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1 | |
Which of the following does not describe an
epidemiological issue with community-acquired
pneumonia (CAP)? |
| | A) | Streptococcus pneumoniae and Mycoplasma
pneumoniae are the most prevalent bacterial
pathogens |
| | B) | CAP caused by CA-MRSA is often a necrotizing
disease only in elderly patients |
| | C) | Necrotizing CAP caused by CA-MRSA is associated
with a high (42%) mortality rate |
| | D) | Viruses are the predominant cause of CAP in
children |
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2 | |
An adult who aspirates their oral contents is at risk of
pneumonia from what organisms? |
| | A) | Staphylococcus aureus and viridans Streptococci |
| | B) | Anaerobes and viridans Streptococci |
| | C) | S. aureus and anaerobes |
| | D) | Anaerobes and S. pneumoniae |
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3 | |
Late-onset ventilator-associated pneumonia (VAP) is
frequently caused by: |
| | A) | S. pneumoniae, Haemophilus influenzae, and MSSA |
| | B) | H. influenzae, enteric GNB, and MSSA |
| | C) | Pseudomonas aeruginosa, Acinetobacter spp., and
MRSA |
| | D) | S. pneumoniae, H. influenzae, and MRSA |
| | E) | P. aeruginosa, Acinetobacter spp., and S. pneumoniae |
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4 | |
Host defenses which protect the lung from infection
include: |
| | A) | Mucous and ciliated cells |
| | B) | Immunoglobulin (IgA, IgG, and IgM) |
| | C) | Alveolar macrophages |
| | D) | A and C |
| | E) | All of the above |
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5 | |
Signs and symptoms associated with CAP include: |
| | A) | A. Cough (productive or nonproductive), shortness of
breath, difficulty breathing |
| | B) | Fever, fatigue, sweats, headache, myalgias, mental
status changes |
| | C) | Temperature may increase or decrease from baseline
but most often it is elevated |
| | D) | A and C |
| | E) | All of the above |
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6 | |
Components of the recommended strategy for the
diagnosis of VAP include: |
| | A) | Obtaining either a quantitative or semiquantitative
culture of a lower respiratory sample |
| | B) | On days two and three, check culture results and
assess clinical response to therapy |
| | C) | If the clinical assessment at day 2 or 3 is improvement
in the patient and the cultures are negative then
antibiotics should be stopped |
| | D) | A and C |
| | E) | All of the above |
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7 | |
Before an empirical regimen can be selected, which of
the following must be evaluated? |
| | A) | Comorbid conditions that the patient has that could
influence the regimen or outcomes |
| | B) | What drugs cover all of the organisms which could
cause pneumonia (no matter how rare the incidence is) |
| | C) | The patient’s cardiac function |
| | D) | A and C |
| | E) | All of the above |
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8 | |
The most common pathogen associated with
community-acquired bacterial pneumonia is
S. pneumoniae. Which of the following statements
best describe the resistance issues associated with this
organism? |
| | A) | Macrolide/azalide resistance has risen slowly since
1999 |
| | B) | Penicillin resistance has risen slowly since 1999 |
| | C) | Resistance to the respiratory fluoroquinolones such
as levofloxacin have remained around 1% or less
since 1999 |
| | D) | A and C |
| | E) | All of the above |
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9 | |
JF is a 60-year-old female, presents to the emergency
department complaining of a productive cough
(greenish/yellowish stuff) and chest tightness. PMH:
IDDM × 10 years, HTN × 4 years. Vitals: 101.2°F
(38.4°C), HR 80, 118/86, respiratory rate 18, pulse
oximetry (oxygen saturation) 96% on room air. Ht: 5'5"
(165 cm), wt 64 kg (140 lb). Allergies: cephalosporins—
hives. Home medications are insulin, and atenolol
50 mg everyday. Chest x-ray: right mid lobe infiltrate.
