Answer ALL of the following statements by selecting THE ONLY ONE correct choice (use the provided answer sheet): ith CML was treated by a tyrosine kinase inhibitor. How can deep, long-lasting molecular response be defined? Giceaato 1% b- BCR-ABL Paragard 31- R.M is 27 years old female with history of anxiety who had tried different courses of antidepressants and benzodiazepines without an adequate response. The next step of her treatment would be: a- Quetiapine b- Arpiprazole Buspirone d- Pregabalin €- Risperidone 32- What is the type should not be left in place for more than 24 hours because of the risk of toxie shock syndrome Edin b- cervical eap c- Male condoms |- Female condoms Spermicide Implanted Barrier 33- The following are the disadvantages of combined oral contraceptive pills, EXCEPT: a- Increase the risk of blood clots, b- Irregular bleeding or spottin, Increase risk of endometrial cancer. d- Not be suitable for breastfeeding women. €- Does not protect against sexual transmitted infect 34- A 27-year-old woman comes to endocrinologist because she has had suffer from hair on her face. chest, and back as well as irregular menses for the past 10 months. She says she also has had easy bruising with poor wound healing during this time. Diagnosis of Cushing syndrome is confirmed by laboratory tests. Which one of the following drugs is most appropriate for this patient? a- Metyrapone b- Osilodrostat Ketoconazole d- Etomidate e- Metformin 35- Regarding the chemotherapy of breast cancer. The adjuvant chemotherapy regimens include all EXCEPT: ‘ae Adriamycin b- Cyclophosphamide Bisphosphonates d- Docetaxel c- Paclitaxel 36- Regarding the prostate cancer, Advanced Disease is characterized by all of the following, EXCEPT: az Back pain and spinal cord compression (urinary frequency Lower extremity edema d+ Pathologic fractures ¢- Anemia and weight loss 37- Although the treatment of GAD can be achieved by a wide range of medications. Acute and long- xm therapy is best achieved by b- Diazepam c- Hydroxyzine d- Buspirone e- All of them 38- IUD is well known to have minimal systemic adverse effects, that is attributed to the primar contraceptive mechanism of the Levonorgestrel US through: a- Negative feedback to the hypothalamus Endometrial atrophy c- Ovulatory Suppression d- Apoptosis of gametes e- All of the above39- Regarding antidepressants administration for the treatment of major depressive disorder, the following statements are true EXCEPT: a- Antidepressants are equal in efficacy when administered in comparable doses, and they are often classified by chemical structure and/or presumed mechanism b- The initial choice of antidepressant is often made empirically Older patients can be given the same initial dose given to younger adults At least a 6-week trial of an antidepressant at maximum dosage is considered an adequate trial of that medication e- An individual's pharmacogenomics may be useful when choosing therapy as a way to better predict antidepressant side effects or response 40- Adrenal insufficiency is caused by multiple etiologies. The most common cause of secondary adrenal insufficiency in countries like Iraq and Egypt is a- Autoimmune disorder b- Tuberculosis c- Air pollution d- Rifamicin ‘long term administration of exogenous corticosteroids 41- A 66 years old woman is suffering from low mineral bone density and strong family history of breast cancer. What would be the best protective agent? a- Tamoxifen (B Raloxifene & Exemestane d- Cyclophosphamide ‘e- None of them ‘The diagnosis of Alzheimer disease is largely based on Identified symptoms b- Laboratory data c+ Chest CT sean Abdominal MRI All the above 43- Ahmed is a 65 years old man with severe Alzheimer disease. The suitable cholinesterase inhibitor is a- Rivastigmine b-Galantamine jonepezil d- Lorazepam e- Aspirin 44- All patients receiving treatment for Alzheimer disease should be monitored for therapeutic outcomes. ‘The following parameter(s) should be monitored a- Drug effectiveness Side effects c- Adherence d- The need for dose adjustment © the above a- Sunday start method = Quick start method c- First-day start method 45- Which method of starting minipills involves taking the first pill on the day of the doctor office visit? (OQ d- Emergency contraception method None of the above {stal is a prescription selective progesterone receptor modulator. It is taken as a single dose of 30 hours of unprotected intercourse. b-48 72 d-96 ei20 47- Samir is 39 years old patient with hypothyroidism on thyroxine. He came to you with preseription for his new GIT problem. The new prescription is (Aluminum hydroxide chewing tab. pantoprazole cap- sucralfate) for 2 months. You phoned the physician to do the following: a- cancel pantoprazole ancel suri ¢ decrease dose of pantoprazole increase dose of thy e- decrease the dose of thyroxin Page 6of 4 may be a or b48- Anxiety Symptoms can be developed with several medicines, EXCEP a- prednisone be theophylline c- ibuprofen d- levothyroxine eerivastatin 49- Adrenal insufficiency produced by Autoimmune dysfunction or drugs, which drug was reported to induce secondary adrenal insufficiency? : a- ketoconazole (medroxyprogesterone c- phenytoin d- rifampin = phenobarbital 50-§ A, is a29 y 0 woman weighing 98 kg (her ideal body weight is 60Kg), taking oral contraceptive pills but she is afraid from her poor adherence. As a pharmacist, what is the best contraception must be used. a- etonogestrel implant @ c- EE pills d- mini pills 51- Women with anovulatory bleeding from PCOS who are pursuing pregnancy. Women may be treated with letrozole b- ethinyl estradiol c- Norgestimate d- Desogestrel e- Drospirenone 52- Which drug is an antiCD-22 and also used in relapsed and refractory B-ALL a- Clofarabine b- Blinatumomab CY notuzumab ozogamicin d- Tisagenlecleucel e- Nelarabine ‘53+ Small-Molecule Inhibitors used to treat CLL, Which drug that targets B-cell lymphoma 2 (BCL-2) Sie and may be used as first line therapy or for patients with relapsed/refractory CLL a)Venetoclax b- Idelalisib c- duvelisib d- Ibrutinib e cealabrut ‘54- Drug used to prevent Breast cancer. Which drug increased incidence of endometrial cancer: a- Exemestane b- anastrozole (Qtamoxifen d- raloxifene e- Letrozole 55- Nausea and vomiting are most common side effect of chemotherapy. Agents with a “high” emetic risk ‘cause emesis in more than 90% of cases if not given any prophylaxis, like a- tamoxifen isplatin c- cyclophosphamide ¢- fluorouracil = methotrexate 56- In case of febrile neutropenia. Liriezolid, quinupristin-dalfopristin, tigecycline, and daptomycin may be used in cases of severe cases b- in availability of suitable antibiotics ancomycin resistant organisms d- high cost of injectable antibi e-allergy 57- Pasireotide is approved for use in Cushing disease primarily because: a Ithas fewer side effects than other therapies _,b- It directly stimulates cortisol breakdown c-Itcan be used as a first-line treatment @ tis effective in patients who cannot have surgery e- It promotes adrenal gland regeneration58- How should patients with Addison's disease using corticosteroid replacement manage their doses during stressful situations? a- No need for adjustments, the body compensates automatically. b- Reduce the dose slightly to avoid overexposure. ¢- Maintain regular dosage regardless of stress levels. {@ Temporarily double their daily dose until the stressful event subsides. €- Stop taking medication until the stressful situation resolves. ‘59- What test results would indicate thyrotoxicosis caused by Graves’ disease? a- Elevated TSH, low RAIU Elevated free T4, elevated free 73, suppressed TSH c- Normal TSH, low RAIU Elevated T3, normal T4, elevated TSH e- Reduced iodine uptake in specific areas of the thyroid 60- Which genetic mutations significantly increase the lifetime risk of breast cancer? \@DBRCAI and BRCA2 b- TPS3 and EGFR c- KRAS and NRAS d- ATM and CHEK2 e- BRCA3 and PALB2 61- Dehydroepiandrosterone (DHEA) is a precursor hormone that can be converted into: a- Only testosterone b- Only estrogen Estrogen, estradiol, and testosterone d- Sclective Estrogen Receptor Modulators (SERMs) = Phytoestrogens 62- When is a levonorgestrel-releasing IUD considered a first-line treatment for dysmenorrhea? a- When combined with NSAIDs ‘When other CHCs haven't been effective c- For dysmenorrhea secondary to endometriosis d- Always the first-line treatment e- Not recommended for treating dysmenorrhea 63+ Which of these statements about the Twirla transdermal patch do you think is correct? a- It provides Ethinyl estradiol (EE) (35 mg) and levonorgestrel (150 mg) daily It provides 0.35 meg of EE and 120 meg of norgestimate daily. Or (30 mcg) and levonorgestrel (120 mcg) are provided daily. used to provide 120 meg of norgestimate and 0.95 mg of EE daily. ¢- It provides 0.35 mg of EE and 0.15 meg of levonorgestrel daily. 