1. A 48-year-old female is being treated for breast carcinoma. Over the past few days, she has been complaining of dysuria and frequency. Laboratory examination revealed the presence of microscopic hematuria. The next day the patient developed gross hematuria. Which of the following agents most likely caused the development of these signs and symptoms?
A. Mitomycin
B. Paclitaxel
C. Vincristine
D. Cyclophosphamide
E. Vinblastine
2. A 41-year-old male on combination therapy for remission maintenance ALL (acute lymphocytic leukemia) develops increase frequency of urine, suprapubic pain, dysuria, and hematuria. Evidence of hemorrhage and UTI is apparent on cystoscopy of the urinary bladder. His liver function and pulmonary function tests are nearly normal but blood test (CBC) and urine microscopic examination revealed leucocytosis and plenty of pus cells respectively. Which of the following agents most likely caused these findings?
A. 6-MP
B. Methotrexate
C. Cyclophosphamide
D. Doxorubicin
E. Carmustine
3. A 28-year-old white man was on vacation for 2 weeks in northern Minnesota in July. He was fishing and hiking in the forest for a number of days. He was healthy, with no known underlying disease or illness. Approximately 3 weeks after returning from his vacation, a red macule–papule developed on his right anterior thigh. Increasing redness developed around the initial site. The central area of this lesion showed some clearing. Several other similar lesions developed on his right leg and trunk. The patient did not note any arthropod bites. Which of the following antimicrobials would be the drug of choice for this patient?
A. Chloramphenicol
B. Cephalexin
C. Doxycycline
D.Gentamicin
E. Ampicillin
4. A 35-year-old man under treatment for pulmonary tuberculosis has acute-onset right big toe pain, swelling, and low- grade fever. His physical examination was consistent with gouty arthritis, and he was found to have high serum uric acid levels. Which of the following antituberculosis drugs is known to cause high uric acid levels?
A. Cycloserine
B. Thiacetazone
C. Pyrazinamide
D. Rifampin
E. Aminosalicylic acid
5. A 26-year-old truck driver, a recent immigrant from Mexico, could not obtain a Florida driving license because of his poor performance in red-green color vision discrimination. He denies any family history of color vision–related problems in the past. He is taking a four-drug regimen for pulmonary tuberculosis. He does not recall the names of the drugs. Which of the following antituberculosis drugs is responsible for his lack of color vision discrimination?
A. Ethambutol
B. Ethionamide
C. Aminosalicylic acid
D. Rifampin
E. Isoniazid
6. A 68-year-old white South African man receiving treatment for lepromatous leprosy has increasing red-brown pigmentation. Which of the following antileprosy drugs is responsible for the patient’s skin pigmentation?
A. Dapsone
B. Rifampin
C. Clofazimine
D. Capreomycin
E. Thiacetazone
7. A 23 year-old college student is diagnosed with Neisseria meningitidis based on his clinical presentation, gram-negative diplococci on Gram stain, and isolation of bacteria from cerebrospinal fluid. Which of the following drugs can be used as a prophylactic agent for roommates and other close contacts?
A. Amoxicillin
B. Isoniazid
C. Dapsone
D. Clarithromycin
E. Rifampin
8. A 65-year-old man with acute leukemia recently underwent induction chemotherapy and subsequently developed neutropenia and fever (with no source of fever identified). Fever persisted despite the use of empirical antibacterial therapy, and amphotericin B has been prescribed for possible fungal sepsis. Which laboratory test is the most helpful in monitoring for toxicities associated with amphotericin B?
A. Liver function tests and fasting lipid profile
B. Renal function tests
C. Serum magnesium, chloride
D. Serum blood sugar both FBS and RBS
E. Hemoglobin and hematocrit
9. A 42-year-old male suddenly develops dysuria and frequency despite the absence of bacteriuria; microscopic hematuria is noted. Over the course of the next few days, gross hematuria is seen. The patient is being treated for non-Hodgkin's lymphoma with a nitrogen mustard-type antineoplastic agent. Which of the following agents could have been administered to prevent the onset of the patient's symptoms?
