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germz mid Flashcards

1
Q

JB is an 82 year old male admitted to the hospital for a complicated urinary tract infection. He is currently on day #6 of piperacillin/tazobactam and begins having frequent bowel movements. His stool is sent for C. diff testing and comes back positive. His SCr is 1.7mg/dL and WBC is 21,000. He is not hypotensive and has no signs of ileus or mega colon.
How should JB’s infection be classified and treated? (Therapeutics)
a. Fulminant, treat with vancomycin 500mg PO q6h
b. Non-severe, treat with vancomycin 125mg PO q6h
c. Severe, treat with vancomycin 125mg PO q6h

A

c. Severe, treat with vancomycin 125mg PO q6h

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2
Q

What occurs in more than 25% of pneumococcal pneumonia patients that can lead to meningitis or endocarditis?
a. Empyema b. Pleuritis
c. Pyrothorax d. Bacteremia

A

d. Bacteremia

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3
Q

Which one of the following drugs inhibits bacterial dihydrofolate reductase a) Fluconazole
b) Ciprofloxacin
c) Trimethoprim
d) Fidaxomicin
e) Sulfamethoxazole

A

c) Trimethoprim

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4
Q

Which of the following would be considered an appropriate empiric antibiotic for the treatment of uncomplicated pyelonephritis in a patient who is not hospitalized?
a) fosfomycin
b) high dose aminoglycoside
c) nitrofurantoin
d) ceftriaxone

A

d) ceftriaxone

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5
Q

Which of the following diseases caused by streptococcus pyogenes are suppurative, requiring the continued presence of bacteria?
a) Rheumatic heart disease
b) Acute post-streptococcal glomerulonephritis
c) Streptococcal pharyngitis
d) Septicemia

A

c) Streptococcal pharyngitis

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6
Q

SATA
In a patient suffering from infectious endocarditis, fragments of the vegetative growth on the heart valve may break off. What observable lesions develop as a consequence?
a) Osler’s nodes
b) Conjunctival petechiae
c) Splinter hemorrhages under fingernails
d) Janeway’s lesions

A

all

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7
Q

Which of the following scenarios describe empiric therapy?
a) A patient receiving vancomycin for blood cultures positive for MRSA
b) A patient with HIV and low CD4 count on trimethoprim-sulfamethoxazole
c) A patient receiving a dose of antibiotics prior to surgery
d) A patient receiving high dose antibiotics for suspected bacterial meningitis,
pending culture reports

A

d) A patient receiving high dose antibiotics for suspected bacterial meningitis,
pending culture reports

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8
Q

SATA
Which of the following are pertinent findings when identifying a patient with infection?
a) Ultrasound showing fluid collection
b) Temp of 101.8 F
c) Wbcs of 13k cells/mm3
d) S epidermidis growing in 1 out of 2 sets of blood cultures in a pt without any
significant risk factors

A

b) Temp of 101.8 F
c) Wbcs of 13k cells/mm3
d) S epidermidis growing in 1 out of 2 sets of blood cultures in a pt without any
significant risk factors

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9
Q

Vancomycin-intermediate (resistant) strains of s aureus (aka VISA, MICs = 4-8 mcg/mL) have the following characteristic:
a) Vancomycin-binding site protection mechanism mediated by bacterial plasmids
b) Increased number of d-ala-d-ala residues serving as dead-end binding sites
c) Inhibition of transpeptidase activity
d) Inhibition of transglycosylation activity
e) Substituting d-alanyl-d-alanine with d-lactate-d-alanine

A

b) Increased number of d-ala-d-ala residues serving as dead-end binding sites

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10
Q

MS, a 60-year-old female, is diagnosed with staphylococcal endocarditis, TEE reveals a
4mm vegetation on her native mitral valve. Th(cut off) cultures are positive for methicillin-susceptible s aureus (MSSA). Which antimicrobial therapy is most appropriate for this patient considering she has no known drug allergies and normal renal function? (therapeutics)

a) Nafcillin IV for 6 weeks
b) Nafcillin IV and rifampin IV for 6 weeks plus gentamicin IV for 2 weeks
c) vancomycin IV for 6 weeks
d) vancomycin IV and rifampin IV for 6 weeks plus gentamicin IV for 2 weeks

A

a) Nafcillin IV for 6 weeks

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11
Q

Which of the following is NOT a major adverse effect of tetracycline? (pharmacology)
a) Photosensitivity
b) Fanconi syndrome because of expired tetracyclines
c) Nephrotoxicity
d) Red man syndrome with infusion of drug
e) discoloration of teeth

A

d) Red man syndrome with infusion of drug

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12
Q

A patient is diagnosed with uncomplicated pyelonephritis and is being admitted to the hospital (cut off) institution is 30%. Which of the following is an appropriate recommendation for empiric treatment?

a) No empiric therapy is needed, just wait for culture and sensitivity results and then start treatment
b) Ciprofloxacin 500mg PO q12H x 14 days
c) TMP/SMX 1ds tab PO Q12H 7 day
d) Ceftriaxone 1g IV x 1 dose, then tailor therapy based on culture and sensitivity results

A

d) Ceftriaxone 1g IV x 1 dose, then tailor therapy based on culture and sensitivity results

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13
Q

The latest vancomycin therapeutic monitoring guidelines recommend targeting an AUC to MIC ratio of >400
a) True
b) False

