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Test Information
Test Name SWTS-PHARMACOLOGY Total Questions 200
a. Dopamine
b. Amrinone
c. Amiodarone
d. Isoprenaline
Your Answer. c
Correct Answer. c
(2). Which of the following antimicrobials needs dose reduction even in mild renal failure
a. Ciprofloxacin
b. Carbenicillin
c. Cefotaxime
d. Ethambutol
Your Answer. c
Correct Answer. d
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(3). The phenomenon of antibiosis was first demonstrated by
a. Gerhard Domagk
b. Louis Pasteur
c. Alexander Fleming
d. Selman Waksman
Your Answer. c
Correct Answer. b
(4). All of the following have been shown to be beneficial in patients with congestive heart failure except
a. Enoximone
b. Ivabradine
c. Thalidomide
d. Vernakalant
Your Answer. c
Correct Answer. d
(5). Which of the following is most commonly responsible for causing superinfections?
a. Clindamycin
b. Tetracyclines
c. Cefoperazone
d. Piperacillin
Your Answer. a
Correct Answer. c
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(6). Which of the following acts as a predominant arteriolar dilator?
a. Nitroglycerine
b. Clevidipine
c. Enalaprilat
d. Nitroprusside
Your Answer. d
Correct Answer. b
a. Conjugation
b. Transduction
c. Transformation
Your Answer. b
Correct Answer. c
a. 0.001 0.005
b. 0.01 0.02
c. 0.04 0.06
d. 0.06 0.08
Your Answer. a
Correct Answer. b
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(9). Anticoagulant action both in-vitro and in-vivo is seen with
a. Coumarin
b. Heparin
c. E.D.T.A.
d. Phenindione
Your Answer. b
Correct Answer. b
a. Brachycephaly
b. Microcephaly
c. Hyperkinetic disorder
d. Congenital malformation
Your Answer. a
Correct Answer. a
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(11). Which teratogen causes deafness?
a. Isotretnoin
b. Chloroquine
c. Alcohol
d. Warfarin
Your Answer. d
Correct Answer. d
(12). All of the following drugs are correctly matched with their metabolism except
b. Carvedilol CYP2D6
c. Digoxin P glycoprotein
* Calcium channel blockers are metabolized by CYP3A4 expressed in the small bowel.
* Carvedilol CYP2D6
* Extensively metabolized by oxidation by CYP2D6 and CYP2C9
* Inhibition of P-glycoprotein may play a role in cases of digoxin toxicity.
* Statins are metabolized by CYP3A4
Your Answer. d
Correct Answer. d
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(13). Highly plasma protein bound opioid among the following is :
a. Pethidine
b. Fentany1
c. Sufentany1
d. Meperidine
Your Answer. c
Correct Answer. c
Your Answer. c
Correct Answer. a
(15). A 63-year old male with a h/o smoking for the past 20 years presents with an acute onset of left-sided chest pain radiating down the left
arm with profuse sweating. An immediate ECG was performed in the emergency room which revealed a ST-segment elevation in leads
V4-V6.For the purpose of pharmacological thrombolysis, 30 mg of streptokinase was infused intravenously. The immediate plasma
concentration of streptokinase was measured to be 0.6 mg/dL. What is the volume of distribution of streptokinase in this patient?
a. 50 L
b. 5 L
c. 18 L
d. 180 L
Your Answer. a
Correct Answer. b
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(16). All of the following are non selective -blockers with additional actions except
a. Carvedilol
b. Betoxalol
c. Oxprenolol
d. Labetolol
Your Answer. b
Correct Answer. b
(17). Anti-Platelet therapy is usually given for patients with stroke, MI and peripheral vascular disease. PPIs are frequently administered along
with these drugs to prevent the risk of increased gastrointestinal erosions and bleeding. The interaction between clopidogrel and PPI has
recently been given much attention due to its clinical significance. The metabolizing enzyme common to these two drugs is
a. CYP2C10
b. CYPA2
c. CYP2C19
d. CYP2C20
Your Answer. c
Correct Answer. c
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(18). Anti-Adrenergic drug which crosses the blood brain barrier minimally is -
a. Propranolol
b. Atenolol
c. Oxprenolol
d. Alprenolol
Your Answer. a
Correct Answer. b
a. Hyperglycemia
b. Pulmonary odema
c. Tachycardia
d. Tremors
Your Answer. a
Correct Answer. a
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(20). Mobius syndrome in fetus can caused by antenatal intake of which of the following?
a. Mifepristone
b. Misoprostol
c. Dinoprostone
d. Methotrexate
Your Answer. c
Correct Answer. b
a. Clindamycin
b. Vancomycin
c. Azithromycin
d. Linezolid
Your Answer. b
Correct Answer. b
a. Acetozolamide
b. Furosemide
c. Epelerone
d. Spironolactone
Your Answer. b
Correct Answer. a
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(23). Anticraving drug used in alcohol dependence?
a. Naltrexone
b. Methadone
c. Vareniciline
d. Rimonabant
Your Answer. a
Correct Answer. a
(24). An antidepressant found to be associated with tardive dyskinesia and neuroleptic malignant syndrome is -
a. Fluxetine
b. Amineptin
c. Amoxapine
d. Trazodone
Your Answer. d
Correct Answer. c
(25). Which of the following drugs causes Retrograde ejaculation as a side effect ?
a. Prazosin
b. Terazosin
c. Alfuzosin
d. Tamsulosin
Your Answer. d
Correct Answer. d
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(26). All are side effects of valproic acid except ?
a. Polycystic ovaries
b. Fulminant hepatitis
c. Tremors
d. Lymadenopathy
Your Answer. d
Correct Answer. d
a. Brain
b. Liver
c. Heart
d. Kidney
Your Answer. a
Correct Answer. b
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(28). Lithium clearance is decreased by
a. Hyperkalemia
b. Hypokalemia
c. Hyponatremia
d. Hypernatremia
Your Answer. a
Correct Answer. c
c. Penciclovir triphosphate has lower affinity for the viral DNA polymerase than acyclovir triphosphate
Your Answer. a
Correct Answer. a
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(30). Diarrhea is a side effect of :
a. Amitryptiline
b. Metformin
c. Atropine
d. Codeine
Your Answer. a
Correct Answer. b
a. Not a Benzodiapezine
Your Answer. c
Correct Answer. c
(32). A patient of peptic ulcer was prescribed ranitidine and sucralfate in the morning hours. Why is this combination incorrect?
b. Combination of these two drugs produces serious side effects like agranulocytosis
Your Answer. a
Correct Answer. d
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(33). Which of the following fluoroquinolones does not require dose adjustment in a patient with creatinine clearance of < 50 mg/minute?
a. Ciprofloxacin
b. Trovafloxacin
c. Lomefloxacin
d. Sparfloxacin
Your Answer. a
Correct Answer. b
(34). Which of the following is the best indication for propofol as an intravenous indication agent?
a. Neurosurgery
d. In neonates
Your Answer. b
Correct Answer. b
(35). Which of the following recent drugs for Hepatitis C has been on hold due to reports of severe pancreatitis?
a. Alisporivir
b. Daclatasvir
c. Ladipasvir
d. Danoprevir
Your Answer. b
Correct Answer. a
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(36). Which of the following is recently approved by U.S. F.D.A. for the treatment of psoriatic arthritis?
a. Tasimelteon
b. Apremilast
c. Ibrutinib
d. Droxidopa
Your Answer. c
Correct Answer. b
(37). The anti-TB capsule RISORINE contains all of the following except
a. Isoniazid
b. Rifampicin
c. Pyrazinamide
d. Piperine
Your Answer. d
Correct Answer. c
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(38). Low dose inhaled corticosteroids (ICS) + Long-acting inhaled 2 agonist therapy is the preferred treatment for which type of bronchial
asthma?
Your Answer. b
Correct Answer. c
(39). Which of the following drugs is a dual PPAR agonist recently approved for diabetic dyslipidemia?
a. Muraglitazar
b. Tesaglitazar
c. Aleglitazar
d. Saroglitazar
Your Answer. d
Correct Answer. d
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(40). Theophylline levels are increased by which of the following drugs?
a. Ciprofloxacin
b. OCPs
c. Erythromycin
Your Answer. d
Correct Answer. d
(41). A patient with intractable itching would best respond to which of the following?
a. Chlorpromazine
b. Pimozide
c. Haloperidol
d. Risperidone
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(42). Zero order kinetic is shown by all except
b. Phenytoin
c. Ethanol
d. Methotrexate
Your Answer. d
Correct Answer. d
(43). The process by which the amount of a drug in the body decreases after administration but before entering the systemic circulation is
called
a. Excretion
d. Metabolism
Your Answer. b
Correct Answer. b
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(44). Physiological antagonism is found in
Your Answer. d
Correct Answer. d
a. Increased glucagon
c. Increased glucocorticoids
d. Increased thyroxine
Your Answer. a
Correct Answer. a
(46). A 26-year-old female with reactive depression complains of missing her period and having milk discharge from her breasts. She has no
signs of pregnancy, including a negative pregnancy test. Which of the following might have caused these findings?
a. Clomipramine
b. Amoxapine
c. Fluoxetine
d. Mirtazapine
Your Answer. c
Correct Answer. b
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(47). All of the following drugs are used topically in the treatment of chronic wide-angle glaucoma. Which of these agents reduces intraocular
pressure by decreasing the formation of the aqueous humor?
