701 Unit 3 Qs
Which parasite is susceptible to niclosamide? A Ascaris lumbricoides (roundworm) B Echinococcus granulosus (hydatid disease) C Fasciola hepatica (sheep liver fluke) D Necator americanus (hookworm) E Taenia solium (pork tapeworm)
E Taenia solium (pork tapeworm)
A mother comes in very worried with her 2-year-old daughter who has had a cough and fever for the last three days. You order labs and can rule out serious infection. You decide to treat the fever. Which of the following is an analgesic and antipyretic drug that lacks an anti-inflammatory action? A Acetaminophen B Celecoxib C Colchicine D Indomethacin E Probenecid
A Acetaminophen
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
A Acyclovir
A 52-year-old woman presented with intense pain, warmth, and redness in the first toe on her left foot. Examination of fluid withdrawn from the inflamed joint revealed crystals of uric acid. Over the next 7 mo, the patient had 2 more attacks of acute gout. Her serum concentration of uric acid was elevated. The decision was made to put her on chronic drug therapy to try to prevent subsequent attacks. Which of the following drugs could be used to decrease this woman's rate of production of uric acid? A Allopurinol B Aspirin C Colchicine D Hydroxychloroquine E Probenecid
A Allopurinol
A student studying medicine at a Caribbean university develops intestinal bilharziasis and oxamniquine is prescribed. Which statement about the proposed drug therapy is accurate? A Hospitalization is recommended if the patient has a history of seizure disorders B Oxamniquine is not effective in the late stages of the disease C Oxamniquine is safe to use in pregnancy D The drug is an antagonist at GABA receptors in trematodes E The drug is very effective in tapeworm infections
A Hospitalization is recommended if the patient has a history of seizure disorders
Which helminthic infection does not respond to treatment with praziquantel? A Hydatid disease B Opisthorchiasis C Paragonimiasis D Pork tapeworm infection E Schistosomiasis
A Hydatid disease
In individuals who need antiplatelet therapy after percutaneous coronary intervention (PCI, stenting), aspirin is the NSAID of choice. Among NSAIDs, aspirin is unique because it A Irreversibly inhibits its target enzyme B Prevents episodes of gouty arthritis with long-term use C Reduces fever D Increases the risk of colon cancer E Selectively inhibits the COX-2 enzyme
A Irreversibly inhibits its target enzyme
A 10-year-old American girl presented to the emergency department with fever, chills, lethargy, and splenomegaly. She had recently returned from Nigeria, where she had spent 3 weeks with her grandparents. She had previously received all standard childhood immunizations but no prophylactic travel medications because her parents had returned to Nigeria several times previously without any medical problems. Laboratory examination reveals low hematocrit and platelet count and elevated creatinine. Blood smear reveals parasites in the erythrocytes and a diagnosis of falciparum malaria is made. This patient should immediately receive A Artemether plus lumefantrine (Coartem) B Artesunate C Pentamidine D Primaquine E Stibogluconate
B Artesunate
A patient with AIDS has a CD4 count of 45/μL. He is being maintained on a 3-drug regimen of indinavir, didanosine, and zidovudine. For prophylaxis against opportunistic infections, he is also receiving cidofovir, fluconazole, rifabutin, and trimethoprim-sulfamethoxazole. The drug most likely to suppress herpetic infections and provide prophylaxis against CMV retinitis in this patient is A Fluconazole B Cidofovir C Indinavir D Rifabutin E Trimethoprim-sulfamethoxazole
B Cidofovir
Plasmodial resistance to chloroquine is due to A Change in receptor structure B Decreased accumulation of the drug in the food vacuole C Increased activity of DNA repair mechanisms D Increased synthesis of dihydrofolate reductase E Induction of drug-inactivating enzymes
B Decreased accumulation of the drug in the food vacuole
A 30-year-old male patient who is HIV-positive and symptomatic has a CD4 count of 250/μL and a viral RNA load of 15,000 copies/mL. His treatment involves a 3-drug antiviral regimen consisting of zidovudine, didanosine, and ritonavir. The patient is taking acyclovir for a herpes infection and ketoconazole for oral candidiasis. He now complains of anorexia, nausea and vomiting, and abdominal pain. His abdomen is tender in the epigastric area. Laboratory results reveal an elevated amylase activity of 220 U/L, and a preliminary diagnosis is made of acute pancreatitis. If this patient has acute pancreatitis, the drug most likely to be responsible is A Acyclovir B Didanosine C Ketoconazole D Ritonavir E Zidovudine
B Didanosine
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 Emtricitabine C Efavirenz D Fosamprenavir E Zalcitabine
B Emtricitabine
A 14-year-old patient has experienced severe headache and double vision for a month. His temperature is 38.6°C (101.5°F). His cerebrospinal fluid culture was positive for cryptococcal antigen. Which of the following drugs would be appropriate to treat this patient systemically (not intrathecally)? A Amphotericin B B Fluconazole C Itraconazole D Ketoconazole E Nystatin
B Fluconazole
A drug that can clear trypanosomes from the blood and lymph nodes and is active in the late CNS stages of African sleeping sickness is A Emetine B Melarsoprol C Nifurtimox D Pentamidine E Suramin
B Melarsoprol
A 16-year-old girl was brought to the emergency department by her parents who found her with an empty pill bottle. She was confused and reported hearing ringing in her ears; her respiratory rate was 28 breaths per minute. You order labs and her arterial blood reveals a pH of 7.2 (normal 7.4). Which of the following drugs did she most likely take? A Acetaminophen B Allopurinol C Aspirin D Colchicine E Probenecid