A

true

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14
Q

The following adverse effect is generally not associated with the combination of vancomycin and gentamicin?

a) Nephrotoxicity
b) Rhabdomyolysis
c) Red man syndrome
d) Ototoxicity

A

b) Rhabdomyolysis

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15
Q

CB is a 28 year old male who presents with a 5cm abscess on his right lower extremity. He is afebrile, has a normal heart rate, and normal respiratory rate. His labs are notable for a mild leukocytosis (WBC=13,500 cells/uL). CB is diagnosed with a moderate, purulent skin and soft tissue infection. Which of the following is the most appropriate recommendation for treatment?

a) I&D + doxycycline 100mg PO q12h
b) I&D + daptomycin 4mg/kg IV daily
c) I&D + cephalexin 500mg po q12h
d) I&D without adjunctive abx

A

a) I&D + doxycycline 100mg PO q12h

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16
Q

A pt comes into the ER with severe headache, stiff neck and rapid onset of fever. Meningitis is suspected. A sample of cerebrospinal fluid shows ma(cut off) neutrophils and gram negative diplococci. What is the most likely organism present?
a) Neisseria meningitidis
b) Cryptococcus neoformans
c) Neisseria gonorrhoeae
d) Toxoplasma gondii

A

a) Neisseria meningitidis

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17
Q

Which one of the following penicillins belongs to the group of antistaphylococcal penicillins?
a) Oxacillin
b) Sulbactam
c) Ticarcillin
d) Piperacillin
e) Amoxicillin

A

a) Oxacillin

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18
Q

Which of the following is a synthetic diterpene derivative and inhibits protein synthesis by binding to 50S ribosomal subunit by having the C14 sulfoacetate moiety? (medchem)
a) Mupirocin
b) Retapamulin
c) Erythromycin
d) Fidaxomicin

A

b) Retapamulin

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19
Q

Which of the following is the most appropriate treatment recommendation for a pt with uncomplicated cystitis?
a) Amoxicillin 500mg po q8h x 7 days
b) Nitrofurantoin 100mg q12h x 5 days
c) Ciprofloxacin 500mg PO q12h x 10 days
d) Fosfomycin 3g PO x 2 doses

A

b) Nitrofurantoin 100mg q12h x 5 days

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20
Q

Which of the following abx doesn’t inhibit the synthesis of bacterial cell wall?

a) Aztreonam
b) Ciprofloxacin
c) Piperacillin
d) Ceftriaxone
e) Vancomycin

A

b) Ciprofloxacin

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21
Q

S aureus and a variety of streptococcal species are amongst the most common causes of native value endocarditis. However, with prosthetic valve endocarditis, the profile of likely infectious agents is somewhat different. What is a more common infectious agent in the first year following the implantation of a prosthetic valve in the heart, compared to native valve endocarditis?

a) Cryptococcus neoformans
b) Staphylococcus epidermis
c) Mycobacterium tuberculosis
d) Escheria coli

A

b) Staphylococcus epidermis

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22
Q

Which of the following is true in regards to C diff diarrhea?

a. Antibiotic exposure is the leading cause of C diff diarrhea
b. Fidaxomicin is associated with less recurrence of C. diff diarrhea compared to vancomycin
c. Vancomycin 125 mg PO QID is recommended for severe C. diff diarrhea
d. All of the above

A

d. All of the above

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23
Q

Which of the following statements is FALSE in regards to IV to PO switch?

a. There should be downward trend in WBCs
b. Keeping a patient on IV antibiotics may improve patient satisfaction
c. Switching a patient to PO antibiotics may increase infection rates
d. The patient must be afebrile for previous 24 hours

A

b. Keeping a patient on IV antibiotics may improve patient satisfaction

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24
Q

SATA
A 62 year old man with chronic pulmonary disease develops a respiratory infection. Staphylococcus aureus was isolated from a deep sputum culture. What factors must be considered when determining an antibiotic regimen for this patient? Select all that apply

a. Lung penetration of the antibiotic
b. Pregnancy and lactation
c. drug allergies and renal function
d. the susceptibility the pathogen isolated

A

a. Lung penetration of the antibiotic
c. drug allergies and renal function
d. the susceptibility the pathogen isolated

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25
Q

The site of action of cephalosporins is

a) Bacterial beta lactamases
b) Bacterial penicillin binding proteins
c) Bacterial chromosomally endocoded methylases
d) Bacterial ribosome 50s subunit
e) Bacterial d alanyl d alanine

A

b) Bacterial penicillin binding proteins

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26
Q

Which of the following is an appropriate empiric oral antibiotic choice for a patient with purulent cellulitis caused by CA – MRSA ?

a) dicloxacillin
b) trimethoprim sulfamethoxazole
c) cephalexin
s) amoxicillin

A

b) trimethoprim sulfamethoxazole

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27
Q

Mechanism of action of vancomycin (it’s a cell wall inhibitor, or non beta lactam) as an antibacterial involves all the following except:

a. Making bacterial cell wall more permeable
b. Inhibiting transglycosylation reaction
c. Bactericidal activity
d. Substituting D alanyl D alanine with D lactate D alanine

A

d. Substituting D alanyl D alanine with D lactate D alanine

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28
Q

EM, a 60 year old man presents to the emergency room for severe headaches, photophobia and altered mental status. On physical assessment he has a temperature of 102F and nuchal rigidity. Bacterial meningitis is suspected. What antibiotics should be initiated for empiric therapy?

