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Bottom of Form Top of Form Question 1 Marks: 0/1 A female patient enters the pharmacy you are working. Over the past couple of days she has found a blistering rash which starts in the middle of her back and follows a line to her right breast. She does not know whether it is related or not but finds she is experiencing a tingling sensation around the rash. What could be the problem?

Choose one answer. a. Cold sore b. Rosacea c. Psoriasis d. Impetigo e. Shingles

Correct, this woman is experiencing all the classic symptoms of shingles. If the rash has appeared, identifying this disease (making a differential diagnosis) only requires a visual examination, since very few diseases produce a rash in a dermatomal pattern (see picture). However, herpes simplex virus (HSV) can occasionally produce a rash in such a pattern. The Tsanck smear is helpful for diagnosing acute infection with a herpes virus, but does not distinguish between HSV and VZV.

Correct Marks for this submission: 1/1. Question 2 Marks: 0/1 What is the IUPAC name for the following compound?

Choose one answer. a. Hexan-2-ol b. Heptan-4-ol c. Hexan-1-ol d. Hexan-3-ol e. Heptan-3-ol

1. Learn how to name hydrocarbons. Halocarbons, organic compounds containing one or more halogens, are named using the same procedure. Take the name of the element attached (chlorine) and replace the -ine with -o (chloro). Use the same group prefixes to describe the amount. Ex: CF3CHBrCl is named 2bromo-2-chloro-1,1,1-trifluoroethane. 2. Learn how to name alcohols. An alcohol is a carbon chain with a hydroxide (OH-) attached. Name the carbon chain, using the suffix -anol. Place a number in front to indicate what carbon the hydroxide is attached to. Ex: CH3CH2CH2(OH) is named 1-propanol. 3. Learn how to name ethers, a carbon chain bonded to an oxygen that is bonded to another carbon chain. The shorter of the two chains becomes the first part of the name (use a prefix). Then add "oxy". Then add the longest chain, preffixed with the ending -ane. Ex: CH3OCH2CH3 is named methoxyethane. The common name is often more commonly used. Name the carbon chains like attached groups. Alphabetize these and place them before the word "ether". Ex: CH3OCH2CH3 is named ethyl methyl ether. Sign up to the full pebcexam.com subscription for much more on IUPAC...

Correct Marks for this submission: 1/1. Question 3 Marks: 0/1 A comedone is a reconisable sign of which condition? Choose one answer. a. Tinea pedis b. Herpes simplex c. Herpes zoster d. Seborrhoea capitis e. Acne vulgaris

Correct, comedones and pustules are the main characteristic feature of acne.

Correct Marks for this submission: 1/1. Question 4 Marks: 0/1 A patient has obtained treatment for testicular cancer in the United States, where he obtained his medicines. He needs to refill his prescription. Which of the following is appropriate? Choose one answer. a. Get from States under special access program if need same drug b. Canadian Dr should write substitutes c. Canadian doctor has to countersign Rx

This is a legal requirement in Canada for the prescription to be filled.

Correct Marks for this submission: 1/1. Question 5 Marks: 0/1 Patient Name: RD History: admitted to coronary care unit for coronary balloon angioplasty. Current medicines: Nitro Patch 0.4 mg

Lisonopril 10 mg Aspirin 325 mg Bisoprolol 5 mg Atorvastatin 10 mg. He is discharged from hospital after successful coronary balloon angioplasty. His future medicines includes: Bisoprolol 10 mg. Aspirin 81 mg. Clopidogrel 75 mg. Lisonopril 10 mg. Omeprazole 20 mg. Atorvastatin 40 mg. After 5 days, AM had an MI followed by a clot in the coronary artery. Which of the following would be the most likely cause for his reocclusion? Choose one answer. a. Discontinuation of Nitropatch 0.4 mg b. Patient did not take Clopidogrel because of cost concern c. Reocclusion is a common complication of precutaneous coronary angioplasty d. Dosage reduction to Aspirin

e. Drug interaction with Omeprazole Reocclusion is the reoccurrence of occlusion in an artery after it has been treated (in this case with aspirin) with apparent success.

