Clinical Pharmacology: Case-Based
Master Test (2026 Edition)|| Questions
And Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
Total Questions: 85
Question Type: Clinical Case Vignettes
Instructions: Select the single best answer. Correct answers are highlighted in
bold. Rationales are provided.
Section 1: Cardiovascular Pharmacology (Qs 1–20)
Q1. A 68-year-old man with HFrEF (EF 30%) on sacubitril/valsartan, bisoprolol,
and eplerenone presents with worsening dyspnea. BP 110/70, HR 88, K+ 4.2.
Which add-on therapy has the strongest mortality benefit per 2026 ESC
guidelines?
A) Digoxin
B) Ivabradine
C) Dapagliflozin
D) Hydralazine+nitrate
*Rationale: SGLT2i (dapagliflozin/empagliflozin) now have Class IA
recommendation in HFrEF regardless of diabetes status.*
Q2. A 55-year-old with STEMI undergoes PCI with DES. DAPT is started. She
has a history of peptic ulcer bleed 2 years ago. Which regimen is preferred for 12
months?
A) Aspirin + Ticagrelor
B) Aspirin + Clopidogrel + PPI
C) Aspirin + Prasugrel
D) Ticagrelor alone
, Rationale: Clopidogrel + PPI reduces GI bleed risk; prasugrel/ticagrelor higher
bleed risk in prior bleed history.
Q3–20: (Additional cases cover amiodarone monitoring, warfarin vs DOAC in
valvular AF, post-MI beta-blocker timing, statin intolerance management, resistant
HTN - spironolactone, etc.)
Section 2: Anti-Infective Pharmacology (Qs 21–35)
Q21. A 72-year-old nursing home resident develops fever, cough, purulent sputum.
CXR: RLL infiltrate. Ceftriaxone + azithromycin started. Day 3, QTc 520 ms.
Which drug is most likely the cause?
A) Ceftriaxone
B) Azithromycin
C) Both
D) Neither
Rationale: Macrolides (azithromycin) prolong QTc; risk higher in elderly,
hypokalemia, or with other QTc-prolonging drugs.
Q22. A 45-year-old with recurrent C. difficile infection (2nd recurrence) fails oral
vancomycin. What is guideline-preferred therapy (2026 IDSA)?
A) Metronidazole
B) Fidaxomicin
C) Fecal microbiota transplantation (FMT)
D) Extended pulsed vancomycin
*Rationale: For 2nd recurrence, FMT is preferred after pulsed-tapered vancomycin
or fidaxomicin failure; fidaxomicin for first recurrence.*
Q23–35: (MRSA bacteremia – daptomycin vs vancomycin, UTI in pregnancy –
nitrofurantoin, HAP due to ESBL – meropenem, antifungal in neutropenia –
voriconazole vs liposomal ampho B, etc.)
Section 3: CNS & Analgesic Pharmacology (Qs 36–50)
Q36. A 30-year-old with migraine with aura fails propranolol and topiramate.
Which CGRP antagonist is preferred for acute treatment?
A) Erenumab
Master Test (2026 Edition)|| Questions
And Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
Total Questions: 85
Question Type: Clinical Case Vignettes
Instructions: Select the single best answer. Correct answers are highlighted in
bold. Rationales are provided.
Section 1: Cardiovascular Pharmacology (Qs 1–20)
Q1. A 68-year-old man with HFrEF (EF 30%) on sacubitril/valsartan, bisoprolol,
and eplerenone presents with worsening dyspnea. BP 110/70, HR 88, K+ 4.2.
Which add-on therapy has the strongest mortality benefit per 2026 ESC
guidelines?
A) Digoxin
B) Ivabradine
C) Dapagliflozin
D) Hydralazine+nitrate
*Rationale: SGLT2i (dapagliflozin/empagliflozin) now have Class IA
recommendation in HFrEF regardless of diabetes status.*
Q2. A 55-year-old with STEMI undergoes PCI with DES. DAPT is started. She
has a history of peptic ulcer bleed 2 years ago. Which regimen is preferred for 12
months?
A) Aspirin + Ticagrelor
B) Aspirin + Clopidogrel + PPI
C) Aspirin + Prasugrel
D) Ticagrelor alone
, Rationale: Clopidogrel + PPI reduces GI bleed risk; prasugrel/ticagrelor higher
bleed risk in prior bleed history.
Q3–20: (Additional cases cover amiodarone monitoring, warfarin vs DOAC in
valvular AF, post-MI beta-blocker timing, statin intolerance management, resistant
HTN - spironolactone, etc.)
Section 2: Anti-Infective Pharmacology (Qs 21–35)
Q21. A 72-year-old nursing home resident develops fever, cough, purulent sputum.
CXR: RLL infiltrate. Ceftriaxone + azithromycin started. Day 3, QTc 520 ms.
Which drug is most likely the cause?
A) Ceftriaxone
B) Azithromycin
C) Both
D) Neither
Rationale: Macrolides (azithromycin) prolong QTc; risk higher in elderly,
hypokalemia, or with other QTc-prolonging drugs.
Q22. A 45-year-old with recurrent C. difficile infection (2nd recurrence) fails oral
vancomycin. What is guideline-preferred therapy (2026 IDSA)?
A) Metronidazole
B) Fidaxomicin
C) Fecal microbiota transplantation (FMT)
D) Extended pulsed vancomycin
*Rationale: For 2nd recurrence, FMT is preferred after pulsed-tapered vancomycin
or fidaxomicin failure; fidaxomicin for first recurrence.*
Q23–35: (MRSA bacteremia – daptomycin vs vancomycin, UTI in pregnancy –
nitrofurantoin, HAP due to ESBL – meropenem, antifungal in neutropenia –
voriconazole vs liposomal ampho B, etc.)
Section 3: CNS & Analgesic Pharmacology (Qs 36–50)
Q36. A 30-year-old with migraine with aura fails propranolol and topiramate.
Which CGRP antagonist is preferred for acute treatment?
A) Erenumab
