therapy 5 midterm exam 200033--5 5225 · 2013-11-14 · chills, pleuritic chest pain, malaise and...

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KING FAISAL UNIVERSITY COLLEGE OF CLINICAL PHARMACY

Therapy 5 Midterm Exam

22000033--552255

Instructor: Dr. Yasir A. Ibrahim

Student Name:

Student #:

Final Score

2

Mini Case

BG is a 7 years old boy who brought to the ER by his parents with severe GI

symptoms, low-grade fever, non-productive cough, headache, and malaise. On taking

the history of the disease the parents reported that BG was complaining since last

week of GI symptoms and some signs of pharyngitis. Chest X-ray showed a bilateral

infiltration and on physical exam showed rales and low-grade fever. Labs; negative

sputum culture, hemolytic anemia, cold agglutinin titer of 1:10,000, and positive

serological test. BG is admitted and diagnosed as CAP.

Questions 1-2 are based on this case

1. Which of the following organism is most likely responsible

A. S. pneumonia

B. H. influenza

C. M. pneumonia

D. Chlamydia

E. Legionella

2. Empiric antibiotic therapy could be initiated with

A. Ceftriaxone IV

B. Doxycycline IV

C. Azithromycin plus ceftriaxone IV

D. TMP/SMZ IV

E. Amoxicillin IV

3. MA is 58 yo old male, heavy smoker diagnosed with community acquired

pneumonia. The sputum culture was positive for S. Which of the following

statements is true in regard of S. pneumonia resistance

A. Newer Flouroquinolones are active against penicillin resistant

strains

B. Mechanism is through -lactamase enzyme production

C. Intermediate and sensitive strains can be treated with regular

doses of ceftriaxone

D. ErmAM is a macrolide resistance gene that increases the drug

efflux and usually resistant to clindamycin

E. TMP/SMZ resistance usually is uncommon

4. ------------- ------------- is a false positive test occur within 1 week and may last to

longer than 1 year

A. Booster effect

B. Latent TB

C. Active TB

D. PPD test

E. Quantiferon test

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5. BG has been diagnosed with influenza type A which of the following treatment/s

can be use

I. Amantadine 100 mg po2xd

II. Zanamivir 10 mg inhaled bid x 5 days

III. SMZ/TMP (15 mg TMP component/kg/d IV in divided doses)

A. I only

B. II only

C. I and II only

D. II and III only

E. I, II, and III

6. Aminoglycosides as monotherapy for the treatment of community acquired

pneumonia (CAP) should be avoided because:.

I. Low pH of the lung tissues

II. Unfavorable tissue for distribution

III. Lower pH of the lung tissues

A. I only

B. II only

C. I and II only

D. II and III only

E. I, II, and III

7. Which of the following/s BEST describe sinusitis:

A. Acute bacterial sinusitis usually lasts for > 30 days

B. Radiography is first initial evaluation done

C. Acute viral rhinosinusitis is easily distinguished from bacterial

rhinosinusitis within the first week

D. Patient can be treated with Zinc preparations

E. 40 -60% of patients with acute bacterial rhinosinusitis will clear

the infection spontaneously

Mini case

MG is a 45years old male who presented to the clinic with 3-day history of fever,

chills, pleuritic chest pain, malaise and productive cough. In clinic his temperature is

102oF. His chest radiograph shows consolidation in the right lower lobe. MG is

diagnosed with community-acquired pneumonia. Pneumonia severity index (PSI) was

performed on MG and was categorized as class II.


