Pharmacy Practice Questions by Mari-Alina Timoshchuk.pptx

Pharmacy study questions for medical school and step 1 USMLE by Mari-Alina Timoshchuk

1. A patient comes into your office complaining of a few recent loss of consciousness episodes. While in the waiting room, he experiences an unconscious episode in which all of his body goes limp and he is completely unresponsive. The most appropriate, 1 st line treatment for this patient is Tiagabin Pre- gabalin Lorazepam Ethosuximide Paraldehyde Gabapentin 1

2. A 14 year old female presents to your office complaining of depression and irritability shortly before each menstrual cycle. You determine that she is suffering from PMDD and decide to prescribe an SSRI. The best choice based on this particular patient is: Citalopram Escitalopram Fluvoxamine Paroxetine Sertraline 2

3. A 50 year old man presents with signs and symptoms consistent with a diagnosis of major depressive episodes. The best anti-depressant to prescribe for a patient such as this is a/an: Atypical MAOI SNRI SSRI Tricyclic 3

4. A patient comes to your office complaining of “being tired a lot.” He reports some weight loss, loss of interest, and inability to concentrate. He says he spends about ¾ of the day in bed and can hardly ever leave the house. You conclude the patient is suffering from major depressive disorder, and you want to prescribe a tricyclic . The best choice based on the patient’s main complaint is: Amitryptyline Clomipramine Doxepin Protryptyline Trimipramine 4

5. Paraldehyde is used for ETOH Withdrawal Seizures Grand Mal Seizures Generalized Tonic- Clonic Seizures Partial-Complex Siezures Partial-Simple Siezures 5

6. A 37 year old woman comes to your office complaining of sleep onset insomnia. The best drug to prescribe to treat her insomnia is Pemoline Bromocriptine Trihexelphenidyl Chloral Hydrate Eszopiclone 6

7. A patient comes into your office complaining of a few recent loss of consciousness episodes. While in the waiting room, he experiences an unconscious episode of very stiff arms and legs followed by rhythmic/jerky movements. The most appropriate, 1 st line treatment for this patient is Phenytoin Carbamazipine Valproic Acid All of the above 7

8. Drug (s) with actions on Na channels, GABA receptors, and T-type Ca Channels is known as Valproic Acid Levetiracetam Zonisamide A and C All of the above 8

9. A patient comes into your office with a severe history of epilepsy. While in the waiting room, she experiences a 35 minute seizure. The most appropriate, 1 st line treatment for this life threatening condition works by Increasing Na Channel Inactivation Inhibits GABA Reuptake Increases GABA Action Irreversibly Inhibits GABA Transaminase 9

10. A patient comes to your office complaining of “being tired a lot.” He reports some weight loss, loss of interest, and inability to concentrate. He says he spends about ¾ of the day in bed and can hardly ever leave the house. You conclude the patient is suffering from major depressive disorder, and you want to prescribe a tricyclic . The best choice based on the patient’s main complaint is: Amitryptyline Clomipramine Doxepin Protryptyline Trimipramine 10

11. A 14 year old female presents to your office complaining of depression and irritability shortly before each menstrual cycle. You determine that she is suffering from PMDD and decide to prescribe an SSRI. The best choice based on this particular patient is: Citalopram Escitalopram Fluvoxamine Paroxetine Sertraline 11

12. A 50 year old man presents with signs and symptoms consistent with a diagnosis of major depressive episodes. The best anti-depressant to prescribe for a patient such as this is a/an: Atypical MAOI SNRI SSRI Tricyclic 12

13. A 55 y/o male with major depressive disorder presents to your office. He has recently suffered from a heart attack. You decide that the best medication to treat his depression based on his medical history is: Amitryptyline Doxepin Escitalopram Protryptyline Venlafaxine 13

14. A 30 year old male being treated for major depressive disorder comes to your office complaining of decreased libido. The mechanism of action responsible for this unwanted side effect is: Decreased norepinephrine Decreased serotonin Increased dopamine Increased norepinephrine Increased serotonin 14

15. Pharmacotherapy of Psychoses Pharm C9 15

16. The tenets of schizophrenia state: ____ cause symptoms similar to schizophrenia ____ cause therapeutic relief of the schizophrenic symptoms Glutamate receptor agonists, Glutamate receptor antagonists GABA receptor antagonists, GABA receptor agonists GABA receptor agonists, GABA receptor antagonists Dopamine receptor agonists, Dopamine receptor antagonists Dopamine receptor antagonists, Dopamine receptor agonists 16