a. Vancomycin + cefepime
b. Ampicillin + ceftriaxone
c. Ampicillin + ceftriaxone + vancomycin
d. Vancomycin + ceftriaxone

A

c. Ampicillin + ceftriaxone + vancomycin

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29
Q

Which of the following best describes a severe ascending UTI affecting the kidneys?

a) Pyelonephritis
b)Pelvic inflammatory disease
c) Cystitis
d) Glomerular nephritis

A

a) pyelonephritis

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30
Q

Cilastatin is used in combination with imipenem to

a. increase the coverage of gram positive bacteria
b. prevent its degradation by the renal enzymes
c. increase the coverage of gram negative bacterial
d. decrease the hypersensitivity potential
e. provide protection against bacterial beta

A

b. prevent its degradation by the renal enzymes

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31
Q

FDA warning on fluoroquinolone use for uncomplicated UTI is because if their

a. DNA gyrase mutations
b. Musculoskeletal adverse effects
c. Their potential to cause hypersensitivity reaction (SJS)
d. Narrow therapeutic index
e. Narrow gram negative spectrum

A

b. Musculoskeletal adverse effects

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32
Q

Third generation cephalosporin cefotazime is effective for all of these except

a. penicillin resistant serious infections
b. meningoccal meningitis
c. penicillin resistant pneumococci
d. enterobacter infection

A

d. enterobacter infection

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33
Q

Which of the following antibiotics does NOT interact with bacterial
membrane?

a. Polymyxin B
b. Vancomycin
c. Daptomycin
d. Telavancin
e. None of the above

A

b. Vancomycin

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34
Q

If a gram positive bacteria have positive catalase and coagulase test they are likely
a. Streptococcus pneumonia
b. Streptococcus pyogenes
c. E Coli
d. Staphylococcus aureus

A

d. Staphylococcus aureus

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35
Q

Methicillin resistance in pneuomococci and enterococci is
primarily due to

a. ribosomal protection mechanism
b. inactivation by B lactamases
c. Modification of penicillin-binding proteins
d. Increased efflux of drugs
e. Impaired penetration of drug

A

c. Modification of penicillin-binding proteins

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36
Q

Which of the following statements about quinupristin is false?

a. administered in combination with dalfopristin
b. gram negative anaerobic bacterial are generally resistant
c. binds at the same site as erythromycin
d. administered by IV infusion only
e. bacterial could become resistant by ribosomal protection mechanism

A

b. gram negative anaerobic bacterial are generally resistant

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37
Q

Which of the following should be considered when determining an empiric antimicrobial therapy?

a. Previous culture results if available
b. Recent hospital admissions
c. Hospital antibiogram
d. All of the above

A

d. All of the above

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38
Q

MC is a sexual acitive 30 yo female patient who has developed a UTI
twice over the past 18 months. Each time the patient was successfully
treated with a short course of a sulfa drug. However the patient wishes to
receive preventative therapy to avoid the ordeal of another UTI. Which of
the following is the most appropriate therapy at this time?

a. The patient should receive nitrofurantoin 100 mg po daily for 3 months
b. The patient should not receive any preventative therapy as this is not
indicated at the time
c. The patient should take tmp/SMX ds one tablet after each episode of sexual activity
d. The patient should receive Ciprofloxacin 250 mg po for six months

A

b. The patient should not receive any preventative therapy as this is not
indicated at the time

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39
Q

Which of the following statements is TRUE with regards to phenazopyridine? Used to help with the pain, but isn’t effective treatment at all

a) The drug has good antimicrobial properties and can be used by
patients to treat mild cases of uncomplicated cystitis
b) Use of the drug make result in urine discoloration
c) The drug promotes urinary health and has been proven to be
effective in the prophylaxis of UTRs when used daily
d) The drug should be used for a minimum of seven to 14 days to
maximize its efficacy

A

b) Use of the drug make result in urine discoloration

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40
Q

TK, a 62 year old man was diagnosed with osteomyelitis. Local resistant data reports more than 10% resistant S aureus in his
community. Which of the following is the most empiric antibiotic of choice?

a. Cephalexin
b. Ciprofloxacin
c. Vancomycin
d. Nafcillin

A

c. Vancomycin

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41
Q

Oral antibiotic therapy may be used in the treatment of osteomyelitis
a) True
b) False

A

true

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42
Q

SATA
A patient is not improving after being on 3 days of antimicrobial
treatment. Which of the following should be considered?

a) undetected pathogens
b) non infectious etiologies
c) potential drug interactions
d) surgical intervention

A

a) undetected pathogens
b) non infectious etiologies
c) potential drug interactions

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43
Q

Which of the following antibiotics acts by binding the 16s rRNA of the
30S subunit of the bacterial ribosome?

a. Quinipristin
b. Clindamycin
c. Chloramphenicol
d. Streptomycin
e. Erthromycin

A

d. Streptomycin

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44
Q

Which of the following is TRUE in regard to bacterial
meningitis caused by streptococcus pneumonia (pneumococcal meningitis)?

a. Chemoprophylaxis with ciprofloxacin is warranted for close contacts
to patients with pneumococcal meningitis
b. Adjunctive dexamethasone has shown benefits in adults with
pneumococcal meningitis
c. Ampicillin is the drug of choice for ceftriaxone resistant S. pneumoniae
d. All of the above

A

b. Adjunctive dexamethasone has shown benefits in adults with
pneumococcal meningitis

