5 - diuretic resistance mcqs

Question 1
What is diuretic resistance?
Short-term decrease in response to a diuretic
Occurrence of braking phenomenon before edema is relieved--------------
Occurrence of braking phenomenon after edema is relieved
Any of the above

Question 2
Diuretic resistance can be due to
Reduced renal function
Reduced peak concentration of loop diuretic in the tubular fluid
Delayed peak concentration of loop diuretic in the tubular fluid
Any of the above------------


Question 3
In renal failure diuretic resistance can be due to
Reduced renal blood flow
Reduced sodium filtration
Accumulation of organic acids that inhibit tubular secretion of the diuretic
Any of the above------------

Question 4
Which of these drugs could lead to apparent diuretic resistance?
Non steroidal anti-inflammatory drugs----------
Prostaglandin E2
None of the above
Both of the above


Question 5
Loop diuretics reach the tubular lumen by
Glomerular filtration
Passive diffusion
Active secretion----------
All the above

Question 6
Chronic administration of loop diuretics results in hypertrophy and hyperplasia in the epithelial cells of the
Proximal convoluted tubule of nephron
Loop of Henle
Distal convoluted tubule of Nephron-------------
None of the above

Question 7
Which of these can overcome diuretic resistance in congestive heart failure?
Increasing the dose of diuretic
More frequent administration of the diuretic
Intravenous administration of the diuretic
All of the above--------------

Question 8
Which of these can be given in combination with a loop diuretic to achieve sequential nephron blockade?
Thiazide diuretic
Thiazide type diuretic
Potassium sparing diuretic
Any of the above--------------

Question 9
In a person requiring diuretic medication, the amount of sodium intake should be
<100mmol/day-----------
<150mmol/day
<200mmol/day
<250mmol/day

Question 10
In which of these conditions loop diuretic may be rendered ineffective after reaching the lumen due to high intraluminal albumin concentration?
Congestive heart failure
Nephrotic syndrome--------------
Hepatic cirrhosis
None of the above

Question 11
Metolazone is a
Thiazide diuretic
Thiazide type diuretic---------
Potassium sparing diuretic
Osmotic diuretic

Question 12
Metolazone is indicated in edema associated with
Congestive heart failure
Chronic kidney disease
Nephrotic syndrome
All the above-----------

Question 13
Which of the following statement is not true with regard to Metolazone?
It is ineffective when glomerular filtration rate is <30ml/min---------
It causes reabsorption of calcium
It inhibits the reabsorption of sodium and chlorine in the distal convoluted tubule of nephron
None of the above

Question 14
Which of the following diuretic can be used in any stage of kidney failure?
Metolazone-------------
Indapamide
Furosemide
None of the above

Question 15
Which of the following statements is true with regard to Metolazone?
Dosage adjustment is not required at any stage of chronic kidney disease
Diuretic effect is observed at doses ranging from 1mg to 25 mg
It exerts its action in the distal and proximal convoluted tubule of the nephron
All are true------------

4 - statins mcqs

Question 1
Apart from reducing cholesterol levels, statins also:
Reduce inflammation
Improve endothelial function
Stabilise atherosclerotic plaque
All the above------------

Question 2
Of the following patients, which group is more likely to have adverse effects of statins?
Elderly
Those receiving immunosuppressive drugs
Those receiving high doses of statins
All the above------------

Question 3
In people taking statins, transaminase values should be estimated:
Before starting therapy
12 weeks after initiation of therapy
At any elevation in dose
At all the above-----------------

Question 4
Which of the following statements is true? Coadministration of ezetimibe with 10mg atorvastatin:
Provides the same reduction in LDL-C as obtained with 80mg of atorvastatin----------------
Provides the same reduction in LDL-C as obtained with 60mg of atorvastatin
Provides the same reduction in LDL-C as obtained with 40mg of atorvastatin
Provides greater reduction in LDL-C as obtained with 80mg of atorvastatin

Question 5
Which of the following statements is true?
There is an increased risk of side effects with combination of statin and gemfibrozil as compared to statin and fenofibrate--------------
There is increased risk of side effects with combination of statin and fenofibrate as compared to statin and gemfibrozil
Increase in risk of side effects is similar when statin is given with fenofibrate or gemfibrozil
Risk of side effects is not increased when statin is given with fenofibrate or gemfibrozil

