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Clinical MCQ TEST

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BY : Muhanad clinical
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clinical pharmacy

1 -Hypertensive crisis is:

A - > 120/60
B - < 160/80
C - < 180/120
D- >180/120
E - > 120/110
Ans:D
2 -which is true about Secondary hypertension:
A - also called essential hypertension
B - caused by chronic kidney disease (CKD) or renovascular disease.
C - asymptomatic initially
D- more 10% of cases
E - all of above
Ans : B
3 - Which drug that may not increase BP:
A - NSAIDs
B - venlafaxine.
C - estrogens
D - minoxidil
E - non of above
Ans : D
4 - ACC/AHA guideline recommends a goal BP is :
A - <130/80
B - ≥130/80
C - ≥140/90
D - none of above
E - all of above
Ans : A
5 - lifestyle modifications used in :
A - elevated BP
B - stage 2 hypertension
C - stage 1 hypertension
D - all of above
E - none of above
Ans : d
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6 -Which is true about nonpharmacologic therapy

A - patients with elevated BP or stage 1 hypertension should be used drugs directly
B - starting drug therapy is ≥130/80 in patient have low risk ASCVD
C - drug therapy for these patients when BP is ≥140/90 mm Hg in low risk ASCVD
D - none of above
E - all of above
Ans : c
7- Which is not true about lifestyle modifications :
A - weight loss if overweight or obese ,
B - reduced salt intake, ideally to 1.5 g/day
C - moderation of alcohol intake
D -smoking cessation control BP
E - none of above
Ans : D
8- should be used for hypertension treatment in patients with SIHD.
A - (ACE) inhibitors,
B - β-Blockers
C - thiazide diuretics
D -calcium channel blockers
E – ARBs
Ans : B
9- Which the option dont consider first line treatment in hypertension
A - (ACE) inhibitors,
B - β-Blockers
C - thiazide diuretics
D -calcium channel blockers
E - ARBs
Ans : B
10- Which the drug may be mask symptoms of hypoglycemia:
A - (ACE) inhibitors,
B - β-Blockers
C - thiazide diuretics
D -calcium channel blocker
E - ARBS
Ans : B
11- All four first-line antihypertensive classes (ACE inhibitors, ARBs CCBs, thiazides)
, reduce CV events in patients with diabetes
A - true
B – false
Ans:A
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12- Using ACE inhibitors and ARBs in patient with Chronic Kidney Disease due :
A - reduce intraglomerular pressure
B - slow CKD progression .
C - all of above
D - none of above
E - elevated serum creatinine
Ans : C
13- Which is true about Secondary Stroke Prevention
A - use thiazide diuretic or loop
B - use thiazide diuretic, either alone or combined with an ACE inhibitor ,
C - starting antihypertensive drug therapy ( BP < 140/80 )
D - A and B
E - C and B
Ans : B
14- Hyperkalemia not occur with :
A - alpha 1 blocker
B - potassium-sparing diuretics
C - mineralocorticoid receptor antagonists
D -direct renin inhibitors.
E - ACE inhibitors
Ans : A
15-Acute Kidney Injury (AKI) is side effect of :
A - alpha 1 blocker
B - potassium-sparing diuretics
C - mineralocorticoid receptor antagonists
D -direct renin inhibitors.
E - ACE inhibitirs
Ans : E
16 - dry cough occurs in up to 20% occur when taken
A - alpha 1 blocker
B - potassium-sparing diuretics
C - mineralocorticoid receptor antagonists
.D -direct renin inhibitors
E - ACE inhibitirs
Ans : E
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17- Which is drug consider contraindicated in pregnancy.

A -ACE inhibitors
B - ARBs
C - direct renin inhibitors
D - All of above
E - non of above
Asn : D
18- combination of an ACE inhibitor and ARB product :
A - increases antihypertensive efficacy.
B - no additional benefit effect
C - lower risk side effects
D - A and B
E - non of above
Ans:B
19-renal insufficiency, hyperkalemia, and orthostatic hypotension side effect of :
A - ARBs
B - β-Blockers
C - thiazide diuretics
D -calcium channel blockers
E - all of above
Ans : A
20- Verapamil is
,A - (ACE) inhibitors
B -β-Blockers
C - thiazide diuretics
D -calcium channel blockers
E - none of above
Ans : D
21- All CCB cause reflex sympathetic activation except:
A - Verapamil
B - felodipine
C - Diltiazem
D - nifedipine
E - none of above
Ans : B
[Link] causes ----------- in about 7% of patients
A - decrease AV node conduction
B - diarrhea
,C - gingival hyperplasia
D - constipation
E –headache Asn : D
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23- Which is true about Calcium Channel Blockers

A - amlodipine may not cause reflex sympathetic activation
B - Diltiazem only can cause cardiac conduction
C - Dihydropyridines do not decrease AV node conduction
.D - Diltiazem causes constipation in about 7% of patients
E - none of above
ANS : C
24- Which is true about diuretics
,A - Loop diuretics such as hydrochlorothiazide
B - thiazides are not ideal antihypertensives
C - Chlorthalidone is preferred over hydrochlorothiazide
D - Loop diuretics are sometimes required over thiazides in patients With low Bp
E - all of above
Ans : C
25- Which drug have intrinsic sympathomimetic activity
A - pindolol
B - atenolol
C - nadolol
D -betaxolol ,
E -metoprolol,
Ans : A
26- Which true about α1-Receptor Blockers
A - used with thiazide to maintain antihypertensive efficacy and minimize edema.
B - second-dose phenomenon characterized by orthostatic hypotension
C - sodium and water retention not occur
D - The patient should take the first dose at 7 A.M
E - 1-Prazosin, betaxolol , and doxazosin are selective α1-receptor
Ans : A
27- Abrupt cessation may lead to rebound hypertension , this side effect of
A - Clonidine ,
B - methyldopa
C - guanfacine ,
D - none of above
E - all of above
Ans : E
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28- Drug rarely causes hepatitis or hemolytic anemia

