Hint: An opportunistic fungal pathogen with a thick capsule as a virulence mechanism

Transcription

1 This is not a real exam. This is a creative adaptation to the material presented in class, and the questions that potentially may appear on the exam. By using this resource, you acknowledge that I may be completely misleading you or guiding you down the yellow brick road. More than likely, it is a healthy balance. PATHOPHYSIOLOGY, DRUG ACTION, & THERAPEUTICS (PDAT): INFECTIOUS DISEASE Midterm Exam II, March 16, 2018, 930AM-1020AM Rules and Instructions Time There are a total of 33 questions multiple choice questions. You have approximately 50 minutes to complete the test. On average, this gives you minutes per question. There is an additional page following the 33 questions that provides the suggested answers to this representative exam. Please be sure to read each question carefully, as it may indicate there are multiple potential answers. Directions Read the entire question and answer to the best of your ability. 1. Examine your booklet exam for completeness; it should contain 7 testing pages and 1 answer sheet 2. Mark the correct answers on the booklet this will be your record to keep 3. Review your answers 4. Check to see if you were correct by viewing the last page. 5. After taking the test, if you disagree with an answer you can submit a regrade request to posen2@uic.edu. Regrades should be submitted with evidence from lecture and an explanation. I look forward to being corrected if I am wrong, as it will help me out as well! 1. A 48 YOM presents to the ED complaining of intense abdominal pain. 2 months prior the patient had received a liver transplant. The patient is hypotensive, and labs show an elevated white count. Imaging suggests multiple organ involvement. The patient should receive as empiric therapy a. Daptomycin b. Vancomycin + Metronidazole c. Ceftriaxone d. Ertepenem + Metronidazole e. Moxifloxacin 2. Complicated intraabdominal infections (CIAI) are often polymicrobial, requiring coverage for enterics and anaerobes. Which of the following a reliable agent against anaerobes that is not overly broad? a. Ceftriaxone b. Imipenem/Cilastatin c. Vancomycin d. Doripenem e. Metronidazole 3. A 37YOF had been receiving ceftriaxone treatment for primary peritonitis. Without any noticeable improvement in 48 hours, the team performed a CT scan and located an abscess. Following drainage, ceftriaxone therapy was re-initiated. Repeat cultures confirmed susceptibility. For how long should ceftriaxone therapy resume? a. 2 days b. 4 days c. 5 days d. 14 days 4. Which of the following would not be an appropriate initial treatment for a patient with an Enteric infection? a. Ceftriaxone b. Tigecycline c. Cefepime d. Piperacillin/Tazobactam

2 5. It s past midnight and you want to go home, but before you leave you hear a moan. A 35yo M walks into the hospital and is complaining of right upper quadrant pain. His heart is racing and you notice he s running a fever. Instinctively you press down on the pain-causing area, and tell the patient exhale. The patient finds themself unable to inhale due to the pain associated. What is the most probably diagnosis? a. Primary peritonitis b. Abscess c. Complicated Intraabdominal Infection d. Cholecystitis e. Cholangitis 6. Refer to Question 5. Source control is established, and the team decides this is a mild case that is communityacquired. What is the most appropriate treatment? a. Ceftriaxone b. Ceftriaxone + Metronidazole c. Piperacillin/Tazobactam d. Ciprofloxacin e. Fentanyl 0.75mcg patch q8º, and Hydrocodone/APAP 7.5/325mg PO q6º PRN breakthrough pain 7. Which of the following is not a contributing component for diagnosing community-acquired pneumonia? a. Identifying an acute infection of the pulmonary parenchyma in patients without recent hospitalizations b. Presence of an infiltrate on chest x-ray c. Data on the level of confusion, uremia, respiratory rate, blood pressure, and patient age (CURB-65) d. Febrile with an elevated WBC count e. Ausculatory findings such as rales and rhonchi 8. A 22yo M is seen at his local CVS Minute Clinic. The nurse practitioner is efficient and positively identifies community-acquired pneumonia. The patient has a CURB-65 score of 0 and has no recent antibiotic therapies. What should the nurse practitioner prescribe? a. ZPAK, PO, 500mg day 1, 250mg on days 2 through 5 b. Clindamycin 300mg, PO, 300mg every 6 hours for 7-14 days c. Levofloxacin 750mg Once daily for 5 days AND Aztreonam 250mg Once daily for 5 days d. Doxycycline 100mg IVPB every 12 hours e. A facemask, sterile gloves, and a few high-fives 9. A patient is in the ICU for the first time in their life. They are diagnosed with community-acquired pneumonia and will be receiving treatment. They have a documented Severe Penicillin Allergy. What is the best treatment? a. Z-Pak you can t go wrong b. Unasyn q6º c. Levofloxacin + Aztreonam d. Augmentin e. Clarithromycin 10. A 7-year-old child presents with a mild fever (38C) and complaints of facial pain and congestion for the past 2 days. The patient blows their nose and shows you some thick discharge. What is the appropriate treatment? a. Zpak you can t go wrong b. Politely ask the child to discard the tissue and hand them an alcohol wipe. Saline nasal spray should be sufficient for the time being. c. Amoxicillin 40-80mg/kg/daily divided every 12 hours for days d. It is now time to administer their influenza shot and enroll the child in a smoking cessation class e. Augmentin 875mg every 12 hours for 5-7 days

