NBME Pharmacology Shelf Practice Exam Questions And Correct
Answers (Verified Answers) Plus Rationales 2026/2027 Q&A | Instant
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1. A 55-year-old man with angina is prescribed a drug that decreases
myocardial oxygen demand by reducing heart rate and
contractility. Which drug is most appropriate?
• A) Nifedipine
• B) Metoprolol
• C) Nitroglycerin
• D) Verapamil
• Rationale: Beta-blockers like metoprolol reduce heart rate and
contractility, lowering myocardial oxygen demand. Nifedipine is a
vasodilator, and nitroglycerin primarily decreases preload.
2. Which of the following antibiotics is bactericidal and inhibits cell
wall synthesis by binding penicillin-binding proteins?
• A) Tetracycline
• B) Ceftriaxone
• C) Azithromycin
• D) Clindamycin
• Rationale: Ceftriaxone, a cephalosporin, is bactericidal and inhibits
peptidoglycan cross-linking via penicillin-binding proteins.
Tetracyclines and macrolides are bacteriostatic.
,3. A patient with schizophrenia develops tardive dyskinesia after
long-term antipsychotic therapy. Which receptor is most
associated with this adverse effect?
• A) 5-HT2A
• B) D2
• C) H1
• D) 𝛼1
• Rationale: Chronic blockade of D2 receptors in the nigrostriatal
pathway leads to extrapyramidal symptoms, including tardive
dyskinesia.
4. Which of the following drugs is most appropriate for treating a
patient with asthma who needs long-term prophylaxis?
• A) Albuterol
• B) Montelukast
• C) Ipratropium
• D) Epinephrine
• Rationale: Montelukast, a leukotriene receptor antagonist, is
effective for long-term asthma control. Albuterol is short-acting
and used for acute symptoms.
5. A patient develops hemolytic anemia after taking a sulfonamide
antibiotic. Which enzyme deficiency is most likely?
• A) Glucose-6-phosphate dehydrogenase
• B) Glucose-6-phosphate dehydrogenase
,• C) Pyruvate kinase
• D) Hexokinase
• Rationale: G6PD deficiency predisposes red blood cells to
oxidative damage from drugs like sulfonamides, causing hemolytic
anemia.
6. Which of the following drugs is used to reverse opioid overdose?
• A) Methadone
• B) Naloxone
• C) Buprenorphine
• D) Fentanyl
• Rationale: Naloxone is a competitive opioid receptor antagonist
used in opioid overdose.
7. A patient on chemotherapy develops gout due to increased uric
acid. Which drug can prevent this complication?
• A) Allopurinol
• B) Allopurinol
• C) Febuxostat
• D) Probenecid
• Rationale: Allopurinol inhibits xanthine oxidase, reducing uric acid
production. Febuxostat is similar; probenecid increases uric acid
excretion.
8. Which antihypertensive drug can cause a persistent dry cough in
some patients?
, • A) Losartan
• B) Lisinopril
• C) Amlodipine
• D) Metoprolol
• Rationale: ACE inhibitors like lisinopril increase bradykinin levels,
causing a dry cough.
9. A patient with status epilepticus is treated with a drug that
enhances GABA-A receptor activity. Which drug is used?
• A) Phenytoin
• B) Valproate
• C) Lorazepam
• D) Carbamazepine
• Rationale: Benzodiazepines, such as lorazepam, enhance GABA-A
receptor-mediated chloride influx, producing anticonvulsant
effects.
10. Which class of drugs can cause gynecomastia by increasing
estrogen-to-androgen ratio?
• A) Statins
• B) Spironolactone
• C) Loop diuretics
• D) Beta-blockers
• Rationale: Spironolactone blocks androgen receptors and inhibits
testosterone synthesis, potentially leading to gynecomastia.
Answers (Verified Answers) Plus Rationales 2026/2027 Q&A | Instant
Download Pdf
1. A 55-year-old man with angina is prescribed a drug that decreases
myocardial oxygen demand by reducing heart rate and
contractility. Which drug is most appropriate?
• A) Nifedipine
• B) Metoprolol
• C) Nitroglycerin
• D) Verapamil
• Rationale: Beta-blockers like metoprolol reduce heart rate and
contractility, lowering myocardial oxygen demand. Nifedipine is a
vasodilator, and nitroglycerin primarily decreases preload.
2. Which of the following antibiotics is bactericidal and inhibits cell
wall synthesis by binding penicillin-binding proteins?
• A) Tetracycline
• B) Ceftriaxone
• C) Azithromycin
• D) Clindamycin
• Rationale: Ceftriaxone, a cephalosporin, is bactericidal and inhibits
peptidoglycan cross-linking via penicillin-binding proteins.
Tetracyclines and macrolides are bacteriostatic.
,3. A patient with schizophrenia develops tardive dyskinesia after
long-term antipsychotic therapy. Which receptor is most
associated with this adverse effect?
• A) 5-HT2A
• B) D2
• C) H1
• D) 𝛼1
• Rationale: Chronic blockade of D2 receptors in the nigrostriatal
pathway leads to extrapyramidal symptoms, including tardive
dyskinesia.
4. Which of the following drugs is most appropriate for treating a
patient with asthma who needs long-term prophylaxis?
• A) Albuterol
• B) Montelukast
• C) Ipratropium
• D) Epinephrine
• Rationale: Montelukast, a leukotriene receptor antagonist, is
effective for long-term asthma control. Albuterol is short-acting
and used for acute symptoms.
5. A patient develops hemolytic anemia after taking a sulfonamide
antibiotic. Which enzyme deficiency is most likely?
• A) Glucose-6-phosphate dehydrogenase
• B) Glucose-6-phosphate dehydrogenase
,• C) Pyruvate kinase
• D) Hexokinase
• Rationale: G6PD deficiency predisposes red blood cells to
oxidative damage from drugs like sulfonamides, causing hemolytic
anemia.
6. Which of the following drugs is used to reverse opioid overdose?
• A) Methadone
• B) Naloxone
• C) Buprenorphine
• D) Fentanyl
• Rationale: Naloxone is a competitive opioid receptor antagonist
used in opioid overdose.
7. A patient on chemotherapy develops gout due to increased uric
acid. Which drug can prevent this complication?
• A) Allopurinol
• B) Allopurinol
• C) Febuxostat
• D) Probenecid
• Rationale: Allopurinol inhibits xanthine oxidase, reducing uric acid
production. Febuxostat is similar; probenecid increases uric acid
excretion.
8. Which antihypertensive drug can cause a persistent dry cough in
some patients?
, • A) Losartan
• B) Lisinopril
• C) Amlodipine
• D) Metoprolol
• Rationale: ACE inhibitors like lisinopril increase bradykinin levels,
causing a dry cough.
9. A patient with status epilepticus is treated with a drug that
enhances GABA-A receptor activity. Which drug is used?
• A) Phenytoin
• B) Valproate
• C) Lorazepam
• D) Carbamazepine
• Rationale: Benzodiazepines, such as lorazepam, enhance GABA-A
receptor-mediated chloride influx, producing anticonvulsant
effects.
10. Which class of drugs can cause gynecomastia by increasing
estrogen-to-androgen ratio?
• A) Statins
• B) Spironolactone
• C) Loop diuretics
• D) Beta-blockers
• Rationale: Spironolactone blocks androgen receptors and inhibits
testosterone synthesis, potentially leading to gynecomastia.
