A 54-year-old woman with severe hypercholesterolemia is to be treated with a combination of niacin and atorvastatin. With this drug combination, it is important that the patient be monitored closely for signs of (a) Agranulocytosis (b) Gallstones (c) Lactic acidosis (d) Myopathy (e) Thyrotoxicosis

A 54-year-old woman with severe hypercholesterolemia is to be treated with a combination of niacin and atorvastatin. With this drug combination, it is important that the patient be monitored closely for signs of (a) Agranulocytosis (b) Gallstones (c) Lactic acidosis (d) Myopathy (e) Thyrotoxicosis
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After being counseled about lifestyle and dietary changes, the patient was started on atorvastatin. During his treatment with atorvastatin, it is important to routinely monitor serum concentrations of (a) Blood urea nitrogen (BUN) (b) Alanine and aspartate aminotransferase (c) Platelets (d) Red blood cells (e) Uric acid

Description : After being counseled about lifestyle and dietary changes, the patient was started on atorvastatin. During his treatment with atorvastatin, it is important to routinely monitor serum concentrations of (a) ... Alanine and aspartate aminotransferase (c) Platelets (d) Red blood cells (e) Uric acid

Last Answer : Ans: D

If the patient has a history of gout, which of the following drugs is most likely to exacerbate this condition? (a) Colestipol (b) Gemfibrozil (c) Lovastatin (d) Niacin (e) Simvastatin

Description : If the patient has a history of gout, which of the following drugs is most likely to exacerbate this condition? (a) Colestipol (b) Gemfibrozil (c) Lovastatin (d) Niacin (e) Simvastatin

Last Answer : Ans: D

Digoxin given for cardiac failure is extremely valuable in patients of (a) Thyrotoxicosis (b) Beriberi (c) Cor pulmonale (d) Atrial fibrillation

Description : Digoxin given for cardiac failure is extremely valuable in patients of (a) Thyrotoxicosis (b) Beriberi (c) Cor pulmonale (d) Atrial fibrillation

Last Answer : Ans: D

Acute renal failure (ARF) may be caused by all of the following except (a) Acute tubular necrosis (ATN) due to drug therapy (e.g., aminoglycosides, contrast media) (b) Severe hypotension or circulatolry collapse (c) Decreased cardiac output, as from congestive heart failure (d) Hemolysis, myoglobinuria (e) Hyperkalemia

Description : Acute renal failure (ARF) may be caused by all of the following except (a) Acute tubular necrosis (ATN) due to drug therapy (e.g., aminoglycosides, contrast media) (b) Severe hypotension ... (c) Decreased cardiac output, as from congestive heart failure (d) Hemolysis, myoglobinuria (e) Hyperkalemia

Last Answer : Ans: E

A patient of acute myocardial infarction being treated in intensive care unit developed left ventricular failure with raised central venous pressure. It was decided to use glyceryl trinitrate. Which route/method of administration would be most suitable. (a) Sublingual (b) Oral (c) Intravenous bolus injection (d) Slow intravenous infusion

Description : A patient of acute myocardial infarction being treated in intensive care unit developed left ventricular failure with raised central venous pressure. It was decided to use glyceryl trinitrate. Which route/ ... (a) Sublingual (b) Oral (c) Intravenous bolus injection (d) Slow intravenous infusion

Last Answer : Ans: D

A patient to be commenced on oral anticoagulant therapy for DVT would be treated with (a) Oral anticoagulant therapy with warfarin for a goal intenational normalized ration (INR) of 2–3 (b) Oral anticoagulant therapy with warfarin for a goal INR of 2.5–3.5 (c) Oral anticoagulant therapy with aspirin for a goal INR of 2–3

Description : A patient to be commenced on oral anticoagulant therapy for DVT would be treated with (a) Oral anticoagulant therapy with warfarin for a goal intenational normalized ration (INR) of 2-3 (b) Oral anticoagulant therapy ... of 2.5-3.5 (c) Oral anticoagulant therapy with aspirin for a goal INR of 2-3

Last Answer : Ans: A

A hypertensive patient has been using nifedipine for some time without untoward effects. If he experiences a rapidly developing enhancement of the antihypertensive effect of the drug, it is probably due to (a) Concomitant use of antacids (b) Fods containing tyramine (c) Grapefruit juice (d) Induction of drug metabolism (e) Over – the – counter decongestants

