comorbidities associated with psoriasis include all of the following except
A. Hyperlipidemia
B. Crohn disease
C. Multiple sclerosis
D. Multiple myeloma
5) A 43-year-old white man has been diagnosed with mild plaque psoriasis.
Presenting clinical signs and symptoms may include all of the following except
A. Hypopigmentation
B. Pruritus
C. Erythema
D. Silvery scales on lesions
6) Appropriate nonpharmacologic therapy for the patient in Question 5 includes all
of the following except
A. Moisturizer applied ad lib
B. Oatmeal baths
C. Tanning beds
D. Stress management clinics
7) Initial pharmacologic therapy for the patient in Question 5 should be
A. Betamethasone dipropionate 0.05% ointment for 2 months
B. Calcipotriol 50 mcg/g cream for 2 months
C. Methotrexate 5 mg/week for 2 months
D. PUVA treatments for 2 months
8) Adverse effects of topical corticosteroids include all of the following except
A. Hyperpigmentation
B. Telangiectases
C. HPA-axis suppression
D. Perioral dermatitis
9) SCAT therapy refers to
A. Steroid plus calcipotriol use
B. Steroid plus coal tar use
C. Anthralin use
D. Tazarotene use
10) RE-PUVA refers to
A. Multiple PUVA treatment courses
B. Acitretin used together with PUVA
C. Psoralens bath plus UVA
D. Methotrexate used together with PUVA
11) Moderate-to-severe psoriatic lesions in a 33-year-old white woman fail to clear
with topical therapy or NB-UVB. The NB-UVB treatments were continued and
acitretin added. Appropriate counseling for this patient includes all of the following
except
A. She must be on effective birth control for the duration of acitretin therapy
B. She must be on effective birth control for 3 years after discontinuing acitretin
C. She must not donate blood
D. She must not have more than two alcoholic drinks per day
12) Adverse effects of cyclosporine include all of the following except
A. Hepatotoxicity
B. Hypertriglyceridemia
C. Hypertension
D. Nephrotoxicity
13) Which of the following drugs can reduce serum cyclosporine concentrations?
A. Oral contraceptives
B. Verapamil
C. Valproic acid
D. Clarithromycin
14) Which of the following drugs is not a TNF-α inhibitor?
A. Etanercept
B. Alefacept
C. Adalimumab
D. Infliximab
15) Joanne is a 25-year-old woman in the first trimester of pregnancy. She has
severe plaque psoriasis that did not improve when she became pregnant. In fact, the
stress of pregnancy has resulted in a flare-up of her psoriasis. An appropriate
treatment for Joanne’s psoriasis would be
A. Methotrexate
B. NB-UVB
C. Topical tazarotene
D. Acitretin
Chapter 80 - Anemias
1) Classification of anemias is not based on:
A. Pathophysiology
B. Morphology
C. RBC indices
D. Etiology
E. Microscopic evaluation
2) Stimulation of erythropoiesis
A. Is due to a decrease in tissue oxygen levels
B. Results in decreased release of reticulocytes from the bone marrow
C. Is due to an increase in tissue oxygen levels
D. Is due to rising levels of erythropoietin from the liver
E. Is dependent on cytokines in the bone marrow
3) Serum iron levels in iron deficiency anemia:
A. May remain within the normal range
B. May have a 20% to 30% diurnal variation
C. Reflect the concentration of iron bound to transferrin
D. All of the above
E. None of the above
4) Iron is best absorbed:
A. From vegetables
B. With concurrent tea administration
C. In the ferrous form
D. In an alkaline environment
E. In a sustained release preparation
5) Which one of the following is correct regarding therapeutic doses of oral iron?
A. The enteric formulation results in increased iron absorption
B. Reticulocytosis occurs within 7 days after initiation of therapy
C. Iron therapy should be continued for 1 week of therapy and then discontinued
D. 10 mg of elemental iron daily is the general requirement
E. Oral iron should preferably be administered in a single dose with food
6) Which one of the following statements is incorrect?
A. A 325-mg tablet of ferrous sulfate contains 65 mg of elemental iron
B. A 300-mg tablet of ferrous gluconate contains 35 mg of elemental iron
C. A 325-mg tablet of ferrous sulfate contains 35 mg of elemental iron
D. A 100-mg tablet of ferrous fumarate contains 33 mg of elemental iron
7) Parenteral iron therapy:
A. Is best administered IV rather than IM
B. Should not be administered at a rate greater than 1 mg/min
C. Should be given initially as a loading dose
D. Requires concurrent erythropoietin therapy
E. Should be given if Hgb does not increase within 7 days of oral iron therapy initiation
8) Select the answer that is clearly diagnostic of vitamin B12 deficiency anemia.
A. Vitamin B12 < 150 pg/mL, peripheral neuropathies, dementia, hypersegmented
neutrophils
B. Vitamin B12 < 200 pg/mL in a patient on oral contraceptives
C. Vitamin B12 < 250 pg/mL in a cancer patient with paresthesias
D. Vitamin B12 < 300 pg/mL in the third trimester of pregnancy
9) Which one of the following is correct regarding the treatment of vitamin B12
deficiency?
