Pharmacology - Therapeutics

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Adverse Effects of Glaucoma Drugs

Which one of the following statements regarding adverse effects of drugs for open-angle glaucoma is false?

  • Beta Blockers should be used with caution in patients with asthma.
  • Carbonic anhydrase inhibitors are contraindicated in patients with a sulfonamide allergy.
  • Alpha-adrenergic agonists should be used with caution in patients taking a monoamine oxidase (MAO) inhibitor.
  • Cholinergic agonists may cause salivation.
Volume 41.1 - Question 26

Transdermal Fentanyl for Chronic Pain

Which one of the following statements about the prescribing of transdermal fentanyl for chronic pain is false?

  • Inappropriate use has been associated with respiratory depression and death.
  • It has been associated with increased patient satisfaction, when used for recommended indications.
  • An enhanced ordering algorithm in EMR, accompanied by pharmacy education, has been shown to reduce inappropriate ordering.
  • Its use is recommended for opioid-naïve patients with acute pain.
Volume 41.1 - Question 24

Neuropathic Pain

Which one of the following statements about the treatment of neuropathic pain is false?

  • Duloxetine results in at least a 50% reduction in pain.
  • There is good evidence to support the use of venlafaxine.
  • Pregabalin at dosages of 300 mg/day or greater leads to at least moderate benefit.
  • Topiramate has no benefit.
Volume 41.1 - Question 22

Managing Angioedema

Which one of the following statements regarding angioedema is false?

  • Histamine-mediated angioedema is the most common form.
  • Most patients with hereditary angioedema experience their first episode within the second decade of life.
  • In patients requiring an emergent airway intervention, surgical airway intervention is common.
  • Tranexamic acid has no role in treatment.
Volume 41.1 - Question 16

Multidose Ondansetron in Children with Gastroenteritis

Among children with gastroenteritis-associated vomiting, the provision of ondansetron after an emergency department visit leads to lower risk of moderate-to-severe gastroenteritis during the subsequent 7 days.

  • True
  • False
Volume 41.1 - Question 9

Antiplatelet Therapy after Drug Coated Balloon Angioplasty

Among participants with acute coronary syndrome who could be treated by drug coated balloon angioplasty exclusively, a stepwise dual antiplatelet therapy (DAPT) de-escalation is non-inferior to 12-month DAPT for net adverse clinical events.

  • True
  • False
Volume 40.6 - Question 34

Extended Anticoagulation for Cancer Patient

Extended anticoagulation with reduced-dose apixaban (2.5 mg twice daily) is noninferior to full-dose apixaban (5 mg twice daily) for the prevention of recurrent venous thromboembolism in patients with active cancer.

  • True
  • False
Volume 40.6 - Question 30

Atrial Fibrillation

In patients with AF and stable CAD, oral anticoagulation monotherapy, when compared with oral anticoagulation plus single antiplatelet therapy, is associated with a statistically significant increased risk of ischemic events.        

  • True
  • False
Volume 40.6 - Question 29

Kounis Syndrome

Which one of the following statements about Kounis Syndrome (KS) (allergic angina) is false?

  • It is diagnosed in 2% of patients with anaphylaxis.
  • Common findings in Type I KS include normal cardiac enzymes.
  • Beta blockers are a recommended treatment.
  • Epinephrine should be reserved for cases involving airway compromise, refractory shock, or hypotension.
Volume 40.6 - Question 25

Penicillin Allergy

In low-risk patients, an oral challenge can safely be used to remove an incorrect label of penicillin allergy.

  • True
  • False
Volume 40.6 - Question 14

Treatment of Genital Warts

Which one of the following statements about treatment of genital warts is false?

  • Sinecatechins are a patient-administered treatment option.
  • When performing smoke-generating procedures such as cautery to destroy or remove HPV-associated lesions, measures should be taken to prevent transmission of HPV DNA to the respiratory tracts of the physician.
  • Imiquimod is recommended in pregnancy.
  • Most successfully treated warts do not recur.
Volume 40.6 - Question 12

COPD

Which one of the following statements comparing the triple inhalers budesonide-glycopyrrolate-formoterol (Breztri) and fluticasone-umeclidinium-vilanterol (Trelegy) in COPD is false?

  • Breztri is associated with a higher incidence of first moderate COPD exacerbations.
  • Breztri is associated with a higher incidence of first admission to hospital for pneumonia.
  • Breztri is a metered dose inhaler containing hydrofluoroalkanes.
  • Breztri is associated with a similar all cause mortality.
Volume 40.6 - Question 9

Asthma Prescribing and Carbon Emissions

Which one of the following statements regarding health professionals’ decision-making when choosing which inhaler to prescribe for asthma to reduce carbon emissions is false?

  • Clinicians assume that older patients would be less motivated by environmental concerns.
  • Familiarity is a key factor in inhaler device choice.
  • Clinicians do not consider stigma a barrier to open discussion of environmental considerations.
  • Pharmacy stock is identified as an external constraint that prevents change in practice.
Volume 40.6 - Question 8

Risk of Fall with Gabapentin vs Duloxetine

In older patients with diabetic neuropathy, postherpetic neuralgia, or fibromyalgia, treatment with gabapentin is associated with increased fall-related inpatient or outpatient visits compared to treatment with duloxetine.

  • True
  • False
Volume 40.6 - Question 7

Cardiovascular Events in Patients with Gout

In patients with gout initiating urate-lowering therapy, gout flare prophylaxis with colchicine is associated with a lower rate of cardiovascular events for up to the next 180 days compared with no prophylaxis.

  • True
  • False
Volume 40.5 - Question 31

Statin Use and Risk of Hepatocellular Carcinoma

In patients 40 years or older with chronic liver disease and a baseline Fibrosis-4 (FIB-4) score of 1.3 or higher, statin use is significantly associated with a reduced risk of incident hepatocellular carcinoma.

  • True
  • False
Volume 40.5 - Question 26

Haemophilia Treatment

Which one of the following statements about treatment of haemophilia is false?

  • Prophylactic treatment to prevent bleeds has become the standard of care for severe haemophilia.
  • Extended half-life Factor IX products have a median half-life three to five times higher than standard products.
  • For treatment of major bleeds, the aim is to increase factor activity levels to the lower end of normal.
  • For treatment after minor surgeries, 1–3 days of full factor coverage usually suffices.
Volume 40.5 - Question 24

Inhaled Corticosteroid Use in Chronic Obstructive Pulmonary Disease

Long-term vs short term inhaled corticosteroid use for chronic obstructive pulmonary disease is associated with significantly greater rates of the composite outcome of type 2 diabetes, cataracts, pneumonia, osteoporosis, and nontraumatic fracture; recurrent pneumonia; and recurrent fracture.

  • True
  • False
Volume 40.5 - Question 22

Migraine Headache Prophylaxis

Candesartan is effective for prevention of episodic and chronic migraines.

  • True
  • False
Volume 40.5 - Question 21

Emergency Department Opioid Prescriptions

Which one of the following outcomes at one year is associated with emergency department opioid prescriptions?

  • Increased rate of overdoses
  • New opioid agonist therapy
  • Increase in mortality
  • Increases in subsequent opioid prescription use
Volume 40.5 - Question 10

Methylphenidate and Atomoxetine in Pregnancy

Pregnant women affected by ADHD who were receiving treatment with methylphenidate showed a significantly higher frequency of congenital anomalies or miscarriages compared to the general population.

  • True
  • False
Volume 40.5 - Question 5

Ticagrelor Compared to Clopidogrel

There is strong evidence for the superiority of ticagrelor over clopidogrel in acute coronary syndrome treatment in North American patients.

  • True
  • False
Volume 40.5 - Question 2

Genitourinary Syndrome of Menopause

Which one of the following statements about genitourinary syndrome of menopause (GSM) is false?

  • It can be confused with UTIs.
  • Measuring vaginal pH is required for diagnosis.
  • In those with recurrent UTIs, vaginal estrogen can serve as appropriate prophylaxis.
  • Physical examination of the vulva should be performed in the context of dysuria to rule out exacerbating conditions.
Volume 40.4 - Question 27

PDE 4 Inhibitor

Which one of the following statements regarding the use of the topical phosphodiesterase-4 inhibitor roflumilast in dermatological conditions is false?

  • Regular blood work is required for monitoring.
  • It has received FDA approval for treatment of plaque psoriasis.
  • It has received FDA approval for seborrheic dermatitis.
  • Its safety profile encourages its long-term use as an alternative to corticosteroids.
Volume 40.4 - Question 26

Acute Management of Migraine

The best performing triptans (eletriptan, rizatriptan, sumatriptan, and zolmitriptan) should be considered as preferred acute treatment for migraine.

  • True
  • False
Volume 40.4 - Question 25

DRESS

Which one of the following statements about drug reaction with eosinophilia and systemic symptoms is false?

  • The prodromal phase is typically followed by a morbilliform eruption that begins on the trunk.
  • Allopurinol has been associated with the shortest disease latency.
  • Atypical lymphocytosis is the earliest hematologic finding.
  • Systemic glucocorticoids are the mainstay of treatment for induction of remission.
Volume 40.4 - Question 24

Acupuncture for Sciatica

When compared to sham acupuncture, acupuncture resulted in less pain in patients with chronic sciatica from herniated disk.

  • True
  • False
Volume 40.4 - Question 23

Methylphenidate Post-Concussion

For adult patients experiencing substantial cognitive fatigue more than 3 months postconcussion who have not responded to nonpharmacological treatments, a trial of methylphenidate might be considered.

  • True
  • False
Volume 40.4 - Question 22

Treatment of Plaque Psoriasis

For the treatment of plaque psoriasis, a combination of calcipotriol (Dovonex) and betamethasone is more effective than betamethasone alone.

  • True
  • False
Volume 40.3 - Question 36

Peptic Ulcer Disease

Which one of the following statements about the management of peptic ulcer disease is false?

  • Aspirin doses of 75 mg to 91 mg are associated with an increased risk of duodenal ulcer.
  • Alcohol intake is not a risk factor for peptic ulcer disease.
  • Infection with H pylori increases the risk of peptic ulcer disease among individuals taking low doses of aspirin.
  • Use of acetaminophen in doses up to 4g/day is not associated with peptic ulcer disease.
Volume 40.3 - Question 35

Bleeding Risks with Anticoagulants and NSAIDs

Patients treated with oral anticoagulants for venous thromboembolism are at increased risk of bleeding from a number of sites when using NSAIDs

  • True
  • False
Volume 40.3 - Question 16

Fezolinetant

In individuals aged 40-65 years with moderate-to-severe vasomotor symptoms associated with menopause, treatment with fezolinetant results in each of the following except:

  • Reduced frequency of vasomotor symptoms
  • Reduced severity of vasomotor symptoms
  • Reduced sleep disturbance
  • Significantly increased side effects
Volume 40.3 - Question 15

Finerenone in Heart Failure

Long-term treatment with finerenone is estimated to extend event-free survival by up to 3 years among people with heart failure with mildly reduced or preserved ejection fraction.

  • True
  • False
Volume 40.3 - Question 31

Tirzepatide for Sleep Apnea

When tirzepatide is used to treat moderate-to-severe sleep apnea in adult obese patients, which one of the following is false?