a. Timolol
b. Echothiophate
c. Pilocarpine
d. Isofluorphate
Your Answer. c
Correct Answer. a
a. Pancuronium
b. Succinylcholine
c. Diazepam
d. Baclofen
Your Answer. a
Correct Answer. a
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(49). Epinephrine may be mixed with certain anesthetics, such as procaine, in order to
b. Promote hemostasis
Your Answer. c
Correct Answer. c
Your Answer. a
Correct Answer. a
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(51). A 10-year-old male displays hyperactivity and is unable to focus on his schoolwork because of an inability to focus on the activity. Which
of the following might prove effective in this patient?
a. Methylphenidate
b. Terbutaline
c. Dobutamine
d. Pancuronium
Your Answer. a
Correct Answer. a
c. Miosis
d. Bradycardia
Your Answer. b
Correct Answer. b
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(53). A naturally occurring substance that is useful in treating Pagets disease of the bone is
a. Etidronate
b. Cortisol
c. Calcitonin
Your Answer. a
Correct Answer. c
(54). A patient becomes markedly tetanic following a recent thyroidectomy. This symptom can be rapidly reversed by the administration of
a. Vitamin D
b. Calcitonin
c. Plicamycin (mithramycin)
Your Answer. d
Correct Answer. d
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(55). A 55-year-old postmenopausal female develops weakness, polyuria, and polydipsia. Nephrocalcinosis is detected by a computed
tomography (CT) scan. Her serum creatinine is elevated. Which of the following agents may have caused these adverse effects?
a. Estrogens
b. Prednisone
c. Etidronate
d. Vitamin D
Your Answer. c
Correct Answer. d
(56). If a drug is given repeatedly at approximately the same time as its half life, after how many dosages will the drug achieve a steady state
in plasma?
a. 2-3
b. 4-5
c. 8-9
d. 6-8
Your Answer. b
Correct Answer. b
a. Oral absorption
b. Duration of action
c. Mechanism of action
d. Antiandrogenic action
Your Answer. d
Correct Answer. d
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(58). Regarding meperidine all are true except :
a. Drug dependence
Your Answer. c
Correct Answer. c
(59). Glucocorticoids are powerful anti-inflammatory agents. Which of the following is not an anti-inflammatory mechanism of action of
glucocorticoids?
Your Answer. c
Correct Answer. c
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(60). A 60-year-old diabetic male on an oral hypoglycemic agent develops abnormal liver function tests. Which of the following agents can
cause this finding?
a. Glyburide
b. Metformin
c. Troglitazone
d. Acarbose
Your Answer. c
Correct Answer. c
(61). In patients with hepatic coma, decreases in the production and absorption of ammonia from the gastrointestinal (GI) tract will be
beneficial. Which of the following is the antibiotic of choice in this situation?
a. Neomycin
b. Tetracycline
c. Penicillin G
d. Chloramphenicol
Your Answer. a
Correct Answer. a
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(62). True about ACE Inhibitor ?
c. Omission of pretreatment with diuretics minimizes the risk of 1st dose hypotension
Solution. Ans 62: (c) Omission of pretreatment with diuretics minimizes the risk of 1st dose hypotension
Ref KDT5th ed- Goodman gilman-9th ed ch-30
Sol:
About Option a-
* Ace inhibitors inhibits formation of angiotensin I to angiotensin II.
About option b-
* t1/2 of enalapril is is 1.3 hrs and its metabolite enalaprilat has t1/2 of 11 hrs but lisinopril has t1/2 of 12 hrs.
About option c-
* A steep fall in blood pressure may occur following the first dose of an ACE inhibitor in patients with elevated PRA.
* Special care should be exercised in patients who are saltdepleted, in patients being treated with multiple antihypertensive drugs, and
in patients who have congestive heart failure.
* Such patients should be started on very small doses of ACE inhibitors, or salt intake should be increased and diuretics stopped before
beginning therapy.
About option d-
* Left ventricular systolic dysfunction ranges from a modest, asymptomatic reduction in systolic performance to a severe impairment of
left ventricular systolic function with florid congestive heart failure.
* Unless contraindicated, ACE inhibitors should be given to all patients with impaired left ventricular systolic function whether or not
they have symptoms of overt heart failure.
Your Answer. a
Correct Answer. c
(63). A drug-drug interaction is possible with sildenafil and which of the following agents?
a. Dobutamide
b. Alprostadil
c. Digoxin
d. Nitrates
Your Answer. d
Correct Answer. d
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(64). A 22-year-old female who requests a postcoital contraceptive after being raped would best be treated with which of the following?
a. Mifepristone
b. Spironolactone
c. Aminoglutethimide
d. Leuprolide
Your Answer. a
Correct Answer. a
a. Metoprolol
b. Dopamine
c. Isoproterenol
d. Epinephrine
Your Answer. b
Correct Answer. d
(66). A male patient is brought to the emergency department (ED) following ingestion of an unknown substance. He is found to have an
elevated temperature, hot and flushed skin, dilated pupils, and tachycardia. Of the following, which would most likely cause these
findings?
a. Propranolol
b. Methylphenidate
c. Guanethidine
d. Atropine
Your Answer. a
Correct Answer. d
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(67). A 65-year-old male has a blood pressure of 170/105 mmHg. Which of the following would be effective in lowering this patients blood
pressure?
a. Methylphenidate
b. Terbutaline
c. Pancuronium
d. Prazosin
Your Answer. d
Correct Answer. d
(68). The EKG of a patient who is receiving digitalis in the therapeutic dose range would be likely to show
Your Answer. d
Correct Answer. b
(69). In a hypertensive patient who is taking insulin to treat diabetes,which of the following drugs is to be used with extra caution and advice
to the patient?
a. Hydralazine
b. Prazosin
c. Guanethidine
d. Propranolol
Your Answer. d
Correct Answer. d
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(70). A 69-year-old male with angina develops severe constipation following treatment with
a. Propranolol
b. Captopril
c. Verapamil
d. Dobutamine
Your Answer. c
Correct Answer. c
(71). Significant relaxation of smooth muscle of both venules and arterioles is produced by which of the following drugs?
a. Hydralazine
b. Minoxidil
c. Diazoxide
d. Sodium nitroprusside
Your Answer. a
Correct Answer. d
(72). Physostigmine was therapeutically used for the first time in treatment of glaucoma in 1877 by
a. Laqueur
c. Ahlquist
Your Answer. b
Correct Answer. a
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(73). Which of the following parenteral anticoagulants is a dual coagulation factor inhibitor?
a. Clavatadine
b. Tifacogin
c. Tanogitran
d. Flovagatran
Your Answer. d
Correct Answer. c
(74). According to the recent classification of antitubercular drugs, which of the following drugs is classified under Group II?
a. Ethambutol
b. Streptomycin
c. Levofloxacin
d. Imipenem/Cilastatin
Your Answer. d
Correct Answer. b
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(75). Glucocorticoids lead to an increase in blood levels of which of the following?
a. Neutrophils
b. Eosinophils
c. Basophils
d. Lymphocytes
Your Answer. a
Correct Answer. a
a. Pentamidine
b. Eflornithine
c. Suramin
d. Melarsopol
Your Answer. b
Correct Answer. c
(77). A 39-year-old pregnant female requires heparin for thromboembolic phenomena. What is the mechanism of action of heparin?
Your Answer. c
Correct Answer. b
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(78). A 42-year-old male with an acute MI is treated with alteplase. What is the mechanism of action of alteplase?
Your Answer. c
Correct Answer. d
(79). Administration of which of the following antianginal agents results in antianginal effects for only 10 hours, despite detectable therapeutic
plasma levels for 24 hours?
a. Atenolol
b. Transdermal nitroglycerin
c. Amlodipine
d. Amyl nitrite
Your Answer. d
Correct Answer. b
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(80). Of the following effects, which is not elicited by activation of the parasympathetic nervous system?
Your Answer. c
Correct Answer. c
(81). A 65-year-old diabetic male with erectile dysfunction would be best treated with which of the following?
a. Sildenafil
b. Gossypol
c. Androstenedione
d. Finasteride
Your Answer. a
Correct Answer. a
(82). The pharmacokinetic value that most reliably reflects the amount of drug reaching the target tissue after oral administration is the
Solution. Ans 82: (d) Area under the blood concentration-time curve (AUC)
Ref Read the text below
Sol:
* The fraction of a drug dose absorbed after oral administration is affected by a wide variety of factors that can strongly influence the
peak blood levels and the time to peak blood concentration.
* The Vd and the total body clearance (Vd first-order ke) also are important in determining the amount of drug that reaches the target
tissue.
* Only the area under the blood concentration-time curve, however, reflects absorption, distribution, metabolism, and excretion factors;
it is the most reliable and popular method of evaluating bioavailability.
Your Answer. c
Correct Answer. d
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(83). What are the most common adverse effects of anticonvulsive drugs?
b. Gastrointestinal symptoms
Your Answer. a
Correct Answer. d
(84). For a drug that obeys first order(linear) kinetics and fits a one compartment model of elimination:
Solution. Ans 84: (a) Its rate of elimination is proportional to its plasma concentration
Ref Read the text below
Sol:
* Although the one compartment model is an oversimplification.
