Pharm final review

Question 1

Which study design is considered the gold standard for determining cause-and-effect relationships?

Answer 1

Randomized controlled trial (RCT)

Question 2

Which of the following is a likely effect of a strong CYP450 enzyme inducer on another CYP450 substrate?

Answer 2

Decreased drug plasma levels, reducing drug effectiveness

Question 3

Jon Lewis is a 35-year-old patient who presents to the clinic with anxiety. He was previously prescribed an antidepressant, and this drug was titrated to the max dose. He is claiming the drug isn’t working. Why might this drug be ineffective for Jon?

Answer 3

He is an ultra metabolizer (ie, CYP2D6 or CYP3A4 probably)

Question 4

What is the mechanism of resistance in Methicillin-Resistant Staphylococcus aureus (MRSA)?

Answer 4

Alteration in the penicillin-binding protein site (ex: Step pneumo)

Question 5

Which of the following antibiotics would be most appropriate for a patient with a type 1 penicillin allergy who needs treatment for a gram-negative infection?
a) Piperacillin-tazobactam
b) Amoxicillin-clavulanate
c) Vancomycin
d) Aztreonam
e) None of the above

Answer 5

d) Aztreonam

Question 6

A 65-year-old male with a Hx of DM & BPH presents with fever, dysuria, and flank pain. A urine culture grows gram-negative bacilli lactose +. The patient has an allergy to Penicillin (minor rash).

Which of the following is the most appropriate empiric antibiotic choice?
A) Ceftriaxone
B) Vancomycin
C) Doxycycline
D) Azithromycin

Answer 6

A) Ceftriaxone

[good for complicated UTIs and gram-negative coverage]

Question 7

A 65 year old male presents to your ER with signs of a UTI, extreme abdominal pain, signs of possible sepsis, and known risk of pseudomonas infection. You decide to empirically treat with a broad spectrum antibiotic. Which is your best choice?
a. Vancomycin
b. Imipenem/cilastin
c. Ertapenem
d. Linezolid

Answer 7

b. Imipenem/cilastin

Question 8

You have a patient come in with yellow crusty bumps around the lips. You think it is impetigo and the culture comes back as community-acquired MRSA - which confirms your diagnosis. The patient has PCN allergy type What should you give them?
A) Sulfamethoxazole and Trimethoprim (Bactrim)
B) Oxacillin
C) Ceftriaxone
D) Codeine

Answer 8

A) Sulfamethoxazole and Trimethoprim (Bactrim)

Question 9

A 35-year-old patient takes dextromethorphan (Delsym) for a cough. Which of the following statements about its metabolism is correct?
a) Dextromethorphan is metabolized by CYP2D6, and poor metabolizers may experience decreased drug effects.
b) Dextromethorphan is a prodrug that must be metabolized into an active form.
c) Dextromethorphan is metabolized by CYP2D6, and ultra metabolizers may experience decreased drug effects.
d) Increased metabolism of dextromethorphan leads to higher drug levels in the body, increasing the risk of toxicity

Answer 9

Dextromethorphan is metabolized by CYP2D6, and ultra metabolizers may experience decreased drug effects.

Question 10

Amy is a 28-year-old pregnant female presenting with very severe nasal congestion that is impacting her daily life activities. What is the best treatment option for this patient? Select all that apply
a) Phenylephrine
b) Pseudoephedrine
c) Oxymetazoline
d) Mucinex D
e) None of the above

Answer 10

b) Pseudoephedrine if she’s past her first trimester
c) Oxymetazoline

[not mucinex D bc you should avoid extended release products]

Question 11

A 28-year-old pregnant woman in her second trimester is experiencing mild seasonal allergies (ie, runny nose). Which of the following is the best first-line treatment?
a) Intranasal cromolyn
b) Pseudoephedrine
c) Phenylephrine
d) Oxymetazoline

