PHARMD | INFECTIOUS DISEASES | ORIGINAL PRACTICE RESOURCE
PharmD Infectious Diseases
2026–2027 Pharmacotherapy Review | 110 Practice Questions, Answers & Rationales
Independent educational examination. These questions are not taken from a university, licensing
examination, or proprietary test bank. Medication selection depends on indication, local
susceptibility, organ function, patient factors, and evolving clinical guidelines. Do not use this
resource for direct prescribing.
Instructions
Choose the single best answer (A–D). Questions 1–55 test foundational clinical decisions; questions
56–110 revisit the same 55 concepts in applied practice scenarios. Answers and explanations follow
each question.
Question 1. [Stewardship] A stable adult with uncomplicated viral upper respiratory
symptoms requests an antibiotic. What is the best approach?
A. Start levofloxacin
B. Start azithromycin
C. Start amoxicillin
D. Offer symptomatic care without antibiotics
Correct answer: D. Offer symptomatic care without antibiotics
Rationale: Antibiotics do not treat viral upper respiratory infection; unnecessary exposure
causes harm and resistance.
Why other options are incorrect:
A. Start levofloxacin — This does not address the key clinical principle: Antibiotics do not
treat viral upper respiratory infection; unnecessary exposure causes harm and resistance.
B. Start azithromycin — This does not address the key clinical principle: Antibiotics do not
treat viral upper respiratory infection; unnecessary exposure causes harm and resistance.
C. Start amoxicillin — This does not address the key clinical principle: Antibiotics do not
treat viral upper respiratory infection; unnecessary exposure causes harm and resistance.
─────────────────────────────────────────────────────────────────
Question 2. [Cultures] A patient with suspected sepsis needs immediate empiric IV antibiotics.
What should be done with blood cultures?
A. Avoid blood cultures in sepsis
B. Collect cultures only after 48 hours
C. Obtain cultures promptly before antibiotics if this does not meaningfully delay treatment
D. Wait for culture results before treatment
Correct answer: C. Obtain cultures promptly before antibiotics if this does not meaningfully
delay treatment
Rationale: Cultures before antibiotics improve organism identification, but should never
meaningfully delay time-sensitive sepsis therapy.
Why other options are incorrect:
2026–2027 • Educational use only • Not an official exam
,PHARMD | INFECTIOUS DISEASES | ORIGINAL PRACTICE RESOURCE
A. Avoid blood cultures in sepsis — This does not address the key clinical principle: Cultures
before antibiotics improve organism identification, but should never meaningfully delay
time-sensitive sepsis therapy.
B. Collect cultures only after 48 hours — This does not address the key clinical principle:
Cultures before antibiotics improve organism identification, but should never meaningfully
delay time-sensitive sepsis therapy.
D. Wait for culture results before treatment — This does not address the key clinical
principle: Cultures before antibiotics improve organism identification, but should never
meaningfully delay time-sensitive sepsis therapy.
─────────────────────────────────────────────────────────────────
Question 3. [De-escalation] A patient initially received broad empiric antibiotics. Cultures
identify an organism susceptible to a narrower agent and the patient is improving. What is
best?
A. Stop all treatment immediately
B. Add a second broad agent
C. Continue all empiric agents indefinitely
D. Narrow therapy to an effective targeted agent
Correct answer: D. Narrow therapy to an effective targeted agent
Rationale: De-escalation reduces unnecessary spectrum while maintaining pathogen-directed
efficacy.
Why other options are incorrect:
A. Stop all treatment immediately — This does not address the key clinical principle: De-
escalation reduces unnecessary spectrum while maintaining pathogen-directed efficacy.
B. Add a second broad agent — This does not address the key clinical principle: De-
escalation reduces unnecessary spectrum while maintaining pathogen-directed efficacy.
C. Continue all empiric agents indefinitely — This does not address the key clinical
principle: De-escalation reduces unnecessary spectrum while maintaining pathogen-
directed efficacy.
