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  • Question 1 - An 11-year-old presented to a GP with a history of headache, neck stiffness...

    Incorrect

    • An 11-year-old presented to a GP with a history of headache, neck stiffness and photophobia. On examination, HR is 122, BP is 87/42, RR is 28, SaO 2 is 95%, temperature is 39.4 o C. There is a recent petechial rash on legs and arms. The GP administered a dose of antibiotics in the prehospital setting before transferring to the Emergency Department. Which of these would the GP have administered?

      Your Answer: IM benzylpenicillin 300 mg

      Correct Answer: IM benzylpenicillin 1.2 g

      Explanation:

      General Practitioners are advised to give a single injection of benzylpenicillin by intravenous or intramuscular injection before transferring the patient urgently to the ED when bacterial meningitis is suspected.

      The recommended doses are:
      Infants under 1 year: 300 mg
      Children ages 1 to 9 years: 600 mg
      Children aged 10 years and over: 1.2g
      Adults: 1.2g

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      9.3
      Seconds

  • Question 2 - A 61-year-old patient experiences a spontaneous rupture of his Achilles tendon following a...

    Incorrect

    • A 61-year-old patient experiences a spontaneous rupture of his Achilles tendon following a course of antibiotics

      Which of the antibiotics listed below is MOST likely to be the cause? 

      Your Answer:

      Correct Answer: Ciprofloxacin

      Explanation:

      Tendinopathy and spontaneous tendon rupture are caused by fluoroquinolones, which are an uncommon but well-known cause. Tendon problems caused by fluoroquinolones are expected to affect 15 to 20 people per 100,000. Patients over the age of 60 are most likely to develop them.

      It usually affects the Achilles tendon, but it has also been described in cases involving the quadriceps, peroneus brevis, extensor pollicis longus, long head of biceps brachii, and rotator cuff tendons. The exact aetiology is uncertain, although the fluoroquinolone medication is thought to obstruct collagen activity and/or cut off blood supply to the tendon.

      Other factors linked to tendon rupture spontaneously include:
      Gout
      Treatment with corticosteroids
      Hypercholesterolaemia
      Long-term dialysis
      Kidney transplant
      Rheumatoid arthritis 

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 3 - For which of the following infections is phenoxymethylpenicillin (penicillin V) primarily used? ...

    Incorrect

    • For which of the following infections is phenoxymethylpenicillin (penicillin V) primarily used?

      Your Answer:

      Correct Answer: Streptococcal tonsillitis

      Explanation:

      Phenoxymethylpenicillin (penicillin V) is less active than benzylpenicillin but both have similar antibacterial spectrum. Because penicillin V is gastric-acid stable, it is suitable for oral administration, but should not be used for serious infections as absorption can be unpredictable and plasma concentrations can be variable.
      Its uses are:
      1. mainly for respiratory tract infections in children
      2. for streptococcal tonsillitis
      3. for continuing treatment after one or more injections of benzylpenicillin when clinical response has begun.
      4. for prophylaxis against streptococcal infections following rheumatic fever and against pneumococcal infections following splenectomy or in sickle-cell disease.

      It should not be used for meningococcal or gonococcal infections.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 4 - A 40-year-old man complains of pain and redness in his lower thigh due...

    Incorrect

    • A 40-year-old man complains of pain and redness in his lower thigh due to an insect bite. He was diagnosed with cellulitis. Select the first-line antibiotic for cellulitis.

      Your Answer:

      Correct Answer: Flucloxacillin

      Explanation:

      Cellulitis is most commonly caused by bacteria from the group Aß-hemolytic streptococcus.

      Cellulitis can be caused by animal bites. For uncomplicated cellulitis, flucloxacillin is the first-line antibiotic. Because it is beta-lactamase stable, it is efficient against Staphylococcus aureus.

    • This question is part of the following fields:

      • Infections
      • Microbiology
      0
      Seconds

  • Question 5 - Regarding amoxicillin, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding amoxicillin, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: It is used first line for bacterial tonsillitis.

