132)  Rifampin  is  an  antibiotic  effective  against  many  Gram-­‐positive  and  Gram-­‐negative  bacteria.

 Which  of  the  following   would  be  an  indication  for  rifampin  monotherapy?     A)  Tuberculosis  caused  by  susceptible  bacteria   B)  Atypical  mycobacterial  infection   C)  Penicillin-­‐resistant  pneumococcal  meningitis   D)  Staphylococcal  endocarditis   E)  Meningococcal  exposure   Rifampin  is  a  DNA  dependent  RNA  polymerase  used  for  mycobacterium  infection,  delays  resistance  to  dapsone  when   used  for  leprosy,  meningococcal  prophylaxis,  and  chemoprophylaxis  for  children  in  contact  with  H.  influenza  type  B.     133)  A  chemotherapeutic  compound  that  is  structurally  similar  to  pyridoxine  has  been  shown  to  inhibit  the  saturation  of   long,  branched  lipids  within  some  bacterial  cells.  This  compound  is  most  likely  to  inhibit  the  growth  of:   A)  Streptococcus   B)  Legionella   C)  Mycobacterium   D)  Treponema   E)  Mycoplasma   Isoniazid  is  really  similar  to  pyridoxine  that  is  depleted  during  mycobacterium  treatment.  It  inhibits  the  synthesis  of   mycolic  acids,  long  branched  fatty  acids,  in  the  cell  wall.   134)  Isolates  of  M.  tuberculosis  obtained  from  a  23  year  old  HIV  positive  male  show  significantly  decreased  activity  of   intracellular  catalase-­‐peroxidase.  The  isolates  would  most  likely  grow  in  the  presence  of:   A)  Isoniazid   B)  Rifampin   C)  Ethambutol   D)  Streptomycin   E)  Pyrazinamide   Isoniazid  is  a  prodrug  requiring  conversion  to  an  active  metabolite  by  mycobacterium  catalase.    This  is  also  how   resistance  builds  up  against  the  drug  –  deletions  in  the  katG  gene  which  encodes  catalase  needed  for  INH  activation.   135)  A  32  year  old  female  is  being  treated  with  antibiotics  for  complicated  cellulitis  of  the  right  foot.  One  week  after   starting  treatment,  she  develops  mild  fever,  nausea,  and  skin  rash.  Laboratory  studies  show  elevated  blood  urea   nitrogen  and  creatinine  levels  as  well  as  eosinophilia.  Which  of  the  following  medications  is  she  receiving?   A)  Nafcillin   B)  Gentamicin   C)  Vancomycin   D)  Clindamycin   E)  Erythromycin   Cellulitis  is  an  acute,  painful  spreading  infection  of  the  dermis  and  subcutaneous  tissue  commonly  caused  by  S  aureus  or   S  pyogenes.  S  pyogenes  can  be  treated  by  Penicillin  whereas  S  aureus  is  resistance  to  Penicillin  must  be  treated  with  a   least  Nafcillin.  If  NRSA,  then  it  should  be  treated  with  Vancomycin.  Methicillin  and  other  penicillin  derivatives  are  known   to  cause  hypersensitivity  reactions  hence  the  eosinophilia  and  drug  induced  interstitial  nephritis  which  explains  the   fever,  rash,  and  nausea.    