3 11. A 5-year-old has been diagnosed with Pharyngitis by his primary care doctor after recognizing the triad sore throat, fever, and pharyngeal inflammation. The patient does not have a cough. The patient has a severeanaphylactic penicillin allergy what is the appropriate treatment? a. Penicillin V 500mg twice daily for 10 days b. Amoxicillin 25mg/kg twice daily for 10 days c. Ibuprofen 200mg every 4 to 6 hours as needed for pain. Max 1200mg/daily. Monotherapy d. Erythromycin at the appropriate dose for 10 days e. The patient is not as risk for Rheumatic fever because they are < 8 years old, and therefore should not be treated. 12. You are starring on the world-renown gameshow Who wants to be a Millionaire, and Regis Philbin asks you the million dollar question: -What is the landmark symptom of bronchitis? a. Diarrhea b. Heart Rate > 100bpm c. Malaise d. Runny nose e. Cough 13. Concerning the diagnosis of Bacterial Endocarditis, which of the following is not true a. Echocardiography should always be used to help determine valvular vegetation b. The hallmark lab finding in bacterial endocarditis is continuous bacteremia c. 3 sets of blood cultures acquired at different sites and times of the day should be collected for precise diagnosis. d. During treatment, 1 to 2 sets of cultures should be collected daily until results are negative e. The most common pathogen in infective endocarditis is V. streptococci 14. An adult patient is able to take medications orally and has no allergies. What is the correct matching for optimal treatment against an active HACEK endocarditis infection and preventative treatment against HACEK organisms (such as prior to going to dental procedure) a. Active: Ceftriaxone Prevention: Gentamicin b. Active: Amoxicillin Prevention: Cefazolin c. Active: Amphotericin Prevention: Azithromycin d. Active: Ceftriaxone Prevention: Amoxicillin e. Active: Flucytosine Prevention: Dextromethorphan 15. What best satisfies the diagnostic criteria for diagnosing a catheter infection? a. A catheter tip culture (>15 CFU) and an intra-arterial blood culture ~ showing the same organism b. A catheter tip culture (>15 CFU) and two peripheral blood cultures ~ showing the same organism c. An otic culure (>50 CFU) and 3 blood cultures collected at different times ~ showing the same organism d. Ascites fluid with > 1500 neutrophils/ml and swollen gonads 16. A 45 yo HM presents to the clinic in respiratory distress. Chest X-Ray shows infiltrates and labs support the attending physician s initial diagnosis of pneumonia. Assuming this is accurate, which of the following phrases by the patient is suggestive of infection by a multi-drug resistant pathogen? a. The last time I took an antibiotic was 2 years ago for some pharyngitis, it gave me the runs b. Well, truth be told, the last time I ve been to a hospital is well over 10 years c. My darn caregiver removed my ventilator a few nights back because I couldn t stop coughing d. Those technicians at the pharmacy are wonderful, beautiful, caring people, but to be honest I m upset they gave me the wrong inhaler last week e. The cheeseburger I had a few days ago really didn t taste that great, I won t be giving them my business anymore

