2025 Flashcards
(100 cards)
1
Q
This alkylating agent is administered orally to treat chronic granulocytic leukemia and other myeloproliferative disorders. In high doses, it produces a rare but sometimes fatal pulmonary fibrosis.
A) Bleomycin
B) Busulfan
C) Cisplatin
D) Cyclophosphamide
A
B) Busulfan
High-Yield Rationale:
* Busulfan is an alkylating agent specifically used in chronic myeloid leukemia (CML) and other myeloproliferative disorders.
* It is administered orally.
* High-dose Busulfan is associated with pulmonary fibrosis (also called “Busulfan lung”), which can be fatal.
Why other options are incorrect:
* A) Bleomycin: Also causes pulmonary fibrosis, but it is not an alkylating agent, and is used for testicular cancer and Hodgkin lymphoma.
* C) Cisplatin: Alkylating-like but causes nephrotoxicity, ototoxicity, and peripheral neuropathy, not pulmonary fibrosis.
* D) Cyclophosphamide: Alkylating agent used in many cancers and autoimmune conditions, but main toxicity is hemorrhagic cystitis, not pulmonary fibrosis.
2
Q
This drug is a potent immunosuppressant. It is used in the management of rheumatoid disorders and autoimmune nephritis. It attacks the N7 of guanine and can cause hemorrhagic cystitis.
A) Daunorubicin
B) Doxorubicin
C) Cyclophosphamide
D) Carmustine
A
3
Q
This pyrimidine antimetabolite is bioactivated to inhibit thymidylate synthetase and is used topically for basal cell carcinoma.
A) 6-MP
B) 6-TG
C) Vincristine
D) 5-FU
A
4
Q
This substance is used to trap acrolein and protects the bladder during cyclophosphamide therapy.
A) Leucovorin
B) Amifostine
C) Mesna
D) Dexrazoxane
A
5
Q
Which of the following drugs is specific to the M phase?
A) Bleomycin
B) Paclitaxel
C) Cisplatin
D) Etoposide
A
6
Q
These drugs are also called anthracyclines.
A) Thiotepa, busulfan, nitrosoureas
B) Cisplatin, carboplatin, oxaliplatin
C) Doxorubicin, daunorubicin
D) Procarbazine, dacarbazine
A
C) Doxorubicin, daunorubicin
High-Yield Rationale:
* Anthracyclines are antitumor antibiotics derived from Streptomyces.
* Includes doxorubicin and daunorubicin.
* MOA: Intercalate into DNA, inhibit topoisomerase Il, and generate free radicals → cardiotoxicity is a major side effect.
Why other options are incorrect:
* A) Thiotepa, busulfan, nitrosoureas: Alkylating agents, not anthracyclines.
* B) Cisplatin, carboplatin, oxaliplatin: Platinum compounds, alkylating-like agents.
* D) Procarbazine, dacarbazine: Methylating/alkylating agents, used in Hodgkin lymphoma and brain tumors; not anthracyclines.
7
Q
These compounds were known as the nitrogen mustard gases that were observed to inhibit cell growth, especially of bone marrow shortly after the war.
A) Alkylating agents
B) Antimetabolites
C) Monoclonal antibodies
D) Platinum complexes
A
A) Alkylating agents
High-Yield Rationale:
* Alkylating agents, including nitrogen mustards (e.g., mechlorethamine), were among the first chemotherapy agents.
* Observed after WWI/WWII when mustard gas exposure caused bone marrow suppression, leading to their development as anticancer drugs.
* MOA: Cross-link DNA → inhibit replication and lead to apoptosis, especially in rapidly dividing cells (e.g., bone marrow, GI tract).
Why other options are incorrect:
* B) Antimetabolites: Interfere with DNA/RNA synthesis (e.g., methotrexate, 5-FU), but not derived from mustard gas.
* C) Monoclonal antibodies: Target specific cell markers; not related to early chemotherapy or nitrogen mustards.
* D) Platinum complexes: Alkylating-like agents (e.g., cisplatin), not mustard derivatives.
8
Q
This drug can cause severe hypoglycemia within 3 hours of administration to type 1 DM patients.
A) Miglitol
B) Pramlintide
C) Insulin
D) Gliclazide
A
9
Q
This drug slows intestinal carbohydrate digestion and absorption, which requires a frequent dosing schedule. ADRs include flatulence and hepatotoxicity.
A) Metformin
B) Acarbose
C) Nateglinide
D) Exenatide
A
10
Q
Exenatide is contraindicated in Annabelle because of which of the following findings?
A) Creatinine clearance of 25 ml/min
B) History of leukemia
C) Lymphocyte count of 7%
D) HbA1c of 8%
A
11
Q
Who among the following patients cannot take Metformin?
A) Mario, 57/M, Serum creatinine of 1.2 mg/dL
B) Elsie, 16/F, 102kg, Serum creatinine of 1.8 mg/dL
C) Martha, 78/F, Serum creatinine of 1.4 mg/dL
D) Lawrence, 65/M, hypertensive metastatic lung cancer patient
A
12
Q
Which of the following is the most potent sulfonylurea?
A) Tolbutamide
B) Chlorpropamide
C) Glyburide
D) Tolazamide
A
: C) Glyburide
High-Yield Rationale:
Glyburide (glibenclamide) is a 2nd-generation sulfonylurea, which are significantly more potent than 1st-gen agents.
Requires lower doses for effect but has a higher risk of hypoglycemia, especially in elderly and renal impairment.
13
Q
Which of the following has the highest risk of hypoglycemia?
A) Tolbutamide
B) Chlorpropamide
C) Glyburide
D) Tolazamide
A
14
Q
Which of the following is the drug to treat diabetes insipidus?
A) Tolbutamide
B) Chlorpropamide
C) Glyburide
D) Tolazamide
A
15
Q
Cynthia, 85/F, has contraindications for Metformin. Dr. Sy instructed you to give her the most appropriate sulfonylurea. Which of the following is your preferred agent?
A) Glipizide
B) Glimepiride
C) Chlorpropamide
D) Tolbutamide
A
16
Q
Jennifer had renal impairment and metformin was contraindicated. What will be the best alternative hypoglycemic drug for her?
A) Glipizide
B) Glimepiride
C) Chlorpropamide
D) Tolbutamide
A
17
Q
Pia is a known case of hyperthyroidism. She got married and is currently on her 8th week of pregnancy. Which of the following is the safest drug for her?
A) Methimazole
B) Carbimazole
C) PTU
D) Iodine 131
A
C) PTU (Propylthiouracil)
High-Yield Rationale:
* PTU is the preferred drug for hyperthyroidism during the first trimester of pregnancy.
* It inhibits both thyroid peroxidase and peripheral T4 → T3 conversion.
* After the first trimester, therapy is usually shifted to methimazole to avoid PTU hepatotoxicity.
Why the others are incorrect:
* A) Methimazole: Teratogenic in 1st trimester (risk of aplasia cutis, choanal/esophageal atresia).
