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01.0 Module 03 Katzung Questions - Pharmacology
Pharmacology/Nutritional Th (Memorial University of Newfoundland)
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MODULE 03 KATZUNG (10th Edition)
QUESTIONS-PHARMACOLOGY
01.0 BETA-LACTAM ANTIBIOTICS & OTHER
CELL WALL SYNTESIS INHIBITORS
1. The primary mechanism of antibacterial
action of the
penicillins involves inhibition of
(A) Beta-lactamases
(B) N-acetylmuramic acid synthesis
(C) Peptidoglycan cross-linking
(D) Synthesis of cell membranes
(E) Transglycosylation
Questions 2 and 3. A 33-year-old man was
seen in a clinic with a
complaint of dysuria and urethral discharge
of yellow pus. He had
a painless clean-based ulcer on the penis
and nontender enlargement
of the regional lymph nodes. Gram stain of
the urethral
exudate showed gram-negative diplococci
within polymorphonucleocytes.
The patient informed the clinic staff that he
was
unemployed and had not eaten a meal for 2
days.
2. The most appropriate treatment of
gonorrhea in this patient is
(A) Ampicillin orally for 7 d
(B) Ceftriaxone intramuscularly as a single
dose
(C) Procaine penicillin G intramuscularly as a
single dose
plus oral probenecid
(D) Tetracycline orally for 5 d
(E) Vancomycin intramuscularly as a single
dose
3. Immunofluorescent microscopic
examination of fluid
expressed from the penile chancre of this
patient revealed
treponemes. Because he appears to be
infected with Treponema
pallidum, the best course of action would
be to
(A) Administer a single oral dose of
fosfomycin
(B) Give no other antibiotics because drug
treatment of
gonorrhea provides coverage for incubating
syphilis
(C) Inject intramuscular benzathine
penicillin G
(D) Treat with oral tetracycline for 7 d
(E) Treat with vancomycin
4. Which statement about imipenem is
accurate?
(A) Active against methicillin-resistant
staphylococci
(B) Has a narrow spectrum of antibacterial
action
(C) In renal dysfunction, dosage reduction is
necessary to
avoid seizures
(D) Is highly susceptible to beta-lactamases
produced by
Enterobacter species
(E) Is used in fixed combination with
sulbactam
5. A 36-year-old woman recently treated for
leukemia is admitted
to the hospital with malaise, chills, and high
fever. Gram
stain of blood reveals the presence of gramnegative bacilli.
The initial diagnosis is bacteremia, and
parenteral antibiotics
are indicated. The records of the patient
reveal that she had a
severe urticarial rash, hypotension, and
respiratory difficulty
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after oral penicillin V about 6 mo ago. The
most appropriate
drug regimen for empiric treatment is
(A) Aztreonam
(B) Cefazolin
(C) Imipenem
(D) Nafcillin
(E) Ticarcillin plus clavulanic acid
Questions 6–8. A 52-year-old man (weight
70 kg) is brought
to the hospital emergency department in a
confused and delirious
state. He has had an elevated temperature
for more than
24 h, during which time he had complained
of a severe headache
and had suffered from nausea and vomiting.
Lumbar puncture
reveals an elevated opening pressure, and
cerebrospinal fluid findings
include elevated protein, decreased
glucose, and increased
neutrophils. Gram stain of a smear of
cerebrospinal fluid reveals
gram-positive diplococci, and a preliminary
diagnosis is made of
purulent meningitis. The microbiology
report informs you that
for approximately 15% of S pneumoniae
isolates in the community,
the minimal inhibitory concentration for
penicillin G is
20 mcg/mL.
6. Treatment of this patient should be
initiated immediately
with intravenous administration of
(A) Ampicillin-sulbactam
(B) Cefazolin
(C) Cefotaxime plus vancomycin
(D) Nafcillin
(E) Ticarcillin
7. Resistance of pneumococci to penicillin G
is due to
(A) Beta-lactamase production
(C) Changes in porin structure
(D) Changes in the D-Ala-D-Ala building
block of peptidoglycan precursor
(B) Changes in chemical structure of target
penicillinbinding
proteins
an
precursor
(E) Decreased intracellular accumulation of
penicillin G
8. If this patient had been 82 years old and
the Gram stain of the
smear of cerebrospinal fluid had revealed
gram-positive rods
resembling diphtheroids, the antibiotic
regimen for empiric
treatment would include
(A) Ampicillin
(B) Aztreonam
(C) Cefazolin
(D) Fosfomycin
(E) Meropenem
9. A patient needs antibiotic treatment for
native valve, culturepositive
infective enterococcal endocarditis. His
medical
history includes a severe anaphylactic
reaction to penicillin G
during the last year. The best approach
would be treatment
with
(A) Amoxicillin-clavulanate
(B) Aztreonam
(C) Cefazolin plus gentamicin
(D) Meropenem
(E) Vancomycin
10. Which statement about vancomycin is
accurate?
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(A) Active against methicillin-resistant
staphylococci
(B) Bacteriostatic
(C) Binds to penicillin-binding proteins
(PBPs)
(D) Hepatic metabolism
(E) Oral bioavailability
02.0 AMINOGLYCOSIDES
1. Regarding the mechanism of action of
aminoglycosides, the
drugs
(A) Are bacteriostatic
(B) Bind to the 50S ribosomal subunit
(C) Cause misreading of the code on the
mRNA template
(D) Inhibit peptidyl transferase
(E) Stabilize polysomes
2. A 50-kg patient with creatinine clearance
of 80 mL/min has
a gram-negative infection. Amikacin is
administered intramuscularly
at a dose of 5 mg/kg every 8 h, and the
patient
begins to respond. After 2 d, creatinine
clearance declines to
40 mL/min. Assuming that no information is
available about
amikacin plasma levels, what would be the
most reasonable
approach to management of the patient at
this point?
(A) Administer 5 mg/kg every 12 h
(B) Decrease the dosage to a daily total of
200 mg
(C) Decrease the dosage to 125 mg every 8
h
(D) Discontinue amikacin and switch to
gentamicin
(E) Maintain the patient on the present
dosage and test
auditory function
3. All of the following statements about the
clinical uses of the
aminoglycosides are accurate EXCEPT
(A) Effective in the treatment of infections
caused by
Bacteroides fragilis
(B) Gentamicin is used with ampicillin for
synergistic effects
in the treatment of enterococcal
endocarditis
(C) Netilmicin is more likely to be effective
than streptomycin
in the treatment of a hospital-acquired
infection
caused by Serratia marcescens
(D) Often used in combination with
cephalosporins in the
empiric treatment of life-threatening
bacterial infections
(E) Owing to their polar nature,
aminoglycosides are not
absorbed after oral administration
4. Which statement is accurate regarding
the antibacterial action
of gentamicin?
(A) Antibacterial activity is often reduced by
the presence of
an inhibitor of cell wall synthesis
(B) Antibacterial action is not concentrationdependent
(C) Antibacterial action is time-dependent
(D) Efficacy is directly proportional to the
duration of time
that the plasma level is greater than the
minimal inhibitory
concentration
(E) Gentamicin continues to exert
antibacterial effects even
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after plasma levels decrease below
detectable levels
5. An adult patient (weight 60 kg) has
bacteremia suspected to
be due to a gram-negative rod. Tobramycin
is to be administered
using a once-daily dosing regimen, and the
loading
dose must be calculated to achieve a peak
plasma level of
20 mg/L. Assume that the patient has
normal renal function.
