Pharmacology Practice Questions
Pharmacology Practice Questions Page 1: You can take these Practice Questions free for your upcoming exam.
USMLE Step 1 Pharmacology Practice Questions.
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USMLE Pharmacology Quiz
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- Question 1 of 9
1. Question
A 37-year-old man who is HIV-positive recently started on a highly active antiretroviral regimen.
The patient’s CD4+ cell count subsequently fell below 200/mm3. Over the course of the next 3 months, he develops diarrhea and
notices a redistribution of fat on his body. Which of the following agents is most likely causing this patient’s symptoms?CorrectThe correct answer is E. Protease inhibitors
such as lopinavir/ritonavir (Kaletra), amprenavir,
nelfi navir, indinavir, and saquinavir can
cause gastrointestinal intolerance and fat redistribution.
Lopinavir/ritonavir is one of the
main combinations forming the basis of highly
active antiretroviral therapy. Two nucleotide
reverse transcriptase inhibitors are added to
form the backbone.IncorrectThe correct answer is E. Protease inhibitors
such as lopinavir/ritonavir (Kaletra), amprenavir,
nelfi navir, indinavir, and saquinavir can
cause gastrointestinal intolerance and fat redistribution.
Lopinavir/ritonavir is one of the
main combinations forming the basis of highly
active antiretroviral therapy. Two nucleotide
reverse transcriptase inhibitors are added to
form the backbone. - Question 2 of 9
2. Question
A patient is being treated with β-blockers for hypertension. Which of the following describes the effects of β-blockers on end-diastolic volume (EDV), blood pressure (BP), contractility, heart rate (HR), and ejection time?
CorrectThe correct answer is D. β-Blockers decrease
contractility and heart rate (resulting in decreased
oxygen consumption) by inhibiting β-receptors in
the heart. A decrease in heart rate will then allow
more time for diastolic fi lling (increasing EDV)
and systolic ejection (increasing ejection time). In
addition, β-blockers will decrease the secretion of
renin, thus diminishing the renin-angiotensin cascade.IncorrectThe correct answer is D. β-Blockers decrease
contractility and heart rate (resulting in decreased
oxygen consumption) by inhibiting β-receptors in
the heart. A decrease in heart rate will then allow
more time for diastolic fi lling (increasing EDV)
and systolic ejection (increasing ejection time). In
addition, β-blockers will decrease the secretion of
renin, thus diminishing the renin-angiotensin cascade. - Question 3 of 9
3. Question
A 68-year-old woman with type 2 diabetes mellitus and a 13.6-kg (30-lb) weight loss over the past 2 months presents to the physician with a history of nausea and bloating. Symptoms are most prominent following a meal. An outpatient gastric emptying study shows esophageal dysmotility. Which of the following is the best treatment for this patient?
CorrectThe correct answer is B. This patient presents
with gastroparesis, specifi cally esophageal dysmotility,
secondary to her diabetes. Other
causes of esophageal dysmotility include diabetic
gastroparesis, Chagas’ disease, lupus, and
other collagen vascular diseases. Initial treatment
consists of promotility agents, with metoclopramide
being fi rst-line therapy.IncorrectThe correct answer is B. This patient presents
with gastroparesis, specifi cally esophageal dysmotility,
secondary to her diabetes. Other
causes of esophageal dysmotility include diabetic
gastroparesis, Chagas’ disease, lupus, and
other collagen vascular diseases. Initial treatment
consists of promotility agents, with metoclopramide
being fi rst-line therapy. - Question 4 of 9
4. Question
A 33-year-old woman with a history of Graves’ disease is brought to the emergency department unresponsive following a bout of confusion and agitation. On physical examination her temperature is 39.2° C (102.5° F), her blood pressure is 100/70 mm Hg, and her pulse is 165/min. A systolic ejection murmur is heard at the apex, and the patient has 3+ pitting edema at the ankles. Following primary stabilization, which of the following would constituteappropriate pharmacotherapy for this patient’s underlying condition?
CorrectThe correct answer is E. This patient is presenting
with a medical emergency: an extreme
form of thyrotoxicosis known as “thyroid
storm.” The symptoms of this syndrome are
due primarily to increased β-adrenergic outfl
ow stimulated by thyroid hormones. After primary
stabilization (airway, breathing, and circulation),
propylthiouracil or methimazole isIncorrectThe correct answer is E. This patient is presenting
with a medical emergency: an extreme
form of thyrotoxicosis known as “thyroid
storm.” The symptoms of this syndrome are
due primarily to increased β-adrenergic outfl
ow stimulated by thyroid hormones. After primary
stabilization (airway, breathing, and circulation),
propylthiouracil or methimazole is - Question 5 of 9
5. Question
A 32-year-old woman presents to her primary care physician complaining of overwhelming fear and apprehension. The patient states that for the past 8 months she has been feeling anxious and worried about many things. She has diffi culty concentrating and diffi culty sleeping because she “can’t seem to keep [her] mind off of the everyday issues of life.” She also says she often feels tense and restless. She denies past substance abuse. Which of the following drugs would be considered fi rst-line treatment for her illness?
