,1. Which of the following is best to avoid in overweight/obese patients due to the side effect of
weight gain?
A. Depo-Provera
B. NuvaRing
C. Ortho Evra
D. YAZ
Correct Answer: A. Depo-Provera
Rationale:
Depo-Provera (medroxyprogesterone injection) is well-known for causing significant weight
gain, especially in overweight or obese patients. Other hormonal options such as NuvaRing,
Ortho Evra, and YAZ have a much lower association with weight gain, making Depo-Provera the
option to avoid.
2. A 68-year-old man with stage IV adenocarcinoma of the lung, severe COPD, home oxygen
use, and an 80-pack-year smoking history presents for treatment planning. Which chemotherapy
regimen is most rational?
A. Cisplatin plus etoposide
B. Carboplatin plus paclitaxel
C. Cisplatin plus gemcitabine
D. Best supportive care
Correct Answer: D. Best supportive care
Rationale:
This patient has poor functional status (bedridden) and severe pulmonary disease requiring
oxygen, making him unable to tolerate cytotoxic chemotherapy. Stage IV disease with extensive
comorbidities warrants palliative and supportive care rather than aggressive chemotherapy,
which would likely worsen morbidity without improving survival.
3. A 57-year-old man diagnosed with AML-M5 is at high risk for tumor lysis syndrome (TLS).
Which of the following management recommendations are appropriate? (Select ALL that apply)
A. Initiating allopurinol
B. Treating electrolyte disturbances
C. Aggressive hydration
D. Colchicine
Correct Answers: A, B, and C
Rationale:
Tumor lysis syndrome results from rapid tumor breakdown leading to elevated uric acid,
potassium, and phosphate. Proper TLS management includes:
• Allopurinol → prevents formation of new uric acid
• Aggressive IV hydration → increases renal excretion of uric acid and electrolytes
• Treating electrolyte abnormalities → prevents life-threatening complications
,Colchicine is used for gout flares, not for TLS prevention or treatment, and therefore is not
appropriate.
4. A 26-year-old male with newly diagnosed Type II diabetes is started on metformin. Which of
the following is a black box warning associated with metformin?
A. Subarachnoid hemorrhage
B. Lactic acidosis
C. Acute kidney injury
D. Agranulocytosis
Correct Answer: B. Lactic acidosis
Rationale:
Metformin carries a black box warning for lactic acidosis, a rare but life-threatening
complication. Risk increases with renal impairment, hypoperfusion, severe infection, or
excessive alcohol use. Metformin does not cause agranulocytosis or SAH, and AKI is a risk
factor, not a black box warning.
5. A 37-year-old woman attempting pregnancy needs hyperlipidemia treatment. Her LDL is 223
mg/dL and she has a history of cholelithiasis. Which medication is most appropriate?
A. Simvastatin
B. Niacin
C. Colesevelam
D. Gemfibrozil
Correct Answer: C. Colesevelam
Rationale:
Colesevelam, a bile acid sequestrant, is the only lipid-lowering class considered safe in
pregnancy.
• Statins (e.g., simvastatin) are contraindicated in pregnancy.
• Niacin and gemfibrozil may worsen cholelithiasis and are not recommended.
Thus, colesevelam is the safest and most appropriate choice.
6. A student predicts a theophylline level of 10 mg/L, but the actual serum concentration is 25
mg/L. Which parameters could have altered theophylline clearance? (Select ALL that apply)
A. Smoking history
B. Hepatic cirrhosis
C. Drug interactions (CYP450 inhibitors: 1A2, 2E1, 3A4)
D. Renal failure
Correct Answers: A, B, C
Rationale:
Theophylline is metabolized extensively by the liver, primarily via CYP450 enzymes.
Factors that can ↓ clearance (leading to higher serum levels) include:
• Hepatic cirrhosis → ↓ metabolism
• Drug interactions → CYP450 inhibitors slow clearance
Smoking induces CYP1A2, which increases clearance (lower levels), and changes in smoking
habits can alter theophylline kinetics.
, Renal failure does not significantly affect theophylline clearance because metabolism is hepatic,
not renal.
7. In what patient(s) may a Haemophilus influenzae type b (Hib) vaccine be administered?
(Select ALL that apply)
A. A 4-month old infant
B. A 20-year-old smoker
C. A 58-year-old man with leukemia
D. A 26-year-old with asplenia
Correct Answers: A, C, D
Rationale:
Hib vaccine is recommended for infants, immunocompromised adults, and asplenic patients.
Healthy adults without risk factors typically do not receive it.
8. Which antiretrovirals should be used with caution in patients with a sulfa allergy? (Select ALL
that apply)
A. Fosamprenavir
B. Tipranavir
C. Darunavir
D. Indinavir
Correct Answers: A, B, C
Rationale:
These antiretrovirals contain sulfonamide moieties and may trigger allergic reactions in sulfa-
sensitive patients. Indinavir is safe in this context.
9. CR is a 52-year-old man starting peg-interferon alpha-2b and ribavirin therapy for HCV.
Which counseling topic is appropriate?
A. Use 2 forms of birth control
B. Therapy will last 24 weeks
C. HCV from contaminated food
D. HCV from perinatal transmission
Correct Answer: A
Rationale:
Ribavirin is teratogenic, so dual contraception is required during and 6 months after therapy.
10. Preparedness is achieved and maintained by which of the following? (Select ALL that apply)
A. Planning
B. Organizing
C. Training
D. Exercising
Correct Answers: A, B, C, D
Rationale:
Preparedness requires a continuous cycle of planning, organizing, training, and exercising to
ensure readiness for emergencies.
weight gain?
