Kaps Exam All System Sorted

GASTROINTESTINALSYSTEM
GASTROINTESTINAL SYSTEM
Peptic Ulcer Disease ................................................................................................................................. 8

Disease conditions (question 100) ........................................................................................................ 8
Drugs and pharmacology( questions-100) .......................................................................................... 57
Inflammatory Bowel Disease ................................................................................................................ 106
Disease conditions (question 100) .................................................................................................... 106
Drugs and pharmacology( questions-100) ........................................................................................ 156
GERD ................................................................................................................................................. 206
Drugs and pharmacology( questions-100) ........................................................................................ 257
CARDIOVASCULAR
CARDIOVASCULARSYSTEM
SYSTEM
ATRIAL FIBRILLATION ................................................................................................................... 305

Drugs and Pharmacology( questions-100) ........................................................................................ 356
HYPERTENSION .............................................................................................................................. 403
Drug and Pharmacology (question 100) ........................................................................................... 453
HEART FAILURE .............................................................................................................................. 502
Drugs and pharmacology ( questions-100) ....................................................................................... 553
ACUTE CORONARY SYNDROMES ............................................................................................... 603
Disease conditions ............................................................................................................................ 603
Drugs and pharmacology ................................................................................................................. 659
CENTRALNERVOUS
CENTRAL NERVOUSSYSTEM
SYSTEM
1. Depression .................................................................................................................................... 708
1.1. Disease conditions (question 100) ...................................................................................... 708
1.2. Drugs and pharmacology( questions-100) .......................................................................... 758
2. Bipolar disorder ........................................................................................................................... 807
2.2. Drugs and pharmacology (questions-100) .......................................................................... 857
3. Schizophrenia ............................................................................................................................... 903
3.2. Drugs and pharmacology ..................................................................................................... 949
4. Anxiety Disorders, ....................................................................................................................... 995
4.2. Drugs and pharmacology( questions-100) ........................................................................ 1042
ENDOCRINE
ENDOCRINESYSTEM
SYSTEM
1. DIABETES MELLITUS .................................................................................................. 1084
1.1. Disease conditions (question 100) ............................................................................. 1084
1.2. Drugs and pharmacology( questions-100) ................................................................. 1130
2. HYPOTHYROIDISM ..................................................................................................... 1174
2.2. Drugs and pharmacology (questions-100) ................................................................. 1218
3. HYPERTHYROIDISM ................................................................................................... 1265
4. ASTHMA ........................................................................................................................ 1367
MUSCULOSKELETALSYSTEM
MUSCULOSKELETAL SYSTEM
1. Osteoarthritis ............................................................................................................................. 1469

2. Rheumatoid Arthritis ................................................................................................................. 1568
3. Osteoporosis ............................................................................................................................... 1659
4. GOUT ........................................................................................................................................ 1758
GENITO URINARY
GENITO URINARY SYSTEM
SYSTEM
1.Urinary incontinence .......................................................................................................... 1858

1.1 Disease conditions (question 100) ............................................................................. 1858
1.2Drugs and pharmacology( questions-100) ................................................................... 1897
2.ERECTILE DYSFUNCTION ............................................................................................ 1933
2.1Disease conditions (question 100) .............................................................................. 1933
3.RENAL FAILURE .............................................................................................................. 1972
3.1Disease conditions (question 100) .............................................................................. 1972
BLOODAND
BLOOD AND NUTRITION
NUTRITION
1.ANEMIA ............................................................................................................................ 2052

1.1Disease conditions (question 100) ................................................................................. 2052
1.2Drugs and pharmacology( questions-100) ...................................................................... 2088
2.DEEP VEIN THROMBOSIS ............................................................................................. 2122
2.1Disease conditions (question 100) ................................................................................ 2122
2.2Drugs and pharmacology( questions-100) ..................................................................... 2160
3.hemorrhagic stroke ............................................................................................................. 2194
3.1Disease conditions (question 100) ................................................................................. 2194
3.2Drug and pharmacology (question 100)......................................................................... 2231
INTRODUCTION TO MULTIPLE CHOICE MCQS
Multiple choice questions each have a number of options for the correct answer, with only one option
being right. Different pharmacy exams to be a registered practitioner have varying details and specifics
depending on the region where the exam is to be taken.
Multiple choice questions is the basis of most of the entrance exams in all fields of study and by looking at
the performance the evaluator can understand the level of knowledge of the students in that particular
subject or category. This form of evaluation is widely accepted in mos
questions are generally prepared by qualified specialist after intense preparation. Making the question is as
hard as answering .mostly the questions are not based on single textbook or reference. Mcq maker does
intense research before come up with the question. The question making is based on multiple reference
and the author should specify the reference to the students so that they can go through the relevant
textbook
Type of questions
There are different kinds of multiple choice questions some are simple and others are complex. Simple
multiple choice questions have not got more than five options where as in the complex form there would
be multiple answers so knowing one answer is not enough to answer the questions.in complex form of
MCQS the student needs to know wrong answer also in order to get it correctly
How to answer the questions
Answering the questions are sometimes very tricky and students need extreme knowledge and some logical
thinking about the answer.one of oldest method is to eliminate the possible wrong answer and narrowing
the options. While studying or answering students need to aware the importance of current working
practice guideline in order to make a judgement.
Preparation Try to gather as many examples as you can of old papers and previous examples of MCQs
used by the department or school in question in the past.Do not, however, try to memorise hundreds of
responses to questions. The factual knowledge you will gain will be superficial and dissociated. It is better
to look for the topic areas that recur frequently and ensure that you have a deeper knowledge of these
topics. Revise with friends and colleagues. You can share knowledge and techniques. Familiarise yourself
with the optical reader cards that you will be using to record your answers in the exam. Examples should
be available from the examinations office. You should know what type of MCQ is being set for you. Will
there be negative marking? How much time will you have and how many questions will there be? On the
day Check that your understanding of the MCQ format is correct. It is negative marking, there are 300
questions, and I have two hours to complete this. Always read the stem for each question carefully. Have
you understood the question? Are there any ambiguities? If so ask an invigilator who will alert an
examiner. There are usually one or two in the room. Allocate three quarters of the time to answering the
questions and a period at the end to checking answers and accuracy
PHARMACY REGISTRATION EXAM IN USA
In the United States, there are three exams available to gain license as a pharmacy practitioner. The
FPGEE, or Foreign Pharmacy Graduate Equivalency Exam, is for international candidates that desire to
practice in the US. There are 250 multiple choice questions to be completed within 5.5 hours. The
knowledge in the practice of pharmacy. It consists of 185 multiple choice questions to be completed
within 4.25 hours. The MPJE, or Multistate Pharmacy Jurisprudence Examination, is concerned with the
laws, regulations, and legal aspect of practicing in particular states and jurisdictions. There are 120
multiple choice questions to be completed within 2.5 hours. (nabp.net).
PHARMACY REGISTRATION EXAMS IN CANADA

In Canada, the PEBC (Pharmacy Examining Board of Canada) is responsible for the Qualifying
Examination that certifies aspiring practitioners. The examination is divided into two parts: the MCQ
(multiple choice questions) and the OSCE (objective structured clinical examination). The MCQ is taken
for two consecutive days, and each day consists of 150 questions within 3.75 hours. (pebc.ca).
PHARMACY REGISTRATION EXAMS IN AUSTRALIA

In Australia, the APC (Australian Pharmacy Council) administers exams to certify competent
practitioners. Foreign candidates will sit for either the KAPS (Knowledge Assessment of Pharmaceutical
Sciences) or the CAOP (Competency Assessment of Overseas Pharmacists). The KAPS is divided into two
multiple choice sections (theory and practice) each consisting of 100 questions within 2 hours. The
CAOP involves 105 multiple choice questions and 1 short-answer question, to be finished within 3 hours.
For Australian natives, the Australian Intern Written Examination must be taken. It consists of 125
multiple choice questions to be completed within 3 hours. (pharmacycouncil.org.au).
PHARMACY REGISTRATION EXAMS IN GULF COUNTRIES

In the Persian Gulf, the different countries each have their own regulatory bodies that conduct exams to
license candidates. The most notable of these are the three exams conducted in the United Arab Emirates,
which are the MOH (Ministry of Health) exam, the DHA (Dubai Health Authority), and the HAAD
Types of multiple choice questions
There are different sections of multiple choice questions in the pharmacy examination. Pharmacology
involves knowledge of the effects of drugs on the brain and nervous system. This area is the major
percentage of the whole exam. Pharmaceutics and biopharmaceutics involves drug preparation and drug
absorption rates, as dependent on how the drug is administered into the body. Pharmacy calculations are
mathematical questions concerning dosage and potency. They make up a smaller percentage of the
prescription medications, and how they can best
prevention.
Tips for preparation of multiple choice questions
In preparation for the multiple choice exam, there are three solid avenues which when combined together
will guarantee success. Review classes: these are preparatory lectures designed by pharmacy institutes to
thoroughly equip candidates for the exam. They cover all areas, and usually last for a few weeks. Review
classes are highly recommended to all candidates. Practice tests and Revisions: exams from past years
provide a great example of what future ones will hold. It is of great importance to study these practice
tests and get acquainted with them. Mock test: this is a test that resembles the actual one in a similar
setting. It is good to go for a mock test before the real exam to eliminate exam-day nervousness and
improve your skills in time-management.
Effective time management in exam
And speaking of time management, it is necessary to allocate a specified amount of time to each section of
the exam, since different sections will consume different lengths of time. For example, pharmacology is
about 50% of the examination, while other areas like biopharmaceutics and clinical pharmacy take up
about 15-20% apiece.
GASTROINTESTINAL SYSTEM
PEPTIC ULCER DISEASE
Disease conditions (question 100)
1. What is peptic ulcer ?

I. Defects in the gastric mucosa.
II. Defect in lungs.
III. Defects in the duodenal mucosa.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Peptic ulcers are defects in the gastric or duodenal mucosa .
2. What is the most common symptom of both gastric and peptic ulcer ?
I. Headache.
II. Epigastric pain.
III. Nausea.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Epigastric pain is the most common symptom of both gastric and duodenal ulcers.
3 What is epigastric pain ?
I. Burning sensation occurs before meals.
II. Burning sensation occurs during meals.
III. Burning sensation occurs after meals.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
It is characterized by a gnawing or burning sensation and occurs after meals
4. When occurs the burning sensation in duodenal ulcer ?

I. Before meal.
II. Just after meal.
III. 2-3 hours after meal.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The burning sensation occurs 2-3 hours afterward with duodenal ulcer.
5. In uncomplicated PUD what are the alarm features ?

I. Severe headache.
II. Unexplained weight loss.
III. Progressive dysphagia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
features include unexplained weight loss, progressive dysphagia
6. What symptom observed in perforated PUD?

I. A sudden onset of severe, sharp abdominal pain.
II. Dysphagia.
III. Bleeding.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Patients with perforated PUD usually present with a sudden onset of severe, sharp abdominal pain.
7. Which laboratory test is useful in all patients with peptic ulcers?

I. Testing for gram positive infection.
II. Testing for H pylori infection.
III. Testing for bacterial infection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Testing for H pylori infection is essential in all patients with peptic ulcers.
8. Which diagnostic test is preferred for suspected PUD patient?
I. Testing for H pylori infection.
II. Lower GI endoscopy.
III. Upper GI endoscopy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Upper GI endoscopy is the preferred diagnostic test in the evaluation of patients with suspected PUD
9. How endoscopy help in diagnosis peptic ulcer ?

I. To visualize the ulcer.
II. To determine the presence and degree of active bleeding.
III. To remove ulcer.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Endoscopy provides an opportunity to visualize the ulcer, to determine the presence and degree of
active bleeding
10. How the PUD patients are treated?
I. By curing of H. Pylori infection.
II. By avoidance of NSAIDS.
III. By using of NSAIDS.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Most patients with PUD are treated successfully with cure of H pylori infection and/or avoidance of
nonsteroidal anti-inflammatory drugs (NSAIDs), along with the appropriate use of antisecretory
therapy.
11. How the PUD patients are treated ?

I. By curing of H. Pylori infection.
II. By using of NSAIDS.
III. By using antisecretory therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Most patients with PUD are treated successfully with cure of H pylori infection and/or avoidance of
nonsteroidal anti-inflammatory drugs (NSAIDs), along with the appropriate use of antisecretory
therapy.
12. What is the primary therapy used to cure the H pylori infection in the U.S. ?
I. NSAIDS.
II. Proton pump inhibitor (PPI).
III. ANTIBIOTICS.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
In the United States, the recommended primary therapy for H pylori infection is proton pump
inhibitor (PPI).
13. In high risk PUD patient what are used as maintenance therapy ?
I. Antisecretory medications.
II. NSAIDS.
III. ANTIBIOTICS.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Maintenance therapy with antisecretory medications (eg, H2 blockers, PPIs) for 1 year is indicated
in high-risk patients.
14. Which antisecretory medications are used in high risk PUD patient ?
I. NSAIDS.
II. H2 blockers.
III. PPIS.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Maintenance therapy with antisecretory medications (eg, H2 blockers, PPIs) for 1 year is indicated
in high-risk patients.
15. Which type of surgical procedure used in PUD ?

I. Cholecystomy.
II. Tubectomy.
III. Vagotomy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Surgical procedures for peptic ulcer disease (PUD) entail some type of vagotomy.
16. Which vagus nerve communicate each other to form esophageal plexus?
I. The left (anterior) branches of the vagus nerve.
II. Hepatic nerve.
III. The right (posterior) branches of the vagus nerve.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The left (anterior) and the right (posterior) branches of the vagus nerve descend along either side of
the distal esophagus. As they enter the lower thoracic cavity, they can communicate with each other
through several cross-branches that comprise the esophageal plexus.
17. Where is esophageal plexus formed ?

I. Upper thoracic cavity.
II. Middle thoracic cavity.
III. Lower thoracic cavity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Esophageal plexus formed at lower thoracic cavity.

18. Which branches formed the anterior vagal trunk ?
I. Heptic branch.
II. Pyloric branch.
III. Celiac branch.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The anterior trunk branches to form the hepatic, pyloric, and anterior gastric branches.
19. Which branches formed the posterior vagal trunk ?

I. Posterior gastric branch .
II. Pyloric branch.
III. Celiac branch.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The posterior trunk branches to form the posterior gastric branch the celiac branch.
20. Which organ is innervated from efferent branches of the hepatic division of the anterior
trunk?
I. Liver.
II. Gallbladder.
III. Lungs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The gallbladder is innervated from efferent branches of the hepatic division of the anterior trunk.
21. Which vagus nerve innervates the entire midgut (except the gallbladder) ?
I. Heptic branch.
II. Pyloric branch.
III. Celiac branch.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The celiac branch of the posterior vagus innervates the entire midgut (with the exception of
the gallbladder).
22. During truncal vagotomy what results occur after transection of the anterior vagus trunk
?
I. Dilated gallbladder.
II. Increased contractility.
III. Cholelithiasis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Consequently, transection of the anterior vagus trunk (performed during truncal vagotomy)
can result in a dilated gallbladder with inhibited contractility and subsequent cholelithiasis.
23. During truncal vagotomy what results occur after transection of the posterior vagus
trunk ?
I. Cholelithiasis.
II. Postoperative ileus.
III. Dilated gallbladder.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The division of the posterior trunk during truncal vagotomy may contribute to postoperative
ileus.
24. Which cells secrete mucus in response to irritation of the epithelial lining of stomach ?
I. Epithelial cells.
II. Endothelial cells.
III. Exothelial cells.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The epithelial cells of the stomach and duodenum secrete mucus in response to irritation of
the epithelial lining and as a result of cholinergic stimulation.
25. How the prostaglandins act as a protective role in PUD ?

I. Increases the production of bicarbonate .
II. Increases the production of mucous layer.
III. Increases the production of acid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Prostaglandins of the E type (PGE) have an important protective role, because PGE increases
the production of both bicarbonate and the mucous layer.
26. Under normal conditions, in which between a physiologic balance exists ?
I. Gastric acid secretion.
II. Gastroduodenal mucosal defense.
III. Saliva secretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Under normal conditions, a physiologic balance exists between gastric acid secretion and
gastroduodenal mucosal defense.
27. What are the aggressive factors ?

I. NSAIDS.
II. Cellular restitution.
III. H pylori infection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Aggressive factors, such as NSAIDs, H pylori infection, alcohol, bile salts, acid, and pepsin.
28. What are the defensive mechanisms?
I. Bile salts.
II. Tight intercellular junctions.
III. Epithelial renewal.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The defensive mechanisms include tight intercellular junctions, mucus, mucosal blood flow,
cellular restitution, and epithelial renewal.
29. How H. pylori spirochete survive for years in hostile acidic environment of stomach ?
I. By urease production.
II. By acid production.
III. By urea production.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The unique microbiologic characteristics of this organism, such as urease production, allows it to
alkalinize its microenvironment and survive for years in the hostile acidic environment of the
stomach.
30. Which physiologic stress may causes the PUD ?
I. CNS trauma.
II. Burns.
III. Smoking.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Stressful conditions that may cause PUD include burns, CNS trauma, surgery, and severe medical
illness.
31. Brain tumour are associated with which type of ulcers ?

I. Cushing ulcers.
II. Curling ulcers.
III. Mouth ulcers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Cushing ulcers are associated with a brain tumor .

32. Extensive burns are associated with which type of ulcers ?
I. Cushing ulcers.
II. Curling ulcers.
III. Mouth ulcers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Extensive burns are associated with Curling ulcers.
33. Which hypersecretory states causes PUD ?

I. Antral G cell hyperplasia.
II. leukemia.
III. Zollinger-Ellison syndrome.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Hypersecretory states may cause PUD:

 Gastrinoma (Zollinger-Ellison syndrome) or multiple endocrine neoplasia type I (MEN-I)
 Antral G cell hyperplasia
34. Which hypersecretory states causes PUD ?
I. Leukemia.
II. Systemic mastocytosis.
III. Hyperparathyroidism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Hypersecretory states may cause PUD:

 Systemic mastocytosis
 Basophilic leukemias
 Cystic fibrosis
 Short bowel syndrome
 Hyperparathyroidism
35. The duodenal ulcers are associated with which physiologic factors ?
I. Increased basal acid output (BAO).
II. Decreased basal acid output (BAO).
III. Increased maximal acid output (MAO).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In duodenal ulcers, basal acid output (BAO) and maximal acid output (MAO) are increased.
36. Which indicates replacement of duodenal villous cells with cells that share morphologic
and secretory characteristics of gastric epithelium.
I. Gastric plasia.
II. Gastric metaplasia.
III. Gastritis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Gastric metaplasia, which indicates replacement of duodenal villous cells with cells that share
morphologic and secretory characteristics of gastric epithelium.
37. Which peptic ulcer conditions are associated with extreme cold climate ?
I. Lower level of HSP70.
II. Lower level of Epidermal growth factor receptor (EGFR).
III. Higher level of nitric oxide synthase (NOS).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Extreme cold climate was associated with significantly lower levels of occluding, HSP70, nitric oxide
synthase (NOS), and epidermal growth factor receptor (EGFR),
38. Which infections are associated with PUD ?
I. HIV.
II. Histoplasmosis.
III. Diptheria.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Additional etiologic factors Other infections, including Epstein-Barr virus, HIV, Helicobacter
heilmannii, herpes simplex, influenza, syphilis, Candida albicans, histoplasmosis, mucormycosis,nd
anisakiasis
39. Which chemotherapeutic agents are associated with PUD ?

I. 5-fluorouracil.
II. 6-fluorouracil.
III. Methotrexate (MTX).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Additional etiologic factors Chemotherapeutic agents, such as 5-fluorouracil (5-FU),

methotrexate (MTX), and cyclophosphamide
40. In U.S. PUD affects approximately how many people annually ?
I. 3.6 Millon.
II. 4.5 Millon.
III. 6.6 Millon.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
In the United States, PUD affects approximately 4.5 million people annually.
41. How patient education help in PUD cases ?

I. By stress reduction counseling.
II. By weight loss counseling.
III. By increasing stress in patient.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Patients should be counseled regarding benefits of weight loss. Stress reduction counseling might be
helpful in individual cases but is not needed routinely.
42. What are the patient education resources ?
I. Digestive Disorder Center.
II. GERD medication understanding.
III. DOTS center.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
For patient education resources, see Digestive Disorders Center as well as Peptic Ulcers, Heartburn,
and Understanding Heartburn/GERD Medications.
43. The possible manifestation observed in PUD patients ?

I. Dyspepsia.
II. Chest discomfort.
III. High B.P.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Other possible manifestations of PUD:

 Dyspepsia, including belching, bloating, distention, and fatty food intolerance
 Chest discomfort
I. Hematemesis.
II. Hypertension.
III. Heartburn.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Other possible manifestations of PUD:

Hematemesis or melena resulting ,Heartburn

I. Hypertension.
II. Hematochezia.
III. Anemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Other possible manifestations of PUD: hematochezia., anaemia (eg, fatigue, dyspnea)

46. What symptoms are promptly warrant the patient to gastroenterology for PUD ?
I. Recurrent vomiting.
II. Family history of GI cancer.
III. HYPERTENSION.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Alarm features that warrant prompt gastroenterology referral[1] include the following:
 Bleeding or anemia
 Early satiety
 Unexplained weight loss
 Progressive dysphagia or odynophagia
 Recurrent vomiting
 Family history of GI cancer
47. Which physical examination are done for uncomplicated PUD ?

I. Epigastric tenderness.
II. Guaiac-positive stool.
III. Dyspepsia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In uncomplicated PUD, the clinical findings are few and nonspecific and include the following:
 Epigastric tenderness (usually mild)
 Right upper quadrant tenderness may suggest a biliary etiology or, less frequently, PUD.
 Guaiac-positive stool resulting from occult blood loss
 Melena resulting from acute or subacute gastrointestinal bleeding
 Succussion splash resulting from partial or complete gastric outlet obstruction
48. Which physical examination are done for uncomplicated PUD ?
I. Dyspepsia.
II. Melena.
III. Succussion splash.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
In uncomplicated PUD, the clinical findings are few and nonspecific and include the following:
 Epigastric tenderness (usually mild)
 Right upper quadrant tenderness may suggest a biliary etiology or, less frequently, PUD.
 Guaiac-positive stool resulting from occult blood loss
 Melena resulting from acute or subacute gastrointestinal bleeding
 Succussion splash resulting from partial or complete gastric outlet obstruction
49. What are the sign and symptoms of septic shock ?

I. Tachycardia.
II. Hypotension.
III. Hypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
These patients may also demonstrate signs and symptoms of septic shock, such as tachycardia,
hypotension, and anuria.
50. What is/ are the sign and symptoms of septic shock ?
I. Bradycardia.
II. Anuria.
III. Hypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
These patients may also demonstrate signs and symptoms of septic shock, such as tachycardia,
hypotension, and anuria.
51. What is the type I gastric ulcer ?

I. Located near angularis incisura.
II. More on curvature.
III. Close to the boarder between antrum and the body of stomach.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Type I gastric ulcers are typically located near the angularis incisura on the lesser curvature, close to
the border between the antrum and the body of the stomach
52. What symptoms are observed in the type I gastric ulcer ?
I. Abnormal or decreased gastric acid secretion.
II. Normal or decreased gastric acid secretion.
III. Normal or Increased gastric acid secretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
. Patients with type I gastric ulcers usually have normal or decreased gastric acid secretion.
53. What is the type II gastric ulcer ?

I. Associated with normal or Decreased gastric acid secretion.
II. Combination of stomach and duodenal ulcers.
III. Associated with normal or increased gastric acid secretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Type II gastric ulcers are a combination of stomach and duodenal ulcers and are associated with
normal or increased gastric acid secretion.
54. What is the type III gastric ulcer ?
I. Prepyloric.
II. Combination of stomach and duodenal ulcers.
III. Associated with normal or increased gastric acid secretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Type III gastric ulcers are prepyloric and are associated with normal or increased gastric acid secretion.
55. What is the type IV gastric ulcer ?

I. Prepyloric.
II. Occur near the gastroesophageal junction.
III. Associated with normal or below normal gastric acid secretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Type IV gastric ulcers occur near the gastroesophageal junction, and gastric acid secretion is normal
or below normal.
56. On which factors the documentation of PUD depend ?
I. Radiographic confirmation.
II. Endoscopic confirmation.
III. Laboratory testing.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Documentation of PUD depends on radiographic and endoscopic confirmation.
57. On diagnosis if PUD is suspected which laboratory test are useful ?

I. CBC count.
II. Liver function test.
III. Biliary test.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
If the diagnosis of PUD is suspected, obtaining CBC count, liver function tests (LFTs), amylase, and
lipase may be useful.
58. Which laboratory studies is used to detect the anemia ?
I. CBC count.
II. Uric acid test.
III. Iron studies.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
CBC count and iron studies can help detect anemia
59. Which test are includes in endoscopic test for H pylori ?

I. Rapid urease test.
II. Histopathology, and culture.
III. Cbc count.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Endoscopic or invasive tests for H pylori include a rapid urease test, histopathology, and culture.
60. How the H pylori is detected in gastric mucosal biopsy specimens ?

I. By testing for the bacterial cell wall.
II. By testing for the bacterial membrane.
III. By testing for the bacterial product urease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The presence of H pylori in gastric mucosal biopsy specimens is detected by testing for the bacterial
product urease.
61. How fecal antigen testing identifies active H pylori infection ?
I. By detecting the presence of H pylori antigens in serum.
II. By detecting the presence of H pylori antigens in stools.
III. By detecting the presence of H pylori antigens in blood.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Fecal antigen testing identifies active H pylori infection by detecting the presence of H pylori antigens
in stools
62. Which kits are commercially available for H pylori testing ?

I. CLO test.
II. Hp-fast.
III. Ph- fast.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Three kits (ie, clotest, Hp-fast, Pyloritek) are commercially available for H pylori testing,
63. Which kits are commercially available for H pylori testing ?
I. Pyloritek.
II.CBC count.
III. CAO test.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Three kits (ie, clotest, Hp-fast, Pyloritek) are commercially available for H pylori testing
64. What is the commercially available for H pylori testing kits contain ?
I. Activator.
II. A urea substrate.
III. A pH sensitive indicator.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Kits contains a combination of a urea substrate and a ph sensitive indicator.

65. How is active H pylori infection detected by Urea breath tests ?
I. By testing for the enzymatic activity of bacterial urease.
II. By testing for the enzymatic activity of bacterial cell wall.
III. By testing for the enzymatic activity of bacterial cell membrane.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Urea breath tests detect active H pylori infection by testing for the enzymatic activity of bacterial
urease.
66. How we can differentiate a benign ulcers from malignant ulcers ?

I. Endoscopy.
II. H pylori testing.
III. By patient history.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Endoscopic allows for biopsies and cytologic brushings in the setting of a gastric ulcer to differentiate
a benign ulcer from a malignant lesion
67. Which diagnosis allows the detection of H pylori infection with antral biopsies for a
rapid urease test ?
I. X-ray.
II. Endoscopy.
III. Ultrasound.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Endoscopic allows for the detection of H pylori infection with antral biopsies for a rapid urease test
68. How endoscopy differentiate a benign ulcer from a malignant lesion ?

I. Biopsies in the setting of a gastric ulcer.
II. Cytologic brushings in the setting of a gastric ulcer.
III. By detecting of H pylori infection with antral biopsies.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Endoscopic allows for biopsies and cytologic brushings in the setting of a gastric ulcer to differentiate
a benign ulcer from a malignant lesion
69. How are the benign ulcers ?
I. Have irregular heaped-up.
II. Have a smooth, regular, rounded edge with a flat smooth base.
III. Have surrounding mucosa that shows radiating folds.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Benign ulcers tend to have a smooth, regular, rounded edge with a flat smooth base and surrounding
mucosa that shows radiating folds.
70. How are the malignant ulcers ?

I. Have irregular heaped-up.
II. Have overhanging margins.
III. Have surrounding mucosa that shows radiating folds.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Malignant ulcers usually have irregular heaped-up or overhanging margins.

71. At endoscopy, how are gastric ulcers appear ?
I. Discrete mucosal lesions.
II. Filled with red fibrinoid exudate.
III. Filled with whitish fibrinoid exudate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
At endoscopy, gastric ulcers appear as discrete mucosal lesions with a punched-out smooth ulcer base,
which often is filled with whitish fibrinoid exudate.
72. At endoscopy, how are duodenal ulcers appear ?

I. Whitish fibrinoid exudate.
II. The presence of a well-demarcated break in the mucosa.
III. The presence of a well-demarcated break in muscularis propria.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Duodenal ulcers are characterized by the presence of a well-demarcated break in the mucosa that may
extend into the muscularis propria of the duodenum .
73. Which type of radiography may approach the diagnostic accuracy of upper GI endoscopy
?
I. Water-soluble contrast.
II. Chest radiograph.
III. Double-contrast radiography.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Double-contrast radiography performed by an experienced radiologist may approach the diagnostic

accuracy of upper GI endoscopy.
74. A patient having massive GI bleedin whom endoscopy cannot be performed how the
PUD diagnosed ?
I. Angiography.
II. H pylori testing.
III. Water-soluble contrast.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Angiography may be necessary in patients with a massive GI bleed in whom endoscopy cannot be
performed
75. What is Zollinger-Ellison syndrome ?
I. Patients with multiple ulcers.
II. Ulcers occurring distal to the duodenal bulb.
III. Ulcer associated with H pylori infection or NSAID use.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Zollinger-Ellison syndrome include

 Patients with multiple ulcers
 Ulcers occurring distal to the duodenal bulb
76. In Which peptic ulcer are not associated with H pylori infection or NSAID use ?
I. Gastric ulcers.
II. Duodenal ulcers.
III. Zollinger-Ellison syndrome.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Zollinger-Ellison syndrome include peptic ulcer not associated with H pylori infection or NSAID use
77. What is Zollinger-Ellison syndrome ?
I. Peptic ulcer associated with hypercalcemia or renal stones.
II. Peptic ulcer associated with H pylori infection or NSAID use.
III. Peptic ulcer associated with diarrhea, steatorrhea, or weight loss.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Zollinger-Ellison syndrome include

 Peptic ulcer associated with diarrhea, steatorrhea, or weight loss
 Peptic ulcer not associated with H pylori infection or NSAID use
 Peptic ulcer associated with hypercalcemia or renal stones
78. Which diagnostic test are used for Zollinger-Ellison syndrome?

I. Secretin stimulation test.
II. The serum gastrin level.
III. Endoscopy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
A secretin stimulation test may be required if the diagnosis of Zollinger-Ellison syndrome cannot be
made on the basis of the serum gastrin level alone.
79. How can we increase the accuracy of biopsy from 70% to 99% ?
I. By taking samples obtained from the base of ulcer.
II. By taking samples obtained from the body of ulcer.
III. By taking samples obtained from the margins of ulcer.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
A single biopsy offers 70% accuracy in diagnosing gastric cancer, but 7 biopsy samples obtained from
the base and ulcer margins increase the sensitivity to 99%.
80. How can we increase the biopsy yield?

I. By taking samples of whole ulcer.
II. Brush cytology.
III. By taking samples obtained from the body of ulcer.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Brush cytology has been shown to increase the biopsy yield,

81. The method biopsy is used in which patients of PUD ?
I. A patient with coagulopathy.
II. A patient with cancer.
III. A patient with hypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Biopsy may be useful when bleeding is a concern in a patient with coagulopathy.
82. How the use of crack cocaine leading to mucosal damage ?

I. Localized vasoconstriction.
II. Reduced blood flow.
III. Increased blood flow.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Use of crack cocaine, which causes localized vasoconstriction, resulting in reduced blood flow and
possibly leading to mucosal damage
83. How the aggressive factor works on epithelial cells ?
I. Protect the mucosal layer.
II. Alter the mucosal defense.
III. Allowing back diffusion of hydrogen ions.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Aggressive factors can alter the mucosal defense by allowing back diffusion of hydrogen ions and
subsequent epithelial cell injury.
84. How the defensive mechanism works on epithelial cells ?

I. causes tight intercellular.
II. Alter the mucosal defense.
III. Cellular restitution.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The defensive mechanisms include tight intercellular junctions, mucus, mucosal blood flow, cellular
restitution, and epithelial renewal
85. By which defensive mechanism aggressive factors do not work on epithelial cells ?
I. Epithelial renewal.
II. Cellular restitution.
III. Alter the mucosal defense.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The defensive mechanisms include tight intercellular junctions, mucus, mucosal blood flow, cellular
restitution, and epithelial renewal
86. What medications are used in NSAIDS associated PUD?

I. PPI.
II. Prostaglandins analog.
III. H2 blockers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Prophylactic regimens that have been shown to dramatically reduce the risk of NSAID-induced gastric
and duodenal ulcers include the use of a prostaglandin analog or a PPI.
87. By which action epithelial cells of stomach and duodenum secrete mucus in response to
irritation?
I. Cholinergic stimulation.
II. Anticholinergic stimulation.
III. Cholinesterase stimulation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The epithelial cells of the stomach and duodenum secrete mucus in response to irritation of the
epithelial lining and as a result of cholinergic stimulation.
88. How mucous layer protect from acid and pepsin to gastric and duodenal membrane ?
I. Mucous layer in gel form and impermeable.
II. Mucous layer in sol form and impermeable.
III. Mucous layer in gel form and permeable.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The superficial portion of the gastric and duodenal mucosa exists in the form of a gel layer, which is
impermeable to acid and pepsin.
89. What are the virulence factor produced by H. pylori ?
I. Urease.
II. Catalase.
III. Urea.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Virulence factors produced by H pylori, including urease, catalase, vacuolating cytotoxin, and
lipopolysaccharide,.
90. What is the virulence factor produced by H. pylori ?

I. Vacuolating cytotoxin.
II. Lipopolysaccharide.
III. Hypo polysaccharide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Virulence factors produced by H pylori, including urease, catalase, vacuolating cytotoxin, and
lipopolysaccharide,
91. What are observed in H. Pylori infected patient ?
I. High levels of gastrin.
II. Low levels of pepsinogen.
III. High levels of pepsinogen.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In patients infected with H pylori, high levels of gastrin and pepsinogen and reduced levels of
Somatostatin have been measured
92. What are observed in H. Pylori infected patient ?

I. High levels of gastrin and pepsinogen.
II. Reduced levels of Somatostatin.
III. Reduced levels of pepsinogen.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In patients infected with H pylori, high levels of gastrin and pepsinogen and reduced levels of
Somatostatin have been measured
93. Which combination of conditions promotes the development of gastric metaplasia ?
I. Reduced duodenal bicarbonate secretion.
II. Increased gastric acid secretion.
III. Increased duodenal bicarbonate secretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The combination of increased gastric acid secretion and reduced duodenal bicarbonate secretion
lowers the ph in the duodenum, which promotes the development of gastric metaplasia
94. Which function is impaired in duodenum by h pylori caused duodenal ulcer?

I. Reduced duodenal bicarbonate secretion.
II. Increased duodenal bicarbonate secretion.
III. Increased gastric acid secretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Most patients with duodenal ulcers have impaired duodenal bicarbonate secretion, which has also
proven to be caused by H pylori because its eradication reverses the defect
95. What is the causes of PUD ?
I. Exercise.
II. Hypersecretory states.
III. Genetic factors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Peptic ulcer disease (PUD) may be due to any of the following:

 H pylori infection
 Drugs
 Lifestyle factors
 Severe physiologic stress
 Hypersecretory states (uncommon)
 Genetic factors
96. What is the causes of PUD ?

I. Lifestyle factors.
II. Drugs.
III. Hormones.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Peptic ulcer disease (PUD) may be due to any of the following:

 H pylori infection
 Drugs
 Lifestyle factors
 Severe physiologic stress
 Hypersecretory states (uncommon)
Genetic factors
97. How the NSAIDS drugs causes ulcers?
I. Disrupt the mucosal permeability barrier.
II. Rendering the mucosa.
III. Increase the mucosa.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
NSAIDS drugs disrupt the mucosal permeability barrier, rendering the mucosa vulnerable to injury
98. Which factors increased the risk of duodenal ulcers in the setting of NSAID use include
history of previous peptic ulcer disease?
I. Concomitant use of anticoagulants.
II. Severe comorbid illnesses.
III. H2 blockers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Factors associated with an increased risk of duodenal ulcers in the setting of NSAID use include history
of previous peptic ulcer disease, advanced age, concomitant use of anticoagulants, and severe comorbid
illnesses.
99. Which factors increased the risk of duodenal ulcers in the setting of NSAID use include
history of previous peptic ulcer disease?
I. Female sex.
II. Male sex.
III. High doses or long-term NSAID use.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Factors associated with an increased risk of duodenal ulcers in the setting of NSAID use include history
of previous peptic ulcer disease, advanced age, female sex, high doses or combinations of NSAIDs,
long-term NSAID use
100. Which drug induced the risk of peptic ulcer in patient who use NSAIDS concurrently
?
I. Corticosteroids.
II. PPI.
III. Antisecretory drugs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Corticosteroids alone do not increase the risk for PUD; however, they can potentiate ulcer risk in
patients who use NSAIDs concurrently.
Drugs and pharmacology( questions-100)
1. What are the different options for the treatment of PUD ?

I. Chemotherapy.
II. Empiric antisecretory therapy.
III. Empiric triple therapy for H pylori infection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Treatment options include empiric antisecretory therapy, empiric triple therapy for H pylori infection,
endoscopy followed by appropriate therapy based on findings
2. What are the different modalities of endoscopic therapy ?

I. Injection Therapy.
II. Coagulation Therapy.
III. Antisecretory therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Several modalities of endoscopic therapy are available, such as injection therapy, coagulation therapy,
hemostatic clips, argon plasma coagulator, and combination therapy.
3. What are the different types of endoscopic therapy ?
I. Antisecretory therapy.
II. Hemostatic clips.
III. Argon plasma Coagulator.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Several modalities of endoscopic therapy are available, such as injection therapy, coagulation therapy,
hemostatic clips, argon plasma coagulator, and combination therapy.
4. What is the ratio of epinephrine to absolute alcohol used in Injection endoscopic therapy
?
I. 1: 1000.
II. 1: 10,000.
III. 1: 100.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Injection therapy is performed with epinephrine in a 1: 10,000 dilution or with absolute alcohol.
5. Which type of probes are used in thermal endoscopic therapy ?
I. Heater probe.
II. Gold probe.
III. Monopolar circumactive probe.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Thermal endoscopic therapy is performed with a heater probe, bipolar circumactive probe, or gold
probe
6. In which method of endoscopic therapy bipolar circumactive probe is used ?

I. Injection therapy.
II. Thermal endoscopic therapy.
III. Coagulation therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Thermal endoscopic therapy is performed with a heater probe, bipolar circumactive probe, or gold
probe
7. Which endoscopic therapy is used in high risk bleeding cancer ?
I. Injection therapy.
II. Thermal therapy.
III. Combined therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
In treating high-risk bleeding ulcers, combined therapy with epinephrine and hemoclips seems to be
more efficacious than injection alone
8. Which two therapy are used in combined endoscopic therapy ?

I. Injection endoscopic therapy.
II. Hemostatic clips.
III. X ray therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In treating high-risk bleeding ulcers, combined therapy with epinephrine and hemoclips seems to be
more efficacious than injection alone
9. What is the mechanism of action of hemoclips to treat bleeding ulcers?
I. By coagulation of the underlying artery.
II. By approximating 2 folds and clipping them together.
III. By vasoconstriction of underlying artery.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Hemoclips have been used successfully to treat an acutely bleeding ulcer by approximating 2 folds and
clipping them together.
10. Which therapy is used as treatment of choice for bleeding peptic ulcer for diagnostic and
therapeutic reasons?
I. Vagotomy.
II. Esophagogastroduodenoscopy (EGD).
III. Injection therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Urgent esophagogastroduodenoscopy (EGD) is the treatment of choice in the setting of a bleeding

peptic ulcer for diagnostic and therapeutic reasons
11. How Esophagogastroduodenoscopy (EGD) help to treat the active bleeding ulcer ?
I. To visualize the ulcer and to determine the degree of active bleeding.
II. To attempt hemostasis by direct measures.
III. By coagulation of the underlying artery.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Endoscopy provides an opportunity to visualize the ulcer, to determine the degree of active bleeding,
and to attempt hemostasis by direct measures.
12. When primary hemostatic therapy (EHT) fails in patient then which therapy is used for
ulcers?
I. Ambolization.
II. Thermal therapy.
III. Transcatheter embolization.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Primary endoscopic hemostatic therapy (EHT) is successful in about 90% of patients; when this fails,
transcatheter embolization may be useful
13. What are the risk factors associated with endoscopic hemostatic therapy (EHT) for non
variceal upper GI bleeding ?
I. Vomiting.
II. Failure to use a PPI after the endoscopic procedure.
III. Post-EHT use of heparin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Risk factors that predict rebleeding following EHT for nonvariceal upper GI bleeding include the
following:
 Failure to use a PPI after the endoscopic procedure
 Endoscopically demonstrated bleeding, especially peptic ulcer bleeding
 EHT monotherapy
 Post-EHT use of heparin
14. What are the risk factors associated with endoscopic hemostatic therapy (EHT) for non
variceal upper GI bleeding ?
I. Fever.
II. Comorbid illness.
III. Posterior wall duodenal ulcer.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Risk factors that predict rebleeding following EHT for nonvariceal upper GI bleeding include the
following:
 Comorbid illness
 Posterior wall duodenal ulcer
15. What is the basic pharmacologic principle of medical management of acute bleeding
from a peptic ulcer?
I. Less alkaline environment.
II. Acid suppression.
III. Reducing gastric acidity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Acid suppression is the general pharmacologic principle of medical management of acute bleeding
from a peptic ulcer. Reducing gastric acidity is believed to improve hemostasis primarily through the
decreased activity of pepsin in the presence of a more alkaline environment.
16. Which two category of drugs are used as acid-suppressing medications ?

I. B-blockers.
II. Histamine-2 receptor antagonists (H2RAs).
III. Proton pump inhibitors (PPIs).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Two classes of acid-suppressing medications currently in use are histamine-2 receptor antagonists
(h2ras) and proton pump inhibitors (PPIs).
17. What are the adverse effect of long term use of PPIs?
I. Clostridium difficile infection.
II. Liver Cancer.
III. Community-acquired pneumonia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
PPIs have a very good safety profile, although attention must continue to be focused on adverse effects,
especially with long-term and/or high-dose therapy, such as Clostridium difficile infection,
community-acquired pneumonia, hip fracture, and vitamin B12 deficiency
18. What are the adverse effect of long term use of PPIs?
I. Vitamin C deficiency.
II. Hip fracture.
III. Vitamin B12 deficiency.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
PPIs have a very good safety profile, although attention must continue to be focused on adverse effects,
especially with long-term and/or high-dose therapy, such as Clostridium difficile infection,
community-acquired pneumonia, hip fracture, and vitamin B12 deficiency
19. What is the adverse effect of long-term use of PPIs on other medications ?
I. Increased absorption of some drugs.
II. Impair gastric secretion of acid.
III. Decreased absorption of some drugs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Long-term use of PPIs is also associated with decreased absorption of some medications. PPIs impair
gastric secretion of acid
20. Long-term use of PPIs is also associated with decreased absorption of some medications,
which are ?
I. Iron salt.
II. Miconazole.
III. Ketoconazole.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Long-term use of PPIs is also associated with decreased absorption of some medications. PPIs impair
gastric secretion of acid; thus, absorption of any medication that depends on gastric acidity, such as
ketoconazole and iron salt, is impaired with long-term PPI therapy.
21 . What is achlorhydria?
I. Presence of intragastric acidity.
II. Absence of intragastric acidity.
III. Absence of intragastric alkalinity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Achlorhydria -- absence of intragastric acidity
22. What is the medication prescribed to non vomiting patients with bleeding ulcers ?
I. Cimetidine.
II. Lansoprazole.
III. Omeprazole.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Non vomiting patients with bleeding ulcers may be treated with oral lansoprazole (120-mg bolus,
followed by 30 mg every 3 hrbased on intragastric ph data, nonvomiting patients with bleeding ulcers
may be treated with oral lansoprazole (120-mg bolus, followed by 30 mg every 3 h).[38] When
indicated, intravenous pantoprazole or omeprazole is administered as an 80-mg bolus followed by a
continuous 8-mg/h infusion for 72 hours.
23. What is the correct dose of Lansoprazole in non vomiting patients with bleeding ulcers
?
I. 120-mg bolus, followed by 30 mg every 3 h.
II. 120-mg bolus, followed by 10 mg every 3 h.
III. 100-mg bolus, followed by 30 mg every 2 h.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Based on intragastric ph data, nonvomiting patients with bleeding ulcers may be treated with oral
lansoprazole (120-mg bolus, followed by 30 mg every 3 h).[
24. What is the correct dose of intravenous pantoprazole in non vomiting patients with
bleeding ulcers ?
I. 80-mg bolus followed by a continuous 8-mg/h infusion for 72 hours.
II. 80-mg bolus followed by a continuous 8-mg/h infusion for 24 hours.
III. 40-mg bolus followed by a continuous 8-mg/h infusion for 72 hours.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
When indicated, intravenous pantoprazole or omeprazole is administered as an 80-mg bolus followed

by a continuous 8-mg/h infusion for 72 hours
25. How the treatment is done of patients with actively bleeding ulcers with a non bleeding
visible vessel or an adherent clot ?
I. Epinephrine injection.
II. 80-mg PPI bolus, followed by 8 mg/h as continuous infusion for 72 hours.
III. 60-mg PPI bolus, followed by 8 mg/h as continuous infusion for 24 hours.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Patients with actively bleeding ulcers and those with a nonbleeding visible vessel or an adherent clot
were treated with (1) epinephrine injection and/or thermal coagulation, then randomized to receive
an intensive regimen of 80-mg PPI bolus, followed by 8 mg/h as continuous infusion for 72 hours
26. How the treatment is done of patients with actively bleeding ulcers with a non bleeding
visible vessel or an adherent clot ?
I. 20-mg PPI bolus daily, followed by saline infusion for 72 hours.
II. 40-mg PPI bolus daily, followed by saline infusion for 72 hours.
III. 20 mg PPI twice daily orally.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer : E
A standard regimen of a 40-mg PPI bolus daily, followed by saline infusion for 72 hours. After the
infusion, all patients were given 20 mg PPI twice daily orally
27. What is the recommended primary therapy for H pylori infection?
I. B blockers based triple therapy.
II. Proton pump inhibitor (PPI) based triple therapy.
III. Calcium channel blocker) based triple therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The recommended primary therapy for H pylori infection is proton pump inhibitor (PPI) based triple
therapy.
28. What is PPI-based triple therapy regimens for H pylori ?

I. PPI+AMOXICILLIN+CLARITHROMYCIN.
II. PPI+SUCRALFATE+CLARITHROMYCIN.
III. PPI+METRONIDAZOLE+CLARITHROMYCIN.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
PPI-based triple therapy regimens for H pylori consist of a PPI, amoxicillin, and clarithromycin for
7-14 days. Amoxicillin should be replaced with metronidazole in penicillin-allergic patients
29. What is PPI-based triple therapy regimens for H pylori in penicillin-allergic patients ?
I. PPI+AMOXICILLIN+CLARITHROMYCIN.
II. PPI+SUCRALFATE+CLARITHROMYCIN.
III. PPI+METRONIDAZOLE+CLARITHROMYCIN.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
PPI-based triple therapy regimens for H pylori consist of a PPI, amoxicillin, and clarithromycin for
7-14 days. Amoxicillin should be replaced with metronidazole in penicillin-allergic patients, because
of the high rate of metronidazole resistance.
30. PPI-based triple therapiess regimen is taken for how many days ?
I. 7-10 days.
II. 2-14 days.
III. 7-14 days.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
PPI-based triple therapy regimens for H pylori for 7-14 days.

31. Which out of the following drug falls in class Antimicrobial agents ?
I. OMEPRAZOLE +AMOXICILLIN+CLARITHROMYCIN.
II. SUCRALFATE +AMOXICILLIN+CLARITHROMYCIN.
III. LANSOPRAZOL+AMOXICILLIN+CLARITHROMYCIN.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
PPI-based triple therapies are a 14-day regimen as shown below:

Omeprazole /Lansoprazole /Rabeprazole Esomeprazole Plus Clarithromycin and
Amoxicillin
I. CIMETIDINE +AMOXICILLIN+CLARITHROMYCIN.
II. RABEPRAZOLE +AMOXICILLIN+CLARITHROMYCIN.
III. ESOMEPRAZOLE +AMOXICILLIN+CLARITHROMYCIN.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

Omeprazole /Lansoprazole /Rabeprazole Esomeprazole Plus Clarithromycin and
Amoxicillin
I. OMEPRAZOLE+METRONIDAZOLE+CLARITHROMYCIN.
II. LANSOPRAZOL+METRONIDAZOLE+CLARITHROMYCIN.
III. ACRABOSE+METRONIDAZOLE+CLARITHROMYCIN.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

Omeprazole /Lansoprazole /Rabeprazole /Esomeprazole Plus Clarithromycin and
Metronidazole
I. RABEPRAZOL+METRONIDAZOLE+CLARITHROMYCIN.
II. GLIPIZIDE+METRONIDAZOLE+CLARITHROMYCIN.
III. ESOMEPRAZOLE+METRONIDAZOLE+CLARITHROMYCIN.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

Omeprazole /Lansoprazole /Rabeprazole /Esomeprazole Plus Clarithromycin and
Metronidazole
35. What is the standard dose of clarithromycin taken in PPI-based triple therapies ?
I. Clarithromycin (Biaxin): 400 mg PO bid.
II. Clarithromycin (Biaxin): 500 mg PO bid.
III. Clarithromycin (Biaxin): 600 mg PO bid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
PPI-based triple therapies Clarithromycin (Biaxin): 500 mg PO bid
36. What is the standard dose of amoxicillin taken in PPI-based triple therapies ?
I. Amoxicillin (Amoxil): 1 g PO bid.
II. Amoxicillin (Amoxil): 10 g PO bid.
III. Amoxicillin (Amoxil): 100g PO bid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
PPI-based triple therapies -Amoxicillin (Amoxil): 1 g PO bid
37. What is the standard dose of metronidazole taken in PPI-based triple therapies ?
I. Metronidazole (Flagyl): 100 mg PO bid.
II. Metronidazole (Flagyl): 200 mg PO bid.
III. Metronidazole (Flagyl): 500 mg PO bid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
PPI-based triple therapies -Metronidazole (Flagyl): 500 mg PO bid

38. Which therapy is used incase standard course of treatment has failed for H pylori
infection?
I. Dual therapies.
II. PPI-based triple therapies.
III. Quadruple therapies.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Quadruple therapies for H pylori infection are generally reserved for patients in whom the standard
course of treatment has failed.
39. Which drugs are included in quadruple treatment ?

I. PPI+BISMUTH+METRONIDAZOLE+TETRACYCLINE.
II. PPI+AMOXCILLIN+METRONIDAZOLE+TETRACYCLINE.
III. PPI+CLARITHROMYCIN+METRONIDAZOLE+TETRACYCLINE.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Quadruple treatment includes the following drugs,

PPI, standard dose, or ranitidine 150 mg, PO bid +Bismuth 525 mg PO qid +Metronidazole 500
mg PO qid +Tetracycline 500 mg PO qid
40. What is the dose of bismuth used in Quadruple treatment ?
I. 525 mg PO qid.
II. 625 mg PO qid.
III. 425 mg PO qid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A

41. What is the dose of tetracycline used in Quadruple treatment ?

I. 300 mg PO qid.
II. 100 mg PO qid.
III. 500 mg PO qid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C

42. What is the period of drugs to taken in Quadruple therapy ?
I. 7 days.
II. 14 days.
III. 21 days.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Quadruple treatment includes drugs, administered for 14 days
43. Who issued the a guideline for prevention of NSAID-related ulcer complications that
supports the recommendations in this section ?
I. JapaenseCollege of Gastroenterology.
II. American College of Gastroenterology.
III. European College of Gastroenterology.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
In 2009, the American College of Gastroenterology (ACG) issued a guideline for prevention of
NSAID-related ulcer complications that supports the recommendations in this section
44. What are the primary prevention for NSAID-induced ulcers ?
I. High doses of NSAIDS.
II. Avoid unnecessary use of NSAIDs.
III. Use acetaminophen.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Primary prevention of NSAID-induced ulcers includes the following:

 Avoid unnecessary use of NSAIDs
 Use acetaminophen or nonacetylated salicylates when possible
 Use the lowest effective dose of an NSAID and switch to less toxic NSAIDs, such as the newer
NSAIDs or cyclooxygenase-2 (COX-2) inhibitors, in high-risk patients without
cardiovascular disease
45. Which drugs are used as a primary prevention in place of NSAIDS ?

I. Cyclooxygenase-1 (COX-1) inhibitors.
II. Cyclooxygenase-2 (COX-2) inhibitors.
III. Acetylcholine inhibitor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Primary prevention of NSAID-induced ulcers includes the following:

 Avoid unnecessary use of NSAIDs
 Use acetaminophen or nonacetylated salicylates when possible
 Use the lowest effective dose of an NSAID and switch to less toxic nsaids, such as the newer
nsaids or cyclooxygenase-2 (COX-2) inhibitors, in high-risk patients without cardiovascular
disease
46. Which type of patient follow the prevention therapy of ulcers ?
I. Patients older than 60 years.
II. Patients with NSAID-induced ulcers.
III. Patients younger than 20 years.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Consider prophylactic or preventive therapy for the following patients:

 Patients with NSAID-induced ulcers who require chronic, daily NSAID therapy
 Patients older than 60 years
47. Which type of patient follow the prevention therapy of ulcers ?

I. Patients with a history of cancer.
II. Patients with a history of PUD.
III. Patients taking concomitant steroids or anticoagulants.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Consider prophylactic or preventive therapy for the following patients:

 Patients with a history of PUD or a complication such as gastrointestinal bleeding
 Patients taking concomitant steroids or anticoagulants or patients with significant comorbid
medical illnesses
48. What drugs are used as a prophylactic regimens in NSAID-induced ulcers ?
I. Misoprostol.
II. Omeprazole.
III. Sucralfate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Prophylactic regimens used in NSAID-induced gastric and duodenal ulcers

Misoprostol , Omeprazole ,Lansoprazole
49. What drugs are used as a prophylactic regimens in NSAID-induced ulcers ?

I. Misoprostol.
II. Lansoprazole.
III. Sucralfate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

Misoprostol , Omeprazole ,Lansoprazole
50. What is dose of misoprostol used as a prophylactic regimens ?
I. 100-200 mcg PO 4 times per day.
II. 10-20 mcg PO 4 times per day.
III. 100-200 mcg PO 2 times per day.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A

 Misoprostol 100-200 mcg PO 4 times per day
 Omeprazole 20-40 mg PO every day
 Lansoprazole 15-30 mg PO every day
51. What is dose of omeprazole used as a prophylactic regimens ?

I. 10-20 mg PO every day.
II. 20-40 mg PO every day .
III. 50-80 mg PO every day.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

52. What is dose of lansoprazole used as a prophylactic regimens ?
I. 10-20 mg PO every day.
II. 20-40 mg PO every day.
III. 15-30 mg PO every day.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C

53. Which drug is used in aspirin-induced ulcer patients in preventing recurrent gastric ulcer
bleeding?
I. Aspirin plus lansoprazole.
II. Aspirin plus misoprostol.
III. Aspirin plus esomeprazole.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Patients with aspirin-induced ulcer, aspirin plus esomeprazole (Nexium) was superior to clopidogrel
(Plavix) in preventing recurrent gastric ulcer bleeding.
54. Which drugs are given to patients with atherosclerosis reduced the recurrence of peptic
ulcers ?
I. Esomeprazole + clopidogrel.
II. Metronidazole+ Tetracycline.
III. Clarithromycin + Tetracycline.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
In a study by Hsu et al, combining esomeprazole and clopidogrel reduced the recurrence of peptic
ulcers in patients with atherosclerosis and a history of peptic ulcers more than the use of clopidogrel
alone
55. What are the characteristics include in high-risk PUD patients ?

I. Fever.
II. Bleeding with hemodynamic instability.
III. Repeated hematemesis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
High-risk patients include those with the following characteristics:

 Bleeding with hemodynamic instability
 Repeated hematemesis or any hematochezia
 Failure to clear with gastric lavage
 Coagulopathy
 Comorbid disease (especially cardiac, pulmonary, or renal)
56. What are the characteristics include in high-risk PUD patients ?
I. Failure to clear with gastric lavage.
II. Coagulopathy.
III. Diabetes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
High-risk patients include those with the following characteristics:

 Bleeding with hemodynamic instability
 Repeated hematemesis or any hematochezia
 Failure to clear with gastric lavage
 Coagulopathy
57. Which comorbid disease are include in high-risk PUD patients ?

I. Cardiac Disease.
II. Pulmonary Disease.
III. Brain Disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
High-risk patients include those with the following characteristics

58. What is GI cocktail ?
I. An antacid with an antiemetic.
II. An antacid with an anesthetic.
III. An antacid with an antidiarrhoeals.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
GI cocktail typically an antacid with an anesthetic
59. Which drugs are contraindicated in PUD patients ?

I. Anticholinergic agents.
II. Antidiarrheal agents.
III. Local Anesthetic.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Anticholinergic agents are contraindicated in PUD.

60. What is mainstays of resuscitation used in the face of continued hypotension after 2 L
in massive gastric bleed ?
I. Endoscopic intervention.
II. Consider blood transfusion.
III. Consider surgery.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Massive gastric bleeds mainstays of resuscitation in the face of continued hypotension after 2 L,
consider blood transfusion.
61. In the massive gastric bleeds mainstays of resuscitation include the following:
I. Medicines.
II. Establishment of adequate IV access.
III. Volume replacement, initially with crystalloid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Massive gastric bleeds mainstays of resuscitation include the following:

Establishment of adequate IV access and volume replacement, initially with crystalloid
62. What is use to monitor the resuscitation in massive gastric bleeds ?
I. A upper venous catheter.
II. A lower venous catheter.
III. A central venous catheter.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C

 Establishment of adequate IV access and volume replacement, initially with crystalloid; in the
face of continued hypotension after 2 L, consider blood transfusion.
 A central venous catheter to monitor such resuscitation may be considered.
63. Which keep the stomach empty and contracted in massive gastric bleed ?
I. SG suction.
II. NG suction.
III. MG suction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer : B

NG suction helps to keep the stomach empty and contracted.
64. In the massive gastric bleeds mainstays of resuscitation include the following:
I. Medicines.
II. Airway protection with intubation.
III. Volume replacement, initially with crystalloid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

Establishment of adequate IV access and volume replacement, initially with crystalloid.
Airway protection with intubation should be considered in the case of massive bleeding.
65. What Indications results for urgent surgery in perforated peptic ulcer ?
I. Failure to achieve hemostasis endoscopically.
II. Recurrent bleeding despite endoscopic attempts.
III. Dyspepsia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The indications for urgent surgery include the following:

 Failure to achieve hemostasis endoscopically
 Recurrent bleeding despite endoscopic attempts at achieving hemostasis (many advocate
surgery after 2 failed endoscopic attempts)
 Perforation
66. What are the factors on which surgical procedure depends on ?
I. The location of the ulcer.
II. The nature of the ulcer.
III. The colour of ulcer.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The appropriate surgical procedure depends on the location and nature of the ulcer.
67. What are the other surgical options for complicated PUD ?
I. Vagotomy and pyloroplasty.
II. Vagotomy and antrectomy.
III. Vasotomy and antrectomy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer : D
Additional surgical options for refractory or complicated PUD include vagotomy and pyloroplasty,
vagotomy and antrectomy with gastroduodenal reconstruction (Billroth I) or gastrojejunal
reconstruction (Billroth II), or a highly selective vagotomy.
68. Which out of the following is surgical options for complicated PUD ?
I. Vasotomy and antrectomy.
II. Vagotomy and antrectomy with gastroduodenal reconstruction (Billroth II).
III. Vagotomy and antrectomy with gastroduodenal reconstruction (Billroth I).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Additional surgical options for refractory or complicated PUD include vagotomy and pyloroplasty,
vagotomy and antrectomy with gastroduodenal reconstruction (Billroth I) or gastrojejunal
reconstruction (Billroth II), or a highly selective vagotomy.
69. What is the contraindication for laparoscopic repair for perforated peptic ulcer ?
I. A posterior location of the perforation.
II. A anterior location of the perforation.
III. A poor general state of health.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Contraindications for laparoscopic repair for perforated peptic ulcer include large perforations, a
posterior location of the perforation, and a poor general state of health.
70. What are the complication observed after surgery ?
I. Fever.
II. Pneumonia.
III. Wound infection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Surgical complications include pneumonia (30%), wound infection, abdominal abscess (15%),
cardiac problems (especially in those >70 y), diarrhea (30% after vagotomy), and dumping syndromes
(10% after vagotomy and drainage procedures).

I. Abdominal abscess.
II. Malaria.
III. Wound infection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
I. Diarrhea (30% after vagotomy).
II. Hear loss.
III. Dumping syndromes (10% after vagotomy and drainage procedures).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
73. What complications are observed after refractory to aggressive antisecretory therapy, H
pylori eradication, or avoidance of NSAIDs ?
I. Perforation.
II. Skin rashes.
III. Obstruction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Refractory, symptomatic peptic ulcers, though rare after eradication of H pylori infection and the
appropriate use of antisecretory therapy, are a potential complication of PUD. Obstruction is
particularly likely to complicate PUD in cases refractory to aggressive antisecretory therapy, H pylori
eradication, or avoidance of NSAIDs.
74. What complications are observed after refractory to aggressive antisecretory
therapy,medical therapy in patients with a history of massive hemorrhage ?
I. Hair fall.
II. Ulcer bleeding.
III. Recurrent bleeding.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Ulcer bleeding, particularly in patients with a history of massive hemorrhage and hemodynamic
instability, recurrent bleeding on medical therapy, and failure of therapeutic endoscopy to control
bleeding is a serious complication.
75. Which out of the following risk factors are related to H pylori infection ?
I. Atrophic gastritis.
II. Gastric cancer.
III. Lung cancer.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
One of the important risk factors is related to H pylori infection. H pylori is associated with atrophic
gastritis, which, in turn, predisposes to gastric cancer.
76. How H pylori infected patient develop the risk of gastric lymphoma or mucosa-associated
lymphoid tissue (MALT) lymphoma ?
I. Mucosa is devoid of organized lymphoid tissue.
II. H pylori infection promotes acquisition of lymphocytic infiltration.
III. The formation of lymphocytic aggregates and follicles develop MALT lymphoma.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
H pylori infection is associated with gastric lymphoma or mucosa-associated lymphoid tissue (MALT)
lymphoma. Normal gastric mucosa is devoid of organized lymphoid tissue. H pylori infection promotes
acquisition of lymphocytic infiltration and often the formation of lymphocytic aggregates and follicles
from which MALT lymphoma develops.
77. Which type of ulcers causes the hemodynamic instability ?

I. Actively bleeding ulcers.
II. Show a visible vessel on endoscopy.
III. Yellow colour ulcers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Surgical consultation is recommended for all patients with bleeding ulcers, especially those patients
who are at high risk of significant bleeding. Such ulcers include those that have caused hemodynamic
instability, those that are actively bleeding, and those that show a visible vessel on endoscopy.
78. A PUD patient is rebleed even after the H pylori has been eradicated what is the
possibility of drug he taken ?
I. H2 blockers.
II. PPIs.
III. NSAIDS.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Peptic ulcer rebleeding is extremely rare after H pylori eradication. The use of maintenance
antisecretory therapy is not necessary if H pylori eradication has been achieved. However, NSAID use
may cause rebleeding even in patients in whom H pylori has been eradicated.
79. What is the maintenance therapy is used in patients with recurrent, refractory, or
complicated ulcers ?
I. Standard doses of H2-receptor antagonists at bedtime.
II. Half of the standard doses of H2-receptor antagonists at bedtime.
III. Double of the standard doses of H2-receptor antagonists at bedtime.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer : B
Consider maintenance therapy with half of the standard doses of H2-receptor antagonists at bedtime
in patients with recurrent, refractory, or complicated ulcers
80. What is the goal of pharmacotherapy in PUD patient ?
I. To avoid complications in patients.
II. To eradicate H pylori infection.
III. To reduce morbidity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The goals of pharmacotherapy are to eradicate H pylori infection, to reduce morbidity, and to prevent
complications in patients with peptic ulcers.
81. What is the mechanism of action of proton pump inhibitors ?

I. Increase the mucus secretions.
II. Allowance of the gastric H+/K+ -ATPase (proton pump) enzyme system.
III. Inhibition of the gastric H+/K+ -ATPase (proton pump) enzyme system.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
PPIs are inhibitors of the gastric H+/K+ -atpase (proton pump) enzyme system, which catalyzes the
exchange of H+ and K+.
82. Which enzyme help in the exchange of H + and K + in gastric wall ?
I. H+/K+ -ATPase.
II. H+/P+ -ATPase.
III. O+/K+ -ATPase.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
PPIs are inhibitors of the gastric H+/K+ -atpase (proton pump) enzyme system, which catalyzes the
exchange of H+ and K+.
83. Which out of the following drugs falls under the class of proton pump inhibitors ?
I. Omeprazole.
II. Lansoprazole.
III. Cimetidine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Proton pump inhibitors

Omeprazole ,Lansoprazole , Rabeprazole ,Esomeprazole ,Pantoprazole
I. Rabeprazole.
II. Esomeprazole.
III. Misoprostol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

I. Misoprostol.
II. Pantoprazole.
III. Cimetidine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

86. What is the S-isomer of omeprazole ?
I. Lansoprazole.
II. Rabeprazole.
III. Esomeprazole.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Esomeprazole is an S-isomer of omeprazole.
87. Which out of the following drug falls in class H2 Receptor blockers?
I. Cimetidine.
II. Clarithromycin.
III. Misoprostol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
H2 Receptor blockers
Cimithidine, Nizatidine, Ranitidine, Famotidine
88. What is the pharmacological mechanism of Ranitidine ?
I. Inhibits histamine stimulation.
II. Block H2 Receptor.
III. B-blockers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Ranitidine inhibits histamine stimulation of the H2 receptor in gastric parietal cells, which, in turn,
reduces gastric acid secretion, gastric volume, and hydrogen ion concentrations.
89. Which drugs inhibit histamine stimulation of the H2 receptor in gastric parietal cells,
which, in turn, reduces gastric acid secretion ?
I. Amoxicillin.
II. Cimithidine.
III. Nizatidine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
90. Which drugs inhibit histamine stimulation of the H2 receptor in gastric parietal cells,
which, in turn, reduces gastric acid secretion ?
I. Sucralfate.
II. Ranitidine.
III. Famotidine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
I. Amoxicillin.
II. Clarithromycin.
III. Misoprostol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Antimicrobial agents
 Amoxicillin
 Clarithromycin
 Tetracycline
 Metronidazole
I. Sucralfate.
II. Tetracycline.
III. Metronidazole.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Antimicrobial agents
 Amoxicillin
 Clarithromycin
 Tetracycline
 Metronidazole
93. What is the pharmacological mechanism of Clarithromycin ?

I. Inhibit RNA-dependent protein synthesis.
II. Increase RNA-dependent protein synthesis.
III. Reversibly binds to the P site of the 50S ribosomal subunit of susceptible organisms.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Clarithromycin is a semisynthetic macrolide antibiotic that reversibly binds to the P site of the 50S
ribosomal subunit of susceptible organisms and may inhibit RNA-dependent protein synthesis by
stimulating the dissociation of peptidyl t-RNA from ribosomes, causing bacterial growth inhibition.
94. What is the mechanism of action of clarithromycin in H-pylori infection ?
I. Increases the synthesis of cell wall.
II. Interferes with the synthesis of cell wall.
III. Bactericidal activity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
It interferes with the synthesis of cell wall mucopeptides during active multiplication, resulting in
bactericidal activity against susceptible bacteria
95. What is the pharmacological mechanism of Metronidazole ?

I. Increase protein synthesis.
II. Inhibit protein synthesis .
III. Causing cell death.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Metronidazole produce intermediate-metabolized compounds formed bind DNA and inhibit protein
synthesis, causing cell death.
96. How antidiarrheal agents act on peptic ulcers?
I. Increased the mucus secretion.
II. Antimicrobial action.
III. Antisecretory action.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Antidiarrheal agents may have antisecretory and antimicrobial action
97. Which out of the following drug falls in class Antidiarrheal agents ?
I. Omeprazole.
II. Bismuth subsalicylate.
III. Sucralfate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer : B
Antidiarrheal agents
Bismuth subsalicylate (Pepto Bismol, Pink Bismuth, Kaopectate Extra Strength)
98. What are the cytoprotective agent used in PUD ?
I. Omeprazole.
II. Misoprostol.
III. Sucralfate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The cytoprotective agents include misoprostol and sucralfate.
99. How the cytoprotective agents works on peptic ulcers?

I. Stimulate mucus production.
II. Decrease mucus production.
III. Enhance blood flow throughout the lining of the gastrointestinal tract.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Cytoprotective agents stimulate mucus production and enhance blood flow throughout the lining of
the gastrointestinal tract. These agents also work by forming a coating that protects the ulcerated
tissue.
100. What is the pharmacological function of the sucralfate cytoprotective agent?

I. Binds with positively charged proteins in exudates.
II. Forms a viscous adhesive substance.
III. Release gastric acid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Sucralfate binds with positively charged proteins in exudates and forms a viscous adhesive substance .
INFLAMMATORY BOWEL DISEASE
1. What is IBD ?
I. Infectious bowel disease.
II. Inflammatory bone disease.
III. Inflammatory bowel disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Inflammatory bowel disease (IBD)
2. What is the cause of inflammatory bowel disease (IBD) ?

I. An idiopathic disease caused by a regulated immune response to host intestinal microflora.
II. An idiopathic disease caused by a dysregulated immune response to host intestinal ulcers.
III. An idiopathic disease caused by a dysregulated immune response to host intestinal microflora.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Inflammatory bowel disease (IBD) is an idiopathic disease caused by a dysregulated immune response
to host intestinal microflora.
3. What are the two types of inflammatory bowel disease ?
I. Ulcerative colitis and Crohn disease (CD).
II. Ulcerative colitis and Curvy disease (CD).
III. Ulcerative Crohn and Crohn disease (CD).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The two major types of inflammatory bowel disease are ulcerative colitis (UC) and Crohn disease
(CD)
4. What is the crohn disease ?

I. Affect any segment of the gastrointestinal tract from the mouth to the anus.
II. Involves "skip lesions," and is transmural.
III. Is limited to the colon.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The two major types of inflammatory bowel disease are ulcerative colitis (UC), which is limited to
the colon, and Crohn disease (CD), which can affect any segment of the gastrointestinal tract from
the mouth to the anus, involves "skip lesions," and is transmural.
5. What are the signs and symptoms of IBD Patients ?
I. Cramping.
II. Irregular bowel habits.
III. Weight gain.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Signs and symptoms

 Cramping
 Irregular bowel habits, passage of mucus without blood or pus
6. What are the signs and symptoms of IBD Patients ?

I. Weight loss.
II. Weight gain.
III. Fever and sweats.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Signs and symptoms

 Weight loss
 Fever, sweats
7. What manifestations are observed in IBD patients ?
I. Weight gain.
II. Malaise, fatigue.
III. Arthralgias.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Signs and symptoms

 Malaise, fatigue
 Arthralgias
8. What growth related manifestation are observed in IBD patients ?

I. Growth retardation.
II. Delayed or failed sexual maturation in children.
III. Increase in height of patient.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Signs and symptoms

 Growth retardation and delayed or failed sexual maturation in children
9. What extraintestinal manifestations are observed in IBD patients ?
I. Arthritis.
II. Uveitis.
III. Lung disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Signs and symptoms

 Extraintestinal manifestations (10-20%): Arthritis, uveitis, or liver disease
10. What manifestations are observed in fifty percent of IBD patients with CD ?
I. Perianal disease.
II. Increase in height of patient.
III. Fistulas, abscesses.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Signs and symptoms

 Grossly bloody stools, occasionally with tenesmus: Typical of UC, less common in CD
 Perianal disease (eg, fistulas, abscesses): Fifty percent of patients with CD
11. Which of the following symptoms may be associated with inflammatory damage in the
digestive tract ?
I. Diarrhea.
II. Dizziness.
III. Constipation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The World Gastroenterology Organization indicates the following symptoms may be associated with
inflammatory damage in the digestive tract:
 Diarrhea: Possible presence of mucus/blood in stool; occurs at night; incontinence
 Constipation: May be the primary symptom in UC and limited to rectum; obstipation may
occur; may proceed to bowel obstruction
12. Which of the following symptoms may be associated with inflammatory damage in the
digestive tract ?
I. Decrease gastric acid secretions.
II. Bowel movement abnormalities.
III. Abdominal cramping and pain.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The World Gastroenterology Organization indicates the following symptoms may be associated with
inflammatory damage in the digestive tract:
 Bowel movement abnormalities: Possible presence of pain or rectal bleeding, severe
urgency, tenesmus
 Abdominal cramping and pain: Commonly present in the right lower quadrant in CD;
occur periumbilically or in the left lower quadrant in moderate to severe UC
13. Which laboratory test is used for the diagnosis of IBD ?
I. Complete blood count.
II. Erythrocyte sedimentation rate.
III. Blood volume test.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Although several laboratory studies may aid in the management of IBD and provide supporting
information, no laboratory test is specific enough to adequately and definitively establish the diagnosis,
including the following:
 Complete blood count
 Erythrocyte sedimentation rate and C-reactive protein levels
14. Which laboratory test is used for the diagnosis of IBD ?

I. Fecal calprotectin level.
II. Urine test.
III. Stool studies.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Although several laboratory studies may aid in the management of IBD and provide supporting
information, no laboratory test is specific enough to adequately and definitively establish the diagnosis,
 Fecal calprotectin level
 Stool studies: Stool culture, ova and parasite studies, bacterial pathogens culture, and
evaluation for Clostridium difficile infection
15. What nutritional evaluation in laboratory is used for the diagnosis of IBD ?
I. Vitamin A evaluation.
II. Vitamin B12 evaluation.
III. Red blood cell folate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Nutritional evaluation: Vitamin B12 evaluation, iron studies, red blood cell folate,
nutritional markers
16. What serologic studies in laboratory is used for the diagnosis of IBD ?
I. Perinuclear antineutrophil cytoplasmic antibodies.
II. Anti- Saccharomyces cerevisiae antibodies.
III. Anti mycobacterium tuberculosis antibodies.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Serologic studies: Perinuclear antineutrophil cytoplasmic antibodies, anti- Saccharomyces

cerevisiae antibodies
17. What stool studies in laboratory is used for the diagnosis of IBD ?
I. Anti mycobacterium tuberculosis antibodies.
II. Stool culture, ova and parasite studies.
III. Evaluation for Clostridium difficile infection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Stool studies: Stool culture, ova and parasite studies, bacterial pathogens culture, and
evaluation for Clostridium difficile infection
18. Which imaging studies used to assess patients with IBD ?

I. Upright chest and abdominal radiography.
II. Barium double-contrast enema radiographic studies.
III. Cobalt contrast radiographic studies.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Imaging studies
The following imaging studies may be used to assess patients with IBD:
 Upright chest and abdominal radiography
 Barium double-contrast enema radiographic studies
I. Cobalt contrast radiographic studies.
II. Abdominal ultrasonography.
III. Computed tomography enterography.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Imaging studies
 Abdominal ultrasonography
 Computed tomography enterography

I. Flexible sigmoidoscopy.
II. Upper gastrointestinal endoscopy.
III. Cobalt contrast radiographic studies.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Imaging studies
 Flexible sigmoidoscopy
 Upper gastrointestinal endoscopy
I. Capsule enteroscopy/double balloon enteroscopy.
II. Cobalt contrast radiographic studies.
III. Colonoscopy , with biopsies of tissue/lesions.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Imaging studies
 Colonoscopy, with biopsies of tissue/lesions
 Capsule enteroscopy/double balloon enteroscopy
22. Why a stepwise medical approach is used for patient with IBD ?
I. Symptomatic care.
II. Mucosal healing.
III. Education purpose.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The medical approach for patients with IBD is symptomatic care (ie, relief of symptoms) and mucosal
healing following a stepwise approach to medication, with escalation of the medical regimen until a
-
23. What medication are used in step-I and IA respectively for patient with IBD ?
I. Antibiotics and Aminosalicylates.
II. Aminosalicylates and Antibiotics.
III. Aminosalicylates and Corticosteroids.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
 Step I Aminosalicylates (oral, enema, suppository formulations): For treating flares and
maintaining remission; more effective in UC than in CD
 Step IA Antibiotics: Used sparingly in UC (limited efficacy, increased risk for antibiotic-
associated pseudomembranous colitis); in CD, most commonly used for perianal disease,
fistulas, intra-abdominal inflammatory masses
24. What medication are used in step-II and III respectively for patient with IBD ?
I. Corticosteroids and Immunomodulators.
II. Immunomodulators and Corticosteroids.
III. Aminosalicylates and Corticosteroids.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
 Step II Corticosteroids (intravenous, oral, topical, rectal): For acute disease flares only
 Step III Immunomodulators: Effective for steroid-sparing action in refractory disease;
primary treatment for fistulas and maintenance of remission in patients intolerant of or not
responsive to aminosalicylates
25. Which statement is /are true for aminosalicylates step-I for patient with IBD ?
I. For treating flares and maintaining remission.
II. For more effective in UC than in CD.
III. Most commonly used for perianal disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Step I Aminosalicylates (oral, enema, suppository formulations): For treating flares and
maintaining remission; more effective in UC than in CD
26. Which statement is /are incorrect for antibiotics step-IA for patient with IBD ?
I. For treating flares and maintaining remission.
II. Used for intra-abdominal inflammatory masses.
III. Most commonly used for perianal disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Step IA Antibiotics: Used sparingly in UC (limited efficacy, increased risk for antibiotic-associated
pseudomembranous colitis); in CD, most commonly used for perianal disease, fistulas, intra-
abdominal inflammatory masses
27. Which statement is /are correct for ccorticosteroids step-II management for patient with
IBD ?
I. Most commonly used for perianal disease.
II. For acute disease flares only.
III. Effective for steroid-sparing action in refractory disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
 Step II Corticosteroids (intravenous, oral, topical, rectal): For acute disease flares only
28. Which statement is /are correct for immunomodulators step-III management for patient
with IBD ?
I. Primary treatment for fistulas in patients intolerant of or not responsive to aminosalicylates.
II. For acute disease flares only.
III. Effective for steroid-sparing action in refractory disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Step III Immunomodulators: Effective for steroid-sparing action in refractory disease;

primary treatment for fistulas and maintenance of remission in patients intolerant of or not
responsive to aminosalicylates
29. Which medication is used as pharmacotherapy in patients with IBD ?
I. Vasodilators.
II. 5-Aminosalicylic acid derivatives.
III. H2-receptor antagonists.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Pharmacotherapy
 5-Aminosalicylic acid derivatives (eg, sulfasalazine, mesalamine, balsalazide, olsalazine)
 H2-receptor antagonists (eg, cimetidine, ranitidine, famotidine, nizatidine)

I. Tumor necrosis factor inhibitors.
II. Corticosteroid agents.
III. Vasoconstrictor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Pharmacotherapy
 Corticosteroid agents (eg, hydrocortisone, prednisone, methylprednisolone, prednisolone,
budesonide, dexamethasone)
 Tumor necrosis factor inhibitors (eg, infliximab, adalimumab, certolizumab pegol)
I. Monoclonal antibodies.
II. Anticholinergic antispasmodic agents.
III. Vasoconstrictor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Pharmacotherapy
 Monoclonal antibodies (eg, natalizumab)
 Anticholinergic antispasmodic agents (eg, dicyclomine,
32. Which out of the following surgery is done in case of ulcerative colitis ?
I. Proctocolectomy with ileostomy.
II. Potential stricturoplasty.
III. Total proctocolectomy with ileoanal anastomosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Surgery
 UC: Proctocolectomy with ileostomy, total proctocolectomy with ileoanal anastomosis
33. Which statement is correct for fulminant colitis ?
I. Surgical procedure of choice is subtotal colectomy with end ileostomy.
II. Creation of a Hartmann pouch.
III. Total proctocolectomy with ileoanal anastomosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Surgery
 Fulminant colitis: Surgical procedure of choice is subtotal colectomy with end ileostomy and
creation of a Hartmann pouch
34. Which type of surgery is done in the patient with severe perianal fistulas ?
I. Total proctocolectomy with ileoanal anastomosis.
II. Resection for symptomatic enteroenteric fistulas.
III. Surgical procedure of choice is subtotal colectomy with end ileostomy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Surgery
 Severe perianal fistulas: Option for diverting ileostomy; generally, resection for symptomatic
enteroenteric fistulas
35. What is true about the pathophysiology of ulcerative colitis ?
I. Involves "skip lesions," and is transmural.
II. Fluid and electrolyte loss.
III. Inflammation of the mucosa of the intestinal tract, causing ulceration, edema, bleeding.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The common end pathway of ulcerative colitis is inflammation of the mucosa of the intestinal tract,
causing ulceration, edema, bleeding, and fluid and electrolyte loss
36. How genetic factors appear to influence the risk of inflammatory bowel disease (IBD) ?
I. By causing a disruption of epithelial barrier integrity.
II. Deficits in autophagy.
III. By generating good epithelial barrier integrity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In several studies, genetic factors appeared to influence the risk of inflammatory bowel disease (IBD)
by causing a disruption of epithelial barrier integrity, deficits in autophagy, [9] deficiencies in innate
pattern recognition receptors, and problems with lymphocyte differentiation
37. How genetic factors appear to influence the risk of inflammatory bowel disease (IBD) ?
I. By generating good epithelial barrier integrity.
II. Deficiencies in innate pattern recognition receptors.
III. Problems with lymphocyte differentiation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
In several studies, genetic factors appeared to influence the risk of inflammatory bowel disease (IBD)
by causing a disruption of epithelial barrier integrity, deficits in autophagy, [9] deficiencies in innate
pattern recognition receptors, and problems with lymphocyte differentiation
38. Which out of following is identified as inflammatory mediators in IBD ?

I. Food product.
II. Cytokines.
III. Immunoglobulin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Inflammatory mediators have been identified in IBD, and considerable evidence suggests that these
mediators play an important role in the pathologic and clinical characteristics of these disorders.
Cytokines .
39. Which type of cells release cytokines in response to various antigenic stimuli ?
I. Macrophages.
II. Parietal cell.
III. Epithelial cell.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Cytokines, which are released by macrophages in response to various antigenic stimuli
40. Which type of cells are associated principally with Crohn disease ?
I. Helper T cells.
II. Type 1 (Th-1).
III. Type 2 (Th-2).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Cytokines differentiate lymphocytes into different types of T cells. Helper T cells, type 1 (Th-1), are
associated principally with Crohn disease, whereas Th-2 cells are associated principally with ulcerative
colitis
41. Which type of cells are associated principally with ulcerative colitis ?
I. Helper T cells.
II. Type 1 (Th-1).
III. Type 2 (Th-2).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Cytokines differentiate lymphocytes into different types of T cells. Helper T cells, type 1 (Th-1), are
associated principally with Crohn disease, whereas Th-2 cells are associated principally with ulcerative
colitis
42. What is the cause of gallstone in crohn disease patient ?

I. A reduced bile salt pool.
II. Increased cholesterol concentration in the bile.
III. Decreased cholesterol concentration in the bile.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Gallstones are formed because of increased cholesterol concentration in the bile, which is caused by a
reduced bile salt pool
43. Which of the following characteristics define the etiology of inflammatory bowel disease
?
I. Genetic predisposition.
II. An altered, dysregulated immune response.
III. A regulated immune response.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Three characteristics define the etiology of inflammatory bowel disease (IBD): (1) genetic
predisposition; (2) an altered, dysregulated immune response; and (3) an altered response to gut
microorganisms
44. Which of the following characteristics define the etiology of inflammatory bowel disease
?
I. An altered response to gut microorganisms.
II. A regulated immune response.
III. Genetic predisposition.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Three characteristics define the etiology of inflammatory bowel disease (IBD): (1) genetic
predisposition; (2) an altered, dysregulated immune response; and (3) an altered response to gut
microorganisms
45. Which of the following gene is considered as a susceptibility gene for Crohn disease ?
I. CARD15.
II. CARD55.
III. CARD75.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
An early discovery on chromosome 16 (IBD1 gene) led to the identification of 3 single nucleotide
polymorphisms (2 missense, 1 frameshift) in the NOD2 gene (now called CARD15) as the first gene
(CARD15) clearly associated with IBD (as a susceptibility gene for Crohn disease).
46. The susceptibility gene CARD 15 for Crohn disease is present on which chromosome ?
I. Chromosome 26.
II. Chromosome 18.
III. Chromosome 16.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
47. What is the configuration of 3 single nucleotide polymorphs in the CARD 15 gene ?
I. 1 missense, 1 frameshift.
II. 2 missense, 1 frameshift.
III. 1 missense, 2 frameshift.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
48. Which type of immunity system is followed by polymorphic geneCARD15 ?

I. Innate immune system.
II. Adaptive immune system.
III. Neuroimmunesystyem.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
CARD15 is a polymorphic gene involved in the innate immune system.

49. Which of the following genomic loci are associated with an increased risk of developing
Crohn Disease ?
I. CCR6.
II. STAT3.
III. IL20B.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In sorting out loci that have been previously discussed, there were 21 new loci that were associated
with an increased risk of developing Crohn Disease and have functional implications, including the
genes CCR6, IL12B, STAT3, JAK2, LRRK2, CDKAL1, and PTPN22.
50. Which of the following genes are associated with an increased risk of developing Crohn
Disease?
I. JAK2.
II. LRRK2.
III. CDOAL1.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In sorting out loci that have been previously discussed, there were 21 new loci that were associated
with an increased risk of developing Crohn Disease and have functional implications, including the
genes CCR6, IL12B, STAT3, JAK2, LRRK2, CDKAL1, and PTPN22.
51. What are the intestinal complication associated with IBD disease ?
I. Erythema nodosum.
II. Gastrointestinal complications.
III. Perianal or pelvic abscesses.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Intestinal complications
IBD can be associated with several gastrointestinal complications, including risk of hemorrhage,
perforation, strictures, and fistulas as well as perianal disease and related complications, such as
perianal or pelvic abscesses, toxic megacolon (complicating acute severe colitis), and malignancy
(colorectal cancer, cholangiocarcinoma complicating primary sclerosing cholangitis).
52. What are the intestinal complication associated with IBD disease?
I. Strictures and fistulas.
II. Erythema nodosum.
III. Toxic megacolon.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Intestinal complications
53. What are the intestinal malignancy associated with IBD disease ?
I. Colorectal cancer.
II. Cholangiocarcinoma.
III. Anemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
54. What are the extraintestinal complication associated with IBD disease ?
I. Toxic megacolon.
II. Osteoporosis.
III. Hypercoagulability.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Extraintestinal complications
These include osteoporosis (usually a consequence of prolonged corticosteroid use), hypercoagulability
resulting in venous thromboembolism, anemia, gallstones, primary sclerosing cholangitis, aphthous
ulcers, iritis (uveitis) and episcleritis, and skin complications (pyoderma gangrenosum, erythema
nodosum).
55. What are the extraintestinal skin complication associated with IBD disease ?
I. Pyoderma gangrenosum.
II. Pelvic abscesses.
III. Erythema nodosum.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Skin complications (pyoderma gangrenosum, erythema nodosum).
56. What are the extraintestinal complication associated with IBD disease ?
I. Iritis (uveitis).
II. Episcleritis.
III. Pelvic abscesses.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
These include osteoporosis (usually a consequence of prolonged corticosteroid use), hypercoagulability
resulting in venous thromboembolism, anemia, gallstones, primary sclerosing cholangitis, aphthous
ulcers, iritis (uveitis) and episcleritis, and skin complications (pyoderma gangrenosum, erythema
nodosum).
57. What are symptoms observed during the physical examination of patient with IBD ?
I. Fever.
II. Bradycardia.
III. Dehydration.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Fever, tachycardia, dehydration, and toxicity may occur in patients with inflammatory bowel disease
(IBD). Pallor may also be noted, reflecting anemia. The prevalence of these factors is directly related
to the severity of the attack.
58. What are symptoms observed during the physical examination of patient with crohn
disease ?
I. Develop a mass in the right upper quadrant.
II. Develop a mass in the right lower quadrant.
III. Positive Hemoccult examination.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Patients with Crohn disease may develop a mass in the right lower quadrant. Perianal complications
(eg, perianal fissures or fistulas, abscesses, rectal prolapse) may be observed in up to 90% of patients
with this disease.[4] Common presenting signs include occult blood loss and low-grade fever, weight
loss, and anemia. The rectal examination often reveals bloody stool or positive Hemoccult
examination.
59. What are symptoms observed during the physical examination of I BD in young patient?
I. Growth retardation.
II. Develop a mass in the right upper quadrant.
III. Bradycardia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Growth retardation may be the only presenting sign of IBD in young patients.
60. Which out of the following hematologic tests are done for diagnosis in IBD patients?
I. Complete blood cell count.
II. Nutritional evaluation.
III. Blood fluid analysis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Hematologic tests
 Complete blood cell count
 Nutritional evaluation: Vitamin B12 evaluation, iron studies, RBC folate, nutritional
markers
 ESR and CRP levels
 Fecal calprotectin levels
61. Which out of the following hematologic tests are done for diagnosis in IBD patients ?
I. ESR and CRP levels.
II. Blood fluid analysis.
III. Fecal calprotectin levels.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Hematologic tests
 Nutritional evaluation: Vitamin B12 evaluation, iron studies, RBC folate, nutritional
markers
 ESR and CRP levels
 Fecal calprotectin levels
62. Which of the following nutritional evaluation are done for diagnosis in IBD patients ?
I. Vitamin B12 evaluation.
II. Iron studies, RBC folate.
III. Vitamin B1 evaluation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Nutritional evaluation: Vitamin B12 evaluation, iron studies, RBC folate, nutritional markers
63. How complete blood cell count help to diagnose the IBD ?
I. Useful indicators of disease activity.
II. Useful indicators of blood volume.
III. Useful indicators iron or vitamin deficiency.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The components of the complete blood cell (CBC) count can be useful indicators of disease activity
and iron or vitamin deficiency. An elevated white blood cell (WBC) count is common in patients
with active inflammatory disease and does not necessarily indicate infection.
64. What is mean by MCV ?

I. Mean coagulation volume.
II. Mean corpuscular volume.
III. Mean capillary volume.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Anemia is common and may be either an anemia of chronic disease (usually normal mean corpuscular
volume [MCV])
65. Which patient develop the vitamin B12 deficiency in crohn disease ?
I. Patients have had terminal ileum disease.
II. Patients have had terminal ileum resection.
III. Patients have had terminal tracheal resection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Vitamin B12 deficiency can occur in patients with Crohn disease who have significant terminal ileum
disease or in patients who have had terminal ileum resection.
66. What is the standard replacement dose of vitamin B12 ?

I. 1000 mg subcutaneously (SC) every month.
II. 1000 mg intravenously (SC) every month.
III. 1000 mg subcutaneously (SC) every day.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The standard replacement dose of vitamin B12 is 1000 mg subcutaneously (SC) every month, because
oral replacement is often insufficient.
67. Which of the following is used for parenteral replacement in iron deficiency in IBD
patient?
I. Intravenous (IV) iron sucrose.
II. Intravenous (IV) iron lactose.
III. Intravenous (IV) iron maltose.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
For parenteral replacement, intravenous (IV) iron sucrose can be used, and dosing is based on the
table in the package insert, with a maximum of 30 ml (1500 mg) at once
68. Which of the following test confirmed the iron deficiency with microcytic hypochromic
anemia?
I. Serum iron/total ion-binding capacity (TIBC).
II. Serum iron/total iron-binding capacity (TIBC).
III. Total iron-binding capacity (TIBC)/serum iron.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Serum iron studies should be obtained at the time of diagnosis, because active IBD is a source for GI
blood loss, making iron deficiency common. A microcytic hypochromic anemia suggests iron deficiency;
if confirmed with serum iron/total iron-binding capacity (TIBC), iron can be replaced either enterally
or parenterally.
69. What is ESR ?
I. Erythrocyte sticking rate.
II. Epithelial sedimentation rate.
III. Erythrocyte sedimentation rate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The erythrocyte sedimentation rate (ESR)
70. What is CRP ?

I. C-reactive protein.
II. C-reactive protease.
III. C-related protein.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
C-reactive protein (CRP) level

71. Which statement is true about the ESR and CRP in IBD patient ?
I. Used as serologic markers for inflammation.
II. They are specific for diagnosis in IBD.
III Inflammatory markers also aids in monitoring disease activity and response to treatment.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level are often used as
serologic markers for inflammation, but they are not specific for IBD. However, measuring such
inflammatory markers also aids in monitoring disease activity and response to treatment
72. What is mean by fecal calprotectin levels ?

I. A invasive surrogate marker of intestinal inflammation in IBD.
II. A non invasive surrogate marker of intestinal inflammation in IBD.
III. A noninvasiveseological marker of intestinal inflammation in IBD.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Fecal calprotectin has been proposed as a noninvasive surrogate marker of intestinal inflammation in
IBD
73. What is PANCA ?
I. Perinuclear antineutrophil cytothoracic antibodies.
II. Perinuclear antineutrophil cytoplasmic antibodies.
III. Perinuclear antineutrophil cytoplasmic antigens.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Perinuclear antineutrophil cytoplasmic antibodies (panca)
74. What is ASCA ?

I. Anti-Saccharomyces cerevisiae antigen.
II. Anti-Streptomycin cerevisiae antibodies.
III. Anti-Saccharomyces cerevisiae antibodies.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Perinuclear antineutrophil cytoplasmic antibodies (panca) have been identified in some patients with
ulcerative colitis, and anti-Saccharomyces cerevisiae antibodies (ASCA) have been found in patients
with Crohn disease.
75. Which of the following antibodies identified in serologic studies of patient with
ulcerative colitis?
II. Anti-Saccharomyces cerevisiae antibodies.
III. Anti-Streptomycin cerevisiae antibodies.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
with Crohn disease
76. Which of the following antibodies identified in serologic studies of patient with crohn
disease ?
II. Anti-Saccharomyces cerevisiae antibodies.
III. Anti-Streptomycin cerevisiae antibodies.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
with Crohn disease.
77. Which of the following combination of antibodies has high specificity for ulcerative
colitis?
I. Positive pANCA and negative ASCA.
II. Negative pANCA and negative ASCA.
III. Negative pANCA and positive ASCA.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The combination of positive panca and negative ASCA has high specificity for ulcerative colitis,
whereas the inverse pattern positive ASCA, negative panca is more specific for Crohn disease.
78. Which of the following combination of antibodies has high specificity for Crohn disease?
I. Positive pANCA and negative ASCA.
II. Negative pANCA and negative ASCA.
III. Negative pANCA and positive ASCA.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The combination of positive panca and negative ASCA has high specificity for ulcerative colitis,
whereas the inverse pattern positive ASCA, negative panca is more specific for Crohn disease.
79. What is the cause of acute terminal ileitis?
I. Yersinia enterocolitis.
II. Saccharomyces cerevisiae.
III. Clostridium difficile.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
As many as 50-80% of cases of acute terminal ileitis may be due to Yersinia enterocolitis
80. What is the life-threatening complication of ulcerative colitis ?

I. Toxic megacolon.
II. Episcleritis.
III. Pelvic abscesses.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Toxic megacolon is a life-threatening complication of ulcerative colitis

81. Which radiographic technique allowed characterization of the typical findings associated
with inflammatory bowel disease (IBD) ?
I. Barium enema imaging technique.
II. Abdominal radiography.
III. Computed tomography.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The barium enema imaging technique was one of the first studies that allowed characterization of
the typical findings associated with inflammatory bowel disease (IBD).
82. What is the meaning of rectal sparing, abnormality found after barium studies of the
colon?
I. Mucosal inflammation.
II. Crohn colitis in the presence of inflammatory changes in other portions of the colon.
III. Areas of inflammation alternating with normal-appearing areas.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Several terms have been used to describe abnormalities found after barium studies of the colon,
 Rectal sparing suggests Crohn colitis in the presence of inflammatory changes in other portions
of the colon (see the image below)
83. What is the meaning of thumbprinting ,abnormality found after barium studies of the
colon ?
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
 Thumbprinting indicates mucosal inflammation (which can also be seen frequently on the
abdominal flat plate) (see the following image)
84. What is the meaning of skip lesions ,abnormality found after barium studies of the colon
?
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
 Skip lesions suggest areas of inflammation alternating with normal-appearing areas, again
suggesting Crohn colitis
85. What is the meaning of lead-pipe or stove-pipe appearance ,abnormality found after
barium studies of the colon ?
I. Crohn colitis in the presence of inflammatory changes in other portions of the colon.
II. Chronic ulcerative colitis.
III. Loss of colonic haustrae due to the colon becoming a rigid foreshortened tube.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 A lead-pipe or stove-pipe appearance suggests chronic ulcerative colitis that has resulted in a
loss of colonic haustrae due to the colon becoming a rigid foreshortened tube (see the following
image)
86. Which of the following diagnostic technique play an essential role in predicting disease
activity and severity in Crohn disease?
I. MRI.
II. CT scanning.
III. Esophagogastroduodenoscopy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
MRI can play an essential role in predicting disease activity and severity in Crohn disease.
87. Which of the following is one of the most valuable tools for the diagnosis and treatment
of inflammatory bowel disease (IBD)?
I. Colonoscopy.
II. Flexible sigmoidoscopy.
III. Esophagogastroduodenoscopy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Colonoscopy is one of the most valuable tools available to the physician for the diagnosis and treatment
of inflammatory bowel disease (IBD),
88. Which disease conditions of IBD are diagnosed by flexible sigmoidoscopy ?

I. Evaluation of upper gastrointestinal tract symptoms.
II. Preliminary diagnosis in patients with chronic diarrhea or rectal bleeding.
III. Diagnose only distal ulcerative colitis or proctitis due to limited length.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Flexible sigmoidoscopy is useful for a preliminary diagnosis in patients with chronic diarrhea or rectal
bleeding; however, because of the limited length of the scope (60 cm), it can only help diagnose distal
ulcerative colitis or proctitis.
89. What is the length of the scope in flexible sigmoidoscopy?
I. 60 cm.
II. 60 m.
III. 60 dm.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Flexible sigmoidoscopy is useful for a preliminary diagnosis in patients with chronic diarrhea or rectal
bleeding; however, because of the limited length of the scope (60 cm), it can only help diagnose distal
ulcerative colitis or proctitis.
90. When is used the esophagogastroduodenoscopy for diagnosis?

I. Evaluation of upper gastrointestinal tract symptoms.
II. Particularly in patients with Crohn disease.
III. Used for finding obscure sources of gastrointestinal (GI) blood loss.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Esophagogastroduodenoscopy (EGD) is used for the evaluation of upper gastrointestinal tract

symptoms, particularly in patients with Crohn disease.
91. Which society provide guidelines on the use of endoscopy in the diagnosis and
management of IBD ?
I. Japanese Society for Gastrointestinal Endoscopy.
II. American Society for Gastrointestinal Endoscopy.
III. Spanish Society for Gastrointestinal Endoscopy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Guidelines on the use of endoscopy in the diagnosis and management of IBD are available from the
American Society for Gastrointestinal Endoscopy.
92. Which of the following type of enteroscopy is used foe diagnosis in IBD?
I. Capsule enteroscopy.
II. Tablet enteroscopy.
III. Double balloon enteroscopy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Enteroscopy
 Capsule enteroscopy
 Double balloon enteroscopy
93. Which of the following is true about capsule enteroscopy?
I. Deep small bowel enteroscopy.
II. Patient swallows an encapsulated video camera that transmits images to a receiver.
III. Used for finding obscure sources of gastrointestinal (GI) blood loss.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
In capsule enteroscopy, the patient swallows an encapsulated video camera that transmits images to a
receiver outside the patient. It is most commonly used for finding obscure sources of gastrointestinal
(GI) blood loss.
94. What is double balloon enteroscopy?

II. A technique whereby a long enteroscope is passed into the intestine using an overtube.
III. The patient swallows an encapsulated video camera.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Double balloon enteroscopy, or deep small bowel enteroscopy, is a technique whereby a long enteroscope
is passed into the intestine using an overtube.
95. What is the done in double balloon enteroscopy?
II. The endoscope is advanced in an "inchworm" fashion in intestine.
III. Both the endoscope and the overtube have balloons that can be inflated and deflated
sequentially.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Double balloon enteroscopy, or deep small bowel enteroscopy, is a technique whereby a long enteroscope
is passed into the intestine using an overtube. Both the endoscope and the overtube have balloons that
can be inflated and deflated sequentially as the endoscope is advanced in an "inchworm" fashion
96. What are observed in biopsy specimen of ulcerative colitis patient?

I. Neutrophilic infiltrate along with crypt abscesses.
II. Neutrophilic infiltrate along with crypt distortion.
III. Neutrophilic infiltrate along with granulomas.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Biopsy specimens demonstrate neutrophilic infiltrate along with crypt abscesses and crypt distortion.
Granulomas do not occur in ulcerative colitis
97. Which of the following statement are correct for severe case of ulcerative colitis?
I. A transmural involvement of the bowel wall by lymphoid infiltrates.
II. Pseudopolyps form, consisting of areas of hyperplastic growth with swollen mucosa.
III. Inflammation and necrosis can extend below the lamina propria.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
In more severe cases, pseudopolyps form, consisting of areas of hyperplastic growth with swollen mucosa
surrounded by inflamed mucosa with shallow ulcers. In severe ulcerative colitis, inflammation and
necrosis can extend below the lamina propria to involve the submucosa and the circular and
longitudinal muscles.
98. Which of the following statement are true for ulcerative colitis ?
I. It involves the mucosa and the submucosa, with formation of crypt abscesses and mucosal
ulceration.
II .The mucosa typically appears granular and friable.
III. A transmural involvement of the bowel wall by lymphoid infiltrates.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Ulcerative colitis primarily involves the mucosa and the submucosa, with formation of crypt abscesses
and mucosal ulceration. The mucosa typically appears granular and friable.
99. What is mean by backwash ileitis?
I. A transmural involvement of the bowel wall by lymphoid infiltrates.
II. When inflammation of the bowel wall almost entirely limited to the large bowel.
III. When the cecum is involved, there may be some inflammation in the distal-most ileum.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Ulcerative colitis is a superficial inflammation of the bowel wall almost entirely limited to the large
bowel (when the cecum is involved, there may be some inflammation in the distal-most ileum, the so-
called "backwash ileitis").
100. What are the characteristic pattern of inflammation observed during d iagnosis sample
of biopsy in crohn disease?
I. When the cecum is involved, there may be some inflammation in the distal-most ileum.
II. Proliferative changes in the muscularis mucosa and in the nerves scattered in the bowel wall and
myenteric plexus.
III. A transmural involvement of the bowel wall by lymphoid infiltrates that contains sarcoid like
granulomas.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The characteristic pattern of inflammation in Crohn disease is a transmural involvement of the bowel
wall by lymphoid infiltrates that contains sarcoidlike granulomas in about half of the cases (most
commonly in the submucosa). Also characteristic are proliferative changes in the muscularis mucosa
and in the nerves scattered in the bowel wall and myenteric plexus.
1. What is the goal of therapy given to IBD patient?

I. To recurrent esophagitis.
II. The achievement of remission (induction).
III. The prevention of disease flares (maintenance).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The 2 goals of therapy are the achievement of remission (induction) and the prevention of disease
flares (maintenance).
2. What is the serious complication of IBD, involving 40% of patients?

I. Osteoporosis.
II. Decreases the risk for fractures.
III. Increases the risk for fractures.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Osteoporosis is a very serious complication, involving 40% of patients with IBD, and increases the
risk for fractures
3. Which of the medication is used in step-I in stepwise therapy?
I. Aminosalicylate.
II. Antibiotics.
III. TNF Inhibitors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
STEP-I---aminosalicylates
4. What is the pharmacological use of aminosalicylates?

I. For treating flares of IBD.
II. To recurrent esophagitis.
III. For maintaining remission of IBD.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
All of the aminosalicylates are useful for treating flares of IBD and for maintaining remission
5. What are the potential side effect associated with antibiotics in IBD patients?
I. Nausea.
II. Anorexia.
III. Skin rashes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Antibiotics have potential adverse effects, including nausea, anorexia, diarrhea, and monilial
(candidal) infections.
6. What are the potential side effect associated with antibiotics in IBD patients?
I. Dyspnoea.
II. Diarrhea.
III. Monilial (candidal) infections.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Antibiotics have potential adverse effects, including nausea, anorexia, diarrhea, and monilial
(candidal) infections.
7. What are the potential complication associated with corticosteroids in IBD patient?
I. Fluid and electrolyte abnormalities.
II. Avascular bone necrosis.
III. Monilial (candidal) infections.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The potential complications of corticosteroid use include fluid and electrolyte abnormalities,
osteoporosis, avascular bone necrosis, peptic ulcers, cataracts, glaucoma, neurologic and endocrine
dysfunctions, infectious complications, and occasional psychiatric disorders (including psychosis).
8. What are the potential complication associated with corticosteroids in IBD patient ?
I. Cataracts and glaucoma.
II. Monilial (candidal) infections.
III. Neurologic and endocrine dysfunctions.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
9. What are the potential complication associated with corticosteroids in IBD patient?
I. Monilial (candidal) infections.
II. Occasional psychiatric disorders.
III. Peptic ulcers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
10. What are the adverse effect associated with immunomodulators in IBD Patient?
I. Pancytopenia.
II. Flulike symptoms.
III. Bone marrow depression.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Use of immune modifiers mandates monitoring of blood parameters; they can cause significant
neutropenia or pancytopenia
11. What are the adverse effect associated with immunomodulators in IBD Patient?
I. Flulike symptoms.
II. Hepatitis.
III. Pancreatitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Other adverse effects of the immune modifiers include fever, rash, infectious complications, hepatitis,
pancreatitis, and bone marrow depression. The most common reason for discontinuing the immune
modifiers within the first few weeks is the development of abdominal pain; occasionally, a
biochemically demonstrable pancreatitis occurs.
12. What are the adverse effect associated with infliximab in IBD Patient?
I. Lupus-like reactions.
II. Flulike symptoms.
III. Pancreatitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The adverse effects of infliximab are uncommon but can include hypersensitivity and flulike
symptoms; the latter can often be avoided by pretreatment with acetaminophen and
diphenhydramine. There have been rare reports of lupus-like reactions and lymphoproliferative
malignancies.
13. What are the adverse effect associated with infliximab in IBD Patient?
I. Hypersensitivity.
II. Pancreatitis.
III. Lymphoproliferative malignancies.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The adverse effects of infliximab are uncommon but can include hypersensitivity and flulike
symptoms; the latter can often be avoided by pretreatment with acetaminophen and
diphenhydramine. There have been rare reports of lupus-like reactions and lymphoproliferative
malignancies.
14. Clinical trial agents tend to be disease-specific, Which of the following is used?
I. Anti-adhesion molecules.
II. Anti cytokine therapies.
III. Antiemetics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Step IV Clinical Trial Agents

Clinical trial agents tend to be disease-specific (ie, an agent works for Crohn disease but not for
ulcerative colitis, or vice versa). These include anti-adhesion molecules and anticytokine therapies.[3]
In Crohn disease, additional agents include T-cell marker therapies and mesenchymal stem cells; in
ulcerative colitis, anti-inflammatory proteins
15. Clinical trial agents tend to be disease-specific, which of the following is studied
specifically for crohn disease?
I. T-cell marker therapies .
II. Anti-inflammatory proteins.
III. Mesenchymal stem cells.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

ulcerative colitis, or vice versa). These include anti-adhesion molecules and anticytokine therapies.[3]
In Crohn disease, additional agents include T-cell marker therapies and mesenchymal stem cells; in
16. Clinical trial agents tend to be disease-specific, which of the following is studied
specifically for ulcerative colitis ?
I. T-cell marker therapies.
II. Anti-inflammatory proteins.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

ulcerative colitis, or vice versa). These include anti-adhesion molecules and anticytokinetherapies.In
Crohn disease, additional agents include T-cell marker therapies and mesenchymal stem cells; in
17. Which therapy is used for early in the management of patient with refractory IBD ?
I. Step-down therapy.
II. DOT therapy.
III. FCFO therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Management of Refractory Disease

Step-down therapy should be considered early in the management of patients with difficult or
refractory disease.
18. Which of the following medications are used in step-down therapy in the management
of patient with refractory IBD ?
I. Immune modifiers.
II. Anti-TNF agents.
III. Anti emetics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Step-down therapy should be considered early in the management of patients with difficult or
refractory disease. This approach uses immune modifiers or anti-TNF agents
19. What is the typical dose of 6-MP or azathioprine used in step-down therapy in the
management of patient with refractory IBD ?
I. 1-2 kg/kg/day.
II. 1-2 mg/kg/day.
III. 1-2 g/kg/day.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The typical dosing of 6-MP or azathioprine is 1-2 mg/kg/day.
20. In what condition the immune modifiers are used in step-down therapy in the
management of patient with refractory IBD ?
I. If the disease is refractory to corticosteroid therapy.
II. If patients are corticosteroid dependent.
III. If patients are antibiotic dependent.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
If it is difficult to reduce the dose of corticosteroids, if the disease is refractory to corticosteroid therapy,
or if patients are corticosteroid dependent, the use of immune modifiers 6-MP or azathioprine should
be used.
21. Which out of the following indication consider for colectomy in ulcerative colitis ?
I. Intractable inflammation.
II. Intolerance to medical therapy.
III. If patients are antibiotic dependent.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The indications for colectomy are the following:

 Intractable inflammation
 Precancerous changes (high-grade dysplasia or proven multicentric, low-grade dysplasia
confirmed by 2 expert pathologists)
 Intolerance to medical therapy
22. Which out of the following indication consider for colectomy in ulcerative colitis ?
I. If patients are antibiotic dependent.
II. Toxic megacolon.
III. Perforation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The indications for colectomy are the following:

 Toxic megacolon
 Perforation
23. What are the commonly used surgical option for ulcerative colitis ?
I. Proctocolectomy with ileostomy.
II. Total proctocolectomy with ileoanal anastomosis.
III. Vagotomy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The surgical options for ulcerative colitis vary. Currently, the 2 most common choices are
proctocolectomy with ileostomy and total proctocolectomy with ileoanal anastomosis.
24. What is IPAA ?

I. Ileal pouch/anal anastomosis.
II. Ileal pouch/anal anatomy.
III. Ileal pouch/air anastomosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Ileal pouch/anal anastomosis (IPAA)

25. What is the main diet modification is consider for reduction of inflammation in persons
with Crohn disease
I. Nothing by mouth (NPO).
II. Nothing by IV.
III. Nothing by IM.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Unlike in patients with ulcerative colitis, diet can influence inflammatory activity in persons with
Crohn disease. Nothing by mouth (NPO) can hasten the reduction of inflammation
26. What should added in diet in case of vitamins B12 or vitamin D deficiency in patients
with IBD?
I. Multivitamin supplementation.
II. Liquid diet.
III. Low fiber diet.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Multivitamin supplementation is recommended in patients with IBD.[3] For patients with vitamins
B12 or vitamin D deficiency, supplementation of these vitamins should be given.
27. What level of 25-hydroxyvitamin D increased risk of surgery and IBD-related
hospitalization ?
I. Lower than 100 ng/ml.
II. Lower than 50 ng/ml.
III. Lower than 20 ng/ml.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Crohn disease patients with 25-hydroxyvitamin D levels lower than 20 ng/ml had an increased risk
of surgery and IBD-related hospitalization
28. What should added in diet in the IBD patient receiving steroids therapy ?
I. Vitamin D supplementation.
II. Vitamin C supplementation.
III. Calcium supplementation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Patients receiving steroid therapy should receive vitamin D and calcium supplementation.
29. Which out of the following agent is contraindicated in women considering pregnancy ?
I. Methotrexate (MTX).
II. Omeprazole.
III. Esomeprazole.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The only agent that is contraindicated in women considering pregnancy is methotrexate (MTX)
30. What adverse effect are demonstrated by methotrexate in in women considering

pregnancy ?
I. Abortion.
II .Teratogenic effect.
III. Child death.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The only agent that is contraindicated in women considering pregnancy is methotrexate (MTX),
which has demonstrated teratogenic effects. MTX should be discontinued 3 months prior to planned
conception.
31. What precaution should be taken for methotrexate in women considering pregnancy ?
I. MTX should be discontinued 3 months prior to planned conception.

II. MTX should be discontinued 3 months after to planned conception.
III. MTX should be continued 3 months to planned conception.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The only agent that is contraindicated in women considering pregnancy is methotrexate (MTX),
which has demonstrated teratogenic effects. MTX should be discontinued 3 months prior to planned
conception.
32. Which out of the following agent is contraindicated in men with IBD ?
I. Sulfasalazine.
II. Methotrexate (MTX).
III. Omeprazole.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
For men with IBD, sulfasalazine can decrease sperm counts and sperm motility, causing a functional
azoospermia
33. What side effects are observed in patient with IBD taken sulfasalazine ?
I. Decrease sperm counts and sperm motility.
II. Causing a functional azoospermia.
III. Increase sperm counts and sperm motility.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
For men with IBD, sulfasalazine can decrease sperm counts and sperm motility, causing a functional
azoospermia
34. Which out of the following drugs should be avoided during lactation in patient with
IBD ?
I. Antibiotics.
II. Immune modifiers.
III. Esomeprazole.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Immune modifiers are excreted in breast milk and should be considered only on a case-by-case basis;
either the immune modifier should be discontinued or the infant should be bottle fed.
Antibiotics (metronidazole [Flagyl], ciprofloxacin [Cipro]) should generally be avoided during
lactation, because they are excreted in breast milk; either breastfeeding or the drugs should be
discontinued. These agents are probably safe for fertility and during pregnancy.
35. How much percentage of patient require surgical intervention with ileocolonic Crohn
disease ?
I. Approximately 10% of patients.
II. Approximately 70% of patients.
III. Approximately 90% of patients.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Surgery for Crohn disease is most commonly performed in cases of complications of the disease (ie,
strictures, fistulas). Approximately 70% of patients with ileocolonic Crohn disease require surgical
intervention
36. How the diarrhea limits the activity in patient with IBD ?
I. Due to good toilet facilities.
II. Due the lack of immediate access to toilet facilities in many locations and/or occupations.
III. Due to dehydration.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
In most instances, diarrhea limits activity primarily because of the lack of immediate access to toilet
facilities in many locations and/or occupations. Dehydration may be an issue, often requiring IV
hydration or the use of oral rehydration solutions.
37. Which out of the following statement is correct for reproduction and pregnancy in IBD
patient ?
I. All of the aminosalicylates appear to be safe in men.
II. All of the aminosalicylate sand corticosteroids appear to be safe in women in all phases of
fertility, pregnancy, and lactation.
III. Men should avoid sulfasalazine during periods when they and their mates are attempting to
become pregnant.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Clinicians are advised to review the prescribing information for medications in women who are
attempting to conceive, are pregnant, or are breastfeeding.[106] All of the aminosalicylates
(sulfasalazine, mesalamine, olsalazine, balsalazide) and corticosteroids appear to be safe in women in
all phases of fertility, pregnancy, and lactation. Men should avoid sulfasalazine during periods when
they and their mates are attempting to become pregnant.
38. Which out of the following statement is correct for contraception taking women in IBD
?
I. There is no side effects associated with contraception in women with IBD.
II. Certain medications prescribed for rectal or genital use may adversely affect the efficacy of
condoms.
III. Who will undergo major elective surgery, should be discontinued for a minimum of 4 weeks
before the procedure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Advise women who have Crohn disease and small bowel disease and malabsorption that oral
contraception may have reduced effectiveness.[106] Additional contraception is recommended for
women on combined hormonal contraception who are also receiving antibiotic regimens for less than
3 weeks, as well as for 7 weeks following cessation of the antibiotic. Note that certain medications
prescribed for rectal or genital use may adversely affect the efficacy of condoms. [106] In addition,
consider whether contraceptive agents may have an effect on diseases associated with IBD (eg,
osteoporosis, venous thromboembolism, primary sclerosing cholangitis).
39. Which of the following statement is correct for hydrocortisone in IBD patient ?
I. Potent inhibitors of inflammation.
II. Increase gastric acid secretion.
III. Decrease gastric acid secretions.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Adrenocortical steroids act as potent inhibitors of inflammation. They may cause profound and varied
metabolic effects, particularly in relation to salt, water, and glucose tolerance, in addition to their
modification of the immune response of the body. Alternative adrenocortical steroids may be used in
equivalent dosage.
40. What are the cell mediated immune reactions ,which suppressed by cyclosporine ?
I. Increased hypersensitivity.
II. Experimental allergic encephalomyelitis.
III. Graft-versus-host disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Cyclosporine is a cyclic polypeptide that suppresses some humoral immunity and, to a greater extent,
cell-mediated immune reactions, such as delayed hypersensitivity, allograft rejection, experimental
allergic encephalomyelitis, and graft-versus-host disease.
41. What are the cell mediated immune reactions ,which suppresses by cyclosporine ?
I. Delayed hypersensitivity.
II. Increased hypersensitivity.
III. Allograft rejection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Cyclosporine is a cyclic polypeptide that suppresses some humoral immunity and, to a greater extent,
cell-mediated immune reactions, such as delayed hypersensitivity, allograft rejection, experimental
allergic encephalomyelitis, and graft-versus-host disease.
42. Which of the following drug is approved by FDA for both Crohn disease and ulcerative
colitis ?
I. Certolizumab.
II. Adalimumab.
III. Sucralfate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Adalimumab is a TNF blocking agent that has been FDA approved for both Crohn disease and
ulcerative colitis. It is administered by subcutaneous injection.
43. Which of the following statement is correct for adalimumab ?
I. Recombinant human immunoglobulin (Ig) G1 monoclonal antibody specific for human TNF.
II. Binds specifically to TNF-alpha and do the interaction with p55 and p75 cell-surface TNF
receptors.
III. Binds specifically to TNF-alpha and blocks the interaction with p55 and p75 cell-surface TNF
receptors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Adalimumab is recombinant human immunoglobulin (Ig) G1 monoclonal antibody specific for

human TNF. It binds specifically to TNF-alpha and blocks the interaction with p55 and p75 cell-
surface TNF receptors.
44. Which forms of dosage is used of certolizumab in treatment of crohn disease ?
I. Subcutaneous injection.
II. Orally.
III. Suppository.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Certolizumab is a TNF blocking agent that has been FDA approved for the treatment of Crohn
disease but not for ulcerative colitis. It is administered by subcutaneous injection.
45. Which of the following drug is approved by FDA only for crohn disease ?
I. Certolizumab.
II. Nizatidine.
III. Sucralfate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Certolizumab is a TNF blocking agent that has been FDA approved for the treatment of Crohn
disease but not for ulcerative colitis. It is administered by subcutaneous injection.
46. What is the mechanism of action of cimetidine ?
I. Increase gastric acid secretion, gastric volume, and hydrogen concentrations.
II. Inhibits histamine at the H2 receptor of the gastric parietal cells.
III. Reduced gastric acid secretion, gastric volume, and hydrogen concentrations.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Cimetidine inhibits histamine at H2 receptors of gastric parietal cells, which results in reduced gastric
acid secretion, gastric volume, and hydrogen concentrations.
47. What is the mechanism of action of nizatidine ?

I. Increase gastric acid secretion, gastric volume, and hydrogen concentrations.
II. Inhibits histamine at the H2 receptor of the gastric parietal cells.
III. Reduced gastric acid secretion, gastric volume, and hydrogen concentrations.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Nizatidine competitively inhibits histamine at the H2 receptor of the gastric parietal cells, resulting
in reduced gastric acid secretion, gastric volume, and hydrogen concentrations.
48. What is the mechanism of action of lansoprazole ?
I. Inhibition of the H+/K+-ATPase enzyme system.
II. Blocks the final step of acid production.
III. Decreasing gastric pH.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Lansoprazole suppresses gastric acid secretion by specific inhibition of the H+/K+-ATPase enzyme
system (ie, proton pump) at the secretory surface of the gastric parietal cell. It blocks the final step of
acid production. The effect is dose-related and inhibits both basal and stimulated gastric acid
secretion, thus increasing gastric pH.
49. What is the mechanism of action of pantoprazole ?

I. Inhibiting the H+/K+-ATPase enzyme system at the secretory surface of gastric parietal cells.
III. Supresses gastric acid secretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Pantoprazole suppresses gastric acid secretion by specifically inhibiting the H+/K+-ATPase enzyme
system at the secretory surface of gastric parietal cells.
50. What is the mechanism of action of rabeprazole sodium ?
I. Inhibiting the H+/K+-ATPase pump at gastric parietal cells.
III. Decrease gastric acid secretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Rabeprazole sodium decreases gastric acid secretion by inhibiting the parietal cell H+/K+-ATPase
pump.
51. What is the mechanism of action of esomeprazole ?

I. Inhibiting the H+/K+-ATPase enzyme system at the secretory surface of gastric parietal cells.
III. Inhibits gastric acid secretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Esomeprazole magnesium is an S-isomer of omeprazole. It inhibits gastric acid secretion by inhibiting

the H+/K+-ATPase enzyme system at the secretory surface of gastric parietal cells.
52. What is esomeprazole ?
I. S-isomer of omeprazole.
II. R-isomer of omeprazole.
III. T-isomer of omeprazole.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Esomeprazole magnesium is an S-isomer of omeprazole.
53. What is mechanism of action of hyoscyamine?

I. Increase the action of acetylcholine at parasympathetic sites in smooth muscle.
II. Blocks the action of acetylcholine at parasympathetic sites in secretory glands.
III. Blocks the action of acetylcholine at parasympathetic sites in the central nervous system.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Hyoscyamine blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory
glands, and the CNS, which, in turn, has antispasmodic effects.
54. When should the step III, constitute with immunomodulators is used in IBD patient ?
I. If proton pump inhibitors fail or are required for prolonged periods.
II. If the step I drugs fail to adequately control the IBD.
III. If corticosteroids fail or are required for prolonged periods.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Immune-modifying agents are step III drugs and are used if corticosteroids fail or are required for
prolonged periods; infliximab and adalimumab are also step III drugs
55. When should the step II, constitute with corticosteroids is used in IBD patient ?
I. If proton pump inhibitors fail or are required for prolonged periods.
II. If the step I drugs fail to adequately control the IBD.
III. If H2 antagonist fail or are required for prolonged periods.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Corticosteroids constitute the step II drugs, which are to be used if the step I drugs fail to adequately
control the IBD
56. What is the mechanism of action of balsalazide ?

I. Increase inflammation.
II. Blocking the production of arachidonic acid metabolites in colonic mucosa.
III. Decrease inflammation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Balsalazide is a prodrug 5-ASA connected to a 4-aminobenzoyl-(beta)-alanine carrier by an azo

bond; colonic bacteria break the azo bond, releasing the active 5-ASA. Metabolites of the drug may
decrease inflammation by blocking the production of arachidonic acid metabolites in colonic mucosa.
57. What is the mechanism of action of metronidazole antibiotics ?
I. Inhibits protein synthesis and causes cell death.
II. Increase protein synthesis and causes cell growth.
III. Causing a loss of helical DNA structure and strand breakage.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Metronidazole is a widely available, inexpensive antibiotic and antiprotozoal agent. This agent
inhibits protein synthesis and causes cell death in susceptible organisms by diffusing into the organism
and causing a loss of helical DNA structure and strand breakage.
58. What is the adverse effect of metronidazole in IBD patient ?

I. Dysgeusia.
II. Hypertension.
III. Neuropathy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Metronidazole's adverse-event profile includes headache, dysgeusia, and neuropathy.

59. What is the function of topoisomerase ?
I. Required for replication and transcription of genetic material.
II. Required for translation of genetic material.
III. Required for differentiation of genetic material.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Topoisomerases, which are required for replication, transcription, and translation of genetic material
60. What is the mechanism of action of ciprofloxacin ?

I. Inhibits bacterial DNA synthesis.
II. Increase bacterial DNA synthesis.
III. Inhibit growth by inhibiting DNA gyrase and topoisomerases.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Ciprofloxacin is a fluoroquinolone antibiotic .This agent inhibits bacterial DNA synthesis and,
consequently, growth by inhibiting DNA gyrase and topoisomerases
61. What is the pharmacological use of ciprofloxacin ?
I. Treatment of urinary infections.
II. Skin, and respiratory tract infections.
III. Lung infection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Ciprofloxacin is a fluoroquinolone antibiotic commonly used for the treatment of urinary, skin, and
respiratory tract infections.
62. What is the mechanism of action of rifampicin used in IBD ?

I. Increase RNA synthesis.
II. Binds to the beta-subunit of bacterial DNA-dependent RNA polymerase.
III. Inhibiting RNA synthesis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
It is a rifampin structural analog and it binds to the beta-subunit of bacterial DNA-dependent RNA
polymerase, thereby inhibiting RNA synthesis.
63. What are the complications are observed if steroids are given for maintaining IBD
remission ?
I. Acne.
II. Facial hair.
III. Skin whitening.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Do not use steroids for maintaining IBD remission, because of their lack of efficacy and potential
complications, including avascular necrosis, osteoporosis, cataracts, emotional lability, hypertension,
diabetes mellitus, cushingoid features, acne, and facial hair.
remission ?
I. Diabetes mellitus.
II. Malaria.
III. Cushingoid features.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
remission?
I. Avascular necrosis.
II. Emotional lability.
III. Cardiac heart failure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
66. What is the side effect associated with methylprednisolone in IBD patient ?
I. Saltwater-retention.
II. Impairs DNA synthesis.
III. Decrease surfactant synthesis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Methylprednisolone has a greater saltwater-retention side effect.

67. What are the adverse effect associated with dexamethasone in IBD patient ?
I. Decrease surfactant synthesis.
II. Increases serum vitamin A concentrations.
III. Inhibits prostaglandin and Proinflammatory cytokines.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Dexamethasone has many pharmacologic benefits, but there are also significant adverse effects. It
stabilizes cell and lysosomal membranes, increases surfactant synthesis, increases serum vitamin A
concentrations, and inhibits prostaglandin and proinflammatory cytokines.
68. The bioavailability of budesonide is only 10%, what is cause of it ?

I. First-pass metabolism.
II. Second-pass metabolism.
III. Third-pass metabolism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Budesonide alters the level of inflammation in tissues by inhibiting multiple types of inflammatory
cells and decreasing the production of cytokines and other mediators involved in inflammatory
reactions. Only 10% is bioavailable because of first-pass metabolism.
69. What is the mechanism of action of methotrexate?
I. Impairs DNA synthesis.
II. Induces the apoptosis and reduction in interleukin (IL)-1 production.
III. Induces the apoptosis and increase in interleukin (IL)-1 production.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Methotrexate impairs DNA synthesis and induces the apoptosis and reduction in interleukin (IL)-1
production. It is indicated for moderate to severe disease and maintenance of remission. The onset of
action is delayed.
70. What is the mechanism of action of 6-mercaptopurine ?

I. Inhibits DNA and RNA synthesis.
II. Causing cell proliferation to arrest.
III. Increase autoimmune activity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
6-Mercaptopurine is a purine analog that inhibits DNA and RNA synthesis, causing cell proliferation
to arrest.
71. What is the mechanism of action of azathioprine ?
I. Inhibits mitosis and cellular metabolism.
II. Antagonizing purine metabolism and inhibiting synthesis of DNA, RNA, and proteins.
III. Increase proliferation of immune cells and result in increase autoimmune activity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Azathioprine inhibits mitosis and cellular metabolism by antagonizing purine metabolism and
inhibiting synthesis of DNA, RNA, and proteins; these effects may decrease proliferation of immune
cells and result in lower autoimmune activity.
72. Which TNF inhibitor is FDA approved only for Crohn disease ?
I. Certolizumab.
II. Adalimumab.
III. Golimumab.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Infliximab and adalimumab are FDA approved for both Crohn disease and ulcerative colitis, whereas
certolizumab is FDA approved only for Crohn disease and golimumab only for ulcerative colitis.
73. Which TNF inhibitor is FDA approved only for ulcerative colitis ?
I. Certolizumab.
II. Adalimumab.
III. Golimumab.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
74. Which TNF inhibitor are FDA approved for both Crohn disease and ulcerative colitis ?
I. Infliximab and certolizumab.
II. Infliximab and adalimumab.
III. Infliximab and golimumab.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
75. Which out of the following drugs falls in class 5-Aminosalicylic Acid Derivatives ?
I. Sulfasalazine.
II. Mesalamine.
III. Rifaximin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
5-Aminosalicylic Acid Derivatives

 Sulfasalazine (Azulfidine, Azulfidine EN-tabs, Sulfazine, Sulfazine EC)
 Mesalamine (Asacol HD, Pentasa, Canasa, Rowasa, Lialda, Apriso, Delzicol)
76. Which out of the following drugs falls in class 5-Aminosalicylic Acid Derivatives ?
I. Rifaximin.
II. Balsalazide.
III. Olsalazine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
5-Aminosalicylic Acid Derivatives

 Balsalazide (Colazal, Giazo)
 Olsalazine (Dipentum)
77. Which out of the following drugs falls in class antibiotics ?
I. Ciprofloxacin.
II. Rifaximin.
III. Hydrocortisone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Antibiotics, Other
 Metronidazole (Flagyl, Flagyl ER, Metro)
 Ciprofloxacin (Cipro, Cipro XR)
 Rifaximin (Xifaxan)
78. Which out of the following drugs falls in class immunosuppressants ?

I. Prednisone.
II. Golimumab.
III. Hydrocortisone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Corticosteroids
 Hydrocortisone (Solu-Cortef, Cortef, A-Hydrocort )
 Prednisone (Rayos)
I. Methylprednisolone.
II. Prednisolone.
III. Golimumab.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Corticosteroids
 Methylprednisolone (Medrol, Solu-Medrol, Depo-Medrol, A-Methapred)
 Prednisolone (Orapred, Pediapred, Millipred, Veripred 20, Flo-Pred)

I. Cyclosporine.
II. Budesonide.
III. Dexamethasone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Corticosteroids
 Budesonide (Entocort EC)
 Dexamethasone (Baycadron, DoubleDex)
I. Methotrexate.
II. Golimumab.
III. Cyclosporine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Immunosuppressants
 Azathioprine (Imuran, Azasan)
 6-Mercaptopurine (Purinethol, Purixan)
 Methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo)
 Cyclosporine (Sandimmune, Neoral, Gengraf
82. Which out of the following drugs falls in class immunosuppressants?

I. Azathioprine.
II. 6-Mercaptopurine.
III. Golimumab.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Immunosuppressants
 Azathioprine (Imuran, Azasan)
 6-Mercaptopurine (Purinethol, Purixan)
 Methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo)
 Cyclosporine (Sandimmune, Neoral, Gengraf)
83. Which out of the following drugs falls in class TNF Inhibitors ?
I. Certolizumab pegol.
II. Natalizumab.
III. Golimumab.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
TNF Inhibitors
 Infliximab (Remicade)
 Adalimumab (Humira)
 Certolizumab pegol (Cimzia)
 Golimumab (Simponi, Simponi Aria)
84. Which out of the following drugs falls in class TNF Inhibitors ?
I. Natalizumab.
II. Infliximab.
III. Adalimumab.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
TNF Inhibitors
 Infliximab (Remicade)
 Adalimumab (Humira)
 Certolizumab pegol (Cimzia)
 Golimumab (Simponi, Simponi Aria)
85. What is the mechanism of action of vedolizumab ?
I. Blocks the interaction of α4β7 integrin with mucosal addressin cell adhesion molecule-1
(MAdCAM-1).
II. Inhibits the migration of memory T-lymphocytes across the endothelium.
III. Irreversible competitive blockers of histamines at the H2 receptors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Vedolizumab is a recombinant humanized monoclonal antibody that binds specifically to α4β7

integrin. It blocks the interaction of α4β7 integrin with mucosal addressin cell adhesion molecule-1
(MAdCAM-1) and inhibits the migration of memory T-lymphocytes across the endothelium into
inflamed gastrointestinal parenchymal tissue
86. What is natalizumab ?

I. A recombinant humanized IgG4-1C monoclonal antibody.
II. A recombinant humanized IgA4-1C monoclonal antibody.
III. A recombinant humanized IgM4-1C monoclonal antibody.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Natalizumab is a recombinant humanized IgG4-1C monoclonal antibody produced in murine

myeloma cells.
87. Which out of the following drugs falls in class alpha 4 Integrin Inhibitors ?
I. Natalizumab.
II. Famotidine.
III. Vedolizumab.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Alpha 4 Integrin Inhibitors

 Natalizumab (Tysabri)
 Vedolizumab (Entyvio)
88. What is the mechanism of action of H2-receptor antagonist ?

I. Reversible competitive blockers of histamines at the H2 receptors.
II. Irreversible competitive blockers of histamines at the H2 receptors.
III. Inhibit acid secretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
H2-receptor antagonists are reversible competitive blockers of histamines at the H2 receptors,

particularly those in the gastric parietal cells, where they inhibit acid secretion.
89. Which out of the following drugs falls in class histamine H2 antagonists ?
I. Famotidine.
II. Nizatidine.
III. Esomeprazole magnesium.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Histamine H2 Antagonists
 Cimetidine (Tagamet)
 Ranitidine (Zantac, DeprizineFusePaq)
 Famotidine (Pepcid)
 Nizatidine (Axid)
90. Which out of the following drugs falls in class histamine H2 antagonists ?
I. Esomeprazole magnesium.
II. Cimetidine.
III. Ranitidine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Histamine H2 Antagonists
 Cimetidine (Tagamet)
 Ranitidine (Zantac, DeprizineFusePaq)
 Famotidine (Pepcid)
 Nizatidine (Axid)
91. What is the mechanism of action of proton pump inhibitor ?
I. Inhibition of the H+ -K+ -ATPase enzyme system in the gastric parietal cells.
III. Reduce gastric acid secretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Proton pump inhibitors (PPIs) reduce gastric acid secretion by inhibition of the H + -K+ -ATPase
enzyme system in the gastric parietal cells. These agents are used in patients with severe esophagitis
and in patients whose disease is not responsive to H2-antagonist therapy.
92. Which out of the following drugs falls in class proton Pump Inhibitors?
I. Pantoprazole.
II. Dicyclomine.
III. Rabeprazole sodium.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Proton Pump Inhibitors

 Omeprazole (Prilosec)
 Lansoprazole (Prevacid)
 Esomeprazole magnesium (Nexium)
 Rabeprazole sodium (Aciphex)
 Pantoprazole (Protonix)
93. Which out of the following drugs falls in class proton Pump Inhibitors?
I. Omeprazole.
II. Lansoprazole.
III. Loperamide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Proton Pump Inhibitors

 Omeprazole (Prilosec)
 Lansoprazole (Prevacid)
 Esomeprazole magnesium (Nexium)
 Rabeprazole sodium (Aciphex)
 Pantoprazole (Protonix)
94. What is the pharmacological action of diphenoxylate and atropine drug combination?
I. Increase peristalsis and increase intestinal motility.
II. Prolongs the movement of electrolytes and fluid through the bowel.
III. Increases viscosity and loss of fluids and electrolytes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Diphenoxylate and atropine is a drug combination that acts as an antidiarrheal agent chemically
related to the narcotic analgesic meperidine. This agent acts on intestinal muscles to inhibit peristalsis
and slow intestinal motility by prolonging the movement of electrolytes and fluid through the bowel
and increasing viscosity and loss of fluids and electrolytes.
95. What is the pharmacological action of loperamide ?
I. Increase peristalsis and increase intestinal motility.
II. Prolongs the movement of electrolytes and fluid through the bowel.
III. Increases viscosity and loss of fluids and electrolytes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Loperamide acts on intestinal muscles to inhibit peristalsis and slow intestinal motility. It prolongs
the movement of electrolytes and fluid through the bowel and increases viscosity and loss of fluids and
electrolytes.
96. What is the pharmacological action of cholestyramine ?

I. Forms a absorbable complex with bile acids.
II. Reduces the induction of colonic fluid secretion.
III. Inhibits enterohepatic reuptake of intestinal bile salts.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Cholestyramine may be used to treat diarrhea associated with excess bile acids. It binds bile acids,
thus reducing damage to the intestinal mucosa. Cholestyramine also reduces the induction of colonic
fluid secretion and forms a nonabsorbable complex with bile acids in the intestine, which, in turn,
inhibits enterohepatic reuptake of intestinal bile salts.
97. Which out of the following drug combination acts as an antidiarrheal agent ?
I. Cholestyramine and atropine.
II. Dicyclomine and atropine.
III. Diphenoxylate and atropine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Diphenoxylate and atropine is a drug combination that acts as an antidiarrheal agent
98. Which out of the following drugs falls in class antidiarrhoeals?

I. Cholestyramine.
II. Loperamide.
III. Dicyclomine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Antidiarrheals
 Diphenoxylate and atropine (Lomotil)
 Loperamide (Imodium A-D, Diamode)
 Cholestyramine (Questran, Prevalite)
99. What is mechanism of action of dicyclomine ?
I. Increase the action of acetylcholine at parasympathetic sites in smooth muscle.
II. Blocks the action of acetylcholine at parasympathetic sites in secretory glands.
III. Blocks the action of acetylcholine at parasympathetic sites in the central nervous system.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Dicyclomine is used to treat gastrointestinal motility disturbances. It blocks the action of acetylcholine
at parasympathetic sites in secretory glands, smooth muscle, and the central nervous system (CNS).
100. Which out of the following drugs falls in class anticholinergic ?

I. Dicyclomine.
II. Hyoscyamine.
III. Loperamide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Anticholinergic, Antispasmodic Agents

 Dicyclomine (Bentyl)
 Hyoscyamine
GERD
1. What is GERD ?
I. Gastroesophageal reflux disease.
II. Gastroepithilial reflux disease.
III. Gastroesophageal reoder disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Gastroesophageal reflux disease ------GERD
2. What is occur in GERD ?

I. The amount of gastric juice that refluxes into the esophagus exceeds the normal limit.
II. Causing symptoms with or without associated esophageal mucosal injury.
III. Causing symptoms with or without associated epithelial injury.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Gastroesophageal reflux disease occurs when the amount of gastric juice that refluxes into the esophagus
exceeds the normal limit, causing symptoms with or without associated esophageal mucosal injury
3. What are the typical esophageal symptoms of GERD ?
I. Heartburn .
II. Regurgitation.
III. Uremia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Typical esophageal symptoms include the following:

Heartburn , Regurgitation , Dysphagia
4. What are the atypical (extra esophageal) symptoms caused by abnormal reflux in GERD
?
I. Hair fall.
II. Coughing and/or wheezing.
III. Hoarseness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Abnormal reflux can cause atypical (extraesophageal) symptoms, such as the following:
Coughing and/or wheezing , Hoarseness, sore throat , Otitis media
Noncardiac chest pain , Enamel erosion or other dental manifestations
?
I. Otitis media.
II. Hair fall.
III. Noncardiac chest pain.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
?
I. Enamel erosion.
II. Sore throat.
III. Hair fall.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
7. Which test are done to evaluate patients with suspected GERD ?
I. Upper gastrointestinal endoscopy.
II. Esophageal manometry.
III. Ambulatory 24-month pH monitoring.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The following studies are used to evaluate patients with suspected gastroesophageal reflux disease:
 Upper gastrointestinal endoscopy/esophagogastroduodenoscopy: Mandatory
 Esophageal manometry: Mandatory
 Ambulatory 24-hour ph monitoring: Criterion standard in establishing a diagnosis of
gastroesophageal reflux disease
8. Which imaging studies are done for diagnosis of GERD ?

I. Upper gastrointestinal contrast-enhanced studies.
II. Magnetic resonance imaging.
III. Chest images.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Upper gastrointestinal contrast-enhanced studies are the initial radiologic procedure of choice in the
workup gastroesophageal reflux disease. Chest images may also demonstrate a large hiatal hernia, but
small hernias can be easily missed.
9. What factors are included in the mechanism of esophageal defense mechanisms ?
I. Esophageal clearance.
II. Mucosal resistance.
III. Acid secretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Esophageal defense mechanisms can be broken down into 2 categories (ie, esophageal clearance and
mucosal resistance).
10. How is the esophageal clearance able to neutralize the acid refluxed through the lower
esophageal sphincter ?
I. Chemical clearance is achieved with acid.
II. Mechanical clearance is achieved with esophageal peristalsis.
III. Chemical clearance is achieved with saliva.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Esophageal clearance must be able to neutralize the acid refluxed through the lower esophageal
sphincter. (Mechanical clearance is achieved with esophageal peristalsis; chemical clearance is
achieved with saliva.)
11. What is lower esophageal sphincter (LES) ?
I. A zone of elevated intraluminal pressure at the esophagogastric junction.
II. A zone of elevated intraluminal pressure at the thoracic junction.
III. A zone of elevated intraluminal pressure at the duodenal junction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The lower esophageal sphincter (LES) is defined by manometry as a zone of elevated intraluminal
pressure at the esophagogastric junction.
12. What is transient relaxation in LES ?

I. Relaxation in the presence of swallowing.
II. Relaxation in the absence of swallowing.
III. Contraction in the absence of swallowing.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Transient relaxation (relaxation in the absence of swallowing).

13. What is the location of the junction for proper LES function ?
I. Located in the lower abdomen so that the diaphragmatic crura can assist the action of the LES.
II. Located in the abdomen so that the diaphragmatic crura can assist the action of the LES.
III. Functioning as an extrinsic sphincter.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
For proper LES function, this junction must be located in the abdomen so that the diaphragmatic
crura can assist the action of the LES, thus functioning as an extrinsic sphincter.
14. What are the different mechanism through which LES dysfunction occurs ?
I. Transient relaxation of the LES.
II. Permanent LES relaxation.
III. Transient decrease of intra-abdominal pressure that overcomes the LES pressure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
LES dysfunction occurs via one of several mechanisms: transient relaxation of the LES (most common
mechanism), permanent LES relaxation, and transient increase of intra-abdominal pressure that
overcomes the LES pressure.
15. What is the mechanism behind the delayed gastric emptying ?
I. Increase in gastric contents resulting in increased intragastric pressure.
II. Increased pressure against the LES, eventually defeats the LES and leads to reflux.
III. Decreased pressure against the LES, eventually defeats the LES and leads to reflux.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The postulated mechanism by which delayed gastric emptying may cause GERD is an increase in
gastric contents resulting in increased intragastric pressure and, ultimately, increased pressure against
the lower esophageal sphincter. This pressure eventually defeats the LES and leads to reflux
16. What is the mechanism behind the reflux occur due to hiatal hernia ?
I. LES may migrate proximally into the chest and the length of the HPZ may decrease.
II. LES increases its abdominal high-pressure zone (HPZ).
III. Diaphragmatic hiatus widened by a large hernia,so gastric contents trapped in the hernial sac.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Buttar and coworkers state that a hiatal hernia may contribute to reflux via a variety of mechanisms
The lower esophageal sphincter may migrate proximally into the chest and lose its abdominal high-
pressure zone (HPZ), or the length of the HPZ may decrease. The diaphragmatic hiatus may be
widened by a large hernia, which impairs the ability of the crura to function as an external sphincter.
Finally, gastric contents may be trapped in the hernial sac and reflux proximally into the esophagus
during relaxation of the LES.
17. What are the risk factors associated with GERD patient ?
I. Weight loss.
II. Morbidly obese.
III. High body mass index (BMI).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Some studies have shown that GERD is highly prevalent in patients who are morbidly obese
and that a high body mass index (BMI) is a risk factor for the development of this condition
18. What is the mechanism by which a high BMI increases esophageal acid exposure ?
I. Increased intragastric pressure and gastroesophageal pressure.
II. Incompetence of the lower esophageal sphincter (LES).
III. Decreased frequency of transient LES relaxations.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The mechanism by which a high BMI increases esophageal acid exposure is not completely understood.
Increased intragastric pressure and gastroesophageal pressure gradient, incompetence of the lower
esophageal sphincter (LES), and increased frequency of transient LES relaxations may all play a role
in the pathophysiology of GERD in patients who are morbidly obese.
19. What is the etiologic effector of GERD ?
I. Excessive anterograde movement of acid-containing gastric secretions from the stomach into the
esophagus.
II. Excessive retrograde movement of acid-containing gastric secretions from the stomach into the
esophagus.
III. Excessive retrograde movement of bile and acid-containing secretions from the duodenum
into the esophagus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Excessive retrograde movement of acid-containing gastric secretions or bile and acid-containing

secretions from the duodenum and stomach into the esophagus is the etiologic effector of GERD.
20. What are the food related factor causes the transient relaxation of LES ?
I. Green vegetables.
II. Coffee and alcohol.
III. Chocolate and fatty meals.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Transient relaxation of the LES can be caused by foods (coffee, alcohol, chocolate, fatty meals),
medications (beta-agonists,[17] nitrates, calcium channel blockers, anticholinergics), hormones (eg,
progesterone), and nicotine.
21. Which of the following medications causes the transient relaxation of LES ?
I. Beta-agonists.
II. Nitrates.
III. Sulphonamides.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
22. Which of the following medications causes the transient relaxation of LES ?
I. Calcium channel blockers.
II. Antibacterial.
III. Anticholinergics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
23. Which of the following factors causes the transient relaxation of LES ?
I. Progesterone Hormone.
II. Nicotine.
III. Green vegetables.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
24. What are the other signs observed in patients typically have numerous daily episodes of
symptomatic reflux ?
I. Pyrosis.
II. Sour taste in the mouth.
III. Diptheria.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Patients typically have numerous daily episodes of symptomatic reflux, including pyrosis, water brash
or sour taste in the mouth, nighttime coughing or aspiration, pneumonia or pneumonitis,
bronchospasm, and laryngitis and voice changes, including hoarseness.
I. Diptheria.
II. Night-time coughing.
III. Bronchospasm.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
I. Laryngitis.
II. Constipation.
III. Voice changes, including hoarseness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
27. What are three parts included in anatomy of esophagus ?
I. Cervical, thoracic, and abdominal.
II. Eye , nose and throat.
III. Stomach ,liver and duodenum.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The esophagus is divided into 3 parts: cervical, thoracic, and abdominal.
28. What is the anatomy of the body of the esophagus ?

I. Made up of inner circular muscular layers.
II. Made up of outer longitudinal muscular layers.
III. Made up of outer horizontal muscular layers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The body of the esophagus is made up of inner circular and outer longitudinal muscular layers.
29. The upper esophageal sphincter in proximal esophagus comprises of which muscles ?
I. Zygomatic muscles.
II. Cricopharyngeus muscles.
III. Thyreopharyngeus muscles.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The proximal esophagus contains the upper esophageal sphincter (UES), which comprises the
cricopharyngeus and thyropharyngeus muscles.
30. Which part of diaphragm form the esophageal hiatus ?

I. Anterior of diaphragm.
II. Right crus of the diaphragm.
III. Left crus of the diaphragm.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
As the thoracic esophagus enters the abdomen through the esophageal hiatus in the diaphragm, it
becomes the abdominal esophagus. The hiatus is formed by the right crus of the diaphragm
31. What forms the angle of HIS ?
I. The esophagogastric junction lies in the abdomen.
II. The gastric duodenal junction lies in the abdomen.
III. The pancreatic junction lies in the abdomen.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Esophagogastric junction lies in the abdomen and forms the angle of His.
32. What are the different education resources for GERD patient ?
I. Heartburn and GERD Center.
II. Gastroesophageal Acid Reflux (GERD) FAQs.
III. Digestive center.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
For excellent patient education resources, visit the Heartburn and GERD Center. Also, see the patient
education articles Reflux Disease (GERD), Gastroesophageal Acid Reflux (GERD) faqs, and
Heartburn and GERD Medications
33. What are the different education resources for GERD patient ?
I. Digestive center.
II. Heartburn and GERD Medications.
III. Reflux Disease (GERD) article.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
For excellent patient education resources, visit the Heartburn and GERD Center. Also, see the patient
education articles Reflux Disease (GERD), Gastroesophageal Acid Reflux (GERD) faqs, and
Heartburn and GERD Medications
34. What is heartburn ?

I. A retrosternal sensation of burning or discomfort.
II. Usually occurs after eating or when lying supine or bending over.
III. Burning of heart.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Heartburn is the most common typical symptom of GERD. It is felt as a retrosternal sensation of
burning or discomfort that usually occurs after eating or when lying supine or bending over.
35. What is regurgitation ?
I. An effortless return of gastric contents into the pharynx.
II. An effortless return of esophageal contents into the pharynx.
III. An effortless return of gastric contents into the Stomach.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Regurgitation is an effortless return of gastric and/or esophageal contents into the pharynx
36. What is dysphagia ?

I. A sensation that food is stuck, particularly in the stomach area.
II. A sensation that food is stuck, particularly in the tracheal area.
III. A sensation that food is stuck, particularly in the retrosternal area.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Patients with dysphagia experience a sensation that food is stuck, particularly in the retrosternal area.
37. What are the complication of GERD ?
I. Esophagitis.
II. Stricture.
III. Facture.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Complications of Disease
Esophagitis , Stricture , Barrett esophagus
38. What are the complication of GERD ?

I. Facture.
II. Barrett esophagus.
III. Esophagitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Complications of Disease
Esophagitis , Stricture , Barrett esophagus
39. Who describes the various degrees of esophagitis ?
I. Savary-Miller.
II. Stein and co-workers.
III. Kahrilas.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Degrees of esophagitis are described by the Savary-Miller classification as follows.

 Grade I Erythema
 Grade II Linear nonconfluent erosions
 Grade III Circular confluent erosions
 Grade IV Stricture or Barrett esophagus
40. What is the grade I type of esophagitis described by the Savary-Miller classification ?
I. Erythema.
II. Linear non confluent erosions.
III. Circular confluent erosions.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A

41. What is the grade II type of esophagitis described by the Savary-Miller classification ?
I. Erythema.
II. Linear nonconfluent erosions.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

42. What is the grade III type of esophagitis described by the Savary-Miller classification ?
I. Erythema.
II. Linear nonconfluent erosions.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C

43. What is the grade IV type of esophagitis described by the Savary-Miller classification ?
I. Linear nonconfluent erosions.
II. Stricture or Barrett esophagus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

44. What is the most serious complication of long-standing or severe GERD ?

I. Development of Barrett esophagus.
II. Development of stricture.
III. Development of esophagitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The most serious complication of long-standing or severe GERD is the development of Barrett
esophagus.
45. How many percentage of GERD patient develop barrett esophagus ?
I. 1-2%.
II. 8-15%.
III. 60-80%.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Barrett esophagus is present in 8-15% of patients with GERD.
46. What is the cause of barrett esophagus ?

I. Chronic reflux of gastric juice into the esophagus.
II. Chronic reflux of saliva into the esophagus.
III. Chronic reflux of blood into the esophagus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Barrett esophagus is thought to be caused by the chronic reflux of gastric juice into the esophagus
47. What mechanism occur in barrett esophagus ?
I. Metaplastic conversion of the normal distal squamous esophageal epithelium to columnar
epithelium.
II. Metaplastic conversion of the columnar epithelium to normal distal squamous esophageal
epithelium.
III. Metaplastic conversion of the normal distal squamous pharyngeal epithelium to columnar
epithelium.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
It is defined by metaplastic conversion of the normal distal squamous esophageal epithelium to

columnar epithelium
48. What is the risk factor associated with barrett esophagus ?

I. Esophageal adenocarcinoma.
II. Renal cell carcinoma.
III. Hepatocellular carcinoma.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Barrett esophagus with intestinal type metaplasia has malignant potential and is a risk factor for the
development of esophageal adenocarcinoma
49. What are the different approaches consider for GERD ?
I. Upper Gastrointestinal Endoscopy.
II. Esophageal Manometry.
III. Spirometry.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Approach considerations
Upper gastrointestinal endoscopy , esophageal manometry
Ambulatory 24-hour pH. monitoring , imaging in gastroesophageal reflux disease
Nuclear medicine gastric emptying study , intraluminal esophageal electrical impedance

I. Spirometry.
II. Ambulatory 24-Hour pH Monitoring.
III. Imaging in Gastroesophageal Reflux Disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Ambulatory 24-hour ph monitoring , imaging in gastroesophageal reflux disease
I. Nuclear Medicine Gastric Emptying Study.
II. Ambulatory 24-month pH Monitoring.
III. Intraluminal Esophageal Electrical Impedance.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Ambulatory 24-hour ph monitoring , imaging in gastroesophageal reflux disease
52. What is the goal of treatment for the management of GERD ?

I. To do esophagitis.
II. To control symptoms.
III. To heal esophagitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The goals are to control symptoms, to heal esophagitis, and to prevent recurrent esophagitis or other
complications.
53. What is the goal of the treatment of gastroesophageal reflux disease (GERD) ?
II. To prevent recurrent esophagitis.
III. To do esophagitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
complications.
54. What are the factors on which treatment of GERD depends ?

I. Lifestyle modification.
II. Control of gastric acid secretion.
III. Increase of gastric acid secretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The treatment is based on lifestyle modification and control of gastric acid secretion through medical
therapy with antacids or proton pump inhibitors or surgical treatment with corrective antireflux
surgery
55. What are the life style modification used in treatment of GERD ?
I. Losing weight (if overweight).
II. Avoiding alcohol, chocolate, citrus juice.
III. Waiting 3 minutes after a meal before lying down.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Lifestyle modifications include the following:

 Losing weight (if overweight)
 Avoiding alcohol, chocolate, citrus juice, and tomato-based products (2005 guidelines
from the American College of Gastroenterology [ACG] also suggest avoiding peppermint,
coffee, and possibly the onion family [7] )
 Avoiding large meals
 Waiting 3 hours after a meal before lying down
 Elevating the head of the bed 8 inches
I. Weight gain.
II. Avoiding large meals.
III. Waiting 3 hours after a meal before lying down.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

57. Which type of food products should be avoided in the case of GERD ?
I. Citrus juice.
II. Tomato-based products.
III. Milk products.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Avoiding alcohol, chocolate, citrus juice, and tomato-based products (2005 guidelines from the
American College of Gastroenterology [ACG] also suggest avoiding peppermint, coffee, and
possibly the onion family
I. Avoiding alcohol, chocolate.
II. Avoiding milk shakes.
III. Avoiding peppermint, coffee.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Avoiding alcohol, chocolate, citrus juice, and tomato-based products (2005 guidelines from
the American College of Gastroenterology [ACG] also suggest avoiding peppermint, coffee,
and possibly the onion family
59. Which medication is used as pharmacotherapy for the management of GERD ?
I. H2 receptor antagonists.
II. Proton pump inhibitors.
III. Ca+2 channel blockers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Pharmacotherapy
The following medications are used in the management of gastroesophageal reflux disease:
 H2 receptor antagonists (eg, ranitidine, cimetidine, famotidine, nizatidine)
 Proton pump inhibitors (eg, omeprazole, lansoprazole, rabeprazole, esomeprazole,
pantoprazole)
 Prokinetic agents (eg, aluminum hydroxide)
 Antacids (eg, aluminum hydroxide, magnesium hydroxide)
60. Which drugs are used as pharmacotherapy for the management of GERD ?
I. Magnesium hydroxide.
II. lansoprazole.
III. Sucralfate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The following medications are used in the management of gastroesophageal reflux disease:
 H2 receptor antagonists (eg, ranitidine, cimetidine, famotidine, nizatidine)
 Proton pump inhibitors (eg, omeprazole, lansoprazole, rabeprazole, esomeprazole,
pantoprazole)
 Prokinetic agents (eg, aluminum hydroxide)
 Antacids (eg, aluminum hydroxide, magnesium hydroxide)
61. What are the surgical options for the management of GERD ?
I. Vagotomy.
II. Transthoracic and transabdominal fundoplications.
III. Partial (anterior or posterior) and circumferential wraps.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Transthoracic and transabdominal fundoplications are performed for gastroesophageal reflux disease,
including partial (anterior or posterior) and circumferential wraps. Open and laparoscopic techniques
may be used.
62. A patient with cardiac conduction defects and GERD ,indicate which of the following
management is used ?
I. Lifestyle management.
II. Fundoplication.
III. Medication.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Indications for fundoplication include the following:

 Patients with cardiac conduction defects
63. Which out of the following are the indication for fundoplication ?
I. Presence of Barrett esophagus.
II. Presence of extraesophageal manifestations.
III. Pregnant women.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 The presence of Barrett esophagus
 The presence of extraesophageal manifestations
 Postmenopausal women with osteoporosis
64. Which out of the following are the indication for fundoplication ?
I. Pregnant women.
II. Poor patient compliance with regard to medications.
III. Postmenopausal women with osteoporosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Poor patient compliance with regard to medications
65. Which out of the following component decreases clearance of acidic material ?
I. Poor esophageal motility.
II. A dysfunctional LES.
III. Delayed gastric emptying.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Poor esophageal motility decreases clearance of acidic material.
66. Which out of the following component allows reflux of large amounts of gastric juice ?
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
A dysfunctional LES allows reflux of large amounts of gastric juice.

67. Which out of the following component increase volume and pressure in the reservoir in
GERD patient ?
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Delayed gastric emptying can increase volume and pressure in the reservoir until the valve mechanism
is defeated, leading to GERD.
68. How the obesity increase the prevalence of GERD and its complications ?
I. Decreased BMI.
II. Increases esophageal acid exposure.
III. Increased BMI.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The hypothesis that obesity increases esophageal acid exposure is supported by the documentation of a
dose-response relationship between increased BMI and increased prevalence of GERD and its
complications.
69. What are the typical symptoms observed in patient with GERD ?
I. Heartburn.
II. Regurgitation.
III. Aspiration.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Patients with GERD can exhibit various symptoms, both typical and atypical. Typical symptoms
include heartburn, regurgitation, and dysphagia.
70. What are the typical symptoms observed in patient with GERD ?
I. Aspiration.
II. Dysphagia.
III. Hoarseness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Patients with GERD can exhibit various symptoms, both typical and atypical. Typical symptoms
include heartburn, regurgitation, and dysphagia.
71. What are the atypical symptoms observed in patient with GERD ?
I. Noncardiac chest pain.
II. Dysphagia.
III. Asthma.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Atypical symptoms include noncardiac chest pain, asthma, pneumonia, hoarseness, and aspiration
I. Pneumonia.
II. Hoarseness.
III. Dysphagia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
I. Asthma.
II. Regurgitation.
III. Aspiration.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
74. Which of the following are to be considered essential before performing an antireflux
operation ?
I. Esophageal manometry.
II. pH monitoring.
III. Medication.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Esophageal manometry and ph monitoring are considered essential before performing an antireflux
operation.
75. Which out of the following laboratory test should perform to distinguish achalasia from
GERD ?
I. Esophageal manometry.
II. pH monitoring.
III. Blood test.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Only esophageal manometry and ph monitoring can be used to distinguish achalasia from GERD
76. Which factors are contribute to the normal closure of the esophagus when intragastric
and intra-abdominal pressures are high ?
I. Acute angle of abdominal esophagus.
II. The length of abdominal esophagus.
III. The length of abdominal stomach.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The acute angle and the length of abdominal esophagus both contribute to the normal closure of the
esophagus when intragastric and intra-abdominal pressures are high.
77. Which of the following statements about esophageal anatomy is correct ?
I. The esophageal serosa consist of thin layer of fibroareolar tissue.
II. The esophageal has poor blood supply.
III. The esophagus is made up of inner circular and outer longitudinal muscular layers. Which are
striated in proximal third and smooth in the distal two thirds.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The body of the esophagus is made up of inner circular and outer longitudinal muscular layers. The
proximal third of the esophagus is striated muscle, which transitions to smooth muscle in the distal
two thirds
78. Which out of the following statement are true about the blood supply of esophagus ?
I. The blood supply of the esophagus is segmental.
II. The inferior thyroid artery supplies the cervical esophagus.
III. The inferior thyroid artery supplies the abdominal esophagus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The blood supply of the esophagus is segmental (see the image below). The inferior thyroid artery
supplies the cervical esophagus.
79. Which branches supply blood to the proximal and distal thoracic esophagus ?
I. Branches of the bronchial arteries to proximal thoracic esophagus.
II. Branches directly off of the aorta supply the distal thoracic esophagus.
III. Branches directly off of the aorta supply the proximal thoracic esophagus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Branches of the bronchial arteries and branches directly off of the aorta supply the proximal and distal
thoracic esophagus, respectively.
80. What is correct about the blood supply of lesser curve of stomach ?
I. Blood supplied by the left and right gastric arteries.
II. Blood supplied by branches of the celiac trunk and proper hepatic artery.
III. Blood supplied supplied by the right gastroepiploic artery.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The blood supply of the stomach is rich, with overlap among the vessels. The lesser curve is supplied
by the left and right gastric arteries, branches of the celiac trunk and proper hepatic artery, respectively.
81. What is correct about the blood supply of greater curve of stomach ?
I. Blood supplied by branches of the celiac trunk and proper hepatic artery.
II. Blood supplied by the right and left gastroepiploic artery.
III. Blood supplied by the short gastric arteries originating from the splenic artery.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The greater curve is supplied by the right gastroepiploic artery arising from the gastroduodenal artery
and the left gastroepiploic artery and the short gastric arteries originating from the splenic artery.
82. What is/are true about the epidemiology of GERD ?

I. GERD is as common in men as in women.
II. The male-to-female incidence ratio for esophagitis is 2: 1-3: 1.
III. The female-to-male incidence ratio for esophagitis is 2: 1-3: 1.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
GERD is as common in men as in women. However, the male-to-female incidence ratio for
esophagitis is 2: 1-3: 1.
83. What is/are true about the epidemiology of Barrett esophagus ?
I. The male-to-female incidence ratio for Barrett esophagus is 10: 1.
II. The male-to-female incidence ratio for Barrett esophagus is 2: 1-3: 1.
III. White males are at a greater risk for Barrett esophagus and adenocarcinoma than other
populations.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The male-to-female incidence ratio for Barrett esophagus is 10: 1. White males are at a greater risk
for Barrett esophagus and adenocarcinoma than other populations.
84. Which of the following statements is/ are true concerning test available for investigation
of esophageal disease ?
I. A 24-hour pH monitoring is the criterion standard in establishing a diagnosis of GERD.

II. A 24-hour conductivity monitoring is the standard in establishing a diagnosis of GERD.
III. The Bernstein test is used in diagnosis of acid reflux disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Ambulatory 24-hour pH. monitoring is the criterion standard in establishing a diagnosis of GERD
85. What is the LOTUS trial ?
I. A 10-year, exploratory randomized, open, parallel-group trial.
II. A 5-year, exploratory randomized, open, parallel-group trial.
III. Demonstrated that with antireflux therapy for GERD.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The LOTUS trial a 5-year, exploratory randomized, open, parallel-group trial demonstrated
that with antireflux therapy for GERD, either using drug-induced acid suppression with esomeprazole
or laparoscopic antireflux surgery, most patients achieve remission and remain in remission at 5 years
86. What symptoms alert the physician to evaluate for delayed gastric emptying ?
I. Nausea and vomiting.
II. Regurgitation.
III. Dyspepsia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
A history of nausea, vomiting, or regurgitation should alert the physician to evaluate for delayed gastric
emptying.
87. What is true about the hoarseness?
I. Irritation of the vocal cords by gastric refluxate.
II. Is often experienced by patients in the evening.
III. Is often experienced by patients in the morning.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Hoarseness results from irritation of the vocal cords by gastric refluxate and is often experienced by
patients in the morning.
88. What is true about strictures ?

I. Advanced forms of esophagitis.
II. Caused by circumferential fibrosis due to chronic deep injury.
III. Increase the length of esophagus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Strictures are advanced forms of esophagitis and are caused by circumferential fibrosis due to chronic
deep injury
89. Which of the following measures of obesity correlates best with mortality ?
I. Body mass index (BMI).
II. Skinfold thickness.
III. Waist to hip ratios.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Some studies have shown that GERD is highly prevalent in patients who are morbidly obese and that
a high body mass index (BMI)
90. What is indications for esophageal manometry and prolonged pH monitoring in GERD
patient ?
I. Persistence of symptoms while taking adequate antisecretory therapy.
II. Recurrence of symptoms after discontinuation of acid-reducing medications.
III. Recurrence of symptoms after continuation of acid-reducing medications.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Indications for esophageal manometry and prolonged pH. monitoring include the following:
 Persistence of symptoms while taking adequate antisecretory therapy, such as PPI therapy
 Recurrence of symptoms after discontinuation of acid-reducing medications
91. What is indications for esophageal manometry and prolonged pH monitoring in GERD
patient ?
I. Investigation of atypical symptoms, such as chest pain or asthma, in patients without esophagitis.
II. Investigation of atypical symptoms, such as chest pain or asthma, in patients with esophagitis.
III. Confirmation of the diagnosis in preparation for antireflux surgery.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Indications for esophageal manometry and prolonged pH. monitoring include the following:
 Investigation of atypical symptoms, such as chest pain or asthma, in patients without
esophagitis
 Confirmation of the diagnosis in preparation for antireflux surgery
92. Why 24-hour pH monitoring is the criterion standard in establishing a diagnosis of

GERD ?
I. A sensitivity of 50% and a specificity of 95%.
II. A sensitivity of 96% and a specificity of 95%.
III. A sensitivity of 96% and a specificity of 40%.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Ambulatory 24-hour pH. monitoring is the criterion standard in establishing a diagnosis of GERD,
with a sensitivity of 96% and a specificity of 95%.
93. What is true about the ambulatory 24-hour pH monitoring ?
I. A sensitivity of 50% and a specificity of 40%.
II. Quantifies the gastroesophageal reflux.
III. Allows a correlation between the symptoms of reflux and the episodes of reflux.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Ambulatory 24-hour ph monitoring ,It quantifies the gastroesophageal reflux and allows a correlation
between the symptoms of reflux and the episodes of reflux.
94. Which out of the following defects are detected with single-contrast techniques?
I. Hiatal hernias.
II. Strictures or esophageal rings.
III. Neoplastic diseases.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Single-contrast techniques are more sensitive for structural defects such as hiatal hernias and strictures
or esophageal rings.[27]
95. What is esophageal manometry ?
I. Defines the function of the LES.
II. Defines the function of the esophageal body (peristalsis).
III. Defines the function of the Lung.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Esophageal manometry defines the function of the LES and the esophageal body (peristalsis).
96. Which out of the following are detected with double-contrast techniques?
I. COPD.
II. Esophageal inflammatory.
III. Neoplastic diseases.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Esophageal inflammatory and neoplastic diseases are better detected with double-contrast techniques
97. Which out of the following are evaluate by gastroesophageal reflux scintigraphy ?
I. Pulmonary aspiration.
II. Degree of reflux.
III. PUD.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Gastroesophageal reflux scintigraphy is much more commonly used evaluating the degree of reflux,
pulmonary aspiration can be detected by imaging over the lungs.
98. How can gastroesophageal reflux scintigraphy be performed ?

I. Performed with acidified orange juice.
II. Using labeled technetium-99m sulfur colloid.
III. Using labeled Cobalt-60m sulfur colloid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Gastroesophageal reflux scintigraphy can be performed with acidified orange juice labeled with
technetium-99m sulfur colloid.
99. What is EEI ?
I. Esophageal electrical importance.
II. Intraluminal esophageal electrical impedance.
III. Intraluminal esophageal electrical impotence.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Intraluminal esophageal electrical impedance (EEI), a newer test, is useful for detecting both acid
reflux and nonacid reflux by measuring retrograde flow in the esophagus.
100. How is intraluminal esophageal electrical impedance useful for detecting both acid
reflux and nonacid reflux ?
I. By measuring Ph of gastric juice.
II. By measuring anterograde flow in the esophagus.
III. By measuring retrograde flow in the esophagus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Intraluminal esophageal electrical impedance (EEI), a newer test, is useful for detecting both acid
reflux and nonacid reflux by measuring retrograde flow in the esophagus.

I. To do esophagitis.
II. To control symptoms.
III. To heal esophagitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
complications.
II. To prevent recurrent esophagitis.
III. To do esophagitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
complications.
3. What are the factors on which treatment of GERD depends ?
II. Control of gastric acid secretion.
III. Increase of gastric acid secretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The treatment is based on (1) lifestyle modification and (2) control of gastric acid secretion through
medical therapy with antacids or PPIs or surgical treatment with corrective antireflux surgery
4. What are the major approaches to treat the GERD ?
I. Medical therapy with antacids.
III. Vagotomy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
5. What are the major approaches to treat the GERD ?

I. Tubectomy.
II. Vagotomy.
III. Surgical treatment with corrective antireflux surgery.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
I. Losing weight (if overweight).
II. Avoiding alcohol, chocolate, citrus juice.
III. Waiting 3 minutes after a meal before lying down.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D


I. Weight gain.
II. Avoiding large meals.
III. Waiting 3 hours after a meal before lying down.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E


I. Citrus juice.
II. Tomato-based products.
III. Milk products.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

I. Avoiding alcohol, chocolate.
II. Avoiding milk shakes.
III. Avoiding peppermint, coffee.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
10. What is posture should adopt in the lifestyle of GERD patient during sleep ?
I. Elevating the head of the bed 8 inches.
II. Elevating the hair of the bed 8 inches.
III. Elevating the head of the bed 20 inches.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Lifestyle modifications include the following: Elevating the head of the bed 8 inches
11. Which out of the following pharmacologic therapy are used for the treatment of GERD
?
I. Antacids.
II. Antibiotics.
III. H2 receptor antagonists and H2 blocker therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Pharmacologic Therapy ------Antacids , H2 receptor antagonists and H2 blocker therapy

Proton pump inhibitors , Prokinetic medications and reflux inhibitors
Indications for Surgical Treatment
?
I. Beta blockers.
III. Prokinetic medications and reflux inhibitors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Pharmacologic Therapy--------Antacids , H2 receptor antagonists and H2 blocker therapy

?
I. Antibiotics.
II. Surgical Treatment.
III. Beta blockers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Pharmacologic Therapy-----Antacids , H2 receptor antagonists and H2 blocker therapy

14. Which out of the following drugs are include in the class H2 receptor antagonists for
GERD patient ?
I. Ranitidine.
II. Sucralfate.
III. Cimetidine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
H2 receptor antagonists are the first-line agents for patients with mild to moderate symptoms and
grades I-II esophagitis. Options include ranitidine (Zantac), cimetidine (Tagamet), famotidine
(Pepcid), and nizatidine (Axid).
15. Which out of the following drugs are include in the class H2 receptor antagonists for
GERD patient ?
I. Famotidine.
II. Nizatidine.
III. Omeprazole.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
grades I-II esophagitis. Options include ranitidine (Zantac), cimetidine (Tagamet), famotidine
(Pepcid), and nizatidine (Axid).
16. What is the side effect of long term use of H2 receptor antagonists ?
I. Bradycardia.
II. Tachycardia.
III. Tachyphylaxis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
H2 receptor antagonists are effective for healing only mild esophagitis in 70-80% of patients with
GERD and for providing maintenance therapy to prevent relapse. Tachyphylaxis has been observed,
suggesting that pharmacologic tolerance can reduce the long-term efficacy of these drugs.
17. What is the reason behind the tachyphylaxis which has been observed the long-term
efficacy of H2 receptor antagonists ?
I. Reduce in pharmacologic tolerance.
II. Increase in pharmacologic tolerance.
III. Stop pharmacologic tolerance.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
H2 receptor antagonists are effective for healing only mild esophagitis in 70-80% of patients with
GERD and for providing maintenance therapy to prevent relapse. Tachyphylaxis has been observed,
suggesting that pharmacologic tolerance can reduce the long-term efficacy of these drugs.
18. Which out of the following drugs comes under class PPIs for GERD ?
I. Nizatidine (Axid).
II. Omeprazole (Prilosec).
III. Lansoprazole (Prevacid).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Available PPIs include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), and
esomeprazole (Nexium).
19. Which out of the following drugs comes under class PPIs for GERD ?
I. Rabeprazole (Aciphex).
II. Nizatidine (Axid).
III. Esomeprazole (Nexium).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Available PPIs include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), and
esomeprazole (Nexium).
20. What are the commonly observed adverse reaction to rabeprazole ?
I. Sore throat.
II. Flatulence.
III. Hair fall.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In clinical trials, the most commonly reported adverse reactions to rabeprazole were sore throat,
flatulence, infection, and constipation in adults, and abdominal pain, diarrhea, and headache in
adolescents.

I. Hair fall.
II. Constipation in adults.
III. Headache in adolescents.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
flatulence, infection, and constipation in adults, and abdominal pain, diarrhoea, and headache in
adolescents.
I. Abdominal pain.
II. Diarrhoea.
III. Hair fall.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
flatulence, infection, and constipation in adults, and abdominal pain, diarrhoea, and headache in
adolescents.
23. What adverse effects are observed of PPIs for long term use ?
I. Diptheria.
II. Interfere with calcium homeostasis.
III. Aggravate cardiac conduction defects.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
PPIs are the most powerful medications have few adverse effects and are well tolerated for long-term
use. However, data have shown that PPIs can interfere with calcium homeostasis and aggravate
cardiac conduction defects.
24. Which of the following drug is responsible for hip fracture in postmenopausal women ?
I. Antibiotics.
II. PPIs.
III. H2 receptor antagonists.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
PPIs agents have also been responsible for hip fracture in postmenopausal women.
25. Which drug is used as prokinetic agent used for GERD only in patients with mild
symptoms ?
I. Domperidone.
II. Metoclopramide.
III. Cisapride.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Prokinetic agents are somewhat effective but only in patients with mild symptoms; other patients
usually require additional acid-suppressing medications, such as PPIs. The usual regimen in adults is
metoclopramide, 10 mg/day orally.
26. What is the dose of metoclopramide in adults for GERD ?
I. 10 mg/day orally.
II. 10 mg/day IV.
III. 50 mg/day orally.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Prokinetic agents are somewhat effective but only in patients with mild symptoms; The usual regimen
in adults is metoclopramide, 10 mg/day orally.
27. What are the historical procedures used for surgical therapy for gastroesophageal reflux
?
I. Allison crural repair.
II. The Boerema anterior gastropexy.
III. Vagotomy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
As in many other fields, surgical therapy for gastroesophageal reflux has evolved a great deal. A few
historical procedures of note include the Allison crural repair, the Boerema anterior gastropexy, and
the Angelchik prosthesis.
28. What are the historical procedures used for surgical therapy for gastroesophageal reflux
?
I. Allison crural repair.
II. The Boerema Posterior gastropexy.
III. The Angelchik prosthesis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
As in many other fields, surgical therapy for gastroesophageal reflux has evolved a great deal. A few
historical procedures of note include the Allison crural repair, the Boerema anterior gastropexy, and
the Angelchik prosthesis.
29. What is Angelchik prosthesis ?

I. Largely accepted because of a low rate of complications.
II. Used in children.
III. A silicone ring that is positioned at the gastroesophageal junction and prevents reflux.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The Angelchik prosthesis is a silicone ring that is positioned at the gastroesophageal junction and
prevents reflux. The Angelchik prosthesis was rarely used in children and has been largely abandoned
because of a high rate of complications.[35]
30. What is Nissen fundoplication ?
I. Transabdominal fundoplications.
II. Transthoracic fundoplications.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Today, both transthoracic and transabdominal fundoplications are performed, including partial
(anterior or posterior) and circumferential wraps. The most commonly performed operation today in
both children and adults is the Nissen fundoplication, which is a 360° transabdominal
fundoplication.
31. What are the surgical procedures used for GERD in todays ?
I. Transabdominal fundoplications.
II. Transthoracic fundoplications.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Today, both transthoracic and transabdominal fundoplications are performed, including partial
(anterior or posterior) and circumferential wraps. The most commonly performed operation today in
both children and adults is the Nissen fundoplication, which is a 360° transabdominal
fundoplication.
32. Which indication show that patient is go for fundoplication for GERD ?
I. Patient with PUD.
II. Patients with well-controlled GERD who desire definitive, one-time treatment.
III. Patients with symptoms that are not completely controlled by PPI therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Patients with symptoms that are not completely controlled by PPI therapy can be considered
for surgery; surgery can also be considered in patients with well-controlled GERD who desire
definitive, one-time treatment
I. Barrett esophagus.
II. Patient with PUD.
III. Poor patient compliance with regard to medications.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 The presence of Barrett esophagus is an indication for surgery
 Poor patient compliance with regard to medications
I. Patients with Brain defects.
II. Postmenopausal women with osteoporosis.
III. Patients with cardiac conduction defects.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Patients with cardiac conduction defect
35. What are the extraesophageal respiratory manifestations of GERD may indicate the need
for surgery?
I. Cough and wheezing.
II. Aspiration.
III. Hoarseness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 The presence of extraesophageal manifestations of GERD may indicate the need for surgery;
these include the following: (1) respiratory manifestations (eg, cough, wheezing, aspiration);
(2) ear, nose, and throat manifestations (eg, hoarseness, sore throat, otitis media); and (3)
dental manifestations (eg, enamel erosion)
36. What are the extraesophageal ear, nose, and throat manifestations of GERD may indicate
the need for surgery?
I. Hoarseness and sore throat.
II. Otitis media.
III. Wheezing and aspiration.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

37. What are the extraesophageal dental manifestations of GERD may indicate the need for
surgery?
I. Hoarseness and sore throat.
II. Otitis media.
III. Enamel erosion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C

38. What is done under laparoscopic fundoplication ?
I. To close the esophagogastric junction.
II. Fundus of the stomach is wrapped around the esophagus.
III. To create a new valve at the level of the esophagogastric junction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Laparoscopic fundoplication is performed under general endotracheal anesthesia. Five small (5-mm
to 10-mm) incisions are used .The fundus of the stomach is wrapped around the esophagus to create
a new valve at the level of the esophagogastric junction.
39. What is the size of incision used in laparoscopic fundoplication ?

I. 5-mm to 10-mm.
II. 10-mm to 20-mm.
III. 20-mm to 30-mm.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Laparoscopic fundoplication is performed under general endotracheal anesthesia. Five small (5-mm
to 10-mm) incisions are used
40. What are the essential elements of the operation under laparoscopic fundoplication ?
I. Reduction of the hiatal hernia.
II. Narrowing of the esophageal hiatus.
III. Creation of a 90° fundoplication.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The essential elements of the operation are as follows:

 Complete mobilization of the fundus of the stomach with division of the short gastric vessels
 Reduction of the hiatal hernia ,
 Narrowing of the esophageal hiatus
 Creation of a 360° fundoplication over a large intraesophageal dilator (Nissen
fundoplication)
41. What are the essential elements of the operation under laparoscopic fundoplication ?
I. Complete mobilization of the fundus of the stomach with division of the short gastric vessels.
II. Creation of a 120° fundoplication over a large intra esophageal dilator.
III. Creation of a 360° fundoplication over a large intra esophageal dilator.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Complete mobilization of the fundus of the stomach with division of the short gastric vessels
 Reduction of the hiatal hernia ,
fundoplication)
42. How much time laparoscopic fundoplication take for operation ?
I. 2-2.5 hours.
II. 4-5.5 hours.
III. 5-7.5 hours.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Laparoscopic fundoplication lasts 2-2.5 hours. The hospital stay is approximately 2 days. Patients
resume regular activities within 2-3 weeks.
43. How much time patient will take to resume regular activities ?
I. 2-3 weeks.
II. 2-3 months.
III. 2-3 years.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Patients resume regular activities within 2-3 weeks

44. How was laparoscopic fundoplication as effective as open fundoplication ?
I. For relieving heartburn and regurgitation.
II. Improving quality of life.
III. Increasing use of antisecretory medications.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The AHRQ found, on the basis of limited evidence, that laparoscopic fundoplication was as effective
as open fundoplication for relieving heartburn and regurgitation, improving quality of life, and
decreasing use of antisecretory medications.
45. Why believe fundoplication is preferable performed to compare PPIs ?

I. PPIs do not eliminate the reflux of bile.
II. PPIs a major contributors to the pathogenesis of Barrett epithelium.
III. PPIs eliminate the reflux of bile.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The authors believe fundoplication is preferable for the following reasons:

 PPIs, although effective in controlling the acid component of the refluxate, do not eliminate
the reflux of bile, which some believe to be a major contributor to the pathogenesis of barrett
epithelium
46. Why fundoplication is preferred compare PPIs in patients with Barrett esophagus ?
I. Have higher LES pressure.
II. Have lower LES pressure.
III. Worse esophageal peristalsis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The authors believe fundoplication is preferable for the following reasons:

 Patients with barrett esophagus tend to have lower les pressure and worse esophageal peristalsis
than patients without barrett esophagus; patients with barrett esophagus are also exposed to
a larger amount of reflux
47. How fundoplication offers the only possibility of stopping any kind of reflux ?
I. By creating a competent LES.
II. By inhibiting a competent LES.
III. By increases secretions.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
A fundoplication offers the only possibility of stopping any kind of reflux by creating a competent LES.
48. What is the goal of pharmacotherapy in patients with gastroesophageal reflux disease
(GERD) ?
I. To prevent complications.
II. To reduce morbidity.
III. To increase morbidity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The goals of pharmacotherapy are to prevent complications and to reduce morbidity in patients with
gastroesophageal reflux disease (GERD)
49. What is the mechanism of action of H2 receptor antagonists ?

I. Competitive blockers of histamine at the H1 receptors, particularly those in the gastric parietal
cells.
II. Competitive blockers of histamine at the H2 receptors, particularly those in the gastric parietal
cells.
III. Competitive blockers of histamine at the H2 receptors, particularly those in the gastric cells.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The H2 receptor antagonists are reversible competitive blockers of histamine at the H2 receptors,
particularly those in the gastric parietal cells, where they inhibit acid secretion. They are highly
selective, do not affect the H1 receptors
50. What is the pharmacological action of ranitidine ?
I. Reduces gastric acid secretion.
II. Reduces gastric volume.
III. Increases hydrogen concentration.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Ranitidine inhibits histamine stimulation of the H2 receptor in gastric parietal cells, which, in turn,
reduces gastric acid secretion, gastric volume, and hydrogen concentrations
51. What is the pharmacological action of cimetidine ?

II. Increase gastric volume.
III. Reduces hydrogen concentration.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Cimetidine inhibits histamine at H2 receptors of gastric parietal cells, which results in reduced gastric
acid secretion, gastric volume, and hydrogen concentrations.
52. What is the pharmacological action of Famotidine ?
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Famotidine competitively inhibits histamine at H2 receptor of gastric parietal cells, resulting in

reduced gastric acid secretion, gastric volume, and hydrogen concentrations.
53. What is the pharmacological action of Nizatidine?

A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Nizatidine competitively inhibits histamine at the H2 receptor of the gastric parietal cells, resulting
in reduced gastric acid secretion, gastric volume, and hydrogen concentrations.
54. What is mechanism of action of proton pump inhibitors (PPIs) ?
I. Inhibit gastric acid secretion.
II. Inhibition of the H+/K+ ATPase enzyme system.
III. Increase gastric acid secretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Proton pump inhibitors (ppis) inhibit gastric acid secretion by inhibition of the H+/K+ atpase enzyme
system in the gastric parietal cells.
55. What medications are used in cases of severe esophagitis and in patients whose conditions
do not respond to H2 receptor antagonist therapy ?
I. Proton pump inhibitors (PPIs).
II. Prokinetic drugs.
III. Antacid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
These agents are used in cases of severe esophagitis and in patients whose conditions do not respond to
H2 receptor antagonist therapy.
56. What is prescription period of omeprazole ?
I. 8 months to treat all grades of erosive esophagitis.
II. 4 weeks to treat and relieve the symptoms of active duodenal ulcers.
III. 8 weeks to treat all grades of erosive esophagitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Omeprazole is used for up to 4 weeks to treat and relieve the symptoms of active duodenal ulcers. It
may be used for up to 8 weeks to treat all grades of erosive esophagitis.
57. What is the pharmacological use of lansoprazole ?

I. Inhibits gastric acid secretion.
III. Destroy gastric cells.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Lansoprazole inhibits gastric acid secretion. It is used for up to 8 weeks to treat all grades of erosive
esophagitis.
58. What is Esomeprazole ?
I. S-isomer of omeprazole.
II. R-isomer of omeprazole.
III. S-isomer of lansoprazole.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Esomeprazole is an S-isomer of omeprazole.
59. What is the mechanism of action of esomeprazole ?

I. Increase gastric acid secretion.
II. Inhibits gastric acid secretion.
III. Inhibit H+/K+-ATPase enzyme system at the secretory surface of gastric parietal cells.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Esomeprazole is an S-isomer of omeprazole. It inhibits gastric acid secretion by inhibiting the H+/K+-
atpase enzyme system at the secretory surface of gastric parietal cells.
60. What is the mechanism of action of pantoprazole ?
I. Increase gastric acid secretion.
II. Inhibits gastric acid secretion.
III. Inhibit H+/K+-ATPase enzyme system at the secretory surface of gastric parietal cells.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Pantoprazole suppresses gastric acid secretion by specifically inhibiting the H+/K+-atpase enzyme
system at the secretory surface of gastric parietal cells.
61. Which out of the following falls in the class of antacids ?

I. Sodium antacids.
II. Magnesium antacids.
III. Aluminum antacids.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Antacids should be taken after each meal and at bedtime. Associated benefits include symptomatic
alleviation of constipation (aluminum antacids, such as alternagel and Amphojel) or loose stools
(magnesium antacids, such as Phillips Milk of Magnesia).
62. Which out of the following falls is aluminum antacids ?
I. Amphojel.
II. Alternagel.
III. Phillips Milk of Magnesia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
63. Which out of the following falls is magnesium antacids?

I. Amphojel.
II. Alternagel.
III. Phillips Milk of Magnesia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
64. What is the mechanism of action of metoclopramide ?
I. Increases GI motility.
II. Decreases resting esophageal sphincter tone.
III. Relaxes the pyloric sphincter.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Metoclopramide is a GI prokinetic agent that increases GI motility, increases resting esophageal

sphincter tone, and relaxes the pyloric sphincter.
65. What is the mechanism of action of aluminum hydroxide ?

I. Decreases gastric pH to less than 4.
II. inhibits proteolytic activity of pepsin.
III. Reducing acid indigestion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Aluminum hydroxide increases gastric ph to greater than 4 and inhibits proteolytic activity of pepsin,
reducing acid indigestion. Antacids can initially be used in mild cases. They have no effect on the
frequency of reflux, but they decrease its acidity.
66. What is the mechanism of action of magnesium hydroxide ?
I. causes osmotic retention of fluid, which distends the colon.
II. Decreases peristaltic activity that provides laxative effect.
III. Relieve indigestion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Magnesium hydroxide is used as antacid to relieve indigestion. It also causes osmotic retention of fluid,
which distends the colon and increases peristaltic activity that provides laxative effect.
67. What is the first line approach of management in pregnant women with GERD ?
I. Fundoplication.
II. Lifestyle modification.
III. Medications.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Lifestyle modifications are the first line of management in pregnant women with GERD
68. What is the optimal time to take an antacid ?
I. Just before meal.
II. After each meal.
III. At bed time.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Antacids should be taken after each meal and at bedtime
69. Which out of the following is/are true about the USFDA approved LINX Reflux
Management System ?
I. The band consists of interlinked copper wires with magnetic cores.
II. The system is a small flexible band that is placed laparoscopically around the esophagus just
above the stomach to create a natural barrier to reflux.
III. The act of swallowing temporarily breaks the magnetic bond, allowing food and liquid to pass
normally.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The US Food and Drug Administration approved the LINX Reflux Management System in March
2012. This device is designed to augment the lower esophageal sphincter. The system is a small flexible
band that is placed laparoscopically around the esophagus just above the stomach to create a natural
barrier to reflux. The band consists of interlinked titanium beads with magnetic cores. The act of
swallowing temporarily breaks the magnetic bond, allowing food and liquid to pass normally
70. Which material consist the band used in LINX Reflux Management System ?
I. Interlinked copper wires with magnetic cores.
II. Interlinked titanium beads with electric cores.
III. Interlinked titanium beads with magnetic cores.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
band ,The band consists of interlinked titanium beads with magnetic cores.
71. What is the mechanism of action of prokinetic agents ?

I. Improve the motility of the esophagus and stomach.
II. Increase the lower esophageal sphincter (LES) pressure.
III. Increase reflux of gastric contents.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Prokinetic agents, such as metoclopramide (Reglan), improve the motility of the esophagus and
stomach and increase the lower esophageal sphincter (LES) pressure to help reduce reflux of gastric
contents. They also accelerate gastric emptying.
72. How prokinetic agents relief the GERD patient ?
I. Accelerate gastric emptying.
II. Increase the lower esophageal sphincter (LES) pressure.
III. Increase reflux of gastric contents.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Prokinetic agents, such as metoclopramide (Reglan), improve the motility of the esophagus and
stomach and increase the lower esophageal sphincter (LES) pressure to help reduce reflux of gastric
contents. They also accelerate gastric emptying.
73. What is the benefit associated with aluminium hydroxide antacid in GERD patie nt ?
I. Symptomatic alleviation of blood volume.
II. Symptomatic alleviation of constipation.
III. Symptomatic alleviation of blood pressure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
These agents are used as diagnostic tools to provide symptomatic relief in infants. Associated benefits
include symptomatic alleviation of constipation
74. What is the risk factor associate with PPIs in postmenopausal women ?
I. Leg bone facture.
II. Rib facture.
III. Hip fracture.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
PPIs agents have also been responsible for hip fracture in postmenopausal women.
75. What should use in patient with severe GERD associate with barrett esophagus ,hav ing
nocturnal acid breakthrough ?
I. H2 blocker.
II. Antacids.
III. Prokinetic agents.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Additional H2 blocker therapy has been reported to be useful in patients with severe disease
(particularly those with Barrett esophagus) who have nocturnal acid breakthrough.
76. What is the brand name of ranitidine generally used ?
I. Zantac.
II. Pepcid.
III. Axid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Ranitidine (zantac)
77. What are the different surgical treatment used in GERD condition ?
I. Sleeve gastrectomy.
II. Laparoscopic fundoplication.
III. Vagotomy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Laparoscopic fundoplication , Sleeve gastrectomy , Devices

78. What statement is true about LINXreflux management system ?
I. This device is designed to augment the lower esophageal sphincter.
II. The band consists of interlinked titanium beads with electric cores.
III. The system is a small flexible band that is placed laparoscopically around the esophagus just
above the stomach to create a natural barrier to reflux.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
band that is placed laparoscopically around the esophagus just above the stomach to create a natural
barrier to reflux. The band consists of interlinked titanium beads with magnetic cores.
79. What is the brand name of metoclopramide generally used in GERD ?

I. Zantac.
II. Reglan.
III. Axid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Metoclopramide (reglan )
80. What is the brand name ofOmeprazole generally used in GERD ?
I. Zantac.
II. Reglan.
III. Prilosec.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Omeprazole (prilosec)
81. What is the brand name oflansoprazole generally used in GERD ?

I. Prevacid.
II. Reglan.
III. Prilosec.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Lansoprazole (prevacid)
82. What is the brand name ofCimetidine generally used in GERD ?

I. Prevacid.
II. Tagamet.
III. Prilosec.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Cimetidine (tagamet)
83. What is the brand name of famotidine generally used in GERD ?

I. Prevacid.
II. Tagamet.
III. Pepcid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Famotidine (pepcid)
84. What is the brand name of Nizatidine generally used in GERD ?

I. Axid.
II. Tagamet.
III. Pepcid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Nizatidine (axid)
85. Which of the following agents used only when condition of GERD has been objectively
documented ?
I. Proton pump inhibitors (PPIs).
II. Prokinetic agents.
III. Antibiotics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Ppis are the most powerful medications available for treating GERD. These agents should be used
only when this condition has been objectively documented.
86. Which of the following statement is/are true for proton pump inhibitors (PPIs) ?
I. PPIs are the most powerful medications available for treating GERD.
II. PPIs have few adverse effects and are well tolerated for long-term use.
III. PPIs are the first-line agents for patients with mild to moderate symptoms and grades I-II
esophagitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Ppis are the most powerful medications available for treating GERD. These agents should be used
only when this condition has been objectively documented. They have few adverse effects and are well
tolerated for long-term use.
87. Which of the following statement is/are true for laparoscopic fundoplication?
I. Fundoplication is the first-line management for patients with mild to moderate symptoms.
II. Laparoscopic fundoplication has also quickly gained acceptance for use in children.
III. Long- term results of laparoscopic antireflux surgery have shown that 90% of patients are
symptom free and only a minority still take PPIs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Laparoscopic fundoplication has also quickly gained acceptance for use in children
 Long-term results of laparoscopic antireflux surgery have shown that, at 10 years, 90% of
patients are symptom free and only a minority still take ppis
88. Which of the following statement is/are incorrect for laparoscopic fundoplication?
I. Fundoplication is the first-line management for patients with mild to moderate symptoms.
II. Laparoscopic fundoplication is performed under general endotracheal anesthesia.
III. Approximately 2% of patients obtain resolution of symptoms after undergoing laparoscopic
fundoplication.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Laparoscopic fundoplication is performed under general endotracheal anesthesia.

 The hospital stay is approximately 2 days. Patients resume regular activities within 2-3 weeks.
Approximately 92% of patients obtain resolution of symptoms after undergoing laparoscopic
fundoplication.
89. Which of the following is not the side effect of H2 receptor antagonists ?
I. Skin rashes.
II. Tachyphylaxis.
III. Hair fall.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Tachyphylaxis has been observed, suggesting that pharmacologic tolerance can reduce the long-term
efficacy of these drugs.
90. What type of food and beverages are avoid according to guidelines of the American
College of Gastroenterology for GERD patient ?
I. Peppermint.
II. Coffee.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
2005 guidelines from the American College of Gastroenterology [ACG] also suggest avoiding
peppermint, coffee, and possibly the onion family
91. GERD is closely linked to which type of cancer ?
I. Blood cancer.
II. Esophageal cancer.
III. Liver cancer.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
GERD is related to Esophageal cancer/adenocarcinoma ,Currently, adenocarcinoma accounts for

more than 50% of esophageal cancers in Western industrialized nations.
92. Which type of medication is preferred in grade I-II esophagitis ?

I. H2 receptor antagonists.
III. Antacids.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
grades I-II esophagitis
93. Which proton pump inhibitor is FDA approved for the treatment of GERD in adults
and adolescents ?
I. First generic versions of rabeprazole sodium delayed-release tablets.
II. First generic versions of esomeprazole sodium delayed-release tablets.
III. First generic versions of lansoprazole sodium delayed-release tablets.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
In November 2013, the FDA approved the first generic versions of rabeprazole sodium delayed-release
tablets for the treatment of GERD in adults and adolescents ages 12 and up
94. Which of following is not essential elements for laproscopic fundoplication operation ?
I. Complete mobilization of the fundus of the stomach.
II. Reduction of the hiatal hernia.
III. Widening of the esophageal hiatus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C

 Complete mobilization of the fundus of the stomach with division of the short gastric
vessels
 Reduction of the hiatal hernia
fundoplication)
95. What is the brand name ofpantoprazole generally used in GERD ?
I. Aciphex.
II. Nexium.
III. Protonix.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Pantoprazole (protonix)
96. What is the brand name ofesomeprazole generally used in GERD ?

I. Aciphex.
II. Nexium.
III. Protonix.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Esomeprazole (nexium)
97. What is the brand name ofrabeprazole generally used in GERD ?

I. Aciphex.
II. Nexium.
III. Protonix.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Rabeprazole (aciphex)
98. What is the benefit associated with magnesium hydroxide antacid in GERD patient ?
I. Symptomatic alleviation of blood volume.
II. Symptomatic alleviation of constipation.
III. Loose stool.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Associated benefits include symptomatic alleviation of constipation (aluminum antacids, such as

alternagel and Amphojel) or loose stools (magnesium antacids, such as Phillips Milk of Magnesia).
99. Which out of the following aluminum hydroxide preparation is used as antacid ?
I. ALternaGEL.
II. Amphojel.
III. Milk of Magnesia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Aluminum hydroxide (alternagel, Amphojel)
100. Which out of the following magnesium hydroxide preparation is used as antacid ?
I. Phillips Milk of Magnesia.
II. Phillips ALternaGEL.
III. Phillips Chewable.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Magnesium hydroxide (Phillips Milk of Magnesia, Phillips Chewable)
CARDIOVASCULAR SYSTEM
ATRIAL FIBRILLATION
1. What is called Paroxysmal AF as per American Heart Association (AHA)?

I. Episodes of AF that terminate spontaneously within 7 days.
II. Episodes of AF that last more than 7 days.
III. AF that has persisted for more than 1 year.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
AF into the following pattern -Paroxysmal AF Episodes of AF that terminate spontaneously within
7 days (most episodes last less than 24 hours).
2. What is called Persistent AF as per classified American Heart Association (AHA)?

I. AF that has persisted for more than 1 year.
II. Episodes of AF that terminate spontaneously within 7 days.
III. Episodes of AF that last more than 7 days.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
AF into the following patterns-Persistent AF - Episodes of AF that last more than 7 days and may
require either pharmacologic or electrical intervention to terminate.
3. What is called permanent AF as per American Heart Association (AHA)?
I. AF that has persisted for more than 1 year.
II. Episodes of AF that last more than 7 days.
III. Episodes of AF that terminate spontaneously within 7 days.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
AF into the following patterns- Permanent AF - AF that has persisted for more than 1 year, either
because cardioversion has failed or because cardioversion has not been attempted.
4. What are the secondary causes of AF?

I. Acute myocardial infarction.
II. Chronic myocardial infarction.
III. Pulmonary embolism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Atrial fibrillation happens secondary to acute myocardial infarction, cardiac surgery, pericarditis,
pulmonary embolism, or acute pulmonary disease is considered separately because, in these situations,
que secondary cause of AF.
5. What are the secondary causes of AF?
I. Acute pulmonary disease.
II. Pericarditis.
III. Angina pectoris.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Atrial fibrillation secondary to acute myocardial infarction, cardiac surgery, pericarditis, pulmonary
embolism, or acute pulmonary disease is considered separately because, in these situations, que
secondary cause of AF.
6. Which are the secondary causes of AF?

I. Cardiac surgery
II. Acute myocardial infarction
III. Hepatic failure
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Atrial fibrillation secondary to acute myocardial infarction, cardiac surgery, pericarditis, pulmonary
embolism, or acute pulmonary disease is considered separately because, in these situations, que
secondary cause of AF.
7. When Atrial fibrillation is considered to be recurrent?
I. When a patient has 1 or more episodes.
II. When a patient has 2 or more episodes.
III. When a patient has 3 or more episodes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Atrial fibrillation is considered to be recurrent when a patient has 2 or more episodes.
8. Which out of the following is true for Persistent AF?

I. Recurrent AF is shortened.
II. Recurrent AF is sustained.
III. Irrespective of whether the arrhythmia is terminated by pharmacologic therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
If recurrent AF is sustained, it is considered persistent, irrespective of whether the arrhythmia is

terminated by either pharmacologic therapy or electrical cardioversion.
9. What is Persistent AF?
I. The result of recurrent episodes of paroxysmal AF.
II. The first presentation of AF.
III. The result of recurrent episodes of paroxysmal AF.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Persistent AF may be either the first presentation of AF or the result of recurrent episodes of paroxysmal
AF.
10. What is the outcome of Persistent AF with an uncontrolled, rapid ventricular heart rate?
I. Dilated cardiomyopathy.
II. Ventricular cardiomyopathy.
III. Atrial flutter.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Persistent AF with an uncontrolled, rapid ventricular heart rate response can cause a dilated
cardiomyopathy and can lead to electrical remodeling in the atria (atrial cardiomyopathy).
11. What is the outcome of dilated cardiomyopathy in patient with Persistent AF?
I. Electrical remodeling in ventricles.
II. Persistent AF.
III. Uncontrolled ventricular heart rate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Persistent AF with an uncontrolled, rapid ventricular heart rate response can cause a dilated
cardiomyopathy and can lead to electrical remodeling in the atria (atrial cardiomyopathy).
12. What is lone AF?

I. Paroxysmal, persistent, or permanent AF in younger patients (< 60 y) who have normal
echocardiographic findings.
II. Paroxysmal, persistent, or permanent AF in patients (> 60 y) who have normal
III. Paroxysmal, persistent, or permanent AF in younger patients (< 70 y) who have normal
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The definition of lone AF remains controversial, but it generally refers to paroxysmal, persistent, or
permanent AF in younger patients (< 60 y) who have normal echocardiographic findings.
13. Which cardiovascular diseases have strong associations with Atrial fibrillation (AF)?
I. Cardiac arrhythmia.
II. Heart failure.
III. Coronary artery disease (CAD).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Atrial fibrillation (AF) shares strong associations with other cardiovascular diseases, such as heart
failure, coronary artery disease (CAD), valvular heart disease, diabetes mellitus, and hypertension.
14. Which cardiovascular diseases have strong associations with Atrial fibrillation (AF)?
I. Valvular heart disease.
II. Hypotension.
III. Diabetes mellitus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Atrial fibrillation (AF) shares strong associations with other cardiovascular diseases, such as heart
failure, coronary artery disease (CAD), valvular heart disease, diabetes mellitus, and hypertension.
15. How cardiovascular risk factors predispose to AF?
I. By hetero dynamic stress.
II. By Catecholamine excess.
III. By hemodynamic stress.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The exact mechanisms by which cardiovascular risk factors predispose to AF are not understood fully
but are under intense investigation. Catecholamine excess, hemodynamic stress, atrial ischemia, atrial
inflammation, metabolic stress, and neurohumoral cascade activation are all purported to promote
AF.

I. By atrial ischemia.
II. By atrial inflammation.
III. By atrial flutter.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
AF.
I. By metabolic stress.
II. By neurohormonal cascade activation.
III. By neurohumoral cascade activation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
AF.
18. which out of following disease is associated with an elevated risk of AF?
I. Diabetes insipidus.
II. Obesity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Because diabetes mellitus and obesity are increasing in prevalence and are associated with an elevated
risk of AF.
19. Which is the most frequent source of automatic foci?
I. Cardiac veins.
II. Pulmonary veins.
III. Pulmonary arteries.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The pulmonary veins appear to be the most frequent source of these automatic foci.
20. What is theorized to promote re-entry and sustained AF?

I. Heterogeneity of electrical conduction.
II. Around the pulmonary veins.
III. Homogeneity of electrical conduction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Heterogeneity of electrical conduction around the pulmonary veins is theorized to promote reentry
and sustained AF.
21. What is multiple wavelet hypothesis?
I. Fractionation of wave fronts propagating through the ventricles.
II. Fractionation of wave fronts propagating through the atria.
III. Results in self-perpetuating "daughter wavelets.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The multiple wavelet hypothesis proposes that fractionation of wave fronts propagating through the
atria results in self-perpetuating "daughter wavelets."21 22 23 In this model, the number of wavelets
is determined by the refractory period, conduction velocity, and mass of atrial tissue. Increased atrial
mass, shortened atrial refractory period, and delayed intra-atrial conduction increase the number of
wavelets and promote sustained AF.
22. How number of wavelets is determined in multiple wavelet model?

I. Mass of cardiac tissue.
II. Refractory period.
III. Conduction velocity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
23. Which mechanisms are responsible for increase in number of wavelets which promote
sustained AF?
I. Increased atrial mass.
II. Delayed inter-atrial conduction.
III. Delayed intra-atrial conduction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
24. What are the risk factors for Atrial fibrillation (AF)?
I. Hetero dynamic stress.
II. Hemodynamic stress.
III. Atrial ischemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Atrial fibrillation (AF) is strongly associated with the following risk factors:
 Hemodynamic stress
 Atrial ischemia
 Inflammation
 Noncardiovascular respiratory causes
 Alcohol and drug use
 Endocrine disorders
 Neurologic disorders
 Genetic factors
Advancing age
25. What are the risk factors for Atrial fibrillation (AF)?
I. Noncardiovascular pulmonary causes.

II. Inflammation.
III. Noncardiovascular respiratory causes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Atrial fibrillation (AF) is strongly associated with the following risk factors :
Inflammation Noncardiovascular respiratory causes.
26. What are the risk factors of Atrial fibrillation (AF) ?

I. Endocrine disorders.
II. Exocrine disorders.
III. Neurologic disorders.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
A l c o h o l a n d d r u g u s e
E n d o c r i n e d i s o r d e r s
N e u r o l o g i c d i s o r d e r s
27. What are the risk factors of Atrial fibrillation (AF) ?
I. Advancing age.
II. Alcohol use.
III. Genetic factors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
G e n e t i c f a c t o r s
A d v a n c i n g a g e
28. What is the result of Increased intra-atrial pressure?

I. Atrial electrical and structural remodeling.
II. Predisposes to AF.
III. Post disposes to AF.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Increased intra-atrial pressure results in atrial electrical and structural remodeling and predisposes to
AF.
29. What is the most common cause of increased atrial pressure?
I. Mitral or tricuspid valve disease.
II. Right ventricular dysfunction.
III. Left ventricular dysfunction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
29 The most common causes of increased atrial pressure are mitral or tricuspid valve disease and left
ventricular dysfunction. Systemic or pulmonary hypertension also commonly predisposes to atrial
pressure overload, and intracardiac tumors or thrombi are rare causes.
30. Severe ventricular ischemia leads to-

I. Increased intra-atrial pressure.
II. Atrial fibrillation.
III. Increased inter-atrial pressure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Severe ventricular ischemia leads to increased intra-atrial pressure and AF.

31. Which out of the following is associated with AF?
I. Thromboembolism.
II. Pulmonary embolism.
III. Pneumonia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer::E
Pulmonary embolism, pneumonia, lung cancer, and hypothermia have been associated with AF

I. Hyperthermia.
II. Hypothermia.
III. Lung cancer.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Pulmonary embolism, pneumonia, lung cancer, and hypothermia have been associated with AF
33. Which eliciting drugs are found to be related to AF?
I. Cocaine.
II. Methamphetamines.
III. Amphetamines.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:D
And illicit drug use (ie, stimulants, methamphetamines, cocaine) have been specifically found to be
related to AF

I. Hyperthyroidism.
II. Hypothyroidism.
III. Pheochromocytoma.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Hyperthyroidism, diabetes, and pheochromocytoma have been associated with AF

35. Which Intracranial processes precipitate AF?
I. Stroke.
II. Subarachnoid hemorrhage.
III. Arachnoid hemorrhage.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
35 Intracranial processes such as subarachnoid hemorrhage or stroke can precipitate AF.
36. What is true related to the incidence of AF in different population?

I. The incidence of AF is significantly higher in women than in men in all age groups.
II. The incidence of AF is not significantly different between men and women in all age groups.
III. The incidence of AF is significantly higher in men than in women in all age groups.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:C
The incidence of AF is significantly higher in men than in women in all age groups
37. What is true related to the appearance of AF in different population?
I. AF appears to be more common in whites than in blacks.
II. AF appears to be more common in blacks than in whites.
III. AF appears to be Lesser in whites than in blacks.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
AF appears to be more common in whites than in blacks, with blacks have less than half the age-
adjusted risk of developing AF
38. In which cardiac disease AF is a common?

I. Chronic myocardial infarction.
II. acute myocardial infarction.
III. subacute myocardial infarction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
AF is a common finding in patients presenting with an acute myocardial infarction.

39. Which parameter should be focused for Initial evaluation in patient with new -onset
atrial fibrillation?
I. Patient's heterodynamic stability.
I. Patient's hemodynamic stability.
III. Patient's hemodynamic unstability.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:B
Initial evaluation of the patient with new-onset atrial fibrillation should focus on the patient's
hemodynamic stability
40. Which intravenous (IV) rate-controlling agents are beneficial for Symptomatic patients
of AF?
I. Beta-adrenergic blockers.
II. Sodium channel blockers.
III. Calcium-channel blockers .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:F
Symptomatic patients may benefit from intravenous (IV) rate-controlling agents, either calcium-
channel blockers or beta-adrenergic blockers
41. How many percentages of AF episodes may not cause symptoms?
I. Upto 95%.
II. Upto 80%.
III. Upto 90%.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
While up to 90% of AF episodes may not cause symptoms
42. What are the symptoms of AF?

I. Palpitations.
II. Anxiety.
III. Perspiration.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
42 43 44 45 46 many patients experience a wide variety of symptoms, including palpitations,

dyspnea, fatigue, dizziness, angina, and decompensated heart failure
I. Tachycardia.
II. Fatigue.
III. Dizziness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

I. Angina.
II. Hypertension.
III. Arrhythmia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:A

I. Compensated heart failure.
II. Decompensated heart failure.
III. Cardiac failure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
46. Which out of the following symptoms are experienced by patients of AF?
I. Wheezing.
II. Dyspnea.
III. Apnea.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
47. Which out of the following patients requiring immediate DC cardioversio n ?

I. Patients with hypertension.
II. Patients with decompensated congestive heart failure (CHF).
III. Patients with hypotension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
47 48 Unstable patients requiring immediate DC cardioversion include the following :

 Patients with decompensated congestive heart failure (CHF )
 P a t i e n t s w i t h h y p o t e n s i o n
P a t i e n t s w i t h u n c o n t r o l l e d a n g i n a / i s c h e m i a
48. Which out of the following patients requiring immediate DC cardioversion ?
I. Patients with infraction.
II. Patients with controlled angina/ischemia.
III. Patients with uncontrolled angina/ischemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Unst ab l e p ati e nts re qu i ri ng i mme di ate DC c ardi o v e rsi o n i ncl u de th e fo ll o w i ng :

Patients with decompensated congestive heart failure (CHF)
P a t i e n t s w i t h h y p o t e n s i o n
P a t i e n t s w i t h u n c o n t r o l l e d a n g i n a / i s c h e m i a
49. Which are less severe symptoms and patient complaints for AF?
I. Fatigue.
II. Presyncope or syncope.
III. Post syncope.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
48 50 Less severe symptoms and patient complaints include the following

 Presyncope or syncope
 Generalized weakness, dizziness
50. Which are Less severe symptoms and patient complaints for AF?
I. Headache.
II. Generalized weakness.
III. Dizziness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Less severe symptoms and patient complaints include the following

 Presyncope or syncope
 Generalized weakness, dizziness
51. What questions should be included in patient history for patient presenting with
suspected AF?
I. Temporality.
II. Precipitating factors.
III. Cocaine use.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:D
51 52 53 In addition to eliciting the symptoms above, history taking of any patient presenting with
suspected AF should include questions relevant to temporality, precipitating factors (including
hydration status, recent infections, alcohol use), history of pharmacologic or electric interventions and
responses, and presence of heart disease
suspected AF?
I. History of pharmacologic or electric interventions.
II. Presence of heart disease.
III. Presence of valvular disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In addition to eliciting the symptoms above, history taking of any patient presenting with suspected
AF should include questions relevant to temporality, precipitating factors (including hydration status,
recent infections, alcohol use), history of pharmacologic or electric interventions and responses, and
presence of heart disease
suspected AF?
I. Smoking.
II. Hydration status.
III. Alcohol use.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
In addition to eliciting the symptoms above, history taking of any patient presenting with suspected
AF should include questions relevant to temporality, precipitating factors (including hydration status,
recent infections, alcohol use), history of pharmacologic or electric interventions and responses, and
presence of heart disease
54. Which are necessary Documentation for clinical type AF?
I. Assessment frequency of symptoms.
II. Assessment duration.
III. Assessment frequency of signs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:D
Documentation of clinical type of AF

 54 Assessment of type, duration, and frequency of symptoms
 55 Assessment of precipitating factors (eg, exertion, sleep, caffeine, alcohol use)
 56 Assessment of modes of termination (eg, vagal maneuvers)
 57 Documentation of prior use of antiarrhythmics and rate-controlling agents
 58 Assessment of presence of underlying heart disease

I. Assessment of precipitating factors (eg, exertion).
II. Assessment of precipitating factors (eg, alcohol use).
III. Assessment of precipitating factors (eg, smoking).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

58 Assessment of presence of underlying heart disease
I. Assessment of modes of termination (eg, vagal maneuvers).
II. Assessment of modes of termination (eg, arterial maneuvers).
III. Assessment of modes of termination (eg, Venus maneuvers).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A


I. Documentation of prior use of antiarrhythmics.
II. Documentation of prior use of rate-controlling agents.
III. Documentation of prior use of antianginal agents.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:D

I. Assessment of presence of underlying Pulmonary disease.
II. Assessment of presence of underlying heart disease.
III. Assessment of absence of underlying heart disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

59. What is checked by physician during initial physical examination?

I. Circulation
II. Sneezing
III. Airway
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:F
Physical examination always begins with airway, breathing, and circulation (abcs) and vital signs,
as these guide the pace of the intervention
60. Which information does physical examination provides?
I. Sequelae of atrial flutter.
II. Sequelae of atrial fibrillation.
III. Underlying causes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:E
.60 The physical examination also provides information on underlying causes and sequelae of atrial
fibrillation
61. Which are the important parameter necessary for evaluating hemodynamic stability and
adequacy of rate control in AF?
I. Nitrogen saturation.
II. Respiratory rate.
III. Oxygen saturation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Heart rate, blood pressure, respiratory rate, and oxygen saturation are particularly important in
evaluating hemodynamic stability and adequacy of rate control in AF
62. Which are the important parameter necessary for evaluating hemodynamic stability and
adequacy of rate control in AF?
I. Heart rate.
II. Blood pressure.
III. Heart pulses.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Heart rate, blood pressure, respiratory rate, and oxygen saturation are particularly important in
evaluating hemodynamic stability and adequacy of rate control in AF
63. Which is Heart rate in Patients with irregularly irregular pulse?

I. 110-140.
II. 120-130.
III. 130-140.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
63Patients will have an irregularly irregular pulse and will commonly be tachycardic, with heart
rates typically in the 110- to 140-range, but rarely over 160-170
64. Which is true for patients with bradycardic atrial fibrillation?
I. Who are hyperthermic?
II. Who are hypothermic?
III. Who have cardiac drug toxicity?
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Patients who are hypothermic or who have cardiac drug toxicity may present with bradycardic atrial
fibrillation.
65. What reveals when examination of head and neck is carried out?
I. Elevated jugular aortic pressures.
II. Cyanosis.
III. Elevated jugular venous pressures.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:E
Examination of the head and neck may reveal exophthalmos, thyromegaly, elevated jugular venous
pressures, or cyanosis
66. What reveals when examination of head and neck is carried out?
I. Exophthalmos.
II. Thyromegaly.
III. Endo thalamus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Examination of the head and neck may reveal exophthalmos, thyromegaly, elevated jugular venous
pressures, or cyanosis
67. What is suggested by Carotid artery bruits?

I. Peripheral arterial disease.
II. Comorbid coronary artery disease.
III. Peripheral ventricular disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Carotid artery bruits suggest peripheral arterial disease and increase the likelihood of comorbid
coronary artery disease
68. What is suggested by pulmonary examination?
I. Dyspnea.
II. Wheezes.
III. Diminished breath sounds.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The pulmonary examination may reveal evidence of heart failure (eg, rales, pleural effusion). Wheezes
or diminished breath sounds are suggestive of underlying pulmonary disease (eg, chronic obstructive
pulmonary disease [COPD], asthma
69. What is the mainstay for diagnosis in examination of patient with AF?
I. Cardiac examination.
II. Valvular examination.
III. Pulmonary examination.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The cardiac examination is central to the physical examination of the patient with AF
70. Which are necessary parameters to evaluate valvular heart disease or cardiomyopathy?
I. Auscultation.
II. Palpation.
III. Perspiration.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Thorough palpation and auscultation are necessary to evaluate for valvular heart disease or
cardiomyopathy.
71. What does a displaced point of maximal impulse or S3 suggests?

I. Elevated right ventricular pressure.
II. Elevated left ventricular pressure.
III. Ventricular enlargement.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
71 A displaced point of maximal impulse or S3 suggests ventricular enlargement and elevated left
ventricular pressure.
72. What does a prominent P2 points suggests?
I. Presence of pulmonary hypotension.
II. Presence of pulmonary hypertension.
III. Absence of pulmonary hypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
72 A prominent P2 points to the presence of pulmonary hypertension
73. Which liver disease suggests right ventricular failure or intrinsic liver disease?
I. Presence of extrinsic liver disease.
II. Presence of ascites.
III. Presence of hepatomegaly.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The presence of ascites, hepatomegaly, or hepatic capsular tenderness suggests right ventricular failure
or intrinsic liver disease
74. Which condition suggests splenic infarct from peripheral embolization?
I. Left lower quadrant pain.
II. Left upper quadrant pain.
III. Right upper quadrant pain.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Left upper quadrant pain may suggest splenic infarct from peripheral embolization.
75. What does a cool or cold pulseless extremity may suggest?

I. Peripheral embolization.
II. Systemic embolization.
III. Peripheral embolization and systemic embolization.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
A cool or cold pulseless extremity may suggest peripheral embolization, and assessment of peripheral
pulses may lead to the diagnosis of peripheral arterial disease or diminished cardiac output.
76. Which out of the following condition is suggestive of hyperthyroidism in AF patient?
I. Evidence of prior stroke.
II. Evidence of Hypertension.
III. Evidence of Hypotension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Evidence of prior stroke and increased reflexes is suggestive of hyperthyroidism
77. Which test is used for the diagnosis, when atrial fibrillation is suspected during
auscultation of the heart with irregularly irregular beats?
I. 11-lead electrocardiogram.
II. 12-lead electrocardiogram.
III. 13-lead electrocardiogram.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
When atrial fibrillation is suspected during auscultation of the heart with irregularly irregular
beats, obtaining a 12-lead electrocardiogram (ECG) is the next step
78. How clinician/doctor identifies irregular atrial activation with irregular conduction
through the atrioventricular (AV) node on electrocardiogram?
I. As irregularly irregular narrow complex tachycardia.
II. As regularly irregular narrow complex tachycardia.
III. As irregularly regular narrow complex tachycardia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Because AF is due to irregular atrial activation at a rate of 350-600 bpm with irregular conduction
through the atrioventricular (AV) node, it appears on ECG as irregularly irregular narrow complex
tachycardia.
79. What is rate of atria in AF patient?

I. 350-600 bpm.
II. 400-700 bpm.
III. 400-750 bpm.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Because AF is due to irregular atrial activation at a rate of 350-600 bpm with irregular conduction
through the atrioventricular (AV) node, it appears on ECG as irregularly irregular narrow complex
tachycardia.
80. What is ventricular rate in AF patient?
I. Between 180 and 280 bpm.
II. Between 120 and 260 bpm.
III. Between 80 and 180 bpm.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The ventricular rate is usually between 80 and 180 bpm. (ventricular rate in AF)
81. Which test is used to confirm AF after initial diagnosis of patient?

I. CBC.
II. ECG.
III. Serum cardiac biomarkers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Therefore, after the diagnosis of AF is confirmed with ECG, an evaluation of serum cardiac
biomarkers and B-type natriuretic peptide (BNP) is usually required to investigate for underlying
heart disease
82. Which out of the following is invasive test for the diagnosis of cardiac function in AF?
I. Electrocardiogram.
II. Stress electrocardiogram.
III. Cardiac catheterization.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
More invasive cardiac tests (eg, cardiac catheterization) may be required depending on signs and
symptoms and findings on initial tests
83. Which out of the following condition can be confirmed/diagnosed using ECG in AF
patient?
I. Prior stroke.
II. Arrhythmia.
III. Prior hypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
ECG findings usually confirm the diagnosis of atrial fibrillation and include the following: The
ventricular rate is typically irregular
patient?
I. Irregular ORS complexes.
II. Irregular XRS complexes.
III. Irregular QRS complexes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
ECG findings usually confirm the diagnosis of atrial fibrillation and include the following
Discrete P waves are absent, replaced by irregular, chaotic F waves, in the setting of irregular
QRS complexes, as shown in the image below
patient?
I. Hyperthyroidism.
II. Ashman phenomenon.
III. Hypothyroidism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Look also for aberrantly conducted beats after long-short R-R cycles (ie, Ashman phenomenon)
patient?
I. Heart rate.
II. blood volume.
III. cardiac output.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
ECG findings usually confirm the diagnosis of atrial fibrillation and include the following Heart
rate (typically in the 110-140 range, but rarely over 160-170)
patient?
I. Acute or prior MI.
II. Prior Stroke.
III. Preexcitation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Preexcitation
Acute or prior MI
patient?
I. Prior hypertension.
II. Bundle-branch block.
III. Left ventricular hypertrophy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 ECG findings usually confirm the diagnosis of atrial fibrillation and include the following
 86 Left ventricular hypertrophy
 87 Bundle-branch block
89. Which test is used to evaluate anemia in AF patient?

I. BNP.
II. CBC count.
III. Haemolysis test.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Laboratory studies indicated include the following

89 CBC count (looking for anemia, infection
90. Which test is used to evaluate electrolyte disturbances or renal failure in AF patient?
I. Serum alpha-fetoprotein.
II. Serum electrolytes and BUN.
III. Serum creatinine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

Serum electrolytes and BUN/creatinine (looking for electrolyte disturbances or renal failure)
91. Which test is used to investigate myocardial infarction in AF patient?

I. Cardiac enzymes CK.
II. Serum creatinine.
III. Troponin level.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

Cardiac enzymes - CK and/or troponin level (to investigate myocardial infarction as a primary or
secondary event)
92. Which test is used to evaluate congestive heart failure in AF patient?
I. Serum creatinine.
II. B-type natriuretic peptide.
III. Serum uric acid level.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

BNP (to evaluate for CHF)
93. Which test is used to evaluate pulmonary embolism workup in AF patient?

I. D-dimer.
II. ECG.
III. 12-lead ECG.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A

D-dimer (if the patient has risk factors to merit a pulmonary embolism workup)
94. Which condition can be ruled out by Thyroid function test?
I. Hypertension.
II. Anemia.
III. Thyrotoxicosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C

Thyroid function studies (looking for thyrotoxicosis, a rare, but not-to-be-missed, precipitant)
95. Why monitoring of digoxin level is important in patient on digoxin?

I. To predict cardiac output.
II. To predict subtherapeutic levels and/or toxicity.
III. To predict work load of heart.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

Digoxin level (may be obtained when appropriate for subtherapeutic levels and/or toxicity; generally
considered safe to give digoxin to patient with AF on digoxin for rate control without waiting for
lab values if patient presents with AF with rapid ventricular response [RVR]) \
96. Which out of the following is included in Laboratory testing during diagnosis of AF?
I. Ethanol level.
II. Nicotine level.
III. Ethanol level and Nicotine level.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A

96 Toxicology testing or ethanol level
97. What is the appllication of echocardiography in AF?

I. To evaluate cardiac myocytes energy expenditure.
II. To evaluate left ventricular hypertrophy.
III. To evaluate pericardial disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Echocardiography may be used to evaluate for valvular heart disease, left and right atrial size, left
ventricular (LV) size and function, left ventricular hypertrophy (LVH), and pericardial disease.
98. What is the application of echocardiography in AF?
I. To evaluate left and right atrial size.
II. To evaluate cardiac myocytes energy expenditure.
III. To evaluate valvular heart disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Echocardiography may be used to evaluate for valvular heart disease, left and right atrial size, left
ventricular (LV) size and function, left ventricular hypertrophy (LVH), and pericardial disease.
99. What is the application of Transesophageal echocardiography in AF?

I. To guide cardioversion.
II. To evaluate cardiac myocytes energy expenditure.
III. To evaluate work load of heart.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Transesophageal echocardiography (TEE) is helpful for making the following determinations:

Evaluate for LA thrombus (particularly in the LA appendage)
To guide cardioversion (if thrombus is seen, cardioversion should be delayed) When TEE is
planned, the concurrent use of TTE may increase cost without providing significant additional
information.
100. What is the application of Transesophageal echocardiography in AF?
I. To evaluate coronary artery blood flow.
II. To Evaluate for LA thrombus.
III. To evaluate cardiac myocytes energy expenditure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Transesophageal echocardiography (TEE) is helpful for making the following determinations:

Evaluate for LA thrombus (particularly in the LA appendage)
To guide cardioversion (if thrombus is seen, cardioversion should be delayed) When TEE is
planned, the concurrent use of TTE may increase cost without providing significant additional
information.
Drugs and Pharmacology( questions-100)
1. What are the cornerstones in management of atrial fibrillation?

I. Rate control and anticoagulation.
II. Rhythm control.
III. Control of Myocardial Infraction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The cornerstones of atrial fibrillation management are rate control and anticoagulation[3] and
rhythm control for those symptomatically limited by AF.
2. On what basis clinician decide to use a rhythm-control or rate-control strategy for the
treatment of AF?
I. Availability of drug.
II. Degree of symptoms.
III. Likelihood of successful cardioversion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The clinical decision to use a rhythm-control or rate-control strategy requires an integrated

consideration of several factors, including degree of symptoms, likelihood of successful cardioversion,
presence of comorbidities, and candidacy for AF ablation (eg, pulmonary vein electric isolation or
MAZE procedure).
3. On what basis clinician decide to use a rhythm-control or rate-control strategy for the
treatment of AF?
I. Candidacy for AF ablation.
II. Availability of drug.
III. Presence of comorbidities.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The clinical decision to use a rhythm-control or rate-control strategy requires an integrated

consideration of several factors, including degree of symptoms, likelihood of successful cardioversion,
presence of comorbidities, and candidacy for AF ablation (eg, pulmonary vein electric isolation or
MAZE procedure).
4. What is the outcome of restoration of sinus rhythm with regularization of the heart's
rhythm in AF?
I. Decrease in cardiac output.
II. Improvement in cardiac hemodynamics.
III. Exercise tolerance.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Restoration of sinus rhythm with regularization of the heart's rhythm improves cardiac
hemodynamics and exercise tolerance
5. Which sign and symptom indicates potential complications of RF ablation of atrial
fibrillation?
I. Cardiac perforation.
II. Pericardial effusion.
III. Cardiac Hyper fusion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Patients who undergo RF ablation of atrial fibrillation should be monitored for the signs and
symptoms of potential complications, such as the following:
 Cardiac perforation
 Pericardial effusion
6. Which out of the following newer anticoagulants are recommended for patients with
nonvalvular AF who have previously suffered a stroke?
I. Dabigatran.
II. Aspirin.
III. Etexilate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In addition to warfarin, 3 new anticoagulants are recommended for patients with nonvalvular AF
who have previously suffered a stroke or TIA or whose CHA 2 DS 2 -vasc score is 2 or above:
dabigatran etexilate, rivaroxaban, and apixaban
7. Which out of the following method can be used as initial treatment in recurrent
symptomatic paroxysmal AF?
I. Radiofrequency catheter ablation.
II. Lionization catheter ablation.
III. Catheter ablation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Radiofrequency catheter ablation can be used as initial treatment in recurrent symptomatic

paroxysmal AF
8. Which out of the following Antithrombotic Therapy is recommended in Patients with

No risk factors associated with Nonvalvular Atrial Fibrillation?
I. Aspirin 90-425 mg daily.
II. Aspirin 81-325 mg daily.
III. Aspirin 91-429 mg daily.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Recommendations for Antithrombotic Therapy in Patients with Nonvalvular Atrial Fibrillation

No risk factors Aspirin 81-325 mg daily
9. Which out of the following Antithrombotic Therapy is recommended in Patients having
one moderate risk factors associated with Nonvalvular Atrial Fibrillation?
I. Aspirin 81-325 mg daily or warfarin (INR 2-3).
II. Aspirin 81-325 mg daily or warfarin (INR 3-4).
III. Aspirin 91-425 mg daily or warfarin (INR 3-4).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A

One moderate-risk factor Aspirin 81-325 mg daily or warfarin (INR 2-3)
10. Which out of the following Antithrombotic Therapy is recommended in Patients

having high-risk factor or more than 1 moderate-risk factor associated with Nonvalvular
Atrial Fibrillation?
I. Aspirin.
II. Nifedipine.
III. Warfarin (INR 2-3).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C

Any high-risk factor or more than 1 moderate-risk factor Warfarin (INR 2-3)
11. Which out of the following is included in High-risk factors associated with AF?
I. Hypotension.
II. Prior stroke.
III. Hypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
High-risk factors include prior stroke, TIA, and systemic thromboembolism.
12. Which out of the following is included in High-risk factors associated with AF?
I. Diabetes.
II. Hypertension.
III. Systemic thromboembolism.
Answer: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
High-risk factors include prior stroke, TIA, and systemic thromboembolism.
13. Which out of the following is included in Moderate -risk factors associated with AF?
I. Hypotension.
II. Hypertension.
III. Age older than 75 years.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Moderate-risk factors include age older than 75 years, hypertension, heart failure, left ventricular
function less than 35%, and diabetes mellitus.
14. Which out of the following is included in Moderate -risk factors associated with AF?
I. Age older than 75 years.
II. Diabetes mellitus.
III. Left ventricular function less than 35%.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Moderate-risk factors include age older than 75 years, hypertension, heart failure, left ventricular
function less than 35%, and diabetes mellitus.
15. Which out of the following is included in Risk factors of unknown significance
associated with AF?
I. Thyrotoxicosis.
II. Age older than 75 years.
III. Coronary artery disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Risk factors of unknown significance include female sex, age 65-74 years, coronary artery disease,
and thyrotoxicosis
16. Which out of the following is included in Risk factors of unknown significance
associated with AF?
I. Female.
II. Age 65-74 years.
III. Age older than 75 years.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Risk factors of unknown significance include female sex, age 65-74 years, coronary artery disease,
and thyrotoxicosis
17. Which is a critical component for the management of new-onset AF?

I. Control of atrial rate.
II. Control of ventricular rate.
III. Control of AV conduction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Control of ventricular rate is a critical component of management of new-onset AF.

18. Which is a main determinant of the ventricular rate during AF?
I. Blood Flow.
II. Intrinsic and extrinsic factors that influence atrioventricular (AV) conduction.
III. Blood pressure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The main determinants of the ventricular rate during AF are those intrinsic and extrinsic factors
that influence atrioventricular (AV) conduction.
19. Which factor influences AV nodal conduction?

I. Sympathetic and parasympathetic tone.
II. Blood pressure.
III. Coronary artery disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Underlying sympathetic and parasympathetic tone also influences AV nodal conduction.

20. What is the mechanism of drugs that control heart rate in AF?
I. Decrease AV nodal refractoriness.
II. Increasing AV nodal refractoriness.
III. Increase SA nodal refractoriness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Rate-controlling agents act primarily by increasing AV nodal refractoriness.
21. Which class of drug are first-line agents for rate control in AF?
II. Antiplatelet Agent.
III. Beta-blockers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Beta-blockers and calcium channel blockers are first-line agents for rate control in AF
22. Which drug is commonly used for AF with a rapid ventricular response?
I. Digoxin.
II. Diltiazem.
III. Aspirin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Intravenous diltiazem or metoprolol are commonly used for AF with a rapid ventricular response.
23. Which class of drug is should be used with caution in patients with reactive airway
disease?
I. Anticoagulant.
II. Calcium channel blocker.
III. Beta-blockers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Caution should be exercised in patients with reactive airway disease who are given beta-blockers.
24. Which class of drug is should be used with caution in elderly patient?
I. Metoprolol.
II. Diltiazem.
III. Digoxin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Digoxin can be used in the acute setting but does little to control the ventricular rate in active
patients. As such, it is rarely used as monotherapy. Caution should be exercised in elderly patients
and those with renal failure receiving digoxin.
25. Which class of drug is should be used with caution in renal failure patient having AF?
I. Furosemide.
II. Digoxin.
III. Metoprolol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Digoxin can be used in the acute setting but does little to control the ventricular rate in active
patients. As such, it is rarely used as monotherapy. Caution should be exercised in elderly patients
and those with renal failure receiving digoxin.
26. Which drug is indicated in patients with heart failure and reduced LV function?
I. Digoxin.
II. Propranolol.
III. Atenolol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Digoxin is indicated in patients with heart failure and reduced LV function.