64- Mr. Ali, 71, with hypertension, presented with memory loss, financial management difficulties, and disorientation. His reduced social activities and mood swings indicated a cognitive decline. An MMSE score of 22 suggested mild Alzheimer’s disease, confirmed by MRI. The following treatments can be used as monotherapy, EXCEPT: a- Donepezil. b- Rivastigmine. @Memantine. e- Aducanumab. c- Galantamine is helpful for treatment of hyperthyroidism. What is a contraindication for 65- Radioactive iodine therapy radioactive iodine therapy? ; i Suspicious thyroid nodules a- Moderate to severe eye disease b- Suspicious t 7" Desire to become pregnant in the next 12 months d-Need for quick control of hyperthyroidism e- Thyroid adenoma68- A.J. is 53 years old man who suffers from insomnia in the last 2.5 months. What can you consider the pe of insomnia for this patient? ))Short term b- Transient c- Long term d- Chronic e- Persistent 69- A patient with chronic insomnia was treated by zolpidem and educated about sleep hygiene. Which one of the following statements regarding the evaluation of therapeutic outcome for this patient is true? a- After 1 week of therapy, the patient should be assessed for drug adherence, effectiveness, and adverse vents b) After 7 days of therapy, the patient should be assessed for drug effectiveness, adverse events, and ‘adherence to non-pharmacologic recommendations c- After | week of therapy, the patient should be assessed for drug effectiveness, and adverse events d- Afier 1 month of therapy, the patient should be assessed for drug effectiveness, adverse events, and adherence to non-pharmacologic recommendations e- None of the above 70- A 41 years old woman with a positive family history of breast cancer. What is the treatment of choice to reduce her risk breast cancer risk? a- Raloxifen b- Letrozole @©Tamoxifen d- Exemestane e-BandD 71- Many cytotoxic drugs are carcinogenic. All of the following drugs have a high risk to cause leukemia as a secondary malignancy EXCEPT; a- Melphalan OO Fluorouracil c- Etoposide d- Doxorubicin & Cyclophosphamide 72 S.A is 61 years old woman diagnosed to have ovarian cancer. All of the followings are common sites for metastases by ovarian cancer EXCEPT: a- Bone b- Lung Baader d- Liver e- Brain 73-A patient with stage 1 colon cancer. The tumor was removed by surgery. What is the aim of surgery for this patient? a- Palliative b- Preventive (Curative d- Diagnostic ¢- None of the above 74- A patient with stage 3 rectal cancer. SFU and leucovorin was given before performing surgical removal of the tumor. What is the type of chemotherapeutic regimen that used for this patient? a- Adjuvant (G)Neoadjuvant c- Palliative d- Salvage e- Induction75+ Y.S. is 70 years old man with AML who was treated by cytarabine and daunorubicin (moderate emetogenic regimen) plus a suitable prophylactic antiemetic regimen. What is the best antiemetic for breakthrough nausea and vomiting for this patient? a- Ondansetron b- Palonosetron (@pProchlorperazine d- Dexamethasone e- Olanzapine 76- A patient with ALL was treated by 4 drugs induction regimen. After treatment, the neutrophil count reduced to 400 cells/microliter. Vital signs: Blood pressure 86/50 mmHg and temperature of 39 C. What is the best treatment for febrile neutropenia for this patient? a- Cefipime jentamycin+Ceftazidime+ Vancomycin‘ Filagrastim c- Amikacin+pipracillin ‘& Meropenem-+filagrastim €- Meropenem + vancomycin 77- A cancer patient suffers from severe chemotherapy induced mucositis. All of the following drugs have a moderate-high risk to cause mucositis EXCEPT: a- Paclitaxel b- Carboplatin c- Methotrexate d- Doxorubicin (> incristine 78- A patient with colon cancer was treated by fluorouracil-based regimen (FOLFOX). The patient developed fluorouracil induced mucositis. Which one of the following statements regarding mucositis is true? a- Symptoms appear within 5 to 7 weeks after chemotherapy b- Amifostine is approved for prevention and treatment of mucositis c- "Magic-mouthwash” compounded rinses are generally recommended by clinical practice guidelines for ucositis prevention )Antimicrobial therapy is necessary to prevent systemic infection in very severe mucositis. e- Palifermin is given as SC injection for treatment of mucositis, 79- A patient recently diagnosed to have prostate cancer. The major pathologic cell type of prostate cancer is : a- Sarcoma —_b-Lipoma (QpAdenocarcinoma -Careinoma e- Hyperplastic 80- A 57 years old man with positive family history of prostate cancer. All of the following statements regarding screening and prevention of prostate cancer are true EXCEPT: 2. Guidelines do not recommend the use of dutasteride for prostate cancer chemoprevention. (® Screening for prostate cancer is important and recommended c- Screening every 5 years may be adequate d+ Males who elect to have screening should do so no more than every 2 years & Guidelines do not recommend the use of finasteride for prostate cancer chemoprevention. 