ClickUP questions Flashcards by Rachel Glass

Miss Y, 36 years old, was booked for an explorative laparotomy following a motor vehicle accident. Fortunately, no injuries were found. Despite good antibiotic prophylaxis, she developed an infection along the incisional wound two days later.
Multiple factors affect the development of surgical site infections, but which factor does NOT?

a. Intraoperative management
b. Bacterial defenses
c. Bacterial load
d. Bacterial virulence
e. A patient with a hip prosthesis

b. Bacterial defenses

How well did you know this?

Not at all

Perfectly

Mr. R, a 43-year-old, is brought into the emergency department by his wife. Mr. R is drowsy and his wife reports that he has been complaining of a headache and a stiff neck. Mr. R’s temperature is 39.4°C. You suspect that Mr. R is suffering from bacterial meningitis and decide to do a lumbar puncture. Before you perform the lumbar puncture, you admit Mr. R and start him on empiric antibiotics. What would the most appropriate empiric antibiotic therapy be for Mr. R?

a. Vancomycin plus ceftazidime or cefepime
b. Vancomycin plus co-trimoxazole
c. Ampicillin and cefotaxime
d. Ceftriaxone or cefotaxime +/- ampicillin
e. Benzylpenicillin

d. Ceftriaxone or cefotaxime +/- ampicillin

How well did you know this?

Not at all

Perfectly

Mrs Adams is a 39-year-old female who has been on quinine treatment for severe malaria for the past 5 days, due to the lack of Co-Artem in the hospital. The patient has been progressively lethargic and confused since she started the treatment, raising concerns that the dose of quinine may be too high. Which one of these findings upon further investigation would NOT be present in cinchonism?

a. Hypernatraemia
b. Haemolysis
c. Hypoglycaemia
d. Agranulocytosis
e. Thrombocytopenia

a. Hypernatraemia

How well did you know this?

Not at all

Perfectly

In which of the following cases is ribavirin indicated?

a. In chronic hepatitis B infection.
b. In all cases of respiratory syncytial virus.
c. In viral hemorrhagic fever – Ebola virus disease.
d. In severe influenza A infection.
e. In hepatitis C infection.

e. In hepatitis C infection.

How well did you know this?

Not at all

Perfectly

Praziquantel is an anti-parasitic agent that is active against the adult and larval stages of most trematodes. For which parasite would you not prescribe praziquantel?

a. Chlonorchiasis
b. Schistosomiasis
c. Tapeworms
d. Fasciola hepatica
e. Cysticercosis

d. Fasciola hepatica

How well did you know this?

Not at all

Perfectly

Mrs B is a pregnant 36 year old nurse. She is a chronic alcoholic with a familial history of hepatocellular carcinoma. Investigations reveal elevated AST/ALT, as well as HBV DNA levels.
What is the best initial management plan for Mrs B?

a. Give an oral combination of tenofovir and emtricitabine.
b. Mrs B is not at risk for progression of the disease, and hence, treatment is supportive.
c. Start immediately on interferon-alpha.
d. As Mrs B is pregnant, she should not be on interferon-alpha and oral entecavir is the best initial step.
e. Administer an HIV test prior to any treatment.

e. Administer an HIV test prior to any treatment.

How well did you know this?

Not at all

Perfectly

Mr P, a 45 year old Caucasian businessman known to have stage 3 lung cancer, comes in complaining of a stiff neck, nausea and vomiting as of 2 days ago. On physical examination you find he has a heart rate of 130 BPM and has a temperature of 38oC. You do a lumbar puncture and are awaiting the results. Which one of the following drugs or combinations should you prescribe?

a. Famciclovir
b. Vancomycin plus ceftazidime
c. Ceftriaxone or cefotaxime
d. Metronidazole
e. Streptomycin

c. Ceftriaxone or cefotaxime

How well did you know this?

Not at all

Perfectly

Mrs X, a 25 year old, presented to Steve Biko Academic Hospital with a fever, lethargy and vomiting. She recently returned from a weekend holiday in northern KZN. She is 28 weeks pregnant using her LNMP. What is the appropriate initial management?

a. Oral coartem
b. Oral quinine plus clindamycin
c. IV quinine
d. Oral quinine plus doxycycline

c. IV quinine

How well did you know this?

Not at all

Perfectly

A 28-year-old woman, gravida 1, para 0, at 20 weeks’ gestation comes to the doctor with her husband for a prenatal visit. Her pregnancy has been uncomplicated. They are planning to travel to Mozambique next month to visit her husband’s family. Medications include folic acid and an iron supplement. Vital signs are within the normal range. Abdominal examination shows a uterus that is consistent with a 20-week gestation. Which of the following drugs is most suitable for pre-exposure prophylaxis against malaria?

a. Mefloquine
b. Chloroquine
c. Primaquine
d. Proguinal
e. Doxycycline

a. Mefloquine

How well did you know this?

Not at all

Perfectly

Fluconazole is a systemic anti-fungal that can be used in the prophylaxis for invasive candida infections. Which species of candida is fluconazole inactive against?

a. Candida lusitaniae
b. Candida albicans
c. Candida auris
d. Candida parapsilosis
e. Candida krusei

e. Candida krusei

How well did you know this?

Not at all

Perfectly

A 41-year-old man comes to the doctor because of a 3-week history of fatigue, cough, and a 4.5-kg weight loss. He does not smoke or drink alcohol. He appears emaciated. A chest x-ray shows a calcified nodule in the left lower lobe and left hilar lymphadenopathy. The doctor initiates therapy for the condition and informs him that he will have to return for monthly ophthalmologic examination for the next 2 months. These examinations are most likely to evaluate the patient for an adverse effect of which one of the following drugs?

a. Ethambutol
b. Isoniazid
c. Pyrazinamide
d. Rifampicin
e. Streptomycin

a. Ethambutol

How well did you know this?

Not at all

Perfectly

An 18 month old child presents with a white, bulging tympanic membrane. A diagnosis of acute otitis media is made and amoxicillin is initiated at a dose of 90 mg/kg per day in two divided doses. How long should the antibiotic treatment be continued?

a. 3 days
b. 10 days
c. 7 days
d. 5 days
e. 14 days

b. 10 days

How well did you know this?

Not at all

Perfectly

You would like to put your patient Mrs X on TB preventative therapy; however, there are factors which need to be excluded before you can start her on isoniazid (INH). Select the option that does NOT exclude Mrs X from starting the treatment.

a. Peripheral neuropathy
b. A previous adverse reaction to INH
c. Critically ill state
d. Signs of active TB
e. Previous infection with TB over 6 months ago (now TB sputum culture negative)

e. Previous infection with TB over 6 months ago (now TB sputum culture negative)

How well did you know this?

Not at all

Perfectly

Mr X, a 66 year old with known hypertension, presents to you with the following complaints: a cough producing purulent, blood-stained sputum, chest pain, and fever for 3 days. Mr X is not confused or delirious. On percussion of the lung fields, you note dullness in the right upper lobe. On auscultation, you hear crackles and bronchial breathing in the right upper lobe. You decide to send him for a CXR and blood work. You make the diagnosis of community-acquired pneumonia with a CURB-65 score of 2. The most appropriate management for this patient is:

a. Admit Mr X to the ward and treat with high dose amoxicillin and tetracycline
b. Admit Mr X to the ward and treat with Augmentin® (amoxicillin-clavulanate) and tetracycline .
c. High dose amoxicillin and tetracycline, which Mr X takes home.
d. Augmentin (amoxicillin-clavulanate) and azithromycin, which Mr X takes at home.
e. Tell Mr X thathe is experiencing severe flu and that he will recover with bed rest and Panado® (paracetamol).

b. Admit Mr X to the ward and treat with Augmentin® (amoxicillin-clavulanate) and tetracycline .

How well did you know this?

Not at all

Perfectly

Mr Z, is an HIV-positive patient. His partner tests positive for an acute hepatitis B infection. Mr Z’s HbsAg (Hepatitis B surface antigen) test comes back positive. Which drugs listed below have activity against both the HIV and hepatitis B viruses?

a. Interferon-alpha
b. Nevirapine
c. Tenofovir, emtricitabine, lamivudine
d. Atazanavir, ritonavir
e. Lopinavir, ritonavir

c. Tenofovir, emtricitabine, lamivudine

How well did you know this?

Not at all

Perfectly

A researcher is studying a new antituberculosis drug. In the laboratory, the drug has been shown to be effective against mycobacteria located within phagolysosomes of macrophages, but it is also significantly less effective against extracellular tuberculoid bacteria. The characteristics of this drug are most similar to which of the following agents?

a. Pyrazinamide
b. Isoniazid
c. Ethambutol
d. Streptomycin
e. Rifampicin

a. Pyrazinamide

How well did you know this?

Not at all

Perfectly

Mr Y, a 17 year old schoolboy, is a known HIV-positive patient on antiretroviral therapy (ART) for over 5 years and has recently come into contact with his uncle who stays in the same home as him. Upon further investigation it is found that his uncle has TB. You take initiative to preventatively treat MR Y but you first do a TB skin test (TST) which comes back as positive. How long will you prescribe isoniazid preventive therapy (IPT)?

a. 0 months
b. 6 months
c. 12 months
d. 18 months
e. 36 months

e. 36 months

How well did you know this?

Not at all

Perfectly

Regarding organisms involved in surgical prophylaxis, choose the most appropriate option:

a. Gram-positive bacteria cause wound infection in colon, gynaecological and, genito-urinary procedures
b. Most surgical infections are nosocomial infections
c. There is no relation between organism potential resistance and hospital epidemiology
d. Staphylococcus aureus is the major pathogen in wound infection after clean surgery

d. Staphylococcus aureus is the major pathogen in wound infection after clean surgery

How well did you know this?

Not at all

Perfectly

A 6 year old boy presents with worsening signs and symptoms of acute rhinosinusitis for the past 14 days. He had a fever and purulent nasal discharge for 3 days at the beginning of his illness and you decide to initiate empiric treatment. Which empiric therapy is not recommended due to high rates of resistance to H. influenzae?

a. Trimethoprim-sulfamethoxazole
b. Doxycycline
c. Clarithromycin
d. Ceftriaxone
e. Amoxicillin-clavulanate

a. Trimethoprim-sulfamethoxazole

How well did you know this?

Not at all

Perfectly

Which is the most common pathogen known for causing community–acquired cystitis?

a. Klebsiella
b. Proteus
c. E. coli
d. Pseudomonas

c. E. coli

How well did you know this?

Not at all

Perfectly

Mr Y has been receiving TB treatment for the past 6 months: rifampicin, isoniazid, pyrazinamide and ethambutol for the first 2 months, and rifampicin and isoniazid for an additional 4 months. If this treatment does not prove to be effective, which of the following drugs can NOT be used as additional treatment?

a. Ethionamide
b. Rifampicin
c. Linezolid
d. Clofazimine
e. Fluoroquinolones

b. Rifampicin

How well did you know this?

Not at all

Perfectly

Mrs Y presents with a high fever and left flank pain. On urine dipstick she has 2++ leukocytes. What is the recommended first-line empirical treatment?

a. Oral trimethoprim-sulfamethoxazole
b. Intravenous cefuroxime
c. Intravenous ceftriaxone
d. Oral nitrofurantoin
e. Intravenous fosfomycin

c. Intravenous ceftriaxone

How well did you know this?

Not at all

Perfectly

Risk factors for severe/complicated influenza do not include the following:

a. Pregnancy up to 2 weeks post-partum
b. Immunosuppressed patients
c. Age ≤18 years receiving chronic aspirin therapy
d. Hypertensive patients
e. Patients who deteriorate rapidly

d. Hypertensive patients

How well did you know this?

