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Infectious Question
Infectious Question
3. G.G. is a 49-year-old female renal transplant recipient who presents to the clinic for a routine follow-up.
She has no food or drug allergies. G.G.s allograft is
functioning well, and she has not been treated for
rejection. Because the inflenza season has just begun, which is the most appropriate means of prevention for
this patient?
A. Oseltamivir 75 mg orally once daily for the
duration of the inflenza season.
B. Inactivated inflenza vaccine and oseltamivir
75 mg orally once daily for 2 weeks.
C. Inactivated inflenza vaccine.
D. Live attenuated inflenza vaccine (LAIV)
7. Answer: C
Vaccination is the most effective method for preventing
inflenza . The inactivated vaccine is preferred in this
patient because she is a transplant recipient. The use of
oseltamivir for 2 weeks at the time of inflenza vaccination (to provide protection until immunity is
established)
may be considered if a patient has an inflenza exposure.
======================================
4. H.H. is 62-year-old woman who presents to her primary care provider for an annual follow-up. She
states that she cannot recall ever having chickenpox
or shingles. Which is the best option to prevent herpes zoster in this patient?
A. Obtain varicella zoster virus (VZV)
immunoglobulin G (IgG), and if negative,
give Varivax; if positive, give Zostavax.
B. Give Varivax.
C. Give Zostavax.
D. Give varicella zoster immune
globulin (VariZIG).
. Answer: C
The ACIP guidelines recommend a one-time dose of
Zostavax to all individuals at 60 years or older, regardless of herpes zoster history. It is thus unnecessary to
obtain VZV serologies for this patient. Varivax is recommended as a routine childhood vaccine and may be
given
to certain immunocompromised patients who are VZV
negative. The VariZIG vaccine is recommended only as
PEP in high-risk VZV-negative patients.
==================================
Patient Case
5. J.C. is a 28-year-old woman who presents to her primary care physician because she had unprotected
sex
with a male acquaintance. Although she has no symptoms, she is concerned that she may have developed
an STD because this man is notorious for having multiple partners. J.C. takes oral birth control, although
she admits to frequently missing doses. An examination is done revealing a positive pregnancy test and
an NAAT test positive for both N. gonorrhoeae and C. trachomatis. Which is the best treatment option for
this patient?
A. Levoflxacin 250 mg orally once plus azithromycin 1 g orally once.
B. Cefiime 400 mg orally once plus azithromycin 1 g orally once.
C. Ceftriaxone 250 mg intramuscularly once plus azithromycin 1 g orally once.
D. Ceftriaxone 250 mg intramuscularly once plus doxycycline 100 mg orally twice daily for 7 days.
. Answer: C
The patients NAAT tests confim both gonorrhea and
chlamydia. Fluoroquinolones are not recommended because of resistance, nor should the patient receive
floroquinolones or tetracyclines because of her positive pregnancy test. Cefiime is recommended only if
ceftriaxone
is not available. The most appropriate choice is ceftriaxone 250 mg intramuscularly once plus azithromycin
1g
orally once.
==========================
Patient Case
6. J.F. is a 39-year-old man with HIV (CD4+ count 225 cells/mm3, HIV viral load less than 48 copies/mL)
who
was treated for secondary syphilis because of the presence of a diffuse rash, generalized lymphadenopathy,
and a previous primary genital chancre. His RPR titer was 1:64, and his FTA-ABS was positive. He denies
neurologic or ophthalmic complaints and receives benzathine penicillin G by intramuscular injection once.
One and one-half years later, the patient has an RPR titer of 1:32 and a positive FTA-ABS. A lumbar
puncture
reveals the absence of white blood cells (WBCs), normal levels of glucose and protein, and a negative
VDRL
test. Which is the most appropriate treatment at this time?
A. Benzathine penicillin G 2.4 million units intramuscularly once.
B. Benzathine penicillin G 2.4 million units intramuscularly once weekly for 3 weeks.
C. Aqueous penicillin G 24 million units daily intravenously for 10 days.
D. Doxycycline 100 mg orally twice daily for 28 days
. Answer: B
The patients therapy for syphilis failed because his RPR
titer did not decrease by 4-fold at follow-up. The FTAABS may remain positive after effective treatment. A
lumbar puncture is indicated when the RPR does not
decrease by 4-fold 612 months after appropriate treatment. This patients lumbar puncture was negative for
neurosyphilis, so intravenous penicillin is not indicated.
Doxycycline is an alternative to penicillin for treatment
of latent syphilis but is not recommended for this patient
because he has no penicillin allergy. In this case, benzathine penicillin G 2.4 million units intramuscularly
once
weekly for 3 weeks is the optimal treatment for late latent syphilis.
==================================
7. You evaluate a new HIV-seropositive patient (risk factor: MSM) who refuses to consider the initiation of
ARV drugs and does not meet the indications for opportunistic infection prophylaxis. His laboratory values
are unremarkable. He is hepatitis A antibody negative, hepatitis B surface antigen negative and surface
antibody positive, and hepatitis C antibody negative. The patient cannot recall his last tetanus booster and is
up-to-date on all childhood immunizations. The patient is allergic to penicillin (rash). Which vaccination(s)
is best ?
A. Intranasal inflenza, hepatitis B.
B. Inflenza (intramuscular), Pneumovax (PPSV23).
C. Hepatitis A; inflenza (intramuscular); Tdap; Prevnar (PCV13).
D. Hepatitis A and B plus inflenza (intramuscular), diphtheria and tetanus toxoids and acellular
pertussis (DTaP), Pneumovax (PPSV23).
. Answer: C
To prevent new-onset infections, close attention should
be paid to the immunization histories of all patients
with HIV infection. Patients with HIV may receive
any killed vaccinations, whereas live vaccinations
should be deferred in most cases. Given the overlap in
risk factors associated with HIV and the hepatic diseases, consideration should be given to immunizations
against hepatitis A and B. In this patient, hepatitis B immunization is unwarranted because he is hepatitis B
antibody positive and antigen negative (indicating a history
of vaccination). Consideration should be given to yearly
inflenza immunizations with the killed intramuscular
formulation. Among patients with HIV infection, community-acquired pneumonia may be particularly
serious;
therefore, pneumococcal vaccination should be administered (ideally fist dose with Prevnar [PCV13],
followed
by Pneumovax [PPSV23]). Because this patient does not
recall his last tetanus vaccination, a booster dose using
Tdap should be provided today and followed every 10
infections?
A. She is not a candidate for prophylaxis, and ciproflxacin 500 mg orally twice daily for 14 days should
be initiated for a resistant infection.
