Antibiotics

Antibiotics is a very important topic for PG-MD/MS entrance. So I have covered every possible important points with images....do make use of it

1. ANTIBIOTICS - I -DR.AKIF A.B Step to PG-MD/MS

2. Erythromycin is given in intestinal hypomotility : A Because it binds to motilin receptors B Increases gastric acid secretion C Improves digestion D None Step to PG-MD/MS

3. Ans. A Because it binds to motilin receptors Macrolides a group of versatile antibiotics with motilin receptor activating property shared by all the member of the group . Erythromycin is however most potent and is hence most commonly used for this purpose . Erythromycin is used in diabetic gastroperesis and dyspepsia for its motilin receptor activating activity . Motilin receptor is a G protein coupled receptor. Step to PG-MD/MS

4. MACROLIDES -It inhibits Translocation of tRNA by acting on 50S Ribosome. Erythromycin Azithromycin Clarithromycin Telithromycin Step to PG-MD/MS

5. ERYTHROMYCIN -DOC in : 1) Diphtheria 2) Pertussis 3) Campylobacteria jejuni 4) Prophylaxis of Rheumatic fever in Penicillin allergic Patients Step to PG-MD/MS

6. AZITHRO MYCIN -DOC in : 1) Legionella 2) Chancroid 3) Mycoplasma pneumoniae Step to PG-MD/MS

7. MACROLIDES S/E M - Motilin receptors : Diarrhea A - Allergy C - Cholestasis R O Reversible Ototoxicity Step to PG-MD/MS

8. PROTEIN SYNTHESIS INHIBITORS 30S 50S Tetracyclines Aminoglycosides Spectinomycin Oxazolidinediones Macrolides Lincosamides Chloramphenicol Step to PG-MD/MS

9. 2) All are true except: (DNB Dec 2011) A Cefoperazone is antipseudomonas B Cefoxitin has no anti anaerobic activity C Ceftazidime is Group III cephalosporin D Cephalosporin act by inhibiting cell wall synthesis Step to PG-MD/MS

10. Ans. B cefoxitin has no anti- anerobic activity. This is answer by exclusion. Cephalosporin ; similar to penicillins act by inhibiting the cell wall synthesis. Ceftazidime is III generation cephalosporin which has strong anti- pseudomonal activity similar to cefoperazone . One of the important feature of II generation compounds – some drugs like cefoxitin are having activity against the anaerobes like B. fragilis . Thus this statement is false. Step to PG-MD/MS

11. 1 st Generation CEPHALOSPORINS Fazol ( Cefazoline ) is a lorry driver ( Cefloridine ) . He works very hard and has become thin ( Cephalothin ) . He has Red watch ( CephRadine ) and Lux soap ( CephaLexine ) . He wears green Drawer ( Cefodroxine ) -Main activity against Gram + ve organism and mild activity against Gram – ve and anaerobes (except bacteroides ) Step to PG-MD/MS

12. 3 rd Generation CEPHALOSPORINS Cefixi me Ceftriax one Ceftazidi me Ceftazoxi me Ceftibu ten Cefoperaz one Cefpodoxi me Me One Ten 3 rd generation Except Cefuroxime which is a 2 nd generation -More active against Gram - ve Ceftoperazone and ceftazidime are active against Pseudomonas. Rest of 3 rd gen. is not active. Step to PG-MD/MS

13. 2 nd Generation CEPHALOSPORINS - Cefuroxime - Cefotetan Cefoxitin Cefmetazole Cefomendole -Active against Gram – ve and anaerobes but less active against Gram + ve Step to PG-MD/MS

14. 4 th Generation CEPHALOSPORINS Cefi pi me Cef pi rome Pi = 4th generation Step to PG-MD/MS

15. 5 th Generation CEPHALOSPORINS Ceftibip rol e Cefta rol ine Rol = 5 th generation Step to PG-MD/MS

16. ANTI-PSEUDOMONAL DRUGS C - Carbepenams Colistim Ciprofloxacin Cephalosporins ; 3 rd gen.: Ceftazidime and Cefoperazone 4 th generation 5 th geneartion A - Aminoglycosides P - Penicillins : 1) Piperacillin 2) Azlocillin 3) Mazlocillin 4) Carbenicillin 5) Ticarcillin Step to PG-MD/MS