Not at all

Perfectly

A 23-year-old man comes to the physician because of a 1-week history of muscle ache, fatigue, and fever that occurs every 2 days. He recently returned from a trip to southern Zambia. A peripheral blood smear shows erythrocytes with brick-red granules. The doctor recommends a combination of two antimicrobial drugs after confirming normal glucose-6-phosphate dehydrogenase activity. Which of the following is the most appropriate rationale for dual therapy?

a. Decrease in enzymatic drug deactivation
b. Prevention of infection relapse
c. Decrease in renal drug secretion
d. Prevention of drug resistance
e. Therapy against polymicrobial infections

b. Prevention of infection relapse

How well did you know this?

Not at all

Perfectly

Mrs Y is a 60 year old female who has abnormal uterine bleeding and is scheduled for a hysterectomy. This surgery is an indication for prophylactic antibiotics; which one of the following surgeries does NOT qualify for prophylactic antibiotics? a. An elective caesarean section b. Joint replacement c. Simple open fracture d. Open reduction internal fixation (ORIF)

a. An elective caesarean section

A mother brings her child into your practice – aged 3 years. She reports that the child had a high fever in the night. She also noted a rash that started on the face 2 days ago. On examination you find that the child has a dry cough and very red eyes. What is the diagnosis? a. Scarlet fever b. Dengue c. Mycoplasma pneumoniae d. Measles e. Rubella

d. Measles

Which of the following symptoms is not found in cystitis? a. dysuria b. pain above pubic region c. flank pain d. bacteria in urine e. increased urinary frequency

c. flank pain

Mr. Jones recently travelled to Mpumalanga and has since been experiencing high fevers and diarrhoea. He was started on chloroquine. Which symptom does NOT correlate with toxicity of this drug? a. Weight loss b. ECG changes c. GIT symptoms d. Blurred vision e. Neuro psychiatric symptoms

a. Weight loss

The following patient is eligible for TB preventative therapy: a. Patient who has completed MDR or XDR TB treatment b. Patient with active liver disease c. Patient with previous adverse reaction to isoniazid d. Pregnant patient e. Patient with signs and symptoms of TB

d. Pregnant patient

Mr X, an 11 year old male presents with fever, cough and myalgia. You suspect influenza. What medication should you start him on and when? a. Zanamivir after diagnosis is confirmed. b. Diphenhydramine after diagnosis is confirmed. c. Oseltamivir within the first 48 hours of symptoms. d. Rimantidine within the first 48 hours of symptoms e. Amoxicilin after diagnosis is confirmed.

c. Oseltamivir within the first 48 hours of symptoms.

What is the correct combination of treatment for a 65 year old patient diagnosed with community-acquired pneumonia requiring ICU admission? a. 3rd generation cephalosporin + tetracycline + ampicillin b. Amoxycillin + aminoglycoside + azalide c. Parenteral penicillin G + amoxycillin + azalide d. Amoxycillin/clavulanate + 2nd generation cephalosporin + e. Amoxycillin/clavulanate + aminoglycosides + macrolide

e. Amoxycillin/clavulanate + aminoglycosides + macrolide

An 8-month old baby girl is brought to your practice by her mother with a 2-day history of a fever and skin rash. The rash started on the face and spares the hands and feet. According to the patient’s road to health booklet, the child last received an immunisation at 14 weeks. On examination, the baby appears malnourished and you find the child has conjunctivitis and a runny nose. You make the diagnosis of measles. What is the most appropriate management for this patient? a. Supportive care b. Supportive care, ribavirin and vitamin A c. Antibiotics d. Ribavirin and vitamin A supplements e. Acyclovir

b. Supportive care, ribavirin and vitamin A

A 72 year old female presents to your practice with cough, blood-stained purulent sputum, chest pain and fever for 3 days. On examination, her vitals are normal but there is consolidation in the right upper lobe and lobar opacity on x-ray. You diagnose community-acquired pneumonia. What is the first-line therapy of choice? a. Fluoroquinolones b. Tetracycline c. Doxycycline d. High dose amoxicillin e. Amoxicillin-clavulanate

e. Amoxicillin-clavulanate

A 58-year-old woman comes to the physician because of a 6-month history of difficulty walking, clumsiness of her arms and legs, and slurred speech. Physical examination shows masked facies and a slow, shuffling gait. When her ankles are passively flexed, there is involuntary, jerky resistance. Treatment is initiated with a combination of levodopa and carbidopa. The addition of carbidopa is most likely to decrease the risk of which of the following potential adverse drug effects? a. Visual hallucinations b. Orthostatic hypotension c. Dyskinesia d. Resting tremor e. Urinary retention

b. Orthostatic hypotension

A 13-year-old boy is brought to the emergency room by his mother for a generalized tonic-clonic seizure that occurred while attending a laser light show. His mother says that he has been otherwise healthy but “he often daydreams”. Over the past several months, he has reported recurrent episodes of jerky movements of his fingers and arms. These episodes usually occurred shortly after waking up in the morning. He has not lost consciousness during these episodes. Which of the following is the most appropriate treatment for this patient's condition? a. Valproate b. Tiagabine c. Ethosuximide d. Carbamazepine e. Phenytoin

a. Valproate

A 10-year-old girl is brought to the emergency department by her mother 30 minutes after having had a seizure. When her mother woke her up that morning, the girl's entire body stiffened and she started shaking vigorously for several minutes. Her mother also reports that over the past few months, her daughter has had multiple episodes of being unresponsive for less than a minute, during which her eyelids were fluttering. The girl did not recall these episodes afterwards. Upon arrival, she appears drowsy. Neurologic examination shows no abnormalities. Which of the following is the most appropriate pharmacotherapy to prevent recurrence of this patient's symptoms? a. Lorazepam b. Phenytoin c. Gabapentin d. Valproate e. Ethosuximide

d. Valproate

A 30-year old well-controlled schizophrenic male sees you for a routine checkup. He says he feels well, and has no complaints. He has been on olanzapine for a year. On examination you note increased blood pressure, high finger prick glucose, and increased waist circumference. Blood results show raised glucose, cholesterol and triglyceride levels. Which of the following antipsychotic medications has the lowest potential to cause weight gain and metabolic syndrome? a. Risperidone b. Olanzapine c. Quetiapine d. Clozapine e. Haloperidol

e. Haloperidol

Mr. T a 23 year old man, has been diagnosed with schizophrenia for 1 year. On his follow-up visit, you discover that his psychosis has intensified. On further questioning you learn that he has not been taking his treatment - he believes that he is not sick. He lives with his mother and is able to come in for check-ups, although he does not take his treatment. He is not aggressive and does not impose harm to himself or anyone around him. What would his next line of treatment be? a. Haloperidol + risperidone oral b. Clozapine depot c. Risperidone depot d. Admit him e. Clozapine oral

c. Risperidone depot

Memantine may decrease the effect of which one of the following? a. Levodopa b. Anticholinergics c. Dopaminergics d. Barbiturates

d. Barbiturates

You diagnose Mr. X, a 64-year-old male, with severe Alzheimer’s disease. You are planning to treat him with memantine. Which of the following is NOT a side effect of memantine? a. Vomiting b. Hallucinations c. Hypotonia d. Confusion

c. Hypotonia`

A 55-year-old woman comes to the office because she has a 20-year history of repetitive actions and is tired of wasting time by repeating these actions. The patient says she repeatedly checks the doors in her house to make sure they are locked, washes her hands several times per hour, and checks her electrical appliances three times each morning before she leaves for work. Medical history includes a second-degree atrioventricular block. Which of the following medications is the most appropriate initial therapy for this patient's psychiatric disorder? a. Sertraline b. Quetiapine c. Clomipramine d. Clonazepam

a. Sertraline

You are a fifth-year medical student on your first day in Weskoppies. A 40-year-old male with a history of schizophrenia presents to the OPD for his checkup and script renewal. When consulting the file, you notice his medication was changed to clozapine 2 months ago. Because the patient is on clozapine, what will form part of the management not previously done while on risperidone a. Total cholesterol b. FBC c. Weighing the patient d. Therapeutic drug monitoring e. Detailed history looking for symptoms and signs of extrapyramidal symptoms (EPS)

b. FBC

Mrs Y, a 35-year-old woman diagnosed with refractory schizophrenia is treated with clozapine 25 mg/day. Select the correct statement regarding the drug clozapine and potential novel targets for treating schiziphrenia a. Clozapine, together with a benzodiazepine, is effective in increasing the seizure threshold in a patient suffering from epilepsy b. A dopamine auto-receptor selective antagonist is another potential site for reducing psychosis in a patient with schizophrenia. c. Only 30-60% of D2 receptors are blocked when 5HT-1 receptors are blocked simultaneously with the use of clozapine d. Blockade of the 5HT-2 receptors in the nigrostriatal pathway decreases dopamine here, reducing the positive symptoms in a patient with schizophrenia e. Another potential site for targeting schizophrenia is using dopamine partial agonists, as well as 5HT2c antagonists

e. Another potential site for targeting schizophrenia is using dopamine partial agonists, as well as 5HT2c antagonists

A 45 years old male patient previously started on a neuroleptic drug come to the emergency room 10 days after initiation of the treatment. He has an altered mental status and on examination there is muscle rigidity, tachycardia, hyperthermia and blood pressure 175/105 mmHg. Blood results show grossly elevated CK levels. Which drug will form part of the drug therapy for treating this patient? a. Sulpiride b. Dantrolene c. Fluphenazine d. Risperidone e. Clozapine

b. Dantrolene

Risperidone is started due to the intolerable side effects of haloperidol. All of the following are absolute contra-indications for prescribing risperidone, except? a. Pregnancy b. Diabetes c. Hyperlipidemia d. Parkinson’s disease

a. Pregnancy

Mr. X is a 19-year-old male who presents to casualty with a first episode of acute psychosis. He is referred to psychiatry for an evaluation of suspected schizophrenia. He is started on 6 mg haloperidol. The drug significantly improves his positive symptoms, but he develops intolerable side effects. Which one of the following is a side effect specific to haloperidol? a. Tremor b. Constipation c. Increased risk of death in patients with dementia d. Neuroleptic malignant syndrome

c. Increased risk of death in patients with dementia

A patient who has been prescribed the anti-parkinsonian medication carbidopa/levodopa, asks the healthcare provider, “Why am I getting these two medications?” How should the healthcare provider respond? a. You will experience more side effects when you take both medications together b. The carbidopa prevents the breakdown of the levodopa c. This drug combination is composed of two types of the same medication d. The levodopa turns the carbidopa into dopamine when it reaches the brain

b. The carbidopa prevents the breakdown of the levodopa

What percentage of levodopa enters the brain unaltered?: a. 1 - 3 % b. 5 -10% c. 15 – 30% d. 30 – 50% e. >50%

b. 5 -10%

Mrs Xiomara,a 70 year old with Parkinson’s Disease went to visit her children during the holidays, and got sick with a virus of some sort. She went to the doctor, who diagnosed an influenza infection. He prescribed a drug with anti-parkinsonian properties as well as anti-viral properties. Which drug did he prescribe? a. pergolide b. procyclidine c. amantadine d. levodopa e. reserpine

c. amantadine

A 60-year-old male presents to your practice complaining of “not being able to move around and do as much as he used to”. Upon examination you find slight rigidity in both legs, a left-sided tremor and bradykinesia. You rule out any psychiatric medication as a possible cause. The diagnosis of early Parkinson’s disease is made. His symptoms are not disabling. You want to start him on treatment, but you are concerned about the long-term motor complications of certain therapeutic drugs. Choose the most suitable initial drug for your patient and identify the class to which it belongs: a. Ropinirole which is a MAOI-B (irreversible) b. Selegiline which is a dopamine agonist c. Ropinirole which is a dopamine agonist d. Selegiline which is a MAOI-B (irreversible) e. Levodopa which is a dopamine precursor

d. Selegiline which is a MAOI-B (irreversible)

