LE 1 Pregnancu

Question 1

A 29-year-old G2P1 (1001) pregnant woman at 33 weeks AOG by LMP came into the ER in preterm labor. She is hypertensive and diabetic with uncontrolled glucose levels. She is non-compliant with her medications. The attending OB-GYN decided to give her medication for fetal lung maturation. Which of the following is an adverse effect of a corticosteroid?
A. Increases risk for intrauterine growth restriction of the fetus
B. Decreases incidence of neonatal sepsis
C. Triggers increase in maternal glucose level
D. Induces fetal lung maturation

Answer 1

C. Triggers increase in maternal glucose level

Rationale: Corticosteroids, such as betamethasone and dexamethasone, are commonly given to pregnant women at risk of preterm labor to accelerate fetal lung maturation. One of the known adverse effects of corticosteroids is the elevation of maternal glucose levels, which is particularly significant in this case as the patient is diabetic with uncontrolled glucose levels.

Question 2

Which of the following clinical uses of uterine relaxants is NOT TRUE?
A. To prevent or arrest preterm labor
B. To treat severe dysmenorrhea during menses
C. To reverse inadvertent overstimulation
D. To facilitate intrauterine manipulations

Answer 2

B. To treat severe dysmenorrhea during menses

Rationale: Uterine relaxants, also known as tocolytics, are primarily used to prevent or arrest preterm labor, reverse uterine overstimulation, and facilitate intrauterine manipulations. They are not typically used to treat severe dysmenorrhea during menses, which is managed with other types of medication such as NSAIDs.

Question 3

A 25-year-old G2P1 (1001) at 33 weeks AOG came into the ER with regular uterine contractions. On PE: Uterine contractions were at 5-minute intervals, moderate; IE: 1 cm, beginning effacement, intact BOW, cephalic, St -2. After 2 hours, the patient’s uterine contractions decreased in interval and intensity. What is the first-line oral tocolytic agent that can be given to the patient?
A. Nifedipine
B. Diphenhydramine
C. Atosiban
D. Celecoxib

Answer 3

A. Nifedipine

Rationale: Nifedipine, a calcium channel blocker, is commonly used as a first-line oral tocolytic agent to manage preterm labor. It works by inhibiting calcium influx into smooth muscle cells, thereby reducing uterine contractions.

Question 4

Expressed in volume per unit of time:
A. Half-life
B. Clearance

Answer 4

B. Clearance

Rationale: Clearance is a pharmacokinetic parameter that describes the volume of plasma from which a drug is completely removed per unit time. It is often expressed in units such as mL/min or L/hr.

Question 5

Effects of aging on absorption, except:
A. Lower peak concentration
B. Delayed time to peak concentration
C. Overall bioavailability is decreased
D. Overall bioavailability is unchanged

Answer 5

C. Overall bioavailability is decreased

Rationale: Aging generally affects drug absorption by decreasing the rate of absorption, leading to a lower peak concentration and delayed time to peak concentration. However, the overall bioavailability of most drugs remains unchanged unless there are significant changes in first-pass metabolism or other age-related physiological changes.

Question 6

What factor affects drug transfer and drug effect on the fetus?
A. Rate of drug that crosses the placenta
B. Maternal bioavailability of the drug
C. Physical property of the drug
D. Volume of distribution

Answer 6

A. Rate of drug that crosses the placenta

Rationale: The rate at which a drug crosses the placenta is a critical factor affecting drug transfer and its effects on the fetus. Other factors such as maternal bioavailability, physical properties of the drug, and volume of distribution are also important but secondary to the rate of placental transfer.

Question 7

A patient is admitted with exacerbation of congestive heart failure. What would you expect to find during your admission assessment?
A. Flat neck and hand veins
B. Furrowed dry tongue
C. Increased blood pressure and crackles throughout the lungs
D. Bradycardia
E. Pitting edema in lower extremities

Answer 7

C. Increased blood pressure and crackles throughout the lungs

Rationale: Exacerbation of congestive heart failure typically presents with increased blood pressure due to fluid overload and crackles throughout the lungs from pulmonary congestion. Other findings may include pitting edema, but increased blood pressure and pulmonary crackles are more direct indicators of heart failure exacerbation.

Question 8

When a patient’s sodium serum level is 120 mEq/L, as the medical clerk on duty, your priority is to monitor the status of which body system?
A. Neurological
B. Gastrointestinal
C. Pulmonary
D. Hepatic
E. Endocrine

Answer 8

A. Neurological

Rationale: A sodium serum level of 120 mEq/L indicates significant hyponatremia, which can lead to neurological symptoms such as confusion, seizures, and even coma. Monitoring the neurological status is therefore a priority in managing severe hyponatremia.

