1.
Which of the following receptors is not involved in nausea and vomiting?
Correct Answer
E. All of these are involved
Explanation
All of these receptors are involved in nausea and vomiting. Dopamine receptors are involved in the chemoreceptor trigger zone (CTZ) in the brain, which is responsible for inducing vomiting. Acetylcholine receptors are involved in the transmission of signals from the CTZ to the vomiting center in the brainstem. Histamine receptors play a role in stimulating the CTZ and vomiting center. Serotonin receptors are involved in the activation of the vagus nerve, which triggers the vomiting reflex. Therefore, all of these receptors are involved in the process of nausea and vomiting.
2.
Which of the following first-line antiemetics does not cause extrapyramidal symptoms?
Correct Answer
E. None of the above
Explanation
The correct answer is "none of the above." This means that all of the first-line antiemetics listed in the question (phenothiazines, serotonin (5-HT3) antagonists, butyrophenones, and benzamides) can cause extrapyramidal symptoms. Extrapyramidal symptoms are movement disorders that can include muscle stiffness, tremors, and involuntary movements.
3.
What is the MOA of benzamides?
Correct Answer
C. Inhibition of dopamine receptors in the gastrointestinal tract and chemoreceptor trigger zone
Explanation
A) serotonin antagonists: ondansetron (Zofran), granisetron (Kytril), dolasetron
B) phenothiazines: prochlorperazine (Compazine), promethazine (Phenergan)
C) benzamides: metoclopramide (Reglan), trimethobenzamide (Tigan)
D) anticholinergics/antihistamines (second line treatment): diphenhydramine (Benadryl, meclizine (Antivert), dimenhydramine (Dramamine), scopolamine (Transderm-Scop)
4.
Which of the following is used for anticipatory nausea?
Correct Answer
B. Benzodiazepines
Explanation
Benzodiazepines are used for anticipatory nausea because they have anti-anxiety properties and can help reduce the feelings of nausea that can occur before a nauseating event, such as chemotherapy. These medications work by increasing the effects of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain, which helps to calm the nervous system and reduce anxiety. By reducing anxiety, benzodiazepines can indirectly help to alleviate anticipatory nausea.
5.
Which of the following affects GABA receptors?
Correct Answer
D. Benzodiazepines
Explanation
A) opiate receptors
B) cholinergic receptors
C) dopamine
D - correct
6.
Which of these antiemetic drugs do not cause blurred vision?
Correct Answer
A. ButyropHenones
Explanation
Butyrophenones are a class of antiemetic drugs that do not cause blurred vision. Unlike phenothiazines, cannabinoids, and antihistamines, butyrophenones do not have the side effect of blurred vision.
7.
Which of the following iss indicated for severe nausea and vomiting?
Correct Answer
D. Serotonin antagonists
Explanation
Serotonin antagonists are indicated for severe nausea and vomiting. These medications work by blocking serotonin receptors in the brain, which helps to reduce the symptoms of nausea and vomiting. They are commonly used in the treatment of chemotherapy-induced nausea and vomiting, as well as post-operative nausea and vomiting. Benzodiazepines, dexamethasone, and phenothiazines may also be used in certain cases, but they are not specifically indicated for severe nausea and vomiting like serotonin antagonists are.
8.
Which antidiarrheal agent agent is only available by prescription?
Correct Answer
B. DipHenoxylate/atropine sulfate
Explanation
A) Immodium
B) Lomotil
C) Pepto Bismol
D) Kaopectate
9.
Which drug should be used cautiously in infectious diarrhea?
Correct Answer
C. Loperamide
Explanation
Loperamide should be used cautiously in infectious diarrhea because it is an anti-diarrheal medication that works by slowing down the movement of the intestines. While this can provide relief from diarrhea symptoms, it can also potentially delay the elimination of infectious pathogens from the body. Therefore, caution should be exercised when using loperamide in infectious diarrhea to ensure that the underlying cause of the diarrhea is properly addressed and not masked by the medication.
10.