* Once absorption and distribution are complete many drugs do obey first order elimination kinetics
Your Answer. d
Correct Answer. a
Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 36/84
(85). Medical management for detrusor instability ?
a. Duloxetine
b. Flavoxate
c. Toletradine
d. Solarifinacin
* Detrusor overactivity is a generic term for involuntary detrusor contractions. The ICS defined overactive detrusor function as
involuntary detrusor contractions during the filling phase, which may be spontaneous or provoked and which the patient cannot
completely suppress .
* The term detrusor overactivity should be used when the etiology of the involuntary detrusor contractions is unclear. Involuntary
detrusor contractions that are due to neurologic disorders are defined as detrusor hyperreflexia, whereas the term detrusor instability
should be use to denote involuntary detrusor contractions that are not due to neurologic disorders.
* Anticholinergics are competitive inhibitors of acetylcholine that block the muscarinic effects. If fully effective, these drugs would result
in abolition of the involuntary detrusor contraction.Propantheline bromide is the prototype anticholinergic, but in current practice
tolterodine and oxybutynin chloride are the two most widely used anticholinergics.
* Overactive urinary bladder disease can be successfully treated with muscarinic antagonists, primarily Tolterodine(goodman gilman ch
7)
* Stress urinary incontinence has been treated with some success with duloxetine (YENTREVE), which acts centrally to influence 5-HT
and NE levels.
Your Answer. b
Correct Answer. c
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(86). Of the following, which is unlikely to be associated with drug distribution into and out of the central nervous system (CNS)?
a. Most drugs enter the CNS by simple diffusion at rates that are proportional to the lipid solubility of the nonionized form of the drug
c. Strongly ionized drugs freely enter the CNS through carrier-mediated transport systems
d. Some drugs leave the CNS by passing from the cerebrospinal fluid into the dural blood sinuses through the arachnoid villi
Solution. Ans 86: (c) Strongly ionized drugs freely enter the CNS through carrier-mediated transport systems
Ref Read the text below
Sol:
* Drugs can enter the brain from the circulation by passing through the blood-brain barrier.
* This boundary consists of several membranes, including those of the capillary wall, the glial cells closely surrounding the capillary, and
the neuron.
* In most cases, lipid-soluble drugs diffuse through these membranes at rates that are related to their lipid-to-water partition coefficients.
Therefore, the greater the lipid solubility of the nonionized fraction of a weak acid or base, the more freely permeable the drug is to the
brain. Some drugs enter the CNS through specific carrier-mediated or receptor-mediated transport processes.
Carrier-mediated systems appear to be involved predominantly in the transport of a variety of nutrients through the blood-brain barrier;
however, the thyroid hormone 3,5,3'-triiodothyronine and drugs such as levodopa and methyldopa, which are structural derivatives of
phenylalanine, cross the blood-brain barrier via carrier-mediated transport. Receptor-mediated transport functions to permit a peptide
(e.g., insulin) to enter the CNS; therefore, some peptide-like drugs are believed to gain access to the brain by this mechanism.
Regardless of the process by which drugs can enter the CNS, strongly ionized drugs (e.g., quaternary amines) are unable to enter the
CNS from the blood. The exit of drugs from the CNS can involve (1) diffusion across the blood-brain barrier in the reverse direction at
rates determined by the lipid solubility and degree of ionization of the drug, (2) drainage from the cerebrospinal fluid (CSF) into the
dural blood sinuses by flowing through the wide channels of the arachnoid villi, and (3) active transport of certain organic anions and
cations from the CSF to blood across the choroid plexuses.
Your Answer. c
Correct Answer. c
a. Levodopa
b. Azathioprine
c. Benorylate
d. Frusemide
Your Answer. d
Correct Answer. d
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(88). A 46-year-old man is admitted to the emergency department. He has taken more than ninety digoxin tablets (0.25 mg each), ingesting
them about three hours after admission. His pulse is fifty to sixty beats per minute, and the electrocardiogram shows third-degree heart
block. Which one of the following is the most important therapy to initiate in this patient?
b. Potassium salts
c. Lidocaine
d. Phenytoin
Your Answer. c
Correct Answer. a
(89). Which of the following agents should be considered for additional antimicrobial therapy with ciprofloxacin in the setting of bioterrorist-
related inhalational anthrax?
a. Ceftazidime
b. Aztreonam
c. Vancomycin
d. Trimethoprim-sulfamethoxazole
Your Answer. d
Correct Answer. c
a. Cimetidine
b. Aspirin
c. Indometacin
d. Amoxicillin
Your Answer. a
Correct Answer. a
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(91). According to the CDC guidelines for the appropriate use of vancomycin, which of the following cases would be considered appropriate
use?
Solution. Ans 91: (d) Methicillin-sensitive S. aureus endocarditis in a patient with a history of anaphylaxis to penicillin
Ref Read the text below
Sol:
The following are CDC guidelines for the prevention of VRE: Situations in which the use of vancomycin is appropriate:
* Treatment of serious infections due to -Iactam-resistant gram-positive organisms
* Treatment of serious infections due to gram-positive organisms in patients with serious -Iactam allergies
* Treatment of antibiotic-associated colitis (AAC) when treatment with metronidazole has failed or if the AAC is potentially life
threatening
* Prophylaxis for endocarditis for certain procedures based on American Heart Association recommendations
* Prophylaxis for certain surgical procedures involving implantation of prosthetic materials in hospitals with a high rate of MRSA or
MRSE.
Your Answer. a
Correct Answer. d
(92). Antimicrobial prophylaxis following a significant exposure to anthrax spores should be continued for how long?
a. 2 days
b. 12 days
c. 45 days
d. 60 days
Your Answer. b
Correct Answer. d
a. Clindamycin
b. Ceftriaxone
c. Metronidazole
d. Cefoxitin
Your Answer. a
Correct Answer. c
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(94). Which antibiotic is a reasonable choice for a healthy young woman diagnosed with an uncomplicated lower urinary tract infection?
a. Imipenem
b. Azithromycin
c. Nitrofurantoin
d. Trovafloxacin
Your Answer. c
Correct Answer. c
(95). If a drug is repeatedly administered at dosing intervals that are equal to its elimination half-life, the number of doses required for the
plasma concentration of the drug to reach the steady state is
a. 2 to 3
b. 4 to 5
c. 6 to 7
d. 8 to 9
Your Answer. b
Correct Answer. b
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(96). Which of the following is classified as belonging to the tyrosine kinase family of receptors?
a. GABA A receptor
b. -adrenergic receptor
c. Insulin receptor
d. Nicotinic II receptor
Solution. Ans 96: (c) Insulin receptor. Reference Read the text below Sol: There are four major classes of receptors:
* Ion channel receptors,
* Receptors coupled to G proteins,
* Receptors with tyrosine-specific kinase activity, and
* Nuclear receptors.
* In most cases, drugs that act via receptors do so by binding to extracellular receptors that transduce the information intracellularly by
a variety of mechanisms.
* Activated ion channel receptors enhance the influx of extracellular ions into the cell; for example, the nicotinic-II cholinergic receptor
selectively opens a channel for sodium ions and the GABAA receptor functions as an ionophore for chloride ions.
* Receptors coupled to guanine nucleotide-binding proteins (G proteins) act either by opening an ion channel or by stimulating or
inhibiting specific enzymes (e.g., -adrenergic receptor stimulation leads to an increase in cellular adenylate cyclase activity).
* When stimulated, receptors with tyrosine-specific protein kinase activity activate this enzyme to enhance the transport of ions and
nutrients across the cell membrane; for example, insulin receptors function in this manner and increase glucose transport into insulin-
dependent tissues.
Your Answer. b
Correct Answer. c
(97). Of the following characteristics, which is unlikely to be associated with the process of facilitated diffusion of drugs?
b. The process is selective for certain ionic or structural configurations of the drug
c. If two compounds are transported by the same mechanism, one will competitively inhibit the transport of the other
d. The drug crosses the membrane against a concentration gradient and the process requires cellular energy
Solution. Ans 97: (d) The drug crosses the membrane against a concentration gradient and the process requires cellular energy.
Reference Read the text below
Sol:
* Drugs can be transferred across biologic membranes by passive processes (i.e., filtration and simple diffusion) and by specialized
processes (i.e., active transport, facilitated diffusion,and pinocytosis). Active transport is a carrier-mediated process that shows all of the
characteristics listed in the question.
* Facilitated diffusion is similar to active transport except that the drug is not transported against a concentration gradient and no
energy is required for this carrier-mediated system to function.
* Pinocytosis usually involves transport of proteins and macromolecules by a complex process in which a cell engulfs the compound
within a membrane-bound vesicle.
Your Answer. b
Correct Answer. d
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(98). Of the following, which is a phase II biotransformation reaction?
a. Sulfoxide formation
b. Nitro reduction
c. Ester hydrolysis
d. Sulfate conjugation
Your Answer. d
Correct Answer. d
a. Penicillin G
b. Penicillin V
c. Erythromycin
d. Ceftriaxone
Your Answer. d
Correct Answer. d
(100). In patients with hepatic coma, decreases in the production and absorption of ammonia from the gastrointestinal (GI) tract will be
beneficial. The antibiotic of choice in this situation would be
a. Neomycin
b. Tetracycline
c. Penicillin G
d. Chloramphenicol
Your Answer. a
Correct Answer. a
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(101). Of the following, which is unlikely to be associated with the binding of drugs to plasma proteins?
a. Acidic drugs generally bind to plasma albumin; basic drugs preferentially bind to 1-acidic glycoprotein
c. The fraction of the drug in the plasma that is bound is inactive and generally unavailable for systemic distribution
d. Plasma protein binding generally limits renal tubular secretion and biotransformation
Solution. Ans 101: (d) Plasma protein binding generally limits renal tubular secretion and biotransformation.