Mr A, a 40 year tourist who has been travelling through South Africa for 5 months, presents to your practice complaining of headaches, achy muscles and chills, runny nose and a dry cough for the past 7 days. On taking his history you discover that he was taking medication to help him cope with the stresses of his job, but ran out of them 2 weeks ago. He did not seek a prescription in South Africa as he felt the medication negatively affected his libido and thus his relationship with his partner. He does not know the names of the medication, and still feels “on edge”. His temperature is normal, and his chest is clear. What is the most appropriate intervention? a. Prescribe paracetamol, cough syrup and send for CXR b. Start him on paroxetine 20 mg c. Prescribe a short course of augmentin and paracetamol d. Prescribe benzodiazepines to manage his stress e. Start him on fluoxetine 20 mg

e. Start him on fluoxetine 20 mg

Mr Q is a 35 year old who has been diagnosed with bipolar disorder and has been prescribed the mood stabiliser, lithium. He presents to you today after 4 months of treatment complaining of nausea and vomiting and you notice he has a hand tremor. Which of the following is not a symptom of lithium toxicity? a. Slurred speech b. Decreased reflexes c. Thyroid enlargement d. Renal failure e. Confusion

b. Decreased reflexes

Mrs X, a 40 year old diagnosed with depression has failed first-line drug therapy and has been prescribed a tricyclic antidepressant (TCA). She presents to you today after 2 months of TCA therapy, complaining of excessive drowsiness after taking her medication as well as noticeable weight gain, which you recognise as antihistamine effects. Which of the following is not a side effect of TCAs? a. Orthostatic hypotension b. Hypersalivation c. Urinary retention d. Blurred vision e. Constipation

b. Hypersalivation

Mr J, a 45 years old has been worried about not having enough money to sustain his family for thirty years. After consulting with his doctor, he is diagnosed with a generalised anxiety disorder that is perpetuated by financial worries. What is the first line treatment for his anxiety disorder? a. Benzodiazepine b. Antipsychotic c. SSRI d. Anticonvulsant e. Monoamine oxidase inhibitor

c. SSRI

A known chronic anxiety patient comes to your consultation rooms complaining of a history of vertigo, double vision and anterograde amnesia that started within a week of the last visit and suspects the drugs that were added to their medication. Which one of the following drugs is likely to be the cause of the patient’s complaints? a. Escitalopram b. Fluoxetine c. Paracetamol d. Lorazepam e. Erythromycin

d. Lorazepam

Mrs X, 23 years old and 3 weeks pregnant, presents to your practice with a complaint of having seizures since she was 16, but recently, they have worsened. You make the diagnosis of epilepsy (generalized seizures). Which one of the following drugs will be the most suitable treatment regimen for her? a. Phenytoin b. Lamotrigine c. Sodium valproate d. Phenobarbitone e. Carbamazepine

b. Lamotrigine

Mrs A, a 29-year old female, is suffering from generalised convulsive status epilepticus. In the past month she had two seizures, each lasting longer than 5 minutes. Regarding the management of status epilepticus, which of the following is incorrect? a. A loading dose of IV phenytoin is administered to prevent relapse b. Anaesthetic agents like thiopentone, chlormethiazole and propofol are used as a last resort. c. Blood pressure should be monitored closely during benzodiazepine administration. d. If seizures persist after the first dose of an IV benzodiazepine, the next step is to administer paraldehyde per rectum e. Status epilepticus is a medical emergency and rapid suppression of seizure activity is essential.

d. If seizures persist after the first dose of an IV benzodiazepine, the next step is to administer paraldehyde per rectum

Mrs X, a 32 year old female and known epileptic, is 12 weeks pregnant with her first child. She is currently controlled on valproate (Epilim®) 450 mg bd po but consults you worried about the effects the medication might have on her baby. You reassure the patient and reiterate the importance of compliance as seizures during pregnancy may cause a miscarriage or stillbirth. Your management plan for Mrs X is to: a. a. Decrease total dose of valproate to 600 mg daily (divided doses) po. b. b. Split dose to tds or qid c. c. Wean her off valproate in order to change medication d. a and c. e. a, b and c.

e. a, b and c.

Mr A is a 22 year old male who suffers from epilepsy. You start him on low dose phenytoin once per day. At the follow-up visit he complains of experiencing physical changes since he started taking this traditional anti-epileptic drug. Which of the following cannot be due to the phenytoin daily dose? a. Gum hypertrophy b. Rash c. Lymphadenopathy d. Sedation e. Cardiac arrhythmia

e. Cardiac arrhythmia

Mr H is a 46 year old man with a 26 pack year history of smoking. He visits your GP practice for assistance to stop smoking. He has been unsuccessfully attempting to stop for the past 5 years. Which of the following statements regarding the treatment of nicotine addiction is correct? a. Bupropion is an antidepressant that is commonly prescribed for its ability to reduce nicotine tolerance. b. Varenicline is a commonly prescribed noradrenaline-dopamine reuptake inhibitor used to increase dopamine. c. Bupropion is a commonly prescribed noradrenaline-dopamine reuptake inhibitor used for its dopaminergic effect. d. Numerous gums, e-cigarettes and nicotine patches have proven effective therapies due to their nicotinic antagonist ability e. Varenicline is a low-affinity antagonist for alpha4beta2 nicotinic acetylcholine receptor subtype causing dopamine release.

c. Bupropion is a commonly prescribed noradrenaline-dopamine reuptake inhibitor used for its dopaminergic effect.

Which of the following hallucinogens binds to NMDA receptors? a. LSD b. Ketamine c. Atropine d. Psilocybin e. MDMA

b. Ketamine

A 28 year old female patient is receiving treatment for opioid addiction. The first step in the “4-Step Approach” of Subutex Maintenance Treatment is the following: a. Maintenance b. Stabilisation c. Induction d. Withdrawal

c. Induction

A 22 year old male enters your emergency department complaining of heart palpitations. On examination you notice that he has dilated pupils, an elevated blood pressure, profuse sweating and aggressive behaviour. You suspect the patient may be under the influence of a stimulant; which of the following could be the culprit? a. Flakka b. Heroin c. Alcohol d. Cocaine

d. Cocaine

A 35 year old male patient comes in the ER with a decreased level of consciousness, shallow breathing and small pupils with a known drug history. You determine that he has suffered an opioid overdose. What is the most appropriate initial treatment? : a. start him on low dose methadone to avoid withdrawal symptoms b. start him on IV naloxone c. counsel the patient on the dangers of drugs and refer him to an addiction program for further help d. monitor the patient and ensure he has IV fluids

b. start him on IV naloxone

Which of the following substance(s) is classified as a strong opioid agonist: a. Naloxone b. Buprenorphine c. Codeine d. Naltrexone e. Fentanyl

e. Fentanyl

Which of the following hallucinogens bind to 5HT2A receptors? a. A. Ketamine b. B. Atropine c. C. LSD d. D. MDMA e. C & D

e. C & D

A 21 year old male comes to your GP practice. He has a 3 year history of cannabis use. He is asking for advice on how to quit. Which of the following receptors form part of the endocannabinoid system? a. NMDA b. Anandamide c. Nicotinic receptors d. GABA receptors e. 5HT2A

b. Anandamide

A 30 year old male arrives at the emergency department with a history of MDMA use. Which of the following clinical effects can you expect? a. sweating b. enhanced ability to concentrate c. None of the above d. increased appetite

a. sweating

A 20 year old patient is brought into the Emergency Department unconscious. He has constricted pupils, decreased respiratory rate and a low BP. If the patient has overdosed on opioids, what would your immediate management be? a. pump the patient’s stomach b. methadone treatment c. naloxone infusion IV d. administer benzodiazepines e. supportive management with subsequent counselling and refer the patient to a rehab facility

c. naloxone infusion IV

A 53-year-old man is brought to the emergency department because of wheezing and shortness of breath that began 1 hour after he took a new medication. Earlier in the day he was diagnosed with stable angina pectoris and prescribed a drug that irreversibly inhibits cyclooxygenase-1 and 2. He has chronic rhinosinusitis and asthma treated with inhaled β-adrenergic agonists and corticosteroids. His respirations are 26/min. Examination shows multiple small, erythematous nasal mucosal lesions. After the patient is stabilized, therapy for primary prevention of coronary artery disease should be switched to a drug with which of the following mechanisms of action? a. Inhibition of vitamin K epoxide reductase b. Potentiation of antithrombin III c. Sequestration of Ca2+ ions d. Blockade of P2Y12 component of ADP receptors e. Direct inhibition of factor Xa

d. Blockade of P2Y12 component of ADP receptors

A 65-year-old woman comes to the physician because of a 3-month history of progressive shortness of breath and a dry cough. She has also noticed gradual development of facial discoloration. She has coronary artery disease, hypertension, and atrial fibrillation. She does not remember which medications she takes. Her temperature is 37°C, pulse is 90/min, respirations are 18/min, and blood pressure is 150/85 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 95%. Examination shows blue-grey discoloration of the face and both hands. Diffuse inspiratory crackles are heard. An x-ray of the chest shows reticular opacities around the lung periphery and particularly around the lung bases. The most likely cause of this patient's findings is an adverse effect to which of the following medications? a. Amiodarone b. Metoprolol c. Lisinopril d. Procainamide e. Digoxin

a. Amiodarone

A 72-year-old man with coronary artery disease comes to the physician because of intermittent episodes of substernal chest pain and shortness of breath. The episodes occur only when walking up stairs and resolves after resting for a few minutes. He is a delivery man and is concerned because the chest pain has impacted his ability to work. His pulse is 98/min and blood pressure is 132/77 mm Hg. Physical examination is unremarkable. An ECG shows no abnormalities. A drug that blocks which of the following is most likely to prevent future episodes of chest pain from occurring? a. Beta adrenergic receptors b. HMGCo-A reductase enzymes c. Aldosterone receptors d. Angiotensin II receptors e. Alpha adrenergic receptors

a. Beta adrenergic receptors

A 55-year-old woman comes to the emergency room 30 minutes after the sudden onset of chest pain radiating to the left shoulder. Prior to the onset of her symptoms, she was lying in bed because of a migraine headache. Episodes of similar chest pain usually resolved after a couple of minutes. She has smoked one pack of cigarettes daily for 20 years. Her only medication is sumatriptan. An ECG shows ST-segment elevations in the anterior leads. Serum troponins are negative on two successive blood draws and ECG shows no abnormalities 30 minutes later. Administration of which of the following is most likely to prevent further episodes of chest pain in this patient? a. Ramipril b. Aspirin c. Diltiazem d. Clopidogrel e. Propranolol

c. Diltiazem

A 59-year-old man is brought to the emergency department one hour after developing shortness of breath and “squeezing” chest pain that began while he was mowing the lawn. He has asthma, hypertension, and erectile dysfunction. Current medications include salmeterol, amlodipine, lisinopril, and vardenafil. His pulse is 110/min and blood pressure is 122/70 mm Hg. Physical examination shows diaphoresis. An ECG shows sinus tachycardia. Sublingual nitroglycerin is administered. Five minutes later, his pulse is 137/min and his blood pressure is 78/40 mm Hg. Which of the following is the most likely mechanism of this patient's hypotension? a. Histamine release b. Cyclic GMP elevation c. Bradykinin accumulation d. Decreased nitric oxide production e. Calcium channel antagonism

