Infection Flashcards
A 47-year-old woman is admitted to the coronary care unit (CCU) and is diagnosed with infective endocarditis. On day 3 of her hospital admission, she is complaining of a ringing sound from her ears. Which antibiotic is most likely to be responsible for these symptoms?
A) Amoxicillin
B) Linezolid
C) Gentamicin
D) Pivmecillinam
E) Ceftazidime
C
RATIONALE: THE RINGING SOUND IN THE EARS IS KNOWN AS TINNITUS, AND IT CAN BE A SIDE EFFECT OF SOME ANTIBIOTICS. AMONG THE ANTIBIOTICS LISTED, GENTAMICIN IS THE MOST LIKELY TO CAUSE TINNITUS AS A SIDE EFFECT. AMOXICILLIN, PIVMECILLINAM, AND CEFTAZIDIME ARE NOT TYPICALLY ASSOCIATED WITH TINNITUS AS A SIDE EFFECT. LINEZOLID IS NOT COMMONLY ASSOCIATED WITH TINNITUS, BUT IT HAS BEEN REPORTED IN RARE CASES.
A 55-year-old patient on an acute medical ward is found to have Pseudomonas aeruginosa in his blood. The junior doctor on the ward asks you which antibiotics can be used to treat Pseudomonas aeruginosa empirically until the sensitivities are available. Which of the following antibiotics can be used to treat an infection caused by Pseudomonas aeruginosa?
A) Ciprofloxacin
B) Amoxicillin
C) Vancomycin
D) Pivmecillinam
E) Co-amoxiclav
RATIONALE: CIPROFLOXACIN IS AN EFFECTIVE ANTIBIOTIC FOR TREATING PSEUDOMONAS AERUGINOSA INFECTIONS EMPIRICALLY UNTIL SENSITIVITIES ARE AVAILABLE. OTHER ANTIBIOTICS LIKE AMOXICILLIN, PIVMECILLINAM, AND VANCOMYCIN ARE NOT EFFECTIVE. CO-AMOXICLAV MAY HAVE SOME ACTIVITY, BUT IT IS NOT A FIRST-LINE AGENT. PSEUDOMONAS AERUGINOSA IS CHALLENGING TO TREAT BECAUSE IT IS INTRINSICALLY RESISTANT TO MANY ANTIBIOTICS.
A 55-year-old female is admitted to the acute admissions ward with diarrhoea and fever. She is diagnosed with a Clostridium difficile infection. Which of the following antibiotics is most likely to increase the risk of a Clostridium difficile infection?
A) Vancomycin
B) Amoxicillin
C) Clindamycin
D) Pivmecillinam
E) Fosfomycin
C
RATIONALE: THE ANTIBIOTIC MOST COMMONLY ASSOCIATED
WITH AN INCREASED RISK OF CLOSTRIDIUM DIFFICILE
Q3 INFECTION (CDI) IS CLINDAMYCIN. VANCOMYCIN IS USED TO
TREAT CDI AND IS NOT ASSOCIATED WITH AN INCREASED RISK OF CDI. AMOXICILLIN AND PIVMECILLINAM ARE NOT TYPICALLY ASSOCIATED WITH AN INCREASED RISK OF CDI.
You are working as a responsible pharmacist in a small community pharmacy. A 64-year-old patient comes into the pharmacy complaining of severe pain near his left heel. After further questioning, you notice that this pain began after starting a new antibiotic. Which antibiotic may be responsible for this pain?
A)Gentamicin
b) Clindamycin
C) Co-amoxiclav
D) Amoxicillin
E) Ciprofloxacin
E
RATIONALE: CIPROFLOXACIN IS THE ANTIBIOTIC MOST COMMONLY ASSOCIATED WITH TENDONITIS OR TENDON RUPTURE, PARTICULARLY IN OLDER PATIENTS. THEREFORE, IT IS THE MOST LIKELY ANTIBIOTIC TO BE RESPONSIBLE FOR THE PATIENT’S PAIN NEAR HIS LEFT HEEL. GENTAMICIN CAN CAUSE KIDNEY DAMAGE AND HEARING LOSS, WHILE CLINDAMYCIN, CO-AMOXICLAV, AND AMOXICILLIN ARE NOT ASSOCIATED WITH TENDONITIS OR TENDON RUPTURE
You are working as a responsible pharmacist in a small community pharmacy. A patient walks in with a prescription for erythromycin. Which antibiotic class does erythromycin belong to?
