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  • Question 1 - In a ward round, you come across a patient's treatment chart prescribed an...

    Correct

    • In a ward round, you come across a patient's treatment chart prescribed an antibiotic to fight his infection. This antibiotic is a protein synthesis inhibitor.

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

      Your Answer: Gentamicin

      Explanation:

      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.

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

      Penicillins and cephalosporins are the major antibiotics that inhibit bacterial cell wall synthesis. They inactivate transpeptidases that help cross-link peptidoglycans in cell walls.

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

      Ciprofloxacin inhibits prokaryotic enzymes topoisomerase II (DNA gyrase) and topoisomerase IV.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      5251.6
      Seconds

  • Question 2 - Aldin is a 24-year-old male patient who arrives at the emergency department diagnosed...

    Incorrect

    • Aldin is a 24-year-old male patient who arrives at the emergency department diagnosed with psittacosis based on his symptoms and history of being a pigeon enthusiast. Which of the following is the causative bacteria of psittacosis?

      Your Answer: Mycoplasma pneumoniae

      Correct Answer: Chlamydia psittaci

      Explanation:

      Chlamydia psittaci is a microorganism that is commonly found in birds.

      These bacteria can infect people and cause psittacosis. Psittacosis is an infectious disease that may cause high fever and pneumonia associated with headaches, altered mental state, and hepatosplenomegaly.

    • This question is part of the following fields:

      • Infections
      • Microbiology
      17.1
      Seconds

  • Question 3 - You investigated a patient with a chest infection and want to start antibiotics right...

    Incorrect

    • You investigated a patient with a chest infection and want to start antibiotics right away. The patient says they she can't take cephalosporins when you ask about allergies.

      Choose the 'second-generation' cephalosporin from the following choices?

      Your Answer: Ceftriaxone

      Correct Answer: Cefuroxime

      Explanation:

      Cephalosporins of the first generation  include cephalexin, cefradine, and cefadroxil. Urinary tract infections, respiratory tract infections, otitis media, and skin and soft-tissue infections are all treated with them.

      Second-generation cephalosporins include cefuroxime, cefaclor, and cefoxitin. These cephalosporins are less vulnerable to beta-lactamase inactivation than the ‘first-generation’ cephalosporins. As a result, they’re effective against germs that are resistant to other antibiotics, and they’re especially effective against Haemophilus influenzae.

      Cephalosporins of the third generation include cefotaxime, ceftazidime, and ceftriaxone. They are more effective against Gram-negative bacteria than second generation’ cephalosporins. They are, however, less effective against Gram-positive bacteria such Staphylococcus aureus than second-generation cephalosporins.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      12.8
      Seconds

  • Question 4 - Regarding co-amoxiclav, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding co-amoxiclav, which of the following statements is INCORRECT:

      Your Answer: Co-amoxiclav therapy is associated with a risk of developing cholestatic jaundice.

      Correct Answer: Clavulanic acid acts to inhibit cross-linking of bacterial peptidoglycan polymers.

      Explanation:

      Co-amoxiclav consists of amoxicillin with the beta-lactamase inhibitor clavulanic acid. Clavulanic acid itself has no significant antibacterial activity but, by inactivating beta-lactamases, it makes the combination active against beta-lactamase-producing bacteria that are resistant to amoxicillin.The most common adverse effects of co-amoxiclav include nausea, vomiting, skin rash and diarrhoea. Pseudomembranous colitis should be considered if a person develops severe diarrhoea during or after treatment with co-amoxiclav. Cholestatic jaundice can occur either during or shortly after the use of co-amoxiclav. An epidemiological study has shown that the risk of acute liver toxicity was about 6 times greater with co-amoxiclav than with amoxicillin. Cholestatic jaundice is more common in patients above the age of 65 years and in men; these reactions have only rarely been reported in children. Jaundice is usually self-limiting and very rarely fatal.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      1389.1
      Seconds

  • Question 5 - Following a phone call from the microbiology consultant, you evaluate a patient who...

    Correct

    • 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: 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
      18.7
      Seconds

  • Question 6 - Herpes simplex encephalitis has a predilection for which of the following sites: ...

    Incorrect

    • Herpes simplex encephalitis has a predilection for which of the following sites:

      Your Answer: Frontal lobe

      Correct Answer: Temporal lobe

      Explanation:

      Herpes simplex virus is the most common cause of infective encephalitis and has a predilection for the temporal lobes. Herpes simplex is transmitted through direct contact. It invades skin locally producing skin vesicles by its cytolytic activity.

    • This question is part of the following fields:

      • Infections
      • Microbiology
      27.4
      Seconds

  • Question 7 - For which of the following infections is phenoxymethylpenicillin (penicillin V) primarily used? ...

    Correct

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

      Your 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
      19.1
      Seconds

  • Question 8 - Which of the following side effects would you least associated with ciprofloxacin: ...

