Random Flashcards
Which of the following has a long period of latency?
a. HIV-1
b. HIV-2
c. HIV-1C
d. All of the above
HIV-2
Which of the following has strong affinity for CD4 receptor?
a. CCR5
b. CXCR4
c. GP120
d. GP41
GP120
Which subtype of HIV is commonly found in Zambia?
a. HIV-1 subtype C
b. HIV-1 subtype G
c. HIV-1 subtype H
d. HIV-1 subtype D
HIV-1 subtype C
In which of the following is the risk of HIV transmission lowest?
a. Men having sex with sexual partners
b. Women having sex with women
c. Protected sexual intercourse with partner on combination antiretroviral therapy
d. Vaginal and anal unprotected
Protected sexual intercourse with partner on combination antiretroviral therapy
Which of the following body fluids have the least possibility of transmitting HIV?
a. Preseminal fluids
b. Breast milk
c. Saliva
d. Vaginal fluids
Saliva
Which of the following has the highest risk of progression to full blown AIDS in an HIV infected person?
a. Seborrhoeic dermatitis
b. Pneumocystis (jirovecii) pneumonia
c. Hepatitis B and current IV drug use
d. Pulmonary tuberculosis
Pneumocystis (jirovecii) pneumonia
Which subtype of HIV is not commonly found in Zambia?
a. HIV-1 and HIV – 2 subtype B
b. HIV-2
c. HIV-1 subtype E
d. HIV-1 subtype C
HIV-1 subtype E
Which of the following drug is a nucleotide reverse transcriptase inhibitor?
a. Saquinavir
b. Tenofovir
c. Lamivudine
d. Didanosine
B
Which of the following will cause severe peripheral neuropathy?
a. Lamivudine
b. Stavudine
c. Tenofovir
d. Zidovudine
B
Which of the following test is required before using abacavir?
a. Tropism
b. HLA*B5701
c. Hypersensitivity
d. CYP2C9
B
Which of the following has the highest genetic barrier to developing resistance?
a. Zidovudine
b. Abacavir
c. Didanosine
d. Emtricitabine
A
Which of the following shows higher viral suppression and fewer discontinuations?
a. Stavudine, lamivudine plus nevirapine
b. Zidovudine,lamivudine plus efavirenz
c. Tenofovir, emtricitabine plus dolutegravir
d. Tenofovir, emtricitabine plus atazanavir
C
Which one of the following is considered high risk exposure?
A. Penetrative sexual assault
B. Large bore needle
C. Deep extensive injury
D. All of the above
D
Which drug should be avoided in patients with Creatinine Clearance less than 50 ml/min?
A. Abacavir sulphate
B. Tenofovir alafenamide
C. Tenofovir disoproxil fumarate D.Zidovudine
C
What is the preferred PEP regimen for an adult patient?
A. TDF + XTC + DTG
B. TDF + XTC + ATV-r
C. TDF + XTC + LPV-r
D. TDF+ XTC + EFV400
A
Who is the Berlin patient?
A. Ray Brown
B. Thomas Ray Brown
C. Timothy Ray Brown
D. Adam Castillejo
C
Who is the London patient?
A. Adam Gupta
B. Anthony Jackson
C. Adam Castillejo
D. Diana Gibb
C
What are AIDS defining Illnesses?
AIDS defining Illnesses are certain serious and life-threatening diseases that occur in HIV-positive people due to severe immunocompromised system. The diseases include such as Pneumocystis (jirovecii) pneumonia, Kaposi sarcoma, HIV encephalopathy.
How would you manage a patient with AIDS defining illness in the package of care available in our setting?
- Ensure the client is on HAART (Highly Active Antiviral Therapy).
- If new or already on treatment, assess factors that may lead to treatment failure such as non-adherence to treatment or resistance.
- If any, manage the underlying diseases and symptoms, decrease the risk of complications and infections.
- Supportive care such as painkillers to manage pain.
- Preventive measures such as counselling on the importance of ART adherence and vaccination.
What strategies are available to prevent HIV/AIDS progression?
- Early diagnosis of HIV and initiation of ART if found positive
- Early diagnosis of opportunistic infections
- Adherence to treatment
- Support groups e.g. adolescent support groups
- Taking prophylactic medications – TPT, Septrin
- Regular hospital visits to monitor CD4 and VL
- Which of the following are members of mycobacterium tuberculosis complex
a. M. bovis
b. Micobacterium avium complex (MAC) F
c. M. africanum
d. M. tuberculosis
B
Which member of mycobacterium complex is endemic to West Africa and infected patients are more likely to be HIV-positive?
a. M. bovis
b. Micobacterium avium complex (MAC)
c. M. africanum T
d. M. tuberculosis
C
Which of the following TB diagnosis test may not be ideal in areas where all the population is vaccinated against TB
a. Microscopical
b. Radiology
c. Skin Test T
d. Mantoux Test T
C
D
Disease that may cause water depletion include:
a. Hypertension
b. Heart failure
c. Diarrhoea T
d. Diabetes mellitus T
C
D
Drugs that may cause dilutional hyponitramia include:
a. prednisolone
b. vincristine T
c. carbamazepine T
d. Diclofenac
B
C
Drugs known to cause hypernatremia include:
a. Amphotericin B
b. Hydrocortisone T
c. Spironolactone
d. Oral contraceptives T
e. Frusemide F
B
D
Drugs known to cause hypokalaemia include:
a. ACE-inhibitor
b. Frusemide T
c. Prednisolone T
d. Amphoterine B T
B
C
D
Clinical features of hypokalaemia include:
a. Shortened action potential F
b. ST-depression T
c. Prolongation of PR-interval T
d. Shortened resting membrane potential F
B
C
Drugs that may cause hypocalcaemia include:
a. frusemide T
b. thiazide diuretics F
c. Phenytoine T
d. phenorbarbitone T
c. Lithium F
A
C
D
Drugs that require monitoring of CrCl include:
a. Ethambutol T
b. Rifampicin F
c. Gentamycin T
d. Paracetamol F
e. Tenofovir T
A
C
E
Which of the following liver enzymes are specific to the liver?