* B) Carbimazole: Prodrug of methimazole; same teratogenic risks in early pregnancy.
* D) lodine 131: Absolutely contraindicated in pregnancy due to its radioactive effect on the fetal thyroid.
18
Q
Which of the following will displace thyroid hormone from protein binding?
A) Rifampin
B) Colestipol
C) Furosemide
D) Lithium
A
19
Q
Which of the following is a 5HT antagonist antidepressant?
A) Sertraline
B) Trazodone
C) Mirtazepine
D) Selegiline
A
B) Trazodone
High-Yield Rationale:
Trazodone is a serotonin antagonist and reuptake inhibitor (SARI).
It blocks 5-HT2A receptors and weakly inhibits serotonin reuptake.
Also used for insomnia due to its sedating effects.
Main adverse effect: priapism (persistent painful erection).
Why the others are incorrect:
A) Sertraline: SSRI (selective serotonin reuptake inhibitor), not a 5-HT antagonist.
C) Mirtazapine: Noradrenergic and specific serotonergic antidepressant (NaSSA); antagonizes α2 and 5-HT2/5-HT3, but it’s not classified as a 5-HT antagonist antidepressant like Trazodone.
D) Selegiline: MAO-B inhibitor used in Parkinson’s; not an antidepressant with 5-HT antagonism.
20
Q
This drug is used for Bipolar Disorder that decreases cAMP and inhibits inositol 1 triphosphate.
A) Amoxapine
B) Bupropion
C) Clomipramine
D) Lithium
A
21
Q
Lyndon was found unconscious in his room. He was brought to the ER and found to have cardiotoxicity and convulsions. The EM team suspects overdose. Which of the following could be the drug?
A) Fluoxetine
B) Duloxetine
C) Amitriptyline
D) Selegiline
A
C) Amitriptyline
High-Yield Rationale:
Amitriptyline is a tricyclic antidepressant (TCA).
TCA overdose → cardiotoxicity (due to Na⁺ channel blockade), CNS toxicity (seizures, coma), and anticholinergic effects.
EKG: Prolonged QRS/QT, ventricular arrhythmias.
Antidote: Sodium bicarbonate.
Why the others are incorrect:
A) Fluoxetine: SSRI; overdose rarely causes cardiotoxicity or seizures.
B) Duloxetine: SNRI; may cause serotonin syndrome but less cardiotoxicity.
D) Selegiline: MAO-B inhibitor; overdose might cause hypertensive crisis, not typically seizures or cardiotoxicity.
22
Q
Which of the following is the drug used for serotonin syndrome?
A) Cyproheptadine
B) Benzodiazepine
C) Lamotrigine
D) Paroxetine
A
23
Q
This drug inhibits neuronal reuptake of serotonin and norepinephrine and is used to treat major depressive disorder and neuropathic pain.
A) Phenelzine
B) Nefazodone
C) Venlafaxine
D) Imipramine
A
C) Venlafaxine
High-Yield Rationale:
Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI).
Effective in major depressive disorder, generalized anxiety, and neuropathic pain (e.g., diabetic neuropathy, fibromyalgia).
Why the others are incorrect:
A) Phenelzine: MAOI; not first-line due to hypertensive crisis risk.
B) Nefazodone: Weak 5-HT/NE reuptake inhibitor; rarely used due to hepatotoxicity.
D) Imipramine: TCA; blocks reuptake of NE and 5-HT but not classified as SNRI, and more side effects (anticholinergic, cardiotoxic).
24
Q
This is a tetracyclic antidepressant that increases amine release from nerve endings by antagonism of presynaptic α2 adrenoreceptors. It also blocks serotonin 5HT2 receptors.
A) Mirtazapine
B) Duloxetine
C) Lithium
D) Alprazolam
A
A) Mirtazapine
High-Yield Rationale:
Mirtazapine is a tetracyclic antidepressant.
MOA: α2 antagonist → increases NE and 5-HT release; also blocks 5-HT2 and 5-HT3 receptors.
Good for patients with depression and insomnia or weight loss, as it increases appetite and causes sedation.
Why the others are incorrect:
B) Duloxetine: SNRI; does not affect α2 receptors.
C) Lithium: Mood stabilizer; not an antidepressant and doesn’t block 5-HT2 or α2.
D) Alprazolam: Benzodiazepine (anxiolytic); not an antidepressant.
25
Johnny was diagnosed with major depression. He was given medications and advised lifestyle changes. One of the hardest habits to let go was smoking. Which among the following antidepressants will help him?
A) Trazodone
B) Amoxapine
C) Mirtazapine
D) Bupropion
D) Bupropion
High-Yield Rationale:
Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI).
Indicated for major depressive disorder and smoking cessation (Zyban formulation).
Does not cause sexual dysfunction (unlike SSRIs), but lowers seizure threshold.
Why the others are incorrect:
A) Trazodone: Used for insomnia; not effective for smoking cessation.
B) Amoxapine: Tetracyclic antidepressant with antipsychotic properties; not indicated for smoking cessation.
C) Mirtazapine: Useful in depression with insomnia or weight loss; no role in nicotine addiction.
26
Priapism is a disorder in which the penis maintains a prolonged, rigid erection in the absence of appropriate stimulation. Which of the following drugs can cause it?
A) Quetiapine
B) Alprazolam
C) Imipramine
D) Terazosin
D) Terazosin
High-Yield Rationale:
Terazosin is an α1-adrenergic blocker used for hypertension and benign prostatic hyperplasia.
Rare adverse effect: priapism, due to vasodilation of penile vessels and prolonged smooth muscle relaxation.
Why the others are incorrect:
A) Quetiapine: Atypical antipsychotic; rarely linked to priapism, but not a common association.
B) Alprazolam: Benzodiazepine; no known risk of priapism.
C) Imipramine: TCA; associated more with anticholinergic and cardiac effects, not priapism.
27
Which of the following antipsychotic drugs has 5HT2 receptor affinity?
A) Chlorpromazine
B) Clozapine
C) Lithium
D) Clonazepam
B) Clozapine
High-Yield Rationale:
Clozapine is an atypical antipsychotic that blocks both dopamine D2 and serotonin 5-HT2 receptors.
This dual mechanism explains fewer extrapyramidal symptoms and better efficacy in treatment-resistant schizophrenia.
Why the others are incorrect:
A) Chlorpromazine: Typical antipsychotic, primarily D2 blocker, less 5-HT2 activity.
C) Lithium: Mood stabilizer, not an antipsychotic, no serotonin receptor blocking.
D) Clonazepam: Benzodiazepine (GABA-A enhancer), not an antipsychotic, no serotonin antagonism.
28
Which of the following antipsychotic drugs has D2 receptor affinity?
A) Chlorpromazine
B) Clozapine
C) Lithium
D) Clonazepam
A) Chlorpromazine
High-Yield Rationale:
Chlorpromazine is a typical (1st-gen) antipsychotic that primarily blocks dopamine D2 receptors, especially in the mesolimbic pathway.