  • In patients not already receiving treatment with positive airway pressure (PAP), it reduces the apnea-hypopnea index (AHI).
  • In patients receiving PAP, it reduces the AHI.
  • It significantly reduces systolic blood pressure.
  • It is associated with a significant increase in gallbladder-related adverse events.
Volume 40.3 - Question 30

GERD Treatment in Infants and Children

Which one of the following statements about the pharmacological treatment of gastroesophageal reflux disease in infants and children is false?

  • H2 blockers may increase the risk of necrotizing enterocolitis in high-risk preterm infants.
  • Proton pumps inhibitors (PPIs) may increase the risk of lower respiratory tract infections.
  • Long-term use of PPIs has been linked to obesity, allergies, and a higher risk of fractures in children.
  • A trial of PPIs for diagnostic purposes is recommended in infants.
Volume 40.3 - Question 11

Alzheimer Disease Treatment

Which one of the following statements about the treatment of Alzheimer Disease (AD) is false?

  • Lower dosages of donepezil (10 mg daily) demonstrate comparable effectiveness to higher dosages.
  • Memantine is used in moderate to severe AD.
  • Brexpiprazole may help improve AD-associated agitation.
  • Rivastigmine is associated with lower risk of gastrointestinal adverse effects.
Volume 40.3 - Question 4

Problems with Antiseizure Medications

Which one of the following statements about possible problems with antiseizure medications is false?

  • The potential risk to offspring of major congenital malformations from in utero exposure is highest with valproate.
  • Combined oral contraceptives may reduce the serum concentration of lamotrigine.
  • Use of antiseizure medications can increase fracture risk in children.
  • Use of generic formulations as opposed to the brand-name drug has been associated with changes in seizure frequency.
Volume 40.2 - Question 28

Superficial Venous Thrombosis

Which one of the following statements about superficial venous thrombosis (SVT) is true?

  • Varicose veins are not a risk factor for lower-limb SVT.
  • D-dimer is a valid tool for the diagnosis of lower limb SVT.
  • Female sex is a predictor of VTE complication at three months.
  • If the superficial thrombus extends to deep circulation, the recommended treatment is a full-dose anticoagulation.
Volume 40.2 - Question 27

De-Escalation from DAPT to Ticagrelor Monotherapy

In patients undergoing percutaneous coronary intervention with a coronary drug-eluting stent, treated with short term dual antiplatelet therapy (DAPT) ranging from 2 weeks to 3 months, de-escalation to ticagrelor monotherapy reduces the risk of major bleeding without increasing ischemic risk compared with 12 months of DAPT.

  • True
  • False
Volume 40.2 - Question 25

Dry Eyes

Laughter exercise, four times a day, is non-inferior to 0.1% sodium hyaluronic acid, four times a day, in improving dry eye disease symptoms and clinical signs.

  • True
  • False
Volume 40.2 - Question 24

Migraine Treatments

Which one of the following statements regarding the treatment of migraine is false?

  • Taking NSAIDs on an empty stomach may increase effectiveness.
  • There is a high risk of serotonin syndrome when combining a triptan and a selective serotonin reuptake inhibitor (SSRI).
  • Prokinetic medications such as metoclopramide can boost the effectiveness of analgesic medications.
  • Subcutaneous administration is more effective than oral administration of triptans.
Volume 40.2 - Question 13

Weight Gain with Antidepressants

Which one of the following antidepressants is associated with lower six-month weight gain when compared with sertraline.

  • Escitalopram
  • Bupropion
  • Venlafaxine
  • Paroxetine
Volume 40.1 - Question 27

Methotrexate and Knee OA Therapeutics

Oral methotrexate added to usual care significantly reduces knee osteoarthritis pain and function at 6 months.

  • True
  • False
Volume 40.1 - Question 26

Topical Anti-Inflammatory Treatments for Eczema

Which one of the following statements about topical anti-inflammatory treatments for eczema is false?

  • Tacrolimus 0.1% is more likely to cause application site reactions than pimecrolimus 1%.
  • There is no evidence for increased pigmentation changes with topical corticosteroids.
  • Longer term outcomes show increased skin thinning with mild topical corticosteroids compared to topical calcineurin inhibitors.
  • Crisaborole 2% and tacrolimus 0.1% are equally effective.
Volume 40.1 - Question 22

Delirium with Morphine in CHF

When used to relieve dyspnea due to heart failure in inpatients, morphine is not associated with delirium.

  • True
  • False
Volume 40.1 - Question 16

Inhalers and Greenhouse Gas Emissions

Which one of the following statements regarding inhalers and greenhouse gas emissions (GHG) is false?

  • Pressurized metered-dose inhalers (MDIs) contribute about 20% of the primary care emissions produced by the United Kingdom National Health Service.
  • MDIs currently rely on hydrofluorocarbon propellants which are potent GHGs.
  • A substantial portion of the GHG emissions from MDIs are released following disposal of the inhaler.
  • Dry powder inhalers have substantially higher carbon footprints than MDIs.
Volume 40.1 - Question 1

Non-Alcoholic Fatty Liver Disease

In patients with Type 2 Diabetes and Non-Alcoholic Fatty Liver Disease, which one of the following statements regarding treatment with oral antidiabetic drugs is false?

  • Thiazolidinediones restore lowered plasma adiponectin levels in patients with nonalcoholic steatohepatitis.
  • Sodium-glucose cotransporter 2 inhibitors might be preferred over other oral antidiabetic drugs with respect to nonalcoholic fatty liver disease regression.
  • Dipeptidyl peptidase-4 (DPP-4) inhibitors are not significantly associated with weight change.
  • DPP-4 inhibitors are significantly associated with a lower incidence of adverse liver-related outcomes when compared with sulfonylureas.
Volume 39.6 - Question 40

Benign Prostatic Hyperplasia

Low dose tadalafil is an effective option for the management of symptoms due to benign prostatic hyperplasia.

  • True
  • False
Volume 39.6 - Question 32

Thiazide Induced Hyponatremia

Thiazide-induced hyponatremia is more common in the initial month of treatment compared to one year later.

  • True
  • False
Volume 39.6 - Question 31

Akathisia

Vitamin B6 has the best risk-benefit ratio for the treatment of antipsychotic drug-induced akathisia.

  • True
  • False
Volume 39.6 - Question 24

BV Treatment with Dequalinium Chloride vs Metronidazole

Which one of the following statements regarding treatment of bacterial vaginosis with vaginal dequalinium chloride compared to oral metronidazole is false?

  • It is better tolerated.
  • It has inferior cure rates.
  • It results in lower rates of candidiasis.
  • It has no clinically relevant reports of resistance.
Volume 39.6 - Question 17

Pediatric UTI

A 5-day treatment of acute febrile UTIs in children with oral amoxicillin-clavulanic acid was non-inferior to a 10-day treatment.

  • True
  • False
Volume 39.6 - Question 14

Depression Treatment

Which one of the following statements about treatment-resistant depression is false?

  • Augmentation by adding a second-generation antidepressant with a different mechanism of action may have some benefit.
  • Cannabis is recommended.
  • Augmentation with a second-generation antipsychotic may have some benefit.
  • Psilocybin may be helpful.
Volume 39.6 - Question 4

Melatonin for Nocturia

In prospective randomized controlled trials, melatonin shows a trend towards treatment response for nocturia in non neurogenic populations. 

  • True
  • False
Volume 39.5 - Question 31

Treatment of Hypertension

Hydrochlorothiazide has a lower risk of causing hypokalemia than indapamide.  

  • True
  • False
Volume 39.5 - Question 30

Cardiovascular Disease in HIV

In patients with low to moderate risk of cardiovascular disease receiving antiretroviral therapy for HIV infection, statin therapy lowers the risk of a major adverse cardiovascular event. 

  • True
  • False
Volume 39.5 - Question 25

SSRI & Anticoagulants

Among patients with atrial fibrillation, concomitant use of SSRIs and oral anticoagulants (OACs) was associated with an increased risk of major bleeding compared with OAC use alone.  

  • True
  • False
Volume 39.5 - Question 22

Pharmacotherapy and Mortality in ADHD

Among individuals diagnosed with ADHD, medication initiation is associated with significantly lower all-cause mortality.  

  • True
  • False
Volume 39.5 - Question 21

Polycystic Ovarian Syndrome

Which one of the following statements about polycystic ovary syndrome (PCOS) is false? 

  • Androgen levels cannot be measured reliably while a patient is on combined hormonal contraceptives.   
  • The addition of metformin to combined hormonal contraceptives can be considered in patients with PCOS in high metabolic risk groups.   
  • The risk of endometrial cancer is 2–6 times higher among people with PCOS than the general population and often presents before menopause. 
  • With assisted reproduction, the cumulative probability of childbirth is lower in patients with PCOS than those without.
Volume 39.5 - Question 10

Subclinical Hypothyroidism

Which one of the following statements about subclinical hypothyroidism is false?

  • It affects 4 – 20% of the adult population.
  • About one in three patients have no symptoms.
  • The risk of progression to overt hypothyroidism ranges between 2% and 5% a year.
  • Thyroid stimulating hormone levels between 4 and 10 mIU/L rarely normalize without intervention.
Volume 33.6 - Question 34

Testosterone Treatment

Testosterone treatment in men with hypogonadism decreases the risk of fractures. 

  • True
  • False
Volume 39.4 - Question 29

Subclinical Atrial Fibrillation

Which one of the following statements regarding subclinical atrial fibrillation (AF) in patients with an implanted cardiac pacemaker or defibrillator is false? 

  • It is present in more than one third of older patients with hypertension who have received a pacemaker.   
  • It is associated with an increased risk of stroke by a factor of 2.5.   
  • The absolute increase in stroke risk is similar to the risk increase observed in clinically detected AF.   
  • In patients with risk factors for stroke who are found to have subclinical AF, apixaban results in a lower risk of stroke or systemic embolism than aspirin. 
Volume 39.4 - Question 28

Doxycycline

Early childhood (before 8 years of age) exposure to doxycycline is associated with dental staining. 

  • True
  • False
Volume 39.4 - Question 10

Pharmacological Intervention for Irritability, Aggression and Self Injury in Autism

At short term follow up (up to 6 months) which one of the following statements is false about pharmacological interventions for symptoms of irritability, aggression and self injury in autistic persons?  

  • Atypical antipsychotics probably reduce self injury.    
  • There is clear evidence that atypical antipsychotics reduce aggression.    
  • ADHD related medications may reduce irritability slightly.    
  • There is no clear evidence antidepressants reduce irritability.  
Volume 39.4 - Question 8

Intranasal Ketorolac for Renal Colic

Intranasal ketorolac is inferior to intravenous for the treatment of renal colic in adults in the emergency department.   

  • True
  • False
Volume 39.4 - Question 2

Dexamethasone and COVID19 Mortality

Mortality is decreased in hospitalized patients with COVID-19 who do not require respiratory support and are given dexamethasone.

  • True
  • False
Volume 36.63 - Question 1

Acetaminophen and Blood Pressure

Regular daily intake of 4 g acetaminophen increases systolic BP in individuals with hypertension.   

