LAHORE MEDICAL ; DENTAL COLLEGEDepartment of Pharmacology &; Therapeutics5th Periodical Test (Chemotherapy) for 3rd year MBBSDate 8th April, 2009Time allowed: 70 minutesTotal marks 50NOTE: Choose the best answer1. An AIDS patient, who is being treated with multiple drugs, develops breast hypertrophy, central adiposity, hyperlipidemia, insulin resistance and nephrolithiasis. If these changes are related to his drug treatment, this drug belongs to which group of anti-retroviral drugs?a) Nucleoside Reverse Transcriptase Inhibitors (NRTIS)b) Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIS)c)Fusion Inhibitorsd)Protease Inhibitorse) Integrase Inhibitors1. A 35 year old HIV positive male patient comes to the OPD with complaint of anorexia, nausea and vomiting and abdominal pain. His abdomen is tender in the epigastric area. Laboratory results reveal a raised serum amylase activity and a preliminary diagnosis is made of acute pancreatitis. Which of the following anti-retroviral drugs has the patient most likely been taking?a) Saquinavirb) Zidovudinec) Didanosined) Efavirenze) Enfuvirtide2. A 40 year old HIV positive patient is receiving HAART regimen (Highly active anti-retroviral therapy). Four weeks after initiating therapy, he comes to the emergency department complaining of severe pain in the flank, nausea and frequent urination. Which one of the following drugs is most likely the cause of his symptoms?a) Zidovudineb) Indinavirc) Efavirenzd) Nevirapinee) Nelfinavir3. A 30 year old man is recently diagnosed with HIV and therapy is started. After the first week of therapy, the patient complains of headaches, irritability, and nightmares. Which one of the following anti-retroviral drugs is most likely to be causing these symptoms?a) Efavirenzb) Indinavirc) Lamivudined) Nevirapinee) Stavudine4. A 35 year old woman is diagnosed with chronic hepatitis B infection and therapy is initiated. Just after a few hours she comes to the emergency department complaining of fever, chills and muscle aches. Which one of the following drugs most likely caused these symptoms?a) Lamivudineb) Adefovirc) Entecavird) Interferon alfae) Ribavirin6. A 60 year old man with known history of Parkinsons disease is to receive prophylaxis against Influenza A virus. He is given a drug that is useful against Parkinsons disease as well for prophylaxis against influenza. The drug with which of the following mechanisms of action is most likely to have been given?a) It prevents entry and penetration of the virusb) It prevents uncoating of the virusc) It prevents replication of the virusd) It prevents assembly of newly synthesized virus particlese) It prevents release of the newly synthesized virusQ7. Antimicrobial agent of choice for the outpatient treatment of infections due to animal bite wound be:a) Cefuroxime sodiumb) Amoxicillin/clavulanate potassiumc) Penicillin Vd) Ampicillin sodium/Salbactam sodiume) Ticarcillin disodium/clavulanate potassiumQ8. An antibiotic is distributed in total body water and has an eliminationhalf lifeof 45 minutes. Which one of the following statements is consistant with that observation?a) The drug is stored in high concentration in fatb) The rapid rate of disappearance rules out metabolism of the drug by the liverc) The drug is actively transported into tubular urined) The drug cannot be bound to plasma proteinse) The drug is eliminated only by glomerular filtrationQ9. Which one of the following is indicated for treatment of chlamydial urethritis during pregnancy?a) Amoxicillin (Amoxil)b) Penicillin Vc) Erythromycin based) Doxycycline (Monodox)e)TetracyclineQ10. A 25-year-old male has a dental infection associated with facial swelling and lymphadenopathy. Which one of the following is the most appropriate antibiotic?a) Cephalexinb) Tetracyclinec) Penicillin (note: watch an animation onpenicillin mechanism of action)d) Erythromycine) GentamicinQ11. A 16-year-old sexually active nulliparous white female complains of pelvic pain and vaginal discharge. On examination she is found to have a temperature of 39.8 C (102.0 F), pain with movement of the cervix, and tenderness and a mass in the right adnexa. Which one of the following treatment would be appropriate?a) Outpatient treatment with penicillin G procaine ,intramuscularly; probenecid orally; plus doxycycline (Vibramycin) orally for 14 days and reexamination in 3 daysb) Outpatient treatment with ceftriaxone intramuscularly; probenecid orally; plus doxycycline twice a day for 14 days and reexamination in 1 weekc) Outpatient treatment with cefoxitin