Question 1
J. T. suffers from an irregular heartbeat called atrial fibrillation. On a Sunday afternoon, his
wife noticed as J. T. was watching a football game on television that his face started to
droop and his speech seemed abnormal. She asked him to smile and his smile was all of a
sudden very uneven.
After he arrives at the hospital, it is determined he is having a stroke as a consequence of his
newly diagnosed atrial fibrillation.
The therapy of choice for J. T. in this particular case is warfarin. However, following a few
hours of warfarin therapy, J. T.'s wife notices excessive nose bleeds and bruising appearing
under his skin that seemed to be coming out of nowhere. From the following options given
and from a genetic standpoint, what could be happening to J. T.?
CORRECT ANSWER
He could have a mutation in his liver CYP2C9 enzyme, causing a 90% decrease in warfarin
clearance, leaving more S-warfarin in his blood, causing excessive bleeding.
Question 2
Patient D. S. is a 45-year-old female who has recently relocated to a new part of the
country for her job. She has intermittently experienced symptoms of allergic rhinitis
throughout her life, and her seasonal allergies have flared significantly since moving. She
presents to your primary care clinic to establish care and is complaining of weeks of a
stuffy or runny nose, itchy eyes, and sneezing. Other PMH includes hypertension, for
which she takes amlodipine 5 mg PO daily. Her temperature is normal, blood pressure (BP)
is 150/86 mmHg, and her heart rate is 76 bpm.
She states that she has been taking over-the-counter (OTC) pseudoephedrine 1 to 2 times
per day as needed for her symptoms. When asked about what worked for her previously,
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@THE STUDY VAULT
,she states that intranasal fluticasone worked well in the past, but her nose has been so
stuffy that she can't effectively use it recently.
What drug therapy would you recommend for thi
CORRECT ANSWER
Reinstate the fluticasone and intermittently use Afrin. Avoid using pseudoephedrine
daily as it can increase blood pressure.
Question 3
Anna is a 36-year-old woman who was diagnosed with human immunodeficiency virus
(HIV) 2 days ago at a community outreach clinic. She has been feeling well for the past 2
years, and she maintains a healthy, active lifestyle by exercising three to four times a week
and eating a balanced diet. Her medications include a multivitamin and occasional
antacids for heartburn, and she does not consistently use birth control methods. She has
never received antiretroviral therapy (ART). She comes to your office for an initial physical
exam and blood work in preparation for treatment initiation. The physical examination is
unremarkable, and the laboratory results are as follows:
Electrolytes, serum creatinine, and liver function tests: within normal limits.
Complete blood count with differential: within normal limits.
CD4+ T-cell count: 400 cells/mm3.
Viral load: 110,000 copies/ml.
Genotype: no resistance mutations detected.
Whic
CORRECT ANSWER
INSTIs (integrase strand transfer inhibitors)
Question 4
I. G. underwent a deceased-donor kidney transplant and is now receiving postoperative
day 1 dose 2 of 4 of antithymocyte globulin for induction immunosuppression. One hour
into the infusion, the nurse calls to report a change in the patient's vital signs, including a
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@THE STUDY VAULT
,blood pressure of 95/65, new tachycardia of 115 beats per minute, and a fever of 101°F.
Other medications on the profile at the time are tacrolimus 2 mg twice daily,
mycophenolate mofetil 500 mg twice daily, and prednisone 5 mg daily.
Which medication is causing these adverse drug reactions?
What changes in therapy are necessary to treat this patient's new symptoms?
The following day, I. G.'s complete blood count reports a white blood cell count of 2.3
cells/mcL, a hemoglobin count of 10.3 mg/dL, and a platelet count of 76,000 cells/mcL.
What should the dose of antithymocyte globulin be for today?
CORRECT ANSWER
Antithymocyte globulin
Slow down the infusion rate of the anti-thymocyte globulin and give acetaminophen 650
mg orally for fever.
1.5 mg/kg; not to exceed 150 mg
Question 5
A 4-year-old child develops allergy symptoms that occur during the late summer and fall
and which resolve for the remainder of the year. The health care provider recommends
seasonal use of cetirizine at what dosage?
CORRECT ANSWER
2.5 mg orally daily
Question 6
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@THE STUDY VAULT
, A patient presents for evaluation of nasal congestion, which has persisted for a few weeks.
It is relieved with use of an over-the-counter intranasal medication, but the patient
reports needing to gradually increase how often the medication is used to achieve the
same effect. Which medication is the patient most likely using?
CORRECT ANSWER
oxymetazoline
Question 7
Which is an example of a type IV hypersensitivity reaction?
CORRECT ANSWER
contact dermatitis
Question 8
A 49-year-old patient with no prior medical history develops wheezing and pruritus shortly
after receiving a vaccine at an outpatient clinic. There is no epinephrine autoinjector
available. What amount of epinephrine solution would be appropriate to administer
intramuscularly?
CORRECT ANSWER
0.3 ml of 1 mg/ml solution
Question 9
A patient expresses interest in initiating preexposure prophylaxis (PrEP). As part of
medication adherence counseling prior to initiating PrEP, at what frequency will the health
care provider counsel the patient to take the medication?
