Infectious disease Questions

1.Isoniazid is a primary antitubercular agent that (A) requires pyridoxine supplementation. (B) may
discolor the tears, saliva, urine, or feces orange-red. (C) causes ocular complications that are
reversible if the drug is discontinued. (D) may be ototoxic and nephrotoxic. (E) should never be used
because of hepatotoxic potential.

2. All of the following factors may increase the risk of nephrotoxicity from gentamicin therapy except
which one? (A) age 70 years (B) prolonged courses of gentamicin therapy (C) concurrent
amphotericin B therapy (D) trough gentamicin levels 2 mg/mL (E) concurrent cisplatin therapy

3. In which of the following groups do all four drugs warrant careful monitoring for drug-related
seizures in high-risk patients? (A) penicillin G, imipenem, amphotericin B, metronidazole (B) penicillin
G, chloramphenicol, tetracycline, vancomycin (C) imipenem, tetracycline, vancomycin, sulfadiazine
(D) cycloserine, metronidazole, vancomycin, sulfadiazine (E) metronidazole, imipenem, doxycycline,
erythromycin

4. AC is a 34-year-old male admitted with a diagnosis of peritonitis. Cultures are positive for
Bacteroides fragilis, Enterococcus faecalis, and Staphylococcus aureus. Which of the following would
be the best initial therapy to recommend? (A) telithromycin (B) quinupristin/dalfopristin (C) tigecycline
(D) trimethoprim/sulfamethoxazole (E) kanamycin

5. TJ is a 45-year-old female presenting with an Enterobacter aerogenes bacteremia with a low-grade

fever (101.6°F). The most appropriate management of her fever would be to (A) give acetaminophen
1000 mg orally every 6 hrs. (B) give aspirin 650 mg orally every 4 hrs. (C) give alternating doses of
aspirin and acetaminophen every 4 hrs. (D) withhold antipyretics and use the fever curve to monitor
her response to antibiotic therapy. (E) use tepid water baths to reduce the fever.

6. BC has an upper respiratory infection. Two years ago, she experienced an episode of
bronchospasm after penicillin therapy. Current cultures are positive for a strain of Streptococcus
pneumoniae that is sensitive to all of the following drugs. Which of these drugs would be the best
choice for this patient? (A) amoxicillin/clavulanate (B) telithromycin (C) ampicillin (D) cefaclor (E)
loracarbef Study Questions

7. All of the following drugs are appropriate therapies for a lower urinary tract infection owing to
Pseudomonas aeruginosa except (A) norfl oxacin. (B) trimethoprim–sulfamethoxazole. (C) ciprofl
oxacin. (D) tobramycin. (E) methenamine mandelate.

8. BT is a 43-year-old female seen by her primary-care physician for a mild staphylococcal cellulitis on
the arm. Which of the following regimens would be appropriate oral therapy? (A) dicloxacillin 125 mg
every 6 hrs (B) vancomycin 250 mg every 6 hrs (C) methicillin 500 mg every 6 hrs (D) cefazolin 1 g
every 8 hrs (E) penicillin V 500 mg every 6 hrs

9. RC is a 33-year-old male with a history of HIV for 10  years who now presents with Mycobacterium
avium-intracellulare (MAI). Which of the following drugs has demonstrated in vitro activity against
MAI? (A) daptomycin (B) clarithromycin (C) erythromycin base (D) cloxacillin (E) minocycline

10. All of the following statements regarding pentamidine isethionate are true except which one? (A) It
is indicated for treatment or prophylaxis of infection owing to Pneumocystis carinii. (B) It may be
administered intramuscularly, intravenously, or by inhalation. (C) It has no clinically significant effect
on serum glucose. (D) It is effective in the treatment of leishmaniasis.

