Question 1

Factors that place a patient at risk of developing an antimicrobial-resistant organism include:

Accepted Answer

Inappropriate use of antimicrobials, such as taking antibiotics when they are not necessary or not completing the full course of treatment, can contribute to the development of antimicrobial-resistant organisms in a patient. Age over 50 years, school attendance, and travel within the U.S. are not necessarily factors that increase a patient's risk of developing antimicrobial-resistant organisms.

Question 2

Patricia has been prescribed doxycycline for a chlamydia infection. She is healthy and her only medication is an oral combined contraceptive. Patricia's education would include:

Accepted Answer

Doxycycline can decrease the effectiveness of oral contraceptives, so it is recommended to use a back-up method of birth control until the next menses.

Answer: C
 If the infection does not clear with doxycycline, it is recommended that the patient's sexual partner(s) also receive treatment to prevent reinfection.

Answer: D 
 This statement is incorrect. Doxycycline is typically used for a 7-day treatment of chlamydia and other STIs, not a one-dose treatment.

Therefore, the best choices are A and C.

Question 3

To prevent the development of peripheral neuropathy in patients taking isoniazid for tuberculosis the patient is also prescribed:

Accepted Answer

Isoniazid (INH) can lead to a deficiency of pyridoxine (vitamin B6), which can cause peripheral neuropathy. Therefore, prescribing pyridoxine along with INH can prevent this complication. Niacin (vitamin B3), riboflavin (vitamin B2), and thiamine (vitamin B1) are not typically associated with INH use or the development of peripheral neuropathy.

Question 4

To prevent further development of antibacterial resistance it is recommended that fluoroquinolones be reserved for treatment of:

Accepted Answer

Fluoroquinolones are broad-spectrum antibiotics that should be used judiciously to prevent the development of resistance. They are recommended for more serious infections where other antibiotics might not be effective, such as community-acquired pneumonia in patients with comorbidities, where their broad-spectrum activity and penetration into lung tissue make them particularly useful. For other options like urinary tract infections, upper respiratory infections, and skin infections, there are usually other antibiotics that are preferred to minimize the risk of developing resistance.

Question 5

Fluoroquinolones have a Black Box Warning regarding ________ even months after treatment.

Accepted Answer

Fluoroquinolones have a Black Box Warning for the risk of tendinitis and tendon rupture, even months after treatment has been completed. This can affect any tendon in the body and primarily occurs in the elderly and in those receiving concomitant corticosteroids. Other recommended alternatives should be considered in patients who are at higher risk or have a history of such events.

Question 6

Lauren is a 13-year-old child who comes to clinic with a 4-day history of cough, low-grade fever, and rhinorrhea. When she blows her nose or coughs the mucous is greenish-yellow. The appropriate antibiotic to prescribe would be:

Accepted Answer

This presentation is suggestive of a viral upper respiratory tract infection, which is self-limiting and not amenable to antibiotic therapy. The color of nasal discharge or sputum does not reliably guide the need for antibiotic treatment. Prescribing antibiotics in such cases only contributes to antibiotic resistance and unnecessary side effects. Therefore, the appropriate course of action would be to provide symptomatic relief and watchful waiting.

Question 7

If a patient is allergic to sulfonamide antibiotics, he or she will most likely have cross-sensitivity to:

Accepted Answer

Patients allergic to sulfonamide antibiotics may have cross-sensitivity to other sulfonamide non-antibiotics, including loop diuretics, sulfonylureas, and thiazide diuretics, due to similarities in the sulfonamide structure.

Question 8

There is often cross-sensitivity and cross-resistance between penicillins and cephalosporins because:

Accepted Answer

Both penicillins and cephalosporins contain a beta-lactam ring that is vulnerable to beta-lactamase-producing organisms, which can lead to cross-resistance and cross-sensitivity between the two drug classes.

Question 9

Jonathan has been diagnosed with strep throat and needs a prescription for an antibiotic. He says the last time he had penicillin he developed a red, blotchy rash. An appropriate antibiotic to prescribe would be:

Accepted Answer

Azithromycin is a macrolide antibiotic and is a suitable alternative for patients who are allergic to penicillin. Also, the fact that Jonathan developed a rash with penicillin raises the concern that it may be a hypersensitivity reaction, so choosing an entirely different class of antibiotic (such as a macrolide) is the preferred choice for safety purposes.

Question 10

Tetracyclines such as minocycline are safe to use in:

Accepted Answer

Tetracyclines are generally safe to use in adolescents, although they should be avoided in pregnant women and patients with renal or hepatic dysfunction.

