50 multiple choice questions on pharmacology of antiretrovirals and antibiotics (tetracyclines, tuberculosis drugs and fluoroquinololones)

These pharmacoloy questions were submitted by Prof. Dr. Shah Murad, Head of the department, Pharmacology and therapeutics, at Lahore Medical and Dental College.

LAHORE MEDICAL ; DENTAL COLLEGE
Department of Pharmacology &; Therapeutics
5th Periodical Test (Chemotherapy) for 3rd year MBBS
Date 8th   April, 2009
Time allowed:  70 minutes
Total marks 50
NOTE: Choose the best answer

1. An AIDS patient, who is being treated with multiple drugs, develops breast hypertrophy, central adiposity, hyperlipidemia, insulin resistance and nephrolithiasis. If these changes are related to his drug treatment, this drug belongs to which group of anti-retroviral drugs?
a) Nucleoside Reverse Transcriptase Inhibitors (NRTIS)
b) Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIS)
c) Fusion Inhibitors
d) Protease Inhibitors
e) Integrase Inhibitors

1.    A 35 year old HIV positive male patient comes to the OPD with complaint of anorexia, nausea and vomiting and abdominal pain. His abdomen is tender in the epigastric area. Laboratory results reveal a raised serum amylase activity and a preliminary diagnosis is made of acute pancreatitis. Which of the following anti-retroviral drugs has the patient most likely been taking?

a)    Saquinavir
b)    Zidovudine
c)    Didanosine
d)    Efavirenz
e)    Enfuvirtide

2.    A 40 year old HIV positive patient is receiving HAART regimen (Highly active anti-retroviral therapy). Four weeks after initiating therapy, he comes to the emergency department complaining of severe pain in the flank, nausea and frequent urination. Which one of the following drugs is most likely the cause of his symptoms?
a)    Zidovudine
b)    Indinavir
c)    Efavirenz
d)    Nevirapine
e)    Nelfinavir

3.    A 30 year old man is recently diagnosed with HIV and therapy is started. After the first week of therapy, the patient complains of headaches, irritability, and nightmares. Which one of the following anti-retroviral drugs is most likely to be causing these symptoms?
a) Efavirenz
b) Indinavir
c) Lamivudine
d) Nevirapine
e) Stavudine

4.    A 35 year old woman is diagnosed with chronic hepatitis B infection and therapy is initiated. Just after a few hours she comes to the emergency department complaining of fever, chills and muscle aches. Which one of the following drugs most likely caused these symptoms?
a)    Lamivudine
b)    Adefovir
c)    Entecavir
d)    Interferon alfa
e)    Ribavirin

6. A 60 year old man with known history of Parkinson’s disease is to receive prophylaxis against Influenza A virus. He is given a drug that is useful against Parkinson’s disease as well for prophylaxis against influenza. The drug with which of the following mechanisms of action is most likely to have been given?

a) It prevents entry and penetration of the virus
b) It prevents uncoating of the virus
c) It prevents replication of the virus
d) It prevents assembly of newly synthesized virus particles
e) It prevents release of the newly synthesized virus
Q7. Antimicrobial agent of choice for the outpatient treatment of infections due to animal bite wound be:
a) Cefuroxime sodium
b) Amoxicillin/clavulanate potassium
c) Penicillin V
d) Ampicillin sodium/Salbactam sodium
e) Ticarcillin disodium/clavulanate potassium
Q8. An antibiotic is distributed in total body water and has an elimination half life of 45 minutes. Which one of the following statements is consistant with that observation?
a) The drug is stored in high concentration in fat
b) The rapid rate of disappearance rules out metabolism of the drug by the liver
c) The drug is actively transported into tubular urine
d) The drug cannot be bound to plasma proteins
e) The drug is eliminated only by glomerular filtration
Q9. Which one of the following is indicated for treatment of chlamydial urethritis during pregnancy?
a) Amoxicillin (Amoxil)
b) Penicillin V
c) Erythromycin base
d) Doxycycline (Monodox)
e) Tetracycline
Q10. A 25-year-old male has a dental infection associated with facial swelling and lymphadenopathy. Which one of the following is the most appropriate antibiotic?
a) Cephalexin
b) Tetracycline
c) Penicillin (note: watch an animation on penicillin mechanism of action)
d) Erythromycin
e) Gentamicin
Q11. A 16-year-old sexually active nulliparous white female complains of pelvic pain and vaginal discharge. On examination she is found to have a temperature of 39.8° C (102.0° F), pain with movement of the cervix, and tenderness and a mass in the right adnexa. Which one of the following treatment would be appropriate?

