Internal-Medicine
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CHAPTER 13<br />
Clinical Pharmacology<br />
Questions<br />
DIRECTIONS (Questions 1 through 43): Each of<br />
the numbered items in this section is followed by<br />
answers. Select the ONE lettered answer that is<br />
BEST in each case.<br />
(C)<br />
(D)<br />
(E)<br />
decreased glomerular filtration rate<br />
increased sodium excretion<br />
active reabsorption of water from the<br />
loop of Henle<br />
1. A 72-year-old man is prescribed hydrochlorothiazide<br />
for hypertension. Which of the following<br />
is the most likely symptomatic side effect?<br />
(A)<br />
(B)<br />
(C)<br />
(D)<br />
(E)<br />
increased serum potassium<br />
metabolic acidosis<br />
sexual impotence<br />
respiratory alkalosis<br />
hypernatremia<br />
2. A 73-year-old man with gastroesophageal reflux<br />
is prescribed ranitidine. Which of the following<br />
is the most likely effect of this medication?<br />
(A) stimulates acid secretion<br />
(B) acts on H1 receptors<br />
(C) acts on the columnar epithelium of the<br />
esophagus<br />
(D) increases bicarbonate production<br />
(E) decreases basal acid secretion<br />
3. A 58-year-old man with a lung lesion develops<br />
hyponatremia (Na 127 mEq/L). He appears<br />
euvolemic clinically and urine electrolytes<br />
reveal a high Na (>20 mmol/L) and high osmolality.<br />
Which of the following is the most likely<br />
mechanism for the low serum sodium?<br />
(A)<br />
(B)<br />
increased permeability of the proximal<br />
renal tubule to water<br />
increased permeability of the distal<br />
renal tubule to water<br />
4. A 38-year-old woman develops palpitations,<br />
weight loss, and heat intolerance. On examination,<br />
she has a mild tremor, an enlarged thyroid,<br />
and resting tachycardia. Biochemical tests<br />
confirm the diagnosis and she is started on<br />
methimazole. Which of the following is the<br />
most likely mechanism of this drug?<br />
(A) inhibition of iodine uptake<br />
(B) inhibition of thyroidal organic binding<br />
and coupling reactions<br />
(C) lowering serum calcium<br />
(D) adrenal suppression<br />
(E) the same mechanism as perchlorate<br />
5. A 69-year-old man with poorly controlled<br />
hypertension is on hydrochlorothiazide and<br />
metoprolol. Compliance with medications and<br />
salt restriction is reviewed with the patient<br />
and he is also prescribed nifedipine for optimal<br />
control of his blood pressure. Which of the following<br />
is the mechanism of action for this<br />
medication?<br />
(A) beta-adrenergic stimulation<br />
(B) interfering with calcium flux<br />
(C) inhibition of angiotensin 1<br />
(D) alpha-adrenergic blockade<br />
(E) direct smooth muscle relaxation<br />
259<br />
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