b. Cyclic GMP elevation

A 78-year-old man is brought to the emergency department by ambulance 30 minutes after the sudden onset of speech difficulties and right-sided arm and leg weakness. Examination shows paralysis and hypoesthesia on the right side, positive Babinski sign on the right, and slurred speech. A CT scan of the head shows a hyperdensity in the left middle cerebral artery and no evidence of intracranial bleeding. The patient's symptoms improve rapidly after pharmacotherapy is initiated and his weakness completely resolves. Which of the following drugs was most likely administered? a. Heparin b. Warfarin c. Alteplase d. Rivaroxaban e. Prasugrel

c. Alteplase

A 45-year-old male patient presents with pallor, dyspnoea, postural dizziness and fatigue. A FBC is done and the following is found: Hb = 9 g/dL, Hct = 30% and an MCV of 75. What could the diagnosis be? a. Vitamin B12 deficiency b. Bone marrow failure c. Sickle cell disease d. Reticulocytosis e. All of the above

c. Sickle cell disease

Which one of the following is NOT an indication for the use of epoetin? a. Chronic renal failure, causing subsequent anaemia b. Anaemia caused by folate-deficiency c. Anaemia of AIDS, which is exacerbated by zidovudine d. Increasing the yield of autologous blood before a blood donation e. Anaemia caused by chemotherapy

b. Anaemia caused by folate-deficiency

Miss Crawford is a 73-year-old who has anaemia due to a vitamin B12 deficiency. Which of the following features are not likely to be observed in her? a. Elevated serum methylmalonic acid b. Cobalamin level of < 200 pg/mL c. MCV > 100 d. Decreased serum homocysteine e. Neuropsychiatric symptoms

d. Decreased serum homocysteine

Mr. Swift is a 58-year-old diabetic patient on dialysis due to chronic kidney disease. What is the target haemoglobin level for patients on dialysis? a. 9 - 10 g/dL b. 10.5 - 11.5 g/dL c. 10 - 11 g/dL d. 11 - 12 g/dL e. 12 - 13 g/dL

d. 11 - 12 g/dL

Which Vitamin K-dependant coagulation factor is not inhibited by warfarin a. XII b. IX c. X d. II

a. XII

Which of the following statements is false with regards to warfarin? a. Patient response is affected by levels of dietary Vit K b. Bridging with heparin is needed if immediate effect is required c. It is metabolised by the liver d. Deficiency of protein S may cause skin necrosis e. None of the above

d. Deficiency of protein S may cause skin necrosis

Which statement about streptokinase is false? a. Risk of cerebral haemorrhage b. Severe allergic reactions are rare c. May be associated with hypotension d. Non-antigenic – does not cause antibody formation

d. Non-antigenic – does not cause antibody formation

Which of the following is false with regards to vitamin K antagonists a. Frequent INR monitoring and dose adjustment required b. Slow onset/offset of action c. Increased risk of bleeding. d. Broad therapeutic window e. Multiple drug-drug interactions

d. Broad therapeutic window

Which type of anticoagulant is used in long-term anticoagulation? a. Direct oral anticoagulant b. LMWH c. Vitamin K antagonist d. Fondaparinux e. UFH

c. Vitamin K antagonist

Which anticoagulant is considered the safest to prescribe during pregnancy? a. Enoxaparin b. Apixaban c. Dabigatran etexilate d. Warfarin e. Rivaroxaban

a. Enoxaparin

Mr X came in complaining of shortness of breath, sweating and constantly requiring to sit upright. You take a sputum sample and you notice that it is frothy. You start him on supplementary oxygen but symptoms do not improve. You then decide to start him on furosemide. What is the most appropriate dose? a. 35 mg IVI stat b. 50 mg IVI stat c. 60 mg IMI stat d. 50 mg IMI stat e. 50 µg IVI stat

b. 50 mg IVI stat

Mr X, a 70 year old male, presents to casualty with dyspnoea sitting upright, respiratory distress and, when you touch him, he feels cold and sweaty. On auscultation you also note bilateral crepitations. How would you manage this patient? a. Give the patient additional oxygen only we he is unable to breath b. Put the patient in a supine position to make him more comfortable c. Give an inotropic agent to the patient immediately d. Give the patient 40-100 mg IV furosemide STAT e. Give the patient 40-100 mg IV furosemide over a period of one hour

d. Give the patient 40-100 mg IV furosemide STAT

Mrs R, a 56 y/o patient presents with acute coronary syndrome. What would the anti-anginal treatment component be for the patient? a. Oral simvastatin 80 mg b. Morphine 5-10 mg I.V. c. Sublingual glyceryl trinitrate 300-500 µg d. I.V. Nitrate 0.6-1.2 mg/hour e. Oral aspirin 325 mg

c. Sublingual glyceryl trinitrate 300-500 µg

Anti cardiac remodelling drugs include the following: a. aspirin, glucocorticoids, nitrates b. beta blocker, calcium channel blocker, ACE-inhibitor c. all of the above e. beta blockers and ACE-inhibitors

d. mineralocorticoids, ACE-inhibitor, beta blocker

Treatment goals in heart failure are: a. early mobilisation b. cure c. all of the above d. improving quality of life

d. improving quality of life

Physiological effects of natriuretic peptides include all the following, except a. inhibition of fibrosis b. increasing sympathetic tone c. natriuresis and diuresis d. increasing vasodilation

b. increasing sympathetic tone

A female patient with heart failure is taking enalapril as part of her treatment plan. The following is true of the treatment of chronic heart failure : a. Enalapril is a neurohormonal antagonist b. Neurohormonal antagonists have been shown to improve survival in patients with HFrEF. The neurohormonal imbalance associated with chronic heart failure is a contributing factor to the progression of the disease. c. The neurohormonal imbalance associated with chronic heart failure is a contributing factor to the progression of the disease. d. Over-activation of the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system (SNS), as well as other systems, contributes to cardiac remodelling and decline in heart function. e. All of the above

e. All of the above

In order to prevent tolerance to nitrates developing in a male patient who uses the drug as part of his treatment for stable angina, the treating doctor should a. give a transdermal preparation of the nitrate b. give smaller doses of the medication, infrequently c. give smaller doses of the medication, frequently. d. instruct the patient to never have a nitrate-free period. e. instruct the patient to have nitrate-free periods of 2-4 hours.

b. give smaller doses of the medication, infrequently

A 60 year old male presents to casualty with bilateral peripheral oedema, has a dry cough and reports difficulty breathing when lying down such that he uses three pillows to prop himself up. You, the eager fifth-year medical student, take out your trusty stethoscope to listen for the apex beat and confirm that it is displaced laterally and you also hear a third heart sound. Assuming there are no contraindications, what treatment regimen would you start the patient on? a. CCB/diuretic/BB b. Diuretic/BB/alpha-blocker c. CCB/ACE-I/diuretic d. ACE-I/diuretic/BB e. Alpha-blocker/CCB/ACE-I

d. ACE-I/diuretic/BB

A 50 year old asthmatic man presents to his local GP with recurrent chest pain that only occurs with effort. The pain lasts between 10 to 15 minutes and is relieved by rest. You prescribe him a drug that is considered first-line therapy in all patients with angina. What side effect is he most likely to experience? a. Throbbing headache b. Bronchospasm c. Palpitations d. Tolerance e. Gingival hyperplasia

b. Bronchospasm

Which one of the following drugs should best be avoided in pregnancy due to the increased risk for foetal growth retardation and neonatal electrolyte imbalance? a. Calcium channel blocker b. Thiazide diuretic c. Labetalol d. Methyldopa

b. Thiazide diuretic

Which one of the following is not a common side-effect of ACE- inhibitors? a. Cough b. Taste disturbance c. Hypokalaemia d. Angioedema

c. Hypokalaemia

Which option is incorrect regarding the complementary mechanism of action of ezetimibe and statins? a. Reduction of hepatic cholesterol b. Reduced cardiovascular risk c. Increased HDL receptor expression d. Increased clearance of plasma LDL-C e. Increased LDL receptor expression

c. Increased HDL receptor expression

Which of the followings drugs works by inhibiting HMG-CoA reductase activity? a. Ezetimibe b. Gemfibrozil c. Simvastatin d. Cholestyramine e. Niacin

c. Simvastatin

Mrs Smith is a 55 year old hypertensive patient with hypercholesterolaemia. She has a family history of myocardial infarcts. Which medication would you start Mrs Smith on? a. Gemfibrozil b. Ezetimibe c. Lovastatin d. Niacin e. Pravastatin

c. Lovastatin

Mr Smith is a 60 year old male. He has a total cholesterol of 5.5 mmol/L, an LDL-C of 3.5 mmol/L and an HDL of 1.2 mmol/L. Over the past year his LDL-C has not come below 3 mmol/L and his BP is constantly greater than 130/80 mmHg. He smokes a pack of cigarettes a day. He does not have diabetes. According to the Framingham Risk Table he has a 10 year CVD event risk of 20%. How would you manage Mr Smith? a. Advise lifestyle changes; and aim to bring the LDL-C to < 3.0 mmol/L b. Advise lifestyle changes; consider the use of a statin; and aim to bring the LDL-C to < 2.5 mmol/ L c. Advise lifestyle changes; immediately start a statin; and aim to bring the LDL-C to < 2.5 mmol/L d. Advise lifestyle changes; consider the use of a statin; and aim to bring the LDL-C to < 3.0 mmol/L e. Advise lifestyle changes; immediately start a statin; and aim to bring the LDL-C to < 1.8 mmol/L

c. Advise lifestyle changes; immediately start a statin; and aim to bring the LDL-C to < 2.5 mmol/L

A 35-year-old woman with irritable bowel syndrome comes to the physician because of increased diarrhoea. She has not had any fever, bloody stools, nausea, or vomiting. The increase in stool frequency began when she started a new job. She is started on loperamide, and her symptoms improve. Which of the following is the primary mechanism of action of this drug? a. µ opioid receptor agonism b. 5HT3 receptor antagonism c. Acetylcholine receptor antagonism d. H2 receptor agonism e. D2 receptor antagonism

a. µ opioid receptor agonism

A 64-year-old man is brought to the emergency department because of dull lower abdominal pain for 3 hours. He has not urinated for 24 hours and has not passed stool for over 3 days. He was diagnosed with herpes zoster 4 weeks ago and continues to have pain even after his rash resolved. He has hypertension, benign prostatic hyperplasia, and coronary artery disease. Physical examination shows a tender, palpable suprapubic mass. Bowel sounds are hypoactive. Abdominal ultrasound shows a large anechoic mass in the pelvis. Which of the following drugs most likely accounts for this patient's current symptoms? a. Desipramine b. Valproate c. Amlodipine d. Pregabalin e. Tamsulosin

a. Desipramine

Which of the following is the largest contributor of drug metabolism by CYP450 enzyme: a. CYP2C19 b. CYP2B6 c. CYP3A4 d. CYP2E1 e. CYP2D6

c. CYP3A4

The following drugs are causes of hepatocellular liver injury, except: a. NSAIDs b. Carbamazepine c. Fluoxetine d. Statins e. Arcabose

b. Carbamazepine

The following drugs cause hepatic encephalopathy, except: a. Opioids b. Lithium c. Loop diuretics d. NSAIDs e. Theophylline

e. Theophylline

Patient X presents with signs of pruritis and jaundice. She has markedly elevated alkaline phosphatases, with an ALP of 4 times greater than the upper limit of normal. Her bilirubin is also raised. Her ALT is normal. Which type of liver injury is the most likely cause? a. Infiltrative liver injury b. Hepatocellular liver injury c. Mixed liver injury d. Drug-induced liver injury e. Cholestatic liver injury

e. Cholestatic liver injury

Mr. Smith, previously on augmentin® (co-amoxiclav), presents with pruritis and jaundice. On investigation, he has markedly elevated (+++) ALP and bilirubin, and slightly raised ALT (+). What is the most likely type of liver injury in this case? a. Cholestatic b. Mixed c. Hepatocellular d. Infiltrative

