MCQs PHARMACOLOGY:Drugs Affecting Blood and Blood Formation

41.1 Absorption of oral iron preparations can be facilitated by coadministering:
A. Antacids
B. Tetracyclines
C. Phosphates
D. Ascorbic acid

41.2 The gut controls the entry of ingested iron in the body by:
A. Regulating the availability of apoferritin which acts as the carrier of iron across the mucosal cell
B. Regulating the turnover of apoferritin-ferritin interconversion in the mucosal cell
C. Complexing excess iron to form ferritin which remains stored in the mucosal cell and is shed off
D. Regulating the number of transferrin recep-tors on the mucosal cell

41.3 In the iron deficient state, transferrin receptors increase in number on the:
A. Intestinal mucosal cells
B. Erythropoietic cells
C. Reticuloendothelial cells
D. All of the above

 

41.4 The percentage of elemental iron in hydrated ferrous sulfate is:
A. 5%
B. 10%
C. 20%
D. 33%

41.5 Select the oral iron preparation which does not impart metallic taste and has good oral tolerability despite high iron content but whose efficacy in treating iron deficiency anaemia has been questioned:
A. Iron hydroxy polymaltose
B. Ferrous succinate
C. Ferrous fumarate
D. Ferrous gluconate

41.6 The daily dose of elemental iron for maximal haemo-poietic response in an anaemic adult is:
A. 30 mg
B. 100 mg
C. 200 mg
D. 500 mg

41.7 The side effect which primarily limits acceptability of oral iron therapy is:
A. Epigastric pain and bowel upset
B. Black stools
C. Staining of teeth
D. Metallic taste

41.8 Choose the correct statement about severity of side effects to oral iron medication:
A. Ferrous salts are better tolerated than ferric salts
B. Complex organic salts of iron are better tolerated than inorganic salts
C. Liquid preparations of iron are better tolerated than tablets
D. Tolerability depends on the quantity of ele-mental iron in the medication

 

41.9 The following is not a valid indication for parenteral iron therapy:
A. Inadequate response to oral iron due to patient noncompliance
B. Anaemia during pregnancy
C. Severe anaemia associated with chronic bleeding
D. Anaemia in a patient of active rheumatoid arthritis

41.10 Iron sorbitol-citric acid differs from iron dextran in that:
A. It cannot be injected i.v.
B. It is not excreted in urine
C. It is not bound to transferrin in plasma
D. It produces fewer side effects

41.11 Choose the correct statement about iron therapy:
A. Haemoglobin response to intramuscular iron is faster than with oral iron therapy
B. Iron must be given orally except in pernicious anaemia
C. Prophylactic iron therapy must be given during pregnancy
D. Infants on breastfeeding do not require medi-cinal iron

41.12 A patient of iron deficiency anaemia has been put on iron therapy. What should be the rate of rise in haemoglobin level of blood so that response is consi-dered adequate:
A. 0.05 – 0.1 g% per week
B. 0.1 – 0.2 g% per week
C. 0.5 – 1.0 g% per week
D. More than 1.0 g% per week

 

41.13 The following chelating agent should not be used systemically to treat acute iron poisoning in a child:
A. Desferrioxamine
B. Calcium edetate
C. Dimercaprol
D. Calcium disodium diethylene triamine penta acetic acid

41.14 Megaloblastic anaemia occurs in:
A. Vitamin B12 but not folic acid deficiency
B. Folic acid but not Vitamin B12 deficiency
C. Either Vitamin B12 or folic acid deficiency
D. Only combined Vitamin B12 + folic acid deficiency

41.15 The metabolic reaction requiring vitamin B12 but not folate is:
A. Conversion of malonic acid to succinic acid
B. Conversion of homocysteine to methionine
C. Conversion of serine to glycine
D. Thymidylate synthesis

41.16 The daily dietary requirement of vit B12 by an adult is:
A. 1-3 μg
B. 50-100 μg
C. 0.1-0.5 mg
D. 1-3 mg

41.17 The following factor(s) is/are required for the absorption of dietary vitamin B12:
A. Gastric acid
B. Gastric intrinsic factor
C. Transcobalamine
D. Both ‘A’ and ‘B’

 

