Quiz 1

Question 1

Concern is raised in an 86-year-old male with non-insulin-dependent diabetes mellitus (NIDDM), or type II diabetes, about the possibility of hypoglycemia when considering the use of an oral hypoglycemic agent. Which of the following antidiabetic drugs is least likely to cause hypoglycemia?
A. Metformin
B. Chlorpropamide
C. Insulin
D. Glyburide
E. All of the above

Answer 1

A. Metformin

Pretest

Question 2

A woman goes into premature labor early enough that there are great concerns about inadequate fetal lung development and the risk of fetal respiratory distress syndrome. Ritodrine therapy is started to slow
labor, but parturition seems imminent. Which of the following adjuncts should be administered prepartum, specifically for the purpose of reducing the risks and complications of the newborn's immature respiratory
system development?
a. Albuterol (beta2 agonist)
b. Betamethasone
c. Ergonovine (or methylergonovine)
d. Indomethacin
e. Magnesium sulfate

Answer 2

b. Betamethasone

Pretest

Question 3

A 23-year-old woman with asthma has what is described as “aspirin (hyper)sensitivity” and experiences severe bronchospasm in response to even small doses of the drug. Which of the following is the most likely mechanism by which the aspirin provokes her pulmonary problems?

a. Blocks synthesis of endogenous prostaglandins that have bronchodilator activity
b. Induces formation of antibodies directed against the salicylate on airway mast cells
c. Induces hypersensitivity of H1 receptors on airway smooth muscles
d. Induces hypersensitivity of muscarinic receptors on airway smooth muscles
e. Prevents or reduces epinephrine binding to beta-2-adrenergic receptors (airways and elsewhere)

Answer 3

a. Blocks synthesis of endogenous prostaglandins that have bronchodilator activity

Pretest

Question 4

A 70-year-old man has a history of ulcer disease. He has recently experienced swelling and pain in the joints of his hands. His physician wants to begin therapy with an NSAID. Which one of the follow- ing drugs might also be prescribed along with the NSAID to reduce the risk of activating this patient’s ulcer disease?
A. Allopurinol. 
B. Colchicine. 
C. Misoprostol. 
D. Probenecid. 
E. Sulindac.

Answer 4

C. Misoprostol.

Lippincott

Question 5

A 12-year-old girl with a childhood history of asthma complained of cough, dyspnea, and wheezing after visiting a riding stable. Her symptoms became so severe that her parents brought her to the emergency room. Physical examination revealed diaphoresis, dyspnea, tachycardia, and tachypnea. Her respira- tory rate was 42 breaths per minute, pulse rate 110 beats per minute, and blood pressure 132/65 mm Hg. Which of the following is the most appropriate drug to rapidly reverse her bronchoconstriction?
A. Inhaled fluticasone.
B. Inhaled beclomethasone.
C. Inhaled albuterol.
D. Intravenous propranolol.
E. Oral theophylline.

Answer 5

C. Inhaled albuterol.

Lippincott

Question 6

A patient has acute gout. The physician initially thinks about prescribing just one or two oral doses of colchicine, 12 h apart, but then decides otherwise. The main reason for avoiding colchicine, even with a very short oral course, is the development of which of the following?

a. Bone marrow suppression
b. Bronchospasm
c. GI distress that is almost as bad as the acute gout discomfort
d. Hepatotoxicity
e. One or two oral doses seldom relieve gout pain
f. Refractoriness/tolerance with just a dose or two

Answer 6

c. “GI distress” that is almost as bad as the acute gout discomfort

pretest

Question 7

A woman has severe, irritable bowel syndrome characterized by fre- quent, profuse, and symptomatic diarrhea. She has not responded to first- line therapies and is started on alosetron. Which of the following is the most worrisome adverse effect associated with this drug?

a. Cardiac arrhythmias (serious, e.g., ventricular fibrillation)
b. Constipation, bowel impaction, ischemic colitis
c. Parkinsonian extrapyramidal reactions
d. Pulmonary fibrosis
e. Renal failure