B. Use prophylactic postcoital therapy with trimethoprim/sulfamethoxazole single-strength tablet.
C. Use prophylactic postcoital therapy with trimethoprim/sulfamethoxazole 1 double-strength tablet
twice daily for 3 days.
D. Use daily prophylaxis with trimethoprim/sulfamethoxazole 1 double-strength tablet daily for
6 months
. Answer: B
Recurrence develops in about 20% of women with
cystitis. If it has been more than 2 weeks since the
last infection, then it is considered a reinfection and
should be treated with an appropriate course of therapy;
therefore, ciproflxacin for 14 days would not be
appropriate. In women who experience symptomatic
reinfections in association with sexual activity, voiding
after intercourse may help prevent infection. In addition,
single-dose prophylactic therapy with Trimethoprim/
sulfamethoxazole ( single-strength tablet) taken
after intercourse considerably reduces the incidence of
recurrent infection. Self-initiated UTI treatment is also
an option in recurrent infections. Long-term prophylaxis
is usually not initiated until the frequency of UTIs is
more than three per year.
=========================================
Patient Case
18. M.J. is an 85-year-old woman whose daughter brings her to the physicians offie because the family has
noticed that she has been sleeping more lately and that she seems very confused. On
physical examination, M.J. is lethargic and not alert and oriented. Her vital signs include temperature of
97.5F, blood pressure 88/55 mm Hg, heart rate 90 beats/minute, and respiratory rate
27 breaths/minute. A chest radiograph taken in the offie reveals a left lower lobe consolidation, and she is
given a diagnosis of CAP. Using the CURB point-of-care patient scoring system,
which statement is the best recommendation for proceeding with the treatment of M.J.s CAP?
A. Treat her as an outpatient for 3 days and reassess.
B. Treat her as an outpatient for 14 days and follow up.
C. Transfer her to the emergency department at the local hospital to be admitted for treatment.
D. Have her transferred to the ICU immediately
. Answer: C
The CURB scoring system is based on a scale of 05,
giving 1 point for each of the following: confusion
caused by pneumonia, urea nitrogen greater than 7
mmol/L, respiratory rate 30 breaths/minute or greater,
blood pressure less than 90 mm Hg systolic or 60 mm
Hg or less diastolic, and age 65 or older. A score of 2 or
treatment course
of metronidazole 500 mg orally three times daily for 10 days. He has not taken antibiotics or any
other
medications in the past 3 weeks, and he now comes to the clinic with severe abdominal pain and
frequent
loose stools for the past few days. The C. diffiile toxin immunoassay comes back positive, and he is
given
a diagnosis of recurrent CDI. Which is the best recommendation for his recurrent infection?
A. Metronidazole 500 mg orally three times daily for 4 weeks.
B. Vancomycin orally tapered over 4 weeks, followed by 4 weeks of pulse dosing.
C. Fidaxomicin 200 mg daily for 10 days.
D. Vancomycin 125 mg orally four times daily for 10 days.
. Answer: B
Because of the potential for neurotoxicity, metronidazole
use is not recommended after the fist recurrence of
CDI. Although fiaxomicin would be a good option
and has decreased recurrent infections compared with
vancomycin, the dose should be 200 mg twice daily.
Vancomycin is the best choice, but because this is the
patients second recurrent infection, a tapered regimen
followed by pulse dosing would be the recommended
dosing, not 125 mg four times daily for 10 days.
Book
25. P.E. is a 56-year-old man who comes to the clinic with
a 3-day history offever, chills, pleuritic chest pain, malaise, and cough productive of sputum. In the clinic,
his
temperature is 102.1F (38.9C) (all other vital signs are
normal). His chest radiograph shows consolidation in
the right lower lobe. His white blood cell count (WBC)
is 14,400/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 P.E.?
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
diabetes mellitus, which is poorly controlled with some diabetic-related complications. G.N. also has
hypertension and a history of several episodes of deep venous thrombosis. Her medications include
glyburide 5
mg/day orally, enalapril 10 mg orally twice daily, warfarin 3 mg/day orally, and metoclopramide 10 mg four
times/day. On physical examination, she is alert and oriented, with the following vital signs: temperature
102.8 (39 ); heart rate 120 beats/minute; respiratory rate 16 breaths/minute; blood pressure (supine):
140/75 mm Hg; and blood pressure (standing) 110/60 mm Hg. Her laboratory values are within normal
limits except for increased international normalized ratio 2.7; BUN 26 mg/dL; serum creatinine 1.88 mg/
dL; and WBC 12,000 (78 polymorphonuclear leukocytes, 7 band neutrophils, 10 lymphocytes, and 5
monocytes). Her urinalysis shows turbidity, 2+ glucose; pH 7.0; protein 100 mg/dL; 50100 WBC; + nitrites;
35
red blood cells; and many bacteria and + casts. Which is the best empiric therapy for G.N.?
A. Trimethoprim/sulfamethoxazole double strength orally twice dailyduration of antibiotics: 7 days.
B. Ciprofloxacin 400 mg intravenously twice daily and then 500 mg orally twice dailyduration of
antibiotics: 10 days.
C. Gentamicin 140 mg intravenously every 24 hoursduration of antibiotics: 3 days.
D. Tigecycline 100 mg once; then 50 mg every 12 hours and then doxycycline 100 mg twice dailyduration
of antibiotics: 10 days.
Answer: B
Although the treatment duration is correct for this
patients diagnosis (7 days), oral trimethoprim/
sulfamethoxazole is inappropriate for complicated
pyelonephritis. It will also interact with warfarin,
increasing the risk of bleeding. Ciprofloxacin 400 mg
intravenously twice daily and then 500 mg orally twice
daily for 10 days is an appropriate choice and duration
(714 days) for this complicated pyelonephritis (it may
also interact with warfarin, but to a lesser extent than
trimethoprim/sulfamethoxazole). It would be expected
to have activity against the common organisms causing
complicated pyelonephritis. Gentamicin for 3 days is
too short a treatment duration, and tigecycline, followed
by doxycycline, is not recommended for complicated
pyelonephritis (although tigecycline is found unchanged
in the urine).
======================================
Patient Case
30. G.N. returns to the clinic in 6 months with no urinary symptoms, but her chief concern is now an ulcer
on her right foot. She recently returned from a vacation in Florida and thinks she might have stepped on
something while walking barefoot on the beach. Her foot is not sore but is red and swollen around the ulcer.
