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Prometric Questions - Yellow File - MOH | SPLE | HAAD | DHA - 31

Seen Qaaf February 27, 2026


A physician prescribes, for a 6-year-old child 10 mg omeprazole daily for seven days as a syrup formulation. Omeprazole capsules strength available in the pharmacy is 10 mg.  Which of the following is the number of capsules required to make to suffice the total doses in the prescription if the final concentration syrup should be 2mg/mL? 
 A) 2 
 B) 3 
 C) 5 
 D) 7

Step 1: Calculate total amount of drug needed
Dose = 10 mg/day
Duration = 7 days
10 mg×7=70 mg total

Step 2: Determine how many capsules are needed
Available strength = 10 mg per capsule
70 mg÷10 mg per capsule=7 capsules

Step 3: Check final concentration requirement
Required concentration = 2 mg/mL
If total drug = 70 mg:
70÷2=35 mL final volume
Why the concentration matters (and why it doesn't change the answer)
While the pharmacist needs to know the 2mg/mL concentration to determine how much liquid (vehicle) to add, it doesn't change the total amount of active drug (omeprazole) required to fulfill the 7-day supply. To achieve that concentration with 7 capsules (70mg), the pharmacist would simply prepare a total volume of 35mL.

So the syrup should be prepared to a final volume of 35 mL, which is feasible.

✅ Final Answer: D) 7

Which of the following represents the immunity acquired by giving living organism with attenuated virus? 
 A) Local immunity 
B)Passive immunity 
C) Natural active immunity 
D) Artificial active immunity 

The correct answer is D) Artificial active immunity.

To understand why, it helps to break down how we classify immunity based on how you get it and how your body responds.

Understanding the Terms
Active Immunity: This occurs when your own immune system does the work. It recognizes an antigen and produces its own antibodies and memory cells. Because your body "remembers" the pathogen, this immunity is usually long-lasting.

Artificial Immunity: This means the exposure was intentional, typically through medical intervention like a vaccine, rather than catching a disease randomly in the environment.

Why "Artificial Active"?
When you give an organism an attenuated (weakened) virus:
It is Artificial because the virus was introduced via a clinical method (vaccination).
It is Active because the weakened virus mimics a real infection, triggering the body to produce its own immune response without causing the full-blown disease.

Comparing the Options
TypeHow it's acquiredExample
Natural ActiveGetting sick naturallyCatching a cold or chickenpox
Artificial ActiveVaccinationAttenuated virus (MMR, Flu mist)
Natural PassiveAntibody transfer (Natural)Breast milk or placenta
Artificial PassiveAntibody injectionAnti-venom or Rabies IG
Note: Passive immunity (Option B) is temporary because the body isn't making the antibodies itself; it's just "borrowing" them from another source.

A 62-year-old man who just had a needle biopsy of pancreas adenocarcinoma. A pharmacist saw his brother in the hall, and told him not to tell the patient because the knowledge would be very bad on his health.  A family conference to discuss the prognosis is scheduled for later that afternoon. What is the way for the healthcare practitioner to handle the situation?  
A) The healthcare practitioner should ask the patient how he wants to receive the information in front of the rest of the family, and for some family discussion time for this matter  
B) The healthcare practitioner should honor the request of the member who is protecting his beloved brother from the patient 
C) The healthcare practitioner should tell the patient, withholding information is not permitted under any circumstances  
D) The practitioner should withhold informing the patient about the  pancreatic cancer because of the grave diagnosis

The correct answer is A) The healthcare practitioner should ask the patient how he wants to receive the information in front of the rest of the family, and allow for some family discussion time for this matter.

This question addresses the ethical principle of Patient Autonomy versus Therapeutic Privilege or "Benevolent Deception." In modern medical ethics, the patient has the primary right to their own medical information.

Why Option A is the Correct Approach

Medical professionals use a framework (often the SPIKES protocol for delivering bad news) to handle these delicate situations.

Establish Autonomy: The practitioner must first determine what the patient already knows and, more importantly, how much they want to know. 

Family Involvement: While the brother is acting out of love (beneficence), he does not have the legal right to intercept the patient's diagnosis unless the patient has been declared mentally incompetent.

Cultural Sensitivity: In some cultures, family-centered decision-making is the norm. By asking the patient how they want to handle the information, the doctor respects the patient’s rights while acknowledging the family’s presence.

Why the other options are incorrect:

B & D (Withholding information): This is known as "Therapeutic Privilege." While historically common, it is now strictly limited to cases where disclosure would cause immediate and severe physical harm (like a suicide attempt). Simply being "upset" by a cancer diagnosis does not justify withholding the truth.

C (Withholding is never permitted): This is too rigid. There is one major exception: if the patient explicitly tells the doctor "I don't want to know the results; tell my brother instead," the doctor must honor that request.

The Ethical Framework: The Four Pillars

The practitioner must balance these four principles in this scenario:

PrincipleApplication in this case
AutonomyThe patient's right to self-determination and his own data.
BeneficenceThe brother's desire to "do good" by preventing emotional pain.
Non-maleficenceEnsuring that not telling the patient doesn't lead to missed treatment opportunities.
JusticeTreating the patient as a person with the same rights as any other diagnostic recipient.
🔑 Ethical Principle:

Always ask the patient about their preferences regarding disclosure before deferring to family wishes.