a. AST F
b. ALT T
c. AP F
d. GGT T
B
D
Which cardiac biomarker is more specific? ( Best choice)
a. Total CK B
b. Troponin T
c. Myoglobin
d. LDH
B
Cellular and biochemical response in cryptococcal meningitis include:
a. predominantly polymorphonuclear leucocytes F
b. predominantly mononuclear leucocytes T
c. CSF glucose is greater than 50% F
d. CSF proteins are greater than 0.4g/L T
B
D
Regarding sodium loading with normal saline pre and post amphotericin-B therapy:
a. Prevent fever F
b. Prevent hypotension T
c. Prevent chills and vomiting F
d. Prevent nephrotoxicity T
B
D
Which one of the following side effects of Amphotericin B is not infusion related?
a. Nausea and vomiting F
b. Headache F
c. Hypokalamia T
d. hypotension F
e. Thrombophlebitis T
C
E
PM is hospitalized with pulmonary oedema secondary to congestive heart failure. Patient is started on enalapril
2.5 mg daily and Furosemide 40mg iv
If PM was hypertensive, a goal BP value will be:
a. < 140/90 mmHg
b. < 130/80 mmHg
c. < 120/80 mmHg
d. <150/80 mmHg
2. Mr EL is hypertensive and has just suffered ischemic stroke. The best pharmacotherapy combination will be:
a. Atenolol and bendroflumethiazide
b. Nifedipine and Atenolol
c. Enalapril and hydrochlorothiazide T
d. Ramipril and bendroflumethiazide T
1.c
2. c,d
Which of the following organism(s) are likely to cause meningitis in neonates?
a. N. meningitides F
b. Heamophylus influenzae type B F
c. Group B streptococci T
d. streptococcus pnemoniae F
C
Which type of bacterial meningitis should an adjunctive steroid therapy be used?
A. community acquired meningitis regardless aetiology T
B. hospital acquired meningitis with unknown aetiology F
C. community acquired meningitis with known aetiology only F
D. None of the above F
A
Which type of meningitis should those who came into contact with the patient be given prophylaxis?
A. pneumococcal F
B. streptococcal F
C. Meningococcal T
D. None of the above F
C
A 4-week-old premature infant presents on the hospital neonatal unit with poor feeding, fever and increasing drowsiness. Lumbar puncture reveals 1200 WBC/uL (80% of which are polymorphs), and low glucose and elevated protein levels. No organisms are seen on a Gram-stained smear of the CSF.
The diagnosis is acute purulent meningitis
Questions
1. What are the likely aetiological agents?
The most common causative organisms
- Which other investigations other than CSF culture might help in establishing the aetiological diagnosis?
- What empiric antibiotic therapy should be commenced?
Why add Amoxicillin or ampicillin to children and the immunocompromised?
- in neonates is Group B Streptococci. However, other less common bacteria includes E. coli and Staphylococcus aureus
- FBC – Elevated White blood cells indicates infections
Differential White blood Count: Chec == High
C reactive Proteins = Elevated (Proteins >3 indicates inflammation)
CSF biochemistry (biochemical changes/ cellular response) – e.g - To cover Listeria monocytogenes which do not respond to cepharosporins
Activated charcoal is………………type of physical antidote
A. Bulky food
B. Adsorbent
C. Demulcent
D. Diluents
B
Which of the following is an example of a prodrug?
A. Imipramine
B. Paracetamol
C. Codeine
D. Diclofenac
C
when calculating average monthly consumption, three months consumption or 6 months consumption can be used.
A. Three months consumption can be used when data is consistent
B. Six months consumption when data is inconsistent
C. Both A and B are correct
D. Both A and B are wrong
C
Which of the following has the highest risk of HIV transmission?
a. Receptive anal intercourse
b. Presence of Herpes Simplex virus infection
c. Current IV drug use
d. Hemophilia disorders
A
- Which one of the following treatment plans could be used safely when the patient is presenting with a haemoglobin count of 7g/dl?
a. Use of prophylactic co-trimoxazole in antiretroviral therapy
b. Use of doxorubicin in karposis sarcoma
c. Use of Vancomycin in Urosepsis
d. Use of ganciclovir for cytomegalovirus retinitis
C
A 65-year –old man with history of depression presents with difficulty in falling or staying asleep. He takes his medicine at bed time. Which one of the following antidepressants would be the cause of his insomnia?
a. Imipramine
b. Amitriptyline
c. Phenelzine
d. Maprotiline
A
A 40-year-old pregnant woman in her seventh month presents to her gynecologist for her monthly routine checkup .Upon physical exam her BP is 158/95 mmHg and urinalysis reveals proteinuria. Which of the following would you consider?
a. No need for antihypertensive treatment since the SBP is <160 mmHg
b. Start lisinopril
c. Start Telmisartan + Hydrochlorothiazide
d. Start Labetalol
D
The nurse in the neonatal intensive care unit (NICU) contacts you for advice .A 3kg baby has been prescribed vancomycin for neonatal sepsis.