Pharmacokinetic parameters of tobramycin
in this patient
are as follows: Vd = 20 L; t1/2 = 3 h; CL = 80
mL/min. What
loading dose should be given?
(A) 100 mg
(B) 200 mg
(C) 400 mg
(D) 600 mg
(E) 800 mg
6. A 67-year-old man is seen in a hospital
emergency department
complaining of pain in and behind the right
ear.
Physical examination shows edema of the
external otic canal
with purulent exudate and weakness of the
muscles on the
right side of the face. The patient informs
the physician that
he is a diabetic. Gram stain of the exudate
from the ear shows
many polymorphonucleocytes and gramnegative rods, and
samples are sent to the microbiology
laboratory for culture
and drug susceptibility testing. A
preliminary diagnosis is
made of external otitis. At this point, which
of the following
is most appropriate?
(A) Amikacin should be administered by
intramuscular injection,
and the patient should be sent home
(B) Analgesics should be prescribed for pain,
but antibiotics
should be withheld pending the results of
cultures
(C) Oral cefaclor should be prescribed
together with analgesics,
and the patient should be sent home
(D) The patient should be hospitalized and
treatment started
with gentamicin plus ticarcillin
(E) The patient should be hospitalized and
treatment started
with intravenous imipenem-cilastatin
7. Regarding the toxicity of aminoglycosides,
which statement is
accurate?
(A) Gentamicin and tobramycin are the least
likely to cause
renal damage
(B) Ototoxicity due to amikacin and
gentamicin includes
vestibular dysfunction that is often
irreversible
(C) Ototoxicity is reduced if loop diuretics
are used to facilitate
aminoglycoside renal excretion
(D) Skin reactions are rare with use of
topical neomycin
(E) With traditional dosage regimens, the
earliest sign of
nephrotoxicity is a reduced blood creatinine
8. This drug has characteristics almost
identical to those of gentamicin
but has much weaker activity in
combination with
penicillin against enterococci.
(A) Amikacin
(B) Erythromycin
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(C) Netilmicin
(D) Spectinomycin
(E) Tobramycin
9. Your 23-year-old female patient is
pregnant and has gonorrhea.
The medical history includes anaphylaxis
following
exposure to amoxicillin. The most
appropriate drug to use is
(A) Azithromycin
(B) Cefixime
(C) Ceftriaxone
(D) Ciprofloxacin
(E) Doxycycline
10. Which statement about “once-daily”
dosing with aminoglycosides
is not accurate?
(A) Convenient for outpatient therapy
(B) Dosage adjustment is less important in
renal insufficiency
(C) Less nursing time is required for drug
administration
(D) Often less toxic than conventional
(multiple) dosing
regimens
(E) Underdosing is less of a problem
03.0 CHLORAMPENICOL, TETRACYCLINE,
MACLORIDE, CLINDAMYCIN, STREPTOMYCIN
& LINEZOID
1. A 2-year-old child is brought to the
hospital after ingesting pills
that a parent had used for bacterial
dysentery when traveling
outside the United States. The child has
been vomiting for
more than 24 h and has had diarrhea with
green stools. He is
now lethargic with an ashen color. Other
signs and symptoms
include hypothermia, hypotension, and
abdominal distention.
The drug most likely to be the cause of this
problem is
(A) Ampicillin
(B) Chloramphenicol
(C) Clindamycin
(D) Doxycycline
(E) Erythromycin
2. The mechanism of antibacterial action of
doxycycline involves
(A) Antagonism of bacterial translocase
activity
(B) Binding to a component of the 50S
ribosomal subunit
(C) Inhibition of DNA-dependent RNA
polymerase
(D) Interference with binding of aminoacyltRNA to bacterial
ribosomes
(E) Selective inhibition of ribosomal peptidyl
transferases
3. Clarithromycin and erythromycin have
very similar spectra of
antimicrobial activity. The major advantage
of clarithromycin
is that it
(A) Does not inhibit hepatic drugmetabolizing enzymes
(B) Eradicates mycoplasmal infections in a
single dose
(C) Has greater activity against M aviumintracellulare complex
(D) Is active against methicillin-resistant
strains of staphylococci
(E) Is active against strains of streptococci
that are resistant to erythromycin
4. The primary mechanism of resistance of
gram-positive
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organisms to erythromycin is
(A) Decreased activity of uptake
mechanisms
(B) Decreased drug permeability of the
cytoplasmic membrane
(C) Formation of drug-inactivating
acetyltransferases
(D) Formation of esterases that hydrolyze
the lactone ring
(E) Methylation of binding sites on the 50S
ribosomal subunit
5. A 26-year-old woman was treated for a
suspected chlamydial
infection at a neighborhood clinic. She was
given a prescription
for oral doxycycline to be taken for 10 d.
Three weeks
later, she returned to the clinic with a
mucopurulent cervicitis.
On questioning she admitted not having the
prescription
filled. The best course of action at this point
would be to
(A) Delay drug treatment until the infecting
organism is
identified
(B) Rewrite the original prescription for oral
doxycycline
(C) Treat her in the clinic with a single oral
dose of cefixime
(D) Treat her in the clinic with a single oral
dose of azithromycin
(E) Write a prescription for oral
erythromycin for 10 d
6. A 55-year-old patient with a prosthetic
heart valve is to
undergo a periodontal procedure involving
scaling and root
planing. Several years ago, the patient had a
severe allergic
reaction to procaine penicillin G. Regarding
prophylaxis
against bacterial endocarditis, which one of
the following
drugs taken orally is most appropriate?
(A) Amoxicillin 10 min before the procedure
(B) Clindamycin 1 h before the procedure
(C) Erythromycin 1 h before the procedure
and 4 h after the
procedure
(D) Vancomycin 15 min before the
procedure
(E) No prophylaxis is needed because this
patient is in the
negligible risk category
Questions 7–9. A 24-year-old woman comes
to a clinic with
complaints of dry cough, headache, fever,
and malaise, which have
lasted 3 or 4 d. She appears to have some
respiratory difficulty, and
chest examination reveals rales but no other
obvious signs of pulmonary
involvement. However, extensive patchy
infiltrates are seen on
chest x-ray film. Gram stain of expectorated
sputum fails to reveal
any bacterial pathogens. The patient
mentions that a colleague at
work has similar symptoms to those she is
experiencing. The patient
has no history of serious medical problems.
She takes loratadine
for allergies and supplementary iron tablets,
and she drinks at least
6 cups of caffeinated coffee per day. The
physician makes an initial
diagnosis of community-acquired
pneumonia.
7. Regarding the treatment of this patient,
which of the following
drugs is most suitable?
(A) Amoxicillin
(B) Clindamycin
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(C) Doxycycline
(D) Linezolid
(E) Vancomycin
8. If this patient were to be treated with the
macrolide erythromycin,
she should
(A) Avoid exposure to sunlight
(B) Avoid taking supplementary iron tablets
(C) Decrease her intake of caffeinated
beverages
(D) Discontinue loratadine temporarily
(E) Have her plasma urea nitrogen or
creatinine checked before treatment
9. A 5-d course of treatment for communityacquired pneumonia
would be effective in this patient with little
risk of drug
interactions if the drug prescribed were
(A) Ampicillin
(B) Azithromycin
(C) Clindamycin
(D) Erythromycin
(E) Vancomycin
10. Concerning quinupristin-dalfopristin,
which statement is
accurate?
