Professional and Linguistic Assessments Board (PLAB) Practice Exam

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What is the first-line treatment for Pneumocystis carinii pneumonia?

Ampicillin
SMP/TMX (co-trimoxazole)
Ciprofloxacin
Doxycycline

The correct answer is: SMP/TMX (co-trimoxazole)

The first-line treatment for Pneumocystis carinii pneumonia, also known as Pneumocystis jirovecii pneumonia, is co-trimoxazole (SMP/TMX). This medication is a combination of sulfamethoxazole and trimethoprim, which works synergistically to inhibit bacterial folate synthesis. Pneumocystis jirovecii is a type of fungus that commonly causes opportunistic infections in immunocompromised patients, especially those with HIV/AIDS. Co-trimoxazole is effective due to its ability to interrupt the metabolic processes that the organism relies on for survival and replication. Its use is supported by numerous clinical guidelines, particularly in patients at high risk for such infections. Other options, while useful for different infections, do not have the same efficacy against Pneumocystis pneumonia. For example, ampicillin is more appropriate for bacterial infections, ciprofloxacin is a fluoroquinolone that targets other types of bacteria, and doxycycline is primarily effective against certain bacterial infections and some atypical pathogens but not the fungi responsible for Pneumocystis pneumonia.