Question 9

The time course and intensity of the pharmacologic effect of a drug:
A. Pharmacodynamics
B. Pharmacokinetics

Answer 9

A. Pharmacodynamics

Rationale: Pharmacodynamics refers to the study of the biochemical and physiological effects of drugs and their mechanisms of action, including the time course and intensity of drug effects.

Question 10

Which of the following is considered a mild adverse effect of OCPs?
A. Weight gain
B. Hirsutism
C. Withdrawal bleeding
D. Breakthrough bleeding

Answer 10

D. Breakthrough bleeding

Rationale: Breakthrough bleeding is a common and mild adverse effect of oral contraceptive pills (OCPs). Other effects such as weight gain, hirsutism, and withdrawal bleeding can occur but are less common or not considered mild adverse effects.

Question 11

What is the teratogenic effect of barbiturates when taken during the critical period in a developing embryo or fetus?
A. Neural tube defect
B. Neonatal lethargy
C. Neonatal dependence
D. Neonatal toxicity

Answer 11

A. Neural tube defect

Rationale: Barbiturates have been associated with an increased risk of congenital malformations, including neural tube defects, when taken during the critical period of embryonic development. Other effects such as neonatal lethargy, dependence, and toxicity are possible but are not classified as teratogenic effects.

Question 12

A 25-year-old G2P1 (1001) at 33 weeks AOG came into the ER with regular uterine contractions. On PE: Uterine contractions were at 5-minute intervals, moderate; IE: 1 cm, beginning effacement, intact BOW, cephalic, St -2. After 24 hours, the patient again had regular uterine contractions with increasing intensity and frequency. You decided to use Magnesium sulfate for neuroprotection in case labor ensues. What is the mode of action of MgSO4?
A. MgSO4 limits Ca++ influx by blocking L-type Ca channels in smooth muscle.
B. MgSO4 inhibits prostaglandin synthesis by inhibiting cyclooxygenase.
C. MgSO4 inhibits oxytocin receptors during active labor.
D. MgSO4 acts as a divalent cation and competes with Ca++ in myometrial cells.

Answer 12

D. MgSO4 acts as divalent cation and competes with Ca++ in myometrial cells.

Rationale: Magnesium sulfate’s mechanism of action in the context of preterm labor is related to its role as a divalent cation that competes with calcium ions (Ca++) in myometrial cells. This competition reduces calcium availability for muscle contraction, thereby relaxing the uterine muscles and potentially delaying labor.

Question 13

This is an anti-progestin that can be used as a post-coital contraceptive:
A. Misoprostol
B. Mifepristone
C. Both A & B
D. Neither A & B

Answer 13

B. Mifepristone

Rationale: Mifepristone is an anti-progestin that can be used as a post-coital contraceptive. It works by blocking the action of progesterone, which is necessary for maintaining pregnancy. Misoprostol, on the other hand, is a prostaglandin used to induce uterine contractions and is not used as a post-coital contraceptive on its own.

Question 14

What FDA category of drugs can be given to pregnant patients?
A. Category A
B. Category B
C. Category C
D. Category A & B
E. Category A, B, C

Answer 14

D. Category A & B

Rationale: FDA categories A and B drugs are considered safe for use in pregnant patients. Category A drugs have been shown to pose no risk to the fetus in controlled human studies, while Category B drugs have shown no evidence of harm in animal studies and no adequate studies in humans, or have shown adverse effects in animals but not in controlled human studies. Category C drugs should be used with caution as they have shown adverse effects in animal studies and lack adequate human studies.

Question 15

Phase I metabolic pathway:
A. Converts to inactive metabolites
B. Converts to metabolites of greater activity
C. Converts to metabolites of equal activity
D. Converts to metabolites of lesser activity

Answer 15

B. Converts to metabolites of greater activity

Rationale: Phase I metabolic pathways often introduce or unmask a functional group (such as hydroxyl, amine, or carboxyl) on the drug molecule through oxidation, reduction, or hydrolysis reactions. These modifications can lead to the formation of metabolites that are more active, less active, or equally active compared to the parent drug. However, it is commonly associated with increasing activity or preparing for further metabolism in Phase II.