a. Cholestatic

ALP is very high (+++) in all the following types of liver injury, except: a. Cholestatic b. Infiltrative c. Mixed d. Hepatocellular

d. Hepatocellular

Mrs C, a 62-year-old and known to have Crohn’s disease, presents to your practice complaining of abdominal pain, diarrhoea as well as rectal bleeding. After careful examination and relevant investigations, you diagnosis an acute exacerbation of her Crohn’s disease. Which of the following medications would be most effective to prescribe Mrs C at this appointment: a. Mesalazine b. Prednisolone c. Sulfasalazine d. Hydrocortisone e. Budesonide

b. Prednisolone

Mrs. Z, a 46 year old female, has recently been diagnosed with inflammatory bowel disease. Which of the following drugs will you prescribe for acute exacerbations? a. Prednisolone b. Omeprazole c. Sulfasalazine d. Olsalazine e. Immunosuppressive drugs

a. Prednisolone

Which of the following is not an anti-diarrhoeal agent? a. Codeine b. Loperamide c. Bismuth subsalicylate d. Ranitidine e. Diphenoxylate

d. Ranitidine

Mr Jones is a diabetic and now suffers from gastroparesis as evidenced by delayed gastric emptying. Which of the following could be used as a pro-kinetic agent in his case? a. Azithromycin b. Augmentin c. Vancomycin d. Verapamil e. Gentamicin

a. Azithromycin

Mr Plant complains of constipation. Which of the following medications are least likely to be responsible? a. Amlodipine b. Verapamil c. Amitriptyline d. Codeine e. Sertraline

e. Sertraline

Mr Page has been on a prolonged course of oral antibiotics and now complains of diarrhoea. On examination his pulse is 128 and he is dehydrated. He has tenderness over his lower abdomen, and radiographic evidence of colonic dilatation. You check his temperature and he has a fever of 38.7°C. What could you prescribe? a. Vancomycin and IV fluids b. Diphenoxylate c. Loperamide d. Codeine e. Bismuth subsalicylate

a. Vancomycin and IV fluids

Mrs X, a 28 year old pregnant woman, complains of infrequent bowel movements with hard to pass stool. Which laxative would you prescribe in this patient? a. Polyethylene glycol b. Senna (Dulcolax) c. Lactulose d. Castor oil e. Mineral oil

c. Lactulose

Of the recommended treatment options for PUD, which drug is contraindicated in pregnancy? a. PPI - uterine contractions b. Alginates - algae extraction c. Prostaglandin - uterine contractions d. Magnesium hydroxide - diarrhoea e. Prostaglandin - erosive oesophagitis

c. Prostaglandin - uterine contractions

A 73-year-old woman recently diagnosed with colonic adenocarcinoma comes to the doctor because of a 1-week history of nausea and multiple episodes of vomiting. These symptoms started shortly after her first infusion of oxaliplatin and fluorouracil. The patient is started on an appropriate medication. Three weeks later, at a follow-up appointment, she states that she has developed headaches and constipation. The patient was most likely treated with a drug with which of the following mechanisms of action? a. Ach (M) receptor antagonist b. D2 receptor antagonist c. 5HT3 receptor antagonist d. GABA A receptor antagonist e. H1 receptor antagonist

c. 5HT3 receptor antagonist

Mrs X, a 35 year old pregnant woman, comes in complaining of a 3 week history of nausea and vomiting. You decide the best medicine to prescribe is cyclizine because you know it is safe in pregnancy and can be used long term if need be. This drug antagonises which one of the following: a. 5HT3 receptors in the chemoreceptor trigger zone b. H1 receptors in the vomiting centre c. H1 receptors in the chemoreceptor trigger zone d. Muscarinic receptors in the vestibular system e. 5HT3 receptors in the peripheral pathways

b. H1 receptors in the vomiting centre

Mrs X is going on a boat cruise, but she is known to have motion sickness and requires medication for nausea and vomiting. Based on the known mechanism of action of anti-emetics, which drug class does not have a sedative effect? a. 5HT3 receptor antagonist b. Neurokinin antagonist c. Dopamine antagonist d. First generation antihistamine e. Benzodiazepines

a. 5HT3 receptor antagonist

In the gastric phase of gastric acid secretion: a. Distension of the stomach inhibits acid secretion b. Acid secretion is stimulated by fatty acids in meals c. Roughly 40% of acid is secreted in this phase d. Acid secretion is stimulated by amino acids in food

d. Acid secretion is stimulated by amino acids in food

Mrs X, a 45-year-old, has been taking omeprazole for 2 months for the prevention of relapse of her GORD. For the past week she has been experiencing muscle cramps, accompanied by confusion. Her doctor informs her that some of the side effects of omeprazole include all of the following, except: a. Diarrhoea, which may be related to Clostridium difficile colitis b. Hypomagnesemia c. Embryolethality, foetal resorptions, and pregnancy disruptions in animal models d. Cognitive enhancement e. Headaches

d. Cognitive enhancement

Mrs. Y, a 41 year old female, is currently on treatment for a chronic recurring gastric ulcer. She has no history of NSAID or aspirin use. You suspect that the recurrence is due to H. pylori infection. Which of the following drug combinations has the highest efficacy rate for H. pylori eradication? a. Omeprazole + amoxycillin b. Bismuth + metronidazole c. Bismuth + metronidazole + tetracycline d. Bismuth + metronidazole + amoxycillin e. Bismuth + amoxycillin