4 17. You re on call and receive a Drug-Information request from a physician in the ICU. They quickly rattle off We re treating for hospital-acquired pneumonia and there s no Vanco left! We highly suspect MRSA due to risk factors, what can we use!? The patient has no contraindications at all! a. Linezolid 600mg IVPB q12h b. Daptomycin 600mg IVPB q12h c. Piperacillin-Tazobactam 500/800mg IVPB q12h d. Ceftriaxone 2g IVPB q12h e. Azithromycin 500mg PO on day 1, then 250mg daily on days 2 through Which of the following is associated the diagnosis or treatment of Pseudomonas aeruginosa Hospital Acquired Pneumonia a. A risk factor consistent with multi-drug resistance is suggestive of Pseudomonas infection b. If the patient s unit has greater than 10% incidence of resistance to the traditional monotherapies of HAP, infection by Pseudomonas should be considered c. For a patient with a past medical history of Cystic Fibrosis and residing in a unit of unknown antibiotic resistance, coverage for Pseudomonas is required. d. Coverage for Pseudomonas requires 2 drugs, Imipenem + Levofloxacin being one option. e. All of the Above 19. More than one answer may be correct. Pictured below is a pathogen capable of infecting humans. Provided the image and hint below, select all of the following that is associated with this pathogen Hint: An opportunistic fungal pathogen with a thick capsule as a virulence mechanism a. It is a yeast fungus b. It is named Candida albicans c. Diseases caused by this organism often present as meningitis or pneumonia d. Amphotericin B is first line treatment e. May be identified by a Galactomannan assay 20. Though the results of the AmBiLoad trial did not achieve statistical significance, what information did it provide? a. Aspergillus infections are best treated with Voriconazole b. Treatment of Aspergillus with Amphotericin B should be complemented with Potassium Chloride supplements c. Lower doses of Amphotericin B are associated with greater survivability than Higher doses d. D5W is a more efficacious vehicle than NS e. All of the Above 21. A pregnant 28yo AAF presents to the Advocate Clinic within Walgreens with pain upon urination. A diagnosis of vaginal candidiasis is made. Can this patient be treated OR- with what can the patient be treated? One answer. a. No, antifungal therapies are contraindicated in pregnant patients b. Yes the patient can be treated, as long as the infective fungus is a mold but not a yeast c. Ciprofloxacin 500mg PO BID for 3 days d. Fluconazole 150mg PO for 1 dose e. Augmentin 875/125mg PO BID for 5 days

5 22. Use the following description of a fungal infection to determine the diagnosis. Choose the correct diagnosis that is correctly paired with an additional factoid. Jimmy brings to the lab some roadkill that he found on his way to work. A curious guy, he takes a tissue sample and puts it under the microscope, recognizing a fungal species growing at obtuse angles. After identifying it, he learns that humans infected by the fungus can experience severe facial pain. a. Zygomycosis; More frequently found in diabetic patients due to their blood sugar levels b. Cryptococcal Disease; Can also present as meningitis or pneumonia c. Aspergillosis; First-line treatment is Voriconazole d. Candidemia; Fire Jimmy, this is highly inappropriate e. Mucor; Vancomycin is first-line treatment 23. A patient has been diagnosed with candidemia. Which of the following actions are not indicated? a. First-line empiric therapy is Eichonocandins b. The patient should receive a funduscopic exam c. Immediately prior to antibiotic therapy, collect a Brochoaveolar Lavage (BAL) sample to identify the infectious agent d. Treatment should continue for 2 weeks beyond the first negative culture result e. The patient should receive empiric therapy within 12 hours of hospitalization 24. More than one answer may be correct. What are the goals of therapy for the treatment and monitoring of fungal diseases? a. To decrease morbidity and mortality b. Monitor for the resolution of signs and symptoms of infection c. Monitoring the resolution of infection on diagnostic imaging d. Resolution of hallmark symptoms e. Using broad spectrum anti-fungals as frequently as possible 25. Refer to the image shown below. If a Chlorine atom is conjugated to the aromatic ring at the position specified by the arrow, what will be the effect on the antimalarial activity? a. The product will exhibit activity against Liver hypnozoites b. The product will be charged in intracellular environment and be unable to enter the plasmondium food vacuole c. The ability to engage in pi-stacking interactions with porphyrin nuclei will be lost d. The reactivity of the molecule will be effectively increased, albeit shortening the duration of action e. The aromatic ring will be deactivated, making the molecule less prone to metabolism 26. Which of the following quinoline drugs has activity against the dormant forms of P. vivax and P. ovale? a. Quinine b. Chloroquine c. Primaquine d. Mefloquine e. Pyrimethamine