Question 16

Potential serious adverse reactions to contraceptives include:
A. Myocardial infarction
B. Pulmonary embolism
C. Thrombophlebitis
D. All of the above

Answer 16

D. All of the above

Rationale: Serious adverse reactions to contraceptives can include myocardial infarction, pulmonary embolism, and thrombophlebitis, particularly in women who smoke or have other risk factors for cardiovascular disease.

Question 17

Progesterone is synthesized in the following, EXCEPT:
A. Ovary
B. Placenta
C. Testes
D. Adrenals

Answer 17

C. Testes

Rationale: Progesterone is primarily synthesized in the ovaries, placenta, and adrenal glands. The testes primarily produce androgens such as testosterone, not progesterone.

Question 18

Renal tubule reabsorption is affected by hormones:
A. Aldosterone
B. Renin/angiotensin
C. Atrial Natriuretic Peptide (ANP)
D. All of the above
E. A and B only

Answer 18

D. All of the above

Rationale: Renal tubule reabsorption is influenced by several hormones including aldosterone, the renin-angiotensin system, and atrial natriuretic peptide (ANP), which all play roles in regulating fluid and electrolyte balance.

Question 19

Phase 1 Metabolic Pathway includes:
A. Oxidation
B. Glucuronidation
C. Conjugation
D. Acetylation

Answer 19

A. Oxidation

Rationale: Phase I metabolic reactions involve the introduction or unmasking of a functional group on the drug molecule, commonly through oxidation. Glucuronidation, conjugation, and acetylation are typically Phase II reactions that involve the conjugation of the drug with another substance to increase its water solubility for excretion.

Question 20

This FDA teratogenic risk category is described as either studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women OR studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the fetus.
A. Category A
B. Category B
C. Category C
D. Category D
E. Category X

Answer 20

C. Category C

Question 21

What is the teratogenic effect of valproic acid when taken during the critical period in a developing embryo or fetus?
A. Neural tube defect
B. Fetal anemia
C. Hypothyroidism
D. Hypoplastic nasal bridge

Answer 21

A. Neural tube defect

Rationale: Valproic acid is well-documented to increase the risk of neural tube defects when taken during the critical period of embryonic development. This is why it is often contraindicated or used with extreme caution in pregnant women.

Question 22

Estrogen is secreted in the following:
A. Corpus luteum
B. Placenta
C. Testes
D. All of the above

Answer 22

D. All of the above

Rationale: Estrogen is secreted by the corpus luteum, placenta, and testes. It plays significant roles in various reproductive and physiological processes in both males and females.

Question 23

This anti-estrogen drug acts as a competitive inhibitor, which prevents bone loss and has a stimulatory effect on the uterus:
A. Raloxifene
B. Toremifene
C. Tamoxifen
D. Any of the above

Answer 23

B. Toremifene

Rationale: Toremifene is an anti-estrogen drug that acts as a competitive inhibitor. It is known to prevent bone loss and has a stimulatory effect on the uterus, which distinguishes it from other selective estrogen receptor modulators (SERMs) like raloxifene, which does not stimulate the uterus but still prevents bone loss and decreases atherosclerosis.

Question 24

This anti-estrogen drug stimulates ovulation by preventing feedback inhibition:
A. Cyproterone acetate
B. Clomiphene citrate
C. Toremifene
D. Tamoxifen

Answer 24

B. Clomiphene citrate

Rationale: Clomiphene citrate is an anti-estrogen that stimulates ovulation by blocking estrogen receptors in the hypothalamus, preventing feedback inhibition and thereby increasing the release of gonadotropins (LH and FSH).

Question 25

This drug is better absorbed when given with food:
A. Ciprofloxacin
B. Cefuroxime
C. Both
D. Neither

Answer 25

B. Cefuroxime

Rationale: Cefuroxime is better absorbed when taken with food, which enhances its bioavailability. Ciprofloxacin’s absorption can be impaired by the presence of certain food components, especially dairy products.

Question 26

Edema is the accumulation of fluid within the interstitial spaces, which may be caused by the following EXCEPT:
A. Increased plasma osmotic pressure
B. Increased hydrostatic pressure
C. Increased capillary membrane permeability
D. Lymphatic channel obstruction
E. C and D only

Answer 26

A. Increased plasma osmotic pressure

Rationale: Edema is typically caused by factors that lead to fluid leakage into the interstitial spaces, such as increased hydrostatic pressure, increased capillary membrane permeability, and lymphatic channel obstruction. Increased plasma osmotic pressure, however, tends to pull fluid back into the vascular compartment, reducing the likelihood of edema.