Description : A hypertensive patient has been using nifedipine for some time without untoward effects. If he experiences a rapidly developing enhancement of the antihypertensive effect of the drug, it is probably due to ... ) Grapefruit juice (d) Induction of drug metabolism (e) Over - the - counter decongestants

Last Answer : Ans: C

Hypercholesterolemia is found in (A) Xanthomatosis (B) Thyrotoxicosis (C) Hemolytic jaundice (D) Malabsorption syndrom

Description : Hypercholesterolemia is found in (A) Xanthomatosis (B) Thyrotoxicosis (C) Hemolytic jaundice (D) Malabsorption syndrom

Last Answer : Answer : A

A 55-year-old patient currently receiving other drugs for another condition is to be started on diuretic therapy for mild heart failure. Thiazides are known to reduce the excretion of (a) Diazepam (b) Fluoxetine (c) Imipramine (d) Lithium (e) Potassium

Description : A 55-year-old patient currently receiving other drugs for another condition is to be started on diuretic therapy for mild heart failure. Thiazides are known to reduce the excretion of (a) Diazepam (b) Fluoxetine (c) Imipramine (d) Lithium (e) Potassium

Last Answer : Ans: D

Regarding verapamil, which one of the following statements is false? (a) Angina pectoris is an important indication for the use of verapamil (b) Contraindicated in the asthmatic patient (c) Relaxes vascular smooth muscle (d) Slows the depolarization phase of the action potential in AV nodal cells (e) Used in management of supraventricular tachycardias

Description : Regarding verapamil, which one of the following statements is false? (a) Angina pectoris is an important indication for the use of verapamil (b) Contraindicated in the asthmatic patient (c) ... phase of the action potential in AV nodal cells (e) Used in management of supraventricular tachycardias

Last Answer : Ans: B

The major limitation of the thiazolidinediones in the treatment of type 2 diabetes mellitus is: A. Frequent hypoglycaemic episodes B. Hyperinsulinemia C. Lactic acidosis D. Low hypoglycaemic efficacy in moderate to severe cases

Description : The major limitation of the thiazolidinediones in the treatment of type 2 diabetes mellitus is: A. Frequent hypoglycaemic episodes B. Hyperinsulinemia C. Lactic acidosis D. Low hypoglycaemic efficacy in moderate to severe cases

Last Answer : D. Low hypoglycaemic efficacy in moderate to severe cases

The patient receiving mitoxantrone (Novantrone) for treatment of secondary progressive multiple sclerosis (MS) is closely monitored for a) leukopenia and cardiac toxicity. Mitoxantrone is an antineoplastic agent used primarily to treat leukemia and lyphoma but is also used to treat secondary progressive MS. Patients need to have laboratory tests ordered and the results closely monitored due to the potential for leukopenia and cardiac toxicity.

Description : The patient receiving mitoxantrone (Novantrone) for treatment of secondary progressive multiple sclerosis (MS) is closely monitored for a) leukopenia and cardiac toxicity. Mitoxantrone is an ... d) hypoxia. Patients receiving mitoxantrone are closely monitored for leukopenia and cardiac toxicity.

Last Answer : a) leukopenia and cardiac toxicity. Mitoxantrone is an antineoplastic agent used primarily to treat leukemia and lyphoma but is also used to treat secondary progressive MS. Patients need to have ... ordered and the results closely monitored due to the potential for leukopenia and cardiac toxicity.

Which of the following statements about the presence of gallstones in diabetes patients is/are correct? A. Gallstones occur with the same frequency in diabetes patients as in the healthy population. B. The presence of gallstones, regardless of the presence of symptoms, is an indication for cholecystectomy in a diabetes patient. C. Diabetes patients with gallstones and chronic biliary pain should be managed nonoperatively with chemical dissolution and/or lithotripsy because of severe complicating medical conditions and a high operative risk. D. The presence of diabetes and gallstones places the patient at high risk for pancreatic cancer. E. Diabetes patients with symptomatic gallstones should have prompt elective cholecystectomy, to avoid the complications of acute cholecystitis and g

Description : Which of the following statements about the presence of gallstones in diabetes patients is/are correct? A. Gallstones occur with the same frequency in diabetes patients as in the ... have prompt elective cholecystectomy, to avoid the complications of acute cholecystitis and gallbladder necrosis.

Last Answer : Answer: E DISCUSSION: Gallstones have been found to be very prevalent in patients with type II (non-insulin-dependent) diabetes mellitus, perhaps related to the dyslipoproteinemia in ... added mortality associated with it. There is no causal relationship between diabetes and pancreatic cancer

For treating the patient with congestive heart failure (CHF), which of the following dosages of dopamine is selected for its positive inotropic effects? (a) 2.0 mg/kg/min (b) 5–10 mg/kg/min (c) 10–20 mg/kg/min (d) 40 mg/kg/min (e) 40 mg/kg/min

Description : For treating the patient with congestive heart failure (CHF), which of the following dosages of dopamine is selected for its positive inotropic effects? (a) 2.0 mg/kg/min (b) 5–10 mg/kg/min (c) 10–20 mg/kg/min (d) 40 mg/kg/min (e) 40 mg/kg/min

Last Answer : Ans: B

When digoxin is used in a patient with congestive heart failure (CHF), it works by exerting a positive effect on (a) Stroke volume (b) Total peripheral resistance (c) Heart rate (d) Blood pressure (e) Venous return

Description : When digoxin is used in a patient with congestive heart failure (CHF), it works by exerting a positive effect on (a) Stroke volume (b) Total peripheral resistance (c) Heart rate (d) Blood pressure (e) Venous return

Last Answer : Ans: A

A patient receiving a class I antiarrhythmic agent on a chronic basis complains of fatigue, low-grade fever, and joint pain suggestive of systemic lupus erythematosus (SLE). The patient is most likely receiving (a) Lidocaine (b) Procainamide (c) Quinidine (d) Flecainide (e) Propranolol

Description : A patient receiving a class I antiarrhythmic agent on a chronic basis complains of fatigue, low-grade fever, and joint pain suggestive of systemic lupus erythematosus (SLE). The patient is most likely receiving (a) Lidocaine (b) Procainamide (c) Quinidine (d) Flecainide (e) Propranolol

Last Answer : Ans: B

In a patient receiving digoxin for congestive heart failure, condition that may facilitate the appearance of toxicity include (a) Hyperkalemia (b) Hypernatremia (c) Hypocalcemia (d) Hypomagnesemia (e) All of the above

Description : In a patient receiving digoxin for congestive heart failure, condition that may facilitate the appearance of toxicity include (a) Hyperkalemia (b) Hypernatremia (c) Hypocalcemia (d) Hypomagnesemia (e) All of the above

Last Answer : Ans: D

___________ drug can cause lactic acidosis. a) Metformin b) Pioglitazone c) Repaglinide d) Glibenclamide

Description : ___________ drug can cause lactic acidosis. a) Metformin b) Pioglitazone c) Repaglinide d) Glibenclamide

Last Answer : a) Metformin  

Propranolol should not be prescribed for a patient of angina pectoris who is already receiving (a) Nifedipine (b) Felodipine (c) Verapamil (d) Isosorbide mononitrate

Description : Propranolol should not be prescribed for a patient of angina pectoris who is already receiving (a) Nifedipine (b) Felodipine (c) Verapamil (d) Isosorbide mononitrate

Last Answer : Ans: C

A patient suffers from spisodic pain diffusely localized over the chest and upper abdomen, which is relieved by sublingual glyceryl trinitrate. He could be suffering from (a) Angina pectoris (b) Biliary colic (c) Esophageal spasm (d) All of the above

Description : A patient suffers from spisodic pain diffusely localized over the chest and upper abdomen, which is relieved by sublingual glyceryl trinitrate. He could be suffering from (a) Angina pectoris (b) Biliary colic (c) Esophageal spasm (d) All of the above

Last Answer : Ans: D

Quinidine can cause paradoxical tachycardia in a patient of (a) Stick sinus syndrome (b) Auricular extrasystoles (c) Auricular fibrillation (d) Ventricular extrasystoles

Description : Quinidine can cause paradoxical tachycardia in a patient of (a) Stick sinus syndrome (b) Auricular extrasystoles (c) Auricular fibrillation (d) Ventricular extrasystoles

