A patient presents to the OPD with complaints of pain in the epigastrium and heart burn.

The attending
physician makes a diagnosis of H Pylori induced duodenal ulcer based on examination and investigations
and decides to prescribe a triple therapy for the eradication of H pylori and subsequent treatment of ulcer.
Which of the following options correctly shows the drugs combination used in triple therapy?
a) Antacid plus Bismuth plus Ranitidine
b) Antacid plus H2 Receptor Blocker plus Sucralfate
c) Bismuth plus Omeprazole plus Ranitidine
d) Bismuth plus Metoclopramide plus Tetracycline
e) Clarithromycin plus Metronidazole plus Omeprazole

Which of the following adverse effects is associated with the use of a magnesium containing antacids?
a) Cardiac Arrhythmias
b) Constipation
c) Diarrhea
d) Hypotension
e) Nausea

A patient taking antiplatelet drug clopidogrel for many years for some cardiovascular condition now
develops peptic ulcer. His physician prescribes him omeprazole, however he is concerned about the
possible interaction between the two drugs. This is because omeprazole:
a. Has no effect on metabolism of clopidogrel
b. May decrease the efficacy of clopidogrel by enhancing its metabolism
c. May increase the efficacy of clopidogrel by enhancing its metabolism
d. May decrease the efficacy of clopidogrel by inhibiting its metabolism
e. May increase the efficacy of clopidogrel by inhibiting its metabolism

Which of the following mechanisms is not involved in the therapeutic efficacy of 5 aminosalicylic acid in
the treatment of inflammatory bowel disease?
a. Inhibit the cellular functions of macrophages and NK cells
b. Interfere with the production of inflammatory cytokines
c. Modulate inflammatory mediators derived from both COX and LOX pathways
d. Scavenge reactive oxygen metabolites
e. Stimulate the activity of nuclear factor kB

Which of the following drugs is most likely given to a patient with severe Irritable Bowel Syndrome
(IBS) in whom diarrhea is the predominant symptom?
a. Alosetron
b. Amitriptyline
c. Atropine
d. Dicyclomine
e. Hyoscine
An extremely lethargic 7 years old boy presents to the hospital with complaints of high grade fever with
chills and rigors for 5 days and diarrhea for two days. On the basis of history, examination and
investigations diagnosis of typhoid fever is made and he is started on a parenteral antibiotic which is
considered to be very effective in children with Chloramphenicol resistant S typhi infection. The drug
most likely prescribed to this patient acts by which of the following mechanisms?
a. Formation of porous channels in the cell membrane
b. Inhibition of bacterial cell wall by inhibiting PBPs
c. Inhibition of bacterial cell membrane
d. Inhibition of bacterial protein trancription
e. Inhibition of DNA gyrase activity
Which of the following antiemetics causes less CNS adverse effects including less extrapyramidal
reactions because it has less penetration into the CNS?
a. Chlorpromazine
b. Domperidone
c. Metoclopramide
d. Prochlorpromazine
e. Promethazine

A 60 years old chain smoker develops lung cancer for which he receives chemotherapy. He now
complains of severe nausea and vomiting. Which one of the following drugs would be most suitable for
this bothersome adverse effect of chemotherapy?
a. Hyoscine
b. Meclizine
c. Metoclopramide
d. Ondansetron
e. Promethazine

Which of the following drugs is a drug of choice for the treatment of pancolitis caused by Bacteroides
Fragilis (most abundant bacterium in the human colon)?
a. Amoxicillin
b. Diloxanide Furoate
c. Metronidazole
d. Pyrimethamine
e. Paromomycin

Ivermectin active against nematodes act by which of the following mechanisms?