What is the main use for bismuth subsalicylate?
Correct Answer
C. Traveler's diarrhea
Explanation
Bismuth subsalicylate is primarily used for treating traveler's diarrhea. This condition is caused by consuming contaminated food or water while traveling, leading to symptoms such as diarrhea and abdominal pain. Bismuth subsalicylate helps to alleviate these symptoms by reducing inflammation in the intestines and slowing down bowel movements. It also has antimicrobial properties that can help kill the bacteria causing the diarrhea. Therefore, it is an effective treatment specifically for traveler's diarrhea.
11.
Which of the following is not a bulk-forming laxative?
Correct Answer
C. Lactulose
Explanation
Lactulose is not a bulk-forming laxative because it works as an osmotic laxative. It is a synthetic sugar that is not absorbed by the body and remains in the colon, where it draws water into the stool, softening it and increasing bowel movements. In contrast, bulk-forming laxatives such as psyllium, polycarbophil, and methylcellulose work by absorbing water in the intestines, forming a bulky gel-like substance that stimulates bowel movements.
12.
Which is a contraindication of lubricant laxative use?
Correct Answer
B. Recumbent patients
Explanation
Recumbent patients refers to individuals who are lying down or in a reclined position. The use of lubricant laxatives in recumbent patients can be contraindicated because it may lead to aspiration pneumonia. When lying down, there is a higher risk of the laxative entering the lungs instead of the digestive tract, causing inflammation and infection. Therefore, caution should be exercised when considering the use of lubricant laxatives in recumbent patients to avoid potential complications.
13.
Which drug is metabolized to solutes in the GI tract, which moves water osmotically and facilitates propulsion and evacuation?
Correct Answer
D. Sorbitol
Explanation
Sorbitol is the correct answer because it is a drug that is metabolized in the GI tract, producing solutes that attract water osmotically. This increased water content in the intestines helps to facilitate propulsion and evacuation, making it an effective treatment for constipation. Milk of magnesia, prune juice, and ExLax are not metabolized in the same way and do not have the same osmotic effects in the GI tract.
14.
Which would not cause problems?
Correct Answer(s)
A. Colace and mineral oil
D. Methylcellulose and mineral oil
Explanation
A) increases liver toxicity
B) mineral oil decreases absorption of fat soluble vitamins
C) MoM is a saline laxative
15.
Which is first line treatment for chronic mild to moderate GERD?
Correct Answer
B. H2 antagonists
Explanation
H2 antagonists are the first line treatment for chronic mild to moderate GERD. These medications work by blocking the histamine receptors in the stomach, which reduces the production of stomach acid. By reducing the amount of acid in the stomach, H2 antagonists help to relieve the symptoms of GERD such as heartburn and acid reflux. They are effective in managing the symptoms of GERD and are generally well-tolerated by patients.
16.
Which of the following properties of NSAIDs contributes to formation of ulcers?
Correct Answer
B. Inhibition of cox-1
Explanation
Inhibition of cox-1 contributes to the formation of ulcers. Cox-1 is an enzyme that is responsible for the production of prostaglandins, which help protect the stomach lining. When cox-1 is inhibited by NSAIDs, the production of prostaglandins is reduced, leading to a decrease in the protective mucus and an increase in stomach acid secretion. This imbalance can result in the erosion of the stomach lining and the formation of ulcers.
17.
Which drug can prevent formation of NSAID induced ulcers?
Correct Answer
C. Misoprostol
Explanation
Misoprostol is the correct answer because it is a prostaglandin analogue that helps prevent the formation of ulcers caused by non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs can cause irritation and damage to the stomach lining, leading to the development of ulcers. Misoprostol works by increasing the production of protective mucus in the stomach and reducing the secretion of stomach acid, thereby reducing the risk of NSAID-induced ulcers.
18.
If the patient is taking phenytoin for seizures, which of the following drugs should be avoided?
