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  • Question 1 - A 6-year-old girl is brought into the paediatric emergency room by her mother...

    Correct

    • 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: 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
      50.1
      Seconds
  • Question 2 - An 11-year-old presented to a GP with a history of headache, neck stiffness...

    Correct

    • 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 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
      55.3
      Seconds
  • Question 3 - 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
      13.6
      Seconds
  • Question 4 - 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: Amoxicillin

      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
      48.1
      Seconds
  • Question 5 - In the Paediatric Emergency Department, you saw a 6-year-old girl with severe bilateral conjunctivitis....

    Correct

    • In the Paediatric Emergency Department, you saw a 6-year-old girl with severe bilateral conjunctivitis. You give her mother some general eye hygiene advice and prescribe chloramphenicol eye drops.

      What is the chloramphenicol's mechanism of action?

      Your Answer: Inhibition of protein synthesis

      Explanation:

      Chloramphenicol is a broad-spectrum antibiotic that inhibits bacterial protein synthesis by blocking the 50S subunit of the bacterial ribosome’s peptidyl transferase activity. When administered systemically, it has limited usage due to the potential of significant side effects such as aplastic anaemia, peripheral neuropathy, and optic neuritis. It’s only used to treat typhoid fever and Haemophilus influenzae meningitis, but it’s usually better to use a broad-spectrum cephalosporin.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      18.8
      Seconds
  • Question 6 - A 23 year old student presents to ED with a widespread maculopapular rash....

    Incorrect

    • A 23 year old student presents to ED with a widespread maculopapular rash. She recently had a sore throat and was started on a course of antibiotics. The most likely antibiotic that she was prescribed is:

      Your Answer: Phenoxymethylpenicillin

      Correct Answer: Amoxicillin

      Explanation:

      Maculopapular rashes are commonly seen with ampicillin and amoxicillin. However they are not usually related to true penicillin allergy. Very often, they occur in patients with glandular fever and so, broad-spectrum penicillins should not be used blindly, for management and treatment of a sore throat. There is also an increased risk of rash in patients with acute or chronic lymphocytic leukaemia or in cytomegalovirus infection.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      20.5
      Seconds
  • Question 7 - Streptococcus viridans has developed subacute bacterial endocarditis in your patient. Which of the...

    Correct

    • 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: 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
      10.9
      Seconds
  • Question 8 - 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: Tetracycline

      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
      26.8
      Seconds
  • Question 9 - A 7-year-old presented to a GP with a history of headache, neck stiffness...

    Correct

    • A 7-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 non-blanching rash on legs and arms. The GP administered a dose of antibiotics before transferring child to the Emergency Department.

      Which of these is the most appropriate antibiotic to administer in this scenario from the choices available?

      Your Answer: Give IM benzylpenicillin 600 mg

      Explanation:

      Meningococcal septicaemia should be suspected in a child with a non-blanching rash especially in the presence of:
      An ill-looking child
      Neck stiffness
      Lesions larger than 2 mm in diameter (purpura)
      Capillary refill time of>3 seconds

      The index child is very sick and shows signs of septic shock. In the prehospital setting, a single dose of benzylpenicillin should be given immediately. The correct dose for this childs age is IM benzylpenicillin 600 mg.

      The recommended doses of benzylpenicillin according to age are:
      Infants <1 year of age: IM or IV benzylpenicillin 300 mg
      Children 1 to 9 years of age: IM or IV benzylpenicillin 600mg
      Children and adults 10 years or older: IM or IV benzylpenicillin 1.2g

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      26.7
      Seconds
  • Question 10 - A 6-year-old child with a few itchy honey crusted sores on her left...

    Incorrect

    • A 6-year-old child with a few itchy honey crusted sores on her left cheek is brought in by her mother. Following a thorough examination of the child, you diagnose impetigo and recommend a course of topical fusidic acid.

      Fusidic acid's mode of action is which of the following?

