APEA Orthopedics Pharmacology | Latest
2026 Revised Questions & Answers
INSTRUCTIONS FOR STUDENTS
Select the best answer for each question. Each question is worth 1 mark.
Answers and detailed rationales are provided immediately after each question.
SECTION 1: GOUT & URIC ACID MANAGEMENT (Questions 1–15)
QUESTION 1
Probenecid, used in the treatment of gout, works by:
A) Decreasing the tubular secretion of uric acid and inhibiting the secretion of penicillin
B) Destroying uric acid crystals in the renal tubular system and slowing the metabolism of
penicillin
C) Increasing the urinary excretion of uric acid and inhibiting the secretion of penicillin
D) Promoting the bactericidal activity of penicillin and breaking down uric acid
Correct Answer: C
Rationale: Probenecid is a uricosuric agent that increases the urinary excretion of uric acid by
inhibiting its reabsorption in the proximal renal tubules. It also inhibits the tubular secretion of
penicillin, which is why it can be used to increase penicillin levels.
QUESTION 2
Which medication helps the kidneys excrete uric acid?
A) Allopurinol (Zyloprim)
B) Colchicine (Colcrys)
C) Indomethacin (Indocin)
D) Probenecid
Correct Answer: D
Rationale: Probenecid is a uricosuric agent used in the treatment of gout. It helps the kidneys
excrete uric acid and is only recommended for patients with good kidney function (creatinine
clearance >50 mL/min).
QUESTION 3
Which of the following is NOT a reason to discontinue allopurinol (Zyloprim)?
A) Acute gout exacerbation
B) Dysuria
C) Jaundice
D) Skin rash
,Correct Answer: A
Rationale: Allopurinol should be discontinued if the patient develops a skin rash (which may
indicate a hypersensitivity reaction), jaundice (signaling hepatotoxicity), or dysuria. An acute
gout exacerbation is actually expected when starting allopurinol and is managed with
prophylactic anti-inflammatory therapy, not by discontinuing the drug.
QUESTION 4
Allopurinol (Zyloprim) is classified as which type of medication?
A) Uricosuric agent
B) Xanthine oxidase inhibitor
C) Anti-inflammatory agent
D) Corticosteroid
Correct Answer: B
Rationale: Allopurinol works by inhibiting xanthine oxidase, the enzyme responsible for
converting hypoxanthine to xanthine and xanthine to uric acid. This reduces uric acid
production.
QUESTION 5
What is the primary mechanism of action of colchicine in treating gout?
A) Increasing uric acid excretion
B) Inhibiting xanthine oxidase
C) Reducing inflammation by disrupting microtubule formation
D) Blocking prostaglandin synthesis
Correct Answer: C
Rationale: Colchicine binds to tubulin and prevents microtubule formation, which interferes with
neutrophil chemotaxis and phagocytosis, thereby reducing the inflammatory response to uric
acid crystals.
QUESTION 6
A patient with acute gout exacerbation should be instructed to avoid:
A) High-purine foods such as organ meats and shellfish
B) Low-fat dairy products
C) Cherries and other fruits
D) Plenty of water
Correct Answer: A
Rationale: High-purine foods (organ meats, shellfish, red meat) can increase uric acid levels
and precipitate gout attacks. Patients should avoid these foods and increase hydration.
QUESTION 7
What baseline test should be obtained before starting allopurinol?
,A) Serum creatinine and BUN
B) Liver function tests
C) Complete blood count
D) Serum uric acid level
Correct Answer: A
Rationale: Allopurinol is renally excreted and requires dose adjustment in renal impairment.
Baseline renal function tests (creatinine, BUN) should be obtained before starting therapy.
QUESTION 8
Colchicine toxicity may present with which of the following symptoms?
A) Nausea, vomiting, and diarrhea
B) Hypertension and tachycardia
C) Hyperglycemia and polyuria
D) Hepatomegaly and jaundice
Correct Answer: A
Rationale: Colchicine has a narrow therapeutic index. Early signs of toxicity include severe
nausea, vomiting, abdominal pain, and diarrhea. These symptoms warrant immediate
discontinuation.
QUESTION 9
Which of the following medications is used for the prophylactic treatment of gout?