A. Neurological manifestations are reversible irregardless of the length of vitamin
B12 deficiency
B. Good sources of vitamin B12 include green leafy vegetables
C. Vitamin B12 given via nasal spray is only appropriate for maintenance therapy
D. Oral replacement therapy cannot be utilized if a patient lacks intrinsic factor
10) Which one of the following is correct regarding folic acid deficiency anemia?
A. Folate is synthesized in the human body
B. Ingestion of alcohol interferes with the absorption of folate
C. Folic acid deficiency anemia results in neurologic manifestations
D. Supplementation with folic acid 1 mcg daily will replenish folate stores
E. Serum concentrations of methylmalonic acid and homocysteine are elevated
11) Patients with anemia of chronic disease
A. Have decreased levels of iron in the bone marrow
B. Can be clearly identified from a review of laboratory values
C. Have increased total iron binding capacity
D. Respond best to oral iron therapy during inflammation
E. May have a normal ferritin
12) Which one of the following is incorrect regarding anemia of critical illness?
A. A blunting of the erythropoietic response is evidenced
B. Supplemental iron in the form of oral or parenteral therapy is often necessary
C. The role of administering erythropoietin in critically ill patients is not clearly
defined.
D. Transfusions are the best treatment option as they are always beneficial
13) Which one of the following statements is incorrect regarding adherence to
anemia therapy?
A. Patients may cease taking oral iron therapy due to concerns regarding the
development of dark stools
B. Oral iron therapy may result in diarrhea or constipation
C. Patients may be nonadherent to parenteral routes of vitamin B12 supplementation due
to fear of injections
D. Combination iron products containing stool softeners are beneficial to avoid
constipation
Chapter 81 - Coagulation Disorders
1) All of the following are potential risks for plasma-derived factor concentrates,
except:
A. HIV contamination
B. Hepatitis contamination
C. Development of factor inhibitor
D. Renal toxicity
E. Allergic reaction
2) The dose of recombinant factor IX concentrate (BeneFix) for an 8-year-old male
who weighs 25 kg to target a 50% correction is:
A. 2,000 units
B. 1,750 units
C. 1,250 units
D. 1,000 units
E. 625 units
3) A potential advantage to using recombinant factor concentrate instead of
plasma-derived product is:
A. Decreased risk of viral contamination
B. Decreased risk of inhibitor development
C. Increased efficacy
D. Easier administration
E. Decreased cost
4) Which of the following is not an appropriate choice for the acute treatment of a
patient with hemophilia A who is bleeding and has a high-titer inhibitor?
A. Cyclophosphamide
B. Factor VIIa concentrate
C. Prothrombin complex concentrates (PCCs)
D. Porcine factor VIII
E. Activated prothrombin complex concentrates (aPCCs)
5) When counseling a patient on potential side effects of desmopressin, you should
include:
A. Facial flushing
B. Water retention
C. Headache
D. Seizures
E. All of the above
6) Which of the following is least likely to occur in a patient with type 1 von
Willebrand disease?
A. Bleeding after dental extraction
B. Menorrhagia
C. Postoperative bleeding
D. Nosebleed
E. Joint hemorrhage
7) A patient with type 2N von Willebrand disease is receiving a plasma-derived
von Willebrand factor containing product. You can monitor all of the following,
for efficacy except:
A. von Willebrand antigen
B. von Willebrand activity (ristocetin cofactor)
C. Prothrombin time
D. Factor VIII activity
E. Symptoms
8) Which of the following is the least likely to occur in a patient with mild factor
VIII deficiency?
A. Bleeding after dental extraction
B. Spontaneous joint hemorrhage
C. Bleeding after tonsillectomy
D. Easy bruising
E. Bleeding after trauma
9) All of the following are possible methods of viral inactivation for plasma-
derived factor replacement products except:
A. Recombinant technology
B. Solvent detergent
C. Dry heat
D. Pasteurization
E. Monoclonal antibody
10) Which common laboratory test is abnormal in patients with hemophilia?
A. Bleeding time
B. Thrombin time
C. Activated partial thromboplastin time (aPTT)
D. Prothrombin time (PT)
E. Platelet count
11) Which of the following is a false statement?