Which one of the following statements is TRUE regarding administration of vancomycin in this baby?
a. Reconstitute with sterile water for injection and administer directly into a large peripheral or central vein a bolus.
b. Reconstituted with sterile water for injection and administer orally.
c. Prior to administration, the patency of the IV catheter should be tested with a flash of heparinated water.
d. Reconstituted solutions are stable at 2-8oc for at least 4 days.
A
Which one of the following drugs could be safely used in a patient with GFR of less than 30 ml/min/1.73m2 admitted with sepsis?
a. Co-trimoxazole
b. Ceftriaxone
c. Imipenem
d. Gentamicin
B
Which one of the following could result in a patient who abruptly stops a dosage regimen of high dose prednisolone therapy?
a. Acute renal failure
b. Weakness, fatigue, weight loss etc
c. Oral candidiasis
d. Sudden drop in hemoglobin
B
MK is a 46 year old man who presents to the outpatient department with severe attack of gouty arthritis. His serum urate concentration was substantially elevated. Which one of the following is TRUE about treatment for MK’s acute gouty arthritis?
a. Treatment should be instituted 7 days after resolution of the acute episode.
b. Allopurinol is not recommended because of long half life of its metabolite oxypurinol.
c. Sulfinpyrazone is an example of a xanthine oxidase inhibitor and is preferred for prophylactic treatment of gouty arthritis.
d. Low oral doses for Colchicine (0.5 -0.6 mg bd daily) could be appropriate for prophylactic therapy.
A
Which one of the following constitutes the 4FDC regimen currently used as first line for tuberculosis in Zambia?
a. Isoniazide + Rifampicin + Pyrazinamide + Ethambutol
b. Isoniazide + Rifampicin + Pyrazinamide + Pyridoxine
c. Isoniazide + Rifampicin + Pyrazinamide + Ethionamide
d. Isoniazide + Rifampicin + Cycloserin + Ethambutol
A
Which one of the following hypoglycemic drugs is appropriate in an obese diabetes type 2 patient?
a. Tolbutamide
b. Glibenclamide
c. Glipizide
d. Metformin
D
Which one of the following drugs will NOT be largely affected by hypoalbinaemic states?
a. Ceftriaxone
b. Furosemide
c. Warfarin
d. Imipenem
D
JJ is a 20-year-old patient admitted with alcohol withdrawal symptoms. He has history of alcohol abuse. Which of the following drugs could be recommended for JJ’s symptoms?
a. Risperidone
b. Trihexyphenidyl
c. Diazepam
d. Fluphenazine
C
Mr. BZ, a 40 –year-old banker, presents to the OPD following onset of chest pain about 2 hours earlier while he was working around his house. He had tried several doses of sublingual glyceryl trinitrate GTN but his pain did not resolve. He had become increasingly breathless and sweaty, with a tight crashing pain across his chest and left shoulder. His past medical history was documented as “angina”. He was noted to be obese (wt > 110kg).His drug history on admission was recorded as GTN, Nifedipine and Isosorbide mononitrate. On examination his blood pressure was found to be 150/110 mmHg with heart rate of 112 bpm.
Routine tests were done and a diagnosis of acute myocardial infarction (AMI) was made. Mr. BZ was initially prescribed dose of each of the following drugs;
• Morphine 5mg
• Metoclopramide 10mg
• Aspirin 300mg
• Clopidogrel 300mg
- IM injections should generally be avoided in patients suffering with AMI. What would be the preferred route of administration for Mr. BZ’ morphine?
a. Intravenously
b. Orally
c. Transdermal patch
d. Subcutaneous injection - What is the rationale for aspirin and clopidogrel administration during AMI?
a. Clopidogrel helps minimize the GI adverse effects of aspirin.
b. The combination reduces mortality and morbidity associated with MI
c. Dual therapy allows Aspirin antithrombotic effect (takes 72 hours) to set in then clopidogrel is withdrawn.
d. The combination is more effective in reducing the risk of bleeding due to MI. - Which one of the following drugs would not be considered appropriate antithrombotic therapy at this stage of Mr. BZ’s AMI?
a. Clopidogrel
b. Aspirin
c. Alteplase
d. Etamsylate - Which of the following is NOT a beneficial effect of morphine in AMI?
a. Analgesic
b. Vasodilating
c. Anxiolytic
d. Drowsing
- A
- B
14.D
15.D
MJ is a 7 year-old- boy diagnosed with infected eczema by a dermatologist in the out-patient specialist clinic. He presents with inflamed red patches on the inside of elbows and wrists, around the back of his neck and behind his knees.