      Explanation:

      Amoxicillin is a derivative of ampicillin and has a similar antibacterial spectrum. It is better absorbed than ampicillin when given orally, producing higher plasma and tissue concentrations; unlike ampicillin, absorption is not affected by the presence of food in the stomach.

      The adverse effects of amoxicillin are mainly gastrointestinal and mild and include nausea, vomiting and diarrhoea. Amoxicillin is used first line for low to moderate severity community acquired pneumonia, exacerbations of chronic bronchitis, for acute otitis media, for acute sinusitis, for oral infections/dental abscess, for Listeria meningitis (in combination with another antibiotic), for infective endocarditis (in combination with another antibiotic) and for H. Pylori eradication (in combination with metronidazole/clarithromycin and a PPI).

      Penicillin V is used first line for bacterial tonsillitis; amoxicillin should be avoided in blind treatment of a sore throat as there is a high risk of a rash if glandular fever is present.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 6 - A patient who shows symptoms of infection and is admitted under supervision of...

    Incorrect

    • A patient who shows symptoms of infection and is admitted under supervision of the medical team. The organism which caused this, is a Gram-negative bacterium, according to the culture. A penicillin therapy is suggested by the microbiologist.

      Which of the penicillins listed below is the most effective against Gram-negative bacteria?

      Your Answer:

      Correct Answer: Amoxicillin

      Explanation:

      Amoxicillin and Ampicillin are more hydrophilic (broad-spectrum) penicillins than benzylpenicillin and phenoxymethylpenicillin. Because they may penetrate through gaps in the outer phospholipid membrane, they are effective against Gram-negative bacteria. Amoxicillin and Ampicillin are resistant to penicillinase-producing microbes.

      Community-acquired pneumonia, otitis media, sinusitis, oral infections, and urinary tract infections are among the most prevalent conditions for which they are prescribed. The normal adult oral dose of Amoxicillin is 500 mg three times/day, which can be increased to 1 g three times/day if necessary. Ampicillin is given to adults in doses of 0.5-1 g every 6 hours.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 7 - Which of the following is NOT a notifiable disease: ...

    Incorrect

    • Which of the following is NOT a notifiable disease:

      Your Answer:

      Correct Answer: Chickenpox

      Explanation:

      Chickenpox is not a notifiable disease.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 8 - Regarding aciclovir, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding aciclovir, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: Aciclovir eradicates herpes simplex virus from the body.

      Explanation:

      Aciclovir is active against herpesviruses but does not eradicate latent virus.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 9 - Which of the following antibiotics may be used for malaria prophylaxis: ...

    Incorrect

    • Which of the following antibiotics may be used for malaria prophylaxis:

      Your Answer:

      Correct Answer: Doxycycline

      Explanation:

      Doxycycline may be used for malaria prophylaxis and as an adjunct to quinine in the treatment of Plasmodium falciparum malaria.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 10 - Which of the following side effects is most likely caused by erythromycin: ...

    Incorrect

    • Which of the following side effects is most likely caused by erythromycin:

      Your Answer:

      Correct Answer: QT - prolongation

      Explanation:

      The side effects of erythromycin include abdominal pain, anaphylaxis,
      cholestatic hepatitis, confusion,
      diarrhoea, dyspepsia, fever, flatulence, hallucinations, hearing loss,
      headache, hypertrophic pyloric stenosis, hypotension, Interstitial
      nephritis, mild allergic reactions, nausea, nervous system effects,
      including seizures, pain, pruritus, pseudomembranous colitis,
      QT prolongation, rash, skin eruptions, tinnitus, urticaria,
      ventricular arrhythmias, ventricular tachycardia, vertigo, vomiting

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 11 - All of the following statements regarding metronidazole are correct except: ...

    Incorrect

    • All of the following statements regarding metronidazole are correct except:

      Your Answer:

      Correct Answer: Metronidazole reduces the anticoagulant effect of warfarin.