Question 27

The hormones aldosterone and ADH both have an important function in:
A. Fluid balance in the body
B. The regulation of acid concentration in the body
C. Stimulation of a conscious desire for water
D. The activity of buffer systems

Answer 27

A. Fluid balance in the body

Rationale: Both aldosterone and antidiuretic hormone (ADH) play crucial roles in maintaining fluid balance in the body. Aldosterone promotes sodium and water reabsorption in the kidneys, while ADH increases water reabsorption in the renal collecting ducts.

Question 28

Which of the following is a contraindication to giving estrogen?
A. Pregnant women
B. Undiagnosed genital bleeding
C. History of DVT
D. All of the above

Answer 28

D. All of the above

Rationale: Estrogen is contraindicated in pregnant women, in cases of undiagnosed genital bleeding, and in individuals with a history of deep vein thrombosis (DVT) due to the increased risk of adverse effects and complications in these conditions.

Question 29

What drug causes discoloration and defects on teeth?
A. Cytarabine
B. Amphetamines
C. Carbamazepine
D. Tetracycline

Answer 29

D. Tetracycline

Rationale: Tetracycline antibiotics are known to cause discoloration and defects in teeth, especially when administered to children whose teeth are still developing.

Question 30

A high sodium diet:
A. Decreases lithium excretion
B. Increases lithium excretion
C. Has no effect on lithium excretion
D. Increases lithium blood level

Answer 30

B. Increases lithium excretion

Rationale: A high sodium diet increases the excretion of lithium because the kidneys process sodium and lithium similarly. Increased sodium intake leads to increased lithium excretion, potentially lowering lithium blood levels and reducing its therapeutic efficacy.

Question 31

Which of the following molecular weights is categorized as “easy” to cross the placenta?
A. 100-200 daltons
B. 200-300 daltons
C. 250-500 daltons
D. 350-500 daltons

Answer 31

C. 250-500 daltons

Rationale: The provided image indicates that molecules with a molecular weight of 250-500 daltons are categorized as “easy” to cross the placenta. This range allows for efficient placental transfer compared to higher molecular weights, which have more difficulty crossing the placenta.

Question 32

Which is NOT a part of the major groups of uterine stimulants?
A. Estrogen receptor antagonists
B. Prostaglandins
C. Oxytocin
D. Ergot alkaloids

Answer 32

A. Estrogen receptor antagonists

Rationale: The major groups of uterine stimulants include prostaglandins, oxytocin, and ergot alkaloids. Estrogen receptor antagonists are not typically used as uterine stimulants.

Question 33

A 29-year-old G2P1 (1001) pregnant woman at 33 weeks AOG by LMP came into the ER in preterm labor. She is hypertensive and diabetic with uncontrolled glucose levels. She is non-compliant with her medications. The attending OB-GYN decided to give her medication for fetal lung maturation. The patient is currently taking an anticoagulant. Which is SAFE during pregnancy?
A. Warfarin
B. Heparin
C. Coumadin
D. Clopidogrel

Answer 33

B. Heparin

Rationale: Heparin is considered safe during pregnancy as it does not cross the placenta. Warfarin, Coumadin, and Clopidogrel have potential risks and are generally avoided.

Question 33

This is a non-steroidal aromatase inhibitor that is used for breast cancer and can also be used for ovulation induction:
A. Anastrazole
B. Exemestane
C. Tamoxifen
D. Letrozole

Answer 33

D. Letrozole

Rationale: Letrozole is a non-steroidal aromatase inhibitor used primarily for treating breast cancer but is also used off-label for inducing ovulation.

Question 34

If a nursing mother must take medications and the drug is a relatively safe one, she should optimally take it how many hours before the next feeding?
A. 1-2 hours
B. 2-3 hours
C. 3-4 hours
D. 4-5 hours

Answer 34

C. 3-4 hours

Rationale: The provided image confirms that if a nursing mother must take medications and the drug is relatively safe, she should optimally take it 30-60 minutes after nursing and 3-4 hours before the next feeding. This timing helps to minimize the drug’s presence in the breast milk during the next feeding.

Question 35

After obtaining an EKG on a patient, you notice that ST depression is present along with an inverted T wave and prominent U wave. What lab value would be the cause of this finding?
A. Potassium level of 2.2
B. Potassium level of 5.6
C. Magnesium level of 2.3
D. Phosphorus level of 2.0
E. Sodium level of 167.0

Answer 35

A. Potassium level of 2.2

Rationale: A potassium level of 2.2 indicates hypokalemia, which can cause EKG changes such as ST depression, inverted T waves, and prominent U waves.

