Pharmacology MCQs for NEET PG
906 worked Pharmacology questions across 126 areas. Each one has its own page with the reasoning for every option.
What this set is
Pharmacology asks what a drug does, how, and what goes wrong. The reliable scoring areas are mechanism, adverse effects, interactions and drug of choice.
This page lists the 906 Pharmacology questions that have a full worked page: 665 application questions that put a fact to use on a patient or a finding, and 241 multi-step questions that combine two or more ideas. Plain one-fact recall items are left out here on purpose. The Pharmacology practice bank in the app is larger, with 4,095 questions in all, and is where timed tests and daily practice draw from.
How to use it
- Pick an area you are weak in, below.
- Answer first, then read why each wrong option fails.
- Write a three-line note for every miss, and revisit it in a week.
- Move to a timed Pharmacology test once an area feels steady.
These are original practice items, not recalled exam questions, and they are not yet reviewed by independent faculty. Confirm important facts in a standard textbook.
What Pharmacology covers in the exam
- General pharmacology and pharmacokinetics
- Autonomic nervous system
- Cardiovascular drugs
- CNS drugs and antiepileptics
- Antimicrobials
- Endocrine drugs
- Chemotherapy
- Toxicology and antidotes
- Drugs in pregnancy
A study map from the standard curriculum; the NBEMS bulletin is the authority. See the Pharmacology study guide.
Worked questions by area
126 areas, largest first. Open an area to see its questions.
Chemotherapy68
- Chemotherapy: daptomycin · ApplicationA 62-year-old man with MRSA pneumonia is considered for daptomycin because vancomycin was not tolerated. Why is daptomycin unsuitable?
- Chemotherapy: once-daily aminoglycoside dosing · Multi-stepWhy is gentamicin often given as a single large daily dose rather than in divided doses?
- Chemotherapy: MRSA resistance mechanism · ApplicationA surgical wound swab grows Staphylococcus aureus resistant to cloxacillin and cefazolin. What is the molecular basis of this resistance?
- Chemotherapy: co-trimoxazole and hyperkalaemia · Multi-stepA 34-year-old man with HIV on high-dose co-trimoxazole for Pneumocystis pneumonia has potassium 6.1 mmol/L with a small rise in creatinine. What explains the hyperkalae…
- Chemotherapy: isoniazid neuropathy · ApplicationA 50-year-old diabetic man on antitubercular therapy has numbness and tingling in both feet. Which agent should be added and why?
- Chemotherapy: pyrazinamide and uric acid · ApplicationDuring the intensive phase of antitubercular therapy, a 45-year-old man has a swollen, intensely painful first metatarsophalangeal joint, and serum uric acid is 11 mg/d…
- Chemotherapy: bedaquiline · Multi-stepA 30-year-old woman with rifampicin-resistant tuberculosis is to start an oral regimen containing bedaquiline, with a fluoroquinolone and clofazimine. Which monitoring…
- Chemotherapy: echinocandins · ApplicationA man with HIV and CD4 count of 40 has headache and neck stiffness, and India ink staining of cerebrospinal fluid shows encapsulated yeasts. A colleague proposes caspof…
- Chemotherapy: abacavir hypersensitivity · ApplicationA man with HIV starts an abacavir-containing regimen. On day 10 he has fever, rash, vomiting, malaise and cough. Which pre-treatment screening test could have prevented…
- Chemotherapy: primaquine and radical cure · Multi-stepA 30-year-old man treated with chloroquine for Plasmodium vivax malaria, and now asymptomatic, needs prevention of relapse. Which is the best step?
- Chemotherapy: ivermectin · ApplicationA family has an outbreak of scabies with intense nocturnal itching and burrows between the fingers. Oral ivermectin is chosen. What is its mechanism of action?
- Chemotherapy: cisplatin nephrotoxicity · ApplicationA 50-year-old man with a testicular germ cell tumour is to receive cisplatin. Which measure best reduces its nephrotoxicity?
- Chemotherapy: bleomycin lung toxicity · Multi-stepA 24-year-old man receiving bleomycin, etoposide and cisplatin for a testicular tumour has a dry cough, dyspnoea and fine basal crackles. DLCO is reduced and the white…
- Chemotherapy: imatinib · ApplicationA 45-year-old man with massive splenomegaly and a leucocyte count of 2.4 lakh per microlitre has the Philadelphia chromosome t(9;22). Imatinib is started. Which stateme…
- Chemotherapy: aromatase inhibitors · ApplicationA 38-year-old premenopausal woman with ER-positive breast cancer is proposed anastrozole alone. Why is this unsuitable, and what adverse effect limits long-term use in…
- Chemotherapy: trastuzumab · ApplicationA 48-year-old woman with HER2-positive breast cancer is to receive trastuzumab after previous doxorubicin. Which monitoring is essential?
- Chemotherapy: rituximab and hepatitis B · Multi-stepA 60-year-old man with diffuse large B-cell lymphoma is to start rituximab-based chemotherapy. HBsAg is negative, anti-HBc total is positive and anti-HBs is negative. W…
- Chemotherapy: fluorouracil and DPD deficiency · ApplicationA 60-year-old woman with colon cancer develops severe mucositis, diarrhoea and neutropenia within days of her first fluorouracil infusion. Which enzyme deficiency is mo…
- Chemotherapy: glucarpidase · Multi-stepA patient treated with high-dose methotrexate has rising creatinine, a markedly elevated methotrexate level at 48 hours and mucositis despite leucovorin. Which agent ra…
- Chemotherapy: carboplatin versus cisplatin · ApplicationA patient with ovarian cancer has poor renal function and prior hearing loss, and a platinum agent with less nephrotoxicity, ototoxicity and emesis is needed. Which is…
- Chemotherapy: taxanes · ApplicationA woman receiving paclitaxel develops flushing, dyspnoea and hypotension within minutes of starting the infusion. How is this reaction prevented?
- Chemotherapy: bevacizumab · ApplicationA patient on bevacizumab for metastatic colorectal cancer develops new hypertension and proteinuria. Which adverse effect profile fits this drug?
- Chemotherapy: anti-EGFR antibodies · Multi-stepA patient with metastatic colorectal cancer whose tumour carries a KRAS mutation is being considered for cetuximab. What is the correct decision?
- Chemotherapy: checkpoint inhibitors · Multi-stepA melanoma patient on pembrolizumab develops profuse diarrhoea with colitis, and later thyroid dysfunction. Which is the best explanation and management?
- Chemotherapy: ATRA in APL · Multi-stepA young woman with acute promyelocytic leukaemia receives all-trans retinoic acid and, on day 8, develops fever, weight gain, dyspnoea and pulmonary infiltrates. What i…
- Chemotherapy: gemcitabine toxicity · ApplicationA 62-year-old man with pancreatic adenocarcinoma receives several cycles of chemotherapy and develops microangiopathic haemolytic anaemia, thrombocytopenia and renal fa…
- Chemotherapy: nitrosoureas · Multi-stepA man with glioblastoma receives a lipid-soluble alkylating agent that crosses the blood-brain barrier. Four to six weeks later his counts fall, and after cumulative do…
- Chemotherapy: dactinomycin · Multi-stepA 4-year-old has a large abdominal mass, haematuria and hypertension, and nephroblastoma is confirmed. After nephrectomy, vincristine is combined with which antitumour…
- Chemotherapy: bortezomib · ApplicationA 65-year-old man with multiple myeloma is treated with a drug that inhibits the 26S proteasome. Which adverse effect is characteristic?
- Chemotherapy: EGFR inhibitors · ApplicationA non-smoking woman with lung adenocarcinoma and an EGFR exon 19 deletion is started on oral targeted therapy. Two weeks later she has an acneiform facial rash and diar…
- Chemotherapy: cytarabine cerebellar toxicity · Multi-stepA man receiving intensive consolidation for acute myeloid leukaemia develops slurred speech, nystagmus, ataxia and dysmetria on day 4. MRI of the brain is normal. Which…
- Chemotherapy: busulfan pulmonary toxicity · ApplicationA man with chronic myeloid leukaemia on long-term oral therapy develops dry cough, breathlessness, fine basal crackles and skin hyperpigmentation. Which drug is the lik…
- Chemotherapy: etoposide mechanism · ApplicationA man with small cell lung cancer is treated with cisplatin and etoposide. What is the mechanism of etoposide?
- Chemotherapy: procarbazine reactions · Multi-stepA man on MOPP chemotherapy for Hodgkin lymphoma drinks alcohol at a party and develops flushing, headache and vomiting. Another day, after eating aged cheese, he has a…
- Chemotherapy: docetaxel premedication · ApplicationA man with castration-resistant prostate cancer on docetaxel develops weight gain, ankle oedema and a pleural effusion with a normal echocardiogram. Which premedication…
- Chemotherapy: selective oestrogen receptor degraders · Multi-stepA postmenopausal woman with ER-positive metastatic breast cancer progresses on tamoxifen and then an aromatase inhibitor. Which intramuscular drug binds the oestrogen r…
- Chemotherapy: multi-targeted kinase inhibitors · ApplicationA 60-year-old man with metastatic clear cell renal carcinoma is started on an oral multi-targeted tyrosine kinase inhibitor that blocks VEGF and PDGF receptors. Which a…
- Chemotherapy: anakinra in autoinflammatory disease · Multi-stepA child has recurrent fever, urticaria-like rash and arthralgia triggered by cold exposure from infancy, caused by gain-of-function mutation of NLRP3. Which drug gives…
- Chemotherapy: secukinumab cautions · ApplicationA patient with moderate plaque psoriasis is to start secukinumab, an IL-17A antibody. Which pre-existing condition calls for particular caution because it may worsen on…
- Chemotherapy: dupilumab target · ApplicationA 25-year-old with moderate to severe atopic dermatitis uncontrolled on topical therapy starts a monoclonal antibody and later develops conjunctivitis. Which target doe…
- Chemotherapy: natalizumab and progressive multifocal leukoencephalopathy · Multi-stepA woman with relapsing multiple sclerosis on natalizumab for three years develops subacute right hemiparesis, a visual field defect and cognitive decline. MRI shows new…
- Chemotherapy: fingolimod first-dose observation · ApplicationA patient starting fingolimod for multiple sclerosis is monitored for six hours after the first dose. What is being watched for?
- Chemotherapy: sirolimus compared with calcineurin inhibitors · ApplicationA renal transplant recipient with tacrolimus-related nephrotoxicity is switched to sirolimus. Which adverse effect is characteristic of sirolimus?
- Chemotherapy: abatacept mechanism · ApplicationA patient with rheumatoid arthritis not controlled by methotrexate is started on abatacept, a fusion protein of CTLA-4 and the Fc portion of IgG1. How does it work?
- Chemotherapy: apremilast · ApplicationA patient with psoriatic arthritis is given apremilast, an oral small molecule that inhibits phosphodiesterase 4. Which adverse effects are characteristic?
- Chemotherapy: belimumab · ApplicationA woman with active systemic lupus erythematosus, positive for anti-dsDNA, remains symptomatic on hydroxychloroquine and prednisolone. Belimumab is added. Which target…
- Chemotherapy: vemurafenib cutaneous adverse effect · Multi-stepA man with metastatic melanoma carrying the BRAF V600E mutation is treated with vemurafenib. After several weeks he develops multiple rapidly growing, crateriform skin…
- Chemotherapy: mitomycin and haemolytic uraemic syndrome · ApplicationA 62-year-old man with gastric adenocarcinoma has received several months of a regimen containing an antitumour antibiotic that is activated by bioreduction to an alkyl…
- Chemotherapy: cladribine in hairy cell leukaemia · ApplicationA 55-year-old man has pancytopenia, massive splenomegaly and a dry marrow tap. Flow cytometry shows B cells with hair-like projections that stain positive for tartrate-…
- Chemotherapy: lenalidomide in del(5q) MDS · ApplicationA 72-year-old woman has transfusion-dependent macrocytic anaemia. Marrow shows myelodysplasia with an isolated deletion of chromosome 5q, and erythropoietin has failed.…
- Chemotherapy: osimertinib and T790M resistance · Multi-stepA 58-year-old woman with lung adenocarcinoma and an EGFR exon 19 deletion responded to gefitinib for 11 months and then progressed. Repeat biopsy shows a T790M gatekeep…
- Chemotherapy: arsenic trioxide in APL · ApplicationWhich drug used in acute promyelocytic leukaemia promotes degradation of the PML-RARA fusion protein and requires ECG monitoring because it prolongs the QT interval?
- Chemotherapy: oxaliplatin acute neuropathy · ApplicationA 60-year-old man receiving FOLFOX for colon cancer reports tingling of the hands and a feeling of throat tightness within hours of each infusion, triggered by cold dri…
- Chemotherapy: pemetrexed vitamin supplementation · ApplicationFolic acid and vitamin B12 supplementation begins before treatment with a multitargeted antifolate given with cisplatin for non-squamous lung cancer and mesothelioma, i…
- Chemotherapy: P-glycoprotein multidrug resistance · Multi-stepA lymphoma that responded to doxorubicin relapses and is now resistant to doxorubicin, vincristine and paclitaxel, drugs with different structures and targets. Which me…
- Chemotherapy: ALK-positive lung cancer · ApplicationA 45-year-old woman who has never smoked has lung adenocarcinoma with an EML4-ALK fusion on molecular testing. EGFR mutation is absent. Which oral targeted drug is appr…
- Chemotherapy: venetoclax and tumour lysis · ApplicationVenetoclax, a BCL-2 inhibitor used for chronic lymphocytic leukaemia, is started at a low dose and escalated weekly over about five weeks. This schedule mainly reduces…
- Chemotherapy: ruxolitinib in myelofibrosis · ApplicationA 66-year-old man with primary myelofibrosis and a JAK2 V617F mutation has massive splenomegaly, night sweats and weight loss. Which drug reduces spleen size and consti…
- Chemotherapy: PARP inhibitors and BRCA · ApplicationA woman with high-grade serous ovarian cancer and a germline BRCA1 mutation has responded to platinum chemotherapy. Which maintenance drug exploits the defect in homolo…
- Chemotherapy: CDK4/6 inhibitors · ApplicationA postmenopausal woman with hormone receptor positive, HER2 negative metastatic breast cancer is given palbociclib with letrozole. What is the target of palbociclib?
- Chemotherapy: irinotecan and UGT1A1 · Multi-stepA man with metastatic colorectal cancer develops grade 4 neutropenia and severe delayed diarrhoea after his first dose of irinotecan. Genotyping shows a homozygous redu…
- Chemotherapy: leucovorin with fluorouracil · Multi-stepLeucovorin is given together with fluorouracil in the FOLFOX regimen for colorectal cancer. How does leucovorin increase the activity of fluorouracil?
- Chemotherapy: methotrexate interaction mechanism · Multi-stepA boy with osteosarcoma receiving high-dose methotrexate is given ibuprofen and piperacillin for fever. He develops severe mucositis and pancytopenia with a persistentl…
- Chemotherapy: streptozocin in islet cell tumours · ApplicationA man with a metastatic pancreatic neuroendocrine tumour is given a nitrosourea alkylating agent that is taken up selectively by pancreatic beta cells through the GLUT2…
- Chemotherapy: mitotane in adrenal carcinoma · ApplicationA 40-year-old woman with Cushing syndrome has a large adrenal mass with local invasion and is diagnosed with adrenocortical carcinoma. Which drug, directly toxic to adr…
- Chemotherapy: capecitabine activation · Multi-stepCapecitabine is an oral prodrug converted to fluorouracil in three steps, and the final step occurs preferentially in tumour tissue. Which enzyme catalyses this final s…
- Chemotherapy · ApplicationMethotrexate inhibits what enzyme?
- Chemotherapy · ApplicationWhat toxicity is common with cisplatin?
Antimicrobials63
- Antimicrobials · ApplicationWhich drug can cause a disulfiram-like reaction when taken with alcohol?
- Antimicrobials · ApplicationWhich drug causes 'gray baby syndrome' in neonates?
- Antimicrobials · ApplicationDuring a rapid intravenous infusion of vancomycin, a patient develops flushing and an erythematous rash over the face, neck and upper trunk with mild hypotension. What…
- Antimicrobials · ApplicationA 68-year-old man on prednisolone for polymyalgia rheumatica is given ciprofloxacin for a urinary infection and develops sudden heel pain and a palpable gap above the c…
- Antimicrobials: antifungals · ApplicationA patient treated for cryptococcal meningitis with conventional amphotericin B develops rising creatinine, hypokalaemia and hypomagnesaemia. What is the underlying caus…
- Antimicrobials: penicillin allergy and cross-reactivity · Multi-stepA patient reports hives after amoxicillin and needs a cephalosporin for a serious infection. Which statement is correct?
- Antimicrobials: ampicillin rash · ApplicationA 17-year-old with sore throat, exudative tonsillitis and generalised lymphadenopathy takes ampicillin and develops a diffuse maculopapular rash. What is the likely dia…
- Antimicrobials: piperacillin-tazobactam · ApplicationA diabetic patient has a hospital-acquired intra-abdominal infection with suspected Pseudomonas and anaerobes. Which drug has both antipseudomonal and anaerobic cover?
- Antimicrobials: ceftaroline · ApplicationWhich cephalosporin has activity against methicillin-resistant Staphylococcus aureus?
- Antimicrobials: cephalosporin adverse effects · Multi-stepA patient on cefoperazone for biliary sepsis develops spontaneous bruising with a raised prothrombin time, and later flushing and palpitations after drinking alcohol. W…
- Antimicrobials: aztreonam · ApplicationA patient with severe penicillin anaphylaxis has a serious gram-negative urinary sepsis. Which beta-lactam can be used with little cross-reactivity and has no gram-posi…
- Antimicrobials: carbapenem-resistant organisms · Multi-stepA patient in an Indian ICU has bacteraemia with a carbapenem-resistant Klebsiella carrying NDM-1 metallo-beta-lactamase. Which option is a recognised treatment approach?
- Antimicrobials: streptomycin and neomycin · ApplicationA patient on prolonged streptomycin complains of vertigo, ataxia and oscillopsia. Which statement describes the toxicity?
- Antimicrobials: tigecycline · ApplicationA patient with complicated intra-abdominal infection due to multidrug-resistant gram-negative bacilli receives tigecycline. Which statement is correct?
- Antimicrobials: clarithromycin in H. pylori and MAC · ApplicationClarithromycin is a component of which two regimens?
- Antimicrobials: respiratory fluoroquinolones · ApplicationWhich pair of fluoroquinolones have enhanced activity against Streptococcus pneumoniae and atypical organisms and are called respiratory quinolones?
- Antimicrobials: cotrimoxazole · ApplicationConsider a newborn whose mother took cotrimoxazole close to term, and an elderly man on cotrimoxazole and ramipril develops weakness. Which adverse effects fit each case?
- Antimicrobials: cotrimoxazole for Pneumocystis · Multi-stepAn HIV-positive patient with CD4 count 60 per microlitre has dry cough, exertional dyspnoea and bilateral ground-glass infiltrates, and Pneumocystis jirovecii is confir…
- Antimicrobials: metronidazole · ApplicationA woman prescribed metronidazole for bacterial vaginosis drinks wine with dinner and experiences flushing, vomiting and palpitations. Which statement is correct about m…
- Antimicrobials: nitrofurantoin · Multi-stepA woman at 38 weeks of pregnancy and an elderly woman with eGFR 20 mL/min both have cystitis. Why is nitrofurantoin a poor choice in these two?
