A 65-year-old man presents to the office with increased frequency, urgency, nocturia, and
hesitancy in micturition for the past week. He also complains of pain in ejaculation. He has no
flank pain, dysuria, hematuria, or fever. He is in a monogamous relationship and uses
condoms regularly. His temperature is 98.6 F (37 C), pulse rate is 77 beats/ minute, respiration
is 14 breaths/minute, and blood pressure is 130/80 mmHg. There is no costovertebral angle
tenderness or suprapubic tenderness, and external genitalia examination is normal. Digital
rectal examination shows normal sphincter tone and reflexes with slightly enlarged and
tender prostate. Urinalysis shows many WBCs with no RBCs or casts. Urine culture grows E.
coli. Serum prostate-specific antigen is 8ng/mL (reference range of less than 3.5 ng/mL).
Which of the following drug class can be used to treat the patient's condition?
fluroquinolone
A 41-year-old G5P4004 at 38 weeks, 0 days pregnant presents for late prenatal testing. She is
found to have IgM-positive antibodies for HSV-2. The patient desires to deliver vaginally.
Which of the following statements is correct regarding the treatment of choice for this
patient's condition?
it is generally safe in pregnancy
A 25-year-old woman presents to the clinician with complaints of frequent burning
micturition and suprapubic discomfort from the past two days. The patient is sexually active
and has no significant past medical history. Urinalysis reveals the presence of leukocyte
esterase and a high level of nitrites. The clinician prescribes her a combination antibiotic that
inhibits two steps in the bacterial biosynthesis of tetrahydrofolate. Which of the following is a
contraindication to the use of this medication?
pregnancy
A 35-year-old woman comes to the office for pain and burning during urination for the past
few days. She denies fever, abdominal or flank pain, bloody urine, or passing any stones while
urinating. She has a medical history of gastroesophageal reflux disease, diabetes mellitus type
2, and hyperlipidemia. She takes over-the-counter antacids, pantoprazole, metformin, and
atorvastatin. She is para 2 with both normal vaginal delivery and her last menstrual period
was three weeks ago. She uses oral contraceptive pills for contraception. Her temperature is
37.2 C, her pulse is 70 beats/min, her respiratory rate is 12 breaths/min, and her blood
pressure is 130/80 mmHg. On examination, she denies suprapubic pain or costovertebral
angle tenderness. Urinalysis reveals white blood cells of 20-25/hpf and red blood cells of 5-
10/hpf with no casts. Urinary nitrites and leukocyte esterase are positive, and glucose and
ketone are absent. White blood cell count is 7800/mm3. Serum creatinine is 1.1 mg/dL and
blood urea nitrogen is 17 mg/dL. Urine culture grows Escherichia coli. The patient is started
on a drug that inhibits an enzyme required in bacterial DNA replication. The patient is
counseled about adherence and the adverse effect of this drug. About which of her other
medications should she be counseled?
antacid
,A 27-year-old male with a past medical history of tuberculosis presents to the outpatient
clinic with complaints of diarrhea and crampy abdominal pain. The patient was diagnosed
with tuberculosis 16 weeks ago and is currently on treatment with isoniazid and rifampicin.
Complete blood count shows an elevated WBC count. Blood testing shows that liver function
tests are normal. Which of the following is the best next step in the management of this
patient?
testing for clostridium difficle
A 5-year-old boy presents with a worsening cough and thick yellow-green nasal discharge for
the past two weeks. He has no chronic medical conditions and is not taking any medication.
His immunizations are up to date. Vital signs show a temperature of 39.2 C (102.6 F), blood
pressure of 120/80 mmHg, pulse of 92/min, and respiratory rate of 20/min. On examination,
nasal turbinates are swollen and erythematous, and there is a thick purulent discharge from
the nares. Lungs are clear on auscultation. Amoxicillin-clavulanate is prescribed for acute
bacterial sinusitis. What is the role of the clavulanate component in amoxicillin-clavulanate?
