Cairo University Faculty of Pharmacy Department of Clinical Pharmacy 4th year students

2008

Community pharmacy and Pharmacy Practice Final Exam

: 2 answer sheets .1 The red one, starts from question number 1 to question number 100 The green one, starts from question number 101 to question number 200 .2 answer sheet .3 .4 Answer Sheet .5 markers .6

Question I: Select the Most Appropriate Answer (only one) by Blackening the Circle with the Corresponding Letter in the Provided Answer Sheet
1. OTC medications: a. Dont mask symptoms of disease b. Can lead to overdose 2. Cold is characterized by: a. Slow onset b. No or mild fever 3. Rhinitis medicamentosa an occur with: a. Topically applied sympathomimetics b. Oral sympathomimetics 4. Nasal sprays are preferable for: a. Adults b. Children over 6 years 5. Sputum is described as "pink and frothy" in: a. Hypertension b. Hyperthyroidism c. Are intended for relief of major ailments d. Cannot be harmful c. Runny nose d. All of the above c. Topically applied antihistamines d. Oral antihistamines c. Children under 6 years d. a & b c. Heart failure d. Liver disease

6. Demulcents are suitable for the management of cough in: a. Pregnant women c. Diabetics b. Children d. a & b 7. Levels of Theophylline in the blood are reduced by: a. Smoking b. Phenytoin 8. Associated with nausea and vomiting: a. Migraine b. Tension headache c. Rifampicin d. All of the above c. Sinusitis d. Temporal arteritis

9. It is the analgesic of choice for children under 12 years: a. Aspirin c. Ketoprofen b. Paracetamol d. Codeine

10. Feverfew is a herb which has been used in the prophylaxis of: a. Migraine c. Cough b. Cold and flu d. Sore throat 11. Injuries in which the muscle is torn or damaged are called: a. Sprains c. Bursitis b. Strains d. Fibrositis 12. Acts as counter-irritant and rubefacient: a. Camphor b. Turpentine oil 13. Sodium cromoglycate is used for the treatment of: a. Allergic conjunctivitis b. Infective conjunctivitis c. Methyl nicotinate d. All of the above c. Corneal ulcers d. Iritis

14. A disease in which the cornea swells, becoming hazy and causing impaired vision and haloes around eye: a. Conjunctivitis c. Corneal ulcers b. Glaucoma d. Iritits 15. Treatment of otitis externa involves the use of: a. Astringent ear drops b. Antibacterial ear drops 16. Treatment of otitis media involves the use of: a. Oral antibiotics b. Topical or oral decongestants 17. Glue ear may result from: a. Recurrent otitis media b. Recurrent otitis externa 18. Has no prodromal phase: a. Classical migraine b. Common migraine c. Anti-inflammatory ear drops d. All of the above c. Topical steroids d. a & b c. Waxy ear d. All of the above c. All of the above d. None of the above

19. The patient should avoid taking the following medicine near bedtime: a. Aspirin c. Ephedrine b. Paracetamol d. Promethazine 20. Should never be recommended for anyone who is driving: a. Aspirin c. Ephedrine b. Paracetamol d. Promethazine 21. Has analgesic and antipyretic effects but little or no anti-inflammatory action: a. Aspirin c. Ibuprofen b. Paracetamol d. a & c 22. Heparinoid and hyaluronidase are used in the treatment of: a. Strains and sprains c. Sore throat b. Cold and flu d. Headache

23. Can be taken as cough suppressant: a. Codeine b. Guaiphenesin 24. Can be taken as expectorant: a. Codeine b. Guaiphenesin

c. Ipecacuanha d. b & c c. Ipecacuanha d. b & c

25. Reasons for high incidence of adverse drug reactions in elderly patients include: a. Polypharmacy c. Increased sensitivity to drugs b. Compliance d. All of the above 26. All of the following contribute to age related alterations in drug distribution EXCEPT: a. Decrease in total body water b. Greater ratio of lean muscle mass to adipose tissue c. Decrease in albumin d. Reduced volume of distribution of water-soluble drugs 27. The best documented age-related physiologic change is: a. Hearing loss c. Decline in hepatic function b. Decline in renal function d. All of the above 28. In elderly patients, benzodiazepines: a. Have a prolonged elimination half life b. Tend to accumulate c. Have a high potential for adverse effects d. All of the above

