Fight Tuberculosis - Quiz About Antitubercular Drugs

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Fight Tuberculosis - Quiz About Antitubercular Drugs - Quiz

The "Fight Tuberculosis: Antitubercular Drugs Quiz" is a crucial educational tool aimed at testing your knowledge of medications used in the treatment of tuberculosis (TB). Tuberculosis is a contagious bacterial infection that primarily affects the lungs but can also target other organs. Antitubercular drugs play a pivotal role in combating this global health threat.
This quiz covers a wide range of topics related to antitubercular medications, including their mechanisms of action, potential side effects, drug interactions, and the importance of treatment adherence. Understanding these aspects is essential for healthcare professionals and anyone involved in the management of TB cases. Read more
By taking this quiz, you not only enhance your knowledge of antitubercular drugs but also contribute to the fight against TB by educating yourself. Remember that the effective treatment and management of TB require a comprehensive understanding of these drugs, as well as their proper administration.
So, take this quiz, challenge your understanding, and join the fight against tuberculosis. Your efforts to learn about antitubercular drugs can make a significant difference in combating this global health challenge. Good luck!


Questions and Answers
  • 1. 

    A 31-year-old homosexual HIV-positive man was found to have latent tuberculosis. A treatment with isoniazid was started. The antibacterial effect of this drug is most likely mediated by the inhibition of the synthesis of which of the following molecules?

    • A.

      Mycolic acids

    • B.

      Peptidoglycan

    • C.

      Arabinogalactan

    • D.

      Topoisomerase II

    • E.

      DNA-dependent RNA polymerase

    Correct Answer
    A. Mycolic acids
    Explanation
    Answer: A
    Isoniazid (INH) inhibits the synthesis of mycolic acid that is a specific constituent of mycobacterial cell wall. It has a narrow-spectrum of activity. It is not effective against all mycobacteria. Mycobacterium leprae and Mycobacterium avium-intracellulare complex are not sensitive to INH.

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  • 2. 

    Which of the following antimycobacterial drugs is inactivated by hepatic acetylation, the rate of which depends on genetic background?

    • A.

      Streptomycin

    • B.

      Ethambutol

    • C.

      Rifampin

    • D.

      Isoniazid

    • E.

      Pyrazinamide

    Correct Answer
    D. Isoniazid
    Explanation
    Answer: D
    Isoniazid is metabolized by hepatic acetylation that shows genetic polymorphism. Patients may be: a) fast acetylators (mainly in Inuits and Japanese). b) slow acetylators (mainly in most Scandinavians, Jews and north African Caucasians). Fast acetylators require higher dosage than slow acetylators to obtain equivalent therapeutic effects. A, B, C, E) These drugs are not metabolized by acetylation.

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  • 3. 

    High level of resistance of tubercle bacilli to isoniazid involves a decrease in the activity of which of the following enzymes?

    • A.

      Catalase-peroxidase

    • B.

      DNA-dependent RNA polymerase

    • C.

      Topoisomerase II

    • D.

      Acetyltransferase

    • E.

      Transpeptidase

    Correct Answer
    A. Catalase-peroxidase
    Explanation
    Answer: A
    Isoniazid is in fact a prodrug that must be converted into the active compound by mycobacterial catalase-peroxidase. Resistance is often associated with the deletion of the KatG gene that codes for the synthesis of catalase. In this way activation of the prodrug cannot occur. B, C, D, E) These enzymes are not involved in the mechanism of resistance of mycobacteria to isoniazid.

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  • 4. 

    A 56-year-old man reports tingling sensation in his limbs and that his arms sometimes feel heavy. He was recently diagnosed with pulmonary tuberculosis and has been receiving isoniazid, rifampin, pyrazinamide and ethambutol for two months. Which of the following drugs would be most appropriate to treat his current symptoms?

    • A.

      Folic acid

    • B.

      Pyridoxine

    • C.

      Cyanocobalamin

    • D.

      Vitamic C

    • E.

