Pharm Tutoring Exam Sample Questions

1. Which of the following patients would most likely NOT have an elevated alkaline phosphatase? A. 6y/o male with growing pains B. 44y/o female with upper abdominal pain consistent with gallstones C. 86y/o male with history of prostate cancer with metastasis to distant sites D. 23y/o female with menstrual cramping x̅ 2. A patient presents to the clinic with complaints of persistent fatigue and numbness around the mouth for several weeks. The nursing assistant informs you that upon inflation of the blood pressure cuff, the patient’s hand involuntarily contracted. Because you are an awesome PA student, you can suspect that this pt likely has which electrolyte abnormality? A. Hyperkalemia B. Hypokalemia C. Hypercalcemia D. Hypocalcemia E. Hypernatremia F. Hyponatremia Bonus question: What is the name of the sign that causes involuntary hand contraction with BP cuff inflation? __________ Trousseau's sign 3. A 27y/o female visits her dermatologist regarding her chronic severe cystic, nodular acne. She expresses that she would like to be taken off of the agent she is currently on so she can try to become pregnant. The most likely MOA of this drug is: A. Androgen receptor inhibitor B. Induce sebocyte apoptosis and reduce hyperkeratinization C. Inactivate collagenase and trypsin-containing enzymes D. Reduce IL production by inhibiting calcineurin Bonus: Name the drugs associated with each of the above MOAs 4. A 30y/o male presents to the clinic with complaint of a rash on his buttocks. The pt explains he was out hiking 2 days ago and in a time of desperation used an unknown leaf to wipe. He explains it is increasingly pruritic and fiery hot. On physical exam, the vesicular and erythematous rash extends from the buttocks to the posterior perineum and thighs. What is the best agent to prescribe for this patient? A. Topical Diphenhydramine B. Topical High Potency Hydrocortisone C. PO Doxycycline D. PO Prednisone 5. A patient with recently diagnosed HSV1 visits the clinic secondary to a recent flare up. The pt states that she suffers from cold sores that are painful and cause her to be more self conscious. Today, she is prescribed Acyclovir. What patient education should you provide this patient? A. Apply Acyclovir to the site of expected outbreak as soon as prodromal symptoms begin B. Apply Acyclovir to the site of expected outbreak daily and indefinitely C. Acyclovir reduces the occurrence of cold sores D. Alternating between topical Hydrocortisone and Acyclovir application will result in quicker resolution of cold sores 6. 28 year old female patient presented to ER with rashes on arms after being in contact with poison ivy while hiking this morning. Which of the following is a contraindication for using topical corticosteroids? A. Hypoglycemia B. Open wounds C. Hyperglycemia D. Striae 7. Which of the following is the most potent topical steroid? A. Group VII ointment B. Group I ointment C. Group I solution D. Group VII solution 8. 20 year old male patient was recently diagnosed with mild- moderate eczema at his PCP’s office. He was prescribed a topical immune modulator which is a calcineurin inhibitor. Why does this medication belong to the REMS category? A. Increased risk of lymphoma B. Teratogenic C. Increased risk of opportunistic infection D. Can cause Hepatitis C 9. A 9-year-old girl who is brought in by her mom, who noticed the child scratching her head at school pickup. She reports that this itchiness has gone on for around 1 week now. Physical exam reveals several ovoid, grayish-white eggs < 1 cm away from the base of the hair shaft at the back of the head and behind the ears. Which of the following is the first line treatment for this condition? A. Topical Ivermectin B. Malathion C. Permethrin D. Spinosad topical suspension Is re-treatment required if the first line treatment is used? Yes 10. A 69-year-old man with male-patterned baldness is concerned because the skin on his scalp is feeling rough, like “sandpaper.” While he is now retired, he was a gardener and often spent hours working under the sun. Physical exam reveals discrete yellow-brown, scaly patches on sun-exposed areas of the face, scalp, ears, forearms, and the dorsum of the hands. Which of the following medications with MOA of inducing thiamine deficiency was prescribed to treat this condition? A. Imiquimod B. Liquid nitrogen C. Tirbanibulin D. 5-FU 0 PT 11. A 65-year-old male patient with a history of atrial fibrillation is currently taking warfarin for anticoagulation. During his follow-up visit, which lab value should be regularly checked to ensure his medication is within the therapeutic range? A. PT/INR B. aPTT C. Albumin D. Bilirubin Which coagulation pathway does PT/INR evaluate? Which coagulation pathway does aPTT evaluate? inftin'sEtcommon 12. Which of the following patients should we suspect to have the highest serum creatinine value? A. 35 year old female with dehydration B. 58 year old female with myasthenia gravis C. 67 year old male with pyelonephritis D. 70 year old healthy female 0 ANSWERS 1. D.- Alk Phos is elevated in conditions such as bone growth, metastasis to bone, and cholelithiasis. An adult female with menstrual cramps is not associated with elevated Alk Phos 2. D.- perioral numbness and Trousseau’s sign are pathognomonic for hypocalcemia 3. B. - The vignette is describing isotretinoin. Isotretinoin is a retinoid that has the listed MOA. Bonus: A= Clascoterone, B= Isotretinoin, C= Silver Sulfadiazine, Mafenide, D= Tacrolimus, Pimecrolimus 4. D.- Systemic anti-inflammatory agents are this patient’s best choice for quick recovery and is indicated as it involves his genitals. C. Topical High Potency Hydrocortisone is not indicated in this patient’s case as the case includes the genitals and already exhibits vesicles/ Topical steroids are best used for poison ivy that does not yet have vesicle formation. A. And C. Are not recommended for poison ivy/oak/sumac treatment. 5. A. 6. B- Contraindications for topical corticosteroids are skin infection and open wounds 7. B- Most potent is Group I. Ointment has highest potency when comparing other drug vehicle due to increased contact time 8. A- Tacrolimus which is a calcineurin inhibitor is only used short term due to increased risk of lymphomas and skin malignancy. Therefore it belongs to the REMS category 9. C- Permethrin- First line management for lice. Retreatment is required as permethrin only kills the lice and not the eggs 10. D- Fluorouracil or 5-FU is used for AK and MOA: Induces thymine deficiency which results in cell death 11. A- INR value is checked for pts on Warfarin. PT/INR- extrinsic pathway, aPTT- intrinsic and common pathway Mnemonic: PT: play tennis -outside( extrinsic) aPTT: play table tennis - inside(intrinsic) 12. C. Males usually have higher Sr. Cr than females. Pyelonephritis can cause higher than normal levels for creatinine.