ANTI-INFECTIVE AGENTS – ANTIBIOTICS

1- Cephalosporin mechanism of action may include:a) Inhibit protein synthesisb) Inhibit cell wall synthesisc) Inhibit synthesis of essential metabolitesd) Alter the function of cell membrane permeabilitye) Inhibit translation of genetic information

2- The bacteriostatic effect of sulphametoxazole may be increased by:a) Penicillinb) Sulbactamc) Clavulanic acidd) Tarzobactame) Trimetroprim

3-Correct statements regarding Penicillin V may include which of the following?I-β-lactamase sensitive antibiotic – acid stableII- Has a short half-life because is rapidly excreted by glomerular filtrationIII- Probenecid increase penicillin’s activitya) I onlyb) III onlyc) I and II onlyd) II and III onlye) All are correct

4- The only antibiotic available as chew able tablet include:a) Penicillinb) Amoxacillinc) Ampicillind) Erytromycine) Claritromycin

5- Correct statements regarding Erythromycin ESTOLATE may include:I- Primarily effective against gram-positive bacteria and also have activity against some gram-negative bacteriaII- It is a macrolid antibiotic very useful as alternative to penicillin for those that have allergy to penicillin antibioticsIII- Regular erythromycin is better absorbed from GIT that erythromycin estolatea) I onlyb) III onlyc) I and II onlyd) II and III onlye) All are correct

6- Penicillin should be administrated 1 hour before meals or 2 to 3 hours after meals in order to:I- Improve the bioavailability II- Maximize the dissolution rateIII- Avoid interaction with calcium ionsa) I onlyb) III onlyc) I and II onlyd) II and III onlye) All are correct

7-Drugs used in the treatment of meningitis are all of the following, EXCEPT:a) Penicillinsb) Cephalosporinsc) Gentamycind) Streptomycine) Sulfonamides

8- Examples of antibiotic that is an acid stable penicillinase resistant include:a) Amoxacillinb) Oxacillinc) Ampicillind) Carbenicilline) Penicillin V

9- All of the following penicillins are acid label penicillins, EXCEPT:a) Penicillin Vb) Penicillin Gc) Methicillind) Nafcilline) Carbenicillin

10-Which of the following are/is correct regarding Tetracycline?I- Inhibit protein synthesisII- May be used in dental worksIII- Cannot be taken for infants less than 8 years olda) I onlyb) III onlyc) I and II onlyd) II and III onlye) All are correct

11- Which of the following describes the mechanism of action of sulphametoxazole?a) Inhibit protein synthesisb) Inhibit cell growth by competitive antagonism with folic acid synthesisc) Inhibit synthesis of essential metabolitesd) Alter the function of cell membrane permeabilitye) Inhibit translation of genetic information

12- Mechanism of inhibit protein synthesis is characteristic of all the following antibiotics, EXCEPT:a) Aminoglycosidesb) Tetracyclinec) Cephalexind) Chlorafenicole) Clindamycin

13- Which of the following agents may interfere with the regular effect of penicillins?a) Antacidsb) Foodc) Probenecidd) Aminoglycosidese) All of the above

14- Which of the following drugs cannot be taken orally?a) INHb) PASAc) ASAd) Streptomycine) Oxacillin

15- Example of drug used in prophylaxis of malaria include:a) Cloroquineb) Quininec) Primaquind) Quinine) Quinidine

16- Which of the following is NOT an anti-fungal drug?a) Amphotericin Bb) Metronidazolec) Grisofulvind) Nystatine) Clotrimazole

17- Examples of drugs that may inhibit DNA gyrase may include:a) Gentamycinb) Ceftriaxonec) Norfloxacined) Erythromycin e) Penicillin

18- Which of the following agents may best treat Meningococcal encephalitis?a) Sulfametoxazoleb) Erythromycinc) Cephalexind) Tetracyclinee) Penicillin

19- Correct statements regarding aminoglycosides may include:I- Has a half-life of 12hoursII- The effect continue remain after all drug is eliminatedIII- The relation plasma concentration and half-life is not cleara) I onlyb) III onlyc) I and II onlyd) II and III onlye) All are correct