27. Which drug is recommended by ACC/AHA/ESC for use as a rate-controlling agent in
patients with CHF?
I. Amiodarone.
II. Nifedipine.
III. Verapamil.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Amiodarone has a class IIa recommendation from the ACC/AHA/ESC for use as a rate-controlling
agent for patients who are intolerant of or unresponsive to other agents, such as patients with CHF
who may otherwise not tolerate diltiazem or metoprolol.
28. Which drug is recommended by ACC/AHA/ESC for use as a rate-controlling agent in

patients who cannot tolerate diltiazem or metoprolol?
I. Propranolol.
II. Verapamil.
III. Amiodarone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
29. Which class of drug contraindicated in patient with Preexcitation syndrome and AF?
I. Beta-blocker.
II. Calcium channel blockers.
III. Anticoagulant.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
30 Calcium channel blockers and digoxin are 31 contraindicated in these patients; flecainide or
amiodarone can be used instead
30. Which class of drug contraindicated in patient with Preexcitation syndrome and AF?
I. Aspirin.
II. Atenolol.
III. Digoxin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Preexcitation syndrome and AF

Calcium channel blockers and digoxin are 31 contraindicated in these patients; flecainide or
31. Which class of drug are used in patient with Preexcitation syndrome and AF?
I. Digoxin.
II. Amiodarone.
III. Flecainide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Preexcitation syndrome and AF

30 Calcium channel blockers and digoxin are 31 contraindicated in these patients; flecainide or
32. What is the dose of low-molecular-weight heparin used to treat newly diagnosed AF
patient?
I. 0.5 mg/kg bid.
II. 0.75 mg/kg bid.
III. 1 mg/kg bid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Patients with newly diagnosed AF and patients awaiting electrical cardioversion can be started on
intravenous heparin (activated partial thromboplastin time [aptt] of 45-60 seconds) or low-
molecular-weight heparin (1 mg/kg bid).
33. What is pharmacological therapy in Patients with newly diagnosed AF and patients
awaiting electrical cardioversion?
I. Aspirin.
II. Intravenous heparin or low-molecular-weight heparin.
III. Verapamil.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Patients with newly diagnosed AF and patients awaiting electrical cardioversion can be started on
intravenous heparin (activated partial thromboplastin time [aPTT] of 45-60 seconds) or low-
molecular-weight heparin (1 mg/kg bid).
34. Which class of drug can be used as an alternative to warfarin in a higher-risk

population with nonvalvular AF?
I. Oral direct thrombin inhibitors.
II. Oral indirect prothrombin inhibitors.
III. Oral direct prothrombin inhibitors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Oral direct thrombin inhibitors may present an alternative to warfarin in a higher-risk population
with nonvalvular AF
35. Which out of the following anticoagulant used for the treatment of AF does not
require serial INR (PT) blood tests for monitoring?
I. Aspirin.
II. Flecainide.
III. Dabigatran.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Warfarin, dabigatran does not require serial INR (PT) blood tests and is not significantly affected
by almost any medication or vitamin (almost any pill can displace warfarin from serum albumin
and thus increase the INR
36. What may be useful in emergency to restore sinus rhythm in patients with new-onset
atrial fibrillation?
I. Decreasing body weight.
II. Cardioversion.
III. Decreasing blood pressure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Cardioversion may be performed electively or emergently to restore sinus rhythm in patients with
new-onset atrial fibrillation
37. What is correct related to Cardioversion?
I. Is successful when initiated within 7 days after onset of AF.
II. Is successful when initiated within 10 days after onset of AF.
III. Is successful when initiated within 14 days after onset of AF.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Cardioversion is most successful when initiated within 7 days after onset of AF.
38. What is the advantage of pharmacological Cardioversion?

I. Prevents ventricular tachycardia.
II. Do not requiring sedation or anesthesia.
III. Prevents ventricular bradycardia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Pharmacologic cardioversion has the advantage of not requiring sedation or anesthesia, but the
major disadvantage is the risk of ventricular tachycardia and other serious arrhythmias
39. What is the disadvantage of pharmacological Cardioversion?
I. Risk of ventricular bradycardia.
II. Requiring sedation or anesthesia.
III. Risk of ventricular tachycardia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Pharmacologic cardioversion has the advantage of not requiring sedation or anesthesia, but the
major disadvantage is the risk of ventricular tachycardia and other serious arrhythmias
40. What should clinician consider/focus, for Long-term management of atrial fibrillation?
I. Reducing the likelihood of AF recurrence.
II. Reducing AF-related symptoms.
III. Ring SA node activity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Long-term management of atrial fibrillation is focused on reducing the likelihood of AF recurrence,

reducing AF-related symptoms, control of ventricular rate, and reducing stroke risk. As discussed
previously,
41. What should clinician consider/focus, for Long-term management of atrial fibrillation?
I. Restoring SA node activity.
III. Reducing stroke risk.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Long-term management of atrial fibrillation is focused on reducing the likelihood of AF recurrence,

reducing AF-related symptoms, control of ventricular rate, and reducing stroke risk. As discussed
previously,
42. What is the goal of long-term anticoagulation in atrial fibrillation?

I. Reduce the risk of hypertension.
II. Reduce the risk of bleeding.
III. Reduce the risk of thromboembolism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The goal of long-term anticoagulation in atrial fibrillation is to reduce the risk of thromboembolism
43. Which sentence is correct related to the use of Anticoagulation therapy and antiplatelet
therapy in AF patient?
I. Anticoagulation therapy with warfarin is significantly more effective than antiplatelet therapy.
II. Anticoagulation therapy with warfarin is no-significantly effective than antiplatelet therapy.
III. Anticoagulation therapy with warfarin is less effective than antiplatelet therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Anticoagulation therapy with warfarin is significantly more effective than antiplatelet therapy
(relative risk of 40%) if the INR is adjusted
44. What should be international normalized ratio goal in AF patient who are at a
significant risk for stroke on Anticoagulant therapy?
I. Between 1.5 and 2.5.
II. Between 1.5 and 3.0.
III. Between 2.5 and 3.5.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The INR goal in AF is usually between 2 and 3, except in patients who are at a significant risk for
stroke (eg, patients with artificial valves, those with rheumatic heart disease, and those at a high risk
for AF with recurrent prior strokes), in whom the INR should be maintained between 2.5 and 3.5
45. What should be international normalized ratio goal in AF patient on Anticoagulant
therapy?
I. Between 2 and 3.
II. Between 2 and 4.
III. Between 3 and 4.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The INR goal in AF is usually between 2 and 3, except in patients who are at a significant risk for
stroke (eg, patients with artificial valves, those with rheumatic heart disease, and those at a high risk
for AF with recurrent prior strokes), in whom the INR should be maintained between 2.5 and 3.5
46. Which out of the following is the risk factor for Anticoagulant therapy in A F patient?
I. History of bleeding.
II. Age older than 75 years.
III. Age less than 75 years.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The major adverse effect of anticoagulation therapy with warfarin is bleeding. Factors that increase
this risk include the following:
 History of bleeding (the strongest predictive risk factor)
 Age older than 75 years
 Liver or renal disease
 Malignancy
 Thrombocytopenia or aspirin use
 Hypertension
 Diabetes mellitus
 Anemia
 Prior stroke
 Fall risk
 Genetic predisposition
 Supratherapeutic INR
47. Which out of the following is the risk factor for Anticoagulant therapy in AF patient?
I. Therapeutic INR.
II. Liver or renal disease.
III. Malignancy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
48. Which out of the following is the risk factor for Anticoagulant therapy in AF patient?
I. Hypertension.
II. Therapeutic INR.
III. Prior stroke.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
49. Which out of the following is contraindication of warfarin?

I. Diabetes.
II. Pregnancy.
III. Hypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
In addition, because of its teratogenic effects, anticoagulation with warfarin is contraindicated in

pregnant women, especially in the first trimester.
50. Which drug may be used as an alternative to warfarin for the prevention of stroke and
systemic thromboembolism in patients with paroxysmal-to-permanent atrial fibrillation?
I. Nifedipine.
II. Esmolol.
III. Dabigatran.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The guidelines recommend dabigatran may be used as an alternative to warfarin for the prevention
of stroke and systemic thromboembolism in patients with paroxysmal-to-permanent atrial
fibrillation and risk factors for stroke or systemic embolization
51. Which class of drug is used in patient, who develops postoperative AF?
II. Beta-blockers.
III. Anticoagulants.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
In general, patients who develop AF only postoperatively do not need anticoagulation.

Administration of preoperative and postoperative beta-blockers is usually sufficient, as postoperative
AF is usually paroxysmal and tends to terminate spontaneously
52. Which drug prevents early recurrences of paroxysmal AF, in patients who underwent
pulmonary vein isolation?
I. Colchicine.
II. Amiodarone.
III. Lignocaine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Research has shown that the administration of colchicine in patients who underwent pulmonary
vein isolation helped to prevent early recurrences of paroxysmal AF.
53. What is the side effect of warfarin?

I. Thyrotoxicosis.
II. Bleeding.
III. Skin necrosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Adverse effects of warfarin therapy are not limited to bleeding, however; other important side effects
include skin necrosis within the first few days of therapy and cholesterol embolization to the skin or
visceral organs in the first few weeks of therapy
54. According to the American Academy of Neurology recommendations, which class of
drug is used in patient with nonvalvular AF and a history of transient ischemic attack
(TIA) or stroke?
I. Antiplatelet.
II. Anticoagulants.
III. Beta blockers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
In 2014, the American Academy of Neurology released level B and C recommendations on the
prevention of stroke in patients with nonvalvular AF
Patients with nonvalvular AF and a history of transient ischemic attack (TIA) or stroke should
routinely be offered anticoagulation therapy.
55. According to the American Academy of Neurology recommendations, which drug

should be administered in patients with a higher intracranial bleeding risk?
I. Sumatriptan.
II. Dabigatran.
III. Rivaroxaban.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Dabigatran, rivaroxaban, or apixaban, which are associated with a lower risk of intracranial
hemorrhage than warfarin, should be administered to patients with a higher intracranial bleeding
risk
should be administered in patients who refuse or are unable to undergo frequent periodic
testing of their international normalized ratio (INR)?
I. Apixaban.
II. Rivaroxaban.
III. Aspirin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Dabigatran, rivaroxaban, or apixaban should also be administered to patients who refuse or are
unable to undergo frequent periodic testing of their international normalized ratio (INR)

should be administered in patients with a higher intracranial bleeding ris k?
I. Apixaban.
II. Aspirin.
III. Liraglutide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Dabigatran, rivaroxaban, or apixaban, which are associated with a lower risk of intracranial
hemorrhage than warfarin, should be administered to patients with a higher intracranial bleeding
risk
58. Which drug is recommended in developing countries in patients who have a moderate
stroke risk?
I. Triflusal in combination with Antiplatelet.
II. Triflusal in combination with moderate anticoagulation.
III. Triflusal in combination with beta blockers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
In developing countries, where newer anticoagulants may be unavailable or too expensive, the
guidelines state that in patients who have a moderate stroke risk, the use of triflusal 600 mg/day
in combination with moderate anticoagulation (INR 1.25-2.0) with acenocoumarol is probably
more effective in reducing stroke risk than is the use of acenocoumarol by itself at the higher INR
(2.0-3.0)
59. Which test can be helpful in evaluation of heart rate variability in AF patient?
I. Twenty-four hour Holter monitoring
II. Twenty-eight hour Holter monitoring.
III. Exercise-treadmill testing.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Twenty-four hour Holter monitoring or exercise-treadmill testing can be helpful in evaluating heart
rate variability
60. Which class of drug is the cornerstone of rate control in long-standing AF?
I. Purkinje fiber blocking medications.
II. SA nodal blocking medications.
III. AV nodal blocking medications.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
AV nodal blocking medications are the cornerstone of rate control in long-standing AF
61. Which out of the following drug have established efficacy in the pharmacologic
conversion of AF to sinus rhythm?
I. Atenolol.
II. Flecainide.
III. Propafenone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Antiarrhythmic drugs (flecainide, propafenone, dofetilide, amiodarone) have established efficacy in

the pharmacologic conversion of AF to sinus rhythm
62. Why amiodarone is drug of choice in patients with cardiac disease such as coronary
artery disease or systolic or diastolic heart failure?
I. Because of its increased proarrhythmic effects.
II. Because of its decreased proarrhythmic effects.
III. Because of its decreased arrhythmic effects.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Nevertheless, in patients with cardiac disease such as coronary artery disease or systolic or diastolic
heart failure, amiodarone becomes the drug of choice because of its decreased proarrhythmic effects
compared with other antiarrhythmic drugs
63. Which condition is associated with drug Sotalol?

I. QT interval prolongation.
II. Torsade de pointes.
III. Obesity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Sotalol is associated with the risk of QT interval prolongation and torsade de pointes.
64. Which out of the following sentence is true for Catheter ablation?
I. First line therapy for AF.
II. It is recommended as an alternative to pharmacologic therapy.
III. Used to prevent recurrent paroxysmal AF in significantly symptomatic patients with little or
no structural heart disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Catheter ablation performed in experienced centers is recommended in the 2011 update to the
ACCF/AHA/HRS AF guidelines for several indications
It is recommended as an alternative to pharmacologic therapy to prevent recurrent paroxysmal AF
in significantly symptomatic patients with little or no structural heart disease [7] or severe pulmonary
disease (Class I, evidence level A
65. Which out of the following is Device-based therapy for AF?

I. Triple site atrial pacemakers.
II. Single- and dual-site atrial pacemakers.
III. Single- and dual-site ventricular pacemaker.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Device-based therapies under investigation include single- and dual-site atrial pacemakers to
prevent AF, as well as atrial defibrillators to rapidly restore sinus rhythm.
66. Which out of the following Device-based therapy is used to rapidly restore sinus
rhythm in AF?
II. Cardiogram.
III. Atrial defibrillators.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Device-based therapies under investigation include single- and dual-site atrial pacemakers to
prevent AF, as well as atrial defibrillators to rapidly restore sinus rhythm.
67. Which out of the following patient should undergo urgent cardioversion?
I. Hemodynamically unstable.
II. Hemodynamically stable.
III. Have severe dyspnea or chest pain with atrial fibrillation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Patients who are hemodynamically unstable, who have severe dyspnea or chest pain with atrial
fibrillation, or who have preexcited atrial fibrillation should undergo urgent cardioversion
68. What is Direct Current cardioversion?
I. Delivery of electrical current that is synchronized to the QRS complexes.
II. Delivery of electrical current that is synchronized to the PRS complexes.
III. Delivery of electrical current that is synchronized to the RSQ complexes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
DC cardioversion is the delivery of electrical current that is synchronized to the QRS complexes; it
can be delivered in monophasic or biphasic waveforms
69. What are the complications of electrical cardioversion?

I. Pulmonary edema.
II. Hypotension.
III. Hypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Other complications of electrical cardioversion may include pulmonary edema, hypotension,

myocardial dysfunction, and skin burns, which may be avoided with the use of steroid cream and
proper technique.
70. Which out of the following approaches is used for the compartmentalization of the
atria in AF?
I. Single cut made to atria.
II. Multiple cuts are made to the atria.
III. Radiofrequency ablation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Two approaches to compartmentalization of the atria are surgical, by which multiple cuts are made
to the atria, and radiofrequency ablation
71. What is the synonym of

I. Single cut made to atria.
II. Surgical compartmentalization of the atria.
III. Multiple cuts are made to the atria.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
as an exciting approach with the potential to cure atrial fibrillation

72. Which sign and symptom indicates potential complications of RF ablation of atrial
fibrillation?
I. Hypertension.
II. Cardiac tamponade.
III. Pulmonary vein stenosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Patients who undergo RF ablation of atrial fibrillation should be monitored for the signs and
symptoms of potential complications, such as the following:
 Cardiac perforation
 Pericardial effusion
 Cardiac tamponade
 Vascular access complications
 Pulmonary vein stenosis
73. What is the pharmacological mechanism of Diltiazem?

I. Beta blocker.
II. Calcium Channel blocker.
III. Antithrombine III inhibitor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Diltiazem ;During depolarization, it inhibits calcium ions from entering the slow channels or
voltage-sensitive areas of vascular smooth muscle and myocardium
74. Which drug falls in class Calcium channel blocker?
I. Atenolol.
II. Diltiazem.
III. Verapamil.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Calcium Channel blockers

Diltiazem, Verapamil
75. What is the pharmacological mechanism of Propranolol?

I. Nonselective beta-adrenergic receptor blocker.
III. Class II antiarrhythmic agent.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Propranolol is a nonselective beta-adrenergic receptor blocker as well as a class II antiarrhythmic,

with membrane-stabilizing activity that decreases the automaticity of contractions
76. What is the half life of Esmolol?
I. 8 min.
II. 9 min.
III. 10 min.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Esmolol;A short half-life of 8 min allows for titration to the desired effect and quick discontinuation
if needed
77. Which drug falls in class Beta-adrenergic Receptor Blockers?

I. Nifedipine.
II. Esmolol.
III. Atenolol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Beta-adrenergic Receptor Blockers

Esmolol, Propranolol, Atenolol, Metoprolol
78. What is the pharmacological mechanism of Digoxin?
I. Beta blocker.
III. Slows the sinus node and AV node via vagomimetic effects.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Digoxin slows the sinus node and AV node via vagomimetic effects and is not very effective if
sympathetic tone is increased
79. Which drug falls in class Beta-adrenergic Cardiac glycosides?

I. Verapamil.
II. Digoxin.
III. Liraglutide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Cardiac glycosides
Digoxin
80. Quinidine is contraindicated in patients with-
I. Prolonged qrc baseline (>460 milliseconds).
II. Prolonged qpc baseline (>460 milliseconds).
III. Prolonged qtc baseline (>460 milliseconds).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Quinidine;It should not be used in patients with a prolonged qtc baseline (>460 milliseconds)
81. What is the main ECG manifestation with all class IA antiarrhythmic agents?
I. QRP and qtc prolongation.
II. QRS and qtc prolongation.
III. QRT and qtc prolongation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
As with all class IA agents, QRS and qtc prolongation are the main ECG manifestations
82. Which drug falls in class Antiarrhythmics, class IA?
I. Warfarin.
II. Quinidine.
III. Procainamide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Antiarrhythmics, class IA, Quinidine, procainamide, and disopyramide
83. Which drug is indicated for the treatment of paroxysmal atrial fibrillation/flutter
associated with disabling symptoms and paroxysmal supraventricular tachycardias?
I. Warfarin.
II. Flecainide.
III. Aspirin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Flecainide ;It is indicated for the treatment of paroxysmal atrial fibrillation/flutter associated with
disabling symptoms and paroxysmal supraventricular tachycardias, including AV nodal reentrant
tachycardia, AV reentrant tachycardia, and other supraventricular tachycardias of unspecified
mechanism associated with disabling symptoms in patients without structural heart disease.
84. Which drug falls in class Antiarrhythmics, class IC?
I. Propafenone.
II. Digoxin.
III. Flecainide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Antiarrhythmics, class IC, Propafenone, Flecainide
85. What is the pharmacological mechanism of Ibutilide?

I. Shorten repolarization.
II. Prolongs repolarization.
III. Increasing the slow inward sodium current and by blocking the delayed rectifier current with
rapid onset.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Ibutilide ;It prolongs repolarization by increasing the slow inward sodium current and by blocking
the delayed rectifier current with rapid onset.
86. What is true for sotalol?
I. Class III agent with beta-blocking effects.
II. Effective in the maintenance of sinus rhythm.
III. Calcium channel blocker.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Sotalol is a class III agent with beta-blocking effects. It is effective in the maintenance of sinus
rhythm
87. What should be monitored during loading dose of Amiodarone?

I. Tachycardia.
II. Hypertension.
III. Bradyarrhythmias.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Amiodarone ;During loading, patients must be monitored for bradyarrhythmias
88. What is maintenance dose of Amiodarone for atrial fibrillation?

I. 100 mg/d.
II. 200 mg/d.
III. 300 mg/d.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Amiodarone ;usual maintenance dose for atrial fibrillation is 200 mg/d
89. Which drug falls in class Antiarrhythmics, class III?

I. Enoxaparin.
II. Amiodarone.
III. Dofetilide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Antiarrhythmics, class III, Amiodarone, Sotalol, Dofetilide, Ibutilide
90. Which antiarrhythmic agent has properties belonging to all 4 Vaughn-Williams

antiarrhythmic classes?
I. Dronedarone.
II. Aspirin.
III. Enoxaparin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Dronedarone is an antiarrhythmic agent with properties belonging to all 4 Vaughn-Williams

antiarrhythmic classes
91. What is the pharmacological mechanism of Warfarin?
I. Increase synthesis of vitamin K dependent coagulation factors.
II. Interferes with the hepatic synthesis of vitamin K dependent coagulation factors.
III. Antiplatelet activity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Warfarin interferes with the hepatic synthesis of vitamin K dependent coagulation factors.
92. What is the pharmacological mechanism of Enoxaparin?

I. Augments the activity of antithrombin III.
II. Promotes conversion of fibrinogen to fibrin.
III. Prevents the conversion of fibrinogen to fibrin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Enoxaparin is a low molecular weight heparin. It augments the activity of antithrombin III and
prevents the conversion of fibrinogen to fibrin
93. What is the pharmacological mechanism of heparin?

I. Augments the activity of antithrombin III.
II. Promotes conversion of fibrinogen to fibrin.
III. Prevents the conversion of fibrinogen to fibrin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Heparin augments the activity of antithrombin III and prevents the conversion of fibrinogen to
fibrin
94. What is the use of anticoagulant in AF?
I. To prevent hypertension.
II. To prevent Hypotension.
III. Prevent thromboembolic complications.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Anticoagulants are used to prevent thromboembolic complications
95. Which drug falls in class Anticoagulants?

I. Aspirin.
II. Heparin.
III. Dabigatran.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Anticoagulants
Heparin, Enoxaparin, Warfarin, Dabigatran Rivaroxaban
96. Which drug falls in class Anticoagulants?

I. Rivaroxaban.
II. Enoxaparin.
III. Aspirin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Anticoagulants
Heparin, Enoxaparin, Warfarin, Dabigatran Rivaroxaban
97. What is the pharmacological mechanism of Aspirin?
I. Beta blocker.
II. Inhibits platelet aggregation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Aspirin irreversibly inhibits platelet aggregation by inhibiting platelet cyclooxygenase. This, in turn,
inhibits conversion of arachidonic acid to PGI2 (potent vasodilator and inhibitor of platelet
activation) and thromboxane A2
98. Which drug is indicated for reduction of atherothrombotic events following recent
stroke?
I. Nifidine.
II. Verapamil.
III. Clopidogrel.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Clopidogrel It is indicated for reduction of atherothrombotic events following recent stroke.

99. What is the pharmacological mechanism of Clopidogrel?
I. Inhibits adenosine diphosphate (ADP) binding to the platelet receptor.
II. Inhibits cyclic-GMP.
III. Inhibits cyclic-AMP.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Clopidogrel selectively inhibits adenosine diphosphate (ADP) binding to the platelet receptor and
subsequent ADP-mediated activation of the glycoprotein gpiib/iiia complex, thereby inhibiting
platelet aggregation.
100. Which drug falls in class Antiplatelet?

I. Clopidogrel.
II. Aspirin.
III. Telmisartan.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Antiplatelet Agents
Clopidogrel, Aspirin
HYPERTENSION
1. What is hypertension?
I. Increase in blood pressure.
II. Increase in arterial blood volume.
III. Increase in venous blood level.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Blood pressure is the increase in blood pressure caused by numerous factors.
2. What is the value of blood pressure in Hypertension?

I. Systolic blood pressure (SBP) = 140 mm Hg.
II. Diastolic blood pressure (DBP) =90 mm Hg.
III. Systolic blood pressure (SBP) = 120 mmhg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Hypertension is defined as a systolic blood pressure (SBP) of 140 mm Hg or more, or a diastolic blood
pressure (DBP) of 90 mm Hg
3. As per the Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure (JNC 7), what is the value of normal
blood pressure in human?
I. Systolic lower than 120 mm Hg, diastolic lower than 80 mm Hg.
II. Systolic 120-139 mm Hg, diastolic 80-89 mm Hg.
III. Systolic lower than 110 mm Hg, diastolic lower than 90 mm Hg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer::A
As per the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure (JNC 7), the value of normal blood pressure in human:
Systolic lower than 120 mm Hg, diastolic lower than 80 mm Hg
Evaluation, and Treatment of High Blood Pressure (JNC 7), what is the value of blood
pressure in Pre-Hypertension?
I. Systolic 110-139 mm Hg, diastolic 80-89 mm Hg.
III. Systolic 140-159 mm Hg, diastolic 90-99 mm Hg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer::B
and Treatment of High Blood Pressure (JNC 7), the value of blood pressure in Pre-Hypertension:
Systolic 120-139 mm Hg, diastolic 80-89 mm Hg
pressure in Stage-I Hypertension?
III. Systolic 140-159 mm Hg, diastolic 90-99 mm Hg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer::C
and Treatment of High Blood Pressure (JNC 7), the value of blood pressure in Stage-I Hypertension:
Systolic 140-159 mm Hg, diastolic 90-99 mm Hg
pressure in Stage 2 Hypertension?

III. Systolic 160 mm Hg or greater, diastolic 100 mm Hg or greater.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer::C
Stage 2: Systolic 160 mm Hg or greater, diastolic 100 mm Hg or greater

7. Which factors are involved in development of primary Hypertension?
I. Disease induced.
II. Environmental causes.
III. Genetic.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer::E
Hypertension may be primary, which may develop as a result of environmental or genetic causes
8. Which factors are involved in development of secondary Hypertension?

I. Endocrine causes.
II. Renal causes.
III. Pulmonary causes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Secondary, which has multiple etiologies, including renal, vascular, and endocrine causes
9. Which type of hypertension is based on multiple etiologies?
I. Primary.
II. Secondary.
III. Prehypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:B
Primary or essential hypertension accounts for 90-95% of adult cases, and secondary hypertension
accounts for 2-10% of cases
10. Which parameters are involved during evaluation of Hypertension?

I. Patient's Drug History.
II. Medical history.
III. Patient's Blood pressure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:E
a focused medical history and physical examination, and obtaining results of routine laboratory studies
11. From following which are the clinical findings for suspected secondary hypertension
and/or evidence of target-organ disease?
I. CBC.
II. Chest radiograph.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:D
Suspected secondary hypertension and/or evidence of target-organ disease, such as CBC, chest
radiograph, uric acid, and urine microalbumin
12. Which type of relationship appears between systemic arterial pressure and morbidity?
I. Quantitative.
II. Qualitative.
III. Independent.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:A
The relationship between systemic arterial pressure and morbidity appears to be quantitative rather
than qualitative
13. As per JNC 7 which are at risk for progression to hypertension?
I. Prehypertension.
II. Stage-1.
III. Stage-2.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:A
With prehypertension are at risk for progression to hypertension and that lifestyle modifications are
important preventive strategies
14. What defines Hypertensive crisis?

I. BP more than 180/120 mm Hg.
II. BP more than 190/120 mm Hg.
III. BP more than 180/130 mm Hg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:A
Especially severe cases of hypertension, or hypertensive crises, are defined as a BP of more than 180/120
mm Hg and may be further categorized as hypertensive emergencies or urgencies
15. Which condition is characterized by evidence of impending or progressive target organ
dysfunction?
I. Hypertensive urgencies.
II. Hypertensive emergencies.
III. Hypertensive crisis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:B
Hypertensive emergencies are characterized by evidence of impending or progressive target organ

dysfunction
16. Which condition is characterized by evidence of impending or progressive target organ

dysfunction?
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:A
Whereas hypertensive urgencies are those situations without progressive target organ dysfunction
17. In which condition BP should be aggressively lowered within minutes to an hour by no
more than 25%?
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:B
In hypertensive emergencies, the BP should be aggressively lowered within minutes to an hour by no

more than 25%, and then lowered to 160/100-110 mm Hg within the next 2-6 hours
18. which out of the following is the mechanism for high-output hypertension?
I. Increased cardiac output.
II. Adrenergic hyperactivity.
III. Decreased peripheral vascular resistance.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
High-output hypertension results from decreased peripheral vascular resistance and concomitant
cardiac stimulation by adrenergic hyperactivity and altered calcium homeostasis. A second mechanism
manifests with normal or reduced cardiac output and elevated systemic vascular resistance due to
increased vasoreactivity.
19. Which out of the following is the overlapping mechanism for high-output hypertension?
I. Increases circulating blood volume.
II. Decreased salt and water reabsorption.
III. Increased salt and water reabsorption.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:F
Another (and overlapping) mechanism is increased salt and water reabsorption (salt sensitivity) by
the kidney, which increases circulating blood volume
20. Which are the genetic components that contribute to hypertension?

I. Obesity.
II. Diabetes.
III. Atherosclerosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:D
Furthermore, obesity, diabetes, and heart disease also have genetic components and contribute to
hypertension
21. Which type of Epigenetic phenomena implicated in the pathogenesis of hypertension
I. Non coding DNA.
II. DNA methylation.
III. Histone modification.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:E
Epigenetic phenomena, such as DNA methylation and histone modification, have also been
implicated in the pathogenesis of hypertension
22. Which factors affecting during pregnancy to increase renin-angiotensin expression in the
fetus
I. Vitamin insufficiency.
II. Maternal water deprivation.
III. Protein restriction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:E
Maternal water deprivation and protein restriction during pregnancy increase renin-angiotensin
expression in the fetus
23. What are the Secondary causes of hypertension related to single genes?
I. 17 beta-hydroxylase enzyme deficiency.
II. Glucocorticoid-remediable hyperaldosteronism.
III. Liddle syndrome.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:E
Secondary causes of hypertension related to single genes are very rare. They include Liddle syndrome,
glucocorticoid-remediable hyperaldosteronism, 11 beta-hydroxylase and 17 alpha-hydroxylase
deficiencies, the syndrome of apparent mineralocorticoid excess, and pseudohypoaldosteronism type II
24. Which enzyme deficiency is the Secondary cause of hypertension related to single genes?
I. 17 beta-hydroxylase enzyme deficiency.
II. 17 alpha-hydroxylase enzyme deficiency.
III. 11 beta-hydroxylase enzyme deficiency.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Secondary causes of hypertension related to single genes are very rare. They include Liddle syndrome,
glucocorticoid-remediable hyperaldosteronism, 11 beta-hydroxylase and 17 alpha-hydroxylase
deficiencies, the syndrome of apparent mineralocorticoid excess, and pseudohypoaldosteronism type II
25. Which are the renal causes for Hypertension?
I. Renal ischemia.
II. Polycystic kidney disease.
III. Urinary tract obstruction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Renal causes (2.5-6%) of hypertension

Polycystic kidney disease
Chronic kidney disease
Urinary tract obstruction
Renin-producing tumor
Liddle syndrome
26. Which are the vascular causes of Hypertension?

I. Vasculitis.
II. Dysplasia.
III. Coarctation of aorta.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Vascular causes include the following:

Coarctation of aorta
Vasculitis
Collagen vascular disease
27. What are the exogenous causes for Hypertension?
I. Administration of glucocorticoids.
II. Administration of Aldosterone.
III. Administration of steroids.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:C
Endocrine causes ;Exogenous causes include administration of steroids
28. How oral contraceptive induces hypertension?

I. It is the progesterone component of oral contraceptives.
II. Activation of the renin-angiotensin-aldosterone system.
III. Hepatic synthesis of angiotensinogen.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:E
Oral contraceptive use. Activation of the renin-angiotensin-aldosterone system (RAAS) is the likely
mechanism, because hepatic synthesis of angiotensinogen is induced by the estrogen component of oral
contraceptives
29. Which drugs have adverse effect on BP?
I. Steroids.
II. NSAIDS.
III. Ramipril.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:B
30. How NSAIDs contribute to the induction of hypertension in a normotensive or

controlled hypertensive patient?
I. Inhibition of COX-2 inhibit its natriuretic effect, which in turn increases sodium retention.
II. Decreases production of vasoconstricting factors.
III. Inhibit the vasodilating effects of prostaglandins.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
NSAIDs block both cyclooxygenase-1 (COX-1) and COX-2 enzymes. The inhibition of COX-2 can
inhibit its natriuretic effect, which, in turn, increases sodium retention. NSAIDs also inhibit the
vasodilating effects of prostaglandins and the production of vasoconstricting factors namely,
endothelin-1. These effects can contribute to the induction of hypertension in a normotensive or
controlled hypertensive patient
31. Which out of the following Endogenous hormonal condition that can cause
hypertension?
I. Goiter.
II. Pheochromocytoma.
III. Congenital adrenal hyperplasia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Endogenous hormonal
 Primary hyperaldosteronism
 Cushing syndrome
 Pheochromocytoma
 Congenital adrenal hyperplasia
32. Which out of the following Neurogenic causes can induce hypertension?
I. Sclerosis.
II. Brain tumor.
III. Intracranial hypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Neurogenic causes include the following:

Brain tumor
Bulbar poliomyelitis
Intracranial hypertension
33. Which out of the following Drugs and toxins can cause hypertension?
I. Erythropoietin.
II. Licorice.
III. Digoxin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Drugs and toxins that cause hypertension include the following:

Erythropoietin
Adrenergic medications
Decongestants containing ephedrine
Herbal remedies containing licorice (including licorice root) or ephedrine (and ephedra)
Nicotine
34. Which out of the following Drugs and toxins can cause hypertension?
I. Spironolactone.
II. Alcohol.
III. Tacrolimus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Drugs and toxins that cause hypertension include the following:

Alcohol
Cocaine
Cyclosporine, tacrolimus
35. Which out of the following is most common form of hypertensive emergency?
I. Unexplained rise in BP in a patient with chronic essential hypertension.
II. Tubulointerstitial nephron.
III. Primary glomerulonephritis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The most common hypertensive emergency is a rapid unexplained rise in BP in a patient with chronic
essential hypertension
36. What is the cause of Non dipping?

I. Frequent apneic/hypopneic episodes.
II. Hypopneic episodes.
III. Apneic episodes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Nondipping is thought to be caused by frequent apneic/hypopneic episodes that end with arousals
associated with marked spikes in BP that last for several seconds
37. What is the most common cause of hypertensive emergencies in patients?
I. Abrupt discontinuation of their medications.
II. History of inadequate hypertensive treatment.
III. Patient compliance.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Most patients who develop hypertensive emergencies have a history of inadequate hypertensive
treatment or an abrupt discontinuation of their medications.
38. which drug can cause hypertensive emergencies on abrupt withdrawal?

I. Telmisartan.
II. Furosemide.
III. Clonidine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Other causes of hypertensive emergencies include the use of recreational drugs, abrupt clonidine
withdrawal, post pheochromocytoma removal, and systemic sclerosis
39. Which out if the following renal parenchymal disease can cause of hypertensive
emergencies?
I. Chronic pyelonephritis.
II. Tubulointerstitial nephron.
III. Primary glomerulonephritis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Renal parenchymal disease: chronic pyelonephritis, primary glomerulonephritis, tubulointerstitial

nephritis accounts for 80% of all secondary causes)
40. Which out if the following Systemic disorders with renal involvement can cause of
hypertensive emergencies?
I. Sclerosis.
II. Systemic lupus erythematosus.
III. Systemic sclerosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Systemic disorders with renal involvement: systemic lupus erythematosus, systemic sclerosis, vasculitides
41. Which out if the following Renovascular disease can cause of hypertensive emergencies?
I. Atherosclerotic disease.
II. Kidney stone.
III. Fibromuscular dysplasia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Renovascular disease: atherosclerotic disease, fibromuscular dysplasia, polyarteritis nodosa
42. Which out if the following Endocrine disease can cause of hypertensive emergencies?
I. Dwarfism.
II. Pheochromocytoma.
III. Cushing syndrome.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Endocrine disease: pheochromocytoma, Cushing syndrome, primary hyperaldosteronism
43. Which out if the following Drug can cause of hypertensive emergencies?
I. Amphetamines.
II. Reserpine.
III. Clonidine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Drugs: cocaine,amphetamines, cyclosporine, clonidine (withdrawal), phencyclidine, diet pills, oral

contraceptive pills
44. Which out if the following Drug interactions can cause of hypertensive emergencies?
I. Monoamine oxidase inhibitors with antihistamines.
II. Monoamine oxidase inhibitors with tricyclic antidepressants.
III. Monoamine oxidase inhibitors with arginine-containing food.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Drug interactions: monoamine oxidase inhibitors with tricyclic antidepressants, antihistamines, or

tyramine-containing food
45. Which out if the following CNS conditions can cause of hypertensive emergencies?
I. CNS trauma.
II. Postoperative hypertension.
III. Preoperative hypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Central nervous system factors:

CNS trauma or spinal cord disorders, such as Guillain-Barré syndrome
Coarctation of the aorta
Preeclampsia/eclampsia
Postoperative hypertension
46. The JNC 7 identifies which out of the following as major cardiovascular risk factors?
I. Glomerular filtration rate less than 60 ml/min.
II. Glomerular filtration rate more than 60 ml/min.
III. Glomerular filtration rate 60 ml/min.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Estimated glomerular filtration rate less than 60 ml/min
47. Which factor plays important role in morbidity and mortality of hypertensive
emergencies?
I. Extent of organ dysfunction.
II. Extent of end-organ dysfunction.
III. Degree to which BP is controlled.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The morbidity and mortality of hypertensive emergencies depend on the extent of end-organ
dysfunction on presentation and the degree to which BP is controlled subsequently
48. Which is one of the possible complications of long-standing hypertension?
I. Nephrolithiasis.
II. Nephrosclerosis.
III. Stoke.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Nephrosclerosis is one of the possible complications of long-standing hypertension
49. Which out of the following sentence is correct for hypertension?

I. Is a lifelong disorder.
II. Short-term lifestyle modifications and pharmacologic therapy is required.
III. Long-term lifestyle modifications and pharmacologic therapy is required.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Hypertension is a lifelong disorder. For optimal control, a long-term commitment to lifestyle

modifications and pharmacologic therapy is required
50. What are possible outcome of patient education and counselling in hypertension?
I. Improve patient compliance.
II. Reduce cardiovascular risk factors.
III. Patient can take non-DASH diet.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Repeated in-depth patient education and counseling not only improve compliance with medical
therapy but also reduce cardiovascular risk factors
51. Which strategies can be implemented to decrease cardiovascular disease risk in

hypertension?
I. Prevention and treatment of obesity.
II. Adequate dietary intake of zinc, born etc.
III. Appropriate amounts of aerobic physical activity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Various strategies to decrease cardiovascular disease risk include the following:

 Prevention and treatment of obesity: an increase in body mass index (BMI) and waist
circumference is associated with an increased risk of developing conditions with high
cardiovascular risk, such as hypertension, diabetes mellitus, impaired fasting glucose, and left
ventricular hypertrophy [LVH] [45]
 Appropriate amounts of aerobic physical activity
hypertension?
I. Diet rich of buffalo milk.
II. Diets low in salt, total fat, and cholesterol.
III. Limited alcohol consumption.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Diets low in salt, total fat, and cholesterol
 Adequate dietary intake of potassium, calcium, and magnesium
 Limited alcohol consumption
 Avoidance of cigarette smoking
 Avoidance of the use of illicit drugs, such as cocaine

hypertension?
I. Avoidance of cigarette smoking.
II. Adequate dietary intake of potassium, calcium, and magnesium.
III. Use of cocaine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Diets low in salt, total fat, and cholesterol
 Adequate dietary intake of potassium, calcium, and magnesium
 Limited alcohol consumption
 Avoidance of cigarette smoking
 Avoidance of the use of illicit drugs, such as cocaine
54. Which out of the following information does clinician extract during detailed patient
history?
I. Extent of end-organ damage.
II. Assessment of lungs.
III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
A detailed history should extract the following information:

 Extent of end-organ damage (eg, heart, brain, kidneys, eyes)

 Exclusion of secondary causes of hypertension
55. How many times should clinician measures blood pressure before he/she defines a person
hypertensive?
I. 2
II. 3
III. 4
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Following the documentation of hypertension, which is confirmed after an elevated blood pressure
follow-up visits after initial screening

56. The JNC 7 identifies which out of the following as targets of end-organ damage?
I. Left ventricular hypertrophy.
II. Asthma.
III. Angina.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) identifies the following as
targets of end-organ damage[3] :
 Heart: left ventricular hypertrophy, angina/previous myocardial infarction, previous coronary
revascularization, and heart failure
 Brain: stroke or transient ischemic attack, dementia
I. BMI < 25 kg/m 2
II. BMI > 30 kg/m 2
III. Elevated LDL cholesterol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The JNC 7 identifies the following as major cardiovascular risk factors[3] :


component of metabolic syndrome
 Diabetes mellitus: component of metabolic syndrome
 2
): component of metabolic syndrome
I. Glomerular filtration rate more than 60 ml/min.
II. Tobacco use.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The JNC 7 identifies the following as major cardiovascular risk factors[3] :

 Tobacco use, particularly cigarettes, including chewing tobacco
 Estimated glomerular filtration rate less than 60 ml/min
 Diabetes
59. Which parameter should clinician consider while obtaining

I. Use of over-the-counter medications.
II. Use of herbal medicines.
III. Use of.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
-the-counter medications; herbal medicines such as herbal

tea containing licorice
60. Which in patient history suggest the of pheochromocytoma?
I. Palpitations.
II. Sweating.
III. Labile hypotension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
A history of sweating, labile hypertension, and palpitations suggests the diagnosis of

pheochromocytoma.
61. What are the symptoms of hypothyroidism?

I. Cold tolerance.
II. Bradycardia.
III. Tachycardia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
A history of cold or heat tolerance, sweating, lack of energy, and bradycardia or tachycardia may
indicate hypothyroidism or hyperthyroidism
62. Which out of the following sentence is correct for the measurement of blood pressure?
I. Average of 3 blood pressure reading should be taken.
II. Blood pressure reading are taken 3 min apart.
III. Blood pressure reading are taken 2 min apart.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
At any given visit, an average of 3 blood pressure readings taken 2 minutes apart using a mercury
manometer is preferable
63. Why clinicians check blood pressure in both arms and in one leg to avoid on the first
visit of patient?
I. To avoid miss-diagnosis of coarctation of aorta.
II. To avoid miss-diagnosis of subclavian artery stenosis.
III. To avoid miss-diagnosis of myocytes necrosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
On the first visit, blood pressure should be checked in both arms and in one leg to avoid missing the
diagnosis of coarctation of aorta or subclavian artery stenosis
I. Should be measured in sitting positions.
II. Should be measured in supine positions.
III. Should be measured in both the supine and sitting positions.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Blood pressure should be measured in both the supine and sitting positions, auscultating with the bell
of the stethoscope
65. Which common practice do cliniciAnswer: follow during measurement of blood

pressure?
I. Document phase V of Korotkoff sounds as the diastolic pressure.
II. Document phase IV of Korotkoff sounds as the diastolic pressure.
III. Document phase IV of Korotkoff sounds as the diastolic pressure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The common practice is to document phase V (a disappearance of all sounds) of Korotkoff sounds as
the diastolic pressure
I. Ambulatory blood pressure monitoring provides a more accurate result.
II. Home blood pressure monitoring provides a more accurate result.
III. Office blood pressure monitoring provides a more accurate result.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Ambulatory or home blood pressure monitoring provides a more accurate prediction of cardiovascular
risk than do office blood pressure readings
67. Which term is used for loss of the usual physiologic nocturnal drop in blood pressure
and is associated with an increased cardiovascular risk
I. Non-dipping.
II. Dipping.
III. Egmaly.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Non-dipping" is the loss of the usual physiologic nocturnal drop in blood pressure and is associated
with an increased cardiovascular risk.
68. What is the value of blood pressure that is associated with a significant incidence of
strokes?
I. Diastolic pressure <100 mm Hg and systolic pressure > 160 mm Hg.
II. Diastolic pressure >100 mm Hg and systolic pressure > 160 mm Hg.
III. Diastolic pressure >100 mm Hg and systolic pressure < 160 mm Hg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Both the high systolic and diastolic pressures are harmful; a diastolic pressure of more than 100 mm
Hg and a systolic pressure of more than 160 mm Hg are associated with a significant incidence of
strokes
69. What is the effect of hypertension on cardiac myocytes?

I. Myocytes become shortened and show nucleomegaly.
II. Myocytes become enlarged and do not show nucleomegaly.
III. Myocytes become enlarged and show nucleomegaly.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The main pathologic findings are in the heart, which shows an increase in mass caused principally by
left ventricular hypertrophy. Histologically, the individual myocytes are enlarged and show
hypertension have an increased incidence of arrhythmia and death

70. Which condition is included in hypertensive heart disease?
I. Pulmonary oedema.
II. Coronary artery disease.
III. Cardiac arrhythmias.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Thus, hypertensive heart disease is a term applied generally to heart diseases such as LVH, coronary
artery disease, cardiac arrhythmias, and CHF that are caused by director in direct effects of elevated
BP
71. What is the outcome of Uncontrolled and prolonged BP elevation?

I. Changes in the myocardial structure.
II. Changes in coronary vasculature.
III. Shortening of myocytes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Uncontrolled and prolonged BP elevation can lead to a variety of changes in the myocardial structure,
coronary vasculature, and conduction system of the heart.
72. Which out of the following is correct for systemic hypertension?
I. Is less common in children than in adults.
II. Is less common in adults than in children.
III. Is less common in children and adults.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Systemic hypertension is less common in children than in adults, but the incidence of hypertension in
children is approximately 1-5%.
73. Which is the most common medical problem encountered during pregnancy?
I. Hypertension.
II. Diabetes.
III. diseases.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Hypertension is the most common medical problem encountered during pregnancy, complicating 2-
3% of pregnancies
74. Which out of the following is not a class of hypertensive disorders during pregnancy?
I. Gestational hypertension.
II. Postural hypertension.
III. Preeclampsia superimposed on chronic hypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Hypertensive disorders during pregnancy are classified into the 4 following categories
Chronic hypertension
Preeclampsia-eclampsia
Preeclampsia superimposed on chronic hypertension
Gestational hypertension (transient hypertension of pregnancy or chronic hypertension identified
in the latter half of pregnancy); this terminology is preferred over the older but widely used term
pregnancy-induced hypertension (PIH) because it is more precise.
75. Which out of the following is not a class of hypertensive disorders during pregnancy?
I. Chronic hypertension.
II. Preeclampsia-eclampsia.
III. Postural hypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Hypertensive disorders during pregnancy are classified into the 4 following categories
Chronic hypertension
Preeclampsia-eclampsia
Preeclampsia superimposed on chronic hypertension
Gestational hypertension (trAnswer:ient hypertension of pregnancy or chronic hypertension
identified in the latter half of pregnancy); this terminology is preferred over the older but widely
used term pregnancy-induced hypertension (PIH) because it is more precise.
76. What are the common manifestations of Primary Aldosteronism?
I. Hyperkalemia.
II. Kaliuresis.
III. Renal sodium retention.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Primary Aldosteronism
Mineralocorticoid excess secondary to primary hyperaldosteronism is infrequently observed and is
characterized by excessive production of aldosterone. Renal sodium retention, kaliuresis, hypokalemia,
and hypochloremic metabolic alkalosis are the common manifestations
77. What is the characteristic of mineralocorticoid excess?

I. Decreased production of bradykinin.
II. Decreased production of aldosterone.
III. Excessive production of aldosterone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Mineralocorticoid excess secondary to primary hyperaldosteronism is infrequently observed and is

characterized by excessive production of aldosterone
78. What dose a clinician do during primary evaluation of hypertension?
I.
II. Performing a focused medical history.
III. Performs MRI.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
pressure, performing a focused medical history and physical examination, and obtaining results of
routine laboratory studies
79. Which out of the following is not an initial laboratory test for the assessment of
hypertension?
I. Glomerular filtration rate.
II. Fasting blood glucose.
III. Serum SGOT.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
79 80 81 Initial laboratory tests may include urinalysis; fasting blood glucose or a1c; hematocrit;
serum sodium, potassium, creatinine (estimated or measured glomerular filtration rate [GFR]), and
calcium; and lipid profile following a 9- to 12-hour fast (total cholesterol, high-density lipoprotein
[HDL] cholesterol, low-density lipoprotein [LDL] cholesterol, and triglycerides). An increase in
cardiovascular risk is associated with a decreased GFR level and with albuminuria
80. During the diagnosis of hypertension, estimation of which ion is necessary?
I. Serum manganese.
II. Serum sodium.
III. Serum potassium.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
81. Which initial laboratory test is performed during assessment of hypertension?

I. Triglycerides level.
II. Serum SGPT.
III. Total cholesterol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
82. Which test is preformed for the assessment of suspected secondary hypertension and/or
evidence of target-organ disease?
I. Urine macroalbumin.
II. Complete blood count.
III. Uric acid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Suspected secondary hypertension and/or evidence of target-organ disease, such as complete blood count
(CBC), chest radiograph, uric acid, and urine microalbumin
83. Which screening test is performed to evaluate chronic kidney disease?

I. Estimation of glomerular filtration rate.
II. Estimation of nephrone filtration rate.
III. Estimation of both nephrone and glomerular filtration rate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
SCREENING TEST
Chronic kidney disease Estimated glomerular filtration rate
84. Which screening test is performed to evaluate Coarctation of the aorta?
II. Computed tomography angiography.
III. Stress electrocardiogram.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
SCREENING TEST
Coarctation of the aorta Computed tomography angiography
85. Which screening test is performed to evaluate Cushing syndrome?

I. Urine dexamethasone level.
II. Serum dexamethasone level.
III. Dexamethasone suppression test.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
SCREENING TEST
Cushing syndrome; other states of glucocorticoid excess (eg, chronic Dexamethasone suppression
steroid therapy test
86. Which screening test is performed to evaluate Pheochromocytoma?
I. 12-hour urinary metanephrine and normetanephrine level.
II. 24-hour urinary metanephrine and normetanephrine level.
III. 48-hour urinary metanephrine and normetanephrine level.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
SCREENING TEST
Pheochromocytoma 24-hour urinary metanephrine and normetanephrine
87. Which screening test is performed to evaluate Primary aldosteronism?

I. 24-hour urinary aldosterone level.
II. Specific mineralocorticoid tests.
III. 12-hour urinary aldosterone level.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
SCREENING TEST
Primary aldosteronism, other states of 24-hour urinary aldosterone level, specific
mineralocorticoid excess mineralocorticoid tests
88. Which screening test is performed to evaluate Renovascular Hypertension?
II. Magnetic resonance angiography.
III. Doppler flow ultrasonography.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
SCREENING TEST
Renovascular Doppler flow ultrasonography, magnetic resonance angiography, computed
hypertension tomography angiography
89. Which screening test is performed to evaluate Sleep Apnea?

I. Sleep study with oxygen saturation.
II. Epworth Sleepiness Scale.
III. Epworth Sleeplessness Scale.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
SCREENING TEST
Sleep Sleep study with oxygen saturation (screening would also include the Epworth Sleepiness
apnea Scale [ESS])
90. Which screening test is performed to evaluate thyroid/parathyroid diseases?
I. Thyroid stimulating hormone level.
II. Iodine uptake test.
III. Serum parathyroid hormone level.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
SCREENING TEST
Thyroid/parathyroid Thyroid stimulating hormone level, serum parathyroid hormone
disease level
91. Which out of the following medicines can induces hypertension?

I. Bitter lemon.
II. Ephedra.
III. Ma huang.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
INDUCE HYPERTENSION dietary supplements and medicines, such as ephedra, ma huang, and
bitter orange
92. What are the drug related causes of hypertension?
I. Non adherence to therapy.
II. Inadequate doses.
III. Appropriate combinations.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Drug-related causes of hypertension may be due to non adherence, inadequate doses, and
inappropriate combinations.
93. What is an early indication of diabetic nephropathy and is also a marker for a higher risk
of cardiovascular morbidity and mortality?
I. Microalbuminuria.
II. Macroalbuminuria.
III. Proteinuria.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Microalbuminuria is an early indication of diabetic nephropathy and is also a marker for a higher
risk of cardiovascular morbidity and mortality. Recommendations suggest that individuals with type
I diabetes should be screened for microalbuminuria.
94. What should be measured to detect evidence of primary hyperaldosteronism?
I. Ratio of catecholamine to plasma renin activity.
II. Ratio of a bradykinin to plasma renin activity.
III. Ratio of aldosterone to plasma renin activity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Measurement of the ratio of aldosterone to plasma renin activity (PRA) is performed to detect evidence
of primary hyperaldosteronism. A ratio of more than 20-30 is suggestive of this condition. Most
antihypertensive medications can falsely raise or lower this ratio; thus, an appropriate washout period
is necessary to obtain an accurate aldosterone-renin ratio
95. At what potassium level, plasma renin activity should be measured in hypertensive
patient?
I. >30 mmol/L.
II. <30 mmol/L.
III. 30 mmol/L.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
If urinary potassium exceeds 30 mmol/L, the patient should have plasma renin activity measured.
96. Which out of the following is a non-invasive radiologic investigation for the diagnosis
of renal artery stenosis?
I. Computed tomographic angiography.
II. Magnetic resonance angiography.
III. Invasive renal angiography.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Renal artery stenosis and if a corrective procedure is considered, further non-invasive radiologic
investigations (eg, computed tomographic angiography [CTA], magnetic resonance angiography
[MRA]) or invasive renal angiography can be performed
97. Which method is the criterion standard for the evaluation of renal and pulmonary causes
of hypertension?
I. Digital addition angiography (DSA) with arterial injection of radiocontrast dye.
II. Digital subtraction angiography (DSA) with ventricular injection of radiocontrast dye.
III. Digital subtraction angiography (DSA) with arterial injection of radiocontrast dye.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Digital subtraction angiography (DSA) with arterial injection of radiocontrast dye is the
criterion standard for the evaluation of renal and pulmonary causes of hypertension, but this
modality carries the risk of dye nephropathy and atheroemboli in patients with diabetes or
chronic kidney disease
98. Which diagnostic method is sufficient to detect left atrial dilatation, left ventricular
hypertrophy (LVH) and diastolic left ventricular dysfunction?
I. Electrocardiography.
II. Limited echocardiography.
III. Stress echocardiogram.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The limited echocardiography study, rather than the complete examination, may detect left
atrial dilatation, left ventricular hypertrophy (LVH), and diastolic or systolic left ventricular
dysfunction more frequently than electrocardiography
99. Which diagnostic method can provide prognostic information in patients with
hypertension and coronary artery disease?
I. Stress echocardiogram.
II. Echocardiogram.
III. Doppler echocardiogram.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
A stress echocardiogram can provide prognostic information in patients with hypertension and
coronary artery disease (CAD)
100. Why urinary vanillylmandelic acid (VMA) is no longer recommended for the diagnosis
of pheochromocytoma?
I. Poor sensitivity.
II. Poor specificity.
III. Poor reproducibility.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Urinary vanillylmandelic acid (VMA) is no longer recommended because of its poor sensitivity
and specificity
Drug and Pharmacology (question 100)
1. What are the various interventions that can be implemented to improve BP control in
patients with hypertension or to treat uncontrolled hypertension?
I. Self-monitoring.
II. Nurse or pharmacist care.
III. Self medication.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Various interventions can be implemented to improve BP control in patients with hypertension or to

treat uncontrolled hypertension. These interventions include the following:
 Self-monitoring
 Nurse or pharmacist care
2. What is the dose of Hydrochlorothiazide in treatment of hypertension?

I. 7.5 mg.
II. 12.5 mg.
III. 24.5 mg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Hydrochlorothiazide; The usual dose is 12.5 mg given alone or in combination with other
antihypertensives, with a maximum dose of 50 mg daily
3. Why metolazone is prescribed in hypertension patient with renal impairment?
I. Does not decrease glomerular filtration rate.
II. Does not diuretics inhibit reabsorption of sodium and chloride mostly in the distal tubules.
III. Does not decrease the renal plasma flow.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Metolazone does not decrease glomerular filtration rate or the renal plasma flow and may be a more
effective option for patients with impaired renal function
4. Which class of drug are included in initial therapy of hypertension?

I. Selective beta blockers.
III. Diuretics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
No longer recommending only thiazide-type diuretics as the initial therapy in most patients
(angiotensin-converting enzyme [ACE] inhibitors, angiotensin receptor blockers [ARBs], calcium
channel blockers [CCBs], or diuretics are recommended
5. According to JNC 8, at what blood pressure treatment for hypertension is initiated in
patients aged 60 years or older?
I. Systolic BP levels at 150 mm Hg or greater or whose diastolic BP levels are 90 mm Hg or greater.
II. Systolic BP levels at 160 mm Hg or greater or whose diastolic BP levels are 100 mm Hg or
greater.
III. Systolic BP levels at 165 mm Hg or greater or whose diastolic BP levels are 95 mm Hg or
greater.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
JNC8 recommends
In patients aged 60 years or older, initiate therapy in those with systolic BP levels at 150 mm Hg or
greater or whose diastolic BP levels are 90 mm Hg or greater; treat to below those thresholds
6. According to JNC 8, what should be the goal of clinician while treating hypertensive
patients younger than 60 years as well as those older than 18 years with either chronic kidney
disease (CKD) or diabetes?
I. 130/90 mm hg.
II. 140/90 mm Hg.
III. 150/100 mM Hg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
JNC8 recommends
In patients younger than 60 years as well as those older than 18 years with either chronic kidney
disease (CKD) or diabetes, the BP treatment initiation and goals should be 140/90 mm Hg
7. According to JNC 8, which class of drug are used while beginning treatment nonblack
hypertensive patients?
I. Thiazide-type diuretic.
II. ACE inhibitor.
III. Selective beta blockers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
JNC8 recommends
In nonblack hypertensive patients, begin treatment with either a thiazide-type diuretic, CCB, ACE
inhibitor, or ARB
8. According to JNC 8, which class of drug are used while beginning treatment black
hypertensive patients?
I. calcium channel blockers.
II. ACE inhibitor.
III. thiazide-type diuretic.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
JNC8 recommends
In hypertensive black patients, initiate therapy with a thiazide-type diuretic or CCB
9. According to JNC 8, which class of drug should be used while beginning the treatment
in hypertensive patients (18 years or older) with chronic kidney disease?
I. ACE inhibitor or ARB.
II. ACE inhibitor and ARB.
III. ACE inhibitor or beta blocker.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
JNC8 recommends
Regardless of race or diabetes status, in patients 18 years or older with CKD, initial or add-on therapy
should consist of an ACE inhibitor or ARB
10. Which drug are not co-administer concurrently in hypertensive patient?

I. Diuretics with ACE inhibitor.
II. Diuretics with ARB.
III. ACE inhibitor with an ARB.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
JNC8 recommends
Do not use an ACE inhibitor in conjunction with an ARB in the same patient
11. According to JNC 8, what should clinician do if a patient's goal BP is not achieved
within 1 month of treatment?
I. Increase the dose of the initial agent.
II. Add an agent from another of the recommended drug classes.
III. Should prescribe newer class (change the drug).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
JNC8 recommends
If a patient's goal BP is not achieved within 1 month of treatment, increase the dose of the initial
agent or add an agent from another of the recommended drug classes; if 2-drug therapy is unsuccessful
for reaching the target BP, add a third agent from the recommended drug classes
12. According to JNC 8, what should clinician do in patients whose goal BP cannot be
reached with 3 agents from the recommended drug classes?
I. Use agents from other drug classes.
II. Refer the patients to a hypertension specialist.
III. Use agents from other drug classes and/or refer the patients to a hypertension specialist.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
JNC8 recommends
In patients whose goal BP cannot be reached with 3 agents from the recommended drug classes, use
agents from other drug classes and/or refer the patients to a hypertension specialist
13. According to joint AHA/ACC/CDC algorithm, what is the level of blood pressure in
stage 1 Hypertension?
I. Systolic BP 140-159 mm Hg or diastolic BP 90-99 mm Hg.
II. Systolic BP 145-159 mm Hg or diastolic BP 90-100 mm Hg.
III. Systolic BP 150-159 mm Hg or diastolic BP 90-105 mm Hg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
A joint AHA/ACC/CDC algorithm

Stage 1 hypertension (systolic BP 140-159 mm Hg or diastolic BP 90-99 mm Hg): Can be treated
with lifestyle modifications and, if needed, a thiazide diuretic
14. According to joint AHA/ACC/CDC algorithm, what should be the treatment for patient
with Stage 1 hypertension?
I. lifestyle modifications.
II. If needed, a thiazide diuretic.
III. Lifestyle modifications and thiazide diuretic.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

Stage 1 hypertension (systolic BP 140-159 mm Hg or diastolic BP 90-99 mm Hg): Can be treated
with lifestyle modifications and, if needed, a thiazide diuretic
15. According to joint AHA/ACC/CDC algorithm, what is the level of blood pressure in
stage 2 Hypertension?
I. Systolic BP >150 mm Hg or diastolic BP >90 mm Hg.
II. Systolic BP >160 mm Hg or diastolic BP >100 mm Hg.
III. Systolic BP >170 mm Hg or diastolic BP >110 mm Hg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

Stage 2 hypertension (systolic BP >160 mm Hg or diastolic BP >100 mm Hg): Can be treated with
a combination of a thiazide diuretic and an ACE inhibitor, an angiotensin receptor blocker, or a
calcium channel blocker
16. According to joint AHA/ACC/CDC algorithm, what should be the treatment for patient
with Stage 2 hypertension?
I. Diuretics.
II. Combination of a thiazide diuretic and an angiotensin receptor blocker.
III. Combination of a thiazide diuretic and an ACE inhibitor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

Stage 2 hypertension (systolic BP >160 mm Hg or diastolic BP >100 mm Hg): Can be treated with
a combination of a thiazide diuretic and an ACE inhibitor, an angiotensin receptor blocker, or a
calcium channel blocker
17. According to joint AHA/ACC/CDC algorithm, what is the recommended blood pressure
goal in hypertension patient?
I. 139/89 mm Hg or less.
II. 139/90 mm Hg or less.
III. 145/90 mm Hg or less.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A

BP: Recommended goal of 139/89 mm Hg or less
18. Why triamterene is contraindicated in patient taking ACE inhibitors, angiotensin

receptor blockers?
I. Risk of hyperkalemia.
II. Risk of over diuresis.
III. Risk of rebound hypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Caution is required when combining triamterene with ACE inhibitors, angiotensin receptor blockers,
aliskiren, and other drugs that increase potassium levels
19. What is the therapeutic dose of Amiloride when used as diuretic in hypertension?
I. 15-20 mg.
II. 6-12 mg.
III. 5-10 mg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Amiloride can be given at a dose of 5-10 mg daily in 1-2 divided doses for hypertension.
20. According to new ESH and ESC guidelines, what should be the goal while treatment in
hypertensive patient with diabetes?
I. Treated to below 70 mm Hg diastolic BP.
II. Treated to below 85 mm Hg diastolic BP.
III. Treated to below 90 mm Hg diastolic BP.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Recommendations of the new ESH and ESC guidelines

Patients with diabetes should be treated to below 85 mm Hg diastolic BP
21. According to new ESH and ESC guidelines, what should be salt intake in hypertensive?
I. 5 to 6 g per day.
II. 7 to 8 g per day.
III. 8 to 9 g per day.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A

Salt intake should be limited to approximately 5 to 6 g per day
22. According to new ESH and ESC guidelines, what should be Body-mass index (BMI) in
obese hypertensive patient?
I. 25 kg/m 2.
II. 26 kg/m 2.
III. 27 kg/m 2 .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A

Body-mass index (BMI) should be reduced to 25 kg/m 2 and waist circumferences should be reduced
to less than 102 cm in men and less than 88 cm in women
23. According to new ESH and ESC guidelines, which out of the following sentence is
correct for waist circumferences in obese hypertensive patient?
I. Should be reduced to less than 102 cm in men and less than 88 cm in women.
II. Should be reduced to less than 103 cm in men and less than 90 cm in women.
III. Should be reduced to less than 104 cm in men and less than 91 cm in women.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III

Body-mass index (BMI) should be reduced to 25 kg/m 2 and waist circumferences should be reduced
to less than 102 cm in men and less than 88 cm in women
24. According to new ESH and ESC guidelines, which out of the following is not an effective
combination for hypertension treatment?
I. Thiazide diuretics with ARBs.
II. Calcium-channel antagonists with ARBs
III. ACE inhibitors with ARBs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

Effective combination therapies include thiazide diuretics with ARBs, calcium-channel antagonists,
or ACE inhibitors; or, calcium-channel antagonists with ARBs or ACE inhibitors
25. According to new ESH and ESC guidelines, why concurrent use of ARBs, ACE
inhibitors, and direct renin inhibitors is not recommended?
I. Risk of hypotension.
II. Kidney failure.
III. Hypokalemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

Dual renin-angiotensin system blockade (ie, ARBs, ACE inhibitors, and direct renin inhibitors) is
not recommended because of the risks of hyperkalemia, low BP, and kidney failure
26. Which is the promising therapy in the treatment of resistant hypertension?

I. Diuretics.
II. Renal denervation.
III. Diuretics/calcium channel blockers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

Although additional data is needed, renal denervation is a promising therapy in the treatment of
resistant hypertension
27. According to ADA 2011, what is the level of blood pressure in mild hypertension?
I. Systolic BP 130-139 mm Hg or diastolic BP 80-89 mm Hg.
II. Systolic BP 130-140 mm Hg or diastolic BP 80-90 mm Hg.
III. Systolic BP 130-141 mm Hg or diastolic BP 80-91 mm Hg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Mild hypertension as defined by the ADA guideline (systolic BP 130-139 mm Hg or diastolic BP 80-
89 mm Hg) may be classified as prehypertension by other organizations
28. According to ADA 2011, what should be initial treatment of mild hypertension?
I. Pharmacologic therapy.
II. Nonpharmacologic therapy.
III. Pharmacologic therapy and nonpharmacologic therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
ADA 2011 standard of medical care states that in individuals with diabetes and mild hypertension,
it may be reasonable to begin treatment with a trial of nonpharmacologic therapy (diet, exercise, and
other lifestyle modifications.)
29. According to ADA 2011, what is cause of hypertension in patients with type 1 diabetes?
I. encephalopathy.
II. Cardiomyopathy.
III. Nephropathy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
ADA 2011
In patients with type 1 diabetes, nephropathy is often the cause of hypertension, whereas in type 2
diabetes, hypertension is one of a group of related cardio metabolic factors
30 According to ADA 2011, what is one of the most common causes of congestive heart
failure?
I. Nephropathy.
II. Hypertension.
III. Diabetes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
ADA 201
Hypertension remains one of the most common causes of congestive heart failure (CHF)
31. What is initial dosage of Metolazone for hypertension?

I. 2.5 to 5 mg given once daily.
II. 2.5 to 5 mg given twice daily.
III. 2.5 to 5 mg given thrice daily.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Metolazone is approved for the treatment of hypertension either alone (uncommon) or in combination
with other antihypertensives. The initial dosage for hypertension is 2.5 to 5 mg given once daily
32. What is initial step in managing hypertension?
I. Lifestyle modifications.
II. Pharmacological therapy.
III. Lifestyle modifications and pharmacological therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Lifestyle modifications are essential for the prevention of high BP, and these are generally the initial
steps in managing hypertension
33. What is the outcome of decrease in BP of 2 mm Hg blood pressure in hypertensive

patient?
I. Reduces the risk of stroke by 10% and the risk of coronary artery disease by 3%.
II. Reduces the risk of stroke by 12% and the risk of coronary artery disease by 5%.
III. Reduces the risk of stroke by 15% and the risk of coronary artery disease by 6%.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
A decrease in BP of 2 mm Hg reduces the risk of stroke by 15% and the risk of coronary artery disease
by 6% in a given population
34. Which out of following is the modern technique used for renovascular hypertension?
I. Saphenous vein graft.
II. Hypogastric artery.
III. Renal artery angioplasty with stenting.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Aortorenal bypass using a saphenous vein graft or a hypogastric artery is a revascularization technique
for renovascular hypertension that has become much less common since the advent of renal artery
angioplasty with stenting
35. What is the pharmacological mechanism of Doxazosin?

I. Selective alpha1-adrenergic antagonist.
II. Selective beta-adrenergic antagonist.
III. Mixed alpha1 and beta-adrenergic antagonist.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Doxazosin is a selective alpha1-adrenergic antagonist.

36. What is the limit of alcohol intake during lifestyle modification i n hypertensive patient?
I. 40 ml of ethanol per day for men and 10 ml of ethanol per day for women.
II. 45 ml of ethanol per day for men and 11 ml of ethanol per day for women.
III. 30 ml of ethanol per day for men and 15 ml of ethanol per day for women.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Limit alcohol intake to no more than 1 oz (30 ml) of ethanol per day for men (ie, 24 oz [720 ml] of
beer, 10 oz [300 ml] of wine, 2 oz [60 ml] of 100-proof whiskey) or 0.5 oz (15 ml) of ethanol per
day for women and people of lighter weight (range of approximate SBP reduction, 2-4 mm Hg)
37. What is the adequate level of dietary potassium during lifestyle modification in
hypertensive patient?
I. Approximately 40 mmol/day.
II. Approximately 90 mmol/day.
III. Approximately 180 mmol/day.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Maintain adequate intake of dietary potassium (approximately 90 mmol/d)

38. What is the minimum period for exercise in lifestyle modification in hypertensive
patient?
I. 30 min.
II. 40 min.
III. 50 min.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Engage in aerobic exercise at least 30 minutes daily for most days (range of approximate SBP
reduction, 4-9 mm Hg)
39. What is the composition of DASH eating plan in hypertensive patient?

I. Diet rich in fruits, vegetables, and low-fat dairy products.
II. Diet rich in fruits, vegetables, and high-fat dairy products.
III. Diet rich in fruits, vegetables, and high-fat non-dairy products.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The DASH eating plan encompasses a diet rich in fruits, vegetables, and low-fat dairy products and
may lower blood pressure by 8-14 mm Hg
40. What is the effect of oral potassium supplementation?
I. Lowers systolic BP.
II. Lowers diastolic BP.
III. Lower both systolic and diastolic BP.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Oral potassium supplementation may lower both systolic and diastolic BP. [64] Calcium and
magnesium supplementation have elicited small reductions in BP.
41 What is the treatment strategy for stage 1 hypertension?

II. Drug therapy with single agent.
III. Combination drug therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In stage 1 hypertension, a single agent is generally sufficient to reduce BP

42. What is the treatment strategy for stage 2 hypertension?
I. Single drug approach.
II. Multi drug approach.
III. Lifestyle modification.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Stage 2, a multidrug approach may be needed. Initiation of 2 antihypertensive agents, either as 2

separate prescriptions or as a fixed-dose combination, should also be considered when BP is more than
20 mm Hg above the systolic goal (or 10 mm Hg above the diastolic goal)
43. Why multidrug regimen is used in controlling hypertension?

I. Combination diminishes risk of hypotension.
II. 2 drugs may be used at lower doses.
III. Avoid the adverse effects.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Several situations demand the addition of a second drug, because 2 drugs may be used at lower doses
to avoid the
Effects that may occur with higher doses of a single agent.
44. How diuretics generally potentiate the effects of other antihypertensive drugs?
I. By increasing bioavailability of other drug.
II. By increasing dissolution of other drug.
III. By minimizing volume expansion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Diuretics generally potentiate the effects of other antihypertensive drugs by minimizing volume
expansion.
45. What is the logic behind the use of a thiazide diuretic in conjunction with a beta-blocker
or an ACE?
I. Antagonism.
II. Additive effect.
III. Partial agonist.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Specifically, the use of a thiazide diuretic in conjunction with a beta-blocker or an ACE inhibitor
has an additive effect, controlling BP in up to 85% of patients
46. Which out of the following class of drug is usually required in patients with diabetes and
hypertension?
I. ACE inhibitor or an ARB.
II. Aldosterone antagonist.
III. Potassium sparing diuretics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Either an ACE inhibitor or an ARB is usually required in patients with diabetes and hypertension
47. What is the correlation between thiazide diuretic and GFR in hypertensive patient?
I. Indicated for those patients with a GFR of 30 ml/min/1.73 m2 or greater to achieve BP goals.
II. Indicated for those patients with a GFR of 28 ml/min/1.73 m2 or lesser to achieve BP goals.
III. Indicated for those patients with a GFR of 25 ml/min/1.73 m2 or lesser to achieve BP goals.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
If needed to achieve BP goals, a thiazide diuretic is indicated for those patients with an estimated
GFR of 30 ml/min/1.73 m2 or greater, and a loop diuretic is indicated for those with an estimated
GFR of less than 30 ml/min/1.73 m2
48. What is the correlation between loop diuretic and GFR in hypertensive patient?
I. Indicated for those with a GFR of more than 33 ml/min/1.73 m2 to achieve BP goals.
II. Indicated for those with a GFR of more than 30 ml/min/1.73 m2 to achieve BP goals.
III. Indicated for those with a GFR of than 30 ml/min/1.73 m2 to achieve BP goals.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
If needed to achieve BP goals, a thiazide diuretic is indicated for those patients with an estimated
GFR of 30 ml/min/1.73 m2 or greater, and a loop diuretic is indicated for those with an estimated
GFR of less than 30 ml/min/1.73 m2
49. What is the characteristic of Hypertensive emergencies?

I. BP (>180/120 mm Hg).
II. Acute end-organ damage.
III. BP (>180/120 mm Hg) associated with acute end-organ damage.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Hypertensive emergencies are characterized by severe elevations in BP (>180/120 mm Hg) associated

with acute end-organ damage
50. Which out of following is an example of acute end-organ damage associated with
Hypertensive emergencies?
I. Stable angina pectoris.
II. Intracerebral hemorrhage.
III. Unstable angina pectoris.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Examples include hypertensive encephalopathy, intracerebral hemorrhage, acute myocardial

infarction, acute left ventricular failure with pulmonary edema, aortic dissection, unstable angina
pectoris, eclampsia,[3] or posterior reversible encephalopathy syndrome (PRES) (a condition
characterized by headache, altered mental status, visual disturbances, and seizures). [49] Patients with
hypertensive emergencies should be monitored and managed in an intensive care unit
51. Which drugs are used to treat hypertensive emergencies?

I. Nitroprusside sodium.
II. Fenoldopam.
III. Nifedipine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Several parenteral and oral therapies can be used to treat hypertensive emergencies, such as
nitroprusside sodium, hydralazine, nicardipine, fenoldopam, nitroglycerin, or enalaprilat. Other
agents that may be used include labetalol, esmolol, and phentolamine
52. Which out of the following drug is not recommended in hypertensive emergencies?
I. Nitroprusside sodium.
II. Fenoldopam.
III. Nifedipine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Avoid using short-acting nifedipine in the initial treatment of this condition because of the risk of
rapid, unpredictable hypotension and the possibility of precipitating ischemic events.
53. What is the goal of antihypertensive treatment in patients who are pregnant?
I. Minimize the risk of maternal cardiovascular or cerebrovascular events.
II. Minimize foetus damage.
III. Minimize maternal and foetus placental transport.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
In patients who are pregnant, the goal of antihypertensive treatment is to minimize the risk of
maternal cardiovascular or cerebrovascular events
54. Which out of the following sentence is correct for Pseudohypertension?
I. Lower cuff pressure may be required to occlude a thickened brachial artery.
II. Overestimation of intra-arterial pressure.
III. Observed in elderly individuals who have thickened, calcified arteries.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Pseudohypertension in an overestimation of intra-arterial pressure by cuff blood pressure (BP)

measurement. This may be observed in elderly individuals who have thickened, calcified arteries, as
the cuff has relatively more difficulty compressing such arteries; much higher cuff pressure may be
required to occlude a thickened brachial artery. The diastolic BP may also be overestimated
55. Why clinician should avoid too rapid a reduction in BP in paediatric hypertensive
patient?
I. There is risk of development of cerebral ischemia.
II. There is risk of development of hemorrhage.
III. It causes rebound hypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Paediatric: As in patients of any age with malignant hypertension, care must be taken to avoid too rapid
a reduction in BP, so as to avoid cerebral ischemia and hemorrhage
56. Which risk is associated with diastolic BP greater than 110 mm Hg in Pregnant
hypertensive patient?
I. Placental abruption.
II. Intrauterine growth restriction.
III. Foetus death.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Pregnant hypertensive patient; diastolic BP greater than 110 mm Hg has been associated with an
increased risk of placental abruption and intrauterine growth restriction, and systolic BP greater
than 160 mm Hg increases the risk of maternal intracerebral hemorrhage.
57. What would a clinician suggest for the management of stage 1 hypertension in pregnant
women?
I. Lifestyle modifications.
II. Pharmacological Therapy.
III. Lifestyle modifications and Pharmacological Therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Lifestyle modifications are generally sufficient for the management of pregnant women with stage 1
hypertension who are at low risk for cardiovascular complications during pregnancy
58. When is pharmacological therapy necessary in pregnant women with hypertension?
I. Systolic BP is greater than 160 mm Hg.
II. Diastolic BP is greater than 90-95mm Hg.
III. Diastolic BP is greater than 100-105 mm Hg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Antihypertensive therapy should be started in pregnant women if the systolic BP is greater than 160
mm Hg or the diastolic BP is greater than 100-105 mm Hg
59. Which drug is generally the preferred first-line agent in pregnant hypertensive women?
I. Labetalol.
II. Atenolol.
III. Methyldopa.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Methyldopa is generally the preferred first-line agent because of its safety profile
60. Which out of the following is not used in treatment of hypertension in pregnant women?
I. Labetalol.
II. Atenolol.
III. Ramipril.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Other drugs that may be considered include labetalol, beta-blockers, and diuretics. Data are limited
regarding the use of clonidine and calcium antagonists in pregnant women with chronic hypertension;
61. Why angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor

(ARB) antagonist should be avoided in pregnant women with hypertension?
I. Risk of hypokalemia.
II. Risk of foetal toxicity.
III. Death.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor (ARB) antagonists

should be avoided because of the risk of fetal toxicity and death
62. What are the causes of resistant hypertension?
I. Improper BP measurement.
II. Use of Vasoactive substances.
III. Patient compliance.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Causes of resistant hypertension; Improper BP measurement, Inadequate treatment and patient

noncompliance, Extracellular volume expansions and Vasoactive substances
63. What is the initial dose of Chlorthalidone in managing of hypertension?

I. 20mg.
II. 25mg.
III. 30mg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Chlorthalidone is indicated for the management of hypertension either alone or in combination with
other antihypertensives. The initial dosage is 25 mg as a single daily dose.
64. Which out of following is drug falls in class Thiazide diuretics?
I. Metolazone.
II. Hydrochlorothiazide.
III. Bumetanide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Diuretics, Thiazide; Hydrochlorothiazide, Chlorthalidone, Metolazone and Indapamide
65. Which out of following is drug falls in class Potassium-Sparing diuretics?

I. Indapamide.
II. Triamterene.
III. Amiloride.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Diuretic, Potassium-Sparing; Triamterene, Amiloride

66. Which out of the following diuretic drug do not poses sulfonamide group in its chemical
structure?
I. Ethacrynic acid.
II. Furosemide.
III. Torsemide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Keep in mind that all available loop and thiazide diuretic agents, except ethacrynic acid, possess a
sulfonamide group, which has important clinical relevance to those individuals with allergies to
sulfonamide agents
67. Which out of following is drug falls in class Loop diuretics?

I. Furosemide.
II. Bumetanide.
III. Triamterene.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Diuretics, Loop; Furosemide, Torsemide and Bumetanide

68. What is etiologic mechanism for the side effects of cough and angioedema associated
with Angiotensin converting enzyme inhibitors?
I. Accumulation of catecholamine.
II. Accumulation of mucus.
III. Accumulation of bradykinin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Angiotensin converting enzyme : Accumulation of bradykinin has been proposed as an etiologic

mechanism for the side effects of cough and angioedema
69. Which class of the drug is preferred in patients with hypertension, chronic kidney
disease, and proteinuria?
I. Angiotensin converting enzyme (ACE) inhibitors.
III. Beta blockers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Angiotensin converting enzyme (ACE) inhibitors are the treatment of choice in patients with
hypertension, chronic kidney disease, and proteinuria
70. Which out of following drug falls in class ACE Inhibitors?
I. Fosinopril.
II. Enalapril.
III. Olmesartan.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
ACE Inhibitors; Fosinopril, Captopril, Ramipril, Enalapril
71. What is the dose of ramipril in treatment of hypertension?

I. 1.5-10 mg/day given once or twice a day.
II. 2.5-20 mg/day given once or twice a day.
III. 3.5-30 mg/day given once or twice a day.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Ramipril ;Doses can range from 2.5-20 mg/day given once or twice a day
72. Which out of the following sentence for angiotensin receptor (ARBs) blockers is correct?
I. It causes vasoconstriction, sodium retention and aldosterone release.
II. ARBs are used in patients who are unable to tolerate ACE inhibitors.
III. ARBs competitively block binding of angiotensin-II to angiotensin type I (AT1) receptors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Angiotensin receptor blockers (ARBs) are used for patients who are unable to tolerate ACE inhibitors.
ARBs competitively block binding of angiotensin-II to angiotensin type I (AT1) receptors, thereby
reducing effects of angiotensin II induced vasoconstriction, sodium retention, and aldosterone release;
the breakdown of bradykinin should not be inhibited
73. Which out of following drug falls in class angiotensin receptor blockers?
I. Olmesartan.
II. Losartan.
III. Atenolol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Angiotensin receptor blockers; Losartan, Valsartan, Olmesartan, Eprosartan and Azilsartan

74. Why clinician does not recommend abrupt discontinuance of beta-blocker therapy?
I. Risk of exacerbations of angina.
II. Risk of coronary artery disease.
III. Risk of myocardial infarction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In addition, exacerbations of angina and, in some cases, myocardial infarction have been reported
following abrupt discontinuance of beta-blocker therapy. The doses should be gradually reduced over
at least a few weeks
75. In which out of the following condition beta blockers are contraindicated?
I. Angina.
II. Chronic obstructive pulmonary disease.
III. Asthma.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Caution should be used in administering these agents in the setting of asthma or severe chronic
obstructive pulmonary disease (COPD), regardless of beta-selectivity profile
76. Which out of the following sentence is correct for beta blockers?
I. Suitable alternative for patient with asthma.
II. Suitable alternatives for compelling cardiac indication.
III. Not recommended as first-line agents for the treatment of hypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Beta-blockers are generally not recommended as first-line agents for the treatment of hypertension;
however, they are suitable alternatives when a compelling cardiac indication (eg, heart failure,
myocardial infarction, diabetes) is present
77. Which out of following drug falls in class Beta-Blockers (Beta-1 Selective)?
I. Propranolol.
II. Atenolol.
III. Labetalol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Beta-Blockers, Beta-1 Selective; Atenolol, Metoprolol, Propranolol

78. Which out of following drug falls in class Beta-Blockers (Alpha Activity)?
I. Carvedilol.
II. Labetalol.
III. Atenolol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Beta-Blockers, Alpha Activity; Labetalol, Carvedilol,
79. Which out of following drug falls in class Beta-Blockers with Intrinsic Sympathomimetic
activity?
I. Pindolol.
II. Labetalol.
III. Acebutolol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Beta-Blockers, Intrinsic Sympathomimetic; Acebutolol, Pindolol

80. In which condition hydralazine use is contraindicated?
I. Hypertension.
III. Asthma.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Caution should be used when hydralazine is administered in patients with concomitant coronary
artery disease
81. Which drug falls in the class vasodilator?

I. Furosemide.
II. Hydralazine.
III. Minoxidil.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Vasodilator; Hydralazine, Minoxidil

82. What is the maximum dose of nifedipine that can be administered in hypertensive
patient?
I. 60 mg/day.
II. 120 mg/day.
III. 240 mg/day.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The usual dose for nifedipine is 30-60 mg once daily (maximum 90 mg/day); when used for
hypertension, nifedipine can be administered to a maximum of 120 mg/day
83. Which drug bind to L-type calcium channels in the sinoatrial and atrioventricular node?
I. Verapamil.
II. Diltiazem.
III. Amlodipine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Non-dihydropyridines such as verapamil and diltiazem bind to L-type calcium channels in the
sinoatrial and atrioventricular node, as well as exerting effects in the myocardium and vasculature
84. Which drug binds L-type calcium channels in the vascular smooth muscle?
I. Amlodipine.
II. Diltiazem.
III. Nifedipine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Dihydropyridines bind to L-type calcium channels in the vascular smooth muscle, which results in
vasodilatation and a decrease in blood pressure
85. Which out of the following are Calcium Channel Blockers?

I. Minoxidil.
II. Verapamil.
III. Nifedipine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Calcium Channel Blockers; Nifedipine, Clevidipine, Amlodipine, Felodipine, Diltiazem and

Verapamil
86. Which aldosterone antagonist has more selectivity towards mineralocorticoid receptor?
I. Spironolactone.
II. Eplerenone.
III. Spironolactone and Eplerenone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Eplerenone ;Although this agent is more specific than spironolactone at the mineralocorticoid receptor,
it is less potent
87. Which out of the following are selective Aldosterone Antagonists?

I. Methyldopa.
II. Spironolactone.
III. Eplerenone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Aldosterone Antagonists, Selective; Eplerenone, Spironolactone
88. Which Alpha2-agonists is not associated with a rebound effect when used to treat
hypertension?
I. Methyldopa.
II. Clonidine.
III. Clonidine and Methyldopa.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Methyldopa is not associated with a rebound effect, as with clonidine
89. Which out of the following are central-acting alpha2-agonists used in treatment of
hypertension?
I. Guanfacine.
II. Methyldopa.
III. Eplerenone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Alpha2-agonists, Central-acting; Methyldopa, Clonidine, Guanfacine
90. What is the pharmacological mechanism of Aliskiren?

I. Rennin inhibitor.
II. ACE inhibitor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Aliskiren ; rennin inhibitor

91. Which out of the following drug belong to class Renin Inhibitors?
I. Clonidine.
II. Terazosin.
III. Aliskiren.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Renin Inhibitors ;Aliskiren
92. In which condition the use of rennin inhibitors is not recommended?

I. Obesity.
II. Pregnancy.
III. Diabetes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Renin Inhibitors ; Avoid the use of these agents in pregnancy.
93. What are the side effects of spironolactone?

I. Hypokalemia.
II. Gynecomastia.
III. Impotence.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Other adverse effects include hyperkalemia, gynecomastia and impotence, which often mitigates the
use of spironolactone in younger men
94. What are the common side effects of Alpha blockers (Terazosin and Doxazosin)?
I. Dizziness.
II. Headache.
III. Hypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Alpha-Blockers ; Common side effects seen in this drug class include dizziness, headache, and
drowsiness, in addition to orthostatic and first-dose hypotension
95. Which out of the following drug belong to class Alpha-Blockers?

I. Labetalol.
II. Prazosin.
III. Doxazosin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Alpha-Blockers; Prazosin, Terazosin and Doxazosin
96. What is the pharmacological mechanism of reserpine?

I. Depleting sympathetic biogenic amines.
II. Alpha blocker.
III. Beta blocker.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Reserpine reduces blood pressure by depleting sympathetic biogenic amines
97. Which out of the following is correct combination of drug used in treatment of
hypertension?
I. Amlodipine/valsartan/hydrochlorothiazide.
II. Furosemide/ hydrochlorothiazide/spironolactone.
III. Amlodipine/aliskiren.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Drug combinations include but are not limited to the following

Amlodipine/valsartan/hydrochlorothiazide (Exforge HCT)
- Amlodipine/aliskiren
98. Which out of is the prodrug used in treatment of hypertension?

I. Carvedilol.
II. Labetalol.
III. Valsartan.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Valsartan is a prodrug that produces direct antagonism of angiotensin II receptors.

hypertension?
I Triamterene/hydrochlorothiazide.
II Enalapril/hydrochlorothiazide.
III Enalapril/ Eplerenone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Triamterene/hydrochlorothiazide is a fixed-combination indicated for hypertension or edema in

patients who are at risk of developing hypokalemia on hydrochlorothiazide alone
hypertension?
I. Amlodipine/benazepril.
II. Amlodipine/olmesartan.
III. Enalapril/spironolactone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Drug combinations include but are not limited to the following:

- Amlodipine/benazepril (Lotrel)
- Amlodipine/olmesartan (Azor)
HEART FAILURE
1. Which of the following is true about Heart Failure?

I. Abnormality of cardiac function.
II. Failed to supply blood as per tissue requirement.
III. Impairment in blood pressure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Heart failure is the pathophysiologic state in which the heart, via an abnormality of cardiac
function (detectable or not), fails to pump blood at a rate commensurate with the requirements of
the metabolizing tissues or is able to do so only with an elevated diastolic filling pressure.
2. Which are the causes of Heart Failure?

I. Myocardial Failure.
II. Failed to fulfill high demand of blood.
III. Stoppage of blood supply.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Heart failure (see the images below) may be caused by myocardial failure but may also occur in the
presence of near-normal cardiac function under conditions of high demand.
3 Which out of the following non cardiac conditions can produce Circulatory Failure?
I. Hypervolemic shock.
II. Septic shock.
III. Hypovolemic shock.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Because various non cardiac conditions (eg, hypovolemic shock, septic shock) can produce circulatory
failure in the presence of normal, modestly impaired, or even supranormal cardiac function
4. Which is the compensatory mechanism active to maintain pumping of heart during

heart failure?
I. Increase Blood Volume.
II. Increase supply of oxygen to heart.
III. Increase Cardiac muscle mass.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
To maintain the pumping function of the heart, compensatory mechanisms increase blood volume,
cardiac filling pressure, heart rate, and cardiac muscle mass
5. During heart failure, which compensatory mechanism is active to maintain heart
pumping?
I. Increase Heart Rate.
II. Increase Blood Volume.
III. Increase Oxygen supply.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
To maintain the pumping function of the heart, compensatory mechanisms increase blood volume,
cardiac filling pressure, heart rate, and cardiac muscle mass
6. Which are not the signs and symptoms of the Heart Failure?
I. Anuria.
II. Dyspnea.
III. Nocturia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Heart failure sign and symptoms are Exertional dyspnea and/or dyspnea at rest, Orthopnea,
Nocturia and oliguria etc.
7. Which are the signs and symptoms of the Heart Failure?
I. Abdominal distension.
II. Hepatomegaly Anasarca.
III. Low cardiac output.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Signs and symptoms of heart failure include tachycardia and manifestations of venous congestion
(eg, edema) and low cardiac output (eg, fatigue), Hepatojugular reflux, Ascites, hepatomegaly,
and/or anasarca ,
8. What are the sign of acute Heart Failure according to chest Radiograph?
I. enlarged cardiac silhouette.
II. edema at the lung bases.
III. Interstitial edema.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Chest radiograph shows an enlarged cardiac silhouette and edema at the lung bases, signs of acute
heart failure.
9. How many classes for Heart Failure as per The New York Heart Association (NYHA)
Classification?
I. 3.
II. 4.
III. 5.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The New York Heart Association (NYHA) classification for heart failure comprises 4 classes
10. NYHA (The New York Heart Association) Classified class of Heart failure based on -
I. Relationship between symptoms and amount of effort required to provoke.
II. Relationship between causes and amount of effort required to provoke.
III. Relationship between symptoms and patient condition.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
NYHA Classified class of Heart failure based on the relationship between symptoms and the
amount of effort required to provoke them
11. According to NYHA classification, which class of patients has no limitation of physical
activity?
I. Class I.
II. Class II.
III. Class III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Class I patients have no limitation of physical activity
12. According to NYHA classification, which class of patients has slight limitation of
physical activity?
I. Class I.
II. Class II.
III. Class III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Class II patients have slight limitation of physical activity

13. According to NYHA classification, which class of patients has marked limitation of
physical activity?
I. Class I.
II. Class II.
III. Class III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Class III patients have marked limitation of physical activity
14 According to NYHA classification, which class of patients has symptoms even at rest
and are unable to carry on any physical activity without discomfort?
I. Class I.
II. Class IV.
III. Class III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Class IV patients have symptoms even at rest and are unable to carry on any physical activity
without discomfort
15. patients with high risk for heart failure but have no structural heart disease or
symptoms of heart failure can be included in which stage according to ACC/AHA) heart
failure guidelines?
I. Stage A.
II. Stage B.
III. Stage C.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Stage A patients are at high risk for heart failure but have no structural heart disease or symptoms
of heart failure
16. According to ACC/AHA) heart failure guidelines, at which stage patients have
structural heart disease but have no symptoms of heart failure?
I. Stage A.
II. Stage B.
II. I Stage D.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
● Stage B patients have structural heart disease but have no symptoms of

heart failure
structural heart disease and have symptoms of heart failure?
I. Stage B.
II. Stage C.
III. Stage D.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
● Stage C patients have structural heart disease and have symptoms of heart
failure
refractory heart failure requiring specialized interventions ?
I. Stage A.
II. Stage B.
III. Stage D.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Stage D patients have refractory heart failure requiring specialized interventions

19. Which type of Laboratory studies are carried out for Heart Failure?
I. Complete Blood Count.
II. Renal Function Studies.
III. Liver Function Studies.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Laboratory studies for heart failure should include a complete blood count (CBC), electrolytes, and
renal function studies.
20. Which type of studies is recommended for initial evaluation of patients with suspected
Heart Failure?
I. Nuclear Imaging.
II. Chest Radiography.
III. 2-Dimensional echocardiography.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Imaging studies such as chest radiography and 2-dimensional echocardiography are recommended in
the initial evaluation of patients with known or suspected heart failure.
21. Which peptides level can be useful in differentiating cardiac and non cardiac causes of
dyspnea?
I. B-type natriuretic peptide (BNP).
II. Pro-B-type natriuretic peptide (NT-probnp).
III. Pre-B-type natriuretic peptide (NT-probnp).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-probnp)
levels can be useful in differentiating cardiac and noncardiac causes of dyspnea.
22. As per Frank-Starling mechanism from which out of following mechanism helps to
sustain cardiac performance?
I. Increased preload.
II. Increased Afterload.
III. Decreased preload.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The Frank-Starling mechanism, in which an increased preload helps to sustain cardiac performance
23. Which out of the following adaptation is true for Heart failure?
I. Alterations in myocyte regeneration.
II. Myocardial hypotrophy.
III. Activation of neurohumoral system.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Adaptations
● Alterations in myocyte regeneration and death
● Myocardial hypertrophy with or without cardiac chamber dilatation, in
which the mass of contractile tissue is augmented
● Activation of neurohumoral systems
24. Which system is activated on Norepinephrine release to maintain arterial pressure?

I. Renin-angiotensin-aldosterone system [RAAS].
II. Sympathetic nervous system [SNS].
III. Peripheral nervous system [PNS].
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:D
The release of norepinephrine by adrenergic cardiac nerves augments myocardial contractility and
includes activation of the renin-angiotensin-aldosterone system [RAAS], the sympathetic nervous
system [SNS], and other neurohumoral adjustments that act to maintain arterial pressure and
perfusion of vital organs
25. What is the primary myocardial response to chronic increased wall stress?
I. Myocyte hypertrophy.
II. Myocyte regeneration.
III. Myocyte degeneration.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The primary myocardial response to chronic increased wall stress is myocyte hypertrophy,
death/apoptosis, and regeneration
26. Which ion is responsible augmentation myocardial contractility?

I. Calcium.
II. Sodium.
III. Potassium.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:: A
The increased calcium entry into the myocytes augments myocardial contractility and impairs
myocardial relaxation (lusitropy).
27. What is responsible for Vasoconstriction?
I. Release of epinephrine and norepinephrine.
II. Vasoactive substances endothelin-1 (ET-1).
III. Release of angiotensin-II.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The release of epinephrine and norepinephrine, along with the vasoactive substances endothelin-1
(ET-1) and vasopressin, causes vasoconstriction
28. Which secondary pathway is activated when calcium enter in cytosol?

I. Cyclic adenosine monophosphate (camp).
II. Cyclic adenosine Diphosphate (cadp).
III. Cyclic guanosine monophosphate (cgmp).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Which increases calcium afterload and, via an increase in cyclic adenosine monophosphate (camp),
causes an increase in cytosolic calcium entry.
29. What is responsible for sudden death in cardiac arrhythmias due to calcium overload?
I. Increase in myocardial energy expenditure.
II. Myocardial cell death/apoptosis.
III. Increase in cardiac output.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The calcium overload may induce arrhythmias and lead to sudden death. The increase in
myocardial energy expenditure leads to myocardial cell death/apoptosis, which results in heart failure
and further reduction in cardiac output, perpetuating a cycle of further increased neurohumoral
stimulation and further adverse hemodynamic and myocardial responses.
30. What is the effect of RAAS(Renin angiotensin aldosterone system) Activation?

I. Salt and water retention.
II. Increase in Blood pressure.
III. Decrease in Blood pressure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The activation of the RAAS leads to salt and water retention that ultimately increase in blood
pressure for maintenance
31. Which out of following is crucial in maintaining effective intravascular homeostasis?
I. Ang I.
II. Ang II.
III. ET-I.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Ang II, along with ET-1, is crucial in maintaining effective intravascular homeostasis mediated by
vasoconstriction and aldosterone-induced salt and water retention.
32. What is the effect of local cardiac Ang II production?

I. Increases inotropy.
II. Decreases lusitropy.
III. Increases lusitropy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
That local cardiac Ang II production (which decreases lusitropy, increases inotropy, and increases
afterload) leads to increased myocardial energy expenditure.
33. Which is the hallmark of myocardial remodelling?
I. Increased myocardial volume and mass.
II. Net loss of myocytes.
III. Decreased myocardial volume and mass.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
These features namely, the increased myocardial volume and mass, along with a net loss of
myocytes are the hallmark of myocardial remodeling
34. What are the changes occur in endogenous vasodilators like Nitric oxide,
Prostaglandins as heart failure progresses?
I. Increase.
II. Decrease.
III. Intact.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
As heart failure advances, there is a relative decline in the counterregulatory effects of endogenous
vasodilators, including nitric oxide (NO), prostaglandins (pgs), bradykinin (BK), atrial natriuretic
peptide (ANP), and B-type natriuretic peptide (BNP)
35. Which type of reflexes occur during Systolic and diastolic heart failure ?
I. Peripheral and central baro reflexes and chemo reflexes.
II. Peripheral cardiac sympathetic afferent reflex.
III. Central cardiac sympathetic afferent reflex and chemoreflex.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Systolic and diastolic heart failure each result in a decrease in stroke volume. This leads to activation
of peripheral and central baro reflexes and chemo reflexes that are capable of eliciting marked
increases in sympathetic nerve traffic.
36. Which out of the following is the endogenously generated peptides activated in
response to atrial and ventricular volume/pressure expansion?
I. ANP.
II. BNP.
III. CNP.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
ANP and BNP are endogenously generated peptides activated in response to atrial and ventricular
volume/pressure expansion
37. Which endogenous peptides promote vasodilation and natriuresis?
I. ANP.
II. BNP.
III. ANF.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
ANP and BNP are released from the atria and ventricles, respectively, and both promote
vasodilation and natriuresis
38. How BNP produces selective afferent arteriolar vasodilation followed by adrenergic
activation?
I. Inhibits sodium reabsorption.
II. Inhibits renin and aldosterone release .
III. Inhibits adrenaline and noradrenaline release.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
BNP, in particular, produces selective afferent arteriolar vasodilation and inhibits sodium
reabsorption in the proximal convoluted tubule. It also inhibits renin and aldosterone release and,
therefore, adrenergic activation
39. Which peptide is potentially important for diagnostic, therapeutic, and prognostic
implications?
I. ANP.
II. BNP.
III. ANF.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
BNP, in particular, has potentially important diagnostic, therapeutic, and prognostic implications
40. Which substance is produced by the vascular endothelium?

I. ET.
II. VE.
III. AT-I.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
ET, a substance produced by the vascular endothelium

41. Which system is regulated myocardial function, vascular tone, and peripheral
resistance?
I. ET receptor system.
II. The adenosine receptor system.
III. Tumor necrosis factor-alpha (TNF-alpha).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
ET receptor system, the adenosine receptor system, vasopressin, and tumor necrosis factor-alpha
(TNF-alpha).ET, a substance produced by the vascular endothelium, may contribute to the
regulation of myocardial function, vascular tone, and peripheral resistance in heart failure.
42. What is Diastolic HFNEF means?

I. Heart failure with normal ejection fraction.
II. Heart failure with normal elevation fraction.
III. Heart failure with normal eventual fraction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Diastolic heart failure (heart failure with normal ejection fraction [HFNEF])
43. HFNEF altered relaxation and increased stiffness of the ventricle is due to-
I. Delayed calcium uptake by the myocyte sarcoplasmic reticulum.
II. Delayed calcium efflux from the myocyte.
III. Delayed calcium influx from the myocyte.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In HFNEF, altered relaxation and increased stiffness of the ventricle (due to delayed calcium uptake
by the myocyte sarcoplasmic reticulum and delayed calcium efflux from the myocyte) occur in
response to an increase in ventricular afterload
44. Which out of following mechanism is responsible for LV chamber stiffness occurs?
I. Rise in filling pressure .
II. Decrease in ventricular distensibility.
III. Increase in ventricular distensibility.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
An increase in LV chamber stiffness occurs secondary to any one of, or any combination of, the
following 3 mechanisms:
● Rise in filling pressure
● Shift to a steeper ventricular pressure-volume curve
Decrease in ventricular distensibility
45. Which out of the following is the most significant of all rhythms associated with heart
failure?
I. Life-threatening ventricular arrhythmias.
II. Life-threatening atrial arrhythmias.
III. Life-threatening supraventricular arrhythmias.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The most significant of all rhythms associated with heart failure are the life-threatening ventricular
arrhythmias
46. Which out of the following are the Specific underlying factors cause various forms of
heart failure?
I. Left ventricular systolic dysfunction.
II. Acute heart failure.
III. Low-output heart failure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Specific underlying factors cause various forms of heart failure, such as systolic heart failure (most
commonly, left ventricular systolic dysfunction), heart failure with preserved LVEF, acute heart
failure, high-output heart failure, and right heart failure
47. Which out of the following are the underlying causes of systolic heart failure?
I. Coronary artery disease .
II. Diabetes mellitus .
III. Hypotension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Underlying causes of systolic heart failure include the following:

● Coronary artery disease
● Diabetes mellitus
48. Which out of the following is not the underlying cause of systolic heart failure?
I. Hypertension .
II. Coronary artery disease .
III. Tachycardia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Underlying causes of diastolic heart failure include the following:

● Coronary artery disease
● Diabetes mellitus
● Hypertension
Valvular heart disease (aortic stenosis
49. What out of the following are the Underlying causes of acute heart failure?
I. Myocardial infarction .
II. Acute valvular regurgitation.
III. Myocardial Stroke.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:D
Underlying causes of acute heart failure include the following:

● Acute valvular (mitral or aortic) regurgitation
● Myocardial infarction
● Myocarditis
50. What out of the following are the Underlying causes of high-output heart failure?
I. Anemia .
II. Hyperthyroidism.
III. Hypothyroidism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Underlying causes of high-output heart failure include the following:

● Anemia
● Systemic arteriovenous fistulas
● Hyperthyroidism
51. What out of the following are the Underlying causes of right heart failure?
I. Left ventricular failure.
III. Left atrial failure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Underlying causes of right heart failure include the following:

● Left ventricular failure
● Coronary artery disease (ischemia)
52. What is most common cause of decompensation in a previously compensated patient

with heart failure?
I. Dietary sodium restriction.
II. Physical activity reduction.
III. Reduction in blood pressure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The most common cause of decompensation in a previously compensated patient with heart failure is
inappropriate reduction in the intensity of treatment, such as dietary sodium restriction, physical
activity reduction, or drug regimen reduction
53. How Systemic infection precipitates heart failure?
I. Increasing total metabolism due to fever and cough.
II. Increasing the hemodynamic burden .
III. Decreasing total metabolism due to fever and cough.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:: D
Systemic infection precipitates heart failure by increasing total metabolism as a consequence of fever,
discomfort, and cough, increasing the hemodynamic burden on the heart
54. How Septic shock precipitate heart failure?

I. Release of endotoxin-induced factors.
II. Release of exotoxin-induced factors.
III. Depress myocardial contractility.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Septic shock, in particular, can precipitate heart failure by the release of endotoxin-induced factors
that can depress myocardial contractility
55. Patients with heart failure, particularly when confined to bed are-
I. High risk of developing pulmonary emboli.
II. High risk of developing Valvular damage.
III. High risk of developing deep vein thrombosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Patients with heart failure, particularly when confined to bed, are at high risk of developing
pulmonary emboli
56. Which out of the following precipitates heart failure when there is increased
myocardial oxygen consumption and demand beyond a critical level?
I. Thyrotoxicosis .
II. Myxedema.
III. Hepatitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Because of increased myocardial oxygen consumption and demand beyond a critical level, the
following high-output states can precipitate the clinical presentation of heart failure:
● Profound anemia
● Thyrotoxicosis
● Myxedema
57. Which factor is responsible for the higher prevalence of heart failure in blacks,
Hispanics, and Native Americans?
I. Higher incidence of hypertension and diabetes.
II. Higher prevalence of hypertension and diabetes.
III. Higher incidence of hypertension and Ischemic heart disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The higher prevalence of heart failure in blacks, Hispanics, and Native Americans is directly related
to the higher incidence and prevalence of hypertension and diabetes
58. What is a difference between men and women in terms of developing heart failure?
I. Men tend to develop heart failure later in life than women do .
II. Women survive longer with heart failure than men do.
III. Men survive longer with heart failure than Women do.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
However, there are still many differences between men and women with heart failure, such as the
following:
● Women tend to develop heart failure later in life than men do
● Women are more likely than men to have preserved systolic function
● Women develop depression more commonly than men do
● Women have signs and symptoms of heart failure similar to those of men,
but they are more pronounced in women
● Women survive longer with heart failure than men do
59. Which is the most common cause of heart failure in industrialized countries?
II. Ischemic cardiomyopathy.

III. Chagas disease .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The most common cause of heart failure in industrialized countries is ischemic cardiomyopathy,
with other causes, including Chagas disease and valvular cardiomyopathy, assuming a more
important role in developing countries.
60. How to prevent recurrence of heart failure in patients in whom heart failure was
caused by dietary factors or medication noncompliance?
I. Educate about the importance of proper diet
II. Educate about disease condition like heart failure.
III. Educate about necessity of medication compliance.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
To help prevent recurrence of heart failure in patients in whom heart failure was caused by dietary
factors or medication noncompliance, counsel and educate such patients about the importance of
proper diet and the necessity of medication compliance
61. Which type of comorbidities and/or risk factors should the clinician ask during
evaluation of heart failure patients?
I. Dyslipidemia .
II. Cardiac arrhythmia.
III. Pheochromocytoma.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In evaluating heart failure patients, the clinician should ask about the following comorbidities
and/or risk factors
● Dyslipidemia
● Coronary/peripheral vascular disease
● Sleep-disordered breathing
● Collagen vascular disease, rheumatic fever
● Pheochromocytoma
● Thyroid disease
● Substance abuse history
● History of chemotherapy/radiation to the chest
62. Which type of comorbidities and/or risk factors is not a part of evaluation of heart
failure?
I. Alcohol use .
II. Myopathy .
III. IBD.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
In evaluating heart failure patients, the clinician should ask about the following comorbidities and/or risk
factors
● Myopathy
● Previous MI
● Valvular heart disease, familial heart disease
● Alcohol use
● Hypertension
● Diabetes
63. From the following who is giving the following recommendations for genetic
evaluation of cardiomyopathy?
I. The Heart Failure Society of America (HFSA) .

II. The Heart Failure Society of Africa (HFSA) .
III. The Heart Failure Society of Australia (HFSA) .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The Heart Failure Society of America (HFSA) also has the following recommendations for genetic
evaluation of cardiomyopathy
64. What is Orthopnea?

I. Early symptom of heart failure.
II. Dyspnea that develops in the recumbent position.
III. Dyspnea due to asthmatic conditions.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Orthopnea is an early symptom of heart failure and may be defined as dyspnea that develops in the
recumbent position and is relieved with elevation of the head with pillows
65. What is responsible for the occurrence of Orthopnea in patient with heart failure?
I. Vital capacity is low.
II. Marked ascites.
III. Tidal volume is low.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Orthopnea occurs rapidly, often within a minute or two of recumbency, and develops when the
patient is awake. Orthopnea may occur in any condition in which the vital capacity is low. Marked
ascites, regardless of its etiology, is an important cause of orthopnea.
66. What is Paroxysmal nocturnal dyspnea?

I. Sudden awakening of the patient, after a couple of hours of sleep, with a feeling of severe
anxiety, breathlessness, and suffocation.
II. Sudden awakening of the patient, after a couple of hours of sleep, with a feeling of severe
anxiety, but no breathlessness and suffocation.
III. Sudden awakening of the patient, after a couple of hours of sleep, with a feeling of severe
anxiety, breathlessness but no suffocation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Paroxysmal nocturnal dyspnea usually occurs at night and is defined as the sudden awakening of the
patient, after a couple of hours of sleep, with a feeling of severe anxiety, breathlessness, and
suffocation
67. What is the mechanism behind dyspnea at rest in heart failure?
I. Decreased compliance and increased airway resistance.
II. Increased pulmonary function.
III. Respiratory muscle dysfunction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Dyspnea at rest in heart failure is the result of the following mechanisms:

● Decreased pulmonary function secondary to decreased compliance and
increased airway resistance
● Respiratory muscle dysfunction, with decreased respiratory muscle strength,
decreased endurance, and ischemia
68. What are the sign and symptoms of pulmonary edema in patient with heart failure?
I. Restless, sweaty and tachypneic.
II. Bradycardia.
III. Coughing with an increased work of breathing.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Pulmonary edema; The patient appears extremely ill, poorly perfused, restless, sweaty, tachypneic,
tachycardic, hypoxic, and coughing, with an increased work of breathing and using respiratory
accessory muscles and with frothy sputum that on occasion is blood tinged
69. What is responsible for Chest pain/pressure in patient with heart failure?
I. Due to damage of cardiac muscle.
II. Primary myocardial ischemia coronary disease.
III. Due to damage of cardiac muscle and primary myocardial ischemia coronary disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Chest pain/pressure may occur as a result of either primary myocardial ischemia from coronary
disease or secondary myocardial ischemia
70. Which out of the following sentence is correct for chest pain in patient with heart
failure?
I. Chest pain is due to secondary myocardial ischemia from hypertension.
II. Chest pain is due to secondary myocardial ischemia from increased filling pressure and
hypertension.
III. Chest pain is due to secondary myocardial ischemia from increased filling pressure and poor
cardiac output.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Chest pain/pressure may occur as a result of either primary myocardial ischemia coronary disease or
secondary myocardial ischemia from increased filling pressure, poor cardiac output (and therefore
poor coronary diastolic filling), or hypotension and hypoxemia
71. Which symptoms are related to poor perfusion of the skeletal muscles in patients with
a lowered cardiac output?
I. Restlessness.
II. Fatigue and weakness.
III. Heaviness in the limbs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Fatigue and weakness are often accompanied by a feeling of heaviness in the limbs and are generally
related to poor perfusion of the skeletal muscles in patients with a lowered cardiac output.
72. What is included in cerebral symptoms in patient with severe heart failure?
I. Confusion.
II. Insomnia.
III. Social withdrawal.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Cerebral symptoms
● Confusion
● Memory impairment
● Anxiety
● Headaches
● Insomnia
73. What is included in Physical Examination in patient with severe heart failure?
I. Icterus.
II. Peripheral cyanosis.
III. Malar flush.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Physical Examination : Central cyanosis, icterus, and malar flush may be evident in patients with
severe heart failure.
74. Increased adrenergic activities in heart failure patient is manifested by -

I. Bradycardia.
II. Diaphoresis and pallor.
III. Peripheral cyanosis with pallor and coldness of the extremities.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Increased adrenergic activity is manifested by tachycardia, diaphoresis, pallor, peripheral cyanosis

with pallor and coldness of the extremities, and obvious distention of the peripheral veins secondary
to venoconstriction
75. What is the earliest cardiac physical finding in decompensated heart failure in the
absence of severe mitral or tricuspid regurgitation or left-to-right shunts?
I. Protodiastolic (S3) gallop.
II. Proto systolic (S3) gallop.
III. Protodiastolic (S4) gallop.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Protodiastolic (S3) gallop is the earliest cardiac physical finding in decompensated heart failure in the
absence of severe mitral or tricuspid regurgitation or left-to-right shunts
76. Which out of the following statement is correct for Pulsus alternans?
I. Pulse palpation, this is the alternation of 1 strong and 1 weak beat without a change in the cycle
length.
II. Heart failure due to increased resistance to Left Ventricular ejection.
III. Heart failure due to increased resistance to Right Ventricular ejection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Pulsus alternans (during pulse palpation, this is the alternation of 1 strong and 1 weak beat without
a change in the cycle length) occurs most commonly in heart failure due to increased resistance to LV
ejection
77. What are the factors responsible for cardiac cachexia, particularly of the right ventricle?
I. Quinidine toxicity.
II. Anorexia from hepatic and intestinal congestion.
III. Digitalis toxicity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Cardiac cachexia is found in long-standing heart failure, particularly of the right ventricle, because
of anorexia from hepatic and intestinal congestion and sometimes because of digitalis toxicity
78. What is responsible for abdominal pain, distention, and bloody stools in preterminal
heart failure?
I. Bowel infection.
II. Inadequate bowel perfusion.
III. Bowel ulcer.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
In preterminal heart failure, inadequate bowel perfusion can cause abdominal pain, distention, and
bloody stools.
79. What is responsible for diaphoresis during feedings in children with heart failure?
I. Catecholamine surge.
II. Emotional stress.
III. Emotional stress and catecholamine surge.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Often, children with heart failure have diaphoresis during feedings, which is possibly related to a
catecholamine surge that occurs when they are challenged with eating while in respiratory distress.
80. Which out of the following statement is correct for Framingham system?
I. Used for the diagnosis of heart failure.
II. Requires that either 1 major criterion or 2 major and 3 minor criteria be present concurrently.
III. Requires that either 2 major criteria or 1 major and 2 minor criterion be present concurrently.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In the Framingham system, the diagnosis of heart failure requires that either 2 major criteria or 1
major and 2 minor criteria be present concurrently, as shown in Table 1 below
81. What are the major and minor criteria in the Framingham system in diagnosis of heart
failure?
I. Paroxysmal nocturnal dyspnea is major criteria while Nocturnal cough is minor criteria.
II. Neck vein distension is major criteria while Dyspnea on ordinary exertion is minor criteria.
III. Weight loss of 9 kg in 5 days in response to treatment is major criteria while Pleural effusion
is minor criteria.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
81 Major Criteria 81 Minor Criteria

Paroxysmal nocturnal dyspnea Nocturnal cough
Weight loss of 4.5 kg in 5 days in response to
Dyspnea on ordinary exertion
treatment
A decrease in vital capacity by one third the maximal
Neck vein distention
value recorded
Rales Pleural effusion
82. What are the basic laboratory tests and studies in the initial evaluation of patients with
suspected heart failure?
I. Complete blood count (CBC).
II. Urinalysis.
III. Blood Uric acid and Nitrogen.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Basic laboratory tests and studies in the initial evaluation of patients with suspected heart failure:
 Complete blood count (CBC), which may indicate anemia or infection as potential causes of
heart failure
 Urinalysis (UA), which may reveal proteinuria, which is associated with cardiovascular
disease
 Serum electrolyte levels, which may be abnormal owing to causes such as fluid retention or
renal dysfunction
 Blood urea nitrogen (BUN) and creatinine levels, which may indicate decreased renal blood
flow
83. What are the basic laboratory tests and studies in the initial evaluation of patients with
suspected heart failure?
I. Fasting blood glucose levels.
II. Liver function tests.
III. A-type natriuretic peptide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Basic laboratory tests and studies in the initial evaluation of patients with suspected heart failure:
 Fasting blood glucose levels, because elevated levels indicate a significantly increased risk for
heart failure (diabetic and nondiabetic patients)
 Liver function tests (lfts), which may show elevated liver enzyme levels and indicate liver
dysfunction due to heart failure
84. Which imaging studies and procedures are recommended by ACC/AHA, HFSA, and
ESC in patient with heart failure?
I. Minimal exercise testing.
II. Chest radiography.
III. 2-D echocardiographic.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The ACC/AHA, HFSA, and ESC also recommend the following imaging studies and procedures [3, 5,
6]
:
 Chest radiography (posterior-anterior, lateral),
 2-D echocardiographic and Doppler flow ultrasonographic studies,
 Coronary arteriography
 Maximal exercise testing with/without respiratory gas exchange and/or blood oxygen
saturation,
85. What can aid clinicians in differentiating between cardiac and noncardiac causes of
dyspnea?
I. B-type natriuretic peptide (BNP) level.
II. A-type natriuretic peptide.
III. N-terminal probnp (NT-probnp) levels.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In such ambiguous cases, rapid measurement of B-type natriuretic peptide (BNP) or N-terminal
probnp (NT-probnp) levels can aid clinicians in differentiating between cardiac and noncardiac
causes of dyspnea
86. What is the major source of plasma BNP?

I. Cardiac ventricles.
II. Cardiac atrium.
III. Purkinje fibres.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The major source of plasma BNP is the cardiac ventricles, and the release of BNP appears to be in
direct proportion to ventricular volume and pressure overload. BNP is an independent predictor of
high LV end-diastolic pressure and is more useful than atrial natriuretic peptide (ANP) or
norepinephrine levels for assessing mortality risk in patients with heart failure
87. Why measurement of BNP is not indicated in patients who are receiving nesiritide?
I. Because it is synthetic BNP analogue.
II. Because nesiritide interferes with BNP synthesis.
III. Because nesiritide interferes with BNP synthesis and release.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Nesiritide is a synthetic BNP analogue; therefore, the measurement of BNP is not indicated in patients
who are receiving nesiritide
88. Which out of the following statement is correct for ARVD/C?

I. It primarily affects the right ventricle.
II. It primarily affects the left ventricle.
III. Progressive fibrofatty replacement of the myocardium.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
ARVD/C is characterized by progressive fibrofatty replacement of the myocardium that predisposes to

ventricular tachycardia and sudden death in young individuals and athletes. It primarily affects the
right ventricle; with time, it may also involve the left ventricle
89. What is the application of Electrocardiography in diagnosis of heart failure?
I. Suggest an acute tachyarrhythmia or bradyarrhythmia.
II. Acute myocardial ischemia or infarction.
III. Circus movement and ectopic focus .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Electrocardiography may suggest an acute tachyarrhythmia or bradyarrhythmia as the cause of heart

failure. It may also aid in the diagnosis of acute myocardial ischemia or infarction as the cause of
heart failure or may suggest the likelihood of prior MI or the presence of coronary artery disease as the
cause of heart failure
90. What is the application of Chest radiographs in diagnosis of heart failure?

I. Infection related to implanted cardiac devices.
II. Heart size and pulmonary congestion.
III. Proper positioning of any implanted cardiac devices.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Chest radiographs (see the images below) are used in cases of heart failure to assess heart size,
pulmonary congestion, pulmonary or thoracic causes of dyspnea, and the proper positioning of any
implanted cardiac devices
91. Which test is used to determine diastolic function and in establishing the diagnosis of
diastolic heart failure?
I. Only Doppler echocardiography.
II. Only 2-D echocardiography.
III. Doppler echocardiography, along with 2-D echocardiography.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Doppler echocardiography, along with 2-D echocardiography, may play a valuable role in
determining diastolic function and in establishing the diagnosis of diastolic heart failure.
Approximately 30-40% of patients presenting with heart failure have normal systolic function but
abnormal diastolic relaxation
92. What is the application of Doppler and 2-D echocardiography in diagnosis of heart
failure?
I. Both systolic and diastolic LV performance, cardiac output.
II. Ectopic focus.
III. Pulmonary artery and ventricular filling pressures.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Doppler and 2-D echocardiography may also be used to determine both systolic and diastolic LV
performance, cardiac output (ejection fraction), and pulmonary artery and ventricular filling
pressures. In addition, echocardiography may be used to identify clinically important valvular disease
93. Which technique is used mainly to assess coronary artery disease (CAD)?
I. Doppler echocardiography.
II. Stress echocardiography.
III. 2-D echocardiography.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Stress echocardiography, also known as dobutamine or exercise echocardiography, has several uses;
however, in heart failure, this technique is used mainly to assess coronary artery disease (CAD).
94. What is the application of Computed tomography (CT) or magnetic resonance imaging
(MRI) in diagnosis of heart failure?
I. Evaluating chamber size and ventricular mass.
II. Cardiac function and wall motion.
III. Aortic trauma and aortitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Computed tomography (CT) or magnetic resonance imaging (MRI) may be useful in evaluating
chamber size and ventricular mass, cardiac function, and wall motion; delineating congenital and
valvular abnormalities; and demonstrating the presence of pericardial disease
95. What is the application of Radionuclide multiple-gated acquisition (MUGA) in
diagnosis of heart failure?
I. Only evaluation of Left Ventricular and wall motion abnormalities.
II. Only Right Ventricular function and wall motion abnormalities.
III. Evaluation of Left Ventricular and Right Ventricular function and wall motion abnormalities.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Radionuclide multiple-gated acquisition (MUGA) scan is a reliable imaging technique for evaluation
of LV and RV function and wall motion abnormalities. Because of its reliability, LV ejection fraction
(LVEF), as determined by MUGA scanning, is often used for serial assessment of post chemotherapy
LV function
96. Which method can be used to obtain accurate measurements of Left Ventricular function
and Right Ventricular ejection fraction (RVEF)?
I. Doppler echocardiography.
II. Stress echocardiography.
III. Radionuclide ventriculography.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Radionuclide ventriculography is most often performed as part of a myocardial perfusion scan to

obtain accurate measurements of LV function and RV ejection fraction (RVEF), but it is unable to
directly assess valvular abnormalities or cardiac hypertrophy and has limited value for assessing
volumes or more subtle indices of systolic or diastolic function
97. Radionuclide tracer test are based on which of the following principle?
I. Norepinephrine uptake in the cardiac sympathetic nervous system.
II. Epinephrine uptake in the cardiac sympathetic nervous system.
III. Norepinephrine uptake in the cardiac parasympathetic nervous system.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The radionuclide tracer, which functions molecularly as a norepinephrine analogue, can show relative
levels of norepinephrine uptake in the cardiac sympathetic nervous system and contribute to risk
stratification in heart failure patients.
98. In which situation cardiac catheterization and coronary angiography should be

considered for patients with heart failure?
I. Heart failure symptoms worsen without angina, and known coronary artery disease
II. Heart failure symptoms worsen with angina, and known coronary artery disease
III. Heart failure caused by systolic dysfunction in association with angina
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Cardiac catheterization and coronary angiography should be considered for patients with heart failure
in the following situations:
 When symptoms worsen without a clear cause in patients with heart failure, no angina, and
known coronary artery disease
 In heart failure caused by systolic dysfunction in association with angina or regional wall-
motion abnormalities and/or scintigraphic evidence of reversible myocardial ischemia when
revascularization is being considered
99. Which method provides important hemodynamic information about filling pressures,
vascular resistance, and cardiac output?
I. 6-minute walk test.
II. Right heart catheterization.
III. Chest X-ray.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Right heart catheterization is useful in providing important hemodynamic information about filling
pressures, vascular resistance, and cardiac output when there is doubt about the patient's fluid status
100. Which test is indicated by European Society of Cardiology (ESC) to evaluate functional
status and prognosis in patients with heart failure?
I. 6-minute walk test.
II. 12-minute walk test.
III. 24-minute walk test.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The European Society of Cardiology (ESC) indicates the 6-minute walk test is a good indicator of
functional status and prognosis in patients with heart failure.[5] It evaluates distance walked, dyspnea
index on a Borg scale from 0 to 10, oxygen saturation, and heart rate response to exercise
Drugs and pharmacology ( questions-100)
1. Non-pharmacologic therapies of the Heart failure includes-

I. Dietary sodium restriction.
II. Attention to weight gain.
III. Increase fluid intake.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Nonpharmacologic therapies include dietary sodium and fluid restriction; physical activity as
appropriate; and attention to weight gain
2. Pharmacologic therapies of the Heart failure includes-

I. Use of diuretic.
II. Use of coagulants.
III. Use of inotropic agents.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Pharmacologic therapies include the use of diuretics, vasodilators, inotropic agents, anticoagulants,
beta-blockers, and digoxin
3. Which of the following class of drug are contraindicated in heart failure patient?
I. Vasodilators.
II. Anticoagulants
III. Class I Anti-arrhythmic agent.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Pharmacologic therapies include the use of diuretics, vasodilators, inotropic agents, anticoagulants,
beta-blockers, and digoxin
4. Which of the following statement is true for Pharmacologic therapy in Heart failure
patient?
I. Use of Ivabradine to prevent repolarization
II. Use of diuretic to reduce edema.
III. Use of inotropes to reduce congestion in heart.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Diuretics, 4 which reduce edema by reduction of blood volume and venous pressures
Inotropic agents, 4 which help to restore organ perfusion and reduce congestion
5. Which of the following can be used for Invasive therapy for heart failure?
I. Resynchronization therapy.
II. Cutaneous coronary intervention.
III. Pacemakers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Invasive therapies for heart failure include electrophysiologic intervention such as cardiac
resynchronization therapy (CRT), pacemakers, and implantable cardioverter-defibrillators (icds);
revascularization procedures such as coronary artery bypass grafting (CABG) and percutaneous
coronary intervention (PCI); valve replacement or repair; and ventricular restoration.
6. Which of the following can be used for Invasive therapy for heart failure?
I. Coronary artery bypass grafting.
II. Defibrillators.
III. Valve replacement.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Invasive therapies for heart failure include electrophysiologic intervention such as cardiac
resynchronization therapy (CRT), pacemakers, and implantable cardioverter-defibrillators (icds);
revascularization procedures such as coronary artery bypass grafting (CABG) and percutaneous
coronary intervention (PCI); valve replacement or repair; and ventricular restoration.
7. When does a doctor suggest heart transplantation in a patient?
I. Progressive end-stage heart failure occur despite maximal medical therapy.
II. The prognosis is poor, and when there is no viable therapeutic alternative.
III. Donor for the heart transplantation is available.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
When progressive end-stage heart failure occurs despite maximal medical therapy, when the
prognosis is poor, and when there is no viable therapeutic alternative, the criterion standard for
therapy has been heart transplantation
8. Which co-morbidities should be considered in Patient with Heart failure?

I. Anxiety.
III. Anemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Comorbidities to consider
Coronary artery disease, Sleep apnea, Anemia, Cardiorenal syndrome
9. What is the potential cause of anaemia in patient with heart failure?
I. Renal dysfunction.
II. Inflammatory cytokines.
III. Proper nutrition.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Potential etiologies of anemia in heart failure involve poor nutrition, aceis, the RAAS,
inflammatory cytokines, hemodilution, and renal dysfunction. Anemia in heart failure is associated
with increased mortality.
10. Which of the following statement is correct for CR1 in Cardio-renal syndrome
classification?
I. Slow worsening of cardiac function leading to acute kidney injury.
II. Moderate worsening of cardiac function leading to acute kidney injury.
III. Rapid worsening of cardiac function leading to acute kidney injury.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Cardiorenal syndrome can be classified into the following 5 type

CR1: rapid worsening of cardiac function leading to acute kidney injury (HFNEF, acute heart
failure, cardiogenic shock, and RV failure)
classification?
I. Worsening renal function due to progression of acute heart failure.
II. Worsening renal function due to progression of chronic heart failure.
III. Worsening renal function due to progression of acute and chronic heart failure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Cardiorenal syndrome can be classified into the following 5 types

CR2: worsening renal function due to progression of chronic heart failure
classification?
I. Heart failure, arrhythmia and ischemia.
II. Abrupt and primary worsening of kidney function leading to acute cardiac dysfunction.
III. Abrupt and primary worsening of kidney function leading to chronic cardiac dysfunction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

CR3: abrupt and primary worsening of kidney function leading to acute cardiac dysfunction (heart
failure, arrhythmia, ischemia)
classification?
I. Chronic kidney disease leading to progressive cardiac dysfunction.
II. Chronic kidney disease leading to progressive left ventricular atrophy.
III. Chronic kidney disease leading to progressive diastolic dysfunction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

CR4: chronic kidney disease leading to progressive cardiac dysfunction, LVH, and diastolic
dysfunction
classification?
I. Combination of cardiac and renal dysfunction due to acute systemic conditions.
II. Combination of cardiac and renal dysfunction due to chronic systemic conditions.
III. Combination of cardiac and renal dysfunction due to acute and chronic systemic conditions.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C

CR5: combination of cardiac and renal dysfunction due to acute and chronic systemic conditions
15. What is pathophysiology of CR1 and CR2 in Cardio-renal syndrome?

I. High arterial pressure, and low central venous pressure.
II. Neurohormonal activation.
III. Lower transglomerular perfusion pressure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The pathophysiology of CR1 and CR2 is complex and multifactorial, involving neurohormonal
activation (RAAS, sympathetic nervous system, arginine vasopressin, natriuretic peptides, adenosine
receptor activation), low arterial pressure, and high central venous pressure, leading to lower
transglomerular perfusion pressure and decreased availability of diuretics to the proximal nephron.
16. Which class of drugs are used in treatment of cardiorenal syndrome in patients with
heart failure?
I. Diuretic.
II. Inotropes.
III. Beta-blockers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Treatment of cardiorenal syndrome in patients with heart failure is largely empirical, but it
typically involves the use of combination diuretics, vasodilators, and inotropes as indicated
17. What is the effect of initiation of diuretic therapy on the level of creatinine in heart
failure patient with cardiorenal syndrome?
I. Sudden increase in creatinine.
II. Sudden decrease in creatinine.
III. Increased creatinine level becomes normal.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
A sudden increase in creatinine can be seen after initiation of diuretic therapy and is often
mistakenly considered evidence of over diuresis or intravascular depletion
18. What is the effect of Low-dose dopamine with diuretic therapy in heart failure patient
with cardiorenal syndrome?
I. Decreased kidney perfusion.
II. Increase kidney perfusion.
III. No change in kidney perfusion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Low-dose dopamine has been used in combination with diuretic therapy, on the supposition that it
can increase kidney perfusion
19. What is hyponatremia?

I. Na < 180 mEq/dl.
II. Na < 150 mEq/dl.
III. Na < 130 mEq/dl.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Hyponatremia (Na < 130 mEq/dl)

20. What is the role of diuretics in patients with current or previous heart failure
symptoms and reduced left ventricular ejection fraction?
I. To reduce edema by reduction of blood volume and venous pressures.
II. To reduce edema by increasing blood volume and venous pressures.
III. To reduce edema by increasing blood volume and arterial pressures.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Diuretics (to reduce edema by reduction of blood volume and venous pressures) and salt restriction (to
reduce fluid retention) in patients with current or previous heart failure symptoms and reduced left
ventricular ejection fraction (LVEF) for symptomatic relief
21. Why angiotensin-converting enzyme inhibitors are used in treatment of heart failure?
I. For neurohormonal modification.
II. Improvement in left ventricular ejection fraction.
III. Vasoconstriction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Angiotensin-converting enzyme inhibitors (aceis) for neurohormonal modification, vasodilatation,

improvement in LVEF, and survival benefit
22. What is the role of angiotensin receptor blockers in treatment of heart failure?
I. Vasodilatation.
II. Increase in preload.
III. Neurohormonal modification.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Angiotensin receptor blockers (ARBs) for neurohormonal modification, vasodilatation, improvement

in LVEF, and survival benefit
23. What is the role of Hydralazine and nitrates in treatment of heart failure?
I. To improve atrial function.
II. To improve ventricular function.
III. To improve exercise capacity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Hydralazine and nitrates to improve symptoms, ventricular function, exercise capacity, and survival
in patients who cannot tolerate an ACEI/ARB or as an add-on therapy to ACEI/ARB and beta-
blockers in the black population for survival benefit
24. What is the role of Beta-adrenergic blockers in treatment of heart failure?
I. Arrhythmia prevention.
III. Control of angina.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Beta-adrenergic blockers for neurohormonal modification, improvement in symptoms and LVEF,

survival benefit, arrhythmia prevention, and control of ventricular rate
25. What is the role of Aldosterone antagonists in treatment of heart failure?
I. Decrease ventricular arrhythmias.

II. Adjunct to other drugs for additive diuresis.
III. Increase in myocardial energy expenditure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Aldosterone antagonists, as an adjunct to other drugs for additive diuresis, heart failure symptom
control, improved heart rate variability, decreased ventricular arrhythmias, reduction in cardiac
workload, improved LVEF, and increase in survival
26. What is the role of Digoxin in treatment of heart failure?
I. Improvement in heart failure symptoms.
II. Large increase in cardiac output.
III. Decreased rate of heart failure hospitalizations.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Digoxin, which can lead to a small increase in cardiac output, improvement in heart failure
symptoms, and decreased rate of heart failure hospitalizations
27. What is the role of Anticoagulants in treatment of heart failure?

I. Decrease the risk of thromboembolism.
II. Decrease cardiac output.
III. Decrease after load.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Anticoagulants to decrease the risk of thromboembolism

28. What is the role of Inotropic agents in treatment of heart failure?
I. Decrease cardiac output.
II. Reduce congestion.
III. To restore organ perfusion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Inotropic agents to restore organ perfusion and reduce congestion
29. Which out of the following is funny current inhibitor?

I. Sotalol.
II. Ivabradine.
III. Captopril.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Funny current" inhibitor, ivabradine (Corlanor)

30. Which drug is indicated to reduce the risk of hospitalization for worsening heart
failure in patients with stable, symptomatic chronic heart failure with an LVEF of 35% or
lower?
I. Sacubitril.
II. Valsartan.
III. Ivabradine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Ivabradine: It is indicated to reduce the risk of hospitalization for worsening heart failure in
patients with stable, symptomatic chronic heart failure with an LVEF of 35% or lower, who are in
sinus rhythm with a resting heart rate of 70 bpm or higher, and who are either on maximally
tolerated doses of beta-blockers or have a contraindication to beta-blocker use
31. What is the mechanism of drug ivabradine?
I. Blocks the hyperpolarization-activated cyclic nucleotide-gated (HCN) channel.

II. Blocks the repolarization-activated cyclic nucleotide-gated (HCN) channel.
III. Blocks the hyperepolarization-activated cyclic nucleotide-gated (HCN) channel.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
This drug blocks the hyperpolarization-activated cyclic nucleotide-gated (HCN) channel responsible
for the cardiac pacemaker I(f) "funny" current, which regulates heart rate without any effect on
ventricular repolarization or myocardial contractility
32. Which drug is used to reduce the risk of cardiovascular death and hospitalization for
heart failure in patients with CHF (NYHA class II-IV) and reduced ejection fraction?
I. Sacubitril.
II. Valsartan.
III. Sacubitril/valsartan.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Combination tablet sacubitril/valsartan (Ernesto) to reduce the risk of cardiovascular death and
hospitalization for heart failure in patients with CHF (NYHA class II-IV) and reduced ejection
fraction
33. What is the pharmacological mechanism of drug sacubitril?

I. Angiotensin Converting Enzyme Inhibitors.
II. Angiotensin receptor-neprilysin inhibitor.
III. Cyclic GMP inhibitor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Combination tablet sacubitril/valsartan: The combination drug is the first approved agent in the
angiotensin receptor-neprilysin inhibitor (ARNI) class and consists of the angiotensin-receptor blocker
valsartan affixed to the neprilysin inhibitor sacubitril
34. What is the effect of combination tablet sacubitril/valsartan on natriuresis and N-
terminal pro-brain natriuretic peptide?
I. Increased natriuresis and decreased N-terminal pro-brain natriuretic peptide.
II. Decreased natriuresis and increased N-terminal pro-brain natriuretic peptide.
III. Increased natriuresis and increased N-terminal pro-brain natriuretic peptide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Combination tablet sacubitril/valsartan: Administration results in increased natriuresis, increased

urine cGMP, and decreased plasma mid-regional periatrial natriuretic peptide (MR-proanp) and N-
terminal pro-brain natriuretic peptide (NT-probnp).
35. According to the ACC/AHA guidelines, Which of the following class of drug should
be avoided in most heart failure patients?
I. Beta blockers.
II. Nonsteroidal anti-inflammatory drugs.
III. Calcium channel blockers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The ACC/AHA guidelines advise that nonsteroidal anti-inflammatory drugs (NSAIDs), calcium
channel blockers, and most antiarrhythmic agents may exacerbate heart failure and should be avoided
in most patients.[3]
36. Why nonsteroidal anti-inflammatory (NSAIDs) are contraindicated in heart failure
patient on diuretics and ACEIS drugs?
I. NSAIDs can cause sodium retention.
II. NSAIDs can cause peripheral vasoconstriction.
III. NSAIDs increases plasma concentration of diuretics and ACEIS.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
36 NSAIDs can cause sodium retention and peripheral vasoconstriction and can attenuate the
efficacy and enhance the toxicity of diuretics and ACEIS
37. What is the goal of Medical therapy in heart failure patients with normal perfusion
and evidence of congestion?
I. Activation of sympathetic nervous system.
II. Inhibition of renin-angiotensin-aldosterone system.
III. Preload and afterload reduction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Medical therapy for heart failure patients, the majority who present with normal perfusion and
evidence of congestion, focuses on the following goals:
 Preload and afterload reduction for symptomatic relief using vasodilators (nitrates, hydralazine,
nipride, nesiritide, ACEI/ARB) and diuretics
 Inhibition of deleterious neurohormonal activation (renin-angiotensin-aldosterone system
[RAAS] and sympathetic nervous system) using ACEI/ARB, beta-blockers, and aldosterone
antagonists resulting in long-term survival benefit
38. How doctors will diagnose Diuretic resistance in patient with heart failure?
I. Through increased Na ion excretion in urine.
II. Decreased urine output.
III. Persistent pulmonary edema.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Diuretic resistance is diagnosed if there is persistent pulmonary edema despite the following
39. Which parameters should be re-evaluated in case of diuretic resistance?

I. Water intake.
II. Food intake.
III. Hemodynamic status.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Volume status, sodium levels, water intake, and hemodynamic status (for signs of poor perfusion)
need to be reevaluated in case of diuretic resistance
40 What are the different approaches for managing diuretic resistance?
I. Increasing the dose and/or frequency of the diuretics.
II. Administering the drug as an IV bolus or IV infusion.
III. Restricting sodium and increasing water intake.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Some approaches to managing resistance to these agents include increasing the dose and/or frequency
of the drug, restricting sodium or water intake, administering the drug as an IV bolus or IV
infusion, and combining diuretics
41. Which of the following drug is human brain natriuretic peptide analogue?
I. Sacubitril.
II. Nesiritide.
III. Valsartan.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Nesiritide (human brain natriuretic peptide analogue

42. Which method is recommended by ACC/AHA and ESC for fluid reduction in patients
with refractory heart failure that is not responsive to medical therapy?
I. Filtration .
II. Reverse osmosis.
III. Ultrafiltration.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The ACC/AHA and ESC recommend the use of ultrafiltration for fluid reduction for patients with
refractory heart failure that is not responsive to medical therapy
43. According to the 2010 Heart Failure Society of America (HFSA) guidelines, in which
condition patient with acute heart failure is hospitalized?
I. Severe acute decompensated heart failure.
II. Acute coronary syndrome.
III. Patient with stable haemodynamic parameters.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The 2010 Heart Failure Society of America (HFSA) guidelines recommend hospitalization for acute
heart failure in the presence of the following[6] :
 Severe acute decompensated heart failure (low blood pressure, worsening renal dysfunction,
altered mentation)
 Dyspnea at rest
 Hemodynamically significant arrhythmia
 Acute coronary syndrome
44. Hospitalization should also be considered in which acute heart failure associate
comorbid conditions?
I. Pneumonia.
II. Diabetic ketoacidosis.
III. Anemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Associated comorbid conditions (eg, pneumonia, pulmonary embolism, diabetic ketoacidosis,

stroke/stroke like symptoms)
45. In which Clinical situations hemodynamic monitoring is necessary in heart failure

patient?
I. Persistent symptomatic hypotension despite initial therapy.
II. Improved renal function after initial therapy.
III. Worsening renal function despite initial therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Clinical situations in which invasive hemodynamic monitoring is recommended to guide therapy

include the following[3] :
 Persistent symptomatic hypotension despite initial therapy
 Worsening renal function despite initial therapy or despite adjustment of recommended
therapies
 Need for parenteral vasoactive agents after initial clinical improvement
 Presumed cardiogenic shock requiring escalating inotrope and/or pressor therapy and
consideration of mechanical support
 Consideration of advanced device therapy or transplantation
46. Which class of drug are indicated for patients with prior MI or hypertension and for
control of ventricular rate in those with atrial fibrillation?
II. Beta-blockers.
III. Inotropes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Beta-blockers are indicated for patients with prior MI or hypertension and for control of ventricular
rate in those with atrial fibrillation
47. What is the treatment of heart failure with normal left ventricular ejection fraction?
I. Digitalis or inotropes.
II. Lifestyle modification.
III. ACEI/ARBs, Beta-blockers, Aldosterone receptor blockers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Treatment of heart failure with normal left ventricular ejection fraction

Lifestyle modification, pharmacological therapy to relieve symptoms (ACEI/ARBs, Beta-blockers,
Aldosterone receptor blockers) Use of digitalis or inotropes in patients with HFNEF is not indicated
48. What should be done to manage right ventricular (RV) failure?
I. Optimization of preload, afterload, and RV contractility.
II. Use of drug that causes Hypotension.
III. Maintenance of sinus rhythm; and atrioventricular synchrony.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Management of right ventricular (RV) failure includes treatment of the underlying cause;
optimization of preload, afterload, and RV contractility; maintenance of sinus rhythm; and
atrioventricular synchrony. Hypotension should be avoided, as it can potentially lead to further RV
ischemia
49. Which devices are used for electrophysiologic intervention in heart failure?
I. cardiac resynchronization therapy devices
II. Pacemakers.
III. Defibrillators.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Devices for electrophysiologic intervention in heart failure include pacemakers, cardiac

resynchronization therapy (CRT) devices, and implantable cardioverter-defibrillators (icds).
50. What is the role of implantable cardioverter-defibrillators (icds) in heart failure
patients?
I. Life-threatening ventricular arrhythmias.
II. Reductions in sudden death from ischemic.
III. Reductions in sudden death from nonischemic sustained ventricular tachyarrhythmias.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
ICD placement results in remarkable reductions in sudden death from ischemic and nonischemic
sustained ventricular tachyarrhythmias in heart failure patients.
51. AHA/ACC and ESC recommend placement of implantable cardioverter-defibrillators

(icds) in which of the following categories of heart failure patients?
I. Patients who have had ventricular fibrillation (VF).
II. Patients with LV dysfunction from a previous MI who are at least 40 days post-Ml.
III. Patients with hemodynamically stable ventricular tachycardia .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
AHA/ACC and ESC recommend ICD placement for the following categories of heart failure patients
 are at least 40 days
post-Ml
 Patients who have had ventricular fibrillation (VF)
 Patients with documented hemodynamically unstable ventricular tachycardia (VT) and/or
VT with syncope; with an LVEF less than 40%; on optimal medical therapy; and expected
to survive longer than 1 year with good functional status
52. In which type of patient ACC/AHA guidelines recommends resynchronization
therapy?
I. Patients with heart failure.
II. Patients with QRS interval <120 ms.
III. Patients with QRS interval >120 ms.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Patients with heart failure and interventricular conduction abnormalities (roughly defined as those
with a QRS interval >120 ms) are potential candidates for CRT by means of an inserted
biventricular pacemaker.
53. How cardiac resynchronization therapy (CRT) improve cardiac performance?

I. Increasing the mismatch between cardiac contractility and energy expenditure.
II. lectrical.
III. Reduces presystolic mitral regurgitation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
and mechanical synchrony.[6] Thus, it reduces presystolic mitral regurgitation and optimizes diastolic
function by reducing the mismatch between cardiac contractility and energy expenditure
54. Which of the following method may be beneficial for patients with class II heart
failure, an LVEF of 30% or less, and QRS duration of more than 150 ms?
I. Cardiac resynchronization therapy (CRT).
II. Biventricular pacing with CRT.
III. Biventricular pacing with implantable cardioverter-defibrillators (ICD) implantation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The combination of biventricular pacing with ICD implantation (CRT-ICD) may be beneficial
for patients with class II heart failure, an LVEF of 30% or less, and QRS duration of more than
150 ms.
55. Which revascularization procedure should be considered in selected patients with heart
failure and CAD?
I. Coronary artery bypass grafting .
II. Percutaneous coronary intervention.
III. Cardiac resynchronization therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
CABG and percutaneous coronary intervention (PCI) are revascularization procedures that should
be considered in selected patients with heart failure and CAD.
56. Which is reliable method to determine which patients with low Ejection Fraction and
aortic stenosis may benefit from Aortic valve replacement?
I. Contractile reserve with dobutamine.
II. Contractile reserve with dopamine.
III. Contractile reserve with Propranolol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Assessment of contractile reserve with dobutamine has been demonstrated as a reliable method to
determine which patients with low EF and aortic stenosis may benefit from AVR
57. Which Surgery is recommended by European Society of Cardiologyin patients with

heart failure and severe mitral valve regurgitation whenever coronary revascularization is an
option?
I. Coronary artery bypass grafting.
II. Mitral valve surgery.
III. Percutaneous coronary intervention.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The ESC recommends considering mitral valve surgery in patients with heart failure and severe mitral
valve regurgitation whenever coronary revascularization is an option.[5] Candidates would include
the following
58. Which out of the following sentence is correct for extracorporeal membrane
oxygenation?
I. Provides both oxygenation and circulation of blood.
II. Lungs and heart gets time to recover.
III. Can be used for 11-15 days.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
ECMO provides both oxygenation and circulation of blood, allowing the lungs and heart time to
recover. Unlike cardiopulmonary bypass, whose duration of use is measured in hours, ECMO can be
used for 3-10 days.
59. What are the complications of ventricular assist device (vads)?

I. Increased blood pressure.
II. Thromboembolic events.
III. Mechanical breakdown.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Potential complications of vads include mechanical breakdown, infection, bleeding, and

thromboembolic events.
60. According to the ACC/AHA, what are the indications for heart transplantation?
I. Refractory cardiogenic shock.
II. Peak oxygen consumption per unit time (VO 2) less than 35 ml/kg/min.
III. Dependence on IV inotropic support for adequacy of organ perfusion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
According to the ACC/AHA, absolute indications for heart transplantation include hemodynamic
compromise following heart failure, including the following scenarios[3] :
 Refractory cardiogenic shock
 Dependence on IV inotropic support for adequacy of organ perfusion
 Peak oxygen consumption per unit time (VO 2) less than 10 ml/kg/min
61. What are the advantages of total artificial heart (TAH) over Left Ventricular Assist
Device (lvads)?
I. Assist patients with severe biventricular failure.
II. Opportunity to treat patients with systemic diseases (eg, amyloidosis, malignancy).
III. Requires device pocket and thus a increased risk of infection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Compared with lvads, the TAH has several potential advantages, including the ability to assist
patients with severe biventricular failure; a lack of device pocket and thus a lessened risk of infection;
and the opportunity to treat patients with systemic diseases (eg, amyloidosis, malignancy) who are not
otherwise candidates for transplantation
62. The choice between CABG and PCI in patient with heart failure depends on -
I. Patient comorbidities.
II. Coronary anatomy.
III. Patient genetic history.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The choice between CABG and PCI depends on the following factors:
 Patient comorbidities
 Coronary anatomy
63. The ACC/AHA recommend that valve repair or replacement in patients with -
I. Patient with severe hypertension.
II. Hemodynamically significant valvular stenosis.
III. Severe aortic or mitral valve stenosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The ACC/AHA recommends that valve repair or replacement in patients with hemodynamically
significant valvular stenosis or regurgitation and asymptomatic heart failure should be based on
contemporary guidelines. In addition, the ACC/AHA indicates that such surgery should be considered
for patients with severe aortic or mitral valve stenosis or regurgitation, even when ventricular function
is impaired
64. What is the dose of Bisoprolol in patient with heart failure?
I. 10 mg.
II. 20 mg.
III. 30 mg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Bisoprolol at the target dose of 10 mg daily has been shown to reduce mortality
65. What is the pharmacological mechanism of Carvedilol?

I. Selective beta-adrenergic blocker.
II. Selective alpha1-adrenergic blocker.
III. Nonselective beta- and alpha1-adrenergic blocker.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Carvedilol is a nonselective beta- and alpha1-adrenergic blocker
66. Which of the following drugs fall in beta-1 blockers class?

I. Metoprolol.
II. Bisoprolol.
III. Carvedilol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Beta-1 blockers Metoprolol, Bisoprolol
67. Why beta-1 blockers are used in heart failure patient?

I. Because they reduce heart rate .
II. Because have positive Chronotropic effects.
III. Because they reduce blood pressure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Beta-1 blockers are selective in blocking beta-1 adrenoreceptors. These agents are used in heart
failure to reduce heart rate and blood pressure.
68. Which of the following is true for Angiotensin-converting enzyme inhibitors (aceis)?
I. Increases aldosterone secretion.
II. Prevent conversion of angiotensin I to angiotensin II.
III. Lower aldosterone secretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Angiotensin-converting enzyme inhibitors (ACEIS) prevent conversion of angiotensin I to

angiotensin II, which results in lower aldosterone secretion
69. Which of the following Angiotensin-converting enzyme inhibitors are used in heart
failure patient?
I. Captopril.
II. Lisinopril.
III. Diltiazem.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Angiotensin-converting enzyme inhibitors Captopril, Enalapril, Lisinopril, Ramipril, Quinapril
70. What is the dose of Valsartan in patient with heart failure?

I. 160 mg; q.i.d.
II. 160 mg; b.i.d.
III. 160 mg; t.i.d.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Valsartan at a target dose of 160 mg twice daily has been shown to improve survival in patients
with heart failure and reduced ejection fraction
71. What is the mechanism of Candesartan?
I. Competitive inhibition of the AT1 receptor.
II. Stimulate the renin-angiotensin-aldosterone system.
III. Block the renin-angiotensin-aldosterone system.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
ARBs block the renin-angiotensin-aldosterone system (RAAS) by competitive inhibition of the AT1
receptor, thereby decreasing afterload and preventing LV remodeling
72. Which class of drug is first-line therapy for patients with mild to moderate heart
failure symptoms and left ventricular (LV) dysfunction?
I .inotropic.
II. Beta blockers.
III. Angiotensin receptor blockers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Angiotensin receptor blockers (ARBs) are reasonable first-line therapy for patients with mild to
moderate heart failure symptoms and left ventricular (LV) dysfunction when patients are already
taking these agents for other indications
73. Which of the following Angiotensin receptor blockers are used in heart failure patient?
I. Valsartan.
II. Dopamine.
III. Losartan.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Angiotensin receptor blockers Losartan, Valsartan, Candesartan, Irbesartan Azilsartan
74. What is the effect of Dobutamine on heart in patient with heart failure?
I. Positive inotropic effect.
II. Positive chronotropic effect.
III. Increases afterload.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Dobutamine, a beta-receptor agonist, increases inotropy and chronotropy and decreases afterload,
thereby improving end-organ perfusion.
75. What is the pharmacological mechanism of Dopamine?
I. Stimulates adrenergic receptors.
II. Stimulates dopaminergic receptors.
III. Stimulates both adrenergic and dopaminergic receptors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Dopamine It stimulates both adrenergic and dopaminergic receptors.
76. What is the pharmacological mechanism of Milrinone?

I. Type 3 phosphodiesterase inhibitor.
II. Type 4 phosphodiesterase inhibitor.
III. Type 5 phosphodiesterase inhibitor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Milrinone is a type 3 phosphodiesterase inhibitor that increases inotropy, chronotropy, and lusitropy,
acting via cyclic guanosine monophosphate (cGMP) to increase the intramyocardial adenosine
triphosphate (ATP
77. What is the effect of Milrinone on heart in patient with heart failure?
I. Positive inotropic effect.
II. Positive chronotropic effect.
III. Negative lusitropy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Milrinone is a type 3 phosphodiesterase inhibitor that increases inotropy, chronotropy, and lusitropy,
acting via cyclic guanosine monophosphate (cGMP) to increase the intramyocardial adenosine
triphosphate
78. Which of the following are Inotropic Agents?

I. Digoxin.
II. Verapamil.
III. Dopamine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Inotropic Agents
Milrinone,Digoxin,Dopamine,Dobutamine
79. What is the role of nitrates in treatment of heart failure?
I. Increases left ventricular filling pressure.
II. Decreases left ventricular filling pressure.
III. Decreases systemic vascular resistance.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Nitrates improve hemodynamic effects in heart failure by decreasing left ventricular filling pressure
and systemic vascular resistance
80. When is Nitroglycerin contraindicated?

I. Hypotensive patient with heart failure.
II. Hypertensive patient with heart failure.
III. Normotensive patient with heart failure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Nitroglycerin is first-line therapy for patients who are not hypotensive

81. What is the pharmacological mechanism of Isosorbide dinitrate?
I. Stimulate intracellular cyclic GMP.
II. Increases intracellular Ca level.
III. Stimulates intracellular cyclic AMP.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Isosorbide dinitrate relaxes vascular smooth muscle by stimulating intracellular cyclic GMP
82. Which out of following drug falls in class Nitrates?

I. Nitroglycerin.
II. Verapamil.
III. Isosorbide mononitrate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Nitrates
Nitroglycerin, Isosorbide dinitrate, Isosorbide mononitrate
83. Which drug is used in patient with acutely decompensated heart failure?
I. Furosemide.
II. Valsartan.
III. Nesiritide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Human B-type natriuretic peptides (hbnps) such as nesiritide are used in patients with acutely
decompensated heart failure.
84. What is the pharmacological mechanism of Furosemide?

I. Interfering with the chloride-binding cotransport system.
II. Inhibits sodium and chloride reabsorption in the ascending loop of Henle and distal renal
tubule.
III. Inhibits sodium and chloride reabsorption in the descending loop of Henle and distal renal
tubule.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Furosemide increases the excretion of water by interfering with the chloride-binding cotransport
system, which, in turn, inhibits sodium and chloride reabsorption in the ascending loop of Henle
and distal renal tubule
85. Which drug is used as First-line diuretic therapy in patient with heart failure?
I. Bumetanide.
II. Bumetanide.
III. Spironolactone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
First-line diuretic therapy is a loop diuretic (furosemide, bumetanide, torsemide) in the lowest
effective dose, either once or twice a day although it can be used up to 3-4 times a day
depending on the individual response and renal function
86. Which out of the following are loop diuretics?

I. Indapamide.
II. Furosemide.
III. Bumetanide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Loop diuretic
Furosemide,Torsemide,Bumetanide
87. What is the pharmacological mechanism of Thiazide diuretics?
I. Inhibit reabsorption of sodium and chloride in the cortical descending limb of the loop of
Henle and the distal tubules
II. Inhibit reabsorption of sodium and chloride in the cortical ascending limb of the loop of
Henle and the distal tubules.
III. Inhibit reabsorption of sodium and chloride in the cortical ascending and descending limb of
the loop of Henle and the distal tubules.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Thiazide diuretics inhibit reabsorption of sodium and chloride in the cortical thick ascending limb
of the loop of Henle and the distal tubules
88. Which out of the following are Thiazide diuretics?

I. Chlorthalidone.
II. Indapamide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Thiazide diuretic
Hydrochlorothiazide,indapamide,Chlorthalidone,Chlorothiazide
89. Which out of the following are Potassium-Sparing diuretics?
I. Chlorothiazide.
II. Amiloride.
III. Triamterene.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Diuretics, Potassium-Sparing
Amiloride, spironolactone, Triamterene
90. What is the pharmacological mechanism of Eplerenone?

I. Stimulate aldosterone at the mineralocorticoid receptors in epithelial and non epithelial.
II. Blocks aldosterone at the mineralocorticoid receptors in epithelial and non epithelial.
III. Blocks adrenergic receptor at the mineralocorticoid receptors in epithelial and non epithelial.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Eplerenone selectively blocks aldosterone at the mineralocorticoid receptors in epithelial (eg, kidney)
and nonepithelial (eg, heart, blood vessels, and brain) tissues;
91. What is the pharmacological effect of Epinephrine on heart in heart failure patient?
I. Negative chronotropic effect.
II. Bronchodilatation.
III. Positive inotropic effects.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Epinephrine : Beta2-agonist effects include bronchodilatation, chronotropic cardiac activity, and

positive inotropic effects
92. What is the pharmacological mechanism of Epinephrine?

I. Alpha-agonist.
II. Beta2-agonist.
III. Alpha-agonist and Beta2-agonist.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Epinephrine is an alpha-agonist and Beta2-agonist

93. Which class of drug are used to improve cardiac output and organ perfusion in the
presence of significant hypotension?
I. Diuretics.
II. Adrenergic agonists.
III. Aldosterone antagonist.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
In the presence of significant hypotension, adrenergic agonists are used to improve cardiac output
and organ perfusion
94. Which out of the following is Alpha/Beta Adrenergic Agonist?
I. Epinephrine.
II. Eplerenone.
III. Norepinephrine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Alpha/Beta Adrenergic Agonists

Epinephrine, Norepinephrine
95. Which class of drugs is used to treat angina in heart failure patients?
II. Diuretics.
III. Adrenergic agonists.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Calcium channel blockers: these agents may be used to treat other conditions, such as hypertension or
angina in heart failure patients
96. Which out of the following Calcium Channel Blockers are used in heart failure
patient?
I. Valsartan
II. Amlodipine.
III. Nifedipine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Calcium Channel Blockers

Amlodipine, Nifedipine
97. Which out of the following sentence is true for Dabigatran?
I. It is Competitive, direct thrombin inhibitor.
II. Inhibits thrombin-induced platelet aggregation.
III. Inhibits only free thrombin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Dabigatran: Competitive, direct thrombin inhibitor. Thrombin enables fibrinogen conversion to

fibrin during the coagulation cascade, thereby preventing thrombus development. Inhibits both free
and clot-bound thrombin and thrombin-induced platelet aggregation
98. Which out of the following Anticoagulants are used in heart failure patient?
I. Warfarin.
II. Aspirin.
III. Dabigatran.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Anticoagulants
Warfarin, Dabigatran
99. Which out of the following Opioid analgesics are used in heart failure patient?
I. Morphine.
II. Paracetamol.
III. Piroxicam.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Opioid analgesics such as morp

dyspnea
100. Which class of analgesic are recommended in patient with heart failure?
I. Non-opioid Analgesics.
II. Opioid Analgesics.
III. Both.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Opioid Analgesics
ACUTE CORONARY SYNDROMES
Disease conditions
1. Which disease is considered asa spectrum of clinical presentations ranging from those for
ST-segment elevation myocardial infarction (STEMI) to presentations found in non ST-
segment elevation myocardial infarction (NSTEMI) or in unstable angina?
I. Bronchitis.
II. Chronic Asthma.
III. Acute coronary syndrome (ACS).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Acute coronary syndrome (ACS) refers to a spectrum of clinical presentations ranging from those for
ST-segment elevation myocardial infarction (STEMI) to presentations found in non ST-segment
elevation myocardial infarction (NSTEMI) or in unstable angina
2. From the following, American College of Physicians (ACP) guidelines do not apply?
I. Symptomatic patients.
II. Teenagers.
III. Athletes before participation in various events A) I only.
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 The ACP recommendations do not apply to symptomatic patients or to screening athletes

before participation in various events.
Remarks- question not clinically relevant need to remove
3. Which disease condition is always associated with rupture of an atherosclerotic plaque
and partial or complete thrombosis of the infarct-related artery?
I. Bronchitis.
II. Chronic Asthma.
III. Acute coronary syndrome (ACS).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Acute coronary syndrome (ACS) refers to a spectrum of clinical presentations ranging from those for
ST-segment elevation myocardial infarction (STEMI) to presentations found in non ST-segment
elevation myocardial infarction (NSTEMI) or in unstable angina. It is almost always associated with
rupture of an atherosclerotic plaque and partial or complete thrombosis of the infarct-related artery.
4. Which is the most common symptom of Acute coronary syndrome (ACS) ?

I. Palpitations.
II. Heavy sweating.
III. Indigestion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Complaints reported by patients with ACS include the following:

 Palpitations
 Pain, which is usually described as pressure, squeezing, or a burning sensation across the
precordium and may radiate to the neck, shoulder, jaw, back, upper abdomen, or either arm
 Exertional dyspnea that resolves with pain or rest
 Diaphoresis from sympathetic discharge
 Nausea from vagal stimulation
 Decreased exercise tolerance
5. Which of the following medicine (which works as an antithrombic) is most suitable if
somebody is diagnosed with possible Acute coronary syndrome (ACS)?
I. Propanolol.
II. Aspirin.
III. Paracetamol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Pharmacologic antithrombotic therapy includes the following:

 Aspirin
 Clopidogrel
 Prasugrel
 Ticagrelor
 Glycoprotein IIb/IIIa receptor antagonists (abciximab, eptifibatide, tirofiban)
6. Which medications are preferred when somebody is diagnosed with definite Acute
coronary syndrome (ACS) ?
I. Aspirin.
II. Paracetamol.
III. Clopidogrel.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Aspirin
 Clopidogrel
 Prasugrel
 Ticagrelor
7. Which, among the following can be found in an ACS patient?
I. Diaphoresis.
II. Swollen legs.
III. Heartburn.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Physical findings can range from normal to any of the following:

 Hypotension: Indicates ventricular dysfunction due to myocardial ischemia, myocardial
infarction (MI), or acute valvular dysfunction
 Hypertension: May precipitate angina or reflect elevated catecholamine levels due to
anxiety or to exogenous sympathomimetic stimulation
 Diaphoresis
 Pulmonary edema and other signs of left heart failure
8. What are some potential harms of cardiac screening?

I. Breathing at a faster rate.
II. Infection.
III. False-positive results causing patients to undergo potentially unnecessary tests and procedures.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Potential harms of cardiac screening include false-positive results causing patients to undergo
potentially unnecessary tests and procedures.
9. What are modifiable risk factors that need to be treated among low risk adults of A cute
coronary syndrome (ACS)?
I. Ulcer.
II. Smoking.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Clinicians should therefore emphasize strategies to reduce cardiovascular risk even further among low-
risk adults by treating modifiable risk factors (smoking, diabetes, blood pressure, hyperlipidemia,
overweight, and exercise).
10. Which drug is NOT considered under Pharmacologic antithrombotic therapy?

I. Clopidogrel.
II. Ticagrelor .
III. Metoprolol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Clinicians should not screen asymptomatic, low-risk adults for cardiac disease using resting or stress
electrocardiography, stress echocardiography, or stress myocardial perfusion imaging.
11. Which is considered as the primary cause of Acute coronary syndrome (ACS) ?
I. Atherosclerosis.
II. Fatty liver.
III. Ulcers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Atherosclerosis is the primary cause of ACS, with most cases occurring from the disruption of a
previously non severe lesion
12. What are the main symptoms (or complaints) reported by the patients of Acute coronary
syndrome (ACS) ?
I. Palpitations.
II. Pain, which is usually described as pressure, squeezing, or a burning sensation across the
precordium and may radiate to the neck, shoulder, jaw, back, upper abdomen, or either arm .
III. Sneezing.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Complaints reported by patients with ACS include the following:

 Palpitations
13. Which type of physical finding are obtained generally during Acute coronary syndrome
(ACS)?
I. Pulmonary oedema.
II. Hypotension.
III. Mood swings.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Hypertension: May precipitate angina or reflect elevated catecholamine levels due to anxiety
or to exogenous sympathomimetic stimulation
 Diaphoresis
 Extracardiac vascular disease
 Jugular venous distention
 Cool, clammy skin and diaphoresis in patients with cardiogenic shock
 A third heart sound (S 3) and, frequently, a fourth heart sound (S 4)
 A systolic murmur related to dynamic obstruction of the left ventricular outflow tract
 Rales on pulmonary examination (suggestive of left ventricular dysfunction or mitral
regurgitation)
14. With which disease, symptoms like cool, clammy skin and diaphoresis in patients with
cardiogenic shock are associated with?
I. Pulmonary edema.
II. Acute coronary syndrome (ACS).
III. Tuberculosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

 Diaphoresis
regurgitation)
15. With which disease, symptoms like third heart sound (S 3) and, frequently, a fourth heart
sound (S 4) are associated with?
I. Acute coronary syndrome (ACS).
II. Hypertension.
III. Diabetes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A

 Diaphoresis
regurgitation)
16. With which disease, a systolic murmur related to dynamic obstruction of the left
ventricular outflow tract, is related with?
I. Pulmonary edema .
II. Acute coronary syndrome (ACS).
III. Tuberculosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

 Diaphoresis
regurgitation)
17. What may be the potential complications of Acute coronary syndrome (ACS) ?
I. Ischemia: Pulmonary edema .
II. Myocardial infarction: Rupture of the papillary muscle, left ventricular free wall, and ventricular
septum .
III. Gastroenteritis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Potential complications include the following:

 Ischemia: Pulmonary edema
 Myocardial infarction: Rupture of the papillary muscle, left ventricular free wall, and
ventricular septum
18. Which of the following ECG changes may be seen during anginal episodes?
I. Transient ST-segment depressions.
II. Dynamic X-wave changes .
III. ST depressions .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The ASPECT study tested a 2-hour, accelerated diagnostic protocol (ADP) that included the use of a
structured pretest probability scoring method, electrocardiography, and a point-of-care biomarker
panel that included troponin, creatine kinase MB, and myoglobin levels.
19. Which enzymes and protein levels are checked in tests, such as accelerated diagnostic
protocol (ADP), for acute coronary disease?
I. Hemoglobin.
II. SGOT & LDP.
III. Troponin, creatine kinase MB, and myoglobin levels.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The ASPECT study tested a 2-hour, accelerated diagnostic protocol (ADP) that included the use of a
structured pretest probability scoring method, electrocardiography, and a point-of-care biomarker
panel that included troponin, creatine kinase MB, and myoglobin levels.
20. Which of the following anti-ischemic drug is only used for symptomatic relief in ACS?
I. Beta-blockers.
II. Nitrates.
III. Aspirin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Pharmacologic anticoagulant therapy includes the following:

 Unfractionated heparin (UFH)
 Low-molecular-weight heparin (LMWH; dalteparin, nadroparin, enoxaparin)
 Factor Xa inhibitors (rivaroxaban, fondaparinux)
21. What is the most common complication of ischemia?
I. Rupture of the papillary muscle.
II. Rupture of the papillary muscle, left ventricular free wall, and ventricular septum.
III. Pulmonary edema.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Complications of ischemia include pulmonary edema, while those of myocardial infarction include
rupture of the papillary muscle, left ventricular free wall, and ventricular septum.
22. What are some common complications of myocardial infarction?

I. Rupture of the papillary muscle.
II. Rupture of the left ventricular free wall, and ventricular septum.
III. Pulmonary edema.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Complications of ischemia include pulmonary edema, while those of myocardial infarction include
rupture of the papillary muscle, left ventricular free wall, and ventricular septum.
23. The major trigger for coronary thrombosis is considered to be plaque rupture caused by
the dissolution of the fibrous cap. What causes dissolution of the fibrous cap?
I. The release of metalloproteinases (collagenases) from activated inflammatory cells.
II. The release of HCl from oxyntic cells.
III. The release of histamine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Guidelines released by the European Society of Cardiology (ESC) in August 2011 for the management
of non-ST-segment elevation acss recommend GRACE or a similar scoring system to score the risk of
an ischemic event in the short-to-mid term
24. Which events follows after plaque rupture due to dissolution of fibrous cap, the major
trigger for coronary thrombosis ?
I. Platelet activation and aggregation.
II. Deactivation of the coagulation pathway.
III. Vasoconstriction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The major trigger for coronary thrombosis is considered to be plaque rupture caused by the dissolution
of the fibrous cap, the dissolution itself being the result of the release of metalloproteinases (collagenases)
from activated inflammatory cells. This event is followed by platelet activation and aggregation,
activation of the coagulation pathway, and vasoconstriction.
25. How many lead electrocardiography (ECG) should be performed for patients with chest
pain or other symptoms suggesting acute coronary syndromes (ACS)?
I. 8 lead electrocardiography (ECG).
II. 12 lead electrocardiography (ECG).
III. 10 lead electrocardiography (ECG).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
 Patients with chest pain or other symptoms suggesting acute coronary syndromes (ACS) should
have 12-lead electrocardiography (ECG) performed and evaluated within 10 min of arrival
at an emergency facility, and serial ECGs should be performed to detect ischemic changes.
26. Within how much time of pa 12-lead

electrocardiography should be (ECG) performed and evaluated ?
I. 30 min.
II. 10 min.
III. 1 hour.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Patients with chest pain or other symptoms suggesting acute coronary syndromes (ACS) should have
12-lead electrocardiography (ECG) performed and evaluated within 10 min of arrival at an
emergency facility, and serial ECGs should be performed to detect ischemic changes.
27. For which type of patients of ACS, non-invasive imaging is reasonable before emergency
department discharge or within 72 hours after discharge?
I. In patients with symptoms consistent with ACS without objective evidence of myocardial
ischemia (nonischemic ECG and normal cardiac troponin levels).
II. In patients with symptoms consistent with ACS with objective evidence of myocardial ischemia.
III. In patients with no symptoms consistent with ACS.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
In patients with symptoms consistent with ACS without objective evidence of myocardial ischemia
(nonischemic ECG and normal cardiac troponin levels), non-invasive imaging is reasonable before
emergency department discharge or within 72 hours after discharge
28. What factors may cause stable coronary artery disease (CAD) result in ACS in the
absence of plaque rupture and thrombosis?
I. When physiologic stress (eg, trauma, blood loss, anemia, infection, tachyarrhythmias) increases
demands on the heart.
II. In patients with symptoms consistent with ACS without objective evidence of myocardial
ischemia.
III. In patients with no symptoms consistent with ACS.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
As previously mentioned, stable coronary artery disease (CAD) may result in ACS in the absence of
plaque rupture and thrombosis, when physiologic stress (eg, trauma, blood loss, anemia, infection,
tachyarrhythmias) increases demands on the heart
29. How is Non ST-segment elevation myocardial infarction (NSTEMI) distinguished
from unstable angina?
I. By increased Hb.
II. By increased heart beat.
III. By elevated levels of cardiac enzymes and biomarkers of myocyte necrosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Non ST-segment elevation myocardial infarction (NSTEMI) is distinguished from unstable angina
by elevated levels of cardiac enzymes and biomarkers of myocyte necrosis
30. How many sets of biomarkers are used to distinguish Non ST-segment elevation
myocardial infarction (NSTEMI) from unstable angina?
I. 3 sets of biomarkers measured at 6- to 8-hour intervals after the patient's presentation to the ED.
II. 4 sets of biomarkers measured at 6- to 8-hour intervals after the patient's presentation to the
ED.
III. 5 sets of biomarkers measured at 6- to 8-hour intervals after the patient's presentation to theed.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Differentiation is generally based on 3 sets of biomarkers measured at 6- to 8-hour intervals after the
patient's presentation to the ED
31. What does the current definition of NSTEMI requires?
I. A typical clinical syndrome.
II. Elevated levels of cardiac enzymes.
III. Elevated troponin (or creatine kinase isoenzyme MB [CK-MB]) levels to over 99% of the
normal reference.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The current definition of NSTEMI requires a typical clinical syndrome plus elevated troponin (or
creatine kinase isoenzyme MB [CK-MB]) levels to over 99% of the normal reference (with a
coefficient of variation of < 10% for the assay).
32. Which is the most important diagnostic test for angina, in the emergency setting?
I. SGOT.
III. Electrocardiography (ECG).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
In the emergency setting, electrocardiography (ECG) is the most important diagnostic test for angina.
33 Which are some important ECG changes that may be seen during anginal episodes?
I. Transient ST-segment elevations .
II. Dynamic T-wave changes: Inversions, normalizations, or hyperacute changes .
III. Hypersensitivity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
ECG changes that may be seen during anginal episodes include the following:
 Transient ST-segment elevations
 Dynamic T-wave changes: Inversions, normalizations, or hyperacute changes
 ST depressions: These may be junctional, downsloping, or horizontal
34. Which type of laboratory studies may be helpful in an angina episode?

I. Creatine kinase isoenzyme MB (CK-MB) levels .
II. Cardiac troponin levels .
III. SGOT.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Laboratory studies that may be helpful include the following:

 Creatine kinase isoenzyme MB (CK-MB) levels
 Cardiac troponin levels
 Myoglobin levels
 Basic metabolic panel
35. Which type of laboratory studies may be helpful in an angina episode?
I. Myoglobin levels .
III. Complete blood count .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Laboratory studies that may be helpful include the following:

 Creatine kinase isoenzyme MB (CK-MB) levels
 Cardiac troponin levels
 Myoglobin levels
 Basic metabolic panel
36. Which type of diagnostic imaging modalities that may be useful, in an angina episode?
I. Chest radiography .
II. Echocardiography.
III. MRI.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Diagnostic imaging modalities that may be useful include the following:

 Chest radiography
 Echocardiography
 Myocardial perfusion imaging
 Cardiac angiography
 Computed tomography, including CT coronary angiography and CT coronary artery calcium
scoring
37. In some instances, stable coronary artery disease (CAD) may result in ACS in the
absence of plaque rupture and thrombosis, when physiologic stress increases demands on
the heart. Which of the following could be a physiologic stress?
I. Trauma.
II. Blood loss.
III. Dry mouth.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In some instances, however, stable coronary artery disease (CAD) may result in ACS in the absence
of plaque rupture and thrombosis, when physiologic stress (eg, trauma, blood loss, anemia, infection,
tachyarrhythmia) increases demands on the heart
38. Which initial therapies are recommended during an anginal episode?

I. Massage.
II.
III. Relieving ischemic pain .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Initial therapy focuses on the following:


 Relieving ischemic pain
 Providing antithrombotic therapy
39. Which initial therapies are recommended during an anginal episode?
I. Relieving ischemic pain .
II. Providing antithrombotic therapy .
III. Giving anti-allergics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Initial therapy focuses on the following:


 Relieving ischemic pain
 Providing antithrombotic therapy
40. Which are the main Pharmacologic anti-ischemic drugs?

I. Diclofenac.
II. Nitrates.
III. Beta blockers (eg, metoprolol).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Pharmacologic anti-ischemic therapy includes the following:

 Nitrates (for symptomatic relief)
 Beta blockers (eg, metoprolol): These are indicated in all patients unless contraindicated
41. Which are the main Pharmacologic antithrombotic drugs in ACS?
I. Aspirin .
II. Clopidogrel.
III. Zantac.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Aspirin
 Clopidogrel
 Prasugrel
 Ticagrelor
42. To which category, drugs like Prasugrel and Ticagrelor belongs?

I. Anti thrombic.
II. Anti- hypertensive.
III. Anti-ischemic.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A

 Aspirin
 Clopidogrel
 Prasugrel
 Ticagrelor
43. In which of the following patient, cardiac screening is of low predictive value?
I. Among adults at high risk of coronary disease.
II. Among elderly at high risk of coronary disease.
III. Among adults at low risk of coronary disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Optical coherence tomography (OCT), palpography, and virtual histology are being studied for use
in identifying vulnerable plaques
44. Which drug would you recommend for Pharmacologic anticoagulant therapy?
I. Tramadol.
II. Low-molecular-weight heparin (LMWH; dalteparin, nadroparin, enoxaparin) .
III. Factor Xa inhibitors (rivaroxaban, fondaparinux) .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Pharmacologic anticoagulant therapy includes the following:

 Unfractionated heparin (UFH)
 Low-molecular-weight heparin (LMWH; dalteparin, nadroparin, enoxaparin)
 Factor Xa inhibitors (rivaroxaban, fondaparinux)
45. Which of the following has prognostic value in the setting of acute myocardial
infarction?
I. Leukocytosis.
II. Pinocytosis.
III. Plasmolysis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Leukocytosis has prognostic value in the setting of acute myocardial infarction.
46. Which of the following is a preferred treatment for ST-elevation MI?

I. Thrombolysis .
II. Percutaneous coronary intervention .
III. Surgery.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Additional therapeutic measures that may be indicated include the following:

 Thrombolysis
 Percutaneous coronary intervention (preferred treatment for ST-elevation MI)
47. Which of the following is included in current guidelines for patients with moderate- or
high-risk ACS?
I. Early invasive approach .
II. Concomitant antithrombotic therapy, including aspirin and clopidogrel, as well as UFH or
LMWH .
III. MRI.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Current guidelines for patients with moderate- or high-risk ACS include the following:
 Early invasive approach
 Concomitant antithrombotic therapy, including aspirin and clopidogrel, as well as UFH or
LMWH
48. With which medical condition, ACS is almost always associated with, in terms of
pathology?
I. Swelling of legs.
II. Constriction of the pupil.
III. With rupture of an atherosclerotic plaque and partial or complete thrombosis of the infarct-
related artery.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
In terms of pathology, ACS is almost always associated with rupture of an atherosclerotic plaque and
partial or complete thrombosis of the infarct-related artery.
49. Which of the following can be used for the diagnosis of acute myocardial infarction?
I. Low Hb levels.
II. Ischemic symptoms .
III. Finding of the typical rise and fall of biochemical markers of myocardial necrosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The diagnosis of acute myocardial infarction in this setting requires a finding of the typical rise and
fall of biochemical markers of myocardial necrosis in addition to at least 1 of the following [3] (See
Workup.):
 Ischemic symptoms
 Development of pathologic Q waves
 Ischemic ST-segment changes on electrocardiogram (ECG) or in the setting of a coronary
intervention
50. Which of the following can be used for the diagnosis of acute myocardial infarction?
I. Development of pathologic Q waves .
II. Ischemic ST-segment changes on electrocardiogram (ECG) or in the setting of a coronary
intervention .
III. Fatty liver.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The diagnosis of acute myocardial infarction in this setting requires a finding of the typical rise and
fall of biochemical markers of myocardial necrosis in addition to at least 1 of the following:
 Ischemic symptoms
 Development of pathologic Q waves
 Ischemic ST-segment changes on electrocardiogram (ECG) or in the setting of a coronary
intervention
51. Why are the terms transmural and nontransmural (subendocardial) myocardial
infarction are no longer used?
I. Because ECG findings in patients with this condition are not closely correlated with pathologic
changes in the myocardium.
II. Because no patients suffers with this type of myocardial infarction.
III. A transmural infarct may occur in the absence of Q waves on ECGs, and many Q-wave
myocardial infarctions may be subendocardial, as noted on pathologic examination.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The terms transmural and nontransmural (subendocardial) myocardial infarction are no longer used
because ECG findings in patients with this condition are not closely correlated with pathologic changes
in the myocardium.
52. Name few beta blockers which can lower rate-pressure product, when managing ACS?
I. Ofloxacin and penicillin.
II. Cetirizine and tramadol.
III. Metoprolol or atenolol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Attention to the underlying mechanisms of ischemia is important when managing ACS. A simple
predictor of demand is rate-pressure product, which can be lowered by beta blockers (eg, metoprolol
or atenolol) and pain/stress relievers (eg, morphine), while supply may be improved by oxygen,
adequate hematocrit, blood thinners (eg, heparin, IIb/IIIa agents such as abciximab, eptifibatide,
tirofiban, or thrombolytics), and/or vasodilators (eg, nitrates, amlodipine).
53. Which of the following are blood thinners?
I. Heparin.
II. Nitrates.
III. Amlodipine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
54. Which of the following are vasodilators?

I. Heparin.
II. Nitrates.
III. Amlodipine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
55. What is the primary cause of Acute coronary syndrome (ACS) ?
I. Atherosclerosis.
II. Pneumonia.
III. Heartburn.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Acute coronary syndrome (ACS) is caused primarily by atherosclerosis.
56. What are some typical causes for which ACS without elevation in demand requires a
new impairment in supply?
I. Thrombosis.
II. Plaque hemorrhage.
III. Hypotension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: - D
Elevated demand can produce ACS in the presence of a high-grade fixed coronary obstruction, due to
increased myocardial oxygen and nutrition requirements, such as those resulting from exertion,
emotional stress, or physiologic stress (eg, from dehydration, blood loss, hypotension, infection,
thyrotoxicosis, or surgery).
57. Which drugs are included in concomitant antithrombotic therapy for patients with
moderate- or high-risk ACS?
I. Aspirin.
II. Ranitidine.
III. Clopidogrel.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: - D
Current guidelines for patients with moderate- or high-risk ACS include the following:
 Early invasive approach
 Concomitant antithrombotic therapy, including aspirin and clopidogrel, as well as UFH or
LMWH
58. Which of the following factors are major determinants of an ACS patient's clinical
presentation and outcome?
I. The severity and duration of coronary arterial obstruction.
II. The volume of myocardium affected.
III. The time of coronary arterial obstruction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The severity and duration of coronary arterial obstruction, the volume of myocardium affected, the
level of demand on the heart, and the ability of the rest of the heart to compensate are major
determinants of a patient's clinical presentation and outcome
59. Why does ACS without elevation in demand requires a new impairment in supply?
I. Due to thrombosis .
II. Due to plaque hemorrhage.
III. Due to diabetes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The severity and duration of coronary arterial obstruction, the volume of myocardium affected, the
level of demand on the heart, and the ability of the rest of the heart to compensate are major
determinants of a patient's clinical presentation and outcome
60. Which part of the body can be affected by ACS?

I. Shoulder.
II. Jaw.
III. Brain.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Pain, which is usually described as pressure, squeezing, or a burning sensation across the precordium
and may radiate to the neck, shoulder, jaw, back, upper abdomen, or either arm
61. What causes Diaphoresis in ACS?
I. Sympathetic discharge.
II. Vagal stimulation.
III. Tissue rupture.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
previously non severe lesion. Complaints reported by patients with ACS include the following:
 Palpitations
62. What causes nausea in ACS?
I. Sympathetic discharge.
II. Vagal stimulation.
III. Tissue rupture.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
previously non severe lesion. Complaints reported by patients with ACS include the following:
 Palpitations
63. In which patients, you can find a cool, clammy skin and diaphoresis?
I. In patients with diabetes.
II. In patients with high BP.
III. In patients with cardiogenic shock.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C

 Diaphoresis
A systolic murmur related to dynamic obstruction of the left ventricular outflow
64. A 62-year-old woman has a history of chronic stable angina and a "valve problem."
Which of the following would you suggest her?
I. Excessive exercise.
II. Drinking lot of water.
III. Timely follow-up with primary care provider .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: c
For patients being discharged home, emphasize the following:

 Timely follow-up with primary care provider
 Compliance with discharge medications, specifically aspirin and other medications used to
control symptoms
 Need to return to the ED for any change in frequency or severity of symptoms
permits risk stratification of patients with ACS and

identifies patients at high risk for adverse cardiac events (ie, myocardial infarction, death)
up to 6 months after the index event?
I. Melanin.
II. Troponin.
III. Oxytocin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:B
An elevated level of troponin (a type of regulatory protein found in skeletal and cardiac muscle)
permits risk stratification of patients with ACS and identifies patients at high risk for adverse cardiac
events (ie, myocardial infarction, death) up to 6 months after the index event
66. Leleiko et al determined that two other compounds are also predictors of cardiac events
in ACS. Name them?
I. Serum choline and free F(2)-isoprostane.
II. Plasma esterante and hectane.
III. Acetylcholine and noradrenaline.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:A
Leleiko et al determined that serum choline and free F(2)-isoprostane are also predictors of cardiac
events in ACS.
deficiency is common in patients with coronary disease and has a
significant negative impact on mortality?
I. Testosterone.
II. Thyroxine.
III. Somatotropin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Testosterone deficiency is common in patients with coronary disease and has a significant negative
impact on mortality.
68. Which of the following are the comorbid conditions that predict mortality in NSTEMI
ACS?
I. Renal dysfunction.
II. Dementia.
III. Diabetes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
A study by Sanchis et al suggests renal dysfunction, dementia, peripheral artery disease, previous heart
failure, and previous myocardial infarction are the comorbid conditions that predict mortality in
NSTEMI ACS
ACS?
I. Hypersensitivity.
II. Peripheral artery disease.
III. Previous heart failure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
NSTEMI ACS
ACS?
I. Previous myocardial infarction.
II. Amoebiasis.
III. Peripheral artery disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:F
NSTEMI ACS
71. Who examined the presentation, management, and outcomes of patients with ACS who
received dialysis before presentation for an ACS?
I. Sanchis et al.
II. Gurm et al .
III. Leleiko et al .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: -B
Gurm et al examined the presentation, management, and outcomes of patients with ACS who received
dialysis before presentation for an ACS.
Remarks- NOT CLINICALLY IMPORTANT
72. Which type of patients are more prone to NSTEMI ACS; those receiving dialysis or
those not receiving dialysis?
I. Receiving dialysis.
II. Not receiving dialysis.
III. Both.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: - A
NSTEMI ACS was the most common in patients receiving dialysis, occurring in 50% of patients
(290 of 579) versus 33% (17,955 of 54,610) of those not receiving dialysis
identifies patients at high risk for adverse cardiac events such as myocardial infarction, and
death?
I. Troponin.
II. Melanin.
III. Fibrin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Chughatai et al suggest that "total time to treatment" should be used as a core measure instead of
"door-to-balloon time.
74. Out of men and women, who more often have coronary events without typical
symptoms, which may explain the frequent failure of clinicians to initially diagnose ACS ?
I. Men.
II. Women.
III. Both.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:B
Despite their smaller coronary vessels and higher risk profile, women with STEMI appear to respond
just as well as men to primary PCI and stenting, according to the Optical Coherence Tomography
Assessment of Gender Diversity in Primary Angioplasty (OCTAVIA) study
Remarks- NOT CLINICALLY RELEVANT SUGGEST REMOVAL

I. Lack of recognition of symptoms may cause tremendous delays in seeking medical attention.
II. Side effects due to drug synergism may occur.
III. Educated patients understand about the dangers of cigarette smoking, a major risk factor for
coronary artery disease (CAD).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Patient education of risk factors is important, but more attention is needed regarding delays in door-
to-balloon time, and one major barrier to improving this delay is patient education regarding his or
her symptoms. Lack of recognition of symptoms may cause tremendous delays in seeking medical
attention.
Educate patients about the dangers of cigarette smoking, a major risk factor for coronary artery disease
(CAD). T
76. Which of the following drug increases the likelihood of successful smoking cessation.
I. Metoprolol.
II. Bupropion.
III. Tramadol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Bupropion increases the likelihood of successful smoking cessation.

77. Which type of diet is recommended for patients with coronary artery disease (CAD)?
I. Low-cholesterol, low-salt diet.
II. High-cholesterol, low-salt diet.
III. Low-cholesterol, high-salt diet.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Diet plays an important role in the development of CAD. Therefore, prior to hospital discharge, a
patient who has had a myocardial infarction should be evaluated by a dietitian. Patients should be
informed about the benefits of a low-cholesterol, low-salt diet. In addition, educate patients about
AHA dietary guidelines regarding a low-fat, low-cholesterol diet.
78. Which of the following mnemonic may useful in educating patients with CAD regarding
treatments and lifestyle changes necessitated by their condition?
I. A = Aspirin and antianginals .
II. B = Beta blockers and blood pressure (BP) .
III. C = Carbonic acid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The following mnemonic may useful in educating patients with CAD regarding treatments and
lifestyle changes necessitated by their condition:
 A = Aspirin and antianginals
 B = Beta blockers and blood pressure (BP)
 C = Cholesterol and cigarettes
 D = Diet and diabetes
 E = Exercise and education
79. Which of the following should be avoided in patients with CAD regarding treatments
?
I. Cholesterol .
II. Cigarettes.
III. Exercise.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The following mnemonic may useful in educating patients with CAD regarding treatments and
lifestyle changes necessitated by their condition:
 A = Aspirin and antianginals
 B = Beta blockers and blood pressure (BP)
 C = Cholesterol and cigarettes
 D = Diet and diabetes
 E = Exercise and education
80. Which of the following points must be emphasized, for patients of CAD being
discharged home?
I. Timely follow-up with primary care provider .
II. Bed rest.
III. Need to return to the ED for any change in frequency or severity of symptoms .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

control symptoms
81. Which of the following points must be emphasized, for patients of CAD being
discharged home?
I. Need to return to the ED for any change in frequency or severity of symptoms.
II. Compliance with discharge medications, specifically aspirin and other medications used to
control symptoms.
III. Blood transfusion in every six months.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:D

control symptoms
82. What are some major determinants of a patient's clinical presentation and outcome in
CAD?
I. The severity and duration of coronary artery obstruction.
II. The volume of myocardium affected.
III. The artery affected.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The severity and duration of coronary artery obstruction, the volume of myocardium affected, the level
of demand, and the ability of the rest of the heart to compensate are major determinants of a patient's
clinical presentation and outcome
83. What are some major determinants of a patient's clinical presentation and outcome in
CAD?
I. The level of demand, and the ability of the rest of the heart to compensate.
II. The severity and duration of coronary artery obstruction.
III. age.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The severity and duration of coronary artery obstruction, the volume of myocardium affected, the level
of demand, and the ability of the rest of the heart to compensate are major determinants of a patient's
clinical presentation and outcome
84. Which disease is usually described as a sensation of chest pressure or heaviness that is
reproduced by activities or conditions that increase myocardial oxygen demand?
I. Tuberculosis.
II. Malaria.
III. Angina.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Typically, angina is a symptom of myocardial ischemia that appears in circumstances of increased

oxygen demand. It is usually described as a sensation of chest pressure or heaviness that is reproduced
by activities or conditions that increase myocardial oxygen demand.
85. Which other diseases have similar symptoms like angina?
I. Fatty liver.
II. Indigestion.
III. Anxiety.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
A new case of angina is more difficult to diagnose because symptoms are often vague and similar to
those caused by other conditions (eg, indigestion, anxiety).
86. With which of the following disease, symptoms like episodic shortness of breath, severe
weakness, light-headedness, diaphoresis, or nausea and vomiting, are related?
I. Polio.
II. Angina.
III. Malaria.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Some patients, including some who are elderly or who have diabetes, present with no pain,
complaining only of episodic shortness of breath, severe weakness, light-headedness, diaphoresis, or
nausea and vomiting
87. Which type of patients are most likely not to complain pain, but only of episodic
shortness of breath, severe weakness, light-headedness, diaphoresis, or nausea and vomiting?
I. Who are elderly or who have diabetes.
II. Who are young or who have hypertension.
III. Who are athletes or who have dementia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Some patients, including some who are elderly or who have diabetes, present with no pain,
complaining only of episodic shortness of breath, severe weakness, light-headedness, diaphoresis, or
nausea and vomiting.
88. What may be the possible complaints of a patient suffering with angina?
I. Palpitations.
II. Indigestion.
III. Pain, which is usually described as pressure, squeezing, or a burning sensation across the
precordium and may radiate to the neck, shoulder, jaw, back, upper abdomen, or either arm.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
A summary of patient complaints is as follows:

 Palpitations
89. What may be the possible complaints of a patient suffering with angina?
I. Exertional dyspnea that resolves with pain or rest.
II. Diaphoresis from sympathetic discharge .
III. Frequent urination.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:D
A summary of patient complaints is as follows:

 Palpitations
90. What is the other name of variant angina?

I. Prizm angina.
II. Prinzmetal angina .
III. Metal angina.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:B
Variant angina (Prinzmetal angina) occurs primarily at rest, is triggered by smoking, and is thought
to be due to coronary vasospasm.
91. Up to how much time, an episodic pain of stable angina can last?
I. 1-2 min.
II. 5-15 min.
III. 60-90min.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Stable angina involves episodic pain lasting 5-15 minutes, is provoked by exertion, and is relieved by
rest or nitroglycerin
92. Which of the following can provoke episodic pain during angina?
I. Exertion.
II. Healthy diet.
III. Rest.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
93. Which of the following can relieve episodic pain during angina?
I. Rest.
II. Nitroglycerin.
III. Instant exercise.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
94. How can one identify that the person is suffering with chest pain?
I. The patient seems to be mentally disturbed.
II. The patient sleeps more than the usually time.
III. The patient will usually lie quietly in bed and may appear anxious, diaphoretic, and pale.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:C
If chest pain is ongoing, the patient will usually lie quietly in bed and may appear anxious,
diaphoretic, and pale
95. What are some common physical findings in an angina patient?
I. Hypotension.
II. Hypertension.
III. Pain in legs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Physical findings can vary from normal to any of the following:

 Hypotension - Indicates ventricular dysfunction due to myocardial ischemia, infarction, or
acute valvular dysfunction
 Hypertension - May precipitate angina or reflect elevated catecholamine levels due to anxiety
 Diaphoresis
I. Headache.
II. Diaphoresis .
III. Pulmonary edema and other signs of left heart failure .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Diaphoresis
I. Extracardiac vascular disease .
II. Shivering .
III. Cool, clammy skin and diaphoresis in patients with cardiogenic shock .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Diaphoresis
98. In which type of patients, a fourth heart sound (S 4) exists?

I. In patients with symptoms of allergy.
II. in patients with inferior-wall ischemia.
III. in patients with ischemia or systolic murmur secondary to mitral regurgitation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In addition, a third heart sound (S3) may be present, and frequently, a fourth heart sound (S4) exists.
The latter is especially prevalent in patients with inferior-wall ischemia and may be heard in patients
with ischemia or systolic murmur secondary to mitral regurgitation
99. What causes systolic murmur related to dynamic obstruction of the left ventricular (LV)
outflow tract?
I. Heart attack.
II. Hyperdynamic motion of the basal left ventricular myocardium.
III. Hyper exercise.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
A systolic murmur related to dynamic obstruction of the left ventricular (LV) outflow tract may also
occur. It is caused by hyperdynamic motion of the basal left ventricular myocardium and may be
heard in patients with an apical infarct.
100. A 50-year-old man with type 1 diabetes mellitus and hypertension presents after
experiencing 1 hour of midsternal chest pain that began after eating a large meal. Pain is
now present but is minimal. Which of the following drug is most suitable for him?
I. Metoprolol.
II. Benzodiazepines.
III. Aspirin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
A 50-year-old man with type 1 diabetes mellitus and hypertension presents after experiencing 1 hour
of midsternal chest pain that began after eating a large meal. Pain is now present but is minimal.
Aspirin is the single drug that will have the greatest potential impact on subsequent morbidity.
100. Which Standard initial medical therapies are used for ACS?
I. Supplemental oxygen for arterial oxygen saturation < 50% or respiratory distress; sublingual
nitroglycerin; oral beta-blocker therapy within the first 12 hr in the absence of heart failure, low
output state.
II. Supplemental oxygen for arterial oxygen saturation < 90% or respiratory distress; sublingual
nitroglycerin; oral beta-blocker therapy within the first 24 hr in the absence of heart failure, low
output state.
III. Supplemental oxygen for arterial oxygen saturation < 40% or respiratory distress; sublingual
tramadol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
 Standard initial medical therapies include supplemental oxygen for arterial oxygen saturation
< 90% or respiratory distress; sublingual nitroglycerin; oral beta-blocker therapy within the
first 24 hr in the absence of heart failure, low output state, increased risk for cardiogenic
shock, or other contraindications to beta-blockade; nondihydropyridine calcium channel
blocker for continuing or recurrent ischemia and contraindication to beta-blockade (in the
absence of clinically significant left ventricular dysfunction).
Drugs and pharmacology
1. What are some standard initial medical therapies suggested by the American College of
Cardiology/American Heart Association (ACC/AHA) ?
I. Sublingual nitroglycerin.
II. Artificial respiration.
III. Oral beta-blocker therapy within the first 24 hr in the absence of heart failure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In 2015, the American College of Cardiology/American Heart Association (ACC/AHA) released the
guidelines recommendations on the management of non-ST-elevation acute coronary syndromes (acss)
to assist in maximizing patient outcomes, including the following:
Standard initial medical therapies include supplemental oxygen for arterial oxygen saturation < 90%
or respiratory distress; sublingual nitroglycerin; oral beta-blocker therapy within the first 24 hr in the
absence of heart failure, low output state,
2. Which category of drugs should not be initiated and should be discontinued during the
hospitalization for NSTE-ACS because of the increased risk of major adverse cardiac events
associated with their use?
I. Nonsteroidal anti-inflammatory drugs (except aspirin).
II. Thrombolytics.
III. Pain killers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
 Nonsteroidal anti-inflammatory drugs (except aspirin) should not be initiated and should be
discontinued during the hospitalization for NSTE-ACS because of the increased risk of major
adverse cardiac events associated with their use.
3. What dose of chewable aspirin at presentation should be given Initial
antiplatelet/anticoagulant therapy?
I. 250 mg.
II. 100 mg.
III. 325 mg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Initial antiplatelet/anticoagulant therapy includes 325-mg chewable aspirin at presentation, followed

by a daily maintenance dose of aspirin at 81-126 mg daily
4. Through which mechanisms, nitrates provide symptomatic relief?

I. Coronary vasodilation.
II. Improved collateral blood flow.
III. Arterial vasoconstriction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Nitrates do not improve mortality.[64] However, they provide symptomatic relief by means of several
mechanisms, including coronary vasodilation, improved collateral blood flow, decrease in preload
(venodilation and reduced venous return), and decrease in afterload (arterial vasodilation).
5. What are some important contraindications for beta-blockers?
I. Systolic blood pressure less than 90 mm Hg .
II. Hypersensitivity.
III. Cardiogenic shock .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Beta-blockers
Beta-blockers are indicated in all patients unless they have the following contraindications:
 Systolic blood pressure less than 90 mm Hg
 Cardiogenic shock
 Severe bradycardia
 Second- or third-degree heart block
 Asthma or emphysema that is sensitive to beta agonists
 Peripheral vascular disease
 Uncompensated CHF
6. In which of the following medical conditions, beta- blockers are contraindicated?

I. Common cold.
II. Second- or third-degree heart block .
III. Uncompensated CHF .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
7. In which of the following medical conditions, beta- blockers are contraindicated?
I. Severe bradycardia .
II. Asthma or emphysema that is sensitive to beta agonists .
III. Tuberculosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:D
8. What may be the possible result of the drugs which inhibit the glycoprotein IIb/IIIa
receptor?
I. Histamine block.
II. Platelet adhesion and aggregation.
III. Pupil dilation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Glycoprotein IIb/IIIa receptor antagonists include abciximab,[87, 88] eptifibatide,[89] and tirofiban.[90]
These drugs inhibit the glycoprotein IIb/IIIa receptor, which is involved in the final common pathway
for platelet adhesion and aggregation
9. Which drug is first-in-class antiplatelet medication a protease-activated receptor 1 (PAR-
1) inhibitor?
I. Vorapaxar.
II. Metoprolol.
III. Clopidogrel.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The most frequently used regimen is IV metoprolol 2-5 mg given every 5 minutes (up to 15 mg total)
followed by 25-100 mg given orally twice a day.
10. Which drug permanently impairs the cyclooxygenase pathway of thromboxane A2

production in platelets, in this way inhibiting platelet function?
I. Aspirin .
II. Clopidogrel.
III. Both.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Aspirin permanently impairs the cyclooxygenase pathway of thromboxane A2 production in platelets,

in this way inhibiting platelet function
11. Which drug inhibits adenosine 5'-diphosphate (ADP) dependent activation of the
glycoprotein IIb/IIIa complex, a necessary step for platelet aggregation
I. Aspirin.
II. Clopidogrel.
III. Both.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:B
Clopidogrel (thienopyridine) inhibits adenosine 5'-diphosphate (ADP) dependent activation of the

glycoprotein IIb/IIIa complex, a necessary step for platelet aggregation
12. Which drug is mostly I recommended for patients when an early non interventional
approach is planned in therapy for at least 1 month and ideally up to 1 year?
I. Aspirin.
II. Clopidogrel.
III. Both.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:B
Clopidogrel is a class I recommendation for patients when an early noninterventional approach is

planned in therapy for at least 1 month and ideally up to 1 year
13. What dosage of clopidogrel should be given as early as possible before or at the time of
PCI, when percutaneous coronary intervention (PCI) is planned
I. 1200 mg.
II. 300-600 mg.
III. 50-100 mg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
14. At least how many days before, clopidogrel should be withhold before elective coronary
artery bypass grafting (CABG)?
I. 5 days.
II. 2 days.
III. 3 days.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Withhold clopidogrel for at least 5 days before elective coronary artery bypass grafting (CABG). Since
12% of patients with non-ST elevation ACS have coronary anatomy that favors CABG, the use of
clopidogrel is withheld until coronary angiography at some institutions.
15. Which drug can be considered an alternative to aspirin in patients with aspirin
intolerance or who are allergic to aspirin?
I. Ciprofloxacin.
II. Clopidogrel.
III. Metoprolol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Clopidogrel can be considered an alternative to aspirin in patients with aspirin intolerance or who
are allergic to aspirin.
16. Which combination of drugs reduces major CV events in patients with established
ischemic heart disease?
I. Benzodiazepines and Aspirin.
II. Aspirin and morphine.
III. Aspirin and clopidogrel.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Dual antiplatelet therapy with clopidogrel and aspirin, compared with aspirin alone, reduces major
CV events in patients with established ischemic heart disease, and it reduces coronary stent thrombosis
but is not routinely recommended for patients with prior ischemic stroke because of the risk of bleeding.
17. With which risk, Clopidogrel alone, aspirin alone, and their combination are all
associated with?
I. Heart block .
II.GI bleeding.
III. Hypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
 Clopidogrel alone, aspirin alone, and their combination are all associated with increased risk
of GI bleeding.
18. What is commonly co administered with clopidogrel to reduce the risk of GI bleeding?
I. PPIs that inhibit CYP2C19.
II. PPIs that inhibit CYP3C20.
III. PPIs that inhibit CYP2C21.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
PPIs that inhibit CYP2C19 are commonly co administered with clopidogrel to reduce the risk of GI
bleeding.
19. Which bacterial infection can increase the risk of for recurrent bleeding on antiplatelet
therapy?
I. Clostridium tetani.
II. Helicobacter pylori.
III. Lactobacillus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
 Patients with prior GI bleeding are at highest risk for recurrent bleeding on antiplatelet
therapy; other risk factors include advanced age, concurrent use of anticoagulants, steroids, or
NSAIDs including aspirin, and Helicobacter pylori infection; risk increases as the number of
risk factors increases.
20. Which receptor antagonists (h2ras) reduces the risk of upper GI bleeding compared with
no therapy?
I. H2 receptor antagonists (h2ras).
II. H1 receptor antagonists (h1ras).
III. H3 receptor antagonists (h3ras).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
 Use of PPIs or histamine H2 receptor antagonists (h2ras) reduces the risk of upper GI bleeding
compared with no therapy; PPIs reduce upper GI bleeding to a greater degree than do H2Ras.
21. Which other drug is a thienopyridine ADP receptor inhibitor that inhibits platelet
aggregation, like clopidogrel?
I. Prasugrel.
II. Aspirin.
III. Tramadol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Like clopidogrel, prasugrel is a thienopyridine ADP receptor inhibitor that inhibits platelet
aggregation.
22. For which medical condition, Prasugrel is indicated?

I. Kidney disease.
II. To reduce new and recurrent myocardial infarctions.
III. Hypertension .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The loading dose is 60 mg PO once and maintenance is 10 mg PO QD (given with aspirin 75-325
mg/d)
23. For which medical condition, prasugrel is indicated?
I. For the reduction of thrombotic cardiovascular events (including stent thrombosis) with ACS
that is managed with PCI.
II. For radiation therapy in cancer.
III. For DOT therapy in tuberculosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Prasugrel is indicated for the reduction of thrombotic cardiovascular events (including stent
thrombosis) with ACS that is managed with PCI.
24. After how much time, Prasugrel should be administered after PCI?
I. No later than 5 hour.
II. No later than 1 hour.
III. No later than 2 hour.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Prasugrel should be administered no later than 1 hour after PCI

25. What is the major side effect associated with Prasugrel?
I. Heart Blockade.
II. Hypersensitivity .
III. Significant, sometimes fatal, bleeding.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Earlier studies also found that significant, sometimes fatal, bleeding occurred more frequently with
prasugrel than with clopidogrel, although the overall mortality rate did not differ significantly
between a treatment group receiving prasugrel and another receiving clopidogrel
26. Which drug was, approved by the FDA to reduce the risk of MI, stroke, cardiovascular
death, and need for revascularization procedures in patients with a previous MI or peripheral
artery disease (PAD),in May 2014?
I. Aspirin.
II. Vorapaxar (Zontivity).
III. Prasugrel.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
In May 2014, the FDA approved vorapaxar (Zontivity) to reduce the risk of MI, stroke,
cardiovascular death, and need for revascularization procedures in patients with a previous MI or
peripheral artery disease (PAD)
27. What is the effect of the concomitant use of clopidogrel and a PPI on the antiplatelet
effects of clopidogrel?
I. No effect .
II. It increases the antiplatelet effects of clopidogrel.
III. It decreases the antiplatelet effects of clopidogrel.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Pharmacokinetic and pharmacodynamic studies, using platelet assays as surrogate endpoints, suggest
that concomitant use of clopidogrel and a PPI reduces the antiplatelet effects of clopidogrel; the
strongest evidence for an interaction is between omeprazole and clopidogrel
28. Which drug is not indicated as monotherapy, but in addition to aspirin and/or
clopidogrel.
I. Vorapaxar (Zontivity).
II. Zantac.
III. Ranitidine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
In May 2014, the FDA approved vorapaxar (Zontivity) to reduce the risk of MI, stroke,
cardiovascular death, and need for revascularization procedures in patients with a previous MI or
peripheral artery disease (PAD). It is a first-in-class antiplatelet medication that is a protease-
activated receptor 1 (PAR-1) inhibitor. It is not indicated as monotherapy, but in addition to aspirin
and/or clopidogrel.
29. What are some major side effects associated with vorapaxar?
I. Moderate or severe bleeding.
II. Vomiting.
III. Intracranial hemorrhage.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
or severe bleeding occurred in 3.4% of patients

compared with 2.1% in the placebo-treated patients. Intracranial hemorrhage occurred in 0.6% of
those taking vorapaxar compared with 0.4% taking placebo
30. Which drug was approved by the US Food and Drug Administration in July 2011 and
is the first reversible oral P2Y receptor antagonist
I. Prasugrel.
II. Ticagrelor (Brilinta).
III. Clopidogrel.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Ticagrelor (Brilinta) was approved by the US Food and Drug Administration in July 2011 and is
the first reversible oral P2Y receptor antagonist
31. Which drug reversibly interact with the platelet P2Y12 ADP-receptor to prevent signal
transduction and platelet activation?
I. Ticagrelor.
II. Prasugrel.
III. Clopidogrel.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:B
Results from the randomized PLATO (platelet inhibition and patient Outcomes) trial showed that
ticagrelor provides faster, greater, and more consistent ADP-receptor inhibition than clopidogrel
32. For how much time, clopidogrel should be given, when percutaneous coronary
intervention (PCI) is planned, if the patient is not at high risk for bleeding?
I. For at least 1 month and for up to 9 months.
II. For at least 6 month and for up to 1 year.
III. For at least 1 year and for up to 3 years.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Clopidogrel is a class I recommendation for patients when an early noninterventional approach is

planned in therapy. When percutaneous coronary intervention (PCI) is planned, clopidogrel is started
and continued for at least 1 month and for up to 9 months, if the patient is not at high risk for
bleeding.
33. Which drug has lower risk of stent thrombosis in the treatment of ACS; clopidogrel or
ticagrelor?
I. Clopidogrel.
II. Ticagrelor.
III. Both has the same risk.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
A subgroup analysis of the PLATO trial indicated that treatment with ticagrelor resulted in a lower
risk of stent thrombosis than treatment with clopidogrel in patients with ACS
34. Which of the following drugs are Glycoprotein IIb/IIIa receptor antagonists?
I. Abciximab.
II. Eptifibatide.
III. Ticagrelor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Glycoprotein IIb/IIIa receptor antagonists include abciximab, eptifibatide, and tirofiban

35. Which of the following drugs are Glycoprotein IIb/IIIa receptor antagonists?
I. Tirofiban.
II. Metoprolol.
III. Abciximab.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Glycoprotein IIb/IIIa receptor antagonists include abciximab,[87, 88] eptifibatide,[89] and tirofiban
36. Which combination of drugs are considered standard antiplatelet therapy for patients at
high risk for unstable angina currently ?
I. H2 receptor antagonists in combination with clopidogrel.
II. IIb/iii antagonists in combination with aspirin.
III. IIb/iii antagonists in combination with clopidogrel.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Currently, IIb/iii antagonists in combination with aspirin are considered standard antiplatelet
therapy for patients at high risk for unstable angina
37. For which of the following medical condition, Thienopyridine drugs like Prasugrel, are
NOT indicated?
I. With acute coronary syndrome (ACS) that is managed with percutaneous coronary intervention
.
II. For unstable angina or non ST-elevation myocardial infarction (NSTEMI).
III. For patients with kidney failure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Thienopyridine drug that inhibits platelet activation and aggregation through the irreversible binding
of its active metabolite to ADP platelet receptors (specifically the P2Y12 receptor). Platelet inhibition
is the result of this action.
Indicated to reduce thrombotic cardiovascular (CV) events (including stent thrombosis) with acute
coronary syndrome (ACS) that is managed with percutaneous coronary intervention (PCI).
Specifically for unstable angina or non ST-elevation myocardial infarction (NSTEMI) or with ST-
elevation myocardial infarction (STEMI) when managed with primary or delayed PCI.
38. Which is found to be more superior to in reducing cardiovascular outcomes:

unfractionated heparin or Low molecular-weight heparin ?
I. Unfractionated heparin.
II. Low molecular-weight heparin.
III. Both are same.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
LMWH might be superior to unfractionated heparin in reducing cardiovascular outcomes, with a

safety profile similar to that of heparin in patients receiving medical care.
39. Which combination of drugs appears to have a more potent antithrombotic effect than
that of eptifibatide and unfractionated heparin?
I. Combination of eptifibatide with enoxaparin.
II. Combination of dalteparin with nadroparin.
III. Combination of eptifibatide with nadroparin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Lev et al found that the combination of eptifibatide with enoxaparin appears to have a more potent
antithrombotic effect than that of eptifibatide and unfractionated heparin
40. What effects are observed when apixaban (5 mg twice daily) is added for antiplatelet
therapy in high-risk patients after ACS?
I. Arterial blockage.
II. It may lead to nausea and vomiting.
III. It may increase the number of major bleeding events without significantly reducing recurrent
ischemic events.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Adding apixaban (5 mg twice daily) to antiplatelet therapy in high-risk patients after ACS may
increase the number of major bleeding events without significantly reducing recurrent ischemic events
41. With which mechanism, Clopidogrel drug that inhibits platelet activation and
aggregation?
I. Through inhibition of ADP-dependent activation of the glycoprotein IIb/IIIa.
II. Through the irreversible binding of its active metabolite to ADP platelet receptors.
III. Through blocking of calcium channels.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Use of the oral Xa inhibitor rivaroxaban in patients with ACS was investigated in the ATLAS ACS
2-TIMI 51 trial
42. Which of the following are oral Xa inhibitors?

I. Rivaroxaban.
II. Apixaban.
III. Fondaparinux.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Use of the oral Xa inhibitor rivaroxaban in patients with ACS was investigated in the ATLAS ACS
2-TIMI 51 trial. Another factor Xa inhibitor, fondaparinux (Arixtra), has been studied for use in
patients with STEMI who do not undergo PCI
43. Out of rivaroxaban and fondaparinux, which is not currently FDA approved for use in
ACS?
I. Rivaroxaban.
II. Fondaparinux.
III. Both.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Fondaparinux is not currently FDA approved for use in ACS.
44 Which is considered as the preferred treatment for STEMI?

I surgery.
II PCI.
III rest.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Although PCI is the preferred treatment for STEMI, the distance to primary PCI centers and the
inherent time delay in delivering primary PCI limits widespread use of this treatment.
45. What limits widespread use of PCI ,although it is the preferred treatment for STEMI,
I. The distance to primary PCI centers and the inherent time delay in delivering primary PCI .
II. It is not found successful in all cases.
III. It is costly.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Although PCI is the preferred treatment for STEMI, the distance to primary PCI centers and the
inherent time delay in delivering primary PCI limits widespread use of this treatment
46. Within how much time, An early invasive strategy (ie, diagnostic angiography with
intent to perform revascularization) should be done for initially stabilized high -risk patients
with unstable angina/NSTEMI?
I. Within 48 hours.
II. Within 36 hours.
III. Within 12-24 hr.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
According to the 2011 American College of Cardiology Foundation/American Heart Association

(ACCF/AHA) guidelines, an early invasive strategy (ie, within 12-24 hours of admission) is a
reasonable choice for initially stabilized high-risk patients with unstable angina/NSTEMI
47. Why Clopidogrel is generally preferred over ticlopidine?
I. It more rapidly inhibits platelets .
II. It can be chewed easily than ticlopidine.
III. Appears to have a more favourable safety profile.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:F
Use of Gp IIb/IIIa blockers followed by early invasive catheterization is the most logical approach
I. Patients with chronic kidney disease who have low platelet response .
II. Patients with a family history of asthma.
III. Patients with tuberculosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Patients with chronic kidney disease who have low platelet response to clopidogrel tend to have worse
outcomes after PCI
49. Which of the following drug is glycoprotein IIb/IIIa inhibitors?
I. Aspirin.
II. Prasugrel.
III. Bivalirudin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
In patients with moderate- or high-risk ACS who were undergoing invasive treatment with
glycoprotein IIb/IIIa inhibitors, bivalirudin was associated with rates of ischemia and bleeding that
were similar to those with heparin
50. What are the main goals of treatment in ACS?

I. To reduce the heart beat.
II. To preserve patency of the coronary artery, augment blood flow through stenotic lesions, and
reduce myocardial oxygen demand.
III. To minimize the blockage of artery.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The goals of treatment are to preserve patency of the coronary artery, augment blood flow through
stenotic lesions, and reduce myocardial oxygen demand
51. Which category of drugs should be given to all patients with ACS?
I. Antiplatelet agents.
II. Antihistamines.
III. Benzodiazepines.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
All patients should receive antiplatelet agents, and patients with evidence of ongoing ischemia should
receive aggressive medical intervention until signs of ischemia, as determined by symptoms and ECG,
resolve.
52. How do antiplatelets function?

I. They inhibit histamine .
II. They inhibit the cyclooxygenase system, decreasing the level of thromboxane A1.
III. They inhibit the cyclooxygenase system, decreasing the level of thromboxane A 2, which is a
potent platelet activator.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Antiplatelets inhibit the cyclooxygenase system, decreasing the level of thromboxane A 2, which is a
potent platelet activator.
53. Name some aspirin whose early administration in patients with acute myocardial
infarction may reduce cardiac mortality in the first month?
I. Anacin.
II. Ascriptin.
III. Prasugrel.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Early administration of aspirin (eg, Anacin, Ascriptin, Bayer Aspirin) in patients with acute
myocardial infarction may reduce cardiac mortality in the first month
54. What are some potential advantages of Bivalirudin (Angiomax)over conventional

heparin therapy ?
I. More predictable and precise levels of anticoagulation.
II. Absence of natural inhibitors (eg, platelet factor 4, heparinase).
III. Anti-histaminic activity .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:D
Bivalirudin (Angiomax) is a synthetic analogue of recombinant hirudin. It inhibits thrombin and is

used for anticoagulation in unstable angina in patients undergoing PTCA. Potential advantages over
conventional heparin therapy include more predictable and precise levels of anticoagulation, activity
against clot-bound thrombin, absence of natural inhibitors (eg, platelet factor 4, heparinase), and
continued efficacy following clearance from plasma (because of binding to thrombin).
55. Through which route, Aspirin can be administered as a suppository if the patient is
unable to take PO medications ?
I. Suppository.
II. Intradermal injections.
III. Intramuscular injection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The adult dose is 160-324 mg PO or chewed. It can be administered as a suppository if the patient
is unable to take PO medications.
56. How much dose of Aspirin is required for the treatment of acute myocardial infarction
, if administered with ticagrelor (Brilinta)?
I. Do not exceed 100 mg/day after a one-time loading dose of 125 mg.
II. Do not exceed 500 mg/day after a one-time loading dose of 200 mg.
III. Do not exceed 100 mg/day after a one-time loading dose of 500 mg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
If administered with ticagrelor (Brilinta), do not exceed 100 mg/day after a one-time loading dose of
325 mg.
57. Which drug reversibly inhibits protease-activated receptor 1 (PAR-1) which is expressed
on platelets, but its long half-life makes it effectively irreversible
I. Vorapaxar.
II. Ticagrelor.
III. Clopidogrel.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Vorapaxar reversibly inhibits protease-activated receptor 1 (PAR-1) which is expressed on platelets,

but its long half-life makes it effectively irreversible
58. For which medical condition, Vorapaxar is indicated?

I. To reduce thrombotic cardiovascular events in patients with a history of MI or with peripheral
arterial disease.
II. Heart disease.
III. Hyper acidity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:A

but its long half-life makes it effectively irreversible. It is indicated to reduce thrombotic cardiovascular
events in patients with a history of MI or with peripheral arterial disease.
59. With which other drugs, Vorapaxar is added to reduce thrombotic cardiovascular events
in patients with a history of MI?
I. Aspirin and/or clopidogrel.
II. Aspirin and/or ranitidine.
III. Betadine and/or clopidogrel.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A

but its long half-life makes it effectively irreversible. It is indicated to reduce thrombotic cardiovascular
events in patients with a history of MI or with peripheral arterial disease.)It is not used as
monotherapy, but added to aspirin and/or clopidogrel.
60. How do nitrates function?

I. Nitrates oppose coronary artery spasm and reduce myocardial oxygen demand by reducing
preload and afterload.
II. It reversibly inhibits protease-activated receptor 1 (PAR-1) which is expressed on platelets, but
its long half-life makes it effectively irreversible.
III. It reduce cardiac mortality.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Nitrates oppose coronary artery spasm and reduce myocardial oxygen demand by reducing preload
and afterload
61. Which drug causes relaxation of the vascular smooth muscle via stimulation of
intracellular cyclic guanosine monophosphate production, causing a decrease in blood
pressure?
I. Prasugrel.
II. Nitroglycerin (Nitro-Bid).
III. Anacin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Nitroglycerin (Nitro-Bid) causes relaxation of the vascular smooth muscle via stimulation of
intracellular cyclic guanosine monophosphate production, causing a decrease in blood pressure
62. How does nitrates provide symptomatic relief ?

I. Coronary vasodilation.
II. Improved collateral blood flow.
III. Coronary vasoconstriction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Nitrates do not improve mortality. However, they provide symptomatic relief by means of several
mechanisms, including coronary vasodilation, improved collateral blood flow, decrease in preload
(venodilation and reduced venous return), and decrease in afterload (arterial vasodilation). Care
should be taken to avoid hypotension, because this can potentially reduce coronary perfusion pressure
(diastolic BP - LV diastolic pressure).
63. How does nitrates provide symptomatic relief ?
I. Decrease in preload (venodilation and reduced venous return).
II. Increase in muscle contraction.
III. Decrease in afterload (arterial vasodilation).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Nitrates do not improve mortality. However, they provide symptomatic relief by means of several
mechanisms, including, improved coronary vasodilation collateral blood flow, decrease in preload
(venodilation and reduced venous return), and decrease in afterload (arterial vasodilation). Care
should be taken to avoid hypotension, because this can potentially reduce coronary perfusion pressure
(diastolic BP - LV diastolic pressure).
64. What are drugs which relieves pain called as?

I. Antitussives.
II. Analgesics.
III. Laxatives.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
65. Which is the drug of choice for narcotic analgesia because of its reliable and predictable
effects, safety profile, and ease of reversibility with naloxone?
I. Isphagula.
II. Astramorph.
III. Duramorph .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Morphine sulfate (Duramorph, Astramorph, MS Contin) is the drug of choice for narcotic analgesia
because of its reliable and predictable effects, safety profile, and ease of reversibility with naloxone
66. How is morphine administered into the body?

I. Rectally.
II. Orally.
III. Intravenously.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Morphine sulfate administered intravenously may be dosed in a number of ways and commonly
titrated until the desired effect is obtained.
67. How does Beta-blockers minimize the imbalance between myocardial supply and
demand?
I. By increasing coronary vasodilation collateral blood flow
II. By reducing afterload and wall stress
III. by increasing collateral blood flow
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:A
Beta blockers have antiarrhythmic and antihypertensive properties, as well as the ability to reduce
ischemia. They minimize the imbalance between myocardial supply and demand by reducing
afterload and wall stress
68. In which patients, betablockers decrease infarct size as well as short- and long-term
mortality, which is a function of their anti-ischemic and antiarrhythmic properties
I. In patients with acute MI.
II. In patients with hypertension.
III. In cancer patients.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
In patients with acute MI, they decrease infarct size as well as short- and long-term mortality, which
is a function of their anti-ischemic and antiarrhythmic properties
69. Which patients should NOT be given beta-blockers?
I. Patients with myocardial infection.
II. patients with cardiogenic shock or signs of heart failure.
III. Patients .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Beta blockers ameliorate dynamic obstruction of the left ventricular outflow tract in patients with
apical infarct and hyperdynamic basal segments. They should not be used acutely in patients with
cardiogenic shock or signs of heart failure on presentation.
70. Which type of drug is Metoprolol (Lopressor)?

I. Selective beta1-adrenergic receptor blocker.
II. Muscarinic receptor blocker.
III. Antihistamine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Metoprolol (Lopressor) is a selective beta1-adrenergic receptor blocker that decreases the automaticity
of contractions.
71. Through which route, Metoprolol (Lopressor) is administered?
I. Intravenously.
II. Intradermally.
III. Subcutaneously.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
During IV administration, blood pressure, heart rate, and ECG should be carefully monitored.
72. What is the main goal of administration of Metoprolol (Lopressor)?

I. Vasoconstriction.
II. To increase the patient's heart rate to 120-140 beats/min.
III. To reduce the patient's heart rate to 60-90 beats/min.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Metoprolol (Lopressor) is a selective beta1-adrenergic receptor blocker that decreases the automaticity
of contractions. During IV administration, blood pressure, heart rate, and ECG should be carefully
monitored. The goal of treatment is to reduce the patient's heart rate to 60-90 beats/min.
73. Which drug is an excellent drug for use in patients at risk for complications from beta
blockers, particularly reactive airway disease, mild to moderate LV dysfunction, and
peripheral vascular disease
I. Metoprolol.
II. Esmolol (Brevibloc).
III. Ranitidine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Esmolol (Brevibloc) is an excellent drug for use in patients at risk for complications from beta blockers,
particularly reactive airway disease, mild to moderate LV dysfunction, and peripheral vascular disease
74. How much is the half life of Esmolol (Brevibloc)

I. 8 min.
II. 30 min.
III. 1 hr.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Esmolol (Brevibloc) is an excellent drug for use in patients at risk for complications from beta blockers,
particularly reactive airway disease, mild to moderate LV dysfunction, and peripheral vascular
disease. Its short half-life of 8 min allows for titration to desired effect with the ability to stop quickly
prn.
75. What type of drugs are abciximab, eptifibatide, and tirofiban?
I. Selective beta1-adrenergic receptor blocker.
II. Muscarinic receptors.
III. Glycoprotein IIb/IIIa receptor antagonists.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Glycoprotein IIb/IIIa receptor antagonists include abciximab, eptifibatide, and tirofiban
76. How do Glycoprotein IIb/IIIa receptor antagonists blocks platelet aggregation?

I. They prevent the binding of acetylcholine.
II. They prevent the binding of renin.
III. They prevent the binding of fibrinogen
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Glycoprotein IIb/IIIa antagonists prevent the binding of fibrinogen, thereby blocking platelet
aggregation.
77. Which receptor is inhibited by drugs such as abciximab, eptifibatide, and tirofiban?
I. Muscarinic receptor.
II. Glycoprotein IIb/IIIa receptor.
III. Glycoprotein Ib/IIIa receptor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:C
Glycoprotein IIb/IIIa receptor antagonists include abciximab, eptifibatide, and tirofiban.

Glycoprotein IIb/IIIa antagonists prevent the binding of fibrinogen, thereby blocking platelet
aggregation. These drugs inhibit the glycoprotein IIb/IIIa receptor, which is involved in the final
common pathway for platelet adhesion and aggregation
78. With which drug, Glycoprotein IIb/IIIa receptor antagonists are combined with, for
antiplatelet therapy for patients at high risk for unstable angina?
I. Aspirin.
II. Clopidogrel.
III. Morphine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Currently, GP IIb/IIIa receptor antagonists in combination with aspirin are considered standard
antiplatelet therapy for patients at high risk for unstable angina.
79. Which Glycoprotein IIb/IIIa receptor antagonists drug is a chimeric human-murine

monoclonal antibody?
I. Abciximab (reopro).
II. Eptifibatide.
III. Tirofiban.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Abciximab (reopro) is a chimeric human-murine monoclonal antibody

80. Which of the following drug is a synthetic analogue of recombinant hirudin ?
I. Bivalirudin .
II. Clopidogrel .
III. Ticlopidine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Bivalirudin (Angiomax) is a synthetic analogue of recombinant hirudin
81. What is the main use of Abciximab?

I. In combination with aspirin to treat MI.
II. In combination with aspirin as standard antiplatelet therapy for patients at high risk for unstable
angina.
III. Elective/urgent/emergent percutaneous coronary intervention.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Abciximab has been approved for use in elective/urgent/emergent percutaneous coronary intervention.
82. Which antagonist of the platelet GP IIb/IIIa receptor reversibly prevents von Willebrand
factor, fibrinogen, and other adhesion ligands from binding to the GP IIb/IIIa receptor ?
I. Eptifibatide (Integrilin).
II. Abciximab .
III. Aspirin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Eptifibatide (Integrilin) is an antagonist of the platelet GP IIb/IIIa receptor; it reversibly prevents

von Willebrand factor, fibrinogen, and other adhesion ligands from binding to the GP IIb/IIIa
receptor
83. What is the end effect of

fibrinogen, and other adhesion ligands from binding to the GP IIb/IIIa recept or?
I. Increased formation of WBC.
II. Inhibition of platelet aggregation.
III. Increased platelet aggregation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Eptifibatide (Integrilin) is an antagonist of the platelet GP IIb/IIIa receptor; it reversibly prevents

von Willebrand factor, fibrinogen, and other adhesion ligands from binding to the GP IIb/IIIa
receptor. The end effect is the inhibition of platelet aggregation
84. Which of the following drug can be used in patients with high-risk features in whom
invasive treatment is not planned?
I. Eptifibatide.
II. Tirofiban.
III. Ranitidine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Use eptifibatide (or tirofiban, see below) in patients with high-risk features in whom invasive
treatment is not planned.
85. Which drug is a non peptide antagonist of the GP IIb/IIIa receptor?

I. Tirofiban (Aggrastat).
II. Aspirin.
III. Ranitidine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
86. Which drugs are used to prevent recurrence of clot after a spontaneous fibrinolysis?
I. Anticoagulants.
II. Antihistamine.
III. Laxative.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Anticoagulants are used to prevent recurrence of clot after a spontaneous fibrinolysis
87. Which antithrombin activity is augmented by Heparin?

I. Antithrombin I.
II. Antithrombin II.
III. Antithrombin III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Heparin augments the activity of antithrombin III

88. How do heparin acts?
I. Heparin augments the activity of antithrombin III and prevents the conversion of fibrinogen to
fibrin.
II. Heparin augments the activity of antithrombin III and prevents the collagen into fibrin.
III. Heparin augments the activity of antithrombin II and prevents the conversion of fibrinogen
to fibrin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Heparin augments the activity of antithrombin III and prevents the conversion of fibrinogen to fibrin
89. Which category is indicated for treatment of ST-segment elevation myocardial infarction
(STEMI) managed medically or with subsequent PCI?
I. Low Molecular Weight Heparin.
II. Unfractioned Heparin.
III. Both.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
LMWH is indicated for treatment of ST-segment elevation myocardial infarction (STEMI) managed
medically or with subsequent PCI.
90. Which drug binds directly to the anion binding site and the catalytic sites of thrombin
to produce potent and predictable anticoagulation?
I. Hirudin.
II. Aspirin.
III. Metoprolol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Hirudin (Lepirudin, Refludan) is the prototype of direct thrombin inhibitors. Hirudin binds directly
to the anion binding site and the catalytic sites of thrombin to produce potent and predictable
anticoagulation.
91. Which Low Molecular Weight Heparin only is used in unstable angina?
I. Aspirin.
II. Hirudin.
III. Enoxaparin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Although 3 LMWH are approved for use in the United States, only enoxaparin is currently approved
for use in unstable angina.
92. To which antithrombin, Low-molecular-weight heparin (enoxaparin; Lovenox) binds
to?
I. Antithrombin I.
II. Antithrombin II.
III. Antithrombin III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Low-molecular-weight heparin (enoxaparin; Lovenox), which is produced by partial chemical or

enzymatic depolymerization of unfractionated heparin, binds to antithrombin III, enhancing its
therapeutic effect.
93. Which factors are inactivated by the heparin antithrombin III complex?
I. Factor X (Xa) and factor II .
II. Factor X (Xb) and factor III .
III. Factor X (Xa) and factor III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:A
The heparin antithrombin III complex binds to and inactivates activated factor X (Xa) and factor
II (thrombin)
94. To which site, direct thrombin inhibitors bind directly to produce potent and
predictable anticoagulation?
I. Anion binding site.
II. Cation binding sit.
Iii. Catalytic site.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Direct thrombin inhibitors bind directly to the anion binding site and the catalytic sites of thrombin
to produce potent and predictable anticoagulation.
95. Which drug is the prototype of direct thrombin inhibitors?

I. Bivalirudin.
II. Hirudin (Lepirudin, Refludan).
III. Angiomax.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Hirudin (Lepirudin, Refludan) is the prototype of direct thrombin inhibitors

96. Currently, for which patients only, hirudin is indicated?
I. For patients of MI.
II. For patients who are unable to receive heparin because of heparin-induced thrombocytopenia.
III. For patients sensitive to Aspirin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Currently, hirudin is indicated only in patients who are unable to receive heparin because of heparin-
induced thrombocytopenia
97. What is the mechanism of action of Bivalirudin?

I. It inhibits thrombin and is used for anticoagulation in unstable angina in patients undergoing
PTCA.
II. It blocks histamine release.
III. It blocks synthesis of platelets by inhibiting fibrin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Bivalirudin (Angiomax) is a synthetic analogue of recombinant hirudin

98. What are some potential advantages of Bivalirudin over conventional heparin therapy?
I. More predictable and precise levels of anticoagulation.
II. Activity against clot-bound thrombin.
III. Presence of natural inhibitors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Bivalirudin (Angiomax) is a synthetic analogue of recombinant hirudin. It inhibits thrombin and is

used for anticoagulation in unstable angina in patients undergoing PTCA. Potential advantages over
conventional heparin therapy include more predictable and precise levels of anticoagulation, activity
against clot-bound thrombin, absence of natural inhibitors (eg, platelet factor 4, heparinase), and
continued efficacy following clearance from plasma (because of binding to thrombin).
99. Which of the following are Thienopyridine adenosine 5'-diphosphate (ADP) antagonists
approved for antiplatelet activity in the United States?
I. Clopidogrel.
II. Tramadol.
III. Ticlopidine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Thienopyridine adenosine 5'-diphosphate (ADP) antagonists approved for antiplatelet activity in the
United States include clopidogrel, ticlopidine, prasugrel, and ticagrelor
100. Almost all Thienopyridine adenosine 5'-diphosphate (ADP) antagonists drugs have
irreversible antiplatelet activity and take several days to manifest an effect. Which drug do
not show this effect?
I. Ticlopidine.
II. Ticagrelor.
III. Prasugrel.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Thienopyridine adenosine 5'-diphosphate (ADP) antagonists approved for antiplatelet activity in the
United States include clopidogrel, ticlopidine, prasugrel, and ticagrelor
CENTRAL NERVOUS SYSTEM

Depression
1. What are the sign and symptoms observed in patient with more severe symptoms of depression?
I. Decline in grooming and hygiene
II. Psychomotor retardation
III. Mal nutritious development
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In patients with more severe symptoms, a decline in grooming and hygiene may be observed, as well as
a change in weight. Patients may also show the following:
 Psychomotor retardation
 Flattening or loss of reactivity in the patient's affect (ie, emotional expression)
 Psychomotor agitation or restlessness
2. What are the sign and symptoms observed in patient with more severe symptoms of depression?
I. Phobia from water
II. Flattening or loss of reactivity in the patient's affect
III. Psychomotor agitation or restlessness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
In patients with more severe symptoms, a decline in grooming and hygiene may be observed, as well as a change
in weight. Patients may also show the following:
 Psychomotor retardation
 Flattening or loss of reactivity in the patient's affect (ie, emotional expression)
 Psychomotor agitation or restlessness
3. What are the major depressive disorder associated with depression ?
I. Depressed mood
II. Diminished interest or loss of pleasure in almost all activities
III. Significant change in standard of life style
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Among the criteria for a major depressive disorder, at least 5 of the following symptoms have to have been
present during the same 2-week period :
 Depressed mood: For children and adolescents, this can also be an irritable mood
 Diminished interest or loss of pleasure in almost all activities (anhedonia)

I. Significant change in standard of life style
II. Significant weight change or appetite disturbance
III. Sleep disturbance
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Significant weight change or appetite disturbance: For children, this can be failure to achieve expected
weight gain
 Sleep disturbance (insomnia or hypersomnia)
I. Psychomotor agitation or retardation
II. Significant change in standard of life style
III. Fatigue or loss of energy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Psychomotor agitation or retardation
 Fatigue or loss of energy

I. Feelings of worthlessness
II. Diminished ability to think or concentrate; indecisiveness
III. Significant change in standard of life style
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Feelings of worthlessness
 Diminished ability to think or concentrate; indecisiveness
I. Significant change in standard of life style
II. Recurrent thoughts of death
III. Recurrent suicidal ideation without a specific plan
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Recurrent thoughts of death
 Recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing
suicide
8. Which of the following drugs are used in the pharmacotherapy for treatment of depression ?
I. Selective serotonin reuptake inhibitors (SSRIs)
II. Serotonin/norepinephrine reuptake inhibitors (SNRIs)
III. Selective calcium channel blockers
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Pharmacotherapy---Drugs used for treatment of depression include the following:

 Selective serotonin reuptake inhibitors (ssris)
 Serotonin/norepinephrine reuptake inhibitors (snris)
I. Prostaglandin analog
II. Atypical antidepressants
III. Tricyclic antidepressants (TCAs)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Atypical antidepressants
 Tricyclic antidepressants (tcas)
I. Monoamine oxidase inhibitors (MAOIs)
II. NSAIDS
III. St. John's wort ( Hypericum perforatum)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Monoamine oxidase inhibitors (maois)
 St. John's wort ( Hypericum perforatum)
11. What are the psychotherapeutic treatments for adults with major depressive disorder on the basis
of evidence ?
I. Interpersonal psychotherapy (IPT)
II. Cognitive-behavioral therapy (CBT)
III. Problem activation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Psychotherapy----Evidence-based psychotherapeutic treatments for adults with major depressive disorder

include the following:
 Interpersonal psychotherapy (IPT)
 Cognitive-behavioral therapy (CBT)
12. What are the psychotherapeutic treatments for adults with major depressive disorder on the basis
of evidence ?
I. Mood swings therapy
II. Problem-solving therapy (PST)
III. Behavioral activation (BA)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Psychotherapy----Evidence-based psychotherapeutic treatments for adults with major depressive disorder

 Problem-solving therapy (PST)
 Behavioral activation (BA)/contingency management
13. What are the psychotherapeutic treatments for children and adolescents with major depressive
disorder on the basis of evidence ?
I. Problem-solving therapy (PST)
II. Behavior therapy (BT)
III. Cognitive-behavioral therapy (CBT)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Evidence-based psychotherapeutic treatments for children and adolescents with major depressive disorder
 Interpersonal psychotherapy (IPT)
 Cognitive-behavioral therapy (CBT)
 Behavior therapy (BT)
14. What are the indication for electroconvulsive therapy which is a highly effective treatment for
depression ?
I. Need for a rapid antidepressant response
II. Less expensive treatment
III. Failure of drug therapies
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Electroconvulsive therapy (ECT) is a highly effective treatment for depression. The indications for ECT include
the following:
 Need for a rapid antidepressant response
 Failure of drug therapies
depression ?
I. Less expensive treatment
II. History of good response to ECT
III. Patient preference
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
the following:
 History of good response to ECT
 Patient preference
depression ?
I. High risk of suicide
II. High risk of medical morbidity and mortality
III. Less expensive treatment
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
the following:
 High risk of suicide
 High risk of medical morbidity and mortality
17. What are the common features of the depressive disorders ?
I. Presence of sad
II. Presence of empty, or irritable mood
III. Presence of empty stomach
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The common feature of the depressive disorders is the presence of sad, empty, or irritable mood, accompanied
18. What are the common features of the depressive disorders ?

