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A 65-year-old man presents with chronic insomnia. He reports that his sleep has improved after beginning a new medication, but he is experiencing concerning adverse effects. His wife noticed him sleepwalking, eating during the night, and attempting to drive his car at night. The patient has no recollection of these events and is concerned. Vitals signs are blood pressure 130/80 mmHg, heart rate 82 bpm, respiratory rate 18 breaths/min, and temperature 98.0 F (36.7 C). Physical examination is normal. What is the mechanism of action of the medication responsible for the patient's adverse effects? - correct answer ✅GABA-A receptor agonist A 26-year-old woman is brought to the emergency department with an acute severe headache. Her partner reports that it started 6 hours ago and that she vomited several times at home. The patient is holding her hands over her eyes and reports severe unilateral retroorbital throbbing pain. She has no significant past medical history and takes no regular medications. Her vital signs are within normal limits. There is no gross neurological deficit on examination of the cranial nerves and limbs. Given the most likely diagnosis, what is the mechanism of action of the best drug for the acute treatment of this patient's condition? - correct answer ✅Cerebral vasoconstriction
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A 42-year-old man presents with a 6-month history of severe, throbbing headaches that are generally unilateral, worsened by light and sound, and occur biweekly and occasionally interrupt his workday. He has no significant improvement with ibuprofen, naproxen, or acetaminophen. Vital signs are blood pressure 139/ mmHg, heart rate 82 bpm, respiratory rate 14 breaths/min, and temperature 98.0 F (36.7 C). Physical examination is normal. Which of the following effects is caused by the most appropriate treatment option? - correct answer ✅Constriction of cerebral blood vessels. A 20-year-old woman presents with a severe headache. She is G2P at 32 weeks gestation. Her blood pressure is 201/98 mm Hg. A urine dipstick shows 3+ protein. Preparations are made for an emergency cesarean section. She is started on a continuous intravenous infusion of magnesium sulfate for the prevention of seizures. What is a severe, yet preventable, complication of continuous intravenous magnesium sulfate therapy? - correct answer ✅Respiratory depression A 55-year-old man presents with difficulty passing urine and suprapubic discomfort for the past 2 days. His symptoms are progressively worsening. The patient's past medical history is
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feels sad. What therapy might be recommended that can both reduce the frequency of her migraine attacks and may also be useful in improving her mood? - correct answer ✅Venlafaxine A patient is diagnosed with metabolic acidosis. His medication record shows that he is prescribed diclofenac, atenolol, albuterol, and topiramate. Which of these medications is most likely responsible for the patient's condition? - correct answer ✅Topiramate A 60-year-old man is brought to the emergency department after an episode of syncope. The patient was watching television when he felt light-headed and lost consciousness. He regained consciousness after a minute spontaneously. The patient's past medical history is significant for hypertension, diabetes, and peripheral neuropathy. His medications include metformin, hydrochlorothiazide, and amitriptyline. ECG in the emergency department shows a QT interval of 480 ms. What is the mechanism of action of the drug responsible for this patient's symptoms and ECG findings? - correct answer ✅Blocking the reuptake of both serotonin and norepinephrine neurotransmitters
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A 23-year-old man recently started taking a new medication for a long-standing history of hallucinations, poor eye contact, flat affect, and poor work performance. After six days of using this medication, this patient presents to the emergency department with acute neck stiffness. On exam, his head is rotated to the left and flexed in a fixed position. The medication used by this patient mainly works by blocking which of the following receptor? - correct answer ✅Dopamine receptor A 40-year-old man is brought to the emergency department due to a severe headache for the past hour. His symptoms started 2 hours after having dinner with his family. On further questioning, his wife reveals that they had pizza and red wine for dinner. On physical exam, he appears anxious and tremulous. Medical history includes atypical depression being treated with phenelzine. He does not smoke or use illicit drugs. Which of the following Is the most likely finding? - correct answer ✅Hypertension A 25-year-old woman presents with depression resistant to multiple classes of antidepressants. A nonselective monoamine oxidase inhibitor (MAOI) is prescribed. Which of the following should be included in patient counseling regarding the prevention of one of
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A 17-year-old female presents for a follow-up on major depressive disorder therapy with venlafaxine. The mother and patient state that the patient's symptoms have improved. She has been performing better at school, enjoying activities with her friends, and going to the gym every day. However, the patient has trouble falling asleep. The mother states that she gives her daughter a cough medication, dextromethorphan, to make her drowsy and help her fall asleep. The mother and patient ask if they should be concerned about the use of dextromethorphan. What is the best response to their question? - correct answer ✅There is an increased risk of serotonin syndrome if dextromethorphan is used with venlafaxine. A 25-year-old woman presents with severe acute asthma exacerbation. She inadequately responds to a combination of nebulized albuterol, inhaled ipratropium, prednisone, and oxygen. The clinical team decides to administer intravenous magnesium. While placing the order, the clinician receives an alert for potential overdose with this medication. Which of the following symptoms is most likely to occur if there is an overdose? - correct answer ✅Muscle weakness A 40-year-old male with a history of bipolar 1 disorder is admitted to a psychiatric inpatient facility after an episode of aggression and
