امتحانات

[DR.hussam alden]

Pharmacology Practice Exam
1. All of the following may be useful in the therapy of acute heart failure with high end-diastolic pressure and pulmonary edema except
a. nitroprusside
b. digoxin
c. oubain
d. propranolol
e. dobutamine
2. Common effects of digitalis on the heart include
a. increased force of contraction
b. decreased atrioventricular conduction velocity
c. increased ectopic automaticity
d. decreased ejection time
e. all of the above
3. Each of the following represents an action of digoxin except
a. inhibition of membrane bound Na/K/ATPase
b. decrease in vagal tone
c. delay impulse transmission through AV node
d. increase in the force of systolic contraction
e. emergence of paired ventricular beats during toxicity
4. The action of digitalis which is primarily responsible for alleviating the symptoms of congestive heart failure is
a. slowing heart rate via a central vagal effect
b. lengthening the P-R interval, allowing a better filling of the ventricles
c. inhibiting Na/K/ATPase in the kidneys, thereby producing a negative sodium balance
d. increasing the force of ventricular contraction
e. causing vomiting, which removes excess fluid
5. Which of the following would be contraindicated for the patient suffering from congestive heart failure and digoxin intoxication?
a. potassium chloride
b. phenytoin
c. calcium chloride
d. quinidine
e. two of the above
6. The pharmacological property of the cardiac glycosides which makes them useful in the treatment of supraventricular arrhythmias is their action to cause
a. inhibition of Na/K/ATPase
b. depression of the T-wave of the ECG
c. increased force of systolic contraction
d. a decrease in venous pressure
e. a decrease ion impulse transmission at the AV node
7. During the therapeutic response to digoxin in congestive heart failure
a. resting heart rate is generally increased
b. Na-Ca exchange at the sarcolemma is accelerated
c. membrane bound Na/K/ATPase is inhibited
d. end-diastolic volume is significantly increased
e. the increase in urine formation is due primarily to direct actions on renal transport mechanisms
8. The cardiac glycosides possess a narrow therapeutic index. All of the following statements regarding toxicity of the cardiac glycosides are correct except
a. the ventricular resting membrane potential decreases (depolarizes)
b. nausea and vomiting may occur
c. potassium supplements increase the likelihood of toxicity
d. catecholamines increase ventricular arrhythmias
e. conduction through the AV node is progressively slowed
9. All of the following statements are accurate except
a. quinidine may cause cardiac arrest in patients with atrioventricular block
b. quinidine increases cardiac contractility
c. quinidine prolongs the effective refractory period
d. quinidine may induce tinnitus
10. Lidocaine typically
a. reduces abnormal automaticity
b. reduces resting potential
c. increases action potential duration
d. increases PR interval
e. increases contractility
11. Which of the following statements concerning antiarrhythmics is incorrect?
a. quinidine depresses cardiac contractility
b. procainamide may induce a lupus-like syndrome
c. lidocaine is indicated primarily for atrial arrhythmias
d. bretylium is indicated for ventricular arrhythmias
e. verapamil is indicated for supraventricular arrhythmia
12. Which of the following antiarrhythmic agents has actions directed especially toward antagonizing digitalis toxicity?
a. quinidine
b. phenytoin
c. procainamide
d. disopyramide
13. Quinidine, procainamide, and disopyramide produce all of the following except
a. negative inotropic effect
b. a degree of muscarinic blocking activity
c. direct depression of conduction velocity
d. deceased ERP/ARD
e. broad-spectrum antiarrhythmic action
14. Each of the following statements about quinidine is correct except
a. it more effectively suppresses ectopic pacemakers than the SA node
b. rapid intravenous administration of quinidine may produce hypotension
c. it may produce a paradoxical increase in heart rate as a result of its anticholinergic action
d. it has a positive inotropic action on the heart
e. it widens the QRS complex
15. Lidocaine is indicated primarily for
a. paroxysmal atrial tachycardia
b. ventricular arrhythmias associated with myocardial ischemia
c. sinus tachycardia
d. atrial fibrillation
e. atrial flutter
16. Which of the following antiarrhythmics most specifically affects the operation of the ion channel, which generates the current largely responsible for Phase 2 of the cardiac action potential?
a. lidocaine
b. verapamil
c. propranolol
d. quinidine
e. bretylium
17. Which of the following antiarrhythmics is paired incorrectly with a legitimate clinical use?
a. verapamil : atrial fibrillation
b. lidocaine : ventricular tachycardia
c. bretylium : atrial flutter
d. quinidine : atrial fibrillation
e. propranolol : supraventricular tachycardia
18. Solutions of aluminum acetate, aluminum sulfate, or zinc sulfate are primarily useful for their
a. astringent action
b. keratolytic action
c. cauterizing action
d. emollient action
19. Weak solutions of which of the following halogens or heavy ----ls has been used to inhibit colonization of burns by Pseudomonas aeruginosa?
a. copper sulfate
b. zinc sulfate
c. tincture of iodine
d. silver nitrate
e. aluminum acetate
20. A quaternary ammonium compound used for disinfection is
a. benzalkonium chloride
b. silver nitrate
c. hexachlorphene
d. aluminum acetate
e. povidone-iodine
21. Which of the following penicillins is effective in infections caused by beta hemolytic streptococci, H. influenzae, and gonococci?
a. penicillin G
b. methicillin
c. oxacillin
d. amoxicillin
e. penicillin VK
22. Of the following antibiotics, which is most suitable for treatment of a hospital acquired staphylococcal infection?
a. tetracycline
b. nafcillin
c. ampicllin
d. chloramphenicol
e. penicillin G
23. All of the following statements concerning the biodisposition of penicillins are accurate except
a. oral absorption of penicillin G is variable owing partly to its acid lability
b. probenecid blocks active renal tubular secretion of penicillins
c. the major mode of elimination of penicillins from the body is via biliary excretion
d. benzathine penicillin G is slowly absorbed, giving low plasma concentrations of penicillin with a longer half-life
e. as polar compounds, the penicillins are not ----bolized by hepatic enzymes to a major extent
24. Which of the following adverse effects is particularly characteristic of ampicillin therapy?
a. constipation
b. acute hemolytic anemia
c. hyponatremia
d. maculopapular skin rashes
e. nephritis
25. Which of the following adverse effects is associated with the use of methicillin?
a. phototoxicity
b. maculopapular skin rashes
c. interstitial nephritis
d. agranulocytosis
26. Which of the following penicillins would likely provide the greatest activity towards H. influenzae?
a. penicillin G
b. cloxacillin
c. penicillin V
d. ampicillin
e. methicillin
27. Which of the following antibiotics is least active versus GI strains of Bacteroides fragilis?
a. cefoxitin
b. clindamycin
c. penicillin G
d. chloramphenicol
e. metronidazole
28. Rank the following penicillins according to their rate of attainment of peak blood levels following an intramuscular injection (fastest to slowest):
a. procaine, benzathine, sodium
b. benzathine, procaine, sodium
c. sodium, benzathine, procaine
d. procaine, sodium, benzathine
e. sodium, procaine, benzathine
29. Which of the following antibiotics is orally active and resistant to degradation by penicillinase?

