Pharma

Question 1

Tf

Adequate testing of medicines prior to marketing is needed

Answer 1

T

Question 2

Government regulation of medicines is needed

Answer 2

T

Question 3

 Most medicines cross the placenta and this results in fetal exposure

Answer 3

T

Question 4

Reporting systems to identify adverse efects of medicines are not needed

Answer 4

F

Question 5

Turkish Medicines and Medical Devices Agency doesn’t have a reporting system

Answer 5

F

Question 6

In children under the age of18,al suspected ADRs occuring,should be reported regardless of whether the medicine is licensed for use in children

Answer 6

T

Question 7

A 27-year-old woman presents to the emergency department 6 hours after reportedly ingesting 20 tablets of acetaminophen 500mg. An acetaminophen level is drawn, but it has to be sent out to another lab and will not return for another 6 hours. What is the most appropriate next step in management of this patient?
- Administer a dose of activated charcoal
- Start empirical N-acetylcysteine therapy
- Wait for the level to return and then decide what to do
- Draw a NAPQI level
- Put a nasogastric tube

Answer 7

Start empirical N-acetylcysteine therapy

Question 8

True. Contraindications to the use of gastric lavage for the removal of drugs from the stomach include:
- An overdose of iron pills
- An unconscious patient with unsecured airway
- Ingestion of a corrosive
- Overdose with a sustained-release formulation
- A drug with enterohepatic circulation.

Answer 8

Ingestion of a corrosive

Question 9

An 81-year-old woman with type 2 diabetes presents to the emergency department in a coma and with tachypnea, tachycardia, hypotension, and severe lactic acidosis approximately 9h after ingesting a number of her metformin tablets. Her serum glucose concentration is 148 mg/dL. Metformin is a base with a pKa of 12.4. The procedure that is most likely to improve her condition is:
- Administration of activated charcoal
- Administration of glucagon
- Administration of syrup of ipecac
- Gastric lavage
- Hemodialysis

Answer 9

Hemodialysis

Question 10

Which of the following is not included in the criteria for serious ADRs?
- Life threatening
- Results in long-term disability
- Manageable with dose adjustment
- Alcongenital anomalies
- Causes or prolongs hospitalisation

Answer 10

Manageable with dose adjustment

Question 11

Predisposing factors for ADRs, T/F?
- Any previous history of an ADR
- Elderly patient
- Neonatal patient
- Normal hepatic and/or renal function
- Using multiple drugs simultaneously (Polypharmacy)

Answer 11

Normal hepatic and/or renal function

Question 12

A 2-year-old girl presented with lethargy, increased respiratory rate, and an elevated temperature that appeared to result from a drug poisoning. Laboratory testing revealed the following serum concentrations: glucose, 36 mg/dL; Na+, 148 mEq/L; K+, 5 mEq/L; Cl−, 111 mEq/L; HCO3−, 12 mEq/L; BUN, 21 mg/dL; osmolality, 300 mOsm/L.
The anion gap in this patient is 25 (Na+ - (Cl- + HCO3-)).
The osmolal gap in this patient is 0 (Measured osmolality - Calculated osmolality).
The patient’s signs, symptoms, and laboratory values are most consistent with an overdose of ethylene glycol.
The treatment for ethylene glycol overdose?

 Acetaminophen  Aspirin
 Ethyleneglycol

 Lead
 Phencyclidine

Answer 12

Aspirin

Question 13

A farm worker was accidentally in the field during the aerial spraying with parathion. He was brought to the emergency department. Which of the following will be used in the treatment of this patient?

 Antiseizuredrugs
 Atropineandpralidoxime
 Hemodialysis
 Hyperbaricoxygen
 Measurestoreducepulmonaryedema

Answer 13

Atropineandpralidoxime

Question 14

You are stuck in traffic in New York City in summer for 3 or 4 hours and you begin to get a headache, a feeling of tightness in the temporal region, and an increased pulse rate. What is the antidote based on the most likely cause of these effects?