A - guanfacine ,
B - pindolol
C - Clonidine ,
D -methyldopa
E - spironolactone
Ans : D
29- may cause gynecomastia in up to 10%:
A - guanfacine
B - spironolactone
C - pindolol
D -candesartan
E -captopril
Ans : B
30- Direct Renin Inhibitor :
A - minoxidil
B - Hydralazine
C - Clonidine ,
D - Prazosin ,
E -Aliskiren
Ans : E
31- used for pregnancy-induced hypertension .
A - Labetalol
B - nifedipine
C - methyldopa
D - all of above
E - only a and c
Ans : D
32- is the agent of choice for minute-to-minute control hypertensive urgencies and
emergencies in most cases .
A - Nitroprusside
B - Prazosin
C - minoxidil
D -nifedipine
E -methyldopa
Ans : A
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33- hypercalcemia side effect of

A - Furosemide
B - Chlorthalidone
C - spironolactone
D –eplerenone
E - none of above
Ans : B
34- --------may cause muscle fatigue or cramps, and severe electrolyte abnormalities may
result in serious cardiac arrhythmias .
A - hyperglycemia
B - hypocalcemia
C - gynecomastia
D - hypomagnesemia
E - sexual dysfunction
Ans : D
35- Which is true about angina pectoris
A - increased myocardial oxygen demand (MVO2)
B - decrease in myocardial oxygen supply because of atherosclerotic plaque
C - requires a 50% increase in coronary flow to maintain myocardial supply.
D - Inflammation also plays a role in IHD
E - all of above
Ans : E
Ans : D
37- patients have plaque and vasospasm at the site of the plaque consider
A - variable threshold angina
B - Prinzmetal angina
C - microvascular angina
D - chronic stable exertional angina
E - unstable angina
Ans : A

38- Ischemic episodes may be more common in the morning hours due
A - long time sleeping
B - taken some drugs in the morning
C - release of vasoconstrictors
D - C-reactive protein may be elevated in morning
E - macrophages and T-lymphocytes more active in this hours
Ans : C
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39--Patients do not have coronary plaque but have vasospasm consider :

A - variable threshold angina
B - Prinzmetal angina
C - microvascular angina
D - chronic stable exertional angina
E - unstable angina
ANS : B
40 - Which is true about chest pain of angina
A - relieved by run or sublingual nitroglycerin
B - chest pain precipitated by rest
C - Ischemic symptoms may be associated with diaphoresis only
D - squeezing, crushing, heaviness, or chest tightness not consider syptoms of angina
E-lasts from 5 to 20 minutes
Ans : E
41- Patients with diabetes mellitus may have decreased pain sensation due
A - insulin resistant
B - taken metformin
C - neuropathy.
D - administration of insulin
E - none of above
Ans : C
42- nonmodifiable risk factors for coronary artery disease :
A - hypertension
B - diabetes mellitus
C - cigarette smoking
D -dyslipidemia
E - age
Ans : E

43- is the most accurate test for confirming CAD but is invasive and requires arterial
access
A - Myocardial perfusion imaging
B - Coronary angiography
C - CT angiography
D - cardiac magnetic resonance
E - none of above
Ans : B
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44- Lifestyle modifications in patient with IHD

A - physical activity,
B - reduced intake of saturated fats
C - smoking cessation
D - psychological interventions
E - all of above
Ans : E
45- Heart Failure, Most common cause to shift from ACE inhibitor to ARB include
A- Hyperkalemia
B- Induction of renal insufficiency
D- angioedema
E- Dry cough
C- Hypotension
Asn : E
46-S.E. is a 28-year-old woman who would like to get pregnant soon. Her medical history
includes hypertension and allergies. Her medications include lisinopril, nasal saline spray,
and folic acid. Which option is best to treat her hypertension while she is pregnant or
trying to conceive?
A- Continue lisinopril and add hydrochlorothiazide.
B-Discontinue lisinopril and all other medications
C- Discontinue lisinopril and start labetalol.
D-Continue lisinopril and add atenolol.
E- Increase dose of lisnopril
Ans : C
47 - A 50 year old man is being treated with hypertension and has been told his dentist
that he has gingival hyperplasia ,Which of the following medication is the most likely to be
the cause?
A- Atorvastatin
b- carvedilo
C- Doxazocon
D- Nifedipine
E- Telmisartan
Ans : D
48- Regarding Treatment Of Hypertension, A.................. , either alone or combined with
an Act inhibitor, is recommended for patients with history of stroke or transient ischemic
attack
A- Thiazide diuretic
B- spironolactone
C- Eplerenone
D- Potassium-sparing diuretics
E- Loop diuretics Ans : A
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49- Regarding Treatment of Heart failure ...... ....... ,may be preterred over loop diuretics
in patients with only mild fluid retention and elevated BP because of their more persistent
antihypertensive effects.
A- Furosemide
B- Bumetanide
c- torsemide
D- Sacubitril
E- Thiazides
Ans : E
50- Which of the following type of angina is likely to be induced, by exertion and relieved
by rest?
A- stable angina
B- Unstable angina
C- variant angina
D- decubitus angina
E- prinzmetal angina
Ans : A
51- A drug may be temporarily held or dose reduced if recent changes are responsible for
acute decompensated HF is
A- B-blocker
B- ACE inhibitors
C- ARBs
D- ARNI
E- aldosterone antagonists
52- A 47 years old female presented to the hospital complaining of chest pain radiated to
her left jaw and the medial side of her arm. After full investigation she diagnosed to have
vasospastic angina". The best long term anti-anginal agent for this patient will be
A- IV nitroglycerine
B- Metoprolol
C - Verapamil
D- Lisinopril
E- Hydralazin
Ans : C
53- Guideline recommended diuretic for starting treatment of newly diagnosed
hypertension is
A- chlorothalidone
B- Hydrochlorothiazide
C-Amiloride
D- furosemide
E- spironolacione
Ans : B
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-54- Regarding hypertension, Angiotensin-Converting Enzyme Inhibitors are

