Non-Bacterial Antimicrobials — Practice Questions

Pharmacology — Antivirals, Antifungals and Antiparasitics, NMC MBBS licence examination syllabus (Nepal Medical Council).

Antivirals, antifungals and antiparasitics — NMC-style practice questions

Practice questions written for this chapter. These are not past NMC papers.

📋 About these questions: These are practice questions written to test the reasoning in this chapter. They are NOT reproduced from any past Nepal Medical Council examination, and no verified past NMC questions were supplied for this chapter. All agents, doses and durations come from national guidance.

Level 1–2 — recall and understanding

Q1. Antifungal and antiviral drugs tend to be MORE toxic than antibacterials because: A. They are given at higher doses B. Viruses use our cellular machinery and fungi are EUKARYOTES — so there are fewer selective targets C. They are older drugs D. They are always given intravenously ANSWER: B. Why: bacteria have cell walls and distinct ribosomes that we lack. Viruses replicate inside our cells, and fungi and parasites are built much as we are. LEARNING POINT: expect renal, hepatic and marrow toxicity, and expect monitoring to be part of the prescription.

Q2. Which viral infection is CURABLE with modern antiviral therapy? A. HIV B. HEPATITIS C C. Herpes simplex D. Hepatitis B ANSWER: B — hepatitis C. Why: most antivirals suppress rather than eradicate. HIV needs lifelong therapy, herpes viruses remain latent, and hepatitis B is suppressed. Hepatitis C is the exception. LEARNING POINT: this is why finding hepatitis C is now worthwhile in a way it was not a decade ago.

Level 3–4 — application and clinical reasoning

Q3. A man stable on warfarin is started on an oral azole antifungal and develops bruising with a raised INR. The mechanism is: A. Warfarin resistance B. The azole INHIBITS HEPATIC ENZYMES, raising the warfarin level C. Vitamin K deficiency D. Poor adherence ANSWER: B. Why: azoles are enzyme inhibitors, so warfarin is metabolised more slowly and accumulates at an unchanged dose. Warfarin has a narrow therapeutic index. LEARNING POINT: check interactions before adding any drug to warfarin.

Q4. A patient on amphotericin has rising creatinine and falling potassium. This represents: A. An unexpected idiosyncratic reaction B. PREDICTABLE toxicity requiring close monitoring and electrolyte replacement C. Treatment failure D. Dehydration only ANSWER: B. Why: amphotericin is nephrotoxic and causes renal potassium and magnesium wasting. These are expected effects, not incidental findings. LEARNING POINT: also ask why this patient has invasive fungal disease — it implies immunocompromise.

Q5. A man requests antibiotics for three days of sore throat and coryza. He is systemically well. The best response is: A. Prescribe to maintain the relationship B. EXPLAIN the expected course, give SAFETY-NETTING advice and document the reasoning C. Refuse without explanation D. Prescribe a delayed course without discussion ANSWER: B. Why: antibacterials target structures viruses do not possess, so the prescription cannot help. But "no antibiotic" is a decision to be explained rather than a request denied. LEARNING POINT: say specifically what would change your assessment.

Level 5 — exception-based

Q6. Why can treating neurocysticercosis WORSEN a patient's symptoms? A. The drug is directly neurotoxic B. DYING CYSTS PROVOKE INFLAMMATION, worsening seizures and raising intracranial pressure C. It causes hypoglycaemia D. It does not — treatment is always safe ANSWER: B. Why: the host inflammatory response to dying parasites is the dangerous part, which is why treatment requires anti-inflammatory cover and anticonvulsant management. LEARNING POINT: this is a specialist decision, never an empirical outpatient prescription.

Q7. Why does mass deworming alone fail to control soil-transmitted helminths? A. The drugs are ineffective B. REINFECTION follows unless SANITATION improves — the drug treats the child, not the soil C. Children refuse treatment D. Resistance develops immediately ANSWER: B. Why: the environmental reservoir is untouched by treating individuals, so children are reinfected after treatment. LEARNING POINT: deworming sits alongside water and sanitation programmes rather than replacing them.

Syllabus points

Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions

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