      Explanation:

      The anticoagulant effect of warfarin is enhanced by metronidazole. If use of both cannot be avoided, one must consider appropriately reducing the warfarin dosage. With alcohol, metronidazole can cause a disulfiram-like reaction, with symptoms like flushing, headaches, dizziness, tachypnoea and tachycardia, nausea and vomiting. The common side effects of metronidazole include a metallic taste and gastrointestinal irritation, in particular nausea and vomiting. These side effects are more common at higher doses. This drug has high activity against anaerobic bacteria and protozoa, and is well absorbed orally. For severe infections, the intravenous route is normally reserved.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 12 - A 35-year-old woman has complaints of nausea, abdominal pain and dark urine. On...

    Incorrect

    • A 35-year-old woman has complaints of nausea, abdominal pain and dark urine. On examination, you notice she has jaundice. She tells you she recently started a new medication.

      Which drug is NOT likely to cause cholestatic jaundice out of the following?

      Your Answer:

      Correct Answer: Isoniazid

      Explanation:

      Isoniazid is an antibiotic used in the treatment of tuberculosis. It can cause acute, dose-dependent, hepatitis but is not a recognised cause of cholestatic jaundice.

      The drugs that cause cholestatic jaundice are the following:
      1. Nitrofurantoin
      2. Erythromycin
      3. Cephalosporins
      4. Verapamil
      5. NSAIDs
      6. ACE inhibitors
      7. Tricyclic antidepressants
      8. Phenytoin
      9. Azathioprine
      10. Carbamazepine
      11. Oral contraceptive pills
      12. Diazepam
      13. Ketoconazole
      14. Tamoxifen

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 13 - Regarding penicillin antibiotics, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding penicillin antibiotics, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Patients with a history of atopy are at higher risk of hypersensitivity reactions.

      Explanation:

      Allergic reactions to penicillins occur in 1 – 10% of exposed individuals; anaphylactic reactions occur in fewer than 0.05% of treated patients. Patients with a history of atopic allergy are at higher risk of anaphylactic reactions to penicillins. Patients with a history of anaphylaxis, urticaria, or rash immediately after penicillin use should not receive a penicillin or other beta-lactam antibiotics; about 0.5 – 6.5 % of penicillin-sensitive patients will also be allergic to the cephalosporins.

      Patients with a history of a more minor rash (i.e. non-confluent, non-pruritic rash restricted to a small area of the body) or delayed reaction (rash occurring more than 72 hours after penicillin administration), may not be truly allergic and may be considered for penicillin or beta-lactam treatment in severe infection (although possibility of allergy should be borne in mind). Other beta-lactam antibiotics (including cephalosporins) can be used in these patients.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 14 - During her pregnancy, a 28-year-old lady was given an antibiotic. The neonate was...

    Incorrect

    • During her pregnancy, a 28-year-old lady was given an antibiotic. The neonate was prematurely born with cyanosis and ashen grey coloured skin as a result of this. Other symptoms were hypotonia, low blood pressure, and poor feeding.

      From the  following antibiotics, which one is most likely to cause this side effect?

      Your Answer:

      Correct Answer: Chloramphenicol

      Explanation:

      Grey baby syndrome is a rare but causes significant adverse effect caused by the build-up of chloramphenicol in neonates (particularly preterm babies).

      The following are the main characteristics of ‘grey baby syndrome’:

      Skin that is ashy grey in colour.
      Feeding problems
      Vomiting
      Cyanosis
      Hypotension
      Hypothermia
      Hypotonia
      Collapse of the cardiovascular system
      Distension of the abdomen
      trouble breathing

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 15 - Regarding ampicillin, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding ampicillin, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Ampicillin may cause a widespread maculopapular rash in a patient with glandular fever.

      Explanation:

      Ampicillin is a broad-spectrum antibiotic, active against certain Gram-positive and Gram-negative organisms but is inactivated by penicillinases (similar to amoxicillin in spectrum). Ampicillin is associated with high levels of resistance, therefore it is often not appropriate for blind treatment of infection. It is principally indicated for the treatment of exacerbations of chronic bronchitis and middle ear infections, both of which may be due to Streptococcus pneumoniae and H. influenzae, and for urinary tract infections.