A) Colchicine
B) Indomethacin
C) Allopurinol
D) Prednisone
Correct Answer: C
Rationale: Allopurinol is used for the long-term prophylactic treatment of gout by reducing uric
acid production. Colchicine, indomethacin, and prednisone are used for acute flare
management.
QUESTION 10
Allopurinol may interact with which of the following medications?
A) Penicillin
B) Warfarin
C) Acetaminophen
D) Aspirin
Correct Answer: B
Rationale: Allopurinol can increase the effects of warfarin by inhibiting its metabolism, leading to
an increased INR and bleeding risk. Close monitoring is required when these drugs are used
together.
, QUESTION 11
What is the most common side effect of probenecid?
A) Gastrointestinal upset
B) Hepatotoxicity
C) Nephrolithiasis
D) Rash
Correct Answer: A
Rationale: The most common side effect of probenecid is gastrointestinal upset, including
nausea and vomiting. Adequate hydration is recommended to prevent uric acid stone formation.
QUESTION 12
Patients taking probenecid should be instructed to:
A) Avoid aspirin
B) Take with food to reduce GI upset
C) Drink plenty of fluids
D) All of the above
Correct Answer: D
Rationale: Patients on probenecid should take it with food to reduce GI upset, drink plenty of
fluids to prevent uric acid stone formation, and avoid aspirin (which can antagonize the
uricosuric effect).
QUESTION 13
Febuxostat (Uloric) is an alternative to allopurinol for the treatment of:
A) Acute gout flare
B) Chronic gout
C) Pseudogout
D) Gouty arthritis prophylaxis
Correct Answer: B
Rationale: Febuxostat is a xanthine oxidase inhibitor used for the chronic management of
hyperuricemia in gout. It is an alternative for patients who cannot tolerate allopurinol.
QUESTION 14
Febuxostat carries a black box warning for:
A) Hepatotoxicity
B) Cardiovascular events
C) Nephrotoxicity
D) Bone marrow suppression
Correct Answer: B
Rationale: Febuxostat has a black box warning for increased risk of cardiovascular events,
2026 Revised Questions & Answers
INSTRUCTIONS FOR STUDENTS
Select the best answer for each question. Each question is worth 1 mark.
Answers and detailed rationales are provided immediately after each question.
SECTION 1: GOUT & URIC ACID MANAGEMENT (Questions 1–15)
QUESTION 1
Probenecid, used in the treatment of gout, works by:
A) Decreasing the tubular secretion of uric acid and inhibiting the secretion of penicillin
B) Destroying uric acid crystals in the renal tubular system and slowing the metabolism of
penicillin
C) Increasing the urinary excretion of uric acid and inhibiting the secretion of penicillin
D) Promoting the bactericidal activity of penicillin and breaking down uric acid
Correct Answer: C
Rationale: Probenecid is a uricosuric agent that increases the urinary excretion of uric acid by
inhibiting its reabsorption in the proximal renal tubules. It also inhibits the tubular secretion of
penicillin, which is why it can be used to increase penicillin levels.
QUESTION 2
Which medication helps the kidneys excrete uric acid?
A) Allopurinol (Zyloprim)
B) Colchicine (Colcrys)
C) Indomethacin (Indocin)
D) Probenecid
Correct Answer: D
Rationale: Probenecid is a uricosuric agent used in the treatment of gout. It helps the kidneys
excrete uric acid and is only recommended for patients with good kidney function (creatinine
clearance >50 mL/min).
QUESTION 3
Which of the following is NOT a reason to discontinue allopurinol (Zyloprim)?
A) Acute gout exacerbation
B) Dysuria
C) Jaundice
D) Skin rash
,Correct Answer: A
Rationale: Allopurinol should be discontinued if the patient develops a skin rash (which may
indicate a hypersensitivity reaction), jaundice (signaling hepatotoxicity), or dysuria. An acute
gout exacerbation is actually expected when starting allopurinol and is managed with
prophylactic anti-inflammatory therapy, not by discontinuing the drug.
QUESTION 4
Allopurinol (Zyloprim) is classified as which type of medication?
