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BMS3031 - Molecular mechanisms of disease - S1 2026

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During the early 20th century influenza pandemic, certain

viral strains adapted to humans by altering their preference for host cell

receptors. These changes affected both viral replication sites and transmission

efficiency.

Which viral adaptation would most plausibly explain

increased population‑level spread during human adaptation?

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Seasonal influenza vaccines must be reformulated each year

to maintain protection.  This requirement

reflects ongoing evolutionary changes in circulating influenza viruses that

affect how well prior immune responses recognise the virus.

Which explanation best accounts for the need to

update influenza vaccines annually?

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A pharmaceutical developer has identified a promising

antibiotic candidate with potent activity against highly drug‑resistant

bacterial pathogens. While early laboratory and animal data are encouraging,

the team anticipates significant obstacles when designing Phase III clinical

trials compared with trials for infections caused by drug‑susceptible

organisms.

Which issue most plausibly accounts for these difficulties?

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A biotechnology firm develops a novel antibiotic targeting

highly drug‑resistant pathogens. Although current therapies can

treat these infections, they are limited by significant adverse effects and

growing resistance. For its phase III clinical evaluation, the company designs

a non‑inferiority

trial rather than attempting to show that the new agent is more effective than

standard therapy.

What is the most appropriate justification for this trial

design?

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Despite the growing global threat of antimicrobial

resistance, many large pharmaceutical companies have reduced or exited

antimicrobial research and development. This trend contrasts with sustained

investment in areas such as oncology and chronic disease therapeutics.

Which factor most strongly explains this withdrawal?

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A clinical isolate of Acinetobacter baumannii

shows

reduced susceptibility to carbapenems. Genetic analysis reveals a nonsense

mutation in the gene

carO

, which encodes a porin protein involved in

antibiotic entry into the bacterial cell.

Which general mechanism best explains the observed

resistance?

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A patient in intensive care has a bloodstream infection

caused by a carbapenem-resistant

Acinetobacter baumannii s

train.  Initial treatment uses colistin, a polymyxin

antibiotic. During treatment, colistin resistance evolves. What is the most

likely mechanism of colistin resistance?  

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An ICU surveillance program detects a multidrug‑resistant

Acinetobacter baumannii i

solate causing septicaemia. Susceptibility

testing demonstrates poor activity of carbapenem antibiotics, while polymyxins

remain effective. Molecular analysis identifies a plasmid‑borne

gene encoding a β‑lactam–hydrolyzing

enzyme.

Which antimicrobial resistance mechanism best accounts for

this resistance pattern?

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A medicinal chemist is designing a new antibiotic intended

to treat infections caused by both Gram-positive and Gram-negative bacteria. To

maximise its clinical usefulness, the drug must reach bacterial targets

effectively while minimising harm to human cells.

Which combination of chemical features would most likely

result in an effective, broad-spectrum antibiotic?

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A patient is infected with a bacterial strain that shows

resistance to one of several commonly used antibiotics. Laboratory testing

reveals that the bacteria produce an enzyme that chemically modifies the

antibiotic by adding a phosphate group, preventing it from binding to its

bacterial target on the ribosome. The antibiotic is normally highly polar and

enters bacteria via specific transporters.

Which class of antibiotics is most likely

affected by this resistance mechanism?

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