─────────────────────────────────────────────────────────────────
Question 4. [Allergy] A patient reports nausea alone after taking penicillin years ago. How
should this be interpreted?
A. Label all beta-lactams as anaphylaxis risks
B. Prescribe epinephrine for every dose
C. Never discuss the history again
D. Clarify and document the reaction; nausea alone is not an IgE-mediated allergy
Correct answer: D. Clarify and document the reaction; nausea alone is not an IgE-mediated
allergy
Rationale: Medication intolerance is distinct from immune-mediated allergy; careful history
can avoid unnecessary antibiotic restrictions.
Why other options are incorrect:
A. Label all beta-lactams as anaphylaxis risks — This does not address the key clinical
principle: Medication intolerance is distinct from immune-mediated allergy; careful history
can avoid unnecessary antibiotic restrictions.
2026–2027 • Educational use only • Not an official exam
,PHARMD | INFECTIOUS DISEASES | ORIGINAL PRACTICE RESOURCE
B. Prescribe epinephrine for every dose — This does not address the key clinical principle:
Medication intolerance is distinct from immune-mediated allergy; careful history can avoid
unnecessary antibiotic restrictions.
C. Never discuss the history again — This does not address the key clinical principle:
Medication intolerance is distinct from immune-mediated allergy; careful history can avoid
unnecessary antibiotic restrictions.
─────────────────────────────────────────────────────────────────
Question 5. [Renal dosing] An older adult with markedly reduced kidney function is
prescribed a primarily renally eliminated antibiotic. What is the priority?
A. Evaluate renal-adjusted dose or interval using the drug-specific guidance
B. Automatically double the dose
C. Ignore kidney function for antibiotics
D. Use body temperature alone to choose dose
Correct answer: A. Evaluate renal-adjusted dose or interval using the drug-specific guidance
Rationale: Renal impairment may reduce clearance and raise toxicity risk; adjustments
depend on the specific medication and indication.
Why other options are incorrect:
B. Automatically double the dose — This does not address the key clinical principle: Renal
impairment may reduce clearance and raise toxicity risk; adjustments depend on the
specific medication and indication.
C. Ignore kidney function for antibiotics — This does not address the key clinical principle:
Renal impairment may reduce clearance and raise toxicity risk; adjustments depend on the
specific medication and indication.
D. Use body temperature alone to choose dose — This does not address the key clinical
principle: Renal impairment may reduce clearance and raise toxicity risk; adjustments
depend on the specific medication and indication.
─────────────────────────────────────────────────────────────────
Question 6. [Time-dependent] For beta-lactam antibiotics, which pharmacodynamic exposure
commonly predicts efficacy?
A. Peak concentration alone
B. Time free drug concentrations remain above the MIC
C. Total tablet count
D. Urine color
Correct answer: B. Time free drug concentrations remain above the MIC
Rationale: Beta-lactams generally exhibit time-dependent killing linked to free time above the
minimum inhibitory concentration.
Why other options are incorrect:
A. Peak concentration alone — This does not address the key clinical principle: Beta-lactams
generally exhibit time-dependent killing linked to free time above the minimum inhibitory
concentration.
C. Total tablet count — This does not address the key clinical principle: Beta-lactams
generally exhibit time-dependent killing linked to free time above the minimum inhibitory
concentration.
2026–2027 • Educational use only • Not an official exam
, PHARMD | INFECTIOUS DISEASES | ORIGINAL PRACTICE RESOURCE
D. Urine color — This does not address the key clinical principle: Beta-lactams generally
exhibit time-dependent killing linked to free time above the minimum inhibitory
concentration.
─────────────────────────────────────────────────────────────────
Question 7. [Concentration-dependent] Which exposure is especially important for
concentration-dependent killing by aminoglycosides?
A. Number of oral doses
B. Plasma sodium alone
C. Time below MIC
D. Peak concentration relative to MIC
Correct answer: D. Peak concentration relative to MIC
Rationale: Aminoglycoside efficacy is associated with high peak-to-MIC exposure, balanced
against nephrotoxicity and ototoxicity risk.