C Aspirin
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 Eradicates adult worms in the colon but not the eggs D Hepatotoxicity is dose-limiting E Synergistic with praziquantel in cestode infections
C Eradicates adult worms in the colon but not the eggs
A 54-year-old woman presented with signs and symptoms consistent with an early stage of rheumatoid arthritis. The decision was made to initiate NSAID therapy. Although the patient's disease was adequately controlled with an NSAID and methotrexate for some time, her symptoms began to worsen and radiologic studies of her hands indicated progressive destruction in the joints of several fingers. Treatment with another second-line agent for rheumatoid arthritis was considered. Which of the following is a parenterally administered DMARD whose mechanism of anti-inflammatory action is antagonism of tumor necrosis factor? A Anakinra B Abatacept C Etanercept D Penicillamine E Sulfasalazine
C Etanercept
A 60-year-old man is diagnosed with esophageal candidiasis and requires oral treatment. Which of the following drugs is least likely to be effective? A Clotrimazole B Fluconazole C Griseofulvin D Itraconazole E Nystatin
C Griseofulvin
A 54-year-old woman presented with signs and symptoms consistent with an early stage of rheumatoid arthritis. The decision was made to initiate NSAID therapy. Which of the following patient characteristics is the most compelling reason for avoiding celecoxib in the treatment of her arthritis? A History of alcohol abuse B History of gout C History of myocardial infarction D History of osteoporosis E History of peptic ulcer disease
C History of myocardial infarction
Metronidazole is not effective in the treatment of A Amebiasis B Infections due to Bacteroides fragilis C Infections due to Pneumocystis jirovecii D Pseudomembranous colitis E Trichomoniasis
C Infections due to Pneumocystis jirovecii
Which statement about the mechanisms of action of antiviral drugs is accurate? A Acyclovir has no requirement for activation by phosphorylation B Ganciclovir inhibits viral DNA polymerase but does not cause chain termination C Interferon-α causes increased activity of host cell ribonucleases that degrade viral mRNA D Foscarnet is phosphorylated by thymidine kinase as the initial step in HSV-infected cells E Fosamprenavir inhibits the reverse transcriptase of HIV with 30-50 times more potency than host cell DNA polymerases
C Interferon-α causes increased activity of host cell ribonucleases that degrade viral mRNA
A 28-year-old man living on the East Coast was transferred by his employer to 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. 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 B Flucytosine C Itraconazole D Micafungin E Terbinafine
C Itraconazole
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 D Oxamniquine E Pyrantel pamoate
C Ivermectin
Which drug enhances the actions of GABA in nematodes causing muscle paralysis? A Albendazole B Diethylcarbamazine C Ivermectin D Oxamniquine E Pyrantel pamoate
C Ivermectin
Question 15 of 30 Serious cardiac effects have occurred when this drug was taken by patients using the antihistamines astemizole or terfenadine A Amphotericin B B Griseofulvin C Ketoconazole D Terbinafine E Voriconazole
C Ketoconazole
An 18-month-old boy dies from an accidental overdose of acetaminophen. Which of the following is the most likely cause of this patient's death? A Arrhythmia B Hemorrhagic stroke C Liver failure D Noncardiogenic pulmonary edema E Respiratory failure
C Liver failure
A 10-year-old American girl presented to the emergency department with fever, chills, lethargy, and splenomegaly. She had recently returned from Nigeria, where she had spent 3 weeks with her grandparents. She had previously received all standard childhood immunizations but no prophylactic travel medications because her parents had returned to Nigeria several times previously without any medical problems. Laboratory examination reveals low hematocrit and platelet count and elevated creatinine. Blood smear reveals parasites in the erythrocytes and a diagnosis of falciparum malaria is made. The patient should have received prophylaxis for the prevention of malaria; what prophylactic regimen would have been most appropriate? A Artesunate B Chloroquine C Mefloquine D Tetracycline
C Mefloquine
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. 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
D Any or all of the above
A patient intolerant to opioids received ketorolac for postoperative inflammatory pain control. The main advantage of ketorolac over aspirin is that ketorolac A Can be combined more safely with an opioid such as codeine B Can be obtained as an over-the-counter agent C Does not prolong the bleeding time D Is available in a parenteral formulation that can be injected intramuscularly or intravenously E Is less likely to cause acute renal failure in patients with some preexisting degree of renal impairment
D Is available in a parenteral formulation that can be injected intramuscularly or intravenously
A 30-year-old male patient who is HIV-positive and symptomatic has a CD4 count of 250/μL and a viral RNA load of 15,000 copies/mL. His treatment involves a 3-drug antiviral regimen consisting of zidovudine, didanosine, and ritonavir. The patient is taking acyclovir for a herpes infection and ketoconazole for oral candidiasis. He now complains of anorexia, nausea and vomiting, and abdominal pain. His abdomen is tender in the epigastric area. Laboratory results reveal an elevated amylase activity of 220 U/L, and a preliminary diagnosis is made of acute pancreatitis. 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
D Lamivudine