Question 6
For which statin, a lower dosage is recommended in Asians as compared to people from western countries?
Atorvastatin
Simvastatin
Rosuvastatin----------
Fluvastatin

Question 7
Which of the following statins should be given in the evening?
Atorvastatin
Simvastatin-------------
Rosuvastatin
All the above

Question 8
The therapeutic potential of statins might extend beyond cholesterol lowering and coronary artery disease to other inflammatory disorders such as:
Multiple sclerosis
Rheumatoid arthritis
Chronic kidney disease
All the above-----------------

Question 9
In patients with renal disease, statins benefit by:
Reducing hyperlipidaemia
Improving glomerular filtration rate(GFR)
Reducing proteinuria
All the above-------------

Question 10
When LDL-C drug is used to treat high risk persons or moderately high risk patients, the serum LDL-C should be reduced by at least:
5-10%
10-20%
20-30%
30-40%------------

Question 11
Which of the following statements is not true?
The beneficial effects of statin in ischemic stroke or transient ischemic attack (TIA) are independent of cholesterol levels
Statin treatment should be initiated soon after an ischemic stroke or TIA
There is no potential risk of recurrent haemorrhage with statins in patients with haemorrhagic stroke-----------------
From the standpoint of statin treatment, stroke or TIA should be considered a coronary heart disease risk equivalent

Question 12
In patients with acute coronary syndrome, statin should be given:
As early as possible-----------
After 24 hours
After stabilisation of patient’s condition
On discharge

Question 13
The principle benefit with statins in acute coronary syndrome are due to their:
Anti-inflammatory effects----------
Lipid lowering effects
Anti-hypertensive effect
Both a and b

Question 14
Which of the following statement is not true?
Statins are the first choice pharmacological therapy for diabetic dyslipidemia
Patients with type 2 diabetes may be canditate for statin therapy regardless of LDL cholesterol
Statin can be combined with fibrate or niacin for more comprehensive lipid control in diabetic patients.
As per latest NCEP guidelines, target LDL-C level in diabetic patients in the absence of cardiovascular disease should be 70 mg/dl-------------------

Question 15
Which of the following statement is not true?
Statins should be given to all patients with a prior atheromatous disease
Statins should be given to all patients at increased risk of cardiovascular disease irrespective of lipid profile
Statins should be given only to patients with cardiovascular disease with coexisting hyperlipidemia--------------
Statins should be given to all patients with a history of ischemic stroke.

3 - anti-coagulants mcqs

Question 1
Anticoagulants are indicated for an indefinite period in patients with:
Atrial fibrillation------------
Venous thromboembolism
High risk of myocardial infarction
All of the above

Question 2
Which of the following sentence is true with regard to warfarin?
Is a vitamin K antagonist------------
Is a thrombin inhibitor
Activates fibrinolysis
Binds to antithrombin III

Question 3
Which of the following is not an approved indication for warfarin therapy?
Atrial fibrillation
Heart valve replacement
Deep vein thrombosis
Peripheral artery disease--------------

Question 4
Time taken for observable anticoagulant effect of warfarin is:
6-12 hours
24-36 hours
2-7 days--------------
8-10days

Question 5
Which of the following is the recommended test to monitor the effect of oral anticoagulant therapy?
Thrombin time
International normalized ratio (INR)----------------
Bleeding time
Partial thromboplastin time (PTT)

Question 6
What is the most acceptable frequency of INR monitoring in a patient taking warfarin?
Initially thrice daily, then twice daily, then daily, then weekly, and then monthly
Initially twice daily, then daily, then weekly, and then monthly
Initially daily, then weekly, and then monthly
Initially twice per week, then weekly, then every two or three weeks, and then monthly----------

Question 7
What is the value of International normalized ratio (INR) above which warfarin does not provide any additional therapeutic benefit in most patients, but is associated with a higher risk of bleeding?
4.0----------
3.5
3.0
2.5

Question 8
Which of the following is used for reversal of anticoagulant effect of warfarin in case of life-threatening bleeding?
Platelets
Protamine
Vitamin K or Vitamin K dependant coagulation factors-----------
Any of the above