Why other options are incorrect:
A. Number of oral doses — This does not address the key clinical principle: Aminoglycoside
efficacy is associated with high peak-to-MIC exposure, balanced against nephrotoxicity and
ototoxicity risk.
B. Plasma sodium alone — This does not address the key clinical principle: Aminoglycoside
efficacy is associated with high peak-to-MIC exposure, balanced against nephrotoxicity and
ototoxicity risk.
C. Time below MIC — This does not address the key clinical principle: Aminoglycoside
efficacy is associated with high peak-to-MIC exposure, balanced against nephrotoxicity and
ototoxicity risk.
─────────────────────────────────────────────────────────────────
Question 8. [Vancomycin monitoring] An adult receiving IV vancomycin for serious MRSA
infection needs exposure monitoring. Which approach is preferred when feasible?
A. Use a fixed trough of 30 mg/L for everyone
B. Dose solely by drug color
C. Never assess kidney function
D. AUC-guided monitoring with a target appropriate to the indication
Correct answer: D. AUC-guided monitoring with a target appropriate to the indication
Rationale: For serious MRSA infections, AUC-guided monitoring is preferred; common
guideline targets are AUC24/MIC 400–600 assuming MIC 1 mg/L.
Why other options are incorrect:
A. Use a fixed trough of 30 mg/L for everyone — This does not address the key clinical
principle: For serious MRSA infections, AUC-guided monitoring is preferred; common
guideline targets are AUC24/MIC 400–600 assuming MIC 1 mg/L.
B. Dose solely by drug color — This does not address the key clinical principle: For serious
MRSA infections, AUC-guided monitoring is preferred; common guideline targets are
AUC24/MIC 400–600 assuming MIC 1 mg/L.
C. Never assess kidney function — This does not address the key clinical principle: For
serious MRSA infections, AUC-guided monitoring is preferred; common guideline targets
are AUC24/MIC 400–600 assuming MIC 1 mg/L.
2026–2027 • Educational use only • Not an official exam
PharmD Infectious Diseases
2026–2027 Pharmacotherapy Review | 110 Practice Questions, Answers & Rationales
Independent educational examination. These questions are not taken from a university, licensing
examination, or proprietary test bank. Medication selection depends on indication, local
susceptibility, organ function, patient factors, and evolving clinical guidelines. Do not use this
resource for direct prescribing.
Instructions
Choose the single best answer (A–D). Questions 1–55 test foundational clinical decisions; questions
56–110 revisit the same 55 concepts in applied practice scenarios. Answers and explanations follow
each question.
Question 1. [Stewardship] A stable adult with uncomplicated viral upper respiratory
symptoms requests an antibiotic. What is the best approach?
A. Start levofloxacin
B. Start azithromycin
C. Start amoxicillin
D. Offer symptomatic care without antibiotics
Correct answer: D. Offer symptomatic care without antibiotics
Rationale: Antibiotics do not treat viral upper respiratory infection; unnecessary exposure
causes harm and resistance.
Why other options are incorrect:
A. Start levofloxacin — This does not address the key clinical principle: Antibiotics do not
treat viral upper respiratory infection; unnecessary exposure causes harm and resistance.
B. Start azithromycin — This does not address the key clinical principle: Antibiotics do not
treat viral upper respiratory infection; unnecessary exposure causes harm and resistance.
C. Start amoxicillin — This does not address the key clinical principle: Antibiotics do not
treat viral upper respiratory infection; unnecessary exposure causes harm and resistance.
─────────────────────────────────────────────────────────────────
Question 2. [Cultures] A patient with suspected sepsis needs immediate empiric IV antibiotics.
What should be done with blood cultures?
A. Avoid blood cultures in sepsis
B. Collect cultures only after 48 hours
C. Obtain cultures promptly before antibiotics if this does not meaningfully delay treatment
D. Wait for culture results before treatment
Correct answer: C. Obtain cultures promptly before antibiotics if this does not meaningfully
delay treatment
Rationale: Cultures before antibiotics improve organism identification, but should never
meaningfully delay time-sensitive sepsis therapy.
