Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Infections and Immunologic Disease--->Antimicrobial Therapy and Resistance
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Question 1# Print Question

A 37-year-old man from Thailand presents to the emergency room with hypoxemia and a 6-week history of coughing, including occasional small-volume hemoptysis. Chest X-ray demonstrates a right lower lobe cavitary lesion. He is placed in a negative-pressure isolation room in the intensive care unit (ICU) and started on rifampicin, isoniazid, ethambutol, pyrazinamide, and clindamycin. Nine days after starting antibiotics, his transaminases are elevated, with alanine aminotransferase 1237 IU/mL and aspartate aminotransferase 964 IU/mL.

Which of the following medication(s) is MOST likely to have caused his acute hepatic injury?

A. Ethambutol
B. Rifampicin, isoniazid, or pyrazinamide
C. Clindamycin
D. Isoniazid

Question 2# Print Question

A 46-year-old man living with HIV presents to the emergency room with confusion and quickly becomes obtunded. Lumbar puncture is notable for elevated opening pressure and cerebrospinal fluid with 14 leukocytes/mL. India ink stain is positive.

Which of the following therapies is the BEST choice for management of his disease?

A. High-dose fluconazole
B. High-dose ketoconazole
C. Liposomal amphotercin B and flucytosine
D. Micafungin or caspofungin 150 mg daily

Question 3# Print Question

A 19-year-old football player sustains a blunt abdominal injury during practice at a local college. He quickly becomes pale and hypotensive and is rushed to the emergency room, where splenic rupture is confirmed. He undergoes emergent splenectomy, survives, and is now admitted to the ICU for further care.

Which vaccines should you give Immediately?

A. Meningococcus, Haemophilus influenzae type B (HiB), and the 23- valent pneumococcus vaccine, followed by 13-valent pneumococcus vaccine 8 weeks later
B. Meningococcus, seasonal influenza, varicella zoster virus, and shingles
C. HiB, 23-valent pneumococcus vaccine, and 13-valent pneumococcus vaccine
D. No vaccinations now—wait until at least 2 weeks after splenectomy to administer vaccines

Question 4# Print Question

A bioterrorist attacks your city, sprinkling a white powder over a half-mile-long crowd attending a parade.

What antibiotic prophylaxis is Most appropriate? 

A. Rifampin 1 g orally to all people within a 1-mile radius of the attack
B. Azithromycin 500 mg orally to all people exposed to the powder
C. Ciprofloxacin, levofloxacin, or doxycycline orally to all people older exposed to the powder
D. Ciprofloxacin 500 mg orally to all people over 5 years of age within a 1-mile radius of the attack, rifampin 500 mg to all people under 5 years of age within a 1-mile radius of the attack

Question 5# Print Question

You admit a 34-year-old woman living with HIV to the ICU after a motor vehicle accident. She sustained blunt abdominal trauma with small bowel injury, requiring removal and re-anastomosis of a section of jejunum. Her CD4 T-cell count 3 weeks before the accident was 273 cells/mL. The surgical team recommends strict avoidance of oral intake and initiating total parenteral nutrition while her bowel heals. The patient is currently taking a three-drug regimen to treat her HIV infection, including dolutegravir, tenofovir, and emtricitabine.

What should be done about HIV treatment while the patient remains nil per os?

A. Stop all HIV medications simultaneously
B. Continue dolutegravir, tenofovir, and emtricitabine intravenously
C. Stop tenofovir immediately, but continue tenofovir and emtricitabine intravenously
D. Stop all HIV medications and start intravenous azithromycin and trimethoprim/sulfamethoxazole prophylaxis against opportunistic infections

Category: Critical Care Medicine-Infections and Immunologic Disease--->Antimicrobial Therapy and Resistance
Page: 1 of 2