Correct Answer
B. Omeprazole
Explanation
Phenytoin is metabolized by the liver through the enzyme CYP2C19, which is also responsible for metabolizing omeprazole. Therefore, taking omeprazole with phenytoin can inhibit the metabolism of phenytoin, leading to increased levels of phenytoin in the body. This can result in toxicity and potentially worsen seizures. Therefore, omeprazole should be avoided in patients taking phenytoin for seizures.
19.
Which of the following, concerning PPIs, is false?
Correct Answer
B. PPIs should be chewed or crushed to promote absorption
Explanation
PPIs should not be chewed or crushed to promote absorption. They should be taken whole, swallowed with water, and should not be broken, crushed, or chewed. This is because the enteric coating on PPIs is designed to protect the medication from stomach acid and ensure it is released in the small intestine where it can be absorbed properly.
20.
Which of the following causes gynecomastia?
Correct Answer
D. Cimetidine
Explanation
Cimetidine is known to cause gynecomastia, which is the enlargement of breast tissue in males. This is because cimetidine has antiandrogenic effects, meaning it can interfere with the action of male hormones like testosterone. By blocking the effects of testosterone, cimetidine can disrupt the hormonal balance in the body, leading to the development of breast tissue in males.
21.
How does sucralfate promote mucosal defenses in PUD?
Correct Answer
C. It reacts with hydrochloric acid in the stomach and binds to the surface of the ulcer
Explanation
Sucralfate promotes mucosal defenses in PUD by reacting with hydrochloric acid in the stomach and binding to the surface of the ulcer. This forms a protective barrier that shields the ulcer from further damage and allows it to heal. By binding to the ulcer, sucralfate also helps to prevent further irritation and inflammation, promoting the overall healing process.
22.
Which of the following is the shortest treatment for h. pylori?
Correct Answer
D. Rabeprazole, clarithromycin, amoxicillin
Explanation
A) 10 days
B) 2 weeks
C) 10 days
D) 7 days
23.
Which is true of metoclopramide in the treatment of GERD?
Correct Answer
B. It increases LES tone
Explanation
Metoclopramide is known to increase the tone of the lower esophageal sphincter (LES). The LES is a muscular ring that separates the esophagus from the stomach and helps to prevent stomach acid from flowing back into the esophagus, which is a common problem in gastroesophageal reflux disease (GERD). By increasing the tone of the LES, metoclopramide can help to reduce the frequency and severity of acid reflux episodes in patients with GERD.
24.
Which of the following is not a 5-aminosalicylate?
Correct Answer
A. Lamivudine
Explanation
Lamivudine is not a 5-aminosalicylate because it belongs to a different class of drugs called nucleoside reverse transcriptase inhibitors. 5-aminosalicylates are a group of drugs commonly used to treat inflammatory bowel disease, and include sulfasalazine, mesalamine, and olsalazine. Lamivudine is used to treat HIV and hepatitis B infections.
25.
Which of the following is released in the terminal ileum for disease affecting the ileum or ascending colon, but has low systemic bioavailability?
Correct Answer
D. Budesonide
Explanation
Budesonide is released in the terminal ileum for diseases affecting the ileum or ascending colon. It has low systemic bioavailability, meaning that it is not easily absorbed into the bloodstream and therefore has limited effects on the rest of the body. This makes it a suitable treatment option for localized conditions in the ileum or ascending colon, as it can target the affected area without causing widespread side effects. Prednisone, hydrocortisone, and azathioprine, on the other hand, have higher systemic bioavailability and can have more widespread effects throughout the body.
26.
Which of the following is correct?
Correct Answer
D. These are all true
Explanation
The statement "these are all true" means that all of the given statements are correct. According to the statement, the treatment for IBD with corticosteroids is indeed at a dosage of 40-60mg daily. Additionally, the hydrocortisone enema is more effective than the foam or the suppository. Lastly, the foam provides greater systemic absorption than the enema. Therefore, all of the statements are true.
27.
Which of the following is not a contraindication of azathioprine use?