8. Which of the following organism would likely be responsible

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A. Staphylococcus aureus

B. Streptococcus pneumonia

C. Pneumocystis carinii

D. Haeomphilus influenzae

E. Mycoplasma pneumonia

9. Based on PSI where would MG could be treated

I. Treated as inpatient

II. Treated as outpatient

III. Treated initially as inpatient then discharge and treated as outpatient

A. I only

B. II only

C. I and II only

D. II and III only

E. I, II, and III

10. According to IDSA and ATS guidelines how can you treat MG

A. Azithromycin 500 mg every 24 hours as an inpatient

B. SMZ/TMP (15 mg TMP component/kg/day IV in divided doses)

as an outpatient

C. Levofloxacin 500mg every 24 hours as an outpatient

D. Clindamycin 600 mg every 8 hours as an inpatient

E. Ceftriaxone 2 gm every 24 hours plus Azithromycin 500mg

every as an inpatient

11. ----------- -------------- is/are highly efficient pathogen/s that may precipitate CAP

through inhalation of organism-containing particles or aerosols

I. S. aureus

II. M. pneumonia

III. S. pneumonia

A. I only

B. II only

C. I and II only

D. II and III only

E. I, II, and III

12. Which of the following statements is most ACCURATE regarding TB

A. TB is spread by shaking someone's hand

B. High socioeconomic status

C. PPD is positive if ≤ 5 mm

D. Interferon TB cold is skin test

E. Breast feeding is not contraindicated in women taking first line

agents

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13. GF is 60 years old male living in a nursing home. Recently there had been an

outbreak of influenza and almost everyone in the nursing home suffered. He had it

too for more than 10 days where his condition started to derteriorate and taken to

the hospital and was diagnosed with pneumonia his sputum showed a coagulase

positive G+ve. Which of the following microorganism is responsible for his

disease

A. Staphylococcus aureus

B. Streptococcus pneumonia

C. Pneumocystis carinii

D. Haeomphilus influenzae

E. Mycoplasma pneumonia

14. Which of the following statements is most ACCURATE regarding RSV

A. RSV sign and symptoms in neonates and infants usually

manifested as upper respiratory tract infection

B. Risk factors for sever disease include high socioeconomic status

C. Routine use of RSV IG and Palvizumab as prophylaxis are

advocated during the season to reduce mortality and morbidity

D. Treatment options is mainly supportive and Ribavarin can be

used for high risk groups

E. Treatment options can be achieved by the use of corticosteroids,

β agonists and antibiotics

Mini case

RK is a 35 year old woman who present to the clinic with a 2 weeks history of night

sweats, fatigue, weight loss, and a cough that won't quit. A PPD test was done in

addition to her sputum was taken and was sent home on levofloxacin 750 mg/d orally.

Two days later her PPD measured 20 mm induration and the sputum sample was

positive for AFB. RK never been outside the Kingdom and the incidence of multidrug

resistant tuberculosis is low.


15. Which of the following steps is crucial to do

I. LFT baseline

II. HIV testing

III. No need for isolation

A. I only

B. II only

C. I and II only

D. II and III only

E. I, II, and III

16. If you decided to treat RK what is the best treatment would be

A. INH 300 mg/d orally for 6 months

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B. INH, rifampicin, pyrazinamide, and ethambutol for 2 months

followed by INH rifampicin for 4 more months

C. INH and rifampicin for 6 months

D. Continue levofloxacin for 2 weeks

E. Start amoxicillin/clavulanate with levofloxacin

17. The culture returned and the showed resistance against INH which of the

following is true

I. INH, PZA and EMB for 6 months

II. RIF, PZA, EMB for a total of 9 months

III. RIF, INH, PZA, EMB for 2 months then RIF for a total of 6 months

A. I only

B. II only

C. I and II only

D. II and III only

E. I, II, and III

18. Indication for invasive diagnostic techniques is warranted when:

I. Good response to empiric therapy

II. Suspicious of non-infectious cause

III. Unexplained deterioration after initial improvement

A. I only

B. II only

C. I and II only

D. II and III only

E. I, II, and III

19. The following statements will lead to increase the risk or incidence of otitis media

EXCEPT A. Day care attendance

B. Carniofacial abnormalities/cleft plat

C. Family history

D. Breast feeding

E. Second hand smoke

20. The following statements are true with regard latent TB EXCEPT

A. Goal is to prevent latent progression into active TB

B. Close contacts should be treated

C. Foreign born persons from low prevalence countries within 1

year should be treated

D. Person working or living in long term care facility should be

treated

E. Homeless persons should be treated

21. Which of the following statements is most ACCURATE regarding RSV

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A. AAP recommend the use of Ribavarin in high risk groups

