Respiratory Pharmacology — MCQ Question Bank

Dr. Mohamed Elshorbgy · 2nd Year · Faculty of Medicine · Ain Shams University · 2026 - 2027

182 questions 13 topics Explained answers
Tap an answer to check it — the right choice turns green, a wrong one turns red, and the explanation from the booklet opens underneath. Everything works offline, with no internet and no app. To start again with a blank sheet, close and reopen the file.

Bronchial Asthma — Definition, Types & Pathogenesis

Questions 1–22↑ Contents
1 Which of the following BEST describes bronchial asthma?

Correct.

Not quite — the answer is A.

Why: The booklet defines asthma as a chronic inflammatory disease with reversible bronchospasm and bronchial hyper-reactivity to triggers.
2 Which type of asthma is MOST associated with a high serum IgE?

Correct.

Not quite — the answer is B.

Why: Allergic (atopic) asthma shows a positive serum IgE and is a type I hypersensitivity reaction, appearing early in childhood.
3 Which immunologic pathway is PRIMARILY involved in allergic asthma?

Correct.

Not quite — the answer is A.

Why: Allergic type II asthma follows a type I hypersensitivity reaction, with IgE bound to mast cells.
4 Which classification refers to asthma with continuous symptoms despite therapy?

Correct.

Not quite — the answer is D.

Why: Persistent asthma is graded mild, moderate or severe; severe persistent means continuous symptoms despite treatment.
5 Which is NOT a typical trigger for bronchial asthma?

Correct.

Not quite — the answer is C.

Why: High altitude is not listed among the triggers in the booklet; pollen, exercise and infection are.
6 Which bronchodilator is MOST selective for β₂ adrenergic receptors?

Correct.

Not quite — the answer is C.

Why: Salbutamol (albuterol) is a selective β₂ agonist used as a SABA. Ipratropium and tiotropium are antimuscarinics and theophylline is a methylxanthine.
7 Which adverse effect is MOST associated with LABA use?

Correct.

Not quite — the answer is C.

Why: Tremor is the most common adverse effect of β₂ agonists. Gastric irritation belongs to theophylline, candidiasis to inhaled corticosteroids and growth retardation to systemic steroids.
8 Which step of asthma management FIRST introduces a maintenance ICS–LABA as the alternative controller?

Correct.

Not quite — the answer is B.

Why: At step 3 the preferred controller is low dose maintenance ICS–formoterol, with low dose maintenance ICS–LABA as the alternative.
9 Which is NOT a pharmacological reliever for an acute asthma attack?

Correct.

Not quite — the answer is C.

Why: An ICS alone is a long-term controller. The as-needed relievers are low dose ICS–formoterol or a SABA; short acting theophylline may also be used as a short-term reliever.
10 Which intervention is LEAST appropriate in acute severe asthma?

Correct.

Not quite — the answer is B.

Why: Physical activity belongs to non-pharmacological control between attacks, not to the management of an emergency.
11 In the early phase of allergic asthma, which interleukin released by TH2 cells drives B cells to secrete IgE?

Correct.

Not quite — the answer is A.

Why: IL-4 activates B cells, which change into plasma cells secreting IgE. IL-5 activates eosinophils and IL-13 increases mucus secretion.
12 Which cytokine released in the early phase of allergic asthma binds receptors on eosinophils and prolongs their survival?

Correct.

Not quite — the answer is C.

Why: IL-5 binds its receptors on eosinophils, activating them and increasing their survival time.
13 The late phase of allergic asthma appears within which time frame?

Correct.

Not quite — the answer is B.

Why: The early phase occurs within 30–60 minutes; the late phase within 2 to 7 hours.
14 Tissue damage in the late asthmatic response activates which pathway?

Correct.

Not quite — the answer is B.

Why: Tissue damage activates the arachidonic acid pathway, producing PGs and LTs that cause bronchospasm, increased vascular permeability and chemoattraction of eosinophils.
15 Type II (atopic) asthma differs from non-type II asthma in that it is:

Correct.

Not quite — the answer is D.

Why: The booklet contrasts type II asthma — more severe, systemic eosinophilia, corticosteroid responsive — with non-type II asthma, which is less severe and without systemic eosinophilia.
16 Classification of asthma into intermittent and persistent depends on all the following EXCEPT:

Correct.

Not quite — the answer is C.

Why: Classification depends on the number of bronchoconstrictor episodes, night-time symptoms and peak expiratory flow.
17 Which non-pharmacological measure is recommended in the treatment outline of bronchial asthma?

Correct.

Not quite — the answer is C.

Why: The non-pharmacological measures listed are smoking cessation, physical activity and avoiding NSAIDs.
18 Which drug group is the first choice in aspirin-induced asthma?

Correct.

Not quite — the answer is A.

Why: Leukotriene pathway inhibitors are first choice in aspirin-induced asthma.
19 A thyrotoxic elderly patient with cardiac disease develops asthma. Which bronchodilator does the booklet prefer?

Correct.

Not quite — the answer is A.

Why: Antimuscarinics are the bronchodilator of choice in asthma due to psychogenic stimulus or β blockers, and in patients intolerant to other bronchodilators — especially thyrotoxic, elderly and cardiac patients.
20 For prophylaxis of exercise-induced asthma, a SABA is taken:

Correct.

Not quite — the answer is C.

Why: A short acting β₂ agonist is given 10 minutes before exercise; a LABA is given 1 hour before.
21 Which drug is useful as maintenance therapy in COPD because vagal-induced bronchospasm is the only reversible cause of obstruction?

Correct.

Not quite — the answer is D.