Answer 11

a) Intranasal cromolyn

Question 12

Which of the following can cause drug-induced nonallergic rhinitis?
a) Beta blockers
b) Oral contraceptives
c) Overuse of topic decongestants
d) Cocaine
e) All the above

Answer 12

e) All the above

Question 13

A 30-year-old pregnant woman at 34 weeks gestation presents with a headache and asks for pain relief. Which of the following medications should be avoided due to risks in the third trimester?
A) Acetaminophen
B) Ibuprofen
C) Diphenhydramine
D) Intranasal cromolyn

Answer 13

B) Ibuprofen

[should be avoided in 3rd trimester because it can cause premature closure of ductus arteriosus, prolonged labor, increased post-partum bleeding, delayed parturition]

Question 14

Cletus, a 6-month-old infant is brought to the emergency department with a 2-day history of cough, fever, and increased work of breathing. On examination, the infant has intercostal retractions and inspiratory rales. A diagnosis of bronchiolitis is made. According to the American Academy of Pediatrics, which of the following is the routinely recommended treatment for Cletus?

a) Albuterol MDI 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed
b) Prednisolone 1 mg/kgs in two divided doses
c) Nebulized hypertonic saline
d) Oseltamivir 3 mg/kg/ dose BID

Answer 14

c) Nebulized hypertonic saline

Question 15

A 4-year-old child presents to the clinic with persistent nasal congestion, purulent nasal discharge, facial pain, and a cough that has lasted 12 days. The child initially had a mild cold, with some improvement around day 5, but symptoms worsened again on day 8. The child has no known drug allergies, attends daycare, and has not been hospitalized or received antibiotics in the past three months.

The PA is considering antibiotic therapy; which of the following factors is the most important in determining the need for high-dose amoxicillin-clavulanate (90 mg/kg/day)?
A) The child’s attendance at daycare
B) The “double worsening” pattern of symptoms
C) The presence of purulent nasal discharge and facial pain
D) The lack of improvement after 7 days of symptoms

Answer 15

A) The child’s attendance at daycare

Question 16

Which of the following is the most correct way to write the IDSA dosage for out-patient non-severe pneumonia? CURB-65 = 0. Patient has no relevant comorbidities.

A. Amoxicillin 1g PO TID for pneumonia
B. PO TID Amoxicillin 1g for pneumonia
C. Pneumonia tx Amoxicillin PO TID 1g
D. Amoxicillin for pneumonia 1g PO TID

Answer 16

A. Amoxicillin 1g PO TID for pneumonia

Question 17

Which of the following is the best treatment option for a 20-year-old college female who presents to the clinic with a persistent cough and sore throat for the past 6 days. She denies any shortness of breath, sinus pressure or congestion, chest pain or fevers and has no relevant medical history. Select all that apply.

a) Albuterol inhaler
b) Azithromycin
c) Tessalon Perles
d) Amoxicillin
e) Cough drops
f) Pseudoephedrine

Answer 17

c) Tessalon Perles
e) Cough drops

Question 18

The contagious period for acute pharyngitis is reduced by how many days when antibiotics are started?

Answer 18

1

Question 19

A 45-year-old male presents to your clinic with a 10-day history of nasal congestion, purulent nasal discharge, facial pain, and pressure that worsened after initial mild improvement. He also reports a low-grade fever and mild headache. He has no significant medical history and no known drug allergies. Based on the most likely diagnosis, which of the following is the best initial antibiotic choice?
A) Azithromycin
B) Amoxicillin-clavulanate
C) Ciprofloxacin
D) Doxycycline

Answer 19

B) Amoxicillin-clavulanate
[875mg PO BID X 7 days]

Question 20

A 3-year-old redheaded step-child presents to your clinic with persistent nasal congestion, purulent nasal discharge, facial pain, and fever of 102.5°F for the past 4 days. The parent report that the child initially had mild, annoying, cold-like symptoms but experienced a worsening of symptoms on day 7 of illness. The child has a history of anaphylaxis to penicillin. The parent states that “drugs are for weak people”, but the child’s illness is causing the parent to miss work.

