Block 13 Pace 2 Part 2(Pharmacy)

22 Questions | Total Attempts: 140

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Block 13 Pace 2 Part 2(Pharmacy)


Questions and Answers
  • 1. 
    A drug abuse specialist is called in to the ER to discuss treatment options for opioid addiction. He could go to either a treatment center or a certified primary care physician for treatment of withdrawal. He may also be interested in long term treatment to help avoid relapse. What mechanism of action would block the rewarding effects of an opioid but also be able to substitute for an opioid?
    • A. 

      Dopamine agonist

    • B. 

      Dopamine reuptake inhibition

    • C. 

      Mu opioid antagonist

    • D. 

      Mu opioid agonist

    • E. 

      Mu opioid partial agonist

  • 2. 
    A 26-year-old women presents to her primary care physician in the winter with a current complaint of sadness and history of a pattern of symptoms.  She “hibernates” all winter and has done so since High School.  She has gained weight from increased sweets, excessive alcohol use, lack of motivation, negative ruminations, and decreased productivity at work.  From a complete history, she has had several episodes of increased mood with overspending and was brought to the emergency room for intoxication.  Her physician recommends a specialist who confirms his diagnosis and suggests she start with which pharmacotherapy?
    • A. 

      Sertraline

    • B. 

      Methylphenidate

    • C. 

      Aripiprazole

    • D. 

      Lithium

    • E. 

      Quetiapine

    • F. 

      Alprazolam ER (option F for discussion only)

  • 3. 
    A 26-year-old man has been binging on a drug of abuse for the past 4 days. He has run out of drug and is selling his possessions for money. When he takes the drug he is relieved and feels momentarily good. He doesn’t get as high as he used to and never feels he can get enough drug.  When he runs out of cash and drug he crashes and feels depressed, fatigued, craves sleep and is anxious about not having the drug. He is now experiencing what?
    • A. 

      Opioid withdrawal

    • B. 

      Benzodiazepine withdrawal

    • C. 

      Stimulant withdrawal

    • D. 

      Stimulant overdose

    • E. 

      Opioid overdose

  • 4. 
    A 21-year-old woman was brought to the emergency room presenting with bizarre behaviors.  She was speaking very fast and she was talking about voices she heard.  She had run out into the street because she thought aliens were chasing her.  She was asked if she would take a medicine to help block the voices and fear she was experiencing.  What drug was she likely given if she takes it voluntarily?
    • A. 

      Haloperidol

    • B. 

      Clozapine

    • C. 

      Lithium

    • D. 

      Risperidone

    • E. 

      Valproate

  • 5. 
    A 32-year-old woman who has type-2 diabetes mellitus is diagnosed with hyperthyroidism. She has been on a combination of metformin and glipizide to control hyperglycemia. For treating her hyperthyroid condition, she is prescribed methimazole and propranolol. She is also on vitamin D and calcium supplements. Which one of her medications is most likely to increase the risk of hypoglycemia by interfering with her normal counter-regulatory mechanisms?
    • A. 

      Methimazole

    • B. 

      Propranolol

    • C. 

      Glipizide

    • D. 

      Metformin

    • E. 

      Vitamin D

  • 6. 
    A 45-year-old woman reports feeling continuously fatigued with bouts of nausea and anorexia for several months. She claims that she frequently gets dizzy when she stands up, and also reports recent craving for salty foods. She has significant tanning of her skin even in non-sun exposed areas. She has a 15 year history of hypothyroidism for which she is taking levothyroxine. Her father had diabetes for 50 years; mother has hypertension and osteoporosis; has three sisters with hypothyroidism and one sister with hyperthyroidism. On physical examination, her BP is 94/70 mmHg (sitting), 84/60 mmHg (standing), pulse 79/min, temp 96.8, weight 60kg, Ht 5’6”. Her skin is dry and skin creases on palms of her hands are pigmented. Her blood reports reveal Na+ 127 mEq/L, K+ 5 mEq/L, BUN 15 mg/dl, glucose 102 mg/dl, and cortisol (at 8 AM) 1.4mcg/dl. Which of the following drugs would be most appropriate for her treatment?
    • A. 

      Hydrocortisone

    • B. 

      Metformin

    • C. 

      Conivaptan

    • D. 

      Desmopressin

    • E. 

      Cinacalcet

    • F. 

      Calcitriol (option F for discussion only)

  • 7. 
    A 55-year-old man with chronic renal failure has been taking calcitriol without much improvement in his serum calcium concentration. Lab results show serum calcium concentration of 7.2 mg/dl and phosphate 6 mg/dl. Which of the following drugs would most likely help correcting the calcium-phosphate balance in his blood?
    • A. 