      Maculopapular rashes commonly occur with ampicillin (and amoxicillin) but are not usually related to true penicillin allergy. They almost always occur in patients with glandular fever; thus broad-spectrum penicillins should not be used for blind treatment of a sore throat. The risk of rash is also increased in patients with acute or chronic lymphocytic leukaemia or in cytomegalovirus infection.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 16 - An elderly female has a bacterial infection and you are asked to prescribe...

    Incorrect

    • An elderly female has a bacterial infection and you are asked to prescribe an antibiotic to her. This antibiotic is a nucleic acid synthesis inhibitor.

      Which of the following antimicrobial drugs will be prescribed to this patient?

      Your Answer:

      Correct Answer: Metronidazole

      Explanation:

      Metronidazole and the other 5-nitroimidazole agents inhibit nucleic acid synthesis by forming toxic free radical metabolites in the bacterial cell that damage DNA.

      Vancomycin inhibits cell wall peptidoglycan formation by binding the D-Ala-D-Ala portion of cell wall precursors.

      Erythromycin inhibits protein synthesis and blocks translocation by binding to the 23S rRNA of the 50S ribosomal subunit.

      Chloramphenicol blocks peptidyl transferase at 50S ribosomal subunit.

      Gentamicin, an aminoglycoside antibiotic, acts by binding to the 30S subunit of the bacterial ribosome inhibiting the binding of aminoacyl-tRNA and thus preventing initiation of protein synthesis.

      An overview of the different mechanisms of action of the various types of antimicrobial agents is shown below:
      1. Inhibition of cell wall synthesis
      – Penicillins
      – Cephalosporins
      – Vancomycin
      2. Disruption of cell membrane function
      – Polymyxins
      – Nystatin
      – Amphotericin B
      3. Inhibition of protein synthesis
      – Macrolides
      – Aminoglycosides
      – Tetracyclines
      – Chloramphenicol
      4. Inhibition of nucleic acid synthesis
      – Quinolones
      – Trimethoprim
      – 5-nitroimidazoles
      – Rifampicin
      5. Anti-metabolic activity
      – Sulphonamides
      – Isoniazid

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 17 - Which of the following statements is correct regarding gentamicin? ...

    Incorrect

    • Which of the following statements is correct regarding gentamicin?

      Your Answer:

      Correct Answer: Gentamicin is ineffective against anaerobic bacteria.

      Explanation:

      Gentamicin is the aminoglycoside of choice and is a parenterally administered, broad spectrum antibiotic typically used for moderate to severe gram negative infections. However, it is inactive against anaerobes. There is poor activity against haemolytic streptococci and pneumococci. It is usually given in conjunction with a penicillin or metronidazole (or both) when used for the blind treatment of undiagnosed serious infections. Nephrotoxicity and ototoxicity are the main toxic effects due to damage to the vestibulocochlear nerve (CN VIII).

      It is contraindicated in myasthenia gravis and should be used with great care in renal disease as it may result in accumulation and a higher risk of toxic side effects.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 18 - Following a phone call from the microbiology consultant, you evaluate a patient who...

    Incorrect

    • Following a phone call from the microbiology consultant, you evaluate a patient who has been diagnosed with urinary sepsis. Following the results of the blood cultures, he recommends that you add gentamicin to the patient's antibiotic treatment.

      Gentamicin produces its pharmacological effect by binding to which of the following?

      Your Answer:

      Correct Answer: The 30S subunit of the bacterial ribosome

      Explanation:

      Antibiotics with aminoglycosides, such as gentamicin, bind to the 30S subunit of the bacterial ribosome and prevent aminoacyl-tRNA from binding, preventing protein synthesis.

      They also cause mRNA misreading, resulting in the production of non-functional proteins. This last mechanism is unique to aminoglycosides, and it may explain why they are bactericidal rather than bacteriostatic, as other protein synthesis inhibitors are.

