Question 1

In a study where Rivaroxaban was compared to enoxaparin to find total VTE following HIP
replacement surgery, there were 17 total VTE out of 1513 patients in the Rivaraoaban group and 57
total VTE out of 1473 patient in the enoxaparin group. What is the relative risk reduction of using
Rivaroxaban over Enoxaparin?

Accepted Answer

B

Explanation: The Relative Risk Reduction (RRR) quantifies the percentage by which the risk of an outcome is reduced in the intervention group compared to the control group. 1. Calculate the event rate (risk) in each group: Risk in Rivaroxaban group (intervention): 17 / 1513 ≈ 0.0112 (1.12%) Risk in Enoxaparin group (control): 57 / 1473 ≈ 0.0387 (3.87%) 2. Calculate the Relative Risk (RR): RR = (Risk in intervention group) / (Risk in control group) = 0.0112 / 0.0387 ≈ 0.29 3. Calculate the Relative Risk Reduction (RRR): RRR = 1 - RR = 1 - 0.29 = 0.71 As a percentage, RRR is 71%.

Question 2

Which of these is an example of postrenal acute kidney injury (AKI)?

Accepted Answer

A

Explanation: Acute kidney injury (AKI) is categorized into prerenal, intrinsic, and postrenal causes. Postrenal AKI occurs due to an obstruction in the urinary tract downstream from the kidney, which impedes urine flow. This obstruction causes an increase in pressure within the urinary collecting system, leading to kidney damage. Benign prostatic hyperplasia (BPH) is a common cause of bladder outlet obstruction, where the enlarged prostate gland compresses the urethra. This blockage prevents urine from leaving the bladder, resulting in a classic example of postrenal AKI.

Question 3

JT is a 58-year-old women who is on vancomycin empirically for pyomyositis confirmed by MRI.
Surgical debridement has successfully removed infected tissue and pus. C&S of the infected tissue
comes back MSSA sensitive to everything on the panel. JT is allergic to PCN (rash), she has had
cephalosporin for her UTI in the past with no problem.
What would be the most appropriate antibiotics to switch to while JT is still in the hospital?

Accepted Answer

E

Explanation: The patient has a confirmed methicillin-sensitive Staphylococcus aureus (MSSA) infection. The first-line treatment for serious MSSA infections is an anti-staphylococcal penicillin (e.g., oxacillin) or a first-generation cephalosporin (e.g., cefazolin). Given the patient's non-severe penicillin allergy (rash) and documented prior tolerance of a cephalosporin, the risk of cross-reactivity is extremely low. Cefazolin is the most appropriate choice as it provides targeted, narrow-spectrum bactericidal therapy, adhering to principles of antimicrobial stewardship by de-escalating from broad-spectrum vancomycin.

Question 4

What is the weight of 1000 ml of serum protein whose specific gravity is 1.27?

Accepted Answer

A

Explanation: Specific gravity is the ratio of the density of a substance to the density of a reference substance, which for liquids is typically water (density ≈ 1 g/mL). Therefore, the density of the serum protein is numerically equal to its specific gravity, i.e., 1.27 g/mL. The weight (mass) of a substance can be calculated by multiplying its volume by its density. Weight = Volume × Density Weight = 1000 mL × 1.27 g/mL Weight = 1270 g

Question 5

Number of new cases per population at risk in a given time period is a definition of which of the following?

Accepted Answer

A

Explanation: Incidence rate, also known as incidence, is a fundamental measure of disease frequency. It quantifies the number of new cases of a health outcome that develop in a population at risk during a specified period. The key components of this definition are the focus on new cases (distinguishing it from prevalence), the specific population at risk in the denominator (excluding those who already have the disease or are immune), and the defined time period over which these new cases are observed. This measure is crucial for understanding the risk of developing a disease and for studying disease etiology.

Question 6

Which of the following is recommended to be monitored in patients on Divalproex Sodium?

Accepted Answer

A, C

Explanation: Divalproex sodium carries a well-documented risk of hepatotoxicity and dose-related thrombocytopenia/other cytopenias. Therefore, authoritative sources direct clinicians to obtain liver function tests (LFTs) and a complete blood count (CBC, including platelets) at baseline and at periodic intervals during therapy. These tests allow early detection of liver injury and hematologic toxicity, the two most clinically significant adverse effects requiring intervention or drug discontinuation.

Question 7

Which of the following antidiabetic medication works by inhibiting carbohydrate breakdown?

Accepted Answer

A

Explanation: Acarbose is classified as an alpha-glucosidase inhibitor. Its mechanism of action involves the competitive and reversible inhibition of pancreatic alpha-amylase and membrane-bound intestinal alpha-glucosidase hydrolase enzymes. These enzymes are essential for the digestion of complex carbohydrates, such as starch and sucrose, into absorbable monosaccharides like glucose. By inhibiting these enzymes, acarbose delays the breakdown and subsequent absorption of carbohydrates from the small intestine, which in turn blunts the postprandial increase in blood glucose levels.

Question 8

An order is received for heparin 18 units per kg per hour on a patient whose weight is 125lb. The IV bag comes as a concentration of 50 units /mL. Calculate the infusion rate in terms of mL/hr.

Accepted Answer

D

Explanation: The calculation requires a three-step process. First, convert the patient's weight from pounds (lb) to kilograms (kg) by dividing by the conversion factor of 2.2 lb/kg. Second, calculate the total hourly dose in units by multiplying the patient's weight in kg by the prescribed dose rate. Finally, determine the infusion rate in mL/hr by dividing the total hourly dose (units/hr) by the available concentration (units/mL). 1. Weight in kg: 125 lb / 2.2 lb/kg = 56.82 kg 2. Total dose: 56.82 kg 18 units/kg/hr = 1022.76 units/hr 3. Infusion rate: 1022.76 units/hr / 50 units/mL = 20.455 mL/hr, which rounds to 20.45 mL/hr.