• a. amoxicillin

b. cloxacillin
c. penicillin V
d. ampicillin
e. carbenicillin

30. Which of the following antibiotics is a poor choice for empirical therapy directed against the indicated suspected pathogen?
a. clindamycin : Bacteroides fragilis
b. vancomycin : Clostridium difficile
c. tetracycline : Rickettsia
d. azlocillin : Pseudomonas aeruginosa
e. cloxacillin : methicillin-resistant S. aureus

31.Which of the following statements regarding penicillins is incorrect?
a.penicillin V provides more reliable oral absorption than penicillin G
b.nafcillin is resistant to penicillinase
c.enterococci are highly susceptible to penicillin G
d.ticarcillin may inactivate gentamicin in vitro
e.ampicillin may produce skin rash

32.In addition to activity against E. coli and Klebsiella, sodium cephalothin is useful in treatment of infections caused by which of the following?
a.pneumocystis carinii
b.penicillinase-producing staphylococci
c.pseudomonas aeruginosa
d.meningococci
e.enterobacter spp

33.All of the following antimicrobials inhibit bacterial protein synthesis except
a.erythromycin
b.cefazolin
c.amikacin
d.tetracycline
e.clindamycin

34.In addition to its effectiveness in infections caused by penicillinase-producing staphylococci, cefazolin has useful activity against?
a.pseudomonas
b.treponema pallidum
c.mycoplasma pneumoniae
d.bacteroides fragilis
e.klebsiella spp

35.Moxalactam would likely be more active than cephalothin against
a.S. aureus
b.Streptococcus pyogenes
c.Serratia marcescens
d.Streptococcus, anaerobic

36.As one progresses from the "first" generation through the "third" generation of cephalosporins which of the following trends is clinically most important?
a.increasing activity versus anaerobic organisms
b.increasing activity versus enteric gram negative bacilli
c.increasing activity versus gram positive cocci
d.increase in duration of action
e.less cross-sensitivity with penicillin allergic patients

37.In each of the following pairs of antibiotics, the first drug possesses a wider spectrum of action than the second drug except
a. ampicillin : penicillin V
b. cephalothin : ceftizoxime
c. mezlocillin : erythromycin
d. chloramphenicol : metronidazole
e. gentamicin : polymixin B
38.First generation cephalosporins are likely more active than penicillin G against
a.S. pneumoniae
b.N. gonorrhea
c.Klebsiella pneumoniae
d.Streptococcus pyogenes
e.Clostridium perfringens

39.Which of the following cephalosporins possesses the widest spectrum of activity?
a.cephalothin
b.cefoperazone
c.cefoxitin
d.cefamandole
e.cefaclor

40.An orally active cephalosporin which demonstrates reliable activity versus H. influenzae is
a.cefaclor
b.cephalexin
c.cefamandole
d.cefuroxime
e.moxalactam

