FPGEE FPGEE Exam 3 — Questions and Answers
Question 1: A patient develops signs of serotonin syndrome after being prescribed linezolid while already on sertraline. Which symptom BEST distinguishes serotonin syndrome from neuroleptic malignant syndrome?
- Hyperthermia
- Muscle rigidity
- Hyperreflexia and clonus (Correct answer)
- Altered mental status
Correct answer: Hyperreflexia and clonus
Hyperreflexia and clonus are hallmark features of serotonin syndrome and are generally absent in neuroleptic malignant syndrome, which features lead-pipe rigidity instead.
Question 2: Which class of antihypertensives is CONTRAINDICATED in bilateral renal artery stenosis?
- Beta-blockers
- Calcium channel blockers
- ACE inhibitors (Correct answer)
- Alpha-1 blockers
Correct answer: ACE inhibitors
ACE inhibitors (and ARBs) block angiotensin II-mediated efferent arteriolar constriction, which is the compensatory mechanism maintaining GFR in bilateral renal artery stenosis, leading to acute kidney injury.
Question 3: A drug has a half-life of 8 hours. How long will it take to reach approximately 94% of steady-state concentration with regular dosing?
- 16 hours
- 24 hours
- 32 hours (Correct answer)
- 40 hours
Correct answer: 32 hours
It takes approximately 4 half-lives to reach ~94% of steady state; 4 × 8 hours = 32 hours.
Question 4: Which antiepileptic drug works primarily by blocking voltage-gated sodium channels and is first-line for focal seizures?
- Valproic acid
- Ethosuximide
- Carbamazepine (Correct answer)
- Gabapentin
Correct answer: Carbamazepine
Carbamazepine blocks voltage-gated sodium channels, stabilizing neuronal membranes, and is a first-line agent for focal (partial) seizures.
Question 5: A compounding pharmacist needs to prepare an isotonic solution. What is the approximate freezing point depression of normal saline (0.9% NaCl)?
- -0.32°C
- -0.52°C (Correct answer)
- -0.72°C
- -1.02°C
Correct answer: -0.52°C
Normal saline (0.9% NaCl) has a freezing point depression of -0.52°C, which equals the freezing point depression of blood, making it isotonic.
Question 6: Which metabolic pathway is PRIMARILY responsible for phase II conjugation of acetaminophen under normal dosing conditions?
- Glucuronidation and sulfation (Correct answer)
- Glutathione conjugation
- Oxidation via CYP2E1
- Methylation
Correct answer: Glucuronidation and sulfation
Under therapeutic doses, acetaminophen is primarily metabolized by glucuronidation (~55%) and sulfation (~30%); CYP2E1-mediated oxidation to NAPQI becomes significant only in overdose when conjugation pathways are saturated.
Question 7: What is the primary mechanism by which aminoglycosides cause nephrotoxicity?
- Obstruction of renal tubules by drug crystals
- Accumulation in proximal tubular cells causing cellular damage (Correct answer)
- Immune-mediated interstitial nephritis
- Reduction in renal blood flow via vasoconstriction
Correct answer: Accumulation in proximal tubular cells causing cellular damage
Aminoglycosides accumulate in proximal tubular epithelial cells through endocytosis, causing mitochondrial dysfunction, oxidative stress, and tubular necrosis.
FPGEE FPGEE Exam 3
A patient develops signs of serotonin syndrome after being prescribed linezolid while already on sertraline.
Which symptom BEST distinguishes serotonin syndrome from neuroleptic malignant syndrome?