- Which one of the following drugs would NOT be appropriate treatment for MJ’s infected eczema?
a. Flucloxacillin
b. Clarithromycin
c. Erythromycin
d. Colistin - Which one of the following statements is TRUE about use of topical corticosteroids for MJ’s infected eczema?
a. Topical corticosteroids are contraindicated in MJ.
b. Steroid cream should not be applied to the areas of eczema where the skin has been broken by scratching.
c. A highest potency steroid used for a longer period of treatment would be appropriate.
d. Steroid treatment should be started and continued until 48 hours after symptoms subside then stepped down. - The dermatologist is considering addition of an emollient to the treatment. As a pharmacist, which one of the following would you recommend?
a. White petroleum jelly
b. Calamine lotion
c. Crotamiton cream
d. All of the above
16.D
17.B
18.A
A 64-year- old male patient with history of hypertension and diabetes mellitus presents to the OPD with severe ankle oedema. Which one of his current medication below would you highly suspect?
a. Atenolol
b. Amlodipine
c. Cardiac aspirin
d. Metformin
B
Which one of the following anti-infectives should be avoided in a neonate presenting with jaundice in neonatal sepsis?
a. Ampicillin
b. Cloxacillin
c. Ceftriaxone
d. Gentamicin
C
Mr. P is a 46 –year-old man admitted (Day 2) to the unit you are part of as a pharmacist in a medical ward. He presents with haematemesis, melaena and marked ascites. He is a known patient of alcoholic liver disease. On admission, a diagnosis of bleeding esophageal varices was made and the bleeding was promptly arrested. Medication history shows that Mr. P has been on Furosemide 80 mg bd.
- A registrar in your firm wishes to add another diuretic. Which one of the following would be appropriate?
a. No need for another diuretic just reduce on salt intake
b. Add triamterene
c. Add Spironolactone
d. Telmisartan, hydrochlorothiazide combination - What long term drug for prevention of rebleeding would you recommend for Mr. P?
a. Spironolactone tablets
b. Propranolol tablets
c. Vitamin k injections
d. Tranexamic acid tablets - Which one of the following actions will NOT be appropriate for prevention of hepatic encephalopathy in Mr. P?
a. Addition of diazepam to calm him
b. Addition of Lactulose for his constipation
c. Addition of Omeprazole for GI bleeding
d. Addition of Neomycin for empiric treatment of infection
- C
22.B
23.A
JJ is a 20-year-old male hospitalized at the ophthalmic ward. His current medications are;
Fusidic acid eye drop 1 drop bd in affected eye
Latanaprost eye drop 1 drop od in affected
Acetazolamide tablets 125mg bd
Timolol eye drops 0.5% 1 drop in affected area
- Which one of the following condition/s are being treated in JJ’s eye?
a. Glaucoma and bacterial infection
b. Allergic conjunctivitis
c. Glaucoma and tear deficiency
d. Tear deficiency and fungal infection - Which one of the following requires monitoring with Latanaprost treatment?
a. Severe nausea and vomiting
b. Thinning and shortening of eye lashes
c. Blood pressure
d. Changes to eye coloration
24.A
26.C
JS is a 25-year-old female who is admitted to the emergency department.
PMH asthma
DH Salbutamol inhaler two puffs three times daily
Beclometasone 200 μg/puff inhaler two puffs twice daily
PC chest tightness, exhaustion
O/E pulse >110 bpm
Respiration rate >25 breaths/minute
Diagnosis exacerbation of asthma
JS was hospitalized and the following therapy started:
Oxygen 60%
Salbutamol nebulizer 2.5 mg four times daily
Hydrocortisone intravenous 200 mg every 6 h
Cefuroxime intravenous 750 mg every 8 h
Clarithromycin tablets 500 mg twice daily
Beclometasone inhaler two puffs twice daily
- Which one of the following is the rationale for using Salbutamol nebulizer with oxygen?
a. To maintain arterial oxygen saturation above 90%.
b. Aggressive treatment is required.
c. Salbutamol may mask symptom severity.
d. The bioavailability of Salbutamol increases. - Which one of the following is TRUE about Salbutamol?
a. Is a long acting selective B2 agonist.
b. Incompatible with Beclometasone.
c. First treatment of choice for acute severe asthma.
d. Causes more palpitations than isoproterenol - Which one of the following is NOT a goal of treatment for CKD?
a. Relieve symptoms.
b. Avoid conditions that might worsen renal failure.
c. At end stage, allow the disease process to resolve physiologically.
d. Implement regular dialysis treatment at the most appropriate time.
26.A
27.C
28. C
Which one of the following statements is TRUE about albumin solutions?
a. It is unnecessary to monitor cardiovascular and respiratory functions.
b. Albumin 5% could be indicated in paracentesis of large volume ascites.
c. Albumin solution used usually after acute illness to correct plasma-volume deficits in edematous states.
d. No need to hydrate the patient when administering 25% solution.
29.C
Preliminary results of the phase 1 clinical trial involving the investigational HIV drug SF2000 were recently disseminated to the public by investigators at the National Health Research Conference held in October in Lusaka. In drug development, phase 1 clinical trials typically involve:
a. Care evaluation of the dose-response relationship and measurement of the pharmacokinetics of the investigational new drug in a small number of normal volunteers
b. Double-blinded evaluation of the new drug in hundreds of patients with the target disease by specialist researchers
c. Evaluation of the investigational new drug under conditions of actual use in several thousand patients with the target disease
d. Collection of information regarding late-appearing drug toxicities from data previously studied in preliminary pre-clinical (phase 0) trials.
