4TH SHIFTING PHARMA MOCK EXAM

A renal transplant patient is given a drug that binds cyclophilin and inhibits calcineurin, preventing cytokine production by T-cells. Which drug is this?

A. Cyclosporine

B. Sirolimus

C. Mycophenolate mofetil

D. Infliximab

A. Cyclosporine

A transplant patient develops renal dysfunction, hypertension, neurotoxicity, hyperglycemia, hyperlipidemia, and cholelithiasis after immunosuppressive therapy. Which class most likely caused this?

A. Corticosteroids

B. Calcineurin inhibitors

C. mTOR inhibitors

D. Antimetabolites

B. Calcineurin inhibitors

A patient after angioplasty receives a drug that inhibits mTOR and is used to prevent restenosis. Which drug is most likely?

A. Cyclosporine

B. Tacrolimus

C. Sirolimus

D. Mycophenolate

C. Sirolimus

Which immunosuppressant inhibits inosine monophosphate dehydrogenase and suppresses B- and T-lymphocyte activation?

A. Methotrexate

B. Azathioprine

C. Cyclophosphamide

D. Mycophenolate mofetil

D. Mycophenolate mofetil

A transplant patient is given an immunosuppressant to reduce cyclosporine-induced nephrotoxicity. The drug commonly causes nausea, diarrhea, and neutropenia. Which drug is this?

A. Mycophenolate mofetil

B. Daclizumab

C. Infliximab

D. Hydroxychloroquine

A. Mycophenolate mofetil

A patient with treatment-resistant Crohn disease is given a monoclonal antibody targeting TNF-alpha. Which drug is used?

A. Basiliximab

B. Infliximab

C. Daclizumab

D. Aldesleukin

B. Infliximab

A renal transplant patient is given a monoclonal antibody that binds the alpha subunit of the IL-2 receptor on T-cells. Which drug is described?

A. Infliximab

B. Aldesleukin

C. Daclizumab

D. Interferon-alpha

C. Daclizumab

A patient with renal cell carcinoma receives recombinant IL-2 to promote cytotoxic T lymphocytes and activate NK cells. Which drug is this?

A. Interferon-alpha

B. Canakinumab

C. Anakinra

D. Aldesleukin

D. Aldesleukin

A pregnant Rh-negative mother delivers an Rh-positive infant. Which product should be given within 24-72 hours to prevent hemolytic disease in future pregnancies?

A. Rh0 immune globulin

B. Infliximab

C. Interferon-gamma-1b

D. Basiliximab

A. Rh0 immune globulin

Which statement is NOT TRUE about passive immunization?

A. It gives immediate protection

B. It creates long-lasting active memory

C. It uses human or animal-derived antibodies

D. Protection lasts only weeks to months

B. It creates long-lasting active memory

A patient receives a vaccine made from weakened organisms that can still replicate and is prone to maternal antibody interference. Which vaccine type is this?

A. Inactivated vaccine

B. Conjugated polysaccharide vaccine

C. Live attenuated vaccine

D. Toxoid vaccine

C. Live attenuated vaccine

Which vaccine type is made T-cell dependent by linking polysaccharide to protein, improving immunogenicity in infants and allowing booster response?

A. Live attenuated vaccine

B. Toxoid vaccine

C. Whole blood product

D. Conjugated polysaccharide vaccine

D. Conjugated polysaccharide vaccine

A patient with anaphylaxis develops symptoms within minutes due to IgE cross-linking on mast cells and basophils. What hypersensitivity type is this?

A. Type I

B. Type II

C. Type III

D. Type IV

A. Type I

A patient develops glomerulonephritis from circulating immune complexes depositing on basement membranes. What hypersensitivity type is this?

A. Type I

B. Type III

C. Type II

D. Type IV

B. Type III

A patient has a positive tuberculin skin test 2-3 days after exposure due to Th1 cells and macrophages. What hypersensitivity type is this?

A. Type I

B. Type II

C. Type IV

D. Type III

C. Type IV

A child develops hemolytic disease of the newborn due to Rh incompatibility. This is best classified as which hypersensitivity reaction?