  • True
  • False
Volume 38.21 - Question 16

Inhaled Budosenide

Inhaled budesonide improves time to recovery, with a chance of also reducing hospital admissions or deaths, in people with COVID-19 in the community who are at higher risk of complications. 

  • True
  • False
Volume 38.21 - Question 11

Paxlovid

Which one of the following statements about Paxlovid for treatment of COVID-19 infection is false? 

  • It can reduce rate of hospitalization.   
  • It can reduce the rate of death.   
  • It is contraindicated for use with drugs that are highly dependent on CYP3A for clearance.   
  • It can be started after 5 days of symptom onset.  
Volume 38.21 - Question 7

Acne

Which one of the following statements about the treatment of acne is false?

  • Concurrent application of dapsone and benzoyl peroxide can cause temporary yellow or orange discoloration of the skin and facial hair.
  • Concurrent application of tretinoin and benzoyl peroxide is recommended.
  • Drug-induced lupus and autoimmune hepatitis can occur with long-term use of minocycline.
  • Spironolactone is used off-label to treat acne in post-pubertal females.
Volume 39.3 - Question 37

Cirrhosis

Which one of the following statements regarding the use of non-selective beta blockers in the management of cirrhosis in patients older than 16 is false?

  • They can reduce the incidence of ascites in people with clinically significant portal hypertension.
  • They have a greater effect on blood pressure in people with cirrhosis.
  • They are less effective than endoscopic variceal band ligation for preventing oesophageal variceal bleeding.
  • Carvedilol should be avoided in people with severe hepatic impairment.
Volume 39.3 - Question 30

Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes

In patients with preexisting cardiovascular disease and BMI of 27 or greater, without diabetes, weekly subcutaneous semaglutide at a dose of 2.4 mg is superior to placebo in reducing the incidence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke.

  • True
  • False
Volume 39.3 - Question 27

Irritable Bowel Syndrome

Low-dose amitriptyline is superior to placebo for adequate relief of irritable bowel syndrome.

  • True
  • False
Volume 39.3 - Question 26

Tranexamic Acid for Trauma

In the context of traumatic injuries, which one of the following statements about the tranexamic acid (TXA) use is false?

  • TXA improves one month mortality.
  • Administering TXA in the out-of-hospital setting improves mortality.
  • TXA administration increases occlusive events.
  • TXA may reduce bleeding by inhibiting the activation of plasmin and maintaining the clot stability and integrity.
Volume 39.3 - Question 25

Drugs for Rheumatoid Arthritis

Which one of the following statements about treatment for Rheumatoid Arthritis (RA) is false?

  • Disease-modifying anti-rheumatic drugs should be used for initial treatment of RA.
  • Methotrexate is the drug of choice for initial treatment of patients with moderate-to-high disease activity.
  • Triple therapy with methotrexate, hydroxychloroquine, and sulfasalazine is not an alternative to addition of a biologic drug.
  • If maximally tolerated doses of methotrexate are not adequately effective, a biologic drug, such as a tumor necrosis factor inhibitor, should be added.
Volume 37.3 - Question 38

Climate Change

Dry powder inhalers produce a smaller carbon footprint than metered dose inhalers when used for asthma maintenance therapy without loss of asthma control.

  • True
  • False
Volume 39.3 - Question 24

Corticosteroid Therapy for CAP

Which one of the following statements about the use of adjunctive corticosteroids for the treatment of patients hospitalized with community acquired pneumonia is false?

  • All cause mortality at 30 days is reduced.
  • Incidence of acute respiratory distress syndrome is reduced.
  • Admissions to ICU are reduced.
  • Incidence of hyperglycaemia is increased.
Volume 39.3 - Question 20

Inappropriate Sexual Behaviour in Long-Term Care

In the pharmacologic management of inappropriate sexual behaviour in long-term care residents with dementia, each of the following drugs, alone or in combination, could be considered as first-line agents except:

  • Sertraline
  • Finasteride
  • Aripiprazole
  • Estrogen
Volume 39.3 - Question 19

Management of Osteoporosis

Which one of the following statements regarding the management of osteoporosis is false?

  • Taking oral bisphosphonates for 5 years or more, compared with shorter durations, likely results in no difference in hip or overall fractures.
  • After 6 years of treatment with bisphosphonates there are more atypical femur fractures compared with 3-5 years of treatment.
  • The risk of osteonecrosis of the jaw with the use of bisphosphonates approximately doubles with use longer than 5 years.
  • Evidence suggests that the benefits of denosumab wane at 10 years of therapy.
Volume 39.3 - Question 17

Levetiracetam for Status Epilepticus in Epilepsy

After initial benzodiazepine therapy, intravenous levetiracetam is superior to valproic acid for the management of status epilepticus. 

  • True
  • False
Volume 37.3 - Question 33

Naltrexone

Which one of the following statements about naltrexone is false?

  • It is approved for treatment of alcohol dependence.
  • It is used for treatment of opioid use disorder.
  • Severe hepatotoxicity has occurred with high doses.
  • It can decrease the effects of cannabinoids.
Volume 37.3 - Question 29

Hyperkalemia

Adverse effects of reducing renin-angiotension-aldosterone system inhibitors outweigh the potential harms of hyperkalemia.

  • True
  • False
Volume 37.3 - Question 28

Gastro-intestinal bleeding from DOACs

Rivaroxaban is associated with higher gastrointestinal bleeding rates than apixaban regardless of treatment indication.

  • True
  • False
Volume 37.3 - Question 27

Maintenance or Discontinuation of Antidepressants

Among patients with a history of at least 2 depressive episodes or who had been taking antidepressants for two years or longer who feel well enough to discontinue antidepressant therapy, those who stop their medication have a higher risk of relapse than those who maintain their current therapy.

  • True
  • False
Volume 37.3 - Question 26

Cluster Headache Treatment

Which one of the following therapies is not recommended for the treatment of cluster headaches?

  • 100% oxygen
  • Nasal lidocaine
  • Long-term use of corticosteroids
  • Melatonin
Volume 37.3 - Question 25

UTI Treatment in Men

In afebrile older men with a suspected urinary tract infection (UTI), a 14-day antibiotic course is superior to a 7-day antibiotic course. 

  • True
  • False
Volume 37.3 - Question 17

Blood pressure lowering and diabetes prevention

Which one of the following antihypertensive medication classes is associated with a reduced risk of developing new onset type 2 diabetes mellitus?

  • Angiotension converting enzyme inhibitors
  • Beta-blockers
  • Thiazide diuretics
  • Calcium channel blockers
Volume 37.3 - Question 14

COVID Booster

A third dose of the mRNA vaccine BNT162b2 (Pfizer-BioNTech) provides an additional 85% protection against detected SARSCoV-2 infection over and above the reduction in the risk conferred by the first 2 doses. 

  • True
  • False
Volume 37.3 - Question 13

Acute Otitis Media in Children

Which one of the following statements about acute otitis media in children is false?

  • Streptococcus pneumoniae is the most common bacterial pathogen.
  • Immediate antibiotic treatment should be prescribed for all children < 2 years old.
  • Macrolide should be considered only for patients with a history of serious penicillin allergy.
  • Clindamycin may be effective.
Volume 37.3 - Question 10

Monoclonal antibody biologics in pregnancy

Which one of the following statements about the use of monoclonal antibody biologics during pregnancy is false?

  • Most monoclonal antibody biologics readily cross the placenta.
  • Insufficient evidence exists to support the routine use of biologics other than anti-tumour necrosis factors (TNF) agents during pregnancy.
  • Maternal use of anti-TNFs is a contraindication to breast feeding.
  • All infants exposed to biologics during pregnancy should receive inactivated immunizations according to the routine schedule.
Volume 37.3 - Question 2

Paxlovid

Which one of the following statements about Paxlovid for treatment of COVID-19 infection is false?

  • It can reduce rate of hospitalization.
  • It can reduce the rate of death.
  • It is contraindicated for use with drugs that are highly dependent on CYP3A for clearance.
  • It can be started after 5 days of symptom onset.
Volume 37.3 - Question 1

Supraventricular Tachycardia

Which one of the following statements about the management of supraventricular tachycardia in children is false?

  • Vagal maneuvers are considered non-invasive first-line treatment of children who are hemodynamically stable.
  • The vagal maneuver with the highest success rate is carotid sinus massage.
  • Primary pharmacological treatment often involves intravenous adenosine.
  • Adenosine is not advised in patients with asthma.
Volume 39.3 - Question 11

Non-Drug Therapy for Depression

Which one of the following non-drug treatments for depression have been shown to be the most effective?

  • Electroconvulsive therapy
  • Transcranial magnetic stimulation
  • Deep brain stimulation
  • Interpersonal therapy
Volume 39.3 - Question 5

Atrial Fibrillation

Which one of the following statements about the treatment of atrial fibrillation is false? 

  • Major bleeding occurs in <1% of patients taking DOACs each year.     
  • Apixaban has shown reasonable safety and effectiveness in patients with end stage renal disease on dialysis.   
  • Amiodarone is the most effective antiarrhythmic.   
  • Catheter ablation reduced recurrences of atrial fibrillation compared with antiarrhythmic drug therapy over five years. 
Volume 36.6 - Question 29

Ibuprofen for Fever in Children

In children under the age of 2, ibuprofen is more effective than acetaminophen at reducing fever. 

  • True
  • False
Volume 36.6 - Question 24

Semaglutide for Weight Loss

In non-diabetic adults with overweight or obesity, once weekly semaglutide plus lifestyle intervention results in each of the following except: 

  • Weight reduction.     
  • Lower systolic blood pressure.   
  • Improvement in physical functioning scores.   
  • Increased hypoglycemia. 
Volume 36.6 - Question 23

Aspirin and Cardiovascular Disease

In patients with established cardiovascular disease, there is no significant difference in cardiovascular events between patients taking 81 mg and those taking 325 mg of aspirin daily. 

  • True
  • False
Volume 36.6 - Question 22

Lyme Disease - 2

Which one of the following statements about Lyme disease is false? 

  • Erythema migrans may go unnoticed because it often asymptomatic.     
  • The removed tick should be tested for the presence of B. burgdorferi.   
  • A single dose of doxycycline given within 72 hours of tick removal is recommended as prophylaxis in adults.   
  • Late disease, which usually presents as arthritis, typically of the knee, can develop months to years after initial infection. 
Volume 36.6 - Question 17

Allergic Conjunctivitis

Which one of the following statements about allergic conjunctivitis is false? 

  • Ophthalmic H1-antihistamines are at least as effective as oral second-generation H1 -antihistamines for treatment of ocular itching.  
  • Topical ketorolac is less effective in relieving ocular symptoms than an ophthalmic H1-antihistamine. 
  • Ophthalmic corticosteroids can be considered for use in patients that fails to respond to other drugs. 
  • Most ophthalmic products used in the treatment of allergic conjunctivitis contain the preservative benzalkonium chloride, which does not cause stinging. 
Volume 36.6 - Question 13

Meningococcal Vaccine

MenQuadfi is the only vaccine available in Canada for use in persons ≥ 56 years old for the prevention of invasive meningococcal disease caused by Neisseria meningitides serogroups A, C, W, and Y.  