Clavulanate inhibits beta-lactamase produced by bacteria to prevent the inactivation of
amoxicillin
A 65-year-old man starts treatment with linezolid for methicillin-resistant Staphylococcus
aureus (MRSA) infection. Two days later, he complains of fever, sweating, confusion, and
agitation. His blood pressure is 150/91 mmHg, and his heart rate is 110/minute. A physical
exam reveals diaphoresis, shivering, and hyperreflexia. The patient has a history of allergic
rhinitis, hypercholesterolemia, depression, and peptic ulcer disease. His usual medications
include lovastatin, astemizole, phenelzine, and famotidine. Which of the following most likely
caused a drug interaction with linezolid?
Phenelzine
A 65-year-old female comes to the clinician with pain behind her left heel for a day. The pain
is aggravated by dorsiflexion of the feet. She denies stiffness, weakness, numbness, tingling,
or redness of her feet and toes. She has diabetes managed with Insulin and osteoarthritis of
the knee managed with painkillers. She was recently treated for an episode of urinary tract
infection. She eats a balanced diet and walks for 30 minutes every day. Her vital signs are
normal. On examination, there is no warmth, redness, or swelling on her feet, but there is
tenderness 3 centimeters above the posterior calcaneus on the left side. Bilateral motor
strength, reflexes, and sensation are normal. Which of the following is the most likely cause of
the condition?
use of prescription medication
A 54-year-old female with no significant past medical history presents with a 6-month history
of recurring "cold sores on my mouth." On exam, there are several vesicular lesions on her
lips. A 5% concentration of the antiviral ointment is administered. Regarding this antiviral
ointment, it is important to teach the patient which one of the following?
lesions may occur again at a later date despite treatment
A 25-year-old sexually active female comes to the clinician with complaints of frequent
urination, burning micturition, and mild supra-pubic pain for two days. She gives no history of
fever, nausea, flank pain, or vomiting. After an appropriate workup, the clinician prescribes
her a medication taken up by bacterial intracellular nitroreductases to produce the active
,form of the drug to treat her condition. Which of the following is a well-known severe adverse
effect of the drug most likely given in this case?
pulmonary toxicity
A 25-year-old female patient comes to you for urinary discomfort and frequency. Urine
culture shows that her infection is susceptible to sulfamethoxazole/trimethoprim. What is the
benefit of using these drugs together?
the drugs inhibit sequential steps of the folate synthesis pathway
A 45-year-old woman develops pruritis, erythematous rash on the face and neck, and
hypotension during initial intravenous antimicrobial treatment. Which of the following most
likely caused this patients presentation?
vancomycin
A 41-year-old woman is involved in a serious skiing accident, requiring surgery for a fractured
femur. Postoperatively she develops methicillin-resistant Staphylococcus aureus (MRSA)
bacteremia. Infusion of a synthetic oxazolidinone antimicrobial drug is initiated. Which of the
following is one of the most common adverse effects of this drug?
headache
An 8-month-old boy presents with a new onset of fever, urinary hesitancy, and frequency for
three days. This is his second episode of similar complaints in the same month. He has a
history of recurrent urinary tract infections since his birth. He has a 4-year-old sibling who is
healthy. He has normal growth and development and achieved his milestones on time. The
urine culture of catheterized specimens grew >100,000 colony-forming units of Escherichia
coli. The renal ultrasound shows mild hydronephrosis of the left kidney, and the voiding
cystourethrogram shows moderate dilatation of the left ureter and pelvis. The patient is
managed with nitrofurantoin and paracetamol. The patient is discharged on a prophylactic
antibiotic for his condition. Which of the following antimicrobial agents is contraindicated in
this patient?
ciprofloxacin
A 16-year-old female is being treated for insulin dependent diabetes mellitus and develops a
perineal abscess. It is foul smelling and you suspect an anaerobic infection. Which of the
following antibiotics has anaerobic activity?
metronidazole
An otherwise healthy 12-year-old boy is brought to the clinic by his mother with fever's chief
complaint for three days. His mother notes he has had a dry cough, congestion, and fevers as
high as 103 F at home. Starting two days ago, he began complaining about pain in his right
ear. The patient's immunizations are up to date, and no one else is currently sick at home.