A. Type I

B. Type III

C. Type IV

D. Type II

D. Type II

A patient with serious staphylococcal endocarditis needs an antistaphylococcal penicillin resistant to staphylococcal beta-lactamase. Which drug is DOC?

A. Nafcillin

B. Penicillin VK

C. Ampicillin

D. Amoxicillin

A. Nafcillin

A patient with EBV infectious mononucleosis is mistakenly given an aminopenicillin and develops a characteristic rash. Which drug is most likely?

A. Nafcillin

B. Amoxicillin

C. Aztreonam

D. Vancomycin

B. Amoxicillin

Which penicillin adverse effect is specifically associated with nafcillin?

A. Hepatitis

B. Pseudomembranous colitis

C. Neutropenia and interstitial nephritis

D. Severe disulfiram-like reaction

C. Neutropenia and interstitial nephritis

Which penicillin is associated with hepatitis?

A. Ampicillin

B. Methicillin

C. Penicillin G

D. Oxacillin

D. Oxacillin

Which beta-lactam combination pairs an antipseudomonal penicillin with a beta-lactamase inhibitor?

A. Piperacillin-tazobactam

B. Penicillin G-benzathine

C. Nafcillin-clavulanate

D. Ceftriaxone-sulbactam

A. Piperacillin-tazobactam

A patient needs a cephalosporin that can cross the blood-brain barrier and belongs to the second generation. Which drug fits?

A. Cefazolin

B. Cefuroxime

C. Cephalexin

D. Cefadroxil

B. Cefuroxime

A patient with MRSA infection is treated with a fourth-generation cephalosporin uniquely indicated for MRSA. Which drug is this?

A. Cefepime

B. Ceftriaxone

C. Ceftaroline

D. Cefuroxime

C. Ceftaroline

A patient develops severe disulfiram-like reaction with alcohol and bleeding tendency due to hypoprothrombinemia from an MTT-containing cephalosporin. Which drug can cause this?

A. Cefazolin

B. Cephalexin

C. Cefuroxime

D. Cefotetan

D. Cefotetan

A patient with Gram-negative infection and beta-lactam allergy receives a monobactam with a monocyclic beta-lactam ring that penetrates CSF. Which drug is this?

A. Aztreonam

B. Imipenem

C. Ceftaroline

D. Vancomycin

A. Aztreonam

Imipenem is given with cilastatin. Why is cilastatin added?

A. To inhibit beta-lactamase

B. To inhibit renal dehydropeptidase

C. To block D-Ala-D-Ala binding

D. To prevent allergic rash

B. To inhibit renal dehydropeptidase

Which carbapenem has the longest half-life in its class?

A. Imipenem

B. Meropenem

C. Ertapenem

D. Doripenem

C. Ertapenem

A patient with MRSA infection receives a drug that binds D-Ala-D-Ala and blocks transglycosylase, causing cell lysis. Which drug is this?

A. Daptomycin

B. Fosfomycin

C. Bacitracin

D. Vancomycin

D. Vancomycin

Which antibiotic interferes with dephosphorylation in the cycling of the lipid carrier that transfers peptidoglycan subunits?

A. Bacitracin

B. Fosfomycin

C. Cycloserine

D. Vancomycin

A. Bacitracin

A secondary anti-TB drug inhibits alanine racemase and prevents D-Ala incorporation into peptidoglycan. Which drug is this?

A. Bacitracin

B. Cycloserine

C. Fosfomycin

D. Telavancin

B. Cycloserine

A patient with HSV encephalitis receives a guanosine analog activated by viral thymidine kinase that inhibits DNA polymerase and causes chain termination. Which drug is DOC?

A. Foscarnet

B. Ganciclovir

C. Acyclovir

D. Cidofovir

C. Acyclovir

A CMV patient with thymidine kinase-deficient resistant virus receives an inorganic pyrophosphate analog that requires no phosphorylation. Which toxicity is classic?

A. Bone marrow suppression

B. Hyperpigmentation

C. Bitter taste

D. Nephrotoxicity and hypocalcemia

D. Nephrotoxicity and hypocalcemia

A CMV retinitis patient develops leukopenia and thrombocytopenia during therapy. Which antiviral is most likely responsible?