Question 9
Which of the following statement(s) concerning heparin is/are true?
It binds to antithrombin III leading to anticoagulant effect
It exhibits varying anticoagulant response
Heparin therapy is monitored with activated partial thromboplastin time (APTT)
All of the above-----------

Question 10
Which of the following is an advantage of low molecular weight heparin (LMWH) over unfractionated heparin?
Does not require monitoring of activated partial thromboplastin time
Has a greater bioavailibility
Given subcutaneously therefore can be administered in “out of hospital setting”
All of the above------------

Question 11
Low molecular weight heparins (LMWHs) do not require monitoring, but when necessary, which of the following is measured?
Anti-factor Xa level-------------
Thrombin time
Prothrombin time
Activated partial thromboplastin time (APTT)

Question 12
The anticoagulant effect of heparin is rapidly reversed with:
Protamine----------------
Infusion of vitamin K dependant coagulation factors
Packed red blood cells
Platelets

Question 13
Which of the following anticoagulant should not be given during pregnancy?
Warfarin-------------
Low molecular weight heparins (LMWHs)
Unfractionated heparin
All of the above

Question 14
Which of the following is correct with regard to patients taking warfarin undergoing surgery with minimal risk of bleeding?
Do not stop warfarin but check INR prior to surgery----------------
Switch over to heparin two days prior to surgery and restart warfarin after surgery
Switch over to heparin five days prior to surgery and restart warfarin after surgery
Switch over to heparin seven days prior to surgery and restart warfarin after surgery

Question 15
Anticoagulation in warfarin users at high risk of thromboembolism, undergoing surgery associated with high risk of bleeding involves:
Stop warfarin 4-5 days prior to surgery
Start with full dose unfractionated heparin or LMWH 2-3 days preoperatively
Restart regular warfarin therapy after surgery once adequate haemostasis is achieved
All of the above-----------

2 - anti-malarials mcqs

1- which of these drugs is the latest addition to the list fo antimalarials ?
a-mepacrine
b-primaquine
c-ARTEMISININ
d-pyrimethamine

2-Question 2
Which of these phases of malarial parasite is the target for prophylactic treatment?
PRE-ERYTHROCYTIC PHASE IN LIVER
Erythrocytic phase
Exo-erythrocytic phase
Any of the above

Question 3
Which of these drugs is not used for prophylaxis of malaria?
QUININE
Chloroquine
Primaquine
Chloroguanide

Question 4
Chloroquine as a prophylactic drug is used in the following dose:
100mg (base) weekly
200mg (base) weekly
300MG BASE WEEKLY--
400mg (base) weekly


Question 5
Which of the following enzyme deficiency should be ruled out before starting Primaquine therapy?
GLUCOSE 6 PHOSPHATE DEHYDROGENASE (G6PD)
lysosomal enzymes
Pancreatic lipase
Pancreatic amylase

6-Drugs attacking which phase of malarial parasite can provide radical cure?
Pre-erythrocytic phase (In liver)
Erythrocytic phase
EXO- ERYTHROCYTIC PHASE
None of the abovE

7-Question 7
Which of these drugs can provide radical cure for falciparum malaria but not for relapsing malaria?
Chloroquine
Mepacrine
ARTEMISININ
Any of the above

Question 8
Primaquine as a radical cure for malaria is used in the following dosage:
15 mg daily for one week
15 MG DAILY FOR TWO WEEKS
15 mg daily for three weeks
15 mg daily for four weeks

Which of these statements is not true with regard to chloroquine?
Plasma half-life varies from 3-10 days
Selective accumulation in retina is responsible for ocular toxicity with prolonged use
CANNOT BE USED IN PREGNANCY
May precipitate an attack of psoriasis

Question 10
Artemisinin group of drugs attack which phase of malarial parasite life cycle in humans?
Pre-erythrocytic phase (In liver)
ERTHROCYTIC PHASE
Exo-erythrocytic phase
All of the above

Question 11
Which of these drugs is not preferred as a therapy in cerebral malaria patients?
Quinine
CHLOROQUINE
Artemether
Artesunate

Question 12
Loading dose of quinine in cerebral malaria is
10mg/kg by i.v. infusion
20MG/KG BY I.V. INFUSION
30mg/kg by i.v. infusion
40mg/kg by i.v. infusion