A) Aminoglycosides
B) Macrolides
C) Glycopeptides
D) Penicillins
E) Lincosamides
B
You are working as a pharmacist in an acute admissions ward. A patient is diagnosed with a Clostridium difficile infection. The ward doctor asks you which antibiotics are effective against C. difficile infection, Which of the following antibiotics can be used for a Clostridium difficile infection?
A) Oral vancomycin
B) Oral doxycycline
C) Intravenous co-amoxiclav
D) Intravenous vancomycin
E) Oral clindamycin
A
RATIONALE: ORAL VANCOMYCIN IF THE FIRST-LINE TREATMENT FOR MILD-SEVERE CASES OF C. DIFFICILE. INTRAVENOUS VANCOMYCIN IS NOT INDICATED OR EFFECTIVE FOR A C. DIFFICILE INFECTION.
During the current pandemic, you are informed that COVID-19 is a notifiable disease. Which of the following conditions is not a notifiable disease?
A) Malaria
B) Leprosy
C) Anthrax
D)Pneumonia
E) Scarlet fever
D
RATIONALE: PNEUMONIA IS NOT A NOTIFIABLE DISEASE. NOTIFIABLE DISEASES ARE THOSE THAT ARE REQUIRED BY LAW TO BE REPORTED TO PUBLIC HEALTH AUTHORITIES.
You are the responsible pharmacist in a community pharmacy. The pharmacy technician recently read that there are five generations of cephalosporin antibiotics. Which of the following cephalosporins belongs to the third generation?
A) Cefalexin
B) Cefuroxime
C) Ceftaroline
D) Ceftazidime
E) Cefradine
D
RATIONALE: CEFTAZIDIME IS AN EXAMPLE OF A THIRD GENERATION CEPHALOSPORIN.
A 37-year-old patient on the ward is diagnosed with aspergillosis, the doctor on the ward is not familiar with the treatment options for aspergillosis. Which antifungal is the treatment of choice for aspergillosis?
A) Fluconazole
B) Amphotericin B
C) Caspofungin
D) Clotrimazole
E) Voriconazole
E
RATIONALE: THE TREATMENT OF CHOICE FOR ASPERGILLOSIS IS VORICONAZOLE. VORICONAZOLE IS AN AZOLE ANTIFUNGAL MEDICATION THAT WORKS BY INHIBITING THE SYNTHESIS OF FUNGAL CELL MEMBRANES, LEADING TO THE DEATH OF THE FUNGUS. IT HAS BEEN SHOWN TO BE EFFECTIVE IN TREATING INVASIVE ASPERGILLOSIS AND HAS FEWER SIDE EFFECTS THAN OTHER ANTIFUNGAL MEDICATIONS SUCH AS AMPHOTERICIN B.
You are a pharmacist working in a GP surgery, A 42-year-old patient is diagnosed with an acute exacerbation of chronic obstructive pulmonary disease (COPD) by the general practitioner. What is the first-line treatment for a patient with an acute exacerbation of COPD? The patient is not severely unwell and is able to take oral medication.
A) Meropenem
B) Clarithromycin
C) Tigecycline
D) Levofloxacin
E) Co-trimoxazole
B
RATIONALE: THE FIRST-LINE TREATMENT FOR A PATIENT WITH AN ACUTE EXACERBATION OF COPD IS AN ORAL ANTIBIOTIC E.G. MACROLIDE OR DOXYCYCLINE/AMOXICILLIN (NOT INCLUDED IN THE OPTIONS). THEREFORE, OPTION B (CLARITHROMYCIN) MAY BE AN APPROPRIATE CHOICE FOR TREATMENT. OPTIONS A, C, AND D ARE NOT TYPICALLY USED AS FIRST-LINE TREATMENTS FOR AN ACUTE EXACERBATION OF COPD.