(A) Active in treatment of infections caused
by E faecalis
(B) Bacteriostatic
(C) Hepatotoxicity has led to FDA drug alerts
(D) Induce formation of hepatic drugmetabolizing enzymes
(E) Used in management of infections
caused by multidrug resistant
Streptococci
04.0 SULFONAMIDES,TRIMETHOPRIM,
&FLUOROQUINOLONE
1. Trimethoprim-sulfamethoxazole is
established to be effective
against which of the following opportunistic
infections in the
AIDS patient?
(A) Cryptococcal meningitis
(B) Disseminated herpes simplex
(C) Oral candidiasis
(D) Toxoplasmosis
(E) Tuberculosis
2. A 24-year-old woman has returned from
a vacation abroad
suffering from traveler’s diarrhea, and her
problem has not
responded to antidiarrheal drugs. A
pathogenic gram-negative
bacillus is suspected. Which drug is most
likely to be effective
in the treatment of this patient?
(A) Amoxicillin
(B) Ciprofloxacin
(C) Sulfacetamide
(D) Trimethoprim
(E) Vancomycin
3. Which statement about the clinical use of
sulfonamides is
false?
(A) Active against C trachomatis and can be
used topically for
the treatment of chlamydial infections of
the eye
(B) Are not effective as sole agents in the
treatment of
prostatitis
(C) Effective in Rocky Mountain spotted
fever in patients
allergic to tetracyclines
(D) Resistance can occur in some strains of
bacteria because
of increased production of PABA
(E) Some resistant bacterial strains exhibit
decreased intracellular
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accumulation of sulfonamides
4. A 31-year-old man has gonorrhea. He has
no drug allergies,
but a few years ago acute hemolysis
followed use of an antimalarial
drug. The physician is concerned that the
patient has
an accompanying urethritis caused by C
trachomatis, although
no cultures or enzyme tests have been
performed. Which of
the following drugs will be reliably effective
against both
gonococci and C trachomatis and safe to
use in this patient?
(A) Cefixime
(B) Ciprofloxacin
(C) Spectinomycin
(D) Sulfamethoxazole-trimethoprim
(E) None of the above
5. Which statement about the
fluoroquinolones is accurate?
(A) A fluoroquinolone is the drug of choice
for treatment of an
uncomplicated urinary tract infection in a 7year-old girl
(B) Antacids increase the oral bioavailability
of fluoroquinolones
(C) Gonococcal resistance to
fluoroquinolones may involve
changes in DNA gyrase
(D) Modification of moxifloxacin dosage is
required in patients
when creatinine clearance is less than 50
mL/min
(E) The fluoroquinolones are
contraindicated in patients
with hepatic dysfunction
6. A 55-year-old man complains of periodic
bouts of diarrhea with
lower abdominal cramping and intermittent
rectal bleeding.
Seen in the clinic, he appears well
nourished, with blood
pressure in the normal range. Examination
reveals moderate
abdominal pain and tenderness. His current
medications
are limited to loperamide for his diarrhea.
Sigmoidoscopy
reveals mucosal edema, friability, and some
pus. Laboratory
findings include mild anemia and decreased
serum albumin.
Microbiologic examination via stool cultures
and mucosal
biopsies do not reveal any evidence for
bacterial, amebic, or
cytomegalovirus involvement. The most
appropriate drug to
use in this patient is
(A) Amoxicillin
(B) Ciprofloxacin
(C) Doxycycline
(D) Sulfasalazine
(E) Trimethoprim-sulfamethoxazole
7. Which adverse effect is most likely to
occur with sulfonamides?
(A) Fanconi’s aminoaciduria syndrome
(B) Hematuria
(C) Kernicterus in the newborn
(D) Neurologic dysfunction
(E) Skin reactions
8. Which drug is effective in the treatment
of nocardiosis and,
in combination with pyrimethamine, is
prophylactic against
Pneumocystis jiroveci infections in AIDS
patients?
(A) Amoxicillin
(B) Ciprofloxacin
(C) Clindamycin
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(D) Sulfadiazine
(E) Trimethoprim
(D) Provide prophylaxis against other
bacterial infections
(E) Reduce the incidence of adverse effects
9. Which statement about ciprofloxacin is
accurate?
(A) Active against most MRSA strains of
staphylococci
(B) Antagonism occurs if it is used with
inhibitors of
dihydrofolate reductase
(C) During treatment, tendinitis and even
tendon rupture
may occur
(D) Most “first-time” urinary tract infections
are resistant to
ciprofloxacin
(E) Organisms associated with middle ear
infections are highly
Resistant
10. Supplementary folinic acid may prevent
anemia in folatedeficient
persons who use this drug; it is a weak base
achieving
tissue levels similar to those in plasma
(A) Ciprofloxacin
(B) Moxifloxacin
(C) Sulfacetamide
(D) Sulfamethoxazole
(E) Trimethoprim
05.0 ANTIMYCOBACTERIAL DRUGS
1. The primary reason for the use of drug
combinations in the
treatment of tuberculosis is to
(A) Delay or prevent the emergence of
resistance
(B) Ensure patient compliance with the drug
regimen
(C) Increase antimycobacterial activity
synergistically
Questions 2–5. A 21-year-old woman from
Southeast Asia has
been staying with family members in the
United States for the last
3 mo and is looking after her sister’s
preschool children during the
day. Because she has difficulty with the
English language, her sister
escorts her to the emergency department
of a local hospital. She
tells the staff that her sister has been feeling
very tired for the last
month, has a poor appetite, and has lost
weight. The patient has
been feeling somewhat better lately except
for a cough that produces
a greenish sputum, sometimes specked with
blood. With the
exception of rales in the left upper lobe, the
physical examination
is unremarkable and she does not seem to
be acutely ill. Laboratory
values show a white count of 12,000/L
and a hematocrit of 33%.
Chest x-ray film reveals an infiltrate in the
left upper lobe with a
possible cavity. A Gram-stained smear of the
sputum shows mixed
flora with no dominance. An acid-fast stain
reveals many thin rods
of pinkish hue. A preliminary diagnosis is
made of pulmonary
tuberculosis. Sputum is sent to the
laboratory for culture.
2. At this point, the most appropriate course
of action is to
(A) Hospitalize the patient and start
treatment with isoniazid
plus rifampin
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(B) Hospitalize the patient and start
treatment with 4 antimycobacterial
drugs
(C) Prescribe isoniazid for prophylaxis and
send the patient
home to await culture results
(D) Prescribe no drugs and send the patient
home to await
culture results
(E) Treat the patient with isoniazid plus
rifampin
3. Which drug regimen should be initiated
in this patient when
treatment is started?
(A) Amikacin, isoniazid, pyrazinamide,
streptomycin
(B) Ciprofloxacin, cycloserine, isoniazid, PAS
(C) Ethambutol, isoniazid, ofloxacin,
streptomycin
(D) Ethionamide, pyrazinamide, rifampin,
streptomycin
(E) Isoniazid, rifampin, pyrazinamide,
ethambutol
4. Which statement concerning the possible
use of isoniazid
(INH) in this patient is false?