The ulcer is deep, and the infection may involve the underlying bone. Her medications are the same as
before. Vital signs are stable, and there is nothing significant on physical examination except for the right
foot
ulcer. Laboratory values are within normal limits (serum creatinine 0.86 mg/dL). Which best describes the
B. All patients should be given antibiotics for 24 hours after the procedure; this will optimize prophylaxis.
C. Preoperative antibiotics can be given up to 4 hours before the incision; this will make giving the
antibiotics logistically easier.
D. Vancomycin should be the antibiotic of choice for surgical wound prophylaxis because of its long
half-life and activity against MRSA
. Answer: A
Re-dosing antibiotics for surgical prophylaxis is very
importantespecially for antibiotics with short halflives, for extended surgical procedures, or for when
there is extensive blood loss. Antibiotics given beyond
the surgical procedure are generally unnecessary and
only increase the potential for adverse drug reactions
and resistant bacteria. Although preoperative antibiotics
given up to 4 hours before the incision may improve the
logistics of administering surgical prophylaxis, study
results show that antibiotics need to be given as close
to the time of the incision as possible (definitely within
2 hours). Vancomycin should not be used routinely for
surgical prophylaxis. The Centers for Disease Control and
Prevention does not recommend the use of vancomycin
for routine surgical prophylaxis other than in a patient
with life-threatening allergy to -lactam antibiotics.
38. A 78-year-old man is admitted to the general medicine floor with flank pain, altered mental
status, and fever. Urinalysis is significant for white blood cell (WBC) count of 20 cells/high-power
field (hpf), large leukocyte esterase, and nitrite positive. Initial urine Gram stain (clean catch sample)
reveals gram-negative rods. Assuming institutional antibiogram data would not influence selection,
what is the best initial therapy?
A. Nitrofurantoin 100 mg orally twice daily
B. Ciprofloxacin 400 mg intravenously twice daily
C. Ampicillin/sulbactam 1.5 g intravenously every 6 hours
D. Piperacillin/tazobactam 3.375 g intravenously every 6 hours
Answer b
=============================================
39-A 77-year-old woman is admitted to the medical step-down unit with severe dehydration and
810 watery stools per day. Three weeks ago, she completed a 10-day course of metronidazole for
Clostridium difficile infection. Current laboratory values include a white blood cell (WBC) count of
19,000 cells/mm3, serum creatinine 1.2 mg/dL (baseline 1.0 mg/dL), and blood urea nitrogen (BUN)
29 mg/dL. Patient is tachycardic (107 beats/minute) with all other vital signs stable. The patient
reports no known drug allergies. C. difficile toxin B polymerase chain reaction (PCR) is positive.
Other concurrent medications include omeprazole 20 mg/day, atorvastatin 10 mg/day, lisinopril 10
mg/day, and hydrochlorothiazide 25 mg/day. What is the best initial management decision at this
point?
A. Initiate metronidazole 500 mg orally every 8 hours.
B. Initiate vancomycin 125 mg orally every 6 hours.
C. Initiate metronidazole 500 mg intravenously every 8 hours and vancomycin 125 mg orally
every 6 hours.
D. Initiate metronidazole 500 mg orally every 8 hours and fidaxomicin 200 mg every 12 hours.
Answer Explanation
B. Initiate vancomycin 125 mg orally every 6 hours.
Vancomycin therapy would be most appropriate, given the clinical status (including elevated white blood
cell [WBC] count), recurrence, and high-risk patient (elderly and receiving proton pump inhibitor [PPI]
therapy). The patient is hemodynamically stable at this point; thus, combination therapy would not be
indicated. Fidaxomicin therapy has not been studied in combination, although it could perhaps be an option
in this patient as monotherapy.
============================================
40Vignette:
A 55-year-old woman with a medical history significant for a
bioprosthetic mitral valve replacement, hypertension, and depression has an
appointment with the dentist next week to have her teeth cleaned. Her current
medications include aspirin 81 mg orally daily, candesartan 16 mg orally daily,
hydrochlorothiazide 25 mg orally daily, and escitalopram 10 mg orally daily.
She states that her throat and lips swell when she takes penicillin.
Which antibiotic regimen, if any, would be most appropriate to prevent infective
endocarditis in this patient?
A
Amoxicillin 2 g orally 3060 minutes before the procedure
B
Azithromycin 500 mg orally 3060 minutes before the procedure
Clindamycin 600 mg orally 3060 minutes before and after the
C
procedure
D
No antibiotic prophylaxis required for this patient
Answer Explanation:
This patient requires antibiotic prophylaxis for infective endocarditis because
she has a bioprosthetic mitral valve and is undergoing a dental procedure
(teeth cleaning) that involves manipulation of her gingival tissue. Therefore,
Answer D is incorrect. Only a single dose of antibiotic therapy is required as
prophylactic therapy, with the dose given 3060 minutes before the procedure.
Therefore, Answer C is incorrect. This patient appears to have experienced an
anaphylactic reaction to penicillin in the past; therefore, penicillin and
penicillin-like drugs (such as amoxicillin) should be avoided in this patient
(Answer A). In patients with an allergy to penicillin, a single dose of
clindamycin, azithromycin, or clarithromycin given 3060 minutes before the
hers, who was also at the party and lives in her dormitory, had similar
symptoms.
She is sent to the emergency department for a lumbar puncture and CT scan
which reveals the following:
Head CT: Meningeal inflammation
Lumbar puncture: Normal opening pressure, glucose 45 mg/dL, protein 300
mg/dL, white blood cell count 150 cells/microliter
Microbiology: Blood Gram stain negative; blood culture pending;
cerebrospinal fluid (CSF) Gram stain Gram stainnegative diplococci; CSF
culture pending
Which would be the most appropriate empiric therapy for the patient?
A
Penicillin G 4 million units intravenously every 4 hours
B
Ceftriaxone 2 g intravenously every 12 hours
Ceftriaxone 2 g intravenously every 12 hours and vancomycin 15
C
mg/kg intravenously every 8 hours
Ceftriaxone 2 g intravenouly every 12 hours, vancomycin 15 mg/kg
D
intravenously every 8 hours, and ampicillin 2 g intravenously every
4 hours
Answer Explanation:
Given her risk factors and age, the patient likely has meningitis caused by N.
meningitidis. However, until culture is finalized and susceptibilities return, we
treat empirically for all potential causative pathogens, which are N.
meningitidis and Streptococcus pneumoniae. Penicillin is the drug of choice for
susceptible N. meningitidis, but empiric treatment, according to the guidelines,
should be ceftriaxone and vancomycin. Ampicillin would not be needed unless
she was immunocompromised, asplenic, or older than 50 years.