You are the ward pharmacist working on a respiratory ward. The medical student on the ward wants to learn about which antibiotics should not be given to a patient with a penicillin allergy. Which of the following antibiotics should not be given to a patient with a penicillin allergy?
A) Co-trimoxazole
B) Tigecycline
C) Ciprofloxacin
D) Piperacillin/tazobactam
e) Azithromycin
D
RATIONALE: PENICILLIN IS A BETA-LACTAM ANTIBIOTIC, AND PATIENTS WHO ARE ALLERGIC TO PENICILLIN MAY ALSO BE ALLERGIC TO OTHER BETA-LACTAM ANTIBIOTICS, INCLUDING PIPERACILLIN/TAZOBACTAM. THEREFORE, PIPERACILLIN/TAZOBACTAM SHOULD NOT BE GIVEN TO PATIENTS WITH A KNOWN PENICILLIN ALLERGY. CO- TRIMOXAZOLE, TIGECYCLINE, CIPROFLOXACIN, AND AZITHROMYCIN ARE NOT BETA-LACTAM ANTIBIOTICS AND ARE NOT STRUCTURALLY RELATED TO PENICILLIN, SO THEY CAN BE GIVEN TO PATIENTS WITH A PENICILLIN ALLERGY.
You are the ward pharmacist working on an acute admissions ward and a 39-year old male patient, Ryan Smith, is diagnosed with cellulitis. Which of the following antibiotics would be the most appropriate treatment option for cellulitis? Mr Smith has a penicillin allergy.
A) Gentamicin
B) Nitrofurantoin
C) Ciprofloxacin
D) Doxycycline
E) Ertapenem
D - DOXYCYCLINE IS ONE OF THE FIRST-LINE TREATMENT OPTIONS FOR A PATIENT WITH CELLULITIS AND CAN BE GIVEN TO A PATIENT WITH A PENICILLIN ALLERGY. DOXYCYCLINE PROVIDES GOOD COVERAGE AGAINST STAPHYLOCOCCUS AUREUS WHICH CAN COMMONLY CAUSE CELLULITIS
You are the ward pharmacist working on a respiratory ward, a 45-year-old male patient is diagnosed with hospital-acquired pneumonia and the junior doctor on the ward asks you about the treatment options. Which of the following antibiotics would be the most appropriate first-line treatment option for hospital-acquired pneumonia? The patient does not have any drug allergies, does not have any severe signs or symptoms and is not at high risk of resistance.
A) Gentamicin
B) Teicoplanin
C) Meropenem
D) Co-amoxiclav
E) Tigecycline
D
RATIONALE: THE MOST APPROPRIATE FIRST-LINE TREATMENT OPTION FOR HOSPITAL-ACQUIRED PNEUMONIA IN A PATIENT WITHOUT DRUG ALLERGIES, SEVERE SIGNS OR SYMPTOMS, AND NOT AT HIGH RISK OF RESISTANCE IS CO- AMOXICLAV.
You are the ward pharmacist working on a cardiology ward, a 52-year-old female patient is diagnosed with infective endocarditis caused by streptococcus species and is due to be started on teicoplanin and low-dose gentamicin. Which antibiotic class does teicoplanin belong to?
A) Aminoglycosides
B) Glycopeptides
C) Macrolides
D) Tetracyclines
E) Penicillins
B
RATIONALE: TEICOPLANIN BELONGS TO THE GLYCOPEPTIDE CLASS OF ANTIBIOTICS.
You are currently working as the responsible pharmacist in a community pharmacy. The trainee pharmacist is currently learning about gentamicin. Which of the following side effects is not associated with gentamicin?
