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Which of the following statements is/are TRUR ABOUT Covid-19? [Select ALL THAT APPLY]

a. COVID-19 infection often begins with malaise, dry cough, dyspnea, fatigue, and feeling of fever.
b. Covid-19 infection has incubation period of 2- to 14-day.
c. In contrast to the sudden onset people report with influenza, progression of symptoms with Covid-19 virus have a slower onset.
d. During early phases of viral spread, symptoms began an average of 7 days before patients sought medical or emergent care.
e. Fever occurs in 89% Covid-19 symptomatic patients.


Which of the following statements is/are TRUR ABOUT Covid-19? [Select ALL THAT APPLY]

a. COVID-19 infection often begins with malaise, dry cough, dyspnea, fatigue, and feeling of fever.
b. Covid-19 infection has incubation period of 2- to 14-day.
c. In contrast to the sudden onset people report with influenza, progression of symptoms with Covid-19 virus have a slower onset.
d. During early phases of viral spread, symptoms began an average of 7 days before patients sought medical or emergent care.
e. Fever occurs in 89% Covid-19 symptomatic patients.

Answer: (a,b,c,e) The COVID-19 often begins with malaise, dry cough, dyspnea, fatigue, and feeling of fever. It progresses over an 11- to 14-day period. It has incubation period of 2- to 14-day. Some patients have had nausea, vomiting, and diarrhea. In contrast to the sudden onset people report with influenza, progression of symptoms with SARS-CoV-2 have a slower onset. During early phases of viral spread, symptoms began an average of 3.5 days (not 7 days) before patients sought medical or emergent care. Fever occurs in almost all symptomatic patients (89%), cough is very common (68%), and some patients have fatigue (38%), sputum production (33%), shortness of breath (19%), sore throat (14%), and headache (14%).

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The transition from mild/moderate symptoms to more severe stages of COVID-19 is marked by the onset of:

a. Loss of or reductions in smell or taste
b. Multi organ failures
c. Severe seizure
d. Acute respiratory distress syndrome
e. Refractory, nonproductive cough


The transition from mild/moderate symptoms to more severe stages of COVID-19 is marked by the onset of:

a. Loss of or reductions in smell or taste
b. Multi organ failures
c. Severe seizure
d. Acute respiratory distress syndrome
e. Refractory, nonproductive cough

Answer:(d). About 5% of patients with COVID-19 (one-fourth of those needing hospitalization) present with advanced symptoms or become critically ill as viral damage in the lungs results in acute respiratory distress syndrome. Multi-organ failure occurs later in the disease course; changes in smell and taste and nonproductive cough are early symptoms of COVID-19.

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Liver toxicity with acetaminophen may occur and is a serious, dose-dependent effect. The maximum recommended dosage is:

a. 15mg/kg/day
b. 30mg/kg/day
c. 45mg/kg/day
d. 75mg/kg/day
e. 100mg/kg/day


Liver toxicity with acetaminophen may occur and is a serious, dose-dependent effect. The maximum recommended dosage is:

a. 15mg/kg/day
b. 30mg/kg/day
c. 45mg/kg/day
d. 75mg/kg/day
e. 100mg/kg/day

Answer: (d). Liver toxicity with acetaminophen may occur and is a serious, dose-dependent effect. The maximum recommended dosage is 75 mg/kg/day (adults not to exceed 4 g/d), and products carry warnings about exceeding this dose.

Signs associated with acetaminophen toxicity can mimic influenza symptoms and may include nausea, vomiting, diarrhea, and excessive sweating.

This may lead parents and caregivers to administer more medication to the child. Care should be taken not to exceed this threshold by administering higher doses more frequently than recommended.

In 2011 and 2012, the manufacturer of brand-name Tylenol products voluntarily reduced the maximum daily dosage to 3000 mg (6 tablets), with the dosing interval changed from 2 tablets every 4 to 6 hours to 2 tablets every 6 hours; the maximum daily dosage for Regular Strength Tylenol has been reduced to 3250 mg.