I. Mutational changes
II. Somatic and cognitive changes
III. capacity to function
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The common feature of the depressive disorders is the presence of sad, empty, or irritable mood, accompanied
by somatic and cognitive changes that s
19. Which of the following tests can be used to screen for depression and bipolar disorder ?
I. Depression screening tests
II. Cosyntropin (ACTH) stimulation test
III. Liver function tests (LFTs)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Depression screening tests can be used to screen for depression and bipolar disorder
20. What is the important factor of pathophysiology underlying the major depressive disorder ?
I. Disturbance in central nervous system Somatostatin activity
II. Disturbance in central nervous system serotonin (5-HT) activity
III. Disturbance in central nervous system Cholinesterase activity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Clinical and preclinical trials suggest a disturbance in central nervous system serotonin (5-HT) activity as an
important factor.
21. Which of the following triggered the seasonal affective disorder which is media ted by alterations
in CNS level of 5- HT ?
I. Alteration in pulse rate
II. Alterations in circadian rhythm
III. Alterations in sunlight exposure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Studies suggest that seasonal affective disorder is also mediated by alterations in CNS levels of 5-HT and
appears to be triggered by alterations in circadian rhythm and sunlight exposure.
22. Which of the following link the fronto striatal pathways which involve in emotion r egulation ?
I. The dorsolateral prefrontal cortex
II. The cerebellum cortex
III. The orbitofrontal cortex
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Vascular lesions may contribute to depression by disrupting the neural networks involved in emotion
regulation in particular, fronto striatal pathways that link the dorsolateral prefrontal cortex, orbitofrontal
cortex, anterior cingulate, and dorsal cingulate.[8] Other components of limbic circuitry, in particular the
hippocampus and amygdala, have been implicated in depression.
23. Which of the following link the fronto striatal pathways which involve in emotion regulation ?
I. The cerebellum cingulate
II. The anterior cingulate
III. The dorsal cingulate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Vascular lesions may contribute to depression by disrupting the neural networks involved in emotion
regulation in particular, fronto striatal pathways that link the dorsolateral prefrontal cortex, orbitofrontal
cortex, anterior cingulate, and dorsal cingulate.[8] Other components of limbic circuitry, in particular the
hippocampus and amygdala, have been implicated in depression.
24. Where are these serotonergic neurons found which implicated in affective depression disorder?
I. The endocrine system
II. The dorsal raphe nucleus
III. The limbic system
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Serotonergic neurons implicated in affective disorders are found in the dorsal raphe nucleus, the limbic system,
and the left prefrontal cortex.
25. Where are these serotonergic neurons found which implicated in affective depression disorder?
I. The dorsal raphe nucleus
II. The right postfrontal cortex
III. The left prefrontal cortex
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Serotonergic neurons implicated in affective disorders are found in the dorsal raphe nucleus, the limbic system,
and the left prefrontal cortex.
26. What are observed in meta-analysis of comparing brain structures in patients with major
depression, in healthy controls, and in patients with bipolar disorder ?
I. Increased lateral ventricle size
II. larger cerebrospinal fluid volume
III. Decreased cerebrospinal fluid volume
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
A meta-analysis comparing brain structures in patients with major depression, in healthy controls, and in
patients with bipolar disorder demonstrated associations between depression and increased lateral ventricle size,
larger cerebrospinal fluid volume, and smaller volumes of the basal ganglia, thalamus, hippocampus, frontal
lobe, orbitofrontal cortex, and gyrus rectus. Patients experiencing a depressive episode had smaller hippocampal
volume than those in remission.
I. Smaller volumes of the basal ganglia
II. Larger volumes of the basal ganglia
III. Smaller volumes of the basal ganglia, thalamus
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
I. Larger volumes of the hippocampus
II. Smaller volumes of the hippocampus
III. Smaller volumes of the frontal lobe
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
I. Smaller volumes of the orbitofrontal cortex
II. Smaller volumes of the gyrus rectus
III. Larger volumes of the gyrus rectus
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
30. Which of the following is most strongly linked to major depression in males ?
I. MDD1 locus located at 12q22-q23.2
II. MDD1 locus located at 15q25.2-q26.2
III. MDD2 locus located at 15q25.2-q26.2
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The MDD1 locus is located at 12q22-q23.2 and is most strongly linked to major depression in males.
31. Which of the following gene has been associated with early onset or recurrent episodes of
depression ?

II. MDD1 locus located at 15q25.2-q26.2
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The MDD2 locus is located at 15q25.2-q26.2 and has been associated with early onset or recurrent episodes
of depression.
32. Which of the following gene encodes a serotonin transporter that is responsible for actively
clearing serotonin from the synaptic space ?
II. SLC6A4 gene, located at 17q11.2
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The SLC6A4 gene, which is located at 17q11.2, encodes a serotonin transporter (also known as 5-
hydroxytryptamine transporter) that is responsible for actively clearing serotonin from the synaptic space.
33. Which of the following gene encodes tryptophan hydroxylase which is the rate-limiting enzyme
in the synthesis of serotonin ?
I. SLC6A4 gene
II. TXHD7 gene
III. TPH2 gene
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The TPH2 gene encodes tryptophan hydroxylase, which is the rate-limiting enzyme in the synthesis of serotonin.
An in vitro study of a TPH2 polymorphism, R441H, found an approximately 80% loss in serotonin
production.
34. Which of the following gene encode serotonin receptors and associated with major depression
in both European and Japanese populations ?
I. The MDD1 locus located at 12q22-q23.2
II. The MDD1 locus located at 15q25.2-q26.2
III. The HTR3A and HTR3B regions located at chromosome 11q23.2
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The HTR3A and HTR3B regions, which encode serotonin receptors and are located at chromosome 11q23.2,
are also known to be associated with major depression in both European and Japanese populations
35. Which of the following gene was associated with depression in females ?
I. The MDD1 locus located at 12q22-q23.2
II. The MDD1 locus located at 15q25.2-q26.2
III. The HTR3A and HTR3B genes and found a single-nucleotide polymorphism
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Yamada e al surveyed 29 polymorphisms located within the HTR3A and HTR3B genes and found a single-
nucleotide polymorphism that was associated with depression in females.
36. Which of the following pharmacological functions are encode by ABCB1 gene ?
I. A transporter of glycoprotein
II. A transporter of fatty acids
III. Functions as an active efflux pump for a number of drugs across the blood-brain barrier
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
A study of the drug transporter gene ABCB1 (which encodes a transporter glycoprotein and functions as an
active efflux pump for a number of drugs across the blood-brain barrier
37. Which of the following stressors play a role in major depressive disorder ?
I. Accidental injury
II. Chronic pain
III. Medical illness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Chronic pain, medical illness, and psychosocial stress can also play a role in major depressive disorder.Chronic
aversive symptoms such as pain associated with chronic medical illness may disrupt sleep and other biorhythms
leading to depression.
38. Which of the following stressors play a role in major depressive disorder ?
I. Psychosocial stress
II. Chronic medical illness
III. Behavioural attitude
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Chronic pain, medical illness, and psychosocial stress can also play a role in major depressive disorder.Chronic
aversive symptoms such as pain associated with chronic medical illness may disrupt sleep and other biorhythms
leading to depression
39. Which of the following are the psychosocial risk factor for depression in late life ?
I. Low standard life style
II. Impaired social supports
III. Caregiver burden
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Other psychosocial risk factors for depression in late life include the following[31] :
 Impaired social supports
 Caregiver burden
I. Low standard life style
II. Loneliness
III. Bereavement
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Loneliness
 Bereavement
I. Negative life events
II. Low standard life style
III. Bereavement
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Negative life events
 Bereavement
42. Which of the following pharmacologic agents increase the risk of depression ?
I. Reserpine
II. Beta-blockers
III. Tricyclic antidepressants
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Exposure to certain pharmacologic agents increases the risk of depression, such as reserpine, beta-blockers, and
steroids such as cortisol.
43. Which of the following pharmacologic steroids increase the risk of depression ?
I. Estradiol
II. Cortisol
III. Dexedrine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Exposure to certain pharmacologic agents increases the risk of depression, such as reserpine, beta-blockers, and
steroids such as cortisol.
44. Which of the following abused substances can also increase risk of major depressive disorder ?
I. Dexedrine
II. Cocaine
III. Amphetamine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Abused substances can also increase risk of major depressive disorder, such as cocaine, amphetamine, narcotics,
and alcohol.
45. Which of the following abused substances can also increase risk of major depressive disorder ?
I. Narcotics
II. Dexedrine
III. Alcohol
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Abused substances can also increase risk of major depressive disorder, such as cocaine, amphetamine, narcotics,
and alcohol.
46. What are the potential biological risk factors which have been identified for depression in the
elderly ?
I. Neurodegenerative diseases
II. Multiple sclerosis
III. Elevated blood ammonia level
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Potential biological risk factors have been identified for depression in the elderly. Neurodegenerative diseases
(especially Alzheimer disease and Parkinson disease), stroke, multiple sclerosis, seizure disorders, cancer,
macular degeneration, and chronic pain have been associated with higher rates of depression
elderly ?
I. Vaginal flora
II. Seizure disorders
III. Cancer
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
elderly ?
I. Macular degeneration
II. Elevated blood ammonia level
III. Chronic pain
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
49. How the parent child relation lead to effective illness of depression in adults ?
I. Low paternal involvement during early childhood
II. High maternal overprotection during early childhood
III. High maternal overprotection during late period of life
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The parent-child relation model conceptualizes depression as the result of poor parent-child interaction. Adults
with depression report low paternal involvement and high maternal overprotection during early childhood.
Troubled relationships with parents, siblings, and peers are common in children and adolescents with affective
illness.
50. Which of the following evidences support the hypothesis that cerebrovascular disease may cause
or contribute to late-life depression ?
I. High maternal overprotection during late period of life
II. Higher incidence of depression following a left-sided stroke
III. Higher prevalence of ischemic white-matter changes in older adults with depression
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The vascular depression hypothesis posits that cerebrovascular disease may cause or contribute to late-life
depression. Various lines of evidence support this hypothesis, including the following[43] :
 Higher incidence of depression following a left-sided stroke
 Higher prevalence of ischemic white-matter changes in older adults with depression than those without
51. Which of the following evidences support the hypothesis that cerebrovascular disease may cause
or contribute to late-life depression ?
I. Bidirectional association between depression and coronary artery disease and depression and diabetes
II. Lower rates of depression among patients with vascular dementia than those with Alzheimer disease
III. Higher rates of depression among patients with vascular dementia than those with Alzheimer disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The vascular depression hypothesis posits that cerebrovascular disease may cause or contribute to late-life
depression. Various lines of evidence support this hypothesis, including the following[43] :
 Bidirectional association between depression and coronary artery disease and depression and diabetes
 Higher rates of depression among patients with vascular dementia than those with Alzheimer disease
concerning the prognosis of late-onset depression ?

I. 2/3 of patients manifest remission and the remaining 1/3 will worsen, regardless of treatment
II. 1/3 of patients manifest remission, another 1/3remain symptomatic in the same condition, and the
remaining 1/3 will worsen, regardless of treatment
III. 1/3 remain symptomatic in the same condition, and the remaining 2/3 will worsen, regardless of
treatment
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Millard suggested the "rule of thirds" concerning the prognosis of late-onset depression, which states that
regardless of treatment, approximately one third of patients will manifest remission, another one third will
remain symptomatic in the same condition, and the remaining one third will worsen.[
53. What are the other risk factor for suicide in addition to older age and male sex ?
I. Diagnosis of major depression
II. Previous history of suicide attempts
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In addition to older age and male sex, risk factors for suicide include the following[70, 71] :
 Diagnosis of major depression
 Previous history of suicide attempts
II. Depressive symptoms with agitation or distress
III. Burden of medical disease and the presence of a current serious medical condition
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Depressive symptoms with agitation or distress
 Burden of medical disease and the presence of a current serious medical condition (although this risk
may be mediated by a diagnosis of depression)
I. Recent stressful life events, especially family discord
II. High maternal overprotection during late period of life
III. Lack of social support
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Recent stressful life events, especially family discord
 Lack of social support
II. Being widowed or divorced
III. The presence of a gun in the home
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Being widowed or divorced
 The presence of a gun in the home
I. Unexplained weight loss
II. High levels of anxiety
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In addition to older age and male sex, risk factors for suicide include the following:
 Unexplained weight loss
 High levels of anxiety
I. Lack of a reason not to commit suicide
II. High maternal overprotection during late period of life
III. Presence of a specific plan that can be carried out
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In addition to older age and male sex, risk factors for suicide include the following:
 Lack of a reason not to commit suicide
 Presence of a specific plan that can be carried out
59. Which of the following websites are valuable resources for patient and family education of
depression ?
I. National Institute of Mental Health
II. Medline Plus
III. Arthritis Center
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The following Web sites are valuable resources for patient and family education:
 National Institute of Mental Health: Depression
 Medline Plus: Depression
 Familydoctor.org: Depression
 Depressionandbipolarsupportalliance(DBSA)
 Familiesfordepressionawareness
60. Which of the following websites are valuable resources for patient and family education of
depression ?
I. Heartburn and GERD Medications
II. FamilyDoctor.org
III. Depression and Bipolar Support Alliance(DBSA)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The following Web sites are valuable resources for patient and family education:
 Familydoctor.org: Depression
 Depression and Bipolar Support Alliance(DBSA)
 Families for Depression Awareness
61. Which of the following websites are specifically resources for late-onset depression ?
I. Heartburn and GERD Medications
II. National Institute of Mental Health
III. University of Maryland Medical Center
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Helpful Web sites specifically for late-onset depression include the following:
 Medline Plus: Depression-elderly
 National Institute of Mental Health: Older Adults: Depression and Suicide Facts
 University of Maryland Medical Center: Depression-elderly
62. Which of the following statement is /are correct for the dysphoric mood state ?
I. It may be expressed by patients as sadness, heaviness, numbness, or sometimes irritability and mood
swings
II. It may be expressed by patients as happiness, lightness, or sometimes irritability and mood swings
III. They often report a loss of interest or pleasure in their usual activities, difficulty concentrating, or loss
of energy and motivation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
A dysphoric mood state may be expressed by patients as sadness, heaviness, numbness, or sometimes irritability
and mood swings. They often report a loss of interest or pleasure in their usual activities, difficulty
concentrating, or loss of energy and motivation. Their thinking is often negative, frequently with feelings of
worthlessness, hopelessness, or helplessness
63. Which of the following statement is /are correct for the dysphoric mood state ?
I. It may be expressed by patients as happiness, lightness, or sometimes irritability and mood swings
II. It may be expressed by patients as sadness, heaviness, numbness, or sometimes irritability and mood
swings
III. Their thinking is often negative, frequently with feelings of worthlessness, hopelessness, or helplessness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
A dysphoric mood state may be expressed by patients as sadness, heaviness, numbness, or sometimes irritability
and mood swings. They often report a loss of interest or pleasure in their usual activities, difficulty
concentrating, or loss of energy and motivation. Their thinking is often negative, frequently with feelings of
worthlessness, hopelessness, or helplessness
64. Which of the following symptoms presence defined anxious distress in patient ?
I. Feeling keyed up or tense
II. Feeling unusually restless
III. Feeling unusually happiness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Anxious distress is defined as the presence of at least 2 of the following symptoms[1] :

 Feeling keyed up or tense
 Feeling unusually restless
 Difficulty concentrating because of worry
 Fear that something awful may happen
 Feeling of potential loss of control
I. Feeling unusually happiness
II. Difficulty concentrating because of worry
III. Fear that something awful may happen
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

I. Feeling of potential loss of control
II. Feeling unusually happiness
III. Feeling unusually restless
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

67. What psychomotor features observed during depressive episode with catatonia in diagnosis
criteria of DSM-5 ?
I. Stupor
II. Catalepsy
III. Euphoria
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The DSM-5 criteria for diagnosis of depressive episodes with catatonia requires the presence of 3 or more of 12
psychomotor features during most of the episode:[1]
 Stupor
 Catalepsy
 Agitation, not influenced by external stimuli
 Grimacing
 Echolalia
 Echopraxia
criteria of DSM-5 ?
I. Euphoria
II. Waxy flexibility
III. Mutism
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Waxy flexibility
 Mutism
criteria of DSM-5 ?
I. Negativism
II. Positivism
III. Posturing
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Negativism
 Posturing
criteria of DSM-5 ?
I. Mannerism
II. Stereotypy
III. Increased sensitivity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Mannerism
 Stereotypy
criteria of DSM-5 ?
I. Increased sensitivity
II. Agitation, not influenced by external stimuli
III. Grimacing
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Agitation, not influenced by external stimuli
 Grimacing
criteria of DSM-5 ?
I. Echolalia
II. Euphoria
III. Echopraxia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Echolalia
 Echopraxia
73. What are the episode of depression identified as atypical features in addition to mood reactivity
?
I. Increased appetite or significant weight gain

II. Increased sleep
III. Deceased sleep
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
An episode of depression may be identified as having atypical features. Characteristics of this subtype are mood
reactivity and exclusion of melancholic and catatonic subtypes in addition to 2 or more of the following for a
period of at least 2 weeks:
 Increased appetite or significant weight gain
 Increased sleep
74. What are the episode of depression identified as atypical features in addition to mood reactivity
?
I. Euphoria
II. Feelings of heaviness in arms or sensitivities of the legs
III. A pattern of longstanding interpersonal rejection sensitivity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
An episode of depression may be identified as having atypical features. Characteristics of this subtype are mood
reactivity and exclusion of melancholic and catatonic subtypes in addition to 2 or more of the following for a
period of at least 2 weeks:
 Feelings of heaviness in arms or sensitivities of the legs
 A pattern of longstanding interpersonal rejection sensitivity
75. Which of the following statement is /are correct for the postpartum depression ?
I. It can develop mood disturbances during this period
II. Women experience a more disabling and persistent form of depression, with an onset later than the
postpartum blues
III. Women losses weight during this period
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Depression in the postpartum period is a common and potentially very serious problem; up to 85% of women
can develop mood disturbances during this period. For most women, symptoms are transient and relatively
-15% of women experience a more disabling and persistent form of
depression, with an onset later than the postpartum blues, and 0.1-0.2% of women experience postpartum
psychosis.
76. What are the common symptoms of postpartum blues ?

I. Rapidly fluctuating mood
II. Weight loss
III. Tearfulness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Rapidly fluctuating mood, tearfulness, irritability, and anxiety are common symptoms of postpartum blues.
77. What are the common symptoms of postpartum blues ?
I. Weight loss
II. Irritability
III. Anxiety
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Rapidly fluctuating mood, tearfulness, irritability, and anxiety are common symptoms of postpartum blues.
78. What are the atypical symptoms observed in patient with seasonal affective disorder ?
I. Hypersomnia
II. Increased appetite
III. Weight loss
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Patients with seasonal affective disorder are more likely to report atypical symptoms, such as hypersomnia,
increased appetite, and a craving for carbohydrates.
79. What are the atypical symptoms observed in patient with seasonal affective disorder ?
I. Hypersomnia
II. Insomnia
III. A craving for carbohydrates
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Patients with seasonal affective disorder are more likely to report atypical symptoms, such as hypersomnia,
increased appetite, and a craving for carbohydrates.
80. Which of the following psychotic features are associated with severe major depressive disorder ?
I. Euphoria
II. Delusions
III. Hallucination
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The presentation of severe major depressive disorder may include psychotic features. Psychotic features include
delusions and hallucination and may be mood congruent or mood incongruent.
81. Which of the following psychotic features are associated with severe major depressive disorder ?
I. Mood congruent
II. Mood incongruent
III. Euphoria
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The presentation of severe major depressive disorder may include psychotic features. Psychotic features include
delusions and hallucination and may be mood congruent or mood incongruent.
82. Which of the following is most widely used ,valuable depression screening tests ?
I. Rehabilitation
II. Patient Health Questionnaire-9 (PHQ-9)
III. Blood test
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Depression screening tests can be valuable, with the most widely one used being the Patient Health
Questionnaire-9 (PHQ-9).
83. Which of the following are include in longer self-report screening instruments for depression ?
I. Patient Health Questionnaire-9 (PHQ-9)
II. Beck Depression Inventory (BDI)
III. Rehabilitation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Longer self-report screening instruments for depression include the following:

 PHQ-9 The 9-item depression scale of the Patient Health Questionnaire; each item is scored 0 to
3, providing a 0 to 27 severity score
 Beck Depression Inventory (BDI) or Beck Depression Inventory-II (BDI-II) 21-question symptom-
rating scales
 BDI for primary care A 7-question scale adapted from the BDI
 Zung Self-Rating Depression Scale A 20-item survey
 Center for Epidemiologic Studies-Depression Scale (CES-D)
I. Rehabilitation program
II. Zung Self-Rating Depression Scale
III. Beck Depression Inventory-II
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

rating scales
I. Center for Epidemiologic Studies-Depression Scale (CES-D)
II. Rehabilitation study
III. Beck Depression Inventory (BDI) for primary care
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

rating scales
86. Which of the following statement is /are correct for geriatric depression scale ?
I. It is developed for older adults, has also been validated in younger adults
II. It comprises 30 items; a short-form GDS has 15 items
III. It comprises 50 items; a short-form GDS has 25 items
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The Geriatric Depression Scale (GDS), although developed for older adults, has also been validated in younger
adults. The GDS comprises 30 items; a short-form GDS has 15 items
87. which of the following scale can be used to determine the category and severity of depression in
older patients with established dementia ?
I. Cornell Scale for Depression in Dementia
II. Geriatric Depression Scale (GDS)
III. Zung Self-Rating Depression Scale
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
In older patients with established dementia, the Cornell Scale for Depression in Dementia (see the image below)
can be used to determine the category and severity of depression. The clinician completes the scale on the basis
88. What are the melancholic features in patient with depression in addition to a loss of pleasure in
almost all activities ?
I. A depressed mood that is distinctly different from the kind that is felt when a loved one is deceased
II. Depression that is worse in the morning
III. Depression that is worse in the evening
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In depression with melancholic features, either a loss of pleasure in almost all activities or a lack of reactivity
to usually pleasurable stimuli is present. Additionally, at least 3 of the following are required:
 A depressed mood that is distinctly different from the kind that is felt when a loved one is deceased
 Depression that is worse in the morning
 Waking up 2 hours earlier than usual
 Observable psychomotor retardation or agitation
 Significant weight loss or anorexia
 Excessive or inappropriate guilt
I. Depression that is worse in the evening
II. Waking up 2 hours earlier than usual
III. Observable psychomotor retardation or agitation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
I. Significant weight loss or anorexia
II. Depression that is worse in the evening
III. Excessive or inappropriate guilt
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
91. A patient is waking up 2 hours earlier than usual in addition to a lack of reactivity from last few
days. Which features he shows ?
I. Depression with melancholic features
II. Depression with metabolic features
III. Depression with psychic features
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
92. A student is preparing for the exam but he feel difficulty in concentrating in study due to worry.
Which features he shows ?
I. Depression with melancholic features
II. Depression with metabolic features
III. Depression with Anxious distress
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Depression with Anxious Distress-------Anxious distress is defined as the presence of at least 2 of the following
symptoms[1] :
93. What is mean by HDRS ?
I. Harvard Depression Rating Scale
II. Hamilton Depression Rating Scale
III. Hamilton Disorder Rating Scale
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Hamilton depression rating scale (hdrs)
94. What is mean by SPECT scanning ?

I. Single-photon emission computed tomography
II. Sucrose-photon emission computed tomography
III. Surbiton-photon emission computed tomography
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Single-photon emission computed tomography (SPECT) scanning

95. Which of the following laboratory studies may be useful to exclude potential medical illnesses
that may present as major depressive disorder ?
I. Sickle cell test
II. Complete blood cell (CBC) count
III. Thyroid-stimulating hormone (TSH)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Depression is a clinical diagnosis, based on the history and physical findings. No diagnostic laboratory tests are
available to diagnose major depressive disorder, but focused laboratory studies may be useful to exclude potential
medical illnesses that may present as major depressive disorder. These laboratory studies might include the
following:
 Complete blood cell (CBC) count
 Thyroid-stimulating hormone (TSH)
I. Vitamin B-12
II. Vitamin K
III. Rapid plasma reagin (RPR)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
following:
 Vitamin B-12
 Rapid plasma reagin (RPR)
I. HIV test
II. Electrolytes, including calcium, phosphate, and magnesium levels
III. Oral glucose tolerance test
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
following:
 HIV test
 Electrolytes, including calcium, phosphate, and magnesium levels
I. Blood urea nitrogen (BUN) and creatinine
II. Microalbumin urine test
III. Liver function tests (LFTs)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
following:
 Blood urea nitrogen (BUN) and creatinine
 Liver function tests (lfts)
I. Coombs test
II. Blood alcohol level
III. Blood and urine toxicology screen
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
following:
 Blood alcohol level
 Blood and urine toxicology screen
I. Arterial blood gas (ABG)
II. Dexamethasone suppression test
III. Antibody test
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
1. Which of the following drugs are used treatment of depression ?
I. Selective serotonin reuptake inhibitors
II. Serotonin/norepinephrine reuptake inhibitors
III. Carbonic anhydrase inhibitors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Drugs used for treatment of depression include the following:

 Selective serotonin reuptake inhibitors (ssris)
 Serotonin/norepinephrine reuptake inhibitors (snris)

I. Mercurial diuretics
II. .Atypical antidepressants
III. Serotonin-Dopamine Activity Modulators
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Atypical antidepressants
 Serotonin-Dopamine Activity Modulators (sdams)
I. Tricyclic antidepressants
II. Prostaglandin analogs
III. Monoamine oxidase inhibitors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Tricyclic antidepressants (tcas)
 Monoamine oxidase inhibitors (maois)

I. St. John's wort
II. Serotonin-Dopamine Activity Modulators
III. Gonadotrophins and gonadotrophin secretion stimulating drugs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Serotonin-Dopamine Activity Modulators (sdams)
 St. John's wort
5. Which of the following drugs falls in the category selective serotonin reuptake inhibitors used for
the treatment of depression ?
I. Trazodone
II. Citalopram (Celexa)
III. Escitalopram (Lexapro)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Selective serotonin reuptake inhibitors

 Citalopram (Celexa)
 Escitalopram (Lexapro)
I. Fluoxetine
II. Trazodone
III. Fluvoxamine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Fluoxetine (Prozac)
 Fluvoxamine (Luvox)
I. Paroxetine
II. Sertraline
III. Trazodone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Paroxetine (Paxil)
 Sertraline (Zoloft)
I. Aripiprazole
II. Vilazodone
III. Vortioxetine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Vilazodone (Viibryd)
 Vortioxetine (Brintellix)
9. What are the adverse effect of selective serotonin reuptake inhibitors used for the treatment of
depression ?
I. Gastrointestinal upset
II. Sexual dysfunction
III. Drowsiness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The adverse-effect profile of ssris is less prominent than that of some other agents, which promotes better
compliance. Common adverse effects include gastrointestinal upset, sexual dysfunction, and changes in energy
level (ie, fatigue, restlessness)
10. What are the adverse effect of selective serotonin reuptake inhibitors used for the treatment of
depression ?
I. Drowsiness
II. Fatigue
III. Restlessness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The adverse-effect profile of ssris is less prominent than that of some other agents, which promotes better
compliance. Common adverse effects include gastrointestinal upset, sexual dysfunction, and changes in energy
level (ie, fatigue, restlessness)
11. Which of the following drugs falls in the category serotonin/norepinephrine reuptake inhibitors
used for the treatment of depression ?
I. Venlafaxine
II. Desvenlafaxine
III. Amitriptyline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Serotonin/norepinephrine reuptake inhibitors

Snris, which include venlafaxine (Effexor), desvenlafaxine (Pristiq), duloxetine (Cymbalta), and Levo
milnacipran (Fetzima)
12. Which of the following drugs falls in the category serotonin/norepinephrine reuptake inhibitors
I. Duloxetine
II. Amitriptyline
III. Levomilnacipran
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Serotonin/norepinephrine reuptake inhibitors

Snris, which include venlafaxine (Effexor), desvenlafaxine (Pristiq), duloxetine (Cymbalta), and
levomilnacipran (Fetzima)
13. Which of the following drugs falls in the categoryatypical antidepressants used for the treatment
of depression ?
I. Bupropion
II. Mirtazapine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Atypical antidepressants include bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone, and

Trazodone (Desyrel).
14. Which of the following drugs falls in the categoryatypical antidepressants used for the treatment
of depression ?
I. Paroxetine
II. Nefazodone
III. Trazodone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Atypical antidepressants include bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone, and

Trazodone (Desyrel).
15. Which of the following drugs falls in the category Serotonin-Dopamine Activity Modulators
I. Brexpiprazole
II. Paroxetine
III. Aripiprazole
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Serotonin-dopamine activity modulators

Sdams include brexpiprazole (rexulti) and aripiprazole (abilify)
16. Which of the following drugs falls in the category tricyclic antidepressants used for the treatment
of depression ?
I. Amitriptyline
II. Clomipramine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Tricyclic antidepressants
 Amitriptyline (Elavil)
 Clomipramine (Anafranil)
of depression ?
I. Levomilnacipran
II. Desipramine
III. Doxepin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Desipramine (Norpramin)
 Doxepin (Sinequan)
of depression ?
I. Imipramine
II. Levomilnacipran
III. Nortriptyline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Imipramine (Tofranil)
 Nortriptyline (Pamelor)
of depression ?
I. Protriptyline
II. Trimipramine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Protriptyline (Vivactil)
 Trimipramine (Surmontil)
20. Which of the following drugs falls in the category monoamine oxidase inhibitors used for the
treatment of depression ?
I. Isocarboxazid
II. Phenelzine
III. Protriptyline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Monoamine oxidase inhibitors---maois include isocarboxazid (Marplan), phenelzine (Nardil), selegiline

(Emsam), and tranylcypromine (Parnate).
21. Which of the following drugs falls in the category monoamine oxidase inhibitors used for the
I. Protriptyline
II. Selegiline
III. Tranylcypromine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Monoamine oxidase inhibitors---maois include isocarboxazid (Marplan), phenelzine (Nardil), selegiline

(Emsam), and tranylcypromine (Parnate).
22. What are the adverse effect of monoamine oxidase inhibitors used for the treatment of depression
?
I. Hypertensive crisis
II. Hypersomnia
III. Insomnia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Because of the risk of hypertensive crisis, patients on these medications must follow a low-tyramine diet. Other
adverse effects can include insomnia, anxiety, orthostasis, weight gain, and sexual dysfunction.
?
I. Anxiety
II. Orthostasis
III. Hypersomnia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
?
I. Hypersomnia
II. Weight gain
III. Sexual dysfunction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
25. Which of the following statement is /are correct for the St. John wort ?
I. It is an herbal remedy available over the counter
II. It is considered a first-line antidepressant in many European countries
III. It is considered a second-line antidepressant in many European countries
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
St. John's wort (Hypericum perforatum) is an herbal remedy available over the counter. Although St. John's
wort is considered a first-line antidepressant in many European countries, it has only recently gained popularity
in the United States.
26. What are the common dosage of St. John wort used for the treatment of depression ?
I. 300 mg 3 times a day with meals to prevent GI upset
II. 600 mg 3 times a day with meals to prevent GI upset
III. 600 mg 1 times a day with meals to prevent GI upset
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
upset.
27. Which of the following statement is /are correct for cognitive-behavioral therapy ?
I. It is directed and time limited, usually involving between 10 and 20 treatments
II. Specific areas of emphasis include grief, interpersonal disputes, role transitions, and interpersonal deficits
III. It includes behavioral strategies and cognitive restructuring for the purpose of changing negative
automatic thoughts and addressing maladaptive schemas
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
CBT is directed and time limited, usually involving between 10 and 20 treatments. CBT for depression
typically includes behavioral strategies (i.e., activity scheduling), as well as cognitive restructuring for the
purpose of changing negative automatic thoughts and addressing maladaptive schemas
28. Which of the following statement is /are correct for interpersonal therapy ?
I. It is a time-limited (typically 56 sessions) treatment for major depressive disorder
II. It is a time-limited (typically 16 sessions) treatment for major depressive disorder
III. It draws from attachment theory and emphasizes the role of interpersonal relationships and focus on
current interpersonal difficulties
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Interpersonal therapy (IPT) is a time-limited (typically 16 sessions) treatment for major depressive disorder.
While more structured than dynamic treatments, IPT has less structure than cognitive and behavioral
approaches. IPT draws from attachment theory and emphasizes the role of interpersonal relationships, [130]
focusing on current interpersonal difficulties.
29. What occurs in the initial phase (sessions 1-4) of interpersonal therapy used for treatment of
major depressive disorder ?
I. It focuses on building a working alliance as well as identifying an area of primary interpersonal focus
II.
have a brief respite from some responsibilities
III. It is a structured program that includes eight weekly, 2-hour group sessions
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Specific areas of emphasis include grief, interpersonal disputes, role transitions, and interpersonal deficits. [131]
The initial phase of treatment (sessions 1-4) focuses on building a working alliance as well as identifying an
area of primary interpersonal focus based on the four areas previously mentioned, although other areas may be
address their
symptoms and have a brief respite from some responsibilities.
30. What occurs in the middle phase (sessions 4-12) of interpersonal therapy used for treatment of
I. Specific interventions are used to address the area of focus in this phase
II. It is a structured program that includes eight weekly, 2-hour group sessions
III. This includes providing validation and support, improving communication skills, and working to solve
interpersonal problems
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
During the middle phase of treatment (sessions 4-12), specific interventions are used to address the area of
focus. This includes providing validation and support, improving communication skills, and working to solve
interpersonal problems.
31. What occurs in the final phase (sessions 13-16) of interpersonal therapy used for treatment of
I. It is a structured program that includes eight weekly, 2-hour group sessions
II. The final phase of treatment focuses on termination of therapy
III. This includes reviewing progress, developing relapse prevention strategies, and addressing emotions that
come with ending the therapy relationship
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The final phase of treatment (sessions 13-16) focuses on termination of therapy. This includes reviewing
progress, developing relapse prevention strategies, and addressing emotions that come with ending the therapy
relationship.[
32. Which of the following statement is /are correct formindfulness based cognitive therapy ?
I. It is a structured program that includes eight weekly, 2-hour group sessions
II. It reduced risk of relapse or recurrence among patients who completed treatment with medications for
depression
III. It is a time-limited (typically 16 sessions) treatment for major depressive disorder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
MBCT is a structured program that includes eight weekly, 2-hour group sessions. Patients are assigned
homework on a daily basis. Research indicated that MBCT reduced risk of relapse or recurrence among patients
who completed treatment with medications for depression.
II. This includes awareness and acceptance of uncomfortable feelings and sensations rather than efforts to
avoid contact with such experiences
III. Patients are encouraged to incorporate mindfulness into their daily activities as well as to practice specific
mindfulness exercises
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
MBCT is a structured program that includes eight weekly, 2-hour group sessions. This includes awareness and
acceptance of uncomfortable feelings and sensations rather than efforts to avoid contact with such experiences.
Patients are encouraged to incorporate mindfulness into their daily activities as well as to practice specific
mindfulness exercises.
I. It aims to improve -solving attitudes and behaviours in order to decrease distress and
improve quality of life
II. It is a time-limited (typically 16 sessions) treatment for major depressive disorder
III. It is based on a model characterizing social problem solving as a mediator and moderator of the
relationship between stress and depression
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Problem- -solving attitudes and behaviours in order

[137, 139]
to decrease distress and improve quality of life. The use of PST for the treatment of major depressive
disorder is based on a model characterizing social problem solving as a mediator (e.g., Nezu& Ronan[140] ) and
moderator (e.g., Nezu, Nezu, Saraydarian, Kalmar, & Ronan[141] ) of the relationship between stress and
depression
35. Which of the following statement is /are correct forsocial problem solving ?
II. It is defined as a cognitive-behavioral process that involves directing efforts to cope with a problem
toward changing the nature of the situation
III. is defined as a cognitive-behavioral process that involves directing efforts to cope with a problem toward
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Social problem solving is defined as a cognitive-behavioral process that involves directing efforts to cope with a
includes the ability to identify and select a variety of coping responses to address the features of a specific stressful
situation.
36. Which of the following skills are applied systematically to effectively solve a problem in adaptive
problem-solving style ?
I. Defining a problem
II. Determining alternative solutions
III. Escaping the problem
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
An adaptive problem-solving style is referred to as rational problem-solving, which includes systematically

applying skills to effectively solve a problem. These skills include: (a) defining a problem, (b) determining
alternative solutions, (c) decision making regarding different solution strategies, and (d) implementing and
evaluating a particular solution strategy.
37. Which of the following skills are applied systematically to effectively solve a problem in adaptive
problem-solving style ?
I. Escaping the problem
II. Decision making regarding different solution strategies
III. Implementing and evaluating a particular solution strategy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
An adaptive problem-solving style is referred to as rational problem-solving, which includes systematically

applying skills to effectively solve a problem. These skills include: (a) defining a problem, (b) determining
alternative solutions, (c) decision making regarding different solution strategies, and (d) implementing and
evaluating a particular solution strategy.
38. Which of the following conditions indicates the patient to electroconvulsive therapy for the
I. Need for a rapid antidepressant response
II. Failure of drug therapies
III. Less expensive treatment
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Thus, the indications for the use of ECT include the following:
 Need for a rapid antidepressant response
 Failure of drug therapies
I. Less expensive treatment
II. History of good response to ECT
III. Patient preference
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 History of good response to ECT
 Patient preference
I. High risk of suicide
II. Less expensive treatment
III. High risk of medical morbidity and mortality
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 High risk of suicide
 High risk of medical morbidity and mortality
41. What are the common adverse effect of bright light therapy ?
I. Eye irritation
II. Restlessness
III. Diarrhoea
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
BLT has the potential to precipitate a hypomanic or manic episode in susceptible individuals. Other common
adverse effects include eye irritation, restlessness, and transient headaches.
42. What are the common adverse effect of bright light therapy ?
I. Diarrhoea
II. Hypomanic
III. Transient headaches
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
BLT has the potential to precipitate a hypomanic or manic episode in susceptible individuals. Other common
adverse effects include eye irritation, restlessness, and transient headaches.
43. What are the other additional therapies may be used for the treatment of depression ?
I. Transdermal magnetic stimulation
II. Transcranial magnetic stimulation
III. Vagus nerve stimulation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Additional Therapies for Depression

 Transcranial magnetic stimulation (TMS)
 Vagus nerve stimulation (VNS)
 Deep brain stimulation (DBS)
44. What are the other additional therapies may be used for the treatment of depression ?
I. Transcranial magnetic stimulation
II. Transdermal magnetic stimulation
III. Deep brain stimulation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Additional Therapies for Depression

 Transcranial magnetic stimulation (TMS)
 Vagus nerve stimulation (VNS)
 Deep brain stimulation (DBS)
45. Which of the following medication is only currently approved by the FDA for the treatment of
depression in children ?
I. Fluoxetine
II. Cimetidine
III. Phenelzine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Fluoxetine is the only medication currently approved by the FDA for the treatment of depression in children
46. Which diet should restricted on prescription of monoamine oxidase inhibitors in depressed
patient ?
I. Aged cheese
II. Aged chicken or beef liver
III. Aged milk
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Dietary restrictions are necessary only when prescribing monoamine oxidase inhibitors (maois). Foods high in
tyramine, which can produce a hypertensive crisis in the presence of maois, should be avoided. These foods
 Aged cheese
 Aged chicken or beef liver
patient ?
I. Green vegetables
II. Air-dried sausage and similar meats
III. Avocados
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Air-dried sausage and similar meats
 Avocados
patient ?
I. Beer and wine
II. Green vegetables
III. Canned figs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Beer and wine (in particular, red wine)
 Canned figs
patient ?
I. Caviar
II. Fava beans
III. Green vegetables
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Caviar
 Fava beans
patient ?
I. Green vegetables
II. Meat tenderizer
III. Overripe fruit
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Meat tenderizer
 Overripe fruit
51. Which of the following foods are rich in tyramine, can produce a hypertensive crisis in the
presence of MAOIs, should be avoided in depressed patient ?
I. Pickled or cured meat or fish

II. Raisins
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Pickled or cured meat or fish
 Raisins
I. Green vegetables
II. Sauerkraut
III. Shrimp paste
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Sauerkraut
 Shrimp paste
I. Sour cream
II. Green vegetables
III. Soy sauce
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Sour cream
 Soy sauce
I. Sauerkraut
II. Yeast extracts
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Sauerkraut
 Yeast extracts
55. What are the complications associated with SSRIs taking patient during treatment of depre ssion
?
I. Low body weight
II. Tumors
III. Skin reactions
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Clinically significant hyponatremia may develop in elderly patients taking ssris. In addition to older age, risk
factors include the following[193] :
 Low body weight
 Tumors
56. What are the complications associated with SSRIs taking patient during treatment of depression
?
I. Antidepressant-induced hypernatremia
II. Respiratory or CNS illnesses
III. Antidepressant-induced hyponatremia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Clinically significant hyponatremia may develop in elderly patients taking ssris. In addition to older age, risk
factors include the following[193] :
 Respiratory or CNS illnesses
 Antidepressant-induced hyponatremia occurs through the syndrome
57. What are the complications associated with the treatment for depression ?
I. Suicidality
II. Cancer
III. Stroke
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Complications of Treatment for Depression

 Suicidality
 Stroke
58. What are the complications associated with the treatment for depression ?
I. Cancer
II. Withdrawal symptoms
III. Interactions with other drugs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Complications of Treatment for Depression

 Withdrawal symptoms
 Interactions with other drugs
59. What are the adverse effect of tricyclic antidepressants result largely from their anticholinergic
and antihistaminic properties ?
I. Sedation
II. Confusion
III. Drowsiness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The adverse effects of tcas, which result largely from their anticholinergic and antihistaminic properties, include
the following:
 Sedation
 Confusion
I. Drowsiness
II. Dry mouth
III. Orthostasis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
the following:
 Dry mouth
 Orthostasis
I. Constipation
II. Urinary retention
III. Drowsiness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
the following:
 Constipation
 Urinary retention
I. Sexual dysfunction
II. Drowsiness
III. Weight gain
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
the following:
 Sexual dysfunction
 Weight gain
63. What is the mechanism of action of citalopram used for the treatment of depression ?
I. It enhances cholinesterase activity as a result of selective reuptake inhibition at the presynaptic neuronal
membrane
II. It enhances serotonin activity as a result of selective reuptake inhibition at the presynaptic neuronal
membrane
III. It reduces serotonin activity as a result of selective reuptake inhibition at the presynaptic neuronal
membrane
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Citalopram enhances serotonin activity as a result of selective reuptake inhibition at the presynaptic neuronal
membrane. It has minimal effects on norepinephrine and dopamine
64. What is the brand name of citalopram used for the treatment of depression ?
I. Celexa
II. Lexapro
III. Ritalin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Citalopram (celexa)
65. Which of the following statement is /are correct for escitalopram used for the treatment of
depression ?
I. It is an SSRI and S-enantiomer of citalopram used for the treatment of depression
II. It is an SSRI and R-enantiomer of citalopram used for the treatment of depression
III. Act by potentiation of serotonergic activity in the central nervous system resulting from inhibition of
CNS neuronal reuptake of serotonin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Escitalopram is an SSRI and S-enantiomer of citalopram used for the treatment of depression. The mechanism
of action is thought to be potentiation of serotonergic activity in the central nervous system resulting from
inhibition of CNS neuronal reuptake of serotonin. Escitalopram has little or no effect on norepinephrine and
dopamine reuptake
66. Which of the following statement is /are correct for fluvoxamine used for the treatment of
depression ?
I. It is a strong inhibitor of cytochrome P-450
II. It enhances serotonin activity due to selective reuptake inhibition at the neuronal membrane
III. It significantly bind to alpha-adrenergic, histamine, or cholinergic receptors and thus has fewer side
effects than tricyclic antidepressants
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Fluvoxamine enhances serotonin activity due to selective reuptake inhibition at the neuronal membrane. It
does not significantly bind to alpha-adrenergic, histamine, or cholinergic receptors and thus has fewer side
effects than tricyclic antidepressants.
67. Which of the following statement is /are correct for fluvoxamine used for the treatment of
depression ?
I. It is FDA approved only for obsessive-compulsive disorder
II. It is an SSRI and S-enantiomer of citalopram used for the treatment of depression
III. it is commonly prescribed for other psychiatric disorders, including social anxiety disorder,
posttraumatic stress disorder, pain disorder, and major depression
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Fluvoxamine is a strong inhibitor of cytochrome P-450. Although fluvoxamine is FDA approved only for
obsessive-compulsive disorder, it is commonly prescribed for other psychiatric disorders, including social anxiety
disorder, posttraumatic stress disorder, pain disorder, and major depression.
68. Which of the following augmentating agents are used for the treatment of treatment-resistant
depression ?
I. Fluvoxamine
II. Lithium carbonate
III. Buspirone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Augmenting agents
 Lithium carbonate (eskalith, lithane, lithobid)
 Buspirone (buspar)
69. Which of the following drugs falls in the class stimulants for the treatment of depression ?
I. Dextroamphetamine
II. Fluvoxamine
III. Methylphenidate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Stimulants
 Dextroamphetamine (Dexedrine)
 Methylphenidate (Ritalin)
70. Which of the following thyroid product is used to modulate the effect of antidepressants ?
I. Thyroid dessicant
II. Levothyroxine
III. Liothyronine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Thyroid hormones liothyronine (T3, Cytomel) may modulate the effect of antidepressants.
71. Which of the following statement is /are correct for the venlafaxine are used for the treatment of
depression ?
I. It inhibit neuronal serotonin and norepinephrine reuptake
II. They are strong inhibitors of dopamine reuptake
III. They causes beta-receptor down-regulation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Venlafaxine and its active metabolite inhibit neuronal serotonin and norepinephrine reuptake. They are weak
inhibitors of dopamine reuptake. In addition, it causes beta-receptor down-regulation.
72. What is the brand name of amitriptyline used for the treatment of depression ?
I. Celexa
II. Elavil
III. Norpramin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Amitriptyline (elavil)
73. Which of the following statement is /are correct for amitriptyline used for the treatment of
depression ?
I. It has a high affinity for histamine H1 and muscarinic M1 receptors
II. It inhibits the reuptake of norepinephrine and, more potently, serotonin at the presynaptic neuronal
membrane, which increases concentration in the CNS
III. It is an SSRI and S-enantiomer of itriptyline used for the treatment of depression
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Amitriptyline inhibits the reuptake of norepinephrine and, more potently, serotonin at the presynaptic neuronal
membrane, which increases concentration in the CNS. It has a high affinity for histamine H1 and muscarinic
M1 receptors.
74. What is the brand name of desipramine used for the treatment of depression ?
I. Celexa
II. Elavil
III. Norpramin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Desipramine (norpramin)
75. Which of the following statement is /are correct for desipramine used for the treatment of
depression ?
I. It inhibits the reuptake of serotonin and, more potently, norepinephrine at the presynaptic neuronal
membrane
II. It is sometimes used for off-label indications such as peripheral neuropathy and attention-
deficit/hyperactivity disorder
III. It is an SSRI and S-enantiomer of citalopram used for the treatment of depression
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Desipramine inhibits the reuptake of serotonin and, more potently, norepinephrine at the presynaptic neuronal
membrane. It is a commonly used TCA that is relatively less sedating and tends to have fewer anticholinergic
and antihistaminic adverse effects than other tcas. It is sometimes used for off-label indications such as
peripheral neuropathy and attention-deficit/hyperactivity disorder
76. What is the mechanism of action of protriptyline ?

I. It increases the synaptic concentration of norepinephrine in the CNS by inhibiting reuptake at the
presynaptic neuronal membrane
II. They irreversibly block monamine oxidase
III. It reduces the synaptic concentration of norepinephrine in the CNS by inhibiting reuptake at the
presynaptic neuronal membrane
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Protriptyline increases the synaptic concentration of norepinephrine in the CNS by inhibiting reuptake at the
presynaptic neuronal membrane. It has less affinity for H1 and M1 receptors and, thus, is better tolerated than
tertiary amine tcas
77. Which of the following enzyme metabolise the phenylethylamine ?
I. Monoamine oxidase a
II. Monoamine oxidase b
III. Decarboxylase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Monoamine oxidase inhibitors were the first antidepressants discovered, in the early 1950s. They are widely
effective in a broad range of affective and anxiety disorders. Maois irreversibly block monamine oxidase, which
has 2 forms, including moaa and moab. Maoa breaks down serotonin and norepinephrine. Moab metabolizes
phenylethylamine. Both forms break down dopamine.
78. Which of the following enzyme breakdown the serotonin and norepinephrine ?
I. Monoamine oxidase a
II. Monoamine oxidase b
III. Decarboxylase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Maois irreversibly block monamine oxidase, which has 2 forms, including moaa and moab. Maoa breaks down
serotonin and norepinephrine. Moab metabolizes phenylethylamine. Both forms break down dopamine.
79. Which of the following statement is /are correct for lithium carbonate used for treatment
resistance depression ?
I. It is the choice of drug in patients with significant renal impairment
II. It can be used as an effective augmenting agent in combination with an antidepressant in cases of
treatment-resistant depression
III. It can also be used to treat or prevent episodes of depression
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Lithium carbonate can be used as an effective augmenting agent in combination with an antidepressant in
cases of treatment-resistant depression. It can also be used to treat or prevent episodes of depression. Lithium is
contraindicated in patients with significant renal impairment.
80. What is the brand name of lithium carbonate prescribed in treatment resistance depression ?
I. Eskalith
II. Lithane
III. Celexa
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Lithium carbonate (Eskalith, Lithane, Lithobid)

81. What is the brand name of lithium carbonate prescribed in treatment resistance depression ?
I. Celexa
II. Eskalith
III. Lithobid
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Lithium carbonate (Eskalith, Lithane, Lithobid)
82. What is the brand name of buspirone used for the treatment of depression ?
I. Eskalith
II. Lithane
III. BuSpar
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Buspirone (buspar)
83. Which of the following statement is /are correct for buspirone used for the treatment of
depression ?
I. It is a partial 5-HT1A agonist with serotonergic and some dopaminergic effects in the CNS
II. It is marketed as an antianxiety medication and have antidepressant effects at doses above 45 mg/day
III. It acts as a reversible monoamine oxidase inhibitors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Buspirone is marketed as an antianxiety medication; however, it may have antidepressant effects at doses above
45 mg/day. Buspirone is a partial 5-HT1A agonist with serotonergic and some dopaminergic effects in the
CNS.
84. What is the mechanism of action of serotonin-dopamine activity modulators ?
I. It act as a partial agonist at 5-HT1A and dopamine D2 receptors at similar potency
II. It acts as a irreversible monoamine oxidase inhibitors
III. It acts as an antagonist at 5-HT2A and noradrenaline alpha1B/2C receptors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Serotonin-dopamine activity modulators (sdams) act as a partial agonist at 5-HT1A and dopamine D2
receptors at similar potency, and as an antagonist at 5-HT2A and noradrenaline alpha1b/2C receptors. This
mechanism of action is unique from other atypical antipsychotic drugs.
85. What is the brand name of bupropion used for the treatment of depression ?
I. Wellbutrin
II. Lithane
III. BuSpar
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Bupropion (wellbutrin)
86. What are the common side effects of bupropion used for the treatment of depression ?
I. Headache
II. Mild weight loss
III. Sexual dysfunction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Bupropion ---Common side effects include headache and mild weight loss. Unlike other antidepressants,
bupropion does not cause sexual dysfunction.
87. What is the mechanism of action of mirtazapine used for the treatment of depression ?
I. It acts as a irreversible monoamine oxidase inhibitors
II. It blocks both presynaptic and postsynaptic alpha-2 receptors but has low affinity for alpha-1 receptors
III. It blocks serotonin receptors 5HT2 and 5HT3
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Mirtazapine blocks both presynaptic and postsynaptic alpha-2 receptors but has low affinity for alpha-1
receptors. It also blocks serotonin receptors 5HT2 and 5HT3
88. What is the common side effect of mirtazapine used for the treatment of depression ?
I. Sedation
II. Dry mouth
III. Priapism
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Common side effects include sedation, weight gain, and dry mouth.
89. Which of the following is a dangerous side effect of Trazodone in men used for the treatment
of depression ?
I. Sedation
II. Dry mouth
III. Priapism
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Trazodone is effective in the treatment of major depression. It inhibits reuptake of serotonin and modulates
serotonergic neurotransmission. It also significantly blocks histamine (H1) receptors. Its most common side
effect is sedation, and thus, it has an off-label indication as a hypnotic. It can be very rarely associated with
priapism, a medical emergency and a dangerous side effect of this drug in men.
90. How is the liothyronine modulate the effect of antidepressants ?

I. It convert nonresponder (ie, nonresponder to antidepressants) to responders by increasing receptor
sensitivity and enhancing the effects of TCAs
II. It blocks both presynaptic and postsynaptic alpha-5 receptors but has low affinity for alpha-1 receptors
III. It blocks serotonin receptors 5HT4 and 5HT3
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Thyroid hormones liothyronine (T3, Cytomel) may modulate the effect of antidepressants. This synthetic salt
of endogenous thyroid hormone may convert nonresponders (ie, nonresponders to antidepressants) to responders
by increasing receptor sensitivity and enhancing the effects of tcas.
91. Which of the following therapy was designed to reduce relapse among individuals who have been
successfully treated for an episode of recurrent major depressive disorder ?
I. Problem solving therapy
II. Mindfulness based cognitive therapy
III. Behavioural activation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Mindfulness based cognitive therapy (MBCT) was designed to reduce relapse among individuals who have
been successfully treated for an episode of recurrent major depressive disorder.
92. Which of the following statement is /are correct for doxepin used for the treatment of depression
?
I. It has the highest affinity for H1 receptors of all TCAs
II. It increases the concentration of serotonin and norepinephrine in the CNS by inhibiting their reuptake
at the presynaptic neuronal membrane
III. It decreases the concentration of serotonin and norepinephrine in the CNS by inducing their reuptake
at the presynaptic neuronal membrane
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Doxepin increases the concentration of serotonin and norepinephrine in the CNS by inhibiting their reuptake
at the presynaptic neuronal membrane. These effects are associated with a decrease in the symptoms of
depression. It has the highest affinity for H1 receptors of all tcas and, thus, is very sedating and can cause weight
gain.
93. Which of the following statement is /are correct for trimipramine used for the treatment of
depression ?
I. It decreases the concentration of serotonin and norepinephrine in the CNS by inducing their reuptake at
the presynaptic neuronal membrane
II. It inhibits reuptake of norepinephrine and serotonin at the presynaptic neuron and elicits strong
anticholinergic effects
III. It has a high affinity for the H1 receptor and is thus very sedating, but it is useful for gastroesophageal
reflux
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Trimipramine inhibits reuptake of norepinephrine and serotonin at the presynaptic neuron and elicits strong
anticholinergic effects. It has a high affinity for the H1 receptor and is thus very sedating, but it is useful for
gastroesophageal reflux.
94. Which of the following drug metabolism are inhibited by the fluvoxamine ,the SSRIs ?
I. Neuroleptics
II. Antiemetics
III. Antiarrhythmics
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Especially for fluvoxamine, the ssris inhibit the metabolism of several medications that are metabolized by the
diverse clusters of hepatic cytochrome P-450 isoenzymes (eg, tcas, neuroleptics, antiarrhythmics,
benzodiazepines, carbamazepine, theophylline, warfarin, terfenadine [removed from United States market]).
This inhibition results in higher plasma levels of those agents
I. Prostaglandin analogs
II. Benzodiazepines
III. Carbamazepine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
I. Theophylline
II. Warfarin
III. Prostaglandin analogs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
II. Terfenadine
III. Tricyclic antidepressants
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
98. What is the mechanism of action of bupropion used for the treatment of depression ?
I. It has a high affinity for the H1 receptor and is thus very sedating, but it is useful for gastroesophageal
reflux
II. It increase neuronal dopamine reuptake and increases the rate of norepinephrine activity
III. It inhibits neuronal dopamine reuptake and decreases the rate of norepinephrine activity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Bupropion inhibits neuronal dopamine reuptake and decreases the rate of norepinephrine activity.
99. What is the brand name of methylphenidateused to augment antidepressants in patients with
resistant depression ?
I. Dexedrine
II. Ritalin
III. Celexa
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The CNS stimulants dextroamphetamine (Dexedrine) and methylphenidate (Ritalin) are sometimes used to
augment antidepressants in patients with resistant depression.
100. What is the brand name of dextroamphetamine used to augment antidepressants in patients
with resistant depression ?
I. Dexedrine
II. Ritalin
III. Celexa
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The CNS stimulants dextroamphetamine (Dexedrine) and methylphenidate (Ritalin) are sometimes used to
augment antidepressants in patients with resistant depression.
Bipolar disorder
1. What is meant by Bipolar disorder?

I. A brain disorder that share features of excessive fear and anxiety and related behavioral
disturbances.
II. A brain disorder that affects how people think, feel, and perceive the world.
III. It is a common, severe and persistent mental illness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Bipolar affective disorder, or manic-depressive illness (MDI), is a common, severe, and persistent mental illness.
2. What is the other name of Bipolar disorder?

I. Mental-depressive illness (MDI)
II. Manic-depressive illness(MDI)
III. Mood-disorder illness(MDI)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Bipolar affective disorder, or manic-depressive illness (MDI), is a common, severe, and persistent mental illness.
3. What are the early signs of Bipolar disorder?
I. Deep, profound depression
II. Prolonged depression
III. Prolonged fear
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Bipolar affective disorder is characterized by periods of deep, prolonged, and profound depression that alternate
with periods of an excessively elevated or irritable mood known as mania.
4. How can you define Manic episodes?

I. Feature of at-least 4 days of irritable mood
II. Feature of at-least 1 week of profound mood disturbance
III. Loss of pleasure or interest characterize by 2 week duration
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Manic episodes are feature at least 1 week of profound mood disturbance, characterized by elation, irritability,
or expansiveness
5. Which of the following are symptoms of Manic episodes?
I. Feeling of guilt & Suicidal ideation
II. Insomnia & Pressured speech
III. Grandiosity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
At least 3 of the following symptoms must also be present[2] :

 Grandiosity
 Diminished need for sleep
 Excessive talking or pressured speech
 Racing thoughts or flight of ideas
 Clear evidence of distractibility
 Increased level of goal-focused activity at home, at work, or sexually
Excessive pleasurable activities, often with painful consequences
6. How can you describe Hypo-manic episodes?

I. Characterized by elevated, irritable mood of at-least 4 consecutive days
II. Characterized by irritability of at-least 1 week
III. Loss of pleasure and interest
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Hypomanic episodes are characterized by an elevated, expansive, or irritable mood of at least 4 consecutive
7. How can you describe Major depressive episode?
I. Characterized by irritability of at-least 1 week
II. Characterized by elevated, irritable mood of at-least 4 consecutive days
III. Depressed mood & loss of pleasure for at-least 2 weeks
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Major depressive episodes are characterized as, for the same 2 weeks, the person experiences 5 or more of the
following symptoms, with at least 1 of the symptoms being either a depressed mood or characterized by a loss of
pleasure or interes
8. Which of the following are symptoms of Major depressive episodes?

I. Grandiosity
II. Diminished pleasure/interest
III. Suicidal ideation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Depressed mood
 Markedly diminished pleasure or interest in nearly all activities
 Significant weight loss or gain or significant loss or increase in appetite
 Hypersomnia or insomnia
 Psychomotor retardation or agitation
 Loss of energy or fatigue
 Feelings of worthlessness or excessive guilt
 Decreased concentration ability or marked indecisiveness
 Preoccupation with death or suicide; patient has a plan or has attempted suicide
9. What are the diagnostic parameters of Bipolar disorder?
I. Appearance, mood& Physical health evaluation
II. Evaluation of fear & failure
III. Thought, perception& self destruction evaluation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Examination of patients with suspected bipolar affective disorder includes evaluation using the Mental Status
Examination as well as assessment of the following:
 Appearance
 Affect/mood
 Thought content
 Perception
 Suicide/self-destruction
 Homicide/violence/aggression
 Judgment/insight
 Cognition
 Physical health
10. What are diagnostic tests of Bipolar disorder?

I. CBC ,ESR& Electrolyte levels
II. Protein, Creatinine& blood urea level
III. Renal function test
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Laboratory tests that may be helpful include the following:

 CBC count
 ESR levels
 Fasting glucose levels
 Electrolyte levels
 Protein levels
 Thyroid hormone levels
 Creatinine and blood urea nitrogen levels
 Liver and lipid panel
 Substance and alcohol screening
11. Which of the following are types of Bipolar disorder?

I. Bipolar disorder typeI, Bipolar disorder type II
II. Bipolar disorder typeI, Bipolar disorder type II, Cyclothymic disorder
III. Bipolar disorder typeI, Bipolar disorder type II, Bipolar disorder type III
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Bipolar disorder type I (BPI)

Bipolar disorder type II
Cyclothymic disorder
12. Which of the following pathologic conditions are common source of morbidity & mortality in
Bipolar disorder patients?
I. CVS diseases
II. Asthma
III. Diabetes & obesity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Among the general comorbid conditions, cardio metabolic conditions such as cardiovascular disease, diabetes,
and obesity are a common source of morbidity and mortality for persons with bipolar disorder.
13. What patient experience in Bipolar disorder type 1 ?
I. Majorly episodes of mania
II. Symptoms of mania & depression also occur together
III. Majorly severe depression
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Bipolar disorder type I :

Although in rarer cases, persons may only experience episodes of mania. In practice, symptoms of mania and
depression can also occur together in what is termed a mixed state as the illness evolves.
14. What patient experience in Bipolar disorder type 2 ?

I. Majorly severe depression with hypomania
II. Majorly mania episodes
III. Symptoms of mania & depression also occur together
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
(BPII) is diagnosed when episodes of severe depression are punctuated with periods of hypomania, a less severe
form of mania that does not include psychosis or lead to gross impairment in functioning.
15. What patient experience in Cyclothymic disorder ?
I. Symptoms of mania & depression also occur together
II. Symptoms of both hypomanic & depression
III. But not major depression or hypo-mania
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Cyclothymic disorder is given to individuals with periods of both hypomanic and depressive symptoms without
meeting the full criteria for mania, hypomania or major depression.
16. Which of the following is false regarding symptoms of Mania?

I. Insomnia ,Pressured speech
II. Excessive sleep
III. Grandiosity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The symptoms of mania include decreased sleep time accompanied by a decreased need for sleep, pressured
speech, increased libido, reckless behavior without regard for consequences, grandiosity, and severe thought
disturbances, which may or may not include psychosis. Between these highs and lows, many patients, if
adequately medicated, usually experience periods of higher functionality and can lead a productive life.
17. What are the major loci is associated with bipolar disorder development?
I. RELN gene
II. MAFD loci
III. COMT loci
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Many loci are now known to be associated with the development of bipolar disorder. These loci are grouped as
major affective disorder (MAFD) loci and numbered in the order of their discovery.
18. What is the abbreviation of MAFD loci?

I. Manic affective disorder loci
II. Major affective disorder loci
III. Mental affective disorder loci
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Major affective disorder (MAFD) loci

19. What is the location of MAFD-1 loci?
I. 17p
II. 18p
III. 19p
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
MAFD1 is located at 18p and was originally described in a group of 22 patients with bipolar disorder
20. What is the location of MAFD-2 loci?

I. Xq28
II. Xq20
III. Xq10
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
MAFD2 is located at Xq28 and, as such, is associated with an X-linked inheritance pattern. The notion of an
X-linked form of bipolar disorder is not a new one, and at least one paper from the pregenetic era discusses this
very possibility.
21. Which of the following gene is associated with MAFD-3 loci?
I. RELN gene
II. TRPM2 gene
III. COMT gene
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
MAFD3 is located at 21q22.13, and the association appears to be with the TRPM2 gene
22. What is the location of MAFD-4 gene?

I. 14p12
II. 16p12
III. 18p12
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
MAFD4 is located at 16p12 and has been associated with susceptibility to bipolar disease in a cohort of 41
Finnish families
23. What is the location of MAFD-7 gene?

I. 22q12
II. 23q12
III. 24q12
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
MAFD7 is located at 22q12.1 and was detected using microsatellite markers in a North American population;
a large region on 22q12 was associated with bipolar disorder in this study
24. Which of the two major genes are involved in pathophysiology of Bipolar disorder?
I. COMT gene
II. ANK3
III. CACNA1C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The first series of genome-wide association studies (gwass) for bipolar disorder were published in 2007 and
2008,[18, 19, 20, 16] and a collaborative analysis of the last 3 studies gave combined support for 2 particular genes,
ANK3 (ankyrin G) and CACNA1C (alpha 1C subunit of the L-type voltage-gated calcium channel) in a
sample of 4387 cases and 6209 controls.
25. What is the major role of ANK3 gene in Human Brain?

I. Regulation of calcium channels
II. Regulation of sodium channels
III. Regulation of potassium channels
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
ANK3 is an adaptor protein found at axon initial segments that regulates the assembly of voltage-gated sodium
channels.
26. Which of the following drug cause down-regulation of ANK3 & Calcium channel?
I. Valproate
II. Lithium
III. Benzodiazepine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Both ANK3 and subunits of the calcium channel are down regulated in mouse brain in response to lithium,
which indicates a possible therapeutic mechanism of action of one of the most effective treatments for bipolar
disorder
27. What is the major role of CACNA1C in Human Brain?

I. Encoding of T-type voltage gated calcium channel
II. Encoding of L-type voltage gated calcium channel
III. Encoding of N-type voltage gated calcium channel
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
CACNA1C, on chromosome 12, encodes the alpha subunit of the L-type voltage-gated calcium ion channel
found in the brain.
28. Which of the following gene has been shown reduced in brain by Gene expression studies?
I. Oligodendrocyte-myelin-related gene
II. Polydendrocyte-myelin-related gene
III. Monodendrocyte-myelin-related gene
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Studies comparing specific regions of postmortem brain tissue from persons with bipolar disorder with tissue
from control subjects have consistently shown that levels of expression of oligodendrocyte-myelin related genes
appear to be decreased in brain tissue from persons with bipolar disorder
29. What is the major function of Oligodendrocyte-myelin-related gene?

I. Production of myelin membranes
II. Metabolism of myelin membranes
III. Efficient conduction of nerve impulse in brain
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Oligodendrocytes produce myelin membranes that wrap around and insulate axons to permit the efficient
conduction of nerve impulses in the brain.
30. Which process is largely affected by loss of Myelin in Brain?
I. Memory process
II. Thinking process
III. Sleep pattern
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Therefore, loss of myelin is thought to disrupt communication between neurons, leading to some of the thought
disturbances observed in bipolar disorder and related illnesses.
31. What are the major cause of Bipolar disorder?

I. Genetic & Environmental
II. Past medical History
III. Biochemical & Psycho dynamic factors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
A number of factors contribute to bipolar affective disorder, or manic-depressive illness (MDI), including
genetic, biochemical, psychodynamic, and environmental factors.
32. Which type of Bipolar disorder has major genetic component involvement?
I. Bipolar type 1
II. Bipolar type 2
III. Cyclothymic disorder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Bipolar type I (BPI) disorder, has a major genetic component, with the involvement of the ANK3,CACNA1C,
and CLOCK genes
33. Which of the following is false regarding etiology of Bipolar disorder?

I. First-degree relatives of BP1 are approx. 7 susceptible in development of BP1
II. Offspring of parent with bipolar disorder have just 10% chances of having psychiatric disorder
III. Offspring of parent with bipolar disorder have 50% chances of having psychiatric disorder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
First-degree relatives of people with BPI are approximately 7 times more likely to develop BPI than the general
population. Remarkably, offspring of a parent with bipolar disorder have a 50% chance of having another
major psychiatric disorder.
34. Which of the following disorders share common expression of decrease in oligodendrocyte -myelin-
related gene with Bipolar disorder?
I. Anxiety
II. Major depression
III. Schizophrenia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Gene expression studies also demonstrate that persons with bipolar disorder, major depression, and
schizophrenia share similar decreases in the expression of oligodendrocyte-myelin-related genes and
abnormalities of white matter in various brain regions.
35. Which of the following anti-hypertensive agent is involved in causing depression ?
I. Propranolol
II. Nifedipine
III. Reserpine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The blood pressure drug reserpine, which depletes catecholamines from nerve terminals, was noted incidentally
to cause depression
36. Which of the following is true regarding catecholamine hypothesis?

I. Increase in Catecholamines cause mania
II. Decrease in Catecholamines cause depression
III. Decrease in Catecholamines cause mania
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
This led to the catecholamine hypothesis, which holds that an increase in epinephrine and norepinephrine
causes mania and a decrease in epinephrine and norepinephrine causes depression
37. Which of the following agents also trigger mania?
I. Cocaine
II. Caffeine
III. L-dopa
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Drugs used to treat depression and drugs of abuse (eg, cocaine) that increase levels of monoamines, including
serotonin, norepinephrine, or dopamine, can all potentially trigger mania, implicating all of these
neurotransmitters in its etiology. Other agents that exacerbate mania include L-dopa, which implicates
dopamine and serotonin-reuptake inhibitors, which in turn implicate serotonin
38. What Functional & Anatomical abnormalities are found in brain of patient suffering from
Bipolar disorder?
I. Diminished gray matter
II. Decrease activity in ventral limbic brain regions
III. Increase activity in ventral limbic brain regions
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Meta-analysis by Houenou et al found decreased activation and diminution of gray matter in a cortical-
cognitive brain network, which has been associated with the regulation of emotions in patients with bipolar
disorder.[50] An increased activation in ventral limbic brain regions that mediate the experience of emotions
and generation of emotional responses was also discovered.
39. Which of the following is true regarding Psycho dynamics of Bipolar disorder?
I. Depression is the manifestation of losses
II. Depression is the manifestation of pain
III. Mania serves as defense against feeling of depression
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Many practitioners see the dynamics of manic-depressive illness as being linked through a single common
pathway. They see the depression as the manifestation of losses (i.e., the loss of self-esteem and the sense of
worthlessness).Therefore, the mania serves as a defense against the feelings of depression
40. Which of the following factor also increase the possibility of postpartum psychosis?
I. Smoking
II. Pregnancy
III. Diabetes
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Environmental factors
In some instances, the cycle may be directly linked to external stresses or the external pressures may serve to
exacerbate some underlying genetic or biochemical predisposition. For example, pregnancy is a particular stress
for women with a manic-depressive illness history and increases the possibility of postpartum psychosis
41. What is the probable mean age of patients susceptible to Bipolar disorder?
I. 8yrs
II. 21-25yrs
III. above 50yrs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
For both BPI and BPII, the age range is from childhood to 50 years, with a mean age of approximately 21
years. Most cases of bipolar disorder commence when individuals are aged 15-19 years. The second most
frequent age range of onset is 20-24 years.
42. What is the reason behind the occurrence of Bipolar disorder in more than 50yrs old patients?
I. Past family history of Bipolar disorder
II. Depression
III. Smoking
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Some patients diagnosed with recurrent major depression may indeed have bipolar disorder and go on to develop
their first manic episode when older than 50 years. These individuals may have a family history of bipolar
disorder.
43. Which individual is more susceptible in development of Bipolar disorder?
I. Male
II. Female
III. Children
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
BPI occurs equally in both sexes; however, rapid-

women than in men. The incidence of BPII is higher in females than in males. Most studies report a nearly
equal male-to-female ratio in the prevalence of bipolar disorder; however, most studies also report an increased
risk in women for BPII/hypomania, rapid cycling, and mixed episodes
44. Which of the following factors worsen the prognosis of Bipolar disorder?
I. Substance abuse
II. Evidence of depression & Psychotic features
III. Smoking
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Factors suggesting a worse prognosis include the following:

 Poor job history
 Substance abuse
 Psychotic features
 Depressive features between periods of mania and depression
 Evidence of depression
 Male sex
 Pattern of depression-mania-euthymia
45. Which of the following may prove better in prognosis of Bipolar disorder?
I. Few psychotic symptoms & late onset age
II. No medical history
III. Few suicidal thoughts
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Factors suggesting a better prognosis include the following:

 Length of manic phases (short duration)
 Late age of onset
 Few thoughts of suicide
 Few psychotic symptoms
Few medical problems
46. What are the benefits of providing Patient education to Mania patients?
I. Improve quality of life
II. Reduced depression
III. Improved patient compliance
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Educational efforts must be directed not only toward the patient but also toward their family and support
system. Furthermore, evidence continues to mount that these educational efforts not only increase patient
compliance and their knowledge of the disease, but also their quality of life
47. What clinical assessment would you perform while diagnosis of manic patient?
I. Psycho-social status & Psychiatric comorbidities
II. Smoking history
III. Current & Past medications
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Perform a thorough clinical assessment for patients with a manic, hypomanic, or mixed episode, or those with
a bipolar depression episode, including in
and psychiatric comorbidities, current and past medications as well as medication compliance, and substance
use
48. What are the major differences between BP1 & BP2 patients?
I. History of suicidal attempt & Unemployment
II. Depressive symptoms
III. Presence of other medical illness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Data from 1429 bipolar patients included in the National Epidemiological Survey on Alcohol and Related
Conditions showed significant differences between BPI and BPII patients in unemployment, a history of a
suicide attempt, depressive symptoms (eg, weight gain, feelings of worthlessness), and the presence of specific
phobias.[65]
49. What major findings did you find in appearance of Bipolar disorder patient in depressive episode?
I. Poor grooming & lack of shaving
II. Inability to recognize
III. They move slowly &talk in low tone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Persons experiencing a depressed episode may demonstrate poor to no eye contact. Their clothes may be unkempt,
unclean, holed, unironed, and ill-fitting. If the person has lost significant weight, the garments may fit loosely.
The personal hygiene of individuals experiencing a depressed episode reflects their low mood, as evidenced by
poor grooming, lack of shaving, and lack of washing. In women, fingernails may show different layers of polish
or one layer partially removed, and they may not have paid attention to their hair. Men may exhibit dirty
fingernails and hands. When these individuals move, their depressed affect is demonstrated: They move slowly
and very little; they show psychomotor retardation; they may talk in low tones or in a depressed or monotone
voice.
50. What major findings did you find in appearance of Bipolar disorder patient in manic episode?
I. Hyperactive & energized individual
II. They talk & act fast
III. They work slowly
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Persons experiencing a hypomanic episode are busy, active, and involved. They have energy and are always on
the go. They are always planning and doing things. Others notice their energy levels and mood changes. In
many ways, the behavior of a patient in the manic phase is the opposite of that of a person in the depressed
phase. Patients experiencing the manic phase are hyperactive and might be hypervigilant. They are restless,
energized, and active. They talk and act fast. Their attire also reflects the mania: Their clothes might have
been put on in haste and are disorganized. Alternately, their garments are often too bright, colourful, or garish.
These individuals stand out in a crowd, because their dress frequently attracts attention.
51. What major findings did you find in mood of Bipolar disorder patient in depressed episode?
I. Sadness dominates
II. Irritable mood
III. Always Hopeless & Helpless
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In persons experiencing a depressed episode, sadness dominates the affect. These individuals feel sad, depressed,
lost, vacant, and isolated. The "2 Hs" hhopeless and hhelpless often accompany their mood. When in the
presence of such patients, one comes away feeling sad and down.
52. What major findings did you find in mood of Bipolar disorder patient in hypo-manic episode?
I. Up & Irritable mood
II. Joyous mood
III. Sad mood & down
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
In persons experiencing a hypomanic episode, the mood is up, expansive, and often irritable.
53. What major findings did you find in Mood of Bipolar disorder patient in manic episod e?
I. Joyous & Jubilant
II. Sometimes irritable
III. Always sad
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In persons experiencing a manic episode, the mood is inappropriately joyous, elated, and jubilant. These
individuals are euphoric. They also may demonstrate annoyance and irritability, especially if the mania has
been present for a significant length of time.
54. What major findings did you find in Mood of Bipolar disorder patient in mixed episode?
I. Depression only
II. Mania only
III. Both depression & mania
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
55. What is the effect of depressed episode on thought content of Bipolar disorder individual?
I. Negative thoughts
II. Positive thoughts
III. Suicidal thoughts
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Patients experiencing a depressed episode have thoughts that reflect their sadness. They are preoccupied with
negative ideas and nihilistic concerns, and they tend to "see the glass as half empty." They are likely to focus on
death and morbid persons, and many think about suicide.
56. What is the effect of hypo-manic episode on thought content of Bipolar disorder individual?
I. Forward thinking
II. Positive thinking
III. Negative thinking
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Patients experiencing a hypomanic episode are optimistic, forward thinking, and have a positive attitude.
57. What is the effect of manic episode on thought content of Bipolar disorder individual?
I. Optimistic thinking
II. Negative thinking
III. Rapid ideas & thoughts
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Patients experiencing a manic episode have very expansive and optimistic thinking. They may be excessively
self-confident or grandiose, often have a very rapid production of ideas and thoughts, perceive their minds as
being very active, and see themselves as being highly engaging and creative. These individuals are highly
distractible and quickly shift from one person to another.
58. What is the effect of mixed episode on thought content of Bipolar disorder individual?
I. Depressive thoughts
II. Euphoric thoughts
III. Lie between depression & euphoria
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Patients experiencing a mixed episode can oscillate dramatically between depression and euphoria, and they
often demonstrate marked irritability.
59. What are two forms of major depression?
I. With psychosis
II. Without psychosis
III. With illusions
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Two forms of a major depression are described, one with psychotic features and the other without. With
psychosis, the patient experiences delusions and hallucinations that are either consistent or inconsistent with the
e
or she is utterly worthless and should live in total deprivation and degradation. Hence, the delusional content
remains consistent with the depressed mood. Some patients experience delusions that are inconsistent with the
depression, such as paranoia or persecutory delusions
60. Which of the following is not experienced by individual with hypo-manic episodes?
I. Hallucinations
II. Manic syndromes
III. Delusions
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
By definition, patients experiencing a hypomanic episode do not experience hallucinations, although milder
manic syndromes may be accompanied by such symptoms.
61. Which of the following has greater risk for suicidal attempt?
I. Patient with depressive episode
II. Patient with manic episode
III. Patient with hypo-manic episode
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Patients experiencing a depressed episode have a very high rate of suicide. They are the individuals who attempt
and succeed at killing themselves. Query patients to determine if they have any thoughts of hurting themselves
(suicidal ideation) and any plans to do so. The more specific the plan, the higher the danger.
62. Which individual has been found with increased risk for suicide?
I. Men
II. Women
III. Children
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Dubovsky has reported that the highest lifetime suicide risk (17.08%) is in men with bipolar disorder and
deliberate self-harm
63. What is the effect of hypo-manic episode on patient behavior?
I. Irritable
II. Aggressiveness
III. Positive behavior
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Patients who are hypomanic frequently show evidence of irritability and aggressiveness. They can be pushy and
impatient with others.
64. What is the effect of manic episode on patient behavior?

I. Intolerance with others
II. Violent
III. Non-violent
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Persons experiencing a manic episode can be openly combative and aggressive. They have no patience or
tolerance for others, and they can be highly demanding, violently assertive, and highly irritable. The homicidal
element is particularly likely to emerge if these individuals have a delusional content to their mania. These
individuals act out of the grandiose belief that others must obey their commands, wishes, and directives. They
may become violent toward those who do not comply with their demands.
65. Which of the following has greater risk of violence than other?
I. Bipolar disorder
II. Anxiety
III. Schizophrenia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Moreover, the evidence suggests that the risk of violence is greater in those with bipolar disorder (particularly
during the manic phase) than in those with schizophrenia
66. What is the effect of depressive episode on patients judgment?

I. Depression dims their judgment
II. Overactive in performing tasks
III. Forget to pay bills
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In persons experiencing a depressive episode, the depression clouds and dims their judgment and colors their
insights. They fail to make important plans/actions, because they are so down and preoccupied with their own
plight. These individuals see no tomorrow; therefore, planning for it is difficult. Frequently, persons in the
middle of a depression have done things such as forgetting to pay their income taxes. At that time, they have
little insight into their behavior. Often, others have to persuade them to seek therapy because of their lack of
insight.
67. What is the effect of hypo-manic episode on patients judgment?
I. Over involved in tasks
II. Down & forget to pay bills
III. They see themselves productive
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Persons experiencing a hypomanic episode generally act expansively and may demonstrate poor judgment by
taking on too many tasks or becoming overinvolved. Often, their distractibility impairs their judgment, and
they have little insight into their driven qualities. They see themselves as productive and conscientious, not as
hypomanic.
68. What is the effect on patients memory suffering from Bipolar disorder?
I. They remember & recognize events ,people
II. Memory is severely effected
III. On later stage memory is effected only
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Impairments in orientation and memory are seldom observed in patients with bipolar disorder unless they are
very psychotic. They know the time and their location, and they recognize people. They can remember
immediate, recent, and distant events. In some cases of hypomanic and even manic episodes, their ability to
recall information can be extremely vivid and expanded.
69. Which of the following disorders are common in patient with Bipolar disorder?
I. CVS disorders
II. Endocrine disorders & obesity
III. Respiratory disorders
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
As Fagiolini pointed out, patients with bipolar disorder have a high incidence of endocrine disorders,
cardiovascular disorders, and obesity,[69] and these factors must be considered when medications are prescribed
70. Why is it necessary to perform laboratory tests?

I. Because certain medications are also responsible for depression
II. Because certain other disease are also responsible for depression
III. Certain blood levels can predict the severity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Third, because bipolar illness is a lifelong disorder, performing certain baseline studies is important to establish
any long-term effects of the medications.
71. Which of the following infectious disease can also produce depression in patients?
I. Hepatitis
II. Encephalitis
III. Bronchitis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
A number of infections, especially chronic infections, can produce a presentation of depression in the patient.
An encephalitis can dramatically manifest as changes in mental status and, in rare situations, present with
bipolar features.
72. Which of the following tests are essential for differential diagnosis?
I. Complete blood count & ESR
II. Glucose & urea level
III. Carbohydrate level
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Complete blood count

Erythrocyte sedimentation rate
Fasting glucose
Electrolytes
Proteins
Thyroid hormones
Creatinine and blood urea nitrogen
Liver and lipid panel
73. Complete blood count is necessary to rule out which of the following disease?
I. Jaundice
II. Anemia
III. Malaria
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
A complete blood count (CBC) with differential is used to rule out anemia as a cause of depression in bipolar
affective disorder, or manic-depressive illness (MDI)
74. Why is it necessary to check the blood levels after anti-convulsants administration?
I. Because they cause jaundice
II. Because they suppress the bone marrow
III. Because they cause gastric bleeding
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Certain anticonvulsants, may depress the bone marrow hence the need to check the red blood cell (RBC) and
white blood cell (WBC) counts for signs of bone marrow suppression.
75. What is the effect of lithium on blood levels?

I. Reversible increase in WBC count
II. Reversible increase in RBC count
III. Reversible increase in platelets
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Lithium may cause a reversible increase in the WBC count.

76. Why is it necessary to carry out ESR of Bipolar disorder individual?
I. To detect any infection
II. To detect any lupus
III. To detect any tumor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The erythrocyte sedimentation rate (ESR) is determined to look for any underlying disease process such a lupus
or an infection. An elevated ESR often indicates an underlying disease process.
77. Why glucose monitoring is important in Bipolar disorder patient?

I. To rule out diabetes
II. To rule out heart problems
III. Some anti-psychotics are associated with irregular glucose level
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In some cases, a fasting glucose level is indicated to rule out diabetes. In addition, atypical antipsychotics have
been associated with weight gain and problems with blood glucose regulation in patients with diabetes,
therefore, a baseline fasting glucose should be obtained.
78. Why is it necessary to check the sodium levels in Bipolar disorder individual?
I. Low sodium levels cause lithium toxicity
II. Lithium effects electrolyte level
III. All anti-psychotics effect Na levels
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Serum electrolyte concentrations are measured to help diagnose electrolyte problems, especially with sodium,
that are related to depression. Treatment with lithium can lead to renal problems and electrolyte problems, and
low sodium levels can lead to higher lithium levels and lithium toxicity. Hence, in screening candidates for
lithium therapy as well as those on lithium therapy, checking electrolytes is indicated.
79. Why is it necessary to check serum calcium in Bipolar disorder patient?

I. To diagnose hyper- or hypo-calcemia associated with hyper-parathyroidism
II. Calcium levels also produce depression
III. Calcium is associated with bipolar disorder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Serum calcium is assessed to diagnose hypercalcemia and hypocalcemia associated with mental status changes
(eg, hyperparathyroidism). An elevated calcium blood level can cause depression or mania.
Hyperparathyroidism, as evidenced by an elevated calcium blood level, produces depression. Certain
antidepressants, such as nortriptyline, affect the heart; therefore, checking calcium levels is important
80. Why is it necessary to detect Protein levels in Bipolar disorder individual?
I. Depression decrease food intake hence lowers serum protein levels
II. To detect other causes of hypoproteinemia
III. Increase of dose of drug is required in case of hypo-proteinemia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Low serum protein levels found in patients who are depressed may be a result of not eating. Such low levels
increase the availability of certain medications, because these drugs have less protein to which to bind.
81. Why thyroid tests are necessary in Bipolar disorder patient?

I. To rule out hypothyroidism which may be cause of mania
II. To rule out hyperthyroidism which may be cause of depression
III. For differential diagnosis only
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Thyroid tests are performed to rule out hyperthyroidism (mania) and hypothyroidism (depression). Treatment
with lithium can cause hypothyroidism, and hypothyroidism may cause rapid cycling of mood, especially in
women.
82. Which of the following hormone is associated with increased levels in Bipolar disorder?
I. T3
II. T4
III. Both T3 &T4
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
In a study to assess the relationship between bipolar affective disorder and thyroid dysfunction, Krishna et al
found that elevated T3 hormone had a statistically significantly association with bipolar disorder. [71] In fact,
patients with bipolar disorder were 2.55 times more commonly associated with thyroid dysfunction than
individuals without bipolar disorder
83. What is the effect of lithium on kidney function?

I. Creatinine levels decrease
II. Blood urea nitrogen increases
III. Creatinine levels increases
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Kidney failure can present as depression. Treatment with lithium can affect urinary clearances, and serum
creatinine and blood urea nitrogen (BUN) levels can increase; however, other signs and symptoms of kidney
failure will appear first. Carefully and regularly monitor renal function.
84. Why is it necessary to conduct lipid profile of patient with bipolar disorder?
I. Antis-psychotics results in hypo-triglyceridemia
II. Anti-psychotics results in hyper-triglyceridemia
III. Higher lipid content increase the severity of disorder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Anti-psychotics agents have also been associated with changes in patients lipid profiles, potentially resulting in
dyslipidemia (e.g., hypertriglyceridemia), as well as liver damage/dysfunction.
85. Urine Copper level testing is done to rule out which of the following in bipolar disorder patient?
I
II. Wilson disease
III. Celiac disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Urine copper level testing may be performed to rule out Wilson disease, which produces mental changes. Wilson
disease is a rare condition that is easily missed.
86. Anti-nuclear antibody test is used to rule out which of the following?
I. Infection
II. Lupus
III. Tumor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Antinuclear antibody testing is used to rule out lupus
87. Why HIV test is performed in Bipolar disorder patient?

I. For differential diagnosis
II. AIDS also cause changes in mental status
III. AIDS also cause depression
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Testing for human immunodeficiency virus (HIV) may be helpful. Acquired immunodeficiency syndrome
(AIDS) causes changes in mental status, including dementia and depression.
88. Why Alcohol screening is necessary in Bipolar disorder patient?
I. Alcohol abuse cause mania
II. To rule out liver dysfunctions
III. Alcohol abuse cause depression
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Alcohol abuse and abuse of a wide variety of drugs can present as either mania or depression. For example,
speed (i.e., amphetamines) and cocaine abuse can present as a mania-like disorder, and barbiturate abuse can
present as a depression like disorder.
89. Why MRI is performed in Bipolar disorder patients?

I. To rule out any other medical etiology
II. To rule out Schizophrenia
III. To detect hyperintensity in temporal lobes
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The total value of performing magnetic resonance imaging (MRI) in a patient with bipolar affective disorder,
or manic-depressive illness (MDI), remains unclear; however, a couple of reasons do exist for performing an
imaging study. Because manic-depressive illness is a lifelong disease, a strong battery of studies rules out any
other medical etiology and establishes a baseline. Some investigators report that patients with mania
demonstrate hyperintensity in their temporal lobes
90. Why ECG is performed in bipolar disorder patient?
I. Heart is also effected in Bipolar disorder patient
II. Lithium can lead to inversion of T-waves
III. MI is associated with depression
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Many of the antidepressants, especially the tricyclic agents and some of the antipsychotics, can affect the heart
and cause conduction problems. Lithium also can lead to changes such as reversible flattening or inversion of
T waves on electrocardiography (ECG). In older patients with bipolar affective disorder, or manic-depressive
illness (MDI), on lithium or tricyclic antidepressant therapy, a pretreatment ECG is important.
91. Why EEG is essential in Bipolar disorder patient?

I .To rule out any Tumor
II .To rule out any neurological problem
III .To rule out headache
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Generally, routine electroencephalography (EEG) is unnecessary in the evaluation of bipolar affective disorder,
or manic-depressive illness (MDI). However, some reasons for ordering EEG in patients with bipolar illness
may be appropriate and include the following:
 EEG provides a baseline and helps to rule out any neurologic problems; use this test to rule out a
seizure disorder and brain tumor
 If electroconvulsive therapy (ECT) is contemplated, an EEG may be helpful; EEG monitoring during
ECT is used to determine the occurrence and duration of seizure
 Some studies have shown that abnormalities in EEG findings have been indicative of anticonvulsant
effectiveness; specifically, an abnormal EEG finding may predict the response to valproate
92. Which of the following is true statement?
I. Antidepressants also cause seizures
II. EEG is used in bipolar patients to determine the duration of seizure
III. EEG is performed to find the inversion of t-waves
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Some patients may have seizures when on medications, especially antidepressants; in addition, lithium can
cause diffuse slowing throughout the brain
93. Which of the following genes show epistatic interaction?

I. MAFD4
II. MAFD5
III. MAFD6
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
It has been concluded that the candidate gene in the MAFD5 locus shows epistatic interaction with the MAFD6
risk locus.
94. Which of the following is associated with childhood or adult-onset psychiatric disorder?
I. MAFD5 gene
II. Single-nucleotide polymorphism
III. COMT gene
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The Cross-Disorder Group of the Psychiatric Genomics Consortium published results of their large GWAS
study of psychiatric disorders, reporting that specific single-nucleotide polymorphisms (snps) are associated with
range of childhood- or adult-onset psychiatric disorders.[23] The study comprised a combined sample of 33,332
persons with schizophrenia, bipolar disorder, major depression, attention deficit disorder and autism spectrum
disorders and 27,888 controls of European ancestry
95. What is the effect of Psychotropic treatments on myelination of neurons?

I. Improves plasticity
II. Remove myelin membrane
III. Repair myelination pathway
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Of note, many widely used psychotropic treatments including those for bipolar disorder share signalling
pathways that affect myelination, its plasticity, andrepair;such pathways may promote myelination of
neurons.[39]
96. Which of the following share similar biological features?
I. Major depression
II. Anxiety
III. Schizophrenia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Gene expression and neuroimaging studies of persons with schizophrenia and major depression also demonstrate
similar findings, indicating that mood disorders and schizophrenia may share some biologic underpinnings,
possibly related to psychosis. These types of data may also lead to the future revision of psychiatric diagnostic
manuals based on a new understanding of the etiology of these disorders.
97. Which of the following brain part is affected by bipolar disorder?

I. Amygdala
II. Hippocampus
III. Cerebrum
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
These findings suggest alteration of hippocampal interneurons in patients with bipolar disorder that might lead
to hippocampal dysfunction
98. Which of the following is true regarding bipolar pathophysiology?
I. Cell damage
II. Memory loss
III. Neuronal death
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Neuroimaging studies of individuals with bipolar disorder or other mood disorders also suggest evidence of cell
loss or atrophy in these same brain regions. Thus, another suggested cause of bipolar disorder is damage to cells
in the critical brain circuitry that regulates emotion. According to this hypothesis, mood stabilizers and
antidepressants are thought to alter mood by stimulating cell survival pathways and increasing levels of
neurotrophic factors to improve cellular resiliency.
99. What is the effect of mood disturbance on Patient?

I. Impairment at work
II. Results in substance abuse
III. Danger to patient
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The mood disturbance is sufficient to cause impairment at work or danger to the patient or others. The mood
is not the result of substance abuse or a medical condition.
100. Which of the following is more common in patients presenting with Bipolar symptoms?
I. Depressive episodes
II. Manic episodes
III. Mixed symptoms
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The mixed symptomatology is quite common in patients presenting with bipolar symptomatology. This often
causes a diagnostic dilemma[62] and has prompted a revision to the definition of bipolar disorder in DSM-5
Drugs and pharmacology (questions-100)
1. Which of the following factors affect treatment of bipolar disorder?

I. Phase of episode
II. Duration of phase
III. Severity of that phase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The treatment of bipolar affective disorder, or manic-depressive illness (MDI), is directly related to the phase
of the episode (i.e., depression or mania) and the severity of that phase.
2. Which treatment option is best for extremely depressed individuals?

I. Outpatient treatment
II. Inpatient treatment
III. Both
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
A person who is extremely depressed and exhibits suicidal behavior requires inpatient treatment.
3. Which treatment option is best for moderately depressed individuals?
I. Outpatient treatment
II. Inpatient treatment
III. Both
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
In contrast, an individual with a moderate depression who still can work would be treated as an outpatient
4. Which of the following should be discontinued to prevent manic or hypo-manic or mixed episode?
I. Anti-depressants
II. Anxiolytics
III. Barbiturates
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
It -manic, or
mixed manic episode. In such patients, discontinue antidepressants or other mania-inducing agents. However,
antidepressants known to have associated discontinuation syndromes should be tapered over several weeks.
5. What are the treatment options for bipolar depression?
I. Anti-psychotics
II. Psycho-social intervention
III. Exercise
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Evaluate and closely monitor patients with bipolar depression for the risk for mood destabilization or switching
to mania and for the presence of emergent symptoms following initiation of pharmacotherapy for a depressive
episode. Initiate an anti-psychotic agent in patients with bipolar depression with psychotic features, and
consider psycho social interventions
6. What are the possible Psychotherapy strategies?

I. Cognitive behavioral therapy & IPSRT
II. Family focused therapy
III. Exercise
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Psychotherapy strategies such as cognitive behavioral therapy [CBT], interpersonal and social rhythm therapy
[IPSRT], family focused therapy; chronic care model-based intervention
7. Which of the following patient is more responsive to Psychotic treatment?
I. Patient experiencing few manic episodes
II. Patient experiencing more than 5 episodes
III. Patients having no Previous manic episode
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Bipolar patients who experienced fewer previous mania episodes (1-5) displayed a twofold increase in the
treatment response rate to olanzapine relative to those who had already experienced more than 5 previous
episodes
8. Which is the best possible approach if patient is not responsive to medications?

I. Electrocardiography
II. Electroconvulsive therapy
III. Electroencephalography
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
. If the patient is in a depressed or manic phase and is not responding to medications, transfer the patient to a
facility where electroconvulsive therapy (ECT) can be administered.
9. What are the indications for inpatient treatment in person with bipolar affective disorder?
I. Total loss of control
II. Danger to self & others
III. Illusions
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The indications for inpatient treatment in a person with bipolar affective disorder, or manic-depressive illness
(MDI), include the following:
 Danger to self
 Danger to others
 Delirium
 Marked psychotic symptoms
 Total inability to function
 Total loss of control (eg, excessive spending, undertaking a dangerous trip)
 Medical conditions that warrant medication monitoring (eg, substance withdrawal/intoxication)
10. What are the benefits of partial hospitalization in Bipolar patients?

I. It offers a bridge to return to work
II. Provides interpersonal support
III. Provide mental support
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
For example, a patient with severe depression who has thoughts of suicide but no plans to act upon them and
who has a high degree of motivation can get well when given a great deal of interpersonal support, especially
during the day, and with the help of a very involved and supportive family. The family needs to be home every
Partial hospitalization also offers a bridge to return to work. Returning directly to work is often difficult for
patients with severe symptoms, and partial hospitalization provides support and interpersonal relationships.
11. What are four major goals of outpatient treatment in bipolar affective disorder patient?
I. Identify Stress handle them & monitoring of medications
II. Provide education & Psychotherapy
III. Provide education & maintain therapeutics alliance
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Outpatient treatment for patients with bipolar affective disorder, or manic-depressive illness (MDI), has 4 m
Look at areas of stress and find ways to handle them
Monitor and support the medication:
Develop and maintain the therapeutic alliance:
Provide education
12. What are the benefits of Psychotherapy in bipolar disorder patient?

I. Improve quality of life
II. Cure disorder completely
III. Decrease relapse rate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Psychotherapy helps patients with bipolar disorder but does not cure the disorder by itself. When Schottle and
colleagues looked at psychotherapy for patients, family, and caregivers, they found that although results were
heterogeneous, most studies demonstrated relevant positive results in regard to decreased relapse rates, improved
quality of life, increased functioning, or more favourable symptom improvement
13. On what factor medication for bipolar affective disorder patient is selected?
I. Severity of disorder
II. Stage of disorder
III. Cause of disorder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Appropriate medication depends on the stage of the bipolar affective disorder, or manic-depressive illness
(MDI), the patient is experiencing.
14. Which of the following is solely indicated for manic episode of bipolar disorder?
I. Lamotrigine
II. Olanzapine
III. Valproate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Valproate Depakote
15. Which of the following is solely indicated for depressive episode?

I. Carbamazepine extended release
II. Olanzapine/fluoxetine combination
III. Valproate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Olanzapine/fluoxetine combination
16. What is the first line therapy for bipolar patient after 1 st episode?
I. Quetiapine or Olanzapine
II. Carbamazepine& lamotrigine
III. Valproate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
First, in a patient with bipolar depression who is not currently being treated with a mood-stabilizing agent (de
novo depression, first or subsequent episode), options include quetiapine or olanzapine, with carbamazepine
and lamotrigine as alternatives.
17. Which of the following class of drugs are used for short term use in Bipolar patient?
I. Anti-psychotics
II. Anxiolytics
III. Anti-depressants
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Antidepressants are options for short-term use, but it remains controversial as to whether it is better to
administer them in combination with mood-stabilizing agents or as monotherapy.
18. Which of the following is the mood stabilizing agent?

I. Valproate
II. Lithium
III. Carbamazepine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Mood-stabilizing agent (appropriate dose, good compliance) such as lithium
19. Which of the following is the best option for Bipolar patient if the patient is previously treated
with lithium?
I. Lamotrigine
II. Olanzapine
III. Carbamazepine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Second, if the patient is already optimally treated with a mood-stabilizing agent (appropriate dose, good
compliance) such as lithium, an option would be lamotrigine
20. Which of the following is false regarding Anti-depressant use in Bipolar disorder patient?
I. There is no extra benefit from anti-depressant
II. More use of antidepressant ,the less responsive towards treatment
III. They are used as first line therapy in bipolar patients
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
No evidence suggests additional benefit from antidepressants if a patient is already being treated with a mood
stabilizer, but this often tried in practice.
One cautionary note of interest: Post and colleagues found that the more different antidepressant trials the
patient with bipolar disorder has received, the less responsive they become to treatment.[
21. Which of the following agent is approved by FDA for treatment of acute agitation in bipolar
type 1?
I. Lamotrigine
II. Valproate
III. Inhaled loxapine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Inhaled loxapine (Adasuve) is the first non injectable therapy approved by the FDA to treat acute agitation
associated with schizophrenia and bipolar disorder type I (BPI).
22. Which of the following therapy is best for treating severe manic or mixed episodes?
I. Anti-psychotic agent
II. Anti-manic medication
III. Combination of both
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Combined therapy with an anti psychotic agent and another anti-manic medication is recommended for
patients with severe mania or mixed episodes, with or without psychotic features
23. Which of the following can be used for treating severe manic episode?
I. Olanzapine or quetiapine
II. Aripiprazole
III. Lamotrigine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Severe mania: olanzapine, quetiapine, aripiprazole, risperidone, or possibly ziprasidone;
24. Which of the following can be used for treating severe mixed episode?
I. Risperidone
II. Haloperidol
III. Valproate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Severe mixed episode: aripiprazole, olanzapine, risperidone, haloperidol or possibly quetiapine or ziprasidone
25. Which of the following drug is associated with serious side effects?
I. Olanzapine
II. Aripiprazole
III. Olanzapine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Despite the serious side effects associated with clozapine, the Veterans Administration/Department of Defense
(VA/dod) suggest this drug may be added to existing medications if it was successfully used previously for severe
mania or mixed episodes or if other antipsychotic agents are unsuccessful
26. What is the optimal therapeutic range of lithium?
I. 0.6-1.2mEq/L
II. 0.5mEq/L
III. 0.6-0.8mEq/L
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The therapeutic range of lithium is a serum trough concentration between 0.6-1.2 meq/L
27. Lithium is recommended in which of the following episode of bipolar?

I. Depressive episode
II. Manic episode
III. Mixed episode
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Initiate lithium, valproate, carbamazepine, aripiprazole, olanzapine, quetiapine, risperidone, or ziprasidone

in patients with mania
28. Which of the following should be included as an initiative therapy in patients with mix ed episode
of bipolar disorder?
I. Valproate or olanzapine
II. Carbamazepine
III. Lamotrigine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In patients with mixed episodes, initiate therapy with valproate, carbamazepine, aripiprazole, olanzapine,
risperidone, or ziprasidone.
29. Which of the following should be included as an initiative therapy in patients with episode of
manic or mixed bipolar disorder?
I. Clozapine
II. Oxcarbazepine
III. Lithium
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Consider clozapine, haloperidol, or oxcarbazepine in patients with mania or mixed episodes, and consider
lithium or quetiapine in those with mixed episodes
30. Which of the following is not recommended to be used to treat patients with mania or mixed
episodes?
I. Lamotrigine
II. Topiramate
III. Oxcarbazepine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
It is not recommended that topiramate, lamotrigine, and gabapentin be used to treat patients with mania or
mixed episodes
31. Which of the following medications are recommended for acute treatment of depression in BP1?
I. Olanzapine-fluoxetine combination
II. Lamotrigine
III. Oxcarbazepine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Medications having the strongest evidence for efficacy for the acute treatment of depression in BPI are the
olanzapine-fluoxetine combination, quetiapine, and lamotrigine
32. Which of the following is used as first line therapy in bipolar depressive episodes?
I. Lithium or Lamotrigine
II. Valproate
III. Quetiapine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The VA/dod considers first-line monotherapy in adult patients with bipolar depression to include quetiapine,
lamotrigine, or lithium
33. Which of the following is used as second line therapy in bipolar depressive episodes?
I. Olanzapine
II. Fluoxetine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Second-line pharmacotherapy includes the combination of olanzapine/fluoxetine owing to its side-effect profile
of weight gain, diabetes risk, and hypertriglyceridemia
34. Which of the following agents are not used in depressive episodes?
I. Lithium
II. Valproate
III. Risperidone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Although the VA/dod found insufficient evidence for or against the use of valproate, carbamazepine,
topiramate, risperidone, ziprasidone, or clozapine for managing bipolar depression,
35. What is the possible approach ,if mono-therapy fails in depressive episodes?
I. Lithium only
II. Lamotrigine only
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
In patients whose bipolar depression is unresponsive to monotherapy, consider the combination of lithium with
lamotrigine
36. Which of the following combination of drug with anti-depressants triggers manic symptoms?
I. Selective serotonin re-uptake inhibitors
II. MAOI
III. Barbiturates
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Alternatively, consider short-term augmentation of antidepressant agents with a selective serotonin reuptake
inhibitor (SSRI), serotonin norepinephrine reuptake inhibitor (SNRI), bupropion, and monoamine oxidase
inhibitor (MAOI); patients using this treatment strategy must be closely monitored for triggering of manic
symptoms
37. Which of the following are ADRS of Olanzapine?
I. Weight gain & Diabetes
II. Weight loss
III. Hypertriglyceridemia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Olanzapine/fluoxetine owing to its side-effect profile of weight gain, diabetes risk, and hypertriglyceridemia
38. What are the alternatives if therapeutic concentration of medications are not known?
I. Increase the dose till symptomatic improvement
II. Toxicity level reached
III. Manufacturers max. dose limits reached
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
For medications without known therapeutic plasma concentrations, increase the dose until symptomatic
improvement, p
39. Which of the following is the benefit of Lithium?

I. Cardioprotective
II. Neuroprotective
III. Cerebro protective
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
A study by Bauer et al suggested that lithium may also have a neuroprotective role.
40. What are the side effects associated with Lithium?
I. Reduced urinary concentrating ability
II. Hyperparathyroidism
III. Weigh loss
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
This agent is also associated with increased risk of reduced urinary concentrating ability, hypothyroidism,
hyperparathyroidism, and weight gain.
41. Which levels should be monitored in case of lithium induced hyper-parathyroidism?

I. Sodium levels
II. Calcium levels
III. Potassium levels
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The consistent finding of a high prevalence of hyperparathyroidism should prompt physicians to check patient
calcium concentrations before and during treatment.
42. Atypical anti-psychotics are increasingly used for the treatment of which of the following?
I. Acute depression
II. Acute mania
III. Mood stabilization
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Atypical antipsychotics are increasingly being used for the treatment of both acute mania and mood
stabilization.
43. Which of the following are best suitable treatment options for acute depressive episode?
I. Anti-depressant
II. Anti-psychotic
III. Electroconvulsive therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The broad range of antidepressants and ECT are used for an acute depressive episode (ie, major depression).
44. Electroconvulsive therapy is indicated mostly in which conditions?

I. Severe or treatment-resistant mania
II. Pregnant women with severe mania
III. Severe depression
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
However, ECT may also be considered for patients with severe mania or treatment-resistant mania, those who
prefer ECT, and pregnant women with severe mania
45. Which of the following is true regarding use of NMDA receptor antagonist?
I. May be helpful in short term treatment of mania
II. May be helpful in short term treatment of depression
III. Effect disappeared after 4 days
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Increasingly, the role of glutamate in mood disorders is being researched, and experimental evidence shows that
the NMDA receptor antagonist ketamine may be helpful in short-term treatment of depression, even in the
context of bipolar disorder.However, it is important to note that the benefit of such treatment disappeared after
4 days.
46. Which of the following class of drugs are more effective compared to other?
I. Anti-depressant
II. Mood-stabilizing drugs
III. Anti-psychotics
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Clinical experiences have shown that patients with bipolar disorder have fewer episodes of mania and depression
when treated with mood-stabilizing drugs.
47. Which property makes mood-stabilizing drugs superior to other class of the drugs?
I. Stabilize the patients mood
II. Rapid action
III. Damp extremes of mania or depression
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
These med
extremes of mania or depression
48. Which of the following drugs are included in class of Atypical anti-psychotics?
I. Quetiapine or Ziprasidone
II. Aripiprazole
III. Lithium
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Atypical antipsychotics (including ziprasidone, quetiapine, risperidone, aripiprazole, olanzapine, and

asenapine) are also now frequently used to stabilize acute mania
49. Which of the following class is useful in maintenance of bipolar disorder?

I. Anti-psychotic
II. Mood-stabilizer
III. Anti-depressant
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The role of mood stabilizers and antipsychotic medications in maintaining patients with bipolar disorder is
well documented,[92] as is the use of long-acting antipsychotics to help with the maintenance phase.
50. Which of the following drugs are combinely used in maintenance of Bipolar disorder?
I. Lithium
II. Lamotrigine
III. Lorazepam
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Treatment of patients with bipolar disorder considered both lamotrigine and lithium to have substantial utility
in the maintenance treatment of patients with bipolar disorder
51. Which of the following drugs show poor maintenance therapy in bipolar disorder?
I. Lithium
II. Valproate
III. Oxcarbazepine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Note that Popovic et al indicated the respective polarity indices for valproate and oxcarbazepine were
potentially unreliable owing to the failure of their maintenance trials.[93]
52. Which of the following mono-therapy is more effective in treating manic or mixed episodes?
I. Olanzapine mono-therapy
II. Haloperidol mono-therapy
III. Divalproex mono-therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
.In several randomized, double-blind, controlled studies, olanzapine monotherapy was significantly more
effective in treating manic or mixed episodes than haloperidol[96] or divalproex monotherapy
53. Which of the following is more effective in manic or mixed disorder?

I. Lithium alone
II. Olanzapine with lithium
III. Risperidone with lithium
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The adjunctive use of olanzapine with divalproex or lithium,[98] or of risperidone with divalproex or lithium,
was also significantly more effective than divalproex or lithium alone
54. Which of the following drug is more effective for the first-line treatment of childhood mania?
I. Lithium
II. Olanzapine
III. Risperidone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
There is evidence that risperidone may be the best first-line treatment for childhood mania, as shown in a
randomized controlled trial with patients aged 6 to 15 years with a Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition, Text Revision, (DSM-IV-TR) diagnosis of BPI (manic or mixed phase).
55. What are the risks associated with Lamotrigine?

I. Anemia
II. Aseptic meningitis
III. Neutropenia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
, the FDA announced that lamotrigine carries a risk of aseptic meningitis

56. What are the side effects associated with Poly-therapy in Bipolar patients?
I. Dry mouth
II. Constipation
III. Diarrhea
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Brooks et al concluded that although poly therapy was fairly common in bipolar disorder, it was also associated
with increased side effects (eg, dry mouth, sexual dysfunction, and constipation) and increased health service
use (almost threefold) but not with improved clinical status or function
57. What is meant by ECT?

I. Electrocardiac therapy
III. Electrocerebral therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Electroconvulsive therapy (ECT

58. In which situations ECT is recommended for bipolar patients?
I. When rapid medical treatment is needed
II. Risks of ECT are less than other treatments
III. No other option is available
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
(ECT) is useful in a number of instances in patients with bipolar affective disorder, or manic-depressive illness
(MDI), such as the following[3] :
 When rapid, definitive medical/psychiatric treatment is needed
 When the risks of ECT are less than that of other treatments
 When the bipolar disorder is refractory to an adequate trial with other treatment strategies
 When the patient prefers this treatment modality
59. Patients with catatonia or food refusal respond to which of the following treatment?
I. Pharmacotherapy
II. Psychotherapy
III. Electroconvulsive therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The 2010 Department of Veterans Affairs/Department of Defense (VA/dod) clinical practice guideline for
management of bipolar disorder indicates ECT is the primary therapy in bipolar disorder patients that present
with psychotic symptoms, catatonia, severe suicidality, food refusal leading to nutritional compromise, or who
have a history of previous positive response to ECT
60. What are the contraindications for use of MAOIs?
I. Pregnancy
II. Restrictions on diet
III. Renal dysfunction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Unless the patient with bipolar affective disorder, or manic-depressive illness (MDI), is on monoamine oxidase
inhibitors (maois), no special diet is required.
61. Why patients taking lithium are advised to take salt in suitable quantity?
I. Increased salt intake lead to reduced lithium levels
II. Reduced salt intake lead to increased toxicity
III. Increased salt leads to decreased excretion rate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Patients should be advised not to make significant changes in their salt intake, because increased salt intake
may lead to reduced serum lithium levels and reduced efficacy, and reduced intake may lead to increased levels
and toxicity.
62. Which of the following symptoms is improved by the use of omega-3?
I. Depressive symptoms
II. Manic symptoms
III. Mixed symptoms
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Although a meta-analysis by Starris et al found strong evidence that bipolar depressive symptoms may be
improved by adjunctive use of omega-3,omega-3 does not improve bipolar mania.
63. Which individuals are encouraged to schedule exercise?

I. Individuals in depressed phase
II. Individuals in manic phase
III. Individuals in mixed phase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Patients in the depressed phase are encouraged to exercise. These individuals should try to develop a regular
daily schedule of major activities, especially times of going to bed and waking up. Propose a regular exercise
schedule for all patients, especially those with bipolar disorder. Both the exercise and the regular schedule are
keys to surviving this illness.
64. Which of the following drug toxicity occurs as a result of Exercise?
I. Valproate toxicity
II. Lithium toxicity
III. Lorazepam toxicity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Increases in exercise level, with increased perspiration, can lead to increased serum lithium levels and lithium
toxicity.
65. What are the complications of bipolar disorder?

I. Suicide
II. Addictions
III. Smoking
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The main complications of bipolar affective disorder, or manic-depressive illness (MDI), are suicide, homicide,
and addictions.
66. According to research which of the following individual is at increased risk for suicide?
I. Black people
II. White people
III. Both equally
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
especially in
white individuals.
67. What are the features of homicidal patients in manic phase?

I. Demanding & violent
II. Grandiose
III. Depressed
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Homicidal patients, often in the manic phase, can be very demanding and grandiose. In this context, they are
angered if others do not immediately comply with their wishes, and they can turn dramatically violent. In
addition, these individuals can become homicidal by acting on delusions.
68. What preventive measures must be adapted for long term treatment of bipolar disorder?
I. Initiation of mood stabilizers
III. Psycho-education for patient & family
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Prevention is the key to the long-term treatment of bipolar affective disorders, , or manic-depressive illness
(MDI), as follows:
 First, use medications such as lithium serve as mood stabilizers
Second, psychoedu
mania and depression

69. What is the minimum duration for re-evaluation of treatment?
I. Every week
II. Every1-2 week for min. of 6 weeks
III. Every month
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Regardless of the pharmacologic regimen chosen in individual patients with acute bipolar mania, hypomania,
or mixed episodes, and those with bipolar depression, re-evaluate for treatment response every 1-2 weeks for a
minimum of 6 weeks.[
70. How full remission is defined in patients with mania?

I. Absence of mania symptoms for 2months
II. Absence of mania symptoms for 4 months
III. Absence of mania symptoms for 6 months
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Full remission is defined in patients with mania as the absence of significant mania symptoms for 2 months;
71. What is the appropriate method for discontinuation of antidepressant?
I. Discontinue at same dose
II. Gradual tapering over 2-4 week period
III. Discontinue when not needed
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Discontinuation should consist of a gradual taper over a minimum 2-4 week period, unless medically
contraindicated
72. Which of the following class of drugs are used for bipolar affective disorder?
I. Mood stabilizer & anti-convulsants
II. Anti-psychotics
III. Anti-epileptics
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Appropriate medication for managing bipolar affective disorder, or manic-depressive illness (MDI), depends
on the stage the patient is experiencing. The choice of agent depends on the presence of symptoms such as psychotic
symptoms, agitation, aggression, and sleep disturbance. Drug categories include mood stabilizers,
anticonvulsants, and antipsychotics
73. What is the mechanism of action of Benzodiazepine?
I. Potentiate effects of GABA
II. Inhibit the effects of GABA
III. Facilitate inhibitory GABA neurotransmission
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
By binding to specific receptor sites, benzodiazepines appear to potentiate the effects of gamma-aminobutyric
acid (GABA) and facilitate inhibitory GABA neurotransmission and the action of other inhibitory
transmitters.
74. Which of the following is intermediate acting benzodiazepine?

I. Diazepam
II. Lorazepam
III. Clonazepam
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Lorazepam is an anxiolytic hypnotic with an intermediate onset of effects and a relatively intermediate half-
life.
75. Which of the following is a long-acting Benzodiazepine?
I. Lorazepam
II. Clonazepam
III. Diazepam
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Clonazepam is a long-acting benzodiazepine that increases presynaptic GABA inhibition and reduces
monosynaptic and polysynaptic reflexes.
76. Which of the following drug is included in mood stabilizer?

I. Lorazepam
II. Diazepam
III. Lithium
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Mood stabilizers
Class Summary
Lithium is the drug commonly used for prophylaxis and treatment of manic episodes.
77. What are the beneficial effects of lithium from following?
I. Preservation of hippocampal volumes
II. Reduced urine concentrating ability
III. Weight gain
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
However, this agent is also associated with an increased risk of reduced urinary concentrating ability,
hypothyroidism, hyperparathyroidism, and weight gain. The consistent finding of a high prevalence of
hyperparathyroidism should prompt physicians to check patient calcium concentrations before and during
treatment.
Lithium is not associated with a significant reduction in renal function in most patients, and the risk of end-
stage renal failure is low.[84] Lithium therapy may serve to protect and preserve the hippocampal volumes,
78. Which of the following drug has anti-suicidal action?

I. Lithium
II. Valproate
III. Lamotrigine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Lithium may also have some anti-suicidal action. A report from lewitka and bauer suggest that lithium may
be an option for patients with affective disorders who are at risk for suicide. However, they caution that lithium
is still a medication that requires careful assessment and monitoring. Patient adherence is essential
79. Which of the following drug should be avoided in pregnant women?
I. Lorazepam
II. Lithium
III. Clonazepam
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Many female patients with bipolar disorder will discontinue their lithium medication when they become
pregnant
80. What is the duration of determination of serum levels of lithium carbonate?

I. Once weekly
II. Twice weekly
III. Thrice weekly
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Serum levels should be determined twice weekly during the acute phase, and until the serum level and clinical
condition of the patient has been stabilized.
81. What is the major action of Anti-convulsants in bipolar affective disorder?
I. Prevention of depression
II. Prevention of mood swings
III. Prevention of suicide
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Anticonvulsants have been effective in preventing mood swings associated with bipolar disorder, especially in
those patients known as rapid cyclers
82. Which of the following are most widely used anti-convulsants?

I. Carbamazepine
II. Oxcarbazepine
III. Lithium
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The most widely used anticonvulsants have been carbamazepine, valproate, and lamotrigine. More recently,
topiramate and oxcarbazepine also are being tried.
83. Which of the following is effective if lithium is not effective?

I. Oxcarbazepine
II. Carbamazepine
III. Lithium
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Carbamazepine is effective in patients who have not had a clinical response to lithium therapy
84. Which of the following has proven effectiveness in preventing mania?
I. Lithium
II. Valproate
III. Carbamazepine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Valproate has proven effectiveness in treating and preventing mania
85. Which of the following is true regarding Lamotrigine?

I. Effective in the treatment of depressed phase
II. Effective in the treatment of manic phase
III. Effective in the treatment of mixed phase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Lamotrigine is an anticonvulsant that appears to be effective in the treatment of the depressed phase in bipolar
disorders. It is used for the maintenance treatment of bipolar I disorder to delay the time to occurrence of mood
episodes
86. Which of the following is not the side effect of Topiramate?

I. Numbness
II. Dizziness
III. Weight gain
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Unlike conventional neuroleptics, topiramate is not associated with weight gain.
87. Which of the following are 2 nd generation Anti-psychotic?
I. Carbamazepine
II. Ziprasidone
III. Asenapine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Antipsychotics, 2nd Generation

Asenapine (Saphris)
Ziprasidone (Geodon)
Paliperidone (Invega)
88. What is the mechanism of action of Asenapine?

I. Antagonism at D2 receptor
II. Antagonism at serotonin receptor
III. Antagonism at both receptor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The efficacy of asenapine is thought to be mediated through a combination of antagonist activity at dopamine
2 and serotonin (5-HT2) receptors.
89. What are the indications of Quetiapine in Bipolar disorder?
I. Acute treatment of manic episodes
II. Acute treatment of mixed episodes
III. Acute treatment of depressed episodes
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Quetiapine is indicated for acute treatment of manic (immediate release and extended release [XR]) or mixed
(XR) episodes that are associated with bipolar I disorder
90. Which of the following can be used in adults or adolescents with bipolar type 1?
I. Quetiapine
II. Risperidone
III. Aripiprazole
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Risperidone can be used in adults and adolescents aged 10-17 years with bipolar I disorder.
91. What is the indication of drug combination of olanzapine-fluoxetine?

I. For acute treatment of manic episodes
II. For acute treatment of depressive episodes
III. For acute treatment of mixed episodes
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The drug combination includes olanzapine, a second-generation antipsychotic, and fluoxetine, a selective
serotonin reuptake inhibitor. This drug is indicated for the acute treatment of depressive episodes associated
with bipolar I disorder in adults. T
92. What is the mechanism of action of Clozapine?

I. D1receptor blocker
II. D2 receptor blocker
III. D3receptor blocker
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Clozapine has an off-label indication for treatment of acute manic episodes associated with bipolar disorder
and treatment of refractory bipolar mania. This agent demonstrates weak D2 receptor and D1 receptor
blocking activity.
93. Which of the following drug is used if patient decline ECT and other medications?
I. Clozapine
II. Aripiprazole
III. Paliperidone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Paliperidone may be used for refractory, moderate to severe mania alone or in combination with lithium or
valproate. This agent is typically reserved for patients who decline electroconvulsive therapy (ECT)
94. What is the mechanism of action of Cariprazine?
I. Partial agonist activity at D2
II. Partial agonist activity at serotonin receptors
III. Partial antagonist activity at D2
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Efficacy could be mediated through a combination of partial agonist activity at central dopamine (D2) and
serotonin 5-HT1A receptors
95. What is the mechanism of action of 1 st generation Anti-psychotics?

I. D2 agonists
II. D2 antagonists
III. D1 agonist
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
First-generation antipsychotics, also known as conventional or typical antipsychotics, are efficacious for treating
both psychotic and nonpsychotic manic and mixed episodes, as well as hypomania. These agents are strong
dopamine D2 antagonists.
96. Which of the following drug is given as inhaled form in Bipolar type 1?
I. Loxapine
II. Lorazepam
III. Carbamazepine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The mechanism of action for loxapine is unknown, but it is theorized to antagonize central dopamine D2 and
serotonin 5-HT2a receptors. The inhaled dosage form is indicated for acute treatment of agitation associated
with schizophrenia or bipolar I disorder in adults.
97. What is the mechanism of action of haloperidol?
I. Blocks D2 receptors
II. Increase dopamine turnover
III. Blocks D1 receptor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
. Haloperidol blocks postsynaptic dopamine receptors (D2) in the mesolimbic system and increases dopamine
turnover by blockade of the D2 somato dendriticauto receptor
98. What is the indication for Chlorpromazine?

I. Treat manic episodes
II. Treat mixed episodes
III. Treat depressed episodes
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Chlorpromazine is used to treat manic and mixed episodes in patients with bipolar I disorder.
99. Which of the following is Anti-Parkinson agent?
I. Aripiprazole
II. Chlorpromazine
III. Pramipexole
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Antiparkinson agents, dopamine agonists

Pramipexole (mirapex, mirapex er)
100. What is the mechanism of action of Pramipexole?

I. D1 receptor agonist
II. D2 receptor agonist
III. D3 receptor agonist
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Pramipexole is a non-ergot, full dopamine agonist that binds to D2 and D3 dopamine receptors
Schizophrenia
1. What is mean by Schizophrenia?

I. A progressive disease of the nervous system marked by tremor, muscular rigidity, and slow, imprecise
movement.
II. A brain disorder affecting people thoughts, feelings& perceptions regarding the world.
III. A brain disorder that slowly destroys memory and thinking skills.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
ANSWER: B
Schizophrenia is a brain disorder that affects how people think, feel, and perceive the world.
2. Which of the following are the major symptoms of Schizophrenia?

I. Auditory hallucinations
II. Delusions
III. Illusions
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The hallmark symptom of schizophrenia is psychosis, such as experiencing auditory hallucinations (voices) and
delusions (fixed false beliefs).
3. Which of the following is true about positive symptoms of Schizophrenia?
I. Patient experience auditory hallucinations, delusions& disorganized speech.
II. Patient experience insomnia & muscle rigidity.
III. Patient experience loss of interests, drive& decrease emotional range.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
 Positive symptoms - Psychotic symptoms, such as hallucinations, which are usually auditory; delusions;
and disorganized speech and behavior
4. Which of the following is true about negative symptoms of Schizophrenia?

I. Mood swings & hallucinations
II. Emotionally weak, loss of interests & drive
III. Neurocognitive deficits
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Negative symptoms - Decrease in emotional range, poverty of speech, and loss of interests and drive; the person
with schizophrenia has tremendous inertia
5. What are the diagnostic parameter of Schizophrenia set by Diagnostic and Statistical Manual of
Mental Disorders, Fifth Edition, (DSM-5) ?
I. Either the patient is associated with 1 or 2 of positive symptoms.
II. Either the patient is associated with 1 or 2 of negative symptoms.
III. At least 1 of Cognitive symptoms .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5), to meet the
criteria for diagnosis of schizophrenia, the patient must have experienced at least 2 of the following symptoms[1]
:
 Delusions
 Hallucinations
 Disorganized speech
 Disorganized or catatonic behavior
 Negative symptoms
6. Which of the following is true about diagnostic parameters of Schizophrenia?

I. At least 1 of the symptoms must be the presence of delusions, hallucinations, or disorganized speech.
II. At least 1 of the symptoms must be loss of activity, emotional changes.
III. Must have all of the positive symptoms.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
At least 1 of the symptoms must be the presence of delusions, hallucinations, or disorganized speech.
7. Which of the following statement is false regarding management of Schizophrenia?
I. Antipsychotic medications diminish the positive symptoms of schizophrenia and prevent relapse.
II. There is no clear antipsychotic drug of choice for schizophrenia
III. Clozapine is most effective medication & is recommended as first-line therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Antipsychotic medications diminish the positive symptoms of schizophrenia and prevent relapses.
There is no clear antipsychotic drug of choice for schizophrenia. Clozapine is the most effective medication but
is not recommended as first-line therapy.
8. What are the major goals of Psycho-social treatments in Schizophrenia patients?

I. To have few or stable symptoms
II. Not to be hospitalized
III. To prevent relapse
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Psychosocial treatments are currently oriented according to the recovery model. According to this model, the
goals of treatment for a person with schizophrenia are as follows:
 To have few or stable symptoms
 Not to be hospitalized
 To manage his or her own funds and medications
9. A child is complaining of hearing voices sometime. His teacher also complaint about his sudden
drop of interest in studies. What is your diagnosis?
I. Alzheimer's disease
II. Attention deficit syndrome
III. Schizophrenia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
When the onset is in childhood or adolescence, the expected level of interpersonal, academic or occupational
functioning is not achieved
10. What is the major Pathology behind Schizophrenia?

I. Genetic Abnormality
II. Immune & Neurotransmitter Abnormality
III. Anatomic Abnormality
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Anatomic, neurotransmitter, and immune system abnormalities have been implicated in the pathophysiology
of schizophrenia.
11. What are the major differences between normal & Schizophrenic effected brain shown in Neuro
image?
I. Brain volume increases in size
II. Changes seen in Hippocampus
III. Ventricles become larger
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Neuroimaging studies show differences between the brains of those with schizophrenia and those without this
disorder. For example, the ventricles are somewhat larger, there is decreased brain volume in medial temporal
areas, and changes are seen in the hippocampus.[
12. What are the major signs shown in MRI of Schizophrenic patient?
I. 2 networks of Grey-matter tracts are increased
II. 2 networks of white-matter tracts are reduced
III. Abnormalities in neocortical & limbic regions
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Magnetic resonance imaging (MRI) studies show anatomic abnormalities in a network of neocortical and
limbic regions and interconnecting white-matter tracts.[5] A meta-analysis of studies using diffusion tensor
imaging (DTI) to examine white matter found that 2 networks of white-matter tracts are reduced in
schizophrenia.[6]
13. What is the major abnormality in neurotransmission of patient suffering from Schizophrenia?
I. Abnormality in dopaminergic system
II. Abnormality in GABAergic system
III. Abnormality in Serotonergic system
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Abnormalities of the dopaminergic system are thought to exist in schizophrenia
14. How can you define Anti psychotic drugs?

I. Drugs that increase the firing rates of mesolimbic dopamine D2 neurons
II. Drugs that diminish the firing rates of mesolimbic dopamine D2 neurons
III. Drugs that diminish the firing rates of mesolimbic dopamine D1 neurons
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Drugs that diminish the firing rates of mesolimbic dopamine D2 neurons are antipsychotic,
15. Which of the following drug exacerbate Schizophrenia?

I. Chlorpromazine
II. Reserpine
III. Amphetamine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Drugs that stimulate these neurons (eg, amphetamines) exacerbate psychotic symptoms.
16. What is the major cause leading to negative symptoms?
I. Hypo dopaminergic activity
II. Hyper dopaminergic activity
III. Hypo GABAergic activity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Hypodopaminergic activity in the mesocortical system, leading to negative symptoms,
17. What is the major cause leading to positive symptoms?

I. Hypodopaminergic activity
II. Hyperdopaminergic activity
III. Hypo GABAergic activity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
And Hyperdopaminergic activity in the mesolimbic system, leading to positive symptoms,

18. Which of the following drug involves other neurotransmitter systems besides dopamine
neurotransmission ?
I. Chlorpromazine
II. Clozapine
III. Amphetamine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Clozapine, perhaps the most effective antipsychotic agent, is a particularly weak dopamine D2 antagonist.
Thus, other neurotransmitter systems, such as norepinephrine, serotonin, and gamma-aminobutyric acid
(GABA), are undoubtedly involved.
19. Schizophrenia can be defined as ?

I. Hypoglutamatergic disorder
II. Hyperglutamatergic disorder
III. Hyperdopaminergic disorder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Some researchers consider schizophrenia, in large part, a hypoglutamatergic disorder.

20. Which of the following inflammatory mediator indicates the over activation of immune system
in Schizophrenic patient?
I. Leukotrienes
II. Cytokines
III. Histamine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Over activation of the immune system (eg, from prenatal infection or postnatal stress) may result in
overexpression of inflammatory cytokines and subsequent alteration of brain structure and function.
21. A patient came to hospital with diagnosis of Schizophrenia. Lab tests reveal increased glucose
levels. What is the major pathology behind these elevated levels?
I. Inflammation
II. Inhibition of Dopamine
III. Genetic cause
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Insulin resistance and metabolic disturbances, which are common in the schizophrenic population, have also
been linked to inflammation. Thus, inflammation might be related both to the psychopathology of
schizophrenia and to metabolic disturbances seen in patients with schizophrenia.[
22. Which of the following are risk factors of Schizophrenia?
I. Smoking
II. Genetic
III. Perinatal
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Most likely, there are at least 2 sets of risk factors, genetic and perinatal
23. Which of the following genes changes the gene expression or protein function resulting in
Schizophrenia?
I. COMT gene
II. RELN gene & GRM3 gene
III. Alcohol dehydrogenase-2
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Some loci of particular interest include the following:

 Catechol-O-methyltransferase ( COMT) gene
 RELN gene
 Nitric oxide synthase 1 adaptor protein ( NOS1AP) gene
 Metabotropic glutamate receptor 3 ( GRM3) gene
24. Word COMT stand for which of the following?
I. Catechol-O-methyltransferase
II. Catechol-O-mono-aminotransferase
III. Catechol-O-meta transferase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Catechol-O-methyltransferase ( COMT) gene
25. What is the function of COMT(Catechol-O-methyltransferase) gene?

I. It codes for enzyme COMT, which is involved in methylation & degradation of
neurotransmitters dopamine, epinephrine and nor-epinephrine.
II. It codes for enzyme COMT, which is involved in alkylation & degradation of
III. It codes for enzyme COMT, which is involved in potentiation of
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The COMT gene codes for the postsynaptic intracellular enzyme COMT, which is involved in the methylation
and degradation of the catecholamine neurotransmitters dopamine, epinephrine, and norepinephrine.
26. Which of the following is the function of gene RELN?
I. It codes for degradation of dopamine neurotransmitter
II. It codes for protein reelin
III. It codes for synthesis of glutamate neurotransmitter
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The RELN gene codes for the protein reelin, which plays a role in brain development and gabaergic activity
27. Which of the following statement is true regarding NOS1AP gene?

I. It codes for enzyme nitric oxide synthase which is found in high conc. in excitatory neurons.
II. It codes for enzyme nitric oxide synthase which is found in high conc. in inhibitory neurons.
III. A single-nucleotide polymorphism in this gene is associated with Schizophrenia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The NOS1AP gene codes for the enzyme nitric oxide synthase, which is found in high concentration in
inhibitory neurons in the brain. Nitric oxide acts as an intracellular messenger. Using a newly developed
statistical technique, the posterior probability of linkage disequilibrium, researchers have identified a single-
nucleotide polymorphism associated with higher levels of expression of this gene
28. Which of the following gene is associated with bipolar affective disorder?
I. Mutation in GRM3 gene
II. Mutation in COMT gene
III. Mutation in RELN gene
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The GRM3 gene is a protein-coding gene associated with bipolar affective disorder. In a 2014 study, researchers
found a variant in the GRM3 gene that was associated with a two- to three-fold increase in the risk of
developing schizophrenia or alcohol dependence and an approximately three-fold greater risk of developing
bipolar disorder.
29. What are the risk factors associated with Perinatal Schizophrenia?
I. Malnourishment during pregnancy
II. Genetic disorder in mother
III. Viral infection during pregnancy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Women who are malnourished or who have certain viral illnesses during their pregnancy may be at greater risk
of giving birth to children who later develop schizophrenia
Children born in the winter months may be at greater risk for developing schizophrenia
30. Which of the following drug use is considered high risk for developing Schizophrenia?
I. Heroine
II. Cocaine
III. Marijuana
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
A new study suggests that heavy marijuana use in teenagers aged 15-17 years may hasten the onset of psychosis
in those at high risk for developing a psychotic disorder.
31. At what age there is an increase chances of occurrence of Schizophrenia?

I. Early childhood
II. Mid 30s
III. In later age of 50
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The onset of schizophrenia usually occurs between the late teens and the mid 30s.[1] For males, the peak age of
onset for the first psychotic episode is in the early to middle 20s; for females, it is in the late 20s.
32. What is the reason behind late onset of Schizophrenia in females than males?
I. Effect of estrogen
II. Effect of FSH
III. Low level of testosterone hormone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The onset of schizophrenia is later in women than in men, and the clinical manifestations are less severe. This
may be because of the antidopaminergic influence of estrogen.
33. Which of the following factors contribute to poor prognosis in Schizophrenic patient?
I. Family history
II. Cognitive symptoms
III. History of any other neurological disorder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Early onset of illness, family history of schizophrenia, structural brain abnormalities, and prominent cognitive
symptoms are associated with a poor prognosis.
34. What factors contributed to increased mortality among Schizophrenic patients?
I. Smoking
II. Excessive food intake
III. Poor medications
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Other factors that contribute to increased mortality include lifestyle issues such as cigarette smoking, poor
nutrition, and lack of exercise, and perhaps poorer medical care and complications of medications.
35. As a health-care provider what do you educate to patient in order to control his disease?
I. Prevention of Alcohol & Drug Abuse
II. Control his Diet
III. Importance of medication compliance
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Nevertheless, teaching the patient to understand the importance of medication compliance and of abstinence
from alcohol and other drugs of abuse is important.
36. What type of information you gather from patient in order to rule out the major cause of
Schizophrenia?
I. Past medical &psychiatric history
II. History of drug abuse
III. Smoking history
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Information about the medical and psychiatric history of the family, details about pregnancy and early
childhood, history of travel, and history of medications and substance abuse are all important. This information
is helpful in ruling out other causes of psychotic symptoms.
37. Which of the following are Cognitive symptoms?

I. Attention & Memory deficits
II. Inability to organize
III. Hallucinations
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Cognitive symptoms - Neurocognitive deficits (eg, deficits in working memory and attention and in
executive functions, such as the ability to organize and abstract); patients also find it difficult to
understand nuances and subtleties of interpersonal cues and relationships
38. What are the early signs of Schizophrenia?
I. Physical anomalies
II. Poor vision
III. Left handedness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Schizophrenia has been associated with left and mixed handedness, minor physical anomalies, and soft
neurologic signs.
39. A child was taken to a psychiatrist. His mother complaints that he feels difficulty in learning.
He mostly play alone and is a regular bed wetter. What is his diagnosis?
I. Parkinsonian Disease
II. Alzheimer's Disease
III. Schizophrenia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The patient usually had an unexceptional childhood. In retrospect, family members may describe the person
with schizophrenia as a physically clumsy and emotionally aloof child. The child may have been anxious and
preferred to play by himself or herself. The child may have been late to learn to walk and may have been a bed
wetter.
40. Which one of the following is helpful in the diagnosis?
I. Neurologic examination
II. Complete blood count (CBC)
III. Physical examination
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The findings from a general physical examination are usually non-contributory. This examination is necessary
to rule out other illnesses. It is sometimes helpful to perform a neurologic examination as a baseline before
initiating antipsychotic medications, because these drugs themselves can cause some neurological signs.
41. Which of the following observations are observed during Mental status examination(MSE)?
I. Patient may be socially awkward.

II. Patient may respond to non-apparent auditory or visual stimuli
III. Patient is very friendly and answer quickly.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Mental status examination

On a detailed mental status examination (MSE), the following observations may be made in a severely ill
patient with schizophrenia:
The patient may be unduly suspicious of the examiner or be socially awkward
The patient may express a variety of odd beliefs or delusions
The patient often has a flat affect (ie, little range of expressed emotion)
The patient may admit to hallucinations or respond to auditory or visual stimuli that are not apparent to the
examiner
42. What is the effect of Schizophrenia on patients speech?
I. Patients speech is difficult to follow & not understood by Psychologist.
II. Patients speech is completely non-understandable.
III. Schizophrenia has no effect on speech.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
f
thoughts follows a logic that is clear to the patient but not to the interviewer
43. Which of the following is false about the behavior of Schizophrenic patient?
I. Drinking too much water
II. Staring at themselves in mirror
III. Wake-sleep cycle is normal
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Persons with schizophrenia may display strange and poorly understood behaviours. These include drinking
water to the point of intoxication, staring at themselves in the mirror, performing stereotyped activities,
hoarding useless objects, and mutilating themselves. Their wake-sleep cycle may be disturbed.
44. Which of the following are complications of Schizophrenia?
I. Anxiety,Violence,Drug abuse
II. Fatigue, Constipation
III. Brain damage ,Difficulty swallowing
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Complications
Substance abuse
)Depression
Anxiety
Violence
45. What drives Schizophrenic patients to get addicted to drug abuse?

I. They think it provide relief from symptoms of illness
II. They think it will help in complete relief from the disease.
III. They think it provide relief from adverse effects of anti psychotic drugs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
For some people, these drugs provide relief from symptoms of the illness or the adverse effects of antipsychotic
drugs, and the drive for this relief is strong enough to allow even patients who are impoverished and
disorganized to find substances to abuse.[61]
46. Which of the following drug abuse worsen the psychotic symptoms in Schizophrenic patients?
I. Nicotine
II. Cannabis
III. Cocaine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Drug use and abuse can also increase symptoms. For example, cannabis use has been shown to be associated
with an earlier onset of psychosis and to correlate, in a bidirectional way, with an adverse course of psychotic
symptoms in persons with schizophrenia. That is, people with more severe psychotic symptoms are more likely
to use cannabis, and cannabis, in turn, seems to worsen psychotic symptoms
47. Which of the following steps should be taken in order to prevent depression in Schizo phrenic
patient?
I. Addition of antidepressants to anti psychotics.
II. Start Antidepressant therapy only.
III. Psychotherapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The research evidence for the use of antidepressant agents in schizophrenic patients is mixed. Further
complicating the situation are the findings that antipsychotic agents may have antidepressant properties.[65] One
meta-analysis suggested that the addition of antidepressants to antipsychotics might help treat the negative
symptoms of chronic schizophrenia, which can be difficult to distinguish from depression.
48. Which of the following anti psychotic agent reduces the risk of Suicidal attempt in Schizophrenic
patient?
I. Olanzapine
II. Clozapine
III. Chlorpromazine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Suicide attempts are lower in people treated with clozapine than with other antipsychotic agents
49. Which of the following anti-anxiety drugs should be used cautiously in patients taking
Clozapine?
I. SSRIs
II. Fluvoxamine
III. Chlorpromazine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Following treatment recommendations for primary anxiety disorder would be reasonable in many cases;
however, fluvoxamine and other selective serotonin reuptake inhibitors (ssris) should be used cautiously in
patients receiving clozapine; they can raise clozapine blood levels.
50. Why SSRIs should be used cautiously in patients taking Clozapine?
I. It has enzyme-inducer property
II. It can raise clozapine blood levels
III. It increases clozapine renal excretion
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Fluvoxamine and other selective serotonin reuptake inhibitors (ssris) should be used cautiously in patients
receiving clozapine; they can raise clozapine blood levels.
51. What is meant by Obsessive-compulsive symptoms?

I. Difficult to learn & memorize
II. Check, count& repetition of activities
III. Too much thinking
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
A number of patients with schizophrenia display obsessive-compulsive symptoms, such as the need to check,
count, or repeat certain activities.
52. Which of the following drug has an adverse effect of Obsessive compulsive symptoms?
I. Chlorpromazine
II. Clozapine
III. Amphetamine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Obsessive-compulsive symptoms are a known adverse effect of some antipsychotic medications, particularly
clozapine.
53. Violence in Schizophrenia is mostly associated with which of the following?

I. Depression
II. Drug abuse
III. Anxiety
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Violence may be associated with substance abuse. However, the rate of violence in patients with schizophrenia
who do not abuse substances is higher than that in people without schizophrenia
54. Which of the following Antipsychotic drug is best choice for treating violence in patients?
I. Clozapine
II. Chlorpromazine
III. Haloperidol
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Clozapine is sometimes recommended for treatment of patients with schizophrenia who are violent.
55. What are the best possible tests to rule out any other illness in Schizophrenic patient?
I. CBC count, Pregnancytesting, Urine cultures
II. Renal, Liver& Thyroid function tests
III. X-ray & Sputum test
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Schizophrenia is not associated with any characteristic laboratory results. The following should be performed
on all patients, both at the beginning of the illness and periodically afterward, to rule out other or concomitant
illnesses:
 Complete blood cell (CBC) count
 Liver, thyroid, and renal function tests
 Electrolyte, glucose, vitamin B-12, serum methylmalonic acid, folate, and calcium levels
 Pregnancy testing (if the patient is a woman of childbearing age)
56. Which of the following test is performed to rule out the suspicion of Drug abuse?
I. CBC(complete blood count)
II. Urine test
III. Brain imaging
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Urine testing for drugs of abuse, such as alcohol, cocaine, opioids, cannabis
57. Brain imaging is done in Schizophrenic patients to exclude which of the following conditions?
I. Tumors
II. Cerebral abscesses
III. Meningitis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Brain imaging to rule out subdural hematomas, vasculitis, cerebral abscesses, and tumors
58. Which type of test is performed for differential diagnosis of Wilson disease?
I. MRI
II. Liver biopsy
III. Spirometry test
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
If a strong suspicion of Wilson disease exists, consider a liver biopsy (or multiple biopsies)
59. What steps should be taken to rule out any metal toxicity in Schizophrenic individuals?
I. Blood test
II. 24-hr urine collection
III. Brain imaging
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Twenty-four-hour urine collections for porphyrins, copper, or heavy metals

60. Which of the following test is considered to detect Hypercortisolism in Schizophrenic
individuals?
I. Corticotropin stimulation test
III. Corticotropin suppression test
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Dexamethasone suppression test for hypercortisolism;
61. Which of the following test is considered to detect Hypocortisolism in Schizophrenic

Individuals?
I. Corticotropin stimulation test
III. Corticotropin suppression test
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Corticotropin stimulation test for hypocortisolism
62. Rapid plasma region RPR) is performed to detect which of the following?
I. Encephalitis
II. Meningitis
III. Neurosyphilis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Rapid plasma reagin (RPR) - If a strong suspicion of neurosyphilis exists
63. Which of the following assay should be performed to elude systemic lupus erythematosus?
I. HIV antibody
II. Antinuclear antibody (ANA)
III. Lyme antibody
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
 Antinuclear antibody (ANA) for systemic lupus erythematosus
64. Which of the following is performed to rule out pulmonary illness?

I. Chest radiography
II. Electroencephalography
III. MRI
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
 Chest radiography to rule out pulmonary illness or occult malignancy
65. Lumbar puncture must be performed to examine?

I. CSF (cerebrospinal fluid)
II. Hypercortisolism
III. Neurosyphilis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Some experts suggest that a lumbar puncture be performed to examine cerebrospinal fluid
66. What common findings do you observe in Schizophrenic patients?

I. Impaired memory
II. Poor executive function
III. Poor vision
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Common findings in patients with schizophrenia are as follows:

 Poor executive functioning (ie, poor planning, organizing, or initiation of activities)
 Impaired memory
 Difficulty in abstraction and recognizing social cues
 Easy distractibility
67. Which factors can be helpful in treatment planning?

I. Neuropsychological testing
II. Patient cognitive weakness determination
III. Determination of patients consciousness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
can be helpful in treatment planning.

68. What is the possible Schizophrenic effect on patients mood?
I. He often seems cheerful
II. He often seems sad
III. He laugh too much
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Mood symptoms - Patients often seem cheerful or sad in a way that is difficult to understand; they often are
depressed
69. What are the diagnostic tests for Schizophrenia?

I. CSF examination
II. MRI
III. There are no characteristics lab tests specified.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Schizophrenia is not associated with any characteristic laboratory results.
70. What duration of signs are required for confirmation of Schizophrenia in patient?
I. Memory deficit in the beginning
II. Continuous disturbance for at-least 6 month
III. Experiencing at least 1 month of active symptoms
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Continuous signs of the disturbance must persist for at least 6 months, during which the patient must experience
at least 1 month of active symptoms (or less if successfully treated), with social or occupational deterioration
problems occurring over a significant amount of time
71.Which of the following is false about Schizophrenia?

I. It is a brain disorder that comprises several separate illness.
II. Its hall mark symptom is impaired cognition
III. People with schizophrenia have low rate of independent living
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Schizophrenia is a brain disorder that probably comprises several separate illnesses. The hallmark symptom of
schizophrenia is psychosis, such as experiencing auditory hallucinations (voices) and delusions (fixed false
beliefs). Impaired cognition or a disturbance in information processing is a less vivid symptom that interferes
with day-to-day life. People with schizophrenia have lower rates of employment, marriage, and independent
living compared with other people
72. Which of the following is the best approach for the treatment of Schizophrenia?
I. Start Anti-psychotic therapy immediately
II. It is only treated with psychological treatments
III. Psycho social rehabilitation is an essential part of treatment
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Treatment of schizophrenia requires an integration of medical, psychological, and psycho-social inputs. The
bulk of care occurs in an outpatient setting and is best carried out by a multidisciplinary team. Psychosocial
rehabilitation is an essential part of treatment.
73. What is meant by DSM?
I. Diagnostic and Statistical Manual of Mental Disorder.
II. Disease and Statistical Manual of Mental Disorder.
III. Diagnostic and Scientific Manual of Mental Disorder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5)
74. Anti-psychotic medications are also known as which of the following?

I. Minor tranquilizer
II. Major tranquilizer
III. Neuroleptic medication
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Anti-psychotic medications, also known as neuroleptic medications or major tranquilizers,
75. Anti psychotic are mostly initiated to diminish which of the following symptoms?
I. Positive symptoms
II. Negative symptoms
III. Cognitive symptoms
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Antipsychotic diminish the positive symptoms of schizophrenia and prevent relapses.

76. A patient came to hospital with history of autism. He has a disorganized speech and
behaiviour.On what basis you diagnose him as a Schizophrenic patient?
I. If prominent symptoms are hallucinations or delusions.
II. Positive symptoms present for at-least 1 month
III. Negative symptoms present for at-least 1 month
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the
additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in
addition to the other required symptoms or schizophrenia are also present for at least 1 month (or less
if successfully treated)
77. Which of the following symptom assessment is helpful in distinguishing between Schizophrenia
& other psychotic disorders?
I. Cognition assessment
II. Delusions
III. Depression assessment
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In addition to the 5 symptom domain areas identified in the first diagnostic criterion, assessment of cognition,
depression, and mania symptom domains is vital for distinguishing between schizophrenia and other psychotic
disorders.
78. Which of the following condition should be assessed in order to prevent chances of co -morbidity
in Schizophrenic patient?
I. Alzheimer Disease
II. Parkinsonian Disease
III. Catatonia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The presence or absence of catatonia is specified. Individuals meeting the criteria for catatonia receive an
additional diagnosis of catatonia associated with schizophrenia to indicate the presence of the comorbidity.
79. Which of the following drugs exacerbate psychotic symptoms?

I. Phencyclidine
II. Clozapine
III. Chlorpromazine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Much research focuses on the N -methyl-D-aspartate (NMDA) subclass of glutamate receptors because NMDA
antagonists, such as phencyclidine and ketamine, can lead to psychotic symptoms in healthy subjects
80. What is the major pathway activated by Cytokines?
I. Activate kynurenine pathway & involved in dopamine regulation.
II. Activate GABAergic pathway & involved in GABA regulation
III. Inhibit kynurenine pathway & involved in dopamine regulation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Schizophrenic patients have elevated levels of Proinflammatory cytokines that activate the kynurenine pathway,
by which tryptophan is metabolized into kynurenic and quinolinic acids; these acids regulate NMDA receptor
activity and may also be involved in dopamine regulation.
81. Which of the following may also be considered as a cause for Schizophrenia?
I. Socioenvironmental factors
II. Past history of Alzheimer
III. Increased paternal age
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In addition, undefined socioenvironmental factors may increase the risk of schizophrenia in international
migrants or urban populations of ethnic minorities.[13, 14, 15] Increased paternal age is associated with a greater
risk of schizophrenia
82. What is the risk of Schizophrenia in child ,if both parents have schizophrenia?
I. 0%
II. 40%
III. 100%
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
If both parents have schizophrenia, the risk of schizophrenia in their child is 40%.
83. Which of the allelic variants of COMT degrades dopamine faster and develop psychotic
symptoms?
I. Valine-Valine variant
II. Methionine-Methionine
III. Valine-Methionine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The several allelic variants of COMT affect its activity. The valine-valine variant degrades dopamine faster
than the valine-methionine variant does; subjects with 2 copies of the methionine allele were less likely to
develop psychotic symptoms
84. What other major genetic changes occur besides hereditary factors?
I. Deletion of segment of DNA
II. Duplication of segment of DNA
III. Mutation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Other genetic changes involve the structure of the gene. For example, copy number variants are deletions and
duplications of segments of DNA; they can involve genes or regulatory regions.
85. Which of the following are major sites where deletion of segment of DNA occur mostly in
Schizophrenic patient?
I. 1q 21.1 , 15q 13.3 ,22q 11.2
II. 2q 21.1 ,16q 13.3, 25q 11.2
III. 5q 21.1 , 18q 13.3 , 28q 11.2
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Copy number variants such as the deletions found at 1q21.1, 15q13.3, and 22q11.2 increase the risk of
developing schizophrenia.[23, 24] At most, however, these findings probably account for only a small part of the
heritability of schizophrenia.
86. What is the lifetime prevalence of Schizophrenia?

I. 90%
II. 1%
III. 50%
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The lifetime prevalence of schizophrenia has generally been estimated to be approximately 1% worldwide.
87. According to cultural bias of practitioner which race is more susceptible to Schizophrenia?
I. Black people
II. White people
III. Both equally
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Some research indicates that schizophrenia is diagnosed more frequently in black people than in white people;
this finding has been attributed to cultural bias of practitioners.
88. A pregnant women with UTI found no significant increase risk of schizophrenia in offspring
while other pregnant women who had family history of psychosis found with greater risk in offspring.
What do you interpret from this behavior?
I. There is an interaction between genetic & environmental influences on Schizophrenia.
II. Only genetic cause results in Schizophrenia
III. Only environmental factors result in schizophrenia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
A study of Finnish women supported an interaction between genetic and environmental influences on causation
of schizophrenia.[50] In this study, a review of 9596 women in Helsinki who received hospital treatment during
pregnancy for an upper urinary tract infection between 1947 and 1990 found no overall significant increase
in the risk of schizophrenia among their offspring but a 5-fold higher risk among the offspring of women who
also had a family history of psychosis.
89. Why educating patients is helpful for Schizophrenic individuals besides medication therapy?
I. It leads to reduction in re hospitalization & symptoms.
II. Improve adherence with medications
III. It require no further medication therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
It is helpful to work with the patient so that both patient and family can learn to recognize early signs of a
decompensation (eg, insomnia or increased irritability). A review of 44 studies showed that education of
patients about the nature of their illness and treatment, when added to standard care, led to reductions in
rehospitalization and symptoms.[57] Education may improve adherence to medication and may help the patient
cope with the illness better in other ways.
90. What basic education you provide to Schizophrenic individuals?

I. Importance of healthy lifestyle
II. Reduction of fatty meals
III. Counseling about sexually transmitted disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Because other illnesses are common in schizophrenia, education about the importance of a healthy lifestyle and
regular health care is helpful. Counseling with respect to sexuality, pregnancy, and sexually transmitted diseases
is important for these patients.
91. What of the following side effect is associated with Anti psychotic medications?
I. These drugs cause hepatic toxicity
II. These drugs themselves can cause neurological signs.
III. These drugs cause enzyme induction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
It is sometimes helpful to perform a neurologic examination as a baseline before initiating antipsychotic

medications, because these drugs themselves can cause some neurological signs.
92. What is the effect of Schizophrenia on patients thoughts?

I. Difficulty in abstract thinking.
II. Inability to understand common proverbs.
III. Think too much
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 The patient has difficulty with abstract thinking, demonstrated by inability to understand common
proverbs or idiosyncratic interpretation of them
93. What symptoms resulted patient into violence state?

I. Hallucinations
II. Cognitive symptoms
III. Delusions
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
However, a few may act violently, sometimes as a result of command hallucinations or delusions.[6
94. Which Schizophrenic patients are subjected to dual-diagnosis treatment?
I. Patients with depression
II. Patients with violence
III. Patients with drug abuse
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: : C
Patients who abuse substances may fare better in dual-diagnosis treatment programs, in which principles from
the mental health field can be integrated with principles from the chemical dependency field.
95. What are the major Psycho-social treatments performed by Psychiatrist?

I. Social skills & cognition training
II. Speaking & memory enhancing therapy
III. Cognitive behavioral & remediation therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The best-studied psychosocial treatments are social skills training, cognitive-behavioral therapy, cognitive
remediation, and social cognition training.
96. How can you specify the severity of Schizophrenia?
I. On the basis of lab tests
II. By evaluating primary psychosis symptoms
III. Evaluating on 5 point scale
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
(Answer: E)
Finally, the current severity of the disorder is specified by evaluating the primary symptoms of psychosis and
rating their severity on a 5-point scale ranging from 0 (not present) to 4 (present and severe).
97. Why Schizophrenia sub types were removed from DSM-5?

I. They didn't provide better-targeted treatment
II. They are difficult to interpret
III. They didn't predict treatment response
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Schizophrenia subtypes were removed from DSM-5 because they did not appear to help with providing better-
targeted treatment or predicting treatment response.
98. Which brain changes detect the severity of psychotic symptoms?
I. Enlargement of ventricles
II. Decrease in brain volume
III. Changes in prefrontal lobes
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The changes in prefrontal lobes were associated with increasing severity of psychotic symptoms.[7]
99. Which of the following statement is false about Schizophrenia?

I. Schizophrenia may be the result of new mutations.
II. Schizophrenic individual always have history of disorder
III. It is a disease in which multiple rare genetic variants lead to a common clinical outcome.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
These findings also lend support to the hypothesis that schizophrenia is a disease in which multiple rare genetic
variants lead to a common clinical outcome.
Some people with schizophrenia have no family history of the disorder. These cases may be the result of new
mutations.
100. Which of the following countries are more susceptible to Schizophrenic syndrome?
I. Under-developed countries
II. Less developed countries
III. Developed countries
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Prevalence estimates from countries considered least developed were significantly lower than those from countries
classed as emerging or developed.

1. What combination of multidisciplinary team is required for patient care?
I. Clinical Pharmacist, Counselor.
II. Psycho pharmacologist , Nurse.
III. Neurologist.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The bulk of care occurs in an outpatient setting and probably is best carried out by a multidisciplinary team,
including some combination of the following: a psychopharmacologist, a counselor or therapist, a social worker,
a nurse, a vocational counselor, and a case manager. Clinical pharmacists and internists can be valuable
members of the team.
2. What are the chances of relapse if patient stops using Anti-psychotics?

I. 10%.
II. 80%.
III. 1%.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Approximately 80% of patients relapse within 1 year if antipsychotic medications are stopped, whereas only
20% relapse if treated.
3. What major warning should be given to patient about anti-psychotic therapy?
I. Adverse effects of drugs.
II. Lifestyle changes.
III. Slowness of response.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
ANSWER: F
Clinicians should warn patients and their families of adverse effects, and the slowness of response.
4. Which of the following D2 antagonists are used as first line therapy?

I. Chlorpromazine.
II. Clozapine.
III. Haloperidol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The first antipsychotic medications, chlorpromazine and haloperidol, were dopamine D2 antagonists. These
and similar medications are known as first-generation,
5. First-generation anti-psychotics are also known as?

I. Atypical anti psychotic.
II. Typical anti psychotic.
III. Conventional anti psychotic.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
These and similar medications are known as first-generation, typical, or conventional antipsychotics.
6. Which of the following D2 antagonists are used as second line therapy?
I. Chlorpromazine.
II. Clozapine.
III. Haloperidol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Other antipsychotics, beginning with clozapine, are known as second-generation, atypical, or novel
antipsychotics.
7. Second-generation anti-psychotics are also known as?

I. Atypical anti-psychotics.
II. Typical anti-psychotics.
III. Novel anti-psychotics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Other antipsychotics, beginning with clozapine, are known as second-generation, atypical, or novel
antipsychotics.
8. Which of the following is false about Conventional anti-psychotic agents?

I. They are less expensive than Novel anti-psychotics.
II. They are more expensive than Novel anti-psychotics.
III. They are available in various dosage forms.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The conventional antipsychotic agents are available in generic forms and are less expensive than the newer
agents. They are available in a variety of vehicles, including liquid and intramuscular (IM) preparations.
9. Which of the following agents are also available as depot preparations?
I. Haloperidol.
II. Chlorpromazine.
III. Fluphenazine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Some of these agents (haloperidol and fluphenazine) are also available as depot preparations, meaning that a
person can be given an injection of a medication every 2-4 weeks
10. Which of the following anti-psychotics are available as long-acting injectable?

I. Risperidone.
II. Olanzapine.
III. Clozapine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Of the second-generation agents, risperidone is available as a long-acting injection that uses biodegradable
polymers; olanzapine, paliperidone, and aripiprazole are also now available in long-acting injectable forms.
11. Which of the following is the adverse effect of First generation Anti psychotic drugs ?
I. Elevated prolactin level.
II. Headache.
III. Weigh loss
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The first-generation antipsychotic drugs tend to cause extrapyramidal adverse effects and elevated prolactin
levels.
12. Which of the following is the adverse effect of Second generation anti-psychotics?
I. Weight gain.
II. Abnormal glucose & lipid level.
III. Weight loss.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The second-generation drugs are more likely to cause weight gain and abnormalities in glucose and lipid control;
13. What is meant by CATIE?

I. Clinical Anti-psychotic Trials of Intervention Effectiveness.
II. Clinical Anti-epileptic trials of Intervention Effectiveness.
III. Clinical Anti-psychotic Treatment Intervention Effectiveness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness)

14. Which of the following Anti psychotic agent is better than others?
I. Perphenazine.
II. Olanzapine.
III. Risperidone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
A large nationwide trial that compared the first-generation antipsychotic perphenazine with the second-
generation drugs olanzapine, risperidone, quetiapine, and ziprasidone, found that olanzapine was slightly
better than the other drugs in terms of the patients choosing to stay on it, and number of hospitalizations,
15. Which of the following dosage form is more effective to treat first episode of Schizophrenia?
I. Long-acting injectable (LAI).
II. Oral anti-psychotic.
III. Sustained release anti-psychotic preparation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
According to the results of a year-long randomized controlled trial, starting a long-acting injectable (LAI)
antipsychotic after a first episode of schizophrenia is more effective than starting an oral antipsychotic.
16. A patient came to clinic with first episode of Schizophrenia. Which of the following is more
effective to control symptoms & relapse rate?
I. Oral risperidone.
II. Long-acting injectable risperidone.
III. Sustained release risperidone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The study included 86 patients with a recent first episode of schizophrenia who were randomly assigned to
receive LAI risperidone (n = 43) or oral risperidone (n = 43) for 12 months. Study data showed that the LAI
formulation of risperidone proved superior to oral risperidone on measures of relapse and symptom control.
17. Which of the following is more effective in controlling symptoms of hallucinations & delusions?
I. LAI risperidone.
II. LAI Olanzapine.
III. Oral risperidone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Treatment with LAI risperidone also provided better control of hallucinations and delusions.
18. Which of the following are adverse effects of Olanzapine, Quetiapine& Risperidone?
I. Drowsiness.
II. Weight gain.
III. Weight loss.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Similarly, the randomized, double-blind CAFE (Comparison of Atypicals for First Episode) study found few
differences between olanzapine, quetiapine, and risperidone in 400 patients experiencing a first episode of
psychosis, with all-cause treatment discontinuance rates in the vicinity of 70% by week 52. Drowsiness and
weight gain were along the most common adverse events with all 3 drugs;
19. Which of the following is most common side effect of olanzapine?

I. Insomnia.
II. Excessive sleep.
III. Weight loss.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Insomnia was seen with olanzapine,
20. Which of the following is most common side effect of Quetiapine?

I. Insomnia.
II. Longer sleep time.
III. Weight loss.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
A longer sleep time with quetiapine,
21. Which of the following is most common side effect of Risperidone?
I. Elevated prolactin level.
II. Irregular menstrual cycle.
III. Insomnia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Menstrual irregularities in women with risperidone.[86]
22. Which of the following drugs should not be used as Fist-line therapy because of ADR profile?
I. Olanzapine.
II. Clozapine.
III. Haloperidol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
However, because of the adverse adverse-effect profile of clozapine and the significant metabolic risks associated
with olanzapine, PORT advised that neither drug should be considered as a first-line treatment for first-episode
schizophrenia.
23. What dose is recommended by PORT in patient with first episode of schizophrenia?
I. Start with low dose.
II. Start with high dose.
III. Start with normal dose.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Noting that both responsiveness to treatment and sensitivity to adverse effects are greater in patients with first-
episode schizophrenia than in those who have had multiple episodes, PORT recommended starting
antipsychotic treatment for the former at doses lower than those recommended for the latter.
24. Which of the following Anti psychotic drug is not effective in lower dose?
I. Clozapine.
II. Olanzapine.
III. Quetiapine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
An exception is quetiapine, which may not be effective in lower doses.

25. Why Clozapine is not recommended as first-line therapy?
I. It has many ADRS.
II. It has not performed well compared to others.
III. It has narrow therapeutic window.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Clozapine is the most effective medication but is not recommended as first-line therapy because it has a high
burden of adverse effects, requires regular blood work, and has not outperformed other medications in first-
episode patients
26. Which of the following drug is recommended if first & second trial fails in patient?
I. Olanzapine.
II. Clozapine.
III. Amphetamine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Response rates fell from about 75% in the first trial to less than 20% in the second trial.[92] The patients who
did not respond to either trial were offered clozapine, and 75% responded.
27. Why Intramuscular therapy is used instead of other route of administration available?
I. Because of Non-compliance with other routes.
II. Because of more effectiveness.
III. Because of less irritation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Noncompliance with or non adherence to pharmacologic therapy is difficult to estimate but is known to be
common, and it is one of the reasons for the use of intramuscular (IM) preparations of antipsychotic medications
28. What is the major advantage associated with Intramuscular medication?

I. Large Dosing Interval.
II. Do not require to take medications daily.
III. Less side effects.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
A regular routine of IM medication, such as every 2-4 weeks, is preferred by some patients since it obviates the
need to take medication every day. As well, it permits easier monitoring of medication adherence by the
clinician.
29. What is the dosing interval of Aripiprazole?
I. Every 2-4 weeks.
II. Every 4-6 weeks.
III. Every 6-8 weeks.
.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
In the United States, several drugs have been approved for every 4-6 week dosing (eg, aripiprazole [Abilify
Maintena, Aristada], paliperidone [Invega Sustenna]
30. What are the approved different dosing interval of Paliperidone?

I. 3 month dosing.
II. 2-4 weeks.
III. 4-6 weeks.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In the United States, several drugs have been approved for every 4-6 week dosing (eg, aripiprazole [Abilify
Maintena, Aristada], paliperidone [Invega Sustenna] and every 3 month dosing (eg, paliperidone [Invega
Trinza])
31. Why patients are non adherent to Anti-psychotic medications?
I. Due to ADR of medications.
II. They feel less likely of themselves.
III. They feel nauseous all times.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Patients tend not to be very adherent to antipsychotic medications, and this may, in part, be due to their adverse
effects. Patients sometimes report they feel less like themselves, or less alert, when taking these medications. One
troubling possibility is that while they are used to combat psychosis and in that sense to preserve brain
functioning, these medications can actually interfere with the usual processes of the brain.
32. What is the major side effect of haloperidol?

I. Hepatotoxicity.
II. Neurotoxicity.
III. Renal toxicity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
33. What are adverse effects of conventional anti-psychotics?
I. Akathisia, Dystonia.
II. Hyperprolactinemia, Tardive dyskinesia.
III. Hypoprolactinemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The following are adverse effects typically associated with conventional antipsychotic agents and with the
atypical antipsychotic risperidone at dosages higher than 6 mg/day:
 Akathisia
 Dystonia
 Hyperprolactinemia
 Neuroleptic malignant syndrome (NMS)
 Parkinsonism
 Tardive dyskinesia (TD)
34. What is meant by Akathisia?

I. Sense of inner restlessness, mental unease & irritability.
II. Sense of anxiety & immobility.
III. Loss of memory.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Akathisia is a subjective sense of inner restlessness, mental unease, irritability, and dysphoria. It can be difficult
to distinguish from anxiety or an exacerbation of psychosis.
35. Which of the following is true about Dystonia?
I. It is a sense of inner restlessness.
II. It consist of painful & frightening muscle cramps.
III. Muscular young are mostly affected.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Dystonia consists of painful and frightening muscle cramps, which affect the head and neck but may extend to
the trunk and limbs. Dystonia usually occurs within 12-48 hours of the beginning of treatment or an increase
in dose. Muscular young men are typically affected.
36. Which of the following results in Hyperprolactinemia in Schizophrenic individuals?

I. High levels of dopamine.
II. Low levels of Glutamine.
III. Low levels of dopamine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Hyperprolactinemia is an elevation of the hormone prolactin in the blood, caused by the lowering of dopamine.
(Dopamine inhibits the release of prolactin from the pituitary.) It is associated with galactorrhea, gynecomastia,
and osteoporosis. In women it is associated with amenorrhea, and in men it is associated with impotence.
37. Which of following are the signs of Neuroleptic malignant syndrome?
I. Muscular rigidity.
II. Altered mental state.
III. Loss of appetite.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
NMS is marked by fever, muscular rigidity, altered mental state, and autonomic instability. Laboratory
findings include increased creatine kinase levels and myoglobinuria. Acute kidney injury may result. Mortality
is significant.
38. Which of the following is not the side effect of clozapine?

I. Dystonia.
II. Neuroleptic Malignant syndrome.
III. Anxiety.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
NMS is thought to be less common in patients taking clozapine or other atypical antipsychotic agents.
39. What is meant by Tardive dyskinesia in Schizophrenic patient?
I. Combination of bradykinesia & rigidity.
II. Muscular rigidity & altered mental state.
III. Involuntary & repetitive movements of mouth & face.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Tardive dyskinesia (TD) consists of involuntary and repetitive (but not rhythmic) movements of the mouth
and face. Chewing, sucking, grimacing, or pouting movements of the facial muscles may occur.
40. What are the risk factors for Tardive dyskinesia in Schizophrenic individual?
I. Older age.
II. Genetic.
III. Female sex.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The incidence of TD is as high as 70% in elderly patients treated with antipsychotic agents. Risk factors for
TD include older age, female sex, and negative symptoms.
41. What is the use of Abnormal involuntary movement scale(AIMS) in Schizophrenic individu al?
I. Detect the absence or presence of Tardive dyskinesia.
II. Detect the absence or presence of Dystonia.
III. Detect the absence or presence of Neuroleptic malignant syndrome.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Regular examinations, using the abnormal involuntary movement scale (AIMS), should be performed to
document the presence or absence of TD.
42. Which of the following is not the side effect of Risperidone?

I. Dry mouth.
II. Constipation.
III. Dystonia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Anticholinergic side effects occur with most antipsychotics (though risperidone, aripiprazole, and ziprasidone
are relatively free of them)
43. Which of the following are Anticholinergic side effects associated with Anti-psychotics?
I. Narrow angle glaucoma, constipation.
II. Open angle glaucoma, diarrhea.
III. Dry mouth.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Such effects include the following:

 Dry mouth
 Acute exacerbation of narrow- or closed-angle glaucoma (if undiagnosed or untreated)
 Confusion
 Decreased memory
 Agitation
 Visual hallucinations
 Constipation
44. Which of the following drug is responsible for prolongation of QTc interval?
I. Thioridazine.
II. Pimozide.
III. Clozapine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Qtc intervals are lengthened by the conventional antipsychotic agents thioridazine, pimozide, and mesoridazine
and, to a lesser extent, by the novel antipsychotic agent ziprasidone.
45. Which of the following drug least likely cause altered glucose & lipid metabolism?
I. Aripiprazole.
II. Olanzapine.
III. Clozapine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Altered glucose and lipid metabolism, with or without weight gain, may occur with most antipsychotic agents,
as can weight gain itself.[104] Aripiprazole and ziprasidone are the antipsychotic drugs least likely to lead to these
adverse effects
46. Which of the following drugs cause altered glucose & lipid metabolism
I. Clozapine.
II. Olanzapine.
III. Haloperidol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Altered glucose and lipid metabolism, with or without weight gain, may occur with most antipsychotic agents,
as can weight gain itself.[104] Aripiprazole and ziprasidone are the antipsychotic drugs least likely to lead to these
adverse effects, whereas olanzapine and clozapine are the drugs most likely to do so
47. Which of the following addition of drug in Anti-psychotic therapy is useful for weight loss?
I. Metformin.
II. Pioglitazone.
III. Phenformin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
It is unclear whether weight-reducing drugs should be added to antipsychotic therapy. In one randomized,
placebo-controlled study conducted in 72 patients with first-episode schizophrenia who gained more than 7%
of their predrug weight, metformin (1000 mg/day) was effective and safe in attenuating antipsychotic-induced
weight gain and insulin resistance
48. Which of the following is also ADR of antipsychotic drugs?

I. Esophageal dysmotility.
II. Intestinal dysmotility.
III. Headache.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
All antipsychotic agents may be associated with esophageal dysmotility, thus increasing the risks of aspiration,
choking, and the subsequent risk of pneumonia
49. Which of the following drugs are responsible for orthostatic hypo-tension in Schizophrenic
individuals?
I. Risperidone.
II. Clozapine.
III. Haloperidol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Orthostatic hypotension can be problematic at the beginning of therapy, with dose increases, and in elderly
patients. This problem is related to alpha1 -blockade and seems to be particularly severe with risperidone and
clozapine.
50. What mechanism Clozapine follows in causing orthostatic hypo-tension?

I. Alpha-1 blockade.
II. Alpha-2 blockade.
III. Beta-1 blockade.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Orthostatic hypotension can be problematic at the beginning of therapy, with dose increases, and in elderly
patients. This problem is related to alpha1 -blockade and seems to be particularly severe with risperidone and
clozapine.
51. Which of the following is most common side effect of Clozapine?
I. Venous thromboembolism.
II. Prolongation of QTc interval.
III. Increase heart rate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Venous thromboembolism may be associated with the use of antipsychotic drugs. Patients treated with clozapine
may be at particular risk for this complication; however, the reasons for this possible association are not
understood
52. What is the effect of high dose of anti-psychotic agents on patients brain?
I. Decrease in white matter.
II. Increase in white matter.
III. Increase in brain volume.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
For example, Ho et al performed structural brain imaging in more than 200 patients with schizophrenia over
7 years and found that whereas patients treated with higher doses of antipsychotic medications seemed to lose
gray matter throughout their brain (except the cerebellum), those treated with lower doses seemed to have a
small increase in white matter
53. What is the advantage of taking measurement of blood levels of Schizophrenic individual?
I. It is helpful in detecting patient compliance.
II. It helps to detect toxicity.
III. It is easiest method.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Regular measurement of blood medication levels in the blood would be helpful in schizophrenia, for the
following reasons:
 Patients may not always take their medications, and checking drug levels can detect this
noncompliance
 Patients may not always be the best reporters of side effects, and monitoring medication levels can
occasionally help the clinician detect toxicity
54. What is the effect of smoking on patients taking Anti-psychotic agents?
I. Smoking inhibits enzyme CYP1A2 & increase level of anti-psychotic agents.

II. Smoking induces enzyme CYP1A2 & metabolize anti-psychotic agents.
III. Smoking has no effect on patients therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Smoking tobacco products induces the liver enzyme CYP1A2 (though nicotine patches, nicotine inhalers,
and chewing tobacco do not); this enzyme metabolizes a number of antipsychotic drugs, so that, for
example, patients who stop smoking while being treated with clozapine or olanzapine often experience
increased antipsychotic levels; a patient who has stopped smoking may have a variety of complaints, and
checking drug levels can help determine their etiology
55. What is the optimal plasma level of Haloperidol?
I. 5-10 ng/mL.
II. 15-25ng/mL.
III. 2-5ng/mL.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Plasma concentrations of haloperidol are correlated to some degree with clinical effects, and levels in the range
of 15-25 ng/ml are thought to be optimal.
56. What is the optimal plasma level of Clozapine?

I. 300-400ng/mL.
II. 100-150ng/mL.
III. 20-50ng/mL.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Plasma concentrations of clozapine in the range of 300-400 ng/ml may be optimal.
57. Long-term use of anti-psychotic agents also produce which of the following effects?
I. Cholinergic symptoms.
II. Adrenergic symptoms.
III. Anti-cholinergic symptoms.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Anticholinergic agents (eg, benztropine, trihexyphenidyl, and diphenhydramine) and amantadine are often
used in conjunction with the conventional antipsychotic agents to prevent dystonic movements or to treat
extrapyramidal symptoms.
58. Which of the following anti-cholinergics are used in conjunction with anti-psychotics?
I. Benztropine.
II. Diphenhydramine.
III. Atropine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Anticholinergic agents (eg, benztropine, trihexyphenidyl, and diphenhydramine) and amantadine are often
used in conjunction with the conventional antipsychotic agents to prevent dystonic movements or to treat
extrapyramidal symptoms.
59. Which of the following agents are used to treat Akathisia in Schizophrenic patients?
I. Anticholinergics.
II. Barbiturates.
III. Benzodiazepines.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Akathisia is particularly difficult to treat, but it occasionally responds to an anticholinergic agent, a

benzodiazepine, or a beta blocker.
60. What is the drug interaction of Clozapine?

I. Carbamazepine.
II. Alprazolam.
III. Diazepam.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Carbamazepine and clozapine should not be used together.
61. What is the benefit of treating patient with Psycho-social treatment?

I. To have few symptoms.
II. Fewer re-hospitalization & more medication compliance.
III. To prevent relapse.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Psychosocial treatments are currently oriented according to the recovery model. According to this model, the
goals of treatment for a person with schizophrenia are as follows:
 To have few or stable symptoms
 To avoid hospitalization
 To manage his or her own funds and medications
 To be either working or in school at least half-time
62. Which of the following is false about cognitive remediation therapy?

I. Cognitive impairment is only improved by medications.
II. It is based on idea that brain has some plasticity.
III. Brain exercise can encourage neurons to grow.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Cognitive impairment is not improved by medication. Cognitive remediation is a treatment modality derived
from principles of neuropsychological rehabilitation and is based, in part, on the ideas that the brain has some
plasticity and that brain exercises can encourage neurons to grow and can develop the neurocircuitry underlying
many mental activities.
63. What is the purpose of Assertive community treatment?
I. They identify indications for treatment & make referrals.
II. They promote engagement with interventions.
III. They improve income & self esteem.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Assertive community treatment is a form of case management that is typically used for patients who have had
multiple hospitalizations. The treatment involves active outreach to patients. Case managers usually have a
fairly small outpatient load (about 10 patients) and are able to go into the community to work with their
clients. The managers coordinate and integrate care by doing the following: they identify indications for
treatment, make referrals to appropriate services, and promote engagement with interventions
64. What are major benefits of Family intervention or family therapy?

I. Prevent relapse .
II. Reduce hospitalization.
III. Prevent medication therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Some studies have found that family therapy or family interventions may prevent relapse, reduce hospital
admission, and improve medication compliance.[123]
65. Why nutritional counseling is important in patients taking anti-psychotic agents?
I. Because anti-psychotic agents cause weight loss.
II. Because anti-psychotic agents cause weight gain.
III. Because there is some food-interaction with these agents.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Because many psychotropic medications are associated with weight gain, and because of the many beneficial
effects of exercise, persons with schizophrenia should be encouraged to be as physically active as possible.
66. Which of the following therapy is better in delayed onset of psychosis for at least 2 years?
I. Pharmacotherapy.
II. Psychological therapy.
III. Food intervention.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
One approach to this problem is to use psychological therapies rather than pharmacotherapy. A German study
of young people at risk for schizophrenia showed that the use of a psychological intervention involving cognitive-
behavioral therapy, group skills training, cognitive remediation and multifamily psychoeducation delayed the
onset of psychosis for at least 2 years
67. What is meant by TMS?
I. Transcranial magnetic stimulation.
II. Trans cerebral magnetic stimulation.
III. Trans limbic magnetic stimulation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
An entirely different kind of treatment for schizophrenia, still in its early stages, is transcranial magnetic
stimulation (TMS).
68. What is the function of TMS in therapy of Schizophrenic individuals?

I. Electromagnetic induction of electric field in brain.
II. Electric field changes excitability of neurons.
III. Electromagnetic induction of magnetic field in brain.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
TMS involves the electromagnetic induction of an electric field in the brain. Standard TMS affects neurons
within 1.5-2 cm from the scalp, and deep TMS can affect cells to a depth of 6 cm. The electric field changes
69. What classes of drugs used to treat Schizophrenia?

I. Anti-psychotics.
II. Anti-depressants.
III. Anti-cholinergics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Antipsychotic medications diminish the positive symptoms of schizophrenia and prevent relapses
70. What are the sub-classes of Anti-psychotic agents?

I. Anti-psychotic 1stgeneration, Anti-psychotic 2ndgeneration, serotonin-dopamine enhancers.
II. Anti-psychotic 1stgeneration ,Anti-psychotic 2ndgeneration,Anti-psychotic 3rdgeneration.
III. Anti-psychotic 1stgeneration,Anti-psychotic 2ndgeneration.
A)I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Anti-psychotic 1stgeneration
Anti psychotic 2nd generation
Serotonin-Dopamine Activity Modulators
71. What major side effects are associated with 1 st generation antipsychotics?
I. Dystonia.
II. Neuroleptic syndrome.
III. Constipation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
First-generation antipsychotics have a high rate of extrapyramidal side effects, including rigidity, bradykinesia,
that is, involuntary movements in the face and
extremities is another adverse effect that can occur with first-generation antipsychotics. Neuroleptic
malignant syndrome (NMS) can occur with these agents.
72. Which of the following is the first conventional antipsychotic?
I. Haloperidol.
II. Chlorpromazine.
III. Fluphenazine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Chlorpromazine is a phenothiazine antipsychotic that is a dopamine D2 receptor antagonist. It was the first
conventional antipsychotic developed and is still in wide use for treatment of schizophrenia
73. What is the mechanism of action of fluphenazine?

I. It cause blockade of post-synaptic D1 receptors.
II. It cause blockade of post-synaptic D2 receptors.
III. It cause blockade of post-synaptic D3 receptors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Fluphenazine is a high-potency typical antipsychotic that blocks postsynaptic dopaminergic D1 and D2

receptors. It has some alpha-adrenergic and anticholinergic effects
74. Which of the following is clinically comparable to Fluphenazine?

I. Chlorpromazine.
II. Haloperidol.
III. Perphenazine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Fluphenazine is clinically comparable to haloperidol, a first-generation antipsychotic with similar potency,
route of administration, side effects, and efficacy.
75. Which of the following is not side effect of Haloperidol?

I. Dystonia.
II. Enzyme interaction.
III. Orthostasis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Haloperidol is a dopamine D2 antagonist noted for high potency and low potential for causing orthostasis. The
drawback is the high potential for extrapyramidal symptoms or dystonia. Haloperidol can interact with
CYP3A4 and CYP2D6 inhibitors and inducers. It also can interact with drugs that prolong qtc intervals
76. What is the mechanism of action of Perphenazine?

I. Blockade of Dopaminergic receptors.
II. Blockade of cholinergic receptors .
III. Blockage of alpha-adrenergic receptors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Perphenazine is a phenothiazine antipsychotic that blocks postsynaptic dopaminergic receptors and has alpha-
adrenergic blocking effects. It has slightly lower potency than haloperidol and it sometimes classified as a
midpotency drug
77. Which of the following drug is rarely used now in US?
I. Haloperidol.
II. Chlorpromazine.
III. Thiothixene.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Thiothixene is a dopamine D2 antagonist with anticholinergic and alpha-blocking effects. It is rarely used in
the United States now.
78. What is the mechanism of action of Thiothixene?

I. It only cause blockade at D1 receptor.
II. It only cause blockade at D2 receptor.
III. It cause blockade at both D1 & D2 receptor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Trifluoperazine is a piperazine phenothiazine agent that is an antagonist at the postsynaptic mesolimbic

dopaminergic D2 receptors.
79. Which of the following 1st generation Anti-psychotic drug is available as Inhaled formulation?
I. Haloperidol.
II. Loxapine.
III. Fluphenazine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Inhaled loxapine is a first-generation agent that may be similar to second-generation agents. In a new
formulation, it can be inhaled, which may make it attractive for some patients.
80. Which of the following drug is indicated to treat acute agitation associated with schizophrenia
and bipolar I disorder?
I. Oral chlorpromazine.
II. Injectable risperidone.
III. Inhaled loxapine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Loxapine inhaled is the first non injectable therapy to treat acute agitation associated with schizophrenia and
bipolar I disorder.
81. What are the major adverse effects of 2 nd generation Anti-psychotics?

I. Weight gain.
II. Neuroleptic malignant syndrome.
III. Metabolic adverse effects.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Second-generation (novel or atypical) antipsychotics, with the exception of aripiprazole, are dopamine D2
antagonists, but are associated with lower rates of extrapyramidal adverse effects and TD than the first-
generation antipsychotics. However, they have higher rates of metabolic adverse effects and weight gain.
82. Which of the following statement is false about Asenapine?
I. It is indicated for acute & maintenance treatment.
II. Available in sublingual form.
III. Has no ADRS.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Asenapine is indicated for acute and maintenance treatment of schizophrenia. It is absorbed poorly in the
gastrointestinal (GI) tract and thus is available in a sublingual form.
83. What is the major side effect associated with Clozapine?

I. Agranulocytosis.
II. Neuroleptic syndrome.
III. Dystonia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Clozapine is the oldest atypical antipsychotic agent and probably the most effective. Because it is associated with
about a 1% risk of agranulocytosis, patients must undergo white blood cell (WBC) count monitoring every
week for the first 6 months (the period of greatest risk), then every 2 weeks for 6 months, and finally every 4
weeks, as long as the absolute neutrophil count (ANC) is normal
84. What are the contraindications of Lurasidone?
I. Do not administer with CYP3A4 inhibitor.
II. Do not administer with CYP3A4 inducer.
III. Do not administer with Anticholinergics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
A major route of metabolism for lurasidone is via CYP3A4. Dose reduction is recommended in the presence of
moderate CYP3A4 inhibitors. Co administration with strong CYP3A4 inducers is not recommended.
85. Quetiapine is available in which of the following dosage forms?

I. Immediate release tablets.
II. Extended release tablets.
III. Suspension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Quetiapine is available in immediate-release and extended-release tablets.
86. Which of the following drug is available as long-acting IM injection?

I. Haloperidol.
II. Quetiapine.
III. Risperidone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Risperidone has both dopamine D2 and serotonin 5-HT2 antagonism. It is available in tablets, oral
disintegrating tablets, and an oral solution, as well as a long-acting form for IM injection that uses microspheres
made of biodegradable polymers.
87. Which of the following 2 nd generation antipsychotic cause less ADRS than others?
I. Risperidone.
II. Quetiapine.
III. Ziprasidone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Ziprasidone appears to cause less weight gain, hyperglycemia, and hyperlipidemia than other drugs in its
category do.
88. What is the indication of Ziprasidone?

I. Indicated for treatment of patients with schizophrenia.
II. Indicated for treatment of acute agitation in patients with schizophrenia.
III. Indicated for treatment of bipolar disorder.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Ziprasidone antagonizes dopamine D2, serotonin 5-HT2, histamine H1, and alpha1-adrenergic receptors. It
is available in capsule and short-acting IM injection forms. It is indicated for treatment of acute agitation in
patients with schizophrenia
89. Which of the following drug form metabolites having action similar to parent drug?
I. Ziprasidone.
II. Cariprazine.
III. Quetiapine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Cariprazine forms 2 major metabolites, desmethyl cariprazine (DCAR) and didesmethyl cariprazine
(DDCAR), which have in vitro receptor binding profiles similar to the parent drug.
90. What is the mechanism of action of Serotonin-Dopamine activity modulators?

I. Partial agonist at 5-HT1A & D2 receptor.
II. Partial agonist at 5-HT1A & D 1 receptor.
III. Antagonist at 5-HT2A receptor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Serotonin-dopamine activity modulators (sdams) act as a partial agonist at 5-HT1A and dopamine D2
receptors at similar potency, and as an antagonist at 5-HT2A and noradrenaline alpha1b/2C receptors.
91. Which of the following are Serotonin-dopamine modulators?
I. Aripiprazole.
II. Brexpiprazole.
III. Quetiapine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Brexpiprazole (rexulti)
Aripiprazole (abilify, abilify maintena, aristada)
92. Which of the following are 1 st generation antipsychotic?

I. Asenapine.
II. Chlorpromazine.
III. Haloperidol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
1st gen antipsychotics : haloperidol chlorpromazine
93. Which of the following are 2 st generation antipsychotic?

I. Iloperidone.
II. Thiothixene.
III. Lurasidone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
2nd gen antipsychotics: Iloperidone ,Lurasidone ,clozapine

94. In which conditions dosage adjustment are required in Brexpiprazole?
I. In Hepatic & Renal impaired patient.
II. If patient is poor metabolizer of CYP2D6.
III. If elimination rate increase.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Brexpiprazole Dosage modifications are necessary with renal or hepatic impairment. Dosage
modifications are also needed for individuals who are poor metabolizers of CYP2D6, or if co
administered drugs alter metabolism by CYP2D6 or CYP3A4.
95. What is the mechanism of action of Aripiprazole?

I. Partial agonist of D2 & 5-HT1A receptor.
II. Partial agonist of D1 & 5-HT1A receptor.
III. Antagonist at serotonin 5-HT2A receptor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Aripiprazole
It is thought to be a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and an antagonist
at serotonin 5-HT2A receptors, alpha1, and histamine H1 receptors.
96. What is the usual dose interval of Intramuscular Aripiprazole?
I. Every 2 week.
II. Every 4 week.
III. Every 6 week.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Aripiprazole It is available in tablets, orally disintegrating tablets, and short- and long-term (once-
monthly, q6wk) IM injections.
97. Which formulation of aripiprazole is indicated for acute treatment of Schizophrenia?

I. IV Aripiprazole.
II. IM Aripiprazole.
III. Oral Aripiprazole.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Oral aripiprazole is indicated for acute and maintenance treatment of schizophrenia. It is also used for acute
and maintenance treatment of bipolar I disorder, adjunctive therapy for major depressive disorder, and
treatment of irritability associated with autistic disorder.
98. Which of the following condition require once-monthly IM injection of Aripiprazole?

I. Major depressive disorder.
II. Acute exacerbation of psychotic symptoms in adults.
III. Maintenance treatment of bipolar I disorder.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The once-monthly IM injection is indicated for treatment of schizophrenia and for treatment of acute
exacerbation of psychotic symptoms in adults.
99. What is the dose of oral Paliperidone?

I. Once daily dosing (OD).
II. Twice daily dosing (BD).
III. Thrice daily dosing (TID).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Paliperidone is the major active metabolite of risperidone and was the first oral agent to allow once-daily
dosing.
100. Which of the following is true about Iloperidone?

I. Causes fewer extrapyramidal symptoms than do other antipsychotics.
II. Affinity for serotonin receptors only.
III. Antagonize Cholinergic receptors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Iloperidone is indicated for acute treatment of schizophrenia. Its precise mechanism of action is unknown, but
it is known to antagonize dopamine D2 and serotonin 5-HT2 receptors. However, it shows high affinity for
5-HT2A, D2, and D3 receptors and low-to-moderate affinity for D1, D4, H1, 5-HT1A, 5HT6, 5-HT7,
and NE alpha1 receptors. Iloperidone causes fewer extrapyramidal symptoms than do other antipsychotics.
Anxiety Disorders,
1. What is meant by Anxiety?
I. A brain disorder that share features of excessive fear and anxiety and related behavioral disturbances.
II. A brain disorder that affects how people think, feel, and perceive the world.
III. A brain disorder characterized by an enduring predisposition to generate epileptic seizures.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral
disturbances.
2. Which of the following is false about disorders of anxiety?

I. Separation anxiety disorder.
II. Social anxiety disorder.
III. Obsessive compulsive disorder.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Some of these disorders include separation anxiety disorder, selective mutism, social anxiety disorder, panic
disorder, and agoraphobia. Obsessive-compulsive disorder and post-traumatic stress disorder are no longer
considered anxiety disorders as they were in the previous version of the DSM.
3. Which of the following brain part is responsible for modulating fear & anxiety?
I. Hippo campus.
II. Amygdala.
III. Cerebellum.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The brain amygdala appears key in modulating fear and anxiety. Patients with anxiety disorders often show
heightened amygdala response to anxiety cues.
4. What mechanism is involved in modulating anxiety by Amygdala?

I. Increased Prefrontal limbic activation.
II. Reduced Prefrontal limbic activation.
III. Complete Inhibition of limbic system.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The amygdala and other limbic system structures are connected to prefrontal cortex regions. Hyper
responsiveness of the amygdala may relate to reduced activation thresholds when responding to perceived social
threat.
5. What therapy reverses the chances of anxiety?

I. Pharmacological only.
II. Psychological only.
III. Both Psychological & Pharmacological therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Prefrontal-limbic activation abnormalities have been shown to reverse with clinical response to psychologic or
pharmacologic interventions.
6. Which of the following are major mediators of causing anxiety disorders?
I. GABA,Dopamine,Serotonin,Nor epinephrine.
II. GABA,Dopamine,Serotonin, Epinephrine.
III. GABA,Glutamine,Serotonin,Nor epinephrine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
In the central nervous system (CNS), the major mediators of the symptoms of anxiety disorders appear to be
norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA).
7. Which of the following hormone also mediates anxiety disorder?

I. Thyroid-releasing factor.
II. Corticotropin-releasing factor.
III. Estrogen-releasing factor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Other neurotransmitters and peptides, such as corticotropin-releasing factor, may be involve
8. Which of the following Autonomic nervous system is responsible for mediating anxiety symptoms?
I. Parasympathetic nervous system.
II. Sympathetic nervous system.
III. Enteric system.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Peripherally, the autonomic nervous system, especially the sympathetic nervous system, mediates many of the
symptoms.
9. What underlying cause is shown by Positron emission tomography (PET) ?
I. Increased flow in right parahippocampal region.
II. Decreased flow in right parahippocampal region.
III. Reduced serotonin type 1A receptor binding.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Positron emission tomography (PET) scanning has demonstrated increased flow in the right parahippocampal
region and reduced serotonin type 1A receptor binding in the anterior and posterior cingulate and raphe of
patients with panic disorder.
10. Which of the following substance has shown elevated level in CSF examinatio n?
I. Orexin.
II. Prolactin.
III. Dopamine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The CSF in studies in humans shows elevated levels of orexin, also known as hypocretin, which is thought to
play an important role in the pathogenesis of panic in rat models.[7]
11. Which of the following are types of Anxiety disorder?
I. Generalized anxiety disorder, Social Phobia.
II. Obsessive compulsive disorder.
III. Panic disorder.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Anxiety disorders in general

Panic disorder
Social anxiety disorder (social phobia)
Specific phobia
12. What are the causes of anxiety?

I. Substance abuse.
II. Smoking.
III. Genetic & Environmental.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Substance-induced anxiety disorder (over-the-counter medications, herbal medications, substances of abuse) is

a diagnosis that often is missed.
Genetic factors significantly influence risk for many anxiety disorders. Environmental factors such as early
childhood trauma can also contribute to risk for later anxiety disorders.
13. What is general anxiety according to cognitive theory?
I. Tendency to underestimate the potential for danger.
II. Tendency to overestimate the potential for danger.
III. Patient tend to avoid crowd, heights or social interaction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Cognitive theory has explained anxiety as the tendency to overestimate the potential for danger. Patients with
anxiety disorder tend to imagine the worst possible scenario and avoid situations they think are dangerous, such
as crowds, heights, or social interaction.
14. What causes Panic anxiety disorder?

I. Decrease GABAergic tone.
II. COMT gene polymorphism.
III. Increase GABAergic tone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Panic disorder appears to be a genetically inherited neurochemical dysfunction that may involve autonomic
imbalance; decreased GABA-ergic tone[14] ; allelic polymorphism of the catechol-O-methyltransferase (COMT)
gene; increased adenosine receptor function; increased cortisol[15] ; diminished benzodiazepine receptor function;
and disturbances in serotonin,[16] serotonin transporter (5-HTTLPR)[17] and promoter (SLC6A4) genes,[18]
norepinephrine, dopamine, cholecystokinin, and interleukin-1-beta.
15. Which of the following is False regarding cause of Panic disorder?
I. Increased adenosine receptor function& cortisol.
II. Disturbances in serotonin.
III. Increased benzodiazepine receptor function.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Panic disorder appears to be a genetically inherited neurochemical dysfunction that may involve autonomic
imbalance; decreased GABA-ergic tone[14] ; allelic polymorphism of the catechol-O-methyltransferase (COMT)
gene; increased adenosine receptor function; increased cortisol[15] ; diminished benzodiazepine receptor function;
and disturbances in serotonin,[16] serotonin transporter (5-HTTLPR)[17] and promoter (SLC6A4) genes,[18]
norepinephrine, dopamine, cholecystokinin, and interleukin-1-beta.
16. What are the risk factors of Panic disorder?

I. Injury, Illness.
II. Cannabis OR Caffeine use.
III. Family history.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
. Triggers of panic can include the following:

 Injury (eg, accidents, surgery)
 Illness
 Interpersonal conflict or loss
 Use of cannabis (can be associated with panic attacks, perhaps because of breath-holding) [21]
 Use of stimulants, such as caffeine, decongestants, cocaine, and sympathomimetics (eg,
amphetamine, MDMA ["ecstasy"]) [2
17. Which of the following drug discontinuation is a risk factor for panic disorder?
I. Benzodiazepine.
II. Selective serotonin re-uptake inhibitor.
III. Barbiturates.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
 The SSRI discontinuation syndrome can induce symptoms similar to those experienced by panic
patients.
18. What factors triggers symptoms of Panic disorder?

I. CO2 inhalation & IV hyper-tonic infusions.
II. Caffeine consumption.
III. Excessive Sleeping.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In experimental settings, symptoms can be elicited in people with panic disorder by hyperventilation, inhalation
of carbon dioxide, caffeine consumption, or intravenous infusions of hypertonic sodium lactate or hypertonic
saline,[24] cholecystokinin, isoproterenol, flumazenil,[25] or naltrexone
19. What are the risk factors for Social phobia?
I. Genetic factors.
II. Smoking.
III. Environmental factors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Genetic factors seem to play a role in social phobia. Based on family and twin studies, the risk for social phobia
appears to be moderately heritable.
Social phobia can be initiated by traumatic social experience (eg, embarrassment) or by social skills deficits that
produce recurring negative experiences. A hypersensitivity to rejection, perhaps related to serotonergic or
dopaminergic dysfunction, is present. Current thought is that social phobia appears to be an interaction between
biological and genetic factors and environmental events.
20. What are the risk factors for Specific phobia?

I. Traumatic experience.
II. Conditioning experience.
III. Alcohol consumption.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Genetic factors seem to play a role in specific phobia as well (eg, in blood-injury phobia), and the risk for such
phobias also seems to be moderately heritable.[28] In addition, specific phobia can be acquired by conditioning,
modeling, or traumatic experience.
21. What is meant by Agoraphobia?
I. Genetically inherited chemical dysfunction that may involve autonomic imbalance.
II. Repeated, unexpected panic attacks or abnormalities in noradrenergic, serotonergic, or GABA-related
neurotransmission.
III. Social skill deficits that produce recurring negative experiences.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Agoraphobia may be the result of repeat, unexpected panic attacks, which, in turn, may be linked to cognitive
distortions, conditioned responses, and/or abnormalities in noradrenergic, serotonergic, or GABA-related
neurotransmission.
22. Which of the following is the most common anxiety disorder among adults?
I. General anxiety disorder.
II. Social anxiety disorder.
III. Specific phobia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Social anxiety disorder (social phobia) is the most common anxiety disorder; it has an early age of onset by
age 11 years in about 50% and by age 20 years in about 80% of individuals that have the diagnosis and it
is a risk factor for subsequent depressive illness and substance abuse
23. Which of the following individual is more susceptible to anxiety disorders?
I. Male.
II. Female.
III. Children.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The female-to-male ratio for any lifetime anxiety disorder is 3:2
24. A child was taken to psychiatrist with the complaint of excessive fear & anxiety while going to
school. What type of anxiety he might be suffering?
I. Panic disorder.
II. Social phobia.
III. Separation anxiety disorder.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Separation anxiety is an anxiety disorder of childhood that often includes anxiety related to going to school.
This disorder may be a precursor for adult anxiety disorders.
25. Which age group of people are more susceptible to panic disorder?
I. 15-24yrs old.
II. 20-30yrs old.
III. 45-54yrs old.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Panic disorder demonstrates a bimodal age of onset in the NCS study in the age groups of 15-24 years and 45-
54 years
26. Which age group people are more susceptible for Social phobia?
I. 16 yrs old.
II. 30 yrs old.
III. 50 yrs old.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Most social phobias begin before age 20 years (median age at illness onset, 16 years.[43] )
27. Which age group is more susceptible to Agoraphobia?

I. 25-29yrs old.
II. 10-15yrs old.
III. 15-20yrs old.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Agoraphobia usually begins in late adolescence to early adulthood (median age at illness onset, 29 years.[43] )
28. Two children were having phobia of different things. One is afraid of cats & other cannot see
blood of any origin. What type of phobia they might be suffering?
I. Social anxiety disorder.
II. Specific phobia.
III. Agoraphobia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Specific phobia appears earlier than social phobia or agoraphobia. The age of onset depends on the particular
phobia. For example, animal phobia is most common at the elementary school level and appears at a mean age
of 7 years; blood phobia appears at a mean age of 9 years; dental phobia appears at a mean age of 12 years;
and claustrophobia appears at a mean age of 20 years.
29. Which median age group is more susceptible to Specific phobia?

I. Childhood.
II. Adulthood.
III. Late adolescence.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Most simple (specific) phobias develop during childhood (median age at illness onset, 15 y).[43] ) and eventually
disappear. Those that persist into adulthood rarely go away without treatment.
30. Which of the following co-morbid conditions are responsible for high rate of morbidity?
I. Major Depression.
II. Alcohol & Drug Abuse.
III. Schizophrenia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Anxiety disorders have high rates of co-morbidity with major depression and alcohol and drug abuse. Some of
the increased morbidity and mortality associated with anxiety disorders may be related to this high rate of co-
morbidity.
31. What mechanism is involved in contributing morbidity & mortality in Anxiety disorders?
I. Neuro-endocrine mechanism.
II. Neuro-exocrine mechanism.
III. Neuro-immune mechanism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Anxiety disorders may contribute to morbidity and mortality through neuroendocrine and neuroimmune
mechanisms or by direct neural stimulation, (eg, hypertension or cardiac arrhythmia).
32. Which of the following anxiety disorder result in functional impairment & decrease life quality?
I. Specific phobia.
II. Social phobia.
III. Agoraphobia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Considerable evidence shows that social phobia (social anxiety disorder) results in significant functional
impairment and decreased quality of life.
33. What are the complications of severe anxiety disorders?
I. Depression.
III. Suicide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Severe anxiety disorders may be complicated by suicide, with or without secondary mood disorders (eg,
depression)
34. What factors precipitate the likelihood of suicidal attempt?

I. Mood disorder.
II. Anxiety disorder,phobias,Mood disorders.
III. Phobias only.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The presence of any anxiety disorder, phobias included, in combination with a mood disorder appears to
increase likelihood of suicide attempts compared with a mood disorder alone.
35. Which of the following is true regarding anxiety disorder?

I. Pure phobias are mostly severe.
II. Co-morbid phobias are generally severe than pure.
III. Both conditions are severe.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Comorbid phobias are generally more severe than pure phobias. Social phobia is also frequently comorbid with
major depressive disorder and atypical depression, which results in increased disability
36. Which of the following are the symptoms of panic disorder?
I. Chest pain.
II. Palpitations.
III. Kidney pain.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Attacks are associated with a constellation of systemic symptoms, including the following:
 Palpitations, pounding heart, or accelerated heart rate
 Sweating
 Trembling or shaking
 Shortness of breath or feeling of smothering
 Choking sensation
 Chest pain or discomfort
 Nausea or abdominal distress
37. What major questions do you ask as a health-care provider to rule out anxiety disorder?
I. History of caffeine or OTC medications intake.
II. Ask the patient about any myoclonic limb jerks during sleep.
III. Ask about his food habits.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
To rule out anxiety disorders secondary to general medical or substance abuse conditions, a detailed history and
review of symptoms is essential. Review use of caffeine-containing beverages (coffee, tea, colas), over-the-counter
sleep partner about apneic episodes or myoclonic limb jerks

38. What symptoms patient feel during the episode of Panic disorder?
I. They have Urge to flee.
II. Headache, cold hands.
III. Nausea & Vomiting.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
During the episode, patients have the urge to flee or escape and have a sense of impending doom (as though they
are dying from a heart attack or suffocation). Other symptoms may include headache, cold hands, diarrhea,
insomnia, fatigue, intrusive thoughts, and ruminations.
39. What behavioural changes are seen in patient suffering from Panic disorder?
I. Avoid situations & locations.
II. Making loud noises.
III. Losing control.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Patients with panic disorder have recurring episodes of panic, with the fear of recurrent attack resulting in
significant behavioral changes (eg, avoiding situations or locations) and worry about the implications of the
attack or its consequences (eg, losing control, going crazy, dying).
40. What other psychiatric disorders are risk factor for panic attacks?
I. Schizophrenia.
II. Depressive & manic disorder.
III. Parkin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Consider other mental illnesses that may result in panic attacks, including schizophrenia, manic disorder,
depressive disorder, posttraumatic stress disorder, phobic disorders, and somatization disorder
41. What are the two major symptoms of Generalized anxiety disorder?
I. Palpitation.
II. Excessive Anxiety.
III. Excessive Worry.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Generalized anxiety disorder

This disorder is characterized by excessive anxiety and worry
42. Which of the following are also symptoms of Generalized anxiety disorder?
I. Blank mind & difficult to concentrate on things.
II. Chest pain & dyspnea.
III. Muscle tension & sleep disturbance.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Anxiety and worry are associated with at least 3 of the following symptoms:
 Restlessness or feeling keyed-up or on edge
 Being easily fatigued
 Difficulty concentrating or mind going blank
 Irritability
 Muscle tension
 Sleep disturbance
43. Which of the following is false regarding Generalized anxiety disorder?
I. There is no suicidal attempt by patient at any stage.
II. There is suicidal ideation.
III. Sometimes completed suicide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Although not a diagnostic feature, suicidal ideation and completed suicide have been associated with
generalized anxiety disorder
44. What factors exacerbate functional impairment in Social Phobia patients?

I. Avoidance behavior.
II. Fear of dying.
III. Distress in feared social or performance setting.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
A person with social phobia will typically report a marked and persistent fear of social or performance situations,
to the extent that his or her ability to function at work or in school is impaired. Exposure to social or
performance situation always produces anxiety. Social or performance situations are avoided or endured with
intense anxiety. Avoidance behavior, anticipation, or distress in the feared social or performance setting
produces significant impairment in functioning.
45. What type of feeling do people with social phobia suffer?
I. Fear of being embarrassed.
II. Fear of death.
III. Fear of being humiliated.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Fear of scrutiny by others or of being embarrassed or humiliated is described commonly by people with social
phobia
46. Which signs show that person is Agoraphobic?

I. Fear of being trapped when alone.
II. Fear of death.
III. Fear of heights.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Agoraphobia
Inquire about any intense anxiety reactions that occur when the patient is exposed to specific situations such as
heights, animals, small spaces, or storms. Other areas of inquiry should include fear of being trapped without
escape (eg, being outside the home and alone; in a crowd of unfamiliar people; on a bridge, in a tunnel, in a
moving vehicle).
47. What type of questions do you ask to suspect Specific Phobia?
I. Fear of blood or needle.
II. Fear of animals or flying or heights.
III. Fear of being alone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
If specific phobias are suspected, specific questions need to be asked about irrational and out of proportion fear
to specific situations (eg, animals, insects, blood, needles, flying, heights).
48. Specific phobia can lead to what type of severe disorders?

I. Alcohol abuse.
II. Suicidal ideation.
III. Obsessive compulsive disorder.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Specific (simple) phobia

Phobias can be disabling and cause severe emotional distress, leading to other anxiety disorders, depression,
suicidal ideation, and substance-related disorders, especially alcohol abuse or dependence. The physician must
inquire about these areas as well.
49. What parameter are assessed in Mental Status Examination?
I. Assessment of behavior, mood& appearance.
II. Level of consciousness.
III. Thought processes & activity level.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
A complete mental status examination should be obtained for each patient with anxiety symptoms, assessing
appearance, behavior, ability to cooperate with the exam, level of activity, speech, mood and affect, thought
processes and content, insight, and judgment.
50. What are the early signs of Anxiety disorder?

I. Excessive fear.
II. Sweaty palms.
III. Restlessness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Patients may exhibit physical signs of anxiety such as sweaty palms, restlessness, and distractibility.
51. What is the effect of mood on anxiety patient?

I. Excited.
II. Normal.
III. Depressed.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Mood may be normal or depressed

52. What is effect of anxiety on Cognitive function?
I. Impaired memory.
II. No effect on memory.
III. Slight memory loss.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Cognition is typically intact with no impairment in memory, language, or speech.
53. What is the effect of anxiety on Patients speech?

I. Difficulty in speech.
II. Slurred speech.
III. No effect on speech.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Cognition is typically intact with no impairment in memory, language, or speech.

54. What kind of mental state assessment would you do in Generalized anxiety disorder?
I. Asking about suicidal ideation plan.
II. Asking about his fears.
III. Testing about his recall memory.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Two main elements of the mental status examination should be assessed in generalized anxiety disorder. The
first involves asking about suicidal/homicidal ideation or plan, such as the following:
 Have you ever wished you were never born, thought you would be better off dead, wish to harm
yourself or others, have a plan to harm yourself or others, or ever tried to kill yourself or seriously injure
yourself or others?
The second involves formal testing of orientation/recall, such as the following:
 Does the patient respond when you call them by name (oriented to person)?
 Is the patient oriented to place and time? When you ask what place, season, day, month, year is it,
does the patient respond appropriately?
55. Which type of diagnostic test is essential for detecting anxiety type?
I. Magnetic resonance imaging.
II. Mental state examination.
III. EEG.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Mental status screening is essential for diagnosis.

56. What signs are shown in Phobic patients after Mental State Examination?
I. Diaphoresis.
II. He feels Anxious.
III. Fear of dying.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Neurovegetative signs (such as tremor or diaphoresis) might be present. The patient also reports feeling anxious
(mood) and can clearly identify the reason for his/her anxiety (thought content). The thought content is
significant for phobic ideation (unrealistic and out of proportion fears). Insight might be impaired, especially
during exposure, but most times the patient has preserved insight and while reporting that they cannot control
their feelings, they also acknowledge that the severity of their fears is not justified.
57. Which of the following is true regarding Phobia disorder?

I. There is no suicidal ideation in Phobic patients.
II. There is always suicidal ideation in Phobic patients.
III. There is suicidal ideation only if co-morbid conditions exist.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
. Phobias do not present with suicidal or homicidal ideation, but co-morbid conditions commonly associated
with phobias, including depression and other anxiety disorders, do present with suicidal or homicidal ideation.
If co-morbid conditions exist, a specific assessment of the suicidal and homicidal risk should also be completed.
58. What are the essential diagnostic tests to rule out anxiety?
I. Laboratory tests, Physicalexamination, MRI.
II. Laboratory tests, Physicalexamination, Mental state examination.
III. Laboratory tests, Physicalexamination, EEG.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
For a patient who presents for a repeat visit with similar complaints, after medical contributors have been ruled
out, a careful mental status examination might be better suited than repeat physical examination and
laboratory investigations
59. On what basis you diagnose the patient with panic disorder?
I. Laboratory tests.
II. EEG.
III. Primarily by history taking.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Panic disorder
No signs on physical examination are specific for panic disorder. The diagnosis is made primarily by history.
60. A patient came to physician with complaint of tremors. His skin is cold and blood pressure is
slightly elevated. What type of anxiety disorder you diagnose?
I. Specific phobia.
II. Generalized anxiety disorder.
III. Panic disorder.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Tachycardia and tachypnea are common; blood pressure and temperature may be within the reference range,
though hypertension may occur as well. Tremors may be noted. Cool clammy skin may be observed.
61. Chvostek sign, Trousseau sign, or overt carpopedal spasm are signs of which of the following?
I. Specific phobia.
II. Panic disorder.
III. Social phobia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Panic disorder
Chvostek sign, Trousseau sign, or overt carpopedal spasm may be present.
62. What is the minimum duration of Panic attack?

I. 20-30 min.
II. 40-50min.
III. 5-10 min.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
A panic attack generally lasts 20-30 minutes from onset-rarely more than an hour
63. What are the common physical signs of Generalized Anxiety disorder?
I. Tachycardia, Sweaty palms.
II. Tachypnea.
III. Headache, Nausea.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Generalized anxiety disorder

Common physical signs of generalized anxiety disorder include tremor, tachycardia, tachypnea, sweaty palms,
and restlessness.
64. Which of the following symptoms children experience in generalized anxiety disorder?
I. Inability to swallow, Increased sweating.
II. Excessive fear of dying.
III. Dry mouth.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Typically, children and adults with generalized anxiety disorder also experience uncomfortable physical
symptoms including rapid heartbeat, feeling short of breath, increased sweating, stomach cramping, a feeling
of a lump in the throat or inability to swallow, frequent need to urinate, dry mouth, nausea, diarrhea, cold
and/or clammy hands, headaches, or neck or backaches
65. What symptoms are accompanied along with feeling of nervous tension in Generalized anxiety
patients?
I. Feeling of shaking or trembling.
II. Body ache.
III. Headache.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
A feeling of nervous tension is often accompanied by a feeling of shaking, trembling, twitching, or body ache
66. Which of the following tests should be performed to exclude any other disease cond ition?
I. Complete blood count, Thyroid function tests.
II. Urinalysis & Chemistry profile.
III. Renal & liver function tests.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
When the index of suspicion for anxiety being produced by a medical disorder is low (lack of physical findings,
younger age, typical anxiety disorder presentation), initial laboratory studies might be limited to the following:
 Chemistry profile
 Thyroid function tests
 Urinalysis
 Urine drug screen
67. Which tests are conducted to rule out any other mental disorder?
I. Lumbar puncture.
II. EEG or CT.
III. Blood tests.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Rule out CNS disorder using electroencephalography (EEG), lumbar puncture, or brain computed tomography
(CT) scan, as indicated by history and associated clinical findings
68. Which of the following test exclude seizure order suspicion in anxiety disorder individual?
I. EEG.
II. MRI.
III. Lumbar puncture.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
EEG may be used to exclude seizure disorder because these conditions may mimic anxiety.
69. Which of the following disorder may also mimic anxiety?

I. Parkinson disease.
II. Schizophrenia.
III. Seizure disorder.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
EEG may be used to exclude seizure disorder because these conditions may mimic anxiety.
70. Which of the following sign suspects about brain tumor besides anxiety disorder?
I. Nausea & vomiting.
II. Headache.
III. Delusions.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
If headache is a prominent feature, an EEG or MRI could be considered along with neurologic consultation
to rule out seizures or brain tumor.
71. Which of the following tests should be performed to exclude suspicion of intracranial
abnormality?
I. EEG.
II. Head CT.
III. MRI scan.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
A head CT scan may be ordered for suspected intracranial abnormality, or an MRI scan for intracranial
abnormality.
72. MRI & PET scanning have shown increase metabolic activity in which of the following patients?
I. Schizophrenic.
III. Seizure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Functional MRI and PET scanning have shown increases in blood flow and metabolic activity in the
orbitofrontal cortex, limbic structures, caudate, and thalamus, with a trend toward right-sided predominance,
in patients with obsessive-compulsive disorder.
73. Which of the following test is used to exclude cardiac disorders in Anxiety patient?
I. EEG.
II. ECG.
III. MRI.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Rule out cardiac disorders (eg, myocardial infarction) using electrocardiography (ECG) or treadmill ECG.
ECG may be used to check for mitral valve prolapse or to exclude arrhythmia.
74. ECG is used to check which of the following cardiac disorders?

I. Arrhythmia & MI.
II. Mitral valve prolapse.
III. Cardiomegaly.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Rule out cardiac disorders (eg, myocardial infarction) using electrocardiography (ECG) or treadmill ECG.
ECG may be used to check for mitral valve prolapse or to exclude arrhythmia.
75. Which of the following tests are used to rule out infectious disease?
I. Lumbar puncture.
II. EEG.
III. HIV testing.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Rule out infectious causes using rapid plasma reagent test, lumbar puncture (CNS infections), or HIV testing.
76. Arterial blood gas analysis is used for confirmation of which of the following?
I. Respiratory alkalosis.
II. Hypoxemia.
III. Metabolic acidosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Arterial blood gas analysis

Arterial blood gas analysis is useful in confirming hyperventilation (respiratory alkalosis) and excluding
hypoxemia or metabolic acidosis. The presence of hypoxemia with hypocapnia or a widened alveolar-arterial
(A-a) gradient should increase the suspicion of pulmonary embolus.
77. Electrolyte analysis should be done in anxiety patients to determine which of the following?
I. Calcium level.
II. Sodium level.
III. Potassium level.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Serum phosphorus and ionized calcium may be diminished in patients with hyperventilation and carpopedal
spasm, Chvostek sign, or Trousseau sign. The serum calcium level may be within the reference range
78. Chest radiography is done in anxiety patients to exclude?

I. Myocardial infarction.
II. Arrhythmia.
III. Pulmonary embolism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Chest radiography
Chest radiography is useful in excluding other causes of dyspnea with chest pain (eg, pulmonary embolism).
79. Which of the following condition is also cause of anxiety?

I. Hypothyroidism.
II. Hyperthyroidism.
III. Hypoalbuminemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Hyperthyroidism is one of the most common medical causes for anxiety related to a medical condition.
80. Which levels should be monitored to exclude Thyroid abnormality?

I. T4 levels.
II. Serum TSH.
III. T3 levels.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Serum thyroid-stimulating hormone and T4 levels should be considered for excluding a primary thyroid
abnormality.
81. Which of the following is true regarding anxiety disorder?
I. They are common psychiatric disorder.
II. Anxiety is often under recognized and under treated.
III. Anxiety is mostly recognized and treated well.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Anxiety disorders are common psychiatric disorders. Many patients with anxiety disorders experience physical
symptoms related to anxiety and subsequently visit their primary care providers. Despite the high prevalence
rates of these anxiety disorders, they often are under recognized and under treated clinical problems
82 Which factors exacerbate anxiety symptoms?

I. Biopsychosocial factors.
II. Trauma or stress.
III. Cardiac issues.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Anxiety disorders appear to be caused by an interaction of biopsychosocial factors, including genetic

vulnerability, which interact with situations, stress, or trauma to produce clinically significant syndromes
83. Which of the following theories explains anxiety better?
I. Psycho-dynamic model.
II. Cognitive-behavioral model.
III. Psycho-static model.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Psychological theories range from explaining anxiety as a displacement of an intrapsychic conflict

(psychodynamic models) to conditioning (learned) paradigms (cognitive-behavioral models). Many of these
theories capture portions of the disorder.
84. What is anxiety according to psycho-dynamic theory?

I. Conflict between Id and ego.
II. Tendency to overestimate he potential for danger.
III. Aggressive drives.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The psychodynamic theory has explained anxiety as a conflict between the id and ego. Aggressive and impulsive
drives may be experienced as unacceptable resulting in repression
85. Which of the following conditions may also exacerbate panic disorder symptoms?
I. Hyperventilation.
II. Hypoxia.
III. CO2 receptor hyper sensitivity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Some theorize that panic disorder may represent a state of chronic hyperventilation and carbon dioxide receptor
hypersensitivity
86. Which of the following chromosomal regions are associated with heritability of panic disorder?
I. 13q.
II. 14q.
III. 10q.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Genetic studies suggest that the chromosomal regions 13q, 14q, 22q, 4q31-q34, and probably 9q31 may be
associated with the heritability of panic disorder phenotype.[20]
87. Which system becomes more sensitive in panic disorder patients according to Cognitive Theory?
I. Autonomic system.
II. Somatic system.
III. Renal system.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The cognitive theory regarding panic is that patients with panic disorder have a heightened sensitivity to
internal autonomic cues (eg, tachycardia)
88. Which of the following anti-depressant can induce panic symptoms?

I. Ariprazole.
II. Diazepam.
III. Sertraline.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Sertraline can induce panic in previously asymptomatic patients.
89. Which of the following gas inhalation provokes panic symptoms?
I. O2.
II. CO2.
III. N2O.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The carbon dioxide inhalation challenge is especially provocative of panic symptoms in smokers
90. What do psychoanalyst conceptualize about social anxiety?

I. Avoidance response associated with dangers.
II. A conditioned response resulting from a past association with a situation.
III. A symptom of a deeper conflict-for instance, low self-esteem or unresolved conflicts.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
A psychoanalyst would likely conceptualize social anxiety as a symptom of a deeper conflict-for instance, low
self-esteem or unresolved conflicts with internal objects.
91. Which is true regarding social anxiety disorder?

I. Some people may develop fear of being embarrassed.
II. Some people may develop fear of being offensive.
III. Some people may develop fear of dying.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In some Far East cultures, individuals with social anxiety disorder may develop fears of being offensive to others
rather than fears of being embarrassed
92. What other medical conditions should be detected if anxiety symptoms occur in older adults?
I. Drug abuse.
II. Smoking.
III. Major depression.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
New-onset anxiety symptoms in older adults should prompt a search for an unrecognized general medical
condition, a substance abuse disorder, or major depression with secondary anxiety symptoms.
93. Chronic anxiety increase the risk of morbidity & mortality in which of the following systems?
I. CNS.
II. CVS.
III. PNS.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Chronic anxiety may be associated with increased risk for cardiovascular morbidity and mortality
94. What factors increase the chances of suicidal attempts in anxiety patients?
I. Embarrassment.
II. Divorce.
III. Financial disaster.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Suicide attempts can be precipitated by adverse life events such as divorce or financial disaster.
95. Which of the following is true regarding co-morbidity of Phobias?
I. Co-morbid Simple and specific phobias are temporarily primary.
II. Co-morbid Simple and specific phobias are temporarily secondary.
III. Co-morbid agoraphobia is temporarily secondary.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Most comorbid simple (specific) and social phobias are temporally primary, while most comorbid agoraphobia
is temporally secondary.
96. Which anxiety condition is concurrent with agoraphobia?

I. Panic disorder.
II. Specific phobia.
III. Generalized anxiety disorder.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
In clinical samples, over 95% of the patients reporting agoraphobia also present with panic disorder,
97. What is the effect of Panic disorder on personality traits?

I. Patient become more passive.
II. Patient become more dependent or withdrawn.
III. Patient become more violent.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Panic disorder may result in changes in personality traits, characterized by the patient becoming more passive,
dependent, or withdrawn
98. Which of the following symptoms should be considered while differential diagnosis of anxiety?
I. Chest pain, Diaphoresis.
II. Muscle cramps.
III. Palpitations.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Angina and myocardial infarction (e.g., dyspnea, chest pain, palpitations, diaphoresis)
99. Which of the following symptoms should be considered while differential diagnosis of anxiety?
I. Palpitations.
II. Tachycardia & heat intolerance.
III. Tachypnea.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Hyperthyroidism (eg, palpitations, diaphoresis, tachycardia, heat intolerance)

100. If the patient has symptoms of dyspnea & wheezing along with anxiety which condition you
can also suspect?
I. Asthma.
II. COPD.
III. Allergy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
1. Which class of drugs are used to treat anxiety disorder?
I. Anti-anxiety drugs
II. Antidepressant drugs
III. Anti-epileptic drugs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Antidepressant agents are the drugs of choice in the treatment of anxiety disorders,
2. What are the benefits of newer Anti-depressants?

I. Long term effect
II. No ADR
III. Easy to use
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
particularly the newer agents, which have a safer adverse effect profile and higher ease of use than the
older tricyclic antidepressants (TCAs), such as selective serotonin re-uptake inhibitors (SSRIs).
3. Which of the following Anti-depressants are not approved by FDA for treating anxiety but yet
effective?
I. Nefazodone
II. Mirtazapine
III. Sertraline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Antidepressants that are not FDA-approved for the treatment of a given anxiety disorder, such as
nefazodone and mirtazapine, still may be beneficial
4. Which of the following older anti-depressants are also effective in treatment of anxiety?
I. SSRIs
II. TCAs
III. MAOIs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Older antidepressants, such as TCAs and monoamine oxidase inhibitors (MAOIs), also are effective in
the treatment of some anxiety disorders
5. Which of following therapy is recommended for panic & phobia by NICE?

I. Computerized CBT(Cognitive behavioral therapy)
II. Psycho-dynamic therapy
III. Simple CBT(Cognitive behavioral therapy)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Computerized CBT (Fear Fighter) has been recommended for panic and phobia by the National Institute
for Health and Clinical Excellence guidelines (NICE)
6. Which factors determine the initiation of therapy & therapy type?
I. Severity of diagnosis & level of functioning
II. Degree of motivation for treatment
III. Type of anxiety
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The outcome of treatment is determined by several factors, including the following:

 Severity of diagnosis
 level of functioning prior to onset of symptoms
 Degree of motivation for treatment
 Level of support (eg, family, friends, work, school)
Ability to comply with medication and/or psychotherapeutic regimen
7. Which of the following class of drug is used to treat acute anxiety attack?
I. Barbiturates
II. Benzodiazepines
III. SSRIs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Patients with significant discomfort from their anxiety can benefit from emergency anxiolytic treatment,
primarily with a benzodiazepine.
8. Which of the following treatment is used to treat acute anxiety attack if patient is also posing
danger for others or themselves?
I. Benzodiazepine alone
II. Benzodiazepine + Psychotherapy
III. Psychotherapy alone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
In addition to ED treatment, patients in an acute anxious state of such severity that they pose a danger to
themselves or to others should have a psychiatric consultation.
9. Which of the following drug is used for patients with severe anxiety?
I. Fast acting Benzodiazepine
II. Slow acting Benzodiazepine
III. Fast acting Barbiturates
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
For patients with more severe anxiety, a short course of a fast-acting anxiolytic agent is recommended. Chronic
anxiety requires a comprehensive approach; the best pharmacotherapy varies for each individual, and
outpatient follow-up with a psychiatrist is recommended.
10. What is the therapy if patient with chronic anxiety also express suicidal thoughts?
I. Fast-acting Benzodiazepine
II. Fast-acting Benzodiazepine +Psychotherapy
III. Psychotherapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
However, these patients can be discharged on a short course of benzodiazepines until they see a psychiatrist. Patients who
express suicidal or homicidal thoughts should have an emergent psychiatric evaluation in the ED.
11. What is the possible therapy for children with mild Generalized anxiety disorder?
I. Cognitive behavioral therapy
II. Anti-depressant Medications
III. Supportive psychotherapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
CBT generally includes self-reward as well as problem solving and can be as effective as medications, especially
for children with mild generalized anxiety disorder
12. What is the alternate therapy if patient is resistant to CBT(Cognitive behavioral therapy) in Gen.
anxiety?
I. Medications
II. CBT+medications
III. Supportive psychotherapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Combining CBT with medications is extremely helpful in resistant cases.[63, 64] Other psychotherapies, such as
relaxation therapy, supportive psychotherapy, or mindfulness therapy, have been used if CBT is not appropriate
13. What are the indications for hospitalization of anxiety patient?
I. Suicidal risk
II. Severe functional & social skill impairment
III. Medication non-compliance
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Indications for hospitalization include the following

 Severe functional impairment (cannot meet own daily needs)
 Suicide or homicide risk
 Social skills deficits (eg, the person is so preoccupied that he or she is unaware that his or her actions
and behaviours have the potential to provoke others to cause harm
14. What is the best treatment plan for patients with Panic disorder?
I. SSRIs
II. Cognitive behavioral therapy
III. Supportive therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The 2011 American Psychiatric Association practice guideline for the treatment of patients with panic disorder
strongly recommends SSRIs, other pharmacotherapy, or CBT as initial treatment.
15. What is the duration of panic attack after reassurance and calming environment?
I. 10-15min
II. 20-30min
III. 40-50min
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Untreated panic attacks can subside spontaneously within 20-30 minutes, especially with reassurance and a
calming environment
16. Which of the following class of Anti-depressants are used as first line therapy?
I. Tricyclic anti-depressants
II. SSRIs
III. Benzodiazepine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Selective serotonin reuptake inhibitors (SSRIs) are generally used as first-line agents, followed remotely by
tricyclic antidepressants (TCAs).
17. Which of the following is most common side effect of Fluoxetine?

I. Sedation
II. Increase anxiety initially
III. Headache
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Fluoxetine (Prozac) can be used (especially if panic disorder occurs with depression); however, patients may
poorly tolerate it initially because it may initially increase anxiety, except at very low starting doses.
18. Which of the following benefit make fluoxetine a good choice?

I. Less ADRs
II. Long-half life
III. Wide therapeutic index
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Fluoxetine has a long half-life, making it a good choice in marginally compliant patients.
19. What are contraindications of Citalopram?
I. Patients with congenital long QT syndrome

II. Patient with arrhythmias
III. Patient with MI
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Dose-dependent QT prolongation has been reported with citalopram. Because of the risk for QT prolongation,
citalopram is contraindicated in individuals with congenital long QT syndrome and the dose should not exceed
40 mg/day
20. What are drug interactions of Citalopram?

I. Fluoxetine
II. Cimetidine
III. Omeprazole
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
citalopram is contraindicated in individuals with congenital long QT syndrome and the dose should not exceed
40 mg/day. Do not exceed a dose of 20 mg/day when co administration with CYP2C19 inhibitors (eg,
cimetidine, fluconazole, omeprazole
21. Which of the following is false about Escitalopram?
I. Cause severe hepatic enzyme interaction
II. Cause fewer hepatic enzyme interaction
III. Patient usually prefer over citalopram
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Escitalopram (Lexapro) is likely to cause fewer hepatic enzyme interactions and may be appropriate initial
choices for patients with complicated medical regimens or those who are concerned about drug interactions
22. What is the mechanism of action of Mirtazapine?

I. Alpha-1 antagonist
II. Alpha-2 antagonist
III. Serotonergic receptor blocker
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Mirtazapine acts distinctly as an alpha-2 antagonist, consequently increasing synaptic norepinephrine and
serotonin, while also blocking some postsynaptic serotonergic receptors that conceptually mediate excessive
anxiety when stimulated with serotonin.
23. Which of the following is true about side effect of Mirtazapine?

I. Sedation
II. Weight loss
III. Weight gain
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Mirtazapine may cause residual morning sedation that often improves with continued therapy and may cause
an increase in appetite or weight gain
24. What is the dose of Mirtazapine?
I. 5-10 mg/d
II. 15-30mg/d
III. 2-5mg/d
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
mirtazapine (15-30 mg/d) administered in the early weeks of treatment may have an earlier-onset action for
anxiety symptoms.
25. Which of the following antidepressant cause sedation?

I. Fluoxetine
II. Paroxetine
III. Mirtazapine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Sedating antidepressants such as paroxetine, mirtazapine, and other TCAs/TeCAs are usually prescribed only
at night before bed to help improve sleep but should include a warning not to operate a motor vehicle or
machinery if feeling sedated or directly after the dose.
26. Which of the following drugs should be used only at night or bed time?
I. Paroxetine
II. Mirtazapine
III. Sertraline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Sedating antidepressants such as paroxetine, mirtazapine, and other TCAs/TeCAs are usually prescribed only
at night before bed to help improve sleep but should include a warning not to operate a motor vehicle or
machinery if feeling sedated or directly after the dose.
27. Which of the following is side effect of Alprazolam?
I. High dependence
II. Rebound anxiety
III. Sedation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Alprazolam (Xanax) has been widely used for panic disorder, but it is currently discouraged because of its
higher dependence potential; alprazolam has a short half-life, which makes it particularly prone to rebound
anxiety and psychological dependence.
28. Why clonazepam has become favoured replacement instead of Alprazolam?

I. Longer-half life
II. Few withdrawal reaction
III. No enzyme interaction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Clonazepam (Klonopin) has become a favoured replacement because it has a longer half-life and empirically
elicits fewer withdrawal reactions upon discontinuation.
29. Which of the following is considered ideal therapy for anxiety?

I. Cognitive & behavioral therapy alone
II. Pharmacotherapy alone
III. Cognitive & behavioral therapy & Pharmacotherapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Cognitive and behavioral psychotherapy can be used alone or in addition to pharmacotherapy. The
combination approach yields superior results for most patients compared to either single modality.
30. What is the aim of Cognitive therapy?
I. Helps patients understand how false belief lead to anxiety
II. Help patient understand how automatic thoughts lead to secondary behavioral response
III. Exposing patient to anxiety provoking stimuli
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Cognitive therapy helps patients understand how automatic thoughts and false beliefs/distortions lead to
exaggerated emotional responses, such as anxiety, and can lead to secondary behavioral consequences.
31. What is the aim of Behavioral therapy?