Vital signs include blood pressure 112/76 mmHg, pulse 107/min, respiratory rate 18/min,
temperature 39 C (102.2 F), SaO2 of 99% on room air. On examination, an erythematous and
moderately bulging right tympanic membrane with a fluid level is observed behind the
membrane. Visual inspection of the left ear reveals a normal-appearing tympanic membrane.
The remainder of the child's exam is unremarkable. What is the mechanism of action of the
medication that would be prescribed to him?
cell wall synthesis inhibitor
A 55-year-old man presents with septicemia after recovering from a motorcycle accident in
the hospital. The clinician suspects that the septicemia is caused by methicillin-resistant
, Staphylococcus aureus (MRSA). Which of the following would provide the best antibiotic
coverage for this patient?
vancomycin
A 17-year-old patient presents to the clinic after experiencing significant dysphagia and
retrosternal heartburn. He was recently prescribed medication to treat a genital chlamydial
infection. Which of the following medications could have caused this patient's presenting
symptoms while treating the genital chlamydial infection?
doxycycline
A 12-month old presents to his pediatrician for a well-child visit. The exam is mostly normal,
except the pediatrician notes significantly discolored teeth. The mother insists that she only
allows her child to drink milk and water. Upon further questioning, the mother reveals she
was on medication for acne before she knew she was pregnant. What medication was she
most likely given?
doxycycline
A 66-year-old man with a history of follicular non-Hodgkins lymphoma is being treated with
anthracycline therapy, interferon adjuvant therapy, and supportive pain medications. Over
the course of his treatment, this patient develops suicidal ideation. Which of the following
medications is most likely responsible for this patient’s symptoms?
interferon-alpha 2b
A 65-year-old man underwent surgery for basal cell carcinoma of the helical rim of the ear.
Margins were clear on frozen sections. Due to the size of the defect, an advancement flap was
performed. What signs or symptoms are associated with the Black Box Warning of the
antibiotic that would be most appropriate for the patient to receive postoperatively?
pain in the achilles tendon
A 5-year-old boy is brought to the clinic by his parents because of a worsening cough and
thick yellow-green nasal discharge for the past 2 weeks. The patient has no chronic medical
conditions, and he is not taking any medication. His immunization is up to date. Vital signs
show temperature 39.2 C, blood pressure 120/80 mmHg, pulse 92/min, and respiratory rate
20/min. On examination, nasal turbinates are swollen and erythematous, and there is a thick
purulent discharge from the nares; lungs are clear on auscultation. Amoxicillin-clavulanate is
prescribed, which results in the complete resolution of symptoms in two days. Which of the
following is the most likely organism responsible for this patient's initial presentation?
moraxella catarrhalis
A 23-year-old female was recently prescribed fluconazole and "other antibiotics she forgets"
after getting a local infection in Mississippi. After receiving treatment for histoplasmosis, she
begins to feel better but now complains of vaginal itching and discharge. She denies any other
symptoms except she had some loose stool after eating some "old food" yesterday. What is
the explanation for this patient's new presenting symptoms?
