• A new medication, “Drug A” has the following
effects on HCI output by the stomach mucosa:
Drug A is most similar to which of the following
substances?
a. Atropine
b. Cimetidine
c. Lansoprazole
d. Sucralfate
e. bethanechol
• A 65 year old male presents to the emergency room complaining of
suprapubic discomfort and no urine output. His past medical history
is significant for BPH diagnosed one year ago that was treated
effectively with finasteride. He also has type 2 DM, HTN,
hyperlipidemia. He was recently seen in the office for painful
peripheral neuropathy. In the emergency room, his vital signs are
within normal limits. examination shows suprapubic fullness and no
other abnormalities. A foley catheter placed in this patient reveals
1000ml of urine. Which of the following medications most likely has
contributed to this patient’s current condition?
• A. finasteride
• B. duloxetine
• C. gabapentine
• D. amitriptyline
• E. carbamazepine
• F. tamsulosin
• G. flutamide
• A 12-year-old male is hospitalized with headache, nausea
and fever. A physical examination is significant for neck
stiffness. Gram negative cocci in pairs are revealed during
CSF microscopy. Which of the following is the best way to
prevent infection in his close contacts?
• A. capsular polysaccharide vaccine
• B. penicillin
• C. ethambutol
• D. rifampin
• E. sulfamethoxazole
• F. trimetoprim
• G. gentamicin
• A 52-year-old male with a long history of diabetes
mellitus is admitted to the hospital after fracturing his
femur in a motor vehicle accident. In the hospital he
recieves NPHinsulin and regular insulin. His blood sugar
readings drop below 50mg/dl at several points during
his hospitalization, but he never experiences symptoms
of hypoglycemia. This is most likely because he is also
taking which of the following medications?
• A. verapamil
• B. doxazosin
• C. hydrochlorothiazide
• D. propanolol
• E. atorvastatin
• E. losartan
• A 28-year-old female is treated with high dose prednisone for
severe lupus nephritis. Several hours after initiating therapy, she
experiences fever, chills and severe fatigue. Her blood pressure is
120/70mmHg and her heart rate is 110/min. serum and urine are
collected for CBC, blood culture, urinalysis and urine culture, to
more fully evaluate the patient’s condition. An increase in which of
the following blood cell counts might be attributable to this
patient’s therapy?
• A. neutrophils
• B. Eosinophils
• C. basophils
• D. monocytes
• E. lymphocytes
• A 12-year-old male bleeds from his mouth after a tooth extraction.
The bleeding lasts for more than 12 hours despite local applications
of thrombotic agents. The bleeding finally stops after desmopressin
(DDVAP) administration. The patient has no past medical history
and takes no medications. His last physical examination with his
pediatrician was unremarkable. Which of the following mechanisms
most likely explains the effect of the drug on this patient?
• A. vasoconstriction
• B. increase in liver protein synthesis
• C. increase in endothelial protein release
• D. inhibition of fibrinolytic system
• E. blood cell mobilization from the spleen
• A 20-year-old female has severe acne resistant to
topical therapies. She has no significant past medical
history and her only current medication is an oral
contraceptive. Before prescribing isotretinoin, which of
the following tests should you perform?
• A. platelet count
• B. bone density test
• C. serum retinol level
• D. serum TSH level
• E. serum β-HCG level
• F. serum creatine kinase level
• A 47-year-old woman is diagnosed with breast cancer
metastasized to the bones and liver. She begins treatment
with anastrozole. She has no other medical problems and
takes no other medications. She does not use tobacco,
alcohol or illicit drugs. Soon after initiating therapy for her
cancer, her primary tumor substantially decreases in size.
Which of the following is the best explanation for the
therapeutic effect?
• A. decreased follicular cell stimulation
• B. decreased androgen synthesis
• C. decreased androgen aromatization
• D. impaired second messenger action
• E. impaired ligand-receptor interaction
• A 22-year-old woman comes to the physician because of
palpitations, weight loss and insomnia. She has lost 15lbs in
the past 3 months. She has no other medical problems and
takes no medication. She does not use tobacco, alcohol or
illicit drugs. Her blood pressure is 130/80mmHg and pulse
is 104/min and regular. Laboratory studies show markedly
decreased serum TSH and elevated T4 levels. Methimazole
monotherapy is initiated. Two months later, her condition
has significantly improved. Inhibition of which of the
following processes is the most likely explanation for this
patient’s improvement?
