Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Infections and Immunologic Disease--->Head and Neck, Upper Airway Infections
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Question 1# Print Question

A 19-year-old woman presents with 5 days of progressive swelling around her right eye. She reports a week of prior nasal pain. On examination, her right eyelid is swollen, the globe is proptotic, and eye movement is limited by pain. Visual acuity is intact. Vital signs are:

  • temperature 38°C
  • HR 94 beats/min
  • BP 128/76 mm Hg

A CT scan demonstrates inflammation of extraocular muscles, fat stranding, and anterior displacement of the globe, with frontal sinusitis. There is no evidence on CT of intracranial inflammation, nor any vascular compromise. While awaiting the results of blood cultures, which of the following antibiotic regimens is MOST appropriate to administer at this time?

A. Levofloxacin
B. Vancomycin and metronidazole
C. Vancomycin and ceftriaxone
D. Piperacillin-tazobactam

Question 2# Print Question

A 55-year-old male with no medical history presents with headache which has lasted for the last 8 days. Approximately 2 weeks ago, he had a furuncle adjacent to the right nares drained. This morning he developed fever, diplopia, and right eye ptosis. On examination, he is febrile to 38.4°C, somnolent but arousable, and hemodynamically stable. He has ptosis and proptosis of the right eye, with a dilated pupil. Neurologic examination shows right third and fourth nerve palsy and decreased sensation on the right side of his face. A highresolution CT scan with contrast shows regions of decreased enhancement, thickening of the lateral walls, and bulging of the cavernous sinus.

Which is the MOST likely causative organism of the infection?

A. Rhizopus
B. Staphylococcus aureus
C. Streptococcus pneumoniae
D. Fusobacterium

Question 3# Print Question

A 28-year-old woman presents with increasing pain and progressive swelling of her neck over the last day. She recently underwent a dental extraction for an abscess but did not complete her course of antibiotics. She denies any respiratory difficulty or distress. On examination, her neck is inflamed, erythematous, with areas of fluctuance and crepitus on palpation. She is to be taken emergently for surgical debridement.

After cultures are obtained in the operating room, what is the MOST appropriate antibiotic regimen to administer? 

A. Vancomycin and clindamycin
B. Meropenem
C. Piperacillin-tazobactam and vancomycin
D. Meropenem and vancomycin and clindamycin

Question 4# Print Question

A 55-year-old male with acute respiratory distress syndrome (ARDS) and ventilator-associated pneumonia (VAP) due to a pansensitive Klebsiella continues to have fevers and a persistently elevated white blood cell count. Blood, sputum, and urine cultures remain negative. His medical history includes prior chest radiation, atrial fibrillation currently managed with a heparin gtt, and a prior cholecystectomy. He is tolerating tube feeding via a nasogastric tube and has solid formed stool.

Which of the following diagnostic tests is MOST likely helpful?

A. CT head
B. Right-upper-quadrant ultrasound
C. Difficile toxin testing
D. Lower extremity duplex ultrasound

Question 5# Print Question

A 43-year-old man presented to the emergency department with complaints of dysphagia and fever. He has felt ill and unable to eat for 2 days. He has a history of type 2 diabetes and reports frequent alcohol use. On examination, he is noted to have poor dentition and is drooling. The floor of the mouth is firm, and the submandibular glands are enlarged and tender. Laboratory testing reveals a leukocytosis to 20,000. He is treated with ampicillin-sulbactam and clindamycin and admitted to the ICU. Over the next 4 hours, he complains of increasing tongue swelling and shortness of breath.

Which of the following is the more appropriate next step in management?

A. Proceed to the OR for intubation or tracheostomy
B. Proceed with intubation in the ICU
C. Administer bronchodilators
D. Drain the submandibular gland

Category: Critical Care Medicine-Infections and Immunologic Disease--->Head and Neck, Upper Airway Infections
Page: 1 of 1