IVMS Comprehensive -USMLE-type- Pharmacology-#1-2012 Examination

1. 3/30/2011
Comprehensive Pharmacology Examination (75 Questions, 90 minutes to Complete)
Directions: Each of the numbered items or incomplete statements in this section is followed by
answers or by completions of the statement. Select the ONE lettered answer or completion that is
BEST in each case.
1. A 17-year-old male was placed on carbamazepine therapy by his neurologist to control newly
developed seizures of unknown etiology. The patient was also recently given a macrolide
antibiotic by his family physician for a presumed “walking pneumonia.” Halfway through his
antibiotic course, the patient again developed seizures. What could account for this new seizure
activity?
A. Inhibition of the cytochrome P-450 monooxygenase system
B. Induction of the cytochrome P-450 monooxygenase system
C. Impairment of renal excretion of the antiseizure medication
D. Induction of glucuronyl transferase activity in the liver
E. Reduction in the amount of nicotinamide adenine dinucleotide phosphate (NADPH)
2. A 21-year-old male sustains multiple blunt traumas after being beaten with a baseball bat by a
gang. Aside from his fractures, a serum creatine kinase measurement is dramatically elevated
and the trauma team is worried as the myoglobinuria caused by the trauma can cause kidney
failure. They immediately begin to administer bicarbonate to alkalinize the urine. How does this
serve to decrease myoglobin levels?
A. Increasing glomerular filtration
B. Promoting renal tubular secretion
C. Inhibiting renal tubular reabsorption
D. Increasing hepatic first-pass metabolism
E. Inducing the P-450 system
3. Which of the following correctly describes the formula for a loading dose?
A. Loading dose = (Desired plasma concentration of drug) × (clearance)
B. Loading dose = (Clearance) × (Plasma drug concentration)
C. Loading dose = (0.693) × (Volume of distribution)/(Clearance)
D. Loading dose = (Amount of drug administered)/(Initial plasma concentration)
E. Loading dose = (Desired plasma concentration of the drug) × (Volume of distribution)
Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D.
Page 1

2. 3/30/2011
4. A 32-year-old HIV-positive male follows up with an infectious disease (ID) specialist in the
clinic. The results of his recent blood work suggest that the virus has become resistant to
multiple nucleoside reverse transcriptase inhibitors. The ID specialist decides to include in the
treatment a nonnucleoside inhibitor (nevirapine), which works by binding to a site near the active
site on the reverse transcriptase. Nevirapine is an example of what?
A. Full agonist
B. Reversible competitive antagonist
C. Partial agonist
D. Noncompetitive antagonist
E. Irreversible competitive antagonist
5. Which of the following drugs is a selective α-adrenergic receptor agonist that is available
over-the-counter?
A. Epinephrine
B. Phenylephrine
C. Isoproterenol
D. Norepinephrine
E. Phentolamine
6. Pilocarpine is what type of pharmacologic agent?
A. Indirect muscarinic agonist
B. α2-Adrenergic agonist
C. Carbonic anhydrase inhibitor
D. β-Adrenergic antagonist
E. Direct-acting muscarinic agonist
7. Which of the following is a short-acting acetylcholinesterase inhibitor?
A. Pyridostigmine
B. Bethanechol
C. Edrophonium
D. Scopolamine
E. Methantheline
8. Dantrolene
A. Inhibits calcium release from the sarcoplasmic reticulum
B. Functions as a GABAB receptor agonist
C. Facilitates GABA activity in the CNS
D. Reactivates acetylcholinesterase
E. Competitively inhibits the effects of acetylcholine
Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D.
Page 2