I. Helps patients understand how false belief lead to anxiety
II. Exposing patient to anxiety provoking stimuli
III. Desensitizing patient to experience
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Behavioral therapy involves sequentially greater exposure of the patient to anxiety-provoking stimuli; over time,
the patient becomes desensitized to the experience.
32. Which of the following therapy helps Patient with anxiety in controlling hypertension?
I. Behavioral therapy
II. Cognitive therapy
III. Respiratory training
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Respiratory training can help control hyperventilation during panic attacks and help patients control anxiety
with controlled breathing
33. Social phobia respond to which of the following drugs?

I. Benzodiazepine
II. SSRIs
III. MAOIs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Social phobia typically responds to either an SSRI or a monoamine oxidase inhibitor (MAOI
34. Which of the following SSRIs are approved for Social phobia?
I. Paroxetine
II. Sertraline
III. Escitalopram
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
SSRIs approved for social phobia include paroxetine[89] (including SR form) and sertraline, but other SSRIs
have also been shown to be effective (eg, fluvoxamine[90] ).
35. Which of the following are not helpful in treatment of Social phobia?
I. Beta-blocker
II. Paroxetine
III. Clonidine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Beta-blockers, clonidine, and buspirone are usually not helpful for long-term treatment, although a beta-blocker
such as atenolol, nadolol, or propranolol may be useful for the circumscribed treatment of
situational/performance anxiety on an as-needed basis.
36. Patient with Specific phobia respond well to which of the following therapy?
I. Cognitive behavioral therapy
II. Respiratory therapy
III. Pharmacotherapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Specific phobias respond well to CBT. Gradual desensitization is the most commonly used treatment.
37. What is the first line therapy in Agoraphobic patient?

I. Normal dose of SSRI
II. Low dose of SSRI
III. Benzodiazepine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Agoraphobia (specifically, the panic symptoms) most often responds to treatment with an SSRI. Treatment
38. Why Benzodiazepine is not used as first line therapy in Agoraphobic patient?
I. Low efficacy
II. Potential for abuse
III. Greater side effects
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Benzodiazepines can be used either as an adjunct or as primary treatment; however, benzodiazepines are
usually not chosen as a first-line treatment because of the potential for abuse
39. Which of the following compounds should be avoided in anxiety symptoms?

I. Caffeine-containing products
II. Cheese
III. OTC medications
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Caffeine-containing products, such as coffee, tea, and colas, should be discontinued (or decreased to a low
reasonable level). Over-the-counter preparations and herbal remedies should be reviewed with special caution
because ephedrine and other herbal compounds may precipitate or exacerbate anxiety symptoms.
40. Which of the following consultation is required if there is cognitive impairment in anxiety
patient?
I. Psychology consultation
II. Cardiology consultation
III. Neurologic consultation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Psychology consultation and testing is indicated if cognitive impairment is of concern or if the patient may be
a candidate for CBT
41. Which of the following consultation is required if there are symptoms of abnormal blood pressure
in anxiety patient?
I. Neurologic consultation
III. Psychologic consultation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Cardiology consultation is indicated when symptoms include heart rate irregularity or abnormal blood pressure
42. Which of the following consultation is required if there is headache or visual abnormalities in
anxiety patient?
III. Endocrinology consultation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Neurology consultation is indicated when symptoms include headaches or visual field abnormalities, balance
abnormalities, or mental status changes.
43. Which of the following consultation is required if there is heat intolerance or mood swings in
anxiety patient?
III. Endocrinology consultation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Endocrinology consultation is indicated when symptoms include heat or cold intolerance, problems with fluid
balance, or mood swings due to cortisol abnormalities.
44. Which of the following drugs belong to Selective serotonin re-uptake inhibitors class?
I. Nefazodone
II. Paroxetine
III. Citalopram
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The ssris include paroxetine (Paxil), escitalopram (Lexapro), sertraline (Zoloft), fluoxetine (Prozac),
fluvoxamine (Luvox), and citalopram (Celexa).
45. What is the treatment course duration of SSRIs ?

I. 2-4 week course
II. 3-5 week course
III. 4-6 week course
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
SSRIs are first-line agents for long-term management of anxiety disorders, with control gradually achieved over
a 2- to 4-wk course, depending on required dosage increases.
46. SSRIs are not helpful in which of the following anxiety disorder?
I. Generalized anxiety disorder
II. Panic disorder
III. Specific phobic disorder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
SSRIs are helpful for generalized anxiety disorder, panic disorder, obsessive-compulsive disorder (OCD), and
social phobia.
47. Higher dos of SSRIs is required in which of the following disorder?

I. Obsessive compulsive disorder
II. Panic disorder
III. Social phobic disorder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
All SSRIs may be equal in the treatment of anxiety disorders; however, higher doses may be necessary in the
treatment of OCD
48. Which of the following SSRI has minimal withdrawal side effects?
I. Fluvoxamine
II. Fluoxetine
III. Paroxetine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Fluoxetine has a very long half-life, making it well suited for patients who have difficulty remembering to take all of their
medications each day. The longer half-life also minimizes the risk and severity of SSRI withdrawal that can occur when
patients exhaust or abruptly discontinue their SSRI.
49. Which of the following SSRI has a potential to cause sedation?
I. Fluvoxamine
II. Paroxetine
III. Escitalopram
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Paroxetine (Paxil)
Alternative sedating SSRI.
50. Escitalopram is primarily indicated for which of the following disorder?

I. OCD
II. Panic disorder
III. Generalized anxiety disorder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Escitalopram (Lexapro)
FDA approved for generalized anxiety disorder.
51. What is the mechanism of action of Escitalopram?

I. Potentiation of serotonergic activity in CNS
II. Inhibition of CNS neuronal re-uptake of serotonin
III. Activation of CNS neuronal re-uptake of serotonin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Mechanism of action is thought to be potentiation of serotonergic activity in central nervous system resulting
from inhibition of CNS neuronal reuptake of serotonin
52. Sertraline is indicated for all of following except?

I. Panic disorder
II. Social phobia & OCD
III. Specific phobia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Sertraline (Zoloft)
FDA-approved for panic disorder, PTSD, social phobia, and OCD
53. What is the major indication of Fluoxetine?
I. Panic disorder
II. OCD
III. Phobic disorder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Fluoxetine (Prozac)
FDA-approved for OCD and panic disorder.
54. Which of the following SSRI is indicated for OCD in children & adults?
I. Fluoxetine
II. Fluvoxamine
III. Paroxetine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Fluvoxamine (Luvox)
FDA approved for OCD in children (8-17 y) and adults
55. Which of the following is true about Citalopram?

I. Citalopram is racemic mixture of r- & s-citalopram
II. Citalopram is racemic mixture of r- & s-Escitalopram
III. Citalopram is enantiomer of Escitalopram
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Citalopram is a 50:50 racemate of r- and s-citalopram
56. What is the mechanism of action of SNRIs?

I. Inhibition of re-uptake of serotonin
II. Inhibition of re-uptake of serotonin & nor-epinephrine
III. Blockage of re-uptake process
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Serotonin And Norepinephrine Reuptake Inhibitors

Class Summary
Pharmacologic agents with reuptake inhibition of serotonin and norepinephrine such as venlafaxine (Effexor
and Effexor XR) and duloxetine (Cymbalta) may be helpful in a variety of mood and anxiety disorders.
57. Which of the following drugs belong to SNRI class?
I. Venlafaxine
II. Fluoxetine
III. Duloxetine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Serotonin And Norepinephrine Reuptake Inhibitors

Class Summary
Pharmacologic agents with reuptake inhibition of serotonin and norepinephrine such as venlafaxine (Effexor
and Effexor XR) and duloxetine (Cymbalta) may be helpful in a variety of mood and anxiety disorders.
58. Venlafaxine is indicated for treatment of which of the following according to FDA?
I. Panic disorder
II. Gen. Anxiety disorder
III. Specific phobia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Venlafaxine (effexor xr)

Fda-approved for generalized anxiety disorder, panic disorder and social anxiety disorder in adults. May be
helpful for other anxiety disorders.
59. What is the indication of Duloxetine?
I. Panic disorder
II. Specific phobia
III. Generalized anxiety disorder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Duloxetine (cymbalta)
Potent inhibitor of neuronal serotonin and norepinephrine reuptake. Indicated for generalized anxiety disorder
60. Which of the following drugs are included in Atypical Anti-depressant?

I. Nefazodone
II. Duloxetine
III. Mirtazapine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Antidepressants that are not FDA-approved for the treatment of a given anxiety disorder, such as nefazodone
and mirtazapine still may be beneficial for the treatment of anxiety disorders. Mirtazapine has a much more
sedating effect, generally reducing its potential to aggravate initial anxiety.
61. What are the major properties of Tri-cyclic anti-depressants?
I. They have sedative effects
II. They have anti-cholinergic effects centrally & peripherally
III. They have cholinergic effects centrally & peripherally
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The tricyclic antidepressants are a complex group of drugs that have central and peripheral anticholinergic
effects, as well as sedative effects
62. Which of the following drugs belong to Tri-cyclic antidepressant class?

I. Imipramine
II. Clomipramine
III. Nefazodone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
They include imipramine (Tofranil) and clomipramine (Anafranil).

63. What are contraindications of Tri-cyclic anti-depressants?
I. Lethal toxicity in overdose
II. Should only be used when SSRIs are ineffective
III. Should be used in combination
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Caution is warranted in the use of tcas because of their higher toxicity and potential lethality in overdose.
Their use should be limited to cases in which ssris are ineffective or cannot be afforded.
64. Which of the following Tri-cyclic agent is effective compared to other drugs in the same class?
I. Imipramine
II. Amitriptyline
III. Clomipramine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Clomipramine has an FDA indication in the treatment of OCD and is the only TCA effective in the treatment
of this condition
65. Which of the following metabolite of Clomipramine affects serotonin uptake?

I. Methyl clomipramine
II. Desmethylclomipramine
III. L-methyl clomipramine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Clomipramine affects serotonin uptake while it affects norepinephrine uptake when converted into its
metabolite desmethylclomipramine. Believed that these actions are responsible for its antidepressant activity.
66. What is the mechanism of action of Nortriptyline?

I. Desensitization of Adenyl cyclase
II. Down regulation of beta receptors
III. Up regulation of beta receptors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Pharmacodynamic effects such as the desensitization of adenyl cyclase and down-regulation of beta-adrenergic
receptors and serotonin receptors also appear to play a role in its mechanisms of action.
67. Which of the following is the metabolite of Amoxapine?
I. 5-hydroxyamoxapine
II. 6-hydroxyamoxapine
III. 7-hydroxyamoxapine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Metabolite (7-hydroxyamoxapine) has significant dopamine receptor blocking activity similar to haloperidol
68. Which of the following statement is true regarding Benzodiazepines?

I. Used as adjunct treatment
II. Used in management of specific phobia
III. Used for rapid control of panic attacks.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Benzodiazepines often are used with antidepressants as adjunct treatment. They are especially useful in the
management of acute situational anxiety disorder and adjustment disorder where the duration of
pharmacotherapy is anticipated to be 6 weeks or less and for the rapid control of panic attacks.
69. What are the side effects of Benzodiazepines?
I. Tolerance & withdrawal
II. Addiction
III. Sedation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Benzodiazepine use may be associated with tolerance, withdrawal, and treatment-emergent anxiety. The risk
of addiction with benzodiazepines should be carefully considered before use in the anxiety disorders. Avoid use
in patients with a prior history of alcohol or other drug abuse.
70. Which of the following belong to benzodiazepines?

I. Oxazepam
II. Chlordiazepoxide
III. Fluoxetine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
)Diazepam (valium)
Chlordiazepoxide (librium)
)oxazepam (serax)
71. What is the onset of action of Lorazepam?
I. Prolong onset of action
II. Short onset of action
III. Medium onset of action
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Lorazepam (ativan)
Sedative hypnotic in the benzodiazepine class that has a short onset of effect and a relatively long half-life
72. What is the peak plasma concentration of Clonazepam?

I. 2-4hr
II. 10-15hr
III. 24hr
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Clonazepam: Reaches peak plasma concentration at 2-4 h after oral or rectal administration.
73. What is the mechanism of action of Chlordiazepoxide?

I. Potentiate GABA activity
II. Inhibit GABA activity
III. Potentiate glutamate activity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Chlordiazepoxide (librium)
Depresses all levels of cns, including limbic and reticular formation, possibly by increasing gamma-
aminobutyric acid (gaba) activity, a major inhibitory neurotransmitter.
74. Which of the following is Anti-anxiety agent?

I. Chlordiazepoxide
II. Buspirone
III. Clonazepam
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Buspirone is a novel antianxiety agent with no other members in its class.
75. What is the mechanism of action of Buspirone?

I. 5-HT1A agonist
II. Dopamine agonist
III. 5-HT1A antagonist
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Buspirone (BuSpar)
5-HT1A agonist affecting serotonergic neurotransmission in CNS. Has some dopaminergic activity as well.
76. Which of the following is the drug of choice in Anti-convulsant class?

I. Divalproex
II. Gabapentin
III. Pregabalin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Anticonvulsant
Class Summary
The drug of choice in this category is the gamma-aminobutyric acid derivative pregabalin (Lyrica)
77. What is the mechanism of action of Pregabalin?
I. Binds to alpha2-delta site
II. Bind to GABA receptor
III. Reduces calcium-dependent release of neurotransmitters
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Pregabalin :Binds with high affinity to alpha2-delta site (a calcium channel subunit). In vitro, reduces
calcium-dependent release of several neurotransmitters, possibly by modulating calcium channel function.
78. Which of the following is structural analogue of GABA?

I. Pregabalin
II. Gabapentin
III. Divalproex
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Gabapentin (Neurontin)
Membrane stabilizer, a structural analogue of inhibitory neurotransmitter gamma-amino butyric acid
(GABA), which paradoxically is thought not to exert effect on GABA receptors
79. What is the indication of Divalproex?
I. Treatment of bipolar disorder
II. Treatment of behavioral disorder
III. Treatment of OCD
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Divalproex (Depakote, Depakote ER)

Has proven effectiveness in treating and preventing mania. Classified as a mood stabilizer and can be used
alone or in combination with lithium. Useful in treating patients with rapid-cycling bipolar disorders and has
been used to treat aggressive or behavioral disorders.
80. Which of the following Anti-hypertensive agents are useful in anxiety?

I. Calcium Channel blocker
II. Beta-blocker
III. Ace-inhibitors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Antihypertensive Agent
Class Summary
Agents in this class may have a positive effect on the physiological symptoms of anxiety. Beta-blockers such as
atenolol, nadolol, or propranolol may be useful for the circumscribed treatment of situational/performance
anxiety on an as-needed basis
81. What is the mechanism of action of clonidine in anxiety patient?
I. Stimulates alpha 2 adrenergic receptor
II. Stimulates alpha 1 adrenergic receptor
III. Decrease of vasomotor tone & heart rate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Clonidine (Catapres)
Investigational agent. Central alpha-adrenergic agonist that stimulates alpha2-adrenoreceptors in brain stem
and activates an inhibitory neuron, resulting in a decrease in vasomotor tone and heart rate.
82. Why Propranolol is not the drug of choice in anxiety patients?

I. GI & cardiac side effects
II. Hypotension
III. Sedation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Propranolol
May cause unpleasant cardiovascular and GI adverse effects and is not the DOC especially as hypotension
and/or cardiac block can occur.
83. Which receptor is blocked by Nadolol?
I. beta 1 receptor
II. beta 2 receptor
III. Both beta-1 &-2 receptors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Nadolol (Corgard)
Competitively blocks beta1 and beta2-receptors.
84. What is the mechanism of action of Beta-adrenergic blocking agents?

I. Negative chronotropic effect
II. Negative inotropic effect
III. Positive inotropic effect
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Beta-adrenergic blocking agents affect blood pressure via multiple mechanisms. Actions include negative
chronotropic effect that decreases heart rate at rest and after exercise, negative inotropic effect that decreases
cardiac output, reduction of sympathetic outflow from the CNS, and suppression of renin release from the
kidneys.
85. Which of the following belong to MAOIs?

I. Selegiline
II. Isocarboxazid
III. Oxacarbazine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Maois are most commonly prescribed for patients with social phobia. They include the agents phenelzine
(Nardil), selegiline (Emsam), tranylcypromine (Parnate), and isocarboxazid (Marplan).
86. What are the major disadvantages of MAOIs?
I. Hypotension
II. Hypertension
III. Weight gain
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Disadvantages are the higher number of adverse effects, including sexual difficulty, hypotension, and weight
gain, and potential lethality in overdose. A diet low in tyramine must be followed to avoid a hypertensive crisis
87. What are the drug interactions of MAOIs?
I. Cocaine
II. Enzyme inducers
III. OTC medicines
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Over-the-counter medications should be used with great caution.
88. What is the lowest dose of Selegiline?

I. 6mg
II. 5mg
III. 2mg
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Selegiline (emsam)
At lowest strength (ie, 6 mg delivered over 24 h), may be used without the dietary restrictions required for oral
maois used to treat depression.
89. What is the mechanism of action of Tranylcypromine?
I. Irreversible binding to MAO, reducing monoamine breakdown
II. Reversible binding to MAO, reducing monoamine breakdown
III. Irreversible binding to MAO, promoting monoamine breakdown
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Tranylcypromine (parnate)
Treats major depression. Binds irreversibly to mao, thereby reducing monoamine breakdown and enhancing
synaptic availability.
90. What is the indication of Anti-psychotic agents?

I. First line treatment option in generalized anxiety disorder
II. Second line treatment option in generalized anxiety disorder
III. In panic disorder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Antipsychotic agent
Class summary
Atypical and typical antipsychotic medications are generally used more as augmentation strategies and are
second-line treatment options in generalized anxiety disorder
91. What ADRS are associated with Anti-psychotic agents?
I. Tardive dyskinesia, Hypertension
II. Diabetic ketoacidosis, Hypotension
III. Weight loss
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
All drugs in this class may increase risk of life-threatening neuroleptic malignant syndrome, acute dystonias,
tardive dyskinesia, weight gain, metabolic syndrome, and potential to cause diabetic ketoacidosis as well as
stroke, hypertension, hypotension, or sudden death from cardiac conduction or cardiac electrophysiological
abnormalities.
92. What is the safest dose of quetiapine in anxiety patients?

I. 5-10 mg
II. 50-300mg
III. 100-150mg
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Quetiapine has a pending application for approval by the FDA for use in generalized anxiety disorder as well
as in major depressive disorder for patients whose symptoms do not remit with other treatments as it seems that
low doses (50-300 mg range) of quetiapine may not be associated with the risk of hyperglycemia and metabolic
syndrome that potentially can occur in higher dosage ranges or with other antipsychotic medications.
93. Which of the following is true about Risperidone?
I. Low affinity binding to D2 receptor
II. High affinity binding to 5-HT2 receptor
III. High affinity binding to D2 receptor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Risperidone (risperdal)
Binds to dopamine d2 receptor with a 20-times lower affinity than for the 5-ht2 receptor.
94. Which of the following is not the side effect of ariprazole?

I. Weight gain
II. Hypertension
III. QTc interval prolongation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Aripiprazole is thought to be a partial dopamine (D2) and serotonin (5HT1A) agonist and antagonize serotonin
(5HT2A). Additionally, no qtc interval prolongation was noted in clinical trials.
95. What makes Quetiapine different from other candidates of same class ?
I. Long term management & less dystonia
II. Few Anticholinergic effects
III. Rapid onset
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Quetiapine (seroquel)
May act by antagonizing dopamine and serotonin effects.
Newer antipsychotic used for long-term management. Improvements over earlier antipsychotics include fewer
anticholinergic effects and less dystonia, parkinsonism, and tardive dyskinesia
96. Which of the following anti-psychotic is drug of choice in Acute psychosis?
I. Haloperidol
II. Clozapine
III. Olanzapine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Haloperidol (haldol)
Doc for patients with acute psychosis when no contraindications exist.
97. Which of the following drug is co-administered with Haloperidol for better anxiolytic effects?
I. Lorazepam
II. Clonazepam
III. Diazepam
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Parenteral dosage form may be admixed in same syringe with 2-mg lorazepam for better anxiolytic effects.
98. Which of the following is true about side effect of Clozapine?

I. Hypertension
II. Agranulocytosis
III. Neutropenia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Associated with a risk of agranulocytosis when used at doses required for treatment of patients with
schizophrenia whose symptoms are refractory to standard neuroleptics. In US, weekly dosing and weekly cbcs
are required for clozapine to be dispensed; discontinuing therapy at first sign of leukopenia decreases but does
not eliminate risk of agranulocytosis;
99. What is the mechanism of action of Olanzapine?
I. Inhibit serotonin effects
II. Inhibit muscarinic effects
III. Inhibit GABA effects
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Olanzapine (zyprexa)
May inhibit serotonin, muscarinic, and dopamine effects.
100. Which of the following drugs are included in Anti-psychotics?

I. Quetiapine
II. Clonazepam, Diazepam
III. Clozapine, Haloperidol
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Quetiapine (seroquel)
Haloperidol (haldol)
Clozapine (clozaril)
ENDOCRINE SYSTEM
DIABETES MELLITUS
1. What is mean by type 2 diabetes mellitus ?

I. It consists of an array of dysfunctions characterized by hyperglycemia.
II. It resulting from the combination of resistance to insulin action, inadequate insulin secretion.
III. It consists of an array of dysfunctions characterized by hypoglycaemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from
the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate
glucagon secretion. See the image below.
2. What are the classic symptoms of type 2 diabetes mellitus ?

I. Polyuria.
II. Weight gain.
III. Polydipsia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Many patients with type 2 diabetes are asymptomatic. Clinical manifestations include the following:
 Classic symptoms: Polyuria, polydipsia, polyphagia, and weight loss
3. What are the classic symptoms of type 2 diabetes mellitus ?
I. Weight gain.
II. Polyphagia.
III. Weight loss.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
4. What are the clinical manifestations of type 2 diabetes mellitus ?

I. Blurred vision.
II. Lower-extremity paresthesias.
III. Weight gain.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Blurred vision
 Lower-extremity paresthesias
5. What are the clinical manifestations of type 2 diabetes mellitus ?
I. Weight gain.
II. Yeast infections (eg, balanitis in men).
III. Weight loss.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Yeast infections (eg, balanitis in men)
6. What is the diagnostic criteria of type 2 diabetes mellitus given by American diabetes association
?
I. A fasting plasma glucose (FPG) level of 126 mg/dL (7.0 mmol/L) or higher.
II. A 2-hour plasma glucose level of 200 mg/dL (11.1 mmol/L).
III. A 2-hour plasma glucose level lower during a 80-g oral glucose tolerance test (OGTT).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Diagnostic criteria by the American Diabetes Association (ADA) include the following[1] :
 A fasting plasma glucose (FPG) level of 126 mg/dl (7.0 mmol/L) or higher, or
 A 2-hour plasma glucose level of 200 mg/dl (11.1 mmol/L) or higher during a 75-g oral glucose
tolerance test (OGTT),
7. What is the diagnostic criteria of type 2 diabetes mellitus given by american diabetes association
?
I. A 2-hour plasma glucose level lower during a 80-g oral glucose tolerance test (OGTT).
II. A 2-hour plasma glucose level higher during a 75-g oral glucose tolerance test (OGTT).
III. A random plasma glucose of 200 mg/dL or higher in a patient with classic symptoms of hyperglycemia
or hyperglycemic crisis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Diagnostic criteria by the American Diabetes Association (ADA) include the following:
tolerance test (OGTT), or
 A random plasma glucose of 200 mg/dl (11.1 mmol/L) or higher in a patient with classic symptoms
of hyperglycemia or hyperglycemic crisis
8. What is the goal of treatment of type 2 diabetes mellitus ?

I. Microvascular risk reduction through control of glycemia and blood pressure.
II. Macrovascular risk reduction through control of lipids and hypertension, smoking cessation.
III. To increase the exercise tolerance of the patient.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Goals of treatment are as follows:

 Microvascular (ie, eye and kidney disease) risk reduction through control of glycemia and blood
pressure
 Macrovascular (ie, coronary, cerebrovascular, peripheral vascular) risk reduction through control of
lipids and hypertension, smoking cessation
9. What is the goal of treatment of type 2 diabetes mellitus ?
I. To increase the exercise tolerance of the patient.
II. Metabolic risk reduction through control of glycemia.
III. Neurologic risk reduction through control of glycemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Goals of treatment are as follows:

 Metabolic and neurologic risk reduction through control of glycemia
10. What are the different approaches to prevent the complications of diabetes ?
I. HbA1c every 3-6 months.
II. Yearly dilated eye examinations.
III. Blood pressure > 150/80 mm Hg, higher in diabetic nephropathy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Approaches to prevention of diabetic complications include the following:

 Hba1c every 3-6 months
 Yearly dilated eye examinations
I. Blood pressure > 150/80 mm Hg, higher in diabetic nephropathy.
II. Annual microalbumin checks.
III. Foot examinations at each visit.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Annual microalbumin checks
 Foot examinations at each visit
I. Blood pressure < 130/80 mm Hg, lower in diabetic nephropathy.
II. Blood pressure > 150/80 mm Hg, higher in diabetic nephropathy.
III. Statin therapy to reduce low-density lipoprotein cholesterol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Blood pressure < 130/80 mm Hg, lower in diabetic nephropathy
 Statin therapy to reduce low-density lipoprotein cholesterol
13. What are the microvascular complications of type 2 diabetes ?

I. Retinal disease.
II. Renal disease.
III. Peripheral vascular disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Microvascular complications of diabetes include retinal, renal, and possibly neuropathic disease.
14. What are the macrovascular complications of type 2 diabetes ?

I. Renal disease.
III. Peripheral vascular disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Macrovascular complications include coronary artery and peripheral vascular disease.
15. What is the pathophysiology of type 2 diabetes ?

I. Peripheral insulin resistance.
II. Inadequate insulin secretion by pancreatic alpha cells.
III. Inadequate insulin secretion by pancreatic beta cells.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Type 2 diabetes is characterized by a combination of peripheral insulin resistance and inadequate insulin
secretion by pancreatic beta cells
16. Which of the following statement is / are correct for insulin resistance in type 2 diabetes ?
I. It has been attributed to elevated levels of free fatty acids and proinflammatory cytokines in plasma.
II. It leads to decreased glucose transport into muscle cells, elevated hepatic glucose production, and
increased breakdown of fat.
III. It has been attributed to reduced levels of free fatty acids and proinflammatory cytokines in plasma.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Insulin resistance, which has been attributed to elevated levels of free fatty acids and proinflammatory cytokines
in plasma, leads to decreased glucose transport into muscle cells, elevated hepatic glucose production, and
increased breakdown of fat.
17. Which of the following gene is associated with decreased beta-cell responsiveness, leading to
impaired insulin processing ?
I. TCF7L2.
II. FSADS1.
III. PPARG.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Decreased beta-cell responsiveness, leading to impaired insulin processing and decreased insulin secretion (
TCF7L2)
18. Which of the following gene is associated with survival and function of beta-islet cells ?
I. SLC30A8.
II. WFS1.
III. KCNJ11.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Survival and function of beta-islet cells ( WFS1)
19. Which of the following gene is associated with control of the development of pancreatic
structures, including beta-islet cells ?
I. SLC30A8.
II. WFS1.
III. HHEX.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Control of the development of pancreatic structures, including beta-islet cells ( HHEX)
20. Which of the following gene is associated with transport of zinc into the beta-islet cells, which
influences the production and secretion of insulin?
I. SLC30A8.
II. WFS1.
III. KCNJ11.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Transport of zinc into the beta-islet cells, which influences the production and secretion of insulin ( SLC30A8)
21. What lipid abnormalities affects cardiovascular risk in people with diabetes is related in part to
insulin resistance?
I. Elevated levels of small, dense low-density lipoprotein (LDL) cholesterol particles.
II. Low levels of high-density lipoprotein (HDL) cholesterol.
III. Reduced levels of triglyceride-rich remnant lipoproteins.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Cardiovascular risk in people with diabetes is related in part to insulin resistance, with the following
concomitant lipid abnormalities:
 Elevated levels of small, dense low-density lipoprotein (LDL) cholesterol particles
 Low levels of high-density lipoprotein (HDL) cholesterol
 Elevated levels of triglyceride-rich remnant lipoproteins
22. What thrombotic abnormalities affects cardiovascular risk in people with diabetes is related in
part to insulin resistance ?
I Elevated type-1 plasminogen activator inhibitor [PAI-1].
II Elevated fibrinogen.
III Suppressed fibrinogen.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Thrombotic abnormalities (ie, elevated type-1 plasminogen activator inhibitor [PAI-1], elevated fibrinogen)
and hypertension are also involved.
23. What are the most common causes of secondary diabetes ?

I. Diseases of the pancreas that destroy the pancreatic beta cells.
II. Diseases of the pancreas that destroy the gamma cells.
III. Hormonal syndromes that interfere with insulin secretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The most common causes of secondary diabetes are as follows:

 Diseases of the pancreas that destroy the pancreatic beta cells (eg, hemochromatosis, pancreatitis, cystic
fibrosis, pancreatic cancer)
 Hormonal syndromes that interfere with insulin secretion (eg, pheochromocytoma)
 Hormonal syndromes that cause peripheral insulin resistance (eg, acromegaly, Cushing syndrome,
pheochromocytoma)
 Drugs (eg, phenytoin, glucocorticoids, estrogens)
24. Which of the following drugs causes secondary diabetes ?
I. Prostaglandin analogs.
II. Phenytoin.
III. Glucocorticoids.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Drugs (eg, phenytoin, glucocorticoids, estrogens)
25. Which hormonal syndrome that cause peripheral insulin resistance are associated with secondary
diabetes ?
I. Acromegaly.
II. Cushing syndrome.
III. Pancreatitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Hormonal syndromes that cause peripheral insulin resistance (eg, acromegaly, Cushing syndrome,
pheochromocytoma)
26. What is mean by gestational diabetes ?
I. It is defined as any degree of lactose intolerance with onset or first recognition during pregnancy.
II. Gestational diabetes mellitus results when maternal insulin secretion cannot increase sufficiently to
counteract the decrease in insulin sensitivity.
III. It is defined as any degree of glucose intolerance with onset or first recognition during pregnancy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Gestational diabetes mellitus is defined as any degree of glucose intolerance with onset or first recognition during
pregnancy (see Diabetes Mellitus and Pregnancy). Gestational diabetes mellitus is a complication of
approximately 4% of all pregnancies in the United States. A steady decline in insulin sensitivity as gestation
progresses is a normal feature of pregnancy; gestational diabetes mellitus results when maternal insulin secretion
cannot increase sufficiently to counteract the decrease in insulin sensitivity.
27. What are the major risk factor for type 2 diabetes mellitus ?
I. Weight less than 20% of desirable body weight.
II. Polycystic ovarian syndrome.
III. History of gestational diabetes mellitus or of delivering a baby with a birth weight of over 9 lb.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The major risk factors for type 2 diabetes mellitus are the following:
 Weight greater than 120% of desirable body weight
 History of gestational diabetes mellitus or of delivering a baby with a birth weight of over 9 lb
 Polycystic ovarian syndrome (which results in insulin resistance)
28. What are the major risk factor for type 2 diabetes mellitus ?
I. Hypertension (>140/90 mm Hg).
II. Weight less than 20% of desirable body weight.
III. Dyslipidemia (HDL cholesterol level < 40 mg/dL or triglyceride level >150 mg/dL).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The major risk factors for type 2 diabetes mellitus are the following:
 Weight greater than 120% of desirable body weight
 Hypertension (>140/90 mm Hg) or dyslipidemia (HDL cholesterol level < 40 mg/dl or triglyceride
level >150 mg/dl)
29. What is mean by MODY ?

I. Maturity onset diabetes of youth.
II. Maturity offset diabetes of youth.
III. Maturity onset disease of youth.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Maturity onset diabetes of youth (MODY),
30. Which of the following mitochondrial disorders are associated with type 2 diabetes ?
I. Kearns-Sayre syndrome.
II. Mitochondrial encephalomyopathy.
III. Anderson syndrome.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Diabetes can also be a finding in more severe mitochondrial disorders such as Kearns-Sayre syndrome and
mitochondrial encephalomyopathy, lactic acidosis, and strokelike episode (MELAS).
31. Which of the following mitochondrial disorders are associated with type 2 diabetes ?
I. Lactic acidosis.
II. Anderson syndrome.
III. Strokelike episode (MELAS).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Diabetes can also be a finding in more severe mitochondrial disorders such as Kearns-Sayre syndrome and
mitochondrial encephalomyopathy, lactic acidosis, and strokelike episode (MELAS).
32. What is mean by Dawn phenomenon ?

I. It is defined as any degree of glucose intolerance with onset or first recognition during pregnancy.
II. Blood glucose increase of over 20 mg/dL occurring at the end of the night, appears to be common in
type 2 diabetes.
III. A fragment of protrypsin that serves as a marker for pancreatin secretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The Dawn phenomenon, defined as a blood glucose increase of over 20 mg/dl occurring at the end of the night,
appears to be common in type 2 diabetes.
33. What are the different stages in the progression of diabetic retinopathy ?
I. Dilation of the retinal venules and formation of retinal capillary microaneurysms.
II. Increased vascular permeability.
III. Decreased vascular permeability.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The following are the 5 stages in the progression of diabetic retinopathy:

 Dilation of the retinal venules and formation of retinal capillary microaneurysms
 Increased vascular permeability
 Vascular occlusion and retinal ischemia
 Proliferation of new blood vessels on the surface of the retina
 Hemorrhage and contraction of the fibrovascular proliferation and the vitreous
I. Decreased vascular permeability.
II. Vascular occlusion and retinal ischemia.
III. Proliferation of new blood vessels on the surface of the retina.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

I. Degeneration of new blood vessels on the surface of the retina.
II. Contraction of the retinal venules.
III. Hemorrhage and contraction of the fibrovascular proliferation and the vitreous.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C

36. Which out of the following statement is /are correct for the schizophrenia ?
I. Dysfunctional signaling involving protein kinase B (Akt) is a possible mechanism for schizophrenia.
II. Acquired Akt defects associated with impaired regulation of blood glucose and diabetes, is
overrepresented in first-episode, medication with schizophrenia.
III. In addition, second-generation antipsychotics are associated with greater risk for hypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Schizophrenia has been linked to the risk for type 2 diabetes. Dysfunctional signaling involving protein kinase
B (Akt) is a possible mechanism for schizophrenia; moreover, acquired Akt defects are associated with impaired
regulation of blood glucose and diabetes, which is overrepresented in first-episode, medication-naive patients
with schizophrenia.[53] In addition, second-generation antipsychotics are associated with greater risk for type-2
diabetes.
37. Which out of the following statement is /are correct for vascular disease consideration in type 2
diabetes mellitus ?
I. If hypertension and hyperlipidemia are treated aggressively, the risk of macrovascular complications
increases aggressively.
II. Patients with diabetes have a lifelong challenge to achieve and maintain blood glucose levels as close to
the reference range.
III. With appropriate glycemic control, the risk of microvascular and neuropathic complications is decreased
markedly.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Patients with diabetes have a lifelong challenge to achieve and maintain blood glucose levels as close to the
reference range as possible. With appropriate glycemic control, the risk of microvascular and neuropathic
complications is decreased markedly. In addition, if hypertension and hyperlipidemia are treated aggressively,
the risk of macrovascular complications decreases as well.
38. What is the major cause of blindness in adult aged 20-74 years in United states ?
I. Pneumonia.
III. Hepatitis B.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Diabetes mellitus is the major cause of blindness in adults aged 20-74 years in the United States
39. What is the leading cause of nontraumatic lower limb amputations in United States ?
I. Bone cancer
II. Diabetes mellitus
III. Hepatitis B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Diabetes mellitus is the leading cause of nontraumatic lower limb amputations in the United States,
40. What results observed if gestational diabetes mellitus remains untreated ?

I. It lead to fetal macrosomia.
II. It lead to fetal hypobilirubinemia.
III. It lead to fetal hypocalcemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Untreated gestational diabetes mellitus can lead to fetal macrosomia, hypoglycemia, hypocalcemia, and
hyperbilirubinemia. In addition, mothers with gestational diabetes mellitus have increased rates of cesarean
delivery and chronic hypertension.
41. What results observed if gestational diabetes mellitus remains untreated ?

I. It lead to fetal hypercalcemia.
II. It lead to fetal hypoglycaemia.
III. It lead to fetal hyperbilirubinemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Untreated gestational diabetes mellitus can lead to fetal macrosomia, hypoglycemia, hypocalcemia, and
hyperbilirubinemia
42. What are the risk associated in mothers with gestational diabetes mellitus ?
I. They have increased rates of cesarean delivery .
II. They have increased rates of chronic hypertension.
III. They have increased rates of uterus cancer.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In addition, mothers with gestational diabetes mellitus have increased rates of cesarean delivery and chronic
hypertension
43. What are the possible physical findings in patients with type 2 diabetes mellitus ?
I. Obesity ,particularly central.
II. Hypertension.
III. Hypotension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Possible physical findings in patients with type 2 diabetes mellitus

 Obesity ,particularly central
 Hypertension
I. Hypotension.
II. Eye-hemorrhages,exudates.
III. Neovascularization.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Eye-hemorrhages,exudates
 Neovascularization
I. Skin-acanthosis nigricans.
II. Candida infection.
III. Increased temperature sensation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Skin-acanthosis nigricans ,candida infection
I. Increased temperature sensation.
II. Neurologic-decreased or absent light touch.
III. Decreased temperature sensation and proprioception.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Neurologic-decreased or absent light touch, temperature sensation and proprioception
 Loss of deep tendon reflexes in ankles
 Feet dry , muscle atropy,claw toes ,ulcers
I. Loss of deep tendon reflexes in ankles.
II. Increased temperature sensation .
III. Muscle atropy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

I. Bone factures.
II. Feet dry.
III. Claw toes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

49. What are the focus examination of diabetes ?

I. Vital signs.
II. Funduscopic examination.
III. Magnetic resonance imaging.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
A diabetes-focused examination includes vital signs, funduscopic examination, limited vascular and neurologic
examinations, and a foot assessment
50. What are the focus examination of diabetes ?

I. Magnetic resonance imaging.
II. Limited vascular and neurologic examinations.
III. A foot assessment.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
A diabetes-focused examination includes vital signs, funduscopic examination, limited vascular and neurologic
examinations, and a foot assessment
51. What are the first two stages of diabetic retinopathy ?

I. Background retinopathy
II. Proliferative retinopathy.
III. Horizontal retinopathy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The first 2 stages of diabetic retinopathy are known as background or nonproliferative retinopathy
52. What process observed in diabetic retinopathy ?

I. Initially dilation of the retinal venules .
II. Initially contraction of retinal venules.
III. Then microaneurysms appear.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Initially, the retinal venules dilate, then microaneurysms (tiny red dots on the retina that cause no visual
impairment) appear
53. What is mean by microaneurysms ?
I. Tiny White dots on the skin that cause no skin impairment.
II. Tiny red dots on the retina that cause no visual impairment.
III. Tiny red dots on the skin that cause no skin impairment.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Microaneurysms (tiny red dots on the retina that cause no visual impairment)
54. What is mean by proliferative retinopathy ?

I. It is characterized by neovascularization
II. It is the development of networks of fragile new muscles that often are seen on the optic disc
III. It is the development of networks of fragile new vessels that often are seen on the optic disc
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Proliferative retinopathy is characterized by neovascularization, or the development of networks of fragile new

vessels that often are seen on the optic disc or along the main vascular arcades.
55. Which out of the following statement is /are correct for proliferative retinopathy ?
I. The development of networks of fragile new vessels undergo cycles of proliferation and regression.
II. Fibrous adhesions develop between the vessels and the vitreous causes dialation of the adhesions.
III. It result in traction on the retina and retinal detachment,contraction also tears the new vessels, which
hemorrhage into the vitreous.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The vessels undergo cycles of proliferation and regression. During proliferation, fibrous adhesions develop
between the vessels and the vitreous. Subsequent contraction of the adhesions can result in traction on the retina
and retinal detachment. Contraction also tears the new vessels, which hemorrhage into the vitreous.
56. What is mean by NGSP ?
I. National Glycohemoglobin Standardization Program.
II. National Glycogenolysis Standardization Program.
III. National Galcatogenesis Standardization Program.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
National glycohemoglobin standardization program (ngsp)
57. What are criteria for the diagnosis of type 2 diabetes according to American diabetes association
?
I. An HbA1c level of 6.5% or higher; the test should be performed by Diabetes Control and Complications
Trial (DCCT) reference assay.
II. A fasting plasma glucose (FPG) level of 126 mg/dL (7.0 mmol/L) or higher.
III. A random plasma glucose of 150 mg/dL (11.1 mmol/L) or lower in a patient with classic symptoms of
hyperglycemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The American Diabetes Association (ADA) criteria for the diagnosis of diabetes are any of the following[1] :
 An hba1c level of 6.5% or higher; the test should be performed in a laboratory using a method that
is certified by the National Glycohemoglobin Standardization Program (NGSP) and standardized
or traceable to the Diabetes Control and Complications Trial (DCCT) reference assay, or
 A fasting plasma glucose (FPG) level of 126 mg/dl (7.0 mmol/L) or higher; fasting is defined as no
caloric intake for at least 8 hours, or
58. What are criteria for the diagnosis of type 2 diabetes according to American diabetes association
?
I. A random plasma glucose of 150 mg/dL (11.1 mmol/L) or lower in a patient with classic symptoms of
hyperglycemia.
II. A 2-hour plasma glucose level of 200 mg/dL (11.1 mmol/L) or higher during a 75-g oral glucose
tolerance test (OGTT).
III. A random plasma glucose of 200 mg/dL (11.1 mmol/L) or higher in a patient with classic symptoms of
hyperglycemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The American Diabetes Association (ADA) criteria for the diagnosis of diabetes are any of the following :
tolerance test (OGTT), or
 A random plasma glucose of 200 mg/dl (11.1 mmol/L) or higher in a patient with classic symptoms
of hyperglycemia
59. Which of the following statement is /are correct for the plasma glucose determination ?
I. It is determined using blood drawn into a gray-top (sodium fluoride) tube.
II. The sodium fluoride tube, inhibits red blood cell glycolysis immediately.
III. It is determined using blood drawn into a red-top (sodium bromide) tube.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Plasma glucose is determined using blood drawn into a gray-top (sodium fluoride) tube, which inhibits red
blood cell glycolysis immediately.
60. Which of the following factors give indication for diabetes screening in asymptomatic adults ?
I. Sustained blood pressure >135/80 mm Hg.
II. Overweight and 1 or more other risk factors for diabetes (eg HDL < 35 mg/dL and/or triglyceride level
>250 mg/dL).
III. Sustained blood pressure <135/80 mm Hg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Indications for diabetes screening in asymptomatic adults includes the following[2, 3] :

 Sustained blood pressure >135/80 mm Hg
 Overweight and 1 or more other risk factors for diabetes (eg, first-degree relative with diabetes, BP
>140/90 mm Hg, and HDL < 35 mg/dl and/or triglyceride level >250 mg/dl)
 ADA recommends screening at age 45 years in the absence of the above criteria
61. Which of the following factors give indication for diabetes screening in asymptomatic adults ?
I. Sustained blood pressure <135/80 mm Hg.
II. Overweight and 1 or more other risk factors for diabetes (eg, first-degree relative with diabetes, BP
>140/90 mm Hg).
III. ADA recommends screening at age 45 years in the absence of the above criteria.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Indications for diabetes screening in asymptomatic adults includes the following :

 Sustained blood pressure >135/80 mm Hg
 Overweight and 1 or more other risk factors for diabetes (eg, first-degree relative with diabetes, BP
>140/90 mm Hg, and HDL < 35 mg/dl and/or triglyceride level >250 mg/dl)
 ADA recommends screening at age 45 years in the absence of the above criteria
62. Which of the following factors accompanied to glucose intolerance ?
I. Induction of insulin resistance.
II. Increased glucagon levels.
III. Decreased glucagon levels.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
During the induction of insulin resistance (such as occurs with a high-calorie diet, steroid administration, or
physical inactivity), increased glucagon levels and increased glucose-dependent insulinotropic polypeptide (GIP)
levels accompany glucose intolerance.
63. Which of the following factors accompanied to glucose intolerance ?

I. Decreased glucagon levels.
II. Increased glucagon levels.
III. Increased glucose-dependent insulinotropic polypeptide (GIP) levels.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
During the induction of insulin resistance (such as occurs with a high-calorie diet, steroid administration, or
physical inactivity), increased glucagon levels and increased glucose-dependent insulinotropic polypeptide (GIP)
levels accompany glucose intolerance.
64. Which of the following genes is associated with lowered early glucose-stimulated insulin release
?
I. MTNR1B.
II. FADS1.
III. FSADS1.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Lowered early glucose-stimulated insulin release ( MTNR1B, FADS1, DGKB, GCK)
65. Which of the following gene is associated with altered metabolism of unsaturated fatty acids ?
I. MTNR1B.
II. FADS1.
III. FSADS1.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Altered metabolism of unsaturated fatty acids ( FSADS1)
66. Which of the following gene is associated with dysregulation of fat metabolism ?
I. PPARG.
II. FADS1.
III. FSADS1.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Dysregulation of fat metabolism ( PPARG)

67. Which of the following gene is associated with inhibition of serum glucose release ?
I. PPARG.
II. FADS1.
III. KCNJ11.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Inhibition of serum glucose release ( KCNJ11)
68. Which of the following genes is associated with increased adiposity and insulin resistance ?
I. FTO.
II. KCNJ11.
III. IGF2BP2.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Increased adiposity and insulin resistance ( FTO and IGF2BP2)
69. Which of the following is the key regulator of the insulin receptor gene (INSR) ?
I. The high mobility group A1 (HMGA1) protein.
II. I The high mobility group G1 (PMGA1) protein.
III. I The high mobility group H1 (FMFA1) protein.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The high mobility group A1 (HMGA1) protein is a key regulator of the insulin receptor gene (INSR).
70. What is mean by DCCT ?
I. Diabetes Control and Complications Trial.
II. Diabetes Cure and Complications Test.
III. Diarrhea Control and Complications Trial.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Diabetes Control and Complications Trial (DCCT)
71. What is mean by ADVANCE ?

I. Action in Diarrhea and Vascular Disease Diapeptide Modified Release Controlled Evaluation.
II. Action in Diptheria and Vascular Disease: Preterax and Diamicron Modified Release Controlled
Evaluation.
III. Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled
Evaluation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation
(ADVANCE)
72. What is mean by VADT ?

I. Veterans Affairs Diabetes Trial.
II. Vascular Associated Diabetes Trial.
III. Vascular Affairs Diabetes Trial.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Veterans affairs diabetes trial (vadt),
73. What is mean by ACCORD ?

I. Acute Control Cardiovascular Risk in Diabetes.
II. Action to Control Cardiovascular Risk in Diabetes.
III. Action to Control Cancer Risk in Diabetes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Action to Control Cardiovascular Risk in Diabetes (ACCORD)
74. What results observed on single photon CT myocardial perfusion imaging in asymptomatic
patients with type 2 diabetes ?
I. Higher risk for cardiovascular events.
II. Higher risk of brain heamorrage.
III. Cardiac death.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Yamasaki et al found that abnormal results on single-photon CT myocardial perfusion imaging in

asymptomatic patients with type 2 diabetes indicated a higher risk for cardiovascular events (13%), including
cardiac death.
75. What was the seventh leading cause of death in United States ?
I. Diabetes mellitus.
II. COPD.
III. Peptic ulcer.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Diabetes mellitus was the seventh leading cause of death in the United States.[
76. What is mean by ESRD ?

I. Early-stage renal disease.
II. End-stage renal disease.
III. Early-stage renal disorder.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
End-stage renal disease (ESRD)
77. Which out of the following statement is/are correct for coronary heart disease ?
I. It is 2-4 times greater in patients with diabetes than in individuals without diabetes.
II. Cardiovascular disease is not associated with the mortality in patients with type 2 diabetes mellitus.
III. Men with diabetes face a 2-fold increased risk for CHD, and women have a 3- to 4-fold increased risk.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The risk for coronary heart disease (CHD) is 2-4 times greater in patients with diabetes than in individuals
without diabetes. Cardiovascular disease is the major source of mortality in patients with type 2 diabetes
mellitus. Approximately two thirds of people with diabetes die of heart disease or stroke. Men with diabetes
face a 2-fold increased risk for CHD, and women have a 3- to 4-fold increased risk
78. Which out of the following statement is/are correct for coronary heart disease in type 2 diabet es
patient ?
I. A fasting glucose level of more than 100 mg/dL significantly contributes to the risk of cardiovascular
disease.
II. Cardiovascular disease is not associated with the mortality in patients with type 2 diabetes mellitus.
III. Men with diabetes face a 2-fold increased risk for CHD, and women have a 3- to 4-fold increased risk.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In patients with type 2 diabetes mellitus, a fasting glucose level of more than 100 mg/dl significantly contributes
to the risk of cardiovascular disease
79. A patient with diabetes is treated on pioglitazone ,Which cancer associated with higher risk ?
I. Lung cancer.
II. Liver cancer.
III. Bladder cancer.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Patients with diabetes have a higher risk for bladder cancer, particularly those patients who use pioglitazone
80. What are the symptoms of hyperglycemia ?
I. Blurred vision.
II. Amboeic infection.
III. Lower extremity paresthesias.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Other symptoms that may suggest hyperglycemia include blurred vision, lower extremity paresthesias, or yeast
infections, particularly balanitis in men.
81. What are the symptoms of hyperglycemia ?

I. Amboeic infection.
II. Yeast infections.
III. Balanitis in men.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Other symptoms that may suggest hyperglycemia include blurred vision, lower extremity paresthesias, or yeast
infections, particularly balanitis in men.
82. Which of the following have been associated with lower scores on memory tests ?
I. Larger retinal arteriolar calibres.
II. Larger retinal venular calibres.
III. Larger pulmonary venular calibres.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Larger retinal arteriolar and venular calibres have been associated with lower scores on memory tests but not
with lower scores on other cognitive tests.[
83. What are the recommendations given for the treatment of type 2 diabetes mellitus from the
european association for the study of diabetes and ADA ?
I. Individualized glycemic targets and glucose-lowering therapies.
II. Use of diazepam as the optimal first-line drug unless contraindicated.
III. Diet, exercise, and education as the foundation of the treatment program.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Recommendations for the treatment of type 2 diabetes mellitus from the European Association for the Study of
Diabetes (EASD) and the American Diabetes Association (ADA) place the patient's condition, desires, abilities,
and tolerances at the center of the decision-making process.[4, 5, 6]
The EASD/ADA position statement contains 7 key points:
1. Individualized glycemic targets and glucose-lowering therapies
2. Diet, exercise, and education as the foundation of the treatment program
I. Use of diazepam as the optimal first-line drug unless contraindicated.
II. Use of metformin as the optimal first-line drug unless contraindicated.
III. After metformin, the use of 1 or 2 additional oral or injectable agents, with a goal of minimizing adverse
effects if possible.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
and tolerances at the center of the decision-making process
1. Use of metformin as the optimal first-line drug unless contraindicated
2. After metformin, the use of 1 or 2 additional oral or injectable agents, with a goal of minimizing
adverse effects if possible
I. Insulin therapy alone or with other agents if needed to maintain blood glucose control.
II. All treatment decisions should involve the patient, with a focus on patient preferences, needs, and values.
III. Use of diazepam as the optimal first-line drug unless contraindicated.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
and tolerances at the center of the decision-making process.[4, 5, 6]
1. Ultimately, insulin therapy alone or with other agents if needed to maintain blood glucose control
2. Where possible, all treatment decisions should involve the patient, with a focus on patient preferences,
needs, and values
3. A major focus on comprehensive cardiovascular risk reduction
86. Which out of the following statement is /are correct for the type 2 diabetes mellitus ?
I. These patients are completely depended on the insulin therapy.
II. Many patients with type 2 diabetes are ultimately treated with insulin because to retain the ability to
secrete some endogenous insulin.
III. These patients are considered to require insulin but not to depend on insulin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
However, many patients with type 2 diabetes are ultimately treated with insulin. Because they retain the ability
to secrete some endogenous insulin, they are considered to require insulin but not to depend on insulin.
87. What is the cause of developing type 2 diabetes mellitus in children while older its was adult -
onset diabetes?
I. Epidemic of obesity in children.
II. Infections in children.
III. Inactivity in children.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Another older term for type 2 diabetes mellitus was adult-onset diabetes. Currently, because of the epidemic of
obesity and inactivity in children, type 2 diabetes mellitus is occurring at younger and younger ages.
88. Which of the following cells secrete the glucagon in human body ?
I. Alpha cell.
II. Beta cell.
III. Gamma cell.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Paracrinopathy in which the reciprocal relationship between the glucagon-secreting alpha cell and the insulin-
secreting beta cell is lost
89. Which of the following cells secrete the insulin in human body ?
I. Alpha cell.
II. Beta cell.
III. Gamma cell.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Paracrinopathy in which the reciprocal relationship between the glucagon-secreting alpha cell and the insulin-
secreting beta cell is lost
90. Which of the following factors increase the blood glucose level in type 2 diabetic patient ?
I. Increased peripheral glucose uptake.
II. Carbohydrate Intake.
III. Increase hepatic glucose production.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Factors increase the blood glucose levels

 Carbohydrate Intake
 Increase hepatic glucose production
 Decreased insulin secretion
 Decreased peripheral glucose uptake
91. Which of the following factors increase the blood glucose level in type 2 diabetic patient ?
I. Decreased insulin secretion.
II. Increased peripheral glucose uptake.
III. Decreased peripheral glucose uptake.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Factors increase the blood glucose levels

 Carbohydrate Intake
 Increase hepatic glucose production
 Decreased insulin secretion
 Decreased peripheral glucose uptake
92. What is the pathophysiology behind the type 2 diabetes mellitus ?
I. Beta-cell dysfunction.
II. Amboeic infection.
III. Insulin resistance.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Pathophysiology behind the type 2 diabetes mellitus

 Beta-cell dysfunction
 Insulin resistance
 Genomic factors
 Amino acid metabolism
93. What is the pathophysiology behind the type 2 diabetes mellitus ?

I. Genomic factors.
II. Amino acid metabolism.
III. Bacterial infection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Pathophysiology behind the type 2 diabetes mellitus

 Beta-cell dysfunction
 Genomic factors
 Amino acid metabolism
94. Which of the following three amino acid play a key role early in the development of type 2
diabetes ?
I. Alanine,Glycine ,Valine.
II. Isoleucine, phenylalanine, and tyrosine.
III. Methionine ,Histidine,Asparagine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
High fasting plasma concentrations of 3 amino acids (isoleucine, phenylalanine, and tyrosine). In this study,
amino acids, amines, and other polar metabolites were profiled using liquid chromatography tandem mass
spectrometry.
95. What is the average life span of red blood cells ?

I. 10 days.
II. 100 days.
III. 120 days.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Lifespan of a red blood cell, which averages 120 days

96. Which out of the following statement is /are correct for glycated haemoglobin ?
I. HbA1c measurements were considered useful for the diagnosis of thyroiditis.
II. It is the binding of glucose to hemoglobin A is a nonenzymatic process that occurs over the lifespan of a
red blood cell.
III. Measurement of glycated hemoglobin thus reflects plasma glucose levels over the preceding 2-3 months.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Binding of glucose to hemoglobin A is a nonenzymatic process that occurs over the lifespan of a red blood cell,
which averages 120 days. Measurement of glycated hemoglobin thus reflects plasma glucose levels over the
preceding 2-3 months.hba1c measurements are the criterion standard for monitoring long-term glycemic
control. In the past, hba1c measurements were not considered useful for the diagnosis of diabetes mellitus
97. Which of the following method is use to study the amino acid metabolism profile ?
I. Liquid chromatography tandem mass spectrometry.
II. Thin layer chromatography.
III. Infrared spectroscopy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
High fasting plasma concentrations of 3 amino acids (isoleucine, phenylalanine, and tyrosine). In this study,
amino acids, amines, and other polar metabolites were profiled using liquid chromatography tandem mass
spectrometry.
98. Which out of the following statement is /are correct for microalbuminuria ?
I. It is the measuring of albumin-to-creatinine ratio and the ratio expressed in mg/g.
II. Normal urine albumin excretion is defined as less than 30 mg daily.
III. Normal urine albumin excretion is defined as less than 300 mg daily.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Annual screening for microalbuminuria (see Microalbumin) is recommended in all patients with diabetes.
Measuring the albumin-to-creatinine ratio in a spot urine sample is probably the easiest method; the ratio,
expressed in mg/g, is equivalent to albumin excretion in milligrams daily. A result greater than 30 mg/g
indicates albuminuria, in which case a quantitation on a timed urine specimen (ie, overnight, 10 h, or 24 h)
should be performed.Normal urine albumin excretion is defined as less than 30 mg daily.
99. What is mean by the C-peptide ?

I. A fragment of protrypsin that serves as a marker for pancreatin secretion.
II. A fragment of proinsulin that serves as a marker for insulin secretion.
III. A fragment of propepsin that serves as a marker for pancreatic secretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
C-peptide (a fragment of proinsulin that serves as a marker for insulin secretion)

100. Which of the following factor differentiate LADA slow-onset type-1 diabetes to type 2 diabetes?
I. Due to the presence of antibodies against the 65-kd isoform of glutamic acid decarboxylase (GAD65) in
type 1 diabetes.
II. Due to the presence of antibodies against the thyroid harmone.
III. Due to the presence of antibodies against the insulin harmone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Latent autoimmune diabetes of adults (LADA) is a form of slow-onset type 1 diabetes that occurs in middle-
aged (usually white) adults. It can be differentiated from type 2 diabetes by confirming the presence of
antibodies against the 65-kd isoform of glutamic acid decarboxylase (GAD65), an enzyme found in pancreatic
beta cells.
1. Which of the following management included in type 2 diabetes care by a multidisciplinary team
of health professionals with expertise in diabetes ?
I. Appropriate goal setting.
II. Dietary and exercise modifications.
III. High carbohydrate diet.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Type 2 diabetes care is best provided by a multidisciplinary team of health professionals with expertise in
diabetes, Management includes the following:
 Appropriate goal setting
 Dietary and exercise modifications
I. Highly saturated fatty acid diet.
II. Medications.
III. Appropriate self-monitoring of blood glucose.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Medications
 Appropriate self-monitoring of blood glucose (SMBG)
I. Regular monitoring for complications.
II. Highly saturated fatty acid diet.
III. Laboratory assessment.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Regular monitoring for complications
 Laboratory assessment
4. What is mean by SMBG ?

I. Self-monitoring of blood glucose.
II. Severe-monitoring of blood glucose.
III. Severe-monitoring of blood galactose.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Self-monitoring of blood glucose (SMBG)
5. Why was biguanide,phenformin taken off the market in the United states in 1970s ?
I. Due risk of causing lactic acidosis.
II. Due to highly expensive drug .
III. Due to associated mortality.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Another biguanide, phenformin, was taken off the market in the United States in the 1970s because of its risk
of causing lactic acidosis and associated mortality (rate of approximately 50%).
6. What is the mechanism of action of metformin in type 2 diabetic patient ?
I. It works by decreasing hepatic gluconeogenesis.
II. It also decreases intestinal absorption of glucose.
III. It also decreases peripheral glucose uptake and utilization.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Metformin works by decreasing hepatic gluconeogenesis production. It also decreases intestinal absorption of
glucose and improves insulin sensitivity by increasing peripheral glucose uptake and utilization
7. What is the mechanism of action of metformin in type 2 diabetic patient ?

I. It works by increasing hepatic gluconeogenesis production.
II. It also decreases peripheral glucose uptake and utilization.
III. It improves insulin sensitivity by increasing peripheral glucose uptake and utilization.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Metformin works by decreasing hepatic gluconeogenesis production. It also decreases intestinal absorption of
glucose and improves insulin sensitivity by increasing peripheral glucose uptake and utilization
8. What is the mechanism of action of sulfonylureas in type 2 diabetic patient ?
I. They are insulin secretagogues.
II. They stimulate insulin release from pancreatic beta cells.
III. They also decreases peripheral glucose uptake and utilization.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Sulfonylureas (eg, glyburide, glipizide, glimepiride) are insulin secretagogues that stimulate insulin release from
pancreatic beta cells and probably have the greatest efficacy for glycemic lowering of any of the oral agents.
9. Which out of the following statement is /are correct for alpha-glucosidase inhibitors ?
I. These agents delay sugar absorption and help to prevent postprandial glucose surges.
II. They help in readily absorption of carbohydrates.
III. They should be titrated slowly to reduce gastrointestinal (GI) intolerance.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Alpha-glucosidase inhibitors---These agents delay sugar absorption and help to prevent postprandial glucose
surges. Alpha-glucosidase inhibitors prolong the absorption of carbohydrates, but their induction of flatulence
greatly limits their use. They should be titrated slowly to reduce gastrointestinal (GI) intolerance.
10. What is mean by CANOE ?

I. Canadian Normoglycemia Outcome and Evaluation trial.
II. Cancerous Normoglycemia Outcome and Evaluation trial.
III. Canadian Normogalactemia Outcome and Evaluation trial.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Canadian Normoglycemia Outcome and Evaluation (CANOE) trial

11. What is the mechanism of action of GLP-1 agonists in type 2 diabetic patient ?
I. They reduce glucose-dependent insulin release, increase glucagon, and slow gastric emptying.
II. They mimic the endogenous incretin GLP-1.
III. They stimulate glucose-dependent insulin release, reduce glucagon, and slow gastric emptying.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
GLP-1 agonists (ie, exenatide, liraglutide, albiglutide, dulaglutide) mimic the endogenous incretin GLP-1;
they stimulate glucose-dependent insulin release, reduce glucagon, and slow gastric emptying.
12. Which of the following drug approved by the FDA as adjunctive therapy to diet and exercise to
improve glycemic control in type 2 diabetes mellitus ?
I. Dulaglutide.
II. Albiglutide.
III. Exenatide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Dulaglutide (Trulicity) was approved by the FDA in September 2014 as adjunctive therapy to diet and exercise
to improve glycemic control in type 2 diabetes mellitus.[
13. What are the adverse effect of dulaglutide in patient with type 2 diabetes mellitus ?
I. Nausea.
II. Diarrhea.
III. Increased appetite.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Adverse effects included nausea, diarrhea, vomiting, abdominal pain, and decreased appetite
14. What are the adverse effect of dulaglutide in patient with type 2 diabetes mellitus ?
I. Increased appetite.
II. Abdominal pain.
III. Decreased appetite.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Adverse effects included nausea, diarrhea, vomiting, abdominal pain, and decreased appetite
15. Which patients are contraindicated for the dulaglutide used in treatment of type 2 diabetes ?
I. Patients with personal or family history of medullary thyroid carcinoma.
II. Patients with personal or family history of peptic ulcer.
III. Patients with multiple endocrine neoplasia syndrome type 2.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Dulaglutide is not recommended for use as first-line pharmacologic treatment for type 2 diabetes, and it is
contraindicated in patients with personal or family history of medullary thyroid carcinoma or in those with
multiple endocrine neoplasia syndrome type 2.[
16. What is the mechanism of action of of SGLT-2 inhibitors in type 2 diabetic patient ?
I. It lowers the renal glucose threshold.
II. Thereby increased urinary glucose excretion.
III. Thereby decreased urinary glucose excretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
SGLT-2 inhibition lowers the renal glucose threshold (ie, the plasma glucose concentration that exceeds the
maximum glucose reabsorption capacity of the kidney). Lowering the renal glucose threshold results in increased
urinary glucose excretion
17. What is the mechanism of action of pramlintide acetate in patient with type 2 diabetes ?
I. It induce gastric emptying, increases postprandial glucagon release, and modulates appetite.
II. It mimics the effects of endogenous amylin, which is secreted by pancreatic beta cells.
III. It delays gastric emptying, decreases postprandial glucagon release, and modulates appetite.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Pramlintide acetate is an amylin analog that mimics the effects of endogenous amylin, which is secreted by
pancreatic beta cells. This agent delays gastric emptying, decreases postprandial glucagon release, and modulates
appetite
18. What are the adverse effect of bromocriptine in patient with type 2 diabetes ?
I. Nausea.
II. Fatigue.
III. Skin rashes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Adverse events most commonly reported in clinical trials of bromocriptine included nausea, fatigue, vomiting,
headache, and dizziness
19. What are the adverse effect of bromocriptine in patient with type 2 diabetes ?
I. Headache.
II. Skin rashes.
III. Dizziness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Adverse events most commonly reported in clinical trials of bromocriptine included nausea, fatigue, vomiting,
headache, and dizziness
20. What are the risks associated with bromocriptine on intiation of therapy and dose escalation ?
I. Brain tumour.
II. Orthostatic hypotension.
III. Syncope.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Bromocriptine can cause orthostatic hypotension and syncope, particularly on initiation of therapy and dose
escalation.
21. What results observed on comparison the effectiveness and safety of oral diabetes medications
for adults with type 2 diabetes by AHRQ ?
I. Metformin decreased LDL cholesterol levels relative to pioglitazone, sulfonylureas.
II. Unfavourable effects on weight were greater with TZDs and sulfonylureas than with metformin.
III. Metformin increased LDL cholesterol levels relative to pioglitazone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Comparison of oral antidiabetic agents--Other AHRQ findings included the following:

 Metformin decreased LDL cholesterol levels relative to pioglitazone, sulfonylureas, and DPP-4
inhibitors
 Unfavorable effects on weight were greater with tzds and sulfonylureas than with metformin (mean
difference of +2.6 kg)
I. Risk of mild or moderate hypoglycemia was 4-fold higher with sulfonylureas than with metformin alone.
II. Metformin increase LDL cholesterol levels relative to sulfonylureas.
III. Risk was more than 5-fold higher with sulfonylureas plus metformin than with a TZD plus metformin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Risk of mild or moderate hypoglycemia was 4-fold higher with sulfonylureas than with metformin alone; this
risk was more than 5-fold higher with sulfonylureas plus metformin than with a TZD plus metformin
I. Metformin increase LDL cholesterol levels relative to sulfonylureas.
II. Risk of heart failure was higher with TZDs than with sulfonylureas.
III. Risk of bone fractures was higher with TZDs than with metformin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Risk of heart failure was higher with tzds than with sulfonylureas
 Risk of bone fractures was higher with tzds than with metformin
I. Diarrhea was more common with metformin than with glitazones.
II. Metformin increase LDL cholesterol levels relative to sulfonylureas.
III. Metformin decreased LDL cholesterol levels relative to sulfonylureas, and DPP-4 inhibitors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Metformin decreased LDL cholesterol levels relative to pioglitazone, sulfonylureas, and DPP-4
inhibitors
 Diarrhea was more common with metformin than with glitazones
25. Why is the metformin preferred initial agent for monotherapy and a standard part of
combination treatments ?
I. Due to its efficacy.
II. Due to absence of weight gain or hypoglycaemia.
III. Relatively high cost.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Metformin is the preferred initial agent for monotherapy and is a standard part of combination treatments.
Advantages of metformin include the following:
 Efficacy
 Absence of weight gain or hypoglycemia
 Generally low level of side effects
 High level of patient acceptance
 Relatively low cost
26. Why is the metformin preferred initial agent for monotherapy and a standard part of
combination treatments ?
I. Relatively high cost.
II. Generally low level of side effects.
III. High level of patient acceptance.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Metformin is the preferred initial agent for monotherapy and is a standard part of combination treatments.
Advantages of metformin include the following:
 Efficacy
 Absence of weight gain or hypoglycemia
 Generally low level of side effects
 High level of patient acceptance
 Relatively low cost
27. How to manage the dyslipidemia which is common in patient with type 2 diabetes mellitus ?
I. By using Statins.
II. By using Fibrates.
III. By using Gamma blockers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Management of Dyslipidemia
 Statins
 Fibrates
 Beta blockers
28. How to manage the dyslipidemia which is common in patient with type 2 diabetes mellitus ?
I. By using Fibrates.
II. By using Gamma blockers.
III. By using Beta blockers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Management of Dyslipidemia
 Statins
 Fibrates
 Beta blockers
29. How to manage the CHD risk in patient with type 2 diabetes mellitus ?
I. By using low dose Aspirin.
II. By using Statins.
III. VLDL cholesterol therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Management of Coronary Heart Disease

 Aspirin
 Statins
 HDL cholesterol therapy
 Triglyceride therapy
 Revascularization
30. How to manage the CHD risk in patient with type 2 diabetes mellitus ?
I. VLDL cholesterol therapy.
II. HDL cholesterol therapy.
III. Triglyceride therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Management of Coronary Heart Disease

 HDL cholesterol therapy
 Triglyceride therapy
 Revascularization
31. How to manage the peripheral neuropathy which is the most common complication observed in
patients with type 2 diabetes in outpatient clinics ?
II. Low-dose tricyclic antidepressants.
III. Duloxetine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Management of Diabetic Neuropathy

Later symptomatic therapy largely is empirical and may include the following:
 Low-dose tricyclic antidepressants
 Duloxetine
 Anticonvulsants (eg, phenytoin, gabapentin, carbamazepine)
 Topical capsaicin
 Various pain medications, including nonsteroidal anti-inflammatory drugs (nsaids)
32. How to manage the peripheral neuropathy which is the most common complication observed in
patients with type 2 diabetes in outpatient clinics ?
I. Topical capsaicin.
II. Prostaglandin analogs.
III. Various pain medications, including NSAIDs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Duloxetine
 Topical capsaicin
 Various pain medications, including nonsteroidal anti-inflammatory drugs (nsaids)
33. Which anticonvulsants are used to manage the peripheral neuropathy in patients with type 2
diabetes in outpatient clinics ?
I. Phenytoin.
II. Diazepam.
III. Gabapentin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Duloxetine
34. Which of the following infectious diseases are associated with diabetes ?
I. Malignant otitis externa.
II. Rhinocerebral mucormycosis.
III. Helmintic infection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Diabetes predisposes patients to a number of infectious diseases, including the following:

 Malignant otitis externa
 Rhinocerebral mucormycosis
I. Amboeic infection.
II. Bacteriuria.
III. Pyuria.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Bacteriuria
 Pyuria
I. Cystitis.
II. Helmintic infection
III. Upper urinary tract infection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Cystitis
 Upper urinary tract infection
I. Intrarenal bacterial infection.
II. Skin and soft tissue infections.
III. Amboeic infection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Intrarenal bacterial infection
 Skin and soft tissue infections
38. Which of the following recommendation for patients with diabetes to prevent the stroke ?
I. Regular blood pressure screening.
II. Physical activity; 30 minutes or more of moderate-intensity activity on a daily basis.
III. A high-sodium, low-potassium diet to reduce blood pressure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The 2010 American Heart Association/American Stroke Association (AHA/ASA) guidelines for the primary
prevention of stroke include the following recommendations for patients with diabetes:
 Regular blood pressure screening
 Physical activity; 30 minutes or more of moderate-intensity activity on a daily basis
I. A high-sodium, low-potassium diet to reduce blood pressure.
II. A low-sodium, high-potassium diet to reduce blood pressure.
III. A diet emphasizing consumption of fruits, vegetables, and low-fat dairy products.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 A low-sodium, high-potassium diet to reduce blood pressure; a diet emphasizing consumption of fruits,
vegetables, and low-fat dairy products (eg, the Dietary Approaches to Stop Hypertension [DASH]
diet) may lower stroke risk
I. A blood pressure goal of less than 130/80 mm Hg.
II. A blood pressure goal of greater than 170/90 mm Hg.
III. Drug therapy with ACE inhibitors or ARBs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 A blood pressure goal of less than 130/80 mm Hg
 Drug therapy with ACE inhibitors or arbs
I. Drug therapy with calcium channel blockers.
II. Statin therapy, especially in patients with other risk factors; monotherapy with fibrates.
III. A blood pressure goal of greater than 170/90 mm Hg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
 Statin therapy, especially in patients with other risk factors; monotherapy with fibrates may also be
considered to lower stroke risk
42. Which out of the following statement is /are correct for the thiazolidinediones used for the
treatment of type 2 diabetes ?
I. It reduce insulin resistance in the periphery and perhaps to a small degree in the liver.
II. It activate insulin resistance in the periphery and perhaps to a large degree in the liver.
III. They activate peroxisome proliferator activated receptor gamma, a nuclear transcription factor do fat
cell differentiation and fatty acid metabolism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Thiazolidinediones reduce insulin resistance in the periphery (ie, they sensitize muscle and fat to the actions of
insulin) and perhaps to a small degree in the liver (ie, insulin sensitizers, antihyperglycemics). They activate
peroxisome proliferator activated receptor (PPAR) gamma, a nuclear transcription factor that is important in
fat cell differentiation and fatty acid metabolism.
43. Which out of the following statement is /are correct for the thiazolidinediones used for the
I. It reduces glucose-dependent insulin secretion by pancreatic gamma cells.
II. The major action of thiazolidinediones is probably actually fat redistribution.
III. These drugs may have beta-cell preservation properties.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The major action of thiazolidinediones is probably actually fat redistribution. These drugs may have beta-cell
preservation properties
44. Which out of the following statement is /are correct for the pioglitazone used for the treatment
of type 2 diabetes ?
I. It is indicated as an adjunct to diet and exercise to improve glycemic control.
II. It reduces glucose-dependent insulin secretion by pancreatic gamma cells.
III. It improves target-cell response to insulin without increasing insulin secretion from the pancreas.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Pioglitazone is indicated as an adjunct to diet and exercise to improve glycemic control. It improves target-cell
response to insulin without increasing insulin secretion from the pancreas.
45. Which out of the following statement is /are correct for the pioglitazone used for the treatment
I. It also increases insulin-dependent glucose use in skeletal muscle and adipose tissue
II. It lowers triglycerides more than rosiglitazone, probably because of its PPAR-alpha effect.
III. It reduces glucose-dependent insulin secretion by pancreatic gamma cells.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
It also increases insulin-dependent glucose use in skeletal muscle and adipose tissue. Pioglitazone lowers
triglycerides more than rosiglitazone, probably because of its PPAR-alpha effect.
46. What is the mechanism of action of exenatide used for the treatment of type 2 diabetes ?
I. It reduces glucose-dependent insulin secretion by pancreatic gamma cells.
II. It enhances glucose-dependent insulin secretion by pancreatic beta cells.
III. It suppresses inappropriately elevated glucagon secretion, and slows gastric emptying.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Exenatide is a GLP-1 agonist that improves glycemic control in patients with type 2 diabetes mellitus. Like
endogenous incretins, it enhances glucose-dependent insulin secretion by pancreatic beta cells, suppresses
inappropriately elevated glucagon secretion, and slows gastric emptying. The drug's 39 amino acid sequence
partially overlaps that of the human incretin GLP-1.
47. Which out of the following statement is /are correct for the exenatide used for the treatment of
type 2 diabetes ?
I. It is a GLP-1 agonist that improves glycemic control in patients with type 2 diabetes mellitus.
II. It may preserve parietal-cell function and yields positive effects on vasculature and inflammation.
III. The drug's 39 amino acid sequence partially overlaps that of the human incretin GLP-1.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Exenatide is a GLP-1 agonist that improves glycemic control in patients with type 2 diabetes mellitus. Like
endogenous incretins, it enhances glucose-dependent insulin secretion by pancreatic beta cells, suppresses
inappropriately elevated glucagon secretion, and slows gastric emptying. The drug's 39 amino acid sequence
partially overlaps that of the human incretin GLP-1.
48. Which out of the following statement is /are correct for the DPP-4 inhibitors used for the
I. It may preserve parietal-cell function and yields positive effects on vasculature and inflammation.
II. They increase insulin release and decrease glucagon levels in the circulation in a glucose-dependent
manner.
III. DPP-4 degrades numerous biologically active peptides, including the endogenous incretins GLP-1 and
glucose-dependent insulinotropic peptide .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Incretin hormones are part of an endogenous system involved in the physiologic regulation of glucose
homeostasis. They increase insulin release and decrease glucagon levels in the circulation in a glucose-dependent
manner. DPP-4 degrades numerous biologically active peptides, including the endogenous incretins GLP-1
and glucose-dependent insulinotropic peptide (GIP). DPP-4 inhibitors prolong the action of incretin
hormones.
49. What is the brand name of glipizide used for the treatment of type 2 diabetes mellitus ?
I. Glucotrol.
II. Glipizide XL.
III. Avandia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Glipizide (glucotrol, glucotrol xl, glipizide xl)

50. What is the brand name of repaglinide used for the treatment of type 2 diabetes mellitus ?
I. Glucotrol.
II. Glipizide XL.
III. Prandin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Repaglinide (prandin)
51. What is the brand name of pioglitazone used for the treatment of type 2 diabetes mellitus ?
I. Avandia.
II. Actos.
III. Prandin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Pioglitazone (actos)
52. Which out of the following statement is /are correct for the pramlintide used for the treatment
I. It may preserve gamma-cell function and yields positive effects on vasculature and inflammation.
II. This agent is a synthetic analogue of human amylin, a naturally occurring hormone made in pancreatic
beta cells.
III. It slows gastric emptying, suppresses postprandial glucagon secretion, and regulates food intake because
of centrally mediated appetite modulation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Pramlintide (Symlin, symlinpen 120, symlinpen 60)---This agent is a synthetic analogue of human amylin, a
naturally occurring hormone made in pancreatic beta cells. It slows gastric emptying, suppresses postprandial
glucagon secretion, and regulates food intake because of centrally mediated appetite modulation.
53. Which out of the following statement is /are correct for the dapagliflozinused for the treatment
I. It reduces glucose reabsorption in the proximal renal tubules and lowers the renal threshold for glucose.
II. It may preserve alpha-cell function and yields positive effects on vasculature and inflammation.
III. It is indicated as an adjunct to diet and exercise to improve glycemic control in type 2 diabetes mellitus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Dapagliflozin reduces glucose reabsorption in the proximal renal tubules and lowers the renal threshold for
glucose, thereby increasing urinary glucose excretion. It is indicated as an adjunct to diet and exercise to improve
glycemic control in type 2 diabetes mellitus.
54. What is the brand name of colesevelam used for the treatment of type 2 diabetes mellitus ?
I. Avandia.
II. WelChol.
III. Prandin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Colesevelam (welchol)
55. What is the onset of action of rapid acting insulin,insulin aspart ?
I. 5-15 minutes.
II. 5-15 seconds.
III. 5-15 hours.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Insulin aspart (novolog)---Insulin aspart has a short onset of action of 5-15 minutes and a short duration of
action of 3-5 hours.
56. What is the duration of action of rapid acting insulin,insulin aspart ?

I. 3-5 seconds.
II. 3-5 minutes.
III. 3-5 hours.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Insulin aspart (novolog)---Insulin aspart has a short onset of action of 5-15 minutes and a short duration of
action of 3-5 hours.
57. What is the brand name of insulin aspart used for the treatment of type 2 diabetes mellitus ?
I. Humalog.
II. NovoLog.
III. Apidra.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Insulin aspart (novolog)
58. What is the onset of action of intermediate acting insulin, insulin NPH ?
I. 5-15 minutes.
II. 3-4 hours.
III. 5-15 hours.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Insulin neutral protamine Hagedorn (NPH) has an onset of action of 3-4 hours. The peak effect occurs within
8-14 hours, and its usual duration of action is 16-24 hours.
59. What is mean by NPH ?

I. Neutral protein Hagedorn.
II. Normal protamine Hagedorn.
III. Neutral protamine Hagedorn.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Insulin neutral protamine Hagedorn (NPH)

60. What is the brand name of insulin NPH used for the treatment of type 2 diabetes mellitus ?
I. Humulin N.
II. Novolin N.
III. NovoLog N.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Insulin nph (humulin n, novolin n)
61. What is the duration of action of intermediate acting insulin, insulin NPH ?
I. 16-24 hours.
II. 3-4 hours.
III. 5-15 hours.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Insulin neutral protamine Hagedorn (NPH) has an onset of action of 3-4 hours. The peak effect occurs within
8-14 hours, and its usual duration of action is 16-24 hours.
62. What is the onset of action of long acting insulin, insulin glargine ?
I. 5-15 hours.
II. 4-8 hours.
III. 3-4 hours.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Insulin glargine has an onset of action of 4-8 hours and a duration of action of 24 hours. Peak effects occur
within 16-18 hours. The FDA has advised of a possible association of
63. What is the brand name of insulin degludec used for the treatment of type 2 diabetes mellitus ?
I. Lantus
II. Levemir
III. Tresiba
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Insulin degludec (Tresiba)
64. Which out of the following is ultra-long acting basal insulin used to improve glycemic control ?
I. Insulin Glargine (Lantus) .
II. Insulin degludec (Tresiba).
III. Insulin detemir (Levemir).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Insulin degludec (Tresiba)---Ultralong-acting basal insulin indicated to improve glycemic control in adults
with diabetes mellitus who require basal insulin.
65. What is the brand name of bromocriptine used for the treatment of type 2 diabetes mellitus ?
I. Cycloset.
II. Tresiba.
III. Levemir.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Bromocriptine (cycloset)
66. What is the onset of action of regular insulin used for treatment of type 2 diabetes ?
I. 0.5-1 hours.
II. 5-10 hours.
III. 15-20 hours.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Regular insulin has a rapid onset of action of 0.5-1 hours and duration of action of 4-6 hours. The peak effects
are seen within 2-4 hours.
67. What is the duration of action of regular insulin used for treatment of type 2 diabetes ?
I. 0.5-1 hours.
II. 4-6 hours.
III. 15-20 hours.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Regular insulin has a rapid onset of action of 0.5-1 hours and duration of action of 4-6 hours. The peak effects
are seen within 2-4 hours.
68. Which out of the following statement is /are correct for empagliflozin used for the treatment of
type 2 diabetes mellitus ?
I. It a SGLT2 inhibitor, decreases blood glucose by increasing urinary glucose excretion.
II. It may preserve alpha-cell function and yields positive effects on vasculature and inflammation.
III. SGLT2 inhibitors reduce glucose reabsorption and lower the renal threshold for glucose.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Empagliflozin, a SGLT2 inhibitor, decreases blood glucose by increasing urinary glucose excretion. SGLT2
inhibitors reduce glucose reabsorption and lower the renal threshold for glucose.
69. Which out of the following statement is /are correct for empagliflozin used for the treatment of
I. It may preserve alpha-cell function and yields positive effects on vasculature and inflammation.
II. It is expressed in the proximal renal tubules.
III. It is responsible for the majority of the reabsorption of filtered glucose from the tubular lumen.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
SGLT-2 is expressed in the proximal renal tubules and is responsible for the majority of the reabsorption of
filtered glucose from the tubular lumen.
70. What is the brand name of exenatide used for the treatment of type 2 diabetes mellitus ?
I. Byetta.
II. Cycloset.
III. Bydureon.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Exenatide (byetta, bydureon)
71. Which out of the following statement is /are correct for rosiglitazone used for the treatment of
I. It may preserve alpha-cell function and yields positive effects on vasculature and inflammation.
II. It is an insulin sensitizer with a major effect on the stimulation of glucose uptake in skeletal muscle and
adipose tissue.
III. It may preserve beta-cell function and yields positive effects on vasculature and inflammation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Rosiglitazone is an insulin sensitizer with a major effect on the stimulation of glucose uptake in skeletal muscle
and adipose tissue. It lowers plasma insulin levels. It is indicated for type 2 diabetes associated with insulin
resistance, as monotherapy and in conjunction with sulfonylureas and/or metformin and insulin. It may
preserve beta-cell function and yields positive effects on vasculature and inflammation. It changes LDL and
HDL particle size.
72. What is the brand name of acarbose used for the treatment of type 2 diabetes mellitus ?
I. Precose.
II. Glyset.
III. Bydureon.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Acarbose (precose)
73. Which out of the following statement is /are correct for acarbose used for the treatment of type
2 diabetes mellitus ?
I. It was the first alpha-glucosidase inhibitor approved by the FDA.
II. It is absorbed to a small degree, so liver function abnormalities can occur rarely.
III. It was the first gamma-glucosidase inhibitor approved by the FDA.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Acarbose was the first alpha-glucosidase inhibitor approved by the FDA. It is absorbed to a small degree, so
liver function abnormalities can occur rarely. It can be used as monotherapy or in combination with other
treatment modalities. The modest effect of acarbose on glycemia and its high degree of GI adverse effects
(flatulence) limit its use.
74. What is the brand name of miglitol used for the treatment of type 2 diabetes mellitus ?
I. Precose.
II. Glyset.
III. Bydureon.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Miglitol (glyset)
75. Which of the following drug agents are used in diabetic therapy for the treatment of type 2
diabetes ?
I. Biguanides.
II. Sulfonylureas.
III. Antifungal drugs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Agents used in diabetic therapy include the following:

 Biguanides
 Sulfonylureas
diabetes ?
I. Antiemetics.
II. Meglitinide derivatives.
III. Alpha-glucosidase inhibitors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Meglitinide derivatives
 Alpha-glucosidase inhibitors
diabetes ?
I. Thiazolidinediones (TZDs).
II. Prostaglandin analogs.
III. Glucagonlike peptide 1 (GLP-1) agonists.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Thiazolidinediones (tzds)
 Glucagonlike peptide 1 (GLP-1) agonists
diabetes ?
I. Dipeptidyl peptidase IV (DPP-4) Inhibitors.
II. Selective sodium-glucose transporter-2 (SGLT-2) inhibitors.
III. II Antihelmintic drugs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Dipeptidyl peptidase IV (DPP-4) Inhibitors
 Selective sodium-glucose transporter-2 (SGLT-2) inhibitors
diabetes ?
II. Insulins.
III. Amylinomimetics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Insulins
 Amylinomimetics
diabetes ?
I. Bile acid sequestrants.
II. Antihelmintic drugs.
III. Dopamine agonists.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Bile acid sequestrants
 Dopamine agonists
81. What is the mechanism of action of biguanides used for the treatment of type 2 diabetes ?
I. Reduce hyperglycemia by decreasing hepatic gluconeogenesis.
II. Reduce hyperglycemia by increasing peripheral insulin sensitivity.
III. Stimulates insulin secretion from beta cells.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
These agents are considered the first choice for oral type 2 diabetes treatment. They reduce hyperglycemia by
decreasing hepatic gluconeogenesis (primary effect) and increasing peripheral insulin sensitivity (secondary
effect). They do not increase insulin levels or cause weight gain. Alone, they rarely cause hypoglycemia.
82. Which out of the following biguanides is used as the first choice for oral type 2 diabetes treatment
?
I. Glyburide.
II. Glipizide.
III. Metformin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Antidiabetics, biguanides
Metformin (glucophage, fortamet, glumetzam, riomet)
83. Which out of the following second-generation sulfonylurea are used for type 2 diabetes treatment
?
I. Metformin.
II. Glipizide.
III. Glimepiride.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Antidiabetics, sulfonylureas
 Glyburide (diabeta, glynase)
 Glipizide (glucotrol, glucotrol xl, glipizide xl)
 Glimepiride (amaryl)
84. What is the mechanism of action of glimepiride ,a second-generation sulfonylurea ?

I. It stimulates insulin secretion from beta cells.
II. It stimulates insulin secretion from gamma cells.
III. It decrease rate of hepatic glucose production and increase insulin receptor sensitivity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Stimulates insulin secretion from beta cells; may also decrease rate of hepatic glucose production and increase
insulin receptor sensitivity
85. Which out of the following meglitinide derivatives are used for type 2 diabetes treatment ?
I. Repaglinide.
II. Glyburide.
III. Nateglinide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Antidiabetics, meglitinide derivatives

 Repaglinide (prandin)
 Nateglinide (starlix)
86. Which out of the following alpha-Glucosidase Inhibitors are used for the treatment of type 2
diabetes ?
I. Acarbose.
II. Glyburide.
III. Miglitol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Antidiabetics, alpha-glucosidase inhibitors

 Acarbose (precose)
 Miglitol (glyset)
87. What is the mechanism of action of alpha-glucosidase inhibitors in type 2 diabetic patient ?
I. It stimulates insulin secretion from beta cells.
II. It inhibits prolong the absorption of carbohydrates and thus help to prevent postprandial glucose surges.
III. It decrease rate of hepatic glucose production and increase insulin receptor sensitivity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Alpha-glucosidase inhibitors prolong the absorption of carbohydrates and thus help to prevent postprandial
glucose surges.
88. Which out of the following thiazolidinediones are used for the treatment of type 2 diabetes ?
I. Pioglitazone.
II. Rosiglitazone.
III. Nateglinide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Antidiabetics, thiazolidinediones
 Pioglitazone (actos)
 Rosiglitazone (avandia)
89. Which out of the following glucagonlike peptide-1 agonists are used for the treatment of type 2
diabetes ?
I. Nateglinide.
II. Exenatide.
III. Liraglutide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Antidiabetics, glucagonlike peptide-1 agonists

 Exenatide (byetta, bydureon)
 Liraglutide (victoza)
 Albiglutide (tanzeum)
 Dulaglutide (trulicity)
90. Which out of the following glucagonlike peptide-1 agonists are used for the treatment of type 2
diabetes ?
I. Albiglutide.
II. Nateglinide.
III. Dulaglutide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Antidiabetics, glucagonlike peptide-1 agonists

 Exenatide (byetta, bydureon)
 Liraglutide (victoza)
 Albiglutide (tanzeum)
 Dulaglutide (trulicity)
91. Which out of the following dipeptidyl peptidase IV Inhibitors are used for the treatment of type
2 diabetes ?
I. Sitagliptin (Januvia).
II. Saxagliptin (Onglyza).
III. Dulaglutide (Trulicity).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Antidiabetics, dipeptidyl peptidase iv inhibitors

 Sitagliptin (januvia)
 Saxagliptin (onglyza)
 Linagliptin (tradjenta)
 Alogliptin (nesina)
92. Which out of the following dipeptidyl peptidase IV Inhibitors are used for the treatment of type
2 diabetes ?
I. Acarbose (Precose).
II. Linagliptin (Tradjenta).
III. Alogliptin (Nesina).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Antidiabetics, dipeptidyl peptidase iv inhibitors

 Sitagliptin (januvia)
 Saxagliptin (onglyza)
 Linagliptin (tradjenta)
 Alogliptin (nesina)
93. Which out of the following amylinomimetics are used for the treatment of type 2 diabetes ?
I. Acarbose .
II. Pramlintide.
III. Alogliptin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Antidiabetics, amylinomimetics
Pramlintide (symlin, symlinpen 120, symlinpen 60)
94. Which out of the following selective sodium-glucose transporter-2 inhibitors are used for the
I. Alogliptin.
II. Canagliflozin.
III. Dapagliflozin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Selective sodium-glucose transporter-2 inhibitors

 Canagliflozin (invokana)
 Dapagliflozin (farxiga)
 Empagliflozin (jardiance)
95. Which out of the following bile acid sequestrants is used for the treatment of type 2 diabetes ?
I. Alogliptin.
II. Canagliflozin.
III. Colesevelam.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Bile acid sequestrants

 Colesevelam (welchol)
96. Which out of the following antidiabetics, rapid-acting insulins are used for the treatment of type
I. Insulin aspart.
II. Insulin glulisine.
III. Insulin NPH.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Antidiabetics, rapid-acting insulins

 Insulin aspart (novolog)
 Insulin glulisine (apidra)
 Insulin lispro (humalog)
 Insulin inhaled (afrezza)
97. Which out of the following antidiabetics, intermediate -acting insulins are used for the treatment
of type 2 diabetes mellitus ?
I. Insulin aspart.
II. Insulin glulisine.
III. Insulin NPH.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Antidiabetics, intermediate-acting insulins

 Insulin nph (humulin n, novolin n)
98. Which out of the following antidiabetics, long -acting insulins are used for the treatment of type
I. Insulin Glargine.
II. Insulin NPH.
III. Insulin degludec.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Antidiabetics, long-acting insulins

 Insulin detemir (levemir)
 Insulin glargine (lantus)
 Insulin degludec (tresiba)
99. Which out of the following antidiabetics, rapid-acting insulins are used for the treatment of type
I. Insulin NPH.
II. Insulin lispro.
III. Insulin inhaled.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Antidiabetics, rapid-acting insulins

 Insulin aspart (novolog)
 Insulin glulisine (apidra)
 Insulin lispro (humalog)
 Insulin inhaled (afrezza)
100. Which out of the following dopamine Agonists are used for the treatment of type 2 diabetes
mellitus ?
I. Bromocriptine.
II. Pramlintide.
III. Alogliptin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Antiparkinson agents, dopamine agonists

 Bromocriptine (cycloset)
Hypothyroidism
1. What is the most common cause of hypothyroidism ?

I. Adequate iodine intake.
II. Autoimmune disease.
III. Heat intolerance.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Adequate iodine intake, autoimmune thyroid disease (Hashimoto disease) is the most common cause of
hypothyroidism
2. What are the symptoms of hypothyroidism ?

II. Fatigue, loss of energy, lethargy.
III. Weight gain.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The following are symptoms of hypothyroidism:

 Fatigue, loss of energy, lethargy
 Weight gain
I. Decreased appetite.
II. Increased appetite.
III. Cold intolerance.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Decreased appetite
 Cold intolerance
4. Which out of following are the symptoms of hypothyroidism ?

I. Dry skin.
II. Hair loss.
III. Diarrhea.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Dry skin
 Hair loss
I. Headache.
II. Sleepiness.
III. Muscle pain, joint pain.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Sleepiness
 Muscle pain, joint pain, weakness in the extremities

I. Diarrhea.
II. Depression.
III. Emotional lability, mental impairment.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Depression
 Emotional lability, mental impairment
I. Forgetfulness, impaired memory, inability to concentrate.
III. Constipation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Forgetfulness, impaired memory, inability to concentrate
 Constipation

I. Menstrual disturbances, impaired fertility.
II. Decreased perspiration.
III. Increased perspiration.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Menstrual disturbances, impaired fertility
 Decreased perspiration
II. Paresthesia and nerve entrapment syndromes.
III. Blurred vision.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Paresthesia and nerve entrapment syndromes
 Blurred vision

I. Decreased hearing.
II. Increased perspiration.
III. Fullness in the throat, hoarseness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Decreased hearing
 Fullness in the throat, hoarseness
11. What are the most sensitive screening tool for primary hypothyroidism ?
I. Bradford protein assay.
II. Third-generation thyroid-stimulating hormone (TSH) assays.
III. Enzyme-linked immunosorbent assay.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Third-generation thyroid-stimulating hormone (TSH) assays are generally the most sensitive screening tool for
primary hypothyroidism.[
12. What abnormalities are found in complete blood count and metabolic profile of patient with
hypothyroidism ?
I. Anemia.
II. Dilutional hyponatremia.
III. Hypolipidemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Abnormalities in the complete blood count and metabolic profile that may be found in patients with
hypothyroidism include the following:
 Anemia
 Dilutional hyponatremia
13. What abnormalities are found in complete blood count and metabolic profile of patient with
hypothyroidism ?
I. Hyperlipidemia.
II. Hypolipidemia.
III. Reversible increases in creatinine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Abnormalities in the complete blood count and metabolic profile that may be found in patients with
hypothyroidism include the following:
 Hyperlipidemia
 Reversible increases in creatinine
 Elevations in transaminases and creatinine kinase
14. What are different type of primary hypothyroidism ?
I. Chronic lymphocytic (autoimmune) thyroiditis.
II. Pulmonary thyroiditis.
III. Postpartum thyroiditis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Types of primary hypothyroidism include the following:

 Chronic lymphocytic (autoimmune) thyroiditis
 Postpartum thyroiditis

I. Metal-induced hypothyroidism.
II. Subacute (granulomatous) thyroiditis.
III. Drug-induced hypothyroidism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Subacute (granulomatous) thyroiditis
 Drug-induced hypothyroidism
 Iatrogenic hypothyroidism
I. Metal-induced hypothyroidism.
II. Iatrogenic hypothyroidism.
III. Postpartum thyroiditis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Chronic lymphocytic (autoimmune) thyroiditis
 Postpartum thyroiditis
 Iatrogenic hypothyroidism
17. Which out of the following statement is /are correct for Hashimoto thyroiditis ?
I. It is chronic lymphocytic (autoimmune) thyroiditis.
II. The body considers the thyroid antigens as foreign, and a chronic immune reaction ensues.
III. The lymphocytic infiltration of the gland and progressive development of functional thyroid tissue.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The most frequent cause of acquired hypothyroidism is chronic lymphocytic (autoimmune) thyroiditis
(Hashimoto thyroiditis). The body considers the thyroid antigens as foreign, and a chronic immune reaction
ensues, resulting in lymphocytic infiltration of the gland and progressive destruction of functional thyroid tissue.
18. Which out of the following statement is /are correct for postpartum thyroiditis ?
I. The lymphocytic infiltration of the gland and progressive development of functional thyroid tissue.
II. This hypothyroid state can be preceded by a short thyrotoxic state.
III. High titers of anti-TPO antibodies during pregnancy have been reported to have high sensitive and
specificity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The hypothyroid state can be preceded by a short thyrotoxic state. High titers of anti-TPO antibodies during
pregnancy have been reported to have high sensitive and specificity for postpartum autoimmune thyroid disease
19. Which out of the following statement is /are correct for subacute granulomatous thyroiditis ?
I. It is also known as de Quervain disease.
II. It is also known as postpartum autoimmune thyroid disease.
III. It is a relatively uncommon disease that occurs most frequently in middle-aged women.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Also known as de Quervain disease, subacute granulomatous thyroiditis is a relatively uncommon disease that
occurs most frequently in middle-aged women. Disease features include low grade fever, thyroid pain,
dysphagia, and elevated erythrocyte sedimentation rate (ESR).
20. Which of the following are the features of the Quervain disease ?
I. Pneumonia.
II. Low grade fever.
III. Thyroid pain.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
21. Which of the following are the features of the Quervain disease ?
I. Dysphagia.
II. Diptheria.
III. Elevated erythrocyte sedimentation rate (ESR).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
22. Which of the following medication have potential to cause drug-induced and iatrogenic
hypothyroidism ?
I. Amiodarone.
II. Interferon alfa.
III. Prostaglandin analogs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Drug-induced and iatrogenic hypothyroidism

 Amiodarone
 Interferon alfa
23. Which of the following medication have potential to cause drug -induced and iatrogenic
hypothyroidism ?
I. Cimithidine.
II. Thalidomide.
III. Stavudine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Thalidomide
 Lithium
hypothyroidism ?
I. Stavudine.
II. Omeprazole.
III. Oral tyrosine kinase inhibitors Sunitinib, imatinib.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Stavudine
 Oral tyrosine kinase inhibitors Sunitinib, imatinib
25. Which of the following gene is associated with risk of developing thyroid disease and
hypothyroidism ?
I. A single-nucleotide polymorphism located near the FOXE1 gene.
II. A single-nucleotide polymorphism located near the TOXE2 gene.
III. A single-nucleotide polymorphism located near the TOLE1 gene.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Genome-wide association studies have suggested that a single-nucleotide polymorphism located near the FOXE1
gene is associated with risk of developing thyroid disease and that the strongest association is with
hypothyroidism.
26. What are the potential cause of central hypothyroidism ?
I. Nervous system breakdown.
II. Hypothalamic-pituitary axis damage.
III. Pituitary adenoma.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Central hypothyroidism (secondary or tertiary) results when the hypothalamic-pituitary axis is damaged. The
following potential causes should be considered:
 Pituitary adenoma
 Tumors impinging on the hypothalamus

I. Tumors impinging on the hypothalamus.
II. Prostate cancer.
III. Lymphocytic hypophysitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
following potential causes should be considered
 Pituitary adenoma
 Tumors impinging on the hypothalamus
 Lymphocytic hypophysitis
I. Sheehan syndrome.
II. History of brain or pituitary irradiation.
III. Anderson syndrome.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Sheehan syndrome
 History of brain or pituitary irradiation

I. Nervous system breakdown.
II. Congenital nongoiterous hypothyroidism type 4.
III. TRH resistance.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Drugs (eg, dopamine, prednisone, or opioids)
 Congenital nongoiterous hypothyroidism type 4
 TRH resistance
 TRH deficiency
30. Which of the following is caused by a mutation in the TSHB gene and is inherited in an
autosomal recessive pattern ?
I. Congenital nongoiterous hyperthyroidism type 1.
II. Congenital nongoiterous hypothyroidism type 4.
III. Congenital nongoiterous hyperthyroidism type 3.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Congenital nongoiterous hypothyroidism type 4 is caused by a mutation in the TSHB gene and is inherited in
an autosomal recessive pattern.
31. Which out of the following statement is/are correct for the hypothyroidism?
I. It is more common in women with small body size at birth and low body mass index during childhood.
II. Iodine deficiency as a cause of hypothyroidism is more common in less-developed countries.
III. It is more common in women with large body size at birth and high body mass index during childhood.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Hypothyroidism is more common in women with small body size at birth and low body mass index during
childhood. Iodine deficiency as a cause of hypothyroidism is more common in less-developed countries.
32. Which of the following drugs can interfere with absorption of thyroid hormone ?
II. Calcium acetate aluminum hydroxide.
III. Proton pump inhibitors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Many drugs (eg, iron, calcium carbonate, calcium acetate aluminum hydroxide, sucralfate, raloxifene, and
proton pump inhibitors) can interfere with absorption and therefore should not be taken within 2-4 hours of
LT4 administration.
33. Which of the following drugs can interfere with absorption of thyroid hormone ?
I. Sucralfate.
II. B-blockers.
III. Raloxifene.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Many drugs (eg, iron, calcium carbonate, calcium acetate aluminum hydroxide, sucralfate, raloxifene, and
proton pump inhibitors) can interfere with absorption and therefore should not be taken within 2-4 hours of
LT4 administration.
34. What are the physical signs of hypothyroidism ?
I. Forgetfulness.
II. Weight gain and dry skin.
III. Slowed speech and movements.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Physical signs of hypothyroidism include the following:

 Weight gain
 Slowed speech and movements
 Dry skin

I. Jaundice.
II. Pallor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Jaundice
 Pallor
I. Coarse, brittle, straw-like hair.
II. Forgetfulness.
III. Loss of scalp hair, axillary hair, pubic hair, or a combination.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Coarse, brittle, straw-like hair
 Loss of scalp hair, axillary hair, pubic hair, or a combination

I. Coarse facial features.
II. Periorbital puffiness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Coarse facial features
 Periorbital puffiness
I. Forgetfulness.
II. Macroglossia.
III. Hoarseness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Macroglossia
 Goiter (simple or nodular)
 Hoarseness

I. Pericardial effusion.
II. Social withdrawal.
III. Abdominal distention, ascites.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Decreased systolic blood pressure and increased diastolic blood pressure
 Bradycardia
 Abdominal distention, ascites
I. Pitting edema of lower extremities.
II. Hypothermia.
III. Forgetfulness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Hypothermia (only in severe hypothyroid states)
 Nonpitting edema (myxedema)
 Pitting edema of lower extremities
41. What is the accepted reference range for normal serum TSH?
I. 0.40-4.2 mIU/L.
II. 4.0-4.2 mIU/L.
III. 40.0-42.0 mIU/L.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The generally accepted reference range for normal serum TSH is 0.40-4.2 miu/L.
42. What is mean by NHANES?

I. National Health and Nutrition Examination Society.
II. National Health and Nutrition Examination Survey.
III. National Health and National Examination Survey.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
National Health and Nutrition Examination Survey (NHANES )
43. What are the symptoms more specific to Hashimoto thyroiditis ?

I. Feeling of fullness in the throat.
II. Painless thyroid enlargement.
III. Corneal dermatitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The following are symptoms more specific to Hashimoto thyroiditis:

 Feeling of fullness in the throat
 Painless thyroid enlargement
44. What are the symptoms more specific to Hashimoto thyroiditis ?

I. Corneal dermatitis.
II. Exhaustion.
III. Transient neck pain, sore throat, or both.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The following are symptoms more specific to Hashimoto thyroiditis:

 Exhaustion
 Transient neck pain, sore throat, or both
45. What are the features of myxedema coma?
I. Altered mental status.
II. Hypothermia.
III. Hperthermia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Features of Myxedema coma are as follows:

 Altered mental status
 Hypothermia

I. Hperthermia.
II. Bradycardia.
III. Hypercarbia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Bradycardia
 Hypercarbia
I. Hyponatremia.
II. Hypernatremia.
III. Cardiomegaly.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Hyponatremia
 Cardiomegaly, pericardial effusion, cardiogenic shock, and ascites may be present

I. Pericardial effusion.
II. Cardiogenic shock.
III. Hypernatremia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Hyponatremia
 Cardiomegaly, pericardial effusion, cardiogenic shock, and ascites may be present
49. What is the treatment of choice for hypothyroidism ?

I. Monotherapy with Parathormone (PTH4).
II. Monotherapy with levothyroxine (LT4).
III. Monotherapy with Isothormone (ITH4).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Monotherapy with levothyroxine (LT4) remains the treatment of choice for hypothyroidism
50. What is the half life of T4 ?
I. 7-10 days.
II. 7-10 Weeks.
III. 7-10 months.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The half-life of T4 is approximately 7-10 days.
51. What results are observed after the routine measurement of patient with hypothyroidism?
I. Elevated TSH with decreased T4 or FTI.
II. Reduced TSH with increased T4 or FTI.
III. Elevated TSH with normal free T4 or FTI in case of mild or subclinical hypothyroidism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Results in patients with hypothyroidism are as follows:

 Elevated TSH with decreased T4 or FTI
 Elevated TSH (usually 4.5-10.0 miu/L) with normal free T4 or FTI is considered mild or subclinical
hypothyroidism
52. What are the various aspect of LT4 treatment in patient with hypothyroidism ?
I. Young and healthy patients can be started on LT4 at anticipated full replacement doses.
II. In elderly patients and those with known ischemic heart disease, begin with one fourth to one half the
expected dose.
III. In elderly patients and those with known ischemic heart disease can be started on LT4 at anticipated
full replacement doses.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Aspects of LT4 treatment are as follows:

 Otherwise young and healthy patients can be started on LT4 at anticipated full replacement doses
 In elderly patients and those with known ischemic heart disease, begin with one fourth to one half the
expected dose and adjust the dose in small increments after no less than 4-6 weeks
53. What are the various aspect of LT4 treatment in patient with hypothyroidism?
I. In elderly patients and those with known ischemic heart disease can be started on LT4 at anticipated full
replacement doses.
II. Achieving a TSH level within the reference range may take several months.
III. LT4 dosing changes should be made every 6-
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Aspects of LT4 treatment are as follows:

 Clinical benefits begin in 3-5 days and level off after 4-6 weeks
 Achieving a TSH level within the reference range may take several months
 LT4 dosing changes should be made every 6-
54. What symptoms and signs of overtreatment should monitored in hypothryoid patient after
dosage stabilization?
I. Tachycardia.
II. Palpitations.
III. Bradycardia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
After dosage stabilization, patients can be monitored with annual or semiannual clinical evaluations and TSH
monitoring. Patients should be monitored for symptoms and signs of overtreatment, which include the
following:
 Tachycardia
 Palpitations
dosage stabilization?
I. Bradycardia.
III. Nervousness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
following:
 Atrial fibrillation
 Nervousness
dosage stabilization ?
I. Tiredness.
II. Headache.
III. Decreased excitability.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
following:
 Tiredness
 Headache
I. Increased excitability.
II. Decreased excitability.
III. Sleeplessness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
following:
 Increased excitability
 Sleeplessness
I. Decreased excitability.
II. Possible angina.
III. Tremors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
following:
 Tremors
 Possible angina
59. What are the updated recommendations concerning hypothyroidism treatment in pregnant
women issued by American Thyroid Association?
I. Levothyroxine replacement therapy with the dose titrated to achieve a TSH concentration within the
trimester-specific reference range.
II. Women taking levothyroxine, 2 additional doses per week of the current levothyroxine dose, given as
one extra dose twice weekly with several days.
III. Serum TSH should be reassessed during the last stage of pregnancy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Updated recommendations concerning hypothyroidism treatment in pregnant women are as follows:

 Pregnant women with overt hypothyroidism should receive levothyroxine replacement therapy with
the dose titrated to achieve a TSH concentration within the trimester-specific reference range.
 In women already taking levothyroxine, 2 additional doses per week of the current levothyroxine dose,
women issued by American Thyroid Association?
I. Serum TSH should be reassessed during the last stage of pregnancy.
II. Serial serum TSH levels assessed every 4 weeks during the first half of pregnancy adjust levothyroxine
dosing maintain TSH within the trimester-specific range.
III. Serum TSH should be reassessed during the second half of pregnancy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Updated recommendations concerning hypothyroidism treatment in pregnant women are as follows:[5, 6]

 Serial serum TSH levels should be assessed every 4 weeks during the first half of pregnancy to adjust
levothyroxine dosing to maintain TSH within the trimester-specific range.
 Serum TSH should be reassessed during the second half of pregnancy
61. What recommendations are given for thr treatment of myxedema coma issued by American
Thyroid Association?
I. Intravenous (IV) LT4 at a dose of 4 µg/kg of lean body weight.
II. Intravenous (IV) LT4 at a dose of 200-250 µg, as a bolus in a single or divided dose.
III. After 24 hours, 500 µg LT4 IV, then 100 µg/day IV.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Treatment of myxedema coma is as follows:

 Intravenous (IV) LT4 at a dose of 4 µg/kg of lean body weight, or approximately 200-250 µg, as a
bol
 After 24 hours, 100 µg LT4 IV, then 50 µg/day IV
62. What does mean by secondary hypothyroidism?
I. The thyroid gland itself is normal, but it receives insufficient stimulation because of low secretion of
thyrotropin from the pituitary gland.
II. The inadequate secretion of thyrotropin-releasing hormone from the hypothalamus leads to insufficient
release of TSH.
III. It is a primary process in which the thyroid gland is unable to produce sufficient amounts of thyroid
hormone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Hypothyroidism can also be secondary that is, the thyroid gland itself is normal, but it receives insufficient
stimulation because of low secretion of thyrotropin (ie, thyroid-stimulating hormone [TSH]) from the pituitary
gland.
63. What does mean by tertiary hypothyroidism?

I. The thyroid gland itself is normal, but it receives insufficient stimulation because of low secretion of
thyrotropin from the pituitary gland.
II. The inadequate secretion of thyrotropin-releasing hormone from the hypothalamus leads to insufficient
release of TSH.
III. It is a primary process in which the thyroid gland is unable to produce sufficient amounts of thyroid
hormone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
In tertiary hypothyroidism, inadequate secretion of thyrotropin-releasing hormone (TRH) from the

hypothalamus leads to insufficient release of TSH, which in turn causes inadequate thyroid stimulation.
64. Which out of the following statement is / are correct for the congenital hypothyroidism ?
I. It affects 1 of every 4000 newborns, is due to congenital maldevelopment of the thyroid.
II. This disorder is included in the newborn screening panel in the United States .
III. This is classically the result of maternal iodine deficiency.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Congenital hypothyroidism, which affects 1 of every 4000 newborns, is due to congenital maldevelopment of
the thyroid (see Pediatric Hypothyroidism). This disorder is included in the newborn screening panel in the
United States and many other countries, and it is readily treatable once detected.
65. Which out of the following statement is / are correct for the congenital hypothyroidism ?
I. It affects 1 of every 4000 newborns, is due to congenital maldevelopment of the thyroid.
II. It is severe hypothyroidism in an infant or child.
III. This is classically the result of maternal iodine deficiency.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Cretinism refers to severe hypothyroidism in an infant or child. This is classically the result of maternal iodine
deficiency, and thankfully is increasingly rare.
66. What is the normal level of T4 release by thyroid gland daily under normal circumstances ?
I. 200-525 nmol.
II. 400-825 nmol.
III. 100-125 nmol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Under normal circumstances, the thyroid releases 100-125 nmol of T4 daily
67. What is the active form of thyroid hormone ?
I. T4.
II. T3.
III. T5.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
-
deiodination.
68. By which process T4, a prohormone is converted to T3 ?

I. B -deflouroination.
II. B -dechlorination.
III. B -deiodination.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
-
deiodination.
69. What changes observed in heart as a result of hypothyroidism ?

I. Decreased contractility.
II. Cardiac enlargement.
III. Increased cardiac output.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The hypothyroid changes in the heart result in decreased contractility, cardiac enlargement, pericardial effusion,
decreased pulse, and decreased cardiac output.
70. What changes observed in heart as a result of hypothyroidism ?

I. Increased cardiac output.
II. Pericardial effusion.
III. Decreased pulse.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The hypothyroid changes in the heart result in decreased contractility, cardiac enlargement, pericardial effusion,
decreased pulse, and decreased cardiac output.
71. What changes observed in gastrointestinal (GI) tract as a result of hypothyroidism ?

I. Achlorhydria.
II. Esophagitis.
III. Prolonged intestinal transit time.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In the gastrointestinal (GI) tract, achlorhydria and prolonged intestinal transit time with gastric stasis can
occur.
72. What should be a routine part of any investigation into menstrual irregularities or infertility ?
I. TSH screening.
II. Blood test.
III. Free testosterone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
TSH screening should be a routine part of any investigation into menstrual irregularities or infertility.
73. What changes observed in metabolic process as a result of decreased thyroid hormone?
I. Increased levels of total cholesterol.
II. Increased levels of Low-density lipoprotein (LDL) cholesterol.
III. Decreased levels of Low-density lipoprotein (LDL) cholesterol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Decreased thyroid hormone effect can cause increased levels of total cholesterol and low-density lipoprotein
(LDL) cholesterol and a possible change in high-density lipoprotein (HDL) cholesterol because of a change in
metabolic clearance.
74. Which out of the following statement is / are correct for the postpartum thyroiditis ?
II. Up to 10% of postpartum women may develop postpartum thyroiditis in the 2-12 months after delivery.
III. The frequency may be as high as 25% in women with type 1 diabetes mellitus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Up to 10% of postpartum women may develop lymphocytic thyroiditis (postpartum thyroiditis) in the 2-12
months after delivery. The frequency may be as high as 25% in women with type 1 diabetes mellitus.
75. Which of the following diseases treated by external neck irradiation which results in
hypothyroidism?
I. Head and neck neoplasms.
II. Hepatitis-B.
III. Breast cancer.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
External neck irradiation (for head and neck neoplasms, breast cancer, or Hodgkin disease) may result in
hypothyroidism
76. Which of the following diseases treated by external neck irradiation which results in
hypothyroidism?
I. Hepatitis-B.
II. Hodgkin disease.
III. Hay fever.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
External neck irradiation (for head and neck neoplasms, breast cancer, or Hodgkin disease) may result in
hypothyroidism
77. Which of the following genes mutations are known to cause congenital hypothyroidism without
goiter?
I. TSHR genes.
II. PAX8 genes.
III. TOXL genes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Mutations in the TSHR and PAX8 genes are known to cause congenital hypothyroidism without goiter.
78. Which out of the following statement is /are correct for pendred syndrome ?
I. It is caused by a mutation in the SLC26A4 gene.
II. It causes a defect in the organification of iodine and, usually, an enlarged thyroid gland.
III. It is not inherited in an autosomal recessive manner.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Pendred syndrome is caused by a mutation in the SLC26A4 gene, which causes a defect in the organification
of iodine (ie, incorporation into thyroid hormone), congenital sensorineural hearing loss, and, usually, an
enlarged thyroid gland. It is inherited in an autosomal recessive manner.[
79. Which out of the following statement is /are correct for autoimmune polyendocrinopathy type
I?
I. It is caused by a mutation in the AIRE gene.
II. It is not inherited in an autosomal dominant fashion.
III. It is characterized by the presence of Addison disease, hypoparathyroidism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Autoimmune polyendocrinopathy type I is caused by a mutation in the AIRE gene and is characterized by the
presence of Addison disease, hypoparathyroidism, and mucocutaneous candidiasis. It is inherited in an
autosomal dominant fashion.
80. Which out of the following statement is /are correct for autoimmune polyendocrinopathy type
2?
II. It is also known as Schmidt syndrome.
III. It is associated with adrenal insufficiency and hypothyroidism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Autoimmune polyendocrinopathy type 2 (Schmidt syndrome) is associated with adrenal insufficiency and
hypothyroidism
81. What is the Wolff-Chiakoff effect?

I. Due to iodine overload, the sodium-iodide symporter shuts down.
II. Inhibition of iodide organification and thyroid hormone synthesis.
III. In it increase in intracellular iodine levels.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Excess iodine can transiently inhibit iodide organification and thyroid hormone synthesis (the Wolff-Chiakoff
effect). In patients with iodine overload, the sodium-iodide symporter shuts down, and this allows intracellular
iodine levels to drop and hormone secretion to resume
82. Which of the following causes death of the pituitary cells by exerting pressure due to tumours in
around the pituitary?
I. Radiation.
II. Rehabilation.
III. Hypophysitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Tumors in or around the pituitary cause impaired pituitary function by exerting pressure on normal pituitary
cells and thereby affect the secretion of TRH, TSH, or both. Radiation, hypophysitis, and Sheehan syndrome
cause death of these cells
83. Which of the following syndrome causes death of the pituitary cells by exerting pressure due to
tumours in around the pituitary?
I. Andereson syndrome.
II. Zollinger Ellison syndrome.
III. Sheehan syndrome.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Tumors in or around the pituitary cause impaired pituitary function by exerting pressure on normal pituitary
cells and thereby affect the secretion of TRH, TSH, or both. Radiation, hypophysitis, and Sheehan syndrome
cause death of these cells
84. What is mean by NHANES?
I. It is National Health and Nutrition Examination Survey done in year 1999-2002.
II. It is National Hormony and Nutrition Examination Survey done in year 1989-2000.
III. It is done on 4392 individuals reflecting the US population reported hypothyroidism in 3.7% of the
population.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The National Health and Nutrition Examination Survey (NHANES 1999-2002) of 4392 individuals
reflecting the US population reported hypothyroidism (defined as TSH levels exceeding 4.5 miu/L) in 3.7% of
the population
85. What is the recommended urinary iodine concentration in general population by WHO?
I. 100 -
II. 150-
III. 250-
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
and a range of 150-
86. What is the recommended urinary iodine concentration in pregnant women by WHO ?
I. 100 -
II. 150-
III. 250-
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
general population
and a range of 150-
87. How to calculate the free T4 index (FTI)?

I. It is the product of T3 resin uptake and total T4 levels .
II. It is the addition of T3 resin uptake and total T4 levels.
III. It is the subtraction of T3 resin uptake and total T4 levels.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The FTI is the product of T3 resin uptake and total T4 levels.
88. How to calculate the free thyroid hormone?

I. It can be estimated by calculating the percentage of available thyroid hormone-binding sites.
II. It can be estimated by by measuring the TBG concentration.
III. It can be estimated by calculating the percentage of available estrogen hormone-binding sites.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Free thyroid hormone levels can be estimated by calculating the percentage of available thyroid hormone-
binding sites (triiodothyronine [T3] resin uptake, or thyroid hormone binding ratio [THBR]) or by measuring
the TBG concentration.
89. Which of the following may be helpful in determining the etiology of hypothyroidism or in
predicting future hypothyroidism?
I. Assay of bradford protein.
II. Assays for anti thyroid peroxidase (anti-TPO).
III. Assays for antithyroglobulin (anti-Tg) antibodies.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Assays for anti thyroid peroxidase (anti-TPO) and antithyroglobulin (anti-Tg) antibodies may be helpful in
determining the etiology of hypothyroidism or in predicting future hypothyroidism.
90. Which out of the following statement is /are correct for color flow Doppler scanning?
I. It blocks assessment of vascularity.
II. It allows assessment of vascularity.
III. It can help to distinguish thyroiditis from Graves disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The use of color flow Doppler scanning allows assessment of vascularity, which can help to distinguish
thyroiditis from Graves disease.
91. What is mean by FDG-PET?

I. F16-fluorodeoxygalactose positron emission tomography.
II. F17-fluorodeoxyglucose positron electron tomography.
III. F18-fluorodeoxyglucose positron emission tomography.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
F18-fluorodeoxyglucose positron emission tomography (FDG-PET)
92. What are the causes of functional tissue destruction and infiltration in hypothyroidism?
I. Rehabilation.
II. Previous administration of radioiodine.
III. Surgical removal.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Other causes of functional tissue destruction and infiltration include the following:
 Previous administration of radioiodine
 Surgical removal
I. Metastasis.
II. Lymphoma.
III. Highly strenous exercise.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Metastasis
 Lymphoma
I. Sarcoidosis.
II. Acidosis.
III. Tuberculosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Sarcoidosis
 Tuberculosis
I. Pneumonia.
II. Amyloidosis.
III. Cystinosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Amyloidosis
 Cystinosis
I. Thalassemia.
II. Riedel thyroiditis.
III. Diptheria.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Thalassemia
 Riedel thyroiditis
I. Thalassemia.
II. Tetnus.
III. Hemochromatosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Thalassemia
 Hemochromatosis
hypothyroidism?
II. p -Aminosalicylic acid.
III. Ipilimumab.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 P -Aminosalicylic acid
 Ipilimumab
99. What are the causes of autoimmune thyroiditis?

I. Decreased iodine turnover.
II. Increased iodine turnover.
III. Defective organification.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Autoimmune thyroiditis causes a decrease in intrathyroidal iodine stores, increased iodine turnover, and
defective organification.
100. What are the causes of autoimmune thyroiditis?

I. Decrease in intrathyroidal iodine stores.
II. Decreased iodine turnover.
III. Defective organification.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Autoimmune thyroiditis causes a decrease in intrathyroidal iodine stores, increased iodine turnover, and
defective organification.
Drugs and pharmacology (questions-100)
1. What symptoms and signs of overtreatment should monitored in hypothryoid patient after dosage
stabilization?
I. Tachycardia.
II. Palpitations.
III. Bradycardia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
following:
 Tachycardia
 Palpitations
stabilization?
I. Bradycardia.
III. Nervousness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
following:
 Atrial fibrillation
 Nervousness
stabilization?
I. Tiredness.
II. Headache.
III. Bradycardia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
following:
 Tiredness
 Headache
stabilization?
I. Increased excitability.
II. Decreased excitability.
III. Sleeplessness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
following:
 Increased excitability
 Sleeplessness
stabilization?
I. Decreased excitability.
II. Possible angina.
III. Tremors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
following:
 Tremors
 Possible angina
6. Which factor should consider before deciding the starting dose of levothyroxine?
I.
II. P
III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
etiology of hypothyroidism, degree of TSH elevation, age, and general clinical context, including the presence
of cardiac disease, should be considered. The serum TSH goal appropriate for the clinical situation should also
be considered.
I.
II. Pregnancy status.
III. Etiology of hypothyroidism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
be considered.
I. Degree of TSH elevation.
II.
III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
When deciding on a starting dose of levothyrox

be considered.
9. What are the adverse effect of hypothyroidism in pregnancy?
I. Preeclampsia.
II. Anemia.
III. Decreased risk of spontaneous abortion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Adverse effects of hypothyroidism in pregnancy include the following:

 Preeclampsia
 Anemia

I. Decreased risk of spontaneous abortion.
II. Postpartum hemorrhage.
III. Cardiac ventricular dysfunction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Postpartum hemorrhage
 Cardiac ventricular dysfunction
I. Increased risk of spontaneous abortion.
II. High birth weight.
III. Low birth weight.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Increased risk of spontaneous abortion
 Low birth weight

I. Impaired cognitive development in the fetus.
II. Fetal mortali.
III. Decreased risk of spontaneous abortion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Impaired cognitive development in the fetus
 Fetal mortali
13. What is the goal of pharmacotherapy of hypothyroidism ?

I. To reduce morbidity.
II. To prevent complications.
III. To increase morbidity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

14. Which out of the following drugs falls in the category of thyroid products used for the treatment
of hypothyroidism?
I. Levothyroxine.
II. Liothyronine.
III. Lignocaine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Thyroid products
 levothyroxine (synthroid, levoxyl, levothroid, unithroid, tirosint)
 liothyronine (cytomel, triostat)
 thyroid desiccated (armour thyroid, nature-throid, westhroid)
15. Which out of the following drugs falls in the category of thyroid products used for the treatment
of hypothyroidism?
I. Levothyroxine.
II. Lignocaine.
III. Thyroid desiccated.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Thyroid products
 levothyroxine (synthroid, levoxyl, levothroid, unithroid, tirosint)
 liothyronine (cytomel, triostat)
 thyroid desiccated (armour thyroid, nature-throid, westhroid)
16. What is the brand name of levothyroxine used for the treatment of hypothyroidism?
I. Synthroid.
II. Tirosint.
III. Triostat.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Levothyroxine (synthroid, levoxyl, levothroid, unithroid, tirosint)
17. What is the brand name of levothyroxine used for the treatment of hypothyroidism?
I. Westhroid.
II. Levoxyl.
III. Levothroid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Levothyroxine (synthroid, levoxyl, levothroid, unithroid, tirosint)
18. What is the brand name of liothyronine used for the treatment of hypothyroidism?
I. Cytomel.
II. Tirosint.
III. Triostat.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Liothyronine (cytomel, triostat)

19. What is the brand name of Thyroid desiccated used for the treatment of hypothyroidism?
I. Armour Thyroid.
II. Nature-Throid.
III. Levothroid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Thyroid desiccated (Armour Thyroid, Nature-Throid, Westhroid)
20. What is the brand name of Thyroid desiccated used for the treatment of hypothyroidism?
I. Westhroid.
II. Levoxyl.
III. Levothroid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Thyroid desiccated (Armour Thyroid, Nature-Throid, Westhroid)
21. What is the half life of liothyronine?

I. 12-24 minutes.
II. 12-24 hours.
III. 12-24 days.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Liothyronine -- half-life, 12-24 hours

22. What is the source of dessicated thyroid?
I. It derived from extracts of bovine thyroid glands.
II. It derived from extracts of porcine thyroid glands.
III. It derived from extracts of horse thyroid glands.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Desiccated thyroid is derived from extracts of bovine or porcine thyroid glands
23. Which of the following constitute the one grain of dessicated thyroid?
I. 38 µg of T3 and 9 µg of T4.
II. 28 µg of T3 and 19 µg of T4.
III. 38 µg of T4 and 9 µg of T3.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Desiccated thyroid is referred to as natural thyroid and generally contains T3 and T4 in a 1:4 ratio. It is made
in a range of strengths, with tablets including 1/8, 1/4, 1/2, 1, 2, 3, 4, or 5 grains. One grain (60 mg) contains
about 38 µg of T4 and 9 µg of T3
24. Which out of the following statement is /are correct for dessicated thyroid?
I. It is referred to as natural thyroid and generally contains T3 and T4 in a 1:4 ratio.
II. One grain of dessicated thyroid is equal to 60 mg.
III. One grain (60 mg) contains about 38 µg of T3 and 9 µg of T4.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Desiccated thyroid is referred to as natural thyroid and generally contains T3 and T4 in a 1:4 ratio. It is made
in a range of strengths, with tablets including 1/8, 1/4, 1/2, 1, 2, 3, 4, or 5 grains. One grain (60 mg) contains
about 38 µg of T4 and 9 µg of T3
25. What precautions should consider before taking levothyroxine tablet?
I. Take tabs with full glass of water preferably 30 min to 1 hr before breakfast on empty stomach.
II. Do not use soybean products before for administering levothyroxine.
III. Take tabs with full glass of water just after heavy lunch.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Take tabs with full glass of water preferably 30 min to 1 hr before breakfast on empty stomach
 Do not use foods that decrease absorption (soybean products) for administering levothyroxine
 Administer oral levothyroxine >4 hr apart from drugs known to interfere with absorption
26. What advice given to patients who unable to swallow intact levothyroxine tabs?
I. Crush appropriate dose and place in 5-10 mL of water.
II. Stored the whole suspension used for one week.
III. Administer resultant suspension by spoon or dropper immediately, do NOT store.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Patients unable to swallow intact tabs

 Crush appropriate dose and place in 5-10 ml of water
 Administer resultant suspension by spoon or dropper immediately, do NOT store
27. What cautions are advice to patient treated by levothyroxine for hypothyroidism?
I. Avoid undertreatment or overtreatment, which may result in adverse effects.
II. Use caution in cardiovascular disease, HTN, endocrine disorders, osteoporosis.
III. Initiate higher dose in elderly, those with angina pectoris.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Cautions
 Avoid undertreatment or overtreatment, which may result in adverse effects
 Use caution in cardiovascular disease, HTN, endocrine disorders, osteoporosis, or myxedema
I. Initiate lower dose in elderly, those with cardiovascular disease.
II. Initiate higher dose in elderly, those with angina pectoris.
III. Symptoms may be exacerbated or aggravated in patients with diabetes mellitus and insipidus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Cautions
 Initiate lower dose in elderly, those with angina pectoris, cardiovascular disease, or in those with severe
hypothyroidism
 Symptoms may be exacerbated or aggravated in patients with diabetes mellitus and insipidus
I. Initiate higher dose in elderly, those with angina pectoris.
II. Check for bioequivalence if switching brands/generics.
III. Do NOT generally use levothyroxine sodium preparations interchangeably.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Cautions
 Do NOT generally use levothyroxine sodium preparations interchangeably, due to narrow therapeutic
index
 Check for bioequivalence if switching brands/generics
I. Levoxyl tabs swell in mouth: take with full glass of water to avoid choking.
II. Avoid use in postmenopausal women >60 years with osteoporosis.
III. Long-term therapy increases bone mineral density; use high dose in postmenopausal women.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Cautions
 Levoxyl tabs swell in mouth: take with full glass of water to avoid choking
 Avoid use in postmenopausal women >60 years with osteoporosis, cardiovascular disease, or systemic
illness
I. Avoid use in patients with large thyroid nodules or long-standing goiters.
II. Long-term therapy increases bone mineral density; use high dose in postmenopausal women.
III. Use caution in patients with adrenal insufficiency.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Cautions
 Avoid use in patients with large thyroid nodules or long-standing goiters, or low-normal TSH levels
 Long-term therapy decreases bone mineral density; use lowest dose in postmenopausal women and
women using suppressive doses
 Use caution in patients with adrenal insufficiency;
32. What is the mechanism of action of levothyroxin?

I. It increases basal metabolic rate, increases utilization and mobilization of glycogen stores.
II. It promotes glucogenolysis; involved in growth development.
III. It promotes gluconeogenesis; involved in growth development and stimulates protein synthesis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Synthetic T4; thyroid hormone increases basal metabolic rate, increases utilization and mobilization of
glycogen stores, promotes gluconeogenesis; involved in growth development and stimulates protein synthesis
33. What is the absorption profile of levothyroxine?
I. 4-8 % from GI tract.
II. 14-18% from GI tract.
III. 40-80% from GI tract.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Absorption
40-80% from GI tract (PO)
34. What is the bioavailability profile of levothyroxine?

I. 64% (nonfasting); 79-81% (fasting).
II. 84% (nonfasting); 29-48% (fasting).
III. 64% (fasting); 79-81% (nonfasting).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Bioavailability: 64% (nonfasting); 79-81% (fasting)
35. What is the half life of levothyroxine in hypothyroid patient?

I. 9-10 days.
II. 3-4 days.
III. 6-7 days.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Half-life: 9-10 days (hypothyroid); 3-4 days (hyperthyroid); 6-7 days (euthyroid)
36. What is the half life of levothyroxine in hyperthyroid patient?
I. 9-10 days.
II. 3-4 days.
III. 6-7 days.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
37. What is the half life of levothyroxine in euthyroid patient?

I. 9-10 days.
II. 3-4 days.
III. 6-7 days.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
38. What is the total body clearance of levothyroxine?

I. 0.8-1.4 L/day.
II. 0.8-1.4 ML/day.
III. 8-14 L/day.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Total body clearance: 0.8-1.4 L/day

39. What is the elimination profile of levothyroxine in hypothyroid patient?
I. Urine (20%), feces (major).
II. Urine (major), feces (20%).
III. Elimination is done by dialysis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Elimination
Excretion: Urine (major), feces (20%)
40. What are the pharmacological uses of levothyroxin?

I. To treat infertility.
II. To treat an underactive thyroid (hypothyroidism).
III. To treat certain types of goiters and thyroid cancer.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Uses
 Levothyroxine is used to treat an underactive thyroid (hypothyroidism).
 This medication is also used to treat other types of thyroid disorders (such as certain types of goiters,
thyroid cancer).
 This medication should not be used to treat infertility unless it is caused by low thyroid hormone levels.
41. Which drugs should separate by atleast 4 hours from levothyroxine treatment?
I. Cholestyramine.
II. Colestipol.
III. Ishagbol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Certain medications (such as cholestyramine, colestipol, colesevelam, antacids, sucralfate, simethicone, iron,
sodium polystyrene sulfonate, calcium supplements, orlistat, sevelamer, among others) can decrease the amount
of thyroid hormone that is absorbed by your body. If you are taking any of these drugs, separate them from this
medication by at least 4 hours.
I. Nifedipine.
II. Colesevelam.
III. Simethicone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
I. Sodium polystyrene sulfonate.
II. Dapsone.
III. Orlistat.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
44. Why antacids should separate by atleast 4 hours from levothyroxine treatment?
I. They decrease the amount of thyroid hormone that is absorbed by your body.
II. They increase the amount of thyroid hormone that is absorbed by your body.
III. They causes diarrhea in the patient and increase the acid secretion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
45. What are the side effects of levothyroxin in patient with hypothyroidism?
I. Hair loss.
II. Insomnia.
III. Serious allergic reaction, including: rash, itching/swelling.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Side effects:
 Hair loss
 Serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe
dizziness, trouble breathing.
46. What are the serious side effect of levothyroxine observed due to high thyroid hormone level?
I. Increased sweating.
II. Sensitivity to heat.
III. Decreased sweating.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
But serious effects of high thyroid hormone levels occur: increased sweating, sensitivity to heat, mental/mood
changes (such as nervousness, mood swings), tiredness, diarrhea, shaking (tremor), headache, shortness of
breath.
47. What are the serious side effect of levothyroxine observed due to high thyroid hormone level?
I. Decreased sweating.
II. Mental/mood changes.
III. Shortness of breath.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
But serious effects of high thyroid hormone levels occur: increased sweating, sensitivity to heat, mental/mood
changes (such as nervousness, mood swings), tiredness, diarrhea, shaking (tremor), headache, shortness of
breath.
48. What are rare but serious side effect of levothyroxine observed due to high thyroid hormone
level?
I. Chest pain.
II. Decreased sweating.
III. Pounding/irregular heartbeat.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
If any of these rare but serious effects of high thyroid hormone levels occur: chest pain, fast/pounding/irregular
heartbeat, swelling hands/ankles/feet, seizures.
49. What are rare but serious side effect of levothyroxine observed due to high thyroid hormone
level?
I. Decreased sweating.
II. Swelling hands/ankles/feet.
III. Seizures.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
If any of these rare but serious effects of high thyroid hormone levels occur: chest pain, fast/pounding/irregular
heartbeat, swelling hands/ankles/feet, seizures.
50. What are the contraindications of liothyronine used for the treatment of hypothyroidism ?
I. Acute MI uncomplicated by hypothyroidism.
II. Treatment of obesity or infertility.
III. Treatment of COPD.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Liothyronine
Contraindications
 Hypersensitivity to thyroid hormone
 Acute mi uncomplicated by hypothyroidism, thyrotoxicosis, untreated adrenal insufficiency
 Treatment of obesity or infertility
51. Which of the following consists an effective approach in patient with myxedema coma ?
I. Give 4 µg of LT4 per kilogram of lean body weight as an IV bolus in a single or divided dose.
II. 24 hours later, give 100 µg IV.
III. Subsequently, give 50 g/hr IV, along with stress doses of IV glucocorticoids.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In patients with myxedema coma, an effective approach consists of the following:

 Give 4 µg of LT4 per kilogram of lean body weight (approximately 200-250 µg) as an IV bolus in a
 24 hours later, give 100 µg IV

 Subsequently, give 50 µg/day IV, along with stress doses of IV glucocorticoids
 Adjust the dosage on the basis of clinical and laboratory findings
women issued by American Thyroid Association ?
I. Levothyroxine replacement therapy with the dose titrated to achieve a TSH concentration within the
trimester-specific reference range.
II. Women taking levothyroxine, 2 additional doses per week of the current levothyroxine dose, given as
one extra dose twice weekly with several days.
III. Serum TSH should be reassessed during the last stage of pregnancy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Pregnant women with overt hypothyroidism should receive levothyroxine replacement therapy with
the dose titrated to achieve a TSH concentration within the trimester-specific reference range.
 In women already taking levothyroxine, 2 additional doses per week of the current levothyroxine dose,
women issued by American Thyroid Association ?
I. Serum TSH should be reassessed during the last stage of pregnancy.
II. Serial serum TSH levels assessed every 4 weeks during the first half of pregnancy adjust levothyroxine
dosing maintain TSH within the trimester-specific range.
III. Serum TSH should be reassessed during the second half of pregnancy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Serial serum TSH levels should be assessed every 4 weeks during the first half of pregnancy to adjust
levothyroxine dosing to maintain TSH within the trimester-specific range.
 Serum TSH should be reassessed during the second half of pregnancy
54. What are the updated guidelines on hypothyroidism for levothyroxine as the preparation of
choice issued by the American Thyroid Association ?
I. If dose requirements are much higher than expected, consider evaluating for gastrointestinal disorders.
II. Dose requirement alter on initiation or discontinuation of estrogen and androgens followed by
reassessment of serum TSH at steady state.
III. Dose requirement of levothyroxine should be higher in all cases.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The updated guidelines on hypothyroidism issued by the American Thyroid Association in 2014 maintain the
recommendation of levothyroxine as the preparation of choice for hypothyroidism, with the following
considerations:
 If levothyroxine dose requirements are much higher than expected, consider evaluating for
gastrointestinal disorders
 Initiation or discontinuation of estrogen and androgens should be followed by reassessment of serum
TSH at steady state, since such medications may alter levothyroxine requirement.
55. What are the updated guidelines on hypothyroidism for levothyroxine as the preparation of
choice issued by the American Thyroid Association ?
I. Dose requirement of levothyroxine should be higher in all cases.
II. Dose adjustments should be made upon significant changes in body weight, with aging, and with
pregnancy.
III. Reference ranges of serum TSH levels are higher in older populations (eg, >65 years), so higher serum
TSH targets may be appropriate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Dose adjustments should be made upon significant changes in body weight, with aging, and with
pregnancy; TSH assessment should be performed 4-6 weeks after any dosage change.
 Reference ranges of serum TSH levels are higher in older populations (eg, >65 years), so higher serum
TSH targets may be appropriate.
56. Which of the following condition have the highest associations with mortality in myxedema
coma?
I. Advanced age.
II. Low-dose T4 therapy.
III. High-dose T4 therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Advanced age, high-dose T4 therapy, and cardiac complications have the highest associations with mortality
in myxedema coma
57. What is the most common complication associated of treatment with LT4 of hypothyroidism ?
I. Corneal dermetitis.
II. Pneumonia.
III. Subclinical hyperthyroidism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Subclinical hyperthyroidism is a more common complication of treatment with LT4
58. Which of the following indications referred the patient to an endocrinologist for
hypothyroidism?
I. Pain in right side of heart.
II. A nodular thyroid, suspicious thyroid nodules, or compressive symptoms.
III. Pregnancy (or planned pregnancy).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Indications for referral to an endocrinologist include any of the following[1] :

 A nodular thyroid, suspicious thyroid nodules, or compressive symptoms (eg, dysphagia)
 Pregnancy (or planned pregnancy)
hypothyroidism?
I. Underlying cardiac disorders or other endocrine disorders.
II. Age younger than 18 years.
III. Brain tumour.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Underlying cardiac disorders or other endocrine disorders
 Age younger than 18 years
hypothyroidism?
I. Pain in right side of heart.
II. Secondary or tertiary hypothyroidism.
III. Unusual constellation of thyroid function test results.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Secondary or tertiary hypothyroidism
 Unusual constellation of thyroid function test results
61. Which of the following indications referred the patient to an endocrinologist for hypothyroidism
?
I. Inability to maintain TSH in the target range.
II. Brain tumour.
III. Unresponsiveness to treatment.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Indications for referral to an endocrinologist include any of the following:

 Inability to maintain TSH in the target range
 Unresponsiveness to treatment
62. What is the dose strength of levothyroxin in mild hypothyroidism ?

I. 100-125 mcg PO qDay; not to exceed 300 mcg/day.
II. 100-125 mcg PO qDay; can be exceed 300 mcg/day.
III. 200-325 mcg PO qDay; can ce exceed 300 mcg/day.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Mild hypothyroidism
1.7 mcg/kg or 100-125 mcg po qday; not to exceed 300 mcg/day
63. What is the dose strength of levothyroxin in mild hypothyroidism in patient of age > 50 years
with CV disease ?
I. Initial dose: 12.5-25 mcg PO qDay ; Dose range: 100-125 mcg PO qDay.
II. Initial dose: 100-125 mcg PO qDay ; Dose range: 12.5-25 mcg PO qDay.
III. May adjust dose by 12.5-25 mcg q4-6weeks until patient becomes euthyroid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Mild hypothyroidism
>50 years with cv disease
 Usual initial dose: 12.5-25 mcg po qday
 May adjust dose by 12.5-25 mcg q4-6weeks until patient becomes euthyroid and serum tsh
concentration normalized; adjustments q6-8weeks also used
 Dose range: 100-125 mcg po qday
64. What is the dose strength of levothyroxin in severe hypothyroidism ?

I. Initial dose: 12.5-25 mcg PO qDay ; Dose range: 100-125 mcg PO qDay.
II. Initial dose: 100-125 mcg PO qDay ; Dose range: 12.5-25 mcg PO qDay.
III. Initial dose: 12.5-25 mcg PO qDay ; Adjust dose by 25 mcg/day q2-4Week PRN.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Severe hypothyroidism
Initial: 12.5-25 mcg po qday;adjust dose by 25 mcg/day q2-4week prn
65. What is the dose strength of levothyroxin in myxedema coma ?
I. 300-500 mcg IV once, then 50-100 mcg qDay.
II. 200-325 mcg PO qDay; can ce exceed 300 mcg/day.
III. Initial dose: 100-125 mcg PO qDay ; Dose range: 12.5-25 mcg PO qDay.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Myxedema coma
300-500 mcg iv once, then 50-100 mcg qday until patient is able to tolerate oral administration; may consider
smaller doses in patients with cardiovascular disease
66. What are the warnings associated with the drug levothyroxine ?
I. This medication should not be used for weight loss.
II. Normal doses of this medication will work for weight loss.
III. Large doses of this medication may cause serious, possibly fatal side effects, especially when taken with
diet pills.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Levothyroxine - oral
Warning: this medication should not be used for weight loss. Normal doses of this medication will not work
for weight loss, and large doses of this medication may cause serious, possibly fatal side effects, especially when
taken with diet pills.
67. What are the points consider regarding the direction to use of levothyroxin ?
I. Take this medication by mouth as directed by your doctor, do not take in empty stomach.
II. Take this medication with a full glass of water.
III. Take this medication by mouth as directed by your doctor, 30 minutes to 1 hour before breakfast.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
HOW TO USE:
Take this medication by mouth as directed by your doctor, usually once daily on an empty stomach, 30 minutes
to 1 hour before breakfast. Take this medication with a full glass of water unless your doctor directs you
otherwise.
I. Take this medication by mouth as directed by your doctor, do not take in empty stomach.
II. If you are taking the capsule form of this medication, swallow it whole.
III. People who cannot swallow the capsule whole ,crush the capsule mix in 1 to 2 teaspoons of water.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
If you are taking the capsule form of this medication, swallow it whole. Do not split, crush, or chew. People
who cannot swallow the capsule whole (such as infants or small children) should use the tablet form of the
medication.
I. People who cannot swallow the capsule whole ,crush the capsule mix in 1 to 2 teaspoons of water.
II. For infants or children who cannot swallow whole tablets, crush the tablet and mix in 1 to 2 teaspoons
(5 to 10 milliliters) of water.
III. Do not prepare a supply in advance or mix the tablet in soy infant formula.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
For infants or children who cannot swallow whole tablets, crush the tablet and mix in 1 to 2 teaspoons (5 to
10 milliliters) of water, and give using a spoon or dropper right away. Do not prepare a supply in advance or
mix the tablet in soy infant formula. Consult your pharmacist for more information.
70. Which factors affects the dosages of levothyroxine in patient with hypothyroidism ?
I.
II.
III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Dosage is based on your age, weight, medical condition, laboratory test results, and response to treatment.
71. Which factors affects the dosages of levothyroxine in patient with hypothyroidism ?
I.
II.
III. ratory test results.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Dosage is based on your age, weight, medical condition, laboratory test results, and response to treatment.
72. What are the symptoms of low thyroid hormone levels ?

I. Tiredness.
II. Muscle aches.
III. Insomnia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Symptoms of low thyroid hormone levels include tiredness, muscle aches, constipation, dry skin, weight gain,
slow heartbeat, or sensitivity to cold.
73. What are the symptoms of low thyroid hormone levels ?

I. Insomnia.
II. Constipation.
III. Dry skin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
74. What are the symptoms of low thyroid hormone levels?
I. Slow heartbeat.
II. High pulse rate.
III. Sensitivity to cold.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
75. Which of the following drugs show drug interactions with levothyroxine?
I. Warfarin.
II. Digoxin.
III. Prostaglandin analogs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
DRUG INTERACTIONS:
Some products that may interact with this drug include: "blood thinners" (such as warfarin), digoxin,
sucroferric oxyhydroxide, theophylline.
76. Which of the following drugs show drug interactions with levothyroxine?
I. B-blockers.
II. Sucroferric oxyhydroxide.
III. Theophylline.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
DRUG INTERACTIONS:
Some products that may interact with this drug include: "blood thinners" (such as warfarin), digoxin,
sucroferric oxyhydroxide, theophylline.
77. What is the dose strength of liothyronine in hypothyroidism ?

I. 300-500 mcg IV once, then 50-100 mcg qDay.
II. 200-325 mcg PO qDay; can ce exceed 300 mcg/day.
III. Initial dose 25 mcg PO qDay; may increase by 25 mcg q1-2Weeks; not to exceed 100 mcg/day.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Liothyronine
Hypothyroidism
Initial: 25 mcg po qday; may increase by 25 mcg q1-2weeks; not to exceed 100 mcg/day
Maintenance: 25-75 mcg po qday
78. What is the dose strength of liothyronine in nontoxic goiter ?
I. Initial: 25-50 mcg IV ;Patients with CVD: 10-20 mcg IV.
II. Initial: 5 mcg PO qDay; may increase by 5-10 mcg q1-2Weeks.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Nontoxic goiter
Initial: 5 mcg po qday; may increase by 5-10 mcg q1-2weeks (5 mcg in elderly)
Maintenance: 75 mcg po qday
79. What is the dose strength of liothyronine in myxedema ?

.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Myxedema
 Initial: 5 mcg PO qday; may increase by 5-10 mcg/day q1-2Weeks
 When reach 25 mcg PO qday, may increase by 5-25 mcg q1-2Weeks
 Maintenance: 50-100 mcg PO qday
80. What is the dose strength of liothyronine in myxedema coma ?
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Myxedema coma
 Initial: 25-50 mcg iv ;patients with cvd: 10-20 mcg iv
 Doses of at least 65 mcg/day iv associated with lower mortality
 Allow 4-12 hr between doses; not to exceed 12 hours
81. What are the warnings associated with the drug liothyronine ?
I. This medication should not be used for weight loss.
II. Normal doses of this medication will work for weight loss.
III. Large doses of this medication may cause serious, possibly fatal side effects, especially when taken with
diet pills.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Liothyronine - oral
Warning: this medication should not be used for weight loss. Normal doses of this medication will not work
for weight loss, and large doses may cause serious, possibly fatal side effects, especially when taken with diet
pills.
82. What are the pharmacological uses of liothyronine ?
I. To treat infertility.
II. To treat an underactive thyroid (hypothyroidism).
III. To treat certain types of goiters and thyroid cancer.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Uses
 Liothyronine is used to treat an underactive thyroid (hypothyroidism).
 This medication is also used to treat other types of thyroid disorders (such as certain types of goiters,
thyroid cancer).
 This medication should not be used to treat infertility unless it is caused by low thyroid hormone levels.
I. Take this medication by mouth as directed by your doctor, usually once daily.
II. Take this medication regularly to get the most benefit from it. Do not stop taking it without first. talking
with your doctor.
III. Take this medication by mouth as directed by your doctor, usually four times daily.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
HOW TO USE:
Take this medication by mouth with or without food as directed by your doctor, usually once daily. It is best
to take it at the same time each day so your thyroid hormone level is kept at a constant level.
Take this medication regularly to get the most benefit from it. Do not stop taking it without first talking with
your doctor. Thyroid replacement treatment is usually taken for life.
84. Which of the following medication decreases the absorption of liothyronine ?
I. Sucralfate.
II. Calcium supplements.
III. Antiemetics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Certain medications can decrease the absorption of liothyronine. Examples include products that contain
aluminum or magnesium, antacids, sucralfate, calcium supplements, iron, bile acid-binding resins (such as
cholestyramine, colestipol, colesevelam), simethicone, sevelamer, sodium polystyrene sulfonate, among others. If
you take any of these medications, take them at least 4 hours before or after liothyronine. If you take lanthanum,
take it at least 2 hours before or after liothyronine.

I. Bile acid-binding resins.
II. Lignocaine.
III. Iron.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
cholestyramine, colestipol, colesevelam), simethicone, sevelamer, sodium polystyrene sulfonate, among others. If
you take any of these medications, take them at least 4 hours before or after liothyronine. If you take lanthanum,
take it at least 2 hours before or after liothyronine.
I. Sulfamethoxazole.
II. Simethicone.
III. Sevelamer.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
cholestyramine, colestipol, colesevelam), simethicone, sevelamer, sodium polystyrene sulfonate, among others.

I. Sodium polystyrene sulfonate.
II. Antacids.
III. Sulphamethoprim.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
cholestyramine, colestipol, colesevelam), simethicone, sevelamer, sodium polystyrene sulfonate, among others.
88. What are the precautions should consider before taking liothyronine for hypothyroidism?
I. Tell your doctor if you are allergic to it, This product may contain inactive ingredients, which can cause
allergic reactions.
II. It passes into breast milk but is unlikely to harm a nursing infant. Consult your doctor before breast-
feeding.
III. It does not passes through milk but causing harm to mother.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
PRECAUTIONS:
Before taking liothyronine, tell your doctor or pharmacist if you are allergic to it; or if you have any other
allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems.
Talk to your pharmacist for more details.
Liothyronine passes into breast milk but is unlikely to harm a nursing infant. Consult your doctor before breast-
feeding.
89. What are the side effects of liothyronine in patient with hypothyroidism ?
I. Insomnia.
II. Temporary hair loss.
III. Rash.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
SIDE EFFECTS:
Temporary hair loss may occur during the first few months of starting this drug, especially in children. If this
effect lasts or gets worse, tell your doctor or pharmacist promptly.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any
symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat),
severe dizziness, trouble breathing.
90. What are the side effects of liothyronine in patient with hypothyroidism?
I. Itching/swelling.
II. Corneal dermatitis.
III. Severe dizziness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any
symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat),
severe dizziness, trouble breathing.
91. What symptoms observes as results of too much thyroid hormone during treatment with
liothyronine in patient with hypothyroidism?
I. Headache.
II. Mental/mood changes.
III. Decreased sweating.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Though unlikely, it is possible to have too much thyroid hormone. Tell your doctor right away if you have
symptoms of too much thyroid hormone, including: headache, mental/mood changes (such as irritability,
nervousness), increased sweating, sensitivity to heat, diarrhea, menstrual changes.
92. What symptoms observes as results of too much thyroid hormone during treatment with
liothyronine in patient with hypothyroidism?
I. Increased sweating.
II. Decreased sweating.
III. Menstrual changes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Though unlikely, it is possible to have too much thyroid hormone. Tell your doctor right away if you have
symptoms of too much thyroid hormone, including: headache, mental/mood changes (such as irritability,
nervousness), increased sweating, sensitivity to heat, diarrhea, menstrual changes.
93. What are the complications associated with thyroid hormone replacement in hypothyroidism?
I. Precipitates keratic in patients with untreated tuberculosis.
II. Precipitate adrenal crises in patients with untreated adrenal insufficiency.
III. Precipitate brain crises in patients with untreated brain tumour.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Thyroid hormone replacement can precipitate adrenal crises in patients with untreated adrenal insufficiency
by enhancing hepatic corticosteroid metabolism.
94. What is the recommended daily dietary iodine intake for adults according to WHO?
I. 150 µg.
II. 200 µg.
III. 50-120 µg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The World Health Organization (WHO) recommends a daily dietary iodine intake of 150 µg for adults, 200
µg for pregnant and lactating women, and 50-120 µg for children
95. What is the recommended daily dietary iodine intake for pregnant and lactating women
according to WHO?
I. 150 µg.
II. 200 µg.
III. 50-120 µg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
96. What is the recommended daily dietary iodine intake for children according to WHO?
I. 150 µg.
II. 200 µg.
III. 50-120 µg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
97. What cautions are advice to patient treated by liothyronine for hypothyroidism?
I. Myxedematous patients are very sensitive to thyroid hormone; start at very high dose.
II. Perform periodic assessment of thyroid status when using as thyroid replacement.
III. Myxedematous patients are very sensitive to thyroid hormone; start at very low dose.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Cautions
 Perform periodic assessment of thyroid status when using as thyroid replacement
 Myxedematous patients are very sensitive to thyroid hormone; start at very low dose
98. What cautions are advice to patient treated by liothyronine for hypothyroidism?
I. Caution in angina, cardiovascular disease, hypopituitarism, DM.
II. Myxedematous patients are very sensitive to thyroid hormone; start at high low dose.
III. May use judiciously in acute MI caused by hypothyroidism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Cautions
 Caution in angina, cardiovascular disease, hypopituitarism, DM
 May use judiciously in acute MI caused/complicated by hypothyroidism
 Perform periodic assessment of thyroid status when using as thyroid replacement
 Myxedematous patients are very sensitive to thyroid hormone; start at very low dose
99. What is the mechanisms of action of liothyronine?

I. It raises basal metabolic rate.
II. It promotes glucogenolysis.
III. It increases utilization and mobilization of glycogen store, and promotes gluconeogenesis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
A synthetic form of natural T3 hormone with same actions as natural product; thyroid hormone raises basal
metabolic rate, increases utilization and mobilization of glycogen store, and promotes gluconeogenesis
100. What is the half life of liothyronine?
I. 2.5 days.
II. 5.0 days.
III. 8.5 days.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Half-life: 2.5 days
HYPERTHYROIDISM
1. What is mean by hyperthyroidism ?

I. It is a set of disorders that involve excess synthesis and secretion of thyroid hormones by the
thyroid gland.
II. It is a set of disorders that involve excess synthesis and secretion of thyroid hormones by the
pitutary gland.
III. It leads to the hypermetabolic condition of thyrotoxicosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Hyperthyroidism is a set of disorders that involve excess synthesis and secretion of thyroid hormones by
the thyroid gland, which leads to the hypermetabolic condition of thyrotoxicosis.
2. What are the different forms of hyperthyroidism ?

I. Diffuse toxic goiter (Graves disease).
II. Toxic multinodular goiter (Plummer disease).
III. Podgara.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The most common forms of hyperthyroidism include diffuse toxic goiter (Graves disease), toxic
multinodular goiter (Plummer disease), and toxic adenoma.
3. What are the common symptoms of thyrotoxicosis ?
I. Nervousness.
II. Anxiety.
III. Podgara.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Common symptoms of thyrotoxicosis include the following:

 Nervousness
 Anxiety

I. Podgara.
II. Increased perspiration.
III. Heat intolerance.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Increased perspiration
 Heat intolerance
I. Hyperactivity.
II. Podgara.
III. Palpitations.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Hyperactivity
 Palpitations
6. What are the common signs of thyrotoxicosis ?

I. Podgara.
II. Tachycardia or atrial arrhythmia.
III. Systolic hypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Common signs of thyrotoxicosis include the following:

 Tachycardia or atrial arrhythmia
 Systolic hypertension
I. Warm, moist, smooth skin.
II. Lid lag.
III. Shiny skin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Warm, moist, smooth skin
 Lid lag

I. Stare.
II. Podgara.
III. Hand tremor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Stare
 Hand tremor
I. Weight gain.
II. Weight loss despite increased appetite.
III. Reduction in menstrual flow or oligomenorrhea.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Weight loss despite increased appetite
 Reduction in menstrual flow or oligomenorrhea
10. Which out of the following thyroid function tests are perform to diagnose
hyperthyroidism ?
I. Free iodine test.
II. Thyroid-stimulating hormone (TSH).
III. Free thyroxine (FT 4).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Diagnosis
Thyroid function tests for hyperthyroidism are as follows:
 Free thyroxine (FT 4) or free thyroxine index (FTI total T 4 multiplied by the correction
for thyroid hormone binding)
 Total triiodothyronine (T 3)
11. Which out of the following thyroid function tests are perform to diagnose
hyperthyroidism ?
I. Total triiodothyronine (T 3).
II. Free iodine test.
III. Free thyroxine index.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Diagnosis
Thyroid function tests for hyperthyroidism are as follows:
 Free thyroxine (FT 4) or free thyroxine index (FTI total T 4 multiplied by the correction
for thyroid hormone binding)
 Total triiodothyronine (T 3)
12. What is mean by thyrotoxicosis ?

I. Marked by evelvated TSH levels.
II. Marked by suppressed TSH levels.
III. Marked by elevated T 3 and T 4 levels.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Thyrotoxicosis is marked by suppressed TSH levels and elevated T 3 and T 4 levels

13. Which out of the following autoantibody tests are perform to diagnose hyperthyroidism
?
I. Pitutary-stimulating immunoglobulin (PSI).
II. Anti ̶ thyroid peroxidase (anti-TPO) antibody.
III. Thyroid-stimulating immunoglobulin (TSI).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Autoantibody tests for hyperthyroidism are as follows:

 Anti ̶ thyroid peroxidase (anti-TPO) antibody
 Thyroid-stimulating immunoglobulin (TSI)
14. What results observed by autoantibody titre in grave disease of hyperthyroidism ?

I. Elevated anti-TPO, elevated TSI.
II. Elevated TSI, elevated anti-TPO.
III. Low or absent anti-TPO.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Autoantibody titers in hyperthyroidism are as follows:

 Graves disease Significantly elevated anti-TPO, elevated TSI
15. What results observed by autoantibody titre in toxic multinodular goiter of
hyperthyroidism ?
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C

 Toxic multinodular goiter- Low or absent anti-TPO
16. What results observed by autoantibody titre in toxic adenoma of hyperthyroidism ?

A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C

 Toxic adenoma Low or absent anti-TPO
17. Why scintigraphy perform to diagnose the thyrotoxicosis ?
I. The quntity of isotope uptake in scintigraphy indicates the type of lung disorder.
II. If the etiology of thyrotoxicosis is not clear after physical examination and other laboratory tests,
it can be confirmed by scintigraphy.
III. The degree and pattern of isotope uptake in scintigraphy indicates the type of thyroid disorder.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
If the etiology of thyrotoxicosis is not clear after physical examination and other laboratory tests, it can
be confirmed by scintigraphy: the degree and pattern of isotope uptake indicates the type of thyroid
disorder.
18. Which isotope is used for scintigraphy in graves disease ?

I. Radioactive carbon.
II. Radioactive cobalt.
III. Radioactive iodine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Graves disease Diffuse enlargement of both thyroid lobes, with uniform uptake of isotope and
elevated radioactive iodine uptake
19. What findings are observed of toxic multinodular goiter in scintigraphy ?
I. Irregular areas of relatively diminished.
II. Diffuse enlargement of both thyroid lobes.
III. Occasionally increased uptake; overall radioactive iodine uptake is mildly to moderately
increased.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Toxic multinodular goiter -- Irregular areas of relatively diminished and occasionally increased
uptake; overall radioactive iodine uptake is mildly to moderately increased
20. What findings are observed of subacute thyroiditis in scintigraphy ?

I. Irregular areas of relatively diminished.
II. Diffuse enlargement of both thyroid lobes.
III. Very low radioactive iodine uptake.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Subacute thyroiditis Very low radioactive iodine uptake

21. What are the symptomatic treatment of hyperthyroidism ?
I. Oral rehydration for dehydrated patients.
II. Potassium channel blockers for relief of neurologic symptoms.
III. Beta-blockers for relief of neurologic and cardiovascular symptoms.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Treatment of hyperthyroidism includes symptom relief, as well as therapy with antithyroid

medications, radioactive iodine-131 (131 I), or thyroidectomy. Symptomatic treatment is as follows:
 Oral rehydration for dehydrated patients
 Beta-blockers for relief of neurologic and cardiovascular symptoms
22. What are the symptomatic treatment for mild ophthalmopathy of hyperthyroidism ?
I. Colour lens uses.
II. Saline eye drops as needed.
III. Tight-fitting sunglasses for outdoors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
For mild ophthalmopathy, saline eye drops as needed and tight-fitting sunglasses for outdoors
23. What are the symptomatic treatment for vision-threatening ophthalmopathy of
hyperthyroidism ?
I. Beta-blockers for relief of patient.
II. High-dose glucocorticoids, with consideration for orbital decompression surgery.
III. Ocular radiation therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
For vision-threatening ophthalmopathy, high-dose glucocorticoids, with consideration for orbital

decompression surgery and ocular radiation therapy
24. Which out of the following statement is /are correct for radioactive iodine in
hyperthyroidism ?
I. Administered orally as a single dose in capsule or liquid form.
II. Administered intramuscular.
III. It causes fibrosis and destruction of the thyroid over weeks to many months.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Radioactive iodine treatment is as follows:

 Administered orally as a single dose in capsule or liquid form
 Causes fibrosis and destruction of the thyroid over weeks to many months
hyperthyroidism ?
I. Administered intramuscular.
II. Pregnancy, breast feeding, and recent lactation are contraindications.
III. Radioactive iodine should be avoided in children younger than 5 years.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Pregnancy, breast feeding, and recent lactation are contraindications
 Radioactive iodine should be avoided in children younger than 5 years
hyperthyroidism ?
I. Preferred therapy for hyperthyroidism
II. Preferred therapy for hypothyroidism.
III. Hypothyroidism is expected.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Preferred therapy for hyperthyroidism
 Hypothyroidism is expected
27. What is the mechanism of secretion of thyroid hormone ?
I. Thyrotropin-releasing hormone from the hypothalamus stimulates the pituitary to release TSH.
II. Binding of TSH to receptors on the thyroid gland leads to the release of thyroid hormones.
III. Elevated levels of thyroid hormones act on the hypothalamus to decrease TRH secretion and
thus the synthesis of TSH.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Normally, the secretion of thyroid hormone is controlled by a complex feedback mechanism involving
the interaction of stimulatory and inhibitory factors (see the image below). Thyrotropin-releasing
hormone (TRH) from the hypothalamus stimulates the pituitary to release TSH . Binding of TSH to
receptors on the thyroid gland leads to the release of thyroid hormones primarily T4 and to a lesser
extent T3.
28. What is the feedback mechanism to control secretion of thyroid hormone ?

I. Thyrotropin-releasing hormone from the hypothalamus stimulates the pituitary to release TSH.
II. Binding of TSH to receptors on the thyroid gland leads to the release of thyroid hormones.
III. Elevated levels of thyroid hormones act on the hypothalamus to decrease TRH secretion and
thus the synthesis of TSH.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Binding of TSH to receptors on the thyroid gland leads to the release of thyroid hormones primarily
T4 and to a lesser extent T3. In turn, elevated levels of these hormones act on the hypothalamus to
decrease TRH secretion and thus the synthesis of TSH.
29. What is the basic requirement for synthesis of thyroid harmone ?
I. Iodine.
II. Sodium.
III. Calcium.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Synthesis of thyroid hormone requires iodine.
30. Which out of the following statement is /are correct regarding the formation of thyroid
harmone ?
I. Dietary inorganic phosphate is transported into the gland by an iodide transporter, converted to
iodine.
II. Iodine bound to thyroglobulin by the enzyme thyroid peroxidase through a process called
organification.
III. This results in the formation of monoiodotyrosine (MIT) and diiodotyrosine (DIT), which
are coupled to form T3 and T4.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Dietary inorganic iodide is transported into the gland by an iodide transporter, converted to iodine,
and bound to thyroglobulin by the enzyme thyroid peroxidase through a process called organification.
This results in the formation of monoiodotyrosine (MIT) and diiodotyrosine (DIT), which are
coupled to form T3 and T4 .
31. Which out of the following statement is /are correct regarding the storage of thyroid
harmone ?
I. T3 and T4, these are stored with thyroglobulin in the liver.
II. T3 and T4, these a
III. T3 and T4, these are stored with thyroglobulin in the kidney.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
This results in the formation of monoiodotyrosine (MIT) and diiodotyrosine (DIT), which are
coupled to form T3 and T4
The thyroid contains a large supply of its preformed hormones.
32. Which out of the following statement is /are correct regarding the thyroid harmone ?
I. Free T4 is 20-100 times more biologically active than free T3.
II. Free T4 is 100-150 times more biologically active than free T4.
III. Free T3 is 20-100 times more biologically active than free T4.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Free T3 is 20-100 times more biologically active than free T4.

33. Which out of the following disorders of thyroid function have been found to be caused
by mutations in the TSHR gene ?
I. Familial gestational hyperthyroidism.
II. One type of nonimmune hyperthyroidism.
III. Two type of nonimmune hypothyroidism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
A number of disorders of thyroid function have been found to be caused by mutations in the TSHR
gene ,These disorders include the following:
 Familial gestational hyperthyroidism
 One type of nonimmune hyperthyroidism
34. Which out of the following disorders of thyroid function have been found to be caused
by mutations in the TSHR gene ?
I. Two type of nonimmune hypothyroidism.
II. Congenital nongoiterous thyrotoxicosis.
III. Toxic thyroid adenoma with somatic mutation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
A number of disorders of thyroid function have been found to be caused by mutations in the TSHR
gene, These disorders include the following:
 Congenital nongoiterous thyrotoxicosis
 Toxic thyroid adenoma with somatic mutation
35. What is the function of TSHR gene ?
I. It encodes the TSH receptor protein.
II. It encodes the TOH receptor protein.
III. It encodes the GNRH receptor protein.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The TSHR gene, which encodes the TSH receptor protein
36. What are the significant risk factors for ophthalmopathy ?

I. Cigarette smoking.
II. Green vegetables.
III. A high TSH receptor autoantibody level.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Cigarette smoking and a high TSH receptor autoantibody level are significant risk factors for
ophthalmopathy
37. What is mean by graves disease ?
I. It is an bone-specific autoimmune disorder characterized by a variety of circulating antigens.
II. It is an organ-specific autoimmune disorder characterized by a variety of circulating antibodies.
III. It is an blood-specific autoimmune disorder characterized by a variety of circulating antigens.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Graves disease is an organ-specific autoimmune disorder characterized by a variety of circulating

antibodies, including common autoimmune antibodies, as well as anti-TPO and anti-TG antibodies.
38. What is the most common cause of thyrotoxicosis ?

I. Graves disease.
II. Peptic ulcer Disease.
III. Intestinal bowel disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The most common cause of thyrotoxicosis is Graves disease (50-60% of cases).

39. Which out of the following statement is /are correct for grave disease ?
I. It is an bone-specific autoimmune disorder characterized by a variety of circulating antigens.
II. The most important autoantibody is TSI, which is directed toward epitopes of the TSH
receptor.
III. TSI binds to the TSH receptor on the thyroid follicular cells to activate thyroid hormone
synthesis and release and thyroid gland growth (hypertrophy).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The most important autoantibody is TSI, which is directed toward epitopes of the TSH receptor and
acts as a TSH-receptor agonist. Like TSH, TSI binds to the TSH receptor on the thyroid follicular
cells to activate thyroid hormone synthesis and release and thyroid gland growth (hypertrophy).
40. Which out of the following statement is /are correct for thyroid gland ?
I. It is located in the lower anterior neck.
II. It is located in the posterior part of brain.
III. The isthmus of the butterfly-shaped gland generally is located just below the cricoid cartilage
of the trachea.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The thyroid is located in the lower anterior neck. The isthmus of the butterfly-shaped gland generally
is located just below the cricoid cartilage of the trachea, with the wings of the gland wrapping around
the trachea.
41. What is mean by ELISA ?
I. Epithilum-linked immunosorbent assay.
II. Enzyme-linked immunosorbent assay.
III. Enzyme-liquid immunosorbent assay.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Enzyme-linked immunosorbent assay (ELISA)
42. What is the normal reference range of TSH ?

I. 0.4 - 4 mIU/L.
II. 0.4 - 8 mIU/L.
III. 0.4 - 14 mIU/L.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Thyrotoxicosis is marked by TSH levels suppressed below the reference range (usually 0.4-4 miu/L)
43. Which out of the following radioactive isotopes used for thyroid scanning by means of
scintigraphy ?
I. Carbon 18.
II. Iodine-123 (123 I).
III. Technetium-99m (99m Tc).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Tests, it can be confirmed by means of scintigraphy. Iodine-123 (123 i) or technetium-99m (99m tc)
can be used for thyroid scanning.
44. What is mean by RAIU ?

I. Radioinactive iodine uptake.
II. Radioactive isotop uptake.
III. Radioactive iodine uptake.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Radioactive iodine uptake (RAIU)

45. What results are observed in thyroid function study of hyperthyroidism ?
I. Patients with milder thyrotoxicosis may have elevation of T 3 levels only.
II. Subclinical hyperthyroidism features decreased TSH and normal T 3 and T 4 levels.
III. Thyrotoxicosis is marked by increased TSH levels and supressed T 3 and T 4 levels.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Thyroid function study results in hyperthyroidism are as follows:

 Patients with milder thyrotoxicosis may have elevation of T 3 levels only
 Subclinical hyperthyroidism features decreased TSH and normal T 3 and T 4 levels
46. What are the special circumstances in which thyroidectomy is done in patient ?
I. Severe hyperthyroidism in children.
II. Patient with severe jaundice.
III. Pregnant women who are noncompliant with or intolerant of antithyroid medication.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Thyroidectomy is reserved for special circumstances, including the following:

 Severe hyperthyroidism in children
 Pregnant women who are noncompliant with or intolerant of antithyroid medication
I. Patient with severe jaundice.
II. Patients with very large goiters or severe ophthalmopathy.
III. Patients who refuse radioactive iodine therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Patients with very large goiters or severe ophthalmopathy
 Patients who refuse radioactive iodine therapy
I. Refractory amiodarone-induced hyperthyroidism.
II. Patients who require normalization of thyroid functions quickly.
III. Patient with severe jaundice.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Refractory amiodarone-induced hyperthyroidism
 Patients who require normalization of thyroid functions quickly
49. Which out of the following statement is/are true for thyroid hormones ?
I. Thyroid hormones diffuse into the peripheral circulation.
II. Free T4 is 20-100 times more biologically active than free T3.
III. More than 99.9% of T4 and T3 in the peripheral circulation is bound to plasma proteins and
is inactive.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Thyroid hormones diffuse into the peripheral circulation. More than 99.9% of T 4 and T3 in the
peripheral circulation is bound to plasma proteins and is inactive. Free T3 is 20-100 times more
biologically active than free T4.
50. Which out of the following statement is/are correct for graves disease?
I. In it circulating autoantibodies against the thyrotropin receptor provide continuous stimulation
of the thyroid gland.
II. It is an bone-specific autoimmune disorder characterized by a variety of circulating antigens.
III. These antibodies cause release of thyroid hormones and thyroglobulin, and they also stimulate
iodine uptake, protein synthesis, and thyroid gland growth.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In Graves disease, circulating autoantibodies against the thyrotropin receptor provide continuous
stimulation of the thyroid gland. These antibodies cause release of thyroid hormones and
thyroglobulin, and they also stimulate iodine uptake, protein synthesis, and thyroid gland growth.
51. Which out of the following disease included in autoimmune thyroid disease ?
I. Andersen disease.
II. Hashimoto hypothyroidism.
III. Graves disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Autoimmune thyroid disease, including Hashimoto hypothyroidism and Graves disease,
52. Which syndrome is caused by mutations in the GNAS gene ?

I. Anderson syndrome.
II. McCune-Albright syndrome.
III. Zollinger Ellison syndrome.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Mccune-Albright syndrome is caused by mutations in the GNAS gene.

53. Which patient have higher prevalence for autoimmune thyroid disease ?
I. Patients with human leukocyte antigen (HLA)-DRw3 and HLA-B89.
II. Patients with human leukocyte antigen (HLA)-BWw3 and HLA-B89.
III. Patients with human leukocyte antigen (HLA)-DRw3 and SLA-B89.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Autoimmune thyroid disease has a higher prevalence in patients with human leukocyte antigen
(HLA)-drw3 and HLA-B89.
54. What are the signs of thyroid ophthalmopathy develop in graves disease ?
I. Periorbital edema.
II. Conjunctival edema.
III. Large eye lashes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Clinical findings specific to Graves disease include thyroid ophthalmopathy (periorbital edema,
chemosis [conjunctival edema], injection, or proptosis)
55. What are the clinical findings observed in graves disease ?
I. Thyroid ophthalmopathy.
II. Andereson syndrome.
III. Dermopathy over the lower extremities.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Clinical findings specific to Graves disease include thyroid ophthalmopathy and, rarely, dermopathy
over the lower extremities.
56. What are the other autoimmune disease associated with graves disease ?
I. Barrel esophagous.
II. Pernicious anemia
III. Myasthenia gravis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Graves disease-- This autoimmune condition may be associated with other autoimmune diseases, such
as pernicious anemia, myasthenia gravis, vitiligo, adrenal insufficiency, celiac disease, and type 1
diabetes mellitus.
I. Vitiligo.
II. Diahrrea.
III. Adrenal insufficiency.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
diabetes mellitus.
I. Esophagitis.
II. Celiac disease.
III. Type 1 diabetes mellitus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
diabetes mellitus.
59. Which out of the following statement is/are correct for toxic multinodular goiter ?
I. In it circulating autoantibodies against the thyrotropin receptor provide continuous stimulation
of the thyroid gland.
II. It occurs more commonly in elderly individuals, especially those with a long-standing goiter.
III. Thyroid hormone excess develops very slowly over time and often is only mildly elevated at
the time of diagnosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Toxic multinodular goiter (Plummer disease) accounts for 15-20% of thyrotoxicosis cases (see the
image below). It occurs more commonly in elderly individuals, especially those with a long-standing
goiter. Thyroid hormone excess develops very slowly over time and often is only mildly elevated at the
time of diagnosis.
60. Which out of the following statement is/are correct for toxic adenoma ?
I. It occurs more commonly in elderly individuals, especially those with a long-standing goiter.
II. It is caused by a single hyperfunctioning follicular thyroid adenoma.
III. The excess secretion of thyroid hormone occurs from a benign monoclonal tumor that usually
is larger than 2.5 cm in diameter.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Toxic adenoma is caused by a single hyperfunctioning follicular thyroid adenoma. This disorder
accounts for approximately 3-5% of thyrotoxicosis cases. The excess secretion of thyroid hormone occurs
from a benign monoclonal tumor that usually is larger than 2.5 cm in diameter.
61. What are the other causes of thyrotoxicosis ?
I. Struma ovarii.
II. Thyroid Dysfunction Induced by Amiodarone Therapy.
III. Cataract.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Other causes of thyrotoxicosis

 Struma ovarii
 Thyroid Dysfunction Induced by Amiodarone Therapy

I. Iodide-induced thyrotoxicosis (Jod-Basedow syndrome ).
II. Metastatic follicular thyroid carcinoma.
III. Patients with jaundice.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Iodide-induced thyrotoxicosis (Jod-Basedow syndrome
 Patients with a molar hydatidiform pregnancy
I. Patients with jaundice.
II. Patients with a molar hydatidiform pregnancy.
III. Thyroid Dysfunction Induced by Amiodarone Therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Thyroid Dysfunction Induced by Amiodarone Therapy
 Patients with a molar hydatidiform pregnancy
64. Which out of the following statement is /are correct for struma ovarii ?
I. It is ectopic thyroid tissue associated with dermoid tumors or ovarian teratomas.
II. It can secrete excessive amounts of thyroid hormone and produce thyrotoxicosis.
III. It occurs in patients with excessive iodine intake.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Struma ovarii is ectopic thyroid tissue associated with dermoid tumors or ovarian teratomas that can
secrete excessive amounts of thyroid hormone and produce thyrotoxicosis.
65. Which out of the following statement is /are correct for iodide-induced thyrotoxicosis?
I. It appears to result from loss of the normal adaptation of the thyroid to iodide excess.
II. It is ectopic thyroid tissue associated with dermoid tumors or ovarian teratomas.
III. It is treated with cessation of the excess iodine intake and with administration of antithyroid
medication.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Iodide-induced thyrotoxicosis appears to result from loss of the normal adaptation of the thyroid to
iodide excess. It is treated with cessation of the excess iodine intake and with administration of
antithyroid medication.
66. Which out of the following statement is /are correct for molar hydatidiform pregnancy
?
I. It is treated with cessation of the excess iodine intake and with administration of antithyroid
medication.
II. It have extremely high levels of beta human chorionic gonadotropin (β-hCG), which can weakly
activate the TSH receptor.
III. At very high levels of β-hCG, activation of the TSH receptors is sufficient to cause
thyrotoxicosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Patients with a molar hydatidiform pregnancy or choriocarcinoma have extremely high levels of beta
human chorionic gonadotropin (β-hcg), which can weakly activate the TSH receptor. At very high
levels of β-hcg, activation of the TSH receptors is sufficient to cause thyrotoxicosis.
67. Which out of the following statement is /are correct for metastatic follicular thyroid
carcinoma?
I. These lesions maintain the ability to make thyroid hormone.
II. In patients with bulky tumors, production may be high enough to cause thyrotoxicosis.
III. It have extremely high levels of beta human chorionic gonadotropin (β-hCG), which can
weakly activate the TSH receptor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Metastatic follicular thyroid carcinoma may also result in thyrotoxicosis. These lesions maintain the
ability to make thyroid hormone, and in patients with bulky tumors, production may be high enough
to cause thyrotoxicosis.
68. Which out of the following conditions associated with the risk of thyrotoxicosis ?
I. Dilated cardiomyopathy.
II. Right heart failure with pulmonary hypertension.
III. Diptheria.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Thyrotoxicosis has been associated with dilated cardiomyopathy, right heart failure with pulmonary
hypertension, and diastolic dysfunction and atrial fibrillation.
69. Which out of the followingg conditions associated with the risk of thyrotoxicosis ?
I. Diptheria.
II. Diastolic dysfunction.
III. Atrial fibrillation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Thyrotoxicosis has been associated with dilated cardiomyopathy, right heart failure with pulmonary
hypertension, and diastolic dysfunction and atrial fibrillation.
70. Which compounds contain large amounts of iodine that can induce thyrotoxicosis in a
patient with thyroid autonomy ?
I. Expectorants.
II. Amiodarone.
III. Milk products.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
A number of compounds including expectorants, amiodarone, iodinated contrast dyes, and health
food supplements containing seaweed or thyroid gland extracts contain large amounts of iodine that
can induce thyrotoxicosis in a patient with thyroid autonomy
71. Which compounds contain large amounts of iodine that can induce thyrotoxicosis in a
patient with thyroid autonomy ?
I. Milk products.
II. Iodinated contrast dyes.
III. Food supplements containing seaweed.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
A number of compounds including expectorants, amiodarone, iodinated contrast dyes, and health
food supplements containing seaweed or thyroid gland extracts contain large amounts of iodine that
can induce thyrotoxicosis in a patient with thyroid autonomy
72. How is the skin affected in graves disease ?

I. Through deposition of glycosaminoglycans in the dermis of the lower leg.
II. These lesions maintain the ability to make thyroid hormone.
III. This causes nonpitting edema, which is usually associated with erythema and thickening of the
skin, without pain or pruritus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In rare instances, Graves disease affects the skin through deposition of glycosaminoglycans in the dermis
of the lower leg. This causes nonpitting edema, which is usually associated with erythema and
thickening of the skin, without pain or pruritus
73. Which out of the following is the most reliable screening measure of thyroid function ?
I. Thyroid-stimulating hormone (TSH) level.
II. Follicle stimulating hormone (FSH) level.
III. Pitutary-stimulating hormone (PSH) level.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The most reliable screening measure of thyroid function is the thyroid-stimulating hormone (TSH)
level.
74. What is the unmeasurable levels of TSH ,which suppressed in thyrotoxicosis ?

I. < 0.05 µIU/mL.
II. < 0.05 µIU/L.
III. > 0.05 µIU/mL.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
TSH levels usually are suppressed to unmeasurable levels (< 0.05 µiu/ml) in thyrotoxicosis.
75. What is the most specific autoantibody test for autoimmune thyroiditis ?
I. Coombs test.
II. Enzyme-linked immunosorbent assay (ELISA) test.
III. Antinuclear antibody test.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The most specific autoantibody test for autoimmune thyroiditis is an enzyme-linked immunosorbent
assay (ELISA) test for anti ̶ thyroid peroxidase (anti-TPO) antibody
76. What is the most specific autoantibody test for for anti ̶ thyroid peroxidase antibody?
I. Coombs test.
II. Antinuclear antibody test.
III. Enzyme-linked immunosorbent assay (ELISA) test.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The most specific autoantibody test for autoimmune thyroiditis is an enzyme-linked immunosorbent
assay (ELISA) test for anti ̶ thyroid peroxidase (anti-TPO) antibody
77. Which out of the following statement is /are correct regarding effect on races of
autoimmune thyroid disease ?
I. It occurs with the same frequency in Caucasians, Hispanics, and Asians.
II. It occurs at lower rates in African Americans.
III. It occurs at higher rates in African Americans.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Autoimmune thyroid disease occurs with the same frequency in Caucasians, Hispanics, and Asians
but at lower rates in African Americans.
78. What is the effect of sex on all thyroid disease ?

I. All thyroid diseases occur more frequently in men than in women.
II. Graves autoimmune disease has a male-to-female ratio of 1:5-10.
III. The male-to-female ratio for toxic multinodular goiter and toxic adenoma is 1:2-4.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
All thyroid diseases occur more frequently in women than in men. Graves autoimmune disease has a
male-to-female ratio of 1:5-10. The male-to-female ratio for toxic multinodular goiter and toxic
adenoma is 1:2-4.
79. Which form of hyperthyroidism is most common in the United States ?
I. Subacute thyroiditis .
II. Plummer disease.
III. Graves disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Graves disease is the most common form of hyperthyroidism in the United States
80. Which out of the following statement is /are true forgraves ophthalmopathy ?
I. It is also called thyroid-associated orbitopathy.
II. It most likely involves an antibody reaction against the H+ receptor.
III. It results in activation of T cells against tissues in the retro-orbital space that share antigenic
epitopes with thyroid follicular cells.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The underlying pathophysiology of Graves ophthalmopathy (also called thyroid-associated

orbitopathy) is not completely characterized. It most likely involves an antibody reaction against the
TSH receptor that results in activation of T cells against tissues in the retro-orbital space that share
antigenic epitopes with thyroid follicular cells.
81. What mechanism causes thickening of the extraocular muscle and increase the volume
of retro-orbit of the adipose and connective tissue ?
I. In graves ophthalmopathy an antibody reaction do not occurs against the TSH receptor.
II. These immune processes lead to an active phase of inflammation, with lymphocyte infiltration
of the orbital tissue.
III. It release of cytokines that stimulate orbital fibroblasts to multiply and produce
mucopolysaccharides , which absorb water.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
These immune processes lead to an active phase of inflammation, with lymphocyte infiltration of the
orbital tissue and release of cytokines that stimulate orbital fibroblasts to multiply and produce
mucopolysaccharides (glycosaminoglycans), which absorb water. In consequence, the extraocular
muscles thicken and the adipose and connective tissue of the retro-orbit increase in volume.
82. Which out of the following statement is/are correct for the antithyroid drug treatment
of hyperthyroidism ?
I. Used for long-term control of hyperthyroidism in children, adolescents, and pregnant women.
II. In adult men and nonpregnant women, used to control hyperthyroidism before definitive
therapy with radioactive iodine.
III. Propylthiouracil is more potent and longer-acting than methimazole.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Antithyroid drug treatment is as follows:

 Used for long-term control of hyperthyroidism in children, adolescents, and pregnant women
 In adult men and nonpregnant women, used to control hyperthyroidism before definitive
therapy with radioactive iodine
 Methimazole is more potent and longer-acting than propylthiouracil
I. Propylthiouracil is more potent and longer-acting than methimazole.
II. Propylthiouracil is reserved for use in thyroid storm, first trimester of pregnancy, and
methimazole allergy.
III. Antithyroid drug doses are titrated every 4 weeks until thyroid functions normalize.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Propylthiouracil is reserved for use in thyroid storm, first trimester of pregnancy, and
methimazole allergy or intolerance
 Antithyroid drug doses are titrated every 4 weeks until thyroid functions normalize
I. Propylthiouracil is more potent and longer-acting than methimazole.
II. Patients with Graves disease may experience remission after treatment for 12-18 months.
III. Toxic multinodular goiter and toxic adenoma will not go into remission.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Patients with Graves disease may experience remission after treatment for 12-18 months, but
recurrences are common within the following year
 Toxic multinodular goiter and toxic adenoma will not go into remission
85. What is mean by anti-TPO ?

I. Anti ̶ thyroid peroxidase antibody.
II. Anti ̶ thyroid pulmonary antibody.
III. Anti ̶ thiamine peroxidase antigen.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Anti ̶ thyroid peroxidase (anti-TPO) antibody

86. What are the presentation of thyrotoxicosis in younger patient ?
I. They exhibit symptoms of sympathetic activation.
II. They exhibit symptoms like anxiety, hyperactivity, tremor.
III. They have more cardiovascular symptoms.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Presentation of thyrotoxicosis varies, as follows:

 Younger patients tend to exhibit symptoms of sympathetic activation (eg, anxiety,
hyperactivity, tremor)
87. What are the presentation of thyrotoxicosis in older patients ?

I. They exhibit unexplained weight loss.
II. They exhibit symptoms like anxiety, hyperactivity, tremor.
III. They have more cardiovascular symptoms (eg, dyspnea, atrial fibrillation).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Presentation of thyrotoxicosis varies, as follows:

 Older patients have more cardiovascular symptoms (eg, dyspnea, atrial fibrillation) and
unexplained weight loss
88. What are the presentation of thyrotoxicosis in patients with ophthalmopathy?
I. They exhibit unexplained weight loss.
II. They exhibit symptoms like periorbital edema, diplopia, or proptosis.
III. They have more cardiovascular symptoms (eg, dyspnea, atrial fibrillation).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Ophthalmopathy (eg, periorbital edema, diplopia, or proptosis) suggests Graves disease
89. Which out of the following developed guidelines for the management of
hyperthyroidism and other causes of thyrotoxicosis ?
I. The American Thyroid Association.
II. The American Association of Clinical Endocrinologists.
III. The German Association of Clinical Endocrinologists.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Guidelines for the management of hyperthyroidism and other causes of thyrotoxicosis have been
developed by the American Thyroid Association and the American Association of Clinical
Endocrinologists
90. Which out of the following leads to the hypermetabolic condition of thyrotoxicosis ?
I. Excess synthesis and secretion of thyroid hormones by the thyroid gland.
II. Reduced synthesis and secretion of thyroid hormones by the thyroid gland.
III. Elevation in levels of FT4, free triiodothyronine (FT3).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Hyperthyroidism is a set of disorders that involve excess synthesis and secretion of thyroid hormones by
the thyroid gland. The resulting elevation in levels of FT4, free triiodothyronine (FT3), or both leads
to the hypermetabolic condition of thyrotoxicosis.
91. Which diseases are associated with the Type II autoimmune polyendocrine syndrome ?
I. Hyperthyroidism.
II. Hypothyroidism.
III. Esophagitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Type II autoimmune polyendocrine syndrome is associated with hyperthyroidism and hypothyroidism,

as well as type 1 diabetes mellitus and adrenal insufficiency.
92. Which diseases are associated with the Type II autoimmune polyendocrine syndrome ?
I. Barrel Esophagus.
II. Type 1 diabetes mellitus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Type II autoimmune polyendocrine syndrome is associated with hyperthyroidism and hypothyroidism,

as well as type 1 diabetes mellitus and adrenal insufficiency.
93. Which out of the following statement is/are correct for graves disease ?
I. It occurs more frequently in patients with defect parietal cells .
II. An HLA-related, organ-specific defect in suppressor T-cell function.
III. It occurs more frequently in patients with HLA-Bw35.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Graves disease is felt to be an HLA-related, organ-specific defect in suppressor T-cell function.

94. Which out of the following statement is/are correct for granulomatous thyroiditis ?
I. It occurs more frequently in patients with defect parietal cells .
II. An HLA-related, organ-specific defect in suppressor T-cell function.
III. It occurs more frequently in patients with HLA-Bw35.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Subacute painful or granulomatous thyroiditis occurs more frequently in patients with HLA-Bw35
95. Which out of the following antibodies characterized the graves disease ?
I. Anti-TPO antibodies.
II. Anti-TG antibodies.
III. Anti-E antibody.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The most common cause of thyrotoxicosis is Graves disease (50-60% of cases). Graves disease is an
organ-specific autoimmune disorder characterized by a variety of circulating antibodies, including
common autoimmune antibodies, as well as anti-TPO and anti-TG antibodies.
96. Which out of the following statement is /are correct for scintigraphy in subacute
thyroiditis ?
I. Diffuse enlargement of left thyroid lobes, with low uptake of isotope
II. Radioactive iodine uptake is very low (approximately 1-2%).
III. Overall RAIU is mildly to moderately increased.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
In subacute thyroiditis radioactive iodine uptake is very low (approximately 1-2%)
97. What are classification of nodules determined by their isotope-concentrating ability

relative to the surrounding normal parenchyma ?
I. "hot," "warm," or "cold".
II. "Large," "medium," or "small".
III. "Rough," "Smooth" or "soft".
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The classification of nodules as "hot," "warm," or "cold" is determined by their isotope-concentrating

ability relative to the surrounding normal parenchyma.
98. What results are observed by scintigraphy in graves disease ?
I. Diffuse enlargement of right thyroid lobes, with low uptake of isotope.
II. Diffuse enlargement of left thyroid lobes, with low uptake of isotope.
III. Diffuse enlargement of both thyroid lobes, with uniform uptake of isotope.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
In Graves disease, scintigraphy shows diffuse enlargement of both thyroid lobes, with uniform uptake
of isotope (see the image below).
99. Which out of the following statement is /are correct for scintigraphy in toxic
multinodular goiters ?
I. Overall RAIU is mildly to moderately decreased.
II. It characterized by irregular areas of relatively diminished and occasionally increased uptake.
III. Overall RAIU is mildly to moderately increased.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Toxic multinodular goiters are characterized by irregular areas of relatively diminished and
occasionally increased uptake . Overall RAIU is mildly to moderately increased.
100. Which out of the following statement is /are correct for scintigraphy in Hashimoto
hypothyroidism ?
I. Diffuse enlargement of right thyroid lobes, with low uptake of isotope.
II. It can be associated with normal, elevated, or suppressed radioactive iodine uptake.
III. It characterized by irregular areas of relatively diminished and occasionally increased uptake.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Occasionally, Hashimoto hypothyroidism can be associated with normal, elevated, or suppressed

radioactive iodine uptake.
1. Which out of the following drugs included in antithyroid drugs ?

I. Methimazole.
II. Propylthiouracil.
III. Propanol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Antithyroid drugs eg, methimazole and propylthiouracil
2. What is the mechanism of action of antithyroid drugs ?

I. It inhibit the formation and coupling of iodotyrosines in thyroglobulin.
II. It increase the formation iodotyrosines in thyroglobulin.
III. It increase the coupling of iodotyrosines in thyroglobulin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Antithyroid medications inhibit the formation and coupling of iodotyrosines in thyroglobulin.

3. What is the frequency of titration of drug dose of antithyroid ?
I. Every 4 weeks until thyroid functions normalize.
II. Every 4 month until thyroid functions normalize.
III. Every 4 years until thyroid functions normalize.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The antithyroid drug dose should be titrated every 4 weeks until thyroid functions normalize.
4. What are the nodular forms of hyperthyroidism ?

I. Toxic multinodular goiter.
II. Podgara.
III. Toxic adenoma.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Nodular forms of hyperthyroidism (ie, toxic multinodular goiter[17] and toxic adenoma)
5. Which out of the following statement is/are correct for methimazole ?
I. It is more potent than propylthiouracil.
II. It has a longer duration of action.
III. It is taken thrice daily.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Methimazole is more potent than propylthiouracil and has a longer duration of action. In addition,
methimazole is taken once daily
6. Which out of the following statement is/are incorrect for methimazole ?

I. It is taken 2-3 times daily.
II. Patient compliance is often better with methimazole than with propylthiouracil.
III. It is taken once daily.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Whereas propylthiouracil is taken 2-3 times daily; consequently, patient compliance is often better
with methimazole than with propylthiouracil.
7. Which out of the following statement is/are correct for propylthiouracil ?
I. It is more potent than methimazole.
II. It is taken once daily.
III. It is taken 2-3 times daily.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Methimazole is more potent than propylthiouracil and has a longer duration of action. In addition,
methimazole is taken once daily. Whereas propylthiouracil is taken 2-3 times daily; consequently,
patient compliance is often better with methimazole than with propylthiouracil.
8. Why is methimazole not recommended for use in the first trimester of pregnancy ?
I. Because it has been associated (albeit rarely) with cloacal abnormalities.
II. Because it has been associated scalp (cutis aplasia) abnormalities.
III. Because it has been associated with abortion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Methimazole is not recommended for use in the first trimester of pregnancy, because it has been
associated (albeit rarely) with cloacal and scalp (cutis aplasia) abnormalities
I. It is not recommended for use in the first trimester of pregnancy.
II. It is taken 2-3 times daily.
III. If a nonpregnant woman who is receiving methimazole desires pregnancy, she should be
switched to propylthiouracil before conception.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Methimazole is not recommended for use in the first trimester of pregnancy, Generally, if a
nonpregnant woman who is receiving methimazole desires pregnancy, she should be switched to
propylthiouracil before conception. After 12 weeks of gestation, she can be switched back to
methimazole, with frequent monitoring.
I. It remains the drug of choice in uncommon situations of life-threatening severe thyrotoxicosis.
II. It inhibit conversion of T4 -to-T3.
III. It is not recommended for use in the first trimester of pregnancy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Propylthiouracil remains the drug of choice in uncommon situations of life-threatening severe

thyrotoxicosis (ie, thyroid storm) because of the additional benefit of inhibition of T4 -to-T3 conversion
11. Which out of the following statement is/are incorrect for propylthiouracil ?
II. It inhibit conversion of T4 -to-T3.
III. It is not recommended for use in the first trimester of pregnancy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C

thyrotoxicosis (ie, thyroid storm) because of the additional benefit of inhibition of T4 -to-T3 conversion
I. It is not recommended for use in the first trimester of pregnancy.
II. It should be administered every 6-8 hours.
III. It reduce T3 theoretically helps reduce the thyrotoxic symptoms more quickly than
methimazole would.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
In this setting, propylthiouracil should be administered every 6-8 hours. The reduction in T3, which
is 20-100 times more potent than T4, theoretically helps reduce the thyrotoxic symptoms more quickly
than methimazole would.
13. Which out of the following statement is/are correct for thyroid harmone ?
I. T3 is 20-100 times more potent than T4.
II. T4 is 20-100 times more potent than T3.
III. T4 is 200-400 times more potent than T3.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
T3 is 20-100 times more potent than T4
I. It is reserved for use in patients who are allergic to or intolerant of methimazole.
II. It is reserved for use in women who are in the first trimester of pregnancy or planning pregnancy.
III. It is considered a first-line drug therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Except in thyroid storm, propylthiouracil is considered a second-line drug therapy. It is reserved for
use in patients who are allergic to or intolerant of methimazole and in women who are in the first
trimester of pregnancy or planning pregnancy.
15. What are the allergic reaction of the antithyroid drug ?
I. Fever.
II. Rash.
III. Sneezing.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The most common adverse effects of antithyroid drugs are allergic reactions manifesting as fever, rash,
urticaria, and arthralgia, which occur in 1-5% of patients, usually within the first few weeks of
treatment
16. What are the allergic reaction of the antithyroid drug ?

I. Cold.
II. Urticaria.
III. Arthralgia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The most common adverse effects of antithyroid drugs are allergic reactions manifesting as fever, rash,
urticaria, and arthralgia,
17. What are the adverse effect associated with antithyroid drugs ?
I. Agranulocytosis.
II. Diptheria.
III. Aplastic anemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Serious adverse effects include agranulocytosis, aplastic anemia, hepatitis, polyarthritis, and a
lupuslike vasculitis.
I. Chicken pox.
II. Hepatitis.
III. Polyarthritis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
I. Lupuslike vasculitis.
II. Pertusis.
III. Allergic reactions.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
20. Which adverse effect are occur more frequently with propylthiouracil ?
I. Agranulocytosis.
II. Polyarthritis.
III. Aplastic anemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
All of these adverse effects, except agranulocytosis, occur more frequently with propylthiouracil.
21. What is mean by G-CSF ?
I. Granulocyte colony-stimulating factor.
II. Ganglia colony-stimulating factor.
III. Granulocyte colony-starting factor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Granulocyte colony-stimulating factor (G-CSF)
22. What is the strongest warning issued by the FDA for propylthiouracil ?
I. Severe liver injury.
II. Acute liver failure.
III. Lung injury.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In 2010, the US Food and Drug Administration (FDA) added a boxed warning, the strongest
warning issued by the FDA, to the prescribing information for propylthiouracil. The warning
emphasized the risk for severe liver injury and acute liver failure, some cases of which have been fatal
23. What is mean by SSKI ?
I. Saturated solution of keratin iodide.
II. Saturated solution of kaoline iodide.
III. Saturated solution of potassium iodide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Saturated solution of potassium iodide (SSKI)
24. What is the mechanism of action of iodine or iodinated contrast agents ?

I. It have been administered to block the conversion of T4 to T3
II. It block the release of thyroid hormone from the gland..
III. It have been administered to block the conversion of T3 to T4.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In severe thyrotoxicosis from Graves disease or subacute thyroiditis, iodine or iodinated contrast agents
have been administered to block the conversion of T4 to T3 and the release of thyroid hormone from
the gland.
25. What is the dose of SSKI in hyperthyroid patient ?
I. 10 drops twice daily.
II. 20 drops twice daily.
III. 50 drops twice daily.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
A saturated solution of potassium iodide (SSKI) can be administered at a dosage of 10 drops twice
daily, with a consequent rapid reduction in T3 levels.
26. What is the dose of Iopanoic acid/ipodate in hyperthyroid patient ?

I. 1 g/day.
II. 10 g/day.
III. 100 g/day.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Iopanoic acid/ipodate at a dosage of 1 g/day is also effective; it has not been available in the United
States for several years but is available in some areas of Europe.
27. What is the mechanism of action of cholestyraminin hyperthyroid patient ?
I. It have been administered to block the conversion of T4 to T3.
II. It block the release of thyroid hormone from the gland.
III. It decreases thyroid hormone levels by depleting the pool by enhancing clearance from
enterohepatic circulation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Another drug that might be considered in management of severe thyrotoxicosis would be

cholestyramine, a bile salt sequestrant. It decreases thyroid hormone levels by depleting the pool by
enhancing clearance from enterohepatic circulation.
28. What is the dose of cholestyramine in hyperthyroid patient ?

I. 22 grams in 3 divided daily dose have been used for 4 weeks.
II. 12 grams in 3 divided daily dose have been used for 8 weeks.
III. 12 grams in 3 divided daily dose have been used for 4 weeks.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Cholestyramine, a bile salt sequestrant. Doses up to 12 grams in 3 divided daily dose have been used
for 4 weeks.
29. Which out of the following statement is/are correct for cholestyramine ?
I. It is reserved for use in patients who are allergic to or intolerant of methimazole.
II. It a bile salt sequestrant.
III. It considered in management of severe thyrotoxicosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Another drug that might be considered in management of severe thyrotoxicosis would be

cholestyramine, a bile salt sequestrant.
30. What is the most common treatment for Graves disease in adults in the United States ?
I. Radioactive iodine therapy
II. Radioactive cobalt therapy.
III. Radioactive carbon therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Radioactive iodine therapy[20] is the most common treatment for Graves disease in adults in the United
States. Although its effect is less rapid than that of antithyroid medication or thyroidectomy, it is
effective and safe and does not require hospitalization.
31. Which out of the following statement is/are correct for radioactive iodine therapy ?
I. Its effect is less rapid than that of antithyroid medication or thyroidectomy.
II. It is effective and safe and does not require hospitalization.
III. It a bile salt sequestrant.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Radioactive iodine therapy is the most common treatment for Graves disease in adults in the United
States. Although its effect is less rapid than that of antithyroid medication or thyroidectomy, it is
effective and safe and does not require hospitalization.
32. Which out of the following statement is/are correct for radioactive iodine therapy ?
I. It is administered orally as a single dose in capsule or liquid form.
II. The iodine is quickly absorbed and taken up by the thyroid.
III. It a bile salt sequestrant.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Radioactive iodine is administered orally as a single dose in capsule or liquid form. The iodine is
quickly absorbed and taken up by the thyroid
33. What are the adverse effect associated with radioactive iodine therapy ?
I. Thyroid-specific inflammatory response.
II. Protection of the thyroid.
III. Fibrosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Consequently, very few adverse effects are associated with this therapy. The treatment results in a
thyroid-specific inflammatory response, causing fibrosis and destruction of the thyroid over weeks to
many months.
34. Why radioactive iodine is only used for treatment of hyperthyroidism ?

I. Because iodine is quickly absorbed and taken up by the thyroid.
II. Because no other tissue or organ in the body is capable of retaining the radioactive iodine.
III. Because It a bile salt sequestrant.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Radioactive iodine is administered orally as a single dose in capsule or liquid form. The iodine is
quickly absorbed and taken up by the thyroid. No other tissue or organ in the body is capable of
retaining the radioactive iodine;
131
35. What is the dose of I used for treatment of hyperthyroidism ?
I. 5-20 Ci/g.
II. 75-200 µCi/g.
III. 15-20 µCi/g.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The dose of131 I administered is 75-200 µci/g of estimated thyroid tissue
36. What is the oldest form of treatment for hyperthyroidism ?

I. Radioactive iodine therapy.
II. Antithyroid medication.
III. Thyroidectomy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Thyroidectomy is the oldest form of treatment for hyperthyroidism

37. What are the different types of thyroidectomy used treatment for hyperthyroidism ?
I. Total thyroidectomy.
II. Combinations of hemithyroidectomies.
III. Antithyroid medication.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Total thyroidectomy and combinations of hemithyroidectomies and contralateral subtotal

thyroidectomies
38. What are the different types of thyroidectomy used treatment for hyperthyroidism ?
I. Antithyroid medication.
II. Combinations of hemithyroidectomies.
III. Contralateral subtotal thyroidectomise.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Total thyroidectomy and combinations of hemithyroidectomies and contralateral subtotal

thyroidectomies
I. Pregnant women who are compliant with or intolerant of thyroidectomy.
II. Patients with very large goiters or severe ophthalmopathy.
III. Patients who refuse radioactive iodine therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Patients with very large goiters or severe ophthalmopathy
 Patients who refuse radioactive iodine therapy
I. Refractory amiodarone-induced hyperthyroidism.
II. Patients who require normalization of thyroid functions quickly.
III. Pregnant women who are compliant with or intolerant of thyroidectomy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Refractory amiodarone-induced hyperthyroidism
 Patients who require normalization of thyroid functions quickly
I. Severe hyperthyroidism in children.
II. Pregnant women who are compliant with or intolerant of thyroidectomy.
III. Pregnant women who are noncompliant with or intolerant of antithyroid medication.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Severe hyperthyroidism in children
 Pregnant women who are noncompliant with or intolerant of antithyroid medication
42. What is include in preparation for thyroidectomy ?

I. Antithyroid medication.
II. Stable (cold) iodine treatment.
III. Rehabilation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Preparation for thyroidectomy includes antithyroid medication, stable (cold) iodine treatment, and
beta-blocker therapy
43 What is include in preparation for thyroidectomy ?
I. Rehabilation .
II. Stable (cold) iodine treatment.
III. Beta-blocker therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Preparation for thyroidectomy includes antithyroid medication, stable (cold) iodine treatment, and
beta-blocker therapy
44. Which out of the following statement is/are correct for preparation for thyroidectomy?
I. Antithyroid drug therapy should be administered until thyroid functions normalize (4-8 weeks).
II. Propranolol is titrated until the resting pulse rate is lower than 80 beats/min.
III. Patient give lignocaine anesthesia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Generally, antithyroid drug therapy should be administered until thyroid functions normalize (4-8
weeks). Propranolol is titrated until the resting pulse rate is lower than 80 beats/min. Finally, iodide
is administered as SSKI (1-2 drops twice daily for 10-14 days) before the procedure. Stable iodide
therapy both reduces thyroid hormone excretion and decreases thyroid blood flow, which may help
reduce intraoperative blood loss.
45. Which out of the following statement is/are correct for preparation for thyroidectomy?
I. Patient give lignocaine anesthesia.
II. Iodide is administered as SSKI (1-2 drops twice daily for 10-14 days) before the procedure.
III. Stable iodide therapy both reduces thyroid hormone excretion and decreases thyroid blood
flow.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Generally, antithyroid drug therapy should be administered until thyroid functions normalize (4-8
weeks). Propranolol is titrated until the resting pulse rate is lower than 80 beats/min. Finally, iodide
is administered as SSKI (1-2 drops twice daily for 10-14 days) before the procedure. Stable iodide
therapy both reduces thyroid hormone excretion and decreases thyroid blood flow
46. Why iodide is administered as SSKI before the procedure for thyroidectomy ?
I. Stable iodide therapy both reduces thyroid hormone excretion and decreases thyroid blood flow.
II. It may help reduce intraoperative blood loss.
III. It increase thyroid blood flow.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Finally, iodide is administered as SSKI (1-2 drops twice daily for 10-14 days) before the procedure.
Stable iodide therapy both reduces thyroid hormone excretion and decreases thyroid blood flow, which
may help reduce intraoperative blood loss
47. What is administrated before thyroidectomy to reduce the nausea, pain, and vomiting
associated with the procedure ?
I. Dexamethasone 8 mg.
II. Mehtimazole 8 mg.
III. Surcalfate 8mg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
A Swiss study found that administration of a single dose of steroid (dexamethasone 8 mg) before
thyroidectomy can reduce the nausea, pain, and vomiting associated with the procedure, as well as
improve voice function
48. Why a single dose of steroid dexamethasone 8 mgadministrated before thyroidectomy ?

I. To reduce the nausea, pain, and vomiting associated with the procedure.
II. To reduce the symptoms of dyspepsia.
III. To improve voice function.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
A Swiss study found that administration of a single dose of steroid (dexamethasone 8 mg) before
thyroidectomy can reduce the nausea, pain, and vomiting associated with the procedure, as well as
improve voice function
49. What is the adverse effect associated with thyroidectomy ?
I. Recurrent laryngeal nerve damage.
II. Hypoparathyroidism.
III. Diptheria.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Adverse effects of thyroidectomy include recurrent laryngeal nerve damage and hypoparathyroidism
from damage to local structures during the procedure.
50. What should avoided in hyperthyroid patient ?

I. Radiographic contrast dyes.
II. Seaweed tablets.
III. Milk products.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Some expectorants, radiographic contrast dyes, seaweed tablets, and health food supplements contain
excess amounts of iodide and should be avoided because the iodide interferes with or complicates the
management of antithyroid and radioactive iodine therapies.
51. What is the mechanism of action of antithyroid drug ?
I. It inhibit the synthesis of thyroxine (T4).
II. It increase the synthesis of thyroxine (T4).
III. It inhibit the synthesis of triiodothyronine (T3).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Antithyroid agents inhibit the synthesis of thyroxine (T4) and triiodothyronine (T3)
52. Which out of the following drug falls in class antithyroid agents for hyperthyroidism ?
I. Methimazole.
II. Propylthiouracil.
III. Cimithidine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Antithyroid agents
 Methimazole (northyx, tapazole)
 Propylthiouracil (propylthyracil, ptu)
 Potassium iodide (sski, thyrosafe, thyroshield, iosat)
 Sodium iodide 131i (iodotope, hicon)
53. Which out of the following drug falls in class antithyroid agents for hyperthyroidism ?
I. Sucralfate.
II. Potassium iodide.
III. Sodium iodide 131I.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Antithyroid agents
 Methimazole (northyx, tapazole)
 Propylthiouracil (propylthyracil, ptu)
 Potassium iodide (sski, thyrosafe, thyroshield, iosat)
 Sodium iodide 131i (iodotope, hicon)
54. What is the brand name of methimazole used for the treatment of hyperthyroidism ?
I. Northyx.
II. ThyroSafe.
III. Tapazole.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Methimazole (northyx, tapazole)

55. What is the brand name of potassium iodide used for the treatment of hyperthyroidism
?
I .ThyroSafe.
II. ThyroShield.
III. Tapazole.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Potassium iodide (SSKI, thyrosafe, thyroshield, iosat)
56. What is the brand name of sodium iodide used for the treatment of hyperthyroidism ?
I. Northyx
II. Iodotope
III. Hicon
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Sodium iodide 131I (Iodotope, Hicon)

57. Why methimazole should avoided in early pregnancy ?
I. Because of increased risk of deformation in chromosomes.
II. Because of increased risk of mutation in genes.
III. Because of increased placental transfer and risk of a rare fetal condition (cutis aplasia).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Methimazole is avoided in early pregnancy because of increased placental transfer and risk of a rare
fetal condition (cutis aplasia).
58. What is the mechanism of action of methimazole used for the treatment of
hyperthyroidism ?
I. It increase the secretion of thyroid hormone.
II. It inhibits thyroid hormone by blocking oxidation of iodine in the thyroid gland.
III. It increase the secretion of pituitary hormone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Methimazole inhibits thyroid hormone by blocking oxidation of iodine in the thyroid gland. It is
readily absorbed and has a serum half-life of 6-8 hours
59. What is the serum half life of methimazole ?
I. 6-8 seconds.
II. 6-8 minutes.
III. 6-8 hours.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
It is readily absorbed and has a serum half-life of 6-8 hours
I. Methimazole is less protein-bound than propylthiouracil.
II. Propylthiouracil is less protein-bound than methimazole.
III. Methimazole's duration of action is longer than its half-life.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Methimazole is less protein-bound than propylthiouracil is.Methimazole's duration of action is longer

than its half-life
61. What is the mechanism of action of propylthiouracil used for the treatment of
hyperthyroidism ?
I. It increase the secretion of thyroid harmone.
II. It blocks oxidation of iodine in the thyroid gland, thereby inhibiting thyroid hormone synthesis.
III. The drug inhibits T4 -to-T3 conversion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
It blocks oxidation of iodine in the thyroid gland, thereby inhibiting thyroid hormone synthesis; the
drug inhibits T4 -to-T3 conversion
62. What is the serum half life of propylthiouracil ?

I. 1-2 hours.
II. 6-8 hours.
III. 10-12 hours.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Propylthiouracil has a serum half-life of 1-2 hours.

63. Which out of the following drug falls in class nonselective beta blockers for the treatment
I. Northyx.
II. Propranolol.
III. ThyroSafe.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Beta blockers, nonselective

 Propranolol (inderal, inderal la, innopran xl)
64. Which out of the following drug falls in class selective beta blockers for the treatment of
hyperthyroidism ?
I. Northyx.
II. Atenolol.
III. Propranolol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Beta blockers, beta1-selective

 Atenolol (tenormin)
65. What is the brand name of atenolol used for the treatment of hyperthyroidism ?
I. Inderal.
II. ThyroSafe.
III. Tenormin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Atenolol (Tenormin)
66. What is the brand name of propranolol used for the treatment of hyperthyroidism ?
I. Inderal.
II. ThyroSafe.
III. Tenormin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Propranolol (Inderal, Inderal LA, innopran XL)
67. What is the brand name of propranolol used for the treatment of hyperthyroidism ?
I. Inderal LA
II. ThyroSafe.
III. InnoPran XL.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Propranolol (Inderal, Inderal LA, innopran XL)
68. What is the brand name of propylthiouracil used for the treatment of hyperthyroidism
?
I. PropylThyracil.
II. PTU.
III. InnoPran XL.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Propylthiouracil (propylthyracil, PTU)
69. Which out of the following statement is/are correct for atenolol ?
I. It controls cardiac and psychomotor manifestations within minutes.
II. It selectively blocks beta1 receptors, with little or no effect on beta2 types.
III. It is a longer-acting drug that can be more useful than propranolol for intraoperative and
postoperative control.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Atenolol selectively blocks beta1 receptors, with little or no effect on beta2 types. It is a longer-acting
drug that can be more useful than propranolol for intraoperative and postoperative control.
70. Which out of the following statement is/are correct for propranolol ?
I. It is the drug of choice for treating cardiac arrhythmias resulting from hyperthyroidism.
II. It controls cardiac and psychomotor manifestations within minutes.
III. It selectively blocks beta1 receptors, with little or no effect on beta2 types.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Propranolol is the drug of choice for treating cardiac arrhythmias resulting from hyperthyroidism. It
controls cardiac and psychomotor manifestations within minutes.
71. What should avoided in hyperthyroid patient ?

I. Health food supplements contain excess amounts of iodide.
II. Expectorants.
III. Milk products.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Some expectorants, radiographic contrast dyes, seaweed tablets, and health food supplements contain
excess amounts of iodide and should be avoided because the iodide interferes with or complicates the
management of antithyroid and radioactive iodine therapies.
72. Why antithyroid medications must be reducedafter 4-6 weeks ?
I. The patient becomes hypothyroid.
II. The patient becomes parathyroid.
III. The patient becomes faint.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
After 4-6 weeks, antithyroid medications usually must be reduced; otherwise, the patient becomes
hypothyroid.
73. When will the ablation of the gland occur in hyperthyroid patient ?
I. 2-5 weeks after radioactive iodine therapy.
II. 2-5 months after radioactive iodine therapy.
III. 2-5 years after radioactive iodine therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Ablation of the gland occurs over 2-5 months after radioactive iodine therapy.
74. Which out of the following statement is/are correct for nonselective beta blockers?
II. It reduce many of the symptoms of thyrotoxicosis, including tachycardia, tremor, and anxiety.
III. It selectively blocks beta1 receptors, with little or no effect on beta2 types.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Nonselective beta blockers reduce many of the symptoms of thyrotoxicosis, including tachycardia,
tremor, and anxiety.
75. Which out of the following is approved by the FDA for treatment of hyperthyroidism
in adults ?
I. Radioactive iodine.
II. Atenolol.
III. Propranolol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Radioactive iodine is approved by the FDA for treatment of hyperthyroidism in adults

I. Potassium iodide and iodine
II. Lactulose and Methanol.
III. Potassium chloride and iodine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Potassium iodide and iodine (Lugol's solution)
77. Which out of the following statement is/are correct for Lugol's solution?
I. Lugol's solution is primarily administered for 10 days before thyroidectomy.
II. It is usually recommended that iodine not be started until after antithyroid drug therapy has
been initiated.
III. T4 and T3 concentrations can be increased for several weeks.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Lugol's solution is primarily administered for 10 days before thyroidectomy or T4 and T3

concentrations can be reduced for several weeks.it is usually recommended that iodine not be started
until after antithyroid drug therapy has been initiated.
78. Which out of the following statement is/are correct for potassium iodide ?
II. It inhibits thyroid hormone secretion.
III. It is primarily used for the treatment of thyroid storm or given preoperatively, 10-14 days
before surgical procedures.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Potassium iodide inhibits thyroid hormone secretion. Iodide therapy is primarily used for the
treatment of thyroid storm or given preoperatively, 10-14 days before surgical procedures (including
thyroidectomy).
I. It is a derivative of thiourea that inhibits organification of iodine by the thyroid gland.
II. It remains the drug of choice in uncommon situations of life-threatening severe thyrotoxicosis.
III. It is primarily used for the treatment of thyroid storm or given preoperatively, 10-14 days
before surgical procedures.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Propylthiouracil is a derivative of thiourea that inhibits organification of iodine by the thyroid gland.
thyrotoxicosis.
I. It is available as a 50-mg tablet. It is readily absorbed and has a serum half-life of 1-2 hours.
II. It is highly protein-bound in the serum.
III. It is given preoperatively, 10-14 days before surgical procedures.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Propylthiouracil is available as a 50-mg tablet. It is readily absorbed and has a serum half-life of 1-
2 hours. It is highly protein-bound in the serum.
I. The drug's duration of action is longer than its half-life.
II. It should be dosed every 6-8 months.
III. It should be dosed every 6-8 hours.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The drug's duration of action is longer than its half-life, and propylthiouracil generally should be
dosed every 6-8 hours (though it can also be administered twice daily).
82. What is mean by FTI ?
I. Free thyroid index.
II. Free thyroxine index.
III. Free thyroxine index.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Free thyroxine index [FTI]
83. Which patient do not use methimazole for the treatment of hyperthyroidism ?
I. Women in the first trimester of pregnancy.
II. Patients in thyroid storm.
III. Women without pregnancy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The exceptions are women in the first trimester of pregnancy, patients in thyroid storm, and patients
with methimazole allergy or intolerance.
84. Which patient do not use methimazole for the treatment of hyperthyroidism ?
I. Women without pregnancy.
II. Patients with methimazole allergy.
III. Patients with methimazole intolerance.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The exceptions are women in the first trimester of pregnancy, patients in thyroid storm, and patients
with methimazole allergy or intolerance.
85. How methimazole administered in patient who cannot take oral medications ?
I. Rectal suppositories.
II. Retention enemas.
III. Intravenous.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Studies have shown that rectal suppositories or retention enemas can be used at the same dose as orally
administered methimazole for patients who cannot take oral medications.
86. What are the stenght available for methimazole tablets ?
I. 5-mg.
II. 10-mg.
III. 50-mg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The drug is available as 5-mg or 10-mg tablets
87. Why care should require after thyroid surgery in patient ?

I. After surgery patient require routine follow-up because hypothyroidism may develop at some
time in the future.
II. After surgery patient does not require any care and routine follow up.
III. After surgery patient require routine follow-up because recurrent hyperthyroidism, may
develop at some time in the future.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Care after thyroid surgery

Patients whose thyroid functions normalize after surgery require routine follow-up because
hypothyroidism (from the chronic thyroiditis), recurrent hyperthyroidism, or thyroid eye disease may
develop at some time in the future.
88. What symptoms of hypothyroidism may develop after initiation of antithyroid
medication ?
I. Fatigue.
II. Weight gain.
III. Diarrhea.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Hypothyroidism causes the usual symptoms of fatigue and weight gain, and in patients with Graves
disease, it has been anecdotally associated with worsening of thyroid ophthalmopathy
89. What are the different treatment of hyperthyroidism ?

I. Antithyroid pharmacotherapy.
II. Radioactive iodine-131 (131 I) therapy.
III. Tubectomy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Treatment of hyperthyroidism includes symptom relief, as well as antithyroid pharmacotherapy,

radioactive iodine-131 (131 I) therapy (the preferred treatment of hyperthyroidism among US thyroid
specialists), or thyroidectomy.
90. What are the different treatment of hyperthyroidism ?
I. Tubectomy.
II. Radioactive iodine-131 (131 I) therapy.
III. Thyroidectomy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Treatment of hyperthyroidism includes symptom relief, as well as antithyroid pharmacotherapy,

radioactive iodine-131 (131 I) therapy (the preferred treatment of hyperthyroidism among US thyroid
specialists), or thyroidectomy.
91. Which out of the following developed guidelines for the management of
hyperthyroidism and other causes of thyrotoxicosis ?
I. The American Thyroid Association.
II. The American Association of Clinical Endocrinologists.
III. The German Association of Clinical Endocrinologists.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Guidelines for the management of hyperthyroidism and other causes of thyrotoxicosis have been
developed by the American Thyroid Association and the American Association of Clinical
Endocrinologists
92. What symptoms of severe ophthalmopathy observed in patients with graves disease ?
I. Diplopia.
II. Visual-field deficits.
III. Change in colour of eye .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Although 50% of patients with Graves disease have mild signs and symptoms of thyroid eye disease,
only 5% develop severe ophthalmopathy (eg, diplopia, visual-field deficits, or blurred vision).
93. What symptoms of severe ophthalmopathy observed in patients with graves disease ?
I. Visual-field deficits.
II. Change in colour of eye.
III. Blurred vision.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Although 50% of patients with Graves disease have mild signs and symptoms of thyroid eye disease,
only 5% develop severe ophthalmopathy (eg, diplopia, visual-field deficits, or blurred vision).
94. Which out of the following is /are correct regarding infiltrative dermopathy ?
I. It usually developing over the face.
II. It is characterized by an accumulation of glycosaminoglycans and inflammatory cells in the
dermis.
III. The skin changes typically include a nonpitting erythematous edema of the anterior shins.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Infiltrative dermopathy, usually developing over the lower extremities, is characterized by an

accumulation of glycosaminoglycans and inflammatory cells in the dermis. The skin changes typically
include a nonpitting erythematous edema of the anterior shins.
95. Which medication are employed for long-term control of hyperthyroidism in children,
adolescents, and pregnant women ?
I. Antiemetic drugs.
II. Antithyroid drugs.
III. Anti TB drugs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
These medications are employed for long-term control of hyperthyroidism in children, adolescents, and
pregnant women.
96. Which out of the following measures recommends by the FDA for patients receiving
propylthiouracil ?
I. For suspected lung injury, promptly continue propylthiouracil.
II. Closely monitor patients for signs and symptoms of liver injury, especially during the first 6
months after initiation of therapy.
III. For suspected liver injury, promptly discontinue propylthiouracil.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The FDA recommends the following measures for patients receiving propylthiouracil (for more
information,
 Closely monitor patients for signs and symptoms of liver injury, especially during the first 6
months after initiation of therapy
 For suspected liver injury, promptly discontinue propylthiouracil, evaluate the patient for
evidence of liver injury, and provide supportive care
97. Which out of the following measures recommends by the FDA for patients receiving
propylthiouracil ?
I. For suspected lung injury, promptly continue propylthiouracil.
II. Counsel patients to contact their health care provider for fatigue, weakness, vague abdominal
pain.
III. Counsel patients to contact their health care provider for loss of appetite, itching, easy bruising.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The FDA recommends the following measures for patients receiving propylthiouracil (for more
information,
 Counsel patients to contact their health care provider promptly for the following signs or
symptoms: fatigue, weakness, vague abdominal pain, loss of appetite, itching, easy bruising,
or yellowing of the eyes or skin
98. Which element administration in the weeks following radioactive iodine therapy may
extend the retention of radioactive iodine and increase its efficacy ?
I. Sodium.
II. Lithium.
III. Calcium.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Administration of lithium in the weeks following radioactive iodine therapy may extend the retention
of radioactive iodine and increase its efficacy.
99. Which of the following treatment is contraindicated to pregnant women for

hyperthyroidism ?
I. Antithyroid drug.
II. Radioactive iodine.
III. Propylthiouracil.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Radioactive iodine should never be administered to pregnant women, because it can cross the placenta
and abl
100. Why radioactive iodine should never be administered to pregnant women ?
I.
II. It causes death of pregnant women.
III. It causes death of fetus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Radioactive iodine should never be administered to pregnant women, because it can cross the placenta
resulting in hypothyroidism.
Asthma
1. What is in the composition of airways of lungs?

I. Cartilaginous bronchi.
II. Cartilaginous thrombus.
III. Membranous bronchi.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The airways of the lungs consist of the cartilaginous bronchi, membranous bronchi, and gas-
exchanging bronchi termed the respiratory bronchioles and alveolar ducts
2. What is in the composition of airways of lungs?

I. Gas-exchanging thrombus.
II. Gas-exchanging bronchi.
III. Gas-exchanging tubes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The airways of the lungs consist of the cartilaginous bronchi, membranous bronchi, and gas-
exchanging bronchi termed the respiratory bronchioles and alveolar ducts
3. What is the function of mucosa?
I. Lubrication.
II. Mucous production.
III. Transport apparatus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Mucosa, which is composed of epithelial cells that are capable of specialized mucous production and
a transport apparatus
4. What is the function of mast cells?

I. Control of releasing adrenaline.
II. Control of releasing antihistamine.
III. Control of releasing histamine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Cellular elements include mast cells, which are involved in the complex control of releasing histamine
and other mediators. Basophils, eosinophils, neutrophils, and macrophages also are responsible for
extensive mediator release in the early and late stages of bronchial asthma
5. What is responsible for extensive mediator release in the early and late stages of bronchial
asthma?
I. Basicphils.
II. Basophils.
III. Eosinophils.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
6. Which is responsible for extensive mediator release in the early and late stages of bronchial
asthma?
I. Neutrophils.
II. Macrophages.
III. Microphages.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
7. What is the main component involved in the pathophysiology of asthma?
I. Thrombus hyperresponsiveness .
II. Bronchial hyperresponsiveness.
III. Thrombi hyporesponsiveness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The pathophysiology of asthma is complex and involves the following components:

 Airway inflammation
 Intermittent airflow obstruction
 Bronchial hyperresponsiveness
8. What are the main components of pathophysiology of asthma?

I. Airway inflammation.
II. Airway inflation.
III. Intermittent airflow obstruction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The pathophysiology of asthma is complex and involves the following components:

 Airway inflammation
 Intermittent airflow obstruction
 Bronchial hyperresponsiveness
9. Which immune cells are identified in airway inflammation?
I. Activated T leucocytes.
II. Activated T lymphocytes.
III. Activated B lymphocytes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Some of the principal cells identified in airway inflammation include mast cells, eosinophils, epithelial
cells, macrophages, and activated T lymphocytes.

I. Basophils.
II. Mast cells.
III. Eosinophils.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
I. Epithelial cells.
II. Endothelial cells.
III. Macrophages.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
12. What is the role of T Lymphocytes?

I. Regulation of airway obstruction.
II. Regulation of airway inflammation.
III. Release of numerous cytokines.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
T lymphocytes play an important role in the regulation of airway inflammation through the release
of numerous cytokines
13. Which out of the followings are adhesion molecules?
I. Entegrins.
II. Selectins.
III. Integrins.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Adhesion molecules (eg, selectins, integrins
14. What is an exaggerated response to numerous exogenous and endogenous stimuli?

I. Thrombi hyperreactivity.
II. Airway hyperresponsiveness.
III. Bronchial hyperreactivity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The presence of airway hyperresponsiveness or bronchial hyperreactivity in asthma is an exaggerated

response to numerous exogenous and endogenous stimuli
15. What is the result of increased bronchial hyperresponsiveonly in asthma?
I. Bronchiolspasm.
II. Bronchospasm.
III. Bronchispasm.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Increased bronchial hyperresponsiveness, which leads to bronchospasm and typical symptoms of

wheezing, shortness of breath, and coughing after exposure to allergens
16. Which are the typical symptoms observed in bronchospasm?

I. Sneezing.
II. Wheezing.
III. Shortness of breath.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

17. Which are the typical symptoms observed in bronchospasm?
I. Bleeding.
II. Coughing after exposure to allergens.
III. Vomiting.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

18. Which out of the following is true related to airway remodeling?

I. Hypoplasia of smooth muscle.
II. Hypertrophy and hyperplasia of smooth muscle.
III. Angiogenesis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Airway remodeling (hypertrophy and hyperplasia of smooth muscle, angiogenesis, and subepithelial
fibrosis) that occurs with chronic untreated disease
19. Which out of the following is true related to airway remodeling?
I. Subepithelial fibrosis.
II. Hypotrophy of smooth muscles.
III. Supraepithelial fibrosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Airway remodeling (hypertrophy and hyperplasia of smooth muscle, angiogenesis, and subepithelial
fibrosis) that occurs with chronic untreated disease
20. Which out of the following Lymphocytes imbalance is responsible for airway
Inflammation?
I. Thh Lymphocytes.
II. T Lymphocyyes.
III. Th lymphocytes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Airway inflammation in asthma may represent a loss of normal balance between two "opposing"
populations of Th lymphocytes.
21. What are the different types of T Lymphocytes?
I. Th'.
II. Th1 .
III. Th2.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Two types of Th lymphocytes have been characterized: Th1 and Th2.
22. Which is critical in cellular defence mechanisms in response to infection produced by

Th1 cells?
I. Interleukin (IL)-2.
II. IFN-α.
III. Interleukin -1.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Th1 cells produce interleukin (IL)-2 and IFN-α, which are critical in cellular defense mechanisms
in response to infection.
23. Which of the following cytokines mediate allergic inflammation?
I. IL-20.
II. IL-9.
III. IL-13.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Th2, in contrast, generates a family of cytokines (IL-4, IL-5, IL-6, IL-9, and IL-13) that can mediate
allergic inflammation.
24. Which of the following cytokines mediate allergic inflammation?

I. IL-2.
II. IL4.
III. IL5.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Th2, in contrast, generates a family of cytokines (IL-4, IL-5, IL-6, IL-9, and IL-13) that can mediate
allergic inflammation.
25. Which of the followings are the causes for Airflow obstruction?
I. Chronic bronchoconstriction.
II. Acute bronchoconstriction.
III. Airway edema.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Airflow obstruction can be caused by a variety of changes, including acute bronchoconstriction, airway
edema, chronic mucous plug formation, and airway remodeling
26. Which out of the followings are the causes for Airflow obstruction?
I. Smooth muscle hypertrophy.
II. Chronic mucous plug formation.
III. Airway remodeling.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
27. What is the outcome of proceeding bronchoconstricton and airway remodelling?
I. Airflow obstruction.
II. Airflow hyperresponsiveness.
III. Airflow infection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
28. What is true from the following related to airway obstruction?

I. increased resistance to airflow.
II. increased expiratory flow rates.
III. decreased expiratory flow rates.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Airway obstruction causes increased resistance to airflow and decreased expiratory flow rates. These
changes lead to a decreased ability to expel air and may result in hyperinflation
29. Respiratory failure leads to-
I. Respiratory acidosis.
II. Respiratory alkalosis.
III. Alkalosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Respiratory failure leads to respiratory acidosis

30. Which factors contribute to asthma or airway hyperreactivity ?
I. Environmental allergens.
II. Genetical.
III. Viral respiratory tract infections.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Factors that can contribute to asthma or airway hyperreactivity may include any of the following:
 Environmental allergens (eg, house dust mites; animal allergens, especially cat and dog;
cockroach allergens; and fungi)
 Viral respiratory tract infections
 Exercise, hyperventilation
 Gastroesophageal reflux disease
 Chronic sinusitis or rhinitis
 Aspirin or nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity, sulfite sensitivity
 Use of beta-adrenergic receptor blockers (including ophthalmic preparations)
 Obesity
 Environmental pollutants, tobacco smoke
 Occupational exposure
 Irritants (eg, household sprays, paint fumes)
 Various high- and low-molecular-weight compounds (eg, insects, plants, latex, gums,
diisocyanates, anhydrides, wood dust, and fluxes; associated with occupational asthma)
 Emotional factors or stress
 Perinatal factors (prematurity and increased maternal age; maternal smoking and prenatal
exposure to tobacco smoke; breastfeeding has not been definitely shown to be protective)
31. Which factors contribute to asthma or airway hyperreactivity?
I. Animal allergens.
II. House dust mites.
III. Viral infection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Environmental allergens (eg, house dust mites; animal allergens, especially cat and dog;
cockroach allergens; and fungi)
 Viral respiratory tract infections

I. Exercise.
II. Hypoventilation.
III. Hyperventilation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Exercise, hyperventilation
I. Chronic sinusitis.
II. Acute sinusitis.
III. Aspirin or nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Gastroesophageal reflux disease
 Chronic sinusitis or rhinitis
 Aspirin or nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity, sulfite sensitivity

I. Use of beta-adrenergic receptor blockers (including ophthalmic preparations).
II. Use of calcium channel blockers.
III. Obesity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Use of beta-adrenergic receptor blockers (including ophthalmic preparations)
 Obesity
I. Environmental pollutants.
II. Tobacco smoke.
III. Alcoholics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Environmental pollutants, tobacco smoke
 Occupational exposure

I. Irritants (eg, household sprays, paint fumes).
II. Various high- and low-molecular-weight compounds (eg, insects, plants).
III. Perfumes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Irritants (eg, household sprays, paint fumes)
 Various high- and low-molecular-weight compounds (eg, insects, plants, latex, gums,
diisocyanates, anhydrides, wood dust, and fluxes; associated with occupational asthma)
I. Emotional factors or stress.
II. Neuronal factors.
III. Perinatal factors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Emotional factors or stress
 Perinatal factors (prematurity and increased maternal age; maternal smoking and prenatal
exposure to tobacco smoke; breastfeeding has not been definitely shown to be protective)

I. Prematurity and increased maternal age.
II. Maternal alcoholism.
III. Prenatal exposure to tobacco smoke.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Perinatal factors (prematurity and increased maternal age; maternal smoking and prenatal exposure
to tobacco smoke; breastfeeding has not been definitely shown to be protective)
I. Gastroesophageal reflux disease.
II. Esophageal reflux disease.
III. Occupational exposure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Occupational exposure
Gastroesophageal reflux disease
40. Which different types of asthma are recognised?