CorrectThe correct answer is C. This patient suffers
from generalized anxiety disorder (GAD),
which is marked by symptoms of excessive
worry and anxiety about every aspect of one’s
life. The Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition, Text Revision
(DSM-IV-TR) criteria for generalized anxiety
disorder include: (1) At least 6 months in
which the person experiences a majority of the
days feeling anxious and apprehensive; (2) the
anxiety and apprehension impair functioning
in areas such as work and social life; (3) there
are ≥3 associated symptoms including restlessness,
diffi culty concentrating, irritability, decreased
energy, muscle tension, and/or sleep
disturbance; and (4) the anxiety and apprehension
are not associated with another medical or
psychiatric disorder. Benzodiazepines are fi rstline
agents in the treatment of GAD due to
their sedative properties. However, patients
with polydrug or alcohol use, chronic pain disorders,
and severe personality disorders probably
should not be prescribed benzodiazepines
in light of the high potential in such patients
for benzodiazepine dependence.IncorrectThe correct answer is C. This patient suffers
from generalized anxiety disorder (GAD),
which is marked by symptoms of excessive
worry and anxiety about every aspect of one’s
life. The Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition, Text Revision
(DSM-IV-TR) criteria for generalized anxiety
disorder include: (1) At least 6 months in
which the person experiences a majority of the
days feeling anxious and apprehensive; (2) the
anxiety and apprehension impair functioning
in areas such as work and social life; (3) there
are ≥3 associated symptoms including restlessness,
diffi culty concentrating, irritability, decreased
energy, muscle tension, and/or sleep
disturbance; and (4) the anxiety and apprehension
are not associated with another medical or
psychiatric disorder. Benzodiazepines are fi rstline
agents in the treatment of GAD due to
their sedative properties. However, patients
with polydrug or alcohol use, chronic pain disorders,
and severe personality disorders probably
should not be prescribed benzodiazepines
in light of the high potential in such patients
for benzodiazepine dependence. - Question 6 of 9
6. Question
A 64-year-old man develops chronic renal failure. He has an extensive medical history, and also complains of increasingly poor vision in his right eye. After a kidney biopsy is taken (see image), his physician immediately starts him on a new medication. What pharmacologic treatment has been shown to most effectively delay the progression of the pathology shown in this photomicrograph?
CorrectThe correct answer is A. The photomicrograph
shows Kimmelstiel-Wilson nodules,
which are pathognomonic for diabetic nephropathy.
Even without recognizing this specifi c
histopathology, however, one should be reminded
of diabetes due to the combination of
renal and visual fi ndings (diabetic nephropathy
and retinopathy). Angiotensin-converting enzyme
(ACE) inhibitors are the drugs of choice
in the control of diabetes-induced renal disease
because they reduce systemic blood pressure,
reduce the effects of angiotensin II (AT II) on
efferent arterioles, and attenuate the stimulatory
effect of AT II on glomerular cell growth
and matrix production. ACE inhibitors have
been conclusively shown to delay the time to
end-stage renal disease by 50% in type 1 diabetics
and to signifi cantly delay progression of renal
disease in type 2 diabetics. All diabetics
should begin ACE inhibitor therapy at the onset
of microalbuminuria, even in the absence
of hypertension.IncorrectThe correct answer is A. The photomicrograph
shows Kimmelstiel-Wilson nodules,
which are pathognomonic for diabetic nephropathy.
Even without recognizing this specifi c
histopathology, however, one should be reminded
of diabetes due to the combination of
renal and visual fi ndings (diabetic nephropathy
and retinopathy). Angiotensin-converting enzyme
(ACE) inhibitors are the drugs of choice
in the control of diabetes-induced renal disease
because they reduce systemic blood pressure,
reduce the effects of angiotensin II (AT II) on
efferent arterioles, and attenuate the stimulatory
effect of AT II on glomerular cell growth
and matrix production. ACE inhibitors have
been conclusively shown to delay the time to
end-stage renal disease by 50% in type 1 diabetics
and to signifi cantly delay progression of renal
disease in type 2 diabetics. All diabetics
should begin ACE inhibitor therapy at the onset
of microalbuminuria, even in the absence
of hypertension. - Question 7 of 9
7. Question
A 5-year-old boy presents to the physician’s offi ce for treatment of chronic recurrent pulmonary infections and bronchitis. The boy’s history is signifi cant for ileus as a newborn and chronic fl oating, foul-smelling diarrhea. Analysis of the child’s sweat reveals an increased concentration of chloride ions. A mutation in which chromosome is responsible for this patient’s disease process?
