Competency Appraisal Reviewer

Topic: Pharmacology

1. A 30 yr old pregnant female has cellulitis Clindamycin and erythromycin

caused by MRSA. Which of the following
antibiotics would be the most appropriate 8. A patient with a gunshot wound to the
option for outpatient therapy? abdomen, which has resulted in spillage of
Clindamycin intestinal contents, is brought to the
emergency room. Which antibiotic would you
2. A patient is being discharged from the select to effectively treat an infection due to
hospital on a 3-week course of clindamycin. Bacteroides fragilis?
Which of the following potential adverse effects Clindamycin
should be discussed with her?
Clostridium difficile diarrhea 9. Children younger than 8 yrs of age should
not recieve tetracyclines because these agents:
3. The culture and sensitivity results from a Deposit in tissues undergoing calcification.
blood sample for a 75-yr old female revealed
an infection with a vancomycin-resistant 10. A 25-yr old male presents to the emergency
enterococcus faceium (VRE). Which antibiotic room with a fever, headache, and skin lesions.
would provide the most efficacious treatment Upon taking the patient's medical history, the
for this patient's infection? physician learns that the young man returned
Linezolid last week from a camping trip in Georgia,
during which time he reports receiving two tick
4. An attending physician asked the medical bites. If the physician wants to treat this
student on rounds in the critical care unit, what patients for Lyme disease, what is the most
would be one advantage of using once-daily appropriate antibiotic that should be
dosing of the aminoglycosides for treating an prescribed?
infection caused by a gram-negative organism? Doxycycline
Post antibiotic effect
11. A pregnant woman was hospitalized and
5. A 46-yr old woman is in the intensive care catheterized with a Foley catheter. She
unit for treatment of a vanomyicn-resistant developed a urinary tract infection caused by
strain of Enterococcus faecium- caused Pseudomonas aeruginosa and was treated with
bacteremia. She is receiving five other gentamicin. Which of the following adverse
medications. To limit the risk of drug effects was a risk to theto the fetus when the
interactions in this woman, which one of the woman was on gentamicin?
following antibiotics should be used? Hearing loss
Linezolid
12. A seventy year old alcoholic male with poor
6. A 52-yr old male, who smokes one pack of dental hygiene is to have his remaining teeth
cigarettes a day, presents to his Primary care extracted for subsequent dentures. He has
Physician (PCP) with a fever, chest pain, and a mitral valve stenosis with mild cardiac
productive cough with purulent sputum. The insufficiency and is being treated with
patient is a good historian and states his captopril, digoxin, and furosemide. The dentist
symptoms began about 4 ays ago, after he decides that his medical history warrants
returned from a business conference that was prophylactic antibiotic therapy prior to the
held at a hotel booked to capacity in Chicago. procedure and prescribes which of the following
Chest x-ray revealed an infiltrate in the lower drugs.
lobe of the right lung. If the PCP suspects the Amoxicillin
patient has pneumonia dut to the pathogen,
Legionella pneumonia, what is the most 13. A patient with degenerative joint disease is
appropriate antibiotic that should be prescribed to undergo insertion of a hip prosthesis. To
for the treatment? avoid complications due to postoperative
Azithromycin infection, the surgeon will pretreat this patient
with an antibiotic. This hospital has a significant
7. Which of the following antibiotic problem with MRSA. Which of the following
combinations is inappropriate based on antibiotics should the surgeon select?
antagonism at the same site of action? Vancomycin
 Competency Appraisal Reviewer
Topic: Pharmacology