Answer 7

b. Constipation, bowel impaction, ischemic colitis

Pretest

Question 8

A 43-year-old woman becomes hypertensive and suffers a fatal acute
coronary syndrome shortly after starting therapy on a drug. Autopsy shows little in the way of coronary atherosclerosis, but EKG changes noted just before her death revealed significant myocardial ischemia in the
myocardium served by the left anterior descending and circumflex coronary arteries. The cause of death is thought to involve coronary vasospasm. Which of the following drugs most likely precipitated this event?
a. Bromocriptine for Parkinson’s disease
b. Ergotamine given to abort a migraine attack
c. Morphine for post-trauma analgesia
d. Phenoxybenzamine used for carcinoid syndrome
e. Phenytoin to manage generalized tonic-clonic seizures

Answer 8

b. Ergotamine given to abort a migraine attack

Pretest

Question 9

a patient with RA is treated with ibuprofen, but joint pain and stiffness are increasing. His physician prescribes another drug that may slow the progression of the disease that is to be used with ibuprofen. Unfortunately, side effects develop, including dizzines, tinnitus, blurred vision, halos around bright lights, and pruritis. Ocular examination reveals corneal deposits and slight retinal pigmentation. The drug more recently prescribed is likely to be: 
A. Auranofin or gold salts 
B. Hydroxychloroquine 
C. Etanercept
D. Methotrexate
E. Thioridazine

Answer 9

B. Hydroxychloroquine

USMLE Step 1 Lecture Notes

Question 10

a 58 year old woman comes to the clinic because of a 3-week history of pain in the area of her eye, blurred vision, nausea, and vomiting. A tonometer shows an increase in intraocular pressure. Prostaglandin analog (latanoprost) is initiated. Which of the following best describes the method of action of this drug in this patient?

A. Contraction of the ciliary muscle
B. Inhibition of carbonic anhydrase
C. Increased uveoslceral outflow of aqueous humor
D. Increased production of aqueous humor
E. Decreased production of aqueous humor

Answer 10

C. Increased uveoslceral outflow of aqueous humor

Question 11

Your patient has rheumatoid arthritis that has been refractory to diclofenac, ibuprofen, indomethacin, and sulindac. In addition, she has experienced numerous GI bleeds in response to those drugs. We start her on therapy with etanercept. Which of the following is the most likely mechanism by which etanercept suppresses the signs, symptoms, or underlying pathophysiology of rheumatoid arthritis?

a. Inhibits eicosanoid synthesis by inhibiting phospholipase A2
b. Inhibits leukocyte migration by blocking microtubular formation
c. Neutralizes circulating tumor necrosis factor (α-TNF)
d. Selectively and effectively inhibits COX-2
e. Stimulates collagen and mucopolysaccharide synthesis in the joints

Answer 11

c. Neutralizes circulating tumor necrosis factor (α-TNF)

Question 12

A patient has been taking one of the drugs listed below for about 4 months and is experiencing the desired therapeutic effects from it. The MD now prescribes indomethacin to treat a particularly severe flare-up of rheuma- toid arthritis. Within a matter of days the therapeutic effects of the first drug wane dramatically, its actions antagonized by the indomethacin. Which of the following was the most likely drug affected by the indomethacin?

a. Allopurinol, given for prophylaxis of hyperuricemia
b. Captopril, given for essential hypertension
c. Fexofenadine, given for managing seasonal allergy responses
d. Sumatriptan, given for abortive therapy of migraine headaches
e. Warfarin, given for prophylaxis of venous thrombosis

