# Tutor profile: Mo L.

## Questions

### Subject: Pharmacy

F.S is a 59 -year-old man who comes to the clinic with a 3-day history of fever, chills, pleuritic chest pain, malaise, and productive cough. In the clinic, his temperature is 102.1°F (38.9°C) (all other vital signs are normal). His chest radiograph reveals consolidation in the right lower lobe. His white blood cell count (WBC) is 14,400 cells/mm3, but all other laboratory values are normal. He is given a diagnosis of community-acquired pneumonia (CAP). He has not received any antibiotics in 5 years and has no chronic disease states. Which is the best empiric therapy for F.S.? A. Doxycycline 100 mg orally twice daily. B. Cefuroxime axetil 250 mg orally twice daily. C. Levofloxacin 750 mg/day orally. D. Trimethoprim/sulfamethoxazole double strength orally twice daily.

Answer: A The patient has CAP that does not require hospitalization (CURB-65 score is 1 at most [no mention of mental status]). Because he has not received any antibiotics in the past 3 months and has no comorbidities, he is at low risk of DRSP. Therefore, the drug of choice is either a macrolide or doxycycline (Answer A is correct). Cefuroxime is not recommended for the treatment of CAP (Answer B is incorrect). Fluoroquinolones are recommended only if the patient has had recent antibiotics or has comorbidities (Answer C is incorrect). Trimethoprim/sulfamethoxazole is not used for CAP (Answer D is incorrect).

### Subject: Biology

What are the different types of cell divisions?

There are two main types of cell divisions namely mitosis and meiosis. Mitosis occurs mainly in somatic cells to form two genetically identical cells. It is the main division responsible for growth, asexual reproduction and the repair of worn out tissues. Meiosis happens in sex cells and produce four haploid genetically diverse gametes, which are essential for sexual reproduction.

### Subject: Statistics

Researchers planned a study to evaluate the percentage of subjects who achieved less than a target blood pressure (less than 140/90 mm Hg) when initiating therapy with two different doses of Drug ABC. In the study of 100 subjects, the ABC drug 50-mg group (n=50) and the ABC drug 100-mg group (n=50) were compared. The investigators used a blood pressure goal as their primary end point, defined as the percentage of subjects who successfully achieved the blood pressure goal at 3 months. Which is the most appropriate statistical test to answer such a question? A. Independent samples t-test. B. Chi-square or Fisher exact test. C. Wilcoxon signed-rank test. D. One-sample t-test.

Answer: B The primary end point in this study, the percentage of subjects at or below the target blood pressure, is nominal data. Subjects at target blood pressure (less than 140/90 mm Hg) are defined as having reached the target. This type of data requires either a chi-square test or a Fisher exact test (depending on the sample size or, more accurately, the number of counts in the individual contingency table cells) (Answer B is correct). An independent samples t-test is not appropriate because actual blood pressure values are not being compared (at least not in this question or this end point) (Answer A is incorrect). If we were comparing the actual blood pressure between the two groups, the test might be appropriate if parametric assumptions were met. The Wilcoxon signed-rank test is the appropriate nonparametric test for comparing paired samples (usually in a crossover trial) (Answer C is incorrect). Finally, a one-sample t-test is used to compare the mean of a single group with the mean of a reference group. This is also incorrect in this situation because two groups are being compared (Answer D is incorrect).