Q1: A 55 year old male begins treatments with an anti-arrhythmic medication
for recurrent atrial fibrillation. The arrhythmic resolves and there is now mild
bradycardia and significant QT interval prolongation on his EKG recording.
Which of the following drugs was most likely used in this patient?.
Answer
1: METOPROLOL
2:BISOPROLOL
3: CARVIDILOL
4:SOTALOL
5: DILTIAZEM
Q2: A 64 year old male presented to your office after a long period without
medical follow up complaining of disturbed color perception, anorexia, nausea,
vomiting and diarrhoea. His medical history is significant for CHF that is
effectively controlled with multiple medication. Which of the following is the
most likely complication of this patients current condition?
Answer
1: angioedema
2: pulmonary oedema
3: bronchoconstriction
4: Arrhythmia
5: Hypotension
Q3: A patients with stage 2 essential hypertension is treated with usually
effective doses of an ACE inhibitor. After a suitable period of time blood
pressure has not been lowered satisfactorily . The patients been complaint
with drug therapy and other recommendation ( e. g weight
reduction ,exercise). A thiazide is added to ACE inhibitor regimen. Which of the
following is the most likely and earliest untoward outcome of this drug add-on
for which you should monitor closely?
Answers
1: sudden prolongation of the P-R interval and increasing the degree of heart
block
2: Paradoxical hypertensive crisis
3: onset of acute heart failure from depression of ventricular contractility
4: hypokalaemia due to synergistic effect of ACE inhibitor and the thiazide on
renal potassium excretion .
5: fall of blood pressure to cause syncope
Q4:A 62 year old male is hospitalized with an arrhythmia. The agent used to
treat this patient condition is known to significantly prolong QT interval on EKG
but despite the drug associated with a low incidence of torsade de points .
which of the following agents was most likely used in this patient
1: Adenosine
2: Esmolol
3: lidocaine
4: procainamide
5: Amiodrone
Q 5: We have a patient with essential hypertension, and usually high circulating
catecholamine levels . our goal is to block both – and adrenergic receptor using
capable of doing that ?
Answer
1: Propranolol
2: Labetalol
3: metoprolol
4: Bisoprolol
5: Timolol
Q6: A 62 year old man with past medical history significant for digestive heart
failure presents with progressively increasing shortness of breath over the past
2 months. He denies any chest pain on exertion or at rest . He was recently
started with on furosemide for management of peripheral oedema and is
complaint with low salt diet. Ejection fraction is less then 32%. The most
important intervention at this time that would most improve his survival?.
Answers
1: enalapril
2: digoxin
3: hydralazine
4: losartan
5: carvedilol
Q7: patient with essential hypertension has been treated with a fixed-dose
combination product that contains hydrochlorothiazide and triamterene. Blood
pressure and serum electrolytes profile have been kept within acceptable
limits for the last 18 months .Now, however blood pressure has risen to the
point, where the physician wants to add a third antihypertensive drug . the
drug is started after several weeks the blood pressure falls into an acceptable
range , but the patients has become hyperkalaemic . Which of the following
drugs was added and was most likely responsible for the desired blood
pressure fall and the unwanted rise of serum potassium levels?.
Answers
1: Prazosin
2: Diltiazem
3: propranolol
4: Ramipril
5: Verapamil
Q8: A 50 year old female is brought to the emergency with squeezing chest
pain and profuse sweating. ECG reveals ST segment elevation in lead 1, avl and
V4=V6 . Cardiac troponin level are high .soon after hospitalization ventricular
tachycardia is noted and therefore antiarrhythmic therapy is considered .
which of the following antiarrhythmic drug has the highest selectivity for
ischemic myocardium compared to normal cardiac tissue?
