lippincott questions

Question 1

A 43-year-old heavy machine operator complains of seasonal allergies. Which one of the following medi- cations would be most appropriate for management of his allergy symptoms?

A. Cyclizine.
B. Doxylamine.
C. Hydroxyzine.
D. Fexofenadine.

Answer 1

D

Question 2

Which one of the following statements concerning
H1 antihistamines is correct?

A. Second-generation H1 antihistamines are
relatively free of adverse effects.
B. Because of the established long-term safety of
first-generation H1 antihistamines, they are the
first choice for allergic rhinitis.
C. The motor coordination involved in driving an
automobile is not affected by the use of first-
generation H1 antihistamines.
D. H1 antihistamines can be used in the treatment of
acute anaphylaxis.
E. Both first- and second-generation H1 antihistamines readily penetrate the blood–
brain barrier.

Answer 2

A

Question 3

Which of the following medications has the most
potential to significantly impair the ability to drive an automobile?

A. Diphenhydramine.
B. Levocetirizine.
C. Fexofenadine.
D. Ranitidine.

Answer 3

A

Question 4

Which of the following histamine receptor antagonists is known to enter the central nervous system readily and is known to be sedative?

A. Hydroxyzine.
B. Cetirizine.
C. Desloratadine.
D. Loratadine.
E. Fexofenadine.

Answer 4

A

Question 5

Which of the following statements about histamine receptor antagonists is MOST ACCURATE?
A. Most antihistamines have no antimuscarinic effects.
B. Alpha Adrenergic effects of antihistamines may cause
hypertension.
C. First-generation antihistamines have no sedative
side effects.
D. Because of their cholinergic properties,
antihistamines may not be effective in the relief of
vertigo associated with motion sickness.
E. Headache may be associated with some second-
generation antihistamines.

Answer 5

E

Question 6

A passenger sitting next to you in a plane boasts that
he was a famous biochemist. He said he carboxylated a sedating antihistamine, and it is now only partially sedating and is a very well-known drug in the market. Which drug is he talking about?
A. Hydroxyzine.
B. Cetirizine.
C. Diphenhydramine.
D. Doxylamine.
E. Cyproheptadine.

Answer 6

B

Question 7

Which of the following is an H1-receptor antagonist that also has serotonin receptor antagonism on the appetite center with the ability to stimulate appetite?
A. Hydroxyzine.
B. Loratadine.
C. Diphenhydramine.
D. Cetirizine.
E. Cyproheptadine.

Answer 7

E

Question 8

Your neighbor said she used an H1 antihistamine that was available over-the-counter (OTC), and it caused her marked drowsiness and dry mouth and she slept quite longer than usual. Which is the most possible drug that she used?
A. Loratadine.
B. Levocetirizine.
C. Diphenhydramine.
D. Fexofenadine.
E. Desloratadine.

Answer 8

C

Question 9

A patient is going on a deep sea fishing trip and is worried about motion sickness. Which of the following would be the most appropriate?
A. Dimenhydrinate 1 hour prior to departure.
B. Desloratadine 1 hour prior to departure.
C. Doxylamine 1 hour prior to departure.
D. Meclizine at onset of symptoms.

Answer 9

A

Question 10

A patient has a severe ear infection that is associated
with significant vertigo. Which of the following might be helpful?
A. Azelastine.
B. Brompheniramine.
C. Meclizine.
D. Olopatadine.

Answer 10

C

Question 11

A 43-year-old heavy machine operator complains of
seasonal allergies. Which medication is most appro-
priate for management of his allergy symptoms?
A. Diphenhydramine
B. Doxylamine
C. Hydroxyzine
D. Fexofenadine

Answer 11

D

Question 12

Which histamine receptor antagonist is known to
enter the central nervous system readily and cause sedation?
A. Hydroxyzine
B. Cetirizine
C. Desloratadine
D. Loratadine

Answer 12

A

Question 13

Which drug is an H1-receptor antagonist that also has serotonin receptor antagonism on the appetite center, with the ability to stimulate appetite?
A. Hydroxyzine
B. Loratadine
C. Diphenhydramine
D. Cyproheptadine

Answer 13

D

Question 14

Which drug for headache is contraindicated in
patients with peripheral vascular disease?
A. Ergotamine
B. Aspirin
C. Acetaminophen
D. Naproxen

Answer 14

A

Question 15

A 29-year-old woman complains of migraine
LIR_CH39.indd 690 headaches associated with early onset vomiting. Currently, she uses ibuprofen as needed for her migraines, but it is not very effective. Which triptan would be ideal for this patient?
A. Naratriptan
B. Zolmitriptan
C. Frovatriptan
D. Almotriptan

Answer 15

B

Question 16

A 35-year-old woman is having several severe
migraines per month. The migraines are usually relieved with one or two doses of triptan drugs. Which is most appropriate for prophylaxis to reduce the frequency of her migraines?
A. Dihydroergotamine
B. Ibuprofen
C. Propranolol
D. Sumatriptan