A. Depo-Provera
B. NuvaRing
C. Ortho Evra
D. YAZ
Correct Answer: A. Depo-Provera
Rationale:
Depo-Provera (medroxyprogesterone injection) is well-known for causing significant weight
gain, especially in overweight or obese patients. Other hormonal options such as NuvaRing,
Ortho Evra, and YAZ have a much lower association with weight gain, making Depo-Provera the
option to avoid.
2. A 68-year-old man with stage IV adenocarcinoma of the lung, severe COPD, home oxygen
use, and an 80-pack-year smoking history presents for treatment planning. Which chemotherapy
regimen is most rational?
A. Cisplatin plus etoposide
B. Carboplatin plus paclitaxel
C. Cisplatin plus gemcitabine
D. Best supportive care
Correct Answer: D. Best supportive care
Rationale:
This patient has poor functional status (bedridden) and severe pulmonary disease requiring
oxygen, making him unable to tolerate cytotoxic chemotherapy. Stage IV disease with extensive
comorbidities warrants palliative and supportive care rather than aggressive chemotherapy,
which would likely worsen morbidity without improving survival.
3. A 57-year-old man diagnosed with AML-M5 is at high risk for tumor lysis syndrome (TLS).
Which of the following management recommendations are appropriate? (Select ALL that apply)
A. Initiating allopurinol
B. Treating electrolyte disturbances
C. Aggressive hydration
D. Colchicine
Correct Answers: A, B, and C
Rationale:
Tumor lysis syndrome results from rapid tumor breakdown leading to elevated uric acid,
potassium, and phosphate. Proper TLS management includes:
• Allopurinol → prevents formation of new uric acid
• Aggressive IV hydration → increases renal excretion of uric acid and electrolytes
• Treating electrolyte abnormalities → prevents life-threatening complications
,Colchicine is used for gout flares, not for TLS prevention or treatment, and therefore is not
appropriate.
4. A 26-year-old male with newly diagnosed Type II diabetes is started on metformin. Which of
the following is a black box warning associated with metformin?
A. Subarachnoid hemorrhage
B. Lactic acidosis
C. Acute kidney injury
D. Agranulocytosis
Correct Answer: B. Lactic acidosis
Rationale:
Metformin carries a black box warning for lactic acidosis, a rare but life-threatening
complication. Risk increases with renal impairment, hypoperfusion, severe infection, or
excessive alcohol use. Metformin does not cause agranulocytosis or SAH, and AKI is a risk
factor, not a black box warning.
5. A 37-year-old woman attempting pregnancy needs hyperlipidemia treatment. Her LDL is 223
mg/dL and she has a history of cholelithiasis. Which medication is most appropriate?
A. Simvastatin
B. Niacin
C. Colesevelam
D. Gemfibrozil
Correct Answer: C. Colesevelam
Rationale:
Colesevelam, a bile acid sequestrant, is the only lipid-lowering class considered safe in
pregnancy.
• Statins (e.g., simvastatin) are contraindicated in pregnancy.
• Niacin and gemfibrozil may worsen cholelithiasis and are not recommended.
Thus, colesevelam is the safest and most appropriate choice.
6. A student predicts a theophylline level of 10 mg/L, but the actual serum concentration is 25
mg/L. Which parameters could have altered theophylline clearance? (Select ALL that apply)
A. Smoking history
B. Hepatic cirrhosis
C. Drug interactions (CYP450 inhibitors: 1A2, 2E1, 3A4)
D. Renal failure
Correct Answers: A, B, C
Rationale:
Theophylline is metabolized extensively by the liver, primarily via CYP450 enzymes.
Factors that can ↓ clearance (leading to higher serum levels) include:
• Hepatic cirrhosis → ↓ metabolism
• Drug interactions → CYP450 inhibitors slow clearance
Smoking induces CYP1A2, which increases clearance (lower levels), and changes in smoking
habits can alter theophylline kinetics.
, Renal failure does not significantly affect theophylline clearance because metabolism is hepatic,
not renal.
7. In what patient(s) may a Haemophilus influenzae type b (Hib) vaccine be administered?
(Select ALL that apply)
A. A 4-month old infant
B. A 20-year-old smoker
C. A 58-year-old man with leukemia
D. A 26-year-old with asplenia
Correct Answers: A, C, D
Rationale:
Hib vaccine is recommended for infants, immunocompromised adults, and asplenic patients.
Healthy adults without risk factors typically do not receive it.
8. Which antiretrovirals should be used with caution in patients with a sulfa allergy? (Select ALL
that apply)
A. Fosamprenavir
B. Tipranavir
C. Darunavir
D. Indinavir
Correct Answers: A, B, C
Rationale:
These antiretrovirals contain sulfonamide moieties and may trigger allergic reactions in sulfa-
sensitive patients. Indinavir is safe in this context.
9. CR is a 52-year-old man starting peg-interferon alpha-2b and ribavirin therapy for HCV.
Which counseling topic is appropriate?
A. Use 2 forms of birth control
B. Therapy will last 24 weeks
C. HCV from contaminated food
D. HCV from perinatal transmission
Correct Answer: A
Rationale:
Ribavirin is teratogenic, so dual contraception is required during and 6 months after therapy.
10. Preparedness is achieved and maintained by which of the following? (Select ALL that apply)
A. Planning
B. Organizing
C. Training
D. Exercising
Correct Answers: A, B, C, D
Rationale:
Preparedness requires a continuous cycle of planning, organizing, training, and exercising to
ensure readiness for emergencies.