29. Elderly patients with hypertension are candidates for treatment with any antihypertensive drug group EXCEPT: a. Thiazide diuretics c. ACE inhibitors b. -blockers d. They can take any of the above 30. Because neonates are relatively achlorhydric, they can have: a. Increased bioavailability of basic drugs. b. Unpredictable absorption of acidic drugs c. Increased bioavailability of drugs normally degraded in the stomach d. All of the above 31. In neonates, lipid soluble drugs may be left insoluble and unabsorbed in the intestine because: a. Decreased bile acid production c. Both a & b b. Low levels of lipases d. Neither a nor b 32. Acidic drugs bind to: a. Albumin b. Alpha-1-acid glycoprotein c. Both a & b d. Neither a nor b

33. In the presence of endogenous substances, significant increase in free plasma concentration of drugs occurs only when: a. The displaced drug more than 90% bound to plasma proteins b. Metabolism of the displaced drug is rate-limited c. Both a & b d. Neither a nor b 34. In renal elimination, tubular reabsorption is: a. An active process b. A passive process c. Can be active or passive d. Is not active or passive 3

35. A physician writes for an antibiotic to be given to a 2-year old, 10 kg infant as 15 mg/kg/day in 3 divided doses. After reconstitution, the antibiotic yields a suspension with a concentration of 100 mg / 5 ml. How much of the antibiotic should the patient take in each dose? a. 1/2 teaspoonful c. 1/2 tablespoonful b. One teaspoonful d. One tablespoonful 36. The most critical stage of development and exposure to drugs during pregnancy is: a. Blastogenesis c. Fetal period b. Organogenesis d. During delivery 37. The placenta is all of the following EXCEPT: a. Functional unit between the fetal body and maternal blood b. Functions for nutrition and respiration c. Produces a number of hormones d. A protective barrier 38. The following drugs can cross the placenta EXCEPT: a. Less than 500 daltons b. Lipid soluble c. Polar drugs d. Weak acids

39. According to FDA classification system of drugs according to their potential risk during pregnancy, category D means that: a. Animal studies demonstrated an adverse effect on animal fetus, but well-controlled human studies did not show similar results b. Human fetal risk is unknown c. There is evidence of human fetal risk, but may be used if the benefit outweighs the risk d. There is proven evidence that these drugs have caused fetal abnormalities in human or animal studies and the risk to the fetus clearly outweighs any benefit 40. The following drugs category should not be used in women planning to conceive: a. B c. D b. C d. X 41. These drugs tend to accumulate in breast milk: a. Large molecular weight b. Weak acids c. Weak bases d. None of the above

42. When giving a drug to a nursing mother, choose the drug with: a. Short half-life c. Lowest distribution in breast milk b. Inactive metabolite d. All of the above 43. The general physical examination starts with the examination of: a. The face c. The heart b. The hands d. The lungs 44. When measuring blood pressure the stethoscope is placed over the a. Radial artery c. Carotid artery b. Brachial artery d. Posterior tibial artery 45. High-pitched sounds are best heard using the stethoscope's: a. Diaphragm c. Both a & b b. Bell d. Neither a nor b

46. The normal adult respiratory rate is: a. 44 breaths per minute b. 20 to 30 breaths per minute c. 16 to 25 breaths per minute

d. 12 to 20 breaths per minute e. 22 to 44 breaths per minute

For each numbered function (47-49). Select the one lettered class of instrument (a, b, c, d or e) Most closely associated with it. Each lettered class may be selected once, more than once, or not at all. 47. To investigate retinopathy 48. To assess breath sound 49. Bone conduction test a. Ophthalmoscope b. Otoscope c. Stethoscope d. Sphygmomanometer e. Tuning fork

50. Nails and nail beds are evaluated for which of the following? a. Clubbing d. All of the above b. Cyanosis e. None of the above c. Trauma 51. "Regularly irregular" heart betas can be detected in all of the following EXCEPT: a. Premature ventricular contraction d. Premature atrial contraction b. Second degree heart block e. None of the above c. Atrial fibrillation For each numbered description (52-56). Select the one lettered class of heart sound (a, b, c, d or e) Most closely associated with it. Each lettered class may be selected once, more than once, or not at all. 52. Presystolic gallop 53. Protodiastolic gallop 54. Created by mitral and tricuspid valve closure 55. Created by the aortic and pulmonic valve closure 56. It is normal in children and young adults a. Dup b. Lub c. S3 d. S4

57. One of the following systems cannot be normally palpated: a. Abdomen d. Face b. Cardiovascular e. Chest c. Lymph nodes 58. For mentally impaired patients: a. Assume that the patient is incapable of participation in their health care b. Communicate clearly and directly with the patient c. Limit the length of the interaction to the shortest possible period d. b & c e. All of the above 59. Which one of the following is not important consideration when writing medical record notes: a. Use black ink d. Begins the note on an unused page b. Title the note with a specific heading e. All of the above c. Document the facts and avoid judgment 5