17. Step to PG-MD/MS

18. PSEUDOMONAS Step to PG-MD/MS

19. PSEUDOMONAS Step to PG-MD/MS

20. 3. Which cephalosporins can be used in ↓GFR A Cefuroxime B Ceftriaxone C Ceftazidime D Cefoperazone Step to PG-MD/MS

21. Ans. D Cefoperazone Cefoperazone is almost totally eliminated by bile. Therefore , it could be used in case of reduced GFR. Ceftrixone too can be used, but has partial elimination by bile. Hence , if we are to choose one option between these, we shall choose cefoperazone Cefoperazone is one of the drug of choice for pseudomonas infection. Step to PG-MD/MS

22. 4. Patients is given tacrolimus . The antibiotic not given is all except A Gentamycin B Cisplatin C Rifampicin D Vancomycin Step to PG-MD/MS

23. Ans. C Rifampicin Rifampin is a potent enzyme inducer. The drug has the chance of inducing the metabolism. This might reduce the efficacy of tacrolimus . Rest of the drugs have nephro or ototoxicity . Though , these too have the potential to interact with tacrolimus but with rifampin such interaction is more likely. Step to PG-MD/MS

24. 5. A girl on sulphonamides developed abdominal pain and presented to emergency with seizure. What is the probable cause? A Acute intermittent porphyria B Congenital erythropoietic porphyria C Infectious mononucleosis D Kawasaki’s disease Step to PG-MD/MS

25. Ans. A Acute intermittent porphyria Acute intermittent porphyria is an autosomal dominant disorder . b. Acute intermittent porphyria , which causes abdominal pain and neurologic symptoms, is the most common acute porphyria . c. Sulmonamides and barbuitures are most common agents precipitating acute intermittent porphyria . d. Acute intermittent porphyria is due to a deficiency of the enzyme porphobilinogen deaminase (also known as hydroxymethylbilane synthase ) that leads to accumulation of the heme precursors delta- aminolevulinic acid and porphobilinogen initially in the liver . f. Abdominal pain is the most common symptom, is usually steady and poorly localized, but may be cramping. Step to PG-MD/MS

26. SULFONAMIDES Sulfadoxine -Longest acting - Used along with Artesunate and Pyrimethamine in Chloroquine Resistant Malaria Sulfadiazine -Used along with Pyrimethamine in Toxoplasmosis Sulfasalazine Used in Ulcerative colitis Rheumatoid Arthritis Sulfadiazine - Silver Sulfadiazine is used in BURNS Step to PG-MD/MS

27. S/E of SULFONAMIDES B - Bone marrow suppression I - Insoluble in Urine ( Crystalluria ) K - Kernicterus in Newborn A - Aplastic Anemia S - Steven Johnson Sx H - Hemolysis in G6PD deficient patient Step to PG-MD/MS

28. Steven Johnson Sx Step to PG-MD/MS

29. COTRIMOXAZOLE - Sulfamethoxazole + Trimethoprim in ratio of 5;1 in tablet But in circulation ratio changes to 1:20 DOC in : 1) Nocardiosis 2) Pneumocystitis Step to PG-MD/MS

30. 6. CELL wall synthesis is inhibited by? (DNB Dec 2010) A Erythromycin B Lomefloxacin C Cefipime D Tetracycline Step to PG-MD/MS

31. C) Cefipime Cell wall Synthesis Inhibition Protein synthesis Inhibition Cell metabolism Inhibition DNA Synthesis Inhibition Penicillin Aminoglycosides Sulfonamides Quinolones Cephalosporins Macrolides Trimethoprim Vancomycin Tetracyclines Carbapenems Linezolid Cycloserine Chloramphenicol Fosfomycin Step to PG-MD/MS

32. 7. Which of the following drug is not used for Methicillin Resistant Staph. Aureus (MRSA).? A Cefaclor B Cotrimoxazole C Ciprofloxacin D Vancomycin Step to PG-MD/MS