17. Aripiperazole ( Abilify ) is a new anti-psychotic medication with a unique mechanism of action. What is the MOA? It is a partial DA antagonist  reduces psychotic symptoms but causes neuroleptic malignant syndrome It is a more selective DA antagonist  does not block neurons in the basal ganglia It is more selective for 5-HT-2A receptors  reduces psychotic symptoms yet improves tardive dykinesia It is a partial DA agonist  reduces psychotic symptoms yet reduces tardive dyskinesia 17

18. The main difference between the 1 st and 2 nd generation of anti-psychotic drugs is: 1 st Generation 2 nd Generation A DA agonists that bind to D2 receptors Weak DA agonists and 5-HT-2A receptor agonists B DA agonists that bind to D1 receptors Weak DA agonists and 5-HT-2A receptor antagonists C DA antagonists that block D2 receptors Weak DA antagonists and 5-HT-2A receptor antagonists D DA antagonists that block D2 receptors Weak DA antagonists and 5-HT-2A receptor agonists E DA antagonists that bind to D1 receptors Weak DA antagonists and 5-HT-2A receptor agonists 18

19. A well known schizophrenic woman is brought into the ER by ambulance. She is smacking her lips, blinking rapidly and grimacing. You check her purse to see what medications she is most likely taking. The drug he is most likely taking is Aripiperazole Clozapine Haloperidol Risperidone Olanzapine 19

20. A well know schizophrenic man gets brought into the ER by ambulance. Although he is not showing any schizophrenic symptoms, he is acutely will with a high grade fever. A CBC shows a severe decrease in granulocytes. This man is most likely taking Aripiperazole Clozapine Haloperidol Risperidone Olanzapine 20

21. A man is brought to his primary care physician by his wife, who is concerned about some recent odd changes in his behavior. He has developed a tremor in his hands that has become progressively more noticeable, and he is becoming more and more unsteady on his feet. After gathering the patient’s history and performing a physical exam, you begin to suspect the onset of Parkinson’s disease. A potential treatment you may give this patient that will cross the blood-brain barrier would be: Benztropine Bromocriptine Levodopa Selegiline 21

22. Upon starting a patient on L- Dopa for Parkinson’s disease, you want to minimize the chances of the patient developing resistance to this drug over time. A good drug to use in combination with L- Dopa to decrease its conversion to dopamine in the periphery (therefore allowing more to reach the brain) is: Carbidopa Pergolide Selegiline Trihexlphenidyl 22

23. The main change that has been attributed to producing symptoms of Parkinson’s disease is: Degeneration of spinal, bulbar, and cortical neurons B. Death of dopaminergic projections between substantia nigra and striatum C. Degeneration in nigrostriatum due to abnormal protein accumulation D. Death of dopaminergic projections between substantia nigra and thalamus 23

24. A 60-year old man presents to your office complaining of a general weakness that has progressively gotten worse over the past few months, along with spasticity. Upon testing his muscle strength, you notice that it is greatly diminished, and that there is a slight degree of atrophy, especially in his upper extremities. You know that although there is no cure for this disease, you can hopefully treat his symptoms with a: A. COMT inhibitor B. GABA A agonist C. GABA B agonist D. Phenothiazine 24

25. A patient has been coming to your office for years since he was first diagnosed with Parkinson’s disease. Up until now, his symptoms have been kept under control using direct replacement therapy with Levodopa . However, the disease has gotten progressively worse, and his quality of life has swiftly declined in the past few months. You consider prescribing Bromocriptine , which is often used in the late stages of Parkinson’s disease. This drug acts on: A. 5HT receptor B. Ach receptor C. Pre-synaptic DA receptor D. Post-synaptic DA receptor 25

26. The symptoms associated with Parkinson’s disease can be attributed to increased stimulatory effects of Ach caused by the disinhibition of dopamine release. A drug that specifically targets the Ach receptor, blocking these effects is: A. Bromocriptine B. Entacapone C. Levodopa D. Trihexlphenidyl 26

27. Pharm Questions, block 3 Anxiolytics and Sedative Hypnotics I 27

28. A 22 year old female patient returns to your office for a follow up visit after struggling to adjust to life after college. She reports that the medication she has been taking for the past month has successfully curbed her anxiety, however she feels excessively tired and has trouble staying awake. What drug has this patient likely been taking? a. Pentobarbital b. Phenytoin c. Sodium thiopental d. Triazolam e. Zolpidem 28