Last Answer : Ans: C

A patient on oral anticoagulant therapy is commenced on sulfamethoxazoletrimethoprim, double-strength twice daily. One may expect to see the international normalized ratio (a) Increase (b) Decrease (c) Remain unchanged

Description : A patient on oral anticoagulant therapy is commenced on sulfamethoxazoletrimethoprim, double-strength twice daily. One may expect to see the international normalized ratio (a) Increase (b) Decrease (c) Remain unchanged

Last Answer : Ans: A

Situations that predispose a digitalistreated patient to toxicity include (a) Hypercalcemia (b) Hyperkalemia (c) Hypermagnesemia

Description : Situations that predispose a digitalistreated patient to toxicity include (a) Hypercalcemia (b) Hyperkalemia (c) Hypermagnesemia

Last Answer : Ans: A

Tolerance to nitroglycerin may be overcome by (a) Initially using the largest safe dose of the drug (b) Using other nitrites (c) Temporarily discontinuing the drug for one or two weeks (d) Use of higher doses (e) None of the above

Description : Tolerance to nitroglycerin may be overcome by (a) Initially using the largest safe dose of the drug (b) Using other nitrites (c) Temporarily discontinuing the drug for one or two weeks (d) Use of higher doses (e) None of the above

Last Answer : Ans: C

What drug is used to prevent embolism in the lung and during myocardial infarction? (a) Alteplase (b) Human growth hormone (c) Granulocyte–macrophage colony – stimulating factor (GM–CSF) (d) EPOGEN (EPO) (e) None of the above

Description : What drug is used to prevent embolism in the lung and during myocardial infarction? (a) Alteplase (b) Human growth hormone (c) Granulocyte–macrophage colony – stimulating factor (GM–CSF) (d) EPOGEN (EPO) (e) None of the above

Last Answer : Ans: A

Which of the following is the drug of choice for management of cardiac arrhythmias that occur in digitalis toxicity? (a) Amiodarone (b) Lidocaine (c) Propranolol (d) Sotalol (e) Prazosin

Description : Which of the following is the drug of choice for management of cardiac arrhythmias that occur in digitalis toxicity? (a) Amiodarone (b) Lidocaine (c) Propranolol (d) Sotalol (e) Prazosin

Last Answer : Ans: B

A drug lacking vasodilator properties that is useful in angina is (a) Isosorbide dinitrate (b) Metoprolol (c) NIfedipine (d) Nitroglycerin (e) Verapamil

Description : A drug lacking vasodilator properties that is useful in angina is (a) Isosorbide dinitrate (b) Metoprolol (c) NIfedipine (d) Nitroglycerin (e) Verapamil

Last Answer : Ans: B

If a fibrinolytic drug is used for treatment of acute myocardial infarction, the adverse drug effect that is most likely to occur is (a) Acute renal failure (b) Development of antiplatelet antibodies (c) Encephalitis secondary to liver dysfunction (d) Hemorrhagic stroke (e) Neutropenia

Description : If a fibrinolytic drug is used for treatment of acute myocardial infarction, the adverse drug effect that is most likely to occur is (a) Acute renal failure (b) Development of antiplatelet antibodies (c) Encephalitis secondary to liver dysfunction (d) Hemorrhagic stroke (e) Neutropenia

Last Answer : Ans: D

Higher incidence of myocardial infarction and increased mortality has been noted with the use of the following antihypertensive drug (a) Nifedipine (b) Verapamil (c) Diltiazem (d) Lisinopril

Description : Higher incidence of myocardial infarction and increased mortality has been noted with the use of the following antihypertensive drug (a) Nifedipine (b) Verapamil (c) Diltiazem (d) Lisinopril

Last Answer : Ans: A

The following drug is used to reduce the frequency of angina pectoris as well as to terminate an acute attack (a) Digoxin (b) Furosemide (c) Enalapril (d) Amrinone

Description : The following drug is used to reduce the frequency of angina pectoris as well as to terminate an acute attack (a) Digoxin (b) Furosemide (c) Enalapril (d) Amrinone

Last Answer : Ans: A

A 73 year old male presented with an acute attack of gout in his left knee. What is the most likely underlying metabolic cause? 1) decreased renal excretion of uric acid 2) endogenous overproduction of uric acid 3) excessive dietary purine intake 4) lactic acidosis 5) starvation

Description : A 73 year old male presented with an acute attack of gout in his left knee. What is the most likely underlying metabolic cause? 1) decreased renal excretion of uric acid 2) endogenous overproduction of uric acid 3) excessive dietary purine intake 4) lactic acidosis 5) starvation

Last Answer : Answers-1 The aetiology of gout can broadly be divided into cases where there is underexcretion of urate via the kidney (90%) or endogenous overproduction of uric acid (10%) although in practical ... diuretic use. Excessive dietary intake of purines is unlikely to be the main cause in this case.