33. Ans. A Cefaclor Drugs used for MRSA : Vancomycin Chloramphenicol Linezolid Minocycline Doxycycline Trimethoprim - sulfamethoxazole Fluoroquinolones Step to PG-MD/MS

34. PENICILLINS Narrow spectrum Penicillins Wide spectrum Penicillins Penicillin G Penicillin V Penicillinase Resistant Penicillins Aminopenicillins Carboxypeniccillins Ureidopenicillins Step to PG-MD/MS

35. PENICILLIN-G Oldest Penicillin It is lipid soluble drug and thus has RAPID oral absorption It is rapidly destructed by acid After parenteral administration, It is rapidly eliminated due to tubular secretions by pumps. Hence it is very short acting drug. To increase its duration of action, one of following are added: 1) Probenicid : It inhibits tubular pumps 2) Procaine 3) Benzathine Makes penicillin water soluble and thus slows its release from site Step to PG-MD/MS

36. Q. Longest Acting Penicillin Ans. Penicillin G Duration of action of 28days Hence is a drug of choice for Prophylaxis Of Rheumatic fever given once in a month. Step to PG-MD/MS

37. PENICILLIN G is DOC for following conditions B Bacillus Anthrax L Leptospirosis A Actinomyces S Streptococcus T Treponema pallidum (Syphilis) My Meningococcus Penicillin Pertenue (Yaws) G Gas gangrene Benzathine Penicillin is used for all stages of Syphilis except Neurosyphilis Where Aqueous Penicillin is used. Step to PG-MD/MS

38. Cutaneous Anthrax Syphilis Step to PG-MD/MS

39. PENICILLIN-V Acid stable Uses similar to Penicillin G It is an oral substitute of Penicillin G Step to PG-MD/MS

40. PENICILLINASE RESISTANT PENICILLINS ACID STABLE ACID LABILE Oxacillin Methicillin Dicloxacillin Nafcicillin Cloxacillin Given orally Given parenteral DRUG SIDE EFFECT Oxacillin Liver toxicity Methicillin Interstitial Nephritis Nafcicillin Agranulocytosis ( Neutropenia ) Step to PG-MD/MS

41. TREATMENT OF S.aureus DOC : Penicilin Penicillin Resistance Penicillinase Resistant Penicillins MRSA DOC : Vancomycin V RSA DOC : Daptomycin Step to PG-MD/MS

42. WIDE SPECTRUM PENICILLINS Aminopenicillins Carboxypeniciilins Ureidopenicillins Amoxycillin Carbenicillin M azlocillin Ampicillin Ticarcillin A zlocillin P iperacillin -all have good oral absorption Step to PG-MD/MS

43. SIDE EFFECTS OF PENICILLINS MC S/E = Hypersensitivity JARISCH HERSCHEIMER REACTION -Acute febrile reaction to Treponemal antigens released due to destruction of Bacteria By penicillin treatment. -C/F: 1) Fever 2) Myalgia 3) Arthralgia 4) Worsening of cutaneous lesions Step to PG-MD/MS

44. 8. Drug effective in pseudomonas infection is A Piperacillin B Amoxicillin C Tetracycline D Vancomycin Step to PG-MD/MS

45. A Piperacillin ANTI-PSEUDOMONAL DRUGS C - Carbepenams Colistim Ciprofloxacin Cephalosporins ; 3 rd gen.: Ceftazidime and Cefoperazone 4 th generation 5 th geneartion A - Aminoglycosides P - Penicillins : 1) Piperacillin 2) Azlocillin 3) Mazlocillin 4) Carbenicillin 5) Ticarcillin Step to PG-MD/MS

46. 9. All of the following are TRUE about Penicillin G EXCEPT (AIIME Nov 2009) A Can be given orally B Main mechanism of action is cell wall synthesis inhibition C Probenecid decreases its secretion D Effective against Gram-positive bacteria Step to PG-MD/MS

47. Ans. A Can be given orally a. Antibacterial spectrum: PcG is a narrow spectrum antibiotic; activity is limited primarily to Gram-positive bacteria and few others . b. Penicillin G is acid labile —destroyed by gastric acid. So it is not given orally c. The pharmacokinetics of PnG is dominated by very rapid renal excretion ; about 10% by glomerular filtration and the rest by tubular secretion . d. Tubular secretion of PnG can be blocked by probenecid ; higher and longer lasting plasma concentrations are achieved . e. Penicillin act by inhibiting cell wall synthesis . f. They are bactericidal drugs. Step to PG-MD/MS