      Calcium gluconate

    • B. 

      Sevelamer

    • C. 

      Teriperatide

    • D. 

      Ibandronate

    • E. 

      Raloxifene

  • 8. 
    A 55-year-old man was brought to the emergency department because he was found by his wife in a comatose condition. On examination it was noted that his mucous membranes were dry, and his random blood sugar was found to be 640mg/dl. His urine was positive for glucose but negative for ketones. Which of the following is the cause of his presentation?
    • A. 

      Decreased insulin production

    • B. 

      Decreased growth hormone

    • C. 

      Insulin resistance

    • D. 

      Cystic fibrosis

    • E. 

      Insulinoma

  • 9. 
    A 48 year-old woman went to her physician for evaluation because she noted she has been unable to see from the rear view mirrors on her car when driving for the past 3 months. She also complained of headaches associated with early morning vomiting. She admits that she is eating a lot and has gained 5kg. Her CT scan confirmed a pituitary tumor. What is the most likely cause of her weight gain?
    • A. 

      Decreased hypothalamic function

    • B. 

      Metabolic syndrome

    • C. 

      Decreased TSH production

    • D. 

      Increased grelin production

    • E. 

      Adrenal hyperplasia

  • 10. 
    A 6-month-old infant is brought in by the social workers for evaluation. His parents were illegal migrant farm workers and did not have access to proper health care. On physical examination he was noted to have a large tongue with coarse dry skin. He had a hoarse cry and poor feeding. His growth was delayed. What is a possible physical examination finding in the neonatal period would make you consider this diagnosis?
    • A. 

      Persistent jaundice

    • B. 

      Low birth weight

    • C. 

      Hypoglycemia

    • D. 

      Hypertonic upper extremities

    • E. 

      A systolic murmur

  • 11. 
    Which of the following factors is most important for reducing acute secretion of corticotrophin-releasing hormone?
    • A. 

      Increased long-term emotional stress

    • B. 

      Increased plasma concentration of adrenocorticotropic hormone (ACTH)

    • C. 

      Increased plasma concentration of cortisol

    • D. 

      Time of day (morning) after a normal sleep cycle

    • E. 

      Increased quantity of corticotropin-binding protein in the plasma

  • 12. 
    Which of the following statements is characteristic of the pituitary gland?
    • A. 

      TSH is derived from the hypothalamus

    • B. 

      TSH is stored in the pars nervosa of the pituitary gland

    • C. 

      Herring bodies produce oxytocin and vasopressin.

    • D. 

      Chromophobes secrete oxytocin and vasopressin

    • E. 

      Basophils produce FSH and LH.

  • 13. 
    The nurse notices that a newborn girl has an unusually enlarged clitoris, and asks the physician whether this might be a disorder of sexual development. Physical examination shows that in addition to the large clitoris the labia are almost completely fused. This abnormality could be caused by an inherited deficiency of one of those enzymes that are needed for corticosteroid synthesis but not androgen synthesis in the adrenal cortex. Which are the two important enzymes that could be missing in this child?
    • A. 

      Desmolase and 17-hydroxylase

    • B. 

      11-hydroxysteroid dehydrogenase and 17-21 lyase

    • C. 

      11-hydroxylase and 21-hydroxylase

    • D. 

      Aromatase and 17-21 lyase

    • E. 

      5α-reductase and 18-hydroxysteroid dehydrogenase

  • 14. 
    A 2-year-old child is brought to the family physician because of failure to thrive. Physical examination shows that the child is short and has coarse facial features, a protruding tongue and an umbilical hernia. The child has not started walking and has no speech development. On enquiry parents say that he is not able to understand verbal commands also. Which of the following laboratory tests is most likely to have a higher than normal level in this child?  
    • A. 

      Urine free cortisol

    • B. 

      Serum thyroxine

    • C. 

      Insulin-like growth factor-1 (IGF-1)

    • D. 

      Serum thyrotropic hormone (TSH)

    • E. 

      Growth hormone

  • 15. 
    The parents of a 5-year-old boy notice that he has developed features that suggest puberty over the past 6 months. On examination the boy has secondary sex characteristics, including pubic hair and penile enlargement. Lab tests show hypernatremia and hypokalemia with mild hypertension. See the attached figure. What is the pathophysiology for hypokelemia in this patient?
    • A. 