Why: Tiotropium is long acting, produces no tolerance and is used as maintenance therapy in COPD.
22 Which preparation is preferred in nocturnal asthma?

Correct.

Not quite — the answer is A.

Why: SR theophylline produces less fluctuation in plasma level and is taken once a day, which suits nocturnal asthma.

Bronchodilator Drugs

Questions 23–34↑ Contents
23 β₂ agonists produce bronchodilation by which mechanism?

Correct.

Not quite — the answer is A.

Why: β₂ stimulation raises cAMP, giving bronchodilation, reduced release of mast cell mediators and increased mucociliary clearance.
24 Besides bronchodilation, β₂ agonists also:

Correct.

Not quite — the answer is C.

Why: They increase mucociliary clearance and decrease the release of mast cell mediators and cytokines.
25 Why must a LABA always be combined with a corticosteroid?

Correct.

Not quite — the answer is C.

Why: LABA has a bronchodilator effect far greater than its anti-inflammatory effect, so alone it masks progression of the disease and increases the risk of mortality.
26 How does a LABA increase the anti-inflammatory effect of cortisone?

Correct.

Not quite — the answer is D.

Why: LABA increases nuclear localisation of the steroid receptor, improving asthma control.
27 Which is a recognised adverse effect of β₂ agonists?

Correct.

Not quite — the answer is A.

Why: β₂ agonists cause tremor, tolerance, tachycardia at high concentration, hypokalaemia with muscle cramps, and hypoxaemia.
28 β₂ agonists may worsen oxygenation because they:

Correct.

Not quite — the answer is D.

Why: Hypoxaemia occurs because vasodilatation exceeds bronchodilatation, worsening the V/Q ratio and lowering blood oxygenation.
29 Tolerance to β₂ agonists is due to:

Correct.

Not quite — the answer is B.

Why: Tolerance results from down-regulation of β₂ receptors. Corticosteroids reduce it by decreasing that down-regulation.
30 Antimuscarinic bronchodilators act by:

Correct.

Not quite — the answer is A.

Why: They block M₃ receptors in bronchial muscles, giving bronchodilation and reduced vagally mediated mucus secretion.
31 Why does ipratropium, unlike tiotropium, produce tolerance?

Correct.

Not quite — the answer is C.

Why: Ipratropium is non-selective: blocking presynaptic M₂ increases ACh release, so tolerance develops. Tiotropium is a selective M₃ antagonist and produces no tolerance.
32 Compared with a β₂ agonist, an antimuscarinic bronchodilator has:

Correct.

Not quite — the answer is D.

Why: Antimuscarinics have a delayed onset and are less effective than β₂ agonists, and they produce tolerance through presynaptic M₂ blockade.
33 Which statement about epinephrine in asthma is correct?

Correct.

Not quite — the answer is D.

Why: Epinephrine is shorter acting and non-selective, risking tachycardia, arrhythmia and hypertension, but is still used in acute bronchospasm, especially anaphylaxis.
34 Bambuterol is best described as:

Correct.

Not quite — the answer is B.

Why: Oral LABAs such as SR salbutamol, SR terbutaline and bambuterol (a prodrug of terbutaline) may be used as controllers when extra bronchodilation is needed.

Methylxanthines

Questions 35–45↑ Contents
35 Methylxanthines produce bronchodilation by:

Correct.

Not quite — the answer is C.

Why: Theophylline inhibits phosphodiesterase, increasing cAMP, and blocks A₂ receptors — both give bronchodilation, with a modest anti-inflammatory effect.
36 Theophylline is eliminated by saturation kinetics, which means:

Correct.

Not quite — the answer is B.

Why: Saturation kinetics plus a narrow safety margin make the risk of toxicity high, so plasma levels need monitoring.
37 Which is a contraindication to methylxanthines?

Correct.

Not quite — the answer is B.

Why: The contraindications listed are peptic ulcer, ischaemic heart disease and epilepsy.
38 Which of these INCREASES theophylline half-life and so requires a DOSE REDUCTION?

Correct.

Not quite — the answer is A.

Why: Enzyme inhibitors such as erythromycin, oral contraceptives, ciprofloxacin, zileuton and zafirlukast raise the level. Rifampicin, phenobarbitone, phenytoin, carbamazepine, smoking and heavy drinking lower it.
39 In which patient would you EXPECT to need a higher theophylline dose?

Correct.

Not quite — the answer is C.

Why: Children, heavy smokers and heavy drinkers clear theophylline faster. Extremes of age, hepatic and heart disease and viral infections slow clearance.
40 Which adverse effect follows rapid intravenous aminophylline?

Correct.

Not quite — the answer is D.

Why: Aminophylline must be given slowly intravenously, as rapid injection can cause cardiac arrest.
41 Theophylline relieves dyspnoea in COPD partly because it:

Correct.

Not quite — the answer is C.

Why: On skeletal muscle it increases contractility and reverses diaphragmatic fatigue in COPD, reducing dyspnoea.
42 Which methylxanthine effect explains its use in neonatal apnoea?

Correct.

Not quite — the answer is B.

Why: Methylxanthines are respiratory stimulants; caffeine is used in neonatal apnoea.
43 Which preparation of theophylline provides a full anti-inflammatory effect with fewer side effects and no need for plasma monitoring?

Correct.

Not quite — the answer is A.

Why: Low dose theophylline gives the full anti-inflammatory effect with fewer side effects and no need to monitor the plasma level.
44 Theophylline can be given by all the following routes EXCEPT:

Correct.

Not quite — the answer is B.

Why: Among its advantages is that it can be given by many routes — except inhalation.
45 Which GIT effect of theophylline explains giving it with meals?

Correct.

Not quite — the answer is D.