48. 10. Which of the following is nephrotoxic ? A Streptomycin B Ciprofloxacin C Piperacillin D Cefotaxime Step to PG-MD/MS

49. Ans. A Streptomycin Common properties of aminoglycoside antibiotics: All are used as sulfate salts, which are highly water soluble; solutions are stable for months . b. They ionize in solution; are not absorbed orally; distribute only extracellularly ; do not penetrate brain or CSF . c. All are excreted unchanged in urine by glomerular filtration . d. All are bactericidal and more active at alkaline pH. They act by interfering with bacterial protein synthesis . e. All are active primarily against aerobic Gram-negative bacilli and do not inhibit anaerobes . g . They have relatively narrow margin of safety . h. All exhibit ototoxicity and nephrotoxicity . Step to PG-MD/MS

50. AMINOGLYCOSIDES Active only against Gram – ve organisms They require ATP and Oxygen for its function. Hence not effective against Anaerobes ( Bacteroides ) Water soluble drugs, Hence has poor oral absorption Inhibits 30S Ribosomes . Step to PG-MD/MS

51. Step to PG-MD/MS

52. DOC : Plague and Tularaemia Used in Inhalational route for Treatment of Pseudomonas associated With Cystic Fibrosis

53. GUT STERILISATION IN HEPATIC ENCEPHALOPATHY DOC = Rifaximin Neomycin can also be used for it.

54. SIDE EFFECTS OF AMINOGLYCOSIDES Auditory Toxicity Vestibulotoxic K - Kanamycin Gentamycin A - Amikacin Streptomycin N - Neomycin - In hindi ear is called as KAN N ephrotoxicity : Max. with N eomycin N euromuscular toxicity : Max. with N eomycin Ototoxicity : Damage to Outer Hair Cell Accidental Intraocular administration of Gentamicin can cause Maculopathy .

55. 12. Which of the following antibiotics inhibit protein synthesis? A Doxycycline B Nitrofurantoin C Cephalosporin D Penicillin Step to PG-MD/MS

56. Ans. A Doxycycline Mechanism of action of various antibiotics Inhibit cell wall synthesis: Penicillin’s, Cephalosporins , Cycloserine , Vancomycin and Bacitracin . b . Inhibit protein synthesis: Tetracyclines , Chloramphenicol , Erythromycin, Clindamycin and Linezolid . f . 5 Inhibit DNA gyrase : Fluoroquinolones , ciprofloxacin and others . g. Interfere with DNA function : Rifampin metronidazole . h. Interfere with intermediary metabolism: Sulfonamides, sulfones , PAS, trimethoprim , pyrimethamine , ethambutol . Step to PG-MD/MS

57. TETRACYCLINES DRUGS FEATURES Tetracyclines Resistance is being developed Doxycycline Demeclocyclines Maximum Photosensitivity Maximum Diabetes Insipidus Oxytetracyclines Chlortetracyclines Minocyclines Maximum vestibular toxicity Step to PG-MD/MS

58. TETRACYCLINES S/E K - Kidney failure A -Anti anabolic P - Photosensitivity I - Diabetes Insipidus L - Liver failure D -Pigmentation of Dentition and bone E - Expired drugs can cause Fanconi Sx V - Vestibulotoxicity - C.I in pregnancy and childrens .