  • True
  • False
Volume 36.6 - Question 12

GLP-1 Receptor Agonists

Which one of the following statements about GLP-1 receptor agonists is false?

  • The dosage recommended for weight loss is higher than the dosage used for the treatment of type 2 diabetes.
  • Liraglutide and semaglutide are approved for weight management in patients without type 2 diabetes.
  • The oral form of semaglutide has been approved for weight management.
  • Gastrointestinal adverse effects are common.
Volume 37.6 - Question 37

Venous Thromboembolism Treatment

Patients with venous thromboembolism (VTE) who are initiated on apixaban have lower rates for recurrent VTE than those initiated on rivaroxaban.

  • True
  • False
Volume 37.6 - Question 34

Treatment of Osteoporosis with Denosumab

Which one of the following statements about denosumab treatment for osteoporosis is false?

  • It is important to correct severe vitamin D deficiency before treatment.
  • Denosumab should not be used in patients with an eGFR of less than 30 mL/min.
  • Treatment effects have a rapid offset following discontinuation of denosumab.
  • There is an increased risk of vertebral fractures in the 12 months after the drug is discontinued
Volume 37.6 - Question 32

Treatment of Osteoporosis

Which one of the following statements about osteoporosis prevention and treatment is false?

  • Vitamin D supplementation greater than 1000 units per day can accelerate bone loss.
  • Calcium supplements in community-dwelling adults prevent fractures.
  • An acute phase response (flu-like illness) occurs in about a third of patients receiving their first intravenous bisphosphonate treatment.
  • A 1-to-2-year drug holiday should be considered after 5 years of treatment with alendronate.
Volume 37.6 - Question 31

Gabapentin for Alcohol Use Disorder

Which one of the following statements regarding gabapentin for alcohol use disorder is false? 

  • It decreased the percentage of heavy drinking days.    
  • It increased total abstinence.   
  • Patients experienced 10% more adverse effects than placebo.   
  • Patients prescribed gabapentin for any reason had double the death rate of the general population.  
Volume 36.6 - Question 10

Memory Decline with Coronary Revascularization

Among older adults undergoing coronary revascularization the type of procedure was not significantly associated with differences in the change of rate of memory decline.

  • True
  • False
Volume 36.6 - Question 9

Macrolides in Pregnancy

Macrolide use in early pregnancy is associated with an increased risk of major birth defects. 

  • True
  • False
Volume 36.6 - Question 5

Pediatric Pneumonia

A five-day course of high-dose amoxicillin for community acquired pneumonia in children was associated with non-inferior rates of clinical cure compared with 10 days of high-dose amoxicillin.  

  • True
  • False
Volume 36.5 - Question 38

Colchicine

Which one of the following statements about colchicine is false? 

  • A low dose of colchicine (0.5 mg once daily) in addition to standard therapy reduces the risk of cardiovascular events compared to placebo in patients with a recent myocardial infarction.   
  • A low dose of colchicine in addition to standard therapy does not reduce the risk of cardiovascular events compared to placebo in patients with chronic coronary artery disease.   
  • Rhabdomyolysis may occur with therapeutic doses of colchicine.   
  • Colchicine doses up to 2 mg daily are not associated with an increased risk of miscarriage.  
Volume 36.5 - Question 29

Antithrombotic Therapy

Which one of the following antithrombotic treatment regimens is recommended for the first month after an acute coronary syndrome in a patient who also has non valvular atrial fibrillation and is not at high risk for bleeding? 

  • Direct oral anticoagulant (DOAC)   
  • Clopidogrel and DOAC   
  • ASA and Clopidogrel   
  • ASA and Clopidogrel and DOAC 
Volume 36.5 - Question 28

Drugs for Multiple Sclerosis

Which one of the following statements about the use of medications to treat Multiple Sclerosis (MS) is false? 

  • Patients with highly active relapsing MS should receive initial treatment with high efficacy disease modifying drugs such as natalizumab or an anti-CD20 antibody.   
  • For less active cases of MS, a less effective drug with less toxicity such as interferon beta or glatiramer acetate may be appropriate.   
  • Interferon beta is not considered safe for use in pregnancy.   
  • Glatiramer acetate can reduce clinical relapse rates of MS by about 30%. 
Volume 36.5 - Question 23

Statins and Muscle Pain

In people who had previously reported severe muscle symptoms when taking statins, atorvastatin 20 mg daily has no effect on overall muscle symptoms compared with placebo. 

  • True
  • False
Volume 36.5 - Question 22

Semaglutide

Which one of the following statements about semaglutide is false? 

  • GI adverse effects are common but are generally transient and mild to moderate in severity.     
  • It is contraindicated in patients with a personal history of medullary thyroid carcinoma.   
  • It may reduce body weight significantly in patients with and without type 2 diabetes when given in addition to lifestyle intervention.    
  • It is approved by Health Canada for weight loss treatment.  
Volume 36.5 - Question 21

Adult Pneumonia

Among patients admitted to hospital with community-acquired pneumonia who are clinically stable, discontinuing β-lactam treatment after 3 days was non-inferior to 8 days of treatment.  

  • True
  • False
Volume 36.5 - Question 20

Lyme Disease

Which one of the following statements about Lyme disease is false? 

  • Erythema migrans may go unnoticed because it is often asymptomatic.   
  • The removed tick should be tested for the presence of B. burgdorferi.   
  • A single dose of doxycycline given within 72 hours of tick removal is recommended as prophylaxis in adults.   
  • Late disease, which usually presents as arthritis, typically of the knee, can develop months to years after initial infection. 
Volume 36.5 - Question 16

Smoking Cessation

Which one of the following statements about pharmacological treatment for smoking cessation is false? 

  • Abstinence at six months is more likely with bupropion than with varenicline.   
  • Abstinence at six months is more likely with a combination of varenicline and nicotine patches than with varenicline alone.   
  • Compared with “waiting for readiness”, prescribing varenicline to people not ready to quit increases abstinence at six months.   
  • Treatment with varenicline for more than 12 weeks is more effective than shorter treatment periods. 
Volume 36.5 - Question 1

Naltrexone/Bupropion

Naltrexone/bupropion has the highest incidence of adverse effects leading to drug discontinuation of all approved weight-loss drugs.

  • True
  • False
Volume 37.6 - Question 24

Oral Minoxidil for Androgenetic Alopecia

Which one of the following statements about the use of oral minoxidil for androgenetic alopecia is false? 

  • It increases hair growth.   
  • It Increases hair thickness.   
  • It increases blood pressure.   
  • It can cause pedal edema. 
Volume 36.4 - Question 43

Topical Acne Therapy

Which one of the following statements about topical acne treatments is false? 

  • Monotherapy with an antibiotic is not recommended because resistance can develop.     
  • Benzoyl peroxide can cause contact dermatitis.    
  • Benzoyl peroxide has not been shown to induce development of bacterial resistance.   
  • Concurrent application of tretinoin and benzoyl peroxide is recommended.  
Volume 36.4 - Question 42

Sunscreen 

Which one of the following statements about sunscreen use is false?  

  • It is not recommended for children under the age of six months.   
  • Some ingredients can reach blood levels that exceed recommended levels.   
  • It needs to be applied at least 30 minutes prior to sun exposure to be effective.   
  • Spray-on sunscreens tend to provide lesser protection compared to cream sunscreens. 
Volume 36.4 - Question 41

Hyponatremia

In patients with hyponatremia due to the syndrome of inappropriate antidiuresis, adding furosemide to fluid restriction improves day 4 serum sodium levels. 

  • True
  • False
Volume 36.4 - Question 39

Lowering LDL Cholesterol in Older Patients

For patients aged 75 years old or older, lowering lipids is as effective in reducing cardiovascular disease as it is in younger patients.  

  • True
  • False
Volume 36.4 - Question 38

Atrial Fibrillation

Among patients with permanent atrial fibrillation and symptoms of heart failure treated with low-dose digoxin or bisoprolol, there was no statistically significant difference in quality of life at six months. 

  • True
  • False
Volume 36.4 - Question 26

Beta Blockers

β-blocker therapy for more than one year is associated with reduced all-cause death among patients undergoing revascularization for acute myocardial infarction without heart failure. 

  • True
  • False
Volume 36.4 - Question 23

Statin Treatment 

Which one of the following statements about choosing statin treatment is false? 

  • Atorvastatin is associated with an increased risk of type 2 diabetes.   
  • HIV patients receiving treatment with protease inhibitors should avoid using lovastatin.   
  • Rosuvastatin is associated with a decrease in proteinuria.   
  • When using immunosuppressants concomitantly with statins, simvastatin should be avoided. 
Volume 36.4 - Question 22

Monoclonal Antibodies for COVID-19 

Bamlanivimab, a monoclonal antibody, is authorized for use in patients who require oxygen therapy because of COVID-19. 

  • True
  • False
Volume 36.4 - Question 15

Treatment of Bipolar Depression 

Which one of the following statements about treatment of bipolar depression is false? 

  • Antidepressants should be avoided in bipolar depression with mixed features.   
  • Quetiapine is effective in both bipolar I and bipolar II depression.   
  • Divalproex has been shown to be superior to lithium in preventing the recurrence of depressive episodes.   
  • Lurasidone has a negligible liability to cause weight gain. 
Volume 36.4 - Question 12

Seasonal Affective Disorder

Which one of the following statements about seasonal affective disorder (SAD) is false? 

  • The spring/summer type of SAD may have atypical symptoms.    
  • Fluoxetine and light therapy have similar effectiveness.    
  • Cognitive behavioural therapy is superior to light therapy for recurrent SAD.   
  • Vitamin D supplementation has been shown to be an effective treatment.
Volume 36.4 - Question 10

HPV Vaccine

Human papillomavirus vaccination is associated with an increased risk of Guillain-Barre syndrome. 

  • True
  • False
Volume 36.4 - Question 3

Colchicine in Chronic Coronary Disease

In patients with chronic coronary disease, colchicine 0.5 mg daily significantly reduces the risk of cardiovascular events.  

  • True
  • False
Volume 36.4 - Question 2

NSAIDs Use in Pregnancy

Use of nonsteroidal anti-inflammatory drugs is not advised during pregnancy beginning at 20 weeks’ gestation. 

  • True
  • False
Volume 36.4 - Question 1

Hydrochlorothiazide and Skin Cancer

There is an increased risk of nonmelanoma skin cancer associated with the use of hydrochlorothiazide.  

  • True
  • False
Volume 36.3 - Question 38

Systemic Acne Therapy

Which one of the following statements about systemic acne therapy is false? 

  • Autoimmune hepatitis can occur with long-term use of minocycline.   
  • Minocycline may have a deleterious effect on spermatogenesis.   
  • Resistance is reported less frequently with erythromycin than tetracyclines.   
  • Trimethoprim/sulfamethoxazole should only be used when other antibiotics are ineffective. 
Volume 36.3 - Question 37

Short-term Systemic Corticosteroids

Which one of the following conditions has evidence to support the use of systemic corticosteroids in its management?    