 Activatedcharcoal
 Atropine
 Fomepizole
 Oxygen
 Pralidoxime

Answer 14

Oxygen

Question 15

11. Chemical warfare agents that had been manufactured in the 1950s were being stored at a military installation. Several civilian workers at the facility began to feel unwell, with symptoms that included dyspnea, abdominal cramps, and diarrhea. They also had copious nasal and tracheobronchial secretions. Which type of toxic compound is most likely to be the cause of these effects?

 Aliphatichydrocarbons
 Botulinumtoxins
 Nitrogenmustards
 Nervegases(sarin,tabun)
 Rotenones

Answer 15

Nervegases(sarin,tabun)

Question 16

2-year-old child was brought to the emergency department 1h after ingestion of tablets he had managed to obtain from a bottle on top of the refrigerator. His symptoms included marked gastrointestinal distress, vomiting (with hematemesis), and epigastric pain. Metabolic acidosis and leukocytosis were also present.

 Acetaminophen

 Aspirin
 Diphenhydramine
 Iron
 VitaminC

Answer 16

Iron

Question 17

A 24-year-old female was rushed to the emergency department after she was found in her room hypotensive, with seizures. In the emergency department, the electrocardiogram confirmed ventricular arrhythmias. An overdose of which of the following drugs is the most likely cause of her symptoms?

Acetaminophen
 Amitriptyline
 Diazepam
 Ethyleneglycol
 Morphine

Answer 17

Amitriptyline

Question 18

An 18-month-old boy presented in a semiconscious state with profound hypotension and bradycardia after ingesting a number of his grandmother’s metoprolol tablets. In this case, the most appropriate antidote is

 Atropine
 Esmolol
 Glucagon
 Naloxone
 Neostigmine

Answer 18

Glucagon

Question 19

A 41-year-old male jeweler presents to the emergency department after he was found unconscious on the floor of the shop by a coworker. The coworker states that the patient complained of being cold this morning around 8 AM (the central heat was broken, and the outdoor temperature was 34°F) and that since noon, he had been complaining of headache, drowsiness, confusion, and nausea. The clinician notices that he has cherry-red skin. The most likely toxin causing his signs and symptoms is

Ethyleneglycol
 Cyanide
 Acetaminophen
 Carbon monoxide

Answer 19

Carbon monoxide

Question 20

16. A 50-year-old migrant field worker comes to the emergency department and complains of diarrhea, tearing, nausea and vomiting, and sweating. The clinician notices that he looks generally anxious and has fine fasciculations in the muscles of the upper chest as well as pinpoint pupils. Which antidote should he receive first?

N-acetylcysteine
Sodium nitrite
Deferoxamine
Atropine

Answer 20

Atropine

Question 21

A healthy 2-year-old boy ingested one of his mother’s 2mg clonazepam tablets 1 hour ago. The child presented to the emergency department with CNS depression but a normal heart rate and blood pressure. His bedside glucose check is also normal. Which antidote might be helpful?

Flumazenil
 Naloxone
 Physostigmine  Fomepizole

Answer 21

Flumazenil

Question 22

A 47-year-old man with a history of a seizure disorder, maintained on phenytoin, presented to the emergency department with salicylate toxicity. The salicylate level was 50 mg/dl (15 to 35 mg/dl therapeutic range) and the phenytoin level was 15 mg/L (10 to 20 mg/L therapeutic range). What therapy can be considered to enhance the elimination of salicylate without impacting the phenytoin?