Answer 16

C

Question 17

A 27-year-old married woman is asking about
treatment options for obesity. She recently stopped taking her birth control medications, as she felt they were contributing to her weight gain. Which medication should be avoided in this patient?
A. Phentermine/topiramate
B. Orlistat
C. Diethylproprion
D. Lorcaserin

Answer 17

A

Question 18

A fellow healthcare provider is concerned about
prescribing orlistat to adolescent patients. Many of his adolescent patients are stopping the med- ication during the 1st month of treatment. Which side effect is the most likely reason the adoles- cents are stopping orlistat?
A. Valvulopathy
B. Suicidal ideation
C. Drowsiness
D. Flatulence

Answer 18

D

Question 19

A 38-year-old obese man with depression is con-
sidering a weight loss medication following sev- eral failed attempts with diet and exercise. Which medication could be considered in this individual?
A. Liraglutide
B. Bupropion + naltrexone
C. Orlistat
D. Lorcaserin

Answer 19

C

Question 20

A 64-year-old man presents with mild-to- moderate
musculoskeletal back pain. He states he has tried
paracetamol without relief. His medical history
includes diabetes, hypertension, hyperlipidemia,
gastric ulcer (resolved), and coronary artery dis-
ease. Which is the most appropriate NSAID regi-
men to treat this patient’s pain?
A. Celecoxib
B. Indomethacin and omeprazole
C. Naproxen and omeprazole
D. Naproxen

Answer 20

C

Question 21

Which statement is correct regarding the difference
between paracetamol and naproxen?
A. Paracetamol has more anti-in”ammatory effects
compared with naproxen.
B. Paracetamol has more GI side effects but less
NSAIDs like naproxen.
C. Paracetamol has less risk for CV events com-
effects similar to other NSAIDs.
D. Paracetamol has fewer antipyretic effects than
naproxen.

Answer 21

C

Question 22

Which statement correctly describes the proposed
mechanism of cardioprotection from low-dose aspirin?
A. Aspirin preferentially inhibits COX-2 to lead to a
relative reduction in thromboxane A2 levels.
B. Aspirin preferentially inhibits COX-1 to lead to a
relative reduction in thromboxane A2 levels.
C. Aspirin preferentially inhibits COX-2 to lead to a
relative reduction in prostacyclin levels.
D. Aspirin preferentially inhibits COX-1 to lead a
relative reduction in prostacyclin levels.

Answer 22

B

Question 23

Which statement correctly describes the proposed
mechanism of cardioprotection from low-dose aspirin?
A. Aspirin preferentially inhibits COX-2 to lead to a
relative reduction in thromboxane A2 levels.
B. Aspirin preferentially inhibits COX-1 to lead to a
relative reduction in thromboxane A2 levels.
C. Aspirin preferentially inhibits COX-2 to lead to a
relative reduction in prostacyclin levels.
D. Aspirin preferentially inhibits COX-1 to lead a
relative reduction in prostacyclin levels.

Answer 23

C

Question 24

Which statement correctly describes the patho-
physiologic actions of prostaglandins at a target tissue?
A. Promote vasoconstriction in the kidneys
B. Promote sodium and water retention in the
kidneys
C. Decrease secretion of mucus at the lining of the
stomach
D. Decrease secretion of gastric acid in the stomach

Answer 24

C

Question 25

Which prostaglandin agents can be used to
maintain the patency of the ductus arteriosus in neonates with congenital heart problems while awaiting surgery? A. Misoprostol B. Epoprostenol C. Bimatoprost D. Alprostadil

Answer 25

D

Question 26

A 34-year-old woman with RA is planning for
pregnancy. Which RA agents are absolutely contra- indicated in pregnancy?
A. Abatacept and rituximab
B. Adalimumab and certolizumab pegol
C. Infiximab and etanercept
D. Methotrexate and le!unomide

Answer 26

D

Question 27

Which agent for RA competes with CD28 to prevent
full T-cell activation?
A. Sarilumab
B. Abatacept
C. Golimumab
D. Adalimumab

Answer 27

B

Question 28

Which statement correctly represents the mecha-
nism of action of tofacitinib in the treatment of RA? A. TNF- alpha inhibitor.
B. Janus kinase inhibitor.
C. IL-6 receptor blocker.
D. Dihydrofolate reductase inhibitor.

Answer 28

B

Question 29

A 54-year-old man with gout is found to have an
issue with renal excretion of uric acid. Which drug is an oral agent that would target the cause of his acute gout attacks?
A. Allopurinol
B. Febuxostat
C. Probenecid
D. Pegloticase

Answer 29

C

Question 30

A 64-year-old man presents with signs and symp-
toms of an acute gouty !are. Which strategy is the least likely to acutely improve his gout symptoms and pain?
A. Naproxen
B. Colchicine
C. Probenecid
D. Prednisone

Answer 30

C

Question 31

Which of the agents listed is a phenanthrene opioid
which exhibits a full and immediate response to
treatment with naloxone?
A. Pethidine
B. Morphine
C. Buprenorphine
D. Fentanyl