      High plasma deoxycorticosterone

    • B. 

      Increased plasma androstenedione

    • C. 

      Decreased plasma aldosterone

    • D. 

      High plasma 11-deoxycortisol

    • E. 

      Increased plasma testosterone

  • 16. 
    A 57-year-old man is found comatose. On physical examination he has decreased skin turgor. Laboratory studies show blood glucose of 780 mg/dl. Urinalysis reveals no ketosis or proteinuria, though there is 4+ glucosuria. The plasma C-peptides are low. Which of the following histopathology pictures is consistent with this patient’s diagnosis?
    • A. 

      A

    • B. 

      B

    • C. 

      C

    • D. 

      D

  • 17. 
    The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) makes a distinction between Personality Disorders, also known as Axis II Disorders, and mental health conditions diagnosed on Axis I.  All but one of the following diagnostic considerations are relevant for both Axis I and Axis II Disorders.  For Axis II disorders ONLY, a diagnosis can be given:
    • A. 

      Even if an individual exhibits only a subset of possible symptoms.

    • B. 

      Only when the possible effects of a general medical condition are ruled out

    • C. 

      Only if the pattern of symptoms is stable and of long duration

    • D. 

      Only when the possible effects of a substance are ruled out.

    • E. 

      When the condition is deemed to cause significant distress or impairment

  • 18. 
    A 45-year-old Caucasian male accountant presents at your family practice for a routine physical examination. Upon meeting you, he states that there were a few irregularities in the HIPAA procedures being followed by the office staff that you may want to know about. He tells you that he has carefully reviewed the law in an effort to know his rights as a patient. When asked about his diet, he describes in great detail how he adheres to the latest recommended dietary guidelines. He also discusses at length the exact procedures for billing his insurance company for services. It seems that he has read all of the fine print on his policy. He further states that he has budgeted a certain amount of money for his health care costs and wants to ensure that there are no unexpected bills that might interfere with his retirement savings this year. This patient’s pattern of behavior appears most consistent with which of the following personality disorders?  
    • A. 

      Avoidant

    • B. 

      Obsessive-Compulsive

    • C. 

      Borderline

    • D. 

      Dependent

    • E. 

      Schizoid

  • 19. 
    A 55-year-old obese woman with a history of ischemic heart disease presents with 12 hours of blurred vision in her right eye. Fundoscopic examination reveals the retina shown for your evaluation below. Which of the following is the most likely diagnosis?
    • A. 

      Retinal artery occlusion

    • B. 

      Retinal vein occlusion

    • C. 

      Age-related macular degeneration

    • D. 

      Primary open-angle glaucoma

    • E. 

      Diabetic retinopathy

  • 20. 
    A 21-year-old man is admitted to the hospital with severe headache, nausea and vomiting, and fever of 39° C. Physical examination reveals neck rigidity and knee pain with hip flexion. Spinal tap reveals increased opening pressure, pleocytosis of polymorphonuclear leukocytes, decreased glucose concentration, and raised protein concentration. Which of the following complications is most likely to develop, if the patient survives?
    • A. 

      Ischemic stroke

    • B. 

      Hemorrhagic stroke

    • C. 

      Brain hemorrhage

    • D. 

      Hydrocephalus

    • E. 

      Syringomyelia

  • 21. 
    A 72-year-old man with a long-standing history of hypertension visits his ophthalmologist for a routine eye examination. Ophthalmologic examination reveals increased intraocular pressure in both eyes. On a field test, there is significant loss of peripheral vision, and a fundoscopic examination reveals cupping. Which of the following structural changes have developed in his retina?
    • A. 

      Formation of fibrovascular membrane above the retina

    • B. 

      Atrophy of ganglionic cells and optic disk

    • C. 

      Formation of fibrovascular membrane below the retina

    • D. 

      Drusen accumulation

    • E. 

      Arteriolar narrowing

  • 22. 
    A 47-year-old woman is brought to her family physician because of rapidly progressive loss of cognitive function, involuntary jerky movements, and excessive somnolence. Physical examination reveals dementia; no other neurologic signs are noted. Laboratory and instrumental evaluation reveals normal CNS findings, and burst of high-voltage slow-wave activity on EEG. Histopathologic changes of the brain characteristic for the presented disease are shown in the image below. Which of the following is the most likely diagnosis?
    • A. 

      Multiple sclerosis

    • B. 

      Alzheimer disease

    • C. 

      Parkinson disease

    • D. 

      Huntington disease

    • E. 

      Creutzfeld-Jacobs disease

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