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WorksheetsID - Exam 2: URTIs and LRTIs
Total questions: 40
Worksheet time: 3hrs 16mins
Which of the following weight-based-doses is appropriate for amoxicillin in the treatment of acute otitis media?
20-25 mg/kg PO BID
30-35 mg/kg PO BID
40-45 mg/kg PO BID
50-55 mg/kg PO BID
60-65 mg/kg PO BID
Which of the following weight-based-doses is appropriate for amoxicillin-clavulanate in the treatment of acute otitis media?
45 mg/kg + 1.6 mg/kg PO BID
90 mg/kg + 3.2 mg/kg PO BID
45 mg/kg + 3.2 mg/kg PO BID
90 mg/kg + 1.6 mg/kg PO BID
All of the following answers are correct.
Which of the following Augmentin doses for ABR in adults is considered to be first-line initial empiric therapy?
875/125 mg PO BID
2000/125 mg PO BID
500/125 mg PO QID
500/125 mg PO BID
875/125 mg PO QID
Which of the following Augmentin doses for ABR in adults is considered to be first-line empiric therapy if initial empiric therapy has failed?
875/125 mg PO BID
2000/125 mg PO BID
500/125 mg PO QID
500/125 mg PO BID
875/125 mg PO QID
Which of the following Veetids doses are appropriate in treating acute bacterial pharyngitis (i.e. "strep throat") for a patient that's 15 y.o.?
250 mg PO BID to TID
250 mg PO TID to QID
500 mg PO BID
500 mg PO TID
500 mg PO QID
Which of the following weight-based dosing and duration of Amoxil is appropriate to recommend for the treatment of acute bacterial pharyngitis?
- 25 mg/kg PO BID (max 500 mg) x 10 days
- 50 mg/kg PO QD (max 1000 mg) x 10 days
1 ONLY
2 ONLY
1 AND 2
None are correct
As the MIC of penicillin increases in Streptococcus pneumoniae, the MIC of the _______s and non-beta-lactams increases. Of the non-beta-lactams, ________ and the _______s are NOT affected.
cephalosporin, vancomycin, fluoroquinolone
carbapenem, daptomycin, respiratory fluoroquinolone
cephamycin, folate antagonists, macrolide
monobactams, tigecycline, oxazolidinones
Streptococcus pneumoniae and Moraxella catarrhalis are the two common pathogens of AOM which regularly produce beta-lactamases as a resistance mechanism to the beta-lactam antibiotics.
False
True
Which of the following AOM patients require immediate antibiotic therapy? Select all that apply.
A 2 month-old with unilateral AOM, otorrhea and severe otalgia (evidenced by consistent crying that has not stopped since you first saw the patient)
A 3 y.o. with unilateral AOM, no otorrhea, and mild otalgia that's lasted for 36 hours
A 10 month-old with unilateral AOM, no otorrhea, and mild otalgia; his parents are both ER RPhs and have an erratic on-call schedules.
A 6 y.o. with unilateral AOM, no otorrhea, and a fever of 40 deg. Celsius.
A 10 y.o. with bilateral AOM, no otorrhea, and no other signs of severe symptoms; her parents are used car salespeople that can bring her back for follow-ups if needed.
Augmentin (45 mg/kg + 3.2 mg/kg PO BID) can become preferred to treat a patient's AOM if they just had _____ prescribed to them within the past 30 days.
Amoxil
Veetids
Cleocin
Unasyn
Avycaz
Which of these statements support the use of 3rd-Gen cephalosporins (such as Omnicef) as SECOND-line agents? Select all that apply.
They achieve inadequate middle ear fluid concentration
They are more expensive than Amoxil
They are useful for patients with a Type 1 Hypersensitivity towards the penicillins.
They are more active than Amoxil
They (esp. Omnicef and Vantin) taste worse than Amoxil
Which of these statements support the use of Cleocin as a SECOND-line agent? Select all that apply.