(A) A lower maintenance dose than usual is
required in a
patient from Southeast Asia
(B) Flushing, sweating, dyspnea, and
palpitations may occur
after ingestion of tyramine-containing foods
(C) Peripheral neuritis may occur during
treatment
(D) The patient should take pyridoxine daily
(E) The risk of the patient developing
hepatitis from INH is
less than 2%
5. On her release from the hospital, the
patient is advised not
to rely solely on oral contraceptives to
prevent pregnancy
because they may be less effective while
she is being maintained
on antimycobacterial drugs. The agent most
likely to
interfere with the action of oral
contraceptives is
(A) Amikacin
(B) Ethambutol
(C) Isoniazid
(D) Pyrazinamide
(E) Rifampin
6. A patient with AIDS and a CD4 cell count
of 100/L has
persistent fever and weight loss associated
with invasive pulmonary
disease due to M avium complex (MAC).
Optimal
management of this patient is to
(A) Select an antibiotic based on drug
susceptibility of the
cultured organism
(B) Start treatment with INH and
pyrazinamide
(C) Treat with rifabutin because it prevents
the development
of MAC bacteremia
(D) Treat with the combination of
clarithromycin, ethambutol,
and rifabutin
(E) Treat with trimethoprimsulfamethoxazole
7. A 10-year-old boy has uncomplicated
pulmonary tuberculosis.
After initial hospitalization, he is now being
treated at
home with isoniazid, rifampin, and
ethambutol. Which statement
about this case is accurate?
(A) A baseline auditory function test is
essential before drug
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treatment is initiated
(B) His mother, who takes care of him, does
not need INH
prophylaxis
(C) His 3-year-old sibling should receive INH
prophylaxis
(D) The patient may develop symptoms of
polyarthralgia
caused by rifampin
(E) The potential nephrotoxicity of the
prescribed drugs
warrants periodic assessment of renal
function
8. Which statement about antitubercular
drugs is accurate?
(A) Antimycobacterial actions of
streptomycin involve inhibition
of arabinosyl transferases
(B) Cross-resistance of M tuberculosis to
isoniazid and
pyrazinamide is common
(C) Ocular toxicity of ethambutol is
prevented by thiamine
(D) Pyrazinamide treatment should be
discontinued immediately
if hyperuricemia occurs
(E) Resistance to ethambutol involves
mutations in the emb gene
9. Once weekly administration of which of
the following antibiotics
has prophylactic activity against bacteremia
caused by
M avium complex in AIDS patients?
(A) Azithromycin
(B) Clarithromycin
(C) Ethambutol
(D) Kanamycin
(E) Rifabutin
10. Risk factors for multidrug-resistant
tuberculosis include
(A) A history of treatment of tuberculosis
without rifampin
(B) Recent immigration from Asia and living
in an area of
over 4% isoniazid resistance
(C) Recent immigration from Latin America
(D) Residence in regions where isoniazid
resistance is known
to exceed 4%
(E) All of the above
06.0 ANTIFUNGAL AGENTS
1. Interactions between this drug and cell
membrane components
can result in the formation of pores lined by
hydrophilic
groups present in the drug molecule.
(A) Amphotericin B
(B) Flucytosine
(C) Griseofulvin
(D) Itraconazole
(E) Terbinafine
2. Which statement about fluconazole is
accurate?
(A) Does not penetrate the blood-brain
barrier
(B) Has the least effect of all azoles on
hepatic drug
metabolism
(C) Is an inducer of hepatic drugmetabolizing enzymes
(D) Is highly effective in the treatment of
aspergillosis
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(E) Oral bioavailability is less than that of
ketoconazole
Questions 3–5. A 37-year-old woman with
leukemia was undergoing
chemotherapy with intravenous
antineoplastic drugs. During
treatment, she developed a systemic
infection from an opportunistic
pathogen. There was no erythema or
edema at the catheter
insertion site. A white vaginal discharge was
observed. After appropriate
specimens were obtained for culture,
empiric antibiotic
therapy was started with gentamicin,
nafcillin, and ticarcillin intravenously.
This regimen was maintained for 72 h,
during which
time the patient’s condition did not improve
significantly. Her
throat was sore, and white plaques had
appeared in her pharynx.
On day 4, none of the cultures had shown
any bacterial growth,
but both the blood and urine cultures grew
out Candida albicans.
3. At this point, the best course of action is
to
(A) Continue current antibiotics and start
amphotericin B
(B) Continue current antibiotics and start
flucytosine
(C) Stop current antibiotics and start
amphotericin B
(D) Stop current antibiotics and start
ketoconazole
(E) Stop current antibiotics and start
terbinafine
4. If amphotericin B is administered, the
patient should be premedicated
with
(A) Diphenhydramine
(B) Ibuprofen
(C) Prednisone
(D) Any or all of the above
(E) None of the above
5. Candida is a major cause of nosocomial
bloodstream infection.
The opportunistic fungal infection in this
patient could
have been prevented by administration of
(A) Caspofungin
(B) Fluconazole
(C) Nystatin
(D) Posaconazole
(E) None of the above
Questions 6 and 7. A 28-year-old man living
on the East Coast
was transferred by his employer to central
California for several
months. On his return, he complains of
having influenza-like
symptoms with fever and a cough. He also
has red, tender nodules
on his shins. His physician suspects that
these symptoms are due
to coccidioidomycosis contracted during his
stay in California.
6. This patient should be treated
immediately with
(A) Amphotericin B
(B) Caspofungin
(C) Terbinafine
(D) Voriconazole
(E) None of these drugs
7. Which is the drug of choice if this patient
is suffering from
persistent lung lesions or disseminated
disease caused by
Coccidioides immitis?
(A) Amphotericin B
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(B) Fluconazole
(C) Ketoconazole
(D) Micofungin
(E) Terbinafine
07.0 ANTIVIRAL CHEMOTHERAPY &
PROPHYLAXIS
8. Which drug is least likely to be effective in
the treatment of
esophageal candidiasis if it is used by the
oral route?
(A) Clotrimazole
(B) Fluconazole
(C) Griseofulvin
(D) Itraconazole
(E) Nystatin
9. Serious cardiac effects have occurred
when this drug was taken
by patients using the antihistamines
astemizole or terfenadine
(A) Amphotericin B
(B) Fluconazole
(C) Griseofulvin
(D) Ketoconazole
(E) Terbinafine
10. Regarding the clinical use of liposomal
formulations of
amphotericin B, which statement is
accurate?
(A) Amphotericin B affinity for these lipids is
greater than
affinity for ergosterol
(B) Less expensive to use than conventional
amphotericin B
(C) More effective in fungal infections
because they increase
tissue uptake of amphotericin B
(D) They decrease the nephrotoxicity of
amphotericin B
(E) They have a wider spectrum of
antifungal activity than
conventional formulations of amphotericin
B
1. Which statement about the mechanisms
of action of antiviral
drugs is accurate?
(A) Acyclovir has no requirement for
activation by
phosphorylation
(B) An increase in activity of host cell
ribonucleases that
degrade viral mRNA is one of the antiviral
actions of
interferon-alpha
(C) Ganciclovir inhibits viral DNA
polymerase but does not
cause chain termination
(D) The initial step in activation of foscarnet
in HSVinfected
cells is its phosphorylation by thymidine
kinase
(E) The reverse transcriptase of HIV is 30–50
times more
sensitive to inhibition by fosamprenavir
than host cell
DNA polymerases
Questions 2 and 3. A 30-year-old male
patient who is HIVpositive
and symptomatic has a CD4 count of
250/L and a viral
RNA load of 15,000 copies/mL. His
treatment involves a 3-drug
antiviral regimen consisting of zidovudine,
didanosine, and ritonavir.