Answer 12

b. Captopril, given for essential hypertension

Question 13

a 76 year old woman with a history of uncontrolled hypertension presents to the emergency department with hypotension and shock-like symptoms. Her daughter reported systolic blood pressures near 200 mmHg earlier in the day, and suspects a dissecting aneurysm, which is confirmed with a CT of the chest. Biopsy of the repaired aorta shows giant cell arteritis, and the woman is placed on a regimen of high dose prednisone. The anti-inflammatory effect of exogenous glucocorticoids is though to be due to which of the following?
A. Increased capillary membrane permeability
B. Increased release of interleukin-1 (pyrogen) from granulocytes
C. Inhibition of Phospholipase A2
D. Activation of Phospholipase A2
E. Increased formation of leukotrienes

Answer 13

C. Inhibition of Phospholipase A2

Physio Pretest

Question 14

A 4 year old girl who is small for her age is diagnosed with juvenile rheumatoid arthritis. Her liver and spleen are palpable, and her joints are swollen and tender. She is unable to move around as freely as she did before. Which of the following is the initial treatment of choice for this patient?
A. Prednisone
B. Acetaminophen 
C. Methotrexate 
D. Naproxen 
E. Etanercept

Answer 14

D. Naproxen

Question 15

A patient suffering status asthmaticus presents in the emergency department. Blood gases reveal severe respiratory acidosis and hypoxia. Even large parenteral doses of a selective β2 agonist fail to dilate the airways adequately; rather, they cause dangerous degrees of tachycardia. Which of the following pharmacologic interventions or approaches is most likely to control the acute symptoms and restore the bronchodilator efficacy of the adrenergic drug?

a. Add inhaled cromolyn
b. Give a parenteral corticosteroid
c. Give parenteral diphenhydramine
d. Switch to epinephrine
e. Switch to isoproterenol (β1/β2 agonist)

Answer 15

b. Give a parenteral corticosteroid

Question 16

A 42 year old patient has had recurrent nocturnal attacks of acute arthritis involving the right first metatarsophalangeal joint, with serum uric acid levels greater than 7.5mg/dl. He develops slowly growing subcutaneous nodules in his feet and olecranon. Aspiration of a nodule reveals crystals of sodium urate. Which of the following drugs will most likely shrink, and possibly eliminate these nodules?
A. Allopurinol 
B. Aspirin 
C. Colchicine
D. Thiazide diuretics 
E. Indomethacin

Answer 16

A. Allopurinol

Question 17

A middle-aged anatomy professor attends the hottest indianapolis 500 race in decades and sits with the sun facing him; there is no breeze. He has a history of borderline high uric acid. Dehydration during the race triggers uric acid crystal formation in his foot. The foot becomes sore, red, hot, and swollen. He drinks about 2L of water and soda at the race and two more liters at home. however, he is anuric for 10-12 hours. his physician prescribes colchicine as an anti-inflammatory. A metaphase-blocking dose of colchicine functions through which one of the following mechanisms?

A. depolymerization of actin
B. depolymerization of myosin
C. enhancement of tubulin polymerization
D. inhibition of tubulin polymerization
E. binding to and stabilizing microtubules

Answer 17

D. inhibition of tubulin polymerization.

Colchicine binds specifically and irreversibly to tubulin at a mitosis inhibiting dose. the colchicine-tubulin complex is added at the positive end of the kinetochore, but it inhibits further addition of tubulin,
Not E. binding to and stabilizing microtubules, because taxol binds and stabilizes microtubules inhibiting mitosis. Colchicine acts by inhibiting tubulin polymerization, so E is wrong.