c. Bismuth + metronidazole + tetracycline

``` A patient suffering from persistent asthma attacks starts using a medication which provides relief of these acute symptoms; He tends to have to use it more than once a week, but does not think anything of it because it works so well. A month later he is using it at least 3-4 times a week, and he now starts experiencing tremors and persistent headaches. What class of drug is he using? ``` a. B2-adrenoreceptor agonist b. Glucocorticoid c. Phosphodiesterase inhibitor d. Leukotriene receptor antagonist e. Anticholinergic

a. B2-adrenoreceptor agonist

A 57 year old man, known hypertensive and diabetic on treatment, comes in complaining of sneezing, blocked stuffy nose and itching ears due to seasonal change. Which of the following drugs is contraindicated in the management of this patient? a. Beclomethasone b. Chlorphenamine c. Cetirizine d. Fluticasone e. Pseudoephedrine

e. Pseudoephedrine

An otherwise healthy 13-year-old boy is brought to the doctor because of asthma attacks that have been increasing in frequency and severity over the past 4 weeks. He was first diagnosed with asthma 6 months ago. Current medications include high-dose inhaled fluticasone and salmeterol daily, with additional salbutamol as needed. He has required several courses of oral corticosteroids. A medication is added to his therapy regimen that results in downregulation of the high-affinity IgE receptor (FcεRI) on mast cells and basophils. Which of the following biological drug was most likely added to the patient's medication regimen? a. Prednisone b. Montelukast c. Theophylline d. Omalizumab e. Nedocromil

d. Omalizumab

Ms X, 20 years old, is a known asthmatic patient on treatment. As a general practitioner you follow the current GINA asthma treatment plan. Which treatment option is incorrect? a. Oral corticosteroids and immunoglobulin therapy should only be used as maintenance therapy with extreme caution (refer to specialist) b. Patients with mild asthma should preferably take an as needed low dose inhaled corticosteroid (ICS)-formoterol combination c. If asthma, is not well-controlled then increase ICS-dose and either add a LABA (long acting beta agonist) or an LTRA (leukotriene receptor antagonist) d. If asthma is not well-controlled then stop the low-dose ICS and add a long acting beta agonist (LABA). e. All adult and adolescent patients with asthma should receive ICS-containing controller medication as baseline asthma treatment

c. If asthma, is not well-controlled then increase ICS-dose and either add a LABA (long acting beta agonist) or an LTRA (leukotriene receptor antagonist)

Mr P was on a hike. He was tired and therefore took a break and placed his arm against the bark of a tree. He felt an instant, sharp burning pain over his elbow. The skin area started to swell and turn red. Shortly thereafter, Mr P started having difficulty breathing and felt as if his throat was starting to swell. What is the incorrect drug in terms of your management of an anaphylaxis? a. Adrenaline b. Aminophylline c. Antihistamine d. Adrenocorticosteroid e. Amiodarone

e. Amiodarone

A 25 year old man presents to your practice with symptoms of allergic rhinitis with sneezing being the predominant symptom. You prescribe an intranasal corticosteroid and a 2nd generation antihistamine. Which of the following is a potentially serious side effect of 2nd generation antihistamines? a. Prolonged QT interval b. Urinary retention c. Hallucinations d. Dry mouth e. Seizures

a. Prolonged QT interval

A 61-year-old man with Alzheimer disease is brought to the emergency department 20 minutes after ingesting an unknown amount of his medications in a suicide attempt. He reports abdominal cramps, diarrhea, diaphoresis, and muscular weakness and spasms in his extremities. His temperature is 38.4°C, pulse is 51/min, respirations are 12/min and laboured, and blood pressure is 88/56 mm Hg. Physical examination shows excessive salivation and tearing, and small pupils bilaterally. Treatment with atropine is initiated. Shortly after, most of his symptoms have resolved, but he continues to have muscular spasms. Administration of which of the following is the most appropriate next step in the treatment of this patient? a. Benztropine b. Pralidoxime c. Physostigmine d. Pancuronium e. Carbachol

b. Pralidoxime When taken in excess, medications for Alzheimer disease such as donepezil can result in symptoms similar to that of organophosphate poisoning. In such cases, pralidoxime is given to restore activity of acetylcholinesterase, which then catalyzes the breakdown of excessive acetylcholine to reverse symptoms. Atropine does not act on nicotinic cholinergic receptors and thus cannot treat symptoms of neuromuscular dysfunction, for which pralidoxime is still necessary. Pralidoxime has poor blood-brain barrier penetration and can lead to a transient worsening of acetylcholinesterase inhibition following administration, which is why atropine is typically administered first to treat CNS symptoms and prevent further acetylcholinesterase inhibition.

A 4 year old female patient presents to Casualty with her grandmother.She presents with a fever, sweating, difficulty hearing and vomiting. Her heart rate is 154, her respiratory rate is 43, her temperature is 38.9 degrees and she has a GCS score of 14/15. One of the patient’s grandparents suffers from a condition that requires a daily dose of 81 mg salicylate. Given that the patient appears somewhat dirty and adequately dressed but not malnourished, what might best describe this situation? a. Intentional self-poisoning b. Criminally negligent poisoning c. Accidental poisoning d. Iatrogenic poisoning e. Criminal poisoning

c. Accidental poisoning

A 4 year old female patient presents to Casualty with her grandmother.She presents with a fever, sweating, difficulty hearing and vomiting. Her heart rate is 154, her respiratory rate is 43, her temperature is 38.9 degrees and she has a GCS score of 14/15. If the patient had already received a gastric lavage for life-threatening salicylate poisoning, the next step in the treatment plan is to administer an antidote. Which of the following is the appropriate antidote? a. Multiple doses of ethanol b. Multiple doses of naloxone c. Multiple doses of salicylate specific antibodies (SSA’s) d. Multiple doses of flumazenil e. Multiple doses of activated charcoal

e. Multiple doses of activated charcoal

a. 150 mg/kg

A 4 year old female patient presents to Casualty with her grandmother. She presents with a fever, sweating, difficulty hearing and vomiting. Her heart rate is 154, her respiratory rate is 43, her temperature is 38.9 degrees and she has a GCS score of 14/15. Assuming this is an overdose, what is your first course of action? a. Draw blood for plasma drug level determination b. Primary survey c. Secondary survey d. Do a gastric lavage e. Administer a benzodiazepine

b. Primary survey

A 4 year old female patient presents to Casualty with her grandmother. She presents with a fever, sweating, difficulty hearing and vomiting. Her heart rate is 154, her respiratory rate is 43, her temperature is 38.9 degrees and she has a GCS score of 14/15. Assuming this is an overdose, what is the most probable causal agent? a. Adderall b. Alcohol c. Aspirin d. Amitriptyline e. Alprazolam

c. Aspirin

A 73-year-old male is rushed into casualty with restlessness, a fever and sweating. He has a heart rate of 140 and a respiratory rate of 28. He mentions an intense buzzing in his ears and is therefore uncooperative. His blood gas shows a pH of 7.28, HCO3 of 18 mEq/L and a BE of - 16mmol/l. What is not part of the treatment of this patient? a. Activated charcoal b. Cool down the patient c. Intravenous N-acetyl cysteine d. Gastric lavage e. Haemodialysis

c. Intravenous N-acetyl cysteine

A 23-year-old patient with a suspected overdose presents to Casualty with pinpoint pupils. The patient is in a coma and hypoventilating. Which of the following drugs will you administer to the patient? a. Vitamin K b. Glucagon c. Atropine d. Naloxone e. Ethanol

d. Naloxone

Which of the following combinations are incorrect ? a. Suborrhoeic Dermatitis - Ketoconazole b. Atopic Dermatitis - Chlorpheniramine c. Erysipelas - Famciclovir d. Acne Vulgaris - Adapalene e. Psoriasis - Betamethasone and Calcipotriene

c. Erysipelas - Famciclovir

Ms P, a 26 year old female, is taking oral isotretinion for severe nodular acne. Which of the following options is not a side effect of this drug? a. Insomnia b. Photosensitivity c. Dermal bleeding d. Dry mucosae e. Worsening of underlying depression

a. Insomnia

Mr Z, a 30 year old male, develops epidermal necrosis and sloughing. Which of the following medications that he is taking is unlikely to cause Stevens-Johnson syndrome? a. Allopurinol b. Co-trimoxazole c. NSAIDs d. Nevirapine e. Lamotrigine

c. NSAIDs

Ms X, a 21 year old, has been suffering with eczema. Which one of these options is not indicated for for the management of eczema? a. Hydrolysed formula b. Reduction of emotional stress c. Betamethasone d. Chlorphenhydramine e. Emollients

a. Hydrolysed formula

Mr Z is a 54 year old man who presents with a 7 month history of difficulty maintaining an erection for sexual function. Which one of the following is not a viable option for the pharmacological treatment of erectile dysfunction? a. Alpha-1-antagonist b. Prostaglandins c. Dopamine agonist d. Hormonal therapy e. Phosphodiesterase inhibitor

a. Alpha-1-antagonist

A 55 year old man presents with a 2 year history of urinary hesitancy, urinary retention and frequent urination. A diagnosis of benign prostate hyperplasia is made. You prescribe alfuzocin as the initial therapy. What is the most common side effect of this drug? a. Orthostatic hypotension b. Pruritis c. Blurred vision d. Diarrhoea e. Constipation

a. Orthostatic hypotension

A patient with benign prostatic hyperplasia was initiated on 5 mg finasteride one year ago. He reports that he has been compliant with his drug therapy. Prior to treatment initiation, his PSA was normal. However, his PSA is now 10 times the normal range. This laboratory result suggests that the patient: a. Is responding to finasteride b. Is probably not compliant with his drug treatment c. Should be evaluated for prostate calculi d. Should be evaluated for prostate cancer e. The laboratory results may be inaccurate and the patient needs to be tested again

d. Should be evaluated for prostate cancer

A 45 year old female returns for her follow-up appointment at your consulting rooms. She was diagnosed with urinary incontinence 3 months ago and was given a prescription for oxybutin. She now presents with symptoms of blurred vision and a "spinning" feeling from time to time. You suspect that she may be experiencing side effects from the oxybutin. Which one of the following is not a side effect of oxybutin? a. Xerostomia b. Diarrhoea c. Drowsiness d. Dizziness e. Confusion

b. Diarrhoea

Mr X is a 65 year old male who complains of a 4 month history of an inability to maintain an erection. After taking a thorough history and doing the International index of erectile function questionnaire, you diagnose erectile dysfunction. You advise him on lifestyle modifications and prescribe first-line therapy, sildenafil. What is its mechanism of action? a. Inhibits breakdown of cGMP b. Inhibits breakdown of cGTP c. Causes smooth muscle contraction d. Increases nitric oxide production e. Decreases nitric oxide production

a. Inhibits breakdown of cGMP

A 25 year old woman, P1G2M0, presents with severe pre-eclampsia at 35 weeks gestation. Which one of the following is the most suitable drug for the definitive management of the patient? a. Misoprostol b. MgSO4 c. Ergometrine d. Oxytocin e. Nifedipine

d. Oxytocin

A 45-year-old man with a history of recurrent gouty arthritis comes to the physician for a follow-up examination. Four weeks ago, he was diagnosed with hyperuricemia and treatment with allopurinol was begun. Since then, he has had another acute gout attack, which resolved after treatment with ibuprofen. His temperature is 37.1°C (98.8°F). Physical examination shows painless, chalky nodules on the metatarsophalangeal joint of his right foot. Laboratory studies show: Serum Creatinine 1.0 mg/dL, Uric acid 11.6 mg/dL, Cholesterol 278 mg/dL; Urine Uric acid 245 mg/24 h (N = 240–755). Based on the urine findings, this patient would most likely benefit from treatment with which of the following drugs to prevent future gout attacks? a. Colchicine b. Indomethacin c. Prednisone d. High dose allopurinol e. Probenicid

e. Probenicid Probenecid is a uricosuric agent used as second-line therapy or in combination with allopurinol in patients with recurrent gouty arthritis that is not controlled with allopurinol therapy alone. Patients with underexcretion of uric acid, like this man, benefit most from probenecid because this drug promotes renal elimination of uric acid by acting as a competitive inhibitor of reabsorption at the proximal convoluted tubule. In addition, this patient has no contraindications for uricosuric therapy (e.g., impaired renal function, history of nephrolithiasis), making him a good candidate for treatment with this drug.

A 26-year-old lady with known systemic lupus erythematosus (SLE) presents with nephrotic syndrome. A renal biopsy is performed and this confirms diffuse proliferative glomeronephritis (WHO Class IV). Which of the following treatment regimens would you advise? a. Azathioprine alone b. Prednisolone alone c. Azathioprine and prednisolone d. Prednisolone and methotrexate e. Prednisolone and intravenous cyclophosphamide

c. Azathioprine and prednisolone

59 year old lady who works as a secretary repeatedly presents with chronic low back pain. After a thorough assessment and investigations you prescribe methadone for the pain. You have also picked up signs of depression and you prescribe a tricyclic antidepressant (TCA). Which of the following is not a sedative TCA? a. Imipramine b. Desipramine c. Clomipramine d. Amitriptyline

b. Desipramine

55 year old female presents with severe joint pain in the knee and hip. She complains of severe pain and swelling on activity and the joints "lock" in the early parts of the morning. A special investigation is conducted and reveals osteoarthritis. No other chronic conditions are noted. What treatment options will benefit this patient? a. Physiotherapy, analgesics, rest b. No exercise, analgesics and lots of rest c. None of the above d. Colchine, NSAIDs and reduced salt diet e. Daily exercise, analgesics, COX-2 selective inhibitors. intra-articular injection with glucocorticoids for severe cases

e. Daily exercise, analgesics, COX-2 selective inhibitors. intra-articular injection with glucocorticoids for severe cases

Eight weeks after starting a new weight-loss medication, a 43-year-old woman with obesity comes to you because of greasy diarrhoea, excessive belching, and flatulence. She also complains of progressively worsening night-time vision. She has had no fever, chills, or vomiting. Physical examination shows dry, scaly skin on her extremities and face. Which of the following is the most likely mechanism of action of the drug she is taking? a. Inhibition of lipase b. Stimulation of monoamine neurotransmitter release c. Stimulation of noradrenaline release d. Secretion of glucose-dependent insulin e. Inhibition of serotonin reuptake