In addition, the patient is taking oral
valacyclovir for a
herpes infection and ketoconazole for oral
candidiasis. Because of
weight loss, he is taking dronabinol. In
addition, verapamil has
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been prescribed because he suffers from
angina. He now complains
of anorexia, nausea and vomiting, and
abdominal pain. His
abdomen is tender in the epigastric area.
Laboratory results reveal
an amylase activity of 220 units/L, and a
preliminary diagnosis is
made of acute pancreatitis.
(B) Treat with single doses of ritonavir and
zidovudine
(C) Treat with full doses of zidovudine for 2
wk
(D) Treat with full doses of zidovudine for 4
wk
(E) Treat with zidovudine plus lamivudine
plus a protease
inhibitor for 4 wk
2. If this patient has acute pancreatitis, the
drug most likely to
be responsible is
(A) Didanosine
(B) Ketoconazole
(C) Ritonavir
(D) Valacyclovir
(E) Zidovudine
Questions 5 and 6. A patient with AIDS has
a CD4 count of
45/L. He is being maintained on a 3-drug
regimen of indinavir,
didanosine, and zidovudine. For prophylaxis
against opportunistic
infections, he is also receiving ganciclovir,
fluconazole, rifabutin,
and trimethoprim-sulfamethoxazole.
3. In the further treatment of this patient,
the drug causing the
pancreatitis should be withdrawn and
replaced by
(A) Atazanavir
(B) Cidofovir
(C) Foscarnet
(D) Lamivudine
(E) Ribavirin
4. In an accidental needlestick, an unknown
quantity of blood
from an AIDS patient is injected into a
resident physician.
The most recent laboratory report on the
AIDS patient shows
a CD4 count of 20/mcL and a viral RNA load
of greater than
107 copies/mL. The most appropriate
course of action regarding
treatment of the resident is to
(A) Monitor the resident’s blood to
determine whether HIV
transmission has occurred
5. The drug most likely to suppress herpetic
infections and provide
prophylaxis against CMV retinitis in this
patient is
(A) Fluconazole
(B) Ganciclovir
(C) Indinavir
(D) Rifabutin
(E) Trimethoprim-sulfamethoxazole
6. The dose of indinavir in this patient may
need to be increased
above normal. This is because
(A) Fluconazole slows gastric emptying
(B) Ganciclovir increases the renal clearance
of indinavir
(C) Indinavir has to be taken with meals
(D) Rifabutin increases liver drugmetabolizing enzymes
(E) Sulfamethoxazole displaces indinavir
from plasma proteins
7. A 27-year-old nursing mother is
diagnosed as suffering
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from genital herpes. She has a history of
this viral infection.
Previously, she responded to a drug used
topically. Apart from
her current problem, she is in good health.
Which drug to be
used orally is most likely to be prescribed at
this time?
(A) Amantadine
(B) Foscarnet
(C) Ritonavir
(D) Trifluridine
(E) Valacyclovir
8. Oral formulations of this drug should not
be used in a pregnant
AIDS patient because they contain
propylene glycol.
One of the characteristic adverse effects of
the drug is hyperpigmentation
on the palms of the hands and soles of the
feet
especially in African-American patients.
(A) Amprenavir
(B) Efavirenz
(C) Emtricitabine
(D) Enfuvirtide
(E) Zalcitabine
9. Regarding interferon-alpha, which of the
following statements is
false?
(A) At the start of treatment, most patients
experience flu-like
symptoms
(B) Indications include treatment of genital
warts
(C) It is used in the management of hepatitis
B and C
(D) Lamivudine interferes with its activity
against hepatitis B
(E) Toxicity includes bone marrow
suppression
10. More than 90% of this drug is excreted
in the urine in intact
form. Because its urinary solubility is low,
patients should
be well hydrated to prevent nephrotoxicity.
Which drug is
described?
(A) Acyclovir
(B) Efavirenz
(C) Indinavir
(D) Trifluridine
(E) Zidovudine
08.0 MISCELLANEOUS ANTIMICROBIAL
AGENTS & URINARY ANTISEPTICS
1. Infections caused by gram-negative bacilli
have occurred when
this cationic surfactant has been used as a
skin antiseptic.
(A) Acetic acid
(B) Cetylpyridinium chloride
(C) Hexachlorophene
(D) Merbromin
(E) Thimerosal
Questions 2 and 3. A young woman is
brought to a hospital emergency
department with intense abdominal pain of
2 d duration.
The pain has spread to the right lower
quadrant and is accompanied
by nausea, vomiting, and fever. She arrives
at the emergency
department with a blood pressure of 85/45,
pulse 120/min, and
temperature 40C. Her abdomen has a
board-like rigidity with
diffuse pain to palpation. Laboratory values
include the following:
WBC 20,000/L and creatinine 1.5 mg/dL.
After abdominal
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x-ray films are taken, a preliminary diagnosis
of abdominal sepsis
is made, possibly resulting from bowel
perforation. After appropriate
samples are sent to the laboratory for
culture, the patient is
hospitalized, and antimicrobial therapy is
started with intravenous
ampicillin and gentamicin.
2. Regarding the treatment of this patient,
which statement is
accurate?
(A) A Gram stain of the blood would provide
positive identification
of the specific organism involved in this
infection
(B) Cultures are pointless because this is
probably a mixed
infection
(C) Empiric antimicrobial therapy of
abdominal sepsis
should always include a third-generation
cephalosporin
(D) The antibiotic regimen should include a
drug active
against anaerobes
(E) The combination of ampicillin and
gentamicin provides
good coverage for all likely pathogens
3. If the antibiotic regimen in this patient is
modified to include
metronidazole
(A) Ampicillin should be excluded from the
regimen
(B) Coverage will be extended to methicillinresistant
staphylococci
(C) Gentamicin should be excluded from the
regimen
(D) Metronidazole should not be
administered intravenously
(E) The patient should be monitored for
candidiasis
4. Which compound is used topically to
treat scabies and
pediculosis?
(A) Benzoyl peroxide
(B) Chlorhexidine
(C) Mupirocin
(D) Permethrin
(E) Silver sulfadiazine
5. Methenamine salts are used as urinary
antiseptics. The reason
they lack systemic antibacterial action is
that they are
(A) Converted to formaldehyde only at low
pH
(B) Metabolized rapidly by hepatic drugmetabolizing enzymes
(C) More than 98% bound to plasma
proteins
(D) Not absorbed into the systemic
circulation after oral
ingestion
(E) Substrates for active tubular secretion
6. Which statement about the actions of
antimicrobial agents is
false?
(A) Daptomycin has activity against strains
of staphylococci
resistant to vancomycin.
(B) Neonatal gonococcal ophthalmia can be
prevented by
silver nitrate
(C) Polymyxins act as cationic detergents to
disrupt bacterial
cell membranes
(D) Resistance to nitrofurantoin emerges
rapidly, and there is
cross-resistance with sulfonamides
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(E) Salicylic acid has useful
antidermatophyte activity when applied
topically.
7. Which antiseptic promotes wound
healing?
(A) Benzalkonium chloride
(B) Chlorhexidine
(C) Hexachlorophene
(D) Iodine
(E) None of the above
8. A 22-year-old man with gonorrhea is to
be treated with
cefixime and will need another drug to
provide coverage for
possible urethritis caused by C trachomatis.
Which of the following
drugs is least likely to be effective in
nongonococcal
urethritis?