A. Ganciclovir

B. Acyclovir

C. Docosanol

D. Letermovir

A. Ganciclovir

Which anti-CMV drug inhibits the viral terminase complex involved in DNA packaging and is used for prophylaxis in stem cell transplant recipients?

A. Cidofovir

B. Letermovir

C. Foscarnet

D. Vidarabine

B. Letermovir

A patient with orofacial HSV applies a topical aliphatic alcohol that inhibits fusion between the viral envelope and host membrane. Which drug is this?

A. Trifluridine

B. Idoxuridine

C. Docosanol

D. Penciclovir

C. Docosanol

Which anti-herpes drugs are too toxic for systemic use and are used topically for herpes keratitis?

A. Acyclovir and valacyclovir

B. Ganciclovir and valganciclovir

C. Foscarnet and cidofovir

D. Trifluridine and idoxuridine

D. Trifluridine and idoxuridine

An HIV patient on NRTI develops bone marrow suppression with anemia and neutropenia. Which drug is most associated?

A. Zidovudine

B. Lamivudine

C. Tenofovir

D. Efavirenz

A. Zidovudine

An HIV patient develops renal failure and Fanconi syndrome while taking a nucleotide reverse transcriptase inhibitor also active against hepatitis B. Which drug is most likely?

A. Lamivudine

B. Tenofovir

C. Abacavir

D. Nevirapine

B. Tenofovir

A patient on an NNRTI develops vivid dreams, dizziness, insomnia, rash, and high cholesterol. Which drug is most likely?

A. Nevirapine

B. Delavirdine

C. Efavirenz

D. Ritonavir

C. Efavirenz

An HIV regimen includes a protease inhibitor used mainly as a pharmacokinetic booster because it strongly inhibits CYP3A4. Which drug is this?

A. Atazanavir

B. Darunavir

C. Indinavir

D. Ritonavir

D. Ritonavir

A protease inhibitor patient develops nephrolithiasis and is advised to hydrate well. Which drug caused this?

A. Indinavir

B. Nelfinavir

C. Lopinavir

D. Saquinavir

A. Indinavir

Which anti-HIV drug binds gp41 and prevents membrane fusion but must be given by subcutaneous injection?

A. Maraviroc

B. Enfuvirtide

C. Ibalizumab

D. Raltegravir

B. Enfuvirtide

An HIV drug binds CCR5 and blocks gp120 attachment to the host cell. Which drug is this?

A. Enfuvirtide

B. Ibalizumab

C. Maraviroc

D. Dolutegravir

C. Maraviroc

A patient with multidrug-resistant HIV receives a monoclonal antibody that binds CD4 receptor and prevents viral entry. Which drug is used?

A. Maraviroc

B. Enfuvirtide

C. Raltegravir

D. Ibalizumab

D. Ibalizumab

Which anti-HIV class inhibits strand transfer of viral DNA into the host genome?

A. Integrase inhibitors

B. Protease inhibitors

C. NNRTIs

D. Fusion inhibitors

A. Integrase inhibitors

A patient with influenza A and B is prescribed an oral prodrug neuraminidase inhibitor activated by hepatic esterases. Which drug is this?

A. Zanamivir

B. Oseltamivir

C. Amantadine

D. Baloxavir

B. Oseltamivir

An asthma patient asks why zanamivir is avoided. Which adverse effect explains the contraindication?

A. Nephrolithiasis

B. Bone marrow suppression

C. Bronchospasm

D. Hyperpigmentation

C. Bronchospasm

Which influenza drug inhibits cap-dependent endonuclease and blocks viral RNA transcription/synthesis?

A. Oseltamivir

B. Zanamivir

C. Rimantadine

D. Baloxavir marboxil

D. Baloxavir marboxil

Which anti-influenza drugs block the M2 proton ion channel but are no longer recommended due to resistance?

A. Amantadine and rimantadine

B. Oseltamivir and zanamivir

C. Peramivir and baloxavir

D. Remdesivir and ribavirin

A. Amantadine and rimantadine

A hospitalized COVID-19 patient with severe disease receives an IV nucleotide analog that inhibits viral RNA polymerase. Which drug is used?