6 27. It is 8:54pm, 6 minutes before close, and you are ready to spend the rest of your evening listening to lectures. Your shift at CVS Pharmacy has been stressful but rewarding. You recognize a patient of yours running over to the drop-off counter. Out of breath, they hand you their phone and their doctor is on the line. The doctor is requesting a preventative therapy for malaria. The patient leaves tomorrow and has a glucose-6-phosphate dehydrogenase deficiency (G6PD), what do you suggest? a. Chloroquine b. Mefloquine c. Artesnute d. Atovaquone/Proguanil e. Primaquine 28. A patient presents to you reporting a 2-day history of water diarrhea. They are frantic, though they are afebrile and not experiencing any pain. You go to the lab with the stool sample they kindly provided you. The lab results show absence of WBC. What should you recommend to the patient? a. Loperamide and hydration therapy b. Glycerin suppositories and hydration therapy c. Z-Pak d. Ciprofloxacin e. Send the patient into surgery to have their bowel resected 29. Which of the following is/are correct about the treatment of and adult with Non-typhoidal Salmonellosis? a. If their presentation is dominated by gastroenteritis, this is likely a self-limiting illness and should not be treated b. If their presentation is dominated by bacteremia, this patient will require empiric therapy with ceftriaxone c. If the culture shows resistance to Nalidixic acid, fluoroquinolones should not be used for empiric therapy. d. Non-typhoidal salmonellosis systemic infections may lead to more severe infections, such as osteomyelitis, endocarditis, and even meningitis. e. All of the above 30. Select the combination of answers that best represents infections with C. difficile I Prevention includes antimicrobial stewardship, and washing of hands II Disease severity is determined by the patient s temperature and stool frequency III Fidaxomicin, although expensive, is especially indicated for relapsing disease IV One of the main causes of C. difficile infection are Fecal microbiota transplantations a. I and IV b. II, III, and IV c. II and III d. I and III e. All of the above 31. The image shown to the right is an intestinal parasite that is transmitted by drinking contaminated waters, in endemic areas such as Russia or the Rocky Mountains. What is the reservoir host for this parasite? a. This parasite does not have a reservoir host b. Water acts as a reservoir host c. Beaver acts as a reservoir host d. Mice act as the reservoir host e. Ancient rocks act as the reservoir host 32. Trichomonas vaginalis is known to cause Trichomoniasis, a STD associated with poor hygiene. Which of the following is not true regarding infection by this luminal parasite a. First-line treatment is a vinegar douche b. Second-line treatment is Metronidazole c. Trichomonas vaginalis thrives in acidic conditions d. Women infected by Trichomonas vaginalis are more susceptible to HIV e. Prevention includes the use of condoms

7 33. Ivermectin is a new drug who s discovery earned Campbell and Omura the Nobel Prize in In order to be effective, patients infected by the indicated pathogen must be treated early before permanent damage is done to the lymphatic system. What bug and infection is this drug most notably effective against? a. Wuchereria bancrofti Elephantiasis b. Toxoplasma gondii Toxicoplasmosis c. Giardia lamblia Giardiasis d. Entamoeba histolytica Amebiasis

8 1. A 2. E 3. B 4. B 5. D 6. A 7. C 8. A 9. C 10. B 11. D 12. E 13. E 14. D 15. B 16. C 17. A 18. E 19. A,C,D 20. C 21. D 22. A 23. C 24. A, B, C, D 25. E 26. C 27. D 28. A 29. E 30. D 31. C 32. C 33. A