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1

which is the answer 

  A 45-year-old male presented to the hospital ED with severe cellulitis and a large abscess on his  left leg. Incision and drainage were performed on the abscess, and cultures revealed methicillin-resistant Staphylococcus aureus. All of the following antibiotics would be appropriate for this infection EXCEPT:

A.Vancomycin

B.Doxycycline

C.Clindamycin

D.Piperacillin-tazobactam

E.Sulfamethoxazole-trimethoprim

F.All would be appropriate

D. Pipercillin Tazo 

2

A 30-year-old pregnant female has cellulitis caused by MRSA. Which of the following would be the most appropriate option for outpatient therapy?

A.Amoxicillin-clavulanate

B.Cephalexin (1st C)

C.Clindamycin

D.Doxycycline

E.Piperacillin-tazobactam

F.Vancomycin

C. Clindamycin 

3

5.  The regimen of choice for treatment of urogenital gonorrhea is:

A.IM ceftriaxone and oral azithromycin

B.Oral cephalexin and oral azithromycin

C.Oral moxifloxacin and oral azithromycin

D.IM ceftriaxone and oral doxycycline

A. IM Ceftriaxone 

4

  A 22-year-old man with gonorrhea is to be treated with ceftriaxone and will need another drug to provide coverage for urethitis caused by C. trachomatis. Which of the following drugs is LEAST likely to be effective in nongonococcal urethitis?

A.Azithromycin

B.Clarithromycin

C.Nitrofurantoin

D.SMX-TMP

E.Doxycycline

C. Nitrofurontin 

5

A 68-year-old man presents to the emergency department because of fever, abdominal pain, and rapidly progressive distension of the abdomen. His appendix was removed for an abscess 3 days ago. The complete blood count showed leukocytosis. Anaerobic culture of the peritoneal fluid needle aspirate showed a gram-negative pathogen identified as Bacteroides fragilis. Which of the following antibiotics should be used in the treatment of this infection?

A.IV clindamycin

B.IV vancomycin

C.Oral vancomycin

D.Oral piperacillin-tazobactam

A. IV clindamycin 

6

An aspirate from a peritoneal abscess grows two organisms.  One is Escherichia coli while the other has the following characteristics: Gram-negative bacillus, obligate anaerobe, catalase-positive, and possesses a polysaccharide capsule.  From your recommended training in microbiology you recognize this organism is most likely Bacteroides fragilis.  From your required training in pharmacology you know that antibiotics with activity against such an anaerobe include all of the following EXCEPT:

A.Clindamycin

B.Metronidazole

C.Gentamicin, an aminoglycoside

D.Piperacillin-Tazobactam

C. Gentamicin, an aminoglycoside 

7

A 22-year-old female presents with a 2-day history of dysuria with increased urinary frequency and urgency. A urine culture and urinalysis are done. She is diagnosed with a urinary tract infection caused by E. coli. All of  the following would be considered appropriate initial therapy for this patient EXCEPT:

A.Amoxicillin-clavulanate

B.Sulfamethoxazole-Trimethoprim

C.Nitrofurantoin

D.Ciprofloxacin

E.Cephalexin

D. Cirpofloxacin 

8

A 24-year-old pregnant woman (8 weeks gestation) presents to the urgent care clinic with fever, urinary frequency and urgency. She is diagnosed with an uncomplicated UTI. Based on potential harm to the fetus, which of the following medications should generally be avoided in treating her UTI?

A.Nitrofurantoin

B.Amoxicillin

C.Cephalexin

D.Ampicillin

E.Trimethoprim-sulfamethoxazole

E. 

9

11.  A 35-year-old, otherwise healthy man is complaining of purulent nasal discharge, fever and facial pain. He says his symptoms began about 2 weeks ago and have gotten worse over the past 2 days despite using a nasal steroid. He has no known drug allergies. Which antibiotic would you recommend for treatment of acute bacterial sinusitis in this patient?

A.Amoxicillin-clavulanate

B.Azithromycin

C.Trimethoprim-sulfamethoxazole

D.Levofloxacin

E.None - symptomatic treatment only

A. amoxi/clauv 

10

  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 one of the following drugs can be given orally for outpatient management of this patient’s infection?