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45
Q

The CSF from a patient with meningitis shows a very high neutrophil count. Which is the most likely etiology?

a. Bacterial
b. Fungal
c. This is not a relevant finding
d. Viral

A

a. Bacterial

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46
Q

The mechanism of interference with dephosphorylation in cycling of the
lipid carrier that transfers peptide subunits to the growing cell wall is a unique mechanism associated with the action of
a. Vancomycin
b. Bacitracin
c. Daptomycin
d. Polymyxin
e. Fosfomycin

A

b. Bacitracin

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47
Q

DH is a 32 year old female who presents to the emergency room with fever (101.7 F), flank pain and nausea with active monitoring. Her white count is elevated with a left shirt (WBC of 12,000 with 15% bands). She is diagnosed with community acquired pyelonephritis. The patient is allergic to sulfonamides (bilateral maculopapular rash) but has no other drug allergies or altered organ function. Which of the following would be the most appropriate empiric regimen for this patient?

a. Ciprofloxacin 400 mg intravenous every 12 hours
b. Moxifloxacin 400 mg orally every 24 hours
c. Ampicillin 500 mg intravenously every 6 hours
d. Bactrim DS 2 vials intravenously every 12 hours

A

a. Ciprofloxacin 400 mg intravenous every 12 hours

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48
Q

While Escherichia Coli is by far the most common cause of uncomplicated urinary tract infections. What gram positive, coagulase negative organism is perhaps the second most common cause of UTIs?

a. Proteus mirabilis
b. Neisseria gonorrhoeae
c. Staphylococcus saprophyticus
d. Pseudomonas aeruginosa

A

c. Staphylococcus saprophyticus

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49
Q

The mechanism of action for sulfamethoxazole involves

a. Inhibition of bacterial dihydrofolate reduction
b. Inhibition of bacterial dihydropteroate synthase
c. Both of the above
d. None of the above

A

b. Inhibition of bacterial dihydropteroate synthase

50
Q

Which of the following penicillins is more effective against bacteria
producing beta lactamases?

a. Penicillin V
b. Nafcillin
c. Ticarcillin
d. Amoxicillin
e. Piperacillin

A

b. Nafcillin

51
Q

QB, a 72 year old women presents with 3 positive blood cultures with
methicillin resistant S. aureus (MRSA). Transthoracic echocardiogram reveals a 3mm vegetation on his prosthetic mitral valve. QB is diagnosed with MRSA prosthetic valve endocarditis. What is the recommended
antibiotic treatment for this patient?

a. Vancomycin 15 mg/kg Q12H x 6 weeks + rifampin 300 mg IV q8h
x 6 weeks + gentamicin 1 mg/kg IV Q8H x 2 weeks
b. Vancomycin 15 mg/kg Q12H x 6 weeks + rifampin 300 mg IV q8h
x 2 weeks + gentamicin 1 mg/kg IV Q8H x 2 weeks
c. Nafcillin 2g IV Q4H x 6 weeks + rifampin 300 mg IV Q8H x 6 weeks + gentamicin 1 mg/kg IV Q8H x 2weeks
d. Nafcillin 2g IV Q4H x 6 weeks + rifampin 300 mg IV Q8H x 6 weeks +
gentamicin 1 mg/kg IV Q8H x 6week

A

a. Vancomycin 15 mg/kg Q12H x 6 weeks + rifampin 300 mg IV q8h
x 6 weeks + gentamicin 1 mg/kg IV Q8H x 2 weeks

52
Q

Which of the following is NOT a major adverse effect of tetracycline?

a. Discoloration of teeth
b. Photosensitivity
c. Nephrotoxicity
d. Fanconi syndrome
e. Grey baby syndrome in newborns

A

e. Grey baby syndrome in newborns

53
Q

Resistance to quinolone antibiotics is due to all these reasons EXCEPT

a. Enzymatic modifications
b. Mutations in bacterial DNA gyrase
c. Quinoline resistance proteins (QNR)
d. Some bacteria can use exogenous folate
e. Decreased permeability to quinolones

A

d. Some bacteria can use exogenous folate

54
Q

EE is a 24 yo old female who complains of increased urgency of
urination accompanied by painful urinary, dysuria and suprapubic pain . The patient has no significant PMH except noted sulfa allergy (manifested by a rash). The patient is diagnosed as suffering from a case of uncomplicated cystitis. Which of the following would be most appropriate treatment for her condition?
a. Fosfomycin 3 grams orally x 1 dose
b. Moxifloxacin 400 mg po daily x 2 weeks
c. Vancomycin 250 mg po every 12 hours x 5 days
d. TMP/SMX 1 DS tablet po every 12 hours x 3 days

A

a. Fosfomycin 3 grams orally x 1 dose

55
Q

Which is the recommended antibiotic treatment for native valve endocarditis caused by highly penicillin susceptible viridans group streptococcus?

a. Ampicillin 2g IV Q4H
b. Aqueous crystalline penicillin G 3 million Units IV Q4H
c. Ceftriaxone 2g IV Q24H
d. All of the above

A

d. All of the above

56
Q

PM is a 28 year old female who presents to her family physician with a 2-3 day history of worsening pain, redness and swelling of her left leg after an abrasion that occurred by sliding during a soccer game. The area is warm to the touch and red. During the past 24 – 36 hours, the leg has become increasingly painful and tight and she has spiked a low grade fever. The physician diagnosed her with moderate cellulitis. She has no other significant past medical history, takes no medications and has no known drug allergies. There is minimal incidence (<5%) of CA-MRSA in her community and the physician states that he does not want to treat her for CA – MRSA. Which of the following is the most appropriate choice of treatment for PMs moderate non-purulent cellulitis?