Reference Read the text below
Sol:
* Because only the free (unbound) fraction of a drug can cross biologic membranes, binding to plasma proteins limits a drugs
concentration in tissues and, therefore, decreases the apparent Vd of the drug.
* Plasma protein binding will also reduce glomerular filtration of the drug because this process is highly dependent on the free drug
fraction.
* Renal tubular secretion and biotransformation of drugs are generally not limited by plasma protein binding because these processes
reduce the free drug concentration in the plasma.
* If a drug is avidly transported through the tubule by the secretion process or is rapidly biotransformed, the rates of these processes
may exceed the rate of dissociation of the drug-protein complex (in order to restore the free:bound drug ratio in plasma) and, thus,
become the rate-limiting factor for drug elimination.
* This assumes that equilibrium conditions exist and that other influences (e.g., changes in pH or the presence of other drugs) do not
occur.
Your Answer. a
Correct Answer. d
(102). Of the following, which is unlikely to be associated with drug distribution into and out of the central nervous system (CNS)?
a. The blood-brain barrier, which involves drug movement through glial cell membranes as well as capillary membranes, is the main
hindrance to drug distribution to the CNS
b. Most drugs enter the CNS by simple diffusion at rates that are proportional to the lipid solubility of the nonionized form of the drug
d. Strongly ionized drugs freely enter the CNS through carrier-mediated transport systems
Solution. Ans 102: (d) Strongly ionized drugs freely enter the CNS through carrier-mediated transport systems.
Reference Read the text below
Sol:
* Drugs can enter the brain from the circulation by passing through the blood-brain barrier. This boundary consists of several
membranes, including those of the capillary wall, the glial cells closely surrounding the capillary, and the neuron.
* In most cases, lipidsoluble drugs diffuse through these membranes at rates that are related to their lipid-to-water partition coefficients.
Therefore, the greater the lipid solubility of the nonionized fraction of a weak acid or base, the more freely permeable the drug is to the
brain. Some drugs enter the CNS through specific carrier-mediated or receptor-mediated transport processes.
* Carrier mediated systems appear to be involved predominantly in the transport of a variety of nutrients through the blood-brain
barrier; however, the thyroid hormone 3,5,3-triiodothyronine and drugs such as levodopa and methyldopa,which are structural
derivatives of phenylalanine, cross the bloodbrain barrier via carrier-mediated transport.
* Receptor-mediated transport functions to permit a peptide (e.g., insulin) to enter the CNS; therefore,some peptide-like drugs are
believed to gain access to the brain by this mechanism.
* Regardless of the process by which drugs can enter the CNS,strongly ionized drugs (e.g., quaternary amines) are unable to enter the
CNS from the blood.
* The exit of drugs from the CNS can involve (1) diffusion across the blood-brain barrier in the reverse direction at rates determined by
the lipid solubility and degree of ionization of the drug, (2) drainage from the cerebrospinal fluid (CSF) into the dural blood sinuses by
flowing through the wide channels of the arachnoid villi, and (3) active transport of certain organic anions and cations from the CSF to
blood across the choroids plexuses.
Your Answer. a
Correct Answer. d
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(103). The mechanism of action by which pyrantel pamoate is effective for the treatment of Necator americanus (hookworm) disease is
Your Answer. a
Correct Answer. c
(104). Vertigo, inability to perceive termination of movement, and difficulty in sitting or standing without visual clues are some of the toxic
reactions that are likely to occur in about 75% of patients treated with
a. Penicillin G
b. Doxycycline
c. Amphotericin B
d. Streptomycin
Your Answer. d
Correct Answer. d
(105). Which of the following is unlikely to be associated with oral drug administration of an enteric-coated dosage form ?
Solution. Ans 105: (d) Variability in absorption caused by fluctuations in gastric emptying time. Reference Read the text below
Sol:
* Tasteless enteric-coated tablets and capsules are formulated to resist the acidic pH found in the stomach.
* Once the preparation has passed into the intestine, the coating dissolves in the alkaline milieu and releases the drug.
* Therefore, gastric irritation, drug destruction by gastric acid, and the forming of complexes of the drug with food constituents will be
avoided.
Your Answer. c
Correct Answer. d
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(106). Which toxicity do all of the first-line TB drugs have in common?
a. Neuropathy
b. Optic neuritis
c. Hepatotoxicity
Your Answer. c
Correct Answer. c
(107). Which drug is currently approved for administration once a week as prophylaxis for MAC in HIV infection?
a. Rifabutin
b. Azithromycin
c. Clarithromycin
d. Ethambutol
Your Answer. b
Correct Answer. b
(108). Which of the following cephalosporins would have increased activity against anaerobic bacteria such as Bacteroides fragilis?
a. Cefaclor
b. Cephalothin
c. Cephalexin
d. Cefoxitin
Your Answer. d
Correct Answer. d
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(109). An epileptic on hypertensive treatment develops acute hemorrhagic pancreatitis. Which medication is the most likely cause ?
a. Propranolol
b. Nifedipine
c. Verapamil
d. Sodium Valproate
Your Answer. d
Correct Answer. d
(110). A 24 year old following her PhD in chemistry is working in a laboratory when a mercury-containing solvent was accidentally spilled over
her desk top. She inhaled the vapour. She started coughing and soon after was severely nauseated .She was urgently admitted to the
emergency department complaining of a tight feeling in her chest, and having difficulty with breathing .Which is the best drug treatment
for mercury poisoning?
a. Penicillamine
b. Hydrocortisone
c. Subcutaneous Adrenalin
d. Glyceryltrinitrate
Your Answer. c
Correct Answer. a
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(111). A 38 year old woman being treated for hypertension and diabetes has the sudden onset of swelling and tenderness of the wrists and
knees. On examination she is febrile and flushed. A friction rub can be heard at the left lower sternal border.
Which of the following drugs is most likely the cause of these findings?
a. Metformin
b. Hydralazine
c. Minoxidil
d. Nitroprusside
Your Answer. b
Correct Answer. b
(112). A patient has muscular weakness secondary to autoantibodies against acetylcholine (ACh) receptor proteins on the cell surfaces of motor
end plates. This condition may be completely relieved for a period of two hours by adminstration of :
a. Intravenous cyclosporine
b. Oral antihistamine
c. Intravenous anticholinesterase
d. Oral pyridostigmine
Your Answer. d
Correct Answer. d
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(113). A 34-year-old male with Hodgkins disease is treated with the adriamycin,bleomycin, vinblastine, and decarbazine (ABVD) regimen. What
is the mechanism of action of vinblastine?
Solution. Ans 113: (d) Prevention of assembly of tubulin dimers into microtubules
Reference Read the text below
Sol:
* Vinblastine binds to tubulin and blocks the protein from polymerizing to microtubules.
* The drug-tubulin complex binds to the developing microtubule,resulting in inhibition of microtubule assembly and subsequent
depolymerization.
Your Answer. d
Correct Answer. d
(114). A 60-year-old male with hematuria is found to have a small localized tumor of the bladder that is diagnosed as a carcinoma. Which of the
following agents should be given intravesicularly?
a. Allopurinol
b. Asparaginase
c. Methotrexate
d. BCG vaccine
Your Answer. d
Correct Answer. d
(115). A 45-year-old male has an insulinoma. Which of the following agents is the treatment of choice?
a. Cyclophosphamide
b. Carboplatin
c. Vincristine
d. Streptozocin
Your Answer. d
Correct Answer. d
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(116). A medication that is associated with gingivitis
a. Phenytoin
b. Carbamazepine
c. Propranolol
d. Diazepam
Your Answer. a
Correct Answer. a
(117). Vascular abnormalities are a known side effect of several cytotoxic drugs. Which of the following cytotoxic drugs is most likely to lead to
thrombotic micro-angiopathy ?
a. Mitomycin
b. 5-fluorouracil
c. Taxoids
d. Cyclopentenyl cytosine
Your Answer. a
Correct Answer. a
(118). A fifty-five year old with chronic cardiac failure is on treatment with digoxin and a loop diuretic.This combination is likely to cause
digoxin toxicity by the following mechanism:
Your Answer. b
Correct Answer. b
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(119). Diplopia and ataxia are the most common dose-related adverse effects of :
a. Vigabatrin
b. Carbamazepine
c. Gabapentin
d. Topiramate
Your Answer. c
Correct Answer. b
(120). A 40 year old has repeated episodes of depressed mood in response to feeling rejected, and a craving for sweets and chocolate. These
reactive mood changes are accompanied by hypersomnia, lethargy and increased appetite, particularly with a preference for
carbohydrates. The most appropriate treatment would be
b. Tricyclic antidepressants
c. Lithium
Your Answer. a
Correct Answer. d
a. Trovafloxacin
b. Gatifloxacin
c. Gemifloxacin
d. Grepafloxacin
Your Answer. b
Correct Answer. c
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(122). Which of the following drugs is effective against HIV with Y181C mutation?
