Cephalosporins are a major class of beta-lactam antibiotics widely studied in pharmacology and therapeutics. Understanding cephalosporin generations, spectrum of activity, mechanism of action (PBP inhibition), pharmacokinetics, clinical uses, and resistance mechanisms is essential for B. Pharm students. Each generation shows predictable changes in Gram-positive and Gram-negative coverage, CSF penetration, and beta-lactamase stability; examples include cefalexin, cefuroxime, ceftriaxone, ceftazidime and ceftaroline. Key adverse effects (hypersensitivity, nephrotoxicity, disulfiram-like reactions) and drug interactions (probenecid, calcium concerns with ceftriaxone) are clinically relevant. This set of focused, application-oriented MCQs will reinforce mechanisms, generation-wise spectra, indications and safe prescribing principles. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. Which cephalosporin generation includes agents with significant MRSA activity?
- Cefalexin (first generation)
- Cefuroxime (second generation)
- Ceftaroline (fifth generation)
- Ceftazidime (third generation)
Correct Answer: Ceftaroline (fifth generation)
Q2. What is the primary mechanism of action of cephalosporins?
- Inhibition of bacterial protein synthesis at the 30S ribosomal subunit
- Disruption of folate synthesis by inhibiting dihydropteroate synthase
- Inhibition of cell wall synthesis by binding to penicillin-binding proteins (PBPs)
- Disruption of bacterial DNA gyrase
Correct Answer: Inhibition of cell wall synthesis by binding to penicillin-binding proteins (PBPs)
Q3. Which pharmacodynamic parameter best correlates with cephalosporin efficacy?
- Peak/MIC ratio
- Area under the curve (AUC)/MIC
- Time above MIC (T>MIC)
- Post-antibiotic effect duration
Correct Answer: Time above MIC (T>MIC)
Q4. Which cephalosporin is commonly used for surgical prophylaxis due to good Gram-positive activity and safety?
- Cefazolin
- Cefotaxime
- Ceftazidime
- Cefepime
Correct Answer: Cefazolin
Q5. Which generation of cephalosporins generally shows improved Gram-negative coverage compared to earlier generations?
- First generation
- Second generation
- Third and later generations
- Cephamycins only
Correct Answer: Third and later generations
Q6. Which cephalosporin is associated with a disulfiram-like reaction and hypoprothrombinemia risk?
- Cefotaxime
- Cefotetan
- Cefepime
- Ceftaroline
Correct Answer: Cefotetan
Q7. Which cephalosporin has excellent CSF penetration and is commonly used for bacterial meningitis?
- Ceftriaxone
- Cefalexin
- Cefazolin
- Cefuroxime axetil (oral)
Correct Answer: Ceftriaxone
Q8. Which cephalosporin is particularly active against Pseudomonas aeruginosa?
- Cefuroxime
- Ceftazidime
- Cefalexin
- Cefaclor
Correct Answer: Ceftazidime
Q9. Which cephalosporin is mainly eliminated by hepatic biliary excretion and often does not require renal dose adjustment?
- Ceftriaxone
- Cefazolin
- Cefepime
- Ceftazidime
Correct Answer: Ceftriaxone
Q10. Extended-spectrum beta-lactamases (ESBLs) typically confer resistance to which cephalosporins?
- Only first-generation cephalosporins
- Most penicillins but not cephalosporins
- Many third-generation cephalosporins
- Carbapenems only
Correct Answer: Many third-generation cephalosporins
Q11. Which cephalosporin is a cephamycin with notable anaerobic (Bacteroides) activity?
- Cefotaxime
- Cefoxitin
- Ceftaroline
- Cefalexin
Correct Answer: Cefoxitin
Q12. Which cephalosporin is a first-generation oral agent commonly used for uncomplicated skin and soft tissue infections and UTI?
- Cefalexin (cephalexin)
- Cefixime
- Cefotaxime
- Ceftriaxone
Correct Answer: Cefalexin (cephalexin)
Q13. A patient with severe penicillin allergy (anaphylaxis) needs a beta-lactam. Which statement is most accurate about cephalosporin cross-reactivity?
- All cephalosporins are safe in severe penicillin allergy
- Cross-reactivity is zero for third-generation cephalosporins
- There is a low but non-zero risk of cross-reactivity; use with caution
- Cephalosporins are absolutely contraindicated if any penicillin allergy exists
Correct Answer: There is a low but non-zero risk of cross-reactivity; use with caution
Q14. For febrile neutropenia empiric therapy targeting Gram-negative rods including Pseudomonas, which cephalosporin is preferred?
- Cefazolin
- Cefepime
- Cefuroxime
- Cefalexin
Correct Answer: Cefepime
Q15. Which cephalosporin combination includes a novel beta-lactamase inhibitor used against KPC and some carbapenemase-producers?