30.A
A patient is brought as an emergency case at UTH Adult Hospital for treatment of suspected drug overdose. The identity of the drug is unknown, but it is observed that when the urine pH is acidic, the renal elimination of the drug is increased and much greater than when the urine pH is alkaline. The overdosed drug is probably a:
a. Strong acid
b. Weak acid
c. Weak base
d. Strong base
C
A 45-year old man with duodenal ulcer due to Helicobactor pylori infection was treated with Pantoprazole, Clarithromycin and Amoxicillin combination. Which of the following is the most accurate description of the mechanism of Pantoprazole’s therapeutic action?
a. Activation of prostaglandin E receptors
b. Formation of protective coating over the ulcer bed
c. Inhibition of Helicobactor pylori’s mechanism of protein synthesis
d. Irreversible inactivation of the ATPase proton pump in parietal cells
D
A 4-year old boy of Ndola was brought to Author Davison Children’s hospital emergency department after accidentally ingesting some wild mushrooms growing in the bush at home. His symptoms included hallucinations and coma; elevated body temperature; hot, dry, flacky skin; moderate tachycardia; dry mouth and eyes with mydriasis. The most likely cause and explanation for these symptoms is:
a. Ingestion of amphetamine-like substance contained in the wild mushroom
b. Ingestion of organophosphate substance contained in the wild mushroom
c. Ingestion of an antimuscarinic substance contained in the wild mushroom
d. Ingestion of phenylephrine-like substance contained in the wild mushroom
C
Mulobezi district in Western Province recorded a high incidence of deaths due to carbon monoxide poisoning. As the District Pharmacist conducting health promotion and sensitization of communities in the district on the dangers associated with using charcoal-fuelled braziers in poorly ventilated rooms, you inform that carbon monoxide poisoning is results from:
a. Bronchial irritation resulting in bronchospasm and pulmonary oedema
b. Depression of the CNS resulting in seizures, coma and cardiorespiratory collapse
c. Impaired oxygen delivery resulting in tissue hypoxia and multi-organ failure
d. Interference with neuronal transmission resulting in muscle weakness and respiratory failure
C
In macrocytic anaemia presenting with early signs of neuropathy, which one of the following drugs will probably be required?
a. Erythropoietin
b. Folic Acid
c. Iron dextran
d. Vitamin B12
D
In managing a patient with essential hypertension and diabetes, which of the following antihypertensive drugs is least likely to aggravate hyperglycaemia?
a. Angiotensin converting enzyme inhibitors
b. Thiazides
c. Beta-receptor blockers
d. Calcium channel blockersA
A
A drug that acts by inhibiting phosphodiesterase enzyme and is used in the treatment of erectile dysfunction in men is:
a. Finasteride
b. Sildenafil
c. Tamarind
d. Mifeprostone
B
Which one of the following drugs often causes tachycardia and tremors as side effects when used in Asthmatic patients?
a. Salbutamol
b. Cromolyn sodium
c. Ipratropium bromide
d. Prednisolone
A
Though opioids are among the drugs most preferred for management of severe pain, they remain highly regulated in Zambia. Which pharmacological effect of opioids is known to lead to dependence and abuse potential among users?
a. Cough suppression
b. Sedation
c. Euphoria
d. Analgesia
C
A 65-year old man admitted to Livingstone Central Hospital with bacteraemia is to be treated with empirical combination antibiotic therapy for three days while awaiting culture and sensitivity results. The inclusion of the aminoglycoside Gentamicin in the empirical antimicrobial drug therapy will provide coverage against:
a. Bacterioides fragilis
b. Klebsiella pneumoniae
c. Methicillin-resistant Staphylococcus aureus
d. Neisseria meningitidis
B
In a patient receiving Digoxin for congestive heart failure, conditions that may increase the sensitivity of the heart to effects of digoxin and precipitate the appearance of digoxin toxicity include the following EXCEPT:
a. Hyperkalaemia
b. Hypo magnesemia
c. Hyper calcemia
d. Hypokalaemia
A
A 24-year old woman comes to the community pharmacy with a prescription for Ciprofloxacin oral tablets to treat a urinary tract infection. A contraindication of the use of Ciprofloxacin in this patient is a history of:
a. Deep vein thrombosis
b. Glucose-6-phosphate dehydrogenase (G6PD) deficiency
c. Gout
d. Tendinitis
D
In the management of HIV/AIDS in Zambia, Cotrimoxazole is used for prophylaxis of opportunistic infection resulting from:
a. Treponema pallidum
b. Pneumocystis jiroveci
c. Mycobacterium avaium-intracellulare
d. Crytococcus neoformans
B
A 65-year old woman with endometrial carcinoma is being treated as an outpatient at Cancer Diseases Hospital. She has come for her first cycle of platinum-based chemotherapy regimen. To prevent chemotherapy-induced nausea and vomiting, this patient is likely to be given which of the following:
a. Promethazine
b. Cisapride
c. Ondansetron
d. Famotidine
C
A patient diagnosed with smear-positive mycobacterium tuberculosis is commenced on Pyrazinamide, Isoniazid, Rifampicin and Ethambutol with supplementary Vitamin B6. Provided that his disease responds well to the treatment regimen and the organism shows sensitivity to the drugs, it would be appropriate after 2 months to:
a. Change his treatment regimen to prophylaxis with Isoniazid
b. Discontinue Pyrazinamide and Ethambutol
c. Monitor amylase activity
d. Stop the supplemental Vitamin B6.
