Antibiotic Practice Questions

You have diagnosed a patient with Hemophilus influenzae. Which one of the following antibiotics is the DOC? A. Ceftriaxone B. Oxacillin C. Ticarcillin D. Cefazolin E. Vancomycin

A. Ceftriaxone

Inhibition of DNA gyrase in Gram negative bacteria and topoisomerase IV in Gram positive bacteria, is a mechanism of action of: A. Ciprofloxacin B. Chloramphenicol C. Doxycycline D. Kanamycin E. Linezolid

A. Ciprofloxacin

Which one of the following antibiotics is combined with aminoglycosides to treat wounds of the abdomen and gut? A. Vancomycin B. Tetracycline C. Trimethoprim D. Clindamycin E. Erythromycin

A. Clindamycin

Which one of the following antibiotics induces "post antibiotic effect" (PAE: persistent suppression of bacterial growth after a brief exposure)? A. Gentamicin B. Tetracycline C. Ciprofloxacin D. Erythromycin E. Azithromycin

A. Gentamicin

A 7yr old child is diagnosed with pharyngitis. Which one of the following beta lactam antibiotics is the drug of choice? A. Penicillin B. Third generation cephalosporins C. Fourth generation cephalosporins D. Carbapenems E. Vancomycin

A. Penicillin

Which one of the following penicillins has prolonged blood and tissue concentrations? A. Procaine penicillin B. Ampicillin C. Amoxicillin D. Nafcillin E. Oxacillin

A. Procaine penicillin

Competitive inhibitor of dihydropteroate synthase, a bacterial enzyme involved in producing a precursor to folic acid, is a mechanism of action of: A. Sulfonamides B. Trimethoprim C. Levofloxacin D. Amikacin E. Streptomycin

A. Sulfonamides

Which one of the following antibiotics deposits in bones and should be avoided in pregnancy? A. Tetracycline B. Aztreonam C. Linezolid D. Sulfamethoxazole E. Trimethoprim

A. Tetracycline

Which one of the following antibiotics is used for serious gram negative bacillary infections especially those due to Pseudomonas aeruginosa? A. Tobramycin B. Clindamycin C. Streptomycin D. Erythromycin E. Neomycin

A. Tobraamycin

A patient is diagnosed with MRSA and E. faecalis. Which one of the following antibiotics would be the most effective drug? A. Vancomycin B. Ceftriaxone C. Ceftarolne D. Sulfamethoxazole E. Doxycycline

A. Vancomycin

Of the following antibiotics, which one of them acts as "conc.dependent" (Peak:MIC: max conc [peak] ___to ___ minimum inhibitory conc ratio)? A. Penicillin B. Aminoglycoside C. Vancomycin D. Linezolid E. Carbapenems

B. Aminoglycoside

A patient is diagnosed with Listeria monocytogenese. Which one of the following antibiotics is the DOC? A. Piperacillin/tazobactam B. Ampicillin C. Dicloxacillin D. Cephalexin E. Cefepime

B. Ampicillin

A patient with rheumatic fever is diagnosed with syphilis. Which one of the following antibiotics is the DOC? A. Penicillin G B. Benzathine penicillin C. Ampicillin D. Ceftazidime E. Cloxacillin

B. Benzathine penicillin

You have diagnosed a patient with MRSA. Which one of the following cephalosporin antibiotics is the DOC? A. Cefuroxime B. Ceftaroline C. Cefazolin D. Cefotetan E. Cefixitin

B. Ceftaroline

Oral or vaginal candidiasis may occur as a result of alteration of normal microbial flora most likely by _____________ ? A. Levofloxacin B. Chloramphenicol C. Trimethoprim D. Erythromycin E. Clarithromycin

B. Chloramphenicol

Which one of the following antibiotics is the DOC for eradication of meningococci from carriers and prophylaxis of infection in neutropenic cancer patients? A. Nafcillin B. Ciprofloxacin C. Azithromycin D. Cefuroxime E. Cefazolin

B. Ciprofloxacin

Caution is warranted when combining _____________ with other QT interval prolonging medications such as antiemetics, antiarrhythmics, and antipsychotics. A. Methylthiotetrazole group cephalosporins B. Fluoroquinolones C. Macrolides D. Aminoglycosides E. Tetracyclines

B. Fluoroquinolones

A patient is diagnosed with necrotizing skin infection. Which one of the following antibiotics is the preferred agent? A. Vancomycin B. Imipenem cilastatin C. Doxycycline D. Chloramphenicol E. Ampicillin