Correct Marks for this submission: 1/1.

Question 6 Marks: 0/1 Which of the following is NOT an effect of prolonged glucocorticoid excess? Choose one answer. a. Excessive water in joints

b. Easy bruising c. Buffalo hump d. Thinning of the skin e. Poor wound healing Correct this is not one of the common side effects of prolonged glucocorticoid usage. Glucocorticoid drugs currently being used act nonselectively, so in the long run they may impair many healthy anabolic processes. To prevent this, much research has been focused recently on the elaboration of selectively-acting glucocorticoid drugs. These are the side-effects that could be prevented: immunosuppression hyperglycemia due to increased gluconeogenesis, insulin resistance, and impaired glucose tolerance ("steroid diabetes"); caution in those with diabetes mellitus increased skin fragility, easy bruising negative calcium balance due to reduced intestinal calcium absorption Steroid-induced osteoporosis: reduced bone density (osteoporosis, osteonecrosis, higher fracture risk, slower fracture repair) weight gain due to increased visceral and truncal fat deposition (central obesity) and appetite stimulation adrenal insufficiency (if used for long time and stopped suddenly without a taper) muscle breakdown (proteolysis), weakness; reduced muscle mass and repair expansion of malar fat pads and dilation of small blood vessels in skin anovulation, irregularity of menstrual periods

growth failure, pubertal delay increased plasma amino acids, increased urea formation; negative nitrogen balance excitatory effect on central nervous system (euphoria, psychosis) glaucoma due to increased cranial pressure cataracts

Correct Marks for this submission: 1/1. Question 7 Marks: 0/1 A child with an unknown cause of vomiting presents themselves to a doctor. The doctor asks your advice as to what to recommend. Choose one answer. a. Cyclizine b. Nabilone c. Metoclopramide d. Cinnarizine e. None of these drugs

Correct, irrelevant of age it is bad practice to prescribe an anti-emetic with out first knowing the cause.

Correct Marks for this submission: 1/1. Question 8 Marks: 0/1 What does the following abbreviation imply: 2 qd ac 2/12

Choose one answer. a. Take two every four months mitte.448 b. Take two four times a day mitte.484 c. Take two four times a day after food mitte. 488 d. Take two four times a day on an empty stomach mitte 428 e. Take two four times a day before food mitte.448

Correct, 2 qd ac 2/12. 2 x4 (28 x 2) Take two four times a day before (ante) food mitte 448.

Correct Marks for this submission: 1/1. Question 9 Marks: 0/1 Yellow is fever is caused by which of the following infective agents? Choose one answer. a. Bacteria b. Protozoa c. Virus

d. Plasmodium e. Molluscum Correct, yellow fever is a virus which is transmitted via a vector (mosquito). Yellow fever is an acute viral hemorrhagic disease. The virus is a 40 to 50 nm enveloped RNA virus with positive sense of the Flaviviridae family.

The yellow fever virus is transmitted by the bite of female mosquitos (the yellow fever mosquito, Aedes aegypti, and other species) and is found in tropical and subtropical areas in South America and Africa, but not in Asia. The only known hosts of the virus are primates and several species of mosquito.

Correct Marks for this submission: 1/1. Question 10 Marks: 1/1 The volume of blood contain within the average human is closest to which approximate value? Choose one answer. a. 8L b. 10L c. 25L d. 5L

e. 15L Correct, approximately 5 liters of blood in the average sized adult male. The larger the male, the more circulating blood he will have. On average, for an adult male it is near 75mL/kg and for a women 65mL/kg, so that would make it 5625mL for a man and 4875mL for a women.

