P3 core exam 2 questions

Which of the following represents a patient with uncomplicated Staphylococcus aureus bacteremia? A. 26-year-old woman with no significant past medical history who developed a central line-associated MSSA bacteremia while being treated in the ICU for pancreatitis B. 44-year-old man with a history of IV drug use with MRSA bacteremia and tricuspid infective endocarditis C. 44-year-old man with persistent MSSA bacteremia secondary to prosthetic joint infection D. 68-year-old woman with MRSA bacteremia and an infected cardiac implantable electronic devi

A. 26-year-old woman with no significant past medical history who developed a central line-associated MSSA bacteremia while being treated in the ICU for pancreatitis to meet criteria for uncomplicated or low-risk S. aureus bacteremia, all of the following criteria must be met: (1) sterile repeat blood cultures 48 to 96 hr after the initial positive culture, (2) defervescence within 72 hr after initiation of active therapy, (3) exclusion of infective endocarditis/secondary metastatic infection, (4) no implanted prostheses (eg, prosthetic valves, cardiac devices, or arthroplasties), (5) not dependent on hemodialysis

Which of the following represents the most likely primary source for Escherichia coli bacteremia? A. Urogenital procedure B. Skin and soft tissue infection C. Community acquired pneumonia D. Total knee arthroplasty

A. Urogenital procedure enterobacterales, which includes E. coli, bacteremia is most likely caused by genitourinary or gastrointestinal or respiratory tract sources, as well as translocation from genitourinary or gastrointestinal due to disruption or procedure

Which situation is most likely to lead to "culture-negative" infective endocarditis? A. Use of antimicrobials prior to blood culture sampling B. Gram-negative bacteria from the HACEK group (eg, Kingella kingae) C. Non-bacterial etiologies (eg, fungi) D. Unidentified subacute, left-sided infective endocarditis

A. Use of antimicrobials prior to blood culture sampling "Culture-negative" infective endocarditis describes a patient in whom a clinical diagnosis of infective endocarditis is likely, but blood cultures do not yield a pathogen, which is most often due to previous antimicrobial therapy

35-year-old man with a history of injection drug use was admitted with fevers and rigors and blood cultures revealed gram-positive cocci in pairs and clusters. He has no known drug allergies, has normal renal function, and appears in no apparent distress. Which of the following is the MOST appropriate empiric antibacterial therapy? A. Vancomycin B. Cefazolin C. Nafcillin D. Piperacillin/tazobactam

A. Vancomycin empirical therapy in patients with suspected S. aureus bacteremia based on gram-positive cocci in pairs and clusters from blood cultures, prior to susceptibility results, should include active against MRSA with either vancomycin or daptomycin in the majority of cases due to the increased rate of MRSA identified in hospital- and community-acquired bacteremias

Which of the following most likely represents a patient with true bacteremia? A. 62-year-old man admitted for diabetic ketoacidosis with Staphylococcus epidermidis isolated from 1 of 4 blood culture bottles B. 22-year-old woman with a history of intravenous drug use with Staphylococcus aureus isolated from 2 of 4 blood culture bottles C. 58-year-old woman admitted with a newly diagnosed DVT and Bacillus spp. isolated from both sets of blood cultures D. 99-year-old man admitted for failure to thrive with Staphylococcus haemolyticus isolated from 2 of 4 blood culture bottles

B. 22-year-old woman with a history of intravenous drug use with Staphylococcus aureus isolated from 2 of 4 blood culture bottles Staphylococcus aureus should always be considered pathogenic whereas Staphylococcus epidermidis, Staphylococcus haemolyticus, and Bacillus spp., are unlikely pathogens when recovered from blood cultures

In which of the following patients could intravenous antimicrobial therapy be transitioned to oral antimicrobial therapy to yield similar safety and efficacy outcomes? A. 65-year-old man with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia after recent total hip arthroplasty B. 23-year-old woman with a pan susceptible Klebsiella pneumoniae bacteremia due to pyelonephritis C. 47-year-old woman with fluoroquinolone-resistant Pseudomonas aeruginosa lifeport associated bacteremia D. 62 year old man with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia due right lower extremity osteomyelitis

B. 23-year-old woman with a pan susceptible Klebsiella pneumoniae bacteremia due to pyelonephritis Oral antimicrobial therapy is not recommended for patients with Staphylococcus aureusbacteremia. Although oral antimicrobial therapy can be used for gram-negative bacteremia, fluoroquinolones are the only oral option for Pseudomonas aeruginosa

In which of the following patients would short course (7 days) of treatment for gram-negative bacteremia be most appropriate? A. 24-year-old woman with a history of intravenous drug use with Enterobacter cloacae bacteremia and a paravalvular abscess B. 66-year-old woman with Escherichia coli bacteremia due a urinary tract infection C. 30-year-old man with Serratia marcescens bacteremia due to recent lumbar fusion D. 40-year-old man with Pseudomonas aeruginosa bacteremia complicated by a prosthetic valve endocarditis

B. 66-year-old woman with Escherichia coli bacteremia due a urinary tract infection Patients with uncomplicated gram-negative bacteremia can be treated with 7 days of antimicrobial therapy

Which of the following are the two MOST important parameters for the diagnosis of infective endocarditis? A. Laboratory abnormalities and positive blood cultures B. Positive blood cultures and echocardiographic changes C. Electrocardiogram changes and positive physical findings D. Positive physical findings and positive blood cultures

B. Positive blood cultures and echocardiographic changes Based on the Modified Duke Criteria, diagnosis of definite infective endocarditis requires positive blood cultures and evidence of endocardial involvement

Which of the following is associated with the highest risk of developing infective endocarditis? A. Mitral valve prolapse with regurgitation B. Presence of a prosthetic heart valve C. Rheumatic fever without valvular defects D. Intravenous drug abuse

B. Presence of a prosthetic heart valve

Which statement is TRUE concerning echocardiography in the diagnosis of infective endocarditis? A. A negative transthoracic echocardiogram (TTE) excludes a diagnosis of infective endocarditis B. Transesophageal echocardiogram (TEE) has better sensitivity than transthoracic echocardiogram (TTE) for detecting vegetations C. Transesophageal echocardiogram (TEE) is unnecessary in patients with congenital heart disease, previous endocarditis, new murmur, or heart failure D. Transesophageal echocardiogram (TEE) has good sensitivity but poor specificity for detecting vegetations

B. Transesophageal echocardiogram (TEE) has better sensitivity than transthoracic echocardiogram (TTE) for detecting vegetations echocardiography is critical in diagnosis of infective endocarditis transthoracic echocardiograms (TTE) are performed first due to accessibility, transthoracic echocardiograms (TEE) are more sensitive and specific (90%-100% and 40%-66%, respectively) TEE should be performed in patients with CHD, previous endocarditis, new murmur, heart failure, or other stigmata of infective endocarditis

76-year-old man with a history of dental abscess was admitted to the clinic with persistent fever and malaise for the last month. A transthoracic echocardiogram (TTE) revealed a large mitral valve vegetation. Which of the following is the MOST likely etiology? A. Group A streptococci B. Viridans group streptococci C. Staphylococcus epidermidis D. Enterococcus faecalis

B. Viridans group streptococci Viridans group streptococci are common inhabitants of the human mouth and gingiva, and they are especially common causes of endocarditis involving native valves which presents in a subacute fashion

What is the most common organism causing infective endocarditis? A. Candida albicans B. Enterococcus faecalis C. Staphylococcus aureus D. Viridans group streptococcus