(A) Azithromycin
(B) Clindamycin
(C) Nitrofurantoin
(D) Ofloxacin
(E) Tetracycline
9. A patient with AIDS has an extremely high
viral RNA titer.
While blood is being drawn from this
patient, the syringe is
accidentally dropped, contaminating the
floor, which is made
of porous material. The best way to deal
with this is to
(A) Clean the floor with a 10% solution of
household bleach
(B) Clean the floor with soap and water
(C) Completely replace the contaminated
part of the floor
(D) Neutralize the spill with a solution of
potassium
permanganate
(E) Seal the room and decontaminate with
ethylene oxide
10. Neuropathies are more likely to occur
with this agent when
it is used in patients with renal dysfunction.
The drug may
cause acute hemolysis in patients with
glucose-6-phosphate
dehydrogenase (G6PD) deficiency.
(A) Chlorhexidine
(B) Halazone
(C) Methenamine
(D) Metronidazole
(E) Nitrofurantoin
09.0 CLINICAL USE OF ANTIMICROBIALS
Questions 1–3. A hospitalized AIDS patient
is receiving antiretroviral
drugs but no antimicrobial prophylaxis. He
develops sepsis
with fever, suspected to be caused by a
gram-negative bacillus.
1. Antimicrobial treatment of this severely
immune-depressed
patient should not be initiated before
(A) Antipyretic drugs have been given to
reduce body
temperature
(B) Infecting organism(s) have been
identified by the microbiology
laboratory
(C) Results of a Gram stain are available
(D) Results of antibacterial drug
susceptibility tests are
available
(E) Specimens have been taken for
laboratory tests and
Examinations
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2. If the aminoglycoside gentamicin is used
in the treatment of
this patient, monitoring of serum drug level
may be advised
because the drug
(A) Does not penetrate into cerebrospinal
fluid
(B) Has a narrow therapeutic window
(C) Is antagonized by beta-lactam antibiotics
(D) Is metabolized by hepatic enzymes
(E) Is hematotoxic
3. A combination of drugs might be given to
this patient to
provide coverage against multiple
organisms or to obtain a
synergistic action. Examples of antimicrobial
drug synergism
established at the clinical level include
(A) Amphotericin B with flucytosine in
cryptococcal
meningitis
(B) Carbenicillin with gentamicin in
pseudomonal infections
(C) Rifampin with vancomycin in
enterococcal infections
(D) Trimethoprim with sulfamethoxazole in
coliform infections
(E) All of the above
Questions 4 and 5. A 27-year-old pregnant
patient with a
history of pyelonephritis has developed a
severe upper respiratory
tract infection that appears to be due to a
bacterial pathogen. The
woman is hospitalized, and an antibacterial
agent is to be selected
for treatment.
4. Assuming that the physician is concerned
about the effects of
renal impairment on drug dosage in this
patient, which drug
would not require dosage modification in
renal dysfunction?
(A) Amikacin
(B) Erythromycin
(C) Ofloxacin
(D) Trimethoprim-sulfamethoxazole
(E) Vancomycin
5. Which antibacterial agent appears to be
the safest to use in the
pregnant patient?
(A) Azithromycin
(B) Clarithromycin
(C) Kanamycin
(D) Sulfadiazine
(E) Tetracycline
Questions 6 and 7. A 48-year-old patient is
scheduled for a
vaginal hysterectomy. An antimicrobial drug
will be used for
prophylaxis against postoperative infection.
It is proposed that
cefazolin, a first-generation cephalosporin,
be given intravenously
at the normal therapeutic dose immediately
before surgery and
continued until the patient is released from
the hospital.
6. Which statement about the proposed
drug management of
this patient is not accurate?
(A) Enteric gram-negative rods, anaerobes,
enterococci, and
group B streptococci are likely pathogens
(B) In this type of surgical procedure,
antimicrobial
prophylaxis has documented efficacy
(C) Nosocomial (hospital-acquired) infection
will be
prevented by treatment throughout the
period of
hospitalization
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(D) This drug will not be effective against
anaerobes
(E) Without prophylaxis, the infection rate
following this
procedure exceeds 5% under optimal
conditions
7. If the patient had been scheduled for
elective colonic surgery,
optimal prophylaxis against infection would
be achieved by
mechanical bowel preparation and the use
of
(A) Intravenous cefotetan
(B) Intravenous third-generation
cephalosporin
(C) Oral ampicillin
(D) Oral fluoroquinolone
(E) Oral neomycin and erythromycin
8. Which drug increases the hepatic
metabolism of other drugs?
(A) Clarithromycin
(B) Erythromycin
(C) Ketoconazole
(D) Rifampin
(E) Ritonavir
9. If ampicillin and piperacillin are used in
combination in the
treatment of infections resulting from
Pseudomonas aeruginosa,
antagonism may occur. The most likely
explanation is
that
(A) Ampicillin is bacteriostatic
(B) Ampicillin induces beta-lactamase
production
(C) Autolytic enzymes are inhibited by
piperacillin
(D) Piperacillin blocks the attachment of
ampicillin to
penicillin-binding proteins
(E) The 2 drugs form an insoluble complex
10. In a patient suffering from
pseudomembranous colitis due to
C difficile with established hypersensitivity
to metronidazole
the most likely drug to be of clinical value is
(A) Chloramphenicol
(B) Clindamycin
(C) Doxycycline
(D) Levofloxacin
(E) Vancomycin
10.0 ANTIPROTOZOAL DRUGS
1. Which statement about antiprotozoal
drugs is accurate?
(A) Chloroquine is an inhibitor of plasmodial
dihydrofolate
reductase
(B) Mefloquine destroys secondary
exoerythrocytic schizonts
(C) Primaquine is a blood schizonticide and
does not affect
secondary tissue schizonts
(D) Proguanil complexes with doublestranded DNA-blocking
replication
(E) Trimethoprim-sulfamethoxazole is the
drug of choice for
Pneumocystis jiroveci pneumonia
2. Plasmodial resistance to chloroquine is
due to
(A) Change in receptor structure
(B) Increase in the activity of DNA repair
mechanisms
(C) Increased synthesis of dihydrofolate
reductase
(D) Induction of drug-inactivating enzymes
(E) Reduced accumulation of the drug in the
food vacuole
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Questions 3–5. A traveler in a geographical
region where chloroquineresistant P falciparum is endemic used a
drug for prophylaxis
but nevertheless developed a severe attack
of P vivax malaria.
3. The drug taken for chemoprophylaxis was
probably
(A) Atovaquone
(B) Diloxanide furoate
(C) Mefloquine
(D) Proguanil
(E) Quinine
4. Which drug should be used for oral
treatment of the acute
attack of P vivax malaria but does not
eradicate exoerythrocytic
forms of the parasite?
(A) Chloroquine
(B) Mefloquine
(C) Primaquine
(D) Pyrimethamine-sulfadoxine
(E) Quinidine
5. Which drug should be given later to
eradicate schizonts and
latent hypnozoites in the patient’s liver?
(A) Amodiaquine
(B) Halofantrine
(C) Primaquine
(D) Quinine
(E) Sulfadoxine
Questions 6 and 7. A male patient presents
with lower
abdominal discomfort, flatulence, and
occasional diarrhea. A
diagnosis of intestinal amebiasis is made,
and E histolytica is
identified in his diarrheal stools. An oral
drug is prescribed,
which reduces his intestinal symptoms.
