Week 15 Quiz
Question 1The first-line treatment consideration for managing acute alcohol withdrawal delirium includes:
a.Intubation
b.Benzodiazepines
c.Avoidance of physical restraints to decrease agitation
d.Antipsychotics
Question 2First-line therapy for a school-aged child diagnosed with attention deficit-hyperactivity disorder (ADHD) is:
a.Atomoxetine
b.Clonidine patch
c.Methylphenidate
d.Lisdexamfetamine
Question 3Which of these hypertension drugs has also been approved for the treatment of attention deficit hyperactivity disorder (ADHD)?
a.Guanabenz
b.Clonidine
c.Guanfacine
d.Doxazosin
: Extended-release guanfacine (Intuniv) is approved for use in the treatment of attention deficit-hyperactivity disorder (ADHD) as both an adjunct therapy and monotherapy
Question 4Which of the following insomnia medications does not have increased risk for patients engaging in activities while somnolent with no memory of having taken a pill?
a.Ramelteon (Rozerem)
b.Zolpidem (Ambien)
c.Zaleplon (Sonata)
d.Eszopiclone (Lunesta)
Question 5Common mistakes practitioners make in treating anxiety disorders include:
a.Switching medications after an 8- to 12-week trial
b.Maximizing dosing of antianxiety medications
c.Encouraging exercise and relaxation therapy before starting medication
d.Thinking a partial response to medication is acceptable
Question 6In choosing a benzodiazepam to treat anxiety the prescriber needs to be aware of the possibility of dependence. The benzodiazepam with the greatest likelihood of causing rapidly developing dependence is:
a.Chlordiazepoxide (Librium)
b.Clonazepam (Klonopin)
c.Alprazolam (Xanax)
d.Oxazepam (Serax)
Question 7Although your patient sees a neurologist for the management of her partial complex seizures, why is it is most important to know her medication regimen?
a.You want to make sure that you have injectable fosphenytoin (Cerebyx) in your outpatient clinic
b.Pregnancy concerns
c.Maria might have high co-pays
d.There are many drug-drug interactions with anticonvulsants
Question 8A patient is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding them:
a.To not abruptly discontinue levetiracetam due to risk for withdrawal seizures
b.To wear sunscreen due to photosensitivity from levetiracetam
c.To get an annual eye exam while on levetiracetam
d.To report weight loss if it occurs
Question 9Peter is a 31-year-old male diagnosed with depression, who has been started on the SSRI, sertraline (Zoloft) 100 mg po daily. After two years on SSRIs, Peter is feeling much better and would like to stop taking his sertraline (Zoloft). What do you recommend to avoid withdrawal syndrome?
a.Slowly taper down the sertraline (Zoloft) dose until off.
b.Because Zoloft has a long half-life, you can discontinue the Zoloft at this visit.
c.Change the sertraline (Zoloft) to 100 mg as needed.
d.Instruct Peter that SSRIs can never be stopped.
Question 10The black box warnings concerning teens and young adults taking antidepressants include:
a.Rapid weight loss
b.Suicidal ideation
c.Growth retardation
d.Increased use of recreational drugs
Question 11Cholinergic blockers are used to:
a.Counteract the extrapyramidal symptom (EPS) effects of phenothiazines
b.Control tremors and relax smooth muscle in Parkinson’s disease
c.Inhibit the muscarinic action of ACh on bladder muscle
d.All of the above
Question 12Which of the following drugs used to treat Alzheimer’s disease is not an anticholinergic?
a.Donepezil
b.Memantine
c.Rivastigmine
d.Galantamine
Question 13Preventative therapy for cluster headaches includes:
a.Massage or relaxation therapy
b.Verapamil
c.Intranasal lidocaine four times a day during “clusters” of headaches
d.Propranolol (Inderal) daily
Question 14Nonpharmacologic therapy for tension headaches includes:
a.Biofeedback
b.Stress management
c.Massage therapy
d.All of the above
Question 15Migraines in pregnancy may be safely treated with:
a.Acetaminophen
b.Sumatriptan (Imitrex)
c.Ergotamine tablets (Ergostat)
d.Dihydroergotamine (DHE)
Question 16Several classes of drugs have interactions with cholinergic blockers. Which of the following is true about these interactions?
a.Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action.
b.Additive antimuscarinic effects may occur with antihistamines.
c.Cholinergic blockers may decrease the sedative effects of hypnotics.
d.Cholinergic blockers are contraindicated with antipsychotics.