Which of the following is the most appropriate antibiotic regimen for this patient per IDSA guidelines?
A. Amoxicillin-clavulanate 90 mg/kg/day BID
B. Doxycycline 100 mg BID
C. Levofloxacin 10-20 mg/kg/day
D. Clindamycin 30-40 mg/kg/day TID + Cefixime 8 mg/kg/day BID

Answer 20

C. Levofloxacin 10-20 mg/kg/day

Question 21

A 16-year-old pampered princess is brought to your clinic by her mother with complaints of sore throat, fever, and difficulty swallowing for the past three days. The mother reports that the child had a similar illness two months ago and must have had a bad doctor because she was treated with a five-day course of azithromycin (Z-pack), but the symptoms persisted, and another round of antibiotics was needed.On examination, the pt has erythematous tonsils with exudates, tender anterior cervical lymphadenopathy, and a temperature of 101.8°F. A rapid antigen-detection test (RADT) for Group A Streptococcus is positive.

Which of the following is the most appropriate next step in management?
A. Repeat a five-day course of azithromycin
B. Start amoxicillin 50 mg/kg/day for 10 days
C. Prescribe cephalexin 20 mg/kg/dose BID for 10 days
D. Treat with clindamycin 7 mg/kg/dose TID for 10 days

Answer 21

B. Start amoxicillin 50 mg/kg/day for 10 days

Question 22

A 61-year-old retired mailman was admitted to the hospital 72 hours ago for observation after showing signs of dehydration and presyncope. The patient is now complaining of shortness of breath and a worsening cough with sputum production. You take a look at the patient’s vitals which reveal temperature of 102.1℉, heart rate 81 bpm, blood pressure 130/85, respiratory rate 20 breaths per minute, and pulse ox 98% on room air. Patient denies having any recent hospitalizations or antibiotic use in the past 90 days. There is no evidence of septic shock and the patient is not intubated. You ordered a CXR which shows evidence of new patchy infiltrates in the perihilar location of the left upper lobe.

Which of the following is the most appropriate treatment for this patient?
A. Cefepime 2 grams IV q 8 h + amikacin 15 mg/kg IV q
24h + vancomycin 15 mg/kg IV q 12 h x 10 days
B. Prednisone 60 mg qday x 5 days
C. Cefepime 2 grams IV q 8 h x 10 days
D. Amoxicillin-clavulanate 90 mg/kg/day PO BID x 10 day

Answer 22

C. Cefepime 2 grams IV q 8 h x 10 days

Question 23

A patient presents with CAP. What is his CURB-65 score, and should he be treated outpatient, inpatient, or inpatient ICU?
· Age: 45
· RR: 32 breaths/min
· BP: 85/60 mmHg
· Uremia: 12

A) CURB-65= 3; inpatient
B) CURB-65 = 1; outpatient
C) CURB-65 = 2; inpatient ICU
D) CURB-65 = 2; inpatient

Answer 23

D) CURB-65 = 2; inpatient

Question 24

A 67-year-old male school teacher presented to the emergency department in mid-December with complaints of worsening cough, fever, dyspnea, and pleuritic chest pain. He claimed he had the flu 3 weeks ago and that these severe symptoms began about a week ago, for which he was treated with Augmentin by his primary care physician for mild CAP. He has shown no improvement. His RR is 32 breaths/min, his BUN is 22 mg/dL, and his PaO2/FlO2 is 220. He is admitted for inpatient treatment but by 24 hours his condition continues to decline. Blood cultures remain negative, and there is no known history of MRSA or Pseudomonas risk factors, no comorbidities, and NKDA. You come into the clinic and see him at this point in time as your new patient.