a. Cephalexin
b. Fluconazole
c. Dicloxacillin + TMP SMX
d. Moxifloxacin

A

a. Cephalexin

57
Q

Which of the following would not be found in vegetative growth of infective endocarditis ?

a. Capillaries
b. Platelets
c. Neutrophils
d. Bacteria

A

a. Capillaries

58
Q

KH is a 28 yo pregnant female (5 months pregnant) who has no
complaints regarding genitourinary symptoms. However she was found to have a significant number of bacteria in her urine. Which of the following drugs would be best to manage this patient’s asymptomatic bacteriuria?

a. No therapy is indicated at this time since she is asymptomatic
b. Doxycycline
c. Ciprofloxacin
d. Amoxicillin

A

d. Amoxicillin

59
Q

Which of the following statements is TRUE in regards to markers of
infection?

a. Bandemia is described by a decreased release of immature neutrophils
b. C reactions protein (CRP) is a specific marker for bacterial infections
c. Leukocytosis describes elevated white blood cells ranging between 4,000 – 11,000 cells/ mm3
d. Elevated white blood cells may be caused by non infectious
reasons such as stress, malignancy and corticosteroids

A

d. Elevated white blood cells may be caused by non-infectious
reasons such as stress, malignancy and corticosteroids

60
Q

PB is a 60 yo male who suffers from an enlarged prostate and has painful urination and has received several courses of beta lactam antibiotics and sulfa drugs in the past. The patient is diagnosed as having prostatitis. Which of the following regimens would be most appropriate to treat this patient’s condition?

a. Ciprofloxacin 500 mg po twice daily x 4 weeks
b. Fosfomycin 3 gms po daily x 1 week
c. Cefixime 400 mg po daily x 7 days
d. Trimethoprim 100 mg tablet twice daily x 7 days

A

a. Ciprofloxacin 500 mg po twice daily x 4 weeks

61
Q

Which of the following shows time dependent
bactericidal activity?
a. Ciprofloxacin
b. Kanamycin
c. Sulfamethoxazole
d. Vancomycin
e. Tetracycline

A

d. Vancomycin

62
Q

The presence of a prosthetic heart valve changes the distribution of
bacteria likely to cause infective endocarditis in a patient. What is the most likely organism to cause endocarditis with such devices?

a. Stretpococcus viridians
b. Staphylcooccus epidermidis
c. Streptococcus pyogens
d. Staphylcoccus aureus

A

d. Staphylcoccus aureus

63
Q

Gram positive bacteria differ with gram negative bacterial with regard to all of this except
a. presence of outer membrane
b. absence of teichoic acid
c. absence of porin channels
d. absence of lipopolysaccharide
e. presence of relatively thicker peptidoglycan layer

A

b. absence of teichoic acid

64
Q

What do mycobacteria, legionellae, and chlamydiae have in common that enable them to evade host defense and cause disease?
a. Intracellular growth
b. Reverse transcriptase
c. Pilli
d. Capsule

A

a. Intracellular growth

65
Q

In post streptococcal glomerulonephritis, what is responsible for triggering
inflammatory response in the glomerulus?

a. Ascending urinary tract infection
b. Disseminated streptococci from primary infection
c. Antigen-antibody complex
d. Streptolysin S and O

A

c. Antigen-antibody complex

66
Q

Which of the following drugs antibacterial drug/ drug classes have concentration dependent bactericidal properties?
a. Sulfonamides
b. Quinolones
c. Macrolides
d. Penicillins
e. Vancomycin

A

b. Quinolones

67
Q

Penicillin-binding protein 2 (PBP2) has ____ activity/activities

a. Carboxypeptidase PP5
b. Transpeptidase- Transglycosylase
c. Transpeptidase PP1
d. Carboxypeptidase/ Transglycosylase
e. Transglycosylase

A

b. Transpeptidase- Transglycosylase

68
Q

Which of the following statements about imipenems is NOT correct?

a. Inactivated by dehydropeptidase in renal tubules
b. Inhibits bacterial cell wall synthesis
c. It is a D-alanyl-D-alanine mimetic
d. Structurally is a B-lactam compound
e. Binds to penicillin binding proteins

A

c. It is a D-alanyl-D-alanine mimetic

69
Q

During translation, the aminoacyl trna coupled with the amino acid
docks the ribosome on

a. 50S subunit P site
b. 30S subunit A site
c. 50S subunit E site
d. 30S subunit P site
e. 50S subunit A site

A

e. 50S subunit A site

70
Q

Which of the following is a short/medium acting t1/2= 6-12 hr sulfa drug?

a. -
b. Sulfalene
c. Sulfamethoxazole d. Sulfadiazine
e. C and d

A

e. C and d

71
Q

SATA
Which of the following statements are TRUE in regards to antimicrobial stewardship?
a. It is designed to promote the optimal use of antibiotics
b. The primary goal is to decrease totally healthcare cost
c. Inappropriate antimicrobial use leads to antimicrobial resistance
d. The secondary goal is to promote the emergence of resistance

A

a. It is designed to promote the optimal use of antibiotics
c. Inappropriate antimicrobial use leads to antimicrobial resistance

