Question 1
Vignette: A 55-year-old male patient with a history of renal impairment and chronic hepatitis B infection is being evaluated for antiviral therapy. He has not received any antiviral treatments in the past. Which of the following medications is most appropriate for this patient?
A. Sofosbuvir
B. Ribavirin
C. Tenofovir
D. Acyclovir
E. Amantadine
Rationale: This drug is a nucleotide reverse transcriptase inhibitor indicated for the treatment of chronic hepatitis B and is suitable for patients with renal impairment, though dose adjustments may be necessary. Sofosbuvir is used for hepatitis C, not B. Ribavirin is also used for hepatitis C and can cause hemolytic anemia, which is not ideal in a patient with renal impairment. Acyclovir is indicated for herpes virus infections, and amantadine is used for influenza A and Parkinson’s disease, making them less appropriate choices for a patient with hepatitis B.
Question 2
Vignette: A 32-year-old female with recurrent genital herpes is seeking a prescription for an antiviral medication. She has no known drug allergies and no other health conditions. Which of the following medications would be most appropriate for her condition?
A. Valacyclovir
B. Lamivudine
C. Oseltamivir
D. Adefovir
E. Lopinavir
Rationale: This drug is an antiviral medication used for the treatment of herpes simplex virus infections, including recurrent genital herpes, due to its efficacy in reducing transmission and severity of outbreaks. Lamivudine is used for hepatitis B and HIV, Oseltamivir for influenza, Adefovir for hepatitis B, and Lopinavir for HIV/AIDS, making them less suitable for treating genital herpes.
Question 3
Vignette: A 45-year-old male with HIV/AIDS is experiencing virological failure on his current antiretroviral therapy regimen. He has a history of non-adherence. Which of the following regimens would be most appropriate to consider next?
A. Emtricitabine/Tenofovir/Elvitegravir/Cobicistat
B. Emtricitabine/Tenofovir/Alafenamide
C. Zidovudine/Lamivudine
D. Darunavir/Ritonavir
E. Abacavir/Lamivudine/Dolutegravir
Rationale: These drugs offer a potent regimen with a high barrier to resistance, which is suitable for patients experiencing virological failure and with a history of non-adherence. It is also preferred due to its once-daily dosing. The other options, while effective in certain contexts, either have lower barriers to resistance or are part of the patient’s failing regimen, making them less ideal in this scenario.
Question 4
Vignette: A pregnant woman at 36 weeks gestation has been diagnosed with influenza A. She is concerned about the safety of medications on her unborn child. Which of the following medications is recommended for the treatment of influenza A in pregnant women?
A. Amantadine
B. Ribavirin
C. Oseltamivir
D. Acyclovir
E. Valacyclovir
Rationale: This drug is recommended for the treatment of influenza A in pregnant women due to its efficacy and safety profile during pregnancy. Amantadine is not recommended due to potential adverse effects on the fetus. Ribavirin is contraindicated in pregnancy due to its teratogenic effects. Acyclovir and Valacyclovir are used for herpes virus infections, not influenza, making them inappropriate choices in this scenario.
Question 5
Vignette: A 23-year-old male with no significant medical history presents with symptoms of acute uncomplicated influenza. He reports symptom onset 48 hours ago. Which of the following medications is most appropriate for this patient?
A. Oseltamivir
B. Acyclovir
C. Ribavirin
D. Amantadine
E. Zanamivir
Rationale: This drug is indicated for the treatment of acute uncomplicated influenza in adults and children, including those with symptom onset within the last 48 hours, making it the most appropriate choice. Acyclovir is for herpes virus infections, Ribavirin for hepatitis C and respiratory syncytial virus, and Amantadine for influenza A (less commonly used due to resistance). Zanamivir could also be appropriate but is less commonly used due to its inhalation route of administration and risk of bronchospasm.
Question 6
Vignette: A 67-year-old female with chronic obstructive pulmonary disease (COPD) presents with confirmed respiratory syncytial virus (RSV) infection. She is experiencing severe symptoms. Which of the following medications is most appropriate for her condition?
A. Ribavirin
B. Oseltamivir
C. Acyclovir
D. Valacyclovir
E. Palivizumab
Rationale: This drug is an antiviral medication that can be used for the treatment of severe respiratory syncytial virus (RSV) infection, especially in high-risk or immunocompromised patients. Oseltamivir and Zanamivir are indicated for influenza, not RSV. Acyclovir and Valacyclovir are used for herpes virus infections, and Palivizumab is a monoclonal antibody used prophylactically against RSV in high-risk infants, not in treatment scenarios.
Question 7
Vignette: A 40-year-old male with chronic hepatitis C genotype 1a infection is evaluating treatment options with his healthcare provider. Which of the following medications is most appropriate for his hepatitis C genotype?