Correct Answer
A. Parkinson's disease
Explanation
Parkinson's disease is not a contraindication for the use of azathioprine. Azathioprine is an immunosuppressive medication commonly used to prevent organ rejection after transplantation and to treat certain autoimmune diseases. It works by suppressing the immune system, which can be beneficial in certain conditions. However, it is contraindicated in pregnancy, active liver disease, and severe renal impairment due to potential risks and complications. Parkinson's disease, which is a neurodegenerative disorder affecting movement, does not have any known interactions or contraindications with azathioprine.
28.
How long does it take for 6-mercaptopurine to take effect?
Correct Answer
B. 3-6 months
Explanation
The correct answer is 3-6 months. 6-mercaptopurine is a medication used to treat certain types of cancer and autoimmune diseases. It is a slow-acting drug that takes time to build up in the body and start producing noticeable effects. The timeframe of 3-6 months is a general estimate for when patients may start experiencing the therapeutic benefits of this medication.
29.
Which drug takes effect in the same amount of time as 6-mercaptopurine and works by the same MOA since 6-mercaptopurine is an active metabolite of it?
Correct Answer
C. Azathioprine
Explanation
Azathioprine is the correct answer because it takes effect in the same amount of time as 6-mercaptopurine and works by the same mechanism of action (MOA) since 6-mercaptopurine is an active metabolite of azathioprine. This means that azathioprine is converted into 6-mercaptopurine in the body, which then exerts its therapeutic effects.
30.
Which is true of antibiotics and bacteria in IBD?
Correct Answer
B. Microorganisms are not proven to be associated with disease progression in IBD
Explanation
The statement "microorganisms are not proven to be associated with disease progression in IBD" suggests that there is no conclusive evidence to support a direct link between microorganisms and the progression of Inflammatory Bowel Disease (IBD). This implies that the role of microorganisms in IBD is not well-established or understood.
31.
What is the mechanism of action of monoclonal antibodies?
Correct Answer
B. Reduce infiltration of inflammatory cells and TNF
Explanation
Monoclonal antibodies work by reducing the infiltration of inflammatory cells and TNF (tumor necrosis factor). This means that they can help to decrease inflammation in the body by preventing the movement of immune cells to the site of inflammation and by blocking the action of TNF, which is a pro-inflammatory cytokine. By doing so, monoclonal antibodies can help to alleviate symptoms and manage conditions associated with excessive inflammation, such as autoimmune diseases.
32.
How often are infusions of infliximab given for ulcerative colitis?
Correct Answer
A. Week 0, 2, 6 and maintenance every 8 weeks
33.
Which of the following may be associated with progressive multifocal leukoencephalopathy caused by the JC virus, which may lead to death?
Correct Answer
C. Natalizumab
Explanation
Progressive multifocal leukoencephalopathy (PML) is a rare and often fatal viral infection of the brain caused by the JC virus. Natalizumab is a medication used to treat multiple sclerosis and Crohn's disease, but it has been associated with an increased risk of developing PML. The drug works by blocking certain immune cells from entering the brain, which can allow the JC virus to replicate and cause damage. Therefore, natalizumab is the correct answer as it is directly associated with the development of PML caused by the JC virus.
34.
What is the treatment for acute viral hepatitis?
Correct Answer
A. Supportive care
Explanation
The treatment for acute viral hepatitis is supportive care. This involves managing the symptoms and providing relief to the patient. Supportive care may include rest, proper nutrition, hydration, and medication to alleviate symptoms such as nausea, fatigue, and pain. While liver transplant, interferons, and nucleoside analogs may be used in certain cases or for specific types of viral hepatitis, they are not the standard treatment for all cases of acute viral hepatitis. Therefore, the correct answer is supportive care.
35.
Which of the following vaccine is incorrectly matched to the type of hepatitis it prevents?
Correct Answer
C. Vaqta - hepatitis B
Explanation
The vaccine Vaqta is incorrectly matched to the type of hepatitis it prevents. Vaqta is actually a vaccine that prevents hepatitis A, not hepatitis B.
36.
Which is not an indication to decrease the interferon dose by 50% in chronic hepatitis?