intramuscularly; plus doxycycline twice a day for 14 days and reexamination in 10 daysd) Hospitalization for treatment with cefoxitin intravenously and doxycycline orally or intravenously, then doxycycline orally twice a day to complete 14 days of treatmente) Erythromycin 2 grams orally as a single doseQ12. A drug that may cause nephrotoxicity, is:a) Penicillin Gb) Erythrocinc) Gentamycind) Cefuroximee) Penicillin VQ13. Which one of the following is a common early side effect of Penicillin?a) Constipationb) Loss of appetitec) Orthostatic hypotensiond) Atrioventricular blocke) Skin rashQ14. Which of the following might be seen in patient of TB, who has regularly been injecting intramuscular injection of streptomycin:a) Depressionb) Sialorrheac) Increased serum alanine aminotransferased) Priapisme) DeafnessQ15. Significant negative interaction has been known to occur between the following drugs if given concurrently:a) Penicillin G & Penicillin Vb) Penicillin & tetracyclinec) Penicillin & Gentamycind) Penicillin & Clavulanic acide) Ticarcillin & Clavulanic acidQ16. Which of the following is NOT a recognized complication of ampicillin toxicity:a) Hemolytic anemiab) Diarrheac) Nausead) Overgrowth of gram-positive organismse) Ventricular fibrillationQ17. Doctor is wrong when he suggests his patient to get drug:a) Streptomycin by IV routeb) Gentamycin by IV routec) Neomycin by oral routed) Penicillin V by oral routee) Cefepime by IV routeQ18. Telithromycin:a) Is structurally related to tetracyclineb) Is structurally related to beta lactam antibioticsc) Is structurally related to aminoglycosides (note: see an animation onaminoglycosides mechanism of action)d) Binds more tightly to ribosomes and so it is a poor substrate for bacterial efflux pumps that mediateantibiotic resistancee) Is used for UTIQ19. Doxycycline is used:a) for Pneumonia as drug of 1st choiceb) for the prevention of TBc) for the prevention of malariad) for the prevention of leprosye) for the treatment of sexually transmitted diseasesQ20. Clindamycin:a) is chemically related to macrolidesb) binds to 30S ribosomal subunitc) is not recommended for oral routed) cross-resistance may be observed between macrolides and Clindamycine) is excreted in breast milkQ21. Which of the following statement is true:a) nafcillin is beta-lactamase resistant antibioticb) cefazolin is second generation cephalosporinc) tazobactam is used in gonorrhea mainlyd) penicillin G is contraindicated in infections caused by spirochetese) thrombocytosis is main side effect ofLinezolidQ22. All of the following statement is true, except:a) chloramphenicol is broad spectrum protein synthesis inhibitorb) linezolid and streptogramins are narrow spectrum protein synthesis inhibitorsc) mechanism of resistance to chloramphenicol is plasmid mediated and occurs through the formation of acetyltransferases that inactivate the drugd) tetracyclines are narrow spectrum protein synthesis inhibitorse) susceptible organisms accumulatetetracyclinesintracellularly via energy dependant transport systems in their cell membranesQ23. in a patient with culture-positive enterococcal endocarditis who has failed to respond tovancomycinbecause of resistance, the treatment most likely to be effective is:a) clarithromicinb) erythromycinc) linezolidd) minocyclinee) TicarcillinQ24. A 24 year old male patient is suffering from peptic ulcer. He was advised anti-peptic ulcer drugs including doxycycline. Which one of the following statements about doxycycline is false?a) it is bacteriostaticb) it is excreted mainly in the fecesc) it is used in Lyme diseased) it has a long elimination half-lifee) it is more active than tetracycline against H. PyloriQ25. A 12 years old female patient came to pediatrician suffering from headache, high grade fever, moderate chest pain, joint pain and drowsy. When doctor got history, he was told to take diazepam 2.5 mg by patient 15 hours ago. Actually it was already a diagnosed case of pneumonia and she was on drug treatment including streptogramin. Concerning streptogramins, which one of the following statements is false:a) they are active against methicillin-resistant staphylococcib) they may cause a syndrome of arthralgia and myalgiac) they are used in the management of infections caused by vancomycin-resistant enterococcid) they are associated with post antibiotic effecte) they induce formation of hepatic drug-metabolizing enzymesQ26. Telithromycin:a) is cell wall synthesis inhibitorb) is a ketolide structurally related to macrolidesc) it binds very loosely to ribosomes so it