      Your Answer: Inhibition of cell wall synthesis

      Correct Answer: Inhibition of protein synthesis

      Explanation:

      By binding EF-G-GDP, fusidic acid prevents both peptide translocation and ribosome disassembly, which slows protein synthesis. Because it has a novel structure and mechanism of action, it is unlikely to cause cross-resistance with existing antibiotics.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      23.5
      Seconds
  • Question 11 - Which of the following side effects would you least associated with ciprofloxacin: ...

    Correct

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

      Your 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
      23.1
      Seconds
  • Question 12 - Regarding amoxicillin, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer: It is used first line for acute otitis media.

      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
      24
      Seconds
  • Question 13 - A 46-year-old male who is suffering from a chest infection. You decide to start giving...

    Incorrect

    • A 46-year-old male who is suffering from a chest infection. You decide to start giving the patient antibiotics, however he is allergic to penicillin. You consult with one of your co-workers about the best choice of antibiotic to give.

      From the following choices, which is considered an example of bacteriostatic antibiotic?

      Your Answer: Ciprofloxacin

      Correct Answer: Trimethoprim

      Explanation:

      Antibiotics that are bactericidal kill bacteria, while antibiotics that are bacteriostatic limit their growth or reproduction. The antibiotics grouped into these two classes are summarized in the table below:

      Bactericidal antibiotics
      Bacteriostatic antibiotics

      Vancomycin
      Metronidazole
      Fluoroquinolone, such as ciprofloxacin
      Penicillins, such as benzylpenicillin
      Cephalosporin, such as ceftriaxone
      Co-trimoxazole
      Tetracyclines, such as doxycycline
      Macrolides, such as erythromycin
      Sulphonamides, such as sulfamethoxazole
      Clindamycin
      Trimethoprim
      Chloramphenicol

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      22.2
      Seconds
  • Question 14 - You review a patient with urinary sepsis and decide to start her...

    Correct

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

      Which statement about gentamicin is true?

      Your 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
      17.7
      Seconds
  • Question 15 - 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: Cefalexin

      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
      21.1
      Seconds
  • Question 16 - Fusidic acid is primarily indicated for infections caused by which of the following...

    Incorrect

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

      Your Answer: Streptococcal infections

      Correct 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
      23.7
      Seconds
  • Question 17 - Following the administration of a drug that was started a few months earlier,...

    Correct

    • 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: 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
      9
      Seconds
  • Question 18 - 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
      17.8
      Seconds
  • Question 19 - 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
      28
      Seconds
  • Question 20 - Co-amoxiclav is used first line for which of the following indications: ...

    Correct

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

      Your 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
      9.2
      Seconds
  • Question 21 - 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
      10.8
      Seconds
  • Question 22 - Flucloxacillin is used first line for all of the following infections EXCEPT for:...

    Incorrect

    • Flucloxacillin is used first line for all of the following infections EXCEPT for:

      Your Answer: Septic arthritis

      Correct Answer: Otitis media

      Explanation:

      Flucloxacillin is used first line for treatment of widespread impetigo infection, cellulitis, mastitis, osteomyelitis, septic arthritis, severe erysipelas, severe/spreading otitis externa and infective endocarditis caused by staphylococci. Amoxicillin is first line for acute otitis media.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      22.5
      Seconds
  • Question 23 - 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 disrupts cell membrane function.

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

      Your 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
      18.9
      Seconds
  • Question 24 - Regarding drug interactions with erythromycin, which of the following statements is INCORRECT: ...

    Correct

    • Regarding drug interactions with erythromycin, which of the following statements is INCORRECT:

      Your Answer: Erythromycin decreases plasma levels of warfarin.

      Explanation:

      Erythromycin and clarithromycin inhibit cytochrome P450-mediated metabolism of warfarin, phenytoin and carbamazepine and may lead to accumulation of these drugs. There is an increased risk of myopathy (due to cytochrome P450 enzyme CYP3A4 inhibition) if erythromycin or clarithromycin is taken with atorvastatin or simvastatin. Erythromycin increases plasma concentrations of theophylline, and theophylline may also reduce absorption of oral erythromycin. All macrolides can prolong the QT-interval and concomitant use of drugs that prolong the QT interval is not recommended.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      29.1
      Seconds
  • Question 25 - During her pregnancy, a 28-year-old lady was given an antibiotic. The neonate is...

