front 1 TG, a 72-year-old male, is hospitalized with a pulmonary embolism. He is receiving unfractionated heparin initiated at a rate of 1,000 units/hour. The control value at this hospital is 22-38 seconds. Select the correct test and an appropriate treatment level for this patient: | back 1 aPTT, 44 secs |
front 2 All of the following medications require monitoring of the absolute neutrophil count EXCEPT: | back 2 Isocarboxazid |
front 3
History of Present Illness: SJ is a 41-year-old
African American female who is at a 1-month follow-up visit with her
PCP after repeat lab testing. Which of the following is true regarding the monitoring of SJ's antiepileptic treatment? | back 3 The reported phenytoin level is within goal range for safety and efficacy |
front 4 A 55-year-old female presented to the hospital with weakness and
dyspnea. She was diagnosed with pneumonia and severe hemolytic anemia.
The Coombs test was positive. The patient received a blood transfusion
and was treated with prednisone and clarithromycin for pneumonia. | back 4 Rifampin |
front 5 SS is an 80-year-old Asian female being treated for S. aureus bacteremia. She is receiving daptomycin at a dose of 6 mg/kg daily at 0800 daily. Of the following lab values, which is most essential to monitor in this patient? | back 5 Creatinine phosphokinase (CPK) |
front 6 Which of the following medications is incorrectly matched with its usual therapeutic range? | back 6 Phenytoin 4-12 mcg/mL |
front 7 A pregnant patient is started on methyldopa for blood pressure control. Which laboratory abnormality can occur due to this drug treatment? | back 7 Positive ANA |
front 8 A 44-year-old Asian female with a history of non-Hodgkin's lymphoma received several cycles of chemotherapy. The patient was in remission for 11 years until recently when she experienced a relapse. She was admitted for inpatient chemotherapy. The patient received the CODOX-M/VAC regimen (cyclophosphamide, doxorubicin, methotrexate, etoposide, and cytarabine). During the hospitalization, she developed Streptococcus viridans sepsis and is being treated with levofloxacin 500 mg IV daily. The patient is found to have decreased serum folate levels. The clinical pharmacist participating in medical rounds is asked if any of the patient's medications could have contributed to the low folate levels. Select the best response: | back 8 The most likely drug contributing to the decrease in folate is methotrexate |
front 9 The CRP and ESR are non-specific tests used to identify and evaluate: | back 9 Autoimmune diseases |
front 10
Urine culture results (9/18): E. coli >
100,000 CFU/mLSusceptible to: nitrofurantoin, ceftriaxone,
ciprofloxacin, levofloxacin, gentamicin,
sulfamethoxazole/trimethoprimResistant to: cefazolin, amoxicillin, ampicillin/sulbactam | back 10 Levofloxacin |
front 11 Which of the following drugs can contribute to low serum sodium levels? (Select ALL that apply.) | back 11 Torsemide, escitalopram, carbamazepine and oxcarbazepine can all cause hyponatremia. |
front 12 What is the correct interpretation of LM's coagulation status? INR = 0.8 | back 12 Her INR is within reference range (A normal INR for a patient who is not taking warfarin is < 1.2. A normal range is often not provided for the INR, because the INR target depends on the indication and whether or not the patient is taking warfarin.) |
front 13 LM presents to her PCP in the clinic. She is known to be sporadically compliant with her medications, but states she has been taking them for the past 3 months since her prescription insurance became active. Past Medical History: Hypothyroidism, dyslipidemia, hypertension, asthma, peri-menopausal
Medications:
Zocor 40 mg daily, levothyroxine 125 mcg daily,
