1. Which of the following is most effective in the treatment of peptic ulcer disease?
(a) Bromocriptine (b) Cimetidine (c) Ergotamine (d) Ketanserin (e) LSD
2. Which laxative should not be used to treat acute constipation because of its slow onset of action?
(a) Glycerin
(b) Bisacodyl suppository (c) Psyllium
(d) Milk of magnesia
3. Which of the following–if given intravenously–will cause increased gastrointestinal motility and diarrhea?
(a) Angiotensin II (b) Bethanechol (c) Bradykinin (d) Renin (e) All of the above
4. A peptide that causes increased capillary permeability and edema is
(a) Angiotensin II (b) Bradykinin (c) Captopril (d) Histamine (e) Losartan
5. A vasodilator that can be inactivated by proteolytic enzymes is
(a) Angiotensin I (b) Isoproterenol (c) Histamine (d) Neuropeptide Y
(e) Vasoactive intestinal peptide
6. Which of the following is released in traumatized tissue, causes pain and edema, and is inactivated by angiotensin converting enzyme?
(a) Angiotensin I (b) Angiotensin II
(c) Atrial natriuretic peptide (d) Bradykinin
(e) Calcitonin gene-related peptide
7. Which of the following is a decapeptide precursor of a vasoconstictor substance?
(a) Angiotensin I (b) Angiotensin II
(c) Atrial natriuretic peptide (d) Bradykinin
(e) Calcitonin gene-related peptide
8. Which is not a risk factor for hyperphos- phatemia and death from sodium phos- phate enemas when used in children?
(a) Renal insufficiency (b) Hirschsprung’s disease (c) Anorectal malformations (d) Children 6 to 12 years of age
9. Which of the following is the most potent vasodilator discovered to date and is found in high concentration in the thyroid?
(a) Angiotensin I (b) Angiotensin II
(c) Atrial natriuretic peptide (d) Bradykinin
(e) Calcitonin gene-related peptide
10. Which of the following statements adequately describes bulk-forming laxaties?
(a) Can cause diarrhea if not taken with water (b) Are derived from polysaccharides and rersemble fiber (bran) in mechanism of action
(c) Onset of action is in 4–8 hours
(d) Produce much more complete evacuation of constipation than stimulant products
11. Cardiac arrhythmias have occurred when this drug was used by patients taking the gastrointestinal promotility agent cisapride
(a) Amphotericin B (b) Clotrimazole (c) Griseofulvin (d) Ketoconazole (e) Voriconazole
12. Metronidazole is least likely to be effective in the treatment of
(a) Amebiasis (b) Giardiasis
(c) Pneumocystosis (d) Psudomembranous colitis
(e) Trichomoniasis
13. Which of the following statements about non-drug therapies for acute diarrhea is not correct?
(a) Breast feeding should be continued as normal (b) Even if the patient is not vomiting, food should
be withheld for 6–12 hours
(c) Fluids can be given to patients who experience vomiting, but small amounts of fluid should be used.
(d) Replacement fluids mainly consist of water, sugar, potassium, sodium and bicarbonates
14. A 2-year-old child was brought to the emergency room 1 hour after ingestion of tablets he had managed to obtain from a bottle on top of the refrigerator. His symptoms included marked gastro- intestinal distress, vomiting (with hemate-
mesis), and epigastric pain. Metabolic acidosis and leukocytosis were also present. This patient is most likely to have ingested tablets containing
(a) Acetaminophen (b) Aspirin
(c) Diphenhydramine (d) Iron
(e) Vitamin C
15. A patient is broght to the emergency room suffering from nausea, vomiting, and abdominal pain. He has muscle weakness, which seems to be progressing downward from the head and neck. The patient has difficulty talking clearly and has ptosis and ophthalmoplegia. The most likely cause of these symptoms is
(a) Accidental ingestion of paraquat (b) An overdose of phenobarbital (c) Excessive consumption of ethanol (d) Food poisoning
(e) Organophosphate poisoning
16. A 55-year-old woman with insulin- dependent diabetes of 40 years’ duration complains of severe bloating and abdominal distress, especially after meals. Evaluation is consistent with diabetic gastroparesis. The drug you would be most likely to recommend is
(a) Docusate (b) Dopamine (c) Loperamide (d) Metoclopramide (e) Sucralfate
17. A patient who must take verapamil for hypertension and angina has become severely constipated. Which of the following drugs would be most suitable as a cathartic?