contraindicated in patients with
A- Hypertension and ischemic heart disease
B- Heart failure. but without hypertension
C-Renal artery stenosis
D- Diabetic nephropathy.
E- Post myocardial infarction
Ans : C
55- in patients with heart failure with reduced ejection fraction (HFrEF),
Sacubitril/valsartan is contraindicated for the above patient if he has which of the
following?
A-hypokalemia
B- Angioedema with ramipril
C- Concomitant therapy with furosemide
D- Heart rate <70 PM
E- None of the above
Ans ; B
56- Compared with enalapril, which adverse effect among the followings is more common
with sacubitril/valsartan:
A- angioedema
B- hypotension
C- cough
D- hyperkalemia
E- all of the given choice
Ans : A
57- Regarding clinical presentation of chronic stable exertional angina, All of the following
are TRUE EXCEPT:
A- Chest pain is described as squeezing, crushing, heaviness, or chest tigntness.
B- Chest pain generally lasts more than 20 minutes
C- Patients with diabetes mellitus may have decreased pain sensation
D- Chest pain is usually relleved by rest
E- Chest pain is usually relieved by sublingual nitroglycerin
Ans:B
58- In patients with HFrEF, Which of the following B-blockers should be used
A- carvedilol
B- bisoprolol
C- Both A and B
D- Labetalol
E- None of the above
Ans : c
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59- Regarding ischemic heart disease, The calcium channel blocker of choice in severe
ventricular dysfunction and Prinzmetal's angina is:
A- Verapamil.
B-Diltiazem.
C- Amlodipine.
D- Nifedipine
E- Nimodipine.
Ans:B
60- A 56 ueaes old male present with heart failure treated with furosemide and enalapril,
but he remains symptomatic in NYHA class 2. BP= 140/80 mmH, what is the best
treatment option?
A- Vasarian
B- spironolactone
C- Digoxin
D - Carvedilol
E- Aspirin
Ans : D
61- A 63 years old male with Diabetes Mellitus has a blood pressure of 180/90 mmHg with
normal clinical examination. ECG reveals evidence of stage I heart failure. Which is the
best choice for treatment for hypertension for such patients
A- carvedlol
B- Lisinopril
C- Sodium nitroprusside
D= Hyarochlorothialazice
E- Doxazosin
Ans : B
62- For which of the following are B blockers not recommended as first line therapy?
A- Chronic heart failure
B- Angina
C- Hypertension
D- Myocardial Infarction
E- Ventricular tachycardia
Ans : C
63- Hypertension of 180/120 mmHg that is result in renal failure is classified as?
A-Isolate sv StOlcavoerension
B- Hypertensive urgency
C- Malignant hypertension
D- Secondary hypertension
E-Hypertensive emergency
Ans : E
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64- The modifiable risk factor associated with coronary artery disease is:
A- Age
B- Obesitv
C- Heredity
D- Gender
E- None of them
Ans : B
65- A patient with angina was treated by coronary stent placement, What is the best
antiplatelet therapy for this patient?
A- Prasugrel
B- Prasugrel plus ticagrelor
C- Aspirin plus Prasugrel
D- Ticagrelor
E- Ticagrelor plus clopidogrel
Ans : C
66- in patients with chronic heart failure :All of the following drugs reduce mortality
(prolong survival) EXCEPT
A- Lisinopril
B- Bisoprolol
C- thiazide diuretics
D- Sacubitril/valsartan combination
E- Candesartan
Ans:C
67- Hypertension of 180/120 mmHg that is result in renal failure is classified as?
A- Hypertensive emergency
B- Hypertensive urgency
C- Isolated systolic hypertension emergency
D- Secondary hypertension
E- Malignant hypertension
ANS:A

68- A 63 years old male with Diabetes Mellitus has a blood pressure of 180/90 mmHg with
normal clinical examination. ECG reveals evidence of stage II heart failure. Which is the
best choice for treatment for hypertension for such patients.
A- Hydrochlorothiazide
B- Sodium nitroprusside
C- Lisinopril
D- Carvedilol
E- Doxazosin
ANS:C
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69 - For which of the following are β blockers not recommended as first line therapy?
A- Hypertension
B- Chronic heart failure
C- Angina
D- Ventricular tachycardia
E- Myocardial infarction
ANS:A
70 - Which is true about risk factor modification :
A - If BP is ≥130/90 , drug therapy in addition to or after a trial of lifestyle modifications.
B - Annual influenza vaccinations are recommended
C - Use only moderate dose statin therapy
D - ezetimibe (second ) or a PCSK9 inhibitor (First) in patients who do not tolerate statins
E - none of above
Ans : B
71- Which drug not relive chest pain in IHD
A - β-Blockers
B - Calcium Channel Blockers
C - aspirin
D - Nitrates
E - none of above
Ans : C
72- Dual antiplatelet therapy ( aspirin plus a P2Y12 inhibitor ) used in
A - do not tolerate statins
B - Diabetes mellitus with high A1C
C - Patient non responsiveness to clopidogrel
D - after PCI with coronary stent placement
E - none of above
ANS:D
73- First line treatment have IHD
A - β-Blockers
B - Calcium Channel Blockers
C - aspirin
D - Nitrates
E - Ranolazine
Ans : A
74 - Which class of drugs have not been shown to improve symptomatic ischemia or
reduce chest pain episodes.
A - β-Blockers
B - Calcium Channel Blockers
C - aspirin
D – Nitrates E - ACE inhibitors Ans : E
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75- should be used in patients with HFrEF