B. RSV incubation period is usually 4 -6 weeks

C. RSV immune globulin is save in patients with cyanotic

congenital heart disease

D. RSV in neonates manifest as upper respiratory tract infection

E. RSV in older children manifest as lower respiratory tract

infection

22. TK is 32 year old female who is HIV positive and present to the clinic with

typical TB symptoms that is confirmed with AFB. She is receiving ART

including boosted PI, Zidovudine and lamivudine. She lives in area where INH

resistance is widespread. Which of the following is the initial treatment of choice

I. Start INH, RIF, PZA, EMB with no change in her HIV medications

II. Rifabutin, PZA, EMB, and Moxifloxacin with HIV RNA monitored

III. Start INH, RIF, PZA and Moxifloxacin with no change in her HIV

medications

A. I only

B. II only

C. I and II only

D. II and III only

E. I, II, and III

23. A good sputum sample should contain:

A. 5 neutrophils and 15 squamous epithelial cells per low power

field

B. 25 neutrophils and 25squamous epithelial cells per low power

field

C. 25 neutrophils and 10squamous epithelial cells per low power

field

D. 25 neutrophils and 5 squamous epithelial cells per low power

field

E. 5 neutrophils and 25 squamous epithelial cells per low power

field

Mini case

MS is 40 yo male released from prison few weeks ago. He presented to the ED

complaining of cough, fever, and night sweats. He said he has lost 20 Ib over the last

month since his release. His AFB was positive


24. Treatment options would be

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A. INH, RIF, PYZ, ETM for 2 months then INH and RIF for 4

months

B. INH, RIF, PYZ, ETM for 6 months

C. INH, PYZ, ETM for 6 months

D. RIF, PYZ, ETM for 6 months

E. RIF, INH, PYZ for 2 months

25. 8 weeks later his spututm was still positive for AFB and his culture was resistant

to INH and RIF. Which of the following is the most accurate treatment

A. D/C INH and RIF add moxifloxacin to PYZ and ETH

B. D/C INH and RIF add moxifloxacin and amikacin to PYZ and

ETH

C. D/C INH and RIF add amikacin and streptomycin to PYZ and

ETH

D. D/C INH and RIF add stretptomycin to PYZ and ETH

E. D/X INH and RIF add Linezolid

Good Luck

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Therapy 5 Final Exam

22000033--552255


Student Name:

Student #:

Final Score

10

Please choose the BEST ANSWER, a total of 45 questions

1. Which of the following statements is most ACCURATE with regard urinary tract

infections (UTI)

a. Asymptomatic patients with catheter related UTI should be

treated

b. Epididymitis in patients older than 35 yrs usually caused by

gonococcal or chlamydia

c. Relapse in recurrent cystitis defined as infection with new

organism within 14 days of discontinuing UTI antibiotics

d. Tuberculosis associated with false negative leukocyte esterase

and positive culture

e. Female patients who develop UTI is usually considered

uncomplicated unless pregnant

2. RT is a an 85 year old woman who is bedridden and lives in a nursing home. She

is chronically catheterized and her urinary catheter was last change 3 weeks ago.

Today her urine is cloudy and urinanlysis shows many bacteria. RT is

asymptomatic. A urine culture is obtained which one of the following therapies

should be given

a. No therapy and keep the catheter

b. No antibiotic, but the catheter should be changed

c. Oral ciprofloxacin 500 mg bid for 7 days and a new catheter

d. Oral ciprofloxacin 500 mg bid for 14-21 days without changing

the catheter

e. SMZ/TMP DS bid for 7 days and a new catheter

3. Which of the followings is a type of anemia diagnosed by exclusion and

characterized by low iron with normal or increased ferritin level and decreased

TIBC on peripheral smear is normocytic.

a. Anemia of chronic illness

b. Iron deficiency anemia

c. Macorcytic anemia

d. Hemolytic anemia

e. Sickle cell anemia

Mini case

RT is 5 years old boy presented to the ER with temperature of 104o F, altered mental

status, petachiae and Kernig sign on physical exam. There is no history of trauma.