Multipledosesofactivatedcharcoal
 Urinaryalkalinization
 Wholebowelirigation
 Urinaryacidification

Answer 22

Urinaryalkalinization

Question 23

It is for adults, not for children, with a decreased level of responsiveness due to medical illness or non-physical trauma. TF

Answer 23

F

Question 24

It is for non-physical trauma victims who don’t need rescue breathing and chest compressions. TF

Answer 24

T

Question 25

The head is tilted back to make sure the airway remains open. TF

Answer 25

T

Question 26

Keeping head tilted and facing downwards, a low liquid material to drain from the mouth. TF

Answer 26

T

Question 27

Checking regularly for normal breathing is not needed, you can leave the victim alone. TF

Answer 27

F

Question 28

Early aspiration for chest pain is for

Answer 28

Conscience adults with non traumatic chest injury due to myocardial infarction

Question 29

The casualty should be encouraged and assisted for the self-administration of 150-300mg of chewable aspirin. TF

Answer 29

T

Question 30

The suggested aspirin dose is the anti-inflammatory dose of aspirin. TF

Answer 30

F

Question 31

Aspirin is used to inhibit platelet aggregation. TF

Answer 31

T

Question 32

Tf Aspirin shouldn’t be administered to adults with a known allergy to aspirin or known gastrointestinal bleeding.

Answer 32

T

Question 33

Antiviral drug and the virus match, T/F?
a) Amantadine - HIV
b) Ganciclovir - CMV
c) Acyclovir - HSV
d) Valacyclovir - HSV
e) Oseltamivir - Influenza A&B

Answer 33

Amantadine-HIV is false

Question 34

27-year-old nursing mother is diagnosed as suffering from genital herpes. She has a history of this viral infection. Previously, she responded to a drug used topically. Apart from her current problem, she is in good health. Which drug to be used orally is most likely to be prescribed at this time?
a) Amantadine
b) Foscarnet
c) Ritonavir
d) Trifluridine
e) Valacyclovir

Answer 34

Valacyclovir

Question 35

Which of the following statements about interferon-α is false?
a) At the start of treatment, most patients experience flu-like symptoms.
b) Indications include treatment of genital warts.
c) It is used in the management of hepatitis B and C.
d) Lamivudine interferes with its activity against hepatitis B.
e) Toxicity includes bone marrow suppression.

Answer 35

Lamivudine interferes with its activity against hepatitis B.

Question 36

More than 90% of this drug is excreted in the urine in intact form. Because its urinary solubility is low, patients should be well hydrated to prevent nephrotoxicity. Which drug is described?
a) Acyclovir
b) Efavirenz
c) Indinavir
d) Trifluridine
e) Zidovudine

Answer 36

Acyclovir

Question 37

In an accidental needlestick, an unknown quantity of blood from an AIDS patient is injected into a resident physician. The most recent laboratory report on the AIDS patient shows a CD4 count of 20/microland a viral RNA load of greater than 10 copies/mL. The most appropriate course of action regarding treatment of the resident is to:
a) Determine whether HIV transmission has occurred by monitoring the patient’s blood.
b) Treat with a single high dose of zidovudine.
c) Treat with full doses of zidovudine for 4 weeks.
d) Treat with single doses of zidovudine and indinavir.
e) Treat with zidovudine plus lamivudine plus ritonavir for 4 weeks.

Answer 37

Treat with zidovudine plus lamivudine plus ritonavir for 4 weeks.

Question 38

General principles of the emergency treatment of the poisoned patient is wrong?
a) Assess and address airway, breathing, circulation initially along with any other immediately life-threatening toxic effect.
b) Administer oxygen, obtain IV access, monitor the patient.
c) If with altered mental status, consider administering IV dextrose, naloxone, and thiamine.
d) Pregnancy tests are not needed for the female patients of childbearing age.
e) Assess acid-base and electrolyte disturbances, acetaminophen and salicylate blood levels, and other appropriate drug screens.

Answer 38

Pregnancy tests are not needed for the female patients of childbearing age.

Question 39

Toxicity and clinical feature match, T/F?
a) Antimuscarinic drugs - delirium, tachycardia, hypertension, hyperthermia, mydriasis.
b) Paracetamol - nausea, vomiting, delayed jaundice, hepatic toxicity, and necrosis.
c) Organophosphates - bronchorrhea, bradycardia, bronchospasm, salivation, pinpoint pupils.