A. Desmopressin is frequently used for patients with von Willebrand disease
B. Antiinhibitor coagulant complex (Feiba VH Immuno) can be effective in patients with
factor VIII inhibitors
C. Recombinant antihemophilic factor concentrate (Bioclate) is a plasma-derived factor
IX product
D. Heat-treated antiinhibitor coagulant complex (Autoplex T) is neither a recombinant
nor a monoclonal product
E. The dose of nonacog alfa (BeneFix) would be higher than a dose of factor IX
concentrate (Mononine) to treat the same patient
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Chapter 82 - Sickle Cell Disease
1) Which of the following statement is incorrect
A. Sickle cell disease (SCD) is a hereditary disorder involving abnormal hemoglobin
B. Patients with sickle cell trait usually are asymptomatic but can become symptomatic
in extreme conditions
C. SCD is only seen in those with African ancestry
D. The primary clinical manifestations of SCD are hemolysis and vasoocclusion
E. Patients with higher level of fetal hemoglobin generally have a milder disease
2) Patients with sickle cell anemia have increased risk of the following infection
A. Streptococcus pneumoniae
B. Candida species
C. Aspergillus species
D. Pseudomonas species
E. Enterobacter species
3) Prevention of pneumococcal infection in SCD include
A. 13-valent pneumococcal conjugated vaccine
B. Oral penicillin
C. 23-valent pneumococcal polysaccharide vaccine
D. All of the above
E. None of the above
4) The appropriate penicillin prophylaxis regimen is
A. Penicillin 125 mg twice daily by mouth from 5 years of age to adolescent
B. Penicillin 125 mg once a day by mouth begin at diagnosis until 5 years of age
C. Penicillin 125 mg twice a day by mouth begin at diagnosis until 3 years of age, then
250 mg twice daily until age 5
D. Penicillin 125 mg twice a day by mouth until the first dose of pneumococcal vaccine
E. Penicillin 250 mg twice a day by mouth begin at diagnosis until the first dose of
pneumococcal vaccine then once daily
5) Hydroxyurea is useful in management of SCD because
A. It is a chemotherapeutic agent
B. It increases fetal hemoglobin production
C. It suppresses bone marrow production of sickle hemoglobin
D. It inhibits the cation transport in red blood cell membrane
E. It has the potential of cure the disease
6) Which of the following statements is correct
A. Hydroxyurea is useful in the management of SCD because the agent is efficacious in
reducing pain episodes and has no toxicities
B. Hydroxyurea is preferred over deferoxamine because its sustain effect on fetal
hemoglobin and lack of side effect with long-term use
C. Hydroxyurea reduces painful episodes but close monitoring is needed because of its
effect on the bone marrow
D. Deferasirox is the drug of choice for fetal hemoglobin induction because of its safety
profile
E. Penicillin prophylaxis can be discontinued once fetal hemoglobin inducer is initiated
7) The appropriate management of sickle cell patients presented with fever include
the followings except:
A. Cefotaxime or ceftriaxone. Vancomycin should also be considered in acutely ill
individuals
B. Ibuprofen or Tylenol for fever
C. Fluid
D. Frequent monitoring
E. Pneumococcal vaccine
8) The primary indication for chronic transfusion program is
A. Prevention of infection
B. Prevention of organ damage
C. Lack of fetal hemoglobin response to hydroxyurea
D. Bone marrow suppression secondary to hydroxyurea
E. Prevention of stroke
9) Patients admitted with signs and symptoms of acute chest syndrome should
A. Avoid opioid analgesics because those agents may suppress ventilation
B. Receive twice maintenance fluid to prevent dehydration from hyperventilation
C. Not receive bronchodilators because those agents cause excessive relaxation of
airway leading to collapse of the airway
D. Receive appropriate pain management, oxygen, balanced fluid, and antimicrobial
agents
E. Be given corticosteroids because the agents reduce hospital stay, need for
transfusions, and supportive care and readmission
10) The most common cause for aplastic crisis is
A. Pneumococcal infection
B. ASPEM syndrome occurred after partial exchange transfusion in patients with
priapism
C. Parvovirus B 19
D. Sequestration of red blood cell in the spleen
E. Splenectomy
11) Which of the followings is true in regard to the management of vasoocclusive
pain episodes
A. Hydration and aggressive analgesic are the primary treatment. Analgesic therapy
should be individualized
B. Opioid analgesics should be minimally used because patients can get addicted to
those agents
C. Patients who require opioid analgesics more than 24 hours are drug-seeking
D. All patients with pain episodes should be hospitalized
E. Fluid restriction should be initiated to prevent fluid overload
12) Analgesic choices for sickle cell patients with mild-to-moderate pain include
the followings except
A. Nonsteroidal antiinflammatory drugs (NSAIDs)
B. Acetaminophen
C. Opioid analgesics
D. Combination of NSAIDs and opioid analgesics
E. Intramuscular meperidine
13) Patient-controlled analgesic (PCA) is useful in the management of sickle cell
pain because
A. It limits the allowable amount that can be delivered to the patient, therefore avoiding
confrontation with the patient
B. This method of delivery results in increased duration of action
C. Intramuscular administration of opioid agents should be avoided, especially for young
children
D. It gives the patient control over the analgesic therapy
E. It minimizes addiction potential
14) Newborn screen can be cost-effective
A. True
B. False
15) Currently available therapy that can cure SCD is
A. HbF inducer
B. Bone marrow transplant
C. Corticosteroids
D. Vaccines
E. Gene therapy targeting BCL11A
Chapter 87 - Influenza
1) Which of the following characteristics is true for the influenza B virus?
A. Responsible for the seasonal epidemics of influenza
B. Typically associated with sporadic outbreaks
C. Categorized into subtypes based on hemagglutinin and neuraminidase
D. Does not cause disease in humans
2) What are the primary subtypes of influenza A that have been circulating among
humans over the past 30 years?
A. H3N2 and H1N1
B. H3N2 and H5N1
C. H2N2 and H1N1
D. H2N2 and H5N1
3) Which of the following statements is true regarding antigenic drift and antigenic
shift?
A. Antigenic shift occurs when point mutations in the surface antigens of a particular
subtype create antigenic variants, resulting in small changes in the hemagglutinin and/or
neuraminidase molecules.
B. Antigenic drift occurs when the influenza virus acquires a new hemagglutinin and/or
neuraminidase via genetic reassortment.
C. Antigenic shift causes seasonal epidemics of influenza and is the rationale behind the
recommendation for annual vaccination.