      Patients with myasthenia gravis should avoid aminoglycosides since they can disrupt neuromuscular transmission. They cross the placenta and are linked to poisoning of the 8th cranial nerve in the foetus, as well as permanent bilateral deafness.

      It is possible that they will cause deafness, although this is not a contraindication. In individuals with renal impairment, serum aminoglycoside concentrations should be closely monitored, but this is still not considered a contraindication.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 19 - You're currently treating an infection in a patient and trying to figure out...

    Incorrect

    • You're currently treating an infection in a patient and trying to figure out which antibiotic would be best.

      Which of the following antimicrobial drugs inhibits the formation of cell walls?

      Your Answer:

      Correct Answer: Cefuroxime

      Explanation:

      Cefuroxime and other cephalosporin antibiotics are bactericidal ß-lactam antibiotics. They work similarly to penicillins in that they prevent cross-linking between the linear peptidoglycan polymer chains that make up the bacterial cell wall. As a result, they prevent the formation of cell walls.
      The following is a summary of the various mechanisms of action of various types of antimicrobial agents:

      1) Inhibition of cell wall synthesis
      Penicillins
      Cephalosporins
      Vancomycin

      2) Disruption of cell membrane function
      Polymyxins
      Nystatin
      Amphotericin B

      3) Inhibition of protein synthesis
      Macrolides
      Aminoglycosides
      Tetracyclines
      Chloramphenicol

      4) Inhibition of nucleic acid synthesis
      Quinolones
      Trimethoprim
      5-nitroimidazoles
      Rifampicin

      5) Anti-metabolic activity
      Sulphonamides
      Isoniazid

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 20 - Co-amoxiclav is used first line for which of the following indications: ...

    Incorrect

    • Co-amoxiclav is used first line for which of the following indications:

      Your Answer:

      Correct Answer: Animal bite

      Explanation:

      Co-amoxiclav is used first line for infected and prophylaxis of infection in animal and human bites.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 21 - A young female was diagnosed with a urinary tract infection and was sent...

    Incorrect

    • A young female was diagnosed with a urinary tract infection and was sent home with medications. However, after 48 hours of discharge, she returned to the hospital because there had been no relief from her symptoms. The urine sensitivity test report is still unavailable. Fresh blood tests were sent, and her estimated GFR is calculated to be >60 ml/minute.

      She was prescribed nitrofurantoin 100 mg modified-release orally twice a day for two days.

      Out of the following, which antibiotic is most appropriate to be prescribed to this patient?

      Your Answer:

      Correct Answer: Fosfomycin

      Explanation:

      The NICE guidelines for women with lower UTIs who are not pregnant are:
      1. Consider prescribing a different antibiotic if symptoms do not improve within 48 hours or worsen at any time
      2. If the urine culture and susceptibility test results are available, review the choice of antibiotic according to the results and change the antibiotic accordingly if symptoms are not improving or bacteria is resistant to the prescribed antibiotic

      The first choice of antibiotics for non-pregnant women aged 16 years and over is:
      1. Nitrofurantoin
      100 mg modified-release PO BD for 3 days – if eGFR >45 ml/minute
      2. Trimethoprim
      200 mg PO BD for three days

      The second-choice (no improvement in lower UTI symptoms on first-choice for at least 48 hours, or when first-choice is not suitable) are:
      1. Nitrofurantoin
      100 mg modified-release PO BD for three days – if eGFR >45 ml/minute
      2. Pivmecillinam
      400 mg PO initial dose, then 200 mg PO TDS for three days
      3. Fosfomycin 3 g single sachet dose

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 22 - Streptococcus viridans has developed subacute bacterial endocarditis in your patient. Which of the...

    Incorrect

    • Streptococcus viridans has developed subacute bacterial endocarditis in your patient. Which of the following locations is most likely to be the organism's origin?