Answer
1: labetalol
2: procainamide
3:digoxin
4: Mexiletine
5: Adenosine
Q9: A 54 year old man presented to the emergency room with dizziness and
intermittent palpitations for the past 12 hours . He denies any syncopal
episodes or headaches or seizure. He has no significant cardiac historyhe was
in the out patients clinic one week ago for pneumonia and was started on
Moxifloxacin . His other medical problem include hypertension for which he is
on Enalapril and gastro-oesophageal reflux disease for which he takes
omeprazole. Which of the following unwanted effects you can find after
administration of Enalapril
Answer
1: hypernatremia
2: hypovolemia
3:metallic taste
4: metabolic Acidosis
5: hyperkalaemia
Q10: A 51 year old man attends his general practitioner for a review of his
blood pressure control. He was found to be hypertensive at a routine physical
assessment 6 months earlier and since been attempting to improve his diet
and increase the amount of exercise blood pressure is 158/92mmgh. Which of
the following drug we prescribe?
Answers
1: Nifedipine
2: ramipril
3: Propranolol
4: hydrochlorothiazide
5: Amlodipine
11. A 52-year-old male is brought to the ER with severe dizziness and
confusion. He states that he had an episode of chest pain and took several
tablets of nitroglycerin. His current medication includes a daily aspirin for heart
attack prevention and occasional acetaminophen for headaches and tadalafil
for impotence. BP 50/20, heart rate 120 b/min. Which of the following celluar
changes is most likely responsible for this patient’s symptoms?
a) Enhanced phospholipid metabolism
b) Cyclic GMP accumulation
c) Thyrosine kinase overactivity
d) Tolerance development
e) Receptor down-regulation
12. A 61-year-old Caucasian male is diagnosed with exertional angina. His
treatment regime includes metoprolol, isosorbide dinitrate and aspirin. He
takes isosorbide dinitrate early in the morning and again in the afternoon, but
he does not take an evening dose. Such a pattern of drung administration is
intended to decrease which of the following?
a) Pharmacodynamic drug interaction
b) Effect potentiation
c) Tolerance development
d) Drug non-compliance
e) Withdrawal symptoms
13. A 60-year-old man comes to the physician because of worsening fatigue
and dyspena on exertion that has started to limit his daily activities. Recently
he also been having difficulty sleeping and require four pillows in order to
sleep at night. His past medical history is significant for a myocardial infarction
two years ago. Physical examination reveals bilateral lung crackles and lower
extremity edema. Chest x-ray shows cardiomegaly. The patient is admitted to
the hospital where his blood pressure is stable 160/100 long term. Control of
his hypertension would be best achieved with which of the following agents.
a) Amlodipine
b) Minoxidil
c) Methyldopa
d) Lisinopril
e) Terazosine
14. Nitrates are useful drugs for the treatment of stable angina. They have
distinct anti-ischemic properties but sometimes can cause a paradoxical
increase in myocardial oxygen demand. Which of the following agents would
be most effective in preventing that paradoxical effect?
a) Hydrolazine
b) Prazosine
c) Nifidipine
d) Bisoprolol
e) N-acetylcysteine
15. Digoxin affects a host of cardiac electrophysiologic properties. Some of its
effects are caused directly by the drug. Others are indirect. They may involve
increasing the vagal tone to the heart or other compensation that arise when
cardiac output is improved in a patient with heart failure. For some parameters
the direct and indirect effects maybe qualitatively but not quantitatively
opposing, but one will predominate over the other. Which of the following is
an expected and predominant effect of the drug?
a) Reduced ventricular automaticity
b) Reduced atrial automatiticity
c) Slowed conduction velocity throught the atrial myocardium and His
purkinji system
d) Slowed AV nodal conduction velocity
e) Increased rate of SA nodal depolarisation
16. Your patient is a 48-year-old post-menopausal female with recent onsent
of stage one hypertension. She has a history of osteoporosis. On exam her
blood pressure is 155/90, heart rate is 80 and regular, and respiration are 16.
Cardiovascular examination is unremarkable. She has no other medical history.