B
A 22-year-old female carrying a preterm pregnancy (33 weeks) is in labour. Which one of the following drugs can be given to the mother to promote foetal lung maturation?
a. Betamethasone injection
b. Hydrocortisone injection
c. Metyrapone injection
d. Triamcinolone injection
A
Which route of administration is most likely to subject a drug to a first-pass effect?
a. Intravenous
b. Inhalational
c. Oral
d. Sublingual
C
At the MSL laboratory, identical doses of a capsule dosage form (“X”) and a tablet dosage form (“Y”) of the same drug were compared on a broad concentration-time plot with respect to peak serum concentration, time to peak concentration, and area under the curve (AUC) after oral administration as shown in the figure below.
This comparison was made to determine which of the following attributes?
a. Potency
b. Bioequivalence
c. Efficacy
d. Therapeutic Index
A
One of the drugs commonly used to treat mycobacterium tuberculosis infection induces microsomal cytochrome P450 enzymes in the liver. Which drug is this?
a. Isoniazid
b. Rifampicin
c. Pyrazinamide
d. Ethambutol
B
Which of the following drugs recommended for the lowering of blood cholesterol levels inhibits the synthesis of cholesterol by blocking 3-hydroxy-3-methylglutaryl-coenzyme A in the liver?
a. Lovastatin
b. Clofibrate
c. Gemfibrozil
d. Cholestyramine
A
Which one of the following anaesthetics is useful for local (topical surface) administration only?
a. Bupivacaine
b. Etidocaine
c. Benzocaine
d. Lignocaine
C
The plasma concentration of a drug is found to be 30mg/L after 2 hours after ingestion and the apparent volume of distribution is 80L, its half-life is 40 hours, and the clearance of the drug is 35L/day, respectively. What was the most approximate dose ingested?
a. 2.4g
b. 3.6g
c. 4.8g
d. 6.4g
A
Which antimalarial drug causes dose-dependent toxic effects which include flushing, sweaty skin, dizziness, nausea, diarrhea, tinnitus, blurred vision, and impaired hearing?
a. Artesunate
b. Pyrimethamine
c. Quinine
d. Atorvaquone
C
Which one of the following drug binds to a CCR5 receptor of CD4 cells blocking the entry of HIV?
a. Abacavir
b. Tenofovir
c. Enfuvirtide
d. Maraviroc
D
25 year old, female, government employee presents with intermittent fever and chills for seven days, relieved temporarily by paracetamol; headache, myalgia, body malaise and vague abdominal pain. She has a one day history of diarrhea. She denies travel to remote area. Unremarkable PE except for T = 38.6o . What laboratory examination would be the most helpful test before starting any antibiotics?
a. Complete blood count
b. Urinalysis
c. Immunochromatographic test (Typhi Dot)
d. Blood culture and sensitivity
D
Which one of the following statements is false regarding the management of complications of malaria?
a. Hypoglycemia: quinine can induce insulin release which can aggravate hyperglyceamia
b. Pulmonary edema: unknown reason why patients develop this, so ventilator support should be given
c. Acidosis: give bicarbonate
d. Renal failure: require dialysis.
A
According to the 2018 Zambia Consolidated Guidelines for Prevention and Treatment of HIV, the preferred PEP ARVs include:
a. TDF + XTC + EFV
b. TDF + XTC + DTG
c. TDF + XTC + LPV/r
d. TDF + XTC + ATV/r
A
TC a 40 year old Laboratory Scientist comes into your pharmacy for consultation following a needle prick he experienced a week ago. His HIV test is negative and would want to know when the repeat test would be. What would be the appropriate advice for TC?
a. Repeat test at 3 weeks, 3 months and 6 months post exposure
b. Repeat test at 3 weeks, 6 months and 9 months post exposure
c. Repeat test at 6 weeks, 3 months and 6 months post exposure
d. Repeat test at 6 weeks, 6 months and 9 months post exposure
C
Which one of the following statements is false
a. A woman taking PrEP who subsequently becomes pregnant and remains at substantial risk of HIV infection should be considered for PrEP
b. A pregnant or breastfeeding HIV negative woman whose partner is HIV positive should be considered for PrEP
c. An HIV positive woman who is trying to conceive whose partner is HIV negative should be considered for PrEP
d. An HIV negative man who is constantly having condom bursts whenever he meets his clients should be considered for PrEP
C
PrEP should be taken
a. For life
b. For a minimum of 14 days in women and 21 days in men to achieve maximal protection from HIV acquisition before engaging in high risk sexual exposure.
c. For a minimum of 7 days in women and 21 days in men to achieve maximal protection from HIV acquisition before engaging in high risk sexual exposure.
d. For a minimum of 21days in women and 7 days in men to achieve maximal protection from HIV acquisition before engaging in high risk sexual exposure.
D
New guidelines, 7 days in both men and women
. During resuscitation, adrenaline is given at a dose of 1 mg at commencement of CPR. After how many compressions can it be repeated if there is no pulse?
a. 15 compressions
b. 25 compressions
c. 10 compressions
d. 30 compressions
D
AB presents to you with acute kidney injury. After taking a drug history, you discover that AB is on cART (TDF/XTC/DTG), Enalapril, Paracetamol and Benylin for a dry cough. After further investigation, AB admits taking an unknown herbal supplement to boost her immunity. Which laboratory parameter can be used to determine the extent of kidney damage in this patient?
a. Albumin
b. Protein
c. Creatinine
d. Alanine transferase
- For the same patient in question 62. above, what drugs would you advise the prescribers to withdraw?