- Antimicrobials: fosfomycin · ApplicationA single 3 g oral sachet is advised for uncomplicated cystitis in a young woman. Which drug inhibits the MurA enzyme in the first step of peptidoglycan synthesis?
- Antimicrobials: polymyxins · ApplicationA patient with carbapenem-resistant Acinetobacter infection is treated with colistin. Which two toxicities need monitoring?
- Antimicrobials: mechanisms of resistance · ApplicationA bacterium becomes resistant to penicillins by producing an enzyme that hydrolyses the beta-lactam ring. Which resistance mechanism is this?
- Antimicrobials: bactericidal and bacteriostatic · Multi-stepWhich grouping is correct?
- Antimicrobials: surgical prophylaxis · ApplicationFor a clean-contaminated abdominal surgery in a patient without MRSA risk, when should the prophylactic cefazolin dose be given?
- Antimicrobials: cycloserine neuropsychiatric toxicity · Multi-stepA patient on a second-line regimen for drug-resistant tuberculosis develops depression, psychosis and a seizure two months into treatment. Which drug and which co-admin…
- Antimicrobials: ethionamide hypothyroidism · ApplicationA patient on a regimen for drug-resistant tuberculosis develops fatigue, weight gain and cold intolerance. TSH is 38 mIU/L with a low free T4. Which drug is the likely…
- Antimicrobials: rifamycins and protease inhibitors · ApplicationA man with HIV on a protease-inhibitor-based regimen develops pulmonary tuberculosis. Which rifamycin is a weaker inducer of CYP3A4 and is preferred over rifampicin in…
- Antimicrobials: pentamidine toxicity · Multi-stepAn HIV-positive man with severe Pneumocystis pneumonia and a sulfonamide allergy is treated with an intravenous drug. On day 5 he has hypoglycaemia, followed by hypergl…
- Antimicrobials: itraconazole and heart failure · Multi-stepAn elderly man treated for onychomycosis with an oral azole develops breathlessness, ankle oedema and an ejection fraction of 30%. Coronary angiography is normal. Which…
- Antimicrobials: mupirocin mechanism · ApplicationA surgical ward nurse with persistent MRSA colonisation of the anterior nares receives intranasal mupirocin. Which bacterial enzyme does it inhibit?
- Antimicrobials: griseofulvin · ApplicationA 7-year-old with tinea capitis is treated with oral griseofulvin for several weeks. Which statement about the drug is correct?
- Antimicrobials: sulbactam activity against Acinetobacter · Multi-stepAmpicillin-sulbactam is used in severe infection with Acinetobacter baumannii mainly for its sulbactam component rather than for its beta-lactamase inhibition. What exp…
- Antimicrobials: fluconazole-resistant Candida · ApplicationA neutropenic patient with leukaemia on long-term fluconazole prophylaxis develops candidaemia. The isolate is intrinsically resistant to fluconazole. Which species is…
- Antimicrobials: fidaxomicin for recurrent C. difficile · ApplicationA 72-year-old has a second recurrence of Clostridioides difficile infection after oral vancomycin. A narrow-spectrum macrocyclic antibiotic that inhibits bacterial RNA…
- Antimicrobials: cefepime neurotoxicity · Multi-stepAn ICU patient with an eGFR of 15 mL/min is treated with standard-dose cefepime for pneumonia. On day 4 he becomes confused with multifocal myoclonus, and EEG shows tri…
- Antimicrobials: luminal amoebicide after liver abscess · Multi-stepA 35-year-old man completes metronidazole for an amoebic liver abscess. To eradicate Entamoeba histolytica cysts in the gut lumen and prevent relapse, which drug should…
- Antimicrobials: zanamivir in asthma · ApplicationA 30-year-old with severe persistent asthma develops influenza. Which anti-influenza drug is generally avoided in patients with airway disease because it can cause bron…
- Antimicrobials: cidofovir and probenecid · ApplicationWhich anti-CMV drug must be given with probenecid and intravenous saline pre-hydration to limit proximal tubular toxicity?
- Antimicrobials: D-test and inducible clindamycin resistance · Multi-stepA Staphylococcus aureus isolate from an abscess is resistant to erythromycin and appears sensitive to clindamycin. On disc testing the clindamycin zone is flattened nex…
- Antimicrobials: neurosyphilis treatment · ApplicationA 40-year-old man has Argyll Robertson pupils, a positive CSF VDRL and a lymphocytic pleocytosis. Which treatment is recommended?
- Antimicrobials: gonorrhoea treatment · ApplicationA 24-year-old man has purulent urethral discharge, and Gram stain shows intracellular Gram-negative diplococci. Because of widespread quinolone resistance, which single…
- Antimicrobials: brucellosis regimen · ApplicationA 30-year-old dairy worker has undulant fever, sweating and sacroiliitis, and serology confirms brucellosis. Which regimen is recommended?
- Antimicrobials: ampicillin for Listeria · ApplicationA 70-year-old man has meningitis, and CSF Gram stain shows Gram-positive rods. Empirical ceftriaxone and vancomycin are running. Which drug should be added to cover Lis…
- Antimicrobials: nocardiosis treatment · ApplicationA renal transplant recipient has pulmonary nodules and a brain abscess. Sputum shows beaded, branching Gram-positive filaments that are weakly acid-fast. Which drug is…
- Antimicrobials: plague treatment · ApplicationA 25-year-old has fever and a painful inguinal bubo after rat fall in his village. Aspirate shows Gram-negative bacilli with bipolar staining. Which antibiotic is the c…
- Antimicrobials: azithromycin for resistant typhoid · Multi-stepA 22-year-old with enteric fever has a Salmonella Typhi isolate resistant to ampicillin, chloramphenicol and co-trimoxazole, with reduced susceptibility to ciprofloxaci…
- Antimicrobials: Mazzotti reaction · ApplicationA man with itchy skin, nodules and microfilariae in skin snips is mistakenly given diethylcarbamazine. Within hours he has fever, intense itching, rash and hypotension.…
- Antimicrobials · ApplicationWhat is the principal mechanism of beta-lactam antibiotics?
- Antimicrobials · ApplicationWhich adverse effect is classically associated with aminoglycosides?
- Antimicrobials · ApplicationWhat is an important reason to use antibiotics judiciously?
- Antimicrobials · ApplicationWhat process does a macrolide antibiotic inhibit?
- Antimicrobials · ApplicationWhat mechanism is used by fluoroquinolone antibiotics?
- Antimicrobials · ApplicationWhat is a notable adverse effect of tetracyclines?
- Antimicrobials · ApplicationWhat is important before starting aminoglycosides?
- Antimicrobials · ApplicationWhat mechanism is used by macrolide antibiotics?
- Antimicrobials · ApplicationWhat adverse effect is characteristic of aminoglycosides?
- Antimicrobials · ApplicationWhat is a common adverse effect of broad-spectrum antibiotics?
- Antimicrobials · ApplicationWhy should aminoglycoside levels be monitored in prolonged therapy?
- Antimicrobials · ApplicationWhich mechanism confers methicillin resistance in Staphylococcus aureus?
- Antimicrobials · ApplicationWhat is the mechanism of vancomycin resistance in VRE?
- Antimicrobials · ApplicationWhy is metronidazole effective against anaerobic bacteria?
- Antimicrobials · ApplicationWhat serious toxicity is associated with chloramphenicol?
Cardiovascular drugs52
- Cardiovascular drugs · ApplicationAn elderly woman on digoxin and furosemide presents with vomiting, visual haloes with yellow vision, and a ventricular arrhythmia with serum potassium of 6.8 mmol/L aft…
- Cardiovascular drugs: toxicity · ApplicationA patient who overdosed on propranolol is bradycardic and hypotensive, and does not respond to atropine. Which drug is most appropriate?
- Cardiovascular drugs: nitrate and sildenafil interaction · ApplicationA 60-year-old man on isosorbide mononitrate for angina takes a friend's sildenafil tablet. Within an hour he collapses with a blood pressure of 70/40 mmHg. What is the…
- Cardiovascular drugs: verapamil with beta-blocker · ApplicationA 68-year-old man with angina on propranolol is given verapamil to improve control. Two days later he has syncope, a pulse of 38 per minute and an ECG showing complete…
- Cardiovascular drugs: hydralazine adverse effects · ApplicationA 50-year-old woman on hydralazine 200 mg per day for 8 months develops fever, arthralgia and pleuritic chest pain. Antinuclear and antihistone antibodies are positive,…
- Cardiovascular drugs: methyldopa adverse effects · ApplicationA 29-year-old woman at 34 weeks of gestation on methyldopa for gestational hypertension becomes pale and tired. Haemoglobin is 8 g/dL, indirect bilirubin is raised, pla…
- Cardiovascular drugs: ACE inhibitors and renal artery stenosis · Multi-stepA 66-year-old smoker with peripheral arterial disease and heart failure is started on ramipril. One week later creatinine has risen from 1.2 to 2.8 mg/dL and potassium…
- Cardiovascular drugs: sacubitril-valsartan · ApplicationA 60-year-old man with heart failure and an ejection fraction of 28% on enalapril is to be switched to sacubitril-valsartan. What is the key precaution?
- Cardiovascular drugs: ivabradine · ApplicationA 62-year-old man with heart failure and an ejection fraction of 30% is in sinus rhythm at 82 per minute despite maximally tolerated bisoprolol, an ACE inhibitor and sp…
- Cardiovascular drugs: amiodarone and thyroid · ApplicationA 70-year-old man on amiodarone for atrial fibrillation for 8 months has weight gain, cold intolerance and constipation. TSH is 28 mIU/L and free T4 is low. What best e…
- Cardiovascular drugs: lignocaine selectivity · ApplicationA 55-year-old man with an anterior myocardial infarction has sustained ventricular tachycardia and is given intravenous lignocaine. Why is it more effective in ischaemi…
- Cardiovascular drugs: class IC antiarrhythmics · Multi-stepA 62-year-old man with a previous myocardial infarction and an ejection fraction of 35% has frequent ventricular premature beats. A colleague proposes flecainide to sup…
- Cardiovascular drugs: adenosine in PSVT · ApplicationA haemodynamically stable 24-year-old woman has narrow-complex tachycardia at 190 per minute that does not respond to vagal manoeuvres. Which drug is most appropriate?
- Cardiovascular drugs: torsades de pointes · Multi-stepA 58-year-old woman on sotalol has serum potassium 2.8 mmol/L. She has episodes of polymorphic ventricular tachycardia with a twisting axis, QTc of 580 ms, and between…
- Cardiovascular drugs: digoxin and potassium · ApplicationA 70-year-old man with heart failure on digoxin and furosemide has nausea and frequent ventricular ectopics. Serum digoxin is 1.5 ng/mL and potassium is 2.9 mmol/L. How…
- Cardiovascular drugs: statin interactions · Multi-stepA 64-year-old man on atorvastatin 40 mg is given clarithromycin for pneumonia. A week later he has severe muscle pain and dark urine, with a creatine kinase of 18,000 U…
- Cardiovascular drugs: clopidogrel and proton pump inhibitors · Multi-stepA 60-year-old woman after coronary stenting is on aspirin and clopidogrel and has reflux symptoms for which omeprazole is prescribed. What is the best approach?
- Cardiovascular drugs: streptokinase antigenicity · Multi-stepA 60-year-old man in a district hospital with no catheterisation facility has an inferior ST-elevation infarction 2 hours after onset. He received streptokinase for a p…
- Cardiovascular drugs: reversal of dabigatran · ApplicationA 78-year-old man with atrial fibrillation on dabigatran develops an intracranial haemorrhage 3 hours after his last dose. Which agent specifically reverses the anticoa…
- Cardiovascular drugs: warfarin skin necrosis · Multi-stepA 52-year-old man with pulmonary embolism is started on warfarin 10 mg without heparin cover. On day 4 he develops painful red patches on the thighs that turn black. Wh…
- Cardiovascular drugs: thiazides and calcium · ApplicationA 40-year-old man has recurrent calcium oxalate stones, and 24-hour urine shows idiopathic hypercalciuria. Which drug reduces recurrence?
- Cardiovascular drugs: nitroprusside toxicity · Multi-stepA 48-year-old woman with renal impairment has been on a sodium nitroprusside infusion at a high rate for 3 days for hypertensive emergency. She now has confusion, sever…
- Cardiovascular drugs: clonidine withdrawal · Multi-stepA 54-year-old man on clonidine 0.2 mg three times a day ran out of tablets 2 days ago. He now has a pounding headache, sweating and palpitations with a blood pressure o…
- Cardiovascular drugs: aldosterone antagonists · ApplicationA man with heart failure on spironolactone develops painful gynaecomastia and wishes to continue an aldosterone antagonist. Which substitute is less likely to cause thi…
- Cardiovascular drugs: phosphodiesterase 3 inhibitors · ApplicationA patient with acute decompensated heart failure on long-term metoprolol responds poorly to dobutamine. Milrinone is added. Which enzyme does milrinone inhibit, and wha…
- Cardiovascular drugs: ticagrelor adverse effect · Multi-stepA man with acute coronary syndrome on aspirin and a reversible P2Y12 antagonist complains of breathlessness. His chest is clear, and ECG, chest film and echocardiogram…
- Cardiovascular drugs: fibrate and statin interaction · Multi-stepA man on simvastatin adds a fibrate for high triglycerides. Two weeks later he has diffuse myalgia, dark urine and a creatine kinase twelve times normal. Which fibrate…
- Cardiovascular drugs: P2Y12 inhibitors and prior stroke · Multi-stepA 70-year-old man with an ischaemic stroke six months ago presents with an NSTEMI, and PCI is planned. Which P2Y12 inhibitor is contraindicated because it increases int…
- Cardiovascular drugs: short-acting dihydropyridines after infarction · Multi-stepA man five days after myocardial infarction has recurrent angina and a blood pressure of 160/100 mmHg. Which drug, given as an immediate-release capsule, should be avoi…
- Cardiovascular drugs: finerenone · Multi-stepA man with type 2 diabetes and albuminuric chronic kidney disease remains albuminuric on a maximally tolerated ACE inhibitor, with serum potassium 4.4 mmol/L. A mineral…
- Cardiovascular drugs: SGLT2 inhibitors in heart failure · ApplicationA non-diabetic man with symptomatic heart failure and an ejection fraction of 30 percent remains breathless despite an ACE inhibitor, a beta-blocker and spironolactone.…
- Cardiovascular drugs: sequential nephron blockade · Multi-stepA man with cardiac oedema has a poor response to high-dose oral furosemide. Metolazone is added and he diureses briskly. Which electrolyte pattern is most characteristi…
- Cardiovascular drugs: levosimendan · ApplicationA patient with acute decompensated heart failure and low output is given intravenous levosimendan. Which action underlies its inotropic effect?
- Cardiovascular drugs: emicizumab · Multi-stepA boy with severe haemophilia A and high-titre factor VIII inhibitors has recurrent joint bleeds despite bypassing agents. Weekly subcutaneous emicizumab is started. Ho…
- Cardiovascular drugs: vericiguat · ApplicationA patient with heart failure and reduced ejection fraction is admitted again despite optimal therapy. Vericiguat is added. What is its mechanism of action?
- Cardiovascular drugs: lidocaine state dependence · Multi-stepLidocaine suppresses ventricular tachycardia from ischaemic myocardium but has little effect on atrial arrhythmias. Which property best explains this selectivity?
- Cardiovascular drugs: nitrate tolerance in workers · ApplicationWorkers in a nitroglycerin factory get headache and dizziness on Monday that settle by the end of the week and return after the weekend break. What explains this pattern?
- Cardiovascular drugs: bile acid sequestrants · ApplicationA man with mixed dyslipidaemia, triglyceride 480 mg per dL, is started on cholestyramine for a high LDL and returns with a higher triglyceride level. What explains this?
- Cardiovascular drugs: aspirin and platelet life span · ApplicationA man taking low-dose aspirin is planned for elective surgery with a high bleeding risk. He is told to stop aspirin about a week before. What is the reason for the inte…
- Cardiovascular drugs: captopril adverse effects · ApplicationA patient on high-dose captopril complains of loss of taste and develops a maculopapular rash. Which structural feature of the drug is held responsible?
- Cardiovascular drugs: acute aortic dissection · Multi-stepA man with a tearing chest pain and a blood pressure of 200/110 mm Hg is diagnosed with acute aortic dissection. Which initial drug is chosen to reduce shear stress on…
- Cardiovascular drugs: atrial fibrillation with accessory pathway · Multi-stepA young man with pre-excited atrial fibrillation in Wolff-Parkinson-White syndrome is haemodynamically stable. Which intravenous drug is contraindicated?
- Cardiovascular drugs: bempedoic acid · Multi-stepA patient with coronary disease cannot tolerate statins because of myalgia, and LDL remains high on ezetimibe. Which oral drug inhibits an enzyme upstream of HMG-CoA re…
- Cardiovascular drugs · ApplicationWhat is the main action of nitrates in angina?
- Cardiovascular drugs · ApplicationWhat effect do beta blockers have on heart rate?
- Cardiovascular drugs · ApplicationWhat is a common adverse effect of calcium-channel blockers such as amlodipine?
- Cardiovascular drugs · ApplicationWhat is the main antianginal effect of nitrates?
- Cardiovascular drugs · ApplicationWhat is a key adverse effect of ACE inhibitors?
- Cardiovascular drugs · ApplicationWhat is a major reason to avoid ACE inhibitors during pregnancy?
- Cardiovascular drugs · ApplicationWhich adverse effect is characteristic of amiodarone therapy?
- Cardiovascular drugs · ApplicationWhat is the main effect of adenosine in regular AV-nodal re-entry tachycardia?
- Cardiovascular drugs · ApplicationWhat electrolyte disturbance increases digoxin toxicity risk?
Endocrine drugs47
- Endocrine drugs: glucocorticoid adverse effects · ApplicationA man with polymyalgia rheumatica on prednisolone 20 mg daily for eight months develops proximal weakness, a fracture after minor trauma and a rise in blood glucose. Wh…
- Endocrine drugs: oestrogen adverse effects · ApplicationA postmenopausal woman with an intact uterus takes oestrogen alone for hot flushes. Which risk is increased, and how is it mitigated?
- Endocrine drugs: mifepristone · ApplicationHow does mifepristone act when used with misoprostol for medical termination of early pregnancy?
- Endocrine drugs: ovulation induction · Multi-stepA woman with polycystic ovary syndrome and anovulatory infertility is offered an oral agent for ovulation induction. Which drug is now often preferred over clomiphene,…
- Endocrine drugs: 5-alpha reductase inhibitors · ApplicationA 58-year-old man with benign prostatic hyperplasia and a large prostate is given finasteride. Which statement is correct?
- Endocrine drugs: antiandrogens · Multi-stepA man with metastatic castration-resistant prostate cancer is started on abiraterone with prednisolone. What is the reason for the steroid?
- Endocrine drugs: vitamin D toxicity · ApplicationA child given very large doses of cholecalciferol for rickets develops vomiting, polyuria and constipation with a serum calcium of 3.4 mmol/L. What is the diagnosis?