A. Leucovorin
B. Allopurinol
C. Penicillamine
D. Mesna (it neutrolyzes acrolin at acidic pH in urine)
E. Sodium thiosulfate
10. A 19-year-old male has just returned from a trip to Southeast Asia. In the past 24 hours, he has developed shaking, chills, and a temperature of 104F. A blood smear reveals Plasmodium vivax. Which of the following agents should be used for Radical cure (exoerythrocytic phase) with the clinical cure of the organism?
A. Primaquine and Pyrimethamine
B. Pyrimethamine
C. Quinacrine
D. Chloroquine and Primaquine combination
E. Chloroquine only
11. Streptomycine and pyrazinamide are administered concurrently with other antitubercular drugs in the treatment of TB in order to
A. Reduce the pain of injection
B. Facilitate penetration of the blood-pulmonary barrier and rapid onset of action.
C. Retard the development of organism resistance
D. Delay excretion of other antitubercular drugs by the kidney and increase half life
E. Retard absorption after intramuscular injection
12. A 55-year-old obese woman with adult-onset diabetes mellitus has been receiving amoxicillin for treatment of an acute exacerbation of chronic bronchitis. After a week of therapy, the patient develops dysuria and increased urinary frequency. Urinalysis shows 10 to 50 white blood cells per high-power field, and Gram stain of urine shows many budding yeasts. Which antifungal agent would be best in treating this patient for Candida cystitis?
A. Oral ketoconazole
B. Oral fluconazole
C. Topical clotrimazole
D. Oral 5-flucytosine
E. Oral itraconazole
13. A 43-year-old woman recently underwent allogeneic bone marrow transplantation after chemotherapy failed in the treatment of metastatic breast carcinoma. The patient has had a stormy hospital course after her transplant, with respiratory failure requiring mechanical ventilation. A month into her hospitalization, surveillance sputum cultures reveal Aspergillus fumigatus, and a new infiltrate appears on her chest radiograph. Which antifungal agent is recommended for the treatment of invasive pulmonary aspergillosis in this patient?
A. Fluconazole
B. Amphotericin B
C. Nystatin
D. Capsofungin
E. Itraconazole
14. A 29-year-old medical entomologist comes to the hospital with chief complaints of fever, headache, and photophobia. This illness began about 6 days prior to admission, when he returned from a 2- month visit to the jungles of Central and South America. On his return flight, about 6 days prior to admission, he described having fever and shaking chills. He saw his physician 2 days prior to admission; the physician made a diagnosis of influenza and prescribed tetracycline. On the day of admission, the patient had shaking chills followed by temperature elevation to 104°F (40°C ). Physical examination revealed a well-developed man who appeared ill. There is some left upper quadrant tenderness but no organomegaly; blood pressure, 126/90; pulse, 120; and respirations, 22. Laboratory findings were hemoglobin, 14.5 mg/dL (normal, 13.4–17.4 mg/dL); hematocrit, 45% (normal, 40–54%); Giemsa stained blood smear (thick and thin) revealed Plasmodium vivax. What is the oral drug of choice to rid the blood of plasmodia?
A. Primaquine
B. Chloroquine
C. Sulfadiazine
D. Quinine
E. Mefloquine
15. A 52-year-old real estate salesperson has a 2-week history of watery diarrhea without blood. The patient states that 4 to 5 weeks ago she and her husband visited Aspen, Colorado, on a backpacking vacation and on occasion drank water from mountain streams. They were sure the water was potable, as the unspoiled, pristine area abounded with fish, beaver, and plant life. She states she has enjoyed perfect health except that she takes antacids for what she describes as gastroesophageal reflux disease. Her physical examination produced unremarkable findings. Examination of liquid stool revealed trophozoites and cysts of G. lamblia .Which of the following is the correct treatment for this disease?
A. Melarsoprol
B. Mefloquine
C. Mebendazole
D. Metronidazole
E. Fluroquinolone
16. To optimize drug therapy, it is necessary to know in what phase of the cell cycle antineoplastic agents are effective. Which one of the following agents is cytotoxic only to cells in the S-phase of the cycle?