I. Immunity related asthma.
II. Immune-related asthma .
III. Non-immune-related asthma.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
40 Two types of occupational asthma are recognized: immune-related and non-immune-related.

41. Which of the following is true for Immune-mediated asthma?
I. Has no latency period.
II. It has a latency of months to years after exposure.
III. May occur within 24 hours after an accidental exposure of respiratory irritants.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
41. Immune-mediated asthma has a latency of months to years after exposure.
42. Which of the following is true for Non-immune-mediated asthma, or irritant-induced

asthma?
I. Has no latency period.
II. It has a latency of months to years after exposure.
III. May occur within 24 hours after an accidental exposure of respiratory irritants.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
42. Non-immune-mediated asthma, or irritant-induced asthma (reactive airway dysfunction

syndrome), has no latency period and may occur within 24 hours after an accidental exposure to high
concentrations of respiratory irritants
43. Which Factors that contribute to exercise-induced bronchospasm symptoms?
I. Exposure to cold or dry air .
II. Environmental pollutants (eg, sulfur, ozone).
III. Tobacco smoke.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Factors that contribute to exercise-induced bronchospasm symptoms (in both people with asthma and
athletes) include the following:
 Exposure to cold or dry air
 Environmental pollutants (eg, sulfur, ozone)

I. Level of bronchial hyperreactivity .
II. Level of bronchus hyperreactivity.
III. Chronicity of asthma and symptomatic control.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Level of bronchial hyperreactivity
 Chronicity of asthma and symptomatic control
I. Coexisting lung infection.
II. Allergen exposure in atopic individuals.
III. Coexisting respiratory infection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Duration and intensity of exercise
 Allergen exposure in atopic individuals
 Coexisting respiratory infection
46. Which key points related regarding asthma should be taught to asthmatic patient?
I. Patient education should be integrated into every aspect of asthma care.
II. All members of the healthcare teamshould provide education. .
III. Head of the member of the healthcare team should provide education.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The key points of education include the following:

 Patient education should be integrated into every aspect of asthma care
 All members of the healthcare team, including nurses, pharmacists, and respiratory therapists,
should provide education.
I. Clinicians should teach patients asthma self-management based on basic asthma facts.
II. Management of asthma discussed to patient.
III. Treatment goals should be developed for the patient and family.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Clinicians should teach patients asthma self-management based on basic asthma facts, self-
monitoring techniques, the role of medications, inhaler use, and environmental control
measures. [39, 40, 41]
 Treatment goals should be developed for the patient and family.
I. orally presented the self management plans.
II. A written, individualized, daily self-management plan should be developed.
III. Several well-validated asthma action plans are now available.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 A written, individualized, daily self-management plan should be developed.
 Several well-validated asthma action plans are now available and are key in the management
of asthma and should therefore be reviewed: ACT (Asthma Control Test), ATAQ (Asthma
Therapy Assessment Questionnaire), and ACQ (Asthma Control Questionnaire).
49. Which is most common symptom of asthma?

I. Cough.
II. Wheezing.
III. Pain.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Wheezing, a musical, high-pitched, whistling sound produced by airflow turbulence, is one of the
most common symptoms.
50. What is addressed by detailed assessment of the medical history?
I. Whether symptoms are attributable to respiratory tract.
II. Whether findings support the likelihood of asthma (eg, family history).
III. Whether symptoms are attributable to asthma.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
A detailed assessment of the medical history should address the following:

 Whether symptoms are attributable to asthma
 Whether findings support the likelihood of asthma (eg, family history)
51.What is addressed by detailed assessment of the medical history ?

I. Respiratory infection severity.
II. Asthma severity.
III. Identification of possible precipitating factors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Detailed assessment of the medical history should address the following:

 Asthma severity
 Identification of possible precipitating factors
52. Why wheezing is not necessary tool for the diagnosis of asthma?
I. Asthma can occur without wheezing.
II. Obstruction involves predominantly the small airways.
III. Asthma occurs with wheezing.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Asthma can occur without wheezing when obstruction involves predominantly the small airways.
Thus, wheezing is not necessary for the diagnosis of asthma.
53. What are causes of airway obstruction?

I. Respiratory failure.
II. Heart failure.
III. Cystic fibrosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Furthermore, wheezing can be associated with other causes of airway obstruction, such as cystic fibrosis
and heart failure.
54. What is heard best over the laryngeal area in the neck in patient with vocal cord
dysfunction?
I. Inspiratory Polyphonic wheeze.
II. Inspiratory monophonic wheeze.
III. Inspiratory Biphonic wheeze.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Patients with vocal cord dysfunction have a predominantly inspiratory monophonic wheeze (different
from the polyphonic wheeze in asthma), which is heard best over the laryngeal area in the neck.
55. Which type of patients has a monophonic wheeze?

I. Patients with bronchomalacia.
II. Patients with tracheomalacia.
III. Patients with trachieolmalacia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Patients with bronchomalacia and tracheomalacia also have a monophonic wheeze

56. Which may be the only symptom of asthma in cases of exercise-induced or nocturnal
asthma?
I. Mucous production.
II. Cough.
III. Wheezing.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Cough may be the only symptom of asthma, especially in cases of exercise-induced or nocturnal asthma
57. Which are typical symptoms observed in exercise induced bronchospasm?

I. Cough.
II. Wheezing.
III. Sneezing.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Exercise-induced bronchospasm
Typical symptoms include cough, wheezing, shortness of breath, and chest pain or tightness
I. Pain in neck.
II. Shortness of breath.
III. Shortness of rhythm.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

I. Chest pain.
II. Tightness.
III. Back pain.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
60. What is observed in mild episode of asthma?
I. Respiratory rate is increased.
II. Accessory muscles of respiration are used.
III. Accessory muscles of respiration are not used.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In a mild episode, the respiratory rate is increased, and accessory muscles of respiration are not used.
The heart rate is less than 100 bpm, and pulsus paradoxus (an exaggerated fall in systolic blood
pressure during inspiration) is not present
61. What is observed in mild episode of asthma?

I. Heart rate is more than 100 bpm.
II. Heart rate is less than 100 bpm.
III. Pulsus paradoxus is not present.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
In a mild episode, the respiratory rate is increased, and accessory muscles of respiration are not used.
The heart rate is less than 100 bpm, and pulsus paradoxus (an exaggerated fall in systolic blood
pressure during inspiration) is not present
62. What is observed in moderately severe episode of asthma?
I. Heart rate is 100-120 bpm.
II. Pulsus paradoxus may be present (10-20 mm Hg).
III. Heart rate is less than 100 bpm.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In a moderately severe episode; The heart rate is 100-120 bpm. Loud expiratory wheezing can be
heard, and pulsus paradoxus may be present (10-20 mm Hg)
63. What is observed in severe episode of asthma?

I. Respiratory rate is often greater than 30 per minute.
II. Accessory muscles of respiration are not used.
III. Accessory muscles of respiration are usually used.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In a severe episode; In a severe episode, the respiratory rate is often greater than 30 per minute.
Accessory muscles of respiration are usually used, and suprasternal retractions are commonly present.
The heart rate is more than 120 bpm. Loud biphasic (expiratory and inspiratory) wheezing can be
heard, and pulsus paradoxus is often present (20-40 mm Hg)
64. What is observed in severe episode of asthma?
I. Heart rate is more than 120 bpm.
II. Pulsus paradoxus is often present (20-40 mm Hg).
III. Heart rate is less than 120 bpm.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In a severe episode; In a severe episode, the respiratory rate is often greater than 30 per minute.
Accessory muscles of respiration are usually used, and suprasternal retractions are commonly present.
The heart rate is more than 120 bpm. Loud biphasic (expiratory and inspiratory) wheezing can be
heard, and pulsus paradoxus is often present (20-40 mm Hg)
65. Skin examination may reveal-

I. Atopic dermis.
II. Atopic dermatitis.
III. Eczema.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Skin examination may reveal atopic dermatitis, eczema, or other manifestations of allergic skin
conditions
66. Skin examination may reveal-
I. Allergic skin conditions.
II. External allergic reaction.
III. Internal allergic reaction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Skin examination may reveal atopic dermatitis, eczema, or other manifestations of allergic skin
conditions
67. At which time occurrence of bronchoconstriction is highest in human?

I. Between the hours of 4:00 am and 6:00 am.
II. Between the hours of 4:00 pm and 6:00 am.
III. Between the hours of 4:00 pm and 6:00 pm.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Bronchoconstriction is highest between the hours of 4:00 am and 6:00 am (the highest morbidity and
mortality from asthma is observed during this time). These patients may have a more significant
decrease in cortisol levels or increased vagal tone at night
68. Which symptoms are observed in patients with bronchoconstricton?
I. Decreased vagal tone at nig.
II. Significant decrease in cortisol levels.
III. Increased vagal tone at night.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
These patients may have a more significant decrease in cortisol levels or increased vagal tone at night
69. How is severity of asthma classified?

I. Intermittent.
II. Persistent.
III. Mild persistent.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The severity of asthma is classified as the following:

 Intermittent,
 Mild persistent
 Moderate persistent
 Severe persisten
70. How is severity of asthma classified?
I. Moderate persistent.
II. Severe persistent.
III. Severely persistent.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The severity of asthma is classified as the following:

 Intermittent,
 Mild persistent
 Moderate persistent
 Severe persisten
71. Which are the characteristics of Intermittent asthma?

I. Difficulty breathing more than twice a week .
II. Difficulty breathing less than twice a week .
III. Flare-ups are brief, but intensity may vary .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Intermittent asthma is characterized as follows:

 Symptoms of cough, wheezing, chest tightness, or difficulty breathing less than twice a week
 Flare-ups are brief, but intensity may vary
I. Nighttime symptoms less than twice a month.
II. Nighttime symptoms more than twice a month.
III. No symptoms between flare-ups .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Nighttime symptoms less than twice a month
 No symptoms between flare-ups

I. Lung function test FEV 1 is 80% or more above normal values.
II. Lung function test FEV 1 is 80% .
III. Peak flow has less than 20% variability am-to-am or am-to-pm, day-to-day.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Lung function test FEV 1 is 80% or more above normal values
 Peak flow has less than 20% variability am-to-am or am-to-pm, day-to-day.
74. Which are the characteristics of Mild persistent asthma?
I. Difficulty breathing 3-6 times a week.
II. Symptoms of cough, wheezing, chest tightness.
III. Difficulty breathing 8-10 times a week.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Mild persistent
Mild persistent asthma is characterized as follows:
 Symptoms of cough, wheezing, chest tightness, or difficulty breathing 3-6 times a week
 Flare-ups may affect activity level

I. Flare-ups are brief, but intensity may vary.
II. Flare-ups may affect activity level .
III. Nighttime symptoms 3-4 times a month .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Nighttime symptoms 3-4 times a month
 Lung function test FEV 1 is 80% or more above normal values
I. Lung function test FEV 1 is 80% or more above normal values.
II. Peak flow has less than 20-30% variability.
III. Peak flow has more than 20-30% variability.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

Peak flow has less than 20-30% variability
77. Which are the characteristics of Moderate persistent asthma?

I. Symptoms of cough, wheezing, chest tightness.
II. Difficulty breathing daily .
III. Difficulty breathing 3-6 times a week.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Moderate persistent asthma

Moderate persistent asthma is characterized as follows:
 Symptoms of cough, wheezing, chest tightness, or difficulty breathing daily
I. Flare-ups may affect activity level .
II. Nighttime symptoms 5 or more times a month.
III. Flare-ups are brief, but intensity may vary .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Flare-ups may affect activity level
 Nighttime symptoms 5 or more times a month

I. Lung function test FEV 1 is 80% or more above normal values .
II. Lung function test FEV 1 is above 60% but below 80% of normal values.
III. Peak flow has more than 30% variability .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Lung function test FEV 1 is above 60% but below 80% of normal values
 Peak flow has more than 30% variability
80. Which are the characteristics of severe persistent asthma?
I. Symptoms of cough, wheezing, chest tightness, or difficulty breathing continual.
II. Nighttime symptoms frequently.
III. Nighttime symptoms 5 or more times a month .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Severe persistent asthma

Severe persistent asthma is characterized as follows:
 Symptoms of cough, wheezing, chest tightness, or difficulty breathing continual
 Nighttime symptoms frequently
81. Which are the characteristics of severe persistent asthma?

I. Lung function test FEV 1 is 60% or less of normal values.
II. Peak flow has more than 30% variability.
III. Peak flow has less than 20-30% variability.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Severe persistent asthma is characterized as follows:

 Lung function test FEV 1 is 60% or less of normal values
 Peak flow has more than 30% variability
82. Which out of the following guide therapy in asthma?
I. Decline serum IgE levels.
II. Eosinophilia.
III. Elevated serum IgE levels.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Eosinophilia and elevated serum ige levels may help guide therapy in some cases.
83. Which are valuable for assessing severity of exacerbations and following response to
treatment?
I. Venous blood gases.
II. Arterial blood gases.
III. Pulse oximetry.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Arterial blood gases and pulse oximetry are valuable for assessing severity of exacerbations and
following response to treatment
84. What is revealed by Arterial blood gas measurement?
I. Hypocarbia secondary to hypoventilation.
II. Dangerous levels of hypoxemia.
III. Hypercarbia secondary to hypoventilation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Arterial blood gas (ABG) measurement provides important information in acute asthma. This test
may reveal dangerous levels of hypoxemia or hypercarbia secondary to hypoventilation; typically,
results are consistent with respiratory alkalosis
85. What is the initial imaging evaluation in most individuals with symptoms of asthma?
I. Chest X ray.
II. Chest radiograph .
III. Lung radiograph.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The chest radiograph remains the initial imaging evaluation in most individuals with symptoms of
asthma
86. Which complications are also detected by chest radiography in bronchial asthm a?
I. Detection of Arterial blood gas.
II. Excluding complications such as pneumonia and asthma mimics.
III. Detection of exacerbations.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Chest radiography usually is more useful in the initial diagnosis of bronchial asthma than in the
detection of exacerbations, although it is valuable in excluding complications such as pneumonia and
asthma mimics, even during exacerbations.
87. What is used for diagnosis of pneumonia and asthma mimics during exacerbations?
I. Chest radiography.
II. MRI.
III. X-Ray radiography.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Chest radiography usually is more useful in the initial diagnosis of bronchial asthma than in the
detection of exacerbations, although it is valuable in excluding complications such as pneumonia and
asthma mimics, even during exacerbations.
88. What is true from following in terms of pneumonia complications?
I. pneumonia is one of the most common complications of asthma.
II. Asthma is one of the most common complications of pneumonia.
III. Pneumonia is one of the most common complications of bronchospasm.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Because pneumonia is one of the most common complications of asthma
89. Which is second-line examinationin method for asthma?

I. High-resolution CT (HRCT).
II. High-resolve CT (HRCT) .
III. High-resolutionary CT (HRCT) .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
High-resolution CT (HRCT) is a second-line examination. It is useful in patients with chronic or

recurring symptoms and in those with possible complications such as allergic bronchopulmonary
aspergillosis and bronchiectasis.[
90. Which complications are examined by High-resolution CT (HRCT)?
I. Allergic bronchopulmonary aspergillosis.
II. Bronchiectasis.
III. Trachiectasis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
High-resolution CT (HRCT) is a second-line examination. It is useful in patients with chronic or

recurring symptoms and in those with possible complications such as allergic bronchopulmonary
aspergillosis and bronchiectasis.[
91. What is used primarily as a problem-solving modality in the workup of patients with
lung, mediastinal, or pleural lesionis?
I. MRI of the thorax .
II. MRI of the larynx.
III. MRI of the bronchi.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
MRI of the thorax is used primarily as a problem-solving modality in the workup of patients with
lung, mediastinal, or pleural lesions.
92. Which type of problem can be solved through MRI of thorax?
I. Patients with lung, mediastinum lesions.
II. Patients with lung, pleural lesions.
III. Patients with lung, mediastinal lesions.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
MRI of the thorax is used primarily as a problem-solving modality in the workup of patients with
lung, mediastinal, or pleural lesions.
93. Which method has been used in the study of aerosol and particulate distribution in the
airways?
I. Respiratory medicine technology.
II. Molecular medicine technology.
III. Nuclear medicine technology.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Nuclear medicine technology has been used in the study of aerosol and particulate distribution in the
airways.
94. Which testing helps determine airway hyperreactivity?
I. Bronchoprovocation testing.
II. Bronchoprovoced testing.
III. Trachoprod testing.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Bronchoprovocation testing helps determine if airway hyperreactivity is present, and a negative test
result usually excludes the diagnosis of asthma
95. What is true from following related to the administration of methacholine?

I. Up to a minimum dose of 16 mg/mL.
II. Up to a maximum dose of 16 mg/mL.
III. 20% decrease in FEV1, up to the 4 mg/mL level.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Methacholine is administered in incremental doses up to a maximum dose of 16 mg/ml, and a 20%

decrease in FEV1, up to the 4 mg/ml level, is considered a positive test result for the presence of
bronchial hyperresponsiveness
96. What is considered a positive test result for the presence of bronchial
hyperresponsiveness?
I. Salbutamolis administered in incremental doses.
II. Terbutaline is administered in incremental doses.
III. Methacholine is administered in incremental doses.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Methacholine is administered in incremental doses up to a maximum dose of 16 mg/ml, and a 20%

decrease in FEV1, up to the 4 mg/ml level, is considered a positive test result for the presence of
bronchial hyperresponsiveness
97. Which is the standard method for assessing patients with exercise-induced
bronchospasm?
I. Exercise spirometer.
II. Exercise spirometry .
III. Exercise challenging test.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Exercise spirometry is the standard method for assessing patients with exercise-induced bronchospasm
98. Which test are used to determine exercise induced asthma?
I. Stop running exercise.
II. Cycle ergometry.
III. A standard treadmill test.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Exercise testing may be accomplished in 3 different ways, using cycle ergometry, a standard treadmill
test, or free running exercise
99. Which method has been used to predict airway inflammation and asthma control?
I. Exhaled nitrous oxide analysis.
II. Exhaled nitric oxide analysis.
III. Inhaled nitric oxide analysis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Exhaled nitric oxide analysis has been shown to predict airway inflammation and asthma control
100. Which test are useful to exclude acute or chronic sinusitis as a contributing factor?
I. Sinus CT scanning.
II. Sinus MRI scanning.
III. sinusitis CT scanninh.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Sinus CT scanning may be useful to help exclude acute or chronic sinusitis as a contributing factor
1. Which out of the following is used for the pharmacologic management of Asthma?
I. Diuretics.
II. Corticosteroids.
III. Skeletal muscle relaxant.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
Pharmacologic management includes the use of control agents such as inhaled corticosteroids, inhaled
cromolyn or nedocromil, long-acting bronchodilators, theophylline, leukotriene modifiers, and more
recent strategies such as the use of anti-immunoglobulin E (ige) antibodies (omalizumab). Relief
medications include short-acting bronchodilators, systemic corticosteroids, and ipratropium
I. Statins.
II. Skeletal muscle relaxant.
III. Cromolyn or nedocromil.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer C
I. Long-acting bronchodilators.
II. Ipratropium.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
I. Theophylline.
II. Systemic corticosteroids.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
I. Skeletal muscle relaxant.
II. Short-acting bronchodilators.
III. Immunoglobulin E (IgE) antibodies (omalizumab).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
6. What should be the goal for successful management of asthma?

I. Achieve and maintain control of asthma symptoms.
II. Maintain normal activity levels, including exercise.
III. Treatment of infection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
The goals for successful management of asthma outlined in the 2008 US National Heart
 Achieve and maintain control of asthma symptoms
 Maintain normal activity levels, including exercise
I. Maintain pulmonary function as close to normal as possible.
II. Prevent asthma exacerbations.
III. Treatment of infection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
 Maintain pulmonary function as close to normal as possible
 Prevent asthma exacerbations

I. Avoid adverse effects from asthma medications.
II. Treatment of infection.
III. Prevent asthma mortality.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
 Avoid adverse effects from asthma medications
 Prevent asthma mortality
9. The pharmacologic treatment of asthma is based on-
I. Stepup therapy.
II. Stepwise therapy.
III. Stepdown therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
The pharmacologic treatment of asthma is based on stepwise therapy
10. What is true related to the use of medication in treatment of intermittent asthma (step
1)?
I. Reliever medication is a long-acting beta-agonist.
II. Reliever medication is a short-acting beta-antagonist.
III. Reliever medication is a short-acting beta-agonist.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer C
Step 1 - Intermittent asthma

A controller medication is not indicated. The reliever medication is a short-acting beta-agonist
(SABA) as needed for symptoms.
11. What is true related to the use of medication in treatment of Mild persistent asthma
(step 2)?
I. The preferred controller medication is a low-dose inhaled corticosteroid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer A
Step 2 - Mild persistent asthma

The preferred controller medication is a low-dose inhaled corticosteroid. Alternatives include sodium
cromolyn, nedocromil, or a leukotriene receptor antagonist (LTRA).
12. What is true related to the use of medication in treatment of Mild persistent asthma
(step 2)?
I. Reliever medication is a short-acting beta-agonist.
II. Alternatives medication includes sodium cromolyn and nedocromil.
III. Alternatives medication includes leukotriene receptor antagonist (LTRA).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
Step 2 - Mild persistent asthma

Alternatives include sodium cromolyn, nedocromil, or a leukotriene receptor antagonist (LTRA).
13. What is true related to the use of medication in treatment of Moderate persistent asthma
(step 3)?
II. The preferred controller medication is either a low-dose inhaled corticosteroid plus a long-
acting beta-agonist.
III. The preferred controller medication is either a low-dose inhaled corticosteroid plus a long-
acting beta-agntagonist.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Step 3 - Moderate persistent asthma

The preferred controller medication is either a low-dose inhaled corticosteroid plus a long-acting beta-
agonist (LABA) (combination medication preferred choice to improve compliance)[75] or an inhaled
medium-dose corticosteroid.
14. What is true related to the use of medication in treatment of Moderate persistent asthma
(step 3)?
I. Alternative medication includes an inhaled low-dose ICS plus a leukotriene receptor antagonist
theophylline.
II. Alternative medication includes an inhaled low-dose ICS plus a leukotriene receptor antagonist
zileuton.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
Step 3 - Moderate persistent asthma

Alternatives include an inhaled low-dose ICS plus either a leukotriene receptor antagonist,
theophylline, or zileuton (Zyflo).
15. What is true related to the use of medication in treatment of Moderate-to-severe
persistent asthma (step 4)?
II. The preferred controller medication is an inhaled medium-dose corticosteroid plus a leukotriene
receptor antagonist.
III. Reliever medication is a short-acting beta-antagonist.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
Step 4 - Moderate-to-severe persistent asthma

The preferred controller medication is an inhaled medium-dose corticosteroid plus a leukotriene
receptor antagonist (combination therapy). Alternatives include an inhaled medium-dose
corticosteroid plus either a leukotriene receptor antagonist, theophylline, or zileuton.
16. What is true related to the use of medication in treatment of Moderate-to-severe

persistent asthma (step 4)?
I. Alternative medication include an inhaled medium-dose corticosteroid plus a leukotriene
II. Reliever medication is a short-acting beta-agonist.
III. Alternatives medication include an inhaled medium-dose corticosteroid plus a theophylline.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
What is true related to the use of medication in treatment of Moderate-to-severe persistent asthma
(step 4)?
17. What is true related to the use of medication in treatment of severe persistent asthma
(step 5)?
III. The preferred controller medication is an inhaled high-dose corticosteroid plus a leukotriene
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer C
The preferred controller medication is an inhaled high-dose corticosteroid plus a leukotriene receptor
antagonist.
(step 5)?
I. Penicilline for patients who have allergies.
II. Omalizumab for patients who have allergies.
III. Pipracilline for patients who have allergies.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
Step 5 - Severe persistent asthma

Consider omalizumab for patients who have allergies.
(step 6)?
I. Preferred controller medication is a high-dose inhaled corticosteroid plus a leukotriene receptor
antagonist plus an oral corticosteroid.
II. Reliever medication is a short-acting beta-agonist.
III. Reliever medication is a short-acting alpha-agonist.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer A
Step 6 - Severe persistent asthma

The preferred controller medication is a high-dose inhaled corticosteroid plus a leukotriene receptor
antagonist plus an oral corticosteroid. Consider omalizumab for patients who have allergies
20. Which drug is used for the prophylaxis of exercise induced Asthma?
I. Terbutaline.
II. Liraglutide.
III. Albuterol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer C
Prophylaxis The most commonly used medications are short-acting beta agonists such as albuterol.
Sodium cromolyn and nedocromil used 30 minutes prior to exercise have also been effective
I. Nedocromil.
II. Orlistat.
III. Rimonabant.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer A
I. Diazepam.
II. Sodium cromolyn.
III. Lorazepam.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
23. What are the preventive measures to avoid dust mites Allergy?
I. Using impervious covers.
II. Putting clothing away in closets and drawers.
III. Poison baits and traps.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
Measures to avoid dust mites include using impervious covers (eg, on mattresses, pillows, comforters,
the most important intervention), washing other bedding in hot water (130°F [54.4°C] most
effective), removing rugs from the bedroom, limiting upholstered furniture, reducing the number of
window blinds, and putting clothing away in closets and drawers.
I. Reducing the number of window blinds.
II. Poison baits and traps.
III. Washing other bedding in hot water.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
window blinds, and putting clothing away in closets and drawers
I. limiting upholstered furniture.
II. Removing rugs from the bedroom.
III. Poison baits and traps.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
window blinds, and putting clothing away in closets and drawers
26. What are the preventive measures to avoid allergy associated cockroaches?
II. Poison baits and traps.
III. Keep food out of the bedroom.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
To control cockroaches, exterminate and use poison baits and traps, keep food out of the bedroom,
and never leave food out in the open
27. What are the preventive measures to avoid allergy associated molds?
I. Keeping areas dry.
II. Reducing the number of window blinds.
III. Removing old wallpaper.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
For indoor molds (size 1-

floors), removing old wallpaper, cleaning with bleach products, and storing firewood outdoors.
28. What are the preventive measures to avoid allergy associated molds?
II. Cleaning with bleach products.
III. Storing firewood outdoors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
For indoor molds (size 1- s keeping areas dry (eg, remove carpets from wet
floors), removing old wallpaper, cleaning with bleach products, and storing firewood outdoors.
29. What are the preventive measures to avoid allergy associated Pollen?
I. Closing windows and doors.
II. Using air conditioning and high-efficiency particulate air filters in the car and home.
III. Storing firewood outdoors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
Pollen (size 1- ssible, but efforts to reduce exposure include

closing windows and doors, using air conditioning and high-efficiency particulate air filters in the car
and home, staying inside during the midday and afternoon when pollen counts are highest, wearing
glasses or sunglasses, and wearing a face mask over the nose and mouth when mowing the lawn
I. Storing firewood outdoors.
II. Staying inside during the midday and afternoon.
III. Removing rugs from the bedroom.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
Pollen (size 1-
I. Wearing glasses or sunglasses.
II. Removing rugs from the bedroom.
III. Wearing a face mask over the nose and mouth when mowing the lawn.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
Pollen (size 1-
32. According to the National Asthma Education and Prevention Program Expert Panel
Report, What are the criteria for the use of immunotherapy in Asthmatic Patient?
I. Symptoms occur all year or during a major portion of the year.
II. Symptoms are difficult to control with Non-pharmacologic management.
III. Symptoms are difficult to control with pharmacologic management.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
The National Asthma Education and Prevention Program Expert Panel Report recommends that
immunotherapy be considered if the following criteria are fulfilled:
 Symptoms occur all year or during a major portion of the year.
 Symptoms are difficult to control with pharmacologic management because the medication is
ineffective, multiple medications are required, or the patient is not accepting of medication.
33. According to the National Asthma Education and Prevention Program Expert Panel
Report, What are the criteria for the use of immunotherapy in Asthmatic Patient?
I. Medication is ineffective.
II. Multiple medications are required.
III. Symptoms are difficult to control with Non-pharmacologic management.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
The National Asthma Education and Prevention Program Expert Panel Report recommends that
immunotherapy be considered if the following criteria are fulfilled:
 Symptoms occur all year or during a major portion of the year.
 Symptoms are difficult to control with pharmacologic management because the medication is
ineffective, multiple medications are required, or the patient is not accepting of medication.
34. What is being used for more than almost 100 years to treat allergic rhinitis?
I. Repeated injections of small doses of allergen.
II. Beta agonist.
III. Corticosteroids.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer A
Repeated injections of small doses of allergen have been used for more than almost 100 years to treat
allergic rhinitis
35. Dosing of allergen extracts is in-
I. Bioavailability allergy units (BAU).
II. Bioequivalent allergy units (BAU).
III. Weight per volume (w/v).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
Dosing of allergen extracts is in bioequivalent allergy units (BAU), weight per volume (w/v), or
protein nitrogen units (PNU), but "major allergen content" may be a more standardized and reliable
method of dosing and characterizing allergen extracts
36. Which is more standardized and reliable method of dosing and characterizing allergen
extracts?
I. Bioequivalent allergy units (BAU).
II. Major allergen content.
III. Weight per volume (w/v).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
Dosing of allergen extracts is in bioequivalent allergy units (BAU), weight per volume (w/v), or
protein nitrogen units (PNU), but "major allergen content" may be a more standardized and reliable
method of dosing and characterizing allergen extracts
37. Which drug
the treatment of moderate-to-severe persistent asthma?
I. Sibutramine.
II. Pregabaline.
III. Omalizumab.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer C
-
to-severe persistent asthma
38. What is true related to the use of Omalizumab for the treatment of asthma?
I. Patients should have IgE levels between 30 and 700 IU.
II. Patients should not weigh more than 150 kg.
III. Patients should weigh less than 150 kg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
Patients should have ige levels between 30 and 700 IU and should not weigh more than 150 kg
39. Which is a novel intervention for asthma delivers controlled thermal energy to the airway
wall during a series of bronchoscopy procedures?
I. Bronchial irridation.
II. Bronchial thermoplasty (BT).
III. Bronchial thermoirridation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
Bronchial thermoplasty (BT) is a novel intervention for asthma in which controlled thermal energy
is delivered to the airway wall during a series of bronchoscopy procedures
40. What is the mainstay of ED therapy for acute asthma?

I. Inhaled beta2 antagonist
II. Inhaled beta2 agonists.
III. Inhaled alpha agonist.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
The mainstay of ED therapy for acute asthma is inhaled beta2 agonists.

41. What is the most effective particle size of droplet expelled by inhaler device for asthma?
I. 0.1-0.5
II. 0.5-0.9
III. 1-
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer C
The most effective particle sizes are 1- hey are deposited
they move in the airways by Brownian motion and do not reach the lower airways
42. Why vice for asthma are ineffective?

I. They move in the airways by newtonian motion.
II. They move in the airways by Brownian motion.
III. They are deposited in the mouth and central airways.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer C
The most effective particle sizes are 1-
43. Why
I. They move in the airways by Brownian motion and do not reach the lower airways.
II. They are deposited in the mouth and central airways.
III. They move in the airways by newtonian motion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer A
The most effective particle sizes are 1- deposited
44. What is the dose of Albuterol for the treatment of asthma?

I. 2.5-5 mg every 10 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed.
II. 2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed.
III. 2.5-5 mg every 30 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
Albuterol is administered 2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as
needed; dilution of 2.5 mg in 3-4 ml of saline or use of premixed nebules is standard.
45. Oxygen or compressed air delivery of the inhaled beta agonists should be at a rate of -
I. 6-8 L/min.
II. 7-10 L/min.
III. 10-12 L/min.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer A
Oxygen or compressed air delivery of the inhaled beta agonists should be at a rate of 6-8 L/min.
46. What is the dose of Albuterol in children for the treatment of asthma?
I. 0.15 mg/kg every 5 minutes for 3 doses, then 0.15-0.3 mg/kg up to 10 mg every 1-4 hours.
II. 0.15 mg/kg every 10 minutes for 3 doses, then 0.15-0.3 mg/kg up to 10 mg every 1-4 hours.
III. 0.15 mg/kg every 20 minutes for 3 doses, then 0.15-0.3 mg/kg up to 10 mg every 1-4 hours.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer C
For children, use 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3
mg/kg up to 10 mg every 1-4 hours as needed
47. Which method is superior to the MDI/holding chamber method in a patient with severe
exacerbations?
I. Nebulization.
II. Inhalation.
III. Continuous nebulization.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer C
Continuous nebulization may be superior to the MDI/holding chamber method in a patient with
severe exacerbations (eg, PEF < 200 L/min). DAPRMCQ49 The dose of albuterol is 10-15 mg in
70 ml of isotonic saline. DAPRMCQ50 For children, this method is reserved for severe asthma at an
albuterol dose of 0.5 mg/kg/h
48. Which method is used during severe exacerbations of asthama?

I. Continuous nebulization.
II. Inhalation.
III. MDI/holding chamber.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
severe exacerbations (eg, PEF < 200 L/min).
49. What is the dose of Albuterol for Continuous nebulization in a patient with severe
exacerbations?
I. 1-1 mg in 70 mL of isotonic saline.
II. 5-10 mg in 70 mL of isotonic saline.
III. 10-15 mg in 70 mL of isotonic saline.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer C
severe exacerbations (eg, PEF < 200 L/min). DAPRMCQ49 The dose of albuterol is 10-15 mg in
70 ml of isotonic saline. DAPRMCQ50 For children, this method is reserved for severe asthma at an
albuterol dose of 0.5 mg/kg/h
50. What is the dose of Albuterol in children for Continuous nebulization in a patient with
severe exacerbations?
I. 0.5 mg/kg/h.
II. 0.8 mg/kg/h.
III. 1.2 mg/kg/h.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer A
severe exacerbations (eg, PEF < 200 L/min). The dose of albuterol is 10-15 mg in 70 ml of isotonic
saline. For children, this method is reserved for severe asthma at an albuterol dose of 0.5 mg/kg/h
51. What is Heliox?
I. Air mixture of helium-oxygen.
II. Air mixture of hydrogen-oxygen.
III. Air mixture of helium-otarium.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer A
Heliox is a helium-oxygen (80:20 or 70:30) mixture that may provide dramatic benefit for ED
patients with severe exacerbations
52. What is the concentration of helium-oxygen in Heliox?

I. 60:40 or 50:50.
II. 70:30 or 10:90.
III. 80:20 or 70:30.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer C
Heliox is a helium-oxygen (80:20 or 70:30) mixture that may provide dramatic benefit for ED
patients with severe exacerbations
53. Heliox-driven nebulizer treatments should have the gas set at a rate of-
I. 0.08-.01 L/min.
II. 0.8-0.1 L/min.
III. 8-10 L/min.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer C
Heliox-driven nebulizer treatments should have the gas set at a rate of 8-10 L/min and with double
the usual amount of albuterol
54. Which risk is associated with the use mechanical ventilation in patients with acute
asthma?
I. Hypertension.
II. High pressures lowering systemic blood pressure.
III. Pneumomediastinum.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
Mechanical ventilation of patients with acute asthma presents special challenges, such as the risk of
high pressures lowering systemic blood pressure (auto-PEEP) and, less commonly, complications such
as barotrauma, pneumothorax, or pneumomediastinum.
55. Which risk is associated with the use mechanical ventilation in patients with acute
asthma?
I. Barotrauma.
II. Hypertension.
III. Pneumothorax.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
Mechanical ventilation of patients with acute asthma presents special challenges, such as the risk of
high pressures lowering systemic blood pressure (auto-PEEP) and, less commonly, complications such
as barotrauma, pneumothorax, or pneumomediastinum
56. Which condition indicates hospitalization of asthmatic patient?

I. Presence of psychiatric illness.
II. Duration and severity of asthma symptoms.
III. Hypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
The decision whether to admit is based on the following:

 Duration and severity of asthma symptoms
 Presence of psychiatric illness
I. Severity of airflow obstruction.
II. Diabetes.
III. Adequacy of support and home conditions.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F

 Severity of airflow obstruction
 Adequacy of support and home conditions

I. Patient on furosemide.
II. Medication use and access to medications.
III. Course and severity of prior exacerbations.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E

 Medication use and access to medications
 Course and severity of prior exacerbations
59. Which condition indicates admission patient to the ICU for close observation and
monitoring of asthmatic patient?
I. Rapidly worsening asthma.
II. Confusion, drowsiness, signs of impeding respiratory arrest, or loss of consciousness.
III. Patient suffering from acromegaly.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
Admit the patient to the ICU for close observation and monitoring in certain situations, such as the
following:
 Rapidly worsening asthma or a lack of response to the initial therapy in the emergency
department
 Confusion, drowsiness, signs of impeding respiratory arrest, or loss of consciousness
60. Which condition indicates admission patient to the ICU for close observation and
monitoring of asthmatic patient?
I. Impending respiratory arrest.
II. Patient suffering from acromegaly.
III. Intubation is required because of the continued deterioration of the patient's condition despite.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
Admit the patient to the ICU for close observation and monitoring in certain situations, such as the
following:
 Impending respiratory arrest, as indicated by hypoxemia (PO 2< 60 mm Hg) despite
supplemental oxygen and/or hypercarbia with PCO 2 greater than 45 mm Hg
 Intubation is required because of the continued deterioration of the patient's condition despite
61. According to National Institute of Health, which drug are considered appropriate for
the treatment of asthma in pregnancy?
I. Adenosine.
II. Theophylline.
III. Prednisone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
The National Institute of Health stated that albuterol (Proventil HFA), cromolyn, beclomethasone
(QVAR), budesonide (Pulmicort Flexhaler or Respules), prednisone (Deltasone, Orasone), and
theophylline, when clinically indicated, are considered appropriate for the treatment of asthma in
pregnancy.
I. Albuterol.
II. Cromolyn.
III. Adenosine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
pregnancy.
I. Prednisone.
II. Timolol .
III. Budesonide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
pregnancy.
64. What is the effect of poorly controlled asthma in pregnant women?

I. Increased prematurity.
II. Maternal death.
III. Increased perinatal mortality.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
Poorly controlled asthma can result in low birth weight, increased prematurity, and increased
perinatal mortality
65. What is the effect of poorly controlled asthma in pregnant women?
I. Low birth weight.
II. Maternal death.
III. Foetus death.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer A
Poorly controlled asthma can result in low birth weight, increased prematurity, and increased
perinatal mortality
66. Asthma medications are generally divided into-

I. Very short acting.
II. Quick relief.
III. Long-term control.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
Asthma medications are generally divided into 2 categories:

 Quick relief (also called reliever medications)
 Long-term control (also called controller medications)
67. What is the usefulness of Quick relief medications?
I. Prevent chronic asthma exacerbations.
II. Prevent exercise-induced asthma.
III. Relieve acute asthma exacerbations.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
Quick relief medications are used to relieve acute asthma exacerbations and to prevent exercise-
induced asthma (EIA) or exercise-induced bronchospasm (EIB) symptoms.
68. Which drug can be classified as Quick relief medications?

I. Short-acting beta agonists.
II. Anticholinergics.
III. Inhaled corticosteroids.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
These medications include short-acting beta agonists (sabas), anticholinergics (used only for severe
exacerbations), and systemic corticosteroids, which speed recovery from acute exacerbations.
69. Which drug can be classified as Quick relief medications?
I. Inhaled corticosteroids.
II. Systemic corticosteroids.
III. Cromolyn sodium.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
These medications include short-acting beta agonists (sabas), anticholinergics (used only for severe
exacerbations), and systemic corticosteroids, which speed recovery from acute
70. Which drug can be classified as Long-term control medications?

I. Systemic corticosteroids.
III. Inhaled corticosteroids.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer C
Long-term control medications include inhaled corticosteroids (icss),[92, 93] cromolyn sodium,
nedocromil, long-acting beta agonists (labas), combination inhaled corticosteroids and long-acting
beta agonists, methylxanthines, and leukotriene antagonists.
I. Anticholinergics.
II. Cromolyn sodium.
III. Systemic corticosteroids.
A) I only
B) II only
C) III only
D) I and II
E) II and II
F) I and III
Answer B

I. Leukotriene antagonists.
III. Nedocromil.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
I. Systemic corticosteroids.
II. Long-acting beta agonists.
III. Methylxanthines.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
74. Which class of drug are considered the primary drug of choice for control of chronic
asthma?
I. Alpha agonist.
II. Inhaled corticosteroids.
III. Alpha antagonist.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
Inhaled corticosteroids are considered the primary drug of choice for control of chronic asthma, but
unfortunately the response to this treatment is characterized by wide variability among patients.
75. Which drug can be classified as Beta2 agonists?
I. Methoxamine.
II. Midodrine.
III. Albuterol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer C
Beta2 agonists (albuterol sulfate [Proventil HFA, Ventolin HFA, proair HFA; pirbuterol acetate
[Maxair Autohaler]; levalbuterol [Xopenex]) relieve reversible bronchospasm by relaxing the smooth
muscles of the bronchi
76. Which drug can be classified as Beta2 agonists?

I. Pirbuterol.
II. Methoxamine.
III. Levalbuterol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
Beta2 agonists (albuterol sulfate [Proventil HFA, Ventolin HFA, proair HFA; pirbuterol acetate
[Maxair Autohaler]; levalbuterol [Xopenex]) relieve reversible bronchospasm by relaxing the smooth
muscles of the bronchi
77. What is the pharmacological mechanism of Albuterol?
I. Alpha antagonist.
II. Beta2-agonist.
III. Alpha agonist.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
Albuterol sulphate; This beta2-agonist is the most commonly used bronchodilator that is available in
multiple forms (eg, solution for nebulization, metered-dose inhaler, oral solution). This is most
commonly used in rescue therapy for acute asthmatic symptoms and is used as needed. Prolonged use
may be associated with tachyphylaxis due to beta2-receptor down-regulation and receptor
hyposensitivity
78. Which is the most commonly used bronchodilator?

I. Terbutaline.
II. Methoxamine.
III. Albuterol sulphate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer C
hyposensitivity
79. Which drug is most commonly used in rescue therapy for acute asthmatic symptoms?
I. Albuterol sulphate.
II. Nifidipine.
III. Methoxamine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
hyposensitivity
80. Why prolong use of Albuterol sulphate is not recommended?

I. Prolong use is associated with tachyphylaxis.
II. Prolong use is associated with anatagonism.
III. Prolong use is associated with agonism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer A
hyposensitivity
81. What is the dose of Pirbuterol when delivered by Autohaler?
I. 2 mcg per actuation.
II. 20 mcg per actuation.
III. 200 mcg per actuation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer C
Pirbuterol; The Autohaler delivers 200 mcg per actuation.
82. What is the adverse effect of albuterol?

I. Tachycardia.
II. Hallucination.
III. Delusion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer A
A nonracemic form of albuterol, levalbuterol (R isomer), is effective in smaller doses and is reported
to have fewer adverse effects (eg, tachycardia, hyperglycemia, hypokalemia
83. What is the adverse effect of albuterol?
I. Hyperglycemia.
II. Hypokalemia.
III. Delusion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
A nonracemic form of albuterol, levalbuterol (R isomer), is effective in smaller doses and is reported
to have fewer adverse effects (eg, tachycardia, hyperglycemia, hypokalemia
84. Which drug can be classified as Anticholinergic Agents?

I. Tiotropium.
II. Valsaratan.
III. Ipratropium.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
Anticholinergic agents; tiotropium, ipratropium

85. What is the pharmacological mechanism of Tiotropium?
I. Inhibits M3-receptors at smooth muscle.
II. Inhibits M2-receptors at smooth muscle.
III. Inhibits M1-receptors at smooth muscle.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer A
Tiotropium is a long-acting antimuscarinic agent, often referred to as an anticholinergic. Inhibits

M3-receptors at smooth muscle, leading to bronchodilation
86. What is the onset of action of Ipratropium?

I. 10 minutes.
II. 15 minutes.
III. 25 minutes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
Ipratropium; It is a short-acting anticholinergic agent with an onset of 15 minutes.

87. Which steroids can be given orally for the treatment of asthma?
I. Ipratropium.
II. Prednisone.
III. Methylprednisolone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
Oral steroids (prednisone [Deltasone, Orasone]; prednisolone [Pediapred, Prelone, Orapred];

methylprednisolone [Solu-Medrol]) are used for short courses (3-10 d) to gain prompt control of
inadequately controlled acute asthmatic episodes
88. Which out of the following is correct drug combination used for the treatment of
asthma?
I. Prednisone and albuterol.
II. Ipratropium and albuterol.
III. Albuterol and prednisone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
Ipratropium and albuterol

89. Which out of the following is Long-acting beta2 agonists?
I. Salmeterol.
II. Formoterol.
III. Prednisone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
Labas are available in the United States: salmeterol (Serevent) and formoterol (Foradil).
90. Which is a recombinant, DNA-derived, humanized IgG monoclonal antibody that binds
selectively to human IgE on the surface of mast cells and basophils?
I. Formoterol.
II. Prednisone.
III. Omalizumab.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer C
Omalizumab is a recombinant, DNA-derived, humanized igg monoclonal antibody that binds

selectively to human ige on the surface of mast cells and basophils
91. Which drug can be classified as Mast cell stabilizers?
I. Prednisone.
II. Formoterol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer C
Mast cell stabilizers; Cromolyn sodium
92. Which drug can be classified as Monoclonal Antibody)?

I. Omalizumab.
II. Prednisone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer A
Monoclonal antibody; omalizumab

93. Which drug can be classified as Corticosteroid (Inhalant)?
I. Ciclesonide.
II. Omalizumab.
III. Beclomethasone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
Corticosteroid, Inhalant; Ciclesonide, Beclomethasone, Fluticasone inhaled, Budesonide inhaled,

Mometasone, Triamcinolone inhaled, Flunisolide inhaled

I. Fluticasone.
II. Budesonide.
III. Omalizumab.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D

I. Omalizumab.
II. Mometasone.
III. Triamcinolone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E

96. What is the pharmacological mechanism of Zafirlukast?

I. Short-acting beta2 agonists.
II. Selective competitive inhibitor of LTD4 and LTE4 receptors.
III. Long-acting beta2 agonists.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
Zafirlukast is a selective competitive inhibitor of LTD4 and LTE4 receptors.

97. Which drug can be classified as Leukotriene Receptor Antagonist?
I. Triamcinolone.
II. Montelukast.
III. Zafirlukast.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
Leukotriene receptor antagonist; zafirlukast, montelukast
98. What is the pharmacological mechanism of Zileuton?

I. Long-acting beta2 agonists.
II. Inhibits leukotriene formation.
III. short-acting beta2 agonists.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
Zileuton inhibits leukotriene formation, which, in turn, decreases neutrophil and eosinophil
migration, neutrophil and monocyte aggregation, leukocyte adhesion, capillary permeability, and
smooth muscle contractions.
99. What is the role of leukotrines in inflammation?
I. Neutrophil and eosinophil migration.
II. Neutrophil and monocyte de aggregation.
III. Neutrophil and monocyte aggregation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
Zileuton inhibits leukotriene formation, which, in turn, decreases neutrophil and eosinophil
migration, neutrophil and monocyte aggregation, leukocyte adhesion, capillary permeability, and
smooth muscle contractions.
100. Which drug can be classified as 5-Lipoxygenase Inhibitors?

I. Salbutamol.
II. Montelukast.
III. Zileuton.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer C
5-lipoxygenase inhibitors; zileuton

MUSCULOSKELETAL SYSTEM
Osteoarthritis
1. What is osteoarthritis?
I. It is a degenerative disorder.
II. Biochemical breakdown of articular (hyaline) cartilage.
III. It is the most common bone disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
It has been thought of as a degenerative disorder arising from biochemical breakdown of articular
(hyaline) cartilage in the synovial joints.
2. What is involved/affected in osteoarthritis?

I. Articular cartilage.
II. Subchondral bone.
III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
However, the current view holds that osteoarthritis involves not only the articular cartilage but also
the entire joint organ, including the subchondral bone and synovium
3. Which weight bearing joints are predominantly involved in Osteoarthritis?
I. Knees.
II. Lumbo-sacral spine.
III. Thoracic-lumber spine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Osteoarthritis predominantly involves the weight-bearing joints, including the knees, hips, cervical
and lumbosacral spine, and feet.
4. Which are the weight bearing joints at where the Osteoarthritis predominantly involves?
I. Feet.
II. Cervical.
III. Elbows.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
5. Which are the weight bearing joints at where the Osteoarthritis predominantly involves?
I. Cranio-sacral.
II. Hips.
III. Upper back.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
6. Which joints are commonly affected joints in osteoarthritis?

I. Distal intraphalangeal (DIP).
II. Distal interphalangeal (DIP).
III. Proximal interphalangeal (PIP).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Other commonly affected joints include the distal interphalangeal (DIP), proximal interphalangeal
(PIP), and carpometacarpal (CMC) joints
7. Which joints are commonly affected joints in osteoarthritis?
I. Proximal interphalangeal (PIP).
II. Carpometacarpo (CMC) joints.
III. Carpometacarpal (CMC) joints.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Other commonly affected joints include the distal interphalangeal (DIP), proximal interphalangeal
(PIP), and carpometacarpal (CMC) joints
8. Historically, osteoarthritis has been divided into-

I. Primary forms.
II. Secondary forms.
III. Preprimary forms.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Historically, osteoarthritis has been divided into primary and secondary forms, though this division is
somewhat artificial.
9. What is secondary osteoarthritis?
I. Disease of the synovial joints.
II. Post disposing condition that has adversely altered the joint tissues.
III. Predisposing condition that has adversely altered the joint tissues.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Secondary osteoarthritis is conceptually easier to understand: It refers to disease of the synovial joints
that results from some predisposing condition that has adversely altered the joint tissues (eg, trauma to
articular cartilage or subchondral bone).
10. What is primary osteoarthritis?

I. It is an idiopathic phenomenon.
II. Not related to ageing process.
III. Typically occurs in younger individuals.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The definition of primary osteoarthritis is more nebulous. Although this form of osteoarthritis is related
to the aging process and typically occurs in older individuals, it is, in the broadest sense of the term,
an idiopathic phenomenon, occurring in previously intact joints and having no apparent initiating
factor
11. What is primary osteoarthritis?
I. Typically occur in older individuals.
II. It is not related to the aging process .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
factor
12. What is true related to primary osteoarthritis?

I. Occurring in previously intact joints.
II. Have no apparent initiating factor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
factor
13. What are the goals of osteoarthritis treatment?
I. Pain alleviation.
II. Improvement of functional status.
III. Pain aggravation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The goals of osteoarthritis treatment include pain alleviation and improvement of functional status
14. What is the cornerstone of osteoarthritis therapy?

I. Nonpharmacologic interventions.
II. Joint replacement.
III. Osteotomy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Nonpharmacologic interventions are the cornerstones of osteoarthritis therapy and include the
following:
Patient education
Application of heat and cold
15. Which out of the following Nonpharmacologic interventions are used in the treatment
of osteoarthritis?
I. Diet.
II. Weight loss .
III. Exercise .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
following:
Weight loss
Exercise
of osteoarthritis?
I. Physical therapy .
II. Occupational therapy .
III. Adjunct therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
following:
Physical therapy
Occupational therapy
of osteoarthritis?
I. Joint unloading in joints (eg, feet).
II. Joint unloading in joints (eg, knee).
III. Joint unloading in joints (eg, hip).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
following:
Joint unloading, in certain joints (eg, knee and hip)
18. Which out of the following is Intra-articular pharmacologic therapy for osteoarthritis?
I. Corticosteroid injection .
II. Viscosupplementation.
III. Glucocorticoid therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Intra-articular pharmacologic therapy includes corticosteroid injection and viscosupplementation,

which may provide pain relief and have an anti-inflammatory effect on the affected joint. (See
Treatment.)
19. What is the role/mechanism of Intra-articular pharmacologic therapy in osteoarthritis?
I. Provide pain relief.
II. An anti-inflammatory effect on the affected joint.
III. An anti-inflammatory effect on the knee bones.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Intra-articular pharmacologic therapy includes corticosteroid injection and viscosupplementation,

which may provide pain relief and have an anti-inflammatory effect on the affected joint. (See
Treatment.)
20. Which drug is used to begin pharmacological therapy in osteoarthritis patient with mild
or moderate pain without apparent inflammation?
I. Acetaminophen.
II. Ibuprofen.
III. Diclofenac.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Oral pharmacologic therapy begins with acetaminophen for mild or moderate pain without apparent
inflammation.
21. Which existing condition indicates the use of arthroplasty to treat osteoarthritis?
I. Other modalities are effective.
II. Osteotomy is not viable.
III. Osteotomy is viable.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
If all other modalities are ineffective and osteotomy is not viable, or if a patient cannot perform his or
her daily activities despite maximal therapy, arthroplasty is indicated.
22. Which existing condition indicates the use of arthroplasty to treat osteoarthritis?
I. Other modalities are effective.
II. Other modalities are ineffective.
III. Patient cannot perform his or her daily activities.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
If all other modalities are ineffective and osteotomy is not viable, or if a patient cannot perform his or
her daily activities despite maximal therapy, arthroplasty is indicated.
23. What are the criteria for the classification of joints?

I. Tissue present.
II. Functional.
III. Structural.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Joints can be classified in either functional or structural terms.

24. According to functional classification, joints can be classified as-
I. Synarthroses (freely moveable).
II. Synarthroses (immovable) .
III. Diarthroses (freely moveable).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Functional classification, based on movement, would categorize joints as follows:

● Synarthroses (immovable)
● Amphiarthroses (slightly moveable)
● Diarthroses (freely moveable)
25. According to functional classification, joints can be classified as -

I. Diarthroses (slightly moveable)
II. Amphiarthroses (slightly moveable) .
III. Amphiarthroses ( moveable) .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
A functional classification, based on movement, would categorize joints as follows:

● Synarthroses (immovable)
● Amphiarthroses (slightly moveable)
● Diarthroses (freely moveable)
26. A structural classification would categorize joints as-
I. Synovial .
II. Fibrous .
III. Febricula.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
A structural classification would categorize joints as follows:

● Synovial
● Fibrous
● Cartilaginous
27. A structural classification would categorize joints as-

I. Cartia ious.
II. Cartilaginous .
III. Fibrous .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
A structural classification would categorize joints as follows:

● Synovial
● Fibrous
Cartilaginous
28. What is the composition of Normal synovial joint?
I. Articular cartilage .
II. Subchondral bone .
III. Chondral bone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Normal synovial joints allow a significant amount of motion along their extremely smooth articular
surface. These joints are composed of the following:
● Articular cartilage
● Subchondral bone
29. What is the composition of Normal synovial joint?

I. Synovial membrane.
II. Synovial fluid .
III. Synovial cavity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Normal synovial joints allow a significant amount of motion along their extremely smooth articular
surface. These joints are composed of the following:
Synovial membrane
Synovial fluid
30. What is the composition of the normal articular surface of synovial joints?
I. Autacoids like proteoglycans and collagen.
II. Micromolecule like proteoglycans and collagen.
III. Macromolecules like proteoglycans and collagen.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The normal articular surface of synovial joints consists of articular cartilage (composed of
chondrocytes) surrounded by an extracellular matrix that includes various macromolecules, most
importantly proteoglycans and collagen.
31. What is the composition of the normal articular surface of synovial joints?
I. Articular cartilage surrounded by an extracellular matrix.
II. Articular cartilage surrounded by an intracellular matrix.
III. Autacoids like proteoglycans and collagen.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The normal articular surface of synovial joints consists of articular cartilage (composed of
chondrocytes) surrounded by an extracellular matrix that includes various macromolecules, most
importantly proteoglycans and collagen.
32. How cartilage facilitates joint function and protects the underlying subchondral bone?
I. Reducing friction at the joint.
II. Maintaining high contact stresses.
III. Maintaining low contact stresses.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The cartilage facilitates joint function and protects the underlying subchondral bone by distributing
large loads, maintaining low contact stresses, and reducing friction at the joint
33. How cartilage facilitates joint function and protects the underlying subchondral bone?
I. Distributing large loads.
II. Distributing large loads unevenly.
III. Disturbing large loads.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
@32 The cartilage facilitates joint function and protects the underlying subchondral bone by
distributing large loads, maintaining low contact stresses, and reducing friction at the joint
34. What is the role of cartilage in joint?
I. Facilitates joint function.
II. Cartilage protects from inflammatory mediator.
III. Protects the underlying subchondral bone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The cartilage facilitates joint function and protects the underlying subchondral bone by distributing
large loads, maintaining low contact stresses, and reducing friction at the joint
35. How is Synovial fluid formed?

I. Through a serum ultrafiltration process.
II. Through Osmosis.
III. Through passive transport.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Synovial fluid is formed through a serum ultrafiltration process by cells that form the synovial
membrane (synoviocytes)..
36. What is manufactured by Synovial cells?
I. Hyaluronic acid.
II. Hyaluronate.
III. Glycosoglycan.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Synovial cells also manufacture hyaluronic acid (HA, also known as hyaluronate), a
glycosaminoglycan that is the major noncellular component of synovial fluid.
37. What is hyaluronic acid?

I. A glycosaminoglycan that is major cellular component of synovial fluid.
II. A glycosaminoglycan that is major noncellular component of synovial fluid.
III. A glucosamine that is major noncellular component of synovial cavity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Synovial cells also manufacture hyaluronic acid (HA, also known as hyaluronate), a
glycosaminoglycan that is the major noncellular component of synovial fluid.
38. What is the importance of Synovial fluid?
I. Supplies nutrients to the avascular articular cartilage
II. Provides the viscosity needed to absorb shock from slow movements.
III. Provides the viscosity needed to absorb shock from fast movements.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Synovial fluid supplies nutrients to the avascular articular cartilage; it also provides the viscosity
needed to absorb shock from slow movements, as well as the elasticity required to absorb shock from
rapid movements
39. What is responsible for inflammation in osteoarthritis?

I. Cytokines.
II. Metalloproteinases
III. Proteinases.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Increasing evidence has shown that inflammation occurs as cytokines and metalloproteinases are
released into the joint. @40 these agents are involved in the excessive matrix degradation that
characterizes cartilage degeneration in osteoarthritis
40. What is the role of inflammatory mediators (cytokines and metalloproteinases) in
osteoarthritis?
I. Excessive matrix degradation.
II. Characterizes cartilage degeneration in osteoarthritis
III. Characterizes cartilage regeneration in osteoarthritis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
@39 increasing evidence has shown that inflammation occurs as cytokines and metalloproteinases are
released into the joint. @40 these agents are involved in the excessive matrix degradation that
characterizes cartilage degeneration in osteoarthritis
41. What is responsible for swelling of the cartilage occurs in early osteoarthritis?
I. Decreased synthesis of proteoglycans
II. Increased synthesis of proteoglycans.
III. Swelling of the cartilage.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
In early osteoarthritis, swelling of the cartilage usually occurs, because of the increased synthesis of
proteoglycans; this reflects an effort by the chondrocytes to repair cartilage damage. @42 This stage
may last for years or decades and is characterized by hypertrophic repair of the articular cartilage
42. Which out of the following cells are involved in repairing cartilage during increased
synthesis of proteoglycans?
I. Endothelial cell
II. Chondrocytes.
III. Vascular cells.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
In early osteoarthritis, swelling of the cartilage usually occurs, because of the increased synthesis of
proteoglycans; this reflects an effort by the chondrocytes to repair cartilage damage. @42 This stage
may last for years or decades and is characterized by hypertrophic repair of the articular cartilage
43. What is role of subchondral bone in early osteoarthritis?

I. Vascular invasion.
II. Increased cellularity.
III. Decreased cellularity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The subchondral bone responds with vascular invasion and increased cellularity, becoming thickened
and dense (a process known as eburnation) at areas of pressure
44. What is the synonym of Osteoarthritic cysts?
I. Chondral cysts.
II. Subchondral cysts.
III. Pseudocysts.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
@44 45 46 Osteoarthritic cysts are also referred to as subchondral cysts, pseudocysts, or geodes (the
preferred European term) and may range from 2 to 20 mm in diameter
45. What is the synonym of Osteoarthritic cysts?

I. Geodes (the preferred European term).
II. Subchondral cysts.
III. Geodes (the preferred Italian term).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Osteoarthritic cysts are also referred to as subchondral cysts, pseudocysts, or geodes (the preferred
European term) and may range from 2 to 20 mm in diameter
46. What is the range of Osteoarthritic cysts?
I. 2 to 20 mm in diameter.
II. 2 to 25 mm in diameter.
III. 1 to 20 mm in diameter.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Osteoarthritic cysts are also referred to as subchondral cysts, pseudocysts, or geodes (the preferred
European term) and may range from 2 to 20 mm in diameter
47. What is an Osteoarthritic cyst in the acetabulum?

I. Egg cysts.
II. Egger cysts.
III. Egger oocysts.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Osteoarthritic cysts in the acetabulum (see the image below) are termed Egger cysts
48. Which out of the following mechanism are responsible for pain in osteoarthritis?
I. Osteophytic periosteal elevation.
II. Vascular congestion of subchondral bone.
III. Vascular congestion of chondral bone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Pain, the main presenting symptom of osteoarthritis, is presumed to arise from a combination of
mechanisms, including the following:
Osteophytic periosteal elevation
Vascular congestion of subchondral bone, leading to increased intraosseous pressure
I. Synovitis with activation of synovial membrane nociceptors .
II. Fatigue in muscles that cross the joint .
III. Synovitis with deactivation of synovial membrane nociceptors .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Synovitis with activation of synovial membrane nociceptors
Fatigue in muscles that cross the joint
I. Joint effusion and relaxing of the joint capsule.
II. Overall joint contracture .
III. Joint effusion and stretching of the joint capsule.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
● Overall joint contracture
● Joint effusion and stretching of the joint capsule
51. Which out of the following mechanism are responsible for pain in osteoarthrit is?
I. Torn menisci .
II. Inflammation of periarticular bursae.
III. Inflammation of articular bursae.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
● Torn menisci
● Inflammation of periarticular bursae
I. Periarticular muscle spasm.
II. Psychological factors .
III. Articular muscle spasm.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
● Periarticular muscle spasm
● Psychological factors
I. Crepitus (a rough or crunchy sensation) .
II. Central pain sensitization.
III. Peripheral pain sensitization.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
● Crepitus (a rough or crunchy sensation)
● Central pain sensitization
54. Which symptoms are observed when spinal cord is involved in osteoarthritis?
I. Severe radicular pain from spinal stenosis.
II. Stiffness.
III. Occasional radicular pain from spinal stenosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
When the spine is involved in osteoarthritis, especially the lumbar spine, the associated changes are very
commonly seen from L3 through L5. Symptoms include pain, stiffness, and occasional radicular pain
from spinal stenosis
55. Which part of the spinal cord is commonly involved in osteoarthritis?

I. Lumbar.
II. Thoracic.
III. Lumbar and Thoracic.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
When the spine is involved in osteoarthritis, especially the lumbar spine, the associated changes are
very commonly seen from L3 through L5. Symptoms include pain, stiffness, and occasional radicular
pain from spinal stenosis
56. Which is a common complication of arthritis of the lumbar spine?
I. Acute spondylolisthesis.
II. Acquired spondylolisthesis.
III. Chronic spondylolisthesis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Acquired spondylolisthesis is a common complication of arthritis of the lumbar spine
57. Which type of joints develops osteoarthritis due to daily stress on it?
I. Weight-bearing joints.
II. Ankle, knee, and hip joints.
III. Weight-gaining joints.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The daily stresses applied to the joints, especially the weight-bearing joints (eg, ankle, knee, and hip),
play an important role in the development of osteoarthritis
58. Which out of the following are Risk factors for osteoarthritis?
I. Age.
II. Obesity
III. Sex.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
58 to 66 Risk factors for osteoarthritis include the following[33, 34, 35, 36] :
 Age
 Obesity
59. Which are Risk factors for osteoarthritis?

I. Trauma.
II. Genetics (significant family history) .
III. Stress.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Trauma
 Genetics (significant family history)
I. Reduced levels of sex hormones .
II. Muscle weakness.
III. Muscle spasm.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Reduced levels of sex hormones

 Muscle weakness [40]

I. Repetitive use (ie, jobs requiring heavy labor and bending) .
II. Occasionally use (ie, jobs requiring heavy labor and bending) .
III. Infection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Repetitive use (ie, jobs requiring heavy labor and bending) [41] Infection
I. Crystal degradation.
II. Crystal deposition .
III. Acromegaly.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Crystal deposition
 Acromegaly

I. Previous inflammatory arthritis (eg, burnt-out rheumatoid arthritis).
II. Heritable metabolic causes (eg, Wilson disease) .
III. Inheritable metabolic causes (eg, Wilson disease) .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Previous inflammatory arthritis (eg, burnt-out rheumatoid arthritis)

 Heritable metabolic causes (eg, alkaptonuria, hemochromatosis, and Wilson disease)
I. Hemoglobinemia.
II. Hemoglobinopathies.
III. Neuropathic disorders leading to a Charcot joint (eg, syringomyelia).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Hemoglobinopathies (eg, sickle cell disease and thalassemia)

 Neuropathic disorders leading to a Charcot joint (eg, syringomyelia, tabes dorsalis, and diabetes)

I. Underlying morphologic risk factors (eg, congenital hip dislocation ) .
II. Disorders of bone (eg, Paget disease and avascular necrosis) .
III. Disorders of joints (eg, Paget disease and avascular necrosis).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
 Underlying morphologic risk factors (eg, congenital hip dislocation and slipped femoral capital
epiphysis)
 Disorders of bone (eg, Paget disease and avascular necrosis)
I. Previous surgical procedures (eg, meniscectomy).
II. Previous surgical procedures (eg, miniscectomy).
III. Bone deterioration.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Previous surgical procedures (eg, meniscectomy)
67. Which type of changes occur With advancing age?

I. Cartilage vascularisation.
II. Proteoglycan content.
III. Cartilage mass.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
With advancing age come reductions in cartilage volume, proteoglycan content, cartilage
vascularization, and cartilage perfusion
68. How obesity can be an inflammatory risk factor for osteoarthritis?
I. Increased levels of adipokines .
II. Decreased levels of adipokines .
III. Chronic, low-grade inflammation in joints.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In addition to its mechanical effects, obesity may be an inflammatory risk factor for osteoarthritis.
Obesity is associated with increased levels (both systemic and intra-articular) of adipokines (cytokines
derived from adipose tissue), which may promote chronic, low-grade inflammation in joints
69. Which disease increases the mechanical stress in a weight-bearing joint?

I. Obesity.
II. Hypertension.
III. Atherosclerosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Obesity increases the mechanical stress in a weight-bearing joint.

70. Which susceptibility genes responsible for osteoarthritis?
I. ADAM12.
II. COL11A2.
III. ADAM11.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
70 71 Osteoarthritis susceptibility genes (eg, ADAM12, CLIP, COL11A2, IL10, MMP3) have also
been found to have differential methylation
71. Which susceptibility genes responsible for osteoarthritis?

I. COL11A2.
II. MMP3.
III. COL11A1.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
72. The prognosis in patients with osteoarthritis depends on-
I. Joints involved.
II. Severity of the condition.
III. Chronicity of the condition.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The prognosis in patients with osteoarthritis depends on the joints involved and on the severity of the
condition
73. What are the characteristics of the progression of osteoarthritis?

I. Slow.
II. Fast.
III. Occurring over several years or decades
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The progression of osteoarthritis is characteristically slow, occurring over several years or decades
74. Etiopathogenesis of osteoarthritis has been divided into-
I. Two stages.
II. Three stages.
III. Four stages.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Etiopathogenesis of osteoarthritis has been divided into three stages
75. What are the characteristics/ etiopathogenesis of Stage 1 osteoarthritis?

I. Proteolytic breakdown of the cartilage matrix .
II. Physiological breakdown of the cartilage matrix.
III. Pathological breakdown of the cartilage matrix.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Stage 1 Proteolytic breakdown of the cartilage matrix occurs

I. The cartilage surface develop Fibrillation and erosion.
II. Proteolytic breakdown of the cartilage matrix.
III. Release of proteoglycan and collagen fragments into the synovial fluid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Stage 2 Fibrillation and erosion of the cartilage surface develop, with subsequent release of
proteoglycan and collagen fragments into the synovial fluid
I. Proteolytic breakdown of the cartilage matrix.
II. A chronic inflammatory response in the synovium due to breakdown products of cartilage.
III. The cartilage surface develop Fibrillation and erosion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Stage 3 Breakdown products of cartilage induce a chronic inflammatory response in the synovium,
which in turn contributes to further cartilage breakdown
78. Which out of the following diseases can be categorized as subsets of primary
osteoarthritis?
I. Hand osteoarthritis.
II. Knee osteoarthritis.
III. Chondromalacia patellae.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Certain diseases are often categorized as subsets of primary osteoarthritis. These include primary
generalized osteoarthritis (PGOA), erosive osteoarthritis, and chondromalacia patellae.
79. Which out of the following diseases can be categorized as subsets of primary
osteoarthritis?
I. Erosive osteoarthritis.
II. Primary generalized osteoarthritis.
III. Hand osteoarthritis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Certain diseases are often categorized as subsets of primary osteoarthritis. These include primary
generalized osteoarthritis (PGOA), erosive osteoarthritis, and chondromalacia patellae.
80. Hand osteoarthritis can been classified as-

I. Thumb base.
II. Erosive.
III. Knee osteoarthritis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Hand osteoarthritis has been classified as follows:

 Erosive
 Thumb base
81. Hand osteoarthritis can been classified as-
I. Interphalangeal.
II. Widespread hand.
III. Long spread hand.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Hand osteoarthritis has been classified as follows:

Interphalangeal (with or without nodes)
Widespread hand
82. Osteoarthritis is typically diagnosed on the basis of-

I. Metabolic evidence.
II. Radiographic evidence.
III. Clinical evidence.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Osteoarthritis is typically diagnosed on the basis of clinical and radiographic evidence

83. Which out of the following can be used as osteoarthritic indicators?
I. Insulin like growth factors
II. Monoclonal antibodies.
III. Synovial fluid markers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Researchers have investigated the use of monoclonal antibodies, synovial fluid markers, and urinary
pyridinium cross-links (ie, breakdown products of cartilage) as osteoarthritic indicators
84. Which out of the following can be used as osteoarthritic indicators?

I. Insulin like growth factors.
II. Urinary pyridinium cross-links.
III. Interleukins.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Researchers have investigated the use of monoclonal antibodies, synovial fluid markers, and urinary
pyridinium cross-links (ie, breakdown products of cartilage) as osteoarthritic indicators
85. What is the white blood cell (WBC) count in synovial fluid analysis of osteoarthritis
patient?
I. Below 2000/µL.
II. Above 2000/µL.
III. Equal to 2000/µL.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The synovial fluid analysis usually shows a white blood cell (WBC) count below 2000/µl, with a
mononuclear predominance
86. Which cells are predominant in synovial fluid analysis of osteoarthritis patient?
I. Eosinophils.
II. Neutrophils.
III. Mononuclear cells.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The synovial fluid analysis usually shows a white blood cell (WBC) count below 2000/µl, with a
mononuclear predominance
87. Why Plain radiography is the imaging method of choice in diagnosis of osteoarthritis?
I. Less cost effective.
II. More cost-effective.
III. Can be obtained more directly.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Plain radiography is the imaging method of choice because it is more cost-effective than other
modalities and because radiographs can be obtained more readily and quickly
88. Why Plain radiography is the imaging method of choice in diagnosis of osteoarthritis?
I. Can be obtained more directly.
II. Can be obtained more quickly.
III. Can be obtained more readily .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Plain radiography is the imaging method of choice because it is more cost-effective than other
modalities and because radiographs can be obtained more readily and quickly
89. Which out of the following pathological condition can be identified using MRI?
I. Osteophytes.
II. Osteocytes.
III. Subchondral Oocyte changes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Pathology that can be seen on MRI includes joint narrowing, subchondral osseous changes, and
osteophytes
90. Which out of the following pathological condition can be identified using MRI?
I. Subchondral Oocyte changes.
II. Subchondral osseous changes.
III. Joint narrowing.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Pathology that can be seen on MRI includes joint narrowing, subchondral osseous changes, and
osteophytes
91. Which diagnosis method can be used in the diagnosis of malalignment of the
patellofemoral joint or foot and ankle joints?
I. Sonography.
II. Computed tomography.
III. Doppler Sonography.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Computed tomography (CT; , it may be used in the diagnosis of malalignment of the patellofemoral
joint or of the foot and ankle joints
92. Which diagnosis method is being investigated as a tool for monitoring cartilage
degeneration, and guide injections of joints which is not easily accessed without imaging?
I. Angiography.
II. Doppler Sonography.
III. Ultrasonography.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Ultrasonography; it is being investigated as a tool for monitoring cartilage degeneration, and it can
be used for guided injections of joints not easily accessed without imaging
93. Which out of the following diagnosis method may be helpful in the early diagnosis of
osteoarthritis of the hand?
I. Bone scan.
II. Doppler Sonography.
III. Computed tomography.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Bone scans may be helpful in the early diagnosis of osteoarthritis of the hand
94. Which out of the following diagnosis method is used to differentiate osteoarthritis from
osteomyelitis and bone metastases?
I. Doppler Sonography.
II. Computed tomography.
III. Bone scan.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Bone scans also can help to differentiate osteoarthritis from osteomyelitis and bone metastases
95. Which gene mutation has been associated with severe and early-onset osteoarthritis?
I. Mutations involving COL11A1.
II. Mutations involving COL11A2.
III. Mutations involving COL11A3.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Mutations involving COL11A2 have been associated with severe and early-onset osteoarthritis
96. Which out of the following clinical features to be associated with more rapid progression
of knee osteoarthritis?
I. Older age.
II. Malnutrition.
III. Higher BMI.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
A systematic review found the following clinical features to be associated with more rapid progression
of knee osteoarthritis[59] :
 Older age
 Higher BMI
97. Which out of the following clinical features to be associated with more rapid progression
of knee osteoarthritis?
I. Malnutrition.
II. Varus deformity.
III. Multiple involved joints.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
A systematic review found the following clinical features to be associated with more rapid progression
of knee osteoarthritis[59] :
Varus deformity
Multiple involved joints
98. Which out of the following joint is not commonly affected in osteoarthritis?
I. Knee
II. Hand
III. Elbow
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The elbow is not commonly affected in osteoarthritis

99. What is the role of Radiography in the diagnosis of Osteoarthritis?
I. Visualize blood supply to cartilage and other joint tissues.
II. Visualize articular cartilage and other joint tissues.
III. Visualize Synovial fluid .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Unlike radiography, MRI can directly visualize articular cartilage and other joint tissues (eg,
meniscus, tendon, muscle, or effusion)
100. What is the role of MRI in the diagnosis of Osteoarthritis?

I. Visualize Synovial fluid.
II. Visualize articular cartilage and other joint tissues.
III. Visualize blood supply to cartilage and other joint tissues.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Unlike radiography, MRI can directly visualize articular cartilage and other joint tissues (eg,
meniscus, tendon, muscle, or effusion)
1. What is the goal of osteoarthritis treatment?
I. Restore normal functioning of affected joint.
II. Alleviation of pain.
III. Improvement of functional status.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The goals of osteoarthritis treatment include alleviation of pain and improvement of functional status
2. What is the optimal treatment strategy for osteoarthritis patient?

I. Only pharmacologic treatment.
II. Only nonpharmacologic.
III. Combination of nonpharmacologic and pharmacologic treatment.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Optimally, patients should receive a combination of nonpharmacologic and pharmacologic treatment

3. Which out of the following is the cornerstones of osteoarthritis treatment?
I. Pharmacologic treatment.
II. Nonpharmacologic interventions.
III. Both nonpharmacologic and pharmacologic treatment.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Nonpharmacologic interventions, DAPMCQ3 which are the cornerstones of osteoarthritis
4. Which out of the following is Nonpharmacologic interventions used for the treatment of
osteoarthritis?
I. Patient education.
II. Arthroplasty.
III. Heat and cold.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Nonpharmacologic interventions
Patient education
Heat and cold
5. which out of the following is Nonpharmacologic interventions used for the treatment of
osteoarthritis?
I. Arthroplasty.
II. Exercise.
III. Weight loss.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Weight loss [9]

Exercise
osteoarthritis?
I. Physical therapy.
II. Arthroscopy.
III. Occupational therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Physical therapy
Occupational therapy
osteoarthritis?
I. Arthroplasty.
II. Unloading in Knee joints.
III. Unloading in hip joints.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Unloading in certain joints (eg, knee, hip)
8. Which is the surgical procedure for osteoarthritis?

I. Intracutaneous nerve stimulation.
II. Trans cutaneus nerve stimulation.
III. Arthroscopy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Surgical procedures for osteoarthritis include arthroscopy, osteotomy, and (particularly with knee or
hip osteoarthritis) arthroplasty
9. Which is the surgical procedure for osteoarthritis?
I. Osteotomy.
II. Arthroplasty.
III. Trans cutaneus nerve stimulation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Surgical procedures for osteoarthritis include arthroscopy, osteotomy, and (particularly with knee or
hip osteoarthritis) arthroplasty
10. According to ACR recommendation, which out of the following can be used for the
treatment of hand osteoarthritis?
I. Tropical clotrimazole.
II. Topical capsaicin.
III. Topical nonsteroidal anti-inflammatory drugs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
For hand osteoarthritis, the ACR conditionally recommends using one or more of the following:
Topical capsaicin
Topical nonsteroidal anti-inflammatory drugs (NSAIDs), including trolamine salicylate
treatment of hand osteoarthritis?
I. Tramadol.
II. Oral NSAIDs.
III. Tropical clotrimazole.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
For hand osteoarthritis, the ACR conditionally recommends using one or more of the following
Oral NSAIDs
Tramadol
treatment of knee osteoarthritis?
I. Acetaminophen.
II. Oral NSAIDs.
III. Tropical benzoic acid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
For knee osteoarthritis, the ACR conditionally recommends using one of the following:
 Acetaminophen
 Oral NSAIDs
I. Tropical benzoic acid.
II. Topical NSAIDs.
III. Tramadol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Topical NSAIDs
 Tramadol
I. Tropical benzoic acid.
II. Intra-articular corticosteroid injections.
III. Tropical clotrimazole.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Intra-articular corticosteroid injections
treatment of hip osteoarthritis?
I. Acetaminophen.
II. Oral NSAIDs.
III. Tropical benzoic acid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
For hip osteoarthritis, the ACR conditionally recommends using one or more of the following for
initial management:
 Acetaminophen
 Oral NSAIDs
treatment of hip osteoarthritis?
I. Tramadol.
II. Valsartan.
III. Intra-articular corticosteroid injections.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
For hip osteoarthritis, the ACR conditionally recommends using one or more of the following for
initial management:
 Tramadol
 Intra-articular corticosteroid injections
17. According to ACR recommendation, which out of the following cannot be used for the
treatment of osteoarthritis?
I. Telmisartan.
II. Topical NSAIDs.
III. Intra-articular hyaluronate injections.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The ACR has no recommendation regarding the use of topical NSAIDs, intra-articular
hyaluronate injections, duloxetine, or opioid analgesics.
18. According to ACR recommendation, which out of the following cannot be used for the
treatment of osteoarthritis?
I. Duloxetine.
II. Nifedipine.
III. Opioid analgesics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The ACR has no recommendation regarding the use of topical NSAIDs, intra-articular hyaluronate
injections, duloxetine, or opioid analgesics.
19. According to American Academy of Orthopaedic Surgeons (AAOS) recommendation,
what should be the treatments of symptomatic osteoarthritis of the knee?
I. Oral NSAIDs.
II. Diltiazem.
III. Topical NSAIDs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
American Academy of Orthopaedic Surgeons (AAOS) recommends

Treatments for symptomatic osteoarthritis of the knee
 Oral NSAIDs
 Topical NSAIDs
 Tramadol
20. According to American Academy of Orthopaedic Surgeons (AAOS) recommendation,

what should be the treatments of symptomatic osteoarthritis of the knee?
I. Verapamil.
II. Nifedipine.
III. Tramadol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
American Academy of Orthopaedic Surgeons (AAOS) recommends

Treatments for symptomatic osteoarthritis of the knee
Tramadol
21. What is the side effect of nonselective Non-steroidal anti inflammatory agent (NSAIDs)?
I. Anuria.
II. Ulcer.
III. Hypotension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Selective NSAIDs as a class were associated with a lower risk of ulcer complications than were the
nonselective NSAIDs naproxen, ibuprofen, and diclofenac
22. Which out of the following is associated with lower risk of ulcer-related complications?
I. Naproxen.
II. Meloxicam.
III. Etodolac.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The partially selective NSAIDs meloxicam and etodolac were associated with a lower risk of ulcer-
related complications and symptomatic ulcers than were various nonselective NSAIDs
23. Which out of the following sentence is correct?
I. Risk of serious GI adverse effects is higher with naproxen than with ibuprofen.
II. Risk of serious GI adverse effects is lower with naproxen than with ibuprofen.
III. Risk of serious GI adverse effects is similar for naproxen and ibuprofen.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The risk of serious GI adverse effects was found to be higher with naproxen than with ibuprofen
24. Which out of the following drug is associated with an increased risk of cardiovascular
adverse effects?
I. Ibuprofen.
II. Celecoxib.
III. Telmisartan.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Celecoxib and the nonselective NSAIDs ibuprofen and diclofenac were associated with an increased
risk of cardiovascular adverse effects when compared with placebo
25. Which out of the following drug is associated with an increased risk of increased risk of
heart attack?
I. Ibuprofen.
II. Warfarin.
III. Diclofenac.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The nonselective NSAIDs ibuprofen and diclofenac, but not naproxen, were associated with an
increased risk of heart attack when compared with placebo

I. Topical diclofenac have similar efficacy to that of oral NSAIDs in localized osteoarthritis.
II. Topical diclofenac have higher efficacy to that of oral NSAIDs in localized osteoarthritis.
III. Topical diclofenac have lower efficacy to that of oral NSAIDs in localized osteoarthritis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The AHRQ noted that topical diclofenac was found to have efficacy similar to that of oral NSAIDs
in patients with localized osteoarthritis
27. Which drug is used to begin/first choice treatment in patient with mild or moderate
osteoarthritic pain without apparent inflammation?
I. Diclofenac.
II. Acetaminophen.
III. Aspirin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Begin treatment with acetaminophen for mild or moderate osteoarthritic pain without apparent
inflammation. DAPMCQ28 If the clinical response to acetaminophen is not satisfactory or if the
clinical presentation of osteoarthritis is inflammatory, consider using an NSAID
28. Which drug is used when clinical response to acetaminophen is not satisfactory or if the
clinical presentation of osteoarthritis is inflammatory?
I. NSAID.
II. Calcium Channel blockers.
III. Beta-blockers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Begin treatment with acetaminophen for mild or moderate osteoarthritic pain without apparent
inflammation. DAPMCQ28 If the clinical response to acetaminophen is not satisfactory or if the
clinical presentation of osteoarthritis is inflammatory, consider using an NSAID
29. Which drug is used to treat highly resistant pain in osteoarthritis?
I. Paracetamol.
II. Naproxen.
III. Tramadol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
In patients with highly resistant pain, consider the analgesic tramadol. DAPMCQ30 Options in
patients at an elevated risk for GI toxicity from NSAIDs include the addition of a proton-pump
inhibitor or misoprostol to the treatment regimen and the use of the selective cyclooxygenase (COX)-2
inhibitor celecoxib instead of a nonselective NSAID
30. Which drug prevents the GI side effect caused due to NSAID?
I. Naproxen.
II. Misoprostol.
III. Mifepristone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
In patients with highly resistant pain, consider the analgesic tramadol. DAPMCQ30 Options in
patients at an elevated risk for GI toxicity from NSAIDs include the addition of a proton-pump
inhibitor or misoprostol to the treatment regimen and the use of the selective cyclooxygenase (COX)-2
inhibitor celecoxib instead of a nonselective NSAID
31. What is the pharmacological mechanism of duloxetine?
I. Selective glycine reuptake inhibitor.
II. Non-selective serotonin-norepinephrine reuptake inhibitor.
III. Selective serotonin-norepinephrine reuptake inhibitor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The selective serotonin-norepinephrine reuptake inhibitor duloxetine has been found to be effective in
treating osteoarthritis pain
32. What are the side effects of duloxetine?

I. Constipation.
II. Dry mouth.
III. Increased appetite.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Duloxetine was also associated with significantly more nausea, dry mouth, constipation, fatigue, and
decreased appetite
33. What are the side effects of duloxetine?
I. Decreased appetite.
III. Fatigue.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Duloxetine was also associated with significantly more nausea, dry mouth, constipation, fatigue, and
decreased appetite
34. Which out of the following represents Intra-articular pharmacologic therapy?

I. Intra-articular injection of a tramadol.
II. Intra-articular injection of a corticosteroid.
III. Intra-articular injection of a sodium hyaluronate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Intra-articular pharmacologic therapy includes injection of a corticosteroid or sodium hyaluronate

(ie, hyaluronic acid [HA] or hyaluronan), which may provide pain relief and have an anti-
inflammatory effect on the affected joint
35. What is the usefulness of Intra-articular pharmacologic therapy?
I. Provide pain relief and have an anti-inflammatory effect.
II. Act as lubricant in joint.
III. Prevents infection of Synovium fluid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Intra-articular pharmacologic therapy includes injection of a corticosteroid or sodium hyaluronate

(ie, hyaluronic acid [HA] or hyaluronan), which may provide pain relief and have an anti-
inflammatory effect on the affected joint
36. Which imaging method can be useful to guide Intra-articular pharmacologic therapy?
I. MRI.
II. Ultrasound.
III. CT scan.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Ultrasound guidance can facilitate arthrocentesis and injection and is increasingly being adopted by
physic answer: such as rheumatologists and physiatrists for this purpose
37. What are contraindications to steroid injection?
I. Pain relief.
II. Infected joint fluid.
III. Bacteremia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Infected joint fluid and bacteremia are contraindications to steroid injection
38. What is the usefulness of steroid injection in patient with knee osteoarthritis?
I. Reduction in pain and inflammation.
II. Act as lubricant in joint.
III. Prevents infection of Synovium fluid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
In patients with osteoarthritic knee pain, steroid injections generally result in clinically and
statistically significant pain reduction as soon as 1 week after injection
39. What is viscosupplementation?

I. Intra-articular injection of naproxen.
II. Intra-articular injection of tramadol.
III. Intra-articular injection of sodium hyaluronate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Intra-articular injection of sodium hyaluronate, also referred to as viscosupplementation,
40. In the United States, intra-articular HAs are classified as-

I. Pharmacological therapy.
II. Medical devices.
III. Non- Pharmacological therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
In the United States, intra-articular has are classified as medical devices rather than as drugs
41. Which out of the following is a non cross linked sodium hyaluronate product?
I. Hyalgam.
II. Hyalgan.
III. Orthovisc.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Intra-articular has approved by the FDA for the treatment of osteoarthritic knee pain include the
naturally extracted, non cross-linked sodium hyaluronate products Hyalgan,[79] Supartz, Orthovisc,
and Euflexxa, as well as the cross-linked sodium hyaluronate product known as hylan G-F 20
(Synvisc)
42. How is Euflexxa derived?
I. Through fermentation process.
II. Through electrophoresis.
III. Through fermentation and electrophoresis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Euflexxa is derived from a fermentation process (Streptococcus),
43. What is the possible pharmacological mechanism of Has?

I. Direct binding to receptors (CD44 in particular) in the synovium and cartilage.
II. Direct binding to receptors (CB44 in particular) in the synovium and cartilage.
III. Direct binding to receptors (CA44 in particular) in the synovium and cartilage.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The exact mechanisms of action through which has provide symptomatic relief are unknown. Possible
mechanisms include direct binding to receptors (CD44 in particular) in the synovium and cartilage
that can lead to several biologic activation pathways
44. What is the most common adverse effect of HA (hyaluronic acid injections)?
I. Injection-site discolouration.
II. Injection-site pigmentation.
III. Injection-site pain.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The HA class in general has demonstrated a very favourable safety profile for chronic pain
management in knee osteoarthritis, with the most common adverse event being injection-site pain.
45. Which out of the following is associated with a clinically distinct acute inflammatory
side effect (ie, severe acute inflammatory reaction)?
I. Hylan G-F 20 product.
II. Hylan F-F 20 product.
III. Hylan H-F 20 product.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Only the cross-linked hylan G-F 20 product has been associated with a clinically distinct acute
inflammatory side effect (ie, severe acute inflammatory reaction [SAIR] or HA-associated intra-
articular pseudosepsis).
46. Which out of the following can be classified as narcotics?
I. Oxycodone.
II. Acetaminophen with codeine.
III. Aspirin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Judicious use of narcotics (eg, oxycodone and acetaminophen with codeine) is reserved for patients
with severe osteoarthritis
47. Judicious uses of narcotics (eg, oxycodone and acetaminophen with codeine) is reserved
for patients with-
I. Mild osteoarthritis.
II. Severe osteoarthritis.
III. Moderate osteoarthritis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Judicious use of narcotics (eg, oxycodone and acetaminophen with codeine) is reserved for patients
with severe osteoarthritis
48. Which class of drug is being tested as disease-modifying drugs in the management of
osteoarthritis?
I. Calcium channel blocker.
II. Matrix metalloproteinase [MMP] inhibitors.
III. Inotropics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Chondro protective drugs (ie, matrix metalloproteinase [MMP] inhibitors and growth factors) are
being tested as disease-modifying drugs in the management of osteoarthritis
49. What is a core component in the management of osteoarthritis?

I. Pharmacological therapy.
II. Surgery.
III. Lifestyle modification.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Lifestyle modification, particularly exercise and weight reduction, is a core component in the
management of osteoarthritis
50. According to Osteoarthritis Research Society International, nonpharmacologic
treatment of hip and knee osteoarthritis should initially focus on-
I. Self-help and patient-driven modalities.
II. Bed ridden.
III. Decrease movement of joint.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Guidelines from Osteoarthritis Research Society International (OARSI) advise that

nonpharmacologic treatment of hip and knee osteoarthritis should initially focus on self-help and
patient-driven modalities rather than on modalities delivered by health professionals
51. According to ACR recommendation, which out of the following are the Non-
pharmacologic measures for patients with knee or hip osteoarthritis?
I. Weight loss, for overweight patients.
II. Weight gain if underweight.
III. Aquatic exercise.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The ACR strongly recommends the following nonpharmacologic measures for patients with knee or
hip osteoarthritis[90] :
Cardiovascular or resistance land-based exercise
Aquatic exercise
Weight loss, for overweight patients
52. According to ACR recommendation, which out of the following should be considered
in patients with knee or hip osteoarthritis?
I. Self-management programs.
II. Psychosocial interventions.
III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The ACR conditionally recommends the following measures for patients with knee or hip
osteoarthritis:
 Self-management programs
 Manual therapy in combination with supervised exercise
 Psychosocial interventions
 Thermal agents
 Walking aids, as needed
I. Medially wedged insoles for temporal-compartment osteoarthritis.
II. Medially directed patellar taping.
III. Tai chi.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
For patients with knee osteoarthritis, the ACR also conditionally recommends the following measures:
 Medially directed patellar taping
 Medially wedged insoles for lateral-compartment osteoarthritis
 Laterally wedged subtalar strapped insoles for medial-compartment osteoarthritis
 Tai chi
I. Laterally wedged subtalar strapped insoles for medial-compartment osteoarthritis.
II. Medially wedged insoles for temporal-compartment osteoarthritis.
III. Medially wedged insoles for lateral-compartment osteoarthritis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
For patients with knee osteoarthritis, the ACR also conditionally recommends the following measures:
 Medially directed patellar taping
 Medially wedged insoles for lateral-compartment osteoarthritis
 Laterally wedged subtalar strapped insoles for medial-compartment osteoarthritis
 Tai chi
55. What is the role of pulsed electromagnetic field stimulation in osteoarthritis?

I. Maintains the glycoprotein composition of chondrocytes.
II. Maintains the proteoglycan composition of chondrocytes.
III. Maintains the glucosamine composition of chondrocytes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Pulsed electromagnetic field stimulation is believed to act at the level of articular cartilage by
maintaining the proteoglycan composition of chondrocytes through downregulation of its turnover
56. What is the role of transwer: cutaneous electrical nerve stimulation (TENS) in
osteoarthritis?
I. Management of leukocyte infiltration.
II. Management of inflammation.
III. Management of pain.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Transwer: cutaneous electrical nerve stimulation (TENS) may be another treatment option for pain
relief
57. What are the criteria for osteotomy in osteoarthritis patient?

I. Patients with age 60 years who have a malaligned hip or knee joint.
II. Patients older than 60 years who have a malaligned hip or knee joint.
III. Patients younger than 60 years who have a malaligned hip or knee joint.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Osteotomy is used in active patients younger than 60 years who have a malaligned hip or knee joint
and want to continue with reasonable physical activity
58. What is the principle of Osteotomy?
I. Removal of joint.
II. Implantation of artificial joint.
III. Shift weight from the damaged cartilage on the medial aspect of the knee to the healthy lateral
aspect of the knee.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The principle underlying this procedure is to shift weight from the damaged cartilage on the medial
aspect of the knee to the healthy lateral aspect of the knee
59. In which patient Osteotomy is most beneficial?

I. Genu varam.
II. Genu varum.
III. Bowleg deformity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Osteotomy is most beneficial for significant genu varum, or bowleg deformity

60. What are the contraindications for osteotomy?
I. A flexion-extension contracture of more than 15°.
II. Knee flexion of less than 90°.
III. Knee flexion to 90°.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Contraindications for osteotomy are as follows:

 Knee flexion of less than 90°
 A flexion-extension contracture of more than 15°

I. Knee flexion to 90°.
II. Varus over 15°-20°.
III. Instability from previous trauma or surgery.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Varus over 15°-20°

Instability from previous trauma or surgery
I. Severe arterial insufficiency.
II. Knee flexion to 90°.
III. Bicompartmental involvement.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Severe arterial insufficiency

Bicompartmental involvement
63. What is Arthroplasty?

I. Joint replacement.
II. Bone is cut to shorten.
III. Surgical removal of joint surface and the insertion of a metal and plastic prosthesis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Arthroplasty consists of the surgical removal of joint surface and the insertion of a metal and plastic
prosthesis (see the images below
64. Which vitamin may play a role in the development and progression of osteoarthritis?
I. Low vitamin C levels.
II. Low vitamin D levels.
III. Low vitamin E levels.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
It has been proposed that low vitamin D levels may play a role in the development and progression of
osteoarthritis
65. Which out of the following pharmacologic agents are used in the treatment of
osteoarthritis?
I. Acetaminophen.
II. Valsartan.
III. Nonsteroidal anti-inflammatory drugs (NSAIDs).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Pharmacologic agents used in the treatment of osteoarthritis include the following:

 Acetaminophen
 Nonsteroidal anti-inflammatory drugs (NSAIDs), oral and topical
osteoarthritis?
I. Intra-articular tramadol.
II. Intra-articular corticosteroids.
III. Intra-articular sodium hyaluronate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Intra-articular corticosteroids
Intra-articular sodium hyaluronate
osteoarthritis?
I. Muscle relaxants.
III. Opioids.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Opioids
Duloxetine
Muscle relaxants
68. Which out of the following is the drug of choice for patients who have a documented
hypersensitivity to aspirin or NSAIDs, history of upper gastrointestinal (GI) tract disease,
or on anticoagulants?
I. Liraglutide.
II. Tramadol.
III. Acetaminophen.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Acetaminophen is the drug of choice for patients who have a documented hypersensitivity to aspirin
or NSAIDs, who have a history of upper gastrointestinal (GI) tract disease, or who are on
anticoagulants
69. What is the potential side effect of Diclofenac?

I. Hepatotoxicity.
III. Weight gain.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Diclofenac can cause hepatotoxicity; hence, liver enzymes should be monitored in the first 8 weeks of
treatment
70. What is the dose of Submicron diclofenac?
I. 35 mg PO; t.i.d.
II. 45 mg PO; t.i.d.
III. 55 mg PO; t.i.d.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Submicron diclofenac 35 mg PO TID
71. What is the most common side effect of NSAIDs?

I. Weight gain.
II. increased appetite.
III. GI ulcer.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
All of these medications increase the risk for GI ulcers and have been associated with increased risk of
cardiovascular disease.
72. Which class of the drug is used as first-line pharmacologic therapy in inflammatory
presentations of osteoarthritis?
I. calcium channel blocker.
II. NSAIDs.
III. Beta-blockers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
In more inflammatory presentations of osteoarthritis, such as knee involvement with effusion, these
agents may be used as first-line pharmacologic therapy
73. What is the pharmacological mechanism of NSAIDs?

I. Prevent leukocyte infiltration.
II. Nonselective inhibition of cyclooxygenase (COX)-1 and COX-2.
III. Immunomodulator.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The mechanism of action is nonselective inhibition of cyclooxygenase (COX)-1 and COX-2, resulting
in reduced synthesis of prostaglandins and thromboxanes
74. What is the outcome of nonselective inhibition of cyclooxygenase?
I. Reduced synthesis of ATP.
II. Reduced synthesis of ADP.
III. Reduced synthesis of prostaglandins and thromboxanes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The mechanism of action is nonselective inhibition of cyclooxygenase (COX)-1 and COX-2, resulting
in reduced synthesis of prostaglandins and thromboxanes
75. Which out of the following is pharmacological action of NSAIDs?

I. Hyperthermia.
II. Anti-inflammatory.
III. Analgesic.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
NSAIDs have analgesic, anti-inflammatory, and antipyretic activities

76. Which out of the following can be classified as Nonsteroidal Anti-inflammatory Drugs?
I. Valsartan.
II. Ketoprofen.
III. Digoxin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Nonsteroidal Anti-inflammatory Drugs (NSAIDs); Ketoprofen, Piroxicam, Meloxicam, Diclofenac,

Celecoxib, Naproxen
I. Furosemide.
II. Meloxicam.
III. Piroxicam.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

Celecoxib, Naproxen
I. Celecoxib.
II. Torsemide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A

Celecoxib, Naproxen
I. Spironolactone.
II. Naproxen.
III. Orlistat.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

Celecoxib, Naproxen
80. What is the pharmacological mechanism of Duloxetine?
I. Glycine reuptake inhibitor.
II. Serotonin and norepinephrine reuptake inhibitor.
III. Glutamate reuptake inhibitor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Duloxetine; Potent inhibitor of neuronal serotonin and norepinephrine reuptake
81. Which out of the following can be classified as Antidepressants used in osteoarthritis?
I. Diclofenac.
II. Aspirin.
III. Duloxetine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Antidepressants, snris; Duloxetine
82. What is the minimum time period for the use of Capsaicin to obtain maximum benefit?
I. 2 weeks.
II. 3 weeks.
III. 4 weeks.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Capsaicin must be used for at least 2 weeks for the full effects to be appreciated.
83. What is the pharmacological mechanism of Capsaicin?
I. Depletes substance J in peripheral sensory neurons.
II. Depletes substance N in peripheral sensory neurons.
III. Depletes substance P in peripheral sensory neurons.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
It may render skin and joints insensitive to pain by depleting substance P in peripheral sensory neurons
84. Capsaicin is derived from plants belonging to family-

I. Zingiber aceae.
II. Solanaceae.
III. Cactaceae.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Derived from plants of the Solanaceae family,
85. Which out of the following is a topical analgesic of choice in osteoarthritis?

I. Capsaicin
II. Clotrimazole.
III. Ivermectin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Capsaicin is a topical analgesic of choice in osteoarthritis.
86. Which out of the following can be classified as topical analgesic agent?
I. Ivermectin.
II. Capsaicin.
III. Clotrimazole.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Analgesic, topical; capsaicin
87. What is the potential side effect of short-acting opioids?

I. Risk of GI ulcer.
II. Inflammatory bowel disease.
III. Risk of fracture.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
During the first 2 weeks after initiation of opioid treatment, short-acting opioids are associated with
a greater fracture risk than long-acting opioids are

I. A higher opioid dose is associated with a greater risk of fracture.
II. A lower opioid dose is associated with a greater risk of fracture.
III. Opioid are not associated with a risk of fracture.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
A higher opioid dose is associated with a greater risk of fracture; this risk is due to an increased risk
of falls
89. Why opioid are associated with the risk of fracture?
I. Due to an increased risk of falls.
II. Due to depletion of Calcium from bone.
III. Due to depletion of Phosphorus from bone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
A higher opioid dose is associated with a greater risk of fracture; this risk is due to an increased risk
of falls
90. Which drug falls in the class Opioid Analgesics?

I. Tramadol.
II. Aspirin.
III. Diazepam.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Opioid analgesics; tramadol, oxycodone
91. Which drug falls in the class Opioid Analgesics?

I. Diazepam.
II. Oxycodone.
III. Midazolam.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Opioid analgesics; tramadol, oxycodone

92. What is the pharmacological mechanism of Betamethasone?
I. Increase migration of PMNs and reversing increased capillary permeability.
II. Suppress migration of PMNs and reversing increased capillary permeability.
III. Suppress migration of natural killer cell and reversing increased capillary permeability.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Betamethasone decreases inflammation by suppressing migration of pmns and reversing increased

capillary permeability. It affects the production of lymphokines and has an inhibitory effect on
langerhanswer: cells
93. What is the pharmacological mechanism of Methylprednisolone?

I. Suppress migration of PMNs and reversing increased capillary permeability
II. Increase migration of PMNs and reversing increased capillary permeability.
III. Suppress migration of natural killer cell and reversing increased capillary permeability.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Methylprednisolone decreases inflammation by suppressing migration of polymorphonuclear

leukocytes (pmns) and reversing increased capillary permeability.
94. Which drug falls in the class Corticosteroids?

I. Tramadol.
II. Methylprednisolone.
III. Diazepam.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Corticosteroids; methylprednisolone, betamethasone, triamcinolone

95. Which drug falls in the class Corticosteroids?
I. Betamethasone.
II. Nitrazepam.
III. Triamcinolone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Corticosteroids; methylprednisolone, betamethasone, triamcinolone
96. What is the pharmacological mechanism of Sodium hyaluronate?

I. Increase synovium fluid.
II. Supports the lubricating and shock-absorbing properties of articular cartilage.
III. Decrease synovium fluid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Sodium hyaluronate is a biological polysaccharide that supports the lubricating and shock-absorbing
properties of articular cartilage
97. What is the pharmacological mechanism of Baclofen?

I. Presynaptic Glycine receptor agonist.
II. Presynaptic serotonin receptor agonist.
III. Presynaptic GABA-B receptor agonist.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Baclofen; Muscle relaxant (central), presynaptic GABA-B receptor agonist that may induce
hyperpolarization of afferent terminals and inhibit both monosynaptic and polysynaptic reflexes at
spinal level
98. What is the therapeutic dose of Dantrolene?
I. 200 mg/day.
II. 300 mg/day.
III. 400 mg/day.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Dantrolene: Most patients respond to 400 mg/day or less. Eliminated in the urine and bile
99. Which drug falls in the class Skeletal muscle relaxants?

I. Betamethasone.
II. Tri cosen.
III. Carisoprodol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Skeletal muscle relaxants; Carisoprodol, Dantrolene, Baclofen
100. Which drug falls in the class Skeletal muscle relaxants?

I. Dantrolene.
II. Diclofenac.
III. Baclofen.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Skeletal muscle relaxants; Carisoprodol, Dantrolene, Baclofen
Rheumatoid Arthritis
1. What is meant by Rheumatoid arthritis?

I. Form of arthritis that affects some people who have psoriasis that features red patches of skin
topped with silvery scales.
II. Degeneration of joint cartilage and the underlying bone, especially in the hip, knee, and thumb
joints .
III. Chronic systemic inflammation disease affecting hands and feet.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of unknown cause. The
hallmark feature of this condition is persistent symmetric polyarthritis (synovitis) that affects the hands
and feet, though any joint lined by a synovial membrane may be involved.
2. What are early signs of Rheumatoid Arthritis?

I. Fever & weakness.
II. Nausea & Headache .
III. Arthralgia & malaise.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In most patients with RA, onset is insidious, often beginning with fever, malaise, arthralgias, and
weakness before progressing to joint inflammation and swelling
3. Which of the following are symptoms of Rheumatoid Arthritis?
I. Poly-arthritis of hands and feet.
II. Degeneration of hip & knee joint.
III. Extra-articular involvement & Difficulty performing tasks.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Signs and symptoms of rheumatoid arthritis may include the following:

 Persistent symmetric polyarthritis (synovitis) of hands and feet (hallmark feature)
 Progressive articular deterioration
 Extra-articular involvement
 Difficulty performing activities of daily living (adls)
 Constitutional symptoms
4. What type of physical examination should be done in diagnosing Rheumatoid arthritis?

I. Upper & lower extremities.
II. Cervical spine .
III. Upper extremities only.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The physical examination should address the following:

 Upper extremities (metacarpophalangeal joints, wrists, elbows, shoulders)
 Lower extremities (ankles, feet, knees, hips)
 Cervical spine
5. Which of the following factors should be assessed while doing physical examination?
I. Stiffness & swelling.
II. Deformity & Pain on motion.
III. Bleeding.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
During the physical examination, it is important to assess the following:

 Stiffness
 Tenderness
 Pain on motion
 Swelling
 Deformity
 Limitation of motion
 Extra-articular manifestations
Rheumatoid nodule
6. Which of the following are diagnostic tests for Rheumatoid Arthritis?

I. CBC & ESR.
II. Rheumatoid factor & Anti-nuclear antibody assay.
III. Renal & Liver function test.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
No test results are pathognomonic; instead, the diagnosis is made by using a combination of clinical,
laboratory, and imaging features. Potentially useful laboratory studies in suspected RA include the
following:
 Erythrocyte sedimentation rate
 C-reactive protein level
 Rheumatoid factor assay
 Antinuclear antibody assay
7. Which of the following organs are also involved in Rheumatoid arthritis?

I. Eyes & skin.
II. Liver.
III. Lungs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Extra-articular involvement of organs such as the skin, heart, lungs, and eyes can be significant.
8. Which of the following laboratory findings are more specific for Rheumatoid Arthritis?
I. C-reactive protein.
II. Anti-cyclic citrullinated protein antibody.
III. Rheumatoid factor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
No laboratory test results are pathognomonic for RA, but the presence of anti-cyclic citrullinated
protein antibody (ACPA) and rheumatoid factor (RF) is highly specific for this condition. (See
Workup.)
9. All of the following is true about DMARDs except?
I. Retard disease progression.
II. Induce less remissions.
III. Immunosuppressive in nature.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Early therapy with DMARDs has become the standard of care; it not only can more efficiently retard
disease progression than later treatment but also may induce more remissions. (See Treatment.) Many
of the newer DMARD therapies, however, are immunosuppressive in nature, leading to a higher risk
for infections.
10. Which of the following is the complication of Juvenile idiopathic arthritis?

I. Cushings syndrome.
II. Macrophage activation syndrome.
III. Lymphocyte activation syndrome.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Macrophage activation syndrome is a life-threatening complication of juvenile idiopathic arthritis

(JIA) that necessitates immediate treatment with high-dose steroids and cyclosporine.
11. What is meant by Clinical remission?
I. Absence of signs of inflammatory disease activity.
II. Absence of symptoms of inflammatory disease activity.
III. Absence of signs & symptoms of inflammatory disease activity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Clinical remission is defined as the absence of signs and symptoms of significant inflammatory disease
activity.
12. Which factors should be considered while making clinical decisions?
I. Structural changes.
II. Functional impairment .
III. Severity of disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Structural changes and functional impairment and comorbidity should be considered when making
clinical decisions, in addition to assessing composite measures of disease activity.
13. What is the pathophysiology behind Rheumatoid arthritis?
I. Infection & trauma.
II. Alcohol.
III. Cigarette smoking.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
An external trigger (eg, cigarette smoking, infection, or trauma) that triggers an autoimmune reaction,
leading to synovial hypertrophy and chronic joint inflammation along with the potential for extra-
articular manifestations, is theorized to occur in genetically susceptible individuals.
14. What major events are involved in pathologic process of Rheumatoid Arthritis?
I. Endothelial cell activation.
II. Aplasia.
III. Uncontrolled inflammation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Synovial cell hyperplasia and endothelial cell activation are early events in the pathologic process that
progresses to uncontrolled inflammation and consequent cartilage and bone destruction.
15. Which of the following factors also contributes to Disease propagation?
I. Genetic factors.
II. Past medical history.
III. Abnormal Immune system .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Genetic factors and immune system abnormalities contribute to disease propagation.
16. Which of the following cells are also involved in pathophysiology of Rheumatoid
Arthritis?
I. Neutrophils & CD4-T cells.
II. Fibroblasts & Osteoclasts.
III. RBCs & platelets.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
CD4 T cells, mononuclear phagocytes, fibroblasts, osteoclasts, and neutrophils play major cellular roles
in the pathophysiology of RA,
17. Which of the following tissues are effected by Rheumatoid arthritis?
I. Bones & Cartilage.
II. Skin.
III. Blood vessels & ligaments.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Ultimately, inflammation and exuberant proliferation of the synovium (ie, pannus) leads to
destruction of various tissues, including cartilage (see the image below), bone, tendons, ligaments, and
blood vessels.
18. What are the causes of Rheumatoid arthritis?

I. Genetic & Environmental.
II. Infectious & Immunological.
III. Smoking.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The cause of RA is unknown. Genetic, environmental, hormonal, immunologic, and infectious factors
may play significant roles
19. Which of the following epitope is also the cause of Rheumatoid arthritis?
I. HLA-DR2 cluster.
II. HLA-DR4 cluster.
III. HLA-DR6 cluster.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
About 60% of RA patients in the United States carry a shared epitope of the human leukocyte antigen
(HLA)-DR4 cluster
20. Which of the following are resistant genes In Rheumatoid Arthritis?

I. MHC.
II. PTPN22.
III. TRAF5.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Genes other than those of the major histocompatibility complex (MHC) are also involved, and results
from sequencing genes of families with RA suggest the presence of several resistance and susceptibility
genes, including PTPN22 and TRAF5
21. Which of the following is false about Juvenile Rheumatoid arthritis?
I. Begins after age of 30 years.
II. Heterogeneous group of diseases.
III. Persist for more than 6 weeks .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Juvenile idiopathic arthritis (JIA), also known as juvenile rheumatoid arthritis (JRA), is a
heterogeneous group of diseases that differs markedly from adult RA. JIA is known to have genetically
complex traits in which multiple genes are important for disease onset and manifestations, and it is
characterized by arthritis that begins before the age of 16 years, persists for more than 6 weeks, and is
of unknown origin
22. Which individual is more susceptible towards Rheumatoid Arthritis?

I. Men.
II. Women.
III. Children.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
RA is significantly more prevalent in women than in men, which suggests that genomic imprinting
from parents participates in its expression.
23. What is the mechanism behind genomic imprinting in Rheumatoid arthritis?
I. Ethylation of chromosomes by the parent of origin.
II. Methylation of chromosomes by the parent of origin.
III. Chlorination of chromosomes by the parent of origin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Imprinting is characterized by differential methylation of chromosomes by the parent of origin,

resulting in differential expression of maternal over paternal genes
24. Which of the following organism is involved in Rheumatoid arthritis?

I. Mycoplasma.
II. Staphylococcus bacilli.
III. Epstein-Barr virus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
For many decades, numerous infectious agents have been suggested as potential causes of RA, including
Mycoplasma organisms, Epstein-Barr virus (EBV), and rubella virus.
25. Which of the following bacteria is also associated with occurrence of Rheumatoid
arthritis?
I. Staphylococcus aureus.
II. Candida albicans.
III. Peri odontopathic bacteria.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Emerging evidence also points to an association between RA and Peri odontopathic bacteria
26. Which of the following are risk factors for Rheumatoid arthritis?
I. Hypo-prolactinoma.
II. Hyper-prolactinemia.
III. Pregnancy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Sex hormones may play a role in RA, as evidenced by the disproportionate number of females with
this disease, its amelioration during pregnancy, its recurrence in the early postpartum period, and its
reduced incidence in women using oral contraceptives. Hyperprolactinemia may be a risk factor for
RA
27. Which of the following cells are activated by T-cells resulting in initiation of
Rheumatoid Arthritis?
I. Macrophages.
II. Antibodies.
III. Synovial fibroblasts.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
T cells are assumed to play a pivotal role in the initiation of RA, and the key player in this respect is
assumed to be the T helper 1 (Th1) CD4 cells. (Th1 cells produce IL-2 and interferon [IFN] gamma.)
These cells may subsequently activate macrophages and other cell populations, including synovial
fibroblasts. Macrophages and synovial fibroblasts are the main producers of TNF-a and IL-1.
Experimental models suggest that synovial macrophages and fibroblasts may become autonomous and
thus lose responsiveness to T-cell activities in the course of RA.
28. Which of the following is true regarding B-cell role in Rheumatoid arthritis?
I. Serve as antigen-presenting cells.
II. Production of antibodies & cytokines.
III. Activation of macrophages.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
B cells are important in the pathologic process and may serve as antigen-presenting cells. B cells also
produce numerous autoantibodies (eg, RF and ACPA) and secrete cytokines.
29. Which of the following is true regarding prognosis of Rheumatoid arthritis?
I. All of the patients become disabled after some years.
II. Only 40% have chances of becoming disabled.
III. Self limited as well chronic disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Approximately 40% of patients with this disease become disabled after 10 years, but outcomes are
highly variable.[23] Some patients experience a relatively self-limited disease, whereas others have a
chronic progressive illness.
30. Which of the following intervention gives best opportunity to achieve disease remission
in early Rheumatoid arthritis?
I. Exercise.
II. DMARDs therapy.
III. Psychotherapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
It has been shown that intervention with DMARDs in very early RA (symptom duration < 12 weeks
at the time of first treatment) gives the best opportunity for attempting to achieve disease remission
31. Which of the following factor is associated with worse prognosis of Rheumatoid arthritis?
I. HLA-DRB1 genotype.
II. RF
III. Auto-antibodies
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The prognosis of RA is generally much worse among patients with positive RF results. For example,
the presence of RF in sera has been associated with severe erosive disease.[26, 27] However, the absence of
RF does not necessarily portend a good prognosis.
32. Which of the following blood markers are associated with severe erosive disease?
I. RF
II. ACPA.
III. Anti-keratin antibodies(AKA).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
In fact, the presence of ACPA and antikeratin antibodies (AKA) in sera has been linked with severe
erosive disease,[26] and the combined detection of these autoantibodies can increase the ability to predict
erosive disease in RA patients.[27]
33. Which of the following time period leads to joint deformity & disability in RA patient?
I. Lasting few months.
II. Lasting few weeks.
III. More than 1 year.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
RA that remains persistently active for longer than 1 year is likely to lead to joint deformities and
disability.[28] Periods of activity lasting only weeks or a few months followed by spontaneous remission
portend a better prognosis.
34. What risk factors may contribute to mortality in RA patient?

I. Cardiovascular disease.
II. Infection & malignancy.
III. Cerebrovascular disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
RA is associated with traditional and nontraditional cardiovascular risk factors. The leading cause of
excess mortality in RA is cardiovascular disease, followed by infection, respiratory disease, and
malignancie
35. What are the benefits of patient education on Rheumatoid Arthritis?
I. Reduce pain .
II. Completely cure disease.
III. Reduce disability.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Patient education and counseling help to reduce pain, disability, and frequency of physician visits
36. Which of the following is the most cost-effective intervention of Rheumatoid Arthritis?
II. Psycho logic therapy.
III. Patient education.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
These may represent the most cost-effective intervention for RA

37. Which of the following articular deterioration are common in RA patient?
I. Difficulty in standing.
II. Difficulty in walking.
III. Difficulty in talking.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Patients with RA may report difficulty performing activities of daily living (adls), such as dressing,
standing, walking, personal hygiene, or use of hands
38. Which of the following constitutional symptoms are found in Rheumatoid Arthritis?
I. Fatigue.
II. Low-grade fever.
III. Weight gain.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer:
In addition to articular deterioration, constitutional symptoms (eg, fatigue, malaise, morning stiffness,
weight loss, and low-grade fever) may be present.
39. What is the time period of remission of Rheumatoid Arthritis?

I. First 2months.
II. First 3-6months.
III. After a year.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Spontaneous remission is uncommon, especially after the first 3-6 months.
40. What assessment is necessary during physical examination of Rheumatoid arthritis?
I. Tenderness & Stiffness.
II. Swelling & Deformity.
III. Bleeding & Tumor .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
During the physical examination, it is important to assess the following:

 Stiffness
 Tenderness
 Pain on motion
 Swelling
 Deformity
 Limitation of motion
 Extra-articular manifestations
 Rheumatoid nodules
41. Which of the following joints are mostly affected in Rheumatoid Arthritis?
I. Metacarpophalangeal & interphalangeal.
II. Clavicle.
III. Cervical spine & hip joint.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In decreasing frequency, the metacarpophalangeal (MCP), wrist, proximal interphalangeal (PIP),

knee, metatarsophalangeal (MTP), shoulder, ankle, cervical spine, hip, elbow, and
temporomandibular joints are most commonly affected.
42. Which of the following signs show affected joints in Rheumatoid Arthritis?
I. Tenderness & warmth.
II. Extreme pain.
III. Decrease range of motion & Swelling.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Affected joints show inflammation with swelling, tenderness, warmth, and decreased range of motion
(ROM). Atrophy of the interosseous muscles of the hands is a typical early finding.
43. What defects are commonly found after joint & tendon destruction in Rheumatoid
Arthritis patient?
I. Ulnar deviation.
II. Joint ankylosis.
III. Face ankylosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Joint and tendon destruction may lead to deformities such as ulnar deviation, boutonniere and swan-
neck deformities, hammer toes, and, occasionally, joint ankylosis.
44. What observations are found in musculoskeletal manifestations of Rheumatoid arthritis?
I. Tenosynovitis.
II. Periarticular osteoporosis.
III. Skeletal limb deformity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Observed musculoskeletal manifestations include the following:

 Tenosynovitis (defined as inflammation of the tendon and its enveloping tendon sheath) and
associated tendon rupture due to tendon and ligament involvement, most commonly involving
the fourth and fifth digital extensor tendons at the wrist
 Periarticular osteoporosis due to localized inflammation
Generalized osteoporosis due to systemic chronic inflammation, immobilization-related changes, or
corticosteroid therapy
45. Which of the following are deformities of finger in Rheumatoid Arthritis?

I. Boutonniere deformity.
II. Patrick maneuver.
III. Swan-neck deformity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The boutonniere deformity

Swan-neck deformity
46. What is meant by boutonniere deformity?
I. Hyper-extension at PIP joint with flexion of DIP joint.
II. Flexion at the PIP joint with hyper-extension of DIP joint.
III. Bony erosion of the tendon.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The boutonniere deformity describes nonreducible flexion at the PIP joint along with hyperextension
of the distal interphalangeal (DIP) joint of the finger.
47. What is meant by Swan-neck deformity?

I. Hyper-extension at PIP joint with flexion of DIP joint.
II. Flexion at the PIP joint with hyper-extension of DIP joint.
III. Bony erosion of the tendon.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Swan-neck deformity of the finger describes hyperextension at the PIP joint with flexion of the DIP
joint
48. What is the patho-physiology behind Flexor tenosynovitis of fingers in Rheumatoid
Arthritis?
I. Thickening of tendon interacts with concomitant tenosynovial proliferation.
II. Rupturing of PIP joint through the central ex-tensor tendon.
III. Bony erosion of the tendon at the wrist.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
occurs when thickening or nodule formation of the tendon interacts with the concomitant tenosynovial
proliferation, trapping the tendon in a flexed position (stenosing tenosynovitis). Tendon rupture may
occur as a consequence of infiltrative synovitis in the digit or bony erosion of the tendon at the wrist
(especially the flexor pollicis longus).
49. What is meant by Arthritis mutilans in Rheumatoid Arthritis?

I. In the small joints of the hands, the phalanges may shorten.
II. Rupturing of tendon.
III. Joint may bend in unusual directions merely under the pull of gravity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Arthritis mutilans (sometimes called opera glass hands) results if destruction is severe and extensive,
with dissolution of bone. In the small joints of the hands, the phalanges may shorten, and the joints
may become grossly unstable. Pulling on the fingers during examination may lengthen the digit in a
manner resembling the opening of opera glasses, or the joint may bend in unusual directions merely
under the pull of gravity.
50. What major deformities occur in wrist of Rheumatoid arthritis patient?
I. Disruption of the radioulnar joint.
II. Rupturing of tendon.
III. Rotation of the carpus on the distal radius.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Multiple deformities may occur in the wrist. Disruption of the radioulnar joint with dorsal
subluxation of the ulna (caput ulnae) as well as rotation of the carpus on the distal radius with an
ulnarly translocated lunate are common.
51. Which of the following is associated with zigzag deformity in Rheumatoid Arthritis?
I. Fingers.
II. Wrists.
III. Shoulders.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The combination of an ulnar drift of the fingers and carpal rotation is known as a zigzag deformity
52. Which of the following is associated with Elbow deformity in Rheumatoid arthritis?
I. Synovial proliferation at radiohumeral joint.
II. Flexion deformity.
III. Disruption of radioulnar joint.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Elbow involvement is often detected by palpable synovial proliferation at the radiohumeral joint and
is commonly accompanied by a flexion deformity, s
53. Which of the following leads to flattening of feet in Rheumatoid arthritis?

I. Midfoot disease.
II. Tibialis tendon.
III. MTP involvement.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Midfoot disease leads to loss of normal arch contour with flattening of the feet.
54. What is the effect of rheumatoid arthritis on Knees of the patient?
I. Effusion.
II. Tendon removal.
III. Synovial thickening.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Affected knees may develop large effusions and abundant accumulation of synovium. Knee effusions
and synovial thickening are common in RA and are easily detected during the early course of the
disease
55. Which of the following has abnormal Patrick maneuver in Rheumatoid art hritis?
I. Knees.
II. Hips.
III. Elbow.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Limited motion or pain on motion and weight bearing are the hallmarks of hip involvement. The
Patrick maneuver (flexion, external rotation, and abduction) is abnormal in this situation.
56. Which of the following test is performed in detecting flexion deformity of hips in RA
patient?
I. Edison test.
II. Addison test.
III. Thomas test.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
A flexion deformity may be demonstrable by conducting a Thomas test, which is performed by flexing
one hip (with the patient supine) while restricting pelvic motion by keeping the other hip in the neutral
position on the examination table
57. Which of the following vertebrae are affected in cervical spine by Rheumatoid arthritis?
I. C1-C2.
II. C2-C3.
III. C3-C4.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Cervical spine involvement (see the following image) usually affects C1-C2 and has the potential to
cause serious neurologic consequences
58. Which of the following structure abnormality is also involved in causing serious
neurologic consequences?
I. Hip joint.
II. Knee joint.
III. Cervical spine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Cervical spine involvement (see the following image) usually affects C1-C2 and has the potential to
cause serious neurologic consequences
59. What are the manifestations of Cervical spine in Rheumatoid arthritis?

I. Immobility of neck.
II. Headache.
III. Neck pain on motion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Neck pain on motion and occipital headache are common manifestations of cervical spine
involvement.
60. Which of the following structural destruction are likely to have symptomatic cervical
spine abnormality?
I. Destruction of knees.
II. Destruction of hands.
III. Destruction of Elbow.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Patients with severe destruction in the hands (arthritis mutilans) are very likely to have symptomatic
cervical spine abnormalities
61. Which of the following are used to relieve stiffness in Rheumatoid Arthritis?
I. Exercise.
II. Application of Pressure .
III. Heat.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
On physical examination, stiffness in patients with RA is determined by limitation of motion, which

may vary with the time of day. However, stiffness that is due to articular surface derangement or soft
tissue contractures about the joint does not vary with the time of day.
Severe stiffness in the hands may improve with heat, but it is most effectively relieved with active
exercise. These modalities reduce stiffness immediately after application, but unfortunately, they do
not prevent the return of stiffness.
62. What methods are used to elicit joint tenderness in Rheumatoid arthritis patient?
I. Direct palpation.
II. Pressure.
III. Heat.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Direct palpation can elicit joint tenderness, which can vary significantly among patients and with the
method of application of force used. To minimize variation over time, the examiner should try to
apply approximately the same pressure for each patient examined.
63. What is the reason behind the swelling in Rheumatoid arthritis patient?
I. Thickening of synovium.
II. Musculotendinous imbalance .
III. Tenosynovitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
In the MCP and MTP joints, the outline of the base of the proximal phalanx may become indistinct,
and in the PIP joints of the fingers, a fusiform swelling is noted that is due to the anatomy of the
synovial reflections
64. Which of the following manifestations are common in men compared to women in
Rheumatoid arthritis patient?
I. Vasculitis.
II. Pleural involvement.
III. Endocarditis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Some of these manifestations are more common in men (eg, pleural involvement, vasculitis, and
pericarditis),
65. Which of the following sites are more commonly affected by Rheumatoid nodules?
I. Back of heel.
II. On Elbow.
III. Proximal ulna.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Rheumatoid nodules occur in approximately 25% of patients with RA, but they occur in fewer than
10% of patients during the first year of the disease. These lesions are most commonly found on extensor
surfaces or sites of frequent mechanical irritation.
The olecranon process, the proximal ulna, the back of the heel, the occiput, and the ischial tuberosities
are common periosteal sites for rheumatoid nodule development
66. Which of the following organs are affected due to Rheumatoid arthritis?
I. Cardiac & pulmonary.
II. Neurologic & GI.
III. Excretory & reproductive system.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Effects on organ systems

RA affects several organ systems, as follows:
 Cutaneous
 Cardiac
 Pulmonary
 Renal
 Gastrointestinal (GI)
 Vascular
 Hematologic
 Neurologic
 Ocular
67. Which of the following is the pulmonary manifestations of Rheumatoid arthritis?

I. Asthma.
II. Pleural effusion.
III. Interstitial fibrosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
RA involvement of the lungs may take several forms, including pleural effusions, interstitial fibrosis,
nodules, and bronchiolitis obliterans organizing pneumonia.
68. What is the reason of renal impairment in Rheumatoid arthritis patients?
I. Medications.
II. Rheumatoid arthritis itself.
III. Inflammation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The kidneys usually are not directly affected by RA. Secondary involvement is common, including that
due to medications (eg, nonsteroidal anti-inflammatory drugs [nsaids], gold, and cyclosporine),
inflammation (eg, amyloidosis), and associated diseases (eg, Sjögren syndrome with renal tubular
abnormalities).
69. Which of the following hematological disorders are common in Rheumatoid arthritis
patient?
I. Anemia
II. Hemophilia.
III. Thrombocytosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Some patients with active RA have an anemia of chronic disease. Several hematologic parameters
parallel disease activity, including normochromic-normocytic anemia, thrombocytosis, and
eosinophilia, though the last of these is uncommon. Leukopenia is a finding in patients with Felty
syndrome
70. In how many types patients are categorized suffering from Rheumatoid Arthritis?
I. 3 stages.
II. 4 stages.
III. 6 stages.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
To determine the progression of RA, patients are categorized by clinical and radiologic criteria into 4
stages
71. Which of the following is categorized in stage 1 in RA individual?

I. Radiographic evidence of osteoporosis.
II. Radiographic evidence of periarticular osteoporosis.
III. No destructive changes observed .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Stage I (early RA) No destructive changes observed upon radiographic examination;

radiographic evidence of osteoporosis is possible
I. Joint deformity observed.
III. Cartilage destruction .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Stage II (moderate progression) Radiographic evidence of periarticular osteoporosis, with or

without slight subchondral bone destruction; slight cartilage destruction is possible; joint
mobility is possibly limited, but no joint deformities are observed; adjacent muscle atrophy is
present; extra-articular soft tissue lesions (eg, nodules and tenosynovitis) are possible

I. Radiographic evidence of cartilage and bone destruction.
II. Joint deformity observed.
III. Radiographic evidence of periarticular osteoporosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Stage III (severe progression) Radiographic evidence of cartilage and bone destruction in
addition to periarticular osteoporosis; joint deformity (eg, subluxation, ulnar deviation, or
hyperextension) without fibrous or bony ankylosis; muscle atrophy is extensive; extra-articular
soft tissue lesions (eg, nodules, tenosynovitis) are possible
I. Presence of fibrous Ankylosis.
III. Joint deformity observed.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Stage IV (terminal progression) Presence of fibrous or bony ankylosis, along with criteria of stage III
75. According to DAS28 scale(0-9.4),at what scale severity of the disease is classified?
I. Greater than 6.1
II. Greater than 7.1.
III. Greater than 5.1.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
 DAS28 (ESR or CRP) (scale, 0-9.4) Low/minimal disease, 2.6 or more to less than 3.2;
moderate disease, 3.2 or more to 5.1 or less; high/severe disease greater than 5.1
76. According to SDAI scale(0-86),at what scale severity of the disease is classified?
I. Greater than 20.
II. Greater than 26.
III. Greater than 30 .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
 SDAI (scale, 0-86) Low/minimal disease, greater than 3.3 to 11.0 or less; moderate disease,
greater than 11.0 to 26 or less; high/severe disease, greater than 26
77. According to measurement of functional status which patients are classified in Class 1
category?
I. Completely able to perform activities
II. Able to perform usual self-care.
III. Limited in vocational & avocational activities.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Measurement of functional status

Patients with RA are categorized into 4 functional classes:
 Class I Completely able to perform usual activities of daily living
category?
I. Completely able to perform usual activities of daily living.
II. Able to perform usual self-care activities.
III. Limited in avocational activities.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Class II Able to perform usual self-care and vocational activities but limited in avocational activitie
category?
I. Completely able to perform usual activities of daily living.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Class III Able to perform usual self-care activities but limited in vocational and avocational
activities
category?
I. Unable to perform usual activities of daily living.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Class IV Limited in ability to perform usual self-care, vocational, and avocational activities
81. Which of the following is true regarding Rheumatoid arthritis?

I. It is a treatable disease
II. It is a manageable disease.
III. It is a completely curable disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
RA is progressive and cannot be cured, but in some patients, the disease gradually becomes less
aggressive, and symptoms may even improve.
82. What are the complications of Rheumatoid arthritis?
I. Anemia & Osteoporosis.
II. Coronary ischemic heart disease.
III. Rickets.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 Anemia
 Infections Patients with RA are at greater risk for infections; immunosuppressive drugs
further increase that risk
 GI problems Patients with RA may experience stomach and intestinal distress; however,
lower rates of stomach and colorectal cancers have been reported in RA patients
 Osteoporosis This condition is more common than average in postmenopausal women with
RA; the hip is particularly affected; the risk of osteoporosis appears to be higher than average
in men with RA who are older than 60 years
 Lung disease A small study found a high prevalence of pulmonary inflammation and fibrosis
in patients with newly diagnosed RA, but this finding may be associated with smoking
Heart disease RA can affect blood vessels and increase the risk of coronary ischemic heart disease
83. Which of the individual is more susceptible to osteoporosis in Rheumatoid arthritis?

I. Greater than 60years men.
II. Greater than 60 years women.
III. Greater than 80 years men.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The risk of osteoporosis appears to be higher than average in men with RA who are older than 60
years
84. Which of the following syndrome is more common in Rheumatoid arthritis patient?
I. Cushings syndrome.
II. Sjogren syndrome.
III. Felty syndrome.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Sjögren syndrome Keratoconjunctivitis sicca is a common complication of RA; oral sicca

and salivary gland enlargement are less common
 Felty syndrome This condition is characterized by splenomegaly, leukopenia, and recurrent
bacterial infections; it may respond to disease-modifying antirheumatic drugs (dmards)
85. Which of the following syndrome is characterized by splenomegaly & bacterial

infections?
I. Felty syndrome.
II. Sjogren syndrome.
III. Cushings syndrome.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
 Felty syndrome This condition is characterized by splenomegaly, leukopenia, and recurrent

bacterial infections; it may respond to disease-modifying antirheumatic drugs (dmards)
86. What are the diagnostic parameters of rheumatoid arthritis?
I. Clinical & imaging studies.
II. Lab studies.
III. Only Clinical studies.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
No test results are pathognomonic for rheumatoid arthritis (RA); instead, the diagnosis is made by
using a combination of clinical, laboratory, and imaging features
87. What results are shown by Bone scanning findings in RA patient?

I. Distinguish inflammatory changes.
II. Detect bone mineral density.
III. Detect bone porosity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Bone scanning findings may help distinguish inflammatory from noninflammatory changes in patients
with minimal swelling
88. What results are shown in Densitometery findings in RA patients?
I. Detect bone mineral density.
II. Detect bone porosity.
III. Detect inflammatory changes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
And densitometry findings are useful for helping diagnose changes in bone mineral density that are
indicative of osteoporosis.
89. Which of the following are markers of inflammation?

I. RF assay
II. ESR level.
III. CRP level.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The ESR and the CRP level are associated with disease activity. The CRP value over time correlates
with radiographic progression.
90. Which of the following is true about hematological parameters of RA?
I. Anemia is related to DMARDS therapy.
II. It doesn't improve with therapy.
III. Hypochromic anemia is associated with use of NSAIDs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The CBC commonly demonstrates anemia of chronic disease and correlates with disease activity; it
improves with successful therapy. Hypochromic anemia suggests blood loss, commonly from the
gastrointestinal (GI) tract (associated with the use of nonsteroidal anti-inflammatory drugs [nsaids]).
Anemia may also be related to disease-modifying antirheumatic drug (DMARD) therapy.
91. Which of the following are immunologic parameters to be considered while diagnosing
RA?
I. RF.
II. CRP.
III. Anti-CCP antibodies.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Immunologic parameters include autoantibodies (eg, RF, anti-CCP antibodies, and anas).
92. What is the major prediction of RF parameter in Rheumatoid Arthritis?
I. Predict bone erosion.
II. Predict bone mineralization.
III. Predict inflammation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The presence of RF predicts radiographic progression of bone erosions, independent of disease activity. [
93. During which state it is difficult to assess the presence of Rheumatoid arthritis?
I. In Renaly impaired patient.
II. During pregnancy.
III. In heart patient.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Pregnancy
RA often goes into remission during pregnancy. The presence of RF neither helps predict nor correlates
with the outcome of arthritis during pregnancy. The ESR cannot be used to assess RA disease activity
during pregnancy, because pregnancy alters the normal values.
94. Which of the following is the most easiest and first line approach for diagnos ing RA?
I. MRI.
II. Radiography.
III. Ultrasonography.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Radiography remains the first choice for imaging in RA; it is inexpensive, readily available, and easily
reproducible, and it allows easy serial comparison for assessment of disease progression.
95. What are the benefits of Magnetic resonance imaging in RA patient?

I. Detection of lesions.
II. Assessing disease progression.
III. Used primarily in cervical spine abnormality.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Magnetic resonance imaging (MRI) provides a more accurate assessment and earlier detection of
lesions than radiography does[51] ; however, the cost of the examination and the small size of the joints
involved militate against its widespread use. MRI is used primarily in patients with abnormalities of
the cervical spine (see the images below); early recognition of erosions on the basis of MRI images has
been sufficiently validated.
96. What benefits does ultrasonography provides in Rheumatoid Arthritis patient?
I. Detection of lesions.
II. Assessing disease progression.
III. Recognition of effusions in joints.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Ultrasonography allows recognition of effusions in joints that are not easily accessible (eg, the hip and,
in obese patients, the shoulder) and of cysts (Baker cysts). In addition, high-resolution sonograms allow
visualization of tendon sheaths, changes and degree of vascularization of the synovial membrane, and
even erosions
97. Which of the following is more accurate for hand diagnosing in RA?
I. MRI.
II. Ultrasonography.
III. Radiography.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Radiography is the mainstay of imaging RA in the hands: It is inexpensive and easily reproducible,
and it allows easy serial comparison for assessment of disease progression. Its main disadvantage is the
absence of specific radiographic findings in early disease; erosions may only be visualized later.
98. In which state Joint aspiration is considered in RA patient?
I. To rule out infection.
II. To rule out asthma.
III. To rule out crystal arthritis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Consider joint aspiration when making the definitive diagnosis of RA or when ruling out coexistent
infection or crystal arthritis in an acutely swollen join
99. What major histologic findings are found in Rheumatoid arthritis patient?
I. Lymphoplasmacytic infiltration.
II. Synovial inflammation.
III. Granulomatous inflammation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The lymphoplasmacytic infiltration of the synovium with neovascularization seen in RA is similar to

that seen in other conditions characterized by inflammatory synovitis. Early rheumatoid nodules are
characterized by small-vessel vasculitis and later by granulomatous inflammation.
100. What is the count of white blood cells during inflammation in Rheumatoid Arthritis?
I. WBC >1500/uL.
II. WBC >2000/uL.
III. WBC >2500/uL.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
In patients with RA, analysis typically reveals inflammation (white blood cell [WBC] count
>2000/µl, generally in the range of 5000-50,000/µl)
1. What are the treatment approach for managing Rheumatoid arthritis?

II. Physiotherapy & exercise.
III. Medication+Non-pharmacologic therapy+Surgery.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Optimal care of patients with rheumatoid arthritis (RA) consists of an integrated approach that includes both
pharmacologic and nonpharmacologic therapies. Many nonpharmacologic treatments are available for this
disease, including exercise, diet, massage, counseling, stress reduction, physical therapy, and surgery.
2. What classes of drug are used to treat Rheumatoid Arthritis?

I. NSAIDS & DMARDs.
II. Opioid analgesics & Local anesthetics.
III. Immunosuppressants & corticosteroids.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Medication-based therapies comprise several classes of agents, including nonsteroidal anti-inflammatory drugs
(nsaids), nonbiologic and biologic disease-modifying antirheumatic drugs (dmards), immunosuppressants, and
corticosteroids.
3. Which of the following is used as a first line therapy for Rheumatoid arthritis?
I. NSAIDs.
II. DMARDs.
III. Immunosuppressive agents.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Early therapy with dmards has become the standard of care, in that it is capable not only of retarding disease
progression more efficiently than later treatment but also, potentially, of inducing more remission
4. What are the surgical options for Rheumatoid Arthritis individual?

I. Synovectomy & tenosynovectomy.
II. Tendon surgery.
III. Tendon realignment & reconstructive surgery.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Surgical treatments for RA include synovectomy, tenosynovectomy, tendon realignment, reconstructive surgery
or arthroplasty, and arthrodesis.
5. What is the time period for monitoring the patient with Rheumatoid Arthritis?
I. Every month.
II. Every 2 month.
III. Every 3 months.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Patients with active disease should be monitored every 3 months, and treatment should be adjusted if there is
no improvement at 6 months
6. Which of the following is considered as first line therapy in Rheumatoid arthritis patient?
I. Sulfasalazine.
II. Methotrexate.
III. Leflunomide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
 Methotrexate (MTX) is recommended as first-line therapy; sulfasalazine (SSZ) or leflunomide can be

substituted if there are contraindications to MTX
7. Which of the following should be combined with DMARDS?

I. NSAIDs.
II. Biologics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Biologics should be combined with disease-modifying antirheumatic drugs (dmards)
8. What is the treatment guideline according to ACR if the patient disease activity is moderate in
less than 6 months?
I. DMARD Therapy.
II. DMARD+Methotrexate.
III. Methotrexate only.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Administer DMARD combination therapy (eg, double or triple therapy) in those with moderate or high disease
activity and poor prognostic features
9. What is the treatment guideline according to ACR if the patient disease activity is severe in less
than 6 months?
I. DMARDS only.
II. Methotrexate+ Anti-TNF.
III. Anti-TNF only .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Use an anti-TNF agent ± MTX in those with high disease activity and poor prognostic features
10. Which of the following DMARDs cannot be used as mono-therapy?

I. Adalimumab.
II. Rituximab.
III. Infliximab.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Except for infliximab, which is used in combination with MTX only (ie, do not use infliximab as monotherapy)
11. Which of the following drug is prescribed if RA patient is also suffering from HCV?
I. Infiximab.
II. Methotrexate.
III. Etanercept.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
In patients with RA requiring treatment who are infected with hepatitis C virus (HCV), etanercept is
recommended.
12. What are the contraindications of biologic agents in RA?

I. Hepatitis A
II. Hepatitis B.
III. Hepatitis C.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
In RA patients with untreated chronic hepatitis B virus (HBV) infection, as well as those with treated chronic
HBV disease of Child-Pugh class B and higher, biologic agents are not recommended.
13. Which of the following is used if the patient is previously treated with solid malignancy or
melanoma skin cancer in RA patient?
I. Methotrexate.
II. Rituximab.
III. Abatacept.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Starting or resuming rituximab is recommended only for the following patients with RA[66] :
 Those with either a previously treated solid malignancy or a previously treated nonmelanoma skin
cancer within the past 5 years
 Those with a previously treated melanoma skin cancer
 Those with a previously treated lymphoproliferative m0alignancy
14. Anti-tumor factor agents are not recommended in which of the following state of RA patient?
I. Congestive heart failure.
II. Diabetes.
III. Pulmonary effusion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Association (NYHA) congestive heart failure (CHF) class III
15. Which of the following screening tests is necessary before initiating biologic agents in RA patient?
I. HBV screening.
II. HIV screening .
III. TB screening.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
In patients with RA who are under consideration for beginning or receiving treatment with biologic agents,
screening for latent tuberculosis (TB) infection (LTBI) is recommended, regardless of whether these individuals
have risk factors for LTBI
16. Which of the following TB tests are performed in Rheumatoid arthritis patient?
I. Tuberculin skin test.
II. Sputum test.
III. Interferon Gamma release assay.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Regardless of the risk factors for LTBI, the initial screening test for TB in patients with RA who are starting
therapy with biologic agents should be the tuberculin skin test (TST) or interferon (IFN) gamma release assays
(igras)
17. Which of the following class of drugs require administration of vaccines in RA patient?
I. DMARD mono-therapy or combination.
II. Anti-TNF biologic agents.
III. Anti-TNF or Non-TNF biologic agents.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Before RA patients start or while they are on nonbiologic DMARD monotherapy (hydroxychloroquine [HCQ],
leflunomide, MTX, minocycline, or SSZ), DMARD combination therapy (double [mostly MTX-based] or
triple [HCQ, MTX, and SSZ]), or anti-TNF (adalimumab, certolizumab, etanercept, golimumab, or
infliximab) or non-TNF (abatacept, rituximab, or tocilizumab) biologic agents, administer all killed vaccines
(pneumococcal, intramuscular influenza, and HBV) and human papillomavirus (HPV) recombinant vaccine
18. Which of the following vaccine is not recommended for RA patient already on Anti -TNF or
non-TNF biologic agents?
I. HBV vaccine.
II. HPV vaccine.
III. HZV vaccine .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The herpes zoster virus (HZV) live attenuated vaccine should only be administered before RA patients start
DMARD monotherapy, combination dmards, and anti-TNF or non-TNF biologic agents, as well as in those
already receiving DMARD monotherapy or combination dmards. This vaccine is not recommended for RA
patients already on anti-TNF or non-TNF biologic agents.
19. Which of the following RA patients are more susceptible towards morbidity & mortality?
I. Rheumatoid arthritis with carpal tunnel syndrome.
II. Rheumatoid arthritis with Felty syndrome.
III. Rheumatoid arthritis with Baker cysts.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Felty syndrome is a triad of RA, neutropenia, and splenomegaly. Patients with Felty syndrome are prone to
serious bacterial infections that result in higher morbidity and mortality than those reported for other patients
with RA. Prompt diagnosis and initiation of antibiotic therapy are required.
20. Which of the following is true about Baker Cysts in Rheumatoid arthritis patient?
I. Pain & edema in knee & calf.
II. Triad of RA,neutropenia & splenomegaly.
III. Treatment is needle puncture of calf & knee joint aspiration.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Ruptured Baker cysts are often confused with deep vein thrombosis (DVT). Baker cysts often occur fairly early
in the course of the disease, with pain, edema, and inflammation in the posterior knee and calf. The diagnosis
is best made with ultrasonography. Treatment includes rest, elevation, needle puncture of the calf, knee joint
aspiration, and referral
21. What is the treatment guideline in RA patient suffering from Carpal tunnel syndrome?
I. Temporary immobilization.
II. NSAIDs.
III. Immunosuppressants.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Carpal tunnel syndrome (median nerve compression neuropathy) is evinced by pain or paresthesias in the
median nerve distribution of the hand, a positive Phalen or positive Tinel test, or positive findings on
electromyography (EMG). Therapy includes rest, temporary immobilization, nsaids, and surgery
22. Which of the following drugs can be used in RA patient in pregnancy?
I. Methotrexate.
II. Low dose corticosteroids.
III. Sulfasalazine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Medications considered low-risk in pregnancy include immunomodulating drugs, low-dose corticosteroids,

antimalarial agents, SSZ, and azathioprine
23. Which of the following drug should be avoided in RA patient during third trimester on ly?
I. Methotrexate.
II. NSAIDs.
III. Rituximab.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Nsaids should be avoided in the third trimester.
24. What are the ADRs associated with methotrexate in pregnancy?

I. Hydrocephaly & ancephaly in fetus.
II. Mental abnormalities in fetus.
III. Abortifacient.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
MTX is contraindicated in pregnancy, because it is an abortifacient and has teratogenic effects, including
craniofacial abnormalities, limb defects, and central nervous system (CNS) defects such as anencephaly,
hydrocephaly, and meningomyelopathy, especially with first-trimester exposure
25. What are the major goals of Rehabilitation therapy in Rheumatoid arthritis patient?
I. Relief of pain & correction of deformity.
II. Improvement in range of motion.
III. Relief from all symptoms.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Goals of rehabilitation for RA patients include relief of pain, improvement in range of motion (ROM),
enhancement of strength and endurance, prevention and correction of deformities, and provision of counseling
and educational services
26. Why heat therapy is necessary in treating rheumatoid arthritis patient?

I. It causes relief of joint pain.
II. It causes relief of stiffness.
III. It is used for treating inflamed joint.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Application of heat, either superficial or deep, is an effective modality for the relief of joint pain and stiffness
caused by RA. In addition, it is used to treat joints in preparation for ROM, stretching, and muscle-
strengthening exercises.
27. What are the heating methods used in treating Rheumatoid arthritis?
I. Hot shower or spas.
II. Paraffin.
III. Radiography.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Heat may be administered via moist hot packs, electric mittens, a hot shower, spas, ultrasonography,
diathermy, or paraffin. Superficial and deep heating methods have been shown to raise the intra-articular
temperature in patients with RA.
28. Why cold therapy is necessary in treating rheumatoid arthritis patient?

I. It causes relief of joint pain.
II. It causes relief of stiffness.
III. It is used for treating inflamed joint.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Cold is preferable for treatment of an acutely inflamed joint. Application of cold results in decreased pain and
decreased muscle spasm. Cold may be delivered via ice packs, ice sticks, topical sprays, or ice water.
29. What are the methods used for applying cold therapy?
I. Topical sprays.
II. Ice water or ice packs.
III. Topical solutions or creams.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Cold may be delivered via ice packs, ice sticks, topical sprays, or ice water.
30. What are the benefits of Orthotic devices in Rheumatoid arthritis?

I. To decrease pain & inflammation.
II. Improve mobility.
III. Reduce deformity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Orthotic devices play an important role in the rehabilitation management of patients with RA. These devices
are used to decrease pain and inflammation, improve function, reduce deformity, and correct biomechanical
malalignment.
31. What is the benefit of metatarsal pad in Rheumatoid arthritis?

I. To remove weight from painful MTP.
II. To reduce deformity.
III. To decrease pain.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
A metatarsal pad or bar is typically used to remove weight from painful metatarsophalangeal (MTP) joints,
32. Why Therapeutic exercise is important in Rheumatoid arthritis?
I. Because of fatigue in RA patient.
II. Because of decreased endurance in RA patient.
III. Because of inflammation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Fatigue and decreased endurance are frequent symptoms in patients with RA. When these patients are compared
with age-matched subjects who do not have RA, a reduction in aerobic capacity and muscle strength is noted,
both because of the disease itself and because of the lack of physical activity in these patients
33. What are the most commonly used hand splints in Rheumatoid arthritis?
I. Finger-ring splint.
II. Resting-hand splint.
III. Thumb-post splint.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The most commonly used splints for the hand are the finger-ring splint and the thumb-post splint.
34. What are the uses of adaptive equipment in Rheumatoid arthritis patient?
I. Used in assisting patients with dressing .
II. Reduce inflammation.
III. Used to maximize function.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Many assistive devices are available to patients with RA and are used to maximize function, maintain
independence, reduce joint stress, conserve energy, and provide pain relief. Equipment is available to assist
patients with transfers, dressing, feeding, toileting, cooking, and ambulation. Physical and occupational
therapists can assist with training in the use of adaptive equipment.
35. What are the recommendations for Joint-protection education?

I. Prevention of joint overuse.
II. Prevention of joint inflammation.
III. Avoiding of torque that bend joint.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Joint-protection education provides the patient with techniques and recommendations for preventing joint
overuse and avoiding of bio-mechanical torques that excessively bend the joint.
36. Which of the following agents are more effective in improving physical function in Rheumatoid
arthritis?
I. Methotrexate.
II. Etanercept.
III. Rituximab.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
A study by Callhoff et al found that biologic agents were significantly more effective than nonbiologic treatments
in improving physical function in RA. In the investigation, a meta-analysis of 35 studies that included 8733
treated patients with RA and 4664 controls. More than 50% of patients treated with biologics experienced
clinically relevant improvement. Etanercept and rituximab were the most effective treatments, both in patients
who had never before taken antirheumatic drugs and in those who had shown an inadequate response to them
37. What are the recommendations for patients with early Rheumatoid arthritis?
I. Methotrexate only.
II. Sulfasalazine only.
III. Combination of both.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
For patients with early RA, the combination of MTX and SSZ does not work better than monotherapy with
either drug
38. Which of the following are associated with complications of Biologic agents in Rheumatoid
Arthritis?
I. Biological agent mono-therapy.
II. Concomitant use of Biologic agent .
III. Immunosuppressent mono-therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Concomitant use of 2 biologic agents has been associated with an increased risk for complications without clear
improved benefit
39. Which of the following are included in Non-biologic DMARDs?

I. Hydroxychloroquine & Sulfasalazine.
II. Chloroquine .
III. Methotrexate & Leflunomide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The nonbiologic dmards include hydroxychloroquine (HCQ), azathioprine (AZA), sulfasalazine (SSZ),
methotrexate (MTX), leflunomide, cyclosporine, gold salts, D-penicillamine, and minocycline.
40. Which of the following are included in Biologic DMARDs?

I. Adalimumab.
II. Etanercept.
III. Sulfsalazine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Biologic dmards include agents such as adalimumab, certolizumab, etanercept, golimumab and infliximab.
41. Which of the following therapy may eliminate the need for other Pharmacologic agents?
I. NSAIDs.
II. DMARDs.
III. Immunosuppresant.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Dmards represent the most important measure in the successful treatment of RA. These agents can retard or
prevent disease progression and, thus, joint destruction and subsequent loss of function.Successful DMARD
therapy may eliminate the need for other anti-inflammatory or analgesic medications; however, until the full
action of dmards takes effect, anti-inflammatory or analgesic medications may be required as bridging therapy
to reduce pain and swelling.
42. Which of the follow.ing DMARDs decrease the risk of diabetes in RA patient?
I. Methotrexate
II. Sulfasalazine.
III. Hydrocholoroquine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The results of a retrospective cohort study found that the use of HCQ may decrease the risk of diabetes in
patients with RA
43. Which of the following has become the standard of care in moderate to severe RA?
I. Sulfasalazine.
II. Methotrexate.
III. Leflunomide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
MTX, either alone or in combination with other agents, has become the standard of care for moderate to severe
RA
44. Which of the following drug is approved as single-dose self-administered subcutaneous injection
in severe adult RA?
I. Rituximab.
II. Methotrexate .
III. SulfaSalazine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The US Food and Drug Administration (FDA) approved the first single-dose, self-administered, disposable
MTX subcutaneous autoinjector (Otrexup).[85] Otrexup is indicated for adults with severe, active RA who have
either responded inadequately to or cannot tolerate first-line therapy,
45. Which of the following is the brand name of first subcutaneous Methotrexate?
I. Zanax.
II. Otrexup.
III. Nuberol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
MTX subcutaneous autoinjector (Otrexup)
46. Which of the following DMARD act as a matrix metalloproteinase inhibitor (MMPI)?
I. Rituximab.
II. Infliximab.
III. Minocycline.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Minocycline may act as a DMARD through its action as a matrix metalloproteinase inhibitor (MMPI).
47. Which of the following is the recent addition to non-biologic DMARDs?

I. Gold salts.
II. Leflunomide.
III. Penicillamine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Leflunomide is the most recent addition to the nonbiologic dmards and has activity similar to that of SSZ and
MTX.
48. What is the mechanism of action of TNF inhibitor?
I. Binds TNF & destroy it.
II. Binds TNF & prevent its interaction with receptors.
III. Binds TNF & changes its structure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The TNF inhibitors that bind TNF and thus prevent its interaction with its receptors
49. What adverse effects are associated with biologic agents?

I. Infections & Generation of antibodies against these compounds.
II. Emergence of ANAs.
III. Cross blood brain barrier.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Adverse effects associated with the biologic agents include the generation of antibodies against these compounds,
emergence of antinuclear antibodies (anas), occasional drug-induced lupuslike syndromes, and infections
(including tuberculosis). Rarely, demyelinating disorders and bone marrow suppression occur
50. Which of the following drug is associated with development of anti-drug antibodies?
I. Adalimumab.
II. Rituximab.
III. Infliximab.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Immunogenicity, such as the development of anti-drug antibodies, has been shown to occur in adalimumab
and infliximab, potentially leading to decreased drug efficacy.
51. When anti-TNF agents are prescribed which of the following must not be administered in RA
patient?
I. Inactive vaccines.
II. Live-virus vaccines.
III. Antibiotics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Patients taking anti-TNF agents must avoid live-virus vaccines. Giving live vaccines to patients receiving
immunosuppressive drugs leads to a higher risk for serious infection.
52. Which of the following therapy increased the risk of septic arthritis in patients with RA?
I. Anti-TNF therapy.
II. Non-Anti TNF therapy.
III. Immunosuppressant.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The results of one study noted that the use of anti-TNF therapy may double the risk of septic arthritis in patients
with RA, with the risk being highest in the early months of therapy
53. Which of the following therapy showed higher rate of bone erosion's repair in RA patients?
I. Methotrexate.
II. TNF inhibitor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
In one study, bone erosions showed a higher rate of repair in RA patients treated with TNF inhibitors than in
patients treated with MTX
54. What is the effective approximate blood levels of adalimumab in RA patient?
I. 2-3ug/mL.
II. 5-8ug/mL.
III. 10ug/mL.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
According to data from a study of 221
additional beneficial effect on disease activity
55. What are the drug interactions of Methotrexate with adalimumab in RA patient?
I. Lower the no. of targets for binding.
II. Reducing blood levels of adalimumab.
III. Increasing blood levels of adalimumab.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
MTX might contribute to increasing adalimumab blood levels by reducing inflammation and lowering the
number of targets for adalimumab to bind to
56. What is the dose of certolizumab in RA patient?

I. 200mg.
II. 400mg.
III. 500mg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
]
In this study, 200 patients were randomized on a 1:1 basis to receive certolizumab 400 mg or placebo every
4 weeks for 24 weeks.
57. What is the mechanism of action of Golimumab?

I. Inhibits TNF-β bioactivity.
II. Inhibits TNF-α bioactivity.
III. Modulating immune activity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
-α monoclonal antibody that inhibits TNF-α bioactivity, thereby

modulating immune activity in patients with RA.
58. What adverse effects are associated with Golimumab in RA patient?

I. Respiratory Infection.
II. UTI.
III. GI irritation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The rate of adverse events and serious adverse events, respectively, at week 24 were 53% and 4% in the
golimumab group and 49% and 2% in the placebo group.[100, 101] The most common adverse events were
"infections and infestations," including upper respiratory tract infection (>5% of patients), urinary tract
infection, and nasopharyngitis.
59. Which of the following is true about Rituximab in RA patient?
I. Effective when Anti-TNF is non-responsive.
II. Effective when immunosuppressant therapy is non-responsive.
III. Deplete CD 20+ B cells.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Rituximab is most often used in combination with MTX. It has been shown to be effective for reducing signs
and symptoms in adult patients with moderately to severely active RA who have had an inadequate response to
therapy with 1 or more TNF inhibitors.[103, 104, 105]
Treatment with rituximab may deplete CD20+ B cells.
60. Which of the following is non-glycosylated form of human IL-1 receptor antagonist?
I. Abatacept.
II. Anakinra.
III. Rituximab.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Anakinra is a recombinant nonglycosylated form of the human IL-1 receptor antagonist (IL-1ra). IL-1ra
occupies the IL-1 receptor without triggering it and prevents receptor binding of IL-1.
61. What is the mechanism of action of Abatacept in RA?
I. Increase T-cell activation.
II. Inhibits T-cell activation.
III. Block the interaction with CD28.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Abatacept is a selective costimulation modulator that inhibits T-cell activation by binding to CD80 and
CD86, thereby blocking their interaction with CD28. CD28 interaction provides a signal needed for the full
T-cell activation that is implicated in RA pathogenesis.
62. Which of the following is the IL-6 receptor antagonist?

I. Abatacept.
II. Tocilizumab.
III. Anakinra.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Tocilizumab, an IL-6 receptor inhibitor, is available as either an IV infusion or SC injection.

63. What is the mechanism of action of Tofacitinib?
I. Prevents phosphorylation of STATs.
II. Increase production of cytokines.
III. Reduces production of cytokines.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
JAK inhibitors modulate the signaling pathway at the point of jaks, preventing the phosphorylation and
activation of stats. These signals maintain the inflammatory condition in RA. Inhibition of jaks reduces
production of and modulates proinflammatory cytokines central to RA.
Tofacitinib is an oral JAK inhibitor[115] that was approved by the US Food and Drug Administration (FDA)
64. Which of the following combination of DMARD is proved successful in RA patient?

I. MTX+SSZ+Gold salt.
II. MTX+SSZ+HCQ.
III. MTX+Leflunomide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Several combinations have proved successful without posing unexpected added risks; most include MTX (eg,
MTX plus SSZ plus HCQ, MTX plus leflunomide, or MTX plus biologic dmards).
65. Which of the following therapy is the best treatment compared to other?
I. MTX alone .
II. MTX+SSZ+HCQ.
III. SSZ+HCQ.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Triple therapy with MTX, SSZ, and HCQ may provide substantially greater clinical improvement than either
MTX alone or SSZ plus HCQ.[122]
66. What ADRs are associated with MTX+Leflunomide combination?

I. Liver toxicity.
II. Bone marrow toxicity.
III. Renal toxicity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Though liver and bone marrow toxicity may be increased if MTX and leflunomide are combined.
67. Which of the following is true about side effect of drug with renal toxicity?
I. Gold salts.
II. Methotrexate.
III. D-penicillamine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Renal toxicity (cyclosporine, parenteral gold salts, and D-penicillamine)

68. Which of the following is true about side effect of allergic skin reactions?
I. Leflunomide.
II. Gold compounds.
III. Sulfasalazine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Allergic skin reactions (gold compounds and SSZ
69. The major side effect associated with cyclosprine is which of the following?
I. Skin reaction.
II. Renal toxicity.
III. Infection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Infections (azathioprine and cyclosporine).
70. Which of the following is correct about the use of corticosteroids in RA patient?
I. Used as monotherapy.
II. Used as adjunct with DMARD.
III. Used as adjunct with NSAID.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Corticosteroids are potent anti-inflammatory drugs that are commonly used in patients with RA to bridge the
time until treatment with dmards is effective.[130, 131] These agents are effective adjuncts to DMARD or NSAID
therapy.
71. What are the adverse effects associated with Corticosteroids?
I. Renal toxicity.
II. Liver toxicity.
III. Heart failure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
One study found that the use of corticosteroids was associated with heart failure in patients with RA,
independent of cardiovascular risk factors and coronary heart disease (CHD).
72. What is the mechanism of action of NSAIDs?

I. Inhibits enzyme COX.
II. Reduce swelling & pain.
III. Retard joint destruction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Nsaids interfere with prostaglandin synthesis through inhibition of the enzyme cyclooxygenase (COX), thus
reducing swelling and pain. However, they do not retard joint destruction and thus are not sufficient to treat
RA when used alone
73. Which of the following are commonly used NSAIDs?

I. Ibuprofen.
II. Leflunomide.
III. Diclofenac.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Commonly used nsaids include ibuprofen, naproxen, ketoprofen, piroxicam, and diclofenac.
74. Which of the following is true about NSAIDs?

I. NSAIDs are COX-1 inhibitors.
II. NSAIDs are COX-2 inhibitors.
III. NSAIDs are non-selective COX inhibitors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
COX-1 has a protective role, particularly in the stomach, whereas COX-2 is strongly upregulated during
inflammation. Traditional nsaids are nonselective COX inhibitors, inhibiting both COX-1 and COX-2
75. What are the Adverse effects associated with NSAIDs?

I. GI toxicity.
II. Hypertension & water retention.
III. Hypotension & water retention.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Coxibs, with their selectivity for COX-2, have been shown to be clinically efficacious and are accompanied by
reduced gastrointestinal (GI) toxicity, the major adverse event related to the use of nonselective COX inhibitors
(ie, nsaids). Other adverse effects, such as water retention, hypertension, and abnormal transaminase levels, are
observed with both nonselective COX inhibitors and selective COX-2 inhibitors.
76. Which of the following is not the benefit of analgesics??
I. Reduction of pain.
II. Reduction of swelling.
III. Prevention of joint destruction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Acetaminophen, tramadol, codeine, opiates, and various other analgesic medications can also be used to reduce
pain. These agents do not affect swelling or joint destruction.
77. On which factors surgery is considered in RA patient?

I. Disease stage & disability level
II. Patients past medical history.
III. Patients age.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
el of disability, as well as
the location of the involved joints, must be considered.
78. Which of the following medications are used as bridging therapy along with DMARDs?
I. Analgesics.
II. Anti-inflammatory medications.
III. Steroids.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Successful DMARD therapy may eliminate the need for other anti-inflammatory or analgesic medications;
however, until the full action of dmards takes effect, anti-inflammatory or analgesic medications may be
required as bridging therapy to reduce pain and swelling.
79. What advice would you gave to patient prescribed with leflunomide?
I. Not to be used in renaly impaired patient.
II. Not to be used in pregnancy.
III. Not to be used in Heart patient.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Leflunomide is contraindicated in women who are or may become pregnant.
80. What is the dose of Sulfasalazine in RA patient?

I. 2g/day.
II. 0.5-1g/day.
III. 3g/day.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
SSZ delayed-release tablets do not have an immediate response; therefore, concurrent treatment with nsaids or
other analgesics is recommended at least until the effect of the delayed-release tablets is apparent. The initial
dosage is 0.5-1 g/day
81. What is the dose of Hydrochloroquine in RA patient?

I. 150mg/day.
II. 400-600mg/day.
III. 800mg/day.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Hydroxychloroquine (HCQ) is approved for the treatment of acute or chronic RA. The initial dosage is 400-
600 mg/day;
82. What is the dosage regimen of Rituximab in RA patient?
I. Single IV infusion of 500mg.
II. 2 IV infusions of 1000 mg.
III. 3Iv infusions of 500mg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The usual regimen consists of 2 intravenous (IV) infusions of 1000 mg, separated by 2 weeks, in combination
with MTX.
83. What is the dose of Azathioprine in RA patients?

I. 1mg/kg/day.
II. 2mg/kg/day.
III. 3mg/kg/day.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The initial dosage is 1 mg/kg/day (50-100 mg/day) given as a single dose or in divided doses twice daily.
84. What are the drug interactions of Tofacitinib in RA patient?

I. Biologic DMARDs .
II. Non- biologic DMARDs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Tofacitinib may be used as monotherapy or in combination with MTX or other nonbiologic dmards, but it
should not be used in combination with biologic dmards or potent immunosuppressive agents
85. Which of the following drug requires close monitoring of renal function?
I. Azathioprine.
II. Methotrexate.
III. Cyclosporine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Cyclosporine is approved for the treatment of patients with severe active RA in which the disease has not
adequately responded to MTX, it is not commonly used to treat RA, because of its nephrotoxicity. When
cyclosporine is used, patients' renal function must be closely monitored.
86. What is the approximate dose of Methotrexate in RA patient?

I. 0.5mg/wk PO.
II. 7.5mg/wk PO.
III. 10mg/wk PO.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
MTX is started at lower doses and increased to full doses within approximately 4-6 weeks. The initial dosage
is 7.5 mg/wk PO in a single dose; alternatively, the weekly regimen may be administered in divided doses of
2.5 mg PO at 12-hour intervals for 3 doses
87. Which of the following belong to class of TNF inhibitors?

I. Infliximab & adalimumab
II. Golimumab & Etanercept.
III. Rituximab.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The TNF inhibitors, which bind TNF and thus prevent its interaction with its receptors, include etanercept,
infliximab, golimumab, certolizumab, and adalimumab.
88. Which of the following is correct about Golimumab?

I. More effective as mono-therapy.
II. Given as SC injection every month.
III. Should be given in combination with MTX.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
It may be administered as either a SC injection every month, or as an IV infusion every 2 months following 2
once monthly doses. Golimumab should be given in combination with MTX
89. Which of the following tetracycline can be used in treatment of RA?

I. Doxycycline.
II. Tetracycline.
III. Minocycline.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Although tetracyclines are not typically used to treat RA, the ACR recommends minocycline monotherapy in
patients with a disease duration shorter than 24 months who have low disease activity and no poor prognostic
factors
90. What is the mechanism of action of Ibuprofen?

I. Inhibition of bone destruction.
II. Inhibits inflammation.
III. Decreases prostaglandin synthesis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Ibuprofen is indicated for patients with mild to moderate pain. It inhibits inflammatory reactions and pain
by decreasing prostaglandin synthesis.
91. Which of the following NSAID is associated with hepatotoxicity?
I. Ibuprofen.
II. Ketoprofen.
III. Diclofenac.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Diclofenac can cause hepatotoxicity; therefore, liver enzymes should be monitored in the first 8 weeks of
treatment. This agent is absorbed rapidly; metabolism occurs in the liver by demethylation, deacetylation, and
glucuronide conjugation
92. At what dose ketoprofen doesn't yield increased therapeutic effect?

I. Higher than 50mg.
II. Higher than 60mg.
III. Higher than 75mg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Doses higher than 75 mg do not yield increased therapeutic effects. Administer high doses with caution, and
closely observe the patient for response.
93. What is the mechanism of action of Celecoxib in RA?

I. Inhibits COX-1.
II. Inhibits COX-2.
III. Inhibits both COX-1 & COX-2.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Celecoxib is approved for the relief of signs and symptoms of RA. It primarily inhibits COX-2, which is
considered an inducible isoenzyme (induced during pain and inflammatory stimuli).
94. Which of the following analgesics is used in patients with RA?
I. Morphine.
II. Fentanyl.
III. Acetaminophen.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Analgesics such as acetaminophen may be used in patients with RA.
95. Which of the following opioid analgesics are used in RA patients?

I. Tramadol.
II. Nalbuphine.
III. Morphine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Opioid analgesics
Class summarytramadol has been used to reduce pain in patients with ra. However, this agent only provides
analgesic effects and does not have anti-inflammatory properties.
96. Which of the following is approved as topical preparation in RA patient treatment?

I. Diclofenac gel .
II. Ibuprofen gel.
III. Naproxen gel.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Diclofenac topical gel is approved in patients with osteoarthritis at a dosage of 32 g/day applied over all affected
joints. It has also been used to provide analgesic effects in patients with RA.
97. Which of the following corticosteroids are used in RA patients?

I. Beclomethasone.
II. Methylprednisolone.
III. Prednisone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
(Mcq97)prednisone (prednisone intensol, sterapred, rayos)

(mcq97)methylprednisolone (depo-medrol, medrol, solu-medrol
98. What is the mechanism of action of prednisolone?

I. Prevents inflammation.
II. Suppress migration of PMNs.
III. Increase capillary permeability.
A) I only
B) II only
C) III only
D) I and IIE) II and III
F) I and III
Answer: D
Prednisolone controls or prevents inflammation by controlling the rate of protein synthesis, suppressing the
migration of pmns and fibroblasts, reversing capillary permeability, and stabilizing lysosomes at the cellular
level.
99. What is the mechanism of action of chelator therapy?

I. Depression of B-cell activity.
II. Depression of T-cell activity.
III. Suppression of inflammation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Chelators
Class Summary
Chelation therapy in RA may suppress inflammation and arthritis by depressing T-cell activity.
100. Which of the following is commonly used chelator?

I. Gold salt.
II. Sulfasalazine.
III. Penicillamine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Penicillamine (cuprimine, depen)

Penicillamine depresses circulating igm rheumatoid factor and t-cell activity.
Osteoporosis
1. What is Osteoporosis?
I. Acute, progressive disease of multifactorial etiology.
II. Chronic, progressive disease of multifactorial etiology.
III. Chronic, progressive disease of multifactorial epidemiology.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Osteoporosis, a chronic, progressive disease of multifactorial etiology (see Etiology), is the most common
metabolic bone disease in the United States.
2. Which of the following statement is true about Osteoporososis?

I. Metabolis bone disease.
II. Metabolic bone disease.
III. Metabolic disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Osteoporosis, a chronic, progressive disease of multifactorial etiology (see Etiology), is the most common
metabolic bone disease in the United States.
3. Which of the following statement is true about occurence of Osteoporososis?
I. Most frequently recognized in elderly men.
II. Most frequently recognized in elderly white women.
III. Occur in both sexes, all races, and all age groups.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
It has been most frequently recognized in elderly white women, although it does occur in both sexes,
all races, and all age groups.
4. What is Osteoporosis?
I. Systemic joint disease.
II. Systemic skeletal disease.
III. Characterized by low bone mass.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural
deterioration of bone tissue, with a consequent increase in bone fragility. The disease often does not
become clinically apparent until a fracture occurs
5. What are the characteristics of Osteoporosis?
I. Microarchitectural deterioration of bone tissue.
II. Consequent decrease in bone fragility.
III. Consequent increase in bone fragility.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural
deterioration of bone tissue, with a consequent increase in bone fragility
6. Which out of the following statement is true about osteoporosis?

I. The disease often become clinically apparent until a fracture do not occur.
II. The disease often does not become clinically apparent until a fracture occurs.
III. The disease often does not become clinically apparent until a fracture does not occur.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The disease often does not become clinically apparent until a fracture occurs
7. Bone mineral density (BMD) in a patient is related to-
I. Peak bone mass.
II. Bone loss.
II.I bone mass.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Bone mineral density (BMD) in a patient is related to peak bone mass and, subsequently, bone loss.
8. What does T-Score reflect in osteoporosis patient?
II.
III. Bone density compared with that of patients age .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Whereas the T-score is

at their peak BMD,
9. What does Z-Score reflect in osteoporosis patient?
II. Bone density compared with that of patients matched for age and sex.
III. Bone density compared with that of patients matched for health.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The Z-score reflects a bone density compared with that of patients matched for age and sex.
10. On what base, WHO has defined the Osteoporosis?

I. BMD Measurements by DYA.
II. BMD Measurements by BXA.
III. BMD Measurements by DXA.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
WHO Definition of Osteoporosis Based on BMD Measurements by DXA

BMD within 1 SD of the mean bone density for
Normal T- 1
young adult women
11. What is the normal value of bone mineral density?
I. BMD 1 2.5 SD below the mean for young-adult women.
II. BMD within 1 SD of the mean bone density for young adult women.
III. BMD within 1 SD of the mean bone density for young adult men.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

BMD within 1 SD of the mean bone density for
Normal T- 1
young adult women
12. What is the normal value of T-score (bone density)?

I. T-score < -1.
II. T-score > -1.
III. T-score between 1 and 2.5.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

BMD within 1 SD of the mean bone density
Normal T- 1
for young adult women
13. What is the value of bone mineral density in osteopenia?
I. BMD within 1 SD of the mean bone density for young adult women.
II. BMD 1 2.5 SD below the mean for young-adult women.
III. BMD 1 2.5 SD below the mean for young-adult men.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

Low bone mass (osteopenia) BMD 1 2.5 SD below the mean for young-adult women
14. What is the value of T-score in osteopenia?

I. T-score between 1 and 2.5.
II. T-score > 2.5 (with fragility fracture[s]).
III. T- 2.5 (with fragility fracture[s]).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A

Low bone mass BMD 1 2.5 SD below the mean for young-adult T-score between 1
(osteopenia) women and 2.5
15. What is the value of bone mineral density in Osteoporosis?
-adult women.
III. BMD 1 2.5 SD below the mean for young-adult women.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

Osteoporosis T-sc 2.5
young-adult women
16. What is the value of T-score in Osteoporosis?

I. T- 1.5.
II. T- 2.5 (with fragility fracture[s]).
III. T- 2.5.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C

Osteoporosis T- 2.5
young-adult women
mean for young-adult women.
II. BMD 1 2.5 SD below the mean for young-adult women.
-adult women.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A

T- 2.5 (with
young-adult women in a patient who has already
osteoporosis fragility fracture[s])
18. What is the value of T-

I. T- 1.5 (with fragility fracture[s]).
II. T- 2.5 (with fragility fracture[s]).
III. T- 3.5 (with fragility fracture[s]).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

T- 2.5
young-adult women in a patient who has (with fragility
osteoporosis
fracture[s])
19. Z-Score should be used for measurement of bone density in-
I. Postmenopausal women.
II. Menopausal women.
III. Premenopausal women.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Z-scores should be used in premenopausal women, men younger than 50 years, and children
20. Z-Score should be used for measurement of bone density in-

I. Men younger than 50 years.
II. Men older than 50 years.
III. Children.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Z-scores should be used in premenopausal women, men younger than 50 years, and children
21. Which cells are responsible for bone resorption?
I. Osteoblasts.
II. Osteocytes.
III. Osteoclasts.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Osteoclasts, derived from mesenchymal cells, are responsible for bone resorption, whereas osteoblasts,
from hematopoietic precursors, are responsible for bone formation (see the images below).
22. Which of the following statement is true about Osteoclasts?

I. Derived from mesenchymal cells.
II. Responsible for bone formation.
III. Responsible for bone resorption.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Osteoclasts, derived from mesenchymal cells, are responsible for bone resorption
23. Which cells are responsible for bone formation?
I. Osteocytes.
II. Osteoclasts.
III. Osteoblasts.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Whereas osteoblasts, from hematopoietic precursors, are responsible for bone formation (see the images
below).
24. Which of the following statement is true about Osteoblasts?

I. Responsible for bone formation.
II. Responsible for bone resorption.
III. From hematopoietic precursors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Whereas osteoblasts, from hematopoietic precursors, are responsible for bone formation (see the images
below).
25. What is embedded in mineralized bone, direct the timing and location of bone
remodeling?
I. Osteocytes.
II. Osteoclasts.
III. Osteoblasts.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Osteocytes, which are terminally differentiated osteoblasts embedded in mineralized bone, direct the
timing and location of bone remodeling
26. What is responsible for increased risk of fracture in periods of rapid remodeling?
I. Newly produced bone is less densely demineralized.
II. Newly produced bone is less densely mineralized.
III. Resorption sites are temporarily unfilled.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
In periods of rapid remodeling (eg, after menopause), bone is at an increased risk for fracture because
the newly produced bone is less densely mineralized, the resorption sites are temporarily unfilled, and
the isomerization and maturation of collagen are impaired.
27. What is responsible for increased risk of fracture in periods of rapid remodeling?
I. Isomerization and maturation of collagen are impaired.
II. Isomerization and immaturation of collagen are impaired.
III. Isomerization and maturation of collagen tissues are impaired.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
28. What is true related to postmenopause?

I. Rapid remodeling of bone occurs.
II. Rapid demodeling of bone occurs.
III. Rapid recovery of bone occurs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
29. Which of the following is the final common pathway for bone resorption?
I. Nuclear factor-kappa B (RANK)/osteoprotegin (OGP) system.
II. Receptor activator of nuclear factor-kappa B ligand (RANKL)/receptor activator .
III. Receptor activator of nuclear factor-kappa B (RANK)/osteoprotegerin (OPG) system.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The receptor activator of nuclear factor-kappa B ligand (RANKL)/receptor activator of nuclear factor-
kappa B (RANK)/osteoprotegerin (OPG) system is the final common pathway for bone resorption.
@30 Osteoblasts and activated T cells in the bone marrow produce the RANKL cytokine
30. Which cells produces RANKL cytokine?

I. Activated T cells.
II. Osteoclasts.
III. Osteoblasts.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Osteoblasts and activated T cells in the bone marrow produce the RANKL cytokine
31. Which of the following statement is true for Bone mass?
I. Peaks around the third decade of life.
II. Slowly increases afterward.
III. Slowly decreases afterward third decade of life.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Bone mass peaks around the third decade of life and slowly decreases afterward
32. What is the hallmark of osteoporosis?

I. Imbalance between bone resorption and bone formation.
II. Balance between bone resorption and bone formation.
III. Imbalance between bone desorption and bone formation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The hallmark of osteoporosis is a reduction in skeletal mass caused by an imbalance between bone
resorption and bone formation.
33. Which important factors contribute in development of osteoporosis?
I. Aging .
II. Loss of gonadal function.
III. Loss of bone function.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Aging and loss of gonadal function are the 2 most important factors contributing to the development
of osteoporosis.
34. What leads to excessive bone resorption?

I. Estrogen overload.
II. Progesterone deficiency .
III. Estrogen deficiency .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Estrogen deficiency can lead to excessive bone resorption accompanied by inadequate bone formation
35. What is the role of T cells in the absence of estrogen?
I. Promote osteoblast recruitment.
II. Promote osteoclast recruitment.
III. Promote osteoclast differentiation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
In the absence of estrogen, T cells promote osteoclast recruitment, differentiation, and prolonged
survival via IL-1, IL-6, and tumor necrosis factor (TNF) alpha.
36. What is the role of T cells in the absence of estrogen?

I. Prolonged survival of osteoclast via IL-1, IL-6.
II. Prolonged survival via IL-12.
III. Prolonged survival of osteoclast via tumor necrosis factor (TNF) alpha.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In the absence of estrogen, T cells promote osteoclast recruitment, differentiation, and prolonged
survival via IL-1, IL-6, and tumor necrosis factor (TNF) alpha.
37. What helps in maintaining bone homeostasis?
I. Calcium.
II. Thyroid Hormone.
III. Parathyroid Hormone (PTH).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Calcium, vitamin D, and PTH help maintain bone homeostasis
38. What can result in secondary hyperparathyroidism via decreased intestinal calcium
absorption?
I. Calcium deficiency.
II. Vitamin D deficiency.
III. Thyroid hormone deficiency.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Vitamin D deficiency can result in secondary hyperparathyroidism via decreased intestinal calcium
absorption.
39. What plays a key role in the fate of mesenchymal stem cells (MSCs)?
I. Mnt signalling.
II. Wnt signaling.
III. β-Catenin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Plays a key role in the fate of mesenchymal stem cells (mscs), which are the progenitor cells of mature
bone-forming osteoblasts
40. Which of the following statements are true about β-Catenin?

I. Intercellular signaling molecule.
II. Intracellular signaling molecule .
III. Normally exists in a phosphorylated state.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Β-Catenin is an important intracellular signaling molecule and normally exists in a phosphorylated

state targeted for ubiquination and subsequent degradation within intracellular lysosomes
41. What is the result of activation of Wnt pathway?
I. Dephosphorylation of intracellular β-catenin .
II. Phosphorylation of intracellular β-catenin .
III. Stabilization of intracellular β-catenin .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Activation of the Wnt pathway leads to dephosphorylation and stabilization of intracellular β-catenin
and rising cytosolic concentrations of β-catenin
42. What is the result of activation of Wnt pathway?

I. Arising cytosolic concentrations of β-catenin.
II. Rising cytosolic concentrations of β-catenin.
III. Rising cytosolic concentrations of β-catechin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Activation of the Wnt pathway leads to dephosphorylation and stabilization of intracellular β-catenin
and rising cytosolic concentrations of β-catenin
43. Which of the followings are antagonists of Wnt pathway?
I. Dkk-2.
II. Dkk-1 .
III. Sclerostin (SOST).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
There are also several antagonists to the Wnt pathway. Two of the most well-known are Dkk-1 and
sclerostin (SOST). Dkk-1 is secreted by mscs[34] and binds to LRP-5 and LRP-6,[35] thereby
competitively inhibiting Wnt signaling.
44. From where Dkk-1 is secreted?

I. Chlorenchymal stem cells.
II. Somatic stem cells.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
45. What causes competitive inhibition of Wnt signaling?
I. Dkk-1 binding to LRP-5 and LRP-6.
II. Dkk-1 binding to LRP-7 and LRP-9.
III. Dkk-1 binding to LRP-7 and LRP-8.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
46. What are the different types of Primary Osteoporosis?

I. Endocrine disorders.
II. Juvenile osteoporosis.
III. Idiopathic osteoporosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Type of Primary Osteoporosis; Juvenile osteoporosis, Idiopathic osteoporosis

47. What are the different types of Primary Osteoporosis?
I. Hypogonadal states.
II. Postmenopausal osteoporosis.
III. Age-associated or senile.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Idiopathic osteoporosis; Postmenopausal osteoporosis, Age-associated or senile
48. What are characteristics of Juvenile osteoporosis?

I. Usually occur in children or young adults of both sexes.
II. Abnormal gonadal function .
III. Normal gonadal function .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
● Usually occurs in children or young adults of both

Juvenile osteoporosis sexes
● Normal gonadal function
I. Age of onset: usually 8-14 years .
II. Fractures of the distal forearm and vertebral bodies common.
III. Age of onset: usually above 14 years.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Juvenile osteoporosis
● Usually occurs in children or young adults of both sexes
● Age of onset: usually 8-14 years
● Hallmark characteristic: abrupt bone pain and/or a fracture following trauma

I. Characterized by a phase of accelerated bone loss, primarily from trabecular bone .
II. Abrupt joint pain and/or a fracture following trauma .
III. Abrupt bone pain and/or a fracture following trauma .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Juvenile osteoporosis
● Usually occurs in children or young adults of both sexes
● Age of onset: usually 8-14 years
● Hallmark characteristic: abrupt bone pain and/or a fracture following trauma
51. What is the characteristic of Postmenopausal osteoporosis (type I osteoporosis)?
I. Occurs in women with estrogen deficiency.
II. Characterized by a phase of accelerated bone loss, primarily from trabecular bone.
III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
 Occurs in women with estrogen deficiency

Postmenopausal osteoporosis (type
 Characterized by a phase of accelerated bone loss,
I osteoporosis)
primarily from trabecular bone
52. What is the characteristic of Postmenopausal osteoporosis (type I osteoporosis)?

I.
II Fractures of the distal forearm and vertebral bodies common.
III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
Postmenopausal osteoporosis (type I osteoporosis); Fractures of the distal forearm and vertebral bodies
common
53. What is the characteristic of Age-associated or senile osteoporosis (type II osteoporosis)?
I. Occur in women and men as BMD gradually declines with aging.
II.
III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer A
Age-associated or senile osteoporosis (type II osteoporosis); Occurs in women and men as BMD
gradually declines with aging
54. What is the characteristic of Age-associated or senile osteoporosis (type II osteoporosis)?

I.
II. Represents bone loss associated with aging.
III. Fractures occur in cortical and trabecular bone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
Age-associated or senile osteoporosis  Represents bone loss associated with aging

(type II osteoporosis)  Fractures occur in cortical and trabecular bone
55. Wrist, vertebral, and hip fractures often seen in patients-
I.
II. Type II osteoporosis.
III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
Occurs in women and men as BMD gradually declines with aging; Wrist, vertebral, and hip fractures
often seen in patients with type II osteoporosis
56. Which are

I. Renal hypercalciuria.
II. Cystic fibrosis.
III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
 Renal hypercalciuria one of the most important secondary causes of

Genetic/congenital osteoporosis; can be treated with thiazide diuretics
 Cystic fibrosis
57. Which are
I.
II. Ehlers-Danlos syndrome.
III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
Genetic/congenital; Ehlers-Danlos syndrome, Hypogonadal states
58. Which are

I. Idiopathic hypercalciuria.
II.
III. Porphyria.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
Genetic/congenital; Porphyria, Idiopathic hypercalciuria

59. Which out of the following
I. Androgen insensitivity.
II. Anorexia nervosa/bulimia nervosa.
III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
 Androgen insensitivity
Hypogonadal states
 Anorexia nervosa/bulimia nervosa
60. Which out of the following orosis?

I.
II. Klinefelter syndrome.
III. Turner syndrome.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
Hypogonadal states; Klinefelter syndrome, Turner syndrome

61. Which out of the following Hypogonadal states
I. Premature menopause.
II.
III. Panhypopituitarism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
Hypogonadal states; Premature menopause, Panhypopituitarism
62. Which out of the following En

I. Cushing syndrome.
III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
 Cushing syndrome
Endocrine disorders
I.
II. Acromegaly.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
Endocrine disorders;
 Acromegaly
 Adrenal insufficiency

I. Estrogen deficiency.
II. Hyperparathyroidism.
III.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
Endocrine disorders
 Estrogen deficiency
 Hyperparathyroidism
I.
II. Pregnancy.
III. Prolactinoma.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
Endocrine disorders;
 Hyperthyroidism
 Pregnancy
 Prolactinoma

I.
II. Calcium deficiency.
III. Magnesium deficiency.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
 Calcium deficiency
Deficiency states
 Magnesium deficiency
I. Protein deficiency.
II.
III. Vitamin D deficiency.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
Deficiency states
 Protein deficiency
 Vitamin D deficiency

I. Bariatric surgery.
II.
III. Celiac disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
Deficiency states
 Bariatric surgery
 Celiac disease
69. Which
I.
II. Inflammatory bowel disease.
III. Ankylosing spondylitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
 Inflammatory bowel disease

Inflammatory diseases
 Ankylosing spondylitis
70. Which
I. Rheumatoid arthritis.
II.
III. Systemic lupus erythematosus.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
Inflammatory diseases
 Rheumatoid arthritis
 Systemic lupus erythematosus
71. Which
I. Hemochromatosis.
II. Hemophilia.
III. lyophilia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
 Hemochromatosis
Hematologic and neoplastic disorders
 Hemophilia
72. Which
I. Metastatic disease.
II. Lyophilia.
III. Thalassemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
Hematologic and neoplastic disorders; Metastatic disease, Thalassemia

73. Which
I. Lyophilia.
II. Sickle cell anemia.
III. Systemic mastocytosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
Hematologic and neoplastic disorders; Systemic mastocytosis, Sickle cell anemia
74. Which
I. Anticonvulsants.
II. Antipsychotic drugs.
III. Boron.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
Medications  Anticonvulsants , Antipsychotic drugs

75. Which
I. Heparin (long term).
II. Boron.
III. Furosemide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
Medications; Heparin (long term), Furosemide
76 Which
I. Boron.
II. Selective serotonin reuptake inhibitors (SSRIs).
III. Lithium.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
Medications: Selective serotonin reuptake inhibitors (ssris), Lithium

77. Which out of the following are risk factors for osteoporosis?
I. Advanced age
II. Female sex.
III. Young age (<50 years).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
Risk factors for osteoporosis include the following[53, 54, 55] :


 Female sex
I. Dowager hump.
II. Calcium deficiency.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
Risk factors for osteoporosis include the following[53, 54, 55]

 Calcium deficiency
 Dowager hump
I. Late menarche.
II. Amenorrhea.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D

 Amenorrhea
 Late menarche
I. Early menopause.
II. Young age (<50 years).
III. Postmenopausal state.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F

 Early menopause
 Postmenopausal state
I. Young age (<50 years).
II. Physical inactivity.
III. Use of certain drugs (eg, anticonvulsants, steroids).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E

 Physical inactivity or immobilization [56]
 Use of certain drugs (eg, anticonvulsants, systemic steroids, thyroid supplements, heparin,
chemotherapeutic agents, insulin)
II. Alcohol and tobacco use.
III. Androgen deficiency.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E

 Alcohol and tobacco use
 Androgen [57] or estrogen deficiency
83. Which fractures often occur with minimal stress, such as coughing, lifting, or bending?
I. Knee fracture.
II. Elbow fracture.
III. Vertebral compression fractures.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer C
Vertebral compression fractures often occur with minimal stress, such as coughing, lifting, or bending.
84. Which out of the following is potentially Nonmodifiable risk factors for osteoporosis?
II. Personal history of fracture as an adult.
III. History of fracture in a first-degree relative.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
Nonmodifiable risk factors include the following:

 Personal history of fracture as an adult
 History of fracture in a first-degree relative
85. Which out of the following is potentially modifiable risk factors for osteoporosis?
I. White race.
II. Black race.
III. Dementia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
Nonmodifiable risk factors include the following:

 White race
 Dementia
86. Which out of the following is potentially modifiable risk factors for osteoporosis?
I Low body weight (< 127 lb).
II. Current cigarette smoking.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Potentially modifiable risk factors include the following:

 Current cigarette smoking
 Low body weight (< 127 lb)
87. Which out of the following are potentially modifiable risk factors for osteoporosis?
I. No falls.
II. Recurrent falls.
III. Alcoholism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Potentially modifiable risk factors include the following:

 Alcoholism
 Impaired eyesight despite adequate correction
 Recurrent falls
88. Which out of the following test are performed during the diagnosis of osteoporosis?
I. Incomplete blood count.
II. Complete blood count.
III. Serum aldehyde levels.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
Laboratory Studies; Complete blood count (CBC), Serum chemistry levels, Liver function tests,
hormone (TSH) level Thyroid-stimulating, 25-Hydroxyvitamin D level
89. Which out of the following test are performed during the diagnosis of osteoporosis?
I. Serum chemistry levels.
II. 25-Hydroxyvitamin D level.
III. Serum aldehyde levels.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
90 .Which out of the following test are performed during the diagnosis of osteoporosis?
I. Serum aldehyde levels.
III. Hormone (TSH) level.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
91. What is the usefulness of 24-Hour urine calcium level test in osteoporosis?
I. Assesses for hypercalciuria.
II. Assesses for hypocalciuria.
III. Assesses of liver.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
24-Hour urine calcium level This study assesses for hypercalciuria and hypocalciuria
92. What is the usefulness of Parathyroid hormone test in osteoporosis?

I. Ruling out diabetes.
II. Ruling out hyperparathyroidism.
III. Ruling out hypotension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
An intact PTH result is essential in ruling out hyperparathyroidism;

Parathyroid hormone
an elevated PTH level may be present in benign familial
(PTH) level
hypocalciuric hypercalcemia
93. What is the usefulness of Thyrotropin level in osteoporosis?
I. To access hypothyroidism.
II. To access hyperthyroidism.
III. To access hypertension.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
Experts are divided on whether to include thyrotropin testing, regardless

Thyrotropin level (if on of a history of thyroid disease or replacement; however, one study showed
thyroid replacement) reduced femoral neck bone mineral density (BMD) in women with
subclinical hypothyroidism and hyperthyroidism[99]
94. What is the usefulness of Testosterone and gonadotropin levels in osteoporosis?

I. Evaluate a sex hormone deficiency as a secondary cause of osteoporosis.
II. To access hypothyroidism.
III. To access hyperthyroidism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer A
Testosterone and gonadotropin levels in These tests may help evaluate a sex hormone deficiency as a secondary
younger men with low bone densities cause of osteoporosis
95. What is the usefulness of Serum tryptase and urine N-methylhistamine levels in
osteoporosis?
I. To access hyperthyroidism.
II. Identify mastocytosis.
III. Identify macrostocytosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer B
Serum tryptase and urine N-

These tests help identify mastocytosis
methylhistamine
96. What is the usefulness of Antigliadin and antiendomysial antibodies levels in

osteoporosis?
I. Identify mastocytosis.
II. To access hyperthyroidism.
III. Identify celiac disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer C
Antigliadin and antiendomysial antibodies These tests can help identify celiac disease
97. Which is a serum marker of bone resorption (osteoclast products)?
I. Osteocalcin (OC).
II. Bone-specific alkaline phosphatase (BSAP).
III. Lithium.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer D
Currently available serum markers of bone formation (osteoblast products) include the following:
 Bone-specific alkaline phosphatase (BSAP)
 Osteocalcin (OC)
98. Which is a serum marker of bone resorption (osteoclast products)?

I. Aminoterminal propeptide of type II collagen (PINP).
II. Aminoterminal propeptide of type I collagen (PINP).
III. Carboxyterminal propeptide of type I collagen (PICP).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
Currently available serum markers of bone formation (osteoblast products) include the following:
 Carboxyterminal propeptide of type I collagen (PICP)
 Aminoterminal propeptide of type I collagen (PINP)
99. Which is a urinary marker of bone resorption (osteoclast products)?
I. Hydroxyproline.
II. Aminoterminal propeptide of type II collagen (PINP).
III. Free and total pyridinolines (Pyd).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer F
Currently available urinary markers of bone resorption (osteoclast products) include the following:
 Hydroxyproline
 Free and total pyridinolines (Pyd)
100. Which is a urinary marker of bone resorption (osteoclast products)?

I. Aminoterminal propeptide of type II collagen (PINP).
II. Free and total deoxypyridinolines (Dpd).
III. C-telopeptide of collagen cross-links (CTx).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer E
Currently available urinary markers of bone resorption (osteoclast products) include the following:
 Free and total deoxypyridinolines (Dpd)
 N-telopeptide of collagen cross-links (ntx)
 C-telopeptide of collagen cross-links (ctx)
1. Why osteoporosis treatment is aimed at fracture prevention?

I. Because of the significant disability and morbidity.
II. Because of the no significant disability and morbidity.
III. Because of the significant mortality, and expenses.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
According to a clinical practice guideline by the American College of Physicians, because of the
significant disability, morbidity, mortality, and expenses associated with osteoporotic fractures
treatment is aimed at fracture prevention
2. What is included in Medical care of osteoporosis patient?

I. Administration of adequate Manganese.
II. Administration of adequate calcium.
III. Administration of adequate Magnesium.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Medical care includes the administration of adequate calcium, vitamin D, and anti-osteoporotic
medication such as bisphosphonates,parathyroid hormone (PTH), raloxifene, and estrogen.
I. Administration of adequate vitamin D.
II. Administration of adequate Magnesium.
III. Administration of adequate Manganese.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A

I. Administration of estrogen.
II. Administration of adequate Manganese.
III. Administration of bisphosphonates.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
I. Administration of adequate Manganese.
II. Administration of parathyroid hormone (PTH).
III. Administration of raloxifene.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
6. Which out of the following surgical procedure is used in osteoporosis patient?

I. Tinosporosis.
II. Kyphoplasty.
III. Vertebroplasty.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Surgical care includes vertebroplasty and kyphoplasty, which are minimally invasive spine procedures
used for the management of painful osteoporotic vertebral compression fractures. However, there may
be an increased risk of adjacent level vertebral fractures after these procedures
7. What is associated with vertebroplasty and kyphoplasty?
I. Risk of heart attack.
II. Risk of adjacent level vertebral fractures.
III. Risk of tachycardia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Surgical care includes vertebroplasty and kyphoplasty, which are minimally invasive spine procedures
used for the management of painful osteoporotic vertebral compression fractures. However, there may
be an increased risk of adjacent level vertebral fractures after these procedures
8. What is the first goal of rehabilitation in osteoporosis patients?

I. Kyphoplasty.
II. Control pain if a fracture has occurred.
III. Vertebroplasty.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The first goal of rehabilitation in osteoporosis patients is to control pain if a fracture has occurred.
Spinal compression fractures can be extremely painful and can cause short- and long-term morbidity.
Oral analgesics on a regular schedule can be implemented. @9 Pain-relieving modalities such as moist
hot packs and transcutaneous electrical nerve stimulation should also be considered.
9. Which Pain-relieving modalities are used to control pain related to fracture?
I. Moist hot packs.
II. Transcutaneous electrical nerve stimulation.
III. Dry cold packs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Pain-relieving modalities such as moist hot packs and transcutaneous electrical nerve stimulation
should also be considered.
10. Which side effect is associated with the use of narcotic analgesics?
I. Urinary urgency.
II. Constipation.
III. Urinary retention.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
During this period, monitoring the patient carefully for signs of constipation, urinary retention, and
respiratory depression, which can occur with the use of narcotic analgesics, is essential.
11. Which side effect is associated with the use of narcotic analgesics?
I. Respiratory depression.
II. Urinary urgency.
III. Anuria.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
During this period, monitoring the patient carefully for signs of constipation, urinary retention, and
respiratory depression, which can occur with the use of narcotic analgesics, is essential.
12. What is the primary reason for the application of a thoracic orthosis?
I. To promote motion in the spine.
II. To permit motion in the spine.
III. To limit motion in the spine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The primary reason for the application of a thoracic orthosis is to limit motion in the spine
13. What should be implanted during the early mobilization period in osteoporosis?
I. Deep breathing exercises.
II. Pectoral and intercostal muscle strengthening.
III. Back damage technique.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
During the early mobilization period, deep breathing exercises, pectoral and intercostal muscle
strengthening, and back conservation techniques need to be implemented.
14. What should be implanted during the early mobilization period in osteoporosis?
I. Deep breathing exercises.
II. Back damage technique.
III. Back conservation techniques.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
During the early mobilization period, deep breathing exercises, pectoral and intercostal muscle
strengthening, and back conservation techniques need to be implemented.
15. Which treatment can completely reverse established osteoporosis?
I. Biphosphates.
II. Calcium and Vitamine D supplement.
III. None of the above.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Currently, no treatment can completely reverse established osteoporosis
16. Which protective measures should be taken in patients taking glucocorticoids?

I. Treat using maximum effective dose
II. Treat using minimum effective dose
III. Discontinuing the drug as soon as possible
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Protective measures should be taken in patients who must take glucocorticoids for other medical
conditions. These include using the minimum effective dose, discontinuing the drug as soon as possible,
and supplementing with calcium and vitamin D.
17. Which protective measures should be taken in patients taking glucocorticoids?
I. Discontinuing the drug as soon as possible.
II. Treat using maximum effective dose.
III. Supplementing with calcium and vitamin D.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Protective measures should be taken in patients who must take glucocorticoids for other medical
conditions. These include using the minimum effective dose, discontinuing the drug as soon as possible,
and supplementing with calcium and vitamin D.
18. Which agents are currently available for the treatment of osteoporosis?
I. Bisphosphonates.
II. Diuretics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The agents currently available for osteoporosis treatment all of which should be accompanied by
sufficient intake of calcium and vitamin D include the following.
 Bisphosphonates
I. Furosemide.
II. Raloxifene.
III. Torsemide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
 Raloxifene
I. Galantimine.
II. Rivastigmine.
III. Calcitonin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
 Calcitonin
I. Atropine.
II. Denosumab.
III. Nimisulide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
 Denosumab
I. Teriparatide.
II. Ondensetron.
III. Quinidine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Teriparatide (recombinant human parathyroid hormone
23. According to the American Association of Clinical Endocrinologists (AACE) guideline,
which drug can be used as First-line agents for the management of osteoporosis?
I. Atenolol.
II. Alendronate.
III. Risedronate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Guidelines from the American Association of Clinical Endocrinologists (AACE), published in 2010,
include the following recommendations for choosing drugs to treat osteoporosis:
 First-line agents: alendronate, risedronate, zoledronic acid, denosumab

which drug can be used as First-line agents for the management of osteoporosis?
I. Zoledronic acid.
II. Denosumab.
III. Ethacrynic acid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
 First-line agents: alendronate, risedronate, zoledronic acid, denosumab
which drug can be used as Second-line agent for the management of osteoporosis?
I. Ethacrynic acid.
II. Ibandronate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
 Second-line agent: ibandronate

which drug can be used as Second- or third-line agent for the management of osteoporosis?
I. orlistat.
II. liraglutide.
III. raloxifene.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
 Second- or third-line agent: raloxifene
which drug can be used as Last-line agent for the management of osteoporosis?
I. apiximab.
II. telmisartan.
III. calcitonin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
 Last-line agent: calcitonin

which drug can in patient with very high fracture risk?
I. levonorgestrol.
II. teriparatide.
III. sumatriptan.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
 Treatment for patients with very high fracture risk or in whom bisphosphonate therapy has
failed: teriparatide
which drug can be used for patient in whom bisphosphonate therapy has failed?
I. Teriparatide.
II. Telmisartan.
III. Estrogen.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Treatment for patients with very high fracture risk or in whom bisphosphonate therapy has failed:
teriparatide
30. According to the National Osteoporosis Guideline Group (NOGG) guideline, which
pharmacotherapies have shown to lower the risk for vertebral fracture?
I. Beta blocker.
II. Bisphosphonate.
III. Alpha mixed blocker.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
In June 2013, the National Osteoporosis Guideline Group (NOGG) updated its guidelines on the
diagnosis and management of osteoporosis in men and postmenopausal women, aged 50 years or older
Pharmacotherapies shown to lower the risk for vertebral fracture (and for hip fracture in some cases)
include bisphosphonates, denosumab, parathyroid hormone peptides, raloxifene, and strontium
ranelate
I. Amlodipine.
II. Denosumab.
III. Parathyroid hormone peptides.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
ranelate
I. Raloxifene.
II. Indinavir.
III. Strontium ranelate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
ranelate
33. Why alendronate is usually used as first-line treatment in osteoporosis?
I. Broad spectrum of anti-fracture efficacy.
II. High cost.
III. Low cost
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Generic alendronate is usually first-line treatment because of its broad spectrum of anti-
fracture efficacy and low cost
34. Which drug can be used if alendronate is contraindicated or poorly tolerated in

osteoporosis?
I. Domperidon.
II. Risedronate.
III. Ibandronate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Ibandronate, risedronate, zoledronic acid, denosumab, raloxifene, or strontium ranelate may
be appropriate therapy if alendronate is contraindicated or poorly tolerated
35. Why parathyroid hormone peptides should be used only in patients at very high risk,
especially for vertebral fractures?
I. Because of low cost.
II. Because of their high cost.
III. Because of less avilability.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
 Because of their high cost, parathyroid hormone peptides should be used only for patients at
very high risk, especially for vertebral fractures
36. According to the National Osteoporosis Guideline Group (NOGG) guideline, what may
be beneficial in Postmenopausal women?
I. Calcium channel blocker.
II. Hormone replacement therapy.
III. Phosphodiesterase inhibitors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
 Postmenopausal women may benefit from calcitriol, etidronate, and hormone replacement
therapy
37. According to the National Osteoporosis Guideline Group (NOGG) guideline, what may
be beneficial in Postmenopausal women?
I. Etidronate.
II. Liraglutide.
III. Calcitriol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Postmenopausal women may benefit from calcitriol, etidronate, and hormone replacement
therapy
38. Which drug is most commonly used for osteoporosis?

I. Hormone replacement therapy.
II. Calcitonin.
III. Bisphosphonates.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Bisphosphonates are the most commonly used agents for osteoporosis. They have been employed for
both treatment and prevention.
39. What is the synonym of cholecalciferol?
I. Vitamin D2.
II. Vitamin D1.
III. Vitamin D3.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Cholecalciferol (vitamin D3)
40. What is indicated for the treatment of osteoporosis in men to increase bone mass?
I. Alendronate/vitamin D1.
II. Alendronate/vitamin D2.
III. Alendronate/vitamin D3.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The combination alendronate/vitamin D3 (Fosamax Plus D) is indicated for the treatment of

osteoporosis in men to increase bone mass.
41. What is the treatment dose of alendronate in osteoporosis?
I. 70 mg/wk.
II. 80 mg/wk.
III. 90 mg/wk.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The treatment dose of alendronate is 70 mg/wk, to be taken sitting upright with a large glass of water
at least 30 minutes before eating in the morning
42. Which out of the following is the most potent bisphosphonate?

I. Etidronate.
II. Zoledronic acid.
III. Etidronate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Zoledronic acid (Reclast) is the most potent bisphosphonate available

43. What are the symptoms of acute phase reaction within 3 days of zoledronic acid
administration?
I. Restlessness.
II. Chills.
III. Pyrexia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Acute phase reaction within 3 days of zoledronic acid administration: symptoms include
pyrexia, fatigue, bone pain and/or arthralgias, myalgias, chills, and influenza-like illness;
symptoms usually resolve within 3 days of onset but can take 7-14 days to resolve, and some
symptoms may persist for a longer duration
administration?
I. Influenza-like illness.
II. Fatigue.
III. Restlessness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
administration?
I. Bone pain and/or arthralgias.
II. Myalgias.
III. Restlessness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
46. What is the symptom of Hypersensitivity reactions?

I. Restlessness.
II. Bronchodilation.
III. Bronchospasms.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Hypersensitivity reactions presenting as bronchospasms; interstitial lung disease (ILD) with positive
re-challenge
47. Which drug is indicated for the treatment and prevention of osteoporosis in
postmenopausal women?
I. Etidronate.
III. Raloxifene.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Raloxifene (Evista) is a SERM indicated for the treatment and prevention of osteoporosis in
postmenopausal women. The usual dose is 60 mg given orally daily
48. What is the therapeutic dose of Raloxifene for the treatment and prevention of
osteoporosis in postmenopausal women?
I. 40 mg given orally daily.
II. 50 mg given orally daily.
III. 60 mg given orally daily.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Raloxifene (Evista) is a SERM indicated for the treatment and prevention of osteoporosis in
postmenopausal women. The usual dose is 60 mg given orally daily
49. Which combination product was approved by the FDA in October 2013 for prevention
of osteoporosis and treatment of vasomotor symptoms in postmenopausal women?
I. Etidronate.
III. Bazedoxifene.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The combination product of bazedoxifene, a SERM, and conjugated estrogens (ces) was approved by
the FDA in October 2013 for prevention of osteoporosis and treatment of vasomotor symptoms in
postmenopausal women.
50. What is the advantage of combining a SERM and conjugated estrogens (CEs)?
I. Lowers the risk of uterine hyperplasia.
II. Increase the risk of uterine hyperplasia.
III. Increase the risk of uterine atrophy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Combining a SERM with ces lowers the risk of uterine hyperplasia caused by estrogens.
51. What are the risks associated with the use of progestin?
I. Breast cancer.
II. Myocardial infarction.
III. Diabetes.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
This eliminates the need for a progestin and its associated risks (eg, breast cancer, myocardial
infarction, venous thromboembolism).
52. Which drug is also approved for the treatment of patients with glucocorticoid -induced
osteoporosis?
I. Pregabalin.
II. Teriparatide.
III. Metronidazole.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Teriparatide is also approved for the treatment of patients with glucocorticoid-induced osteoporosis.
53. Which test is preformed before the use of teriparatide?
I. Serum Manganese.
II. Serum calcium.
III. PTH.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Before treatment with teriparatide, levels of serum calcium, PTH, and 25(OH)D need to be
monitored.
54. Which test is preformed before the use of teriparatide?

I. 23-hydroxyvitamin D (25(OH)D).
II. 24-hydroxyvitamin D (25(OH)D).
III. 25-hydroxyvitamin D (25(OH)D).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Before treatment with teriparatide, levels of serum calcium, PTH, and 25(OH)D need to be
monitored.
55. Teriparatide is contraindicated in patients with pre-existing-
I. Normal alkaline phosphatase.
II. Unexplained elevated alkaline phosphatase.
III. History of bone metastases.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Teriparatide cannot be given for more than 2 years. It is contraindicated in patients with pre-existing
hypercalcemia, severe renal impairment, pregnancy, breast-feeding mothers, history of bone metastases
or skeletal malignancies, and patients who are at an increased baseline risk for osteosarcoma including
those with Paget disease, unexplained elevated alkaline phosphatase

I. Severe renal impairment.
II. Normal alkaline phosphatase.
III. Hypercalcemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
or skeletal malignancies
I. Normal alkaline phosphatase.
II. Severe renal impairment.
III. Breast-feeding mothers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
or skeletal malignancies.
58. Which hormone decreases osteoclast activity?

I. Calcitonin-salmon.
II. Growth hormone.
III. Testosterone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Calcitonin-salmon (Fortical, Miacalcin) is a hormone that decreases osteoclast activity, thereby

impeding postmenopausal bone loss
59. Which drug is used in patients who cannot tolerate estrogens or in whom estrogens are
contraindicated?
I. Debrisoquine.
II. Calcitonin-salmon.
III. Amlodipine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Calcitonin-salmon should be reserved for patients who refuse or cannot tolerate estrogens or in whom
estrogens are contraindicated
60. What is the common side effect of nasally administered Calcitonin?

I. Nasal discomfort.
II. Gastric ulcer.
III. Constipation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Calcitonin is an option for patients who are not candidates for other available osteoporosis treatments.
Common side effects of nasally administered calcitonin include nasal discomfort, rhinitis, irritation
of nasal mucosa, and occasional epistaxis.
I. Gastric ulcer.
II. Rhinitis.
III. Constipation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

I. Occasional epistaxis.
II. Gastric ulcer.
III. Irritation of nasal mucosa.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
63. What is methylmethacrylate?
I. Plastic cement.
II. Acrylic cement.
III. Plaster of paris.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Both procedures involve the injection of acrylic cement (methylmethacrylate) into the fractured
vertebral body
64. What is vertebroplasty and kyphoplasty?

I. Procedures involve the injection of plastic cement into the fractured vertebral body.
II. Procedures involve the injection of acrylic cement into the fractured vertebral body.
III. Procedures involve the injection of plaster of paris into the fractured vertebral body.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Both procedures involve the injection of acrylic cement (methylmethacrylate) into the fractured
vertebral body
65. What is the role of Vitamin D in human body?
I. Calcium depletion.
II. Calcium absorption.
III. Key element in overall bone health.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Vitamin D is increasingly being recognized as a key element in overall bone health, calcium
absorption, balance (eg, reduction in risk of falls),and muscle performance.
66. What is the role of Vitamin D in human body?

I. Balance (eg, reduction in risk of falls).
II. Muscle performance.
III. Calcium depletion.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Vitamin D is increasingly being recognized as a key element in overall bone health, calcium
absorption, balance (eg, reduction in risk of falls),and muscle performance.
67. What is the minimum daily requirement of vitamin D in patients with osteoporosis?
I. 1800 IU of cholecalciferol.
II. 2800 IU of cholecalciferol.
III. 800 IU of cholecalciferol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The minimum daily requirement of vitamin D in patients with osteoporosis is 800 IU of

cholecalciferol.
68. What is the commonly used calcium supplement?

I. Calcium nitrate.
II. Calcium carbonate.
III. Calcium citrate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Commonly used calcium supplements include calcium carbonate and calcium citrate
69. What is the synonym of cholecalciferol?
I. Vitamin D4.
II. Vitamin D3.
III. Vitamin D2.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Vitamin D is available as ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3)
70. What is the synonym of ergocalciferol?

I. Vitamin D2.
II. Vitamin D3.
III. Vitamin D4.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Ergocalciferol (vitamin D2)

71. Physical therapy focuses on improving a patient's-
I. Posture.
II. Balance to prevent falls.
III. Blood haemoglobin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Physical therapy focuses on improving a patient's strength, flexibility, posture, and balance to prevent
falls and maximize physical function
72. Physical therapy focuses on improving a patient's-

I. Blood haemoglobin.
II. Patient's strength.
III. Flexibility.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Physical therapy focuses on improving a patient's strength, flexibility, posture, and balance to prevent
falls and maximize physical function
73. What is the goal of patient education in osteoporosis patient?
I. Chronic alcohol intake.
II. Smoking cessation.
III. Moderated alcohol intake.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Patients should be counseled on smoking cessation and moderated alcohol intake.

I. Regular weight-bearing exercise.
II. Chronic alcohol intake.
III. Promote back extensor strengthening.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Regular weight-bearing exercise and back extensor strengthening help delay bone loss.
I. Chronic alcohol intake.
II. Promote intake of calcium and vitamin D supplementation.
III. Promote back extensor strengthening.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Patients who have disorders or take medications that can cause or accelerate bone loss should receive
calcium and vitamin D supplementation and, in some cases, pharmacologic treatment.
76. Pharmacologic prevention methods for osteoporosis includes-

I. Magnesium supplement.
II. Calcium supplementation.
III. Lithium supplement.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Pharmacologic prevention methods include calcium supplementation and administration of

raloxifene or bisphosphonates (alendronate or risedronate).
77. Pharmacologic prevention methods for osteoporosis includes-
I. Administration of beta blockers.
II. Administration of bisphosphonates.
III. Administration of raloxifene.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Pharmacologic prevention methods include calcium supplementation and administration of

raloxifene or bisphosphonates (alendronate or risedronate).
78. What is the usefulness/application of Orthotics?

I. Increase the flexion forces.
II. Decrease the flexion forces.
III. Increase the stress.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Orthotics are used to decrease the flexion forces to prevent the worsening of kyphosis and to reduce the
pressure on the fracture site in the acute phase of disease
79. What is the usefulness/application of Orthotics?
I. Reduce the pressure on the fracture site.
II. Increase the flexion forces.
III. Increase the stress.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Orthotics are used to decrease the flexion forces to prevent the worsening of kyphosis and to reduce the
pressure on the fracture site in the acute phase of disease
80. Which out of the following is commonly used orthotics?

I. Gewett brace.
II. Cruciform anterior abdominal hyperextension (CASH) brace.
III. Thoracolumbosacral orthosis (TLSO).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Common orthotics used include the following:

 Thoracolumbosacral orthosis (TLSO)
 Cruciform anterior spinal hyperextension (CASH) brace
 Jewett brace
81. Which out of the following is commonly used orthotics?
I. Gewett brace.
II. Cruciform anterior spinal hyperextension (CASH) brace.
III. Jewett brace.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Common orthotics used include the following:

 Thoracolumbosacral orthosis (TLSO)
 Cruciform anterior spinal hyperextension (CASH) brace
 Jewett brace
82. Which drug can be classified as Calcium Metabolism Modifiers?

I. Tramadol.
II. Alendronate.
III. Risedronate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Calcium Metabolism Modifiers; Alendronate, Risedronate, Calcitonin salmon, Ibandronatem,

Zoledronic acid
I. Pregabalin.
III. Liraglutide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

Zoledronic acid

I. Ibandronatem.
II. Navirapine.
III. Calcitonin salmon.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

Zoledronic acid
85. What is the pharmacological mechanism of Alendronate?
I. Inhibits the formation, aggregation, and dissolution of hydroxyapatite crystals in bone.
II. Promotes the formation, aggregation, and dissolution of hydroxyapatite crystals in bone.
III. Blocks the transformation of calcium phosphate into hydroxyapatite.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Alendronate inhibits osteoclast activity and bone resorption. By binding to calcium salts, alendronate
blocks the transformation of calcium phosphate into hydroxyapatite and inhibits the formation,
aggregation, and dissolution of hydroxyapatite crystals in bone
86. Which drug can be classified as Parathyroid Hormone Analogues?

I. Teriparatide.
II. Alendronate.
III. Risedronate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Parathyroid hormone analogues; teriparatide

87. What is the pharmacological mechanism of Teriparatide?
I. Increase number and activity of osteoblasts.
II. Increase number and activity of osteoclast.
III. Decreases number and activity of osteoblasts.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Teriparatide; It works primarily to stimulate new bone by increasing number and activity of
osteoblasts (bone-forming cells).
88. Which drug can be classified as Selective Estrogen Receptor Modulator?

I. Risedronate.
II. Teriparatide.
III. Raloxifene.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Selective estrogen receptor modulator; raloxifene

89. Which drug can be classified as Monoclonal Antibodies?
I. Risedronate.
II. Denosumab.
III. Raloxifene.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Monoclonal antibodies, endocrine; denosumab
90. What is the pharmacological mechanism of Denosumab?

I. Binds to the receptor activator of nuclear factor-kappa B ligand (RANKL).
II. Binds to the receptor activator of nuclear factor-kappa C ligand (RANKL).
III. Binds to the receptor activator of nuclear factor-kappa D ligand (RANKL).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Denosumab binds to the receptor activator of nuclear factor-kappa B ligand (RANKL), a

transmembrane or soluble protein essential for the formation, function, and survival of osteoclasts,
which are the cells that are responsible for bone resorption
91. What is the therapeutic dose of Denosumab?
I. 60 mg every 1 month as an SC injection in the upper arm.
II. 60 mg every 3 months as an SC injection in the upper arm.
III. 60 mg every 6 months as an SC injection in the upper arm.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Denosumab; The general dosage is 60 mg every 6 months as an SC injection in the upper arm, upper
thigh, or abdomen. Patients should be instructed to take 1000 mg of calcium daily and at least 400
IU of vitamin D daily
92. Which drug can be classified as Calcium Salts?

I. Calcium nitrate.
III. Calcium citrate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Calcium Salts; Calcium citrate, Calcium carbonate

93. Which drug can be classified as Estrogen Derivatives ?
I. Conjugated estrogens.
III. Estradiol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Estrogen Derivatives; Conjugated estrogens, Estradiol, Estropipate
94. Which drug can be classified as Estrogen Derivatives ?

I. Estropipate.
III. Calcium nitrate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Estrogen Derivatives; Conjugated estrogens, Estradiol, Estropipate

95. Which is fat soluble Vitamin?
I. Vitamin B.
II. Vitamin C.
III. Vitamin D.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Vitamin D is a fat-soluble sterol compound that includes ergocalciferol (vitamin D 2) and

cholecalciferol (vitamin D3
96. What is provitamin D3?

I. 7-dehydrocholesterol.
II. 8-dehydrocholesterol.
III. 9-dehydrocholesterol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Following exposure to UV light, 7-dehydrocholesterol (provitamin D3) is converted to cholecalciferol,

97. What is responsible for the conversion of 7-dehydrocholesterol to cholecalciferol?
I. Heat.
II. UV light.
III. Cold.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Following exposure to UV light, 7-dehydrocholesterol (provitamin D3) is converted to cholecalciferol,
98. Which out of the following is correct drug combination used for osteoporosis?
I. Estradiol/norgestimate.
II. Estradiol/topiramate.
III. Estradiol/neomycin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Estradiol/norgestimate (Prefest)
Estradiol/norgestimate is approved for the prevention of postmenopausal osteoporosis. It is available
as a combination of estradiol 1 mg/norgestimate 0.09 mg
99. Which drug is approved for the prevention of postmenopausal osteoporosis?
I. Estradiol/neomycin.
II. Estradiol/norgestimate.
III. Estradiol/topiramate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

100. What is the therapeutic dose of Estradiol/norgestimate for the prevention of

postmenopausal osteoporosis?
I. Estradiol 1 mg/norgestimate 0.009 mg.
II. Estradiol 1 mg/norgestimate 0.09 mg.
III. Estradiol 1 mg/norgestimate 0.9 mg.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B

GOUT
1. What is the cause of gout ?
I. Monosodium urate monohydrate crystals.
II. Calcium pyrophosphate crystals.
III. Sugar crystals.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Gout is caused by monosodium urate monohydrate crystals;
2. What is the cause of pseudogout ?

I. Monosodium urate monohydrate crystals.
II. Calcium pyrophosphate crystals.
III. Sugar crystals.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Pseudogout is caused by calcium pyrophosphate crystals

3. What are the complications associated with gout ?
I. Corneal dermatitis.
II. Severe degenerative arthritis.
III. Urate or uric acid nephropathy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Complications of gout include the following:

 Severe degenerative arthritis
 Secondary infections
 Urate or uric acid nephropathy

I. Urate nephropathy.
II. Esophagitis.
III. Renal stones.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Increased susceptibility to infection
 Urate nephropathy
 Renal stones
I. Barrel esophagus.
II. Nerve or spinal cord impingement.
III. Fractures in joints with tophaceous gout.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III

 Nerve or spinal cord impingement
 Fractures in joints with tophaceous gout
6. What are the examination studies helpful in diagnosis of gout ?

I. Joint aspiration and synovial fluid analysis.
II. Serum uric acid measurement.
III. 24-seconds urinary uric acid evaluation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Diagnosis
Studies that may be helpful include the following:
 Joint aspiration and synovial fluid analysis
 Serum uric acid measurement (though hyperuricemia is not diagnostic of gout)
7. What are the examination studies helpful in diagnosis of gout ?
I. 24-seconds urinary uric acid evaluation.
II. 24-hour urinary uric acid evaluation.
III. Blood studies.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Diagnosis
Studies that may be helpful include the following:
 24-hour urinary uric acid evaluation
 Blood studies (including white blood cells [wbcs, triglyceride, high-density lipoprotein,
glucose, and renal and liver function tests)
8. Which out of the following imaging technique are helpful in diagnosis of gout ?
I. Plain radiographs.
II. Scanning laser polarimetry.
III. Ultrasonographic.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Diagnosis
 Computed tomography (CT)
 Magnetic resonance imaging (MRI)
9. Which out of the following imaging technique are helpful in diagnosis of gout ?
I. Computed tomography (CT).
II. Magnetic resonance imaging (MRI).
III. Scanning laser polarimetry.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Diagnosis
 Plain radiographs
 Ultrasonographic
10. What is the goal of long-term management of gout ?

I. Is focused on lowering IOP levels.
II. Is focused on lowering uric acid levels.
III. Is focused on lowering acetic acid levels.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Long-term management of gout is focused on lowering uric acid levels. Agents used include the
following:
 Allopurinol
 Febuxostat
 Probenecid
11. Which out of following drug agent is used for long-term management of gout ?
I. Allopurinol.
II. Febuxostat.
III. Acetazolamide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Long-term management of gout is focused on lowering uric acid levels. Agents used include the
following:
 Allopurinol
 Febuxostat
 Probenecid
12. Which out of the following nonpharmacologic measures warrant the gout patient ?
I. Avoidance or restricted consumption of high-purine foods.
II. Avoidance or restricted consumption of green vegetables.
III. Avoidance of excess ingestion of alcoholic drinks, particularly beer.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Nonpharmacologic measures that may be warranted are as follows:

 Avoidance or restricted consumption of high-purine foods
 Avoidance of excess ingestion of alcoholic drinks, particularly beer
I. Avoidance or restricted consumption of green vegetables.
II. Avoidance of sodas and other beverages or foods sweetened with high-fructose corn syrup.
III. Limited use of naturally sweet fruit juices, table sugar, and sweetened beverages and desserts.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Avoidance of sodas and other beverages or foods sweetened with high-fructose corn syrup
 Limited use of naturally sweet fruit juices, table sugar, and sweetened beverages and desserts,
as well as table salt
I. Maintenance of a high level of hydration with
II. A low-cholesterol, low-fat diet, if such a diet is otherwise appropriate for the patient.
III. Avoidance or restricted consumption of green vegetables.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D


 A low-cholesterol, low-fat diet, if such a diet is otherwise appropriate for the patient
 Weight reduction in patients who are obese
15. What are the basic steps for the management of gout ?
I. Treating the acute attack.
II. Providing prophylaxis to prevent acute flares.
III. Increase the amount of urate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Gout is managed in the following 3 stages:

 Treating the acute attack
 Providing prophylaxis to prevent acute flares
 Lowering excess stores of urate
16. What is the principal risk factor for developing gout ?

I. Elevated serum uric acid levels.
II. Reduced serum uric acid levels.
III. Elevated bile uric acid levels.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Elevated serum uric acid levels are the principal risk factor for developing gout
17. What is the goal of the treatment of gout ?
I. To relieve pain.
II. To prevent disease progression.
III. To relieve allergy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Treatment of gout is important to relieve pain; to prevent disease progression; and to prevent
deposition of urate crystals in the renal medulla or uric acid crystals in the renal collecting system,
which may produce kidney stones or urate nephropathy.
18. What is the goal of the treatment of gout ?

I. To prevent deposition of urate crystals in the renal medulla .
II. To prevent deposition uric acid crystals in the renal collecting system.
III. To produce kidney stones or urate nephropathy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Treatment of gout is important to relieve pain; to prevent disease progression; and to prevent
deposition of urate crystals in the renal medulla or uric acid crystals in the renal collecting system,
which may produce kidney stones or urate nephropathy.
19. What is mean by gout ?
I. A disorder of metabolism that allows propionic acid to accumulate in blood and tissues.
II. A disorder of metabolism that allows acetic acid to accumulate in blood and tissues.
III. A disorder of metabolism that allows uric acid or urate to accumulate in blood and tissues.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Gout can be considered a disorder of metabolism that allows uric acid or urate to accumulate in blood
and tissues.
20. What are the conditions in which uric acid crystals are formed ?
I. When tissues become supersaturated, the urate salts precipitate.
II. The crystals are less soluble under acid conditions and at low temperatures.
III. When tissues become old, the acetate salts precipitate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
When tissues become supersaturated, the urate salts precipitate, forming crystals. In addition, the
crystals also are less soluble under acid conditions and at low temperatures, such as occur in cool,
peripheral joints (eg, the metatarsophalangeal joint of the big toe
21. What is the characterstics of urate crystals observed during polarizing microscopy ?
I. Needlelike crystals.
II. Circular crystals.
III. Light-retarding (phase-shifting) characteristics of crystals.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Urate initially precipitates in the form of needlelike crystals. The light-retarding (phase-shifting)
characteristics of urate crystals allow them to be recognized by polarizing microscopy
22. What is mean by ENPP1 ?

I. Ectonucleotide phosphodiesterase pyrophosphatase.
II. Endonucleotide phosphodiesterase pyrophosphatase.
III. Endonucleotide chlorophodiesterase pyrophosphatase.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Ectonucleotide phosphodiesterase pyrophosphatase (ENPP1)

23. What is the calciumpyrophosphate (CPP) crystals ?
I. A combination of organic phosphate and calcium.
II. A combination of organic pyrophosphate and calcium.
III. A combination of inorganic pyrophosphate and calcium.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The CPP crystals that produce pseudogout comprise a combination of inorganic pyrophosphate and
calcium.
24. How the inorganic pyrophosphate produced in pseudogout ?

I. A catalytic enzymeENPP1 found in chondrocytes of cartilage produce inorganic pyrophosphate.
II. The pyrophosphate is exported potently by the membrane transporter ANKH.
III. When tissues become supersaturated, the urate salts precipitate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The inorganic pyrophosphate is produced in large part by ectonucleotide phosphodiesterase

pyrophosphatase (ENPP1), a catalytic enzyme found in chondrocytes of cartilage, and the
pyrophosphate is exported potently by the membrane transporter ANKH.
25. What are the factors that triggered the gout attack ?
I. Release of crystals.
II. Precipitation of crystals in a supersaturated microenvironment.
III. By inorganic pyrophosphate and calcium.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
A gout attack may be triggered either by release of crystals (eg, from partial dissolution of a microtophus
caused by changing serum urate levels) or by precipitation of crystals in a supersaturated
microenvironment (eg, release of urate as a consequence of cellular damage).
26. What does mean by release of crystals in gout attack ?

I. Partial dissolution of a microtophus caused by changing serum urate levels.
II. Release of urate as a consequence of cellular damage.
III. The pyrophosphate is exported potently by the membrane transporter ANKH.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
By release of crystals (eg, from partial dissolution of a microtophus caused by changing serum urate
levels)
27. What does mean by precipitation of crystals in a supersaturated microenvironment in
gout attack ?
I. Partial dissolution of a microtophus caused by changing serum urate levels.
II. Release of urate as a consequence of cellular damage.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
By precipitation of crystals in a supersaturated microenvironment (eg, release of urate as a consequence

of cellular damage).
28. Which out of the following statement is/are correct for urate crystals produced in gout
?
I. Naked urate crystals then interact with intracellular and surface receptors of local dendritic cells
and macrophages.
II. Triggering a danger signal to activate the innate immune system.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In either situation, it is believed, naked urate crystals then interact with intracellular and surface
receptors of local dendritic cells and macrophages, triggering a danger signal to activate the innate
immune system
29. In which form the uric acid is store in gout ?
I. In the form of disodium urate.
II. In the form of monosodium urate.
III. In the form of monolithium urate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Gout develops in the setting of excessive stores of uric acid in the form of monosodium urate.
30. By which mechanism uric acid is produced in body ?

I. An end-stage by-product of first pass metabolism.
II. An end-stage by-product of pyrimidine metabolism.
III. An end-stage by-product of purine metabolism.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Uric acid is an end-stage by-product of purine metabolism

31. Which out of the following case show that the overproduction of uric acid is the result
of a genetic disorder ?
I. Hypoxanthine-guanine phosphoribosyltransferase deficiency ( Lesch-Nyhan syndrome).
II. Glucose-6-phosphatase deficiency (von Gierke disease).
III. Maltose-6-phosphatase deficiency (von Gierke disease).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Overproduction of uric acid is the result of a genetic disorder, such as the following:
 Hypoxanthine-guanine phosphoribosyltransferase deficiency ( Lesch-Nyhan syndrome)
 Glucose-6-phosphatase deficiency (von Gierke disease)
32. Which out of the following case show that the overproduction of uric acid is the result
of a genetic disorder ?
I. Lactose 1-phosphate aldolase deficiency.
II. Fructose 1-phosphate aldolase deficiency.
III. Superactivity of phosphoribosyl pyrophosphate synthetase (PRPP).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Overproduction of uric acid is the result of a genetic disorder, such as the following[20] :
 Fructose 1-phosphate aldolase deficiency
 Superactivity of phosphoribosyl pyrophosphate synthetase (PRPP)
33. Which out of the following statement is /are correct regarding overproduction of uric
acid ?
I. It occur in disorders that cause high cell turnover with release of purines .
II. It occur in disorders that cause high cell turnover with release of lactose.
III. Myeloproliferative and lymphoproliferative disorders, psoriasis, and hemolytic anemias include
overproduction of uric acid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Overproduction of uric acid may also occur in disorders that cause high cell turnover with release of
purines that are present in high concentration in cell nuclei. These disorders include myeloproliferative
and lymphoproliferative disorders, psoriasis, and hemolytic anemias
34. Which comorbid conditions are associated with a higher incidence of gout ?
I. Hypertension.
III. Esophagitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Certain comorbid conditions are associated with a higher incidence of gout, including the following:
 Hypertension
I. Skin rashes.
II. Renal insufficiency.
III. Hypertriglyceridemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
 Renal insufficiency
 Hypertriglyceridemia
I. Hypercholesterolemia.
II. Corneal dermatitis.
III. Anemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
 Hypercholesterolemia
 Obesity
 Anemia
37. Which foods that are rich in purines is associated with an increased risk of gout ?
I. Anchovies.
II. Sardines.
III. Milk product.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Foods that are rich in purines include anchovies, sardines, sweetbreads, kidney, liver, and meat
extracts. Consumption of fructose-rich foods and beverages (eg, those sweetened with high-fructose
corn syrup) is associated with an increased risk of gout in both men and women
38. Which foods that are rich in purines is associated with an increased risk of gout ?
I. Sweetbreads.
II. Kidney, liver, and meat extracts.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
extracts.
39. Which food products should be avoided to reduce risk of gout in both men and women
I. Foods that are rich in purines.
II. Milk products.
III. Fructose-rich foods and beverages.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
extracts. Consumption of fructose-rich foods and beverages (eg, those sweetened with high-fructose
corn syrup) is associated with an increased risk of gout in both men and women
40. Which out of the following genes are noted to have a strong association with
hyperuricemia ?
I. Glucose transporter 9 (GLUT9)gene.
II. Urate transporter 1 (URAT1) gene.
III. Collagen type IV,alpha 2.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
In particular, 3 genes are noted to have a strong association with hyperuricemia.

 The glucose transporter 9 (GLUT9) gene
 Urate transporter 1 (URAT1) gene
 Polymorphisms in the ABCG2 gene
41. Which out of the following genes are noted to have a strong association with
hyperuricemia ?
I. Glucose transporter 9 (GLUT9)gene.
II. Collagen type IV,alpha 2.
III. Polymorphisms in the ABCG2 gene.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In particular, 3 genes are noted to have a strong association with hyperuricemia.

 The glucose transporter 9 (GLUT9) gene
 Urate transporter 1 (URAT1) gene
 Polymorphisms in the ABCG2 gene
42. What is the cause of higher of uric acid levels in men than in women ?
I. Due to the minor allele of rs2231142 in ABCG2.
II. Due to the minor allele of rs2231111 in ABCG2.
III. Due to the minor allele of rs2111142 in ABCD2.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Elevation of uric acid levels is greater in men than in women with the minor allele of rs2231142 in
ABCG2
43. What is mean by podagra ?
I. Inflammation in the metatarsal-phalangeal joint of the great toe.
II. Inflammation in the metafemurl-phalangeal joint of the great toe.
III. Inflammation in the metaalna-phalangeal joint of the great toe.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Inflammation in the metatarsal-phalangeal joint of the great toe (podagra)
44. Which disease may also observed podagra in patient ?