(a) Aluminum hydroxide (b) Diphenoxylate
(c) Magnesium hydroxide (d) Metoclopramide (e) Mineral oil
18. Your cousin is planning a three-week trip overseas and asks your advice regarding medications for traveler’s diarrhea. A drug suitable for noninfectious diarrhea is
(a) Aluminum hydroxide (b) Diphenoxylate
(c) Magnesium hydroxide (d) Metoclopramide (e) Mineral oil
19. Which of the following products should not be used to replenish lost fluids from acute diarrhea?
(a) Pedialyte solution (b) Kool-Aid
(c) Gatorade (half-strength diluted with water) (d) The world Health Organization (WHO)
solution
20. A drug associated with the long QT syndrome and cardiac arrhythmias is
(a) Aluminum hydroxide (b) Cisapride
(c) Granisetron (d) Loperamide (e) Metromidazole
21. On your way to an examination you experience that vulnerable feeling that an attack of diarrhea is imminent. If you stopped at a drugstore, you could buy this antidiarrheal drug without a prescription even though it is related chemically to the strong opioid – analgesic meperidine
(a) Aluminum hydroxide (b) Diphenoxylate (c) Loperamide
(d) Magnesium hydroxide (e) Metoclopramide
22. This antibiotic is not appropriate for use as an oral agent in the treatment of recurrent peptic ulcer associated with Helicobacter pylori
(a) Amoxicillin (b) Clarithromycin (c) Metronidazole (d) Tetracycline (e) Vancomycin
23. Which of the following statements about adsorbant drugs used for diarrhea is true?
(a) Useful for treatment of severe diarrhea (b) Very unsafe because not absorbed systemically (c) In general, small doses are needed to relieve
diarrhea
(d) Kaolin is now generally recognized as a safe and effective OTC antidiarrheal agent.
24. Which one of the following drugs has no effect on prothrombin but increases the likelihood of bleeding in patients who are also taking warfarin?
(a) Carbamazepine (b) Cholestyramine (c) Naproxen (d) Rifampin (e) Vitamin K
25. Which one of the following drugs has resulted in severe hematotoxicity when administered to a patient being treated with azathioprine?
(a) Allopurinol (b) Cholestyramine (c) Digoxin (d) Lithium
(e) Theophyline
26. Which one of the following antibodies has the longest half-life?
(a) Black widow spider antivenin (b) Botulinum antitoxin
(c) Diphtheria antitoxin
(d) Hepatitits B immune globulin (e) Snake bite antivenin
27. Hepatitis B vaccine is least likely to be recommended for prophylactic use in
(a) Dialysis patients
(b) Intravenous drug abusers (c) Newborns
(d) Raw oyster eaters (e) Surgeons
28. Which of the following statements concerning traveler’s diarrhea (TD) is true?
(a) TD can usually be avoided by not eating raw vegetables, seafood or eggs when traveling to third-world countries
(b) TD can be prevented by taking one dose of antibiotic 1 day before a trip
(c) A specific of Helicobacter pylori is the primary pathogen responsible for TD (d) Phillip’s milk of magnesia is used to prevent/
treat TD
29. Dietary supplementation with DHEA is best documented to have therapeutic value in the treatment of
(a) Acne
(b) Diabetes insipidus
(c) Hirsutism in female patient (d) Postmenopausal osteoporosis (e) Systemic lupus erythematosus
30. Which one of the following compounds has been shown to have value in managing symptoms of jet lag?
(a) DHEA (b) Garlic (c) Ginseng (d) Melatonin (e) Sassfras
31. A patient with Zollinger–Ellison syndrome has been receiving high doses of cimetidine for 7 weeks. A frequent adverse effect of cimetidine is
(a) Agranulocytosis
(b) Systemic lupus erythematosus
(c) Inhibition of hepatic metabolism of other drugs
(d) Antiestrogenic effects (e) Hypertension
32. Most weak acid drugs as well as weak base drugs are absorbed primarily from the small intestine after oral administration because
(a) Both types are more ionized in the small intestine
(b) Bothe types are less ionized in the small intestine
(c) The blood flow is greater in the small intestine than that of other parts of the gut
(d) The surface area of the small intestine is greater than other parts of the gut
(e) The small intestine has nonspecific carriers for most drugs
33. A patient with a 30-year history of type 1 diabetes comes to you with a complaint
of bloating and sour bleaching after meals. On several occasions, vomiting has occurred after a meal. Evaluation reveals delayed emptying of the stomach, and you diagnose diabetic gastro paresis. Which of the following drugs would be most useful in this patient?
(a) Famotidine (b) Metoclopramide (c) Misoprostol (d) Omeprazole (e) Ondansetron
34. Which one of the following agents is least likely to protect the upper gastrointestinal tract from ulcer formation?
(a) Antacids (b) Celecoxib (c) Cimetidine (d) Misoprostol (e) Sucralfate
35. This agent is the drug of choice in severe amebic disease and for hepatic abscess. It is activated to toxic intermediates by the pyruvate – ferredoxin oxidoreductase enzyme system present in the parasite.
(a) Diloxanide furoate (b) Emetine
(c) Iodoquinol (d) Metronidazole (e) Paromomycin
36. All of the following agents are considered close to ideal laxatives except
(a) emollient laxatives (b) bulk-forming laxatives (c) fiber
(d) stimulant laxatives
37. Which solution is used as an astringent?
(a) Strong iodine solution USP
(b) Aluminum acetate topical solution USP (c) Acetic acid NE
(d) Aromatic ammonia spirit USP (e) Benzalkonium chloride
38. Mechanistically, which of the following drugs will decrease stomach acid secretion by blockade of H2 histaminic receptors?