      Your Answer:

      Correct Answer: Oral cavity

      Explanation:

      Streptococci that are alpha-haemolytic, such as Streptococcus viridans, are major components of the flora in the oral cavity.

    • This question is part of the following fields:

      • Infections
      • Microbiology
      0
      Seconds

  • Question 23 - Following the administration of a drug that was started a few months earlier,...

    Incorrect

    • Following the administration of a drug that was started a few months earlier, a patient presents with features of peripheral neuropathy.

      Which of the following drugs is most likely to cause peripheral neuropathy?

      Your Answer:

      Correct Answer: Isoniazid

      Explanation:

      Isoniazid, a first-line agent for the treatment of tuberculosis, has the commonest side effect of peripheral neuropathy. It occurs in up to 20% of patients taking the drug at a dose > 6 mg/kg daily.

      Isoniazid combines with pyridoxine (vitamin B6) to form hydrazone, which is excreted in the urine. This causes a deficiency of biologically active pyridoxine leading to peripheral neuropathy.

      Peripheral neuropathy of isoniazid is prevented by the co-administration of pyridoxine at a dose of 10 mg for each 100 mg of isoniazid given.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 24 - A 6-year-old girl is brought into the paediatric emergency room by her mother...

    Incorrect

    • A 6-year-old girl is brought into the paediatric emergency room by her mother in a state of high-grade fever and extreme irritability. She is also reluctant to urinate as it is associated with lower abdominal pain and stinging. She has no history of any UTIs requiring antibiotics in the past 12 months.

      The urine sensitivity test report is still unavailable. A clean catch urine sample is taken for urine dipstick, which reveals the presence of blood, protein, leukocytes and nitrites. Fresh blood tests were sent, and her estimated GFR is calculated to be 40 ml/minute.

      Out of the following, which antibiotic is most appropriate to be prescribed to this patient?

      Your Answer:

      Correct Answer: Trimethoprim

      Explanation:

      The NICE guidelines for children and young people under 16 years lower UTIs are:
      1. Get a urine sample before antibiotics are taken, and do a dipstick test OR send for culture and susceptibility
      2. Assess and manage children under 5 with lower UTI with fever as recommended in the NICE guideline on fever in under 5s.
      3. Prescribe an immediate antibiotic prescription and take into account the previous urine culture and susceptibility results, previous antibiotic use, which may have led to resistant bacteria
      4. If urine culture and susceptibility report is sent
      – Review the choice of antibiotic when the results are available AND
      – change the antibiotic according to susceptibility results if the bacteria are resistant and symptoms are not improving, using a narrow-spectrum antibiotic wherever possible

      The choice of antibiotics for non-pregnant young people under 16 years with lower UTI is summarised below:
      1. Children under 3 months:
      – Refer to paediatric specialist and treat with intravenous antibiotic in line with NICE guideline on fever in under 5s
      2. Children over 3 months:
      – First-choice
      Nitrofurantoin – if eGFR >45 ml/minute
      Trimethoprim – (if low risk of resistance*)
      – Second-choice (no improvement in lower UTI symptoms on first-choice for at least 48 hours, or when first-choice not suitable)
      Nitrofurantoin – if eGFR >45 ml/minute and not used as first-choice
      Amoxicillin (only if culture results available and susceptible)
      Cefalexin

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 25 - Regarding benzylpenicillin, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding benzylpenicillin, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: If meningococcal disease is suspected, benzylpenicillin should be given before transfer to hospital.

      Explanation:

      Benzylpenicillin (although inactivated by bacterial beta-lactamases) is effective for many streptococcal (including pneumococcal), gonococcal, and meningococcal infections and also for anthrax, diphtheria, gas gangrene, leptospirosis, and treatment of Lyme disease. If meningococcal disease (meningitis with non-blanching rash or meningococcal septicaemia) is suspected, benzylpenicillin should be given before transfer to hospital, so long as this does not delay the transfer; benzylpenicillin is no longer the drug of first choice for pneumococcal meningitis. Although benzylpenicillin is effective in the treatment of tetanus, metronidazole is preferred. Benzylpenicillin is inactivated by gastric acid and absorption from the gastrointestinal tract is poor and therefore it must be given by injection.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 26 - In a ward round, you come across a patient's treatment chart prescribed an...

