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LAHORE MEDICAL ; DENTAL COLLEGE

Department of Pharmacology &; Therapeutics


5th Periodical Test (Chemotherapy) for 3rd year MBBS
Date 8th April, 2009
Time allowed: 70 minutes
Total marks 50
NOTE: Choose the best answer
1. 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 antiretroviral drugs?
a) Nucleoside Reverse Transcriptase Inhibitors (NRTIS)
b) Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIS)
c) Fusion Inhibitors
d) Protease Inhibitors
e) Integrase Inhibitors
1. 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)
b)
c)
d)
e)

Saquinavir
Zidovudine
Didanosine
Efavirenz
Enfuvirtide

2. 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) Zidovudine
b) Indinavir
c) Efavirenz
d) Nevirapine
e) Nelfinavir

3. 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) Efavirenz
b) Indinavir
c) Lamivudine
d) Nevirapine
e) Stavudine
4. 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) Lamivudine
b) Adefovir
c) Entecavir
d) Interferon alfa
e) Ribavirin
6. 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 virus
b) It prevents uncoating of the virus
c) It prevents replication of the virus
d) It prevents assembly of newly synthesized virus particles
e) It prevents release of the newly synthesized virus
Q7. Antimicrobial agent of choice for the outpatient treatment of
infections due to animal bite wound be:
a) Cefuroxime sodium
b) Amoxicillin/clavulanate potassium
c) Penicillin V
d) Ampicillin sodium/Salbactam sodium
e) Ticarcillin disodium/clavulanate potassium
Q8. An antibiotic is distributed in total body water and has an
elimination half life of 45 minutes. Which one of the following
statements is consistant with that observation?
a) The drug is stored in high concentration in fat
b) The rapid rate of disappearance rules out metabolism of the

drug by the liver


c) The drug is actively transported into tubular urine
d) The drug cannot be bound to plasma proteins
e) The drug is eliminated only by glomerular filtration
Q9. Which one of the following is indicated for treatment of
chlamydial urethritis during pregnancy?
a) Amoxicillin (Amoxil)
b) Penicillin V
c) Erythromycin base
d) Doxycycline (Monodox)
e) Tetracycline
Q10. 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) Cephalexin
b) Tetracycline
c) Penicillin (note: watch an animation on penicillin mechanism of
action)
d) Erythromycin
e) Gentamicin
Q11. 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 days
b) Outpatient treatment with ceftriaxone intramuscularly;
probenecid orally; plus doxycycline twice a day for 14 days and
reexamination in 1 week
c) Outpatient treatment with cefoxitin intramuscularly; plus
doxycycline twice a day for 14 days and reexamination in 10 days
d) Hospitalization for treatment with cefoxitin intravenously and
doxycycline orally or intravenously, then doxycycline orally twice
a day to complete 14 days of treatment
e) Erythromycin 2 grams orally as a single dose
Q12. A drug that may cause nephrotoxicity, is:
a) Penicillin G
b) Erythrocin
c) Gentamycin
d) Cefuroxime

e) Penicillin V
Q13. Which one of the following is a common early side effect of
Penicillin?
a) Constipation
b) Loss of appetite
c) Orthostatic hypotension
d) Atrioventricular block
e) Skin rash
Q14. Which of the following might be seen in patient of TB, who
has regularly been injecting intramuscular injection of
streptomycin:
a) Depression
b) Sialorrhea
c) Increased serum alanine aminotransferase
d) Priapism
e) Deafness
Q15. Significant negative interaction has been known to occur
between the following drugs if given concurrently:
a) Penicillin G & Penicillin V
b) Penicillin & tetracycline
c) Penicillin & Gentamycin
d) Penicillin & Clavulanic acid
e) Ticarcillin & Clavulanic acid
Q16. Which of the following is NOT a recognized complication of
ampicillin toxicity:
a) Hemolytic anemia
b) Diarrhea
c) Nausea
d) Overgrowth of gram-positive organisms
e) Ventricular fibrillation
Q17. Doctor is wrong when he suggests his patient to get drug:
a) Streptomycin by IV route
b) Gentamycin by IV route
c) Neomycin by oral route
d) Penicillin V by oral route
e) Cefepime by IV route
Q18. Telithromycin:
a) Is structurally related to tetracycline
b) Is structurally related to beta lactam antibiotics
c) Is structurally related to aminoglycosides (note: see an
animation on aminoglycosides mechanism of action)
d) Binds more tightly to ribosomes and so it is a poor substrate

for bacterial efflux pumps that mediate antibiotic resistance


e) Is used for UTI
Q19. Doxycycline is used:
a) for Pneumonia as drug of 1st choice
b) for the prevention of TB
c) for the prevention of malaria
d) for the prevention of leprosy
e) for the treatment of sexually transmitted diseases
Q20. Clindamycin:
a) is chemically related to macrolides
b) binds to 30S ribosomal subunit
c) is not recommended for oral route
d) cross-resistance may be observed between macrolides and
Clindamycin
e) is excreted in breast milk
Q21. Which of the following statement is true:
a) nafcillin is beta-lactamase resistant antibiotic
b) cefazolin is second generation cephalosporin
c) tazobactam is used in gonorrhea mainly
d) penicillin G is contraindicated in infections caused by
spirochetes
e) thrombocytosis is main side effect of Linezolid
Q22. All of the following statement is true, except:
a) chloramphenicol is broad spectrum protein synthesis inhibitor
b) linezolid and streptogramins are narrow spectrum protein
synthesis inhibitors
c) mechanism of resistance to chloramphenicol is plasmid
mediated and occurs through the formation of acetyltransferases
that inactivate the drug
d) tetracyclines are narrow spectrum protein synthesis inhibitors
e) susceptible organisms
accumulate tetracyclines intracellularly via energy dependant
transport systems in their cell membranes
Q23. in a patient with culture-positive enterococcal endocarditis
who has failed to respond tovancomycin because of resistance,
the treatment most likely to be effective is:
a) clarithromicin
b) erythromycin
c) linezolid