(a) Pyrilamine (b) Hydroxyzine (c) Cisapride (d) Omeprazole (e) Ranitidine
39. Lansoprazole would be effective in the treatment of
(a) Gastroesophageal reflux disease (b) Peptic ulcer disease
(c) Zollinger-Ellison syndrome (d) All of the above
(e) None of the above
40. All of the following statements about stool softners are true except
(a) There is minimal systemic absorption (b) the onset of action is usually 1–2 days (c) they are useful in patients with constipation
who have experienced an acute myocardial infractioon
(d) they can be taken with little or no water
41. All of the following statements adequately describe bulk-forming laxatives except
(a) they produce a much more complete evacuation of constipation than stimulant products
(b) they can cause constipation if not taken with water
(c) they are derived from polysaccharides and resemble fiber (bran)in the mechanism of action
(d) the onset of action is 24–72 hours
42. Which of the following statements adequately describes bulk-forming laxatives?
(a) Can cause diarrhea if not taken with water (b) Are derived from polysaccharides and resemble fiber (bran)in mechanism of action (c) Onset of action is in 4–8 hours
(d) Produce much more complete evacuation of constipation than stimulant products
43. Which of the following statements about adsorbent drugs used for diarrhea is true?
(a) Useful for treatment of severe diarrhea (b) Very safe because not absorbed systemically (c) In general, small doses are needed to relieve
diarrhea
(d) Kaolin and pectin are considered to be very effective (category I)adsorbents
44. Which of the following statements concerning traveler’s diarrhea (TD) is true?
(a) TD can usually be avoided by not eating raw vegetables, seafood, or eggs when traveling to third-world countries.
(b) TD can be prevented by taking one dose of antibiotic one day before a trip
(c) A specie of Helicobacter pylori is the primary pathogen responsible for TD
(d) Phillip’s Milk of Magnesia is used to prevent / treat TD
45. All of the following statements about stool softeners are true except
(a) There is minimal systemic absorption (b) The onset of action is usually 1–2 days (c) They are useful in patients with constipation
who have experienced an acute myocardial infarction
(d) They can be taken with little or no water
46. Which of the following is an appropriate non-pharmacologic recommendation for patients with gastroesophageal reflux disease (GERD)?
(a) Eat larger but fewer meals (b) Avoid meals high in protein
(c) Eat evening meals at least 3 hours before bed
(d) Prop a patient’s head up with 2 pillows at night
47. Which of the following organisms has been implicated as a possible cause of chronic gastritis and peptic ulcer disease?
(a) Campylobacter jejuni (b) Escherichia coli (c) Helicobacter pylori
(d) Calymmatobacterium granulomatis (e) Giardia lamblia
48. A patient suffering from acute infectious diarrhea caused by Shigella can be managed in all of the following ways except
(a) no treatement because signs and symptoms usually resolve in 48 hours
(b) use of glucose solutions (e.g., soda, apple juice)to settle the stomach and decrease the number of stools
(c) avoiding food for at least 6 hours, then slowly increasing fluid intake.
(d) using antibiotics (e.g. Bactrim, doxycycline) for 7 days
49. As part of a comprehensive management strategy to treat peptic ulcer disease, patients should be encouraged to do all of the following except
(a) Decrease caffeine ingestion (b) Eat only bland foods (c) Stop smoking (d) Avoid alcohol
(e) Avoid the use of milk as a treatment modality
50. A gastric ulcer patient requires close follow-up to document complete ulcer healing because
(a) Perforation into the intestine is common (b) Spontaneous healing of the ulcer may occur
in 30% – 50% of cases
(c) There is the risk of the ulcer being cancerous (d) Symptoms tend to be chronic and recur (e) Weight loss may be severe in gastric ulcer
patients
51. For each effect, select the agent that is most likely associated with it
(a) Sodium bicarbonate (b) Aluminum hydroxide (c) Calcium carbonate (d) Magnesium hydroxide (e) Propantheline
(1) May cause diarrhea
(2) Cannot be used by patients with heart failure
(3) Use with milk and an alkaline substance can cause milk-alkali syndrome
(4) May cause dry mouth
(5) Can be alternated with an antacid mixture to control diarrhea
52. Aluminum hydroxide is used to treat hyperphosphatemia associated with renal failure. Chronic use of aluminum hydroxide may cause all of the following conditions except
(a) Phosphate depletion
(b) Calcium resorption and bone demineralization (c) Anorexia and constipation
(d) Fluid retention
53. Which local anesthetic should be used to treat symptoms of pain, itching, burning and discomfort in patients with an established lidocaine allergy?
(a) Tetracaine (b) Dibucaine (c) Pramoxine (d) Benzocaine
54. Which of the following agents in most useful for carcinoma of the liver?
(a) Vinblastine (b) Floxuridine (FUDR) (c) Vincristine (d) Cytarabine (Cytosar) (e) Mercaptopurine
55. All of the following vasoconstrictors are deemed safe and effective for the temporary relief of itching and swelling except
(a) ephedrine 0.1% – 1.25% (b) epinephrine 0.005% – 0.01% (c) phenylpropanolamine 1% – 10% (d) phenylephrine 0.25%
56. Bisacodyl frequently can cause
(a) Abdominal cramps (b) Constipation
(c) Skin rashes (d) Dizziness