Why: Theophylline is stimulatory to the GIT, increasing HCl and causing gastric irritation, so it is given with meals and avoided in peptic ulcer.

Anti-inflammatory & Biologic Therapy

Questions 46–63↑ Contents
46 Glucocorticoids control asthma mainly by:

Correct.

Not quite — the answer is B.

Why: They inhibit PLA₂ and cytokines, reducing mediator release and influx of inflammatory cells, so inflammation, hyper-reactivity and recurrence all fall.
47 Corticosteroids potentiate β₂ agonists because they:

Correct.

Not quite — the answer is D.

Why: By decreasing down-regulation of the receptors they reduce tolerance to β₂ agonists.
48 Oral corticosteroids as rescue medication in an acute exacerbation are given for a maximum of:

Correct.

Not quite — the answer is C.

Why: Oral rescue steroid is given for 7 days at most in an exacerbation not responding to β₂ agonists.
49 How is oropharyngeal candidiasis from inhaled corticosteroids avoided?

Correct.

Not quite — the answer is D.

Why: Gargling and spitting after inhalation and using a spacer device reduce local adverse effects; the others listed are hoarseness of voice and candidiasis.
50 Which inhaled corticosteroid is a prodrug activated by bronchial esterases, with less systemic effect and less frequent candidiasis?

Correct.

Not quite — the answer is B.

Why: Ciclesonide is activated by bronchial esterases and has high first-pass metabolism and high plasma protein binding, so fewer systemic side effects.
51 Which is a systemic adverse effect of corticosteroids listed in the booklet?

Correct.

Not quite — the answer is B.

Why: The systemic effects listed are osteoporosis, growth retardation, diabetes, adrenal suppression, cataract and glaucoma, hypertension, Cushing syndrome and hypokalaemia.
52 Zileuton acts by:

Correct.

Not quite — the answer is D.

Why: Zileuton inhibits 5-lipoxygenase, reducing leukotriene synthesis. It is not commonly used because of hepatic toxicity.
53 Montelukast and zafirlukast act by:

Correct.

Not quite — the answer is B.

Why: Both are LT receptor antagonists, giving bronchodilation plus an anti-inflammatory effect.
54 Which advantage do leukotriene pathway inhibitors have over inhaled therapy, especially in children?

Correct.

Not quite — the answer is D.

Why: Their advantages are oral therapy (easier than inhalation, especially in children), long duration of action and minimal side effects.
55 Zafirlukast interacts with other drugs because it is:

Correct.

Not quite — the answer is B.

Why: Zafirlukast is an enzyme inhibitor, and both zafirlukast and zileuton raise liver enzymes.
56 Cromolyn and nedocromil act by:

Correct.

Not quite — the answer is A.

Why: They are weak anti-inflammatories that inhibit mast cell degranulation, reducing the early response, and inhibit eosinophil activation, reducing the late response.
57 Which statement about cromolyn is correct?

Correct.

Not quite — the answer is B.

Why: Cromolyn is prophylactic, used by inhalation in antigenic and exercise-induced asthma and in mild persistent asthma with an ICS — never in an acute attack, and never alone.
58 Throat irritation, cough and bronchospasm from powdered cromolyn are avoided by:

Correct.

Not quite — the answer is D.

Why: The booklet advises prior inhalation of a β₂ agonist to avoid these effects with the powder form.
59 Omalizumab works by:

Correct.

Not quite — the answer is A.

Why: Omalizumab is a humanised monoclonal antibody that binds circulating IgE, inhibiting its binding to mast cells. It is add-on therapy in severe uncontrolled allergic asthma.
60 Which monoclonal antibody is directed against IL-4 and is also used in atopic dermatitis?

Correct.

Not quite — the answer is D.

Why: Dupilumab is anti-IL-4; its uses are the same as the anti-IL-5 agents plus atopic dermatitis, and it may cause blood eosinophilia.
61 Benralizumab differs from mepolizumab in that it binds:

Correct.

Not quite — the answer is D.

Why: Mepolizumab and reslizumab are anti-IL-5; benralizumab binds the IL-5 receptor (anti-IL-5R).
62 The most serious adverse effect of omalizumab is:

Correct.

Not quite — the answer is D.

Why: Omalizumab carries an increased risk of anaphylaxis along with reactions at the injection site.
63 Ketotifen is best described as:

Correct.

Not quite — the answer is C.

Why: Ketotifen is related to cromolyn: a mast cell stabiliser with antihistamine activity.

Acute Exacerbation & Status Asthmaticus

Questions 64–69↑ Contents
64 In a mild to moderate acute exacerbation, the recommended oral prednisone dose is:

Correct.

Not quite — the answer is A.

Why: Mild or moderate acute exacerbation is treated with inhaled SABA, oral prednisone 40–50 mg and oxygen at 95%.
65 Status asthmaticus is refractory to the usual treatment because of all the following EXCEPT:

Correct.

Not quite — the answer is C.

Why: The booklet attributes refractoriness to DOWN-regulation of β receptors, mucus plugging and acidosis.
66 Which drug class must be AVOIDED in status asthmaticus?

Correct.

Not quite — the answer is B.

Why: Sedatives are avoided because of respiratory depression.
67 In status asthmaticus, aminophylline is given:

Correct.

Not quite — the answer is A.

Why: IV aminophylline is used in severe cases and must be infused slowly to avoid cardiac arrest.
68 Which is part of the hospitalisation measures in status asthmaticus?

Correct.

Not quite — the answer is B.

Why: Hospital measures are endotracheal intubation and suction, humidified oxygen, IV fluids for dehydration, electrolytes and acidosis, and antibiotics for infection.
69 Salbutamol in a mild to moderate acute exacerbation is given by inhalation, but may also be given:

Correct.