3. 3/30/2011
9. A 63-year-old male, with a history of multiple myocardial infarctions is admitted for shortness
of breath. A diagnosis of congestive heart failure is made on clinical grounds, and a cardiologist
orders a positive inotropic agent for his heart failure. He is also concerned about maintaining
perfusion to the kidneys, so an agent that increases renal blood flow is also desirable. Which of
the following agents produces both of these desired effects?
A. Epinephrine
B. Dopamine
C. Isoproterenol
D. Terbutaline
10. Clonidine works by
A. Activating β1-adrenergic receptors
B. Activating α1-adrenergic receptors
C. Activating β2-adrenergic receptors
D. Activating α2-adrenergic receptors
E. Blocking β-adrenergic receptors
11. A 23-year-old female presents with hypertension, anxiety, and palpitations. Her thyroid-
stimulating hormone levels are normal, but she has increased levels of urinary catecholamines.
She is referred to a endocrine surgeon after a CT scan shows a unilateral pheochromocytoma.
The surgeon should start therapy with which of the following agents prior to removing the
lesion?
A. Dopamine
B. Phentolamine
C. Pancuronium
D. Pseudoephedrine
E. Isoproterenol
12. A 45-year-old male with a history remarkable for both asthma and angina now has a kidney
stone stuck in his right ureter. The urologist needs to perform cystoscopy, but the
anesthesiologist is concerned about using a β-blocker during surgery to control the patient's
blood pressure in light of his history of asthma. Ultimately, it is decide to use an ultra-short-
acting β-blocker and closely monitor both his blood pressure and respiratory status. Which of the
following is best to use in this situation?
A. Atenolol
B. Norepinephrine
C. Albuterol
D. Pseudoephedrine
E. Esmolol
Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D.
Page 3

4. 3/30/2011
13. A neurosurgeon decides to start a patient on a diuretic that works by altering the diffusion of
water relative to sodium (an osmotic diuretic) that is helpful in reducing cerebral edema. Which
agent did the physician likely prescribe?
A. Furosemide
B. Hydrochlorothiazide
C. Spironolactone
D. Acetazolamide
E. Mannitol
14. Which of the following would be useful in treating nocturnal enuresis?
A. Mannitol
B. Indomethacin
C. Furosemide
D. Vasopressin
E. Probenecid
15. Vasopressin
A. Reduces ADH levels
B. Increases permeability of the collecting duct
C. Inserts aquaporins into the plasma membrane of collecting duct cells
D. Increases diffusion of sodium
E. Reduces production of prostaglandins
16. A 45-year-old male with a 60-pack/year history of smoking presents to his primary care
provider with loss of appetite, nausea, vomiting, and muscle weakness. His chest CT reveals
enlarged hilar lymph nodes and a suspicious mass in the left hilar region. A presumptive
diagnosis of lung cancer is made. Laboratory results reveal low levels of sodium, which in this
setting has likely contributed to the syndrome of inappropriate ADH secretion. Which
medication might be helpful for this patient's symptoms?
A. Clofibrate
B. Demeclocycline
C. Allopurinol
D. Acetazolamide
E. Furosemide
17. Which of the following drugs inhibits xanthine oxidase?
A. Colchicine
B. Indomethacin
C. Probenecid
D. Clofibrate
E. Allopurinol
Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D.
Page 4

5. 3/30/2011
18. Which of the following is a common adverse effect of quinidine?
A. Cinchonism
B. Lupuslike syndrome
C. Seizures
D. Constipation
E. Pulmonary fibrosis
19. What is the mechanism of action of β-blockers in heart disease?
A. Prolongation of AV conduction
B. Activation of the sympathetic system
C. Promotion of automaticity
D. Increase in heart rate
E. Arteriolar vasodilation
20. Which of the following would be useful in the management of arrhythmia due to Wolf-
Parkinson-White syndrome?
A. Digoxin
B. Lidocaine
C. Amiodarone
D. Adenosine
E. Atropine
21. Which of the following inhibit HMG-CoA reductase?
A. Nicotinic acid
B. Rosuvastatin
C. Ezetimibe
D. Cholestyramine
E. Gemfibrozil
22. Which of the following would be a good option to help a patient fall asleep with minimal
“hangover”?
A. Secobarbital
B. Zolpidem
C. Chlordiazepoxide
D. Flumazenil
E. Buspirone
23. Which of the following is a good choice to treat newly diagnosed generalized anxiety
disorder (GAD) in a patient who is a truck driver?
A. Alprazolam
B. Triazolam
C. Buspirone
D. Trazodone
E. Thiopental
Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D.
Page 5