59. TETRACYCLINES USES S - SIADH ( Demeclocycline ) R - Rickketsia (DOC) I - Inguinale Granuloma L - LGV (DOC) A - Atypical Pneumonia ( DOC : Macrolides ) N -None K - Cholera (DOC) A - Amoebiasis - Also a DOC for Pleurodesis and Pericardiodesis Step to PG-MD/MS

60. CHLORAMPHENICOL -Acts on 50S ribosome S/E : 1) Bone marrow suppression 2) Grey baby Syndrome Step to PG-MD/MS

61. Step to PG-MD/MS

62. SHAKEN BABY SYNDROME Step to PG-MD/MS

63. 13. TRUE about the Side-effects of Tetracycline include all of the following EXCEPT A Can cause Pseudotumor cerebri B NOT teratogenic if used during pregnancy C Discoloration of teeth may occur D Superinfection can occur Step to PG-MD/MS

64. Ans. B NOT teratogenic if used during pregnancy Adverse effects of tetracycline a. Irritative effects: Tetracyclines can cause epigastric pain, nausea, vomiting and diarrhea by their irritant property. b. Dose related toxicity i . Liver damage: Fatty infiltration of liver and jaundice occurs occasionally. ii. Kidney damage: A reversible Fanconi syndrome iii. Phototoxicity iv. Teeth and bones: Given during late pregnancy or childhood, tetracyclines can cause temporary suppression of bone growth. The ultimate effect on stature is mostly insignificant, but deformities v. and reduction in height are a possibility with prolonged use. vi. Anti anabolic effect vii. Increased intracranial pressure viii. Diabetes insipidus ix. Vestibular toxicity c. Hypersensitivity d. Superinfection Step to PG-MD/MS

65. 14. A patient on antimicrobial therapy develops the following signs and symptoms that ultimately are found to be drug-induced ; cough , dyspnea , and pulmonary infiltrates ; neutropenia and bleeding tendencies; and paresthesias . Which of the following is the most likely cause of this patient’s symptoms? A Amoxicillin B Azithromycin C Ciprofloxacin D Nitrofurantoin Step to PG-MD/MS

66. Ans. D Nitrofurantoin a. Although several of the antimicrobial agents listed here can cause one of the adverse responses noted here, nitrofurantoin is the most likely cause . b. GI side effects (anorexia, nausea, vomiting) are the most common side effects caused by this drug, which is still widely used for managing acute lower urinary tract infections (e.g., many strains of E. coli, staphylococci streptococci, Neisseria , Bacteroides ). c. Acute pulmonary reactions to nitrofurantoin are an uncommon side effect of therapy and can cause minor or life-threatening pulmonary dysfunction. d. Symptoms include fever, chills, cough, pleuritic chest pain, dyspnea . Rarely, pleural effusion and/or pulmonary hemorrhage may occur. e. Diagnosis is made by clinical suspicion and exclusion of other causes of respiratory compromise. Chronic toxicity ofd drug presents as pulmonary infiltrates after an year or so of the drig treatment. f. It should promptly be discontinued. If this is not sufficient, then the condition should be treated by corticosterioids . g. The drug can also cause acute or subacute pulmonary reaction such as those described: e.g. various hematologic reactions (in particular, leukopenia and thrombocytopenia) and peripheral sensory and motor neuropathies. Step to PG-MD/MS

67. CLINDAMYCIN -Causes Pseudomembranous Colitis Secreted in Bile Used for Anaerobic bacterial Infection -DOC for Pseudomembranous colitis : Metronidazole > Vancomycin Step to PG-MD/MS

68. VANCOMYCIN -Orally not effective except in Pseudomembranous colitis I.V - Histamine = Red Man Sx S/E : Nephrotoxic Ototoxic Not effective against Pseudomonas Uses : 1) DOC in MRSA 2) Pseudomembranous colitis Step to PG-MD/MS

69. PSEUDOMEMBRANOUS COLITIS MC cause = 3 rd generation Cephalosporins > Clindamycin Max. risk with = Clindamycin MC bacteria cause = Clostridium difficile DOC for Pseudomembranous colitis : Metronidazole > Vancomycin Step to PG-MD/MS

70. 15. A patient requires an antibiotic that is most effective against P. aeruginosa . Which of the following is the quinolone of choice? A Ciprofloxacin B Enoxacin C Lomefloxacin D Norfloxacin Step to PG-MD/MS

71. Ans. A Ciprofloxacin Ciprofloxacin is highly effective against P. aeruginosa . Others in the fluoroquinolone class have less activity toward P. aeruginosa , although they are effective against many other common gram-negative organisms. It is a potent enzyme inhibitor and participates in several of the clinically significant drug interactions. Step to PG-MD/MS

