Reproductive Drugs & Beta-Lactam Antibiotics

1. The major ovarian estrogen in women is:

A. Estrone
B. Estradiol
C. Estriol
D. Ethinyl estradiol

Answer: B. Estradiol is the major ovarian estrogen in women. Ethinyl estradiol is used in oral
contraceptives.

2. The following effects of estrogen in the body are true, except:

A. It reduces bone resorption
B. It enhances blood coagulability
C. It reduces LDL cholesterol
D. It reduces HDL cholesterol

Answer: D. Estrogen increases HDL cholesterol. The rest are correct.

3. Some of the clinical uses of estrogen are:

A. Hormonal replacement in menopause & treatment of hypogonadism
B. Treatment of endometrial and breast cancer
C. Treatment of male-pattern baldness to offset effects of testosterone
D. To stimulate RBC production in certain anemias & promote weight gain in wasting syndromes

Answer: A. Some of the uses of estrogens are as contraceptives; as HRT, example for menopause;
and in prevention of osteoporosis. Estrogens may increase the risk for endometrial cancer.
Antagonists of estrogen receptors may be used for breast cancer. Male-pattern baldness is
treated with antiandrogens. And, androgens stimulate RBC production and promote weight gain.

4. A 14-year old female with hypogonadism is given estrogen agents to promote puberty. Which of the
following side effects would she experience?
A. Headache, depression, & weight gain
B. Masculinization, with acne, growth of facial hair, & deepening of the voice
C. Nausea & breast tenderness; may lead to short stature
D. Dizziness & galactorrhea

Answer: C. Nausea and breast tenderness are among the most common adverse effects of
estrogen therapy. In hypogonadal girls, the dosage of estrogen must be adjusted carefully to
prevent premature closure of the epiphyses of the long bones and short stature. The major
adverse effects associated with the use of progestins are headache, depression, weight gain, and
changes in libido. Use of androgens in females may promote masculinization. Use of estrogens
 may increase the risk for migraine but is not associated with dizziness. It will not cause
galactorrhea also.

5. Progestins are used in combination with estrogen in HRT to:

A. To prevent estrogen-induced breast cancer
B. To prevent estrogen-induced endometrial cancer
C. To inhibit ovulation
D. To prevent thromboembolism

Answer: B. Progestins are added in HRT to prevent estrogen-induced endometrial cancer.

6. This type of oral contraceptive provides dosages of estrogen & progesterone that mimic the hormonal
changes in a menstrual cycle.
A. Monophasic preparation
B. Biphasic/Triphasic preparation
C. Progestin-only preparation
D. Postcoital contraceptive

Answer: B. Biphasic/triphasic preparations are combination preparations in which the progestin

or estrogen dosage, or both, changes during the month (to more closely mimic hormonal changes
in a menstrual cycle).

7. The primary action of combined hormonal contraceptives is to:

A. Inhibit ovulation
B. Thicken cervical mucus
C. Prevent implantation in the endometrium
D. Interfere with fertilization

Answer: A. The primary action of COCs is to inhibit ovulation. The estrogen provides a negative
feedback on the release of LH and follicle-stimulating hormone (FSH) by the pituitary gland, thus
preventing ovulation.

8. Progestin-only pills mainly prevent pregnancy by:

A. Inhibiting ovulation
B. Affecting cervical mucus, tubal function, and the endometrial lining
C. Causing miscarriage
D. All of the above

Answer: B. Progestin-only agents do not always inhibit ovulation and instead affect cervical
mucus, tubal function, and the endometrial lining. The progestin inhibits LH release and thickens
the cervical mucus, thus hampering the transport of sperm.
9. The major toxic effect of COCs:
A. Breast cancer
B. Osteoporosis
C. Endometriosis
D. Thromboembolism

Answer: D. The major toxic effects of the combined hormonal contraceptives relate to the action
of the estrogenic component on blood coagulation. However, the risk of thromboembolism
incurred by the use of these drugs is usually less than that imposed by pregnancy.

10. A selective estrogen receptor modulator that is effective in treating hormone-responsive breast
cancer. It acts as an antagonist to prevent receptor activation by endogenous estrogens. However, as
an agonist of endometrial receptors, it increases the risk for endometrial cancer.

A. Tamoxifen
B. Raloxifene
C. Clomiphene
D. Mifepristone

Answer: A. The statement describes tamoxifen, an SERM. Raloxifene is used in the treatment of
osteoporosis in postmenopausal women. It decreases the incidence of breast CA, but has no
effect in endometrial tissue.

11. This drug is used to stimulate ovulation in anovulatory women who wish to become pregnant. It acts
by selectively blocking estrogen receptors in the pituitary, thus reducing negative feedback, and
increasing FSH and LH output.