What is the appropriate treatment step per IDSA?
a. Start ceftriaxone 2g IV Q24H + azithromycin 500 mg IV Q24H
b. Continue Augmentin and add azithromycin 500 mg on day 1 and 250 mg on days 2-5
c. Switch to piperacillin-tazobactam plus azithromycin 500 mg IV
d. Initiate cefepime 1g IV Q8hr plus vancomycin

Answer 24

a. Start ceftriaxone 2g IV Q24H + azithromycin 500 mg IV Q24H → correct answer

Question 25

A patient presents with an **FEV1 of 35% of their predicted normal** and a heart rate of 110 bpm. Choose the true statement regarding treatment options for this patient’s severe acute asthma exacerbation. a) Administer one B2 agonist nebulization every 60 minutes for 3 doses over 3 hours b) Avoid using inhaled B2 agonist due to patient’s elevated heart rate! c) Start with continuous B2 agonist nebulization d) Give nebulized tiotropium

Answer 25

c) Start with continuous B2 agonist nebulization

Question 26

A 28 yo female with h/o of asthma presents with worsening SOB and wheezing with nighttime awakenings. She is currently using her SABA multiple times (3-4x)a week, but not tracking her symptoms with an asthma action plan. What is the most appropriate change of therapy? a) Increase SABA frequency b) Add a daily low dose ICS c) Prescribe a LABA by itself d) Refer to specialist

Answer 26

b) Add a daily low dose ICS [GINA step 3 per given symptoms]

Question 27

A 50-year-old patient comes in with complaints of wheezing, chest tightness almost daily, waking up at night once a week due to dyspnea. FEV1/FVC ratio is 68% prebronchodilator but improves to 92% post-bronchodilator. What do you suspect as the diagnosis and what would you recommend for initial treatment? a. COPD- PRN Albuterol b. COPD- Tiotropium c. Asthma- Low dose formoterol + ICS d. Asthma- PRN Albuterol

Answer 27

c. Asthma- Low dose formoterol + ICS

Question 28

Your patient, Johnny Lewis, a 30-year-old male, presents to your clinic with a chief complaint of worsening SOB. Upon review of Mr. Lewis's chart, you note he has a history of asthma and has been treating with 80/4.5mcg budesonide-formoterol with two inhalations BID. Today, Mr. Lewis states he has also been experiencing chest tightness and coughing daily, along with the SOB. He states, "I wake up at night at least 2 times a week! At, first I thought I was just so excited to attend my Space Prom, I couldn't sleep, but now, I wake up feeling like I can't breathe and am coughing out the wazoo!!!!" **What is the preferred treatment method for Mr. Lewis, so he can attend and enjoy his Space Prom?** a) Tell him to avoid Space Prom altogether, zero gravity dancing and intergalactic travel are known asthma triggers. b) Increase his ICS-formoterol dose to 160/4.5mg two inhalations BID and encourage him to bring a backup inhaler as needed. c) Refer him to a pulmonologist to rule out any other underlying condition contributing to his worsening symptoms. d) Prescribe a increased SABA and advise him to use it before going to bed and before he feels his symptoms worsen.

Answer 28

b) Increase his ICS-formoterol dose to 160/4.5mg two inhalations BID and encourage him to bring a backup inhaler as needed. [Mr. Lewis has uncontrolled asthma as evidenced by the symptoms. The preferred step-up therapy based on GINA guidelines for moderate to severe asthma is ICS-formoterol as MART to control and reduce exacerbations].