72
Q

Agents such as tazobactam and clavulanate
a. Are used in combination with third-generation fluoroquinolones
b. Have excellent activity against gram negative organisms and are used as single agents
c. Have excellent activity against gram positive organisms and are used as single agents
d. Are pharmacokinetic enhancers acting on CYP enzymes
e. Are used in combination with extended spectrum penicillins and cephalosporins

A

e. Are used in combination with extended spectrum penicillins and cephalosporins

73
Q

Which most likely causes a suppurative skin infection?
a. Staph aureus
b. P. aeruginosa
c. Other stuff

A

a. staph aureus

74
Q

for co-trimoxazole (TMP-SMZ) involves ___
a. inhibition of bacterial dihydropteroate synthase
b. inhibition of bacterial dihydrofolate reductase
c. both of the above
d. none of the above

A

c. both of the above

75
Q

The primary reason for a hypersensitivity reaction to augmentin is ___

a. potassium in augmentin depolarizes immune cells
b. binding of clavulanate to protein causes immune responses
c. G6PDH deficient patients have amoxicillin immune response
d. binding of penicillin acid to protein causes immune response
e. all of the above

A

e. all of the above

76
Q

All of the following are important factors to consider when deciding on
an appropriate antibiotic regimen EXCEPT:

a. determining the ability of the drug to penetrate the site of infection
b. reviewing contamination medication to prevent drug to drug interaction
c. investigating whether a document drug allergy is a true allergy, intolerance or toxicity
d. using the Cockcroft gault equation

A

d. using the Cockcroft gault equation

77
Q

Which of the following scenarios represent a true pathogen?

a) S. aureus growing in multiple blood cultures
b) Coagulase-negative staphylococcus isolated from 1 out of 2 set of blood cultures in a patient with no risk factors
c) Sputum culture with predominance of epithelial cells
d) Gram-negative bacteria in urine collected from catheter bag; urinalysis is absent of WBCs

A

a) S. aureus growing in multiple blood cultures

78
Q

Which of the following drugs are NOT used in community-acquired pneumonia due to its interaction with pulmonary surfactants?

a) Tobramycin
b) Vancomycin
c) Daptomycin
d) Streptogramin
e) None of the other choices

A

c) Daptomycin

79
Q

RM is a 70 year old male diagnosed with enterococcal endocarditis on his native valve (penicillin and gentamicin susceptible). Assuming RM has no know drug allergies and a CrCl of 40 ml/min, which antimicrobial therapy is most appropriate for this patient?

a) Ampicillin plus ceftriaxone x 6 weeks
b) Vancomycin plus gentamicin x 6 weeks
c) ampicillin plus gentamicin x 6 weeks
d) daptomycin x 6 weeks

A

a) Ampicillin plus ceftriaxone x 6 weeks

80
Q

As per the IDSA guidelines, adjunctive dexamethasone should be considered in which of the following patients?

a) A 42 year old female with endocarditis due to S. aureus
b) A 70 year old male with meningitis due to S. pneumoniae
c) A 62 year old male with meningitis due to N. meningitidis
d) A 3 year old child with meningitis due to N. meningitidis

A

b) A 70 year old male with meningitis due to S. pneumoniae

81
Q

A 22 year old female is diagnosed with an uncomplicated urinary tract infection and will be treated as an outpatient. The local TMP/SMX resistance rate in the area is 23% and Fluoroquininolone resistance rate is 10%. Which of the following antibiotics would be considered the most appropriate first line agent (to)**** treat her with?

a) Trimethoprim/sulfamethoxazole 1DS tab PO q12h x 3 days
b) Nitrofurantoin 100mg PO q12h x 5 days
c) Ciprofloxacin 500mg PO q12h x 7 days
d) Fosfomycin 3g PO x 2 doses

A

b) Nitrofurantoin 100mg PO q12h x 5 days

82
Q

Which of the following patient would NOT require prophylactic amoxicillin-clavulanate after an animal bite?

a) 72 year old receiving chemotherapy
b) 18 year old with severe injury to her hand
c) 46 year old with end stage liver disease
d) 60 year old with hypertension

A

d) 60 year old with hypertension

83
Q

A patient comes into the emergency room with a severe headache, stiff neck, and rapid onset of fever. Meningitis is suspected. A sample of cerebrospinal fluid shows many neutrophils and gram negative diplococci. What is the most likely organism present?

a) Toxoplasma gondii
b) Cryptococcus neoformans
c) Neisseria gonorrhoeae
d) Neisseria meningitidis

A

d) Neisseria meningitidis

84
Q

The mechanism of action of fidaxomicin is:

a) Bacterial DNA decatenation
b) Inhibition of protein synthesis by binding to ribosomes
c) Inhibition of RNA synthesis by RNA polymerase
d) Inhibition of bacterial transglycosylation

A

c) Inhibition of RNA synthesis by RNA polymerase

85
Q

PC, a 52 year old male, was diagnosed with streptococcal endocarditis that is highly susceptible to penicillin on his prosthetic mitral valve. The patient has no known drug allergies and normal renal function. Which of the following antimicrobial regimens is most appropriate for this patient?

a) Vancomycin 1 gram IV Q12H for 4 weeks
b) Penicillin G IV for 6 weeks
c) Penicillin G IV for 4 weeks and gentamicin for 2 weeks
d) Penicillin G IV for 4 weeks