Not quite — the answer is A.

Why: The booklet notes that salbutamol can be given IV in mild or moderate acute exacerbation.

Drug Therapy of Cough

Questions 70–88↑ Contents
70 Which of the following is CORRECTLY matched?

Correct.

Not quite — the answer is B.

Why: Menthol (a volatile oil) acts both as a peripheral antitussive demulcent and as an expectorant. Guaifenesin is an expectorant, acetylcysteine a mucolytic and dextromethorphan a central antitussive.
71 The cough reflex is controlled by a centre in the:

Correct.

Not quite — the answer is A.

Why: Cough results from stimulation of irritant receptors in the respiratory passages or outside them, and the reflex is controlled by the cough centre in the medulla.
72 Cough receptors may be stimulated from sites OUTSIDE the respiratory passages, including all the following EXCEPT:

Correct.

Not quite — the answer is D.

Why: The booklet lists the oesophagus, heart and ears as extra-respiratory sources of cough.
73 Central antitussives are indicated in:

Correct.

Not quite — the answer is D.

Why: Central antitussives act on the cough centre in the medulla and are used in moderate to severe dry cough. Productive cough is treated with mucolytics and expectorants.
74 Which is the FIRST choice central antitussive?

Correct.

Not quite — the answer is A.

Why: Dextromethorphan is listed as first choice; it crosses the blood–brain barrier and acts as a σ₁ agonist and NMDA antagonist on the cough centre.
75 Which adverse effect of codeine is characteristically PARADOXICAL in children?

Correct.

Not quite — the answer is C.

Why: Codeine causes drowsiness in adults but paradoxical excitement in children.
76 Dextromethorphan is preferred to codeine because it causes less:

Correct.

Not quite — the answer is B.

Why: In antitussive doses it has less liability to constipation, respiratory depression and dependence. Its own serious adverse effect is hallucination.
77 Which is the characteristic adverse effect of pholcodine?

Correct.

Not quite — the answer is D.

Why: Pholcodine is a semisynthetic opioid with fewer adverse effects than codeine, but causes sputum retention.
78 Antihistamines such as diphenhydramine suppress cough by:

Correct.

Not quite — the answer is C.

Why: They are H₁ antagonists that suppress the central cough mechanism and raise the threshold for the afferent cough impulse; their adverse effects are anticholinergic.
79 The mechanism of peripheral antitussives such as menthol is:

Correct.

Not quite — the answer is D.

Why: Volatile oil acts as a demulcent, protecting irritant receptors with a mucin layer; it is used in lozenges or hot steam for mild to moderate dry cough.
80 Which serious adverse effects are attributed to menthol?

Correct.

Not quite — the answer is B.

Why: The booklet lists seizure, coma and death as the serious adverse effects of volatile oil (menthol).
81 Acetylcysteine and carbocysteine reduce sputum viscosity by:

Correct.

Not quite — the answer is C.

Why: They break the disulfide bonds of thick mucus and also act as antioxidant and anti-inflammatory. Ambroxol and bromhexine break down acid mucopolysaccharide fibres.
82 Which mucolytic is also the antidote in paracetamol toxicity?

Correct.

Not quite — the answer is A.

Why: Among the therapeutic uses of mucolytics the booklet lists acetylcysteine as the antidote in paracetamol toxicity.
83 Ambroxol acts by:

Correct.

Not quite — the answer is B.

Why: Ambroxol, and bromhexine by the same mechanism, break down acid mucopolysaccharide fibres, promoting clearance.
84 Which adverse effect is characteristic of bromhexine?

Correct.

Not quite — the answer is D.

Why: Bromhexine shares ambroxol's mechanism; its adverse effect is GIT upset with pain in the upper part of the stomach. Acetylcysteine causes angioedema, pruritus and peripheral oedema.
85 Guaifenesin acts as an expectorant by:

Correct.

Not quite — the answer is C.

Why: It increases volume and decreases viscosity, letting ciliary movement carry secretions upwards.
86 Which cough therapy is CONTRAINDICATED in children?

Correct.

Not quite — the answer is D.

Why: The booklet contraindicates dextromethorphan, pholcodine, antihistamines such as diphenhydramine, doxylamine and promethazine, guaifenesin, pseudoephedrine and phenylephrine in children.
87 Which group is used in the SPECIFIC treatment of cough?

Correct.

Not quite — the answer is B.

Why: Specific treatment targets the cause: bronchodilators (β₂ agonists, theophylline) and decongestants such as ephedrine, pseudoephedrine and phenylephrine.
88 Mucolytics are indicated in all the following EXCEPT:

Correct.

Not quite — the answer is D.

Why: Mucolytic uses are productive cough, asthmatic bronchitis, COPD, cystic fibrosis, bronchiectasis and care of a tracheostomy tube. A dry cough calls for an antitussive.

Pulmonary Tuberculosis

Questions 89–109↑ Contents
89 Which drug is NOT first-line therapy for pulmonary tuberculosis?

Correct.

Not quite — the answer is D.

Why: First-line drugs are rifampicin, isoniazid, pyrazinamide, ethambutol and streptomycin. Linezolid is reserved for extensively drug-resistant TB.
90 A patient with latent TB infection can be treated with:

Correct.

Not quite — the answer is C.

Why: Latent TB is treated with isoniazid monotherapy for 9 months, or a combination of INH and rifapentine for 3 months.
91 Which drug is recommended in extensively drug-resistant tuberculosis (XDR-TB)?

Correct.

Not quite — the answer is B.

Why: For XDR-TB the booklet lists clofazimine and linezolid.
92 Which is NOT an expected adverse effect of rifampin?