a. TDF/XTC/DTG, Enalapril, Paracetamol, Benylin cough syrup and the herbal supplement
b. Only the herbal supplement
c. Enalapril, Paracetamol, DTG and XTC
d. TDF, Enalapril and the herbal supplement
- C
- D
A 19 year old boy weighing 50 Kg presents with fever of 39.90C, convulsions and severe headache. On examination, it is discovered that he has malaria falciparum and RDT +++. What antimalarial can be used treat his condition?
a. Coartem 80/480 mg tablets x 3 doses
b. Artesunate 240 mg I.V x 3 doses over 7 days
c. Artesunate 120 mg I.V x 4 doses over 3 days
d. Artesunate 80 mg I.V x 4 doses
C
Dopamine has different effects at different doses. The following statements are false except:
a. 5-15 µg/Kg/min I.V may increase renal output and stimulate vasoconstriction
b. 1-5 µg/Kg/min I.V may increase renal output and renal blood flow
c. 1-5 µg/Kg/min I.V may increase renal blood flow, cardiac output, heart rate and cardiac contractility
d. 5-15 µg/Kg/min I.V may increase renal blood flow, cardiac out, heart rate and contractility.
B
H.B is a 32-year-old man weighing 48kg with an LVEF of less than 25% who presents to Internal Medicine today for follow-up of his recent HF hospitalization.
His blood pressure is 120/85 mm Hg and his pulse is 70 beats/minute. His current medications include Lisinopril 10 mg every day, metoprolol succinate 150 mg every day and furosemide 20 mg every day. You have reviewed his chart and noted that these are the maximal tolerated doses of lisinopril and metoprolol owing to dizziness and near syncope with higher doses. Today his laboratory results show that his SCr is 60 mmol/L and his potassium level is 3.5 mEq/L and his RBS is 14mmol/L. An additional diagnosis of Type 1 diabetes is made after further investigations which revealed a glycosylated Hb of 14%.
66. What is the appropriate insulin dosage for HB?
a. 48 units
b. 32 Units
c. 24 Units
d. 25 Units
67. Owing to the low ejection fraction, what loading dose of Digoxin would you recommend for HB?
a. 2.5mg
b. 2.5µg
c. 0.25µg
d. 0.125µg
68. Which one of the following drugs would you consider adding to HB’s current regimen?
a. Carvedilol
b. Aldosterone
c. Labetalol
d. Hydrochlorothiazide
- C
- D
- B
All of the following drugs are not used in HIV-1/2 infection except?
a. Atazanavir
b. Lopinavir
c. Efavirenz
d. Nevirapine
B
The following PIs are recommended for use in HIV/TB co-infection for patients on Rifampicin except?
a. Atazanavir
b. Lopinavir
c. Darunavir
d. Raltegravir
A
PM is newly diagnosed HIV 1 & 2 co-infection. What is the first line regimen you would commence him on?
a. TDF/3TC/EFV
b. TDF/3TC/DTG
c. TDFC/3TC/LPV-r
d. TDF/3TC/RAL
B
- HK, male, is newly Diagnosed HIV positive. What first line regimen would you recommend for HK?
a. TDF/3TC/DTG
b. TDF/3TC/EFV
c. TDF/3TC/LPV-r
d. TDF/3TC/NVP - After 9 months of treatment, HK is confirmed to have HIV treatment failure while on the regimen above. What would be the preferred second line you would recommend?
a. TDF/3TC/ATV-r
b. TDF/3TC/LPV-r
c. AZT/3TC/LPV-r
d. AZT/3TC/RAL - If HK was anaemic, what modification would you make to the regimen chosen in 73 above?
a. AZT/3TC/ATV-r
b. RAL/3TC/LPV-r
c. TDF/3TC/LPV-r
d. TDF/3TC/ATV-r
- A
- C
- C
DM, 6 months old baby presents to OPD with sunken eyes, irritability, dry mouth, skin tugor, diarrhea and vomiting. What would be the first thing to consider in managing this patient?
a. Rehydration therapy
b. Culture and sensitivity
c. Metronidazole plus Norfloxacin
d. Zinc sulphate.
A
Which of the following I.V fluids is used in the management of cholera?
a. Normal saline
b. Dextrose saline2q
c. Ringers lactate
d. Dextrose 5%
C
In the management of Kaposis sarcoma, which one of the following drugs may be used as premedication?
a. Deflazacort
b. Prednisolone
c. Triamcinolone
d. Hydrocortisone
B
Which one of the following anti-TB drugs would be implicated in CNS adverse effects
a. Isoniazid
b. Pyrazinamide
c. Ethambutol
d. Rifampicin
A
What microorganisms are most likely to be implicated in neonatal meningitis?
a. Pseudomonas Aeruginosa
b. Neisseria Menengitidis
c. E. coli
d. Group B streptococci
D
Which TB drug causes retro-bulber neuritis?
a. Kanamycin
b. Ethambutol
c. Streptomycin
d. Levofloxacin
B
Mr H is started on PEP on 30/11/18. On 21/12/18 Mr H had unprotected sexual intercourse with a known HIV positive Patient who is not on treatment. After counselling Mr H regrets his actions and promises not to expose himself again. When is Mr H expected to stop taking ARVs?
a. After 28 day (on 28/12/18) since Mr H is already on PEP
b. On the 18/01/19
c. 6months after the last exposure
d. 4 weeks after the first exposure
B
Mr A is a 30 year old man who present to the hospital with a severe cough and he is diagnosed with severe pneumonia with CURB 65 score of 5. The patient disclose that he is HIV positive and is on treatment since 2015 on TDF/3TC/EFV regimen but stopped taking ARV drugs about a year ago. The doctor asks for your intervention as a pharmacist, what would you recommend?