Correct Marks for this submission: 1/1. Question 11 Marks: 0/1 A disadvantage of using inhaled beclomethasone include: Choose one answer.

a. Adrenal suppression b. Hoarseness Correct!

c. The patient cannot stop treatment abruptly d. During long term use it can cause macular degeneration e. It only comes as one strength Correct, oral steroids are prone to causing candidiasis in the mouth which can lead to hoarseness. The use of inhaled steroids for the treatment of asthma can sometimes increase the risk of developing thrush. Thrush, also called oral candidiasis, is caused by an overgrowth of yeast in the mouth due to a decrease in the infection-fighting ability of the immune system in the mouth as a result of using inhaled steroids. Thrush can normally be prevented with mouth rinsing and tooth brushing after the use of inhaled steroids, but some people still tend to get thrush despite following these measures.

Correct Marks for this submission: 1/1. Question 12 Marks: 0/1 Patient Name: AM History: admitted to coronary care unit for coronary balloon angioplasty. Current medicines: Nitro Patch 0.4 mg., Lisonopril 10 mg., Aspirin 325 mg., Bisoprolol 5 mg., Atorvastatin 10 mg. He is discharged from hospital after successful coronary balloon angioplasty. His future medicines includes: Bisoprolol 10 mg. QD Aspirin 81 mg. QD Clopidogrel 75 mg.

QD Lisonopril 10 mg. QD Omeprazole 20 mg. QD Atorvastatin 40 mg. After few weeks, AM returns to the pharmacy and complaining that he has no energy at all and he is always tired. What would be the MOST probable cause of his tiredness? Choose one answer. a. Side effect of Lisinopril b. High dose of Bisoprolol

c. High dose of Atorvastatin d. A side effect of omperazole e. Clopidogrel addition Adverse drug reactions (ADRs) associated with the use of beta blockers include: nausea, diarrhea, bronchospasm, dyspnea, cold extremities, exacerbation of Raynaud's syndrome, bradycardia, hypotension, heart failure, heart block, fatigue, dizziness, abnormal vision, decreased concentration, hallucinations, insomnia, nightmares, clinical depression, sexual dysfunction, erectile dysfunction and/or alteration of glucose and lipid metabolism. Additional note: In animal testing bisoprolol compared to propranolol has shown less sedative effects and only slightly reduced glucose tolerance.

Correct Marks for this submission: 1/1. Question 13 Marks: 0/1 All of the following are viral infections EXCEPT: Choose one answer. a. Hepatitis

b. Mumps c. Rubella d. Chickenpox e. Tinea pedis

Correct, this is a fungal infection otherwise known as Athletes Foot. A fungal infection of the skin that causes scaling, flaking, and itch of affected areas. It is typically transmitted in moist areas where people walk barefoot, such as showers or bathhouses. Although the condition typically affects the feet, it can spread to other areas of the body, including the groin. Athlete's foot can be prevented by good hygiene, and is treated by a number of pharmaceutical and other treatments.

Correct Marks for this submission: 1/1. Question 14 Marks: 0/1 Name: Mr.T Age: 67 years old Medical history: peripheral vascular disease which was resolved by angioplasty. Chronic asthma which is well controlled using a corticosteroid and a LABA. The patient was recently found to be hypertensive and given lisinopril. The patient presents themselves in your pharmacy after taking the first dose. Mr.T is complaining of nausea and lack of appetite. Which one of the following could be a possible further diagnosis? Choose one answer. a. Liver failure

b. Kidney failure

Correct.

c. Heart failure d. Diabetes e. Stomach cancer Kidney failure is a risk when taking ACE Inhibitors. The primary agents that cause prerenal acute renal failure are angiotensin-converting enzyme (ACE) inhibitors and nonsteroidal anti-inflammatory drugs (NSAIDs). The inhibition of ACE prevents the conversion of angiotensin I to angiotensin II, leading to decreased levels of angiotensin II. Angiotensin II increases the glomerular filtration rate by causing constriction of the efferent arteriole; its absence decreases the glomerular filtration rate because of dilatation of the efferent arteriole. In certain patients (e.g., those with hypovolemia or bilateral renal artery stenosis), the glomerular filtration rate is particularly dependent on the effects of angiotensin II. If these patients take an ACE inhibitor, their glomerular filtration rate decreases, and prerenal acute renal failure can develop. Potassium, BUN and creatinine levels should be obtained soon after patients start taking an ACE inhibitor. NSAIDs cause prerenal acute renal failure by blocking prostaglandin production, which also alters local glomerular arteriolar perfusion. www.aafp.org www.wikipedia.org

