NEET-PG 2017 - Pharmacology PYQs Practice Questions

Q: A 50-year-old woman with rheumatic heart disease is on medication for heart disease. She feels unwell for most part of the day. Which of the following medicine is responsible for the ECG changes shown below? (Recent NEET Pattern 2016-17)

Digoxin. ***Digoxin*** - The ECG shows changes characteristic of **digoxin toxicity**, specifically **downsloping ST depressions (scooping)** and **flattened or inverted T waves**, particularly in leads with dominant R waves. - The patient's symptoms of feeling "unwell for most part of the day" are consistent with **digoxin toxicity**, which can include nausea, fatigue, and cardiac arrhythmias. *ACE inhibitor* - ACE inhibitors primarily affect the **renin-angiotensin-aldosterone system** and do not typically cause these specific ECG changes. - Common side effects include cough and **hyperkalemia**, not the "scooped" ST segments seen here. *Diuretics* - Diuretics can cause **electrolyte imbalances**, such as hypokalemia, which might manifest as **flattened T waves** or **prominent U waves** on ECG, but not the characteristic "scooped" ST depression. - The symptoms of malaise are non-specific and while possible with electrolyte disturbances, the specific ECG pattern points away from diuretics as the primary cause. *Ivabradine* - Ivabradine is a **selective If channel inhibitor** that primarily reduces heart rate, without affecting myocardial contractility or repolarization significantly. - It does not cause the **ST segment changes** characteristic of digoxin effect or toxicity. [Practice more Pharmacology PYQs on OnCourse]

Q: A 65-year-old patient of dilated cardiomyopathy was prescribed 1 mg warfarin tablet for sustained atrial fibrillation. The chemist however gave him 2 mg tablets by mistake which resulted in him developing hemorrhagic complications (bleeding). CT scan is performed. This is which kind of ADR? (Recent NEET Pattern 2016-17) Warfarin Sodium Tablets, USP Crystalline 2 mg Protect from light

Type A. ***Type A*** - This is an **exaggerated pharmacological effect** of warfarin due to a higher than intended dose, leading to excessive anticoagulation and subsequent **hemorrhagic stroke** (bleeding in the brain). - Type A ADRs are **predictable** based on the known pharmacology of the drug and are dose-dependent. *Type B* - Type B ADRs are **unpredictable**, idiosyncratic reactions that are not directly related to the pharmacological action of the drug (e.g., allergic reactions). - They are typically **dose-independent** and often occur in a small subset of the population. *Type C* - Type C ADRs are associated with **long-term exposure** to a drug, leading to chronic effects or tolerance. - Examples include drug dependence or adrenal suppression from prolonged corticosteroid use. *Type D* - Type D ADRs are also related to **delayed effects** of drug exposure, such as carcinogenesis or teratogenesis. - These effects may not manifest until months or years after the drug was taken. [Practice more Pharmacology PYQs on OnCourse]

Q: The effect of both drugs given together on the blood pressure of a patient was evaluated in comparison with the effect of individual drugs on BP. The following curve represents: (Recent NEET Pattern 2016-17)

Synergism. ***Synergism*** - The graph shows that the effect of drugs A and B when given together (A+B) is significantly **greater than the sum of their individual effects**. - This amplified effect, where the combined response is more than the simple addition of individual responses, is the definition of **synergism** (also called potentiation or supra-additive effect). *Summation* - Summation occurs when the **combined effect** of two drugs is **equal to the arithmetic sum** of their individual effects. - In the depicted graph, the peak effect of A+B is clearly much higher than the sum of the peaks of A and B individually, ruling out simple summation. *Additive effects* - Additive effects are synonymous with summation, meaning the combined effect is precisely the sum of individual effects. - The graph demonstrates a response that **exceeds a simple additive effect**, indicating a synergistic interaction rather than mere additive action. *Antagonism* - **Antagonism** occurs when one drug reduces or blocks the effect of another drug, resulting in a combined effect that is **less than the sum** of individual effects. - In the depicted graph, the combined effect (A+B) clearly shows enhancement rather than reduction, ruling out antagonism. [Practice more Pharmacology PYQs on OnCourse]