41.All of the following statements about aminoglycosides are accurate except
a.they are polar compounds mainly excreted unchanged in the urine
b.they inhibit protein synthesis and exert bactericidal effects
c.they are accumulated by anaerobes, including Bacteroides
d.they are active against gram negative bacteria, including enterobacter and pseudomonas spp
e.they are not absorbed well from GI tract

42.Adverse effects of aminoglycosides include all of the following except
a.vertigo and ataxia
b.decreased creatinine clearance
c.contact dermatitis
d.diminished ability to hear high-frequency sounds
e.anemia with elevated serum iron

43.Appropriate clinical uses of aminoglycosides include all of the following except
a.infected burns due to Pseudomonas
b.hospital-acquired staphylococcal enterocolitis
c.sepsis caused by Serratia
d.bacteremia due to Enterobacter
e.enterococcal endocarditis

44.Which of the following mechanisms is the principal type of resistance to aminoglycosides in gram negative enteric bacteria?
a.changed cell membrane permeability to aminoglycosides
b.altered DNA-dependant RNA polymerases
c.change in 30s ribosomal receptor affinity for aminoglycosides
d.production of transferase enzymes that inactivate aminoglycosides
e.increased synthesis of PABA

45.Monitoring antimicrobial drug concentrations in body fluids is not usually necessary but may be important in the case of aminoglycosides because
a.their excretion depends on biliary function
b.they have a low therapeutic index
c.most gram negative organisms are resistant
d.they are extensively bound to plasma proteins
e.they are poorly absorbed from the GI tract

46.Plasmid-mediated bacterial resistance to this drug group involves the synthesis of transferase enzymes that inactivate by addition of acetyl or other groups
a.macrolides
b.tetracyclines
c.aminoglycosides
d.penicillins
e.sulfonamides

47.The drug most likely to be effective in a serious hopsital-acquired infection due to Serratia marcescens is
a.ampicillin
b.amikacin
c.tetracycline
d.neomycin
e.erythromycin

48.All of the following statements about aminoglycosides are accurate except
a.they may cause dose-dependant vestibular dysfunction
b.they are bactericidal inhibitors of protein synthesis
c.they are primary drugs for gram-negative bacterial infections
d.they are effective against anaerobes, including Bacteroides spp
e.they are polar compounds eliminated mainly by renal glomerular filtration

49.The aminoglycosides with the greatest degree of resistance to inactivating bacterial enzymes is
a.amikacin
b.gentamycin
c.tobramycin
d.streptomycin
e.kanamycin

50.A rational synergistic antibiotic combination is
a.penicillin + gentamycin
b.cephalexin + penicillin
c.penicillin + tetracycline
d.cephalexin + tetracycline
e.gentamycin + amikacin

51.Which of the following are not true concerning gentamycin?
a.well absorbed from the GI tract
b.indicate for serious infections due to Pseudomonas aeruginosa
c.toxic to the VIII cranial nerve
d.rapidly excreted by the kidney
e.inhibits bacterial protein synthesis

52.Which of the following statements concerning the aminoglycosides is incorrect?
a.loading dose is based on ideal body weight
b.maintenance dose is based on renal function
c.toxicity is referable to the VIII cranial nerve
d.entry into the bacteria is based on membrane components of oxidative phosphorylation
e.efficacy is lowered in more acidic environments such as abscesses

53.Which of the following statements regarding aminoglycoside antibiotics is incorrect?
a.loading dose is based on ideal body weight
b.maintenance dose is based on renal function
c.clinical importance is based on activity versus enteric gram (-) bacilli
d.activity is increased in acidic or inflammatory environments
e.toxicity is directed toward the VIII cranial nerve

54.Appropriate clinical uses of chloramphenicol include infections caused by al of the following organisms except
a.Bacteroides
b.Rickettsiae
c.Staphylococcus aureus
d.Hemophilus
e.Meningococci

55.This drug is important for treating serious infections caused by anaerobic bacteria, but its use can result in the GI tract due to Clostridium difficile
a.gentamycin
b.clindamycin
c.erythromycin
d.vancomycin
e.penicillin G

56.A valid clinical use of chloramphenicol is
a.chlamydial infections of the urinary tract
b.viral infections of the upper respiratory tract
c.treatment of syphilis in penicillin allergy
d.empiric treatment of neonatal sepsis
e.ampicillin-resistant Hemophilus influenzae infections

57.A valid clinical use of clindamycin is
a.treatment of gonorrhea
b.severe infection due to Bacteroides spp
c.respiratory infection due to Mycoplasma spp
d.Clostridium difficile GI infection
e.Rickettsial infections

58.An antibacterial drug characterized by its effectiveness against severe infections with Salmonella and its propensity to cause blood dyscrasias is
a.cephalothin
b.chloramphenicol
c.ampicillin
d.erythromycin
e.clindamycin

59.Which of the following antibiotics is likely not active against the indicated microorganisms?
a. clindamycin : Klebsiella pneumoniae
b. vancomycin : Staphylococcus aureus
c. ampicillin : Proteus mirabilis
d. erythromycin : Streptococcus pyogenes
e. cefamandole : Hemophilus influenzae