D2 blockade explains antipsychotic effects as well as extrapyramidal side effects (EPS).
Why the others are incorrect:
B) Clozapine: Atypical antipsychotic with low D2 affinity and high 5-HT2A antagonism.
C) Lithium: A mood stabilizer, not an antipsychotic, and does not bind D2.
D) Clonazepam: A benzodiazepine, acts on GABA-A, no D2 activity.
29
Which of the following dopaminergic tracts controls eating behavior?
A) Mesocortical-mesolimbic
B) Nigrostriatal
C) Medullary periventricular
D) Tuberoinfundibular
30
Lianne was diagnosed with GERD (Stage 3). Which of the following is your drug of choice?
A) Omeprazole
B) Ranitidine
C) Bismuth
D) Aluminum hydroxide
C) Medullary periventricular
High-Yield Rationale:
The medullary periventricular dopaminergic tract is involved in eating behavior and satiety regulation.
It influences feeding via connections with the hypothalamus.
Why the others are incorrect:
A) Mesocortical-mesolimbic: Regulates mood, reward, and cognition; implicated in schizophrenia.
B) Nigrostriatal: Controls movement; degeneration causes Parkinson's disease and EPS.
D) Tuberoinfundibular: Inhibits prolactin secretion via D2 receptor activity in the hypothalamus.
31
Chico tested positive for H. pylori, and you gave him a quadruple therapy. Which of the following is NOT included in this protocol?
A) Bismuth 525 mg for 7 days
B) Metronidazole 250 mg QID for 7 days
C) Tetracycline 500 mg for 7 days
D) Lansoprazole 100 mg for 7 days
D) Lansoprazole 100 mg for 7 days
High-Yield Rationale:
Quadruple therapy includes:
PPI (e.g., lansoprazole, omeprazole)
Bismuth subsalicylate (or subcitrate)
Metronidazole
Tetracycline
Lansoprazole is included, but 100 mg is an incorrect dose.
Usual dose: 30 mg BID.
The high dose of 100 mg is not standard and thus makes this option technically incorrect in the protocol.
Why the others are correct:
A) Bismuth 525 mg: Correct and standard part of quadruple therapy.
B) Metronidazole 250 mg QID: Correct dosing.
C) Tetracycline 500 mg: Standard part of the regimen.
32
You prescribed Triple Therapy for H. pylori eradication to Craig. He asked you how many days he will take the medications. What is your best response?
A) 7-10 days
B) At least 2 weeks
C) 21 days minimum
D) This is a maintenance medication
B) At least 2 weeks
High-Yield Rationale:
Standard triple therapy (PPI + amoxicillin + clarithromycin OR metronidazole) is now recommended for 14 days (2 weeks) for optimal eradication.
Shorter durations (7–10 days) are less effective and no longer preferred.
Why the others are incorrect:
A) 7–10 days: Old practice, now considered suboptimal.
C) 21 days: Too long; unnecessary and increases risk of side effects and resistance.
D) Maintenance: H. pylori therapy is curative, not maintenance.
33
Roda experienced hyperacidity, headache, and nausea. She self-medicated with drugs that are available in their stock. After a day, she experienced diarrhea. Which of the following drugs has a laxative effect?
A) Magnesium hydroxide
B) Probiotics
C) Calcium carbonate
D) Ranitidine with sodium bicarbonate
34
This antibiotic has tetracycline rings with the sugar daunosamine. It is a DNA intercalating agent that blocks the synthesis of DNA and RNA. This agent is primarily toxic during the S phase of the cell cycle and can cause cardiotoxicity.
A) Adriamycin
B) Cytarabine
C) 6-Mercaptopurine
D) 6-Thioguanine
A) Adriamycin
(aka Doxorubicin)
High-Yield Rationale:
Adriamycin (Doxorubicin) is an anthracycline antibiotic.
Contains tetracyclic ring + sugar daunosamine.
Intercalates DNA, inhibits topoisomerase II, and generates free radicals.
Active during S-phase, causing inhibition of DNA and RNA synthesis.
Major toxicity: cardiotoxicity (especially dilated cardiomyopathy) — prevented by Dexrazoxane.
Why the others are incorrect:
B) Cytarabine: Pyrimidine analog used in leukemias; inhibits DNA polymerase, not intercalating.
C) 6-Mercaptopurine: Purine analog; inhibits de novo purine synthesis; works in S-phase but no intercalating or cardiotoxicity.
D) 6-Thioguanine: Similar to 6-MP; purine analog; no DNA intercalation or anthracycline structure.
35
Which of the following is NOT true about antacids?
A) Weak bases that react with gastrin and HCl
B) Mainstay in Acid-Peptic Disease until H2 blockers and PPIs were introduced in the market
C) Taken with meals
D) Neutralizes acid for 2 hours
C) Taken with meals
High-Yield Rationale:
Antacids work best between meals or 1–3 hours after eating, when acid is highest.
Taking them with meals can delay gastric emptying and reduce effectiveness.
They're weak bases that neutralize HCl, not gastrin (A is technically wrong wording too, but C is more clearly incorrect behaviorally).
Why the others are correct:
A) Weak bases that react with gastrin and HCl: Slightly misleading since antacids react with HCl, not gastrin — but test writers often ignore that nuance. C is still the better answer.
B) Mainstay before PPIs/H2 blockers: Historically true.
D) Neutralizes acid for ~2 hours: Accurate.
36
Which of the following is NOT true about Cimetidine?
A) In some patients, cimetidine acts as a nonsteroidal antiandrogen
B) Interferes with estrogen metabolism
C) Improves male sexual function
D) Gynecomastia
C) Improves male sexual function
High-Yield Rationale:
Cimetidine is a H2-receptor antagonist that also:
Inhibits CYP450 enzymes
Acts as a non-steroidal antiandrogen
Leads to ↓ libido, impotence, gynecomastia in men
So, it impairs, not improves, male sexual function.
Why the others are correct:
A) Acts as non-steroidal antiandrogen: True.
B) Interferes with estrogen metabolism: True — by CYP450 inhibition.
D) Causes gynecomastia: Well-documented adverse effect due to antiandrogen action.
37
Which among the following has no effect on gastric emptying time?
A) Calcium hydroxide
B) Famotidine
C) Magnesium hydroxide
D) Aluminum hydroxide
38
Which of the following stimulates prostaglandin receptors?
A) Pirenzepine
B) Nizatidine
C) Misoprostol
D) Proglumide
C) Misoprostol
High-Yield Rationale:
Misoprostol is a PGE1 analog that stimulates prostaglandin receptors.
Used to prevent NSAID-induced gastric ulcers by promoting mucus and bicarbonate secretion.
Also used in labor induction and medical abortion.
Why the others are incorrect:
A) Pirenzepine: Selective M1 muscarinic antagonist, not prostaglandin-related.
B) Nizatidine: H2 blocker, no action on prostaglandin receptors.
D) Proglumide: Gastrin receptor antagonist, not related to prostaglandins.
39
Which of the following blocks cholinergic (Muscarinic) receptors?