Question 36

Protein malnutrition:
A. Increases the possibility of bleeding with warfarin
B. Decreases the activity of warfarin
C. Decreases the therapeutic effect of phenytoin
D. Increases the breakdown of both warfarin and phenytoin

Answer 36

A. Increases the possibility of bleeding with warfarin

Rationale: Protein malnutrition decreases the levels of plasma proteins, which warfarin binds to. This increases the free (active) warfarin, raising the risk of bleeding.

Question 37

Which of the following malformations is/are effects of isotretinoin when given at a critical period?
A. Cleft palate
B. Thymic aplasia
C. Neural tube defects
D. All of the above

Answer 37

D. All of the above

Rationale: Isotretinoin, a retinoid used to treat severe acne, is known to cause multiple malformations if taken during pregnancy. These include cleft palate, thymic aplasia, and neural tube defects among others.

Question 38

Which patient is at most risk for fluid volume deficit?
A. A patient who has been vomiting and having diarrhea for 2 days
B. A patient with continuous nasogastric suction
C. A patient with an abdominal wound vac at intermittent suction
D. All of the above are correct
E. A and B only

Answer 38

E. A and B only

Rationale: Both patients who have been vomiting and having diarrhea for 2 days and those with continuous nasogastric suction are at high risk for fluid volume deficit due to significant fluid loss. A patient with an abdominal wound vac at intermittent suction has some risk but typically less than the first two conditions.

Question 39

What is the major branch of the umbilical vein that traverses the liver to enter the inferior vena cava directly?
A. Ductus venosus
B. Portal sinus
C. Umbilical artery
D. Umbilical vein

Answer 39

A. Ductus venosus

Rationale: The ductus venosus is the major branch of the umbilical vein that bypasses the liver and directly enters the inferior vena cava, allowing oxygenated blood from the placenta to reach the fetal heart efficiently.

Question 40

This can be an indication to give progesterone:
A. Dysmenorrhea
B. Endometriosis
C. Hormonal replacement therapy
D. All of the above

Answer 40

D. All of the above

Rationale: Progesterone can be indicated for dysmenorrhea, endometriosis, and hormone replacement therapy, as it plays a role in regulating the menstrual cycle, alleviating symptoms, and balancing hormones.

Question 41

What drug causes Gray Baby Syndrome in neonates during lactation?
A. Radioactive iodine
B. Chloramphenicol
C. Chloral hydrate
D. Theophylline

Answer 41

B. Chloramphenicol

Rationale: Chloramphenicol can cause Gray Baby Syndrome in neonates due to their inability to metabolize the drug effectively, leading to toxicity.

Question 42

Clinical manifestations of hypokalemia:
A. Weakness, flaccid paralysis, respiratory arrest, constipation
B. Dysrhythmias, appearance of U wave
C. Postural hypotension
D. A and B only
E. All of the above

Answer 42

E. All of the above

Rationale: Hypokalemia can manifest with various symptoms, including weakness, flaccid paralysis, respiratory arrest, constipation, dysrhythmias, appearance of a U wave, and postural hypotension.

Question 43

An anti-androgen drug that inhibits binding to androgen receptor used to treat hirsutism:
A. Clomiphene
B. Cyproterone
C. Spironolactone
D. Danazol

Answer 43

B. Cyproterone

Rationale: Cyproterone acetate is an anti-androgen that inhibits binding to the androgen receptor, making it effective in treating hirsutism by reducing androgenic effects.

Question 44

A 25-year-old G2P1 (1001) at 33 weeks AOG came into the ER with regular uterine contractions. On PE: Uterine contractions were at 5-minute intervals, moderate; IE: 1 cm, beginning effacement, intact BOW, cephalic, St -2. If the patient is asthmatic, what tocolytic agent should NOT be given because of the risk of pulmonary edema?
A. Nifedipine
B. Nitric oxide
C. Terbutaline
D. Magnesium sulfate

Answer 44

C. Terbutaline

Rationale: Terbutaline, a beta-agonist used as a tocolytic, can increase the risk of pulmonary edema, particularly in asthmatic patients. Therefore, it is generally avoided in such cases.

Question 44

Which of the following statements is a physiologic effect of progesterone?
A. It is an important intermediate in steroid biogenesis.
B. Increases plasma levels of amino acids.
C. Decreases body temperature.
D. It affects protein and carbohydrate metabolism.