    Incorrect

    • Which of the following side effects would you least associated with ciprofloxacin:

      Your Answer: Seizures

      Correct Answer: Folate deficiency

      Explanation:

      Common side effects include diarrhoea, dizziness, headache, nausea and vomiting.
      Other adverse effects include: Tendon damage (including rupture), Seizures (in patients with and without epilepsy), QT-interval prolongation, Photosensitivity and Antibiotic-associated colitis

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      38
      Seconds

  • Question 9 - Regarding aciclovir, which of the following statements is INCORRECT: ...

    Correct

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

      Your 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
      17.4
      Seconds

  • Question 10 - A 73-year-old woman arrives at the emergency department 48 hours after being discharged from...

    Incorrect

    • A 73-year-old woman arrives at the emergency department 48 hours after being discharged from the hospital after a two-week stay for sepsis treatment. She has fever, productive cough with thick green sputum, and shortness of breath. An X-ray shows left lower lobe pneumonia. Which of the bacteria listed below is more likely to be the causative agent:

      Your Answer: Streptococcus pneumoniae

      Correct Answer: Pseudomonas aeruginosa

      Explanation:

      Hospital-acquired pneumonia (HAP), or nosocomial pneumonia, is a lower respiratory infection that was not incubating at the time of hospital admission and that presents clinically 2 or more days after hospitalization. Pneumonia that presents sooner should be regarded as community­ acquired pneumonia. VAP refers to nosocomial pneumonia that develops among patients on ventilators. Ventilator-associated pneumonia (VAP) is defined as pneumonia that presents more than 48 hours after endotracheal intubation.

      Common bacteria involved in hospital-acquired pneumonia (HAP) include the following [10] :
      Pseudomonas Aeruginosa
      Staphylococcus aureus, including methicillin-susceptible S aureus (MSSA) and methicillin-resistant S aureus (MRSA)
      Klebsiella pneumoniae
      Escherichia coli

    • This question is part of the following fields:

      • Infections
      • Microbiology
      18
      Seconds

  • Question 11 - Which of the following side effects is most likely caused by erythromycin: ...

    Correct

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

      Your 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
      13.4
      Seconds

  • Question 12 - A 78-year-old man develops renal impairment and hearing loss after inpatient management...

    Correct

    • A 78-year-old man develops renal impairment and hearing loss after inpatient management for sepsis.

      Which of these antibiotics is most likely to have been used?

      Your Answer: Gentamicin

      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.

      Two of its most notable side effects are reversible nephrotoxicity(caused by the inhibition of protein synthesis in renal cells, which causes acute tubular necrosis) and hearing loss (caused by damage to the vestibular apparatus of the inner ear).

      Both side effects are dose-related and occur commonly in the elderly.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      14.2
      Seconds

  • Question 13 - Regarding amoxicillin, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer: It has a similar antibacterial spectrum to ampicillin.

      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
      21.9
      Seconds

  • Question 14 - You need to give your patient antibiotics, so you call microbiology for some advice.

    Of...

    Incorrect

    • You need to give your patient antibiotics, so you call microbiology for some advice.

      Of the following antibacterial drugs, which of them is a protein synthesis inhibitor?

      Your Answer: Cefalexin

      Correct Answer: Erythromycin

      Explanation:

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

      Action Mechanisms- Examples:

      Cell wall production is inhibited
      Vancomycin
      Vancomycin
      Cephalosporins

      The function of the cell membrane is disrupted
      Nystatin
      Polymyxins
      Amphotericin B

      Inhibition of protein synthesis
      Chloramphenicol
      Macrolides
      Aminoglycosides
      Tetracyclines

      Nucleic acid synthesis inhibition
      Quinolones
      Trimethoprim
      Rifampicin
      5-nitroimidazoles
      Sulphonamides
      Anti-metabolic activity
      Isoniazid

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      14.6
      Seconds

  • Question 15 - 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. She is pregnant in her second trimester.

      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: Ciprofloxacin

      Correct Answer: Cefalexin

      Explanation:

      The NICE guidelines for pregnant women with lower UTIs are:
      1. Prescribe an antibiotic immediately, taking into account the previous urine culture and susceptibility results or avoiding past antibiotics that may have caused resistance
      2. Obtain a midstream urine sample before starting antibiotics and send for urine culture and susceptibility
      – Review the choice of antibiotic when the results are available
      – change the antibiotic according to susceptibility results if the bacteria are resistant, using a narrow-spectrum antibiotic wherever possible

      The first choice of antibiotics for pregnant women aged 12 years and over is:
      1. Nitrofurantoin
      100 mg modified-release PO BD for 3 days – if eGFR >45 ml/minute

      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. Amoxicillin
      500 mg PO TDS for seven days (ONLY if culture results available and susceptible)
      2. Cefalexin
      500 mg BD for seven days
      Alternative second-choices – consult local microbiologist, choose antibiotics based on culture and sensitivity results

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      28.5
      Seconds

  • Question 16 - 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: It acts by binding to the 50S subunit

      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
      14.3
      Seconds

  • Question 17 - 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: Erythromycin

      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
      56.8
      Seconds

  • Question 18 - An elderly female has a bacterial infection and you are asked to prescribe...