  • Acute pharyngitis    
  • Acute gout   
  • Lumbar radiculopathy    
  • Herpes zoster 
Volume 36.3 - Question 36

Acute Liver Failure

N-acetylcysteine improves overall survival in the treatment of non-acetaminophen-related acute liver injury. 

  • True
  • False
Volume 36.3 - Question 33

Maintenance Treatment of Asthma

Which one of the following statements about asthma is false? 

  • An inhaled corticosteroid is the most effective maintenance treatment for asthma of any severity.     
  • For persistent asthma, budesonide/formoterol as a single maintenance and reliever therapy reduces the risk of asthma exacerbations.   
  • Neuropsychiatric events have been reported with montelukast.   
  • Anaphylaxis associated with omalizumab invariably occurs within 40 minutes. 
Volume 36.3 - Question 32

Cannabinoid Hyperemesis Syndrome

For the acute treatment of cannabis-associated hyperemesis, IV haloperidol is superior to IV ondansetron. 

  • True
  • False
Volume 36.3 - Question 23

Low dose Quad-pill for Hypertension Versus Standard Dose Monotherapy

Hypertension treatment with a fixed dose quadruple agent (irbesartan, amlodipine, indapamide and bisoprolol) can achieve greater blood pressure lowering as compared to antihypertensive monotherapy at standard doses.

  • True
  • False
Volume 37.1 - Question 28

Treatment of C. difficile Infections

In patients with an initial C. difficile infection episode, treatment with fidaxomicin reduces the risk of recurrence compared to vancomycin.

  • True
  • False
Volume 37.1 - Question 8

Tympanostomy for Otitis Media

Which one of the following statements is false?

  • Tympanostomy tubes (TT) insertion is superior to medical management in reducing the incidence of acute otitis media (AOM) 2 years after surgery.
  • Studies show decreased incidence of AOM in the first year after TT insertion.
  • The most common short-term complication of TT insertion is otorrhea.
  • Routine immunization of infants and children in Canada with pneumococcal conjugate vaccines is associated with a reduction in the overall incidence of AOM.
Volume 37.6 - Question 9

Tezepelumab for Severe Asthma

Add-on maintenance treatment with once-monthly injections of tezepelumab can reduce exacerbations in adolescents and adults with severe uncontrolled asthma, irrespective of blood eosinophil levels.

  • True
  • False
Volume 37.6 - Question 8

Dexlansoprazole

Once-daily dexlansoprazole is more likely to be effective when compared to twice daily use of other proton pump inhibitors.

  • True
  • False
Volume 37.6 - Question 5

Oral Moxifloxacin for Appendicitis

For adults with uncomplicated acute appendicitis, treatment with seven days of oral moxifloxacin resulted in treatment success rates greater than 65%.  

  • True
  • False
Volume 36.3 - Question 21

ACE Inhibitors and COVID-19

Discontinuing angiotensin-converting enzyme inhibitors for 30–days improves mortality in patients admitted to hospital with mild to moderate COVID–19. 

  • True
  • False
Volume 36.3 - Question 17

Pharmacotherapy for Smoking Cessation

Among smokers not yet ready to abstain from tobacco, beginning therapy with varenicline is unlikely to be of benefit. 

  • True
  • False
Volume 36.3 - Question 13

Bipolar Disorder

Which one of the following statements about bipolar disorder is false? 

  • Adults with bipolar disorders are approximately 20–30 times more likely to die by suicide compared with the general population.   
  • Bipolar II disorder is associated with a higher suicide rate than bipolar I disorder.   
  • Suicide is the most common cause of premature mortality.   
  • Maintenance treatment with lithium reduces suicide risk. 
Volume 36.3 - Question 12

Fractures and Bisphosphonates

Which one of the following statements about the use of bisphosphonates is false? 

  • There is a higher risk of atypical femur fracture among Asians compared with Whites.   
  • The risk of atypical femur fracture increases with longer duration of bisphosphonate use.   
  • The absolute risk of atypical femur fracture is similar to the risk of other osteoporotic fractures when using bisphosphonates.   
  • The risk of atypical femur fracture decreases with discontinuation.  
Volume 36.2 - Question 38

Antacid for Epigastric Pain

Antacid/lidocaine 2% viscous gel is superior to antacid monotherapy in reducing epigastric pain at 30 minutes. 

  • True
  • False
Volume 36.2 - Question 33

Bleeding Risk Prediction Scores for Direct Oral Anticoagulants

Bleeding risk prediction scores have an excellent diagnostic accuracy in predicting risk of major bleeding for patients on direct oral anticoagulants for atrial fibrillation or venous thromboembolism (VTE). 

  • True
  • False
Volume 36.2 - Question 31

Haloperidol in Headache

Haloperidol (2.5 mg intravenously) is a rapid and effective treatment for acute, severe, benign headache in ED patients aged 18 to 55 years. 

  • True
  • False
Volume 36.2 - Question 27

Nirsevimab and Respiratory Syncytial Virus

In healthy preterm infants, a single injection of nirsevimab results in fewer medically attended RSV-associated lower respiratory tract infections throughout the respiratory syncytial virus season. 

  • True
  • False
Volume 36.2 - Question 26

Canagliflozin and Amputation

In patients aged 65 or older with cardiovascular disease, canagliflozin increases the rate of lower limb amputation. 

  • True
  • False
Volume 36.2 - Question 25

Post-menopausal Hormone Therapy and Breast Cancer

The use of conjugated equine estrogen (CEE) for the treatment of menopause in women with prior hysterectomy is associated with a statistically significantly lower incidence of breast cancer. 

  • True
  • False
Volume 36.2 - Question 24

Expired Drugs

Which one of the following statements about drugs past their expiration date is false? 

  • There are no published reports of human toxicity due to ingestion of a currently available drug formulation after its expiration date.   
  • It is considered reasonable to use oseltamivir tablets for up to 15 years after their date of manufacture if stored properly.   
  • Epinephrine solutions may lose potency after the expiration date.   
  • Naloxone samples past expiration retain less than 50% of their labeled content. 
Volume 36.2 - Question 23

Type 2 Diabetes

Which one of the following statements about Type 2 Diabetes treatment is false? 

  • In drug-naive patients at low cardiovascular risk, no medications improve cardio-vascular outcomes.     
  • When used as an add-on to metformin-based therapy, glucagon-like peptide-1 receptor agonists are the most efficacious in reducing hemoglobin A1c level.   
  • In patients at increased cardiovascular risk receiving metformin-based background therapy, the addition of oral liraglutide reduces all-cause mortality.   
  • Subcutaneous semaglutide has no effect on the odds of stroke. 
Volume 36.2 - Question 22

Prevention of Depression with Vitamin D 

In adults aged 50 years and older vitamin D supplementation (2000 IU/d) reduces the incidence of depression. 

  • True
  • False
Volume 36.2 - Question 15

Prevention of Bacterial Vaginosis with Probiotics

The use of Lactin-V (Lactobacillus crispatus CTV-05) after treatment of bacterial vaginosis with vaginal metronidazole resulted in a significantly lower incidence of recurrence of bacterial vaginosis at 12 weeks. 

  • True
  • False
Volume 36.2 - Question 10

Vasomotor Menopausal Symptoms 

Which one of the following statements about the treatment of vasomotor menopausal symptoms is false? 

  • Systemic estrogen is the most effective treatment.   
  • Women with an intact uterus treated with a systemic estrogen should receive a progestogen to reduce the risk of endometrial cancer.   
  • A combination of conjugated estrogens and the selective estrogen receptor modulator bazedoxifene is approved for the treatment of mild symptoms.   
  • There is no evidence that bioidentical hormones are more effective than conjugated hormones.  
Volume 36.2 - Question 9

Tinnitus

Which one of the following should not be used in the treatment of tinnitus associated conditions?

  • Cognitive behavior therapy
  • Tricyclic antidepressants
  • Melatonin
  • Benzodiazepines
Volume 37.2 - Question 19

Empagliflozin for Heart Failure with Preserved Ejection Fraction

Empagliflozin reduces the risk of primary composite outcome events (death from cardiovascular causes or hospitalization for heart failure) in patients with heart failure with a preserved ejection fraction with or without diabetes.

  • True
  • False
Volume 37.2 - Question 5

Smoking Cessation

In adults who smoke at least 5 cigarettes per day, extending varenicline from 12 weeks to 24 weeks improves smoking cessation effectiveness at one year.

  • True
  • False
Volume 37.4 - Question 42

Off-Label Treatment for Alcohol Use Disorder

Which one of the following off-label treatments should not be recommended in the management of alcohol use disorder?

  • Topiramate
  • Gabapentin
  • Baclofen
  • Selective serotonin reuptake inhibitors
Volume 37.4 - Question 41

Rivaroxaban after Lower Limb Revascularization

In patients having undergone a lower extremity revascularization procedure, rivaroxaban 2.5 mg BID plus aspirin is superior to aspirin alone in reducing the composite endpoint of acute limb ischemia, major amputation, myocardial infarction, ischemic stroke, or cardiovascular death.

  • True
  • False
Volume 37.4 - Question 37

Rapid Agitation Control

For patients in the emergency department with severe agitation, intramuscular ketamine resulted in a significantly shorter time to adequate sedation than a combination of intramuscular midazolam and haloperidol.

  • True
  • False
Volume 37.4 - Question 34

Acamprosate

Which one of the following statements about acamprosate is false?

  • It must be taken three times daily because of its low bioavailability.
  • It is used to maintain abstinence from alcohol.
  • Abdominal pain is the most common adverse effect.
  • It has no clinically significant drug interactions.
Volume 37.4 - Question 33

Subacute Thyroiditis

Which one of the following statements about subacute thyroiditis is false?

  • It may present with a prodrome of fatigue, myalgias, low-grade fever, and pharyngitis.
  • Anterior neck pain is usually the presenting symptom.
  • It is treated with antithyroid medications.
  • It is generally self-limited.
Volume 37.4 - Question 32

Hashimoto Thyroiditis

Which one of the following statements about Hashimoto thyroiditis is false?

  • It may present with other autoimmune disorders.
  • It often presents with a painless goiter, with or without overt hypothyroidism.
  • Thyroid peroxidase antibodies are found in 95% of patients.
  • Only symptomatic patients require treatment.
Volume 37.4 - Question 30

DOAC and ICH

In patients with atrial fibrillation, direct oral anticoagulants (DOACs) are associated with less intracranial hemorrhage risk than vitamin K antagonists.

  • True
  • False
Volume 37.4 - Question 28

Prescribed Mifepristone in Canada

Which one of the following statements about normally prescribed mifepristone as compared to when it was unavailable in Canada is false?

  • The abortion rate has continued to increase.
  • The proportion of abortions provided by medication increased rapidly.
  • There was a small increase in ongoing intrauterine pregnancy continuing to delivery.
  • Adverse results remain stable.
Volume 37.4 - Question 26

Chronic Myeloid Leukemia

Which one of the following statements about chronic myeloid leukemia (CML) is false?