A) Pirenzepine
B) Nizatidine
C) Misoprostol
D) Proglumide
A) Pirenzepine
High-Yield Rationale:
Pirenzepine is a selective M1 muscarinic receptor antagonist.
Reduces gastric acid secretion by blocking neural stimulation of parietal cells.
Rarely used now due to limited efficacy and availability.
Why the others are incorrect:
B) Nizatidine: H2 blocker, no anticholinergic action.
C) Misoprostol: Prostaglandin analog, no cholinergic receptor blockade.
D) Proglumide: Antagonist of gastrin receptors, not cholinergic.
40
Which of the following blocks muscarinic receptors?
A) Terbutaline
B) Tiotropium
C) Theophylline
D) Tetracycline
B) Tiotropium
High-Yield Rationale:
Tiotropium is a long-acting muscarinic antagonist (LAMA).
It blocks M3 muscarinic receptors in the airway, leading to bronchodilation.
Commonly used in COPD and sometimes in asthma maintenance therapy.
Why the others are incorrect:
A) Terbutaline: β2-agonist, causes bronchodilation by stimulating β2 receptors, not blocking muscarinic receptors.
C) Theophylline: PDE inhibitor; increases cAMP for bronchodilation; no anticholinergic activity.
D) Tetracycline: Antibiotic, not involved in bronchodilation or muscarinic receptors.
41
Which of the following inhibits early response bronchoconstriction?
A) Corticosteroids
B) Cromolyn
C) Zafirlukast
D) Aspirin
B) Cromolyn
High-Yield Rationale:
* Cromolyn sodium stabilizes mast cells, preventing degranulation and histamine release.
* It inhibits the early-phase allergic response seen in asthma (bronchoconstriction, mucosal edema).
* Most effective as prophylaxis, not in acute attacks.
Why the others are incorrect:
* A) Corticosteroids: Primarily inhibit the late-phase inflammatory response, not the early bronchoconstriction.
* C) Zafirlukast: Leukotriene receptor antagonist; works more on late-phase allergic inflammation.
* D) Aspirin: Can worsen bronchoconstriction in aspirin-sensitive asthma (AERD).
42
Daniel had COPD. Which antimicrobial will you give to reduce the number of exacerbations?
A) Ciprofloxacin
B) Azithromycin
C) Sultamicillin
D) Ceftriaxone
B) Azithromycin
High-Yield Rationale:
* Azithromycin, a macrolide, is used in COPD not just for infections but also for its anti-inflammatory and immune-modulating effects.
* Chronic azithromycin therapy (e.g., 250 mg daily or 3x/week) has been shown to reduce exacerbation frequency in patients with frequent COPD exacerbations.
Why the others are incorrect:
* A) Ciprofloxacin: Used in acute exacerbations, but not for long-term exacerbation prevention.
* C) Sultamicillin: Broad-spectrum antibiotic (ampicillin + sulbactam); used for acute bacterial infections, not long-term control.
* D) Ceftriaxone: Parenteral cephalosporin used for severe infections; not suitable for long-term outpatient prophylaxis.
43
Emmanuel was newly diagnosed with COPD. The following are the main treatments, except:
A) Inhaled bronchodilators
B) Inhaled glucocorticoids
C) Oxygen therapy
D) Salbutamol
44
Taylor visited the Philippines for a vacation. He was brought to the ER due to an asthma attack. He told you that he has Omalizumab in his purse. What is this for?
A) Monoclonal antibody directed against human IgE
B) Prevents IgA binding with its receptors on mast cells & basophils
C) Increases release of allergic mediators
D) Used for treatment of aspirin-induced asthma
Answer: A) Monoclonal antibody directed against human IgE
High-Yield Rationale:
* Omalizumab is a monoclonal antibody that binds to free IgE, preventing it from attaching to mast cells and basophils, thereby reducing allergic response.
* Used in moderate to severe allergic asthma not controlled with inhaled steroids and LABAs.
* Administered subcutaneously.
Why the others are incorrect:
* B) Prevents IgA binding...: Incorrect immunoglobulin; Omalizumab targets IgE, not lgA.
* C) Increases release of allergic mediators: Opposite; Omalizumab inhibits their release.
* D) Used for aspirin-induced asthma: No - Leukotriene modifiers (e.g., montelukast) are preferred.
45
Which of the following is a CysLT1 receptor antagonist?
A) Omalizumab
B) Zileuton
C) Cromolyn
D) Zafirlukast
46
Bitter-tasting, prophylactic anti-inflammatory drug that reduces bronchial hyperactivity and is effective in preventing exercise-induced asthma.
A) Chromones
B) Leukotriene antagonist
C) Glucocorticoid
D) Anti-IgE monoclonal antibody
A) Chromones
High-Yield Rationale:
* Chromones (e.g., Cromolyn sodium, Nedocromil) are mast cell stabilizers.
* Used prophylactically to prevent bronchial hyperreactivity, especially exercise-induced asthma.
* Bitter taste is a notable side effect.
* MA: Prevent mast cell degranulation, thereby reducing histamine and leukotriene release.
Why the others are incorrect:
* B) Leukotriene antagonist: Used in asthma but not effective for immediate exercise-induced attacks and not known for bitter taste.
* C) Glucocorticoid: Preventive and anti-inflammatory, but not specific for exercise-induced asthma and not characterized by bitter taste.
* D) Anti-IgE monoclonal antibody: Used in severe allergic asthma, not for exercise-induced bronchospasm.
47
Which of the following is a phosphodiesterase inhibitor that promotes bronchodilation, increases diaphragmatic contraction, and stabilizes mast cell membranes?
A) Terbutaline
B) Theophylline
C) Salbutamol
D) Salmeterol
B) Theophylline
High-Yield Rationale:
Theophylline is a methylxanthine that:
* Inhibits phosphodiesterase → T CAMP → bronchodilation
* Improves diaphragmatic contractility
* Stabilizes mast cells
Narrow therapeutic index → monitor for toxicity (e.g., seizures, arrhythmias).
Why the others are incorrect:
* A) Terbutaline: Short-acting B2 agonist; bronchodilator only, no PDE inhibition or mast cell effect.
* C) Salbutamol: Also a B2 agonist; similar to Terbutaline.
* D) Salmeterol: Long-acting B2 agonist; no PDE inhibition or mast cell stabilization.
48
This is a long-acting bronchodilator (12 hours) that has high lipid solubility (creates depot effect), given by inhalation. It is not used to relieve acute episodes of asthma but is used for nocturnal asthma.
A) Salbutamol
B) Theophylline
C) Cromolyn
D) Salmeterol
D) Salmeterol
High-Yield Rationale:
Salmeterol is a long-acting ß2-agonist (LABA) with:
* High lipid solubility - depot effect
* 12-hour duration
* Used for nocturnal asthma and maintenance therapy
* Not used for acute attacks due to delayed onset
Why the others are incorrect:
* A) Salbutamol: Short-acting B2 agonist (SABA); used for acute relief.