Toxicological studies were negative. His labs include WBC of 32000 with left shift. RT

goes to day care. An LP was done and showed > 5000 WBC, with > 3000 neutrophils, 5

mg/dl glucose, and 300 mg/dl protein. He has no known allergy.

Questions 4- 7 are based on this case

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4. RT diagnosis is

a. Viral enchephalitis

b. RSV

c. Bacterial meningitis

d. Otitis media

e. ADHD

5. Which of the following microorganisms might contribute to RT disease

I. H. influenzae

II. Neiseseria meningitidis

III. E. coli

a. I only

b. II only

c. I and II only

d. II and III only

e. I, II, and III

6. Which of the following embiric treatment is/are accurate for RT disease

I. Ampicillin plus gentamicin

II. Ceftriaxone ± vancomycin plus dexamethasone

III. Ampicillin plus cefotaxime

a. I only

b. II only

c. I and II only

d. II and III only

e. I, II, and III

7. Which of the following statements is most ACCURATE regarding RT case

I. RT should be given steroids

II. All those come in contact with RT should be given prophylaxis with

rifampicin

III. All those come in contact with RT should be given prophylaxis with

ceftriaxone

a. I only

b. II only

c. I and II only

d. II and III only

e. I, II, and III

8. Which of the following microorganism/s is/are associated with atypical

pneumonia;

I. Streptococcus pneumonia

II. Mycoplasma pneumonia

III. Legionella

a. I only

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b. II only

c. I and II only

d. II and III only

e. I, II, and III

9. A 50 year old male was admitted to the ICU for CAP with a history of COPD.

The intern physician asked you for your recommendation. What is your BEST

treatment option would be.

I. Trimethoprim/Sulfamethoxazole

II. Levofloxacin

III. Piperacillin/tazobactam

a. I only

b. II only

c. I and II only

d. II and III only

e. I, II, and III

Mini case

RE is a 33 year old man who has been HIV since 1999. He has never started on any

HAART before. He presented with enlarge lymph nodes, weight loss, recently his CD4

counts have started to decrease significantly and reached 170. PMHx include depression,

IV drug abuse that he stated he has been clean for the last 4 yrs.


10. Given this scenario what would you manage this case

I. Send for genotyping

II. Consider starting Bactrim DS every other day

III. Consider starting Azithromycin 1200 mg weekly

a. I only

b. II only

c. I and II only

d. II and III only

e. I, II, and III

11. If you wanted to start RE on treatment what would be your best option

a. Efavirenz plus emtricitabine/tenofovir

b. Atazanavir/ritonavir plus emtricitabine/tenofovir

c. Lopinavir/ritonavir plus emtricitabine/tenofovir

d. Raltegravir plus emtricitabine/tenofovir

e. Abacavir plus lamiviudine plus zidoviudine

12. PI is a 35 year old woman who present to the clinic with a 2 week history of night

sweats, fatigue, weight loss, and cough won't quit. A PPD test was done and was

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send home on Levofloxacin 750 mg po daily. Two days later her PPD was 20 mm

induration and her sputum was positive for acid fast bacilli. She has no pertinent

medical history and has never left the country before, and she lives in a low

incident area of multidrug resistant tuberculosis. What is the best treatment for PI

a. INH 600 mg daily for 9 months

b. INH, rifampin, pyrazinamide, and ethambutol for 2 months

followed by INH and rifampin for more 4 months

c. INH and rifampin for 6 month

d. Continue on levofloxacin for 15 days

e. Rifampin, pyrazinamide, and ethambutol for 9 months

13. KJ developed AIDS and was diagnosed with P. carinii pneumonia (PCP) what

would be your treatment options

I. SMZ/TMP (15 mg TMP component/kg/day IV in divided doses)

II. Clindamycin plus primaquin

III. Zanamivir

a. I only

b. II only

c. I and II only

d. II and III only

e. I, II, and III

Mini case:

MJ 19 yo male has sustained a high cervical spine injury at C-2 due to a trampoline

accident. His neurological injury is complete at the C-2/C-3 level and he is intubated.