D. Antigenic drift causes seasonal epidemics of influenza and is the rationale behind the
recommendation for annual vaccination.
4) In addition to novelty, an influenza virus must possess which of the following
characteristics in order to potentially cause a pandemic?
A. Replication in humans.
B. Person-to-person transmission.
C. Both A and B are necessary.
D. Novelty alone is sufficient for an influenza virus to potentially cause a pandemic.
5) The influenza virus can be transmitted person-to-person via which of the
following mechanisms?
A. Influenza virus is not transmitted person-to-person.
B. Via inhalation of respiratory droplets after someone sneezes.
C. Contact with an object contaminated with respiratory secretions, such as a used
tissue.
D. Both B and C could allow viral transmission.
6) How long after the onset of illness are children considered infectious?
A. 2 days
B. 5 days
C. 7 days
D. ≥10 days
7) A 52-year-old female presents with fever, malaise, nonproductive cough, and
sore throat for the last 5 days. She is diagnosed with influenza. What other signs
and symptoms of influenza would be classical for this patient?
A. Rhinitis.
B. Nausea and vomiting.
C. Otitis media.
D. None of the above is a classical sign and symptom of influenza.
8) Which diagnostic test would be the most appropriate to use in the patient from
Question 7 to provide a rapid result?
A. Rapid antigen test.
B. Direct fluorescence antibody test.
C. Viral culture.
D. All of the above could be used in this patient for rapid diagnosis.
9) Which of the following patients is not at high risk for complications or severe
disease from seasonal influenza infection?
A. A 28-year-old pregnant woman at 34 weeks’ gestation with no significant medical
history
B. A 47-year-old male with hypertension successfully managed with lisinopril
C. An 82-year-old female residing in a nursing home
D. A 12-year-old boy with asthma
10) Which of the following patients should receive the trivalent influenza vaccine
(TIV) but not the live-attenuated influenza vaccine (LAIV)?
A. A 37-year-old female with HIV and a CD4 cell count of 150 cells/mm3 (150 × 106/L)
B. A 45-year-old male hemodialysis patient with a hypersensitivity to eggs
C. A healthy 2-year-old girl
D. A healthy 39-year-old accountant
11) Which of the following statements is true?
A. Thimerosal-free vaccines are available because thimerosal causes autism.
B. No thimerosal-free formulations of the influenza vaccine are available.
C. The risks of using a thimerosal-containing vaccine outweigh the benefits of receiving
the influenza vaccine.
D. No scientifically persuasive evidence exists to suggest harm from thimerosal
exposure from a vaccine.
12) Adamantane monotherapy would be most appropriate in which of the
following situations?
A. Prophylaxis for patients in a nursing home during an influenza A outbreak.
B. Prophylaxis for patients in a nursing home during an influenza B outbreak.
C. Treatment in a 58-year-old male presenting within 36 hours of the onset of illness.
D. Use of the adamantanes is not appropriate for monotherapy because of rapid
development of resistance.
13) In which of the following patients would prophylaxis with an antiviral
medication be appropriate?
A. A vaccinated (received 1 month ago) 74-year-old male resident of a long-term care
facility with a current influenza outbreak.
B. A 54-year-old female presenting to clinic to receive her influenza vaccination because
she heard about several influenza cases in the community.
C. An unvaccinated 34-year-old mother of three (healthy children aged 3, 6, and 9
years).
D. Prophylaxis with antiviral medication is appropriate in all of the above.
14) Which of the following is the most appropriate prophylactic regimen for the
patient(s) requiring prophylaxis from Question 13?
A. Oseltamivir 75 mg daily for the duration of influenza activity
B. Zanamivir 10 mg twice daily for 5 days
C. Rimantadine 200 mg once daily for the duration of influenza activity
D. Zanamivir 10 mg twice daily for 2 days
15) A 21-year-old, otherwise healthy, female college student presents to clinic with
a history of 4 days of fever, myalgia, dry cough, and malaise. She is diagnosed
with influenza A infection. What would be the most appropriate recommendation
for her?
A. Oseltamivir 75 mg once daily for 5 days
B. Oseltamivir 75 mg plus rimantadine 100 mg twice daily for 5 days
C. Maintenance of fluid intake, warm tea, and cough lozenges
D. Zanamivir 10 mg twice daily for 5 days plus maintenance of fluid intake, warm tea,
and cough lozenges
Chapter 90 - Tuberculosis
1) Which of the following regimens might you recommend for your patient with
newly diagnosed culture-positive pulmonary TB caused by a drug-susceptible
organism, based on guidelines provided by the CDC?
A. Isoniazid, rifampin, pyrazinamide, and ethambutol daily × 2 months, followed by
isoniazid and pyrazinamide × 4 months
B. Isoniazid, rifampin, pyrazinamide, and clarithromycin daily × 2 months, followed by
isoniazid and rifampin × 4 months
C. Isoniazid, rifampin, pyrazinamide, and ethambutol daily × 2 months, followed by
isoniazid and ethambutol × 4 months
D. Isoniazid, rifampin, pyrazinamide, and ethambutol daily × 2 months, followed by
isoniazid and rifampin × 4 months
2) TC is a 74-year-old man recently diagnosed with MDR-TB. His physician is
thinking about starting a regimen of amikacin, levofloxacin, cycloserine, and p-
aminosalicylic acid, but is uncertain if this is correct. Therefore, he asks you to
evaluate this proposed regimen. You note that his susceptibility tests indicate his
organism is susceptible to amikacin, ethambutol, levofloxacin, cycloserine, and p-
aminosalicylic acid. His estimated creatinine clearance is 25 mL/min; he has a
history of psychosis. From this information, you recommend the following:
A. Replace the planned cycloserine with ethambutol 15 mg/kg orally three times per
week; make adjustments to AK for renal dysfunction.