  • Most patients are diagnosed while asymptomatic.
  • The hallmark of CML is the Philadelphia chromosome.
  • Tyrosine kinase inhibitors are the first line therapeutic option.
  • Lifelong treatment is necessary to maintain remission in all patients.
Volume 37.4 - Question 25

Second Line Diabetes Treatment

When used in combination with metformin for the treatment of Type 2 diabetes, sodium-glucose cotransporter 2 (SGLT2) inhibitors, as compared to sulfonylureas, are associated with a reduced risk of all-cause mortality. 

  • True
  • False
Volume 37.4 - Question 23

Cannabis

Which one of the following statements about conditions related to cannabis use is false?

  • Cannabis withdrawal syndrome occurs within 7 days of reducing cannabis use.
  • Cannabis hyperemesis occurs during recurrent cannabis intoxication.
  • Cannabis withdrawal symptoms can last for months.
  • There is no role for selective serotonin reuptake inhibitors in the management of withdrawal symptoms.
Volume 37.4 - Question 19

Fluvoxamine in COVID-19

In unvaccinated adults with COVID-19 infection and risk factors for disease progression, treatment with fluvoxamine reduces the risk of hospitalization compared with placebo.

  • True
  • False
Volume 37.4 - Question 17

Drug Induced Akathisia

Which one of the following statements about acute drug induced akathisia is false?  

  • It develops soon after starting new medications or after dosage adjustments.   
  • It lasts less than six months.  
  • It generally resolves when the medicine triggering it is discontinued.  
  • Akathisia rarely occurs concurrently with akinesia.
Volume 36.1 - Question 23

Post-menopausal Hormone Therapy and Risk of Breast Cancer

The use of conjugated equine estrogen (CEE) for the treatment of menopause in women with prior hysterectomy is associated with a statistically significantly lower incidence of breast cancer. 

  • True
  • False
Volume 36.1 - Question 22

Haloperidol in Headache

Haloperidol (2.5 mg intravenously) is a rapid and effective treatment for acute, severe, benign headache in emergency department patients aged 18 to 55 years. 

  • True
  • False
Volume 36.1 - Question 21

Statin Uses in Older Patients

Among individuals ≥ 75 years with no history of atherosclerotic cardiovascular disease at baseline, new statin use is associated with lower risk of mortality.  

  • True
  • False
Volume 36.1 - Question 20

Dexamethasone and COVID-19 Mortality

Mortality is decreased in hospitalized patients with COVID-19 who do not require respiratory support and are given dexamethasone.  

  • True
  • False
Volume 36.1 - Question 17

Inhaled Budosenide

Inhaled budesonide improves time to recovery, with a chance of also reducing hospital admissions or deaths, in people with COVID-19 in the community who are at higher risk of complications.

  • True
  • False
Volume 37.4 - Question 3

Non-Hormonal Menopausal Treatments

Which one of the following statements about non-hormonal treatment for vasomotor menopausal symptoms is false? 

  • Escitalopram reduces the frequency of hot flashes.   
  • Venlafaxine reduces the frequency of hot flashes. 
  • Evidence supporting the use of pregabalin is lacking. 
  • Long-term use of oxybutynin is recommended.  
Volume 36.1 - Question 7

Treatment of Chronic Hypertension in Pregnancy

 Which one of the following statements about antihypertensive treatment for pregnant women with chronic hypertension is false? 

  • Amlodipine is associated with a lower rates of preeclampsia.  
  • Atenolol is associated with a higher risk of small-for-gestational-age infants.   
  • Nifedipine is associated with a lower incidence of severe hypertension. 
  • Methyldopa is associated with lower rates of placental abruption.
Volume 36.1 - Question 3

Anticoagulation Discontinuation in Home Palliative Care

Anticoagulant discontinuation after beginning home palliative care was associated with higher rates of thrombosis compared with continuing anticoagulation. 

  • True
  • False
Volume 38.1 - Question 31

Statins

Which one of the following statements about statin therapy is false? 

  • Statin-induced liver damage is rare. 
  • Creatine kinase levels should be measured if myalgia occurs. 
  • They are contraindicated for use during pregnancy. 
  • They have been associated with a small increased incidence of cognitive adverse effects. 
Volume 38.1 - Question 27

PCSK9 Inhibitors

Which one of the following statements about proprotein convertase substilin/kevin type 9 (PCSK9) inhibitors is false? 

  • They bind to PCSK9 and prevent it from binding to low-density lipoprotein (LDL) receptors on hepatocytes. 
  • Adding alirocumab or evolocumab to a statin reduces LDL-cholesterol levels by 50-60%. 
  • They have been associated with a reduction in atherosclerosis when given after a myocardial infarction. 
  • They have been associated with cognitive adverse effects. 
Volume 38.1 - Question 26

Vitamin D Supplementation

Vitamin D supplementation is associated with a significantly lower incidence of confirmed autoimmune disease. 

  • True
  • False
Volume 38.1 - Question 24

Viscose Supplementation for Knee Osteoarthritis

Intra-articular hyaluronic acid for knee osteoarthritis results in a small, non-clinically important reduction in pain intensity. 

  • True
  • False
Volume 38.1 - Question 20

Gonorrhea

Which one of the following statements about gonorrhea is false? 

  • Chlamydia trachomatis infection is present in 10-30% of patients with gonorrhea. 
  • A single 800 mg dose of oral cefixime can be used to treat uncomplicated urogenital infection. 
  • Test of cure is not recommended after treatment in patients with pharyngeal gonorrhea. 
  • Rescreening is recommended 3-6 months after completing treatment.  
Volume 38.1 - Question 15

Rivaroxaban in Rheumatic Heart Disease Associated AF

Among patients with rheumatic heart disease–associated atrial fibrillation, vitamin K antagonist therapy leads to a lower rate of a composite of cardiovascular events or death than rivaroxaban therapy, without a higher rate of bleeding.

  • True
  • False
Volume 38.2 - Question 30

Constipation Management

Which one of the following statements about the management of chronic constipation is false?

  • Increased fluid intake alone has been shown to improve constipation in all patients.
  • Probiotics may improve colonic transit.
  • Biofeedback therapy is superior to laxatives for defecatory dysfunction.
  • Stimulant laxatives are a short-term, second line adjunctive treatment.
Volume 38.2 - Question 29

Drugs for Treatment and Prevention of Venous Thromboembolism

Which one of the following statements about drugs for venous thromboembolism (VTE) is false?

  • In patients with severe renal failure (CrCl <30 ml/min), VTE can be appropriately treated with apixaban.
  • Direct oral anticoagulants are safe for use in pregnancy.
  • Aspirin can reduce the recurrence rate of VTE in patients who are no longer taking an anticoagulant.
  • Low-dose apixaban can reduce the recurrence rate of symptomatic VTE in patients having completed 6-12 months of anticoagulation therapy.
Volume 38.2 - Question 28

Monkeypox

Post-exposure prophylaxis with monkeypox vaccination for recently exposed persons is recommended.

  • True
  • False
Volume 38.2 - Question 27

Ezetimibe

Which one of the following statements about ezetimibe is false?

  • It reduces low-density lipoprotein (LDL) cholesterol levels by about 20-25%.
  • The incidence of adverse events with ezetimibe plus a statin was similar to that with a statin alone.
  • Patients with moderate liver impairment can take it.
  • It may increase the anticoagulant effect of warfarin.
Volume 38.2 - Question 26

PPIs and Gastric Cancer

There is a clinically significant increase in the risk of gastric cancer in patients taking a proton pump inhibitor (PPI) compared with those taking H2 receptor antagonists.

  • True
  • False
Volume 38.2 - Question 22

Nonopioid Drugs for Pain

For treatment of moderate to severe acute pain, a combination of an NSAID and acetaminophen may be as effective as an opioid/acetaminophen combination.

  • True
  • False
Volume 37.5 - Question 40

Tenecteplase for Acute Ischemic Stroke

For treatment of acute ischaemic stroke, use of tenecteplase results in similar functional outcomes compared to alteplase in patients presenting with acute ischaemic stroke who meet standard criteria for thrombolysis.

  • True
  • False
Volume 38.2 - Question 12

Chlamydia

Which one of the following statements about chlamydial infections is false?

  • A single dose of oral azithromycin is less effective than doxycycline for rectal infection.
  • The regimen of choice for treatment of oropharyngeal and urogenital infection is 7 days of oral doxycycline.
  • Test of cure is required for non-pregnant patients.
  • All patients should be tested for reinfection 3-6 months after completing treatment.
Volume 38.2 - Question 8

Gastroesophageal Reflux Disease

Which one of the following statements about the treatment of gastroesophageal reflux disease is false?

  • Antacids can decrease the absorption of some other drugs by altering gastric acidity.
  • H2-Receptor Antagonists (H2RAs) have a slower onset of action than PPIs.
  • PPIs are more effective than H2RAs in healing erosive esophagitis.
  • Addition of an H2RA as needed may be helpful for patients who still have symptoms despite twice-daily PPI treatment.
Volume 37.5 - Question 35

Bullous Pemphigoid

Which one of the following statements about bullous pemphigoid due to dipeptidyl-peptidase 4 (DPP4) inhibitors is false?

  • Median onset time from DPP4 inhibitor commencement is 11 months.
  • Skin biopsy is required for diagnosis.
  • Clinically, lesions are more widespread than traditionally described bullous pemphigoid.
  • Most patients with moderate to severe cases are sufficiently treated by potent topical corticosteroids.
Volume 37.5 - Question 29

Alpha Blockers for BPH

Which one of the following statements about alpha blockers in the treatment of benign prostatic hyperplasia is false?

  • They are usually effective within days of starting treatment.
  • They slow disease progression.
  • Doxazosin and terazosin should be titrated slowly to reduce the risk of syncope.
  • They are associated with an increased risk of intraoperative floppy iris syndrome in patients undergoing cataract surgery.
Volume 37.5 - Question 27

Reductase Inhibitors

Which one of the following statements about 5α-reductase inhibitors in the treatment of benign prostatic hyperplasia is false?

  • They decrease the size of the prostate over several months.
  • Co-administration of tadalafil, a PDE-5 inhibitor, may mitigate some of the sexual adverse effects.
  • Maximal symptomatic relief is always seen by two months from treatment initiation.
  • They decrease prostate-specific antigen concentrations about 50%.
Volume 37.5 - Question 26

Atrial Fibrillation and Diabetes

In patients with atrial fibrillation and diabetes, which one of the following statements about the hazards of diabetic complications with non-vitamin K antagonist oral anticoagulants as compared to warfarin is false?

  • There is a lower risk of microvascular complications.
  • There is a lower risk of macrovascular complications.
  • There is a lower mortality risk.
  • There are more frequent glycemic emergencies.
Volume 37.5 - Question 23

Estetrol/Drospirenone

Which one of the following statements about the combination oral contraceptive containing estetrol and drosipirenone is false?

  • Estetrol is the first new estrogen to become available in Canada in 50 years.
  • Estetrol has a shorter half-life than estradiol.
  • Weight gain is one of the most common adverse effects.
  • Women not currently using a hormonal contraceptive should take the first active tablet on the first day of menses.
Volume 37.5 - Question 11

Acetaminophen and Blood Pressure

Regular daily intake of 4 g acetaminophen increases systolic BP in individuals with hypertension.