41.18 A 60-year-old patient presented with anorexia, weak-ness, paresthesia and mental changes. His tongue was red, tendon reflexes were diminished, haemo-globin was 6 g% with large red cells and neutrophils had hypersegmented nuclei. Endoscopy revealed atrophic gastritis. Deficiency of which factor is likely to be responsible for his condition:
A. Folic acid
B. Vitamin B12
C. Pyridoxine
D. Riboflavin

41.19 Features of methylcobalamin include the following:
A. It is an active coenzyme form of vit B12
B. It is required for the synthesis of S-adenosyl methionine
C. It is specifically indicated for correcting neurological defects of vit B12 deficiency
D. All of the above

41.20 Hydroxocobalamin differs from cyanocobalamin in that:
A. It is more protein bound and better retained
B. It is beneficial in tobacco amblyopia
C. It benefits haematological but not neurologi-cal manifestations of vit B12 deficiency
D. Both ‘A’ and ‘B’ are correct

41.21 Megaloblastic anaemia developing under the following condition is due entirely to folate deficiency not associated with vitamin B12 deficiency:
A. Malnutrition
B. Blind loop syndrome
C. Phenytoin therapy
D. Pregnancy (p. 555) 41.18 B 41.19D 41.20D 41.21 C

 

41.22 A patient of megaloblastic anaemia was treated with oral folic acid 5 mg daily. After 2 weeks he reported back with cognitive deficit, sensory disturbance, depressed knee jerk, while blood picture and haemo-globin level were improved. What could be the most likely explanation:
A. Folic acid was not adequately absorbed resul-ting in partial response
B. Folate therapy has precipitated vitamin B12 deficiency in the neural tissue
C. Folate therapy has unmasked pyridoxine deficiency
D. Patient has folate reductase abnormality in the nervous system

41.23 Folinic acid is specifically indicated for:
A. Prophylaxis of neural tube defect in the offspring of women receiving anticonvulsant medication
B. Counteracting toxicity of high dose metho-trexate
C. Pernicious anaemia
D. Anaemia associated with renal failure

41.24 Recombinant human erythropoietin is indicated for:
A. Megaloblastic anaemia
B. Haemolytic anaemia
C. Anaemia in patients of thalassemia
D. Anaemia in chronic renal failure patients

 

41.25 A patient of chronic renal failure maintained on intermittent haemodialysis has anaemia not respond-ing to iron therapy. Which of the following additional drug is indicated:
A. Epoetin
B. Cyanocobalamin
C. Folic acid
D. Pyridoxine

42.1 Vitamin K is indicated for the treatment of bleeding occurring in patients:
A. Being treated with heparin
B. Being treated with streptokinase
C. Of obstructive jaundice
D. Of peptic ulcer

42.2 Choose the preparation(s) of vitamin K that should not be injected in the newborn:
A. Phytonadione
B. Menadione
C. Menadione sod.diphosphate
D. Both ‘B’ and ‘C’

42.3 Menadione (vitamin K3) can produce kernicterus in neonates by:
A. Inducing haemolysis
B. Inhibiting glucuronidation of bilirubin
C. Displacing plasma protein bound bilirubin
D. Both ‘A’ and ‘B’ are correct

42.4 Select the correct statement about ethamsylate:
A. It checks capillary bleeding
B. It inhibits platelet aggregation
C. It is an antifibrinolytic drug
D. It is used to fibrose bleeding piles

 

42.5 The primary mechanism by which heparin prevents coagulation of blood is:
A. Direct inhibition of prothrombin to thrombin conversion
B. Facilitation of antithrombin III mediated inhi-bition of factor Xa and thrombin
C. Activation of antithrombin III to inhibit factors IX and XI
D. Inhibition of factors XIIa and XIIIa

42.6 Low concentrations of heparin selectively interfere with the following coagulation pathway(s):
A. Intrinsic pathway
B. Extrinsic pathway
C. Common pathway
D. Both ‘A’ and ‘C

42.7 Low doses of heparin prolong:
A. Bleeding time
B. Activated partial thromboplastin time
C. Prothrombin time
D. Both ‘B’ and ‘C’

