NBME Pharmacology 2

Question 1

A patient on warfarin presents with INR of 8 and active bleeding. Which agent provides the most rapid reversal of warfarin anticoagulation?

Accepted Answer

Fresh frozen plasma

Answer

Vitamin K (oral)

Answer

Protamine sulfate

Answer

Tranexamic acid

Question 2

Which mechanism best explains why ACE inhibitors cause a dry cough in approximately 10-15% of patients?

Accepted Answer

Increased bradykinin accumulation in the lungs

Answer

Decreased angiotensin II production

Answer

Direct bronchospasm from ACE inhibition

Answer

Potassium retention causing airway irritation

Question 3

A 72-year-old patient develops confusion, bradycardia, and yellow-green visual disturbances while on a drug for atrial fibrillation. Toxicity from which drug best explains these findings?

Accepted Answer

Digoxin

Answer

Amiodarone

Answer

Metoprolol

Answer

Diltiazem

Question 4

Aminoglycosides such as gentamicin are associated with nephrotoxicity. Which nephron segment is primarily damaged?

Accepted Answer

Proximal tubule

Answer

Glomerulus

Answer

Loop of Henle

Answer

Collecting duct

Question 5

A patient is receiving heparin for a DVT. Her platelet count drops from 250,000 to 60,000 after 8 days of therapy. Which drug should be used to continue anticoagulation?

Accepted Answer

Argatroban

Answer

Low molecular weight heparin

Answer

Warfarin

Answer

Aspirin

Question 6

Which beta-blocker property makes carvedilol preferable over metoprolol in patients with heart failure and peripheral vascular disease?

Accepted Answer

Alpha-1 blocking activity causing vasodilation

Answer

Cardioselectivity for beta-1 receptors

Answer

Intrinsic sympathomimetic activity

Answer

Membrane-stabilizing activity

Question 7

A child is brought to the ER after ingesting penicillin tablets. Allergic reaction to penicillin is most commonly mediated by which mechanism?

Accepted Answer

Type I (IgE-mediated) hypersensitivity

Answer

Type II (cytotoxic) hypersensitivity

Answer

Type III (immune complex) hypersensitivity

Answer

Type IV (delayed-type) hypersensitivity