A patient with worm infestation is to be treated with Niclosamide. Which one of the following parasites is
susceptible to this drug?
a. Ascaris lumbricoides
b. Echinococcus granulosus
c. Enterobious vermicularis
d. Necator americans
e. Tenia saginata

Kaolin is used as an antidiarrheal agent, it decreases the liquidity and frequency of stools. Which of the
following options describes its mechanism of action?
a. Acts as bile salt binding resin
b. Adsorbs water and toxins in the intestine
c. Has antibacterial as well as anti-inflammatory activity
d. Inhibits the release of GIT hormones
e. Stimulates the opioid receptors
Which of the following laxatives is correctly matched with its mechanism of action?
a. Bisacodyl: Stimulant purgative
b. Lubiprostone: Na channel activator
c. Magnesium Sulphate: Stool softner
d. Mineral Oil: Osmotic purgative
e. Psyllium: Opioid receptor agonist

Which of the following drugs given in high doses has high levels of reactive metabolite N acetyl
benzoaminoquinone (NAPQI) that causes hepatotoxicity especially when the drug is given with an
enzyme inducer?
a. Acetaminophen
b. Amiodarone
c. Aspirin
d. Colchicine
e. Indomethacin

Which of the following NRTIs is used as one of the first line agents to treat Hepatitis B viral infection?
a. Abacavir
b. Didanosine
c. Lamivudine
d. Stavudine
e. Tenofovir

A patient of hepatitis C is receiving a drug that acts that acts through cytokine receptors, has multiple
targets of actions and is specifically designed for longer duration of action. Which one of the following
drugs is he most likely taking?
a. Acyclovir
b. Interferon
c. Ribavirin
d. Saquinavir
e. Zidovudine

A patient with multiple medical problems is taking several drugs one of which is warfarin. The patient
suffers some GI distress for which he starts taking a drug intended for decreasing acidity. However he
develops bruising and nose bleed, blood tests reveal high warfarin plasma concentrations. Which of the
following drugs the patient most likely self-prescribed?
a. Cimetidine
b. Famotidine
c. Omeprazole
d. Nizatidine
e. Ranitidine

A 51 years old man with a long history of medication dependent reflux esophagitis sees his physician for
an annual checkup, which reveals a blood gastrin levels three times the upper limit of normal. His
physician is concerned that he may develop atrophic gastritis. The medication the patient is most likely
taking inhibits gastric acid secretion by which of the following mechanisms?
a. Activation of Prostaglandin E receptors
b. Antagonism of Muscarinic Receptors on Parietal cells
c. Antagonism of H2 receptors on Parietal cells
d. Formation of protective coating over the ulcer base
e. Irreversible Inhibition of H+/K+ ATPase in Parietal cells
Five days after starting self-medication for diarrhea and other GI complaints, a 35 years old patient
comes to the ER with complaints that his tongue has turned black and his stools have darkened too.
History and examination reveals that his description doesn’t at all fit with what would be expected if the
patient had a bleed anywhere in the GI tract. Considering that the above signs are drug induced, which of
the following drugs is most most likely to have caused these signs?
a. Bismuth salts
b. Calcium carbonate
c. Cimetidine
d. Esomeprazole
e. Magnesium-aluminum antacid combination

The mechanism responsible for the therapeutic effects exerted by sulfasalazine in ulcerative colitis is:
a. Breakdown of the drug to release 5 aminosalicylic acid which suppresses inflammation locally
b. Breakdown of the drug in the liver to release anti inflammatory metabolites
c. Inhibitory action of the unabsorbed drug on the abnormal colonic flora
d. Release of sulfapyridine which suppresses bacteria locally
e. Systemic immunomodulatory action of the drug

A woman has severe irritable bowel syndrome characterized by frequent, profuse and symptomatic
diarrhea. She has not responded to first line therapies and is started on alosetron. What is the most
worrisome adverse effect associated with this drug?
a. Cardiac Arrhythymias esp ventricular
b. Constipation, ischemic colitis
c. Parkinsonean extrapyramidal symptoms
d. Pulmonary fibrosis
e. Renal Failure

A 65 years old woman has returned from a vacation suffering from traveler’s diarrhea and her problem
has not responded to anti diarrheal drugs. A pathogenic gram negative bacillus is suspected. The drug
most likely to be effective in the treatment of this patient acts by which of the following mechanisms?
a. Formation of porous channels in the cell membrane
b. Inhibition of bacterial cell wall by inhibiting PBPs
c. Inhibition of bacterial cell membrane
d. Inhibition of bacterial protein trancription
e. Inhibition of DNA gyrase activity

