Paper II — 2023 July (Supplementary) (2019 Scheme) — Q6
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Paper II
2023 July (Supplementary) (2019 Scheme) · 100 marks · 180 min
Question
(
(a) Discuss the uses of Glucocorticoids.
( 4 mark(s)
(b) Describe the rationale in Combining antimicrobial agents in clinical practice. 4 mark(s)
Q68 marksShort Essays
Answer
a) Uses of glucocorticoids
Replacement therapy — Addison’s disease
Anti-inflammatory/immunosuppressive use — rheumatoid arthritis, SLE
Allergic emergencies — anaphylaxis, angioedema, severe asthma
Organ transplant rejection prophylaxis
Cerebral edema
Nephrotic syndrome
Antenatal fetal lung maturation in threatened preterm labour
b) Rationale for combining antimicrobial agents
Broadening empirical coverage — when the causative organism is unknown and the clinical situation is too urgent to await culture results.
Synergism — some combinations produce a killing effect greater than the sum of each drug’s individual effect (e.g. a beta-lactam’s cell-wall-weakening action improving an aminoglycoside’s access to its intracellular ribosomal target, exploited in treating enterococcal endocarditis).
Preventing emergence of resistance during therapy — particularly where resistant mutants can readily arise against a single agent (the core rationale for multi-drug antitubercular therapy).
Treating known polymicrobial infections — where no single agent covers every likely organism.
Combination therapy is not automatically superior to monotherapy — it carries real costs (increased toxicity, cost, and the risk of antagonism, where a bacteriostatic agent can blunt a bactericidal agent’s effect), so it is used only where one of the specific rationales above genuinely applies.