B. Imipenem cilastatin

Blocking the binding of aminoacyl tRNA to the acceptor site on the mRNA ribosome complex is a mechanism of action applies to ______________ ? A. Clindamycin B. Tetracycline C. Gentamycin D. Chloramphenicol E. Linezolid

B. Tetracycline

For treatment of urinary tract infections (UTIs), which one of the following antibiotics is commonly used? A. Ampicillin B. Trimethoprim sulfamethoxazole C. Doxycycline D. Gentamicin E. Azithromycin

B. Trimethoprim sulfamethoxazole

A patient flowing long duration of hospitalization is diagnosed with pseudomonas aeruginosa and Hemophilus influenzae. Which one of the following antibiotic combinations would be appropriate granted if the patient does not have any contraindications to such combinations? A. Amoxicillin and Cephalexin B. Amoxicillin and Cefazolin C. Amikacin and levofloxacin D. Erythromycin and Trimethoprim E. Amikacin and Penicillin V

C. Amikacin and levofloxacin

The risks of oto and nephrotoxicity by __________, has led clinicians to limit their use. A. Tetracyclines B. Macrolides C. Aminoglycosides D. Fluoroquinolones E. Sulfonamides

C. Aminoglycosides

___________ are actively transported across the cell membrane into the cytoplasm by an oxygen dependent process, by which the transmembrane electrochemical gradient supplies the energy for this process, and transport is coupled to a proton pump. A. Glycopeptides B. Sulfonamides C. Aminoglycosides D. Macrolides E. Fluoroquinolones

C. Aminoglycosides

Prolongation of QT interval is an adverse effect associate with: A. Ceftriaxone B. Clindamycin C. Azithromycin D. Doxycycline E. Vancomycin

C. Azithromycin

Which one of the following antibiotics is the DOC for Lungs infection P. Aeruginosa? A. Vancomycin B. Azithromycin C. Aztreonam D. Tetracycline E. Cefazolin

C. Aztreonam

Photosensitivity, cartilage damage and prolongation of the QTc interval are adverse effects associated with _______________ ? A. 50 S inhibitors B. 30 S inhibitors C. DNA gyrase inhibitors D. PABA inhibitors E. PBP inhibitors

C. DNA gyrase inhibitors

A 60 year old woman comes to the clinic requesting an evaluation for ongoing diarrhea. She is a relatively healthy in no acute distress. Her diarrhea has persisted for about 4 days and occurs 36 times per day with cramping and abdominal pain. She presents with nausea, but no vomiting. The patient reports that the diarrhea often occurs with abdominal cramping and, when she checks her temperature, it is 99.5 degrees F. On physical exam, she appears dehydrated and with lower abdominal tenderness. CBC & differential reveals leukocytosis. Renal function tests are pending. Stool examination shows fecal leukocytes. She reports being hospitalized for two weeks period two months ago for treatment of a complicated pneumonia. What is your dx?

C. Diff

Which one of the following antibiotics produces drug interaction with theophylline, warfarin, methylprednisone and oral digoxin? A. Gentamicin B. Kanamycin C. Erythromycin D. Azithromycin E. Clindamycin

C. Erythromycin

Tendon rupture and peripheral neuropathy are some of the serious adverse effects associated with the use of: A. Macrolides B. Sulfonamides C. Fluoroquinolones D. Tetracyclines E. Aminoglycosides

C. Fluoroquinolones

Production of a transferase enzyme or enzymes inactivates the aminoglycoside by adenylylation, acetylation, or phosphorylation are mechanisms of antibiotic resistance associated with: A. Ciprofloxacin B. Clindamycin C. Gentamicin D. Azithromycin E. Linezolid

C. Gentamicin

Which one of the following antibiotics is the preferred drug for both E. faecalis, E. faecium? A. Ampicillin B. Cefuroxime C. Linezolid D. Clindamycin E. Doxycycline

C. Linezolid

Which one of the following antibiotics class acts specifically as folate synthesis inhibitor? A. Macrolides B. Fluoroquinolones C. Sulfonamides D. Aminoglycosides E. Tetracyclines

C. Sulfonamides

Tet(AE), Tet(K) and Tet(M) are clinical important gene associate with _______________ resistance? A. Macrolides B. Fluoroquinolones C. Tetracyclines D. Third generation cephalosporins E. PABA inhibitors