She has previously been controlling her hypertension with lifestyle
modification and diet. Which of the following medication is the best choice for
initial pharmacological treatment of her hypertension?
a) Atenolol
b) Lisinopril
c) Methyldopa
d) Labetalol
e) Amlodipine
17. A 25-year-old male presents to ER with sudden onset of palpitation. He had
an episode similar to this one year ago that resolved spontaneously. Rapid IV
injection of a drug into this patient results instantaneous resolution of the
arrythmia is a companied with transitory flashing, burning in the chest, and
shortness of breath. Which of the following drug was used to treat this
patient’s condition?
a) Propafenone
b) Amiodrone
c) Lidocaine
d) Dronedarone
e) Adenosine
18. A 67 year old immigrant from Europe comes to the physician because of a
four week history of low-grade fever, multiple joint pain, and well-demarcated
erytherematous rash on his face and trunk. The patient denies hair-loss,
mucosal ulceration, photosensitivity. His serum test is positive for the presence
ANA in very high titres. The patient reports a past medical history of CHD, CHF
and cardiac arrythmia. This patient should be questioned about the intake of
which of the following medications?
a) Lidocaine
b) Procainamide
c) Adenosine
d) Amiodarone
e) Propranolol
19. A 68 year old man came to the hospital complaining of chest pain that had
developed when he was running for a bus. The pain was crushing in nature and
was located in the centre of his chest radiating to his left arm and jaw. He used
the drug and pain subsequently resolved. Which of the following drug may
used by patient?
a) Ramipril
b) Metoprolol
c) Amlodipine
d) Atorvastatin
e) Glycerol Nitrate
20. A 38 year old African-american male nurse is evaluated in your office
because his blood pressure was found to be elevated when the doctor
employee health centre checked his blood pressure. He was checked in the
employee health three months ago and at that time his blood pressure was
146/94 and a repeat reading by the same doctor was 148/92 a month ago. He
checked his blood pressure at home two times at his home and it was ranging
between 120/76 to 124/82. He does not trust this doctor at his work place, so
he decided to come and visit you. He denies any dizziness, chest pain,
palpitation or shortness of breath. He does not smoke or does not drink
alcohol. Several members in family have history of hypertension. On
examination his blood pressure is 150/94, his body mass index is 26 kg/m2.
Cardiac examination shows regular heart sounds. There are no audible
murmurs. Electrocardiogram reveals positive voltage criteria for left ventricular
hypertrophy. A subsequent 2D echo reveals left ventricular hypertrophy with
good ejection fraction at 60% and no vulvular problems. Serum creatinine is 1%
and urine analysis is normal. A lipid profile has been ordered. Which of the
following drug is the first choice for treatment of hypertension?
a) Carvedilol
b) Ramipril
c) Bisoprolol
d) Amlodipine
e) Hydrochlorothiazide
21. We are contemplating administration of a non-selective adrenergic blocker
to a patient. In which of the following condition is this considered generally
acceptable, appropriate and safe.
a) Severe congestive heart failure
b) Bradycardia
c) Hyperthyroidism symptomatic and acute
d) Asthma
e) Diabetes Mellitus and insulin dependent and poorly controlled
22. A 75 year old woman with past medical history of type 2 diabetes mellitus,
hypertension and hypotension and ski mix stroke presents to your office for a
new patient visit. She has been under the care of another primary care
physician who has retired from practise so the patient has decided to establish
care with you. She has left sided residual weakness from her old cerebro
vascular accident. She has no other complaints. She requests you for a refill of
Warfarin for and which she has been taking for three years. This drug was
prescribed by her former physician for stroke prevention. Which of the
following drug used for this patient hypertension treatment?
a) Amlodapine
b) Prazosin
c) Minoxidil
d) Hydraliazine
e) Lizinopril
23, a 55 year old airline pilot presents for a follow up visit for hypertension. He
was diagnosed with hypertension a year ago and has been on treatment with
hydro chloral thiazide and lisinopril. He denies any chest pain, palpitations or
shortness of breath on exertion. He has no other significant health issues. His
haemoglobin A1C about six months ago was 5%. A lipid profile obtained 3
months ago showed a total cholesterol of 270MG percentage with HDL
cholesterol of 34 milligrammes percentage. he smokes about one pack per day
but denies any drug or alcohol abuse. There is no family history of diabetes or
coronary artery diseases or abdominal aorta aneurysm. On examination his
blood pressure is 138 / 74. Cardiac examination shows regular heart sound
with no S3 gallop or S4. There are no audible murmurs. Abdominal
examination is benign and there are no audible brutes. A complete blood
count, comprehensive metabolic panel and urine analysis unremarkable.