I. Sarcoidosis.
II. Gonococcal arthritis.
III. Gonorrohea.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Podagra is not synonymous with gout, however: it may also be observed in patients with pseudogout,
sarcoidosis, gonococcal arthritis, psoriatic arthritis, and reactive arthritis.
45. Which symptoms are highly suggestive of acute crystal-induced arthritis ?
I. Inflammation in the metafemurl-phalangeal joint of the great toe.
II. Onset of excruciating pain, edema.
III. Inflammation in the metatarsal-phalangeal joint of the great toe.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The spontaneous onset of excruciating pain, edema, and inflammation in the metatarsal-phalangeal
joint of the great toe (podagra) is highly suggestive of acute crystal-induced arthritis. Podagra is the
initial joint manifestation in 50% of gout cases; eventually, it is involved in 90% of cases.
46. What are the common sites of gouty arthritis ?

I. The great toe.
II. The instep.
III. The cervical.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Other than the great toe, the most common sites of gouty arthritis are the instep, ankle, wrist, finger
joints, and knee
I. The finger joints.
II. The ribs.
III. The knee.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
joints, and knee

I. The ankle.
II. The wrist .
III. The cervical.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
joints, and knee
49. Which situations lead to acute flares of gout ?
I. Increased levels of serum uric acid.
II. The consumption of beer or liquor.
III. The consumption of green vegetables.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Acute flares of gout can result from situations that lead to increased levels of serum uric acid, such as
the consumption of beer or liquor, overconsumption of foods with high purine content, trauma,
dehydration, or the use of medications that elevate levels of uric acid.
50. Which situations lead to acute flares of gout ?

I. The use of medications that elevate levels of uric acid.
II. The consumption of green vegetables.
III. Overconsumption of foods with high purine content.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Acute flares of gout can result from situations that lead to increased levels of serum uric acid, such as
the consumption of beer or liquor, overconsumption of foods with high purine content, trauma,
dehydration, or the use of medications that elevate levels of uric acid.
51. What does mean by tophi ?
I. Collections of acetate crystals in the soft tissues.
II. Collections of urate crystals in the soft tissues.
III. Collections of phosphate crystals in the soft tissues.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Tophi are collections of urate crystals in the soft tissues.
52. At which locations tophi are developed in gout patient ?

I. The nose.
II. Along the helix of the ear.
III. The prepatellar bursa.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Tophi are classically located along the helix of the ear, but they can be found in multiple locations,
including the fingers, the toes, the prepatellar bursa, and along the olecranon, where they can resemble
rheumatoid nodules .
53. At which locations tophi are developed in gout patient ?
I. Along the olecranon.
II. The fingers.
III. The lips.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Tophi are classically located along the helix of the ear, but they can be found in multiple locations,
including the fingers, the toes, the prepatellar bursa, and along the olecranon, where they can resemble
rheumatoid nodules .

I. Severe degenerative arthritis.
II. Skin whitening.
III. Secondary infections.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Complications
 Severe degenerative arthritis
 Secondary infections
I. Urate or uric acid nephropathy.
II. Increased susceptibility to infection.
III. Decrease susceptibility to infection.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Complications
 Urate or uric acid nephropathy
 Increased susceptibility to infection

I. Bile stone.
II. Urate nephropathy.
III. Renal stones.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Complications
 Urate nephropathy
 Renal stones
I. Nerve or spinal cord impingement.
II. Decrease susceptibility to infection.
III. Fractures in joints with tophaceous gout.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Complications
 Nerve or spinal cord impingement
 Fractures in joints with tophaceous gout
58. Which out of the following statement is/are correct for monosodium urate (MSU) in
gout ?
I. It appear as needle-shaped intracellular and extracellular crystals.
II. They are positively birefringent, appearing blue when aligned parallel.
III. They examined with a polarizing filter and red compensator filter.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
In gout, crystals of monosodium urate (MSU) appear as needle-shaped intracellular and extracellular
crystals. When examined with a polarizing filter and red compensator filter,
59. Which out of the following statement is/are correct for monosodium urate (MSU) in
gout ?
I. They are yellow when aligned parallel to the slow axis of the red compensator.
II. They are blue when aligned across the direction of polarization (they exhibit negative
birefringence).
III. They are positively birefringent, appearing blue when aligned parallel.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
When examined with a polarizing filter and red compensator filter, they are yellow when aligned
parallel to the slow axis of the red compensator but turn blue when aligned across the direction of
polarization (ie, they exhibit negative birefringence). Negatively birefringent urate crystals are seen
on polarizing examination in 85% of specimens.
60. Which out of the following statement is/are correct for calcium pyrophosphate (CPP)
crystals in pseudogout ?
I. They appear shorter than MSU crystals and are often rhomboidal.
II. They are blue when aligned across the direction of polarization (they exhibit negative
birefringence).
III. They are positively birefringent, appearing blue when aligned parallel with the slow axis of the
compensator .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Microscopic analysis in pseudogout shows calcium pyrophosphate (CPP) crystals, which appear shorter
than MSU crystals and are often rhomboidal. Under a polarizing filter, CPP crystals change color
depending upon their alignment relative to the direction of the red compensator. They are positively
birefringent, appearing blue when aligned parallel with the slow axis of the compensator and yellow
when perpendicular
61. What are the symptoms of gout ?
I. Podagra.
II. Arthritis in other sites.
III. Loss of vision.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Signs and symptoms

 Podagra
 Arthritis in other sites
62. What are the symptoms of gout ?

I. Loss of vision.
II. Monoarticular involvement.
III. Chronic polyarticular arthritis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Signs and symptoms

 Monoarticular involvement
 Chronic polyarticular arthritis
63. Which out of the following physical findings observed in gout ?
I. Fever.
II. Loss of vision.
III. Migratory polyarthritis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Physical findings may include the following:

 Fever (also consider infectious arthritis)
 Migratory polyarthritis (rare)
64. Which out of the following physical findings observed in gout ?

I. Loss of vision.
II. Posterior interosseous nerve syndrome.
III. Tophi in soft tissues.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Posterior interosseous nerve syndrome (rare)
 Tophi in soft tissues (helix of the ear, fingers, toes, prepatellar bursa, olecranon)
65. Which out of the following physical findings of eye involvement observed in gout ?
I. Band keratopathy.
II. Anterior uveitis.
III. Colour of eye.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Eye involvement Tophi, crystal-containing conjunctival nodules, band keratopathy, blurred vision,
anterior uveitis (rare), scleritis
66. Which out of the following signs of inflammation observed in gout ?

I. Swelling and warmth.
II. Esophagitis.
III. Erythema and tenderness.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III

 Involvement of a single (most common) or multiple joints
 Signs of inflammation Swelling, warmth, erythema (sometimes resembling cellulitis), and
tenderness
67. What are the stages involve for the management of gout ?
II. Treat only chronic attack.
III. Providing prophylaxis to prevent acute flares.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Lowering excess stores of urate to prevent flares of gouty arthritis and to prevent tissue
deposition of urate crystals
68. What are the stages involve for the management of gout ?
I. Treat only chronic attack.
II. Lowering excess stores of urate to prevent flares of gouty arthritis.
III. Lowering excess stores of urate to prevent tissue deposition of urate crystals.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

69. Which out of the following agents used for acute treatment of crystal-induced arthritis
?
I. Nonsteroidal anti-inflammatory drugs (NSAIDs).
II. Antiemetics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Acute treatment of proven crystal-induced arthritis is directed at relief of the pain and inflammation.
Agents used in this setting include the following:
 Nonsteroidal anti-inflammatory drugs (nsaids), such as indomethacin
 Corticosteroids
70. Which out of the following agents used for acute treatment of crystal-induced arthritis
?
I. Colchicine.
II. Adrenocorticotropic hormone (ACTH).
III. Antiemetics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Acute treatment of proven crystal-induced arthritis is directed at relief of the pain and inflammation.
Agents used in this setting include the following:
 Nonsteroidal anti-inflammatory drugs (nsaids), such as indomethacin
 Corticosteroids
 Colchicine (now less commonly used for acute gout than it once was)
 Adrenocorticotropic hormone (ACTH)
71. Which out of the following drug combination is used for acute treatment of crystal-
induced arthritis ?
I. Colchicine plus NSAIDs.
II. Oral corticosteroids plus colchicines.
III. Antiemetics plus colchicines.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Combinations of drugs (colchicine plus nsaids, oral corticosteroids plus colchicine, intra-articular
steroids plus colchicine or nsaids)
72. Which out of the following drug combination is used for acute treatment of crystal-
induced arthritis ?
I. Intra-articular steroids plus colchicines.
II. Antiemetics plus colchicines.
III. Intra-articular steroids plus NSAIDs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Combinations of drugs (colchicine plus nsaids, oral corticosteroids plus colchicine, intra-articular
steroids plus colchicine or nsaids)
73. What is mean by primary gout ?
I. It is related to medications or conditions that cause hyperuricemia.
II. Underexcretion or overproduction of uric acid.
III. Associated with a mix of dietary excesses or alcohol overuse and metabolic syndrome.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Primary gout is related to underexcretion or overproduction of uric acid, often associated with a mix
of dietary excesses or alcohol overuse and metabolic syndrome.
74. What is mean by secondary gout ?

I. It is related to medications or conditions that cause hyperuricemia.
II. Underexcretion or overproduction of uric acid.
III. Associated with a mix of dietary excesses or alcohol overuse and metabolic syndrome.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Secondary gout is related to medications or conditions that cause hyperuricemia,

75. Which out of the following condition causes hyperuricemia leads to secondary gout ?
I. Myeloproliferative diseases or their treatment.
II. Renal failure.
III. Bile stone.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Secondary gout is related to medications or conditions that cause hyperuricemia, such as the following
 Myeloproliferative diseases or their treatment
 Therapeutic regimens that produce hyperuricemia
 Renal failure
76. Which out of the following condition causes hyperuricemia leads to secondary gout ?
I. Bile stone.
II. Lead poisoning.
III. Hyperproliferative skin disorders.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Secondary gout is related to medications or conditions that cause hyperuricemia, such as the following
 Lead poisoning
 Hyperproliferative skin disorders
77. Which out of the following medication increase uric acid levels via effects on renal
tubular transport ?
I. Loop and thiazide diuretics.
II. Niacin.
III. Allopurinol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Medications that increase uric acid levels via effects on renal tubular transport include loop and
thiazide diuretics, niacin, low-dose aspirin, and cyclosporine A
78. Which out of the following medication increase uric acid levels via effects on renal
tubular transport ?
I. Allopurinol.
II. Low-dose aspirin.
III. Cyclosporine A.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Medications that increase uric acid levels via effects on renal tubular transport include loop and
thiazide diuretics, niacin, low-dose aspirin, and cyclosporine A
79. What is the estimated prevalence of gout in men and women respectively ?
I. 5.9% in men and 2% in women.
II. 2% in men and 5.9% in women.
III. 5.9% in men and 5.6% in women.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The estimated prevalence of gout is 5.9% in men and 2% in women
80. What is mean by cellulitis ?

I. The erythema over the joint.
II. The skin may desquamate.
III. The skin may damage.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The erythema over the joint may resemble cellulitis

81. Which out of the following study is done for diagnosis of gout ?
I. Pachymetry.
II. Synovial fluid analysis.
III. Gonioscopy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
When a patient presents with acute inflammatory monoarticular arthritis, aspiration of the involved
joint is critical to rule out an infectious arthritis and to attempt to confirm a diagnosis of gout or
pseudogout on the basis of identification of crystals
82. Which out of the following statement is correct regarding synovial fluid analysis for
crystals ?
I. The sensitivity of a synovial fluid analysis for crystals is 80%, with a specificity of 80%.
II. The sensitivity of a synovial fluid analysis for crystals is 84%, with a specificity of 50%.
III. The sensitivity of a synovial fluid analysis for crystals is 84%, with a specificity of 100%.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The sensitivity of a synovial fluid analysis for crystals is 84%, with a specificity of 100%.
83. Which out of the following statement is correct regarding synovial fluid analysis for
glucose levels ?
I. Synovial fluid glucose levels are usually normal .
II. Synovial fluid glucose levels are usually high.
III. Synovial fluid glucose levels may be depressed in septic arthritis and occasionally in rheumatoid
arthritis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Synovial fluid glucose levels are usually normal, whereas they may be depressed in septic arthritis and
occasionally in rheumatoid arthritis.
84. Which out of the following statement is correct regarding for monosodium urate crystals
formed in gout ?
I. MSU is water-soluble and dissolves in formalin.
II. MSU is oil-soluble and dissolves in lanoline oil.
III. Absolute (100%) alcohol fixed tissue is best for identification of urate crystals.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The pathologic specimens must be processed anhydrously. MSU is water-soluble and dissolves in
formalin; therefore, only the ghosts of urate crystals may be seen if formalin is used. Absolute (100%)
alcohol fixed tissue is best for identification of urate crystals.
85. Which formulas are used to estimate the glomerular filtration rate ?
I. The Chronic bladder Disease Epidemiology Collaboration (CBD-EPI) equation.
II. The Modification of Diet in Renal Disease (MDRD) Study equation.
III. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The glomerular filtration rate can be estimated by using formulas such as the Modification of Diet
in Renal Disease (MDRD) Study equation or the Chronic Kidney Disease Epidemiology
Collaboration (CKD-EPI) equation.
86. Which out of the following statement is correct regarding blood studies in gout ?
I. The WBC count may be elevated in patients during the acute gouty attack.
II. The RBC count may be elevated in patients during the acute gouty attack
III. Hypertriglyceridemia and low levels of high-density lipoprotein are associated with gout.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The WBC count may be elevated in patients during the acute gouty attack, particularly if it is
polyarticular. Hypertriglyceridemia and low levels of high-density lipoprotein (HDL) are associated
with gout.
87. During histology study What does mean by large pale pink acellular areas in chronic
tophaceous gouty ?
I. It represent dissolved urate crystals, surrounded by histiocytes and multinucleated giant cells.
II. It represent dissolved CPP crystals, surrounded by histiocytes and multinucleated giant cells.
III. It represent dissolved sugar crystals, surrounded by histiocytes and multinucleated giant cells.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Chronic tophaceous gouty deposits frequently show large pale pink acellular areas, which represent
dissolved urate crystals, surrounded by histiocytes and multinucleated giant cells
88. What are the other therapeutic agents used for the treatment of gout ?
I. Vitamin B12 .
II. Uricase and pegloticase.
III. Vitamin C.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Other therapeutic agents that may be considered include the following:

 Uricase and pegloticase
 Vitamin C
 Anakinra
 Fenofibrate
I. Anakinra.
II. Fenofibrate.
III. Vitamin B12.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Uricase and pegloticase
 Vitamin C
 Anakinra
 Fenofibrate
90. Which diagnosis technique for tumoral calcium pyrophosphate crystal deposition,
differentiating it from gouty tophus or soft-tissue malignancy ?
I. Plain radiograph.
II. Ultrasonograph.
III. Dual-energy CT.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The use of dual-energy CT to diagnose tumoral calcium pyrophosphate crystal deposition,

differentiating it from gouty tophus or soft-tissue malignancy.
91. What are the typical charaterstics of erosions of gout ?
I. Maintenance of the joint space.
II. Absence of periarticular osteopenia.
III. Presence of periarticular osteopenia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Characteristics of erosions that are typical of gout but not of rheumatoid arthritis include the
following:
 Maintenance of the joint space
 Absence of periarticular osteopenia
92. What are the typical charaterstics of erosions of gout ?

I. Presence of periarticular osteopenia.
II. Location outside the joint capsule.
III. Sclerotic borders.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Characteristics of erosions that are typical of gout but not of rheumatoid arthritis include the
following:
 Location outside the joint capsule
 Sclerotic borders
93. What is mean by chondrocalcinosis ?
I. A thick, hyperechoic band within fibrocartilage and punctuated pattern on fibrocartilage.
II.A thin, hyperechoic band within hyaline cartilage and punctuated pattern on fibrocartilage.
III. A thick, hyperechoic band within cricoid cartilage and punctuated pattern on fibrocartilage.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Chondrocalcinosis show up as a thin, hyperechoic band within hyaline cartilage and punctuated
pattern on fibrocartilage
94. What are the findings of ultrasonogragh in established gout ?

I. -
II. Muscle erosions adjacent to tophaceous deposits.
III. Wet clumps of sugar.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Ultrasonographic findings in established gout include the following[90, 91, 92] :

 -

 Bony erosions adjacent to tophaceous deposits
95. What is mean by wet clumps of sugar ?
I. Tophaceous material.
II. Hyperechoic and hypoechoic heterogeneous material with an anechoic rim.
III. Irregular line of MSU crystals on the surface of articular cartilage.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

hypoechoic heterogeneous material with an anechoic rim
96. What is mean by double contour ?

I. A hyperechoic, irregular line of MSU crystals .
II. Tophaceous material.
III. Crystals on the surface of articular cartilage overlying an adjacent hyperechoic bony contour.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
A -
articular cartilage overlying an adjacent hyperechoic bony contour
97. Which out of the following statement is /are correct for ultrasonography ?
I. It demonstrate urate crystal deposition in tissues of asymptomatic patients with hyperuricemia.
II. Its is not use for diagnosis for gout.
III. It had higher sensitivity than radiography for detection of calcium pyrophosphate crystal
deposition (CPPD).
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Ultrasonography may demonstrate urate crystal deposition in tissues of asymptomatic patients with
hyperuricemia.Ultrasonography had higher sensitivity than radiography for detection of calcium
pyrophosphate crystal deposition (CPPD)
98. What is the specificity of double contour sign for gout ?

I. 14%.
II. 54%.
III. 64%.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The double contour sign is 85% sensitive and 80% specific for crystalline arthritis in general, with
specificity for gout of 64% and for calcium pyrophosphate deposition disease of 52%.
99. What is the specificity of double contour sign for calcium pyrophosphate deposition
disease?
I. 12%.
II. 52%.
III. 72%.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
The double contour sign is 85% sensitive and 80% specific for crystalline arthritis in general, with
specificity for gout of 64% and for calcium pyrophosphate deposition disease of 52%.
100. Which technique is used to assess chemical composition, labeling urate deposits in red
?
I. Plain radiograph.
II. Ultrasonograph.
III. Dual-energy CT, using a renal stone color-coding protocol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Dual-energy CT, using a renal stone color-coding protocol, assesses chemical composition, labeling
urate deposits in red
1. What are the stages for the management of gout ?

II. Providing prophylaxis to prevent acute flares.
III. Avoid the treating the acute attack.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

2. What are the stages for the management of gout ?

I. Avoid the treating the acute attack.
II. Lowering excess stores of urate to prevent flares of gouty arthritis.
III. Lowering excess stores of urate to prevent tissue deposition of urate crystals.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

3. What are the other risk factor observed for gout flares?
I. Male gender.
II. Female gender.
III. Failure to attain serum uric acid goal.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Other risk factors for gout flares included the following:

 Male gender
 Failure to attain serum uric acid goal
I. Female gender.
II. Presence of three or more comorbidities.
III. Use of diuretics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E

 Presence of three or more comorbidities
 Use of diuretics
I. No changes in initial urate-lowering therapy dose.
II. Female gender.
III. Nonadherence to urate-lowering therapy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 No changes in initial urate-lowering therapy dose
 Nonadherence to urate-lowering therapy
6. Which out of the following drugs are used for treatment of acute gouty attacks ?
I. Nonsteroidal anti-inflammatory drugs.
II. Colchicine.
III. Diuretics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Treatment of Acute Attacks

 Nonsteroidal anti-inflammatory drugs
 Colchicine
 Corticosteroids
7. Which out of the following drugs are used for treatment of acute gouty attacks ?
I. Diuretics.
II. Colchicine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Treatment of Acute Attacks

 Nonsteroidal anti-inflammatory drugs
 Colchicine
 Corticosteroids
8. Which out of the following drugs combination therapy are used for treatment of acute
gouty attacks ?
I. Colchicine plus NSAIDs.
II. Oral corticosteroids plus colchicines.
III. Intra-articular steroids plus loop diuretics.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Treatment of Acute Attacks------Combination therapy

 Colchicine plus nsaids
 Oral corticosteroids plus colchicine
 Intra-articular steroids plus colchicine or nsaids
9. Which out of the following drugs combination therapy are used for treatment of acute
gouty attacks ?
I. Intra-articular steroids plus colchicines.
II. Intra-articular steroids plus loop diuretics.
III. Intra-articular steroids plus NSAIDs.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Treatment of Acute Attacks------Combination therapy

 Colchicine plus nsaids
 Oral corticosteroids plus colchicine
 Intra-articular steroids plus colchicine or nsaids
10. Which out of the following statement is /are true for NSAIDs used for the treatment of
gout ?
I. NSAIDs are the drugs of choice in most patients with acute gout who do not have underlying
health problems.
II. Indomethacin is the NSAID traditionally chosen for acute gout.
III. Furesemide is the NSAID traditionally chosen for acute gout.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Nsaids are the drugs of choice in most patients with acute gout who do not have underlying health
problems. Although indomethacin is the NSAID traditionally chosen for acute gout, most of the other
nsaids can be used as well.
11. Which out of the following NSAIDs drugs are used for the treatment of acute gout
attack ?
I. Indomethacin.
II. Aspirin.
III. Cyclooxygenase-2 (COX-2) inhibitors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Nsaids drugs are used for the treatment of acute gout attack
Indomethacin
Cyclooxygenase-2 (COX-2) inhibitors
gout ?
I. Furesemide is the NSAID traditionally chosen for acute gout.
II. Avoid NSAIDs in patients with a history of peptic ulcer disease .
III. Avoid NSAIDs in patients with a history abnormal hepatic function, those taking warfarin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Avoid nsaids in patients with a history of peptic ulcer disease or gastrointestinal (GI) bleeding, those
with renal insufficiency or abnormal hepatic function, those taking warfarin (a selective COX-2
inhibitor can be used)
gout ?
I. Use NSAIDs cautiously in patients with diabetes.
II. Furesemide is the NSAID traditionally chosen for acute gout.
III. Use NSAIDs cautiously in patients who are receiving concomitant angiotensin-converting
enzyme inhibitors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Use nsaids cautiously in patients with diabetes and those who are receiving concomitant angiotensin-
converting enzyme (ACE) inhibitors.
14. Why the NASIDS use limits in elderly patients ?

I. Because of the potential for adverse central nervous system (CNS) effects.
II. Because of the potential for adverse rheumathoid effects.
III. Because of the potential for adverse cardio vascular system (CVS) effects.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Those in the intensive care unit (ICU) who are predisposed to gastritis. Limit NSAID use in elderly
patients, because of the potential for adverse central nervous system (CNS) effects
15. Which out of the following statement is /are true for colchicine used for the tr eatment
of acute gouty attack ?
I. Colchicine therapy is ideally initiated within 36 hours of onset of the acute attack.
II. Indomethacin is the colchicine traditionally chosen for acute gout.
III. Colchicine causes adverse GI effects, particularly diarrhea and vomiting, in 80% of patients.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Colchicine therapy is ideally initiated within 36 hours of onset of the acute attack. When used for
acute gout in classic hourly dosing regimens (no longer recommended), colchicine causes adverse gi
effects, particularly diarrhea and vomiting, in 80% of patients.
16. Which out of the following statement is /are true for colchicine used for the treatment
of acute gouty attack ?
I. Colchicine therapy is ideally initiated within 36 hours of onset of the acute attack.
II. The regimen currently favored consists of 1.2 mg of colchicine, followed by 0.6 mg 1 hour.
III. Indomethacin is the colchicine traditionally chosen for acute gout.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
The regimen currently favored consists of 1.2 mg of colchicine, followed by 0.6 mg 1 hour later to
initiate treatment of the early gout flare.
17. Which out of the following statement is /are true for corticosteroids used for the
treatment of acute gouty attack ?
I. Indomethacin is the colchicine traditionally chosen for acute gout.
II. Steroids can be given orally, IV, intramuscularly (IM), or intra-articularly.
III. Corticosteroids can be given to patients with gout who cannot use NSAIDs or colchicines.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Corticosteroids can be given to patients with gout who cannot use nsaids or colchicine. Steroids can
be given orally, IV, intramuscularly (IM), or intra-articularly.
18. At which level of serum uric acid denotes a higher risk for recurrent gouty arthritis and
tophi ?
I. >9 mg/dL.
II. >9 g/dL.
III. >9 kg/dL.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The decision to begin therapy depends partly on the baseline serum uric acid levels (>9 mg/dl denotes
a higher risk for recurrent gouty arthritis and tophi).
19. What is the goal of long-term management of gout ?
I. To reduce serum uric acid levels to below 6 mg/dL, at minimum.
II. To reduce serum uric acid levels to below 16 mg/dL, at minimum.
III. To reduce serum uric acid levels to below 6 g/dL, at minimum.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Long-term management of gout is focused on lowering uric acid levels. The goal of therapy is to reduce
serum uric acid levels to below 6 mg/dl, at minimum.
20. Which out of the following medication use should avoided that elevate uric acid in
patients ?
I. Allpurinol.
II. Low-dose aspirin.
III. Angiotensin-receptor blocker (ARB) losartan.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Low-dose aspirin is also uricosuric. The angiotensin-receptor blocker (ARB) losartan

21. What is the standard dose of colchicines for the prophylaxis of gout ?
I. 0.6 mg twice daily.
II. 0.6 g twice daily.
III. 0.6 kg twice daily.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The standard dosage of colchicine for prophylaxis is 0.6 mg twice daily,
22. What is a particular risk in patients with renal insufficiency on long-term use of
colchicine ?
I. Allopurinol- induced neuromyopathy.
II. Colchicine-induced neuromyopathy.
III. Colchicine-induced cadiomyopathy.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Even in prophylactic doses, however, long-term use of colchicine . Colchicine-induced neuromyopathy

is a particular risk in patients with renal insufficiency
23. What is the mechanism of action of Allopurinol ?
I. It blocks xanthine oxidase.
II. It reduces the generation of uric acid.
III. It increase the generation of uric acid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Allopurinol blocks xanthine oxidase and thus reduces the generation of uric acid.
24. What is symptoms of intolerancedeveloped with allopurinol ?

I. Dyspepsia.
II. Diptheria.
III. Diarrhea.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Approximately 3-10% of patients taking allopurinol develop symptoms of intolerance, such as

dyspepsia, headache, diarrhea, or pruritic maculopapular rash.
25. What is symptoms of intolerancedeveloped with allopurinol ?
I. Herutism.
II. Headache.
III. Pruritic maculopapular rash.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Approximately 3-10% of patients taking allopurinol develop symptoms of intolerance, such as

dyspepsia, headache, diarrhea, or pruritic maculopapular rash.
26. Which rare syndrome is develop in patients taking allopurinolwhich carries a mortality
of 20-30% ?
I. Allopurinol hypersensitivity syndrome.
II. Zollinger-elison syndrome.
III. Andersen syndrome.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Less frequently (1% of cases), patients taking allopurinol can develop severe allopurinol
hypersensitivity syndrome, which carries a mortality of 20-30%.
27. What is the features of allopurinol hypersensitivity syndrome ?
I. Toxic epidermal necrolysis.
II. Bone marrow suppression.
III. Diptheria.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Features of allopurinol hypersensitivity syndrome syndrome include fever, toxic epidermal necrolysis,
bone marrow suppression, eosinophilia, leukocytosis, renal failure, hepatic failure, and vasculitis.
Corticosteroids are often used to treat severe allopurinol hypersensitivity syndrome.

I. Eosinophilia.
II. Diptheria.
III. Leukocytosis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
I. Renal failure.
II. Hepatic failure.
III. Cardiac failure.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

I. Diptheria.
II. Fever.
III. Vasculitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
31. Which of the following drug medication is used to treat severe allopurinol
hypersensitivity syndrome ?
I. Antiemetics.
II. Corticosteroids.
III. Calcium channel blockers.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Corticosteroids are often used to treat severe allopurinol hypersensitivity syndrome.
32. What is mean by DRESS syndrome ?

I. Drug rash with eosinophilia and severe symptoms syndrome.
II. Death rash with eosinophilia and systemic symptoms syndrome.
III. Drug rash with eosinophilia and systemic symptoms syndrome.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome.

33. What is mean by allopurinol hypersensitivity syndrome ?
I. Zollinger Ellison syndrome.
II. Stevens-Johnson syndrome.
III. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Severe allopurinol hypersensitivity syndrome may present as Stevens-Johnson syndrome or as drug rash
with eosinophilia and systemic symptoms (DRESS) syndrome.
34. What is the maximum dosage of allopurinol approved by the US Food and Drug
Administration ?
I. 800 mg/day.
II. 800 g/day.
III. 1200 mg/day.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
The maximum dosage of allopurinol approved by the US Food and Drug Administration (FDA) is
800 mg/day
35. Which drugs half life are prolonged by allopurinol ?
I. Azathioprine .
II. 6-mercaptopurine.
III. Cyclophosphamide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Allopurinol prolongs the half-life of azathioprine and 6-mercaptopurine.
36. What is the drug interaction of allopurinol with cyclophosphamide ?

I. It enhances the blood toxicity of cyclophosphamide.
II. It enhances the bone marrow toxicity of cyclophosphamide.
III. It enhances the brain toxicity of cyclophosphamide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Allopurinol enhances the bone marrow toxicity of cyclophosphamide

37. Which out of the following drug is used for the treatment of chronic gout ?
I. Loop diuretics.
II. Allopurinol.
III. Febuxostat.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Treatment of Chronic Gout

 Allopurinol
 Febuxostat
 Lesinurad
 Uricase
38. Which out of the following drug is used for the treatment of chronic gout ?
I. Lesinurad.
II. Loop diuretics.
III. Uricase.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Treatment of Chronic Gout

 Allopurinol
 Febuxostat
 Lesinurad
 Uricase
39. Which out of the following statement is /are true for febuxostat for the treatment of
chronic gout ?
I. It a nonpurine selective inhibitor of xanthine oxidase.
II. It is a potential alternative to allopurinol in patients with gout.
III. It enhances the bone marrow toxicity of cyclophosphamide.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Febuxostat, a nonpurine selective inhibitor of xanthine oxidase, is a potential alternative to

allopurinol in patients with gout
40. Which out of the following drugs falls in class NSAIDs for treatment of chronic gout ?
I. Naproxen.
II. Probenecid.
III. Ketoprofen.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Nsaids
 Naproxen (Anaprox, Naprelan, Naprosyn)
 Ketoprofen
 Diclofenac (Voltaren XR, Cataflam, Arthrotec)
 Indomethacin (Indocin)
 Celecoxib (Celebrex)
I. Probenecid.
II. Diclofenac.
III. Indomethacin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Nsaids
 Ketoprofen
I. Celecoxib.
II. Ketoprofen.
III. Probenecid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Nsaids
 Ketoprofen
43. Which out of the following drugs falls in class uricosuric agents for treatment of chronic gout ?
I. Ketoprofen.
II. Colchicine.
III. Probenecid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Uricosuric agents
 Colchicine (colcrys)
 Probenecid
44. Which out of the following drugs falls in class corticosteroids for treatment of chronic gout ?
I. Prednisone.
II. Triamcinolone.
III. Probenecid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Corticosteroids
 Prednisone
 Triamcinolone (Aristocort)
 Corticotropin (HP Acthar Gel, Acthar Gel)
45. Which out of the following drugs falls in class corticosteroids for treatment of chronic gout ?
I. Triamcinolone.
II. Probenecid.
III. Corticotropin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Corticosteroids
 Prednisone
 Triamcinolone (Aristocort)
 Corticotropin (HP Acthar Gel, Acthar Gel)
46. Which out of the following drugs falls in class xanthine oxidase inhibitors for treatment of
chronic gout ?
I. Allopurinol.
II. Corticotropin.
III. Febuxostat.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Xanthine oxidase inhibitors

 Allopurinol (zyloprim, aloprim)
 Febuxostat (uloric)
47. Which out of the following drugs falls in class selective uric acid reabsorption inhibitor
for treatment of chronic gout ?
I. Allopurinol.
II. Corticotropin.
III. Lesinurad .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Selective Uric acid Reabsorption Inhibitor (SURI)

 Lesinurad (Zurampic)
48. Which out of the following drugs falls in class rheumatologics for treatment of chronic
gout ?
I. Allopurinol.
II. Pegloticase.
III. Lesinurad.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Rheumatologics, other
 Pegloticase (krystexxa)
49. Which out of the following drugs falls in class corticotropic hormones for treatment of chronic
gout ?
I. Cosyntropin .
II. Pegloticase.
III. Lesinurad.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Corticotropic hormones
 Cosyntropin (cortrosyn, synthetic acth)
50. What is the mechanism of action of naproxen in gout patient ?

I. It inhibits inflammatory reactions and pain.
II. It increasing activity of the enzyme cyclooxygenase, resulting in prostaglandin synthesis..
III. It decreasing activity of the enzyme cyclooxygenase, resulting in prostaglandin synthesis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Naproxen is used for relief of mild to moderate pain. It inhibits inflammatory reactions and pain by
decreasing activity of the enzyme cyclooxygenase, resulting in prostaglandin synthesis.
51. What is the mechanism of action of diclofenac in gout patient ?
I. It increases formation of prostaglandin precursors.
II. It inhibits prostaglandin synthesis by decreasing activity of the enzyme cyclooxygenase.
III. It decreases formation of prostaglandin precursors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Diclofenac inhibits prostaglandin synthesis by decreasing activity of the enzyme cyclooxygenase, which
in turn decreases formation of prostaglandin precursors.
52. What is the mechanism of action of indomethacin in gout patient ?

II. It blocks cyclooxygenase.
III. It reduces the generation of prostaglandins.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Indomethacin blocks cyclooxygenase and thereby reduces the generation of prostaglandins.

53. What is the mechanism of action of uricosuric agents in gout patient ?
I. They lower uric acid levels by inhibiting renal tubular reabsorption of uric acid.
II. They blocks cyclooxygenase.
III. They increasing net renal excretion of uric acid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Uricosuric agents lower uric acid levels by inhibiting renal tubular reabsorption of uric acid, thereby
increasing net renal excretion of uric acid.
54. What is the mechanism of action of colchicine in gout patient ?

II. It also may inhibit generation of prostaglandins.
III. It inhibits microtubules ,phagocytosis, neutrophil mobility, and chemotaxis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Colchicine inhibits microtubules and may thereby inhibit phagocytosis, neutrophil mobility, and
chemotaxis. It also may inhibit generation of prostaglandins.
55. What is the mechanism of action of probenecid in gout patient ?
I. It lowers tissue stores of uric acid by increasing net renal excretion of uric acid.
II. It inhibit tubular reabsorption of uric acid.
III. It increases formation of prostaglandin precursors.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Probenecid lowers tissue stores of uric acid by increasing net renal excretion of uric acid through
inhibition of tubular reabsorption.
56. What is mean by PMN activity ?

I. Polymorphonuclear leukocyte activity.
II. Polymorphonuclear liquid activity.
III. Polynuclear leukocyte activity.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Polymorphonuclear leukocyte (PMN) activity

57. What is the mechanism of action of corticotropin in gout patient ?
I. It stimulates endogenous production of corticosteroids and directly acts on peripheral leukocyte
activation.
II. It lowers tissue stores of uric acid by increasing net renal excretion of uric acid.
III. It decreases inflammation by suppressing migration of PMNs and reversing increased capillary
permeability.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Corticotropin stimulates endogenous production of corticosteroids and directly and rapidly acts on
peripheral leukocyte activation. It decreases inflammation by suppressing migration of pmns and
reversing increased capillary permeability.
58. What is the mechanism of action of xanthine oxidase in gout patient ?

I. It inhibit synthesizes uric acid from hypoxanthine.
II. It reduces the synthesis of uric acid without disrupting the biosynthesis of vital purines.
III. It lowers tissue stores of uric acid by increasing net renal excretion of uric acid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Inhibition of xanthine oxidase, the enzyme that synthesizes uric acid from hypoxanthine, reduces the
synthesis of uric acid without disrupting the biosynthesis of vital purines. This results in the reduction
of the tissue stores of uric acid.
59. What is the mechanism of action of allopurinol in gout patient ?
II. It reduces the synthesis of uric acid without disrupting the biosynthesis of vital purines.
III. It reduces production of uric acid, thereby allowing the body to dispose of excess uric acid
stores.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Allopurinol reduces production of uric acid, thereby allowing the body to dispose of excess uric acid
stores.
60. What is the mechanism of action of febuxostat in gout patient ?

II. It prevents uric acid production and lowers elevated serum uric acid levels.
III. It reduces the synthesis of uric acid without disrupting the biosynthesis of vital purines.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Febuxostat is a xanthine oxidase inhibitor that prevents uric acid production and lowers elevated
serum uric acid levels.
61. What are the adverse effect associated with febuxostat in gout patient ?
I. Upper respiratory tract infections.
II. Arthralgias.
III. Esophagitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Common adverse events include upper respiratory tract infections, arthralgias, diarrhea, headache,
and liver function abnormalities. Atrioventricular block or atrial fibrillation and cholecystitis also
have been reported.As with other uricosuric agents, initiation of febuxostat may precipitate gouty
attacks.
I. Esophagitis.
II. Diarrhea.
III. Headache.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
attacks.
I. Atrioventricular block.
II. Esophagitis.
III. Cholecystitis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
attacks.
64. What is the mechanism of action of lesinurad in gout patient ?

I. It reduces the synthesis of uric acid without disrupting the biosynthesis of vital purines.
II. It acts by inhibiting the urate transporter, URAT1, which is responsible for the renal
reabsorption of uric acid.
III. It also inhibits organic anion transporter 4 (OAT4), a uric acid transporter associated with
diuretic-induced hyperuricemia.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Lesinurad is the first selective uric acid reabsorption inhibitor to be approved in the United States. It
acts by inhibiting the urate transporter, URAT1, which is responsible for the majority of the renal
reabsorption of uric acid. It also inhibits organic anion transporter 4 (OAT4), a uric acid transporter
associated with diuretic-induced hyperuricemia.
65. What is mean by SURI ?
I. Selective uric acid reabsorption inhibitor.
II. Selective uric acid reabsorption increase.
III. Selective uric acid release inhibitor.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Selective uric acid reabsorption inhibitor (SURI)
66. With gout and pseudogout joint inflammation is caused by crystalsthat form in synovial
fluid in pseudo gout,these crystals are ?
I. Uric acid.
II. Purine.
III. Calcium pyrophosphate.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Pseudogout--- Calcium pyrophosphate

67. What is the breakdown product of purine ?
I. Uric acid.
II. Calcium pyrophosphate.
III. Ntric acid.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Uric acid is a breakdown product of purine
68. Which out of the following food should be avoided in gout patient ?
I. Anchovies.
II. Haddock.
III. Cheese.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
High-purine foods should be either avoided or consumed only in moderation. Foods moderately high
in purines include anchovies, trout, haddock, scallops, mutton, veal, liver, bacon, salmon, kidneys,
and turkey.
I. Trout.
II. Milk products.
III. Scallops.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
and turkey.
I. Mutton.
II. Veal.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
and turkey.
I. Bacon.
II. Salmon.
III. Milk product.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
and turkey.
I. Coffee.
II. Kidneys.
III. Turkey.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
and turkey.
73. Which out of the following food should be avoided in gout patient taking colchicine?
I. Grapefruit.
II. Grapefruit juice.
III. Rice.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Patients taking colchicine should avoid grapefruit and grapefruit juice.
I. Buttermilk.
II. Foods sweetened with high-fructose corn syrup.
III. Sweetened beverages and desserts.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Patients should avoid sodas and other beverages or foods sweetened with high-fructose corn syrup.
They should also limit their use of naturally sweet fruit juices, table sugar, and sweetened beverages
and desserts, as well as table salt.
I. Table salt.
II. Table sugar.
III. Grain.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Patients should avoid sodas and other beverages or foods sweetened with high-fructose corn syrup.
They should also limit their use of naturally sweet fruit juices, table sugar, and sweetened beverages
and desserts, as well as table salt.
76. What should prefer for maintaining a high level of hydration with water in gout patient
?
I. At least 8 glasses of liquids per day.
II. At least 8 glasses of beer per day.
III. At least 8 glasses of grapejuice per day.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Maintaining a high level of hydration with water (at least 8 glasses of liquids per day) may be helpful
in avoiding attacks of gout.
I. Anakinra.
II. Fenofibrate.
III. Vitamin B12.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D

 Benzbromarone
 Vitamin C
 Anakinra
 Fenofibrate
I. Benzbromarone.
II. Vitamin B12.
III. Vitamin C.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F

 Benzbromarone
 Vitamin C
 Anakinra
 Fenofibrate
79. Which out of the following statement is /are correct for colchicine in gout patient ?
I. It should generally be avoided if the glomerular filtration rate (GFR) is lower than 10 mL/min,.
II. It should generally be given if the glomerular filtration rate (GFR) is lower than 10 mL/min,.
III. It should also be avoided in patients with hepatic dysfunction, biliary obstruction, or an
inability to tolerate diarrhea.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Colchicine should generally be avoided if the glomerular filtration rate (GFR) is lower than 10
ml/min, and the dose should be decreased by at least half if the GFR is lower than 50 ml/min.
Colchicine should also be avoided in patients with hepatic dysfunction, biliary obstruction, or an
inability to tolerate diarrhea.
80. What is the dose of prednisone in gout patient ?

I. Approximately 40 mg for 1-3 days.
II. Approximately 60 mg for 1-3 days.
III. Approximately 80 mg for 1-3 days.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Prednisone can be given at a dose of approximately 40 mg for 1-3 days

81. Which CYP3A4 inhibitors drug doses reduce in prophylaxis treatment of gout ?
I. Clarithromycin.
II. Cyclosporin.
III. Cimithidine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
CYP3A4 inhibitors (eg, clarithromycin or cyclosporine
82. Which drug should immediately be discontinued in patients who develop pruritus or a
rash consistent with allopurinol hypersensitivity ?
I. Cyclosporin.
II. Allopurinol.
III. Clarithromycin.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Allopurinol should immediately be discontinued in patients who develop pruritus or a rash consistent with
allopurinol hypersensitivity.
83. What should do with the dosage of allopurinol in patients with renal impairment
according to ACR guidelines?
I. Can be raised above 300 mg/day.
II. Can be raised above 500 mg/day.
III. Can be raised above 300 g/day.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
ACR guidelines advise that the dosage of allopurinol can be raised above 300 mg/day, even in patients with
renal impairment,
84. What is the drug interaction of allopurinol with probenecid ?

I. Allopurinol increases the excretion of probenecid.
II. Probenecid increases the excretion of allopurinol.
III. Probenecid decreases the excretion of allopurinol.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Allopurinol can be used in combination with probenecid. However, note that probenecid increases the excretion
of allopurinol.
85. What is mean by FACT ?
I. Feursemide Versus Allopurinol Controlled Trial.
II. Febuxostat Versus Acarbose Controlled Trial.
III. Febuxostat Versus Allopurinol Controlled Trial.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
Fact (febuxostat versus allopurinol controlled trial)
86. What is mean by APEX ?

I. Allopurinol- and Purite-Controlled, Efficacy Study of Febuxostat
II. Allopurinol- and Placebo-Controlled, Efficacy Study of Febuxostat.
III. Acarbose- and Placebo-Controlled, Efficacy Study of Febuxostat.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
APEX (Allopurinol- and Placebo-Controlled, Efficacy Study of Febuxostat)
87. What is the brand name of colchicines used for the treatment of gout ?
I. Celebrex.
II. Colcrys.
III. Cortrosyn.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Colchicine (colcrys)
88. What is the brand name of drug allopurinol used for the treatment of gout ?
I. Cortrosyn.
II. Zyloprim.
III. Aloprim.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Allopurinol (zyloprim, aloprim)
89. Which out of the following statement is /are correct for fenofibrate for gout patient ?
I. The lipid-lowering drug fenofibrate, a fibric acid derivative, lowers serum uric acid levels.
II. It is an ineffective treatment of acute crystal-induced arthritis in postoperative patients.
III. It reducing very-low-density lipoprotein (VLDL), total cholesterol, and triglyceride levels.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
The lipid-lowering drug fenofibrate, a fibric acid derivative, lowers serum uric acid levels while reducing very-
low-density lipoprotein (VLDL), total cholesterol, and triglyceride levels.[
90. Which patients should avoid the vitamin C treatment for gout ?
I. Patients with nephrolithiasis.
II. Patients with urate nephropathy.
III. Patients with diarrhea.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Vitamin C treatment should be avoided in patients with nephrolithiasis, urate nephropathy, or cystinuria.
91. Which patients should avoid the vitamin C treatment for gout ?
I. Patients with diarrhea.
II. Patients with cystinuria.
III. Patients with scurvey.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: B
Vitamin C treatment should be avoided in patients with nephrolithiasis, urate nephropathy, or

cystinuria.
92. Which out of the following statement is /are correct for canakinumab for gout patient ?
I. It is selective IL-1β antibody.
II. It reducing very-low-density lipoprotein (VLDL), total cholesterol, and triglyceride levels.
III. It yielded fast and lasting relief of pain in patients with acute gouty arthritis flares .
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Selective IL-1β antibody canakinumab yielded fast and lasting relief of pain in patients with acute
gouty arthritis flares refractory to treatment with nsaids or colchicine.
93. Which out of the following statement is /are correct for celecoxib for gout patient ?
I. It is selective COX-1 inhibitor.
II. It is selective COX-2 inhibitor.
III. It relieving inflammation and pain, but with a lower risk of GI side effects.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
The selective COX-2 inhibitor celecoxib offers the possibility of relieving inflammation and pain,
but with a lower risk of GI side effects.
94. What is the risk factor associated with selective COX-2 inhibitors ?
I. Cardiac disease.
II. Lung disease.
III. Brain disease.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Selective COX-2 inhibitors may increase the risk of cardiac disease;
95. What is the brand name of drug lesinurad for the treatment of gout ?
I. Zurampic.
II. Zyloprim.
III. Cortrosyn.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: A
Lesinurad (zurampic)
96. What are the complication associated with pegloticase in gout patient ?
I. Loss of vision.
II. Pyrexia.
III. Nephrolithiasis.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: E
Complications include anaphylaxis, infusion reactions, flare of gout attacks in 63-86% of patients
and nephrolithiasis in 13-14%, along with arthralgias, nausea, dyspepsia, muscle spasms, pyrexia,
back pain, diarrhea, and rash.Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a
contraindication.
97. Which out of the following statements is/are true for pegloticase in gout patient ?
I. It is a pegylated uric acid specific enzyme that is a polyethylene glycol conjugate of recombinant
uricase.
II. It also inhibits organic anion transporter 4 (OAT4), a uric acid transporter associated with
diuretic-induced hyperuricemia.
III. It achieves its therapeutic effect by catalyzing oxidation of uric acid to allantoin, thereby
lowering serum uric acid levels.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Pegloticase is a pegylated uric acid specific enzyme that is a polyethylene glycol conjugate of
recombinant uricase. It achieves its therapeutic effect by catalyzing oxidation of uric acid to allantoin,
thereby lowering serum uric acid levels.
98. What is the dose of pegloticase in gout patient ?
I. 8 kg IV every 2 weeks.
II. 8 g IV every 2 weeks.
III. 8 mg IV every 2 weeks.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: C
The dosage is 8 mg IV every 2 weeks.
99. What are the complication associated with pegloticase in gout patient ?
I. Anaphylaxis.
II. Loss of vision.
III. Infusion reactions.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: F
Complications include anaphylaxis, infusion reactions, flare of gout attacks in 63-86% of patients
and nephrolithiasis in 13-14%, along with arthralgias, nausea, dyspepsia, muscle spasms, pyrexia,
back pain, diarrhea, and rash. Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a
contraindication.
100. What is the mechanism of action of cosyntropin in gout patient ?
I. It is an adrenocorticotropic hormone (corticotropin) that stimulates the production and release
of endogenous steroids.
II. It is an effective treatment of acute crystal-induced arthritis in postoperative patients.
III. It is a pegylated uric acid specific enzyme that is a polyethylene glycol conjugate of
recombinant uricase.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Answer: D
Cosyntropin is an adrenocorticotropic hormone (corticotropin) that stimulates the production and

release of endogenous steroids. It is an effective treatment of acute crystal-induced arthritis in
postoperative patients and in other patients who cannot take oral medications.
GENITO URINARY SYSTEM
Urinary incontinence
1 Urinary incontinence disease is common in which gender?

I Male
II Female
III Equally likely in both
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Urinary incontinence is an underdiagnosed and underreported problem that increases with age affecting
50-84% of the elderly in long-term care facilities and at any age is more than twice as common in females
than in males. (Page 6)
2 Which of the following are types of urinary incontinence?
I Stress
II Urge
III Unique
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Types of urinary incontinence:
Stress: Urine leakage associated with increased abdominal pressure from laughing, sneezing, coughing,
climbing stairs, or other physical stressors on the abdominal cavity and, thus, the bladder
Urge: Involuntary leakage accompanied by or immediately preceded by urgency. (Page 6)
3 What id functional Uninary incontinence?

I The inability to hold urine due to neuro-urologic and lower urinary tract dysfunction reasons
II The inability to hold urine due to reasons other than neuro-urologic and upper urinary tract
dysfunction
III The inability to hold urine due to reasons other than neuro-urologic and lower urinary tract
dysfunction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Functional: The inability to hold urine due to reasons other than neuro-urologic and lower urinary tract
dysfunction (eg, delirium, psychiatric disorders, urinary infection, impaired mobility). (Page 6)
4 What basic evaluation patients with urinary incontinence should undergo?

I History
II Mental examination
III Urinalysis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Patients with urinary incontinence should undergo a basic evaluation that includes a history, physical
examination, and urinalysis. (Page 6)
5 Which of the following additional tests can be used to confirm urinary in continence?
I Cold stress test
II Cotton swab test
III Cough stress test
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
In selected patients, the following may also be needed:
Voiding diary
Cotton swab test
Cough stress test
Measurement of postvoid residual (PVR) urine volume
Cystoscopy
Urodynamic studies (Page 6)
6 What study is used to test Detrusor instability with urge incontinence?

I Urodynamic study
II Urinedymo study
III Uroinconti study
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Urodynamic study revealing detrusor instability in a 75-year-old man with urge incontinence. Note the
presence of multiple uninhibited detrusor contractions (phasic contractions) that is generating 40- to 75-cm
H2O pressure during the filling cystometrogram (CMG). (Page 7)
7 Which of the following points regarding the clinical presentation should be sought when
obtaining the history?
I Severity and quantity of urine lost and frequency of incontinence episodes
II Whopping cough
III Medications
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
The following points regarding the clinical presentation should be sought when obtaining the history:
Severity and quantity of urine lost and frequency of incontinence episodes
Duration of the complaint and whether problems have been worsening
Triggering factors or events (eg, cough, sneeze, lifting, bending, feeling of urgency, sound of running
water, sexual activity/orgasm)
Constant versus intermittent urine loss
Associated frequency, urgency, dysuria, pain with a full bladder
History of urinary tract infections (UTIs)
Concomitant fecal incontinence or pelvic organ prolapse
Coexistent complicating or exacerbating medical problems
Obstetrical history, including difficult deliveries, grand multiparity, forceps use, obstetrical
lacerations, and large babies
History of pelvic surgery, especially prior incontinence procedures, hysterectomy, or pelvic floor
reconstructive procedures
Other urologic procedures
Spinal and central nervous system surgery
Lifestyle issues, such as smoking, alcohol or caffeine abuse, and occupational and recreational factors
causing severe or repetitive increases in intra-abdominal pressure
Medications (Page 7)
8 Which of the following medical problems could exacerbate Urinary Incontinence?

I COPD
II Diabetes mellitus
III Benign prostate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Relevant complicating or exacerbating medical problems may include the following:
Chronic cough
Chronic obstructive pulmonary disease (COPD)
Congestive heart failure
Diabetes mellitus
Obesity
Connective tissue disorders
Postmenopausal hypoestrogenism
CNS or spinal cord disorders
Chronic UTIs
Urinary tract stones
Benign prostatic hyperplasia
Cancer of pelvic organs (Page 6,7)
9 Which of the following Medications that may be associated with urinary incontinence?
I Estrogen enhancers
II Cholinergic or anticholinergic drugs
III Alpha-blockers
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Medications that may be associated with urinary incontinence include the following:
Cholinergic or anticholinergic drugs
Alpha-blockers
Over-the-counter allergy medications
Estrogen replacement
Beta-mimetics
Sedatives
Muscle relaxants
Diuretics
Angiotensin-converting enzyme (ACE) inhibitors (Page 8)
10 Which of the following is/are type(s) of Urinary Incontinence?

I Stress Incontinence
II Pressure Incontinence
III Urge Incontinence
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Successful treatment of urinary incontinence must be tailored to the specific type of incontinence and its
cause. The usual approaches are as follows:
Stress incontinence: Pelvic floor physiotherapy, anti-incontinence devices, and surgery
Urge incontinence: Changes in diet, behavioral modification, pelvic-floor exercises, and/or
medications and new forms of surgical intervention
Mixed incontinence: Pelvic floor physical therapy, anticholinergic drugs, and surgery
Overflow incontinence: Catheterization regimen or diversion
Functional incontinence: Treatment of the underlying cause (Page 8)
11 Which of the following is/are treatment(s) for Mixed incontinence?

I Anticoagulation drugs
II Pelvic floor physical therapy
III Anticholinergic drugs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Successful treatment of urinary incontinence must be tailored to the specific type of incontinence and its
cause. The usual approaches are as follows:
Stress incontinence: Pelvic floor physiotherapy, anti-incontinence devices, and surgery
Urge incontinence: Changes in diet, behavioral modification, pelvic-floor exercises, and/or
medications and new forms of surgical intervention
Mixed incontinence: Pelvic floor physical therapy, anticholinergic drugs, and surgery
Overflow incontinence: Catheterization regimen or diversion
Functional incontinence: Treatment of the underlying cause (Page 8)
12 How is Overflow incontinence treated?

I Cardiac Catheterization
II Urinary Catheterization
III Intravenous Catheterization
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Overflow incontinence: Catheterization regimen or diversion. (Page 8)
13 Antispasmodic drugs and estrogen provide benefit in which problem?

I urinary incontinence
II Pressure incontinence
III stress incontinence
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
In stress and urge urinary incontinence, the following medications may provide some benefit:
Alpha-adrenergic agonists
Anticholinergic agents
Antispasmodic drugs
Estrogen
Alpha-adrenergic blockers
Botulinum toxin (Page 9)
14 Which of the following procedures increase urethral outlet resistance?

I Bladder neck suction
II Bladder neck suspension
III Artificial urinary sphincter
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Surgical care for stress incontinence involves procedures that increase urethral outlet resistance, including the
following:
Bladder neck suspension
Periurethral bulking therapy
Midurethral slings
Artificial urinary sphincter (Page 9)
15 Under what circumstances is transobturator male sling used?

I Men who experience urge incontinence after prostatectomy
II Men who experience stress incontinence
III Men who experience stress incontinence after prostatectomy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The transobturator male sling may be of particular benefit to men who experience stress incontinence after
prostatectomy. Transobturator vaginal tape (TVT-O) is widely used for stress incontinence in women. (Page
9)
16 Which of the following equipment is used to encounter stress incontinence in women?

I Transobturator vaginal tape
II TVT-O
III Transorbituary vaginal tape
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The transobturator male sling may be of particular benefit to men who experience stress incontinence after
prostatectomy. Transobturator vaginal tape (TVT-O) is widely used for stress incontinence in women. (Page
9)
17 which of the following surgical procedure(s) that improve bladder compliance?

I Bladder swelling
II Bladder enlargement
III Bladder augmentation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Surgical care for urge incontinence involves procedures that improve bladder compliance or bladder capacity,
Sacral nerve modulation
Injection of neurotoxins such as botulinum toxin
Bladder augmentation (Page 9)
18 What can be said regarding the etiologies of urinary incontinence?

I Incompletely understood
II Completely understood
III Singular
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Urinary incontinence should not be thought of as a disease, because no specific etiology exists; most individual
cases are likely multifactorial in nature. The etiologies of urinary incontinence are diverse and, in many
cases, incompletely understood. (Page 9)
19 Which studies are reserved to evaluate complex cases of stress urinary incontinence?
I Viralurodynamic studies
II Videourodynamic studies
III Vernacurodynamic studies
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Videourodynamic studies are reserved to evaluate complex cases of stress urinary incontinence.
Videourodynamic studies combine the radiographic findings of a voiding cystourethrogram and multichannel
urodynamics. (Page 10)
20 How many types of urinary incontinence are defined in the Clinical Practice Guideline
issued by the Agency for Health Care Policy and Research?
I Four
II Five
III Six
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Four types of urinary incontinence are defined in the Clinical Practice Guideline issued by the Agency for
Health Care Policy and Research: stress, urge, mixed, and overflow. (Page 10)
21 A male, 50 years of age experiences urine leakage associated with increased abdominal
pressure from laughing, sneezing, coughing, climbing stairs, or other physical stressors on
the abdominal cavity and, thus, the bladder. What type of urinary incontinence he suffer
from?
I Urge incontinence
II Stress incontinence
III Mixed incontinence
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Stress incontinence is characterized by urine leakage associated with increased abdominal pressure from
laughing, sneezing, coughing, climbing stairs, or other physical stressors on the abdominal cavity and, thus,
the bladder. (Page 10)
22 Which urinary incontinence is involuntary leakage accompanied by or immediately

preceded by urgency?
I Urge incontinence
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Urge urinary incontinence is involuntary leakage accompanied by or immediately preceded by urgency. (Page
10)
23 A 48 year old woman suffers from exertion, effort, sneezing or coughing which are
accompanied with an urgent need to go to bathroom. Which of the following urinary
incontinence does the lady suffer from?
I Urge incontinence
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Mixed urinary incontinence is a combination of stress and urge incontinence; it is marked by involuntary
leakage associated with urgency and also with exertion, effort, sneezing or coughing. (Page 10)
24 Other than urinary incontinence, which of the following terms can be used to define
uninary incontinence?
I Enuresis
II Diurnal enuresis
III Nocturnal enuresis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Other terms describing urinary incontinence are as follows:
Enuresis - Involuntary loss of urine
Nocturnal enuresis - Loss of urine occurring during sleep
Continuous urinary incontinence - Continuous leakage (Page 10)
25 Within the last decade what trend is seen regarding funding opportunities for
incontinence research?
I Increasing
II Decreasing
III Stable
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
In the last decade, funding opportunities for incontinence research have increased vastly. (Page 11)
26 What is the approximate range of women with

medical evaluation and treatment for urinary incontinence because of social stigma?
I 30-50%
II 50-70%
III 70-90%
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
An estimated 50-70% of women with urinary incontinence fail to seek medical evaluation and treatment
because of social stigma. (Page 11)
27 Which of the following products are commonly used to counter adult incontinence?
I Underwears
II Absorbable pads
III Deodorants
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Some individuals pay out of pocket for adult incontinence undergarments, absorbable pads, skin care
products, deodorants, and increased laundry expenses. (Page 11)
28 Who developed a questionnaire to assess the quality of life of women with
incontinence?
I Kholler et al
II Kelleher et al
III Kardarshian et al
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Kelleher et al developed a questionnaire to assess the quality of life of women with incontinence. (Page 12)
29 What is the name given to the phenomenon of fainting shortly after or during
urination?
I Macturition
II Micnutrition
III Micturition
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Micturition requires coordination of several physiological processes. Somatic and autonomic nerves carry
bladder volume input to the spinal cord, and motor output innervating the detrusor, sphincter, and bladder
musculature is adjusted accordingly. (Page 12)
30 What happens during urination?

I Increase in urethral resistance
II Decrease in urethral resistance
III No change in urethral resistance
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
When urination occurs, sympathetic and somatic tones in the bladder and periurethral muscles diminish,
resulting in decreased urethral resistance. (Page 12)
31 What is Normal bladder capacity?

I 150 and 300 mL
II 300-500 mL
III 400-600 mL
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Normal bladder capacity is 300-500 mL, and the first urge to void generally occurs between bladder volumes
of 150 and 300 mL. (Page 12)
32 What is the bladder volume when the first urge to urinate usually occurs?
I 150 and 300 mL
II 300-500 mL
III 400-600 mL
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Normal bladder capacity is 300-500 mL, and the first urge to void generally occurs between bladder volumes
of 150 and 300 mL. (Page 12)
33 When does incontinence occur?

I Micturition physiology and functional toileting ability
II Micturition physiology or functional toileting ability
III Neither Micturition physiology nor functional toileting ability
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Incontinence occurs when micturition physiology, functional toileting ability, or both have been disrupted.
(Page 12)
34 What is the only cause of stress incontinence in males?

I Loss of function of external sphincter mechanism
II Loss of function of internal sphincter mechanism
III Loss of function of both the internal and the external sphincter mechanism
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Intrinsic sphincter deficiency, resulting from loss of function of both the internal and the external sphincter
mechanism, is the only cause of stress incontinence in males. (Page 13)
35 What is Urethral hypermobility?

I During this, the proximal urethra and the bladder neck ascend to rotate away and out of the pelvis at
times of increased intra-abdominal pressure
II During this, the proximal urethra and the bladder neck descend to rotate away and out of the pelvis at
times of increased intra-abdominal pressure
III During this, the proximal urethra and the bladder neck descend to rotate away and out of the pelvis at
times of decreased intra-abdominal pressure
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Urethral hypermobility is related to impaired neuromuscular functioning of the pelvic floor coupled with
injury, both remote and ongoing, to the connective tissue supports of the urethra and bladder neck. When this
occurs, the proximal urethra and the bladder neck descend to rotate away and out of the pelvis at times of
increased intra-abdominal pressure. (Page 13)
36 Damage to which of the following tissues is important in the genesis of stress

incontinence?
I The muscles and connective tissue of pelvic floor
II The nerves, muscle, and connective tissue of the pelvic floor
III The nerves and connective tissue of the pelvic floor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Damage to the nerves, muscle, and connective tissue of the pelvic floor is important in the genesis of stress
incontinence. (Page 14)
37 Which of the following types of lesions can occur during childbirth?

I Elevator ani muscle tears
II Connective tissue breaks
III Pudendal nerve denervation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
During childbirth, 3 types of lesions can occur: levator ani muscle tears, connective tissue breaks, and
pudendal/pelvic nerve denervation. (Page 14)
38 What is the name of the condition in which the urethral sphincter is unable to coapt
and generate enough resting urethral closing pressure to retain urine in the bladder?
I Intrinsic sphincter deficiency
II Intrinsic spinster deficiency
III Intrinsic sphinster deficiency
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Intrinsic sphincter deficiency is a condition in which the urethral sphincter is unable to coapt and generate
enough resting urethral closing pressure to retain urine in the bladder. (Page 15)
39 When should incontinence procedures be performed?

I As soon as urinary incontinence is diagnosed
II If bladder neck hypermobility is present but incontinence has been ruled out
III Should be performed only when necessary
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
This study points out that bladder neck procedures need not be performed if potential incontinence has been
ruled out, even if bladder neck hypermobility is present. Indeed, incontinence procedures are not without
their own morbidities and should not be performed unless necessary. (Page 16)
40 Which urinary incontinence procedure corresponds to urodynamic term is detrusor

overactivity?
I Mixed incontinence
II Urge incontinence
III Stress incontinence
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Urge incontinence is involuntary urine loss associated with a feeling of urgency. The corresponding
urodynamic term is detrusor overactivity, which is the observation of involuntary detrusor contractions
during filling cystometry. (Page 16)
41 Urge incontinence may be due to

I Detrusor myopathy
II Neuropathy
III Neither of two
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Urge incontinence may be a result of detrusor myopathy, neuropathy, or a combination of both. (Page 16)
42 What is idiopathic urge incontinence?

I When the identifiable cause is unknown
II When the identifiable cause is known
III When a definable causative neuropathic disorder exists
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Urge incontinence may be a result of detrusor myopathy, neuropathy, or a combination of both. When the
identifiable cause is unknown, it is termed idiopathic urge incontinence. (Page 16)
43 When a definable causative neuropathic disorder exists, the coexisting urinary

incontinence disorder is termed
I Idiopathic urge incontinence
II Neurogenic detrusor overactivity
III Detrusor instability
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
When a definable causative neuropathic disorder exists, the coexisting urinary incontinence disorder is
termed neurogenic detrusor overactivity. (Page 16)
44 A woman, 65 years old, has an overactive bladder but on examination an absence of

neurologic causes was found. What type of urinary incontinence is it?
I Urge incontinence
III Detrusor instability
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Symptoms of overactive bladder or urge incontinence in the absence of neurologic causes are known as
detrusor instability. (Page 16)
45 What is the status of etiology of overactive bladder in adults?

I Unclear
II Partially clear
III Completely clear
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Overactive bladder in adults is a disorder of unclear etiology and incompletely understood pathophysiology.
(Page 16)
46 What are the possible contributor(s) to explain the mechanism of denervation in

idiopathic detrusor overactivity?
I Subtle obstruction
II Unhindered obstruction
III The effects of aging on smooth muscle and the autonomic nervous system
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
The mechanism of denervation in idiopathic detrusor overactivity is less certain. Subtle obstruction and the
effects of aging on smooth muscle and the autonomic nervous system are 2 possible contributors. (Page 17)
47 Which of the following is/are, smooth muscle relaxants?
I Vasoactive amines
II Vasodilators
III Vasoactive intestinal peptide
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Vasoactive intestinal peptide, a smooth muscle relaxant, is decreased markedly in the bladders of patients
with detrusor overactivity. (Page 17)
48 Which enzyme in muscle fibers can be stained to differentiate patchy partial

denervation of the detrusor from areas of normal innervations?
I Argininosuccinate synthetase
II Acetylcholinesterase
III Monoamine oxidase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Patchy partial denervation of the detrusor with areas of normal innervation and areas of reduced
innervation by fibers staining for acetylcholinesterase. (Page 17)
49 Mills and colleagues conducted a comparison study of bladder muscle strips from
patients with severe idiopathic detrusor overactivity and from organ donors with no known
urologic problems. Which of the following was observed by them?
I Supersensitivity to potassium
II Supersensitivity to sodium
III Supersensitivity to calcium
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Mills and colleagues conducted a comparison study of bladder muscle strips from patients with severe
idiopathic detrusor overactivity and from organ donors with no known urologic problems. The following are
some of the findings:
Patchy partial denervation of the detrusor with areas of normal innervation and areas of reduced
innervation by fibers staining for acetylcholinesterase
A reduced force of contraction in response to electrical field stimulation: This finding is in contrast
to a previous study showing an increased sensitivity to electrical field stimulation, but the authors
believe that the muscle strips may have had increased sensitivity to direct electrical stimulation
(non nerve mediated).
Supersensitivity to potassium
Increased electrical coupling of cells via cell-to-cell junctions
Variability in the activity of muscle strips from the same bladder (Page 17)
50 In males, early obstruction due to benign prostatic hyperplasia (BPH) may result in
I Stress incontinence
II Urge Incontinence
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
In males, early obstruction due to benign prostatic hyperplasia (BPH) may result in urge incontinence. (Page
18)
51 As per a study approximately what percentage of patients with bacterial urinary tract
infections had nonneuropathic bladder instability?
I 8%
II 9%
III 10%
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
One study showed that approximately 8% of patients with bacterial urinary tract infections had
nonneuropathic bladder instability. (Page 18)
52 What is interstitial cystitis?
I Bacterial associated inflammatory conditions of the bladder
II Nonbacterial inflammatory conditions of the bladder
III Fungi associated inflammatory conditions of the bladder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Nonbacterial inflammatory conditions of the bladder, including interstitial cystitis, have been associated with
detrusor overactivity. (Page 19)
53 Other than urinary incontinence, which of the following have been linked to bladder
irritability and instability?
I Skin rashes
II Bladder stones
III Neoplasms
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Foreign bodies, including permanent sutures, bladder stones, and neoplasms, also have been linked to bladder
irritability and instability. (Page 19)
54 Approximately what percentage of female suffers from mixed incontinence?

I 20-40%
II 40-60%
III 60-80%
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Approximately 40-60% of females with incontinence have this combination. (Page 19)
55 A patient suffering from meningomyelocele and an incompetent bladder neck with a

hyperreflexic detrusor. What type of urinary incontinence can be diagnosed?
I Mixed
II Stress
III Urge
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
A classic example of mixed incontinence is a patient with meningomyelocele and an incompetent bladder
neck with a hyperreflexic detrusor; however, a combination of urethral hypermobility and detrusor instability
is a more common scenario. (Page 19)
56 A 55-year old woman complains to her general physician that she is unable to control
her urine passing especially when is laughing. The doctor found out urethral hypermobility
and detrusor instability. What type of urinary incontinence does she have?
I Mixed
II Urge
III Stress
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
A classic example of mixed incontinence is a patient with meningomyelocele and an incompetent bladder
neck with a hyperreflexic detrusor; however, a combination of urethral hypermobility and detrusor instability
is a more common scenario. (Page 19)
57 What category of patients mostly have mixed incontinence?

I Men
II Women
III Elderly
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Mixed incontinence is a common finding in older patients with urinary incontinence disorders. (Page 19)
58 What are the common neurologic disorders associated with reflex incontinence?
I Dementia
II disease
III Depression
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Common neurologic disorders associated with reflex incontinence include stroke, Parkinson disease, and
brain tumors. (Page 19)
59 When patients with suprapontine or suprasacral spinal cord lesions present with
symptoms of urge incontinence, what is the condition called?
I Detrusor hyperreflexia
II Ditrusor hyperreflexia
III Detrusor hyporeflexia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
When patients with suprapontine or suprasacral spinal cord lesions present with symptoms of urge
incontinence, this is known as detrusor hyperreflexia. (Page 19)
60 Which pathways are crucial for voluntary and involuntary inhibition?

I Sacral reflex arc from the suprasacral spinal cord
II Sacral reflex arc from the cerebral cortex
III Sacred reflex arc from the higher centers
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Spinal cord injuries interrupt the sacral reflex arc from the suprasacral spinal cord, cerebral cortex, and
higher centers. These pathways are crucial for voluntary and involuntary inhibition. (Page 19)
61 Which procedure can produce lower urinary tract disorders for MS patients?
I Demyelinating plaques in the frontal lobe or lateral columns
II Demyelinating impurities in the frontal lobe or lateral columns
III Myelinating plaques in the frontal lobe or lateral columns
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
In multiple sclerosis (MS), demyelinating plaques in the frontal lobe or lateral columns can produce lower
urinary tract disorders. Incontinence may be the presenting symptom of MS in about 5% of cases. (Page
19,20)
62 Approximately 40-70% of patients with Parkinson disease have urinary tract

dysfunction in which section?
I Higher
II Lower
III Middle
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Approximately 40-70% of patients with Parkinson disease have lower urinary tract dysfunction. (Page 20)
63 What is the correlation between Parkinson disease and bladder dysfunction?
I Direct
II Inverse
III Unestablished
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Controversy exists as to whether specific neurologic problems in patients with Parkinson disease lead to
bladder dysfunction or if bladder symptoms simply are related to aging. (Page 20)
64 Which of the following may result in incontinence?

I CNS neoplasms
II DNS
III AML
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
CNS neoplasms may result in incontinence. (Page 20)
65 What is the major contributing factor to overflow incontinence?

I Bladder-out obstruction
II Bladder inlet obstruction
III Bladder outlet obstruction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The major contributing factor to overflow incontinence is incomplete bladder emptying secondary to
impaired detrusor contractility or bladder outlet obstruction. (Page 20)
66 Why is effective emptying of bladder not possible in case of overflow incontinence?

I Contractile detrusor muscle
II Acontractile detrusor muscle
III Acontractile intrusor muscle
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Effective emptying is not possible because of an acontractile detrusor muscle. (Page 20)
67 What are the common causes of bladder outlet obstruction in men?

I Urethral strictures
II Malignant prostatic hyperplasia
III Vesical neck contracture
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Common causes of bladder outlet obstruction in men include benign prostatic hyperplasia (BPH), vesical
neck contracture, and urethral strictures. (Page 20,21)
68 Which of the following procedures can result in iatrogenically induced overflow

incontinence in woman?
I Sling neck suspension
II Row neck suspension
III Bladder neck suspension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
In women, urethral obstruction after anti-incontinence surgery such as a sling or bladder neck suspension can
result in iatrogenically induced overflow incontinence. (Page 21)
69 How is people suffering for functional incontinence different from other incontinence?
I They have difficulty reaching the toilet because of physical impediments
II They have difficulty reaching the toilet because of physiological impediments
III They have difficulty reaching the toilet because of mental impediments
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Functional incontinence is seen in patients with normal voiding systems but who have difficulty reaching the
toilet because of physical or psychological impediments. (Page 21)
70 Which of the following is a common mnemonic which is helpful in remembering the

functional contributors to incontinence?
I DIAPERS
II DIAPPERS
III DIAPPPERS
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
D - Delirium
I - Infection, urinary
A - Atrophic urethritis or vaginitis
P - Pharmacologic agents
P - Psychiatric illness
E - Endocrine disorders
R - Reduced mobility or dexterity
S - Stool impaction (Page 21)
71 What is continuous incontinence?

I Severe type of incontinence characterized by intermittent leakage with no symptoms other than wetness
II Severe type of incontinence characterized by constant or near constant leakage with multiple symptoms
other than wetness
III Severe type of incontinence characterized by constant or near constant leakage with no symptoms
other than wetness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
This severe type of incontinence is characterized by constant or near constant leakage with no symptoms other
than wetness. (Page 71)
72 Which of the following is/ are a classic example of continuous incontinence?

I Urogenital fistulas
II Eurogenital fistulas
III Eurogenital fiscals
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Urogenital fistulas are a classic example. (Page 22)
73 Which of the following can cause the urethra to fail?

I urethral spinster paralysis
II Scarring and fibrosis from previous surgery
III Partial urethral resection for vulvar cancer
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Scarring and fibrosis from previous surgery, partial urethral resection for vulvar cancer, and urethral
sphincter paralysis due to lower motor neuron disease can cause the urethra to fail. (Page 21)
74 Which causes account for most cases of pediatric incontinence?

I Structural
II Nonstructural
III Functional
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Nonstructural causes account for most cases of pediatric incontinence. (Page 22)
75 Which enuresis is the most common pediatric incontinence disorder?

I Diurnal
II Nocturnal
III Didactic
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Nocturnal enuresis is the most common pediatric incontinence disorder. (Page 22)
76 What are the possible reasons for women to lose pelvic support?
I Fever
II Postmenopausal estrogen loss
III Childbirth
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Women may lose this pelvic support with postmenopausal estrogen loss, childbirth, surgery, or certain disease
states that affect tissue strength. (Page 23)
77 Which of the following are major contributing factors with aging-related urinary
incontinence?
I Impairments in mobility and cognitive functioning.
II Weakening of connective tissue
III Pelvic facture
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Contributing factors with aging-related urinary incontinence include a weakening of connective tissue,
genitourinary atrophy due to hypoestrogenism, increased incidence of contributing medical disorders,
increased nocturnal diuresis, and impairments in mobility and cognitive functioning. (Page 23)
78 Stones or neoplasms may result in incontinence due to?

I Contraction
II Obstruction
III Construction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Stones or neoplasms may also result in incontinence due to obstruction. (Page 24)
79 By how much does cerebrovascular disease increase the risk for urinary incontinence in
older women?
I Double
II Triple
III Quadriple
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Cerebrovascular disease doubles the risk for urinary incontinence in older women. (Page 24)
80 Which of the following medication may result in incontinence?

I Sodium Channel blockers
II Alpha-adrenergic agonists
III Anti-depressants
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Medication may result in incontinence through the following mechanisms:
Drugs with anticholinergic properties or side effects (eg, antipsychotics, antidepressants) - Urinary
retention and thus overflow incontinence
Alpha-adrenergic agonists - Urinary retention and thus overflow urinary incontinence
Alpha-antagonist - Urethral relaxation
Diuretics Overwhelming of bladder capacity in elderly persons
Calcium channel blockers - Decreased smooth muscle contractility in the bladder, causing urinary
retention with overflow incontinence
Sedative-hypnotics - Immobility secondary to sedation, leading to functional incontinence
Angiotensin-converting enzyme (ACE) inhibitors Diuretic effect, as well as side effect of cough
with relaxation of pelvic floor musculature, can exacerbate incontinence
Antiparkinson medications - Urinary urgency and constipation (Page 25)
81 How do diuretics cause incontinence?

I Urethral relaxation
II Overwhelming of bladder capacity
III Urinary retention and thus overflow urinary incontinence
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Medication may result in incontinence through the following mechanisms:
Drugs with anticholinergic properties or side effects (eg, antipsychotics, antidepressants) - Urinary
retention and thus overflow incontinence
Alpha-adrenergic agonists - Urinary retention and thus overflow urinary incontinence
Alpha-antagonist - Urethral relaxation
Diuretics Overwhelming of bladder capacity in elderly persons
Calcium channel blockers - Decreased smooth muscle contractility in the bladder, causing urinary
retention with overflow incontinence
Sedative-hypnotics - Immobility secondary to sedation, leading to functional incontinence
Angiotensin-converting enzyme (ACE) inhibitors Diuretic effect, as well as side effect of cough
with relaxation of pelvic floor musculature, can exacerbate incontinence
Antiparkinson medications - Urinary urgency and constipation (Page 25)
82 Which type of incontinence is more common in more common in women older than
65 years?
I Urge
II Stress
III Mixed
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
In general, studies have shown that stress urinary incontinence tends to be more common in women younger
than 65 years, while urge urinary incontinence and mixed urinary incontinence is more common in women
older than 65 years. (Page 26)
83 Stress incontinence is statistically significant in which race of woman?

I Black
II White
III Asian
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Sears et al reported that, among patients with incontinence, urge incontinence was more common in black
women (51.5%), whereas stress incontinence was statistically significantly more common in white women
(66.2%). (Page 26)
84 what are the improvement rates with muscle exercise and surgery for sufferers of stress
incontinence?
I 87% and 88%
II 86% and 87%
III 88% and 89%
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
In stress incontinence, the improvement rate with alpha-agonists is 19-74%; improvement rates with muscle
exercise and surgery, improvement rates are 87% and 88%, respectively. (Page 27)
85 What can untreated UTIs potentially cause?

I Urosepsis
II Unconsciousness
III Death
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Untreated UTIs may lead to urosepsis and death. (Page 27)
86 Which of the following points regarding the clinical presentation should be sought
when obtaining the history?
I Severity and quantity of urine lost and frequency of incontinence episodes
II Duration of the complaint and whether problems have been worsening
III Knee surgery
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
In addition, the following points regarding the clinical presentation should be sought when obtaining the
history:
Severity and quantity of urine lost and frequency of incontinence episodes
Duration of the complaint and whether problems have been worsening
Triggering factors or events (eg, cough, sneeze, lifting, bending, feeling of urgency, sound of running
water, sexual activity/orgasm)
Constant versus intermittent urine loss and provocation by minimal increases in intra-abdominal
pressure, such as movement, changes in position, and incontinence with an empty bladder
Associated frequency, urgency, dysuria, pain with a full bladder, and history of urinary tract
infections (UTIs)
Concomitant symptoms of fecal incontinence or pelvic organ prolapse
Coexistent complicating or exacerbating medical problems
Obstetrical history, including difficult deliveries, grand multiparity, forceps use, obstetrical
lacerations, and large babies
History of pelvic surgery, especially prior incontinence procedures, hysterectomy, or pelvic floor
reconstructive procedures
Other urologic procedures
Spinal and CNS surgery
Lifestyle issues, such as smoking, alcohol or caffeine abuse, and occupational and recreational factors
causing severe or repetitive increases in intra-abdominal pressure
Medications (Page 27,28)
87 Which of the following relevant complicating or exacerbating medical problems may

result from incontinence?
I Chronic obstructive pulmonary disease (COPD)
II Chronic cough
III Chronic pain
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Relevant complicating or exacerbating medical problems may include the following:
Chronic cough
Chronic obstructive pulmonary disease (COPD)
Congestive heart failure
Diabetes mellitus
Obesity [32]
Connective tissue disorders
Postmenopausal hypoestrogenism
CNS or spinal cord disorders
Chronic UTIs
Urinary tract stones
Benign prostatic hyperplasia
Cancer of pelvic organs (Page 28)
88 What is a voiding diary?

I A voiding diary is a daily record of the patient's drinking habits
II A voiding diary is a daily record of the patient's visit to the bathroom
III A voiding diary is a daily record of the patient's bladder activity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
A voiding diary is a daily record of the patient's bladder activity and is a useful supplement to the medical
history of the patient. (Page 30)
89 What all physical examination are done as part of determining urinary incontinence?
I Stick test
II Neurological examination
III Pelvic floor examination
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Pelvic floor examination and neurological examination are two of several physical examination done to
determine urinary incontinence. (Page 31,32)
90 What is the optimal cut-off point for the change in angle from resting to straining in
cotton swab test to determine urethral hypermobility?
I 30°
II 45°
III 90°
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
A cotton swab angle greater than 30° denotes urethral hypermobility. (Page 35)
91 A 80 year old male complains that his underwear is always wet. What test can be used
to determine whether the fluid loss the patient is experiencing is urine?
I Pad test
II Cotton swab test
III Paper towel test
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The pad test is an objective test that determines whether the fluid loss the patient is experiencing is in fact
urine. (Page 35)
92 Which test provides a quick estimate of the degree of stress urine loss?
I Pad test
II Cotton swab test
III Paper towel test
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
A paper towel test provides a quick estimate of the degree of stress urine loss. (Page 36)
93 When is standing cough stress test performed?

I If leakage is observed while performing cough leak test with the patient in the lithotomy position
II If leakage is not observed while performing cough leak test with the patient in the lithotomy position
III If leakage is observed while performing cough leak test with the patient in supine position
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
If the cough leak test is initially performed with the patient in the lithotomy position and leakage is not
observed, repeat this test with the patient in the standing position. (Page 38)
94 What is another name for Marshall test?

I Marshall-Bonnet test
II Marshall-Bonney test
III Marshall-Bonet test
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
If the cough stress test is positive, a Marshall test (also known as the Marshall-Bonney test) may determine if
the urine loss is caused by urethral hypermobility. (Page 38)
95 What tests should be done if a person shows up in ED with urinary incontinence?

I Check for medication consumption
II Check glucose level
III Check serum electrolytes and calcium levels
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Obtain a urinalysis and urine culture
Hematuria should be evaluated with urinary cytological studies
Check serum electrolytes and calcium levels
Check blood urea nitrogen (BUN)/creatinine levels; decreased muscle mass in elderly patients may
affect renal function measurement
Check glucose level, especially in diabetic patients or patients with polyuria or polydipsia (Page 40)
96 What constitutes Urodynamic Studies?

I Urodynamics are a means of evaluating the pressure-flow relationship between the bladder and the
urethra for the purpose of defining the functional status of the upper urinary tract
II Urodynamics are a means of evaluating the pressure-flow relationship between the bladder and the
urethra for the purpose of defining the functional status of the lower urinary tract
III Urodynamics are a means of evaluating the pressure-flow relationship between the bladder and the
uterus for the purpose of defining the functional status of the lower urinary tract
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Urodynamics are a means of evaluating the pressure-flow relationship between the bladder and the urethra
for the purpose of defining the functional status of the lower urinary tract. (Page 42)
97 Chain-Bead Cystography test is

I An invasive technique
II A non-invasive technique
III Banned from being practised
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Incontinence experts no longer use this test. Instead, less invasive techniques, including the cotton swab test,
bladder neck ultrasound, video urodynamics, and dynamic pelvic floor magnetic resonance imaging (MRI),
now are used to study bladder neck anatomy and function. (Page 42)
98 What is the combined procedure of Cystoscopy and Urethroscopy called?

I Cysturethroscopy
II Cystourethroscopy
III Cystorourethroscopy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Cystourethroscopy allows an anatomical assessment of the bladder and the urethra. (Page 43)
99 In what cases is pessary trial useful?

I In the preoperative evaluation of female patients who have severe pelvic organ prolapse but no
complaints of urinary incontinence
II In the postoperative evaluation of female patients who have severe pelvic organ prolapse but no
complaints of urinary incontinence
III In the preoperative evaluation of female patients who have severe pelvic organ prolapse and complaints
of urinary incontinence
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
A pessary trial may be useful in the preoperative evaluation of female patients who have severe pelvic organ
prolapse but no complaints of urinary incontinence. (Page 43)
100 When is MRI used for the assessment of urinary incontinence?

I As a conformatory diagonosis
II For clinical diagnosis
III For investigational purposes
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
MRI remains investigational in the assessment of urinary incontinence. (Page 43)
1 The following treatment is used for which type of incontinence - Surgery, pelvic floor
physiotherapy, anti-incontinence devices, and medication?
III Overflow incontinence
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Stress incontinence - Surgery, pelvic floor physiotherapy, anti-incontinence devices, and medication. (Page
74)
2 The following treatment is used for which type of incontinence - Changes in diet,
behavioral modification, pelvic-floor exercises, and/or medications and new forms of
surgical intervention
III Overflow incontinence
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Urge incontinence - Changes in diet, behavioral modification, pelvic-floor exercises, and/or medications and
new forms of surgical intervention. (Page 74)
3 Under what conditions should absorbent products be used?

I Presence of an incontinence disorder that cannot be corrected by exercise
II Presence of an incontinence disorder that cannot be helped by medications
III Presence of an incontinence disorder that cannot be corrected by surgery
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The criteria for use of these products are fairly clear-cut, and these products are beneficial for patients who
meet the following conditions:
Persistent incontinence despite all appropriate treatments
Inability to participate in behavioral programs, due to illness or disability
Presence of an incontinence disorder that cannot be helped by medications
Presence of an incontinence disorder that cannot be corrected by surgery (Page 75)
4 What is the acronym for national support group for incontinent patients?
I NAEF
II NAFC
III NADF
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
More than 50% of the members of the National Association for Continence (NAFC), a national support
group for incontinent patients, use some form of protective garment to remain dry. (Page 75)
5 Improper use of absorbent products may contribute to

I Skin breakdown
II UTIs
III hair ingrowth
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
In addition, improper use of absorbent products may contribute to skin breakdown and urinary tract
infections (UTIs). Thus, appropriate use, meticulous care, and frequent pad or garment changes are needed
when absorbent products are used. (Page 75,76)
6 What are the various types of absorbant products available?

I Washable pads
II Panty shields
III Washable pants
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Absorbent products used include underpads, panty shields, pant guards, adult diapers (briefs), various
washable pants and disposable pad systems, or combinations of these products. (Page 76)
7 Which company makes Impress Softpatch?

I Amgen, LA
II Genetect, SF
III UroMed Corporation, Mass.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The Impress Softpatch (UroMed Corporation, Needham, Mass.) is an adhesive foam patch designed for a
single use. (Page 76)
8 What is Reliance Urinary Control Insert?

I Balloon inflated with leaking urine
II Balloon inflated with air
III A small catheterlike device that is inserted into the urethra
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The Reliance Urinary Control Insert (UroMed Corporation, Needham, Mass.) is a small catheterlike device
that is inserted into the urethra. The balloon is inflated with air. (Page 76)
9 Under what circumstances are Incontinence pessaries used?

I High stress incontinence
II Moderate stress incontinence
III Mild stress incontinence
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Incontinence pessaries also are available for use in mild stress incontinence. (Page 77)
10 What does RARP stand for?

I Robot-assisted radical prostatectomy
II Razor-assisted rational prostatectomy
III Rayon-assisted radiant prostatectomy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
For patients undergoing robot-assisted radical prostatectomy (RARP), a study by Lee et al found that the
bladder plication stitch is an effective technical modification for lessening the period of recovery of urinary
continence. (Page 77)
11 For which incontinence urethral catheter should be used?

I Urge
II Stress
III Overflow
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Bladder catheterization may be a temporary measure or a permanent solution for overflow incontinence. The
use of a urethral catheter is contraindicated in the treatment of urge incontinence. (Page 77)
12 Which of the following is used as a catheter drainage?

I Forago catheter drainage
II Forage catheter drainage
III Foley catheter drainage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Some patients respond well to temporary continuous Foley catheter drainage. Their bladder capacity returns
to normal, and voluntary detrusor pressure improves. (Page 78)
13 Which of the following are different types of bladder catheterization?

I Suprapubic tubes
II Indwelling urethral catheters
III Continuous self-catheterization
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Different types of bladder catheterization include indwelling urethral catheters, suprapubic tubes, and
intermittent self-catheterization. (Page 78)
14 Ideally, how often should urethral catheters be changed for a long-term condition?
I Biweekly
II Monthly
III Fortnightly
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
If urethral catheters are being used for a long-term condition, they need to be changed monthly. (Page 78)
15 What is the standard catheter size for treating urinary retention?

I 16 F
II 17 F
III 18 F
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
The standard catheter size for treating urinary retention is 16F or 18F, with a 5-mL balloon filled with 5-
10 mL of sterile water. (Page 78)
16 What is the ideal way to treat a catheter that leaks?

I Eliminating the cause of the leakage
II Increasing the balloon size
III Decreasing the balloon size
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Increasing the balloon size to treat a catheter that leaks is not appropriate. Treat leakage around a catheter
by eliminating the cause of the leakage. (Page 78)
17 What can be done to reduce the soreness that can be produced because of a catheter
especially in males?
I Use of a water-resistant surgical lube
II Use of a water-soluble surgical lube
III Use of a lube
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The authors also recommend the routine use of a water-soluble surgical lubricant on the catheter where it
exits the urethra, especially in males because of the soreness that can be produced there. (Page 79)
18 All indwelling catheters become colonized with bacteria after how many weeks?
I One
II Two
III Three
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
After more than 2 weeks in the urinary bladder, all indwelling catheters become colonized with bacteria.
Bacterial colonization does not mean the patient has a clinical bladder infection. (Page 79)
19 Which of the following are symptoms of a bladder infection?

I No odor
II Purulent urine
III Hematuria
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Symptoms of bladder infection include foul odor, purulent urine, and hematuria. (Page 79)
20 What can be used to dissolve the encrustations that tend to form in the drainage bags?
I Dilute HCl solution
II Dilute H2SO4 solution
III Dilute vinegar solution
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
A dilute vinegar solution can be used to dissolve the encrustations that tend to form in the drainage bags.
(Page 79)
21 How much hydrogen peroxide can be added to the drainage bags immediately before
connecting them to the Foley catheter?
I 15 mL
II 20 mL
III 30 mL
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
30 mL of hydrogen peroxide can be added to the drainage bags immediately before connecting them to the
Foley catheter. This supposedly reduces odor and bacterial growth by using a safe, nontoxic, and inexpensive
agent. (Page 79)
22 What severe complications are associated with indwelling urethral catheters?

I Retinal damage
II Formation of bladder stones
III Renal damage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
More severe complications include formation of bladder stones, development of periurethral abscess, renal
damage, and urethral erosion. (Page 79,80)
23 Which of the following procedures is beneficial for preserving the bladder integrity
with long-term catheter use?
I Anticholinergic therapy
II Antiemetic therapy
III Intermittent clamping of the catheter
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Anticholinergic therapy and intermittent clamping of the catheter in combination have been reported to be
beneficial for preserving the bladder integrity with long-term catheter use. (Page 80)
24 What are the risks associated with Foley catheter clamping?

I Cystolysis
II Cystitis
III Pyelonephritis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Foley catheter clamping is not a benign procedure. Potential risks include cystitis, pyelonephritis, urosepsis,
and bladder perforation. (Page 80)
25 The maximum time limit for Foley clamping is
I 1-2 hours
II 2-3 hours
III 3-4 hours
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C.
The maximum time limit for Foley clamping to expand the bladder capacity should be tailored to the
individual but should not exceed 3-4 hours. (Page 80)
26 Which of the following is an attractive alternative to a urethral catheter?

I Suprapubic catheter
II Superpubic catheter
III Suprapublic catheter
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
When long-term catheterization is anticipated, a suprapubic catheter is an attractive alternative to a
urethral catheter. (Page 80)
27 Under what circumstances should indwelling catheters be used?

I As comfort measures for terminally ill patients
II For acutely ill persons in whom obtuse fluid balance must be monitored
III For severely impaired persons for whom bed and clothing changes are painful or disruptive
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Restrict the use of indwelling catheters to the following situations:
As comfort measures for terminally ill patients
To avoid contamination or to promote healing of severe pressure sores
In case of inoperable urethral obstruction that prevents bladder emptying
In individuals who are severely impaired for whom alternative interventions are not an option
When an individual lives alone and a caregiver is unavailable to provide other supportive measures
For acutely ill persons in whom accurate fluid balance must be monitored
For severely impaired persons for whom bed and clothing changes are painful or disruptive (Page
80)
28 Which of the following are advantages of Suprapubic catheters?

I Single catheter can be used for two months
II The risk of urethral damage is eliminated
III Multiple voiding trials may be performed without having to remove the catheter
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Suprapubic catheters have many advantages, as follows:
The risk of urethral damage is eliminated
Multiple voiding trials may be performed without having to remove the catheter
Because the catheter comes out of the lower abdomen rather than the vaginal area, a suprapubic
tube is more patient-friendly
Bladder spasms occur less often because the suprapubic catheter does not irritate the trigone as the
urethral catheter does
Suprapubic tubes are more sanitary for the individual; bladder infections are minimized because
the tube is away from the perineum (Page 81)
29 If the suprapubic tube falls out inadvertently, the exit hole of the tube seals up in how
much time?
I Within 6 hours
II Within 12 hours
III Within 24 hours
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
If the suprapubic tube falls out inadvertently, the exit hole of the tube seals up and closes quickly within 24
hours if the tube is not replaced with a new one. (Page 81)
30 Intermittent catheterization is most appropriate for which type of patients?

I Overflow obstruction
II Functional obstruction
III Detrusor hyperreflexia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Intermittent catheterization is most appropriate for patients with detrusor hyperreflexia and functional
obstruction. (Page 82)
31 What is myelomeningocele?
I It is a type of Spina bifida
II A birth defect in which the backbone and spinal canal do not close before birth
III Also known as spiral bifido
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Young children with myelomeningocele have benefited from the use of intermittent catheterization. In
addition, self-catheterization is recommended by some surgeons for women during the acute healing process
after anti-incontinence surgery. (Page 82)
32 What is the incidence of bacteriuria in patients with spinal cord injuries?

I 1-2 episodes per 100 days
II 1-3 episodes per 50 days
III 1-4 episodes per 100 days
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
1-4 episodes of bacteriuria occur per 100 days of intermittent catheterization. (Page 83)
33 What are the potential complications of intermittent catheterization?
I Utheral stricture
II Urethral inflammation
III Urethral trauma
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Potential complications of intermittent catheterization include bladder infection, urethral trauma, urethral
inflammation, and stricture. (Page 83)
34 What is the use of Medicated and silver-coated catheters?

I Reduce the risk of catheter-related UTI
II Cost less than conventional urinary catheters
III Catheterizations exceeding 2-3 weeks
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Although silver alloy catheters cost about $6 more than conventional urinary catheters, they may be worth the
extra cost to prevent symptomatic UTIs and urosepsis. (Page 84)
35 Which of the following are examples of Alpha-adrenergic agonists?

I Pro-Amatine
II Sudafed
III Hafed
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Alpha agonists, such as midodrine (Pro-Amatine) or pseudoephedrine (Sudafed), may improve symptoms of
mild stress incontinence by increasing intrinsic urethral tone due to these effects on the urethral
sphincter. (Page 84)
36 Which of the following was a the first-line pharmacologic therapy for women with
stress incontinence but was recalled from the US market?
I Phenylpropanolamine hydrochloride
II Phenylpropyleneamine hydrochloride
III Propanolamine hydrosulphide
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Phenylpropanolamine hydrochloride (Entex LA, Ornade) was the first-line pharmacologic therapy for
women with stress incontinence; however, it has been recalled from the US market. (Page 84)
37 In addition to treating depression, tricyclic antidepressants are also used to treat

I Mixed incontinence
II Overflow incontinence
III Nocturnal enuresis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
TCAs have historically been used to treat major depression, but their pharmacological effects also make these
drugs good choices for mixed incontinence, nocturia, and nocturnal enuresis. TCAs have also been used in the
treatment of stress incontinence. (Page 85)
38 Which is the most widely used tricyclic for urologic indications?

I Tofranil
II Imipramine
III Protanil
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Imipramine (Tofranil) is the most widely used tricyclic for urologic indications. It facilitates urine storage by
decreasing bladder contractility and increasing outlet resistance. (Page 85)
39 Which tricyclic antidepressant is extremely effective in decreasing symptoms of urinary

frequency in women with pelvic floor muscle dysfunction?
I Amitriptyline
II Elavil
III Imipramine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Amitriptyline (Elavil) is a tricyclic antidepressant with sedative properties that increases circulating levels of
norepinephrine and serotonin by blocking their reuptake at nerve endings. (Page 85)
40 Which of the following drugs is marketed specifically for stress urinary incontinence?
I Dulexrine
II Duloxetine
III Dilloextrine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The serotonin/norepinephrine reuptake inhibitor duloxetine is the first drug developed and marketed
specifically for stress urinary incontinence. Duloxetine has been approved for the treatment of stress
incontinence in Europe, but is not approved for this indication by the US Food and Drug Administration.
(Page 85,86)
41 What is Propantheline bromide?
I Antihistamine agent
II Anticholinergic agent
III Anticoagulating agent
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Propantheline bromide is an anticholinergic agent that has been used to treat detrusor overactivity. (Page
87)
42 Which drug reduces incontinence episodes by 83-90%?

I Detrol
II Oxybutynin
III Duloxetine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Oxybutynin reduces incontinence episodes by 83-90%. (Page 87)
43 which of the following is/are potent antimuscarinic agent(s) for treating detrusor
overactivity?
I Tolterodine
II Detrol
III Oxybutynin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Tolterodine (Detrol) is a potent antimuscarinic agent for treating detrusor overactivity. (Page 87)
44 What is the mechanism of action of Trospium?

I Antagonizing acetamine effect on muscarinic receptors
II Antagonizing acetylcholine effect on muscarinic receptors
III Antagonizing acetylcholine effect on spasmodic receptors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Trospium (Sanctura) elicits antispasmodic and antimuscarinic effects. It acts by antagonizing acetylcholine
effect on muscarinic receptors. Parasympathetic effect reduces smooth muscle tone in the bladder. (Page 87)
45 Which of the following is a competitive muscarinic receptor antagonist that causes

anticholinergic effects and inhibits bladder smooth muscle contraction?
I Solifenacin
II Sofitcin
III VESIcare
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Solifenacin (VESIcare) is a competitive muscarinic receptor antagonist that causes anticholinergic effects and
inhibits bladder smooth muscle contraction. (Page 88)
46 Co-administration of darifenacin with CYP-2D6 substrates may increase toxicity from

which other substrate?
I 2D6
II 3D6
III 2D8
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Additive toxicity may occur if administered with other anticholinergics (eg, antihistamines).
Coadministration with CYP-2D6 substrates that have a narrow therapeutic index (eg, flecainide,
thioridazine, TCAs) may cause toxicity of these other 2D6 substrates. (Page 88)
47 Which of the following are commonly observed adverse effects of using antimuscarinic
drugs?
I Xenophobia
II Constipation
III Blurred vision
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
More commonly observed adverse effects include xerostomia, constipation, and blurred vision. (Page 88)
48 Which of the following drugs have been FDA approved for symptoms of overactive
bladder?
I Furistaride
II Fesoterodine
III Fusiline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Fesoterodine (Toviaz) has been FDA approved for symptoms of overactive bladder (eg, urinary urge
incontinence, urgency, frequency). (Page 88)
49 Which drug is a direct smooth muscle relaxant with very weak anticholinergic
properties?
I Oxybutynin
II Dicyclomine
III Flavoxate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Flavoxate is a direct smooth muscle relaxant with very weak anticholinergic properties. (Page 89)
50 Which drug is a smooth muscle relaxant that has been used most commonly to treat
irritable bowel syndrome?
I Oxybutynin
II Dicyclomine
III Flavoxate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Dicyclomine is a smooth muscle relaxant that has been used most commonly to treat irritable bowel
syndrome. (Page 89)
51 Which drug was once a very popular drug for the treatment of detrusor overactivity but
was withdrawn from the market due to a potential for serious adverse cardiac effects?
I Teradiline
II Tetradiline
III Terodiline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Terodiline was once a very popular drug for the treatment of detrusor overactivity in Europe but has since
been withdrawn from the market due to a potential for serious adverse cardiac effects. (Page 89)
52 What is the primary function of Mirabegron drug?
I It is a beta-3 adrenergic receptor agonist, causes relaxation of the detrusor miuscle and increases bladder
capacity
II It is a alpha-3 adrenergic receptor agonist, causes relaxation of the detrusor miuscle and increases
bladder capacity
III It is a gamma-3 adrenergic receptor agonist, causes relaxation of the detrusor miuscle and increases
bladder capacity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Mirabegron (Myrbetriq), a beta-3 adrenergic receptor agonist, causes relaxation of the detrusor miuscle and
increases bladder capacity. It is indicated for overactive bladder with symptoms of urge urinary incontinence,
urgency, and urinary frequency. (Page 90)
53 DDAVP is used in children with nocturnal enuresis, What does DDAVP stand for?
I 1-desamino-6-D-arginine vasodialator
II 1-desamino-8-D-arginine vasopressin
III 1-desamino-5-D-arginine vasopressin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The agent 1-desamino-8-D-arginine vasopressin (DDAVP) has been used in children with nocturnal
enuresis, with good results. (Page 90)
54 How does estrogen help patients with stress incontinence?

I Increase the density of beta-receptors in the urethra
II Increase the density of alpha-receptors in the urethra
III Decrease the density of alpha-receptors in the urethra
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Estrogen therapy may have several positive effects in patients with stress incontinence who are estrogen
deficient. Estrogen may increase the density of alpha-receptors in the urethra. (Page 90)
55 Botulinum toxin is produced by which organism?

I Clostridium botulinum
II Clostridic botulinic
III Clostridal botulinal
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Botulinum is a neurotoxin produced by Clostridium botulinum. (Page 91)
56 The Anticholinergic therapy vsonabotulinumtoxinA for urgency incontinence trial is

also known as
I BCA trial
II ABC trial
III CAB trial
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The ABC trial (Anticholinergic therapy vsonabotulinumtoxinA for urgency incontinence) shed some light on
the utility of 100 units of onabotulinumtoxinA in the setting of overactive bladder. (Page 91)
57 Intravesical capsaicin, the main pungent ingredient of hot peppers, has been evaluated
for the treatment of
I Detrusor overactivity
III Muscular detrusor activity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Intravesical capsaicin, the main pungent ingredient of hot peppers, has been evaluated for the treatment of
detrusor overactivity and neurogenic detrusor overactivity. (Page 91)
58 Which of the following pungent substance from the Euphorbia resinifera plant, has
been shown to have very potent capsaicinlike activity?
I Resinferrytoxin
II Resiniferatoxin
III Resinferatoxin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Resiniferatoxin, a naturally occurring pungent substance from the Euphorbia resinifera plant, has been
shown to have very potent capsaicinlike activity. (Page 92)
59 How do Potassium channel openers relax smooth muscle?

I By increasing potassium efflux
II By decreasing potassium efflux
III By balancing the potassium efflux
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Potassium channel openers relax smooth muscle by increasing potassium efflux, with resultant membrane
depolarization. (Page 92)
60 What is the disadvantage of using potassium channel openers to relax smooth muscle?
I Short-term effect
II Lack of organ specificity
III High dosage requirement
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
One problem in the development of potassium channel openers for use in bladder disorders has been the lack
of organ specificity. (Page 92)
61 How much concentration of Nasal DDAVP decreases nighttime urine production?

I 10-40 mg
II 40-70 mg
III 70-100 mg
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Nasal DDAVP at 10-40 mg decreases nighttime urine production. (Page 93)
62 Women who have nocturia more than twice a night or experience nighttime bed-
wetting may benefit from which technique?
I Fluid restriction
II Taking sleep aids
III Elimination of caffeine-containing beverages from their diet in the evening
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Women who have nocturia more than twice a night or experience nighttime bed-wetting may benefit from
fluid restriction and the elimination of caffeine-containing beverages from their diet in the evening. (Page
93)
63 Which exercises have been shown to improve the strength and tone of the muscles of
the pelvic floor?
I Kegel exercises
II Kroger exercises
III Kenel exercises
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Kegel exercises have been shown to improve the strength and tone of the muscles of the pelvic floor (ie, the
levator ani, and particularly the pubococcygeus). (Page 94)
64 How long pelvic floor strengthening exercises are required to be done before
improvement is noted?
I 6-12 weeks
II 3-6 months
III Varies for each individual
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Approximately 6-12 weeks of exercises are required before improvement is noted, and 3-6 months are needed
before maximal benefit is reached. (Page 94)
65 What are vaginal cones?

I Vaginal cones are the only devices which can increase the strength of the pelvic floor muscles.
II Vaginal cones are weighted devices designed to increase the strength of the pelvic floor muscles.
III Vaginal cones are weighted devices designed to decrease the strength of the pelvic floor muscles.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Vaginal cones are weighted devices designed to increase the strength of the pelvic floor muscles. (Page 95)
66 Which weights are available in vaginal cone set?

I 32.5 g
II 45.4 g
III 45 g
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
The cones are available in sets of 5, with identical shape and volume but increasing weights (ie, 20 g, 32.5 g,
45 g, 60 g, 75 g). (Page 95)
67 How many times should vaginal cone exercise be performed in a day?

I Once
II Twice
III Thrice
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
This exercise is performed twice daily. (Page 95)
68 In premenopausal women with stress incontinence, the subjective cure or improved

continence status is approximately 70-80% after how many weeks of treatment?
I 2-4 weeks
II 4-6 weeks
III 6-8 weeks
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
In premenopausal women with stress incontinence, the subjective cure or improved continence status is
approximately 70-80% after 4-6 weeks of treatment. (Page 95)
69 Biotreatment is used for which all incontinence?

I Functional incontinence, urge incontinence, and mixed incontinence
II Stress incontinence, urge incontinence, and overflow incontinence
III Stress incontinence, urge incontinence, and mixed incontinence
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Biofeedback therapy is recommended for treatment of stress incontinence, urge incontinence, and mixed
incontinence. (Page 95)
70 What type of recording does biofeedback use?

I Multifeedback recording
II Multimeasurement recording
III Multichannel recording
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Biofeedback, using multimeasurement recording, displays the simultaneous measurement of pelvic and
abdominal muscle activity on the computer monitor. (Page 96)
71 What is the benefit of biofeedback therapy?

I It provides the patient with minute-by-minute feedback on the quality and intensity of her pelvic floor
contraction.
II It provides the patient with second-by-second feedback on the quality and intensity of her pelvic floor
contraction.
III It provides the patient with hour-by-hour feedback on the quality and intensity of her pelvic floor
contraction.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The benefit of biofeedback therapy is that it provides the patient with minute-by-minute feedback on the
quality and intensity of her pelvic floor contraction. (Page 96)
72 Biofeedback combined with pelvic floor exercises show a what percenta ge range of
improvement with incontinence?
I 56-89%
II 55-88%
III 54-87%
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Studies on biofeedback combined with pelvic floor exercises show a 54-87% improvement with incontinence.
(Page 96)
73 What is electrical stimulation?

I Stimulation of levatory ani muscles using painless electric currents.
II Stimulation of levator ani muscles using pricking electric currents.
III Stimulation of levator ani muscles using painless electric currents.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Electrical stimulation is a more sophisticated form of biofeedback used for pelvic floor muscle rehabilitation.
This treatment involves stimulation of levator ani muscles using painless electric currents. (Page 97)
74 Where can electrical stimulation be performed?
I Office
II Home
III Either office or home
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Similar to biofeedback, electrical stimulation can be performed at the office or at home. Electrical
stimulation can be used in conjunction with biofeedback or pelvic floor muscle exercises. (Page 97)
75 What equipment nonimplantable pelvic floor electrical stimulation use?

I Vaginal sensors
II Anal sensors
III Olfactory sensors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Nonimplantable pelvic floor electrical stimulation uses vaginal sensors, anal sensors, or surface electrodes.
(Page 97)
76 In order to derive significant benefit, electrical stimulation must be performed for a

minimum of how many weeks?
I Two
II Four
III Three
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
In order to derive significant benefit, stimulation must be performed for a minimum of 4 weeks, and patients
must continue pelvic floor exercises after the treatment. (Page 97)
77 What are the main modes of electrical stimulation therapy?

I Middle-term stimulation
II Long-term stimulation
III Short-term maximal stimulation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The 2 main modes of electrical stimulation therapy are long-term stimulation and short-term maximal
stimulation. (Page 97)
78 Subthreshold stimulation is used in which type of electrical stimulation?

I Middle-term stimulation
II Long-term stimulation
III Short-term maximal stimulation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The 2 main modes of electrical stimulation therapy are long-term stimulation and short-term maximal
stimulation. Long-term therapy requires the use of an intravaginal or intra-anal probe for several hours a
day. Low intensity, subthreshold stimulation is used. Patient acceptance can be low due to the discomfort of
wearing the probe for several hours each day. (Page 97)
79 What does TENS stand for?

I Transcutaneous electrical neurological stimulation
II Transcutaneous electrical nerval stimulation
III Transcutaneous electrical nerve stimulation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Transcutaneous electrical nerve stimulation (TENS) has been tried in patients with detrusor overactivity,
using several different methods. (Page 98)
80 Which of the following is a type of TENS?

I Interferential therapy
II Interfacial therapy
III Intraferential therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Interferential therapy is a type of TENS in which external electrodes are positioned over the pelvis, and the
interference produced by the competing electrical fields produces low-level nerve stimulation in the area of
interference. (Page 98)
81 Extracorporeal magnetic resonance therapy has been introduced as a therapy f or

I Urge Continence
II Mixed incontinence
III Stress incontinence
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Extracorporeal magnetic resonance therapy has been introduced as a therapy for stress incontinence. (Page
98)
82 Which of the following has been identified as a risk factor for development of urinary
incontinence?
I Obesity
II Food carvings
III High BP
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Given that obesity has been identified as a risk factor for development of urinary incontinence, it is not
surprising that interventions to address obesity can result in improved continence. (Page 98)
83 What is Bladder training?

I Learning how to urinate frequently
II learning how to urinate
III Relearning how to urinate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Bladder training involves relearning how to urinate. (Page 99)
84 What does surgical care for stress incontinence imporve?

I Strengthen urethral inlet
II Decrease urethral outlet resistance
III Increase urethral outlet resistance
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Surgical care for stress incontinence involves procedures that increase urethral outlet resistance, which include
the following:
Bladder neck suspension
Periurethral bulking therapy
Artificial urinary sphincter placement
Midurethral sling surgery (Page 100,101)
85 What dietary stimulants worsen symptoms of urinary frequency and urge incontinence?
I Cause irritative voiding symptoms
II Exacerbate irritative voiding symptoms
III Exceed irritative voiding symptoms
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Dietary stimulants are substances contained within the food or drink that either cause or exacerbate irritative
voiding symptoms. (Page 101)
86 Which of the following are examples of hot spices that cause urge incontinence?
I Bell pepper
II Cayenne pepper
III Chili pepper
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Spicy foods may contribute to urge incontinence. Some examples of hot spices include curry, chili pepper,
cayenne pepper, and dry mustard. (Page 102)
87 What worsens irritative bladder symptoms?

I Drinking excessive water
II Drinking 6-8 glasses of water a day
III Drinking water when thirsty
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Drinking water to excess actually worsens irritative bladder symptoms. (Page 102)
88 What class of medications are used to treat incontinence?

I Antidepprasants
II TCAs
III Antispasmodic agents
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The goal of therapy is to improve the symptoms of frequency, nocturia, urgency, and urge incontinence.
Treatment options include anticholinergics, antispasmodic agents, and tricyclic antidepressants (TCAs).
(Page 103)
89 Which of the following is an an alpha1-agonist?
I Desglymidrine
II Desglymododrine
III Desglymidodrine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The active metabolite of midodrine, desglymidodrine, is an alpha1-agonist that may increase bladder outlet
resistance. (Page 104)
90 Which of the following is/are trade name(s) of Pseudoephedrine hydrochloride?

I SudoGest
II Sudafed
III Sudofero
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Pseudoephedrine hydrochloride (Sudafed, Genaphed, SudoGest) (Page 104)
91 Which drug has a high affinity for M3 receptors involved in bladder and GI smooth
muscle contraction, saliva production, and iris sphincter function?
I Enablex
II Darifenacin
III Bentyl
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Darifenacin is an extended-release product eliciting competitive muscarinic receptor antagonistic activity. It
reduces bladder smooth muscle contractions. Darifenacin has high affinity for M3 receptors involved in
bladder and GI smooth muscle contraction, saliva production, and iris sphincter function. It is indicated for
overactive bladder with symptoms of urge incontinence, urgency, and frequency. Swallow whole; do not
chew, divide, or crush. (Page 105)
92 Which quaternary ammonium compound that elicits antispasmodic and antimuscarinic

effects?
I Trospium
II Tolterodine
III Fesoterodine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Trospium (Sanctura)
Quaternary ammonium compound that elicits antispasmodic and antimuscarinic effects. Antagonizes
acetylcholine effect on muscarinic receptors. Parasympathetic effect reduces smooth muscle tone in the bladder.
Indicated to treat symptoms of overactive bladder (eg, urinary incontinence, urgency, frequency). (Page 106)
93 Which of the following are trade names of Oxybutynin chloride?

I Ditropan IR
II Ditropan IX
III Ditropan XL
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Oxybutynin chloride (Ditropan IR, Ditropan XL, Gelnique). (Page 107)
94 Which of the following are estrogen drugs?

I Premarin
II Cymbalta
III Dibenzyline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Premarin is an estrogen drug. (Page 109)
95 Minipress is a trade name for which drug?

I Prazosin
II Pracosin
III Pradasil
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Prazosin (Minipress). (Page 110)
96 A 55-year old female who is suffering from urinary incontinence complains of

drowsiness after taking her medications. Which drug is she consuming?
I Aspirin
II Tofranil
III Elavil
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Amitriptyline hydrochloride (Elavil):
A TCA with sedative properties, amitriptyline increases the circulating levels of norepinephrine and serotonin
by blocking their reuptake at nerve endings. It ineffective for use in urge incontinence but is extremely
effective in decreasing symptoms of urinary frequency in women with pelvic floor muscle dysfunction. (Page
108)
97 Which drug is used for used for symptomatic relief of dysuria, urgency, nocturia, and
incontinence?
I Flavoxate
II Urispas
III Flovate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Flavoxate is used for symptomatic relief of dysuria, urgency, nocturia, and incontinence, as may occur in
cystitis, prostatitis, urethritis, and urethrocystitis/urethrotrigonitis. (Page 107)
98 Which of the following drug(s) is a competitive muscarinic receptor antag onist?

I Toviaz
II Topaz
III Toporol
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Fesoterodine (Toviaz):
Competitive muscarinic receptor antagonist. Antagonistic effect results in decreased bladder smooth muscle
contractions. Indicated for symptoms of overactive bladder (eg, urinary urge incontinence, urgency, and
frequency). Available as 4- or 8-mg extended-release tab. (Page 106)
99 What are the trade names for Tolterodine?

I Detrol
II Detrol LA
III Detrol LX
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Tolterodine (Detrol and Detrol LA). (Page 106)
100 A prototypical anticholinergic agent, propantheline blocks action of acetylcholine at

postganglionic parasympathetic receptor sites. Which drug is it?
I Propantheline
II Phenolphathaline
III Pyridimol
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Propantheline (Pro-Banthine)
A prototypical anticholinergic agent, propantheline blocks action of acetylcholine at postganglionic
parasympathetic receptor sites. (Page 106)
ERECTILE DYSFUNCTION
1 Which of the following physiologic processes integrate the penile erection ?

I Central nervous
II Hormonal, and vascular systems
III Seketal system
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Penile erections are produced by an integration of physiologic processes involving the central nervous,
peripheral nervous, hormonal, and vascular systems.
2 Which of the following factor determines the degree of contraction of cavernosal smooth
muscle ?
I The functional state of the left ventricles
II The functional state of the penis
III The functional state of the penis artery
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The degree of contraction of cavernosal smooth muscle determines the functional state of the penis.
3 Which of the following factor mediate contraction in the penis ?

I Noradrenaline
II Endothelin-1
III Melatonin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Factors that mediate contraction in the penis include noradrenaline, endothelin-1, neuropeptide Y,
prostanoids, angiotensin II, and others not yet identified.
I Adiponectin
II Neuropeptide Y
III Prostanoids
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E

I Noradrenaline
II Cortistatin
III Angiotensin II
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
6 Which of the following factor mediate relaxation in the penis ?

I Acetylcholine
II Nitric oxide (NO)
III Ghrelin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Factors that mediate relaxation include acetylcholine, nitric oxide (NO), vasoactive intestinal polypeptide,
pituitary adenylyl cyclase activating peptide, calcitonin gene related peptide, adrenomedullin, adenosine
triphosphate, and adenosine prostanoids.

I Melanocyte stimulating hormone
II Vasoactive intestinal polypeptide
III Pituitary adenylyl cyclase activating peptide
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E

I Calcitonin gene related peptide
II Melanocyte stimulating hormone
III Adrenomedullin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F

I Adenosine triphosphate
II Adenosine prostanoids
III Anti-mullerian hormone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
10 Which of the following is involved in the regulation of cavernosal smooth muscle

contraction ?
I The fatty acid B-oxidation pathways
II The pentose phosphate pathway
III The RhoA Rho kinase pathway
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The RhoA Rho kinase pathway is involved in the regulation of cavernosal smooth muscle contraction.
11 What is mean by male erectile dysfunction ?

I It is also called as Impotence in male
II It is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance
III It is the inability to circulate blood in scortum
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Defined impotence as "male erectile dysfunction, that is, the inability to achieve or maintain an erection
sufficient for satisfactory sexual performance."
12 Which of the following examination is necessary to entails evaluation of the erectile

dysfunction ?
I Blood pressure
II Peripheral pulses
III Blood count
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
A physical examination is necessary for every patient, emphasizing the genitourinary, vascular, and
neurologic systems. A focused examination entails evaluation of the following:
 Blood pressure
 Peripheral pulses

dysfunction ?
I Blood count
II Sensation
III Status of the genitalia and prostate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Sensation
 Status of the genitalia and prostate

dysfunction ?
I Size and texture of the testes
II Size of the penis
III Presence of the epididymis and vas deferens
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Size and texture of the testes
 Presence of the epididymis and vas deferens
15 Which of the following abnormalities of the penis is/are examined to entails evaluation
of the erectile dysfunction ?
I Hypospadias
II Peyronie plaques
III Testicular torsion
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Abnormalities of the penis (eg, hypospadias, Peyronie plaques) .
16 Which of the following functional tests may be helpful in diagnosis of erectile

dysfunction ?
I Blood urea nitrogen
II Direct injection of prostaglandin E1 (PGE1; alprostadil) into the corpora cavernosa
III Biothesiometry
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Functional tests that may be helpful include the following:
Direct injection of prostaglandin E1 (PGE1; alprostadil) into the corpora cavernosa
 Biothesiometry Infrequently indicated
17 Which of the following functional tests may be helpful in diagnosis of erectile

dysfunction ?
I Nocturnal penile tumescence testing
II Functional residual capacity
III Formal neurologic testing
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Functional tests that may be helpful include the following:
 Nocturnal penile tumescence testing Once frequently performed, this is rarely used in current
practice, though it can be helpful when the diagnosis is in doubt
 Formal neurologic testing Not needed in the vast majority of ED patients, though it may offer
some benefit to patients with a history of central nervous system problems, peripheral neuropathy,
diabetes, or penile sensory deficit
18 Which of the following agent are used as first-line therapy for erectile dysfunction
according to American Urological Association ?
I Oral Phosphodiesterase type 5 (PDE5) inhibitors
II Oral Prostaglandin analogs
III Oral parathyroid hormone and analogs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
According to American Urological Association (AUA) guidelines, oral phosphodiesterase type 5 (PDE5)
inhibitors are first-line therapy unless contraindicated.
19 Which of the following drugs are used as first-line therapy for erectile dysfunction
I Sildenafil
II Serzone
III Vardenafil
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
inhibitors are first-line therapy unless contraindicated.[1] Agents include the following:
 Sildenafil
 Vardenafil
 Tadalafil
 Avanafil
20 Which of the following drugs are used as first-line therapy for erectile dysfunction
I Tekturna
II Tadalafil
III Avanafil
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
inhibitors are first-line therapy unless contraindicated.[1] Agents include the following:
 Sildenafil
 Vardenafil
 Tadalafil
 Avanafil
21 Which of the following external device may be used for the treatment of erectile
dysfunction ?
I Vacuum devices to draw blood into the penis
II Constriction devices placed at the base of the penis to maintain erection
III Hemodialysis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
External devices that may be used include the following:
 Vacuum devices to draw blood into the penis
 Constriction devices placed at the base of the penis to maintain erection
22 What is the common and important cause of erectile dysfunction ?

I Vasculogenic
II Improper diet
III Smoking
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
A common and important cause of ED is vasculogenic.
23 Which of the following relationship factor involve in erectile disorder ?

I Social withdrawal
II Communication problems
III Differing levels of desire for sexual activity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Thus, in addition to the criteria for erectile disorder, the following must be considered:
 Partner factors (eg, partner sexual problems or health issues)
 Relationship factors (eg, communication problems, differing levels of desire for sexual activity, or
partner violence)
24 Which of the following statement is /are correct for penile artery ?

I It derives from the internal pudendal artery
II It derives from the internal lobular artery
III It branches into the dorsal, bulbourethral, and cavernous arteries
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
The common penile artery, which derives from the internal pudendal artery, branches into the dorsal,
bulbourethral, and cavernous arteries.
25 Which of the following statement is /are correct for vascular anatomy of penis ?
I The dorsal artery provides for engorgement of the glans during erection
II The bulbourethral artery supplies the bulb and the corpus spongiosum
III The renal artery supplies the bulb and the corpus spongiosum
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The dorsal artery provides for engorgement of the glans during erection, whereas the bulbourethral artery
supplies the bulb and the corpus spongiosum.
26 Which of the following pathways play an important role in the integration and control
of reproductive and sexual functions ?
I The hypothalamic pathways
II The limbic pathways
III The pentose phosphate pathway
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The hypothalamic and limbic pathways play an important role in the integration and control of reproductive
and sexual functions.
27 Which of the following nerves regulate blood flow during erection and detumescence ?
I The occipital nerve
II The cavernosal nerves
III The dorsal somatic nerves
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The cavernosal nerves are a part of the autonomic nervous system and incorporate both sympathetic and
parasympathetic fibers. They travel posterolaterally along the prostate and enter the corpora cavernosa and
corpus spongiosum to regulate blood flow during erection and detumescence.
28 Which of the following nerves are primarily responsible for penile sensation ?
I The vagus nerves
II The cavernosal nerves
III The dorsal somatic nerves
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The dorsal somatic nerves are also branches of the pudendal nerves. They are primarily responsible for penile
sensation.[
29 What are the biochemical features of nitric oxide synthase enzyme ?

I They are noncompetitively inhibited by albumin derivatives
II They are competitively inhibited by arginine derivatives
III They are calcium-dependent, they require calmodulin and reduced nicotinamide adenine dinucleotide
phosphate for catalytic activity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
All NOS subtypes produce NO, but each may play a different biologic role in various tissues. nNOS and
eNOS are considered constitutive forms because they share biochemical features: They are calcium-dependent,
they require calmodulin and reduced nicotinamide adenine dinucleotide phosphate for catalytic activity, and
they are competitively inhibited by arginine derivatives.
30 Which of the following are involve in autonomic nervous system during normal erectile
process ?
I Erection
II Sustaining and maintaining an erection
III Orgasm, and tumescence
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
The autonomic nervous system is involved in erection, orgasm, and tumescence.
31 Which of the following are involve in parasympathetic nervous system during normal
erectile process ?
I Erection
II Orgasm, and tumescence
III Sustaining and maintaining an erection, which is derived from S2-S4 nerve roots
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The parasympathetic nervous system is primarily involved in sustaining and maintaining an erection, which
is derived from S2-S4 nerve roots.
32 What are the sexual dysfunction in which testosterone plays a key role ?
I Low libido
II Poor erection quality
III Early mensuration
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
It also plays a key role in sexual dysfunction (eg, low libido, poor erection quality, ejaculatory or orgasmic
dysfunction, reduced spontaneous erections, or reduced sexual activity).
33 What are the sexual dysfunction in which testosterone plays a key role ?
I Early mensuration
II Ejaculatory or orgasmic dysfunction
III Reduced spontaneous erections
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
It also plays a key role in sexual dysfunction (eg, low libido, poor erection quality, ejaculatory or orgasmic
dysfunction, reduced spontaneous erections, or reduced sexual activity).
34 Which of the following neurologic disease and conditions are associated with erectile
dysfunction ?
I Guillain-Barré syndrome
II Alzheimer disease
III Andereson syndrome
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Neurologic causes
 Guillain-Barré syndrome
 Alzheimer disease
 Trauma
35 Which of the following nutritional disease and conditions are associated with erectile
dysfunction ?
I Zinc deficiency
II Sodium deficiency
III Sickle cell anemia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Malnutrition
Zinc deficiency
Sickle cell anemia
36 Which of the following drugs are associated with ED ?

I Psychotropic drugs
II Antihypertensive agents
III Anti fungal drugs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
psychotropic drugs and antihypertensive agents are associated with ED.
37 What are the different resources of erectile dysfunction for patient education ?
I Heartburn and GERD Center
II Erectile Dysfunction Center
III Impotence/Erectile Dysfunction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
For patient education information, see the following:
 Erectile Dysfunction Center
 Cancer and Tumors Center
 Impotence/Erectile Dysfunction
 Erectile Dysfunction FAQs
 Nonsurgical Treatment of Erectile Dysfunction
 Understanding Erectile Dysfunction Medications
 Surgical Treatment of Erectile Dysfunction
I Erectile Dysfunction FAQs
II Gastroesophageal Acid Reflux (GERD) FAQs
III Nonsurgical Treatment of Erectile Dysfunction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
I Understanding Erectile Dysfunction Medications
II Surgical Treatment of Erectile Dysfunction
III Heartburn and GERD Medications
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
40 Which of the following prescribed medications have been associated with ED ?

I Antiemetic drugs
II Antiulcer drugs
III Lipid-lowering
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Prescription medications have been associated with ED, including the following:
 Antihypertensive drugs
 Antiulcer drugs (eg, proton pump inhibitors [PPIs] and cimetidine)
 Lipid-lowering (eg, statins and fibrates) [60]
 5-Alpha reductase inhibitors (eg, finasteride and dutasteride) [61]
 Antidepressants
 Antipsychotic drugs
 Testosterone and anabolic steroids
41 Which of the following prescribed medications have been associated with ED ?

I 5-Alpha reductase inhibitors
II Beta-blockers
III Testosterone and anabolic steroids
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Prescription medications have been associated with ED, including the following:
 5-Alpha reductase inhibitors (eg, finasteride and dutasteride) [61]
 Testosterone and anabolic steroids
42 Which of the following psychological state are associated with erectile dysfunction ?
I Wakefulness
II Indications of depression
III Loss of libido
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Factors that give rise to stress factors and tension, whether at work or at home, should be explored. The
 Indications of depression
 Loss of libido
I Problems and tension in the sexual relationship
II Insomnia
III Acathexia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
 Problems and tension in the sexual relationship

 Insomnia
I Lethargy
II Anhidrosis
III Moodiness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Lethargy
 Moodiness
45 Which of the following questionnaires have been developed to gather objective data
regarding ED ?
I The International Index of Erectile Function (IIEF)
II The Self-Esteem and Relationship (SEAR)
III The adult health history questionnaire
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Various formal questionnaires have been developed to gather objective data regarding ED and to assist
clinicians in the evaluation of their patients,[62, 63] including the International Index of Erectile Function
(IIEF), the Sexual Encounter Profile (SEP), the Global Assessment Question (GAQ), the Psychological and
Interpersonal Relationship Scales (PAIRS), the Self-Esteem and Relationship (SEAR) questionnaire, and the
Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS).
46 Which of the following questionnaires have been developed to gather objective data
regarding ED ?
I Ischemic heart disease disability benefits questionnaire
II The Psychological and Interpersonal Relationship Scales (PAIRS)
III The Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Various formal questionnaires have been developed to gather objective data regarding ED and to assist
clinicians in the evaluation of their patients,[62, 63] including the International Index of Erectile Function
(IIEF), the Sexual Encounter Profile (SEP), the Global Assessment Question (GAQ), the Psychological and
Interpersonal Relationship Scales (PAIRS), the Self-Esteem and Relationship (SEAR) questionnaire, and the
Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS).
47 What is mean by biothesiometry ?

I The sensitivity of the skin of the penis to detect vibrational stimuli
II The sensitivity of the skin of the scortum to detect vibrational stimuli
III The vibrational amplitude is adjusted until the subjective sensory threshold is reached, which is
determined by questioning the patient by a small electromagnetic test probe
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Biothesiometry------The sensitivity of the skin of the penis to detect vibrational stimuli (ie, biothesiometry)
can be employed as a simple nerve function office screening test, but it is infrequently indicated. In this test, a
small electromagnetic test probe is placed on the right and left sides of the penile shaft and on the glans. The
vibrational amplitude is adjusted until the subjective sensory threshold is reached, which is determined by
questioning the patient.
48 Which of the following is used to evaluate the vascular function with in the penis ?
I Duplex ultrasonography
II Biothesiometry
III Nocturnal penile tumescence testing
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Vascular function within the penis can be evaluated by means of duplex ultrasonography.
49 What are the two domains of the SEAR questionnaire for measure of psychosocial
outcomes in men with ED ?
I Fertility (item 1-8 )
II Sexual relationship (items 1-8)
III Confidence (items 9-14)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The SEAR questionnaire[67] is a subject-reported measure of psychosocial outcomes in men with ED. It
consists of 14 items assessing two domains, as follows:
 Sexual relationship (items 1-8)
 Confidence (items 9-14)
50 What are the two subscales of confidence domain, the SEAR questionnaire for measure
of psychosocial outcomes in men with ED ?
I Self-esteem (items 9-12)
II Overall relationship (items 13 and 14)
III Social behaviour (items 9-12)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The confidence domain is comprised of \two subscales, as follows:
 Self-esteem (items 9-12)
 Overall relationship (items 13 and 14)

1 What are the adverse effect of intracavernosal injection ?
I Painful erection
II Priapism
III Statin intolerance
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The main adverse effects of intracavernosal injection are as follows :
 Painful erection
 Priapism
 Development of scarring at the injection site
2 What are the adverse effect of intracavernosal injection ?

I Development of scarring at the injection site
II Statin intolerance
III Seizures
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The main adverse effects of intracavernosal injection are as follows :
 Painful erection
 Priapism
 Development of scarring at the injection site
3 Which of the following statement is /are correct for Medicated Urethral System for
Erections (MUSE) ?
I It involves the formulation of alprostadil (PGE1) into a small intraurethral suppository
II It is another option for ED and can be inserted into the urethra
III It is another option for ED and can be inserted into the vagina
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Another option for ED is the Medicated Urethral System for Erections (MUSE). MUSE involves the
formulation of alprostadil (PGE1) into a small intraurethral suppository that can be inserted into the
urethra.
4 What are the most common adverse effect of Medicated Urethral System for Erections
(MUSE) ?
I Statin intolerance
II Painful erection
III Urethral burning
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Few adverse effects occur. The most common is a painful erection and urethral burning.
5 What is mean by VEGF ?
I Vascular endothelial genetic factor
II Vascular epithilial growth factor
III Vascular endothelial growth factor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
vascular endothelial growth factor (VEGF), an angiogenic growth factor and endothelial cell mitogen. VEGF
is produced by vascular smooth muscle, endothelial, and inflammatory cells. It increases production of nitric
oxide (NO), which results in improves endothelial function and blood flow in chronic ischemic disorders.
6 Which of the following statement is /are correct for vascular endothelial growth factor
(VEGF) ?
I It is an angiogenic growth factor and endothelial cell mitogen
II It is produced by vascular smooth muscle, endothelial, and inflammatory cells
III It decreases production of nitric oxide (NO), which results in block endothelial function and blood
flow in chronic ischemic disorders
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
vascular endothelial growth factor (VEGF), an angiogenic growth factor and endothelial cell mitogen. VEGF
is produced by vascular smooth muscle, endothelial, and inflammatory cells. It increases production of nitric
oxide (NO), which results in improves endothelial function and blood flow in chronic ischemic disorders.
7 Which of the following oral medication were investigated for treatment of ED Before the
advent of oral PDE5 inhibitors ?
I Adrenergic receptor antagonists
II Dopamine receptor antagonists
III Acetylcholine receptor antagonist
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Before the advent of oral PDE5 inhibitors, various other oral medications were investigated for treatment of
ED, including the following[76] :
 Adrenergic receptor antagonists (eg, phentolamine, yohimbine, and delequamine)
 Dopamine receptor antagonists (eg, apomorphine and bromocriptine)
 Serotoninergic receptor activators (eg, trazodone)
 Xanthine derivatives (eg, pentoxifylline)
 Oxytocinergic receptor stimulators (eg, oxytocin)
I Acetylcholine receptor antagonist
II Serotoninergic receptor activators
III Xanthine derivatives
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
I Serotoninergic receptor activators
II Acetylcholine receptor antagonist
III Oxytocinergic receptor stimulators
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
10 Which of the following are the external erection facilitating devices ?

I Constriction devices
II Vaccum devices
III Relaxation devices
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
External Erection-Facilitating Devices
 Constriction devices
 Vaccum devices
11 Which of the following statement is /are correct for vaccum device used for the
treatmebt of ED ?
I These devices are steel cylinders that are placed over the penis. Air is pumped out
II These devices are plastic cylinders that are placed over the penis. Air is pumped out, causing a partial
vacuum
III Releasing the vacuum after a few minutes and then reapplying the vacuum ,an erection is obtained, a
constricting band is placed at the base of the penis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Vacuum devices for drawing blood into the penis are a relatively inexpensive method for producing an
erection that has been used for many years. These devices are plastic cylinders that are placed over the penis.
Air is pumped out, causing a partial vacuum. Releasing the vacuum after a few minutes and then reapplying
the vacuum sometimes gives a better result. After an erection is obtained, a constricting band is placed at the
base of the penis (see the images below).[
12 What are the adverse effect of vaccum device used for the treatment of ED ?
I Pain
II Statin intolerance
III Lower penile temperature
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Other adverse effects include pain, lower penile temperature, numbness, absent or painful ejaculation, and
pulling of scrotal tissue into the cylinder.
I Statin intolerance
II Numbness
III Absent or painful ejaculation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
I Pulling of scrotal tissue into the cylinder
II Absent or painful ejaculation
III Statin intolerance
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
15 Which of the following statement is /are correct for surgical revascularization ?

I It is used when healthy young men have developed ED as a result of trauma to the pelvic arteries
II It is used when healthy young men have developed ED as a result of trauma to the renal arteries
III It procedures such as rotating the epigastric artery (or even smaller vessels) into the corpora have been
attempted
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Surgical revascularization:
A small number of healthy young men have developed ED as a result of trauma to the pelvic arteries.
Revascularization procedures such as rotating the epigastric artery (or even smaller vessels) into the corpora
have been attempted.
16 What is the last effective therapy for men with organic ED ?

I Surgical revascularization
II The placement of prosthetic devices within the corpora
III The placement of prosthetic devices within the kidney head
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The placement of prosthetic devices within the corpora was the only effective therapy for men with organic
ED. At present, however, it is the last option considered.
17 What are the disadvantages of semirigid or malleable rod implants ?

I Mimics the natural process of rigidity flaccidity
II Constant erection at all times
III May be difficult to conceal
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Semirigid or malleable rod implants--
Constant erection at all times
May be difficult to conceal

I Does not increase width of penis
II Mimics the natural process of rigidity flaccidity
III Risk of infection
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Does not increase width of penis

Risk of infection
Permanently alters or may injure erection bodies
Most likely implant to cause pain or erode through skin
If unsuccessful, interferes with other treatments

I Permanently alters or may injure erection bodies
II Most likely implant to cause pain or erode through skin
III Mimics the natural process of rigidity flaccidity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Does not increase width of penis

Risk of infection
Permanently alters or may injure erection bodies
Most likely implant to cause pain or erode through skin
If unsuccessful, interferes with other treatments
20 What are the advantages of fully inflatable implants ?

I Most likely implant to cause pain or erode through skin
II Mimics the natural process of rigidity flaccidity
III User controls the state of erection
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Advantages of fully inflatable implants:
 Mimics the natural process of rigidity flaccidity
 User controls the state of erection

I Natural appearance
II No concealment problems
III Most likely implant to cause pain or erode through skin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
 Natural appearance
 No concealment problems

I Increase the width of the penis when activated
III highly effective with 70-80% success rate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Increase the width of the penis when activated
 highly effective with 70-80% success rate
23 What are the disadvantages of fully inflatable implants ?

I Relatively high rate of mechanical failure
II Risk of infection
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Disadvantages of fully inflatable implants:
 Relatively high rate of mechanical failure

 Risk of infection
 Most expensive implant
 Permanently alters or may injure erection bodies
 If unsuccessful, interferes with other treatments
24 What are the disadvantages of fully inflatable implants ?

II Most expensive implant
III Permanently alters or may injure erection bodies
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Disadvantages of fully inflatable implants:
 Relatively high rate of mechanical failure

 Most expensive implant
 If unsuccessful, interferes with other treatments
25 What are the disadvantages of self-contained inflatable unitary implants ?

I Sometimes difficult to activate the inflatable device
II Does not increase width of penis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
 Sometimes difficult to activate the inflatable device
 Does not increase width of penis
 Mechanical breakdowns possible
 Long-term results not available
 Relatively expensive

II Mechanical breakdowns possible
III Long-term results not available
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E

I Risk of infection
III Relatively expensive
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F

I Permanently alters or may injure erection bodies
II Sometimes difficult to activate the inflatable device
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
29 What are the two broad categories of penile prosthese ?

I Semirigid
II Fully rigid
III Inflatable
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Penile prostheses can be divided into 2 broad categories as follows:
 Semirigid
 Inflatable
30 What are the advantages of semirigid or malleable rod implants ?

I Simple surgery
II No moving parts
III Natural appearance
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Advantages of semirigid or malleable rod implants:
 Simple surgery
 Relatively few complications
 No moving parts
 Least expensive implant
 Success rate of 70-80%
31 Which of the the following drugs fall in class phosphodiesterase-5 enzyme inhibitors
used for the treatment of erectile dysfunction ?
I Sildenafil
II Vardenafil
III Sucralfate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Phosphodiesterase-5 Enzyme Inhibitors:
 Sildenafil (Viagra)
 Vardenafil (Levitra, Staxyn)
 Tadalafil (Cialis)
 Avanafil (Stendra)
32 Which of the the following drugs fall in class phosphodiesterase-5 enzyme inhibitors
used for the treatment of erectile dysfunction ?
I Theophylline
II Tadalafil
III Avanafil
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Phosphodiesterase-5 Enzyme Inhibitors
 Sildenafil (Viagra)
 Vardenafil (Levitra, Staxyn)
 Tadalafil (Cialis)
 Avanafil (Stendra)
33 What is the brand name of sildenafil used for the treatment of erectile dysfunction ?
I Viagra
II Levitra
III Staxyn
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Sildenafil (Viagra)
34 What is the brand name of vardenafil used for the treatment of erectile dysfunction ?
I Viagra
II Levitra
III Staxyn
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Vardenafil (Levitra, Staxyn)
35 What is the brand name of tadalafil used for the treatment of erectile dysfunction ?
I Viagra
II Levitra
III Cialis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Tadalafil (Cialis)
36 What is the brand name of avanafil used for the treatment of erectile dysfunction ?
I Stendra
II Levitra
III Cialis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Avanafil (Stendra)
37 Which of the following statement is /are correct for avanafil used for the treatment of
erectile dysfunction ?
I It is a PDE5 inhibitor that inhibits cGMP degradation
II It enhances the effects of NO in smooth muscle relaxation of the corpus cavernosum
III It reduces the effects of NO in smooth muscle relaxation of the corpus cavernosum
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Avanafil is a PDE5 inhibitor that inhibits cGMP degradation and thereby enhances the effects of NO in
smooth muscle relaxation of the corpus cavernosum. May take 30 min prior to sexual activity.
38 Which of the the following drugs fall in class vasodilators used for the treatmen t of
I Theophylline
II Alprostadil
III Papaverine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Vasodilators
 Alprostadil (Caverject, Caverject Impulse, Edex, Muse)
 Papaverine
 Phentolamine
39 Which of the the following drugs fall in class vasodilators used for the treatment of
I Alprostadil
II Theophylline
III Phentolamine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Vasodilators
 Alprostadil (Caverject, Caverject Impulse, Edex, Muse)
 Papaverine
 Phentolamine
40 What is the brand name of alprostadil used for the treatment of erectile dysfunction ?
I Caverject
II Caverject Impulse
III Cialis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Alprostadil (Caverject, Caverject Impulse, Edex, Muse)
41 What is the brand name of alprostadil used for the treatment of erectile dysfunction ?
I Stendra
II Edex
III Muse
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Alprostadil (Caverject, Caverject Impulse, Edex, Muse)
42 What is mean by MUSE ?

I Medicated Urethral System for Erections
II Medicated Urinary System for Excretion
III Medicated Urethral System for Excretion
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Medicated Urethral System for Erections (MUSE).
43 Which of the following statement is /are correct for alprostadil used for the treatment
of erectile dysfunction ?
I It relaxes trabecular smooth muscle and dilates cavernosal arteries

II It blocks trabecular smooth muscle and constricts cavernosal arteries
III It promoting blood flow and entrapment in the lacunar spaces of the penis, causing penile erection
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Alprostadil is identical to naturally occurring PGE1 and has various pharmacologic effects, including
vasodilation and inhibition of platelet aggregation. When injected into the penile shaft, it relaxes trabecular
smooth muscle and dilates cavernosal arteries, thereby, in turn, promoting blood flow and entrapment in the
lacunar spaces of the penis, causing penile erection.
44 Which of the following statement is /are correct for phentolamine used for the
treatment of erectile dysfunction ?
I It is an alpha1- and alpha2-adrenergic blocking agent
II It is a beta-adrenergic blocking agent
III It blocks circulating epinephrine and norepinephrine, reducing the hypertension that results from
catecholamine effects on the alpha-receptors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Phentolamine is an alpha1- and alpha2-adrenergic blocking agent that blocks circulating epinephrine and
norepinephrine, reducing the hypertension that results from catecholamine effects on the alpha-receptors.
Injected into the penis, it causes an erection.
45 Which of the following drugs fall in class androgen used for the treatment of erectile
dysfunction ?
I Theophylline
II Testosterone
III Sucralfate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Androgens:
Testosterone (AndroGel, Axiron, Depo-Testosterone, Testopel, Testim, Androderm, Striant, Fortesta).
46 What is the brand name of testosterone used for the treatment of erectile dysfunction?
I AndroGel
II Edex
III Axiron
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
I Depo-Testosterone
II Testopel
III Edex
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
I Edex
II Testim
III Androderm
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
I Striant
II Edex
III Fortesta
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
50 Which of the following statement is /are correct for inflatable devices ?

I It consist of 2 Silastic or Bioflex cylinders inserted into the corpora cavernosa
II It consist of a pump placed in the scrotum to inflate the cylinders, and a reservoir
III It consist of a pump placed in the penis inflate the cylinders, and a reservoir
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The inflatable devices consist of 2 Silastic or Bioflex cylinders inserted into the corpora cavernosa, a pump
placed in the scrotum to inflate the cylinders, and a reservoir that is contained either within the cylinders or
in a separate reservoir placed beneath the fascia of the lower abdomen (see the images below). The inflatable
prosthesis generally remains functional for 7-10 years before a replacement may be necessary.
RENAL FAILURE
1 What is mean by Acute kidney injury ?
I It is defined as an abrupt or rapid decline in renal filtration function.

II It is defined as an abrupt or rapid decline in lung filtration function.
III It is defined as an abrupt or rapid decline in bladderl filtration function.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Acute kidney injury (AKI) is defined as an abrupt or rapid decline in renal filtration function.
2 Which out of the following sign and symptoms of skin examination may reveal by
patients with AKI ?
I Mucosal or cartilaginous ulcerations

II Maculopapular rash
III Track marks
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Signs and symptoms:
Skin examination may reveal the following in patients with AKI:
 Livido reticularis, digital ischemia, butterfly rash, palpable purpura: Systemic vasculitis
 Maculopapular rash: Allergic interstitial nephritis
 Track marks (ie, intravenous drug abuse): Endocarditis
3 Which out of the following sign and symptoms of skin examination may reveal by
patients with AKI ?
I Livido reticularis
II Butterfly rash
III Mucosal or cartilaginous ulcerations
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Signs and symptoms:
Skin examination may reveal the following in patients with AKI:
 Livido reticularis, digital ischemia, butterfly rash, palpable purpura: Systemic vasculitis
4 Which out of the following sign of ear examination may reveal by patients with AKI ?
I Hearing loss
II Maculopapular rash
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Hearing loss: Alport disease and aminoglycoside toxicity

 Mucosal or cartilaginous ulcerations: Wegener granulomatosis
5 Which out of the following sign and symptoms of cardiovascular examination may reveal
by patients with AKI ?
I Irregular rhythms
II Murmurs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Cardiovascular examination may reveal the following:
 Irregular rhythms (ie, atrial fibrillation): Thromboemboli
 Murmurs: Endocarditis
6 Which out of the following sign and symptoms of cardiovascular examination may reveal
by patients with AKI ?
I Pericardial friction rub

II Mucosal or cartilaginous ulcerations
III Increased jugulovenous distention
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Cardiovascular examination may reveal the following:
 Pericardial friction rub: Uremic pericarditis
 Increased jugulovenous distention, rales, S 3: Heart failure
7 Which of the following signs of AKI may be discovered during an abdominal

examination?
I Pulsatile mass
II Costovertebral angle tenderness
III Pericardial friction rub
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The following signs of AKI may be discovered during an abdominal examination:
 Pulsatile mass or bruit: Atheroemboli
 Abdominal or costovertebral angle tenderness: Nephrolithiasis, papillary necrosis, renal
artery thrombosis, renal vein thrombosis
8 Which of the following signs of AKI may be discovered during an abdominal

examination?
I Pericardial friction rub

II Prostatic hypertrophy
III Limb ischemia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The following signs of AKI may be discovered during an abdominal examination:
 Pelvic, rectal masses; prostatic hypertrophy; distended bladder: Urinary obstruction
 Limb ischemia, edema: Rhabdomyolysis
9 Which of the following signs of AKI may be observed during an pulmonary examination
?
I Rales
II Prostatic hypertrophy
III Hemoptysis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Pulmonary examination may reveal the following:
 Rales: Goodpasture syndrome, Wegener granulomatosis
 Hemoptysis: Wegener granulomatosis
10 Which out of the following tests can aid in the diagnosis and assessment of AKI ?
I Complete blood count

II Allergy test
III Peripheral smear
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
The following tests can aid in the diagnosis and assessment of AKI:
 Peripheral smear
I Allergy test
II Kidney function studies
III Serologic tests
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Kidney function studies:
 Serologic tests:
I Fractional excretion of sodium and urea

II Bladder pressure
III Clamydia test
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
 Fractional excretion of sodium and urea
 Bladder pressure
I Clamydia test
II Ultrasonography
III Aortorenal angiography
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Ultrasonography:
 Aortorenal angiography :
 Renal biopsy: Can be useful in identifying intrarenal causes of AKI
14 Which out of the following tests are the hallmarks of renal failure ?
I Increased levels of blood urea nitrogen (BUN)
II Increased levels of creatinine
III Identifying intrarenal causes
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Kidney function studies: Increased levels of blood urea nitrogen (BUN) and creatinine are the
hallmarks of renal failure.
15 What is the bladder pressure of patient which suspected of having AKI caused by
abdominal compartment syndrome ?
I Above 25 mm Hg
II Above 05 mm Hg
III Above 15 mm Hg
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Patients with a bladder pressure above 25 mm Hg should be suspected of having AKI caused by
abdominal compartment syndrome.
16 What is the primary goal of AKI treatment ?
I Maintenance of volume homeostasis

II Correction of biochemical abnormalities
III Correction of brain abnormalities
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Maintenance of volume homeostasis and correction of biochemical abnormalities remain the
primary goals of AKI treatment
17 Which out of the following measures include in the management of AKI treatment ?
I Correction of fluid overload with furosemide

II Correction of severe acidosis with bicarbonate administration
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
AKI treatment may include the following measures:
 Correction of fluid overload with furosemide
 Correction of severe acidosis with bicarbonate administration, which can be important as a
bridge to dialysis
18 Which out of the following measures include in the management of AKI treatment ?
I Correction of brain abnormalities

II Correction of hyperkalemia
III Correction of hematologic abnormalities
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
AKI treatment may include the following measures:
 Correction of hyperkalemia
 Correction of hematologic abnormalities (eg, anemia, uremic platelet dysfunction) with
measures such as transfusions and administration of desmopressin or estrogens
19 what is mean by BUN ?

I Brain urea nitrogen
II Blood uracil nitrogen
III Blood urea nitrogen
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Blood urea nitrogen [BUN] .
20 What is mean by azotemia ?
I A rise in blood uracil nitrogen concentration

II A rise in blood urea nitrogen concentration
III A rise in blood sugar nitrogen concentration
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Azotemia (a rise in blood urea nitrogen [BUN] concentration).
21 What is the general categories of AKI ?
I Prerenal, Intrinsic, Postrenal

II Smallrenal, Intrinsic, largerenal
III Initialrenal, Intrinsic, Posteriorrenal
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
AKI may be classified into 3 general categories, as follows:
 Prerenal
 Intrinsic
 Postrenal
22 What is mean by prerenal AKI ?
I As an adaptive response to severe volume depletion and hypotension, with structurally intact
nephrons
II In response to cytotoxic, ischemic, or inflammatory insults to the kidney, with structural and
functional damage
III From obstruction to the passage of urine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Prerenal - As an adaptive response to severe volume depletion and hypotension, with structurally
intact nephrons.
23 What is mean by intrinsic AKI ?
nephrons
functional damage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Intrinsic - In response to cytotoxic, ischemic, or inflammatory insults to the kidney, with structural
and functional damage.
24 What is mean by postrenal AKI ?
nephrons
functional damage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Postrenal - From obstruction to the passage of urine.
25 What is mean by oliguria ?
I A daily urine volume of less than 400 mL and has a worse prognosis, except in prerenal injury
II A urine output of less than 100 mL/day
III if abrupt in onset, suggests bilateral obstruction or catastrophic injury to both kidneys
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Oliguria is defined as a daily urine volume of less than 400 mL and has a worse prognosis, except in
prerenal injury.
26 What is mean by anuria ?
I A daily urine volume of less than 400 mL and has a worse prognosis, except in prerenal injury
II A urine output of less than 100 mL/day
III if abrupt in onset, suggests bilateral obstruction or catastrophic injury to both kidneys
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Anuria is defined as a urine output of less than 100 mL/day and, if abrupt in onset, suggests
bilateral obstruction or catastrophic injury to both kidneys.
27 According to RIFLE classification ,What is indicate the the letter R ?
I Risk of renal dysfunction

II Risk of liver dysfunction
III Risk of stomach dysfunction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
RIFLE (Risk of renal dysfunction, Injury to the kidney, Failure or Loss of kidney function, and
End-stage kidney disease).
28 According to RIFLE classification ,What is indicate the the letter I ?
I Injury to the liver

II Injury to the kidney
III Injury to the stomach
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
29 According to RIFLE classification ,What is indicate the the letter F ?
I Failure of liver function

II Failure of stomach function
III Failure of kidney function
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
30 According to RIFLE classification ,What is indicate the the letter E ?
I End-stage kidney disease

II End-stage liver disease
III End-stage stomach disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
31 What is mean by AKIN ?
I Acute Kidney Injury Network

II Acute Kidney Ion Neutral
III Acquired Kidney Injury Network
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Acute Kidney Injury Network (AKIN)
32 Which out of the following statement is / are correct for the Acute Kidney Injury
Network ?
I It has developed specific criteria for the diagnosis of AKI
II It defines AKI as abrupt (within 48 hours) reduction of kidney function
III It has developed specific criteria for the diagnosis of COPD
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The Acute Kidney Injury Network (AKIN) has developed specific criteria for the diagnosis of AKI.
The AKIN defines AKI as abrupt (within 48 hours) reduction of kidney function.
33 What are the cardiovascular complication associated with AKI ?
I Heart failure
II Myocardial infarction
III Cyanosis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Cardiovascular complications (eg, heart failure, myocardial infarction, arrhythmias, cardiac arrest).
34 What are the cardiovascular complication associated with AKI ?
I Cyanosis
II Arrhythmias
III Cardiac arrest
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Cardiovascular complications (eg, heart failure, myocardial infarction, arrhythmias, cardiac arrest).
35 What are the pulmonary complications associated with AKI ?
I Goodpasture syndrome
II Myocardial infarction
III Granulomatosis with polyangiitis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Pulmonary complications
 Goodpasture syndrome
 Granulomatosis with polyangiitis (Wegener granulomatosis)
I Myocardial infarction
II Polyarteritis nodosa
III Cryoglobulinemia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Pulmonary complications
 Polyarteritis nodosa
 Cryoglobulinemia
 Sarcoidosis
I Sarcoidosis
II Wegener granulomatosis
III Cyanosis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Pulmonary complications:
 Sarcoidosis
 Granulomatosis with polyangiitis (Wegener granulomatosis)
38 What are the frequent GI complications associated with AKI ?
I Nausea, vomiting
II Anorexia
III Sarcoidosis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Nausea, vomiting, and anorexia are frequent GI complications of AKI.
39 What are the other GI complications associated with AKI ?
I Pancreatitis
II Sarcoidosis
III Hepatitis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Pancreatitis
 Jaundice
 Hepatitis
40 What are the other GI complications associated with AKI ?
I Sarcoidosis
II Jaundice
III Cyanosis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
 Pancreatitis
 Jaundice
 Hepatitis
41 What is mean by normotensive ischemic AKI ?
I Depressed RBF eventually leads to ischemia and cell death

II This may happen before frank systemic hypotension is present
III This may happen before frank systemic hypertension is present
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Depressed RBF eventually leads to ischemia and cell death. This may happen before frank systemic
hypotension is present and is referred to as normotensive ischemic AKI.
42 What is the cause of afferent arteriolar vasoconstriction in prerenal AKI ?
I Hypercalcemia
II Hypocalcemia
III Hepatorenal syndrome
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Afferent arteriolar vasoconstriction can be caused by the following:
 Hypercalcemia
 Hepatorenal syndrome
43 Which out of the following drugs cause the afferent arteriolar vasoconstriction in
prerenal AKI ?
I NSAIDs
II Amphotericin B
III Prostaglandin analogs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Drugs - NSAIDs, amphotericin B, calcineurin inhibitors, norepinephrine, radiocontrast agents.
44 Which out of the following drugs cause the afferent arteriolar vasoconstriction in
prerenal AKI ?
I Calcineurin inhibitors
II Prostaglandin analogs
III Norepinephrine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Drugs - NSAIDs, amphotericin B, calcineurin inhibitors, norepinephrine, radiocontrast agents.
45 Which out of the following diseases may decrease effective arterial blood volume in
prerenal AKI ?
I Hypovolemia
II Sepsis
III Pertusis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Diseases that decrease effective arterial blood volume include the following:
 Hypovolemia
 Sepsis
46 Which out of the following diseases may decrease effective arterial blood volume in
prerenal AKI ?
I Atheroembolic disease
II Heart failure
III Liver failure
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Diseases that decrease effective arterial blood volume include the following:
 Heart failure
 Liver failure
47 What are the vascular causes which results in intrinsic AKI ?
I Transplant rejection
II Atheroembolic disease
III Plague disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
To summarize, vascular (large- and small-vessel) causes of intrinsic AKI include the following:
 Transplant rejection
 Atheroembolic disease
48 What are the vascular causes which results in intrinsic AKI ?
I Anti-neutrophil cytoplasmic antibody

II Renal vein obstruction
III Renal artery obstruction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
To summarize, vascular (large- and small-vessel) causes of intrinsic AKI include the following:
 Renal artery obstruction - Thrombosis, emboli, dissection, vasculitis
 Renal vein obstruction - Thrombosis
49 What are the glomerular causes which results in intrinsic AKI ?
II Anti-glomerular basement membrane (GBM) disease
III Anti-neutrophil cytoplasmic antibody
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Glomerular causes include the following:
 Anti-glomerular basement membrane (GBM) disease
 Anti-neutrophil cytoplasmic antibody
50 What are the glomerular causes which results in intrinsic AKI ?
I Immune complex glomerulonephritis

II Atheroembolic disease
III Anti-neutrophil cytoplasmic antibody
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Glomerular causes include the following:
 Anti-neutrophil cytoplasmic antibody
 Immune complex glomerulonephritis
51 What are the different causes of obstruction in postrenal AKI ?
I Stone disease
II Stricture
III Atheroembolic disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Postrenal AKI. Causes of obstruction include the following:
 Stone disease
 Stricture
52 What are the different causes of obstruction in postrenal AKI ?
II Intraluminal, extraluminal, or intramural tumors
III Thrombosis or compressive hematoma
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
postrenal AKI. Causes of obstruction include the following:
 Intraluminal, extraluminal, or intramural tumors
 Thrombosis or compressive hematoma
 Fibrosis
53 What are the different causes of postrenal AKI ?
I Ureteric obstruction
II Cyanosis
III Bladder neck obstruction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Causes of postrenal AKI include the following:
 Ureteric obstruction - Stone disease, tumor, fibrosis, ligation during pelvic surgery
 Bladder neck obstruction - Benign prostatic hypertrophy (BPH), cancer of the
54 What are the different causes of postrenal AKI ?
I Cyanosis
II Intra-abdominal hypertension
III Renal vein thrombosis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Causes of postrenal AKI include the following:
 Intra-abdominal hypertension - Tense ascites
 Renal vein thrombosis
55 Which out of the following comorbid conditions are at a higher risk for developing
AKI?
I Hypertension
II Hypotension
III Chronic heart failure
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
People with the following comorbid conditions are at a higher risk for developing AKI:
 Hypertension
 Chronic heart failure
AKI?
I Thelesemia
II Diabetes
III Liver disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Diabetes
 Liver disease
AKI?
I Obesity
II Multiple myeloma
III Thelesemia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
 Obesity [31, 32, 33]
 Multiple myeloma
AKI?
I Thelesemia
II Chronic infection
III Myeloproliferative disorder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Chronic infection
 Myeloproliferative disorder
AKI?
I Connective tissue disorders

II Antifungal disease
III Autoimmune diseases
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Connective tissue disorders
 Autoimmune diseases
60 Which out of the following laboratory tests are useful for assessing the etiology of acute
kidney injury (AKI) ?
I Complete blood count (CBC)

II Serum biochemistries
III Clamydia test
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Several laboratory tests, including the following, are useful for assessing the etiology of acute kidney
injury (AKI) and can aid in proper management of the disease:
 Complete blood count (CBC)
 Serum biochemistries
61 Which out of the following laboratory tests are useful for assessing the etiology of acute
kidney injury (AKI) ?
I Clamydia test
II Urine analysis with microscopy
III Urine electrolytes
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Several laboratory tests, including the following, are useful for assessing the etiology of acute kidney
injury (AKI) and can aid in proper management of the disease:
 Urine analysis with microscopy
 Urine electrolytes
62 In what the ratio of BUN to creatinine can exceed 20:1 ?
I The conditions in which enhanced reabsorption of urea is favored

II The conditions in which enhanced secretion of urea is favored
IIIThe conditions in which enhanced reabsorption of water is favored
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The ratio of BUN to creatinine is an important finding. The ratio can exceed 20:1 in conditions in
which enhanced reabsorption of urea is favoured.
63 What is the first laboratory test approved by USFDA to evaluate the risk of developing
moderate to severe AKI ?
I Complete blood count (CBC)

II NephroCheck
III Serum biochemistries
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
In September 2014 the US Food and Drug Administration (FDA) approved NephroCheck, the
first laboratory test to evaluate the risk of developing moderate to severe AKI in hospitalized,
critically ill patients.
64 What test are done to define the pigment nephropathy in AKI ?

I Myoglobin or free hemoglobin
II Increased serum uric acid level
III Serum lactate dehydrogenase (LDH)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The presence of the following, along with related findings, may help to further define the etiology of
AKI:
 Myoglobin or free hemoglobin - Eg, pigment nephropathy
 Increased serum uric acid level - Eg, tumor lysis syndrome
 Serum lactate dehydrogenase (LDH) - Eg, renal infarction
65 What test are done to define the tumor lysis syndrome in AKI ?

III Serum lactate dehydrogenase (LDH)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
AKI:
66 What test are done to define the renal infarction in AKI ?

III Serum lactate dehydrogenase (LDH
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
AKI:
67 What are the other serologic tests used to diagnose the etiology of AKI ?
I Complement levels
II Antinuclear antibody (ANA)
III Clamydia test
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Although serologic tests can be informative, the costs can be prohibitive if these tests are not ordered
judiciously. Possible tests include the following:
 Complement levels
 Antinuclear antibody (ANA)
I Aspartate aminotransferase
II Antineutrophil cytoplasmic antibody (ANCA)
III Anti-glomerular basement membrane (anti-GBM) antibody
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Antineutrophil cytoplasmic antibody (ANCA)
 Anti-glomerular basement membrane (anti-GBM) antibody
I Hepatitis B and C virus studies

II Aspartate aminotransferase
III Antistreptolysin (ASO)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Hepatitis B and C virus studies
 Antistreptolysin (ASO)
70 What is the colour of urine in the presence of myoglobin or haemoglobin ?
I Reddish brown or cola-colored urine

II Yellowish urine
III Greenish urine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Reddish brown or cola-colored urine suggests the presence of myoglobin or hemoglobin, especially in
the setting of a positive dipstick for heme and no red blood cells (RBCs) on the microscopic
examination.
71 What is the meaning of eumorphic RBC in urine during urinalysis ?
I It suggest bleeding along the collecting system

II It indicate glomerular inflammation, suggesting glomerulonephritis is present
III It suggests pyelonephritis or acute interstitial nephritis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The presence of RBCs in the urine is always pathologic. Eumorphic RBCs suggest bleeding along the
collecting system.
72 What is the meaning of dysmorphic RBC in urine during urinalysis ?

A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Dysmorphic RBCs or RBC casts indicate glomerular inflammation, suggesting glomerulonephritis is
present.
73 What is the meaning of presence of white blood cells in urine during urinalysis ?

A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The presence of white blood cells (WBCs) or WBC casts suggests pyelonephritis or acute interstitial
nephritis. The presence of urine eosinophils is helpful in establishing a diagnosis but is not necessary
for allergic interstitial nephritis to be present
74 What is the meaning of presence of eosinophils in urine with wright stain during
urinalysis ?
I It suggests interstitial nephritis

II It suggests pyelonephritis or acute interstitial nephritis
III It can also be seen in urinary tract infections, glomerulonephritis, and atheroembolic disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
The presence of eosinophils, as visualized with Wright stain or Hansel stain, suggests interstitial
nephritis. However, this finding can also be seen in urinary tract infections, glomerulonephritis, and
atheroembolic disease.
75 What is the cause of ATN associated with uric acid nephropathy ?
I The presence of uric acid crystals in urine

II The presence of calcium oxalate crystals in urine
III The presence of sugar crystals in urine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The presence of uric acid crystals may represent ATN associated with uric acid nephropathy.
76 What is the cause of ethylene glycol poisoning?
I The presence of uric acid crystals in urine

II The presence of calcium oxalate crystals in urine
III The presence of sugar crystals in urine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Calcium oxalate crystals are usually present in cases of ethylene glycol poisoning.
77 What can be a valuable test for helping to detect extreme renal avidity for sodium in
hepatorenal syndrome ?
I The fractional excretion of urea

II Urinalysis
III The fractional excretion of sodium
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
FENa can be a valuable test for helping to detect extreme renal avidity for sodium in conditions
such as hepatorenal syndrome.
78 Which out of the following statement is/are correct for the glomerular pressure ?
I The driving force for glomerular filtration is the pressure gradient from the glomerulus to the
Bowman space
II Glomerular pressure depends primarily on pulmonary blood flow
III Glomerular pressure depends primarily on renal blood flow and is controlled by the
combined resistances of renal afferent and efferent arterioles
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
The driving force for glomerular filtration is the pressure gradient from the glomerulus to the
Bowman space. Glomerular pressure depends primarily on renal blood flow (RBF) and is controlled
by the combined resistances of renal afferent and efferent arterioles.
79 What are the other injuries associated with case of acute tubular necrosis ?
I Contraction of the lumen

II Loss of brush borders
III Flattening of the epithelium
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Acute tubular necrosis.
Less obvious injuries include the following (see the images below):
 Loss of brush borders
 Flattening of the epithelium
I Detachment of cells
II Contraction of the lumen
III Formation of intratubular casts
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Detachment of cells
 Formation of intratubular casts
I Dilatation of the lumen

II Flattening of the epithelium
III Contraction of the lumen
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
 Flattening of the epithelium
 Dilatation of the lumen
82 What is the main cause of reduced net ultrafiltration ?
I Urine backflow
II Intratubular obstruction
III The presence of WBC in urine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Urine backflow and intratubular obstruction (from sloughed cells and debris) are causes of reduced
net ultrafiltration.
83 What is a physiologic hallmark of acute tubular necrosis ?
I A failure to maximally dilute or concentrate urine (isosthenuria)

II Increased levels of creatinine
III Identifying intrarenal causes
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
A physiologic hallmark of ATN is a failure to maximally dilute or concentrate urine (isosthenuria).
84 The volume loss can provoke the AKI ,what are the causes of volume depletion ?
I Renal losses - Diuretics, polyuri

II GI losses - Vomiting, diarrhea
III Pulmonary embolus
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Volume loss can provoke this syndrome ,To summarize, volume depletion can be caused by the
following:
 Renal losses - Diuretics, polyuria
 GI losses - Vomiting, diarrhea
85 The volume loss can provoke the AKI ,what are the causes of volume depletion ?
I Pulmonary embolus
II Cutaneous losses - Burns, Stevens-Johnson syndrome
III Hemorrhage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Volume loss can provoke this syndrome ,To summarize, volume depletion can be caused by the
following:
 Cutaneous losses - Burns, Stevens-Johnson syndrome
 Hemorrhage
 Pancreatitis
86 What are the causes of decreased cardiac output leads to AKI ?
I Heart failure
II Pulmonary embolus
III Pancreatitis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Decreased cardiac output can be caused by the following:
 Heart failure
 Pulmonary embolus
87 What are the causes of decreased cardiac output leads to AKI ?
I Pancreatitis
II Acute myocardial infarction
III Severe valvular disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Decreased cardiac output can be caused by the following:
 Acute myocardial infarction
 Severe valvular disease
 Abdominal compartment syndrome - Tense ascites
88 What are the causes of systemic vasodilation leads to AKI ?
I Sepsis
II Abdominal compartment syndrome
III Anaphylaxis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Systemic vasodilation can be caused by the following:
 Sepsis
 Anaphylaxis
 Anesthetics
 Drug overdose
89 What are the causes of systemic vasodilation leads to AKI ?
I Abdominal compartment syndrome

II Anesthetics
III Drug overdose
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Systemic vasodilation can be caused by the following:
 Sepsis
 Anaphylaxis
 Anesthetics
 Drug overdose
90 Which out of the following genetic syndrome have a feature of renal arterial stenosis ?
I Type 1 neurofibromatosis
II Andereson syndrome
III Williams syndrome
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Renal arterial stenosis, especially in the setting of hypotension or initiation of ACE inhibitors or
ARBs. Renal artery stenosis typically results from atherosclerosis or fibromuscular dysplasia, but is
also a feature of the genetic syndromes type 1 neurofibromatosis, Williams syndrome, and Alagille
syndrome.
91 Which out of the following genetic syndrome have a feature of renal arterial stenosis ?
I Andereson syndrome
II Alagille syndrome
III Zollinger Ellison syndrome
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Renal arterial stenosis, especially in the setting of hypotension or initiation of ACE inhibitors or
ARBs. Renal artery stenosis typically results from atherosclerosis or fibromuscular dysplasia, but is
also a feature of the genetic syndromes type 1 neurofibromatosis, Williams syndrome, and Alagille
syndrome.
92 What are the different emergency biomarkers being investigated to risk stratify and
predict AKI in patients ?
I Neutrophil gelatinase-associated lipocalin (NGAL)

II Plasma B-type natriuretic peptide (BNP)
III Serum T-type natriuretic peptide (TNP)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Consequently, a number of biomarkers are being investigated to risk stratify and predict AKI in
patients at risk for the disease.
 neutrophil gelatinase-associated lipocalin (NGAL),
 plasma B-type natriuretic peptide (BNP)
 serum cystatin C
93 What are the different emergency biomarkers being investigated to risk stratify and
predict AKI in patients ?
I Serum T-type natriuretic peptide (TNP)

II Serum cystatin C
III Plasma B-type natriuretic peptide (BNP)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Consequently, a number of biomarkers are being investigated to risk stratify and predict AKI in
patients at risk for the disease.
 neutrophil gelatinase-associated lipocalin (NGAL),
 plasma B-type natriuretic peptide (BNP)
 serum cystatin C
94 What is the normal value of an intra-abdominal pressure ?
I Less than 10 mm Hg
II Less than 50 mm Hg
IIILess than 80 mm Hg
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
An intra-abdominal pressure of less than 10 mm Hg is considered normal.
95 Which out of the following statement is/are correct for doppler scans ?
I It is useful for detecting the presence and nature of renal blood flow
II It can be quite useful in the diagnosis of thromboembolic or renovascular disease
III It can be useful in identifying extrarenal causes of AKI
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Doppler scans are useful for detecting the presence and nature of renal blood flow. Because renal
blood flow is reduced in prerenal and intrarenal AKI, findings are of little use in the diagnosis of
AKI. However, Doppler scans can be quite useful in the diagnosis of thromboembolic or
renovascular disease.
96 Which out of the following is used in radionuclide imaging to assess renal blood flow,
as well as tubular function ?
I Maganese-54
II Tc-diethylenetriamine penta-acetic acid
III Iodine-131)-hippurate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Radionuclide imaging with technetium-99m-mercaptoacetyltriglycine (99m Tc-MAG3),99m Tc-
diethylenetriamine penta-acetic acid (99m Tc-DTPA), or iodine-131 (131 I)-hippurate can be used to
assess renal blood flow, as well as tubular function.
97 Which out of the following is used in radionuclide imaging to assess renal blood flow,
as well as tubular function ?
I Technetium-99m-mercaptoacetyltriglycine
II Tc-diethylenetriamine penta-acetic acid
III Maganese-54
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Radionuclide imaging with technetium-99m-mercaptoacetyltriglycine (99m Tc-MAG3),99m Tc-
diethylenetriamine penta-acetic acid (99m Tc-DTPA), or iodine-131 (131 I)-hippurate can be used to
assess renal blood flow, as well as tubular function.
98 Which out of the following renal vascular diseases can be diagnosed by aortorena l
angiography ?
I Pulmonary artery stenosis

II Atherosclerosis with aortorenal occlusion
III Polyarteritis nodosa
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Aortorenal angiography can be helpful in establishing the diagnosis of renal vascular diseases,
 Atherosclerosis with aortorenal occlusion
 Certain cases of necrotizing vasculitis (eg, polyarteritis nodosa)
99 Which out of the following renal vascular diseases can be diagnosed by aortorenal
angiography ?
I Renal artery stenosis

II Renal atheroembolic disease
III Pulmonary artery stenosis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Aortorenal angiography can be helpful in establishing the diagnosis of renal vascular diseases,
 Renal artery stenosis
 Renal atheroembolic disease
100 Which out of the following statement is/are correct for renal biopsy ?
I A renal biopsy can be useful in identifying intrarenal causes of AKI

II A renal biopsy may also be indicated when renal function return for a prolonged period
III Humoral rejection in a transplanted kidney can be definitively diagnosed only by performing
a renal biopsy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
A renal biopsy can be useful in identifying intrarenal causes of AKI and can be justified if the results
may change management (eg, initiation of immunosuppressive medications). A renal biopsy may
also be indicated when renal function does not return for a prolonged period ..Acute cellular or
humoral rejection in a transplanted kidney can be definitively diagnosed only by performing a renal
biopsy.

1 What are the primary goals of the treatment of AKI ?
I Maintenance of volume homeostasis

II Correction of biochemical abnormalities
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
primary goals of treatment.
2 Which out of the following measures consider for the treatment of AKI ?
I Correction of fluid overload with furosemide

II Correction of brain abnormalities
III Correction of severe acidosis with bicarbonate administration
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
primary goals of treatment and may include the following measures:
 Correction of fluid overload with furosemide
 Correction of severe acidosis with bicarbonate administration, which can be important as a
bridge to dialysis
3 Which out of the following measures consider for the treatment of AKI ?

II Correction of hyperkalemia
III Correction of hematologic abnormalities
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
primary goals of treatment and may include the following measures:
 Correction of hyperkalemia
 Correction of hematologic abnormalities (eg, anemia, uremic platelet dysfunction) with
measures such as transfusions and administration of desmopressin or estrogens
4 Which out of the following hematologic abnormalities measures consider for the
treatment of AKI ?
I Anemia
II Uremic platelet dysfunction
III Blood glucose
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Correction of hematologic abnormalities (eg, anemia, uremic platelet dysfunction).
5 Which drug can be used to correct volume overload when patients are still responsive ?
I Furosemide
II Sucralfate
III Cimithidine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Furosemide can be used to correct volume overload when patients are still responsive.
6 Which out of the following statement is/are correct for furosemide used for the
treatment of AKI ?
I It can be used to correct volume overload when patients are still responsive
II It often requires high intravenous (IV) doses
III It is use to correct the hematologic abnormalities
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Furosemide can be used to correct volume overload when patients are still responsive; this often
requires high intravenous (IV) doses.
7 What are the different approaches to lowering serum potassium in AKI Patient ?
I Increasing the intake of potassium in diet or tube feeds

II Decreasing the intake of potassium in diet or tube feeds
III Exchanging potassium across the gut lumen using potassium-binding resins
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Approaches to lowering serum potassium include the following:
 Decreasing the intake of potassium in diet or tube feeds
 Exchanging potassium across the gut lumen using potassium-binding resins
I Promoting intracellular shifts in potassium with insulin

II Increasing the intake of potassium in diet or tube feeds
III Promoting intracellular shifts in potassium with dextrose solutions
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Promoting intracellular shifts in potassium with insulin, dextrose solutions, and beta
agonists
I Promoting intracellular shifts in potassium with beta agonists

II Instituting dialysis
III Increasing the intake of potassium in diet or tube feeds
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
 Promoting intracellular shifts in potassium with insulin, dextrose solutions, and beta
agonists
 Instituting dialysis
10 Which out of the following nephrotoxic agents should be avoided in AKI patient ?
I Radiocontrast agents
II Antibiotics with nephrotoxic potential
III Loop diuretics
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
In AKI, the kidneys are especially vulnerable to the toxic effects of various chemicals. All nephrotoxic
agents (eg, radiocontrast agents, antibiotics with nephrotoxic potential, heavy metal preparations,
cancer chemotherapeutic agents, nonsteroidal anti-inflammatory drugs [NSAIDs]) should be
avoided or used with extreme caution.
I Loop diuretics
II Heavy metal preparations
III Cancer chemotherapeutic agents
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
I Calcium channel blockers

II Nonsteroidal anti-inflammatory drugs [NSAIDs]
III Antibiotics with nephrotoxic potential
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
13 What is the goal of vasodialator therapy in AKI patient ?
I It improve brain perfusion may reduce damage

II It improve renal perfusion may reduce renal damage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The rationale for vasodilator therapy in AKI is that improved renal perfusion may reduce renal
damage.
14 What is the mechanism of action of dopamine in AKI patient ?
I It causes selective dilatation of the renal vasculature

II It enhanc renal perfusion
III It increase the sodium absorption
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Dopamine in small doses (eg, 1-5 mcg/kg/min) causes selective dilatation of the renal vasculature,
enhancing renal perfusion. Dopamine also reduces sodium absorption; this enhances urine flow,
which helps to prevent tubular cast obstruction.
15 Which out of the following statement is/are correct for dopamine in AKI patient ?
I It reduces sodium absorption; this enhances urine flow

II It helps to prevent tubular cast obstruction
III It increases sodium absorption; this reduces urine flow
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
enhancing renal perfusion. Dopamine also reduces sodium absorption; this enhances urine flow,
which helps to prevent tubular cast obstruction.
16 Which dialysisis prefer in the patient with AKI for renal replacement therapy ?
I Biocompatible membrane dialyzers

II Solid membrane dialyzers
III Semisolid membrane dialyzers
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Dialysis, especially hemodialysis, may delay the recovery of patients with AKI. Most authorities
prefer using biocompatible membrane dialyzers for hemodialysis. Indications for dialysis (ie, renal
replacement therapy) in patients with AKI are as follows
17 What indication are considered for dialysis in patients with AKI ?
I Volume expansion that cannot be managed with diuretics

II Hyperkalemia refractory to medical therapy
III Hypokalemia refractory to medical therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Abs:D
Indications for dialysis (ie, renal replacement therapy) in patients with AKI are as follows:
 Volume expansion that cannot be managed with diuretics
 Hyperkalemia refractory to medical therapy
18 What indication are considered for renal replacement therapy in patients with AKI ?

II Correction of severe acid-base disturbances that are refractory to medical therapy
III Severe azotemia (BUN >80-100)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Correction of severe acid-base disturbances that are refractory to medical therapy
 Severe azotemia (BUN >80-100)
19 What indication are considered for dialysis in patients with AKI ?
I Volume expansion that cannot be managed with diuretics

II Correction of brain abnormalities
III Uremia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Volume expansion that cannot be managed with diuretics
 Uremia
20 What is mean by ATN ?
I Acute Renal Failure Trial Network

II Acute tubular network
III Acute liver Failure Trial Network
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Acute Renal Failure Trial Network (ATN).
21 What is mean by CRRT ?
I Continuous renal replacement therapy

II Common renal replacement therapy
III Continuous renal recovery therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
continuous renal replacement therapy (CRRT).
22 What are the different methods for the prevention of contrast induced nephropathy ?
I A normal saline solution

II Isotonic CaCO3 solution
III Isotonic NaHCO3 solution
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Prevention of Contrast-Induced Nephropathy
 A normal saline solution
 Isotonic NaHCO3 solution
 Oral N -acetylcysteine
 Statin treatment
23 What are the different methods for the prevention of contrast induced nephropathy ?
I Isotonic CaCO3 solution

II Oral N -acetylcysteine
III Statin treatment
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Prevention of Contrast-Induced Nephropathy
 A normal saline solution
 Isotonic NaHCO3 solution
 Oral N -acetylcysteine
 Statin treatment
24 Which out of the following pharmacologic agents are used to protect renal function
perioperatively ?
I Dopamine and its analogues

II Diuretics
III Prostaglandin Analogs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
A review of randomized, controlled trials of pharmacologic measures used to protect renal function
perioperatively found no reliable evidence that any of the following interventions are effective :
 Dopamine and its analogues
 Diuretics
perioperatively ?
I Antifungal agents
II Calcium channel blockers
III Angiotensin-converting enzyme (ACE) inhibitors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
perioperatively found no reliable evidence that any of the following interventions are effective
 Calcium channel blockers
 Angiotensin-converting enzyme (ACE) inhibitors
perioperatively ?
I N-acetylcysteine
II Prostaglandin Analogs
III Atrial natriuretic peptide (ANP)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 N-acetylcysteine [49]
 Atrial natriuretic peptide (ANP)
perioperatively ?
I Antifungal agents
II Sodium bicarbonate
III Antioxidants
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Sodium bicarbonate
 Antioxidants
perioperatively ?
I Erythropoietin (EPO)
II Specific hydration fluids
III Prostaglandin Analogs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
 Erythropoietin (EPO)
 Specific hydration fluids
29 Which out of the following drug falls in class loop diuretics for the treatment of AKI ?
I Nifedepine
II Dopamine
III Furosemide
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Diuretics, Loop
 Furosemide (Lasix)
30 What is brand name of furosemide used for the treatment of AKI ?
I Acetadote
II Lasix
III Inotropin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Furosemide (Lasix)
31 What is the mechanism of action of furosemide ?
I It increases the excretion of water by interfering with the chloride-binding cotransport system
II It increase sodium and chloride reabsorption in the thick ascending loop of Henle
III It inhibits sodium and chloride reabsorption in the thick ascending loop of Henle and the
distal renal tubule
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
system, which, in turn, inhibits sodium and chloride reabsorption in the thick ascending loop of
Henle and the distal renal tubule. It is a potent and rapid-acting agent with peak action at 60
minutes and a 6- to 8-hour duration of action.
32 Which out of the following statement is /are correct for furosemide used for the
treatment of AKI ?
I It is a potent and rapid-acting agent with peak action at 60 minutes

II It has a 6- to 8-hour duration of action
III It enhance renal perfusion
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
system, which, in turn, inhibits sodium and chloride reabsorption in the thick ascending loop of
Henle and the distal renal tubule. It is a potent and rapid-acting agent with peak action at 60
minutes and a 6- to 8-hour duration of action.
33 Which out of the following drug falls in class Inotropic Agents for the treatment of AKI
?
I Fenoldopam
II Dopamine
III Furosemide
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Inotropic Agents
 Dopamine (Intropin)
34 What is brand name of dopamine used for the treatment of AKI ?
I Corlopam
II Lasix
III Intropin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Dopamine (Intropin)
35 Which out of the following statement is /are correct for dopamine used for the
treatment of AKI ?
I It in small doses (eg, 1-5 mcg/kg/min) causes selective dilatation of the renal vasculature
enhancing renal perfusion
II It enhance renal perfusion
III It has a 6- to 8-hour duration of action
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
enhancing renal perfusion.
treatment of AKI ?
I It has a 6- to 8-hour duration of action

II It reduces sodium absorption, thereby decreasing the energy requirement of the damaged
tubules
III It enhances urine flow, which, in turn, helps to prevent tubular cast obstruction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Dopamine also reduces sodium absorption, thereby decreasing the energy requirement of the
damaged tubules. This enhances urine flow, which, in turn, helps to prevent tubular cast
obstruction.
treatment of AKI ?
I It stimulates adrenergic and dopaminergic receptors

II It has a 6- to 8-hour duration of action
III Its hemodynamic effect is dose dependent
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Dopamine stimulates adrenergic and dopaminergic receptors. Its hemodynamic effect is dose
dependent.
treatment of AKI ?
I It has a 6- to 8-hour duration of action

II Lower doses (0.5-3.0 mcg/kg/min) predominantly stimulate dopaminergic receptors, which, in
turn, produce renal and mesenteric vasodilation
III Higher doses produce cardiac stimulation and renal vasodilation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Lower doses (0.5-3.0 mcg/kg/min) predominantly stimulate dopaminergic receptors, which, in turn,
produce renal and mesenteric vasodilation. Higher doses produce cardiac stimulation and renal
vasodilation.
39 What are the potential complications of dopamine use ?
I Cardiac arrhythmias
II Myocardial ischemia
III Brain tumour
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Potential complications of dopamine use include cardiac arrhythmias, myocardial ischemia, and
intestinal ischemia.
40 What are the potential complications of dopamine use ?
I Corneal dermatitis
II Intestinal ischemia
III Myocardial ischemia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Potential complications of dopamine use include cardiac arrhythmias, myocardial ischemia, and
intestinal ischemia.
41 Which out of the following drug falls in class vasodilators for the treatment of AKI ?
I Fenoldopam
II Dopamine
III Furosemide
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Vasodilators
 Fenoldopam (Corlopam)
42 What is brand name of fenoldopam used for the treatment of AKI ?
I Corlopam
II Lasix
III Intropin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Fenoldopam (Corlopam)
43 What is the mechanism of action of fenoldopam used for the treatment of AKI ?
I It decreases systemic vascular resistance and increases renal blood flow to the cortex and
medullary regions in the kidney
II It has been noted to improve renal function in patients with severe hypertension
III It stimulates adrenergic and dopaminergic receptors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Fenoldopam decreases systemic vascular resistance and increases renal blood flow to the cortex and
medullary regions in the kidney. It has been noted to improve renal function in patients with severe
hypertension.
44 Which out of the following statement is /are correct for fenoldopam used for the
treatment of AKI ?
I It is a selective dopamine-receptor agonist that acts as a rapid-acting vasodilator

II It is 6 times more potent than dopamine in producing renal vasodilation
III It stimulates adrenergic and dopaminergic receptors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Fenoldopam is a selective dopamine-receptor agonist that acts as a rapid-acting vasodilator. It is 6
times more potent than dopamine in producing renal vasodilation.
45 Which out of the following statement is /are correct for fenoldopam used for the
treatment of AKI ?

II It increases diuresis and has minimal adrenergic effects
III It is indicated for the treatment of severe hypertension, including patients with renal
compromise
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
It increases diuresis and has minimal adrenergic effects. Fenoldopam is indicated for the treatment
of severe hypertension, including patients with renal compromise.
46 Which out of the following drug falls in class calcium channel blockers for the
treatment of AKI ?
I Fenoldopam
II Nifedipine
III Furosemide
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Calcium Channel Blockers

 Nifedipine (Adalat, Procardia, Afeditab CR, Nifediac CC, Nifedical XL)
47 What is brand name of nifedipine used for the treatment of AKI ?
I Adalat
II Lasix
III Procardia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Nifedipine (Adalat, Procardia, Afeditab CR, Nifediac CC, Nifedical XL)
I Corlopam
II Afeditab CR
III Nifediac CC
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
I Corlopam
II Lasix
III Nifedical XL
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
50 What is the mechanism of action of nifedipine used for the treatment of AKI ?
I It relaxes smooth muscle and produces vasodilation

II It stimulates adrenergic and dopaminergic receptors
III It improves blood flow and oxygen delivery
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Nifedipine relaxes smooth muscle and produces vasodilation, which, in turn, improves blood flow
and oxygen delivery.
51 Which out of the following drug falls in class antidotes for the treatment of AKI ?
I Fenoldopam
II Nifedipine
III N-acetylcysteine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Antidotes, Other
 N-acetylcysteine (Acetadote)
I Adalat
II Acetadote
III Procardia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
N-acetylcysteine (Acetadote)
53 Which out of the following statement is /are correct for N -acetylcysteine used for the
treatment of AKI ?

II It is used for the prevention of contrast toxicity in susceptible individuals, such as those with
diabetes mellitus
III It is indicated for the treatment of severe hypertension, including patients with renal
compromise
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
N -acetylcysteine is used for the prevention of contrast toxicity in susceptible individuals, such as
those with diabetes mellitus.
54 What is the mechanism of N acetylcysteine to prevent contrast-induced nephropathy?
I It is presumed to be its ability to scavenge free radicals and improve endothelium-dependent

vasodilation
II It stimulates adrenergic and dopaminergic receptors
III It increases diuresis and has minimal adrenergic effects
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The mechanism by which it prevents contrast-induced nephropathy is presumed to be its ability to
scavenge free radicals and improve endothelium-dependent vasodilation.
55 Which out of the following statement is /are correct for N -acetylcysteine used for the
treatment of AKI ?

II It is used for the prevention of contrast toxicity in susceptible individuals, such as those with
diabetes mellitus
III This drug may provide substrate for conjugation with toxic metabolites
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
N -acetylcysteine is used for the prevention of contrast toxicity in susceptible individuals, such as
those with diabetes mellitus. This drug may provide substrate for conjugation with toxic
metabolites.
56 Which out of the following statement is /are correct for Dietary Modification for AKI
patient ?
I Dietary changes are an important facet of AKI treatment

II Restriction of salt and fluid becomes crucial in the management of oliguric renal failure
III Dietary changes are not an important facet of AKI treatment
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Dietary Modification
Dietary changes are an important facet of AKI treatment. Restriction of salt and fluid becomes
crucial in the management of oliguric renal failure, wherein the kidneys do not adequately excrete
either toxins or fluids.
57 Why the restriction of potassium and phosphorus in the diet of patients with AKI ?
I Because potassium and phosphorus are not excreted optimally in patients with AKI
II Patients may require dietary supplementation of potassium and phosphorus
III The blood levels of potassium and phosphorus electrolytes tend to be high
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Because potassium and phosphorus are not excreted optimally in patients with AKI, blood levels of
these electrolytes tend to be high. Restriction of these elements in the diet may be necessary, with
guidance from frequent measurements.
58 What is occur in the polyuric phase of AKI ?
I Because potassium and phosphorus are not excreted optimally in patients with AKI
II The blood levels of potassium and phosphorus electrolytes tend to be high
III Potassium and phosphorus may be depleted, so that patients may require dietary
supplementation and IV replacement
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
In the polyuric phase of AKI, potassium and phosphorus may be depleted, so that patients may
require dietary supplementation and IV replacement.
59 How the saline solution given to prevent the contrast induced nephropathy ?
I A normal saline solution of 1 mL/kg/h administered 12 hours before the procedure

II A normal saline solution of 1 mL/kg/h administered 12 hours after the procedure
III A normal saline solution of 100 mL/kg/h administered 12 hours before the procedure
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Saline:
In patients undergoing imaging studies with contrast, prophylactic administration of IV fluid has
been shown to decrease the incidence of contrast nephropathy. A normal saline solution of 1 mL/kg/h
administered 12 hours before the procedure and then 12 hours after the procedure is recommended
for most patients.
60 How is the isotonic NaHCO3 solution prepared for prevent the contrast induced
nephropathy ?
I Mixing 1 ampules of NaHCO3 in a liter of 5% dextrose in water (D5W)

II Mixing 2 ampules of NaHCO3 in a liter of 5% dextrose in water (D5W)
III Mixing 3 ampules of NaHCO3 in a liter of 5% dextrose in water (D5W)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
It can be prepared by mixing 3 ampules of NaHCO3 in a liter of 5% dextrose in water (D5W).
61 How the isotonic NaHCO3 solution given to prevent the contrast induced
nephropathy ?
I It is given at a rate of 10 mL/kg/h for 1 hour prior to the procedure, with the rate decreased to
5 mL/kg/h during the procedure and for 6 hours afterward
II It is given at a rate of 3 mL/kg/h for 1 hour prior to the procedure, with the rate decreased to 1
mL/kg/h during the procedure and for 6 hours afterward
III It is given at a rate of 5 mL/kg/h for 1 hour prior to the procedure, with the rate decreased to
1 mL/kg/h during the procedure and for 6 hours afterward
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
It can be given at a rate of 3 mL/kg/h for 1 hour prior to the procedure, with the rate decreased to
1 mL/kg/h during the procedure and for 6 hours afterward.
62 Isotonic NaHCO3 solution should be administered before and after the proce dure in
which patients ?
I Patients who are at high risk for volume overload

II Patient have a left ventricular ejection fraction of less than 40%
III Patients who are at high risk for GI bleeding
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
In patients who are at high risk for volume overload in particular, those with chronic heart
failure who have a left ventricular ejection fraction of less than 40% isotonic NaHCO3 solution
should be administered before and after the procedure.
63 Which out of the following statement is /are correct for N acetylcysteine ?
I It is a oral prophylactic agent at a dosage of 1200 mg every 12 hours

II It is given at a rate of 5 mL/kg/h for 1 hour prior to the procedure, with the rate decreased to 1
mL/kg/h during the procedure
III This is administered to high-risk patients the day before a contrast study is performed and is
continued the day of the procedure
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Another prophylactic agent, used with varying success, is oral N -acetylcysteine at a dosage of 1200
mg every 12 hours. This is administered to high-risk patients the day before a contrast study is
performed and is continued the day of the procedure.
64 What is mean by RIPC ?
I Remote ischemic preconditioning

II Remote ischemic postconditioning
III Regular ischemic preconditioning
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Remote ischemic preconditioning (RIPC)
65 Which out of the following statement is/ are correct for furosemide used for the
treatment of AKI ?
I In renal failure, higher doses must be used for greater diuretic effect
II Doses as high as 600 mg/day may be needed under monitored conditions
III In lung failure, higher doses must be used for greater diuretic effect
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
In renal failure, higher doses must be used for greater diuretic effect. Doses as high as 600 mg/day
may be needed under monitored conditions.
66 Which out of the following statement is/ are correct for furosemide used for the
treatment of AKI ?
I IV infusions of drug are often helpful in intensive care settings, in which larger doses are
necessary
II In lung failure, higher doses must be used for greater diuretic effect
III Frequently, IV doses are needed in AKI to maintain urine output
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Frequently, IV doses are needed in AKI to maintain urine output. IV infusions are often helpful in
intensive care settings, in which larger doses are necessary.
67 Which out of the following pharmacologic drug agent is/are used for treatment of AKI
?
I Diuretics, Loop
II Antiemetics
III Local anesthetic
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Medication Summary
 Diuretics, Loop
 Inotropic Agents
?
I Local anesthetic
II Inotropic Agents
III Anticoagulants
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Medication Summary
 Diuretics, Loop
 Inotropic Agents
?
I Prostaglandin analogs
II Anticoagulants
III Vasodilators
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Medication Summary
 Vasodilators
 Calcium Channel Blockers
?
I Calcium Channel Blockers

II Antiemetics
III Local anesthetic
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Medication Summary
 Antidotes, Other
?
I Local anesthetic
II Antidotes
III Anticoagulants
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Medication Summary
 Antidotes, Other
72 Which out of the following element may require dietary supplementation and IV
replacement in the polyuric phase of AKI ?
I Potassium
II Lithium
III Coblat
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
73 Which out of the following element may require dietary supplementation and IV
replacement in the polyuric phase of AKI ?
I Lithium
II Coblat
III Phosphorus
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
74 Which out of the following drugs is /are used for treatment of AKI ?
I Furosemide
II Dopamine
III Cimithidine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Medication Summary
I Aspirin
II Fenoldopam
III Nifedipine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Medication Summary
I N-acetylcysteine (Acetadote)
II Aspirin
III Furosemide (Lasix)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Medication Summary
77 What is a novel investigative method for preventing perioperative AKI ?
I Remote ischemic postconditioning

II Regular ischemic preconditioning
III Remote ischemic preconditioning
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Remote ischemic preconditioning (RIPC) is a novel investigative method for preventing
perioperative AKI.
78 What is mean by GFR ?
I Glucose filtration rate

II Glomerular filtration rate
III Glomerular filtration rate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Glomerular filtration rate (GFR)
79 What should administered to correct the severe acidosis ?
I Bicarbonate administration
II Chloride administration
III Sulphide administration
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Correction of severe acidosis with bicarbonate administration, which can be important as a bridge
to dialysis.
80 Which out of the following hematologic abnormalities consider for the treatment of
AKI ?
I WBC deformation
II Anemia
III Degeneration of WBC
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Correction of hematologic abnormalities (eg, anemia, uremic platelet dysfunction) with measures
such as transfusions and administration of desmopressin or estrogens.
81 Which out of the following hematologic abnormalities consider for the treatment of
AKI ?
I Degeneration of WBC
II WBC deformation
III Uremic platelet dysfunction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Correction of hematologic abnormalities (eg, anemia, uremic platelet dysfunction) with measures
such as transfusions and administration of desmopressin or estrogens.
82 How to lower serum potassium across the gut lumen ?
I Exchanging potassium by using potassium-binding resins

II By decreasing the intake of potassium in diet
III By increasing the intake of potassium in diet
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Exchanging potassium across the gut lumen using potassium-binding resins.
83 Which out of the following drugs triple therapy significantly increases the risk of
hospitalization for AKI ?
I NSAIDs with a diuretic along with an angiotensin-converting enzyme (ACE) inhibitor

II NSAIDs with a local anaestheic along with an angiotensin-converting enzyme inhibitor
III NSAIDs with a diuretic along with beta blocker selective
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
A 2013 study indicated that triple therapy using nonsteroidal anti-inflammatory drugs (NSAIDs)
with 2 antihypertensive medications a diuretic along with an angiotensin-converting enzyme
(ACE) inhibitor or an angiotensin-receptor blocker (ARB) significantly increases the risk of
hospitalization for AKI.
84 Which out of the following drugs triple therapy significantly increases the risk of
hospitalization for AKI ?
I NSAIDs with a diuretic along with beta blocker selective

II NSAIDs with a diuretic along with an angiotensin-receptor blocker (ARB)
III NSAIDs with a local anaestheic along with an angiotensin-converting enzyme inhibitor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
A 2013 study indicated that triple therapy using nonsteroidal anti-inflammatory drugs (NSAIDs)
with 2 antihypertensive medications a diuretic along with an angiotensin-converting enzyme
(ACE) inhibitor or an angiotensin-receptor blocker (ARB) significantly increases the risk of
hospitalization for AKI.
85 Which out of the following statement is/are correct for fenoldopam used for the
treatment of AKI?
I The vasodilator fenoldopam reduces the need for renal replacement therapy
II The vasoconstrictor fenoldopam reduces the need for renal replacement therapy
III It lowers the mortality rate in patients with AKI
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
the vasodilator fenoldopam reduces the need for renal replacement therapy and lowers the mortality
rate in patients with AKI.
86 What is the small dose of dopamine causes selective dilatation of the renal vasculature?
I 1-5 mcg/kg/min
II 10-15 mcg/kg/min
III 1-5 g/kg/min
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Dopamine in small doses (eg, 1-5 mcg/kg/min) causes selective dilatation of the renal vasculature.
87 What is mean by BUN ?
I Brain urea nitrogen

II Blood urea nitrogen
III Bone urea nitrogen
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Blood urea nitrogen (BUN).
88 Which out of the following condition resulting in hypernatremia ?
I An elevated blood urea nitrogen (BUN) level

II An excess of water loss
III A reduced blood urea nitrogen (BUN) level
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
an elevated blood urea nitrogen (BUN) level and water loss resulting in hypernatremia.
89 In which conditions calculation of the nitrogen balance can be challenging ?
I In the presence of volume contraction

II In the presence of hypercatabolic states
III In the presence of volume overload
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Calculation of the nitrogen balance can be challenging, especially in the presence of volume
contraction, hypercatabolic states, GI bleeding, and diarrheal disease.
90 In which conditions calculation of the nitrogen balance can be challenging ?
I In the presence of GI bleeding

II In the presence of volume overload
III In the presence of diarrheal disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Calculation of the nitrogen balance can be challenging, especially in the presence of volume
contraction, hypercatabolic states, GI bleeding, and diarrheal disease.
91 What is occur in severe azothemia ?
I The blood urea nitrogen level becomes greater than 80-100

II The blood urea nitrogen level becomes greater than 8-10
III The blood urea nitrogen level becomes greater than 18-20
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Severe azotemia (BUN >80-100)
92 Which out of the following statement is/are correct for patients with dialysis-dependent
AKI ?
I The patient receive dialysis at least 3 hemodialysis treatments per week with a delivered Kt/V
value of 1.2
II The patient receive dialysis at least 13 hemodialysis treatments per week with a delivered Kt/V
value of 12
III The patient receive dialysis at least 2 hemodialysis treatments per week with a delivered Kt/V
value of 12
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The best evidence suggests that patients with dialysis-dependent AKI should receive at least 3
hemodialysis treatments per week with a delivered Kt/V value of 1.2, or continuous hemodialysis
(continuous venovenous hemodialysis or hemofiltration) of 20 mg/kg/h (prescribed).
93 When will the intensive statin therapy is given to prevent the contrast induced
nephrophathy ?
I Before vagotomy
II Before coronary angiography
III Before cholecystomy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
A meta-analysis of intensive statin therapy before coronary angiography and percutaneous coronary
intervention.
94 When will the intensive statin therapy is given to prevent the contrast induced
nephrophathy ?
I Before cholecystomy
II Before vagotomy
III Before percutaneous coronary intervention
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
A meta-analysis of intensive statin therapy before coronary angiography and percutaneous coronary
intervention.
95 Which patient were at moderate to high risk for perioperative AKI ?
I Patients who were undergoing on-pump coronary bypass grafting

II Patients who were undergoing medication
III Patients who were undergoing rehabilation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
In a randomized trial in 240 patients who were undergoing on-pump coronary bypass grafting and
were at moderate to high risk for perioperative AKI.
96 What is mean by ANP ?
I Atrial neutral protein

II Atrial natriuretic peptide
III Arota normal pluse
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Atrial natriuretic peptide (ANP)
97 What is mean by AKI ?
I Acute keratin inflammation

II Acquired kidney insomnia
III Acute kidney injury
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Acute kidney injury (AKI)
98 Which out of the following statement is/are correct for loop diuretics in AKI patient ?
I They are useful in fluid homeostasis

II They have been used to reduce the requirement of exercise
III They have been used to reduce the requirement of surgery
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Although diuretics seem to have no effect on the outcome of established AKI, they appear to be useful
in fluid homeostasis and are used extensively. They have also been used to reduce the requirement
for renal replacement therapy.
99 Which out of the following statement is/are correct for loop diuretics in AKI patient ?
I They have been used to reduce the requirement of exercise

II They have been used to reduce the requirement for renal replacement therapy
III They have been used to reduce the requirement of surgery
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Although diuretics seem to have no effect on the outcome of established AKI, they appear to be useful
in fluid homeostasis and are used extensively. They have also been used to reduce the requirement
for renal replacement therapy.
100 What is the active ingredient of acetadote drug used for the treatment of AKI ?
I N-acetylcysteine
II Furosemide
III Nifedipine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
N-acetylcysteine (Acetadote)
BLOOD AND NUTRITION
ANEMIA
Disease
1 What is anemia?
I decrease in red blood cell (RBC) volume

II decrease in red blood cell (RBC) mass
III decrease in red blood cell (RBC) count
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Anemia is strictly defined as a decrease in red blood cell (rbc) mass
2 What is the function of the RBC?
I to deliver oxygen from the tissues to the lungs

II to deliver oxygen from the lungs to the tissues
III to deliver carbon dioxide from the tissues to the lungs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The function of the RBC is to deliver oxygen from the lungs to the tissues and carbon dioxide from
the tissues to the lungs.
3 which out of the following is true for Hemoglobin?
I It is a tetramer protein
II It is composed of heme and globin
III It is a dimer protein
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
This is accomplished by using hemoglobin (Hb), a tetramer protein composed of heme and globin .
4 What is responsible for reduction of the life span of RBCs?
I certain glycolic enzymes

II Abnormalities of the membrane
III the chemical composition of the Hb
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Abnormalities of the membrane, the chemical composition of the Hb, or certain glycolytic enzymes
can reduce the life span of RBCs to cause anemia.
5 what is the source of most serious complications of severe anaemia?
I tissue hipoxia
II tissue hypoxia
III tissue hyperxia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
5The most serious complications of severe anemia arise from tissue hypoxia.
6 which complications of anaemia arise due to hypoxia?
I coronary and pulmonary insufficiency

II bradycardia
III hypotension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
6Shock, hypotension, or coronary and pulmonary insufficiency can occur .
7 What is the sequence for differentiation of Erythroid precursors?
I from stem cells to erythroblasts to progenitor cells to normoblasts

II from stem cells to progenitor cells to erythroblasts to normoblasts
III from stem cells to progenitor cells to normoblasts to erythroblasts
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Erythroid precursors differentiate sequentially from stem cells to progenitor cells to erythroblasts to
normoblasts in a process requiring growth factors and cytokines.
8 Which out of the following is necessary for the development of normoblast from
Erythroid precursors?
I Growth factors
II cytokines
III Insulin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Erythroid precursors differentiate sequentially from stem cells to progenitor cells to erythroblasts to
normoblasts in a process requiring growth factors and cytokines.
9 Erythroid precursors are released into circulation as-
I Reticulocytes
II Erythrocytes
III Progenitor cells
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Normally, erythroid precursors are released into circulation as reticulocytes .
10 Which out of the following can be called as mature Reticulocytes?
I Erythroblasts
II Erythrocytes
III Erythroid precursor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
They remain in the circulation for approximately 1 day before they mature into erythrocytes, after the
digestion of RNA by reticuloendothelial cells.
11 Which cells are responsible for digestion of Reticulocytes?
I Reticuloendothelial cells
II Reticuloexothelial cells
III Reticuloendothelius cells
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
They remain in the circulation for approximately 1 day before they mature into erythrocytes, after the
digestion of RNA by reticuloendothelial cells.
12What is the normal life span of Erythrocyte in blood circulation?
I about 90 days
II about 60 days
III about 120 days
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The mature erythrocyte remains in circulation for about 120 days before being engulfed and destroyed
by phagocytic cells of the reticuloendothelial system.
13 Which cells are responsible for the fate of Erythrocyte?
I Phagocytus cells
II Endophagocytic cells
III Phagocytic cells
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The mature erythrocyte remains in circulation for about 120 days before being engulfed and destroyed
by phagocytic cells of the reticuloendothelial system.
14 Which system is involved in the fate of Erythrocyte?
I Reticuloendothelial system
II Rennin angiotensin system
III Hypothelamic system
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
They possess a negative charge on their surface, which may serve to discourage phagocytosis. Because
erythrocytes have no nucleus, they lack a Krebs cycle and rely on glycolysis via the Embden-Meyerhof
and pentose pathways for energy.
15 How is energy/ATP produced in erythrocyte?
I through Krebs cycle

II through glycolysis via the Embden-Meyerhof pathway
III through glycolysis via pentose pathways
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Because erythrocytes have no nucleus, they lack a Krebs cycle and rely on glycolysis via the Embden-
Meyerhof and pentose pathways for energy.
16 what is true related to ion-concentration in ageing cell?
I increase in sodium concentration

II increase in potassium concentration
III decrease in potassium concentration
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
In addition, the aging cell has a decrease in potassium concentration and an increase in sodium
concentration.
17 Which information should be provided to patient suffering from anaemia?
I Inform patients about the etiology of anemia

II therapeutic options available for treatment
III significance of their physical condition
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Inform patients of the etiology of their anemia, the significance of their medical condition, and the
therapeutic options available for treatment.
18 What is treatment plan in patient with no effective specific treatment of the existing
anaemia?
I requiring periodic transfusions about the signs

II requiring periodic transfusions about the symptoms
III requiring periodic trAns:lations about the symptoms
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
If no effective specific treatment of the underlying disease exists, educate patients requiring periodic
transfusions about the symptoms that herald the need for transfusion .
19 What is true related to the anemia due to acute blood loss?
I reduction in oxygen-carrying capacity

II decrease in intravascular volume
III decrease in intervascular volume
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
With anemia due to acute blood loss, a reduction in oxygen-carrying capacity occurs along with a
decrease in intravascular volume, with resultant hypoxia and hypovolemia.
20 What is true related to the anemia due to acute blood loss?
I Hypertension
II Hypotension
III decrease in blood pressure
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Hypovolemia leads to hypotension.
21 Which neurotrAns:mitter is released due to increased sympathetic outflow?
I discharge of epinephrine and norepinephrine from the adrenal cortex

II norepinephrine release from sympathetic nerve endings
III discharge of epinephrine and norepinephrine from the adrenal medulla
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Increased sympathetic outflow leads to norepinephrine release from sympathetic nerve endings and
discharge of epinephrine and norepinephrine from the adrenal medulla.
22 What is the role of ADH in pathophysiology of anaemia?
I increases free water reabsorption in the distal collecting tubules

II increases free water reabsorption in the loop of Henle
III increases free water reabsorption in the proximal collecting tubules
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
ADH increases free water reabsorption in the distal collecting tubules .
23 which enzyme is responsible for conversion of angiotensin I into angiotensin II?
I angiotensinII converting enzyme (ACE)

II angiotensinI converting enzyme (ACE)
III angiotensin-converting enzyme (ACE)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Angiotensin I, which is converted by angiotensin-converting enzyme (ACE) to angiotensin II.
24 What is the role of angiotensin II?
I stimulates the zona glomerulosa of the adrenal medulla

II stimulates the zona glomerulosa of the adrenal cortex
III to produce aldosterone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Angiotensin II also stimulates the zonaglomerulosa of the adrenal cortex to produce aldosterone .
25 What is the role of Aldosterone?
I increasing intervascular volume

II increases sodium reabsorption from the proximal tubules of the kidney
III increasing intravascular volume
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Aldosterone increases sodium reabsorption from the proximal tubules of the kidney, thus increasing
intravascular volume.
26 What is the effect of sympathetic nervous system?
I increased stroke volume

II decreased blood volume
III increased systemic vascular resistance (SVR)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Therefore, stroke volume, heart rate, and SVR all are maximized by the sympathetic nervous system.
Oxygen delivery is enhanced by the increased blood flow.
27 What is the cause of anemia?
I decrease in blood loss

II increased destruction of RBCs (hemolysis)
III decreased production of RBCs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Only three causes of anemia exist: blood loss, increased destruction of RBCs (hemolysis), and decreased
production of RBCs. Each of these causes includes a number of disorders that require specific and
appropriate therapy.
28 What is the cause of anemia?
I Decreased destruction of RBCs

II blood loss
III decreased production of RBCs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Only three causes of anemia exist: blood loss, increased destruction of RBCs (hemolysis), and decreased
production of RBCs. Each of these causes includes a number of disorders that require specific and
appropriate therapy.
29 Which out of the following is an genetic etiologie of anemia?
I myoglobinopathies
II Hemoglobinopathies
III Thalassemias
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Genetic etiologies include the following:
 Hemoglobinopathies
 Thalassemias
I Enzyme abnormalities of the glycolytic pathways

II Enzyme abnormalities of the aglycolytic pathways
III Defects of the RBC cytoskeleton
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Enzyme abnormalities of the glycolytic pathways
 Defects of the RBC cytoskeleton
I Congenital hyserythropoietic anemia

II Congenital dyserythropoietic anemia
III Rh null disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Congenital dyserythropoietic anemia
 Rh null disease
I Hereditary xerocytosis
II Hereditary xenocytosis
III Fanconi anemia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Hereditary xerocytosis
 Abetalipoproteinemia
 Fanconi anemia
33 Which out of the following is an Nutritional etiologie of anemia?
I Vitamin B-6 deficiency

II Iron deficiency
III Vitamin B-12 deficiency
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Nutritional etiologies include the following:
 Iron deficiency
 Vitamin B-12 deficiency
34 Which out of the following is an Nutritional etiologie of anemia?
I Starvation and generalized malnutrition

II Folate deficiency
III difolate deficiency
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Folate deficiency
Starvation and generalized malnutrition
35 Which out of the following is an physical etiologie of anemia?
I seizure
II Trauma
III Burns
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Physical etiologies include the following:
 Trauma
 Burns
36 Which out of the following is an physical etiologie of anemia?
I Prostbite
II Frostbite
III Prosthetic valves and surfaces
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Frostbite
Prosthetic valves and surfaces
37 Which out of the following is an chronic disease and malignant etiologies of anemia?
I Renal disease
II Hepatic disease
III Cardiac disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Chronic disease and malignant etiologies include the following:

 Renal disease
 Hepatic disease
I Chronic infections
II Neoplasia
III acute infections
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
 Chronic infections
 Neoplasia
I Collagen vascular diseases

II Collagen arterial diseases
III Collagen avascular diseases
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Collagen vascular diseases
40 Which out of the following is an Infectious etiology of anemia?
I Viral - Hepatitis, infectiousnucleosis, cytomegalovirus

II Viral - Hepatitis, infectious mononucleosis, cytomegalovirus
III Viral - Hepatitis, infectious mononucleosis, cyclomegalovirus
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Infectious etiologies include the following:
 Viral - Hepatitis, infectious mononucleosis, cytomegalovirus
 Bacterial - Clostridia, gram-negative sepsis
41 Which out of the following is an Infectious etiology of anemia?
I Bacterial - Clostridia, gram-negative sepsis

II Bacterial - Hepatitis, infectious mononucleosis, cytomegalovirus
III Protozoal - Malaria, leishmaniasis, toxoplasmosis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Protozoal - Malaria, leishmaniasis, toxoplasmosis
42 What is the common cause of aplastic and hypoplastic group of disorders?
I Toxins
II Drugs
III chemicals
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Drugs or chemicals commonly cause the aplastic and hypopl astic group of disorders .
43 Which out of the following can develop bone marrow depression with pancytopenia?
I sufficient dose of inorganic arsenic

II smoking
III usual chemotherapeutic agents used for treatment of neoplastic diseases
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Any human exposed to a sufficient dose of inorganic arsenic, benzene, radiation, or the usual
chemotherapeutic agents used for treatment of neoplastic diseases develops bone marrow depression
with pancytopenia.
44 Which out of the following is true related to prevelance of anemia?
I anemia is twice as prevalent in females as in males

II anemia is twice as prevalent in males as in females
III anemia is thrice as prevalent in females as in males
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Overall, anemia is twice as prevalent in females as in male s
45 What is the amount iron present in one gram of Hb?
I 3.16 mg of iron
II 3.76 mg of iron
III 3.46 mg of iron
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
One gram of Hb contains 3.46 mg of iron (1 mL of blood with an Hb concentration of 15 g/dL =
0.5 mg of iron).
46 Which out of the following play an significant role in the pro gnosis of anemia?
I symptoms of anemia
II severity of the anemia
III the rapidity with which anemia develops
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The prognosis depends on the underlying cause of the anemia.
47 How a doctor establish the duration of anemia?
I by obtaining a history of previous physical examinations

II by obtaining a history of previous genetic disease
III by obtaining a history of previous blood examinations
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Often, the duration of anemia can be established by obtaining a history of previous blood
examinations and, if necessary, by acquiring those records.
48 which disease condition should be consider while obtaining medical history of anemia
patient?
I cholelithiasis
II abnormal Hbs
III hepatactomy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Obtain a careful family history not only for anemia but also for jaundice, cholelithiasis, splenectomy,
bleeding disorders, and abnormal Hbs.
49 which out of the following should be consider while obtaining medical history of
anemia patient?
I prior medical treatment

II drugs (including over-the-counter medications and vitamins)
III life style
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Carefully document the patient's occupation, hobbies, prior medical treatment, drugs (including over-
the-counter medications and vitamins), and household exposures to potentially noxious agents.
50 which out of the following should be considered when the etiologie of anemia is blood
loss?
I irregular menses
II menstrual loss
III abortions
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
In searching for blood loss, carefully document pregnancies, abortions, and menstrual loss .
51 What are the symptoms of iron deficiency anemia?
I frequently chew or suck ice

II pagophagia
III frequently drink water
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Patients with iron deficiencies frequently chew or suck ice (pagophagia). Occasionally, they complain
of dysphasia, brittle fingernails, relative impotence, fatigue, and cramps in the calves on climbing
stairs that are out of proportion to their anemia.
52 What are the symptoms in patient with iron deficiency anemia?
I brittle toes
II dysphasia
III brittle fingernails
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E I
53What are the symptoms in patient with iron deficiency anemia?
I relative impotence
II hand muscle cramping
III cramps in the calves on climbing stairs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
54 What are the symptoms of vitamin B12 deficiency anemia?
I early whitening of the hair

II a burning sensation in the tongue
III loss of proprioception
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
In vitamin B-12 deficiency, early graying of the hair, a burning sensation in the tongue, and a loss
of proprioception are common.
55 What are the symptoms of folate deficiency anemia?
I sore tongue
II cheilosis
III sore throat
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Patients with folate deficiency may have a sore tongue, cheilosis, and symptoms associated with steatorrhe a
56 Which out of the following condition can cause hyperthermia?
I neoplasms
II collagen vascular disease
III neoplasia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Obtain a history of fever or identify the presence of fever, because infections, neoplasms, and collagen
vascular disease can cause anemia.
57 Which condition suggests the occurrence of either thrombocytopenia or other bleeding

disorders?
I occurrence of ecchymoses
II occurrence of purpura
III occurrenceof acchymoses
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The occurrence of purpura, ecchymoses, and petechiae suggest the occurrence of either
thrombocytopenia or other bleeding disorders.
58 What is the Hb value in adult patient with anemia as per WHO criterion?
I hemoglobin (Hb) valueisless than 12.5 g/dL

II hemoglobin (Hb) value of less than 13 g/dL
III hemoglobin (Hb) value of less than 13.5 g/dL
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The World Health Organization (WHO) criterion for anemia in adults is a hemoglobin (Hb) value
of less than 12.5 g/dL.
59 When Children aged 6 months to 6 years are considered anaemic?
I Hb levels are less than 13 g/dL

II Hb levels are less than 11 g/dL
III Hb levels are less than 12 g/dL
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
@59 Children aged 6 months to 6 years are considered anemic at Hb levels less than 11 g/dL,
60 When children aged 6-14 years are considered anemic?
I Hb levelsare less than 12 g/dL

II Hb levels less than 14 g/dL
III Hb levels less than 13 g/dL
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Children aged 6-14 years are considered anemic when Hb levels are less than 12 g/dL.
61 What is a rational approach to determine etiology of anemia?
I examining the peripheral smear

II laboratory values obtained on the blood count
III examining the central smear
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
A rational approach to determining etiology is to begin by examining the peripheral smear and
laboratory values obtained on the blood count.
62 What is the level of MCV microcytic anaemia?

I mean corpuscular volume [MCV] > 84
II mean corpuscular volume [MCV] = 84
III mean corpuscular volume [MCV] < 84
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
If the anemia is microcytic (mean corpuscular volume [MCV] < 84).
63What is the level of MCV macrocytic anaemia?
I mean corpuscular volume [MCV] >96

II mean corpuscular volume [MCV] <95
III mean corpuscular volume [MCV] = 96
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
If the anemia is macrocytic (MCV >96).
64 What is Hypochromic form of RBCs?
ILoss of central pallor

II Less hemoglobin in cell
III Enlarged area of central pallor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
@64Hypochromic Less hemoglobin in cell. Enlarged area of central pallor. See Table 1 .
65 What is Spherocyte form of RBCs?
I often macrocytic
II Loss of central pallor
III often microcytic
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
@65 Spherocyte Loss of central pallor, stains more densely, often microcytic. Hereditary spherocytosis
and certain acquired hemolytic anemias.
66 What is called as Leptocyte form of RBCs?
I Hypochromic cell with a normal diameter

II increased MCV
III decreased MCV
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
@66 Leptocyte H y p o c h r o m i c c e l l w i t h a n o r m a l d i a m e t e r a n d d e c r e a s e d M C V .
Thalassemia
67 What is called as Elliptocyte form of RBCs?
I Oval to cigar shaped

II Oblong shape
III Hereditary elliptocytosis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
@ 67 Elliptocyte Oval to cigar shaped. Hereditary elliptocytosis, certain anemias (particularly
vitamin B-12 and folate deficiency).
68 What is called as Schistocyte form of RBCs?
I Fragmented helmet- or triangular-shaped RBCs

II Macroangiopathic anemia
III Microangiopathic anemia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
@68 Schistocyte Fragmented helmet- or triangular-shaped RBCs. Microangiopathic anemia,
artificial heart valves, uremia, and malignant hypertension
6 9What is called as Stomatocyte form of RBCs?
I Slitlike area of central pallor in erythrocyte

II loss of central pallor
III Slitlike area of central pallor in neoplasms
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
@ 69 Stomatocyte Slitlike area of central pallor in erythrocyte. Liver disease, acute alcoholism,
malignancies, hereditary stomatocytosis, and artefact.
70 What is called as Tear shaped form of RBCs?
I Myelofibrosis and infiltration of marrow with tumor

II Drop-shaped erythrocyte, often microcytic
III Drop-shaped erythrocyte, often macrocytian
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
@ 70 Tear-shaped RBCs Drop-shaped erythrocyte, often microcytic. Myelofibrosis and infiltration
of marrow with tumor. Thalassemia
71 What is called as Acanthocyte form of RBCs?
I Five to nine spicules of various lengths at irregular intervals on surface of RBCs

II Five to 10 spicules of various lengths at irregular intervals on surface of RBCs
III Five to 10 spicules of various lengths at irregular intervals on surface of WBCs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
@71 Acanthocyte Five to 10 spicules of various lengths and at irregular intervals o n
surface of RBCs
72 What is called as Echinocyte form of RBCs?
I Evenly distributed spicules on surface of RBCs,usually 10-30

IIEvenly distributed spicules on surface of RBCs,usually 10-40
III Evenly distributed spicules on surface of RBCs,usually 10-50
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
@72 Echinocyte Evenly distributed spicules on surface of RBCs, usually 10-30. Uremia, peptic ulcer,
gastric carcinoma, pyruvic kinase deficiency, and preparative artefact
73 What is called as Sickle cell form of RBCs?
I Oblongated cell with pointed ends

II Elongated cell with pointed ends
III Hemoglobin S and certain types of hemoglobin C and l
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
@ 7 3 S i c k l e c e l l Elongated cell with pointed ends. Hemoglobin S and c ertain types of
hemoglobin C and l
74 By which measurements Iron deficiency and the depletion of iron stores can be detected
several weeks after bleeding?
I serum Ferrate level

II serum iron level
III TIBC
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Iron deficiency and the depletion of iron stores can be detected several weeks after bleeding by
measurements of the serum iron level and the TIBC (the patient has low serum iron levels and an
elevated TIBC) and/or special stains of bone marrow specimens showing an absence of storage iron.
75 What can be used for the conformation of the diagnosis of iron deficiency anemia?
I Serum oxygen level

II Serum Carbon dioxide level
III serum ferritin level
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
A low serum ferritin level provides confirmation of the diagnosis of iron deficiency anemia.
76 How one can identify haemolytic anaemia form the life span of erythrocyte?
I life span (< 50 days)

II life span (< 40 days)
III life span (<60 days)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
If the erythrocytic life span is shortened significantly (< 40 d), the patient has a hemolytic disorder.
77 Which out of the following disorder can be classified as hemolytic disorder?
I Hereditary spherocytosis
II Lukemia
III Vitamin B-12 and folic acid deficiency
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Classification of the Hemolytic Disorders; 1. Hereditary spherocytosis 2. Vitamin B-12 and folic acid
deficiency.
I hereditary intracorpuscular
II hereditary extracorpuscular
III Neoplasm
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Only 4 groups of hemolytic disorders are possible hereditary intracorpuscular, hereditary
extracorpuscular, acquired intracorpuscular, and acquired extracorpuscular.
I Neoplastic disorder
II acquired intracorpuscular
III acquired extracorpuscular
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Only 4 groups of hemolytic disorders are possible hereditary intracorpuscular, hereditary
extracorpuscular, acquired intracorpuscular, and acquired extracorpuscular.
80 What is the common cause of acquired anaemia disorders?
I extracorpuscular abnormalities
II intracorpuscular defects
III intracorpuscular defects and extracorpuscular abnormalities
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
All hereditary hemolytic disorders are due to intracorpuscular defects, and most acquired disorders are
due to extracorpuscular abnormalities.
81 What is the common cause of all hereditary hemolytic disorders?
I extracorpuscular abnormalities
II intracorpuscular defects
III intracorpuscular defects and extracorpuscular abnormalities
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
All hereditary hemolytic disorders are due to intracorpuscular defects, and most acquired disorders are
due to extracorpuscular abnormalities.
82 Which finding is important in peripheral smear of hereditary elliptocytosis patient?
I ovalocytes
II spherocytes
III sickle cells
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
A careful examination of the peripheral smear may reveal spherocytes in hereditary spherocytosis,
ovalocytes in hereditary elliptocytosis, sickle cells in patients with major hemoglobinopathies associated
with sickle Hb.
83 Which finding is important in peripheral smear of major hemoglobinopathies

associated with sickle Hb?
I ovalocytes
II sickle cells
III spherocytes
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
with sickle Hb.
84 Which finding is important in peripheral smear of hereditary spherocytosis patient?
I ovalocytes
II spherocytes
III sickle cells
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
with sickle Hb.
85 What is the level of Mean corpuscular hemoglobin concentration (MCHC) in

Hereditary spherocytosis?
I = 36 %
II < 36 %
III > 36 %
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Hereditary spherocytosis - MCHC greater than 36%, incubated osmotic fragility in oxalate, and
detection of the underlying molecular defect.
86 Which test is used for the diagnosis of Hemoglobinopathies?

I Acid hemolysis (Ham) test
II heat denaturation test for unstable Hbs
III
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Hemoglobinopathies - Sickle cell preparation, Hb electrophoresis at 1 or more pH, heat
denaturation test for unstable Hbs, oxygen disassociation for Hbs with abnormal oxygen affinity.
87 Which test is used for the diagnosis of Thalassemia?
I A2 and fetal Hb
II Acid hemolysis (Ham) test
III quantification of alpha and beta chains
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Thalassemia - A2 and fetal Hb, Hb electrophoresis, characterization of the molecular defect,
quantification of alpha and beta chains
88 Which test is used for the diagnosis of congenital dyserythropoietic anemias?
I Acid hemolysis (Ham) test

II A2 and fetal Hb
III quantification of alpha and beta chains
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Congenital dyserythropoietic anemias - Demonstration of abnormalities of erythroid precursors in
bone marrow aspirates, positive acid hemolysis (Ham) test, with normal result of sucrose hemolysis
test in one form of this disease (hereditary erythroblastic multinuclearity with a positive acidified
serum test [HEMPAS])
89 Which method is used for the diagnosis of Hereditary RBC enzymatic deficiencies?
I A2 and fetal Hb
II Acid hemolysis (Ham) test
III Specific RBC enzyme assay
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Hereditary RBC enzymatic deficiencies - Specific RBC enzyme assay
90 What is the usefulness of imaging studies in diagnosis of Anemia?
I to identify extracorpuscular etiology

II to identify neoplastic etiology
III to identify intracorpuscular etiology
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Imaging studies are useful in the workup for anemia when a neoplastic etiology is suggested.
91 Which method is used to Investigate GI bleeding?
I endoscopy
II Colorectal transmission study
III Colorectal trAns:it study
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Investigate GI bleeding by endoscopy and radiographic studies to identify the bleeding site
92 What is the limitation of endoscopy and radiographic studies in diagnosis of GI

bleeding?
I Time consuming procedure

II Very expensive
III do not detect the bleeding site or the lesion if small
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Investigate GI bleeding by endoscopy and radiographic studies to identify the bleeding site. However,
even these methods may leave a source of GI bleeding undetected, because these procedures do not
detect the bleeding site or the lesion if small.
93 Which method is used to Investigate GI bleeding?
I Colorectal transmission study

II Colorectal trAns:it study
III radiographic studies
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Investigate GI bleeding by endoscopy and radiographic studies to identify the bleeding site
94 Bone marrow aspirates and biopsy findings are particularly useful in establishing the
etiology of anemia in patients with-
I decreased production of RBCs
II decreased production of nromoblast
III decreased production of stem cell
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Bone marrow aspirates and biopsy findings are particularly useful in establishing the etiology of
anemia in patients with decreased production of RBCs
95 Which test can be used for the diagnosis of leukemias and lymph omas?
I CBC
II Bone marrow aspirates and biopsy
III hemogram
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Bone marrow aspirates and biopsy finding; In addition, they lead to a definitive histologic diagnosis
of leukemias, lymphomas, myelomas, and metastatic carcinomas
96 Which method can be used to document the existence of iron deficiency anemia or the
sideroblastic anemias?
I CBC
II hemogram
III Iron stains of the bone marrow aspirate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Iron stains of the bone marrow aspirate can be used to document the existence of iron deficiency
anemia or the sideroblastic anemias.
97 Which test can be used for the diagnosis of myelomas and metastatic car cinomas?
I Bone marrow aspirates and biopsy

II hemogram
III ECG
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Bone marrow aspirates and biopsy finding; In addition, they lead to a definitive histologic diagnosis
of leukemias, lymphomas, myelomas, and metastatic carcinomas
98 Why Bone marrow aspirates and biopsy is less useful in diagnosing congenital
dyserythropoietic anemia?
I it reveal the non nucleated form of erythroid precursors

II it reveal the multinuclearity of erythroid precursors
III it reveal the multinuclearity of blastocyte precursors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Bone marrow aspirates and biopsy finding; and @ 98 they are also less useful in diagnosing congenital
dyserythropoietic anemia, in which they reveal the multinuclearity of erythroid precursors
99 Which test is used to detect thalassemia minor?
I bone marrow biopsy

II ECG
III routine hemogram
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Thalassemia minor is not detected until a routine hemogram is performed.
100 Which out of the following is the most commonplace of the hereditary disorders?
I Insulin defeciency
II lactate dehydrogenase deficiency
III G-6-PD deficiency
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The most commonplace of the hereditary disorders is G-6-PD deficiency.

Drug and pharmacology
1 What is the purpose of establishing the etiology of an anemia?
I to permit selection of a specific and effective therapy

II to prevent blood loss
III to prevent sickle cell formation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The purpose of establishing the etiology of an anemia is to permit selection of a specific and effective
therapy.
2 Which method is advantageous in hereditary spherocytosis?