72. FLUOROQUINOLONES -DNA Gyrase Inhibitor Bactericidal Effective orally Wide spectrum Effective against MRSA and Pseudomonas Excreted in Kidneys except Pefloxacin and Moxifloxacin . Hence C.I in Renal failure Step to PG-MD/MS

73. FLUOROQUINOLONES DRUGS FEATURES Norfloxacin Used in UTI Gatifloxacin Causes Dysglycemia ( Withdrwan from market) Sparfloxacin Longest acting T ravofloxacin Hepa t o t oxic Moxifloxacin -longest acting Safe in Renal failure Respiratory FQs Effective against Anaerobes Step to PG-MD/MS

74. S/E of FLUOROQUINOLONES SIDE EFFECT FEATURE Tendinitis Common in elderly Nausea and Vomiting MC S/E Pseudomembranous colitis Cartilage defect Hence C.I in pregnancy and Children QT Prolongation Maximum with Sparfloxacin Photosensitivity Except P - Pefloxacin M - Moxyfloxacin T - Trovafloxacin Step to PG-MD/MS

75. RESPIRATORY FQs Oh - Ofloxacin My - Moxifloxacin God - Gatifloxacin Love - Levofloxacin Step to PG-MD/MS

76. QT PROLONGATION QT3 Q - Quinidine T - Thioridazine T - TCAs 3 - Class 3 AntiArrhythmics ; Amiodarone / Procainamide / Diisopyramide Step to PG-MD/MS

77. DRUGS ACTING ON MEMBRANES Polymyxin - B Polymyxin – E ( Colistin ) Daptomycin : DOC for VRSA Step to PG-MD/MS

78. GENERAL PROPERTIES Minimum Inhibitory Concentration Lowest concentration of drug which inhibits visible growth after 24hrs of Incubation. Time dependent Killing (TDK) Effects persist only for the time for which concentration of drug is above MIC. Hence has short Post antibiotic effect Beta lactams Vancomycin Concentration dependent killing (CDK) It depends only on concentration but not on MIC. So effect is seen even after drug concentration is below MIC. Hence it has prolonged post antibiotic effect. Fluoroquinolones Aminoglycosides Both CDK & TDK Beta lactams FQs Aminoglycosides Macrolides Step to PG-MD/MS

79. 17) Streptomycin and other aminoglycosides inhibit bacterial protein synthesis by binding to which of the following? A 30S ribosomal particles B DNA C mRNA D RNA polymerase Step to PG-MD/MS

80. Ans. A 30S ribosomal particles The bactericidal activity of streptomycin and other aminoglycosides involves a direct action on the 30S ribosomal subunit, the site at which these agents both inhibit protein synthesis and diminish the accuracy of translation of the genetic code . b. Proteins containing improper sequences of amino acids (known as nonsense proteins) are often nonfunctional. Streptomycin is used in treatment rhinoscleroma , pelvic inflmmatory diseases, brucella and resistant tuberlosis . Step to PG-MD/MS

81. 19. Which of the following drugs is primarily used in pneumonia caused by P. carcinii ? (AIIMS May 2010) A Carbenicillin B Metronidazole C Nifurtimox D Pentamidine Step to PG-MD/MS

82. Ans. D Pentamidine Both trimethoprim-sulfamethoxazole and pentamidine are effective in pneumonia caused by P carinii . This protozoal disease usually occurs in immunodeficient patients, such as those with AIDS. Nifurtimox is effective in trypanosomiasis and metronidazole in amebiasis and leishmaniasis , as well as in anaerobic bacterial infections. Penicillins are not considered drugs of choice for this particular disease state. Step to PG-MD/MS

83. 21. Compared with most other cephalosporins , the administration of cefoperazone , or cefotetan is associated with a higher incidence of which of the following? (AIPG 2009) A Acute heart failure B Acute renal failure C Bleeding tendencies in patients taking warfarin D Hypertension Step to PG-MD/MS