A middle aged female presented with following symptoms - Hirsutism, fragility of skin, with easy bruising, broad purplish striae and signs of proximal myopathy. The first step in confirming the diagnosis will be Options: 1) Advice 24 hours urinary free cortisol excretion 2) Exclude exogenous Glucocorticoid use 3) Advice plasma ACTH estimation 4) Advice dexamethasone overnight test

Description : A middle aged female presented with following symptoms - Hirsutism, fragility of skin, with easy bruising, broad purplish striae and signs of proximal myopathy. The first step in ... Exclude exogenous Glucocorticoid use 3) Advice plasma ACTH estimation 4) Advice dexamethasone overnight test

Last Answer : Correct Answer: 2) Exclude exogenous Glucocorticoid use

A 59-year-old trauma patient has suffered multiple septic complications including severe pneumonia, intraabdominal abscess, and major wound infection. He has now developed signs of multisystem organ failure. Which of the following statement(s) is/are true concerning necessary changes to be made in his nutritional management? a. Carbohydrate load should be reduced in the face of respiratory failure b. In patients with renal failure, protein intake should be diminished c. During hemodialysis protein intake should be limited to the same extent d. In patients with hepatic failure, carbohydrate load should be increased

Description : A 59-year-old trauma patient has suffered multiple septic complications including severe pneumonia, intraabdominal abscess, and major wound infection. He has now developed signs of multisystem organ ... the same extent d. In patients with hepatic failure, carbohydrate load should be increased

Last Answer : Answer: a, b The most severe complication of sepsis is multiple system organ dysfunction syndrome, which may result in death. The development of organ failure requires changes in the ... should be provided as fat emulsion. If encephalopathy develops, protein load should also be reduced0

Which of the following statements are true of elevated–anion gap metabolic acidosis? A. Hypoperfusion from the shock state rarely produces an elevated anion gap. B. Retention of sulfuric and phosphoric acids may lead to this form of acidosis. C. Copious diarrhea does not produce this condition. D. Rapid volume expansion may produce this form of acidosis. E. Use of lactated Ringer's solution is inappropriate in the treatment of lactic acidosis.

Description : Which of the following statements are true of elevated-anion gap metabolic acidosis? A. Hypoperfusion from the shock state rarely produces an elevated anion gap. B. Retention of sulfuric and phosphoric ... E. Use of lactated Ringer's solution is inappropriate in the treatment of lactic acidosis.

Last Answer : Answer: BC DISCUSSION: An elevated anion gap may be produced by lactic acidosis from shock or by retention of inorganic acids from uremia. Lactated Ringer's solution rapidly corrects the ... . Bicarbonate loss from diarrhea and dilutional acidosis are non-anion gap types of metabolic acidosis

A 20 yr. old female patient presents with pain in thyroid region of the neck since few days. She gives recent history of mumps. On palpation thyroid is tender and her thyroid function test reveals raised levels of T3, T4 and low TSH. Iodine uptake is also low. Probable diagnosis in this case is:1) de Quervain’s thyroiditis 2) Silent thyroiditis 3) Primary thyrotoxicosis 4) Hashimoto’s thyroiditis

Description : A 20 yr. old female patient presents with pain in thyroid region of the neck since few days. She gives recent history of mumps. On palpation thyroid is tender and her thyroid function ... 1) de Quervain's thyroiditis 2) Silent thyroiditis 3) Primary thyrotoxicosis 4) Hashimoto's thyroiditis

Last Answer : Correct Answer: 1) de Quervain’s thyroiditis

A 55-year-old patient with severe posthepatitis cirrhosis is started on a diuretic for another condition. Two days later he is found in a coma. The drug most likely to cause coma in a patient with cirrhosis is (a) Acetazolamide (b) Amiloride (c) Furosemide (d) Hydrochlorothiazide (e) Spironolactone

Description : A 55-year-old patient with severe posthepatitis cirrhosis is started on a diuretic for another condition. Two days later he is found in a coma. The drug most likely to cause coma in a patient with cirrhosis is (a) Acetazolamide (b) Amiloride (c) Furosemide (d) Hydrochlorothiazide (e) Spironolactone

Last Answer : Ans: A

Lactic acidosis?

