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

Fresh frozen plasma provides immediate replenishment of all clotting factors and is the fastest reversal for life-threatening warfarin-related bleeding.

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

ACE inhibitors block the breakdown of bradykinin, causing its accumulation in pulmonary tissue and stimulating cough receptors.

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

Digoxin toxicity classically presents with visual changes (xanthopsia), GI upset, and arrhythmias including bradycardia, particularly in elderly patients.

Question 4

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

Accepted Answer

Proximal tubule

Answer

Aminoglycosides accumulate in proximal tubular cells via endocytosis and cause direct tubular cell necrosis.

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

Heparin-induced thrombocytopenia (HIT) requires immediate discontinuation of all heparin products and substitution with a direct thrombin inhibitor such as argatroban.

NBME Practice Test

NBME Practice Test

NBME Pharmacology 2