disruption of normal vaginal flora
A 48-year-old male presents for a pre-employment checkup. Currently, he is not experiencing
any symptoms. His past medical history includes type 2 diabetes mellitus, hypertension, and
hypercholesterolemia. Medications include metformin, hydrochlorothiazide, multivitamin
supplements, and atorvastatin. He practices healthy lifestyle habits and consumes a lot of
vegetables. He has a 10-pack-year smoking history. His heart rate is 82 bpm, respirations are
hesitancy in micturition for the past week. He also complains of pain in ejaculation. He has no
flank pain, dysuria, hematuria, or fever. He is in a monogamous relationship and uses
condoms regularly. His temperature is 98.6 F (37 C), pulse rate is 77 beats/ minute, respiration
is 14 breaths/minute, and blood pressure is 130/80 mmHg. There is no costovertebral angle
tenderness or suprapubic tenderness, and external genitalia examination is normal. Digital
rectal examination shows normal sphincter tone and reflexes with slightly enlarged and
tender prostate. Urinalysis shows many WBCs with no RBCs or casts. Urine culture grows E.
coli. Serum prostate-specific antigen is 8ng/mL (reference range of less than 3.5 ng/mL).
Which of the following drug class can be used to treat the patient's condition?
fluroquinolone
A 41-year-old G5P4004 at 38 weeks, 0 days pregnant presents for late prenatal testing. She is
found to have IgM-positive antibodies for HSV-2. The patient desires to deliver vaginally.
Which of the following statements is correct regarding the treatment of choice for this
patient's condition?
it is generally safe in pregnancy
A 25-year-old woman presents to the clinician with complaints of frequent burning
micturition and suprapubic discomfort from the past two days. The patient is sexually active
and has no significant past medical history. Urinalysis reveals the presence of leukocyte
esterase and a high level of nitrites. The clinician prescribes her a combination antibiotic that
inhibits two steps in the bacterial biosynthesis of tetrahydrofolate. Which of the following is a
contraindication to the use of this medication?
pregnancy
A 35-year-old woman comes to the office for pain and burning during urination for the past
few days. She denies fever, abdominal or flank pain, bloody urine, or passing any stones while
urinating. She has a medical history of gastroesophageal reflux disease, diabetes mellitus type
2, and hyperlipidemia. She takes over-the-counter antacids, pantoprazole, metformin, and
atorvastatin. She is para 2 with both normal vaginal delivery and her last menstrual period
was three weeks ago. She uses oral contraceptive pills for contraception. Her temperature is
37.2 C, her pulse is 70 beats/min, her respiratory rate is 12 breaths/min, and her blood
pressure is 130/80 mmHg. On examination, she denies suprapubic pain or costovertebral
angle tenderness. Urinalysis reveals white blood cells of 20-25/hpf and red blood cells of 5-
10/hpf with no casts. Urinary nitrites and leukocyte esterase are positive, and glucose and
ketone are absent. White blood cell count is 7800/mm3. Serum creatinine is 1.1 mg/dL and
blood urea nitrogen is 17 mg/dL. Urine culture grows Escherichia coli. The patient is started
on a drug that inhibits an enzyme required in bacterial DNA replication. The patient is
counseled about adherence and the adverse effect of this drug. About which of her other
medications should she be counseled?
antacid
,A 27-year-old male with a past medical history of tuberculosis presents to the outpatient
clinic with complaints of diarrhea and crampy abdominal pain. The patient was diagnosed
with tuberculosis 16 weeks ago and is currently on treatment with isoniazid and rifampicin.
Complete blood count shows an elevated WBC count. Blood testing shows that liver function
tests are normal. Which of the following is the best next step in the management of this
patient?
testing for clostridium difficle
A 5-year-old boy presents with a worsening cough and thick yellow-green nasal discharge for
the past two weeks. He has no chronic medical conditions and is not taking any medication.
His immunizations are up to date. Vital signs show a temperature of 39.2 C (102.6 F), blood
pressure of 120/80 mmHg, pulse of 92/min, and respiratory rate of 20/min. On examination,
nasal turbinates are swollen and erythematous, and there is a thick purulent discharge from
the nares. Lungs are clear on auscultation. Amoxicillin-clavulanate is prescribed for acute
bacterial sinusitis. What is the role of the clavulanate component in amoxicillin-clavulanate?