a. To continue on the same regimen (TDF/3TC/EFV) and check for possible treatment failure after 3 months
b. To start the recommended first line drugs TDF/3TC/DTG and check for possible treatment failure after 3 months
c. To change to the recommended second line drugs AZT/3TC/LPV/r and check for possible treatment failure
d. To change to the recommended second line drugs TDF/3TC/ATV/r and check for possible treatment failure
A
After 2months on cART and before the viral load and resistance test results are out, Mr A comes back to the hospital and is found to be having renal impairment with CrCl of 32ml/min and his doctor makes a decision to change his ARV drugs to ABC/3TC based regimen. What is the appropriate dose for Abacavir and lamivudine should be given?
a. ABC 300mg od and 3TC 150mg od
b. ABC 300mg od and 3TC 100mg od
c. ABC 300mg bd and 3TC 150mg od
d. ABC 300mg bd and 3TC 50mg bd
C
Which one of the following statements is not true regarding ARVs normal dosages in adult patients?
a. Abacavir 300mg tablet can be dosed at double strength 600mg once a day
b. Nevirapine 400mg ER tablet is dosed one a day
c. Neverapine 200mg IR can be dosed at double strength 400mg once a day
d. Lopinavir/ritonavir 200mg/50mg is only dosed twice a day and in HIV/TB coinfection treatment the dose is doubled.
D
Which one of the following carbepenem antibiotics has a high propensity to induce seizures and should be avoided in meningitis?
a. Ertapenem
b. Doripenem
c. Meropenem
d. Imipenem
D
Ceftriaxone is a once-daily drug for almost all indications except in?
a. Meningitis
b. Septicaemia
c. Pyelonephritis
d. Nosocomial infection
A
Which one of the following antibiotics does not have activity against pseudomonas aeruginosa?
a. Cefepime
b. Ertapenem
c. Piperacillin/tazobactam
d. Aztreonam
B
Which one of the following is true regarding ophthalmic antihistamines?
a. Pheniramine and Tetrahydrozoline are the only two nonprescription ophthalmic antihistamines available.
b. Ophthalmic antihistamines are available only in combination with Naphazoline.
c. Ophthalmic antihistamines may cause burning, stinging, dry eyes, or mydriasis.
d. Ophthalmic antihistamines may produce rebound congestion if used in excess or for extended durations.
C
The definition of a surfactant (an ingredient in toothpaste) can best be described by which one of the following statements?
a. It prevents drying of the preparation.
b. It removes debris by its detergent action and causes foaming, which is usually desired by the patient.
c. It physically removes plaque and debris.
d. It determines the texture, dispersiveness, and appearance of the product.
B
Which one of the following cleansing products would a pharmacist recommend for a patient with inflammatory acne?
a. An abrasive facial sponge and soap used 4 times a day
b. Aluminum oxide particles used 2 times a day
c. Sulfur 5% soap used 2 times a day
d. Mild facial soap used 2 times a day
D
If a patient needs a second application of an Over - The-Counter (OTC) Pyrethrin pediculicide shampoo, how many days after the first application should this be done?
a. 4-5
b. 6
c. 7-10
d. 14-21
C
Which one of the following treatments for personal articles infested with head lice would not be effective?
a. Placing woolen hats in a plastic bag for 2 weeks.
b. Using an aerosol of Pyrethrins with Piperonyl Butoxide sprayed in the air of all bathrooms.
c. Machine-washing clothes in hot water and drying them using the hot setting on the dryer.
d. Dry-cleaning woolen scarves.
B
Which one of the following should not be mentioned by a Pharmacist when when educating patients about acne?
a. Eliminating all chocolate and fried foods from the diet.
b. Cleansing skin gently 2-3 times Daily.
c. Using water -based noncomedogenic cosmetics.
d. Not squeezing acne lesions.
A
A 15-year-old male patient has been using Benzoyl Peroxide 5% cream faithfully every day for the past 2 months with no apparent side effects. Which one of the following can not be said about this patient?
a. He has been using this product for a long enough time to determine if the dose and dosage form are going to have any benefit.
b. He should use this product no more frequently than every other day because of its irritating properties.
c. This starting dose and dosage form are useful, especially if he has dry skin or it is winter time.
d. His scalp hair may look bleached i f the product comes in contact with it.
A
The role of the pharmacy regulator (The Health Profession’s Council Zambia) is:
a. To protect, promote and maintain the health, safety and wellbeing of members of the public in order to uphold standards and public trust in pharmacy.
b. To raise the standing of the profession and to protect the interests of its members.
c. To promote pharmacy and to advance science, practice, and education in pharmacy.
d. To protect the interests and rights of members of the pharmacy profession.
B
Which one of the following is true about the functions of Zambia Medicine Regulatory Authority?
a. Control of drug trafficking.
b. Licensing of pharmacists.
c. Confiscation of drugs not authorized to dispense.
d. Registration of pharmacy training schools
C
What makes pharmacists unique in the health care team?
a. Pharmacists advise patients on how take their medicines.
b. Pharmacists are experts on communicating with patients and other health care professionals.
c. Pharmacists have access to a vast amount of knowledge on medicines and the actions of drugs.
d. Pharmacists are experts on medicine formulation and use and can apply this to patient care.
D