B. Continue the planned regimen, but make adjustments to amikacin for renal
dysfunction.
C. Replace cycloserine with EMB 25 mg/kg orally once daily; make adjustments to
amikacin for renal dysfunction.
D. Replace p-aminosalicylic acid with ethambutol 15 mg/kg orally three times per week;
make adjustments to amikacin for renal dysfunction.
3) Which one of the following patients would be at greatest risk of developing TB
disease?
A. Joe, who recently traveled to Canada
B. Eric, your 28-year-old pastry chef from France, with cough and fever
C. Samantha, a world traveler whose medication list includes tenofovir, emtricitabine,
and etravirine
D. Lee, your symptom-free patient from Vietnam
4) Which of the following tests is performed in the laboratory as a blood test to
identify patients who have been infected with M. tuberculosis?
A. Mantoux test
B. Nucleic acid amplification test
C. AFB smear
D. Interferon-γ release assay (QuantiFERON®-TB Gold)
5) Which of the following drugs can cause patients to develop pruritus and orange
discoloration of their urine, sputum, sweat, and tears?
A. Isoniazid
B. Ethambutol
C. Rifampin
D. Streptomycin
6) A 68-year-old Asian male with active TB has been on a four-drug anti-TB
medication (rifampin, isoniazid, pyrazinamide, and ethambutol) regimen for 5
weeks. He complains that his right big toe has been painful for 2 weeks and
recently he has a hard time walking around the house. On examination, the right
big toe is tender and red. Laboratory testing shows an elevated uric acid level and
gout is suspected. Which of the following anti-TB medications is most likely
associated with this side effect?
A. Isoniazid
B. Pyrazinamide
C. Rifampin
D. Ethambutol
7) An otherwise healthy 29-year-old Asian female with active TB has been
improving symptomatically after 6 weeks of anti-TB medications (rifampin,
isoniazid, pyrazinamide, and ethambutol). However, for the past 2 weeks, she has
noticed trouble reading phone numbers in the phone book, and has had trouble
reading the newspaper. On examination, her visual acuity and red/green perception
are diminished. The most likely diagnosis is:
A. Ethambutol-associated optic neuritis
B. Isoniazid-induced hepatitis
C. Macular degeneration
D. TB dissemination to her eyes
8) Which of the following antiretroviral medications can be used in a patient who
is also taking rifampin?
A. Indinavir (Crixivan)
B. Lopinavir (Kaletra)
C. Delavirdine (Rescriptor)
D. Efavirenz (Sustiva)
9) A 55-year-old emergency room nurse was exposed to TB 4 weeks ago.
Susceptibility data are pending for the patient’s isolate. Her current PPD was read
as 8 mm induration. She has no symptoms and her chest x-ray is normal. Which of
the following is the best option in this patient?
A. No treatment is needed at this time because the patient is asymptomatic.
B. Rifampin daily for 4 months.
C. Isoniazid daily for 9 months.
D. Rifampin and pyrazinamide for 2 months.
10) Which of the following regimens would be the best option for a 26-year-old
pregnant female recently diagnosed with active TB?
A. Isoniazid, rifampin, and pyrazinamide
B. Isoniazid, rifampin, and ethambutol
C. Isoniazid, ethambutol, and pyrazinamide
D. Isoniazid, rifampin, and streptomycin
11) A 67-year-old male has received 8 weeks of therapy with rifampin, isoniazid,
ethambutol, and pyrazinamide. His initial chest radiograph showed cavitation in
the right lung and his culture at this time is positive, although his signs and
symptoms of TB are better. Which of the following would be the best option for
the patient at this time?
A. Continue current treatment and check serum concentrations of his TB drugs.
B. Add moxifloxacin and check serum concentrations of his TB drugs.
C. Extend his current TB treatment to 9 months.
D. Discontinue ethambutol and pyrazinamide, and continue rifampin and isoniazid for 4
months.
12) A 23-year-old Hispanic male with HIV infection and active TB is receiving
highly active antiretroviral therapy and antituberculous treatment with rifabutin,
isoniazid, pyrazinamide, and ethambutol by DOT. He reports that his right eye has
been hurting him for 3 days and is now red. What is the most likely medication-
induced condition?
A. Ethambutol-induced optic neuritis
B. Isoniazid-induced peripheral neuropathy
C. Pyrazinamide-induced acidosis leading to optic neuritis
D. Rifabutin-related uveitis
13) A 40-year-old HIV-positive male presents with a positive PPD (6 mm). His
chest x-ray is clear and he does not have any signs or symptoms of active TB.
Which of the following options is best to treat latent TB in a 40-year-old HIV-
positive male on antiretroviral therapy?