  • True
  • False
Volume 37.5 - Question 3

Recurrent UTI

Methenamine Hippurate as a preventative treatment for recurrent UTI is non-inferior to current guideline recommended low dose prophylactic antibiotics.

  • True
  • False
Volume 37.5 - Question 1

Chronic Urticaria

Which one of the following statements about chronic urticaria is false? 

  • Most affected patients are men.
  • There is usually no identifiable cause.
  • A history of nonblanching lesions persisting for more than 24 hours that leave a residual bruise, suggests the alternative diagnosis of cutaneous vasculitis.
  • Up to 30% of patients have cutaneous exacerbations provoked by the use of NSAIDS.
Volume 38.1 - Question 10

Covid-19 Vaccine Effectiveness in Children

Vaccination with the Pfizer vaccine in children 5 to 11 years of age provides moderate protection against symptomatic Covid-19, since the omicron variant became dominant. 

  • True
  • False
Volume 38.1 - Question 7

Smoking Cessation

Which one of the following statements about the treatment to achieve smoking cessation is false? 

  • Among smokers who use a single smoking-cessation agent, varenicline is superior to other medications in achieving continuous abstinence.  
  • The maximum-strength nicotine patch produces steady-state plasma nicotine concentrations that are equal to smoking 20 cigarettes per day. 
  • A nicotine patch plus a short-acting nicotine-replacement formulation results in cessation success similar to varenicline. 
  • Quit success might be higher with varenicline plus a nicotine patch than with varenicline alone. 
Volume 38.1 - Question 4

COPD and Drugs for Diabetes

In patients with COPD and type 2 diabetes, SGLT-2 inhibitors, compared to sulfonylureas, are associated with a reduced risk of severe COPD exacerbations.

  • True
  • False
Volume 38.4 - Question 30

Oral Minoxidil

Which one of the following statements about the use of oral minoxidil in the treatment of hair loss is false?

  • The dose used in hair loss is higher than the dose used for the treatment of hypertension.
  • It is as effective as topical minoxidil in improving hair density.
  • It has a higher incidence of adverse effects compared to topical minoxidil.
  • It should not be used in pregnancy.
Volume 38.4 - Question 25

Temporomandibular Disorders

Which one of the following is not recommended in the treatment of temporomandibular disorders?

  • Opioids
  • Cyclobenzaprine
  • Amitriptyline
  • Gabapentin
Volume 38.4 - Question 24

Treatment of Anal Fissure

Topical treatments with Vitamin E may be more effective than topical nitrates for treatment of chronic anal fissures in adults.

  • True
  • False
Volume 38.4 - Question 23

Problems with Opioids

Which one of the following statements about opioid use is false?

  • Tolerance usually develops rapidly to the constipating effect of opioids.
  • Opioid hyperalgesia has been reported in some patients treated with high doses of opioids.
  • Use of morphine has been associated with an increased risk of myocardial infarction in patients taking clopidogrel after an acute coronary syndrome.
  • Intranasal naloxone should be offered to opioid-treated patients who are also taking gabapentinoids.
Volume 38.4 - Question 22

Chlorthalidone

When used in the treatment of hypertension in patients 65 or older, chlorthalidone has a lower occurrence of major cardiovascular outcome events or non–cancer-related deaths than hydrochlorothiazide.

  • True
  • False
Volume 38.4 - Question 20

Topical Nonsteroidal Anti-Inflammatory Drugs

Which one of the following statements about topical NSAIDS is false? 

  • They provide effective pain relief for acute strains and sprains. 
  • They are safer than oral NSAIDS. 
  • Systemic uptake is limited to around 5% 
  • They provide inferior pain relief to oral NSAIDS for patients with chronic osteoarthritis. 
Volume 39.1 - Question 38

Drugs for Inflammatory Bowel Disease

Which one of the following statements about drugs for treatment of ulcerative colitis (UC) is false? 

  • Oral aminosalicylates are effective for induction and maintenance of remission in mild UC. 
  • Corticosteroids can be used for maintenance of remission. 
  • In moderate to severe disease, early use of a biologic drug is recommended. 
  • Tumor necrosis factor inhibitors are effective for induction and maintenance of remission. 
Volume 39.1 - Question 36

Haloperidol for the Treatment of Delirium in ICU Patients

Among patients in the ICU with delirium, treatment with haloperidol will lead to a significantly fewer days alive and out of the hospital at 90 days than placebo.

  • True
  • False
Volume 38.3 - Question 33

Gout

Which one of the following statements about gout is false?

  • Women are more likely to have atypical joint involvement.
  • Sodium-glucose transport protein 2 (SGLT-2) inhibitors lower serum urate concentrations.
  • Allopurinol hypersensitivity syndrome is a potentially life-threatening treatment complication.
  • Patients who receive beta-blockers are at decreased risk for gout.
Volume 38.3 - Question 31

Parkinson Disease

Which one of the following is a common feature of Parkinson Disease?

  • Neck and trunk rigidity more prominent than limb rigidity.
  • Prominent postural instability early in the course of illness.
  • Absence of nonmotor symptoms after 5 years.
  • Neuropsychiatric symptoms in early stages.
Volume 38.3 - Question 30

Allopurinol and Ischemic Heart Disease

Allopurinol in patients aged 60 years or older with ischaemic heart disease, but no history of gout, reduces adverse cardiovascular outcomes.

  • True
  • False
Volume 38.3 - Question 29

Minor Stroke

For patients with minor nondisabling acute ischemic stroke, 90-day functional outcome following treatment with dual antiplatelet therapy is non-inferior to intravenous alteplase. 

  • True
  • False
Volume 39.1 - Question 28

Progression of Atrial Fibrillation after Cryoablation or Drug Therapy

Initial treatment of paroxysmal atrial fibrillation with catheter cryoballoon ablation is associated with a lower incidence of persistent atrial fibrillation over 3 years of follow-up than initial use of antiarrhythmic drugs.

  • True
  • False
Volume 38.3 - Question 27

Alcohol-Associated Hepatitis

Which one of the following statements about alcohol-associated hepatitis is false?

  • Glucocorticoids can improve long-term survival.
  • Women are more susceptible to alcohol injury.
  • Mortality from moderate disease is up to 20% at one year.
  • The use of alcohol anticraving drugs has not been rigorously tested in the context of alcohol-associated hepatitis.
Volume 38.3 - Question 23

Febrile Neutropenia

Which one of the following statements about the management of febrile neutropenia is false?

  • Granulocyte colony–stimulating factors are not typically recommended in the treatment of febrile neutropenia.
  • Routine rectal examination to rule out mucositis is advised.
  • About 20% to 30% of patients with febrile neutropenia will have an identifiable infectious cause.
  • Low risk patients may be treated with oral antibiotics.
Volume 38.3 - Question 14

Venous Thromboembolism Prophylaxis in Pregnancy

In women with a history of venous thromboembolism, weight-adjusted intermediate-dose low molecular-weight heparin during the combined antepartum and post-partum periods is associated with a lower risk of recurrence than fixed low-dose low-molecular-weight heparin.

  • True
  • False
Volume 38.4 - Question 9

Buprenorphine Use Myths

Which one of the following statements regarding buprenorphine use and opioid use disorder is false?

  • It can effectively treat pain.
  • It replaces one addiction for another.
  • It reduces cravings for other opioids.
  • It provides stability from craving-withdrawal cycle.
Volume 38.3 - Question 11

Ketamine and Depression

In treatment resistant depression, the antidepresskant effect of intravenous ketamine is prolonged when combined with a computerized training that targets self-esteem.

  • True
  • False
Volume 38.3 - Question 10

Breastfeeding #3

Which one of the following statements about medications during breastfeeding is false?

  • Fluoxetine is preferred over Paroxetine to treat depression.
  • Lorazepam is preferred over clonazepam to treat anxiety.
  • Angiotensin-converting enzyme inhibitors do not pass significantly into breast milk.
  • Metformin is preferred over newer oral medications for diabetes.
Volume 38.3 - Question 9

Breastfeeding #2

Trimethoprim / Sulfamethoxazole should not be taken by the mother while breastfeeding during the first month postpartum.

  • True
  • False
Volume 38.3 - Question 8

Breastfeeding #1

Which one of the following statements about medications during breastfeeding is false?

  • Topical medications are generally safer than oral medications.
  • Administer single daily-dose medication after breastfeeding and just before the longest sleep interval for the infant to minimize infant exposure to maternal medication.
  • The LactMed database is a peer-reviewed online resource that can be helpful.
  • Long-term use of naproxen is preferred over ibuprofen for analgesia during lactation.
Volume 38.3 - Question 7

Local Anesthetic Systemic Toxicity

Which one of the following statements regarding local anesthetic systemic toxicity (LAST) is false?

  • Bupivacaine is most commonly implicated in events.
  • Symptoms of toxicity include a metallic taste.
  • Severe manifestations may appear up to 6 hours after initial symptom onset.
  • Pregnancy may increase the risk of an event.
Volume 38.3 - Question 2

Bacterial Meningitis

Which one of the following statements about bacterial meningitis is false?

  • Streptococcus pneumoniae causes most cases in people older than 16 years.
  • The classic triad of fever, stiff neck, and a change in mental status occurs in more than half of patients.
  • The diagnostic accuracy of Kernig’s sign is poor.
  • Less than 10% of adults presenting with meningitis have bacterial meningitis.
Volume 38.3 - Question 1

Mindfulness-Based Stress Reduction

Mindfulness based interventions are inferior to escitalopram for the treatment of adults with anxiety disorders.

  • True
  • False
Volume 38.4 - Question 3

Statins in Primary Prevention in People Over 80 Years

Which one of the following statements regarding the impacts of cholesterol and the use of statins in primary prevention in people over age 80 is false?

  • Total cholesterol levels are not associated with an increased rate of major cardiovascular events.
  • Statins have not been shown to reduce mortality.
  • A significant increase of side effects with the use of statins in this population has not been demonstrated.
  • There is an increased risk of cognitive issues with statin use.
Volume 38.4 - Question 1

Once-Weekly Insulin

Which one of the following statements about once weekly insulin icodec vs once daily insulin degludec in adults with insulin naive type 2 diabetes is false?

  • It is similarly effective at reducing HbA1C.
  • The total weekly insulin dose is the same.
  • Injection site reactions are lower.
  • There is a higher rate of hypoglycaemia.
Volume 39.2 - Question 32

Low-Dose Aspirin Treatment

In a primary prevention setting among healthy older (> 70 years old) patients with no cardiovascular disease, long-term daily low-dose aspirin treatment reduces ischemic stroke.

  • True
  • False
Volume 39.2 - Question 30

Management of Epilepsy During Pregnancy and Lactation

Which one of the following statements regarding the management of epilepsy during pregnancy and lactation is false?

  • Rates of successful pregnancy in women with epilepsy are generally comparable with other women.
  • Valproate has the highest risk of major congenital malformations.
  • Levetiracetam and lamotrigine have the lowest risk of major congenital malformations.
  • Breastfeeding in women with epilepsy is not recommended.
Volume 39.2 - Question 29

Chlamydia and Gonorrhea

Which one of the following statements about chlamydia and gonorrhea is false?