84. Ans. C Bleeding tendencies in patients taking warfarin a . Cefmetazole and cefotetan , both second-generation cephalosporins , and cefoperazone (third generation) can interfere with hepatic vitamin K metabolism, leading to what amounts to a deficiency ot vitamin K-dependent clotting factor activity. b. Because this is the general mechanism by which warfarin exerts its anticoagulant effects, combined use of one of these cephalosporins can cause further (and poten­tially dangerous) prolongations of the International Normalized Ratio (or prothrombin time); the clinical consequence can be spontaneous, pro­longed, or excessive bleeding. c. One should also be cautious when these cephalosporins are given to patients taking aspirin or other antiplatelet drugs (e.g., clopidogrel ) or thrombolytics . d. Although most cephalosporins are excreted unchanged by the kidneys, renal failure (especially severe and acute) seldom occurs with these or other cephalosporins . Step to PG-MD/MS

85. 22. The Amikacin differs from gentamicin mainly in that it: (AIIME Nov 2012) A Does not require monitoring of blood levels during therapy B Exerts significant bactericidal effects against anaerobes too C Has broadest spectrum against gram-negative bacilli D Lacks ototoxic potential Step to PG-MD/MS

86. Ans. C Has broadest spectrum against gram-negative bacilli a . Amikacin stands out among all the aminoglycosides in two main ways: it has the broadest spectrum against gram-negative bacilli, and it is least susceptible to bacterial enzymes that inactivate aminoglycosides and lead to resistance. Step to PG-MD/MS

87. 23. Resistance to Methicillin in the microorganism given in picture is due to Beta lactamase Efflux Altered Penicillin binding protein Mec A gene Step to PG-MD/MS

88. C) Altered Penicillin binding protein Grape like clusters in gram stain is due to Staphylococcus aureus , in which resistance is seen due to Penicillinase production But in Penicillinase Resistant penicillin like Methicillin , Resistance is due to Altered penicillin binding protein. Step to PG-MD/MS

89. 24. DOC for the given condition is Ceftriaxone Piperacillin Carbapenems Ceftazidime Step to PG-MD/MS

90. D. Ceftazidime This condition is known as Green Nail Syndrome caused By Pseudomonas - DOC ; Ceftazidime Step to PG-MD/MS

91. Q. DOC for condition given below A.Doxycycline B.Gentamycin C.Erythromycin D.Penicillin G Step to PG-MD/MS

92. Ans. C) Erythromycin This is Diphtheria DOC for Diphtheria is : Erythromycin Step to PG-MD/MS

93. NEMATODES DRUG OF CHOICE Round worm Albendazole Hook worm Albendazole Whipworm Albendazole Trichinella spiralis Albendazole Enterobius vermicularis Albendazole Dracunculiasis Albendazole Threadworm Ivermectin Onchocerca volvulus Ivermectin Filariasis DEC Loa loa DEC DRUG OF CHOICE Step to PG-MD/MS

94. DRUG OF CHOICE CESTODES DRUG OF CHOICE Neurocysticercosis Albendazole Echinococcus Albendazole T.Solium Praziquantel > Niclosamide T.Saginata Praziquantel > Niclosamide Hymenolepsis nana Praziquantel > Niclosamide Diphylobothrium latum Praziquantel > Niclosamide Step to PG-MD/MS

95. DRUG OF CHOICE TREMATODES DRUG OF CHOICE Liver fluke Triclabendazole Lung fluke Praziquantel Schistosoma Praziquantel Step to PG-MD/MS

96. Cutaneous Leishmaniasis Visceral Leishmaniasis ( Kala Azar ) Sodium stibogluconate (DOC) Amphotericin B (DOC) Amphotericin B Miltefosine Paromomycin Sodium stibogluconate Pentamidine Pentamidine Paromomycin Sitamaquine Step to PG-MD/MS

97. TRYPANOSOMIASIS LATE EFLORNITHINE BENZNIDAZOLE (DOC) EARLY PENTAMIDINE LATE Melarsoprol EARLY SURAMIN WEST EAST AMERICAN (CHAGAS DISEASE) AFRICAN SLEEPING SICKNESS Step to PG-MD/MS

98. VRE Daptomycin (DOC) Vancomycin (DOC) Ampicillin (DOC) Faecium Faecalis ENTEROCOCCUS Vancomycin (DOC) Step to PG-MD/MS

99. Step to PG-MD/MS