A. Isoniazid daily for 6 months
B. Isoniazid daily for 9 months
C. Isoniazid and rifampin daily for 9 months
D. Rifampin daily for 4 months
14) Which of the following patients would most benefit from therapeutic drug
monitoring?
A. A patient who is smear positive after 6 weeks of treatment.
B. An HIV-positive patient responding to therapy.
C. An HIV-positive patient being treated for latent TB.
D. Therapeutic drug monitoring is recommended in all patients undergoing treatment for
TB.
15) Rifabutin should be chosen over rifapentine or rifampin when a patient is on
certain combined antiretroviral combinations because:
A. It has a better side effect profile in HIV-positive patients.
B. It is less likely to induce hepatic clearance of the antiretroviral drugs.
C. It has a lower risk of uveitis.
D. Serum concentration monitoring is available for rifabutin.
MM is a 45-year-old white man who was recently diagnosed with colon cancer.
Further workup determined the tumor to be T3N1M0 in "TNM" staging. He has
begun systemic treatment with a chemotherapy regimen including 5-fluorouracil,
leucovorin, and oxaliplatin.
4) Based on MM’s TNM stage, which of the following best describes his
anticancer treatment?
A. Adjuvant
B. Neoadjuvant
C. Induction
D. Palliative
5) Leucovorin is included in the chemotherapy regimen to:
A. Reduce the toxicity of the 5-fluorouracil
B. Increase the cytotoxicity of the 5-fluorouracil
C. Reduce the toxicity of the oxaliplatin
D. Increase the cytotoxicity of the oxaliplatin
6) The toxicities commonly associated with this chemotherapy regimen include:
A. Diarrhea and nephropathy
B. Diarrhea and neuropathy
C. Neuropathy and ototoxicity
D. Nephropathy and ototoxicity
7) MM’s absolute neutrophil count (ANC) dropped below 500 cells/mm3 (0.5 ×
109/L) during his last treatment cycle and he developed an infection that required
IV antibiotics. What intervention, if any, is recommended to minimize the risk of
neutropenic fever with subsequent treatment cycles?
A. Begin pegfilgrastim as secondary prophylaxis
B. Reduce the dose of oxaliplatin and 5-fluorouracil
C. Begin prophylactic antibiotics against common pathogens
D. No intervention is required
8) Select the correct statement:
A. All cells in a tumor mass have identical genes
B. Combination regimens are used to maximize clinical benefit
C. Anticancer treatment destroys tumor cells equally well in every part of the body
D. None of the above statements are correct
9) LY recently started consolidation with high-dose cytarabine as an IV infusions
after a documented complete response following induction therapy with
daunorubicin plus cytarabine. Her creatinine clearance is approximately 30
mL/min (0.50 mL/s) (estimated) and her bilirubin is 2.4 mg/dL (41 μmol/L). What
are her risk factors for cerebellar dysfunction?
A. Renal dysfunction
B. Hepatic dysfunction
C. Administration schedule
D. Cumulative dose
10) All of the following agents are believed to work through effects on
topoisomerases enzymes except:
A. Taxanes
B. Anthracyclines
C. Camptothecins
D. Etoposide
11) PM is a 65-year old male diagnosed with stage IV with non-small-cell lung
cancer about to receive carboplatin plus paclitaxel. The order is written as follows:
carboplatin AUC 6. The patient has a calculated CrCl of 80 mL/min (1.33 mL/s)
and a BSA of 2 m2. What dose of carboplatin should PM receive?
A. 1,260 mg
B. 630 mg
C. 275 mg
D. 12 mg
12) The suffix -ximab in rituximab indicates the antibody source was:
A. Human
B. Chimeric
C. Mouse
D. Humanized
13) Which of the following anticancer treatments does not cause profound
lymphopenia necessitating prophylaxis for Pneumocystis pneumonia or other
opportunistic infections?
A. Fludarabine
B. Cetuximab
C. Cladribine
D. Alemtuzumab
14) Anticancer treatments that affect which of the following intracellular signaling
pathways are most likely to cause perforation, thrombosis, and hemorrhaging?
A. MAPK
B. VEGF
C. HER
D. PI3K
15) KH is a 30-year-old woman recently diagnosed with stage IV melanoma. All of
the following patient- or tumor-specific factors should be known before starting
treatment with vemurafenib except:
A. BRAF V600E mutation status
B. Hepatic function
C. Cardiac rhythm
D. UGT1A1 status
8) What is the appropriate dose of paclitaxel for DG to receive for each cycle?
A. 175 mg
B. 265 mg
C. 285 mg
D. 320 mg
E. 350 mg
9) What is the appropriate dose of carboplatin for DG to receive for each cycle?
A. 340 mg
B. 380 mg
C. 420 mg
D. 440 mg
E. 495 mg
10) When would you consider consolidation chemotherapy for DG?
A. If after six cycles her CA-125 was still greater than 35 U/mL
B. Negative physical exam
C. Negative CT scan
D. Positive PET scan
E. All of the above
11) RT is a 27-year-old female who presented with a solid mass on her right ovary.
She underwent TAH/BSO tumor debulking surgery and was diagnosed with Stage
IIA, low-grade ovarian cancer. What adjuvant treatment should she receive after
surgery?