C. Staphylococcus aureus

Which of the following would be the MOST appropriate antimicrobial regimen for methicillin-resistant Staphylococcus aureus (MRSA) prosthetic valve infective endocarditis? A. Vancomycin 15 mg/kg IV every 12 hours for 6 weeks B. Vancomycin 15 mg/kg IV every 12 hours plus gentamicin 1 mg/kg IV every 8 hours for 6 weeks C. Vancomycin 15 mg/kg IV every 12 hours and rifampin 300 mg po every 8 hours for 6 weeks plus gentamicin 1 mg/kg IV every 8 hr for the first 2 weeks D. Doxycycline 100 mg IV every 12 hours and rifampin 300 mg po every 8 hours for 6 weeks plus gentamicin 1 mg/kg IV every 8 hours for the first 2 weeks

C. Vancomycin 15 mg/kg IV every 12 hours and rifampin 300 mg po every 8 hours for 6 weeks plus gentamicin 1 mg/kg IV every 8 hr for the first 2 weeks 6 Weeks of IV vancomycin and PO rifampin should be combined with 2 weeks of IV gentamicinin patients with methicillin-resistant Staphylococcus aureus (MRSA) prosthetic valve endocarditis

Which of the following represents the MOST appropriate events in the management of Staphylococcus aureus bacteremia? A. infectious diseases consultation, source control, appropriate antimicrobial therapy B. echocardiography, repeat blood cultures, appropriate antimicrobial therapy C. infectious diseases consultation, echocardiography, source control, repeat blood cultures, appropriate antimicrobial therapy D. infectious diseases consultation, echocardiography, repeat blood cultures, appropriate antimicrobial therapy

C. infectious diseases consultation, echocardiography, source control, repeat blood cultures, appropriate antimicrobial therapy treatment of S. aureus bacteremia includes source control, consultation with infectious diseases, echocardiography to evaluate for infective endocarditis, repeat blood cultures, and appropriate antimicrobial therapy

The following are true regarding initiation of anti-infective therapy in acute CNS infection, EXCEPT: A. Empiric anti-infective therapy should be initiated as soon as possible after a diagnosis is suspected. B. Blood samples should be collected before administration of anti-infective agents. C. Supportive care including fluids, electrolytes, antipyretics, and antiemetics should also be given during treatment for possible CNS infections. D. Corticosteroids should not be initiated until a final diagnosis of meningitis is confirmed.

D. Corticosteroids should not be initiated until a final diagnosis of meningitis is confirmed.

A patient presents with complaints of fevers, chills, malaise, and dyspnea for the past 2 days. A grade 3/6 systolic murmur and thin, linear hemorrhages under the fingernail beds are discovered on examination. Based on these findings, the patient is suspected to have infective endocarditis. Which of the following would be the MOST appropriate empirical antimicrobial regimen? A. Cefazolin 2 g IV every 8 hours B. Vancomycin 15 mg/kg IV every 12 hours C. Vancomycin 15 mg/kg IV every 12 hours plus ampicillin/sulbactam 3 g IV every 6 hours D. Vancomycin 15 mg/kg IV every 12 hours plus ceftriaxone 2 g IV every 12 hours

D. Vancomycin 15 mg/kg IV every 12 hours plus ceftriaxone 2 g IV every 12 hours in patients with acute presentations of infective endocarditis, IV vancomycin should be combined with ceftriaxone to cover the most common causes of infective endocarditis, staphylococci, streptococci, enterococci, and aerobic gram-negative bacilli

The appropriate duration of antimicrobial treatment for acute contamination of the abdomen without established infection is: a. 24 hours or less b. 10 days c. 3 days d. 4-7 days

a. 24 hours or less

Which of the following statements regarding initial empiric vancomycin therapy in febrile neutropenic patients with cancer is FALSE? a. All initial empiric regimens should contain vancomycin. b. Patients with evidence of IV catheter infections may benefit from initial empiric therapy with vancomycin. c. Decreased mortality from penicillin-resistant viridans streptococcal infections has been observed with initial empiric vancomycin therapy. d. If empiric vancomycin therapy is initiated and no evidence of gram-positive infection is found after 24 to 48 hours, vancomycin should be discontinued.

a. All initial empiric regimens should contain vancomycin vancomycin may be included as part of the initial empiric antimicrobial regimen in carefully selected patients, but is not appropriate for all patients with neutropenic fever and should not be routinely used in all cases

A 45-year-old female undergoes hematopoietic stem cell transplantation for advanced metastatic breast cancer and develops cytomegalovirus (CMV) disease 2 months after transplantation. She is started on ganciclovir 5 mg/kg intravenously every 12 hours. The most important ganciclovir-related adverse effect that should be carefully monitored for in this patient would be: a. Bone marrow suppression b. Mucositis c. Nephrotoxicity d. Central nervous system toxicities

a. Bone marrow suppression although considered the drug of choice for most patients with invasive CMV disease, ganciclovir's potential for myelosuppressive toxicity is an important consideration in patients who have undergone HCT

A patient presents with an abscess in the abdomen, most likely associated with a perforated diverticulum in the colon. Which of the following would be the most appropriate initial antimicrobial regimen? a. Ceftriaxone plus metronidazole b. Clindamycin c. Ampicillin-sulbactam d. Gentamicin plus metronidazole

a. Ceftriaxone plus metronidazole most likely pathogens based on anatomical location, nature of infection are Streptococcus, anaerobes such as Bacteroides, and Enterobacterales aminoglycoside is unnecessary for this patient and carries significant toxicity risk increasing resistance rates among enterobacterales among amp-sulbactam

According to current guidelines, what class of antimicrobials would be indicated for treatment in a 62-year-old patient with confirmed enterocolitis due to a Salmonellaspecies? a. Cephalosporin b. Aminoglycoside c. Macrolide d. Carbapenem

a. Cephalsporin Treatment strategies for salmonellosis include ceftriaxone, ciprofloxacin, or ofloxacin. Of these options, ceftriaxone is a cephalosporin and the fluoroquinolones are not listed as an option

Which of the following antibiotic regimens is/are preferred for managing episodes of febrile neutropenia in low-risk patients? a. Ciprofloxacin plus amoxicillin/clavulanate b. Vancomycin plus levofloxacin c. Ciprofloxacin plus clindamycin d. Metronidazole plus moxifloxacin

a. Ciprofloxacin plus amoxicillin/clavulanate oral ciprofloxacin plus amoxicillin/clavulanate is the preferred antibiotic regimen for treatment of neutropenic fever in low-risk patients due to appropriate antibacterial coverage and favorable data from clinical studies

Which of the following statements regarding diagnosis of Clostridium difficileinfection (CDI) is/are TRUE? a. Diagnosis of CDI requires presence of bacterial-released toxin and a host response to that toxin. b. Testing for toxin production in CDI with solid, formed stools is appropriate to ensure eradication of the organism. c. CDI diagnosis requires anaerobic cultures for confirmation. d. All of the above are true.

a. Diagnosis of CDI requires presence of bacterial-released toxin and a host response to that toxin. Diagnosis of C. difficile infections require symptoms and a positive toxin test. Cultures are not recommended and solid stools should never be tested for C. difficile

Compared to monotherapy, which of the following is TRUE regarding the use of empiric dual-gram-negative coverage for high-risk febrile neutropenic patients: a. Dual therapy is associated with a greater risk of drug-related adverse effects b. Dual therapy is associated with a greater risk of breakthrough resistant infections c. Dual therapy is associated with a lower risk of 30-day mortality d. Dual therapy is associated with a lower risk of secondary fungal infections

a. Dual therapy is associated with a greater risk of drug-related adverse effects dual, or combination, initial therapy of febrile neutropenia has not been proven to improve overall patients outcomes but may result in increased rates of adverse drug effects compared to β-lactam monotherapy