11. RE is a 23-year-old male with a history of severe asthma. An outbreak of H1N1 infl uenza has just
been reported in his community, and he is exhibiting initial symptoms of the infection. Which agent
would be the most useful to treat RE? (A) cidofovir (B) famciclovir (C) oseltamivir (D) zanamivir (E)
ribavirin

12. Dr. Jones requests your help in selecting a protease inhibitor as part of a regimen for a treatment-
naive male patient. Which of the following would you recommend? (A) darunavir/ritonavir (B)
lopinavir/ritonavir (C) nelfi navir (D) saquinavir/ritonavir (E) tipranavir/ritonavir Directions for questions

13–14: Th e questions and incomplete statements in this section can be correctly answered or
completed by one or more of the suggested answers. Choose the answer, A–E. A if I only is correct B
if III only is correct C if I and II are correct D if II and III are correct E if I, II, and III are correct 13.
Drugs usually active against penicillinase-producing Staphylococcus aureus include which of the
following? I. piperacillin–tazobactam II. amoxicillin–clavulanate III. nafcillin

14. Antiviral agents that are active against cytomegalovirus (CMV) include which of the following? I.
ganciclovir II. foscarnet III. acyclovir

15–17: Each description listed in this section is most closely associated with one of the following
drugs. The drugs may be used more than once or not at all. Choose the best answer, A–E. A
clofazimine ,B itraconazole C levofl oxacin D neomycin

15. It may be administered once per day for the treatment of urinary tract infections. 16. It may cause
pink to brownish skin pigmentation within a few weeks of initiation of therapy. 17. Coadministration
with astemizole or terfenadine may lead to life-threatening cardiac dysrhythmias.

Answers and Explanations 1. Th e answer is A [see VI.B.2.d.(5)]. Isoniazid increases the excretion of
pyridoxine, which can lead to peripheral neuritis, particularly in poorly nourished patients. Pyridoxine
(a form of vitamin B6) defi ciency may cause convulsions as well as the neuritis, involving synovial
tenderness and swelling. Treatment with the vitamin can reverse the neuritis and prevent or cure the
seizures.

2. Th e answer is D [see II.B.4.b]. Trough serum levels 2 mg/mL are considered appropriate for
gentamicin and are recommended to minimize the risk of toxicity from this aminoglycoside. Because
aminoglycosides accumulate in the proximal tubule of the kidney, nephrotoxicity can occur.

3. Th e answer is A [see II.C.4.6; II.F.e.2; V.C.3.b.(4); VI.B.2.d.(5)]. Seizures have been attributed to
the use of penicillin G, imipenem, amphotericin B, and metronidazole. Seizures are especially likely
with high doses in patients with a history of seizures and in patients with impaired drug elimination. 4.
Th e answer is C [see II.K.14]. Although active against various gram-positive and negative organisms,
tigecycline is only agent approved for the treatment of intra-abdominal infections caused by these
organisms.

5. Th e answer is D [see I.H.1]. Th e fever curve is useful for monitoring a patient’s response to
antimicrobial therapy. Antipyretics can be used to reduce high fever in patients at risk for
complications (e.g., seizures) or, in some cases, to make the patient more comfortable.

6. Th e answer is B [see II.K.13; II.D.4.6]. Amoxicillin and ampicillin are all penicillins and should be
avoided in patients with histories of hypersensitivity to other penicillin compounds. Although the risk of
cross-reactivity with cephalosporins (e.g., cefaclor, loracarbef) is now considered low, most clinicians
avoid the use of these agents in patients with histories of type I hypersensitivity reactions (e.g.,
anaphylaxis, bronchospasm, giant hives).

7. Th e answer is B [see II.B.2.b.(3); II.I.2.a; II.J.2.a; II.J.2.c.(1)]. Norfl oxacin, ciprofl oxacin,
tobramycin, and methenamine mandelate achieve urine concentrations high enough to treat urinary
tract infections caused by P.  aeruginosa. Trimethoprim–sulfamethoxazole is not useful for treating
infection caused by this organism, although the combination is useful for treating certain other urinary
tract infections.