I bone marrow trAns:plant
II hepatectomy
III Splenectomy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Splenectomy has been advantageous in hereditary spherocytosis.
3 Why Urologic consultation is necessary in patient with anemia?
I to investigate Sugar level

II to investigate hematuria
III to investigate bile acid level
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Urologic consultation may be needed to investigate hematuria.
4 Why consultation of gastroenterologists is required in patient with anaemia?
I to identify a bleeding site in the gut

II to identify gut flora
III to identify digestive enzyme level
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Consultation with gastroenterologists is frequently sought to identify a bleeding site in the gut.
5 Why follow-up care is necessary in anaemia patient?
I to ensure that therapy is being continued

II to access the drug interaction
III to assess the efficacy of treatment
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Follow-up care is necessary to ensure that therapy is being continued and to assess the efficacy of
treatment.
6 Which out of the following is risk factor of blood product transfusions?
I risk of diabetes
II Hemolytic transfusion reactions
III transmission of infectious disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Hemolytic transfusion reactions and transmission of infectious disease are risks of blood product
transfusions
7 Which patient is at greater risk of a hemolytic transfusion reaction?
I Patients with diabetes

II Patients with autoimmune antibodies against RBCs
III Patients with insulin deficiency
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Patients with autoimmune antibodies against RBCs are at greater risk of a hemolytic transfusion
reaction because of difficulty in cross-matching the blood.
8 What is the appropriate treatment of anaemia due to blood loss?
I oral administration of ferrous sulfate

II correction of the underlying condition
III
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The appropriate treatment of anemia due to blood loss is correction of the underlying condition and
oral administration of ferrous sulfate until the anemia is corrected and for several months afterward
to ensure that body stores are replete with iron
9 Blood transfusions should be reserved for the treatment of-
I Diabetes
II shock or hypoxia
III obesity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Relatively few indications exist for the use of parenteral iron therapy, and blood transfusions should
be reserved for the treatment of shock or hypoxia.
10 What is the traditional dosage of ferrous sulphate in anaemia?
I 325 mg; t.i.d

II 335 mg; t.i.d
III 345 mg; t.i.d
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Although the traditional dosage of ferrous sulfate is 325 mg (65 mg of elemental iron) orally three
times a day, lower doses (eg, 15-20 mg of elemental iron daily) may be as effective and cause fewer
side effects
11 Which out of the following lower dose of ferrous sulphate can also be used to treat
Anaemia?
I 15-20 mg of elemental iron daily

II 25-30 mg of elemental iron daily
III 25-35 mg of elemental iron daily
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
side effects.
12 What is the logic behind the use of lower dose of ferrous sulphate?
I improve bioavibility
II improve iron excretion
III fewer side effects
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
side effects.
13 Which substance interferes with iron absorption from stomach?
I fruits
II tea
III vegetable
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
To promote absorption, patients should avoid tea and coffee and may take vitamin C (500 units)
with the iron pill once daily.
14 Which substance promotes absorption of iron from stomach?
I vitamin C
II tea
III coffee
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
15 Which substance interferes with iron absorption from stomach?
I fruits
II vegetable
III coffee
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
16 Which medication is used when ferrous sulfate produces unacceptable side effects?
I ferric chloride
II ferrous gluconate
III ferric ammonium nitrate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
If ferrous sulfate has unacceptable side effects, ferrous gluconate, 325 mg daily (35 mg of elemental
iron) is a possible alternative for patients who cannot tolerate ferrous sulfate
17 What is the therapeutic dose of ferrous gluconate in Anaemia?
I 325 mg daily
II 335 mg daily
III 345 mg daily
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
If ferrous sulfate has unacceptable side effects, ferrous gluconate, 325 mg daily (35 mg of elemental
iron) is a possible alternative for patients who cannot tolerate ferrous sulfate
18 Which out of the following is an injectable formulation used in anaemia?
I carboxymaltose
II ferric chloride
III ferrous sulphate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Adults with iron deficiency anemia who cannot tolerate oral iron or who have an unsatisfactory
response to it can be treated with ferric carboxymaltose injection.
19 Which drug may be useful in the treatment of certain patients with sideroblastic
anemia?
I Pyridoxine
II ammonium chloride
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Pyridoxine may be useful in the treatment of certain patients with sideroblastic anemia, even
though this is not a deficiency disorder.
20 Which out of the following is true for iron absorption?
I heme iron is not more efficiently absorbed than inorganic food iron
II heme iron is more efficiently absorbed than inorganic food iron
III heme iron is less absorbed than inorganic food iron
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
However, heme iron is more efficiently absorbed than inorganic food iron.
21 Which out of the following people encounters with Folic acid deficiency?
I who drinks
II who smokes
III who consume few leafy vegetables
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Folic acid deficiency occurs among people who consume few leafy vegetables.
22 Which countries have Coexistence of iron and folic acid deficiency?
I common in developing countries

II common in developed countries
III common in backward countries
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Coexistence of iron and folic acid deficiency is common in developing nations.
23 Which method may provide sufficient improvement in patients with hypoplastic

anemia?
I Ayurvedic medication
II drug treatment
III Splenectomy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Splenectomy may provide sufficient improvement for patients with hypoplastic.
24 What is useful in the treatment of autoimmune hemolytic anemias?
I ferrous sulphate
II Splenectomy
III vasodilators
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Splenectomy is useful in the treatment of autoimmune hemolytic anemias and in certain hereditary
hemolytic disorders (ie, hereditary spherocytosis and elliptocytosis, certain unstable Hb disorders,
pyruvic kinase deficiency.
25 What is useful in the treatment of autoimmune hereditary hemolytic disorders?
I Splenectomy
II vasodilators
III vasoconstrictors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Splenectomy is useful in the treatment of autoimmune hemolytic anemias and in certain hereditary
hemolytic disorders (ie, hereditary spherocytosis and elliptocytosis, certain unstable Hb disorders,
pyruvic kinase deficiency.
26 Which vaccine is used for the immunization of patient prior to splenectomy?
I cholera vaccine
II pneumococcal vaccine
III AIDS vaccine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Prior to splenectomy, patients should be immunized with polyvalent pneumococcal vaccine.
27 When is pneumococcal vaccine administered in patient undergoing splenectomy?
I more than 3 week prior to surgery

II more than 2 week prior to surgery
III more than 1 week prior to surgery
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Preferably, this should be administered more than 1 week prior to surgery.
28 Bone marrow and stem cell transplantation have been used in patients with-
I Diabetes
II leukemia
III Lymphoma
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Bone marrow and stem cell transplantation have been used in patients with leukemia, lymphoma,
Hodgkin lymphoma, multiple myeloma, myelofibrosis, and aplastic disease
29 Bone marrow and stem cell transplantation have been used in patients with -
I multiple myeloma
II Hodgkin lymphoma
III Obesity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
30 Bone marrow and stem cell transplantation have been used in patients with -
I myelofibrosis
II CAD
III aplastic disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
31 Which procedure has successfully corrected phenotypic expression of sickle cell disease
and thalassemia?
I Allogeneic bone marrow transplantation

II stem cell transplantation
III Allogeneic stem cell transplantation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Allogeneic bone marrow transplantation has successfully corrected phenotypic expression of sickle cell
disease and thalassemia and provided enhanced survival in patients who survived transplantation .
32 What is March hemoglobinuria?
I Individuals develop hemoglobinuria during sleep

II Individuals develop hemoglobinuria after marching or running on hard surfaces
III Individuals develop hemoglobinuria during bathing
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
March hemoglobinuria is a rare hemolytic disorder usually observed in young males. Individuals
develop hemoglobinuria after marching or running on hard surfaces
33 which out of the following are therapeutic approaches for the treatment of anemia?
I eating vegetable
II use of blood and blood products
III use of vasodilators
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Therapeutic approaches to anemia include the use of blood and blood products, immunotherapies,
hormonal/nutritional therapies, and adjunctive therapies
34 which out of the following are therapeutic approaches for the treatment of anemia?
I use of vasodilators
II hormonal therapies
III nutritional therapies
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Therapeutic approaches to anemia include the use of blood and blood products, immunotherapies,
hormonal/nutritional therapies, and adjunctive therapies
35 What is the goal of therapy in acute anemia?
I restore blood volume

II restore the hemodynamics of the vascular systems
III restore normal WBC count
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The goal of therapy in acute anemia is to restore the hemodynamics of the vascular systems and to
replace lost red blood cells.
36 What is the goal of therapy in acute anemia?
I restore blood volume

II restore normal WBC count
III to replace lost red blood cells
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
36 The goal of therapy in acute anemia is to restore the hemodynamics of the vascular systems and
to replace lost red blood cells.
37 what is used in the treatment of Acute Anemia?
I mineral and vitamin supplements

II blood transfusions
III platelets
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
To achieve this, the practitioner may use mineral and vitamin supplements, blood transfusions,
vasopressors, histamine (H2) antagonists, and glucocorticosteroids.
38 what is used in the treatment of Acute Anemia?
I vasodilators
II vasopressors
III histamine (H2) antagonists
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
To achieve this, the practitioner may use mineral and vitamin supplements, blood transfusions,
vasopressors, histamine (H2) antagonists, and glucocorticosteroids.
39 Which out of the following can be classified as blood and blood products?
I vasodilators
II Fresh frozen plasma
III vasopressors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Blood and Blood Products; Packed red blood cells, Fresh frozen plasma, Cryoprecipitate, Platelets,
Factor IX and Recombinant factor VIII.
I Cryoprecipitate
II vasopressors
III Factor IX
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
I Recombinant factor VI
II Recombinant factor VIII
III Platelets
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
42 What is sufficient for the ongoing significant hemorrhage or haemolysis?
I transfusion of blood
II ferrous sulphate
III platelet transfusion
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
With significant ongoing hemorrhage or hemolysis, transfusion of blood alone is insufficient
43 Why packed red blood cells (PRBCs) are preferred over whole blood?
I less volume
II more volume
III immunogenic
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Packed red blood cells (PRBCs) are used preferentially to whole blood, since they limit volume,
immune, and storage complications.
44 Why packed red blood cells (PRBCs) are preferred over whole blood?
I No immune reaction
II No storage comlipcation
III more volume
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
45 What is the characteristic of Packed red blood cells (PRBCs)?
I have 90% less plasma

II have 80% less plasma
III less immunogenic
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
PRBCs have 80% less plasma, are less immunogenic, and can be stored about 40 days (versus 35 d
for whole blood).
46 Which blood product is used in patient who is transplant candidate/recipient and have
reported prior febrile transfusion reaction?
I Leukocyte-poor PRBCs
II Leukocyte-rich PRBCs
III Neutrophilis-poor PRBCs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Leukocyte-poor PRBCs are used in patients who are transplant candidates/recipients and in those
with prior febrile transfusion reactions.
47 Which blood product is used in individual with hypersensitivity transfusion reactions?
I Leukocyte-rich PRBCs
II Washed or frozen PRBCs
III Leukocyte-rich RBCs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Washed or frozen PRBCs are used in individuals with hypersensitivity transfusion reactions
48 Which out of the following is present/content of Fresh frozen plasma (FFP)?
I protein J
II coagulation factors
III protein C and protein S
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Fresh frozen plasma (FFP) contains coagulation factors, as well as protein C and protein S.
49 Which blood product is used to treat coagulopathies and thrombotic thrombocytopenic

purpura?
I Washed or frozen PRBCs

III Cryoprecipitate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Its uses include the treatment of coagulopathies and thrombotic thrombocytopenic purpura (TTP)
and the reversal of warfarin.
50 Which agent is used for the treatment of Von Willebrand disease?
I Cryoprecipitate
III Fresh frozen plasma
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Cryoprecipitate: This agent is used for the treatment of Von Willebrand disease.
51 What is the content of Cryoprecipitate?

I fibrinogen and factor VI
II fibrinogen and factor VIII
III von Willebrand factor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Cryoprecipitate: It contains fibrinogen, factor VIII, and von Willebrand factor and can be used in
lieu of factor VIII concentrate if the latter is unavailable.
52 Which blood product is used in patient with thrombocytopenic and have clinical
evidence of bleeding?
I platelet transfusion
III fresh frozen plasma
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Patients who are thrombocytopenic and have clinical evidence of bleeding should receive a platelet
transfusion.
53 Patients with platelet counts of less than 10,000/mcL are at risk for-
I for spontaneous cerebral hemorrhage

II for diuresis
III for anuria
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Patients with platelet counts of less than 10,000/mcL are at risk for spontaneous cerebral
hemorrhage and require a prophylactic transfusion.
54 What is the preferred treatment for TTP and hemolytic-uremic syndrome?
I small-volume plasmapheresis with FFP replacement

II large-volume plasmapheresis with FFP replacement
III large-volume FFP replacement
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The preferred treatment for TTP and hemolytic-uremic syndrome is large-volume plasmapheresis
with FFP replacement.
55 What is the characteristic of Immune thrombocytopenic purpura (ITP)?
I rapid destruction of platelet

II rapid destruction of RBC
III rapid destruction of WBC
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Immune thrombocytopenic purpura (ITP) is rarely treated with transfusion , as the transfused
platelets are destroyed rapidly. In stable patients, initial treatment is with prednisone.
56 What is the treatment of Hemophilia B?
I factor X concentrate
II factor XI concentrate
III factor IX concentrate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Hemophilia B is treated with factor IX concentrate.
57 What is the treatment of Hemophilia A?
I factor IX concentrate
II Recombinant factor VIII
III factor X concentrate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Recombinant factor VIII: This is used to treat hemophilia A.
58 Why prophylactic administration of Iron is necessary during pregnancy?
I as a prophylaxis
II anticipated requirements of the fetus
III compensate iron loss that occur during delivery
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Iron is administered prophylactically during pregnancy because of the anticipated requirements of
the fetus and the losses that occur during delivery.
59 Which out of the following can be classified as Iron product used for anemia?
I Carbonyl iron
II Ferrous sulphate
III ferric chloride
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Iron Products: Ferrous sulphate, Carbonyl iron, Iron dextran complex and Ferric carboxymaltose.
60 Which out of the following can be classified as Iron product used for anemia?
I Ferric carboxymaltose
II ferric ammonium chloride
III ferric chloride
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
61 what is the logic behind the use of slower release iron supplement (Carbonyl iron)?
I more bioavibility
II safety if ingested by children
III less renal excretion
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Carbonyl iron: The slower release affords the agent greater safety if ingested by children.
62 Which out of the following can be classified as Iron product used in anemia?
I ferric ammonium chloride

II ferric chloride
III Iron dextran complex
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
63 Why Carbonyl iron is preferred over ferrous sulphate?
I more bioavibility
II It has less gastrointestinal (GI) toxicity
III less renal excretion
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Carbonyl iron; Claims are made that there is less gastrointestinal (GI) toxicity, prompting use when
ferrous salts are producing intestinal symptoms and in patients with peptic ulcers and gastritis.
64 Which out of the following is true for Iron dextran complex?
I replenish depleted iron stores in the bone marrow

II less renal excretion than ferrous sulphate
III less renal excretion than ferrous sulphate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Iron dextran complex replenishes depleted iron stores in the bone marrow, where it is incorporated
into haemoglobin.
65 why parenteral iron-carbohydrate complexes should be used with caution?

I It causes anaphylactic reactions
II It causes gastric perforation
III It causes diuresis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Parenteral use of iron-carbohydrate complexes has caused anaphylactic reactions, and its use should
be restricted to patients with an established diagnosis of iron deficiency anemia whose anemia is not
corrected with oral therapy.
66 How is Iron dextran complex dose calculated?
I 1.5 mg iron/g of hemoglobin

II 2.5 mg iron/g of hemoglobin
III 3.5 mg iron/g of hemoglobin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The required dose can be calculated (3.5 mg iron/g of hemoglobin) or obtained from tables in the
prescribing information.
67 What are the properties of Ferric carboxymaltose?
I It is nondextran V colloidal iron hydroxide in complex with carboxymaltose

II It is nondextran IV colloidal iron hydroxide in complex with carboxymaltose
III It is nondextran VI colloidal iron hydroxide in complex with carboxymaltose
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Ferric carboxymaltose is a nondextran IV colloidal iron hydroxide in complex with carboxymaltose,
a carbohydrate polymer that releases iron.
68 Which iron supplement is indicated for iron deficiency anemia (IDA) in adults having
intolerance or an unsatisfactory response to oral iron?
I ferric chloride
II ferric ammonium nitrate
III Ferric carboxymaltose
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Ferric carboxymaltose ;It is indicated for iron deficiency anemia (IDA) in adults who have
intolerance or an unsatisfactory response to oral iron.
69 Which iron supplement is indicated for IDA in adults with non-dialysis-dependent

chronic kidney disease?
I Ferric carboxymaltose
II ferric chloride
III ferric ammonium nitrate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Ferric carboxymaltose ;It is also indicated for IDA in adults with non-dialysis-dependent chronic
kidney disease.
70 Which out of the following can be classified as Vitamins?
I ferric chloride
II Cyanocobalamin
III Vitamin K
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Vitamins: Cyanocobalamin, Folic acid and Vitamin K.
71 Which out of the following can be classified as Vitamins?
I ferric chloride
II Folic acid
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Vitamins: Cyanocobalamin, Folic acid and Vitamin K.
72 Which Vitamin supplement are used to treat megaloblastic and macrocytic anemias
secondary to deficiency?
I Cyanocobalamin
II ferric chloride
III folic acid
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Cyanocobalamin (vitamin B12) and folic acid are used to treat megaloblastic and macrocytic
anemias secondary to deficiency.
73 What is the role of vitamin B12 and folic acid in human body?
I required for synthesis of DNA

II required for synthesis of purine nucleotides
III required for synthesis of RNA
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Both vitamin B12 and folic acid are required for synthesis of purine nucleotides and metabolism of
some amino acids. Each is essential for normal growth and replication.
74 What is the role of vitamin B12 and folic acid in human body?
I required for synthesis of RNA

II required for synthesis of DNA
III required for metabolism of some amino acids
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Both vitamin B12 and folic acid are required for synthesis of purine nucleotides and metabolism of
some amino acids. Each is essential for normal growth and replication.
75 What is the outcome of Vitamin K deficiency?
I diuresis
II elevation of prothrombin time
III hypotension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Vitamin K deficiency causes elevation of prothrombin time and is commonly seen in patients with
liver disease.
76 Which are active forms of vitamin B12 in humans?
I Oxyadenosylcobalamin
II hydroxocobalamin
III Deoxyadenosylcobalamin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Deoxyadenosylcobalamin and hydroxocobalamin are active forms of vitamin B12 in humans.
77 How Vitamin B12 deficiency occurs in human?
I partial or total gastrectomy

II increased renal excretion
III diseases of the distal ileum
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Vitamin B12 deficiency may result from intrinsic factor (IF) deficiency (pernicious anemia), partial
or total gastrectomy, or diseases of the distal ileum.
78 What is the role of folic acid in the production of red blood cells (RBCs)?
I essential for maintaining osmolarity

II essential for ATP production
III It is an essential cofactor for enzymes
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Folic acid is an essential cofactor for enzymes used in the production of red blood cells (RBCs).
79 What is the possible outcome of Vitamin K deficiency?
I diuresis
II anuria
III risk of bleeding
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
A decrease in levels of vitamin K dependent factors (II, VII, IX, X, protein C, protein S) can lead
to bleeding.
80 Which out of the following are vitamin K dependent factors?
I Factor II
II Factor I
III Factor VII
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
to bleeding.
81 Which out of the following are vitamin K dependent factors?
I Protein J
II Protein C
III Protein S
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
to bleeding.
82 Which out of the following can be classified as Electrolyte Supplements in anaemia?
I Zinc chloride
II potassium chloride
III Manganese sulphate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Electrolyte Supplements: potassium chloride.
83 What is responsible for decreased Serum potassium levels?
I Protein S deficiency
II folate deficiency
III Protein C deficiency
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Serum potassium levels can fall during therapy for folate deficiency or folate deficiency and can lead
to sudden death.
84 What is the role of potassium chloride in human body?

I contraction of cardiac muscle
II Production of ATP
III transmission of nerve impulses
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
KCL; Essential for transmission of nerve impulses, contraction of cardiac muscle, maintenance of
intracellular tonicity, skeletal and smooth muscles, and maintenance of normal renal function.
85 What is the role of potassium chloride in human body?
I maintenance of normal renal function

II maintenance of intracellular tonicity
III Production of ATP
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Essential for transmission of nerve impulses, contraction of cardiac muscle, maintenance of
intracellular tonicity, skeletal and smooth muscles, and maintenance of normal renal function.
86 what are the different ways for the gradual potassium depletion from Body?
I renal excretion
II through GI loss
III through perspiration
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Gradual potassium depletion occurs via renal excretion, through GI loss or because of low intake
87 How depletion of potassium occurs?
I through perspiration
II diuretic therapy
III CCBs therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
KCL; Depletion usually results from diuretic therapy, primary or secondary hyperaldosteronism,
diabetic ketoacidosis, severe diarrhea, if associated with vomiting, or inadequate replacement during
prolonged parenteral nutrition.
I primary or secondary hyperaldosteronism

II CCBs therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Depletion usually results from diuretic therapy, primary or secondary hyperaldosteronism, diabetic
ketoacidosis, severe diarrhea, if associated with vomiting, or inadequate replacement during
I prolonged parenteral nutrition

II severe diarrhea
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Depletion usually results from diuretic therapy, primary or secondary hyperaldosteronism, diabetic
ketoacidosis, severe diarrhea, if associated with vomiting, or inadequate replacement during
90 What is the role of vasopressors in Anemia?
I vasodilation
II Used in variceal bleeding
III Used in CAD
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Vasopressors: The major indication is variceal bleeding.
91 What is the pharmacological mechanism of Vasopressors?
I vasodilation of cardiac muscle

II vasodilation of vascular smooth muscles
III vasoconstriction of vascular smooth muscles
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Vasopressin causes vasoconstriction of vascular smooth muscles and increases water permeability and
reabsorption in the collecting tubules.
92 What is the effect of Vasopressors in collecting tubules?
I increases water permeability and reabsorption

II decreases water permeability
III decreases water reabsorption
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Vasopressin causes vasoconstriction of vascular smooth muscles and increases water permeability and
reabsorption in the collecting tubules.
93 Which out of the following can be classified as Vasopressors?
I verapamil
II Nifidipine
III Vasopressin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Vasopressors: Vasopressin
94 What is the pharmacological mechanism of ranitidine?
I inhibits histamine stimulation of the H1 receptor

II inhibits histamine stimulation of the H3 receptor
III inhibits histamine stimulation of the H2 receptor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Ranitidine inhibits histamine stimulation of the H2 receptor in gastric parietal cells.
95 What is the primary indication of Ranitidine?
I diabetes
II Obesity
III gastric ulcers
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The primary indication is to reduce symptoms and accelerate healing of gastric ulcers.
96 Which out of the following are Histamine (H2) Antagonists?
I Famotidine
II Nifidipine
III Nizatidine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Histamine (H2) Antagonists: Cimetidine, Ranitidine, Famotidine and Nizatidine.
97 Which out of the following are Histamine (H2) Antagonists?
I Nifidipine
II Cimetidine
III Ranitidine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Histamine (H2) Antagonists: Cimetidine, Ranitidine, Famotidine and Nizatidine.
98 Which class of drug are used to treat idiopathic and acquired autoimmune hemolytic
anemias?
I Valsartan
II Nifidipine
III Glucocorticoids
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Glucocorticoids ;These agents are used to treat idiopathic and acquired autoimmune hemolytic
anemias.
99 What is the pharmacological mechanism of clucocoticoids?
I inhibit phagocytosis of antibody-covered platelets

II induces phagocytosis of antibody-covered platelets
III Calcium channel blocker
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Glucocorticoids inhibit phagocytosis of antibody-covered platelets.
100 Which out of the following drug can be classified as Glucocorticoids?
I Valsartan
II Nifidipine
III Prednisone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Glucocorticoids; Prednisone
DEEP VEIN THROMBOSIS
1 What is the manifestation of Deep venous thrombosis (DVT) ?
I arterial thromboembolism
II arteria thrombolism
III venous thromboembolism
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Deep venous thrombosis (DVT) is a manifestation of venous thromboembolism.
2 What is the characteristics of DVT( Deep venous thrombosis)?
I occult
II resolves spontaneously with complication
III resolves spontaneously without complication
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Although most DVT is occult and resolves spontaneously without complication.
3 What are the symptoms of deep venous thrombosis (DVT) ?

I Headache
II Tenderness
III Edema
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Symptoms of deep venous thrombosis (DVT) may include the following:
 Edema - Most specific symptom
 Leg pain - Occurs in 50% of patients but is nonspecific
 Tenderness - Occurs in 75% of patients
 Warmth or erythema of the skin over the area of thrombosis
Clinical symptoms of pulmonary embolism (PE) as the primary manifestation
4 What are the symptoms of deep venous thrombosis (DVT) ?
I Leg pain
II joint pain
III Warmth or erythema of the skin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
5 which out of the following is true related to symptoms of deep venous thrombosis?
I Tenderness - Occurs in 75% of patients

II Edema - Most nonspecific symptom
III Leg pain - Occurs in 50% of patients but is nonspecific
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
6 Which out of the following is true related to diagnosis of deep venous thrombosis?
I single genetic finding is sufficient for diagnosis of DVT

II single physical finding is not sufficient for diagnosis of DVT
III combination of symptoms and signs is not sufficient for diagnosis of DVT
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
No single physical finding or combination of symptoms and signs is sufficiently accurate to establish
the diagnosis of DVT.
7 What are the physical findings in DVT?
I Variable discoloration of the lower extremity

II Calf pain on dorsiflexion of the foot
III Calf pain on dorsiflexion of the hand
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
But physical findings in DVT may include the following:

 Calf pain on dorsiflexion of the foot (Homans sign)
 A palpable, indurated, cordlike, tender subcutaneous venous segment
 Variable discoloration of the lower extremity
Blanched appearance of the leg because of edema (relatively rare
8 What are the physical findings in DVT?
I Variable discoloration of the upper extremity

II palpable, indurated, cordlike, tender subcutaneous venous segment
III Blanched appearance of the leg because of edema
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
but physical findings in DVT may include the following:

 Calf pain on dorsiflexion of the foot (Homans sign)
 A palpable, indurated, cordlike, tender subcutaneous venous segment
 Variable discoloration of the lower extremity
Blanched appearance of the leg because of edema (relatively rare
9 Which are the Potential complications of DVT ?
I Prethrombotic syndrome
II Postthrombotic syndrome
III Paradoxic emboli
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Potential complications of DVT include the following:

 As many as 40% of patients have silent PE when symptomatic DVT is diagnosed [4]
 Paradoxic emboli (rare)
 Recurrent DVT
Postthrombotic syndrome (PTS)
10 Which are the Potential complications of DVT?
I Paradoxic thrombi
II 40% of patients have silent PE
III Recurrent DVT
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Potential complications of DVT include the following:
 As many as 40% of patients have silent PE when symptomatic DVT is diagnosed [4]
 Paradoxic emboli (rare)
 Recurrent DVT
Postthrombotic syndrome (PTS)
11 What are manifestations of venous thromboembolism (VTE)?
I Deep vein thrombosis (DVT)

II Deep venous thrombosis (DVT)
III pulmonary embolism (PE)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
11 Deep venous thrombosis (DVT) and pulmonary embolism (PE) are manifestations of a single
disease entity, namely, venous thromboembolism (VTE).
12 Which out of the following is true for deep venous Thrombosis (DVT)?
I presence of coagulated blood, a thrombus

II one of the deep venous conduits that return blood to the heart
III one of the deep venous conduits that return blood to the organ
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
12 DVT is the presence of coagulated blood, a thrombus, in one of the deep venous conduits that
return blood to the heart.
13 How does the potentially life-threatening PE(Pulmonary embolism) occurs?
I thrombus may become fragmented or dislodged

II migrate to obstruct the arterial supply to the lung
III migrate to obstruct the arterial supply to the heart
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
However, if left untreated, the thrombus may become fragmented or dislodged and migrate to obstruct
the arterial supply to the lung, causing potentially life-threatening PE See the images below.
14 Which condition most commonly involves the deep veins of the leg or arm, often
resulting in potentially life-threatening emboli to the lungs or debilitating valvular
dysfunction and chronic leg swelling?
I DVT
II Pulmonary embolism
III venous embolism
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
DVT most commonly involves the deep veins of the leg or arm, often resulting in potentially life-
threatening emboli to the lungs or debilitating valvular dysfunction and chronic leg swelling.
15 What are the functions of the peripheral venous system?
I as a conduit to supply blood from the periphery to the heart and lungs
II as a reservoir to hold extra blood
III as a conduit to return blood from the periphery to the heart and lungs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The peripheral venous system functions both as a reservoir to hold extra blood and as a conduit to
return blood from the periphery to the heart and lungs.
16 Which out of the following are the well defined layers of arteries?
I a thick intima
II well-developed muscular media
III fibrous adventitia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Unlike arteries, which possess 3 well-defined layers (a thin intima, a well-developed muscular media,
and a fibrous adventitia), most veins are composed of a single tissue layer.
17 Which out of the following are the paired deep veins of calf?
I the anterior tibial veins, draining the dorsum of the foot

II the anterior tibial veins, draining the sole of the foot
III the posterior tibial veins, draining the sole of the foot
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
The calf has 3 groups of paired deep veins: the anterior tibial veins, draining the dorsum of the foot;
the posterior tibial veins, draining the sole of the foot; and the peroneal veins, draining the lateral
aspect of the foot.
18 Which factor are critically important in the development of venous thrombosis
described by Rudolf Virchow?
I activation of blood coagulation

II venous stasis
III formation of emboli
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Over a century ago, Rudolf Virchow described 3 factors that are critically important in the
development of venous thrombosis: (1) venous stasis, (2) activation of blood coagulation, and (3) vein
damage.
19 Factor described by Rudolf Virchow are also known as?
I the Virchow trio

II the Virchow triad
III the Virchow thrice
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
These factors have come to be known as the Virchow triad.
20 How venous stasis occur?
I emboli occur that obstructs the flow of venous blood

II anything that fasts or obstructs the flow of venous blood
III anything that slows or obstructs the flow of venous blood
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Venous stasis can occur as a result of anything that slows or obstructs the flow of venous blood.
21 Which out of the following factor is responsible of venous stasis?
I increase in viscosity and the formation of microthrombi

II thrombus that forms may then grow and propagate
III emboli that forms may then grow and propagate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
This results in an increase in viscosity and the formation of microthrombi, which are not washed
away by fluid movement; the thrombus that forms may then grow and propagate.
22 How does hypercoagulable state occur?
I due to a biomechanical imbalance between circulating factors

II due to a biochemical unbalance between circulating factors
III due to a biochemical imbalance between circulating factors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
A hypercoagulable state can occur due to a biochemical imbalance between circulating factors.
23 Which biochemical factors are responsible to development hypercoagulable state?
I decrease in circulating plasma thrombin and fibrinolysins

II decrease in circulating plasma antithrombin and fibrinolysins
III increase in circulating tissue activation factor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
A hypercoagulable state can occur due to a biochemical imbalance between circulating factors. This
may result from an increase in circulating tissue activation factor, combined with a decrease in
circulating plasma antithrombin and fibrinolysins
24 What contributes to the development of chronic venous insufficiency?
I vein valve destruction

II Decreased vein wall contractility
III vein valve dysfunction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Decreased vein wall contractility and vein valve dysfunction contribute to the development of chronic
venous insufficiency.
25 Which clinical symptoms are seen due to rise in ambulatory venous pressure?
I varicose veins
II venous ulceration
III Upper extremity edema
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The rise in ambulatory venous pressure causes a variety of clinical symptoms of varicose veins, lower
extremity edema, and venous ulceration.
26 Which out of the following is true for Thrombosis?
I homeostatic mechanism whereby emboli coagulates or clots

II homeostatic mechanism whereby blood coagulates or clots
III establishment of hemostasis after a wound
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Thrombosis is the homeostatic mechanism whereby blood coagulates or clots, a process crucial to the
establishment of hemostasis after a wound.
27 Which self-regulating steps of coagulation mechanism results in the production of a

fibrin clot?
I controlled by a number of relatively active cofactors or zymogen

II controlled by a number of relatively inactive cofactors or zymogens
III when activated Cofactors that promote or accelerate the clotting process.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
27 28 For the most part, the coagulation mechanism consists of a series of self-regulating steps that
result in the production of a fibrin clot. These steps are controlled by a number of relatively inactive
cofactors or zymogens, which, when activated, promote or accelerate the clotting process. These
reactions usually occur at the phospholipid surface of platelets, endothelial cells, or macrophages.
28 Where does the reaction of coagulation mechanism usually occur?

I at the phospholipid surface of platelets
II endothelial cells
III microphages
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
27 28 For the most part, the coagulation mechanism consists of a series of self-regulating steps that
result in the production of a fibrin clot. These steps are controlled by a number of relatively inactive
cofactors or zymogens, which, when activated, promote or accelerate the clotting process. These
reactions usually occur at the phospholipid surface of platelets, endothelial cells, or macrophages.
29 Initiation of coagulation process can be divided into-
I an intrinsic system
II an extrinsic system
III an intersic system
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The initiation of the coagulation process can be divided into 2 distinct pathways, an intrinsic system
and an extrinsic system (see the image below).
30 How does the extrinsic system of coagulation process operate?
I operates as the result of activation by tissue lipoprotein

II operates as the result of mechanical injury or trauma
III operates as the result of activation by tissue fibrinogen
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The extrinsic system operates as the result of activation by tissue lipoprotein, usually released as the
result of some mechanical injury or trauma.
31 Which out of the following is involved in the intrinsic system of coagulation process?
I circulating clotting factors

II circulating plasma factors
III circulating lipoprotein factors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The intrinsic system usually involves circulating plasma factors.
32 Which out of the following is key step during clot formation?
I conversion of prothrombin to thrombin (factor II)

II conversion of prethrombin to thrombin (factor II)
III conversion of fibrinogen to fibrin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Which is activated to form factor Xa. This in turn promotes the conversion of prothrombin to
thrombin (factor II). This is the key step in clot formation, for active thrombin is necessary for the
transformation of fibrinogen to a fibrin clot
33 What is the role of activated Thrombin?
I Transformation of fibrinogen to fibrin clot

II Transformation of prothrombin to thrombin
III Translation of fibrinogen to fibrin clot
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Which is activated to form factor Xa. This in turn promotes the conversion of prothrombin to
thrombin (factor II). This is the key step in clot formation, for active thrombin is necessary for the
transformation of fibrinogen to a fibrin clot.
34What is the role of plasmin in coagulation process?
I inactivates clotting factors VI

II digests fibrin
III inactivates clotting factors V
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Plasmin digests fibrin and also inactivates clotting factors V and VIII and fibrinogen.
35 Which factors are involved in body anticoagulant mechanisms that exist to prevent
inadvertent activation of the clotting process?
I thrombomodulin protein C
II heparin-antithrombin III (ATIII)
III thrombomodulin protein S
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Three naturally occurring anticoagulant mechanisms exist to prevent inadvertent activation of the
clotting process. These include the heparin-antithrombin III (ATIII), protein C and thrombomodulin
protein S, and the tissue factor inhibition pathways.
36 Which out of the following factor is affected during trauma?
I circulating ATIII is increased

II circulating ATII is decreased
III circulating ATIII is decreased
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
When trauma occurs, or when surgery is performed, circulating ATIII is decreased.
37 What can be demonstrated by histological examination of vein wall remodeling after

venous thrombosis?
I development of acute venous insufficiency

II imbalance in connective tissue matrix regulation
III loss of regulatory venous contractility
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Histological examination of vein wall remodeling after venous thrombosis has demonstrated an
imbalance in connective tissue matrix regulation and a loss of regulatory venous contractility that
contributes to the development of chronic venous insufficiency
38Which symptoms are common in patients who have large DVT?
I acute edema
II chronic edema
III Venous stasis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Venous stasis, venous reflux, and chronic edema are common in patients who have had a large DVT.
39 Which type of thrombi in the lower extremities tend to resolve spontaneously after
surgery?
I Most small emboli

II Most large thrombi
III Most small thrombi
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Most small thrombi in the lower extremities tend to resolve spontaneously after surgery.
40 What are the different forms of upper-extremity DVT?
I effort-induced thrombosis (Paget-von Schrötter syndrome)

II secondary thrombosis
III emboli-induced thrombosis (Paget-von Schrötter syndrome)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The 2 forms of upper-extremity DVT are (1) effort-induced thrombosis (Paget-von Schrötter
syndrome) and (2) secondary thrombosis.
41 Which out of the following is also known as Effort induced thrombosise?
I Paget-van Schrötter Syndrome

II Paget-von Schrötter Syndrome
III Paget-voan Schrötter Syndrome
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Effort induced thrombosis, or Paget-von Schrötter syndrome, accounts for 25% of cases.[48] Paget in
England and von Schrötter in Germany independently described effort thrombosis more than 100
years ago.
42 Which contributing factors are responsible for DVT in patients with secondary
thrombosis?
I hypocoagulability
II indwelling central venous catheters
III hypercoagulability
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
In 75% of patients with secondary thrombosis, hypercoagulability and/or indwelling central venous
catheters are important contributing factors.
43 How pulmonary embolism develops?
I II venous thrombi travel to pulmonary vein

II venous thrombi travel to pulmonary artery
III venous thrombi travel into the arota
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
PE develops as venous thrombi break off from their location of origin and travel through the right
heart and into the pulmonary artery, causing a ventilation perfusion defect and cardiac strain.
44 What are the frequent causes of DVT?
I augmentation of venous stasis

II peripheral venous obstruction
III central venous obstruction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
The frequent causes of DVT are due to augmentation of venous stasis due to immobilization or central
venous obstruction
45 What are the frequent causes of DVT?
I augmentation of venous stasis

II immobilization or central venous obstruction
III augmentation of veinstasis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
venous obstruction.
46 What is responsible for augmentation of venous stasis in DVT?
I central venous obstruction

II immobilization
III Peripheral venous obstruction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
venous obstruction.
47 What is also known as Compression of the iliac vein?
I May-Thurner syndrome
II May-Cocekett syndrome
III Cockett syndrome
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Compression of the iliac vein is also called May-Thurner syndrome or Cockett syndrome.
48 What is the Common cause of caval thrombosis?
I tumors involving the kidney or liver

II compression of the inferior vena cava due to tumour
III compression of the superior vena cava due to tumour
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Common causes of caval thrombosis include tumors involving the kidney or liver, tumors invading
the inferior vena cava, compression of the inferior vena cava by extrinsic mass, and retroperitoneal
fibrosis.
49 What is responsible for conversion of normal antithrombogenic endothelium to become

prothrombotic in DVT?
I thrombonectin
II von Willebrand factor
III Endothelial injury
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Endothelial injury can convert the normally antithrombogenic endothelium to become prothrombotic
by stimulating the production of tissue factor, von Willebrand factor, and fibronectin
50 What are the risk factors for Deep Vein Thrombosis (DVT)?
I Age
II Pregnancy and the postpartum period
III Immobilization for shorter period of time
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Risk factors
 Age
 Immobilization longer than 3 days
 Pregnancy and the postpartum period
 Major surgery in previous 4 weeks
 Long plane or car trips (> 4 hours) in previous 4 weeks
 Cancer
 Previous DVT
 Stroke
 Acute myocardial infarction (AMI)
 Congestive heart failure (CHF)
 Sepsis
 Nephrotic syndrome
 Ulcerative colitis
 Multiple trauma
 CNS/spinal cord injury
 Burns
 Lower extremity fractures
 Systemic lupus erythematosus (SLE) and the lupus anticoagulant
 Behçet syndrome
 Homocystinuria
 Polycythemia rubra vera
 Thrombocytosis
 Inherited disorders of coagulation/fibrinolysis
 Antithrombin III deficiency
 Protein C deficiency
 Protein S deficiency
 Prothrombin 20210A mutation
 Factor V Leiden
 Dysfibrinogenemias and disorders of plasminogen activation
 Intravenous (IV) drug abuse
 Oral contraceptives
 Estrogens
 Heparin-induced thrombocytopenia (HIT
I angina pectoris
II Cancer
III Congestive heart failure (CHF)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Risk factors
52What are the risk factors for Deep Vein Thrombosis (DVT)?
I Liver inflammation
II Nephrotic syndrome
III Ulcerative colitis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Risk factors
I Homocystinuria
II Polycythemia rubra vera
III Heterocystinuria
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Risk factors
I Antithrombin 20210A mutation

II Antithrombin III deficiency
III Protein C deficiency
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Risk factors
I Intravenous (IV) drug abuse

II Oral contraceptives
III Steroid abuse
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Risk factors
56 Which test stats the development of lower extremity thrombi during surgery?
I radioactive labeled thrombi

II radioactive labeled fibrin
III radioactive labeled fibrinogen
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Based on radioactive labeled fibrinogen, about half of lower extremity thrombi develop
intraoperatively.
57 Which factors contribute to the development of surgical venous thrombosis?
I Perioperative immobilization
II coagulation abnormalities
III Postoperative immobilization
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Perioperative immobilization, coagulation abnormalities, and venous injury all contribute to the
development of surgical venous thrombosis.
58 Which condition is most common in patients with idiopathic venous thrombosis?

I idiopathic thrombophilia
II Genetic thrombophilia
III Secondary thrombophilia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Genetic thrombophilia is identified in 30% of patients with idiopathic venous thrombosis.
59 Which coagulation inhibitors' deficiencies is associated with thrombotic events?
I thrombin
II protein S
III antithrombin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Primary deficiencies of coagulation inhibitors antithrombin, protein C, and protein S are associated
with 5-10% of all thrombotic events.
60 What is Antiphospholipid syndrome?
I disorder of the immune system

II antiphospholipid antibodies are associated with hypocoagulability
III antiphospholipid antibodies are associated with hypercoagulability
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Antiphospholipid syndrome is considered a disorder of the immune system, where antiphospholipid
antibodies (cardiolipin or lupus anticoagulant antibodies) are associated with a syndrome of
hypercoagulability.
61Whic out of the following is the most specific symptom of DVT?
I Edema
II venous obstruction
III Immobilization
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Edema is the most specific symptom of DVT.
62 Thrombus that involves the iliac bifurcation, the pelvic veins, or the vena cava
produces-
I leg edema that is usually lateral rather than unilateral

II leg edema that is usually bilateral rather than lateral
III leg edema that is usually bilateral rather than unilateral
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Thrombus that involves the iliac bifurcation, the pelvic veins, or the vena cava produces leg edema
that is usually bilateral rather than unilateral.
63 Which out of the following is the rare in DVT patient?
I Massive edema with hypotension

II Massive edema with cyanosis
III Massive edema with ischemia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Massive edema with cyanosis and ischemia (phlegmasia cerulea dolens) is rare.
64 What is the time-honored sign of DVT?
I Straight foot muscles

II Discomfort in the calf muscles on forced dorsiflexion of the foot
III straight knee
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The classic finding of calf pain on dorsiflexion of the foot (Homans sign) is specific but insensitive
and present in one half of patients with DVT.[87] Discomfort in the calf muscles on forced dorsiflexion
of the foot with the knee straight has been a time-honored sign of DVT.
65 What are the characteristics of Superficial thrombophlebitis?
I tender subcutaneous venous segment

II tender cutaneous venous segment
III Cordlike subcutaneous venous segment
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
65 Superficial thrombophlebitis is characterized by the finding of a palpable, indurated, cordlike,
tender, subcutaneous venous segment.
66 What is the most common abnormal hue for patients with venous thrombosis?
I reddish blue from venous engorgement
II reddish purple from venous engorgement
III reddish brown from venous engorgement
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Patients with venous thrombosis may have variable discoloration of the lower extremity. The most
common abnormal hue is reddish purple from venous engorgement and obstruction.
67 What is phlegmasia alba dolens ("painful white inflammation)?
I associated vascular pasm

II massive ileofemoral venous thrombosis
III clinical triad of pain, edema, and blanched appearance
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The clinical triad of pain, edema, and blanched appearance is termed phlegmasia alba dolens
thrombosis and associated arterial spasm. This is also known as milk-leg syndrome when it is
associated with compression of the iliac vein by the gravid uterus.
68 Which term is used to describe massive ileofemoral venous thrombosis and associated
arterial spasm?
I milk-leg syndrome
II milk-foot syndrome
III milk-knee syndrome
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The clinical triad of pain, edema, and blanched appearance is termed phlegmasia alba dolens
thrombosis and associated arterial spasm. This is also known as milk-leg syndrome when it is
associated with compression of the iliac vein by the gravid uterus.
69 Which out of the following emboli occurs in patient with cardiac defects (usually atrial
septal defect)?
I Pulmonary
II paradoxic
III illiac
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Although rare, paradoxic emboli can occur in patients with cardiac defects (usually atrial septal
defect), who are at risk for the passage of emboli to the arterial circulation and resultant stroke or
embolization of a peripheral artery.
70 Recurrent Deep Venous Thrombosis increases the risk of-
I pulmonary embolism
II postthrombotic syndrome
III coronary artery disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Recurrence increases the risk of postthrombotic syndrome (PTS) Recurrent Deep Venous Thrombosis.
71 Which out of the following are the symptoms of Postthrombotic Syndrome?

I mild erythema
II GI tract bleeding
III massive extremity swelling and ulceration
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Postthrombotic Syndrome; Symptoms range from mild erythema and localized induration to massive
extremity swelling and ulceration, usually exacerbated by standing and relieved by elevation of the
extremity.
72 Which test is recommended in selected patients with low pretest probability of DVT or
pulmonary embolism?
I high-sensitivity D-dimer
II Cardiography
III Stress Cardiography
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Second, in appropriately selected patients with low pretest probability of DVT or pulmonary
embolism, it is reasonable to obtain a high-sensitivity D-dimer.
73 Which test is recommended for the diagnosis of lower-extremity DVT?
I high-sensitivity D-dimer
II ultrasonography
III Angiography
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Third, in patients with intermediate to high pretest probability of lower-extremity DVT,
ultrasonography is recommended.
74 Which imaging studies are used for the diagnosis of pulmonary embolism?
I multidetector helical computed axial tomography (CT)

II echocardiogram
III Stress Cardiography
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Patients with intermediate or high pretest probability of pulmonary embolism require diagnostic
imaging studies.
Options include a ventilation-perfusion (V/Q) scan, multidetector helical computed axial tomography
(CT), and pulmonary angiography; however, CT alone may not be sufficiently sensitive to exclude
pulmonary embolism in patients who have a high pretest probability of pulmonary embolism.
I dopplar sonography
II Cardiography
III pulmonary angiography
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
imaging studies.
I ventilation-perfusion (V/P) scan
II ventilation-perfusion (V/Q) scan
III ventilation-perfusion (V/R) scan
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
imaging studies.
77 Which medical condition remains an underdiagnosed disease?
I coronary artery disease

II intracranial haemorrhage
III Venous thromboembolism
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Venous thromboembolism (VTE) remains an underdiagnosed disease, and most cases of pulmonary
embolism (PE) are diagnosed at autopsy.
78 Which method is main stay for the conclusion of DVT?
I Ultra sonography
II venography
III high-sensitivity D-dimer
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Conclusive diagnosis historically required invasive and expensive venography, which is still considered
the criterion standard.
79 Which out of the following initial screening test for is used for rapid screening of
DVT?
I simpler and cheaper D-dimer test

II venography
III Ultra sonography
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The recent validation of the simpler and cheaper D-dimer test as an initial screening test permits a
rapid, widely applicable screening that may reduce the rate of missed diagnoses.
80 Which out of the following Laboratory analysis has also been used in aiding the
diagnosis of venous thrombosis?
I Protein S
II protein C
III protein K
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Laboratory analysis has also been used in aiding the diagnosis of venous thrombosis. Protein S, protein
C, antithrombin III (ATIII), factor V Leiden, prothrombin 20210A mutation, antiphospholipid
antibodies, and homocysteine levels can be measured. Deficiencies of these factors or the presence of
these abnormalities all produce a hypercoagulable state.
I antithrombin IV
II antithrombin III
III factor V Leiden
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
I prothrombin 20210A mutation

II antiphospholipid antibodies
III antiphospholipid antigen
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
I Arginine levels
II cysteine levels
III homocysteine levels
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
84 What are D-dimers?
I degradation products of cross-linked fibrin by globulin

II degradation products of cross-linked fibrin by albumin
III degradation products of cross-linked fibrin by plasmin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
D-dimers are degradation products of cross-linked fibrin by plasmin that are detected by diagnostic
assays.
85 In which medical condition D-dimer level may be elevated?
I clot
II Hypotension
III recent surgery
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
D-dimer level may be elevated in any medical condition where clots form. D-dimer level is elevated
in trauma, recent surgery, hemorrhage, cancer, and sepsis.
86 what is the time period during which D-dimer levels remain elevated in DVT
I 14 days
II 7 days
III 1 day
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
D-dimer levels remain elevated in DVT for about 7 days.
87 Why D-dimer assay should only be used to rule out DVT, not to confirm the diagn osis
of DVT?
I it has a relatively poor specificity

II it has a relatively higher specificity
III it has a relatively moderate specificity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The D-dimer assay has a high sensitivity (up to 97%); however, it has a relatively poor specificity (as
low as 35%)[95] and therefore should only be used to rule out DVT, not to confirm the diagnosis of
DVT.
88 What is the limitation of Traditional enzyme-linked immunosorbent assays (ELISAs) in

DVT?
I time-consuming
II not practical for use in the emergency department
III practical for use in the emergency department
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Traditional enzyme-linked immunosorbent assays (ELISAs), although accurate, are time-consuming
and not practical for use in the emergency department.
89 Which out of the following test is sensitive for proximal vein DVT but less so for calf
vein DVT?
I Ultra sonography
II Angiography
III rapid qualitative red blood cell agglutination assay
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
A rapid qualitative red blood cell agglutination assay (SimpliRED) is available. It is sensitive for
proximal vein DVT but less so for calf vein DVT.
90 Why Ultrasonography is the current first-line imaging examination for DVT?
I Expensive
II relative ease of use
III absence of irradiation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Ultrasonography is the current first-line imaging examination for DVT because of its relative ease of
use, absence of irradiation or contrast material, and high sensitivity and specificity in institutions
with experienced sonographers.
91Which out of the following is the current first-line imaging examination method for
DVT?
I Angiography
II D-dimer test
III Ultrasonography
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Ultrasonography is the current first-line imaging examination for DVT because of its relative ease of
use, absence of irradiation or contrast material, and high sensitivity and specificity in institutions
with experienced sonographers.
92 What is the limitation of venography?
I Non-invasive nature
II invasive nature
III significant consumption of resources
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The criterion standard to diagnostic imaging for DVT remains venography with pedal vein
cannulation, intravenous contrast injection, and serial limb radiographs. However, the invasive
nature and significant consumption of resources are only 2 of its many limitations.
93 What is the limitation of impedance plethysmography?
I insensitivity for calf vein thrombosis

II insensitivity for nonoccluding proximal vein thrombus
III sensitivity for calf artery thrombosis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Impedance plethysmography (IPG) has been the initial noninvasive diagnostic test of choice and has
been shown to be sensitive and specific for proximal vein thrombosis. However, IPG also has several
other limitations; among them are insensitivity for calf vein thrombosis, nonoccluding proximal vein
thrombus, and iliofemoral vein thrombosis above the inguinal ligament.
94 Which out of the following is the initial non-invasive diagnostic test of choice for
DVT?
I venography
II cardiography
III impedance plethysmography
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Impedance plethysmography (IPG) has been the initial noninvasive diagnostic test of choice and has
been shown to be sensitive and specific for proximal vein thrombosis. However, IPG also has several
other limitations; among them are insensitivity for calf vein thrombosis, nonoccluding proximal vein
thrombus, and iliofemoral vein thrombosis above the inguinal ligament.
95 Which out of the following is the diagnostic test of choice for suspected iliac vein or
inferior vena caval thrombosis when CT venography is contraindicated or technically
inadequate?
I CT-scan
II MRI
III sonography
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
MRI is the diagnostic test of choice for suspected iliac vein or inferior vena caval thrombosis when CT
venography is contraindicated or technically inadequate.
96 Which out of the following different unit are used to express D-dimer assay result?
I fibrinogen equivalent units
II fibrinogen units
III nanograms per milliliter
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Different units may be used; some assay results are reported as fibrinogen equivalent units (FEU) and
others in nanograms per milliliter (ng/mL).
97 What is the Wells DVT score in person with no low-to-moderate risk of DVT?
I>2
II = 2
III < 2
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
A negative D-dimer assay result rules out DVT in patients with low-to-moderate risk (Wells DVT
score < 2).
98 Which out of the following is true for negative D-dimer assay result?
I It has high specificity

II obviates surveillance and serial testing
III It has poor sensitivity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
A negative result also obviates surveillance and serial testing in patients with moderate-to-high risk
and negative ultrasonographic findings.
99 What is the Wells DVT score in patients with a moderate-to-high risk of DVT?
I >2
II < 2
III = 2
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
All patients with a positive D-dimer assay result and all patients with a moderate-to-high risk of
DVT (Wells DVT score >2) require a diagnostic study (duplex ultrasonography).
100 Which diagnostic study is performed in patient with Wells DVT score >2?
I duplex ultrasonography
II MRI
III CT-scan
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
All patients with a positive D-dimer assay result and all patients with a moderate-to-high risk of
DVT (Wells DVT score >2) require a diagnostic study (duplex ultrasonography).
1 What are the primary objectives for the treatment of deep venous thrombosis (DVT)?
I maximize the risk of developing the postthrombotic syndrome

II to develop pulmonary embolism
III reduce morbidity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The primary objectives for the treatment of deep venous thrombosis (DVT) are to prevent pulmonary
embolism (PE), reduce morbidity, and prevent or minimize the risk of developing the postthrombotic
syndrome (PTS)
2 What are the primary objectives for the treatment of deep venous thrombosis (DVT)?
I to prevent pulmonary embolism

II minimize the risk of developing the postthrombotic syndrome
III to prevent hypertension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The primary objectives for the treatment of deep venous thrombosis (DVT) are to prevent pulmonary
embolism (PE), reduce morbidity, and prevent or minimize the risk of developing the postthrombotic
syndrome (PTS).
3 Which class of the drug is main stay for the treatment of deep venous thrombosis
(DVT)?
I Analgesic
II Anticoagulation
III Plasminogen activator
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The mainstay of medical therapy has been anticoagulation since the introduction of heparin in the
1930s.
4 What is the contraindication of Anticoagulant therapy?
I Hypotension
II Diabetes
III intracranial bleeding
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Absolute contraindications to anticoagulation treatment include intracranial bleeding, severe active
bleeding, recent brain, eye, or spinal cord surgery, pregnancy, and malignant hypertension.
5 What is the contraindication of Anticoagulant therapy?
I malignant hypertension
II Diabetes
III pulmonary congestion
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Absolute contraindications to anticoagulation treatment include intracranial bleeding, severe active
bleeding, recent brain, eye, or spinal cord surgery, pregnancy, and malignant hypertension.
6 What is the relative contraindication of Anticoagulant therapy?
I Hypotension
II hyperthyroidism
III recent cerebrovascular accident
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Relative contraindications include recent major surgery, recent cerebrovascular accident, and severe
thrombocytopenia.
I hyperthyroidism
II severe thrombocytopenia
III hypothyroidism
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
thrombocytopenia.
I recent accident
II recent minor surgery
III recent major surgery
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
thrombocytopenia.
9 Which class of the drug are used to treat DVT in an outpatient setting?
I Plasminogen activator
II LMWH
III Streptokinase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Acute DVT may be treated in an outpatient setting with LMWH.
10 What is the duration of anticoagulant therapy in DVT patient?
I 3-12 months
II 4-15 months
III 5-17 months
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Anticoagulant therapy is recommended for 3-12 months depending on site of thrombosis and on the
ongoing presence of risk factors.
11 What are the exclusion criteria for outpatient management in DVT patient?
I proven concomitant PE
II Significant cardiovascular or pulmonary comorbidity
III trauma
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Exclusion criteria for outpatient management are as follows:
 Suspected or proven concomitant PE
 Significant cardiovascular or pulmonary comorbidity
I Contraindications to analgesic
II Iliofemoral DVT
III Contraindications to anticoagulation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Iliofemoral DVT
 Contraindications to anticoagulation
I Familial bleeding disorder

II parents with obesity
III Pregnancy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Familial bleeding disorder
 Pregnancy
I homesick
II Unable to follow instructions
III Homeless
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Unable to follow instructions
 Homeless
15 What is the initial dose of warfarin in DVT patients?
I 5 mg PO daily
II 6 mg PO daily
III 7 mg PO daily
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Warfarin 5 mg PO daily is initiated and overlapped for about 5 days until the international
normalized ratio (INR) is therapeutic >2 for at least 24 hours.
16 What is the goal of warfarin treatment in DVT patients?
I given for about 5 days until the international normalized ratio (INR) is therapeutic >2 for at least
24 hours
II given for about 6 days until the international normalized ratio (INR) is therapeutic >2 for at
least 24 hours
III given for about 7 days until the international normalized ratio (INR) is therapeutic >2 for at
least 24 hours
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Warfarin 5 mg PO daily is initiated and overlapped for about 5 days until the international
normalized ratio (INR) is therapeutic >2 for at least 24 hours.
17 Which parameters are monitored in admitted patients treated with unfractionated
heparin (UFH)?
I heparin activity level must be monitored every 5 hours

II heparin activity level must be monitored every 6 hours
III heparin activity level must be monitored every 7 hours
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
For admitted patients treated with UFH, the activated partial thromboplastin time (aPTT) or
heparin activity level must be monitored every 6 hours while the patient is taking intravenous (IV)
heparin until the dose is stabilized in the therapeutic range.
18 When Heparin or LMWH is discontinued in DVT patient?
I platelet count greater than 75,000

II platelet count falls below 75,000
III platelet count falls below 75, 0000
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Platelets should be monitored. Heparin or LMWH should be discontinued if the platelet count falls
below 75,000.
19 Which out of the following is not associated with the use of Fondaparinux?
I bleeding
II hepatin-induced thrombocytopenia
III intracranial haemorrhage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Fondaparinux is not associated with hepatin-induced thrombocytopenia (HIT).
20 Why Anticoagulant therapy remains the mainstay of medical therapy for DVT?
I therapy is cheap
II it is noninvasive
III it has a low risk of complications
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Anticoagulant therapy remains the mainstay of medical therapy for DVT because it is noninvasive,
it treats most patients (approximately 90%) with no immediate demonstrable physical sequelae of
DVT, it has a low risk of complications, and its outcome data demonstrate an improvement in
morbidity and mortality.
21 When Long-term anticoagulation therapy is required for DVT?
I to prevent the high frequency of recurrent venous thrombosis

II to prevent the high frequency of recurrent artrial thrombosis
III to prevent the high frequency of thromboembolic events
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Long-term anticoagulation is necessary to prevent the high frequency of recurrent venous thrombosis
or thromboembolic events.
22 Which out of the following is correct related to the use of Anticoagulant in DVT?
I it does not remove the thrombus

II it removes clot
III does not have risk of bleeding
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Although it inhibits propagation, it does not remove the thrombus, and a variable risk of clinically
significant bleeding is observed.
23 Which out of the following Heparin products are used in the treatment of deep venous
thrombosis?
I fractionated heparin
II unfractionated heparin
III low molecular weight heparin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Heparin products used in the treatment of deep venous thrombosis (DVT) include unfractionated
heparin and low molecular weight heparin (LMWH).
24 Which out of the following is correct related to the use of Heparin in DVT?
I increase the incidence of fatal and nonfatal pulmonary embolism

II prevents extension of the thrombus
III reduce the incidence of fatal and nonfatal pulmonary embolism
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Heparin prevents extension of the thrombus and has been shown to significantly reduce (but not
eliminate) the incidence of fatal and nonfatal pulmonary embolism and recurrent thrombosis.
25 What is the Pharmacological mechanism of larger fragment of heparin?
I interacting with antithrombin II

II interacting with antithrombin III
III interacting with antithrombin IV
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The larger fragments exert their anticoagulant effect by interacting with antithrombin III (ATIII) to
lant, inactivates thrombin and inhibits the
activity of activated factor X in the coagulation process.
26 What is the Pharmacological mechanism of low-molecular-weight fragments of heparin?
I inhibiting the activity of activated factor IX

II inhibiting the activity of activated factor X
III inhibiting the activity of activated factor XI
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The low-molecular-weight fragments exert their anticoagulant effect by inhibiting the activity of
activated factor X.
27 What is responsible for hemorrhagic complications attributed to heparin?
I from the larger higher-molecular-weight fragments

II LMWH
III fractionated heparin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The hemorrhagic complications attributed to heparin are thought to arise from the larger higher-
molecular-weight fragments.
28 How LMWH is prepared?
I from fractionated heparin

II from unfractionated heparin
III from both fractionated and unfractionated heparin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
LMWH is prepared by selectively treating unfractionated heparin to isolate the low molecular weight
(< 9000 Da) fragments.
29 What is the pharmacological mechanism of Fondaparinux?
I direct selective inhibitor of factor XI

II direct selective inhibitor of factor XII
III direct selective inhibitor of factor Xa
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Fondaparinux, a direct selective inhibitor of factor Xa, overcomes many of the aforementioned
disadvantages of LMWHs.
30 What is the dose of Fondaparinux in DVT patient?
I single dose of 3.5 mg

II single dose of 5.5 mg
III single dose of 7.5 mg
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Furthermore, a single dose of 7.5 mg is effective over a wide range of patient weights between 50 and
100 kg.
31 What is the pharmacological mechanism of Rivaroxaban?
I factor XI inhibitor
II factor Xa inhibitor
III factor Xb inhibitor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Rivaroxaban (Xarelto) is an oral factor Xa inhibitor approved by the FDA in November 2012 for
treatment of DVT or PE and for reduction of the risk of recurrent DVT and PE after initial
treatment.
32 What is the role of Rivaroxaban in DVT patient?
I reduction of the risk of recurrent DVT and PE after initial treatment

II removes thrombus
III prevents hypotension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
treatment.
33 Which out of the following oral factor Xa inhibitor was approved by the FDA in
November 2012 for the treatment of DVT?
I Aspirin
II streptokinase
III Rivaroxaban
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
treatment.
34 What is the role of apixaban in DVT patient?
I treatment of DVT and PE who have undergone hip- or knee-replacement surgery

II prophylaxis of DVT and PE who have undergone hip- or knee-replacement surgery
III prophylaxis of bleeding and PE who have undergone hip- or knee-replacement surgery
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
In March 2014, the FDA approved apixaban (Eliquis) for the additional indication of prophylaxis
of DVT and PE in adults who have undergone hip- or knee-replacement surgery.
35 What is the pharmacological mechanism of Dabigatran?
I inhibit free thrombus

II inhibits thrombus-induced platelet aggregation
III inhibits free and clot-bound thrombin and thrombin-induced platelet aggregation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Dabigatran (Pradaxa) inhibits free and clot-bound thrombin and thrombin-induced platelet
aggregation.
36 Which out of the following drug was approved in 2010 to reduce the risk of stroke and
systemic embolism in patients with nonvalvular atrial fibrillation?
I streptokinase
II apixaban
III Dabigatran
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Dabigatran; This agent was approved in 2010 to reduce the risk of stroke and systemic embolism in
patients with nonvalvular atrial fibrillation.
37 Which out of the following was approved for the treatment of DVT and PE in patients
who have been treated with a parenteral anticoagulant for 5-10 days?
I Enoxaparine
II Dabigatran
III streptokinase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Dabigatran; In April 2014, it was approved for the treatment of DVT and PE in patients who have
been treated with a parenteral anticoagulant for 5-10 days.
38 Which out of the following was approved to reduce the risk of DVT and PE recurrence
in patients who have been previously treated with anticoagulant?
I Dabigatran
II Rivaroxaban
III streptokinase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
38 Additionally, it was approved to reduce the risk of DVT and PE recurrence in patients who have
been previously treated.
39 What is the treatment period in patient with first episode of DVT?
I for 3-6 months

II for 5-16 months
III for 5-10 months
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
For the first episode of DVT, patients should be treated for 3-6 months. Recurrent episodes should be
treated for at least 1 year.
40 What is the treatment period in patient with recurrent episode of DVT?
I 2 years
II 3 years
III for at least 1 year
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
For the first episode of DVT, patients should be treated for 3-6 months. 40 Recurrent episodes should
be treated for at least 1 year.
41 Which out of the following patients have higher rate of DVT recurrence?
I diabetic patients
II hypertension patients
III cancer patients
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Patients with cancer have a particularly higher rate of DVT recurrence than noncancer patients.
42 What should be the therapy for the patients with recurrent episodes of venous
thrombosis regardless of the cause?
I Anticoagulant
II Indefinite therapy
III plasminogen activator
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Indefinite therapy is recommended for patients with recurrent episodes of venous thrombosis regardless
of the cause.
43 Which out of the following are High-risk populations for developing DVT?
I patient with <65 y with a history of stroke

II patient with >65 y with a history of stroke
III patient with >65 y with a history of GI bleeding
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
High-risk populations (>65 y with a history of stroke, GI bleed, renal insufficiency, or diabetes) have
a 5-23% risk of having major hemorrhage at 90 days.
44 Which out of the following condition are associated with the use of anticoagulant?
I Postural hypotension
II hematemesis
III GI hemorrhage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Significant bleeding (ie, hematemesis, hematuria, GI hemorrhage) should be thoroughly investigated
because anticoagulant therapy may unmask a preexisting disease (eg, cancer, peptic ulcer disease,
arteriovenous malformation).
45 What should be done in patient who develops haemorrhage while receiving heparin?
I discontinuing the heparin

II decrease dose of heparin
III decreasing absorption of heparin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Patients who hemorrhage while receiving heparin are best treated by discontinuing the drug.
46 What is the antidote for the intracranial or massive gastrointestinal bleeding cau sed by
heparine?
I Ramipril
II protamine
III quinidine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
For severe hemorrhage, such as intracranial or massive gastrointestinal bleeding, heparin may be
neutralized by protamine at a dose of 1 mg for every 100 units. Protamine should be administered at
the same time that the infusion is stopped.
47 What is the dose of protamine in heparin overdose?
I 0.5 mg protamine for every 100 units

II 1 mg protamine for every 100 units
III 1.5 mg protamine for every 100 units
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
48 Which out of the following is correct for the use of protamine during haemorrhage due
to heparin?
I Protamine should be given orally

II Protamine should be administered at the same time that the infusion is stopped
III Protamine should be administered after 1 hr
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
49 Which risk factors are responsible for bleeding in patient on warfarin ?
I drug interactions
II poor follow-up
III Diabetes
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The risk of bleeding on warfarin is not linearly related to the elevation of the INR. The risk is
conditioned by other factors, including poor follow-up, drug interactions, age, and preexisting
disorders that predispose to bleeding.
50 Which risk factors are responsible for bleeding in patient on warfarin?
I Sex
II preexisting disorders that predispose to bleeding
III age
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The risk of bleeding on warfarin is not linearly related to the elevation of the INR. The risk is
conditioned by other factors, including poor follow-up, drug interactions, age, and preexisting
disorders that predispose to bleeding.
51 What is the treatment for the patient who hemorrhage while receiving oral warfarin?
I withholding the drug and administering vitamin E

II withholding the drug and administering vitamin C
III withholding the drug and administering vitamin K
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Patients who hemorrhage while receiving oral warfarin are treated by withholding the drug and
administering vitamin K.
52 What is used to manage Severe life-threatening hemorrhage?
I fresh frozen plasma in addition to vitamin E

II fresh frozen plasma in addition to vitamin C
III fresh frozen plasma in addition to vitamin K
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Severe life-threatening hemorrhage is managed with fresh frozen plasma in addition to vitamin K.
53 Which out of the following is used for CNS hemorrhage?
I Recombinant factor VIIa

II Recombinant factor VIa
III Recombinant factor Va
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Recombinant factor VIIa is another option especially for CNS hemorrhage.
54 What are the complications of anticoagulant therapy in DVT patient?
I anuria
II Systemic embolism
III Chronic venous insufficiency
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Additional complications include the following:
 Systemic embolism
 Chronic venous insufficiency
 PTS (ie, pain and edema in the affected limb without new clot formation)
 Soft tissue ischemia associated with massive clot and very high venous pressures - phlegmasia
cerulea dolens
55 What are the complications of anticoagulant therapy in DVT patient?
I Soft tissue ischemia

II anuria
III hypotension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Additional complications include the following:
 Systemic embolism
 Chronic venous insufficiency
 PTS (ie, pain and edema in the affected limb without new clot formation)
 Soft tissue ischemia associated with massive clot and very high venous pressures - phlegmasia
cerulea dolens
56 What are the qualities of an ideal anticoagulant agent for DVT?
I Expensive
II ease of administration
III efficacy and safety
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The qualities desired in the ideal anticoagulant are ease of administration, efficacy and safety (with
minimal complications or adverse effects), rapid onset, a therapeutic half-life, and minimal or no
monitoring.
57 Which out of the following are newer anticoagulants?
I idraparinux
II razaxaban
III Heparin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
A partial listing of these emerging new anticoagulants includes razaxaban, idraparinux, bivalirudin,
lepirudin, and ximelagatran.
58 Which out of the following are newer anticoagulants?
I aspirin
II ximelagatran
III streptokinase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
A partial listing of these emerging new anticoagulants includes razaxaban, idraparinux, bivalirudin,
lepirudin, and ximelagatran.
59 Which factor increases the risk of bleeding when the thrombolytic medication is
administered?
I hyperthyroidism
II recent surgery
III stroke
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The need should be compelling when thrombolysis is considered in a setting of known
contraindications. Factors such as recent surgery, stroke, GI or other bleeding, and underlying
coagulopathy increase the bleeding risk when the thrombolytic medication is administered.
60 What is Percutaneous trAns:catheter treatment in patients with deep venous thrombosis

(DVT)?
I thrombus removal with catheter-directed thromboembolism

II thrombus removal with catheter-directed thrombolysis
III thrombus removal with catheter-directed lysis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Percutaneous trAns:catheter treatment of patients with deep venous thrombosis (DVT) consists of
thrombus removal with catheter-directed thrombolysis, mechanical thrombectomy, angioplasty,
and/or stenting of venous obstructions.
61 What is the goal behind the development of Percutaneous mechanical thrombectomy i n

DVT?
I avoid costly ICU stays during thrombolytic infusion
II to shorten treatment time
III to increase treatment time
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Percutaneous mechanical thrombectomy has developed as an attempt to shorten treatment time and
avoid costly ICU stays during thrombolytic infusion.
62 Which is the basic mechanical method for thrombectomy?
I thromboaspiration
II thromboabsorption
III Percutaneous trAns:catheter
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The most basic mechanical method for thrombectomy is thromboaspiration, or the aspiration of
thrombus through a sheath.
63 What is the disadvantage of mechanical disruption of venous thrombosis in DVT?
I invasive procedure
II damaging venous endothelium
III damaging valves
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Mechanical disruption of venous thrombosis has the potential disadvantage of damaging venous
endothelium and valves, in addition to thrombus fragmentation and possible pulmonary embolism.
64 When is surgical thrombus removal performed in DVT?
I intracranial bleeding
II GIT bleeding
III massive swelling and phlegmasia cerulea dolens
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Surgical thrombus removal has traditionally been used in patients with massive swelling and
phlegmasia cerulea dolens.
65 Which method is a more reliable guide to the anatomy and the pathology of DVT?
I MRI
II venography
III CT scan
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Duplex ultrasonography may sometimes be sufficient for this purpose, but venography (including
routine contralateral iliocavography) is a more reliable guide to the anatomy and the particular
pathology that must be addressed.
66 Which method may be used to reduce the likelihood of embolization?
I MRI
II proximal balloon
III temporary caval filter
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
A proximal balloon or a temporary caval filter may be used to reduce the likelihood of embolization.
67 Which method is mandatory to confirm the clearance of the thrombus?
I MRI
II CT scan
III Venography
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Venography is mandatory to confirm the clearance of the thrombus.
68 Which drug is initiated before surgery to reduce the likelihood of rethrombosis?
I heparin
II enoxaparine
III streptokinase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
To reduce the likelihood of rethrombosis, heparin anticoagulation is usually initiated before surgery,
continued during the procedure, and maintained for 6-12 months afterward.
69 Which out of the following devices are useful to maintain venous flow?
I Leg compression devices

II ventilator
III pulmonary ventilator
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Leg compression devices are useful to maintain venous flow.
70 Which out of the following was developed in an attempt to trap emboli and minimize
venous stasis?
I superior vena cava filters

II Inferior vena cava filters
III pulmonary artery filters
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Inferior vena cava filters were developed in an attempt to trap emboli and minimize venous stasis.
71 What is the mechanism of inferior vena cava filter?
I it is mechanical barrier to the flow of emboli larger than 1 mm

II it is mechanical barrier to the flow of emboli larger than 2.5 mm
III it is mechanical barrier to the flow of emboli larger than 4 mm
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
An inferior vena cava filter is a mechanical barrier to the flow of emboli larger than 4 mm.
72 Which out of the following is inferior vena cava filter?

I Greenfield filter
II Greenleaf filter
III Greenford filter
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Many different filter configurations have been used, but the current benchmark remains the
Greenfield filter with the longest long-term data.
73 Which out of the following are the American Heart Association recommendations for
the use of inferior vena cava filters?
I No thromboembolism while on anticoagulation

II Confirmed acute proximal DVT or acute PE in patient with contraindication for
anticoagulation
III No bleedingc omplications
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
American Heart Association recommendations for inferior vena cava filters include the following [10] :
 Confirmed acute proximal DVT or acute PE in patient with contraindication for
anticoagulation (this remains the most common indication for inferior vena cava filter
placement)
 Recurrent thromboembolism while on anticoagulation
 Active bleeding complications requiring termination of anticoagulation therapy
74 Which out of the following are the American Heart Association recommendations for
the use of inferior vena cava filters?
I Active bleeding complications requiring termination of anticoagulation therapy

II acute PE
III Recurrent thromboembolism while on anticoagulation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
American Heart Association recommendations for inferior vena cava filters include the following [10] :
 Confirmed acute proximal DVT or acute PE in patient with contraindication for
anticoagulation (this remains the most common indication for inferior vena cava filter
placement)
 Recurrent thromboembolism while on anticoagulation
 Active bleeding complications requiring termination of anticoagulation therapy
75 Which out of the following are the Relative contraindications for the use of inferior
vena cava filters?
I Large, free-floating iliofemoral thrombus in high-risk patients

II Chronic PE in patient with pulmonary hypertension
III Patient with no fall risk
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Relative contraindications include the following:
 Large, free-floating iliofemoral thrombus in high-risk patients
 Propagating iliofemoral thrombus while on anticoagulation
 Chronic PE in patient with pulmonary hypertension and cor pulmonale
 Patient with significant fall risk
76 Which out of the following is correct related to the heparin use in DVT?
I prevents accumulation of a clot

II prevents reaccumulation of a clot after a spontaneous fibrinolysis
III prevents reaccumulation of a clot after a spontaneous thrombus
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Heparin prevents reaccumulation of a clot after a spontaneous fibrinolysis.
77 What is the pharmacological mechanism of Heparin?
I augments activity of antithrombin III and prevents conversion of fibrinogen to fibrin

II augments activity of antithrombin II and prevents conversion of fibrinogen to fibrin
III augments activity of antithrombin I and prevents conversion of fibrinogen to fibrin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Heparin augments activity of antithrombin III and prevents conversion of fibrinogen to fibrin.
78 Which drug belongs to the class Anticoagulants?
I Aspirin
II Rivaroxaban
III Apixaban
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Anticoagulants; Rivaroxaban, Apixaban, Fondaparinux sodium, Heparin.
79 Which drug belongs to the class Anticoagulants?
I streptokinase
II Heparin
III Fondaparinux
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Anticoagulants; Rivaroxaban, Apixaban, Fondaparinux sodium, Heparin.
80 Which drug is used in treatment of DVT and PE as well as DVT prophylaxis?
I Aspirin
II Enoxaparin
III streptokinase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Enoxaparin is an LMWH used in treatment of DVT and PE as well as DVT prophylaxis.
81 What is the pharmacological mechanism of Dalteparin?
I inhibition of factor XIa and thrombin

II inhibition of factor XI and thrombin
III inhibition of factor Xa and thrombin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Dalteparin enhances inhibition of factor Xa and thrombin by increasing antithrombin III activity.
82 What is the molecular weight of Low-molecular-weight-heparin?
I < 9000 Da
II < 10000 Da
III < 11000 Da
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Low-molecular-weight-heparin (LMWH) is prepared by selectively treating UFH to isolate the low
molecular weight (< 9000 Da) fragments.
83 Which drug belongs to the class Low Molecular Weight Heparins?
I Dalteparin
II heparin
III Enoxaparin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Low Molecular Weight Heparins; Dalteparin, Enoxaparin, Tinzaparin.
84 What is correct related to the use of heparin in DVT?
I dose must be individualized and adjusted to maintain INR at 2-3

II dose must be individualized and adjusted to maintain INR at 3-4
III dose must be individualized and adjusted to maintain INR at 4-5
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Warfarin ;The dose must be individualized and adjusted to maintain INR at 2-3.
85 What is the pharmacological mechanism of vitamin K antagonist?
I interfere with the interaction between vitamin K and coagulation factors III, VII, IX, and X
II interfere with the interaction between vitamin K and coagulation factors II, VIII, IX, and X
III interfere with the interaction between vitamin K and coagulation factors II, VII, IX, and X
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The mechanism of action is to interfere with the interaction between vitamin K and coagulation
factors II, VII, IX, and X. Vitamin K acts as a cofactor at these levels.
86 Which drug belongs to the class vitamin K antagonist?
I Heparin
II Warfarin
III Aspirin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Vitamin K Antagonists; Warfarin.
87 Which therapeutic agents are used to dissolve a pathologic intraluminal thrombus or

embolus that has not been dissolved by the endogenous fibrinolytic system?
I Thrombolytic
II Antiplatelet
III calcium channel blocker
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Thrombolytic ;These agents are used to dissolve a pathologic intraluminal thrombus or embolus that
has not been dissolved by the endogenous fibrinolytic system.
88 Which drug belongs to the class Thrombolytc?
I streptokinase
II Urokinase
III Tenecteplase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Thrombolytic; Tenecteplase
89 What is the pharmacological mechanism of Urokinase?
I indirect plasminogen activator

II direct plasminogen activator
III direct plasmid activator
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Urokinase is a direct plasminogen activator isolated from human fetal kidney cells grown in culture.
90 Which out of the following is true for Urokinase isolation?
I isolated from human fetal kidney cells grown in culture

II isolated from human adult kidney cells grown in culture
III isolated from human aged kidney cells grown in culture
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Urokinase is a direct plasminogen activator isolated from human fetal kidney cells grown in culture.
91 Which out of the following is true for Reteplase?
I used in the management of acute hypotension

II produced by recombinant DNA
III used in the management of acute myocardial infarction, acute ischemic stroke and PE
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Reteplase is a tPA produced by recombinant DNA and used in the management of acute myocardial
infarction, acute ischemic stroke, and PE.
92 What is the pharmacological mechanism of Streptokinase?
I acts with plasminogen to convert plasminogen to plasmin

II acts with plasminogen to convert plasminogen to fibrin
III acts with plasminogen to convert plasminogen to fibrinogen
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Streptokinase acts with plasminogen to convert plasminogen to plasmin.
93 Which out of the following is true for Reteplase?
I it is a thrombolytic agent
II It is anticoagulant
III It is a tissue plasminogen activator
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Alteplase is a thrombolytic agent for DVT or PE. It is a tissue plasminogen activator (tPA) produced by
recombinant DNA and used in the management of acute myocardial infarction, acute ischemic stroke, and
PE.
94 Which drug is used to treat blood clots (such as in deep vein thrombosis-DVT or
pulmonary embolus-PE) and to prevent the blood clots from forming again?
I warfarin
II heparin
III Rivaroxaban
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
RIVAROXABAN; It is also used to treat blood clots (such as in deep vein thrombosis-DVT or
pulmonary embolus-PE) and to prevent the blood clots from forming again.
95 Which drug is used to prevent blood clots from forming due to a certain irregular
heartbeat (atrial fibrillation) or after hip or knee replacement surgery?
I warfarin
II protamine
III Rivaroxaban
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Rivaroxaban is used to prevent blood clots from forming due to a certain irregular heartbeat (atrial
fibrillation) or after hip or knee replacement surgery.
96 Which drug is used to prevent serious blood clots from forming due to a certain
irregular heartbeat (atrial fibrillation) or after hip/knee replacement surgery?
I streptokinase
II Apixaban
III urokinase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Apixaban is used to prevent serious blood clots from forming due to a certain irregular heartbeat
(atrial fibrillation) or after hip/knee replacement surgery.
97 What is the side effect of apixaban?
I tachycardia
II Nausea
III easy bruising
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
97 apixaban ; Nausea, easy bruising, or minor bleeding (such as nosebleed, bleeding from cuts) may
occur.
98 Which out of the following is true for apixaban?
I it does not cause nausea

II patient should tell doctor or pharmacist if he is allergic to it
III it does not cause easy bruising
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Apixaban ;Before taking apixaban, tell your doctor or pharmacist if you are allergic to it; or if you
have any other allergies.
99 Which out of the following drug have interation with Apixaban?
I clopidogrel
II mifepristone
III heparin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Apixaban; Some products that may interact with this drug include: mifepristone, other drugs that can
cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, "blood thinners" such as
warfarin, enoxaparin), certain antidepressants (including SSRIs such as fluoxetine, SNRIs such as
venlafaxine.
100 What are the Symptoms of overdose of apixaban?
I bloody/black/tarry stools
II anuria
III prolonged bleeding
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Apixaban; Symptoms of overdose may include: bloody/black/tarry stools, pink/dark urine,
unusual/prolonged bleeding.
HEMORRHAGIC STROKE
1 Which is true for hemorrhagic stroke?
I bleeding occurs directly into the brain parenchyma

II bleeding occurs directly into the brain stroma
III bleeding occurs directly into the brain lobes
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
In hemorrhagic stroke, bleeding occurs directly into the brain parenchyma.
2 What is the mechanism for hemorrhagic stroke?
I leakage from small intracerebral arteries

II damaged by chronic hypertension
III leakage from large intracerebral arteries
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The usual mechanism is thought to be leakage from small intracerebral arteries damaged by chronic
hypertension.
3 From following which are the terms that can be used interchangeably?
I intracerebral hemorrhage
II hemorrhagic transformation of ischemic stroke
III hemorrhagic stroke
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
The terms intracerebral hemorrhage and hemorrhagic stroke are used interchangeably in this article
and are regarded as separate entities from hemorrhagic transformation of ischemic stroke.
4 Which type of patients are more likely to have headache, altered mental status, seizures,
marked hypertension?
II intracerebral bleeds
III ischemic stroke
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Patients with intracerebral bleeds are more likely than those with ischemic stroke to have headache,
altered mental status, seizures, nausea and vomiting, and/or marked hypertension.
5 Which type of symptoms are observed in patients with intracerebral bleeds?

I seizures
II marked hypertension
III anxiety
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
6 Which type of symptoms are more likely observed in patients with intracerebral bleeds
than those with ischemic stroke?
II intracerebral bleeding
III Marked hypertension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
7 Focal neurological deficit depend on what?

I area of cerebral
II area of brain involved
III area of hemisphere
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The type of deficit depends on the area of brain involved. If the dominant (usually the left) hemisphere
is involved.
8 What are the syndromes of deficit in dominant left hemisphere?

I Left hemisensory loss
II Left gaze preference
III Right hemiparesis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ana:E
A syndrome consisting of the following may result:
 Right hemiparesis
 Right hemisensory loss
 Left gaze preference
 Right visual field cut
 Aphasia
Neglect (atypical)
9 What are the syndromes of deficit in dominant left hemisphere?

I Right gaze preference
II Aphasia
III Right visual field cut
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
A syndrome consisting of the following may result:
 Aphasia
Neglect (atypical)
10 What are the syndromes of deficit in dominant right hemisphere?

I Right gaze preference
II Right hemisensory loss
III Left hemiparesis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
If the nondominant (usually the right) hemisphere is involved, a syndrome consisting of the following
may result:
 Left hemiparesis
 Left hemisensory loss
 Right gaze preference
 Left visual field cut
11 What are the syndromes of deficit in dominant right hemisphere?

I Left gaze preference
II Left visual field cut
III Right gaze preference
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
may result:
12 which out of the following is true for stroke (ie; stroke caused by thrombosis or
embolisms)?
I Hemorrhagic stroke is less common than ischemic stroke
II Ischemic stroke is less common than heomorrhagic stroke
III Hemorrhagic stroke is less common than acute ischemic stroke
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Hemorrhagic stroke is less common than ischemic stroke (ie, stroke caused by thrombosis or embolisms.
13 which out of the following is true for stroke (ie; stroke caused by thrombosis or
embolisms)?
I hemorrhagic stroke is associated with higher mortality rates than is ischemic stroke
II ischemic stroke is associated with higher mortality rates than is hemorrhagic stroke
III hemorrhagic stroke is associated with lower mortality rates than is ischemic stroke
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Hemorrhagic stroke is associated with higher mortality rates than is ischemic stroke.
14 Brain imaging studies is a crucial for which type of stroke?
I acute ischemic stroke

II ischemic stroke
III hemorhagic stroke
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Brain imaging aids in excluding ischemic stroke, and it may identify complications of hemorrhagic
stroke such as intraventricular hemorrhage, brain edema, and hydrocephalus.
15 Which complications of haemorrhagic stroke that can be identified by brain imaging

studies?
I brain edema
II intraventricular hemorrhage
III interventricular hemorrhage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Brain imaging aids in excluding ischemic stroke, and it may identify complications of hemorrhagic
stroke such as intraventricular hemorrhage, brain edema, and hydrocephalus.
16 Which method are preferred for the diagnosis of hemorrhagic stroke?
I noncontrast computed tomography (NCCT)

II magnetic resonance imaging (MRI)
III Computed Tonmography (CT) Scan
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Either noncontrast computed tomography (NCCT) scanning or magnetic resonance imaging (MRI)
is the modality of choice.
17 Which artery supplies the blood to cerebral?

I anterior cerebral artery
II interior cerebral artery
III middle cerebral artery
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
The cerebral hemispheres are supplied by 3 paired major arteries: the anterior, middle, and posterior
cerebral arteries.
18 Which out of the following is true for anterior and middle cerebral arteries?
I responsible for the anterior circulation

II arise from the supraclinoid internal carotid arteries
III responsible for the posterior circulation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
18 The anterior and middle cerebral arteries are responsible for the anterior circulation and arise
from the supraclinoid internal carotid arteries.
19 Which out of the following is true for posterior cerebral arteries?
I arise from the basilar artery

II form posterior circulation
III form anterior circulation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
19 20 The posterior cerebral arteries arise from the basilar artery and form the posterior circulation,
which also supplies the thalami, brainstem, and cerebellum.
20 To which part of brain does posterior cerebral arteries supplies blood?

I Brain stem
II cerebellum
III hypothlamus
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Posterior cerebral arteries, which also supplies the thalami, brainstem, and cerebellum.
21 In intracerebral hemorrhage, bleeding occurs directly into which area of the brain ?
I parenchyma
II chlorenchyma
III aerenchyma
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
In intracerebral hemorrhage, bleeding occurs directly into the brain parenchyma.
22 What is the mechanism involved in intracerebral hemorrhage?

I bleeding diatheses
II bleeding paratheses
III iatrogenic anticoagulation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Other mechanisms include bleeding diatheses, iatrogenic anticoagulation, cerebral amyloidosis, and
cocaine abuse.
23 What is the mechanism involved in intracerebral hemorrhage?

I alcohol abuse
II cerebral amyloidosis
III cocaine abuse
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Other mechanisms include bleeding diatheses, iatrogenic anticoagulation, cerebral amyloidosis, and
cocaine abuse.
24 Intracerebral hemorrhage has a predilection at which sites in the brain?

I hypothalamus
II putamen
III thalamus
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Intracerebral hemorrhage has a predilection for certain sites in the brain, including the thalamus,
putamen, cerebellum, and brainstem.
25 Intracerebral hemorrhage has a predilection at which sites in the brain?

I cerebellum
II duramen
III brainstem
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
25 Intracerebral hemorrhage has a predilection for certain sites in the brain, including the thalamus,
putamen, cerebellum, and brainstem.
26 Which out of the following is true for intracerebral hemorrhage occurrence?
I increase in intercranial pressure

II decrease in intracranial pressure
III increase in intracranial pressure
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
A general increase in intracranial pressure may occur.
27 What is the outcome of SAH (subarachnoid hemorrhage)?
I impairs cerebral autoregulation

II elevated intercranial pressure
III elevated intracranial pressure
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
SAH results in elevated intracranial pressure and impairs cerebral autoregulation.
28 Which condition along with SAH (subarachnoid hemorrhage) can result in profound
reduction in blood flow and cerebral ischemia?
I acute vasoconstriction
II microvascular platelet aggregation

III chronic vasoconstriction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
These effects can occur in combination with acute vasoconstriction, microvascular platelet
aggregation, and loss of microvascular perfusion, resulting in profound reduction in blood flow and
cerebral ischemia.
29 Which condition along with SAH (subarachnoid hemorrhage) can result in profound
reduction in blood flow and cerebral ischemia?
I loss of microvascular perfusion
II cerebral ischemia
III profound elevation in blood flow
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
These effects can occur in combination with acute vasoconstriction, microvascular platelet
aggregation, and loss of microvascular perfusion, resulting in profound reduction in blood flow and
cerebral ischemia.
30 What is the Aetiology of stroke?

I infraction
II ischemic
III hemorrhagic
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The etiologies of stroke are varied, but they can be broadly categorized into ischemic or hemorrhagic.
31 What is the most common cause of stroke?
I ischemic infarction
II thrombotic cerebrovascular occlusion
III embolic cerebrovascular occlusion
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Approximately 80-87% of strokes are from ischemic infarction caused by thrombotic or embolic
cerebrovascular occlusion.
32 What are the cause of ischemic infraction?
I thrombotic cerebrovascular occlusion

II embolic cerebrovascular occlusion
III pulmonary hypotension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Approximately 80-87% of strokes are from ischemic infarction caused by thrombotic or embolic
cerebrovascular occlusion.
33 How much time is sufficient for hemorrhagic transformation in patients with ischemic
infarction?
I Within 1 week
II within 2 week
III within 5 days
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
In 20-40% of patients with ischemic infarction, hemorrhagic transformation may occur within 1
week after ictus.
34 Which factor increase the risk of hemorrhagic stroke?

I Advanced age
II Previous history of stroke
III Over eating
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The risk of hemorrhagic stroke is increased with the following factors:
 Advanced age
 Hypertension (up to 60% of cases)
 Previous history of stroke
 Alcohol abuse
 Use of illicit drugs (eg, cocaine, other sympathomimetic drugs)
35 Which factor increase the risk of hemorrhagic stroke?
I Alcohol abuse
II Hypertension
III Use of Sympatholytic drugs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The risk of hemorrhagic stroke is increased with the following factors:

 Advanced age
 Hypertension (up to 60% of cases)
 Previous history of stroke
 Alcohol abuse
 Use of illicit drugs (eg, cocaine, other sympathomimetic drugs)
36 What are the Causes of hemorrhagic stroke?

I Hypertension
II Cerebral amyloidosis
III Antiplatelate therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Causes of hemorrhagic stroke include the following[11, 12, 14, 15, 16] :
 Hypertension
 Cerebral amyloidosis
 Coagulopathies
 Anticoagulant therapy
 Thrombolytic therapy for acute myocardial infarction (MI) or acute ischemic stroke (can
cause iatrogenic hemorrhagic transformation)
 Arteriovenous malformation (AVM), aneurysms, and other vascular malformations (venous
and cavernous angiomas)
 Vasculitis
 Intracranial neoplasm
I coagulant therapy
II Coagulopathies
III Anticoagulant therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Causes of hemorrhagic stroke :
 Coagulopathies
 Anticoagulant therapy
I Thrombolytic therapy
II Arterioventricular Malformation (AVM)
III chronic ischemic strok
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Causes of hemorrhagic stroke :

 Thrombolytic therapy for acute myocardial infarction (MI) or acute ischemic stroke (can
cause iatrogenic hemorrhagic transformation)
 Arteriovenous malformation (AVM), aneurysms, and other vascular malformations (venous
and cavernous angiomas)
 Vasculitis
39 What is the outcome of liver disease in coagulopathies?
I bleeding parathesis
II bleeding diathesis
III bleeding monothesis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Liver disease can result in a bleeding diathesis.
40 Which gene polymorphism influence warfarin metabolism?

I CYP3C9 genes
II CYP2C8genes
III CYP2C9 genes
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Warfarin metabolism is influenced by polymorphism in the CYP2C9 genes.
41 Which gene variant is associated with typical response to dosage of warfarin?
I CYP2C9*1
II CYP2C9*2
III CYP2C9*3
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Three known variants have been described. CYP2C9*1 is the normal variant and is associated with
typical response to dosage of warfarin. Variations *2 and *3.
42 Which disorder is more susceptible due to Polymorphisms in the IL6 gene?
I AVM (Arteriovenous malformations)

II AVM (Arteriovenous malnutrition)
III AVM (Arterioventricular malformations)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Polymorphisms in the IL6 gene increase susceptibility to a number of disorders, including
AVMArteriovenous malformations.
43 Which autosomal dominant disorder causes dysplasia of the vasculature?
I Osler-Weber-Rendu syndrome
II Hereditary hemorrhagic telangiectasia (HHT)
III Hereditary ischemic telangiectasia (HIH)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Hereditary hemorrhagic telangiectasia (HHT), previously known as Osler-Weber-Rendu syndrome,
is an autosomal dominant disorder that causes dysplasia of the vasculature.
44 What is Osler-Weber-Rendu syndrome?

I autonomus dominant disorder
II causes dysplasia of the vasculature
III autosomal dominant disorder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
45 Which gene mutation induce Hereditary hemorrhagic telangiectasia ?

I SMAD1
II SMAD4
III ACVRL1
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Hereditary hemorrhagic telangiectasia HHT is caused by mutations in ENG, ACVRL1, or SMAD4
genes. Mutations in SMAD4 are also associated with juvenile polyposis.
46 Which gene mutation is associated with juvenile polyposis?

I ACVRL1
II SMAD5
III SMAD4
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Mutations in SMAD4 are also associated with juvenile polyposis.
47 What are the diagnosing parameters for HHT patients?

I telangiectasias on skin
II chronic epistaxis from AVMs in nasal mucosa
III acute epistaxis from AVMs in nasal mucosa
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
HHT is most frequently diagnosed when patients present with telangiectasias on the skin and mucosa
or with chronic epistaxis from AVMs in the nasal mucosa.
48 What is the most common etiology of primary hemorrhagic stroke ?

I ischemia
II hypertension
III Myocardial infraction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The most common etiology of primary hemorrhagic stroke (intracerebral hemorrhage) is hypertension.
49How the Hypertensive small-vessel disease results ?

I tiny lipohyalinotic aneurysms that subsequently rupture
II intraparenchymal ischemia
III intraparenchymal hemorrhage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Hypertensive small-vessel disease results from tiny lipohyalinotic aneurysms that subsequently rupture
and result in intraparenchymal hemorrhage.
50 What is the most common cause of atraumatic hemorrhage into the subarachnoid
space?
I rupture of an intercranial aneurysm
II rupture of an intracranial aneurysm
III rupture of an extracranial aneurysm
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The most common cause of atraumatic hemorrhage into the subarachnoid space is rupture of an
intracranial aneurysm.
51 For what Aneurysms may less commonly be related ?

I polycystic ovarian disease
II collagen vascular disease
III septic emboli
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Aneurysms are focal dilatations of arteries, with the most frequently encountered intracranial type
being the berry (saccular) aneurysm. Aneurysms may less commonly be related to altered
hemodynamics associated with AVMs, collagen vascular disease, polycystic kidney disease, septic
emboli, and neoplasms.
52 What is responsible for the formation of Berry aneurysms ?

I hemodynamic stresses
II heterodynamic stresses
III acquired or congenital weakness in vessel wall
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
52 Berry aneurysms are most often isolated lesions whose formation results from a combination of
hemodynamic stresses and acquired or congenital weakness in the vessel wall.
53 What is responsible for Intracranial aneurysms ?
I Cranial disorders
II genetic disorders
III metabolic disorders
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Intracranial aneurysms may result from genetic disorders.
54 Which genes are mainly responsible for genetic causes of aneurysms?
I ANIC genes
II SMAD4 genes
III ANIB genes
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
A number of genes, all categorized as ANIB genes, are associated with this predisposition.
55 From following what is true for Loeys-Dietz syndrome (LDS) ?

I marked ventricular tortuosity
II craniofacial abnormalities
III craniosynostosis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Loeys-Dietz syndrome (LDS) consists of craniofacial abnormalities, craniosynostosis, marked arterial
tortuosity, and aneurysms and is inherited in an autosomal dominant manner
56 What is true for Ehlers-Danlos syndrome?

I fragility
II hyperextensibility of the joints
III improve wound healing
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Ehlers-Danlos syndrome is a group of inherited disorders of the connective tissue that feature
hyperextensibility of the joints and changes to the skin, including poor wound healing, fragility, and
hyperextensibility.
57 What is known to cause spontaneous rupture of hollow viscera and large arteries,
including arteries in the intracranial circulation?
I Ehlers-Danlos vascular type (type III)

II Ehlers-Danlos vascular type (type IV)
III Ehlers-Danlos vascular type (type V)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Ehlers-Danlos vascular type (type IV) also is known to cause spontaneous rupture of hollow viscera
and large arteries, including arteries in the intracranial circulation.
58 What are the symptoms of Ehlers-Danlos syndrome?
I lobeless ears
II a thin upper lip
III blunt nose
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Patients with Ehlers-Danlos syndrome may also have mild facial findings, including lobeless ears, a
thin upper lip, and a thin, sharp nose.
59 What does Hemorrhagic transformation represents?
I conversion of a severe infarction into an area of hemorrhage

II conversion of a bland infarction into an area of hemorrhage
III conversion of a acute infarction into an area of hemorrhage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Hemorrhagic transformation represents the conversion of a bland infarction into an area of
hemorrhage.
60 What is the mechanism behind hemorrhagic transformation?
I ischemia
II ischemia with hypotension
III reperfusion of ischemically injured tissue
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Proposed mechanisms for hemorrhagic transformation include reperfusion of ischemically injured
tissue, either from recanalization of an occluded vessel or from collateral blood supply to the ischemic
territory or disruption of the blood-brain barrier.
61 Which method can be used for reperfusion of ischemically injured tissue in

haemorrhagic stroke?
I recanalization of an occluded vessel
II angioplasty
III stent placement
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
62 What is the time for the Hemorrhagic transformation of an ischemic infarct?
I 3-20 days postictus

II 2-14 days postictus
III 4-20 days postictus
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Hemorrhagic transformation of an ischemic infarct occurs within 2-14 days postictus, usually within
the first week.
63 What is also more likely following administration of tissue plasminogen activator

(tPA)?
I Hemorrhagic transformation
II hypertension
III hypotension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Hemorrhagic transformation is also more likely following administration of tissue plasminogen
activator (tPA) in patients whose.
64 On which factor does the prognosis in patients with hemorrhagic stroke depends?
I ischemic or nonischemic
II severity of stroke
III location and the size of the hemorrhage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The prognosis in patients with hemorrhagic stroke varies depending on the severity of stroke and the
location and the size of the hemorrhage.
65 What scores in hemorrhagic stroke patient with poorer prognosis and higher mortality
rates?
I Lower Glasgow Coma Scale

II Higher Glasgow Coma Scale
III Moderate Glasgow Coma Scale
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Lower Glasgow Coma Scale (GCS) scores are associated with poorer prognosis and higher mortality
rates.
66 What is outcome of the growth of the hematoma volume in hemorrhagic stroke?
I poorer functional outcome

II increased mortality rate
III decreased mortality rate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Growth of the hematoma volume is associated with a poorer functional outcome and increased
mortality rate.
67 What is most commonly used instrument for predicting outcome in hemorrhagic

stroke?
I intracranial hemorrhage score

II intracerebral hemorrhage score
III cerebral hemorrhage score
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The intracerebral hemorrhage score is the most commonly used instrument for predicting outcome in
hemorrhagic stroke.
68 What is included in patient medical history during assessment of haemorrhagic stroke?
I onset and progression of symptoms

II risk factors and possible causative events
III pathophysiology of disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Obtaining an adequate history includes determining the onset and progression of symptoms, as well
as assessing for risk factors and possible causative events.
69 What is more common in hemorrhagic stroke than in the ischemic kind?
I increased BP
II Seizures
III diarrhoea
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Seizures are more common in hemorrhagic stroke than in the ischemic kind.
70 Which out of the following is correct for the occurrence and onset of seizure?
I 28 % occurrence and onset within 24 hour

II 28 % occurrence and onset within 48 hour
III 30 % occurrence and onset within 48 hour
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Seizures occur in up to 28% of hemorrhagic strokes, generally at the onset of the intracerebral
hemorrhage or within the first 24 hours.
71What are the symptoms of Focal stroke?
I delusion
II Vertigo or ataxia
III Aphasia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Focal symptoms of stroke include the following:
 Weakness or paresis that may affect a single extremity, one half of the body, or all 4 extremities
 Facial droop
 Monocular or binocular blindness
 Blurred vision or visual field deficits
 Dysarthria and trouble understanding speech
 Vertigo or ataxia
Aphasia
I Blurred vision or visual field deficits

II Monocular or binocular blindness
III Trinocular blindness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
 Facial droop
Aphasia
I Weakness
II Facial droop
III Trinocular blindness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III

 Facial droop
Aphasia
74 What are the symptoms of subarachnoid haemorrhage?
I Syncope - Transient or atypical

II Syncope - Prolonged or atypical
III Signs of meningismus with nuchal rigidity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Symptoms of subarachnoid hemorrhage may include the following:
 Sudden onset of severe headache
 Signs of meningismus with nuchal rigidity
 Photophobia and pain with eye movements
 Nausea and vomiting
Syncope - Prolonged or atypical
75 What are the symptoms of subarachnoid haemorrhage?
I Sudden onset of severe headache

II Sudden onset of back pain
III Nausea and vomiting
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Symptoms of subarachnoid hemorrhage may include the following:
 Sudden onset of severe headache
 Signs of meningismus with nuchal rigidity
 Photophobia and pain with eye movements
 Nausea and vomiting
 Syncope - Prolonged or atypical
76 Which is most common clinical scoring systems for grading aneurysmal subarachnoid
haemorrhage?
I Hunt and grass grading scheme

II Hunt and Hess grading scheme
III World Federation of Neurosurgeons (WFNS) grading scheme
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The most common clinical scoring systems for grading aneurysmal subarachnoid hemorrhage are the
Hunt and Hess grading scheme and the World Federation of Neurosurgeons (WFNS) grading scheme,
which incorporates the Glasgow Coma Scale. The Fisher Scale incorporates findings from noncontrast
computed tomography (NCCT) scans
77 Which out of following is done during general physical examination in hemorrhagic

strokepatients?
I examination of head
II examination of nose
III examination of abdomen
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The assessment in patients with possible hemorrhagic stroke includes vital signs; a general physical
examination that focuses on the head, heart, lungs, abdomen, and extremities; and a thorough but
expeditious neurologic examination
78 What is associated with early neurologic deterioration in haemorrhagic patient?
I Normal initial BP
II Higher initial BP
III Lower initial BP
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Higher initial BP is associated with early neurologic deterioration, as is fever.
79 What may result from blood in the subarachnoid space?
I menengitis
II cerebral congestion
III Meningismus
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Meningismus may result from blood in the subarachnoid space.
80 Which out of the following scoring system are used for evaluation of haemorrhagic
patient?
I Glasgow Hemorrhage Scale

II Glasgow Coma Scale
III the Intracerebral Hemorrhage Score
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Examination results can be quantified using various scoring systems. These include the Glasgow Coma
Scale (GCS), the Intracerebral Hemorrhage Score (which incorporates the GCS; see Prognosis).
81Which syndrome is associated with involvement of dominant hemisphere (usually the
left) in haemorrhagic stroke?
I Right visual field cut

II Left visual field cut
III Aphasia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
The type of deficit depends upon the area of brain involved. If the dominant hemisphere (usually the
left) is involved, a syndrome consisting of the following may result:
 Aphasia
 Neglect (atypical)
82Which syndrome are associated with involvement of dominant hemisphere (usually the
left) in haemorrhagic stroke?
I Right hemiparesis
II Left gaze preference
III Right gaze preference
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The type of deficit depends upon the area of brain involved. If the dominant hemisphere (usually the
left) is involved, a syndrome consisting of the following may result:
 Aphasia
 Neglect (atypical)
83Which syndrome is associated with involvement of nondominant (usually the right)

hemisphere in haemorrhagic stroke?
I Right hemiparesis
II Left hemiparesis
III Left hemisensory loss
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
may result:
84Which syndrome is associated with involvement of nondominant (usually the right)

hemisphere in haemorrhagic stroke?
I left gaze preference

II Right gaze preference
III Left visual field cut
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
may result:
85 Which part of the brain is responsible for herniation and brainstem compression in
haemorrhagic stroke patient?
I cerebrum
II spon
III cerebellum
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
If the cerebellum is involved, the patient is at high risk for herniation and brainstem compression.
86 What may cause a rapid decrease in the level of consciousness and may result in apnea
or death?
I dehydration
II Herniation
III pulmonary embolism
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Herniation may cause a rapid decrease in the level of consciousness and may result in apnea or death.
87Which symptoms are associated when haemorrhagic stroke involves Putamen?
I Contralateral hemiparesis
II contralateral conjugate
III contralateral conjugate gaze paresis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Putamen - Contralateral hemiparesis, contralateral sensory loss, contralateral conjugate gaze paresis,
homonymous hemianopia, aphasia, neglect, or apraxia.
88Which symptoms are associated when haemorrhagic stroke involves Thalamus?
I miosis
II Contralateral sensory loss
III phasia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Thalamus - Contralateral sensory loss, contralateral hemiparesis, gaze paresis, homonymous
hemianopia, miosis, aphasia, or confusion.
89Which symptoms are associated when haemorrhagic stroke involves Lobar?
I phasia
II Contralateral hemiparesis
III abulia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Lobar - Contralateral hemiparesis or sensory loss, contralateral conjugate gaze paresis, homonymous
hemianopia, abulia, aphasia, neglect, or apraxia.
90Which symptoms are associated when haemorrhagic stroke involves Caudate nucleus?
I Contralateral hemiparesis
II confusion
III lateral hemiparesis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Caudate nucleus - Contralateral hemiparesis, contralateral conjugate gaze paresis, or confusion.
91Which symptoms are associated when haemorrhagic stroke involves Brainstem?
I Quadriparesis
II confusion
III decreased level of consciousness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Brainstem - Quadriparesis, facial weakness, decreased level of consciousness, gaze paresis, ocular
bobbing, miosis, or autonomic instability.
92 Which symptoms are associated when haemorrhagic stroke involves cerebellum?
I skew reorganization
II Ipsilateral ataxia
III facial weakness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Cerebellum Ipsilateral ataxia, facial weakness, sensory loss; gaze paresis, skew deviation, miosis, or
decreased level of consciousness.
93 Which out of the following test are performed during examination of haemorrhagic
stroke?
I inactivated partial thromboplastin time

II complete blood count
III inactivated partial thromboptic time
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Laboratory tests should include a complete blood count, a metabolic panel.
94 Which out of the following test is used for coagulation studies?
I international normalized ratio

II prothrombin time
III inactivated partial thromboplastin time
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
coagulation studies (ie, prothrombin time or international normalized ratio [INR] and an activated
partial thromboplastin time.
95 What is a crucial step in the evaluation of suspected hemorrhagic stroke and must be
obtained on an emergent basis?
I Complete blood count

II Brain imaging
III Urine analysis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Brain imaging is a crucial step in the evaluation of suspected hemorrhagic stroke and must be obtained
on an emergent basis.
96 Which test can be performed in patients who are unable to tolerate a magnetic
resonance examination?
I Computed tomography (CT)-scan

II Dopplar sonography
III stress cardiogram
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Computed tomography (CT)-scan studies can also be performed in patients who are unable to tolerate
a magnetic resonance examination or who have contraindications to MRI, including pacemakers,
aneurysm clips, or other ferromagnetic materials in their bodies.
97When is MRI contraindicated in haemorrhagic stroke diagnosis?
I patient with pacemaker

II patient with cardiac puncture
III patient with ferromagnetic materials
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Computed tomography (CT)-scan studies can also be performed in patients who are unable to tolerate
a magnetic resonance examination or who have contraindications to MRI, including pacemakers,
aneurysm clips, or other ferromagnetic materials in their bodies.
98 Which test is used to identify patients at risk for hematoma expansion ?

I Non - CT angiography
II CT angiography
III contrast-enhanced CT scanning
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
98 CT angiography and contrast-enhanced CT scanning may be considered for helping identify
patients at risk for hematoma expansion
99 Which out of the following test are used for the diagnosis of structural lesion in
haemorrhagic stroke patient?
I Non - CT angiography
II CT angiography
III CT venography
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
When clinical or radiologic findings suggest an underlying structural lesion, useful techniques include
CT angiography, CT venography, contrast-enhanced CT scanning, contrast-enhanced MRI,
magnetic resonance angiography (MRA), or magnetic resonance venography.
100 Which test is the gold standard in evaluating for cerebrovascular disease and for
providing less-invasive endovascular interventions?
I CABG
II angioplasty
III Conventional angiography
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Conventional angiography is the gold standard in evaluating for cerebrovascular disease and for
providing less-invasive endovascular interventions.
Drug and pharmacology (question 100)
1 Management of patients with acute intracerebral hemorrhage depends on-
I cause of intracerebral hemorrhage

II severity of the rebleeding
III severity of the bleeding
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The treatment and management of patients with acute intracerebral hemorrhage depends on the cause
and severity of the bleeding.
2 Which out of the following are done during Management of acute intracerebral
hemorrhage?
I rebleeding
II Basic life support
III control of intracranial pressure
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Basic life support, as well as control of bleeding, seizures, blood pressure (BP), and intracranial
pressure, are critical.
3 What is the role of Anticonvulsants in Management of acute intracerebral hemorrhage?

I To prevent gastric motality
II To prevent seizure recurrence
III To prevent gastric spasm
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Anticonvulsants - To prevent seizure recurrence.
4 What is the role of Antihypertensive agents in Management of acute intracerebral

hemorrhage?
I To reduce BP and other risk factors of heart disease

II To increase BP and other risk factors of heart disease
III To produce hypotension and other risk factors of heart disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Antihypertensive agents - To reduce BP and other risk factors of heart disease.
5 What is the role of Osmotic diuretic agent in Management of acute intracerebral

hemorrhage?
I To decrease intracranial pressure in the arachnoid space

II To decrease intracranial pressure in the subarachnoid space
III To increase intracranial pressure in the subarachnoid space
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Osmotic diuretics - To decrease intracranial pressure in the subarachnoid space.
6 What is performed in acute intracerebral hemorrhage patients with a decreased level of

consciousness and poor airway protection?
I occipital intubation
II lobar intubation
III endotracheal intubation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Perform endotracheal intubation for patients with a decreased level of consciousness and poor airway
protection.
7 What clinician dose when intracranial pressure is elevated in acute intracerebral

hemorrhage patient?
I Intubate and hyperventilate

II administration of diazepam
III administration of mannitol
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Intubate and hyperventilate if intracranial pressure is elevated, and initiate administration of
mannitol for further control.
8 What is the role of Antacids in Management of acute intracerebral hemorrhage?
I prevent associated gastric alkalosis

II prevent associated gastric ulcers
III prevent associated gastric infection
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Antacids are used to prevent associated gastric ulcers.
9 Which out of the following drug is used for rapid seizure control?
I furodemide
II lorazepam
III diazepam
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Patients for whom treatment is indicated should immediately receive a benzodiazepine, such as
lorazepam or diazepam, for rapid seizure control.
10 Anticonvulsant therapy is accompanied by which out of the following dru g for longer-
term control of seizures?
I fosphenytoin
II phenytoin
III furosemide
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
This should be accompanied by phenytoin or fosphenytoin loading for longer-term control.
11 According to The 2010 AHA/ASA guidelines, What is indicated in patients with

intracranial hemorrhage whose mental status is depressed out of proportion to the degree
of brain injury?
I prophylactic anticonvulsants
II EEG monitoring
III prophylactic anticoagulant
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The 2010 AHA/ASA guidelines do not offer recommendations on prophylactic anticonvulsants, but
suggest that continuous EEG monitoring is probably indicated in patients with intracranial
hemorrhage whose mental status is depressed out of proportion to the degree of brain injury.
I lobar hemorrhages
II subarachnoid hemorrhage
III aneurysmal subarachnoid hemorrhage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Prophylactic anticonvulsant therapy has been recommended in patients with lobar hemorrhages to
reduce the risk of early seizures.
13 According to
anticonvulsant therapy has been recommended?
I aneurysmal subarachnoid hemorrhage

II aneurysmal arachnoid hemorrhage
III eurysmal subarachnoid hemorrhage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
In addition, AHA/ASA guidelines from 2012 suggest that prophylactic anticonvulsants may be
considered for patients with aneurysmal subarachnoid hemorrhage.
14 Which out of the following sentence is correct for the use of anticonvulsant in patient
with acute intracerebral hemorrhage?
I Routine long-term use is recommended

II it may be considered in patients with a prior seizure history
III may be considered in patients with a prior intractable hypertension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Routine long-term use is not recommended, but it may be considered in patients with a prior seizure
history, intracerebral hematoma, intractable hypertension, or infarction or aneurysm at the middle
cerebral artery.
15 What is the outcome of greatly elevated BP?
I hematoma reduction
II lead to rebleeding
III hematoma expansion
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
But greatly elevated BP is thought to lead to rebleeding and hematoma expansion.
16 Which drug is used to control blood pressure in hemorrhagic stroke patient?
I labetalol
II enalapril
III hydrochlorthiazide
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Suggested agents for use in the acute setting are beta blockers (eg, labetalol) and angiotensin-converting
enzyme inhibitors (ACEIs) (eg, enalapril).
17 Which drug is used to control refractory hypertension in hemorrhagic stroke patient?
I hydrochlorthiazide
II nicardipine
III hydralazine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
For more refractory hypertension, agents such as nicardipine and hydralazine are used.
18 Which drug is contraindicated in hemorrhagic stroke patient?
I nitroprusside
II Diuretics
III ARBs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Avoid nitroprusside because it may raise intracranial pressure.
19 Why nitroprusside is contraindicated in hemorrhagic stroke patient?
I serious adverse effects like cardiac arrest

II it may raise intracranial pressure
III pulmonary embolisam
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Avoid nitroprusside because it may raise intracranial pressure.
20 What clinician does when hemorrhagic stroke patient have systolic BP is over 200 mm
Hg or mean arterial pressure (MAP) is over 150 mm Hg?
I check BP every 5 minutes

II aggressive reduction of BP with continuous IV infusion
III acute reduction of BP
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
systolic BP is over 200 mm Hg or mean arterial pressure (MAP) is over 150 mm Hg, then consider
aggressive reduction of BP with continuous IV infusion; check BP every 5 minutes.
21 What clinician does when hemorrhagic stroke patient have systolic BP is over 180 mm
Hg or MAP is over 130 mm Hg and intracranial pressure is elevated?
I monitoring hematoma
II monitoring intracranial pressure
III cerebral perfusion pressure of 60 mm Hg or higher
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
If systolic BP is over 180 mm Hg or MAP is over 130 mm Hg and intracranial pressure may be
elevated, then consider monitoring intracranial pressure and reducing BP using intermittent or
continuous intravenous medications, while maintaining a cerebral perfusion pressure of 60 mm Hg
or higher.
22 21 What clinician does when hemorrhagic stroke patient have systolic BP is over 180 or
MAP is over 130 mm Hg and there is no evidence of elevated intracranial pressure?
I target MAP of 110 mm Hg or target BP of 160/100 mm Hg

II target MAP of 110 mm Hg or target BP of 160/90 mm Hg
III target MAP of 110 mm Hg or target BP of 170/90 mm Hg
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
If systolic BP is over 180 or MAP is over 130 mm Hg and there is no evidence of elevated intracranial
pressure, then consider modest reduction of BP (target MAP of 110 mm Hg or target BP of 160/90
mm Hg) using intermittent or continuous intravenous medications to control it, and perform clinical
reexamination of the patient every 15 minutes.
23 What clinician does when hemorrhagic stroke patient have systolic BP of 150 to 220
mm Hg?
I acute lowering of systolic BP to 150 mm Hg

II acute lowering of systolic BP to 145 mm Hg
III acute lowering of systolic BP to 140 mm Hg
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
In patients presenting with a systolic BP of 150 to 220 mm Hg, acute lowering of systolic BP to 140
mm Hg is probably safe.
24 According to the 2012 AHA/ASA guidelines, what is goal BP in patients with

aneurysmal subarachnoid hemorrhage to reduce rebleeding?
I below 180 mmHg
II below 170 mmHg
III below 160 mmHg
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
For patients with aneurysmal subarachnoid hemorrhage, the 2012 AHA/ASA guidelines recommend
lowering BP below 160 mmHg acutely to reduce rebleeding.
25 What is the responsible for the elevation of intracranial pressure?
I hypotension
II hematoma
III edema
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Elevated intracranial pressure may result from the hematoma itself, from surrounding edema, or from
both.
26 What dose cliniciAns: suggest to a hemorrhagic stroke patient to be considered while

sleeping?
I Elevate the head of the bed to 30°

II Elevate the head of the bed to 40°.
III Elevate the head of the bed to 50°.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Elevate the head of the bed to 30°. This improves jugular venous outflow and lowers intracranial
pressure.
27 What is the logic behind the patient head elevated to 30°?
I improves cardiac venous outflow and lowers intracranial pressure

II improves jugular venous outflow and lowers intracranial pressure
III improves carotid artery outflow and lowers intracranial pressure
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Elevate the head of the bed to 30°. This improves jugular venous outflow and lowers intracranial
pressure.
28 What is the treatment for the management of intracranial pressure?
I osmotic therapy
II Hyperventilation
III barbiturate anesthesia and neuromuscular blockage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
More aggressive therapies, such as osmotic therapy (ie, mannitol, hypertonic saline), barbiturate
anesthesia, and neuromuscular blockage.
29 Which out of the following is correct related to Hyperventilation?
I partial pressure of carbon dioxide [PaCO2] of 25 to 30-35 mm Hg

II partial pressure of carbon dioxide [PaCO2] of 25 to 30-40 mm Hg
III partial pressure of carbon dioxide [PaCO2] of 25 to 30-45 mm Hg
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Hyperventilation (partial pressure of carbon dioxide [PaCO2] of 25 to 30-35 mm Hg) is not
recommended, because its effect is transient, it decreases cerebral blood flow, and it may result in
rebound elevated intracranial pressure.
30 Why Hyperventilation is not recommended in during control of intracranial pressure?
I produces hypotension
II its effect is trAns:ient
III rebound elevation in intracranial pressure
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Hyperventilation (partial pressure of carbon dioxide [PaCO2] of 25 to 30-35 mm Hg) is not
recommended, because its effect is transient, it decreases cerebral blood flow, and it may result in
rebound elevated intracranial pressure
31 What is the preferred therapy to stop ongoing hemorrhage or prevent hematoma

expansion ?
I rFVIa
II rFVIIa
III rFVIIIa
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The use of hemostatic therapy with rFVIIa to stop ongoing hemorrhage or prevent hematoma
expansion has generated much interest.
32 What is the treatment for Anticoagulation-associated Intracranial Hemorrhage?
I Intravenous vitamin K
II diazepam infusion
III Fresh frozen plasma
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Treatment of Anticoagulation-associated Intracranial Hemorrhage:
 Intravenous vitamin K
 Fresh frozen plasma (FFP)
 Prothrombin complex concentrates (PCC)
 rFVIIa
33 What is the treatment for Anticoagulation-associated Intracranial Hemorrhage?
I mannitol infusion
II rFVIIa
III Prothrombin complex concentrates
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Treatment of Anticoagulation-associated Intracranial Hemorrhage:
 Intravenous vitamin K
 Fresh frozen plasma (FFP)
 Prothrombin complex concentrates (PCC)
 rFVIIa
34 Why vitamin K should be administered with either Fresh frozen plasma or

Prothrombin complex concentrates?
I because vitamin K requires more than 6 hours to normalize international normalized ratio
II because vitamin K requires less than 6 hours to normalize international normalized ratio
III because vitamin K requires 6 hours to normalize international normalized ratio
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Because vitamin K requires more than 6 hours to normalize the INR, it should be administered with
either FFP or PCC.
35 What is administered along with vitamin K to treat Anticoagulation-associated

Intracranial Hemorrhage?
I Frozen RBC
III Prothrombin complex concentrates
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Because vitamin K requires more than 6 hours to normalize the INR, it should be administered with
either FFP or PCC.
36 What is the dose of Fresh frozen plasma to treat Anticoagulation-associated Intracranial

Hemorrhage?
I 10-12 mL/kg
II 15-20 mL/kg
III 11-15 mL/kg
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
FFP needs to be given in a dose of 15-20 mL/kg and therefore requires a large-volume infusion.
37 What is the logic behind the large-volume infusion of Fresh frozen plasma?
I to be given in a dose of 10-12 mL/kg
II to be given in a dose of 11-15 mL/kg
III to be given in a dose of 15-20 mL/kg
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
FFP needs to be given in a dose of 15-20 mL/kg and therefore requires a large-volume infusion.
38Why the volume of Prothrombin complex concentrates is smaller than Fresh frozen
plasma?
I contains high levels of vitamin E-dependent cofactors

II contains high levels of vitamin K-dependent cofactors
III contains high levels of vitamin C-dependent cofactors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
PCC contains high levels of vitamin K-dependent cofactors and thus involves a smaller-volume
infusion than FFP and more rapid administration.
39 What is the complication of Prothrombin complex concentrates?
I endovascular complications
II thrombotic complications
III cardiac complications
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
PCC is associated with high rates of thrombotic complications.
40 What is the treatment of hemorrhagic stroke developed in Patients on heparin (either

unfractionated or low molecular weight heparin [LMWH])?
I labetalol
II protamine
III famotidine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Patients on heparin (either unfractionated or low molecular weight heparin [LMWH]) who develop
a hemorrhagic stroke should immediately have anticoagulation reversed with protamine.
41 What is the treatment in Patients with severe deficiency of a specific coagulation factor
that develops spontaneous intracerebral hemorrhage?
I drug therapy
II use of factor XIa
III factor replacement therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Patients with severe deficiency of a specific coagulation factor who develop spontaneous intracerebral
hemorrhage should receive factor replacement therapy.
42 Which drug is used in Patients with renal failure and platelet dysfunction?
I Furosemide
II desmopressin
III torsemide
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Patients with renal failure and platelet dysfunction may also benefit from the administration of
desmopressin (DDAVP).
43 According the 2010 AHA/ASA guideline, what is recommended for management of

spontaneous intracerebral hemorrhage along with severe thrombocytopenia?
I platelet transfusions
II RBC transfusions
III WBC transfusions
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The 2010 AHA/ASA guideline for management of spontaneous intracerebral hemorrhage
recommends platelet transfusions only when such hemorrhaging complicates severe thrombocytopenia.
44 What is the potential treatment for hemorrhagic stroke?
I Life style modification

II surgical evacuation of the hematoma
III using drug
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
A potential treatment for hemorrhagic stroke is surgical evacuation of the hematoma.
45 In patients with cerebellar hemorrhage, surgical intervention has been shown to

improve outcome if-
I hematoma is greater than 1 cm in diameter
II hematoma is greater than 2 cm in diameter
III hematoma is greater than 3 cm in diameter
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
In patients with cerebellar hemorrhage, surgical intervention has been shown to improve outcome if
the hematoma is greater than 3 cm in diameter.
46 Which Endovascular treatment for aneurysms?
I Endovascular therapy using double coil embolization

II Endovascular therapy using coil embolization
III Endovascular therapy using triple coil embolization
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Endovascular treatment of aneurysms Endovascular therapy using coil embolization, as an alternative
to surgical clipping, has been increasingly employed in recent years with great success.
47 What are the circumstances under which Endovascular treatment of aneurysms may be
favored over surgical clipping?
I The aneurysm is in a location that is difficult to access surgically

II The aneurysm is small-necked and located in the posterior fossa
III The aneurysm is large-necked and located in the posterior fossa
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Endovascular treatment of aneurysms may be favored over surgical clipping under the following
circumstances[54] :
 The aneurysm is in a location that is difficult to access surgically, such as the cavernous
internal carotid artery (ICA) or the basilar terminus
 The aneurysm is small-necked and located in the posterior fossa
 The patient is elderly
 The patient has a poor clinical grade
48 What are the circumstances under which Endovascular treatment of aneurysms may be
favored over surgical clipping?
I young patient
II The patient is elderly
III young patient with stroke risk
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Endovascular treatment of aneurysms may be favored over surgical clipping under the following
circumstances[54] :
 The aneurysm is in a location that is difficult to access surgically, such as the cavernous
internal carotid artery (ICA) or the basilar terminus
 The aneurysm is small-necked and located in the posterior fossa
 The patient is elderly
 The patient has a poor clinical grade
49 What are the factors that militate against endovascular treatment?
I Wide-based aneurysms or those without an identifiable neck

II Aneurysms with a vessel extending off the aneurysm dome
III eurysms with a vessel extending off the eurysm dome
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The following factors militate against endovascular treatment:
 Wide-based aneurysms or those without an identifiable neck
 Aneurysms with a vessel extending off the aneurysm dome
 Severely atherosclerotic or tortuous vessels that limit the endovascular approach
50 Which out of the following drug are used to treat vasospasm in hemorrhagic stroke
patient?
I nicardipine
II verapamil
III furosemide
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Although vasospasm may be treated with intra-arterial pharmaceutical agents, such as verapamil or
nicardipine, balloon angioplasty can be used for opening larger vessels.
51 Which method is used for opening larger vessels in hemorrhagic stroke patient?
I angioplasty
II balloon angioplasty
III stent placing
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
52 What is the route of administration of verapamil and nicardipine in treatment of

vasospasm?
I intra-venous
II oral
III intra-arterial
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
53 Which method is often used in the setting of obstructive hydrocephalus?
I Placement of an intraventricular catheter for cerebrospinal fluid drainage

II Placement of an intraartrial catheter for cerebrospinal fluid drainage
III Placement of an intarvenous catheter for cerebrospinal fluid drainage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Placement of an intraventricular catheter for cerebrospinal fluid drainage (ie, ventriculostomy) is
often used in the setting of obstructive hydrocephalus.
54 What is ventriculostomy?
I Placement of an intraartrial catheter for cerebrospinal fluid drainage

II Placement of an intraventricular catheter for cerebrospinal fluid drainage
III Placement of an arterial catheter for cerebrospinal fluid drainage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Placement of an intraventricular catheter for cerebrospinal fluid drainage (ie, ventriculostomy) is
often used in the setting of obstructive hydrocephalus.
55 which is a common complication of thalamic hemorrhage?
I obstructive hydrooesophagus
II obstructive hydrocephalus
III obstructive Thyrodism
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Obstructive hydrocephalus; which is a common complication of thalamic hemorrhage.
56 Which out of the following is the risk factor associated with Ventriculostomies?
I risk of Dry cough

II risk of infection
III risk of pulmonary embolism
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ventriculostomies are associated with a risk of infection, including bacterial meningitis.
57 According to guidelines, what is the recommended level of BP to prevent a first stroke?
I below 130/90 mm Hg
II below 140/80 mm Hg
III below 140/90 mm Hg
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
In addition, the guidelines strongly recommend maintenance of BP below 140/90 mm Hg to prevent
a first stroke.
58 What is the treatment goal for BP In patients with hypertension plus either diabetes or
renal disease?
I below 120/80 mm Hg
II below 130/80 mm Hg
III below 140/80 mm Hg
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
In patients with hypertension plus either diabetes or renal disease, the treatment goal is BP below
130/80 mm Hg.
59 Which class of the drug are used to treat hypertension according to the 2011 AHA/ASA
primary prevention guidelines in haemorrhagic stroke patient?
I ACEIs
II Coagulants
III ARBs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
For patients with diabetes, the use of ACEIs and ARBs to treat hypertension is a class I-A
recommendation (strongest and best-documented), according to the 2011 AHA/ASA primary
prevention guidelines.[3
60 Which drug is considered second-line agents for reductions in BP in haemorrhagic

stroke patient?
I thiazide diuretics
II Beta blockers
III ARBs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Beta blockers are considered second-line agents given their inferiority in preventing vascular events,
despite producing similar reductions in BP.
61 What is the most common side effect of ARBs?
I hypertension
II irritation
III cough
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
(Adverse effects of ACEIs include cough [10%], which is less common with ARBs.)
62 What is the lifestyle modification in haemorrhagic stroke patient?
I Smoking cessation
II a low-fat diet
III alchol drinking
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Smoking cessation, a low-fat diet (eg, Dietary Approaches to Stop Hypertension [DASH] or
Mediterranean diets), weight loss, and regular exercise should be encouraged as strongly as
pharmacologic treatment.
63 What is the lifestyle modification in haemorrhagic stroke patient?
I regular exercise
II a high-fat diet
III weight loss
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Smoking cessation, a low-fat diet (eg, Dietary Approaches to Stop Hypertension [DASH] or
Mediterranean diets), weight loss, and regular exercise should be encouraged as strongly as
pharmacologic treatment.
64 What is the different way for smoking cessation?
I ramipril patch
II nicotine patch
III bupropion
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
For smoking cessation (ie, nicotine patch, bupropion, varenicline.
65 Which out of the following is correct related to salt intake in haemorrhagic stroke
patient?
I Reducing sodium intake and increasing consumption of foods high in manganese

II Reducing sodium intake and increasing consumption of foods high in potassium
III Reducing sodium intake and increasing consumption of foods high in Aluminium
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Reducing sodium intake and increasing consumption of foods high in potassium to reduce BP may
also help in primary prevention.[56]
66 What is the limit of alcohol intake in haemorrhagic stroke patient?
I 30 drinks per month

II 40 drinks per month
III 50 drinks per month
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
High alcohol intake should be reduced, as drinking more than 30 drinks per month has been tied to
increased risk of intracerebral hemorrhage.
67 What is the recommended physical activity level in haemorrhagic stroke patient?
I 160 minutes per week

II 150 minutes per week
III 140 minutes per week
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The guidelines endorse the 2008 Physical Activity Guidelines for AmericAns:, which include a
recommendation of at least 150 minutes per week of moderate-intensity aerobic physical activity.
68 Which out of the following drug falls in class anticonvulsant?
I Diazepam
II furosemide
III Lorazepam
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Anticonvulsants Diazepam, Lorazepam, Phenytoin, Fosphenytoin.
69 What is the pharmacological mechanism of diazepam?
I presynaptic inhibition of gamma-aminobutyric acid type A (GABA-A) trAns:mission

II NMDA receptor blocker
III NMDA receptor agonist
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Diazepam controls active seizures by modulating the postsynaptic effects of gamma-aminobutyric acid
type A (GABA-A) trAns:mission, resulting in an increase in presynaptic inhibition.
70 Diazepam act on the which part of brain to produce calming effect?
I limbic system, thalamus and cerebrum

II limbic system, thalamus and hypothalamus
III limbic system, thalamus and cerebellum
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
It appears to act on part of the limbic system, the thalamus, and hypothalamus, to induce a calming
effect.
71 Which out of the following is also the effect of diazepam along with its anticonvulsant
effect?
I skeletal muscle contraction
II skeletal muscle relexant
III dehydration
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
It also acts as an effective adjunct for the relief of skeletal muscle spasm caused by upper motor neuron
disorders.
72 Which drug is used to augment the effect of diazepam?
I lorazepam
II phenytoin
III midazolam
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Diazepam should be augmented by longer-acting anticonvulsants, such as phenytoin or
phenobarbital, because it rapidly distributes to other body fat stores.
73 Which out of the following drug falls in class Hydantoins anticonvulsant?
I diazepam
II Phenytoin
III Fosphenytoin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Hydantoins Phenytoin, Fosphenytoin.
74 Which out of the following is prodrug?
I Fosphenytoin
II diazepam
III midazolam
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Fosphenytoin is a diphosphate ester salt of phenytoin that acts as water-soluble prodrug of phenytoin.
75 What is the reason behind the Concomitant administration of an intravenous

benzodiazepine with Phenytoin?
I to control blood pressure

II to control status epilepticus
III to control intracranial pressure
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Concomitant administration of an intravenous benzodiazepine will usually be necessary to control
status epilepticus.
76 What is the dose of labetelol to control blood pressure in haemorrhagic patient?
I 5 -20 mg intravenous bolus over 1 minutes, then as a continuous infusion at 2 mg/min

II 5 -20 mg intravenous bolus over 2 minutes, then as a continuous infusion at 2 mg/min
III 5 -20 mg intravenous bolus over 3 minutes, then as a continuous infusion at 2 mg/min
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Labetalol blocks beta1-, alpha-, and beta2-adrenergic receptor sites to decrease BP. It is administered
as a 5-20 mg intravenous bolus over 2 minutes, then as a continuous infusion at 2 mg/min (not to
exceed 300 mg/dose).
77 Which out of the following drug falls in class beta-1 selective beta blocker?
I torsemide
II Furosemide
III Esmolol
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Beta Blockers, Beta-1 Selective; Esmolol.
78 What is the half life of Esmolol?
I 8 minutes
II 9 minutes
III 10 minutes
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Esmolol; its short half-life of 8 minutes allows for titration and quick discontinuation, if necessary.
79 Which out of the following drug falls in class Vasodilators?
I verapamil
II Hydralazine
III diltiazem
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Vasodilators; Hydralazine.
80 What is the pharmacological mechanism of Vasodilators?
I indirect vasodilation and relaxation of the vascular smooth muscle

II direct vasodilation and relaxation of the vascular smooth muscle
III direct vasodilation andcontraction of the vascular smooth muscle
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Vasodilators lower BP through direct vasodilation and relaxation of the vascular smooth muscle.
81 What is the application of Calcium channel blockers in patient with haemorrha gic
stroke?
I increasing the amount of blood and oxygen that is delivered to the heart
II
III
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Calcium channel blockers are used to lower BP by relaxing the blood vessels and increasing the amount
82 Which out of the following are first-line agents for long-term BP control in stroke
patients?
I vasodilators
II CCB
III ACEIs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
CCB These are first-line agents for long-term BP control in stroke patients (along with thiazides,
ACEIs, and angiotensin receptor blockers [ARBs]).
83 Which out of the following drug falls in class Angiotensin-converting Enzyme

Inhibitors?
I Ramipril
II furosemide
III Enalapri
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Angiotensin-converting Enzyme Inhibitors; Enalapri, Ramipril, Lisinopril.
84 What is the pharmacological mechanism of ACEIs?
I prevent the conversion of angiotensin II to angiotensin I

II prevent the conversion of angiotensin I to angiotensin II
III prevent the conversion of angiotensin I to angiotensin IV
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
ACEIs prevent the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in
lower aldosterone secretion.
85 Which out of the following drug falls in class Angiotensin Receptor Blockers?
I Losartan
II Candesartan
III Amlodepine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Angiotensin Receptor Blockers; Losartan, Candesartan, Valsartan.
86 Which class of the drug are used as alternative to ACEIs in patients who develop
adverse effects, such as a persistent cough?
I DIuretics
II CCB
III ARBs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
ARBs may be used as an alternative to ACEIs in patients who develop adverse effects, such as a
persistent cough.
87 What is the pharmacological mechanism of valsartan?
I direct antagonism of angiotensin II receptors

II direct antagonism of angiotensin III receptors
III direct antagonism of angiotensin IV receptors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Valsartan produces direct antagonism of angiotensin II receptors. It displaces angiotensin II from the
AT1 receptor and may lower BP by antagonizing AT1-induced vasoconstriction, aldosterone release,
catecholamine release, arginine vasopressin release, water intake, and hypertrophic responses.
88 Which out of the following drug falls in class Thiazide Diuretics?
I Hydrochlorothiazide
II Chlorthalidone
III Furosemide
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Diuretics, Thiazide; Hydrochlorothiazide, Chlorthalidone.
89 What is the pharmacological mechanism of Thiazide Diuretics?
I inhibit sodium reabsorption in the distal tubules of the kidney

II inhibit sodium and chloride reabsorption in the distal tubules of the kidney
III inhibit sodium, chloride and potassium reabsorption in the distal tubules of the kidney
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Thiazide diuretics inhibit sodium and chloride reabsorption in the distal tubules of the kidney,
resulting in increased urinary excretion of sodium and water.
90 Which out of the following drug falls in class Osmotic Agents used as Diuretics?
I hydroclorthiazide
II bumetanide
III Mannitol
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Diuretics, Osmotic Agents; Mannitol.
91 What is the pharmacological mechanism of Mannitol?
I reduces cerebral edema with the help of passive diffussion

II reduces cerebral edema with the help of osmotic forces
III decreases blood viscosity, resulting in reflex vasoconstriction and lowering of intracranial
pressure
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Mannitol reduces cerebral edema with the help of osmotic forces. It also decreases blood viscosity,
resulting in reflex vasoconstriction and lowering of intracranial pressure.
92 Which out of the following drug falls in class Analgesics?
I Diazepam
II labetelol
III Acetaminophen
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Analgesics; Acetaminophen.
93 Which out of the following drug falls in class Hemostatics?
I Vitamin E
II Vitamin K1
III Vitamin K2
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Hemostatics; Vitamin K1.
94 What is the pharmacological mechanism of Vitamin K?
I promote vitamin k synthesis

II promote the formation of anti-clotting factors
III promote the formation of clotting factors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Vitamin K is used to promote the formation of clotting factors.
95 What is the therapeutic use of Phytonadione?
I treatment of coagulant drug overdose

II treatment of anticoagulant drug overdose
III treatment of antiplatelet drug overdose
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Phytonadione can overcome the competitive block produced by warfarin and other related
anticoagulants.
96 What is the emergency treatment to manage warfarin-related intracranial hemorrhage?
I fresh frozen plasma (FFP) infusion followed by oral vitamin E

II fresh frozen plasma (FFP) infusion followed by oral vitamin K
III fresh frozen plasma (FFP) infusion followed by oral vitamin C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
A fresh frozen plasma (FFP) infusion followed by oral vitamin K should be given without delay in
the emergency department to manage warfarin-related intracranial hemorrhage.
97 Which out of the following are blood components?
I RBC
III Platelets
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Blood Components; Fresh frozen plasma, Platelets, Prothrombin complex concentrate.
98 What is the indication of Blood Components?
I correction of blood pressure

II correction of abnormal hemostatic parameters
III correction of abnormal intracranial pressure
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Blood Components These agents are indicated for the correction of abnormal hemostatic parameters.
99 When is the blood component platelet indicated in patient?
I platelet count drops below 50,000/µL

II platelet count drops below 60,000/µL
III platelet count drops below 70,000/µL
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
A single random donor unit of platelets per 10 kg is administered in adults when the platelet count
drops below 50,000/µL
100 What is the pharmacological mechanism of Desmopressin?
I releases von brand protein from endothelial cells

II releases von Willed protein from endothelial cells
III releases von Willebrand protein from endothelial cells
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Desmopressin releases von Willebrand protein from endothelial cells. It improves bleeding time and
hemostasis in patients with mild and moderate von Willebrand disease without abnormal molecular
forms of von Willebrand protein.
HIV INFECTION
Multiple choice questions
Disease conditions
1 Which of the following is true about HIV?
I It is heterovirus
II It is blood borne Virus
III Human immunodeficiency virus
Ans: E
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Human immunodeficiency virus (HIV) is a blood-borne virus.
2 How HIV is transmitted in Human?
I Sexual Intercourse
II Kissing
III Mother to child transmission
Ans: F
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Typically transmitted via sexual intercourse, shared intravenous drug paraphernalia, and mother-
to-child transmission (MTCT), which can occur during the birth process or during breastfeeding.
3 HIV-1 belongs to which of the following Families of virus?
I Retroveridae
II Retroviridae
III Retroviredae
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
HIV-1 or HIV-2, which are retroviruses in the Retroviridae family, Lentivirus genus.
4 What is HIV wasting syndrome?
I chronic weight loss with identifiable cause.

II chronic diarrhea and weight loss with identifiable cause.
III chronis diarrhea and weight loss with no identifiable cause.
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
HIV wasting syndrome (chronic diarrhea and weight loss with no identifiable cause).
5 Which test/tests are recommended for the screening of HIV?
I Serum SGPT and SGOT

II Enzyme-linked immunoabsorbent assay
III Western blot Assay
Ans: E
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
A high-sensitivity enzyme-linked immunoabsorbent assay (ELISA) should be used for screening; a

positive result should be followed with confirmatory testing (eg, Western blot assays or similar specific
assay.
6 Which of the following method is most reliable to determine the risk of acquiring
opportunistic infection in patient?
I CD4 T-cell count

II Enzyme-linked immunoabsorbent assay
III Western blot Assay
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
CD4 T-cell count reliably reflects the current risk of acquiring opportunistic.
7 What is the reference range of CD4 T-cell in Human?
I 300-2000
II 400-2000
III 500-
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
CD4 T-cell count Reference range, 500-
8 What is the Number of CD4 cell used to determine the HIV infected p erson is suffering
from AIDS?
I < 200
II < 300
III 200-300
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
-defining in the United States.

9 Patient having Asymptomatic HIV infection without a history of symptoms or AIDS -
defining conditions can be classified in which category of CDC Classification?
I Category A
II Category B
III Category C
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Category A: Asymptomatic HIV infection without a history of symptoms or AIDS-defining conditions.
10 Which of the following animal species is responsible for the origin of HIV Virus?
I Macaque
II chimpanzees
III Reus Monkey
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
HIV-1 probably originated from one or more cross-species transfers from chimpanzees in central
Africa.
11 What is the characteristic of HIV Infection?
I Decline in CD4+ helper T cells

II Dysregulation of B-cell antibody production
III Increase in CD4+ helper T cells
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
There is a specific decline in the CD4+ helper T cells, resulting in inversion of the normal CD4/CD8
T-cell ratio and dysregulation of B-cell antibody production.
12 Which gene in HIV is responsible for encoding protease (the viral enzymes)?
I gag
II pol
III env
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The pol gene encodes polymerase; it also contains integrase and protease (the viral enzymes).
13 How is HIV-1 differentiated form HIV-2 on basis of gene?
I HIV-1have vpu gene while HIV-2 have vpx gene

II HIV-1have vpx gene while HIV-2 vpu gene
III HIV-1have vpx gene while HIV-2 vif gene
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
HIV-1 has 6 additional accessory genes: tat, rev, nef, vif, vpu, and vpr. HIV-2 does not have vpu but
instead has the unique gene vpx.
14 What makes GI tract ideal site for HIV replication?
I Large amount of lymphoid tissue

II Acidic Environment
III Microbial flora of gut which aggravates infection
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
GI tract contains a large amount of lymphoid tissue, making this an ideal site for HIV replication.
15 Which are the different phases of HIV infection in Human?
I Acute seroconversion → Asymptomatic infection → AIDS

II Asymptomatic infection → Acute seroconversion → AIDS
III AIDS → Asymptomatic infection → Acute seroconversion
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Clinical HIV infection undergoes 3 distinct phases: acute seroconversion, asymptomatic infection, and
AIDS.
16 Which cells are the first cellular targets of HIV?
I CD4 helper T cell

II Macrophage
III Langerhans cells
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Animal models show that Langerhans cells are the first cellular targets of HIV.
17 Which symptoms are experienced by patient during acute seroconversion phase of HIV?
I Fever, Flulike illness and Lymphadenopathy

II Rash
III Weight Loss
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Symptoms during this time may include fever, flulike illness, lymphadenopathy, and rash. These
manifestations develop in approximately half of all people infected with HIV.
18 Which phase of HIV infection shows steady state decline in CD4+ T-cell?
I Acute seroconversion
II Asymptomatic infection
III AIDS
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
During this time, the viral load, if untreated, tends to persist at a relatively steady state, but the CD4+
T-cell count steadily declines. This rate of decline is related to, but not easily predicted by, the steady-
state viral load.
19 Which of the following sign indicates the patient is suffering from AIDS after HIV
infection?
I Significant opportunistic infections

II CD4+ T-
III Loss of Appetite
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
When the immune system is damaged enough that significant opportunistic infections begin to
develop, the person is considered to have AIDS.
20 Why the patients with HIV infection are monitored for the first 6 months of
antiretroviral therapy?
I Because of relatively high risk for opportunistic infections

II Because of relatively high risk for AIDS-related events
III Because during initial stage of antiretroviral therapy it is less effective against HIV
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
All patients remain at a relatively high risk for opportunistic infections and other AIDS-related events
for the first 6 months of antiretroviral therapy.
21 Which out of the following is not an Opportunistic infection?
I Pheumonia
II Malaria
III Candidiasis
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Although malaria is not typically considered an opportunistic infection, its incidence was found to be
significantly higher among children in Tanzania that were perinatally infected with HIV than those
without HIV infection.
22 Which of the following HIV related condition shows cognitive impairment?
I HIV Encephalopathy
II Kaposi sarcoma
III Immunoblastic Lymphoma
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
HIV Encephalopathy is a severe condition usually seen in end-stage disease. Milder cognitive
impairments may exist with less advanced disease.
23 What is overall mortality rate in patient with untreated HIV infection?
I 80-90 %
II < 90 %
III > 90 %
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The prognosis in patients with untreated HIV infection is poor, with an overall mortality rate of more
than 90%.
24 What is an average time in a patient, from HIV infection to death?
I 8-10 years
II 5-8 years
III 3-5 years
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The average time from infection to death is 8-10 years, although individual variability ranges from
less than 1 year to long-term nonprogression.
25 What is survival period in untreated AIDS patients?

I Less than 6 months
II Less than 1 year
III less than 2 year
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Once infection has progressed to AIDS, the survival period is usually less than 2 years in untreated
patients.
26 What is the outcome of, two HIV-infected person having a sex?
I It is safe to do so
II It is not safe to do so
III It may or may not be safe to do so
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Some HIV-infected people actively seek out other persons with HIV infection for sex under the
assumption that they are not putting themselves or anyone else at an increased risk. However, it is
clear that co-infections with multiple HIV strains (whether the same or different clades) can and do
occur.
27 Which is not risk factor for HIV trAns:mission?
I Multiple sexual partner

II Homosexual
III Prevention of mucosal contact with infected blood
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
A large number of sexual partners is risk factor.
28 During outbreak, what is the correlation between Prior Gonorrhea and chlamydia
infections and HIV Infection?
I Raise the transmission risk of HIV

II Decrease the transmission risk of HIV
III No change in the transmission risk of HIV
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Prior or current sexually transmitted diseases (STDs): Gonorrhea and chlamydia infections increase
the HIV transmission risk 3-fold, syphilis raises the transmission risk 7-fold, and herpes genitalis raises
the transmission risk up to 25-fold during an outbreak.
29 Can mucosal contact with infected blood cause HIV infection?
I Yes
II No
III say
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Mucosal contact with infected blood or needle-stick injuries Risk Factor.
30 Which out of the following is the preferred mode of transmission of HIV infection
from mother to Child ?
I During pregnancy through placenta

II During breast feeding
III cesarean labour
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
31 Subject having high risk to acquire HIV infection?
I Using barrier contraception

II Drug addict
III Person getting repeated blood trAns:fusion
Ans: E
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Sharing of intravenous drug paraphernalia.

Receipt of blood products (before 1985 in the United States).
32 choose the odd one out-
I gag
II tat
III nif
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
HIV contains 3 species-defining retroviral genes: gag, pol, and env.
33 Which structural component of HIV is required for cell- cell fusion?
I gp 41
II gp 120
III p 24
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Glycoprotein 120, the viral-envelope protein, binds to the host CD4+ molecule.
34 Which out of following is the most common opportunistic infection of people with
AIDS?
I sarcoma
II pneumocystis carnie pneumonia
III Wasting syndrome
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Prophylaxis for Pneumocystisjiroveci (a normally harmless commensal organism) is most important,

as this causes a common, preventable, serious infection.
35 Opportunistic infections are diseases that:
I Are not life threatening to people with HIV/AIDS

II Develop the same in healthy people as in people with HIV/AIDS
III benefit from a vulnerable immune system
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
36 Which form of sexual interaction presents the most risk for spreading HIV among men
and women?
I anal intercourse
II Vaginal intercourse
III oral sex
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Early on, nearly all cases of HIV infection detected in the Western Hemisphere were in homosexual
men.
37 In testing for HIV infection:
I the Western blot is given first and the ELISA is used to recheck positives
II the ELISA is given first and the Western blot is used to recheck positives
III the only test used now is the DNA-HIV
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
A positive ELISA result should be followed with confirmatory testing in the form of one or more
Western blot assays or similar specific assay. Specific diagnostic criteria vary by test.
38 Which is the leading way that AIDS is spread worldwide?
I heterosexual sexual activity

II homosexual sexual activity
III IV drug use
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Early on, nearly all cases of HIV infection detected in the Western Hemisphere were in homosexual
men.
39 How do most children contract HIV?
I infected breast milk

II perinatal trAns:mission
III Sexual abuse
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Children may become infected by transplacental transmission or by breastfeeding. Rare cases of

children infected after sexual abuse by HIV-infected adults have also been reported.
40 Patient having HIV infection with symptoms that are directly attributable to HIV
infection or that are complicated by HIV infection can be classified in which category of
CDC Classification?
I Category A
II Category B
III Category C
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Category B: HIV infection with symptoms that are directly attributable to HIV infection (or a defect
in T-cell mediated immunity) or that are complicated by HIV infection.
41 Patient having HIV infection with AIDS-defining opportunistic infections can be

classified in which category of CDC Classification?
I Category A
II Category B
III Category C
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Category C: HIV infection with AIDS-defining opportunistic infections.
42 What is the difference between HIV and AIDS?
I HIV is a virus and AIDS is a bacteria

II There is no difference between HIV and AIDS
III HIV is the virus that causes AIDS
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
43 Which out of following is very common among HIV-infected individuals?
I AIDS
II lymphadenopathy
III opportunistic infection
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Generalized lymphadenopathy is common and may be a presenting symptom.
44 Patient history form of HIV infected should address-

I Previous or current sexually transmitted diseases
II Mucosal contact with infected blood or needle-stick injuries
III Number of previous blood trAns:fusion
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
History should address risk factors:

 Previous or current sexually transmitted diseases (STDs)
 Mucosal contact with infected blood or needle-stick injuries
45 Which of the following statement is true for the children younger than 5 years?
I CD4 T-cell percentage is considered important to warrant therapy

II CD4 T-cell count considered important to warrant therapy
III CD4 T-cell percentage and CD4 T-cell count considered important to warrant therapy
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
In children younger than 5 years, the CD4 T-cell percentage is considered more important than the
absolute count (< 25% is considered to warrant therapy).
46 What is used as a surrogate marker of viral replication rate?
I Viral load in peripheral blood

II viral load in Lymph node
III Viral load in peripheral Tissue
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Viral load in peripheral blood is used as a surrogate marker of viral replication rate; however.
47 Which out of following statement is true?
I Rate of progression to AIDS and death after HIV infection is related to the viral load
II Rate of progression to AIDS and death after HIV infection is related to the rate viral replication
III Rate of progression to AIDS and death after HIV infection is not related to the viral load and
rate viral replication
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Rate of progression to AIDS and death is related to the viral load; patients with viral loads greater
to die of AIDS than those with undetectable viral loads.
48 What is undetectable level of viral loads ?
I 80 copies/mL
II < 80 copies/mL
III < 20-75 copies/mL
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Therapy, viral loads can often be suppressed to an undetectable level (< 20-75 copies/mL; optimal
viral suppression).
49 Which test was approved by FDA for rapid HIV test for the simultaneous detection of
HIV-1 p24 antigen as well as antibodies to both HIV-1 and HIV-2 in human serum?
I Western blot test

II Alere Determine HIV-1/2 Ag/Ab Combo test
III Reverse-trAns:cription polymerase chain reaction
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The FDA approved Alere Determine HIV-1/2 Ag/Ab Combo test (Orgenics, Ltd) as the first rapid
HIV test for the simultaneous detection of HIV-1 p24 antigen as well as antibodies to both HIV-1
and HIV-2 in human serum, plasma, and venous or fingerstick whole blood specimens.
50 What Is CD4+ T-cell count in Sub category C3 of Category C (CDC Classification of

HIV Infection)?
I > 500/µL
II 200-400/µL
III < 200/µL
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
< 200/µL: Categories A3, B3, C3
51 What Is CD4+ T-cell count in Sub category B2 of Category C (CDC Classification of

HIV Infection)?
I > 500/µL
II 200-400/µL
III < 200/µL
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
200-400/µL: Categories A2, B2, C2

52 What Is CD4+ T-cell count in Sub category A1 of Category C (CDC Classification of
HIV Infection)?
I > 500/µL
II 200-400/µL
III < 200/µL
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
> 500/µL: Categories A1, B1, C1
53 What is true for the antiretroviral therapy and CD4 count?
I Antiretroviral therapy should be initiated with a CD4 count below 350/µL

II Antiretroviral therapy should be initiated with a CD4 count below 550/µL
III Antiretroviral therapy should be initiated regardless of CD4 cell count in pregnant patients
Ans: F
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Antiretroviral therapy should be initiated in all patients with a history of an AIDS-defining illness
or with a CD4 count below 350/µL.
Antiretroviral therapy should be initiated regardless of CD4 count in pregnant patients, patients
with HIV-associated nephropathy, and those with hepatitis B virus (HBV) coinfection when
treatment of HBV infection is indicated.
54 At what CD4 cell count antiretroviral therapy is initiated in patients with HIV-
associated nephropathy?
I below 350/µL
II between 350-500/µL
III regardless of CD4 cell count
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Antiretroviral therapy should be initiated regardless of CD4 count in pregnant patients, patients with
HIV-associated nephropathy, and those with hepatitis B virus (HBV) coinfection when treatment of
HBV infection is indicated.
55 Which out of the following sentence is true?
I Infection with HIV-1 tend to have a lower viral load than people with HIV-2
II Infection with HIV-2 tend to have a lower viral load than people with HIV-1
III Infection with HIV-1 and HIV-2 have similar viral load
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
HIV-2 tend to have a lower viral load than people with HIV-1,[13, 14] and a greater viral load is
associated with more rapid progression to AIDS in HIV-1 infections.[15, 16]
56 Which out of the following sentence is true in term of progression to AIDS after HIV
infection?
I Rapid progression to AIDS in HIV-1 infections

II Rapid progression to AIDS in HIV-2 infections
III HIV-1 infections and HIV-2 infections have same progression rate to AIDS
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
HIV-2 tend to have a lower viral load than people with HIV-1,[13, 14] and a greater viral load is
associated with more rapid progression to AIDS in HIV-1 infections.[15
57 What is difficulty in dealing with HIV on a global scale?

I Due to lack of Antiretroviral Drug availability
II Due to the fact that HIV infection is far more common in resource-poor countries
III Due to lack of communication and understanding between different countries
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The difficulty in dealing with HIV on a global scale is largely due to the fact that HIV infection is
far more common in resource-poor countries.
58 What is necessary to improve prognosis and increase survival rate in HIV Infected
Patients?
I Education (awareness such that testing and prevention of infection)

II Vaccination with AIDS virus
III Antiretroviral therapy
Ans: F
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
In the developed world, antiretroviral therapy has greatly improved prognosis and increased survival
rates. Public education programs have raised awareness such that testing and prevention of infection
are more common. Both of these approaches are difficult in countries with undereducated or
underfunded populations.
59 Which gene encodes the viral envelope in HIV?
I gag
II env
III pol
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The env gene encodes the viral envelope the outer structural proteins responsible for cell-type
specificity.
60 Which gene encodes group-specific antigen;the inner structural proteins in HIV?
I gag
II env
III pol
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The gag gene encodes group-specific antigen; the inner structural proteins.
61 Which out of the following is true for the opportunistic infection?
I Pattern of infection depends on the pathogen common to that area.

II Pneumocystis specie infection is common in AIDS patient of United States
III Candida species infection is not common in AIDS patient of United States
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The pattern of opportunistic infections in a geographic region reflects the pathogens that are common
in that area. For example, persons with AIDS in the United States tend to present with commensal
organisms such as Pneumocystis and Candida species.
62 Which site shows early viral seeding and establishment of the proviral reservoir?
I Blood
II Gut-associated lymphoid tissue
III Vaginal tissue
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
MCQ62 GALT has been shown to be a site of early viral seeding and establishment of the proviral
reservoir.
63 HIV replication in GALT is-
I compartmentalized
II Non- compartmentalized
III Both
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
A feature of HIV replication in GALT is that it is compartmentalized, even among different areas of
the gut.
64 How is viral replication detected in HIV patient with suppressed replication?
I GALT viral replication measurement

II GALT viral load measurement
III Plasma viral load measurement
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
In addition, HIV replication can be detected even in patients with supposedly suppressed replication,
as judged by plasma viral load measurements.
65 What are the characteristic of Untreated HIV infection?
I Increase in number of mature CD4 T cells

II Rapid T-cell turnover
III Defect in T-cell replication from the thymus
Ans: E
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Studies of T-cell replication kinetics have revealed that untreated HIV infection is characterized by
rapid T-cell turnover but a defect in T-cell replication from the thymus.
66 How HIV interferes in production of normal cytokine profile in body?
I HIV causes cell-cycle

II HIV causes cell-cycle arrest
III HIV causes cell-cycle
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
It is known that normal cell cycling is necessary to produce a normal cytokine profile[41] and that HIV
causes cell-cycle arrest.
67 How HIV proteins affect normal T-cell function?
I Down-regulating the CD4 molecule

II Prevents T cell maturation in Thymus
III Disrupting cell cycling
Ans: F
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Several of the HIV proteins directly affect T-cell function, either by disrupting cell cycling or down-
regulating the CD4 molecule. The loss of T cells is clearly a primary issue, as the T-cell repertoire
narrows in terms of which antigens the immune system will recognize and respond to.
68 Which out of the following statement is true for antiviral therapy?
I It reverses immune capacity to recognise and respond to HIV

II It prevents the loss of T cells
III It increases T cell number to normal level
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The loss of T cells is clearly a primary issue, as the T-cell repertoire narrows in terms of which antigens
the immune system will recognize and respond to. MCQ68 Antiviral therapy is able to reverse these
changes.
69 What is the correlation between HIV therapy and Cytokine level?
I HIV infection does not affect cytokines

II HIV corrects decreased IL-7 and IL-2 level
III HIV corrects increased TNF-alpha and IP-10 level
Ans: E
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
HIV show that cytokines involved in T-cell homeostasis were definitely affected, and therapy partially
corrected these defects. In particular there was decreased IL-7, IL-12, IL-15 and FGF-2, and
increased TNF-alpha and IP-10.[43, 44]
70 What is the reason behind the loss of CD4 T-cell in HIV infection?
I Due to cytotoxic effect of viral replication

II T cell apoptosis due to immune hyperactivation
III Cell cycle arrest by HIV virus
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Direct cytotoxic effects of viral replication are likely not the primary cause of CD4 T-cell loss; a
significant bystander effect[46] is likely secondary to T-cell apoptosis as part of immune hyperactivation
in response to the chronic infection.
71 Which chemokine receptor is involved in initial HIV infection?
I Chemokine receptor 3
II Chemokine receptor 4
III Chemokine receptor 5
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The initial infection nearly always involves a strain that uses the chemokine receptor 5 (CCR5),
which is found on macrophages and dendritic cells.
72 Which immune cell shows chemokine receptor 5?
I Macrophage
II Dendritic cells
III B cell
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Which is found on macrophages and dendritic cells.

73 Which chemokine receptor are involved in advanced HIV infection?
I Chemokine receptor 5
II chemokine-related receptor (CXCR4)
III chemokine-related receptor (CXCR121)
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Over time, the receptor usage shifts to chemokine-related receptor (CXCR4) and other related receptors
found on CD4+ T cells.
74 Which infected immune cell releases virus in proviral reservoir during acute
seroconversion phase?
I Macrophage
II B cell
III T cell
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
This reservoir consists of persistently infected cells, typically macrophages, and appears to steadily
release virus.
75 How is proviral reservoir measured?
I by Western blot method

II by ELISA
III by DNA polymerase chain reaction
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The proviral reservoir, as measured by DNA polymerase chain reaction (PCR).
76 Which statement is correct for proviral reservoir?
I proviral reservoir correlates to anti-HIV CD8+ T-cell responses

II proviral reservoir correlates to the steady-state viral load
III treatment in newly infected patients yields no long-term benefit
Ans: E
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The size of the proviral reservoir correlates to the steady-state viral load and is inversely correlated to
the anti-HIV CD8+ T-cell responses. Aggressive early treatment of acute infection may lower the
proviral load, but generally, treatment in newly infected (but postseroconversion) patients yields no
long-term benefit.
77 Which immune cells are primary involved in immunologic control of HIV?
I CD8+ cytotoxic T-cells

II Macrophage
III B cell
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The primary mechanism for immunologic control of HIV appears to be CD8+ cytotoxic T-cells.
78 Which statement is correct for HIV infected patient?
I there is no risk opportunistic infections in patient with low CD4 T cell on antiretroviral therapy
II there is risk opportunistic infections in patient with low CD4 T cell on antiretroviral therapy
III there is no risk opportunistic infections in patient with high CD4 T cell on antiretroviral
therapy
Ans: F
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Even after starting therapy and with effective suppression of viral load, patients with persistently low
CD4 counts remain at high risk for opportunistic infections.
79 Which country has highest overall prevalence of HIV infection?
I Swaziland
II Africa
III India
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Swaziland has the highest overall prevalence of HIV infection.
80 In HIV infected patient Co-infection with which diseases is very common in

developing nation?
I Candiadid
II Tuberculosis
III Syphilis
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
In developing nations, co-infection with HIV and tuberculosis is very common.
81 What is the prevalence of HIV infection in developed and developing countries?

I It is more common in male in developed and equally common in both sex in developing
countries.
II It is more common in female in developed and common in female in developing countries.
III It is equally common in both sex in developed and developing countries
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
In the developed world, HIV infection is much more common in males.

In the developing world, HIV infection is equally common in males and females.
82 Which secondary test may be performed to assist with diagnosis or staging of HIV
infection?
I Viral culture
II Phenotypic of viral DNA
III Lymph node biopsy
Ans: F
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Secondary testing:
 Viral culture
 Lymph node biopsy
 Proviral DNA polymerase chain reaction (PCR)
 Genotyping of viral DNA/RNA
83 fourth-generation test in HIV diagnosis identifies-
I viral protein HIV-1 p23 antigen

II viral protein HIV-1 p24 antigen
III viral protein HIV-1 p25 antigen
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Diagnosis starts with a fourth-generation test that detects HIV in the blood earlier than antibody tests
can; it identifies the viral protein HIV-1 p24 antigen, which appears in the blood before antibodies
do.
84 Enzyme-linked immunoabsorbent assay (ELISA) can be used for the screening of-
I HIV-1
II HIV-2
III Both
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
A high-sensitivity enzyme-linked immunoabsorbent assay (ELISA) should be used for screening. Most
ELISAs can be used to detect HIV-1 types M, N, and O and HIV-2.
85 Enzyme-linked immunoabsorbent assay (ELISA) can be used for the screening of -
I HIV type M
II HIV type O
III HIV type J
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Most ELISAs can be used to detect HIV-1 types M, N, and O and HIV-2.
86 What is optimal viral suppression in HIV patient?
I viral loads < 20-75 copies/mL

II Viral Load < 85-90 copies/ml
III Viral load < 85-100 copies/ml
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
With therapy, viral loads can often be suppressed to an undetectable level (ie, < 20-75 copies/mL,
depending on the assay used); this is considered optimal viral suppression.
87 How Genotyping of viral DNA/RNA can guide therapy?
I patterns of mutations can help in selecting antiviral drug

II Viral DNA directly gives information about the antiviral drug
III Viral RNA directly gives information about the antiviral drug
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Genotyping of viral DNA/RNA can guide therapy. Because patterns of mutations that lead to
resistance to specific drugs or drug classes are now well-recognized, sequencing of the viral genome
allows for the selection of specific antivirals that are more likely to elicit a response.
88 Where dose the most viral replication occur in human body?
I Peripheral blood
II Lymph node
III Thymus
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
This is a surrogate because most of the viral replication occurs in the lymph nodes rather than in the
peripheral blood.
89 Which out of following is quantitative viral-load assays?
I reverse-trAns:cription polymerase chain reaction

II nucleic acid sequence-based amplification
III western blot assay
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Nucleic acid sequence-based amplification (NASBA), reverse-trAns:cription polymerase chain

reaction (RT-PCR), or similar technologies. Quantitative viral-load assays should not be used as a
diagnostic tool because several false-positive misdiagnoses have been reported in the literature.
90 Rapid amplification testing is used for the testing of-
I tuberculosis infection
II gonococcal infection
III chlamydial infection
Ans: E
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Rapid amplification testing for gonococcal and chlamydial infection.
91 Why viral culturing is not useful tool for diagnosis of HIV?
I It is expensive and time-consuming

II IT is less sensitive in patients with low viral loads
III treatment cannot assigned on basis viral load
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Viral culture is expensive and time-consuming and is less sensitive in patients with low viral loads.
Viral culture may be performed as part of phenotypic drug-resistance testing.
92 In newly diagnose HIV infection, testing of other infection includes -
I lymph node eximination

II Cytomegalovirus (CMV) testing
III Ophthalmologic examination
Ans: E
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Newly diagnosed HIV infection include:

 Cytomegalovirus (CMV) testing
 Syphilis testing
 Rapid amplification testing for gonococcal and chlamydial infection
 Ophthalmologic examination
93 Rapid plasma reagent is used for the testing of-
I syphilis
II Gonorrhea
III chlamydia
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
For syphilis screening, rapid plasma reagent (RPR) testing can be used initially.
94 What is characteristic finding in patients with HIV encephalopathy?

I Multinucleated giant cells
II microgliosis
III Non nucleated giant cell
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Multinucleated giant cells are a characteristic finding in patients with HIV encephalopathy. Myelin
pallor and microgliosis may also be observed.
95 What is the characteristic of disrupted lymph node?
I hyperplasia
II multinucleated syncytia of T cells
III nononucleated syncytia of T cells
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The lymph node architecture is progressively disrupted; this can be reversed with effective antiviral
therapy. Findings include hyperplasia, multinucleated syncytia of T cells, and loss of the normal
follicular dendritic network. cells, and loss of the normal follicular dendritic network.
96 What is CD4+ T-cell counts in sub category A1, B1 and C1 of category C (CDC
Classification)?
I > 300/µL
II > 400/µL
III > 500/µL
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Categories A1, B1, and C1 are characterized by CD4+ T-cell counts greater than 500/µL.
Classification)?
I 200/µL-400/µL
II 300/µL-500/µL
III 400/µL-600/µL
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Categories A2, B2, and C2 are characterized by CD4+ T-cell counts between 200/µL and 400/µL.
Classification)?
I <200/µL
II <300/µL
III <400/µL
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
HIV infections in patient with CD4+ T-cell counts under 200/µL are designated as A3, B3, or
C3.Liverfunction test.
99 Which test is used for evaluation of tuberculosis infection?
I Purified protein derivative skin test

II Serum SGPT
III Liver Biopsy
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
A purified protein derivative skin test is placed to evaluate for tuberculosis infection. Chest
radiography should be performed in patients with a positive PPD test result.
100 Ophthalmologic examination in HIV infection is used to evaluate-
I CMV retinitis
II herpes simplex retinitis
III Herpes complex retinitis
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ophthalmologic examination is used to evaluate for CMV retinitis in people with very low CD4 T-
cell counts.
1 Treatment of human immunodeficiency virus (HIV) disease depends on-
I stage of the disease

II Viral replication rate
III concomitant opportunistic infections
Ans: F
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The treatment of human immunodeficiency virus (HIV) disease depends on the stage of the disease
and any concomitant opportunistic infections.
2 Which principal method is used for preventing immune deterioration in HIV infected
Patients?
I Highly active antiretroviral therapy

II Decreasing number of sexual partner
III preventing multiple blood trAns:fusion
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Highly active antiretroviral therapy (HAART) is the principal method for preventing immune
deterioration.
3 What are the outcomes of highly active antiretroviral therapy?
I gradual recovery of CD4 T-cell numbers

II improvement of T-cell repertoire
III decreased B cell
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
HAART results in a gradual recovery of CD4 T-cell numbers and an improvement of immune
responses and T-cell repertoire (previously lost antigen responses may be restored).
4 Which non-AIDS-defining condition are reduced when patient treated with highly active
antiretroviral therapy?
I Cardiac
II Renal
III Psychiatric
Ans: E
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Non-AIDS-defining, in particular psychiatric and renal disease, may also be reduced when on
HAART.
5 HIV infected patient should be vaccinated against-
I pneumococcal infection
II influenza
III Hepatitis O
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
HIV infected should vaccinated against pneumococcal infection, influenza, varicella, and hepatitis A
and B.
6 According to IDSA Guideline, Which test are necessary in HIV infected patient?
I screening for diabetes, osteoporosis

II Lipid monitoring
III Blood group
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
IDSA Guideline test necessary.

Undergo screening for diabetes, osteoporosis, and colon cancer.
Lipid monitoring and management of lipids and other cardiovascular risk factors should be
performed.
7 What is Time period for HIV patient to undergo blood monitoring for viral levels?
I every 6-12 months

II every 12-24 months
III every 24 months
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Patients with well-controlled infection should undergo blood monitoring for viral levels every 6-12
months .
8 According to Infectious Diseases Society of America, Women with HIV should undergo -
I annual screening for gonorrhea

II annual trichomoniasis screening
III quarterly screening for gonorrhea
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The Infectious Diseases Society of America (IDSA):
Women with HIV should undergo annual trichomoniasis screening, and all infected patients who
may be at risk should undergo annual screening for gonorrhea and chlamydia.
9 Which out of following is most common AIDS related Cancer?
I non-Hodgkin lymphoma
II Hodgkin lymphoma
III Cervical cancer
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Which showed that cancers as a cause of mortality decreased overall but increased as a percentage of
deaths, with non-Hodgkin lymphoma being the most common AIDS-related cancer and lung cancer
being the most common non AIDS-related cancer.
10 What is the count of CD4 cells to initiate antiretroviral therapy according to the US
guidelines?
I 500
II 450
III
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
US guidelines recommending that antiretroviral therapy be initiated at a CD4 count threshold of
11 What is the count of CD4 cells to initiate antiretroviral therapy according to the World
Health Organization?
I 500
II 450
III
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Although 2013 guidelines from the World Health Organization (WHO) now recommend a threshold
12 According to European AIDS Clinical Society diagnosis and management of which

comorbid conditions is necessary?
I Hyperlactemia
II hyperprolactemia
III Sexual dysfunction
Ans: F
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The European AIDS Clinical Society (EACS):

 Hyperlactemia and lactic acidosis
 Sexual dysfunction

comorbid conditions is necessary ?
I Dyslipidemia
II Vitamin D deficiency
III Vitamine K defeciency
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III

 Dyslipidemia
 Vitamin D deficiency

comorbid conditions is necessary ?
I Vitamin B deficiency
II Hypertension
III Type 2 diabetes
Ans: E
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
In addition, they address diagnosis and management of comorbid conditions, including the following:
 Hypertension
 Type 2 diabetes
15 According to DHHS guideline, When Antiretroviral therapy should be initiated?
I Patient with AIDS-defining illness

II CD4 count below 350 cells/µL
III CD4 count below 550 cells/µL
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
DHHS guideline:
Antiretroviral therapy should be initiated in all patients with a history of an AIDS-defining illness
(see Staging) or with a CD4 count below 350 cells/µL .
16 In which conditions/circumstance antiretroviral therapy should be initiated regardless

of CD4 count?
I Pregnency
II HIV-associated nephropathy
III HIV-associated dirrhea
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Antiretroviral therapy should be initiated regardless of CD4 count in pregnant patients, patients with
HIV-associated nephropathy, and those with hepatitis B virus coinfection when treatment of hepatitis
B virus infection is indicated .
17 Which out of the following is odd in terms of antiretroviral Classification of Drug?
I Protease inhibitors
II Nucleoside reverse transcriptase inhibitors
III Phosphatase inhibitor
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Classes of antiretroviral agents:

 Nucleoside reverse transcriptase inhibitors (NRTIs)
 Protease inhibitors (PIs)
I Nonnucleoside reverse transcriptase inhibitors

II Nucleus reverse transcriptase inhibitors
III Fusion inhibitors
Ans: F
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III

 Nonnucleoside reverse transcriptase inhibitors (NNRTIs)
 Fusion inhibitors
I CCR5 co-receptor antagonists

II HIV integrase strand transfer inhibitors
III Ribosome s30 Inhibitor
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III

 HIV integrase strand transfer inhibitors
 CCR5 co-receptor antagonists (entry inhibitors
20 According to 2011 DHHS guidelines which drug is recommended in patient with HIV
infection?
I Efavirenz/tenofovir/emtricitabine
II lopinavir/ritonavir plus zidovudine/Indinavir
III Ritonavir-boosted atazanavir + tenofovir/emtricitabine
Ans: F
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The January 2011 DHHS guidelines preferred treatment:

 Efavirenz/tenofovir/emtricitabine (EFV/TDF/FTC)
 Ritonavir-boosted atazanavir + tenofovir/emtricitabine (ATV/r + TDF/FTC)
21 According to 2011 DHHS guidelines which drug is recommended in patient with HIV
infection?
I lopinavir/ritonavir plus zidovudine/lamivudine

II Ritonavir-boosted darunavir + tenofovir/emtricitabine
III Raltegravir + tenofovir/emtricitabine
Ans: E
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The January 2011 DHHS guidelines preferred treatment:

 Ritonavir-boosted darunavir + tenofovir/emtricitabine (DRV/r + TDF/FTC)
 Raltegravir + tenofovir/emtricitabine
22 According to 2011 DHHS guidelines Which drug is recommended in pregnant women
with HIV infection?
I lopinavir/ritonavir plus zidovudine/Sativudine

II lopinavir/ritonavir plus zidovudine/Indinavir
III lopinavir/ritonavir plus zidovudine/lamivudine
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The January 2011 DHHS guidelines :

except in pregnant women, in whom twice-daily lopinavir/ritonavir plus zidovudine/lamivudine
remains preferred.
23 What are the criteria for the selection of antiretroviral regimen in HIV infected Patient?
I Drug resistance testing results

II Virologic efficacy
III Serum bioavilabilty of drug
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Antiretroviral regimen selection is individualized, on the basis of the following[6] :

 Virologic efficacy
 Toxicity
 Drug resistance testing results
 Comorbid conditions
24 What are the drug related criteria for the selection of antiretroviral regimen in HIV
infected Patient?
I Pill burden
II Avilability of drug
III Drug-drug interaction potential
Ans: F
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Antiretroviral regimen selection is individualized, on the basis of the following:

 Pill burden
 Dosing frequency
 Drug-drug interaction potential
25 According to 2011 DHHS guidelines which testing is recommend to guide the choice of
initial therapy in antiretroviral-naïve patients?
I genotypic
II phenotypic
III Serological
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The January 2011 DHHS guidelines recommend genotypic testing to guide the choice of initial
therapy in antiretroviral-naïve patients, as well as in patients in whom first or second regimens
produce a suboptimal virologic response or virologic failure.
26 Which testing are necessary when complex drug resistance mutation patterns, especially
to protease inhibitors, are confirmed or suspected?
I Phenotypic
II genotypic
III serum SGPT
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Phenotypic testing is generally added to genotypic testing when complex drug resistance mutation
patterns, especially to protease inhibitors, are confirmed or suspected.
27 According to study of Lennox et al, which out of following drug demonstrates benefit
over efavirenz as part of combination in antiretroviral therapy?
I raltegravir
II Lamivudine
III Sativudine
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
A study by Lennox et al in treatment-naive patients from 67 centers on 5 continents demonstrated

benefits of raltegravir (another INSTI) over efavirenz (an NNRTI) as part of combination
antiretroviral therapy.
28 According to Antiviral Society-USA (IAS-USA) Initial regimens for the HIV infected
patient includes-
I One nucleoside reverse transcriptase inhibitors and a two boosted drug
II Two nucleoside reverse transcriptase inhibitors and a third single or boosted drug
III Three nucleoside reverse transcriptase inhibitors and boosted drug if necessary
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The International Antiviral Society-USA (IAS-USA) released antiretroviral treatment

recommendations for adults, including the following[130, 131] :
 Initiate ART for all HIV-infected adults who are willing/ready to start therapy.
 Initial regimens: Include two nucleoside reverse transcriptase inhibitors (NRTIs) (eg,
abacavir/lamivudine or tenofovirdisoproxil fumarate/emtricitabine) and a third single or
boosted drug, either an integrase strand transfer inhibitor (eg, dolutegravir, elvitegravir,
raltegravir), a non-NRTI (eg, efavirenz, rilpivirine), or a boosted protease inhibitor (eg,
darunavir, atazanavir); alternative regimens may be used.
29 Which drugs are used for the prophylaxis of Pneumocystis pneumonia in HIV infected
patient?
I Chloremphenicol
II trimethoprim-sulfamethoxazole
III Amikacin
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX; Bactrim) has been shown to prevent

Pneumocystis pneumonia (PCP).
30 Which test is necessary for the patient taking dapsone?
I Lactate dehydrogenase
II glucose-6-phosphate dehydrogenase
III Alkaline Phosphatase
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Dapsone (after screening for glucose-6-phosphate dehydrogenase [G6PD] deficiency).
31 Which drugs are used as alternative to trimethoprim-sulfamethoxazole in treating

Pneumocystis pneumonia?
I atovaquone
II dapsone
III Doxycycline
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
When TMP-SMX cannot be used, alternatives include dapsone (after screening for glucose-6-
phosphate dehydrogenase [G6PD] deficiency) and atovaquone or monthly nebulized pentamidine
treatments.
32 Which drug will doctor suggest in patient with CD4+ counts below 50/µL and patient
at risk for Mycobacterium avium complex infection?
I Ofloxacine
II Doxycycline
III Azithromycin
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
CD4+ counts below 50/µL place the patient at risk for Mycobacterium avium complex infection, and
weekly azithromycin or clarithromycin is recommended as prophylaxis.
33 Which drug is used for prophylaxis of fungal infection in patients with HIV infection?
I Albandazole
II fluconazole
III Mebandazole
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Prophylaxis for fungal or viral infections is not routinely necessary, but some have recommended
fluconazole in patients with CD4+ T-cell counts under 50/µL to prevent candidal or cryptococcal
infections.
34 Which drug is used for prophylaxis of cytomegalovirus infection in patients with

advanced AIDS?
I Aciclovir
II Ganciclovir
III Ritonavir
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Oral ganciclovir is indicated for prophylaxis of cytomegalovirus infection in patients with advanced
AIDS and is about 50% effective in reducing invasive disease.
35 What is HIV lipodystrophy?
I Decreased serum LDL

II Increased serum HDL
III Abnormal central fat accumulation
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
HIV lipodystrophy is a syndrome of abnormal central fat accumulation and/or localized loss of fat
tissue that occurs in patients taking antiretroviral drugs.
36 Which infecton is common in patient infected with HIV?
I herpes simplex virus type 2 (HSV-2)

II herpes simplex virus type 1(HSV-1)
III HSV-1 and HSV-1
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Most individuals infected with HIV-1 are also infected with herpes simplex virus type 2 (HSV-2).
Suppressive therapy of HSV-2 with acyclovir reduces plasma HIV-1 concentrations.
37 Which drug was approved by FDA in2012 for the treatment of diarrhea in patients
with HIV/AIDS undergoing antiretroviral therapy?
I Loperamide
II crofelemer
III didanosine
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
In December 2012, the FDA approved crofelemer for the relief of diarrhea in patients with
HIV/AIDS who are undergoing antiretroviral therapy.
38 Which Prevention measures should be considered to prevent sexual transmission of

HIV?
I Abstinence when possible

II Multiple sexual partners
III Using barrier contraception
Ans: F
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Sexual transmission
Prevention measures include the following:

 Abstinence when possible
 Using barrier contraception
39 Doctors will prefer which delivery option in HIV infected pregnant women?
I Cesarean
II Normal
III Both are safe
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Cesarean delivery can avoid HIV transmission.
40 What is the importance of antiretroviral therapy in pregnant women?
I protects against premature birth

II protects against fetal demise
III protects against blood loss during pregnency
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Outcome of art:
ART provided a protective effect against mortality, fetal demise, and premature birth.
41 What is basic PEP regimen in HIV Infection?
I Treatment with zidovudine plus lamivudine

II Treatment with tenofovir plus didanosine
III Treatment with zidovudine plus emtricitabine
Ans: F
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
CDC recommendations for PEP are as follows: preffered

 Basic PEP 2-drug regimen: zidovudine plus lamivudine, zidovudine plus emtricitabine,
tenofovir plus lamivudine, or tenofovir plus emtricitabine.
42 What is Alternative basic PEP regimen in HIV Infection?
I Treatment with emtricitabine plus Ritonavir

II Treatment with lamivudine plus stavudine
III Treatment with lamivudine plus didanosine
Ans: E
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
 Alternative basic PEP regimen: lamivudine plus stavudine, lamivudine plus didanosine,
emtricitabine plus stavudine, or emtricitabine plus didanosine.
43 What is Expanded Postexposure prophylaxis regimen in HIV Infection?
I Postexposure prophylaxis regimen plus lopinavir-Zidovudine

II Postexposure prophylaxis regimen plus lopinavir-Lamivudine
III Postexposure prophylaxis regimen plus lopinavir-ritonavir
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Expanded PEP regimen: basic PEP regimen plus lopinavir-ritonavir.
44 Which drugs can be used as alternative expendaded regimen in Postexposure

prophylaxis in HIV Infection?
I Basic PEP regimen plus Nelfinavir

II Basic PEP regimen plus Indinavir with or without ritonavir
III Basic PEP regimen plus Lamivudine
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Alternative expanded PEP regimen includes the basic PEP regimen plus one of the following:
 Atazanavir with or without ritonavir

 Fosamprenavir with or without ritonavir
 Indinavir with or without ritonavir
 Saquinavir with or without ritonavir
 Nelfinavir
 Efavirenz
45 Why vaccination against HIV is not successful?
I mutation of antigenic portions

II It is very tough to isolate HIV and denature
III
Ans: F
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The initial hope of an effective vaccine against HIV has not been fulfilled. Aside from the virus being
able to rapidly mutate antigenic portions of key surface proteins, HIV infection progresses despite the
normal host response to HIV.
46 Which combination of the HIV vaccines was found to be effective in those who
maintained lower-risk sexual behaviour?
I ALVAC-HIV and AIDSVAC B/E

II ALVAC-HIV and AIDSVAX B/E
III ALVAX-HIV and AIDSVAC B/E
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
With respect to risk behavior, a post-hoc analysis of efficacy found that the combination of the HIV
vaccines, ALVAC-HIV (vCP1521) and AIDSVAX B/E effective in those who maintained lower-risk
sexual behavior compared
name.
47 Which is the only medication regimen approved by the FDA and recommended for
Pre-exposure prophylaxis in all population?
I Tenofovirdisoproxil fumarate 200 mg and Emtricitabine 100 mg

II Tenofovirdisoproxil fumarate 300 mg and Emtricitabine 200 mg
III Tenofovirdisoproxil fumarate 400 mg and Emtricitabine 300 mg
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The only medication regimen approved by the FDA and recommended for PrEP with all the
populations specified in the CDC guideline is daily TDF tenofovirdisoproxil fumarate 300 mg
coformulated with FTC emtricitabine 200 mg (Truvada); evidence level IA .
48 Which out of following combination is recommended for Preexposure HIV

Prophylaxis?
I emtricitabine and tenofovir

II emtricitabine and zidovudine
III emtricitabine and Sativudine
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Preexposure prophylaxis
 Daily emtricitabine/tenofovir is one prevention option that is part of the general guidelines
for HIV prevention. For more information.
49 According to 2014 International Antiviral Society-USA-
I All adults and adolescents should perform HIV testing at least once
II All adults and adolescents should perform HIV testing every 1 year
III All adults and adolescents should perform HIV testing every 2 year
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
July 2014 International Antiviral Society-USA (IAS-USA)

Perform HIV testing at least once for all adults and adolescents; repeat testing often for those at
increased risk.
50 According to 2014 International Antiviral Society-USA, What should be done in HIV-

confirmed patients?
I individualized risk assessment and counseling

II support for treatment adherence
III Provide free Antiretroviral drug
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
For HIV-confirmed patients, provide multimodal interventions to include prompt initiation of ART,
support for treatment adherence, individualized risk assessment and counseling, assistance with
partner notification, and periodic screening for common sexually transmitted infections.
51 According to 2014 International Antiviral Society-USA, which drug should be

administered for preexposure prophylaxis in HIV-uninfected patients?
I emtricitabine and tenofovirdisoproxil fumarate
II emtricitabine and ritonavir
III tenofovirdisoproxil fumarate and Sativudine
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
For high-risk, HIV-uninfected patients, administer preexposure prophylaxis with daily

emtricitabine/tenofovirdisoproxil fumarate and provide multimodal interventions (eg, individualized
counseling on risk reduction).
52 Guidelines from the DHHS Panel suggest which out of following tests every 3 months
in patients on antiretroviral therapy?
I Clotting time
II Basic chemistry profile
III Liver function studies
Ans: E
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Guidelines from the DHHS Panel the following tests every 3 months in patients on antiretroviral
therapy
 Basic chemistry profile

 Liver function studies
 Complete blood count with differential
53 Doctor recommends which serum test in HIV infected patient?
I Bicarbonate
II Blood urea nitrogen
III Protein
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The basic chemistry studies should include serum sodium, potassium, bicarbonate, chloride, blood
urea nitrogen (BUN), and creatinine, and glucose (preferably fasting), plus an estimate of creatinine
clearance.
54 According to 2011 DHHS guidelines, what is the time interval for the measurement of
CD4+ T-cell count?
I monitored every 6-12 months

II monitored every 12-18 months
III monitored every 12-20 months
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
2011 DHHS guidelines recommend that the CD4+ T-cell count may be monitored every 6-12 months
(instead of every 3-6 months), unless.
55 What is the number of antiretroviral drugs that have been approved for the treatment
of HIV infection?
I 20
II 30
III 40
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Nearly 30 antiretroviral drugs have been approved for use in HIV-infected adults and adolescents;
18 of these have an approved pediatric treatment indication and 15 are available as a pediatric
formulation or capsule size.
56 Which out of following does not fall in class of Antiretroviral Therapy?
I Nucleoside reverse transcriptase inhibitors

II Fluoroquinolons
III Cellular chemokine receptor (CCR5) antagonists
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Antiretroviral Drug Classe:

 Nucleoside reverse transcriptase inhibitors
 Cellular chemokine receptor (CCR5) antagonists
57 Which of following is a class of Antiretroviral Therapy?
I Integrase inhibitors
II Aminoglyosides
III Non-nucleoside reverse transcriptase inhibitors
Ans: F
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Antiretroviral Drug Classes:

 Integrase inhibitors
 Non-nucleoside reverse transcriptase inhibitors
58 Which drug out of the following does not act through protease inhibition?
I Indinavir
II Elvitegravir
III Raltegravir
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Protease inhibitors (PIs) Amprenavir (Agenerase, AVP)*

Atazanavir (Reyataz , ATV)
Darunavir (Prezista, DRV)
Fosamprenavir (Lexiva, f-APV)
Indinavir (Crixivan, IDV)
Saquinavir (Invirase [hard gel] capsule, SQV)
Tipranavir
59 Etravirine and Rilpivirine Belongs to which Class?
I Non-nucleoside reverse transcriptase inhibitors

II Nucleoside reverse transcriptase inhibitors
III Cellular chemokine receptor (CCR5) antagonist
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Non-nucleoside reverse transcriptase inhibitors

Efavirenz (Sustiva, EFV)
Etravirine (Intelence, ETR)
Etravirine (Viramune, NVP)
Rilpivirine (Edurant)
60 What is the mechanism of action of Enfuvirtide?
I Protease inhibitor
II Fusion inhibitors
III Non-nucleoside reverse transcriptase inhibitors
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Fusion inhibitors Enfuvirtide (Fuzeon, T-20)
61 Which out of following is a Cellular chemokine receptor (CCR5) antagonist?
I Rilpivirine
II Maraviroc
III Raltegravir
Ans: E
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Cellular chemokine receptor (CCR5) antagonists

Maraviroc, Raltegravir
62 Which out of following is Integrase inhibitor?
I Dolutegravir
II Elvitegravir
III Fosamprenavir
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Integrase inhibitors
Dolutegravir (Tivicay, DTG)
Elvitegravir (Vitekta, EVG)
63 Which out of following is Nucleoside reverse transcriptase inhibitor (NRTIs)?
I Delavirdine
II Didanosine
III Emtricitabine
Ans: E
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Nucleoside reverse transcriptase inhibitors (NRTIs)

Abacavir, Didanosine, Emtricitabine, Lamivudine, Stavudine, Tenofovir, Zalcitabine, Zidovudine
64 Which drug does not fall in protease inhibitor Class?
I Lopinavir
II Abacavir
III Nelfinavir
Ans: F
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Protease inhibitor
Lopinavir and ritonavir (Kaletra, LPV/r)
Nelfinavir (Viracept, NFV)
Ritonavir (Norvir, RTV)
65 Lamivudine and Stavudine falls in which class of Antiretroviral therapy?
I Nucleoside reverse transcriptase inhibitors

II Non-nucleoside reverse transcriptase inhibitors
III Integrase Inhibitor
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Lamivudine and Stavudine Nucleoside reverse transcriptase inhibitors

66 Tenofovir and Zalcitabine falls in which class of Antiretroviral therapy?
I Fusion Inhibitor
III Nucleoside reverse transcriptase inhibitors
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Nucleoside reverse transcriptase inhibitors (NRTIs)

Tenofovir and Zalcitabine
67 Efavirenz and Etravirine falls in which class of Antiretroviral therapy?
I nucleoside reverse transcriptase inhibitors

III Protease inhibitor
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Non-nucleoside reverse transcriptase inhibitors

Efavirenz and Etravirine
68 Why combination therapy is important in patient with HIV infection?
I reduce the likelihood of drug resistance

II easily cures HIV infection
III progression to AIDS is significantly slowed
Ans: F
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Combination therapy has been shown to dramatically reduce the likelihood of drug resistance (many
drug-resistant mutations are mutually exclusive) and to suppress viral replication to the point that
progression to AIDS is significantly slowed.
69 What is the pharmacological mechanism of Abacavir?
I interferes with HIV viral DNA dependent polymerase

II interferes with HIV viral DNA dependent RNA polymerase
III interferes with HIV viral RNA dependent DNA polymerase
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Abacavir This NRTI interferes with HIV viral RNA dependent DNA polymerase and inhibits viral
replication.
70 2011 guidelines of the Department of Health and Human Services Panel recommends
which test before starting regimen containing Abacavir?
I HLA-B*5707
II HLA-B*5701
III HLA-B*5700
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
In its 2011 guidelines, the Department of Health and Human Services Panel on Clinical Practices
for Treatment of HIV Infection recommends screening for HLA-B*5701 before starting patients on
a regimen that contains abacavir, to reduce the risk of hypersensitivity reaction.
71 Which out of the following drug is analogue of cytosine?
I Entecavir
II Telbivudine
III Emtricitabine
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Emtricitabine This agent is a synthetic nucleoside cytosine analog classified as an NRTI
72 What is the pharmacological mechanism of Emtricitabine?
I competes with deoxyguanosine -5'-triphosphate and incorporates into viral DNA, causing chain
termination
II competes with deoxycytidine-5'-triphosphate and incorporates into viral DNA, causing chain
termination
III competes with guanosine -5'-phosphate and incorporates into viral DNA, causing chain
termination
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
.Emtricitabine It competes with deoxycytidine-5'-triphosphate and incorporates into viral DNA,

causing chain termination.
73 Which out of the following drug is analogue of thymidine?
I Lamivudine
II Abacavir
III Ritonavir
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Lamivudine is a thymidine analog that inhibits viral replication.

74 What is the pharmacological mechanism of Stavudine?
I competes with deoxycytidine-5'-triphosphate and incorporates into viral DNA, causing chain
termination
II competes with Adinosine-5'-triphosphate and incorporates into viral DNA, causing chain
termination
III competes with Guanine-5'-triphosphate and incorporates into viral DNA, causing chain
termination
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Stavudine competes with deoxycytidine-5'-triphosphate and incorporates into viral DNA, causing
chain termination.
75 One of the following is prodrug of Tenofovir?
I 3´Azido-2´,3´-dideoxythymidine, azidothymidine
II 2´,3´-Dideoxy-3´-thiacytidine
III bis-isopropoxycarbonyloxymethyl
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
It is administered as the prodrug bis-isopropoxycarbonyloxymethyl ester derivative of tenofovir, which

is converted, through various enzymatic processes.
76 Which drug is adenosine 5'-monophosphate analogue?
I Stavudine
II Tenofovir
III Emtricitabine
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
To tenofovir, a nucleotide analog of adenosine 5'-monophosphate.
77 Which out of following drugs Bioavailability is enhanced by a high-fat meal?
I Tenofovir
II Idoxuridine
III Nevirapine
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Tenofovir
Bioavailability is enhanced by a high-fat meal
Which is thymidine analog?
I Zidovudine
II Idoxuridine
III Trifluridine
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Zidovudine is a thymidine analog that inhibits viral replication.
79 What is the mechanism of azapeptide?
I Protease inhinitor
II selectively inhibiting Gag and Gag-Pol polyproteins in HIV-1 infected cells
III Neuleoside reverse transcriptase inhibitor
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
An azapeptide HIV-1 PI, atazanavir prevents virion maturation by selectively inhibiting Gag and
Gag-Pol polyproteins in HIV-1 infected cells.
80 Which of the following sentence is true for Darunavir?
I Neuleoside reverse transcriptase inhibitor

II Gag and Gag-Pol polyproteins
III Non- Neuleoside reverse transcriptase inhibitor
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Darunavir
Protease inhibitor
81 Why Darunavir is coadministered with other anti-HIV agents (eg, NRTIs)?
I Increase Plasma Protein binding

II increases maximum plasma concentration (Cmax)
III increases area under the curve (AUC)
Ans: E
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Darunavir is typically coadministered with other anti-HIV agents (eg, NRTIs). Food increases
maximum plasma concentration (Cmax) and area under the curve (AUC).
82 Which Cellular enzyme converts Fosamprenavir to amprenavir?

I Integrase
II Phosphatases
III Protease
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Fosamprenavir is a prodrug that is converted to amprenavir by cellular phosphatases in vivo.
83 Why Tipranavir must be coadministered with ritonavir?
I To increase absorption from intestine of Tipranavir

II To decrease side effect of Tipranavir
III To attain therapeutic levels of Tipranavir
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Tipranavir must be coadministered with ritonavir (200 mg) to attain therapeutic levels (ie,
tipranavir/ritonavir).
84 Which out of following is non-competitive inhibition of HIV-1 reverse trAns:criptase?
I Saquinavir
II Rilpivirine
III Ritonavir
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Rilpivirine is a NNRTI that inhibits HIV-1 replication by noncompetitive inhibition of HIV-1
reverse trAns:criptase. It does not inhibit the human cellular DNA polymerases alpha, beta, and
gamma.
85 Which of the following statement are correct for Dolutegravir?
I It is an integrase strand transfer inhibitor

II It is approved for use in children 12 years or older who weigh at least 40 kg
III It is safe to use in patient with kidney problem
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
MCQ85 Dolutegravir is an integrase strand transfer inhibitor (INSTI) that inhibits catalytic
activity of HIV-1 integrase, an HIV encoded enzyme required for viral replication. It is approved for
use in children 12 years or older who weigh at least 40 kg.
86 Enfuvirtide binds to which surface protein, to prevent the fusion of HIV with healthy
T cells?
I gp103
II gp41
III gp30
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Enfuvirtide binds to HIV gp41 surface protein, thereby, disrupting the virus's ability to fuse with and
infect healthy T cells.
87 Which drug will doctor suggest to a patients experiencing HIV-1 replication despite
ongoing antiretroviral therapy?
I Enfuvirtide
II Zidoudine
III Maraviroc
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Enfuvirtide fusion inhibitor Indicated for use in combination with other antiretroviral agents for
HIV-1 infection in treatment-experienced patients who demonstrate evidence of HIV-1 replication
despite ongoing antiretroviral therapy.
88 Which statement is true for Maraviroc?
I Blocks viral entry via the CCR5 co-receptor into WBCs

II Reduces viral load and increases T-cell counts
III Inhibits enzyme protease
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Maraviroc
Maraviroc blocks viral entry via the CCR5 co-receptor into WBCs, reduces viral load, and increases
T-cell counts in infection with CCR5-tropic HIV-1 (ie, R5 virus).
89 Which of the following listed Combination (Trizivir) is a correct in ART?
I Abacavir, lamivudine and zidovudine

II Abacavir, ritonavir and dolutegravir
III Abacavir, ritonavir and tenofovir
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Abacavir, lamivudine, zidovudine (Trizivir) MCQ89

90 What is the role of cobicistat when used in combination with Elvitegravir, cobicistat,
emtricitabine and tenofovir in ART?
I booster for elvitegravir

II booster for emtricitabine
III booster for tenofovir
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
MCQ90 Contains an integrase inhibitor and 2 NRTIs plus cobicistat, a CYP3A4 inhibitor used as
a booster for elvitegravir.
91 Why ritonavir, cobicistat used in ART are also Knows as Boosting agents?
I Inhibits CYP340
II increases absorption of adjuvant drug from intestine
III Decreases Excretion of adjuvant drug
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
CYP340 Inhibitors
Boosting agents (eg, ritonavir, cobicistat)
92 Which of the following listed Combination (Epizicom) is a correct in ART?
I Lamivudine and Zidovudine

II Abacavir and Lamivudine
III Abacavir and Zidovudine
Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Abacavir/lamivudine (Epzicom) MCQ92
93 Which of the following listed Combination (Atripla) is a correct in ART?
I Efavirenz,emtricitabine and ritonavir

II Efavirenz,emtricitabine and Doltuegravir
III Efavirenz,emtricitabine and tenofovir
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Efavirenz/emtricitabine/tenofovir (Atripla)
94 Which of the following listed Combination (Triumeq) is a correct in ART?
I Abacavir 400 mg, Dolutegravir 50 mg and Lamivudine 300 mg

II Abacavir 500mg, Dolutegravir 50 mg and Lamivudine 300 mg
III Abacavir 600 mg, Dolutegravir 50 mg and Lamivudine 300 mg
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Triumeq: Abacavir 600 mg, Dolutegravir 50 mg, Lamivudine 300 mg
95 What is the dose of Emtricitabine and Tenofovir when used in combination (ART)?
I 200 mg and 300 mg

II 300 mg and 400 mg
III 400 mg and 500 mg
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Emtricitabine 200 mg
Tenofovir DF 300 mg
96 What is the dose of Lamivudine and Zidovudine when used in combination (ART)?
I 100 mg and 200mg

Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Lamivudine 150 mg
Zidovudine 300 mg dose
97 Which out of following statement is correct for Cobicistat?
I CYP3A inhibitor
II increase systemic exposure of atazanavir or darunavir
III Increases absorption of drug from intestine
Ans: D
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Cobicistat: CYP3A inhibitor. As a single agent, it is indicated to increase systemic exposure of

atazanavir or darunavir (once-daily dosing regimen) in combination with other antiretroviral agents.
98 What is the mechanism of Sulfamethoxazole and Trimethoprim?

I Inhibits HIV-2 synthesis of dihydrofolic acid by competing with paraaminobenzoic acid
II Inhibits HIV-1 synthesis of dihydrofolic acid by competing with paraaminobenzoic acid
III Inhibits bacterial synthesis of dihydrofolic acid by competing with paraaminobenzoic acid
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Sulfamethoxazole and Trimethoprim This combination inhibits bacterial synthesis of dihydrofolic

acid by competing with paraaminobenzoic acid.
99 Which Drug is indicated in HIV-associated lipodystrophy?
I Tesamorelin
II Orlistat
III Liraglutide
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Tesamorelin is a growth hormone releasing factor (GRF) analog indicated for reduction of excess
abdominal fat in patients with HIV-associated lipodystrophy.
100 Which of the following sentence is a correct for Tesamorelin?
I It is non-nucleoside reverse-transcriptase inhibitor

II It is protease inhibitor
III It is growth hormone releasing factor (GRF) analog
Ans: C
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Tesamorelin is a growth hormone releasing factor (GRF) analog.
101 What is the dose of Abacavir and Lamivudine when used in combination (ART)??
I 200 mg and 500 mg

Ans: B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Abacavir 600 mg
Lamivudine 300 mg 1 tab
MCQ101 Epzicom
PO qd
102 Which of the following listed Combination (Stribild) is a correct in ART?
I cobicistat, elvitegravir, emtricitabine and tenofovir

II cobicistat, elvitegravir, emtricitabine and lamivudine
III cobicistat, elvitegravir, emtricitabine and Zidovudine
Ans: A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
cobicistat, elvitegravir, emtricitabine and tenofovir. Stribild
BENIGN PROSTATE HYPERTROPHY

1 What is synonym of benign prostatic hypertrophy?

I Benign prostatic hypertrophy (BPH)
II Benign prostatic hyperplasia (BPH)
III Begin prostatic hyperplasia (BPH)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is a histologic
diagnosis characterized by proliferation of the cellular elements of the prostate.
2 Which of the following statement is true about Benign prostatic hyperplasia (BPH)?
I propagation of the cellular elements of the prostate

II Instability of the cellular elements of the prostate
III proliferation of the cellular elements of the prostate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is a histologic
diagnosis characterized by proliferation of the cellular elements of the prostate.
3 What causes epithelial and stromal proliferation and apoptosis in BHP?
I Cellular necrosis
II Cellular accumulation
III cellular Damage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Cellular accumulation and gland enlargement may result from epithelial and stromal proliferation,
impaired preprogrammed cell death (apoptosis), or both
4 What causes epithelial and stromal proliferation and apoptosis in BHP?
I gland enlargement
II gland diminution
III gland reduction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Cellular accumulation and gland enlargement may result from epithelial and stromal proliferation,
impaired preprogrammed cell death (apoptosis), or both
5 What is the outcome of Hyperplasia of prostate gland in BPH?
I enlargement of the prostate

II reduction of prostate gland
III diminution of prostate gland
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The hyperplasia presumably results in enlargement of the prostate that may restrict the flow of urine
from the bladder.
6 What is the effect of Hyperplasia of prostate gland on urinary tract in BPH?
I reduction of prostate gland

II restrict the flow of urine from the bladder
III enlargement of the ureter
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The hyperplasia presumably results in enlargement of the prostate that may restrict the flow of urine
from the bladder.
7 which out of the following sentence is correct for occurrence of BPH?
I BPH is considered a normal part of the aging process in women

II BPH is considered a normal part of the aging process in men
III BPH is considered a abnormal part of the aging process in men
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
BPH is considered a normal part of the aging process in men and is hormonally dependent on
testosterone and dihydrotestosterone (DHT) production.
8 Which hormones play an important role in development of BPH?
I testosterone
II dihydrotestosterone (DHT)
III prolactin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
BPH is considered a normal part of the aging process in men and is hormonally dependent on
testosterone and dihydrotestosterone (DHT) production.
9 which out of the following sentence is correct for occurrence of BPH?
I An estimated 50% of men demonstrate histopathologic BPH by age 40 years

II An estimated 50% of men demonstrate histopathologic BPH by age 60 years
III An estimated 50% of men demonstrate histopathologic BPH by age 50 years
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
An estimated 50% of men demonstrate histopathologic BPH by age 60 years
10 Which is the cause of voiding dysfunction?
I prostate gland enlargement

II prostate gland reduction
III bladder outlet obstruction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
The voiding dysfunction that results from prostate gland enlargement and bladder outlet obstruction
(BOO) is termed lower urinary tract symptoms (LUTS). @11 It has also been commonly referred to
as prostatism.
11 What is Prostatism?
I blood outlet obstruction (BOO)

II prostate gland enlargement
III bladder outlet obstruction (BOO)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans:E
The voiding dysfunction that results from prostate gland enlargement and bladder outlet obstruction
(BOO) is termed lower urinary tract symptoms (LUTS). @11 It has also been commonly referred to
as prostatism.
12 What do you mean by Nocturia?
I awakening at midnight to urinate

II awakening at night to urinate
III Not awakening at night to urinate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Nocturia (awakening at night to urinate).
13 Which out of the following is correct related to prostate anatomy?
I The prostate surrounds the distal urethra

II The prostate is located at the apex of the bladder
III The prostate surrounds the proximal urethra
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Normal prostate anatomy. The prostate is located at the apex of the bladder and surrounds the
proximal urethra.
14 What is the composition of Prostate Gland?
I It has several zones or lobes that are enclosed by an outer layer of cell (capsule)
II It has several zones or lobes that are enclosed by an outer layer of tissue (capsule)
III It has several zones or lobes that are not enclosed by an outer layer of tissue (capsule)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
14 15 The gland is composed of several zones or lobes that are enclosed by an outer layer of tissue
(capsule). These include the peripheral, central, anterior fibromuscular stroma, and transition zones.
15 Which different zone is present in prostate gland?
I transition zones
II peripheral and transition zones
III central and anterior fibromuscular stroma
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The gland is composed of several zones or lobes that are enclosed by an outer layer of tissue (capsule).
These include the peripheral, central, anterior fibromuscular stroma, and transition zones.
16 What is the origin of BPH?
I central zone
II peripheral zone
III transition zone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
BPH originates in the transition zone, which surrounds the urethra.
17 Which zone surrounds urethra in urinary tract?
I central zone
II peripheral zone
III transition zone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans:C
BPH originates in the transition zone, which surrounds the urethra.
18 which Hormone is responsible for the Prostatic enlargement?
I testosterone
II dehydrotestosterone (DHT)
III dihydrotestosterone (DHT)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans:C
Prostatic enlargement depends on the potent androgen dihydrotestosterone (DHT).
19 Which enzyme is responsible for metabolism of circulating testosterone in prostate

gland?
I type I 5-alpha-reductase
II type II 5-alpha-reductase
III type III 5-alpha-reductase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
In the prostate gland, type II 5-alpha-reductase metabolizes circulating testosterone into DHT, which
works locally.
20 Which receptors are predominant in the smooth muscle of the stroma and capsule of
the prostate, as well as in the bladder neck?
I alpha-2-adrenergic receptors
II alpha-1-adrenergic receptors
III beta-1-adrenergic receptors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
In vitro studies have shown that large numbers of alpha-1-adrenergic receptors are located in the
smooth muscle of the stroma and capsule of the prostate, as well as in the bladder neck.
21 What happen when alpha-1-adrenergic receptors are Stimulated?
I decrease in smooth-muscle tone

II increase in smooth-muscle tone
III worsen LUTS (lower urinary tract symptoms)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Stimulation of these receptors causes an increase in smooth-muscle tone, which can worsen LUTS.
22 Who does not develop BPH?
I African male
II Castrated males
III Asian male
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Castrated males (ie, who are unable to make testosterone) do not develop BPH.
23 Which are the contributing factors for urinary frequency and LUTS?
I large volumes of urine in the bladder

II increased sensitivity (detrusor overactivity [DO])
III small volumes of urine in the bladder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
This increased sensitivity (detrusor overactivity [DO]), even with small volumes of urine in the
bladder, is believed to contribute to urinary frequency and LUTS.
24 Which factors is responsible for increased residual urine volume in Bladder?
I weakened bladder
II bladder lose ability to empty completely
III bladder poses ability to empty completely
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The bladder may gradually weaken and lose the ability to empty completely, leading to increased
residual urine volume and, possibly, acute or chronic urinary retention.
25 What are the symptoms of weakened bladder?
I increased residual urine volume

II decreased residual urine volume
III acute or chronic urinary retention
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans:F
The bladder may gradually weaken and lose the ability to empty completely, leading to increased
residual urine volume and, possibly, acute or chronic urinary retention.
26 What is the outcome of obstruction in bladder?
I smooth-muscle-cell hypotrophy
II smooth-muscle-cell hypertrophy
III smooth-muscle-cell hyperplasia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
In the bladder, obstruction leads to smooth-muscle-cell hypertrophy.
27 What is the main function of prostate gland?
I to release an alkaline fluid

II to secrete an acidic fluid
III to secrete an alkaline fluid
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The main function of the prostate gland is to secrete an alkaline fluid that comprises approximately
70% of the seminal volume.
28 What is the composition of alkaline fluid which is secreted from prostate gland?
I comprises approximately 80% of the seminal volume
II comprises approximately 70% of the seminal volume
III comprises approximately 75% of the seminal volume
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans:B
The main function of the prostate gland is to secrete an alkaline fluid that comprises approximately
70% of the seminal volume.
29 What is the function of f alkaline fluid secreted form prostate?
I lubrication for vaginal fluid

II lubrication for the sperm
III lubrication during intercourse
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The secretions produce lubrication and nutrition for the sperm.
30 What is the function of alkaline fluid secreted form prostate?
I nutrition for the sperm

II nutrition for ovam
III nutrition for follicle
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The secretions produce lubrication and nutrition for the sperm.
31 What is a function of the alkaline fluid secreted from prostate?
I Solidifaction of the seminal plug

II liquefaction of the seminal plug
III makes vaginal environment viscous
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The alkaline fluid in the ejaculate results in liquefaction of the seminal plug and helps to neutralize
the acidic vaginal environment.
32 What is a function of the alkaline fluid secreted from prostate?
I Solidifaction of the seminal plug

II neutralize the acidic vaginal environment
III makes vaginal environment viscous
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The alkaline fluid in the ejaculate results in liquefaction of the seminal plug and helps to neutralize
the acidic vaginal environment.
33 Why BPH tends to be more severe and progressive in African-American men?
I higher testosterone levels

II Lower testosterone levels
III 5-alpha-reductase activity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
However, BPH tends to be more severe and progressive in African-American men, possibly because of
the higher testosterone levels, 5-alpha-reductase activity, androgen receptor expression, and growth
factor activity in this population.
34 Why BPH tends to be more severe and progressive in African-American men?
I androgen receptor expression

II growth factor activity in population
III androgen receptor down regulation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
However, BPH tends to be more severe and progressive in African-American men, possibly because of
the higher testosterone levels, 5-alpha-reductase activity, androgen receptor expression, and growth
factor activity in this population.
35 Which features are essential/plays important role to make the correct diagnosis of BPH?
I Onset and duration of disease severity

II General health issues (including sexual history)
III Onset and duration of symptoms
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Special attention to the following features is essential to making the correct diagnosis:
 Onset and duration of symptoms
 General health issues (including sexual history)
I Fitness for any possible presurgical interventions

II Fitness for any possible surgical interventions
III Fitness for any possible postsurgical interventions
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
 Fitness for any possible surgical interventions
I Severity of drugs
II Severity of symptoms
III how they are affecting quality of life
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Severity of symptoms and how they are affecting quality of life
I Previously attempted treatments

II Disease
III Medications
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Medications
 Previously attempted treatments
39 What is the role of patient history physical examination in diagnosis of BPH?
I ruling out other etiologies responsible for BPH

II a formality
III patient history physical examination is gold standard test
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Symptoms often attributed to BPH can be caused by other disease processes, and a history and physical
examination are essential in ruling out other etiologies.
40 What are the common symptoms of BPH?
I Urinary emergency
II Urinary frequency
III Urinary urgency
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans:E
Common symptoms: Urinary frequency, Urinary urgency, Hesitancy, Straining, Decreased force of
stream, Dribbling.
I Increased force of stream

II Decreased force of stream
III Dribbling
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
stream, Dribbling.
I Hesitancy
II Staining
III Straining
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
stream, Dribbling.
43 Which sentence is true related to Urinary frequency?
I the need to urinate frequently during the day or night

II voiding large amounts of urine with each episod
III voiding only small amounts of urine with each episode
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans:F
Urinary frequency - The need to urinate frequently during the day or night (nocturia), usually voiding
only small amounts of urine with each episode.
44 Which sentence is true related to Urinary urgency?

I the sudden, urgent need to urinate
II owing to the sensation of imminent loss of urine without control
III owing to the sensation of imminent loss of urine with control
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Urinary urgency - The sudden, urgent need to urinate, owing to the sensation of imminent loss of
urine without control.
45 Which sentence is true related to Hesitancy in BPH?
I weak urinary stream

II Difficulty initiating the urinary stream
III The feeling of persistent residual urine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Hesitancy - Difficulty initiating the urinary stream; interrupted, weak stream
Incomplete bladder emptying - The feeling of persistent residual urine, regardless of the frequency of
urination.
46 Which sentence is true related to Straining in BPH?
I the need strain or push to initiate and maintain urination to more fully evacuate the bladder
II loss of force of the urinary stream
III loss of force of the urinary stream over time
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Straining - The need strain or push (Valsalva maneuver) to initiate and maintain urination in order
to more fully evacuate the bladder.
Decreased force of stream - The subjective loss of force of the urinary stream over time.
47 Which sentence is true related to Dribbling in BPH?
I The loss of large amounts of urine due to a poor urinary stream

II The loss of small amounts of urine due to a strong urinary stream
III The loss of small amounts of urine due to a poor urinary stream
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Dribbling - The loss of small amounts of urine due to a poor urinary stream.
48 On basis of epidemiologic studies, what is as an independent risk factor for erectile

dysfunction and ejaculatory dysfunction?
I lower urinary tract symptoms

II bladder stone
III kidney stone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
A sexual history is important, as epidemiologic studies have identified LUTS as an independent risk
factor for erectile dysfunction and ejaculatory dysfunction.
49 Why focused physical examination is conducted during the diagnosis of BPH?
I to assess the pubic area for signs of bladder distention

II to assess the superpubic area for signs of bladder distention
III to assess the suprapubic area for signs of bladder distention
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Conduct a focused physical examination to assess the suprapubic area for signs of bladder distention
and a neurological examination for sensory and motor deficits.
50 Why neurological examination is conducted during the diagnosis of BPH?
I to rule out sensory deficits

II to rule out motor deficits
III to rule out immune deficits
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Conduct a focused physical examination to assess the suprapubic area for signs of bladder distention
and a neurological examination for sensory and motor deficits.
51 Which method is an integral part of the evaluation in men with presumed BPH?
I the diagonal rectus examination

II the digital rectal examination
III the double rectal examination
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The digital rectal examination (DRE) is an integral part of the evaluation in men with presumed
BPH..
52 What is assessed in digital rectal examination (DRE)?

I prostate neuron
II prostate size
III prostate contour
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
BPH. During this portion of the examination, prostate size and contour can be assessed, nodules can
be evaluated, and areas suggestive of malignancy can be detected.
53 What is evaluated in digital rectal examination (DRE)?
I prostate neurone
II nodules can be evaluated
III blood flow prostate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
54 What is detected in digital rectal examination (DRE)?
I areas suggestive of immalignancy

II areas suggestive of malignancy
III neuron deficient area
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
55 What is the approximate prostate volume in a young man?
I approximately 25 g
II approximately 10 g
III approximately 20 g
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The normal prostate volume in a young man is approximately 20 g.
56 How more precise volumetric determination can be made during diagnosis of BPH?
I trisrectas ultrasonography (TRUS) of the prostate

II Transrectal ultrasonography (TRUS) of the prostate
III trAns:rectaliar ultrasonography (TRUS) of the prostate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
A more precise volumetric determination can be made using Transrectal ultrasonography (TRUS) of
the prostate.
57 what indicates underlying neurological disorder in BPH patient?
I decreased anal sphincter tone

II Increased anal sphincter tone
III the lack of a bulbocavernosus muscle reflex
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Decreased anal sphincter tone or the lack of a bulbocavernosus muscle reflex may indicate an
underlying neurological disorder.
58 How the prostate is examined?
I using the index finger of the dominant hand

II using the ring finger of the dominant hand
III using the pointer finger of the dominant hand
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The prostate is examined using the index finger of the dominant hand.
59 Which out of the following can be assessed using digital rectal examination (DRE) in
BPH patient?
I pelvic floor tone

II creatinine level
III presence of glucose
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The digital rectal examination (DRE); In addition, pelvic floor tone, the presence or absence of
fluctuance (ie, prostate abscess), and pain sensitivity of the gland @62 (prostatodynia/prostatitis) can
be assessed.
BPH patient?
I Creatinine level
II presence or absence of fluctuance
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
be assessed.
BPH patient?
I Creatinine level
II presence of glucose
III pain sensitivity of the gland
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
be assessed.
62 What is called as prostate abscess?
I presence of fluctuance
II presence of blood
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The presence or absence of fluctuance (ie, prostate abscess).
63 Which out of the following are complications related to bladder outlet obstruction
(BOO) secondary to BPH?
I Urinary retention
II Renal sufficiency
III Renal insufficiency
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Complications related to bladder outlet obstruction (BOO) secondary to BPH include the following:
 Urinary retention
 Renal insufficiency
I Renal sufficiency
II decreased urine volume
III Recurrent urinary tract infections
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
 Recurrent urinary tract infections
I decreased urine volume

II Gross hematuria
III Bladder calculi
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Gross hematuria
I Renal uremia
II decreased urine volume
III Renal failure
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Renal failure or uremia (rare in current practice)
67 Which method is used to examine the urine in BPH patient?
I bluestick test
II Matchstick test
III dipstick test
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Examine the urine using dipstick methods and/or via centrifuged sediment evaluation to assess for the
presence of blood, leukocytes, bacteria, protein, or glucose.
68 Which method is used to examine the urine in BPH patient?
I centrifuged sediment evaluation

II bluestick test
III Matchstick test
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
presence of blood, leukocytes, bacteria, protein, or glucose
69 Which parameters are screened in urine analysis in BPH patient?
I presence of Na
II presence of blood
III presence of K
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B

I presence of leukocytes
II presence of Na
III presence of K
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
I presence of K
II presence of Na
III presence of bacteria
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
I presence of Na
II presence of protein
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
73 Which out of the following sentence is true related to the BPH and prostate cancer?
I man with BPH suffers from prostate cancer

II men at risk for BPH are also at risk for prostate cancer
III man with man with suffers from BPH
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Although BPH does not cause prostate cancer, men at risk for BPH are also at risk for prostate cancer
and should be screened accordingly.
74 Which diagnostic parameter serve as useful screening tools for chronic renal
insufficiency in patients with high postvoid residual (PVR) urine volumes?
I Electrolytes level
II blood urea nitrogen
III SGOT
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Electrolytes, BUN, and Creatinine; These evaluations are useful screening tools for chronic renal
insufficiency in patients who have high postvoid residual (PVR) urine volumes.
75 Which diagnostic parameter serve as useful screening tools for chronic renal
insufficiency in patients with high postvoid residual (PVR) urine volumes?
I SGOT
II Creatinine
III SGPT
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Electrolytes, BUN, and Creatinine; These evaluations are useful screening tools for chronic renal
insufficiency in patients who have high postvoid residual (PVR) urine volumes.
76 Which method is useful to determine bladder and prostate size and the degree of
hydronephrosis in patients with urinary retention?
I MRI
II CT scanning
III Ultrasonography
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Ultrasonography (abdominal, renal, trAns:rectal) and intravenous urography are useful for helping
determine bladder and prostate size and the degree of hydronephrosis (if any) in patients with urinary
retention or signs of renal insufficiency.
77 Which method is useful to determine bladder and prostate size and the degree of
hydronephrosis in patients with urinary retention?
I CT scanning
II intravenous urography
III MRI
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Ultrasonography (abdominal, renal, trAns:rectal) and intravenous urography are useful for helping
determine bladder and prostate size and the degree of hydronephrosis (if any) in patients with urinary
retention or signs of renal insufficiency.
78 Which method is recommended/used to determine the dimensions and volume of the

prostate gland?
I MRI
II Transrectal ultrasonography
III CT scanning
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Transrectal ultrasonography (TRUS) of the prostate is recommended in selected patients, to determine
the dimensions and volume of the prostate gland.
79 Which diagnostic method is useful in BPH patient with elevated prostate -specific
antigen level (PSA) levels?
I CT scanning
II MRI
III Transrectal ultrasonography guided biopsy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
In patients with elevated PSA levels, TRUS-guided biopsy may be indicated.
80 Which out of the following imaging studies have no role in the evaluation and
treatment of uncomplicated BPH?
I CT scanning
II Transrectal ultrasonography
III MRI
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Other imaging studies, such as CT scanning and MRI, have no role in the evaluation and treatment
of uncomplicated BPH.
81 Which out of the following questioners is used to determine severity of BPH?
I drug-specific quality of life (QOL)

II decompose-specific quality of life (QOL)
III disease-specific quality of life (QOL)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The severity of BPH can be determined with the International Prostate Symptom Score
(IPSS)/American Urological Association Symptom Index (AUA-SI) plus a disease-specific quality of
life (QOL) question.
I International Prostate Symptom Score (IPSS)

II Indian Prostate Symptom Score (IPSS)
III Indonesian Prostate Symptom Score (IPSS)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
life (QOL) question
I Australian Urological Association Symptom Index (AUA-SI)

II American Urological Association Symptom Index (AUA-SI)
III African Urological Association Symptom Index (AUA-SI)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
life (QOL) question.
84 According to the AUA-SI/IPSS questionnaire, what is the score in BPH patient who is
moderately symptomatic?
I 0-7
II 8-19
III 20-35
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The AUA-SI/IPSS questionnaire is available online. Based on the sum of the score for all 8 questions,
patients are classified as 0-7 (mildly symptomatic), 8-19 (moderately symptomatic), or 20-35 (severely
symptomatic).
mildly symptomatic?
I 0-7
II 8-19
III 20-35
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
symptomatic).
severely symptomatic?
I 0-7
II 8-19
III 20-35
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
symptomatic).
87 Which parameter is useful in the initial assessment and to help determine the response
to BPH treatment?
I prostate size
II Flow rate
III prostate volume
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Flow rate is useful in the initial assessment and to help determine the response to treatment.
88 What is urodynamic testing?
I a pressure flow study

II a flow study
III a pressure study
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
A pressure flow study (urodynamic testing).
89 What is the normal level of maximal flow rate (Qmax)?
I < 7 mL/s
II = 7 mL/s
III > 15 mL/s
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
A Qmax value of greater than 15 mL/s is considered by many to be normal.
90 When maximal flow rate (Qmax) is considered abnormal?
I < 7 mL/s
II > 7 mL/s
III > 10 mL/s
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
A value of less than 7 mL/s is widely accepted as low.
91 Which parameter indicates bladder dysfunction and/or bladder outlet obstruction?
I high PVR (ie, 350 mL)

II high PVR (ie, 200 mL)
III high PVR (ie, 100 mL)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
A high PVR (ie, 350 mL) may indicate bladder dysfunction and/or bladder outlet obstruction and
may predict a poor response to treatment.
92 Which method helps to distinguish poor bladder contraction ability (detrusor

underactivity) from outlet obstruction?
I sonography
II Urodynamic studies
III Cystoscopy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Urodynamic studies are the only way to help distinguish poor bladder contraction ability (detrusor
underactivity) from outlet obstruction.
93 What are the characteristics of bladder outlet obstruction?

I high intravesical voiding pressures (>60 cm water)
II high intravesical voiding pressures (Qmax < 15 mL/s)
III high intravesical voiding pressures (Qmax > 15 mL/s)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
BOO is characterized by high intravesical voiding pressures (>60 cm water) accompanied by high
intravesical voiding pressures (Qmax < 15 mL/s).
94 Which test should be considered in patients with predominantly irritative voiding

symptoms?
I sonography
II Cytologic examination of the urine
III Doppler sonography
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Cytologic examination of the urine may be considered in patients with predominantly irritative
voiding symptoms.
95 Which diagnostic test is used to detect malignancy?
I sonography
II Doppler sonography
III Cystoscopy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Cystoscopy may be indicated in patients scheduled for invasive treatment or in whom a foreign body
or malignancy is suspected. In addition.
96 Which diagnostic test is used to detect gonococcal urethritis?
I Doppler sonography
II sonography
III endoscopy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Endoscopy may be indicated in patients with a history of sexually transmitted disease (eg, gonococcal
urethritis), prolonged catheterization, or trauma.
97 Which diagnostic test is used to detect sexually transmitted disease?
I sonography
II endoscopy
III Doppler sonography
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Endoscopy may be indicated in patients with a history of sexually transmitted disease (eg, gonococcal
urethritis), prolonged catheterization, or trauma.
98 What is the characteristic of BPH?
I colloadenomyomatous pattern of hyperplasia in prostate

II fibroadenomyomatous pattern of hyperplasia in prostate
III adenomyomatous pattern of hyperplasia in prostate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
BPH is characterized by a varying combination of epithelial and stromal hyperplasia in the prostate.
Some cases demonstrate an almost pure smooth-muscle proliferation, although most demonstrate a
fibroadenomyomatous pattern of hyperplasia.
99 What are the characteristics of BPH?
I epithelial cell hyperplasia in the prostate

II stromal cell hyperplasia in the prostate
III myocytes hyperplasia in the prostate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
BPH is characterized by a varying combination of epithelial and stromal hyperplasia in the prostate.
Some cases demonstrate an almost pure smooth-muscle proliferation, @99 although most demonstrate
a fibroadenomyomatous pattern of hyperplasia.
100 Which out of the following test is not indicated in the initial evaluation o f men with
LUTS secondary to BPH?
I Routine measurement of serum creatinine

II prostate examination
III Physical examination
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Routine measurement of serum creatinine is not indicated in the initial evaluation of men with LUTS
secondary to BPH.
1 Which therapy has long been accepted as the criterion standard for relieving bladder
outlet obstruction (BOO) secondary to BPH?
I Transurethral resection of the prostate

II Alfa adrenergic blockers
III Beta blockers
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Transurethralresection of the prostate (TURP) has long been accepted as the criterion standard for
relieving bladder outlet obstruction (BOO) secondary to BPH
2 The smooth-muscle tension is mediated by-
I beta-1-adrenergic receptors
II alpha-1-adrenergic receptors
III tetra-1-adrenergic receptors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The smooth-muscle tension is mediated by the alpha-1-adrenergic receptors
3 What is the effect of alpha-adrenergic receptor blocking agents on urinary tract?
I contraction and/or relaxation of the smooth muscle

II contraction of the smooth muscle
III relaxation of the smooth muscle
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Therefore, alpha-adrenergic receptor blocking agents should theoretically decrease resistance along the
bladder neck, prostate, and urethra by relaxing the smooth muscle and allowing passage of urine.
4 Which out of the following is a subtype of the alpha-1 receptor?
I 1a
II 2a
III 3a
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Three subtypes of the alpha-1 receptor have been identified: 1a, 1b, and 1c.
I 1b
II 2b
III 3b
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
I 1c
II 2c
III 3c
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
7 The alpha-1a receptor is most specifically concentrated in the-
I tongue
II prostate
III bladder neck
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The alpha-1a receptor is most specifically concentrated in the bladder neck and prostate.
8 Which drug is considered the most pharmacologically uroselective of the commercially

available agents?
I Furosemide
II Tamsulosin
III Torsemide
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Tamsulosin is considered the most pharmacologically uroselective of the commercially available agents
because of its highest relative affinity for the alpha-1a receptor subtype.
9 In 2008, which newer alpha-1a receptor selective blocker was approved by the US Food
and Drug Administration (FDA)?
I Torsemide
II silodosin
III Amytriptyline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
In 2008, the US Food and Drug Administration (FDA) approved a new alpha-1a receptor selective
blocker, silodosin (Rapaflo)
10 Which out of the following is true related to alpha-blockers?
I the efficacy of the titratable alpha-blockers is dose-dependent

II maximum tolerable doses have not been defined for any alpha-blocker
III maximum tolerable doses have been defined for any alpha-blocker
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The efficacy of the titratable alpha-blockers doxazosin and terazosin (Hytrin) is dose-dependent.
Maximum tolerable doses have not been defined for any alpha-blocker;
11 Which out of the following is the adverse effect of alpha-blockers?
I Hyperglycaemia
II orthostatic hypotension
III dizziness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
However, the higher the dose, the more likely the adverse events (orthostatic hypotension, dizziness,
fatigue, ejaculatory disorder, nasal congestion).
I fatigue
II ejaculatory disorder
III Hyperglycaemia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
I Hyperglycaemia
II nasal congestion
III Hypoglycaemia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
14 What should be monitored in patient on alpha-blockers?
I blood glucose level

II blood pressure
III blood urea level
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
@14 Despite the requirement for dose titration and blood pressure monitorind.
15 What is expected improvement in IPSS/AUA-SI scores when alpha-blockers are used in

patient with BPH?
I 4- to 6-point
II 8- to 12-point
III 16- to 24-point
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
An approximately 4- to 6-point improvement is expected in IPSS/AUA-SI scores when alpha-blockers
are used.
16 On basis of which criterion, the alpha-blocking agents used in BPH therapy are
subgrouped?
I plasma protein binding

II according to receptor subtype selectivity
III duration of serum elimination half-lives
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The alpha-blocking agents administered in BPH studies can be subgrouped according to receptor
subtype selectivity and the duration of serum elimination half-lives.
17 Which out of the following is Nonselective alpha-blocker?
I prazosin
II phenoxybenzamine
III indoramin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Nonselective alpha-blockers - phenoxybenzamine
18 Which out of the following is Selective short-acting alpha-1 blocker?
I indoramin
II prazosin
III phenoxybenzamine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Selective short-acting alpha-1 blockers - prazosin, alfuzosin, indoramin
19 Which out of the following is Selective long-acting alpha-1 blocker?
I terazosin
II phenoxybenzamine
III alfuzosin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Selective long-acting alpha-1 blockers - terazosin, doxazosin, slow-release (SR) alfuzosin.
20 Which out of the following is partially subtype (alpha-1a) selective agent?

I phenoxybenzamine
II tamsulosin
III silodosin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Partially subtype (alpha-1a) selective agents tamsulosin, silodosin
21 Which out of the following is the first alpha-blocker, studied for the treatment of BPH?
I furosemide
II tamsulosin
III Phenoxybenzamine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Phenoxybenzamine was the first alpha-blocker studied for BPH. @22 It is nonselective, antagonizing
both the alpha 1- and alpha 2-adrenergic receptors, which results in a higher incidence of adverse
effects.
22 What is the pharmacological mechanism of Phenoxybenzamine?
I partial agonist of alpha 1- and alpha 2-adrenergic receptors

II selective antagonist of alpha 1- and alpha 2-adrenergic receptors
III nonselective antagonist of alpha 1- and alpha 2-adrenergic receptors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
21 Phenoxybenzamine was the first alpha-blocker studied for BPH. @22 It is nonselective,
antagonizing both the alpha 1- and alpha 2-adrenergic receptors, which results in a higher incidence
of adverse effects.
23 Which out of the following drug is also approved for the treatment of simultaneous
BPH and erectile dysfunction (ED)?
I Phenoxybenzamine
II tadalafil
III Amoxipine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
It has also been approved for the treatment of simultaneous BPH and erectile dysfunction (ED).
24 What is the effect of Phosphdiesterase-5 (PDE5) inhibitors on lower urinary tract?
I smooth muscle relaxation in the lower urinary tract

II smooth muscle contraction in the lower urinary tract
III sphincter muscle contraction in the lower urinary tract
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Phosphdiesterase-5 (PDE5) inhibitors are known to mediate smooth muscle relaxation in the lower
urinary tract.
25 Which out of the following is the characteristic/symptom of Intraoperative floppy iris

syndrome (IFIS)?
I bradycardia
II miosis
III tachycardia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Intraoperative floppy iris syndrome (IFIS) is characterized by miosis, iris billowing, and prolapse in
patients undergoing cataract surgery who have taken or currently take alpha-1-blockers.

syndrome (IFIS)?
I tachycardia
II skin pigmentation
III iris billowing
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III

syndrome (IFIS)?
I virtigo
II prolapse
III nausea
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
28 Which disease occurs due to dihydrotestosterone deficiency?

I hypoplastic prostate
II vertigo
III night blindness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
DHT deficiency (due to a lack of 5-alpha-reductase activity). This deficiency produced a hypoplastic
prostate.
29 Which out of the following is true related to 5-alpha-reductase?
I There is one types of 5-alpha-reductase (type 1)

II There is two types of 5-alpha-reductase (type 1 and type 2)
III There is three types of 5-alpha-reductase (type 1, type 2 and type 3)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
ANS: B
The two types of 5-alpha-reductase include type 1 (predominantly located in extraprostatic tissues,
such as skin and liver) and type 2 (predominant prostatic reductase).
30 Type-1 5-alpha-reductase is predominantly located in-
I extraprostatic tissues, such as skin and liver

II tongue
III spleen
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
31 Type-2 5-alpha-reductase is predominantly located in-
I tongue
II spleen
III prostate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
32 Which enzyme is responsible for the conversion of testosterone to DHT?
I lactate dehydrogenase
II 5-alpha-reductase
III 5-alpha-oxidase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Inhibition of 5-alpha-reductase type 2 blocks the conversion of testosterone to DHT, resulting in lower
intraprostatic levels of DHT.
33 Which hormone plays an important role in growth of prostate gland?
I prolactin
II testosterone
III DHT
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Inhibition of 5-alpha-reductase type 2 blocks the conversion of testosterone to DHT, resulting in lower
intraprostatic levels of DHT. This leads to inhibition of prostatic growth, apoptosis, and involution.
The exact role of 5-alpha-reductase type 1 in normal and abnormal prostatic development is
undefined.
34 How 5-Alpha-reductase inhibitors improve lower urinary tract symptoms (LUTS)?
I by decreasing prostate volume

II by increasing prostate volume
III by increasing prostate size
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
5-Alpha-reductase inhibitors improve LUTS by decreasing prostate volumes; thus, patients with
larger prostates may achieve a greater benefit.
35 What is the time duration/treatment duration for maximal reduction in prostate

volume in BPH?
I 1 month
II 6 months
III 12 months
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Further, maximal reduction in prostate volume requires 6 months of therapy.
36 Which out of the following is a 4-aza-steroid?

I Furosemide
II Celicoxib
III Finasteride
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Finasteride (Proscar), a 4-aza-steroid, has demonstrated 5-alpha type II blocking activity, resulting
in the inhibition of DHT-receptor complex formation.
37 What is true related to the drug Finasteride?
I it inhibits DHT-receptor complex formation

II it has 5-alpha type I blocking activity
III it has 5-alpha type II blocking activity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Finasteride (Proscar), a 4-aza-steroid, has demonstrated 5-alpha type II blocking activity, resulting
in the inhibition of DHT-receptor complex formation.
38 What is the outcome of decreased intraprostatic DHT concentration in BPH?
I increase in prostate size

II reduction in prostate size
III increase in prostate volume
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
This effect causes a profound decrease in the concentration of DHT intraprostatically, resulting in a
consistent decrease in prostate size.
39 Which out of the following drug has an affinity for both type 1 and type 2 5 -alpha-
reductase receptors?
I liraglutide
II carbamazipine
III Dutasteride
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Dutasteride (Avodart) has an affinity for both type 1 and type 2 5-alpha-reductase receptors.
40 What is the adverse effect of finasteride?
I decreased libido
II hyperglycaemia
III tachycardia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Finasteride ; Adverse effects are primarily sexual in nature (decreased libido, erectile dysfunction,
ejaculation disorder.
41 What is the adverse effect of finasteride?
I erectile dysfunction
II tachycardia
III ejaculation disorder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Finasteride ; Adverse effects are primarily sexual in nature (decreased libido, erectile dysfunction,
ejaculation disorder.
42 Why finasteride is contraindicated in children and pregnant females?
I because it interferes with the metabolism of prolactin

II because it interferes with the metabolism of testosterone
III because it interferes with the metabolism of estrogen
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Because these drugs interfere with the metabolism of testosterone, they are contraindicated in children
and pregnant females.
43 Why the use anticholinergic agent was discouraged in men with BPH?
I because of urinary urgency

II because of Hyperinsulinemia
III because of urinary retention
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Anticholinergics were discouraged in men with BPH because of concerns of inducing urinary
retention.
44 What is the criterion for the use of anticholinergic agents for management of LUTS in
BPH patients?
I Normal postvoid residual urine volumes (PVR)

II Normal prostate size
III Normal prostate volume
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The 2010 AUA BPH guidelines recommend anticholinergic agents for management of LUTS in
patients who do not have an elevated PVR and whose LUTS are primarily irritative.
45 When should be anticholinergics used with caution in BPH patient?
I PVR greater than 250-300 mL

II PVR less than 250-300 mL
III PVR equal to 250-300 mL
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Caution with anticholinergics is recommended with patients whose PVR is greater than 250-300
mL.
46 Which out of the following active component is present in Phytotherapeutic Agents

used for the treatment of BPH?
I lectins
II glycoside
III plant oils
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Some suggested active components include phytosterols, fatty acids, lectins, flavonoids, plant oils, and
polysaccharides. Some preparations derive from a single plant; others contain extracts from 2 or more
sources.

