Review for ANS

1. A 43-year-old man recently diagnosed with pheochromocytoma (an adrenal gland

tumor) started a treatment with a drug that can cause a pronounced decrease in
norepinephrine and epinephrine by blocking the first rate-limiting step in
catecholamine biosynthesis. Which of the following enzymes was most likely
inhibited by the drug?
A. Aromatic l-amino acid decarboxylase
B. Dopamine--hydroxylase
C. Tyrosine hydroxylase
D. Phenylethanolamine methyltransferase
E. Monoamine oxidase
2. A 55-year-old woman suffering from postural hypotension started a treatment
with an 1-adrenergic drug. Which of the following is a body site where autonomic
receptors are primarily 1 adrenergic?
A. Bronchial muscle
B. Sphincter muscle of the iris
C. Atrioventricular node
D. Purkinje fibers
E. Skin vessels
3. A 24-year-old woman admitted to the hospital after a car accident was diagnosed
with neurogenic shock due to a spinal cord injury. An emergency treatment was
started that included the administration of norepinephrine. Which of the following
expected effects of the drug was most likely mediated by the activation of
peripheral postsynaptic 1 receptors?
A. Bronchodilation
B. Uterine relaxation
C. Increased liver gluconeogenesis
D. Increased renin secretion
E. Decreased insulin secretion
F. Increased sweating of the palms of the hands
4. A 28-year-old woman presented to the emergency department with breathing
difficulty and increasing swelling of her face, eyes, lips, and tongue. An hour earlier
she had received an intramuscular injection of ampicillin to treat acute pharyngitis.
A diagnosis of anaphylactic reaction was made, and an intramuscular injection of
epinephrine was given. Which of the following expected effects of the drug was
most likely mediated by the activation of peripheral postsynaptic 2 receptors?
A. Mydriasis
B. Decreased secretion of insulin
C. Increased secretion of renin
D. Constriction of skin vessels
E. Increased heart rate
F. Dilation of skeletal muscle vessels
5. A 62-year-old man suffering from postural hypotension started therapy with a
drug that selectively activates 1 receptors. Which of the following postreceptor
mechanisms most likely mediated the therapeutic effect of the drug in this patient?

A. Decreased synthesis of inositol triphosphate (IP3) and diacylglycerol (DAG)

B. Increased activation of phospholipase C
C. Opening of ligand-gated K+ channels
D. Blockade of voltage-gated Ca2+ channels
E. Increased synthesis of cyclic guanosine monophosphate (cGMP)
6. The bronchial effects of a new alpha-beta agonist that does not cross the
bloodbrain barrier was studied in laboratory animals. It was found that the drug
caused relaxation of bronchiolar smooth muscle. The activation of which of the
following pairs of adrenoceptors most likely mediated the effect of the drug?
A. 2 postsynaptic and 2 presynaptic
B. 1 presynaptic and 1 postsynaptic
C. 2 postsynaptic and 3 postsynaptic
D. 1 presynaptic and 2 presynaptic
E. 1 postsynaptic and 2 presynaptic
7. A 35-year-old farmer was brought to the emergency department with severe
abdominal cramps and vomiting. He reported that he was working in the field with
an organophosphate pesticide. The physician observed all of the typical symptoms
of acetylcholine excess. Which of the following symptoms of the patient were most
likely due to the activation of nicotinic Nm receptors only?
A. Salivation, decreased blood pressure
B. Difficulty in breathing, miosis
C. Diarrhea, sweating
D. Bradycardia, urinary urgency
E. Diplopia, difficulty in swallowing
8. A 34-year-old woman was at the dentist for an endodontic procedure. Before
starting the procedure, the dentist injected a solution of lidocaine plus epinephrine
near the tooth in order to provide local anesthesia. The epinephrine-induced
increased duration of the lidocaine effect was most likely mediated by the activation
of which of the following adreno- ceptors?
A. 1
B. 2
C. 3
D. 1
E. 2
9. A 16-year-old girl was treated topically with eye drops during a routine
ophthalmoscopic examination. After 15 minutes, the ophthalmologist measured an
increase in pupillary diameter with negligible changes in lens curvature and
intraocular pressure. Which of the following drugs was most likely administered to
the patient?
A. Phenylephrine B. Timolol C. Acetylcholine D. Apraclonidine E. Epinephrine
10. A 15-year-old boy suffering from asthma routinely self- administered albuterol
through a metered-dose inhaler. Which of the following actions most likely
contributed to the therapeutic efficacy of the drug in the patients disorder?
A. Increased microvascular permeability
B. Decreased bronchial secretions
C. Release of histamine from mast cells
D. Increased residual respiratory volume
E. Increased mucociliary clearance