diagnosed with pulmonary tuberculosis and has

14. A 25 year old male returns home from a been receiving isoniazid, rifampin,
holiday in the Far East and complains of 3 days pyrazinamide and ethambutol for two months.
of dysuria and a purulent urethral discharge. Which of the following drugs would be most
You diagnose this to be a case of gonorrhea. appropriate to treat his symptoms?
Which of the following is appropriate Pyrodoxine
treatment?
Ceftriaxone IM 21. The mechanism of action of rifampin
includes an inhibition of which of the following
15. Drug that inhibits 50s ribosomal subunit enzymes?
that is used to treat bronchitis, pneumonia and DNA dependent RNA-polymerase
STD.
Azithromycin 22. Which of the following is the most likely
mechanism of resistance of M.tuberculosis to
16. rifampin?
1. Pseudomembranous colitis - Clindamycin Changes in bacterial RNA polymerase
2. Red man’s syndrome - Vancomycin
3. Cartilage abnormalities - Ciprofloxacin 23. A 63-year-old man presented to the
4. . Ototoxicity - Neomycin hospital complaining of anorexia, nausea and
5. Gray baby syndrome - Chloramphenicol vomiting and abdominal discomfort. He also
had pain on motion and stiffness in several
17. A 31-year-old homosexual HIV-positive man joints. He was recently diagnosed with renal
was found to have latent tuberculosis. A tuberculosis and started on a 4 drug
treatment with isoniazid was started. The combination regimen one month ago. Lab
antibacterial effect of this drug is most likely results showed raised serum uric acid of 13
mediated by the inhibition of the synthesis of mg /dl. Which of the following drugs has most
which of the following molecules? likely caused the patient symptoms and signs?
Mycolic Acid Pyrazinamide

18. Which of the following antimycobacterial 24. A 7-year-old girl was admitted to the
drugs is inactivated by hepatic acetylation, the hospital with high fever and nuchal rigidity and
rate of which depends on genetic background? was later diagnosed with meningococcal
Isoniazid meningitis. Which of the following drugs was
most likely given prophylactically to her 10
year old sister?
Rifampin

25. A 45-year-old woman complained of blurred

vision and inability to distinguish green objects
from red objects. The woman, recently
diagnosed with cavitary pulmonary
tuberculosis, has been receiving a 3 drug
combination regimen for two months. Which of
the following drugs has most likely caused
these adverse effects?
Ethambutol

19. High level of resistance of tubercle bacilli to 26. A 67-year-old man, recently diagnosed with
isoniazid involves a decrease in the activity of pulmonary tuberculosis, started a treatment
which of the following enzymes? with antitubercular drugs. The man has been
Catalase-peroxidase suffering from atrial fibrillation, and he is
presently taking warfarin as one his various
20. A 56-year-old man complained of tingling drugs. At this point, which of the following
sensation in his limbs and that his arms changes in the therapeutic regimen of the
sometimes felt heavy. He was recently patient would be appropriate?
 Competency Appraisal Reviewer
Topic: Pharmacology

To increase the dose of warfarin B. Inhibition of bronchial secretion.

C. Contraction of sphincter muscle in the
27. A 37-year-old homosexual man with AIDS iris of the eye (miosis).
was recently diagnosed with pulmonary D. Contraction of sphincter of urinary bladder.
tuberculosis and a treatment with isoniazid, E. Increase in heart rate.
rifampin, pyrazinamide and ethambutol was
started. Which of the following statements best 32. Which of the following is characteristic of
explains why ethambutol was added to the the sympathetic nervous system?
therapeutic regimen? A .Discrete response to activation.
To delay the emergence of drug resistance B. Actions mediated by muscarinic and nicotinic
receptors.
28. A 32-year-old woman, who was HIV C. Effects only mediated by norepinephrine.
positive, presented with fever, profuse night D. Responses predominate during
sweats, poor appetite and a 20-pound weight physical activity or when experiencing
loss over the past 3 months. Physical fright.
examination revealed a cachectic female with a E. Subjected to voluntary control.
prominent oral thrust and mild splenomegaly.
Her CD4+ lymphocyte count was 45 cells/mm 33. Patient presents with salivation,
and a DNA probe test confirmed the diagnosis lacrimation, urination and defecation as side
of Mycobacterium Avium complex infection. An effects of a medication. Which one of the
appropriate multidrug regimen for this patient following receptors mediates the actions of this
would include which of the following drugs? drug?
Azithromycin A. Nicotinic receptors.
B. α Receptors.
29. A 48-year-old man presented to the C. Muscarinic receptors.
emergency room with the symptoms of acute D. β Receptors.
gouty arthritis. He was diagnosed with gout a 34. A patient with an acute attack of glaucoma
year before and had been taking medications is treated with pilocarpine. The primary reason
for the chronic control of the disease. He is also for its effectiveness in this condition is its:
on treatment for hypertension. Recently, one A. Action to terminate acetylcholinesterase.
and half month ago, he was diagnosed with B. Selectivity for nicotinic receptors.
pulmonary tuberculosis and was started on C. Ability to inhibit secretions, such as tears,
antitubercular therapy. Which of the following saliva, and sweat.
drugs had most likely aggravated his gout? D. Ability to lower intraocular pressure.
Pyrazinamide E. Inability to enter the brain.

