Q No.

Which one of the following statements about the use of alprazolam in this patient is
false?

1. Additive CNS depression will occur with ethanol and with over-the-counter
antihistamines

2. Alternative nondrug treatments should have been tried long before 3 years had
elapsed

3. Tolerance can be anticipated with chronic use of any benzodiazepine

4. The anxiolytic effects of sedative- hypnotic drugs encourage dependence

5. If she had discontinued alprazolam after 1 month, she would not have experienced
any withdrawal signs at that time
Q No. 2
The main reason for hospitalization of this patient was to be able to effectively
control

1. Anxiety
2. Cardiac arrhythmias
3. Respiratory depression
4. Seizures
5. Thyroid dysfunction

Q No. 3
The symptoms being experienced by this hospitalized patient can best be
ameliorated by the administration of

1. Amphetamine
2. Chlordiazepoxide
3. Oxycodone
4. Propranolol
5. Secobarbital

Q. No. 4
Which one of the following statements about abuse of the opioid analgesics is false?

1. A patient experiencing withdrawal from heroin is free of the symptoms of

abstinence is 6-8 days
2. In withdrawal from opioids, clonidine may be useful in reducing symptoms
caused by sympathetic overactivity
 3. Lacrimation, rhinorrhoea, yawning, and sweating are early signs of withdrawal
from opioid analgesics
4. Naloxone may precipitate a severe withdrawal state in abusers of opioid
analgesics with symptoms starting in less than 15-30 minutes
5. Methadone alleviates most of the symptoms of heroin withdrawal

Q. No. 5
A young male patient is brought to the emergency room of a hospital suffering from
an overdose of cocaine following intravenous administration. His symptoms are
unlikely to include.

1. Agitation
2. Bradycardia
3. Hyperthermia
4. Myocardial infarct
5. Seizures

Q. No. 6
Which one of the following statements about central nervous system stimulants is
false?

1. “Herbal ecstasy” causes amphetamine-like effects

2. Withdrawal from caffeine may lead to severe headaches
3. MDMA (“ectasy,” XTC) is reported to be neurotoxic to brain serotonergic
systems
4. While psychologic dependence to amphetamines is strong, physiologic
dependence does not occur
5. Treatment of cocaine overdose may include the use of diazepam and propranolol

Q. No. 7
Which one of the following statements about inhalants is false?

1. Mescaline and related hallucinogens are thought to exert their CNS actions
through dopaminergic systems in the brain
2. Teratogenic effects are known to occur with the use of LSD during pregnancy
3. Scopolamine is unique among hallucinogens in that animals will self-administer it
4. Dilated pupils, tachycardia, tremor, and increased alertness are characteristic
effects of psilocybin
5. Phencyclidine can be anticipated to cause dry mouth and urinary retention

Q. No. 8
Which one of the following statements about inhalants is false?

1. Solvent inhalation is mainly a drug abuse problem in boys age 8-12 years
 2. Euphoria, numbness, and tingling sensations with visual and auditory
disturbances occur in most persons who inhale 35% nitrous oxide
3. Methemoglobinemia is a common toxicologic problem following repetitive
inhalation of industrial solvents
4. Fluorocarbons may cause sudden death due to cardiac arrhythmias
5. The use of isobutyl nitrite is likely to cause headache

Q. No. 9
Which one of the following signs or symptoms is likely to occur with marijuana?

1. Bradycardia
2. Conjunctival reddening
3. Hypertension
4. Increased psychomotor performance
5. Mydriasis

Items 10-11 A college student is brought to the emergency room by friends. The
physician is in formed that the student had taken a drug and then “went crazy,” The
patient is agitated and delirious. Several persons are required to hold him down. His skin
is warm and sweaty, and his pupils are dilated. Bowel sounds are normal. Signs and
symptoms include tachycardia., marked hypertension, hyperthermia, increased uscle tone,
and both horizontal and vertical nystagmus.

Q. No. 10
The most likely cause of these signs and symptoms is intoxication due to

1. Hashish
2. LSD
3. Mescaline
4. Phencyclidine
5. Scopolamine

Q. No.11
The management of this patient is unlikely to include

1. Activated charcoal
2. Benzodiazepine administration
 3. Haloperidol if psychosis ensues
4. Nasogastric suction
5. Urinary alkalinization to increase drug elimination not readily detected by taste
and have been used in “date rape” attacks. The drug is chemically related to a
brain inhibitory neurotransmitter. Which one of the following most closely
resembles the description given?

6. Amyl nitrite
7. Flunitrazepam
8. Gamma hydroxybutyrate
9. Hashish
10. Metcathinone

Q. No. 12
Which one of the following CNS receptors is directly coupled to an lon channel so
that the effects of its activation do not involve second messenger systems?