60.An antibiotic which may reduce the antibacterial effect of erythromycin by interfering with its ribosomal binding is
a.clindamycin
b.penicillin G
c.tetracycline
d.gentamycin
e.sulfamethoxazole

61.An antibiotic effective against gram (-) bacillary meningitis based on penetration characteristics into the CNS is
a.chloramphenicol
b.cephalexin
c.penicillin G
d.amikacin

62.A decrease in renal function would significantly prolong the biological half-life of all of the following antibiotics except
a.gentamycin
b.penicillin G
c.cephalexin
d.clindamycin
e.vancomycin

63.A long time diabetic patient with swelling posterior to the first ----tarsal head. The patient reports stepping on a small piece of glass in the kitchen 48 hours previously, Inspection of the lesion reveals a serous, blood stained discharge. The wound is very painful and there is marked swelling of the area. Gram stain reveals the presence of gram (+) rods. All of the following antibiotics would likely be useful in the antimicrobial therapy of this infection except
a.penicillin G
b.gentamycin
c.cefoxitin
d.chloramphenicol
e.clindamycin

64.Appropriate clinical uses of tetracyclines include infections caused by all of the following organisms except
a.mycoplasma pneumoniae
b.chlamydiae
c.penicillinase-producing gonococci
d.rickettsiae
e.methicillin-resistant staphylococci

65.This drug inhibits aminoacyl trans********s and blocks peptide initiation by binding to a specific ribosomal RNA component of the 50s subunit.
a.vancomycin
b.metronidazole
c.erythromycin
d.bacitracin
e.streptomycin

66.The elimination half-life of these drugs is not significantly changed in anuria (creatinine clearance less than 5 ml/min).
a.penicillin G, ampicillin
b.cephalothin, cefazolin
c.gentamycin, tobramycin
d.erythromycin, ketaconazole
e.tetracycline, minocycline

67.All of the following statements about tetracyclines are accurate except
a.they bind 30s ribosomal subunits of bacteria
b.they are active against chlamydia
c.they may cause candidal superinfections
d.resistance involves production of inactivating enzymes
e.oral absorption may be decreased by multivalent cations

68.All of the following antibiotics exert their effect by interfering with cell membrane synthesis or function except
a.bacitracin
b.azlocillin
c.moxalactam
d.erythromycin
e.amphotericin B

69.A 53 y/o male with a history of severe chronic alcoholism presents with a soft tissue abscess. Readily observable signs of hepatic cirrhosis (e.g. gynecomastia, "spider" angiomas on the face and neck) are present. Which of the following antibiotics would be contraindicated at "normal" doses and dosage schedule for this patient?
a.penicillin G
b.cephalothin
c.nystatin
d.erythromycin
e.procaine penicillin

70.A patient presents with soft-tissue infection due to betahemolytic streptococci. The patient has a history of anaphylaxis to penicillin. Which of the following would likely be the alternative choice as the antibiotic?
a.erythromycin
b.ampicillin
c.chloramphenicol
d.tetracycline
e.cephalexin

71.In a patient who reports a history of anaphylaxis to penicillin, which of the following antibiotics would be the best choice to treat a suspected streptococcal soft tissue infection?
a.cephalexin
b.erythromycin
c.gentamycin
d.polymixin B
e.chloramphenicol

72.For each of the following antibiotics, a biochemical mechanism is indicated which may account for the development of resistance. Which mechanism has not been identified for the indicated antibiotic?
a. penicillin V : elaboration of penicillinase
b. gentamycin : presence of adenylating enzymes
c. tetracycline : alteration in 50s ribosomal binding site
d. cefamandole : elaboration of beta lactamase sulfamethoxazole : increase in bacterial dihydrofolate reductase

73.This drug group selectively inhibits bacterial dihydrofolate reductase and can act synergistically with sulfonamides.
a.pyrimethamine
b.trisulfapyrimidines
c.methotrexate
d.trimethoprim
e.triamcinolone

74.These drugs should be avoided in neonates, since they can displace bilirubin from plasma proteins and may cause effects on basal ganglia.
a.cephalosporins
b.erythromycins
c.penicillins
d.sulfonamides
e.lincomycins

75.Sulfonamides act synergistically with trimethoprim because
a.sulfonamides inhibit the ----bolism of trimethoprim
b.trimethoprim does no inhibit mammalian dihydrofolate reductase
c.both drugs act at different steps in inhibiting reduced folic acid synthesis
d.trimethoprim inhibits the ----bolism of sulfonamides
e.none of the above

76.Dose-dependant decreases in visual acuity, optic neuritis, and possible retinal damage are serious toxic effects of this drug.
a.rifampin
b.isoniazid
c.ethambutol
d.ethionamide
e.viomycin

77.This drug is inactivated by acetylating enzymes in the liver at rates that depend on genetic background; Eskimos, native North Americans, and Orientals are often "fast" acetylators.
a.ethionamide
b.aminosalicylic acid
c.ethambutol
d.tetracycline
e.isoniazid