Answer 44

A. It is an important intermediate in steroid biogenesis.

Rationale: Progesterone is crucial as an intermediate in the biosynthesis of other steroid hormones. It also affects protein and carbohydrate metabolism and can increase body temperature, but the correct answer addresses its role in steroid biogenesis.

Question 45

What drug causes neonatal narcotic dependence in neonates during lactation?
A. Radioactive iodine
B. Chloramphenicol
C. Chloral hydrate
D. Theophylline
E. Opioids (Heroin, Methadone, and Morphine)

Answer 45

E. Opioids (Heroin, Methadone, and Morphine)

Rationale: Opioids such as heroin, methadone, and morphine can cause neonatal narcotic dependence when taken by a nursing mother, as these substances can pass into breast milk and affect the infant.

Question 46

What cervical ripening agent can be given during the induction or augmentation of labor?
A. PGE2
B. PGF2 Alpha
C. Oxytocin
D. Atosiban

Answer 46

A. PGE2

Rationale: Prostaglandin E2 (PGE2) is commonly used for cervical ripening and can be administered during the induction or augmentation of labor to soften and dilate the cervix.

Question 47

Drugs that have crossed the placenta enter the fetal circulation through:
A. Ductus venosus
B. Portal sinus
C. Umbilical artery
D. Umbilical vein

Answer 47

D. Umbilical vein

Rationale: Drugs that have crossed the placenta enter the fetal circulation through the umbilical vein, which carries oxygenated blood and nutrients from the placenta to the fetus.

Question 48

Which is associated with neonatal withdrawal syndrome?
A. Amphetamine
B. Barbiturates
C. Antidepressants
D. Cocaine

Answer 48

C. Antidepressants

Rationale: The provided image confirms that tricyclic antidepressants such as clomipramine, desipramine, and imipramine have been associated with neonatal withdrawal symptoms. This highlights the potential for withdrawal syndrome in neonates exposed to these medications in utero.

Question 49

A 29-year-old G2P1 (1001) pregnant woman at 33 weeks AOG by LMP came into the ER in preterm labor. She is hypertensive and diabetic with uncontrolled glucose levels. She is non-compliant with her medications. The attending OB-GYN decided to give her medication for fetal lung maturation. What corticosteroid can be given to this patient?
A. Prednisone
B. Dexamethasone
C. Hydrocortisone
D. Clobetasol

Answer 49

B. Dexamethasone

Rationale: Dexamethasone is commonly given to promote fetal lung maturation in preterm labor. It is effective and safe for use in pregnant women with complications such as hypertension and diabetes.

Question 50

During induction of labor, oxytocin infusion may be started how many hours after the removal of prostaglandins?
A. 6 hours
B. 8 hours
C. 12 hours
D. 18 hours

Answer 50

A. 6 hours

Rationale: It is generally recommended to wait at least 6 hours after the removal of prostaglandin preparations before starting an oxytocin infusion to minimize the risk of uterine hyperstimulation and other complications.

Question 51

The following are teratogenic effects of smoking, except:
A. Neural tube defect
B. IUGR
C. Preterm birth
D. None of the above

Answer 51

A. Neural tube defect

Rationale: The teratogenic effects of smoking during pregnancy include intrauterine growth restriction (IUGR) and preterm birth. Neural tube defects are not typically associated with smoking; rather, they are more commonly linked to folic acid deficiency and other factors.

Question 52

Which of the following barbiturates induce fetal hepatic enzymes and are responsible for glucuronidation of bilirubin, decreasing the incidence of jaundice?
A. Thiopental
B. Phenobarbital
C. Pentobarbital
D. Amobarbital

Answer 52

B. Phenobarbital

Rationale: Phenobarbital is known to induce fetal hepatic enzymes, which are responsible for the glucuronidation of bilirubin, thereby decreasing the incidence of jaundice in neonates.

Question 53

Which of the following statements is true regarding combined oral contraceptive pills (OCP)?
A. Estrogen inhibits secretion of FSH via positive feedback on the anterior pituitary.
B. Progesterone inhibits FSH and thus prevents ovulation.
C. Estrogen suppresses the development of an ovarian follicle.
D. Cervical mucus becomes less viscous, thus less favorable for sperm entry.

Answer 53

C. Estrogen suppresses the development of an ovarian follicle.

Rationale: Estrogen in combined oral contraceptive pills works by suppressing the development of an ovarian follicle through negative feedback on the hypothalamus and pituitary, reducing the secretion of follicle-stimulating hormone (FSH). Progesterone primarily inhibits the luteinizing hormone (LH) surge to prevent ovulation.