is good substrate for bacterial efflux pumps that mediate resistanced) is used in Lyme disease mainlye) is used in pneumonia as drug of 1st choiceQ27. Which statement is true about tetracyclines?a) resistance mechanisms include decreased activity of the uptake systems and, most importantly, the development of mechanisms like efflux pumps for active extrusion of tetracyclinesb) is contraindicated in gram-positive bacterial infectionsc) is absolutely contraindicated in gram-negative bacterial infectionsd) mechanism of action of tetracycline is same as Clindamycine) resistant organisms are killed when tetracycline is used in large dosesQ28. A 33 years old male patient has been diagnosed mycoplsma pneumoniae infection. He was treated by one of the broad spectrum antibacterial drug group tetracycline 2 gram TID for 21 days. What may be most appropriate toxicity?a) anemiab) hepatic necrosisc) thrombocytosisd) alopeciae) sleeplessnessQ29. an elderly debilitated patient has a fever believed to be due to an infection. He has extensive skin lesions, scrapings of which reveal the presence of large numbers of gram-positive cocci. The most appropriate drug to use for treatment of this patient is:a) amoxicillinb) salbactamc) cefoxitind) nafcilline) penicillin GQ30. A 21 year old man was seen in a clinic with a complaint of dysuria and urethral discharge of yellow pus. He has a painless clean-base ulcer on the penis and nontender enlargement of the regional lymph nodes. Gram stain of the urethral exudates showed gram negative diplococci within polymorphonucleocytes. The patient informed the clinic staff that he was unemployed and had not eaten a meal for two days. The most appropriate treatment of gonorrhea in this patient is:a) amoxicillin orally for 7 daysb)vancomycinintramuscularly as a single dosec) ceftriaxone intramuscularly as a single dosed) tetracycline orally for 7 dayse) procaine penicillin G intramuscularly as a single dose plus one gram of probenecidQ31. Eighty years old male patient having 73 Kg body weight was suffering from fever, headache and lumbar pain since last 7 days. He was examined in clinic. Gram stain of the smear of CSF revealed gram positive rods resembling diphtheroids. The antibiotic regimen for empiric treatment would include:a) Erythromycinb) Ticarcillinc) Cefotetand) Cefazoline) AmpicillinQ32. A 25 year old male presents to the medical OPD with complaint of cough and low grade fever since the last 3 months. Laboratory tests show sputum positive for acid fast bacteria. Which of the following combination of drugs is most likely to be administered at the start to this patient?a) Streptomycin, Isoniazid, Rifampicin and Pyrazinamideb) PAS, Pyrazinamide and Rifampicinc) Pyrazinamide, Ethambutol and Isoniazidd) Streptomycin and Rifampicine) Streptomycin aloneQ33. A 25 year old male has been given treatment for pulmonary tuberculosis for 2 months as initial phase. Now he comes to the OPD for medication for the continuation phase. Which of the following drugs will he most likely be given for the continuation phase?a) Pyrazinamide and Isoniazidb) Ethambutol and Streptomycinc) Isoniazid and Rifampicind) Rifampicin and Streptomycine) Ethambutol and PyrazinamideQ34. A young man 26 years old is started treated for pulmonary tuberculosis. He comes to the medical OPD after 1 week with complaint of orange red colored urine and sweat and tears. Which of the following drugs is most likely causing these symptoms?a) Streptomycinb) Rifampicinc) Ethambutold) Pyrazinamidee) ThiacetazoneQ35. A 30 year old male with known TB infection and taking medication since 1 month comes to the Eye OPD with complaint of visual disturbances including decreased visibility and slight color blindness. If these symptoms are due to his drug treatment, which one of the following drugs is most likely the cause of his symptoms?a) Streptomycinb) Ciprofloxacinc) Ethambutold) Rifampicine) IsoniazidQ36. A 35 year old male recently diagnosed with tuberculosis and is started on medication. After a few days he comes to the emergency department a few hours after taking a meal at McDonalds with severe pain in the big toe. Blood tests show a very high uric acid level. Which of the following drugs most likely caused these symptoms?a) Streptomycinb) Rifampicinc) Isoniazidd) Amikacine) PyrazinamideQ37. A 40 year old male taking medication for tuberculosis since the last 2 months comes to the ENT OPD with complaint of hearing problems and ringing in the years. The drug with which of the following mechanisms of action is most likely causing