Norvasc 10 mg daily, Flovent HFA 88 mcg (2 puffs)
BID, multivitamin AST (IU/L) = 142 (10 – 40) ALT (IU/L) = 130 (10 – 40) T Bili (mg/dL) = 0.8 (0.1 – 1.2) Which of LM's lab abnormalities is a well-known adverse effect of one of her medications? | back 13 Increased LFTs |
front 14 Medications: Zocor 40 mg daily, levothyroxine 125 mcg daily, Norvasc 10 mg daily, Flovent HFA 88 mcg (2 puffs) BID, multivitamin TSH (mIU/L) = 0.15 (0.3 – 3) FT4 (ng/dL) = 4.2 (0.9 – 2.3) Which of the following is the correct assessment of LM's thyroid function? | back 14 She is currently hyperthyroid. Decrease levothyroxine dose. (Low TSH and increased FT4 indicate hyperthyroidism.) |
front 15 Which of the following medications are known to contribute to drug-induced hemolysis and would require discontinuation in a patient who developed hemolysis after use of the drug? (Select ALL that apply.) | back 15 Methyldopa, quinidine, rasburicase (The Coombs test is used in the diagnosis of hemolytic anemia. If the Coombs test is positive and a drug-induced cause is suspected, discontinue the offending drug. Drugs with the highest risk of causing hemolytic anemia are also discussed in the Anemia chapter.) |
front 16 TG, a 72-year-old male, is hospitalized with a pulmonary embolism. He is receiving unfractionated heparin initiated at a rate of 1,000 units/hour. The control value at this hospital is 22-38 seconds. Select the correct monitoring parameters for patients receiving heparin. (Select ALL that apply.) | back 16 aPTT, PLTs, Hgb/Hct and signs of bleeding |
front 17 The pharmacist on rounds has a patient with an acid-base imbalance. The pharmacist has calculated the patient's anion gap. Why is this calculation performed? | back 17 To identify if the patient has an anion gap or non-anion gap metabolic acidosis |
front 18 Which of the following drugs can cause folic acid deficiency? (Select ALL that apply.) | back 18 Bactrim, methotrexate |
front 19 Which of the following drugs should not be dispensed to a patient with known G6PD deficiency? (Select ALL that apply.) | back 19 Methylene blue, dapsone, pegloticase |
front 20
New Orders:Nothing by mouth Which laboratory value is most essential to monitor given the new orders listed for TP? | back 20 CPK |
front 21 Plt (cells/mm3) = 202 (150 – 450 x
103) TP's laboratory findings show evidence of: | back 21 A left shift |
front 22 The time that is generally preferred to take drug levels (for most drugs) is called: | back 22 Steady state (Steady state occurs when the amount of drug entering the body is equal to the amount leaving the body (through metabolism, excretion).) |
front 23 A patient has G6PD deficiency. What can occur as a result of this disease if the patient receives primaquine for malaria prophylaxis? | back 23 The patient will be at risk for excessive destruction of RBCs |
front 24 Which diagnosis is most likely based on the lab results from August 6th? RPR is reactive+ | back 24 Syphilis |
front 25 Which lab value obtained on August 6th suggests that BH is malnourished? Albumin 2.9 | back 25 Albumin |
front 26 BH is a 34-year-old female with a history of asthma, type 2 diabetes and hypertension. She presents to her PCP on August 6th for a 3-month follow-up visit. She mentions that she has lost 11 pounds without dieting since her last visit in May.
Medications:Metformin XR 2,000 mg PO daily Which medication/s could be contributing to BH's electrolyte abnormality on May 7th? (Select ALL that apply.) | back 26 Insulin, ventolin |
front 27 (same case from above) What lab-related issues were present on Feb 3rd? | back 27 Dehydration and leukocytosis |
front 28 LC, a 62-year-old male, is hospitalized with a pulmonary embolism.