20- Which of the following statement is/are correct regarding Gray Babies syndrome?I- Occurs in premature and new born infants when choraphenicol is administrated during the first few days of lifeII- Due to inability of the infant to metabolize the drug because of glucoronyl transferase deficiencyIII- Glucoronyl transferase is required to detoxify cloraphenicola) I onlyb) III onlyc) I and II onlyd) II and III onlye) All are correct

21- Correct statements regarding Pellagra include:I- Caused due to deficiency of niacinII- Caused by failure in converting tryptophan to niacinIII- Characterized by dermatitis, diarrhea and dementiaa) I onlyb) III onlyc) I and II onlyd) II and III onlye) All are correct

22- Gonorrhea, a sexually transmitted disease may be treated by which of the following agents?I- CefiximeII- CeftriaxoneIII- Ciprofloxacina) I onlyb) III onlyc) I and II onlyd) II and III onlye) All are correct

23- Nosocomial infections may be best treated by which of the following agents?I- Cephalosporin 3rd generationII- Macrolides antibioticsIII- Penicillinsa) I onlyb) III onlyc) I and II onlyd) II and III onlye) All are correct

24- Viral encephalitis, a CNS infection, may be best be treated by which of the following agents?a) Benzyl penicillinb) Ceftriaxonec) Acyclovird) Streptomycine) Vancomycin

25- Example of drug(s) used to treat pneumonia include:I- Ampicilin combined with aminoglycosidesII-ChlaritromycinIII- Levofloxacina) I onlyb) III onlyc) I and II onlyd) II and III onlye) All are correct

26- Otite extern, an ear infection may be best is best treated by:a) Ciprofloxacin eardropb) Gentamicin eardropc) Prednisone eardropd) Levobunolol eardrope) Saline solution

27- Otite media is an ear infection normally caused by S. pneumoniae and may be best treated by:a) Amoxacillinb) Penicillin Vc) Ampicilind) Amoxacillin clavulanatee) Oxacillin

28- First line treatment for UTI-Urinary Tract Infection may include:a) Sulphametoxazole + Trimetroprineb) Amoxacillin clavulanatedc) Penicillin procained) Erythromycine) All are very effective in treating UTI

29- Which of the following agents would be used in the treatment of infections caused by Helicobacter pylori as combination therapy?a) Penicillin, amoxacillin, ampicillin and metronidazoleb) Chlaritromycin, amoxacillin, omeprazole and metronidazolec) Chlaritromycin, azithromycin and lansoprazoled) Ceftriaxone and metronidazole onlye) Combinations of antibiotic should not be used due to resistance.

30- Treatment of large intestine infection mainly caused by food intoxication may include:I- Lots of fluidsII- CiprofloxacinIII- Metronidazolea) I onlyb) III onlyc) I and II onlyd) II and III onlye) All are correct

31- Colitis associated with antibiotic use can best be treated by:a) Cephalosporinsb) Macrolidesc) Aminoglycosidesd) Vancomycine) Penicillin

32- Antibiotics that often cause colitis-acute inflammation of colon as side effect include:I- Broad-spectrum penicillinsII- CephalosporinsIII- Clindamycina) I onlyb) III onlyc) I and II onlyd) II and III onlye) All are correct

33- Drug used together with chloroquine in the treatment of malaria with the purpose to kill persistants parasites in the liver of a person infected with Plasmodium vivax is:a) Quinineb) Pyrimethaminec) Sulfadoxined) Primaquinee) Quinidine

34- Patient is resistant to chloroquine and need to be treated for malaria. Which of the following drugs or combination should be more appropriate for this patient?a) Atovaquone onlyb) Chloroquine and primaquinec) Quinine and doxacyclined) Mefloquinee) C and D are correct

35- Correct statements regarding antibiotics may include:a) Drugs derivated from synthetic substances that can kill or inhibit bacterial growthb) Drugs derivated from natural source that can kill or inhibit bacteria growthc) Drug with ability only to kill bacteriad) Drug with ability only to inhibit bacterial growthe) All are wrong regarding antibiotics

36- Drugs derivated from synthetic substances that can kill bacteria is normally called:a) Bacteriostatic antibioticb) Bactericidal antibioticc) Bactericidal antimicrobiald) Bacteriostatic antimicrobiale) Bacteriostatic bactericidal antimicrobial