a) Outpatient treatment with penicillin G procaine ,intramuscularly; probenecid  orally; plus doxycycline (Vibramycin) orally for 14 days and reexamination in 3 days
b) Outpatient treatment with ceftriaxone intramuscularly; probenecid orally; plus doxycycline twice a day for 14 days and reexamination in 1 week
c) Outpatient treatment with cefoxitin  intramuscularly; plus doxycycline twice a day for 14 days and reexamination in 10 days
d) Hospitalization for treatment with cefoxitin intravenously and doxycycline orally or intravenously, then doxycycline orally twice a day to complete 14 days of treatment
e) Erythromycin 2 grams orally as a single dose
Q12. A drug that may cause nephrotoxicity, is:
a) Penicillin G
b) Erythrocin
c) Gentamycin
d) Cefuroxime
e) Penicillin V
Q13. Which one of the following is a common early side effect of Penicillin?
a) Constipation
b) Loss of appetite
c) Orthostatic hypotension
d) Atrioventricular block
e) Skin rash
Q14. Which of the following might be seen in patient of TB, who has regularly been injecting intramuscular injection of streptomycin:
a)    Depression
b)    Sialorrhea
c)    Increased serum alanine aminotransferase
d)    Priapism
e)    Deafness
Q15. Significant negative interaction has been known to occur between the following drugs if given concurrently:
a) Penicillin G & Penicillin V
b) Penicillin & tetracycline
c) Penicillin & Gentamycin
d) Penicillin & Clavulanic acid
e) Ticarcillin & Clavulanic acid
Q16. Which of the following is NOT a recognized complication of ampicillin toxicity:
a) Hemolytic anemia
b) Diarrhea
c) Nausea
d) Overgrowth of gram-positive organisms
e) Ventricular fibrillation

Q17. Doctor is wrong when he suggests his patient to get drug:
a)    Streptomycin by IV route
b)    Gentamycin by IV route
c)    Neomycin by oral route
d)    Penicillin V by oral route
e)    Cefepime by  IV route

Q18. Telithromycin:
a)    Is structurally related to tetracycline
b)    Is structurally related to beta lactam antibiotics
c)    Is structurally related to aminoglycosides (note: see an animation on aminoglycosides mechanism of action)
d)    Binds more tightly to ribosomes and so it is a poor substrate for bacterial efflux pumps that mediate antibiotic resistance
e)    Is used for UTI

Q19. Doxycycline is used:
a)    for Pneumonia as drug of 1st choice
b)    for the prevention of TB
c)    for the prevention of malaria
d)    for the prevention of leprosy
e)    for the treatment of sexually transmitted diseases

Q20. Clindamycin:
a)    is chemically related to macrolides
b)    binds to 30S ribosomal subunit
c)    is not recommended for oral route
d)    cross-resistance may be observed between macrolides and Clindamycin
e)    is excreted in breast milk

Q21. Which of the following statement is true:
a)    nafcillin is beta-lactamase resistant antibiotic
b)    cefazolin is second generation cephalosporin
c)    tazobactam is used in gonorrhea mainly
d)    penicillin G is contraindicated in infections caused by spirochetes
e)    thrombocytosis is main side effect of Linezolid

Q22.  All of the following statement is true, except:
a)    chloramphenicol is broad spectrum protein synthesis inhibitor
b)    linezolid and streptogramins are narrow spectrum protein synthesis inhibitors
c)    mechanism of resistance to chloramphenicol is plasmid mediated and occurs through the formation of acetyltransferases that inactivate the drug
d)    tetracyclines are narrow spectrum protein synthesis inhibitors
e)    susceptible organisms accumulate tetracyclines intracellularly via energy dependant transport systems in their cell membranes

Q23. in a patient with culture-positive enterococcal endocarditis who has failed to respond to vancomycin because of resistance, the treatment most likely to be effective is:
a)    clarithromicin
b)    erythromycin
c)    linezolid
d)    minocycline
e)    Ticarcillin

Q24. A 24 year old male patient is suffering from peptic ulcer. He was advised anti-peptic ulcer drugs including doxycycline. Which one of the following statements about doxycycline is false?
a)    it is bacteriostatic
b)    it is excreted mainly in the feces
c)    it is used in Lyme disease
d)    it has a long elimination half-life
e)    it is more active than tetracycline against H. Pylori

Q25. A 12 years old female patient came to pediatrician suffering from headache, high grade fever, moderate chest pain, joint pain and drowsy. When doctor got history, he was told to take diazepam 2.5 mg by patient 15 hours ago. Actually it was already a diagnosed case of pneumonia and she was  on drug treatment including streptogramin. Concerning streptogramins, which one of the following statements is false:
a)    they are active against methicillin-resistant staphylococci
b)    they may cause a syndrome of arthralgia and myalgia
c)    they are used in the management of infections caused by vancomycin-resistant enterococci
d)    they are associated with post antibiotic effect
e)    they induce formation of hepatic drug-metabolizing enzymes