- Endocrine drugs: sulfonylurea hypoglycaemia · Multi-stepAn elderly woman with renal impairment on glibenclamide has recurrent hypoglycaemia that returns after dextrose correction. Which drug reduces insulin release and helps…
- Endocrine drugs: glucocorticoid-induced osteoporosis · ApplicationA man with rheumatoid arthritis on prednisolone 10 mg daily for two years is found to have a low bone density. Which drug is the usual first-line therapy for prevention…
- Endocrine drugs: sulfonylurea and hyponatraemia · ApplicationA 60-year-old diabetic man on a long-acting sulfonylurea has a serum sodium of 122 mmol/L, is euvolaemic, and has concentrated urine. Which drug is most likely responsi…
- Endocrine drugs: diazoxide in hyperinsulinism · Multi-stepAn infant with persistent hyperinsulinaemic hypoglycaemia is started on an oral drug that opens ATP-sensitive potassium channels on beta cells. Which adverse effect sho…
- Endocrine drugs: mineralocorticoid replacement · Multi-stepA woman with primary adrenal insufficiency on hydrocortisone and a stable dose has postural hypotension, serum sodium 128 mmol/L and potassium 5.8 mmol/L. Which additio…
- Endocrine drugs: selective oestrogen receptor modulators · Multi-stepA 58-year-old postmenopausal woman with osteoporosis has a strong family history of breast cancer and an intact uterus. Which drug improves bone density and lowers inva…
- Endocrine drugs: phosphate binder choice in dialysis · Multi-stepA haemodialysis patient taking calcium carbonate has a serum calcium of 11.0 mg/dL and a phosphate of 7.5 mg/dL. Which change is most appropriate?
- Endocrine drugs: pasireotide in Cushing disease · Multi-stepA woman with persistent Cushing disease after pituitary surgery is treated with pasireotide, a somatostatin analogue with high affinity for SST5. Compared with octreoti…
- Endocrine drugs: budesonide in Crohn disease · ApplicationFor mild to moderate ileocaecal Crohn disease, oral controlled-release budesonide is preferred to prednisolone. What is the main reason?
- Endocrine drugs: elagolix · Multi-stepA woman with endometriosis-related pelvic pain is given the oral GnRH antagonist elagolix. Unlike depot leuprolide, it causes no initial flare of symptoms. Why?
- Endocrine drugs: atosiban tocolysis · ApplicationA woman at 30 weeks in preterm labour has severe cardiac disease, so a beta-agonist and nifedipine are avoided. Atosiban is chosen. Atosiban inhibits uterine contractio…
- Endocrine drugs: nitisinone in tyrosinaemia · Multi-stepAn infant with liver failure and a coagulopathy is found to have raised succinylacetone in urine, diagnosing hereditary tyrosinaemia type 1. Nitisinone is started. Whic…
- Endocrine drugs: sapropterin in phenylketonuria · ApplicationA subset of patients with phenylketonuria who have residual phenylalanine hydroxylase activity improve on an oral synthetic preparation of a cofactor. Which cofactor is…
- Endocrine drugs: perioperative steroid cover · ApplicationA 50-year-old man has taken prednisolone 10 mg daily for rheumatoid arthritis for two years. He is posted for major abdominal surgery. What is the correct perioperative…
- Endocrine drugs: adrenal crisis management · ApplicationA 35-year-old woman with Addison disease stopped her tablets during gastroenteritis. She presents with blood pressure 70/40 mmHg, sodium 124 mmol/L, potassium 6.2 mmol/…
- Endocrine drugs: bisphosphonate and atypical femoral fracture · ApplicationA 70-year-old woman has taken alendronate for nine years. She develops a dull pain in the thigh, and radiographs show lateral cortical thickening with a transverse subt…
- Endocrine drugs: zoledronic acid acute-phase reaction · ApplicationA 66-year-old woman receives her first intravenous zoledronic acid infusion for osteoporosis. Twenty-four hours later she has fever, myalgia and malaise that resolve in…
- Endocrine drugs: active vitamin D in kidney disease · Multi-stepA 55-year-old man with stage 5 chronic kidney disease has low calcium, high phosphate and high PTH. Despite adequate cholecalciferol, his 1,25-dihydroxyvitamin D is low…
- Endocrine drugs: post-thyroidectomy hypocalcaemia · ApplicationOn day 2 after total thyroidectomy a woman has perioral tingling, carpopedal spasm and a positive Chvostek sign. Serum calcium is 1.6 mmol/L and the ECG shows a long QT…
- Endocrine drugs: demeclocycline in SIADH · ApplicationA man with chronic SIADH and persistent hyponatraemia cannot tolerate fluid restriction. Which tetracycline derivative, which antagonises ADH action in the collecting d…
- Endocrine drugs: progestin-only pill in lactation · ApplicationA woman 8 weeks after delivery is exclusively breastfeeding and wants a daily oral contraceptive. Which type is preferred?
- Endocrine drugs: testosterone and erythrocytosis · ApplicationA 50-year-old man with hypogonadism uses testosterone gel. After six months his haemoglobin is 18.5 g/dL and haematocrit 56 percent. Which adverse effect is this?
- Endocrine drugs: glucocorticoid haematological effects · ApplicationA man started on prednisolone 40 mg daily has a blood count taken one week later. Which pattern is expected?
- Endocrine drugs: radioiodine and Graves ophthalmopathy · Multi-stepA 40-year-old smoker with active Graves disease and moderate thyroid eye disease is planned for radioiodine. What measure reduces the risk of worsening of the eye disea…
- Endocrine drugs: desmopressin and hyponatraemia · ApplicationA 9-year-old on intranasal desmopressin for nocturnal enuresis drinks a lot of fluid at bedtime and develops headache, vomiting and a seizure. Serum sodium is 120 mmol/…
- Endocrine drugs: levothyroxine in coronary disease · ApplicationA 72-year-old man with angina has newly found overt hypothyroidism with TSH 60 mIU/L. Which approach to levothyroxine is correct?
- Endocrine drugs: transdermal oestrogen and thrombosis · Multi-stepA 52-year-old woman with obesity needs menopausal hormone therapy and the clinician wants the lowest additional thrombotic risk. Which route and reasoning are best?
- Endocrine drugs: alternate-day glucocorticoid · ApplicationA 7-year-old with steroid-dependent nephrotic syndrome on daily prednisolone has slowed growth and cushingoid features. Which change reduces growth suppression and adre…
- Endocrine drugs: octreotide adverse effects · ApplicationA man with acromegaly has been on long-acting octreotide for two years. He now has intermittent right upper quadrant pain after meals, and ultrasound shows echogenic fo…
- Endocrine drugs · ApplicationWhat is a common long-term adverse effect of systemic corticosteroids?
- Endocrine drugs · ApplicationWhat is levothyroxine used to treat?
- Endocrine drugs · ApplicationWhat is an important counseling point for systemic glucocorticoids used long term?
- Endocrine drugs · ApplicationWhat is the main action of bisphosphonates?
- Endocrine drugs · ApplicationWhat is a common therapy for hyperthyroidism that reduces hormone synthesis?
- Endocrine drugs · ApplicationWhat long-term adverse effect is associated with systemic corticosteroids?
- Endocrine drugs · ApplicationWhat is a major adverse effect of systemic corticosteroids?
- Endocrine drugs · ApplicationWhat important adverse effect can follow sulfonylurea treatment?
- Endocrine drugs · ApplicationWhich drug class can cause euglycaemic diabetic ketoacidosis?
- Endocrine drugs · ApplicationWhich adverse effect is important with long-term systemic glucocorticoids?
- Endocrine drugs · ApplicationWhy should levothyroxine be separated from iron supplements?
Pharmacokinetics34
- Pharmacokinetics · ApplicationA drug has an apparent volume of distribution of several hundred litres in an adult. What does this most likely indicate?
- Pharmacokinetics · Multi-stepA drug has an apparent volume of distribution of 40 L and an oral bioavailability of 50 percent. What oral loading dose is needed to achieve a plasma concentration of 1…
- Pharmacokinetics · Multi-stepA patient on phenytoin 300 mg/day has a plasma level of 10 mg/L. The dose is raised to 400 mg/day and the level rises to 25 mg/L with nystagmus and ataxia. What explain…
- Pharmacokinetics: steady state · ApplicationA drug with a half-life of 6 hours is given by constant intravenous infusion. About how long will it take to reach approximately 94% of the steady-state concentration?
- Pharmacokinetics: maintenance dose · Multi-stepA drug has a clearance of 2 L/h and an oral bioavailability of 0.8. A steady-state plasma concentration of 5 mg/L is required. What oral dose given every 12 hours is ne…
- Pharmacokinetics: half-life · ApplicationA drug has an apparent volume of distribution of 70 L and a clearance of 7 L/h. What is its approximate elimination half-life?
- Pharmacokinetics: ion trapping and excretion · ApplicationA 20-year-old woman presents with tinnitus, fast deep breathing and vomiting after taking many aspirin tablets. Which measure enhances renal elimination of the drug?
- Pharmacokinetics: high extraction drugs · Multi-stepA patient with severe congestive heart failure is given a standard lignocaine infusion for ventricular arrhythmia and develops confusion and seizures. What is the best…
- Pharmacokinetics: protein binding · Multi-stepA 30-year-old woman with nephrotic syndrome on phenytoin has nystagmus and ataxia, but her total serum phenytoin is 8 mg/L (usual range 10 to 20). What is the correct i…
- Pharmacokinetics: drug metabolism in liver disease · ApplicationA 55-year-old man with decompensated alcoholic cirrhosis needs a benzodiazepine for alcohol withdrawal. Which agent is preferred, and why?
- Pharmacokinetics: bioavailability from AUC · Multi-stepIn a study, 50 mg of a drug is given intravenously and gives an AUC of 40 mg.h/L. A 100 mg oral dose of the same drug gives an AUC of 40 mg.h/L. What is its oral bioava…
- Pharmacokinetics: ion trapping · ApplicationA 20-year-old woman is brought in after ingesting a large number of aspirin tablets. She has tinnitus, rapid breathing and a mixed acid-base disturbance. Aspirin is a w…
- Pharmacokinetics: bioavailability from AUC · Multi-stepA drug is given as 200 mg orally and the area under the plasma concentration-time curve is 30 mg.h/L. When 100 mg of the same drug is given intravenously, the area unde…
- Pharmacokinetics: maintenance dose calculation · Multi-stepAn oral drug has a clearance of 3 L per hour and a bioavailability of 50 percent. It is to be given every 12 hours to achieve an average steady-state plasma concentrati…
- Pharmacokinetics: high extraction drugs in portal shunting · Multi-stepA 55-year-old man with cirrhosis and extensive portosystemic shunting is given the usual oral dose of propranolol and develops marked bradycardia and hypotension. Which…
- Pharmacokinetics: properties favouring dialysis · ApplicationA 60-year-old woman on long-term lithium presents with coarse tremor, ataxia, confusion and a markedly raised serum lithium with acute kidney injury. Haemodialysis is p…
- Pharmacokinetics · ApplicationWhat term describes drug removal per unit time?
- Pharmacokinetics · ApplicationWhat describes drug distribution volume relative to plasma?
- Pharmacokinetics · ApplicationWhat does bioavailability describe?
- Pharmacokinetics · ApplicationWhat is the main site of first-pass metabolism for many oral drugs?
- Pharmacokinetics · ApplicationWhat does a drug half-life represent?
- Pharmacokinetics · ApplicationWhat is the volume of distribution a conceptual measure of?
- Pharmacokinetics · ApplicationWhat organ is a major route of elimination for many hydrophilic drugs?
- Pharmacokinetics · ApplicationWhat does clearance describe for a drug?
- Pharmacokinetics · ApplicationWhat is steady state during repeated drug dosing?
- Pharmacokinetics · ApplicationWhat can low plasma albumin increase for a highly protein-bound drug?
- Pharmacokinetics · ApplicationWhat route completely avoids first-pass hepatic metabolism?
- Pharmacokinetics · ApplicationWhat property determines the fraction of an oral dose reaching systemic circulation?
- Pharmacokinetics · ApplicationWhat happens to drug half-life when clearance falls but volume of distribution is unchanged?
- Pharmacokinetics · ApplicationWhat is the main clinical consequence of a high volume of distribution?
- Pharmacokinetics · ApplicationWhat does first-pass metabolism reduce after oral drug administration?
- Pharmacokinetics · ApplicationWhat is the purpose of a loading dose?
- Pharmacokinetics · ApplicationWhat does steady state mean during repeated drug dosing?
- Pharmacokinetics · ApplicationHow many half-lives are usually required to approach steady state?
Drugs in pregnancy27
- Drugs in pregnancy: ACE inhibitor fetopathy · ApplicationA woman who conceived while taking enalapril for hypertension continued it into the third trimester. Ultrasound at 32 weeks would most likely show which finding?
- Drugs in pregnancy: diethylstilbestrol · ApplicationA 19-year-old woman has a clear cell adenocarcinoma of the vagina. Her mother took a synthetic non-steroidal oestrogen during pregnancy to prevent miscarriage. Which dr…
- Drugs in pregnancy: hypertensive emergency · ApplicationA 30-year-old woman at 34 weeks of gestation has a blood pressure of 170/112 mmHg, headache and proteinuria. Which is an appropriate drug for rapid control?
- Drugs in pregnancy: retinoids · ApplicationA newborn has microtia, cleft palate, hydrocephalus, a ventricular septal defect and thymic hypoplasia. The mother treated her severe acne with an oral retinoid during…
- Drugs in pregnancy: antithyroid drugs · Multi-stepA woman at 7 weeks of gestation has newly diagnosed Graves disease with a heart rate of 112 per minute. Which treatment plan is most appropriate?
- Drugs in pregnancy: aminoglycosides · ApplicationA pregnant woman received prolonged streptomycin therapy for tuberculosis. Which fetal complication is the main concern?
- Drugs in pregnancy: thalidomide · ApplicationA baby is born with absent long bones of the limbs and flipper-like hands after maternal drug exposure in the first trimester. Which drug is classically responsible?
- Drugs in pregnancy: fetal hydantoin syndrome · ApplicationA child born to a mother with epilepsy has cleft palate, hypoplastic nails and distal phalanges and growth deficiency. Which drug was she taking?
- Drugs in pregnancy: magnesium sulfate regimens · ApplicationA woman with severe pre-eclampsia has an eclamptic fit, and magnesium sulfate is started using the Pritchard regimen. Which description is correct?
- Drugs in pregnancy: nitrofurantoin near term · Multi-stepA woman at 39 weeks with a urinary infection is considered for an antibiotic that can cause haemolysis in a G6PD-deficient newborn when used at term. Which drug is it?
- Drugs in pregnancy: warfarin embryopathy · Multi-stepA newborn has nasal hypoplasia, stippled epiphyses on radiographs and short fingers. The mother has a mechanical mitral valve and took an oral anticoagulant through the…
- Drugs in pregnancy: nausea and vomiting of pregnancy · ApplicationA woman at 8 weeks of gestation has persistent nausea and vomiting that has not improved with dietary changes. Which combination is a widely used first-line drug treatm…
- Drugs in pregnancy: androgenic drugs and virilisation · Multi-stepA newborn girl has clitoromegaly and fused labioscrotal folds, with normal adrenal steroids. Her mother was treated for endometriosis in early pregnancy before the preg…
- Drugs in pregnancy: neonatal withdrawal · ApplicationA newborn is irritable with a high-pitched cry, tremor, sneezing and watery diarrhoea on day 2. His mother took a prescribed opioid throughout pregnancy. What is the mo…
- Drugs in pregnancy: ribavirin · ApplicationA woman with chronic hepatitis C is treated with interferon and ribavirin. Which statement about ribavirin is correct?
- Drugs in pregnancy: SSRIs late in gestation · ApplicationA term neonate whose mother took an SSRI throughout pregnancy develops tachypnoea and cyanosis soon after birth. Echocardiography shows a structurally normal heart. Lat…
- Drugs in pregnancy: mycophenolate embryopathy · Multi-stepA newborn has microtia with atresia of the ear canal, cleft lip and palate, and hypoplastic nails. His mother had a renal transplant and took an immunosuppressant combi…
- Drugs in pregnancy: leflunomide washout · ApplicationA woman with rheumatoid arthritis on leflunomide wishes to conceive. Because the active metabolite persists in the body for months, which drug is used to accelerate its…
- Drugs in pregnancy: insulin and the placenta · ApplicationA woman with gestational diabetes not controlled by diet is started on insulin. Which property makes insulin suitable in pregnancy from the point of view of fetal expos…
- Drugs in pregnancy: all-or-none period · ApplicationA woman takes a known teratogen in the first week after conception, before she knows she is pregnant. According to the principles of teratology, what is the most likely…
- Drugs in pregnancy: valproate neurodevelopment · ApplicationA woman with generalised epilepsy on sodium valproate wishes to conceive. Besides neural tube defects, which long-term outcome in the child is linked to in-utero valpro…
- Drugs in pregnancy: enzyme inducers and neonatal bleeding · Multi-stepA newborn of a mother who took phenytoin throughout pregnancy bleeds from the umbilical stump and gut on the first day. The prothrombin time is prolonged with a normal…
- Drugs in pregnancy: drugs during lactation · ApplicationA breastfeeding mother with a tension headache and fever needs a drug. Which of these is considered acceptable during lactation?
- Drugs in pregnancy: beta-agonist tocolysis · ApplicationA woman at 30 weeks in preterm labour is given an intravenous beta-2 agonist infusion. Several hours later she is breathless, with tachycardia and bibasal crackles. Whi…
- Drugs in pregnancy: atenolol and fetal growth · ApplicationA woman with chronic hypertension asks which beta-blocker should be avoided during pregnancy because prolonged exposure is associated with fetal growth restriction. Whi…
- Drugs in pregnancy: hydroxychloroquine in lupus · ApplicationA woman with SLE in remission on hydroxychloroquine finds she is 6 weeks pregnant and asks if she should stop it. What is the best advice?
- Drugs in pregnancy: uterotonic choice in hypertension · ApplicationA woman with severe pre-eclampsia and blood pressure of 170/110 mmHg has postpartum haemorrhage from uterine atony. Which uterotonic should be avoided?
Toxicology27
- Toxicology: organophosphates · ApplicationA farmer is brought in after drinking an organophosphate pesticide. He has pinpoint pupils, salivation, bronchorrhoea and fasciculations. Atropine is given. Which addit…
- Toxicology: ethylene glycol · Multi-stepA man with ethylene glycol poisoning is unable to get fomepizole at a remote hospital, and ethanol infusion is considered. What is the rationale?
