MN 553 Unit 10 Final Exam LATEST Verion-1 2026 TEST EXAM
WITH ACTUAL 100 QUESTION AND CORRECT DETAILED
ANSWERS WITH RATIONALES.
QUESTION
A woman who is pregnant and has hyperthyroidism is best managed by a specialty team
who will most likely treat her with which of the following medications?
a. Methimazole
b. Propylthiouracil (PTU)
c. Radioactive iodine
d. Nothing, treatment is best delayed until after her pregnancy ends
CORRECT ANS: b. Propylthiouracil (PTU)
EXPERT RATIONALE
Propylthiouracil (PTU) is the preferred antithyroid medication for the treatment of
hyperthyroidism during pregnancy, particularly in the first trimester, due to its lower
transplacental passage and reduced risk of fetal teratogenicity compared to
methimazole. PTU is preferred because it has a lower risk of causing aplasia cutis, a rare
congenital scalp defect, which has been associated with methimazole use in the first
trimester. Additionally, PTU has the advantage of inhibiting the peripheral conversion of
T4 to T3, which can be beneficial in severe hyperthyroidism. Radioactive iodine is
absolutely contraindicated during pregnancy because it crosses the placenta and can
cause fetal thyroid destruction and hypothyroidism. Delaying treatment until after
pregnancy is not appropriate, as uncontrolled hyperthyroidism during pregnancy poses
significant risks to both the mother and fetus, including preeclampsia, preterm birth,
and fetal thyroid dysfunction. Endocrine society guidelines recommend that pregnant
women with hyperthyroidism be managed by a multidisciplinary team, including an
endocrinologist and a maternal-fetal medicine specialist.
QUESTION
The dosage of Vitamin B12 to initially treat pernicious anemia is which of the following?
a. Nasal cyanocobalamin 1 gram spray in each nostril daily x 1 week then weekly x 1
month
b. Vitamin B12 IM monthly
,c. Vitamin B12 1,000 mcg IM daily x 1 week then 1,000 mg IM weekly for a month
d. Oral cobalamin 1,000 mcg daily
CORRECT ANS: c. Vitamin B12 1,000 mcg IM daily x 1 week then 1,000 mcg IM weekly
for a month
EXPERT RATIONALE
Pernicious anemia is caused by a deficiency of intrinsic factor, which is required for the
absorption of vitamin B12 from the gastrointestinal tract. As a result, oral vitamin B12 is
ineffective in patients with pernicious anemia, and parenteral administration is required.
The standard initial treatment regimen for pernicious anemia involves administering
cyanocobalamin 1,000 mcg intramuscularly daily for one week to rapidly replenish
depleted stores and correct the neurological and hematological manifestations of
vitamin B12 deficiency. Following the initial daily loading dose, the regimen transitions
to 1,000 mcg IM weekly for one month, and then to 1,000 mcg IM monthly for
maintenance therapy. Nasal cyanocobalamin may be used for maintenance therapy in
some patients but is not appropriate for initial treatment. Oral cobalamin is not effective
in pernicious anemia due to the absence of intrinsic factor.
QUESTION
A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for
breast cancer to achieve which of the following primary goals?
a. Ensure the patient will not have increased adverse drug reactions to the tamoxifen
b. Identify potential drug-drug interactions that may occur with tamoxifen
c. Reduce the likelihood of therapeutic failure with tamoxifen treatment
d. Identify poor metabolizers of tamoxifen
CORRECT ANS: c. Reduce the likelihood of therapeutic failure with tamoxifen treatment
EXPERT RATIONALE
Tamoxifen is a prodrug that requires conversion to its active metabolite, endoxifen, by
the cytochrome P450 enzyme CYP2D6. Genetic polymorphisms in the CYP2D6 gene can
result in decreased enzyme activity, leading to reduced conversion of tamoxifen to its
active metabolite and potentially therapeutic failure. Testing for CYP2D6 variants prior
to initiating tamoxifen therapy is recommended to identify patients who are poor
metabolizers and may have reduced clinical response to tamoxifen. In such patients,
alternative therapies, such as aromatase inhibitors, may be considered. While identifying
,poor metabolizers is part of the rationale, the primary goal of testing is to reduce the
likelihood of therapeutic failure by selecting the most appropriate therapy for the
individual patient. The testing does not primarily aim to predict adverse drug reactions
or drug-drug interactions.
QUESTION
First-line therapy for treating topical fungal infections such as tinea corporis (ringworm)
or tinea pedis (athlete's foot) would be which of the following?
a. OTC topical azole (clotrimazole, miconazole)
b. Oral terbinafine
c. Oral griseofulvin microsize
d. Nystatin cream or ointment
CORRECT ANS: a. OTC topical azole (clotrimazole, miconazole)
EXPERT RATIONALE
Topical antifungal agents, particularly over-the-counter azoles such as clotrimazole and
miconazole, are the first-line treatment for localized, uncomplicated dermatophyte
infections such as tinea corporis (ringworm) and tinea pedis (athlete's foot). These
agents are effective, well-tolerated, and available without a prescription. Topical
terbinafine is also available over-the-counter and is an appropriate first-line option. Oral
antifungal therapy, such as oral terbinafine, is reserved for extensive or refractory
infections, or for infections involving the nails, hair, or other areas where topical therapy
is impractical. Griseofulvin is an older oral antifungal agent that is less commonly used
due to its side effect profile and the availability of more effective agents. Nystatin is
effective against Candida infections but is not effective against dermatophytes, so it
would not be appropriate for tinea corporis or tinea pedis.