A. Tamoxifen
B. Raloxifene
C. Clomiphene
D. Mifepristone

Answer: C. Clomiphene is used to promote ovulation and pregnancy in anovulatory women.

12. A 16-year old male athlete is using high doses of anabolic steroids illicitly to enhance his performance.
The following side effects can occur, except:
A. Cholestatic jaundice & hepatocellular carcinoma
B. Testicular shrinkage & infertility
C. Premature closure of epiphyseal plates
D. Menstrual irregularities

Answer: D. All of the said risks are associated with anabolic drug abuse but menstrual
irregularities would of course occur in females only.
13. A drug that is a competitive antagonist of androgen receptors, used to treat patients with prostate
carcinoma.
A. Spironolactone
B. Finasteride
C. Flutamide
D. Raloxifene

Answer: C. Flutamide is an antiandrogen used to treat prostate cancer. Spironolactone is used

in the treatment of hirsutism in women. Finasteride is a 5α-reductase inhibitor used to treat
BPH and male-pattern baldness. Raloxifene is used in the treatment of osteoporosis in
postmenopausal women.

14. Which of the following statements is true?

A. HRT reduces the risk of endometrial cancer
B. Estrogen use by postmenopausal women may increase the risk of breast cancer, MI, and
stroke
C. Estrogen is required for the maintenance of pregnancy
D. Testosterone decreases bone density

Answer: B. Estrogen use may increase the risk of breast CA & cardiovascular events in
postmenopausal women. HRT increases the risk of endometrial CA. Progesterone is the
hormone of pregnancy. Testosterone helps maintain normal bone density.

15. A potassium-sparing diuretic that also inhibits androgen receptors, thus used in the treatment of
hirsutism in women.
A. Spironolactone
B. Flutamide
C. Leuprolide
D. Danazol

Answer: A. Spironolactone is a potassium-sparing diuretic that is used to treat hirsutism in

women. Flutamide & leuprolide are used for prostate CA. Danazol is a gonadal synthesis
inhibitor used in the treatment of endometriosis and fibrocystic disease of the breast.

16. Similarities between penicillins and cephalosporins include:

A. They both inhibit cell-wall synthesis
B. They contain beta-lactam rings
C. They are bactericidal
D. All of the above

Answer: D. All of the above characteristics are similarly found in penicillins and cephalosporins.
17. Which of the following is a first-generation cephalosporin?
A. Cefaclor
B. Cefuroxime
C. Cephalexin
D. Cefixime

Answer: C. Cephalexin is a first-generation cephalosporin. Cefaclor and cefuroxime are second-

generation cephalosporins. Cefixime is a 3rd generation cephalosporin.

18. Which of the following is a second-generation cephalosporin?

A. Cefazolin
B. Cephalexin
C. Cefuroxime
D. Cefepime

Answer: C. Cefuroxime is a second-generation cephalosporin. Cefazolin & cephalexin are first-

generation cephalosporins. Cefepime is a 4th generation cephalosporin.

19. The following are true of penicillins, except:

A. All penicillins are derivatives of 6-aminopenicillanic acid and contain a beta-lactam ring
structure that is essential for antibacterial activity.
B. Enzymatic hydrolysis of its beta-lactam ring results in loss of antibacterial activity.
C. Most penicillins cross the blood-brain barrier even when the meninges are not inflamed.
D. They are usually excreted unchanged in the urine.

Answer: C. Most penicillins cross the BBB only when the meninges are inflamed.

20. A narrow spectrum penicillinase-susceptible penicillin that is the drug of choice for syphilis.
A. Penicillin V
B. Penicillin G
C. Methicillin
D. Ampicillin

Answer: B. Penicillin G is the drug of choice for syphilis. It is a narrow-spectrum penicillinase

susceptible penicillin.
21. A 70-year-old alcoholic male with poor dental hygiene is to have his remaining teeth extracted for
subsequent dentures. He has mitral valve stenosis with mild cardiac insufficiency and is being treated
with captopril, digoxin, and furosemide. The dentist decides that his medical history warrants
prophylactic antibiotic therapy prior to the procedure and prescribes which of the following drugs?
A. Vancomycin
B. Amoxicillin
C. Cefixime
D. Oxacillin

Answer: B. Multiple tooth extractions can lead to bacteremia, and the mitral valve stenosis
cardiac insufficiency place him at risk for developing endocarditis. The present American
Heart Association guidelines indicate amoxicillin (2 g given 1 hour before procedure). For
penicillin-allergic patients, cephalexin, cefadroxil, clindamycin, clarithromycin or azithromycin
are alternative medications listed as prophylactic regimens for dental procedures.