60. The best way to deal with antagonistic patients is to do which of the following: a. Avoid them b. Suggest less expensive alternative medications c. Speak slowly and distinctly d. Limit the length of each interaction e. All of the above

Question II: Read carefully and write in Your Answer Sheet the Letter (T) for the True Answer or (F) for False (incorrect answers cancel true ones)
1. A combination of local anti-inflammatory and anesthetics is first drug of choice to treat difficulty in ingestion associated with inflammation of the pharynx. ( ) 2. Sore throat is generally caused by a viral infection that is self-limiting within a week. ( )

3. A thrush can occur as a result of bacterial infection in babies or associated with immune-deficiency problems and requires referral. ( ) 4. Glandular fever occurs in teenagers and is characterized by inflammation of the throat associated with enlarged glands and axillae and presence of creamy exudates. ( ) 5. Poor inhalation techniques or administration of large doses of steroids aerosols may result in candida infection and inflammation of the throat. ( ) 6. A combination of Benzydamine, Benzocaine and Chlorhexidine in the form of mouthwash is very useful in treatment of sore throat. ( ) 7. Animal hairs and house dust are the major allergens causing seasonal allergic response. ( 8. Allergic reactions can occur only in young age and usually associated with family history. ( 9. Allergic rhinitis is characterized by a runny nose, nasal congestion, sneezing and watery eyes. ( ) ) )

10. Astemizole is a non-sedating antihistaminic with a short duration of action and is usually used for treatment of hay fever. ( ) 11. Antihistaminics are used to alleviate nasal congestion associated with hay fever. ( )

12. Sodium cromoglycate can be used to prevent seasonal allergic reaction and must be started 2-3 weeks before hay fever season. ( ) 13. Major Aphthous ulcers are characterized by the appearance of fresh crops of ulcers tend to emerge before the original crop has healed. ( ) 14. Minor Aphthous ulcers are more common in women especially before menstrual cycle and usually stop before pregnancy. ( ) 15. Buccal hydrocortisone pellets can be used to decrease inflammation and pain associated with mouth ulcers. ( ) 16. Obesity, smoking, bending down and eating large meals are among the factors that can aggravate heartburn symptoms. ( ) 17. Regurgitation is the forced expulsion of gastric contents through the mouth as a result of cancer or peptic ulcer. ( ) 6

18. Calcium channel blockers, nitrates and Tricyclic antidepressants can induce heartburn symptoms. ( 19. Sodium bicarbonate should be avoided by hypertension patients suffering from heartburn. ( )

20. Duodenal ulcer is characterized by a local pain in the upper abdomen especially after eating and aggravated by NSAIDs and smoking. ( ) 21. The presence of single or multiple stones in the bile duct may result in biliary colics especially after fatty stricture. ( ) 22. Atypical angina is chartered by a severe pain that is felt in the lower chest or upper abdomen especially after a fatty meal. ( ) 23. For a longer duration of action, antacids are best administrated one hour before meals. ( )

24. Beside their acid neutralization effect aluminum salts can cause osmotic diarrhea that can help relieving slight constipation that may be associated with heartburn. ( ) 25. Aspirin, antibiotics and digoxin are nauseating drugs therefore better taken with foods. ( )

26. Continuous use of stimulant laxative such as methylcellulose may result in atonic colon therefore they should not be used for more than one week. ( ) 27. Lubricant laxatives act by coating and softening the feces and preventing further absorption of water in the colon so keep the feces moist and lubricated. ( ) 28. Constipated pregnant women are best treated with bulk laxatives and increased dietary fiber intake. ( 29. Multi-drug regimens are major cause of constipation in elderly patients. ( ) )

30. Diarrhea caused by salmonella usually occurs one day after ingestion of uncooked or contaminated food and should be treated with erythromycin. ( ) 31. In children, diarrhea may result from air borne viral infection and may be associated with fever, runny nose and sore throat. ( ) 32. Chronic diarrhea may be due to Crohn's syndrome characterized by colon spasms and alteration in bowel habits. ( ) 33. Oral rehydration therapy is the standard treatment for any type of acute diarrhea and can be prepared using water or carbonated beverages. ( ) 34. Anal fissures associated with hemorrhoids can be managed by correcting constipation and administration of a local anesthetics cream. ( ) 35. Suppositories can be used for continuous contact with weak irritants in detergents for a long period. ( 36. Housewives eczema results from continuous contact with weak irritants in detergents for a long period. ( ) 37. A mixture of calamine and 1% menthol may be useful as antibacterial to prevent microbial growth and secondary bacterial infection in contact dermatitis. ( ) 38. Acne occurs mainly in teenagers as a consequence of increase in androgen secretions during puberty. ( ) 7 )