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is currently prescribed aripiprazole. While on the inpatient psychiatric unit, he continues to be agitated with the inpatient staff and other patients on the unit. The psychiatrist prescribes him lithium to augment treatment for agitation. Lithium, by acting on which of the neurotransmitters, will be helpful for the patient's agitation? - correct answer ✅Serotonin A 45-year-old man is brought to the hospital by his sister with a history of seeing a man following him for the last nine months. He says that only he can see this man. She also says he lost his job four months ago because of poor performance. Since then, the patient has been living in his room and does not go outside because he thinks someone might kill him. On examination, the patient's vitals are normal. The clinician prescribes a medication that is known for extrapyramidal symptoms. This patient is at increased risk of developing which of the following in the next 24 hours? - correct answer ✅Acute dystonia A 65-year-old man presents with confusion and anuria. His past medical history is significant for hypertension, hyperlipidemia, insomnia, and diabetes mellitus with peripheral neuropathy. The patient is awake and oriented to person only. His blood pressure is 110/80 mmHg, pulse 90/min; respiratory rate is 18/min, and
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A 67-year-old man comes to the emergency department due to an acute episode of confusion, dizziness, and diaphoresis for the past three hours. A detailed history reveals that the patient took a sex- enhancing drug he ordered online. He took the drug four hours ago and started to feel dizzy soon after. His past medical history is significant for hypertension, ischemic heart disease, and diabetes mellitus. He claims to be very compliant with his medication and never misses a dose. Vital signs show a blood pressure of 80/ mmHg, pulse of 105 bpm, respiratory rate of 18 breaths/min, and a temperature of 37 C (98.6 F). Examination of the abdomen reveals a soft, non-tender abdomen with no masses on deep palpation. Cardiopulmonary examination shows no pertinent findings as well. Emergency treatment with intravenous normal saline is started, and the patient stabilizes. What is the likely mechanism of action of the drug? - correct answer ✅Inhibition of phosphodiesterase 5 A 22-year-old patient with type 1 diabetes mellitus receives 12 units of regular insulin and 26 units of NPH insulin subcutaneously daily. Which of the following is an appropriate instruction for this patient regarding her new prescription? - correct answer ✅Roll the NPH insulin bottle between the palms of the hands before drawing it up.
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Which of the following is an adverse effect of administering the drug of choice in anaphylactic shock? - correct answer ✅Hypertension Which of the following is the most likely consequence of the rapid administration of high-dose intravenous epinephrine? - correct answer ✅Tachycardia A 60-year-old man suddenly falls to the ground while walking. Chest compressions are immediately performed, and he is placed on a Lucas device en route to the emergency department. Upon reaching the emergency department, a cardiac monitor is attached, showing a heart rate of 44 bpm and unrecordable blood pressure. His pulses are still not palpable. What is the first drug this patient should receive? - correct answer ✅Epinephrine A 59-year-old male is admitted to the coronary care unit for the management of decompensated heart failure. Vital signs are heart rate 98 bpm, blood pressure 80/50 mm Hg, and respiratory rate 25 breaths/min. The physical examination reveals basal crepitations and bilateral pedal edema. Dobutamine is administered to maintain
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A patient develops endometrial carcinoma. Which of the following drugs has the patient been taking? - correct answer ✅Tamoxifen A 50-year-old male presents to the clinic complaining of numbness in the hands and feet. He also complains of an increased urinary frequency. On presentation, he is afebrile, has a pulse rate of 76 bpm, a blood pressure of 130/80 mmHg, and a respiratory rate of 14 breaths/min. A detailed physical examination does not reveal any significant findings. He has a hemoglobin of 13 g/dl, a total leukocyte count of 4800/mm^3, and a platelet count of 280,000/mm^3. His blood sugar levels are 288 mg/dl, 2 hours postprandial. He was diagnosed with hypertension two years ago, and his medical record shows he is compliant with medications. He is planning to be put on oral hypoglycemic treatment with metformin. He is also prescribed atorvastatin for vascular disease prevention; which acts by which of the following mechanisms? - correct answer ✅HMG-CoA reductase inhibition A 65-year-old man presents to the office for a follow-up. He had a stent placed in his right coronary artery two years ago for unstable angina. He reports that he exercises regularly and is compliant with a heart-healthy diet. His current medications include atorvastatin