      Folinic acid

    Correct Answer
    B. Pyridoxine
    Explanation
    Answer: B
    The patient is most likely suffering from isoniazid-induced peripheral neuropathy, and adverse effect of the drug that can affect as many as 20% of patients at risk, like diabetics and alcoholics. Administration of pyridoxine can correct most symptoms of isoniazid-induced neuropathy, both central and peripheral.

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  • 5. 

    The mechanism of action of rifampin includes an inhibition of which of the following enzymes?

    • A.

      DNA dependent RNA-polymerase

    • B.

      Arabinosyl transferase

    • C.

      Transpeptidase

    • D.

      Topoisomerase II

    • E.

      RNA-dependent DNA-polymerase

    Correct Answer
    A. DNA dependent RNA-polymerase
    Explanation
    Answer: A
    Rifampin inhibits DNA dependent RNA-polymerase in mycobacteria and other sensitive microorganisms, by binding strongly to the beta-subunit of this enzyme. This leads to suppression of RNA synthesis. The ultimate effect is bactericidal.
    B) This enzyme would be inhibited by ethambutol.
    C) This enzyme would be inhibited by beta-lactam antibiotics.
    D) This enzyme would be inhibited by fluoroquinolones.
    E) This enzyme would be inhibited by reverse transcriptase inhibitors

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  • 6. 

    Which of the following is the most likely mechanism of resistance of M. tuberculosis to rifampin?

    • A.

      Loss of mycolic acid

    • B.

      Altered bacterial topoisomerase II

    • C.

      Altered bacterial RNA polymerase

    • D.

      Altered bacterial peptidyl-transferase

    • E.

      Increased bacterial acetylation of the drug

    Correct Answer
    C. Altered bacterial RNA polymerase
    Explanation
    Answer: C
    Resistance to rifampin results from mutation in the gene that codes for the beta subunit of RNA polymerase. This mutation prevents binding of rifampin to the enzyme. A, B, D, E) These enzymes are not involved in the bacterial resistance to rifampin.

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  • 7. 

    A 63-year-old man presented to the hospital complaining of abdominal pain, and pain and stiffness in several joints. He was recently diagnosed with renal tuberculosis and started on a regimen of 4 antitubercular drugs one month ago. Lab results showed raised serum uric acid of 13 mg /dl. Which of the following drugs has most likely caused the patient’s current symptoms?

    • A.

      Rifampin

    • B.

      Pyrazinamide

    • C.

      Isoniazid

    • D.

      Streptomycin

    • E.

      Azithromycin

    Correct Answer
    B. Pyrazinamide
    Explanation
    Answer: B
    The gastrointestinal symptoms together with the joint pain and hyperuricemia strongly indicate that pyrazinamide is the drug that caused these adverse effects. Hepatotoxicity is the major limiting adverse effect of pyrazinamide and is dose-related. Gouty arthritis and arthralgia is also common and dose-related. Hyperuricemia is likely due to inhibition of uric acid secretion in the renal tubules. A) Rifampin can causes hepatitis, more so in combination with isoniazid. However, it does not cause hyperuricemia. C, D, E) These drugs do not cause hyperuricemia.

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  • 8. 

    A 7-year-old girl is admitted to the hospital with high fever and nuchal rigidity, later diagnosed with meningococcal meningitis. Which of the following drugs would most likely be given prophylactically to her 10 year old sister?

    • A.

      Amikacin

    • B.

      Piperacillin

    • C.

      Isoniazid

    • D.

      Nafcillin

    • E.

      Rifampin

    Correct Answer
    E. Rifampin
    Explanation
    Answer: E
    Rifampin is the drug of first choice for chemoprophylaxis of close contacts of patients with meningococcal meningitis. The potential for a close contact to become infected with N. Meningitidis is much greater than for the total population. The drug should be administered as soon as possible since the risk of secondary disease is greatest within two to five days after exposure to index case. Other drugs used for chemoprophylaxis include ceftriaxone and ciprofloxacin. A, B, C, D) These antibiotics are not active against N. Meningitidis.

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  • 9. 