Question 11

Infants and young children are at higher risk of developing antibiotic-resistant infections due to:

Accepted Answer

Infants and young children may be more susceptible to antibiotic-resistant infections due to their exposure to pathogens in daycare or other group settings where illness can spread easily. Antibiotic use in these settings can also contribute to the development of antibiotic resistance. Developmental differences in pharmacokinetics may require different dosages or medications, but do not necessarily increase the risk of antibiotic resistance. Parents insisting on preventive antibiotics or immunosuppression from vaccines are not primary factors in the development of antibiotic resistance in this age group.

Question 12

Jamie has glucose-6-phosphate dehydrogenase deficiency (G6PD) and requires an antibiotic. Which class of antibiotics should be avoided in this patient?

Accepted Answer

Sulfonamides should be avoided in patients with G6PD deficiency as they can cause hemolysis (destruction of red blood cells) in these individuals. The other antibiotic classes listed (penicillins, macrolides, and cephalosporins) are generally safe to use in patients with G6PD deficiency. However, it is important to note that each individual patient's situation may vary and appropriate antibiotic choice should be made in consultation with a healthcare provider.

Question 13

Janet was recently treated with clindamycin for an infection. She calls the advice nurse because she is having frequent diarrhea that she thinks may have blood in it. What would be the appropriate care for her?

Accepted Answer

Clindamycin is known to cause pseudomembranous colitis, which can cause bloody diarrhea. Janet needs to be assessed for this potential complication and may require further treatment such as antibiotics or fecal transplantation. Encouraging increased fluids and fiber or eating yogurt would not be enough to address this issue, and starting an antidiarrheal medication may worsen the condition by slowing down the elimination of the toxins causing the diarrhea.

Question 14

Joanna had a small ventricle septal defect (VSD) repaired when she was 3 years old and has no residual cardiac problems. She is now 28 and is requesting prophylactic antibiotics for an upcoming dental visit. The appropriate antibiotic to prescribe according to current American College of Cardiology and American Heart Association guidelines is:

Accepted Answer

According to current American College of Cardiology and American Heart Association guidelines, prophylactic antibiotics are not recommended for patients with a history of VSD repair without residual cardiac problems. Therefore, no antibiotic is required for Joanna's upcoming dental visit.

Question 15

Providers should use an antibiogram when prescribing. An antibiogram is:

Accepted Answer

An antibiogram is a chart of local resistance patterns to antibiotics developed by laboratories, which allows healthcare providers to select the most appropriate antibiotic for a particular infection based on local resistance patterns. Knowing local resistance patterns helps providers avoid prescribing antibiotics that are likely to be ineffective.

Question 16

Keng has chronic hepatitis that has led to mildly impaired liver function. He has an infection that would be best treated by a macrolide. Which would be the best choice for a patient with liver dysfunction?

Accepted Answer

The answer of Keng has chronic hepatitis that has led...

Question 17

Sarah is a 25-year-old female who is 8 weeks pregnant and has a urinary tract infection. What would be the appropriate antibiotic to prescribe for her?

Accepted Answer

Amoxicillin is usually safe to prescribe during pregnancy and is effective against most urinary tract infections. Ciprofloxacin and doxycycline are contraindicated in pregnancy as they can harm the developing fetus. Trimethoprim-sulfamethoxazole is also not usually recommended in the first trimester of pregnancy.

Question 18

Pong-tai is a 12-month-old child who is being treated with amoxicillin for acute otitis media. His parents call the clinic and say he has developed diarrhea. The appropriate action would be to:

Accepted Answer

Diarrhea is a common side effect of amoxicillin, and typically resolves on its own. Advising the parents that this is normal and recommending probiotics can be a helpful strategy. Changing the antibiotic is not necessary unless the diarrhea is severe or persistent. Stool cultures are not indicated unless there are other signs of infection or suspicion of a different pathogen. Recommending increased fluids and fiber may help with diarrhea but is not specific to this case.

Question 19

Nicole is a 16-year-old female who is taking minocycline for acne. She comes to the clinic complaining of a headache. What would be the plan of care?

Accepted Answer

DMinocycline, an antibiotic often used for acne, can cause pseudotumor cerebri (increased pressure in the skull mimicking a brain tumor) as a side effect, which presents with headaches. Therefore, evaluating her for pseudotumor cerebri (C) is crucial. Assessing lifestyle factors such as caffeine intake and sleep patterns (D) is also important, as these can contribute to headaches and should be part of a comprehensive assessment.

Question 20

Tetracyclines should not be prescribed to children younger than 8 years due to:

Accepted Answer

Tetracyclines can lead to adverse effects on bone growth and teeth discoloration in children younger than 8 years, which is why their use is generally avoided in this age group.

Quiz 24: Drugs Used in Treating Infectious Diseases