NEET-PG 2022 - Pharmacology PYQs Practice Questions

Q: Which of the following anticancer drugs is MOST characteristically associated with pulmonary fibrosis?

Busulfan. ***Busulfan*** - **Busulfan** is an **alkylating agent** that is **MOST characteristically** associated with **pulmonary fibrosis** among the given options. - Causes **"Busulfan lung"** - a distinctive chronic interstitial pulmonary fibrosis that can occur in **4-6% of patients**. - Typically develops **insidiously** after prolonged therapy with **cumulative dose-related toxicity**. - Presents with **progressive dyspnea, dry cough**, and restrictive lung pattern on pulmonary function tests. - This is a **classic association** emphasized in medical examinations. *Cyclophosphamide* - **Cyclophosphamide** can also cause **pulmonary fibrosis**, particularly with high cumulative doses. - However, it is **less characteristically** associated with this complication compared to busulfan. - Pulmonary toxicity is more **variable and less predictable** in severity. *Methotrexate* - **Methotrexate** can cause lung toxicity, most commonly as **acute methotrexate pneumonitis** (hypersensitivity reaction). - While **chronic fibrosis can occur**, it is less frequent than the acute inflammatory process. - Not the **most characteristic** association for pulmonary fibrosis. *Mercaptopurine* - **Mercaptopurine** is an **antimetabolite** primarily associated with **hepatotoxicity** and **myelosuppression**. - **Not associated** with pulmonary fibrosis. [Practice more Pharmacology PYQs on OnCourse]

Q: Which of the following is NOT a mechanism of action of theophylline in bronchial asthma?

Beta-2 receptor stimulation. ***Beta-2 receptor stimulation*** - Theophylline is a **non-selective phosphodiesterase inhibitor** and an **adenosine receptor antagonist**, but it does not directly stimulate beta-2 receptors. - **Beta-2 receptor agonists** like salbutamol or formoterol are the medications that work by stimulating these receptors to cause bronchodilation. *Phosphodiesterase inhibition* - Theophylline inhibits **phosphodiesterase enzymes**, leading to an increase in intracellular **cAMP** levels. - This increase in **cAMP** promotes bronchodilation by relaxing airway smooth muscle. *Adenosine receptor antagonism* - Theophylline acts as an antagonist at **adenosine receptors**, particularly A1 and A2B. - Antagonism of adenosine receptors can reduce bronchoconstriction and inflammatory mediator release, contributing to its anti-asthmatic effects. *Increased histone deacetylation* - Theophylline, particularly at lower concentrations, increases the activity of **histone deacetylase (HDAC)**. - This action helps to **repress inflammatory gene expression**, which is a unique anti-inflammatory mechanism separate from its bronchodilatory effects. [Practice more Pharmacology PYQs on OnCourse]

Q: A female patient presents to you with a unilateral headache. It is associated with nausea, photophobia, and phonophobia. What is the drug of choice for acute management?

Sumatriptan. ***Sumatriptan*** - **Sumatriptan**, a **triptan**, is an effective abortive therapy for **acute migraine attacks** due to its selective serotonin 5-HT1B/1D receptor agonist action, leading to vasoconstriction and inhibition of neurogenic inflammation. - The symptoms described—**unilateral headache**, nausea, **photophobia**, and **phonophobia**—are classic features of migraine. *Flunarizine* - **Flunarizine** is a **calcium channel blocker** used for migraine **prophylaxis**, not for acute treatment. - It is typically prescribed for patients experiencing frequent or severe migraine attacks to reduce their incidence. *Propranolol* - **Propranolol** is a **beta-blocker** primarily used for migraine **prophylaxis**. - It helps prevent migraine attacks by modulating cerebral blood flow and neuronal excitability, but it is not effective for acute pain relief during an attack. *Topiramate* - **Topiramate** is an **antiepileptic drug** often used for migraine **prophylaxis**. - It works by various mechanisms, including altering neurotransmitter activity, but it does not provide acute symptomatic relief for an ongoing migraine attack. [Practice more Pharmacology PYQs on OnCourse]

Q: A patient presents to the emergency department with a history of ingestion of ten tablets of paracetamol. He has developed oliguria and liver function tests show deranged values. In the context of paracetamol overdose, which of the following can be used in the management of this condition?

N-acetylcysteine. **Correct: N-acetylcysteine** - **N-acetylcysteine (NAC)** is the specific antidote for **paracetamol overdose**, working by replenishing **glutathione** stores in the liver. - Replenishing **glutathione** helps detoxify the toxic metabolite **N-acetyl-p-benzoquinone imine (NAPQI)**, preventing further **hepatic damage** and facilitating recovery in cases of **liver failure** and potential **renal damage** (oliguria). - Most effective when given within **8 hours** of ingestion, but remains beneficial even with **established hepatotoxicity** (as in this case with deranged LFTs). *Incorrect: Dopamine* - **Dopamine** is a **vasopressor** primarily used to increase **blood pressure** and **cardiac output** in conditions like **shock**. - While it might be used to support circulation in severe overdose complications, it does not directly treat the **paracetamol toxicity** itself. *Incorrect: Ursodeoxycholic acid* - **Ursodeoxycholic acid (UDCA)** is a **cholagogue** used in the management of **cholestatic liver diseases** (e.g., primary biliary cholangitis) by improving bile flow. - It has no role in the direct management of **acute liver failure** due to **paracetamol overdose**. *Incorrect: Furosemide* - **Furosemide** is a **loop diuretic** used to increase **urine output** in conditions like **fluid overload** or **heart failure**. - While **oliguria** is present, it is often a sign of **acute kidney injury** requiring supportive care, and furosemide would not address the underlying **toxic mechanism** of paracetamol. [Practice more Pharmacology PYQs on OnCourse]

Q: A patient comes with a history of asthma and sinusitis. On looking into his medical records, you notice this has been attributed to Samter’s triad. Which drug should be avoided in this patient due to its potential to exacerbate respiratory symptoms?