Q26. Telithromycin:
a)    is cell wall synthesis inhibitor
b)    is a ketolide structurally related to macrolides
c)    it binds very loosely to ribosomes so it is good substrate for bacterial efflux pumps that mediate resistance
d)    is used in Lyme disease mainly
e)    is used in pneumonia as drug of 1st choice

Q27. Which statement is true about tetracyclines?
a)    resistance mechanisms include decreased activity of the uptake systems and, most importantly, the development of mechanisms like efflux pumps for active extrusion of tetracyclines
b)    is contraindicated in gram-positive bacterial infections
c)    is absolutely contraindicated in  gram-negative bacterial infections
d)    mechanism of action of tetracycline is same as Clindamycin
e)    resistant organisms are killed when tetracycline is used in large doses

Q28. A 33 years old male patient has been diagnosed mycoplsma pneumoniae infection. He was treated by one of the broad spectrum antibacterial drug group tetracycline 2 gram TID for 21 days. What may be most appropriate toxicity?
a)    anemia
b)    hepatic necrosis
c)    thrombocytosis
d)    alopecia
e)    sleeplessness

Q29. an elderly debilitated patient has a fever believed to be due to an infection. He has extensive skin lesions, scrapings of which reveal the presence of large numbers of gram-positive cocci. The most appropriate drug to use for treatment of this patient is:
a)    amoxicillin
b)    salbactam
c)    cefoxitin
d)    nafcillin
e)    penicillin G

Q30. A 21 year old man was seen in a clinic with a complaint of dysuria and urethral discharge of yellow pus. He has a painless clean-base ulcer on the penis and nontender enlargement of the regional lymph nodes. Gram stain of the urethral exudates showed gram negative diplococci within polymorphonucleocytes. The patient informed the clinic staff that he was unemployed and had not eaten a meal for two days. The most appropriate treatment of gonorrhea in this patient is:
a)    amoxicillin orally for 7 days
b)    vancomycin intramuscularly as a single dose
c)    ceftriaxone intramuscularly as a single dose
d)    tetracycline orally for 7 days
e)    procaine penicillin G intramuscularly as a single dose plus one gram of probenecid

Q31. Eighty years old male patient having 73 Kg body weight was suffering from fever, headache and lumbar pain since last 7 days. He was examined in clinic. Gram stain of the smear of CSF revealed gram positive rods resembling diphtheroids. The antibiotic regimen for empiric treatment would include:
a)    Erythromycin
b)    Ticarcillin
c)    Cefotetan
d)    Cefazolin
e)    Ampicillin

Q32. A 25 year old male presents to the medical OPD with complaint of cough and low grade fever since the last 3 months. Laboratory tests show sputum positive for acid fast bacteria. Which of the following combination of drugs is most likely to be administered at the start to this patient?
a)    Streptomycin, Isoniazid, Rifampicin and Pyrazinamide
b)    PAS, Pyrazinamide and Rifampicin
c)    Pyrazinamide, Ethambutol and Isoniazid
d)    Streptomycin and Rifampicin
e)    Streptomycin alone

Q33. A 25 year old male has been given treatment for pulmonary tuberculosis for 2 months as initial phase. Now he comes to the OPD for medication for the continuation phase. Which of the following drugs will he most likely be given for the continuation phase?
a) Pyrazinamide and Isoniazid
b) Ethambutol and Streptomycin
c) Isoniazid and Rifampicin
d) Rifampicin and Streptomycin
e) Ethambutol and Pyrazinamide

Q34. A young man 26 years old is started treated for pulmonary tuberculosis. He comes to the medical OPD after 1 week with complaint of orange red colored urine and sweat and tears. Which of the following drugs is most likely causing these symptoms?
a) Streptomycin
b) Rifampicin
c) Ethambutol
d) Pyrazinamide
e) Thiacetazone

Q35. A 30 year old male with known TB infection and taking medication since 1 month comes to the Eye OPD with complaint of visual disturbances including decreased visibility and slight color blindness. If these symptoms are due to his drug treatment, which one of the following drugs is most likely the cause of his symptoms?
a) Streptomycin
b) Ciprofloxacin
c) Ethambutol
d) Rifampicin
e) Isoniazid

Q36. A 35 year old male recently diagnosed with tuberculosis and is started on medication. After a few days he comes to the emergency department a few hours after taking a meal at McDonald’s with severe pain in the big toe. Blood tests show a very high uric acid level. Which of the following drugs most likely caused these symptoms?
a) Streptomycin
b) Rifampicin
c) Isoniazid
d) Amikacin
e) Pyrazinamide