Description : Lactic acidosis?

Last Answer : DefinitionLactic acidosis is when lactic acid builds ups in the blood stream faster than it can be removed. Lactic acid is produced when oxygen levels in the body drop.Causes, ... correcting the underlying medical problem that causes the condition.ReferencesOh MS. Evaluation of renal function,

All the following features are found in blood chemistry in uncompensated lactic acidosis except (A) pH is decreased (B) Bicarbonate is decreased (C) pCO2 is normal (D) Anion gap is normal

Description : All the following features are found in blood chemistry in uncompensated lactic acidosis except (A) pH is decreased (B) Bicarbonate is decreased (C) pCO2 is normal (D) Anion gap is normal

Last Answer : Answer : D

Anion gap is normal in (A) Hyperchloraemic metabolic acidosis (B) Diabetic ketoacidosis (C) Lactic acidosis (D) Uraemic acidosis

Description : Anion gap is normal in (A) Hyperchloraemic metabolic acidosis (B) Diabetic ketoacidosis (C) Lactic acidosis (D) Uraemic acidosis

Last Answer : Answer : A

Why excessive intake of alcohol produces lactic acidosis?

Description : Why excessive intake of alcohol produces lactic acidosis? 

Last Answer : During alcohol oxidation, NADH is generated, which converts pyruvate to lactate.

Metformin is preferred over phenformin because: A. It is more potent B. It is less liable to cause lactic acidosis C. It does not interfere with vitamin B12 absorption D. It is not contraindicated in patients with kidney disease

Description : Metformin is preferred over phenformin because: A. It is more potent B. It is less liable to cause lactic acidosis C. It does not interfere with vitamin B12 absorption D. It is not contraindicated in patients with kidney disease

Last Answer : B. It is less liable to cause lactic acidosis

Select the hypolipidemic drug that enhances lipoprotein synthesis, fatty acid oxidation and LDLreceptor expression in liver through paroxisome proliferator-activated receptor α: A. Lovastatin B. Atorvastatin C. Bezafibrate D. Nicotinic acid

Description : Select the hypolipidemic drug that enhances lipoprotein synthesis, fatty acid oxidation and LDLreceptor expression in liver through paroxisome proliferator-activated receptor α: A. Lovastatin B. Atorvastatin C. Bezafibrate D. Nicotinic acid

Last Answer : C. Bezafibrate

The chief use of levoarterenol is to treat (a) Shock (b) Diabetes (c) Hypertension (d) Cardiac arrhythmias (e) Iron deficiencies

Description : The chief use of levoarterenol is to treat (a) Shock (b) Diabetes (c) Hypertension (d) Cardiac arrhythmias (e) Iron deficiencies

Last Answer : Ans: A

Which of the following is used to lower blood lipid levels? (a) Trimethadione (b) Clofibrate (c) Flucytosine (d) Coumarin (e) Propranolol

Description : Which of the following is used to lower blood lipid levels? (a) Trimethadione (b) Clofibrate (c) Flucytosine (d) Coumarin (e) Propranolol

Last Answer : Ans: B

In case of acute pain of angina pectoris the most effective treatment would be to administer (a) Mannitol hexanitrate (b) Erythrityl tetranitrate (c) Sodium nitrate (d) Pentaerythritol tetranitrate (e) Nitroglycerin

Description : In case of acute pain of angina pectoris the most effective treatment would be to administer (a) Mannitol hexanitrate (b) Erythrityl tetranitrate (c) Sodium nitrate (d) Pentaerythritol tetranitrate (e) Nitroglycerin

Last Answer : Ans: E

The action of digitalis is enhanced by (a) Sodium (b) Calcium (c) Magnesium (d) Potassium (e) Chloride

Description : The action of digitalis is enhanced by (a) Sodium (b) Calcium (c) Magnesium (d) Potassium (e) Chloride

Last Answer : Ans: B