C. Tetracyclines

The bacterial enzyme dihydropteroate reductase, is the target for _______________ ? A. Doxycycline B. Linezolid C. Trimethoprim D. Kanamycin E. Ciprofloxacin

C. Trimethoprim

An immunocompromised patient is diagnosed with toxoplasmosis. Which one of the following antibiotics is the DOC? A. Kanamycin B. Erythromycin C. Trimethoprim sulfamethoxazole D. Ticarcillin E. Carbenicillin

C. Trimethoprim sulfamethoxazole

A 52 year old man with history asthma and diabetes was admitted for abdominal pain, watery diarrhea, and subjective fevers for 3 days. Had had received antibiotics for pneumonia two weeks prior. On physical exam, he was febrile (103º), tachycardic (128 beats/min) and blood pressure was 100/70 mmHg. Abdominal exam revealed diminished bowel sounds and diffuse abdominal tenderness, without rebound or guarding. Laboratory data showed white blood cell count of 16,000 cells/ul with 2% bands. Stool sample for C. difficile toxin was positive. Because it was a mild case of drug hypersensitivity, oral antibiotic for C. diff started. The patient following the 5th dose, developed flushing, erythema, and pruritus of the face, and neck. Which one of the following antibiotics is the most likely cause of this patient's adverse reaction? A. Aztreonam B. Linezolid C. Vancomycin D. Ciprofloxacin E. Kanamycin

C. Vancomycin

For treatment of lower respiratory tract infections, which one of the following penicillins of the preferred agent? A. Penicillin G procaine B. Nafcillin C. Ticarcillin D. Amoxicillin E. Penicillin V

D. Amoxicillin

You have diagnosed a college student with lower respiratory infection during a winter month. What one of the following beta lactam antibiotics would you consider? A. Penicillin G B. Penicillin V C. Nafcllin D. Amoxicillin E. Penicillin G procaine

D. Amoxicillin

Which one of the following antibiotics has the most favorable PK profile penetrating most tissues (except cerebrospinal fluid) and phagocytic cells extremely well, with tissue concentrations exceeding serum concentrations by 10 to 100 fold. A. Clindamycin B. Erythromycin C. Gentamicin D. Azithromycin E. Clarithromycin

D. Azithromycin

Which one of the following antibiotics is a monobactam antibiotics effective for treatment of P aeruginosa? A. Ceftriaxone B. Ceftazidime C. Carbenicillin D. Aztreonam E. Meropenem

D. Aztreonam

In treating hospital acquired pneumonia, which one of the following beta lactam antibiotics is the preferred agent? A. Penicillin V B. Carbenicillin C. Cephalexin D. Ceftazidime E. Cefazolin

D. Ceftazidime

High oral bioavailability and excellent tissue penetration, are two PK properties of a broadspectrum antibiotic: A. Penicillin V B. First generation cephalosporins C. Second generation cephalosporins D. Ciprofloxacin E. Trimethoprim

D. Ciprofloxacin

For treatment of infected wounds and burns, which one of the following antibiotics is the DOC? A. Levofloxacin B. Ceftazidime C. Oxacillin D. Gentamicin E. Erythromycin

D. Gentamicin

Optic and peripheral neuropathy and lactic acidosis are adverse effects most likely associated with _______________ ? A. Amoxicillin B. Carbenicillin C. Minocycline D. Linezolid E. Clindamycin

D. Linezolid

For treatment of bacterial conjunctivitis, which one of the following antibiotics is the DOC? A. Penicillin G B. Penicillin V C. Cefepime D. Sodium sulfacetamide E. Silver sulfadiazine

D. Sodium sulfacetamide

Which one of the following antibiotics is the most likely cause of this patient's adverse reaction SJS TEN? A. Clindamycin B. Clarithromycin C. Ciprofloxacin D. Sulfonamide E. Chloramphenicol

D. Sulfonamide

Multivalent cations (Ca2+, Mg2+, Fe2+, Al3+) interfere with absorption of __________ ? A. Clindamycin B. Azithromycin C. Clarithromycin D. Tetracycline E. Chloramphenicol

D. Tetracycline

Which one of the following antibiotics has the longest half life? A. Penicillin G B. Ampicillin C. Clarithromycin D. Tigecycline E. Doxycycline

D. Tigecycline

Which one of the following antibiotic class produce drug interaction with loop diuretics? A. Macrolides B. Third generation cephalosporins C. Fluoroquinolones D. Glycopeptides E. Aminoglycosides