Vital signs are P 62, BP of 82/44 RR 18 with BSA of 1.5M2. He has been given 4 L of

NS and his BP has not responded. A PAC was established in MJ and the following

parameters were recorded, CO 4 L/min, PCWP 14 mmHg, SVR 600 dynes/cm5.


14. MJ calculated CI is

a. 2.6

b. 6

c. 8.7

d. 3.5

e. 4

15. MJ MAP is

a. 60

b. 56.6

c. 69.3

d. 82

e. 72

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16. The drug of his shock is

a. Epinephrine

b. Norepinephrine

c. Dopamine

d. Dobutamine

e. Vasopressin

17. Goal of therapy in sepsis include all the following EXCEPT

a. Timely diagnosis and identification of the pathogen

b. Rapid elimination of the source of infection

c. Use appropriate antibiotic based on the culture results

d. Interruption of the pathogenic sequence leading to septic shock

e. Avoidance of organ failure

18. Which is NOT TRUE about dobutamine

a. Induces catecholamine release

b. Indicated in cardiac decompensation secondoray to decreased

cardiac contractility

c. It is contraindicated in patients with idiopathic hypertrophic

subaortic stenosis

d. When given with tricyclic antidepressants significant increase in

blood pressure may occur

e. Has a drug drug interaction with bretylium

Mini case:

LG is a 48 year old woman with a history of mitral valve prolapse. She presents to her

physician's office with malaise and low grade fever. Her physician notes that here

murmur is louder than normal and orders blood cultures and an echocardiogram. A large

vegetations is observed on LG's mitral valve, and her blood cultures are growing

Enterococcus faecalis (susceptible to all antibiotics).


19. Based on this presentation LG can be diagnosed with

I. Septic shock

II. Definite endocarditis

III. Cardigogenic shock

a. I only

b. II only

c. I and II only

d. II and III only

e. I, II, and III

20. The best treatment for LG would be

I. Penicillin G plus gentamicin for 4-6 weeks

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II. Dobutamine

III. Norepinephrine

a. I only

b. II only

c. I and II only

d. II and III only

e. I, II, and III

21. Which of the following is/are the Most Common bacterial microoraganisms

associated with HAP, VAP and HCAP:

I. Pseudomonas aeruginosa

II. Acinetobacter spp.

III. Coagulase negative Staph aureus

a. I only

b. II only

c. I and II only

d. II and III only

e. I, II, and III

Mini case:

QB is a 25 year old woman who present to ER with a 2 day history of dysuria, frequency

and urgency. She has no significant medical history, and the only drug she takes is oral

contraceptives.


22. QB is best diagnosed with

I. Complicated UTI

II. Uncomplicated UTI

III. Epididymitis

a. I only

b. II only

c. I and II only

d. II and III only

e. I, II, and III

23. QB treatment should compose of

I. TMP/SMZ 5 days

II. Levofloxacin 5 days

III. Mechanical contraceptive

a. I only

b. II only

c. I and II only

d. II and III only

e. I, II, and III

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24. MR is a 24 yo man with a history of IV drug abuse. He is currently admitted with

10 day history of malaise and intermittent fevers. He has no history of

endocarditis nor artificial valves. On physical exam was noted to have a new

murmur. A vegetation is observed on the tricuspid valve on echocardiography.

