MSN 611 FINAL Questions and answers
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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
latest update
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