Pretest Cell Biology

Question 18

two groups of people are treated with penicillin V. Group 1 consists of individuals who are not undergoing concurrent therapy with any other drug. Group 2 consists of individuals who have gouty arthritis and are concurrently being treated with an appropriate drug for this condition. The penicillin dosage and dosing interval are te same for individuals in both group. In group 1(control subjects), penicillin V has a half-life of 1 hour and a serum concentration of 50 ig/mL. In group 2 (patients with gouty arthritis), penicillin V has a half-life of 2 hours and a serum concentration of 100 ig/mL. The patients in group 2 are most likely undergoing concurrent therapy with

A. Acetaminophen 
B. Sulindac
C. Colchicine 
D. Allopurinol
E. Probenecid

Answer 18

E. Probenecid

Question 19

A 47-year-old man presents with acute pain in his big toe. Laboratory tests reveal a uric acid level of 10 mg/dL. He is started on medication.
Several days after the resolution of the acute attack, he is started
on a second medication that decreases uric acid in both serum and the urine. Which if the following is the
second medication?
a. Allopurinol
b. Colchicine
c. Indomethacin
d. Probenecid
e. Sulfinpyrazone

Answer 19

a. Allopurinol

Question 20

A patient with asymptomatic hyperuricemia is started on probenecid. In a couple of days he develops acute gout. Which of the following is the best explanation of how probenecid triggered this acute gouty arthritic episode?

a. Accelerated synthesis of uric acid by the probenecid
b. Coprecipitation of probenecid and urate in the joints
c. Idiosyncratic response
d. Probenecid-induced systemic acidosis, favoring uric acid crystallization
e. Reduced renal excretion of uric acid

Answer 20

e. Reduced renal excretion of uric acid

Question 21

Which of the following drugs can be used to treat or prevent severe chemotherapy-induced emesis, motion sickness, dystonias, and hay fever?

A. Metoclopramide 
B. Scopolamine
C. Diphenoxylate
D. Ondansetron
E. Diphenhydramine

Answer 21

E. Diphenhydramine

Question 22

A 21 year old woman has polymorphic, erythematous, and well-circumscribed edematous papules (wheals) over her entire body. The patient explains that the lesions cause intense itching, appeared overnight, and has been present for 3 days. She has driven her automobile to the appointment and needs to drive herself home. Which of the following is the most appropriate drug for treatment of this patient?

A. Diphenhydramine
B. Granisetron
C. Loratadine
D. Prednisone
E. Ranitidine

Answer 22

C. Loratadine

Question 23

A 33 year old woman has been having left-sided pulsatile headaches for the past 6 months. The headaches are preceded by bilateral flashes of light and a sensation of light-headedness. Which of the following disorders would be a contraindication for prescribing sumatriptan for the treatment of this patient's migraine headache? 
A. Coronary artery disease
B. Psychosis
C. Gastroesophageal reflux disease 
D. Asthma 
E. Depression

Answer 23

A. Coronary artery disease

Question 24

a 43 year old man ith a history of recurrent myocardial infarction is instructed by his physician to take aspirin prophylactically. Inhibition of which of the following mediators by aspirin is most beneficial to this patient?

A. Oxidative Phosphorylation 
B. NF-eB
C. Prostaglandin E2 (PGE2)
D. PGF2a
E. TXA2

Answer 24

E. TXA2

Question 25

A 5 year old girl with moderate bronchial asthma is being managed with the inhalation of a drug containing 100 ug of beclomethasone and 50 ug of salmeterol per inhalation. The drug is administered in the morning and at night, about 12 hours apart. Which of the following molecular entities is likely to be up-regulated by beclomethasone in this patient?
A. Phospholipase A2
B. Cyclooxygenase-2 
C. 5- Lipoxygenase
D. Tumor necrosis factor
E. B-Adrenergic receptors

Answer 25

E. B-Adrenergic Receptors

Question 26

A 23 year old woman comes to the doctor because of a 5 month history of left-sided headaches that occur at least once a week. The headaches are preceded by bilateral flases of light and a feeling of light-headedness that lasts 15-30 minutes. They are often accompanied by nausea, vomiting, and photophobia. History is significant for severe asthma treated with albuterol and beclomethasone. Which of the following medications is most appropriate to prevent the onset of these symptoms?

A. Fluphenazine
B. Valproic Acid 
C. Propanolol
D. Lithium 
E. Sumatriptan

Answer 26

B. Valproic Acid