A. Sofosbuvir/Ledipasvir
B. Lamivudine
C. Adefovir
D. Ribavirin alone
E. Tenofovir
Rationale: This drug(s) is a direct-acting antiviral combination that is highly effective for the treatment of chronic hepatitis C genotype 1a, offering a high cure rate with a short course of therapy. Lamivudine, Adefovir, and Tenofovir are used for the treatment of hepatitis B, not C. Ribavirin alone is not effective for hepatitis C and is usually used in combination with other direct-acting antivirals.
Question 8
Vignette: A 58-year-old male with advanced HIV infection is experiencing renal insufficiency. Which of the following antiretroviral medications should be used with caution in this patient due to its potential nephrotoxic effects?
A. Abacavir
B. Tenofovir disoproxil fumarate
C. Emtricitabine
D. Lamivudine
E. Raltegravir
Rationale: This drug(s) is known for its potential nephrotoxic effects, particularly in patients with pre-existing renal insufficiency, and therefore should be used with caution or avoided in such patients. Dose adjustments or monitoring of renal function may be necessary. Abacavir, Emtricitabine, Lamivudine, and Raltegravir do not share this nephrotoxic profile and are generally considered safer in patients with renal impairment.
Question 9
Vignette: A 30-year-old female with no prior medical history presents to the clinic with a confirmed case of varicella-zoster virus (VZV) infection. She is experiencing severe pain and rash. Which of the following medications is most appropriate for the treatment of her condition?
A. Valacyclovir
B. Lamivudine
C. Oseltamivir
D. Ribavirin
E. Acyclovir
Rationale: This drug is an antiviral medication specifically indicated for the treatment of varicella-zoster virus (VZV) infections, which cause chickenpox and shingles, due to its efficacy in reducing the duration and severity of the disease. Valacyclovir, a prodrug of acyclovir, could also be appropriate, but acyclovir is the standard treatment. Lamivudine is for hepatitis B and HIV, Oseltamivir for influenza, and Ribavirin for hepatitis C and RSV, making them less suitable for treating VZV infections.
Question 10
Vignette: A 29-year-old male with newly diagnosed HIV infection has a CD4 count of 250 cells/mm³ and a high viral load. He is about to start antiretroviral therapy (ART). Which of the following regimens is recommended as an initial treatment regimen for this patient?
A. Darunavir/Ritonavir plus Tenofovir/Emtricitabine
B. Abacavir/Lamivudine for patients with a positive HLA-B5701 allele
C. Zidovudine/Lamivudine plus Atazanavir
D. Efavirenz/Tenofovir/Emtricitabine
E. Dolutegravir plus Abacavir/Lamivudine in patients without a positive HLA-B5701 allele
Rationale: These drug(s) are recommended initial treatment regimen for HIV infection due to its efficacy, once-daily dosing, and the overall safety profile. This regimen has been widely used and is preferred for its convenience and effectiveness in reducing viral load and increasing CD4 count. Darunavir/Ritonavir plus Tenofovir/Emtricitabine is also a potent option, but the simplicity and tolerability of Efavirenz-based therapy often make it a first choice for treatment-naive patients. Abacavir/Lamivudine is recommended only for patients without the HLA-B5701 allele due to the risk of hypersensitivity reactions, and Zidovudine is less favored due to its side effect profile. Dolutegravir plus Abacavir/Lamivudine is another effective regimen but requires HLA-B5701 allele testing prior to initiation.and Ribavirin for hepatitis C and RSV, making them less suitable for treating VZV infections.
Question 10
Vignette: A 29-year-old male with newly diagnosed HIV infection has a CD4 count of 250 cells/mm³ and a high viral load. He is about to start antiretroviral therapy (ART). Which of the following regimens is recommended as an initial treatment regimen for this patient?
A. Darunavir/Ritonavir plus Tenofovir/Emtricitabine
B. Abacavir/Lamivudine for patients with a positive HLA-B5701 allele
C. Zidovudine/Lamivudine plus Atazanavir
D. Efavirenz/Tenofovir/Emtricitabine
E. Dolutegravir plus Abacavir/Lamivudine in patients without a positive HLA-B5701 allele
Rationale: These drug(s) are recommended initial treatment regimen for HIV infection due to its efficacy, once-daily dosing, and the overall safety profile. This regimen has been widely used and is preferred for its convenience and effectiveness in reducing viral load and increasing CD4 count. Darunavir/Ritonavir plus Tenofovir/Emtricitabine is also a potent option, but the simplicity and tolerability of Efavirenz-based therapy often make it a first choice for treatment-naive patients. Abacavir/Lamivudine is recommended only for patients without the HLA-B5701 allele due to the risk of hypersensitivity reactions, and Zidovudine is less favored due to its side effect profile. Dolutegravir plus Abacavir/Lamivudine is another effective regimen but requires HLA-B5701 allele testing prior to initiation.