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80 mg daily for dyslipidemia. The lipid profile shows total cholesterol is 195 mg/dL, HDL is 33 mg/dL, LDL is 110 mg/dL, and triglycerides are 120 mg/dL. Which of the following has been shown to improve cardiovascular outcomes when added to statins for secondary prevention? - correct answer ✅Ezetimibe A 16-year-old girl presents with a decreased level of consciousness and abdominal pain. Her mother says that she vomited twice before coming to the hospital. She has no known medical history, and this is the first time to have these symptoms. Her family history is significant for diabetes in her mother and 2 uncles. Her glucose level is 574 mg/dL, creatinine 0.8 mg/dL, potassium 3.7 mEq/L, sodium 137 mEq/L, and white blood count 12700/microL. Her urine dipstick shows glucose 4+ and ketones 3+. She is given normal saline. She is also given an infusion of the next appropriate medication. Which of the following side effects is most likely to occur with this infusion? - correct answer ✅Hypokalemia A 45-year-old man presents for follow-up after a diagnosis of diabetes mellitus type 2 and initiation of metformin 3 months ago. He says he would like to discontinue the metformin because of its adverse effects. He feels embarrassed at work because of
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A patient with type 2 diabetes mellitus presents complaining of nausea, vomiting, abdominal bloating, tachypnea, and feeling weak. Palpation reveals a tender and enlarged liver and elevated liver enzymes. His serum bicarbonate is low, and his lactate level reads high at 4.5 mmol/L. Which anti-glycemic drug is the most likely culprit? - correct answer ✅Metformin A healthcare provider reviews home medications for a 65-year-old man with a history of hypertension, diabetes mellitus, and hyperlipidemia. He was admitted to the cardiac unit for unstable angina. Among his medications, he is on an HMG-CoA reductase inhibitor. Which of the following would need to be monitored regularly in this patient? - correct answer ✅Liver function tests A group of clinical researchers is investigating the management of osteoarthritis in patients with underlying psychiatric disorders. Patients recruited for the study are analyzed based on their medication regimen. 25% of patients in the study take a medication that binds to opioid receptors. What is a primary indication for the use of the drug mentioned above? - correct answer ✅Analgesia
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A 60-year-old woman presents with joint pain and swelling in her hands. She says the pain is typically worst in the mornings when she wakes up and improves during the day. She has no past medical history and takes no medications. On examination, she has warm, tender swelling of the metacarpophalangeal joints bilaterally. She is prescribed a drug that is neither a non-steroidal anti-inflammatory or corticosteroid. What is the class of the drug that has most likely been prescribed? - correct answer ✅Disease-modifying anti-rheumatic A 60-year old man is brought to the emergency department after an episode of syncope. The patient was watching television when he felt lightheaded and lost consciousness. He does not remember any abnormal body movements associated with the episode and he regained consciousness after a minute. However, the patient is still feeling lightheaded. The physical examination of the patient shows a pulse rate of 45/min and a blood pressure of 100/60 mmHg. Emergency department ECG reveals sinus bradycardia. The patient is given oxygen support and is started on an IV medication that will block which of the following receptors to improve this patient's heart rate? - correct answer ✅Cholinergic receptors
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shows significant slurring of speech and 3/5 strength in the upper and lower extremities on the right. He is sent for computed tomography (CT) scan for concern of an ischemic stroke, which reveals no active bleeding. His point of care glucose shows 30 mg/dL, his platelet count is 200,000 per microliter and an INR of 1.1. Which of the following excludes him from consideration of alteplase at this time? - correct answer ✅His abnormal glucose testing excludes him. A 35-year-old female patient diagnosed with rheumatoid arthritis visits a rheumatology clinic. Her provider is considering prescribing a disease-modifying antirheumatic drug. Her past medication history reveals an allergic reaction to sulfa containing antibiotics. She is not planning to be pregnant. She prefers an oral drug than an injection. Which of the following drugs is most likely suitable for her? - correct answer ✅Methotrexate Emergency medical services are called to a house party where a 21- year-old man has been unresponsive. On initial assessment, he is snoring with a respiratory rate of 6 breaths/min and a Glasgow Coma Scale score (GCS) of E2V2M4. His pupils are constricted and nonreactive to light. He is given an intramuscular (IM) injection, and his GCS improves to E3V4M6 within a few minutes. What is the
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mechanism of action of the drug given via IM injection? - correct answer ✅Competitive antagonist Which of the following medications is known to decrease both basal and stimulated gastric acid secretion? - correct answer ✅Omeprazole A 45-year-old man presents via emergency medical services with a seizure. In the emergency department, the seizure resolves after 2 doses of lorazepam 2 mg IV. The patient is in a post-ictal state. Vital signs are blood pressure 140/90 mm Hg, heart rate 85 bpm, temperature 99° F (37° C), and respiratory rate 14 breaths/min. Laboratory tests show serum sodium of 91 mEq/L, potassium of 4. mEq/L, and chloride of 106 mEq/L. The decision is made to intubate the patient using etomidate and succinylcholine. A propofol drip is started for sedation. Twenty minutes later, the healthcare provider notices that the patient's blood pressure is now 98/65 mmHg. What caused the drop the blood pressure? - correct answer ✅Vasodilation A 21 yr old man is administered an anesthetic medication before a surgical procedure that results in visual distortions and a feeling as if he is floating and detached from reality. After the patient regains