78.This drug is important in the treatment of infections due to staphylococci, including those resistant to methicillin. It can also be used in enterococcal endocarditis.
a.nafcillin
b.erythromycin
c.clindamycin
d.vancomycin
e.penicillin G

79.A drug active against methicillin-resistant staphylococcal strains is
a.gentamycin
b.cephalothin
c.erythromycin
d.vancomycin
e.tetracycline

80.An inhibitor of DNA-dependant RNA polymerase, useful in tuberculosis, is
a.isoniazid
b.streptomycin
c.rifampin
d.ethambutol
e.ethionamide

81.Which of the following are practically important determinants of isoniazid elimination in the human?
a.induction of liver microsomal enzymes
b.genetic differences in liver acetylene activity
c.renal excretory capacity
d.degree or protein binding

82.Which of the following urinary tract antiseptics is active via pH-dependent generation of formaldehyde?
a.sulfamethoxazole
b.methenamine
c.nalidixic acid
d.oxolinic acid
e.nitrofurantoin

83.Drugs effective against gram (+) organisms which normally account for much of the cutaneous flora include each of the following except
a.oxacillin
b.cephalothin
c.erythromycin
d.polymixin
e.bacitracin

84.In each of the following pairs, the drug on the right possess a wider antimicrobial spectrum than the drug on the left except
a. penicillin G : mezlocillin
b. cephalexin : cefoperazone
c. chloramphenicol : vancomycin
d. isoniazid : rifampin
e. ampicillin : cefotaxime

85.The mechanism of antifungal action of this drug involves disruption of cell membrane function via binding to ergosterol. It may cause "shake and bake" chills and fevers when administered for systemic fungal infections.
a.ketaconazole
b.nystatin
c.amphotericin B
d.griseofulvin

86.This drug is active against mycoses as well as Candida albicans and dermatophytes. It can cause gynecomastia in circulating adrenosteroids.
a.griseofulvin
b.ketoconazole
c.amphotericin B
d.flucytosine
e.nystatin

87.This drug inhibits mitosis in dermatophytes and has caused lethargy, confusion, impaired judgement, and loss of memory. It also stimulates porphyrin formation.
a.flucytosine
b.miconazole
c.griseofulvin
d.amphotericin B
e.trimethoprim

88.This is an antifungal (and anticancer drug) active against Cryptococcus that undergoes "lethal synthesis". Resistance occurs by several mechanisms, including decreased active uptake and a decrease in the activity of bioactivating enzymes.
a.methotrexate
b.flucytosine
c.clotrimazole
d.tolnaftate
e.cisplatin

89.All of the following drugs have clinically useful activity against Candida albicans except
a.nystatin
b.ketoconazole
c.griseofulvin
d.amphotericin B
e.flucytosine

90.All of the following statement concerning griseofulvin are true except
a.it is deposited in keratin precursor cells
b.it is active against dermatophytes
c.it is most effective after topical administration
d.it causes an induction of cytochrome p450
e.it causes a disruption of fungal mitotic spindles

91.Which of the following drugs is administered orally for the therapy of dermatophytic infections?
a.amphotericin B
b.griseofulvin
c.minocycline
d.tolnaftate
e.miconazole

92.Nystatin acts by
a.blocking cell wall synthesis
b.blocking synthesis of the cytoplasmic cell membrane
c.depressing protein synthesis
d.increasing the permeability of the cytoplasmic cell membrane
e.interfering with intermediary ----bolism

93.Which of the following agents would you recommend for the relief of an infection caused by T. rubrum on the foot?
a.isoniazid
b.trimethoprim-sulfamethoxazole
c.miconazole
d.amphotericin B
e.flucytosine

94.Which of the following actions is not involved in antimycotic effect of miconazole?
a.direct inhibition of fungal protein synthesis
b.an increase in the ******* of saturated fatty acids in the cell membrane
c.disturbance of membrane permeability
d.inhibition of ergosterol synthesis
e.intracellular accumulation of hydrogen peroxide

95.A patient presents with a case of persistent nail infection and tinea pedis. Culture of the nail scraping indicates the presence of both Candida and Epidermophyton floccosum. Each of the fo0llowing exerts antifungal effects against both of these pathogens except
a.miconazole
b.clotrimazole
c.griseofulvin
d.ciclopirox
e.econazole

96.Which of the following statements regarding griseofulvin is incorrect?
a.therapy results in the appearance of giant, multinucleated fungal cells
b.it may cause a decrease in white blood cell count
c.duration of therapy for mycotic nails may last several months
d.absorption is impaired by fatty meals
e.it may cause an induction of cytochrome p450

97.An orally active imidazole derivative effective in the therapy of chronic mucocutaneous candidiasis is
a.miconazole
b.amphotericin B
c.ketoconazole
d.clotrimazole
e.castellani paint

98.Which of the following antifungal agents is used for the therapy of most deep mycotic infections and causes a decline in renal function in most patients who require therapy with it?
a.griseofulvin
b.amphotericin B
c.flucytosine
d.miconazole