29. Your patient suffers from simple partial seizures. What is the mechanism of the drug most likely used to treat this patient’s condition? a. Directly inhibits the release of glutamate from pre-synaptic nerve terminals b. Increase the duration of chloride ( Cl -) channel opening, to increase GABA-A c. Increase the effects of GABA-B and decrease glutamate release d. Indirectly inhibit the effects of Ach e. NMDA receptor antagonist, inhibits Ca2+ mediated excitotoxicity f. Selectively inhibit the degradation of dopamine in the synaptic cleft 29

30. A 34 year old man is rushed into the ER. His brother found him passed out on the couch when he came over for a visit. The man is unresponsive, has barely palpable pulses, and is taking only shallow, faint breaths. The brother reports seeing empty liquor bottles and an empty prescription bottle near his brother – but did not bring the bottle. He tells you that his brother had a life-long history of epilepsy, but had not had a seizure in over a decade. What is the most likely drug this patient had been taking? Carbamazepine Ethosuximide Lamotrigine Phenobarbital Midazolam 30

31. A 74 year old man presents to the ER. His wife is with him and is concerned that he is slurring his speech and stumbles when he walks. On physical exam, he is slightly bradyepnic . Otherwise, physical exam is normal. She tells you that he was confused this morning, and might have taken a few doses of his normal insomnia medication. You are relieved when you hear what he has been taking, since you know there is an antidote you can give him. You quickly call for: Dantrolene Flumazenil Naloxone Naltrexone Pralidoxime 31

32. A 6-year old boy arrives to the hospital for a scheduled tonsillectomy. The surgery itself takes less than an hour. The patient (obviously) needs to be sedated for the procedure. What drug would most likely be used for an outpatient surgery, such as a tonsillectomy? Alprazolam Chlordiazepoxide Diazepam Flurazepam Midazolam 32

33. A 37 year old woman comes to your office complaining of sleep onset insomnia. The best drug to prescribe to treat her insomnia is Pemoline Bromocriptine Trihexelphenidyl Chloral Hydrate Eszopiclone 33

34. All of the following drugs can be used to treat insomnia except Temazepam Trazadone Buspirone Melatonin Zolipidem 34

35. A 24 year old violinist experiences stage fright during concerts. You decide the best treatment for her condition is Triazolam Propranolol Hydroxyzine Melatonin Zolipidem 35

36. A patient presents to your office with recurrent, discrete periods of sudden intense fear. The best treatment for this condition is Citalopram Oxazepam Flumazenil Meprobamate Buspirone 36

37. A patient with Alzheimer’s disease sometimes becomes agitated and aggressive. To help reduce these episodes, you prescribe Clonazepam Eszopiclone Alprazolam Buspirone Midazolam 37

38. CNS Stimulants 38

39. Prior administration of the antipsychotic reserpine will most likely inhibit the effects of the CNS stimulant: Amphetamine Atomoxetine / Strattera Cocaine Modafinil / Provigil Theophylline 39

40. A 25-year old man has a 3-day history of worsening fatigue, depression, and constant sleepiness. Physical exam reveals bradycardia , and the patient appears to be irritable and restless. The patient has a history of polydrug abuse, and the most likely cause of his current symptoms is Barbiturate dependence Benzodiazepine withdrawal Cocaine withdrawal Marijuana overdose TCA overdose 40

41. Your 16-year old patient has comorbid depression and ADD. You are considering a drug that is an indirect-acting adrenergic agonist marketed to treat his depression. However, this drug is not considered to be a CNS stimulant and would not generally be used to treat ADD. The drug is most likely Amphetamine Atomoxetine / Strattera Ephedrine Pargyline Theophylline 41

42. All of the following are side effects of CNS stimulants except Depression Cardiac arrhythmia Increased blood pressure Increased rate and depth of respiration Psychotic symptoms 42

43. One of the indications for CNS stimulants to which tolerance develops is ADD/ADHD Bipolar Disorder Depression Narcolepsy Obesity 43

44. A condition in which peripheral opioid μ receptors are upregulated and opioid analgesics would prove beneficial is Guillan Barre syndrome Osteoarthritis Multiple sclerosis Fibromyalgia Rheumatoid arthritis 44

45. The endogenous opioid that can be detected in blood and shares the same precursor molecule as ACTH is α -neo-endorphin Β -endorphin Dynorphin Met- enkephalin endomorphin 45

46. A woman is brought into the ER unresponsive. The paramedics report she overdosed on codeine. The condition NOT associated with an opioid overdose is Abdominal muscle spasm Slow, labored breathing Miosis Low blood pressure Increased pulse 46