Aspirin. ***Aspirin (Correct Answer)*** - Samter's triad, or **aspirin-exacerbated respiratory disease (AERD)**, is characterized by **asthma**, **nasal polyps with chronic rhinosinusitis**, and a severe reaction to **aspirin** and other **NSAIDs**. - **Aspirin** inhibits COX-1, leading to an overproduction of **leukotrienes**, which causes bronchoconstriction and exacerbates respiratory symptoms in susceptible individuals. - This is the drug that **must be avoided** in patients with Samter's triad. *Cotrimoxazole (Incorrect)* - **Cotrimoxazole** (trimethoprim-sulfamethoxazole) is an antibiotic not directly involved in the cyclooxygenase pathway. - While allergic reactions can occur, it is **not specifically contraindicated** in Samter's triad. *Co-amoxiclav (Incorrect)* - **Co-amoxiclav** (amoxicillin/clavulanic acid) is a penicillin-class antibiotic, and its mechanism of action does not involve prostaglandin synthesis. - It does not pose a specific risk for exacerbating respiratory symptoms in patients with **Samter's triad**. *Chloramphenicol (Incorrect)* - **Chloramphenicol** is an antibiotic that inhibits bacterial protein synthesis and is not associated with the pathogenesis of Samter's triad. - It does not impact the **cyclooxygenase or lipoxygenase pathways** that are central to AERD. [Practice more Pharmacology PYQs on OnCourse]

Question 1

Which of the following anticancer drugs is MOST characteristically associated with pulmonary fibrosis?

Accepted Answer

Busulfan

Answer

Mercaptopurine

Answer

Methotrexate

Answer

Cyclophosphamide

Question 2

Which of the following is NOT a mechanism of action of theophylline in bronchial asthma?

Accepted Answer

Beta-2 receptor stimulation

Answer

Adenosine receptor antagonism

Answer

Increased histone deacetylation

Answer

Phosphodiesterase inhibition

Question 3

A female patient presents to you with a unilateral headache. It is associated with nausea, photophobia, and phonophobia. What is the drug of choice for acute management?

Accepted Answer

Sumatriptan

Answer

Flunarizine

Answer

Propranolol

Answer

Topiramate

Question 4

A patient presents to the emergency department with a history of ingestion of ten tablets of paracetamol. He has developed oliguria and liver function tests show deranged values. In the context of paracetamol overdose, which of the following can be used in the management of this condition?

Accepted Answer

N-acetylcysteine

Answer

Dopamine

Answer

Ursodeoxycholic acid

Answer

Furosemide

Question 5

A patient comes with a history of asthma and sinusitis. On looking into his medical records, you notice this has been attributed to Samter’s triad. Which drug should be avoided in this patient due to its potential to exacerbate respiratory symptoms?

Accepted Answer

Aspirin

Answer

Cotrimoxazole

Answer

Co-amoxiclav

Answer

Chloramphenicol

Question 6

A middle-aged male patient presents with protrusion of the chin, excessive sweating, impaired glucose tolerance, and enlargement of hands and feet. Which of the following is a growth hormone receptor antagonist used to treat this condition?

Accepted Answer

Pegvisomant

Answer

Olcegepant

Answer

Cabergoline

Answer

Octreotide

Question 7

A woman presenting with symptoms of urinary tract infection was prescribed a drug that    causes tendon rupture and arthropathy. What is the mechanism of action of the drug?

Accepted Answer

DNA gyrase inhibition

Answer

Ribosomal inhibition

Answer

Cell wall synthesis

Answer

Inhibition of folic acid synthesis

Question 8

Multidrug-resistant (MDR) tuberculosis shows resistance to which of the following drugs?

Accepted Answer

Isoniazid and rifampicin only

Answer

Isoniazid, rifampicin, and fluoroquinolone

Answer

Fluoroquinolone

Answer

Isoniazid, rifampicin, and kanamycin

Question 9

A 55-year-old woman is undergoing chemotherapy for breast cancer and experiences severe nausea and vomiting. Which antiemetic, recognized for its minimal extrapyramidal side effects, would be appropriate for her condition?

Accepted Answer

Ondansetron

Answer

Metoclopramide

Answer

Promethazine

Answer

Prochlorperazine

Question 10

The mechanism of action of botulinum toxin A is best described by:

Accepted Answer

Presynaptic blockade of acetylcholine release

Answer

Slowing of myelinated nerve fiber transmission

Answer

Postsynaptic receptor blockade

Answer

Acetylcholinesterase inhibition

NEET-PG 2022 — Pharmacology