Therapeutics question examples

Examples of therapeutics short-answer and single best answer multiple-choice questions follow. The examples include the candidate's question and the examiner's answer key.

Question: An otherwise healthy 65 year old woman presents with a 3 week history of aching and morning stiffness in both shoulders with difficulty dressing. She has no temporal artery tenderness, headache, jaw pain or visual disturbance. Her ESR (Erythrocyte sedimentation rate) is 100 and you have made the diagnosis of POLYMYALGIA RHEUMATICA (PMP). What would you choose as the drug of first choice for initial medical therapy? (Drug, dose, route of administration and duration are required.)

Answer: ______________________________________________________________

Answer key the marker receives:
PREDNISONE 7.5 – 20 mg PO od for 2-4 weeks following resolution of symptoms

Question: An otherwise healthy 55 year old male with a history of childhood “chickenpox” presents with a 2 day history of painful unilateral vesicular eruption in a restricted dermatonal distribution. You make a diagnosis of HERPES ZOSTER (shingles). What would you choose as the drug of first choice to promote healing and lessen the neuropathic pain? (Drug, dose, route of administration and duration are required.)

Answer:___________________________________________________________

Answer key the marker receives:
VALACYCLOVIR (VALTREX ®) 1000 mg PO tid X 7 days
OR
FAMCICLOVIR (FAMVIR ®) 500 - 750 mg PO tid X 7 days
OR
ACYCLOVIR (ZORIVAX ®) 800 mg PO 5X / day X 7 days)

Question: You have recently diagnosed an otherwise healthy 45 year old male with essential hypertension and have decided to initiate antihypertensive management with PERINDOPRIL 4 mg PO once daily; an angiotensin converting enzyme inhibitor (ACE inhibitor). List the 2 most likely serious adverse effects to which this patient is at risk after initiation of the ACE inhibitor.

Answer:
  1. _________________________________________________________
  2. _________________________________________________________

Answer key the marker receives:
Acute renal failure / rise in serum creatinine
Hyperkalemia

Question: You have made the diagnosis of acute, uncomplicated cystitis in a 25 year old female. She has been previously healthy and has no known drug allergies. Write a prescription for antibiotic treatment. She is not pregnant.

Answer key the marker receives:

TRIMETHOPRIM – SULFAMETHOXAZOLE (BACTRIM DS ®) 160/800 mg PO bid X 3 days
OR
CIPROFLOXACIN (CIPRO ®) 250 mg PO bid X 3 days
OR
LEVOFLOXACIN (LEVAQUIN®) 250 mg PO once daily X 3 days
OR
NITROFURANTOIN (MACROBID ®) 100 mg bid X 5 days
OR
AMOXICILLIN / CLAVULANATE (CLAVULIN ®) 500 mg bid X 7 days

A 65-year-old woman presents with a three-hour history of acute pain in the right eye, blurred vision and seeing haloes around objects.  On examination, the cornea is edematous and hazy, the right pupil is irregular and the sclera injected. Intraocular pressure is raised at 25mmHg. Which one of the following would be the most appropriate immediate treatment? 

  1. Atropine.
  2. Ketotiphen.
  3. Chloramphenicol.
  4. Fluohydrocortisone.
  5. *Acetazolamide.

In a 55-year-old sedentary woman, which one of the following measures would have the greatest impact on all causes of mortality?

  • Statins in women with no heart disease.
  • Blood pressure control.
  • Mediterranean diet.
  • *Smoking cessation.
  • Low-dose  acetylsalicylic acid.

A 17-year-old male presents with a sore throat, fever, malaise and night sweats. He was started on an amoxicillin 5 days ago at a walk-in clinic. He now has a diffuse non-pruritic rash. Examination reveals large erythematous tonsils with exudate. His temperature is 37.8 °C. You recommend stopping the amoxicillin. What would be the next most appropriate action?

  • Change to erythromycin.
  • Advise about allergy to penicillin group.
  • Change to clindamycin.
  • Do a throat swab.
  • *Order a complete blood count.