CORRECT ANSWER
daily
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@THE STUDY VAULT
J. T. suffers from an irregular heartbeat called atrial fibrillation. On a Sunday afternoon, his
wife noticed as J. T. was watching a football game on television that his face started to
droop and his speech seemed abnormal. She asked him to smile and his smile was all of a
sudden very uneven.
After he arrives at the hospital, it is determined he is having a stroke as a consequence of his
newly diagnosed atrial fibrillation.
The therapy of choice for J. T. in this particular case is warfarin. However, following a few
hours of warfarin therapy, J. T.'s wife notices excessive nose bleeds and bruising appearing
under his skin that seemed to be coming out of nowhere. From the following options given
and from a genetic standpoint, what could be happening to J. T.?
CORRECT ANSWER
He could have a mutation in his liver CYP2C9 enzyme, causing a 90% decrease in warfarin
clearance, leaving more S-warfarin in his blood, causing excessive bleeding.
Question 2
Patient D. S. is a 45-year-old female who has recently relocated to a new part of the
country for her job. She has intermittently experienced symptoms of allergic rhinitis
throughout her life, and her seasonal allergies have flared significantly since moving. She
presents to your primary care clinic to establish care and is complaining of weeks of a
stuffy or runny nose, itchy eyes, and sneezing. Other PMH includes hypertension, for
which she takes amlodipine 5 mg PO daily. Her temperature is normal, blood pressure (BP)
is 150/86 mmHg, and her heart rate is 76 bpm.
She states that she has been taking over-the-counter (OTC) pseudoephedrine 1 to 2 times
per day as needed for her symptoms. When asked about what worked for her previously,
1
@THE STUDY VAULT
,she states that intranasal fluticasone worked well in the past, but her nose has been so
stuffy that she can't effectively use it recently.
What drug therapy would you recommend for thi
CORRECT ANSWER
Reinstate the fluticasone and intermittently use Afrin. Avoid using pseudoephedrine
daily as it can increase blood pressure.
Question 3
Anna is a 36-year-old woman who was diagnosed with human immunodeficiency virus
(HIV) 2 days ago at a community outreach clinic. She has been feeling well for the past 2
years, and she maintains a healthy, active lifestyle by exercising three to four times a week
and eating a balanced diet. Her medications include a multivitamin and occasional
antacids for heartburn, and she does not consistently use birth control methods. She has
never received antiretroviral therapy (ART). She comes to your office for an initial physical
exam and blood work in preparation for treatment initiation. The physical examination is
unremarkable, and the laboratory results are as follows:
Electrolytes, serum creatinine, and liver function tests: within normal limits.
Complete blood count with differential: within normal limits.
CD4+ T-cell count: 400 cells/mm3.
Viral load: 110,000 copies/ml.
Genotype: no resistance mutations detected.
Whic
CORRECT ANSWER
INSTIs (integrase strand transfer inhibitors)
Question 4
I. G. underwent a deceased-donor kidney transplant and is now receiving postoperative
day 1 dose 2 of 4 of antithymocyte globulin for induction immunosuppression. One hour
into the infusion, the nurse calls to report a change in the patient's vital signs, including a
2
@THE STUDY VAULT
,blood pressure of 95/65, new tachycardia of 115 beats per minute, and a fever of 101°F.
Other medications on the profile at the time are tacrolimus 2 mg twice daily,
mycophenolate mofetil 500 mg twice daily, and prednisone 5 mg daily.
Which medication is causing these adverse drug reactions?
What changes in therapy are necessary to treat this patient's new symptoms?
The following day, I. G.'s complete blood count reports a white blood cell count of 2.3
cells/mcL, a hemoglobin count of 10.3 mg/dL, and a platelet count of 76,000 cells/mcL.
What should the dose of antithymocyte globulin be for today?
CORRECT ANSWER
Antithymocyte globulin
Slow down the infusion rate of the anti-thymocyte globulin and give acetaminophen 650
mg orally for fever.
1.5 mg/kg; not to exceed 150 mg
Question 5
A 4-year-old child develops allergy symptoms that occur during the late summer and fall
and which resolve for the remainder of the year. The health care provider recommends
seasonal use of cetirizine at what dosage?
CORRECT ANSWER
2.5 mg orally daily
Question 6
3
@THE STUDY VAULT
, A patient presents for evaluation of nasal congestion, which has persisted for a few weeks.
It is relieved with use of an over-the-counter intranasal medication, but the patient
reports needing to gradually increase how often the medication is used to achieve the
same effect. Which medication is the patient most likely using?
CORRECT ANSWER
oxymetazoline
Question 7
Which is an example of a type IV hypersensitivity reaction?
CORRECT ANSWER
contact dermatitis
Question 8
A 49-year-old patient with no prior medical history develops wheezing and pruritus shortly
after receiving a vaccine at an outpatient clinic. There is no epinephrine autoinjector
available. What amount of epinephrine solution would be appropriate to administer
intramuscularly?
CORRECT ANSWER
0.3 ml of 1 mg/ml solution
Question 9
A patient expresses interest in initiating preexposure prophylaxis (PrEP). As part of
medication adherence counseling prior to initiating PrEP, at what frequency will the health
care provider counsel the patient to take the medication?
CORRECT ANSWER
daily
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@THE STUDY VAULT