8. Th e answer is A [see II.F.2.c.(4)]. Although vancomycin, methicillin, and cefazolin have excellent
activity against staphylococci, they are not eff ective orally for systemic infections. Vancomycin is
prescribed orally for infections limited to the gastrointestinal tract, but because it is poorly absorbed
orally, it is not eff ective for systemic infections. Most hospitaland community-acquired staphylococci
are currently resistant to penicillin. Th us, of the drugs listed, the most appropriate drug for oral
therapy of staphylococcal cellulitis is dicloxacillin.

9. Th e answer is B [see II.D.6.a–b]. Clarithromycin, an alternative to erythromycin, has demonstrated

in vitro activity against MAI. Clarithromycin is also used against Toxoplasma gondii and
Cryptosporidium spp., and it is more active than erythromycin against staphylococci and streptococci.
Vancomycin and cloxacillin are used to treat staphylococci and streptococci, but has no demonstrated
activity versus MAI.

10. Th e answer is C [see V.D]. Pentamidine isethionate is indicated for both treatment and
prophylaxis of infection from P. carinii. It can be administered intramuscularly, intravenously, or by
inha lation. Inhalation may produce bronchospasm. Blood glucose should be carefully monitored
because pentamidine may produce either hyperglycemia or hypoglycemia.

11. Th e answer is C [see VII.B.9]. Cidofovir and famciclovir have little or no in vivo activity against
H1N1 infl uenza. Ribavirin has some activity but is not used for infl uenza and is mainly indicated for
treatment of hepatitis C in combination with interferon. Zanamivir and oseltamivir are agents that
demonstrate activity against H1N1 infl uenza and are indicated for the treatment of infl uenza
infections. Zanamivir is an inhaled agent that should be avoided in patients with a history of asthma or
chronic obstructive pulmonary disease, due to the risk of bronchospasm and acute decline in lung
function. Oseltamivir is an oral agent that is most appropriate in this case.

12. Th e answer is A [see VII.C.5.a–i]. Lopinavir/ritonavir is a PI used in alternative regimens for

treatment-naïve patients and is only a preferred PI in pregnant women. Nelfi navir, saquinavir/
ritonavir, and tipranavir/ritonavir are not preferred PIs due to inferior virologic potency and/or adverse
eff ects. Darunavir/ritonavir is considered a preferred PI. Shargel_8e_CH36.indd 741 07/08/12 2:00
AM 742 Chapter 36

13. Th e answer is E (I, II, III) [see II.E.2–4]. Piperacillin and amoxicillin each include a -lactamase
inhibitor. Th ese combinations off er activity against S. aureus similar to that of the penicillinase-
resistant penicillins, such as nafcillin.

14. Th e answer is C (I, II) [see VII.B.1; VII.B.7–8]. Only ganciclovir and foscarnet are active against
CMV infections. Th ese agents are virustatic and arrest DNA synthesis by inhibiting viral DNA
polymerase. Foscarnet is a broad-spectrum antiviral agent and is used in patients with ganciclovir
resistance. Acyclovir is not clinically useful for the treatment of CMV infections because CMV is
relatively resistant to acyclovir in vitro.

15. Th e answer is C [see II.I.3.c]. Levofl oxacin is appropriate for treatment of urinary tract infections,
and may be dosed once daily.

16. Th e answer is A [see II.K.5.d.(1)]. Because clofazimine contains phenazine dye, it can cause pink
to brown skin pigmentation. Th is change in pigmentation occurs in 75% to 100% of patients taking
clofazimine, and it occurs within a few weeks of the initiation of therapy. Th e discoloration of skin has
reportedly led to severe depression and even suicide in some patients. Clofazimine is used in the
treatment of leprosy and several atypical Mycobacterium infections.
17. Th e answer is B [see III.F.5.d]. Administration of itraconazole or ketoconazole with astemizole or
terfenadine may increase the level of astemizole or terfenadine, which can lead to lifethreatening
dysrhythmias and death. Itraconazole, which is an imidazole, is a fungistatic agent. Specifi - cally,
itraconazole can be taken orally to treat aspergillosis infections and other deep fungal infections, such
as blastomycosis, coccidioidomycosis, cryptococcosis, and histoplasmosis.