47. A desirable analgesic property of opioids that NSAIDS and acetaminophen lack is Orthostatic hypertension Nausea and vomiting No ceiling effect D. Decreased risk of cardiovascular events E. GI problems 47

48. The candidate in which opioid usage would be appropriate and beneficial is Elderly asthmatic man diagnosed with BPH Young, schizophrenic male with cholecystitis Hypertensive pre-menopausal female with Grave’s disease Heroin addict in car accident Epileptic teen with concussion 48

49. Opioid receptors in which two regions can inhibit pain messages to the brain? Pick two. Spinothalamic tract Dorsal horn of spinal cord IMLCC of spinal cord Periaqueductal gray Locus cereleus 49

50. You check your patient before morning rounds. After being on morphine for 24 hours, she complains of spasms ‘around my tummy’, itching, dizziness, constipation and ‘difficulty seeing in the dark.’ You tell her most of the symptoms will improve within several days except her itching, constipation Dizziness, miosis Spasms, dizziness Spasms, constipation Miosis , constipation 50

51. Your patient was in a severe MVA and had several surgeries on arrival. On Friday, he was started on morphine and seemed to be progressing well. When you return on Monday, you find him in acute renal failure. He’s become increasingly confused, sedated and both his blood pressure and respiration rate have dropped. His blood shows elevated levels of Diacetylmorphine Morphine-6B-glucuronide monoacetylmorphine Normeperidine dihydrocodeine 51

52. Your dentist gives you codeine before beginning to take out your wisdom teeth. You fail to become drowsy and the analgesic effects do not set in. You have an inactive A. CYP450-1A2 B. CYP450-2A13 C. CYP450-2C19 D. CYP450-2D6 E. CYP450-2E1 52

53. On your surgery rotation, you watch a partial bowel resection. The surgeon asks you what opiate would be best the first day post-op. You flatly reply the opiate with fewer muscle spasms than morphine is Meperedine Hydromorphine Codeine Oxycodone fentanyl 53

54. In the OR, you begin to worry when the patient’s pulse, respiration rate and blood pressure begin to decrease steadily. The anesthesiologist says, “don’t worry– I gave a bit too much, but this opiate will wear off in a few minutes.” He’s likely referring to Naloxone Hydromorphone Methadone Butorphanol Alfentanil 54

55. While taking a patient’s history, she tells you she’s a heroin addict and has been going to rehab for three months. “They have me on some pill I take each morning. I was told the longer I take it, the longer I’ll feel its effects. I’m not sure I believe that.” The likely drug she’s taking for her narcotic dependence is Naloxone Nalmefene Methadone Carfentanil Cyclazocine 55

56. The property of naloxone that is utilized in combination with oxycodone and pentazocine tablets is No hepatotoxicity Increased duration of action with repeated use Ineffective orally Long plasma half-life Antagonist of mu, delta and kappa receptors 56

57. An ex-heroin addict has an emergency appendectomy. The analgesic drug of choice is Naloxone Buprenorphine Tramadol Methadone Fentanyl 57

58. Tramadol functions as a synergistic analgesic. It does so by these two actions: DA and NE reuptake blocker 5-HT and NE reuptake blocker Reversibly inhibiting Cox-1 Alpha-2 receptor agonist Beta-1 receptor agonist 58

59. A 73 year old women comes in to your clinic complaining of shooting, burning pain on the right side of her mid back and chest, and there is nothing she can recall that causes the pain to increase or decrease. She has tried OTC Ibuprofen to treat the pain, but has had no relief. Her history is significant for total hysterectomy, shingles, gallbladder removal, and chronic arthritis. The most likely cause of her pain is: Total Hysterectomy Shingles Gallbladder removal Chronic Arthritis None of these 59

60. Post-herpetic neuralgia pain can best be treated with: Celecoxib Oxycodone Fentanyl Tramadol Clonidine 60

61. Matching: Nerve Fibers A β Fibers A δ Fibers C Fibers First pain response; Low threshold nociceptive stimuli Persistent, throbbing pain; higher threshold nociceptive response Light touch; chronic neuropathic pain; NOT involved in normal nociceptive pain 61

62. Matching: Na Cannels Na v1.6 Na v1.7 Na v1.8 TTX resistant; found predominantly in small peripheral neurons; rapid repriming TTX sensitive; found predominantly in Nodes of Ranvier ; very rapid repriming TTX sensitive; slow inactivation and repriming ; most important channel involved in pain perception 62