44Vignette:
A 47-year-old male is admitted to the general medicine floor of your hospital
with a 3-day history of a productive cough with greenish yellow sputum and
shortness of breath. He has a white blood cell count of 13 K/mm3(baseline 5),
serum creatinine of 1.2 mg/dL (baseline 11.3 mg/dL), and Tmax of 38.3C,
and his admission chest X-ray shows a left lower lobe pneumonia. He has
no known drug allergies but a medical history significant for a living related
kidney transplant 10 years ago for end-stage renal disease caused by
polycystic kidney disease. In his history from a transplant clinic note 5 months
ago, you see that he has had no recent treated rejections; is maintained on
tacrolimus 1 mg orally twice daily with goal serum troughs between 2 and 4
ng/mL and prednisone 5 mg daily; and is seen yearly by the transplant
nephrologists but that he has no other history of hospital
or emergency department contact. The medical resident calls you for help with
antibiotic initiation.
Which of the following is the best choice for empiric antibiotic therapy?
Piperacillin/tazobactam 4.5 g intravenously every 6 hours and
A
vancomycin dosed for trough 1520 mcg/mL
Azithromycin 500 mg orally x 1; then 250 mg orally daily x 4 more
B
days
Cefepime 2 g intravenously every 8 hours, tobramycin 7 mg/kg
C
intravenously every 24 hours, and vancomycin dosed for a trough
1520 mcg/dL
Ceftriaxone 1 g intravenously every 24 hours and azithromycin 500
D
mg orally daily
Answer Explanation:
Answer: D.
Although the patient is immunocompromised on
immunosuppression, he has no recent significant history of contact with
resistant organisms and no recent antibiotic therapy, and he is on a very low
amount of immunosuppression. Therefore, answer A is incorrect because you
do not need to cover health-care associated pathogens. Answer B is incorrect
because the patient required hospital admission. Answe C is incorrect
because there is no need to cover healthcare associated pathogens. Answer
D is correct because the patient has community-acquired pneumonia
necessitating hospital admission.
=============================================
45A study found administration of amoxicillin 1-2 hours prior to dental extraction
reduced the presence of bacteria in blood by 46% when blood cultures were
drawn immediately after extraction. Which patient would benefit most from
amoxicillin taken orally before a root canal?
A 46-year-old man with unilateral total knee replacement 6 months
A
ago
A 54-year-old woman with unilateral total hip replacement 5 years
B
ago
C
A 65-year-old man with mitral valve prolapse
A 72-year-old woman with a history of bioprosthetic mitral valve
D
replacement
Answer Explanation:
It was previously thought that those with a history of knee and hip replacement
required antibiotic prophylaxis before dental procedures to prevent hip and
knee infections. However, this is no longer true; therefore, prophylaxis before
dental procedures is no longer recommended. Prophylaxis continues to be
recommended for patients with a history of valve replacement for the
prevention of infective endocarditis, but not for patients with valvulopathy,
including those with valvular prolapse.
46Vignette:
A 37-year-old woman is admitted to the trauma intensive care unit for a
fracture-dislocation of the thoracic spine secondary to a motor vehicle collision.
She is immediately taken to the operating room for stabilization of her spine.
She has no significant medical history and no known drug allergies.
Which option is most appropriate for perioperative antibiotic administration in
this patient?
A
Vancomycin
B
Piperacillin/tazobactam
C
Ceftriaxone
D
Cefazolin
Answer Explanation:
Cefazolin has an appropriate spectrum of activity against gram-positive
organisms such as Staphylococcusspp., adequate tissue penetration, and
adequate concentrations in the spinal disks. Furthermore, the guidelines for
antimicrobial prophylaxis in surgery specify that patients undergoing
orthopedic procedures involving the spinal cord receive prophylaxis with
cefazolin (i.e., first-generation cephalosporin); therefore, answer D is correct.
Vancomycin is an alternative choice for patients with a beta-lactam allergy or
those colonized with MRSA (methicillin-resistant S. aureus); therefore, Answer
A is not the best choice. Using broader coverage promotes bacterial resistance
and is unnecessary in this scenario; therefore, Answer B and Answer C are
also incorrect.
=======================================
47M.J. is an 85-year-old woman whose daughter brings her to the physicians office because the family has
noticed that she has been sleeping more lately and that she seems very confused. On physical examination,
M.J. is lethargic and not alert and oriented. Her vital signs include temperature of 97.5F, blood pressure
88/55 mm Hg, heart rate 90 beats/minute, and respiratory rate 27 breaths/minute. A chest radiograph taken in
the office reveals a left lower lobe consolidation, and she is given a diagnosis of CAP. Using the CURB
point-of-care patient scoring system, which statement is the best recommendation for proceeding with the
treatment of M.J.s CAP?
A. Treat her as an outpatient for 3 days and reassess.
B. Treat her as an outpatient for 14 days and follow up.
C. Transfer her to the emergency department at the local hospital to be admitted for treatment.
D. Immediately have her transferred to the ICU.
Answer is C
CAP
Which means community acquired pneumonia
In CAP
HAP)hospital acquired pneumonia
curb 65 score
5
48-P.E. is a 56-year-old man who comes to the clinic with a 3-day history of fever, chills, pleuritic chest
pain, malaise, and cough productive of sputum. In the clinic, his temperature is 102.1F (38.9C) (all other
vital signs are normal). His chest radiograph shows consolidation in the right lower lobe. His white blood
cell count (WBC) is 14.4/mm3, but all other laboratory values are normal. He is given a diagnosis of
community-acquired pneumonia. He has not received any antibiotics in 5 years and has no chronic disease
states. Which one of the following is the best empiric therapy for P.E.?