99.This drug is a nitrogen mustard that must be bioactivated by liver enzymes to become an alkylating agent. Its side effects include bone marrow depression, GI distress, and amenorrhea.
a.cytarabine
b.cyclophosphamide
c.carmustine
d.methotrexate
e.mechlorethamine

100.An anti----bolite, used in acute myelogenous leukemia, this drug is phosphorylated to form a nucleotide inhibitor of DNA polymerases. Its major toxicity is myelosuppression.
a.cyclophosphamide
b.vincristine
c.prednisone
d.cytarabine
e.cisplatin

101.This antibiotic preparation is used in the drug treatment of testicular carcinoma and breast cancer. Its adverse effects include hyperpigmentation and distinctive pulmonary toxicity.
a.doxorubicin
b.neomycin
c.dactinomycin
d.rifampin
e.bleomycin

102.This drug is an anti----bolite that inhibits dihydrofolate reductase and is used in certain leukemias and lymphomas. Its myelosuppressant and GI side effects can be reduced by "leucovorin rescue".
a.semustine (methyl-CCNU)
b.thioguanine
c.methotrexate
d.fluorouracil
e.mechlorethamine

103.This anticancer drug with specificity for the S phase of the cell cycle is activated by kinases to form an inhibitor of DNA polymerase.
a.prednisone
b.cyclophosphamide
c.methotrexate
d.doxorubicin
e.cytarabine

104.The mechanism of the anticancer action of doxorubicin involves
a.inhibition of folate reductase
b.block of lymphoid cell differentiation
c.intercalation between base pairs of DNA
d.interaction with tubulin to block mitosis
e.inhibition of thymidylate synthase

105.Characteristic toxic effects of the anticancer plant alkaloid vincristine include
a.cardiac abnormalities and tachycardia
b.pulmonary infiltrates
c.areflexia, peripheral neuritis, and paralytic ileus
d.adrenal suppression
e.renal dysfunction

106.Cancer chemotherapeutic agents considered anti----bolites include all of the following except
a.methotrexate
b.cisplatin
c.6-mercaptopurine
d.thioguanine
e.cytarabine

107.Which of the following antineoplastics is incorrectly associated with a major mechanism of action?
a. mechlorethamine : alkylation of critical cell macromolecules
b. dactinomycin : intercalation with DNA
c. asparaginase : hydrolyzes asparagine
d. bleomycin : conversion to fraudulent ribonucleotide

108.Which of the following compounds directly inhibits the reduction of dihydrofolic acid to tetrahydrofolic acid, thus interfering with the transfer of single carbon units for purine biosynthesis?
a.6-mercaptopurine
b.sulfamethoxazole
c.methotrexate
d.leucovorin
e.cisplatin

109.Which of the following statements concerning antineoplastic agents is incorrect?
a.daunorubicin causes cardiac myopathy
b.bleomycin causes pulmonary fibrosis
c.vincristine causes peripheral neuropathy
d.methotrexate is antagonized by the administration of folic acid
e.busulfan inhibits granulocytopoiesis

110.The agent that exploits a biochemical difference between lymphoblastic leukemia cells and normal cells is
a.fluorouracil
b.azathioprine
c.vinblastine
d.L-asparaginase
e.Cisplatin

111.An agent utilized in the MOPP regimen for cancer chemotherapy and noted for a relatively minor degree of myelosuppression is
a.mechlorethamine
b.vincristine
c.procarbazine
d.6-mercaptopurine
e.methotrexate

112.All of the following are characteristics of the alkylating group of antineoplastic agents except
a.nausea and vomiting
b.covalent linkage with guanine residues in DNA
c.myelosuppression
d.formation of carbonium ions
e.stimulation of the immune response

113.Generalized actions for the alkylating agent group of chemotherapeutic agents include all of the following except
a.nausea and vomiting
b.myelosuppression
c.direct inhibition of folic acid ----bolism
d.increased risk of fetal abnormalities
e.decreased resistance to infection

114.Antineoplastic agents which cause a relatively low degree of myelosuppression and are therefore popular components of combination chemotherapy regimens include all of the following except
a.vincristine
b.bleomycin
c.busulfan
d.cisplatin

115.Which of the following antineoplastic agents is incorrectly paired with its major mechanism of action?
a. vinblastine : binds to tubulin; inhibits mitosis
b.cyclophosphamide : alkylating agent
c.doxorubicin : intercalated with DNA
d.bleomycin : fragments DNA
e.5-flurouracil : inhibits ribosomal protein synthesis

116.Allopurinol may increase the toxicity of
a.6-mercaptopurine
b.thioguanine
c.cytarabine
d.methotrexate
e.procarbazine

117.Cyclosporine is effective in organ transplantation and bone marrow transplantation. Although its precise mechanism of action is unknown, it
a.interferes with antigen recognition
b.blocks tissue responses to inflammatory mediators
c.inhibits proliferation and differentiation of T cells
d.increases catabolism of IgG antibodies
e.stimulates production of NK cells