37- Antiviral drugs act in many different ways, they can be classified in:a) RNA inhibitors onlyb) DNA inhibitors onlyc) RNA and DNA inhibitorsd) Protease inhibitorse) All are correct

38- Examples of very narrow spectrum penicillins include all of the following, EXCEPT:a) Amoxacillinb) Nafcillinc) Metcillind) Oxacilline) All are very narrow spectrum penicillins

39- Examples of extended spectrum penicillin may include:a) Amoxacillinb) Ampicillinc) Cloxacillind) Carbenicilline) Dicloxacillin

40- Resistance is the major problem with penicillins due to ability of bacteria to breakdown the lactam ring of penicillin and inactivates the drug. To overcome these problem penicillins can be administrated together with β-lactamase inhibitors. Examples of β-lactamase inhibitors is/are:I- Clavulanic acidII- SulbactamIII- Tazobactama) I onlyb) III onlyc) I and II onlyd) II and III onlye) All are correct

41- Correct statements regarding CEPHALOSPORINS include:I- Bactericidal antimicrobialII- Derivated from natural source: Cephalosporium acremonium III- Broad-spectrum agent a) I onlyb) III onlyc) I and II onlyd) II and III onlye) All are correct

42- Example of fourth generation cephalosporin include:a) Ceftriaxoneb) Cefipimec) Cefiximed) Cefotaximee) Cefoxitin

43- Correct statement regarding the mechanism of action of Vancomycin may include:a) Inhibit release of tRNA bound to peptyl site after peptide bond formationb) Inhibit peptide bound formation between acylaminoacids bound to the peptyl and acceptor sitec) Inhibit stage II of cell wall synthesis preventing polymerization of the linear peptideoglycand) Inhibit DNA gyrase in the bacteriae) Bind to ergosterol from pores resulting in linkage of cellular contents

44- Which of the following is one of the most common side effects of vancomycin?a) Ototoxicityb) Dissulfiran like side effectc) Diarrhead) Weight gaine) Hallucinations

45- All of the following are narrow spectrum protein synthesis inhibitors, EXCEPT:a) Erythromycinb) Azithromycinc) Chlarithromycind) Tetracyclinee) Clindamycin

46- Which of the following is NOT a side effect of tetracycline?a) Alteration in gut florab) Dissulfiran like reactionsc) Teeth permanent discolorationd) Fanconi like syndromee) Hyperchloremic metabolic acidosis

47- Which of the following agents can be classified as macrolide antibiotics?I- AzithromycinII- ChlarithromycinIII- Erythromycina) I onlyb) III onlyc) I and II onlyd) II and III onlye) All are correct

48- Wrong statement regarding MACROLIDES ANTIBIOTICS include:a) Used in both gram-positive and gram-negative infectionsb) Used as an alternative to penicillin when patient has allergy to penicillinsc) Inhibit cell wall synthesis of microorganismsd) Increase gastric motility causing cramps and diarrhea as major side effecte) Very safe for children

49- All of the following are examples of aminoglycosides drugs, EXCEPT:a) Nystatinb) Gentamicinc) Amikacind) Streptomycine) Garamycin

50- Which of the following is an anti-infective agent with lowest therapeutic index?a) Macrolideb) Cephalosporinsc) Clorafenicold) Aminoglycosidese) Antifungal agents

51- Fluoroquinolone are anti-infective agents analogs of:a) PABAb) Folic acidc) Vitamin Kd) Cyanidee) Nalidixic acid

52- Which of the following best classify metronidazole?a) Antiprotozoab) Antibioticc) Antifungald) Antivirale) Antimicrobial

53- Example of drug(s) used in treatment of tuberculosis include:I- IsoniazideII- RifampinIII- Ethambutola) I onlyb) III onlyc) I and II onlyd) II and III onlye) All are correct

54- Drug of choice in the treatment of percutaneous blood infection-schistosomyasis may include:a) Niclosamideb) Prazinquatelc) Mebendazoled) Dapsonee) Thiabendazole

55- All are examples of antihelmintic drugs, EXCEPT:a) Niclosamideb) Prazinquatelc) Mebendazoled) Dapsonee) Thiabendazole

56- Which of the following is considered a polyene antifungal agent?a) Miconazoleb) Clotrimazolec) Amphotericind) Itraconazolee) Ketoconazole

57- Wrong statement regarding antifungal agents includes which of the following?a) Polyene antifungal act binding to ergosterol from pores resulting in linkage of cellular contentsb) Azoles antifungal act blocking the synthesis of ergosterol.c) Polyene antifungal has the widest spectrum compared to any other agentd) Side effects of antifungals include fever, chills, anorexia, headaches and muscle pain e) Side effects of antifungals cannot be treat for Tylenol due to high drug interaction.