    Incorrect

    • In a ward round, you come across a patient's treatment chart prescribed an antibiotic to fight his infection. This antibiotic disrupts cell membrane function.

      Which of the following antimicrobial drugs is prescribed to this patient?

      Your Answer:

      Correct Answer: Nystatin

      Explanation:

      Nystatin binds ergosterol (unique to the fungi cell membrane) and forms membrane pores that allow K+ leakage, acidification, and subsequent death of the fungus.

      Vancomycin inhibits cell wall peptidoglycan formation by binding the D-Ala-D-Ala portion of cell wall precursors.

      Flucloxacillin inhibits the synthesis of bacterial cell walls. It inhibits cross-linkage between the linear peptidoglycan polymer chains that make up a major component of the cell wall of Gram-positive bacteria.

      Trimethoprim inhibits bacterial dihydrofolate reductase.

      Isoniazid decreases the synthesis of mycolic acids in mycobacteria.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 27 - You review a patient with urinary sepsis and decide to start her...

    Incorrect

    • You review a patient with urinary sepsis and decide to start her on gentamicin.

      Which statement about gentamicin is true?

      Your Answer:

      Correct Answer: Ototoxicity is a dose-related effect

      Explanation:

      Gentamicin, an aminoglycoside antibiotic, acts by binding to the 30S subunit of the bacterial ribosome inhibiting the binding of aminoacyl-tRNA, and thus prevents initiation of protein synthesis.

      Gentamicin is given by injection because it is NOT absorbed orally.

      It is excreted in the kidneys by glomerular filtration

      Gentamicin is not to be used for the treatment of Neisseria meningitidis, Neisseria gonorrhoea, or Legionella pneumophila.There is a risk of patient going into shock from lipid A endotoxin release.

      Two of its most notable side effects are hearing loss reversible nephrotoxicity and which are both dose-related and levels should be monitored in patients.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 28 - Which of the following is NOT a notifiable disease: ...

    Incorrect

    • Which of the following is NOT a notifiable disease:

      Your Answer:

      Correct Answer: HIV

      Explanation:

      HIV mainly infects CD4+ T helper cells. Viral replication results in progressive T-cell depletion and impaired cell-mediated immunity with subsequent secondary opportunistic infections and increased risk of malignancy. B-cell function is also reduced as a result of lack of T-cell stimulation.
      HIV is not a notifiable disease.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 29 - A 58-year-old male has cellulitis of his left leg. Because he is allergic to...

    Incorrect

    • A 58-year-old male has cellulitis of his left leg. Because he is allergic to penicillin, you start him on erythromycin.

      What is erythromycin's mechanism of action?

      Your Answer:

      Correct Answer: Inhibition of protein synthesis

      Explanation:

      Bacteriostatic antibiotics include erythromycin and other macrolide antibiotics. They work by attaching to the bacterial ribosome’s 50S subunit, preventing translocation and thereby protein synthesis. Macrolide antibiotics are actively concentrated inside leukocytes and delivered to the infection site as a result.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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  • Question 30 - Regarding macrolide antibiotics, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding macrolide antibiotics, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Macrolides are first line for treatment of whooping cough.

      Explanation:

      A macrolide antibiotic is recommended first line for whooping cough (if onset of cough is within the previous 21 days)
      Prescribe clarithromycin for infants less than 1 month of age.
      Prescribe azithromycin or clarithromycin for children aged 1 month or older, and non-pregnant adults.
      Prescribe erythromycin for pregnant women.
      Macrolides interfere with bacterial protein synthesis and are mainly active against Gram-positive organisms. They have a similar antibacterial spectrum to penicillin and are thus a useful alternative in penicillin-allergic patients. Erythromycin is commonly associated with gastrointestinal upset.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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      Seconds

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