Recommended prophylaxis for traveler's diarrhea should include which of the following? a. Education on proper food and personal hygiene b. Famotidine 20 mg orally twice daily while traveling c. Ciprofloxacin 750 mg orally once daily while traveling d. All of the above should be recommended

a. Education on proper food and personal hygiene

A 68-year-old man, KL, with a long-standing history of poorly controlled diabetes mellitus, is admitted to the medical floor of a hospital with a diagnosis of community-acquired pneumonia. His most recent ABG is as follows: pH 7.30, PCO2 34 mm Hg (4.5 kPa), HCO3− 15 mEq/L (mmol/L), and PO2 80 mm Hg (10.6 kPa), and his most recent serum labs demonstrate Na 135 mEq/L (mmol/L), K 5.4 mEq/L (mmol/L), Cl 116 mEq/L (mmol/L), TCO2 15 mEq/L (mmol/L), and blood glucose 146 mg/dL (8.1 mmol/L). KL is found to be hypertensive (BP 170/92 mm Hg) and the medical resident asks if there is an antihypertensive that should be avoided in KL based on the underlying condition contributing to KL's current acid-base status. Which agent should be avoided in KL at this time? a. Enalapril b. Clonidine c. Hydralazine d. Amlodipine

a. Enalapril underlying etiology of Type IV RTA is aldosterone deficiency or aldosterone resistance and present with hyperkalemia medications such as ACE inhibitors should be avoided

Which of the following is considered a first-line antibiotic therapy for ESBL E. coli pneumonia? a. Ertapenem b. Tobramycin c. Cefepime d. Ceftriaxone

a. Ertapenem

Which of the following statements is/are TRUE regarding CDI prevention? a. Hand washing with soap and water can help prevent person-to-person transmission of CDI. b. Room disinfection after a CDI patient is discharged must be performed with alcohol-based cleaners. c. C. difficile spores survive only hours outside the host, so time is another method of preventing CDI transmission. Respiratory precautions (masks and face shields) should be utilized when entering and taking care of a CDI patient. None of the above are true.

a. Hand washing with soap and water can help prevent person-to-person transmission of CDI Rooms must be fully cleaned with chlorine-based disinfectants. C. difficile spores can remain on surfaces for long periods of time so caution needs to be taken with any possible infectious patient. respiratory precautions are not necessary for C. difficile patients

All of the following are true regarding infections caused by Candida species EXCEPT: a. Infections are associated with a low rate of mortality when appropriate antifungal therapy is promptly initiated as soon as a patient becomes febrile. b. While C. albicans remains the most common species causing infection, other species, including C. glabrata and C. parapsilosis, have become more common. c. The role of antifungal prophylaxis in the surgical ICU remains extremely controversial. d. Prophylactic antifungals are indicated in patients with recurrent intestinal perforations and/or anastomotic leak. e. Alternatives to fluconazole should be considered when patients have a history of recent exposure to fluconazole or other azoles, and when non-albicans species are isolated.

a. Infections are associated with a low rate of mortality when appropriate antifungal therapy is promptly initiated as soon as a patient becomes febrile Unfortunately, mortality due to invasive candidiasis remains high, despite available antifungal therapies. This may be a reflection of the underlying comorbidity of patients who are at risk for developing candidiasis, such as critically ill surgical patients and those with significant immunocompromise

Which of the following statements regarding rehydration therapy in a patient with gastroenteritis is FALSE? a. Intravenous fluid replacement is indicated in all pediatric patients with infectious diarrhea. b. Glucose and other simple sugars in high concentrations can worsen diarrhea in a patient acutely ill with gastroenteritis. c. If a patient presents with gastroenteritis and an ileus, intravenous fluid replacement is indicated. d. None of the above are FALSE.

a. Intravenous fluid replacement is indicated in all pediatric patients with infectious diarrhea. Fluid replacement therapy should be instituted for all patients with infectious diarrhea. However, intravenous therapy is not required in pediatric or adult patients unless certain severity criteria are met

Which of the following antibiotic regimens is preferred for the initial management of an episode of febrile neutropenia in a hemodynamically stable patient with a MASCC score <21? a. Intravenous piperacillin/tazobactam b. Intravenous cefepime plus ciprofloxacin c. Intravenous meropenem plus vancomycin d. Intravenous ceftaroline

a. Intravenous piperacillin/tazobactam patients with MASCC score <21 should be initially treated with broad-spectrum intravenous therapy that covers gram-negative bacteria (including Pseudomonas aeruginosa) as well as gram-positive bacteria however, monotherapy is as effective as combination regimens for initial therapy and is preferred in most patients

In children <2 years of age and adults >50 years of age, empiric coverage of which of the following pathogen is recommended? a. Listeria monocytogenes b. Legionella pneumophila c. Neisseria meningitidis d. Mycoplasma pneumoniae

a. Listeria monocytogenes primarily affects neonates, alcoholic or immunocompromised individuals (including pregnant women), and the elderly

Identify the correct statement: a. Mild-to-moderate community-acquired complicated intra-abdominal infections DO NOT require empiric coverage for Enterococcus spp. b. Empiric coverage for methicillin-resistant Staphylococcus aureus is routinely required for healthcare-associated complicated intra-abdominal infections. c. Empiric coverage for Candida spp. is routinely required for high-risk/severe community-acquired complicated intra-abdominal infections. d. Empiric coverage for Candida spp. is routinely required for mild-to-moderate community-acquired complicated intra-abdominal infections.

a. Mild-to-moderate community-acquired complicated intra-abdominal infections DO NOT require empiric coverage for Enterococcus spp.

Which of the following is the most common cause of bronchiolitis? a. Respiratory syncytial virus b. Parainfluenza virus c. Mycoplasma d. Adenovirus

a. Respiratory syncytial virus

The main rationale for the inclusion of vancomycin to the empiric regimen of non-healthcare-associated bacterial meningitis is for covering possible resistant: a. Streptococcus pneumoniae b. Staphylococcus aureus c. Enterococcus facium d. Listeria monocytogenes

a. Streptococcus pneumoniae

The generally recommended duration of intravenous antibiotic treatment of meningitis caused by Streptococcus pneumoniaea is: a. 7 days b. 10-14 days c. 4-6 weeks d. 12-18 weeks

b. 10-14 days

All of the following statements regarding fungal disease are correct EXCEPT: a. Histoplasma capsulatum exists as mycelial forms at room temperature and yeast forms at body temperature. b. All patients with early coccidioidal infections should be treated aggressively to prevent disseminated disease. c. Blastomycosis often involves skin, bones, joints, and genitourinary tract. d. Histoplasmosis may result in mediastinal fibrosis. e. Pregnant women are at high risk for developing disseminated coccidioidomycosis

b. All patients with early coccidioidal infections should be treated aggressively to prevent disseminated disease approximately 60% of patients infected with Coccidioides have an asymptomatic, self-limited infection patients with disease located outside the lung should generally receive therapy regarding isolated pulmonary disease, patients with a large inoculum, severe infection, or concurrent risk factors probably should be treated

Identify the INCORRECT statement regarding complicated healthcare-associated intra-abdominal infections in adults. a. Microbiologic results and the patient's history of infecting organisms should guide empiric antibiotic therapy. b. Ampicillin-sulbactam is appropriate for the treatment of complicated healthcare-associated, complicated intra-abdominal infections. c. Piperacillin-tazobactam is appropriate for the treatment of healthcare-associated complicated intra-abdominal infections. d. Ertapenem is appropriate for the treatment of complicated healthcare-associated intra-abdominal infections.

b. Ampicillin-sulbactam is appropriate for the treatment of complicated healthcare-associated, complicated intra-abdominal infections. lacks pseudomonas coverage which is required in health care associated infections

Which of the following would be the most appropriate therapy for the treatment of Mycoplasma pneumonia in a patient with compliance issues and currently receiving theophylline? a. Erythromycin b. Azithromycin c. Clindamycin d. Clarithromycin

b. Azithromycin recommended treatment of Mycoplasma pneumonia is a macrolide clarithromycin and erythromycin have been shown to increase serum concentrations of theophylline and increase the risk of toxicity