However, generic manufacturers may still have a maximum dose of 4000 mg on the product label.


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The probable mechanism of action of Baloxavir Marboxil?

a. HMG-CoA inhibitor
b. Neuraminidase inhibitor
c. Cap-dependent endonuclease inhibitor
d. DNA dependent RNA polymerase inhibitor
e. PABA inhibitor


The probable mechanism of action of Baloxavir Marboxil?

a. HMG-CoA inhibitor
b. Neuraminidase inhibitor
c. Cap-dependent endonuclease inhibitor
d. DNA dependent RNA polymerase inhibitor
e. PABA inhibitor

Answer: (c) The active ingredient found in Xofluza (Baloxavir marboxil) is Baloxavir marboxil. Xofluza (Baloxavir marboxil) is a polymerase acidic (PA) endonuclease inhibitor.

Baloxavir marboxil is a prodrug that is converted by hydrolysis to baloxavir, the active form that exerts anti-influenza virus activity. Baloxavir inhibits the endonuclease activity of the polymerase acidic (PA) protein, an influenza virus-specific enzyme in the viral RNA polymerase complex required for viral gene transcription, resulting in inhibition of influenza virus replication.


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Prescription antiviral medications with influenza virus activity may be useful adjuncts in influenza prevention and treatment and are most effective when administered within _______ of symptom onset.

a. 24 hours
b. 48 hours
c. 72 hours
d. 4 days
e. 12 hours



Prescription antiviral medications with influenza virus activity may be useful adjuncts in influenza prevention and treatment and are most effective when administered within _______ of symptom onset.

a. 24 hours
b. 48 hours
c. 72 hours
d. 4 days
e. 12 hours

Answer: (b). Prescription antiviral medications with influenza virus activity may be useful adjuncts in influenza prevention and treatment and are most effective when administered within 48 hours of symptom onset.


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What is a strain number of influenza virus in A/Texas/50/2012 (H3N2)?

a. A
b. Texas
c. 50
d. 2012
e. H3N2


What is a strain number of influenza virus in A/Texas/50/2012 (H3N2)?

a. A
b. Texas
c. 50
d. 2012
e. H3N2

Answer: (c) Influenza is named according to the type, the location of initial isolation, the strain designation, and the year of isolation. For example, A/Texas/50/2012 (H3N2), or H3N2, is influenza type A with origin in Texas, with strain No. 50, isolated in 2012 and of the H3N2 subtype.

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In which aspect, Salicylate is different from NSAIDs? [Select ALL THAT APPLY]

a. Provide greater pain control with equivalent doses.
b. May cause GI side effects more frequently than NSAIDs.
c. May inhibit prostaglandin synthesis irreversibly; whereas NSAIDs do reversibly.
d. May cause more renal damage than NSAIDs.
e. Risk of bleeding is more with Salicylate compared to NSAIDs.


In which aspect, Salicylate is different from NSAIDs? [Select ALL THAT APPLY]

a. May provide greater pain control with equivalent doses.
b. May cause more GI side effects than NSAIDs.
c. Inhibits prostaglandin synthesis irreversibly; where NSAIDs do reversibly.
d. May cause more renal damage than NSAIDs.
e. May increase the risk of bleeding more compared to NSAIDs.

Answer (b,c): Salicylates, like NSAIDs, work by inhibiting prostaglandin synthesis by inhibiting both COX-1 and COX-2 enzymes; however, salicylates do so in an irreversible manner, while NSAIDs do so reversibly.

Absorption in the gut is affected by the dosage form, gastric pH, gastric emptying time, dissolution rate, and food/antacids.

Aspirin is widely bioavailable with an onset of analgesia within 30 minutes and lasting 4 to 6 hours.

FDA-approved uses for salicylates include treatment of symptoms for osteoarthritis, rheumatoid arthritis, and other rheumatologic diseases, as well as temporary relief of minor aches and pains associated with backache or muscle aches.