Why other options are incorrect:
2026–2027 • Educational use only • Not an official exam
,PHARMD | INFECTIOUS DISEASES | ORIGINAL PRACTICE RESOURCE
A. Avoid blood cultures in sepsis — This does not address the key clinical principle: Cultures
before antibiotics improve organism identification, but should never meaningfully delay
time-sensitive sepsis therapy.
B. Collect cultures only after 48 hours — This does not address the key clinical principle:
Cultures before antibiotics improve organism identification, but should never meaningfully
delay time-sensitive sepsis therapy.
D. Wait for culture results before treatment — This does not address the key clinical
principle: Cultures before antibiotics improve organism identification, but should never
meaningfully delay time-sensitive sepsis therapy.
─────────────────────────────────────────────────────────────────
Question 3. [De-escalation] A patient initially received broad empiric antibiotics. Cultures
identify an organism susceptible to a narrower agent and the patient is improving. What is
best?
A. Stop all treatment immediately
B. Add a second broad agent
C. Continue all empiric agents indefinitely
D. Narrow therapy to an effective targeted agent
Correct answer: D. Narrow therapy to an effective targeted agent
Rationale: De-escalation reduces unnecessary spectrum while maintaining pathogen-directed
efficacy.
Why other options are incorrect:
A. Stop all treatment immediately — This does not address the key clinical principle: De-
escalation reduces unnecessary spectrum while maintaining pathogen-directed efficacy.
B. Add a second broad agent — This does not address the key clinical principle: De-
escalation reduces unnecessary spectrum while maintaining pathogen-directed efficacy.
C. Continue all empiric agents indefinitely — This does not address the key clinical
principle: De-escalation reduces unnecessary spectrum while maintaining pathogen-
directed efficacy.
─────────────────────────────────────────────────────────────────
Question 4. [Allergy] A patient reports nausea alone after taking penicillin years ago. How
should this be interpreted?
A. Label all beta-lactams as anaphylaxis risks
B. Prescribe epinephrine for every dose
C. Never discuss the history again
D. Clarify and document the reaction; nausea alone is not an IgE-mediated allergy
Correct answer: D. Clarify and document the reaction; nausea alone is not an IgE-mediated
allergy
Rationale: Medication intolerance is distinct from immune-mediated allergy; careful history
can avoid unnecessary antibiotic restrictions.
Why other options are incorrect:
A. Label all beta-lactams as anaphylaxis risks — This does not address the key clinical
principle: Medication intolerance is distinct from immune-mediated allergy; careful history
can avoid unnecessary antibiotic restrictions.
2026–2027 • Educational use only • Not an official exam
,PHARMD | INFECTIOUS DISEASES | ORIGINAL PRACTICE RESOURCE
B. Prescribe epinephrine for every dose — This does not address the key clinical principle:
Medication intolerance is distinct from immune-mediated allergy; careful history can avoid
unnecessary antibiotic restrictions.
C. Never discuss the history again — This does not address the key clinical principle:
Medication intolerance is distinct from immune-mediated allergy; careful history can avoid
unnecessary antibiotic restrictions.
─────────────────────────────────────────────────────────────────
Question 5. [Renal dosing] An older adult with markedly reduced kidney function is
prescribed a primarily renally eliminated antibiotic. What is the priority?
A. Evaluate renal-adjusted dose or interval using the drug-specific guidance
B. Automatically double the dose
C. Ignore kidney function for antibiotics
D. Use body temperature alone to choose dose
Correct answer: A. Evaluate renal-adjusted dose or interval using the drug-specific guidance
Rationale: Renal impairment may reduce clearance and raise toxicity risk; adjustments
depend on the specific medication and indication.
Why other options are incorrect:
B. Automatically double the dose — This does not address the key clinical principle: Renal
impairment may reduce clearance and raise toxicity risk; adjustments depend on the
specific medication and indication.