A) Uricosuric agent
B) Xanthine oxidase inhibitor
C) Anti-inflammatory agent
D) Corticosteroid
Correct Answer: B
Rationale: Allopurinol works by inhibiting xanthine oxidase, the enzyme responsible for
converting hypoxanthine to xanthine and xanthine to uric acid. This reduces uric acid
production.
QUESTION 5
What is the primary mechanism of action of colchicine in treating gout?
A) Increasing uric acid excretion
B) Inhibiting xanthine oxidase
C) Reducing inflammation by disrupting microtubule formation
D) Blocking prostaglandin synthesis
Correct Answer: C
Rationale: Colchicine binds to tubulin and prevents microtubule formation, which interferes with
neutrophil chemotaxis and phagocytosis, thereby reducing the inflammatory response to uric
acid crystals.
QUESTION 6
A patient with acute gout exacerbation should be instructed to avoid:
A) High-purine foods such as organ meats and shellfish
B) Low-fat dairy products
C) Cherries and other fruits
D) Plenty of water
Correct Answer: A
Rationale: High-purine foods (organ meats, shellfish, red meat) can increase uric acid levels
and precipitate gout attacks. Patients should avoid these foods and increase hydration.
QUESTION 7
What baseline test should be obtained before starting allopurinol?
,A) Serum creatinine and BUN
B) Liver function tests
C) Complete blood count
D) Serum uric acid level
Correct Answer: A
Rationale: Allopurinol is renally excreted and requires dose adjustment in renal impairment.
Baseline renal function tests (creatinine, BUN) should be obtained before starting therapy.
QUESTION 8
Colchicine toxicity may present with which of the following symptoms?
A) Nausea, vomiting, and diarrhea
B) Hypertension and tachycardia
C) Hyperglycemia and polyuria
D) Hepatomegaly and jaundice
Correct Answer: A
Rationale: Colchicine has a narrow therapeutic index. Early signs of toxicity include severe
nausea, vomiting, abdominal pain, and diarrhea. These symptoms warrant immediate
discontinuation.
QUESTION 9
Which of the following medications is used for the prophylactic treatment of gout?
A) Colchicine
B) Indomethacin
C) Allopurinol
D) Prednisone
Correct Answer: C
Rationale: Allopurinol is used for the long-term prophylactic treatment of gout by reducing uric
acid production. Colchicine, indomethacin, and prednisone are used for acute flare
management.
QUESTION 10
Allopurinol may interact with which of the following medications?
A) Penicillin
B) Warfarin
C) Acetaminophen
D) Aspirin
Correct Answer: B
Rationale: Allopurinol can increase the effects of warfarin by inhibiting its metabolism, leading to
an increased INR and bleeding risk. Close monitoring is required when these drugs are used
together.
, QUESTION 11
What is the most common side effect of probenecid?
A) Gastrointestinal upset
B) Hepatotoxicity
C) Nephrolithiasis
D) Rash
Correct Answer: A
Rationale: The most common side effect of probenecid is gastrointestinal upset, including
nausea and vomiting. Adequate hydration is recommended to prevent uric acid stone formation.
QUESTION 12
Patients taking probenecid should be instructed to:
A) Avoid aspirin
B) Take with food to reduce GI upset
C) Drink plenty of fluids
D) All of the above
Correct Answer: D
Rationale: Patients on probenecid should take it with food to reduce GI upset, drink plenty of
fluids to prevent uric acid stone formation, and avoid aspirin (which can antagonize the
uricosuric effect).
QUESTION 13
Febuxostat (Uloric) is an alternative to allopurinol for the treatment of:
A) Acute gout flare
B) Chronic gout
C) Pseudogout
D) Gouty arthritis prophylaxis
Correct Answer: B
Rationale: Febuxostat is a xanthine oxidase inhibitor used for the chronic management of
hyperuricemia in gout. It is an alternative for patients who cannot tolerate allopurinol.
QUESTION 14
Febuxostat carries a black box warning for:
A) Hepatotoxicity
B) Cardiovascular events
C) Nephrotoxicity
D) Bone marrow suppression
Correct Answer: B
Rationale: Febuxostat has a black box warning for increased risk of cardiovascular events,
