Repeated USMLE Questions Step 1- Review- 99

Q- Which one of the following medications acts by irreversible inhibition of the platelet P2Y12 receptor?

A- Aspirin

B- Clopidogrel

C- Enoxaparin

D- Heparin

B- Clopidogrel- Clopidogrel is a thienopyridine antiplatelet agent that irreversibly inhibits the platelet P2Y12 receptor, thereby preventing platelet aggregation. This action helps reduce the risk of thrombotic events, particularly in patients with cardiovascular disease.

Q- Which of the following medications should be considered to help reduce the risk of gastrointestinal side effects associated with alendronate?

A- Acetaminophen

B- Cimetidine

C- Omeprazole

D- Ranitidine

C- Omeprazole- Omeprazole is a proton pump inhibitor (PPI) that reduces gastric acid secretion. It is commonly used to prevent and treat gastrointestinal side effects associated with bisphosphonate medications like alendronate, which can irritate the esophagus and stomach lining, leading to heartburn and dyspepsia. Therefore, adding omeprazole to the patient’s regimen can help reduce the risk of gastrointestinal side effects while continuing treatment with alendronate.

Q- A 45-year-old man with a history of hypertension presents to the emergency department with a severe headache and visual disturbances. His blood pressure is elevated at 180/110 mmHg. An urgent CT scan of the head reveals a subarachnoid hemorrhage (SAH).

Which of the following medications is the most appropriate initial treatment to lower his blood pressure?

A- Amlodipine

B- Labetalol

C- Metoprolol

D- Nitroprusside

B- Labetalol- Labetalol is a non-selective beta-blocker with alpha-blocking activity, making it effective for rapidly lowering blood pressure in hypertensive emergencies such as SAH. It provides both beta-adrenergic and alpha-adrenergic blockade, leading to a decrease in heart rate, cardiac output, and systemic vascular resistance. This helps reduce blood pressure while maintaining cerebral perfusion pressure, which is crucial in the setting of SAH to prevent further bleeding and ischemic injury.

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