81- E.D. is 71 years old man with prostate cancer who is treated by relugolix. Which one of the following statements regarding relugolix is true? a- It act as GnRH agonist be It can cause tumor flare up c- It reduces the production of testosterone 4: It is administered subcutaneously CG Itcan cause hyperglycemia to castrate levels in 28 days82- S.K is 79 years old man with metastatic castrate resistant prostate cancer. All of the following drugs are suitable or treating SK EXCEPT: boiraterone b- Radium-223 c- Sipuleucel-T Darolutamide e- Rucaparib 83- A 63 years old patient with CML was not responding to imatinib. Upon investigations T3151 mutation was negative. The patient has a history of torsades de pointes (a type of arrythmia with long QT interval). What is the most suitable therapy for this patient? a Ibrutini b-Nilotinib c-Omacetaxine —_d- Ponatinib josutinib 84- A 67 ycars old man with a history of atrial fibrillation, He is recently diagnosed to-Rave CLL with deletion of 17 P. What is the best initial therapy for this patient? a- Ibratinib (HVenetoclax plus obinutuzumab -~ FCR (fludarabine, cyclophosphamide, and rituximab) Idelalisib plus rituximab - Duvelisib 85- A young adult suspected to have schizophrenia. Which one of the following set of symptoms if present for >1 month can confirm the diagnosis of schizophrenia? usion and impaired attention b- Catatonic behavior and anhedonia Disorganized speech and catatonic behavior d- Hallucitiations and impaired memory None of the above 86- H.K is a 28 years old woman was recently diagnosed to have schizophrenia. She also suffers from menstrual irregularities due to hyperprolactinemia. She has a history of non-adherence to therapies with more than once daily regimen. Which one of the following drugs is the preferred first line therapy for HK? a- Ziprasidone b- Haloperidol c-Risperidone @) Aripiprazole e+ Clozapine 87- K.K is 47 years old man. His schizophrenia is treated by olanzapine. Olanzapine has a high risk for developing all these side effects EXCEPT: lurred vision b- New onset diabetes ¢- Dyslipidemia @Psedoparkinsonism c- Weight gain 88- R.S is a young adult man who suffers from depression symptoms, According to monoamine hypothesis, the brain level of serotonin and norepinephrine is a- Both are increased b- Not affected © Both are decreased d- Both are slightly increased e- Serotonin is decreased and norepinephrine is increased 89- A 25 years old pregnant woman with depression. Why the physician did not prescribe her paroxetine? a- Because of its effect to increase birth weight Because of its effect to cause respiratory distress ‘c- Because it has limited benefit for pregnant women d+ Because of its short duration of action e- All of the above 90- G.A. is 45 years old man with depression who is not responding to treatment by paroxetine. All of the following options are suitable to manage GA case EXCEPT: a- Changing paroxetine to amitriptyline 'b- Changing paroxetine to duloxetine a of psychotherapy d- Addition of ECT eIncreasing paroxetine dose a Page 12 of 1491- D.K is 54 years old man diagnosed to have major depression. The physician ordered ECG before prescribing a drug to this patient. What do you expect the drug that the physician prescribed for D.K? a- Fluoxetine Impramine ¢- Venlafaxine d- Phenelzine e- Bupropion 92- A depressed man with a history of epilepsy was prescribed paroxetine. After few months of treatment, he noticed improvement in his depression but with increase in sexual dysfunction. What is the best alternative drug for this patient? a-Desimpramine _b- Bupropion ©Mirtazapine d- Escitalopram e- Phenelzine 93- An adult woman patient with classic Cushing's disease (caused by a pituitary adenoma) referred to surgery; Laparoscopic adrenalectomy is her current treatment according to her physician mostly because? ‘@))Transsphenoidal surgery and pituitary radiotherapy have failed or cannot be used. Preferred for bilateral adrenal adenomas c- Preferred for tumors invading the dura or cavernous sinus d- Treatment of choice for both ACTH dependent and ACTH independent Cushing syndrome €- Pharmacotherapy failed to be used as first line treatment 94- What is the recommended first-line therapy for patients with functional hypothalamic amenorrhea, according to the 2017 Endocrine Society Clinical Practice Guideline? a- Oral contraceptives b- Conjugated equine estrogen Estradiol patch non-pharmacological treatment A short-term transdermal estrogen with cyclic oral progestins 95+ Which medication, administered intrarcctally before each dose of radiation therapy for rectal cancer, may be considered to prevent gastrointestinal (Gl) mucositis? a- Gelclair b- Caphasol @ Aviifoetine d- Biotene e- Benzydamine mouthwash 96- Which of the following clinical presentations of depression is more common in pediatric Loss of pleasure b- Loss of