CorrectThe correct answer is C. This is the classic presentation
of a child with cystic fi brosis, an autosomal
recessive defect in the cystic fi brosis transmembrane
conductance regulator (CFTR) gene
on chromosome 7. This results in a defective
chloride channel, leading to the secretion of abnormally
thick mucus in the lungs, pancreas,
and liver.IncorrectThe correct answer is C. This is the classic presentation
of a child with cystic fi brosis, an autosomal
recessive defect in the cystic fi brosis transmembrane
conductance regulator (CFTR) gene
on chromosome 7. This results in a defective
chloride channel, leading to the secretion of abnormally
thick mucus in the lungs, pancreas,
and liver. - Question 8 of 9
8. Question
A 70-year-old man presents to his cardiologist with shortness of breath, crackles along both lung bases, and 1+ pitting edema in his lower extremities. His cardiologist diagnoses him with mild congestive heart failure and places him on a thiazide diuretic. Two days later, the patient comes to the emergency department obtunded and oliguric, with a highly elevated creatinine level of 8.3 mg/dL. His wife reports that the only medication that he took besides his diuretic was “some ibuprofen for his headache.” Which of the following is the most likely reason for this patient’s sudden renal failure?
CorrectThe correct answer is B. Renal failure is a very
dangerous adverse event associated with nonsteroidal
anti-infl ammatory drugs (NSAIDs).
The patient was in congestive heart failure
when he fi rst presented. His cardiologist consequently
treated him with a diuretic, intending
to reduce his total body fl uids. When the
amount of fl uids in the body contracts, the
body attempts to compensate by releasing angiotensin
II, a potent vasoconstrictor. In order
to protect the kidney from losing its perfusion
due to this vasoconstriction, the kidney simultaneously
releases prostaglandins at both the
afferent and efferent arterioles, where they act
as vasodilators. By taking an NSAID like ibuprofen
and inhibiting the cyclooxygenase
(COX)-1 and COX-2 enzymes, this patient
blocked the pathway producing the prostaglandins
that were keeping the afferent arteriolesIncorrectThe correct answer is B. Renal failure is a very
dangerous adverse event associated with nonsteroidal
anti-infl ammatory drugs (NSAIDs).
The patient was in congestive heart failure
when he fi rst presented. His cardiologist consequently
treated him with a diuretic, intending
to reduce his total body fl uids. When the
amount of fl uids in the body contracts, the
body attempts to compensate by releasing angiotensin
II, a potent vasoconstrictor. In order
to protect the kidney from losing its perfusion
due to this vasoconstriction, the kidney simultaneously
releases prostaglandins at both the
afferent and efferent arterioles, where they act
as vasodilators. By taking an NSAID like ibuprofen
and inhibiting the cyclooxygenase
(COX)-1 and COX-2 enzymes, this patient
blocked the pathway producing the prostaglandins
that were keeping the afferent arterioles - Question 9 of 9
9. Question
A 74-year-old man comes to the physician complaining of increased urinary frequency along with diffi culty starting and stopping urination. Assuming a benign underlying cause, which of the following is the mechanism of action of a common medication used to treat this condition?
CorrectThe correct answer is E. This man has the
symptoms of benign prostatic hypertrophy,
which include diffi culty starting and maintaining
a urine stream, feeling as though the bladder
is never emptied, having the urge to urinate
again soon after voiding, and pain on
urination or dysuria. Finasteride is most commonly
used to treat this condition. Finasteride
acts by inhibiting the conversion of testosterone
to dihydrotestosterone by inhibiting
5α-reductase. This leads to a reduction in the
size of the prostate, providing symptomatic
relief.IncorrectThe correct answer is E. This man has the
symptoms of benign prostatic hypertrophy,
which include diffi culty starting and maintaining
a urine stream, feeling as though the bladder
is never emptied, having the urge to urinate
again soon after voiding, and pain on
urination or dysuria. Finasteride is most commonly
used to treat this condition. Finasteride
acts by inhibiting the conversion of testosterone
to dihydrotestosterone by inhibiting
5α-reductase. This leads to a reduction in the
size of the prostate, providing symptomatic
relief.
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