I phytosterols
II flavonoids
III cardiac glycoside
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
sources.

I terpenoids
II fatty acids
III polysaccharides
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
sources.
49 What are the different modes of action of Phytotherapeutic Agents used for the
treatment of BPH?
I Antiandrogenic effect
II Inhibition of prostatic cell proliferation
III calcium channel blocking
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Each agent has one or more proposed modes of action. The following modes of action are suggested:
 Antiandrogenic effect
 Inhibition of prostatic cell proliferation
treatment of BPH?
I galactagogue
II Antiestrogenic effect
III Interference with prostaglandin metabolism
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Antiestrogenic effect
 Interference with prostaglandin metabolism
treatment of BPH?
I Protection and strengthening of detrusor

II galactagogue
III Inhibition of 5-alpha-reductase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Inhibition of 5-alpha-reductase
 Protection and strengthening of detrusor
treatment of BPH?
I Blockage of alpha receptors

II galactagogue
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
 Blockage of alpha receptors
treatment of BPH?
I galactagogue
II Antiedematous effect
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
 Antiedematous effect
treatment of BPH?
I Anti-rheumatic
II galactagogue
III Anti-inflammatory effect
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
 Anti-inflammatory effect
55 Which out of the following is phytotherapeutic agents used for the treatment of BPH?
I South African star grass roots

II Alfalfa
III Saw palmetto fruit
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
The origins of phytotherapeutic agents are as follows:
 Saw palmetto, (American dwarf palm; Serenoa repens, Sabal serrulata) fruit
 South African star grass ( Hypoxis rooperi) roots
I Alfalfa
II African plum tree bark
III Stinging nettle roots
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 African plum tree ( Pygeum africanum) bark
 Stinging nettle ( Urtica dioica) roots
I Rye pollen
II Aloe pollen
III Pumpkin seeds
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Rye ( Secale cereale) pollen
 Pumpkin ( Cucurbita pepo) seeds
58 Which part of the pumpkin is used for the treatment of BPH?
I seeds
II root
III rhizome
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Pumpkin ( Cucurbita pepo) seeds
59 Which part of the Stinging nettle is used for the treatment of BPH?
I rhizome
II roots
III stem
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Stinging nettle ( Urtica dioica) roots
60 Which part of the Saw palmetto is used for the treatment of BPH?
I stem
II root
III fruit
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Saw palmetto, (American dwarf palm; Serenoa repens, Sabal serrulata) fruit
61 What are the active components of Saw palmetto?
I mixture of fatty acids

II alcohols
III terpanoids
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Saw palmetto; @61 The active components are believed to be a mixture of fatty acids, phytosterols,
and alcohols.
62 What is the proposed mechanism of action of Saw palmetto for the treatment of BPH?
I antiandrogenic effects
II Antidiabetic
III 5-alpha-reductase inhibition
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Saw palmetto; The proposed mechanisms of action are antiandrogenic effects, 5-alpha-reductase
inhibition, and anti-inflammatory effects
63 What is the recommended dosage of Saw palmetto for the treatment of BPH?
I 80 mg orally twice daily

II 160 mg orally twice daily
III 260 mg orally twice daily
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Saw palmetto; The recommended dosage is 160 mg orally twice daily.
64 What is the proposed mechanism of action of African plum tree for the treatment of
BPH?
I inhibition of fibroblast proliferation and anti-inflammatory

II antiestrogenic effects
III Antidiabetic
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
African plum tree; Suggested mechanisms of action include inhibition of fibroblast proliferation and
anti-inflammatory and antiestrogenic effects.
65 What is used as raw material for the extract preparation of Rye?
I pollen
II root
III stem
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Rye; This extract is made from pollen taken from rye plants growing in southern Sweden.
66 What is the proposed mechanism of action of Rye for the treatment of BPH?
I beta- blockade
II alpha-blockade
III prostatic zinc level increase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Rye; @66 Suggested mechanisms of action involve alpha-blockade, prostatic zinc level increase, and
5-alpha-reductase activity inhibition.
67 What is the usefulness of sildenafil?
I improve mild-to-moderate LUTS

II treating erectile dysfunction
III treating acromegaly
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
In addition to treating erectile dysfunction, sildenafil may improve mild-to-moderate LUTS.
68 What is the effect of Nitric oxide on urinary tract?
I contraction of the prostatic uterus

II contraction of the prostatic urethra and/or bladder neck
III relaxation of the prostatic urethra and/or bladder neck
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Nitric oxide may mediate relaxation of the prostatic urethra and/or bladder neck.
69 Which out of the following is an indication to proceed with a surgical intervention in

BPH?
I Hypertension
II Recurrent gross hematuria
III Hypotension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The indications to proceed with a surgical intervention include the following:
 Recurrent gross hematuria

BPH?
I respiratory tract infection
II Urinary tract infection
III Hypertension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
 Urinary tract infection

BPH?
I Hypertension
II respiratory tract infection
III Renal insufficiency secondary to obstruction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
 Renal insufficiency secondary to obstruction
72 Which procedure is considered the criterion standard for relieving BOO secondary to
BPH?
I Transurethral incision of the prostate

II Transurethral microwave therapy
III Transurethral Resection of the Prostate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
TURP is considered the criterion standard for relieving BOO secondary to BPH
73 Open Prostatectomy is now reserved for patients with-
I prostates >75 g
II prostates < 75 g
III prostates = 75 g
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Open Prostatectomy ; This procedure is now reserved for patients with very large prostates (>75 g),
patients with concomitant bladder stones or bladder diverticula, and patients who cannot be
positioned for transurethral surgery.
74 Open Prostatectomy is now reserved for patients with-
I bladder verticular
II concomitant bladder stones
III bladder diverticula
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Open Prostatectomy ; This procedure is now reserved for patients with very large prostates (>75 g),
patients with concomitant bladder stones or bladder diverticula, and patients who cannot be
positioned for Transurethral surgery.
75 What is the mechanism of most minimally invasive therapies in treatment of BPH?
I use of electric current to destroy prostatic tissue

II use of heat to destroy prostatic tissue
III use of cold treatment to destroy prostatic tissue
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Most minimally invasive therapies rely on heat to destroy prostatic tissue.
76 What are the different ways to deliver heat for the treatment of BPH?
I laser energy
II microwaves
III UV radiation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Heat may be delivered in the form of laser energy, microwaves, radiofrequency energy, high-intensity
ultrasound waves, and high-voltage electrical energy.
77 What are the different ways to deliver heat for the treatment of BPH?
I UV radiation
II radiofrequency energy
III high-intensity ultrasound waves
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Heat may be delivered in the form of laser energy, microwaves, radiofrequency energy, high-intensity
ultrasound waves, and high-voltage electrical energy.
78 Why Transurethral incision of the prostate is preferred over Transurethral resection of
the prostate?
I no incidence of retrograde ejaculation and impotence than TURP

II higher incidence of retrograde ejaculation and impotence than TURP
III lower incidence of retrograde ejaculation and impotence than TURP
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
TUIP is associated with less bleeding and fluid absorption than TURP. It is also associated with a
lower incidence of retrograde ejaculation and impotence than TURP.
79 Why Transurethral incision of the prostate is preferred over Transurethral resection of

the prostate?
I more bleeding and fluid absorption than TURP

II less bleeding and fluid absorption than TURP
III no bleeding and fluid absorption than TURP
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
TUIP is associated with less bleeding and fluid absorption than TURP. It is also associated with a
lower incidence of retrograde ejaculation and impotence than TURP.
80 What is the logic behind the use of laser for the treatment of BPH?
I Lasers heat prostate tissue, causing tissue death by trauma

II Lasers heat prostate tissue, causing tissue death by apoptosis
III Lasers heat prostate tissue, causing tissue death by coagulative necrosis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Lasers deliver heat to the prostate in various ways. Lasers heat prostate tissue, causing tissue death by
coagulative necrosis.
81 Which laser is used to cut and/or enucleate the prostate in BPH patient?
I holmium
II Potassium-titanyl-phosphate
III helium
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Potassium-titanyl-phosphate (KTP) and holmium lasers are used to cut and/or enucleate the prostate,
similar to the TURP technique.
82 Which complication is associated with the Microwave treatment in BPH?
I significant prostatic swelling

II hypotension
III hypertension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Microwave treatment appears to be associated with significant prostatic swelling; a considerable
number of patients require a urinary catheter until the swelling subsides.
83 Which complications are associated with the use of Prostatic stents?
I hypotension
II encrustation
III pain
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Prostatic stents are flexible devices that can expand when put in place to improve the flow of urine
past the prostate. Complications associated with their use include encrustation, pain, incontinence,
and overgrowth of tissue through the stent, possibly making their removal quite difficult.
84 Why prazosin is preferred over nonselective alpha-adrenergic blockers for the treatment
of BPH?
I once-daily regimen
II selective alpha-adrenergic blocker
III twice a day regimen
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The advantage of prazosin over nonselective alpha-adrenergic blockers includes a lower incidence of
adverse effects. Because of availability of longer-acting, once-daily selective agents, however, the
clinical utility of prazosin for BPH has been reduced.
85 Why prazosin is preferred over nonselective alpha-adrenergic blockers for the treatment
of BPH?
I no adverse effects
II lower incidence of adverse effects
III higher bioavailability
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
85 84 The advantage of prazosin over nonselective alpha-adrenergic blockers includes a lower
incidence of adverse effects. Because of availability of longer-acting, once-daily selective agents,
however, the clinical utility of prazosin for BPH has been reduced.
86 Which out of the following drug is used for the treatment of Hypertension and BPH?
I Prazosin
II Simvastatin
III pramastatin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Prazosin is currently approved for the treatment of hypertension. Prazosin improves urine flow rates
by relaxing smooth muscle.
87 Which out of the following is Alpha-Adrenergic Blockers?
I simvastatin
II Phenoxybenzamine
III diclofenac
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Alpha-Adrenergic Blockers; Phenoxybenzamine, Prazosin, Alfuzosin, Indoramin, Terazosin,
Doxazosin, Tamsulosin and Silodosin.
I Nimisuide
II diclofenac
III Prazosin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
I Alfuzosin
II Nimisuide
III piroxicam
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
I Indonavir
II piroxicam
III Indoramin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
I Terazosin
II Ritonavir
III Doxazosin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
I Silodosin
II Tamsulosin
III Quinidine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
93 Finasteride improves urinary flow rate by
I 2 mL/s
II 3 mL/s
III 4 mL/s
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Finasteride improves urinary flow rate by 2 mL/s.
94 Which drug is beneficial in men with prostates larger than 40 g?
I spinolactone
II primaquine
III Finasteride
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Finasteride; It is beneficial in men with prostates larger than 40 g and can improve symptoms and
reduce prostatic size by 20-30%. Reduction in prostate size is sustained for 5 years following
treatment.
95 Which out of the following is 5-Alpha-Reductase Inhibitors?
I Finasteride
II primaquine
III Dutasteride
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
5-Alpha-Reductase Inhibitors; Finasteride, Dutasteride
96 Which out of the following is true related to cGMP and Nitric oxide?
I increased cGMP activity increases vasodilatory effects of nitric oxide

II decreased cGMP activity increases vasodilatory effects of nitric oxide
III increased cGMP activity decreases vasodilatory effects of nitric oxide
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
PDE5 selective inhibitor. Inhibition of PDE5 increases cGMP activity, which increases vasodilatory
effects of nitric oxide.
97 What is the effect of tadalafil on cGMP activity?
I decrease cGMP activity

II increases cGMP activity
III increase or decrease cGMP activity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
PDE5 selective inhibitor. Inhibition of PDE5 increases cGMP activity, which increases vasodilatory
effects of nitric oxide.
98 Which out of the following is Phosphodiesterase-5 Inhibitors?
I Tamoxifen
II Liraglutide
III Tadalafil
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Phosphodiesterase-5 Enzyme Inhibitors; Tadalafil
99 What is the therapeutic dose of dutasteride and tamsulosin when used

combined/together for the treatment of BHP?
I dutasteride 0.6 mg and tamsulosin 0.3 mg
II dutasteride 0.5 mg and tamsulosin 0.4 mg
III dutasteride 0.4 mg and tamsulosin 0.5 mg
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The combination of dutasteride, a 5-alpha-reductase inhibitor, and tamsulosin, an alpha-adrenergic
antagonist is indicated for benign prostatic hypertrophy in men with an enlarged prostate. @99 Each
cap contains dutasteride 0.5 mg and tamsulosin 0.4 mg.
100 Which out of the following is correct drug combination used for the tre atment of
BHP?
I dutasteride and tamsulosin

II Simvastatin and tamsulosin
III dutasteride and simvastatin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The combination of dutasteride, a 5-alpha-reductase inhibitor, and tamsulosin, an alpha-adrenergic
antagonist is indicated for benign prostatic hypertrophy in men with an enlarged prostate. @99 Each
cap contains dutasteride 0.5 mg and tamsulosin 0.4 mg.
DEMENTIA
1 What is the most common form of dementia?
I Frontotemporal dementia
II Alzheimer disease (AD)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The most common form of dementia, Alzheimer disease (AD).
2 What is the role of Microtubules?
I act like tracks

II guiding nutrients from the axon and back to the body of the cell
III guiding nutrients from the body of the cell down to the ends of the axon and back
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
These microtubules act like tracks, guiding nutrients and molecules from the body of the cell down to
the ends of the axon and back. A special kind of protein, tau, binds to the microtubules and stabilizes
them.
3 How the neurofibrillary tangles are formed in brain?
I tau protein change chemically

II Tau protein binds to microtubules
III begins to pair with other threads of tau and then become tangled together
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
neurofibrillary tangles; In AD, tau is changed chemically. It begins to pair with other threads of tau,
which become tangled together.
4 What plays an important role in pathology of AD?
I senile plaques
II senile tangels
III neurofibrillary tangles(NFTs)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
In addition to NFTs, the anatomic pathology of AD includes senile plaques.
5 What is senile plaques (SPs) in Alzheimer's disease?
I neurofibrillary tangles
II beta-amyloid plaques
III amyloid precursor protein
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
(SPs; also known as beta-amyloid plaques)
6 Which is the initial site of tangle deposition and atrophy in AD?
I frontal temporal lobe

II occipital lobe
III medial temporal lobe
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The hippocampus and medial temporal lobe are the initial sites of tangle deposition and atrophy.
7 Which is the initial site of tangle deposition and atrophy in AD?
I frontal temporal lobe

II occipital lobe
III hippocampus
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The hippocampus and medial temporal lobe are the initial sites of tangle deposition and atrophy.
8 Which neuronal processes are affected due to disease?
I communication
II metabolism
III integrity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
8 9 AD affects the 3 processes that keep neurons healthy: communication, metabolism, and repair.
9 Which neuronal processes are affected due to AD?
I formation
II metabolism
III repair
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
AD affects the 3 processes that keep neurons healthy: communication, metabolism, and repair.
10 What are the outcome of the destruction and death of nerve cells in AD?
I memory failure
II personality changes
III changes in hearing and speaking ability
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
10 11 12 The destruction and death of these nerve cells causes the memory failure, personality changes,
problems in carrying out daily activities, and other features of the disease.
11 What are the outcome of the destruction and death of nerve cells in AD?
I problems in carrying out daily activities

II other features of the disease
III problems in walking
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The destruction and death of these nerve cells causes the memory failure, personality changes, problems
in carrying out daily activities, and other features of the disease.
12 Which is responsible for the development of signs and symptoms in AD?
I destruction of the brain cells

II destruction of the nerve cells
III death of the nerve cells
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The destruction and death of these nerve cells causes the memory failure, personality changes, problems
in carrying out daily activities, and other features of the disease.
13 Which of the following accumulation primarily precedes the clinical onset of AD?
I NFTs
II SPs
III beta-amyloid plaques
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The accumulation of SPs primarily precedes the clinical onset of AD.
14 Which of the following accompanies the progression of cognitive decline in AD?
I NFTs
II loss of synapses
III SPs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
@14 NFTs, loss of neurons, and loss of synapses accompany the progression of cognitive decline.
15 What is the main constituent of NFTs?
I macrotubule-associated protein tau

II microtubule-associated protein tau
III microtubule- associated protein taw
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The main constituent of NFTs is the microtubule-associated protein tau (see Anatomy).
16 Which part of neuron shows accumulation of hyperphosphorylated tau In AD?
I perikarya of large pyramidal neurons

II perikarya of medium pyramidal neurons
III perikarya of small pyramidal neurons
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
In AD, hyperphosphorylated tau accumulates in the perikarya of large and medium pyramidal
neurons.
17 What accumulates in the perikarya of large and medium pyramidal neurons in AD?
I hyperphospholated tau
II hypophosphorylated tau
III hyperphosphorylated tau
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
In AD, hyperphosphorylated tau accumulates in the perikarya of large and medium pyramidal
neurons.
18 What is the outcome of the tau gene mutations?
I Alzheimers disease
II frontotemporal dementia
III Par
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Somewhat surprisingly, mutations of the tau gene result not in AD but in some familial cases of
frontotemporal dementia.
19 What is the ultimate result of various lesion produce in AD?
I the cognitive manifestations of the disorder

II the behavioral manifestations of the disorder
III the asymptomatic manifestations of the disorder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
original papers were published. These include the granulovacuolar degeneration of Shimkowicz; the
neuropil threads of Braak et al[14] ; and neuronal loss and synaptic degeneration, which are thought
to ultimately mediate the cognitive and behavioral manifestations of the disorder.
20 Which lesions are also involved in the pathogenesis of AD?
I granulovacuolar degeneration of Shimkowicz

II the neuropil threads of Braak
III granulovacuolar regeneration of Shimkowicz
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
21 Which lesions are also involved in the pathogenesis of AD?
I neuronal loss
II synaptic regeneration
III synaptic degeneration
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
In addition to NFTs and SPs, many other lesions o
22 What is true related to plaque formation in AD?
I mostly insoluble deposits of protein

II cellular material outside and around the neurons
III cellular material inside the neurons
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Plaques are dense, mostly insoluble deposits of protein and cellular material outside and around the
neurons.
23 What is responsible for formation of Plaques in AD?
I NFTs
II beta-amyloid (Ab)
III a protein fragment snipped from a larger protein called amyloid precursor protein (APP)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Plaques are made of beta-amyloid (Ab), a protein fragment snipped from a larger protein called
amyloid precursor protein (APP).
24 Which part of brain develops plaques in AD?
I cerebrum
II hippocampus
III cerebral cortex
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
In AD, plaques develop in the hippocampus, a structure deep in the brain that helps to encode
memories, and in other areas of the cerebral cortex that are used in thinking and making decisions
25 What is the function of hippocampus?
I thinking and making decisions

II a structure deep in the brain that helps to encode calculations
III a structure deep in the brain that helps to encode memories
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
memories, and in other areas of the cerebral cortex that are used in thinking and making decisions.
26 What is the function of cerebral cortex?
I a structure deep in the brain that helps to encode memories

II thinking and making decisions
III balance and coordination
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
memories, and in other areas of the cerebral cortex that are used in thinking and making decisions.
27 NFTs are found in several other neurodegenerative disorders like-
I progressive supranuclear palsy

II dementia pugilistica
III progressive supernuclear palsy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Although NFTs and SPs are characteristic of AD, they are not pathognomonic. NFTs are found in
several other neurodegenerative disorders, including progressive supranuclear palsy and dementia
pugilistica
28 Which characteristic change is observed when cultured cortical and hippocampal

neurons treated with Ab protein?
I nuclear chromatin condensation

II plasma membrane blebbing
III nuclear chromatin compesation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Cultured cortical and hippocampal neurons treated with Ab protein exhibit changes characteristic of
apoptosis (self-regulated cell destruction), including nuclear chromatin condensation, plasma
membrane blebbing, and internucleosomal DNA fragmentation.
29 Which characteristic change is observed when cultured cortical and hippocampal

neurons treated with Ab protein?
I internucleosomal DNA fragmentation

II intranucleosomal DNA fragmentation
III internucleosomal RNA fragmentation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Cultured cortical and hippocampal neurons treated with Ab protein exhibit changes characteristic of
apoptosis (self-regulated cell destruction), including nuclear chromatin condensation, plasma
membrane blebbing, and internucleosomal DNA fragmentation.
30 Which gene has been linked with significantly increased risk for developing AD?
I apolipoprotein E (APOE) E4 allele

II apolipoprotein E (APOE) E6 allele
III apolipoprotein E (APOE) E2 allele
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The apolipoprotein E (APOE) E4 allele, which has been linked with significantly increased risk for
developing AD.
31 What is responsible for stabilization of neuronal microtubules?
I SPs
II The tau protein
III NFTs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The tau protein stabilizes neuronal microtubules.
32 Granulovacuolar degeneration occurs almost exclusively in the-
I hippocampus
II cerebral cortex
III brain stem
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Granulovacuolar degeneration occurs almost exclusively in the hippocampus.
33 How cholinergic deficiency affects the AD?
I causes cognitive decline

II causes behavioral changes
III causes symptomatic changes
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The cholinergic system is involved in memory function, and cholinergic deficiency has been implicated
in the cognitive decline and behavioral changes of AD.
34 Which enzymatic activity is significantly reduced in hippocampus and amygdala in

patients with AD?
I anabolic enzyme acetylcholinesterase

II choline acetyltrAns:ferase (CAT)
III catabolic enzyme acetylcholinesterase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Activity of the synthetic enzyme choline acetyltrAns:ferase (CAT) and the catabolic enzyme
acetylcholinesterase are significantly reduced in the cerebral cortex, hippocampus, and amygdala in
patients with AD.
35 Which part of brain shows decreased enzymatic activity (choline acetyltrAns:ferase) in

AD?
I cerebral cortex
II amygdala
III brain stem
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Activity of the synthetic enzyme choline acetyltrAns:ferase (CAT) and the catabolic enzyme
acetylcholinesterase are significantly reduced in the cerebral cortex, hippocampus, and amygdala in
patients with AD.
36 What is responsible for cognitive impairment and reaction-time performance in AD?
I Loss of cortical CAT

II increase acetylcholine synthesis
III decline in acetylcholine synthesis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Loss of cortical CAT and decline in acetylcholine synthesis in biopsy specimens have been found to
correlate with cognitive impairment and reaction-time performance.
37 Oxidative stresses play a critical role in pathogenesis of neurodegenerative d iseases like-
II amyotrophic bilateral sclerosis

III amyotrophic lateral sclerosis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Oxidative stress is believed to be a critical factor in normal aging and in neurodegenerative diseases
such as Parkinson disease, amyotrophic lateral sclerosis, and AD.
38 Which of the following is an index of oxidative damage in AD?
I free carbonyls
II thiobarbituric acid-reactive intermediates
III thiobarbituric acid-reactive products
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Formation of free carbonyls and thiobarbituric acid-reactive products, an index of oxidative damage,
are significantly increased in AD brain tissue compared with age-matched controls.
39 Which out of the following oxidative parameter is significantly increased in AD brain?
I formation of free carbonyls

II Formation of thiobarbituric acid-reactive products
III Formation of thiobarbiturate acid-reactive products
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Formation of free carbonyls and thiobarbituric acid-reactive products, an index of oxidative damage,
are significantly increased in AD brain tissue compared with age-matched controls.
40 Which mechanisms develop oxidative stress in cell?
I production of reactive oxygen species in the cell membrane

II production of reactive oxygen species in the cell body
III production of reactive oxygen species in the cell surface
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Multiple mechanisms exist by which cellular alterations may be induced by oxidative stress, including
production of reactive oxygen species (ROS) in the cell membrane (lipid peroxidation.
41 what is true for the cytokines levels in AD as compared with aged -matched control
patients?
I increased cytokine levels are seen in the serum

II increased cytokine levels are seen in the cortical plaques
III increased cytokine levels are seen in the blood
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Reactive microglia are embedded in neuritic plaques. Increased cytokine levels are seen in the serum,
cortical plaques, and neurons of patients with AD, as compared with aged-matched control patients.
Interestingly, transforming growth factor beta 1 (TGF-β1), which is an anti-inflammatory cytokine,
has been found to promote or accelerate the deposition of amyloid (How inflammation is involved in
AD).
42 Which cytokine has been found to promote or accelerate the deposition of amyloid
protein?
I transforming growth factor beta 1 (TGF-β1)

II transforming growth factor beta 2 (TGF-β2)
III transforming growth factor beta 3 (TGF-β3)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
AD).
43 What is the role of transforming growth factor beta 1 (TGF-β1)-an anti-inflammatory

cytokine in AD?
I to promote the deposition of amyloid

II to accelerate the deposition of amyloid
III to promote the growth of amyloid
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
AD).
44 Which plasma protein plays an important role in the pathogenesis of AD?
I Clusterase
II Clustin
III Clusterin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Clusterin, a plasma protein, plays an important role in the pathogenesis of AD.
45 Which candidate gene is linked to a significant proportion of early -onset autosomal-

dominant AD?
I chromosome 14-presenilin-1 (PS1)

II chromosome 14-presenilin-2 (PS2)
III chromosome 1-presenilin-2 (PS2)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
A significant proportion of early-onset autosomal-dominant AD cases have been linked to a candidate
gene on chromosome 14 (14q24.3) called presenilin-1 (PS1) and a candidate gene on chromosome 1
called presenilin-2 (PS2).
46 Which part of brain shows PS1 localization in AD?
I endoplasmic reticulum
II mitochondria
III Golgi complex
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Immunochemical analyses indicate that PS1 localizes to intracellular compartments, such as the
endoplasmic reticulum and the Golgi complex, that are involved in similar functions
47 Which diagnostic method indicates PS1 localization in intracellular compartments?
I Immunomodulatory analyses
II Immunochemical analysation
III Immunochemical analyses
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Immunochemical analyses indicate that PS1 localizes to intracellular compartments, such as the
endoplasmic reticulum and the Golgi complex, that are involved in similar functions.
48 What is the outcome of the decreased expression of PS1 gene?
I decrease in proteolytic cleavage of amyloid precursor protein (APP) by secretase

II increase in proteolytic cleavage of amyloid precursor protein (APP) by secretase
III decrease in proteolysis cleavage of amyloid precursor protein (APP) by secretase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Mice deficient in the expression of PS1 exhibit a dramatic decrease in proteolytic cleavage of the
trAns:membrane domain of amyloid precursor protein (APP) by secretase.
49 Which enzyme is responsible for proteolytic cleavage of the trAns:membrane domain of

amyloid precursor protein (APP)?
I Hydrolase
II secretase
III protease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Mice deficient in the expression of PS1 exhibit a dramatic decrease in proteolytic cleavage of the
trAns:membrane domain of amyloid precursor protein (APP) by secretase.
50 What is true from following for the risk of AD in women?
I menopausal women are at higher risk than men for AD

II Postmenopausal women are at higher risk than men for AD
III Premenopausal women are at higher risk than men for AD
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Postmenopausal women are at higher risk than men for AD
51 What is the role of estrogen in human neuroblastoma cell cultures?
I to exert amyloid toxicity

II to exert cytoprotective effects
III to prevent amyloid toxicity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Estrogen has also been shown to exert cytoprotective effects and to prevent amyloid toxicity in human
neuroblastoma cell cultures.
52 What is the cause of AD?
I genetic risk factors

II converging disease state
III converging environmental
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
The cause of AD is unknown. Several investigators now believe that converging environmental and
genetic risk factors trigger a pathophysiologic cascade that, over decades, leads to Alzheimer pathology
and dementia.
53 What are the risk factors for Alzheimer-type dementia?
I Smoking habits
II Advancing age
III Family history
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The following risk factors for Alzheimer-type dementia have been identified
 Advancing age
 Family history
I APOE 4 genotype
II Obesity
III APOE 5 genotype
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The following risk factors for Alzheimer-type dementia have been identified:
 APOE 4 genotype
 Obesity
I Insulin resistance
II Insulin sensitive
III Vascular factors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Vascular factors
I Dyslipidemia
II Hypertension
III Hypotension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
 Dyslipidemia
 Hypertension
I Heart disease
II Inflammatory markers
III Tachycardia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
 Inflammatory markers
I Down syndrome
II Traumatic nerve injury
III Traumatic brain injury
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
The following risk factors for Alzheimer-type dementia have been identified
Down syndrome
Traumatic brain injury
59 Which gene mutaion unequivocally cause early-onset autosomal dominant AD?
I The amyloid precursor protein ( APP) gene on chromosome 21

II The presenilin-1 ( PS2) gene on chromosome 14
III The presenilin-1 ( PS1) gene on chromosome 14
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Mutations in the following genes unequivocally cause early-onset autosomal dominant AD:
The amyloid precursor protein ( APP) gene on chromosome 21
The presenilin-1 ( PS1) gene on chromosome 14
60 Which gene mutaion unequivocally cause early-onset autosomal dominant AD?
I The presenilin-2 ( PS2) gene on chromosome 1

II The presenilin-2 ( PS2) gene on chromosome 14
III The presenilin-2 ( PS1) gene on chromosome 1
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Mutations in the following genes unequivocally cause early-onset autosomal dominant AD:
The amyloid precursor protein ( APP) gene on chromosome 21
61 What is the role of mutated gene in terms of production of Ab peptide?
I stickier 40-amino acid form of the Ab peptide

II stickier 42-amino acid form of the Ab peptide
III less sticky 40-amino-acid form Ab peptide
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
All 3 of these genes lead to a relative excess in the production of the stickier 42-amino acid form of
the Ab peptide over the less sticky 40-amino-acid form.
62 Which gene plays an important role in development of AD?
I Clusterin (CLU) gene

II Phosphatidylinositol-binding clathrin assembly protein ( PICALM) gene
III Clusterin (CLU) gene
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
However, genome-wide association studies have identified the following additional susceptibility
loci[34] :
 Clusterin ( CLU) gene
 Phosphatidylinositol-binding clathrin assembly protein ( PICALM) gene
I Complement receptor 1 ( CR1) gene

II ATP-binding cassette sub-family A member 7 gene ( ABCA7)
III Complement receptor 2 ( CR2)gene
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
loci[34] :
Complement receptor 1 ( CR1) gene
ATP-binding cassette sub-family A member 7 gene ( ABCA7)
I Membrane-spanning gene cluster ( MS4A6A/MS4A4E)

II Membrane-spanning gene cluster ( MS4A4A/MS4A6E)
III Ephrin receptor A1 ( EPHA1)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
loci[34] :
Membrane-spanning gene cluster ( MS4A6A/MS4A4E)
Ephrin receptor A1 ( EPHA1)
65 Which species of spirochates are associated with the development of AD?
I periodontal pathogen Treponemas

II periodontal pathogen echrechaia coli
III periodontal pathogen Borrelia burgdorferi
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Emerging field of research suggests a significant association between AD and chronic infection with
various species of spirochetes, including the periodontal pathogen Treponemas and Borrelia
burgdorferi, as well as pathogens such as herpes simplex virus type 1.
66 Which species of virus are associated with the development of AD?
I herpes simplex virus type 1

II herpes simplex virus type 2
III herpes simplex virus type 3
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
An emerging field of research suggests a significant association between AD and chronic infection with
various species of spirochetes, including the periodontal pathogen Treponemas and Borrelia
burgdorferi, as well as pathogens such as herpes simplex virus type 1.
67 What is true related to the prevalence of AD?
I AD is most prevalent in individuals elder than 60 years

II AD is most prevalent in individuals younger than 60 years
III AD is most prevalent in individuals older than 60 years
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The prevalence of AD increases with age. AD is most prevalent in individuals older than 60 years.
68 What is mean by the term anomia?
I experience speaking disorders

II experience letters disorders
III experience language disorders
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Experience language disorders (eg, anomia)
69 Which type of physical examinations is carried out during initial diagnosis of AD?
I detailed neurologic examination

II a mental status examination
III a physical status examination
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
69 70 At the time of initial diagnosis, a complete physical examination, including a detailed
neurologic examination and a mental status examination, should be performed to evaluate disease
stage and rule out comorbid conditions.
70 What is evaluated after complete physical examination during intial diagnosis in AD?
I disease stage
II disorder stage
III rule out comorbid conditions
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
At the time of initial diagnosis, a complete physical examination, including a detailed neurologic
examination and a mental status examination, should be performed to evaluate disease stage and rule
out comorbid conditions.
71 What is evaluated during Initial mental status testing for AD?
I Attention and concentration

II Recent and remote memory
III Recent and remote talks
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Initial mental status testing should include evaluation of the following:
 Attention and concentration
 Recent and remote memory
I Language
II postaxis
III Praxis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F

 Language
 Praxis
I Executive function
II Visuospatial function
III Visuoexecutive function
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
 Visuospatial function
 Executive function
74 What are the Cognitive features of early AD?
I memory loss
II mild anomic aphasia
III Chronic anomic aphasia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Cognitive features of early AD include memory loss, mild anomic aphasia, and visuospatial
dysfunction.
75 What are the Cognitive features of early AD?
II visuospatial dysfunction
III visuospatial function
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Cognitive features of early AD include memory loss, mild anomic aphasia, and visuospatial
dysfunction.
76 Which out of the following is a standardized examination method for assessment of

AD?
I Mini-Mental Status Examination (MMSE)

II the Montreal Cognitive Assessment (MoCA)
III Maxi-Mental Status Examination (MMSE)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Brief standardized examinations for assessment of AD; Mini-Mental Status Examination (MMSE),
the Montreal Cognitive Assessment (MoCA) and the Saint Louis University Mental Status (SLUMS)
examination.
77 Which out of the following is a standardized examination method for assessment of

AD?
I Saint Lotus University Mental Status (SLUMS) examination

II Saint Louis University Mental Status (SLUMS) examination
III Mental Cognitive Assessment (MoCA)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Brief standardized examinations; Mini-Mental Status Examination (MMSE), the Montreal
Cognitive Assessment (MoCA) and the Saint Louis University Mental Status (SLUMS) examination.
78 What are the different stages for AD?
I Preclinical
II Mild
III clinical
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
AD can be classified into the following stages:
 Preclinical
 Mild
 Moderate
 Severe
79 What are the different stages for AD?
I chronic
II Moderate
III Severe
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
AD can be classified into the following stages:
 Preclinical
 Mild
 Moderate
 Severe
80 What is the first visible sign of amnestic mild cognitive impairment (MCI)?
I Memory loss
II trauma
III confusion
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Memory loss, the first visible sign, is the main feature of amnestic mild cognitive impairment (MCI).
81 Which is often an initial, trAns:itional clinical phase between normal brain aging and
AD?
I moderate cognitive impairment (MCI)

II mild cognitive impairment (MCI)
III severe cognitive impairment (MCI)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Many scientists think MCI is often an initial, trAns:itional clinical phase between normal brain
aging and AD.
82 At which stage of AD clinical diagnosis is usually performed?
I moderate Alzheimers disease

II severe Alzheimers disease
III mild Alzheimers disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The clinical diagnosis of AD is usually made during this stage mild AD
83 Which out of the following are Signs of mild AD?
I Memory loss
II ataxia
III Confusion about the location of familiar places
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Signs of mild AD can include the following:
 Memory loss
 Confusion about the location of familiar places (getting lost begins to occur)
I Taking longer to accomplish normal daily tasks

II taking longer to speak something
III Trouble handling money and paying bills
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Taking longer to accomplish normal daily tasks
 Trouble handling money and paying bills
I Compromised judgment often leading to bad decisions

II Loss of self confidence
III Loss of spontaneity and sense of initiative
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Compromised judgment often leading to bad decisions
 Loss of spontaneity and sense of initiative
86 Which out of the following are symptoms of mild AD?
I Increasing memory loss and confusion

II Shortened attention span
III Shortened alertness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The symptoms of this stage can include the following:
 Increasing memory loss and confusion
 Shortened attention span
87 Which of the following are Symptoms of mild AD?
I Problems recognizing friends and family members

II Difficulty with language; problems with reading, writing, working with numbers
III Problem in recognizing ownself
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
 Problems recognizing friends and family members
 Difficulty with language; problems with reading, writing, working with numbers
88 Which out of the following are Symptoms of mild AD?
I Difficulty organizing thoughts and thinking logically

II Inability to learn new things or to cope with new or unexpected situations
III ability to learn new things or to cope with new or unexpected situations
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
 Difficulty organizing thoughts and thinking logically
 Inability to learn new things or to cope with new or unexpected situations
89 Which out of the following are Symptoms of mild AD?
I Restlessness and wandering, especially in the late afternoon or at night

II Repetitive statements or movement; occasional muscle relaxation
III Repetitive statements or movement; occasional muscle twitches
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Restlessness, agitation, anxiety, tearfulness, wandering, especially in the late afternoon or at
night
 Repetitive statements or movement; occasional muscle twitches
90 What is the patient's behaviour at severe stage of AD?
I Patients cannot recognize family and loved ones

II Patients forget about things to put
III completely dependent on others for care
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
90 91 Patients cannot recognize family and loved ones or communicate in any way. They are
completely dependent on others for care
91 At which stage of AD patients does not recognize family and loved ones?
I Alzheimer's disease
II Severe Alzheimer's disease
III mild Alzheimer's disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Patients cannot recognize family and loved ones or communicate in any way. They are completely
dependent on others for care.
92 Which ancillary imaging studies is used for the diagnosis of AD?
I computed tomography [CT]

II magnetic resonance imaging [MRI]
III Neuromagnetic Resonance(NMR)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
However, ancillary imaging studies (eg, computed tomography [CT]; magnetic resonance imaging
[MRI]; and, in selected cases, single-photon emission CT [SPECT] or positron emission tomography
[PET]) and laboratory tests may be used.
I single-photon extinction CT[SPECT]

II single-photon emission CT[SPECT]
III single-photon elevation CT[SPECT]
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
I positron emission tomography [PET])

II laboratory tests
III tomographic imaging studies
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
95 Noncontrast computed tomography (CT) scan or magnetic resonance image (MRI) is

used for the diagnosis of-
I cognitive mispairment (eg, stroke, small vessel disease, tumor)

II cognitive impairment (eg, stroke, small vessel disease, tumor)
III cognitive unpairment (eg, stroke, small vessel disease, tumor)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
American Academy of Neurology (AAN) recommendations indicate that structural neuroimaging
with either a noncontrast computed tomography (CT) scan or magnetic resonance image (MRI) is
appropriate in the initial evaluation of patients with dementia, in @95 order to detect lesions that
may result in cognitive impairment (eg, stroke, small vessel disease, tumor.
96 Which structural neuroimaging studies are carried out during intial evaluation of
dementia?
I contrast computed tomography (CT)

II magnetic resonance image (MRI)
III noncontrast computed tomography (CT)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
American Academy of Neurology (AAN) recommendations indicate that structural neuroimaging
with either a noncontrast computed tomography (CT) scan or magnetic resonance image (MRI) is
appropriate in the initial evaluation of patients with dementia, in @95 order to detect lesions that
may result in cognitive impairment (eg, stroke, small vessel disease, tumor.
97 Which is valuable tool for Creutzfeldt-Jakob disease diagnosis?
I Electroencephography (EEG)
II Electroencardiography (EEG)
III Electroencephalography (EEG)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Electroencephalography (EEG) is valuable when Creutzfeldt-Jakob disease or other prion-related
disease is a likely diagnosis.
98 Which is true from following in terms of protein concentration in AD?
I CSF levels of tau and phosphorylated tau are elevated in AD

II amyloid levels are usually low
III amyloid levels are usually High
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
CSF levels of tau and phosphorylated tau are often elevated in AD, whereas amyloid levels are usually
low.
99 Why lumber puncture is performed in selected AD patients?
I normal-pressure hydrocephalus
II central nervous system infection
III central venous system infection
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Perform lumbar puncture in select cases to rule out conditions such as normal-pressure hydrocephalus
or central nervous system infection (eg, neurosyphilis, neuroborreliosis, cryptococcosis.
100 When testing for the APP and presenilin genes associated with early -onset autosomal
dominant AD should be performed?
I In persons with a family history of autosomal dominant dementia with one or more cases of
delay-onset AD
II In symptomatic patients with early-onset AD who have a family history of dementia or an
unknown family history
III In persons with a family history of autosomal dominant dementia with one or more cases of
early-onset AD
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
According to guidelines from the American College of Medical Genetics and the National Society of
Genetic Counselors, testing for the APP and presenilin genes associated with early-onset autosomal
dominant AD should be offered in the following situations[33] :
 In symptomatic patients with early-onset AD who have a family history of dementia or an
unknown family history (eg, because of adoption)
 In persons with a family history of autosomal dominant dementia with one or more cases of
early-onset AD

1 Which of the following statement is correct related to the treatment of Alzheimer disease
(AD)?
I Only symptomatic therapies for Alzheimer disease (AD) are available

II Alzheimer disease is completely curable
III Rivastigmine is calcium channel blocker
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
To date, only symptomatic therapies for Alzheimer disease (AD) are available.
2 Drugs approved by the US Food and Drug Administration (FDA) for the treatments of
AD modulate neurotrAns:mitters like-
I acetylcholine
II Norepinephrine
III glutamate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
All drugs approved by the US Food and Drug Administration (FDA) for the treatment of AD
modulate neurotrAns:mitters, either acetylcholine or glutamate.
3 Which different class of drug are used for the treatment of AD?
I calcium channel blocker

II cholinesterase inhibitors (ChEIs)
III partial N -methyl-D-aspartate (NMDA) antagonist
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The standard medical treatment for AD includes cholinesterase inhibitors (ChEIs) and a partial N -
methyl-D-aspartate (NMDA) antagonist.
4 Which out of the following classes of psychotropic medications have been used to treat
secondary symptoms of AD?
I Antidepressants
II Anxiolytics
III Anaesthetic
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The following classes of psychotropic medications have been used to treat these secondary symptoms:
 Antidepressants
 Anxiolytics
5 Which out of the following classes of psychotropic medications have been used to trea t
I Beta-blockers
II Antiparkinsonian agents
III Anaesthetic
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
 Antiparkinsonian agents
 Beta-blockers
I Anaesthetic
II Antiepileptic drugs
III Diuretics
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
 Antiepileptic drugs (for their effects on behaviour.
I Neuroleptics
II Diuretics
III Anaesthetic
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
 Neuroleptics
8 Current pharmacologic research in AD focuses principally on the development of -
I Diuretics
II disease-modifying drugs that can slow or reverse the progression of AD
III Anaesthetic
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Current pharmacologic research in AD focuses principally on the development of disease-modifying
drugs that can slow or reverse the progression of AD. Targets of these investigational agents have
included beta-amyloid production, aggregation, and clearance, as well as tau phosphorylation and
assembly.
9 Which out of the following is the targeted during the drug development programme for
the treatment of AD?
I beta-amyloid production
II beta-amyloid aggregation
III senile plaque formation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
assembly.
10 What is used to prevent or delay the deterioration of cognition in patients with AD

(treatment of mild to moderate disease)?
I Diuretics
II Cholinesterase inhibitors
III mental exercises
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Cholinesterase inhibitors (ChEIs) and mental exercises are used in an attempt to prevent or delay the
deterioration of cognition in patients with AD (treatment of mild to moderate disease).
11Which out of the following is the targeted during the drug development programme for
the treatment of AD?
I beta-amyloid clearance
II alfa-amyloid clearance
III alfa-amyloid aggregation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
assembly.
12 Which systems modulate information processing in the hippocampus and neocorte x in
human?
I Cholinergic
II Anti-cholinergic
III prolactin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Numerous lines of evidence suggest that cholinergic systems that modulate information processing in
the hippocampus and neocortex are impaired early in the course of AD.
13What is the function of cholinesterase inhibitor?
I promotes formation of acetylcholine

II promotes breakdown of acetylcholine
III prevent the breakdown of acetylcholine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Centrally acting ChEIs prevent the breakdown of acetylcholine.
14 Which agents have been approved by the FDA for the treatment of AD?
I Donepezil
II Furosemide
III valsartan
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Four such agents have been approved by the FDA for the treatment of AD, as follows:
 Donepezil (Aricept, Aricept ODT).
I telmisartan
II Rivastigmine
III amlodipine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
 Rivastigmine (Exelon, Exelon Patch) .
I Rivastigmine
II nicadipine
III Galantamine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
 Galantamine (Razadyne, Razadyne ER).
17 Why usefulness of cholinesterase inhibitor (ChEIs) was expected to be limited to the

early and intermediate stages of AD?
I because acetylcholine is not synthesized in end stage of disease

II because the cholinergic deficit becomes more severe later in disease
III because acetylcholine is synthesized more in end stage of disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Although the usefulness of ChEIs was originally expected to be limited to the early and intermediate
stages of AD (because the cholinergic deficit becomes more severe later in disease and because fewer
intact cholinergic synapses are present).
18 Why usefulness of cholinesterase inhibitor (ChEIs) was expected to be limited to the

early and intermediate stages of AD?
I because acetylcholine is not synthesized in end stage of disease

II because acetylcholine is synthesized more in end stage of disease
III because fewer intact cholinergic synapses are present
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Although the usefulness of ChEIs was originally expected to be limited to the early and intermediate
stages of AD (because the cholinergic deficit becomes more severe later in disease and because fewer
intact cholinergic synapses are present).
19 What is Lewy body variant of AD?
I AD and dementia with Lewy bodies occur in twins

II AD and dementia with Lewy bodies occur in heterozygous twins
III AD and dementia with Lewy bodies occur in the same patient
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Frequently, AD and dementia with Lewy bodies occur in the same patient; this is sometimes called
the Lewy body variant of AD.
20What is the common adverse effect of cholinesterase inhibitor (ChEIs)?
I diuresis
II nausea
III anuria
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The ChEIs share a common profile of adverse effects, the most frequent of which are nausea, vomiting,
diarrhea, and dizziness.
21 What is the common adverse effect of cholinesterase inhibitor (ChEIs)?
I vomiting
II diuresis
III diarrhea
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
22 What is the common adverse effect of cholinesterase inhibitor (ChEIs)?
I diuresis
II anuria
III dizziness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
23 What are the different ways to reduce gastrointestinal side effect of cholinesterase
inhibitor (ChEIs)?
I use oral drug delivery system

II use trAns:dermal patch for drug delivery
III use of oral extended release formulation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
In addition, gastrointestinal side effects may be reduced by using the trAns:dermal patch rather than
the oral form of the drug.
24What are the different ways to reduce gastrointestinal side effect of cholinesterase
inhibitor (ChEIs)?
I dose titration (slow up-titration to the desired maintenance dose)

II use of oral extended release formulation
III use oral drug delivery system
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
These are typically dose related and can be mitigated with slow up-titration to the desired
maintenance dose.
25 Which class of drug are used for the treatment of incontinence?
I duretics
II antidepressant
III antimuscarinic
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
As antimuscarinic drugs are used for the treatment of incontinence, logically, ChEIs might exacerbate
incontinence.
26 cholinesterase inhibitor (ChEIs) are contraindicated in patient with-
I Alzheimers disease
II symptomatic bradycardia
III memory loss
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
26 27 ChEIs prescribed to treat dementia can provoke symptomatic bradycardia and syncope and
precipitate fall-related injuries, including hip fracture.
27 cholinesterase inhibitor (ChEIs) are contraindicated in patient with-
I syncope
II memory loss
III Alzheimers disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
ChEIs prescribed to treat dementia can provoke symptomatic bradycardia and syncope and precipitate
fall-related injuries, including hip fracture.
28 Which class of drug is used to counteract the activity ofcholinesterase inhibitor

(ChEIs)?
I nootropic
II Antidepressant
III anticholinergic agents
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
It is not uncommon for patients to receive both ChEIs and anticholinergic agents, which counteract
each other.
29Which class of drug can cause cognitive dysfunction?
I tricyclic antidepressants
II diphenhydramine
III diuretic
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
29 30 31 32 Medications with anticholinergic effects, such as diphenhydramine, tricyclic
antidepressants (eg, amitriptyline, nortriptyline), and oxybutynin (commonly used for bladder
spasticity can cause cognitive dysfunction.
30 Which drug can be classified as tricyclic antidepressants?
I torsemide
II amitriptyline
III nortriptyline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Medications with anticholinergic effects, such as diphenhydramine, tricyclic antidepressants (eg,
amitriptyline, nortriptyline), and oxybutynin (commonly used for bladder spasticity can cause
cognitive dysfunction.
31 Which out of the following medications have anticholinergic effects?
I diphenhydramine
II valsartan
III oxybutynin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
32 Which out of the following drug is commonly used for bladder spasticity?
I valsartan
II oxybutynin
III methyldopa
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
33Which mentally challenging activities may reduce the risk in of AD?
I crossword puzzles
II clash of clan
III brainteasers
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Many experts believe that mentally challenging activities, such as doing crossword puzzles and
brainteasers, may reduce the risk in such patients
34 What is cognitive rehabilitation?
I various form of visual retraining

II various forms of cognitive retraining
III various form of hearing retraining
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Some investigators have attempted various forms of cognitive retraining, also known as cognitive
rehabilitation.
35 Which drug can be called as partial N -methyl-D-aspartate (NMDA) antagonist?
I tamoxifen
II valsartan
III memantine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The partial N -methyl-D-aspartate (NMDA) antagonist memantine (Namenda, Namenda XR)
is believed to work by improving the signal-to-noise ratio of glutamatergic transmission at the
NMDA receptor.
36 What is the pharmacological mechanisam of memantine?
I increased intracellular Ca accumulation through blockade of NMDA receptor

II increased intracellular Ca accumulation through blockade of Glycine receptor
III decreases intracellular Ca accumulation through blockade of NMDA receptor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Blockade of NMDA receptors by memantine is thought to slow the intracellular calcium
accumulation and thereby help prevent further nerve damage.
37 Which ion accumulation can cause nerve damage?
I intracellular calcium
II intracellular sodium
III extracellular calcium
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Blockade of NMDA receptors by memantine is thought to slow the intracellular calcium
accumulation and thereby help prevent further nerve damage.
38 Which drug can be safely used in combination with ChEIs?

I diclofenac
II memantine
III tamoxifen
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Several studies have demonstrated that memantine can be safely used in combination with
ChEIs.
39What are most common side effects of memantine?
I anuria
II Dizziness
III polyuria
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Dizziness, headache, and confusion are some of the most common side effects of memantine.
40 What are most common side effects of memantine?
I headache
II anuria
III confusion
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Dizziness, headache, and confusion are some of the most common side effects of memantine.
41In June 2013, which drug was approved for the treatment of severe AD?
I rivastigmine extended release

II tamoxifen trAns:dermal
III rivastigmine trAns:dermal
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
In June 2013, the FDA approved rivastigmine trAns:dermal for severe AD.
42Which interventions are often combined with the more widely used pharmacologic
interventions (cholinesterase inhibitors) for the treatment of AD?
I diuretics
II anxiolytics
III renin inhibitors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
These interventions are often combined with the more widely used pharmacologic
interventions, such as anxiolytics for anxiety and agitation, neuroleptics for delusions or
hallucinations, and antidepressants or mood stabilizers for mood disorders and specific
manifestations (eg, episodes of anger or rage).
43 Which interventions are often combined with the more widely used pharmacologic
I renin inhibitors
II diuretics
III neuroleptics
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
44 Which interventions are often combined with the more widely used pharmacologic
I ACE inhibitors
II renin inhibitors
III antidepressants
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
45 What is the role of anxiolytics in patient with AD?
I treatment of anxiety
II treatment of agitation
III treatment of diuresis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
46 What is the role of neuroleptics in patient with AD?
I treatment of hallucinations
II treatment of anuria
III treatment of delusions
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
47 What is the role of antidepressants in patient with AD?
I treatment of smoking
II treatment of episodes of anger
III treatment of episodes of rage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
48What is associated with the use of atypical neuroleptics in AD patient?
I increased risk of death

II increased risk of stroke
III increased risk of anuria
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
In 2005, the FDA added a black-box warning on the use of atypical neuroleptics in the treatment
of secondary symptoms of AD such as agitation.[101] Analyses suggested that patients on atypical
neuroleptics had increased risk of death or stroke.
49 What is maximum recommended dose of citalopram in AD patient?
I 10 mg a day
II 25 mg a day
III 40 mg a day
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Because citalopram can cause dose-dependent increases in the QT interval, the FDA
recommends using a maximum of 40 mg a day and considering 20 mg a day in the elderly.
50 What is maximum recommended dose of citalopram in elderly AD patient?
I 20 mg a day
II 30 mg a day
III 40 mg a day
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Because citalopram can cause dose-dependent increases in the QT interval, the FDA
recommends using a maximum of 40 mg a day and considering 20 mg a day in the elderly.
51 Which drug can be helpful for the treatment of disruptive behaviors and outbursts of
anger in AD patient?
I valsartan
II nimisulide
III valproic acid
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Other mood modulators, such as valproic acid, can be helpful for the treatment of disruptive
behaviors and outbursts of anger.
52 Which out of the following is an experimental therapy proposed for AD patient?
I diuretic therapy
II antiamyloid therapy
III alphaamyloid therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
A variety of experimental therapies have been proposed for AD. These include antiamyloid
therapy, reversal of excess tau phosphorylation, estrogen therapy, vitamin E therapy, and free-
radical scavenger therapy.
I reversal of excess tau phosphorylation

II free-radical scavenger therapy
III alphaamyloid therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
I vitamin E therapy
II diuretics
III estrogen therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
55 Which out of the following study is related to antiamyloid therapy?
I Administration of triclonalantiamyloid antibodies

II Administration of monoclonal antiamyloid antibodies
III Vaccination with amyloid species
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
In the past 10 years, numerous antiamyloid therapy studies have been conducted to decrease
toxic amyloid fragments in the brain, including studies of the following:
 Vaccination with amyloid species
 Administration of monoclonal antiamyloid antibodies
I Selective amyloid-lowering agents

II Administration of intravenous immune globulin that may contain amyloid-binding antibodies
III Administration of triclonalantiamyloid antibodies
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
 Administration of intravenous immune globulin that may contain amyloid-binding
antibodies
 Selective amyloid-lowering agents
I Chelating agents to prevent amyloid polymerization

II Administration of triclonalantiamyloid antibodies
III Brain shunting to improve removal of amyloid
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Chelating agents to prevent amyloid polymerization
 Brain shunting to improve removal of amyloid
I alpha-secretase inhibitors
II teta-secretase inhibitors
III Beta-secretase inhibitors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
 Beta-secretase inhibitors to prevent generation of the A-beta amyloid fragment
59What is a central player in AD pathogenesis?
I tau protein
II alpha-amyloid
III tau-lipoprotein
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Growing awareness that tau is a central player in AD pathogenesis has suggested that this protein
may offer an avenue for therapeutic intervention.
60 Which out of the following is prescription medical food used in AD?
I asvandhaga
II kumari
III caprylidene
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
caprylidene (Axona) is a prescription medical food that is metabolized into ketone bodies, and
the brain can use these ketone bodies for energy when its ability to process glucose is impaired.
61 What is alternative source of energy for brain when its ability to process glucose is
impaired?
I protein
II carbohydrate
III ketone bodies
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
62caprylidene is metabolized by human body into-
I carbohydrate
II ketone bodies
III lipoprotein
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
63Which out of the following dietary modification plays an important role in management
of AD?
I elimination of simple carbohydrates from the diet

II elimination of complex carbohydrate from diet
III decreased fruit consumption
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Although interventions were tailored to each patient, they all included elimination of simple
carbohydrates from the diet, increased consumption of fruit, vegetables, and non-farmed fish,
and adherence to a strict meal pattern with timed periods of fasting.
of AD?
I timed periods of fasting

II increased consumption of fruit
III elimination of complex carbohydrate from diet
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
of AD?
I elimination of complex carbohydrate from diet

II adherence to a strict meal pattern
III non-farmed fish
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
66Which out of the following lifestyle modification plays an important role in

management of AD?
I exercise program
II elimination of complex carbohydrate from diet
III use of melatonin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
All interventions also included an exercise program, counseling on stress reduction techniques,
and use of a variety of daily supplements, including vitamin D3, fish oil, coenzyme Q10,
melatonin, and methylcobalamin.
67Which out of the following lifestyle modification plays an important role in

management of AD?
I use of coenzyme Q10

II counseling on stress reduction techniques
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
68 Which out of the following lifestyle modification plays an important role in

management of AD?
I use of vitamin D6
II use of fish oil
III use of vitamin D3
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
69Which sentence is correct for patient with AD?
I activity of each patient should be individualized

II
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
and familiar.
70 Why too much activity is not recommended in patient with AD?
I due to risk of agitation

II due to risk of anuria
III due to risk of polyuria
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Too much activity can cause agitation, but too little can cause the patient to withdraw and
perhaps become depressed.
71 Why too little activity is not recommended in patient with AD?
I patient becomes excited

II patient becomes depressed
III patient hallucinate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Too much activity can cause agitation, but too little can cause the patient to withdraw and
perhaps become depressed.
72 What is the importance of healthy lifestyles in patient with AD?
I reduce risk of diabetes

II reduce risk of obesity
III reduce the risk of AD
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
There are no proven modalities for preventing AD. Evidence, largely epidemiologic, suggests
that healthy lifestyles can reduce the risk of AD. Physical activity, exercise, and cardiorespiratory
fitness may be protective.
73 Which out of the following plays an important role in management of AD?
I increased water intake

II Physical activity
III cardiorespiratory fitness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
There are no proven modalities for preventing AD.[3] Evidence, largely epidemiologic, suggests
74 Which out of the following plays an important role in management of AD?
I increased water intake

II decreased water intake
III exercise
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
There are no proven modalities for preventing AD.[3] Evidence, largely epidemiologic, suggests
75 What is the first line treatment in AD?
I calcium channel blockers

II cholinesterase inhibitors
III ACE inhibitors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The mainstay of therapy for patients with Alzheimer disease (AD) is the use of centrally acting
cholinesterase inhibitors to attempt to compensate for the depletion of acetylcholine (ACh) in
the cerebral cortex and hippocampus.
76 Which drug can be classified as Cholinesterase inhibitors (ChEIs)?
I nifidipine
II donepezil
III warfarin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Cholinesterase inhibitors (ChEIs) are used to palliate cholinergic deficiency. All 4 currently
approved ChEIs (ie, donepezil, rivastigmine, galantamine) inhibit acetylcholinesterase (AChE)
at the synapse.
77 Which drug can be classified as Cholinesterase inhibitors (ChEIs)?
I warfarin
II rivastigmine
III galantamine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Cholinesterase inhibitors (ChEIs) are used to palliate cholinergic deficiency. All 4 currently
approved ChEIs (ie, donepezil, rivastigmine, galantamine) inhibit acetylcholinesterase (AChE)
at the synapse.
78 What is the pharmacological mechanism of Rivastigmine?
I Calcium channel blocker

II butyrylcholinesterase inhibitor
III increased Na intake
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Rivastigmine also inhibits butyrylcholinesterase (BuChE).
79 What is the pharmacological mechanism of Galantamine?
I presynaptic nicotinic modulator

II postsynaptic nicotine modulation
III increase K intake
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Galantamine has a different second mechanism of action; it is also a presynaptic nicotinic
modulator.
80What is the role of acetylcholinesterase in human?
I Na level regulation
II metabolism of acetylcholine
III metabolism of pilocarpine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
It selectively inhibits acetylcholinesterase, the enzyme responsible for the destruction of
acetylcholine, and improves the availability of acetylcholine.
81 What is recommended dose of donepezil for mild to moderate AD?
I 1-3 mg; once daily

II 3-5 mg; once daily
III 5-10 mg; once daily
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Donepezil Dosing recommendations for mild to moderate AD are 5-10 mg given once daily.
82 What is recommended dose of donepezil for moderate to severe AD?
I 1 or 2 mg once daily
II 10 or 23 mg once daily
III 25 or 45 mg once daily
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Donepezil; Patients with moderate to severe AD can be given 10 or 23 mg once daily.
83What is the maximum recommended dose of Rivastigmine in AD?
I 6mg/day PO
II 12 mg/day PO
III 32 mg/day PO
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Rivastigmine; Initial dosing recommendations are 1.5 mg PO BID, with a maximum dose of
12 mg/day PO. Rivastigmine is a potent, selective inhibitor of brain AChE and BChE.
Rivastigmine is considered a pseudo-irreversible inhibitor of AChE.
84 Which drug is considered a pseudo-irreversible inhibitor of AChE?

I amlodipine
II valsartan
III Rivastigmine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Rivastigmine is considered a pseudo-irreversible inhibitor of AChE.
85 What is the dosing recommendation for the immediate-release formulation of

Galantamine?
I 4 mg twice daily
II 10mg twice daily
III 12 mg twice daily
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Galantamine; The dosing recommendation for the immediate-release formulation is 4 mg twice
daily. The extended-release formulation is given at a dose of 8 mg once daily.
86What is the dosing recommendation for the immediate-release formulation of

Galantamine?
I 50mg once daily

II 25 mg once daily
III 5 mg once daily
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Memantine; The initial dose for the immediate-release formulation is 5 mg once daily, and it
can be titrated to a maximum dose of 20 mg/day.
87 What is the recommended dose of Caprylidene in AD?
I 80g/day
II 60 g/day
III 40 g/day
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Caprylidene is indicated for clinical dietary management of metabolic processes associated with
mild to moderate AD. G@87 eneral dosing recommendations include administering 40 g/day
(1 packet of caprylidene powder, containing 20 g of medium-chain triglycerides) during
breakfast.
88 Which out of the following can be classified as Diagnostic Imaging Agent?
I Florbetapir F 18
II Florbetapir F 19
III Florbetapir F 20
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Diagnostic Imaging Agents; Florbetapir F 18, Flutemetamol F 18, Florbetaben F 18.
89 Which out of the following can be classified as Diagnostic Imaging Agent?
I Florbetaben F 16
II Florbetaben F 17
III Florbetaben F 18
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
90 Which out of the following can be classified as Diagnostic Imaging Agents?
I Flutemetamol F 17
II Flutemetamol F 18
III Flutemetamol F 19
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
91 Which out of the following is correct drug combination used in AD?
I memantine and donepezil

II memantine and rivastigmine
III memantine and simvastatin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Fixed dose combination capsule containing memantine extended-release and donepezil available
in 2 strengths (14mg/10mg and 28mg/10mg). Patients stabilized on memantine (10 mg BID
or 28 mg extended-release qDay) and donepezil 10 mg/day can be switched to Namzaric 28
mg/10 mg, taken once a day in the evening.
92 What is the recommended dose of combination containing memantine and donepezil

used in AD?
I 27 mg/9 mg
II 28 mg/10 mg
III 29mg/11mg
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Fixed dose combination capsule containing memantine extended-release and donepezil available
in 2 strengths (14mg/10mg and 28mg/10mg). Patients stabilized on memantine (10 mg BID
or 28 mg extended-release qDay) and donepezil 10 mg/day can be switched to Namzaric 28
mg/10 mg, taken once a day in the evening.
93 What is the pharmacological mechanism of Memantine?
I calcium channel blocker

II NMDA receptor antagonist
III diuretic
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Memantine is a NMDA receptor antagonist and donepezil is an acetylcholinesterase inhibitor.
94 What is the pharmacological mechanism of donepezil?
I glycine receptor agonist

II calcium channel blocker
III acetylcholinesterase inhibitor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Memantine is a NMDA receptor antagonist and donepezil is an acetylcholinesterase inhibitor.
95 What is the advantage of the use of combination products for the treatment of AD?
I ease of administration
II increased bioavailability
III enhance compliance
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Combination products may aid in ease of administration (decreased pill burden) and enhance
compliance.
96 Which radioactive diagnostic agent binds to beta-amyloid neuritic plaques?
I Flutemetamol F18
II Flutemetamol F19
III Flutemetamol F20
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Flutemetamol F18 is a radioactive diagnostic agent for use with PET brain imaging. It binds to
beta-amyloid neuritic plaques, and the F18 isotope produces a positron signal that is detected
by a PET scanner.
97 What is the initial recommended dose of the extended-release formulation of

Memantine?
I 5mg once daily

II 6mg once daily
III 7 mg once daily
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Memantine; The initial dose for the extended-release formulation is 7 mg once daily, and it can
be titrated to a maximum dose of 28 mg/day.
98 What is the maximum recommended dose of the extended-release formulation of

Memantine?
I 27mg/day
II 28 mg/day
III 30 mg/day
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Memantine The initial dose for the extended-release formulation is 7 mg once daily, and it can
be titrated to a maximum dose of 28 mg/day.
99 What is the maintenance dose of Galantamine in AD?
I 16-24 mg/day
II 17-25 mg/day
III 18-26 mg/day
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Galantamine@99 The maintenance dose after dose titration is 16-24 mg/day.
100 What is the drug delivery rate in trAns:dermal patch of Rivastigmine used in AD?
I 12.3mg/24 h
II 13.3 mg/24 h
III 14.3 mg/24 h
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Rivastigmine; The trAns:dermal patch 13.3 mg/24 h is approved for all stages of Alzheimer
disease, including severe. Dose titration is needed when initiating.
PARKINSON DISEASE
1 What is Parkinson disease?
I metabolic disorders
II neurologic disorders
III Psychological disorders
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Parkinson disease is recognized as one of the most common neurologic disorders.
2 Which of the followings are major neuropathologic findings in Parkinson disease?
I loss of non pigmented dopaminergic neurons

II loss of pigmented dopaminergic neurons
III presence of Lewy bodie
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
There are 2 major neuropathologic findings: the loss of pigmented dopaminergic neurons in the
substantia nigra pars compacta (SNpc) and the presence of Lewy bodie.
3 Which part of brain shows loss of dopaminergic neurons in Brain?
I substantia nigrum pars compacta (SNpc)

II substantia nigra pars compacta (SNpc)
III substantia nigra pars completion (SNpc)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
There are 2 major neuropathologic findings: the loss of pigmented dopaminergic neurons in the
substantia nigra pars compacta (SNpc) and the presence of Lewy bodie.
4 Parkinson disease is predominantly a disorder of the-
I basal ganglia
II trAns:verse ganglia
III lateral ganglia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Parkinson disease is predominantly a disorder of the basal ganglia, which are a group of nuclei
situated at the base of the forebrain.
5 What is true for direct pathway that exists within the basal ganglia circuit?
I outflow from the striatum directly inhibits the GPi and SNr
II striatal neurons containing D1 receptors constitute the direct pathway
III project to the GPe
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Two pathways exist within the basal ganglia circuit, the direct and indirect pathways, as follows:
 In the direct pathway, outflow from the striatum directly inhibits the GPi and SNr;
striatal neurons containing D1 receptors constitute the direct pathway and project to
the GPi/SNr.
6 What is true for indirect pathway that exists within the basal ganglia circuit?
I inhibitory connections between the striatum and the globus pallidus (GPe)
II striatal neurons with D2 receptors are part of the indirect pathway
III project to the GPi/SNr
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Two pathways exist within the basal ganglia circuit, the direct and indirect pathways, as follows:
 The indirect pathway contains inhibitory connections between the striatum and the
external segment of the globus pallidus (GPe) and between the GPe and the subthalamic
nucleus (STN); striatal neurons with D2 receptors are part of the indirect pathway and
project to the GPe.
7 Which of the followings are environmental risk factors of Parkinson's disease?
I use of pesticides
II living near river
III living in a rural environment
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Environmental risk factors commonly associated with the development of Parkinson disease
include use of pesticides, living in a rural environment, consumption of well water, exposure to
herbicides, and proximity to industrial plants or quarries.
I exposers to pollution
II consumption of well water
III exposure to herbicides
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
herbicides, and proximity to industrial plants or quarries
I second hand smoking

II proximity to industrial plants or quarries
III alcohol consumption
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
herbicides, and proximity to industrial plants or quarries.
10 Which enzyme is responsible for oxidation of MPTP into 1-methyl-4-
phenylpyridinium (MPP+)?
I monoamine oxidase (MAO)-A

II monoamine oxidase (MAO)-B
III monoamide oxidase (MAO)-B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
MPTP crosses the blood-brain barrier and is oxidized to 1-methyl-4-phenylpyridinium (MPP+)
by monoamine oxidase (MAO)-B.
11 Which of the following loci gene mutation is responsible for Parkinson's Disease?
I ADP
II SNCA
III LRRK2
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
A total of 18 loci in various genes have now been proposed for Parkinson disease. Mutations
within 6 of these loci (SNCA, LRRK2, PRKN, DJ1, PINK1, and ATP 13A2) are well-validated
causes of familial parkinsonism.
12 Which of the following loci gene mutation is responsible for Parkinson's Disease?
I 13A1
II PRKN
III DJ1
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
A total of 18 loci in various genes have now been proposed for Parkinson disease. Mutations
within 6 of these loci (SNCA, LRRK2, PRKN, DJ1, PINK1, and ATP 13A2) are well-validated
causes of familial parkinsonism.
13 Which of the following are risk factors of Parkinson's disease?
I polymorphisms within MAPT and GBA

II polymorphisms within SNCA and LRRK2
III variations in MAPT and GBA
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
In addition, polymorphisms within SNCA and LRRK2, as well as variations in MAPT and GBA,
are risk factors for Parkinson disease
14 What is the major component of Lewy bodies and Lewy neurites?
I Abnormally aggregated alpha-synuclein

II normally aggregated alpha-synuclein
III Abnormally aggregated beta-synuclein
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Abnormally aggregated alpha-synuclein is the major component of Lewy bodies and Lewy
neuritis.
15 What plays a central role in the pathogenesis of Parkinson disease?
I Refunction of alpha-synuclein
II Dysfunction of beta-synuclein
III Dysfunction of alpha-synuclein
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Dysfunction of alpha-synuclein appears to play a central role in the pathogenesis of Parkinson
disease.
16 Which of the followings are nonmotor symptoms in patients with early P arkinson
disease ?
I Excessive saliva
II Forgetfulness
III Excessive perspiration
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The most commonly experienced nonmotor symptoms in patients with early Parkinson disease
in this study included the following:
 Excessive saliva
 Forgetfulness
17Which of the followings are nonmotor symptoms in patients with early Parkinson disease
?
I Hyperosmia
II Urinary urgency
III Hyposmia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Urinary urgency
 Hyposmia
18Which of the followings are nonmotor symptoms in patients with early Parkinson
disease ?
I Vomiting
II Diarrhoea
III Constipation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
 Constipation
19Which of the followings are initial clinical symptoms of Parkinson's disease?
I Tremor
II subtle decrease in dexterity
III subtle increase in dexterity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Initial clinical symptoms in Parkinson disease include the following:
 Tremor
 A subtle decrease in dexterity; for example, a lack of coordination with activities such as
playing golf or dressing (about 20% of patients first experience clumsiness in one hand)
I Increased arm swing on the first-involved side

II Decreased arm swing on the first-involved side
III Soft voice
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Decreased arm swing on the first-involved side
 Soft voice
I Increased facial expression

II Decreased facial expression
III Sleep disturbances
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Decreased facial expression
 Sleep disturbances
I Decreased sense of smell

II REM behaviour disorder
III Increased sense of smell
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
 RBD, in which there is a loss of normal atonia during REM sleep: In one study, 38%
of 50-year-old men with RBD and no neurologic signs went on to develop parkinsonism
[22]
 Decreased sense of smell
23 Which of the followings are initial clinical symptoms of Parkinson's disease?
I Symptoms of autonomic dysfunction

II general feeling of weakness, malaise, or lassitude
III Symptoms of autonomic function
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
 Symptoms of autonomic dysfunction, including constipation, sweating abnormalities,
sexual dysfunction, and seborrheic dermatitis
 A general feeling of weakness, malaise, or lassitude
24 Which of the followings are initial clinical symptoms of Parkinson's disease?
I Depression or anhedonia
II Faster thinking process
III Slowness in thinking
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Depression or anhedonia
 Slowness in thinking
25 Which of the followings are Symptoms of autonomic dysfunction in Parkinson's

disease?
I constipation
II seborrheic dermatitis
III diarrhoea
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
 constipation
26 Which of the followings are common early motor signs of Parkinson disease?
I bradykinesia
II tremor
III tachykinesia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Common early motor signs of Parkinson disease include tremor, bradykinesia, rigidity, and
dystonia.
27 Which of the followings are common early motor signs of Parkinson disease?
I alstonia
II rigidity
III dystonia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Common early motor signs of Parkinson disease include tremor, bradykinesia, rigidity, and
dystonia.
28 Which factors can precipitate Tremors in Parkinson disease?
I stress
II fear
III anxiety
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Tremor can vary considerably, emerging only with stress, anxiety, or fatigue. Classically, the
tremor of Parkinson disease is a resting tremor (occurring with the limb in a resting position)
and disappears with action or use of the limb, but this is not seen in all patients
29 What is mean by resting tremor in Parkinson disease?
I occurring with the limb in moving position

II occurring with the limb in a resting position
III occurring with the joint in a resting position
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Tremor can vary considerably, emerging only with stress, anxiety, or fatigue. The tremor of
Parkinson disease is a resting tremor (occurring with the limb in a resting position) and
disappears with action or use of the limb, but this is not seen in all patients.
30 Which of the following is true related to tremor in Parkinson disease?
I It is resting tremor
II appears with action or use of the limb
III disappears with action or use of the limb
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
The tremor of Parkinson disease is a resting tremor (occurring with the limb in a resting
position) and disappears with action or use of the limb, but this is not seen in all patients.
31 What is mean by the term Bradykinesia?
I slowness of metabolic movement

II slowness of movement
III slowness of stimuli transfer movement
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Bradykinesia refers to slowness of movement. Symptoms of bradykinesia are varied and can be
described by patients in different ways. These may include a subjective sense of weakness,
without true weakness on physical examination; loss of dexterity, sometimes described by
patients as the "message not getting to the limb"; fatigability; or achiness when performing
repeated actions.
32 Which of the followings are symptoms of Bradykinesia?
I Fatiguability
II achiness
III fatigability
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
These may include a subjective sense of weakness, without true weakness on physical
examination; loss of dexterity, sometimes described by patients as the "message not getting to
the limb"; fatigability; or achiness when performing repeated actions.
33 What is true from following for loss of dexterity?
I "message getting to the limb"

II "message not getting to the limb"
III "message not getting to the brain"
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
These may include a subjective sense of weakness, without true weakness on physical
examination; loss of dexterity, sometimes described by patients as the "message not getting to
the limb"; fatigability; or achiness when performing repeated actions.
34 Which of the followings are the characteristics of facial bradykinesia?
I increased blink rate and facial expression

II decreased blink rate and facial expression
III Speech become softer and less distinct
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Facial bradykinesia is characterized by decreased blink rate and facial expression. Speech may
become softer, less distinct, or more monotonal.
35 What are the symptoms of Truncal bradykinesia?
I slowness or difficulty in rising from a chair

II turning in bed
III decreased blink rate and facial expression
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Truncal bradykinesia results in slowness or difficulty in rising from a chair, turning in bed, or
walking.
36 What is micrographia?
I effortful eating
II effortful handwriting
III effortful talking
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
In the upper extremities, bradykinesia can cause small, effortful handwriting (ie, micrographia).
37 What are the characteristics of Dystonia in Parkinson disease?
I plantar inflexion
II inversion
III plantar flexion
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Dystonia in Parkinson disease commonly consists of a foot involuntary turning in (inversion) or

down (plantar flexion), often associated with cramping or aching in the leg. Dorsiflexion of the
big toe may also occur. Another common dystonia in Parkinson disease is adduction of the arm
and elbow, causing the hand to rest in front of the abdomen or chest.
38 Which of the following statement is true for Parkinson disease?
I adduction of the arm and elbow

II causing the hand to rest in front of the abdomen or chest
III causing the hand to rest in front of the heart
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Another common dystonia in Parkinson's disease is adduction of the arm and elbow, causing
the hand to rest in front of the abdomen or chest
39 How many types of cardinal signs are there in Parkinson disease?
I3
II 4
III 5
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
There are 4 cardinal signs of Parkinson disease
40 Which of the followings is cardinal sign of Parkinson disease?
I Resting tremor
II Rigidity
III Kinetic Tremor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D

● Resting tremor
● Rigidity
41 Which of the followings is cardinal sign of Parkinson disease?
I Postural stability
II Bradykinesia
III Postural instability
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
● Bradykinesia
● Postural instability
42 What can be observed during the finger-to-nose test?
I kinetic tremor (tremor with voluntary movement)

II resting tremor (tremor with voluntary movement)
III kinetic tremor (tremor with involuntary movement)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Kinetic tremor (tremor with voluntary movement) can be observed during the finger-to-nose
test.
43 Which is the characteristic of tremors in Parkinson disease?
I rigid tremor
II kinetic tremor
III resting tremor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Although a resting tremor is the tremor characteristic of Parkinson disease, many Parkinson
disease patients also have some postural and/or kinetic tremor.
44 What is micrographia?
I large handwriting
II small handwriting
III medium handwriting
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Micrographia (small handwriting).
45 What is mean by hypomimia?
I increased facial expression

II decreased facial expression
III decreased facial extension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Hypomimia (decreased facial expression), decreased blink rate.
46 W
I hyperphonia
II hypophonia
III hypophonia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Hypophonia (soft speech).
47 What play a key role in the assessment of the vibratory characteristics of the vocal folds?
I Rigid stboroscopy
II Rigid stroboscopy
III Soft stroboscopy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Rigid stroboscopy plays a key role in the assessment of the vibratory characteristics of the vocal
folds, including the presence of masses, lesions, or scar and glottic configuration abnormalities,
including an elliptical closure pattern, phase asymmetry, and abnormal phase closure.
48 Which of the followings is a glottic configuration abnormality in vibratory
characteristics of the vocal fold?
I phase symmetry
II phase asymmetry
III elliptical closure pattern
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Rigid stroboscopy plays a key role in the assessment of the vibratory characteristics of the vocal
folds, including the presence of masses, lesions, or scar and glottic configuration abnormalities,
including an elliptical closure pattern, phase asymmetry, and abnormal phase closure.
49 Which condition often becomes a concern during late stage of Parkinson disease?
I orthostatic pressure
II Orthostatic hypotension
III Orthostatic hypertension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Orthostatic hypotension often becomes a concern in late disease, and impaired intestinal
motility can lead to constipation and, sometimes, vomiting or impaired absorption.
I bladder retention
II Urinary retention
III bladder infection
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Urinary symptoms, retention, and bladder infection can occur, and erectile dysfunction is not
uncommon.
51 Which urinary symptoms a
I Urinary symptoms
II erectile dysfunction
III Stomach upset
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Urinary symptoms, retention, and bladder infection can occur, and erectile dysfunction is not
uncommon.
52 What is a Parkinson-plus syndrome?
I Atypical diabetes
II Typical Parkinsonism
III Atypical
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Atypical parkinsonism, or Parkinson-plus syndromes.
53 Which prominent autonomic dysfunction suggest multiple system atrophy (MSA)

rather than Parkinson disease?
I profound orthostatic hypertension

II frank urinary incontinence
III profound orthostatic hypotension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Prominent autonomic dysfunction, especially frank urinary incontinence or profound
orthostatic hypotension, may suggest multiple system atrophy (MSA) rather than Parkinson
disease.
54 Which prominent autonomic dysfunction suggest multiple system atrophy (MSA)

rather than Parkinson disease?
I flexed posture
II Sway back posture
III Flat back posture
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The flexed posture of patients with Parkinson disease can lead to kyphosis, cause a reduction in
pulmonary capacity, and produce a restrictive lung disease pattern.
55 What causes a reduction in pulmonary capacity, and produce a restrictive lung disease
pattern?
I kyphosis
II kyphoses
III Lordosis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The flexed posture of patients with Parkinson disease can lead to kyphosis, cause a reduction in
pulmonary capacity, and produce a restrictive lung disease pattern.
56 Parkinson's disease patients should be screened regularly for-
I dementia
II depression
III psychosis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
These patients should be screened regularly for depression.
57 Which symptoms of Parkinson's disease overlapped depression?
I masklike facies
II insomnia
III anxiety
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
However, assessment of depression in patients with Parkinson disease is complicated by the fact that
some symptoms of Parkinson disease overlap with those of depression (eg, masklike facies, insomnia,
psychomotor slowing, difficulty concentrating, fatigue
58 Which symptoms of Parkinson's disease overlapped depression?
I psychomotor slowing
II difficulty in walking
III difficulty concentrating
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
psychomotor slowing, difficulty concentrating, fatigue). @60 Guilt and self-reproach are less
prominent in depression in patients with Parkinson disease, whereas anxiety and pessimism are more
prominent.
59 Which of the following sentence is true related to neurodegenerative diseases?
I Some symptoms of depression overlap with those of Parkinson disease

II Some symptoms of Parkinson disease overlap with those of depression
III Some symptoms of Parkinson disease overlap with those of dementia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
psychomotor slowing, difficulty concentrating, fatigue).
60 Which symptoms are less prominent in depression in patients with Parkinson disease ?
I pessimism
II Guilt
III self-reproach
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Guilt and self-reproach are less prominent in depression in patients with Parkinson disease, whereas
anxiety and pessimism are more prominent.
61 Which of the following is most common comorbidities associated with Parkinson's

Disease?
I dementia
II Alzheimer disease
III cerebrovascular disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
In the affected age group, comorbidity with other neurodegenerative disorders, particularly Alzheimer
disease and cerebrovascular disease, is common.
62 Which of the following functions are impaired in patients with Parkinson disease
dementia?
II short-term memory
III learning
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Executive function, short-term memory, and visuospatial ability may be impaired in patients with
Parkinson disease dementia, but aphasia is not present.
63 Which of the following functions are impaired in patients with Parkinson disease
dementia?
I visuospatial inability
II visuospatial ability
III audiopatial ability
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Executive function, short-term memory, and visuospatial ability may be impaired in patients with
Parkinson disease dementia, but aphasia is not present.
64 Which of the following sentence is true for diagnosis of Parkinson disease?
I Parkinson disease is a nonclinical diagnosis

II Parkinson disease is a clinical diagnosis
III Biomarkers are available
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Parkinson disease is a clinical diagnosis.
65 Which of the following testing reveal hyposmia?
I subarachnoid testing
II Cranial testing
III Olfactory testing
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Olfactory testing can reveal hyposmia.
66 Why MRI evaluation is necessary in patients who do not have tremor?
I to exclude blood clot

II to exclude stroke
III to exclude tumor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Patients who do not have tremor should generally be considered for MRI evaluation to exclude brain
lesions such as stroke, tumor, or demyelination.
67 Why MRI evaluation is necessary in patients who do not have tremor?
I to exclude demyelination
II to exclude myelination
III to exclude demyelination
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Patients who do not have tremor should generally be considered for MRI evaluation to exclude brain
lesions such as stroke, tumor, or demyelination.
68 Which diagnostic test is used for the diagnosis of Parkinson's d isease?
I lumbar puncture
II lumbar snap
III CSF collection
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
In patients with an unusual presentation, diagnostic testing may be indicated to exclude other
disorders in the differential diagnosis. Such tests may include serum ceruloplasmin, sphincter
electromyography, or lumbar puncture.
69 Which diagnostic test is used for the diagnosis of Parkinson's disease?
I Plasma ceruloplasmin
II serum ceruloplasmin
III sphincter electromyography
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
In patients with an unusual presentation, diagnostic testing may be indicated to exclude other
disorders in the differential diagnosis. Such tests may include serum ceruloplasmin, sphincter
electromyography, or lumbar puncture.
70 What is obtained as a screening test in Wilson disease patients younger than 40 years?
I Serum plasmin concentration

II Serum ceruloplasmin concentration
III Plasma ceruloplasmin concentration
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Serum ceruloplasmin concentration is obtained as a screening test for Wilson disease in patients
younger than 40 years who present with parkinsonian signs. If the ceruloplasmin level is low,
measurement of 24-hour urinary copper excretion and slit-lamp examination for Kayser-Fleischer
rings must be performed.
71 Which test is performed in Parkinson patient with low ceruloplasmin level?
I Asser-Fleischer rings
II Kayser-Fleischer rings
III Kayser-Fischer rings
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
72 Which test is performed in Parkinson patient with low ceruloplasmin level?
I 24 -hour blood copper excretion

II 24 -hour urinary copper excretion
III slit-lamp examination
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
73 Olfactory testing may help differentiate Parkinson disease from-
I Cortico-basal-ganglionic degeneration(CBD)
II Progressive super nuclear palsy(PSP)
III Progressive supranuclear palsy(PSP)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Olfactory testing may help differentiate Parkinson disease from PSP and CBD, but olfaction is also
reduced in MSA.
74 Which of the followings can be classified as radiological studies?
I Electron emission tomography

II Magnetic resonance imaging
III Positron emission tomography (PET)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Radiologic Studies; Magnetic resonance imaging, Positron emission tomography (PET) and single-
photon emission computed tomography (SPECT) scanning.
75 Which of the followings can be classified as radiological studies?
I double-photon emission computed tomography (SPECT) scanning

II single-photon emission computed tomography (SPECT) scanning
III single-photon emption computed tomography (SPECT) scanning
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Radiologic Studies; Magnetic resonance imaging, Positron emission tomography (PET) and single-
photon emission computed tomography (SPECT) scanning.
76 What is the usefulness of MRI?
I to detect hydrocephalus
II to detect multi-infarct state
III to detect hypophalus
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Magnetic resonance imaging (MRI) is useful to exclude strokes, tumors, multi-infarct state,
hydrocephalus, and the lesions of Wilson disease.
I to detect hypophalus
II to detect strokes
III to detect tumors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
I to detect lesions of Wilson disease

II to detect hypophalus
III to detect hypnophalus
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
79 Which of the following patient is the candidate of MRI during diagnosis of PD?
I patient older than 55 years

II patient having an acute or stepwise progression
III patient younger than 55 years
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
MRI should be obtained in patients whose clinical presentation does not allow a high degree of
diagnostic certainty, including those who lack tremor, have an acute or stepwise progression, or are
younger than 55 years.
80 Which of the following patient is the candidate of MRI during diagnosis of PD?
I patient older than 55 years

II patient whose clinical presentation does not allow a high degree of diagnostic certainty
III patient whose clinical presentation allow a high degree of diagnostic certainty
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
MRI should be obtained in patients whose clinical presentation does not allow a high degree of
diagnostic certainty, including those who lack tremor, have an acute or stepwise progression, or are
younger than 55 years.
81 What is the classical pathologic finding in Parkinson disease?
I regeneration of locus ceruleus

II degeneration of the neurons containing neuromelanin
III regeneration of the neurons containing neuromelanin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Classic pathologic findings in Parkinson disease include degeneration of the neurons containing
neuromelanin, especially in the substantia nigra and the locus ceruleus.
82 What is the classical pathologic finding in Parkinson disease?
I degeneration of locus ceruleus

II regeneration of locus ceruleus
III generation of locus ceruleus
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Classic pathologic findings in Parkinson disease include degeneration of the neurons containing
neuromelanin, especially in the substantia nigra and the locus ceruleus.
83 What is the outcome of degeneration of dopamine-producing cells in the substantia

nigra?
I loss of striatal dopamine

II regeneration of locus ceruleus
III generation of locus ceruleus
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The primary biochemical defects are loss of striatal dopamine, which results from degeneration of
dopamine-producing cells in the substantia nigra, as well as hyperactivity of the cholinergic neurons
in the caudate nucleus.
84 What is the outcome of hyperactivity of the cholinergic neurons in the caudate nucleus?
I generation of locus ceruleus

II loss of striatal dopamine
III regeneration of locus ceruleus
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The primary biochemical defects are loss of striatal dopamine, which results from degeneration of
dopamine-producing cells in the substantia nigra, as well as hyperactivity of the cholinergic neurons
in the caudate nucleus.
85 What is the characteristic of Lewy body?
I cytoplasmic inclusions with peripheral halos

II less cores
III dense cores
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Lewy bodies are concentric, eosinophilic, cytoplasmic inclusions with peripheral halos and dense cores.
86 What is the characteristic of Lewy body?
I concentric
II eosinophilic
III less cores
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Lewy bodies are concentric, eosinophilic, cytoplasmic inclusions with peripheral halos and dense cores.
87 Which part of brain shows Lewy bodies in Parkinson disease?
I locus ceruleus
II intermediolateral column of the spinal cord
III ventricles
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Lewy bodies are also found in the cortex, nucleus basalis, locus ceruleus, intermediolateral column of
the spinal cord, and other areas.
I ventricles
II nucleus basalis
III locus ceruleus
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
I locus ceruleus
II ventricles
III cortex
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
90 Lumbar puncture should be considered if-
I signs of normal-pressure hydrocephalus (NPH) are observed

II signs of abnormal-pressure hydrocephalus (NPH) are observed
III signs of normal-pressure hypophalus (NPH) are observed
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Lumbar puncture should be considered if signs of normal-pressure hydrocephalus (NPH) are observed
(eg, incontinence, ataxia, dementia).
91 Which of the following are the signs of normal-pressure hydrocephalus?
I constipation
II ataxia
III incontinence
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
92 Which of the following are the signs of normal-pressure hydrocephalus?
I constipation
II amentia
III dementia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
93 Which test should be considered in patients with juvenile-onset dystonia and

parkinsonism?
I Dopa-responsive tonia
II Dopa-responsive dystonia
III Dopa-responsive dysphoria
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Dopa-responsive dystonia should be considered in patients with juvenile-onset dystonia and
parkinsonism. Additional tests for this condition include measurement of CSF concentrations of
biopterin, neopterin, and the neurotrAns:mitter metabolites homovanillic acid (HVA), 5-
hydroxyindoleacetic acid (5-HIAA), and 3-methoxy-4-hydroxyphenylglycol (MHPG).

parkinsonism?
I measurement of CSF concentrations of biopterin

II measurement of 5-hydroxyindoleacetic acid
III measurement of 6-hydroxyindoleacetic acid
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D

parkinsonism?
I measurement of 3-methoxy-4-hydroxyphenylglycol
II measurement of 6-hydroxyindoleacetic acid
III measurement of CSF concentrations of neopterin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F

parkinsonism?
I measurement of 6-hydroxyindoleacetic acid

II measurement of homovanillic acid (HVA
III measurement of 7-hydroxyindoleacetic acid
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
97 Clinical diagnosis requires the presence of-
I 2 of 3 cardinal signs
II 4 of 5 cardinal signs
III 5 of 6 cardinal signs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Clinical diagnosis requires the presence of 2 of 3 cardinal signs:
98 What is the goal of medical management of Parkinson disease?
I provide good control of motor signs of Parkinson disease for 10 years

II provide good control of motor signs of Parkinson disease for 15 years
III provide control of signs and symptoms with minimum adverse effects
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The goal of medical management of Parkinson disease is to provide control of signs and symptoms for
as long as possible while minimizing adverse effects.
99 What is true related to the Symptomatic drug therapy of Parkinson disease?
I provide good control of motor signs of Parkinson disease for 4-6 years
II provide good control of motor signs of Parkinson disease for 10 years
III provide good control of motor signs of Parkinson disease for 15 years
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Symptomatic drug therapy
 Usually provides good control of motor signs of Parkinson disease for 4-6 years
 Levodopa/carbidopa: The gold standard of symptomatic treatment
100 What is true related to the Symptomatic drug therapy of Parkinson disease?
I Levodopa/tolcapone is the gold standard of symptomatic treatment

II Levodopa/carbidopa is the gold standard of symptomatic treatment
III Levodopa/amlodipine is the gold standard of symptomatic treatment
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Symptomatic drug therapy

 Usually provides good control of motor signs of Parkinson disease for 4-6 years
 Levodopa/carbidopa: The gold standard of symptomatic treatment

1 What should be the goal of medical management of Parkinson disease?
I provide control of signs and symptoms with maximum adverse effects of drug
II provide control of signs and symptoms with minimum adverse effects of drug
III provide control of Parkinson with maximum adverse effects of drug
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The goal of medical management of Parkinson disease is to provide control of signs and symptoms for
as long as possible while minimizing adverse effects.
2 Pharmacologic treatment of Parkinson disease can be divided into-
I symptomatic therapy
II Ameliorative therapy
III Neuroprotective therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Pharmacologic treatment of Parkinson disease can be divided into symptomatic and neuroprotective
(disease modifying) therapy.
3 What remains the gold standard of symptomatic treatment for Parkinson disease?
I Levodopa/selegiline
II Levodopa/ carbidopa
III Levodopa/tolcapone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Levodopa, coupled with carbidopa, a peripheral decarboxylase inhibitor (PDI), remains the gold
standard of symptomatic treatment for Parkinson disease.
I provide greatest antiparkinsonian benefit

II fewest adverse effects in the short term
III more adverse effects in the short term
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Levodopa provides the greatest antiparkinsonian benefit for motor signs and symptoms, with the fewest
adverse effects in the short term; however, its long-term use is associated with the development of motor
-
I tremor
II cognitive/psychiatric
III sensory
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Nonmotor symptoms can be categorized as autonomic, cognitive/psychiatric, and sensory.
6 What of the following are the Nonmotor symptoms
I tremor
II autonomic
III rigidity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Nonmotor symptoms can be categorized as autonomic, cognitive/psychiatric, and sensory.
7 Which drug is used for the treatment of erectile dysfunction?
I terbinafine
II levodopa
III Sildenafil
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
In 2010, the AAN released guidelines on the treatment of nonmotor symptoms of Parkinson disease.
Recommendations included the following:
 Sildenafil citrate (Viagra) may be considered to treat erectile dysfunction
treat constipation?
I metronidazole
II loperamide
III Polyethylene glycol
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
 Polyethylene glycol may be considered to treat constipation
considered for patients who subjectively experience excessive daytime somnolence?
I loperamide
II Modafinil
III metronidazole
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
 Modafinil should be considered for patients who subjectively experience excessive daytime
somnolence
considered to treat periodic limb movements of sleep in Parkinson disease?
I Levodopa/carbidopa
II Levodopa/tolcapone
III Levodopa/selegiline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
 Levodopa/carbidopa should be considered to treat periodic limb movements of sleep in

Parkinson disease, but there are insufficient data to support or refute the use of non ergot
dopamine agonists to treat this condition or that of restless-legs syndrome
11 Which of the following drug has the potential for addiction?
I Aspirin
II Methylphenidate
III Dicyclomine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
 Methylphenidate may be considered for fatigue (note: methylphenidate has the potential for
abuse and addiction)
may be
considered for fatigue?
I Dicyclomine
II furosemide
III Methylphenidate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
abuse and addiction)
13 Which of the following drug has the potential for abuse?
I Methylphenidate
II domperidone
III rabeprazole
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
abuse and addiction).
14 Which medications are commonly used for symptomatic benefit of motor symptoms in
early Parkinson disease?
I levodopa
II levosulpride
III monoamine oxidase (MAO)-B inhibitors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Medications commonly used for symptomatic benefit of motor symptoms in early Parkinson disease
include levodopa, monoamine oxidase (MAO)-B inhibitors, and dopamine agonists.
15 Which medications are commonly used for symptomatic benefit of motor symptoms in
early Parkinson disease?
I phosphodiesterase inhibitors
II dopamine agonists
III calcium channel blocker
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Medications commonly used for symptomatic benefit of motor symptoms in early Parkinson disease
include levodopa, monoamine oxidase (MAO)-B inhibitors, and dopamine agonists.
16 Which are commonly used dopamine agonists?
I atenolol
II pramipexole
III ropinirole
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Commonly used dopamine agonists include pramipexole and ropinirole.
17 Which of the following is one of the most commonly used anticholinergic?
I trihexyphenidyl
II cabergoline
III sumatriptan
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
One of the most commonly used anticholinergic is trihexyphenidyl.
I "go" time
II "on" time
III "gone" time
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The time when medication is providing benefit for bradykinesia, rigidity, and tremor is called "on"
time, and the time when medication is not providing benefit is called "off" time.
I "go" time
II "gone" time
III "on" time
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
medication is not providing benefit for bradykinesia,
I "go" time
II "gone" time
III "off" time
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
21 Which strategies can be used to provide more sustained dopaminergic therapy?
I Adding furosemide
II Adding a dopamine agonist
III Adding a catechol- O -methyltrAns:ferase (COMT) inhibitor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Several different strategies, either alone or in combination, can be used to provide more sustained
dopaminergic therapy. Possible strategies include the following:
 Adding a dopamine agonist, catechol- O -methyltrAns:ferase (COMT) inhibitor, or

monoamine oxidase (MAO)-B inhibitor
I Adding furosemide
II Dosing levodopa more frequently
III Adding torsemide
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
 Dosing levodopa more frequently
I Adding furosemide
II Adding torsemide
III Increasing the levodopa dose
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
 Increasing the levodopa dose
I Switching from immediate-release (IR) to sustained-release levodopa/carbidopa

II Switching from immediate-release (IR) to substance-release levodopa/carbidopa
III Switching from immediate-release (IR) to suitable-release levodopa/carbidopa
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
 Switching from immediate-release (IR) to sustained-release (CR) levodopa/carbidopa or
levodopa/carbidopa/entacapone
 Continuous intra jejunal infusion of a carbidopa/levodopa enteral suspension
25 What is choreiform movement?
I twisting/turning movements that occur when levodopa-derived dopamine levels are peaking
II circus movement that occur when levodopa-derived dopamine levels are peaking
III tingling movements that occur when levodopa-derived dopamine levels are peaking
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
choreiform, which is twisting/turning movements that occur when levodopa-derived dopamine levels
are peaking.
26 Which is the only available drug that can reduce dyskinesis?
I amantadine
II liraglutide
III orlistat
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Importantly, the one available drug that can reduce dyskinesis is amantadine.
27 What is the side effect of Amantadine?
I diarrhoea
II hallucinations
III tumor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The principal side effects of amantadine are hallucinations and confusion, so the drug is usually not
appropriate for patients with pre-existing cognitive dysfunction.
I tumor
II diarrhoea
III confusion
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The principal side effects of amantadine are hallucinations and confusion, so the drug is usually not
appropriate for patients with pre-existing cognitive dysfunction.
29 What is true related to the Neuroprotective therapies?
I slow underlying loss of neurons

II increase underlying loss of neurons
III promotes underlying loss of neurons
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Neuroprotective therapies are defined as those that slow underlying loss of neurons
30 What has become the surgical procedure of choice for Parkinson disease?
I Deep spinal stimulation

II Deep heart stimulation
III Deep brain stimulation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Deep brain stimulation (DBS) has become the surgical procedure of choice for Parkinson disease for
the following reasons.
31 Why Deep brain stimulation has become the surgical procedure of choice for Parkinson
disease?
I It is irreversible
II It does not involve destruction of brain tissue
III It is reversible
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
the following reasons:
 It does not involve destruction of brain tissue
 It is reversible
32 Why Deep brain stimulation has become the surgical procedure of choice for Parkinson
disease?
I It can be adjusted as the disease progresses or adverse events occur

II Bilateral procedures can be performed without a significant increase in adverse events
III It is irreversible
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
the following reasons:
 It can be adjusted as the disease progresses or adverse events occur
 Bilateral procedures can be performed without a significant increase in adverse events
33 What are the different types of Deep brain stimulation?
I sub trauma nucleus (STN) stimulation

II globus pallidus interna (GPi) stimulation
III subthalamic nucleus (STN) stimulation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
DBS surgery includes subthalamic nucleus (STN) stimulation, globus pallidus interna (GPi)
stimulation, and thalamic deep brain stimulation.
34 What are the different types of Deep brain stimulation?
I thalamic deep brain stimulation

II sub trauma nucleus (STN) stimulation
III globus pallidus interna (GPi) stimulation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
DBS surgery includes subthalamic nucleus (STN) stimulation, globus pallidus interna (GPi)
stimulation, and thalamic deep brain stimulation.
35 What has been used in patients with predominantly severe and disabling tre mor?
I sub trauma nucleus (STN) stimulation

II Thalamic DBS
III globus pallidus interna (GPi) stimulation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Thalamic DBS has been used in patients with predominantly severe and disabling tremor.
I destruction of targeted areas of the brain
II destruction of targeted neurone
III destruction of targeted nerve
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Lesion surgeries involve the destruction of targeted areas of the brain to control the symptoms of
Parkinson disease.
37 What is used to destroy a specific deep brain target during neuro ablation?
I thermocoagulation
II thermopalpation
III thermo ligation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
During neuro ablation, a specific deep brain target is destroyed by thermocoagulation. A
radiofrequency generator is used most commonly to heat the lesioning electrode tip to the prescribed
temperature in a controlled fashion.
38 What is used most commonly to heat the lesioning electrode tip during neuro ablation?
I A UV generator
II A radiofrequency generator
III A IR generator
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
During neuroablation, a specific deep brain target is destroyed by thermocoagulation. A
radiofrequency generator is used most commonly to heat the lesioning electrode tip to the prescribed
temperature in a controlled fashion.
39 What is Thalamotomy?
I destruction of a part of the thalamus

II destruction of a part of the cerebellum
III destruction of a part of the cerebrum
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Thalamotomy involves destruction of a part of the thalamus, generally the ventralis intermedius
(VIM), to relieve tremor.
40 What is considered the best target for tremor suppression?
I cerebellum nucleus
II ventralis intermedius (VIM) nucleus
III cerebrum nucleus
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
The ventralis intermedius (VIM) nucleus is considered the best target for tremor suppression, with
excellent short- and long-term tremor suppression in 80-90% of patients with Parkinson disease.
41 What is Pallidotomy?
I destruction of a part of the cerebellum
II destruction of a part of the thalamus
III destruction of a part of the Globus pallidus (GPi)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Pallidotomy involves destruction of a part of the GPi.
42 What is the usefulness of Pallidotomy in Parkinson disease?
I increased tremors
II improvement in tremor
III improvement in rigidity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Pallidotomy studies have demonstrated significant improvements in each of the cardinal symptoms of
Parkinson disease (tremor, rigidity, bradykinesia), as well as a significant reduction in dyskinesia.
43 What is the usefulness of Pallidotomy in Parkinson disease?
I improvement in rigidity
II increased bradykinesia
III significant reduction in dyskinesia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Pallidotomy studies have demonstrated significant improvements in each of the cardinal symptoms of
Parkinson disease (tremor, rigidity, bradykinesia), as well as a significant reduction in dyskinesia.
44 What is the most serious and frequent adverse effect of pallidotomy?
I scotoma
II deafness
III numbness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The most serious and frequent (3.6%) adverse effect of pallidotomy is a scotoma in the contralateral
lower-central visual field.
45 What is the complication of bilateral pallidotomy in Parkinson disease?
I deafness
II speech difficulties
III numbness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Bilateral pallidotomy is not recommended because complications are relatively common and include
speech difficulties, dysphagia, and cognitive impairment.
46 What is the complication of bilateral pallidotomy in Parkinson disease?
I dysphagia
II cognitive impairment
III numbness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Bilateral pallidotomy is not recommended because complications are relatively common and include
speech difficulties, dysphagia, and cognitive impairment.
47 Which factors play crucial role in successful subthalamic nucleus (STN) deep brain
stimulation (DBS)?
I A diagnosis of Parkinson disease

II Positive response to levodopa
III Negative response to levodopa
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Patient selection is particularly important for successful subthalamic nucleus (STN) deep brain
stimulation (DBS), because a number of factors determine positive surgical outcome. These can be
summarized as follows:
 A diagnosis of Parkinson disease

 Positive response to levodopa
stimulation (DBS)?
I Advanced disease, virtually unmanageable with dopaminergic medications

II Negative response to levodopa
III Absence of atypical parkinsonian features
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Absence of atypical parkinsonian features

 Advanced disease, virtually unmanageable with dopaminergic medications
stimulation (DBS)?
I Negative response to levodopa

II Absence of active psychiatric disease
III No significant cognitive impairment
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 No significant cognitive impairment

 Absence of active psychiatric disease
 Good social support and access to programming
50 Which drug is approved for the treatment of symptoms of idiopathic PD?
I Carbidopa/levodopa
II Carbidopa/amantadine
III Carbidopa/levosulpride
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Carbidopa/levodopa is approved for the treatment of symptoms of idiopathic PD, postencephalitic
parkinsonism, and symptomatic parkinsonism that may follow injury to the nervous system by carbon
monoxide and/or manganese intoxication.
51 Which drug is approved for the treatment of symptoms of symptomatic Parkinsonism

that may follow injury to the nervous system by carbon monoxide and/or manganese
intoxication?
I Carbidopa/tamsulosin
II Carbidopa/levosulpride
III Carbidopa/levodopa
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
52 Which drug is approved for the treatment of symptoms of idiopathic PD?
I Carbidopa/tamsulosin
II Carbidopa/levodopa
III Carbidopa/tramadol
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
53 Which drug is peripheral decarboxylase inhibitor?
I levodopa
II carbidopa
III tramadol
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
peripheral decarboxylase inhibitor (PDI) such as carbidopa.
54 What is the side effect of Levodopa, when it is administered alone?
I increased appetite
II nausea
III vomiting
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
When administered alone, levodopa causes a high incidence of nausea and vomiting due to the
formation of dopamine in the peripheral circulation.
55 Most patients experience a good response on a daily levodopa dosage of -
I 30-60 mg/day
II 300-600 mg/day
III 500-900 mg/day
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Most patients experience a good response on a daily levodopa dosage of 300-600 mg/day (usually
divided 3 or 4 times daily) for 3-5 years or longer.
56 What of the following is the side effect of Levodopa?
II agitation
III hallucinations
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Other side effects include dizziness and headache. In elderly patients, confusion, delusions, agitation,
hallucinations, and psychosis may be more commonly seen.
I delusions
II increased appetite
III confusion
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
II confusion
III headache
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
I psychosis
II dizziness
III increased appetite
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
60 Which drug can be classified as Dopamine agonists?
I Amantadine
II Ropinirole
III carbidopa
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Dopamine Agonists; Apomorphine, Pramipexole, Ropinirole, Amantadine.
I carbidopa
II Pramipexole
III Eugenol
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
I carbidopa
II tolcapone
III Apomorphine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
63 Which drug is nonergoline dopamine agonist?

I tolcapone
II Apomorphine
III olanzapine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Apomorphine is a nonergoline dopamine agonist indicated for the acute, intermittent treatment of
hypomobility "off" episodes ("end-of-dose wearing off" and unpredictable "on/off" episodes) associated
with advanced PD.
64 Which drug is indicated for the acute, intermittent treatment of hypomobility "off"
episodes ("end-of-dose wearing off" and unpredictable "on/off" episodes) associated with
advanced PD?
I midazolam
II diazepam
III Apomorphine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Apomorphine is a nonergoline dopamine agonist indicated for the acute, intermittent treatment of
hypomobility "off" episodes ("end-of-dose wearing off" and unpredictable "on/off" episodes) associated
with advanced PD.
65 What is the pharmacological mechanism of Apomorphine?
I activation of postsynaptic D2 receptors in the striatum

II activation of presynaptic D2 receptors in the striatum
III downregulation of postsynaptic D2 receptors in the striatum
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Apomorphine; it is thought to occur via activation of postsynaptic D2 receptors in the striatum.
66 Which drug is non ergot dopamine agonist?
I Ropinirole
II midazolam
III acetazolamide
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Ropinirole is a non ergot dopamine agonist that has high relative in vitro specificity and full intrinsic
activity at the D2 subfamily of dopamine receptors; it binds with higher affinity to D3 than to D2
or D4 receptor subtypes. The mechanism of action of ropinirole is stimulation of dopamine D2
receptors in striatum.
67 Which drug has high relative in vitro specificity and full intrinsic activity at the D2
subfamily of dopamine receptors?
I acetazolamide
II Ropinirole
III diazepam
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
68 Which of the following drug binds with higher affinity to D3 than to D2 or D4 receptor
subtypes?
I acetazolamide
II ethacrynic acid
III Ropinirole
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
69 What is the pharmacological mechanism of Ropinirole?
I activation of presynaptic D2 receptors in the striatum

II stimulation of dopamine D2 receptors in striatum
III downregulation of postsynaptic D2 receptors in the striatum
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Ropinirole is a nonergot dopamine agonist that has high relative in vitro specificity and full intrinsic
70 Which drug is approved for the treatment of idiopathic PD?
I tolcapone
II carbidopa
III Amantadine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Amantadine is approved for the treatment of idiopathic PD, postencephalitic parkinsonism, and
symptomatic parkinsonism, which may follow injury to the nervous system by carbon monoxide
intoxication. The usual dosage is 100 mg given twice a day when used alone.
71 Which drug is approved for the treatment of postencephalitic parkinsonism?
I Amantadine
II carbidopa
III tolcapone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
72 What is the therapeutic dose of Amantadine?
I 100 mg given twice a day

II 200 mg given twice a day
III 300 mg given twice a day
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
73 Which receptor is stimulated by Dopamine agonist?
I D3
II D5
III D2
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Dopamine agonist stimulating D3, D2, and D1 receptors.
74 Which drug can be classified as Anticholinergic?
I Amantadine
II Trihexyphenidyl
III Benztropine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Anticholinergic; Trihexyphenidyl, Benztropine.
75 Which of the following is a synthetic tertiary amine anticholinergic agent?
I furosemide
II Amantadine
III trihexyphenidyl
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
trihexyphenidyl; It is a synthetic tertiary amine anticholinergic agent. It has a direct antispasmodic
action on smooth muscle and has weak mydriatic, antisecretory, and positive chronotropic activities.
76 What is the effect of trihexyphenidyl in human body?
I increased secretion
II antispasmodic action on smooth muscle
III antisecretory
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Trihexyphenidyl; It is a synthetic tertiary amine anticholinergic agent. It has a direct antispasmodic
77 What is the effect of trihexyphenidyl in human body?
I weak mydriatic
II positive chronotropic activities
III negative chronotropic activities
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Trihexyphenidyl; It is a synthetic tertiary amine anticholinergic agent. It has a direct antispasmodic
78 What is the pharmacological mechanism of trihexyphenidyl?
I anticholinergic
II inhibit reuptake and storage of dopamine at central dopamine receptors
III negative chronotropic activities
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
In addition to suppressing central cholinergic activity, trihexyphenidyl may also inhibit reuptake and
storage of dopamine at central dopamine receptors, thereby prolonging the action of dopamine.
79 Which drug is approved for use as an adjunct in the therapy of all forms of PD?
I liraglutide
II sibutramine
III Benztropine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Benztropine mesylate is approved for use as an adjunct in the therapy of all forms of PD.
80 Which drug can be classified as MAO-B inhibitors?
I Selegiline
II rimonabant
III Benztropine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
MAO-B inhibitors; Selegiline, Rasagiline
81 Which drug can be classified as MAO-B inhibitors?
I Benztropine
II ketoconazole
III Rasagiline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
MAO-B inhibitors; Selegiline, Rasagiline
82 What is the usefulness of selegiline in patients experiencing motor fluctuations due t o

levodopa/carbidopa?
I reduces off time

II increase off time
III reduces on time
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
For patients who are experiencing motor fluctuations on levodopa/carbidopa, the addition of selegiline
reduces off time, improves motor function, and allows levodopa dose reductions.
83 What is the usefulness of selegiline in patients experiencing motor fluctuations due to

levodopa/carbidopa?
I increase off time

II reduces on time
III improves motor function
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
84 What is the usefulness of selegiline in patients experiencing motor fluctuations due to

levodopa/carbidopa?
I increase off time

II allows levodopa dose reductions
III reduces on time
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
85 What is the therapeutic dose of Rasagiline?
I 4 mg once daily
II 2 mg once daily
III 1 mg once daily
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Rasagiline is an irreversible MAO-B inhibitor that blocks dopamine degradation. Rasagiline at a
dosage of 1 mg once daily is given as monotherapy.
86 Which drug can be classified as central Acetylcholinesterase Inhibitors?
I benztropine
II Donepezil
III carbidopa
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Acetylcholinesterase Inhibitors, Central; Donepezil, Rivastigmine, Galantamine
87 Which drug can be classified as central Acetylcholinesterase Inhibitors?
I Rivastigmine
II benztropine
III Galantamine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Acetylcholinesterase Inhibitors, Central; Donepezil, Rivastigmine, Galantamine
88 What is the effect of Acetylcholinesterase inhibitors?
I increase activity of acetylcholinesterase enzyme

II inhibition of acetylcholinesterase enzyme
III inhibition of tertarycholinesterase enzyme
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Acetylcholinesterase inhibitors may exert their therapeutic effect by enhancing cholinergic function
through inhibition of acetylcholinesterase.
89 Which drug can be classified as central NMDA Antagonists?
I benztropine
II Galantamine
III Memantine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
NMDA Antagonists; Memantine
90 Which mechanism has been hypothesized to contribute to the symptomatology of

dementia?
I Persistent activation of CNS NMDA receptors by the glutamate

II Persistent deactivation of CNS NMDA receptors by the glutamate
III Persistent activation of CNS NDDA receptors by the glutamate
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Persistent activation of CNS N-methyl-D-aspartate (NMDA) receptors by the excitatory amino acid
glutamate has been hypothesized to contribute to the symptomatology of dementia.
91 What is the initial dosage of immediate-release tablets of Memantine?
I 1 mg once daily
II 2.5 mg once daily
III 5 mg once daily
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Memantine is approved for the treatment of moderate to severe dementia in Alzheimer disease. Initial
dosage is 5 mg once daily for immediate-release tablets and 7 mg once daily for extended-release
tablets.
92 What is the role of Catechol-O -methyl trAns:ferase (COMT)?
I responsible for peripheral metabolism of carbidopa

II responsible for peripheral metabolism of levodopa
III responsible for peripheral metabolism of amantadine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Catechol-O -methyl trAns:ferase (COMT) inhibitors inhibit the peripheral metabolism of levodopa,
making more levodopa available for trAns:port across the blood-brain barrier over a longer time. For
patients with motor fluctuations on levodopa/carbidopa, the addition of a COMT inhibitor decreases
off time, improves motor function, and allows lower levodopa doses.
motor fluctuations on levodopa/carbidopa?
I increase off time

II decreases off time
III improves motor function
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
For patients with motor fluctuations on levodopa/carbidopa, the addition of a COMT inhibitor
decreases off time, improves motor function, and allows lower levodopa doses.
94 Which drug can be classified as COMT Inhibitors?
I Tolcapone
II Entacapone
III Memantine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
COMT Inhibitors; Tolcapone, Entacapone
95 What is the potential side effect of tolcapone?
I neurotoxicity
II cardiotoxicity
III hepatotoxicity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Because of the risk of hepatotoxicity, tolcapone is reserved for patients who have not responded
adequately.
96 What is the therapeutic dose of Amantadine?
I 10 mg per day
II 100 mg per day
III 1000 mg per day
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Amantadine is commonly introduced at a dose of 100 mg per day and slowly increased to an initial
maintenance dose of 100 mg 2 or 3 times daily.
I insomnia
II nausea
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The most concerning potential side effects of amantadine are confusion and hallucinations. Common
side effects include nausea, headache, dizziness, and insomnia.
I headache
II dizziness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
The most concerning potential side effects of amantadine are confusion and hallucinations. Common
side effects include nausea, headache, dizziness.
99 What is the initial dose of Benztropine?
I 0.5-1 mg daily at bedtime

II 1-5 mg daily at bedtime
III 5-10 mg daily at bedtime
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Benztropine (Cogentin) is also commonly used, with an initial dose of 0.5-1 mg daily at bedtime.
100 Which drug is very helpful in relieving refractory nausea?
I Benztropine
II carbidopa
III Domperidone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Domperidone, a peripheral dopamine agonist available outside the United States, is very helpful in
relieving refractory nausea.
PNEUMONIA
1 Which is Pneumonia?
I infection of the heart

II infection of the lung
III infection of the kidney
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Pneumonia can be generally defined as an infection of the lung parenchyma, in which consolidation
of the affected part and a filling of the alveolar air spaces with exudate, inflammatory cells, and fibrin
is characteristic.
2 Which out of the following is true about Pneumonia?
I alveolar air spaces gets filled with exudate and inflammatory cells
II alveolar air spaces gets filled with lead
III alveolar air spaces gets filled with fibrin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Pneumonia can be generally defined as an infection of the lung parenchyma, in which consolidation
of the affected part and a filling of the alveolar air spaces with exudate, inflammatory cells, and fibrin
is characteristic.
3 What is the most common cause of pneumonia?
I millipedes
II rickettsia
III fungi
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Infection by bacteria or viruses is the most common cause, although infection by other micro-
orgamisms such as rickettsiae, fungi and yeasts, and mycobacteria may occur.
4 What is the most common cause of pneumonia?
I bacteria
II millipedes
III virus
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Infection by bacteria or viruses is the most common cause, although infection by other micro-
orgamisms such as rickettsiae, fungi and yeasts, and mycobacteria may occur.
5 What is Community-acquired pneumonia (CAP)?
I pneumonia that develops in the outpatient setting

II pneumonia that develops in the inpatient setting
III pneumonia that develops within 48 hours of admission to a hospital
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Community-acquired pneumonia (CAP) is defined as pneumonia that develops in the outpatient
setting or within 48 hours of admission to a hospital.
6 What is Institutional-acquired pneumonia (IAP)?
I nursing hospital associated pneumonia (NHAP)

II pneumonia that develops in the outpatient setting
III pneumonia that develops within 48 hours of admission to a hospital
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Institutional-acquired pneumonia (IAP) includes HCAP and nursing home associated pneumonia
(NHAP).
7 What is health care associated pneumonia (HCAP)?
I pneumonia that develops in the outpatient setting

II within 8 hours of admission to a hospital in patients with exposure to MDR bacteria
III within 48 hours of admission to a hospital in patients with exposure to MDR bacteria
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
HCAP is defined as pneumonia that develops in the outpatient setting or within 48 hours of admission
to a hospital in patients with increased risk of exposure to MDR bacteria as a cause of infection.
8 Which out of the following are the Risk factors for exposure to MDR bacteria in HCAP?
I Hospitalization for two or more days in an acute care facility within 90 days of current illness
II Hospitalization for one days in an acute care facility within 30 days of current illness
III Exposure to antibiotics, chemotherapy, or wound care within 30 days of current illness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Risk factors for exposure to MDR bacteria in HCAP include the following:
 Hospitalization for two or more days in an acute care facility within 90 days of current illness
 Exposure to antibiotics, chemotherapy, or wound care within 30 days of current illness
9 Which out of the following are the Risk factors for exposure to MDR bacteria in HCAP?
I Residence in a nursing home or long-term care facility

II Hemodialysis at a hospital or clinic
III Heterodialysis at a hospital or clinic
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
● Residence in a nursing home or long-term care facility

● Hemodialysis at a hospital or clinic
10 Which out of the following are the Risk factors for exposure to MDR bacteria in
HCAP?
I short-term care at hospital

II Home nursing care (infusion therapy, wound care)
III Contact with a family member or other close person with infection due to MDR bacteria
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
● Home nursing care (infusion therapy, wound care)

● Contact with a family member or other close person with infection due to MDR bacteria
11 what is called as Nosocomial infections?
I infection acquired at home

II infection acquired at hospital
III infection acquired at collage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Nosocomial infections are generally described as those acquired in the hospital setting.
12 What is defined as Hospital acquired pneumonia (HAP)?
I pneumonia that develops at least 48 hours after admission to a hospital

II pneumonia that develops at home
III pneumonia that develops at collage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
HAP is defined as pneumonia that develops at least 48 hours after admission to a hospital.
13 Which out of the following are the risk factors for exposure to organisms in HAP?
I Antibiotic therapy within 90 days of the hospital-acquired infection

II Current length of hospitalization of five days or more
III Current length of hospitalization of one day
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Risk factors for exposure to such organisms in HAP include the following:
● Antibiotic therapy within 90 days of the hospital-acquired infection

● Current length of hospitalization of five days or more
I Immunostimulant therapy
II High frequency of antibiotic resistance in the local community
III Immunosuppressive disease or therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Risk factors for exposure to such organisms in HAP include the following[6] :
● High frequency of antibiotic resistance in the local community or within the specific hospital
unit
● Immunosuppressive disease or therapy
I Presence of HCAP risk factors for exposure to MDR bacteria
II Immunostimulant therapy
III Immunosuppressive disease or therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Risk factors for exposure to such organisms in HAP include the following[6] :
 Presence of HCAP risk factors for exposure to MDR bacteria
16 What is the common mechanisms for the acquisition of pneumonia?
I ventilator use
II expiration
III aspiration
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
16 Common mechanisms for the acquisition of pneumonia include ventilator use and aspiration.(
Hospital-acquired pneumonia).
17 Whatis defined as ventilator-associated pneumonia (VAP)?
I pneumonia that develops more than 48 hours after endotracheal intubation

II pneumonia that develops more than 48 hours after exotracheal intubation
III pneumonia that develops within 48 hours of extubation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
VAP is defined as pneumonia that develops more than 48 hours after endotracheal intubation or
within 48 hours of extubation.
18 What is the different way for the development of Aspiration pneum onia?
I after the exhalation of oropharyngeal secretions

II after the inhalation of oropharyngeal secretions
III inhalation of colonized organisms
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Aspiration pneumonia develops after the inhalation of oropharyngeal secretions and colonized
organisms.
19 Which reason increases risk of aspiration and/or the development of aspiration

pneumonia?
I Decreased ability to clear oropharyngeal secretions

II Increased volume of secretions
III Decreased volume of secretions
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Patients may be at increased risk of aspiration and/or the development of aspiration pneumonia for a
number of reasons, as follows:
 Decreased ability to clear oropharyngeal secretions - Poor cough or gag reflex, impaired
swallowing mechanism (eg, dysphagia in stroke patients), impaired ciliary trAns:port (eg,
from smoking)
 Increased volume of secretions
20 Which reason increases risk of aspiration and/or the development of aspiration
pneumonia?
I Increased bacterial burden of secretions

II Decreased bacterial burden of secretions
III Presence of comorbidities
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Patients may be at increased risk of aspiration and/or the development of aspiration pneumonia for a
number of reasons, as follows:
 Increased bacterial burden of secretions

 Presence of other comorbidities - Anatomic abnormalities, gastroesophageal reflux disease (
GERD), achalasia.
I hypotension
II Anatomic abnormalities
III gastroesophageal reflux disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Presence of other comorbidities - Anatomic abnormalities, gastroesophageal reflux disease ( GERD),
achalasia.
I hypotension
II achalasia
III GFRD (gastro phageal reflux disease)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Presence of other comorbidities - Anatomic abnormalities, gastroesophageal reflux disease ( GERD),
achalasia.
23 What is responsible for decreased ability to clear oropharyngeal secretions in aspiration

pneumonia?
I Poor gag reflex

II Poor cough
III proper gag reflex
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Decreased ability to clear oropharyngeal secretions - Poor cough or gag reflex, impaired swallowing
mechanism (eg, dysphagia in stroke patients), impaired ciliary trAns:port (eg, from smoking).
24 What is responsible for decreased ability to clear oropharyngeal secretions in aspiration

pneumonia?
I impaired swallowing mechanism

II improved swallowing mechanism
III impaired ciliary trAns:port
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Decreased ability to clear oropharyngeal secretions - Poor cough or gag reflex, impaired swallowing
mechanism (eg, dysphagia in stroke patients), impaired ciliary trAns:port (eg, from smoking).
25 Which condition/reasons increase the risk of acquiring aspiration pneumonia in

critically ill patients?
I dysmotility
II normal immune response
III Gastroparesis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Critically ill patients are at notably increased risk of aspiration due to the following:
● The challenge of appropriate, risk-minimizing positioning

● Gastroparesis/dysmotility

I Impaired cough/gag/swallow reflexes

II Impaired immune response
III normal immune response
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
● Impaired cough/gag/swallow reflexes (illness- or drug-induced)

● Impaired immune response

I Intubation
II midtubaion
III extubation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
● Intubation/extubation
28 Which out of the following bacteria is implicated in aspiration pneumonia?
I Coccusteroids
II Peptostreptococcus
III Bacteroides
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Historically, the bacteria implicated in aspiration pneumonia have been the anaerobic oropharyngeal
colonizers such as Peptostreptococcus, Bacteroides, Fusobacterium, and Prevotella species.
29 Which out of the following bacteria is implicated in aspiration pneumonia?
I Fusobacterium
II Fusovotella species
III Prevotella species
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Historically, the bacteria implicated in aspiration pneumonia have been the anaerobic oropharyngeal
colonizers such as Peptostreptococcus, Bacteroides, Fusobacterium, and Prevotella species.
30 What are the different cause for the development of pneumonia?
I intrinsic
II extrinsic
III tumorogenic
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The causes for the development of pneumonia are extrinsic or intrinsic, and various bacterial causes
are noted.
31 Which out of the followings are included in Extrinsic factors for the develo pment of
pneumonia?
I Loss of protective upper airway reflexes

II exposure to a causative agent
III exposure to pulmonary irritants
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Extrinsic factors include exposure to a causative agent, exposure to pulmonary irritants, or direct
pulmonary injury.
32 Which out of the following is Intrinsic factors for the development of pneumonia?
I exposure to a causative agent

II exposure to pulmonary irritants
III Loss of protective upper airway reflexes
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Intrinsic factors are related to the host. Loss of protective upper airway reflexes allows aspiration of
contents from the upper airways into the lung.
33 What are the different cause for the loss of upper airway reflexes?
I vaccination
II altered mental status due to intoxication
III metabolic states and neurologic cause
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Various causes for this loss include altered mental status due to intoxication and other metabolic states
and neurologic causes, such as stroke and endotracheal intubation
34 What is the characteristic of acute inflammation in pulmonary infection?
I migration of RBC out of capillaries

II migration of platelet into air spaces
III migration of neutrophils into the air spaces
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Thus, during pulmonary infection, acute inflammation results in the migration of neutrophils out of
capillaries and into the air spaces.
35 What is general mechanisms of increased bacterial virulence?
I Genetic flexibility allowing the development of resistance to various classes of antibiotics

II Flagellae and other bacterial appendages that facilitate spread of infection
III increased responsiveness of immune system
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
General mechanisms of increased bacterial virulence include the following:
● Genetic flexibility allowing the development of resistance to various classes of antibiotics

● Flagellae and other bacterial appendages that facilitate spread of infection
I increased immune cell production

II bacterial capsules resistant to attack by immune defense cells
III capsule resistant to adhesion of immune cell
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
● Capsules resistant to attack by immune defense cells and that facilitate adhesion to host cells
● Quorum sensing systems allow coordination of gene expression based on complex cell-signaling
for adaptation to the local cellular environment
I increased immune cell production

II Quorum sensing systems allow coordination of gene expression
III Iron scavenging
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Quorum sensing systems allow coordination of gene expression based on complex cell-signaling
for adaptation to the local cellular environment
 Iron scavenging
38 What causes decrease in host defenses to mount appropriate acute inflammatory

response?
I bacterial resistance
II Deficits in neutrophil quantity
III Deficits in neutrophil quality
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Deficits in various host defenses and an inability to mount an appropriate acute inflammatory
response can predispose patients to infection, as follows:
● Deficits in neutrophil quantity, as in neutropenia

● Deficits in neutrophil quality, as in chronic granulomatous disease
39 What causes decrease in host defenses to mount appropriate acute inflammatory

response?
I Deficiencies of immunoglobulins
II bacterial resistance
III Deficiencies of complement
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Deficits in various host defenses and an inability to mount an appropriate acute inflammatory
response can predispose patients to infection, as follows[13] :
● Deficiencies of complement
● Deficiencies of immunoglobulins
40 Which out of the followings is the risk factors for pneumonia?
I local lung pathologies

II hypotension
III chronic gingivitis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Other risk factors include local lung pathologies (eg, tumors, chronic obstructive pulmonary disease
[COPD], bronchiectasis), chronic gingivitis and periodontitis, and smoking which impairs resistance
to infection.
I periodontitis
II smoking
III weight loss
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
to infection.
42 Which out of the followings lung pathologies increases risk of pneumonia?
I tumors
II ulcerative colitis
III chronic obstructive pulmonary disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
to infection.
43 Which out of the followings lung pathologies increases risk of pneumonia?
I bronchiectasis
II ulcerative colitis
III chrons disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
to infection.
I altered sensorium
II central nervous system (CNS) impairment
III weight loss
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Risk factor; Furthermore, any individual with an altered sensorium (eg, seizures, alcohol or drug
intoxication) or central nevous system (CNS) impairment (eg, stroke) may have a reduced gag reflex.
I seizures
II alcohol or drug intoxication
III obesity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Risk factor; Furthermore, any individual with an altered sensorium (eg, seizures, alcohol or drug
intoxication) or central nevous system (CNS) impairment (eg, stroke) may have a reduced gag reflex.
46 What is the most common cause of typical bacterial pneumonia?
I E.coli
IIPneumococcosis
III pseudomonas
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Streptococcus pneumoniae: This organism is a facultative anaerobe identified by its chainlike staining
pattern. Pneumococcosis is by far the most common cause of typical bacterial pneumonia.
47 Which microorganism is observed in intravenous drug abusers (IVDAs) and individuals
with debilitating disorders?
I E.coli
II Pneumococcosis
III S aureus pneumonia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
S aureus pneumonia is observed in intravenous drug abusers (IVDAs) and individuals with
debilitating disorders.
48 Which microorganism is group D streptococci?
I E coli
II E faecalis
III E faecium
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Enterococcus ( E faecalis, E faecium): These organisms are group D streptococci that are well-known
normal gut florae that can be identified by their pair-and-chain staining pattern. The emergence of
vancomycin-resistant Enterococcus (VRE) is indicative of the importance of appropriate antibiotic
use.
49 How one can identify of Enterococcus (E faecalis, E faecium) organism?
I rod shaped
II pair and chain staining pattern
III cylindrical shape
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Enterococcus ( E faecalis, E faecium): These organisms are group D streptococci that are well-known
normal gut florae that can be identified by their pair-and-chain staining pattern. The emergence of
vancomycin-resistant Enterococcus (VRE) is indicative of the importance of appropriate antibiotic
use.
50 Which microorganism is known to form abscesses and sulfur granules in human?
I E faecium
II E faecalis
III Actinomyces israelii
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
A israelii is known to form abscesses and sulfur granules.
51 What is the characteristic of Actinomyces israelii?
I filamentous
II anaerobic organism
III aerobic organism
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Actinomyces israelii: This is a beaded, filamentous anaerobic organism that grows as normal flora in
the gastrointestinal (GI) tract and can colonize the oral cavity in patients with periodontal disease.
52 Which microorganism occur in most individuals who are debilitated,
immunocompromised, or recently hospitalized?
I Gram-negative pneumonias
II Gram-positive pneumonias
III Gram-neutral pneumonias
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Gram-negative pneumonias occur most often in individuals who are debilitated,
immunocompromised, or recently hospitalized.
53 What is the characteristic of Pseudomonas aeruginosa?
I anaerobic
II aerobic
III grapelike odor
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Pseudomonas aeruginosa: P aeruginosa is an aerobic, motile bacillus often characterized by its
distinct (grapelike) odor.
54 What is the characteristic of Klebsiella pneumoniae?
I facultatively anaerobic
II encapsulated bacillus
III aerobic
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Klebsiella pneumoniae: K pneumoniae is a facultatively anaerobic, encapsulated bacillus that can
lead to an aggressive, necrotizing, lobar pneumonia. Patients with chronic alcoholism, diabetes,
or COPD are at increased risk for infection with this organism.
55 Which microorganism causes aggressive, necrotizing and lobar pneumonia?
I Klebsiella pneumoniae
II Pseudomonas aeruginosa
III Pseudomonas coli
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Klebsiella pneumoniae: K pneumoniae is a facultatively anaerobic, encapsulated bacillus that can
lead to an aggressive, necrotizing, lobar pneumonia. Patients with chronic alcoholism, diabetes,
or COPD are at increased risk for infection with this organism.
56 What is the characterstic of Haemophilus influenza?
I aerobic bacillus
II anaerobic bacillus
III encapsulated
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Haemophilus influenzae: H influenzae is an aerobic bacillus that comes in both encapsulated
and nonencapsulated forms.
57 Which microorganism produce the essential vitamin K for human?
I Haemophilus influenza
II Escherichia coli
III Klebsiella pneumoniae
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Escherichia coli: E coli is a facultatively anaerobic, motile bacillus. It is well known to colonize
the lower GI tract and produce the essential vitamin K.
58 Which aerobic diplococcus known is known as common colonizer of the respiratory

tract?
I Moraxella catarrhalis
II Acinetobacter baumannii
III Escherichia coli
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Moraxella catarrhalis: M catarrhalis is an aerobic diplococcus known as a common colonizer of
the respiratory tract.
Acinetobacter baumannii: A baumannii is a pathogen that has been well described in the context
of ventilator-associated pneumonia (VAP).
59 Which microorganism causes tularemia?
I Francisella tularensis
II Acinetobacter baumannii
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Francisella tularensis: F tularensis is the causative agent of tularemia or rabbit fever..
60 Which microorganism is typically transmitted to humAns: via a tick bite?
I Escherichia coli
II F tularensis
III Acinetobacter baumannii
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
F tularensis is a facultative intracellular bacterium that multiplies within macrophages and that
is typically transmitted to humAns: via a tick bite. Its reservoir animals include rodents, rabbits,
and hares.
61 Which animal act as reservoir for F tularensis?
I rodents
II rabbits
III monkey
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
and hares.
62 Which animal act as reservoir for F tularensis?
I chimpanzee
II monkey
III hares
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
and hares.
63 Which microorganism infection is also known as black plague?
I Y pestis
II pseudomonas
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Yersinia pestis: Y pestis infection is better known as the black plague.
64 Which organisms are generally associated with a milder form of pneumonia?
I antic
II typical
III Atypical
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Atypical organisms are generally associated with a milder form of pneumonia, the so-called
"walking pneumonia.
65 Which organism can be called as atypical organism?
I Mycoplasma species
II Bordetella pertussis
III E. coli
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Atypical organisms; Mycoplasma species, Chlamydophila species ( C psittaci, C pneumoniae),
Legionella species, Coxiella burnetii, Bordetella pertussis.
I C psittaci
II E. coli
III C pneumoniae
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
I E. coli
II Legionella species
III Coxiella burnetii
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
68 Which microorganism is the smallest known free-living organisms in existence?
I Chlamydophila species
II mycoplasmas species
III Legionella species
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Mycoplasma species: The mycoplasmas are the smallest known free-living organisms in
existence. These organisms lack cell walls (and therefore are not apparent after Gram stain) but
have protective 3-layered cell membranes.
69 Which organism lack cell wall but have protective 3-layered cell membranes?
I Chlamydophila species
II mycoplasmas species
III Legionella species
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Mycoplasma species: The mycoplasmas are the smallest known free-living organisms in
existence. These organisms lack cell walls (and therefore are not apparent after Gram stain) but
have protective 3-layered cell membranes.
70 Which disease is caused by C psittaci (associated with the handling of various types of
birds)?
I parrot fever
II hay fever
III Q fever
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Chlamydophila species ( C psittaci, C pneumoniae): Psittacosis, also known as parrot disease or
parrot fever, is caused by C psittaci and is associated with the handling of various types of birds.
71 Which is the causative agent of Q fever?
I Bordetella pertussis
II C psittaci
III Coxiella burnetii
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Coxiella burnetii: C burnetii is the causative agent of Q fever. It is spread from animals to
humAns:; person-to-person transmission is unusual. Animal reservoirs typically include cats,
sheep, and cattle.
72 Which microorganism is responsible for pertussis or whooping cough?

I C burnetii
II Bordetella pertussis
III C psittaci
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Bordetella pertussis: B pertussis is the agent responsible for pertussis or whooping cough.
73 Which is the most consistent presenting symptom in pneumonia patients?
I cough
II low sugar level
III decreased creatinine clearance
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The presence of cough, particularly cough productive of sputum, is the most consistent
presenting symptom.
74 Which out of the condition is associated with bacterial pneumonias?
I Sudden onset of symptoms

II rapid illness progression
III anuria
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Sudden onset of symptoms and rapid illness progression are associated with bacterial
pneumonias.
75 Which out of the following signs indicates defect in pulmonary system?
I Chest pain
II anuria
III dyspnea
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Chest pain, dyspnea, hemoptysis (when clearly delineated from hematemesis), decreased exercise
tolerance, and abdominal pain from pleuritis are also highly indicative of a pulmonary process.
I decreased exercise tolerance

II hemoptysis
III hypertension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
I abdominal pain from pleuritis

II weight gain
III hypertension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
78 Which microorganism is classically associated with a production of rust-colored sputum

in pneumonia?
I S pneumoniae
II Klebsiella species
III Pseudomonas
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
S pneumoniae is classically associated with a cough productive of rust-colored sputum.
79 Which microorganism is associated with a production of green colored sputum in

pneumonia?
I Pseudomonas
II Haemophilus
III Klebsiella species
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Pseudomonas, Haemophilus, and pneumococcal species may produce green sputum.
80 Which microorganism is associated with a production of red currant-jelly sputum in
pneumonia?
I Haemophilus
II Klebsiella species
III Pseudomona
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Klebsiella species pneumonia is classically associated with a cough productive of red currant-
jelly sputum.
81 Which microorganism is associated with a production foul-smelling or bad-tasting

sputum in pneumonia?
I Anaerobic
II Aerobic
III gram positive aerobic
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Anaerobic infections often produce foul-smelling or bad-tasting sputum.
82 Which nonspecific symptoms of pneumonia are common in pneumonia patient?
I weight gain
II fever
III rigors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Nonspecific symptoms such as fever, rigors or shaking chills, and malaise are common.
83 Which nonspecific symptoms of pneumonia are common in pneumonia patient?
I malaise
II shaking chills
III weight gain
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Nonspecific symptoms such as fever, rigors or shaking chills, and malaise are common.
84 Which out of the following are nonspecific symptoms of pneumonia?
I weight gain
II myalgias
III headache
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Other nonspecific symptoms that may be seen with pneumonia include myalgias, headache,
abdominal pain, nausea, vomiting, diarrhea, anorexia and weight loss, and altered sensorium.
I abdominal pain
II weight gain
III nausea
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
I diarrhea
II anorexia
III weight gain
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
87 Which are the specific signs of bacterial pneumonia?
I Hyperthermia
II hypothermia
III Tachypnea
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Signs of bacterial pneumonia may include the following:
 Hyperthermia
 Tachypnea
I Use of accessory respiratory muscles

II bradycardia
III Tachycardia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Use of accessory respiratory muscles
 Tachycardia
I bradycardia
II Central cyanosis
III Altered mental status
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Central cyanosis
 Altered mental status
90 What is Tachypnea?
I more than 18 respirations/min

II less than 15 respirations/min
III less than 16 respirations/min
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Tachypnea (>18 respirations/min) .
91 What is Tachycardia?
I more than 100 bpm

II less than 100 bpm
III less than 90 bpm
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Tachycardia (>100 bpm)
92 Which test is carried out during analysis of Serum in pneumonia patient?
I sodium
II potassium
III
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Serum chemistry panel (sodium, potassium, bicarbonate, blood urea nitrogen [BUN],
creatinine, glucose).
93 Which test is carried out during analysis of Serum in pneumonia patient?
I bicarbonate
II serum Lead
III blood urea nitrogen
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Serum chemistry panel (sodium, potassium, bicarbonate, blood urea nitrogen [BUN],
creatinine, glucose).
94 What is the importance of Arterial blood gas in diagnosis of pneumonia?
I to determine blood sugar level

II to determine Hypoxia
III to determine respiratory acidosis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Arterial blood gas (ABG) determination (serum pH, arterial oxygen saturation, arterial partial
pressure of oxygen and carbon dioxide) Hypoxia and respiratory acidosis may be present.
95 What is the importance of Routine Laboratory Tests in diagnosis of pneumonia?
I useful for classifying illness severity

II site-of-care/admission decisions
III it is standard method to determine pneumonia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Routine Laboratory Tests
The following laboratory tests may not be useful for diagnostic purposes but are useful for
classifying illness severity and site-of-care/admission decisions.
96 Which out of the following is routine laboratory test for pneumonia?
I Chest radiography
II Serum lactate level
III Serum free cortisol value
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Serum free cortisol value
 Serum lactate level
97 Which out of the following is routine laboratory test for pneumonia?
I Venous blood gas determination

II Complete blood cell
III Chest radiography
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
 Venous blood gas determination (central venous oxygen saturation)

 Complete blood cell (CBC) count with differential
98 What is the importance pulse oximetry in diagnosis of pneumonia?
I to determine blood sugar level

II to determine hypoxia
III to determine blood cholesterol level
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
A pulse oximetry finding of < 90-92% indicates significant hypoxia, and an elevated C-reactive
protein (CRP) level may be predictive of more serious disease.
99 What is Leukopeni?
I WBC count = 5000 cells/µL

II WBC count > 5000 cells/µL
III WBC count < 5000 cells/µL
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Leukopenia (usually defined as a WBC count < 5000 cells/µL) may be an ominous clinical sign
of impending sepsis.
100 Which is the standard method for diagnosing the presence of pneumonia?
I Chest radiography
II pulse oxymetry
III sonograpny
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Chest radiography is considered the standard method for diagnosing the presence of pneumonia,
that is, the presence of an infiltrate is required for the diagnosis.

1 What is mandatory in patient with septic shock?
I treating patient in intensive care unit

II treating patient in outpatient setting
III No special attention is required
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Direct admission to an intensive care unit (ICU) is mandated for any patient with septic shock
requiring intravenous infusion of vasopressors to support the blood pressure or with acute
respiratory failure requiring intubation and mechanical ventilation.
2 What is mandatory in patient with septic shock?
I treating patient in outpatient setting

II intravenous infusion of vasopressors
III No special attention is required
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Direct admission to an intensive care unit (ICU) is mandated for any patient with septic shock
requiring intravenous infusion of vasopressors to support the blood pressure or with acute
respiratory failure requiring intubation and mechanical ventilation.
3 What is the mainstay of treatment of bacterial pneumonia?
I corticosteroid therapy
II Antibiotic therapy
III Analgesic
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Antibiotic therapy is the mainstay of treatment of bacterial pneumonia.
4 Which out of the following is a sulfonamide derivative antibiotic?
I tetracycline
II Sulfamethoxazole
III trimethoprim
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Sulfamethoxazole and trimethoprim is a sulfonamide derivative antibiotic. This agent inhibits
bacterial synthesis of dihydrofolic acid by competing with paraaminobenzoic acid, thereby
inhibiting folic acid synthesis and resulting in inhibition of bacterial growth.
5 What is the pharmacological mechanism of Sulfamethoxazole and trimethoprim?
I bind to bacterial DNA

II inhibits bacterial dihydrofolic acid
III bind to bacterial RNA
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Sulfamethoxazole and trimethoprim is a sulfonamide derivative antibiotic. This agent inhibits
bacterial synthesis of dihydrofolic acid by competing with paraaminobenzoic acid, thereby
inhibiting folic acid synthesis and resulting in inhibition of bacterial growth.
6 Which device provides high oxygen concentrations?
I Venti-mask
II Steri-mask
III partial rebreathing face mask
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Moderate dyspnea requires high oxygen concentrations, such as those provided by a Venti-mask
or partial rebreathing face mask. Use these masks with caution in patients with chronic
obstructive pulmonary disease (COPD) and/or hypercarbia.
7 Venti-mask or partial rebreathing face mask is used with caution in pa tients with-
I dyspnea
II chronic obstructive pulmonary disease (COPD)
III hypercarbia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Moderate dyspnea requires high oxygen concentrations, such as those provided by a Venti-mask
or partial rebreathing face mask. Use these masks with caution in patients with chronic
obstructive pulmonary disease (COPD) and/or hypercarbia.
8 What is done to high oxygen concentrations in COPD patient with respiratory failure?
I Venti-mask
II endotracheal intubation
III ventilation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Patients in respiratory failure or those with COPD who need high oxygen concentrations may
require endotracheal intubation and ventilation.
9 Which out of the following is recombinant version of human activated protein C?
I drotrecogin alfa
II Factor VI
III Factor VII
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
A recombinant version of human activated protein C, drotrecogin alfa (Xigris) was the first
immunomodulatory drug approved for the treatment of severe sepsis.
10 Which is the first immunomodulatory drug approved for the treatment of severe sepsis?
I hydrocortisone
II drotrecogin alfa
III dexamethasone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
A recombinant version of human activated protein C, drotrecogin alfa (Xigris) was the first
immunomodulatory drug approved for the treatment of severe sepsis.
11 What should be the goal of pharmacotherapy in pneumonia patient?
I increases mortality
II to eradicate the infection
III reduce morbidity
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
The goals of pharmacotherapy for bacteria pneumonia are to eradicate the infection, reduce
morbidity, and prevent complications.
12 Which out of the following is first line antimicrobial agent for the treatment of
Penicillin susceptible Streptococcus pneumonia?
I Macrolide
II Penicillin G
III cephalosporin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Streptococcus pneumoniae
Penicillin susceptible Macrolide, cephalosporin (oral or parenteral),
Penicillin G, amoxicillin clindamycin, doxycycline, respiratory
(MIC < 2 mcg/mL) fluoroquinolone
Penicillin resistant Agents chosen on the basis Vancomycin, linezolid, high-dose amoxicillin
of sensitivity
13 Which out of the following is first line antimicrobial agent for the trea tment of
Penicillin susceptible Streptococcus pneumonia?
I cephalosporin
II Macrolide
III amoxicillin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
of sensitivity
14 Which out of the following is used as alternative antimicrobial agent for the treatment
of Penicillin susceptible Streptococcus pneumonia?
I amoxicillin
II Macrolide
III Penicillin G
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
of sensitivity
of Penicillin susceptible Streptococcus pneumonia?
I clindamycin
II doxycycline
III Penicillin G
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
of sensitivity
16Which out of the following is used as alternative antimicrobial agent for the treatment
of Penicillin resistant Streptococcus pneumonia?
I Vancomycin
II Penicillin G
III amoxicillin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
of sensitivity
of Penicillin resistant Streptococcus pneumonia?
I amoxicillin
II linezolid
III high-dose amoxicillin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
of sensitivity
Methicillin susceptible Streptococcus aureus?
I penicillin
II Macrolide
III Vancomycin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Staphylococcus aureus
Methicillin susceptible Antistaphylococcal penicillin Cefazolin, clindamycin
Methicillin resistant Vancomycin, linezolid Trimethoprim- sulfamethoxazole
Methicillin resistant Streptococcus aureus?
I Vancomycin
II Cefazolin
III linezolid
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
20 Which out of the following is alternative antimicrobial agent for the treatment of
Methicillin susceptible Streptococcus aureus?
I Vancomycin
II Cefazolin
III clindamycin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Methicillin resiatance Streptococcus aureus?
I Vancomycin
II Trimethoprim- sulfamethoxazole
III linezolid
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
22 Which out of the following is first line antimicrobial agent for the treatment of Non
beta-lactamase producing Haemophilus influenzae?
I doxycycline
II Fluoroquinolone
III Amoxicillin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Haemophilus influenzae
Non beta-
Fluoroquinolone, doxycycline,
lactamase Amoxicillin
azithromycin, clarithromycin
producing
Beta-lactamase Second- or third-generation cephalosporin, Fluoroquinolone, doxycycline,
producing amoxicillin/clavulanate azithromycin, clarithromycin
23 Which out of the following is first line antimicrobial agent for the treatment of beta -
lactamase producing Haemophilus influenzae?
I doxycycline
II amoxicillin/clavulanate
III clarithromycin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Non beta-
producing
24 Which out of the following is first line antimicrobial agent for the tr eatment of beta-
lactamase producing Haemophilus influenzae?
I Second- or third-generation cephalosporin

II clarithromycin
III azithromycin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Non beta-
producing
of Non beta-lactamase producing Haemophilus influenzae?
I Fluoroquinolone
II doxycycline
III Amoxicillin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Non beta-
producing
of Non beta-lactamase producing Haemophilus influenzae?
I clarithromycin
II Amoxicillin
III azithromycin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Non beta-
producing
of beta-lactamase producing Haemophilus influenzae?
I doxycycline
II Amoxicillin
III Fluoroquinolone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Non beta-
producing
of beta-lactamase producing Haemophilus influenzae?
I clarithromycin
II azithromycin
III Amoxicillin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Non beta-
producing
Mycoplasma pneumoniae?
I Macrolide
II tetracycline
III Fluoroquinolone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Mycoplasma pneumoniae Macrolide, tetracycline Fluoroquinolone

of Mycoplasma pneumoniae?
I Macrolide
II Fluoroquinolone
III tetracycline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans:B
Mycoplasma pneumoniae Macrolide, tetracycline Fluoroquinolone
Chlamydophila pneumoniae?
I Fluoroquinolone
II Macrolide
III tetracycline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Chlamydophila pneumoniae Macrolide, tetracycline Fluoroquinolone
of Chlamydophila pneumoniae?
I Fluoroquinolone
II Macrolide
III tetracycline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Chlamydophila pneumoniae Macrolide, tetracycline Fluoroquinolone
Legionella species?
I Doxycycline
II Fluoroquinolone
III azithromycin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Legionella species Fluoroquinolone, azithromycin Doxycycline
of Legionella species?
I Fluoroquinolone
II Doxycycline
III azithromycin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Legionella species Fluoroquinolone, azithromycin Doxycycline
Chlamydophila psittaci?
I clarithromycin
II Azithromycin
III Tetracycline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Chlamydophila psittaci Tetracycline Macrolide
Coxiella burnetii?
I clarithromycin
II Tetracycline
III Azithromycin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Coxiella burnetii Tetracycline Macrolide
Francisella tularensis?
I streptomycin
II Doxycycline
III Gentamicin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Francisella tularensis Doxycycline Gentamicin, streptomycin

Francisella tularensis?
I Doxycycline
II Gentamicin
III streptomycin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Francisella tularensis Doxycycline Gentamicin, streptomycin
39 Which out of the following is first line antimicrobial agent for the treatment of Yersinia
pestis?
I Streptomycin
II gentamicin
III Doxycycline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Yersinia pestis Streptomycin, gentamicin Doxycycline, fluoroquinolone
Yersinia pestis?
I Doxycycline
II Streptomycin
III fluoroquinolone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Yersinia pestis Streptomycin, gentamicin Doxycycline, fluoroquinolone
41 Which out of the following is first line antimicrobial agent for the treatment of Baci llus
anthracis?
I Ciprofloxacin
II levofloxacin
III rifampin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Other fluoroquinolones, beta-lactam (if

Bacillus anthracis Ciprofloxacin,
susceptible), rifampin, clindamycin,
(inhalational) levofloxacin, doxycycline
chloramphenicol
Bacillus anthracis?
I rifampin
II Ciprofloxacin
III clindamycin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Other fluoroquinolones, beta-lactam (if

Bacillus anthracis Ciprofloxacin,
susceptible), rifampin, clindamycin,
(inhalational) levofloxacin, doxycycline
chloramphenicol
Enterobacteriaceae?
I carbapenem
II fluoroquinolone
III Beta-lactam
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Third-generation Beta-lactam/beta-lactamase inhibitor,

Enterobacteriaceae
cephalosporin, carbapenem fluoroquinolone
Enterobacteriaceae?
I carbapenem
II fluoroquinolone
III cephalosporin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Third-generation Beta-lactam/beta-lactamase inhibitor,

Enterobacteriaceae
cephalosporin, carbapenem fluoroquinolone
Pseudomonas aeruginosa?
I Aminoglycoside plus ciprofloxacin

II Antipseudomonalbeta-lactam plus ciprofloxacin
III aminoglycoside
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Antipseudomonalbeta-lactam plus
Pseudomonas Aminoglycoside plus ciprofloxacin or
ciprofloxacin,levofloxacin,or
aeruginosa levofloxacin
aminoglycoside
Pseudomonas aeruginosa?
I Antipseudomonalbeta-lactam plus ciprofloxacin

II Aminoglycoside plus ciprofloxacin
III levofloxacin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Antipseudomonalbeta-lactam plus
Pseudomonas Aminoglycoside plus ciprofloxacin or
ciprofloxacin,levofloxacin,or
aeruginosa levofloxacin
aminoglycoside
Bordetella pertussis?
I Macrolide
II Trimethoprim
III sulfamethoxazole
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Bordetella pertussisMacrolideTrimethoprim- sulfamethoxazole.
Bordetella pertussis?
I Azithromycin
II Trimethoprim- sulfamethoxazole
III clarithromycin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Bordetella pertussis Macrolide Trimethoprim- sulfamethoxazole
Anaerobe?
I clindamycin
II Carbapenem
III levosulpiride
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Beta-lactam/beta-lactamase inhibitor,
Anaerobe (aspiration) Carbapenem
clindamycin
Anaerobe?
I Beta-lactam/beta-lactamase inhibitor
II clindamycin
III Carbapenem
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Anaerobe (aspiration) Beta-lactam/beta-lactamase inhibitor, clindamycin Carbapenem
51 Antibiotic choices in the outpatient setting should be driven by-
I presence of patient risk factors

II genetic mutation in human
III local trends in antibiotic resistance
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Antibiotic choices in the outpatient setting should be driven by the presence of patient risk factors,
including recent exposure to antibiotics, comorbidities, and local trends in antibiotic resistance.
52 Antibiotic choices in the outpatient setting should be driven by -
I genetic mutation in human

II recent exposure to antibiotics
III comorbidities
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
Antibiotic choices in the outpatient setting should be driven by the presence of patient risk factors,
including recent exposure to antibiotics, comorbidities, and local trends in antibiotic resistance.
53 According to Centers for Medicare and Medicaid Services (CMS) and Joint
Commission consensus guidelines, what should be the treatment in inpatient setting for
non-intensive care unit (ICU) pneumonia patients?
I Beta-lactam (intravenous or intramuscular) plus macrolide (IV or oral)
II Beta-lactam (IV or IM) plus doxycycline (IV or PO)
III Beta-lactam (PO) plus doxycycline (PO)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
For non-intensive care unit (ICU) patients, choose one option below:
 Beta-lactam (intravenous [IV] or intramuscular [IM] administration) plus macrolide (IV or
oral [PO])
 Beta-lactam (IV or IM) plus doxycycline (IV or PO)
non-intensive care unit (ICU) pneumonia patients?
I Antipneumococcal quinolone monotherapy (PO)

II Antipneumococcal quinolone monotherapy (IV or IM)
III administer macrolide monotherapy (IV or PO) in younger patient
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
For non-intensive care unit (ICU) patients, choose one option below:
 Antipneumococcal quinolone monotherapy (IV or IM)
 If the patient is younger than 65 years with no risk factors for drug-resistant organisms,
administer macrolide monotherapy (IV or PO)
intensive care unit (ICU) pneumonia patients?
I IV beta-lactam plus IV macrolide

II PO beta-lactam plus PO antipneumococcal quinolone
III IV beta-lactam plus IV antipneumococcal quinolone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
For ICU patients, choose one option below:
 IV beta-lactam plus IV macrolide
 IV beta-lactam plus IV antipneumococcal quinolone
 If the patient has a documented beta-lactam allergy, administer IV antipneumococcal

quinolone plus IV aztreonam
intensive care unit (ICU) pneumonia patients?
I administer PO antipneumococcal quinolone plus IV aztreonam

II administer IV antipneumococcal quinolone plus IV aztreonam
III administer IV antipneumococcal quinolone plus PO aztreonam
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
For ICU patients, choose one option below:
If the patient has a documented beta-lactam allergy, administer IV antipneumococcal quinolone plus
IV aztreonam.
57 Which out of the following are the supportive measures for pneumonia?
I Analgesia
II antipyretics
III Antibiotics
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Supportive measures include the following (some were mentioned previously):
 Analgesia and antipyretics
I Chest physiotherapy
II Antibiotics
III Intravenous fluids
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Chest physiotherapy
 Intravenous fluids (and, conversely, diuretics) if indicated
I Antibiotics
II Monitoring Pulse oximetry
III Oxygen supplementation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Monitoring Pulse oximetry with or without cardiac monitoring, as indicated
 Oxygen supplementation
I Positioning of the patient to minimize aspiration risk

II Antibiotics
III Respiratory therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Positioning of the patient to minimize aspiration risk
 Respiratory therapy, including treatment with bronchodilators and, perhaps, N -

acetylcysteine in selected patients
I Antibiotics
II Suctioning and bronchial hygiene
III Mechanical ventilatory support with low tidal volumes
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Suctioning and bronchial hygiene
 Mechanical ventilatory support with low tidal volumes (6 mL/kg of ideal body weight)
I Systemic support may include proper hydration

II Antibiotics
III Systemic support may include proper nutrition
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Systemic support may include proper hydration, nutrition, and early mobilization to create
a positive host milieu to fight infection and speed recovery.
63 What are the potential complications of bacterial pneumonia?
I Destruction and fibrosis

II fat cavitation
III Bronchiectasis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Potential complications of bacterial pneumonia include the following:
 Destruction and fibrosis/organization of lung parenchyma with scarring
 Bronchiectasis
I fat cavitation
II Necrotizing pneumonia
III Frank cavitation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Necrotizing pneumonia
 Frank cavitation
I Empyema
II Pulmonary abscess
III fat cavitation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
 Empyema
 Pulmonary abscess
I Respiratory failure
II fat cavitation
III Acute respiratory distress syndrome
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Respiratory failure
 Acute respiratory distress syndrome

I fat cavitation
II Ventilator dependence
III Superinfection
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E
 Ventilator dependence
 Superinfection
I Meningitis
II fat cavitation
III Bullous myringitis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
 Meningitis
 Bullous myringitis
 Death
69 Which Interventions should be considered to prevent nosocomial pneumonia?
I nutritional support
II attention to the size and nature of the gastrointestinal reservoir of microorganisms
III Horizontal-rotation bed therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Interventions that should be considered or undertaken include nutritional support, attention to the
size and nature of the gastrointestinal reservoir of microorganisms, careful handling of ventilator
tubing and associated equipment, subglottic secretion drainage, and lateral-rotation bed therapy.
70 Which Interventions should be considered to prevent nosocomial pneumonia?
I careful handling of ventilator tubing and associated equipment

II horizontal-rotation bed therapy
III lateral-rotation bed therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Interventions that should be considered or undertaken include nutritional support, attention to the
size and nature of the gastrointestinal reservoir of microorganisms, careful handling of ventilator
tubing and associated equipment, subglottic secretion drainage, and lateral-rotation bed therapy.
71 Which drug can be classified as fluoroquinolone?
I doxycycline
II Ciprofloxacin
III tetracycline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Ciprofloxacin is a fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth,
by inhibiting DNA gyrase and topoisomerases.
72 What is the pharmacological mechanism of Ciprofloxacin?
I binding to the 30S and possibly 50S ribosomal subunits of susceptible bacteria
II inhibits DNA gyrase and topoisomerases
III inhibits bacterial dihydrofolate reductase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Ciprofloxacin is a fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth,
by inhibiting DNA gyrase and topoisomerases.
73 Which is a lincosamide semisynthetic antibiotic produced by 7(S)-chloro-substitution

of 7(R)-hydroxyl group of lincomycin?
I tertacycline
II Ciprofloxacin
III Clindamycin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Clindamycin is a lincosamide semisynthetic antibiotic produced by 7(S)-chloro-substitution of 7(R)-
hydroxyl group of the parent compound lincomycin.
74 What is the pharmacological mechanism of Doxycycline?
II inhibits DNA gyrase and topoisomerases
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Doxycycline inhibits protein synthesis and, thus, bacterial growth, by binding to the 30S and possibly
50S ribosomal subunits of susceptible bacteria.
75 What is the pharmacological mechanism of clavulanate?
II inhibits beta-lactamase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
The addition of clavulanate inhibits beta-lactamase producing bacteria.
76 What is the dose of amoxicillin/clavulanic in children weighing above 40 kg?
I 250/125
II 350/125
III 450/125
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
For children older than 3 months, base the dosing protocol on the amoxicillin content. Due to different
amoxicillin/clavulanic acid ratios in the 250-mg tablet (250/125) vs 250 mg chewable tablet
(250/62.5), do not use the 250-mg tablet until the child weighs >40 kg.
77 Which drug can be classified as third-generation cephalosporin?
I Ceftazidime
II tetracycline
III Ceftriaxone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Ceftazidime is a third-generation cephalosporin, Ceftriaxone is a third-generation cephalosporin.
78 Which drug is the L stereoisomer of the parent compound ofloxacin?
I Ceftazidime
II Levofloxacin
III Ceftriaxone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Levofloxacin is the L stereoisomer of the D/L parent compound ofloxacin, the D form being inactive.
79 Which stereoisomer of ofloxacin has an antibacterial activity?
I Ceftazidime
II Ceftriaxone
III Levofloxacin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Levofloxacin is the L stereoisomer of the D/L parent compound ofloxacin, the D form being inactive.
80 Which agent is a semisynthetic macrolide antibiotic that reversibly binds to the P site
of the 50S ribosomal subunit of susceptible organisms?
I Clarithromycin
II Ceftazidime
III Levofloxacin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Clarithromycin ; This agent is a semisynthetic macrolide antibiotic that reversibly binds to the P site
of the 50S ribosomal subunit of susceptible organisms and may inhibit RNA-dependent protein
synthesis by stimulating dissociation of peptidyl t-RNA from ribosomes, causing bacterial growth
inhibition.
81 Which drug can be classified as macrolide antibiotics?
I Clarithromycin
II Erythromycin
III Levofloxacin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Erythromycin is a macrolide that inhibits bacterial growth possibly by blocking dissociation of peptidyl
t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
82 Which drug is a lipoglycopeptide antibacterial that is a synthetic derivative of

vancomycin?
I Levofloxacin
II Erythromycin
III Telavancin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F
Telavancin is a lipoglycopeptide antibacterial that is a synthetic derivative of vancomycin. It is
indicated for treatment of adults with hospital-acquired and ventilator-associated bacterial
pneumonia (HABP/VABP).
83 Which drug is indicated for treatment of adults with hospital-acquired and ventilator-
associated bacterial pneumonia (HABP/VABP)?
I Telavancin
II Erythromycin
III Levofloxacin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Telavancin is a lipoglycopeptide antibacterial that is a synthetic derivative of vancomycin. It is
indicated for treatment of adults with hospital-acquired and ventilator-associated bacterial
pneumonia (HABP/VABP).
84 Which antibiotic inhibits A subunits of DNA gyrase in bacteria?
I doxycycline
II tetracycline
III Moxifloxacin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Moxifloxacin is a fluoroquinolone that inhibits the A subunits of DNA gyrase, resulting in inhibition
of bacterial DNA replication and trAns:cription. Use caution in prolonged therapy, and perform
periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic).
85 What is the contradiction of Moxifloxacin?
I renal failure
II hepatic failure
III hypotension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Moxifloxacin is a fluoroquinolone that inhibits the A subunits of DNA gyrase, resulting in inhibition
of bacterial DNA replication and trAns:cription. Use caution in prolonged therapy, and perform
periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic).
86 What is the pharmacological mechanism of Penicillin G?
I inhibits dihydrofolate reductase

II interferes with the synthesis of cell wall mucopeptides
III inhibits beta-lactamase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Penicillin G interferes with the synthesis of cell wall mucopeptides during active multiplication,
resulting in bactericidal activity against susceptible microorganisms.
87 Which out of the following is correct drug combination used for the treatment of
pneumonia?
I Piperacillin and tazobactam

II Piperacillin and penicilline
III Piperacillin and doxycycline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Piperacillin and tazobactam ; Perform CBC counts before the initiation of therapy and at least weekly
during therapy. In addition, monitor for liver function abnormalities by measuring AST and ALT
levels during therapy, and perform urinalysis and BUN and creatinine determinations during
therapy.
88 Which antibiotic can be classified as fifth-generation cephalosporin?
I Piperacillin
II Ceftaroline
III tazobactam
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Ceftaroline is a fifth-generation cephalosporin indicated for community-acquired bacterial
pneumonia and for acute bacterial skin and skin structure infections, including methicillin-resistant
Staphylococcus aureus (MRSA).
89 Which drug is indicated for community-acquired bacterial pneumonia and acute

bacterial skin and skin structure infections?
I Ceftaroline
II tazobactam
III Piperacillin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Ceftaroline is a fifth-generation cephalosporin indicated for community-acquired bacterial
pneumonia and for acute bacterial skin and skin structure infections, including methicillin-resistant
Staphylococcus aureus (MRSA).
90 Why Cefprozil is not coadministered with furosemide?
I increase neurone damage

II increases nephrotoxic effects
III increase cardiac damage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B
Cefprozil; 91 90 Use this agent with caution in patients with renal impairment (coadministration
with furosemide and aminoglycosides increases nephrotoxic effects). Probenecid coadministration also
increases the effect of cefprozil.
91 Why Cefprozil is not coadministered with aminoglycosides?
I increase cardiac damage

II increase neurone damage
III increases nephrotoxic effects
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Cefprozil; 91 90 Use this agent with caution in patients with renal impairment (coadministration
with furosemide and aminoglycosides increases nephrotoxic effects). Probenecid coadministration also
increases the effect of cefprozil.
92 Which out of the following is correct drug combination used for the treatment of
pneumonia?
I Ticarcillin and clavulanate

II Piperacillin and penicilline
III Piperacillin and doxycycline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
Ticarcillin and clavulanate.
93 How recombinant form of human activated protein C exerts antithrombotic effect?
I inhibiting factors Va
II inhibiting factors IVa
III inhibiting factors VIa
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A
The recombinant form of human activated protein C exerts antithrombotic effect by inhibiting factors
Va and VIIIa.
94 How recombinant form of human activated protein C exerts antithrombotic effect?
I inhibiting factors VIa

II inhibiting factors IVa
III inhibiting factors VIIIa
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
The recombinant form of human activated protein C exerts antithrombotic effect by inhibiting factors
Va and VIIIa.
95 Which out of the following is Recombinant Human Activated Protein C?
I doxycycline
II tetracycline
III Drotrecogin alfa
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C
Recombinant Human Activated Protein C; Drotrecogin alfa.
96 What is the pharmacological mechanism of Hydrocortisone?
I mineralocorticoid activity
II glucocorticoid effects
III aspirin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D
Hydrocortisone; 96 Hydrocortisone is the drug of choice because of its mineralocorticoid activity and
glucocorticoid effects.
97 Which drug can be classified as Glucocorticoids?
I aspirin
II Hydrocortisone
III paracetamol
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Glucocorticoids; Hydrocortisone.
98 Pneumococcal vaccine is recommended for individuals who are-
I hypotension
II have functional or anatomic asplenia
III cerebrospinal fluid leaks
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
These vaccines are also recommended for individuals who are immunocompromised (eg, HIV, cancer,
renal disease), or have functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants.
99 Pneumococcal vaccine is recommended for individuals who are-
I immunocompromised
II cochlear implants
III hypertension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
These vaccines are also recommended for individuals who are immunocompromised (eg, HIV, cancer,
renal disease), or have functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants.
100 Which out of the following can be classified as Pneumococcal vaccine?
I Pneumococcal vaccine 13-valent

II Pneumococcal vaccine 14-valent
III Pneumococcal vaccine polyvalent
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Vaccines; Pneumococcal vaccine 13-valent, Pneumococcal vaccine polyvalent.
MIGRAINE

1. Which of the following are symptoms of Migraine;
I Unilateral and localized pain
II Headache that lasts 4-72 hours
III Pain in TrAns:versospinalis and Oculus muscles
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Typical symptoms of migraine include the following:

Throbbing or pulsatile headache, with moderate to severe pain that intensifies with movement or
physical activity
Unilateral and localized pain in the frontotemporal and ocular area, but the pain may be felt
anywhere around the head or neck
Pain builds up over a period of 1-2 hours, progressing posteriorly and becoming diffuse
Headache lasts 4-72 hours
Nausea (80%) and vomiting (50%), including anorexia and food intolerance, and light-
headedness
Sensitivity to light and sound (Page 7)
2 A woman of 35 years, with a history of migraine attacks, was admitted to hospital with
ocular musle paralysis and ptosis with negligible papillary response. Which of the
following migraine types does she suffer from?
I Hemiplegic migraine
II Basilar-type migraine
III Ophthalmoplegic migraine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. A migraine variant may be suggested by focal neurologic findings, such as the following, that occur
with the headache and persist temporarily after the pain resolves:
Unilateral paralysis or weakness - Hemiplegic migraine
Aphasia, syncope, and balance problems - Basilar-type migraine
Third nerve palsy with ocular muscle paralysis and ptosis, including or sparing the pupillary
response - Ophthalmoplegic migraine (Page 8)
3 Under what circumstances should neuroimaging studies be performed to diagnose

migraine
I When a person have had stable headaches that meet criteria for migraine
II When a person have had migraine-like headache for first time
III When a person is having headache which relieve even after taking pain killers
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. Don't perform neuroimaging studies in patients with stable headaches that meet criteria for
migraine. (Page 9)
4 Which of the following drugs are used as a prophylactic drug for migraine
I Aspirin
II Valproate
III Metoprolol
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. Prophylactic medications include the following:

Antiepileptic drugs
Beta blockers
Calcium channel blockers
Selective serotonin reuptake inhibitors (SSRIs)
NSAIDs
Serotonin antagonists
Botulinum toxin (Page 9)
5 A working man of 42 years of age have had mild to moderate symptoms of migraine
during his office hours due to which he is unable to concentrate on the work assigned to
him. What drug(s) would you recommend to him
I Aspirin
II Lopressor
III Drink coffee
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. Coffee is helpful for non-recurrent headaches (Page 9)
6 What is typical of a migraine pain as told by patients?

I Increased heart rate
II Moderate to severe throbbing
III Unilateral head pain
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. Migraine is characterized most often by unilateral head pain that is moderate to severe, throbbing,
and aggravated by activity. (Page 10)
7 Which of the following is NOT a type of migraine

I Basilar migraine
II Hemiplegic migraine
III Sinusitis migraine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. III is not a type of migraine but sinusitis is sinus problem (Page 10).
8 According to International Classification of Headache Disorders (ICHD), which of the

following statement defines chronic migraines;
I A migraine pain that occurs for 15 days of the month for more than 3 months
II A migraine pain that occurs for 10 days a month for more than 3 months
III A migraine pain that occurs for 15 days a month for more than 2 months
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. A migraine pain that occurs for 15 days of the month for more than 3 months (Page 12).
9 Which of the following criteria must be met for the diagnosis of migraine with aura as
per ICHD
I Each aura symptom should last 5 min to 1 hour
II The aura being accompanied by or followed shortly by headache
III The aura should observable by surrounding people
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. In migraine with aura, each aura symptom should last 5 min to 1 hour.
And The aura should be accompanied by or followed shortly by headache (Page 12).
10 Select the false sentence

I Migraine can be accompanied with aura or without aura
II A migraine pain is always unilateral
III Migraine is more common in females than in males
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. A migraine pain is always unilateral or bilateral. (page 11).
11 According to International Headache Society, how many bouts of migraine -like

headache should a person have in order to be prescribed for medication?
I4
II 3
III 5
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. According to the International Headache Society, the diagnosis of migraine requires that the patient
has experienced at least 5 attacks that fulfill 3 migraine criteria and that are not attributable to another
disorder. (page 12).
12 In June 2013, which edition of International Classification of Headache Disorders was

published
I Second edition
II Third edition
III Fourth edition
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. In June 2013, the International Classification of Headache Disorders, Third Edition (ICHD-III,
beta version) was published and is available for field testing, which will take place for several years before the
final version is published. (page 12)
13 Which of the following line(s) is the correct definition of thunderclap headache?

I It is a severe headache and has a sudden onset
II Its maximum intensity is reached within minutes
III It is more common in women than in men
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. For thunderclap headaches, the headache must last at least 5 minutes, but the criterion of not
recurring regularly during subsequent weeks or months has been discarded. (page 12)
14 Which of the following is false regarding hypnic headaches

I They occur only after the age of 50 years
II They last for 15-180 min
III They commonly occur at night
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Hypnic headaches no longer have to first occur after age 50 years .(page 12)
15 Which of the following theories try to explain the pathophysiology of migraine

I Neuro theory
II Vascular theory
III Neurovascular theory
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. Neurovascular theory explain the pathophysiology of migraine .(page 13)
16 What similarity is observed between a person suffering from migraine and another
person suffering from epilepsy
I Both are accompanied with cephalgia
II Both demonstrate postictal headache
III Both demonstrate interictal neuronal irritability
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. At baseline, a migraineur who is not having any headache has a state of neuronal hyperexcitability
in the cerebral cortex, especially in the occipital cortex.[14] This finding has been demonstrated in studies of
trAns:cranial magnetic stimulation and with functional magnetic resonance imaging (MRI).
This observation explains the special susceptibility of the migrainous brain to headaches.[15] One can draw
a parallel with the patient with epilepsy who similarly has interictal neuronal irritability. (page 14)
17 What is cortical spreading depression

I It is a theory to explain the mechanism of migraine with aura
II It is a theory to explain the mechanism of migraine without aura
III It is theory used to explain both types of migraine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Please refer to page 14
18 What is CSD?
I It stands for cortical spreading depression
II It is a well-defined wave of neuronal excitation
III It spreads from its site of origin at the rate of 10 mm/min
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. CSD is a well-defined wave of neuronal excitation in the cortical gray matter that spreads from its
site of origin at the rate of 2-6 mm/min. (page 14)
19 What is the neurochemical basis of CSD?

I Release of potassium or the excitatory amino acid glutamate from neural tissue
II Release of sodium or the excitatory amino acid alanine from neural tissue
III Release of potassium or the excitatory amino acid proline from neural tissue
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. The neurochemical basis of the CSD is the release of potassium or the excitatory amino acid
glutamate from neural tissue. (page 14)
20 Which of the following drugs has been successful in inhibiting CSD?

I Phenyltoin
II Tonabersat
III Levipil
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Tonabersat has been successful in inhibiting CSD. (page 14)
21 During a migrainous aura, what is seen in a PET scan regarding the blood flow?
I The blood flow is moderately reduced
II The blood flow is moderately increased
III The blood flow neither increases nor decreases
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Positron emission tomography (PET) scanning demonstrates that blood flow is moderately reduced
during a migrainous aura, but the spreading oligemia does not correspond to vascular territories. (page 14)
22 Which system is activated during CSD period?
I Peripheral Vascular system
II Trigeminovascular system
III Trigeminal vascular system
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Activation of the trigeminovascular system by CSD stimulates nociceptive neurons on dural blood
vessels to release plasma proteins and pain-generating substances such as calcitonin gene-related peptide,
substance P, vasoactive intestinal peptide, and neurokinin A. (page 14)
23 What causes migraine pain?

I Inflammation
II Vasodilation
III Constriction
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Inflammation and Vasodilation cause migraine pain. (page 14)
24 Which Metalloproteinase level increase during migraine?

I MMP-7
II MMP-2
III MMP-5
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Increased net activity of matrix metalloproteinase 2 (MMP-2) has been demonstrated in
migraineurs. (page 15)
25 What is induced by a single episode of CSD?

I Acute hypoxia
II Chronic hypoxia
III Acute hyperoxia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Hypoxia can be induced by a single episode of CSD. (page 15)
26 Which substances released during Perivascular nerve activity result in dilation

I Neurokinin A
II Neurokinin B
III Nitric oxide
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. Perivascular nerve activity also results in release of substances such as substance P, neurokinin A,
calcitonin gene-related peptide, and nitric oxide, which interact with the blood vessel wall to produce
dilation, protein extravasation, and sterile inflammation. (page 15)
27 Which receptors are activated during pain process?

I Nociceptors
II 3-HT receptors
III F-protein coupled receptors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. , the pain process requires not only the activation of nociceptors of pain-producing intracranial
structures but also reduction in the normal functioning of endogenous pain-control pathways that gate the
pain. (page 15)
28 Based on PET scan, which of the following has been proposed as potential migraine
center
I Periaqueductal gray
II Midbrain reticular formation
III locus cercelius
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. A potential "migraine center" in the brainstem has been proposed, based on PET-scan results
showing persistently elevated rCBF in the brainstem (ie, periaqueductal gray, midbrain reticular formation.
(page 16)
29 Which of the following levels are increased during a migraine without aura
I rCFB
II rCBF
III rFCB
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. A potential "migraine center" in the brainstem has been proposed, based on PET-scan results
showing persistently elevated rCBF in the brainstem (ie, periaqueductal gray, midbrain reticular formation,
locus ceruleus) even after sumatriptan-produced resolution of headache and related symptoms. (page 16)
30 Which of the following can trigger cutaneous allodynia?

I Wearing shoes
II Combing the hair
III Wearing glasses
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. Burstein et al described the phenomenon of cutaneous allodynia, in which secondary pain pathways
of the trigeminothalamic system become sensitized during a migrainous episode.[22] This observation
demonstrates that, along with the previously described neurovascular events, sensitization of central pathways
in the brain mediates the pain of migraine. (page 16)
31 Which of the following is Dopamine antagonists

I Prochlorperazine
II Naloxone
III Naltrexone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Dopamine receptor hypersensitivity has been shown experimentally with dopamine agonists (eg,
apomorphine). Dopamine antagonists (eg, prochlorperazine) completely relieve almost 75% of acute
migraine attacks. (page 17)
32 Which of the following mineral deficiency can result in Migraine?

I Sodium
II Calcium
III Magnesium
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. Another theory proposes that deficiency of magnesium in the brain triggers a chain of events, starting
with platelet aggregation and glutamate release and finally resulting in the release of 5-hydroxytryptamine,
which is a vasoconstrictor. (page 17)
33 During which phase are woman more predisposed to having migraine attack?
I Premenopausal
II End of the month
III On New eve
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Nitric oxide levels continue to be increased even in the headache-free period in migraineurs. In
premenopausal women with migraine, particularly in those with migraine aura, increased endothelial
activation, which is a component of endothelial dysfunction, is evident. (page 17)
34 Which is the most important receptor in the headache pathway?
I 5-HT
II 3-HT
III 4-HT
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. The serotonin receptor (5-hydroxytryptamine [5-HT]) is believed to be the most important receptor
in the headache pathway. (page 17)
35 Which of the following is a migraine risk factor?

I Increased levels of TNF-beta
II Increased levels of interleukins
III High blood pressure
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. Predisposing vascular risk factors for migraine include the following:
Increased levels of C-reactive protein
Increased levels of interleukins
Increased levels of TNF-alpha and adhesion molecules (systemic inflammation markers)
Oxidative stress and thrombosis
Increased body weight
High blood pressure
Hypercholesterolemia
Impaired insulin sensitivity
High homocysteine levels
Stroke
Coronary heart disease (page 18)
36 Which of the following types of medication overuse by people having high frequency of
headaches results in migraine progression?
I Ibuprofen
II Amitiza
III Glycolax
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Acute overuse of symptomatic medication is considered one of the most important risk factors for
migraine progression. (page 18)
37 What percentage of migraine patients have a first-degree relative with a history of

migraine?
I 80%
II 70%
III 60%
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Approximately 70% of migraine patients have a first-degree relative with a history of migraine.
(page 18)
38 What does FHM stand for?

I Familial hemiplegic migraine
II Familiar hemiplegic migraine
III Familial Homoplegic migraine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Familial hemiplegic migraine (FHM) is a rare type of migraine with aura that is preceded or
followed by hemiplegia, which typically resolves. (page 19)
39 FHM type I disorder is caused by mutations in the CACNA1A gene located on

I 17p13
II 18p13
III 19p13
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. FHM type 1 is characterized clinically by episodes that commonly include nystagmus and cerebellar
signs. This disorder is caused by mutations in the CACNA1A gene located on 19p13, which codes for a
brain-specific calcium channel. (page 19)
40 FHM type II occurs in patients who also have a

I Seizure disorder
II Fatty liver
III Heart disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. FHM type 2 occurs in patients who also have a seizure disorder. (page 19)
41 FHM type 3 is caused by mutations in which gene

I SCN2A
II SCN1A
III SCN3A
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. FHM type 3 is caused by mutations in the SCN1A gene, located on 2q24. (page 19)
42 Migraine occurs with increased frequency in patients with which of the following
disorders
I MELAS
II CADASIL
III CAFASIL
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Migraine occurs with increased frequency in patients with mitochondrial disorders, such as MELAS
(mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes). (page 19)
43 Which of the following autosomal dominant disorders result in migraine

I HRCT
II HIHRATL
III RVCL
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. Migraine is also a common symptom in other genetic vasculopathies, including 2 autosomal
dominant disorders: (1) RVCL (retinal vasculopathy with cerebral leukodystrophy), which is caused by
mutations in the TREX1 gene, and (2) HIHRATL (hereditary infantile hemiparesis, retinal arteriolar
tortuosity, and leukoencephalopathy), which is suggested to be caused by mutations in the COL4A1
gene.(page 19)
44 Which of the following are commonly identified precipitants of migraine events

I White wine
II Insufficient sleep
III Stress
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. Various precipitants of migraine events have been identified, as follows:

Hormonal changes, such as those accompanying menstruation (common), pregnancy, and ovulation
Stress
Excessive or insufficient sleep
Medications (eg, vasodilators, oral contraceptives )
Smoking
Exposure to bright or fluorescent lighting
Strong odors (eg, perfumes, colognes, petroleum distillates)
Head trauma
Weather changes
Motion sickness
Cold stimulus (eg, ice cream headaches)
Lack of exercise
Fasting or skipping meals
Red wine (page 20)
45 Which of the following foods and food additives have are commonly identified
precipitants of migraine?
I Artificial sweeteners (eg, aspartame, saccharin)
II Monosodium glutamate (MSG)
III Carrot juice
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Certain foods and food additives have been suggested as potential precipitants of migraine, including
the following:
Caffeine
Artificial sweeteners (eg, aspartame, saccharin)
Monosodium glutamate (MSG)
Citrus fruits
Foods containing tyramine (eg, aged cheese)
Meats with nitrites (page 20)
46 Which of the following vascular diseases commonly accompany migraine headache?

I Cardiovascular disease
II Perivascular disease
III Cerebrovascular disease
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. People who suffer from migraine headaches are more likely to also have cardiovascular or
cerebrovascular disease (ie, stroke, myocardial infarction). (page 20)
47 Migraineurs had increased local iron deposits in

I putamen
II globus pallidus
III White nucleus
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. In a population-based MRI study by Kruit et al, migraineurs had increased local iron deposits in the
putamen, globus pallidus, and red nucleus, compared with controls.(page 21)
48 As per ICHD, which of the following races is most affected by migraine?

I African AmericAns:
II Asian AmericAns:
III Whites
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. The prevalence of migraine appears to be lower among African AmericAns: and Asian AmericAns:
than among whites. (page 21)
49 As per American Migraine Study, on the average how many bed-rest days per year are
required for men and women for migraineurs?
I 3.8 bed-rest days per year for men and 5.6 bed-rest days per year for women
II 4.0 bed-rest days per year for men and 5.6 bed-rest days per year for women
III 4.0 bed-rest days per year for men and 5.0 bed-rest days per year for women
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Migraineur men required 3.8 bed-rest days per year, whereas women required 5.6 bed-rest days per
year. (page 22)
50 What is the relationship between migraine prevalence to household income and level of
education in the United States?
I Direct
II Inverse
III Equal
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. In the United States, migraine prevalence is inversely correlated with household income and level of
education. (page 22)
51 What fold increased risk of subclinical cerebellar stroke do migraineurs have?

I2
II 2.5
III 3
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Migraineurs, male and female, have a 2.5-fold increased risk of subclinical cerebellar stroke and
those with migraines with aura and increased headache frequency are at the highest risk. (page 23)
52 Which medication(s) increases the risk of migraine with aura in woman?

I Analgesics
II ACE inhibitors
III Oral Contraceptives
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. The Women's Health Study, which included professional women older than 45 years, showed that
any history of migraine is associated with a higher incidence of major cardiovascular disease and that the
highest risk is associated with migraine with aura, with a 2.3-fold risk of cardiovascular death and a 1.3-
fold risk of coronary vascularization. However, those who have migraine without aura have the same risks as
the general population. (page 23)
53 Woman suffering from migraine with aura have an increased risk of which of the
following diseases
I Cardiovascular disease
II Coronary vascularization
III Varicose veins
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. The Women's Health Study, which included professional women older than 45 years, showed that
any history of migraine is associated with a higher incidence of major cardiovascular disease and that the
highest risk is associated with migraine with aura, with a 2.3-fold risk of cardiovascular death and a 1.3-
fold risk of coronary vascularization.[64] However, those who have migraine without aura have the same
risks as the general population. (page 23)
54 More than two-thirds of the females report attacks lasting longer than
I 72 hours
II 24 hours
III 48 hours
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. The headache typically lasts from 4-72 hours. Among females, more than two thirds of patients
report attacks lasting longer than 24 hours. (page 24)
55 Which of the following are common associated symptoms of migraine, reported in

more than 50% of the patients
I Vomiting
II Nausea
III Hunger pangs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Nausea and vomiting usually occur later in the attack in about 80% and 50% of patients,
respectively, along with anorexia and food intolerance. (page 24)
56 What neurological symptoms may accompany migraine?

I Aphasia
II Confusion
III Heightened alertness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Other neurologic symptoms that may be observed include the following:
Hemiparesis (this symptom defines hemiplegic migraine)
Aphasia
Confusion
Paresthesias or numbness (page 24)
57 Although it is tough to observe any premonitory symptoms of migraine, especially if

they occur in isolation to headache, still which of the following usually predate migraine
attack
I Heightened sensitivity to light, sound, and odors
II Anemia
III Lethargy or uncontrollable yawning
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. Plea. Although the prodromal features vary, they tend to be consistent for a given individual and
may include the following:
Heightened sensitivity to light, sound, and odors
Lethargy or uncontrollable yawning
Food cravings
Mental and mood changes (eg, depression, anger, euphoria)
Excessive thirst and polyuria
Fluid retention
Anorexia
Constipation or diarrhea (page 24)
58 Migraine aura occurs

I Before the headache phase
II During the headache phase
III After the headache phase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. The migraine aura is a complex of neurologic symptoms that may precede or accompany the
headache phase or may occur in isolation. It usually develops over 5-20 minutes and lasts less than 60
minutes. The aura can be visual, sensory, or motor or any combination of these. (page 25)
59 What negative visual phenomena are observed during migraine

I Eye twiching
II Tunnel vision
III Complete blindness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. Auras most commonly consist of visual symptoms, which may be negative or positive. Negative
symptoms (see the images below) include negative scotomata or negative visual phenomena, such as the
following:
Homonymous hemianopic or quadrantic field defects
Central scotomas
Tunnel vision
Altitudinal visual defects
Complete blindness (page 25)
60 A woman, 25 years of age, experiences partial loss of vision in the centre before a
migraine attack. What kind of migraine is she suffering from?
I Migraine without aura
II Migraine with aura
III Scotoma
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Migraine with aura associated with partial loss of vision. (page 25)
61 Apart from Scotoma, which of the following visual symptoms a person suffering from
migraine with aura might experience
I macropsia
II micropsia
III Mirage
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Heat waves, fractured vision, macropsia, micropsia, and achromatopsia are other visual symptoms
that may occur. (page 27)
62 At what rate does parathesias occur compared to TIA (TrAns:ient Ischemic attack)
I Slower
II Faster
III Same
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Just as a visual aura spreads across the visual field slowly, paresthesias may take 10-20 minutes to
spread, which is slower than the spread of sensory symptoms of TIA. (page 28)
63 Speech and language disturbances have been reported in what percentage of the
patients?
I 10-13%
II 14-17%
III 17-20%
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. Speech and language disturbances have been reported in 17-20% of patients. (page 28)
64 What is acephalic migraine?

I A headache occurring in both sides of brain
II An aura is not followed by a headache
III Headache along with neck pain
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. When an aura is not followed by a headache, it is called a migraine equivalent or acephalic
migraine. (page 28)
65 Which of the following is/are considered a diagnostic of migraine even in the absence
of a headache?
I Scintillating scotoma
II Coruscating scotoma
III Congruent scotoma
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Scintillating scotoma has been considered to be diagnostic of migraine even in the absence of a
headache; however, paresthesias, weakness, and other trAns:ient neurologic symptoms are not. (page 28)
66 Which of the following Postdromal symptoms may persist for 24 hours after the
headache
I Feeling irritable
II Feeling suicidal
III Feeling euphoric
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. Postdromal symptoms may persist for 24 hours after the headache and can include the following:
Tired, or irritable feeling
Unusually refreshed or euphoric feeling
Muscle weakness or myalgias
Anorexia or food cravings (page 28)
67 Which of the following medications can trigger Migraine?

I Aspirin
II Histamine
III Estrogen
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. A history of migraine triggers may be elicited. Common triggers include the following:
Hormonal changes (eg, those resulting from menstruation, ovulation, oral contraceptives, or
hormone replacement)
Head trauma
Lack of exercise [47]
Sleep changes
Medications (eg, nitroglycerin, histamine, reserpine, hydralazine, ranitidine, estrogen)
Stress (page 29)
68 Which of the following is true regarding the genetic influence in causing migraine
I Approximately 60% of patients have a first-degree relative with a history of migraine
II All the SNPs that cause migraine have been identified
III The specific nature of the genetic influence is not yet completely understood
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. Migraine headache generally shows a multifactorial inheritance pattern, but the specific nature of
the genetic influence is not yet completely understood. (page 29)
69 Which questionnaire is ideally followed to quantify the extent of disability on the first
visit
I MDA (Migraine disability assessment)
II MIDAS (Migraine disability assessment scale)
III DDM (Disability due to Migraine)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Simple questionnaires, such as the Migraine Disability Assessment Scale (MIDAS), can be used to
quantify the extent of disability on the first visit. These questionnaires can also be used for follow-up
evaluations. (page 29)
70 Which of the following physical symptoms is NOT related to migraine?

I Dim scotoma lasting a few seconds to several minutes (ie, amaurosis)
II Leucoderma
III Increased lethargy (unrelated to medication use)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Pertinent physical examination findings that suggest a headache diagnosis other than migraine
Dim scotoma lasting a few seconds to several minutes (ie, amaurosis)
Temporal artery tenderness in the elderly
Meningismus
Increased lethargy (unrelated to medication use)
Mental status changes (page 29 & 30)
71 What is Basilar-type migraine?

I It is migraine accompanied with aphasia, syncope, and balance problems
II It is migraine accompanied with unilateral paralysis or weakness
III It is migraine accompanied with third nerve palsy, with ocular muscle paralysis and ptosis, including
or sparing the pupillary response
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. focal neurologic findings that occur with the headache and persist temporarily after the pain resolves
suggest a migraine variant, as follows:
Aphasia, syncope, and balance problems - Basilar-type migraines
Third nerve palsy, with ocular muscle paralysis and ptosis, including or sparing the pupillary
response - Ophthalmoplegic migraine (page 30)
72 What is hemiplegic migraine?

A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. focal neurologic findings that occur with the headache and persist temporarily after the pain resolves
73 What is Ophthalmoplegic migraine?
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. focal neurologic findings that occur with the headache and persist temporarily after the pain resolves
74 Which of the following migraines with aura are common among children?
I Ophthalmoplegic migraine
II Basilar-type migraines
III Hemiplegic migraine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Ophthalmic migraines cause a visual disturbance (usually lateral field deficit). This variant is more
common in children, with the abnormal motor findings lasting hours to days after the headache. (page 30)
75 What is phonophobia?
I It is the fear of loud sounds
II It is an anxiety disorder
III It is a hearing disorder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. In addition, during the headache the patient must have had at least 1 of the following:
Nausea and/or vomiting
Photophobia and phonophobia (page 30)
76 Which of the following are variants of migraine?

I xenophobic migraine
II Status migrainosus
III Retinal migraine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. Migraine variants include the following:

Childhood periodic syndromes
Late-life migrainous accompaniments
Basilar-type migraine
Hemiplegic migraine
Status migrainosus
Ophthalmoplegic migraine
Retinal migraine (page 31)
77 Which of the following are symptoms of benign paroxysmal vertigo?

I Recurrent attacks of vertigo
II Vomiting
III Pain in the legs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Benign paroxysmal vertigo of childhood involves recurrent attacks of vertigo, often associated with
vomiting or nystagmus. (page 31)
78 Which of the following are symptoms of cyclic vomiting?

I Intense nausea
II Ringing in the ears
III emetia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. In cyclic vomiting, the child has at least 5 attacks of intense nausea and vomiting ranging from 1
hour to 5 days. (page 31)
79 Which of the following are symptoms of abdominal migraine?

I Knee pain
II Nausea
III episodic midline abdominal pain lasting 1-72 hours
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. Abdominal migraine consists of episodic midline abdominal pain lasting 1-72 hours with at least 2
of 4 other symptoms (ie, nausea, vomiting, anorexia, and/or pallor). (page 31)
80 Status migrainosus occurs when the migraine attack persists for more than
I 24
II 48
III 72
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. Status migrainosus occurs when the migraine attack persists for more than 72 hours. It may result in
complications such as dehydration. (page 33)
81 Migraine is associated with which of the following diseases

I Epilepsy
II Anxiety
III Ingrowth of nails
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Migraine is associated with the following:

Epilepsy (eg, benign rolandic epilepsy, benign childhood epilepsy)
Familial dyslipoproteinemias
Hereditary hemorrhagic telangiectasia
Tourette syndrome
Hereditary essential tremor
Hereditary cerebral amyloid angiopathy
Ischemic stroke (migraine with aura is a risk factor, with an odds ratio of 6)
Depression and anxiety
Asthma
Patent foramen ovale
Obesity
Posttraumatic stress disorder (page 33)
82 Which of the following increases the risk of Ischemic stroke?

I Cigarette smoking
II Citrus fruits
III Estrogen use
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. Ischemic stroke may occur as a rare, but serious, complication of migraine.[70] In migraines with
aura, hemorrhagic stroke is also a possible, but rare, complication.[71] Risk factors for stroke include the
following:
Migraine with aura
Female sex
Cigarette smoking
Estrogen use (page 34)
83 Under what circumstances is diagnostic investigation of migraine performed?

I As part of routine check-up
II To check for drug overdose
III To exclude structural, metabolic, and other causes of headache that can mimic or coexist with
migraine.
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. Migraine is a clinical diagnosis. Diagnostic investigations are performed for the following reasons:
Exclude structural, metabolic, and other causes of headache that can mimic or coexist with migraine
Rule out comorbid diseases that could complicate headache and its treatment
Establish a baseline for treatment and exclude contraindications to drug administration
Measure drug levels to determine compliance, absorption, or medication overdose (page 34)
84 A 52 year-old male has migraine-like headache and scalp tenderness. Which test may be
appropriate to rule out temporal/giant cell arthritis?
I Magnetic resonance imaging (MRI)
II erythrocyte sedimentation rate (ESR)
III C-reactive protein (CRP)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. The choice of laboratory and/or imaging studies is determined by the individual presentation. For
example, in an older person with compatible findings (eg, scalp tenderness), measurement of erythrocyte
sedimentation rate (ESR) and C-reactive protein (CRP) may be appropriate to rule out temporal/giant cell
arteritis. (page 34)
85 Which of the following is an aid in the diagnosis of chronic migraine by serving as a

biomarker?
I GCRP
II CGRP
III CGPR
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. A 2013 study suggested that high peripheral blood levels of calcitonin gene-related peptide (CGRP),
a neurotrAns:mitter that causes vasodilation, can aid in the diagnosis of chronic migraine by serving as a
biomarker for permanent trigeminovascular activation. (page 34)
86 As per American Board of Internal Medicine (ABIM), which of the following test(s)
have been termed unnecessary for migraine testing?
I Performing neuroimaging studies in patients with stable headaches that meet criteria for migraine
II Performing computed tomography (CT) imaging for headache when magnetic resonance imaging
(MRI) available
III Prescribing opioid or butalbital-containing medications as second-line treatment for recurrent
headache disorders
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. The American Headache Society released a list of 5 commonly performed tests or procedures that are
not always necessary in the treatment of migraine and headache, as part of the American Board of Internal
Medicine (ABIM) Choosing Wisely campaign. The recommendations include:
Don't perform neuroimaging studies in patients with stable headaches that meet criteria for
migraine.
Don't perform computed tomography (CT) imaging for headache when magnetic resonance imaging
(MRI) is available, except in emergency settings.
Don't recommend surgical deactivation of migraine trigger points outside of a clinical trial.
Don't prescribe opioid or butalbital-containing medications as first-line treatment for recurrent
headache disorders.
Don't recommend prolonged or frequent use of over-the-counter (OTC) pain medications for
headache. (page 35)
87 What is the relation between insurance status and migraine care?

I Patients with migraines with no insurance or with Medicaid are less likely than privately insured patients
to receive either abortive or prophylactic migraine therapy
II Patients with migraines with no insurance or with Medicaid are more likely than privately insured
patients to receive either abortive or prophylactic migraine therapy
III with migraines with no insurance or with Medicaid are equally likely than privately insured patients to
receive either abortive or prophylactic migraine therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. After controlling for age, gender, race, and geographic location, the investigators found evidence that
patients with migraines with no insurance or with Medicaid are less likely than privately insured patients to
receive either abortive or prophylactic migraine therapy. (page 35)
88 Under what circumstances is neuroimaging prescribed?

I Abnormal neurologic examination
II Headache without fever
III Onset of migraine after age 50 years
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. Neuroimaging is indicated for any of the following:

First or worst severe headache
Change in the pattern of previous migraine
Abnormal neurologic examination
Onset of migraine after age 50 years
New onset of headache in an immunocompromised patient (eg, one with cancer or HIV infection)
Headache with fever
Migraine and epilepsy
New daily, persistent headache
Escalation of headache frequency/intensity in the absence of medication overuse headache
Posteriorly located headaches (especially in children, but also in adults) (page 35)
89 Under what circumstances is CT scan of migraine patients done?

I To rule out intracranial mass or hemorrhage
II To detect any small subarachnoid tumors, and strokes
III To detect arteriovenous malformation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. CT scanning of the head is indicated to rule out intracranial mass or hemorrhage in selected or
atypical cases. A negative CT scan may miss some small subarachnoid hemorrhages, tumors, and strokes,
particularly those in the posterior fossa. A CT scan without intravenous contrast also may miss some
aneurysms. MRI and MRA are more sensitive for the detection of aneurysm or arteriovenous malformation.
(page 36)
90 Under what circumstances is Lumbar puncture advocated, after CT or MRI scan is
done?
I If a person feels sleepy all the time
II If a patient is experiencing severe, rapid-onset, recurrent headache
III If a patient is experiencing unresponsive, chronic, intractable headache
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. Indications for LP include the following:

First or worst headache of a patient's life
Severe, rapid-onset, recurrent headache
Progressive headache
Unresponsive, chronic, intractable headache (page 36)
91 Which of the following are prescribed as first-line medication for migraine?

I Opioid
II Caffeine
III Butalbital
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Caffeine prescribed as first-line medication for migraine. (page 35)
92 What is the visual characteristic of migraine with aura?

I Positive
II Negative
III Neutral
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. visual characteristic of migraine with aura can be either positive or negative. (page 7)
93 Which of the following physical findings may present during a migraine headache?
I Swelling of legs
II Hypertension or hypotension
III Cranial/cervical muscle tenderness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. Hypertension or hypotension, or Cranial/cervical muscle tenderness may present during a migraine
headache. (page 7)
94 What does DHE stand for?

I Dihydroergetamine
II Dihydroergotamine
III Dihydroargotamine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. DHE stand for Dihydroergotamine. (page 9)
95 Which of the following may be considered indications for prophylactic migraine

therapy?
I Frequency of migraine attacks is greater than 2 per month
II Use of abortive medications more than twice a week
III Drug and alcohol abuse
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Out of the many indications, Frequency of migraine attacks is greater than 2 per month and Use of
abortive medications more than twice a week are considered as indications for prophylactic migraine therapy
.(page 9)
96 Which of the following Treatment of migraine may also be included?

I Reduction of migraine triggers
II Doing strenuous physical exercise
III Cognitive-behavioral therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. Alternative treatment to migraine are Cognitive-behavioral therapy and Reduction of migraine
triggers. (page 10)
97 People with genetic predisposition to migraine usually have which relative as

migraineurs
I First-degree
II Second-degree
III Third-degree
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. People with First-degree relatives having genetic predisposition to migraine usually are migraineurs
themselves. (Page 10)
98 Hemiplegic migraine pain is usually associated with

I Vertigo
II Heartburn
III Weakness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. Hemiplegic migraine pain is usually associated with Weakness .(page 11)
99 Which of the following therapies are used for migraine?

I Acute
II Preventive
III Obtuse
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Acute and Preventive therapies are used for migraine .(page 11)
100 Which of these age groups has the highest incidence of migraine?
I Teens
II 20 to 40
III Old age (>50)
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. 20 to 40 years of aged people has the highest incidence of migraine. (page 21)

1 Patients having frequent migraine attack require which therapy?
I Frequent
II Abortive
III Prophylactic
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. Patients with frequent attacks usually require both acute (abortive) and preventive (prophylactic)
therapy. (page 67)
2 Under what circumstances is the preventive treatment given?

I In the absence of headache for a migraineur
II Stop the progression of headache
III Improve quality of life
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F Preventive treatment, which is given even in the absence of a headache, aims to reduce the frequency
and severity of the migraine attack, make acute attacks more responsive to abortive therapy, and perhaps also
improve the patient's quality of life .(Page 67)
3 Which of the following is correct overview of migraine treatment?

I Diagnose migraine, Patient education, Assess disability, Individual management, Stratified Care
II Diagnose migraine, Assess disability, Patient education, Individual management, Stratified Care
III Diagnose migraine, Patient education, Assess disability, Stratified Care, Individual management
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. (Page 67)
4 Which analgesic(s) should not be given in ED till a thorough neurologic examination is

done?
I Opiate
II NSAIDs
III Acetaminophen
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Once in the emergency department (ED), most patients should not receive opiate analgesics until a
thorough neurologic examination can be completed by the responsible physician. (Page 67)
5 More than 90% of patients who present to the ED because of headache have
I Mixed-type malignant headache
II Migraine
III Tension
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. While the emergency physician must be able to identify patients with serious headache etiology, note
that more than 90% of patients who present to the ED because of headache have migraine, tension, or
mixed-type benign headache. (Page 67)
6 Which medicines provide comparable relief for post-ED recurrent migraine?

I Naproxen 500 mg
II Locostop 100 mg
III Oral sumatriptan 100 mg
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. Friedman et al found that nearly three quarters of ED patients with migraine or other primary
headache reported headache recurrence within 48 hours of ED discharge; in this study, naproxen 500 mg
and oral sumatriptan 100 mg provided comparable relief of post-ED recurrent migraine. (Page 67-68)
7 Under what circumstances is hospitalization for migraine required?

I Treatment of severe nausea, vomiting, and subsequent dehydration
II Status migrainosus
III Status epilipticus
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Hospital admission for migraine may be indicated for the following:
Treatment of severe nausea, vomiting, and subsequent dehydration
Treatment of severe, refractory migraine pain (ie, status migrainosus)
Detoxification from overuse of combination analgesics, ergots, or opioids (Page 68)
8 A 25 year old woman has noticed that she tends to get a migraine attack whenever she
sleeps late, eats burgers or performs strenuous physical exercise. What is the best option for
her to reduce the migraine triggers?
I Maintain a sleep schedule
II Eat balance food
III Stain your body by doing exercise
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Patients should avoid factors that precipitate a migraine attack (eg, lack of sleep, fatigue, stress,
certain foods, use of vasodilators). (Page 68)
9 Which of the following non-pharmacologic therapy is frequently effective against

migraine?
I Relaxation therapy
II Circadian rhythm
III Biofeedback
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. Biofeedback, cognitive-behavioral therapy, and relaxation therapy are frequently effective against
migraine headaches and may be used adjunctively with pharmacologic treatments. (Page 68)
10 A 32 year old male experiences headaches which are refractory to other forms of
treatment. What alternative form of treatment is helpful to this person?
I Oscillatory nerve stimulators
II Occipital nerve stimulators
III Optical nerve stimulators
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Occipital nerve stimulators may be helpful in patients whose headaches are refractory to other forms
of treatment. (Page 68)
11 Which was the first device approved by FDA to relieve pain caused by migraine
headache with aura for use in patients aged 18 years and older
I Cerena TrAns:cranial Magnetic Stimulator
II Serena TrAns:cranial Magnetic Stimulator
III Celena TrAns:cranial Magnetic Stimulator
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. In December 2013, the FDA approved the Cerena TrAns:cranial Magnetic Stimulator
(CerenaTMS), the first device to relieve pain caused by migraine headache with aura for use in patients aged
18 years and older. (Page 68)
12 Under what instances should magnetic stimulation to relieve migraine pain not be
used?
I Patients having active implanted medical device (eg, pacemaker, deep brain stimulator)
II If a person has any metal implant in head, neck or upper body
III If a person is wearing a removable metal adornment
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Contraindications and precautions regarding the use of the CerenaTMS include the following:
Do not use for patients with any metal in the head, neck, or upper body that is attracted by a magnet
Do not use for patients with an active implanted medical device (eg, pacemaker, deep brain stimulator)
Do not use for patients with suspected/diagnosed epilepsy or who have a personal or family history of seizures
(Page 68 69)
13 Combination of which nonpharmacologic and pharmacologic preventive treatment

improved outcomes in patients with frequent migraines
I Beta-blocker therapy and behavioral management
II Tricyclic antidepressants and behavioural management
III Tricyclic antidepressants and beta-blocker therapy
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. A 16-month randomized, placebo-controlled trial by Holryod et al found that the combination of
beta-blocker therapy and behavioral management improved outcomes in patients with frequent migraines,
while neither intervention was effective by itself. (Page 69)
14 Which of the following abortive medication(s) is used based on moderate headache

severity?
I NSAIDs
II Aminophylline
III Estradiol
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. NSAIDs are a class of drugs used for moderate migraine headache treatment. (Page 69)
15 Which of the following class of drug(s) are used to treat extremely severe migraine?
I Opioids
II DHE (IV)
III Digoxin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Opioids and DHE (Dihydroergotamine) are the most potent drugs available to treat migraine.
(Page 69)
16 Which of the following drug(s) is used to treat moderate to severe migraine?

I Naratriptan
II Rizatriptan
III Opioids
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Naratriptan and Rizatriptan are used to treat moderate and severe migraine while opioids are used
for extremely severely migraine. (Page 69)
17 Acute treatment is most effective when given within how many minutes of pain onset
I 15 minutes
II 20 minutes
III 25 minutes
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Acute treatment is most effective when given within 15 minutes of pain onset and when pain is
mild. (Page 69)
18 Why were propoxyphene products were withdrawn from the United States market in
2010?
I Prolonged PR interval
II Widened ORS complex
III Widened QRS complex
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. Analgesics used in migraine include acetaminophen, NSAIDs, and narcotic analgesics (eg, oxycodone,
morphine sulfate). Propoxyphene (Darvon) was formerly used; however, propoxyphene products were
withdrawn from the United States market in 2010, because this agent can cause prolonged PR interval,
widened QRS complex, and prolonged QT interval at therapeutic doses. (Page 69-70)
19 The use of abortive medications must be limited to how many days a week to prevent
development of a rebound headache phenomenon?
I 3-4
II 1-2
III 2-3
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. The use of abortive medications must be limited to 2-3 days a week to prevent development of a
rebound headache phenomenon. (Page 70)
20 Which the effective amount of Metoclopramide in the treatment of acute migraine.

I 10 mg
II 20 mg
III 40 mg
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Intravenous metoclopramide is recognized as an effective therapy for acute migraine, but the optimal
dosing has not been established. A study by Friedman et al determined that 20 or 40 mg of metoclopramide
is no better in the treatment of acute migraine than 10 mg of the drug. (Page 70)
21 Other than opioid, which one is an effective alternative agent for the relief of acute
migraine headache in the ED?
I ketorolac
II meperidine
III sumatriptan
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Ketorolac provides pain relief similar to that with meperidine (with less potential for addiction) and
is more effective than sumatriptan. (Page 70)
22 Which of the following categories are migraine-specific oral medications?

I Ergot alkaloids
II HBP
III TriptAns:
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. The 2 categories of migraine-specific oral medications are triptAns: and ergot alkaloids. (Page 70)
23 Which of the following belong to the class of Triptan drugs?

I Sumotriptan
II Almotriptan
III Frovatriptan
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. Almotriptan and Frovatriptan belong to triptan class of drugs. (Page 70)
24 Although triptAns: share a common route of action, in which of the following

categories do they differ?
I Assimilation of drug
II Onset of action
III Duration of action
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. Although the triptAns: share a common mechanism of action, they differ in the available routes of
administration, onset of action, and duration of action. (Page 70)
25 What are the various routes of administration of triptAns:?

I Oral
II Intravenous
III Intranasal
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. Routes of administration include oral, intranasal, subcutaneous, and intramuscular. (Page 70)
26 Sumatriptan can be delivered

I Intranasally
II TrAns:dermally
III Intervenously
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. TrAns:dermal patches have proved effective for the delivery of sumatriptan, and one such product
has received FDA approval. (Page 70)
27The FDA approved the first breath-powered intranasal medication delivery system to
treat migraines in Jan, 2016. What was the constituent medicine(s)
I 22 mg Sumatriptan powder
II 22 mg Rizatriptan
III 22 mg Zolmitriptan
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. The FDA approved a low-dose intranasal sumatriptan powder for migraine in January 2016. The
product consists of 22 mg of sumatriptan powder and is the first breath-powered intranasal medication
delivery system to treat migraines. (Page 70)
28 How many different types of triptAns: can be used within a 24-hour time period?
I0
II 1
III 2
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. . While different formulations of a specific triptan may be used in the same 24-hour period, only 1
triptan may be used during this time frame. (Page 71)
29 Which of the following TriptAns: may be used continuously for several days (mini -
prophylaxis) to treat menstrual migraine?
I Frovatriptan
II Naratriptan
III Naritriptan
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. The longer-acting triptAns: (eg, frovatriptan, naratriptan) may be used continuously for several days
(mini-prophylaxis) to treat menstrual migraine. (Page 71)
riptAns: for migraine?

I Patients with known coronary artery disease
II Patients with suspected coronary artery disease
III Patients who have sinus headache
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. The safety of triptAns: is well established, and the risk of de novo coronary vasospasm from triptan
use is exceedingly rare. However, triptAns: should not be taken by patients with known or suspected coronary
artery disease, as they may increase risk of myocardial ischemia, infarction, or other cardiac or
cerebrovascular events. (Page 71)
31 A 35 year-old male has been taking propranolol for hypertension since past 5 -years.
Recently he was diagnosed with migraine without aura. Which of the following triptan
drug should he not be prescribed?
I 5 mg rizatriptan
II 2 mg rizatriptan
III 10 mg rizatriptan
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. The dose of rizatriptan must be reduced to 5 mg in patients taking propranolol. (Page 71)
32 Sumatriptan, zolmitriptan, and rizatriptan are primarily metabolized by

I Monoamine oxidase
II Monoamine dioxidase
III Monoamine trioxidase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Sumatriptan, zolmitriptan, and rizatriptan are primarily metabolized by monoamine oxidase
(MAO) and should be avoided in patients taking MAO-A inhibitors. (Page 71)
33 What are the constituent salts of Treximet?

I Zolmitriptan and naproxen sodium
II Rizatriptan and naproxen sodium
III Sumatriptan and naproxen sodium
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. Treximet contains sumatriptan and naproxen sodium. (Page 71)
34 Patients with known complicated migraine should treat their acute attacks with which
of the available agents
I Prochlorperazine
II Treximet
III Rizatriptan
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Vasoconstrictors, such as ergots or triptAns:, should not be administred to patients with known
complicated migraine; treat their acute attacks with one of the other available agents, such as NSAIDs or
prochlorperazine. (Page 71)
35 What are antiemetics used for?

I Treatment of acute headache
II Treatment of nausea and vomiting
III Treatment of unconsciousness
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Antiemetics (eg, chlorperazine, promethazine) are used to treat the emesis associated with acute
migraine attacks. (Page 71)
36 Which antiemetics are used to treat the emesis associated with acute migraine attacks as
a first line of treatment?
I Chlorperazine
II Diazepam
III Promethazine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. Antiemetics (eg, chlorperazine, promethazine) are used to treat the emesis associated with acute
migraine attacks. (Page 71)
37 Patients with severe nausea and vomiting at the onset of an attack may respond best to
I Intravenous chlorperazine
II Intravenous prochlorperazine
III Intravenous promethazine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Patients with severe nausea and vomiting at the onset of an attack may respond best to intravenous
prochlorperazine. These patients may be dehydrated, and adequate hydration is necessary. (Page 71)
38 What is the common risk associated with people suffering for severe nausea and emesis?
I Dandruff
II Skin rash
III Dehydration
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. Patients with severe nausea and vomiting may be dehydrated, and adequate hydration is necessary.
(Page 71)
39 What is akathisia?
I Movement disorder characterized by feeling of restlessness and a constant need to move
II Disorder of the brain where when is unable to stop chatter
III Knee disorder where one is unable to sit or stand for long hours
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Antiemetics are commonly combined with diphenhydramine to minimize the risk of akathisia. (Page
71)
40 Antiemetics are commonly combined with which drug to minimize the risk of
akathisia?
I Diphenhydrazine
II Diphenhydramine
III Diphenylamine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Antiemetics are commonly combined with diphenhydramine to minimize the risk of akathisia. (Page
71)
41 Under what circumstances is the prophylactic migraine therapy considered?
I The headaches cause major disruptions in the lifestyle, with significant disability that lasts 3 or
more days
II Abortive therapy fails or is overused
III Symptomatic medications are effective
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. The following may be considered indications for prophylactic migraine therapy:
Frequency of migraine attacks is greater than 2 per month
Duration of individual attacks is longer than 24 hours
The headaches cause major disruptions in the lifestyle, with significant disability that lasts
3 or more days
Abortive therapy fails or is overused
Symptomatic medications are contraindicated or ineffective
Use of abortive medications more than twice a week
Migraine variants such as hemiplegic migraine or rare headache attacks producing profound
disruption or risk of permanent neurologic injury. (Page 72)
42 What is/are the major goal of preventive therapy?

I Reduce attack frequency, severity, and/or duration
II Reduce responsiveness to acute attacks
III Reduce disability
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. The goals of preventive therapy are as follows:

Reduce attack frequency, severity, and/or duration
Improve responsiveness to acute attacks
Reduce disability. (Page 72)
43 Which of the following mechanism(s) is used by prophylactic medications for migraine?

I 5-HT2 antagonism
II Regulation of blood-brain barrier
III Regulation of voltage-gated ion channels
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. The major prophylactic medications for migraine work via one of the following mechanisms:
5-HT2 antagonism - Methysergide
Regulation of voltage-gated ion channels - Calcium channel blockers
Modulation of central neurotrAns:mitters Beta blockers, tricyclic antidepressants
Enhancing gamma-aminobutyric acid-ergic (GABAergic) inhibition - Valproic acid, gabapentin.
(Page 72)
44 Besides mechanism followed by prophylactic medications, which other mechanism(s)

are followed?
I Alteration of neuronal hyperexcitability by sodium replacement
II Alteration of neuronal oxidative metabolism by riboflavin
III Reduction of neuronal hyperexcitability by magnesium replacement
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. A notable mechanism besides prophylactic medication pathway is alteration of neuronal oxidative
metabolism by riboflavin and reduction of neuronal hyperexcitability by magnesium replacement. (Page 72)
45 Selection of a preventive medication must take into consideration;

I Co-morbid conditions
II the side-effect profile
III Number of hours of sleep
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. As with abortive medications, the selection of a preventive medication must take into consideration
comorbid conditions and the side-effect profile. (Page 72)
46 Compared with placebo, most preventive medications therapeutic gain/efficiency is
I 50%
II more than 50%
III less than 50%
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. Most preventive medications have modest efficacies and have therapeutic gains of less than 50%
when compared with placebo. (Page 72)
47 A person suffering from migraine without aura has hypertension as a comorbid

condition. Which of the following is the best preventive medication for her/him?
I Gamma blokers
II Beta blockers
III Alpha blockers
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. If the Comorbid Condition is Hypertension, best preventive medicine is Beta blockers. (Page 73)
48 If someone is suffering from migraine with or without aura also has depression. Which
of the following is the best preventive medication for her/him?
I Lorazepam
II Tricyclic antidepressants
III SSRIs
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. If the Comorbid Condition is depression, best preventive medicine is Tricyclic antidepressants and
SSRIs. (Page 73)
49 What is the best line of preventive treatment who is obese and has migraine?
I Topiramate
II Benzodiazepine
III Protriptyline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. If the Comorbid Condition is obesity, best preventive medicine is Topiramate and Protriptyline.
(Page 73)
50 If a person is suffering from both mania and migraine attacks, what is the best
preventive medicine(s) for migraine?
I Valeric acid
II Valproic acid
III Vanillylmandelic acid
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. If the Comorbid Condition is mania, best preventive medicine is Valproic acid. (Page 73)
51 What is the full form of SSRIs?

I Selective serotonin reuptake inhibitors
II Selective serotonin reuptake intiators
III Selective serotonin reupload inhibitors
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. SSRIs = selective serotonin reuptake inhibitors. (Page 73)

52 Which of the following drugs have been approved by FDA for migraine prophylaxis?
I Methysergide
II Timolol
III Tonact
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Propranolol, timolol, methysergide, valproic acid, and topiramate (Topamax) have been approved
by the FDA for migraine prophylaxis. (Page 74)
53 A lady regula
separate medicine for each problem. Which drug(s) would you suggest for her?
I Glucophage
II Divalproex
III Amitriptyline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. Misra et al reported that in migraineurs with allodynia, prophylactic therapy with divalproex and
amitriptyline were equally effective in relieving allodynia. (Page 74)
54 Under what cases is use of naproxen sodium recommended for prophylactic therapy?
I Heat-triggered migraines
II Menstrual migraines
III Cold-triggered migraines
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. The NSAID naproxen sodium has also been used for prophylaxis. In controlled clinical trials,
naproxen sodium demonstrated better efficacy than placebo and similar efficacy to propranolol. However,
this agent should be reserved for short-term use, such as for menstrual migraines. (Page 74)
55 Which are the 3 principal classes of medications that are effective for migraine
prevention?
I Antiepileptics, Antidepressants, Antihypertensives
II Antiepileptics, Antidepressants, Antidiuretic
III Antiviral, Antidepressants, Antihypotensives
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. The 3 principal classes of medications that are effective for migraine prevention are as follows:
Antiepileptics
Antidepressants
Antihypertensives (Page 74)
56 Till when the maximum tolerable dose should be given for prophylaxis to be considered
a success?
I 15 days
II 20 days
III 30 days
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. For any of the prophylactic agents, prophylaxis should not be considered a failure until it has been
given at the maximum tolerable dose for at least 30 days. (Page 74)
57 What the main adverse effects of topiramate?

I Dysentry
II Weight loss
III Dysesthesia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. The main adverse effects of topiramate are weight loss and dysesthesia. (Page 74)
58 What is the trade name of Valproic acid?

I Depasote
II Depakote
III Depacote
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. The trade name of valproic acid is Depakote. (Page 74)
59 What are potential side-effects Valproic acid in young females?

I Weight gain and hair loss
II Polycystic ovary disease
III Depression
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Valproic acid (Depakote) is useful as a first-line agent. It is a good mood stabilizer and can benefit
patients with concomitant mood swings. However, it can cause weight gain, hair loss, and polycystic ovary
disease; therefore, it may not be ideal for young female patients who have a tendency to gain weight. (Page
74)
60 Under what cases is Valproic acid suitable for woman?

I Women who have had tubal ligation
II Women who cannot tolerate calcium channel blockers
III Women who are pregnant
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Valproic acid carries substantial risks in pregnancy; it may be best suited for women who have had
tubal ligation and who cannot tolerate calcium channel blockers because of dizziness. (Page 74)
61 Which of the following Tricyclic antidepressants are commonly used as second -line
alternatives for migraine and depression treatment?
I Nortriptyline
II Nontriptyline
III Amitriptyline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. Tricyclic antidepressants are good second-line alternatives because of their adverse-effect profile and
efficacy. Head-to-head comparisons of agents in this class have not been conducted, but amitriptyline and
nortriptyline are commonly used. (Page 75)
62 SSRIs are not recommended for

I Migraine prevention
II Migraine treatment
III They are unrelated to migraine treatment
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Although selective serotonin reuptake inhibitors (SSRIs) are widely used, data regarding their efficacy
in migraine prevention are lacking; consequently, SSRIs are not recommended for migraine prevention.
(Page 75)
63 Which of the following antihypertensive drugs are also effective for migraine
prevention?
I Lisinopril
II Clandestine
III Candesartan
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. Angiotensin-converting enzyme (ACE) inhibitors (eg, lisinopril) and angiotensin-receptor blockers
(eg, candesartan) have also been shown to be effective for migraine prevention.
64 Which of the following would be beneficial for intractable, chronic migraine that has
failed to respond to at least 3 conventional preventive medications?
I Botulinum toxin C
II Botulinum toxin A
III Botulinum toxin B
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Botulinum toxin A (onabotulinumtoxinA; BOTOX®) may be beneficial in patients with intractable,
chronic migraine that has failed to respond to at least 3 conventional preventive medications. (Page 75)
65 How long can TENS be worn in a day?

I 10 mins
II 15 mins
III 20 mins
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. In March 2014, the FDA approved the first device for the preventive treatment of migraine
headaches for adults, a trAns:cutaneous electrical nerve stimulation (TENS) device that is worn for 20
minutes a day. (Page 76)
66 A biogenic amine that accumulates in food as it ages and is known to cause migraine?
I Tyneamine
II Tyramine
III Tynelamine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Tyramine, a biogenic amine that accumulates in food as it ages, may provoke migraine. (Page 78)
67 Which of the following techniques are recommended for migraine relief?

I Yoga
II Acupressure
III Sleeping
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Techniques that some patients use for headache relief include the following:
Body work - Eg, chiropractic, massage, and craniosacral therapy)
Nutritional/herbal supplements - Eg, vitamins and herbs
Yoga
Acupressure and acupuncture
Biofeedback (Page 77)
68 The immediate future of preventive treatment for migraine headaches will likely involve
I Guanidine N-methyl-D-aspartic acid receptor antagonists
II Glutamate N-methyl-D-aspartic acid receptor antagonists
III gap-junction blockers
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. The immediate future of preventive treatment for migraine headaches will likely involve glutamate
N-methyl-D-aspartic acid (NMDA) receptor antagonists and gap-junction blockers. (Page 79)
69 What are the most common side effects of triptAns:?
I Chest burn
II Excessive urination
III Asthenia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. The most common side effects of triptAns: are as follows:

- Asthenia
- Nausea/vomiting
- Dizziness
- Somnolence
- Chest, throat, or jaw tightness/discomfort
- Worsening of head pain (often trAns:ient) (Page 80)
70 Which of the following options are available for delivery of Sumatriptan?

I Internasal
II Subcutaneous
III Oral formulation
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: E. Sumatriptan has the most options for drug delivery. It is available in intranasal, subcutaneous, and
oral formulations. (Page 80)
71 What is the efficacy of sumatriptan at 20 minutes when administered by injection?

I 80%
II 81%
III 82%
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. The efficacy of sumatriptan is 82% at 20 minutes when administered by injection, 52-62% at 2
hours when administered intranasally, and 67-79% at 4 hours when administered orally. (Page 80)
72 What is the trade name of Naratriptan?

I Emerge
II Amerge
III Dmerge
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Trade name of Naratriptan is amerge. (Page 80)
73 What is the efficacy of zolmitriptan at 2 hours?

I 60%
II 61%
III 62%
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. Zolmitriptan has an efficacy of 62% at 2 hours and of 75-78% within 4 hours.
74 When does rizatriptan action start?

I 15 mins
II 30 mins
III 45 mins
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Rizatriptan has a reported early onset of action (30 min) and an efficacy of 71% at 2 hours.
75 What does consumption of almotriptan result in?
I Induces cranial vessel constriction
II Inhibits neuropeptide release
III Increases pain transmission in trigeminal pathways
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Almotriptan induces cranial vessel constriction, inhibits neuropeptide release, and reduces pain
transmission in trigeminal pathways. (Page 81)
76 Which of the following triptAns: that is not contraindicated for use in combination
with MAOIs?
I Almotriptan
II Rizatriptan
III Frovatriptan
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. Frovatriptan is one of the few triptAns: that is not contraindicated for use in combination with
MAOIs. (Page 81)
77 Which drugs trade name is Relpax?

I Eletriptan
II Electriptan
III Eltriptan
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. the trade name is Relpax. (Page 82)
78 Treximet is the combination of which two drugs?

I Topiramate and Flunarizine
II Sumatriptan and naproxen
III Cyproheptadine and Gabapentin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Sumatriptan and naproxen make up Treximet. (Page 82)
79 Naproxen decreases the activity of?

I Cyclic-oxygenase
II Cyclo-oxygenase
III Cyclical-oxygenase
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Naproxen decreases the activity of cyclo-oxygenase (COX), thereby interrupting prostaglandin
synthesis. (Page 82)
80 Xsail breath-powered delivery device is used to deliver Sumatriptan intranasally in

which form?
I liquid nasal spray
II Wet powder
III Dry powder
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. Sumatriptan intranasal is available as a liquid nasal spray or a dry powder administered using the
Xsail breath-powered delivery device. (Page 82)
81 Sumatriptan trAns:dermal patch is delivered along with?

I Ionphoresis
II Iontophoresis
III Ionotophoresis
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Sumatriptan trAns:dermal - Indicated for treatment of acute migraine attack with or without aura.
Delivered as a trAns:dermal patch along with iontophoresis. (Page 82)
82 Ergot derivatives are used to treat which level of migraines?

I Mild to moderate
II Moderate to mildly severe
III Moderately severe to severe
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. Ergot derivatives can be used for the abortive treatment of moderately severe to severe migraine
headache. (Page 82)
83 What dosage form is available for Ergotamine tartrate?

I Bilingual
II Sublingual
III Tetralingual
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Ergotamine tartrate is available in a sublingual dosage form. (Page 83)
84 What is the trade name for Ergotamine tartrate?

I Ergomar
II Egnomer
III Egonomer
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. The trade name for Ergotamine tartrate is Ergomar. (Page 83)
85 What dose of Dihydroergotamine metoclopramide is safe and effective for treatment of

status migrainosus?
I 1 mg intravenously every 4 hours
II 1 mg intravenously every 6 hours
III 1 mg intravenously every 8 hours
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. . A dose of 1 mg intravenously every 8 hours with or without metoclopramide is safe and effective for
treatment of status migrainosus. (Page 83)
86 What is the drug composition of Tylenol?

I Acetamine
II Acetaminophen
III Acetaaminopheron
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. The drug composition of Tylenol is acetaminophen. (Page 83)

87 Why should opioids not be used long-term?
I They are habit-forming
II They cause diabetes
III They cause pneumonia
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Opioids should not be used long-term, because they are habit-forming. Also, they can contribute to
rebound headaches. (Page 84)
88 OxyContin, Roxicodone, Oxecta are trade names of which drug?

I Oxycodone
II Oxykodone
III Oxyprone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. OxyContin, Roxicodone, Oxecta are trade names of Oxycodone. (Page 84)
89 Which drug can reverse the side effects of morphine?

I Oxycontin
II Demerol
III Naloxone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. Morphine is the drug of choice for narcotic analgesia because of its reliable and predictable effects,
safety profile, and ease of reversibility with naloxone. (Page 84)
90 The drug Meperidine trade name is?
I Dermarol
II Demerol
III Denimrol
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. The drug Meperidine trade name is Demerol. (Page 84)
91 Which of the following drug(s) is habit-forming?

I Stadol
II Morphine
III Naloxone
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Both Stadol and Morphine are habit-forming drugs and hence should be used in moderation. (Page
85)
92 Which of the following is trade name of Aspirin?

I Bufferin
II Ecotrin
III Asriptin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Ecotrin, Ascriptin, Halfprin, Bayer Aspirin, Bufferin are trade names of aspirin. (Page 85)
93 Which of the following is/are trade name(s) for Ibuprofen?

I Motrin
II Anvil
III Advil
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. Motrin, Advil, Neoprofen, Caldolor are trade names for Ibuprofen. (Page 86)
94 Acetaminophen and codeine have what trade name?

I Tylenol no. 1
II Tylenol no. 2
III Tylenol no. 3
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: C. Acetaminophen and codeine trade name is Tylenol no. 3. (Page 86)
95 What increases GI absorption?

I Aspirin
II Caffeine
III Acetophenamine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Caffeine is used to increase GI absorption. (Page 87)
96 Which of the following drugs act as antienemic agents?

I Droperidol
II Chlorpromazine
III Prochlorperazine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. Droperidol and Prochlorperazine act as antienemic agents. (Page 88)
97 Which of the following anticonvulsants drugs can be effective in prophylaxis of

migraine headache?
I Depakote
II Topamax
III Depacote
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: D. Depakote and Topamax double up as both anticonvulsant and anti-migraine drugs. (Page 88-89)
98 Which of the following Tricyclic Antidepressants has proven efficacy as a antimigraine?

I Protriptyline
II Amitriptyline
III Doxepin
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: B. Amitriptyline, nortriptyline, doxepin, and protriptyline have been used for migraine prophylaxis, but
only amitriptyline has proven efficacy. It appears to exert its antimigraine effect independent of its effect on
depression. (Page 90)
99 Calcium channel blockers are commonly used as prophylactic medication for migraine,
although studies of their effectiveness have shown mixed results. Which of the following
drug(s) act as Calcium Channel Blockers?
I Verapamil
II Doxepin
III Protriptyline
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: A. Verapamil inhibits calcium ions from entering slow channels or voltage-sensitive areas of vascular
smooth muscle during depolarization. Verapamil has an off-label indication for migraines. (Page 91)
100 Which of these antihistamine drugs also help in migraine prevention?

I Cyproheptadine
II Sertraline
III Promethazine
A) I only
B) II only
C) III only
D) I and II
E) II and III
F) I and III
Ans: F. Cyproheptadine and Promethazine act both as antihistamine and antimigraine drug. (Page 92)

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GASTROINTESTINALSYSTEM

Peptic Ulcer Disease ................................................................................................................................. 8

ATRIAL FIBRILLATION ................................................................................................................... 305

1. Osteoarthritis ............................................................................................................................. 1469

1.Urinary incontinence .......................................................................................................... 1858

1.ANEMIA ............................................................................................................................ 2052

PHARMACY REGISTRATION EXAMS IN CANADA

PHARMACY REGISTRATION EXAMS IN AUSTRALIA

PHARMACY REGISTRATION EXAMS IN GULF COUNTRIES

Types of multiple choice questions

Tips for preparation of multiple choice questions

Effective time management in exam

1. What is peptic ulcer ?

Peptic ulcers are defects in the gastric or duodenal mucosa .

It is characterized by a gnawing or burning sensation and occurs after meals

4. When occurs the burning sensation in duodenal ulcer ?

5. In uncomplicated PUD what are the alarm features ?

6. What symptom observed in perforated PUD?

7. Which laboratory test is useful in all patients with peptic ulcers?

9. How endoscopy help in diagnosis peptic ulcer ?

11. How the PUD patients are treated ?

15. Which type of surgical procedure used in PUD ?

17. Where is esophageal plexus formed ?

Esophageal plexus formed at lower thoracic cavity.

19. Which branches formed the posterior vagal trunk ?

25. How the prostaglandins act as a protective role in PUD ?

27. What are the aggressive factors ?

31. Brain tumour are associated with which type of ulcers ?

Cushing ulcers are associated with a brain tumor .

Extensive burns are associated with Curling ulcers.

33. Which hypersecretory states causes PUD ?

Hypersecretory states may cause PUD:

Hypersecretory states may cause PUD:

39. Which chemotherapeutic agents are associated with PUD ?

Additional etiologic factors Chemotherapeutic agents, such as 5-fluorouracil (5-FU),

41. How patient education help in PUD cases ?

43. The possible manifestation observed in PUD patients ?

Other possible manifestations of PUD:

Other possible manifestations of PUD:

45. The possible manifestation observed in PUD patients ?

Other possible manifestations of PUD: hematochezia., anaemia (eg, fatigue, dyspnea)

47. Which physical examination are done for uncomplicated PUD ?

49. What are the sign and symptoms of septic shock ?

51. What is the type I gastric ulcer ?

53. What is the type II gastric ulcer ?

55. What is the type IV gastric ulcer ?

Documentation of PUD depends on radiographic and endoscopic confirmation.

57. On diagnosis if PUD is suspected which laboratory test are useful ?

CBC count and iron studies can help detect anemia

59. Which test are includes in endoscopic test for H pylori ?

60. How the H pylori is detected in gastric mucosal biopsy specimens ?

62. Which kits are commercially available for H pylori testing ?

Kits contains a combination of a urea substrate and a ph sensitive indicator.

66. How we can differentiate a benign ulcers from malignant ulcers ?

68. How endoscopy differentiate a benign ulcer from a malignant lesion ?

70. How are the malignant ulcers ?

Malignant ulcers usually have irregular heaped-up or overhanging margins.

72. At endoscopy, how are duodenal ulcers appear ?

Double-contrast radiography performed by an experienced radiologist may approach the diagnostic

Zollinger-Ellison syndrome include

Zollinger-Ellison syndrome include

78. Which diagnostic test are used for Zollinger-Ellison syndrome?

80. How can we increase the biopsy yield?

Brush cytology has been shown to increase the biopsy yield,