Which of the following would be appropriate empiric antibiotic therapy for a patient being admitted to the intensive care unit requiring mechanical ventilation due to community-acquired pneumonia? a. Ceftriaxone b. Ceftriaxone + azithromycin c. Levofloxacin d. Levofloxacin + azithromycin

b. Ceftriaxone + azithromycin empiric treatment of severe CAP should consist of combination therapy with a β-lactam backbone

A 23-year-old woman who is not severely ill and is otherwise in good health is determined to have a perforated appendix. Which of the following is the best antimicrobial regimen for this patient? a. Cefazolin plus vancomycin b. Ceftriaxone plus metronidazole c. Aztreonam plus vancomycin d. Cefazolin plus gentamicin

b. Ceftriaxone plus metronidazole

Which of the following regimens is reliably active against both Enterobacterales such as E. coli AND anaerobes such as Bacteroides fragilis? a. Levofloxacin b. Ceftriaxone plus metronidazole c. Cefepime plus clindamycin d. Ampicillin/sulbactam

b. Ceftriaxone plus metronidazole levo and amp/sul are less likely to be active against enterobacterales, clindamycin does not have reliable bacteroids coverage

Visual changes observed in patients during voriconazole therapy: a. Can cause permanent damage to the retina if therapy is continued for greater than 2 weeks. b. Generally do not require discontinuation of the drug. e. Are observed in less than 1% of patients. d. Do not decrease or disappear despite continued therapy. e. Are not associated with changes in electroretinogram tracings.

b. Generally do not require discontinuation of the drug Photopsia is a unique side effect to voriconazole, is common, and often decreases in severity or disappears with continued therapy no permanent damage to the retina has been demonstrated

Which of the following supportive agent has been associated with increased mortality in patients with bacterial meningitis? a. Mannitol b. Glycerol c. 3% hypertonic saline d. Levetiracetam

b. Glycerol

When assessing infections caused by Candida species: a. Candidemia is a rare cause of bloodstream infections in hospitals. b. Mortality associated with infections due to C. auris appears to be quite high. c. The proportion of infections caused by C. albicans has increased, while those caused by non-albicans species has decreased. d. C. glabrata resistance to azoles is rare, and does not "cross" to other azoles. e. Combination therapy is routinely recommended.

b. Mortality associated with infections due to C. auris appears to be quite high C. auris is an emerging pathogen and has been associated with poor outcomes the proportion of infections caused by non-albicans species has increased, most notably C. glabrata, which is complicated by its cross-resistance to the azole class of antifungals

Which of the following viral causes of infectious gastroenteritis could be seen during the winter months and would be common in adults? a. Rotavirus b. Norovirus c. Astrovirus d. Coronavirus

b. Norovirus

Which of the following antipseudomonal agent is NOT included in the recommended regimen for the treatment of healthcare-associated meningitis and ventriculitis? a. Meropenem b. Piperacillin-tazobactam c. Cefepime d. Ceftazidime

b. Piperacillin-tazobactam not recommended because tazobactam does not penetrate BBB

Which of the following would be the most preferred antimicrobial agents in the treatment of aspiration pneumonia in a hospitalized patient with a necrotizing lesion on chest radiograph? a. Clindamycin and ceftriaxone b. Piperacillin/tazobactam and vancomycin c. Cefepime d. Ceftriaxone

b. Piperacillin/tazobactam and vancomycin coverage P. aeruginosa is required in this patient because the aspiration occurred in the hospital coverage of MRSA is also required because the hospital MRSA prevalence is unknown at this time anaerobic coverage is indicated in patients with aspiration pneumonia who have signs of anaerobic pneumonia on imaging, such as a necrotizing lesion or abscess

Risk factors for invasive candidiasis include all of the following EXCEPT: a. Long ICU stay. b. Prior infection with P. aeruginosa. c. The use of total parenteral nutrition (TPN). d. The presence of acute renal failure. e. The presence of central venous catheter.

b. Prior infection with P. aeruginosa major risk factors for invasive candidiasis include the use of central venous catheters, total parenteral nutrition, multifocal Candida colonization, and extensive surgery while receipt of multiple antibiotics is also a risk factor for candidiasis, prior bacterial infection has not been identified as a strong risk factor for subsequent development of invasive candidiasis

What is the MOST important risk factor for development of severe infections in cancer patients? a. Alteration of normal flora by chemotherapy and antimicrobial therapy b. Prolonged neutropenia c. Severe mucositis d. Humoral and cellular immune system defects

b. Prolonged neutropenia although the other listed factors are important, the duration of neutropenia is the most critical risk factor for the development of severe infections in cancer patients

A 31-year-old man, LG, was found to be unresponsive and apneic and transferred to the emergency department. His arterial blood gas (ABG) sample on arrival revealed the following: pH 7.08, PCO2 80 mm Hg (10.6 kPa), and HCO3− 23 mEq/L (mmol/L). His serum labs demonstrated Na 130 mEq/L (mmol/L); Cl 111 mEq/L (mmol/L), and TCO2 23 mEq/L (mmol/L). His acid-base disturbance is: a. Respiratory acidosis with an elevated anion gap b. Respiratory acidosis with a normal anion gap c. Metabolic acidosis with a normal anion gap d. Metabolic acidosis with an elevated anion gap

b. Respiratory acidosis with a normal anion gap the pH is less than 7.35 indicating acidosis. The PCO2 is elevated (greater than 40 mm Hg [5.3 kPa]), indicating primary respiratory disorder the anion gap is calculated as AG = Na+ - (Cl− + HCO3−) = 130 mEq/L - (111 mEq/L + 23 mEq/L) = -4 (normal) the etiology is hypoventilation due to the patient being unresponsive and apneic leading to hypercarbia and respiratory acidosis

A 77-year-old female presents to the Emergency Department with increased bilateral lower extremity swelling, fatigue, and dyspnea upon exertion consistent with heart failure exacerbation. Due to the COVID-19 pandemic, she has been eating more canned goods and ordering take out, so she doesn't have to go to the grocery store and risk exposure. Her heart failure is managed outpatient with furosemide, metoprolol, and lisinopril. She increased her furosemide to twice daily dosing 5 days ago. Her most recent ABG is as follows: pH 7.51, PCO248 mmHg (6.4 kPa), HCO3− 40 mEq/L (mmol/L), and PO2 85 mm Hg (11.3 kPa), and her most recent serum labs demonstrate Na 133 mEq/L (mmol/L), K 3 mEq/L (mmol/L), Cl 91 mEq/L (mmol/L), and TCO2 40 mEq/L (mmol/L). Urine chloride is less than 10 mEq/L (mmol/L). Her acid-base disturbance is: a. Acute respiratory alkalosis b. Saline responsive metabolic alkalosis c. Saline resistant metabolic alkalosis d. Chronic respiratory alkalosis

b. Saline responsive metabolic alkalosis pH is greater than 7.45 indicating alkalosis HCO3- is high indicating primary metabolic process urine chloride is less than 10 mEq/L indicating saline responsive etiology is increased furosemide dosing

Plasma level monitoring of antifungals ... a. Rarely is necessary unless toxicity is observed. b. Should probably be performed in all patients receiving long-term voriconazoletherapy for aspergillosis. c. Probably is needed for fluconazole, voriconazole, and caspofungin because the efficacy and toxicity of these agents correlate with peak levels. d. Is only necessary in patients receiving fluconazole therapy for CNS infections. e. Is not useful for voriconazole since neither efficacy nor toxicity is correlated with plasma concentrations.

b. Should probably be performed in all patients receiving long-term voriconazoletherapy for aspergillosis. therapeutic drug monitoring (TDM) is rarely performed or indicated in patients receiving fluconazole, echinocandins, or amphotericin B products TDM is warranted in most patients receiving voriconazole due to significant pharmacokinetic variability and correlations of clinical success and toxicity to levels