A. Dexamethasone

B. Remdesivir

C. Ribavirin

D. Oseltamivir

B. Remdesivir

A severe COVID-19 patient with pulmonary complications and cytokine storm receives a corticosteroid. Which drug is used?

A. Remdesivir

B. Azithromycin

C. Dexamethasone

D. Hydroxychloroquine

C. Dexamethasone

Which statement is NOT TRUE about hydroxychloroquine and azithromycin for COVID-19 based on the file?

A. They are standard DOC for severe COVID-19

B. Major organizations do not recommend them

C. Remdesivir is used as direct antiviral

D. Dexamethasone suppresses inflammatory response

A. They are standard DOC for severe COVID-19

A chronic hepatitis B patient needs first-line therapy with high barrier to resistance and 100% bioavailability. Which drug is this?

A. Lamivudine

B. Adefovir

C. Entecavir

D. Ribavirin

C. Entecavir

A patient taking sofosbuvir with amiodarone develops severe bradycardia risk. Which HCV class is sofosbuvir?

A. NS5A inhibitor

B. NS3/4A protease inhibitor

C. Interferon

D. NS5B nucleotide polymerase inhibitor

D. NS5B nucleotide polymerase inhibitor

A patient with HCV receives ribavirin. Which adverse effect and warning is most important?

A. Hemolytic anemia and strict teratogenicity

B. Red man syndrome

C. Gynecomastia

D. Bronchospasm

A. Hemolytic anemia and strict teratogenicity

Which antiviral used for hepatitis has flu-like symptoms, neurotoxicity, and myelosuppression and is contraindicated in pregnancy and seizures?

A. Entecavir

B. Interferon-alpha

C. Lamivudine

D. Sofosbuvir

B. Interferon-alpha

A systemic antifungal binds ergosterol and forms membrane pores. Which formulation is least nephrotoxic according to the file?

A. Amphotericin B deoxycholate

B. Nystatin

C. Abelcet

D. Griseofulvin

C. Abelcet

A patient with cryptococcal meningitis is given an antifungal that enters via cytosine permease and is converted to 5-FU, inhibiting DNA/RNA synthesis. Which drug is this?

A. Amphotericin B

B. Fluconazole

C. Voriconazole

D. 5-Flucytosine

D. 5-Flucytosine

Which imidazole was the first oral azole but is no longer recommended for skin or nail infections because of low selectivity and high mammalian CYP450 inhibition?

A. Ketoconazole

B. Clotrimazole

C. Itraconazole

D. Fluconazole

A. Ketoconazole

A patient with histoplasmosis, blastomycosis, or sporotrichosis needs DOC triazole therapy. Which drug is used?

A. Fluconazole

B. Itraconazole

C. Voriconazole

D. Posaconazole

B. Itraconazole

A patient with invasive aspergillosis receives the DOC but later develops visual disturbances and rash. Which drug is most likely?

A. Fluconazole

B. Itraconazole

C. Voriconazole

D. Griseofulvin

C. Voriconazole

Which triazole has the broadest spectrum and may cause hyperaldosteronism, hypertension, and hypokalemia?

A. Fluconazole

B. Itraconazole

C. Voriconazole

D. Posaconazole

D. Posaconazole

Which antifungal has high water solubility and CSF penetration and is DOC for secondary prophylaxis of cryptococcal meningitis?

A. Fluconazole

B. Ketoconazole

C. Miconazole

D. Clotrimazole

A. Fluconazole

Which antifungal inhibits 1,3-beta-D-glucan synthesis and is used for invasive candidiasis and candidemia?

A. Griseofulvin

B. Caspofungin

C. Nystatin

D. Terbinafine

B. Caspofungin

A patient with oral and vaginal candidiasis needs DOC topical polyene produced by Streptomyces noursei. Which drug is this?

A. Amphotericin B

B. Terbinafine

C. Nystatin

D. Griseofulvin

C. Nystatin

A patient with tinea corporis, cruris, or pedis needs DOC topical allylamine that inhibits squalene-2,3-epoxidase. Which drug is used?