58- Which of the following statement is RIGHT regarding influenza treatment?I- Type A influenza is best treated by amantadine and rimantadineII- Type B influenza is best treated by oseltamivir and zenamivirIII- Influenza should not be treated with antiviral agentsa) I onlyb) III onlyc) I and II onlyd) II and III onlye) All are correct

59- All of the following are examples of quinolone antimicrobial agents, EXCEPTa) Cephalexineb) Ofloxacinec) Norfloxacined) Ciprofloxacinee) Levofloxacine

60- Which of the following conditions is quinolone antimicrobial drugs mainly used?a) Respiratory tract infectionsb) Urinary tract infectionsc) Gastrointestinal tract infectionsd) Endocarditise) Cerebral infections

61- Which of the following statements best describes the action of the antitubercular agent ISONIAZID?a) Inhibit cell wall synthesis of mycobacteriumb) Inhibit the DNA duplication of mycobacteriumc) Inhibit arachydonic acids that feed mycobacteriumd) Inhibit mycolic acids that are unique for mycobacteriume) Inhibit protein synthesis of mycobacterium

62- Which of the following complications is considered the gravest side effect associated with isoniazid treatment?a) Cardiac dysfunctionb) Mental dysfunctionc) Hepatitisd) Renal complicationse) Discoloration of skin

63- The side effects of isoniazid are potentialized by deficiency of which vitamin?a) Thiamineb) Pyridoxinec) Folic acidd) Niacine) Cyanocobalamin

64- All of the following are examples of amino penicillin, EXCEPT:a) Ampicillinb) Cloxacillinc) Amoxacillind) Bicampiciline) All are correct

65- Which of the following is an antiviral drug used in the treatment of AIDS-HIV?I- AcyclovirII- ZidovudineIII- Stavudinea) I onlyb) III onlyc) I and II onlyd) II and III onlye) All are correct

66- Bacterial resistance to an antibiotic may occurs due to:I- MutationII- AdaptationIII- Gene transfera) I onlyb) III onlyc) I and II onlyd) II and III onlye) All are correct

67- The effectiveness of VANCOMYCIN is seen ONLY in:a) Virusb) Gram-negative bacteriasc) Gram-positive bacteriasd) Both gram-positive and negative bacteriase) Plasmodium

68- Protein synthesis inhibitors may bind to:a) 30s ribosomal subunit onlyb) 50s ribosomal subunit onlyc) 70s ribosomal subunit onlyd) 30s and 50s and 70s ribosomal subunitse) 30s and 70s ribosomal subunits

69- Broad-spectrum antibiotic that may cause severe impairment of bone marrow include which of the following agents?a) Tetracyclineb) Aminoglycosidesc) Vancomycind) Clorafenicole) Clindamycin

70- Which of the following agent is classified as lincosamide antibiotic?a) Tetracyclineb) Aminoglycosidesc) Vancomycind) Clorafenicole) Clindamycin

CORRECT ANSWERSANTI-INFECTIVE AGENTS

1- B Comments: Cephalosporin is antibiotics that act by inhibition of bacteria’s cell wall synthesis.

2- EComments: Trimetropin is used together with sulphametoxazole to avoid resistance and to increase the action of sulphametoxazole.

3- EComments: Penicillin V is an acid-stable beta-lactamase sensitive antibiotic often used together with probenecid, a beta-lactamase inhibitor, to avoid resistance of bacterias.

4- BComments: Amoxacillin is the only antibiotic available as chewable tablets.

5- CComments: Erythromycin estolate is a salt type of erythromycin; a macrolide antibiotic that is better absorbed from GIT that erythromycin base.

6- AComments: Penicillins should be administrated in an empty stomach in order to improve its bioavailability.

