120)

An isolate of Streptococcus pneumonia from a patient with meningitis is incubated with low-dose radiolabeled ceftriaxone and then subjected to protein electrophoresis. Five distinct bands are detected by autoradiography. These bands most likely represent which of the following? A) Cell wall glycoproteins B) Nuclear proteins C) Porins D) Ribosomal proteins E) Transpeptidases Transpeptidases are proteins that bind peptidoglycan in the bacterial cell wall. Inhibition of this when treated with ceftriaxone leads to cell wall breakdown. . Vancomycin targets cell wall glycoproteins, Fluoroquinolones target cell replication in the nucleus, Macrolides/Tetracycline target ribosomal proteins, and no antibiotics target porins. 121) Another isolate of Streptococcus pneumonia from a patient with meningitis is also incubated with low-dose ceftriaxone and subjected to protein electrophoresis. Only two bands are detected using autoradiography. Which of the following best explains the observed finding? A) Action of beta-lactamases B) Change in protein structure C) Salvage metabolic pathway D) Transmembranous efflux pumps E) Upregulation of protein synthesis Having only two isolates means you have only two penicillin binding proteins. A change in the amount of penicillin binding sites indicates that the other protein binding sites have been altered. This explains ceftriaxone resistance. 122) A mother brings her 4 year old son to see you because he has been experiencing decreased appetite, fever, and right-sided ear discharge for the past 24 hours. His past medical history is significant for three episodes of otitis media over the last year. You prescribe amoxicillin. Adding clavulanic acid to this treatment regimen would serve which of the following purposes? A) Kill bacteria via a different mechanism of action B) Decrease amoxicillin cleavage by immune cells C) Decrease amoxicillin cleavage by bacterial cells D) Slow liver metabolism of amoxicillin E) Decrease renal clearance of amoxicillin Some bacteria have a beta lactamase enzyme that cleaves antibiotics rendering them useless which is what happened here. Adding clavulanic acid will happen these beta lactamase containing bacteria allowing amoxicillin to work. 123) An 18 year old presents to her physician because of severe cutaneous erythema, blistering, and desquamation on the face and other sun-exposed areas. She was recently seen in the clinic for acne. The most likely cause of her current condition is: A) Benzoyl peroxide B) Erythromycin C) Penicillin D) Minocycline E) Clindamycin F) Metronidazole

Tetracylcines such as doxycycline and minocycline cause photosensitivity. The rest are not used for acne except benzoyl peroxide which would not cause these rashes and is applied topically. 124) A 26 year old male presents with a single genital ulcer. The lesion is indurated and painless. He has no significant past medical history. The first-line treatment for this patient is a structural analog of which of the following? A) L-Ala-D-Gln B) N-acetylmuramic acid C) N-acetylglucosamine D) D-Ala-D-Ala E) D-Glu-D-Glu F) Folic acid This sounds like a case of syphilis. Treponema pallidum is sensitive to penicillin because it is Gram negative with a peptidoglycan. Penicillins work by inhibiting transpeptidase, the enzyme that catalyzes the final crosslinking step in peptidoglycan cell wall formation, thus the final step is inhibited and the cell wall doesnt form. The amino acid of one peptidoglycan molecule to the terminal d-ala-d-ala. 125) An 18 year old female receiving treatment with nafcillin is most likely to have initially presented with: A) Lung abscess in an alcoholic patient B) Pustule that spread to involve several hair follicles C) Nausea and vomiting one hour after eating D) Facial swelling and dark urine following a recent skin infection E) Yellow vaginal discharge following unprotected sexual intercourse Methicillin, nafcillin, and dixloxacillin are penicillinase-resistant penicillins commonly used for S. aureus but not MRSA. Nafcillin is commonly used to treat skin infections which S aureus is the common cause. 126) Enterococci strains isolated from a patient with bacteremia are known to substitute D-alanine for D-lactate in the synthesis of pentapeptide proteoglycan precursors. This substitution decreases pentapeptide binding for which of the following antibiotics? A) Vancomycin B) Penicillin C) Cycloserine D) Polymixin E) Tetracycline F) Amikacin Vancomycin binds to D-ala-D-ala in the cell wall and prevents formation of peptidoglycan. VRE Vancomycin works by changing D-ala-D-ala to D-ala-D-lac. 127) A 23 year old male presents to your office with dysuria and a small amount of urethral discharge. Under the microscope, the discharge is neutrophil rich. A single IM injection of ceftriaxone is administered, but the patient returns in one week saying his symptoms have not improved. Which of the following is most likely to improve his condition? A) Another injection of ceftriaxone B) Penicillin G C) Azithromycin D) Metronidazole E) Fluconazole

The patient is suffering from urethritis. This is typically an STD in young adults. If there is a dual infection with Chlamydia trachomatis, then it is necessary to be treated with a macrolide (such as azithromycin). 128) When tazobactam is used together with piperacillin the spectrum of antimicrobial activity is much greater than if either agent were used alone. The mechanism for this increased efficacy is: A) Increasing piperacillins ability to penetrate bacteria B) Decreasing destruction of piperacillin C) Slowing the hepatic metabolism of piperacillin D) Attacking bacteria via a different mechanism E) Providing anaerobic coverage Antibiotic resistance occurs when bacteria begins producing beta lactamase which cleaves beta lactam, the mechanism of penicillin.By appling a b lactamase inhibitor such as claulanic aicd, sulbactam, or tazobactam, the bacterias reisistance now becomes ineffective. 129) A 2 month old boy is brought to the ER with fever, irritability, and vomiting. Lumbar puncture reveals CSF pleocytosis and you proceed with empirical ceftriaxone therapy. You must also administer ampicillin to cover for which of the following bacteria? A) Neisseria meningitidis B) Streptococcus pneumoniae C) Group B streptococci D) Listeria monocytogenes E) Haemophilus influenzae Ampicillin helps by killing gram negative rods such as haemophilus influenza, e coli, listeria monoytogenes, proteus mirabilis, salmonella, and enterococci. Ampicillin should be administered to children with meningitis or immunocompromised patients with Listeria. It is not haemophilus because listeria is a common cause of meningitis in babies up to 6 months. H. influenza commonly affects children 6 mons to 6 years. 130) A 32 year old male presents to the emergency room reporting right knee pain and swelling for the past 12 hours. On physical examination, his knee is swollen and red. Synovial fluid analysis reveals a white blood cell count of 100,000/mm3. The best initial treatment for this patient is: A) Indomethacin B) Colchicine C) Ceftriaxone D) Allopurinol E) Observation This sounds like a case of arthritis caused by bacterial infection as indicative of a high white blood cell count, hence septic arthritis. Ceftraixone should be given as the other drugs Colchicine & NSAID Indomethacin are used for acute gout and Allopurinol is used for chronic gout. 131) A 6 year old female is brought to the ER with fever, headache, and confusion. The family notes that three years ago she suffered a severe allergic reaction to penicillin that required hospitalization. She is admitted, and on day 4 of her hospitalization CBC shows: Hemoglobin 9.0 g/L Erythrocyte count 2.2 mln/mm3 Platelets 90,000/mm3 Leukocyte count 2500/mm3

The patient most likely received treatment with: A) Clindamycin B) Gentamycin C) Chloramphenicol D) Metronidazole E) Vancomycin Chloramphenicol is a 50S inhibitor used for meningitis which causes anemia, aplastic anemia, or gray baby syndrome. This is a cause of aplastic anemia due to suppression of stem cell function. As we can see, both erythrocytes, platelets and leukocytes have been decreased.