Cholinergic/Adrenergic drugs — MCQs

A 21-year-old man presents with eye redness, itching, and watering; nasal congestion, and rhinorrhea. He reports that these symptoms have been occurring every year in the late spring since he was 18 years old. The patient’s medical history is significant for endoscopic resection of a right maxillary sinus polyp at the age of 16. His father and younger sister have bronchial asthma. He takes oxymetazoline as needed to decrease nasal congestion. The patient’s blood pressure is 120/80 mm Hg, heart rate is 71/min, respiratory rate is 18/min, and temperature is 36.7°C (98.0°F). On physical examination, there is conjunctival injection and clear nasal discharge bilaterally. His lymph nodes are not enlarged and his sinuses do not cause pain upon palpation. Heart and lung sounds are normal. Which of the following is most likely to be a part of his condition’s pathogenesis?

A 67-year-old man with type 2 diabetes mellitus and benign prostatic hyperplasia comes to the physician because of a 2-day history of sneezing and clear nasal discharge. He has had similar symptoms occasionally in the past. His current medications include metformin and tamsulosin. Examination of the nasal cavity shows red, swollen turbinates. Which of the following is the most appropriate pharmacotherapy for this patient's condition?

A 28-year-old gravida-2-para-1 at 12 weeks gestation presents for a prenatal visit. Over the past week, she has felt increasingly tired, even after waking up in the morning. She is vegan and avoids all animal products. She was diagnosed with Graves’ disease 6 months ago. Before conception, methimazole was switched to propylthiouracil (PTU). Other medications include folic acid and a multivitamin. The vital signs include: temperature 37.1℃ (98.8℉), pulse 72/min, respiratory rate 12/min, and blood pressure 110/75 mm Hg. The conjunctivae and nail beds are pale. Petechiae are present over the distal lower extremities. The pelvic examination reveals a uterus consistent in size with a 12-week gestation. Examination of the neck, lungs, heart, and abdomen shows no abnormalities. The laboratory studies show the following: Laboratory test Hemoglobin 9.0 g/dL Mean corpuscular volume 90 μm3 Leukocyte count 4,000/mm3 Segmented neutrophils 55% Lymphocytes 40% Platelet count 110,000/mm3 Serum Thyroid-stimulating hormone 0.1 μU/mL Thyroxine (T-4) 8 μg/dL Lactate dehydrogenase 60 U/L Total bilirubin 0.5 mg/dL Iron 100 μg/dL Ferritin 110 ng/mL Total iron-binding capacity 250 μg/dL Which of the following best explains these findings?

A 25-year-old man is brought to the emergency department by police for abnormal behavior in a mini-market. The patient was found passed out in the aisle, and police were unable to arouse him. The patient has a past medical history of alcohol abuse and is not currently taking any medications according to his medical records. His temperature is 99.5°F (37.5°C), blood pressure is 120/87 mmHg, pulse is 50/min, respirations are 5/min, and oxygen saturation is 93% on room air. On physical exam, the patient is minimally responsive. He responds to painful stimuli by retracting his limbs and groaning, but otherwise does not answer questions or obey commands. Which of the following is most likely to be found in this patient?

A researcher is studying receptors that respond to epinephrine in the body and discovers a particular subset that is expressed in presynaptic adrenergic nerve terminals. She discovers that upon activation, these receptors will lead to decreased sympathetic nervous system activity. She then studies the intracellular second messenger changes that occur when this receptor is activated. She records these changes and begins searching for analogous receptor pathways. Which of the following receptors would cause the most similar set of intracellular second messenger changes?

A 33-year-old man comes to the emergency department because of a dry mouth and blurred vision for the past 30 minutes. Prior to this, he was on a road trip and started to feel nauseous, dizzy, and fatigued, so his friend gave him a drug that had helped in the past. Physical examination shows dry mucous membranes and dilated pupils. The remainder of the examination shows no abnormalities. Administration of which of the following drugs is most likely to cause a similar adverse reaction in this patient?

A 50-year-old woman presents with acute onset fever and chills for the past hour. She mentions earlier in the day she felt blue, so she took some St. John’s wort because she was told by a friend that it helps with depression. Past medical history is significant for hypertension, diabetes mellitus, and depression managed medically with captopril, metformin, and fluoxetine. She has no history of allergies. Her pulse is 130/min, the respiratory rate is 18/min, the blood pressure is 176/92 mm Hg, and the temperature is 38.5°C (101.3°F). On physical examination, the patient is profusely diaphoretic and extremely irritable when asked questions. Oriented x 3. The abdomen is soft and nontender with no hepatosplenomegaly. Increased bowel sounds are heard in the abdomen. Deep tendon reflexes are 3+ bilaterally and clonus is elicited. The sensation is decreased in the feet bilaterally. Mydriasis is present. Fingerstick glucose is 140 mg/dL. An ECG shows sinus tachycardia but is otherwise normal. Which of the following is the most likely cause of this patient’s condition?

A 32-year-old woman presents with diplopia. She says that she has been experiencing drooping of her eyelids and severe muscle weakness. She reports that her symptoms are worse at the end of the day. Which of the following additional findings would most likely be seen in this patient?

A 42-year-old man is admitted to the hospital for pain and swelling in his right foot. His temperature is 39.7°C (103.5°F), pulse is 116/min, respirations are 23/min, and blood pressure is 69/39 mmHg. A drug is administered via a peripheral intravenous line that works primarily by increasing inositol trisphosphate concentrations in arteriolar smooth muscle cells. Eight hours later, the patient has pain at the right antecubital fossa. Examination shows the skin around the intravenous line site to be pale and cool to touch. After discontinuing the infusion, which of the following is the most appropriate pharmacotherapy to prevent further tissue injury in this patient?

A 22-year-old woman comes to the physician because of a 12-week history of persistent cough. The cough is nonproductive and worse at night. She otherwise feels well. She has not had any changes in appetite or exercise tolerance. For the past year, she has smoked an occasional cigarette at social occasions. Use of herbal cough medications has not provided any symptom relief. She has no history of serious illness but reports getting a runny nose every morning during winter. Her temperature is 37°C (98.6°F), pulse is 68/min, respirations are 12/min, and blood pressure is 110/76 mm Hg. Cardiopulmonary examination and an x-ray of the chest show no abnormalities. Her FEV1 is normal. Which of the following is the most appropriate next step in management?