7- DComments: Streptomycin is not used in the treatment of meningitis. The main treatment of bacterial meningitis may include penicillins, cephalosporins and vancomycin while viral meningitis is mainly treated by acyclovir IV.

8- BComments: Oxacillin and cloxacillin are examples of acid-stable penicillanase resistant.

9- BComments: Penicillin V is an acid-stable penicillanase sensitive.

10- EComments: Tetracycline is broad-spectrum protein synthesis inhibitors that must be avoided in children less than 8 years old due to its irreversible side effects as deposition of the drug in teeth and bones causing permanent discoloration of teeth and bad structural-formation in children’s teeth.

11- BComments: Sulphametoxazole act competing with PABA for incorporation into the pathway leading to the synthesis of folic acid. Results in inhibition of folic acid synthesis that is required for synthesis of purines and pyrimidines.

12- CComments: Cephalexin is a first generation cephalosporin that acts by inhibition of bacterial cell wall synthesis.

13- EComments: Antacids and food interfere with the regular effect of penicillin by decreasing the bioavailability of penicillin while probenecid and streptomycin increase the bioavailability and effectiveness of penicillin when used currently.

14- DComments: Streptomycin is only available in injectable form because it is not properly absorbed by GIT.

15- AComments: Cloroquine is the main drug in prophylaxis and treatment of malaria.

16- BComments: Metronidazole is antiprotozoa drug acting by breakage of cell DNA.

17- CComments: Norfloxacine is a quinolone synthetic bactericidal antibiotic that acts by inhibition of DNA gyrase in the bacteria.

18- EComments: Meningococcal encephalitis is a type of septic meningitis that normally is best treated by penicillins, having Ceftriaxone and vancomycin as alternative treatment.

19- D Comments: Aminoglycosides are inhibitors of protein synthesis characterized for having a very small therapeutic window and for having the relation plasma concentration and half-life not clear, therefore its therapeutic use should be closely monitored to avoid serious side effect.

20- EComments: Gray Babies syndrome occurs in premature and new born infants when choraphenicol is administrated during the first few days of life. It happens due to inability of the infant to metabolize the drug because of glucoronyl transferase deficiency that is essential to detoxify cloraphenicol.

21- EComments: Pellagra is a disease characterized by niacin deficiency and/or failure of body to convert tryptophan to niacin. It is mainly characterized by dermatitis, diarrhea and dementia.

22- E Comments: Cefixime 400mg orally as single dose, ceftriaxone 125mg IM as single dose and ciprofloxacin 500mg orally as single dose are the recommended regimens for the treatment of uncomplicated gonorrhea.

23- AComments: Nosocomial infections are normally hospital developed secondary diseases and may be best treated by third generation cephalosporin or ciprofloxacin.

24- CComments: Viral encephalitis is mainly caused by HSV-1 and 2 viruses and may be treated by acyclovir IV.

25- EComments: The treatment of pneumonia is based on the agent causative. Bacteria pneumonia is mainly treated by the currently used of amoxacillin with aminoglycosides or clarithromycin or levofloxacin.

26- BComments: Otite externa also known as swimmer’s ear is mainly caused by pseudomonas, staphylococcus or enterobacterias and may be treated by garamycin or gentamycin eardrops.

27- DComments: Otite media may be caused by caused by S. pneumoniae, H. influenza and M. cataharlis, and may be treated by amoxacillin clavulanated.

28- AComments: First line treatment of UTI associated with E.coli infected agent is mainly treated by sulphametoxazole and trimetroprim.

29- BComments: Helicobacter pylori is a GI infection associated with peptic ulcer and gastric cancer that may be treated by the “triple therapy” that involves amoxacillin, clarithromycin and omeprazole with or without metronidazole.

30- EComments: Treatment of large intestine infection mainly caused by food intoxication include ciprofloxacin and metronidazole as therapeutic agents and increase the volume of intake fluids as a non-pharmacologic help.

31- DComments: Vancomycin is the drug of choice in the treatment of pseudomembranous colitis associated with antibiotic use.

32- EComments: Antibiotics that often cause colitis-acute inflammation of colon as side effect include broad-spectrum penicillins, cephalosporins and clindamycin.

33- DComments: Primaquine is normally used together with Cloroquine in the treatment of malaria with the purpose to kill persistants parasites in the liver of a person infected with Plasmodium vivax.