A - carvedilol
B - metoprolol succinate
C - bisoprolol
D - all of above
E - none of above
Ans : D
76- CCBs or long-acting nitrates should be prescribed for relief of symptoms IHD
A - β-blockers are contraindicated
B - provide some decrease in supply
C - to obtain reflex tachycardia
D - to reduced side effect such as bradycardia, hypotension, AV block
E - None of above
Ans : A
77- decreases digoxin clearance is:
A - Verapamil ,
B - cyclosporine
C - carvedilol
D -nitroglycerin
E -simvastatin
Ans : A
78- ------- produces more impairment of LV function than amlodipine and felodipine
A - isradipine ,
B - verapamil
C - diltiazem
D -nitroglycerin
E -Nifedipine
Ans : E
79- reflex tachycardia of nitrates can be mitigated by :
A - nitroglycerin
B - β-blockers
C - isradipine
D -Nifedipine
E - aspirin
Ans : B
80- Chronic nitrate use should incorporate a 10- to 14-hour nitrate free interval
A - to reduce nitrate tolerance
B - to prevent acute angina episodes
C - be used routinely as monotherapy
D - none of above
E - all of above Ans : A
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81- Nitrates should not be used routinely as monotherapy for stable IHD due
A - to reduce nitrate tolerance
B - to prevent acute angina episodes
C - lack of angina coverage during the nitrate free interval
D - due side effect headache, flushing, nausea, postural hypotension, and syncope
E - none of above
Ans : c
81- Common nitrate side effects include headache can treated by :
A - nitrate-free interval.
B - chanege the drugs
C - used combination with another class of anti ischemic
D - treated with acetaminophen
E - rotating the application site
Ans : D
82- Which drugs does not impact HR, BP
A - β-Blockers
B - Calcium Channel Blockers
C - aspirin
D - Nitrates
E - Ranolazine
Ans : E
83- Which drug cause prolong the QTc interval
A - β-Blockers
B - Calcium Channel Blockers
C - aspirin
D - Nitrates
E - Ranolazine
Ans : E
83- Which drugs is consider contraindication in Prinzmetal Angina
A - β-Blockers
B - Calcium Channel Blockers
C - Verapamil
D - Nitrates
E - Ranolazine
Ans : E
84-Heart failure (HF) is
A - that impair the ability of the right ventricle to fill with or eject blood.
B - that impair the ability of the left ventricle to fill with or eject blood.
C - that impair the ability of the arota to fill with or eject blood.
D - that impair the ability of the left atrium to fill with or eject blood.
E -that impair the ability of the right atrium to fill with or eject blood.
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Ans : B
85-HF may be caused by
A - Tachycardia and increased contractility
B - increases stroke volume
C - abnormality in systolic function, diastolic function, or both.
D -Vasoconstriction
E - none of above
Ans : c
86-In heart failure , compensatory responses to maintain circulation except
A - Tachycardia and increased contractility
B - increases stroke volume
C -using drugs such as direct cardiotoxicity
D -Vasoconstriction
E - none of above
Ans : c
87-Causes of systolic dysfunction
A - decreased contractility
B - restriction in ventricular filling
C - coronary artery disease
D -hypertension.
E -Vasoconstriction
Ans : A
88-Primary symptoms of HF
A - tachypnea,
B - orthopnea,
C - fatigue,
D -dyspnea
E -poor appetite.
Ans : D
89-Laboratory tests in diagnosis of HF
A - lipid profile
B - renal test
C - A1C.
D -thyroid function tests
E - all of above
Ans : E
90-Ventricular hypertrophy can be demonstrated on
A - Chest x-ray
B - Laboratory tests
C - chest radiograph or
D -electrocardiogram (ECG).
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E - both C nad D
Ans : E
91-Chest x-ray used to detect execpt
A - cardiac enlargement,
B - Ventricular hypertrophy
C - pleural effusions
D -pulmonary edema
E - none of abov
Ans : B
92-New York Heart Association Functional Classification System , the FC-II consider
A - no limitation of physical activity.
B - slight limitation
C - marked limitation
D -have structural heart disease but no HF signs or symptoms.
E -unable to carry on physical activity without discomfort.
Ans : B
93-Goals of Treatment of HF includs :
A - Improve quality of life
B - relieve or reduce symptoms
C - slow disease progression,
D -prevent or minimize hospitalizations
E - all of above
Ans : E
94-ACC/AHA Stage B treatment includs
A - ACE inhibitor (or ARB) and β-blocker
B - ACE inhibitors or ARBs
C - an ACE inhibitor and ARNI and aldosterone antagonist
D - ACE inhibitor (or ARB) and β-blocker and digoxin,
E - aldosterone antagonist and digoxin and Loop diuretics
Ans : A
95-Nonpharmacologic Therapy of Chronic Heart Failure includs
A - dietary sodium intake.
B - restriction of fluid intake
C - Revascularization
D - both a and b
E - all of above
Ans : E
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96-____ are relatively weak diuretics and are infrequently used alone in HF
A - metolazone
B - hydrochlorothiazide)
C - bumetanide,
D -(furosemide,
E -torsemide)
Ans : B
97-usually necessary to restore and maintain euvolemia in HF
A - metolazone
B - hydrochlorothiazide
C - furosemide,
D -Valsartan/Sacubitril
E - digoxin
Ans : c
98-diuretics are not required for patients without fluid retention due
A - do not alter disease progression or prolong survival,
B - loop diuretics are relatively weak
C - diuretic there is no evidence in fluid retention
D - are effective only in elevated BP
E - none of above
Ans : A
99-Thiazides may be preferred over loop diuretics in pstient
A - restore and maintain euvolemia in HF
B - have persistent HF symptoms despite maximally tolerated GDMT.
C - at high risk for developing HF
D -patients have slight limitation.
E -mild fluid retention and elevated BP
Ans : E

100-Which is not true about ACE inhibitor

A - slow disease progression, and decrease mortality
B - ACE inhibitor cause cough or angioedema.
C - may take weeks to months before the full benefits are apparent.
D -if symptoms do not improve, discontinue therapy
E - 1-ARBs as an alternative to ACE inhibitor
Ans : D
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101-Which is not true about angiotensin receptor–neprilysin Inhibitor (ARNI)

A - Neprilysin is an enzyme that degrades angiotensin
B - reduce the risk of cardiovascular death and hospitalization
C - Discontinue ACE inhibitors 36 hours prior to initiating the ARNI
D -.ARNI reduce morbidity and mortality.
E - (ARNI) such as Valsartan/Sacubitril
Ans : A
102-Which is true about β-Blockers
A - β-blockers reduce HF mortality only
B - patients should receive a β-blocker even if symptoms are mild
C - β-blockers used in unstable patients who have no or minimal evidence of fluid overload
D -4-Carvedilol, metoprolol tartarte (CR/XL), and bisoprolol used
E -start β-blockers in very high doses with slow upward dose titration
Ans : B
103-Guidelines recommend addition of ____ to African Americans with HFrEF and
NYHA class III–IV symptoms treated is
A - ACE inhibitors (or ) and
B - ARBs
C - β-blockers
D - digoxin
E -hydralazine/ISDN
Ans : E
104-first-line therapy for ADHF patients with volume overload.
A - IV loop diuretics
B - thiazide
C - Vasopressin Antagonists
D -hydralazine/ISDN
E -ACE inhibitors
Ans : A
105-Which is not true about Tolvaptan
A - selectively binds to and inhibits the V2 receptor.
B - IV agent indicated for hypervolemic and euvolemic
C - used in hyponatremia in patients with HF.
D -studies do not support routine use of tolvaptan in ADHF
E -it should be reserved for managing severe hyponatremia.
Ans : B
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106-cyanide and thiocyanate toxicity are caused by :