* B) Theophylline: Can be used for maintenance but not inhaled and lacks the depot effect.
* C) Cromolyn: Preventive anti-inflammatory; not a bronchodilator and not long-acting.
49
The following are TRUE about Epinephrine, EXCEPT:
A) Potent bronchodilator
B) Rapid action (maximum effect within 15 min)
C) Selective beta agonist
D) Drug of choice for acute anaphylaxis (hypersensitivity reactions)
C) Selective beta agonist
High-Yield Rationale:
Epinephrine is a non-selective adrenergic agonist, meaning it activates:
* a1, a2 receptors → vasoconstriction
* B1 receptors → increased heart rate/contractility
* B2 receptors → bronchodilation
It's fast-acting and the drug of choice for anaphylaxis due to its ability to counteract multiple components of the reaction (bronchospasm, hypotension, edema).
Why the others are correct:
* A) Potent bronchodilator: True, via ß2 receptor activation.
* B) Rapid action: True, especially via IM or IV administration, with peak action in ~15 minutes.
* D) Drug of choice for anaphylaxis: Correct.
50
Which of the following is TRUE about opioids?
A) Stimulates the cough reflex
B) Indirectly acts in the cough center
C) Acts directly in the medulla
D) Used for productive cough
C) Acts directly in the medulla
High-Yield Rationale:
* Opioids (e.g., codeine) suppress cough by directly acting on the cough center in the medulla.
* They reduce the sensitivity of the cough reflex pathway and are used for dry, non-productive cough.
Why the others are incorrect:
* A) Stimulates the cough reflex: False - opioids suppress it.
* B) Indirectly acts in the cough center: False - action is direct.
* D) Used for productive cough: False - not recommended as they inhibit the clearance of secretions.
51
Which of the following is NOT a toxidrome?
A) Cholinergic
B) Anticholinergic
C) Sympatholytic
D) Sedative hypnotic
C) Sympatholytic
High-Yield Rationale:
* Toxidromes are clinical syndromes caused by toxic substance exposure, each with a characteristic set of signs/symptoms.
Recognized toxidromes include:
* Cholinergic (e.g., organophosphates)
* Anticholinergic (e.g., atropine, antihistamines)
* Sympathomimetic (e.g., cocaine, amphetamines)
* Sedative-hypnotic (e.g., benzodiazepines, barbiturates)
Sympatholytic is not a recognized toxidrome - although these agents (e.g., B-blockers, clonidine) have toxicity, they don't produce a classic toxidrome.
Why the others are correct toxidromes:
* A) Cholinergic: SLUDGE symptoms (salivation, lacrimation, urination, etc.).
* B) Anticholinergic: "Hot as a hare, dry as a bone, blind as a bat..."
* D) Sedative-hypnotic: CNS depression, respiratory depression.
52
Keziah was found unconscious lying on the floor with an empty vial of iron supplements in her right palm. You found a receipt showing the vial contained 30 capsules of iron bought the same day. What will be the antidote for this?
A) Pyridoxine
B) Methylene Blue
C) Deferoxamine
D) Atropine
53
Robbin was highly intoxicated after binge drinking alcohol over the past 8 hours. Which is the drug of choice to counter this?
A) Glucagon
B) Fomepizole
C) Flumazenil
D) Na bicarbonate
54
Nicca is a grade 8 student who overdosed with acetaminophen after a bad breakup with Thomas, her boyfriend. What is the best antidote for this?
A) Acetylcysteine
B) Calcium gluconate
C) Digoxin
D) Dimercaprol
55
Jefferson was diagnosed with tuberculosis. Aside from HRZE, he was given Vitamin B6 (pyridoxine). What is this for?
A) To address polyneuropathy that can be caused by Isoniazid
B) To address optic neuritis that can be caused by ethambutol
C) To address hepatotoxicity that can be caused by pyrazinamide
D) To address ototoxicity that can be caused by streptomycin
56
Ismael, a farmer in Batangas, was brought to the ER due to organophosphate poisoning. What is the best antidote for this?
A) Ethanol
B) Pyridoxine
C) Glucagon
D) Pralidoxime
57
The following are indications for gastric lavage EXCEPT:
A) Ingestion within 8 hours
B) Substance exceeds adsorptive capacity of initial activated charcoal (AC) dosing
C) Agents not adsorbed by AC
D) Substances likely to form concretions after overdose
A) Ingestion within 8 hours
High-Yield Rationale:
* Gastric lavage is only indicated within 1 hour of ingestion of a potentially life-threatening toxin.
* After 1 hour, gastric emptying reduces efficacy and increases aspiration risk.
Why the others are correct indications:
* B) Substance exceeds adsorptive capacity of activated charcoal: Yes — lavage may be useful in
massive overdose.
* C) Agents not adsorbed by AC: E.g., metals (iron, lithium), alcohols - lavage may be useful.
* D) Substances forming concretions (bezoars): E.g., salicylates, carbamazepine - may require
lavage for mechanical removal.
58
Jerry, a 55-year-old male weighing 55 kg, was brought to the ER due to a possible overdose of an unknown substance. Your senior instructed you to give activated charcoal. How much will you give?
A) 55 g of AC as initial dose
B) 6 g of AC as initial dose
C) 82.5 g of AC as initial dose
D) 110 g of AC as initial dose
59
Alkalinization with NaHCO3 is useful for the ingestion of the following drugs, EXCEPT:
A) Salicylate
B) Phenobarbital
C) Methotrexate
D) Iron
D) Iron
High-Yield Rationale:
Sodium bicarbonate alkalinization is useful for enhancing urinary excretion of weak acids, such as:
* A) Salicylates
* B) Phenobarbital
* C) Methotrexate
Iron, however:
* Is a metal, does not bind to charcoal.
* Not excreted via urine significantly, so alkalinization is ineffective.
* Treated with deferoxamine.
Why the others are correct:
* A-C: All are weak acids whose renal elimination increases with urine alkalinization.
60
Gianne was advised to undergo hemodialysis after multiple ingestions of which of the following?
A) Atenolol
B) Quetiapine
C) Benzodiazepine
D) Acetaminophen
61
Nikolai admitted that she took 25-30 pieces of acetaminophen. What will you expect to happen if she is left untreated for 72 hours?
A) Asymptomatic
B) Acute Liver Injury
C) Maximal Liver Injury
D) Respiratory depression
62
Dindo, 35/M, complained about the worst headache of his life, fell down, and lost consciousness. Scans and laboratory confirmed a subarachnoid hemorrhage. Which calcium channel blocker is best for his case?
A) Verapamil
B) Diltiazem
C) Nifedipine
D) Amlodipine
C) Nifedipine
High-Yield Rationale:
* Nimodipine is a dihydropyridine CCB specifically used to prevent cerebral vasospasm after subarachnoid hemorrhage.
* It improves neurological outcomes.
* Nifedipine, though similar in class, is less selective and not the first-line, but among the listed options, it's the closest substitute.