6. 3/30/2011
24. A 57-year-old male with a strong family history of Parkinson's disease sees a neurologist for
an evaluation. On examination, the neurologist notes a slight pill-rolling tremor and subtle gait
abnormalities. He begins treatment with levodopa, along with the addition of carbidopa. How
does carbidopa work in this setting?
A. Restores dopamine levels in the substantia nigra
B. Inhibits monoamine oxidase (MAOI)
C. Inhibits catechol-O-methyltransferase (COMT)
D. Functions as a dopamine agonist
E. Inhibits the metabolism of levodopa outside the CNS
25. The patient in the previous question returns to see his neurologist 3 years later. At this time
the patient's symptoms have progressed, and he now has marked bradykinesia and a profound
shuffling gait. In an attempt to prevent further deterioration, the neurologist prescribes a
catechol-O-methyltransferase (COMT) inhibitor on top of the patient's levodopa and carbidopa.
Which agent below is likely to have been added?
A. Entacapone
B. Selegiline
C. Ropinirole
D. Amantadine
E. Benztropine
26. Which of the following is a noncompetitive NMDA receptor inhibitor that can be used to
treat Alzheimer's disease?
A. Memantine
B. Donepezil
C. Tacrine
D. Tolcapone
E. Pergolide
27. A 43-year-old high-profile attorney sees a psychiatrist with expertise in addiction medicine.
He explains that he has recently received his third drunk driving citation and fears losing his
license to practice unless he stops drinking altogether. He says he “just can't stop” once he starts.
He tells the physician that he doesn't have time to attend Alcoholic Anonymous and “wants a
pill.” The physician explains that there is something that might work if the patient is truly
serious. What agent is the physician considering?
A. Lorazepam
B. Flumazenil
C. Naloxone
D. Disulfiram
E. Carbamazepine
Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D.
Page 6

7. 3/30/2011
28. A nonstimulant agent that can be used to treat attention-deficit/hyperactivity disorder
(ADHD) is
A. Methylphenidate
B. Caffeine
C. Dextroamphetamine
D. Atomoxetine
E. Modafinil
29. Which of the following can be used to treat a 22-year-old with a recent diagnosis of
schizophrenia?
A. Baclofen
B. Haloperidol
C. Chloral hydrate
D. Phenobarbital
E. Imipramine
30. Soon after drug administration, the patient in the above question begins making odd faces
with spastic movements of his neck. Which of the following should be administered to treat these
dystonic reactions?
A. Fluphenazine
B. Bromocriptine
C. Dantrolene
D. Prolactin
E. Benztropine
31. Which of the following is a potential side effect of clozapine?
A. Cholestatic jaundice
B. QT prolongation
C. Agranulocytosis
D. Photosensitivity
E. Galactorrhea
32. Risperidone works primarily through inhibition of receptors for
A. Dopamine
B. Serotonin
C. Histamine
D. Acetylcholine
E. Norepinephrine
33. A 7-year-old boy is brought to the neurologist by his mother. She says that the boy's teacher
says there are times in class when he stares “out into space” and smacks his lips. In the office the
boy has one such episode while having an EEG, which demonstrates a 3-per-second spike and
wave tracing. Which drug is the best for this absence seizure?
A. Phenytoin
Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D.
Page 7

8. 3/30/2011
B. Carbamazepine
C. Prednisone
D. Lorazepam
E. Ethosuximide
34. Which of the following is a complication of phenytoin use?
A. Hepatotoxicity
B. Gingival hyperplasia
C. Thrombocytopenia
D. Aplastic anemia
E. Stevens-Johnson syndrome
35. Tiagabine works by
A. Inhibiting GABA uptake by inhibiting the GABA transporter
B. Increasing GABA by stimulating its release from neurons
C. Increasing GABA-stimulated chloride channel opening
D. Prolonging GABA-induced channel opening
E. Blocking T-type calcium channels
36. Which of the following agents is approved for treatment of diabetic neuropathy?
A. Phenytoin
B. Carbamazepine
C. Acetazolamide
D. Valproic acid
E. Gabapentin
37. A 5-year-old boy is brought to the emergency room by his parents after they found him with
an empty bottle of aspirin. They are not sure how many tablets the boy consumed. On
examination, the child is hyperpneic and lethargic. While the emergent treatment is started, a
sample is drawn for an arterial blood determination. What pattern is most likely to be indicated
by the arterial blood gas values?
A. Mixed metabolic alkalosis and respiratory alkalosis
B. Mixed respiratory alkalosis and metabolic acidosis
C. Mixed respiratory acidosis and metabolic acidosis
D. Mixed respiratory acidosis and metabolic alkalosis
E. Mixed metabolic acidosis and metabolic alkalosis
38. Which of the following is an antineoplastic agent that has been shown to help patients with
rheumatoid arthritis?
A. Valdecoxib
B. Ketorolac
C. Methotrexate
D. Entocort
Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D.
Page 8