Correct.

Not quite — the answer is A.

Why: Rifampin causes rash, fever, GIT upset, liver damage and jaundice, enzyme induction, flu-like syndrome and red discolouration of urine, tears and sputum — not nephrotoxicity.
93 Which statement about isoniazid is WRONG?

Correct.

Not quite — the answer is B.

Why: INH is an enzyme INHIBITOR, so it increases phenytoin and carbamazepine levels rather than decreasing them.
94 Which statement about the rifamycins is INCORRECT?

Correct.

Not quite — the answer is D.

Why: Rifapentine has a LONGER half-life, allowing once-weekly dosing and better compliance.
95 Which antituberculous drug does NOT cause hepatic toxicity?

Correct.

Not quite — the answer is C.

Why: Ethambutol's adverse effects are ocular — optic neuritis, red/green colour blindness, reduced visual acuity — plus reduced uric acid excretion.
96 Which drug is NOT correctly matched with its adverse effect?

Correct.

Not quite — the answer is C.

Why: Optic neuritis belongs to ethambutol. Pyrazinamide causes hepatitis, hyperuricaemia, arthralgia and GIT upset.
97 A woman on TB therapy is warned that one of her drugs will lower the plasma level of her oral contraceptive. Which drug?

Correct.

Not quite — the answer is D.

Why: Rifampicin is a potent enzyme inducer, causing serious drug interactions including failure of oral contraceptives.
98 All the following statements about rifampicin are true EXCEPT:

Correct.

Not quite — the answer is B.

Why: Pyridoxine (vitamin B6) is added to ISONIAZID to prevent neurotoxicity, not to rifampicin.
99 Why is combination therapy required in tuberculosis?

Correct.

Not quite — the answer is A.

Why: The booklet's first listed problem is that resistance occurs with monotherapy, so combination therapy is required.
100 Direct observation therapy (DOT) is used in TB mainly to:

Correct.

Not quite — the answer is A.

Why: Poor compliance with multidrug therapy over a long period is the third listed problem; DOT ensures therapy is completed.
101 The initial intensive phase of TB treatment consists of:

Correct.

Not quite — the answer is D.

Why: Rifampicin, INH, pyrazinamide and ethambutol (or streptomycin) for 2 months, to lower the bacillary load and avoid resistance. The continuation phase is INH and rifampicin for 4 months.
102 MDR-TB is defined as resistance to:

Correct.

Not quite — the answer is C.

Why: MDR-TB is resistance to rifampicin and INH. XDR-TB is MDR plus resistance to a fluoroquinolone and at least one injectable second-line drug.
103 Isoniazid acts by:

Correct.

Not quite — the answer is A.

Why: INH affects the enzyme responsible for mycolic acid synthesis, disrupting the cell wall, and acts both intracellularly and extracellularly.
104 Neurotoxicity from isoniazid occurs mainly in:

Correct.

Not quite — the answer is B.

Why: Neurotoxicity — neuritis, memory impairment and convulsions from B6 deficiency — occurs with slow acetylators; hepatitis is commoner with rapid acetylators.
105 Why does isoniazid cause pyridoxine deficiency?

Correct.

Not quite — the answer is A.

Why: INH metabolites inhibit pyridoxine phosphokinase, which converts B6 to its active form needed for GABA synthesis; the result is CNS stimulation.
106 Which drug crosses into the CSF and is therefore valuable in tuberculous meningitis?

Correct.

Not quite — the answer is D.

Why: Pyrazinamide is highly lipophilic, crosses the blood–brain barrier and penetrates CSF, making it valuable in tuberculous meningitis.
107 Which first-line antituberculous drug is BACTERIOSTATIC?

Correct.

Not quite — the answer is D.

Why: In the mega summary ethambutol is listed as static; rifampicin, INH and pyrazinamide are cidal.
108 Rifabutin is preferred over rifampin in TB patients with HIV because it:

Correct.

Not quite — the answer is D.

Why: Rifabutin produces less enzyme induction, reducing interactions with antiretroviral drugs.
109 Patient monitoring during TB therapy includes clinical evaluation, monthly culture and watching especially for toxicity of which organ?

Correct.

Not quite — the answer is B.

Why: The booklet specifies watching for drug side effects, especially liver.

Pharyngitis

Questions 110–117↑ Contents
110 The first choice in acute bacterial pharyngitis is:

Correct.

Not quite — the answer is D.

Why: Penicillin is first choice — effective, narrow spectrum, safe and low cost. Penicillin V is the oral form; amoxicillin is preferred in children for its better taste.
111 In a patient with pharyngitis and type I penicillin allergy, azithromycin is given for:

Correct.

Not quite — the answer is D.

Why: Type I penicillin allergy: azithromycin for 5 days, or clindamycin for 10 days.
112 A 9-year-old has acute sore throat, fever and headache, with a positive rapid antigen test for group A streptococcus and no drug allergy. Which regimen treats the infection and prevents acute rheumatic fever?

Correct.

Not quite — the answer is C.

Why: Penicillin or amoxicillin for a full 10 days is needed to prevent the non-suppurative complications; amoxicillin suits children because of its taste.
113 A 7-year-old with bacterial pharyngitis has a history of amoxicillin causing throat swelling and difficulty breathing. Which is appropriate?

Correct.

Not quite — the answer is D.

Why: Throat swelling and difficulty breathing indicate a type I reaction, so all β-lactams including cephalosporins are avoided; the booklet gives azithromycin for 5 days or clindamycin for 10 days.
114 In pharyngitis without allergy, a single intramuscular dose of benzathine penicillin is:

Correct.