C. Ignore kidney function for antibiotics — This does not address the key clinical principle:
Renal impairment may reduce clearance and raise toxicity risk; adjustments depend on the
specific medication and indication.
D. Use body temperature alone to choose dose — This does not address the key clinical
principle: Renal impairment may reduce clearance and raise toxicity risk; adjustments
depend on the specific medication and indication.
─────────────────────────────────────────────────────────────────
Question 6. [Time-dependent] For beta-lactam antibiotics, which pharmacodynamic exposure
commonly predicts efficacy?
A. Peak concentration alone
B. Time free drug concentrations remain above the MIC
C. Total tablet count
D. Urine color
Correct answer: B. Time free drug concentrations remain above the MIC
Rationale: Beta-lactams generally exhibit time-dependent killing linked to free time above the
minimum inhibitory concentration.
Why other options are incorrect:
A. Peak concentration alone — This does not address the key clinical principle: Beta-lactams
generally exhibit time-dependent killing linked to free time above the minimum inhibitory
concentration.
C. Total tablet count — This does not address the key clinical principle: Beta-lactams
generally exhibit time-dependent killing linked to free time above the minimum inhibitory
concentration.
2026–2027 • Educational use only • Not an official exam
, PHARMD | INFECTIOUS DISEASES | ORIGINAL PRACTICE RESOURCE
D. Urine color — This does not address the key clinical principle: Beta-lactams generally
exhibit time-dependent killing linked to free time above the minimum inhibitory
concentration.
─────────────────────────────────────────────────────────────────
Question 7. [Concentration-dependent] Which exposure is especially important for
concentration-dependent killing by aminoglycosides?
A. Number of oral doses
B. Plasma sodium alone
C. Time below MIC
D. Peak concentration relative to MIC
Correct answer: D. Peak concentration relative to MIC
Rationale: Aminoglycoside efficacy is associated with high peak-to-MIC exposure, balanced
against nephrotoxicity and ototoxicity risk.
Why other options are incorrect:
A. Number of oral doses — This does not address the key clinical principle: Aminoglycoside
efficacy is associated with high peak-to-MIC exposure, balanced against nephrotoxicity and
ototoxicity risk.
B. Plasma sodium alone — This does not address the key clinical principle: Aminoglycoside
efficacy is associated with high peak-to-MIC exposure, balanced against nephrotoxicity and
ototoxicity risk.
C. Time below MIC — This does not address the key clinical principle: Aminoglycoside
efficacy is associated with high peak-to-MIC exposure, balanced against nephrotoxicity and
ototoxicity risk.
─────────────────────────────────────────────────────────────────
Question 8. [Vancomycin monitoring] An adult receiving IV vancomycin for serious MRSA
infection needs exposure monitoring. Which approach is preferred when feasible?
A. Use a fixed trough of 30 mg/L for everyone
B. Dose solely by drug color
C. Never assess kidney function
D. AUC-guided monitoring with a target appropriate to the indication
Correct answer: D. AUC-guided monitoring with a target appropriate to the indication
Rationale: For serious MRSA infections, AUC-guided monitoring is preferred; common
guideline targets are AUC24/MIC 400–600 assuming MIC 1 mg/L.
Why other options are incorrect:
A. Use a fixed trough of 30 mg/L for everyone — This does not address the key clinical
principle: For serious MRSA infections, AUC-guided monitoring is preferred; common
guideline targets are AUC24/MIC 400–600 assuming MIC 1 mg/L.
B. Dose solely by drug color — This does not address the key clinical principle: For serious
MRSA infections, AUC-guided monitoring is preferred; common guideline targets are
AUC24/MIC 400–600 assuming MIC 1 mg/L.
C. Never assess kidney function — This does not address the key clinical principle: For
serious MRSA infections, AUC-guided monitoring is preferred; common guideline targets
are AUC24/MIC 400–600 assuming MIC 1 mg/L.
2026–2027 • Educational use only • Not an official exam