- Toxicology: nitroprusside and cyanide · ApplicationA 60-year-old man receives a high-dose sodium nitroprusside infusion for 3 days for hypertensive emergency. He develops confusion, tachypnoea and severe lactic acidosis…
- Toxicology: methaemoglobinaemia · ApplicationA young man treated with dapsone becomes cyanosed with a saturation of 85% that does not improve on oxygen. His arterial blood is chocolate brown and PaO2 is normal. Wh…
- Toxicology: carbon monoxide · ApplicationA family in a poorly ventilated room warmed by a coal stove is found with headache, vomiting and drowsiness. Pulse oximetry reads 99% on room air. What is the most appr…
- Toxicology: iron · ApplicationA 3-year-old child who swallowed his mother's iron tablets has haematemesis, abdominal pain and shock, and the serum iron is well above 500 mcg/dL. Which chelator is us…
- Toxicology: lead · ApplicationA 4-year-old child with pica has anaemia with basophilic stippling, constipation and a blood lead level of 52 mcg/dL. He is alert and has no encephalopathy. Which chela…
- Toxicology: calcium channel blocker overdose · Multi-stepA woman who took a large amount of verapamil has a heart rate of 38 per minute and blood pressure 70/40 mmHg with hyperglycaemia. Atropine, fluids and intravenous calci…
- Toxicology: mercury · Multi-stepA worker exposed to methylmercury in contaminated fish has paraesthesia, ataxia and constriction of visual fields. A trainee proposes intramuscular dimercaprol. Why is…
- Toxicology: tricyclic antidepressants · Multi-stepA 22-year-old woman who took amitriptyline tablets has a Glasgow Coma Scale score of 9, blood pressure 80/50 mmHg, dilated pupils and a QRS of 140 ms. Which treatment i…
- Toxicology: organophosphate intermediate syndrome · Multi-stepA farmer recovered from an acute organophosphate cholinergic crisis. On day 3 he develops weakness of neck flexion, proximal limbs and respiratory muscles with cranial…
- Toxicology: aluminium phosphide · ApplicationA farmer who swallowed grain-preservative tablets develops a garlic odour on the breath, refractory hypotension and metabolic acidosis. Which mechanism best explains th…
- Toxicology: paraquat · Multi-stepA 20-year-old man swallowed a herbicide. He has oral mucosal ulceration and then renal failure, and 10 days later progressive breathlessness with hypoxaemia and fibrosi…
- Toxicology: local anaesthetic systemic toxicity · ApplicationDuring a brachial plexus block with bupivacaine, a patient develops perioral numbness and tinnitus, followed by a generalised seizure and ventricular arrhythmia. Which…
- Toxicology: salicylate · ApplicationA 6-year-old child who swallowed aspirin tablets has tinnitus, fast deep breathing and fever. His arterial blood gas shows a mixed respiratory alkalosis and high anion…
- Toxicology: paracetamol overdose timing · Multi-stepA man presents 10 hours after a single acute ingestion of about 25 g of paracetamol. A level is sent, and the result will take four hours. What is the most appropriate…
- Toxicology: isoniazid · ApplicationA young woman who intentionally took a large number of isoniazid tablets has recurrent seizures that do not respond to diazepam alone, and metabolic acidosis. Which age…
- Toxicology: yellow oleander poisoning · ApplicationA 24-year-old woman in South India is brought after chewing seeds of the yellow oleander (Thevetia peruviana). She has vomiting, a pulse of 42 per minute with first-deg…
- Toxicology: kerosene ingestion · ApplicationA 2-year-old child is brought 30 minutes after drinking kerosene from a bottle. He is coughing and has a respiratory rate of 40 per minute with oxygen saturation of 94%…
- Toxicology: Indian red scorpion sting · ApplicationA 6-year-old child in a rural area is brought 3 hours after a scorpion sting with cold sweaty extremities, tachycardia, hypertension, priapism and pulmonary oedema. Whi…
- Toxicology: atropine endpoint in organophosphate poisoning · Multi-stepA man with organophosphate poisoning has received 6 mg of atropine intravenously. His pupils are now dilated and heart rate is 130 per minute, but there are still crepi…
- Toxicology: cocaine-associated chest pain · Multi-stepA 28-year-old man presents agitated and sweating 30 minutes after using cocaine, with central chest pain, pulse 124 per minute, blood pressure 175/105 mmHg and ST depre…
- Toxicology: corrosive acid ingestion · ApplicationA 3-year-old child accidentally drinks a toilet cleaner containing hydrochloric acid. He has drooling and pain on swallowing but a patent airway. Which approach is corr…
- Toxicology: Gloriosa superba colchicine poisoning · ApplicationA farm worker in Tamil Nadu mistakes tubers of the glory lily (Gloriosa superba) for a yam and eats them. After vomiting and profuse diarrhoea, he develops leukopenia a…
- Toxicology: long-acting anticoagulant rodenticide · Multi-stepA 20-year-old woman who ingested a brodifacoum-based rat poison presents on day 3 with epistaxis, an INR of 8 and a prolonged prothrombin time. Intravenous vitamin K1 c…
- Toxicology: paracetamol poisoning · Multi-stepA young woman presents 6 hours after ingesting 20 g of paracetamol. Which treatment is indicated, and what guides the decision?
- Toxicology: thalassaemia chelators · ApplicationA transfusion-dependent thalassaemia patient on an oral iron chelator develops fever and a neutrophil count of 0.3 thousand per microlitre. Which drug is responsible?
CNS drugs and antiepileptics25
- CNS drugs and antiepileptics: absence with generalised seizures · Multi-stepA 9-year-old boy has frequent staring spells with 3 Hz spike-and-wave discharges and has now begun to have generalised tonic-clonic seizures. Which single drug covers b…
- CNS drugs and antiepileptics: Parkinson disease off episodes · ApplicationA man with Parkinson disease on levodopa-carbidopa has sudden unpredictable freezing 'off' episodes that do not respond quickly to oral doses. Which subcutaneously inje…
- CNS drugs and antiepileptics: antipsychotics and prolactin · ApplicationA 25-year-old woman with schizophrenia on an antipsychotic develops galactorrhoea and amenorrhoea. Serum prolactin is markedly raised and imaging of the pituitary is no…
- CNS drugs and antiepileptics: mixed agonist-antagonist opioids · Multi-stepA heroin-dependent man who is not currently in withdrawal receives an intravenous analgesic for renal colic. Within minutes he has yawning, sweating, abdominal cramps a…
- CNS drugs and antiepileptics: Dravet syndrome · Multi-stepAn 8-month-old develops prolonged febrile hemiclonic seizures, later myoclonic seizures and ataxia, and genetic testing shows an SCN1A mutation. Seizures worsened after…
- CNS drugs and antiepileptics: ropivacaine versus bupivacaine · ApplicationA labouring woman needs prolonged epidural analgesia by continuous infusion, and the anaesthetist chooses ropivacaine over bupivacaine. What is the main reason?
- CNS drugs and antiepileptics: desflurane airway effects · ApplicationAn anaesthetist avoids inhalational induction with desflurane in a child scheduled for a day-case procedure. What is the principal reason?
- CNS drugs and antiepileptics: nalbuphine in opioid dependence · Multi-stepA man who takes morphine daily for chronic pain receives nalbuphine after surgery. Within minutes he develops sweating, lacrimation, yawning and abdominal cramps. What…
- CNS drugs and antiepileptics: pregabalin mechanism · ApplicationA patient with post-herpetic neuralgia is started on pregabalin. Through which target does it reduce neuropathic pain?
- CNS drugs and antiepileptics: ziconotide · ApplicationA patient with refractory cancer pain receives an intrathecal infusion of a peptide derived from the venom of a marine cone snail. Which channel does it block?
- CNS drugs and antiepileptics: agomelatine monitoring · ApplicationA patient with major depression and insomnia is started on an antidepressant that agonises MT1 and MT2 receptors and blocks 5-HT2C receptors. Which monitoring is requir…
- CNS drugs and antiepileptics: tetrabenazine · ApplicationA man with Huntington disease and troublesome chorea is given tetrabenazine, a VMAT2 inhibitor. Which adverse effect needs the closest watch?
- CNS drugs and antiepileptics: felbamate toxicity · ApplicationA 19-year-old with Lennox-Gastaut syndrome, resistant to several drugs, is given a new add-on antiepileptic. Six weeks later she has fatigue, pallor, mucosal bleeding a…
- CNS drugs and antiepileptics: cyproheptadine in serotonin syndrome · ApplicationA man on sertraline is given linezolid for an infection. Within hours he is agitated and sweating, with temperature 39 C, inducible ankle clonus and brisk reflexes. Bot…
- CNS drugs and antiepileptics: barbiturate induction and porphyria · ApplicationA 30-year-old woman has recurrent colicky abdominal pain, psychiatric disturbance and urine that darkens on standing. She needs emergency surgery under general anaesthe…
- CNS drugs and antiepileptics: carbamazepine autoinduction · ApplicationA 55-year-old man with trigeminal neuralgia is stabilised on carbamazepine. Four weeks later, despite perfect adherence, his pain recurs and the serum level has fallen.…
- CNS drugs and antiepileptics: trazodone priapism · ApplicationA 45-year-old man takes a low-dose sedating antidepressant at night for insomnia. He presents with a painful erection lasting five hours without sexual stimulation. Whi…
- CNS drugs and antiepileptics: thiamine before glucose · ApplicationA 48-year-old man with chronic alcohol use is brought in with confusion, an ataxic gait and horizontal nystagmus. Capillary glucose is 52 mg/dL and an intravenous dextr…
- CNS drugs and antiepileptics: lamotrigine and oestrogen · Multi-stepA 25-year-old woman has been seizure-free on lamotrigine alone. After she starts a combined oestrogen-progestin pill she has breakthrough seizures, and her lamotrigine…
- CNS drugs and antiepileptics: clozapine and smoking cessation · Multi-stepA man with treatment-resistant schizophrenia has been stable for a year on a fixed dose of clozapine. After admission to a smoke-free ward he stops smoking, and within…
- CNS drugs and antiepileptics: ester local anaesthetic allergy · ApplicationA patient reports a rash and swelling after dental procaine in the past. A different local anaesthetic is needed for a minor procedure. Which is the safest choice?
- CNS drugs and antiepileptics: inhalational agent for fast emergence · ApplicationA day-care surgeon wants an inhalational agent with the fastest onset and recovery for a short procedure in a patient already intubated. Which agent has the lowest bloo…
- CNS drugs and antiepileptics: rescue midazolam without IV access · ApplicationA 7-year-old with known epilepsy has been convulsing for six minutes at home. There is no intravenous access and the nearest hospital is 30 minutes away. Which rescue t…
- CNS drugs and antiepileptics: valproate and mitochondrial disease · Multi-stepA 14-month-old with developmental regression, intractable seizures and raised blood lactate is suspected to have a POLG mitochondrial disorder. Which antiepileptic shou…
- CNS drugs and antiepileptics: antipsychotics in dementia · ApplicationAn 80-year-old woman with Alzheimer disease is agitated and aggressive, and a family member asks about starting an antipsychotic. What serious risk carries a boxed warn…
Autonomic nervous system22
- Autonomic nervous system: ganglion blockers · ApplicationA drug that blocks nicotinic receptors at all autonomic ganglia, such as hexamethonium, is given to a volunteer in a study. Which set of effects is expected?
- Autonomic nervous system: ACE inhibitor structure and taste disturbance · ApplicationA hypertensive man on an ACE inhibitor complains of a metallic taste and has a maculopapular rash. Which structural feature of the drug is held responsible for these ef…
- Autonomic nervous system: alpha blockade first in phaeochromocytoma · Multi-stepA man with episodic headache, sweating and palpitations has raised plasma metanephrines and an adrenal mass. A junior doctor gives intravenous propranolol alone for tac…
- Autonomic nervous system: beta blockers with partial agonist activity · ApplicationA hypertensive man with a resting heart rate of 52 per minute needs a beta blocker, and the prescriber wants one least likely to worsen resting bradycardia. Which drug…
- Autonomic nervous system: dornase alfa in cystic fibrosis · ApplicationA 9-year-old with cystic fibrosis has recurrent plugging by thick, purulent sputum. A nebulised recombinant enzyme is added to thin the secretions. On which component o…
- Autonomic nervous system: lactulose in hepatic encephalopathy · ApplicationA man with cirrhosis becomes drowsy and confused with asterixis after a gastrointestinal bleed. A non-absorbable disaccharide is started to lower his blood ammonia. How…
- Autonomic nervous system: sulfasalazine adverse effects · ApplicationA young man with ulcerative colitis on sulfasalazine presents with infertility and a macrocytic anaemia. Semen analysis shows a low sperm count. Which statement best ex…
- Autonomic nervous system: linaclotide mechanism · Multi-stepA woman with irritable bowel syndrome with constipation has not responded to fibre and an osmotic laxative. She is started on linaclotide. Which mechanism lies behind i…
- Autonomic nervous system: alosetron adverse effect · ApplicationThe use of the 5-HT3 antagonist alosetron in women with severe diarrhoea-predominant irritable bowel syndrome is tightly restricted. Which serious adverse effect is the…
- Autonomic nervous system: methylnaltrexone · ApplicationA palliative care patient on long-term oral morphine has severe constipation despite senna and lactulose. Pain control must not be reversed. Which agent is suitable?
- Autonomic nervous system: ivacaftor · Multi-stepA teenager with cystic fibrosis carries the G551D gating mutation. His CFTR protein reaches the cell surface but the channel stays closed. Which drug type is most appro…
- Autonomic nervous system: teduglutide in short bowel syndrome · ApplicationA woman with short bowel syndrome after extensive resection remains dependent on parenteral nutrition. Teduglutide is started. How does it reduce her dependence?
- Autonomic nervous system: muscarinic agonists for xerostomia · ApplicationA 50-year-old woman with Sjogren syndrome has severe dry mouth that does not respond to saliva substitutes. Which oral drug can increase salivary secretion, and what ad…
- Autonomic nervous system: phenylephrine reflex bradycardia · ApplicationDuring spinal anaesthesia an anaesthetist gives a phenylephrine bolus for hypotension. Blood pressure rises, but the heart rate falls from 80 to 58 beats per minute. Wh…
- Autonomic nervous system: midodrine · ApplicationA 62-year-old with autonomic failure has marked fall in blood pressure on standing. An oral prodrug whose metabolite is an alpha-1 agonist is started. Which drug is it?
- Autonomic nervous system: pancuronium · ApplicationAfter a non-depolarising neuromuscular blocker is given for surgery, an anaesthetist notes a rising heart rate and blood pressure. Which agent is most likely responsible?
- Autonomic nervous system: muscarine mushroom poisoning · ApplicationA man develops profuse sweating, salivation, lacrimation, small pupils and a pulse of 48 per minute within an hour of eating wild mushrooms. Which drug reverses these e…
- Autonomic nervous system: nicotine action at ganglia · ApplicationIn a toxicology lecture, nicotine is described as stimulating autonomic ganglia at low doses and blocking them at high doses. What is the basis of the block at high dos…
- Autonomic nervous system: clonidine withdrawal · ApplicationA hypertensive woman stops her clonidine abruptly and within a day has headache, tremor, sweating and a blood pressure of 220/120 mm Hg. What is the basis of this react…
- Autonomic nervous system: antimuscarinics and angle-closure glaucoma · ApplicationAn elderly woman with a shallow anterior chamber is given a drug for motion sickness and develops severe eye pain, halos around lights and a mid-dilated pupil. Which dr…
- Autonomic nervous system: reversal of neuromuscular block · ApplicationAt the end of surgery an anaesthetist reverses vecuronium with neostigmine and also gives glycopyrrolate. Why is the glycopyrrolate given?
- Autonomic nervous system: pheochromocytoma and beta-blockade · Multi-stepA man with a catecholamine-secreting adrenal tumour is given propranolol alone to control a fast heart rate and develops a hypertensive crisis. What is the best explana…
Cardiovascular20
- Cardiovascular: ACE inhibitors in pregnancy · ApplicationA woman with hypertension on enalapril finds she is 14 weeks pregnant. What is the best action?
- Cardiovascular: ACE inhibitor first-dose hypotension · ApplicationA patient already on a high dose of furosemide for heart failure is given his first dose of captopril and becomes dizzy and hypotensive. What predisposed him?
- Cardiovascular: losartan and uric acid · ApplicationA hypertensive man with gout is considered for an ARB. Which ARB has a mild uricosuric effect?
- Cardiovascular: aliskiren · ApplicationAliskiren lowers blood pressure by which mechanism?
- Cardiovascular: thiazide-like diuretics · ApplicationA 55-year-old man with stage 2 hypertension needs a diuretic with proven outcome benefit and a long duration of action for once-daily use. Which is preferred?
- Cardiovascular: loop diuretic ototoxicity · Multi-stepA patient with sepsis on gentamicin is given high-dose intravenous furosemide and complains of ringing in the ears. What explains the risk?
- Cardiovascular: acetazolamide for altitude sickness · ApplicationA trekker ascending quickly to high altitude wishes to prevent acute mountain sickness. Which drug is recommended and what is its mechanism?
- Cardiovascular: mannitol contraindication · ApplicationIn which situation is mannitol contraindicated?
- Cardiovascular: nimodipine · ApplicationAfter subarachnoid haemorrhage, which calcium channel blocker is given to reduce delayed ischaemic deficit from vasospasm?
- Cardiovascular: minoxidil · ApplicationA man with resistant hypertension on minoxidil complains of increased facial hair growth. Why does this occur?
- Cardiovascular: trimetazidine · ApplicationTrimetazidine is added for a patient with chronic stable angina whose heart rate and blood pressure are already low. How does it act?
- Cardiovascular: digoxin interactions · ApplicationA patient with atrial fibrillation stable on digoxin starts quinidine. What happens to digoxin level and why?
- Cardiovascular: class IA antiarrhythmics · ApplicationClass IA antiarrhythmic drugs such as quinidine and procainamide have which effect on the action potential?
- Cardiovascular: procainamide-induced lupus · Multi-stepA man treated with procainamide for ventricular arrhythmia for 18 months develops arthralgia, pleuritis and positive anti-histone antibodies. What should be done?
- Cardiovascular: amiodarone toxicity · Multi-stepA man on amiodarone for three years complains of progressive breathlessness and dry cough, and chest imaging shows bilateral infiltrates. His TSH is also abnormal. Whic…
- Cardiovascular: dronedarone · ApplicationFor which patient is dronedarone contraindicated?
- Cardiovascular: pulmonary hypertension drugs · ApplicationBosentan, used in pulmonary arterial hypertension, acts through which mechanism?
- Cardiovascular: hypertension in pregnancy · Multi-stepA woman at 28 weeks with blood pressure 170/110 mmHg and no seizures needs urgent control. Which oral antihypertensive is appropriate?
- Cardiovascular · ApplicationWhat is an ACE inhibitor adverse effect?
- Cardiovascular · ApplicationWhat is a common calcium-channel-blocker effect?
Toxicology and antidotes20
- Toxicology and antidotes: chelator adverse effects · Multi-stepA woman on long-term treatment for Wilson disease develops 4 g per day of proteinuria and oedema. A renal biopsy shows membranous nephropathy. Which drug is the likely…
- Toxicology and antidotes: zinc in Wilson disease · ApplicationA patient with Wilson disease has been decoppered and is on maintenance therapy with zinc acetate. How does zinc reduce body copper?
- Toxicology and antidotes: quinine and hypoglycaemia · ApplicationA patient with severe falciparum malaria on an intravenous quinine infusion becomes drowsy and sweaty. Which metabolic complication should be checked for first?
- Toxicology and antidotes: whole bowel irrigation · Multi-stepA toddler has swallowed many ferrous sulfate tablets, and an abdominal film shows numerous tablets in the stomach and small bowel. Activated charcoal does not bind iron…
- Toxicology and antidotes: uridine triacetate for fluorouracil toxicity · ApplicationA patient is accidentally given a large overdose of capecitabine and within hours develops severe mucositis, neutropenia and confusion. Which antidote reduces the toxic…
- Toxicology and antidotes: cadmium poisoning · ApplicationA 45-year-old woman who has lived for years near a zinc smelter and eaten rice grown nearby has bone pain and multiple fractures with osteomalacia. Urine shows low-mole…
- Toxicology and antidotes: lead encephalopathy chelation · Multi-stepA 3-year-old child with pica has a blood lead level of 110 micrograms/dL, persistent vomiting, ataxia and a generalised seizure. Which chelation regimen is appropriate?