Question 29

A 27-year-old patient with a personal best peak expiratory flow rate (PEFR) of 430 L/min measures their PEFR at 315 L/min. According to the NAEPP traffic light monitoring system, in which zone does this patient fall, and what is the recommended course of action? a.Green zone; continue current treatment b. Yellow zone; step up therapy and possibly begin oral corticosteroid c.Red zone; seek emergency medical attention d.Blue zone; no action is needed

Answer 29

b. Yellow zone; step up therapy and possibly begin oral corticosteroid

Question 30

PJ is a 4-year-old male who presents to clinic following up for PEF values falling into the yellow zone. He is currently taking a daily low dose of and ICS and has a SABA to use prn. Which of the following treatments approved by the GINA guidelines is approved for PJ if he were to move up a step? A. Low dose ICS-LABA and prn SABA B. Double the low dose ICS and prn SABA C. Low dose maintenance and prn ICS-formoterol D. ICS to take whenever SABA is taken

Answer 30

B. Double the low dose ICS and prn SABA

Question 31

You have a 40 year old pt complaining of muscle pain following a change in their exercise routine. They have NKDA and have a history of asthma. What medication do you NOT recommend they take? a) 16% menthol topical lotion b) Aspirin 325mg PO Q 4-6 hours PRN c) Acetaminophen 650mg Q 8 hours PRN d) Ibuprofen 200mg Q 4-6 hours PRN

Answer 31

b) Aspirin 325mg PO Q 4-6 hours PRN [can make asthma worse]

Question 32

A 68-year-old male patient with a history of smoking (40 pack-years) presents to the clinic complaining of shortness of breath, chronic cough, and a significant increase in sputum production over the past month. He reports having these "episodes" several times in the past year. His mMRC score is 3 and his CAT score is 12. His eosinophils come back as 450. 1) What group would you place this patient in and what would you recommend as initial therapy for this patient? a. Group B: LABA + LAMA b. Group B: Symbicort (ICS + formorterol) c. Group E: LABA + LAMA + ICS + PRN albuterol d. Group E: LABA + LAMA 2) How do you Tx the acute exacerbation?

Answer 32

1) c. Group E: LABA + LAMA + ICS + PRN albuterol 2) -Prednisone 40 mg PO Qday x 5-7 days -Augmentin 875/125 mg PO q 12H x 5-7 days or Levaquin 500 mg PO q 24 hours x 5-7 days

Question 33

Jane Doe is a 54 year old female presenting with chest tightness and a cough. She has recently had multiple exacerbations of her symptoms leading to admission to the hospital. A CBC with differential was ordered and her eosinophil count was 342 cells/mcL. Her mMRC = 3 and her CAT = 12. According to GOLD, what group of COPD would she fall into, and what are the best treatment options for her symptoms? Select all that apply a) Group B: LABA + LAMA b) Group A: bronchodilator c) Group E: consider LABA + LAMA d) Group E: consider LABA + LAMA + ICS

Answer 33

c) Group E: consider LABA + LAMA d) Group E: consider LABA + LAMA + ICS

Question 34

A 65-year-old male smoker presents with COPD. He has had one exacerbation in the last year that did not lead to a hospital admission. His mMRC score is 3. What treatment protocol is most appropriate for this patient? a. Budesonide (Pulmicort) b. Albuterol c. Umeclidinium bromide/vilanterol trifenatate (Anoro Ellipta) and albuterol d. Fluticasone furoate/umeclidinium bromide/vilanterol trifenatate (Trelegy) and albuterol

Answer 34

c. Umeclidinium bromide/vilanterol trifenatate (Anoro Ellipta) and albuterol [Patient had one exacerbation and his mMRC was 3, this puts him in group B. The appropriate treatment for Group B is a LAMA/LABA and a SABA]

Question 35

Jimmy is a 68-year-old male who has been coming to the clinic with frequent COPD exacerbations for the past year. He is currently using Anoro Ellipta once daily, and albuterol PRN, though more frequently after each exacerbation. Since he is currently being seen for his 5th exacerbation this year, you need to make some adjustments to his current regimen. Given that his current eosinophil count is <100, and he is still actively trying to quit smoking,  what medication regimen could you consider? a) Add Azithromycin, 250mg 3x weekly b) Prescribe an ICS/LAMA/LABA (Trelegy Ellipta) c) Roflumilast added to current regimen d) Swap his LAMA/LABA to an ICS/LABA e) Add dupilumab (Dupixent)