Question 54

Which of the following statements is a physiologic effect of estrogen?
A. Inhibits follicular growth in ovaries
B. Cornification of epithelial cells with thinning of the epithelium in the vagina
C. Increase of cervical mucus with lowered viscosity
D. Thinning of the endometrial lining

Answer 54

C. Increase of cervical mucus with lowered viscosity

Rationale: Estrogen increases the production of cervical mucus and lowers its viscosity, making it more favorable for sperm entry. This change in cervical mucus is part of the normal menstrual cycle.

Question 55

Alendronate should be:
A. Taken with food
B. Taken with something acidic like juice
C. Increased with intake of caffeine
D. Taken two hours before a meal

Answer 55

D. Taken two hours before a meal

Rationale: Alendronate should be taken on an empty stomach with a full glass of water, at least 30 minutes to 2 hours before the first meal, beverage, or medication of the day to ensure optimal absorption.

Question 56

Regulating electrolytes is important for:
A. Maintenance of fluid balance
B. Contributing to acid-base regulation
C. Facilitating enzyme reactions
D. Transmitting neuromuscular reactions
E. All of the above

Answer 56

E. All of the above

Rationale: Electrolytes are crucial for maintaining fluid balance, contributing to acid-base regulation, facilitating enzyme reactions, and transmitting neuromuscular reactions. All of these functions are vital for normal physiological processes.

Question 57

A 25-year-old G2P1 (1001) at 33 weeks AOG came into the ER with regular uterine contractions. On PE: Uterine contractions were at 5-minute intervals, moderate; IE: 1 cm, beginning effacement, intact BOW, cephalic, St -2. What is the best treatment option for this patient, due to its rapid onset and short half-life?
A. Nifedipine
B. Nitric oxide
C. Terbutaline (Half-life 2 hrs)
D. Magnesium sulfate

Answer 57

C. Terbutaline (Half-life 2 hrs)

Rationale: Terbutaline is a beta-agonist that has a rapid onset and a relatively short half-life of about 2 hours, making it effective for the short-term management of preterm labor by relaxing the uterine muscles.

Question 58

What is the estrogen component of a combined oral contraceptive pill?
A. Norgestimate
B. Norethindrone
C. Ethinyl estradiol
D. Desogestrel

Answer 58

C. Ethinyl estradiol

Rationale: Ethinyl estradiol is the estrogen component commonly used in combined oral contraceptive pills. The other options (Norgestimate, Norethindrone, and Desogestrel) are progestins.

Question 59

A major stimulus for the release of antidiuretic hormone is:
A. Inhibition of the osmoreceptors
B. A rise in plasma osmolality
C. An increase in potassium levels in the ICF
D. Stimulation of the baroreceptors
E. An increase in ECF water concentration

Answer 59

B. A rise in plasma osmolality

Rationale: A rise in plasma osmolality is a major stimulus for the release of antidiuretic hormone (ADH). This hormone helps to retain water in the body, thereby reducing plasma osmolality.

Question 60

Fraction of a drug dose reaching the systemic circulation:
A. Absorption
B. Bioavailability
C. Distribution
D. Therapeutic level

Answer 60

B. Bioavailability

Rationale: Bioavailability is the fraction of an administered dose of a drug that reaches the systemic circulation in an active form.

Question 61

If a teratogen was given at 4-5 weeks embryonic period, the following fetal parts will be affected, EXCEPT:
A. Eyes
B. Limbs
C. CVS
D. CNS

Answer 61

D. CNS

Rationale: At 4-5 weeks of the embryonic period, critical development is occurring for the eyes, limbs, and cardiovascular system (CVS). The central nervous system (CNS) is also developing, but its critical period extends beyond this timeframe.

Question 62

When an excess of body fluid exists in the intravascular compartment, all of the following signs can be expected except:
A. Rales
B. A bounding pulse
C. Engorged peripheral veins
D. An elevated hematocrit level
E. Puffy eyelids

Answer 62

D. An elevated hematocrit level

Rationale: An elevated hematocrit level is typically associated with dehydration or a reduced plasma volume, not excess intravascular fluid. Signs of fluid overload include rales, a bounding pulse, engorged peripheral veins, and puffy eyelids.

Question 63

The major source of water loss from the body is:
A. Sweat
B. Insensible respiratory loss
C. Feces
D. Urine
E. Insensible skin loss

Answer 63

D. Urine

Rationale: The major source of water loss from the body is through urine. Other sources include sweat, insensible respiratory loss, feces, and insensible skin loss, but urine accounts for the largest amount.