    Correct

    • During her pregnancy, a 28-year-old lady was given an antibiotic. The neonate is born with bilateral deafness as a result of this.

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

      Your Answer: Gentamicin

      Explanation:

      Aminoglycosides cross the placenta and are linked to poisoning of the 8th cranial nerve in the foetus, as well as permanent bilateral deafness.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      23
      Seconds
  • Question 26 - A 73-year-old woman arrives at the emergency department 48 hours after being discharged from...

    Correct

    • 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: 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
      27.4
      Seconds
  • Question 27 - What is the mechanism of action of penicillin antibiotics: ...

    Correct

    • What is the mechanism of action of penicillin antibiotics:

      Your Answer: Inhibition of bacterial cell wall synthesis

      Explanation:

      Penicillins and the other ß-lactam antibiotics are bactericidal. They produce their antimicrobial action by preventing cross-linkage between the linear peptidoglycan polymer chains that make up the bacterial cell wall. They, therefore, inhibit cell wall synthesis.
      The integrity of the ß-lactam ring is essential for antimicrobial activity. Many bacteria (including most Staphylococci) are resistant to benzylpenicillin and phenoxymethylpenicillin because they produce enzymes (penicillinases, ß-lactamases) that open the ß-lactam ring.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      11.2
      Seconds
  • Question 28 - Aldin is a 24-year-old male patient who arrives at the emergency department diagnosed...

    Correct

    • 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: 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
      15.1
      Seconds
  • Question 29 - Which of the following bacteria is a rod-shaped, oxidase-positive, opportunistic gram-negative bacteria that...

    Incorrect

    • Which of the following bacteria is a rod-shaped, oxidase-positive, opportunistic gram-negative bacteria that can cause a catheter-related urinary tract infection (UTI)?

      Your Answer: Klebsiella pneumoniae

      Correct Answer: Pseudomonas aeruginosa

      Explanation:

      Listeria monocytogenes is a gram-positive bacteria that does not produce spores.

      Staphylococcus aureus is a gram-positive bacteria, while Candida albicans is a gram-positive yeast with a single bud.

      Among the choices, gram-negative bacteria include only Klebsiella pneumoniae and Pseudomonas aeruginosa.

      Pseudomonas aeruginosa is an oxidase-positive bacterium, while Klebsiella pneumoniae is an oxidase-negative bacterium.

      P. aeruginosa can cause urinary tract infections (UTIs) and is spread through poor hygiene or contaminated medical equipment or devices, such as catheters that haven’t been fully sterilized.

    • This question is part of the following fields:

      • Infections
      • Microbiology
      27.1
      Seconds
  • Question 30 - A 22-year-old man comes to the emergency department with a human bite injury to...

    Correct

    • A 22-year-old man comes to the emergency department with a human bite injury to his hand received from a punch during a fight 3 hours earlier outside a bar. On closer inspection, you discover bite marks on his first and second knuckles. Which of the following is the best treatment option for this patient:

      Your Answer: Oral co-amoxiclav for 7 days

      Explanation:

      Even if there is no evidence of infection, prophylactic antibiotics should be administered for all human bite wounds that are less than 72 hours old. The first-line therapy is 7 days of co-amoxiclav. In penicillin-allergic people, metronidazole + doxycycline is an option. Streptococcus spp., Staphylococcus aureus, Haemophilus spp., Eikenella corrodens, Bacteroides spp., and other anaerobes are the most prevalent organisms found in human bites.

    • This question is part of the following fields:

      • Infections
      • Microbiology
      17.4
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Infections (20/30) 67%
Pharmacology (16/25) 64%
Microbiology (4/5) 80%
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