a. Festinavir
b. Lersivirine
c. Elvitegravir
d. Dolutegravir
(123). Which of the following is granted orphan drug status for the treatment of Dravets syndrome?
a. Stiripentol
b. Icatibant
c. Pitolisant
d. Tafamidis
Your Answer. a
Correct Answer. a
(124). Which of the following statins can be administered at any time during the day?
a. Lovastatin
b. Simvastatin
c. Pravastatin
d. Atorvastatin
Your Answer. c
Correct Answer. d
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(125). Cardiotoxicity is a well-known side effect of several cytotoxic drugs. Which of the following cytotoxic drugs is most likely to lead to long
term morbidity due to cardiotoxicity ?
a. Doxorubicin
b. 5-fluorouracil
c. Taxoids
d. Cyclopentenyl cytosine
a. Alpha-receptor antagonist
b. Anticholinergic
c. Muscarinic agonist
d. Beta blocker
Your Answer. a
Correct Answer. a
(127). The most useful medication that may be used in absence seizures
a. Phenytoin
b. Primidone
c. Carbamazepine
d. Valproic acid
Your Answer. d
Correct Answer. d
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(128). Contra-indicators to -blockers include all of the following except
a. Raynaud's disease
b. Wolff-Parkinson-White syndrome
d. Intermittent claudication
Your Answer. d
Correct Answer. b
a. Trimethoprim an phenytoin
Your Answer. b
Correct Answer. b
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(130). Tramadol
a. Is a controlled drug
b. Has affinity for binding at the mu opioid receptor comparable to that of morphine
Solution. Ans 130 : (c) Acts predominantly by inhibiting the reuptake of noradrenaline and serotonin (5-HT)
Ref:Read the text below
Sol:
* Tramadol is not a controlled drug. It has a weak affinity for opioid receptors.
* The affinity for binding at the mu receptor is 2.1 M compared with 0.0003 M for morphine.
* Its main mode of action is the modulation of central monoaminergic pathways.
* As with pethidine (and possibly other opioids), the use of tramadol with MAOI is contraindicated. Both drugs delay the removal of 5-HT
from its site of action.
* The interaction may presents clinically as sudden agitation, unmanageable behaviour, headaches, hypertension or hypotension, rigidity,
hyperpyrexia, convulsions and coma
Your Answer. b
Correct Answer. c
(131). The metabolism of which of the following does not follow zero-order kinetics in clinical doses
a. Phenytoin
b. Aspirin
c. Ethanol
d. Propranolol
Your Answer. d
Correct Answer. d
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(132). The following are examples of hepatic enzyme inducer
a. Cimetidine
b. Erythromycin
c. Griseofulvin
d. Amiodarone
Your Answer. a
Correct Answer. c
Your Answer. b
Correct Answer. c
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(134). Select incorrect statement regarding First-order kinetics
c. The rate of elimination and elimination half-life is constant, irrespective of plasma concentration
Solution. Ans 134 : (d) The enzyme responsible for the reaction is saturated
Ref:Read the text below
Sol:
Zero-order kinetics are observed when the enzyme responsible for the reaction is saturated and when the reaction is represented by a
linear relationship. Summary of the differences between zero-order and first-order kinetics: Zero-order:
* Absolute amount eliminated is the same, regardless of plasma concentration;
* Rate of elimination varies with the plasma concentration;
* Constant amount of drug metabolised per unit time;
* Reflects saturation of enzyme: occurs when plasma concentration exceeds capacity of enzyme.
First-order:
* Constant proportion of drug metabolised in a given time period;
* Absolute amount eliminated is greatest when plasma concentration is greatest;
* Rate of elimination and elimination half-life are constant, irrespective of concentration.
Your Answer. b
Correct Answer. d
a. Is greater for drug A if A is effective in a dose of 100 g than for drug B if B is effective in a dose of 100 mg
Solution. Ans 135 : (d) Describes the ability of a drug to produce its therapeutic effect
Ref:Read the text below
Sol:
* The dose of a drug required to produce a given effect decribes its potency, not its efficacy.
* In the example described, drug A is more potent than drug B.
* The therapeutic index of a drug is a measure of its safety (ED50/LD50).
* Efficacy, however, is a measure of the maximal effect of an agonist.
Your Answer. c
Correct Answer. d
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(136). A new drug is being studied to find the most appropriate dose in a dose response study. Small doses of the drug lead to a linear increase
in serum drug concentration. At higher doses there is an exponential rise in serum drug concentration. Which of the following best
describes the pharmacokinetic properties of this new drug?
c. Saturation kinetics
Your Answer. d
Correct Answer. c
a. Amantadine
b. Bromocriptine
c. Chlorpromazine
d. Levodopa/Carbidopa
Your Answer. c
Correct Answer. c
Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 58/84
(138). The latest and most effective therapy for AIDS patients includes azidothymidine (AZT), dideoxyinosine (DDI), and saquinavir or similar
agents. Use of these three drugs would inhibit which of the following viral processes?
a. RNase, DNase
Your Answer. d
Correct Answer. d
(139). The first drug to be effective against AIDS, including the reduction of maternal-to-child AIDS transmission by 30%, was AIDS drug
azidothymidine (AZT). Which of the following describes its mechanism of action?
Your Answer. d
Correct Answer. d
Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 59/84
(140). The first H2 receptor blocker was synthesized in 1972 by
d. Vane
Your Answer. c
Correct Answer. b
(141). The antiretroviral drug that can bind to both CCR2 and CCR5 is -
a. Cenicriviroc
b. Vicriviroc
c. Ipalizumab
d. Bevirimat
Your Answer. a
Correct Answer. a
a. a. Type 1 pneumocytes
b. b. Type 2 pneumocytes
Your Answer. a
Correct Answer. a
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(143). Which of the following is approved for the treatment of cystic fibrosis with G551D mutation?
a. Biostrophin
b. Peginesatide
c. Lumacaftor
d. Ivacaftor
Your Answer. b
Correct Answer. d
a. Sulfasalazine
b. Methotrexate
c. Infliximab
d. Corticosteroids
Your Answer. a
Correct Answer. d
(145). All of the following are anti-craving agents for alcohol withdrawl except
a. Fluoxetine
b. Nitrafezole
c. Naltrexone
d. Acamprosate
Your Answer. a
Correct Answer. b
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(146). Which of the following drugs for moderate-to-severe psoriasis inhibits both IL-12 and IL23?
a. Alefacept
b. Efalizumab
c. Ustekinumab
d. Abatacept
Your Answer. d
Correct Answer. c
(147). Which of the following enzymes can polymerize deoxyribonucleotides into DNA?
a. DNA ligase
b. DNA gyrase
d. Reverse transcriptase
Your Answer. c
Correct Answer. d
(148). Hypotension, bradycardia, respiratory depression, and muscle weakness,all unresponsive to atropine and neostigmine, would most likely
be due to
a. Diazoxide
b. Isofluorphate
c. Tubocurarine
d. Nicotine
Your Answer. c
Correct Answer. d
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(149). A predictably dangerous side effect of nadolol that constitutes a contraindication to its clinical use in susceptible patients is the induction
of
a. Hypertension
b. Cardiac arrhythmia
c. Asthmatic attacks
d. Respiratory depression
Your Answer. b
Correct Answer. c
(150). The cholinomimetic drug that is useful for treating postoperative abdominal distention and gastric atony is
a. Acetylcholine (ACh)
b. Methacholine
c. Carbachol
d. Bethanechol
Your Answer. b
Correct Answer. d
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(151). Which of the following cardiovascular agents is classified chemically as a glycoside?
a. Nifedipine
b. Digoxin
c. Flecainide
d. Cholestyramin
Your Answer. b
Correct Answer. b
a. Lignocaine
b. Tolbutamide
c. Quinidine
d. Propranolol
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(153). A patient is on propanolol. Adverse affects of beta blocker are all except
a. Seizures
b. Rebound tachycardia
c. Hypotension
Your Answer. a
Correct Answer. b
a. Ciprofloxacin
b. Penicillin
c. Erythromycin
d. Nalidixic acid
Your Answer. d
Correct Answer. c
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(155). Which of the following drug has lipemia clearing action?
a. Warfarin
b. Heparin
d. Streptokinase
Your Answer. d
Correct Answer. b
(156). Most specific drug for the treatment of peptic ulcer caused due to chronic use of NSAIDs is
a. Rabeprazole
b. Loxatidine
c. Misoprostol
d. Esomeprazole
Your Answer. c
Correct Answer. c
(157). The drug of choice for rapid correction of PSVT in known asthmatic is
a. Adenosine
b. Esmolol
c. Neostigmine
d. Verapamil
Your Answer. d
Correct Answer. d
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(158). Which of the following is wrongly matched combination of anti-arrhythmic drugs and their class
a. Mexiletine-IB
b. Verapamil-IV
c. Amiodarone-III
d. Lignocaine-IA
Your Answer. a
Correct Answer. d
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(159). Which of the following has the maximum half life?
a. Adenosine
b. Amiodarone
c. Esmolol
d. Lidocaine
Your Answer. b
Correct Answer. b
(160). The 5 reductase inhibitor that has been found to be effective both in benign prostatic hypertrophy and male pattern baldness is
a. Flutamide
b. Finasteride
c. Prazosin
d. Minoxidil
Your Answer. b
Correct Answer. b
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(161). Which of the following drugs is preferred for long term treatment of severe anxiety disorder with intermittent panic attacks ?
a. Phenothiazine
b. Azapirone
c. blocker
Solution. Ans-161: (d) Selective serotonin reuptake inhibitor Ref: Harrison 16th Ed. Pg. 2548 Sol: Appropriate medication is highly
effective for panic disorder. Although there is little evidence that pharmacological interventions can directly alter phobias, few studies
have been performed, and medication treatment of panic makes phobia treatment far easier. Medications can include:
Antidepressants (SSRIs, MAOIs, tricyclic antidepressants): these are taken regularly every day, and alter neurotransmitter
configurations which in turn can help to block symptoms. Although these medications are described as "antidepressants", nearly all of
them especially the tricyclic antidepressants have anti-anxiety properties, in part, due to their sedative effects. SSRIs have been
known to exacerbate symptoms in panic disorder patients, especially in the beginning of treatment and have even provoked panic attacks
in otherwise healthy individuals. SSRIs are also known to produce withdrawal symptoms which include rebound anxiety and panic
attacks. Comorbid depression has been cited as imparting the worst course, leading to chronic, disabling illness.