A 38-year-old man is using citalopram 20mg PO daily for depression which he has been taking for 1 year. A week ago, he had an infection and was prescribed linezolid 600 mg PO q12h for a total of 14 days. The patient began to get confused and easily agitated like he was breathing rapidly and started to sweat and developed tachypnea. He was noticeably shaking. Which of the following is name of this drug-drug interaction happened to this patient?  
A) Hepatotoxicity  
B) Seizure activity  
C) Serotonin syndrome  
D) Stevens Johnson syndrome

The correct answer is C) Serotonin syndrome.

This is a classic clinical scenario involving a dangerous drug-drug interaction between an SSRI (Citalopram) and a specific type of antibiotic (Linezolid).

Why this happened

  • Citalopram is a Selective Serotonin Reuptake Inhibitor (SSRI) that increases serotonin levels in the synaptic cleft.
  • Linezolid, while primarily an antibiotic, also acts as a non-selective Monoamine Oxidase Inhibitor (MAOI).
  • Because MAO is the enzyme responsible for breaking down serotonin, adding Linezolid to an SSRI prevents the breakdown of serotonin while the SSRI is simultaneously preventing its reuptake. This leads to a toxic "flood" of serotonin in the central nervous system.

Recognizing the Symptoms

The patient’s symptoms match the clinical triad of Serotonin Syndrome perfectly:

CategoryPatient's Symptoms
Cognitive/Mental StatusConfusion, agitation
Autonomic HyperactivityRapid breathing (tachypnea), sweating (diaphoresis)
Neuromuscular AbnormalitiesShaking (tremor/myoclonus)
Why the other options are incorrect:
Hepatotoxicity: While many drugs affect the liver, the rapid onset of neurological and autonomic symptoms (shaking/sweating) points toward a neurotransmitter issue rather than liver failure.

Seizure activity: While severe Serotonin Syndrome can lead to seizures, the constellation of sweating, agitation, and rapid breathing specifically describes the syndrome itself.

Stevens-Johnson Syndrome (SJS): This is a severe skin reaction characterized by blistering and "sloughing" of the skin, usually caused by a reaction to medications like sulfonamides or anticonvulsants, not a serotonin overdose.

It is crucial to be aware of these interactions because many patients don't realize that common over-the-counter (OTC) medications or even specialized treatments can interfere with their mental health prescriptions.

Here is a breakdown of common medications that can trigger Serotonin Syndrome when combined with an SSRI like Citalopram:
Medication CategoryCommon ExamplesWhy it's a Risk
Pain Relief (Opioids)Tramadol, Meperidine, FentanylThese inhibit serotonin reuptake in addition to their pain-relieving effects.
Cough/Cold OTCsDextromethorphan (the "DM" in many syrups)Acts as a mild serotonin reuptake inhibitor.
Migraine MedsSumatriptan, Rizatriptan (Triptans)These are serotonin receptor agonists (they mimic serotonin).
Herbal SupplementsSt. John’s WortKnown to increase serotonin levels significantly.
Antibiotics/MAOIsLinezolid, Methylene BlueThey inhibit the breakdown (metabolism) of serotonin.
Management of Serotonin Syndrome
If a patient presents with these symptoms, the protocol usually involves:
  • Immediate Discontinuation: Stopping all serotonergic agents.
  • Supportive Care: IV fluids for sweating/dehydration and cooling blankets for hyperthermia.
  • Benzodiazepines: Used to control agitation and muscle tremors (shaking).
  • Cyproheptadine: A specific serotonin antagonist used in moderate to severe cases to "block" the excess serotonin.

Which of the following in electrocardiograph (ECG) represent  absolute refractory period?  
A) P wave  
B) PR interval  
C) ST segment  
D) QRS complex

The correct answer is D) QRS complex.

While it might seem counterintuitive since the QRS complex represents depolarization, the Absolute Refractory Period (ARP) begins at the start of the QRS complex and extends through the first part of the T wave.

Here is the breakdown of why the QRS complex is the best fit among the choices and how it relates to the cardiac cycle:

The Relationship Between ECG and Refractory Periods
The refractory period is the time during which a cardiac cell cannot be re-excited by a new stimulus. It ensures the heart muscle has time to contract and relax properly without entering a state of permanent contraction (tetany).

QRS Complex: This marks the beginning of ventricular depolarization. The ARP starts here because the sodium channels are already open or inactivated; therefore, no second action potential can be triggered, no matter how strong the stimulus.

ST Segment: This represents the "plateau phase" of the action potential. The heart is still in the absolute refractory period during this stage.

T Wave: The first half of the T wave is generally considered part of the ARP, while the latter half represents the Relative Refractory Period (RRP), where a sufficiently strong stimulus could trigger a premature contraction (the "R-on-T phenomenon").

Why the other options are incorrect:
P wave: This represents atrial depolarization, which happens before the ventricles even begin their cycle.

PR interval: This is the time it takes for the impulse to travel from the SA node to the ventricles; it is a delay period, not a refractory period.

ST segment: While the heart is refractory during this segment, the ARP technically initiates with the onset of the QRS complex. In many standardized exams, the QRS is identified as the start of this physiological state.  



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