63. The two most important neurotransmitters involved in pain conduction are: NE, Dopamine Glutamate, 5-HT NE, 5-HT Glutamate, Substance P Ach, GABA 63

64. A mother brings her 2 year old child to your clinic for an evaluation. At birth, the child had slightly flushed skin on his lower extremities, including his feet and buttocks. He now is presenting with burning dysesthesia of his rectum along with redness all around his genital region. After performing several tests on him (including genetic testing), you discover he has a mutation in the SCN9A gene. This child’s most likely diagnosis is: Inherited Primary Familial Erythromelalgia Congenital Insensitivity to Pain Paroxysmal Extreme Pain Disorder Polycythemia Vera Sezary Syndrome 64

65. Which of the following is an example of a cause of a primary headache? A. Intracranial hemorrhage B. Migraine C. Meningitis D. Trigeminal neuralgia E. Temporal arteritis 65

66. A 26-year old woman is sitting at her desk at work when she notices a throbbing behind her left eye. Thirty minutes later, she begins to feel nauseous, and the pain behind her eye has spread to both sides of her head. She is most likely experiencing a: A. Cluster headache B. Exertional headache C. Migraine headache D. Tension headache E. Paroxysmal hemicrania 66

67. A treatment that may be used for the woman in the previous question that will help her “sleep off” the migraine is: A. Butalbital B. Ergotamine C. Fentanyl D. NSAID E. Prednisone 67

68. A prophylactic treatment that may be useful in reducing the intensity and frequency of headaches is: A. Codeine B. Ergotamine C. Promethazine D. Propanolol E. Sumatriptan 68

69. The class of drugs that is the gold standard for treating headaches is: A. Barbiturates B. Corticosteroids C. NSAID D. Phenothiazines E. Triptans 69

70. A 46-year old male presents to his primary care physician after experiencing headaches about once a month for the past six months. He describes it as a stabbing pain on one side of his head, and he notices the skin on that side of his face appears flushed during an episode. He tells you that this is the worst pain he has ever experienced, and it causes him to stop whatever physical activity he may be doing at the moment. It usually lasts for about 15-20 minutes. A prophylactic treatment for this type of headache is: A. Codeine B. Ergotamine C. Prednisone D. Promethazine E. Sumitriptan 70

71. The primary purpose of the Warfarin Sensitivity DNA Test is to determine drug to use if patient bleeds outs drug to use if patient gets DVT d osage range for patient Specific polymorphism for patient’s family to be tested Precise cause of death 71

72. The identification of SNPs (single nucleotide polymorphisms) can help Predict drug responses Predict adverse reactions Determine particular therapeutic course Determine risk of specific diseases All of the above 72

73. Codeine is metabolized to morphine via CYP2D6. If rapidity of analgesic onset was more important that duration, you’d want the patient to be a Slow metabolizer Fast metabolizer Normal metabolizer 73

74. Before beginning a course of mercaptopurine for a seven y/o with acute lymphocytic leukemia you take a family history. The mother says, “Chemo drugs act really strongly in our family. The doctor that treated my mother’s ovarian cancer said she had some different gene.” Before you start the mercaptopurine , you test for polymorphisms in Pseudocholinesterase Thiopurine methlytransferase BCR-ABL protein CYP2D6 CYP2C9 74

75. 75

76. Pharmacology Exam #3 Practice Questions General and Local Anesthetics 76

77. Which of the following local anesthetics is an amino ester? A) Lidocaine B) Etidocaine C) Prilocaine D) Procaine E) Bupivacaine 77

78. What can be added to a local anesthetic to make them less ionized and diffuse faster/have quicker onset? A) Bicarbonate B) Epinephrine C) Saline D) Glucose E) Acetic acid 78

79. In which of the following drug groupings can an allergic reaction mediated by the compound PABA ( para-aminobenzoic acid) occur? A) Amino amides B) Amino esters C) NMJ depolarizers D) NMJ non-depolarizers E) Inhalational anesthetics 79

80. What is the treatment for an overdose on a local anesthetic? A) B icarbonate B) Intubation + anti-seizure drug C) O 2 mask + epinephrine D) Neostigmine + Glycopyrolate E) None of the above 80

81. What is the first muscle to return after neuromuscular blockade? A) Levator palpebrae superioris B) Sternocleidomastoid C) Diaphragm D) Biceps brachii E) Flexor carpi radialis 81