Arresting electrocardiogram shows changes consistent with left ventricular
hypertrophy. He had a colonoscopy five years ago which was normal. Which of
the following adverse effects predictable by diuretics?
a) Hypernatremia
b) Hypercalcemia
c) Hyperkalemia
d) Increase HDL level
e) Hypoglycemia
24. A 62 year old Mel is hospitalised with an arrhythmia. The agent used to
treat this patient condition is known to significantly prolong qtc interval on
ECG but despite the drug is associated with a low incidence of torsade de
pointus. which of Which of the following agents was most likely used in this
patient ?
a) Esmolol
b) Lidocaine
c) Procanamide
d) Amiodrone
e) Adenosine
25. A 70 year old white man with type 2 diabetes mellitus and hypertension is
evaluated in the emergency room for lazy published discoloration of the lower
extremities the developed few hours ago. He reports diffuse body aches and
low grade fever. He denies chest pain or shortness of breath. His past medical
history is significant for coronary artery disease for which he underwent
cardiac catheterization with percutaneous coronary reintervention one week
ago. He has a history of chronic atrial fibrillation for which he is on 5MG
coumadin daily. His most recent I an awe has been therapeutic at 2.5. Physical
examination reveals Lacey purplish pattern on bilateral lower extremities.
Which of the following antihypertensive drug is contraindicated book?
a) Minoxidil
b) Amlodapine
c) Hydrolazine
d) Methydopa
e) Propranolol
26. Angiotensin converting enzyme [ACE] inhibiters are among the first line
drugs for managing essential hypertension [prehypertension or stage 1
hypertension]. However, in contrast with the main alternatives [thiazide or
thiazide like diuretics, blockers or calcium channel blockers], the ACE inhibitors
are associated with a comparatively high incidence off a rather unusual
adverse reaction. Which of the following is that?
a) Hepatitis
b) Hypokalemia
c) Bradycardia often involving AV block
d) Hirsutism
e) Proteinuria renal insufficiency
27. A 24 year old woman presented to the hospital with lower abdominal pain
and vomiting. Her past medical history included gastroesophageal reflux
disease and tuberculosis. Her regular medications included isoniazid, rifampin,
pyrazinamide, omeprazole and oral contraceptive pill. Which of the following
drug may induce pregnancy in this patient?
a) Rifampin
b) Isoniazid
c) Oral Contraceptive Pill
d) Pyrazinamide
e) Omeprazol
28. A new drug, drug A undergoes a series of phase one metabolic reaction
before it is metabolised ultimately or eliminated. Which of the following
statements best describes the characteristics of drug A or the role of phase
one reaction in its metabolism or action.
a) Drug A will be biologically inactive until it is metabolised
b) Phase one metabolism of drug A involves conjugation, as with
glucocuronic acid or sulphate
c) Drug A is a very polar substance
d) Complete metabolism of drug A by phase one reactions will yield
products that are less likely to undergo renal tubular reabsorption
e) Phase I metabolism of drug A will increase its intracellular access and
actions
29. A 56 year old female presented to the emergency department with 6 h
history of worsening shortness of breath and sharp, right sided chest pain that
was worse on deep inspiration. She denied experiencing palpitations, did not
complain of nausea and was not feeling lightheaded. She had a history of
recurrent deep vein thrombosis for which she was on lifelong warfarin. Patient
used isoniazid, rifampicine, pyrazinamide and ethambutol for tuberculosis. She
used aspirin. Which of the following drug may induce a pulmonary embolus?
a) Aspirin
b) Rifampicin
c) Isoniazid
d) Ethambutol
e) Pyrazinamided
30. A 65 year old woman is evaluated in your office during a follow up visit. Her
medical problems include diabetes mellitus type 2 and hypertension. She is
being managed on oral metformin, glyburide and hydrochlorothyazide. Her
most recent haemoglobin A1C is 6.5% her urine was negative for microalbumin
3 months ago her past medical history is significant for hospitalisation for
angioedema which occured after initiation of enalapril three years ago.
Physical examination is unremarkable. Which of the following drug may
substitute enalapril?
a) Metoprolol
b) Amlodipine
c) Verapamil
d) Valderstartan
e) Aliskiren