11. A 7-year-old girl recently diagnosed with persistent asthma started treatment
with inhaled albuterol as needed. Which of the following adverse effects was most
likely to occur during the therapy?
A. Atrioventricular block B. Restlessness C. Sleepiness D. Postural hypotension E.
Ventricular tachycardia
12. A 52-year-old woman suffering from severe bronchial asthma was recently
diagnosed with open-angle glaucoma. An appropriate local therapy was prescribed.
Which of the following drugs most likely would be included in the glaucoma
treatment of this patient?
A. Carbachol B. Epinephrine C. Propranolol D. Pilocarpine E. Timolol
13. A 65-year-old woman suffering from open-angle glaucoma was prescribed a
treatment regimen that included apraclonidine eye drops. Which of the following
actions on aqueous humor most likely mediated the therapeutic effect of the drug in
the patients disease?
A. Increased out flow through the Schlemm canal
B. Decreased production by the trabecular meshwork
C. Increased out flow through the uveoscleral route
D. Decreased production by eye vessel constriction
E. Decreased production by the ciliary epithelium
14. A 51-year-old man, recently diagnosed with pheochromocytoma, was scheduled
for surgery to remove the tumor. One week before surgery, phenoxybenzamine was
prescribed. Which of the following actions most likely mediated the therapeutic
effect of the drug in the patients disease?
A. Decreased peripheral vascular resistance
B. Increased cardiac output
C. Decreased epinephrine release from the adrenal medulla
D. Increased heart rate
E. Decreased firing from the vasomotor center
15. A 58-year-old man complained to his physician of weakness, drowsiness,
dizziness, and palpitations. He was recently diagnosed with bladder obstruction due
to benign prostatic hyperplasia and had been taking a drug for 2 weeks. Which of
the following drugs most likely caused the patients symptoms?
A. Bethanechol B. Tamsulosin C. Propranolol D. Flutamide E. Albuterol F.
Phenylephrine
16. A 28-year-old woman presented to the outpatient clinic with a 5-day history of
left hand and arm pain. She noted that the fingers of her left hand became cold and
somewhat blue, especially when exposed to cold. Physical examination showed that
the patients extremities had appropriate sensation. When her hands were placed in
cold water, several white splotches appeared, and tingling was felt in the
hands.Which of the following drugs would be appropriate to treat the patients
disorder?
A. Neostigmine B. Propranolol C. Prazosin D. Clonidine E. Phenylephrine
17. A 47-year-old man who had been suffering from diabetes for 10 years was
admitted to the hospital following a myocardial infarction. He was discharged 10
days later with a postdischarge therapy that included atenolol. The patient was

instructed to monitor his blood glucose level carefully for both hyper- and
hypoglycemia after the drug was initiated. Which of the following statements about
atenolol best explains the reason for glucose monitoring?
A. It can dangerously increase blood sugar levels.
B. It can blunt some symptoms of hypoglycemia.
C. It can increase insulin secretion.
D. It can impair lipid metabolism.
E. It decreases renin release.
18. A 57-year-old woman was discharged from the hospital after an acute
myocardial infarction. The woman had been suffering from mild seasonal asthma for
15 years. Her postdischarge therapy included atenolol, one tablet daily. Which of the
following was the most likely rationale behind prescribing atenolol to this patient?
A. It can counteract pulmonary vasoconstriction.
B. It blocks 1 adrenoceptors only.
C. It has antiinflammatory effects in asthmatics.
D. It can block pulmonary adrenoceptors.
E. It has an intermediate half-life (about 6 hours).
19. A 63-year-old woman underwent a total hysterectomy to remove a uterine
leiomyoma. General anesthesia was induced with thiopental sodium, maintained
with halothane and nitrous oxide, and supplemented with tubocurarine. Which of
the following drugs did the patient most likely receive after the operation to reverse
the skeletal muscle paralysis?
A. Apraclonidine B. Edrophonium C. Neostigmine D. Bethanechol E. Pralidoxime
20. A 38-year-old patient was admitted to the emergency department with
extensive soft tissue burns. He was semiconscious and was artificially ventilated.
His uncoordinated respiratory movements were interfering with the mechanical
ventilation. Which of the following drugs would most likely be effective to decrease
the patients spontaneous breathing?
A. Diazepam B. Vecuronium C. Botulinum toxin D. Dantrolene E. Baclofen F.
Tizanidine
21. A 57-year-old woman was admitted semiconscious to the emergency
department after an accident at home. Artificial ventilation was needed, and a drug
was given to facilitate intubation. This drug has the shortest duration of action
among skeletal muscle relaxants. Which of the following drugs was most likely
administered?
A. Succinylcholine B. Cisatracurium C. Dantrolene D. Vecuronium E. Tubocurarine F.
Tizanidine
22. A 59-year-old woman was undergoing surgery for breast cancer. General
anesthesia was supplemented with a nondepolarizing neuromuscular blocker that
has a short duration of action and is metabolized by plasma pseudocholinesterase.
Which of the following drugs was most likely administered?
A. Succinylcholine B. Tubocurarine C. Vecuronium D. Mivacurium E. Cisatracurium

23. A 74-year-old man underwent abdominal surgery to remove a colon carcinoma.

The patient had severely impaired hepatic and renal function, and the
anesthesiologist decided to supplement general anesthesia with a muscle relaxant
that is inactivated primarily by a form of spontaneous breakdown (also known as
Hoffmann elimination). Which of the following drugs was most likely given?
A. Succinylcholine B. Dantrolene C. Tubocurarine D. Cisatracurium E. Mivacurium
24. A 61-year-old man underwent surgery for prostate cancer. The anesthesia was
induced by thiopental and maintained by halothane and nitrous oxide. Vecuronium
was added to ensure adequate muscle relaxation. Which of the following was most
likely the sequence of the paralysis of skeletal muscles induced by vecuronium in
this patient?
A. Eye extrinsic muscles, limb muscles, diaphragm
B. Limb muscles, diaphragm, eye extrinsic muscles
C. Diaphragm, eye extrinsic muscles, limb muscles
D. Diaphragm, limb muscles, eye extrinsic muscles
E. Limb muscles, eye extrinsic muscles, diaphragm
25. A 54-year-old man who had been suffering from amyotrophic lateral sclerosis for
1 year complained of generalized muscle spasms. His physician prescribed
diazepam to reduce spasticity. Which of the following statements best explains the
mechanism of the spasmolytic effect of diazepam in this patient? A. Blockade of
calcium release from the sarcoplasmic reticulum
B. Blockade of acetylcholine release from motor nerves
C. Depolarization blockade of Nm receptors
D. Facilitation of GABAA actions in the spinal cord
E. Activation of GABA B receptors in the spinal cord