Q37. A 40 year old male taking medication for tuberculosis since the last 2 months comes to the ENT OPD with complaint of hearing problems and ringing in the years. The drug with which of the following mechanisms of action is most likely causing these symptoms?
a) Binds to 30 S Ribosome subunit & inhibits initiation complex
b) Inhibits DNA Dependent RNA Polymerase
c) Inhibits synthesis of mycolic acid
d) Inhibits synthesis of arabinoglycan subunits
e) Inhibits DNA Gyrase

Q38. A 35 year old female taking medication for tuberculosis and oral contraceptives comes to the Gynaecology OPD with complaint of amenorrhea. Laboratory test shows a positive pregnancy test. Which one of the following drugs most likely caused her to become pregnant?
a) Rifampicin
b) Pyrazinamide
c) Streptomycin
d) Ethambutol
e) Isoniazid

Q39. A 45 year old male with diagnosed chronic liver disease gets infected with the tuberculosis. Which one of the following drugs would be most safe for this patient for the treatment of tuberculosis?
a) Isoniazid
b) Rifampin
c) Pyrazinamide
d) Ethambutol
e) Ethionamide

Q40. A 48 year old male is diagnosed with tuberculosis and has been treated for 2 months with isoniazid and rifampicin with good response. But the patient develops numbness and paresthesias in the extremities. What will you most likely do next?
a) Add pyridoxine
b) Stop isoniazid
c) Add vitamin E
d) Replace rifampin with ethambutol
e) Replace isoniazid with streptomycin

Q41. A 30 year old male presents with history of fever occurring in a step-ladder fashion for the last 10 days. He also feels abdominal pain after taking meals. Lab tests show decreased TLC count and a positive Widal test. The drug which is most likely to be given acts by which one of the following mechanisms?
a) Ciprofloxacin
b) Ampicillin
c) Cotrimoxazole
d) Cefixime
e) Azithromycin

Q42. A 35 year old pregnant woman presents to the gynecology department with complaint of pain with rising fever since the last 5 days. Lab tests show gram negative bacilli and widal test comes out positive. Which one of the following drugs will most likely be administered?
a) Ciprofloxacin
b) Levofloxacin
c) Ofloxacin
d) Norfloxacin
e) Ampicillin

Q43. A 27 year old male football player gets injured in a match. He comes to the emergency department with pain and swelling near the ankle. On examination, there is small wound with a tender swelling near the ankle joint. Further tests reveal tendon rupture with tendonitis setting in. Which one of the following antibiotics, if required, will most probably not be given to this patient?
a) Ceftriaxone
b) Clarithromycin
c) Aminoglycoside
d) Ciprofloxacin
e) Amoxicillin

Q44. A 40 year old male comes to the medical OPD with symptoms of cough & fever for the last few days. Sputum culture shows presence of gram positive cocci. Which one of the following Fluoroquinolones is most likely to be administered to this patient?
a) Ciprofloxacin
b) Norfloxacin
c) Ofloxacin
d) Gatifloxacin
e) Levofloxacin

Q45. A 50 year old patient comes to the emergency department, a day after he has been administered an antibiotic for an on-going infection, with complaint of palpitations. ECG reveals prolonged QT interval. Which one of the following Fluoroquinolones most likely caused this adverse effect?
a) Ciprofloxacin
b) Norfloxacin
c) Levofloxacin
d) Ofloxacin
e) Gatifloxacin

Q46. Disinfectants are:
a) Strong chemical agents that inhibit or kill micro-organisms
b) Agents with sufficient toxicity for host cells
c) They kill both vegetative cells and spores
d) A process intended to kill or remove all types of micro-organisms including spores and include viruses
e) A process that kills non-sporulating microorganisms by hot water or steam at 65-100 C

Q47. A patient with watery stools is diagnosed as suffering from amebic dysentery. He is given a drug that causes a metalic taste in the mouth which drug may be given.
a)    Iodoquinol
b)    Diloxanide furate
c)    Metronidazole
d)    Pentamiline
e)    Emetine.

Q48. The reason for giving Metronidazole for oropharyngeal infection is due to its good activity against:
a)Gram positive cocci
b)Gram Negative cocci
c)Gram positive bacilli
d)Gram negative bacilli
e)Anaerobes like B. fragilis

Q49. Patient comes to emergency with the complaints of marked visual and auditory abnormities, vomiting diarrhea abdominal pain & skin rashes. From the history of the patient it was revealed that he took some drug for the treatment of fever. What could be probable diagnosis?
a)Cinchonism
b)Acute gastro enteritis
c)Cholera
d)Typhoid fever
e)Acid peptic disease

Q50. A 37 year old male is having repeated episodes of fever with chills with blood smear positive for malaria since last one year. He was given chloroquine each time & the fever subsided. Which of the following drugs would you add with chloroquine this time?
a)Artemether
b)Mefloquine
c)Malarone
d)Primaquine
e)Halofantrine

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