Later he presents with
severe dysentery, right upper quadrant
pain, weight loss, fever,
and an enlarged liver. Amebic liver abscess
is diagnosed, and
the patient is hospitalized. He has a recent
history of drug
treatment for a tachyarrhythmia.
6. The preferred treatment that he should
have received for the
initial symptoms (which were indicative of
mild to moderate
disease) is
(A) Diloxanide furoate
(B) Iodoquinol
(C) Metronidazole
(D) Metronidazole plus diloxanide furoate
(E) Paromomycin
7. The drug regimen most likely to be
effective in treating severe
extraintestinal disease in this patient is
(A) Chloroquine
(B) Diloxanide furoate plus iodoquinol
(C) Emetine plus diloxanide furoate plus
chloroquine
(D) Pentamidine followed by mefloquine
(E) Tinidazole plus diloxanide furoate
8. After a backpacking trip in the mountains,
a 24-year-old
man develops diarrhea. He acknowledges
drinking stream
water without purification, and you suspect
he is showing
symptoms of giardiasis. Because you know
that laboratory
detection of cysts or trophozoites in the
feces can be difficult,
you decide to treat the patient empirically
with
(A) Chloroquine
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(B) Emetine
(C) Metronidazole
(D) Pentamidine
(E) TMP-SMZ
(D) Oxamniquine
(E) Suramin
9. This drug can clear trypanosomes from
the blood and lymph
nodes and is active in the late CNS stages of
African sleeping
sickness.
(A) Emetine
(B) Eflornithine
(C) Melarsoprol
(D) Nifurtimox
(E) Suramin
10. Metronidazole is not effective in the
treatment of
(A) Amebiasis
(B) Infections due to Bacteroides fragilis
(C) Infections due to Pneumocystis jiroveci
(D) Pseudomembranous colitis
(E) Trichomoniasis
11.0 ANTIHELMINTHIC DRUGS
1. A missionary from the United States is
sent to work in a
geographic region of a Central American
country where
Onchocerca volvulus is endemic. Infections
resulting from
this tissue nematode (onchocerciasis) are a
cause of “river
blindness,” because microfilariae migrate
through subcutaneous
tissues and concentrate in the eyes. Which
drug should be
used prophylactically to prevent
onchocerciasis?
(A) Albendazole
(B) Diethylcarbamazine
(C) Ivermectin
2. A nonindigenous person who develops
onchocerciasis in
an endemic region and receives drug
treatment is likely to
experience a severe reaction. Symptoms
include headache,
weakness, rash, muscle aches, hypotension,
and peripheral
edema. Which statement concerning this
reaction is
accurate?
(A) Bithionol was prescribed
(B) Extensive fluid replacement is essential
(C) Symptoms are more intense in
indigenous adults than
expatriate adults
(D) The reaction is due to drug toxicity
(E) The reaction is due to killing of
microfilariae
3. Which statement about pyrantel
pamoate is accurate?
(A) Acts as an antagonist at GABA receptors
(B) Equivalent in efficacy to niclosamide in
the treatment of
tapeworm infections
(C) Hepatotoxicity is dose-limiting
(D) Kills adult worms in the colon but not
the eggs
(E) Synergistic with praziquantel in fluke
infections
4. A student studying medicine at a
Caribbean university develops
fever, chills, and diarrhea resulting from S
mansoni, and
oxamniquine is prescribed. Which
statement about the proposed
drug therapy is accurate?
(A) If the patient has a history of seizure
disorders, hospitalization
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is recommended during treatment
(B) It is not effective in the late stages of the
disease
(C) Oxamniquine is safe to use in pregnancy
(D) The drug blocks GABA receptors in
trematodes
(E) The drug is also effective in tapeworm
infections
5. A 22-year-old South Korean man has
recently moved to
Minnesota. He has symptoms of
clonorchiasis (anorexia,
upper abdominal pain, eosinophilia),
presumably contracted
in his homeland where the Oriental liver
fluke is endemic.
He also has symptoms of diphyllobothriasis
(abdominal discomfort,
diarrhea, megaloblastic anemia), probably
caused by
consumption of raw fish from lakes near the
Canadian border.
Which drug is most likely to be effective in
the treatment
of both clonorchiasis and diphyllobothriasis
in this patient?
(A) Ivermectin
(B) Niclosamide
(C) Praziquantel
(D) Thiabendazole
(E) Pyrantel pamoate
6. Which helminthic infection does not
respond to treatment
with praziquantel?
(A) Hydatid disease
(B) Opisthorchiasis
(C) Paragonimiasis
(D) Pork tapeworm infection
(E) Schistosomiasis
7. Which drug causes muscle paralysis in
nematodes by enhancing
the actions of GABA?
(A) Albendazole
(B) Diethylcarbamazine
(C) Ivermectin
(D) Mebendazole
(E) Pyrantel pamoate
8. Which parasite is susceptible to
niclosamide?
(A) Ascaris lumbricoides
(B) Echinococcus granulosus
(C) Fasciola hepatica
(D) Necator americanus
(E) Taenia solium
9. Which adverse effect occurs with the use
of mebendazole during
intestinal nematode therapy?
(A) Cholestatic jaundice
(B) Corneal opacities
(C) Hirsutism
(D) Peripheral neuropathy
(E) None of the above
10. A malnourished 12-year-old child who
lives in a rural area
of the southern United States presents with
weakness, fever,
cough, abdominal pain, and eosinophilia.
His mother tells
you that she has seen long, thin worms in
the child’s stools,
sometimes with blood. A presumptive
diagnosis of ascariasis
is confirmed by the presence of the ova of A
lumbricoides in
the stools. However, microscopy also
reveals that the stools
contain the eggs of Necator americanus.
The drug most likely
to be effective in the treatment of this child
is
(A) Albendazole
(B) Diethylcarbamazine
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(C) Ivermectin
(D) Niclosamide
(E) Praziquantel
(D) Methotrexate
(E) Tamoxifen
12.0 CANCER CHEMOTHERAPY
Questions 1–3. A 32-year-old woman
underwent segmental
mastectomy for a breast tumor of 3 cm
diameter. Lymph node
sampling revealed 2 involved nodes.
Because chemotherapy is of
established value in her situation, she
underwent postoperative
treatment with antineoplastic drugs. The
regimen consisted of
doxorubicin followed by
cyclophosphamide/methotrexate/fluoroura
cil.
Adjunctive drugs included tamoxifen
because the tumor
cells were hormone receptor-positive.
1. Which of the following best describes the
mechanism of anticancer
action of cellular metabolites of
fluorouracil?
(A) Cross-linking of double-stranded DNA
(B) Inhibition of DNA-dependent RNA
synthesis
(C) Interference with the activity of
topoisomerases I
(D) Irreversible inhibition of thymidylate
synthase
(E) Selective inhibition of DNA polymerases
2. The chemotherapy undertaken by this
patient caused acute
hemorrhagic cystitis. Which drug was most
likely to be
responsible for this toxicity?
(A) Cyclophosphamide
(B) Doxorubicin
(C) Fluorouracil
3. After several cycles of chemotherapy, the
patient was found
to have a high resting pulse rate. A
noninvasive radionuclide
scan revealed evidence of cardiomyopathy.
The drug that is
most likely responsible for the cardiac
toxicity is
(A) Cyclophosphamide
(B) Doxorubicin
(C) Fluorouracil
(D) Methotrexate
(E) Tamoxifen
4. Which of the following is a cell cyclespecific anticancer drug
that acts mainly in the M phase of the cell
cycle?
