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Impairs bacterial cell wall synthesis
10%
30/307
Inhibits transpeptidation and translocation
9%
29/307
Prevents conversion of RNA to DNA
11%
35/307
Requires activation by a viral protein
50%
155/307
Reversibly binds to 30S ribosomal subunit
27/307
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This patient who presents with painful vesicular lesions on the vulva with coalescence of several lesions into ulcers most likely has a herpes infection. Herpes simplex virus can be treated with acyclovir, which requires activation by viral thymidine kinase to be effective. Acyclovir is a guanosine analog that only functions after activation by a virally encoded thymidine kinase. The phosphorylated form of the drug subsequently impairs viral DNA polymerase and prevents further spread of the infection. It is used in the treatment of Herpes simplex virus and can be administered for both the oral and genital versions of this infection. Of note, genital herpes will present with multiple painful vesicles on an erythematous base. This can be distinguished from syphilis and lymphogranuloma venereum because the latter 2 have painless lesions. Chancroid can also present with a painful lesion but only a singular lesion. Incorrect Answers: Answer 1: Impairing bacterial cell wall synthesis describes the mechanism of action of penicillin, which can be used in the treatment of syphilis; however, this disease presents with a single painless lesion with nontender lymphadenopathy. Answer 2: Inhibiting transpeptidation and translocation describes the mechanism of action of macrolides such as azithromycin, which can be used in the treatment of chancroid; however, this disease will present with a singular painful lesion with tender lymph nodes. Answer 3: Prevents conversion of RNA to DNA describes reverse transcriptase inhibitors that are used the in the treatment of HIV. HIV infection can predispose patients to numerous opportunistic infections of the vagina and vulva; however, painful vesicles is more consistent with the presentation of herpes simplex virus, which can infect immunocompetent patients as well. Answer 5: Reversibly binding to 30S ribosomal subunit describes the mechanism of action of doxycycline, which can be used in the treatment of lymphogranuloma venereum; however, this disease will present with a singular painless ulcer with tender lymphadenopathy. Bullet Summary: Acyclovir is a guanosine analog that requires activation by a virally-encoded thymidine kinase before it can inhibit viral DNA polymerase.
3.8
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