1. N(Ach)
2. A(NE)
3. D2A (DA)
4. u(beta endorphin)
5. SHT2 (serotonin)
Q. No. 13
Lorazepam can be safely used as a preanesthetic medication in a patient undergoing
liver transplantation without fear of excessive CNS depression because the drug is

1. Excreted in unchanged form

2. Actively secreted into the GI tract
3. Conjugated extrahepatically
4. A selective ansiolytic devoid of CNS depressant actions
5. Reversible by naloxone

Q. No. 14
Benzodiazepines are thought to cause sedative and/or anxiolytic effects by
1. Increasing functional activity at GABAB receptiors
2. Blocking the NMDA glutamate receptor subtype
3. Facilitating GABA-medicated increases in chloride ion conductance

Q. No.15
Which one of the following is an established clinical use of morphine?
1. Management of generalized anxiety disorders
2. Relief of pain associated with biliary colic
3. Pulmonary congestion
4. Treatment of cough associated with use of ACE inhibitors
5. Suppression of the ethanol withdrawal syndrome

Q. No. 16
A 40- year- old man was brought to the ER after ingesting an unknown quantity of
phe-nobarbital, the plasma level of which was 50mg/L on admission.
Pharmacokinetic parameters for Phenobarbital are: Vd= 40L, CL = 6L/day, half-
life= days, oral bioavailability f=1. The quantity of the drug that the patient ingested
must have been close to
1. 100mg
2. 500mg
3. 1g
4. 2g
5. 5g

Q. No. 17
Which one to the following is characteristic of phenytoin?
1. Inhibition of hepatic cytochromes P450
2. First- order elimination at high therapeutic doses
3. Enhances the effects of estrogenic steroids
4. The drug is safe to use in pregnancy
5. Slows the rising phase of the action potential
Q. No. 18
A patient known to be a heroin abuser comes to the ER with a painful stab wound.
The ER resident administers nalbuphine for the pain. Why is this not a good idea?

1. The patient is probably tolerant to nalbuphine.

2. The drug may precipitate a withdrawal state.
3. Nalbuphine is a weaker analgesic than codeine.
4. Vasodilating effects of nalbuphine increase blood loss.
5. Nalbuphine is a strong u receptor agonist.

Q. No. 19
Anesthesia for day surgery ( outpatients) may include sevoflurance because
recovery from this agent is more rapid than that for older inhaled anesthetics. Rapid
recovery from anesthesia with sevoflurane is associated with its

1. Redistribution from to skeletal muscle

2. Low MAC value
3. Rapid metabolism by liver enzymes
4. Low blood –gas partition coefficient
5. Reversal of anesthesia by naloxone

Q. No. 20
Tricyclic antidepressants

1. Increase the antihypertensive effect of guanerthidine

2. Have anticonvulsant activity
3. Should not be used in patients with glaucoma
4. May increase oral absorption of levodopa
5. Are sometimes used as antiarrhythmics

Items 21-22 A young woman employed as a computer programmer suffers from

myoclonic jerking with no overt signs of neurologic deficit. There is no history of
generalized tonic-clonic seizures.
You are considering drug therapy for this patient.

Q. No. 21
If the seizures are to be effectively controlled without excessive sedation, the most
appropriate drug is

a) Acctazolamide
b) Carbamazepine
c) Clonazepam
d) Valproic acid
e) Vigabatrin
Q. No. 22
In the management of this patient with the most appropriate drug, which one of the
following considerations is LEAST important?

1. Abdominal pain and heartburn are likely side effects

2. Liver enzymes should be monitored
3. She should be examined every 2 or 3 months for deep tendon reflex activity
4. She should contact her physician immediately if she becomes prenant
5. The Patient should avoid barbiturates

Q. No. 23.
With chronic use in seizure states, the adverse effects of this drug include
coarsening of facial features hirsutism, gingival hyperplasia, and osteomalacia.

1. Carbamazepine
2. Ethosuximide
3. Gabapentin
4. Phenytoin
5. Valproic acid

Q. No. 24. A young male patient suffers from a seizure disorder characterized by
tonic rigidity of the extremities followed in 15-30 seconds by tremor progressing to
massive jerking of the body. This clonic phase lasts for a minute or two, leaving the
patient in a stuporouts state. The anti-seizure drug of choice for chronic
management of this patient is

1. Clonazepam
2. Ethosuximide
3. Fosphenytoin
4. Lamotrigine
5. Valproic acid

Items 25-26: Bradykinesia has now made drug treatment necessary in a 60- year- old
male patient with Parkinson,s disease. You decide to initiate therapy with levodopa.

Q. No. 25. As the physician, you could tell the patient (and close family members) all
of the following things about levodopa EXCEPT.