Answer 39

True

Question 40

Antidote-poison match, T/F?
a) Flumazenil - Benzodiazepines.
b) Naloxone - Opioid analgesics.
c) Oxygen - Carbon monoxide.
d) Acetylcysteine - Salicylates.
e) Ethanol - Methanol, ethylene glycol.

Answer 40

Acetylcysteine - Salicylates.

Question 41

Pediatric Basic Life Support, T/F?
a) If the child is unresponsive, open the airway and assess breathing for no longer than 10 seconds.
b) In the unresponsive child, if breathing is absent or abnormal, give 5 initial rescue breaths.
c) Rate of chest compressions should be 100-120 per minute.
d) Depth of chest compressions at least one-third of the anterior-posterior dimension of the chest (compressions should never be deeper than the adult 6 cm limit).
e) Physical trauma patients who are unconscious and clearly have normal breathing should be positioned in a recovery position.

Answer 41

Physical trauma patients who are unconscious and clearly have normal breathing should be positioned in a recovery position.

Question 42

The main purpose of chest compressions during basic life support, ?
a) To open the airway.
b) To mimic how the heart pumps and keep blood flowing, especially to vital organs.
c) To wake up the patient.
d) To keep you and patients safe.
e) To provide 30 compressions and 2 rescue breaths.

Answer 42

To mimic how the heart pumps and keep blood flowing, especially to vital organs.

Question 43

The purpose and mission of airway management, T/F?
a) To facilitate the transport of oxygen to the lungs.
b) To protect the airway from contamination with blood, fluids, or food.
c) To insert an oropharyngeal airway.
d) To ensure a patent airway.
e) To institute positive-pressure ventilation when spontaneous breathing is inadequate or absent.

Answer 43

To insert an oropharyngeal airway.

Question 44

How long does it take for hypoxia to begin to cause irreversible brain injury in a patient?
a) 1 minute.
b) 5 minutes.
c) 10 minutes.
d) Immediately.
e) Hypoxia alone does not cause irreversible brain injury.

Answer 44

5 minutes.

Question 45

Which of the following protects the trachea from aspiration of secretions and stomach contents?
a) Oropharyngeal airway.
b) Nasopharyngeal airway.
c) Cuffed endotracheal tube.
d) All of the above.
e) None of the above

Answer 45

Cuffed endotracheal tube.

Question 46

The most common cause of airway obstruction in the unconscious patient is:
a) Food bolus in the posterior pharynx.
b) Loss of tone in the submandibular muscles resulting in prolapse of the tongue into the posterior pharynx.
c) Collapse of the trachea due to loss of tone in the supporting muscles.
d) Laryngospasm due to aspiration of oral secretions.

Answer 46

b) Loss of tone in the submandibular muscles resulting in prolapse of the tongue into the posterior pharynx.

Question 47

When managing an unconscious patient who has is making labored and noisy respirations, the physician must first:
a) Commence positive pressure ventilation with a bag-mask device immediately.
b) Immediately perform endotracheal intubation.
c) Perform a “fingersweep” to clear the oropharynx of foreign material.
d) Perform a simple maneuver such as a head tilt-chin lift to open the airway.

Answer 47

Perform a simple maneuver such as a head tilt-chin lift to open the airway.

Question 48

The jaw thrust maneuver for opening the airway has the advantage over the head tilt-chin lift maneuver in that:
a) It is easier to perform.
b) It permits the use of either an oropharyngeal or nasopharyngeal airway.
c) It can be performed without neck manipulation.
d) It more closely approximates the natural airway anatomy.