A

b) Penicillin G IV for 6 weeks

86
Q

Antimicrobial chemoprophylaxis is warranted in close contacts of patients diagnosed with bacterial meningitis due to Neisseria meningitidis
a) True
b) False

A

true

87
Q

For Amoxicillin:
Statement 1 - Belongs to the class of anti-staph penicillins (nafcillin, oxacillin
Statement 2 - Belongs to the class of aminopenicillins
Statement 3 - can be combined with a beta-lactamase inhibitor

a. all are true
b. only 3 is false
c. All are FALSE
d. only 2 is false
e. only 1 is false

A

e. only 1 is false

88
Q

Methicillin resistance in S. aureus is mainly due to:
a) Porin downregulation
b) PBP-2 mutations
c) Ribosomal protection
d) Plasmid-encoded efflux pumps
e) Chromosomal-encoded beta lactamases

A

b) PBP-2 mutations

89
Q

Which one of the following antibiotics acts by binding to the 30S subunit of the ribosome?

a) Chloramphenicol
b) Tigecycline
c) Erythromycin
d) Clindamycin

A

b) Tigecycline

90
Q

Which of the following statements is NOT true regarding the management of necrotizing fasciitis?

a) Antibiotics should be streamlined based on culture and sensitivity results
b) Type I necrotizing fasciitis is associated with polymicrobial infection
c) Empiric antibiotic therapy should provide coverage of MRSA
anaerobes
d) Not all patients with necrotizing fasciitis require surgical intervention.

A

d) Not all patients with necrotizing fasciitis require surgical intervention.

91
Q

BM, a 66 year old female, was admitted to the hospital for bacterial meningitis. She has no known drug allergies. Which empiric antimicrobial therapy is most appropriate for this patient?

a) Vancomycin + Ceftriaxone
b) Vancomycin + Cefepime + Ampicillin
c) Ampicillin + Cefuroxime
d) Vancomycin + Ceftriaxone + Ampicillin

A

d) Vancomycin + Ceftriaxone + Ampicillin

92
Q

The class of penicillins that nafcillin belongs to is _____ and thus it is _____.

a) Extended spectrum; resistant to bacterial beta-lactamases
b) Antistaphylococcal; resistant to bacterial beta-lactamases
c) Antistaphylococcal; used along with beta-lactamase inhibitors
d) Extended spectrum; used along with beta-lactamase inhibitors

A

b) Antistaphylococcal; resistant to bacterial beta-lactamases

93
Q

Aminoglycosides’ mechanism of action involves reversible binding to bacterial
ribosomes.
a) True
b) False

A

false

94
Q

The combination of sulfamethoxazole and trimethoprim

a) Is synergistic in their effect
b) Is antagonistic in their effect
c) Always avoided due to trimethoprim hypersensitivity
d) Always avoided due to serious musculoskeletal effects
e) Is additive in their effect

A

a) Is synergistic in their effect

95
Q

AC, 20 year old female college student, was admitted to the hospital for suspected community acquired bacterial meningitis. Which empiric antimicrobial therapy is most appropriate for AAC assuming she has no known drug allergies?

a) Meropenem and vancomycin
b) Ceftriaxone and vancomycin
c) Piperacillin-tazobactam and vancomycin
d) Ceftriaxone, vancomycin, and ampicillin

A

b) Ceftriaxone and vancomycin

96
Q

ET is an 80 year old woman who presents to the ED with fevers, chills, and a new heart murmur. A TTE reveals a 6-mm vegetation in her native mitral valve. Her preliminary blood cultures are growing gram positive cocci in clusters suggestive of Staphylococcus aureus. Which empiric antimicrobial therapy is most appropriate in this patient assuming she has no known drug allergies and normal renal function?
a) vancomycin IV
b) vancomycin IV plus rifampin plus gentamicin IV
c) nafcillin IV
d) nafcillin IV plus rifampin plus gentamicin IV

A

a) vancomycin IV

97
Q

Which of the following statements about vancomycin is FALSE?

a) Conversion of D-ALA to D-Ala-D-lactate results in bacterial resistance
b) Mechanism of action involves hydrogen bonding with D-Ala-D-Ala
c) It is a beta lactam antibiotic
d) Is bactericidal and shows clinically relevant post-antibiotic effect
e) useful for infection by MRSA or enterococci

A

c) It is a beta lactam antibiotic

98
Q

Which of the following antibacterials inhibits bacterial cell wall synthesis in an irreversible manner via alkylation?

a) Ceftaroline fosamil
b) Tedizolid
c) Oritavancin
d) Aztreonam
e) Fosfomycin

A

e) Fosfomycin

99
Q

A 65 year old male is diagnosed with osteomyelitis of his left calcaneal bone. His bone biopsy is growing MRSA. Which of the following is the most appropriate in management of his infection?

a) Start cefazolin and monitor weekly ESR/CRP
b) Start vancomycin and monitor weekly ESR/CRP
c) Start daptomycin plus cefepime and monitor weekly ESR/CRP/CPK
d) Start nafcillin and monitor weekly ESR/CRP

A

b) Start vancomycin and monitor weekly ESR/CRP

100
Q

MLS-B type of resistance is shown by all of the following drugs except:

a) Azithromycin
b) Clindamycin
c) Kanamycin
d) Erythromycin
e) Streptogramins

A

c) Kanamycin

101
Q

The mechanism of action of ciprofloxacin involves

a) Interaction with bacterial cell membrane
b) Inhibition of bacterial translation
c) Interfering with bacterial peptidoglycan synthesis
d) Inhibiting bacterial folate transport
e) Inhibiting relaxation of DNA supercoils