High-dose aspirin (900-1000 mg) has been established as an effective treatment option for acute migraine.

Aspirin causes dyspepsia and GI irritation even more frequently than OTC NSAIDs.

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Botox (OnabotulinumtoxinA) inhibits the release which of the following?

a. Serotonin
b. Histamine
c. Acetylcholine
d. GABA
e. Dopamine


Botox (OnabotulinumtoxinA) inhibits the release which of the following?

a. Serotonin
b. Histamine
c. Acetylcholine
d. GABA
e. Dopamine

The active ingredient found in Botox is OnabotulinumtoxinA. It is an acetylcholine release inhibitor and a neuromuscular blocking agent.

Botox (OnabotulinumtoxinA) blocks neuromuscular transmission by binding to acceptor sites on motor or autonomic nerve terminals, entering the nerve terminals, and inhibiting the release of acetylcholine. This inhibition occurs as the neurotoxin cleaves SNAP-25, a protein integral to the successful docking and release of acetylcholine from vesicles situated within nerve endings.

When injected intramuscularly at therapeutic doses, Botox (OnabotulinumtoxinA) produces partial chemical denervation of the muscle resulting in a localized reduction in muscle activity. In addition, the muscle may atrophy, axonal sprouting may occur, and extrajunctional acetylcholine receptors may develop. There is evidence that reinnervation of the muscle may occur, thus slowly reversing muscle denervation produced by Botox (OnabotulinumtoxinA).

When injected intradermally, Botox (OnabotulinumtoxinA) produces temporary chemical denervation of the sweat gland resulting in local reduction in sweating.

Following intradetrusor injection, Botox (OnabotulinumtoxinA) affects the efferent pathways of detrusor activity via inhibition of acetylcholine release.

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At 1000 mg dose, Acetaminophen is usually effective treating which of the following Migraine related symptoms? [Select ALL THAT APPLY]

a. Nausea
b. Vomiting
c. Blurry vision
d. Photophobia
e. Phonophobia



At 1000 mg dose, Acetaminophen is usually effective treating which of the following Migraine related symptoms?[Select ALL THAT APPLY]

a. Nausea
b. Vomiting
c. Blurry vision
d. Photophobia
e. Phonophobia

Answer: (d,e). Acetaminophen has been shown in studies to reduce pain, as well as improve photophobia and phonophobia in individuals with migraine and tension-type headache. They have not been shown to improve symptoms of nausea, vomiting, or blurry vision with migraine.

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Which of the following statements is NOT TRUE about the tension-type headaches? [Select ALL THAT APPLY]

a. Pain associated with this type of headache is unilateral
b. Mild photophobia or phonophobia is reported with the headache
c. Routine physical activity usually aggravates the headache
d. Headache has fast onset of action and last for few hours.
e. It is also known as stress headache.


Which of the following statements is NOT TRUE about the tension-type headaches? [Select ALL THAT APPLY]

a. Pain associated with this type of headache is unilateral
b. Mild photophobia or phonophobia is reported with the headache
c. Routine physical activity usually aggravates the headache
d. Headache has fast onset of action and last for few hours.
e. It is also known as stress headache.

Answer: (a,c,d)

1. Tension-type headaches often are caused by stress, depression, anxiety, emotional conflicts, or other stimuli.

2. They are sometimes called stress headaches and may result from pericranial muscle contraction.

3. Patients experience bilateral symptoms that may be over the top of the head to the neck and vary from diffuse ache to tight, pressing, and constricting pain.

4. They have gradual onset and may last minutes to days.

5. They are not accompanied by nausea or vomiting but may have either mild photophobia or phonophobia.

6. Routine physical activity such as walking or climbing stairs does not aggravate the headache.

7. Tension-type headaches may be episodic or chronic. Episodic headaches occur less than 15 days per month. Chronic headaches occur 15 or more days per month for at least 3 months.