Question 64

Phase II Metabolic pathway includes:
A. Hydroxylation
B. Dealkylation
C. Conjugation
D. Reduction

Answer 64

C. Conjugation

Rationale: Phase II metabolic pathways include conjugation reactions, which involve the attachment of a drug to another substance to increase its water solubility and facilitate excretion.

Question 65

Which of the following statements is TRUE for a teratogen?
A. Exerts its effect on all particular stages of fetal development
B. Shows a dose-dependent incidence
C. Non-selective in affecting organs
D. Results in characteristic malformations

Answer 65

B. Shows a dose-dependent incidence

Rationale: Teratogens show a dose-dependent incidence, meaning the likelihood and severity of fetal abnormalities increase with the dosage and duration of exposure. They typically affect specific stages of fetal development and can result in characteristic malformations.

Question 66

These are natural estrogens, EXCEPT:
A. Estriol
B. Estrone
C. Ethinyl estradiol
D. 17B-Estradiol

Answer 66

C. Ethinyl estradiol

Rationale: Ethinyl estradiol is a synthetic estrogen used in contraceptives, whereas estriol, estrone, and 17β-estradiol are natural estrogens.

Question 67

Which of the following may be a possible cause of edema in the tissues?
A. Decreased blood pressure
B. Decreased level of proteins in the plasma
C. The ingestion of a large amount of carbohydrates in the diet
D. Reduced temperature at the skin surface

Answer 67

B. Decreased level of proteins in the plasma

Rationale: A decreased level of plasma proteins (hypoalbuminemia) reduces the osmotic pressure, causing fluid to leak into tissues and resulting in edema. Other options do not typically cause edema.

Question 68

Which of the following is the goal of therapeutics?
A. To achieve the maximum effect of the drug, with minimal adverse effects
B. To achieve the desired beneficial effect, with minimal adverse effects
C. To achieve the desired beneficial effect, with no adverse effects
D. To achieve the maximum effect of the drug, with no adverse effects

Answer 68

B. To achieve the desired beneficial effect, with minimal adverse effects

Rationale: The primary goal of therapeutics is to achieve the desired beneficial effect of a drug while minimizing adverse effects.

Question 69

The intracellular fluid compartment refers to all the water found in:
A. The bones of the body
B. Areas outside the body cells
C. Areas within the gastrointestinal tract
D. All cells of the body

Answer 69

D. All cells of the body

Rationale: The intracellular fluid compartment includes all the water found within the cells of the body.

Question 70

NSAIDs + Hypertension can lead to:
A. Urinary retention
B. Constipation
C. Fluid retention
D. Hypoxia

Answer 70

C. Fluid retention

Rationale: NSAIDs can lead to fluid retention, which can exacerbate hypertension.

Question 71

A type of combination oral contraceptive which provides varying amounts of progestin but a constant amount of estrogen:
A. Monophasic
B. Biphasic
C. Triphasic
D. Any of the above

Answer 71

B. Biphasic

Rationale: Biphasic combination oral contraceptives provide varying amounts of progestin while maintaining a constant level of estrogen.

Question 72

The first pass effect of medication in the geriatric population is:
A. Increased
B. Decreased

Answer 72

B. Decreased

Rationale: The first pass effect is generally decreased in the geriatric population due to reduced liver function and blood flow.

Question 73

What is the teratogenic effect of warfarin when taken during the critical period in a developing embryo or fetus?
A. Neural tube defect
B. Fetal anemia
C. Hypothyroidism
D. Hypoplastic nasal bridge

Answer 73

D. Hypoplastic nasal bridge

Rationale: Warfarin is known to cause specific teratogenic effects, including hypoplastic nasal bridge and stippled epiphyses, when taken during pregnancy.

Question 74

Which of the following drugs can increase serum estrogen levels when given concomitantly with OCP?
A. Phenytoin
B. Phenobarbital
C. Atorvastatin
D. Prednisone

Answer 74

C. Atorvastatin

Rationale: Atorvastatin can increase serum estrogen levels when given concomitantly with oral contraceptives by inhibiting their metabolism.

Question 75

Which is not a cause of hypokalemia?
A. Insulin administration
B. Adrenaline infusion
C. Alkalosis
D. Digoxin overdose

Answer 75

D. Digoxin overdose

Rationale: Digoxin overdose typically leads to hyperkalemia, not hypokalemia. Insulin administration, adrenaline infusion, and alkalosis are known causes of hypokalemia.