9. 3/30/2011
E. Auranofin
39. Which of the following is true regarding infliximab?
A. It is a recombinant antibody to TNF-α
B. It is a humanized antibody to TNF-α
C. It is a fusion protein that binds to TNF-α receptor
D. It is a recombinant protein resembling IL-1
E. It is a recombinant protein composed of a portion of LFA-3
40. Which of the following is useful in an acute gout attack?
A. Probenecid
B. Sulfinpyrazone
C. Allopurinol
D. Colchicine
E. Celecoxib
41. What is the mechanism of action of tacrolimus?
A. It inhibits transport to the nucleus of the transcription factor NF-AT
B. It stimulates apoptosis of some lymphoid lineages
C. It decreases the activity of calcineurin
D. It inhibits mTOR, which in turn delays the G1—S transition
E. It inhibits proliferation of promyelocytes
42. Which of the following is an alkylating agent that may cause hemorrhagic ceptitis and
cardiomyopathy?
A. Azathioprine
B. Cyclosporine
C. Tacrolimus
D. Cyclophosphamide
E. Basiliximab
43. Your resident asks you what the mechanism of action of tPA is. What is your answer?
A. It inhibits platelet aggregation
B. It increases antithrombin activity
C. It impairs inhibits fibrin polymerization
D. It blocks GPIIa/IIIb
E. It activates plasminogen bound to fibrin
44. Which of the following is an antidote for iron overdose?
A. Protamine
B. Deferoxamine
C. Vitamin K
D. Fresh frozen plasma
E. Charcoal
Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D.
Page 9

10. 3/30/2011
45. Which of the following medications would provide the best relief from episodic attacks of
Ménìre's disease?
A. Furosemide
B. Ondansetron
C. Diazepam
D. Emetrol
E. Phentermine
46. A 56-year-old female with severe rheumatoid arthritis returns to see her rheumatologist. She
had been referred to a gastroenterologist, who had found multiple gastric ulcers on
esophogastroduodenoscopy. She is reluctant to give up the use of NSAIDS and afraid of the
potential cardiovascular toxicity of COX-2 inhibitor. At this point, what would be reasonable for
the rheumatologist to prescribe?
A. Omeprazole
B. Lansoprazole
C. Nizatidine
D. Metronidazole
E. Misoprostol
47. A 29-year-old male who recently immigrated to the United States sees his physician for a
burning sensation in his epigastrium. He is referred to a gastroenterologist, who performs
esophogastroduodenoscopy with biopsy that demonstrate ulcers with the presence of
Helicobacter pylori. Use of which of the following regimens would provide the most effective
and shortest treatment?
A. Pepto Bismol, metronidazole, tetracycline, and omeprazole
B. Pepto Bismol, metronidazole, tetracycline, and ranitidine
C. Clathromycin, metronidazole, and omeprazole
D. Clathromycin, amoxicillin, and omeprazole
E. Pepto Bismol, metronidazole, and amoxicillin
48. An 83-year-old male with multiple medical problems develops worsening constipation
during his hospitalization for lower extremity cellulitis. The hospitalist decides to start giving a
laxative. Which of the following is an appropriate choice and why?
A. Psyllium, because it is a bulk-forming laxative good for chronic constipation
B. An osmotic agent, such as senna, which is administered rectally
C. A stool softener such as lactulose administered rectally
D. A stool softener such as methyl cellulose that inhibits water reabsorption
E. A salt-containing osmotic agent such as docusate, useful in preventing constipation
49. A 35-year-old intravenous drug abuser in a methadone maintenance program is admitted to
the hospital for a work-up of suspected pulmonary tuberculosis. While in the hospital, he
complains of diarrhea and cramping. After stool studies return with a negative result, you decide
to begin an antidiarrheal. Which of the following is a good choice for this patient?
A. Kaolin
B. Codeine
C. Diphenoxylate
Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D.
Page 10