Clavulanate inhibits beta-lactamase produced by bacteria to prevent the inactivation of
amoxicillin
A 65-year-old man starts treatment with linezolid for methicillin-resistant Staphylococcus
aureus (MRSA) infection. Two days later, he complains of fever, sweating, confusion, and
agitation. His blood pressure is 150/91 mmHg, and his heart rate is 110/minute. A physical
exam reveals diaphoresis, shivering, and hyperreflexia. The patient has a history of allergic
rhinitis, hypercholesterolemia, depression, and peptic ulcer disease. His usual medications
include lovastatin, astemizole, phenelzine, and famotidine. Which of the following most likely
caused a drug interaction with linezolid?
Phenelzine
A 65-year-old female comes to the clinician with pain behind her left heel for a day. The pain
is aggravated by dorsiflexion of the feet. She denies stiffness, weakness, numbness, tingling,
or redness of her feet and toes. She has diabetes managed with Insulin and osteoarthritis of
the knee managed with painkillers. She was recently treated for an episode of urinary tract
infection. She eats a balanced diet and walks for 30 minutes every day. Her vital signs are
normal. On examination, there is no warmth, redness, or swelling on her feet, but there is
tenderness 3 centimeters above the posterior calcaneus on the left side. Bilateral motor
strength, reflexes, and sensation are normal. Which of the following is the most likely cause of
the condition?
use of prescription medication
A 54-year-old female with no significant past medical history presents with a 6-month history
of recurring "cold sores on my mouth." On exam, there are several vesicular lesions on her
lips. A 5% concentration of the antiviral ointment is administered. Regarding this antiviral
ointment, it is important to teach the patient which one of the following?
lesions may occur again at a later date despite treatment
A 25-year-old sexually active female comes to the clinician with complaints of frequent
urination, burning micturition, and mild supra-pubic pain for two days. She gives no history of
fever, nausea, flank pain, or vomiting. After an appropriate workup, the clinician prescribes
her a medication taken up by bacterial intracellular nitroreductases to produce the active
,form of the drug to treat her condition. Which of the following is a well-known severe adverse
effect of the drug most likely given in this case?
pulmonary toxicity
A 25-year-old female patient comes to you for urinary discomfort and frequency. Urine
culture shows that her infection is susceptible to sulfamethoxazole/trimethoprim. What is the
benefit of using these drugs together?
the drugs inhibit sequential steps of the folate synthesis pathway
A 45-year-old woman develops pruritis, erythematous rash on the face and neck, and
hypotension during initial intravenous antimicrobial treatment. Which of the following most
likely caused this patients presentation?
vancomycin
A 41-year-old woman is involved in a serious skiing accident, requiring surgery for a fractured
femur. Postoperatively she develops methicillin-resistant Staphylococcus aureus (MRSA)
bacteremia. Infusion of a synthetic oxazolidinone antimicrobial drug is initiated. Which of the
following is one of the most common adverse effects of this drug?
headache
An 8-month-old boy presents with a new onset of fever, urinary hesitancy, and frequency for
three days. This is his second episode of similar complaints in the same month. He has a
history of recurrent urinary tract infections since his birth. He has a 4-year-old sibling who is
healthy. He has normal growth and development and achieved his milestones on time. The
urine culture of catheterized specimens grew >100,000 colony-forming units of Escherichia
coli. The renal ultrasound shows mild hydronephrosis of the left kidney, and the voiding
cystourethrogram shows moderate dilatation of the left ureter and pelvis. The patient is
managed with nitrofurantoin and paracetamol. The patient is discharged on a prophylactic
antibiotic for his condition. Which of the following antimicrobial agents is contraindicated in
this patient?
ciprofloxacin
A 16-year-old female is being treated for insulin dependent diabetes mellitus and develops a
perineal abscess. It is foul smelling and you suspect an anaerobic infection. Which of the
following antibiotics has anaerobic activity?
metronidazole
An otherwise healthy 12-year-old boy is brought to the clinic by his mother with fever's chief
complaint for three days. His mother notes he has had a dry cough, congestion, and fevers as
high as 103 F at home. Starting two days ago, he began complaining about pain in his right
ear. The patient's immunizations are up to date, and no one else is currently sick at home.