Blood culture was positive for MRSA. Which of the following is the best therapy

for MR

a. Vanocmycin for 2 weeks

b. Vancomycin for 2 weeks plus gentamicin for 3-5 days

c. Vancomycin for 6 weeks

d. Vancomycin plus gentamicin both for 6 weeks

e. Vancomycin plus rifampin both for 6 weeks

25. Which of the following best described as an acute skin infection that involves the

deep dermis and subcutaneous fat and characterized by poor defined margins and

happens as a result of minor trauma, abrasions, ulcers or surgery.

a. Cellulitis

b. Erysipelas

c. Necrotizing fasciitis

d. Leishmaniasis

e. Diabetic foot infection

26. Which of the followings is/are the risk factors for developing antibiotic resistance

I. Prior antimicrobial use

II. Prolonged hospitalization

III. Underdosage of antibiotics

a. I only

b. II only

c. I and II only

d. II and III only

e. I, II, and III

27. When treating a patient with TB which of the following points should be

addressed during counseling the patient with regard the drug use

I. If the patient complained of blurred vision might be contributed to

Pyrazinamide and its optic neuritis side effect

II. Alcohol consumption might increase INHl liver toxicity

III. Rifampicin might lead to orange discoloration of body fluids

a. I only

b. II only

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c. I and II only

d. II and III only

e. I, II, and III

28. RK, a 47 yo immigrant presented to ED with severe abdominal pain, while taking

the history he mentioned he had many episodes of amebiasis that he was not

compliant with taking the medication for it. After a comprehensive investigation

was found to have liver amebiasis. What would be the best treatment option for

RK.

a. Paromomycin

b. Emetine

c. Chloroquine phosphate

d. Tinidazole

e. Diloxanide furoate

29. Which of the following occur during or after an influenza infection

I. Resolution with antiviral drugs

II. Bacterial superinfection

III. Reliable protective immunity against influenza in the next seasons

a. I only

b. II only

c. I and II only

d. II and III only

e. I, II, and III

Mini case:

VN is 56 yo woman who came to the primary care clinic for an evaluation of a tender and

painful inflamed area on her left leg. She has noticed increasing pain and swelling over

the past 2 days. She was playing with her grandson over the weekend and tripped and fell

down scrapping her leg. She has a medical history of hypertension for which is taking

HCTZ 25 mg daily and NKA. .


30. Which of the following is most likely cause of her cellulitis

a. Pseudomonas aeruginosa

b. Streptococcus pyogenes

c. Klepsiella pneumonia

d. Enterococcus faecalis

e. Enterococcus faecium

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31. Which one of the following is the best treatment option

a. Naficillin

b. Bactrim

c. Ciprofloxacin

d. Vancomycin

e. Erythromycin

32. Severe sepsis is composed of

I. SIRS

II. Organ dysfunction

III. Hypotension not responding to fluid resuscitation

a. I only

b. II only

c. I and II only

d. II and III only

e. I, II, and III

33. OA was diagnosed with open angle glaucoma with IOP of 30 mmHg, vertical cup

disk ration of 0.8 and visual field defects. Which of the following drugs would

you recommend as first line treatment

a. Topical beta blockers

b. Latanoprost

c. Oral CAI

d. Carbachol

e. Argon laser

Mini case:

TR is a personnel who works with the WHO, his sector that he covers include, Iraq, |Iran,

SA, Afghanistan, and Kuwait. He has been visiting remote places in those countries for

the last 1.5 years. Recently he noticed scattered dry type of ulcers with a size ranging

from 1-2 cms with no exudates and painless around exposed pats of his body.