30. Which one of the following statements 35. A soldier's unit has come under attack with
concerning the parasympathetic nervous a nerve agent. The symptoms exhibited are
system is correct? skeletal muscle paralysis, profuse bronchial
A. The parasympathetic system uses secretions, miosis, bradycardia, and
norepinephrine as a neurotransmitter. convulsions. The alarm indicates exposure to
B. The parasympathetic system often an organophosphate. What is the correct
discharges as a single, functional system. treatment?
C. The parasympathetic division is A. Do nothing until you can confirm the nature
involved in accommodation of near vision, of the nerve agent.
movement of food, and urination. B. Administer atropine, and attempt to confirm
D. The postganglionic fibers of the the nature of the nerve agent.
parasympathetic division are long compared to C. Administer atropine and 2-PAM
those of the sympathetic nervous system. (pralidoxime).
E. The parasympathetic system controls the D. Administer pralidoxime.
secretion of the adrenal medulla.
36. A patient on a diagnostic test for
31. Which one of the following is characteristic myasthenia gravis would be expected to have
of parasympathetic stimulation? improved neuromuscular function after being
A. Decrease in intestinal motility. treated with:
 Competency Appraisal Reviewer
Topic: Pharmacology

A. Donepezil. 42. Nondepolarizing neuromuscular blockers

B. Edrophonium. are associated with all of the following except:
C. Atropine. A. Initial activation of ACh receptor and
D. Echothiophate. depolarization of the motor end plate
E. Neostigmine. B. Effects are reversed by acetylcholinesterase
inhibitors.
37. The drug of choice for treating decreased C. Intermediate to long duration of action
salivation accompanying head and neck D. Bind but do not activate ACh receptor
irradiation is: E. Most of these agents have minimal
A. Physostigmine cardiovascular effects.
B. Scopolamine
C. Carbachol 43. A 68-year-old man presents to the
D. Acetylcholine emergency department with acute heart
E. Pilocarpine failure. The patient requires immediate drug
therapy to improve his cardiac function. Which
38. A 75-year-old man who was a smoker is one of the following drugs would be most
diagnosed with chronic obstructive pulmonary beneficial?
disease and suffers from occasional A. Albuterol. B. Dobutamine. C. Epinephrine.
bronchospasm. Which of the following would be D. Norepinephrine. E. Phenylephrine.
effective in treating him?
A. Ipratropium aerosol 44. Remedies for nasal stuffiness often contain
B. Scopolamine patches which one of the following drugs?
C. Mecamylamine. A. Albuterol. B. Atropine. C. Epinephrine. D.
D. Oxygen Norepinephrine. E. Phenylephrine
E. Nicotine
45. Which one of the following drugs, when
39. Which of the following may precipitate an administered intravenously, can decrease blood
attack of open-angle glaucoma if instilled into flow to the skin, increase blood flow to skeletal
the eye? muscle, and increase the force and rate of
A. Physostigmine B. Atropine C. Pilocarpine cardiac contraction?
D. Echothiophate E. Tropicamide A. Epinephrine. B. Isoproterenol. C.
Norepinephrine. D. Phenylephrine. E.
40. The prolonged apnea sometimes seen in Terbutaline.
patients who have undergone an operation in
which succinylcholine was used as a muscle 46. In which one of the following conditions
relaxant has been shown to be due to: would aspirin be contraindicated?
A. Urinary atony A. Myalgia. B. Fever. C. Peptic ulcer. D.
B. Depressed levels of plasma Rheumatoid arthritis. E. Unstable angina
cholinesterase
C. A mutation in acetylcholinesterase 47. Which one of the following statements
D. A mutation in the nicotinic receptor at the concerning COX-2 inhibitors is correct?
neuromuscular junction A. The COX-2 inhibitors show greater analgesic
E. Weak histamine-releasing action activity than traditional NSAIDs.
B. The COX-2 inhibitors decrease platelet
41. A 50-year-old male farm worker is brought function
to the emergency room. He was found C. The COX-2 inhibitors do not affect the kidney
confused in the orchard and since then has lost D. The COX-2 inhibitors show anti-
consciousness. His heart rate is 45, and his inflammatory activity similar to that of
blood pressure is 80/40 mm Hg. He is sweating the traditional NSAIDs
and salivating profusely. Which of the following E. The COX-2 inhibitors are cardioprotective.
treatments is indicated?
A. Physostigmine. B. Norepinephrine. C. 48. An 8-year-old girl has a fever and muscle
Trimethaphan. D. Atropine. E. Edrophonium aches from a presumptive viral infection. Which
one of the following drugs would be most
appropriate to treat her symptoms?
 Competency Appraisal Reviewer
Topic: Pharmacology