- Toxicology and antidotes: trientine in Wilson disease · ApplicationA woman with Wilson disease on penicillamine develops fever, rash and a lupus-like syndrome, and the drug is stopped. Which copper chelator is a suitable alternative?
- Toxicology and antidotes: isopropyl alcohol poisoning · Multi-stepA man found drowsy with a fruity odour on his breath has normal blood glucose and strongly positive serum ketones. Arterial pH is 7.38 with normal bicarbonate, the osmo…
- Toxicology and antidotes: chronic arsenic poisoning · ApplicationA 40-year-old man from a village with contaminated groundwater has raindrop-like hyperpigmentation of the trunk, thickened palms and soles, and transverse white lines o…
- Toxicology and antidotes: lead and haem synthesis · ApplicationA child with chronic lead exposure has microcytic anaemia with basophilic stippling and raised urinary delta-aminolaevulinic acid. Which pair of haem synthesis enzymes…
- Toxicology and antidotes: muscarine mushroom poisoning · ApplicationThirty minutes after eating foraged wild mushrooms, a man has profuse sweating, salivation, lacrimation, miosis, bradycardia and wheeze. There are no fasciculations and…
- Toxicology and antidotes: strychnine poisoning · Multi-stepA man who swallowed ground nux vomica seeds has violent generalised extensor spasms triggered by light touch or noise, risus sardonicus and a clear sensorium. Which rec…
- Toxicology and antidotes: thiamine before glucose · ApplicationA malnourished man with chronic alcohol use is brought in confused, with nystagmus, ataxia and a blood glucose of 40 mg/dL. What is the correct treatment sequence?
- Toxicology and antidotes: antivenom reaction · ApplicationDuring infusion of polyvalent anti-snake venom, a bitten patient develops urticaria, wheeze and a blood pressure of 80/50 mmHg. What is the immediate step?
- Toxicology and antidotes: dialysis and tricyclic overdose · ApplicationWhich overdosed drug is least likely to be removed by haemodialysis because of its large volume of distribution and high protein binding?
- Toxicology and antidotes: multiple-dose activated charcoal · ApplicationIn which of these overdoses does repeated-dose activated charcoal enhance elimination of the drug?
- Toxicology and antidotes: organophosphate delayed neuropathy · Multi-stepA farmer recovered from organophosphate poisoning after atropine and pralidoxime. Two weeks later he has burning feet followed by symmetrical distal weakness with foot…
- Toxicology and antidotes: acetylcysteine infusion reaction · ApplicationDuring the loading infusion of intravenous acetylcysteine for paracetamol poisoning, a woman develops flushing, urticaria and mild wheeze with a stable blood pressure.…
- Toxicology and antidotes: smoke inhalation and cyanide · Multi-stepA man rescued from an enclosed house fire is comatose and hypotensive with a lactate of 12 mmol/L and a raised carboxyhaemoglobin. Cyanide toxicity is suspected. Which…
Antibiotics19
- Antibiotics: Jarisch-Herxheimer reaction · ApplicationFour hours after a first dose of benzathine penicillin for secondary syphilis, a man develops fever, chills, myalgia and accentuation of his rash. There is no wheeze, u…
- Antibiotics: cephalosporins in neonates · Multi-stepA 7-day-old jaundiced neonate with sepsis has a serum bilirubin of 18 mg/dL and is receiving intravenous calcium gluconate. Which cephalosporin should be avoided?
- Antibiotics: macrolides as prokinetics · ApplicationA 50-year-old diabetic with symptomatic gastroparesis does not respond to dietary change. Low-dose erythromycin is added. By which mechanism does it improve gastric emp…
- Antibiotics: tetracycline in renal failure · ApplicationA 62-year-old woman with CKD (eGFR 20 mL/min) has fever and an axillary eschar, and scrub typhus is suspected. Which tetracycline can be used without dose reduction?
- Antibiotics: fluoroquinolone cautions · ApplicationA 60-year-old woman with myasthenia gravis stable on pyridostigmine develops a urinary tract infection. Which antibiotic should be avoided?
- Antibiotics: ESBL infections · Multi-stepA 70-year-old man has urosepsis. Blood culture grows Klebsiella pneumoniae resistant to ceftriaxone and ceftazidime, and an ESBL phenotype is confirmed. Which antibioti…
- Antibiotics: aminoglycoside dosing · ApplicationA hospital pharmacist advises giving gentamicin as a single daily dose rather than three divided doses for a Gram-negative infection. What is the main pharmacological r…
- Antibiotics: Clostridioides difficile infection · Multi-stepA 68-year-old woman treated with clindamycin for a skin abscess develops profuse watery diarrhoea on day 6, with abdominal cramping, fever and leucocytosis. Stool C. di…
- Antibiotics · ApplicationVancomycin primarily targets what?
- Antibiotics · ApplicationFluoroquinolones inhibit what bacterial enzyme?
- Antibiotics · ApplicationSulfonamides inhibit which pathway?
- Antibiotics · ApplicationLinezolid acts at which ribosomal subunit?
- Antibiotics · ApplicationWhat do cephalosporins inhibit?
- Antibiotics · ApplicationWhat toxicity is associated with chloramphenicol?
- Antibiotics · ApplicationWhat toxicity is associated with fluoroquinolones?
- Antibiotics · ApplicationWhat mechanism has rifampicin?
- Antibiotics · ApplicationWhat is the major toxicity of linezolid with prolonged use?
- Antibiotics · ApplicationWhy are tetracyclines avoided in young children?
- Antibiotics · ApplicationWhat serious adverse effect is associated with fluoroquinolones?
Antiepileptics19
- Antiepileptics · ApplicationWhat is the preferred first-line drug for a patient in generalised convulsive status epilepticus?
- Antiepileptics · ApplicationWhich drug is preferred for uncomplicated childhood absence seizures?
- Antiepileptics · ApplicationA woman with idiopathic generalised epilepsy planning pregnancy is on sodium valproate. Which fetal risk is most characteristic, and which supplementation is advised?
- Antiepileptics: adverse effects · ApplicationA young woman on valproate for epilepsy is started on lamotrigine for better seizure control. The dose is escalated quickly and she develops fever and a widespread rash…
- Antiepileptics: intravenous phenytoin · ApplicationIntravenous phenytoin during status epilepticus must be infused slowly, at no more than 50 mg per minute in adults. What is the main reason?
- Antiepileptics: topiramate adverse effects · ApplicationA 28-year-old woman on an antiepileptic for focal seizures has lost weight and presents with colicky flank pain and haematuria. Serum bicarbonate is low and a stone is…
- Antiepileptics: infantile spasms · ApplicationA 6-month-old infant with tuberous sclerosis has clusters of flexor spasms and hypsarrhythmia on EEG. Which drug from the options is preferred?
- Antiepileptics: gabapentin pharmacokinetics · ApplicationA 68-year-old man with diabetic neuropathic pain and an eGFR of 25 mL/min is given gabapentin 600 mg three times daily and becomes drowsy with myoclonus. What is the mo…
- Antiepileptics: valproate hyperammonaemia · Multi-stepA 9-year-old boy with epilepsy on sodium valproate for two years becomes lethargic and vomits repeatedly, with a flapping tremor. Liver enzymes are normal, but blood am…
- Antiepileptics: aggravation of generalised seizures · Multi-stepA 16-year-old girl has morning jerks of her arms and occasional generalised tonic-clonic seizures after late nights. She is started on carbamazepine for presumed focal…
- Antiepileptics: neonatal seizures · ApplicationA term neonate with hypoxic-ischaemic encephalopathy has repeated seizures on day 2. Blood glucose, calcium and magnesium are normal. Which drug is recommended as the f…
- Antiepileptics: vigabatrin adverse effect · ApplicationA 30-year-old man with refractory focal epilepsy is started on vigabatrin as add-on therapy. Which long-term adverse effect needs scheduled ophthalmological monitoring?
- Antiepileptics: fosphenytoin · ApplicationWhy is fosphenytoin preferred over intravenous phenytoin for status epilepticus loading?
- Antiepileptics: carbamazepine in trigeminal neuralgia · ApplicationA 60-year-old woman with lancinating facial pain triggered by touching her cheek is diagnosed with trigeminal neuralgia. Which is the drug of choice, and which adverse…
- Antiepileptics: valproate toxicity · Multi-stepA 15-year-old girl with juvenile myoclonic epilepsy is on sodium valproate and presents with vomiting, severe epigastric pain and a very high serum amylase. Which adver…
- Antiepileptics · ApplicationWhich drug can cause gingival hyperplasia?
- Antiepileptics · ApplicationWhat adverse effect is associated with carbamazepine?
- Antiepileptics · ApplicationWhy is valproate generally avoided during pregnancy?
- Antiepileptics · ApplicationWhat is a notable adverse effect of phenytoin?
General pharmacology and pharmacokinetics19
- General pharmacology and pharmacokinetics: dose in renal failure · ApplicationA patient with an estimated creatinine clearance of 20 mL/min needs gentamicin. Almost all of the drug is excreted unchanged by the kidneys. What is the most appropriat…
- General pharmacology and pharmacokinetics: drug use in the elderly · ApplicationAn 82-year-old woman takes a nightly sedative, amlodipine, atorvastatin and calcium with vitamin D. She has had two falls in a month, with daytime confusion. Which drug…
- General pharmacology and pharmacokinetics: drug interaction torsades · Multi-stepA man taking an older non-sedating antihistamine for hay fever is started on ketoconazole for tinea corporis. A week later he has syncope, and the ECG shows a long QT i…
- General pharmacology and pharmacokinetics: receptor reserve · Multi-stepIn an isolated smooth muscle preparation, an agonist produces the full maximal contraction while occupying only about 10 percent of the available receptors. The concent…
- General pharmacology and pharmacokinetics: warfarin pharmacogenetics · ApplicationAn elderly patient needs only 1.5 mg of warfarin daily to hold the INR at 2.5, far below the usual requirement. Genotyping shows a variant in the gene that encodes warf…
- General pharmacology and pharmacokinetics: Schedule H1 · ApplicationTo curb antimicrobial misuse, Indian regulations require a pharmacist to keep a separate register of patient and prescriber details for every sale of third-generation c…
- General pharmacology and pharmacokinetics: crossover trial design · Multi-stepIn a randomised trial comparing two antihypertensive drugs, each patient takes drug A for 4 weeks, then drug B for 4 weeks, with a 2-week drug-free gap between the peri…
- General pharmacology and pharmacokinetics: Cockcroft-Gault estimation · ApplicationBefore prescribing gentamicin to a 70-year-old woman, a resident estimates her creatinine clearance using the Cockcroft-Gault equation. Which set of variables does the…
- General pharmacology and pharmacokinetics: phase 0 trial · ApplicationA first-in-human study gives a very small, sub-therapeutic dose of a new compound to about ten volunteers to learn how it is absorbed and distributed, with no intention…
- General pharmacology and pharmacokinetics: high extraction ratio drugs · Multi-stepA drug has a hepatic extraction ratio of about 0.9. A patient with acute cardiac failure develops marked congestion and low output. Which change is most likely to lower…
- General pharmacology and pharmacokinetics: P-glycoprotein · Multi-stepLoperamide is an opioid agonist that normally causes no central effects, yet volunteers given loperamide with quinidine developed respiratory depression. Which transpor…
- General pharmacology and pharmacokinetics: TPMT pharmacogenetics · ApplicationA child with acute lymphoblastic leukaemia develops severe pancytopenia within weeks of starting a standard dose of mercaptopurine. Deficiency of which enzyme is the li…
- General pharmacology and pharmacokinetics: active metabolites · ApplicationAn elderly man is drowsy and unsteady for three days after taking one dose of diazepam at night for insomnia. Which feature of diazepam best explains the prolonged effe…
- General pharmacology and pharmacokinetics: half-life and elimination · ApplicationA drug with first-order elimination and a half-life of 4 hours is given as a single intravenous bolus. What percentage of the dose remains in the body 16 hours later?
- General pharmacology and pharmacokinetics: maintenance dose calculation · Multi-stepAn oral drug has a clearance of 5 L per hour and an oral bioavailability of 0.5. The target average steady-state plasma concentration is 10 mg per L. Which regimen give…
- General pharmacology and pharmacokinetics: certain safety factor · ApplicationA pharmacologist wants a safety index that compares the dose lethal to the most sensitive 1 percent with the dose effective in 99 percent, because the dose-response cur…
- General pharmacology and pharmacokinetics: carrier-mediated absorption · ApplicationA man with Parkinson disease on levodopa notices more off periods after he switches to a diet very high in protein. Which mechanism best explains this change?
- General pharmacology and pharmacokinetics: enzyme inhibition onset · ApplicationA man on stable doses of theophylline for asthma starts cimetidine for dyspepsia and within two days develops tremor, palpitations and vomiting with a high theophylline…
- General pharmacology and pharmacokinetics: CYP2D6 ultra-rapid metabolisers · Multi-stepA breastfeeding mother who is an ultra-rapid CYP2D6 metaboliser takes codeine for post-caesarean pain. Her infant becomes lethargic with slow breathing. What is the lik…
Pharmacodynamics18
- Pharmacodynamics: partial agonist · ApplicationA man maintained on methadone for opioid dependence is given sublingual buprenorphine by mistake. Within an hour he has sweating, yawning, abdominal cramps and dilated…
- Pharmacodynamics: competitive antagonism · ApplicationA reversible competitive antagonist is added to a tissue preparation and the agonist dose-response curve is repeated. What change is expected?
- Pharmacodynamics: tachyphylaxis · ApplicationA patient is given repeated doses of ephedrine every 15 minutes to correct hypotension. The pressor response becomes progressively smaller with each dose. What best exp…
- Pharmacodynamics: partial agonist in dependence · ApplicationA man stable on methadone maintenance is given sublingual buprenorphine for a pain complaint and within an hour develops sweating, yawning, abdominal cramps and mydrias…
- Pharmacodynamics: tachyphylaxis · ApplicationDuring spinal anaesthesia a man is given ephedrine boluses every few minutes for hypotension, and each successive dose produces a smaller rise in blood pressure. What i…
- Pharmacodynamics · ApplicationWhat describes maximal response a drug can produce?
- Pharmacodynamics · ApplicationWhat is a drug with no intrinsic activity at receptor?
- Pharmacodynamics · ApplicationWhat is a drug that binds a receptor and produces a response called?
- Pharmacodynamics · ApplicationWhat does a competitive antagonist usually do to an agonist dose-response curve?
- Pharmacodynamics · ApplicationWhat is efficacy of a drug?
- Pharmacodynamics · ApplicationWhat is potency best reflected by?
- Pharmacodynamics · ApplicationWhat is a partial agonist?
- Pharmacodynamics · ApplicationWhat is the therapeutic index intended to reflect?
- Pharmacodynamics · ApplicationWhat does drug efficacy describe?
- Pharmacodynamics · ApplicationWhat is an antagonist at a receptor?
- Pharmacodynamics · ApplicationWhat is the usual effect of a noncompetitive antagonist on a dose-response curve?
- Pharmacodynamics · ApplicationWhat is efficacy in pharmacology?
- Pharmacodynamics · ApplicationWhat is a partial agonist capable of doing in presence of full agonist?
Anticancer drugs17
- Anticancer drugs · ApplicationA patient receiving high-dose methotrexate for osteosarcoma develops severe mucositis and myelosuppression. Which agent is used to rescue normal cells, and how does it…
- Anticancer drugs: toxicity prevention · ApplicationA patient receiving high-dose cyclophosphamide develops haematuria. Which drug is given to prevent this complication, and how does it work?
- Anticancer drugs: cisplatin nephroprotection · ApplicationA 45-year-old man with testicular germ cell tumour is to receive cisplatin. Which measure best reduces its dose-limiting nephrotoxicity?
- Anticancer drugs: bleomycin and oxygen · Multi-stepA 28-year-old man treated for Hodgkin lymphoma with a regimen containing bleomycin needs an abdominal operation under general anaesthesia. Which precaution is most impo…
- Anticancer drugs: trastuzumab cardiotoxicity · Multi-stepA woman with HER2-positive breast cancer treated with doxorubicin and cyclophosphamide is receiving trastuzumab. A routine echocardiogram shows left ventricular ejectio…
- Anticancer drugs: imatinib resistance · Multi-stepA 50-year-old man with chronic myeloid leukaemia initially responded to imatinib, but BCR-ABL transcripts are now rising and sequencing shows a T315I mutation in the ki…
- Anticancer drugs: asparaginase · Multi-stepA 9-year-old boy in induction therapy for acute lymphoblastic leukaemia develops epigastric pain with raised lipase, a low fibrinogen and a cerebral venous sinus thromb…
- Anticancer drugs: fluorouracil toxicity · Multi-stepA 58-year-old man with colon cancer develops severe mucositis, profuse diarrhoea and profound neutropenia one week after his first cycle of fluorouracil at standard dos…
- Anticancer drugs: aromatase inhibitors in premenopausal women · Multi-stepA 40-year-old premenopausal woman with ER-positive breast cancer is proposed anastrozole alone. Why is this inappropriate?
- Anticancer drugs: tumour lysis and G6PD · Multi-stepA 12-year-old boy with Burkitt lymphoma is about to start chemotherapy and has hyperuricaemia. He is known to have G6PD deficiency. Which urate-lowering measure should…
- Anticancer drugs: irinotecan diarrhoea · Multi-stepDuring an irinotecan infusion a patient develops abdominal cramps, sweating, lacrimation and watery diarrhoea within 30 minutes. Which drug best treats this acute event?
- Anticancer drugs · ApplicationWhat is a major dose-limiting toxicity of many cytotoxic anticancer drugs?
- Anticancer drugs: cyclophosphamide · Multi-stepMesna is co-prescribed with high-dose cyclophosphamide to prevent which toxicity?
- Anticancer drugs: methotrexate rescue · Multi-stepAfter high-dose methotrexate chemotherapy, leucovorin is administered. What is its purpose?
- Anticancer drugs · ApplicationWhy is methotrexate toxicity increased by trimethoprim?
- Anticancer drugs · ApplicationWhat is a major toxicity of cisplatin?
- Anticancer drugs · ApplicationWhy is folinic acid used after high-dose methotrexate?
Anticoagulants15
- Anticoagulants: low molecular weight heparin · ApplicationCompared with unfractionated heparin, enoxaparin has which characteristic?
- Anticoagulants: fondaparinux · Multi-stepA patient who developed heparin-induced thrombocytopenia needs a subcutaneous anticoagulant that selectively inhibits factor Xa through antithrombin and is not neutrali…
- Anticoagulants: mechanical valves · ApplicationA 40-year-old woman has just undergone mechanical mitral valve replacement. Which long-term anticoagulant is appropriate?
- Anticoagulants · ApplicationWhat reverses heparin?
- Anticoagulants · ApplicationWhat is the principal target of warfarin therapy monitoring?
- Anticoagulants · ApplicationWhat antidote reverses excessive warfarin anticoagulation?
- Anticoagulants · ApplicationWhat drug reverses unfractionated heparin?
- Anticoagulants · ApplicationWhat clinical adverse effect is shared by antiplatelet and anticoagulant drugs?
- Anticoagulants · ApplicationWhat laboratory test is used to monitor warfarin therapy?
- Anticoagulants · ApplicationWhat reverses unfractionated heparin?