A. Fluorouracil (pyrimidines antagonist
B. Mechlorethamine (alkylating, can act on all stages p.300)
C. Bleomycin
D. Carmustin
E. Methotrexate (in general: antimetabolites are S Phase-specific
17. Which class of drugs bind avidly to tubulin/microtubule and cause arrest of cells in metaphase?
A. Fluorouracil
B. Mechlormethamine
C. Bleomycin
D. Vincristine
E. Methotrexate
18. A 58-year-old female develops sudden onset of orthopnea, paroxysmal nocturnal dyspnea, and nocturia. On examination, the patient is tachycardic and both pulmonary rales and a third heart sound (S3) are noted. X-ray chest P/A and lateral views and ECG revealed cardiomegaly and arrhythmia respectively. If the patient is receiving antineoplastic therapy for treatment of breast cancer, which of the following agents did she most likely receive?
A. Bleomycin
B. Cisplatin
C. Doxorubicin
D. Methotrexate
E.Methotrexate
19. An anticancer chemotherapeutic agent that acts by first-order kinetics would be expected to kill a
A. constant number of cancer cells
B. constant proportion of cancer cells
C. variable number of cells depending on the half-life of the drug
D. variable number of cells depending on the proportion of cells in S phase
E. variable proportion of cells depending on the number of cells in the G0 phase
20. A 33-year-old woman presents with profound nausea, vomiting, sweating, hyperventilation, tachycardia, and vertigo. She states that she was out with a couple of friends having a few glasses of wine when she suddenly became ill. She has been previously diagnosed with a duodenal ulcer and is currently taking medication for her condition. Which of the following medications is most likely responsible for her latest symptoms?
A. Amoxicillin
B. Bismuth subsalicylate
C. Erythromycin
D. Metronidazole (it has disulfiram like effect, alcohol should be avoided)
E. Tetracycline
21. A 32-year-old male, infected with HIV, is diagnosed with Hodgkin's lymphoma. If the patient's CD4 count is 505/mm3, which of the following agents would be suitable for the treatment of this patient's lymphoma without further compromising his immune system?
A. Cyclophosphamide
B. Busulfan
C. Paclitaxel
D. Vincristine
E. Methotrexate
22. A 33-year-old man receiving chemotherapy for testicular carcinoma develops signs of renal tubular damage. Which of the following drugs is most likely responsible for this nephrotoxicity?
A. Cyclophosphamide
B. Bleomycin
C. Vinblastine
D. Vincristine
E. Methotrexate (MTX)
23. A 25-yr-old male AIDS pt has a fever of 102 F and complains of severe headaches during the past week. Staining of his CSF with India ink reveals Cryptococcus neoformans. The patient is admitted to the hospital and is treated with
A. IV amphotericin B plus flucytosine
B. Oral ketokonazole
C. Intrathecal (within a sheath, within either the subarochnoid or subdural space) Amphotericin B plus IV flucytosine
D. oral fluconazole
E. IV amphotericin B plus fluconazole
24. A 45-year-old female being treated for a chronic UTI develops acute alcohol intolerance. Which of the following agents could have caused this intolerance?
A. Cefoperazone (3rd generation Cephalosporin)
B. Amoxicillin
C. Sulfamethoxazole-trimethoprim
D. Norfloxacin
E. Tetracycline
25. A 27-year-old male with a three-year history of AIDS complains of progressive blurring of vision for two days. Eye examination reveals evidence of retinitis consistent with cytomegalic virus inclusion disease. Intravenous treatment is started, and within five days the patient complains of muscular weakness and cramping. Blood chemistries show a creatinine of 5.2 mEq/L and Hb% of 9 mg/dl but normal Ca level. Select the drug that most likely caused the adverse effect:
A. Ribavirin
B. Amantadine
C. Dideoxycytidine
D. Foscarnet
E. Ganciclovir
Answers: 1 D, 2 C, 3 C, 4 C, 5 A, 6 C, 7 E, 8 B, 9 D, 10 D, 11 C, 12 B, 13 B, 14 B, 15 C, 16 E, 17 D, 18 C, 19 B, 20 D
21 D, 22 E, 23 C, 24 A, 25 E
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