Question 17A woman at 32 weeks’ gestation has a positive throat culture for strep pyogenes. She denies allergies but gets very nauseated with erythromycin. Which of the following is the best choice for this pregnant patient?
a.Clarithromycin (Biaxin)
b.Trimethoprim/sulfamethoxazole (Bactrim DS)
c.Ofloxacin (Floxin)
d.Penicillin (Pen VK)
Question 18William is a 62-year-old male who is requesting a prescription for sildenafil (Viagra). He should be screened for ________________ before receiving a prescription for sildenafil.
a.Renal dysfunction
b.Unstable coronary artery disease
c.Benign prostatic hypertrophy
d.History of priapism
Question 19Men who are prescribed sildenafil (Viagra) need ongoing monitoring for:
a.Development of chest pain or dizziness
b.Weight gain
c.Priapism
d.Renal function
Question 20 The drug of choice for treatment of primary or secondary syphilis is:
a.Ceftriaxone intramuscular (IM)
b.Benzathine penicillin G IM
c.Oral azithromycin
d.Oral ciprofloxacin
Question 21An adult female presents with a malodorous vaginal discharge and is confirmed to have a Trichomonas infection. Treatment for her would include:
a.Metronidazole 2 g PO x 1 dose
b.Topical intravaginal metronidazole daily x 7 days
c.Intravaginal clindamycin daily x 7 days
d.Azithromycin 2 g PO x 1 dose
Question 22Which of the following is a CDC-recommended treatment for a case of uncomplicated gonorrheal and chlamydial infection?
a.Metronidazole (Flagyl) 250 mg PO TID x 7 days
b.Valacyclovir (Valtrex) 500 mg PO BID x 10 days
c.Azithromycin 1 g orally OR doxycycline 100 mg orally twice a day for 7 days
d.1 dose of oral fluconazole (Diflucan) 150 mg
Question 23Ongoing monitoring is essential after treating for gonorrhea. The patient should be rescreened for gonorrhea and chlamydia in:
a.Four weeks
b.3 to 6 weeks
c.3 to 6 months
d.One year
Question 24The goals of treatment when prescribing for sexually transmitted infections include:
a.Treatment of infection
b.Prevention of disease spread
c.Prevention of long-term sequelae from the infection
d.All of the above
Question 25An adolescent who admits to a high amount of sexual behavior and is prescribed tenofovir and emtricitabine (Truvada®) pre-exposure prophylaxis (PrEP) should be educated regarding:
a.A high risk of developing hypertension, requiring blood pressure check every three months
b.The unique dosing schedule of taking the medication just before high risk activity
c.The need for annual HIV and hepatitis B testing
d.The possibility of developing kidney problems, requiring monitoring of renal function every six months
Question 26An adult female has been prescribed doxycycline for a chlamydia infection. She is healthy and her only medication is an oral combined contraceptive. Education would include:
a.Use a back-up method of birth control (condom) until her next menses.
b.Doxycycline may cause tendonitis and she should report any joint pain.
c.Her partner will need treatment if her infection doesn’t clear with the doxycycline.
d.Doxycycline is used for one-dose treatment of sexually transmitted infections (STIs); take the whole prescription at once.
Question 27Postmenopausal women with an intact uterus should not be prescribed:
a.An estrogen/progesterone combination
b.Intramuscular (IM) medroxyprogesterone (Depo-Provera)
c.Estrogen alone
d.Androgens
Question 28The goals of therapy when prescribing hormone replacement therapy (HRT) include reducing:
a.Cardiovascular risk
b.Risk of stroke or other thromboembolic event
c.Risk of breast cancer
d.Vasomotor symptoms
Question 29Why are SERMs generally not ordered for women early into menopause?
a.The rapid onset of severe hot flashes can be unbearable.
b.The bone remodeling effect results in osteoporosis.
c.They tend to induce intermittent spotting.
d.The increased risk of breast cancer isn’t worth the benefits of a SERM.
Question 30Dysmenorrhea is one of the most common gynecological complaints in young women. The first line of drug treatment for this disorder is:
a.Oral contraceptive pills
b.Caffeine
c.Nonsteroidal anti-inflammatory drug (NSAIDs)
Question 31A 19-year-old female is a nasal Staph aureus carrier and is placed on five days of rifampin for treatment. Her only other medication is combined oral contraceptives. What education should she receive regarding her medications?
a.Separate the oral ingestion of the rifampin and oral contraceptive by at least an hour.
b.Both medications are best tolerated if taken on an empty stomach.
c.She should use a back-up method of birth control such as condoms for the rest of the current pill pack to avoid the low possibility of birth control pill (BCP) ineffectiveness.
d.If she gets nauseated with the medications, she should call the office for an antiemetic prescription.