Vital signs include blood pressure 112/76 mmHg, pulse 107/min, respiratory rate 18/min,
temperature 39 C (102.2 F), SaO2 of 99% on room air. On examination, an erythematous and
moderately bulging right tympanic membrane with a fluid level is observed behind the
membrane. Visual inspection of the left ear reveals a normal-appearing tympanic membrane.
The remainder of the child's exam is unremarkable. What is the mechanism of action of the
medication that would be prescribed to him?
cell wall synthesis inhibitor
A 55-year-old man presents with septicemia after recovering from a motorcycle accident in
the hospital. The clinician suspects that the septicemia is caused by methicillin-resistant
, Staphylococcus aureus (MRSA). Which of the following would provide the best antibiotic
coverage for this patient?
vancomycin
A 17-year-old patient presents to the clinic after experiencing significant dysphagia and
retrosternal heartburn. He was recently prescribed medication to treat a genital chlamydial
infection. Which of the following medications could have caused this patient's presenting
symptoms while treating the genital chlamydial infection?
doxycycline
A 12-month old presents to his pediatrician for a well-child visit. The exam is mostly normal,
except the pediatrician notes significantly discolored teeth. The mother insists that she only
allows her child to drink milk and water. Upon further questioning, the mother reveals she
was on medication for acne before she knew she was pregnant. What medication was she
most likely given?
doxycycline
A 66-year-old man with a history of follicular non-Hodgkins lymphoma is being treated with
anthracycline therapy, interferon adjuvant therapy, and supportive pain medications. Over
the course of his treatment, this patient develops suicidal ideation. Which of the following
medications is most likely responsible for this patient’s symptoms?
interferon-alpha 2b
A 65-year-old man underwent surgery for basal cell carcinoma of the helical rim of the ear.
Margins were clear on frozen sections. Due to the size of the defect, an advancement flap was
performed. What signs or symptoms are associated with the Black Box Warning of the
antibiotic that would be most appropriate for the patient to receive postoperatively?
pain in the achilles tendon
A 5-year-old boy is brought to the clinic by his parents because of a worsening cough and
thick yellow-green nasal discharge for the past 2 weeks. The patient has no chronic medical
conditions, and he is not taking any medication. His immunization is up to date. Vital signs
show temperature 39.2 C, blood pressure 120/80 mmHg, pulse 92/min, and respiratory rate
20/min. On examination, nasal turbinates are swollen and erythematous, and there is a thick
purulent discharge from the nares; lungs are clear on auscultation. Amoxicillin-clavulanate is
prescribed, which results in the complete resolution of symptoms in two days. Which of the
following is the most likely organism responsible for this patient's initial presentation?
moraxella catarrhalis
A 23-year-old female was recently prescribed fluconazole and "other antibiotics she forgets"
after getting a local infection in Mississippi. After receiving treatment for histoplasmosis, she
begins to feel better but now complains of vaginal itching and discharge. She denies any other
symptoms except she had some loose stool after eating some "old food" yesterday. What is
the explanation for this patient's new presenting symptoms?
disruption of normal vaginal flora
A 48-year-old male presents for a pre-employment checkup. Currently, he is not experiencing
any symptoms. His past medical history includes type 2 diabetes mellitus, hypertension, and
hypercholesterolemia. Medications include metformin, hydrochlorothiazide, multivitamin
supplements, and atorvastatin. He practices healthy lifestyle habits and consumes a lot of
vegetables. He has a 10-pack-year smoking history. His heart rate is 82 bpm, respirations are