 nausea.  Trimethoprim  given  to  the   patient  leads  to  rapid  resolution  of  symptoms.  trimethorpim.  anorexia.  delays  resistance  to  dapsone  when   used  for  leprosy.136)  After  a  positive  PPD  test.  Several  days  later.  meningococcal  prophylaxis.  a  64  year  old  male  begins  isoniazid  therapy.  Resistance   of  tuberculosis  occurs  by  altering  the  structure  of  enzymes  involving  in  RNA  synthesis.     138)  A  32  year  old  HIV-­‐positive  male  is  diagnosed  with  pulmonary  tuberculosis  and  started  on  four-­‐drug  combination   therapy.  Rifampin  is  a  DNA  dependent  RNA  polymerase.     .  Gram-­‐negative  cocci  in  pairs  are  revealed  during  CSF  microscopy.  and  nausea.  influenza  type  B.  and  pryimethamine  are  dihydrofolate  redutcatase  inhibitors  used  for  treatment  of  simple   UTIs.  and  nausea.  anorexia.  A  physical  examination  is  significant  for  neck   stiffness.  and  bilirubin  and  known  to  produce   fever.    If  Vit  B6  is  taken.  and  fever.  tuberculosis  are  resistant  to  several  chemotherapeutic  drugs.  Which  of  the  following  drugs  has  the  same  intracellular  target  as  the  drug   used  in  this  patient?   A)  Sulfamethoxazole   B)  Metronidazole   C)  Imipenem   D)  Bacitracin   E)  Methotrexate   Methotrexate.  What  is  the  most  likely  cause  of  his  symptoms?   A)  Peripheral  nerve  damage   B)  Hepatocyte  damage   C)  Gastric  mucosal  damage   D)  Serum  sickness   E)  Factitious  disorder   Isoniazid  is  known  for  its  neuro-­‐  and  heptatoxicity  side  effects.  it  can  prevent  neurotoxicity  but  the  symptoms  seen  would  not  be  caused   by  peripheral  nerve  damage.  AST.  Which  of  the  following  is  the  best  way  to   prevent  infection  in  his  close  contacts?     A)  Capsular  polysaccharide  vaccine   B)  Pilus  protein  vaccine   C)  Lipopolysaccharide  vaccine   D)  Penicillin   E)  Sulfamethoxazole   F)  Rifampin   Rifampin  is  a  DNA  dependent  RNA  polymerase  used  for  mycobacterium  infection.     137)  A  12  year  old  male  is  hospitalized  with  headache.  It  increases  ALT.  he  presents  complaining  of  red  urine  and  red  staining  of  his  contact  lenses.  and  chemoprophylaxis  for  children  in  contact  with  H.     139)  A  21  year  old  female  presents  to  your  office  with  dysuria  and  burning  on  urination.  Which  of  the  following  best  explains  the   bacterial  resistance  to  the  drug  that  is  responsible  for  this  patient’s  complaints?   A)  Upregulation  of  beta-­‐lactamase  synthesis   B)  Decreased  activity  of  bacterial  catalase-­‐peroxidase   C)  Altered  structure  of  bacterial  ribosomal  proteins   D)  Altered  structure  of  enzymes  involved  in  DNA  winding-­‐unwinding   E)  Altered  structure  of  enzymes  involved  in  RNA  synthesis   Rifampin  causes  red  orange  bodily  fluids  which  is  non-­‐toxic.  Sulfamethoxazole  inhibits  dihydropteroate  synthetase.  His  sputum   isolates  of  M.  One  month  later  he  presents  complaining  of   fever.

  144)  A  31  year  old  male  farm  worker  comes  to  the  physician  complaining  of  an  itchy  rash  on  his  chest.  she   develops  facial  flushing.  vomiting.  it  would  have  to  be  the  culprit.  It  is  from  this  that  the  toxicity  occurs.   This  patient  is  most  likely  being  treated  for  which  of  the  following  conditions?   A)  Chlamydial  urethritis   B)  Candida  vaginitis   C)  Hypothyroidism   D)  Pharyngitis     E)  Menstrual  cramps   F)  Trichomonas  vaginitis   Cephalosporins  and  metronidazole  are  drugs  known  with  disulfiram-­‐like  reaction  with  alcohol.  Since  metronidazole  is   the  only  one  that  treats  Trichomonas  infections.  and  abdominal  cramps  immediately  after  having  an  alcoholic  drink.  Many  of  amphotericin  B’s  toxic  effects  are  due  to  its  binding  of:     A)  Cytochrome  P450  enzymes       B)  Cell  membrane  cholesterol     C)  Microtubular  proteins     D)  Ribosomal  subunits     E)  Mitochondrial  enzymes     Amphotericin  tears  holes  in  the  fungal  membrane  causing  leakage  of  electrolytes.  headache.     143)  A  43  year  old  Caucasian  male  undergoing  treatment  for  invasive  aspergillosis  with  amphotericin  B  experiences   headaches.  After  one   of  the  drugs  is  eliminated  from  his  treatment  regimen.  It  would  require  often  visual  acuity  tests.     141)  A  45  year  old  male  treated  for  pulmonary  tuberculosis  experiences  decreased  visual  acuity  in  both  eyes.  hypotension  and  a  decline  in  renal  function.  his  vision  gradually  improves.  Physical   examination  reveals  an  annular  and  scaling  plaque  five  centimeters  in  diameter  with  central  clearing  on  the  chest.  nausea.  Acid-­‐fast  bacterial  isolates  obtained  from  this  patient   are  resistant  to  some  antimycobacterial  drugs.   Toxicitiy  is  red  green  color  blindless  (optic  neuropathy).140)  A  45  year  old  male  is  diagnosed  with  pulmonary  tuberculosis.  KOH   .  The  withdrawn  drug  most  likely   affects  bacterial:   A)  Mycolic  acid  synthesis   B)  Carbohydrate  polymerization   C)  DNA  winding-­‐unwinding   D)  RNA  synthesis   E)  Folic  acid  utilization   This  sounds  like  Ethambutol  which  decreases    carbohydrate  polymerization  of  mycobacterium  cell  wall.  While  at  a  college  party.  Adding  ethambutol  to  this  patient’s  regimen  would  most  likely  require   periodic  testing  of:   A)  Visual  acuity   B)  Hepatic  function   C)  Hearing  and  vestibular  function   D)  Complete  blood  count   E)  Renal  function   Ethambutol  decreases    carbohydrate  polymerization  of  mycobacterium  cell  wall  by  blocking  arabinosyltransferase.   142)  A  21  year  old  female  is  taking  medication  for  a  recently  diagnosed  medical  problem.