A. Doxycycline 100 mg orally 2 times/day.
B. Cefuroxime axetil 250 mg orally 2 times/day.
C. Levofloxacin 750 mg/day orally.
D. Trimethoprim/sulfamethoxazole (TMZ/SMZ) double strength orally 2 times/day
The answer: A
This patient with CAP(community acquired pneumonia)
Calculate Curb 65 score = 0 or max 1 as confusion is not mentioned ,,,,, so oupatient treatment
Following that
We look for comorbidities +/- history of antibiotics administration over the last 3 months
If patient has neither comorbidities nor history of taking antibiotics in tha past 3 months,,,,,, so less risk of
drug resistance so monotherapy
This patient with CAP so the most suspected microorganism is mycoplasma or chlamydia which are atypical
bacteria so the choice will be doxycycline or macrolides
If patient with comorbidities or history of taking antibiotics so the choice will be between fluoroquinolones
only or double therapy and one of them should be doxy or macrolide
In this case patient has no history of AB nor comorbidities so the treatment will be monotherapy macrolide
or doxycyclin
So the preferred answer is A
Moreover
5047-year-old male is admitted to the general medicine floor of your hospital with a 3-day history of a
productive cough with greenish yellow sputum and shortness of breath. He has a white blood cell count of
13 K/mm3(baseline 5), serum creatinine of 1.2 mg/dL (baseline 11.3 mg/dL), and Tmax of 38.3C, and his
admission chest X-ray shows a left lower lobe pneumonia. He has no known drug allergies but a medical
history significant for a living related kidney transplant 10 years ago for end-stage renal disease caused by
polycystic kidney disease. In his history from a transplant clinic note 5 months ago, you see that he has had
no recent treated rejections; is maintained on tacrolimus 1 mg orally twice daily with goal serum troughs
between 2 and 4 ng/mL and prednisone 5 mg daily; and is seen yearly by the transplant nephrologists but
that he has no other history of hospital or emergency department contact. The medical resident calls you for
help with antibiotic initiation. Question # 138 Which of the following is the best choice for empiric
antibiotic therapy?
A-Piperacillin/tazobactam 4.5 g intravenously every 6 hours and vancomycin dosed for trough 1520
mcg/mL
B-Azithromycin 500 mg orally x 1; then 250 mg orally daily x 4 more days
C-Cefepime 2 g intravenously every 8 hours, tobramycin 7 mg/kg intravenously every 24 hours, and
vancomycin dosed for a trough 1520 mcg/dL
D- Ceftriaxone 1 g intravenously every 24 hours and azithromycin 500 mg orally daily
Answer: D
Although the patient is immunocompromised on immunosuppression, he has no recent significant history of
contact with resistant organisms and no recent antibiotic therapy, and he is on a very low amount of
immunosuppression. Therefore, answer A is incorrect because you do not need to cover health-care
associated pathogens. Answer B is incorrect because the patient required hospital admission. Answe C is
incorrect because there is no need to cover healthcare associated pathogens. Answer D is correct because the
patient has community-acquired pneumonia necessitating hospital admission
51A 2-year-old child has experienced total body hives following amoxicillin administration. Which agent could
be safely administered to this patient?
A. Cefdinir
B. Cefaclor
C. Cephalexin
D. Cephradine
Answer : A
Cefdinir (correct answer, because, according to the American Academy of Pediatrics, it is the only agent
with a dissimilar 7-position side chain of the listed oral cephalosporins. This specific patient is showing
evidence of immunoglobulin E (IgE)-associated reaction (hives), and the other three listed agents are
similarly in the 7-position; thus, they more likely to be associated with cross-reactivity with amoxicillin).
REFERENCE: MOCK 2013
52
A.W. is a 5-year-old boy (27.3 kg) brought to the pediatric clinic with a high temperature, chills, malaise,
sore throat, dry cough, and nausea and diarrhea that started about 1 day ago. A rapid influenza comes back
positive for influenza A. Which is the best therapy recommendation for A.W.?
A. Zanamivir 2 inhalations (5 mg per inhalation) twice daily for 5 days plus acetaminophen for fever.
B. Supportive care only with acetaminophen for fever
. C. Oseltamivir 60 mg orally twice daily for 5 days plus Pepto-Bismol for nausea and diarrhea.
D. Oseltamivir 60 mg orally twice daily for 5 days plus acetaminophen for fever.
Answer: D
This patient presents within 48 hours of symptom onset, so antiviral therapy can be initiated. Although
zanamivir may be used for prevention in those 5 years and older, it is not indicated for treatment of influenza
in patients younger than 7 years. Aspirin or aspirin-containing products (e.g., bismuth
subsalicylatePepto-Bismol) should not be administered to any child or adolescent younger than 19 years
with confirmed or suspected influenza because of the risk of Reye syndrome. For relief of fever, other
antipyretic medications (e.g., acetaminophen or NSAIDs) are recommended. Therefore, oseltamivir 60 mg
orally twice daily for 5 days (dose for children 2440 kg) plus acetaminophen for fever is the best choice
53Community-acquired pneumonia is most commonly associated with
A) Staphylococcus aureus
B) Listeria monocytogenes
C) Legionella species
D) Streptococcus pneumonia
answer : D
Answer : B
55Which of the following would be the most appropriate therapy for the treatment of Mycoplasma pneumonia
for a patient with compliance issues and currently receiving theophylline?
A) Erythromycin
B) Azithromycin
C) Clindamycin
D) Clarithromycin
Answer:B
Azithromycin will be preferred in such case for many reasons
It is the least one to cause drug interactions
Also it the least macrolide to cause QT prolongation but erythromycin and clarithromycin cause it more and
here as the pateint is already on theophylline which in turn causes Arrythmia so better to avoid both and use
azithromycin
56A 35-year-old woman is admitted for suspected septic shock secondary to pneumonia. On admission, her
heart rate was 102 beats/minute, and her blood pressure was 80/50 mm Hg after fluid resuscitation. What is
the most appropriate initial resuscitation strategy for this patient?
A. Begin antibiotic therapy within 1 hour.
B. Maintain goal mixed venous O2 saturation greater than 90%.
C. Start intravenous hydrocortisone 100 mg every 8 hours.
D. Give intravenous fluid challenge if urine output is less than 0.5 mL/kg/hour.
Answer :A
Begin antibiotic therapy within 1 hour.
According to the Surviving Sepsis Campaign Guidelines 2008, antibiotics should be administered within
1 hour of recognition of severe sepsis or septic shock as part of the initial resuscitation strategy. A
patients goal mixed venous oxygen saturation should be 65% or more. Although steroids such as
hydrocortisone decrease mortality and provide shock reversal in certain populations, particularly when
blood pressure is unresponsive to vasopressors, corticosteroids did not provide mortality reduction in a
large clinical trial of patients with septic shock in whom blood pressure may or may not have been
responsive to vasopressors (CORTICUS study). Thus, there is no longer a routine recommendation to
initiate hydrocortisone for initial resuscitation of patients with severe sepsis or septic shock.
Hydrocortisone can be initiated (maximum 300 mg/day) in patients whose blood pressure is not
responsive to fluid resuscitation or vasopressor support. Although urine output of less than 0.5
mL/kg/hour for at least 2 hours, despite fluid resuscitation, is a marker of a sepsis diagnosis, it is not part
of the initial sepsis resuscitation strategy to administer intravenous fluids to maintain urine output greater
than 0.5 mL/kg/hour. Fluids are typically administered to maintain a target central venous pressure of 8
mm Hg or more (or 12 mm Hg or more if mechanically ventilated).