1. Taking the drug in divided doses will decrease nausea and vomiting
2. He should be careful when he stands up because he may get dizzy
3. Uncontrollable muscle jerks may occur
4. A net-like reddish to blue discoloration of the skin is a likely side effect of
antipsychotic drugs
 5. Protects against cancer in patients with melanoma
6. Has toxic effects that include pulmonary infiltrates

Q. No. 26. The major reason why carbidopa is of value in parkinsonism is that the
compound
1. Crosses the blood-brain barrier
2. Inhibits monoamine oxidase type A
3. Inhibits aromatic L-amino acid decarboxylase
4. Is converted to the false neurotransmitter carbidopamine
5. Inhibits monoamine oxidase type B

Q. No. 27. A 72- year- old patient with parkinsonism presents with swollen feet.
They are red, tender, and very painful. You could clear up these symptoms within a
few days if you told the patient to stop taking

1. Amantadine
2. Benxtropine
3. Bromocriptine
4. Levodopa
5. Selegiline

Q. No. 28. The concomitant use of selegiline may increase the peripheral adverse
effects of levodopa writhing movements of her tongue andhands. In addition, she
has delusions of veing persecuted. The women has no past history of psychiatric or
neurologic disorders. The most appropriate drug for treatment is

1. Amantadine
2. Bromocriptine
3. Haloperidol
4. Levodopa
5. Trihexyphenidyl

Q. No. 29
. Which one of the following drugs is most suitable for management of essential
tremor in a patient who has pulmonary disease?

1. Diazepam
2. Levodopa
3. Metoprolol
4. Propranolol
5. Terbutaline
Q. No. 30.
A- year-old women presents with symptoms of major depression that are unrelated to
ageneral medical condition, bereavement, or substance abuse. She is not currently taking
any prescription or over-the counter medications. Drug treatment is to be initiated with a
selective serotonin reuptake inhibitor. In your information to the patient, you would NOT
tell her that

a) Divided doses may help to reduce nausea and gastrointestinal distress

b) Muscle cramps and twitches sometimes occur
c) She must inform you if she anticipates using other medications
d) Taking the drug in the evening will ensure a good night’s sleep
e) The drug may require 2 weeks or more to become effective

Q. No. 31
A 54 -year- old male patient was using fluoxetine for depression but decided to stop
taking the drug. When questioned, he said that it affected his sexual performance and that
“he wasn’t getting any younger.” You notice that he is a user of tobacco products. If you
decide to reinstitute drug therapy in this patient, the best choice would be

a) Amoxapine
b) Bupropion
c) Imipramine
d) Sertraline
e) Venlafaxine
Q. No. 32.
Regarding the clinical use of antidepressant drugs, which one of the following statements
is false?

a) Patients should be advised not to abruptly discontinue antidepressant medications

b) In selecting an appropriate drug for treatment of depression, the past history of
patient, response to specific drugs is a valuable guide
c) In the treatment of major depressive disorders, sertraline is usually more effective
than fluoxtine
d) MAO inhibitors are sometimes effective in depressions with attendant anxiety,
phobic features, and hypoehondriasis
e) Weight loss often occurs in patients taking SSRIs
Item 33-34: A patient under treatment for a major depressive disorder is brought to the
emergency room after ingesting 30 times the normal daily therapcutic dose of
amitriptyline.

Q. No. 33.
Of the possible signs and symptoms in this patient, which one of the following is not
likely to be observed?

a) Acidosis
b) Coma and shock
c) Hot dry skin
d) Hypotension
e) Pinpoint pupils

Q.No. 34.
In sever tricyclie antidepressant overdose, it would NOT be of value to

a) Administer lidocaine (to hasten drug elimination)

b) Institute hemodialysis (to hasten drug elimination)
c) Administer bicarbonate and potassium chloride (to correct acidosis and
hypokalemia)
d) Provide intravenous diazepam (to control seizures)
e) Maintain the rhythm of the heart by electrical pacing
Q. No. 35.
A recently bereaved 74- year old female patient was treated with a benzodiazepine for
several weeks after the death of her husband, but she did not like the daytime sedation it
causes. She has no major medical problems but appears rather infirm for her age and has
poor eyesight. Because her depressive symptoms are not abating, you decide on a trial of
an antidepressant medication. When one of the following drugs would be the most
appropriate choice for this patient?

a) Amitriptyline
b) Mirtazapine
c) Paroxetine
d) Phenelzine
e) Trazodone
Q. No. 36.
Which one of the following drugs is most likely to be f value in obsessive-compulsive
disorders (OCD)?