A - nitroglycerin
B - Conivaptan
C - Tolvaptan
D -milrinone
E -Nitroprusside
Ans : E
107-is a β1- and β2-receptor agonist with some α1- agonist effects
A - Dobutamine
B - Norepinephrine
C - Milrinone
D -Nitroprusside
E -nitroglycerin
Ans : A
108-What is not true about Digoxin
A - neutral effects or reductions in hospitalizations
B - contorl supraventricular arrhythmias
C - help control ventricular rate in patients with HFrEF
D - digoxin is considered a first-line agent in HF
E -neutral or detrimental effects of digoxin on mortality.
Ans : D
109-unable to carry on physical activity without discomfort , is classification of
A - ACC/AHA Stage A
B - New York Heart Association FC-IV
C - ACC/AHA Stage D
D -ACC/AHA Stage C
E -New York Heart Association FC-III
Ans : B
110-occurs when patients awaken suddenly with a feeling of breathlessness and suffocation
is
A - orthopnea,
B - peripheral edema.
C - Paroxysmal nocturnal dyspnea
D -tachypnea,
E -bloating
Ans : c
 1
Clinical MCQ TEST

asthma+UTI+peptic ulcer

BY : Muhanad clinical
clinical pharmacy muhanad clinical

1-Which is not true peptic ulcer disease

A - refers to ulcerative disorders
B - require acid and pepsin for their formation
C – usually occur in lower GIT
D – is classified to gastric and duodenal ulcer
E – all of above
2-three common etiologies include except
A - Helicobacter pylori
B-nonsteroidal anti-inflammatory drug (NSAID)
C - stress-related mucosal damage (SRMD(
D - use COX -2 selective inhibitors
E - none of above
3-which is true about erosions
A - its can occur in antrum and lesser curvature
B - occur in the first part of the duodenum
C - its similar of duodenal ulcers
D -can occur anywhere in the doudenal
E - none of above
4-Which is true about Pathophysiology of peptic ulcer disease
A - aggressive factors such as mucosal defense and repair
B - protective factors such as gastric acid and pepsin
C - Increased acid secretion with gastric ulcers
D -Gastric acid, H. pylori infection that disruption of mucosal integrity
E - all of above

1 2 3 4
C D A D
clinical pharmacy muhanad clinical

5-Which is normally protect the gastroduodenal mucosa from noxious endogenous and
exogenous substances
A - Mucus membrane
B - bicarbonate secretion
C - intrinsic epithelial cell defense
D -mucosal blood flow
E - all of above
6-Increased acid secretion may be involved in duodenal ulcers
True / false
7-hypochlorhydria occur with
A - duodenal ulcers,
5 E
B - gasrtic ulcer 6 True
7 B
C - NSAID use 8 A
D -H. pylori infection 9 E
E -mucosal blood flow
8-All following [Link] enzymes , except
A - dehydrogenase
B- proteases
C - lipases
D -urease
E - none of above
9-aspirin cause gastric ulcer by
A - Direct or topical irritation of the gastric epithelium,
B - Systemic inhibition of endogenous mucosal PG synthesis
C - interact with acid secretion
D - increase pepsin secretion
E- both a and b
clinical pharmacy muhanad clinical

10-COX-2 selective inhibitors may be cause ulcer when

A - Taking with carbonated beverages, coffee, tea, beer, milk,
B - with ethanol ingestion in high concentrations
C - Taking with aspirin
D - When taking with celecoxib
E - None of above
11-Which conditions cause ulcer
A - Patient have psychological stress
B - Patient used aspirin for 2 days
C - Patient use COX-2 selective inhibitors
D -patient taking ethanol ingestion in high concentrations
E - Patient use of corticosteroids with NSAIDs
10 C
12-is the most frequent PUD symptom 11 E
A - Nocturnal pain 12 B
13 D
B - Abdominal pain
C - Nausea ,
D -vomiting
E -anorexia
13-Which is true about gastric ulcer
A - pain occurs 1–3 hours after meals
B - Antacids provide rapid pain relief and treatment
C - Nausea, vomiting, and anorexia are more common in duodenal ulcer
D -food may precipitate ulcer pain in gastric ulcers
E - Heartburn only accompany pain
clinical pharmacy muhanad clinical

14-Ulcer complications includes, except

A - epigastric tenderness
B - perforation into the peritoneal cavity,
C - gastric outlet obstruction
D - GI bleeding
E - none of above
15-The symptoms of gastric outlet obstruction, except
A - weight loss.
B - nausea, vomiting ,
14 A
C - bloating
15 E
D - early satiety 16 C
17 E
E - Nocturnal pain
16-Which is true about diagnosis of PUD
A - epigastric tenderness that sometimes radiates to the left of intestine .
B - blood tests are helpful in establishing a diagnosis of PUD.
C - Diagnosis of PUD depends on visualizing the ulcer
D -Diagnosis of H. pylori infection can be made using endoscopic only
E -radiography more accurate diagnosis
17-Diagnosis of H. pylori infection can be made using
A - UBT
B - serologic antibody
C - fecal antigen
D - both a and c
E - all of above
clinical pharmacy muhanad clinical

18-Which is not true about non-pharmacologic therapy of PUD

A - surgery is usually performed
B - NSAIDs should be avoided if possible
C - Lifestyle modifications
D -stress reduction and smoking cessation
E -patients should avoid foods and beverages that cause dyspepsia
19-first-line therapy to eradicate H. pylori infection.
A - Non-bismuth quadruple
18 A
B - Bismuth quadruple therapy
19 B
C - Sequential therapy 20 A
21 C
D -Hybrid therapy
E -Levofloxacin-based regimens
20-therapy means that all four drugs are given at the same time twice daily called
A - Concomitant therapy
B - Bismuth quadruples therapy
C - Sequential therapy
D -Hybrid therapy
E -Levofloxacin-based regimens
21-PPI plus antibiotics given in sequence rather than together . And then to follow with
different antibiotics
A - Concomitant therapy
B - Bismuth quadruples therapy
C - Sequential therapy
D -Hybrid therapy
E -Levofloxacin-based regimens
clinical pharmacy muhanad clinical