A. Acetaminophen. B. Aspirin. C. Celecoxib. D. prescribed sublingual nitroglycerin for

Codeine. E. Indomethacin treatment of acute chest pain. Which of the
following adverse effects is likely to be
49. A 70-year-old man has a history of ulcer experienced by this patient?
disease. He has recently experienced swelling A. HYPERTENSION B. THROBBING
and pain in the joints of his hands. His HEADACHE C. BRADYCARDIA D. SEXUAL
physician wants to begin therapy with an DYSFUNCTION E. ANEMIA
NSAID. Which one of the following drugs might
also be prescribed along with the NSAID to 55. A 65 yr old male experiences uncontrolled
reduce the risk of activating this patient's ulcer angina attacks that limit his ability to do
disease? household chores. He is adherent to a
A. Allopurinol. B. Colchicine. C. Misoprostol. maximized dose of beta-blocker with a low
D. Probenecid. E. Sulindac heart rate and low blood pressure. He was
unable to tolerate an increase in isosorbide
50. Dihydroergotamine: mononitrate due to headache. Which is the
A. Causes vasodilation. most appropriate addition to his antianginal
B. Exerts its actions by binding to specific therapy?
ergotamine receptors. Ranolazine
C. Is useful in treating acute migraine
headaches. 56. The pt prescribed in question num 54 is
D. Is useful for maintaining uterine muscle tone also prescribed propranolol to prevent episodes
during pregnancy. of angina. The beta blocker has the added
E. Has actions similar to those of nitroprusside. benefit of preventing which of the following
side effects of SL nitroglycerin?
51. A 43-year-old ship's captain complains of A. DIZZINESS B. METHEMOGLOBINEMIA
seasonal allergies. Which one of the following B. THROBBING HEADACHE D. REFLEX
would be indicated? TACHYCARDIA E. EDEMA
A. Cyclizine. B. Doxepin. C. Doxylamine. D.
Hydroxyzine. E. Fexofenadine 57. A nurse is providing patient teaching to a
patient who has been experiencing unstable
52. Which one of the following statements angina. What will the nurse's explanation of
concerning H1 antihistamines is correct? this condition include?
A. Second-generation H1 antihistamines A) A coronary vessel has become completely
are relatively free of adverse effects. occluded and is unable to deliver blood to your
B. Because of the established long-term safety heart.
of f irst-generation H1 antihistamines, they are B) The pain is caused by a spasm of a blood
the f irst choice for initial therapy. vessel, not just from the vessel narrowing.
C. The motor coordination involved in driving C) There is serious narrowing of a
an automobile is not affected by the use of coronary artery that is causing a
firstgeneration H1 antihistamines. D. H1 reduction in oxygen to the heart.
antihistamines can be used in the treatment of D) Your body's response to a lack of oxygen in
acute anaphylaxis. the heart muscle is pain.
D. Both first- and second-generation H1
antihistamines readily penetrate the blood- 58. Which of the following drugs bind bile acids
brain barrier. in the intestine, thus preventing their return to
the liver via enterohepatic circulation?
53. Which one of the following drugs could A. NIACIN B. FENOFIBRATE C.
significantly impair the ability to drive an CHOLESTYRAMINE D. EZETIMIBE
automobile? 59. Which of the following drugs decreases the
A. Diphenhydramine. B. Ergotamine. C. de novo cholesterol synthesis by inhibiting the
Fexofenadine. D. Ranitidine. enzyme 3- hydroxy-3-methylglutaryl CoA
reductase?
54. A 56 yr old patient complains of chest pain A. FENOFIBRATE B. NIACIN C.
following any sustained exercise. He is CHOLESTYRAMINE D. LOVASTATIN E.
diagnosed with atherosclerotic angina. He is GEMFIBROZIL
 Competency Appraisal Reviewer
Topic: Pharmacology