Not quite — the answer is C.

Why: The booklet gives benzathine penicillin as a single IM dose of 1.2 MU.
115 Antibiotic therapy in GABHS pharyngitis shortens the infectious period from:

Correct.

Not quite — the answer is D.

Why: Antibiotic therapy reduces the infectious period from 10 days to 2 days; children stay home until afebrile and for the first 24 hours of treatment.
116 Which is a NON-suppurative complication of streptococcal pharyngitis?

Correct.

Not quite — the answer is C.

Why: Non-suppurative complications are acute rheumatic fever (up to 7 days to occur) and acute glomerulonephritis; the suppurative ones are peritonsillar abscess, otitis media and sinusitis.
117 In non-type I penicillin allergy with pharyngitis, which is used?

Correct.

Not quite — the answer is A.

Why: A first generation cephalosporin (cephalexin, cefadroxil) is used; the booklet warns against 2nd or 3rd generation agents for 10 days.

Otitis Media

Questions 118–133↑ Contents
118 The first choice in acute, NOT severe otitis media without penicillin allergy is:

Correct.

Not quite — the answer is A.

Why: The booklet names high-dose amoxicillin/clavulanate the drug of choice for 10 days — very effective, high middle ear concentration, safe, low cost and good taste for children.
119 The first choice in acute SEVERE otitis media is:

Correct.

Not quite — the answer is B.

Why: For severe AOM the first choice is high-dose amoxicillin/clavulanate; ceftriaxone IV or IM for 1–3 days is used where there are oral problems.
120 The first choice in acute severe otitis media with TYPE I penicillin allergy is:

Correct.

Not quite — the answer is C.

Why: Type I penicillin allergy: not severe is treated with a macrolide, severe with clindamycin.
121 Ceftriaxone for severe otitis media should not exceed:

Correct.

Not quite — the answer is D.

Why: Standard oral therapy runs 10 days, with exceptions: azithromycin 3 days and ceftriaxone 3 days.
122 Ibuprofen used for pain in otitis media should not be given for more than:

Correct.

Not quite — the answer is D.

Why: Acetaminophen or ibuprofen is used with fever, but ibuprofen is not preferred in children under 3 months and not for more than 3 days.
123 Azithromycin in NOT severe otitis media is given for:

Correct.

Not quite — the answer is B.

Why: For type I penicillin allergy that is not severe, a macrolide such as azithromycin is given once daily for 3 days, separated from antacids.
124 Ceftriaxone IV or IM may be used in otitis media that is:

Correct.

Not quite — the answer is C.

Why: Ceftriaxone is used for severe AOM without allergy and for severe AOM with non-type I penicillin allergy.
125 Oral cefuroxime may be used in otitis media that is:

Correct.

Not quite — the answer is C.

Why: Cefuroxime, a 2nd generation cephalosporin, is used for not-severe AOM without allergy and for not-severe AOM with non-type I penicillin allergy, for 10 days.
126 Clindamycin could be used in otitis media that is:

Correct.

Not quite — the answer is B.

Why: Clindamycin is the choice for severe acute otitis media with type I penicillin allergy, and it is also used when first-line therapy has failed.
127 Which type of otitis media does NOT need antibiotic therapy?

Correct.

Not quite — the answer is A.

Why: Acute otitis media needs antibiotics; otitis media with effusion does not.
128 Which organisms causing otitis media are penicillin-resistant through β-lactamase production?

Correct.

Not quite — the answer is D.

Why: The causes are viral, S. pneumoniae and H. influenzae — the latter two may produce β-lactamase.
129 A topical anaesthetic such as benzocaine for ear pain should NOT be used in children under:

Correct.

Not quite — the answer is A.

Why: Without fever and in mild cases a topical anaesthetic may be used, but not in children under 2 years.
130 Which adjunctive treatments are NOT proven effective in otitis media?

Correct.

Not quite — the answer is C.

Why: The booklet states these have not been proved effective.
131 Ceftriaxone should be avoided in infants under:

Correct.

Not quite — the answer is A.

Why: The booklet warns to avoid ceftriaxone in patients under 2 months.
132 An 18-month-old girl has two days of rhinorrhoea, then irritability, fever of 38.5°C and right-ear tugging, and is diagnosed with acute otitis media. She has no known allergy. Which is the first choice?

Correct.

Not quite — the answer is D.

Why: With no allergy, high-dose amoxicillin/clavulanate is the drug of choice for 10 days.
133 Which antibiotic is NOT an option for acute otitis media in a 1-month-old infant?

Correct.

Not quite — the answer is D.

Why: Ceftriaxone is avoided under 2 months of age.

Sinusitis

Questions 134–141↑ Contents
134 Which antibiotic is NOT recommended in acute bacterial rhinosinusitis in a 6-year-old child?

Correct.

Not quite — the answer is B.

Why: Doxycycline is contraindicated in children; in children the first choice is amoxicillin/clavulanate.
135 A 7-year-old has uncomplicated acute bacterial sinusitis with 12 days of purulent nasal discharge and daytime cough, and no drug allergy. The recommended first-line oral regimen is:

Correct.

Not quite — the answer is D.

Why: In children the first choice is amoxicillin/clavulanate, in high dose where there is a risk of pneumococcal resistance.
136 Antibiotics are indicated in acute bacterial rhinosinusitis when symptoms are moderate or severe and persist for more than:

Correct.

Not quite — the answer is B.

Why: The indication is persistent severe ABRS with moderate or severe symptoms for more than 10 days; duration of therapy is 10–14 days, up to 21.
137 Intranasal decongestants in sinusitis are limited to 3 days to avoid:

Correct.

Not quite — the answer is D.