Answer 48

It can be performed without neck manipulation

Question 49

To perform a jaw thrust maneuver, the physician:
a) Stands to the left of the patient, grasps the chin between the thumb and index finger of the left hand, and pulls the jaw forward.
b) Stands at the patient’s head looking down at the patient and pushes up on the angle of the mandible using the middle fingers of each hand.
c) Encourages the patient to thrust their jaw forward to maintain an open airway.
d) Pushes down on the patient’s forehead with his left hand to extend the neck and elevates the mandible using the tips of his right index and middle fingers.

Answer 49

b) Stands at the patient’s head looking down at the patient and pushes up on the angle of the mandible using the middle fingers of each hand.

Question 50

Airway adjuncts such as oropharyngeal and nasopharyngeal airways:
a) Prevent the tongue from occluding the airway and therefore create an open conduit for air to pass.
b) Free the physician’s left hand so he can deliver a larger volume of air by squeezing the bag-mask device with both hands.
c) Provide an open conduit for air to pass into the trachea and protect the trachea from aspiration of oral secretions.
d) Allow the physician to ventilate the patient without the use of a mask device.

Answer 50

Prevent the tongue from occluding the airway and therefore create an open conduit for air to pass.

Question 51

The nasopharyngeal airway has the advantage over the oropharyngeal airway in that it:
a) Is made of soft plastic and therefore is less traumatic during insertion.
b) Is usually better tolerated in a semi-conscious patient and can be inserted in a patient who has their teeth clenched.
c) Has a larger internal diameter and therefore allows a greater volume of gas exchange.
d) Makes it easier to suction the oropharynx of excess secretions.

Answer 51

Is usually better tolerated in a semi-conscious patient and can be inserted in a patient who has their teeth clenched.

Question 52

Bag-mask ventilation:
a) Will deliver a larger volume of air than mouth-to-mouth ventilation.
b) Is a relatively easy skill that permits positive pressure ventilation with oxygen-rich air.
c) Is a difficult skill to master but has the advantage of delivering oxygen-rich air if performed correctly.
d) If performed correctly, can avoid the need for endotracheal intubation.

Answer 52

If performed correctly, can avoid the need for endotracheal intubation.

Question 53

The correct size of mask to use with the bag ventilator:
a) Should cover the mouth and seal against the nose to avoid air leaks during ventilation.
b) Should cover the mouth such that oxygen-rich ambient air is able to pass through the nose unobstructed during ventilation.
c) Should seal against the nose if a nasopharyngeal airway is being used and seal against the mouth if an oropharyngeal airway is being used.
d) Should cover the mouth and nose and create a tight seal to avoid air leaks during positive pressure ventilation.

Answer 53

Should cover the mouth and nose and create a tight seal to avoid air leaks during positive pressure ventilation.

Question 54

To create a tight seal with the mask during positive pressure ventilation, the physician should:
a) Push the mask firmly down against the patient’s face.
b) Lift up on the mandible with the third, fourth, and fifth fingers to maintain an open airway, while holding the mask firmly in place with the thumb and index finger.
c) Hold the patient’s mouth open with the third, fourth, and fifth fingers while holding the mask firmly in place with the thumb and index finger.
d) Hold the mask firmly with the thumb and index finger of both hands while squeezing the bag device between the palms of both hands.

Answer 54

Lift up on the mandible with the third, fourth, and fifth fingers to maintain an open airway, while holding the mask firmly in place with the thumb and index finger.

Question 55

Endotracheal intubation with a cuffed tube:
a) Will protect the airway from secretions and vomitus, so it should be undertaken immediately and before commencing positive pressure ventilation.
b) Is the only way to ensure adequate positive pressure ventilation and should be performed as soon as possible during a resuscitation.
c) Should be performed as soon as possible in a patient who is unable to protect their own airway, but only by a person with specific training and expertise in the technique.
d) Will make the technique of bag-mask ventilation easier, protect the airway, and permit delivery of oxygen-rich air to the patient.

Answer 55

Should be performed as soon as possible in a patient who is unable to protect their own airway, but only by a person with specific training and expertise in the technique.