42.8 The following action(s) of heparin is/are essential for inhibition of factor Xa:
A. Facilitation of antithrombin III mediated inhibition of factor XIIa
B. Provision of scaffold for the clotting factor to interact with antithrombin III
C. Induction of a configurational change in antithrombin III to expose its interacting sites
D. Both ‘A’ and ‘B’

 

42.9 The following is true of heparin except:
A. Sudden stoppage of continuous heparin therapy causes rebound increase in blood coagulability
B. High doses of heparin inhibit platelet aggre-gation
C. Heparin is the physiologically active circula-ting anticoagulant
D. Heparin clears lipemic plasma in vivo but not in vitro

42.10 Low molecular weight heparins differ from unfractionated heparin in that:
A. They selectively inhibit factor Xa
B. They do not significantly prolong clotting time
C. They are metabolized slowly and have longer duration of action
D. All of the above are correct

42.11 Low molecular weight heparins have the following advantages over unfractionated heparin except:
A. Higher efficacy in arterial thrombosis
B. Less frequent dosing
C. Higher and more consistent subcutaneous bioavailability
D. Laboratory monitoring of response not required

42.12 Low dose subcutaneous heparin therapy is indicated for:
A. Prevention of leg vein thrombosis in elderly patients undergoing abdominal surgery
B. Ischaemic stroke
C. Patients undergoing neurosurgery
D. Prevention of extention of coronary artery thrombus in acute myocardial infarction

 

42.13 Heparin is contraindicated in patients suffering from the following diseases except:
A. Pulmonary tuberculosis
B. Bleeding due to defibrination syndrome
C. Subacute bacterial endocarditis
D. Large malignant tumours

42.14 The following can be used to antagonise the action of heparin in case of overdose:
A. Heparan sulfate
B. Dextran sulfate
C. Protamine sulfate
D. Ancrod

42.15 Blood level of which clotting factor declines most rapidly after the initiation of warfarin therapy:
A. Factor VII
B. Factor IX
C. Factor X
D. Prothrombin

42.16 The following statements are true of oral anticoagulants except:
A. They interfere with an early step in the synthesis of clotting factors
B. Irrespective of the dose administered, their anticoagulant effect has a latency of onset of 1-3 days
C. Their dose is adjusted by repeated measure-ment of prothrombin time
D. They are contraindicated during pregnancy

 

42.17 You are treating a patient of deep vein thrombosis with warfarin. What value of International normalized ratio (INR) will you attempt by adjusting dose of the anticoagulant for an adequate therapeutic effect:
A. 1.2 – 1.5
B. 1.3 – 1.7
C. 1.5 – 2.0
D. 2.0 – 3.0

42.18 The following drug reduces the effect of oral anti-coagulants:
A. Broad spectrum antibiotic
B. Cimetidine
C. Aspirin
D. Oral contraceptive

42.19 The most clear cut beneficial results are obtained in the use of anticoagulants for the following purpose:
A. Prevention of recurrences of myocardial infarction
B. Prevention of venous thrombosis and pulmo-nary embolism
C. Cerebrovascular accident
D. Retinal artery thrombosis

42.20 Anticoagulant medication is indicated in:
A. Immobilized elederly patients
B. Buerger’s disease
C. Stroke due to cerebral thrombosis
D. All of the above

 

42.21 Use of anticoagulants in acute myocardial infarction affords the following benefit(s):
A. Reduces short-term mortality
B. Prevents thrombus extension and subse-quent attack
C. Prevents venous thromboembolism
D. All of the above

42.22 The most effective drug for prevention of stroke in atrial fibrillation patients is:
A. Aspirin
B. Warfarin
C. Low dose subcutaneous heparin
D. Digoxin

42.23 Select the fibrinolytic drug(s) that is/are antigenic:
A. Streptokinase
B. Urokinase
C. Alteplase
D. Both ‘A’ and ‘B’

42.24 Which fibrinolytic agent(s) selectively activate(s) fibrin bound plasminogen rather than circulating plasminogen:
A. Urokinase
B. Streptokinase
C. Alteplase
D. Both ‘A’ and ‘C’

42.25 The most important complication of streptokinase therapy is:
A. Hypotension
B. Bleeding
C. Fever
D. Anaphylaxis