A) Ototoxicity
B) Nephrotoxicity
C) Peripheral neuropathy
D) Thrombocytosis
E) Antibiotic associated colitis
D
RATIONALE: THROMBOCYTOSIS, OR AN INCREASE IN THE NUMBER OF PLATELETS IN THE BLOOD, IS NOT A KNOWN SIDE EFFECT OF GENTAMICIN.
You are working as the ward pharmacist in the accident and emergency department and a 32-year-old female patient is diagnosed with a lower urinary tract infection. The junior doctor on the ward wants to learn about the bacteria that cause urinary tract infections. Which bacteria has been found to most commonly cause urinary tract infections?
A) Escherichia coli
B) Staphylococcus aureus
C) Streptococcus pneumoniae
D) Pseudomonas aeruginosa
E) Serratia marcescens
A
URINARY TRACT INFECTIONS (UTIS) ARE CAUSED BY A VARIETY OF BACTERIAL SPECIES, BUT ESCHERICHIA COLI (E. COLI) IS BY FAR THE MOST COMMON CAUSE. E. COLI ACCOUNTS FOR APPROXIMATELY 80-85% OF ALL UTIS, PARTICULARLY IN WOMEN.
You are currently working as a pharmacist in a hospital pharmacy. You are clinically checking a prescription for dalbavancin for an acute bacterial skin infection. Which antibiotic class does dalbavancin belong to?
A) Aminoglycosides
B) Macrolides
C) Glycopeptides
D) Lincosamides
E) Penicillins
C
RATIONALE: DALBAVANCIN BELONGS TO THE GLYCOPEPTIDE CLASS OF ANTIBIOTICS.
You are currently working as the ward pharmacist on a respiratory ward. A 37-year old male patient is diagnosed with tuberculosis. He is started on four antibiotics as part of the initial phase of treatment for tuberculosis Which one of the following antibiotics is not used for the treatment of tuberculosis?
A) Isoniazid
B) Rifampicin
C) Pyrazinamide
D) Fosfomycin
E) Ethambutol
RATIONALE: D. FOSFOMYCIN IS NOT USED FOR THE TREATMENT OF TUBERCULOSIS. IT IS AN ANTIBIOTIC USED PRIMARILY FOR THE TREATMENT OF URINARY TRACT INFECTIONS CAUSED BY SUSCEPTIBLE ORGANISMS. THE STANDARD FOUR-DRUG REGIMEN FOR THE INITIAL PHASE OF TREATMENT OF TUBERCULOSIS CONSISTS OF ISONIAZID, RIFAMPICIN, PYRAZINAMIDE, AND ETHAMBUTOL.
You are currently working as the ward pharmacist on an acute cardiorespiratory ward and a patient is diagnosed with community-acquired pneumonia. Which of the following bacteria is not likely to cause community acquired pneumonia?
A) Staphylococcus aureus
B) Streptococcus pneumoniae
C) Haemophilus influenzae
D) Proteus mirabilis
E) Legionella pneumophila
D
RATIONALE: PROTEUS MIRABILIS IS NOT LIKELY TO CAUSE COMMUNITY ACQUIRED PNEUMONIA.
You are working on an endocrinology ward and a patient has been started on an antibiotic to treat a diabetic foot infection caused by Methicillin-resistant Staphylococcus aureus (MRSA). The patient has noticed that his vision is blurred and he is struggling to discern details when looking at objects since starting the antibiotic and is concerned. Which of the following antibiotics is most likely to be associated with this side effect?
A) Doxycycline
B) Amoxicillin
C) Dalbavancin
D) Ertapenem
E) Linezolid
E
RATIONALE: THE ANTIBIOTIC MOST LIKELY TO BE ASSOCIATED WITH BLURRED VISION AND DIFFICULTY DISCERNING DETAILS IS LINEZOLID. THIS SIDE EFFECT CAN OCCUR DUE TO OPTIC NERVE TOXICITY ASSOCIATED WITH PROLONGED USE OF LINEZOLID.