A. Nystatin

B. Miconazole

C. Clotrimazole

D. Terbinafine

D. Terbinafine

Which antifungal inhibits microtubule function, disrupts the mitotic spindle, and is fungistatic against Microsporum, Epidermophyton, and Trichophyton?

A. Griseofulvin

B. Fluconazole

C. Caspofungin

D. Amphotericin B

A. Griseofulvin

Metronidazole targets which enzyme or process in protozoa?

A. Ornithine decarboxylase

B. Pyruvate-ferredoxin oxidoreductase

C. Dihydropteroate synthase

D. Glycolytic enzymes

B. Pyruvate-ferredoxin oxidoreductase

Artemisinins such as artesunate, artemether, and qinghaosu act through which mechanism listed in the file?

A. Inhibiting D-Ala-D-Ala

B. Blocking CCR5

C. Free radicals plus Ca ATPase blockade

D. Blocking viral terminase

C. Free radicals plus Ca ATPase blockade

A patient with hepatic amoebic abscess needs therapy. Which regimen is listed?

A. Paromomycin alone

B. Diloxanide alone

C. Albendazole plus steroid

D. Metronidazole or tinidazole plus chloroquine

D. Metronidazole or tinidazole plus chloroquine

A patient has asymptomatic intestinal amoebiasis. Which drug choice is appropriate?

A. Diloxanide furoate or paromomycin

B. Chloroquine alone

C. Praziquantel

D. Ivermectin

A. Diloxanide furoate or paromomycin

A pregnant patient develops toxoplasmosis. Which drug is listed for toxoplasmosis in pregnancy?

A. Pyrimethamine

B. Spiramycin

C. Albendazole

D. Quinine

B. Spiramycin

A patient with Pneumocystis jirovecii infection needs therapy. Which regimen is listed?

A. Metronidazole plus tinidazole

B. Praziquantel plus niclosamide

C. TMP-sulfa or clindamycin plus primaquine

D. DEC alone

C. TMP-sulfa or clindamycin plus primaquine

Which protozoal infection is treated with clindamycin plus quinine?

A. Giardiasis

B. Trichomoniasis

C. Balantidiasis

D. Babesiosis

D. Babesiosis

A patient with giardiasis needs DOC therapy from the file. Which drugs are listed?

A. Metronidazole or tinidazole

B. Praziquantel or niclosamide

C. Albendazole or mebendazole

D. DEC or ivermectin

A. Metronidazole or tinidazole

A patient with ascariasis is treated with first-line benzimidazole therapy. Which pair is listed?

A. Praziquantel or niclosamide

B. Albendazole or mebendazole

C. DEC or ivermectin

D. Chloroquine or amodiaquine

B. Albendazole or mebendazole

A patient with strongyloidiasis needs therapy. Which drugs are listed?

A. DEC or doxycycline

B. Praziquantel or bithionol

C. Ivermectin or thiabendazole

D. Chloroquine or primaquine

C. Ivermectin or thiabendazole

A patient with filariasis caused by Wuchereria bancrofti is treated with the DOC that immobilizes microfilariae and alters their surface for immune clearance. Which drug is this?

A. Albendazole

B. Ivermectin

C. Praziquantel

D. Diethylcarbamazine

D. Diethylcarbamazine

Which drug is DOC for onchocerciasis and may cause a Mazzotti reaction?

A. Ivermectin

B. Diethylcarbamazine

C. Praziquantel

D. Albendazole

A. Ivermectin

A patient on ivermectin develops high fever, hypotension, and bronchospasm due to a Mazzotti reaction. Which drug is listed to manage this reaction?

A. Hydroxychloroquine

B. Prednisone

C. Dexamethasone

D. Interferon-alpha

B. Prednisone

Which is a rare adverse effect of ivermectin?

A. Bone marrow suppression

B. Cyanide toxicity

C. Corneal opacities

D. Gynecomastia

C. Corneal opacities

Which patient should avoid ivermectin based on contraindications in the file?

A. Adult with scabies

B. Adult with head lice

C. Adult with rosacea

D. Child younger than 5 years

D. Child younger than 5 years

Which drug combination should be avoided with ivermectin because it enhances GABA activity?