82. Which of the following patients would need a HIGHER level of a volatile inhalation anesthetic? A) Pregnant woman B) Hyponatremic patient C) Anemic patient D) Chronic alcoholic E) 85 year old patient 82

83. After use of sevoflurane on a 4 year old undergoing tonsillectomy, the patient is found to have muscle rigidity, rhabodomyolysis , and a temperature of 103°F. What is the treatment of this condition? A) Flumazenil B) Naloxone C) Naltrexone D) Nalmefene E) Dantrolene 83

84. Which of the following patients would need a LOWER level of a volatile inhalation anesthetic? A) 9 year old patient B) Bipolar patient taking lithium C) Cocaine addicted patient D) Hypernatremic patient E) Hyperthyroid patient 84

85. Which of the following volatile anesthetics is the quickest to leave the patient’s system? A) Isoflurane B) Desflurane C) Sevoflurane E) Enflurane D) Halothane 85

86. Which of the following is NOT a factor governing the uptake of a volatile/inhalational anesthetic? A) Age B) Cardiac Output C) Solubility D) Barometric Pressure E) Rate of diffusion 86

87. What is the primary target for many general anesthetics? A) GABA A receptor B) M 1 receptor C) β 2 receptor D) α 2 receptor E) NMDA receptor 87

88. Which IV general anesthetic would be best to use in a patient with limited cardiac reserve? A) Thiopental B) Etomidate C) Propofol D) Ketamine E) Dexmedetomidine 88

89. If someone is accidently overdosed on Midazolam (benzodiazepine) what is the next drug to give them? A) Flumazenil B) Naloxone C) Naltrexone D) Nalmefene E) There is no drug to give – just wait for benzo to wear off 89

90. Which inhalational anesthetic can cause hepatitis as a toxicity? A) Isoflurane B) Desflurane C) Sevoflurane E) Enflurane D) Halothane 90

91. A patient presents to the ED intermittent seizures, diaphoresis, miosis , diarrhea, and drooling. You notice a strong scent of garlic as well. When you ask the patient what he has been doing lately, he says that he has been working near a strawberry farm where they are spraying lots of pesticides. What is the most likely substance that has caused this patient’s condition? Amphetamines Benzodiazepines Ethanol Mushrooms Organophosphates 91

92. The father of modern toxicology and pharmacology, Paracelsus, described toxicology in which of the following ways: “Toxicity depends on dose and duration of exposure.” “Everything is a poison; there is nothing which is not.” “Pharmacology is the essence of mixing different poisons properly.” “Toxicology is the study of what happens when dumb people play with substances.” 92

93. A patient came into the ED early this morning. He presented with very dry skin, flushed, and tachycardic He was preparing to go on a fishing trip into the Gulf of Mexico, but he was very nervous about getting motion sickness, so he took a bunch of pills that his friend told him to take because it was supposed to prevent him from getting sick. What pills did he most likely take? Amphetamine Benzodiazepines Cocaine Scopolamine Theophylline 93

94. Sympathomimetic toxidrome would resemble anticholinergic toxidrome in all of the following ways EXCEPT: Diaphoresis Delirium Hyperthermia Mydriasis Tachycardia 94

95. A patient presents to the ED with bradycardia , hypotension, hypoventilation, and mydriasis . You suspect a narcotic toxidrome , but what specific substance is extremely high on your index of suspicion? Codeine Demerol Fentanyl Heroin Methadone 95

96. A patient presents to the ED with slurred speech, delirium, and an abnormal gait. You suspect alcohol poisoning, and order a routine lab panel (CBC, electrolytes, BUN/Cr, glucose, and ABG) to discern the chemical cause of the patient’s condition. Tests reveal that the patient is without an anion gap, but has an osmolal gap. What substance do you suspect? Cyanide Ethanol Isopropyl alcohol Lactic acidosis Salicylates 96

97. A patient presents to the ED in a comatose state. Which of the following is NOT in the “coma cocktail?” Dextrose Flumazenil Nalmefene Oxygen Thiamine 97

98. A patient presents to the ED and appears to have ingested a poison. Your attending asks whether or not a dose of activated charcoal is the proper treatment. An overdose of which of the following would be treatable with activated charcoal? Arsenic Cyanide Iodine Methanol Salicylates 98

99. A patient presents to the ED in acute liver failure. You ask the patient what, if any, medications she had taken recently. She says that she has only taken tylenol for some back pain. What treatment do you immediately order? Urine alkalinization Cathartics (like sorbitol ) Hemodialysis N- acetylcysteine Whole bowel irrigation 99