57-Vaccine
Pneumococcal vaccinations can be effective at reducing invasive pneumococcal disease.
Important issues regarding the available pneumococcal vaccinations include:
A Using either available pneumococcal vaccination series in children and/or high-risk adults
B Using the pneumococcal polysaccharide (PPSV23) series beginning at 2 months of age
C Using the pneumococcal conjugate (PCV13) series beginning at 2 months of age
D Using the pneumococcal conjugate (PCV13) series in high-risk patients only
Answer: C
According to the recommended vaccination schedule for individuals 018 years (2013), the PCV13 series is
a routine series started at 2 months of age, not just used in high risk individuals making D incorrect. The
PPSV23 series is not routine in early childhood (ie < 2 months of age, making answer B incorrect) and is
reserved for high-risk individuals.
PCV13
4
,,, 15 6 ,,,,,
PPSV23
5 ) (
65 65
65 5
68 5 63
5814- A 6-year-old patient with documented bacterial rhinosinusitis and no known drug allergies is empirically
best-treated with which of the following options:
A. Moxifloxacin
B. Amoxicillin
C. Amoxicillin-clavulanate
D. Azithromycin
Answer:C
Amoxicillin-clavulanate
Amoxicillin/clavulanate (recommended agent in the 2012 Infectious Diseases Society of America [IDSA]
Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults)
59A 78-year-old man is admitted to the general medicine floor with flank pain, altered mental status, and fever.
Urinalysis is significant for white blood cell (WBC) count of 20 cells/high-power field (hpf), large leukocyte
esterase, and nitrite positive. Initial urine Gram stain (clean catch sample) reveals gram-negative rods.
Assuming institutional antibiogram data would not influence selection, what is the best initial therapy?
A. Nitrofurantoin 100 mg orally twice daily
B. Ciprofloxacin 400 mg intravenously twice daily
C. Ampicillin/sulbactam 1.5 g intravenously every 6 hours
D. Piperacillin/tazobactam 3.375 g intravenously every 6 hours
Answer:B
Ciprofloxacin 400 mg intravenously twice daily
Current cystitis/pyelonephritis guidelines recommend a fluoroquinolone (FQ) as first-line therapy for
hospitalized patients with suspected upper tract disease (pyelonephritis). Gram stain reveals gram-negative
rods, increasing the likelihood of Escherichia coli as the causative pathogen. -Lactam therapy is not
preferred unless local susceptibility data reveal significant FQ resistance (greater than 20%) and spectrum of
coverage (specifically for piperacillin/tazobactam is not necessary). Nitrofurantoin is not indicated for upper
urinary tract disease
60The Pharmacy and Therapeutics (P&T) Committee at your hospital recommends that the pharmacy
department conduct a medication-use evaluation on the management of diabetic foot infections. Which
medication regimens would be the best to evaluate for appropriate use in the management of diabetic foot
infections, based on empiric antibiotic regimen and clinical severity of infection?
A. Oral dicloxacillin for mild foot infections
B. Parenteral ceftriaxone for moderate foot infections
C. Oral clindamycin for mild foot infections
D. Parenteral imipenem/cilastatin for moderate foot infections
Answer: D
Parenteral imipenem/cilastatin for moderate foot infections
According to the Infectious Diseases Society of America (IDSA) guidelines on diabetic foot infections,
parenteral imipenem/cilastatin, a broad-spectrum antibiotic, is recommended for use in severe foot infections
when polymicrobial coverage is needed. Therefore, the use of imipenem/cilastatin for diabetic foot
infections of moderate severity would be a preferred target of a medication-use evaluation. Answer D is the
correct answer
61Which vaccine would you recommend to a 6-month-old child?
A. PCV 13
B. PCV 23
C. Influenza (live)
D. Menningococcal
Answr: A
PCV13 replaces a previous conjugate vaccine (PCV7), which protected against 7 pneumococcal types
(rather than the 13 of PCV13) and has been in use since 2000 and is recommended by the Centers of Disease
Control (CDC) for children under 5-years-old
62A patient has confirmed lumbar spinal osteomyelitis and intraoperative cultures reveal
methicillin-susceptible Staphylococcus aureus (MSSA). His past medical
history is significant for long-term depression treated with paroxetine and hypercholesterolemia treated with
simvastatin. Social history is significant for current intravenous drug use. Which antibacterial regimen is
most appropriate in the treatment of this patients infection?
A. Vancomycin
B. Linezolid
C. Cefazolin
D. Telavancin
Answer : C
Cefazolin (correct answer because vancomycin is inferior to cell wallactive antistaphylococcal agents like
cefazolin in the treatment of methicillin-sensitive Staphylococcus aureus [MSSA]; linezolid should be
avoided because of potential serotonin syndrome with concomitant paroxetine; there is no experience with
telavancin in the treatment of osteomyelitis)
63The patient's CSF cultures eventually grow Neisseria meningitidis. Which group of individuals would be
appropriate candidates for chemoprophylaxis?
A: The nurse and physician who examined P.K. when she presented to the family medicine clinic and the
emergency department staff who came in contact with her
B: Her roommate
C: Her roommate, her boyfriend, and the students at the party with whom she may have shared beverages
D: Her boyfriend and her entire dormitory
Answer : C
Chemoprophylaxis should be given to all close contacts within 1 week of symptom onset, which include
those with more than 8 hours of contact within 3 feet of the patient and/or those in contact with oral
secretions. Therefore, her roommate and boyfriend as well as individuals who may have shared drinks with
her at the party, would be indicated.
64A 3-week-old infant presents to the emergency department with a 2-day history of increased fussiness,
decreased oral intake, and vomiting. The lumbar puncture reveals hazy cerebral spinal fluid, white blood
cells (WBCs) of 15,000, and protein of 176. The mothers birth history is unknown. Which is best empiric
antibiotic regimen?
A. Ampicillin plus gentamicin plus acyclovir
B. Ampicillin plus cefotaxime
C. Vancomycin plus gentamicin plus acyclovir
D. Vancomycin plus cefotaxime
Answer : B
Ampicillin plus cefotaxime
The most likely organisms in neonates are group B streptococcus, Escherichia coli, and other
gram-negative enteric bacilli. Although not as common, coverage for listeria monocytogenes should be
part of empiric therapy. Acyclovir is not used empirically unless herpes simplex virus (HSV) is strongly
suggested. Vancomycin is not recommended for initial therapy in a neonate
Answer : B
listeria monocytogenes
66A 55-year-old woman with a medical history significant for a bioprosthetic mitral valve replacement,
hypertension, and depression has an appointment with the dentist next week to have her teeth cleaned. Her
current medications include aspirin 81 mg orally daily, candesartan 16 mg orally daily, hydrochlorothiazide
25 mg orally daily, and escitalopram 10 mg orally daily. She states that her throat and lips swell when she
takes penicillin.