Which of the following is most correct regarding administration of IV sodium bicarbonate to a patient with septic shock who has a high anion gap metabolic acidosis and an arterial pH of 7.15? a. Sodium bicarbonate use will reduce mortality. b. Sodium bicarbonate use may paradoxically reduce intracellular pH. c. Sodium bicarbonate use will reduce the efficacy of norepinephrine. d. Sodium bicarbonate IV is indicated for a patient with a pH of 7.3.

b. Sodium bicarbonate use may paradoxically reduce intracellular pH sodium bicarbonate IV is indicated in severe metabolic acidosis defined as a pH less than 7.2 CO2 diffuses more readily compared to bicarb leading to paroxdoxial reduction in intracellular pH and produces an increased risk of intracellular acidosis ADRs

RH is a 68-year-old male who is 6 months status post allogeneic hematopoietic stem cell transplantation, complicated by graft-versus-host disease. As his most recent chest radiograph indicates that he has invasive pulmonary aspergillosis that appears unresponsive to his current therapy with liposomal amphotericin B, his physician wishes to place RH on combination therapy with voriconazole and anidulafungin. Which of the following statements is most correct regarding RH's therapy? a. As RH's amphotericin B regimen has resulted in an elevated serum creatinine, his anidulafungin dosage may need to be decreased, as anidulafungin is eliminated primarily via the kidneys. b. The dosage of the patient's tacrolimus will likely require adjustment, given the CYP3A4 inhibition of voriconazole. c. Fluconazole would be a more appropriate choice than voriconazole to cover aspergillosis. d. Prophylaxis with posaconazole would not have been recommended in this patient, and would not have potentially prevented the development of aspergillosis. e. Combination therapy with voriconazole and anidulafungin is not recommended, as a clinical trial identified higher failure rates with this combination than with voriconazole monotherapy, suggesting a pharmacodynamic interaction.

b. The dosage of the patient's tacrolimus will likely require adjustment, given the CYP3A4 inhibition of voriconazole. antifungal prophylaxis with posaconazole has been shown to significantly reduce the risk of aspergillosis in high-risk patients such as RH while combination therapy with voriconazole and anidulafungin is controversial, it has demonstrated a trend towards improved survival anidulafunginis not predominantly renally eliminated and thus does not require renal dose adjustment, but voriconazole is a significant inhibitor of several CYP enzyme systems

SM is a 34-year-old woman currently being treated with voriconazole for invasive pulmonary aspergillosis caused by Aspergillus fumigatus. She develops a skin rash, which you believe due to voriconazole. Which of the following statements is most correct regarding appropriate antifungal therapy for SM? a. An echinocandin should not be utilized, as its chemical structure is similar to that of azole antifungal agents such as fluconazole. b. Therapy with an echinocandin (caspofungin or micafungin) is unlikely to cause a rash in this patient, as echinocandins are chemically unrelated to azole antifungal agents. c. Micafungin should not be utilized as an alternative agent in this patient, as it demonstrates poor in vitro and in vivo activity against A. fumigatus. d. Caspofungin could be utilized as an alternative agent in SM, as it demonstrates excellent in vitro and in vivo activity against Aspergillus fumigatus; however, SM is likely to experience a rash due to cross-sensitivity between azoles and echinocandin antifungals. e. Micafungin would not be an appropriate alternative agent in this patient, as it demonstrates very poor efficacy in the treatment of pulmonary aspergillosis.

b. Therapy with an echinocandin (caspofungin or micafungin) is unlikely to cause a rash in this patient, as echinocandins are chemically unrelated to azole antifungal agents. echinocandins are a distinct class of agents from the azole antifungals, structurally, mechanistically, and in terms of common toxicities they are not preferred options for the treatment of invasive aspergillosis, they may be considered in patients refractory to or intolerant of other therapies (rash)

In patients with primary peritonitis, bacteria may enter the abdomen via all of the following routes, EXCEPT: a. Through a cerebrospinal-peritoneal shunt b. Through the damage done to the GI tract by blunt trauma c. Through the bloodstream when there is no damage to the GI tract d. Through a peritoneal dialysis catheter

b. Through the damage done to the GI tract by blunt trauma damage from trauma = secondary peritonitis

Patients undergoing hematopoietic stem cell transplantation are routinely recommended to receive all of the following vaccinations within 2 years of transplant, EXCEPT: a. Haemophilus influenzae type B vaccine b. Varicella vaccine c. 23-valent pneumococcal vaccine d. Influenza vaccine

b. Varicella vaccine VZV-seronegative patients undergoing HCT may be considered for receipt of the varicella vaccine to prevent primary infection however, due to the live-virus nature of the product the varicella vaccine should generally not be administered within at least 24 months following transplantation

According to the Infectious Diseases Society of America, the recommended treatment regimen for a 40-year-old patient with suspected acute, community-acquired bacterial meningitis consists of: a. Cefazolin, vancomycin, and levofloxacin b. ceftriaxone and vancomycin c. Ceftriaxone, ampicillin, and aminoglycoside d. Ceftriaxone and ampicillin

b. ceftriaxone and vancomycin

The most important component of treatment of a perforated appendix is: a. Using the best antimicrobial regimen b. Aggressive IV fluid therapy c. A surgical procedure, including drainage and repair d. Enteral nutrition supplementation

c. A surgical procedure, including drainage and repair uncomplicated appendicitis may be treated nonsurgically, with antibiotics alone. however, if perforated, drainage and repair is required to decrease morbidity SOURCE CONTROL

Which of the following would be considered optimal therapy for community-acquired acute cholecystitis? a. Meropenem b. Ciprofloxacin c. Ceftriaxone d. Cefepime

c. Ceftriaxone Streptococcus and Enterobacterales coverage is required for this indication, ceftriaxone provides good coverage for both cefepime and meropenem are incorrect because Pseudomonas coverage is not needed ciprofloxacin is not ideal given a significant risk of Enterobacterales resistance and poor Streptococcus coverage

A 45-year-old female, AR, is transferred to the intensive care unit with septic shock due to acute peritonitis. Her ABG sample revealed the following: pH 7.25, PCO2 29 mm Hg (3.9 kPa), and HCO3− 15 mEq/L (mmol/L). Her serum labs demonstrated Na 142 mEq/L (mmol/L); Cl 105 mEq/L (mmol/L), and TCO2 15 mEq/L (mmol/L), lactate 5.8 mEq/L (mmol/L). Which statement is most true regarding the expected compensation for AR's acid-base disturbance? a. Compensation is initiated within days through increased renal elimination of bicarbonate. b. Compensation is initiated within hours through renal accumulation of bicarbonate. c. Compensation is initiated within hours through increased respiratory rate. d. Compensation is initiated within days through decreased respiratory rate.

c. Compensation is initiated within hours through increased respiratory rate. this patient is presenting with elevated anion gap metabolic acidosis due to septic shock in such cases, the lungs will increase the RR which decreases the PCO2 in order to restore the pH to normal - respiratory compensation begins within minutes to hours

All of the following infections would be anticipated during the immediate period (within approximately 1 month) after lung transplantation, EXCEPT: a. Surgical wound infections b. Pneumonia c. Cytomegalovirus (CMV) disease in a patient who was CMV-seronegative before transplantation d. Reactivation of herpes simplex virus (HSV) infection in a patient who was HSV-seropositive before transplantation

c. Cytomegalovirus (CMV) disease in a patient who was CMV-seronegative before transplantation infections in the immediate post-transplant period typically involve infections at the site of the transplant, infections of the transplanted organ itself, or reactivation of existing infections cytomegalovirus-related disease typically occurs 1 to 6 months after transplantation

Which of the following pathogens should be highly suspected when prescribing empiric antimicrobial therapy to a newborn? a. Mycoplasma b. Group A Streptococcus c. Group B Streptococcus d. Pseudomonas

c. Group B Streptococcus because Group B Streptococcus is a normal colonizing bacteria of the vaginal epithelium- they get infected at birth