34. Based on this presentation what is BEST diagnosis of his condition would be

a. Localized cutaneous leishmaniasis caused by L. tropica

b. Localized cutaneous leishmaniasis caused by L. aethipica

c. Localized cutaneous leishmaniasis caused by L. infantum

d. Localized cutaneous leishmaniasis caused by L. chagasi

e. Localized cutaneous leishmaniasis caused by L. braziliensis

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35. Given this case what would be BEST describes the treatment

a. Pentostam can be used for the treatment given for 10 days orally

b. Amphotericin is the first line for treatment of cutaneous

leishmaniasis

c. Pentamidine isethionate can be given orally and associated with

many side effects including acute renal failure

d. Glucantime is given for 20-28 days and the resolution may take

up to 2 years for TR

e. Miltefosine is a phospocohline analogue that must be given IM

or IV because is it poorly absorbed from the GI

36. Which of the following statements is most ACCURATE with regard HIV

a. HIV transmission decreases with increased sexual partners

b. Western blot is the first test we use to check HIV

c. RNA testing can be used to diagnose acute HIV infection

d. Postpartum transmission in not possible through breastfeeding

e. ELISA assay has low sensitivity and specifity

37. All the following drugs may induce or potentiate increased intraocular pressure in

open angel glaucoma EXCEPT

a. Opthalmic corticosteroids

b. Systemic corticosteroids

c. Fenoldopam

d. Carbonic anhydrase

e. Cimetidine

38. Which of the following statements is TRUE with regard sickle cell clinical

presentation

a. Sicke cell trait carrier rarely experience pain unless provoked by

heavy exercise and usually have normal Hgb level

b. Sickle cell HgbC usually have sever hematuria and common

vaso-occlusive crises

c. Sickle cell β-thalassemia have rare crises due to no production of

HgbA

d. Sickle cell α thalassemia severity similar to sickle trait carrier

due to production of HgbA

e. Sickle cell anemia is due to iron deficiency and characterized by

acute pain crises

Mini case:

ED is 25 yo young man with a history of Sickle Cell disease, recently has many visits to

the ER with chief complain of severe chest pain, this episode he has a history of fever,

cough and SOB


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39. What would be your approach to treat ED

I. Give antipyretics/analgesics but not narcotics

II. O2 supplementation

III. Hgb transfusion

a. I only

b. II only

c. I and II only

d. II and III only

e. I, II, and III

40. Which of the following constitute an ideal treatment plan for ED

I. Routine vaccination against flu and pneumococcal

II. Folic acid

III. Hydroxy urea

a. I only

b. II only

c. I and II only

d. II and III only

e. I, II, and III

41. When dealing with UTI which of the following pathogens might not be associate

with the disease

a. E. coli

b. Proteous mirabilis

c. S. pneumonia

d. Klebsiella

e. Pseudomonas

42. Despite your plan ED did not follow and this time was admitted to the ER with

altered mental status and from the history from the family it was noticed that he

was complaining of severe headache and he started to limp. Given this scenario

what would be the appropriate approach

I. Should be assessed for VTE

II. Supportive care

III. Long term transfusion

a. I only

b. II only

c. I and II only

d. II and III only

e. I, II, and III

43. ED condition after recovering from the previous episode he started to deteriorate

further with a rapid fall in Hgb concentration and rise in reticulocyte count with

splenomegaly. What is the next treatment option for ED.

I. Vaccination

II. Splenectomy

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III. Nothing since he is going to recover after this episode

a. I only

b. II only

c. I and II only

d. II and III only

e. I, II, and III

44. Which of the following statements is NOT TRUE regarding amebiasis

a. All E. histolytica infections should be treated, even in the

absence of symptoms

b. Goal of treating intestinal amebiasis is to eradicated both the

trophozoites and cysts

c. Cholorquine is effective only for intestinal amebiasis

d. Tissue amebicide acts on trophozoites only eg metronidazole

e. Luminal amebicides acts only in the bowel lumen with minimal

systemic absorption e.g. diloxanide furoate

45. ST recently returned from a trip to an endemic area of falciparum resistant

malaria, 2 weeks later he presented to the ER with high fever, severe headache,

nausea and vomiting. A blood smear showed P. falciparum. Which of the

following is your best treatment option.

a. Chloroquine phosphate IV

b. Mefloquine oral

c. IV quinine plus tetracycline

d. Primaquine orally

e. Artemisinin single agent

BEST OF LUCK

22


Therapy 5 Lab Final Exam

22000033--552255


Student Name:

Student #:

Final Score

23

The exam consists of a total of 3 Questions with a total of 15 marks.