34- EComments: Treatment of malaria in those patients resistant to Cloroquine is normally done by the currently use of quinine and doxacycline.

35- BComments: Antibiotics are drugs derivated from natural sources that can kill or inhibit bacteria growth.

36- CComments: Bactericidal drugs have the capacity to completely kill the bacteria and antimicrobial are drugs derivated from synthetic substances that can kill or inhibit bacterial growth.

37- EComments: Antiviral drugs are classified as RNA inhibitor, DNA inhibitors, RNA and DNA inhibitors, and protease inhibitors.

38- AComments: Amoxacillin is a wide spectrum penicillin antibiotic.

39- DComments: Carbenicillin is extended spectrum penicillin often given IV for serious infections.

40- EComments: All, clavulanic acid, sulbactam and tazobactam are beta-lactamase inhibitors used together with penicillins sensitive.

41- DComments: Cephalosporins are bactericidal antibiotics derivated from cephalosporium acremonium. They are broad-spectrum agents and are resistant to many types of beta-lactamase. They may be classified by first, second, third and fourth generation.

42- BComments: Cefipime is a fourth generation cephalosporin antibiotic.

43- CComments: Vancomycin is a bactericidal agent that acts inhibiting stage II of cell wall synthesis preventing polymerization of the linear peptideoglycan.

44- AComments: Side effects of vancomycin may include ototoxicity, phlebitis, chills and fever.

45- DComments: Tetracyclines are broad-spectrum inhibitors of protein synthesis.

46- BComments: Dissulfiran side effects are characterized by skin rashes, headache, acne, drowsiness, tiredness, impotence and metallic or garlic taste in the mouth therefore is not a side effect of tetracyclines.

47- EComments: Azithromycin, clarithromycin and erythromycin are examples of macrolides antibiotics.

48- CComments: Macrolide antibiotics are protein synthesis inhibitors and have no effect on cell wall synthesis inhibition.

49- AComments: Nystatin is a polyene antifungal drug.

50- DComments: Aminoglycosides are protein synthesis inhibitor agents characterized by its low therapeutic index.

51- EComments: Fluoroquinolones are quinolones analog of nalidixic acid.

52- AComments: Metronidazole is an antiprotozoa agent that acts by breakage of cell DNA.

53- EComments: Isoniazide is the single most important drug used in TB. Rifampin is normally used in combination with Isoniazide. Ethambutol is only used in TB treatment given in combination with isoniazide.

54- BComments: Prazinquatel is an antihelmintic drug used in the treatment of schistosomiase.

55- DComments: Dapsone is an antimycobacterium drug of choice in the treatment of leprosy.

56- CComments: Amphotericin is the polyene antifungal prototype.

57- EComments: Tylenol and ibuprofen are considered the best drugs in the treatment of side effects caused by antifungal drugs.

58- CComments: Influenza is a viral disease and must be treated by antiviral agents.

59- CComments: Cephalexine is a first generation cephalosporin.

60- BComments: The most common use of quinolone is in the treatment of urinary tract infections.

61- DComments: Isoniazide act by inhibiting mycolic acids that are unique for mycobacterium

62- CComments: Hepatitis may be a grave side effect associated with isoniazide therapy.

63- B Comments: Isoniazide is a structural congener of pyridoxine-Vitamin B6, therefore deficiency of pyridoxine potentate the effects of isoniazide.

64- BComments: Aminopenicillins are penicillins with amine group on its molecular structure. Cloxacillin does not have an amine group on its molecular structure

65- DComments: Acyclovir is not used in HIV treatment.

66- EComments: Bacterial resistance to an antibiotic may occurs by mutation, adaptation and/or gene transfer.

67- CComments: Vancomycin is a narrow spectrum bactericidal agent with activity only against gram-positive bacterias.

68- DComments: Protein synthesis inhibitors bind to 30s (aminoglycosides), 50s(Choraphenicol) and 70s (macrolide) ribosomal subunits

69- DComments: Choraphenicol is a broad-spectrum antibiotic that may cause hematological disorders as side effect including severe impairment of bone marrow.

70- EComments: Clindamycin is a lincosamide antibiotic that acts by inhibition of bacterial of protein synthesis.