Why the others are incorrect:
* A) Verapamil and B) Diltiazem: Non-dihydropyridines → act mainly on heart rate and contractility,
not cerebral vasculature.
* D) Amlodipine: Long-acting antihypertensive, not used in SAH or to prevent vasospasm.
63
Which of the following is the drug of choice for digoxin-induced atrial and ventricular arrhythmia?
A) Lidocaine
B) Phenytoin
C) Tocainide
D) Mexiletine
64
Ana Marie had arrhythmia and was given medications. She noticed that she has been experiencing tinnitus, hearing loss, headaches, vomiting, and visual disturbances. Which of the following could have caused these?
A) Amiodarone
B) Quinidine
C) Disopyramide
D) Verapamil
B) Quinidine
High-Yield Rationale:
Quinidine is a Class IA antiarrhythmic known for causing cinchonism, a syndrome characterized by:
* Tinnitus
* Hearing loss
* Headache
* Visual disturbances
* Nausea/vomiting
It prolongs the QT interval and can lead to torsades de pointes.
Why the others are incorrect:
* A) Amiodarone: Causes pulmonary fibrosis, thyroid dysfunction, blue-gray skin, but not classic
cinchonism.
* C) Disopyramide: Also Class A but primarily has anticholinergic side effects (dry mouth, urinary
retention).
* D) Verapamil: Non-dihydropyridine CCB; may cause bradycardia, constipation, but not cinchonism.
65
What is the goal blood pressure for malignant hypertension?
A) Normalization
B) 50% reduction
C) 25% reduction
D) 10% reduction
C) 25% reduction
High-Yield Rationale:
In malignant or hypertensive emergency, the goal is to reduce mean arterial pressure (MAP) by no more than 25% within the first hour to prevent ischemic complications.
Too rapid a drop can lead to stroke, MI, or acute kidney injury.
66
Sophia had 2 healthy kids with uncomplicated pregnancies delivered by a midwife at home in the province. At 38, she was diagnosed with hypertension and was given medication. At 40, she was pregnant with her third child. She refused to have consultations and laboratory work-ups believing that her midwife was serving them well. She continued taking her antihypertensive drug. She delivered prematurely, and was surprised when she was informed that the baby had hypotension, anuria, and multiple malformations. What might have caused these?
A) Enalapril
B) Losartan
C) Nadolol
D) Amlodipine
A) Enalapril
High-Yield Rationale:
* ACE inhibitors (e.g., Enalapril) and ARBs (e.g., Losartan) are contraindicated in pregnancy, especially during the 2nd and 3rd trimesters.
They can cause:
* Fetal hypotension
* Renal agenesis or anuria
* Oligohydramnios
* Limb and skull malformations
* Fetal demise
Why the others are incorrect:
* B) Losartan: Also teratogenic, but Enalapril is more widely recognized in this context and is classically tested.
* C) Nadolol: Beta-blockers may cause fetal bradycardia or growth restriction, but not malformations/anuria.
* D) Amlodipine: Dihydropyridine CCB; relatively safe in pregnancy.
67
Rocky, 75/M, is still sexually active. He learned on TikTok that he can order sildenafil online without a prescription. He self-medicated with it. After a few days of taking it, he was found lifeless in his bedroom. What might have caused it?
A) Sildenafil can cause life-threatening hypotension
B) Sildenafil can cause delirium
C) Sildenafil causes rebound hypertension
D) Sildenafil can cause psychosis
A) Sildenafil can cause life-threatening hypotension
High-Yield Rationale:
* Sildenafil is a PDE-5 inhibitor used for erectile dysfunction.
* It potentiates nitric oxide → 1 cGMP → vasodilation.
* When taken without supervision, especially in elderly men with cardiovascular disease or on nitrates, it can cause severe hypotension → syncope, Ml, or death.
* TikTok-style misinformation and unsupervised use is dangerous.
Why the others are incorrect:
* B) Delirium: Not a known side effect.
* C) Rebound hypertension: Not associated with sildenafil.
* D) Psychosis: No psychiatric adverse effects typically linked to this drug.
68
The following are done to treat digitalis toxicity, EXCEPT:
A) Treatment of hypokalemia
B) Lidocaine
C) Cardiac pacer
D) Dimercaprol
D) Dimercaprol
High-Yield Rationale:
* Dimercaprol is a chelating agent used for arsenic, mercury, gold, and lead poisoning.
* It has no role in digitalis toxicity.
Appropriate treatments include:
* A) Correcting hypokalemia: Digoxin binds more when K* is low, worsening toxicity.
* B) Lidocaine: Class IB antiarrhythmic useful in ventricular arrhythmias due to digoxin.
* C) Cardiac pacer: Used in bradyarrhythmias or AV block unresponsive to medical therapy.
69
Which of the following has a constipating effect?
A) CaCO3 + Mg(OH)2 → MgCl + H2O
B) CaCO3 + Al(OH)3 → AlCl + H2O
C) NaHCO3 + HCl → CO2 + NaCl
D) NaHCO3 alone
70
NaHCO3 must be taken with caution in the following cases due to the possibility of exacerbating fluid retention:
A) Heart failure
B) Hypotension
C) Hepatitis
D) Anorexia nervosa
A) Heart failure
High-Yield Rationale:
* Sodium bicarbonate (NaHCOs) contains sodium, which can lead to fluid retention.
* In heart failure, sodium and fluid overload can worsen pulmonary congestion and edema.
* Therefore, it should be used with caution or avoided.
Why the others are incorrect:
* B) Hypotension: NaHCO, may increase sodium but doesn't worsen hypotension through fluid loss.
* C) Hepatitis: Not directly worsened by NaHCO, unless cirrhosis with ascites is present (but HF is more directly related).
* D) Anorexia nervosa: Caution is needed in general, but fluid retention is not the primary concern
here.
71
Which of the following causes gynecomastia?
A) Digoxin
B) Ethambutol
C) Furosemide
D) Ranitidine
A) Digoxin
High-Yield Rationale:
* Digoxin can cause gynecomastia due to its estrogen-like effects.
* Rare but well-documented side effect.
* Mechanism: possibly due to steroid hormone-like structure and influence on hormone metabolism.
Why the others are incorrect:
* B) Ethambutol: Side effect is optic neuritis, not hormonal.
* C) Furosemide: Can cause ototoxicity, hypokalemia, not gynecomastia.
* D) Ranitidine: Rarely linked in older reports, but not a consistent or major cause; cimetidine is the H2-blocker more famously associated with gynecomastia.
72
Which of the following causes cyanide toxicity?
A) Diazoxide
B) Minoxidil
C) Verapamil
D) Na nitroprusside
D) Sodium nitroprusside
High-Yield Rationale:
* Sodium nitroprusside is a potent vasodilator used in hypertensive emergencies.
* It is metabolized to cyanide and thiocyanate, which can accumulate and cause cyanide toxicity, especially with prolonged use or renal impairment.
* Signs include metabolic acidosis, confusion, seizures, and cardiovascular collapse.