Question 32Monitoring for a patient who is using androgens includes evaluation of:
a.Complete blood count (CBC) and C-reactive protein levels
b.Lipid levels and liver function tests
c.Serum potassium and magnesium levels
d.Urine protein and potassium levels
Question 33Absolute contraindications that clinicians must consider when initiating estrogen therapy include:
a.Undiagnosed dysfunctional uterine bleeding
b.Deep vein or arterial thromboemboli within the prior year
c.Endometriosis
d.A and B
Question 34Women who are prescribed progestin-only contraception need education regarding which common adverse drug effects?
a.Increased migraine headaches
b.Increased risk of developing blood clots
c.Irregular vaginal bleeding for the first few months
d.Increased risk for hypercalcemia
Question 35Oral emergency contraception (Plan B) is contraindicated in women who:
a.Had intercourse within the past 72 hours
b.May be pregnant
c.Are taking combined oral contraceptives
d.Are using a diaphragm
Question 36Effects of estrogen include:
a.Regulation of the menstrual cycle
b.Maintenance of bone density by increasing bone reabsorption
c.Maintenance of the normal structure of the skin and blood vessels
d.A and C
Question 37A 56-year-old woman is complaining of vaginal dryness and dyspareunia. To treat her symptoms with the lowest adverse effects she should be prescribed:
a.Low-dose oral estrogen
b.A low-dose estrogen/progesterone combination
c.A vaginal estradiol ring
d.Vaginal progesterone cream
Question 38Monitoring of an older male patient on testosterone replacement includes:
a.Oxygen saturation levels at every visit
b.Serum cholesterol and lipid profile every 3 to 6 months
c.Digital rectal prostate screening exam at three and six months after starting therapy
d.Bone mineral density at three and six months after starting therapy
Question 39Which of the following is not a side effect of anticholinergic therapy for urinary incontinence?
a.Diarrhea
b.Dry mouth
c.Constipation
d.Tachycardia
Question 40A 25-year-old female is eight weeks pregnant and has a urinary tract infection. What would be the appropriate antibiotic to prescribe for her?
a.Ciprofloxacin (Cipro)
b.Amoxicillin (Trimox)
c.Doxycycline
d.Trimethoprim-sulfamethoxazole (Septra)
Question 41A 25-year-old female is eight weeks pregnant and has a urinary tract infection. What would be the appropriate antibiotic to prescribe for her?
a.Ciprofloxacin (Cipro)
b.Amoxicillin (Trimox)
c.Doxycycline
d.Trimethoprim-sulfamethoxazole (Septra)
Question 42A child has head lice and their mother is asking which products are available that are not neurotoxic. The only non-neurotoxic head lice treatment is:
a.Permethrin 1% (Nix)
b.Lindane shampoo
c.Malathion (Ovide)
d.Benzoyl alcohol (Ulesfia)
Question 43A patient presents with fungal infection of two of their toenails (onychomycosis). Treatment for fungal infections of the nail includes:
a.Miconazole cream
b.Ketoconazole cream
c.Oral griseofulvin
d.Mupirocin cream
Question 44An adolescent football player presents to the clinic with athlete’s foot. Patients with tinea pedis may be treated with:
a.Over-the-counter (OTC) miconazole cream for four weeks
b.Oral ketoconazole for six weeks
c.Mupirocin ointment for two weeks
d.Nystatin cream for two weeks
Question 45A child has classic tinea capitis. Treatment for tinea on the scalp is:
a.Miconazole cream thoroughly rubbed in for four weeks
b.Oral griseofulvin for 6 to 8 weeks
c.Ketoconazole shampoo daily for six weeks
d.Ciclopirox cream daily for four weeks
Question 46A young adult patient comes to the clinic complaining of copious yellow-green eye discharge. Gram stain indicates she most likely has gonococcal conjunctivitis. While awaiting the culture results, the plan of care should be:
a.None, wait for the culture results to determine the course of treatment
b.Ciprofloxacin (Ciloxan) ophthalmic drops
c.Intramuscular (IM) ceftriaxone
d.High-dose oral amoxicillin
Question 47Whether prescribing an antibiotic for a child with acute otitis media or not, the parents should be educated about:
a.Using decongestants to provide faster symptom relief
b.Providing adequate pain relief for at least the first 24 hours
c.Using complementary treatments for acute otitis media, such as garlic oil
d.Administering an antihistamine/decongestant combination (Dimetapp) so the child can sleep better
Question 48Conjunctivitis in a child that is accompanied by acute otitis media is treated with:
a.Sulfacetamide 10% ophthalmic solution (Bleph-10)
b.Bacitracin/polymyxin B (Polysporin) ophthalmic drops
c.Ciprofloxacin (Ciloxan) ophthalmic drops
d.High-dose oral amoxicillin-clavulanate
Question 49A patient presents to the clinic with hard earwax in both ear canals. Instructions regarding home removal of hard cerumen include:
a.Moisten a cotton swab (Q-tip) and swab the ear canal twice daily.