39. Inflammatory lesion resulting from acne such as pustules can be easily treated by application of Benzoyl peroxide cream for duration of two weeks. ( ) 40. Resorcinol can be used for acne treatment although some studies showed that it may have comedogenic action. ( ) 41. A combination of Benzoyl peroxide and Miconazole would be the drug of choice for treatment of cane. ( ) 42. Acne patients should not be exposed to sunlight and must not eat any fatty foods. ( )

43. Pigmented skin cancer can be secondary to warts and is characterized by an irregular, wavy outline and a small ulcer that never seems to heal. ( ) 44. Babies with scabies infection on their backs, faces or scalps can be treated by application of lindane on those body parts but only with soft brush. ( ) 45. Diabetic patient with athlete's foot o\infection should be referred to GP due to impaired circulation or innervations of the feet. ( ) 46. Compound benzoic acid ointment is the drug of choice for treatment of athlete's foot. ( )

47. Athlete's foot patient should wear leather shoes or open toed sandals and change socks daily as a part of their treatment. ( ) 48. German measles exert significant problems only if transmitted from a child to his pregnant mother in early pregnancy. ( ) 49. The symptoms of the common cold usually last for 3-5 days while that of flu last for about 7 days. ( 50. Over-the-counter medications should be given the same care and respect given to prescription. ( 51. Serum creatinine is a good predictor of renal function for all age groups. ( 52. Phase I metabolic reactions are relatively stable (unchanged) over age. ( 53. When initiating drug therapy in the elderly, start low and titrate slowly. ( 54. Geriatric patients can have atypical presentations of adverse drug reactions. ( 55. The main site for absorption of acidic drugs in the stomach. ( ) ) ) ) ) ) ) ) ) )

56. A fast rate of gastric emptying can reduce the extent of drug absorption. ( 57. Formula-fed infants empty their stomach twice as fast as breast-fed infants. (

58. The skin of a full-term neonate has barrier properties to drug absorption similar top adult skin. (

59. In neonates, the ability to conjugate most groups in phase II reactions is reduced except for sulfate group. ( ) 60. Normal corneal reflex should be unilateral. ( ) ) 8

61. When testing the patient's visual field, you use your own visual field for comparison. (

62. Pharmacy practice involves diagnosis, drug prescribing, selection and utilization reviews. (

63. For proper communication use the correct title and try to guess whether the adults are married or single. ( ) 64. Pharmacists must be able to communicate with patients with special needs. The patient is responsible for recognizing the special situation and having the flexibility to ensure appropriate communication. ( ) 65. Intra-abdominal structures may be more palpable if the abdomen is obese or distended by fluids. ( 66. The risk of lung cancer is reduced to one half just after five years of smoking cessation. ( 67. Combined birth control pills are proved to be more effective than IUD. ( ) ) )

Answers
I) MCQs:
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 B D A D C D D A B A B D A B D D A B C D 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 B A A D D B B D B D C A C C A () B D B C D 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 C D B B A D A C E D C D C B A C C B D D

II) T & F:
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 F T F T T T F F T F F T F () T () T T F T T F 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 T F F F T F T T T F T F F T F T F T F F 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 T F F F T F T T F T F F T T F T F T T F 61 62 63 64 65 66 67 T F F F F F () F ()

 Question I: Select the Most Appropriate Answer (only one) by Blackening the Circle with the Corresponding Letter in the Provided Answer Sheet
.c .d .1 : .a .b

.2 : .c .a .d .b .c .d .3 : .a .b

.4 : .c .a .d .b

Question II: Complete the following sentences

.1 .2 .3 .4 ... .. .5 .6 .. .. . . . .7 10

 .8 .9 .10 .11 .. . .. .... .12 . .. .... .13 .. .. .14 . .. .... .15 ................ .. .... .16 . .... . ... .... . ... .17 . .... .18 + : .19 .20 1 .. . . ... .21 3 .. . . ... .22 4 .. . . ... .23 5 .. . . ... 11

 .24 6 .. . . ... .25 .26 .27 .28 .29 .30 .31 .32 .. .33 12