A.Penicillin V K

B.Levofloxacin

C.Gentamicin-aminoglycoside

D.Clindamycin

E.Ceftriaxone

B. Levofloxacin 

11

Which of the following is an advantage of using bactericidal agents rather than bacteriostatic agents to treat infectious disease?

A.Their effects are often irreversible.

B.They act more quickly to resolve infections.

C.They can compensate for impaired host defense mechanisms.

D.They retain efficacy against infections located at sites inaccessible to the immune system.

E.All are advantages of bactericidal agents.

E

12

14.  Which of the following antibiotics are considered to exert bacteriostatic actions against most organisms in their spectrum at readily attained clinical levels?

A.Tobramycin

B.Vancomycin

C.Ceftriaxone

D.Clindamycin

E.Levofloxacin

D. Clindamycin 

13

15.  A 58-year-old male with a history of hepatitis C, cirrhosis, and ascites presents with spontaneous bacterial peritonitis. Which of the following antibiotics might require cautious consideration of use in this patient given his liver disease?

A.Erythromycin

B.Amoxicillin-clavulanate

C.Levofloxacin

D.Cephalexin

A. Eryhtromycin

14

17.  Which of the following drugs is INcorrectly matched with the mechanism of resistance to the organism?

A.Amoxicillin

B.Azithromycin 

C.Penicillins

D.Dicloxacillin 

E.Ceftriaxone 

F. Piperacillin

E. Ceftriaxone 

15

A 45-year-old male presented to the hospital ED with severe cellulitis and a large abscess on his  left leg. Incision and drainage were performed on the abscess, and cultures revealed methicillin-resistant Staphylococcus aureus. All of the following antibiotics would be appropriate for this infection EXCEPT:

A.Vancomycin

B.Doxycycline

C.Clindamycin

D.Piperacillin-tazobactam

E.Sulfamethoxazole-trimethoprim

F.All would be appropriate

D. Pipercillin tazo 

16

19.  A 22-year-old man with gonorrhea is to be treated with ceftriaxone and will need another drug to provide coverage for urethitis caused by C. trachomatis. Which of the following drugs is LEAST likely to be effective in nongonococcal urethitis?

A.Azithromycin

B.Clarithromycin

C.Nitrofurantoin

D.SMX-TMP

E.Doxycycline

C. Nitrofurontin 

17

20.  Select the antibacterial agent that rapidly accumulates in bladder and urine resulting in its clinical utility as a urinary tract antiseptic in the treatment of cystitis:

A.Ampicillin

B.Gentamicin (an aminoglycoside)

C.Levofloxacin

D.Nitrofurantoin

E.Amoxicillin

D. Nitrofurantoin 

18

21.  All of the following statements about the clinical uses of the aminoglycosides are accurate EXCEPT:

A.Owing to their polar nature, aminoglycosides are not absorbed after oral administration

B.Trough plasma levels are monitored to reduce the risk of hepatotoxicity

C.Aminoglycoside-induced ototoxicity can be irreversible if not identified early

D.They lack activity against infections caused by anaerobic organisms

B.Trough plasma levels are monitored to reduce the risk of hepatotoxicity

19

Select the FALSE statement about clinical use of sulfamethoxazole-trimethoprim?

A.No cross-allergenicity occurs between sulfonamides and penicillins

B.No activity against MRSA skin infections

C.Kernicterus may occur if sulfonamides are given late in pregnancy or in first 2 months after birth

D.Exerts bactericidal action against susceptible organisms

E.Trimethoprim inhibits bacterial dihydrofolate reductase and has less selective toxicity than sulfamethoxazole

B.No activity against MRSA skin infections

20

23.  A 24-year-old pregnant woman (8 weeks gestation) presents to the urgent care clinic with fever, urinary frequency and urgency. She is diagnosed with an uncomplicated UTI. Based on potential harm to the fetus, which of the following medications should generally be avoided in treating her UTI?

A.Nitrofurantoin

B.Amoxicillin

C.Cephalexin

D.Ampicillin

E.Trimethoprim-sulfamethoxazole

E.Trimethoprim-sulfamethoxazole

21

A 52-year-old male with diabetes presents with a diabetic foot infection. Cultures from the wound are growing Streptococcus pneumoniae and Escherichia coli. Of the following antibiotics, which one would most likely provide the best coverage for these two pathogens?

