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JOHNS HOPKINS UNIVERSITY PHARM
EXAM 3REAL 340+Qs&As||GRADED A+
1. A 55-year-old man with glaucoma presents with eye pain
and blurred vision. Which medication, if given, would worsen
his condition if he has narrow-angle glaucoma?
A) Pilocarpine
B) Timolol
C) Atropine
D) Latanoprost
Answer: C) Atropine
Rationale: Atropine is a muscarinic antagonist that causes mydriasis
(pupil dilation). In narrow-angle glaucoma, this can further block
aqueous humor outflow, precipitating acute angle-closure
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glaucoma. Pilocarpine (muscarinic agonist) constricts pupil and is
used to treat glaucoma.
2. A patient on a beta-blocker for hypertension develops
bronchospasm. Which beta-blocker is most likely responsible?
A) Metoprolol
B) Atenolol
C) Propranolol
D) Esmolol
Answer: C) Propranolol
*Rationale: Propranolol is non-selective (blocks β1 and β2). β2
blockade in lungs causes bronchoconstriction. Cardioselective
beta-blockers (metoprolol, atenolol) are preferred in asthmatics
but still carry risk at high doses.*
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3. A 30-year-old woman with myasthenia gravis experiences
cholinergic crisis (muscle weakness, salivation, bradycardia).
Which drug is the antidote?
A) Neostigmine
B) Atropine
C) Pralidoxime
D) Edrophonium
Answer: B) Atropine (plus pralidoxime if organophosphate
poisoning)
Rationale: Cholinergic crisis from excess acetylcholinesterase
inhibitor (e.g., neostigmine) causes muscarinic excess. Atropine
blocks peripheral muscarinic receptors. Pralidoxime regenerates
acetylcholinesterase only in organophosphate poisoning.
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4. A patient receives epinephrine during cardiac arrest. Which
receptor activation primarily increases coronary and cerebral
perfusion?
A) β1 only
B) α1
C) β2
D) Dopamine
Answer: B) α1
Rationale: Epinephrine’s α1 effects cause vasoconstriction,
increasing diastolic blood pressure, which drives coronary and
cerebral blood flow during CPR. β1 increases heart rate and
contractility but is secondary in arrest.
5. Scenario: A 65-year-old man with benign prostatic
hyperplasia (BPH) starts tamsulosin. He experiences dizziness
when standing up. This is due to:
JOHNS HOPKINS UNIVERSITY PHARM
EXAM 3REAL 340+Qs&As||GRADED A+
1. A 55-year-old man with glaucoma presents with eye pain
and blurred vision. Which medication, if given, would worsen
his condition if he has narrow-angle glaucoma?
A) Pilocarpine
B) Timolol
C) Atropine
D) Latanoprost
Answer: C) Atropine
Rationale: Atropine is a muscarinic antagonist that causes mydriasis
(pupil dilation). In narrow-angle glaucoma, this can further block
aqueous humor outflow, precipitating acute angle-closure
,Page 2 of 152
glaucoma. Pilocarpine (muscarinic agonist) constricts pupil and is
used to treat glaucoma.
2. A patient on a beta-blocker for hypertension develops
bronchospasm. Which beta-blocker is most likely responsible?
A) Metoprolol
B) Atenolol
C) Propranolol
D) Esmolol
Answer: C) Propranolol
*Rationale: Propranolol is non-selective (blocks β1 and β2). β2
blockade in lungs causes bronchoconstriction. Cardioselective
beta-blockers (metoprolol, atenolol) are preferred in asthmatics
but still carry risk at high doses.*
,Page 3 of 152
3. A 30-year-old woman with myasthenia gravis experiences
cholinergic crisis (muscle weakness, salivation, bradycardia).
Which drug is the antidote?
A) Neostigmine
B) Atropine
C) Pralidoxime
D) Edrophonium
Answer: B) Atropine (plus pralidoxime if organophosphate
poisoning)
Rationale: Cholinergic crisis from excess acetylcholinesterase
inhibitor (e.g., neostigmine) causes muscarinic excess. Atropine
blocks peripheral muscarinic receptors. Pralidoxime regenerates
acetylcholinesterase only in organophosphate poisoning.
, Page 4 of 152
4. A patient receives epinephrine during cardiac arrest. Which
receptor activation primarily increases coronary and cerebral
perfusion?
A) β1 only
B) α1
C) β2
D) Dopamine
Answer: B) α1
Rationale: Epinephrine’s α1 effects cause vasoconstriction,
increasing diastolic blood pressure, which drives coronary and
cerebral blood flow during CPR. β1 increases heart rate and
contractility but is secondary in arrest.
5. Scenario: A 65-year-old man with benign prostatic
hyperplasia (BPH) starts tamsulosin. He experiences dizziness
when standing up. This is due to:
