Mixed pharmacology assessment #2

These pharmacology questions are exceedingly HY for the USMLE Step 1. It’s not a matter of if they will increase your score; they will increase your score.

They are presented in tutor-mode fashion, with a succinct explanation appearing instantly after selecting an answer.

Questions are heavily cited from the literature.

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1. A 6-year-old Caucasian boy with a history of recurrent respiratory infections, failure to thrive, and failure to pass meconium for 72 hours after birth has genotyping performed in order to be considered for a novel treatment for his condition. Gene sequencing shows a G551D mutation in the CFTR gene, in which glycine (G) in position 551 is replaced with aspartic acid (D). He does not carry a Phe508del (ΔF508; deletion of phenylalanine at position 508) mutation. Which of the following agent(s) may be used in this patient as a result of these findings?

 
 
 
 
 

2. A 55-year-old man presents with shooting groin pain unlike anything he has ever experienced in his life. He is afebrile and stable. A non-contrast urologic CT shows a small ureteral calculus. The physician recommends copious fluid intake and simple analgesia with the hopes of spontaneous passage. The patient doesn’t like this idea and demands medication to decrease the risk of recurrence. The physician discusses with the patient that occasionally diuretic therapy may be attempted to decrease recurrence, however he does not recommend it as this time. Which of the following best describes the target of the diuretic the physician is referring to?

 
 
 
 
 
 
 
 

3. A 19-year-old man being treated with chemotherapy for testicular cancer presents to hospital with tinnitis and high-frequency hearing loss. His creatinine is 1.8 mg/dL. Diuresis with 0.9% NaCl is initiated. Administration of which of the following agents may have prevented these findings?

 
 
 
 
 

4. A 43-year-old man presents to emergency with a 5-day history of hematemesis and hematochezia on a background of chronic alcoholism and hepatitis C. His skin tone is pale and he is sudoretic (hyperhydrotic). HR is 135 bpm, RR 12, and BP 85/38 mm Hg. The liver edge is palpable 4 cm below the right costal margin. Palmar erythema is salient. After adequate hemodynamic resuscitation with 0.9% NaCl and packed RBCs, he undergoes emergent upper GI endoscopic treatment. He is also administered pharmacologic therapy to directly address his presenting pathology. Which of the following might be an effect of receiving this pharmacologic therapy?

 
 
 
 

5. A 54-year-old man has a four-month history of nocturnal dry cough and burning sensation in his chest, particularly if he lies down after meals. He has been trying out different medications that he’s found around the drug store to treat his condition. He has also been experiencing occasional diarrhea. Which of the following agents might be responsible for his bowel symptoms?

 
 
 
 
 

6.

A 35-year-old woman comes to the physician because of a 9-kg (20-lb) weight loss over the past four months. The spleen tip is palpable 5 cm below the left costal margin. Laboratory studies show:

Hematocrit: 47%
Leukocyte count: 25,500/mm3
Segmented neutrophils: 52%
Bands: 13%
Metamyelocytes: 6%
Eosinophils: 2%
Basophils: 3%
Lymphocytes: 14%
Myelocytes: 10%
Platelet count: 600,000/mm3

After approximately 48 months of aggressive chemotherapy, he develops progressive dyspnea. Chest x-ray (CXR) shows a reticulonodular pattern. FEV1/FVC is normal. Which of the following agents is most likely responsible for these findings?

 
 
 
 
 

7. A 64-year-old man with a 50-pack-year history of smoking has 10-kg (22-lb) weight loss over the past four months. He has worsening cough with specks of blood. Chest x-ray shows a 3-cm central cavitating lesion. Biopsy is performed and shows advanced stage bronchogenic squamous cell carcinoma. Among the various treatment options, the physician considers a drug called erlotinib, which has demonstrated efficacy in treating non-small cell lung cancer. Which of the following best describes the molecular target of this agent?

 
 
 
 
 
 

8. A 57-year-old man with a 10-year history of hepatitis C is enrolled in a treatment study. After commencing treatment, his laboratory results are as follows:

Total bilirubin: 3.3 mg/dL (normal range: <1.2)
Direct bilirubin: 0.2 mg/dL (NR: < 0.3)
Reticulocyte count: 9.1% (NR: 0.5-2.5)
Hematocrit: 38.5% (male NR: 40-54)

Which of the following is the most likely causative agent?