 the  drug  inhibits  liver  cytochrome  P450-­‐dependent  metabolism  of  several  drugs.   147)  A  43  year  old  male  with  advanced  HIV  infection  is  admitted  for  impaired  vision.     .  On  the  third  day  of  hospitalization.     145)  A  new  medication  inhibits  fungal  colony  growth  by  altering  the  fungal  cell  membrane  composition.     146)  In  the  experimental  setting.  and  topical  application  of  terbinafine  was  prescribed.  Side  effects  include   nephrotoxicity.  Azole  inhibits  lanosterol  -­‐>  ergosterol.   he  develops  generalized  seizures  and  is  found  to  be  hypocalcemic  and  hypomagnesemic.  This  new  drug  is  most   similar  to  which  of  the  following?   A)  Amphotericin  B   B)  Itraconazole   C)  Terbinafine   D)  Griseofulvin   E)  Capsofungin   F)  Flucytosine   Azoles  like  Itraconazole  inhibit  P450  whereas  Griseofulvin  increase  their  production.  Which  of  the  following  drugs  is   most  likely  responsible  for  the  observed  effects?     A)  Acyclovir       B)  Ganciclovir     C)  Foscarnet     D)  Indinavir     E)  Lamivudine   Foscarnet  is  used  for  CMV  retinitis  in  immunocompromised  patients  when  ganciclovir  fails.  In  human   volunteers.  These  organisms  would  most  likely  be  resistant  to  which  of  the   following  agents?   A)  Penicillin   B)  Flucytosine   C)  Griseofulvin   D)  Nystatin   E)  Capsofungin   F)  Cyclosporine   The  only  drug  listed  that  acts  on  the  cell  membrane  here  is  Nystatin.preparation  of  skin  scrapings  shows  branching  septate  hyphae.  It  works  on  the  same  principal  as  Amphotericin  –   binds  ergosterol  and  forms  membrane  pores  –  but  is  the  topical  form  of  Amphotericin.   Which  of  the  following  mechanisms  of  action  explains  the  antifungal  activity  of  the  drug?   A)  Binds  to  ergosterol       B)  Inhibition  of  squalene  epoxidase     C)  Blocking  beta-­‐D-­‐glucan  synthesis     D)  Preventing  mitosis  by  binding  tubulin     E)  Inhibition  of  fungal  protein  synthesis   Terbinafine  inhibits  squalene  -­‐>  lanosterol.  The  others  work  by  a  different   mechanism  altogether.  certain  microorganisms  have  demonstrated  treatment  resistance  by  decreasing   ergosterol  incorporation  into  the  cell  membrane.