b.Instill tap water in both ears while bathing.
c.Squirt hydrogen peroxide into ears with each bath.
d.Instill carbamide peroxide (Debrox) twice daily until canals are clear.
Question 50Which of the following is a common adverse drug Reaction of ocular antihistamines (H1 blockers)?
a.Dry eyes
b.Red eyes
c.Increase ocular pressure in the left eye
d.Blurred vision
Question 51An 82-year-old patient has herpes zoster (shingles) and would benefit from an antiviral such as valacyclovir. Prior to prescribing valacyclovir they will need an assessment of:
a.Complete blood count to rule out anemia
b.Liver function
c.Renal function
d.immunocompetence
Question 52Effective treatment for pinworms in children is:
a.Over-the-counter (OTC) pyrantel pamoate
b.Ivermectin
c.Itraconazole
d.Metronidazole
Question 53A patient has been diagnosed with scabies. Education would include:
a.She should leave the scabies treatment cream on for an hour and then wash it off.
b.Scabies may need to be retreated in a week after initial treatment.
c.All members of the household and close personal contacts should be treated.
d.Malathion is flammable and she should take care until the solution dries.
Question 54Scabies treatment for a 4-year-old child includes a prescription for:
a.Permethrin 5% cream applied from the neck down
b.Pyrethrin lotion
c.Lindane 1% shampoo
d.All of the above
Question 55When choosing a topical corticosteroid cream to treat diaper dermatitis, the ideal medication would be:
a.Intermediate potency corticosteroid ointment (Kenalog)
b.A combination of a corticosteroid and an antifungal (Lotrisone)
c.A low-potency corticosteroid cream applied sparingly (hydrocortisone 1%)
d.A high-potency corticosteroid cream (Diprolene AF)
Question 56Appropriate initial treatment for psoriasis would be:
a.An immunomodulator (Protopic or Elidel)
b.Wet soaks with Burow’s or Domeboro solution
c.Intermittent therapy with intermediate potency topical corticosteroids
d.Anthralin (Dithrocream)
Question 57Patients who are treated with more than 100 grams per week of topical calcipotriene for psoriasis need to be monitored for:
a.High vitamin D levels
b.Hyperkalemia
c.Hypercalcemia
d.Hyperuricemia
Question 58An adolescent female calls the clinic with concerns that her acne is worse two weeks after starting topical tretinoin. What would be the appropriate care for her?
a.Change her to a different topical acne medication as she is having an adverse reaction to the tretinoin.
b.Switch her to an oral antibiotic to treat her acne.
c.Advise her to apply an oil-based lotion to her face to soothe the redness.
d.Reassure her that the worsening of acne is normal and it should improve with continued use.
Question 59John, a 10-year-old boy, has type 1 diabetes. His late afternoon blood sugars over the past 2 weeks have ranged between 210 mg/dL and 230 mg/dL. He is currently on 10 units of regular insulin and 25 units of NPH in the morning and 15 units of regular insulin and 10 units of NPH insulin in the evening. Which of the following is the best treatment plan for this patient?
a.Increase both types of the morning dose
b.Increase only the NPH insulin in the morning
c.Decrease the afternoon dose of NPH insulin
d.Decrease both NPH and regular insulin doses in the morning
Question 60A 17-year-old competitive runner presents with hip pain that began after falling while running. Their only medical problem is severe acne for which they take isotretinoin (Accutane). What should the provider be concerned about?
a.The patient may have pulled a muscle and needs to rest to recover.
b.They are at risk for bone injuries and need to be evaluated for fracture.
c.Isotretinoin interacts with ibuprofen, which is the pain medication of choice.
d.Teen athletes are at risk for repetitive stress injuries.