• A. iodine uptake by the thyroid
• B. iodine organification and coupling of iodotyrosines
• C. colloid deposition
• D. T3/T4 effect on target tissues
• E. peripheral T4 to T3 conversion
• A 40-year-old female with a history of
schizophrenia is treated with risperidone. She
was brought to the hospital by her group home
because she has not had a menstrual period in 6
months. Her BMI is 28kg/m2. which of the
following is the most likely cause of her
amenorrhea?
• A. schozophrenia
• B. risperidone
• C. premature menopause
• D. pregnancy
• E. polycystic ovarian disease
• A 32-year-old woman with no significant past medical
history complains of feeling sad for the past three
months and often finds herself crying for no obvious
reason. She also states that her sleep has been
fragmented and that she wakes up early in the
morning and then has difficulty falling back to sleep.
Her appetite is decreased. She denies any suicidal
ideation. She denies any chest pain, abdominal pain,
headaches, palpitations or excessive sweating. Her TSH
level is normal. She is started on the appropriate
treatment. Two days later she is brought to the hospital
because of agitation and confusion. She is tremulous,
and has abdominal cramps and diarrhea.
• Vital signs are temperature 38.9C (102F), BP 210/120mmHg
and heart rate 120/min regular. On examination, her pupils
are dilated. There is bilateral hyperreflexia and inducible
ankle clonus.
• Increased CNS activity caused by a derivative of which of
the following amino acids is responsible for this patient’s
condition?
• A. glutamic acid
• B. histidine
• C. methionine
• D. tyrosine
• E. tryptophan
• The patient is admitted to the hospital and
supportive therapy is initiated. Which of the
following is the antidote for this patient’s
condition?
• A. propanolol
• B. Haloperidol
• C. flumazeni
• D.cyproheptadine
• E. naloxone
• A 28-year-old female presents to your office for a
routine check-up. Her past medical history is not
significant. She does not smoke or consume alcohol.
She is in a monogamous relationship with her husband
and uses combination oral cotraceptives regularly.
Which of the following most likely prevents pregnancy
in this patient?
• A. low serum prolactin level
• B. low serum gonadotropin levels
• C. increased endogenous estrogen synthesis
• D. impaired sperm penetration into the uterus
• E. impaired embryo implantation
• A 56-year-old African American male is diagnosed with
essential hypertension. He has no symptoms or
comorbid illnesses. You prescribe hydrochlorotiazide.
In reponse to this treatment, the serum level of which
of the following is most likely to increase?
• A. potassium
• B. sodium
• C. creatinine
• D. cholesterol
• E. High density lipoprotein
• F. alkaline phosphatase
• A 56-year-old male with type 2 diabetes mellitus is
treated with pioglitazone two weeks after initiation of
therapy, there is no meaningful improvement in
glycemic control. You soothe the patient’s concerns
that “this new medication just isn’t working” by
explaining that the mechanism of action of the drug
involves which of the following?
• A. hormone secretion
• B. decrease glucose absorption
• C. receptor down-regulation
• D. enzyme inactivation
• E. transcription modulation
• A new drug has been developed that seems promising
for the treatment of asthma. It works by reversing
irritant-induced bronchoconstriction. In vagectomized
animals, the compound has no bronchodilatory effects.
The drug s most similar to which of the following
medications?
• A. albuterol
• B. theophylline
• C. ipratropium
• D. zileuton
• E. nifedipine
• In a patient with severely impaired left ventricular
function. IV digoxin administration increases cardiac
output and decreases rigt atrial pressure and
pulmonary capillary wedge pressure. Which of the
following is the initial cellular event triggering this
responses to digoxin?
• A. deceased sodium efflux
• B. increased calcium influx
• C. increased potassium influx
• D. increased cAMP concentration
• E. troponin sensitization to calcium
• A 26-year-od male presents to your office complaining
of hair loss. He says he fears going bald like his father.
Physical examination reveals moderate hair loss from
the anterior scalp and vertex. Which of the following
drugs can be used to treat this patient’s condition?