118.Azathioprine
a.is an inhibitor of dihydrofolate reductase
b.is bioactivated to a cytotoxic intermediate by xanthine oxidase
c.blocks both cellular and serologic immune mechanisms
d.is not toxic to bone marrow cells
e.prevents Rh hemolytic disease of the newborn

119.All of the following statements about cyclosporine are accurate except
a.it is an effective immunosuppressant in organ and bone marrow transplants
b.it inhibits proliferation and early differentiation of lymphoid T cells
c.it causes marked bone marrow toxicity
d.it is a lipophilic peptide antibiotic
e.its nephrotoxicity may be reduced by mannitol diuresis

120.Which of the following cell types is most directly affected by cyclosporine?
a.granulocytes
b.macrophages
c.T-helper cells
d.T-suppressor cells
e.B-cells

121.This drug blocks the fusion of the viral envelope with endosomal membranes preventing entry into the cell cytoplasm. Its major use is for influenza A virus.
a.fluorouracil
b.methisazone
c.acyclovir
d.amantidine
e.vidarabine

122.This agent is bioactivated via a sequence of reactions catalyzed by host and viral enzymes and eventually can both inhibit viral DNA polymerase and act as a substrate for the enzyme to become incorporated into DNA.
a.trifluorothymidine
b.acyclovir
c.idoxuridine
d.methisazone
e.rifampin

123.Idoxuridine has been promoted for the treatment for infections due to
a.RNA viruses
b.Herpes simplex virus
c.Influenza virus
d.Mycobacterium
e.Gonococci

124.Acyclovir, after conversion to acycloguanosine triphosphate, inhibits replication of herpes simplex by
a.phosphorylating the viral initiation factor for protein synthesis
b.activating an endonuclease which degrades viral mRNA
c.producing tRNA deficiencies
d.inhibiting viral DNA polymerase
e.preventing viral penetration of the host cell

125.A prophylactic antiviral agent most effective against influenza type A is
a.acyclovir
b.vidarabine
c.amantidine
d.idoxuridine
e.methisazone

126.Effects commonly associated with acute or subacute lead poisoning include all of the following except
a.abdominal pain
b.headache
c.lead "lines" (deposits) in the gums
d.encephalopathy
e.anemia

127.Sodium nitrite may be used to treat poisoning with
a.carbon monoxide
b.cyanide
c.acetaminophen
d.ferrous sulfate
e.nitroglycerin

128.The principal toxic effect observed in humans exposed to DDT is
a.CNS stimulation
b.voluntary muscle paralysis
c.bronchial constriction
d.lowering of plasma pseudocholinesterase
e.hepatocellular damage

129.The toxic agent likely to produce colic, wrist and foot drop, is
a.lead
b.gold
c.mercury
d.arsenic
e.cadmium

130.The toxicity of mercury is related in part to its ability to bind to sulfhydryl tissue compounds. Dimercaperol (BAL) is used to treat Hg toxicity because
a.it has greater affinity for the SH groups than does Hg++
b.it reduces tissue sulfhydryl groups to a form that Hg dose not bind to
c.it binds the Hg with a greater affinity than do tissue components
d.it prevents absorption of Hg

131.Which of the following toxicological hazards is paired incorrectly with one of its major target organ or tissue effects?
a. DDT (chlorinated insecticides) : CNS depression
b. benzene : bone marrow depression
c. CCl4 : hepatic injury
d. cyanide : inhibition of tissue aerobic respiration
e. iron : hepatic and pancreatic necrosis

• MULTIPLE-MUTIPLES

DIRECTIONS (items 132-150): For each item in this section, ONE or MORE of the numbered options are correct, Select:
A if 1, 2, and 3 are correct
B if 1 and 3 are correct
C if 2 and 4 are correct
D if 4 only is correct
E if all are correct

132.Effects of digitalis on electrical functions of the heart include
1.prolonged atrioventricular refractory period
2.slowed sinoatrial nodal rate
3.increased atrial rate in atrial flutter
4.decreased ventricular rate in atrial flutter

133.Which of the following would tend to decrease or reverse a digitalis-induced arrhythmia?
1.decreased serum potassium
2.decreased serum calcium
3.acceleration of heart rate with isoproterenol
4.slowing heart rate with propranolol

134.In a patient receiving digoxin for congestive heart failure, conditions that may facilitate the appearance of toxicity include
1.hypercalcemia
2.hypomagnesemia
3.hypokalemia
4.hypernatremia

135.Which of the following measures is a rational component of the treatment of congestive heart failure?
1.diuretic therapy
2.reduction in heart rate with a beta-blocker
3.increase in contractile performance with digitoxin
4.prophylaxis against arrhythmias with quinidine

136.Recognized side effects of quinidine include
1.cinchonism
2.GI hyperactivity
3.angioneurotic edema
4.displacement of digoxin from its binding sites

137.Quinidine
1.increases the ERP/APD
2.antagonizes muscarinic and alpha receptors
3.is a myocardial suppressant
4.inhibits activation of the fast Na channel