A.Clindamycin

B.Ceftriaxone

C.Vancomycin

D.Azithromycin

B.Ceftriaxone

22

  Amoxicillin and first-generation cephalosporins share all of the following properties EXCEPT:

A.Inhibit cell wall synthesis

B.Activity against gram negative organisms

C.Elimination primarily by the kidneys

D.Contain beta-lactam ring in structure

E.Inactivation by penicillinase (NSBL)

E.Inactivation by penicillinase (NSBL)

23

26.  An important  distinction between 1st and 3rd generation cephalosporins is:

A.1st generation agents have greater activity against methicillin-resistant Staphylococcus aureus

B.3rd generation agents have less activity against Pseudomonas

C.3rd generation agents have increased activity against chlamydia

D.1st generation agents have increased penetration into the CNS

E.3rd generation agents have increased activity against resistant gram-negative organisms

E.3rd generation agents have increased activity against resistant gram-negative organisms

24

27.  A 68-year-old man presents to the emergency department because of fever, abdominal pain, and rapidly progressive distension of the abdomen. His appendix was removed for an abscess 3 days ago. The complete blood count showed leukocytosis. Anaerobic culture of the peritoneal fluid needle aspirate showed a gram-negative pathogen identified as Bacteroides fragilis. Which of the following antibiotics should be used in the treatment of this infection?

A.IV clindamycin

B.IV vancomycin

C.Oral vancomycin

D.Oral piperacillin-tazobactam

A.IV clindamycin

25

28.  A patient is being discharged from the hospital on a 2-week course of clindamycin. Which of the following potential adverse effects should be discussed with her?

A.Nephrotoxicity

B.Drug interactions due to enzyme induction

C.Severe diarrhea

D.Skin rash

E.Ototoxicity

C.Severe diarrhea

26

A 30-year-old pregnant female has cellulitis caused by MRSA. Which of the following would be the most appropriate option for outpatient therapy?

A.Amoxicillin-clavulanate

B.Cephalexin (1st C)

C.Clindamycin

D.Doxycycline

E.Piperacillin-tazobactam

F.Vancomycin

C.Clindamycin

27

30.  A 28-year-old man presents with a complaint of penile discharge. He says that he noticed a yellowish watery discharge from his penis since last week. He adds that he has painful urination only in the mornings, but he sometimes feels a lingering pain in his genital region throughout the day. He denies any fever, body aches, or joint pains. Physical examination is unremarkable. The penile discharge is collected and sent for analysis. Ceftriaxone IM is administered, after which the patient is sent home with a prescription for an oral medication. Which of the following oral drugs was most likely prescribed to this patient?

A.Azithromycin

B.Doxycycline

C.Gentamicin

D.Clindamycin

A.Azithromycin

28

  You notice that an otherwise healthy patient has developed a mild case of oral candidiasis (thrush) while receiving antibiotic treatment for a respiratory infection.  Which of these drugs is a broad-spectrum antibacterial agent that would be most likely have caused this fungal superinfection?

A.Penicillin V

B.Dicloxacillin

C.Doxycycline

D.Clindamycin (CleocinÒ)

E.Clarithromycin

C.Doxycycline

29

32.  Doxycycline is:

A.Bactericidal

B.Eliminated slowly and can be dosed 1-2 times a day

C.Preferred over macrolides for use in small children

D.Given in lower doses to patients with renal dysfunction

E.Can be used to treat pseudomonas UTIs

B.Eliminated slowly and can be dosed 1-2 times a day

30

33.  Which statement about the fluoroquinolones is FALSE?

A.Antacids decrease the bioavailability of fluoroquinolones

B.Modification of ciprofloxacin dose may be necessary in patients with a CrCl less than 30 ml/min

C.A fluoroquinolone is the drug of choice for treatment of an uncomplicated UTI in a 7-year-old girl

D.Most “first-time” urinary tract infections are sensitive to ciprofloxacin

E.Rapidly bactericidal via inhibition of bacterial DNA gyrase

C.A fluoroquinolone is the drug of choice for treatment of an uncomplicated UTI in a 7-year-old girl