You are working on an acute admissions ward with a pharmacy student, A patient is admitted with an infection and currently takes sodium valproate for epilepsy. The pharmacy student wants to know whether there are any antibiotics that should not be given to a patient with epilepsy. Which of the following antibiotics should be avoided in a patient taking sodium valproate?
A) Amoxicillin
b) Ertapenem
C) Co-trimoxazole
D) Linezolid
E) Teicoplanin
B
RATIONALE: SODIUM VALPROATE IS KNOWN TO INTERACT Q21 WITH CERTAIN ANTIBIOTICS BY INCREASING THE RISK OF SEIZURES. AMONG THE ANTIBIOTICS LISTED, ERTAPENEM
SHOULD BE AVOIDED IN PATIENTS TAKING SODIUM VALPROATE. IT IS IMPORTANT TO NOTE THAT IF ERTAPENEM IS THE MOST APPROPRIATE ANTIBIOTIC FOR THE INFECTION, THE PATIENT’S SODIUM VALPROATE THERAPY MAY NEED TO BE CLOSELY MONITORED, AND ADJUSTMENTS MADE IF NECESSARY.
You are working on a ward in a hospital and a 44-year-old female patient is diagnosed with invasive candidiasis, as candida species have been found in her blood culture. The sensitivities are not available from the microbiology laboratory and the medical team will start empirical treatment until the sensitivities are available. The patient is not currently stable and is acutely unwell. Which of the following antifungals is the first-line empirical therapy for invasive candidiasis?
A) Fluconazole
B) Amphotericin B
C) Clotrimazole
D) Caspofungin
E) Nystatin
D
RATIONALE: CASPOFUNGIN IS THE FIRST-LINE EMPIRICAL THERAPY FOR INVASIVE CANDIDIASIS, AS IT HAS BROAD- SPECTRUM COVERAGE AND IS EFFECTIVE AGAINST MANY DIFFERENT CANDIDA SPECIES.
You are the hospital pharmacist working on a respiratory ward and a patient is diagnosed with community-acquired pneumonia (CAP). The patient is prescribed doxycycline. Which of the following is not a likely side effect of doxycycline?
A) Photosensitivity
B) Dysphagia
C) Visual disturbances
D) Teeth discolouration
E) Nephrotoxicity
E
RATIONALE: THE UNLIKELY SIDE EFFECT OF DOXYCYCLINE AMONG THE OPTIONS PROVIDED IS NEPHROTOXICITY (E). DOXYCYCLINE IS GENERALLY WELL-TOLERATED, AND THE MOST COMMON SIDE EFFECTS ARE GASTROINTESTINAL, SUCH AS NAUSEA, VOMITING, AND DIARRHOEA.
You are the hospital pharmacist working on a respiratory ward and a patient is diagnosed with community acquired pneumonia caused by Legionella pneumophila. Which of the following antibiotics is effective against Legionella pneumophila?
A) Co-amoxiclav
B) Amoxicillin
C) Piperacillin/tazobactam
d) Ceftazidime
E) Levofloxacin
E
RATIONALE: LEVOFLOXACIN (E) IS EFFECTIVE AGAINST LEGIONELLA PNEUMOPHILA. LEVOFLOXACIN IS A FLUOROQUINOLONE ANTIBIOTIC WITH ACTIVITY AGAINST MANY GRAM-NEGATIVE BACTERIA, INCLUDING LEGIONELLA PNEUMOPHILA.
You are the hospital pharmacist working on an admission ward with a trainee pharmacist. The trainee pharmacist wants to learn more about the spectrum of activity of antibiotics. Which of the following antibiotics has a narrow spectrum of activity?
A) Co-amoxiclav
B) Meropenem
C) Doxycycline
D) Fidaxomicin
E) Ciprofloxacin
D
RATIONALE: FIDAXOMICIN (D) IS A NARROW-SPECTRUM MACROLIDE ANTIBIOTIC THAT IS ACTIVE AGAINST CLOSTRIDIUM DIFFICILE, A SPECIFIC ANAEROBIC BACTERIUM THAT CAUSES GASTROINTESTINAL INFECTIONS.