Correct Marks for this submission: 1/1. Question 15 Marks: 0/1 A deficiency of which of the following is thought to be a characteristic feature of Parkinson's disease? Choose one answer. a. Noradrenaline in the spinal motor neurons. b. Acetylcholine in the motor cortex. c. Gamma amino butyric acid (GABA) in inhibitory pathways.

d. Serotonin in the brain stem. e. Dopamine in the nigrostriatal pathway.

Parkinson's disease belongs to a group of conditions called movement disorders. It is characterized by muscle rigidity, tremor, a slowing of physical movement (bradykinesia) and a loss of physical movement (akinesia) in extreme cases. The primary symptoms are the results of decreased stimulation of the motor cortex by the basal ganglia, normally caused by the insufficient formation and action of dopamine, which is produced in the dopaminergic neurons of the brain. Information leaflet on Parkinsons National Institute of Neurological conditions

Correct Marks for this submission: 1/1. Question 16 Marks: 0/1 Bioavailability describes the amount of drug that reaches the: Choose one answer. a. Kidney for excretion b. Systemic circulation Correct

c. Small intestine d. Liver e. Blood Brain Barrier Correct, bioavailability is the term that describes how much drug gets into systemic circulation.

Correct

Marks for this submission: 1/1. Question 17 Marks: 0/1 Agents that could be recommended for dandruff include all EXCEPT: Choose one answer. a. Selenium sulphide b. Ketoconazole c. Permethrin Correct!

d. Coal tar e. Salicylic acid Permethrin is an insecticidal and would be useless in the treatment of dandruff which is a fungal infection. Link to further information.

Correct Marks for this submission: 1/1. Question 18 Marks: 0/1 A patient enters your pharmacy and is complaining of a dry mouth. Further investigation reveals the patient is on the following regimen, which one may cause this side effect? Choose one answer. a. Paracetamol b. Atorvastatin c. Amitryptilline

d. Amlodipine e. Colchicine Correct, all tricyclic antidepressants have anti-muscarinic side effects which can cause the drying of secretions and therefore, dry mouth. Pharmacists can advise patients to: Sip water or sugarless drinks often. Sip water or sugarless drinks during meals. This will make chewing and swallowing easier. It may also improve the taste of food. Avoid drinks with caffeine, such as coffee, tea, and some sodas. Caffeine can dry out the mouth. Don't use tobacco or alcohol; they dry out the mouth. Use a humidifier at night. Be aware of spicy or salty foods. These may cause pain in a dry mouth. Chew sugarless gum or suck on sugarless, hard candy to stimulate saliva flow; cinnamon or mint-flavored candies are good choices. Check this link for further info.

Correct Marks for this submission: 1/1. Question 19 Marks: 0/1 HB, a 76-year old, 40 kg patient wishes to purchase the following herbal products. Which would you NOT sell based on the following patient record information? Allergies: No known allergies. Current medications: Warfarin (Coumadin) 2.5mg daily x 2 years. Donepezil (Aricept) 5 mg daily x 2 months

I-Ginkgo biloba II-Evening primrose oil III-Vitamin B complex Choose one answer. a. I only

b. I and II c. None of these options d. II and III e. III only Ginkgo may have undesirable effects, especially for individuals with blood circulation disorders and those taking anticoagulants such as ibuprofen, aspirin, or warfarin.

Correct Marks for this submission: 1/1. Question 20 Marks: 0/1 A woman who visited a private clinic a few weeks back is complaining that she is not producing enough milk for her new-born child. Which drug may be responsible? Choose one answer. a. Methanamine b. Vasopressin c. Travoprost d. Pergolide Correct, pergolide can decrease lactation in women.

e. Pantoprazole

Correct Marks for this submission: 1/1.

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