68. Which of the following drugs is a class III

60. Exertion- induced angina, which is relieved anti arrythmic agent that is effective in the
by rest, nitroglycerin or both is referred to as: acute management of atrial fibrillation or atrial
A. PRINZMETAL B. UNSTABLE C. STABLE D. flutter of recent onset?
VARIANT A. PROPRANOLOL B. DOFETILIDE C.
METOPROLOL D. DISOPYRAMIDE E. DILTIAZEM
61. Which of the following agents used in
prinzmetal angina has spasmolytic actions, 69. Which of the following agents represents a
which increase coronary blood supply? relatively new class of drugs used in treating
A. NITROGLYCERIN B. DILTIAZEM C. TIMOLOL hypertension?
D. ISOSORBIDE MONONITRATE E. A. TANDOLAPRIL B. CARVEDILOL C.
PROPRANOLOL IRBESARTAN D. MOEXIPRIL E. NIMODIPINE

62. Myopathy is an adverse effect of all of the 70. A 65 year old man presents with stage i
following agents except: hypertension. He has diabetes mellitus and
A. LOVASTATIN B. SIMVASTATIN C. chronic kidney disease and is intolerant to
PRAVASTATIN D. GEMFIBROZIL E. COLESTIPOL lisinopril. Which of the following agents would
be appropriate selection for initial treatment in
63. Strong anticholinergic effects limits the this patient?
antiarrythmic use of ________. A. CHLORTHIAZIDE B. PROPRANLOL C.
A. QUINIDINE B. PROCAINAMIDE C. TOCAINIDE NITROPRUSSIDE D. CANDESARTAN E.
D. DISOPYRAMIDE CLONIDIN

64. A 68-year-old man has been successfully 71. A 45 year old man has recently been
treated for exercise-induced angina for several diagnosed with hypertension and started on
years. He recently has been complaining about monotherapy designed to reduce peripheral
being awakened at night with chest pain. Which resistance and prevent NaCl and water
of the following drugs would be useful in retention. He has developed a persistent
preventing this patient's nocturnal angina? cough. Which of the following drugs would have
A. Amyl nitrite.B. Nitroglycerin (sublingual).C. the same benefits but would not cause cough?
Nitroglycerin (transdermal).D. Esmolol.E. A. LOSARTAN B. NIFEDIPINE C. PRAZOSIN D.
Hydralazine. PROPRANOLOL

65. Which of the following type III 72. Which of the following drugs may cause a
antiarrythmics has been reported as causing precipitous fall in blood pressure and fainting
torsades de pointes type of ventricular on initial administration?
tachyardia? A. ATENOLOL B. HYDROCHLOROTHIAZIDE C.
A. LIDOCAINE B. AMIODARONE C. QUINIDINE NIFEDIPINE D. PRAZOSIN E. VERAPAMIL
D. FLECAINIDE E. DILTIAZEM
73. Which of the following drugs can precipitate
66. A patient receiving a class I antiarrythmic a hypertensive crisis following abrupt cessation
agent on a chronic basis complains of fatigue, of therapy?
low grade fever and joint pain suggestive of A. CLONIDINE B. DILTIAZEM C. ENALAPRIL D.
systemic lupus erythematosus. The patient is LOSARTAN E. HYDROCHLOROTHIAZIDE
most likely receiving?
A. LIDOCAINE B. PROCAINAMIDE C. 74. A 60 year old hypertensive woman is
QUINIDINE D. FLECAINIDE E. PROPRANOLOL currently being treated with Nitroglycerin,
Carvedilol, Furosemide, Nifedipine, Ramipril,
67. Which of the following drugs is a class IV ASA and Digoxin. She is admitted with a
anti arrythmic that is primarily indicated for the diagnosis of stage C heart failure. • Which
treatment of supraventricular tachyarrythmias? agent is most likely to be discontinued in this
A. IBUTILIDE B. MEXILETINE C. VERAPAMIL D. patient?
QUINIDINE E. PROPRANOLOL A. NIFEDIPINE B. CARVEDILOL C. ASPIRIN D.
DIGOXIN E. FUROSEMIDE
 Competency Appraisal Reviewer
Topic: Pharmacology