• A. local glucocorticoids
• B. isotretinoin
• C. progesterone
• D. finasteride
• E. terbinafne
• A 24-year-old female with a history of Munchausen
syndrome presents to the emergency room with
epstaxis, bleeding gums bruises and petechiae. She has
an episode of bloody emesis and guaiac positive stool.
After much questioning, she admits to having ingested
rat position. Immediate treatment of this patient
should include:
• A. fresh frozen plasma
• B. cryoprecipitate
• C. platelet infusion
• D. protamine sulfate
• A 35-year-old male develops a deep vein thrombosis of
his right lower extremity, and you decide to treat him
with warfarin. His past medical history is significant for
epilepsy. After initiation of therapy you discover that
the patient requires high doses of warfarin to achieve
his target INR values. Which of the following is the
most likely explanation for your discovery?
• A. low intestinal absorpption
• B. high gastric degradation
• C. increased liver metabolism
• D. increased renal excretion
• E. inappropriate drug formulation
• A 30-YEAR-OLD woman comes to the physician for an initial
health maintenance examination. Physical examination
shows no abnormalities. Fasting serum lipid studies show
• Cholesterol total
300mg/dl
• HDL-cholesterol
35mg/dl
• LDL-cholesterol
232mg/dl
• Triglycerides
165mg/dl
• Treatment with which of the following drugs is likely to be
most effective to lower LDL-cholesterol in this patient?
• A. colesevelam
• B. ezetimibe
• C. gemfibrozil
• D. niacin
• E. rosuvastatin
• A 6-year-old girl is brought to the emergency
department because of difficulty breathing after being
stung by a bee. She is in acute respiratory distress.
Examination shows urticaria and edematous eyes and
lips. Which of the following pharmacologic agents is
most likely to promptly relieve the respiratory distress?
• A. α₁-adrenergic agonist
• B. α₁-adrenergic antagonist
• C. α₂-adrenergic agonist
• D. α₂-adrenergic antagonist
• E. Β₁-adrenergic agonist
• F. β₁-adrenergic antagonist
• G. β₂-adrenergic agonist
• H. β₂-adrenergic antagonist
• An unconscious 40-year-old woman is brought to
the emergency department after taking an
overdose of a drug. For which of the following
drugs is a method for active removal from the
blood available using an immunologic strategy?
• A. digoxin
• B. parathion
• C. phenoxybenzamine
• D. tranylcypromine
• A 50-year-old man with schizophrenia develops
fever, catatonia and muscle rigidity 48 hours after
starting treatment with chlorpromazine. His
temperature is 39.2̊°C (102.5°F). Laboratory
studies show myoglobinemia and an increased
serum creatine kinase activity. Which of the
following is the most likely diagnosis?
• A. acute dystonia
• B. akathisia
• C. neuroleptic malignant syndrome
• D. parkinsonian syndrome
• E. tardive dyskinesia
• A 48-year-old man with coronary artery disease
and renal insufficiency starts treatment with
atorvastatin to decrease his serum cholesterol
concentration. If he needs additional
hypocholesterolemic therapy, which of the
following would be safest to avoid
rhabdomyolysis?
• A. cholestyramine
• B. fenofibrate
• C. fluvastatin
• D. gemfibrozil
• A 26-year-old woman with a stable asthma
wheezes when exposed to cats. Which of the
following is the appropriate prophylactic therapy?
• A. inhaled ipratropium
• B. oral cimetidine
• C. oral corticosteroids
• D. oral theophylline
• E. inhaled cromolyn
• An infant born to a 23-year-old female develops vomiting
and lethargy several days after birth. Physical examination
reveals hypertonicity and muscle rigidity. The mother also
notices an odor of burnt sugar in her diapers. Which of the
following amino acids should most likely be restricted in
this infant’s diet?
• A. phenyalanine
• B. tyrosine
• C. leucine
• D. histidine
• E. lysine
• F. methionine
• An RNA molecule isolated from a culture of grampositive bacteria consists of 90 nucleotides and
contains both dihydrouracil and acetylcytosine
residues. Which of the following is the most likely
composition of the 3’ end of this molecule?
• A. TATA
• B. CCA
• C. poly-A
• D. AUG
• E. methyguanosine triphosphate
• F. UAG