Why the others are incorrect:
* A) Diazoxide: Opens K* channels; no cyanide formation.
* B) Minoxidil: Vasodilator causing hypertrichosis, not cyanide toxicity.
* C) Verapamil: Calcium channel blocker; no cyanide risk.
73
Which is TRUE about Spironolactone?
A) Antiestrogenic
B) Can cause metabolic alkalosis
C) Can treat Conn's disease
D) Can cause hypokalemia
C) Can treat Conn's disease
High-Yield Rationale:
* Spironolactone is a potassium-sparing diuretic and aldosterone antagonist.
* It is the treatment of choice for primary hyperaldosteronism (Conn's syndrome), where aldosterone is in excess → hypertension + hypokalemia.
* It blocks aldosterone receptors in the distal nephron, promoting Na* excretion and K* retention.
Why the others are incorrect:
* A) Antiestrogenic: X False — it is antiandrogenic, not antiestrogenic. It can actually cause gynecomastia.
* B) Can cause metabolic alkalosis: X False — it can cause metabolic acidosis and hyperkalemia.
* D) Can cause hypokalemia: X False - it causes hyperkalemia due to potassium-sparing effect.
74
Which of the following is TRUE regarding DIGITOXIN?
A) Renal secretion
B) Stimulates vagus nerve centrally
C) 4-8H half-life
D) 20-30% protein bound
B) Stimulates vagus nerve centrally
High-Yield Rationale:
* Digitoxin, like digoxin, increases vagal tone → leads to increased parasympathetic stimulation.
* This helps in slowing AV conduction, making it useful in controlling atrial fibrillation.
Why the others are incorrect:
* A) Renal secretion: X False - Digitoxin is metabolized in the liver (unlike digoxin, which is renally excreted).
* C) 4-8h half-life: X False - Digitoxin has a long half-life (~5-7 days).
* D) 20-30% protein bound: X False — it is ~95% protein bound, contributing to its longer duration and slower onset.
75
Carlo was diagnosed with insulinoma. Which is the drug of choice to prevent insulin release?
A) Furosemide
B) Na Nitroprusside
C) Minoxidil
D) Diazoxide
76
This drug is an indirect adrenergic antagonist that is used to treat high blood pressure but can cause bradycardia. It also is used to treat severe agitation in patients with mental disorders but may cause CNS depression.
A) Guanethidine
B) Reserpine
C) Epinephrine
D) Norepinephrine
B) Reserpine
High-Yield Rationale:
* Reserpine is an indirect adrenergic antagonist that works by irreversibly inhibiting VMAT (vesicular monoamine transporter), depleting NE, dopamine, and serotonin from presynaptic terminals.
* Used historically to treat hypertension and psychotic agitation.
Side effects:
* Bradycardia, hypotension
* CNS depression (can cause severe depression or sedation)
Why the others are incorrect:
* A) Guanethidine: Also an indirect adrenergic blocker but not used for CNS/mental disorders, and does not cross the blood-brain barrier.
* C & D) Epinephrine/Norepinephrine: Direct adrenergic agonists, not antagonists; both increase
blood pressure and heart rate.
77
Guan has been taking Nadolol for the past 3 months. Which among the following side effects can be attributed to the drug?
A) Exacerbation of asthma, bradycardia, and sedation
B) Tachycardia, wakefulness, and asthma
C) Asthma, rashes, and palpitations
D) Wakefulness, rashes, and palpitations
78
Elee was rushed to the ER due to hypertensive crisis, but you noticed that the heart rate was between 42-56 bpm. Which of the following will you give her?
A) Beta blocker with alpha-blocking properties
B) Beta blocker with Beta agonistic properties
C) Beta agonist with beta-blocking properties
D) Beta agonist with alpha-blocking properties
79
Cherished had Graves' disease since 2019. She was rushed to the ER due to severe diarrhea. After a series of tests, you confirmed that she is suffering from thyroid storm. Which of the following is the best drug for her?
A) Cardioselective beta blocker
B) Non-selective beta blocker
C) Beta blocker with beta agonistic properties
D) Beta-blocker with alpha-blocking properties
80
Rojhun underwent exploratory laparotomy and was noticed to have hypertensive emergency and focal atrial tachycardia. You are the clerk on duty, and Dr. Villavicencio (Anesthesiologist) told you to get an ultrashort-acting cardioselective beta-adrenergic blocker when he noticed hypertensive episodes and tachycardia intraoperatively. Which of the following will you give him?
A) Nadolol
B) Metoprolol
C) Propranolol
D) Esmolol
81
Phillip had pheochromocytoma. He was admitted due to spinal cord injury from a fall. He was noted to have hypertension and hyperreflexia. Which of the following drugs is best for him?
A) Yohimbine
B) Phenoxybenzamine
C) Phentolamine
D) Adenosine
82
Grandpa Emilio visited the cardiologist at the new clinic nearby. He was given new medications. A few minutes after he arrived home, you noticed that he was dizzy, pale, and weak. BP was 80/50. Which of the following drugs may have caused it?
A) Terazosin
B) Amlodipine
C) Gliclazide
D) Vitamin D3
A) Terazosin
High-Yield Rationale:
* Terazosin is an al-adrenergic blocker used for BPH and hypertension.
* It causes vasodilation, which can lead to first-dose orthostatic hypotension, especially in elderly patients.
* Symptoms: dizziness, weakness, pallor, syncope - classic a-blocker side effect.
Why the others are incorrect:
* B) Amlodipine: Can cause hypotension, but less likely to cause acute severe orthostatic drop seen with terazosin.
* C) Gliclazide: A sulonylurea - can cause hypoglycemia, but wouldn't directly drop BP like this
unless from neuroglycopenia.
* D) Vitamin D3: Does not affect blood pressure acutely.
83
Jana was admitted for monitoring of bradycardia. Which of the following are signs of atropine toxicity?
A) Drooling
B) Excessive sweating
C) Bradycardia
D) Blurred vision beyond 72 hours
84
Which of the following muscarinic antagonists has antidepressant properties?
A) Ipratropium bromide
B) Diphenhydramine
C) Thorazine
D) Benztropine
85
Which of the following reversible indirect cholinergic agonists can be an antidote to atropine toxicity?
A) Edrophonium
B) Pyridostigmine
C) Physostigmine
D) Neostigmine
86
Ivermectin is a helminthic glutamate-gated channel antagonist that causes worm paralysis and is effective against which of the following?
A) Pinworm
B) Schistosomiasis
C) Strongyloides
D) Fluke
Q2: Ivermectin is effective against which parasite?
Correct Answer: C) Strongyloides
High-Yield Rationale:
* Ivermectin works by activating glutamate-gated chloride channels in invertebrate nerve and muscle cells → causes paralysis and death of the worm.
* It is the drug of choice for:
* Strongyloides stercoralis
* Onchocerca volvulus (river blindness)
* Also effective in lice and scabies
Why the others are incorrect:
* A) Pinworm: Treated with mebendazole or albendazole.
* B) Schistosomiasis: Treated with praziquantel.