- Ceftazidime–avibactam
- Ceftriaxone–sulbactam
- Cefotaxime–clavulanate
- Cefazolin–tazobactam
Correct Answer: Ceftazidime–avibactam
Q16. Which adverse effect is most characteristic of cephalosporins as a class?
- Ototoxicity as dose-limiting toxicity
- Hypersensitivity reactions ranging from rash to anaphylaxis
- Severe bone marrow suppression universally
- Hepatocellular carcinoma risk
Correct Answer: Hypersensitivity reactions ranging from rash to anaphylaxis
Q17. Which cephalosporin is recommended as first-line therapy for uncomplicated gonorrhea (current guidelines vary; select classic single-dose injectable agent)?
- Ceftriaxone
- Cefalexin
- Cefuroxime axetil
- Cefaclor
Correct Answer: Ceftriaxone
Q18. Which generation of cephalosporins is classically best at treating community-acquired Gram-positive infections like streptococci and MSSA?
- First generation
- Third generation
- Fourth generation
- Fifth generation only
Correct Answer: First generation
Q19. Which laboratory monitoring concern is particularly relevant with some cephalosporins that share a methoxy group (cephamycins and cefotetan)?
- QT interval prolongation monitoring
- Prothrombin time/INR monitoring for hypoprothrombinemia
- Liver enzyme monitoring due to high hepatotoxicity risk
- Serum magnesium monitoring
Correct Answer: Prothrombin time/INR monitoring for hypoprothrombinemia
Q20. Which resistance mechanism involves bacterial enzymes that hydrolyze cephalosporins and other beta-lactams and can be plasmid-mediated?
- Altered ribosomal target site
- Efflux pump overexpression only
- Extended-spectrum beta-lactamases (ESBLs)
- Reduced cell wall thickness
Correct Answer: Extended-spectrum beta-lactamases (ESBLs)
Q21. Which cephalosporin is an effective option for community-acquired pneumonia and has good activity against Streptococcus pneumoniae and good tissue penetration?
- Ceftriaxone
- Ceftazidime
- Cefalexin
- Cefoxitin
Correct Answer: Ceftriaxone
Q22. Which cephalosporin has enhanced activity against Gram-negative organisms and improved stability to many beta-lactamases and is often used in nosocomial infections?
- Cefuroxime
- Cefepime
- Cefalexin
- Cefaclor
Correct Answer: Cefepime
Q23. Which cephalosporin is least likely to require dosage adjustment in renal impairment?
- Cefazolin
- Cefepime
- Ceftriaxone
- Ceftazidime
Correct Answer: Ceftriaxone
Q24. What effect does probenecid have on many cephalosporins when co-administered?
- Decreases cephalosporin absorption from the gut
- Increases renal excretion of cephalosporins
- Reduces urinary concentrations of cephalosporins
- Decreases renal tubular secretion and increases plasma levels
Correct Answer: Decreases renal tubular secretion and increases plasma levels
Q25. Which cephalosporin is particularly indicated for complicated intra-abdominal infections due to activity against anaerobes?
- Cefuroxime
- Cefoxitin
- Ceftaroline
- Cefalexin
Correct Answer: Cefoxitin
Q26. Which statement about cephalosporins and bactericidal activity is correct?
- Cephalosporins are bactericidal because they inhibit protein synthesis
- Cephalosporins are bacteriostatic at therapeutic doses
- Cephalosporins are bactericidal by inhibiting cell wall synthesis
- Cephalosporins require host immune system to be effective and have no direct killing
Correct Answer: Cephalosporins are bactericidal by inhibiting cell wall synthesis
Q27. Which cephalosporin is specifically useful in treating complicated urinary tract infections and has stability against many Pseudomonas strains when combined with tazobactam?
- Ceftolozane–tazobactam
- Cefazolin–clavulanate
- Cefotaxime–sulbactam
- Cefalexin–tazobactam
Correct Answer: Ceftolozane–tazobactam
Q28. Which cephalosporin generation marked a major improvement in CSF penetration and Gram-negative bacilli coverage, often used for serious systemic infections?
- First generation
- Second generation
- Third generation
- Fifth generation only
Correct Answer: Third generation
Q29. Which clinical use is most appropriate for cefuroxime axetil (oral second-generation cephalosporin)?
- Oral therapy for uncomplicated otitis media and sinusitis
- First-line for MRSA skin infections
- Empiric therapy for meningitis in neonates
- Primary therapy for Pseudomonas bloodstream infections
Correct Answer: Oral therapy for uncomplicated otitis media and sinusitis
Q30. Which cephalosporin adverse event is important in neonates and infants, particularly with concurrent calcium-containing IV solutions?
- Risk of hemolytic anemia
- Kernicterus and precipitation with calcium-containing solutions (neonatal risk)
- Severe peripheral neuropathy
- Marked hyperglycemia
Correct Answer: Kernicterus and precipitation with calcium-containing solutions (neonatal risk)
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
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