- Anticoagulants: warfarin initiation · ApplicationWhy is heparin commonly overlapped when warfarin is started for acute venous thromboembolism?
- Anticoagulants: heparin-induced thrombocytopenia · Multi-stepFive days after starting unfractionated heparin, a patient has a platelet fall of 55% and a new painful swollen leg. What is the best immediate action?
- Anticoagulants: direct oral anticoagulants · ApplicationWhich direct oral anticoagulant directly inhibits thrombin (factor IIa) rather than factor Xa?
- Anticoagulants · ApplicationWhich laboratory test is used to monitor unfractionated heparin therapy?
- Anticoagulants · ApplicationWhat is the mechanism of direct oral factor Xa inhibitors?
Antihypertensives12
- Antihypertensives: alpha-methyldopa · ApplicationA 30-year-old woman at 28 weeks of pregnancy has been on alpha-methyldopa for chronic hypertension for five months. She now has fatigue and pallor, with haemoglobin 7.8…
- Antihypertensives: hydralazine-induced lupus · ApplicationA 55-year-old man on hydralazine for several months develops fever, arthralgia, pleuritic chest pain and a facial rash. Antinuclear antibody is positive. Which antibody…
- Antihypertensives: minoxidil co-prescription · Multi-stepA 50-year-old man with severe resistant hypertension and chronic kidney disease is started on minoxidil. The physician also prescribes a beta-blocker and a loop diureti…
- Antihypertensives · ApplicationACE inhibitors commonly cause what adverse effect?
- Antihypertensives · ApplicationWhich drug is contraindicated in pregnancy due to fetotoxicity?
- Antihypertensives · ApplicationWhich class commonly causes a dry cough through bradykinin accumulation?
- Antihypertensives · ApplicationWhat electrolyte change can be caused by thiazide diuretics?
- Antihypertensives · ApplicationWhat class blocks angiotensin II at its AT1 receptor?
- Antihypertensives · ApplicationWhat adverse effect should be monitored with spironolactone?
- Antihypertensives · ApplicationWhat electrolyte effect can occur with ACE inhibitors?
- Antihypertensives · ApplicationWhat adverse effect is common with dihydropyridine calcium-channel blockers?
- Antihypertensives: ACE inhibitors · ApplicationA patient develops a persistent dry cough after beginning enalapril. Accumulation of which mediator most directly explains it?
Autonomic12
- Autonomic: physostigmine versus neostigmine · Multi-stepWhy can physostigmine reverse the central features of anticholinergic poisoning whereas neostigmine cannot?
- Autonomic: neostigmine reversal of neuromuscular block · ApplicationAt the end of surgery, a patient has residual neuromuscular block after vecuronium. Neostigmine is given with glycopyrrolate. Why is glycopyrrolate added?
- Autonomic: pralidoxime and carbamates · ApplicationA farm worker is poisoned with carbaryl, a carbamate insecticide, and has mild cholinergic features. Why is pralidoxime generally not needed?
- Autonomic: atropine toxicity · ApplicationA child who ate Datura seeds is flushed with dry skin, dilated pupils, fever and delirium. Which phrase best summarises the mechanism of these effects?
- Autonomic: atropine contraindications · Multi-stepAn elderly man with a shallow anterior chamber is given atropine as pre-anaesthetic medication and soon complains of severe eye pain and haloes. Why did atropine cause…
- Autonomic: drug-induced parkinsonism · ApplicationA young man on haloperidol develops rigidity and tremor. Which drug is most appropriate to relieve these symptoms while continuing the antipsychotic?
- Autonomic: dobutamine · ApplicationA patient cannot exercise for a cardiac stress test. Which catecholamine, a selective beta-1 agonist, is infused to induce stress during echocardiography?
- Autonomic: isoprenaline · Multi-stepA patient with complete heart block and recurrent torsades de pointes secondary to bradycardia needs temporary rate support until a pacemaker is available. Which drug i…
- Autonomic: beta-2 agonist adverse effects · ApplicationA patient with severe asthma receives repeated nebulised salbutamol and develops palpitations and muscle cramps. Which metabolic abnormality is expected?
- Autonomic: LABA monotherapy · Multi-stepA 28-year-old with persistent asthma has been using only salmeterol inhaler for months. What is the main concern with this regimen?
- Autonomic: tamsulosin and floppy iris syndrome · ApplicationA 68-year-old man on tamsulosin for benign prostatic hyperplasia is listed for cataract surgery. What should the ophthalmologist anticipate?
- Autonomic: carvedilol · ApplicationWhich beta blocker also blocks alpha-1 receptors, giving vasodilation, and is used in chronic heart failure?
Autonomic pharmacology12
- Autonomic pharmacology · ApplicationA young man who ate datura seeds is agitated and delirious, with hot dry flushed skin, dilated pupils and tachycardia. Which drug can reverse both central and periphera…
- Autonomic pharmacology · ApplicationWhich receptor is primarily responsible for slowing heart rate when stimulated?
- Autonomic pharmacology · ApplicationWhat is a typical effect of beta-2 receptor stimulation?
- Autonomic pharmacology · ApplicationWhich drug is an antidote for symptomatic bradycardia due to excess vagal tone?
- Autonomic pharmacology · ApplicationWhat effect is expected from alpha-1 receptor stimulation?
- Autonomic pharmacology · ApplicationWhat is a common effect of muscarinic receptor stimulation?
- Autonomic pharmacology · ApplicationWhich drug can be used to reverse muscarinic effects of organophosphate toxicity?
- Autonomic pharmacology · ApplicationWhat is a common clinical use of an alpha-1 blocker?
- Autonomic pharmacology · ApplicationWhat is a common effect of beta-1 receptor blockade?
- Autonomic pharmacology · ApplicationWhat is a common adverse effect of beta blockers in susceptible patients?
- Autonomic pharmacology · ApplicationWhat effect follows muscarinic receptor blockade?
- Autonomic pharmacology · ApplicationWhat effect follows alpha-1 receptor stimulation?
CNS drugs12
- CNS drugs · ApplicationWhat is a common therapeutic use of benzodiazepines?
- CNS drugs · ApplicationWhat is a dangerous consequence of abruptly stopping long-term benzodiazepines?
- CNS drugs · ApplicationWhat is a typical effect of anticholinergic medications?
- CNS drugs · ApplicationWhat is an important adverse effect of opioids requiring monitoring?
- CNS drugs · ApplicationWhat is a common use of antiepileptic drugs?
- CNS drugs · ApplicationWhy should some antiepileptic drugs not be stopped abruptly?
- CNS drugs · ApplicationWhich receptor complex is enhanced by benzodiazepines to increase inhibitory signaling?
- CNS drugs · ApplicationWhat is a major risk of abrupt benzodiazepine withdrawal?
- CNS drugs · ApplicationWhat is a common adverse effect of benzodiazepines?
- CNS drugs · ApplicationWhich drug reverses selected benzodiazepine toxicity?
- CNS drugs · ApplicationWhy must levodopa be combined with a peripheral decarboxylase inhibitor?
- CNS drugs · ApplicationWhich adverse effect is associated with antipsychotic dopamine D2 blockade?
Adrenergic drugs10
- Adrenergic drugs · Multi-stepA patient with a catecholamine-secreting phaeochromocytoma is being prepared for surgery. Which drug should be started first to control blood pressure?
- Adrenergic drugs · ApplicationAn elderly man with benign prostatic hyperplasia needs an alpha-blocker with minimal effect on blood pressure. Which drug is the most suitable?
- Adrenergic drugs: vasomotor reversal · Multi-stepIn an anaesthetised animal pretreated with phenoxybenzamine, an intravenous bolus of adrenaline is given. Compared with the response before pretreatment, what happens t…
- Adrenergic drugs: isoprenaline · ApplicationA healthy volunteer receives an intravenous infusion of isoprenaline in a pharmacology experiment. Which combination of cardiovascular effects is expected?
- Adrenergic drugs: dobutamine · Multi-stepA 60-year-old man with acute decompensated heart failure has pulmonary congestion, cold peripheries and low urine output. Blood pressure is 96/60 mmHg. Which drug is th…
- Adrenergic drugs: beta2 agonist in hyperkalaemia · ApplicationA 55-year-old man on dialysis has serum potassium 6.9 mmol/L with peaked T waves and has received intravenous calcium gluconate. Which additional drug lowers serum pota…
- Adrenergic drugs: tyramine reaction · ApplicationA man on phenelzine for atypical depression eats mature cheese and red wine, and an hour later has a severe throbbing headache and blood pressure of 220/130 mmHg. Which…
- Adrenergic drugs: nasal decongestants · Multi-stepA 30-year-old man has used oxymetazoline nasal drops several times daily for three weeks for a cold. The cold has resolved but he now has worse nasal obstruction that i…
- Adrenergic drugs: midodrine · ApplicationA 68-year-old man with diabetic autonomic neuropathy has a fall in systolic pressure of 40 mmHg on standing despite fluids and compression stockings. Midodrine is presc…
- Adrenergic drugs: noradrenaline versus adrenaline on heart rate · ApplicationIn a healthy volunteer, an intravenous infusion of noradrenaline raises mean arterial pressure markedly but the heart rate falls, whereas an adrenaline infusion at a si…
Antidiabetic drugs10
- Antidiabetic drugs · Multi-stepAn elderly man with reduced renal function on glibenclamide has recurrent hypoglycaemia that returns hours after each dextrose bolus. Which drug is most appropriate to…
- Antidiabetic drugs: SGLT2 inhibitors · ApplicationA woman with type 2 diabetes on empagliflozin presents with nausea, abdominal pain and deep breathing during an acute illness with poor oral intake. Glucose is 190 mg/d…
- Antidiabetic drugs: pioglitazone · ApplicationA 64-year-old man with type 2 diabetes has weight gain, bilateral ankle swelling and exertional dyspnoea a few weeks after a new oral drug is added. Which drug is the m…
- Antidiabetic drugs: GLP-1 agonists · ApplicationA 45-year-old obese woman with type 2 diabetes is considered for weekly semaglutide. Which history is a contraindication?
- Antidiabetic drugs: DPP-4 inhibitors in renal failure · Multi-stepA 78-year-old man with type 2 diabetes, eGFR 20 mL/min and HbA1c 8.4% has had metformin stopped. A DPP-4 inhibitor that needs no renal dose reduction is wanted. Which d…
- Antidiabetic drugs: acarbose · ApplicationA man with type 2 diabetes on insulin and acarbose has a hypoglycaemic episode with sweating and confusion at home. What should he be advised to take for treatment?
- Antidiabetic drugs: metformin adverse effects · ApplicationA 62-year-old man with type 2 diabetes on metformin for ten years has macrocytic anaemia and paraesthesia of the feet. Which adverse effect of the drug explains this?
- Antidiabetic drugs: metformin · ApplicationWhich condition is a strong reason to withhold metformin because of increased lactic acidosis risk?
- Antidiabetic drugs: sulfonylureas · ApplicationSulfonylureas increase insulin secretion by closing which channel on pancreatic beta cells?
- Antidiabetic drugs: GLP-1 receptor agonists · ApplicationWhich effect contributes to weight loss with semaglutide?
Antipsychotics10
- Antipsychotics: clozapine · Multi-stepA 29-year-old woman with treatment-resistant schizophrenia, on clozapine for 6 weeks, develops fever and a sore throat. What is the most appropriate next step?
- Antipsychotics: hyperprolactinaemia · ApplicationA 26-year-old woman on risperidone for schizophrenia develops galactorrhoea and amenorrhoea. What is the mechanism?
- Antipsychotics: neuroleptic malignant syndrome · Multi-stepA 30-year-old man started on haloperidol a week ago develops temperature 40 degrees Celsius, generalised lead-pipe rigidity, diaphoresis and fluctuating consciousness o…
- Antipsychotics: acute dystonia · ApplicationA 22-year-old man receives his second dose of haloperidol for acute psychosis. Within hours he develops sustained upward deviation of the eyes, a clenched jaw and neck…
- Antipsychotics: high-potency typical agents · ApplicationA young man on haloperidol rapidly develops rigidity and akathisia. Which statement about typical antipsychotics explains this?
- Antipsychotics: tardive dyskinesia · Multi-stepA woman on long-term perphenazine develops persistent lip smacking and tongue protrusion. Which drug class is approved for treating this?
- Antipsychotics: metabolic effects of atypicals · ApplicationA young man with schizophrenia gains 14 kg in six months with raised fasting glucose and triglycerides after starting an antipsychotic. Which drug is most likely respon…
- Antipsychotics: chlorpromazine adverse effects · ApplicationA patient on long-term chlorpromazine develops jaundice with pruritus and a cholestatic pattern, along with photosensitivity and corneal deposits. Which statement is co…
- Antipsychotics: thioridazine · Multi-stepA patient on thioridazine for schizophrenia is found to have pigmentary retinopathy and a QTc of 520 ms. Which statement is correct?
- Antipsychotics · ApplicationWhich adverse effect is linked to dopamine blockade?
Diuretics10
- Diuretics: potassium-sparing · ApplicationA man with heart failure, already on an ACE inhibitor, is started on spironolactone. Two weeks later his potassium is 6.3 mmol/L, and he also notices breast tenderness.…
- Diuretics · ApplicationWhich diuretic acts on Na-K-2Cl transporter?
- Diuretics · ApplicationWhich diuretic can cause hypercalcemia?
- Diuretics · ApplicationWhich diuretic is potassium sparing?
- Diuretics · ApplicationWhere do loop diuretics act primarily?
- Diuretics · ApplicationWhat electrolyte abnormality may occur with loop diuretics?
- Diuretics · ApplicationWhere do thiazide diuretics act primarily?
- Diuretics · ApplicationWhat effect is typical of loop diuretics on calcium?
- Diuretics: spironolactone · ApplicationA man taking spironolactone for heart failure develops breast tenderness and enlargement. Which property of spironolactone accounts for this adverse effect?
- Diuretics · ApplicationWhy can spironolactone cause breast tenderness?
Analgesics9
- Analgesics · ApplicationWhat is a major adverse effect of NSAID use?
- Analgesics · ApplicationWhat is the main danger of acetaminophen overdose?
- Analgesics · ApplicationWhat is a major adverse effect of long-term opioid use?
- Analgesics · ApplicationWhat is the antidote for severe opioid overdose?
- Analgesics · ApplicationWhat is a major risk of NSAID therapy?
- Analgesics · ApplicationWhat organ is most threatened by acetaminophen overdose?
- Analgesics · ApplicationWhy is naloxone given cautiously to opioid-dependent patients?
- Analgesics · ApplicationWhich opioid adverse effect is least likely to develop tolerance?
- Analgesics · ApplicationWhy is tramadol use with SSRIs monitored carefully?
Drug interactions8
- Drug interactions · ApplicationA woman using an oral contraceptive pill is started on rifampicin for tuberculosis. Why is the contraceptive likely to fail?
- Drug interactions · Multi-stepA kidney transplant patient on azathioprine is started on allopurinol for gout and develops pancytopenia. What explains this?
- Drug interactions · Multi-stepA patient on sertraline for depression is started on linezolid for a resistant staphylococcal infection. Three days later he has agitation, tremor, diarrhoea, hyperrefl…
- Drug interactions: CYP3A4 and food · ApplicationA hypertensive patient on stable felodipine begins drinking a large glass of grapefruit juice every morning and develops flushing, ankle oedema and a low blood pressure…
- Drug interactions · ApplicationWhat is enzyme induction likely to do to a substrate drug concentration?
- Drug interactions · ApplicationWhat is enzyme inhibition likely to do to a substrate drug concentration?
- Drug interactions · ApplicationWhy can macrolide antibiotics increase toxicity of some statins?
- Drug interactions · ApplicationWhat interaction occurs when two drugs have additive sedative effects?
General pharmacology8
- General pharmacology: zero-order kinetics · ApplicationA man drinks heavily and his blood alcohol falls by roughly the same amount every hour, whether the level is high or low. Which kinetic pattern does this describe?
- General pharmacology: time to steady state · Multi-stepA patient is on a constant intravenous infusion of a drug with a half-life of 6 hours. The infusion rate is doubled. Roughly how long will it take to reach the new stea…
- General pharmacology: high first-pass metabolism · ApplicationA patient with ventricular arrhythmia is considered for lidocaine. Why is lidocaine given parenterally rather than orally?
- General pharmacology: ion trapping of weak bases · Multi-stepA student wants to speed up the renal excretion of amphetamine, a weak base, after an overdose. Which change in urine is appropriate in principle?
- General pharmacology: enzyme inducer interaction · ApplicationA renal transplant recipient stable on cyclosporine starts a herbal preparation of St John's wort for low mood, and graft rejection follows. What explains this?
- General pharmacology: CYP2D6 and tamoxifen · Multi-stepA woman with oestrogen receptor positive breast cancer on tamoxifen develops depression and is started on paroxetine. Why might tamoxifen efficacy fall?
- General pharmacology: non-competitive antagonism · ApplicationPhenoxybenzamine binds covalently to alpha adrenoceptors. What happens to the noradrenaline dose-response curve after adequate dosing?
- General pharmacology: therapeutic index · Multi-stepA drug has an LD50 of 400 mg/kg in animals and an ED50 of 20 mg/kg. What is its therapeutic index, and what does the value indicate?
GI drugs8
- GI drugs: H2 blockers versus PPIs · ApplicationHow do H2 receptor blockers and proton pump inhibitors differ in their effect on gastric acid?
- GI drugs: long-term PPI adverse effects · Multi-stepA 70-year-old woman on omeprazole for six years develops tetany, muscle cramps and a prolonged QT interval, and calcium and potassium replacement fails to correct her s…
- GI drugs: misoprostol · ApplicationA patient on chronic diclofenac for osteoarthritis has had a gastric ulcer, and a prostaglandin E1 analogue is added for ulcer prophylaxis. Which statement is correct a…
- GI drugs: sucralfate · ApplicationA patient with duodenal ulcer is prescribed sucralfate along with an antacid taken at the same time. Why is this combination undesirable?
- GI drugs: antiemetics for chemotherapy · Multi-stepA woman receiving cisplatin for ovarian cancer has severe delayed vomiting despite ondansetron. Which agent should be added to target the delayed phase through a differ…
- GI drugs: domperidone · ApplicationA patient on domperidone for gastroparesis is also given clarithromycin. What is the main risk?
- GI drugs: metoclopramide extrapyramidal effects · ApplicationA 22-year-old woman given intravenous metoclopramide for vomiting develops involuntary upward deviation of the eyes and neck spasm. How is this reaction best treated?
- GI drugs: H. pylori regimens · ApplicationWhere clarithromycin resistance is high or the first regimen has failed, which regimen is preferred for Helicobacter pylori?
Opioids8
- Opioids: interactions · ApplicationA 45-year-old man on phenelzine for depression becomes agitated, hyperthermic and rigid with clonus after receiving an analgesic postoperatively. Which analgesic was mo…
- Opioids: naloxone duration · Multi-stepA 24-year-old man receives naloxone 0.4 mg after a methadone overdose and wakes with normal breathing. Two hours later he is drowsy with a respiratory rate of 6 per min…
- Opioids: morphine in renal failure · Multi-stepA 70-year-old man with end-stage kidney disease and cancer pain on oral morphine becomes drowsy with pinpoint pupils, myoclonic jerks and slow breathing. What explains…
- Opioids: remifentanil · ApplicationAn anaesthetist wants an opioid with a very short context-sensitive half-life that is independent of liver and kidney function. Which agent is chosen?