Please Explain and Rationalize your answers.

1- (8 marks)

CC: DA is a 17 year old previously healthy boy who presents to a local ER with fever

and altered mental status.

PMHx:

DA is a new university student living in the barracks, has had a 2 day history of

intermittent fever and painful headache unrelieved by extra-strength acetaminophen

tablets. This morning DA complained of increasing lethargy and slept much of the

remaining day. Six hours prior to admission, DA was difficult to arouse and had three

documented episodes of vomiting

FHx:

Non contributory

MHx:

DA has a 3 year history of intermittent AFib, associated with Wolff-Parkinson-white

syndrome, which has improved on procainamide, which has not fully suppressed the

arrhythmia.

Procainamide 750 mg po q 6h

Allergies

NKDA

SHx:

Son of a single mother, just accepted to the university where he moved and stayed in the

barracks, non-smoker or alcohol drinker.

PE:

GEN Male disoriented to person, place, and thing, in mild respiratory distress

VS BP 135/72, HR 95 and regular, RR 30, T40.5, Wt 62.5 kg (Usual Wt 65),

Ht 170 cm

HEENT Head was without trauma, ears clear, PERRLA, normal vessels without

papilledema, normal dentition

NECK Decreased mobility, positive Brudzinski's sign

COR NL heart sounds, RRR

CHEST Rales could heard on the right side, decreased breath sounds and dullness

to percussion: right greater than left

ABD WNL

GU WNL

RECT WNL

EXT WNL

NEURO Lethargic, not oriented to person, place or thing, reflexes were 3+

throughout and symmetrical, motor was intact

24

Result of lab test:

Na 145 Scr 0.9 Mg 2.1

K 4 HCT 46 Alb 4.5

Cl 105 Hgb 14.8 Glucose 90

HCO3 24 WBC 16.5

BUN 18 Plt 285

CSF: WBC 1.8, 90% PMN

Glu: 30

Protein: 125

Gram stain: Positive diplococcic

ABG: pH 7.48, pCO2 35, PO2 90, HCO3 24, O2 Sat 90%

25

2- DA was admitted to the ICU where was intubated and was on treatment, 3 days later

his condition started to deteriorate and his ventilator parameters were altered, he has a

lot of yellowish secretions. His labs showed a sudden increase in WBC despite initial

decline in WBC to reach 23,000, BP is 70/40 that is not responding to fluid

resuscitation.

Explain with rationalizing your answer for the followings (3 marks)

a. Based on this presentation what do you think is the reason for DA

deterioration?

b. What is the name of his current diagnosis?

c. How can you treat this new condition?

26

3- 42 yo male, 72 kg, BSA 1.8 M2, admitted to the ER with severe chest pain not

relieved by 3 NTG, EKG was consistent with AMI, 10-115 PVCs were noticed on the

monitor with some coupled. BP 90/40, P 90, RR 30. At the ER 4 mg of MS IV< 40

mg furosemide IV x 1, O2 at 2 L/min lidocaine total of 150 mg bolus, now at 2

mg/min. PVC now about 3/min. Patient stable for now.

An Arterial line and S-G catheter was placed, data as follows:

BP 84/45, P 90, RR 20, CO 2.9, PCWP 24

ABGs on 50% FIO2

pH 7.2, , pO2 50, pCO2 50, HCO3 22

Skin is cold and clammy, pt. is confused and drowsy

CXR suggests pulmonary edema

Urine output 10 ml over last 30 mi

Explain with rationalizing your answer for the followings (4 marks)

a. What is your diagnosis for this condition?

b. How would you approach this case?

c. What is the treatment options for this case would be explaining your

rational for it?

GOOD LUCK

therapy 5 midterm exam 200033--5 5225 · 2013-11-14 · chills, pleuritic chest pain, malaise and...

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