E. Aminoglycosides

Which one of the following antibiotics is the most likely risk factor for diarrhea and colitis due to C. diff. A. Penicillin G B. Penicillin V C. Cefazolin D. Cephalexin E. Clindamycin

E. Clindamycin

Plasmid mediated Qnr antibiotic resistance gene is associated with ___________ ? A. Penicillins B. Sulfonamides C. Macrolides D. Aminoglycosides E. Fluoroquinolones

E. Fluoroquinolones

These antibiotics are known to chelate with di and tri valent cations, resulting in decreased antibiotic absorption and potentially treatment failure. A. Penicillins B. Cephalosporins C. Sulfonamides D. Macrolides E. Fluoroquinolones

E. Fluoroquinolones

A 64 year old male with a previous history of coronary artery bypass presents with complaints of dyspnea, fever, confusion and an apical holosystolic murmur. Transthoracic and transesophageal echocardiography showed the presence vegetation on the aortic valve. Dx of infective endocarditis is made. Empirical therapy with which one of the following antibiotic combinations is the most appropriate regimen? A. Cephalexin and cefazolin B. Piperacillin and cephalexin C. Nafcillin and cefazolin D. Trimethoprim and chloramphenicol E. Gentamicin and penicillin

E. Gentamicin and penicillin

What PK property/properties of an antibiotic makes it an ideal drug in the treatment of blood stream infections? A. High affinity receptor binding B. Slow drug metabolism C. High volume of distribution and rapid metabolism D. Low protein binding and high volume of distribution E. High protein binding and low volume of distribution

E. High protein binding and low volume of distribution

A hunter who lives in Rocky Mountain region is diagnosed with Rickettsia. Which one of the following antibiotics is the preferred agent? A. Kanamycin B. Gentamicin C. Vancomycin D. Clindamycin E. Tetracycline

E. Tetracycline

Based upon your dx C. Diff, what antibiotic would you recommend? A. Trimethoprim sulfamethoxazole B. 1st generation cephalosporin C. 2nd generation cephalosporin D. Aztreonam E. Vancomycin

E. Vancomycin

Which one of the following beta lactam antibiotics does not target PBPs? A. Nafcillin B. Oxacillin C. Imipenem D. Ertapenem E. Vancomycin

E. Vancomycin

When treating Gram negative infections, third and fourth generation cephalosporins are NOT utilized because they lack activity against Gram negative organisms. A. True B. False

False

A 65 year old smoker with a history ischemic heart disease and type 2 diabetes presented with a history of dry cough, low grade fever and loss of appetite of one and half month's duration. He had retired a few months back as a supervisor in a company dealing with iron products where he had exposure to iron dust during his work. Chest x ray revealed right upper lung nodular opacities as shown below. Patient was treated with cefotaxime 1g 8hrly for 5 days. Bronchoalveolar lavage (BAL) was examined and sent for acid fast bacilli (AFB), PCR for Mycobacterium tuberculosis, fungal culture and histopathology. AFB, PCR for M tuberculosis and fungal culture were negative. Histology was suggestive of an acute infective lesion. Further microbiological examination confirmed an opportunistic pathogen Gram negative bacillus (rodshaped, asporogenous, and flagellated bacterium), which is widely found in nature, in soil and water, which also affects burn victims. What is the most likely diagnosis?

P. Aeruginosa

An 18 year old woman presented to the emergency department with a generalized painful skin rash along with extensive blistering with mucosal involvement for one day (see figure). She had UTI and fever few days prior to the appearance of rash for which she had taken an antibiotic orally. On the 3rd day of oral medication, she developed extensive rash. There was significant eruption of bumps starting from the trunk and spreading all over the body. Her eyelids and lip were extensively swollen, and this was later associated with blistering and crusting. Around 20% skin detachment of body surface area was involved. What is the most likely dx?

Stevens Johnson syndrome toxic epidermal necrolysis (SJS TEN)

Nephrotoxicity is a clinical concern with vancomycin therapy. A. True B. False

True

Penicillins are generally well tolerated however, hypersensitivity reactions are clinical concern. A. True B. False

True

With regards to penicillin, approximately 10~20% of renal excretion occurs by glomerular filtration and ~80% by active tubular secretion, a process that may be deliberately inhibited (to prolong effective concentrations in the body) by probenecid. A. True B. False

True