 
 
 
 
 

9. An 8-year-old boy is brought to the physician by his mother for several episodes of unusual “daydreaming” over the past three weeks in which he will suddenly stop all activity and stare into space with a blank look. Sometimes it appears as though his eyelids flutter. These episodes generally last less than ten seconds. His teacher has also reported observing similar episodes. One year ago, he was treated for a tonic-clonic seizure. Which of the following best describes the most appropriate pharmacologic therapy for this patient?

 
 
 
 

10. A 27-year-old woman experiences reduced visual acuity and color vision in her left eye. This is accompanied by general facial weakness, numbness, and dysarthria. The symptoms resolve fully within 24 hours. Three months later she begins experiencing muscle spasticity, balance problems, and the urge to run to the bathroom. She undergoes an MRI which reveals white matter lesions in her brain and spinal cord. An agent with which of the following mechanisms of action might be effective in treating her spasticity?

 
 
 
 
 
 
 
 
 
 
 
 

11.

A 70-year-old man being treated for Parkinson disease develops the above appearance of his legs. Which of the following agents is most likely responsible?

 
 
 
 
 
 
 
 
 

12. A 71-year-old woman is brought to the physician by her brother because of a 4-year history of worsening memory impairment and difficulty finding words. Her brother says that she has been angry at the suggestion that she may have a progressive impairment, but others have also noticed a decline in her general housekeeping and ability to maintain financial affairs. She appears well-groomed, alert, and friendly. Her neurological examination and psychiatric screen are both unremarkable. She scores a 22/30 on the Mini-Mental State Exam (MMSE). Her brother self-pays for an MRI that shows diffuse cerebral atrophy. A medication with which of the following mechanisms of action may provide initial benefit for this patient?

 
 
 
 
 

13. A 23-year-old girl experiences periodic pounding unilateral headaches. She self-medicates with acetaminophen and ibuprofen, although these have been modestly effective at best. An agent with which of the following mechanisms of action may provide benefit as an abortive therapy for future episodes?

 
 
 
 
 
 

14. A 55-year-old man is diagnosed with prostatic adenocarcinoma and started on hormonal therapy. Which of the following is most appropriate for this patient?

 
 
 
 
 
 

15. A 32-year-old IV drug user is commenced on empiric antibiotic therapy for acute bacterial endocarditis. He develops severe oliguria and dark urine. The agent most likely responsible demonstrates which of the following molecular inhibition and binding patterns?

 
 
 
 
 
 

16. A 54-year-old comes to the physician because of a 5-month history of diffuse muscle cramping. Physical examination shows diffuse muscle atrophy, fasciculations, and a left foot-drop. His deep tendon reflexes are brisk. Sensory examination is unremarkable. The physician considers a relatively novel treatment agent believed to function as a free radical scavenger, in addition to reducing lipid peroxides and hydroxyl radicals. Which of the following pharmacologic therapies is being considered?

 
 
 
 
 

17. A 68-year-old man with benign prostatic hyperplasia desires medication to improve his urinary outflow. Digital rectal exam demonstrates marked prostatic enlargement. Which of the following would be most effective at improving this patient’s urinary symptoms?

 
 
 
 
 

18. A 28-year-old woman presents with a two-month history of worsening dyspnea. Chest x-ray (CXR) shows increased prominence of vascular markings. Cardiac exam demonstrates a loud S2. She says she occasionally gets painful fingers that change color in the cold. Examination of her hands shows healing ulcerations of the skin secondary to spontaneous exfoliation from calcium deposits. Her appearance is remarkable for scattered dilated facial capillaries. Which of the following might be an effective treatment for her pulmonary symptoms?

 
 
 
 
 

19. A 45-year-old woman runs 10 miles a day and was recently treated for a metatarsal stress fracture. She is 5’8″ (173 cm) and weighs 96 lbs (43.6 kg). She has not had a menstrual period in four months. She states life is not worth living and that she has had zero interest in socializing with friends for the past six months. She wakes up around 4am every day and cannot fall back asleep, despite saying she would like to sleep longer. Which of the following medications is most appropriate for this patient?

 
 
 
 
 
 
 

20. A 42-year-old man who processes bear pelts in Umiat, Alaska has had a six-month history of weakness, fatigue, and anterograde amnesia. He has also had subtle muscle twitches and shaking every few minutes. Serum studies detect the presence of a heavy metal in high amounts. Which of the following is the most appropriate treatment?