d)
e)

minocycline
Ticarcillin

Q24. 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 bacteriostatic
b) it is excreted mainly in the feces
c) it is used in Lyme disease
d) it has a long elimination half-life
e) it is more active than tetracycline against H. Pylori
Q25. 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 staphylococci
b) they may cause a syndrome of arthralgia and myalgia
c) they are used in the management of infections caused by
vancomycin-resistant enterococci
d) they are associated with post antibiotic effect
e) they induce formation of hepatic drug-metabolizing enzymes
Q26. Telithromycin:
a) is cell wall synthesis inhibitor
b) is a ketolide structurally related to macrolides
c) it binds very loosely to ribosomes so it is good substrate for
bacterial efflux pumps that mediate resistance
d) is used in Lyme disease mainly
e) is used in pneumonia as drug of 1st choice
Q27. 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 tetracyclines
b) is contraindicated in gram-positive bacterial infections
c) is absolutely contraindicated in gram-negative bacterial
infections
d) mechanism of action of tetracycline is same as Clindamycin
e) resistant organisms are killed when tetracycline is used in
large doses

Q28. 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) anemia
b) hepatic necrosis
c) thrombocytosis
d) alopecia
e) sleeplessness
Q29. 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) amoxicillin
b) salbactam
c) cefoxitin
d) nafcillin
e) penicillin G
Q30. 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 days
b) vancomycin intramuscularly as a single dose
c) ceftriaxone intramuscularly as a single dose
d) tetracycline orally for 7 days
e) procaine penicillin G intramuscularly as a single dose plus
one gram of probenecid
Q31. 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) Erythromycin
b) Ticarcillin
c) Cefotetan

d)
e)

Cefazolin
Ampicillin

Q32. 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 Pyrazinamide
b) PAS, Pyrazinamide and Rifampicin
c) Pyrazinamide, Ethambutol and Isoniazid
d) Streptomycin and Rifampicin
e) Streptomycin alone
Q33. 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 Isoniazid
b) Ethambutol and Streptomycin
c) Isoniazid and Rifampicin
d) Rifampicin and Streptomycin
e) Ethambutol and Pyrazinamide
Q34. 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) Streptomycin
b) Rifampicin
c) Ethambutol
d) Pyrazinamide
e) Thiacetazone
Q35. 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) Streptomycin
b) Ciprofloxacin
c) Ethambutol

d) Rifampicin
e) Isoniazid
Q36. 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) Streptomycin
b) Rifampicin
c) Isoniazid
d) Amikacin
e) Pyrazinamide
Q37. 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
complex
b) Inhibits DNA Dependent RNA Polymerase
c) Inhibits synthesis of mycolic acid
d) Inhibits synthesis of arabinoglycan subunits
e) Inhibits DNA Gyrase
Q38. 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) Rifampicin
b) Pyrazinamide
c) Streptomycin
d) Ethambutol
e) Isoniazid
Q39. 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) Isoniazid
b) Rifampin

c) Pyrazinamide
d) Ethambutol
e) Ethionamide
Q40. 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 pyridoxine
b) Stop isoniazid
c) Add vitamin E
d) Replace rifampin with ethambutol
e) Replace isoniazid with streptomycin
Q41. 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) Ciprofloxacin
b) Ampicillin
c) Cotrimoxazole
d) Cefixime
e) Azithromycin
Q42. 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) Ciprofloxacin
b) Levofloxacin
c) Ofloxacin
d) Norfloxacin
e) Ampicillin
Q43. 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) Ceftriaxone

b) Clarithromycin
c) Aminoglycoside
d) Ciprofloxacin
e) Amoxicillin
Q44. 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) Ciprofloxacin
b) Norfloxacin
c) Ofloxacin
d) Gatifloxacin
e) Levofloxacin
Q45. 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) Ciprofloxacin
b) Norfloxacin
c) Levofloxacin
d) Ofloxacin
e) Gatifloxacin
Q46. Disinfectants are:
a) Strong chemical agents that inhibit or kill micro-organisms
b) Agents with sufficient toxicity for host cells
c) They kill both vegetative cells and spores
d) A process intended to kill or remove all types of microorganisms including spores and include viruses
e) A process that kills non-sporulating microorganisms by hot
water or steam at 65-100 C
Q47. 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) Iodoquinol
b) Diloxanide furate
c) Metronidazole
d) Pentamiline
e) Emetine.

Q48. The reason for giving Metronidazole for oropharyngeal


infection is due to its good activity against:
a)Gram positive cocci
b)Gram Negative cocci
c)Gram positive bacilli
d)Gram negative bacilli
e)Anaerobes like B. fragilis
Q49. 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)Cinchonism
b)Acute gastro enteritis
c)Cholera
d)Typhoid fever
e)Acid peptic disease
Q50. 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)Artemether
b)Mefloquine
c)Malarone
d)Primaquine
e)Halofantrine

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