22-involves 7 days of dual therapy (PPI and amoxicillin) followed by 7 days of quadruple
therapy
A - Concomitant therapy
B - Bismuth quadruples therapy
C - Sequential therapy
D -Hybrid therapy
E -Levofloxacin-based regimens
23-LOAD composed from
A - Levofloxacin, PPI, nitazoxanide , and doxycycline
B - Levofloxacin, PPI, nitazoxanide , and domperidone
C - Levofloxacin, PPI, nitrte , and doxycycline
D - PPI, clarithromycin, amoxicillin 22 D

E -none of above 23 A
24 C
24-The adverse effect of fluoroquinolone 25 E
A - Epigastric tenderness
B - Nocturnal pain
C - Tendonitis
D -weight loss.
E -gastric outlet obstruction
25-Patient has NSAID - induced ulcer treatment with
A - PPI
B - H2RA,
C - Sucralfate
D - Discontinue the NSAID
E - All of above
clinical pharmacy muhanad clinical

26- Verification of H. pylori eradication by urea breath test (UBT) must be delayed until
after completion of antibiotic treatment by at least:
A- 1 Week
26 D
B- 2 Week
27 A
C- 3 Week
28 A
D- 4 Week
29 B
E- None of the above
27- Regarding to the eradicate H. pylori infection, The preferred first-line therapy is
A- Bismuth quadruple therapy
B- Clarithromycin triple therapy
C- Sequential therapy
D- Both A and C
E- None of the above
28- Regarding Peptic ulcer disease, The following factor does not increase risk of ulcer or
complications
A- Use of corticosteroids alone
B- use of corticosteroid and NSAIDs concurrently
C- use of nonselective NSAIDs
D- H. pylori infection
E- stress-related mucosal damage (SRMD)
29- A 53-year-old otherwise healthy female was admitted to the emergency department following two
bouts of hematemesis and a single melenic stool. She drink a cup of tea 4 times daily. The patient
reported being prescribed naproxen 500 mg twice daily for the 2 months prior for osteoarthritis.
Endoscopy revealed a 1×1 cm hemorrhagic gastric ulcer in the antrum, which was cauterized at the
time of endoscopy, In this case the cause of peptic ulcer disease is:
A- Helicobacter Pylori
B- Nonsteroidal Anti-Inflammatory Drugs
C- Stress-Related Mucosal Damage
D- Zollinger–Ellison Syndrome
E- Increased caffeine intake
clinical pharmacy muhanad clinical

30- Regarding peptic ulcer disease, Accurate diagnosis and direct visualization of the
ulcer maintained by:
A- Endoscopy
B- Physical examination
C- E- Fecal antigen
D- Serologic antibody detection
E- urea breath test
31-Lower tract infections include except
A - cystitis
B - Pyelonephritis.
30 A
C - urethritis
31 B
D -prostatitis 32 D
33 C
E - none of above
32-Which is not true about complicated UTIs
A - result of a predisposing lesion of the urinary tract
B - such as a congenital abnormality or distortion of the urinary tract ,
C - such as neurologic deficit that interferes with the normal flow of urine and urinary tract
defenses
D -not associated with structural or functional abnormalities
E - such as stone, indwelling catheter ,prostatic hypertrophy, obstruction,
33-Which is not true
A - Reinfections are caused by different organism
B - Relapse is repeated infections caused by the same initial organism.
C - Recurrent UTIs, two or more UTIs occurring more than 6 years
D -Upper tract infections involve the kidney and are referred to as pyelonephritis
E - none of above
clinical pharmacy muhanad clinical

34-The bacteria causing UTIs usually entry into the urinary tract via :
A - ascending ,
B - hematogenous
C - descending
D -lymphatic pathways
E - all of above
35-more than 80%–90% of community-acquired infections is
A - Staphylococcus saprophyticus
B - E. coli
34 E
C - Proteus spp,.
35 B
D -Pseudomonas aeruginosa 36 C
37 E
E -Klebsiella pneumoniae
36-Which is true about UTI
A - patients with stones, indwelling urinary catheters, or chronic renal abscesses, single
organisms may be isolated .
B - Most UTIs are caused by a multiple organism
C - Vancomycin-resistant E. faecalis and E. faecium in patients with long-term hospitalizations
D - both a and b
E - both and c
37-Upper UTI symptoms is
A - Dysuria,frequency,
B - urgency
C - nocturia
D -suprapubic heaviness
E -Flank pain
clinical pharmacy muhanad clinical

38-The most reliable method of diagnosing UTIs is by

A - quantitative urine culture
B - urinalysis
C - phyiscal examination
D - history
E - pyuria test
39-Eradication of bacteria from the urinary tract is directly depeding on
A - sensitivity of the organism
B - achievable concentration of the antimicrobial agent in the urine.
C - the quanitiy of organism
D - both A and B
E -all of above
40-considered first-line treatments of UTI
38 A
A - Amoxicillin 39 D
B - trimethoprim–sulfamethoxazole 40 C
41 B
C - nitrofurantoin
D -fluoroquinolones
E -ampicillin
41-Acute Uncomplicated Cystitis caused by
A - Staphylococcus saprophyticus
B - E. coli
C - Proteus spp,.
D -Pseudomonas aeruginosa
E -Klebsiella pneumoniae
clinical pharmacy muhanad clinical

42-In treatment of acute Upuncomplicated cystitis , the patient have resistance to

trimethoprim–sulfamethoxazole which used
A - Amoxicillin
B - sulfamethoxazole
C - fosfomycin
D -fluoroquinolones
E -ampicillin
43-In treatment of acute Upuncomplicated cystitis , the amoxicillin or ampicillin is not
recommended due
A - high cost
B - resistant to Staphylococcus saprophyticus 42 C
C - due excerted by liver 43 D
D -high incidence of resistant E. coli. 44 B
45 E
E - none of above
44-Which is not true about Acute Pyelonephritis
A - high-grade fever (>38.3°C(
B - Severely ill patients should be hospitalized and oral drugs administered initially
C - Milder cases may be managed with oral antibiotics in an outpatient setting
D - Fluoroquinolones are the first-line choice in mild-to moderate pyelonephritis.
E - none of above
45-In treatment of acute Pyelonephritis , if patient has infections ( Streptococcus faecalis )
should be treated with
A - Amoxicillin
B - sulfamethoxazole
-fluoroq C - fosfomycin
D uinolones
E -ampicillin
clinical pharmacy muhanad clinical

