Question

Julie W. is a junior dental hygiene student who had the misfortune to puncture her glove with a contaminated instrument. Although her patient tested negative for both hepatitis C and human immunodeficiency virus, the wound became badly infected. Her physician prescribed 500 mg of amoxicillin three times a day for 7 days, but at the end of 3 days, the infection is worse and is spreading. Julie feels too ill to attend classes, and she returns to the college’s health center to see the physician again. Her temperature is 103.4° F, her pulse rate is 110 bpm, and her cervical lymph nodes are swollen. The physician is concerned about the infection and admits Julie to the hospital. Her current medications include oral contraceptive pills and multivitamins.

1. Which bacteria are most likely responsible for the infection?

a. Staphylococcus aureus and Streptococcus viridans
b. Escherichia coli
c. Salmonella sp. and Shigella sp.
d. Clostridium difficile
  
2. Why has Julia’s infection not responded to the amoxicillin?
a. The amoxicillin should have been administered parenterally.
b. Amoxicillin is effective only against gram-negative organisms.
c. The bacteria have developed resistance to the antibiotic.
d. The dose was insufficient to treat the infection.

3. Laboratory tests show the presence of penicillinase in Julie’s blood. Which antibiotic would be indicated next?
a. Penicillin G
b. Ampicillin
c. Cloxacillin
d. Penicillin VK

4. Within hours after the first dose of cloxacillin, Julie becomes extremely nauseated and starts vomiting. Which type of reaction is she having to the medication?
a. Allergic reaction
b. Toxic reaction
c. Idiosyncratic reaction
d. Therapeutic reaction

5. In spite of the change in antibiotics, Julie’s condition continues to worsen, and the infection becomes life threatening. Her physician tells her family that they are going to administer an intravenous antibiotic that has not developed cross-resistance with other antibiotics because it has a different structure than other antibiotics. The physician also tells her family that this antibiotic is also used as a last resort against methicillin-resistant S. aureus. To which antibiotic is the physician referring?
a. Aminoglycosides
b. Vancomycin
c. Sulfonamides
d. Quinolones (fluoroquinolones)

Answer 1

Ans-1--- cl.difficile

Ans-2 Bacteria is resistand and this is no more effective against this

Ans-3 -D penicillin vk as this is new panicilline and effective agaist this enzyme

Ans-4. A allergic reaction as lots of penicillin have allergic reaction

Ans-5 b vancomycin is given to MRSA resistant case