Question 9

Which of the following is dichotomous variable?

Accepted Answer

A, B, C

Explanation: A dichotomous variable, also known as a binary variable, is a type of categorical variable that can have only two possible, mutually exclusive outcomes. In this question, "Sex" (when defined as male/female), "Pain yes/ Pain no," and "alive / dead" all represent variables with exactly two categories. These are fundamental data types used in biostatistics and clinical trials to represent the presence or absence of a condition, a specific outcome, or a demographic characteristic. Variables with more than two ordered categories, such as cancer grade or NYHA class, are classified as ordinal variables, not dichotomous.

Question 10

A 23-year-old female presents to your clinic complaining of intermittent throbbing headaches that
usually last for several hours and are made worse by the presence of light. She endorses occasional
nausea without vomiting during the most severe episodes. Physical examination is unrevealing, and
she has no significant past medical history.
Which of the following treatments is considered an abortive therapy for this patient’s underlying
condition?

Accepted Answer

A

Explanation: The patient's clinical presentation of a unilateral, throbbing headache associated with photophobia and nausea is characteristic of a migraine. The question asks for an abortive therapy, which is a medication taken to stop a migraine attack after it has started. Sumatriptan is a serotonin (5-HT1B/1D) receptor agonist (a "triptan") and is a first-line abortive treatment for moderate-to-severe migraine attacks. It works by causing vasoconstriction of cranial arteries and inhibiting the release of vasoactive neuropeptides. The other medications listed are used for migraine prophylaxis (prevention), not for treating an acute attack.

Question 11

After talking to the patient you find out LT has been incompliant with her three times a day Valproic acid, level came back at 35 mmol/L. What is the most appropriate course of action?

Accepted Answer

D

Explanation: The delayed-release action of divalproex allows for less frequent dosing than valproic acid in some patients. Divalproex sodium contains sodium valproate and valproic acid in a 1:1 molar stable co- ordination compound. Valproic acid, sodium valproate, and divalproex share the same pharmacology; however, there are pharmacokinetic differences among products.

Question 12

CJ is a 69-year-old male with a history of diabetes, hypertension and hypercholesterolemi
a. His fasting lipid profile is TC 530 mg/dL; LDL-C 125; HDL-C 48 mg/dL; and TG 640 mg/dL. His A1c
8.1, calculate creatinine clearance is 65mls/hr, BP 135/80 mm Hg, HR 70 beats /min.
His current medications include metformin 1000mg po bid, lisinopril 20mg daily, sitagliptin 50mg bid
and atorvastatin 40mg daily.
What is the best pharmacological agent to initiate on CJ?

Accepted Answer

C

Explanation: The patient's most critical lab value is the severely elevated triglyceride (TG) level of 640 mg/dL. TGs > 500 mg/dL significantly increase the risk of acute pancreatitis, making TG reduction the primary therapeutic priority. Fibrates are the most effective class of drugs for lowering very high triglycerides. The patient is already on a high-intensity statin. While combining a statin and a fibrate increases the risk of myopathy, fenofibrate has a much lower risk of this interaction compared to gemfibrozil. Therefore, initiating fenofibrate is the most appropriate and safest choice to address the immediate risk of pancreatitis.

Question 13

How does pregabalin work in the treatment of seizures?

Accepted Answer

B

Explanation: Pregabalin exerts its anticonvulsant effect by binding with high affinity to the alpha-2-delta (α2δ) subunit of voltage-gated calcium channels in the central nervous system. This binding modulates calcium influx at the presynaptic nerve terminals, thereby reducing the release of excitatory neurotransmitters such as glutamate, norepinephrine, and substance P. This decrease in neuronal excitability is the primary mechanism responsible for its therapeutic effects in treating seizures, neuropathic pain, and anxiety. Pregabalin is a structural derivative of the inhibitory neurotransmitter GABA but does not directly interact with GABA receptors.

Question 14

A physician orders Dopamine 5 mcg/kg/min. The concentration of the Dopamine IV bag is 400 mg in 250 D5W. The patient’s weight is 168 lbs. Calculate the infusion rate in mL/hr.

Accepted Answer

C

Explanation: The calculation requires a multi-step process using dimensional analysis. 1. Convert weight to kg: 168 lbs ÷ 2.2 lbs/kg = 76.36 kg. 2. Calculate the required dose in mg/hr: (5 mcg/kg/min) × (76.36 kg) × (60 min/hr) ÷ (1000 mcg/mg) = 22.91 mg/hr. 3. Determine the concentration of the IV solution: 400 mg ÷ 250 mL = 1.6 mg/mL. 4. Calculate the final infusion rate: (22.91 mg/hr) ÷ (1.6 mg/mL) = 14.32 mL/hr. The closest available option is 14.29 mL/hr.

Question 15

If a patient is getting NS IVF at 120mls/hr, how much Sodium Chloride in grams is this patient getting in 24 hours? NS is 0.9% sodium chloride.

Accepted Answer

A

Explanation: First, calculate the total volume of Normal Saline (NS) infused over 24 hours. At a rate of 120 mL/hour, the total volume is 120 mL/hr × 24 hours = 2880 mL. Normal Saline is a 0.9% w/v (weight/volume) solution of sodium chloride. This concentration means there are 0.9 grams of sodium chloride for every 100 mL of solution. To find the total grams of sodium chloride in 2880 mL, use the following calculation: (0.9 g NaCl / 100 mL) × 2880 mL = 25.92 grams of NaCl.

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