Question 13
Which of these statements is not true with regard to Artemisinin?
Artemisinins act very rapidly, reducing parasitaemia by a factor of 104 with each cycle
Artemisinin drugs are short acting
When used as monotherapy the dose is 2.4 mg/kg on day one followed by 1.2 mg/kg for six days
CAN ONLY BE GIVEN IN INJECTABLE FORM

Question 14
According to WHO recommendations, if artesunate is given for less than seven days, treatment should be followed by a therapeutic dose of:
MEFLOQUINE
Pyrimethamine
Chloroquine
Quinine

Question 15
Artesunate can be given in combination with:
Mefloquine
Chloroquine
Sulfadoxine-Pyrimethamine
ALL THE ABOVE .

1 - diuretics mcqs

READ PAGE N O 1473 - HARRISONS 16 TH EDITION -----

Question 1
1. Thiazides are the most frequently used diuretics for treating hypertension. They lower blood pressure by:
A. Decreasing the intravascular volume.
B. Decreasing the peripheral vascular resistance by direct action on vascular smooth muscles
C. Decreasing the responsiveness of smooth muscles to noradrenaline
D. All of the above-----

Question 2
2. Which is the most appropriate diuretic for treating acute pulmonary oedema?
A. Loop diuretics----
B. Thiazide diuretics
C. Potassium sparing diuretics
D. Osmotic diuretics

Question 3
3. Thiazide diuretics will have a beneficial effect in all these conditions, except
A. Osteoporosis
B. Gout-----
C. Diabetes insipidus
D. Calcium nephrolithiasis

Question 4
4. Which diuretic competes with Aldosterone and is used for treatment of Hyperaldosteronism?
A. Hydrochlorthiazide
B. Isosorbide
C. Furosemide
D. Spironolactone-------

Question 5
5. Ototoxicity is a unique side effect of which group of diuretics?
A. Loop diuretics------
B. Thiazide diuretics
C. Potassium sparing diuretics
D. Osmotic diuretics

Question 6
6. Which of the following actions is related to Thiazide diuretics?
A. Hyperuricemia--------
B. Hyperkalemia
C. Hypoglycemia in Diabetics
D. Hypercalcemia

Question 7
7. All the following diuretics will be effective in a person suffering from Addison's disease, except
A. Chlorthiazide
B. Urea
C. Spironolactone-----
D. Furosemide

Question 8
8. Mannitol is contraindicated in all the following conditions, except
A. Pulmonary congestion
B. Cerebral oedema-------
C. Active cranial bleeding
D. Anuria due to severe renal disease

Question 9
9. Which of these is not true with regard to loop diuretics?
A. Can cause hyperuricemia (rarely leading to Gout)
B. Can cause hyperglycaemia ( May precipitate Diabetes mellitus)
C. Increase plasma level of LDL Cholesterol
D. Increase plasma level of HDL Cholesterol-------

Question 10
10. Primary site of action of Thiazide diuretics in the nephron is:
A. Proximal tubule
B. Loop of Henle
C. Distal tubule--------
D. All of the above

Question 11
11. Although a diuretic, Thiazides benefit by reducing the urine output in which of these conditions?
A. Nephrotic syndrome
B. Nephrogenic Diabetes insipidus---------
C. Diabetes mellitus
D. None of the above because urine output is always increased with diuretics.

Question 12
12. Which class of diuretics is useful in reducing intraocular pressure during acute attacks of Glaucoma?
A. Loop diuretics
B. Thiazide diuretics
C. Potassium sparing diuretics
D. Osmotic diuretics------------------

Question 13
13. When resistance develops to loop diuretics in congestive heart failure, the following class of diuretics can be used.
A. Potassium sparing diuretics
B. Osmotic diuretics
C. Thiazide diuretics---------
D. Carbonic anhydrase inhibitors

Question 14
14. Thiazide diuretics can have beneficial effect in osteoporosis/calcium nephrolithiasis due to which effect?
A. Hypercalciuria
B. Hypocalciuria--------
C. Hyperuricemia
D. Hyperkalemia

Question 15
15. Which class of diuretics is preferred in elderly patients with isolated systolic hypertension?
A. Potassium sparing diuretics
B. Thiazides---------
C. Osmotic diuretics
D. Loop diuretics