a. Inhibition of lipase Lipase inhibitors such as orlistat inactivate gastric and pancreatic lipase enzymes within the intestine, preventing the complete hydrolyzation of dietary fats into monoglycerides and fatty acids. This decreases the amount of fat absorbed in the gastrointestinal tract and increases faecal fat excretion. Adverse effects of orlistat, therefore, include symptoms of fat malabsorption, such as steatorrhoea, abdominal cramps, and bloating. It may also cause fat-soluble vitamin deficiencies (in this case, vitamin A deficiency

A 54-year-old man comes to the doctor for a routine health maintenance examination. He was diagnosed with type 2 diabetes mellitus 1 year ago. His only medication is metformin. His serum glucose is 186 mg/dL and his hemoglobin A1c is 7.6%. The doctor prescribes an additional antidiabetic drug and counsels the patient on its delayed onset of action. At a follow-up appointment 4 weeks later, the patient reports that his home blood glucose readings have improved. He also mentions that he has had a weight gain of 4 kg. The patient has most likely been treated with which of the following drugs? a. Liraglutide b. Rosiglitazone c. Glyburide d. Empagliflozin e. Sitagliptin

b. Rosiglitazone Thiazolidinediones, such as rosiglitazone and pioglitazone, activate the transcription factor peroxisome proliferator-activated receptor gamma (PPAR-γ). Activation of PPAR-γ improves insulin sensitivity over several weeks by upregulating the transcription of adiponectin and GLUT4 glucose transporters in adipose and muscle cells. It causes weight gain, as seen in this patient, in addition to other adverse effects, such as fluid retention, exacerbation of congestive heart failure, and osteoporosis

Ms. Y is a 69-year-old obese female who has not sought medical treatment since the birth of her eldest child 35 years ago. She has not been on medical treatment since then. She consults you because she has been drinking more water as well as urinating more than usual. You do a full clinical workup and find the following: BP 163/88, Urine dipstick: 3+ glucose, fasting blood glucose: 8.6 mmol/l, eGFR: 70 mL/min/1.73m2. How would you initially approach the patient? a. Start her on daily long-acting insulin bolus and appropriate hypertension regime b. Give her a thiazide diuretic to get her to urinate more c. Start her on 500 mg metformin once daily and titrate up slowly until HbA1C <8.5% or to a maximum of 1 000 mg/day. Also start her on appropriate lifestyle modifications and anti-hypertension regimes. d. Start her on 500 mg metformin once daily and titrate up to 2 550 mg tds to achieve cardiovascular benefit as well as an HbA1C of <7%. Also start an appropriate hypertension regime e. Control her hypertension with a thiazide diuretic and follow up to initiate diabetic treatment when blood pressure is <130/80

c. Start her on 500 mg metformin once daily and titrate up slowly until HbA1C <8.5% or to a maximum of 1 000 mg/day. Also start her on appropriate lifestyle modifications and anti-hypertension regimes.

Which one of the following drugs does not promote weight loss? a. Olanzapine b. Liraglutide c. Phentermine d. Orlistat e. Lorcaserin

a. Olanzapine

Which one of the following is not an anti-obesity drug? a. Endocannabinoid b. Benzphentamine c. Phentermine d. Diethylpropion e. Phendimetrizine

a. Endocannabinoid

Which one of the following antidepressants is likely to cause weight loss? a. Mirtazapine b. Paroxetine c. Nefazodone d. Bupropion

d. Bupropion

Ms. X, a 30-year-old female, complains of recent weight gain although she is keeping a healthy diet and exercising. She tells you that she was recently given medication to deal with her depression. Which of the following antidepressants causes the most weight gain in patients? a. Fluoxetine b. Amitriptyline c. Sertraline d. Paroxetine

b. Amitriptyline

Which of the following is not an indication for Hormone Replacement Therapy? a. To prevent DVT’s and pulmonary emboli in patients with a history of such. b. Treatment of osteoporosis in women <60 years old c. To relieve vasomotor symptoms. d. Treatment of atrophic changes of the urogenital tract

a. To prevent DVT’s and pulmonary emboli in patients with a history of such.

The following are side effects of risedronate and alendronate, EXCEPT: a. GORD b. Diarrhoea c. Oesophageal ulceration d. Osteonecrosis of the jaw e. Increased risk for atrial fibrillation

b. Diarrhoea

The following is true of raloxifene: a. Identical to oestrogen b. Decreased risk for DVT compared to oestrogen c. Increases risk for breast cancer d. Decreases risk for breast cancer e. Can be used to treat post-menopausal symptoms

d. Decreases risk for breast cancer

Correct administration of alendronate includes: a. Take after meals b. Alendronate is an injection given 12 times a year c. Take in the evening, and lie down to minimize side effects d. Take whole, first thing in the morning, on an empty stomach e. Take twice a day

d. Take whole, first thing in the morning, on an empty stomach

The following is true of raloxifene (Evista®): a. None of the above b. Inhibits osteoblasts and stimulates osteoclasts c. Binds to oestrogen receptors and inhibits bone resorption d. Inhibits osteoblasts and inhibits osteoclasts e. Stimulates osteoblasts and stimulates osteoclasts

c. Binds to oestrogen receptors and inhibits bone resorption

Mrs Y, a 55-year-old female presented to casualty with a fracture of the left femur. She was not on any current or chronic medication. She was subsequently diagnosed with osteoporosis. Her current treatment may include the following, EXCEPT: a. Bisphosphonates b. Oestrogens and related compounds c. Parathyroid hormone d. Strontium ranelate e. Vitamin D preparations

d. Strontium ranelate

Mrs Wilson is a 70 year old patient who was diagnosed with SLE at a very young age and has been on treatment ever since. Mrs Wilson is well clued up on her condition and fears that because of her age and current treatment she may be at risk of fracturing her hip. She comes to you for advice. Which one of the following drugs would be best suited for Mrs Wilson? a. Tibolone b. Raloxifene c. Estradiol Volerate d. Oestrogen/Medroxyprogesterone e. Tamoxifen

b. Raloxifene

What special precautions should be taken with IV bisphosphonates? a. Zoledronic acid should be given twice a year. b. The medicine should be injected while the patient is upright. c. Vitamin D and calcium supplements should be taken. d. Ibandronate should be given 3 times a year. e. The medicine should be injected on an empty stomach

c. Vitamin D and calcium supplements should be taken.

Mrs M was recently started on a bisphosphonate to treat her osteoporosis. Which of the following bisphosphonates contain vitamin D in their preparation? a. A. Alendronate b. B. Risedronate c. C. Etidronate d. D. Ibandronate e. B and D

e. B and D

A 24-year-old female patient consults you at the local clinic. She is in a new relationship and does not want to have children yet. She also mentions that since she was young she has had heavy periods with extreme cramps that often force her to miss school or work. Which one of the following contraceptive options is contraindicated in her case? a. Copper IUD b. Oral contraceptive pill c. Condom d. Implanon e. Injectable contraceptives

a. Copper IUD

A 29-year-old female patient consults you at the local clinic. She is in a new relationship and does not want children yet. She suffers from diabetes, depression and anaemia. She also mentions that since she was young she has had heavy periods with extreme cramps that often force her to miss work. Hormonal contraception is likely to benefit all of her requirements and conditions, except: a. Diabetes b. Depression c. Family planning d. Anaemia e. Dysmenorrhea

b. Depression

A woman who is 6 weeks postpartum seeks contraception. She would like to have another child in 2 years. She is currently breastfeeding and plans to do so for the required 24 months. The following contraceptive methods are preferred, except: a. Mirena IUD b. Breastfeeding c. Progestin-only pill (POP) d. Implanon (implant) e. Depo-Provera (injectable)

b. Breastfeeding

Miss P is a 14-year-old female who gave birth 2 months ago, after an unwanted pregnancy. She is not breastfeeding and does not want another unplanned pregnancy. Which non-hormonal contraceptive will most likely benefit her? a. Depo-Provera b. Paragard copper T c. Progestin IUD d. Combined hormonal contraceptive e. Mirena

b. Paragard copper T

Mrs. X has been on a Combined Oral Contraceptive (COC) for the past year and a half. She recently, about a month and a half ago, consulted you – her attending GP. After a thorough history, physical examination and appropriate special investigations, you conclude that Mrs. X is suffering from epilepsy. You decide to start Mrs. X on carbamazepine. Which answer is the most correct? a. Carbamazepine decreases hepatic metabolism of COC, resulting in increased COC efficacy. b. The use of a progesterone IUD is advised. c. Using barrier methods in addition to her COC is advised. d. Carbamazepine does not significantly decrease the efficacy of COCs. e. All patients on carbamazepine require Depo Provera in addition to COCs

c. Using barrier methods in addition to her COC is advised.

A 34-year-old woman comes into the clinic requesting hormonal contraception. She gave birth to her 4th child last year and does not want to have any more children. During the consultation you discover she suffers from frequent migraines (non-focal), has an elevated cholesterol level and has an elevated blood pressure despite being on treatment for 3 months. Which of the following are absolute contra-indications to hormonal contraception a. Her advanced age b. The number of children already delivered c. Hyperlipidaemia d. Uncontrolled hypertension e. Her migraines

d. Uncontrolled hypertension

Mrs T is a 38 year old with a history of hypertension that is under control. She has 2 children and apart from a DVT, during her 1st pregnancy, her pregnancies were uneventful. She also admits to smoking a packet of cigarettes a day. Her doctor wants to start her on a Combined Oral Contraceptive (COC). Why would it not be wise to prescribe a COC for Mrs T? a. She is a 38 year old who smokes b. She has hypertension. c. She has a history of DVT d. All of the above.

d. All of the above.

Mrs S presents with a 3 week history of fatigue, dry skin, constipation and cold sensitivity. She also noted that she went 3 dress sizes up in the last 3 months, but maintains a healthy diet. You decide to do a thyroid panel and find elevated TSH (6 mlU/L) and low unbound T4. She also has evidence of thyroid autoantibodies (TPOAb+). Which of the following treatments do you start the patient on? a. Iodine b. Liothyronine c. Carbimazole d. Levothyroxine e. Propranolol

d. Levothyroxine

Indicate the therapeutic use of iodine: a. simple non toxic goiter b. thyroid storm c. hyperthyroidism d. toxic goiter e. hypothyroidism

a. simple non toxic goiter

Mrs T has recently been diagnosed with a thyroid disorder. She was started on treatment and has since developed a skin rash with associated pruritus. Which one of the following agents may be the cause of this adverse effect? a. Levothyroxine b. Iodine c. Liothyronine d. Carbimazole e. Propylthiouracil

d. Carbimazole

The ICU treatment of thyroid crisis/storm, provided there are no contra-indications include a. Propranolol and carbimazole b. Carbimazole, hydrocortisone and aspirin c. Liothyronine, levothyroxine and iodine d. Propranolol if the patient has asthma e. Carbimazole, iodine, propranolol and hydrocortisone

e. Carbimazole, iodine, propranolol and hydrocortisone

The agent of choice to block sympathetic nervous system manifestations of thyrotoxicosis is: a. Reserpine b. Guanethidine c. Propranolol d. Phenoxybenzamine e. Trimethaphan

c. Propranolol

An anaesthetist administered scoline (succinylcholine - a muscle relaxant) to a patient undergoing surgery in theatre. The surgery was successful but the patient is still intubated four hours after the surgery was completed. The anaesthetist now worries about scoline apnoea. What is the underlying cause for scoline apnoea? a. Deficiency of N-acetyltransferase b. Scoline’s interaction with CYP450 c. Excess acetylcholine transferase d. All of the above e. Pseudocholinesterase unable to hydrolyse scoline

e. Pseudocholinesterase unable to hydrolyse scoline

Dr Y prescribes methadone with a half-life (t1/2) of 24- 55 hours for severe refractory pain management. What are the clinical implications and considerations of a drug with a long t1/2? a. requires intramuscular administration b. disappears quickly with a short washout c. steady state is reached within minutes of initiating the drug d. requires a decreased dosing frequency e. short duration of action

d. requires a decreased dosing frequency

Which one of the Health Acts listed below will refer to the following: To provide for the registration of medicines (human and animal use) To provide for registration of medical devices Establishment of a Medicines Control Council To schedule substances and medical devices To control manufacturers, wholesalers and distributors To control persons compounding and dispensing medicine a. National health act (61 of 2003) b. Health professions act (56 of 1974) c. Pharmacy Act (53 of 1974) d. Medicines and related substances act (101 of 1965) e. Health act (63 of 1977)

d. Medicines and related substances act (101 of 1965)

Which one of the following antibiotic drugs is a POTENT inducer of CYP 450 isoenzymes and has been well documented to reduce the effectiveness of oral contraceptives? a. Penicillin b. Pyrazinamide c. Rifampicin d. Ethambutol e. Isoniazid

c. Rifampicin

With regards to the emergence of pharmacogenomics in drug development, which statement is true? a. The number of patients in clinical trials will be reduced b. Drug development time will be reduced c. Time-to-market will be shortened d. Drug development cost will be reduced e. All of the above

e. All of the above

Based on the pharmacodynamics and pharmacokinetics of drug interactions, which one of the following is correct? a. Taking warfarin and aspirin simultaneously makes a patient hypercoagulable b. Using a bronchodilator and an antihypertensive provides a synergistic effect c. Ketoconazole is insufficiently absorbed in a more acidic GIT environment d. It is important not to take tetracycline with dairy products e. Macrolide antibiotics need to be given prior to digoxin to increase the bioavailability of digoxin

d. It is important not to take tetracycline with dairy products

Mr X is a 43-year old known hypertensive patient with a previous history of myocardial infarction. He presents to your practice complaining of erectile dysfunction. He is currently taking hydrochlorothiazide, amlodipine and glyceryl trinitrate. You prescribe sildenafil for the management of his erectile dysfunction. Which potentially fatal adverse effect may Mr X experience? a. Hyperglycaemia b. Myocardial infarction c. Hypotension d. Hypoxaemia e. Hypercapnoea