Which of the following is considered a first-line antibiotic therapy for MRSA pneumonia? a. Daptomycin b. Clindamycin c. Linezolid d. Telavancin

c. Linezolid 1st line for MRSA pneumonia = vancomycin and linezolid

Prophylaxis of candidemia: a. Is recommended in all non-neutropenic patients who are admitted to the ICU. b. Is recommended in neutropenic patients for 1 week prior to and 6 months after they become neutropenic. c. May be indicated in patients with recurrent intestinal perforations and/or anastomotic leaks. d. Should never be utilized since the risk of antifungal resistance is increasing rapidly and our antifungal armamentarium is limited. e. Is unnecessary, since prompt initiation of antifungal therapy in patients with clinical, laboratory, or radiologic surrogate markers of infection results in high rates of clinical success.

c. May be indicated in patients with recurrent intestinal perforations and/or anastomotic leaks. Prophylaxis of candidemia, especially in non-neutropenic patients, is controversial. Given the high mortality of invasive candidiasis, studies have attempted to delineate whether prophylaxis in certain patient populations could improve outcomes. Unfortunately, clinical trials in these settings have generally not been successful, although one small study did identify a benefit in patients with recurrent intestinal perforations and/or anastomotic leaks

Which of the following requires the empiric coverage of anaerobes? a. Primary (spontaneous) bacterial peritonitis b. Community-acquired acute cholecystitis c. Mild-to-moderate community-acquired complicated intra-abdominal infection d. Peritoneal dialysis-associated peritonitis

c. Mild-to-moderate community-acquired complicated intra-abdominal infection

Which of the following statements is FALSE? a. Antimicrobial regimens for secondary intra-abdominal infections should cover a broad spectrum of aerobic and anaerobic bacteria. b. Antimicrobial treatment of acute bacterial contamination after trauma to the GI tract is adequately treated with an antianaerobic cephalosporin. c. Most patients should not complete their antimicrobial regimen orally after an uncomplicated secondary intra-abdominal infection. c. Four to 7 days of antimicrobial treatment is typically adequate for intra-abdominal infections with adequate source control.

c. Most patients should not complete their antimicrobial regimen orally after an uncomplicated secondary intra-abdominal infection.

Which of the following would be the most appropriate empiric therapy for hospital-acquired pneumonia in a patient who has not received antibiotics in the past 90 days in a hospital with an MRSA prevalence of 10%? a. Ceftriaxone b. Vancomycin c. Piperacillin/tazobactam d. Cefepime + vancomycin

c. Piperacillin/tazobactam only choice C provides coverage for both MSSA and P. aeruginosa without providing unnecessary MRSA coverage need MRSA coverage if prevalence >20%

In the absence of a complicating bacterial infection, which of the following is the MOST appropriate approach to treating acute bronchitis? a. Prescribing broad-spectrum antibiotics b. Routinely recommending non-prescription cough and cold preparations c. Providing symptomatic and supportive care d. Discouraging hydration and bed rest

c. Providing symptomatic and supportive care acute bronchitis is typically self limiting, limited evidence to support non-prescription cough and cold, most likely viral (no abx)

Which of the following organisms should be routinely treated empirically in patients with high-risk/severe community-acquired complicated intra-abdominal infection? a. Vancomycin-resistant Enterococcus spp. b. Methicillin-resistant Staphylococcus aureus c. Pseudomonas aeruginosa d. Acinetobacter baumannii

c. Pseudomonas aeruginosa

Which of the following is NOT a risk factor for multidrug-resistant ventilator-associated pneumonia? a. Receipt of intravenous antibiotics in the past 90 days b. Acute respiratory distress syndrome preceding VAP onset c. Receipt of a blood transfusion in the past 90 days d. Receipt of renal replacement therapy prior to VAP onset

c. Receipt of a blood transfusion in the past 90 days

Which of the following is a risk factor for multidrug-resistant hospital-acquired pneumonia? a. Receipt of intravenous chemotherapy in the past 90 days b. Receipt of corticosteroids in the past 90 days c. Receipt of intravenous antibiotics in the past 90 days d. Receipt of highly active antiretroviral therapy (HAART) in the past 90 days

c. Receipt of intravenous antibiotics in the past 90 days

Which of the following causes of dysentery diarrhea currently has an available vaccine in the United States that may prevent some species of the disease? a. Shigellosis b. Campylobacteriosis c. Salmonellosis d. Yersiniosis e. None of the above have available vaccine

c. Salmonellosis

The most common bacterial microorganism(s) causing infections in neutropenic cancer patients is/are: a. Klebsiella pneumonia and Escherichia coli b. Pseudomonas aeruginosa c. Staphylococci and streptococci d. Clostridium species

c. Staphylococci and streptococci although infection with many different bacterial pathogens are possible and/or relatively common, the majority of infections are caused by gram-positive bacteria including staphylococci and streptococci

Which of the following pathogen is the leading cause of acute bacterial meningitis in adults in the western societies? a. Streptococcus group B b. Neisseria meningitides c. Streptococcus pneumoniae d. Haemophilus influenzae

c. Streptococcus pneumoniae

Which of the following statements regarding the treatment of E. coli-related infectious diarrhea is FALSE? a. Initial treatment should include appropriate hydration with low-osmolar or isotonic fluid replacement. b. the use of antimotility agents, like loperamide, could potentially increase diarrheal symptoms due to prolonged exposure to bacterial toxin. c. Using fluoroquinolone agents for treatment of this infection is appropriate when bloody stools are present and serotype is undetermined. d. None of the above are FALSE

c. Using fluoroquinolone agents for treatment of this infection is appropriate when bloody stools are present and serotype is undetermined. preference would be to avoid antimicrobials, if possible, or obtain serotype testing prior to initiating antimicrobial therapy with fluoroquinolones or any potential agent

The most reasonable initial intraperitoneal empiric antimicrobial therapy for a 46-year-old male patient with peritoneal dialysis-associated peritonitis and a history of immediate hypersensitivity reaction (reaction occurred within the last year) to penicillin is: a. Cefazolin plus ceftazidime (LD 500 mg/L, MD 125 mg/L for each) b. Cefepime (LD 500 mg/L, MD 125 mg/L) c. Vancomycin (LD 1,000 mg/L, MD 25 mg/L) plus tobramycin (LD 8 mg/L, MD 4 mg/L) d. Metronidazole (LD 250 mg/L, MD 50 mg/L)

c. Vancomycin (LD 1,000 mg/L, MD 25 mg/L) plus tobramycin (LD 8 mg/L, MD 4 mg/L) cefepime monotherapy is reasonable empiric therapy; however, the patient's immediate hypersensitivity reaction to penicillin precludes cefepime use response A is also incorrect for the same reason and furthermore using two cephalosporins at the same time is suboptimal Metronidazole only covers anaerobes which are not likely to be causative of this syndrome

An appropriate regimen for the treatment of confirmed invasive pulmonary aspergillosis in a neutropenic cancer patient would be: a. Fluconazole 800 mg intravenously × one dose, followed by 400 mg intravenously once daily b. Liposomal amphotericin B 1 mg/kg intravenously once daily c. Voriconazole 6 mg/kg intravenously twice daily × two doses, followed by 4 mg/kg intravenously twice daily d. All of the above would be appropriate regimens for the stated patient

c. Voriconazole 6 mg/kg intravenously twice daily × two doses, followed by 4 mg/kg intravenously twice daily voriconazole is the preferred agent for initial therapy of invasive Aspergillus infections, including pulmonary aspergillosis, because of proven efficacy and fewer toxicities compared to amphotericin B products