(A) Bleomycin
(B) Cisplatin
(C) Etoposide
(D) Methotrexate
(E) Paclitaxel
5. An adult patient is being treated for acute
leukemia with a
combination of anticancer drugs that
includes cyclophosphamide,
mercaptopurine, methotrexate, vincristine,
and prednisone.
He is also using ondansetron for emesis, a
chlorhexidine
mouthwash to reduce mucositis, and
laxatives. The patient
complains of “pins and needle” sensations
in the extremities
and muscle weakness. He is not able to
execute a deep knee
bend or get up out of a chair without using
his arm muscles.
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He is also very constipated. If these
problems are related to
the chemotherapy, which of the following is
the most likely
causative agent?
(A) Cyclophosphamide
(B) Mercaptopurine
(C) Methotrexate
(D) Prednisone
(E) Vincristine
6. Which of the following is a drug that is
used in combination
therapy for testicular carcinoma and is also
associated with
nephrotoxicity?
(A) Bleomycin
(B) Cisplatin
(C) Etoposide
(D) Leuprolide
(E) Vinblastine
7. A cancer cell that is resistant to the
effects of both vincristine
and methotrexate probably has developed
the resistance as a
result of which of the following
mechanisms?
(A) Changes in the properties of a target
enzyme
(B) Decreased activity of an activating
enzyme
(C) Increased expression of a P-glycoprotein
transporter
(D) Increased production of drug-trapping
molecules
(E) Increase in proteins that are involved in
DNA repair
Questions 8 and 9. A 23-year-old man with
Hodgkin’s lymphoma
was treated unsuccessfully with the MOPP
regimen
(mechlorethamine, vincristine, prednisone,
procarbazine). He
subsequently underwent a successful
course of therapy with the
ABVD regimen (doxorubicin, bleomycin,
vinblastine, dacarbazine).
8. Which of the following classes of
anticancer drugs used in the
treatment of this patient is cell cycle specific
(CCS) and used
in both the MOPP and ABVD regimens?
(A) Alkylating agents
(B) Antibiotics
(C) Antimetabolites
(D) Glucocorticoids
(E) Plant alkaloids
9. During the second course of drug
treatment (ABVD regimen),
this patient developed dyspnea, a
nonproductive cough,
and intermittent fever. Chest x-ray film
revealed pulmonary
infiltration. If these problems are due to the
anticancer drugs
to which he has been exposed, which of the
following is the
most likely causative agent?
(A) Bleomycin
(B) Dacarbazine
(C) Doxorubicin
(D) Prednisone
(E) Vinblastine
10. All the following agents have been used
in drug regimens for
the treatment of breast carcinoma. Which
one has specific
activity in a subset of female breast
cancers?
(A) Cyclophosphamide
(B) Doxorubicin
(C) Fluoxymesterone
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(D) Methotrexate
(E) Trastuzumab
of the most active drugs in leukemias.
Although myelosuppression
is dose limiting, the drug may also cause
cerebellar B
DIRECTIONS: 11–13. For each numbered
item, select the
ONE lettered option from the following list
that is most closely
associated with it. Each lettered option may
be selected once,
more than once, or not at all.
(A) Bleomycin
(B) Cytarabine
(C) Dacarbazine
(D) Doxorubicin
(E) Etoposide
(F) Flutamide
(G) Fluorouracil
(H) Leuprolide
(I) Mechlorethamine
(J) Mercaptopurine
(K) Methotrexate
(L) Paclitaxel
(M) Procarbazine
(N) Tamoxifen
(O) Vincristine
11. If allopurinol is used adjunctively in
cancer chemotherapy
to offset hyperuricemia, the dosage of this
anticancer drug
should be reduced to 25% of normal. J
12. This drug is used in combination therapy
for testicular carcinoma.
It is a CCS drug that acts in the late S and
early G0
phases of the tumor cell cycle via
interactions with topoisomerase
II. E
13. This antimetabolite inhibits DNA
polymerase and is one
13.0 IMMUNOPHARMACOLOGY
1. Cyclosporine is effective in organ
transplantation. Which of
the following most accurately describes the
immunosuppressant
action of cyclosporine?
(A) Activation of NK cells
(B) Blockade of tissue responses to
inflammatory mediators
(C) Increased catabolism of IgG antibodies
(D) Inhibition of the gene transcription of
interleukins
(E) Interference with MHC II-peptide
activation of T cells
2. Which of the following is a widely used
drug that suppresses
cellular immunity, inhibits prostaglandin
and leukotriene
synthesis, and increases the catabolism of
IgG antibodies?
(A) Cyclophosphamide
(B) Cyclosporine
(C) Infliximab
(D) Mycophenolate mofetil
(E) Prednisone
3. Which of the following drugs is used to
prevent the primary
immune response of an Rh-negative mother
to an Rh-positive
newborn?
(A) Cyclosporine
(B) Cyclophosphamide
(C) Methotrexate
(D) Rho(D) immune globulin
(E) Tacrolimus
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4. Tumor necrosis factor (TNF)-α appears to
play an important
role in autoimmunity and inflammatory
diseases. Which of
the following is a humanized monoclonal
antibody that binds
to TNF-α and inhibits its action?
(A) Etanercept
(B) Infliximab
(C) Muromonab-CD3
(D) Sirolimus
(E) Thalidomide
Questions 5 and 6. A patient was treated
for a bacterial infection
with a penicillin. Within a few minutes of
the antibiotic injection,
he developed severe bronchoconstriction,
laryngeal edema, and
hypotension. Because of the rapid
administration of epinephrine,
the patient survived. Unfortunately, a year
later he was treated
with an antipsychotic drug and developed
agranulocytosis.
5. Which type of immunologic process was
triggered by the
penicillin injection?
(A) An autoimmune syndrome
(B) A cell-mediated reaction
(C) A type II drug allergy
(D) Mediated by IgE
(E) Serum sickness
6. Which type of immunologic process was
triggered by the
antipsychotic drug?
(A) A type III drug reaction
(B) A type IV drug reaction
(C) Delayed-type hypersensitivity
(D) Mediated by IgG or IgM antibodies
(E) Stevens-Johnson syndrome
7. Which of the following is an
immunosuppressant that suppresses
both B and T lymphocytes via inhibition of
de novo
synthesis of purines?
(A) Cyclophosphamide
(B) Methotrexate
(C) Mycophenolate mofetil
(D) Prednisone
(E) Tacrolimus
8. Recombinant interleukin-2 has proved
useful in the treatment
of which of the following diseases?
(A) Graft-versus-host disease in patients
with hematopoietic
stem cell transplantation
(B) Psoriasis
(C) Renal cell carcinoma
(D) Rheumatoid arthritis
(E) Superficial bladder carcinoma
9. Although sirolimus and cyclosporine have
similar immunosuppressant
effects, their toxicity profiles differ. Which of
the following toxicities is more likely to be
associated with
sirolimus than with cyclosporine?
(A) An anaphylactic reaction
(B) Hypertension
(C) Osteoporosis
(D) Renal insufficiency
(E) Thrombocytopenia
10. Which of the following is an immune
modulator that
increases phagocytosis by macrophages in
patients with
chronic granulomatous disease?
(A) Aldesleukin
(B) Interferon-γ
(C) Lymphocyte immune globulin
(D) Prednisone
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(E) Trastuzumab
By Ntugwa,Jagadi
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