these symptoms?a) Binds to 30 S Ribosome subunit & inhibits initiation complexb) Inhibits DNA Dependent RNA Polymerasec) Inhibits synthesis of mycolic acidd) Inhibits synthesis of arabinoglycan subunitse) Inhibits DNA GyraseQ38. A 35 year old female taking medication for tuberculosis and oral contraceptives comes to the Gynaecology OPD with complaint of amenorrhea. Laboratory test shows a positive pregnancy test. Which one of the following drugs most likely caused her to become pregnant?a) Rifampicinb) Pyrazinamidec) Streptomycind) Ethambutole) IsoniazidQ39. A 45 year old male with diagnosed chronic liver disease gets infected with the tuberculosis. Which one of the following drugs would be most safe for this patient for the treatment of tuberculosis?a) Isoniazidb) Rifampinc) Pyrazinamided) Ethambutole) EthionamideQ40. A 48 year old male is diagnosed with tuberculosis and has been treated for 2 months with isoniazid and rifampicin with good response. But the patient develops numbness and paresthesias in the extremities. What will you most likely do next?a) Add pyridoxineb) Stop isoniazidc) Add vitamin Ed) Replace rifampin with ethambutole) Replace isoniazid with streptomycinQ41. A 30 year old male presents with history of fever occurring in a step-ladder fashion for the last 10 days. He also feels abdominal pain after taking meals. Lab tests show decreased TLC count and a positive Widal test. The drug which is most likely to be given acts by which one of the following mechanisms?a) Ciprofloxacinb) Ampicillinc) Cotrimoxazoled) Cefiximee) AzithromycinQ42. A 35 year old pregnant woman presents to the gynecology department with complaint of pain with rising fever since the last 5 days. Lab tests show gram negative bacilli and widal test comes out positive. Which one of the following drugs will most likely be administered?a) Ciprofloxacinb) Levofloxacinc) Ofloxacind) Norfloxacine) AmpicillinQ43. A 27 year old male football player gets injured in a match. He comes to the emergency department with pain and swelling near the ankle. On examination, there is small wound with a tender swelling near the ankle joint. Further tests reveal tendon rupture with tendonitis setting in. Which one of the following antibiotics, if required, will most probably not be given to this patient?a) Ceftriaxoneb) Clarithromycinc) Aminoglycosided) Ciprofloxacine) AmoxicillinQ44. A 40 year old male comes to the medical OPD with symptoms of cough & fever for the last few days. Sputum culture shows presence of gram positive cocci. Which one of the following Fluoroquinolones is most likely to be administered to this patient?a) Ciprofloxacinb) Norfloxacinc) Ofloxacind) Gatifloxacine) LevofloxacinQ45. A 50 year old patient comes to the emergency department, a day after he has been administered an antibiotic for an on-going infection, with complaint of palpitations. ECG reveals prolonged QT interval. Which one of the following Fluoroquinolones most likely caused this adverse effect?a) Ciprofloxacinb) Norfloxacinc) Levofloxacind) Ofloxacine) GatifloxacinQ46. Disinfectants are:a) Strong chemical agents that inhibit or kill micro-organismsb) Agents with sufficient toxicity for host cellsc) They kill both vegetative cells and sporesd) A process intended to kill or remove all types of micro-organisms including spores and include virusese) A process that kills non-sporulating microorganisms by hot water or steam at 65-100 CQ47. A patient with watery stools is diagnosed as suffering from amebic dysentery. He is given a drug that causes a metalic taste in the mouth which drug may be given.a) Iodoquinolb) Diloxanide furatec) Metronidazoled) Pentamilinee) Emetine.Q48. The reason for giving Metronidazole for oropharyngeal infection is due to its good activity against:a)Gram positive coccib)Gram Negative coccic)Gram positive bacillid)Gram negative bacillie)Anaerobes like B. fragilisQ49. Patient comes to emergency with the complaints of marked visual and auditory abnormities, vomiting diarrhea abdominal pain & skin rashes. From the history of the patient it was revealed that he took some drug for the treatment of fever. What could be probable diagnosis?a)Cinchonismb)Acute gastro enteritisc)Cholerad)Typhoid fevere)Acid peptic diseaseQ50. A 37 year old male is having repeated episodes of fever with chills with blood smear positive for malaria since last one year. He was given chloroquine each time & the fever subsided. Which of the following drugs would you add with chloroquine this time?a)Artemetherb)Mefloquinec)Malaroned)Primaquinee)Halofantrine