Which of the following statements about interferon-α 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
D Lamivudine interferes with its activity against hepatitis B
A 55-year-old man 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 cardiac arrhythmia. 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
D Metronidazole plus diloxanide furoate
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 Caspofungin B Flucytosine C Griseofulvin D Nystatin E Terbinafine
D Nystatin
22-year-old man from South Korea 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 Albendazole B Ivermectin C Niclosamide D Praziquantel E Pyrantel pamoate
D Praziquantel
A 22-year-old man from South Korea 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 Albendazole B Ivermectin C Niclosamide D Praziquantel E Pyrantel pamoate
D Praziquantel
A 10-year-old American girl presented to the emergency department with fever, chills, lethargy, and splenomegaly. She had recently returned from Nigeria, where she had spent 3 weeks with her grandparents. She had previously received all standard childhood immunizations but no prophylactic travel medications because her parents had returned to Nigeria several times previously without any medical problems. Laboratory examination reveals low hematocrit and platelet count and elevated creatinine. Blood smear reveals parasites in the erythrocytes and a diagnosis of falciparum malaria is made. If the girl recovers from the acute falciparum attack but a month later develops P vivax malaria, what drug or drugs should be given to eradicate schizonts and latent hypnozoites in the liver? A Artesunate B Dapsone C Halofantrine D Primaquine E Quinine
D Primaquine
A patient with AIDS has a CD4 count of 45/μL. He is being maintained on a 3-drug regimen of indinavir, didanosine, and zidovudine. For prophylaxis against opportunistic infections, he is also receiving cidofovir, fluconazole, rifabutin, and trimethoprim-sulfamethoxazole. 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 Gastric absorption is inhibited by fluconazole D Rifabutin increases hepatic drug metabolism E Sulfamethoxazole increases indinavir plasma protein binding
D Rifabutin increases hepatic drug metabolism
A 52-year-old woman presented with intense pain, warmth, and redness in the first toe on her left foot. Examination of fluid withdrawn from the inflamed joint revealed crystals of uric acid. In the treatment of this woman's acute attack of gout, a high dose of colchicine will reduce the pain and inflammation. However, many physicians prefer to treat acute gout with a corticosteroid or indomethacin because high doses of colchicine are likely to cause A Behavioral changes that include psychosis B High blood pressure C Rash D Severe diarrhea E Sudden gastrointestinal bleeding
D Severe diarrhea
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. At this point, the best course of action is to A Continue current antibiotics and start griseofulvin B Continue current antibiotics and start amphotericin B C Stop current antibiotics and start itraconazole D Stop current antibiotics and start amphotericin B E Stop current antibiotics and start terbinafine
D Stop current antibiotics and start amphotericin B
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 Extensive fluid replacement is essential B Symptoms are more intense in indigenous adults than nonindigenous adults C The reaction is due to treatment with suramin D The reaction is due to killing of microfilariae E The symptoms are characteristic of treatment with diethylcarbamazine
D The reaction is due to killing of microfilariae
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
D They decrease the nephrotoxicity of amphotericin B
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 B Emetine C Pentamidine D Tinidazole E TMP-SMZ
D Tinidazole
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. 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 Flucytosine C Nystatin D Voriconazole E None of the above
E None of the above
Which adverse effect occurs with the use of albendazole during intestinal nematode therapy? A Cholestatic jaundice B Corneal opacities C Hirsutism D Peripheral neuropathy E None of the above
E None of the above
A 28-year-old man living on the East Coast was transferred by his employer to 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. This patient should be treated immediately with A Amphotericin B B Caspofungin C Ketoconazole D Terbinafine E None of these drugs
E None of these drugs
Which of the following drugs is most likely to increase the risk of toxicity of methotrexate, a weak acid that is primarily cleared in the urine? A Acetaminophen B Allopurinol C Colchicine D Hydroxychloroquine E Probenecid
E Probenecid
A 55-year-old man 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 cardiac arrhythmia. 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
E Tinidazole plus diloxanide furoate
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/μL 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 Determine whether HIV transmission has occurred by monitoring the patient's blood B Treat with a single high dose of zidovudine C Treat with full doses of zidovudine for 4 weeks D Treat with single doses of zidovudine and indinavir E Treat with zidovudine plus lamivudine plus ritonavir for 4 weeks
E Treat with zidovudine plus lamivudine plus ritonavir for 4 weeks
Which statement about antiprotozoal drugs is most 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 double-stranded DNA, blocking replication E Trimethoprim-sulfamethoxazole is the drug of choice for Pneumocystis jirovecii pneumonia
E Trimethoprim-sulfamethoxazole is the drug of choice for Pneumocystis jirovecii pneumonia
A 27-year-old nursing mother is diagnosed as suffering 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
E Valacyclovir