  • From 2010 to 2019, reported cases of gonorrhea in Canada increased by more than 100%.
  • Patient-collected swabs are equivalent to provider-collected swabs.
  • The Canadian Task Force on Preventive Health Care recommends annual opportunistic screening for chlamydia and gonorrhea in all sexually active people younger than 30 years.
  • Compared with urine testing, vaginal swab detects fewer infections.
Volume 39.2 - Question 20

Treatment of Anxiety

Which one of the following statements about drug treatment of anxiety is false?

  • Pregabalin is as effective as an SSRI in relieving symptoms.
  • The onset of action of pregabalin is more rapid than SSRIs.
  • Buspirone is similar in efficacy to benzodiazepines for generalized anxiety disorder.
  • There is good evidence to support the efficacy of cannabinoids.
Volume 39.2 - Question 17

Deprescribing Benzodiazepines

Which one of the following statements about deprescribing of benzodiazepines is false?

  • High maintenance doses can be decreased up to 25% initially.
  • Adjustments often need two to four weeks before the next taper.
  • Doses may need to be modified if withdrawal symptoms become problematic.
  • Cognitive behaviour therapy has not been shown to improve outcomes.
Volume 39.2 - Question 16

Major Depression Treatment

For treatment-resistant major depression without psychosis, ketamine is inferior to electroconvulsive therapy.

  • True
  • False
Volume 39.2 - Question 13

Antenatal Corticosteroids

Infants exposed to one course of antenatal corticosteroids have an increased risk of serious infection during the first 12 months of life.

  • True
  • False
Volume 39.2 - Question 6

NSAID and Emergency Contraception

Oral piroxicam 40 mg co-administered with levonorgestrel improved efficacy of emergency contraception.

  • True
  • False
Volume 39.2 - Question 2

Vaccines for Prevention of RSV Disease

Vaccination for prevention of respiratory syncytial virus (RSV) reduces the incidence of RSV-associated lower respiratory tract disease in adults ≥ 60 years old. 

  • True
  • False
Volume 39.1 - Question 7

Parkinson – Treatment

Which one of the following about the treatment of Parkinson Disease is false?

  • Delaying levodopa initiation until severe symptoms develop worsens disability.
  • Medications for Parkinson Disease should not be stopped abruptly.
  • Psyllium is the treatment of choice for constipation.
  • Botulinum toxin A injections are highly effective for the treatment of sialorrhea.
Volume 38.6 - Question 36

Primary Aldosteronism

Which one of the following questions regarding primary aldosteronism is false?

  • About 30% of patients with hypokalemia and hypertension seen in primary care have PA.
  • Patients with PA are at an increased risk of chronic disease if untreated.
  • Most antihypertensive medications should be discontinued during work-up.
  • An elevated aldosterone-to-renin ratio is suggestive of PA.
Volume 38.6 - Question 32

Acetaminophen Effect on Blood Pressure

Daily use of acetaminophen is significantly associated with increased systolic blood pressure.

  • True
  • False
Volume 38.6 - Question 31

Bell Palsy

Which one of the following statements about Bell palsy is false?

  • The facial weakness usually spares the forehead.
  • Ipsilateral recurrent Bell palsy suggests an underlying tumor.
  • Patients should not be treated with antivirals alone.
  • Combination therapy with corticosteroids and antivirals leads to lower rates of synkinesis.
Volume 38.6 - Question 30

Short-Term Adverse Outcomes After Mifepristone-Misoprostol

Which one of the following statements regarding oral mifepristone combined with misoprostol for first-trimester pharmaceutical induced abortion is false?

  • The combination has an efficacy of about 97%.
  • There is an ongoing pregnancy rate of less than 1% when used before 10 weeks gestation.
  • There is an ongoing pregnancy rate of about 10% when used after 10 weeks gestation.
  • Short-term adverse events are more likely after mifepristone–misoprostol induced abortion than procedural induced abortion.
Volume 38.6 - Question 29

Anticholinergic Drugs for Overactive Bladder

Which one of the following statements about anticholinergic drugs for overactive bladder is false?

  • Extended-release formulations cause less dry mouth than immediate-release formulations.
  • Patients who experience intolerable side effects with one anticholinergic drug do not benefit from switching to another.
  • Solifenacin is selective for M3 muscarinic receptors.
  • Long-term use of anticholinergic drugs has been associated with a dose-related increase in the risk of dementia.
Volume 38.6 - Question 28

Drugs for Overactive Bladder

Which one of the following statements about drugs for overactive bladder is false.

  • Anticholinergic drugs are better tolerated than beta-3 agonists.
  • Coadministration of a beta-3 agonist and an anticholinergic drug can increase the risk of urinary retention.
  • Use of an anticholinergic drug and a beta-3 agonist may be more effective than either drug alone.
  • Tadalafil may improve urinary symptoms in women with overactive bladder.
Volume 38.6 - Question 27

Factor Prothrombin Complex Concentrate in Patients with Trauma

Among patients with trauma at risk of massive transfusion, there is no significant reduction of 24-hour blood product consumption after administration of 4 factor prothrombin complex concentrate.

  • True
  • False
Volume 38.6 - Question 25

Group A Streptococcal Pharyngitis

Which one of the following statements about Group A Streptococcal (GAS) pharyngitis is false?

  • It is the most common cause of acute pharyngitis.
  • In children and adolescents, throat culture is recommended when a rapid antigen test is negative and GAS pharyngitis is suspected.
  • When clindamycin is used in patients with severe penicillin allergy, there is a >20% GAS may be resistant to clindamycin.
  • Tetracyclines are not recommended for treatment.
Volume 38.6 - Question 20

Community-Acquired Pneumonia

Which one of the following statements about community-acquired pneumonia (CAP) is false?

  • Pneumococcal vaccination has substantially reduced the incidence of CAP caused by  pneumoniae.
  • High dose amoxicillin or doxycycline is the recommended treatment of CAP in most cases.
  • Macrolides can prolong the QT interval.
  • Shorter courses of antibiotic treatment (5-7 days) are less efficacious than long courses (8-10 days).
Volume 38.6 - Question 19

Metformin for Gestational Diabetes Mellitus

In patients with gestational diabetes Mellitus treated with metformin, neonatal birth weight is significantly lower compared to those treated with insulin.

  • True
  • False
Volume 38.6 - Question 12

Progestin-Only Oral Contraceptives

Which one of the following statements about progestin-only oral contraceptives is false?

  • They are less effective than combination oral contraceptives.
  • They are used predominantly when estrogen is contraindicated.
  • Backup contraception is recommended for women who start treatment > 5 days after menses onset.
  • They have been associated with a risk of developing breast cancer.
Volume 38.6 - Question 8

Oral Contraceptives

Which one of the following statements about combination oral contraceptives is false?

  • Formulations that contain ≤ 20 mcg of ethinyl estradiol are less effective than those containing higher doses.
  • Those that contain drospirenone have been shown to improve premenstrual dysphoric disorder symptoms.
  • Those that contain drospirenone rarely cause hyperkalemia.
  • The risk of venous thromboembolism may be lower with those that contain estetrol than with those containing ethinyl estradiol.
Volume 38.6 - Question 7

Eczema Management

Which one of the following statements regarding the use of topical steroids in the management of eczema is false?

  • High potency topical steroids are more effective than medium potency.
  • Medium potency topical steroids are more effective than low potency.
  • Weekend therapy is recommended to prevent relapse in those with frequent disease flare-ups.
  • Twice daily applications are no more effective than once daily applications.
Volume 38.6 - Question 2

Drugs for Hypothyroidism

Which one of the following statements regarding treatment of hypothyroidism with levothyroxine is false?

  • It should ideally be taken with water on an empty stomach 60 minutes before breakfast.
  • After starting treatment symptoms of hypothyroidism usually begin to improve in 6 weeks.
  • After change in dosage, TSH levels should be checked in 6 weeks.
  • Supratherapeutic doses can cause weight loss.
Volume 38.5 - Question 37

Sinusitis

Which one of the following statements about sinusitis is false?

  • Bacterial sinusitis in otherwise healthy adults often improves without antibiotic therapy.
  • Amoxicillin/clavulanate is the antibiotic of choice for the treatment of bacterial sinusitis in adults and children.
  • Doxycycline is an option for adults with a penicillin allergy.
  • Trimethoprim/sulfamethoxazole is a recommended treatment.
Volume 38.5 - Question 35

Insulin Icodec

When switching to once weekly icodec insulin from once-daily glargine in people with long-standing type 2 diabetes on a basal-bolus regimen, which one of the following is least likely to occur?

  • Similar improvements in glycemic control.
  • Lower total weekly insulin dose.
  • Increased level one hypoglycemia.
  • Increased weight gain.
Volume 38.5 - Question 27

Diagnosis and Management of Patients with Polyneuropathy

Which one of the following statements about polyneuropathy is false?

  • Common mimics include cervical myelopathy.
  • A pattern of multiple concurrent mononeuropathies suggests a vasculitis cause.
  • Autonomic symptoms do not occur.
  • Tricyclic antidepressants have similar efficacy to serotonin norepinephrine reuptake inhibitors in painful diabetic neuropathy.
Volume 38.5 - Question 24

Timing of Medication

Which one of the following statements about the timing of medication is false?

  • Metformin extended release has increased absorption when taken on an empty stomach.
  • Pairing iron tablets with rice meals showed higher absorption than with other meals.
  • Evening administration of dihydropyridine calcium channel blockers can reduce pedal edema rates.
  • Taking rivaroxaban (dose of ≥ 15 mg) on an empty stomach may result in inadequate anticoagulation.
Volume 38.5 - Question 23

Trazodone for Insomnia

The American Academy of Sleep Medicine clinical practice guidelines for the pharmacologic treatment of insomnia in adults recommend that clinicians do not use trazodone for insomnia.

  • True
  • False
Volume 38.5 - Question 22

IUDs in Canada

Which one of the following statements about intrauterine devices (IUDs) is false?

  • They may reduce the risk of cervical cancer.
  • Their presence increases the risk of pelvic inflammatory disease.
  • Systemic levonorgestrel exposure is significantly lower with hormonal IUDs than with oral formulations.
  • Fertility returns rapidly upon removal.
Volume 38.5 - Question 20

Vaginal Estrogen and Recurrent UTIs

Hypoestrogenic women with recurrent urinary tract infection who use vaginal estrogen can expect a greater than 50% reduction in urinary tract infection frequency in the following year.

  • True
  • False
Volume 38.5 - Question 19

Pharmacologic Prevention of Migraine

Which one of the following statements about migraine prevention is false?

  • Migraine prophylaxis should be offered to patients with 4 or more migraine headache days per month.
  • Preventative treatment should be considered for patients with atypical aura.
  • OnabotulinumtoxinA (Botox) injection has shown a reduction in headache days by 50% or more.
  • Calcitonin gene-related peptide monoclonal antibodies take 6 months to show statistically significant treatment effect.
Volume 38.5 - Question 13

Metformin to Prevent Long COVID

Adults with SARS-CoV-2 infection who take metformin for 2 weeks are less likely than those who take placebo to later report a diagnosis of long COVID.

  • True
  • False
Volume 38.5 - Question 12

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