Answer 35

c) Roflumilast added to current regimen

Question 36

A patient with COPD presents to your primary care clinic and has decided to quit smoking after a recent stroke one week prior. The patient has a history of malnutrition, substance use disorder, and anorexia. What pharmacotherapy do you recommend for smoking cessation? a) Bupropion SR b) Nicotine replacement therapy c) Varenicline (chantix) d) Switch to e-cigarettes

Answer 36

c) Varenicline (chantix)

Question 37

With what disease(s) is it advised to get a pneumonia vaccination between the ages of 19 - 49? **Select all that apply.** a) Asthma b) Alzheimer's c) COPD d) Parkinson's

Answer 37

a) Asthma c) COPD

Question 38

What should you do if your patient is experiencing dyskinesias while taking Carbidopa/L-dopa? A. Give them a walker B. Add amantadine to their therapy C. Abruptly stop the carbidopa/L-dopa D. Add an antibiotic to their therapy

Answer 38

B. Add amantadine to their therapy

Question 39

Which Parkinson’s medication is administered IM, and is used to reduce “off” time in patients with motor fluctuations? A) Apomorphine B) Benztropine C) Trihexyphenidyl D) Amantadine E) None of the above

Answer 39

E) None of the above [apomorphine is subq]

Question 40

Match the non-motor Parkinson's symptoms with their recommended medication for treatment. **Symptoms:** 1) Overactive Bladder 2) Restless Leg Syndrome 3) Hallucinations/Psychosis 4) Depression 5) Insomnia **Treatments:** a) Gabapentin b) Pimavanserin c) Nonbenzodiazepine GABA(A) agonist d) Anti muscarinic agent e) SSRI

Answer 40

1) Overactive Bladder: d) Anti muscarinic agent 2) Restless Leg Syndrome: a) Gabapentin 3) Hallucinations/Psychosis: b) Pimavanserin 4) Depression: e) SSRI 5) Insomnia: c) Nonbenzodiazepine GABA(A) agonist

Question 41

What is the mechanism of action of catechol-O-methyltransferase (COMT) inhibitors in the treatment of Parkinson's disease? Select all that apply. A) Enhancing central L-dopa bioavailability B) Inhibiting dopamine receptors C) Promoting dopamine reuptake D) Increasing dopamine release

Answer 41

D) Increasing dopamine release (downstream effect) [I think A) Enhancing central L-dopa bioavailability is also correct?]

Question 42

T is a 70 yo M who has been diagnosed with Alzheimer’s disease. He has been taking memantine 10mg BID for a long time. He has been diagnosed with chronic kidney disease and has severe renal impairment (ie, CrCl = 20 mL/min). T’s cognitive decline has worsened recently and upon assessing MMSE- his score is 18. What is the most appropriate change in T’s current treatment? A. Discontinue memantine, Start donepezil 5mg twice a day because no renal adjustment is needed. B. Switch to memantine ER 5mg once a day due to severe renal impairment. C. Reduce to memantine 5mg twice a day due to severe renal impairment; could still add donepezil 5 mg daily D. Consider adding donepezil 5mg once a day along with memantine 10mg twice a day.

Answer 42

C. Reduce to memantine 5mg twice a day due to severe renal impairment; could still add donepezil 5 mg daily

Question 43

Mrs. Jane is a 75-year-old female, and she was diagnosed with Alzheimer's disease three years ago. She was also diagnosed with glacuoma two years ago. Her daughter is her primary caretaker, and she is complaining her mother has become too hard to take care of due to her behavior. She was wondering if there was any anti-psychotic drugs you could prescribe her mother to help ease the situation. What counseling points do you provide? a) All antipsychotics have a BBW warning due to increased risk of mortality with dementia-related psychosis b) You tell her you can prescribe her a tricyclic antidepressant c) You reassure her the antipsychotics will help to improve cognition levels d) Antipsychotics have a warning for GI bleeding and an increased risk of cardiovascular outcomes