c. Hypotension

Mrs Y is a 45 year old known mental health care user currently on phenelzine. She presents to casualty with a hypertensive crisis after taking an over-the counter agent. Which one of the following may be the cause of the hypertensive crisis due to an interaction with phenelzine? a. Prednisolone b. Pseudoephedrine c. Cimetidine d. Saline e. Codeine

b. Pseudoephedrine

Miss Y missed work for the past 3 days because she has been feeling ill. During these 3 days she went to consult her doctor. She explained to the doctor that she feels extremely tired, she’s lost 6 kg in weight in the last 4 weeks and she has been experiencing progressive dysphagia for the last month. She can hardly swallow any solids now and feels weak because she is not getting adequate nutrition. Based on her history and examination performed by the doctor, the doctor suspected a possible tumour in the oropharynx or upper GI tract. The doctor referred her to General Surgery for a work up booked in a week. Miss Y’s employer phoned the doctor with regards to the sick note without Miss Y’s knowledge. Which statement is CORRECT with regards to what the doctor can and cannot tell Miss Y’s employer? a. The doctor can tell Miss Y’s employer everything in terms of the dates he booked Miss Y off work, confirmation that he issued the sick note and her possible diagnosis. b. The doctor cannot confirm what her possible diagnosis is without Miss Y’s consent because that breaches patient confidentiality. c. The doctor cannot confirm that he issued the sick note because it breaches patient confidentiality between him and Miss Y. d. The doctor cannot confirm the days he booked Miss Y off from work because it breaches patient confidentiality e. The doctor cannot suggest to her employer that Miss Y is sick by saying: “ In my opinion, she is not well enough to perform her duty at work at this stage.” Her illness has nothing to do with her employer even if doctor does not disclose what the illness is.

The doctor cannot confirm what her possible diagnosis is without Miss Y’s consent because that breaches patient confidentiality.

A 59-year-old man is brought to the emergency department one hour after developing shortness of breath and “squeezing” chest pain that began while he was mowing the lawn. He has asthma, hypertension, and erectile dysfunction. Current medications include salmeterol, amlodipine, lisinopril, and vardenafil. His pulse is 110/min and blood pressure is 122/70 mm Hg. Physical examination shows diaphoresis. An ECG shows sinus tachycardia. Sublingual nitroglycerin is administered. Five minutes later, his pulse is 137/min and his blood pressure is 78/40 mm Hg. Which of the following is the most likely mechanism of this patient's hypotension? a. Bradykinin accumulation b. Calcium channel antagonism c. Histamine release d. Decreased nitric oxide production e. Cyclic GMP elevation

e. Cyclic GMP elevation Nitrates (e.g., sublingual nitroglycerin) and PDE-5 inhibitors (e.g., vardenafil) both work by increasing the intracellular concentration of cGMP. Nitrates increase intracellular NO, which is responsible for activating guanylate cyclase, leading to increased synthesis of cGMP. PDE-5 inhibitors, as their name implies, inhibit phosphodiesterase (PDE), which leads to a decreased breakdown of cGMP. Accumulation of cGMP leads to activation of myosin-light-chain phosphatase (MLCP), which dephosphorylates the light chains of myosin. This results in smooth muscle cell relaxation in blood vessels with subsequent vasodilation. Life-threatening hypotension can occur if these two drugs are taken in combination

Mrs X is on an oral contraceptive (schedule 3 drug). The doctor who issued the prescription indicated that the prescription is valid for dispensing 3 times. For no longer than what period will this prescription be valid? a. 4 weeks b. 6 weeks c. 2 months d. 3 months e. 6 months

e. 6 months

Mrs T likes to start her day with a nice cup of coffee. Coffee is known to contain caffeine, which is metabolised by N-acetyltransferase. Which one of the following drugs is not metabolized by N-acetyltransferase? a. Hydralazine b. Sulfonamides c. Omeprazole d. Procainamide e. Isoniazid

c. Omeprazole

# Choose the incorrect option with regards to development of drugs and other pharmaceutical agents: a. Pharmaceutical Innovation is attractive to investors due to increasing payor pressures and short exclusivity periods b. The average development cycle of a pharmaceutical agent continues passed a decade c. Neither China nor India have successfully developed a drug d. The Pharma brand has a perception problem e. A randomised, double blind, placebo controlled clinical trial was the most significant finding of the 20th century.

a. Pharmaceutical Innovation is attractive to investors due to increasing payor pressures and short exclusivity periods

Which of the following drug combinations can cause serotonin syndrome: a. SSRI + MAOI b. MAOI + tryptophan c. All of the above d. Tramadol + sumatriptan e. SSRI + valproate

c. All of the above

Dr B was confronted with a patient who told the doctor he was “sick”. The patient refused to be examined and demanded that the doctor should just give him a sick note. Dr B refused to do this and the patient threatened he would just make his own sick note and state, “it’s from Dr B”. Being a doctor, Dr B is aware that he is going to have to report this patient if the patient does forge the sick note as this is illegal. If Dr B does not report a forgery of the sick note, what may or may not the HPCSA do to him? a. They can find Dr B guilty of unprofessional conduct if he does notreport the forgery b. They cannot do anything to Dr B because he is not responsible forreporting crime – that’s the police’s job c. They can find Dr B guilty because he did not issue the sick patient asick note d. They cannot do anything to Dr B if Dr B does not inform them e. They can award him R20 000 if he reports the forgery

a. They can find Dr B guilty of unprofessional conduct if he does not report the forgery

South Africa has already completed two total drug developments namely that of triptorelin and rifapentine. Clinical trials form an important part of the drug development process. Choose the correct option with regards to clinical trials a. should avoid good clinical practice (GCP) principles only the patient should be kept blind as to whether they are receiving the tested drug or not b. is the first step taken in the process of developing new drugs c. The drug should be compared to a control group taking a placebo to test its efficacy d. doctors should choose whether their patients get the drug or placebo as they know their patients best

c. The drug should be compared to a control group taking a placebo to test its efficacy

Which one of the following may in certain circumstances be prescribed by a nurse: a. Tranquilisers b. Antidepressants c. Testosterone replacements d. Oestrogen replacements

d. Oestrogen replacements

The randomised, double-blind, placebo-controlled clinical trial was one of themost significant discoveries of the 20th century. It is, however, just one step in the process of drug discovery and development. Which of these is the correctsequence of steps in drug discovery and development? a. Disease & target identification > Lead identification > Lead optimisation > Hit identification > Preclinical testing > Clinical testing > Approval & Launch b. Disease & target identification > Hit identification > Lead identification > Lead optimisation > Preclinical testing > Clinical testing > Approval & Launch c. Disease & target identification> Preclinical testing > Clinical testing > Approval & Launch d. Hit identification > Lead identification > Lead optimisation > Disease & target identification > Preclinical testing > Clinical testing > Approval & Launch e. Phase I Clinical Trial > Phase II Clinical Trial > Phase III Clinical Trial > Phase IV Clinical Trial

b. Disease & target identification > Hit identification > Lead identification> Lead optimisation > Preclinical testing > Clinical testing > Approval& Launch

Mr Z, 28 years old, was diagnosed with major depressive disorder (MDD) four months ago. Mr Z visited one of the local GPs one month ago who prescribed him paroxetine. After two weeks, Mr Z visited another GP since he felt that his current medication was not effective. The doctor prescribed phenelzine, an irreversible monoamine oxidase inhibitor (MAOI). Instead of Mr Z discontinuing his previous medication, he used both of his medications together. He now presents to your practice complaining of diarrhoea, palpitations and lethargy. a. Serotonin syndrome b. Diabetic keto-acidosis c. Irritable bowel syndrome d. Neuroleptic malignant syndrome e. Acute coronary syndrome

a. Serotonin syndrome

A 43-year-old man is brought to the physician for a follow-up examination. He has a history of epilepsy that has been treated with a stable dose of phenytoin for 15 years. He was recently seen by another physician who added a drug to his medications, but he cannot recall the name. Shortly after, he started noticing occasional double vision. Physical examination shows slight vertical nystagmus and gait ataxia. Which of the following drugs was most likely added to this patient's medication regimen? a. St John’s wort b. Carbamazepine c. Cimetidine d. Theophylline e. Modafinil

c. Cimetidine Cimetidine is an inhibitor of CYP450 and a commonly prescribed drug for relief of GORD symptoms. Concurrent intake of cimetidine and phenytoin will lead to increased serum levels of phenytoin that are causing the toxicity seen in this patient. There are numerous drugs that affect CYP450 and careful revision of a patient's medication list is imperative prior to any changes

The scheduling of medicines aims to do all of the following, except: a. limit units of medicines available b. protect the general public against misuse c. prevent abuse or addiction d. limit and control their use by medical professionals

a. limit units of medicines available

Pharmacology is changing drug development. Which of the following options is incorrect with regards to this statement? a. Emerging world of general medicine b. Innovative study designs c. Predictive bio-simulation d. Increased use of biomarkers e. Creative process delivery

a. Emerging world of general medicine

All the below are factors affecting the scheduling of medicines, except a. Amount of active ingredient b. Protein binding c. Mechanism of pharmacological action d. Dosage e. Dosage form

b. Protein binding

Codeine is metabolised to morphine by which CYP450 isoenzyme? a. None of the above b. CYP2D6 c. CYP2C9 d. CYP2C19 e. CYP3A4

b. CYP2D6

Lucy, a 20-year-old female, has been struggling with inflammatory acne. She went to her local GP who prescribed doxycycline, oral 100 mg daily for 3 months. Which one is true regarding tetracycline drug interactions a. Tetracycline is best taken on an empty stomach to avoid food-drug interactions b. All of the above c. Iron preparations should be avoided 2 hours before and after dosing as they may interfere with absorption d. Tetracycline should not be taken with dairy products as the bioavailability of the drug is decreased e. Antacids form an insoluble complex with tetracyclines

b. All of the above

Dr J is a junior doctor writing out her first script for a Schedule 6 drug – Ritalin® (methylphenidate). What detail makes this script DIFFERENT from a normal prescription of lower schedule drugs? a. Dr J must include the date the script was prescribed b. Dr J must not issue a repeat prescription c. Dr J must use abbreviations in the whole script so she can get to the next patient quicker d. Dr J must include her MP number and her qualification e. Dr J must not include her written hand signature in the script

b. Dr J must not issue a repeat prescription

Mr. X is a 6-year-old whose mother brings him to you as he has been complaining of pain when swallowing for the past 2 days. The mother further explains that he is feverish and not his playful self. On examination, you find that his tonsils are swollen with streaks of pus. He also has swollen and tender lymph nodes in his neck. His mother has only given him some Panado® (paracetamol) syrup for his fever and pain. He is an asthmatic and also has a penicillin allergy. What is the most important thing you need to take into consideration when writing a prescription for the antibiotic treatment of strep throat for this specific patient? a. Drug-drug interactions b. Asthma c. Food-drug interactions d. Age of the patient e. Penicillin allergy

e. Penicillin allergy

Scheduling of drugs depends on all of the following, except: a. Addiction potential b. Dosage form c. Volume of distribution d. Pack size e. Amount of active ingredient

c. Volume of distribution

Mrs X is diagnosed with major depressive disorder (MDD) by her local doctor. He places her on fluoxetine 40 mg po mane (an SSRI). Fluoxetine is metabolised to an ACTIVE metabolite, norfluoxetine. Mrs X shows no improvement on treatment even after waiting an adequate time and taking proper dosages. Her doctor suspects that she might not be responding to the SSRI due to the presence of a polymorphism or variation for the gene encoding the …………. isoenzyme, causing her to metabolise the drug at a very low rate. a. CYP3A4 b. CYP5O9 c. CYP2C19 d. CYP2D6 e. CYP450

d. CYP2D6

Mrs B Mrs B is a 46 year old female on life-long warfarin therapy due to her mitral valve replacement 5 years ago. Her recent sputum test was positive for TB infection and she will therefore need to be started on anti-TB medication immediately. Which one of the following is correct in the management of Mrs B? a. a. Isoniazid may increase INR by inhibiting warfarin's metabolism via CYP2C9 b. b. Isoniazid may decrease INR by inhibiting warfarin’s metabolism via CYP2C9 c. c. Her warfarin dosage will need to be reduced d. d. Her warfarin dosage will need to be increased a. None of the above b. Both a and c c. Both b and d d. Both a and d e. Both b and c

b. Both a and c

Mr F is a 36 year old male with a history of major depression. For 6 months, Dr GP has been treating Mr F and is well acquainted with his medical and surgical history. Mr F has been on a course of antidepressants with positive results and Dr GP feels one more month would be beneficial to Mr F. Which one of the following is true? a. He may prescribe another course after consulting a registered psychiatrist b. He may prescribe another course if Mr F and his family consent c. He may not prescribe another course of the same drug class d. He may prescribe another course based on the severity of Mr F’s condition

He may prescribe another course after consulting a registered psychiatrist

From what age is an individual allowed to buy schedule 1 and up drugs, without a prescription issued by an authorised prescriber, or on a written order disclosing the purpose for which such substance is to be used and bears a signature known to the seller: a. 10 years b. 12 years c. 14 years d. 18 years e. 21 years

c. 14 years