Anti-anxiety drugs (benzodiazepines): Use of benzodiazepines for panic disorder is controversial with opinion differing in the medical
literature. The American Psychiatric Association states that benzodiazepines can be effective for the treatment of panic disorder and
recommends that the choice of whether to use benzodiazepines, antidepressants with antipanic properties or psychotherapy should be
based on the individual patients history and characteristics. They reported that in their view there is insufficient evidence to recommend
one treatment over another for panic disorder. The APA noted that while benzodiazepines have the advantage of a rapid onset of action,
that this is offset by the risk of developing a benzodiazepine dependence.
The National Institute of Clinical Excellence came to a different conclusion, they pointed out the problems of using uncontrolled clinical
trials to assess the effectiveness of pharmacotherapy and based on placebo controlled research they concluded that benzodiazepines
were not effective in the long-term for panic disorder and recommended that benzodiazepines not be used for longer than 4 weeks for
panic disorder. Instead NICE clinical guidelines recommend alternative pharmacotherapeutic or psychotherapeutic interventions.
Other experts believe that benzodiazepines are best avoided due to the risks of the development of tolerance and physical dependence.
The World Federation of Societies of Biological Psychiatry, say that benzodiazepines should not be used as a first line treatment option
but are an option for treatment resistant cases of panic disorder.
Despite increasing focus on the use of antidepressants and other agents for the treatment of anxiety as recommended best practice,
benzodiazepines have remained a commonly used medication for panic disorder
Your Answer. d
Correct Answer. d
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(162). A patient of endogenous depression was prescribed imipramine. After what duration of time interval is the therapeutic effect of
imipramine likely to manifest?
a. Three days
b. One week
c. Three weeks
d. Three months
Solution. Ans-162: (c) Three weeks Ref: KDT--441 Sol: The mechanism of action of imipramine HCl is not definitely known. However, it
does not act primarily by stimulation of the central nervous system. The clinical effect is hypothesized as being due to potentiation of
adrenergic synapses by blocking uptake of norepinephrine at nerve endings. The mode of action of the drug in controlling childhood
enuresis is thought to be apart from its antidepressant effect.
INDICATIONS AND USAGE Depression For the relief of symptoms of depression. Endogenous depression is more likely to be alleviated
than other depressive states. One (1) to 3 weeks of treatment may be needed before optimal therapeutic effects are evident. Childhood
Enuresis
May be useful as temporary adjunctive therapy in reducing enuresis in children aged 6 years and older, after possible organic causes
have been excluded by appropriate tests.
In patients having daytime symptoms of frequency and urgency, examination should include voiding cystourethrography and cystoscopy,
as necessary. The effectiveness of treatment may decrease with continued drug administration.
CONTRAINDICATIONS
The concomitant use of monoamine oxidase inhibiting compounds is contraindicated.
Hyperpyretic crises or severe convulsive seizures may occur in patients receiving such combinations.
The potentiation of adverse effects can be serious, or even fatal. When it is desired to substitute imipramine HCl in patients receiving a
monoamine oxidase inhibitor, as long an interval should elapse as the clinical situation will allow, with a minimum of 14 days. Initial
dosage should be low and increases should be gradual and cautiously prescribed.
The drug is contraindicated during the acute recovery period after a myocardial infarction.
Patients with a known hypersensitivity to this compound should not be given the drug. The possibility of cross-sensitivity to other
dibenzazepine compounds should be kept in mind.
Your Answer. c
Correct Answer. c
a. Vancomycin
b. Ciprofloxacin
c. Carbenicillin
d. Nystatin
Solution. Ans-163: (a) Vancomycin Ref: Read the text below. Sol:
Both CA-MRSA and HA-MRSA are resistant to traditional anti-staphylococcal beta-lactam antibiotics, such as cephalexin. CA-MRSA has
a greater spectrum of antimicrobial susceptibility, including to sulfa drugs (like co-trimoxazole/trimethoprim-sulfamethoxazole),
tetracyclines (like doxycycline and minocycline) and clindamycin, but the drug of choice for treating CA-MRSA has is now believed to be
Vancomycin, according to a Henry Ford Hospital Study
Vancomycin and teicoplanin are glycopeptide antibiotics used to treat MRSA infections.
Teicoplanin is a structural congener of vancomycin that has a similar activity spectrum but a longer half-life.
Because the oral absorption of vancomycin and Teicoplanin is very low, these agents must be administered intravenously to control
systemic infections.
Drugs are administered via a Peripherally inserted central catheter, or a Picc Line, which is inserted by radiologists, doctors, physician
assistants (in the U.S.), radiologist assistants (in the U.S.), or specially trained certified registered nurses. Treatment of MRSA infection
with vancomycin can be complicated, due to its inconvenient route of administration. Moreover, many clinicians believe that the efficacy
of vancomycin against MRSA is inferior to that of anti-staphylococcal beta-lactam antibiotics against MSSA.
Several newly discovered strains of MRSA show antibiotic resistance even to vancomycin and teicoplanin. These new evolutions of the
MRSA bacterium have been dubbed Vancomycin intermediate-resistant Staphylococcus aureus (VISA). Linezolid,
quinupristin/dalfopristin(synercid), daptomycin, and tigecycline are used to treat more severe infections that do not respond to
glycopeptides such as vancomycin.
Your Answer. a
Correct Answer. a
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(164). Which of the following drugs is most likely to cause loss of equilibrium and auditory damage?
a. Amikacin
b. Ethambutol
c. Isoniazid
d. Rifabutin
Your Answer. b
Correct Answer. a
(165). Which of the following anticancer drugs has highest emetogenic potential?
a. Vincristine
b. Chlorambucil
c. 6-Mercaptopurine
d. Cisplatin
Solution. Ans-165: (d) Cisplatin Ref: Read the text below Sol: Cisplatin has a number of side-effects that can limit its use:
Nephrotoxicity (kidney damage) is a major concern. The dose is reduced when the patient's creatinine clearance (a measure of renal
function) is reduced. Adequate hydration and diuresis is used to prevent renal damage. The nephrotoxicity of platinum-class drugs seems
to be related to reactive oxygen species and in animal models can be ameliorated by free radical scavenging agents (e.g., amifostine).
Nephrotoxicity is a dose-limiting.
Neurotoxicity (nerve damage) can be anticipated by performing nerve conduction studies before and after treatment.
Nausea and vomiting: cisplatin is one of the most emetogenic chemotherapy agents, but this symptom is managed with prophylactic
antiemetics (ondansetron, granisetron, etc.) in combination with corticosteroids. Aprepitant combined with ondansetron and
dexamethasone has been shown to be better for highly emetogenic chemotherapy than just ondansetron and dexamethasone.
Ototoxicity (hearing loss): unfortunately there is at present no effective treatment to prevent this side effect, which may be severe.
Audiometric analysis may be necessary to assess the severity of ototoxicity. Other drugs (such as the aminoglycoside antibiotic class)
may also cause ototoxicity, and the administration of this class of antibiotics in patients receiving cisplatin is generally avoided. The
ototoxicity of both the aminoglycosides and cisplatin may be related to their ability to bind to melanin in the stria vascularis of the inner
ear or the generation of reactive oxygen species.
Electrolyte disturbance: Cisplatin can cause hypomagnesaemia, hypokalaemia and hypocalcaemia. The hypocalcaemia seems to occur in
those with low serum magnesium secondary to cisplatin, so it is not primarily due to the Cisplatin.
Your Answer. d
Correct Answer. d
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(166). The penicillin G preparation with the longest duration of action is
a. Benzathine penicillin
b. Sodium penicillin
c. Potassium penicillin
d. Procaine penicillin
Solution. Ans-166: (a) Benzathine penicillin Ref: Read the text below Sol:
Benzathine benzylpenicillin (rINN) is a form of penicillin also known as benzathine penicillin.
It is slowly absorbed into the circulation, after intramuscular injection, and hydrolysed to benzylpenicillin in vivo.