Q: Drug A is epinephrine and drug B is cocaine. The effect of both drugs given together on the blood pressure of a patient was evaluated in comparison with effect of individual drugs on BP. The following curve represents:

Synergism. ***Synergism*** - **Synergism** occurs when the combined effect of two drugs is significantly greater than the sum of their individual effects. In the provided graph, the peak blood pressure with drugs A+B is notably higher than the sum of the peaks for A and B administered separately. - Epinephrine (Drug A) is a **vasoconstrictor**, and cocaine (Drug B) **inhibits norepinephrine reuptake**, potentiating epinephrine's effects by increasing synaptic levels of catecholamines. This leads to a much stronger combined increase in blood pressure than expected from simple addition. *Summation* - **Summation** implies that the combined effect of two drugs is equal to the sum of their individual effects. - The graph clearly shows that the combined effect (A+B) produces a blood pressure response that is much greater than simply adding the individual responses of A and B, ruling out summation. *Additive effects* - **Additive effects** are a type of summation where the combined effect of two or more drugs is numerically equal to the arithmetic sum of their individual effects. - Similar to summation, this option is incorrect because the observed combined effect of A and B is significantly *more* than the mathematical sum of their separate effects, indicating potentiation rather than simple additivity. *Antagonism* - **Antagonism** occurs when one drug reduces or blocks the effect of another drug. - This is incorrect because the graph shows that the combined administration of epinephrine and cocaine produces a *greater* blood pressure response, not a reduced one. Antagonism would result in a combined effect less than expected or less than either drug alone. [Practice more Pharmacology PYQs on OnCourse]

Question 1

A 50-year-old woman with rheumatic heart disease is on medication for heart disease. She feels unwell for most part of the day. Which of the following medicine is responsible for the ECG changes shown below? (Recent NEET Pattern 2016-17)

Accepted Answer

Digoxin

Answer

ACE inhibitor

Answer

Diuretics

Answer

Ivabradine

Question 2

A 65-year-old patient of dilated cardiomyopathy was prescribed 1 mg warfarin tablet for sustained atrial fibrillation. The chemist however gave him 2 mg tablets by mistake which resulted in him developing hemorrhagic complications (bleeding). CT scan is performed. This is which kind of ADR? (Recent NEET Pattern 2016-17) Warfarin Sodium Tablets, USP Crystalline 2 mg Protect from light

Accepted Answer

Type A

Answer

Type B

Answer

Type C

Answer

Type D

Question 3

The effect of both drugs given together on the blood pressure of a patient was evaluated in comparison with the effect of individual drugs on BP. The following curve represents: (Recent NEET Pattern 2016-17)

Accepted Answer

Synergism

Answer

Summation

Answer

Additive effects

Answer

Antagonism

Question 4

Drug A is epinephrine and drug B is cocaine. The effect of both drugs given together on the blood pressure of a patient was evaluated in comparison with effect of individual drugs on BP. The following curve represents:

Accepted Answer

Synergism

Answer

Summation

Answer

Additive effects

Answer

Antagonism

Question 5

A 20-year-old woman is admitted with the following presentation. 1% pilocarpine is not showing any response on the side of mydriasis. What is the diagnosis? (Recent NEET Pattern 2016-17)

Accepted Answer

Pharmacological block

Answer

Diabetic neuropathy

Answer

Uncal herniation

Answer

Adie tonic pupil

Question 6

A neonate presents with a congenital heart disease as shown below. Which drug should be started immediately? (Recent NEET Pattern 2016-17)

Accepted Answer

Alprostadil

Answer

Digoxin

Answer

Ivabradine

Answer

Propranolol

Question 7

Which anti-epileptic drug marked X will act at the site shown?

Accepted Answer

Tiagabine

Answer

Vigabatrin

Answer

Gabapentin

Answer

Rufinamide

Question 8

The application of the following product can lead to development of: (Recent NEET Pattern 2016-17)

Accepted Answer

Methemoglobinemia

Answer

Seizures

Answer

Depression

Answer

Hypertension

NEET-PG 2017 — Pharmacology