A. Pelvic radiation one-shot
B. Observation with routine 3-month follow-up exams
C. Paclitaxel 175 mg/m2 over 3 hours plus carboplatin AUC = 5 over 1 hour for six
cycles
D. Letrozole 2.5 mg once daily for six cycles
E. Bevacizumab 15 mg/kg once every 3 weeks for 12 months
12) Which of the following would be appropriate chemotherapy treatment for
patient with recurrent platinum-sensitive cancer for a curative intent?
A. Six cycles of gemcitabine 1,000 mg/m2 plus cisplatin 40 mg/m2 on days 1 and 15
given once every 28 days
B. Six cycles of topotecan 0.75 mg/m2 on days 1, 2, and 3 plus cisplatin 40 mg/m2 on
day 1 only given once every 21 days
C. Six cycles of liposomal doxorubicin 40 mg/m2 plus carboplatin AUC = 5 over 1 hour
given once every 28 days
D. Both (A) and (C)
E. All of the above
13) What is a common complication of progressive ovarian cancer that may require
a surgical intervention for patient comfort?
A. New peritoneal implants
B. Small bowel obstruction
C. Lung nodule
D. Ascites
E. All of the above
14) Which of the following agents would you recommend in a patient with
significant renal insufficiency for the treatment of platinum-resistant recurrent
ovarian cancer?
A. Weekly paclitaxel
B. Gemcitabine
C. Topotecan
D. Liposomal doxorubicin
E. All of the above
15) A patient with recurrent ovarian cancer receiving oxycodone extended release
for pain management calls with new complaint of increasing constipation and
nausea. What potential complication of ovarian cancer would you want to rule out
prior to changing her bowel regimen?
A. Small bowel obstruction
B. Small bowel perforation
C. Ascites accumulation
D. Neuropathy
E. Thrombosis
A 70-year-old man was admitted to the hospital after a 3-week history of nausea,
vomiting, diarrhea, and increasing abdominal girth. The initial physical
examination revealed a pelvic mass, which was confirmed by a computed
tomography (CT) scan. Subsequent barium enema revealed an obstruction of the
sigmoid colon. The patient was subsequently taken to surgery for exploratory
laparotomy at which time the patient underwent an omentectomy, a jejunal–ileal
anastomosis, and central venous access placement. After surgery, the patient
developed hypotension and respiratory failure requiring mechanical ventilation.
The patient continued to have a distended abdomen on postoperative day 9. A
nasogastric tube was placed for low continuous gastric suction with approximately
600 to 800 mL/day output. The patient has no renal or liver function laboratory
abnormalities and remains hemodynamically stable requiring continuous
intravenous norepinephrine for blood pressure support. He is receiving propofol 30
mL/h intravenously for sedation. The Nutrition Support Team is consulted to begin
parenteral nutrition (PN). The patient’s goal regimen was determined to be (final
concentrations) 6% amino acids and 20% dextrose at 70 mL/h continuous infusion
with 20% IV fat emulsion (IVFE) 250 mL/day via piggyback infusion over 12
hours.
Pertinent Data:
Results Reporter
1) Which of the following strategies has been recommended to minimize the risk of
aspiration in patients receiving enteral nutrition (EN)?
A. Keep the head of the bed elevated to a 30- to 45-degree angle
B. Add blue food dye to the enteral formula
C. Change from continuous to bolus administration
D. Change from standard polymeric to high caloric density formula
2) The end-product of bacterial degradation of fiber within the colon is:
A. Medium-chain triglycerides
B. Long-chain triglycerides
C. Omega-3 fatty acids
D. Short-chain fatty acids
3) In a patient with normal functioning motility who will require long-term EN in
the home setting due to dysphagia, the preferred access choice is:
A. Nasogastric
B. Nasojejunal
C. Gastrostomy
D. Jejunostomy
4) An advantage of the bolus method of EN administration compared to the
continuous method is that it:
A. Requires less equipment
B. Is preferred when feeding into the jejunum
C. Is better tolerated
D. Is preferred when initiating feeding
5) EN should be avoided in which of the following patients?
A. A patient receiving cancer chemotherapy
B. A patient with diabetic gastroparesis
C. A patient with necrotizing enterocolitis
D. A patient with acute pancreatitis
6) Which of the following techniques is appropriate for medication administration
via a nasogastric feeding tube?
A. Never administer hypertonic medications
B. Always hold the feeding for 1 hour before and after administering medications
C. Always flush the tube with at least 30 mL of water before and after administering the
medication
D. Only administer medications that are available in a liquid form
7) When EN is started in a patient receiving warfarin, which of the following
is most likely to occur:
A. Increase in warfarin dose required due to decreased absorption
B. Increase in warfarin dose required due to increased elimination
C. Decrease in warfarin dose required due to increased absorption
D. Decrease in warfarin dose required due to decreased elimination
8) Components of gut barrier function include all of the following except:
A. Gut-associated lymphoid tissue (GALT)
B. Small bowel peristalsis
C. Bacterial translocation
D. Secretion of hydrochloric acid by the stomach
9) Specialized enteral formulas designed to improve outcomes in patients with
acute respiratory distress syndrome and severe acute lung injury are:
A. Low in fat content
B. Supplemented with omega-3 fatty acids
C. High in carbohydrate content
D. Supplemented with glutamine
10) In a geriatric patient with a history of massive stroke and a hemicolectomy,
which of the following is an advantage of EN via a jejunostomy compared with a
gastrostomy?