Answer 43

a) All antipsychotics have a BBW warning due to increased risk of mortality with dementia-related psychosis

Question 44

Mr. Thompson is a 74-year-old male recently diagnosed with mild-to-moderate Alzheimer's Disease (AD). He was started on donepezil 5 mg daily six months ago. His MMSE score at baseline was 23, and today his MMSE score is 22. Which of the following best describes the next appropriate step in therapy? A) Increase donepezil to 10 mg daily to optimize dosing B) Switch to a different medication due to lack of efficacy C) Add memantine for combination therapy D) Continue current therapy, as the patient is showing a successful response

Answer 44

D) Continue current therapy, as the patient is showing a successful response

Question 45

Which of the following is the best choice to consider for an AD patient that is beginning Donepezil as their prescribed treatment? a) Begin daily at night to avoid daytime nausea b) Begin daily in the morning to avoid sleep disturbances c) Take with meals to avoid any GI upset or side effects d) Adjust the dosage depending on pts renal function

Answer 45

b) Begin daily in the morning to avoid sleep disturbances

Question 46

Your patient, Jody Crew, is a 54-year-old male with epilepsy. He said he just went to the Bahamas for 5 days. He tells you he forgot to bring his medications on his trip. He is currently taking vitamin D, Prilosec, Lamictal, and carbamazepine. **What should you do? Select all that apply.**  a) Tell him he’s fine to continue taking his medications at the pre-trip dose since it hasn’t been 10 days yet. b) Try taking him off the medicine to see how he does since he didn’t report a seizure on his trip. c) Re-titrate his Lamictal since it’s been past 2.5 days.  d) Change his carbamazepine to valproic acid because you can go longer without re-titrating it. e) Counsel him on the risk of forgetting and stopping his medication suddenly.

Answer 46

c) Re-titrate his Lamictal since it’s been past 2.5 days.  e) Counsel him on the risk of forgetting and stopping his medication suddenly.

Question 47

Why is the anti-epileptic drug Vigabatrin part of a REMS program? a) It's in Phase IV of clinical trials and all Phase IV drugs must be on a REMS program. b) Vigabatrin has a narrow therapeutic range and increased serum levels have been linked to an increased risk of status epilepticus. c) Vigabatrin has a risk of permanent vision loss, and the REMS program requires patients to have an eye exam every 3 months. d) Vigabatrin is correlated with an increase in blood pressure. The REMS program requires that patients have their blood pressure monitored once a month.

Answer 47

c) Vigabatrin has a risk of permanent vision loss, and the REMS program requires patients to have an eye exam every 3 months.

Question 48

A 25-year-old woman experiences sudden episodes where she stops mid-sentence, stares blankly for a few seconds, then resumes talking as if nothing happened. EEG shows 3-Hz spike-and-wave discharges. Which medication is the best first-line treatment for her condition? A) Phenytoin B) Ethosuximide C) Carbamazepine D) Valproic Acid

Answer 48

B) Ethosuximide [Carbamazepine and Phenytoin can actually worsen absence seizures, while Valproic Acid is an alternative but has more side effects]

Question 49

Blanche Devereaux, a 19 y/o female is brought to the ED for an initial Tonic-Clonic. Immediately after her arrival she began seizing again and the patient has not regained consciousness in between her recurrent seizures for the last twenty minutes. You decide to begin immediate treatment to interrupt the seizure activity. IV access is achieved, what is the preferred medication for her initial treatment? A. IV valproate B. IV midazolam C. IV lorazepam D. Peanut M&Ms but only the red ones.