Correct Answer
A. Platelets at 52,000
Explanation
A platelet count of 52,000 is not an indication to decrease the interferon dose by 50% in chronic hepatitis. Platelets are important for blood clotting, and a low platelet count can increase the risk of bleeding. However, it is not directly related to interferon dosage adjustment in chronic hepatitis. The other options, such as serious mood changes, daily nausea with occasional vomiting, and fatigue, are more commonly associated with interferon therapy and may warrant a decrease in dosage.
37.
Which is an indication to discontinue interferon?
Correct Answer
C. Fatigue severe enough to require bed rest
Explanation
Fatigue severe enough to require bed rest is an indication to discontinue interferon because it suggests a significant level of exhaustion and weakness. This level of fatigue may be a sign of severe side effects or complications from the interferon treatment. It is important to discontinue the medication in order to prevent further deterioration of the patient's health and to explore alternative treatment options.
38.
Which of the nucleosides has no activity against HIV, unlike the other two?
Correct Answer
B. Entecavir (Baraclude)
Explanation
Entecavir (Baraclude) is the correct answer because it is a nucleoside analog reverse transcriptase inhibitor (NRTI) that is primarily used to treat chronic hepatitis B virus (HBV) infection. While lamivudine (Epivir) and adefovir (Hepsera) are also NRTIs, they are commonly used in the treatment of HIV infection, unlike entecavir. Therefore, entecavir does not have any activity against HIV, unlike the other two nucleosides.
39.
Which genotype of hepatitis C is least likely to respond to interferon?
Correct Answer
A. Genotype 1
Explanation
Genotype 1 is the least likely to respond to interferon among the given options. This is because genotype 1 is known to have a lower response rate to interferon-based therapies compared to genotypes 2 and 3. Interferon is a type of antiviral medication used to treat hepatitis C, but its effectiveness can vary depending on the specific genotype of the virus. Genotype 1 is generally considered more difficult to treat and may require alternative or combination therapies for better response rates.
40.
How long would treatment take with combination therapy for about an 80% response with genotype 2 or 3 HCV?
Correct Answer
C. 24 weeks
Explanation
Combination therapy for genotype 2 or 3 HCV typically involves the use of direct-acting antiviral medications. The recommended treatment duration for these genotypes is typically 12 weeks. However, in cases where there is a high chance of achieving a good response (around 80%), the treatment duration can be shortened to 24 weeks. This allows for effective eradication of the virus and reduces the risk of relapse. Therefore, 24 weeks is the correct answer for achieving an 80% response rate with combination therapy for genotype 2 or 3 HCV.
41.
Which is not a contraindication of hepatitis vaccines?
Correct Answer
D. These are all contraindications
Explanation
The correct answer is "none of these are contraindications." This means that breast feeding, yeast hypersensitivity, and immunosuppression are not contraindications for hepatitis vaccines. In other words, individuals who are breastfeeding, have a hypersensitivity to yeast, or are immunosuppressed can still receive hepatitis vaccines without any issues or concerns.
42.
Which is a treatment for esophageal varices associated with cirrhosis?
Correct Answer
B. Non-selective beta blocker
Explanation
A non-selective beta blocker is a treatment for esophageal varices associated with cirrhosis. These medications help to reduce the pressure in the portal vein, which is often elevated in patients with cirrhosis and can lead to the development of esophageal varices. By reducing the pressure, non-selective beta blockers can help to prevent bleeding from these varices and decrease the risk of complications. Lactulose is used to treat hepatic encephalopathy, not esophageal varices. Calcium channel blockers and mannitol are not typically used in the treatment of esophageal varices associated with cirrhosis.
43.
Which of the following is not an IV coloid?