A. Decreased risk of aspiration
B. Decreased colostomy output
C. Decreased flatulence
D. Decreased cost associated with placement
11) When initiating EN in a pediatric patient with a jejunostomy, which of the
following methods is preferred?
A. Continuous infusion of a half-strength formulation
B. Continuous infusion of a full-strength formulation
C. Bolus administration of a half-strength formulation
D. Bolus administration of a full-strength formulation
12) Potential advantages of EN compared to parenteral nutrition include all of the
following except:
A. Less infectious complications
B. Less cost
C. Improved nitrogen balance
D. Improved glucose tolerance
13) Which of the following enteral formulas is most likely to contribute to the
development of diarrhea?
A. Use of a fiber-containing formula
B. Use of a peptide-based formula
C. Use of an MCT-containing, low fat formula
D. Use of a powder formula that requires reconstitution
14) In an adult patient receiving EN who experiences a gastric residual volume of
150 mL, which of the following interventions is preferred?
A. Hold the feeding
B. Decrease the administration rate
C. Dilute the formulation and continue the same rate
D. No intervention required
15) When should EN be initiated in an adult critically ill patient with multiple
trauma who is mechanically ventilated?
A. Upon arrival to the intensive care unit
B. Within 24 to 48 hours after hospital admission
C. Within 5 to 7 days after hospital admission
D. It will depend on the patient's underlying nutritional status
1) Compute the body mass index (BMI) for a 53-year-old Hispanic woman who is
5 ft, 5 in tall and weighs 175 lb (87.5 kg).
A. 22 kg/m2
B. 29 kg/m2
C. 35 kg/m2
D. 40 kg/m2
2) According to the National Institutes of Health (NIH) guidelines, which one of
the following categories best describe an African American woman with a BMI of
38 kg/m2?
A. Normal
B. Overweight
C. Obese
D. Extremely obese
3) All of the following medical conditions are more prevalent in patients with
obesity except
A. Infertility
B. Diabetes
C. Depression
D. Hyperthyroidism
4) Which of the following initial weight loss goals is most appropriate for a 268-lb
(122-kg) patient considering weight loss intervention for obesity?
A. Rapid weight loss of 6 lb (3 kg) over 1 month
B. Rapid weight loss of 13 lb (6.5 kg) over 1 month
C. Gradual weight loss of 26 lb (13 kg) over 6 months
D. Gradual weight loss of 100 lb (50 kg) over 6 months
5) Which one of the following interventions represents the mainstay of weight loss
therapy?
A. Low-calorie diet, exercise, and behavioral modification
B. Phentermine 30 mg orally every morning
C. Leptin injections
D. Laparoscopic vertically banded gastroplasty
6) Which of the following choices best describes the appropriate criteria for
initiation of drug therapy for weight loss after a patient has failed a 6-month trial of
diet, exercise, and behavior modification?
A. A BMI above 27 kg/m2 with comorbidities or a BMI above 29 kg/m2
B. A BMI above 27 kg/m2 with comorbidities or a BMI above 30 kg/m2
C. A BMI above 25 kg/m2 with comorbidities or a BMI above 30 kg/m2
D. A BMI above 25 kg/m2 with comorbidities or a BMI above 29 kg/m2
7) Which of the following choices best describes the appropriate criteria for
consideration of bariatric surgery therapy after a patient has failed trials of lifestyle
modification and pharmacologic therapy?
A. A BMI above 25 kg/m2 with comorbidities or a BMI above 30 kg/m2
B. A BMI above 30 kg/m2 with comorbidities or a BMI above 35 kg/m2
C. A BMI above 35 kg/m2 with comorbidities or a BMI above 40 kg/m2
D. A BMI above 30 kg/m2 with comorbidities or a BMI above 40 kg/m2
8) All of the following supplements are required to prevent nutritional deficiencies
in bariatric surgery patients except
A. Calcium citrate
B. Iron
C. Folic acid
D. Potassium chloride
9) Which of the following postoperative considerations is important in bariatric
surgery patients?
A. Altered drug absorption
B. Altered nutrient absorption
C. Enhanced adverse drug effects
D. All of the above
10) Which of the following medications may require dosing adjustments in patients
receiving orlistat therapy?
A. Atorvastatin
B. Digoxin
C. Cyclosporine
D. Metformin
11) Which of the following effects would most likely be experienced by a patient
taking lorcaserin?
A. Paraesthesia
B. Dumping syndrome
C. Headache
D. Dysgeusia
12) Lorcaserin therapy should be discontinued if a patient fails to loss 5% of his or
her initial body weight after
A. 8 weeks
B. 12 weeks
C. 16 weeks
D. 20 weeks
13) Which of the following effects would most likely be experienced by a patient
taking phentermine–topiramate extended release?
A. Increased heart rate
B. Dumping syndrome
C. Headache
D. Priapism
14) Which of the following weight loss medications requires monitoring of serum
electrolytes and creatinine?
A. Lorcaserin
B. Orlistat
C. Diethylpropion
D. Phentermine–topiramate
15) Dietary supplements containing bitter orange can best be described as
A. Nonhydrolyzable fiber
B. Sympathomimetic amines
C. Ephedra alkaloids
D. Hoodia extracts