Answer 49

C. IV lorazepam

Question 50

You are seeing 24-year-old female Lily Carter. She is diagnosed with epilepsy and is currently taking lamotrigine. She is also taking OCP. She has NKDA, does not drink or smoke. Vitals are BP 120/80, HR 72, RR 18, T 98.6 F. She is seeing you because her medication is not working for her, as she is still experiencing symptoms. What should you do? A) Take her off her medicine and see how she does since she hasn’t had a full seizure. B) Council her on a copper IUD placement since efficacy decreases with estrogen OCP. C) Double her lamotrigine dose. D) Switch her to carbamazepine since lamotrigine is not working and will cause fetal harm if she accidently gets pregnant.

Answer 50

B) Council her on a copper IUD placement since efficacy decreases with estrogen OCP. C) Double her lamotrigine dose.

Question 51

A 24 year old female is seen at your office for recent behavioral changes. Pt is not currently having an episode, but reports recent agitation, feeling disorganized, seeing things when they aren’t there and increased depression. You determine the pt has had an increase in hallucinations and psychosis recently due to her current medication. The pt is currently taking Levetiracetam for her epilepsy and has been well-controlled in the past. What should you consider changing her medication to? A. Brivaracetam B. Topiramate C. Lamotrigine D. Gabapentin

Answer 51

A. Brivaracetam

Question 52

Your 12-year-old pt with meningitis had a CSF Cx come back positive for N. meningitidis. What drug and dosing are appropriate chemoprophylaxis for the pt? A. ‎don't give any chemoprophylaxis B. Ceftriaxone 125 mg single IM dose C. Ceftriaxone 250 mg single IM dose D. Ceftriaxone 125 mg PO BID x 2 days

Answer 52

B. Ceftriaxone 125 mg single IM dose

Question 53

A 60-year-old immunocompromised patient presents with high fever, severe headache, and confusion. Bacterial meningitis is suspected. Blood cultures are drawn and you are also planning to do imaging and a lumbar puncture. What is the most appropriate next step? A) Administer broad-spectrum antibiotics and dexamethasone immediately, even before neuroimaging and lumbar puncture, to prevent disease progression and reduce complications. B) Do not give antibiotics until after CSF collection to maximize diagnostic accuracy, since antibiotics will reduce the accuracy of cultures. C) Perform neuroimaging first, followed by lumbar puncture, and start antibiotics ONLY if CSF findings confirm bacterial meningitis. D) Give APAP for fever and supportive care while awaiting neuroimaging and lumbar puncture results to ensure results confirm bacterial meningitis.

Answer 53

A) Administer broad-spectrum antibiotics and dexamethasone immediately, even before neuroimaging and lumbar puncture, to prevent disease progression and reduce complications.

Question 54

A 12-year-old female presents with a sudden onset of fever, neck pain, headache and is starting to become confused and disoriented. Patient is positive for Brudzinski and Kernig signs. Patient does not have any risk factors and has no drug allergies. What initial empiric therapy based on most likely diagnosis & patients demographics should we start this patient on? a) We absolutely cannot treat this patient until we get a lumbar puncture no matter how long they must wait b) Triple therapy with Vancomycin + Ampicillin + Ceftriaxone c) Dual therapy with Vancomycin + Ceftriaxone d) Give Dexamethasone and 1 hour later give Ampicillin

Answer 54

c) Dual therapy with Vancomycin + Ceftriaxone

Question 55

What is an acceptable empiric treatment for a 3-week-old that has meningitis? Pt has NKDA. a) Ampicillin + cefotaxime b) Gentamicin + cefotaxime c) Ampicillin + ceftriaxone d) Gentamicin + ceftriaxone

Answer 55

a) Ampicillin + cefotaxime

Question 56

A 2-year-old patient comes in with fever, headache, and neck stiffness. Your gram stain results are positive for a gram(-) cocci bacteria. You suspect bacterial meningitis and are considering prescribing dexamethasone. What potential side effects would you see with this medication? A. Bone growth suppression B. Discoloration of the teeth C. Mood changes D. Hypoglycemia E. Hearing loss

Answer 56

C. Mood changes [Not A. Bone growth suppression bc that's long-term]