Questions are multiple choice questions by mikesanye


									Questions 1-21 are multiple-choice questions.

1.       JJ is a 43-year-old female with a urinary tract infection secondary to E. coli. Which of the following
         antibiotics DOES NOT have activity against the organism?
         A.         A.       Piperacillin/tazobactam
         B.         B.       Penicillin
         C.         C.       Cefazolin
         D.         D.       Meropenem
         E.         E.       Ceftriaxone

2.       2.      Which of the following best describes the minimum inhibitory concentration (MIC)?
         A.       A.      The optimal antimicrobial concentration achieved in plasma or tissue
         B.       B.       The in vitro antimicrobial concentration known to inhibit the growth of an organism
         C.       C.       The zone of inhibition around an antimicrobial-laden disk placed in an agar plate
         D.       D.       The quotient of the peak serum concentration divided by the MIC90

3.       3.       While on rounds you discover that your patient has a penicillin allergy. The patient describes her
         reaction to penicillin as Òshortness of breath and difficulty with breathingÓ. Which of the following
         antibiotics can you administer safely to your patient?
         A.         A.       Piperacillin
         B.         B.        Meropenem
         C.         C.        Aztreonam
         D.         D.        Cefazolin
         E.         E.       Nafcillin

4.       4.      In which of the following patients would it be appropriate to use nitrofurantoin?
         A.       A.       An elderly man diagnosed with pyelonephritis
         B.       B.       A middle-aged diabetic woman with end-stage renal disease diagnosed with cystitis
                  (bladder infection)
         C.       C.       A hospitalized man diagnosed with a Pseudomonas UTI
         D.       D.       An otherwise healthy woman diagnosed with cystitis (bladder infection) caused by E. coli

5.       5.      Which of the following antibiotics would most likely invoke a reaction if administered with an
         alcohol-containing product?
         A.        A.      Cefazolin
         B.        B.       Ceftizoxime
         C.        C.       Cefotetan
         D.        D.       Cefoxitin
         E.        E.      Cefepime

6.       6.      Which of the following antibiotics can cause Clostridium difficile?
         A.       A.      Penicillin
         B.       B.       Meropenem
         C.       C.       Piperacillin/tazobactam
         D.       D.       Ceftriaxone
         E.       E.      All of the above

7.       7.       Which of the following cephalosporins has the following attributes: long half-life allowing for once
         daily dosing, no dosing adjustments required in patients with renal insufficiency, and a dose-dependent
         Òpseudo cholelithiasis syndromeÓ?
         A.        A.       Cefazolin
         B.        B.       Cefotetan
         C.        C.       Ceftazidime
         D.        D.       Cefepime
         E.        E.       Ceftriaxone

8.       8.       A new antimicrobial agent with activity against anaerobes would be most likely to inhibit which of
         the following?
         A.        A.      Serratia marsescens
         B.        B.      Clostridia difficile
         C.        C.      Pseudomonas aeruginosa
         D.        D.      Staphylococcus aureus
      E.       E.       Enterobacter cloacae

9.    9.     JJ is an 88 year-old male who is currently receiving Meropenem for empiric coverage for an intra-
      abdominal infection. This antibiotic DOES NOT inhibit which of the following organisms?
      A.      A.        Bacteroides fragilis
      B.      B.        Streptococcus pneumoniae
      C.      C.        Methicillin resistant Staphylococcus aureus {MRSA}
      D.      D.        Pseudomonas aeruginosa
      E. E.        Hemophilus influenzae

10.   10.    A college senior presents to the STD clinic and is diagnosed with syphilis [Treponema pallidum].
      Which of the following antibiotics is the drug of choice for this infection?
      A.       A.       Amoxicillin
      B.       B.       Nafcillin
      C.       C.       Penicillin
      D.       D.       Piperacillin
      E.       E.       Dicloxacillin

11.   11.     Which one of the following has a non-renal route of elimination and would therefore not require
      dosage adjustment in a patient with renal insufficiency?
      A.       A.      Ticarcillin
      B.       B.       Nafcillin
      C.       C.       Ampicillin/sulbactam
      D.       D.       Penicillin
      E.       E.       Amoxicillin

12.   12.     Fluoroquinolone resistance is mediated by all of the following EXCEPT:
      A.       A.      Target site mutation
      B.       B.       Efflux pumps
      C.       C.       Porin channel loss
      D.       D.       Enzymatic degradation

13.   13.      TP is a 77-year-old male who is currently receiving Vancomycin empirically for a presumed
      nosocomially-acquired -lactam resistant infection. Which lab test would you be most interested in ordering
      in order to dose the vancomycin in TP correctly?
      A.         A.      Serum creatinine
      B.         B.       EKG
      C.         C.       Total bilirubin
      D.         D.       Liver function tests (ALT, AST)
      E.         E.       WBC