- Opioids: tramadol · Multi-stepA patient with epilepsy and on sertraline is prescribed tramadol for pain. What is the main concern?
- Opioids: methadone · ApplicationA man with opioid dependence is maintained on methadone and develops palpitations and a QTc of 510 ms. Which property of methadone explains the choice for maintenance a…
- Opioids · ApplicationWhat adverse effect commonly follows opioids?
- Opioids · ApplicationWhat receptor is chiefly responsible for opioid analgesia?
Pregnancy8
- Pregnancy: ACE inhibitors · Multi-stepA woman at 30 weeks of gestation, who continued enalapril for hypertension, has a fetal ultrasound showing oligohydramnios and small kidneys. What is the underlying mec…
- Pregnancy: warfarin · ApplicationA woman with a mechanical mitral valve took warfarin throughout the first trimester. Which features are most likely in her newborn?
- Pregnancy: tetracyclines · ApplicationA woman at 28 weeks of pregnancy is inadvertently treated with tetracycline for two weeks. Which fetal adverse effect is most likely?
- Pregnancy: retinoids · Multi-stepA 22-year-old woman with severe nodulocystic acne asks for isotretinoin. Which requirement is essential?
- Pregnancy: lithium · ApplicationA newborn is cyanosed with cardiomegaly, and echocardiography shows downward displacement of the tricuspid valve and an atrialised right ventricle. His mother took lith…
- Pregnancy: antithyroid drugs · Multi-stepA woman at 8 weeks of gestation with Graves disease is on methimazole, still needs treatment and has a free T4 at the upper limit. What is the best change in her manage…
- Pregnancy: magnesium sulphate toxicity · Multi-stepA woman with severe pre-eclampsia on a magnesium sulphate infusion becomes drowsy. Her patellar reflexes are absent and her respiratory rate is 8 per minute. What is th…
- Pregnancy: NSAIDs in late gestation · ApplicationA woman at 34 weeks of gestation takes diclofenac regularly for back pain. Which fetal complication is of greatest concern?
Respiratory drugs8
- Respiratory drugs: stepwise asthma therapy · Multi-stepA 30-year-old man with asthma has daytime symptoms three times a week using salbutamol as needed. Which step best improves control and reduces exacerbation risk, per cu…
- Respiratory drugs: theophylline interactions · Multi-stepA 55-year-old man with COPD stable on theophylline is given ciprofloxacin for a urinary infection and soon develops tremor, vomiting and a seizure. What explains this?
- Respiratory drugs: omalizumab · ApplicationA patient with severe persistent allergic asthma and high serum IgE remains uncontrolled on high-dose inhaled steroid plus LABA. Which biologic targets IgE?
- Respiratory drugs · ApplicationWhat is the main effect of a short-acting beta-2 agonist inhaler?
- Respiratory drugs · ApplicationWhat is a main role of inhaled corticosteroids in asthma?
- Respiratory drugs · ApplicationWhy should inhaled corticosteroids be used with a spacer and mouth rinse when appropriate?
- Respiratory drugs · ApplicationWhat is the role of leukotriene receptor antagonists in asthma?
- Respiratory drugs · ApplicationWhy are nonselective beta blockers used cautiously in asthma?
Thyroid drugs8
- Thyroid drugs: levothyroxine interactions · ApplicationA 40-year-old woman with hypothyroidism has been stable on levothyroxine 100 micrograms for a year. After starting ferrous sulphate and calcium carbonate tablets her TS…
- Thyroid drugs: thyroid storm · Multi-stepA 35-year-old woman with Graves disease develops fever of 40 C, heart rate 165 per minute, agitation and vomiting after a surgical procedure. Thyroid storm is diagnosed…
- Thyroid drugs: antithyroid toxicity · Multi-stepA woman on carbimazole for five weeks for Graves disease develops fever and sore throat. What should be done first?
- Thyroid drugs: iodides · ApplicationA patient with Graves disease is given Lugol's iodine for 10 days before thyroidectomy. What is the rationale?
- Thyroid drugs: myxoedema coma · Multi-stepA 70-year-old woman is brought in during winter with hypothermia 32 degrees Celsius, bradycardia, hyponatraemia and unresponsiveness. Her TSH is above 100 mU/L and free…
- Thyroid drugs: levothyroxine in pregnancy · ApplicationA 28-year-old woman with primary hypothyroidism is stable on levothyroxine 100 micrograms daily. A pregnancy test is positive at 5 weeks. What is the appropriate change…
- Thyroid drugs: thionamides · Multi-stepA patient taking methimazole reports fever and a sore throat. What urgent investigation is indicated?
- Thyroid drugs: propylthiouracil · Multi-stepWhich additional action distinguishes propylthiouracil from methimazole?
Antidepressants7
- Antidepressants: bupropion contraindications · ApplicationA 28-year-old woman with bulimia nervosa and a past tonic-clonic seizure wants help to stop smoking. Which agent should be avoided because it lowers the seizure thresho…
- Antidepressants: amitriptyline uses · ApplicationA 50-year-old man with painful diabetic neuropathy and difficulty sleeping is started on a low dose at night of an antidepressant that also helps migraine prophylaxis.…
- Antidepressants: paroxetine · ApplicationAn elderly man with depression and prostatism is started on an SSRI and develops urinary retention and constipation. Which SSRI has the strongest anticholinergic proper…
- Antidepressants: SNRIs · ApplicationA patient with depression and diabetic peripheral neuropathy is given an antidepressant that inhibits serotonin and noradrenaline reuptake and can raise blood pressure.…
- Antidepressants: mirtazapine · ApplicationAn elderly underweight patient with depression, insomnia and poor appetite is started on an antidepressant that blocks alpha-2 and 5-HT2 and 5-HT3 receptors. Which is it?
- Antidepressants: esketamine · ApplicationIntranasal esketamine is approved for treatment-resistant depression. What is its primary pharmacological target?
- Antidepressants · ApplicationWhat is a risk when stopping SSRI abruptly?
Antifungals7
- Antifungals: terbinafine · ApplicationA 40-year-old man has distal subungual onychomycosis due to a dermatophyte and is started on terbinafine. What is its mechanism of action?
- Antifungals: invasive aspergillosis · Multi-stepA 35-year-old man with acute leukaemia and prolonged neutropenia has persistent fever on broad-spectrum antibiotics. CT chest shows a nodule with a halo sign and serum…
- Antifungals: mucormycosis · Multi-stepA 52-year-old man with uncontrolled diabetes presents with diabetic ketoacidosis, facial swelling and a black necrotic eschar on the palate. Biopsy shows broad, ribbon-…
- Antifungals: azole mechanism and ketoconazole · ApplicationA man with prostate cancer is treated with high-dose ketoconazole and develops gynaecomastia and low cortisol. What is the explanation?
- Antifungals: flucytosine · ApplicationFlucytosine is combined with amphotericin B for cryptococcal meningitis. Which statement about it is correct?
- Antifungals · ApplicationAmphotericin B binds what membrane component?
- Antifungals · ApplicationAzoles inhibit what synthesis?
Antiretrovirals7
- Antiretrovirals: tenofovir nephrotoxicity · ApplicationA 42-year-old man has taken a fixed-dose regimen of tenofovir, lamivudine and dolutegravir for three years. He now has glycosuria with normal blood glucose, hypophospha…
- Antiretrovirals: NRTI toxicity · Multi-stepA patient on a stavudine-containing regimen for years develops loss of facial and limb fat, and another on zidovudine develops severe anaemia. Which statement explains…
- Antiretrovirals: efavirenz and nevirapine · ApplicationA patient started on an efavirenz-containing regimen complains of vivid dreams, dizziness and mood disturbance in the first weeks. Which statement is correct?
- Antiretrovirals: ritonavir boosting · Multi-stepWhy is low-dose ritonavir added to other protease inhibitors such as lopinavir or atazanavir?
- Antiretrovirals: first-line ART in India · ApplicationA newly diagnosed adult with HIV without comorbidity starts first-line therapy under the national programme. Which fixed-dose combination is recommended?
- Antiretrovirals: entry and long-acting agents · ApplicationWhich drug blocks the CCR5 coreceptor, and which is a long-acting injectable integrase inhibitor?
- Antiretrovirals: post-exposure prophylaxis · ApplicationA health worker sustains a needlestick injury from an HIV-positive patient. What is the correct approach?
Antivirals7
- Antivirals: antiretroviral toxicity · Multi-stepA man on tenofovir-lamivudine-dolutegravir who also takes co-trimoxazole prophylaxis develops glycosuria with normal blood glucose, hypophosphataemia and a normal anion…
- Antivirals: aciclovir · ApplicationA patient with herpes simplex encephalitis receives rapid intravenous aciclovir and has a rise in creatinine with crystals in the urine. How is this prevented?
- Antivirals: CMV drugs · Multi-stepA transplant recipient with CMV retinitis is treated with ganciclovir and develops a neutrophil count of 0.6 thousand per microlitre. Another patient on a different ant…
- Antivirals: influenza drugs · ApplicationA healthy adult presents on day 1 of influenza with a high fever. Which agent, a neuraminidase inhibitor, is best started within 48 hours of onset?
- Antivirals: COVID-19 drugs · ApplicationNirmatrelvir, combined with ritonavir, is used in early COVID-19. What is its mechanism?
- Antivirals · ApplicationAcyclovir is commonly used for what virus group?
- Antivirals · ApplicationOseltamivir targets what infection?
NSAIDs7
- NSAIDs: Reye syndrome · ApplicationA 6-year-old child recovering from varicella is given aspirin for fever and then develops vomiting, confusion and raised liver enzymes with hypoglycaemia. Which conditi…
- NSAIDs: aspirin-exacerbated respiratory disease · Multi-stepA 35-year-old asthmatic with nasal polyps develops severe wheezing within an hour of taking aspirin. What is the underlying mechanism?
- NSAIDs: COX-2 selective inhibitors · ApplicationA 62-year-old man with prior myocardial infarction and peptic ulcer history needs an NSAID. Which concern applies to a selective COX-2 inhibitor such as celecoxib?
- NSAIDs: patent ductus arteriosus · ApplicationA preterm neonate has a haemodynamically significant patent ductus arteriosus. Which drug is used to promote closure?
- NSAIDs: colchicine in gout · Multi-stepA patient with an acute gout flare cannot take NSAIDs because of peptic ulcer disease and is given colchicine. How does it act?
- NSAIDs · ApplicationWhich GI risk rises with NSAID use?
- NSAIDs · ApplicationWhat is a renal effect of NSAIDs?
Antiarrhythmics6
- Antiarrhythmics: amiodarone and warfarin interaction · Multi-stepA 68-year-old man with atrial fibrillation has a stable INR of 2.5 on warfarin. Amiodarone is started and two weeks later the INR is 5.8 with no bleeding. What is the e…
- Antiarrhythmics: class IC drugs after myocardial infarction · ApplicationA 62-year-old man two weeks after anterior myocardial infarction with an ejection fraction of 35 percent has frequent asymptomatic ventricular premature beats. A collea…
- Antiarrhythmics: adenosine interactions · Multi-stepA 40-year-old woman with paroxysmal supraventricular tachycardia has been taking dipyridamole for secondary stroke prevention. Adenosine is planned to terminate an atta…
- Antiarrhythmics: amiodarone · ApplicationWhich baseline and follow-up test is particularly important in a patient receiving long-term amiodarone?
- Antiarrhythmics: adenosine · ApplicationA regular narrow-complex supraventricular tachycardia terminates immediately after intravenous adenosine. What is adenosine's principal action?
- Antiarrhythmics: pre-excited atrial fibrillation · Multi-stepA patient with Wolff-Parkinson-White syndrome develops irregular broad-complex tachycardia from atrial fibrillation. Which drug should be avoided?
Drug safety6
- Drug safety · ApplicationWhy are drug interactions clinically important?
- Drug safety · ApplicationWhy should renal function be considered when prescribing many medications?
- Drug safety · ApplicationWhat patient factor can increase the risk of digoxin toxicity at a usual dose?
- Drug safety · ApplicationWhat does a narrow therapeutic index imply?
- Drug safety · ApplicationWhat is a black-box warning intended to communicate?
- Drug safety · ApplicationWhat is the purpose of therapeutic drug monitoring?
Lipid drugs6
- Lipid drugs: statin adverse effects · ApplicationA man on atorvastatin develops diffuse muscle pain, dark urine and a very high creatine kinase. What is the diagnosis?
- Lipid drugs: ezetimibe · ApplicationA patient with LDL cholesterol above target on maximal statin therapy is given an add-on drug that blocks intestinal cholesterol absorption. Which target does it act on?
- Lipid drugs: inclisiran · Multi-stepA patient with familial hypercholesterolaemia needs twice-yearly subcutaneous therapy that lowers LDL by reducing hepatic PCSK9 synthesis. Which agent works through RNA…
- Lipid drugs: fibrates · ApplicationA patient with severe hypertriglyceridaemia and recurrent pancreatitis is started on fenofibrate. Through which receptor does it act?
- Lipid drugs: bile acid sequestrants · ApplicationA man on cholestyramine for hypercholesterolaemia develops constipation and a rise in triglycerides. Which statement about resins is correct?
- Lipid drugs: lomitapide · Multi-stepA young adult with homozygous familial hypercholesterolaemia and no functional LDL receptors does not respond adequately to statins. Which oral drug that inhibits micro…
Antibacterials5
- Antibacterials: daptomycin limitation · Multi-stepA patient on a ventilator has MRSA-positive ventilator-associated pneumonia. The team considers using daptomycin because the organism is susceptible in vitro. Why is it…
- Antibacterials: macrolide and statin interaction · ApplicationA 66-year-old man on simvastatin 40 mg is given clarithromycin for pneumonia. Four days later he has severe muscle pain, dark urine and a markedly raised creatine kinas…
- Antibacterials: linezolid prolonged therapy · ApplicationA 30-year-old man with drug-resistant tuberculosis has been on a linezolid-containing regimen for six weeks. His platelet count has fallen to 60 x 10^9/L and haemoglobi…
- Antibacterials: carbapenem and valproate interaction · Multi-stepA 30-year-old man with epilepsy has been seizure-free on sodium valproate. He is admitted with sepsis and given meropenem, and develops breakthrough seizures with a ver…
- Antibacterials: trimethoprim and hyperkalaemia · Multi-stepA 35-year-old man with HIV receiving high-dose co-trimoxazole for Pneumocystis pneumonia has a potassium of 5.8 mmol/L and a creatinine rise from 0.9 to 1.3 mg/dL, with…
Antitubercular drugs5
- Antitubercular drugs: isoniazid neuropathy · ApplicationA 45-year-old malnourished alcoholic man on a standard antitubercular regimen without pyridoxine develops burning paraesthesia in both feet in the second month. What is…
- Antitubercular drugs: pyrazinamide · ApplicationThree weeks after starting four-drug therapy for pulmonary tuberculosis, a man develops an acutely painful, red, swollen first metatarsophalangeal joint. Which drug is…
- Antitubercular drugs: BPaLM regimen · Multi-stepUnder current programme guidance, a patient with rifampicin-resistant pulmonary tuberculosis with fluoroquinolone-susceptible disease is eligible for a six-month all-or…
- Antitubercular drugs: NTEP regimen · ApplicationIn India, a new adult patient with drug-sensitive pulmonary tuberculosis is started on the national programme regimen. Which describes it?
- Antitubercular drugs: TB preventive therapy · ApplicationA household contact of a pulmonary TB patient is advised a short-course rifamycin-based preventive regimen given once a week for twelve weeks. Which regimen is this?
Antiviral drugs5
- Antiviral drugs · ApplicationAn HIV patient on a zidovudine-containing regimen develops macrocytic anaemia. What is the mechanism of this toxicity?
- Antiviral drugs · ApplicationWhy is acyclovir selectively toxic to herpes-infected cells?
- Antiviral drugs · ApplicationAn HIV patient with CMV retinitis is treated with ganciclovir. Which adverse effect is most likely to limit therapy?
- Antiviral drugs · ApplicationWhat enzyme is targeted by many nucleoside analog antiviral agents?
- Antiviral drugs · ApplicationWhat is the target of acyclovir after viral activation?
Autonomic drugs5
- Autonomic drugs · ApplicationWhich receptor blockade causes atropine-induced tachycardia?
- Autonomic drugs · ApplicationWhat is the principal action of an alpha-1 agonist such as phenylephrine?
- Autonomic drugs · ApplicationWhat is a common effect of beta-2 agonist overdose?
- Autonomic drugs · ApplicationWhat is the principal effect of muscarinic M3 activation in bronchi?
- Autonomic drugs · ApplicationWhich drug reverses severe muscarinic toxicity from organophosphate poisoning?
Diabetes5
- Diabetes · ApplicationWhich drug class promotes glucosuria by inhibiting SGLT2?
- Diabetes · ApplicationSulfonylureas lower glucose by doing what?
- Diabetes · ApplicationWhat is main adverse effect of sulfonylurea?
- Diabetes · ApplicationWhat is a GLP-1 agonist effect?
- Diabetes: SGLT2 inhibitors · Multi-stepA patient taking empagliflozin presents with nausea, abdominal pain, ketonaemia, and only mildly elevated glucose. Which adverse effect is most likely?
Diabetes drugs5
- Diabetes drugs · ApplicationWhat is metformin's main effect?
- Diabetes drugs · ApplicationWhat complication is most important with insulin therapy?
- Diabetes drugs · ApplicationWhat is metformin's main glucose-lowering action?
- Diabetes drugs · ApplicationWhat adverse event is most important with insulin therapy?
- Diabetes drugs · ApplicationWhat is metformin's main action?
General anaesthetics5
- General anaesthetics · ApplicationDuring surgery under halothane and succinylcholine, a patient develops muscle rigidity, rising end-tidal carbon dioxide, tachycardia and a rapidly rising temperature. W…
- General anaesthetics: induction in shock · ApplicationA trauma patient with a blood pressure of 80/50 mmHg and a heart rate of 130 per minute needs emergency laparotomy. Among these, which induction agent is least likely t…
- General anaesthetics: etomidate · ApplicationA patient in septic shock is intubated with etomidate and then has refractory hypotension that improves with hydrocortisone. What is the underlying mechanism?
- General anaesthetics: nitrous oxide and closed air spaces · ApplicationA patient with a small traumatic pneumothorax awaiting a chest drain needs a short general anaesthetic for fracture fixation. Which agent should be avoided because it c…
- General anaesthetics: propofol infusion syndrome · Multi-stepA 25-year-old man with severe head injury has been sedated with a high-dose propofol infusion for four days. He develops metabolic acidosis, rhabdomyolysis, hyperkalaem…
Immunosuppressants5
- Immunosuppressants · ApplicationA renal transplant recipient on an immunosuppressant develops gum overgrowth, hirsutism and hypertension. Which drug is responsible?
- Immunosuppressants: mycophenolate · ApplicationA renal transplant recipient is on mycophenolate mofetil. What is its mechanism and a key risk?
- Immunosuppressants: calcineurin inhibitors · ApplicationTacrolimus prevents T-cell activation primarily by reducing transcription of which cytokine?
- Immunosuppressants · ApplicationWhat is the key toxicity of ciclosporin?
- Immunosuppressants · ApplicationWhat is the mechanism of methotrexate in inflammatory disease?
Neuro drugs5
- Neuro drugs: riluzole · ApplicationWhich drug that reduces glutamate release prolongs survival modestly in amyotrophic lateral sclerosis?