 His  last  CD4+  cell  count  was   47/mcL.  Zidovudine  inhibits  which  of  the  following  components  of  viral   genome  replication?   A)  Nucleotide  phosphorylation   B)  Folate  dependent  uracil  methylation   C)  5’ 3’  phosphodiester  linkage  formation   D)  Proper  base  pairing  and  hydrogen  bond  formation   NTRI  Zidovudine  works  by  competitively  inhibiting  nucleotide  bonding  to  reverse  transcriptase  thereby  terminating  the   DNA  chain  which  lacks  a  3’-­‐OH  group.       150)  A  43  year  old  HIV-­‐positive  male  presents  to  the  ED  complaining  of  progressive  vision  impairment.     149)  A  32  year  old  male  with  advanced  HIV  infection  receives  zidovudine  therapy.  It  must  be  phosphorylated  by  thymidine  kinase  to  be  active.  not  inhibited.  Ophthalmoscopy  reveals  the  following:       Which  of  the  following  medications  is  the  best  initial  therapy  for  this  patient?   A)  Pentamidine   B)  Clarithromycin   C)  Acyclovir   D)  Ganciclovir   E)  Flucytosine   F)  Interferon-­‐alpha     The  most  common  cause  of  retinitis  in  immunodeficiency  patients  such  as  this  one  would  be  CMV.  It  has   nothing  to  do  with  folate  methylation  or  proper  base  pairing  as  long  as  it  is  integrated  into  the  DNA  chain.   .  It  is  commonly  treated  by  Ganciclovir  or  Foscarnet  when  Gangciclovir  fails.148)  A  78  year  old  nursing  home  resident  develops  fever  and  myalgias  and  is  treated  with  oseltamivir.  CMV  spreads  to  the   eye  and  results  in  retinal  necrosis  and  edema.  He  was  previously   placed  on  antiretroviral  therapy  but  has  been  noncompliant  with  prescribed  medications.  Intracellular  synthesis  of  viral  DNA   decreases  precipitously  once  the  treatment  is  initiated.  Which  of  the   following  is  most  likely  impaired  in  the  patient’s  infected  cells  as  a  result  of  the  treatment?   A)  Viral  uncoating   B)  Foreign  protein  synthesis   C)  Foreign  protein  splitting   D)  Viral  RNA  replication   E)  Virion  particle  release   Oseltamivir  inhibits  influenza  neuraminidase  decreasing  the  release  of  the  virus.    Amantadine  would  be  viral  uncoating.

4  mg/dL  from  a  baseline  of  0.9  mg/dL  at  admission.     .  Drug  A  is  not  phosphorylated  intracellularly  and  is  structurally  unrelated  to  nucleosides.  his  serum  creatinine  level  increases  to  3.  Viral  strains  isolated  from  this  patient  lack  phosphosylating  enzymes.  does  not  require  activation  by  phosphorylation.     152)  A  34  year  old  male  with  advanced  HIV  infection  is  hospitalized  with  a  vesicular  skin  rash  suggestive  of  varicella   zoster  virus  infection.  Which  of  the  following  drugs   is  most  likely  to  be  effective  in  treating  this  patient’s  infection?   A)  Acyclovir   B)  Ganciclovir   C)  Valacyclovir   D)  Famciclovir   E)  Cidofovir   The  2  types  of  treatment  for  VZV  in  this  scenario  would  be  acyclovir  and  cidofovir.  it  is  easily  to  conclude  that  the  current  drug  is   Cidofovir.  The   observed  finding  could  have  been  potentially  prevented  by  which  of  the  following?   A)  Careful  allergy  history  taking   B)  Monitoring  the  blood  drug  levels   C)  Pre-­‐treatment  with  allopurinol   D)  Pre-­‐treatment  with  prednisone   E)  Aggressive  intravenous  hydration   Elevation  of  creatinine  suggests  nephrotoxicity.  This  antiviral  agent  is  most  likely  to  inhibit  which  of   the  following?   A)  Viral  attachment  to  target  cells   B)  Viral  penetration  into  target  cells   C)  Viral  DNA  synthesis  from  RNA  template   D)  Viral  polyprotein  cleavage   E)  Viral  DNA  integration  into  the  host  genome   Gp41  is  a  fusion  inhibitor  which  inhibits  the  fusion  of  the  virus  to  the  target  CD4  cells  blocking  entry  and  thus  replication.  one  of  the  side  effects  of  acyclovir  when  its  concentration  exceeds  its   solubility.  Since  acyclovir  works  by   phosphorylation  by  viral  thymidine  kinase  and  Cidofovir  doesn’t.  unlike  NTRIs.  On  the  third  day  of   hospitalization.       154)  A  new  antiviral  agent  is  shown  to  selectively  bind  to  HIV  gp41.  Thus  the  proper  management  would  be  to  ensure  adequate  hydration.  Drug  A  is  most   similar  to  which  of  the  following  agents?     A)  Zidovudine   B)  Zalcitabine   C)  Ritonavir   D)  Nevirapine   E)  Enfurvitide   Nevirapine  is  an  NNRTI  that.     153)  A  23  year  old  male  hospitalized  for  confusion  and  seizures  is  treated  with  IV  high-­‐dose  acyclovir.  Reverse  transcriptases   prevent  synthesis  of  viral  DNA  from  RNA  template.151)  The  infected  lymphocytes  of  a  25  year  old  male  treated  with  Drug  A  are  unable  to  synthesize  viral  DNA  from  the   RNA  template.

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