14.   14.     Fluoroquinolones derive their antibiotic effect through which of the following mechanisms
      A.       A.      Dose the fluoroquinolone 2hrs before or 4hrs after taking certain antacids and vitamins
      B.       B.       Bind to D-ALA-D-ALA residues on the bacterial cell wall preventing cell wall synthesis
      C.       C.       Bind to the bacterial 30S ribosomal subunit preventing protein synthesis
      D.       D.       Bind to DNA gyrase and topoisomerase interfering with bacterial DNA replication
      E.       E.       Bind to bacterial enzymes interfering with folate metabolism

15.   15.     The first generation cephalosporin, cefazolin, inhibits all of the following organisms EXCEPT:
      A.       A.        Proteus mirabilis
      B.       B.        Klebsiella pneumoniae
      C.       C.        Methicillin-sensitive Staphylococcal aureus
      D.       D.        Streptococcus spp
      E.       E.        H.influenzae

16.   16.     RR is a 70-year-old female receiving imipenem for a nosocomially acquired multi-resistant gram-
      negative rod infection. While on rounds, you find out that she has severely impaired renal function {CrCL <
      20 mL/min} and you subsequently recommend an imipenem dosage change to avoid the following adverse
      A.        A.       Biliary sludging syndrome
      B.        B.        Neutropenia
      C.        C.        Hyperkalemia
         D.        D.       Seizure
         E.        E.       Rash

17.      17.      When dispensing a prescription for an oral fluoroquinolone, a community pharmacist would counsel
         the patient on all of the following points EXCEPT:
         A.        A.        Minimize sunlight exposure or wear sunscreen while taking the fluoroquinolone
         B.        B.         Bodily fluids such as tears and urine may turn a red/orange color while taking the
         C.        C.         Fluoroquinolones may be associated with significant nausea, vomiting, or diarrhea

18.      18.      Which of the following organisms would NOT be inhibited by daptomycin?
         A.        A.      MSSA
         B.        B.       MRSA
         C.        C.       Streptococcus spp
         D.        D.       E.coli
         E.        E.       Enterococcus faecalis

19.      19.      Which one of the following statements about Vancomycin is false?
         A.        A.       If vancomycin is infused too quickly a histamine related reaction called Red ManÕs
                   Syndrome can occur
         B.        B.       The primary route of elimination is hepatic
         C.        C.       The half-life of vancomycin can increase significantly in patients with renal insufficiency
         D.        D.        Vancomycin should be reserved for the treatment of beta-lactam resistant gram-positive
         E.        E.       Vancomycin crosses the BBB when the meninges are inflamed

20.      20.      Which organism would be considered an aerobic coagulase negative gram positive coccus?
         A.        A.      Bacteroides fragilis
         B.        B.      Enterococcus faecalis
         C.        C.      Enterobacter aerogenes
         D.        D.      Streptococcus pneumoniae
         E.        E.      Staphylococcus epidermidis

True or False:
21.      21.     Cephalosporins cannot be administered to a patient with a history of an ampicillin-associated
         macular papular rash.
         A.       A.       True
         B.       B.       False

Short Answer Question:
3 points
1.       1.    a.Via what route are drugs used in the treatment of cystitis (bladder infection) eliminated?

         b.        Explain in a few sentences why this is clinically important and name an example of a drug that is
                   used to treat cystitis.

         c.        Explain if we can use this drug to treat pyelonephritis, which is a systemic infection.

1.      1.      B
2.      2.      B
3.      3.      C
4.      4.      D
5.      5.      C
6.      6.      E
7.      7.      E
8.      8.      B
9.      9.      C
10.     10.     C
11.     11.     B
12.     12.     D
13.     13.     A
14.     14.     D
15.     15.     E
16.     16.     D
17.     17.     B
18.     18.     D
19.     19.     B
20.     20.     E WILL ALSO ACCEPT D
21.     21.     B

Short Answer:
2.       2.     a.Via what route are drugs used in the treatment of cystitis (bladder infection) eliminated?
                           Renal elimination.
        b.       Explain in a few sentences why this is clinically important and name an example of a drug that is
                 used to treat cystitis.
                           This is important because the drug will concentrate in the urine and will not have
                           been metabolized before it gets to the kidney. Example nitrofurantoin
        c.       Explain if we can use this drug to treat pyelonephritis, which is a systemic infection.

                           We cannot use nitrofurantoin for pyelonephritis, since it never reaches high enough
                           concentration in the blood to treat the infection (the Cp never reaches minimal
                           therapeutic concentrations)

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