Which of the following is NOT one of the most common causes of viral encephalitis in the United States? a. Arbovirus b. Herpes simplex virus c. Zika virus d. Enterovirus

c. Zika virus

For the treatment of CNS infection due to inhaled Bacillus anthracis, CDC recommended: a. ≥3 antibiotics with activity against Bacillus anthracis c. Anthrax Vaccine Adsorbed c. Antitoxin (raxibacumab or AIGIV) d. All of the above

d. All of the above

All of the following are appropriate antibiotic de-escalation strategies for antimicrobial coverage after a period of febrile neutropenia, EXCEPT: a. Antibiotics can be discontinued after an appropriate duration for the isolated organism and site, provided neutropenia has resolved b. In low-risk patients, empiric therapy can be de-escalated to an oral regimen after 2 days of intravenous therapy provided the patient is now afebrile and has no evidence of infection c. In high-risk patients, empiric therapy should be de-escalated to narrow spectrum agents once an organism is isolated to prevent antibiotic resistance d. All of the above are appropriate antibiotic de-escalation strategies

d. All of the above are appropriate antibiotic de-escalation strategies all of the given options are potentially appropriate de-escalation strategies depending on laboratory results, clinical response to therapy, and continued risk factors for infection in individual patients, for example, continued neutropenia

Patients undergoing hematopoietic cell transplantation are at significant risk for infection in all of the following scenarios, EXCEPT: a. Primary or recurrent Varicella Zoster Virus infection in a patient with graft-versus-host disease b. Cytomegalovirus (CMV) infection in a CMV-seronegative recipient receiving stem cell donations from a CMV-seropositive donor c. Candida or Aspergillus infections in patients receiving allogeneic hematopoietic cell transplants d. All of the above are scenarios in which patients are at high risk of infection

d. All of the above are scenarios in which patients are at high risk of infection patients undergoing HCT are at high risk for a wide variety of infections due to prolonged periods of profound immunosuppression these infections include reactivation of existing infections as well as diseases caused by acquisition of new bacterial, viral, and fungal pathogen

Treatment for an adult with campylobacteriosis that started having bloody diarrhea 2 days ago should be initiated on which of the following medication? a. Ciprofloxacin b. Doxycycline c. Metronidazole d. Azithromycin e. No antimicrobial therapy is warranted

d. Azithromycin Because the patient is showing signs of dysentery diarrhea, antimicrobial therapy is often recommended for campylobacteriosis. Here the preferred agent is a macrolide and azithromycin would be the preferred option

All of the following antimicrobials are reasonable options for prophylaxis of infections in a HCT recipient expected to be profoundly neutropenic for >7 days, EXCEPT: a. Levofloxacin b. Posaconazole c. Acyclovir d. Aztreonam

d. Aztreonam prophylaxis with orally administered, systemically available antibiotics is effective at reducing gram-negative infections and is recommended for selected high-risk patients prophylaxis with antiviral and antifungal agents may also be appropriate in selected high-risk patients

A 44-year-old moderately dehydrated female was admitted with a two-day history of acute severe diarrhea. Her most recent ABG is as follows: pH 7.31, PCO2 28 mm Hg (3.7 kPa), pO2 93 mm Hg (12.4 kPa), HCO3− 16 mEq/L (mmol/L), O2 saturation 94% [0.94], and her most recent serum labs demonstrate Na 134 mEq/L (mmol/L), K 3.1 mEq/L (mmol/L), Cl 108 mEq/L (mmol/L), TCO2 15 mEq/L (mmol/L), BUN 31 mg/dL (11.1 mmol/L), creatinine 1.5 mg/dL (133 µmol/L). Baseline creatinine is 0.7 mg/dL (62 µmol/L). What is the most appropriate treatment of choice for this patient with normal anion gap metabolic acidosis? a. Replace bicarbonate deficit with sodium bicarbonate intravenously during the first 24 hours of admission. b. Replace ½ the bicarbonate deficit with sodium bicarbonate intravenously during the first 24 hours of admission. c. Replace bicarbonate deficit with bicarbonate oral solution during the first 24 hours of admission. d. Correct the underlying cause. Bicarbonate therapy not indicated.

d. Correct the underlying cause. Bicarbonate therapy not indicated this patient does not have an indication for IV sodium bicarbonate due to pH (pH greater than 7.2) and current clinical condition fluid resuscitation and treatment for diarrhea is indicated

Which of the following is TRUE regarding chronic bronchitis? a. The majority of patients who suffer from chronic bronchitis have a negative smoking history. b. N-acetylcysteine should be routinely prescribed to treat associated bronchospasm. c. Given the low incidence of bacterial resistance, broad-spectrum antibiotics are rarely employed. d. During acute exacerbations, the use of antimicrobial is controversial; however, patients with prominent symptoms may benefit.

d. During acute exacerbations, the use of antimicrobial is controversial; however, patients with prominent symptoms may benefit. acute exacerbations of chronic bronchitis may benefit from antimicrobial therapy if patients have two of the three symptoms: increase in shortness of breath, increase in sputum, and increase in purulent sputum use of antimicrobials should also take into account risk factors and severity of symptoms

Which of the following statements is TRUE regarding the treatment of bronchiolitis? a. The routine use of systemic corticosteroids should be encouraged. b. The use of aerosolized albuterol is associated with significant improvement in a majority of patients. c. Due to its clinical efficacy, ribavirin should be routinely prescribed. d. Hypertonic saline has proven efficacy after 1 day of use.

d. Hypertonic saline has proven efficacy after 1 day of use. management of bronchiolitis includes symptomatic and supportive care options based on the severity of symptoms use of bronchodilators and steroids have not shown significant benefit and may cause harm Ribavirin is not recommend for routine use but may be considered for severely ill patients

Therapeutic drug monitoring is recommended during use of all of the following agents, EXCEPT: a. Voriconazole b. Vancomycin c. Posaconazole d. Isavuconazonium

d. Isavuconazonium therapeutic drug monitoring of isavuconazonium is not currently recommended due to lack of recommended target concentrations and unavailability of drug assays

Which of the following is the best choice for complicated intra-abdominal infections due to extended-spectrum β-lactamase-producing Enterobacterales? a. Tigecycline b. Sulfamethoxazole/trimethoprim c. Polymyxin B or Colistin d. Meropenem

d. Meropenem tigecycline should be reserved for patients who have no other therapeutic options given the potential for increased risk of toxicity and mortality polymyxins should also be reserved for patients with multidrug-resistant pathogens where no other agents are active ESBL plasmids usually resistance to sulf/tri

A 68-year-old man, KL (weight: 70 kg; height: 69 in. [175 cm]), with a long-standing history of poorly controlled diabetes mellitus, is admitted to the medical floor of a hospital with a diagnosis of community-acquired pneumonia. His most recent ABG is as follows: pH 7.30, PCO2 34 mm Hg (4.5 kPa), HCO3− 15 mEq/L (mmol/L), and PO2 80 mm Hg (10.6 kPa), and his most recent serum labs demonstrate Na 135 mEq/L (mmol/L), K 5.4 mEq/L (mmol/L), Cl 116 mEq/L (mmol/L), TCO2 15 mEq/L (mmol/L), and blood glucose 146 mg/dL (8.1 mmol/L). He is hemodynamically stable. His acid-base disturbance is: a. Respiratory alkalosis b. Metabolic alkalosis c. Respiratory acidosis d. Metabolic acidosis

d. Metabolic acidosis pH is less than 7.35 indicating acidosis PCO2 is low = metabolic ---- if it was respiratory PCO2 and HCO3 would be high the HCO3- is low indicating primary metabolic disorder the calculated AG = 135 mEq/L - (116 mEq/L + 15 mEq/L) = 4 which is considered normal