46-If the patient has been hospitalized in the last 6 months, has a urinary catheter should
be used
A - ceftazidime
B - ticarcillin–clavulanic acid
C - piperacillin
D -meropenem
E - all of above
47-Male have urinary tract infections , in culture show have gram-negative bacteria
,which is drug effective on this condition
A - Amoxicillin
B - sulfamethoxazole
C - fosfomycin
D -fluoroquinolones
E -ampicillin
48-A pregnant woman in the fifth month suffers from back pain, high temperature, and
burning when urinating. Upon doing the necessary analyzes, it was found that she has a
urinary tract infection. Which of the following treatments is preferable to be used in this
case?
A - fluoroquinolones
B - Tetracyclines
C - amoxicillin/clavulanate
,D -cephalexin
E - both C and D
49-fluoroquinolones should not be given to pregnant woman due
A - kernicterus and hyperbilirubinemia . 46 E
B - inhibit cartilage and bone development in the newborn. 47 D
48 E
C - teratogenic effects 49 B
D - increase plasma protein in newborn
E - cross placenta and causes damage on brain
clinical pharmacy muhanad clinical

50-sulfonamides should not be given to pregnant woman due

A - kernicterus and hyperbilirubinemia .
B - inhibit cartilage and bone development in the newborn.
C - teratogenic effects
D - increase plasma protein in newborn
E - cross placenta and causes damage on brain
51-Tetracyclines should not be given to pregnant woman due
A - kernicterus and hyperbilirubinemia .
B - inhibit cartilage and bone development in the newborn.
50 A
C - teratogenic effects 51 C
D - increase plasma protein in newborn 52 A
53 D
E - cross placenta and causes damage on brain
52-from the following antibiotics Which of them required single dose only when used in
the treatment of lower Urinary tract infection: :
A- Fosfomycin
B- Levofloxacin
C- Amoxicillin-clavulanate
D- Ceftriaxone
E- Nitrofurantoin
53- A 24-year-old woman would like to know what she can do for her frequent Urinary
Tract Infections. She notices that she mainly gets them after sexual intercourse, What
would be the best recommendation to try first for this patient?
A- Drink cranberry juice daily
B- Levofloxacin 500 mg daily for 1 year
C- Topical estrogen cream
D- Urine voiding after intercourse
E- None of the above
clinical pharmacy muhanad clinical

54-which is not a recommended regimen for treatment of UTI in the pregnant woman
A- Trimethoprim 300 mg orally daily for 5 days
B- Augmentin duo orally b.d for 5 days
C- Cephalexin 500 mg orally bi.d for 5 days
D- Nitrofurantoin 50 mg qid for 5 days
E- All of the above
55-G.S 22 year-old woman with no previous history of UTI, complains of burning on urination,
frequent urination of a small amount, and bladder pain. She has no fever. Midstream urine sample
shows gram-negative rods on Gram stain. Results of a urinalysis are as follows: WBC, 10 to 15
cells/LPF (normal, 0–2 cells/LPF) Red blood cells (RBC), 0 to 1 cells/LPF (normal, 0–2 cells/ LPF)
Bacteria, many (normal, 0 to rare). She was diagnosed with acute uncomplicated cystitis. Which of the
following is true regarding acute uncomplicated cystitis treatment:
A- The first line treatment include 5-day course of ceftriaxone
B- The first line treatment include 5-day course of gentamicin
C- The first line treatment include 3-day course of trimethoprim–sulfamethoxazole
D- The first line treatment include 10-day course of nitrofurantoin
E- The first line treatment include Moxifloxacin
56-The symptoms of asthma includs
A - shortness of breath 54 A

B - wheezing 55 C
C - chest tightness 56 E
D -cough 57 A
E - all of above
57-Which is not true about pathophysiology of asthma
A - acute inflammation, inhaled allergens in allergic patients cause activation of cells bearing
(Igm) antibodies .
B - airway mast cells and macrophages release proinflammatory mediators such as histamine
C - Histamine can induce smooth muscle constriction and bronchospasm
D -Neutrophils also release mediators that contribute to airway inflammation
clinical pharmacy muhanad clinical

58-intermittent symptoms of asthma that require

A - LABAs
B - SABAs
C - ICS
D -Leukotriene Modifiers
E -Anticholinergics
59-treatment choice for acute severe asthma and Exercise induced bronchospasm
A - Albuterol
B - salmeterol
58 B
C - formoterol
59 A
D -indacaterol
60 C
E -vilanterol
61 D
60-long-acting β2-agonists is
A - Albuterol
B - Ipratropium
C - formoterol
D -indacaterol ,
E -vilanterol
61-Combination treatment with ICS/LABA used for
A - for chronic obstructive pulmonary disease (COPD(
B - intermittent episodes of bronchospasm
C - for acute severe asthma
D -provides greater asthma control
E - none of above
clinical pharmacy muhanad clinical

62-ultra-LABAs , except
A - Albuterol
B - indacaterol
C - olodaterol
62 A
D -vilanterol
63 C
E - all of above
64 B
63-oropharyngeal candidiasis side effect of
65 E
A - LABAs
B - SABAs
C - ICS
D -Leukotriene Modifiers
E -Anticholinergics
64-oropharyngeal candidiasis reduced by using
A - ICS with low-to-moderate doses
B - spacer device
C - ICS/LABA
D - using another medication
E - all of above
65-high doses of ICS causes , except
A - growth suppression in children , ,
B - osteoporosis
C - cataracts
D -dermal thinning
E - dilated in kidney
clinical pharmacy muhanad clinical

66-tiotropium is
A - LABAs
B - SABAs
C - ICS
D -Leukotriene Modifiers
E -Anticholinergics
66 E
67-Ipratropium bromide is approved by the FDA
67 A
A - for chronic obstructive pulmonary disease (COPD)
68 D
B - intermittent episodes of bronchospasm
69 D
C - for acute severe asthma
D -provides greater asthma control
E - none of above
68-tiotropium bromide has a duration
A - (30–60 minutes )
B - 5–10 minutes
C - 12 hour
D - 24 hour
E - 8 hour
69-montelukast is
A - LABAs
B - SABAs
C - ICS
D -Leukotriene Modifiers
E -Anticholinergics
clinical pharmacy muhanad clinical

70-Which is not true about Zafirlukast?