interest c- Depressed mood e-AandB 97- Remission induction therapy of acute lymphocytic leukemia. A 44 years old adult patient diagnose¢ with acute lymphocytic leukemia, which option of the following is not included for his remissior induction therapy? a- Vinoristi d- Dexamethasone b- Lasparaginase Q Clofarabine e- Anthracycline 98- concerning Generalized anxiety disorder. The diagnosis requires excessive anxiety and worry mos days for at least a- 3 months (G36 months cI month d-2 months e- 8 weeks ms, EXCEPT: : b-alogia c- anhedonia d-social isolation _¢-avolition concerning schizophrenia. The followings are negative symptot jusions100- MRE baseline and afler treatment should be recommended whih. J Aducanumab e- Galantamine as Rivastigmine be Donopesil > Memantine 1OL- M.S, a SS-yearold female on Etomidate prepured (0 ‘Trunssphenoidal resection of the pituitary tumor for her Cushing disease, Recently she developed an emergent medic addition ofan oral hypoglycemic drug to her regimen and this peration not possible to be performed, Which medication is most optimal to be used at this time {0 control patient symptoms regarding the elevated cortisol level? ae Metyrapone with Ketoconazole be Higher doses of Etomidate £)Mitepristone d+ Pasircotide €- Osilodrostat 102- A 35-years old mate patient with tuberculosis, few months after his recovery this patient developed weakness, additional weight loss, sult craving, headaches, memory impairment, depression, and postural dizziness. Prednisolone tab 5 mg and fludrocortisone acetate 0.1 mg tab daily were preseribed (o contro his symploms. Recently this patient exposed to eur accident resulled in massive blood loss and head injury. What is the recommended management plan regarding his cond! a- Double his oral daily doses of both Prednisolone and Fludrocortisone with using proper Nuid therapy ‘until sf b- Double his daily oral Prednisolone dose and switch to Deoxycorticosterone trimethylacetate injection with proper fluid therapy until stabilized c= Switch to oral Hydrocortisone 25 mg with proper uid therapy and omit fludrocortisone. \PBwiteh to ydrocortisone 100 mg 1V by pid infusion, followed by 200 mg over 24 hours as a Sontinuous infusion with proper fluid therapy until stabilized, e Switch to oral Hydrocortisone $0 mg every 6-8 hours with proper fluid therapy until stabil omit Mudrocortisone. 103- Different neurotransmitter play pole in schizophrenia. The significant one is a Serotonin Dopamine - Acetylcholine d- GABA ppinephrine 104- ‘The important indicator of disease recurrence and a predictor of outcome for patients with acute a+ White Blood Cell count b- DNA content Minimal Residual Disease (MRD) |- Age of the paticnt ¢- Sex and age of the patient 105- Which of the following antidepressants can be used in pregnant women with anxiety? Venlafaxine b- escitalopram ¢- paroxetine traline - Quetiapine 106- Which antipsychotic medication carries the highest risk of neutropenia and agranulocytosis, necessitating regular blood monitoring during treatment? ; a- Risperidone be Olanzapine clozapine d- Paliperidone Haloperidol Page 13 of 14107- Biologic or Targeted Therapy is one of approach for treatment of breast cancer. Which one of the following regimens is considered first line treatment for HER2 positive breast cancer? a- pertuzumab-trastuzumab be trastuzumab-taxane (©pertuzumab-trastuzumab-taxane combination rtuzumab-taxane combination e- Adotrastuzumab emtansine-pertuzumab-taxane 108- J.A. is 48 years old woman with breast cancer. Which one of the followings is a risk factor for breast cancer? a- Young age with low physical activity b- Young age at menopause c- Young age at first birth @® Young age at menarche e- Old age at menarche 109- R.S is 68 years old patient with history of Hypertension, MI, DM and depression who was stabilized on Mirtazapine due to its safety profile regarding patients with polypharmacy. recently he developed symptoms indicative of cognitive decline and memory issues. What treatment should you start for this patient? a- Add Omega 3 capsules b- Add Donepezil c- Switch antidepressant with Nefazodone d- Reduce antidepressant dose witch antidepressant with Vortioxetine 110- Which of the following statements about the use of antipsychotics in pregnancy is accurate? a- All antipsychotics are completely safe to use throughout pregnancy (B) Haloperidol has been the most studied first-generation antipsychotic in pregnancy ‘econd-generation antipsychotics significantly increase the risk of congenital malformations d- Antipsychotics should never be used during pregnancy under any circumstance e- In utero exposure to antipsychotics has no effect on neonatal outcomes,