Correct Answer
D. Lactated ringers
Explanation
Lactated ringers is not an IV colloid. IV colloids are solutions that contain large molecules, such as proteins or starches, which help to increase blood volume. Albumin and blood are examples of IV colloids, as they contain proteins. Dextrose, on the other hand, is a type of sugar and is not considered an IV colloid. Lactated ringers, also known as Ringer's lactate solution, is a type of intravenous fluid that contains electrolytes and is used to replace fluids and electrolytes in the body. It does not contain large molecules like proteins or starches, which are characteristic of IV colloids.
44.
Which of the acute tubular necrosis drugs carries the risk of volume overload?
Correct Answer
E. Mannitol
Explanation
Mannitol is a diuretic drug that is commonly used to treat acute tubular necrosis. It works by increasing urine production, which helps to remove excess fluid from the body. However, one of the potential side effects of mannitol is volume overload, which means that it can cause an excessive buildup of fluid in the body. This is because mannitol can increase the volume of fluid within the bloodstream, leading to an increased risk of fluid overload. Therefore, mannitol carries the risk of volume overload in patients with acute tubular necrosis.
45.
Which is a risk of using CCBs for treatment of acute tubular necrosis?
Correct Answer
A. PeripHeral hypotension
Explanation
CCBs, or calcium channel blockers, are commonly used to treat acute tubular necrosis. However, one of the risks associated with their use is peripheral hypotension. CCBs work by relaxing the blood vessels, which can lead to a decrease in blood pressure. This can cause symptoms such as dizziness, lightheadedness, and fainting. Therefore, peripheral hypotension is a potential risk that should be considered when using CCBs for the treatment of acute tubular necrosis.
46.
Which drug causes intrarenal vasoconstriction?
Correct Answer
C. Cyclosporine
Explanation
Cyclosporine is known to cause intrarenal vasoconstriction. It is an immunosuppressive drug commonly used in organ transplant patients to prevent rejection. However, one of its side effects is vasoconstriction, which can lead to decreased blood flow to the kidneys. This can result in reduced renal function and potential kidney damage. ACE inhibitors, NSAIDs, and vancomycin do not typically cause intrarenal vasoconstriction.
47.
Chronic interstitial nephritis is associated with which of the following?
Correct Answer
B. Lithium
Explanation
Chronic interstitial nephritis is associated with lithium. This is because long-term use of lithium, a medication commonly used to treat bipolar disorder, has been known to cause chronic interstitial nephritis. This condition involves inflammation and scarring of the kidney's tubules and can lead to impaired kidney function. Other medications such as NSAIDs, sulfa drugs, and amphotericin B are not typically associated with chronic interstitial nephritis.
48.
Which of the following is not a cause of obstructive nephropathy?
Correct Answer
B. NSAIDs
Explanation
NSAIDs are not a cause of obstructive nephropathy. Obstructive nephropathy refers to a condition where there is a blockage in the urinary system, leading to impaired kidney function. High doses of methotrexate, tumor lysis syndrome, and IV phosphate and calcium given together can all potentially cause obstructive nephropathy. However, NSAIDs are not known to cause this condition. NSAIDs are commonly used for pain relief and reducing inflammation, but they do not typically cause blockages in the urinary system.
49.
Which is not a treatment of symptomatic potassium imbalance associated with chronic renal failure?
Correct Answer
A. Calcitriol
Explanation
Calcitriol is not a treatment for symptomatic potassium imbalance associated with chronic renal failure. Calcitriol is a form of vitamin D that is used to treat low levels of calcium in the blood. It helps the body absorb calcium from the intestines and promotes bone growth. It does not have a direct effect on potassium levels. Other options like calcium gluconate, insulin/dextrose, and kayexalate are commonly used to treat high potassium levels in patients with chronic renal failure.
50.
Treatment of which of the following does not include calcium products?
Correct Answer
A. Uremic bleeding
Explanation
Uremic bleeding refers to excessive bleeding that occurs in patients with kidney failure. The treatment for uremic bleeding does not involve the use of calcium products. Calcium products are commonly used in the treatment of hyperphosphatemia, potassium imbalance, and osteodystrophy. However, in the case of uremic bleeding, other interventions such as blood transfusions, medications to promote clotting, and dialysis may be used instead.