A - They are more effective than low-dose ICS
B - less effective than LABAs when added to ICS for moderate persistent asthma
C - They are not used to treat acute exacerbations and must be taken on a regular basis
D -hepatic failure associated with zafirlukast.
E - none of above 70 A

71-The side effect of Leukotriene Modifiers is 71 E

A - irritability 72 D

B - aggressiveness 73 E

C - sleep disturbances
D -neuropsychiatric
E - all of above
72-The most common side effect of zafirlukast is
A - renal failure
B - MI
C - strok
D -hepatic failure
E - CNS depression
73-Zileuton is
A - long-acting muscarinic antagonist (LAMA(
B - Biologic Agents
C - Corticosteroids
D - target the IgE pathway
E -5-lipoxygenase inhibitor;
clinical pharmacy muhanad clinical

74-Which is not true abiut Zileuton

A - reduced hepatic enzymes and inhibition of metabolism of drugs
B - is a 5-lipoxygenase inhibitor
C - interact with warfarin activation
D - inhibt metabolism of theophylline
E - all of above
75-Which is not true about Omalizumab
A - consider biologic Agents
B - Dosage (is determined by baseline total serum IL-13)
C - is an anti-IgE antibody approved for treatment of allergic asthma 74 A
D -It is given subcutaneously (SC ) 75 B
E - none of above 76 D
76-Which is true
77 B
A - Mepolizumab and reslizumab are monoclonal antibodies directed
antagonist IL-5
B - reslizumab is administered S.C
C - Mepolizumab and benralizumab are administered IV
D -Mepolizumab and reslizumab block activation of the IL-5 receptor on eosinophils
E - Benralizumab binds to IL-5 receptor of neutrophil
77-Benralizumab given
A - intramuscular
B - subcutaneously
C - intravenous
D - orally
E - inhlation
clinical pharmacy muhanad clinical

78-Which is not true about dupilumab

A - administered IV .
B - blocking signaling of IL4 and IL-13, which are cytokines that promote IgE synthesis
C - Dupilumab targets the IL-4α receptor
D -approved for patients with an eosinophilic phenotype
E - none of above
79-Which is true about Magnesium sulfate
A - mild bronchodilator
B - relaxation of smooth muscle by blocking K+ ion influx 78 A

C - may also have antiinflammatory effect 79 C

D - both a and b 80 E

E - all of above 81 D

80-Adverse effects of Magnesium Sulfate

A - hypotension
B - facial flushing
C - hypothermia ,
D -sweating
E - all of above
81-Magnesium Sulfate used for
A - single 2 g IV bolus for severe asthma exacerbations
B - single 1g IV infusion for severe asthma exacerbations
C - multiple 2 g IV bolus for severe asthma exacerbations
D -single 2 g IV infusion for severe asthma exacerbations
E - single 3g IV infusion for severe asthma exacerbations
clinical pharmacy muhanad clinical

82-Methylxanthines are rarely used today for asthma due

A - high risk of severe life-threatening
B - high toxicity
C - numerous drug interactions ,
D -decreased efficacy compared with ICS, LABAs, and biologics . 82 E
83 B
E - all of above 84 C
83-Which is true about Theophylline 85 A

A - Theophylline is available for oral and IM administration

B - Theophylline dosing requires monitoring of serum concentrations
C - not causes seizures and death .
D - no drug interactions
E - all of above
84-Which is rarely used today
A - Omalizumab
B - Albuterol
C - Theophylline
D -Magnesium Sulfate
E -Benralizumab
85-Which is blocking signaling of IL4 and IL-13 ,
A - Dupilumab
B - Benralizumab
C - Omalizumab
D -Mepolizumab
E -reslizumab
clinical pharmacy muhanad clinical

86- At home to assess therapy and determine if a patient with asthma should seek
emergency care. Which of the
A- Forced expiratory volume in one second (FEV1
86
B- Forced vital capacity (FVC 87 A
88 B
C- Total lung capacity (TLC 89
D- Peak expiratory flow rate (PEFR
E- Allergy-skin Test
87- C.V is 23 year old female. She was having breathlessness 3 days per week which
require the use of salbutamol MDI and nocturnal awakenings 2 times per month. Her
medications include albuterol metered-dose aerosol inhalation QID PRN. Diagnosed with
mild persistant asthma. What is the MOST suitable long-term treatment for this
A- Low dose ICS
B- Montelukast
C- Theophylline
D- Low dose ICS/LABA
E- Prednisone
88- An Asthmatic patient is poorly controlled. The patient reports using their rescue
inhaler 4 times a week. In addition, the patient's asthma is not responding to other
treatments. The physician orders the patient to take a medication that works by blocking
the role of the immunoglobulin IgE. This describes which of the following
A- Montelukast
B- Omalizumab
C- Cromolyn
D- Salmeterol
E-Magnesium sulfate
clinical pharmacy muhanad clinical

89- The adverse effect of oral candidiasis in the asthmatic patient is associated with the use
of:
A- Nebulized ipratropium
B- Inhaled Albuterol
C- Oral prednisone
D - Inhaled beclomethasone
E- Oral montelukast
90- Regarding Treatment Of Asthma, Which one of the following drugs is inhaled SABAs ?
A- Formoterol
B- Albuterol
C- Indacaterol
D- Vilanterol
E- Olodaterol
91-- When low-dose inhaled steroids fail to control asthma symptoms, The best drug to be
?given is
A- fluticasone
B- Ipratropium
C- salmeterol
D- terbutaline
E- higher dose of systemic steroid
91- Regarding clinical presentation of asthma, Common symptoms of asthma are
A- Coughing
B- Wheezing
C- Chest tightness
D- All of above
clinical pharmacy muhanad clinical

92- A 15-year-old female is brought to the emergency department. She is breathing 30

times per minute, is unable to speak in full sentences, and has a peak expiratory flow rate
(PEFR)< 50% predicted. The preferred first-line therapy for her asthma exacerbation is
A- Theophylline
B- Beta-agonist.
C- Corticosteroid
D- Cromolyn sodium.
E- B and C

A-