    Q. 9 A 67-year-old man, recently diagnosed with pulmonary tuberculosis, is started on treatment with rifampin. The man has been suffering from atrial fibrillation, and he is presently taking warfarin as one of his drugs. At this point, which of the following changes in the therapeutic regimen of the patient would be most appropriate?

    • A.

      To increase the dose of warfarin

    • B.

      To reduce the dose of isoniazid

    • C.

      To increase the dose of rifampin

    • D.

      To stop pyrazinamide

    Correct Answer
    A. To increase the dose of warfarin
    Explanation
    Answer: A Rifampin is a strong inducer of the hepatic CYP450 system and can increase the metabolism of many drugs including oral contraceptives, antiepilectic drugs, protease inhibitors, theophylline and warfarin. Therefore the dose of warfarin should be increased to maintain an appropriate anticoagulant effect.

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  • 10. 

    A 45-year-old woman complained of blurred vision and inability to distinguish green objects from red objects. The woman, recently diagnosed with cavitary pulmonary tuberculosis, has been receiving a 4 drug combination regimen for two months. Which of the following drugs has most likely caused these adverse effects?

    • A.

      Isoniazid

    • B.

      Pyrazinamide

    • C.

      Rifampin

    • D.

      Ethambutol

    • E.

      Streptomycin

    Correct Answer
    D. Ethambutol
    Explanation
    Answer: D
    The symptoms and signs of the patient are most likely due to ethambutol-induced optic neuritis, a serious adverse effect of the drug that is dose- and duration-related. Because of this, periodic visual acuity testing is desirable during ethambutol therapy.

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  • 11. 

    A 37-year-old homosexual man with AIDS was recently diagnosed with pulmonary tuberculosis and a treatment with isoniazid, rifampin, pyrazinamide and ethambutol was started. Which of the following statements best explains why ethambutol was added to the therapeutic regimen?

    • A.

      To enhance the antibacterial activity of pyrazinamide

    • B.

      To provide antibacterial activity against atypical mycobacteria

    • C.

      To prevent the neurotoxic effects of isoniazid

    • D.

      To prevent Pneumocystis carinii pneumonia

    • E.

      To delay the emergence of drug resistance

    Correct Answer
    E. To delay the emergence of drug resistance
    Explanation
    Answer: E
    The main reason for the use of any drug combination in the therapy of tuberculosis is to delay the emergence of resistance. In the case of ethambutol this is by far the primary reason, since the drug has only weak bacteriostatic activity against M. Tuberculosis and so cannot add significant antibacterial effect to a given therapeutic regimen.

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  • 12. 

    A 32-year-old woman, who was HIV positive, presented with fever, profuse night sweats, poor appetite and a 20-pound weight loss over the past 3 months. Physical examination revealed a cachectic female with a prominent oral thrust and mild splenomegaly. Her CD4+ lymphocyte count was 45 cells/mm and a DNA probe test confirmed the diagnosis of Mycobacterium Avium complex infection. An appropriate multidrug regimen for this patient would include which of the following drugs?

    • A.

      Ceftriaxone

    • B.

      Doxycycline

    • C.

      Metronidazole

    • D.

      Azithromycin

    • E.

      Vancomycin

    Correct Answer
    D. Azithromycin
    Explanation
    Answer: D
    Mycobacterium Avium-intracellulare complex (MAC) infection is common in AIDS patients and the risk of developing the infection is the highest when the CD4+ lymphocyte count is < 75 cells/mcL like in the present case. MAC is much less susceptible than M. Tuberculosis to most antimycobacterial drugs and in most cases disseminated MAC is incurable and therapy is life-long. Drug regimens for MAC should include two or three drugs and at least one of these must be a macrolide (azithromycin or clarithromycin). Other drugs active against MAC include rifabutin, ethambutol, and fluoroquinolones.

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Amanda Nwachukwu |Pharm(D) |
Medical Expert
Amanda is an accomplished clinical pharmacist and medical writer, proficient in simplifying intricate medical concepts into comprehensible content. With her expertise, she enhances patient care and comprehension through precise and accessible medical information. Her dedication to the healthcare field drives her passion for delivering quality content.
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