A. Benzodiazepines or barbiturates

B. Cephalosporins

C. Azoles

D. Macrolides

A. Benzodiazepines or barbiturates

A patient with schistosomiasis needs DOC therapy. Which drug is listed?

A. Albendazole

B. Praziquantel

C. Ivermectin

D. Diethylcarbamazine

B. Praziquantel

A patient with fascioliasis needs therapy. Which drug is listed as a main option?

A. Niclosamide

B. Oxamniquine

C. Triclabendazole

D. Metronidazole

C. Triclabendazole

A patient with neurocysticercosis is treated with which drugs from the cestode table?

A. DEC or ivermectin

B. Metronidazole or tinidazole

C. Triclabendazole or bithionol

D. Albendazole or praziquantel

D. Albendazole or praziquantel

A patient with echinococcosis needs antiparasitic treatment. Which drug is listed?

A. Albendazole

B. Niclosamide

C. Praziquantel

D. Ivermectin

A. Albendazole

Which antihelminthic is larvicidal and ovicidal, has erratic absorption improved by fatty meals, and is a prodrug to albendazole sulfoxide?

A. Mebendazole

B. Albendazole

C. Praziquantel

D. Diethylcarbamazine

B. Albendazole

A patient taking long-term albendazole develops fever, fatigue, alopecia, increased LFTs, and pancytopenia. What monitoring is important?

A. ECG only

B. Serum calcium only

C. CBC and LFTs

D. Audiometry only

C. CBC and LFTs

Which drug increases albendazole levels?

A. Carbamazepine

B. Phenobarbital

C. Phenytoin

D. Cimetidine

D. Cimetidine

Which drug decreases albendazole levels?

A. Phenytoin

B. Dexamethasone

C. Praziquantel

D. Cimetidine

A. Phenytoin

A patient with fascioliasis cannot receive triclabendazole. Which alternative drug is listed?

A. Praziquantel

B. Bithionol

C. Albendazole

D. Mebendazole

B. Bithionol

Which helminth infection treatment includes mebendazole or albendazole plus steroids?

A. Ascariasis

B. Enterobiasis

C. Trichinosis

D. Hymenolepiasis

C. Trichinosis

Which helminth infection is treated with praziquantel or niclosamide?

A. Strongyloidiasis

B. Filariasis

C. Visceral larva migrans

D. Taeniasis

D. Taeniasis

Which statement is NOT TRUE about albendazole?

A. It inhibits microtubule synthesis in nematodes

B. It is avoided in pregnancy and children younger than 2 years

C. Its absorption is improved by fatty meals for tissue parasites

D. It should always be taken with fatty meals for intraluminal parasites

D. It should always be taken with fatty meals for intraluminal parasites

A patient with Rh-negative blood receives Rh0 immune globulin after delivery of an Rh-positive infant. What is the main goal?

A. Prevent maternal antibody production against Rh-positive cells

B. Stimulate live attenuated immunity

C. Treat active hemolysis in the fetus only

D. Replace all maternal IgM antibodies

A. Prevent maternal antibody production against Rh-positive cells

Which beta-lactam resistance mechanism makes penicilloic acid with no antibacterial activity?

A. Altered folate synthesis

B. Beta-lactamase hydrolysis of the beta-lactam ring

C. Ribosomal methylation

D. Viral thymidine kinase mutation

B. Beta-lactamase hydrolysis of the beta-lactam ring

Which drug causes cell membrane depolarization, potassium efflux, and rapid bacterial cell death?

A. Bacitracin

B. Vancomycin

C. Daptomycin

D. Fosfomycin

C. Daptomycin

A UTI patient receives a phosphoenolpyruvate analog that inhibits enolpyruvate transferase in early cell wall synthesis. Which drug is this?

A. Bacitracin

B. Vancomycin

C. Cycloserine

D. Fosfomycin

D. Fosfomycin

Which cephalosporin is banned because it causes tubular necrosis?

A. Cephaloridine

B. Ceftriaxone

C. Cefepime

D. Cefazolin

A. Cephaloridine