Which antibiotic regimen, if any, would be most appropriate to prevent infective endocarditis in this patient?
A Amoxicillin 2 g orally 3060 minutes before the procedure
B Azithromycin 500 mg orally 3060 minutes before the procedure
C Clindamycin 600 mg orally 3060 minutes before and after the procedure
D No antibiotic prophylaxis required for this patient
Answer: B
This patient requires antibiotic prophylaxis for infective endocarditis because she has a bioprosthetic mitral
valve and is undergoing a dental procedure (teeth cleaning) that involves manipulation of her gingival tissue.
Therefore, Answer D is incorrect. Only a single dose of antibiotic therapy is required as prophylactic therapy,
with the dose given 3060 minutes before the procedure. Therefore, Answer C is incorrect. This patient
appears to have experienced an anaphylactic reaction to penicillin in the past; therefore, penicillin and
penicillin-like drugs (such as amoxicillin) should be avoided in this patient (Answer A). In patients with an
allergy to penicillin, a single dose of clindamycin, azithromycin, or clarithromycin given 3060 minutes
before the procedure is recommended (Answer B).
67a patient started on 1000mg vancomycin infusion over 60 mints after the start of the iv inf he had red patches
over his body what you should do
5 pneumococcal vaccnation
pcv 13
ppsv23 ()
pcv 13
ppsv23 5
) 5 65 )
pcv13 ppsv 23
ppsv 23 pcv13
ppsv23 pcv13
===================================
68. An elderly diabetic patient is admitted to the hospital with pneumonia. The sputum
culture stains for a gram-negative rod. The patient is started on IV ampicillin. Two days later,
the patient is not improving, and the microbiology laboratory reports the organism to be a
-lactamase producing H. influenzae.
What course of treatment is indicated?
A. Continue with the IV ampicillin.
B. Switch to IV cefotaxime.
C. Switch to oral vancomycin.
D. Add gentamicin to the ampicillin therapy.
Answer: B
-lactamase producing H. influenzae. First line treatment in pneumonia thrd generation
cephalosporin .
===================================
69. A 57-year-old man complains of fever, headache, confusion, aversion to light, and neck
rigidity. A presumptive diagnosis of bacterial meningitis is made. Antimicrobial therapy
should be initiated after which one of the following occurrences?
A. Fever is reduced with antipyretic drugs.
B. Sample of blood and cerebrospinal fluid have been taken.
C. A Gram stain has been performed.
D. The results of antibacterial drug susceptibility tests are available.
E. Infecting organism(s) have been identified by the microbiology laboratory.
Answer: B
===========================
70. In which one of the following clinical situations is the prophylactic use of antibiotics not
warranted?
A. Prevention of meningitis among individuals in close contact with infected patients.
B. Patient with a hip prosthesis who is having a tooth removed.
C. Presurgical treatment for implantation of a hip prosthesis.
D. Patient who complains of frequent respiratory illness.
E. Presurgical treatment in gastrointestinal procedures.
Answer: D
Antibiotic prophylaxis recommendations exist for two groups of patients:
- those with heart conditions that may predispose them to infective endocarditis
- those who have a prosthetic joints and may be at risk for developing hematogenous
infections at the site of the prosthetic.
=============================
71. Which one of the following patients is least likely to require antimicrobial treatment
tailored to the individuals condition?
A. Patient undergoing cancer chemotherapy.
B. Patient with kidney disease.
C. Elderly patient.
D. Patient with hypertension.
E. Patient with liver disease.
Answer: D
============================
72. A 70-year-old alcoholic male with poor dental hygiene is to have his remaining teeth
extracted for subsequent dentures. He has mitral valve stenosis with mild cardiac
insufficiency and is being treated with captopril, digoxin, and furosemide. The dentist
decides that his medical history warrants prophylactic antibiotic therapy prior to the
procedure and prescribes which of the following drugs?
A. Vancomycin.
B. Amoxicillin.
C. Tetracycline.
D. Cotrimoxazole.
E. Imipenem.
Answer: B
drug of choice Amoxicillin given 30-60 m before procedure
=================================
73. Which one of the following is the best route of administration and dosing schedule for
treatment with aminoglycosides based on the drugs concentrationdependent killing
property?
A. Oral every 8 hours.
B. Oral every 24 hours.
C. Parenterally by continuous intravenous infusion.
E 24 8 Because toxicity depends more on duration of
D. Parenterally every 8 hours.
therapeutic levels than on peak levels and because efficacy is
E. Parenterally every 24 hours.
concentration-dependent rather than time-dependent, frequent doses are avoided.
Once/day IV dosing is preferred for most indications except enterococcal endocarditis.
IV aminoglycosides are given slowly (30 min for divided daily dosing or 30 to 45 min for
once/day dosing).
Answer: D
Since they are not absorbed from the gut, they are administered intravenously and
intramuscularly Every 8 hours
==================================
74. C.G. is a 63-year-old woman with a history of breast cancer (treated 5 years ago) and
hypothyroidism. She recently received antibiotics for a lower respiratory infection. Now, she
has had significant, watery diarrhea for the past 3 days. The stool tests positive for
Clostridium difficile toxin. Which one of the following is the best initial antibiotic regimen
for C.G.?
A. Vancomycin 1 g intravenously every 12 hours for 14 days.
B. Vancomycin 125 mg oral 4 times/day for 3 days.
C. Metronidazole 500 mg intravenously every 8 hours for 7 days.
D. Metronidazole 500 mg orally every 8 hours for 10 days.
Answer: D
Metronidazole 500 mg orally every 8 hours for 10 days. Vancomycin given intravenously is
ineffective for Clostridium difficile colitis because not enough drug reaches the infection site.
In addition, the length of therapy is 10-14 days. Vancomycin orally is effective in treating C.
difficile colitis, but a 3-day course is too short to effectively treat the infection. Although
intravenous metronidazole can be used to treat C. difficile colitis, the oral route of
administration is a more optimal regimen. Moreover, 7 days is not long enough to treat the
infection. Therefore, Answer D is the best initial regimen for C.G.
=========================================
75. R.O., a 42-year-old man, presents to the pharmacy for a flu shot. He states that he is in
good health and has no other medical conditions. You note a pack of cigarettes in his shirt
pocket. Which one of the following is the best option for R.O.?