138.Concerning antiseptics and disinfectants
1.povidone-iodine is an effective antibacterial agent, killing vegetative forms and clostridial spores
2.chlorhexidine disrupts bacterial cell membranes, especially those of gram-positive organisms
3.mercury interacts with sulfhydryl groups to inactivate microbial enzymes
4.benzalkonium chloride will completely eradicate Pseudomonas and other gram-negative bacteria when applied to the skin

139.Characteristics of the penicillins include which of the following?
1.ampicillin is active against penicillinase-producing staphylococci
2.carbenicillin is active against Pseuodmonas aeruginosa
3.aminoglycosides antagonize the action of penicillin G against enterococci
4.penicillin G is eliminated by the kidney via active tubular secretion

140.Characteristics of the cephalosporin drug group include which of the following?
1.they are beta-lactam inhibitors of cell wall synthesis
2.cefazolin is active against strains of staphylococci resistant to methicillin
3.cephalothin is active against staphylococci, E. coli, and Klebsiella spp
4.1st generation drugs can be used as alternatives to penicillin G in menigococcal meningitis

141.Gentamycin is a commonly used antibiotic, especially in hospitals. Its adverse effects include
1.tinnitus and loss of perception of high-frequency sounds
2.elevation of serum iron
3.acute tubular necrosis
4.the "gray baby" syndrome

142.Valid clinical uses of erythromycin include
1.streptococcal infections in penicillin-allergic patients
2.genital infections caused by Chlamydia spp
3.respiratory infections due to Mycoplasma pneumoniae
4.methicillin-resistant staphylococcal infection

143.Which of the following antibiotic regimens is correctly paired with a recommended therapeutic use?
1. cephalothin + aminoglycoside : Klebsiella pneumoniae infection
2. penicillin G + aminoglycoside : Enterococcal endocarditis
3. erythromycin : Mycoplasma pneumonia
4. metronidazole : Enterobacter aerogenes bacteremia

144.Trimethoprim-sulfamethoxazole
1.demonstrates synergistic activity versus many gram (-) bacilli
2.is used to treat Pneumocystis carinii infections in AIDS patients
3.is contraindicated in patients with megaloblastic patients
4.may be useful for antibiotic prophylaxis in neutropenic patients

145.Appropriate clinical uses or trimethoprim-sulfamethoxazole include
1.salmonella resistant to ampicillin
2.hospital-acquired staphylococcal osteomyelitis
3.pneumonia due to Pneumocystis carinii
4.enterococcal endocarditis

146.Adverse effects of sulfonamides include
1.hematuria
2.thrombocytopenia
3.exfoliative dermatitis
4.skin rashes

147.Drugs used in the treatment of tuberculosis include
1.isoniazid
2.rifampin
3.ethambutol
4.methenamine

148.Examples of antimicrobial drug synergism include
1.penicillins and aminoglycosides on enterococci
2.beta-lactam aminoglycoside on aerobic gram-negative bacilli (e.g. Pseudomonas aeruginosa)
3.amphotericin B
4.penicillin and tetracycline on pneumococci

149.Anticancer drugs that are cytotoxic through the formation of reactive intermediates that alkylate nucleophilic groups on DNA bases include
1.dactinomycin
2.carmustine
3.methotrexate
4.cyclophosphamide

150.Methotrexate
1.exerts its cytotoxic effect during the S-phase of the cell cycle
2.inhibits mammalian dihydrofolate reductase
3.administration may cause renal damage
4.toxicity is reduced by leucovorin (folinic acid)

ANSWER KEY
1. D 51. A 100. D
2. E 52. A 101. E
3. B 53. D 102. C
4. D 54. C 103. E
5. E 55. B 104. C
6. E 56. E 105. C
7. C 57. B 106. B
8. C 58. B 107. D
9. B 59. A 108. C
10. A 60. A 109. D
11. C 61. A 110. D
12. B 62. D 111. B
13. D 63. B 112. E
14. D 64. E 113. C
15. B 65. C 114. C
16. B 66. D 115. E
17. C 67. D 116. A
18. A 68. D 117. C
19. D 69. D 118. C
20. A 70. A 119. C
21. D 71. B 120. C
22. B 72. C 121. D
23. C 73. D 122. B
24. D 74. D 123. B
25. C 75. C 124. D
26. D 76. C 125. C
27. C 77. E 126. C
28. E 78. D 127. B
29. B 79. D 128. A
30. E 80. C 129. A
31. C 81. B 130. C
32. B 82. B 131. E
33. B 83. D 132. C
34. E 84. C 133. A
35. C 85. C 134. B
36. B 86. B 135. E
37. B 87. C 136. E
38. C 88. B 137. A
39. B 89. C 138. C
40. A 90. C 139. B
41. C 91. B 140. B
42. E 92. D 141. A
43. B 93. C 142. A
44. D 94. A 143. E
45. B 95. C 144. B
46. C 96. D 145. E
47. B 97. C 146. A
48. D 98. B 147. A
49. A 99. B 148. C
50. A 149. E

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