A

e) Inhibiting relaxation of DNA supercoils

102
Q

all floroquines share a common feature of ___

a. activity against gram negative aerobic bacteria
b. inhibiting DNA topoisomerase I and II
c. fluorine at position 7 of the parent drug
d. activity against MRSA
e. inhibiting dihydrofolate reductase

A

c. fluorine at position 7 of the parent drug

103
Q

All of the following drugs must undergo biotransformation in order to become pharmacologically active except:

a) Methenamine
b) Metronidazole
c) Cefpodoxime axetil
d) Cefuroxime proxetil
e) Linezolid

A

e) Linezolid

104
Q

All of the following can be used to treat an infection due to gram-negative aerobes except

a) Levofloxacin
b) Imipenem + cilastatin
c) Ciprofloxacin
d) Penicillin G
e) Tobramycin

A

d) Penicillin G

105
Q

All of the following are primarily excreted in the urine in the unchanged form except

a) Erythromycin
b) Penicillin G
c) Levofloxacin
d) Cephalexin
e) Fosfomycin

A

a) Erythromycin

106
Q

All of the following can be used as part of the treatment regimen for H. pylori except

a) Metronidazole
b) Amoxicillin
c) Ampicillin
d) Clarithromycin
e) Tetracycline

A

c) Ampicillin

107
Q

All of the following can inhibit protein synthesis by interacting with the ribosomes except

a) Aminoglycosides
b) Linezolid
c) Clarithromycin
d) Clindamycin
e) Sulfamethoxazole

A

e) Sulfamethoxazole

108
Q

All of the following drugs can produce some degree of hemolytic anemia except

a) Pyrimethamine
b) Sulfamethoxazole + trimethoprim
c) Azithromycin
d) Nitrofurantoin
e) Primaquine

A

c) Azithromycin

109
Q

All of the following could be used to treat a skin infection due to MRSA except

a) Daptomycin
b) Tigecycline
c) Linezolid
d) Quinupristin + dalfopristin
e) Imipenem

A

e) Imipenem

110
Q

All of the following are correctly matched except:

a) Transpeptidase - crosslinks glycan chains via formation of amide bonds between
the peptides located on N-acetyl-muramic acid
b) Transglycosylase - crosslinks NAG and NAM residues via a 1,4 beta linkage
c) PBP2 - act as a carboxypeptidase
d) PBP4 and PB7 - act as endopeptidase
e) PBP1a and 1b - can contain domains that code for transpeptidase and
transglycosylase

A

d) PBP4 and PB7 - act as endopeptidase

111
Q

Which drug listed below would be considered to have the widest antimicrobial spectrum?

a) Clindamycin
b) Vancomycin
c) Imipenem
d) Aztreonam
e) Metronidazole

A

c) Imipenem

112
Q

Which drug listed below does not have significant activity against the so-called atypical infections?
a) Doxycycline b) Azithromycin c) Telithromycin d) Meropenem

A

d) meropenem

113
Q

Which drug listed below would be least suitable for treating infections due to aerobic gram-positive bacteria?
a) Imipenem
b) Tobramycin
c) Cefepime
d) Gemifloxacin
e) Vancomycin

A

d) Gemifloxacin

114
Q

All of the following could be used to treat a mild community acquired infection due to MSSA except
a) Nafcillin
b) Cephalexin
c) Clarithromycin
d) Clindamycin
e) Amoxicillin

A

e) Amoxicillin

115
Q

All of the following drugs can disrupt cell wall synthesis except
a) Vancomycin
b) Fosfomycin
c) Cefuroxime
d) Penicillin G
e) Levofloxacin

A

e) levofloxacin

116
Q

All of the following drugs primarily produce a bactericidal action except
a) Linezolid
b) Ampicillin
c) Metronidazole
d) Moxifloxacin
e) Cefuroxime

A

a) Linezolid

117
Q

All of the following drugs primarily produce a bacteriostatic action except
a) Doxycycline
b) Azithromycin
c) Daptomycin
d) Clindamycin
e) Chloramphenicol

A

c) Daptomycin

118
Q

All of the following enzymes are classified as PBP except

a) Transglycolase
b) Transpeptidase
c) Endopeptidase
d) Carboxypeptidase
e) Beta-lactamase

A

e) Beta-lactamase

119
Q

Which of the molecular classes of beta-lactamases listed below is not a serine-containing beta-lactamase
a) Class A
b) Class d
c) Class B
d) Class C

A

c) Class B

120
Q

Which of the below would not be classified as a “genetic” mechanism of resistance
a) Integron
b) Transposition
c) Transduction
d) Conjugation
e) Bacteria enter a non-growing phase

A

e) Bacteria enter a non-growing phase

121
Q

All of the following are considered to be special sites of penetration except:
a) Bone
b) Brain
c) Eye
d) Skin
e) Necrotic or devitalized tissue

A

d) skin

122
Q

What feature if possessed by Streptococcus pneumonia or Hemophilis influenziae, enable these organisms to avoid host defenses and cause pneumonia?
a. Pili
b. Fibriae
c. Capsule
d. Intracellular residence

A

c. Capsule

dddd (5 decks)

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