It is the drug-of-choice when prolonged low concentrations of benzylpenicillin are required and appropriate, allowing prolonged
antibiotic action over 24 weeks after a single IM dose
Your Answer. a
Correct Answer. a
(167). Which fluoroquinolone is highly active against Mycobacterium leprae and is being used in alternative multidrug therapy regimens
a. Norfloxacin
b. Ofloxacin
c. Ciprofloxacin
d. Lomefloxacin
Solution. Ans-167 (b) Ofloxacin Ref: KDTs 6th Ed. Pg. 756 Sol: Single lesion single dose treatment of leprosy utilizes ROM therapy.
R : rifampicin
O : Ofloxacin
M : Minocycline
Your Answer. b
Correct Answer. b
a. Artemether
b. Mefloquine
c. Chloroquine
d. Proguanil
Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 72/84
(169). All are true about Ifosfamide except
a. It is nitrogen mustard
Solution. Ans 169: (d) Less neurotoxic then cyclophosphamide Ref Read the text below Sol
Ifosfamide is an oxazaphosphorine, similar to cyclophosphamide.
Cyclophosphamide has two chloroethyl groups on the exocyclic nitrogen atom, whereas one of the two-chloroethyl groups of ifosfamide
is on the cyclic phosphoamide nitrogen of the oxazaphosphorine ring.
Ifosfamide is activated in the liver by CYP3A4. The activation of ifosfamide proceeds more slowly, with greater production of
dechlorinated metabolites and chloroacetaldehyde.
These differences in metabolism likely account for the higher doses of ifosfamide required for equitoxic effects, the greater neurotoxicity
of ifosfamide, and the possible differences in antitumor spectrum of the two agents
Your Answer. d
Correct Answer. d
a. Sumatriptan
b. Oxyfedrine
c. Dipyridamole
d. Thyroxine
Solution. Ans 170: (b) Oxyfedrine Ref http://www.ncbi.nlm.nih.gov/pubmed/20326 Sol Mechanism of the antianginal action of
oxyfedrine
Oxyphedrine was found to depress the tonicity of coronary vessels, increase the coronary circulation volume, the oxygen uptake by the
heart and also to exert a positive inoand chronotropic action in test with urethan and cloralose anesthetized cats.
These effects were caused by stimulation of the betaadrenoreceptors of the heart and vessels.
In non-anesthetized cats oxyphedrine did not produce tachycardia. Furthermore, under certain conditions (when superimposed on a
preliminary administration of practolol- a beta-blocking agent) oxyphedrine can exert a direct inhibitory action on the myocardium.
Your Answer. a
Correct Answer. b
a. Insulinoma
b. Glucagonoma
c. Glioma
d. Carcinoids
Solution. Ans 171: (c) Glioma Ref Harrison 17th Edition Pg. 2228, 2225 Sol
Synthetic analogues of somatostatin (octreotide, lanreotide) are the most widely used agents to control the symptoms of patients with
carcinoid syndrome.
Octreotide controls symptoms in >80% of patients, including the diarrhea and flushing, and 70% of patients have a >50% decrease in
urinary 5HIAA excretion.
Long-acting somatostatin analogues such as octreotide are acutely effective in 40% of patients of insulinoma. However, octreotide needs
to be used with care because it inhibits growth hormone secretion and can alter plasma glucagon levels; therefore, in some patients it
can worsen the hypoglycemia
Long-acting somatostatin analogues such as octreotide or lanreotide improve the skin rash in 75% of patients of glucagonoma and may
improve the weight loss, pain, and diarrhea but usually do not improve the glucose intolerance.
Your Answer. b
Correct Answer. c
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(172). All are true about exenatide except
b. It is GLP1 analogue
d. Given subcutaneously
Solution. Ans 172: (c) Used in type 1DM Ref Read the text below Sol Exenatide
It is a synthetic analog of glucagon-like-polypeptide 1 (GLP-1). Exenatide is approved as an injectable, adjunctive therapy in persons with
type 2 diabetes treated with metformin or metformin plus sulfonylureas who still have suboptimal glycemic control. In clinical studies,
exenatide therapy was shown to have multiple actions such as potentiation of glucose-mediated insulin secretion, suppression of
postprandial glucagon release through as-yet unknown mechanisms, slowed gastric emptying, and a central loss of appetite. The
increased insulin secretion is speculated to be due in part to an increase in betacell mass. Exenatide is injected subcutaneously
within 60 minutes before a meal; therapy is initiated at 5 mcg twice daily, with a maximum dosage of 10 mcg twice daily. The major
adverse effects are nausea (about 44% of users) and vomiting and diarrhea. The nausea decreases with ongoing exenatide usage. Weight
loss is reported in some users, presumably because of the nausea and anorectic effects. A serious and, in some cases, fatal adverse effect
of exenatide is necrotizing and hemorrhagic pancreatitis.
SITAGLIPTIN
Sitagliptin is an inhibitor of dipeptidyl peptidase-4 (DPP-4), the enzyme that degrades incretin and other GLP-1-like molecules. Its major
action is to increase circulating levels of GLP-1 and GIP. This ultimately decreases postprandial glucose excursions by increasing
glucose-mediated insulin secretion and decreasing glucagon levels. Common adverse effects include nasopharyngitis, upper respiratory
infections, and headaches. Sitagliptin can be given as monotherapy or combined with metformin or Tzds
Your Answer. c
Correct Answer. c
a. Phenobarbitone
b. Flumazenil
c. Beta-carboline
d. Gabapentin
Your Answer. c
Correct Answer. c
Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 74/84
(174). Absolute contraindication to morphine use is
b. Myocardial infarciton
c. Head injury
Solution. Ans-174: (c) Head injury Ref: Read the text below. Sol: Morphine is contraindicated in
Respiratory depression
Head injury
Hypersensitivity
Paralytic ileus
Delayed gastric emptying
Obstructive airway disease,
Acute hepatic disease
Mao inhibitor administration
Pregnancy
Lactation
Children.
Your Answer. c
Correct Answer. c
(175). Which of the following colloid solutions has proven thromboprophylactic effect?
a. Dextran
b. Gelatin preparation
c. Haemacceal
d. Hydroxyethyl starch
Your Answer. a
Correct Answer. a
(176). Hypercoagulability and dermal vascular necrosis are early appearing adverse effects of
a. Clopidogrel
b. Heparin
c. Warfain
d. Vitamin K
Your Answer. c
Correct Answer. c
Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 75/84
(177). Which of the following is the clinical indication for the use of recombinant human erythropoietin?
a. Megaloblastic anemia
b. Hemolytic anemia
Solution. Ans-177: (d) Anemia in chronic renal failure patients Ref: KDT-592 Sol:
Erythropoietin is available as a therapeutic agent produced by recombinant DNA technology in mammalian cell culture.
It is used in treating anemia resulting from chronic kidney disease and myelodysplasia, from the treatment of cancer (chemotherapy and
radiation).
Your Answer. d
Correct Answer. d
a. Ciprofloxacin
b. Amoxicillin
c. Erythromycin
d. Cimetidine
Your Answer. b
Correct Answer. b
(179). A patient undergoing cancer chemotherapy is vomiting frequently. A drug that might help in this situation is
a. Bromocriptine
b. Ketanserin
c. Loratidine
d. Ondansetron
Your Answer. d
Correct Answer. d
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(180). The most important channel of elimination of digoxin is
a. Glomerular filtration
b. Tubular secretion
c. Hepatic metabolism
d. Excretion in bile
Your Answer. c
Correct Answer. a
(181). Prolonged use of hydralazine for the treatment of hypertension is likely to cause
a. Gynaecomastia
b. Thrombocytopenia
c. Hemolytic anemia
d. Lupus erythematosis
Solution. Ans-181: (d) Lupus erythematosis Ref: KDT-548 Sol: Common side-effects include:
Diarrhea
Compensatory tachycardia due to baroreceptor reflex ->Angina
Headache
Loss of appetite
Nausea or vomiting
Depression
Pounding heartbeat
Drug-Induced Lupus Erythematosus
ANCA-associated Vasculitis - Generally MPO-ANCA positive
Patients given hydralazine over a period of six months may develo
Hydralazine is differentially acetylated by fast and slow acetylator phenotypes, hence incidence of lupus-like disease in slow acetylators
Your Answer. d
Correct Answer. d
a. Indapamide
b. Furosemide
c. Hydrochlorthiazide
d. Acetazolamide
Your Answer. b
Correct Answer. d
Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 77/84
(183). Which of the following agents is useful for the oral treatment of both pituitary as well as renal diabetes insipidus?
a. Vasopressin
b. Hydrochlorthiazide
c. Chlorpropamide
d. Carbamazepine
Your Answer. b
Correct Answer. b
c. Uterine inertia
Solution. Ans-184: (a) Spontaneous premature labour Ref: KDT-328 Sol: INDICATIONS Antepartum
Oxytocin) is indicated for the initiation or improvement of uterine contractions, where this is desirable and considered suitable, in order
to achieve early vaginal delivery for fetal or maternal reasons.
It is indicated for (1) induction of labor in patients with a medical indication for the initiation of labor, such as Rh problems, maternal
diabetes, pre-eclampsia at or near term, when delivery is in the best interest of mother and fetus or when membranes are prematurely
ruptured and delivery is indicated; (2) stimulation or reinforcement of labor, as in selected cases of uterine inertia; (3) as adjunctive
therapy in the management of incomplete or inevitable abortion.
