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WorksheetsID - Exam 2: CDI and IAIs
Total questions: 22
Worksheet time: 17mins
Which of these patients are at most risk for developing CDI? Select all that apply.
A 90 y.o. woman with early stage colon cancer.
A 12 y.o. girl that's just finished taking clindamycin for her MRSA infection
A 25 y.o. woman who just gave birth to fraternal twins two weeks ago
A 40 y.o. man who is recovering in the hospital following a successful Whipple procedure (i.e., a complex surgical event involving the pancreas, small intestines, and gall bladder)
A patient taking 81 mg Bayer Aspirin for coronary artery disease (CAD)
Which of the following antibiotics are especially notable in contributing to CDI risk? (Note: All of them can contribute to CDI, but which one is more "infamous?")
Cleocin
Keflex
Vibramycin
Amikacin INHALE
Principen
KC is in the clinic for a follow-up visit after a successful treatment of his nonsevere CDI. Which of the following factors would predispose KC to a recurrence of the CDI? Select all that apply.
KC is 90 y.o.
KC received Fidaxomicin therapy to treat the CDI on top of Clindamycin therapy meant for outpatient treatment of a DFI (left foot) caused by MRSA
KC has GERD and thus takes Omeprazole 40 mg capsules before each meal.
KC is uninsured and lives in a food desert.
KC only received oral Vancomycin therapy to threat the CDI because he had no prior health conditions prior to the infection.
Which of these patients should be diagnosed with CDI?
A patient who has radiographic evidence of toxic megacolon following admission into the ER
A patient who is complaining of severe, bloody diarrhea which has occured 10 times in the past 24 hours
A patient who, against medical advice, received an endoscopy procedure that visualized white-yellowish plaques all over their colorectal mucosa
A patient who received PCR-based toxin testing results indicating that they have C. difficile toxins present in their stool despite being of perfect health
A patient who is complaining of abdominal discomfort and more than 3 unformed, watery stools in the past 24 hours
Given the following disease severity markers, select an appropriate treatment of CDI.
WBCs: 15,000 cells/mm3
SCr: 0.8 mg/dL
BP: 120/100 mmHg
Radiography: "No evidence of toxic megacolon or ileus"
Vancomycin 125 mg IV Q6H x 10 days AND Metronidazole 500 mg PR via retention enema QID
Fidaxomicin 200 mg PO BID x 10 days
Metronidazole 250 mg PO Q8H x 10 days
Fidaxomicin 200 mg IV Q12H x 10 days
Vancomycin 500 mg PO QID x 10 days
Given the following disease severity markers, select an appropriate treatment of CDI.
WBCs: 90,000 cells/mm3
SCr: 4.8 mg/dL
BP: 80/50 mmHg
Radiography: Evidence of ileus and toxic megacolon present
Vancomycin 500 mg IV Q8H AND Metronidazole 125 mg PR via retention enema Q6H
Metronidazole 125 mg IV Q8H AND Vancomycin 500 mg PR via retention enema Q6H
Metronidazole 500 mg IV Q8H AND Vancomycin 500 mg PR via retention enema Q6H
Vancomycin 125 mg IV Q8H AND Metronidazole 500 mg PR via retention enema Q6H
Vancomycin 125 mg IV Q8H AND Metronidazole 500 mg PR via retention enema Q6H
Which of the following treatments is NOT a recommended treatment for severe, NON-fulminant CDI? Select all that apply.
Vancomycin 125 mg PO QID x 10 days
Fidaxomicin 200 mg PO BID x 10 days
Metronidazole 500 mg PO Q8H x 10 days
Vancomycin 500 mg PO Q6H x 10 days
Fidaxomicin 500 mg PO Q8H x 10 days
In the outpatient treatment of non-severe CDI, it is important to tell your patients to come back every 3 days for repeat stool testing during antibiotic therapy of CDI as a test for cure and efficacy of treatment.
False
True
If a patient with non-severe CDI that was originally treated with Flagyl 500 mg PO TID (Q8H) x 10 days reports back to the clinic with a relapse, what modified therapy can you recommend to treat their CDI this time around?