A 40 years old man with a long history of GIT problems (nausea, vomiting, acidity, bloating, etc) for
which he has regularly been taking some medication, comes to you with complaints of choreoathetoid
movements and lip smacking. Previously he also had complaint of gynecomastia and sexual dysfunction.
Which of the following drugs is the most likely cause of his symptoms?
a. Cimetidine
b. Domperidone
c. Metocloperamide
d. Misoprostol
e. Omeprazole

A patient with liver cirrhosis presents to ER with complaints of episodes of hematemesis, passage of
black stools, dizziness and abdominal discomfort. On examination patient appears pale and dyspneic with
hypotension and cyanosed tongue and lips. Abdominal examination reveals ascites with dilated veins on
anterior abdominal wall. While making a probable diagnosis volume resuscitation and IV drug therapy is
initiated. Which of the following drugs has most likely been given to treat the acute condition?
a. Esmolol
b. Metocloperamide
c. Propranolol
d. Somatostatin
e. Terlipressin
Two weeks after vacations in a remote mountain resort, a chronic alcoholic develops foul smelling watery
diarrhea, abdominal cramps and flatulence. He says that he drank water from a nearby stream. Blood tests
show leukocytosis with increased ESR while fresh stool microscopy reveals trophozoites with
intracytoplasmic RBCs. A diagnosis is made and patient is prescribed a drug. However after taking
alcohol with the given drug he comes back with symptoms of flushing, throbbing headache, nausea,
vomiting, hypotension and confused state. Which of the following drugs is most likely responsible for the
symptoms in this patient?
a. Cefoperazone
b. Diloxanide Furoate
c. Emetine
d. Metronidazole
e. Tinidazole

Albendazole active against nematodes act by which of the following mechanisms?

Three days after returning from trip to several countries a person develops anorexia, abdominal pain and
diarrhea. Blood tests show eosinophilia and stool sample reveals Tenia saginata. Which of the following
drugs is the treatment of choice for this helminthic infection?
a. Albendazole
b. Ivermectin
c. Levamisole
d. Praziquantel
e. Pyrantal Pamoate

All of the following are the mechanisms by which opioids exert their anti diarrheal effects except?
a. Central effect: Cause inattention to defecation reflex
b. Decreased GIT secretions
c. Decreased tone and segmental contractions but increased propulsive movements
d. Spasm of pyloric, ileocecal and anal sphincters
e. Tone of the duodenum and colonic smooth muscles may be increased

Which of the following laxatives is broken down into ricinoleic acid in the small intestine, which is very
irritating to the gut and promptly increases peristalsis?
a. Bisacodyl
b. Castor Oil
c. Liquid Paraffin
d. Psyllium
e. Senna
A depressed female attempts suicide by taking more than 4 gms of a fever reducing drug. She now
complains of persistant nausea, vomiting, tremors and severe abdominal pain. Lab tests show raised ALT
and AST as well as hypothrombinemia. However there was no significant acid base disturbance. Which
of the following drugs is the most appropriate antidote for the counteracting the toxicity of the taken
drug?
a. Acetylcysteine
b. Activated Charcoal
c. Dimercaprol
d. Penicillamine
e. Sodium Bicarbonate

A 37 years old woman presents with fever, malaise and right upper quadrant pain. Blood tests show that
she has increased levels of liver enzymes. In addition hepatic serology indicates that she has hepatitis B
infection. A once weekly subcutaneous dose of drug is given. However after few months the patient
comes back with complaints of feeling depressed at most of the time, weight loss, myalgias, alopecia,
hearing as well as visual loss. The drug most likely responsible for these adverse effects is:
a. Adefovir Dipivoxil
b. Entecavir
c. Interferon 
d. Lamivudine
e. Tenofovir Disoproxil
Which of the following drugs is given in combination with interferon therapy for patients who have
turned serologically positive for hepatitis C surface antigen?
a. Acyclovir
b. Adefovir
c. Daclatasvir
d. Ribavirin
e. Sofosbuvir