    Correct

    • 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: 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
      29.8
      Seconds

  • Question 19 - Regarding ampicillin, which of the following statements is CORRECT: ...

    Incorrect

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

      Your Answer: Ampicillin may be used for organisms resistant to amoxicillin.

      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
      99.9
      Seconds

  • Question 20 - 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: Flucloxacillin

      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
      18.8
      Seconds

  • Question 21 - A 30-year-old woman presents with a history of fever and sore throat. On...

    Correct

    • A 30-year-old woman presents with a history of fever and sore throat. On examination, there is tonsillar exudate and cervical lymphadenopathy and a diagnosis of tonsillitis is made. A course of penicillin is prescribed.

      What is the mechanism of action of penicillin?

      Your Answer: Inhibition of cell wall synthesis

      Explanation:

      Penicillin is bactericidal and produces its antimicrobial action by preventing cross-linkage between the linear peptidoglycan polymer chains that make up the bacterial cell wall. This action inhibits cell wall synthesis.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      57
      Seconds

  • Question 22 - A 23-year-old student presents to the emergency department with a terrible headache, photophobia,...

    Incorrect

    • A 23-year-old student presents to the emergency department with a terrible headache, photophobia, and a fever. On her lower limbs, you see a non-blanching purpuric rash. In the department, a lumbar puncture is conducted. What do you think you'll notice on Gram stain:

      Your Answer: Gram positive coccobacilli

      Correct Answer: Gram negative diplococci

      Explanation:

      Bacterial meningitis and septicaemia are most commonly caused by meningococcal bacteria. The Gram-negative diplococci Neisseria Meningitidis causes meningitis. Gram stain and culture of CSF identify the etiologic organism, N meningitidis. In bacterial meningitis, Gram stain is positive in 70-90% of untreated cases, and culture results are positive in as many as 80% of cases.

    • This question is part of the following fields:

      • Infections
      • Microbiology
      20.6
      Seconds

  • Question 23 - Regarding macrolide antibiotics, which of the following statements is CORRECT: ...

    Incorrect

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

      Your Answer: They can not be given to penicillin-allergic patients.

      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
      144.5
      Seconds

  • Question 24 - A 40-year-old man complains of pain and redness in his lower thigh due...

    Correct

    • 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: 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
      7.4
      Seconds

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

    Correct

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

      Your 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
      14.6
      Seconds

  • Question 26 - 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: Cefalexin

      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
      25
      Seconds

  • Question 27 - All of the following statements regarding metronidazole are correct except: ...

    Correct

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

      Your 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
      46.3
      Seconds

  • Question 28 - Regarding penicillin antibiotics, which of the following statements is CORRECT: ...

    Incorrect

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

      Your Answer: Anaphylactic reactions to penicillin occur in about 1 - 10% of treated patients.

      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
      64
      Seconds

  • Question 29 - Fusidic acid is primarily indicated for infections caused by which of the following...

    Correct

    • Fusidic acid is primarily indicated for infections caused by which of the following microorganisms:

      Your Answer: Staphylococcal infections

      Explanation:

      Fusidic acid is a narrow spectrum antibiotic used for staphylococcal infections, primarily topically for minor staphylococcal skin (impetigo) or eye infection. It is sometimes used orally for penicillin-resistant staphylococcal infection, including osteomyelitis or endocarditis, in combination with other antibacterials.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      7.2
      Seconds

  • Question 30 - A patient allergic to penicillin and with marked cellulitis presents and you...

    Incorrect

    • A patient allergic to penicillin and with marked cellulitis presents and you decide to start him on erythromycin.

      Which statement about macrolide antibiotics is true?

      Your Answer: They act by binding to the 30S subunit of the bacterial ribosome

      Correct Answer: They are actively concentrated within leukocytes

      Explanation:

      Macrolide antibiotics are bacteriostatic.

      They act by binding to the 50S subunit of the bacterial ribosome inhibit protein synthesis.

      Macrolide antibiotics are actively concentrated within leukocytes, because of this, they are transported into the site of infection.

      Macrolide antibiotics are not effective in meningitis as they do not penetrate the central nervous system well.

      They are mainly against Gram-positive organisms and can be used as an alternative in patients with penicillin allergy.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      22.4
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Infections (12/30) 40%
Pharmacology (11/25) 44%
Microbiology (1/5) 20%
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