21. The drug of choice for the gram-positive bacillus Listeria monocytogenes.
A. Amoxicillin
B. Piperacillin
C. Methicillin
D. Ampicillin

Answer: D. Ampicillin is the drug of choice for Listeria monocytogenes.

22. A penicillin that is used primarily to treat staphylococcal infections but is now rarely used due to
nephrotoxic potential.
A. Amoxicillin
B. Piperacillin
C. Methicillin
D. Ampicillin

Answer: C. Methicillin is a very-narrow-spectrum penicillinase-resistant drug that is primarily used

to treat staphylococcal infections. However, it is rarely used because it can cause interstitial
nephritis.

23. An antipseudomonal penicillin.

A. Amoxicillin
B. Piperacillin
C. Methicillin
D. Ampicillin
 Answer: B. Piperacillin and ticarcillin are antipseudomonal penicillins because of their activity
against P. aeruginosa. They are wide spectrum penicillins.

24. Which penicillin is associated with pseudomembranous colitis?

A. Ampicillin
B. Methicillin
C. Nafcillin
D. Ticarcillin

Answer: A. Ampicillin has been implicated in pseudomembranous colitis.

25. The following are true of cephalosporins, except:

A. The cephalosporins are derivatives of 7-aminocephalosporanic acid and contain the
beta-lactam ring structure.
B. Most are administered parenterally
C. Most first- and second-generation cephalosporins do not the cerebrospinal fluid even
when the meninges are inflamed.
D. Cephalosporins may be given as an alternative to those who are severely allergic to
penicllins.

Answer: D. Patients who have had an anaphylactic response to penicillins should not receive
cephalosporins - about 5-15 percent show cross-sensitivity.

26. Which cephalosporin is usually used as prophylaxis prior to surgery, including orthopedic surgeries
because of its ability to penetrate the bone.
A. Cefazolin
B. Ceftriaxone
C. Cephalexin
D. Cefotaxime

Answer: A. Cefazolin is usually given as a single prophylaxis dose prior to surgery because of its
1.8-hour half-life and its activity against penicillinase-producing S. aureus. Cefazolin is effective
for most surgical procedures, including orthopedic surgery because of its ability to penetrate
bone.

27. First-generation cephalosporins are:

A. Active against gram-positive cocci, including staphylococci and common streptococci.
B. Active against three additional gram-negative organisms: H. influenzae, Enterobacter
aerogenes, and some Neisseria species, whereas activity against gram-positive organisms
is weaker.
C. Active against gram-negative bacilli
D. Equally active against gram-positive cocci & gram-negative bacilli
 Answer: A. First-generation cephalosporins are active against gram-positive cocci,
including staphylococci and common streptococci.

28. A 30-year old man complains of dysuria and purulent discharges from the urethra. Gram-staining of
the exudate showed gram-negative diplococci within polymorphonucleocytes. The patient was
diagnosed with gonorrhea. Which would be the most appropriate treatment?
A. Ampicillin orally for 7 days
B. Ceftriaxone IM as a single dose
C. Penicillin G IM as a single dose
D. Cephalexin orally for 7 days

Answer: B. The treatments of choice for gonorrhea include a single dose of ceftriaxone
(intramuscularly). Because of the high incidence of beta-lactamase-producing gonococci, the use
of penicillin G or amoxicillin is no longer appropriate for gonorrhea. Cephalexin is a first-
generation cephalosporin, thus is active only against gram-positive cocci and not against gram-
negative microorganisms.

29. This drug combines the gram-positive activity of first-generation agents with the wider gram-negative
spectrum of third-generation cephalosporins.
A. Cefazolin
B. Cefepime
C. Cefotaxime
D. Ceftriaxone

Answer: B. Cefepime is a fourth-generation cephalosporin. Fourth-generation cephalosporins

combine the gram-positive activity of first-generation agents with the wider gram-negative spectrum
of third-generation cephalosporins.

30. Which cephalosporin is an agent of choice in treating meningitis?

A. Cefazolin
B. Cefuroxime
C. Cephalexin
D. Ceftriaxone

Answer: D. Ceftriaxone or cefotaxime (3rd generation cephalosporins) have become agents of

choice in the treatment of meningitis. Cephazolin and cephalexin are first-generation
cephalosporins. Cefuroxime is a 2nd generation cephalosporin. Most first- and second-generation
cephalosporins do not enter the cerebrospinal fluid even when the meninges are inflamed.
Adequate therapeutic levels in the CSF, regardless of inflammation, are achieved only with the
third-generation cephalosporins.