QUESTION
Goals when treating tuberculosis include which of the following?
a. Completion of recommended therapy
b. Negative purified protein derivative at the end of therapy
, c. Completely normal chest x-ray
d. All of the above
CORRECT ANS: a. Completion of recommended therapy
EXPERT RATIONALE
The primary goal of treating tuberculosis is the completion of the recommended
therapy regimen to ensure eradication of the Mycobacterium tuberculosis bacteria,
prevent relapse, and reduce the development of drug resistance. Treatment regimens
typically last 6 to 9 months and require strict adherence to the medication schedule. A
negative purified protein derivative (PPD) test at the end of therapy is not a realistic or
expected goal, as the PPD test may remain positive for life due to previous exposure. A
completely normal chest x-ray is not always achievable, as scarring and other changes
from the infection may persist. The most important and achievable goal is the
completion of therapy, which is associated with cure and reduced transmission.
Monitoring includes sputum cultures to confirm conversion to negative, not PPD testing
or normalization of chest x-ray.
QUESTION
A potentially life-threatening adverse response to angiotensin-converting enzyme
inhibitors is angioedema. Which of the following statements is true about this adverse
response?
a. Swelling of the tongue or hoarseness are the most common symptoms.
b. It appears to be related to the decrease in aldosterone production.
c. Presence of a dry, hacky cough indicates a high risk for this adverse response.
d. Because it takes time to build up a blood level, it occurs after being on the drug for
about 1 week.
CORRECT ANS: a. Swelling of the tongue or hoarseness are the most common
symptoms.
EXPERT RATIONALE
Angioedema is a potentially life-threatening adverse effect of ACE inhibitors
characterized by rapid swelling of the lips, tongue, face, and upper airway. Swelling of
the tongue or hoarseness are the most common symptoms and should be treated as a
medical emergency, as airway compromise can occur. Angioedema is thought to be
related to the accumulation of bradykinin due to inhibition of ACE, which is responsible
WITH ACTUAL 100 QUESTION AND CORRECT DETAILED
ANSWERS WITH RATIONALES.
QUESTION
A woman who is pregnant and has hyperthyroidism is best managed by a specialty team
who will most likely treat her with which of the following medications?
a. Methimazole
b. Propylthiouracil (PTU)
c. Radioactive iodine
d. Nothing, treatment is best delayed until after her pregnancy ends
CORRECT ANS: b. Propylthiouracil (PTU)
EXPERT RATIONALE
Propylthiouracil (PTU) is the preferred antithyroid medication for the treatment of
hyperthyroidism during pregnancy, particularly in the first trimester, due to its lower
transplacental passage and reduced risk of fetal teratogenicity compared to
methimazole. PTU is preferred because it has a lower risk of causing aplasia cutis, a rare
congenital scalp defect, which has been associated with methimazole use in the first
trimester. Additionally, PTU has the advantage of inhibiting the peripheral conversion of
T4 to T3, which can be beneficial in severe hyperthyroidism. Radioactive iodine is
absolutely contraindicated during pregnancy because it crosses the placenta and can
cause fetal thyroid destruction and hypothyroidism. Delaying treatment until after
pregnancy is not appropriate, as uncontrolled hyperthyroidism during pregnancy poses
significant risks to both the mother and fetus, including preeclampsia, preterm birth,
and fetal thyroid dysfunction. Endocrine society guidelines recommend that pregnant
women with hyperthyroidism be managed by a multidisciplinary team, including an
endocrinologist and a maternal-fetal medicine specialist.
QUESTION
The dosage of Vitamin B12 to initially treat pernicious anemia is which of the following?
a. Nasal cyanocobalamin 1 gram spray in each nostril daily x 1 week then weekly x 1
month
b. Vitamin B12 IM monthly
,c. Vitamin B12 1,000 mcg IM daily x 1 week then 1,000 mg IM weekly for a month
d. Oral cobalamin 1,000 mcg daily
CORRECT ANS: c. Vitamin B12 1,000 mcg IM daily x 1 week then 1,000 mcg IM weekly
for a month
EXPERT RATIONALE
Pernicious anemia is caused by a deficiency of intrinsic factor, which is required for the
absorption of vitamin B12 from the gastrointestinal tract. As a result, oral vitamin B12 is
ineffective in patients with pernicious anemia, and parenteral administration is required.