11. 3/30/2011
D. Loperamide
E. Propantheline
50. Which of the following would be an appropriate treatment to begin in a patient with Crohn's
disease?
A. Glucocorticoids
B. Sulfasalazine
C. Bismuth subsalicylate
D. Octreotide
E. Loperamide
51. The above patient returns for follow-up, and she still complains of bloody diarrhea, fever,
and weight loss. The gastroenterologist has placed her on a trial of steroids, and yet she still
complains of her symptoms. The gastroenterologist could consider using which of the following
agents?
A. Infalyte
B. Opium tincture
C. Mesalamine
D. Infliximab
E. Diphenoxylate
52. Adverse effects seen with high blood levels of theophylline include
A. Seizures
B. Arrhythmias
C. Nervousness
D. Nausea and vomiting
E. All of the above
53. A 62-year-old male alcoholic being treated for non-insulin-dependent diabetes mellitus
comes to the emergency department with a 1-hour history of nausea, vomiting, headache,
hypotension, and profuse sweating. What is the most likely causative agent?
A. Clomiphene
B. Glyburide
C. Chlorpropamide
D. Nandrolone
E. Vasopressin
54. An 81-year-old man with a history of coronary artery disease and a recent diagnosis of
hypothyroidism presents to the emergency department with an acute myocardial infarction (MI).
What is the most likely causative agent?
A. Medroxyprogesterone
B. Levothyroxine
C. Thiocyanate
D. Flutamide
Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D.
Page 11

12. 3/30/2011
E. Diethylstilbestrol (DES)
55. A 32-year-old woman being treated for an acute exacerbation of lupus erythematosus
complains of pain on eating. What is the most likely causative agent?
A. Oxytocin
B. Androlone
C. Vasopressin
D. Prednisone
E. Clomiphene
56. It is likely that the acquisition of antibiotic resistance in gram-negative bacilli such as
vancomycin is a result of
A. Spontaneous mutation
B. Transformation
C. Transduction
D. Conjugation
E. Transposition
57. A 30-year-old patient is undergoing chemotherapy for Hodgkin's disease and develops a
fever, prompting an admission by his oncologist. He is found to have a severely decreased white
blood cell count and therapy is started with several antibiotics for febrile neutropenia. Assuming
his regimen contains imipenem, which of the following must also be administered?
A. Probenecid
B. Clavulanic acid
C. Sulbactam
D. Cycloserine
E. Cilastatin
58. A 17-year-old male presents with right lower quadrant pain with guarding and rebound. A
CT scan demonstrates appendicitis, and he is taken to the operating room. What would be a good
antibiotic to administer prophylactically before the surgery?
A. Cefazolin
B. Cefoxitin
C. Ceftriaxone
D. Aztreonam
E. Oxacillin
59. A 23-year-old female, who is 23 weeks pregnant, develops a bladder infection due to
Pseudomonas sp. As well, she has a documented allergy to penicillin. What might be the best
choice, given the patient's history and condition?
A. Cefoxitin
B. Aztreonam
C. Imipenem
D. Piperacillin
E. Ciprofloxacin
Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D.
Page 12

13. 3/30/2011
60. A 37-year-old alcoholic is recovering from pneumonia due to Haemophilus influenzae in the
hospital. His treatment included the use of intravenous antibiotics. The nurse calls you to
evaluate the patient as he returned from a visit from his “buddy” outside. The nurse tells you he
smells like alcohol and he is flush, warm, and uncomfortable. You suspect a disulfiram-like
reaction. What antibiotic was he likely treated with?
A. Vancomycin
B. Bacitracin
C. Chloramphenicol
D. Isoniazid
E. Cefamandole
61. Which of the following can occur in a patient treated with chloramphenicol?
A. Gray baby syndrome
B. Bone marrow suppression
C. Disulfiram-like reaction
D. Nephrotoxicity
E. Ototoxicity
62. A 32-year-old male complains of persistently dry cough for several days with a mild fever
and fatigue. The family physician suspects a diagnosis of “walking pneumonia” on clinical
grounds, presumably due to Mycoplasma pneumoniae. Which of the following groups of
antibiotics would be effective?
A. Penicillins
B. Cephalosporins
C. Vancomycin
D. Chloramphenicol
E. Macrolides
63. Which of the following is a side effect of clindamycin?
A. Dizziness
B. Bruising
C. Difficulty hearing
D. Diarrhea
E. Tendon pain
64. An 18-year-old African-American army recruit with a history of G-6-PDH deficiency is to be
stationed in Somalia. During his tour of duty he develops a cyclic fever, malaise, and weakness.
A thin blood smear shows malarial organisms within red blood cells. Which antimalarial is likely
to give him the most hemolysis with use, given his enzyme deficiency?
A. Chloroquine
B. Pyrimethamine
C. Doxycycline
D. Primaquine
E. Sulfasalazine
Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D.
Page 13