a) Amitriptyline
b) Bupropion
c) Clomipramine
d) Desipramine
e) Mirtazapine

Q. No. 37.
Established clinical uses of this drug include enuresis and chronic pain.

a) Bupropion
b) Fluvoxamine
c) Impipramine
d) Phenelzine
e) Selegiline

Q. No. 38.
A 56- year- old man, very overweight, complains of not sleeping well and feeling tired
during the day. He tells his wife is the cause of the problem because she wakes him up
several times during the night due to his loud snores. This appears to be a breathing-
related sleep disorder, so you will probably write a prescription for

a) Clorazepate
b) Flurazepam
c) Secobarbital
d) Triazolam
e) None of the above
Q. No. 39.
Regarding the characteristic properties of the drug prescribed for this young man, the
physician should inform the patient to anticipate

a) Additive CNS depression wityh alcoholic beverages

b) A significiant effect on memory
c) That the drug will take a week or so to begin working
d) A need to gradually increase drug dosage because of tolerance
e) That if he stops taking the drug abruptly he will experience withdrawal signs

Q. No. 40.
A 28-year-old woman has sporadic attacks of intense anxiety, with marked physical
symptoms including hyperventilation, tachyeardia, and sweating. If she is diagnosed as
suffering form a panic disorder, the most appropriate drug to use is

a) Alprazolam
b) Chloral hydrate
c) Flurazepam
d) Meprobamate
e) Propranolol
Q. No. 41.
The main reason for hospitalization of this patient was to be able to effectively control

a) Anxiety
b) Cardiac arrhythmias
c) Respiratory depression
d) Seizures
e) Thyroid dysfunction
Q. No.42.
A 26-year-old woman develops a seizure disorder characterized by recurrent contractions
of the muscles in the right hand which then spread to the right arm and to the right side
of the face ("jacksonian march"). Consciousness is not impaired, and the attacks usually
last for only a minute or two. Which one of the following drugs is LEAST likely to be
useful in the treatment of this patient?
a) Carbamazcpinc
b) Ethosuximidc
c) Lumotrigine
d) Phcnytoin
e) Primidonc
Q. No 43.
A 9-year-old child is having learning difficulties at school. He has brief lapses of
awareness with eyelid fluttering that occur every 5-.0 minutes. EEC studies reveal
brief 3-Hz spike and wave discharges appearing synchronously in all leads. Which
one of the following drugs would be effective in this child but has the disadvantages of
causing sedation and tolerance
a) Clonaxcpam
b) Diazcpam
c) Ethosuximide
d) Phcnobarbital
e) Valproicacid
Q. No. 44.
Which one ol the following statements concerning proposed mechanisms of action of
anticon-vulsant drugs is false?

Diazepam facilitates GABA-mediated inhibitory actions

Etho.suximide selectively blocks Kion channels in thalamic neurons
Phcnobarbital has multiple actions, including enhancement of the effects of GABA,
antagonism of glutamatc receptors, and blockade of Nation channels
Phcnytoin prolongs the inactivated state of the Naion channel
Vigabatrin elevates brain GABA levels
Q. No. 45.
Which of the following antisci/ure drugs is most likely to elevate the plasma
concentration of other drugs administered concomitantly?

Carbamazepine
Diazepam
Phenobarbital
Phcnytoin
Valproicacid

I t e m s 46-47: A young woman employed as a computer programmer Buffers from

myoclonic jerkine with no overt signs of neurologic deficit, "['here is no history of
generalized tonic-clonic seizures. You are considering drug therapy for this patient.

Q. No. 46.
If the seizures arc to be effectively controlled without excessive sedation, the most
appropriate drug is

Acctazoiamide
Carbamazcpinc
Clonazopam
Valproic acid
 Vigabatrin

Q. No. 47.
In the management of this patient with the most appropriate drug, which one of the
following considerations is LEAST important?

a) Abdominal pain and heartburn are likely side effects

b) Liver enzymes should be monitored
c) She should be examined every 2 or 3 months for deep tendon reflex activity
d) She should contact her physician immediately if she become
pregnant
e) The patient should avoid barbiturates

Q. No. 48.

Which one of the following statements about abuse of the opioid analgesics is false?

a) A patient experiencing withdrawal from heroin is free of the symptoms of

abstinence in 6-8 days
b) In withdrawal form opioids, clonidine may be useful in reducing symptoms
caused by sympathetic over activity
c) Lacrimation, rhinorrhoea, yawning, and sweating are early signs of withdrawal
from opiod analgesics
d) Naloxone may precipitate a severe withdrawal state in abusers of opioid
analgesics with symptoms starting in less than 15-30 minutes
e) Methadone alleviates most of the symptoms of heroin withdrawal

Q. No. 49.
A young male patient is brought to the emergency room of a hospital suffering from an
overdose of cocaine following intravenous administration. His symptoms are unlikely to
include.

a) Agitation
b) Bradycardia
c) Hyperthermia
d) Myocardial
e) Seizures

Q. No. 50
Which one of the following signs or symptoms is likely to occur with mariiuana?

a) Bradyeardia
b) Conjuctival reddening
c) Hypertension
d) Increased psychomotor performance
e) Mydriasis