A. Give him the influenza vaccine, and assess his readiness for smoking cessation.
B. Give him the influenza vaccine, and remind him that he will need the pneumococcal
vaccine earlier than age 65 if his smoking causes chronic obstructive pulmonary disease
(COPD).
C. Give him the influenza vaccine, and suggest that he also receive the pneumococcal
vaccine because he is a smoker.
D. Give him the influenza vaccine, and suggest that he, and everyone exposed to his smoking
in the household, receive the pneumococcal vaccine.
Answer: C
Answer C is the best recommendation. Answer A is incorrect. Even though these are
appropriate responses, he also needs to receive the pneumococcal vaccine. Answer B is also
incorrect. Although patients with COPD require the pneumococcal vaccine, R.O. needs the
vaccine now because he is a current smoker. Answer D is incorrect. Although he should
receive the pneumococcal vaccine, household contacts of a smoker need not receive it.
=======================================
76. M.V. is a 48-year-old man with type 2 diabetes mellitus. His diabetes is poorly controlled,
and he now has peripheral neuropathy and early renal insufficiency. He comes to the
emergency department with a red swollen left foot and a deep ulcer that is 2 cm x 3 cm on
the bottom of his left foot. Which one of the following is the best treatment for M.V.?
A. Ertapenem 1 g intravenously daily.
B. Linezolid 600 mg intravenously twice daily.
C. Azithromycin 500 mg intravenously daily.
D. Cefazolin 1 g intravenously every 8 hours.
Answer: A
Answer A is the correct answer. Answer B is incorrect; because M.V.'s foot infection is deep
and potentially limb threatening, he needs to be treated with antibiotics with broad activity.
Linezolid has only gram-positive activity. Azithromycin has very limited activity against
organisms that cause cellulitis and/or diabetic foot infections. Answer D is incorrect; because
M.V.'s foot infection is deep and potentially limb threatening, he needs to be treated with
antibiotics with broader activity.
=======================================
77. W.T. is a 62-year-old woman who presents to her hemodialysis clinic with a 3-day history
of cough, fever, and chills. Yesterday, her temperature was as high as 102.0F, and she began
coughing up yellowish sputum. She has a history of hypothyroidism, hypertension, chronic
renal disease (on hemodialysis 3 days/week), and gastroesophageal reflux disease. Her
medications include levothyroxine, amlodipine, pantoprazole, calcium carbonate,
erythropoietin, and ferrous sulfate. She has had no recent antibiotic therapy. She is given a
diagnosis of pneumonia. Which one of the following would be the best empiric therapy for
W.T.?
A. Doxycycline 100 mg orally twice daily.
B. Levofloxacin 750 mg intravenously x 1; then, 500 mg every 48 hours with dialysis.
C. Piperacillin/tazobactam 2.25 g intravenously every 8 hours plus azithromycin 500 mg
intravenously daily.
D. Cefepime 500 mg intravenously every 24 hours plus tobramycin dosed after each dialysis
plus linezolid 600 mg intravenously every 12 hours.
Answer :D
Doxycycline alone is only recommended in patients with community-acquired pneumonia
(CAP) and no coexisting comorbidities. W.T., because of her history of dialysis, has health
care-associated pneumonia (HCAP). Levofloxacin is appropriate therapy for hospitalized
patients with CAP, but this patient has HCAP. Azithromycin is unnecessary for HCAP
because atypical organisms are uncommon. In addition, this regimen contains only one agent
for Pseudomonas and no antibiotic with methicillin-resistant Staphylococcus aureus (MRSA)
activity. Therefore, Answer D is the best recommendation. A patient with HCAP needs to be
treated for multidrug-resistant organisms - two agents for Pseudomonas and an antibiotic
with MRSA activity.
======================================
78. A 4-year-old boy who presents to the minor medical clinic for treatment of a spider bite
on his leg that is inflamed, red, and draining pus. Which medication is the most appropriate
to empirically cover this patient's methicillin-resistant Staphylococcus aureus (MRSA)
infection?
A. Clindamycin
B. Sulfamethoxazole/trimethoprim (SMX/TMP)
C. Rifampin
D. Doxycycline
Answer: A
Clindamycin has more evidence to support its use than sulfamethoxazole/trimethoprim
(SMX/TMP) and rifampin. Doxycycline should not be used in children younger than 8 years
old.
==============================================
81. Which patient should receive antibiotic prophylaxis prior to dental procedures?
A. Patient a with history of mitral valve prolapse diagnosed 24 years ago.
B. Patient a with history of infective endocarditis diagnosed 4 years ago.
C. Patient a with history of surgically-repaired foramen ovale (PFO) with patch 2 years
ago.
D. Patient a with history of mitral stenosis diagnosed 7 years ago
Answer: B
Guidelines for the prevention of infective endocarditis (IE) were updated in 2007. These
recommendations significantly reduced the population of patients who should be considered
for antibiotic prophylaxis. Patients with a history of valvular abnormalities are not candidates
for antibiotic prophylaxis unless they have a history if IE or recent repair (within 6 months)
or unless a prosthetic heart valve is present. Therefore, the most correct answer is the patient
in Answer B, who has history of developing IE
================================================
82-A pregnant woman was hospitalized and catheterized with a Foley catheter. She
developed a urinary tract infection caused by Pseudomonas aeruginosa and was treated with
gentamicin. Which of the following adverse effects was a risk to the fetus when the woman
was on gentamicin?
A. Skeletal deformity.
B. Hearing loss.
C. Teratogenesis.
D. Blindness.
E. Mental retardation.
Answer: B
================================================
83-All of the following factors may increase the risk of nephrotoxicity from gentamicin
therapy except which one?
(A) age 70 years
(B) prolonged courses of gentamicin therapy
(C) concurrent amphotericin B therapy
(D) trough gentamicin levels 2 mg/mL
(E) concurrent cisplatin therapy
Answer: D
Trough serum levels
2 mg/mL are considered appropriate for gentamicin and are
recommended to minimize the risk of toxicity from this aminoglycoside. Because
aminoglycosides accumulate in the proximal tubule of the kidney, nephrotoxicity can occur.
=====================================
84-BT is a 43-year-old female seen by her primary-care physician for a mild staphylococcal
cellulitis on the arm. Which of the following regimens would be appropriate oral therapy?
(A) dicloxacillin 125 mg every 6 hrs
(B) vancomycin 250 mg every 6 hrs
(C) methicillin 500 mg every 6 hrs
(D) cefazolin 1 g every 8 hrs
(E) penicillin V 500 mg every 6 hrs
Answer: A