Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Infections and Immunologic Disease--->Systemic Infections
Page: 2

Question 6# Print Question

A 77-year-old woman with chronic obstructive pulmonary disease is brought from her skilled nursing facility to the emergency room with fever and mixed hypoxemic-hypercarbic respiratory failure. She was last hospitalized 4 months ago for a hip fracture and last received antibiotics during that hospitalization. She has no known history of multidrug resistant infections, and no risk factors for methicillin-resistant Staphylococcus aureus infection. Chest X-ray demonstrates a right middle lobe infiltrate, and she is admitted to the intensive care unit for hypoxemia.

What is the MOST appropriate antibiotic choice and duration for her pneumonia?

A. Piperacillin-tazobactam for 5 to 7 days
B. Cefepime for 7 to 8 days
C. Levofloxacin for 7 to 8 days
D. Cefepime plus levofloxacin for 5 to 10 days

Question 7# Print Question

A 66-year-old man is admitted to the intensive care unit in respiratory distress. He was attending a conference in a local hotel when he developed fevers and shortness of breath, followed by mild confusion. He also has end-stage renal disease managed with thriceweekly hemodialysis and is anuric. Chest X-ray demonstrates a patchy infiltrate in the left upper lobe. As you admit him to the intensive care unit, you are called by the emergency department for a second admission—this time for a 52-year-old woman with chronic obstructive pulmonary disease who also attended the same conference. In addition to fever and tachypnea, the second patient has a serum sodium of 119 mEq/L, diarrhea, and vomiting. Her chest X-ray demonstrates diffuse bilateral patchy infiltrates.

What is the MOST sensitive test to diagnose the organism causing these patients’ symptoms?

A. Urinary antigen
B. Polymerase chain reaction (PCR) performed on a lower respiratory tract specimen
C. Microbiologic culture of a lower respiratory tract specimen
D. Gram stain

Question 8# Print Question

You admit a 28-year-old man to the intensive care unit in July for a generalized tonic-clinic seizure in the setting of 2 days of fevers, headache, and myalgias. The patient’s girlfriend tells you that they were backpacking in Tennessee’s Great Smoky Mountains National Park the week before the patient became ill, and 3 weeks before he became ill they went for a hike in the woods on Massachusetts’ Cape Cod. Chest X-ray is clear, and his white blood cell count is normal. Platelet count on presentation is 139,000/µL, and hemoglobin and hematocrit are normal. Two days after admission, he develops worsening thrombocytopenia and a rash.

What is the MOST likely diagnosis?

A. Babesiosis
B. Rocky Mountain Spotted Fever (RMSF)
C. Mumps
D. Lyme disease

Question 9# Print Question

Which of the following patients should receive antiviral medication for seasonal influenza infection?

A. A breastfeeding 32-year-old woman who is 6 weeks postpartum
B. A 25-year-old man receiving a TNF-α antagonist for inflammatory bowel disease
C. A 56-year-old man with cirrhosis from alcohol use
D. Both B and C

Question 10# Print Question

A 47-year-old woman with poorly controlled insulin-dependent diabetes mellitus presents to the emergency room with diabetic ketoacidosis. She reports severe pain in her paranasal sinuses with purulent discharge from the bilateral nares for 1 day. On examination, you notice swelling of the paranasal soft tissues and a dark eschar over the left nasal mucosa.

What is the BEST management strategy?

A. Emergent surgical debridement and liposomal amphotericin B
B. Emergent surgical debridement and voriconazole
C. Blood cultures followed by vancomycin, meropenem, and clindamycin
D. Insulin infusion plus liposomal amphotercin B plus voriconazole

Category: Critical Care Medicine-Infections and Immunologic Disease--->Systemic Infections
Page: 2 of 2