14. 3/30/2011
65. A 54-year-old diabetic female was seen in the emergency room 3 weeks ago with complaints
of swelling, warmth, and pain in her foot. She was diagnosed with cellulitis and sent home on a
10-day course of an oral first-generation cephalosporin. She returns with severe diarrhea, and
Clostridium difficile is suspected. What is the initial treatment for this condition?
A. Clindamycin
B. Metronidazole
C. Ciprofloxacin
D. Neomycin
E. Silver sulfadiazine
66. A 37-year-old female recently had a large soft tissue sarcoma surgically resected from her
retroperitoneum. She is to receive both radiation and chemotherapy, with cyclophosphamide as
part of her chemotherapy. Which agent should be given in conjunction with this drug?
A. MESNA
B. Allopurinol
C. Leucovorin
D. Cilastatin
E. MOPP
67. A 54-year-old female is undergoing an experimental high-dose regimen with adriamycin and
cyclophosphamide for breast cancer. As this treatment is particularly myelosuppressive, the
oncologist is worried that her white blood cell count will drop dangerously low, making her
susceptible to opportunistic infections. In addition to the chemotherapy, what is the oncologist
likely to administer to prevent neutropenia?
A. Epoetin alpha
B. Filgrastim
C. Interferon-α
D. Oprelvekin
E. Amifostine
68. Trastuzumab works by
A. Inhibiting the oncoprotein bcr-abl
B. Blocking estrogen-mediated gene transcription
C. Preventing phosphorylation of a receptor tyrosine kinase
D. Targeting cells for destruction by antibody-mediated cellular cytotoxicity (ADCC)
E. Reducing circulating levels of tumor necrosis factor (TNF)
69. Which of the following might be considered for treatment of acute myelocytic anemia (M3
variant)?
A. Cisplatin
B. Lomustine
C. Tretinoin
D. Fluorouracil
E. Streptozocin
Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D.
Page 14

15. 3/30/2011
70. Chromosomal studies in a 56-year-old male indicate a (9:22) translocation, the Philadelphia
chromosome, confirming the diagnosis of chronic myelocytic leukemia (CML). Which of the
following might be used in his treatment?
A. Anastrozole
B. Rituximab
C. Imatinib
D. Gefitinib
E. Amifostine
71. Which agent can be used to treat hairy cell leukemia?
A. Interferon-α
B. Interleukin-2
C. All-trans-retinoic acid
D. Rituximab
E. Daunorubicin
72. A 63-year-old female develops metastatic colon cancer. The pathologist confirms that a
biopsy specimen retrieved from a recent colonoscopy demonstrates that the tumor overexpresses
epidermal growth factor receptor (EGFR). The oncologist decides to add a monoclonal antibody
to EGFR to her treatment. Which of the following would be added?
A. Rituximab
B. Erlotinib
C. Gefitinib
D. Cetuximab
E. Traztuzamab
73. A 62-year-old female complains of severe back pain refractory to NSAID use. An x-ray film
of the lumbar spine demonstrates “punched-out” lytic lesions. Her IgG levels are elevated and
show a monoclonal spike. A bone marrow biopsy specimen showing malignant plasma cells
confirms the diagnosis of multiple myeloma. In addition to chemotherapy, a bisphosphonate is
started. Which of the following would be the best choice?
A. Plicamycin
B. Retinoic acid
C. Thalidomide
D. Zoledronic acid
E. Etidronate
74. Which of the following should be considered to treat an acetominophen (APAP) overdose in
a 17-year-old female?
A. Trientine
B. Sorbitol
C. N-acetylcysteine
D. Ipecac
E. Diazepam
75. Organophosphate poisoning is treated with
Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D.
Page 15

16. 3/30/2011
A. Pralidoxime
B. Parathion
C. Amyl nitrate
D. Bethanechol
E. Nicotine
Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D.
Page 16