Her ECG is normal, renal function is normal (creatinine
clearance 75 mL/min) and WBCs are 11.8 × 103/mm3
(11.8 × 109/L). Which of the following would be the
most appropriate empirical therapy for JF’s pneumonia? |
| | A) | Azithromycin 500 mg orally every 24 hours |
| | B) | Levofloxacin 750 mg orally every 24 hours |
| | C) | Ceftriaxone 1 g IV every 24 hours plus azithromycin
500 mg IV every 24 hours |
| | D) | Cefepime 2 g IV every 12 hours plus doxycycline 100
mg IV every 12 hours |
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10 | |
DR is a 72-year-old male who presented to the hospital
for a hernia repair. PMH is significant for smoking for
the last 20 years. He has been intubated for the last 2
days and attempts to wean DR off of the ventilator have
failed. The nurses noted increased volume and purulence
of secretions from the ventilator. Chest x-ray: left lower
lobe infiltrate. Urinary DFA for Legionella is negative. Ht:
5'10" (178 cm), wt 75 kg (165 lb) and he has NKDA. PMH
is negative and home medications are one multivitamin
once daily. Creatinine clearance is 70 mL/min, WBCs
are 13.5 × 103/mm3 (13.5 × 109L), and temperature is 38°C
(100.4°F). Which of the following organisms are the most
likely pathogens for DR’s pneumonia? |
| | A) | MRSA, extended-spectrum ß-lactamase producing
Klebsiella pneumoniae, P. aeruginosa, Acinetobacter spp. |
| | B) | S. pneumoniae, MSSA, Escherichia coli, K. pneumoniae |
| | C) | Anaerobes, viridans Streptococci,
E. coli, K. pneumoniae |
| | D) | S. pneumoniae, H. influenzae, Moraxella catarrhalis,
Mycoplasma pneumoniae, Chlamydia pneumoniae,
and Legionella pneumophila |
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11 | |
DR underwent bronchoscopy and the gram stain of the
bronchoalveolar lavage shows moderate gram-positive
cocci in pairs, moderate gram-negative bacilli, and
many WBCs. Which of the following would be the most
appropriate empirical regimen for DR’s pneumonia? |
| | A) | Moxifloxacin 400 mg IV or orally every 24 hours |
| | B) | Nafcillin 2 g IV every 6 hours plus ceftriaxone 1 g IV
every 24 hours plus tobramycin |
| | C) | Vancomycin 1500 mg IV every 12 hours plus
ceftriaxone 1 g IV every 24 hours plus tobramycin |
| | D) | Azithromycin 500 mg IV every 24 hours plus
ceftriaxone 1 g IV every 24 hours |
| | E) | Ertapenem 1 g IV every 24 hours plus ceftriaxone 1 g
IV every 24 hours |
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12 | |
Which of the following factors is/are the most
important considerations for determining the duration
of therapy for DR? |
| | A) | Clinical pulmonary infection score (CPIS) |
| | B) | Time to the start of clinical improvement |
| | C) | Risks for toxicity associated with the therapy |
| | D) | A and C |
| | E) | All of the above |
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13 | |
Outcome evaluations to be made on your patient with
pneumonia include: |
| | A) | Improvement of symptoms within 48 to 72 hours for
CAP, HAP, HCAP, and VAP |
| | B) | Resolution of symptoms within 48 to 72 hours for
CAP, HAP, HCAP, and VAP |
| | C) | Consideration of noninfectious reasons for
persistence of symptoms |
| | D) | A and C |
| | E) | All of the above |
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14 | |
Which of the following are considered at high risk for
complications from influenza and should be vaccinated? |
| | A) | People 65 years of age and older |
| | B) | Health care workers |
| | C) | Children 6 months and older with chronic heart or
lung conditions, including asthma |
| | D) | A and C |
| | E) | All of the above |
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15 | |
A 2-month-old child to be vaccinated against
S. pneumoniae should receive: |
| | A) | The polysaccharide vaccine |
| | B) | The conjugated vaccine |
| | C) | No vaccine because they are not effective in
2-month-old children |
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