The standard initial treatment regimen for pernicious anemia involves administering
cyanocobalamin 1,000 mcg intramuscularly daily for one week to rapidly replenish
depleted stores and correct the neurological and hematological manifestations of
vitamin B12 deficiency. Following the initial daily loading dose, the regimen transitions
to 1,000 mcg IM weekly for one month, and then to 1,000 mcg IM monthly for
maintenance therapy. Nasal cyanocobalamin may be used for maintenance therapy in
some patients but is not appropriate for initial treatment. Oral cobalamin is not effective
in pernicious anemia due to the absence of intrinsic factor.
QUESTION
A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for
breast cancer to achieve which of the following primary goals?
a. Ensure the patient will not have increased adverse drug reactions to the tamoxifen
b. Identify potential drug-drug interactions that may occur with tamoxifen
c. Reduce the likelihood of therapeutic failure with tamoxifen treatment
d. Identify poor metabolizers of tamoxifen
CORRECT ANS: c. Reduce the likelihood of therapeutic failure with tamoxifen treatment
EXPERT RATIONALE
Tamoxifen is a prodrug that requires conversion to its active metabolite, endoxifen, by
the cytochrome P450 enzyme CYP2D6. Genetic polymorphisms in the CYP2D6 gene can
result in decreased enzyme activity, leading to reduced conversion of tamoxifen to its
active metabolite and potentially therapeutic failure. Testing for CYP2D6 variants prior
to initiating tamoxifen therapy is recommended to identify patients who are poor
metabolizers and may have reduced clinical response to tamoxifen. In such patients,
alternative therapies, such as aromatase inhibitors, may be considered. While identifying
,poor metabolizers is part of the rationale, the primary goal of testing is to reduce the
likelihood of therapeutic failure by selecting the most appropriate therapy for the
individual patient. The testing does not primarily aim to predict adverse drug reactions
or drug-drug interactions.
QUESTION
First-line therapy for treating topical fungal infections such as tinea corporis (ringworm)
or tinea pedis (athlete's foot) would be which of the following?
a. OTC topical azole (clotrimazole, miconazole)
b. Oral terbinafine
c. Oral griseofulvin microsize
d. Nystatin cream or ointment
CORRECT ANS: a. OTC topical azole (clotrimazole, miconazole)
EXPERT RATIONALE
Topical antifungal agents, particularly over-the-counter azoles such as clotrimazole and
miconazole, are the first-line treatment for localized, uncomplicated dermatophyte
infections such as tinea corporis (ringworm) and tinea pedis (athlete's foot). These
agents are effective, well-tolerated, and available without a prescription. Topical
terbinafine is also available over-the-counter and is an appropriate first-line option. Oral
antifungal therapy, such as oral terbinafine, is reserved for extensive or refractory
infections, or for infections involving the nails, hair, or other areas where topical therapy
is impractical. Griseofulvin is an older oral antifungal agent that is less commonly used
due to its side effect profile and the availability of more effective agents. Nystatin is
effective against Candida infections but is not effective against dermatophytes, so it
would not be appropriate for tinea corporis or tinea pedis.
QUESTION
Goals when treating tuberculosis include which of the following?
a. Completion of recommended therapy
b. Negative purified protein derivative at the end of therapy
, c. Completely normal chest x-ray
d. All of the above
CORRECT ANS: a. Completion of recommended therapy
EXPERT RATIONALE
The primary goal of treating tuberculosis is the completion of the recommended
therapy regimen to ensure eradication of the Mycobacterium tuberculosis bacteria,
prevent relapse, and reduce the development of drug resistance. Treatment regimens
typically last 6 to 9 months and require strict adherence to the medication schedule. A
negative purified protein derivative (PPD) test at the end of therapy is not a realistic or
expected goal, as the PPD test may remain positive for life due to previous exposure. A
completely normal chest x-ray is not always achievable, as scarring and other changes
from the infection may persist. The most important and achievable goal is the
completion of therapy, which is associated with cure and reduced transmission.
Monitoring includes sputum cultures to confirm conversion to negative, not PPD testing
or normalization of chest x-ray.
QUESTION
A potentially life-threatening adverse response to angiotensin-converting enzyme
inhibitors is angioedema. Which of the following statements is true about this adverse
response?
a. Swelling of the tongue or hoarseness are the most common symptoms.
b. It appears to be related to the decrease in aldosterone production.
c. Presence of a dry, hacky cough indicates a high risk for this adverse response.
d. Because it takes time to build up a blood level, it occurs after being on the drug for
about 1 week.
CORRECT ANS: a. Swelling of the tongue or hoarseness are the most common
symptoms.
EXPERT RATIONALE
Angioedema is a potentially life-threatening adverse effect of ACE inhibitors
characterized by rapid swelling of the lips, tongue, face, and upper airway. Swelling of
the tongue or hoarseness are the most common symptoms and should be treated as a
medical emergency, as airway compromise can occur. Angioedema is thought to be
related to the accumulation of bradykinin due to inhibition of ACE, which is responsible