* D) Flukes (trematodes): Also treated with praziquantel, not ivermectin.
87
You were an exchange student assigned to a government hospital in Malaysia. Your first patient was Sidharta, a native from West Malaysia, a known chloroquine-resistant region. He was diagnosed with malaria. What will be your treatment of choice?
A) Quinine + Doxycycline
B) Mefloquine + Doxycycline
C) Mefloquine + Clindamycin
D) Atovaquone + Clindamycin
Q3: Treatment of chloroquine-resistant malaria in Malaysia (Sidharta)
A) Quinine + Doxycycline
High-Yield Rationale:
* In regions with chloroquine-resistant Plasmodium falciparum (like West Malaysia), the preferred treatment is:
* Quinine sulfate + Doxycycline or Clindamycin
* Doxycycline is used in adults, while clindamycin is preferred in children and pregnant women.
Why the others are less preferred:
* B) Mefloquine + Doxycycline: Not a common or recommended combo; mefloquine can be used as monotherapy or prophylaxis, not typically paired with doxy.
* C) Mefloquine + Clindamycin: Less established combo; mefloquine's neuropsychiatric effects limit its use.
* D) Atovaquone + Clindamycin: Atovaquone is paired with proguanil (Malarone), not clindamycin.
88
Ekay is a Grade 7 student who came to you at the school clinic crying after being bullied due to her head lice. Which of the following will you prescribe?
A) Ketoconazole shampoo
B) Gugo shampoo
C) Aloe Vera shampoo
D) Lindane shampoo
89
Metronidazole is the drug of choice for the following except:
A) Entamoeba histolytica
B) Giardia sp.
C) Toxoplasma gondii
D) T. vaginalis
90
Evangeline, 23/F, was diagnosed with HIV a few months after she finished a series of vampire facials. Which of the following vaccines will you NOT recommend to her?
A) Pneumococcal
B) Influenza
C) Varicella
D) Hepatitis
Q3: Vaccine NOT recommended in HIV-positive patients (Evangeline)
C) Varicella
High-Yield Rationale:
Varicella vaccine is a live attenuated virus, which is contraindicated in:
* Severely immunocompromised patients (e.g., CD <200 cells/uL)
* Risk of disseminated infection
Why the others are recommended:
* A) Pneumococcal: Inactivated; recommended in HIV due to 1 risk of pneumonia.
* B) Influenza: Inactivated flu vaccine (IM) is safe and recommended yearly.
* D) Hepatitis (A/B): Inactivated; recommended due to higher risk of coinfections.
91
This thymidine analog is metabolized to stavudine triphosphate, which inhibits HIV reverse transcriptase and DNA polymerase. It prevents DNA elongation.
A) Zidovudine
B) Didanosine
C) Zalcitabine
D) Stavudine
92
Serena was diagnosed with bronchiolitis from Respiratory syncytial virus. Which of the following is the best treatment for her?
A) Ribavirin
B) Acyclovir
C) Amantadine
D) Rimantadine
A) Ribavirin
High-Yield Rationale:
* Ribavirin is a broad-spectrum antiviral used (inhaled form) for severe RSV infection (especially in hospitalized infants and high-risk groups).
* MOA: Inhibits viral RNA synthesis.
Why the others are incorrect:
* B) Acyclovir: For herpesviruses (HSV, VZV); not active against RSV.
* C) Amantadine and
* D) Rimantadine: Target influenza A M2 protein, ineffective against RSV and no longer widely used due to resistance
93
You were assigned to the PICU and met Anisha, a 1-year-old patient with CMV retinitis and who is currently immunocompromised. Her laboratory results showed renal toxicity, hypocalcemia, and anemia. Which of the following drugs may have caused these?
A) Corticosteroids
B) Vitamin B infusion
C) Foscarnet
D) Levofloxacin
94
Uno was diagnosed with blastomycosis, which caused him hypokalemia and high triglycerides. Which anti-fungal drug is this?
A) Fluconazole
B) Ketoconazole
C) Itraconazole
D) Griseofulvin
95
Evangeline was readmitted to the ICU, this time due to Cryptococcal meningitis. Which of the following is the drug of choice?
A) Fluconazole
B) Ketoconazole
C) Miconazole
D) Econazole
96
Anton is a clerk diagnosed with Pulmonary tuberculosis. On his third month, he experienced red-green blindness. Which of the following might have caused it?
A) Isoniazid
B) Rifampicin
C) Pyrazinamide
D) Ethambutol
97
This compound binds to guanine in DNA and RNA, and the interaction is stabilized by hydrogen bonding.
A) Paclitaxel
B) Vinblastine
C) Cisplatin
D) Etoposide
98
This alkaloid prevents microtubule assembly, causing cells to arrest in the late G2 phase by preventing formation of mitotic filaments for nuclear and cell division.
A) Vincristine
B) Bleomycin
C) Busulfan
D) Tamoxifen
Q2: Alkaloid that prevents microtubule assembly, causing G2/M arrest
A) Vincristine
High-Yield Rationale:
* Vincristine is a vinca alkaloid that binds ß-tubulin and inhibits microtubule polymerization, thereby preventing spindle formation.
* It causes cell cycle arrest at metaphase (M phase), although some references note late G2/M transition.
* Used in leukemias, lymphomas, and solid tumors.
Why the others are incorrect:
* B) Bleomycin: Causes DNA strand breaks, active in G2 phase, but not a microtubule inhibitor.
* C) Busulfan: Alkylating agent used in CML; causes DNA cross-linking, not microtubule-related.
* D) Tamoxifen: Selective estrogen receptor modulator (SERM); used in ER+ breast cancer, no action on mitotic spindles or microtubules.
99
This drug has its greatest effect on neoplastic cells in the G2 phase of the cell replication cycle. The major cytotoxicity is believed to result from iron-catalyzed free radical formation and DNA strand breakage.
A) Methotrexate
B) Oncovin
C) Bleomycin
D) 5-Fluorouracil
Q1: Drug acting in G2 phase via iron-catalyzed free radicals and DNA strand breakage
C) Bleomycin
High-Yield Rationale:
* Bleomycin is a cytotoxic antibiotic that:
* Has maximal effect in the G2 phase
* Causes DNA strand breaks via iron-mediated free radical formation
* Major toxicity: Pulmonary fibrosis
Incorrect choices:
* A) Methotrexate - Acts in S phase; inhibits dihydrofolate reductase.
* B) Oncovin (Vincristine) - Disrupts microtubules; acts in M phase.
* D) 5-Fluorouracil - Antimetabolite; active in S phase.
100
Peejay, a known asthmatic since childhood, was diagnosed with open-angle glaucoma at age 50. While driving, he experienced difficulty breathing. He injected himself with Epinephrine. Which of the following is the expected effect or ADR?
A) Mydriasis and worsened glaucoma
B) Bronchodilation and increased outflow of aqueous humor
C) Miosis and worsened glaucoma
D) Bronchodilation and decreased aqueous humor synthesis