All of his labs were normal upon admission to the hospital and he was
taking no medications before admission. Platelets: 73 (150 - 420) Based on the patient's labs, there is a concern for what new medical issue? | back 28 HIT (Heparin-induced thrombocytopenia (HIT) is suspected when platelets drop > 50% from baseline. The scenario stated that the patient's lab values were normal at baseline. All other relevant lab values are within normal limits.) |
front 29 (same case from above) Which of the patient's lab values are most indicative of a decline in renal function? | back 29 BUN, creatinine, phosphate |
front 30 WBC (cells/mm3) = 14.3 (4 – 11x103) Neut (%) = 88 (45 – 73) Bands (%) = 7 (3 – 5) CRP (mg/dL) = 53 (0 – 0.5) Without knowing JS's medications or past medical history, what is most likely diagnosis based on his labs? | back 30 Bacterial infection |
front 31 A patient presents with a butterfly-shaped rash on her face and achy joints. The physician is concerned for drug-induced lupus. The patient's chronic medications include potassium chloride, furosemide, metoprolol succinate, hydralazine/isosorbide dinitrate, candesartan and eplerenone. Which of the daily medications is most likely contributing to this presentation? | back 31 Hydralazine/isosorbide dinitrate (Isosorbide dinitrate and hydralazine (BiDil) can cause drug-induced lupus due to the hydralazine component.) |
front 32 A patient's albumin level is 2. Which of the following would need to have the level adjusted due to this albumin level? (Select ALL that apply.) | back 32 Calcium, phenytoin, valproate |
front 33 CRP is a marker for which of the following? | back 33 Inflammation |
front 34 A patient presents with confusion and rapid breathing. A lab report reveals a low serum bicarbonate level and metabolic acidosis. Which of the following medications would most likely cause this abnormality? | back 34 Topiramate |
front 35 When the liver cells (hepatocytes) are acutely damaged these enzymes are released and will be elevated in the serum: | back 35 AST and ALT |
front 36 A drug that is highly protein bound (95% or higher bound to albumin) will have a large change in free drug concentration when the protein level changes. If a patient was using warfarin and the albumin decreased from 2.5 g/dL to 1.5 g/dL what would be expected to happen to the warfarin and the INR result? | back 36 The free warfarin level would increase, which would cause the INR to increase |
front 37 Calcium levels may decrease with chronic use of these drugs: (Select ALL that apply.) | back 37 Bumetanide, cinacalcet, alendronate |
front 38 The pharmacy department received the following parenteral nutrition
orders for a 79-year-old patient. If the pharmacist becomes concerned that the lipid infusion is causing complications related to hypertriglyceridemia, evaluation of which laboratory tests would be most appropriate? | back 38 Amylase and lipase |
front 39 DL's antiarrhythmic treatment could be contributing to which laboratory abnormality? | back 39 TSH |
front 40 A pharmacist wishes to take a drug level at steady state. The drug is started on Monday at 14:00 hours. It has a half-life of 8 hours and is dosed twice daily. Of the following options, which is the earliest reasonable time to order a steady state drug level? | back 40 Wednesday at 6:00 (It takes approximately 5 half-lives to reach steady-state.) |
front 41 Which medication can cause B12 deficiency when used long-term? | back 41 Omeprazole |
front 42 EK is beginning amiodarone therapy. She is easily stressed and worried about having "racing heart and dizziness" or what her physician said was an "arrhythmia". She uses furosemide and has had hypokalemia in the past. She has been told that her potassium and magnesium need to be within normal limits to keep her heart at a normal rhythm and that she should try to relax. The physician has decided that she wants to check magnesium and potassium and orders a Basic Metabolic Panel (BMP). Select the correct statement: | back 42 The physician should also order the magnesium level, this is not included in the BMP (The BMP includes glucose, sodium, potassium, bicarbonate, chloride, blood urea nitrogen and creatinine.) |
front 43 A 7-year-old child is receiving the low molecular weight heparin, enoxaparin. The clinical team in the pediatric unit is not sure if the medication is being dosed correctly due to the child's age and body weight. They will order a lab test to check for subtherapeutic, therapeutic or supratherapeutic dosing. Which test should be ordered? | back 43 Anti-Xa |
front 44 The CBC includes each of the following lab values except: | back 44 BUN |
front 45 LM is a 55-year-old female recently diagnosed with multiple myeloma with a history of anxiety, hypertension and rheumatoid arthritis. She has been treated with prednisone and methotrexate. The patient initially presented to her primary care physician with bilateral ankle edema and a 28-pound weight gain. She was found to be in acute kidney failure and was admitted for further evaluation. Abnormal laboratory findings included an elevated serum creatinine, BNP and white blood cell count. The elevated BNP will warrant assessment by the following team: | back 45 Cardiology |
front 46 Select the name of the lab test used to distinguish between a microcytic and macrocytic anemia: | back 46 MCV (The volume (and size) will be lower (low mean corpuscular volume) in a small cell (microcytic) anemia, and larger in a large cell (macrocytic) anemia.) |
front 47 TY is being seen today in the emergency department. Which of the
following is the most likely diagnosis based on his labs? | back 47 Viral infection |
front 48 A patient with non-small cell lung cancer is receiving cisplatin as part of a chemotherapy treatment regimen. Select the lab test that should be ordered to monitor for leukopenia. | back 48 CBC |
front 49 The BMP includes each of the following lab values except: | back 49 Phosphate |