Question 61When an elderly diabetic patient is constipated the best treatment options include:
a.Mineral oil
b.Bulk-forming laxatives such as psyllium
c.Stimulant laxatives such as senna
d.Stool softeners such as docusate
Question 62 Clonidine has several off-label uses, including:
a.Alcohol and nicotine withdrawal
b.Postherpetic neuralgia
c.Both answers are
d.Neither answer is
Question 63The drugs recommended by the American Academy of Pediatrics for use in children with diabetes (depending upon type of diabetes) are:
a.Metformin and insulin
b.Sulfonylureas and insulin glargine
c.Split-mixed dose insulin and glucagon-like peptide-1 (GLP-1) agonists
d.Biguanides and insulin lispro
Question 64All diabetic patients with known cardiovascular disease should be treated with:
a.Beta blockers to prevent myocardial infarctions (MIs)
b.Angiotensin-converting enzyme inhibitors and aspirin to reduce risk of cardiovascular events
c.Sulfonylureas to decrease cardiovascular mortality
d.Pioglitazone to decrease atherosclerotic plaque buildup
Question 65 Drugs used to treat diabetic peripheral neuropathy include:
a.Metoclopramide
b.Cholinergic agonists
c.Cardioselective beta blockers
d.Gabapentin
Question 66 Insulin is used to treat both types of diabetes. It acts by:
a.Increasing beta cell response to low blood-glucose levels
b.Stimulating hepatic glucose production
c.Increasing peripheral glucose uptake by skeletal muscle and fat
d.Improving the circulation of free fatty acids
Question 67Type 1 diabetes results from autoimmune destruction of the beta cells. Eighty-five to ninety percent of type 1 diabetics have:
a.Autoantibodies to two tyrosine phosphatases
b.Mutation of the hepatic transcription factor on chromosome 12
c.A defective glucokinase molecule due to a defective gene on chromosome 7p
d.Mutation of the insulin promoter factor
Question 68Protein restriction helps slow the progression of albuminuria, glomerular filtration rate, decline, and end stage renal disease in some patients with diabetes. It is useful for patients who:
a.Cannot tolerate angiotensin-converting enzyme inhibitors or angiotensin receptor blockers
b.Have uncontrolled hypertension
c.Have HbA1C levels above 7%
d.Show progression of diabetic nephropathy despite optimal glucose and blood pressure control
Question 69Angiotensin-converting enzyme (ACE) inhibitors are considered renal-protective in DM; however, they must be reduced and/or discontinued when:
a.The patient reaches stage 3 chronic kidney disease (CKD)
b.Creatinine levels reach 1.1
c.Potassium levels are consistently found to be below four
d.The patient first starts spilling protein in their urine
Question 70A common side effect of metformin (Glucophage) therapy is:
a.Weight gain
b.Lactic acidosis
c.Hypoglycemic episodes
d.Gastrointestinal problems
Question 71Prior to prescribing metformin, the provider should:
a.Draw a serum creatinine to assess renal function
b.Try the patient on insulin
c.Tell the patient to increase iodine intake
d.Have the patient stop taking any sulfonylurea to avoid dangerous drug interactions
Question 72A patient on metformin and glipizide arrives at her 11:30 a.m. clinic appointment diaphoretic and dizzy. She reports taking her medication that morning and having a bagel and coffee for breakfast. Blood pressure (BP) is 110/70 and random finger-stick glucose is 64. How should this patient be treated?
a.12 oz apple juice with 1 tsp sugar
b.10 oz diet soda
c.8 oz milk or 4 oz orange juice
d.4 cookies and 8 oz chocolate milk
Question 73Treatment of a patient with hypothyroidism and cardiovascular disease consists of:
a.Levothyroxine
b.Liothyronine
c.Liotrix
d.Methimazole
Question 74Hyperthyroid patients require which specialty consultation even when asymptomatic for that organ system?
a.Hepatology
b.Pulmonary
c.Ophthalmology
d.Rheumatology
Question 75 After decades of thyroid supplementation in a patient with TSH at the low end of the range, the patient has increased risk for what?
a.Cataracts
b.Osteoporosis
c.Cancer
d.Dementia