- Neuro drugs: migraine prophylaxis · ApplicationA woman with frequent migraines and hypertension needs preventive therapy. Which drug serves both conditions?
- Neuro drugs: ergotamine toxicity · Multi-stepA woman with chronic migraine taking ergotamine daily presents with cold, painful, pulseless feet and paraesthesias. What is the diagnosis?
- Neuro drugs: ADHD · ApplicationA child with ADHD and a history of tics and substance misuse in the family is started on a non-stimulant that selectively inhibits noradrenaline reuptake. Which drug is…
- Neuro drugs: narcolepsy · ApplicationA young man with narcolepsy with cataplexy has excessive daytime sleepiness. Which agent promotes wakefulness, and which agent treats cataplexy?
Neuromuscular blockers5
- Neuromuscular blockers: sugammadex · ApplicationAfter a rocuronium-based anaesthetic, the anaesthetist reverses the block with sugammadex. Why is an antimuscarinic drug not needed along with it, unlike with neostigmi…
- Neuromuscular blockers: succinylcholine hyperkalaemia · ApplicationA man with 40% burns sustained 12 days ago is anaesthetised for debridement and given succinylcholine. Within minutes he develops peaked T waves and ventricular arrhyth…
- Neuromuscular blockers: pseudocholinesterase deficiency · Multi-stepA 28-year-old man remains apnoeic and paralysed for three hours after a standard dose of suxamethonium for a short procedure. His brother had a similar episode. What is…
- Neuromuscular blockers: cisatracurium · ApplicationA patient with combined hepatic and renal failure needs a non-depolarising muscle relaxant for a prolonged procedure. Which drug is preferred because its elimination is…
- Neuromuscular blockers: interaction with aminoglycosides · Multi-stepA 55-year-old man undergoing bowel surgery receives vecuronium. Intraperitoneal gentamicin lavage is used at the end, and he remains weak and poorly ventilated, with fa…
Anthelmintics4
- Anthelmintics: albendazole · ApplicationA patient with seizures has ring-enhancing cysts with a scolex on neuroimaging, consistent with neurocysticercosis. Which anthelmintic is the drug of choice, and what i…
- Anthelmintics: praziquantel · ApplicationA farmer from an endemic area has schistosomiasis. Which drug acts by increasing calcium permeability in the worm, causing spastic paralysis?
- Anthelmintics: diethylcarbamazine in filariasis · ApplicationIn the national programme for lymphatic filariasis in India, mass drug administration uses which combination?
- Anthelmintics: pyrantel pamoate · ApplicationWhich anthelmintic acts as a depolarising neuromuscular blocker, producing spastic paralysis of roundworms and hookworms?
Antidotes4
- Antidotes: warfarin reversal · Multi-stepA 70-year-old man on warfarin, with INR 8.5, has a large intracerebral haemorrhage with deteriorating consciousness. Which management is most appropriate?
- Antidotes: cobra envenomation · Multi-stepA man bitten by a snake that spread a hood has ptosis and descending paralysis, with a normal 20-minute whole blood clotting test. Neurological signs persist after poly…
- Antidotes: snake antivenom response monitoring · Multi-stepA farmer bitten by a Russell's viper is treated with an initial dose of polyvalent anti-snake venom. The 20-minute whole blood clotting test is repeated six hours later…
- Antidotes: hydrofluoric acid burns · ApplicationA technician spills dilute hydrofluoric acid on his fingers. After an hour he has severe throbbing pain out of proportion to the minimal skin changes. Which local treat…
Antimalarials4
- Antimalarials: radical cure of vivax · Multi-stepA 25-year-old man has completed chloroquine for P. vivax malaria and the blood smear is now negative. To prevent relapses, which drug should be given, and what must be…
- Antimalarials: severe malaria · ApplicationA 30-year-old man with Plasmodium falciparum malaria is comatose with parasitaemia of 12%, jaundice and creatinine of 3 mg/dL. Which is the preferred antimalarial?
- Antimalarials: chemoprophylaxis · ApplicationA traveller to a mefloquine-resistant region has a history of depression and seeks malaria prophylaxis. Which drug should be avoided, and which is an alternative?
- Antimalarials · ApplicationWhich drug class may cause hemolysis in G6PD deficiency?
Autonomics4
Corticosteroids4
- Corticosteroids: adrenal suppression · Multi-stepA 50-year-old man treated with prednisolone 30 mg daily for pemphigus for three months stops it abruptly. He develops fatigue, nausea, blood pressure 88/54 mmHg and sod…
- Corticosteroids: antenatal steroids · ApplicationA woman at 30 weeks of gestation has threatened preterm labour. Which corticosteroid is chosen to accelerate fetal lung maturity, and why?
- Corticosteroids: prodrug glucocorticoids · ApplicationA physician is choosing a glucocorticoid for a patient with severe hepatic failure. Which commonly used glucocorticoid is a prodrug that depends on hepatic conversion t…
- Corticosteroids: adrenal suppression · ApplicationWhy should long-term high-dose prednisolone not be stopped abruptly?
Gastrointestinal drugs4
- Gastrointestinal drugs · ApplicationWhat is the main action of proton-pump inhibitors?
- Gastrointestinal drugs · ApplicationWhat class includes ondansetron?
- Gastrointestinal drugs · ApplicationWhy is long-term proton-pump inhibitor therapy reviewed regularly?
- Gastrointestinal drugs · ApplicationWhat is the antiemetic mechanism of ondansetron?
Pharmacogenetics4
- Pharmacogenetics: plasma cholinesterase deficiency · Multi-stepA 35-year-old man remains apnoeic for 3 hours after succinylcholine for appendicectomy. His brother had a similar episode. He is haemodynamically stable with a normal t…
- Pharmacogenetics: prodrug activation · ApplicationA 60-year-old man on clopidogrel after coronary stenting develops stent thrombosis. Genotyping shows CYP2C19*2/*2. What is the likely mechanism of drug failure?
- Pharmacogenetics: prodrug and enzyme inhibition · Multi-stepA 45-year-old woman on paroxetine for depression is prescribed codeine for post-operative pain and reports almost no analgesia, though she takes it as directed. What ex…
- Pharmacogenetics · ApplicationWhy can codeine have variable analgesic effect between patients?
Adverse drug reactions3
- Adverse drug reactions · ApplicationWhich term describes an unwanted harmful effect at normal therapeutic doses?
- Adverse drug reactions · ApplicationWhat type of adverse reaction is dose-dependent and predictable?
- Adverse drug reactions · ApplicationWhich reaction is a predictable type A adverse drug reaction?
Antiplatelets3
- Antiplatelets: glycoprotein IIb/IIIa inhibitors · ApplicationDuring primary percutaneous coronary intervention, a drug that blocks the final common pathway of platelet aggregation by binding the fibrinogen receptor is given intra…
- Antiplatelets: cilostazol · ApplicationA patient with intermittent claudication is started on cilostazol. Which condition is a contraindication?
- Antiplatelets · ApplicationClopidogrel blocks which receptor?
Cholinergic drugs3
- Cholinergic drugs: bethanechol · ApplicationA 62-year-old man cannot void on the second day after hernia repair. Bladder scan shows 700 mL, the prostate is not enlarged and there is no mechanical obstruction. Whi…
- Cholinergic drugs: cholinergic crisis · Multi-stepA woman with myasthenia gravis on large doses of pyridostigmine develops worsening weakness with salivation, sweating, diarrhoea, miosis and muscle fasciculations. A sm…
- Cholinergic drugs: pilocarpine in angle closure · ApplicationA 60-year-old woman has a painful red eye, a mid-dilated fixed pupil, corneal haze and intraocular pressure of 58 mmHg. After intravenous acetazolamide and mannitol, wh…
DMARDs3
- DMARDs: leflunomide · ApplicationLeflunomide is used in rheumatoid arthritis. What is the enzyme target of its active metabolite teriflunomide?
- DMARDs: anti-TNF screening · Multi-stepA patient with rheumatoid arthritis in India is about to begin infliximab. Which pre-treatment evaluation is essential?
- DMARDs: tofacitinib · ApplicationTofacitinib, used in moderate to severe rheumatoid arthritis, belongs to which class?
Emergency drugs3
- Emergency drugs · ApplicationA patient develops stridor, wheeze and hypotension minutes after an injection. What is the first-line drug and route?
- Emergency drugs · ApplicationWhat is the principal action of intramuscular adrenaline in anaphylaxis?
- Emergency drugs · ApplicationWhat is the immediate pharmacological treatment for torsades de pointes with prolonged QT?
Insulin3
- Insulin: potassium in diabetic ketoacidosis · Multi-stepA 22-year-old woman with type 1 diabetes presents with diabetic ketoacidosis, pH 7.1, glucose 480 mg/dL and a serum potassium of 2.8 mmol/L. Intravenous fluids have bee…
- Insulin: intravenous use and hyperkalaemia · Multi-stepA patient with a serum potassium of 7.0 mmol/L and ECG changes receives calcium gluconate. Which additional measure lowers serum potassium within minutes by shifting it…
- Insulin: Somogyi effect and dawn phenomenon · Multi-stepA type 1 diabetic on bedtime NPH insulin has fasting glucose of 220 mg/dL, and a 3 a.m. glucose of 48 mg/dL. What is the likely explanation and adjustment?
Lipid-lowering drugs3
- Lipid-lowering drugs · ApplicationA patient started on nicotinic acid for dyslipidaemia complains of intense facial flushing and warmth. Which drug taken beforehand reduces this adverse effect, and why?
- Lipid-lowering drugs: statin interactions · Multi-stepA patient on simvastatin starts clarithromycin and soon develops severe myalgia with a markedly raised creatine kinase. What is the likely interaction?
- Lipid-lowering drugs: PCSK9 inhibitors · ApplicationHow do monoclonal antibodies against PCSK9 lower plasma LDL cholesterol?
Local anaesthetics3
- Local anaesthetics: mechanism · ApplicationLocal anaesthetics block nerve conduction mainly by which mechanism?
- Local anaesthetics: prilocaine methaemoglobinaemia · Multi-stepA neonate given a large dose of prilocaine cream becomes cyanosed with a low saturation on pulse oximetry that does not improve with oxygen, and blood appears chocolate…
- Local anaesthetics: adrenaline addition · ApplicationWhy is adrenaline added to lidocaine for infiltration, and where must the mixture be avoided?
Pharmacovigilance3
Posterior pituitary drugs3
- Posterior pituitary drugs: desmopressin · ApplicationAfter a head injury a man passes 6 litres of dilute urine per day, with urine osmolality 120 mOsm/kg that rises to 600 mOsm/kg after desmopressin. By what mechanism doe…
- Posterior pituitary drugs: tolvaptan · Multi-stepA 66-year-old man with lung cancer has euvolaemic hyponatraemia from SIADH, sodium 118 mmol/L with mild symptoms, and tolvaptan is started in hospital. What is the most…
- Posterior pituitary drugs: oxytocin water intoxication · ApplicationA woman in prolonged labour receives high-dose oxytocin in a large volume of 5% dextrose for 12 hours. She develops headache, vomiting and a generalised seizure. Serum…
Psychiatric drugs3
- Psychiatric drugs · Multi-stepA patient with bipolar disorder stable on lithium is started on hydrochlorothiazide for hypertension. Two weeks later he has coarse tremor, vomiting and ataxia. What is…
- Psychiatric drugs · ApplicationWhat dangerous syndrome can result from combining serotonergic medicines?
- Psychiatric drugs · ApplicationWhy must lithium concentration be monitored?
Sedative-hypnotics3
- Sedative-hypnotics: mechanism · Multi-stepWhich statement correctly distinguishes how benzodiazepines and barbiturates act at the GABA-A receptor?
- Sedative-hypnotics: flumazenil · Multi-stepA 40-year-old woman on long-term clonazepam is brought unconscious after ingesting an unknown quantity of clonazepam and amitriptyline. Respiration is shallow and the E…
- Sedative-hypnotics: alcohol withdrawal in cirrhosis · Multi-stepA 48-year-old man with decompensated alcoholic cirrhosis (Child-Pugh C) is admitted on day 2 of abstinence with tremor, sweating and agitation. A benzodiazepine is need…
Sex hormone modulators3
- Sex hormone modulators: tamoxifen · ApplicationA 58-year-old woman on tamoxifen for ER-positive breast cancer reports postmenopausal bleeding, and ultrasound shows endometrial thickness of 14 mm. Which property of t…
- Sex hormone modulators: aromatase inhibitors · Multi-stepWhy is an aromatase inhibitor such as anastrozole used alone only in postmenopausal women and not in premenopausal women with ER-positive breast cancer?
- Sex hormone modulators: clomiphene · ApplicationA 27-year-old woman with polycystic ovary syndrome and anovulatory infertility is given clomiphene citrate. How does it induce ovulation?
Alcohol dependence2
- Alcohol dependence: naltrexone · ApplicationA 38-year-old man completing alcohol detoxification wants a drug to reduce craving and relapse. He has normal liver function and takes no other medication. Which drug a…
- Alcohol dependence: disulfiram · ApplicationA man in an alcohol de-addiction programme is started on disulfiram. What happens if he drinks alcohol?
Antiemetics2
Antiparkinsonian drugs2
- Antiparkinsonian drugs: COMT inhibitors · ApplicationA 62-year-old man on levodopa with carbidopa has motor fluctuations, with symptoms returning an hour before each next dose. Entacapone is added. How does it help?
- Antiparkinsonian drugs: dopamine agonists · ApplicationA 55-year-old man with Parkinson's disease on pramipexole develops compulsive gambling and hypersexuality over three months. What is the most appropriate management?
Antituberculous drugs2
Bone drugs2
- Bone drugs: teriparatide · ApplicationA 68-year-old woman has had three vertebral fractures and a T-score of minus 3.5 despite two years of alendronate. An anabolic agent is planned. Which drug and which pa…
- Bone drugs: denosumab discontinuation · Multi-stepA 72-year-old woman completes three years of six-monthly denosumab and then stops it without any follow-on treatment. Nine months later she presents with several new ve…
Contraceptives2
- Contraceptives: contraindications to combined pills · Multi-stepWhich of these women should not be prescribed a combined oral contraceptive pill?
- Contraceptives: emergency contraception · ApplicationA woman presents 96 hours after unprotected intercourse requesting emergency contraception. Which options are effective?
Drug receptors2
Gout2
- Gout: allopurinol hypersensitivity · ApplicationA patient of Han Chinese ancestry starts allopurinol and three weeks later develops fever, mucosal ulcers and widespread skin blistering. Which genotype is associated w…
- Gout: rasburicase · Multi-stepA child with Burkitt lymphoma starts chemotherapy and is at high risk of tumour lysis syndrome with a rapidly rising uric acid. Which agent most rapidly lowers uric aci…
Haematology2
- Haematology: tranexamic acid · ApplicationA woman with heavy menstrual bleeding is prescribed a drug that competitively blocks lysine binding sites on plasminogen. Which drug is this?
- Haematology: hydroxyurea in sickle cell disease · ApplicationA child with sickle cell anaemia has frequent painful crises. Which drug reduces crises by raising fetal haemoglobin?
Heart failure drugs2
- Heart failure drugs: ivabradine · ApplicationA 58-year-old man with HFrEF (ejection fraction 30 percent) in sinus rhythm has a resting heart rate of 82 per minute despite maximally tolerated beta-blocker, ACE inhi…
- Heart failure drugs: sacubitril-valsartan transition · Multi-stepA 64-year-old man with symptomatic HFrEF on enalapril is to be switched to sacubitril-valsartan. Which instruction is correct?
Neuromuscular junction2
- Neuromuscular junction: botulinum toxin · ApplicationA 45-year-old man with cervical dystonia receives botulinum toxin type A injections into the sternocleidomastoid, with relief for about three months. At the nerve termi…
- Neuromuscular junction: Lambert-Eaton syndrome · ApplicationA 62-year-old smoker has proximal leg weakness that briefly improves after repeated effort, dry mouth and absent knee jerks. Electrophysiology shows an incremental resp…
Ocular pharmacology2
- Ocular pharmacology: timolol · ApplicationA 64-year-old man with primary open-angle glaucoma starts a new eye drop and within weeks develops wheeze and a pulse of 48 per minute. Which drug and mechanism of lowe…
- Ocular pharmacology: apraclonidine test in Horner syndrome · Multi-stepA 50-year-old man has a right-sided ptosis and a smaller right pupil that dilates poorly in the dark. After one drop of dilute apraclonidine in each eye, the right pupi…
Parkinsonism2
- Parkinsonism: vitamin B6 and levodopa · Multi-stepA patient receiving levodopa alone takes a multivitamin containing pyridoxine and his symptom control worsens. What explains this?
- Parkinsonism: amantadine · ApplicationA patient with Parkinson disease on levodopa has troublesome involuntary movements at peak dose. Which drug, also used for influenza, reduces levodopa-induced dyskinesia?
Pituitary drugs2
- Pituitary drugs: dopamine agonists · ApplicationA 28-year-old woman with amenorrhoea, galactorrhoea and a serum prolactin of 150 ng/mL has a pituitary microadenoma. Which first-line drug and notable safety concern wi…
- Pituitary drugs: pegvisomant · Multi-stepA man with acromegaly has persistently raised IGF-1 after incomplete surgery and while on a somatostatin analogue. Pegvisomant is added. How should therapy be monitored?
Portal hypertension2
- Portal hypertension: terlipressin · Multi-stepA man with cirrhosis presents with rapidly rising creatinine, ascites and no response to volume expansion, consistent with hepatorenal syndrome. Which vasoconstrictor w…
- Portal hypertension: octreotide · ApplicationIn acute variceal haemorrhage, octreotide is infused. What is its main haemodynamic effect?
Steroids2
Adrenergic neurone blockers1
Adverse effects1
Anaesthesia drugs1
Antiplatelet drugs1
Autacoids and NSAIDs1
Cardiovascular pharmacology1
Immunopharmacology1
Obstetric drugs1
Opioid analgesics1
Rheumatology drugs1
Common questions
How many Pharmacology questions are there?
906 original questions across 705 topics, and the bank grows over time.
Which Pharmacology topics are covered?
Emergency drugs, Antiepileptics, Antimicrobials, Autacoids and NSAIDs, Pharmacokinetics, Autonomic pharmacology, Adrenergic drugs, General anaesthetics, Drug interactions, Psychiatric drugs, Antiviral drugs, Immunosuppressants, and more.
How difficult are these Pharmacology questions?
0 are recall, 665 are application and 241 are multi-step. The tags are our own editorial judgement, not an official difficulty rating.
Are these Pharmacology questions from past papers?
No. They are original practice items. NBEMS does not publish its paper or an official key, and we do not use recalled or leaked questions.
Can I practise Pharmacology for free?
Yes. The free plan includes 20 practice questions a day across all subjects, and the free 20-question assessment covers every subject. A paid term removes the daily limit.
Is there a timed Pharmacology test?
Yes. The Pharmacology subject test is included with a paid term, with a countdown and a question palette.
How should I use these Pharmacology questions?
Answer before you look, read the reason for every option, and write a three-line note for each mistake. A few questions you fully review are worth more than many you skim.
Have these Pharmacology questions been reviewed by faculty?
Not yet. They are original and drafted with AI assistance, then edited by our team. Independent faculty review is planned, and each item shows its status. Confirm important facts in a standard textbook.