QUM in special populations: pediatrics and geriatrics MCQs With Answer

QUM in special populations: pediatrics and geriatrics MCQs With Answer

Introduction: This blog presents a focused set of multiple-choice questions designed for M.Pharm students studying Principles of Quality Use of Medicines (MPP 201T). The questions explore pharmacokinetic and pharmacodynamic differences, dosing strategies, monitoring, formulation and excipient risks, prescribing tools, and clinical safety considerations specific to pediatric and geriatric populations. Each item emphasizes practical decision-making: estimating renal function, adjusting doses, selecting formulations, recognizing high-risk medications, and applying deprescribing or vaccine guidance. These MCQs aim to deepen understanding of age-related variability and support safe, evidence-based medicine use in vulnerable patients, preparing students for clinical and regulatory roles.

Q1. Which physiological characteristics most influence drug distribution in neonates compared with older children and adults?

• High body fat and increased plasma proteins
• High total body water and reduced plasma protein binding
• Decreased total body water and increased hepatic enzyme activity
• Increased renal clearance and mature blood–brain barrier

Correct Answer: High total body water and reduced plasma protein binding

Q2. When is body surface area (mg/m2) dosing preferred over mg/kg dosing in pediatric patients?

• For drugs with narrow therapeutic indices and when metabolic capacity correlates with body surface area
• Whenever the child is under 2 years of age
• Only for vaccines and immunoglobulins
• For all oral antibiotics regardless of age

Correct Answer: For drugs with narrow therapeutic indices and when metabolic capacity correlates with body surface area

Q3. Which formula is most appropriate for estimating glomerular filtration rate (GFR) in a 7-year-old child for drug dosing?

• Cockcroft–Gault equation
• MDRD (Modification of Diet in Renal Disease)
• Schwartz formula
• CKD-EPI

Correct Answer: Schwartz formula

Q4. The Beers Criteria are primarily used to:

• Estimate renal function in older adults
• Identify potentially inappropriate medications in elderly patients
• Calculate body surface area for dosing
• Assess pediatric vaccine schedules

Correct Answer: Identify potentially inappropriate medications in elderly patients

Q5. Which hepatic change commonly seen in older adults most affects clearance of high-extraction drugs?

• Increased hepatic enzyme induction
• Increased hepatic blood flow
• Reduced hepatic blood flow and decreased phase I metabolism
• Enhanced biliary excretion

Correct Answer: Reduced hepatic blood flow and decreased phase I metabolism

Q6. Which pharmaceutical excipient is classically associated with “gasping syndrome” and should be avoided in neonates?

• Sorbitol
• Benzyl alcohol
• Gelatin

Correct Answer: Benzyl alcohol

Q7. Which drug class typically requires therapeutic drug monitoring in neonates and children due to variable pharmacokinetics and narrow therapeutic window?

• Beta-lactam antibiotics (e.g., amoxicillin)
• Aminoglycosides (e.g., gentamicin)
• Proton pump inhibitors
• Topical corticosteroids

Correct Answer: Aminoglycosides (e.g., gentamicin)

Q8. Which medication class is most frequently implicated in emergency hospitalizations for adverse drug events among older adults?

• Topical antibiotics
• Anticoagulants (e.g., warfarin)
• Nasal decongestants
• Vitamin supplements

Correct Answer: Anticoagulants (e.g., warfarin)

Q9. For drug dosing recommendations provided by many product labels in elderly patients, which renal function estimate is commonly required?

• Measured inulin clearance
• Back-calculated creatinine clearance using Cockcroft–Gault
• Urine dipstick protein level
• Serum cystatin C alone

Correct Answer: Back-calculated creatinine clearance using Cockcroft–Gault

Q10. Which statement about off-label and unlicensed prescribing in pediatric practice is true?

• It is illegal and never practiced in hospitals
• It is common due to lack of pediatric-specific trials and often requires careful dosing and monitoring
• It always leads to adverse drug reactions and should be avoided
• It only applies to vaccines and not to therapeutic drugs

Correct Answer: It is common due to lack of pediatric-specific trials and often requires careful dosing and monitoring

Q11. Neonates have a relatively high gastric pH compared with older children. What is a likely consequence for oral drug absorption?

• Decreased absorption of acid-labile drugs
• Increased absorption of acid-labile drugs and decreased absorption of weak acids
• Faster gastric emptying increasing absorption of all drugs
• Enhanced first-pass hepatic metabolism

Correct Answer: Increased absorption of acid-labile drugs and decreased absorption of weak acids

Q12. Which analgesic should generally be avoided in children and adolescents with suspected viral illness because of the risk of Reye’s syndrome?

• Ibuprofen
• Aspirin (salicylates)
• Paracetamol (acetaminophen)
• Naproxen

Correct Answer: Aspirin (salicylates)

Q13. Which clinical tool is designed to identify potentially inappropriate prescriptions and omissions in older people and is widely used in Europe?

• Beers Criteria
• STOPP/START criteria
• Schwartz formula
• WHO Essential Medicines List

Correct Answer: STOPP/START criteria

Q14. Why are older adults generally more sensitive to central nervous system depressants such as benzodiazepines?

• Increased blood–brain barrier impermeability
• Reduced receptor sensitivity and faster clearance
• Decreased homeostatic reserve and altered pharmacodynamics increasing susceptibility to sedation and falls
• Greater hepatic enzyme induction causing higher active metabolite levels

Correct Answer: Decreased homeostatic reserve and altered pharmacodynamics increasing susceptibility to sedation and falls

Q15. In pediatric clinical research, what does “assent” refer to?

• Parental legal permission for study participation
• The child’s affirmative agreement to participate when capable of understanding
• A waiver of informed consent by the ethics committee
• Automatic enrollment of newborns without consent

Correct Answer: The child’s affirmative agreement to participate when capable of understanding

Q16. For dosing aminoglycosides in obese pediatric patients, which weight metric is commonly recommended to better reflect distribution volume?

• Actual total body weight without adjustment
• Ideal body weight only
• Adjusted (or dosing) body weight
• Body surface area calculated in m2 only

Correct Answer: Adjusted (or dosing) body weight

Q17. Which type of vaccine is generally contraindicated in patients with severe immunosuppression?

• Inactivated (killed) vaccines
• Toxoid vaccines
• Conjugate vaccines
• Live attenuated vaccines

Correct Answer: Live attenuated vaccines

Q18. In older adults, an increased volume of distribution for lipophilic drugs typically leads to which clinical consequence?

• Shortened half-life and decreased drug effect
• Prolonged half-life and potential drug accumulation (e.g., benzodiazepines)
• Reduced oral bioavailability
• Immediate increase in renal clearance

Correct Answer: Prolonged half-life and potential drug accumulation (e.g., benzodiazepines)

Q19. Which condition commonly increases the risk of digoxin toxicity in elderly patients?

• Hyperkalemia
• Hypokalemia
• High serum albumin
• Increased hepatic blood flow

Correct Answer: Hypokalemia

Q20. Which intervention is most effective to improve medication adherence in pediatric outpatients?

• Prescribing the maximum number of daily doses to ensure coverage
• Using palatable formulations combined with caregiver education and clear dosing instructions
• Providing only written instructions without demonstration
• Switching all medications to topical formulations

Correct Answer: Using palatable formulations combined with caregiver education and clear dosing instructions

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