In the first trimester, curettage is generally considered primary therapy. In the second trimester abortion, oxytocin infusion will often be
successful in emptying the uterus. Other means of therapy, however, may be required in such cases.
Postpartum Oxytocin injection is indicated to produce uterine contractions during the third stage of labor and to control postpartum
bleeding or hemorrhage.
Spotaneous premature labour is an indication for use of tocolytics and not oxytocin.
Your Answer. a
Correct Answer. a
Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 78/84
(185). The antithyroid drug with the most rapid onset of antithyroid action is
a. I131
b. Sodium iodide
c. Methimazole
d. Propylthiouracil
Your Answer. b
Correct Answer. b
b. Diabetes mellitus
c. Hypertension
d. Peptic ulcer
Your Answer. a
Correct Answer. a
a. Carbamazipine
b. Phentoin
c. Valproate
d. Lamotrigine
Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 79/84
(188). Phenobarbitone in mother causes all in baby except :
a. Hypoglycemia
b. Ataxia
c. Neonatal drowsiness
d. Vitamin K deficiency
Your Answer. d
Correct Answer. a
a. Phase 1
b. Phase 2
c. Phase 3
d. Phase 4
Your Answer. c
Correct Answer. c
a. It is a factor X a inhibitor
b. It is thrombin inhibitor
Solution. Ans-190: (d) It is a factor X a inhibitor Ref: Read the text below Sol:
Apixaban (INN, trade name Eliquis) is an anticoagulant for the prevention of venous thromboembolism and venous thromboembolic
events.
It is a direct factor Xa inhibitor. Apixaban has been available in Europe since May 2011 and was approved for preventing venous
thromboembolism after elective hip or knee replacement.
The FDA approved apixaban in December 2012 with an indication of reducing the risk of stroke and dangerous blood clots (systemic
embolism) in patients with atrial fibrillation that is not caused by a heart valve problem
Your Answer. a
Correct Answer. d
Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 80/84
(191). Clofazimine therapy can cause all except
a. Skin
b. Icthyosis
c. Subacute
d. Peripheral
Solution. Ans-191: (d) Peripheral neuropathy Ref: Read the text below Sol:
Nimodipine (marketed by Bayer as Nimotop) is a dihydropyridine calcium channel blocker originally developed for the treatment of high
blood pressure.
It is not frequently used for this indication, but has shown good results in preventing a major complication of subarachnoid hemorrhage
(a form of cerebral hemorrhage) termed vasospasm; this is now the main use of nimodipine.
Nimodipine binds specifically to L-type voltage-gated calcium channels. There are numerous theories about its mechanism in preventing
vasospasm, but none are conclusive.
a. Aliskrein
b. Losartan
c. Perindopril
d. Vernakalant
Your Answer. a
Correct Answer. a
a. Phenformin
b. Urokinase
c. Streptokinase
d. Alteplase
Solution. Ans-193: (a) Phenformin Ref: Read the text below Sol :
Phenformin, along with buformin and metformin, inhibits the growth and development of cancer.
The anticancer property of these drugs may be due to their ability to disrupt the Warburg effect and revert the cytosolic glycolysis
characteristic of cancer cells to normal oxidation of pyruvate by the mitochondria.
Metformin reduces liver glucose production in diabetics and disrupts the Warburg effect in cancer by AMPK activation and inhibition of
the mTor pathway
Your Answer. a
Correct Answer. a
Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 81/84
(194 All of the following medications used for bronchial asthma act as
). bronchodilators except
a. Albuterol
b. Fluticasone propionate
c. Theophylline
d. Toflimilast
Solution. Ans-194: (b) Fluticasone propionate Ref.: Read the text below
Sol : Fluticasone propionate.
Your Answer. b
Correct Answer. b
(195). According to a recent FDA recommendation, the dosage of paracetamol in a single tablet should not exceed
a. 325 mg
b. 450 mg
c. 500 mg
d. 650 mg
Solution. Ans-195: (a) 325 mg Ref.: Read the text below Sol :
According to a recent FDA recommendation issued in January 2014, the dosage of paracetamol in a single tablet should not exceed 325
mg.
Your Answer. d
Correct Answer. a
a. 7 10%
b. ~ 20%
c. ~ 60%
d. 15 70%
Solution. Ans-196: (a) 7 10% Ref.: Read the text below Sol : Side effects of Lithium
Hypothyroidism 7 10%
Reversible T wave flattening ~ 20%
Polyuria / DI ~ 60%
Fine tremors 15 70%
Your Answer. d
Correct Answer. a
Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 82/84
(197). All of the following diuretics act from the luminal side of the nephron except
a. Bumetanide
b. Eplerenone
c. Amiloride
d. Acetazolamide
Solution. Ans-197: (b) Eplerenone Ref.: Read the text below Sol : Eplerenone. Aldosterone receptor antagonists act from the basolateral
side.
a. Rudolph Buchheim
b. Oswald Schmiedeberg
c. Paul Ehrlich
d. Gerhard Domagk
Solution. Ans-198: (b) Oswald Schmiedeberg Ref.: Read the text below Sol : Oswald Schmiedeberg. He gave many fundamental concepts
of pharmacology.
Rudolph Buchheim opened the first institute for research in pharmacology in Germany.
Paul Ehrlich developed arsphenamine and neoarsphenamine for syphilis; and atoxyl for sleeping sickness. He also coined the term
chemotherapy
Gerhard Domagk used prontosil for treatment of streptococcal infections. Sulphonamides were later developed from these dyes.
Your Answer. a
Correct Answer. b
Solution. Ans-199: (d) A block of sodium/calcium exchange Ref.: Read the text below Sol : A block of sodium/calcium exchange. Digitalis
causes inhibition of Na+-K+-ATPase pump leading to secondary
Increase in the systolic intracellular calcium levels
Inhibition of sodium/calcium exchange and
Increase in calcium uptake by sarcoplasmic reticulum
Your Answer. a
Correct Answer. d
Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 83/84
(200). Which of the following pairs of drug and its classification is correct?
a. Tigecycline Tetracycline
c. Dalbavancin Oxazolidinedione
d. Spiramycin Macrolide
Solution. Ans-200: (d) Spiramycin Macrolide Ref.: Read the text below Sol : Spiramycin Macrolide
Tigecycline is a glycylcycline.
Nalidixic acid is a quinolone.
Dalbavancin is a glycopeptide.
Your Answer. b
Correct Answer. d
Test Answer
1.(c) 2.(d) 3.(b) 4.(d) 5.(c) 6.(b) 7.(c) 8.(b) 9.(b) 10.(a)
11.(d) 12.(d) 13.(c) 14.(a) 15.(b) 16.(b) 17.(c) 18.(b) 19.(a) 20.(b)
21.(b) 22.(a) 23.(a) 24.(c) 25.(d) 26.(d) 27.(b) 28.(c) 29.(a) 30.(b)
31.(c) 32.(d) 33.(b) 34.(b) 35.(a) 36.(b) 37.(c) 38.(c) 39.(d) 40.(d)
41.(a) 42.(d) 43.(b) 44.(d) 45.(a) 46.(b) 47.(a) 48.(a) 49.(c) 50.(a)
51.(a) 52.(b) 53.(c) 54.(d) 55.(d) 56.(b) 57.(d) 58.(c) 59.(c) 60.(c)
61.(a) 62.(c) 63.(d) 64.(a) 65.(d) 66.(d) 67.(d) 68.(b) 69.(d) 70.(c)
71.(d) 72.(a) 73.(c) 74.(b) 75.(a) 76.(c) 77.(b) 78.(d) 79.(b) 80.(c)
81.(a) 82.(d) 83.(d) 84.(a) 85.(c) 86.(c) 87.(d) 88.(a) 89.(c) 90.(a)
91.(d) 92.(d) 93.(c) 94.(c) 95.(b) 96.(c) 97.(d) 98.(d) 99.(d) 100.(a)
101.(d) 102.(d) 103.(c) 104.(d) 105.(d) 106.(c) 107.(b) 108.(d) 109.(d) 110.(a)
111.(b) 112.(d) 113.(d) 114.(d) 115.(d) 116.(a) 117.(a) 118.(b) 119.(b) 120.(d)
121.(c) 122.(b) 123.(a) 124.(d) 125.(a) 126.(a) 127.(d) 128.(b) 129.(b) 130.(c)
131.(d) 132.(c) 133.(c) 134.(d) 135.(d) 136.(c) 137.(c) 138.(d) 139.(d) 140.(b)
141.(a) 142.(a) 143.(d) 144.(d) 145.(b) 146.(c) 147.(d) 148.(d) 149.(c) 150.(d)
151.(b) 152.(b) 153.(b) 154.(c) 155.(b) 156.(c) 157.(d) 158.(d) 159.(b) 160.(b)
161.(d) 162.(c) 163.(a) 164.(a) 165.(d) 166.(a) 167.(b) 168.(a) 169.(d) 170.(b)
171.(c) 172.(c) 173.(c) 174.(c) 175.(a) 176.(c) 177.(d) 178.(b) 179.(d) 180.(a)
181.(d) 182.(d) 183.(b) 184.(a) 185.(b) 186.(a) 187.(c) 188.(a) 189.(c) 190.(d)
191.(d) 192.(a) 193.(a) 194.(b) 195.(a) 196.(a) 197.(b) 198.(b) 199.(d) 200.(d)
Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 84/84