A 31-year-old male presents with lethargy, weakness, confusion, and rapid breathing. He has had type 1 diabetes mellitus for 15 years and has been suffering from the "intestinal flu" for a day or so, for which he has been avoiding food to help prevent further vomiting and "make his stomachache go away." Since he stopped eating, he thought that it would be a good idea to stop taking his insulin. When seen in the emergency department his urine dipstick was positive for both glucose and ketones and his breath had a strange sweet, fruity smell. The following ABG data were obtained: pH 7.26, PCO2 23 mm Hg (3.1 kPa), and HCO3− 10 mEq/L (mmol/L). His most recent serum chemistries are as follows: Na 140 mEq/L (mmol/L), Cl 100 mEq/L (mmol/L), K 4.5 mEq/L (mmol/L), TCO2 11 mEq/L (mmol/L), and glucose 793 mg/dL (44 mmol/L). His acid-base disturbance is: a. Metabolic alkalosis (normal anion gap) due to rapid breathing b. Metabolic alkalosis (elevated anion gap) due to inadequate oral intake c. Metabolic acidosis (normal anion gap) due to vomiting d. Metabolic acidosis (elevated anion gap) due to diabetic ketoacidosis

d. Metabolic acidosis (elevated anion gap) due to diabetic ketoacidosis pH is less than 7.35 indicating acidosis. HCO3- is low indicating primary metabolic disorder AG = 140 mEq/L - (100 mEq/L + 11 mEq/L) = 29 which is elevated presence of ketones in the urine dipstick, fruity breath, history of type 1 diabetes mellitus, stopping insulin therapy, and glucose of 793 mg/dL

According to current (2009) Infectious Diseases Society of America guidelines, initial antifungal therapy for Candida bloodstream infections: a. Is similar for all Candida species. b. Should always be initiated with fluconazole, due to its low cost and excellent safety profile. c. Should always be initiated with echinocandins, since resistance rates of Candidaspecies to fluconazole are high. d. Should take into consideration whether the patient is unstable or severely immunocompromised, has a history of recent exposure to fluconazole or other azoles, or if non-albicans species are suspected. e. Should be initiated as recommended in all patients, prior to obtaining positive blood cultures, if they are critically ill and not responding to antibacterial agents

d. Should take into consideration whether the patient is unstable or severely immunocompromised, has a history of recent exposure to fluconazole or other azoles, or if non-albicans species are suspected Echinocandins are generally preferred as initial antifungal therapy for candidemia, but fluconazole may be appropriate in patients who are not severely ill, have no recent azole exposure, and who are unlikely to have a fluconazole-resistant isolate

Community-acquired bacterial pneumonia is most commonly caused by: a. Staphylococcus aureus b. Listeria monocytogenes c. Legionella species d. Streptococcus pneumoniae

d. Streptococcus pneumoniae

A 31-year-old man, LG, was found to be unresponsive and apneic and transferred to the emergency department. His ABG sample on arrival revealed the following: pH 7.08, PCO2 80 mm Hg (10.6 kPa), and HCO3− 23 mEq/L (mmol/L). His serum labs demonstrated Na 130 mEq/L (mmol/L); Cl 111 mEq/L (mmol/L), and TCO2 23 mEq/L (mmol/L). Which statement is MOST true about extracellular buffering? a. The bicarbonate buffer system is the most important because it is not dependent on the amount of bicarbonate filtered by the kidney. b. The carbonic acid buffer system plays a minimal role given the low amount of CO2produced by the body. c. The stomach plays an important role given its ability to easily adjust the amount of gastric acid produced. d. The phosphate buffer system plays a limited role given the low concentrations of extracellular phosphate.

d. The phosphate buffer system plays a limited role given the low concentrations of extracellular phosphate extracellular phosphate is present in low concentrations, its usefulness as an extracellular buffering system is limited the bicarbonate/carbonic acid buffer system is the most important buffer system in the body

Which of the following is appropriate empiric therapy for a patient with VAP who is currently in septic shock? a. Vancomycin + piperacillin/tazobactam b. Piperacillin/tazobactam + tobramycin c. Linezolid + ertapenem + ciprofloxacin d. Vancomycin + cefepime + tobramycin

d. Vancomycin + cefepime + tobramycin empiric therapy for patients with VAP who are currently in septic shock should cover MRSA and double cover P. aeruginosa because septic shock is considered an MDR risk factor in patients with VAP

Which of the following pathogens is most commonly associated with dysentery (bloody) diarrhea? a. Vibrio cholerae b. Escherichia coli c. Clostridioides difficile d. Yersinia enterocolitica

d. Yersinia enterocolitica

Adjunctive use of corticosteroids would be indicated for: a. Brain abscess with significant edema b. Meningitis due to Haemophilus influenzae in children c. Meningitis due to Streptococcus pneumoniae in adults d. Meningitis due to Mycobacterium tuberculosis e. All of the above

e. All of the above

Blastomycosis is often mild and self-limited and may not require treatment. However, consideration should be given to treating which of the following infected individuals to prevent extrapulmonary dissemination? a. All individuals with moderate-to-severe pneumonia b. HIV-infected individuals c. Individuals who are immunocompromised d. Patients who have undergone hematopoietic stem cell transplantation e. All of the above

e. All of the above all individuals with moderate-to-severe pneumonia, disseminated infection, or those who are immunocompromised require antifungal therapy

Which of the following would NOT be considered a common pathogen in causing traveler's diarrhea? a. Enterotoxigenic Escherichia coli b. Rotavirus c. Shigella dysenteriae d. Vibrio cholerae e. All of the above are common pathogens in traveler's diarrhea

e. All of the above are common pathogens in traveler's diarrhea

In the treatment of coccidioidal meningitis: a. Fluconazole 400 mg daily is the drug of choice. b. Lifelong suppressive therapy must be followed. c. Ketoconazole should not be recommended routinely due to its poor CNS penetration. d. May require intrathecal amphotericin B therapy in patients who do not respond to fluconazole or itraconazole. e. All of the above.

e. All of the above. Fluconazole is the drug of choice for the treatment of coccidioidal meningitis. However, since fluconazole therapy only leads to remission, suppressive therapy must be continued for life. Patients with refractory infection may require intrathecal amphotericin B

According to current guidelines, a patient diagnosed with first-episode CDI that is determined to be critically ill (has systemic symptoms including hypotension) should be treated with which of the following for C. difficile treatment? a. Metronidazole orally b. Vancomycin orally c. Vancomycin intravenously d. Fidaxomicin orally e. Metronidazole intravenously + vancomycin orally

e. Metronidazole intravenously + vancomycin orally IV vancomycin does not readily achieve appropriate concentrations in the GI tract and thus would be ineffective patient is hypotensive/severe --> needs more than 1 drug

A patient is having some diarrhea and is diagnosed with food poisoning following eating potato salad and tapioca pudding at his family reunion. In all likelihood, the causative pathogen is Staphylococcus aureus. Which of the following antibacterials should be recommended for his treatment in combination with ORT? a. Ciprofloxacin b. Azithromycin c. Trimethoprim-sulfamethoxazole d. Linezolid e. No antibiotic therapy is warranted

e. No antibiotic therapy is warranted If the duration of the symptoms last longer than 24 hours, a patient should be seen by a physician and potential options delineated Fluid replacement is appropriate in these patients

A patient is diagnosed with CDI and has a WBC of 17,500 cells/mm3 (17.5 x 109/L). Which of the following regimens would be an appropriate selection for treatment, according to the most recent guidelines for the treatment of CDI? a. Metronidazole 500 mg orally every 8 hours b. Vancomycin 125 mg orally every 6 hours c. Fidaxomicin 200 mg orally twice daily d. All of the above are appropriate e. Only TWO of the above are appropriate

e. Only TWO of the above are appropriate Oral vancomycin or fidaxomicin is the recommended treatment option at this point

The most common cause of infectious diarrhea in American children is which of the following pathogens? a. Vibrio cholerae b. Campylobacter jejuni c. Yersinia enterocolitica d. Escherichia coli e. Rotavirus

e. Rotavirus