Why: They are used for 3 days only, in severe cases and in patients over 6 years, to avoid rebound congestion.
138 Which antihistamines should NOT be used in acute bacterial sinusitis?

Correct.

Not quite — the answer is D.

Why: First generation agents are avoided for their atropine-like thickening of mucus; second generation agents are preferred in chronic or allergic sinusitis, and antihistamines are contraindicated in acute bacterial sinusitis.
139 In an ADULT with acute bacterial rhinosinusitis and type I penicillin allergy, which is appropriate?

Correct.

Not quite — the answer is A.

Why: In adults with type I penicillin allergy the booklet gives doxycycline or quinolones such as levofloxacin and moxifloxacin.
140 Which is NOT an option for acute bacterial sinusitis in an adult?

Correct.

Not quite — the answer is B.

Why: Plain penicillin V does not cover the β-lactamase producing organisms and anaerobes involved in sinusitis; it is the pharyngitis first choice, not the sinusitis one.
141 Organisms causing sinusitis are those of otitis media PLUS:

Correct.

Not quite — the answer is C.

Why: The booklet states the causative organisms are as in otitis media plus anaerobes.

Lower Respiratory Tract Infection

Questions 142–149↑ Contents
142 Antibiotics in acute bronchitis are indicated only when fever or respiratory symptoms persist beyond:

Correct.

Not quite — the answer is C.

Why: Antibiotics are used only if fever or respiratory symptoms last more than 4–6 days, or in elderly or immunocompromised patients.
143 A 25-year-old has a persistent cough for 5 days with mild fever and chest discomfort, scattered wheezes and no signs of pneumonia. Which statement about his acute bronchitis is TRUE?

Correct.

Not quite — the answer is D.

Why: Acute bronchitis is usually viral; antibiotics are reserved for persistent symptoms. Corticosteroids are only for cough persisting beyond 14 days, and ribavirin aerosol is approved only for RSV.
144 A 10-month-old infant has two days of cough, nasal congestion and increasing difficulty breathing, and is diagnosed with bronchiolitis. Which treatment is appropriate?

Correct.

Not quite — the answer is A.

Why: Ribavirin aerosol is approved for RSV infection and reserved for severely ill infants and those with chronic lung disease, congenital heart disease, prematurity or immunodeficiency. Corticosteroids have no proven effect in bronchiolitis.
145 In hospitalised children with bronchiolitis, which nebulised drug does the booklet call more effective than albuterol?

Correct.

Not quite — the answer is B.

Why: Nebulised epinephrine is described as more effective than albuterol in hospitalised patients.
146 Chronic bronchitis is defined as a productive cough with sputum lasting:

Correct.

Not quite — the answer is C.

Why: The definition excludes underlying bronchiectasis or tuberculosis.
147 Which organism is NOT a common pathogen in chronic bronchitis?

Correct.

Not quite — the answer is B.

Why: The common pathogens listed are H. influenzae, M. catarrhalis and S. pneumoniae.
148 Duration of antibiotic therapy in chronic bronchitis is:

Correct.

Not quite — the answer is D.

Why: 5–7 days, with fluoroquinolone therapy as a short course of 5 days once daily.
149 Which is NOT an indication for antibiotics in chronic bronchitis?

Correct.

Not quite — the answer is A.

Why: Antibiotics are indicated for moderate to severe symptoms or risk factors: old age, cardiac disease, repeated antibiotic therapy and home oxygen use.

Pneumonia

Questions 150–177↑ Contents
150 IV ceftazidime combined with ciprofloxacin is used in:

Correct.

Not quite — the answer is D.

Why: When Pseudomonas is suspected, two antipseudomonal drugs are combined: an IV β-lactam (ceftazidime, piperacillin-tazobactam or meropenem) plus a fluoroquinolone.
151 An IV aminoglycoside combined with IV azithromycin is used in:

Correct.

Not quite — the answer is B.

Why: The second antipseudomonal option is an aminoglycoside plus azithromycin or an IV fluoroquinolone.
152 IV meropenem combined with levofloxacin is used in:

Correct.

Not quite — the answer is D.

Why: Meropenem is one of the IV β-lactams combined with a fluoroquinolone when Pseudomonas is suspected — a hospital, not an outpatient, regimen.
153 IV ceftriaxone combined with azithromycin is used in:

Correct.

Not quite — the answer is D.

Why: A β-lactam plus azithromycin covers typical and atypical organisms in the inpatient, non-ICU setting.
154 Oral cefuroxime combined with azithromycin is used in:

Correct.

Not quite — the answer is A.

Why: For a patient with comorbidities the booklet allows combination therapy with an oral β-lactam plus azithromycin, covering typical and atypical organisms.
155 In adult pneumonia with suspected ORSA, all of the following could be added EXCEPT:

Correct.

Not quite — the answer is B.

Why: Daptomycin is NOT used, because it is inactivated by pulmonary surfactant. Vancomycin or linezolid is added to any regimen.
156 In suspected ORSA, empiric therapy of pneumonia should include:

Correct.

Not quite — the answer is A.

Why: The booklet is explicit: add vancomycin or linezolid to any regimen, and daptomycin is not used.
157 An adult inpatient with pneumonia and no complications can be discharged within:

Correct.

Not quite — the answer is A.

Why: Patients are discharged from hospital within 5 days if there is no complication.
158 Adult pneumonia treatment duration with a NEGATIVE blood culture is:

Correct.

Not quite — the answer is A.

Why: For a hospitalised patient with negative blood culture the duration is 7–14 days.
159 Duration of therapy for pneumonia with a POSITIVE blood culture is:

Correct.

Not quite — the answer is D.