Answer 31

B

Question 32

A 76-year-old female with renal insuf!ciency has
LIR_CH14.indd 294
severe pain secondary to a compression fracture in the lumbar spine. She reports that the pain has been uncontrolled with tramadol and it is decided to start treatment with an opioid. Which is the best opioid for this patient?
A. Pethidine
B. Fentanyl transdermal patch
C. Hydrocodone/acetaminophen
D. Morphine

Answer 32

C

Question 33

Which statement about buprenorphine is correct?
A. Buprenorphine has a much higher incidence of opioid-induced respiratory depression compared
to other agonists.
B. Buprenorphine has many dosage formulations
and all formulations can be prescribed for the
treatment of pain or opioid dependence.
C. Buprenorphine has a lower number of drug–drug
interactions compared to methadone.
D. Buprenorphine is a full ! agonist, an antagonist
of the NMDA receptor, and a norepinephrine and
serotonin reuptake inhibitor.

Answer 33

C

Question 34

A 56-year-old patient has suffered with painful
diabetic neuropathy and severe chronic back pain with radiculopathy secondary to spinal stenosis for many years. This patient has failed to receive relief from his neuropathic pain with 1st-line agents such as tricyclics, SNRIs, or anticonvulsants. Based on the mechanism of action, which opioid could be considered in this patient to treat both nociceptive and neuropathic pain?
A. Pethidine
B. Oxymorphone
C. Morphine
D. Tapentadol

Answer 34

D

Question 35

Which of the following statements regarding
methadone is correct?
A. Methadone is an excellent choice for analgesia
in most patients because there are limited drug–
drug interactions.
B. The equianalgesic potency of methadone is
similar to that of morphine.
C. The duration of analgesia for methadone is much
shorter than the elimination half-life.
D. The active metabolites of methadone accumulate
in patients with renal dysfunction.

Answer 35

C

Question 36

AN is a 57-year-old man who has been treated
with oxycodone for chronic nonmalignant pain for over 2 years. He now reports increased pain in the afternoon while at work. Which of the following is a short-acting opioid and is the best choice for this patient’s breakthrough pain?
A. Methadone
B. Fentanyl
C. Hydrocodone
D. Nalbuphine

Answer 36

C

Question 37

A 64-year-old man is preparing for a total knee
replacement. He is taking many medications that are metabolized by the CYP450 enzyme system and is worried about drug interactions with the pain medication that will be used following surgery. Which of the following opioids would have the lowest chance of drug interactions in this patient?
A. Methadone
B. Tapentadol
C. Tramadol
D. Oxycodone

Answer 37

B

Question 38

Which of the following statements regarding adverse
effects of opioid therapy is correct?
A. The risk of respiratory depression is highest
during an initial opioid initiation or following a
dose increase.
B. Opioid-induced constipation is only seen with
the initiation of opioid therapy.
C. The incidence of nausea and sedation increases
with long-term use of opioid therapy.
D. Decreased testosterone levels are commonly
seen with short-term use of opioid therapy.

Answer 38

A

Question 39

KM is a 64-year-old man who has been hospitalized
LIR_CH14.indd 296
following a car accident in which he sustained a broken leg and broken arm. He has been converted to oral morphine in anticipation of discharge from the hospital. Upon discharge, which medication should he receive along with the morphine?
A. Diphenhydramine
B. Methylphenidate
C. Senna
D. Docusate sodium

Answer 39

C

Question 40

AN is a 67-year-old man who has been treated
with oxycodone for chronic nonmalignant pain with no changes in the dosing regimen for over 2!years. His pain has been fairly well controlled, and he remains active, reports satisfaction with his pain regimen, and denies any side effects. He has been recently diagnosed with COPD and obstructive sleep apnea (OSA). Which of the following options is the BEST treatment recommendation for him at this time?
A. Taper off all opioids due to increased risk of
opioid-induced respiratory depression.
B. Prescribe naloxone nasal spray to have at home
in case he experiences an opioid overdose.
C. Prescribe oral naloxone tablets to have at home
in case he experiences an opioid overdose.
D. No action needed at this time. His pain is well controlled, and he is reporting no side effects.

Answer 40

B

Question 41

A 15-year-old asthmatic patient has been told that
marijuana may help his anxiety. Which adverse
effect has been associated with marijuana and
may be a reason for this patient to avoid use of
marijuana?
A. Short-term memory loss
B. Hyperthermia
C. Hepatitis
D. Hyponatremia

Answer 41

A

Question 42

A 21-year-old college student is curious about the
effects of LSD. She asks what type of risks may
be involved with using the drug for the !rst time.
Which is a correct response to her question?
A. Exaggerated hallucinations
B. Cardiomyopathy
C. Hyperphagia
D. Bronchitis

Answer 42

A

Question 43

A 58-year-old man is brought into the emergency
department following an automobile accident. His blood alcohol level on admission is 280 mg/dL. He has been treated in the past for seizures related to alcohol abuse, and he con!rms that he has been drinking heavily over the past month since losing his job. What treatment should be given to this patient if he begins to go into withdrawal while hospitalized?
A. Acamprosate
B. Lorazepam
C. Naltrexone
D. Disul!ram

Answer 43

B