75. Because of proven beneficial effects on

cardiac remodelling, a particular group of 82. A 68 year old man presents to the
agents is now indicated as a first line therapy in emergency department with acute heart
HF patients. Which of the following is a failure. You decide that this patient requires
representative of this group? immediate drug therapy to improve his cardiac
A. HYDROCHLOROTHIAZIDE B. LISINOPRIL C. function. Which one of the following drugs
LOSARTAN D. CARVEDILOL E. FUROSEMIDE would be most beneficial?
A. Albuterol B. Dobutamine C. Epinephrine D.
76. A patient being diagnosed for myasthenia Norepinephrine E. Phenylephrine
gravis would be expected to have improved
neuromuscular function after being treated 83. Remedies for nasal stuffiness often contain
with: which one of the following drugs?
A. Donepezil B. Edrophonium C. Atropine D. A. Albuterol B. Atropine C. Epinephrine D.
Isoflurophate E. Neostigmine Norepinephrine E. Phenylephrine

77. The drug of choice for treating decreased 84. Which one of the following drugs, when
salivation accompanying head and neck administered intravenously, can decrease blood
irradiation is: flow to the skin, increase blood flow to skeletal
A. Physostigmine B. Scopolamine C. Carbachol muscle, and increase the force and rate of
D. Acetylcholine E. Pilocarpine cardiac contraction?
A. Epinephrine B. Isoproterenol C.
78. A 75-year-old man who was a smoker is Norepinephrine D. Phenylephrine E. Terbutaline
diagnosed with chronic obstructive pulmonary
disease and suffers from occasional 85. A 38 year old male has recently started
bronchospasm. Which of the following would be monotherapy for mild hypertension. At his most
effective in treating him? recent office visit, he complains of tiredness
A. Ipratoprium aerosol B. Scopolamine and not being able to complete three sets of
patches C. Mecamylamine D. Oxygen tennis. Which one of the following drugs is he
most likely to be taking for hypertension?
79. Which of the following may precipitate an A. Albuterol B. Atenolol C. Ephedrine D.
attack of open-angle glaucoma if instilled into Phentolamine E. Prazosin
the eye?
A. Physostigmine B. Atropine C. Pilocarpine D. 86. A 60 year old asthmatic man comes in for a
Echothiophate checkup and complains that he is having some
difficulty in “starting to urinate.” Physical
80. The prolonged apnea sometimes seen in examination indicates that the man has a blood
patients who had undergone an operation in pressure of 160/100 mm Hg and a slightly
which succinylcholine was employed as a enlarged prostate. Which of the following
muscle relaxant has been shown to be due to: medications would be useful in treating both of
A. urinary atony these conditions?
B. Depressed levels of plasma A. Doxazosin B. Labetalol C. Phentolamine D.
cholinesterase Propranolol E. Isoproterenol
C. a mutation in acetylcholinesterase
D. a mutation in the nicotinic receptor at the
neuromuscular junction

81. A 50 year old male farm worker is brought

to the emergency room. He was found
confused in the orchard and since then has lost
consciousness. His heart rate is 45 and his
blood pressure is 80/40 mmHg. He is sweating
and salivating profusely. Which of the following
treatments is indicated?
A. Physostigmine B. Norepinephrine C.
Trimethaphan D. Atropine E. Edrophonium