Why: The booklet counts 14 days from the day the blood culture becomes negative.
160 Which statement about pneumonia therapy is WRONG?

Correct.

Not quite — the answer is B.

Why: Daptomycin is inactivated by pulmonary surfactant and is never used for pneumonia.
161 An adult has pneumonia with no other disease and no antibiotic exposure. Which is suitable?

Correct.

Not quite — the answer is C.

Why: With no comorbidity and no recent antibiotics there is no resistance risk, so monotherapy is started: azithromycin, doxycycline or a respiratory fluoroquinolone.
162 An adult with no other disease had azithromycin one month ago and now has pneumonia. Which is suitable?

Correct.

Not quite — the answer is D.

Why: Previous exposure means the antibiotic must come from a different class, so the macrolide is avoided.
163 A 50-year-old with congestive heart failure is treated as an outpatient for pneumonia and had erythromycin a month ago. Which is appropriate?

Correct.

Not quite — the answer is B.

Why: He has a comorbidity and recent macrolide exposure, so a more potent drug from a different class is used: a respiratory fluoroquinolone, and levofloxacin's course is 5 days.
164 A 60-year-old with cancer is treated as an outpatient for pneumonia, having had erythromycin two months ago. Which is appropriate?

Correct.

Not quite — the answer is C.

Why: Cancer is a comorbidity and the macrolide was given within 3 months, so a fluoroquinolone from a different class is chosen; levofloxacin's duration is 5 days.
165 Which regimen is most appropriate for severe late-onset nosocomial pneumonia with suspected Pseudomonas AND ORSA?

Correct.

Not quite — the answer is A.

Why: Pseudomonas needs two antipseudomonal drugs — an IV β-lactam plus a fluoroquinolone — and ORSA needs vancomycin or linezolid added to the regimen.
166 When Pseudomonas is suspected in a 45-year-old ICU patient, which single choice is adequate?

Correct.

Not quite — the answer is B.

Why: Two antipseudomonal drugs must be combined; a single agent is not adequate.
167 Conversion from IV to oral therapy in pneumonia requires all the following EXCEPT:

Correct.

Not quite — the answer is B.

Why: The three criteria are stable vital signs for 24 hours, improved and stable oxygenation, and tolerance of oral therapy with a normal GIT.
168 Which is the MOST common bacterial pathogen in community acquired pneumonia?

Correct.

Not quite — the answer is C.

Why: S. pneumoniae is first and M. pneumoniae second; Moraxella is noted especially at the extremes of age.
169 In the CURB-65 score, which value of blood urea nitrogen scores a point?

Correct.

Not quite — the answer is C.

Why: CURB-65 scores one point each for new confusion, urea above 7 mmol/l, respiratory rate 30 or more, systolic BP under 90 or diastolic 60 or less, and age 65 or over.
170 A CURB-65 score of 3–5 means the patient:

Correct.

Not quite — the answer is B.

Why: 0–1 is outpatient, 2 is a short stay or close watching, and 3–5 requires hospitalisation with consideration of ICU.
171 Hospital acquired pneumonia is defined as pneumonia occurring:

Correct.

Not quite — the answer is C.

Why: HAP occurs more than 48 hours after admission; ventilator associated pneumonia occurs 48–72 hours after endotracheal intubation.
172 Which pathogens are characteristic of aspiration pneumonia?

Correct.

Not quite — the answer is A.

Why: Aspiration of oropharyngeal contents gives anaerobes and S. viridans; aspiration of GIT contents gives enteric Gram-negative bacilli. Risk factors are GERD and acid suppressants.
173 Pneumonia in a neutropenic patient is characteristically caused by:

Correct.

Not quite — the answer is A.

Why: The booklet lists staphylococci, Pseudomonas and fungal infection in the neutropenic patient.
174 The first priority in managing a patient with pneumonia is:

Correct.

Not quite — the answer is C.

Why: The booklet is explicit: respiratory function first, antimicrobial selection second.
175 A patient with pneumonia, no comorbidity and no recent antibiotics should start on:

Correct.

Not quite — the answer is C.

Why: Category I — no risk of drug resistance — begins with monotherapy.
176 A patient with comorbidities who had antibiotics within the last 3 months should be given:

Correct.

Not quite — the answer is B.

Why: Category III follows category II but selects an antibiotic from a class different from the one recently used.
177 Azithromycin and levofloxacin courses in an adult outpatient with pneumonia last:

Correct.

Not quite — the answer is D.

Why: Adult outpatient treatment is 7–10 days, except azithromycin and levofloxacin, which run 5 days.

Diphtheria

Questions 178–182↑ Contents
178 The role of diphtheria antitoxic serum is to:

Correct.

Not quite — the answer is B.

Why: The antitoxin neutralises the toxin before irreversible binding and damage; penicillin or erythromycin is what reduces the bacilli in the throat.
179 Before giving diphtheria antitoxic serum it is essential to:

Correct.

Not quite — the answer is D.

Why: A sensitivity test to horse serum must be done; in allergic patients hyposensitisation is carried out with slowly increasing doses.
180 In diphtheria, penicillin or erythromycin is given to:

Correct.

Not quite — the answer is C.

Why: Antibiotics reduce the bacillary load and hence toxin production; the antitoxin deals with toxin already released.
181 Management of contacts of a diphtheria case includes:

Correct.

Not quite — the answer is A.

Why: Contacts receive single-dose IM penicillin and the toxoid vaccine if unvaccinated or incompletely vaccinated.
182 Tracheostomy in diphtheria is indicated in cases of:

Correct.

Not quite — the answer is A.

Why: The booklet gives suffocation as the indication.
↑ Back to contents