Vancomycin 125 mg PO QID x 10 days
Fidaxomicin 400 mg PO BID x 10 days
Metronidazole 500 mg PO Q8H x 10 days
Vancomycin 500 mg PR via retention enema
Fidaxomicin 200 mg PO BID x 10 days
If a patient with non-severe CDI that was originally treated with Vancocin 125 mg PO QID (Q6H) x 10 days reports back to the clinic with a relapse, what modified therapy can you recommend to treat their CDI this time around?
Vancomycin 125 mg PO QID x 10 days
Fidaxomicin 400 mg PO BID x 10 days
Metronidazole 500 mg PO Q8H x 10 days
Vancomycin 500 mg PR via retention enema
Fidaxomicin 200 mg PO BID x 10 days
Which of the following infections count as uncomplicated intra-abdominal infections (uIAIs)? Select all that apply.
Diverticulitis
Appendicitis
Cholangitis
Pancreatitis
Pyelonephritis
Tertiary peritonitis is severe primary or secondary peritonitis which fails to respond to appropriate therapy OR happens again after ___ hours
12
24
36
48
96
Which of these bacteria would be expected to cause community-acquired IAIs? Select all that apply.
Escherichia coli
Bacteroides fragilis
Clostridium perfringens
Carbapenemase-producing Klebsiella pneumoniae (KPC)
Methicillin-resistant Staphylococcus aureus (MRSA)
Which of these bacteria would be expected to cause healthcare-associated IAIs? Select all that apply.
Listeria monocytogenes
Enterococcus faecalis
Acinetobacter baumannii
Carbapenemase-producing Klebsiella pneumoniae (KPC)
Methicillin-resistant Staphylococcus aureus (MRSA)
Which of the following signs and symptoms classifies a patient's IAI as severe? Select all that apply.
Abdominal pain
Nausea
Constipation
Septic shock
Diarrhea
IAI can be diagnosed from diagnostic paracentesis if the ascitic fluid contains levels of polymorphonuclear (PMN) leukocytes that are _______ (units are in cells/mm3)
equal to 250
less than 250
greater than 250
equal OR less than 250
equal OR greater than 250
When treating IAIs, the administration of appropriate antimicrobial therapy supersedes any requirements for hemodynamic stabilization.
False
True
Uncomplicated intra-abdominal infections (uIAIs) should have limited or minimal use of antimicrobials along with source control interventions as this is the mainstay of therapy?
False
True
Which of these patients, all of which have complicated IAIs, would most likely be classified as high-risk or severe? Select all that apply.
A patient who is 90 y.o.
A patient who also has Stage IVB small cell lung cancer that has metastasized to the brain, liver, and kidneys
A patient who decided to attend an Ariana Grande concert (she reports "she felt fine" during the concert) and delayed treatment for over 48 hours
A patient who takes oral tacrolimus (an immunosuppressant) to prevent his body from rejecting his kidney transplant
A patient whose IAI has not been able to be controlled despite several surgical interventions
An IAI patient who is known to have been colonized by MRSA (anterior nares) can have their IAI classified as low-risk/mild-moderate in severity?
False
True
A patient who has a community-acquired IAI that is low-risk/mild-moderate in severity requires a recommendation for antibiotic therapy. Given that the patient has beta-lactam allergies (PMH of anaphylaxis after receiving Bicillin L-A to treat primary syphilis), which agent should you recommend?
Invanz (E. coli susceptibility: 100%)
Bicillin C-R (E. coli susceptibility: 0%)
Mefoxitin (E. coli susceptibility: 10%)
Rocephin + Flagyl (E. coli susceptibility: 15% and 0%)
Avelox (E. coli susceptibility: 81%)
What is the treatment duration of antibiotic treatment of cIAIs (assuming source control procedures were also performed)?
3-5 days (although longer depending if the infection is slow to resolve)
1-2 weeks (treatment duration highly variable)
5 days (although longer depending if infection is slow to resolve)
10 days
4-7 days (longer durations are NOT associated with improved outcomes)