They achieve inadequate middle ear fluid concentration
They are more expensive than Amoxil
They are useful for patients with a Type 1 Hypersensitivity towards the penicillins.
They are more active than Amoxil
They (esp. Omnicef and Vantin) taste worse than Amoxil
Which of the following statements are true in terms of AOM therapy monitoring?
The patient should be brought in for a follow-up at 48-72 hours of initial diagnosis
Following symptomatic improvement, a patient initially diagnosed with severe AOM should continue for 7 more days of antibiotic therapy.
During the 24 hours after the diagnosis of AOM, symptoms may slightly worsen.
Following symptomatic improvement, a 9 y.o. patient initially diagnosed with moderate AOM should continue 5-7 more days of antibiotic therapy.
The presence of middle ear fluid after treatment is likely and does NOT warrant a repeat treatment.
The 3 common bacteria seen in AOM (i.e., S. pneumoniae, H. influenzae, and M. catarrhalis) are the same in acute bacterial rhinosinusitis (ABR)?
False
True
Order the steps of Acute bacterial rhinosinusitis (ABR) pathophysiology. (e.g. 1, 2, 3, 4, 5, 6)
- ABR occurs
- Blockage of sinus ostia occurs
- Mucosal secretions are trapped
- Local defenses are impaired
- The patient initially comes down with a viral respiratory tract infection
- Mucosal inflammation occurs
(a)
Which of the following factors or signs and symptoms (S/SX) indicate that your patient may be suffering from acute bacterial rhinosinusitis? Select all that apply.
Their S/SX are persistent and have not improved in the past 10 days
They reported an initial fever of 38 deg. Celsius, no purulent nasal discharge, and no facial pain at the onset of illness.
They reported suffering from a viral illness that lasted 5 days and seemed to be improving until they noticed an increase in nasal discharge and began to experience a new-onset headache.
They reported facial pain lasting for 7 consecutive days at the onset of illness.
They reported suffering from a viral illness that lasted 5 days and is currently improving day by day.
Since it is considered to be the "gold standard," a sinus puncture should always be performed for the initial DX of acute bacterial rhinosinusitis.
True
False
Which of the following are factors for choosing a high-dose (2000/125 mg) Augmentin PO BID regimen over 7-10 days (given improvement is seen after 3-5 days) for a patient with ABR?
The patient is 90 y.o.
The patient is 22 y.o. pharmacy school student.
The patient had recently taken a Azithromycin 1 g PO x 1 dose for the treatment of gonorrhea (and chlamydia)
The patient (a Cowboys fan) had recently been hospitalized for clenched-fist injuries after attempting (and failing) at throwing hands (at a Cardinals fan) during the Cowboys-Cardinals Game at AT&T Stadium
The patient has a temperature of 37 deg. Celsius upon admission
Which of the following agents (and corresponding dosing) are appropriate to use in outpatient treatment of ABR for a patient with a Type 1 Hypersensitivity to penicillins? Select all that apply.
Vibramycin 100 mg PO BID
Levaquin 500 mg PO QD
Avelox 400 mg PO QD
Cipro 300 mg PO QD
Zyvox 150 mg PO QOD
Which of the following symptoms are NOT indicative of acute pharyngitis caused by GABHS (i.e., which are the symptoms of viral acute pharyngitis)? Select all that apply.
Sudden onset of sore throat
Fever
Rhinorrhea
Hoarseness
Painful swallowing
Patients with the following symptoms should be tested via throat culture or rapid antigen testing: conjunctivitis, rhinorrhea, cough, oral ulcers, hoarseness
False
True
Which of the following statements on the monitoring of acute bacterial (GABHS) pharyngitis therapy is false?
Expect a response in 24-48 hours of therapy initiation
Fever and other symptoms will resolve within 3-4 days of onset WITHOUT antibiotics
Symptoms will improve 0.5 to 2.5 days earlier WITH antibiotic therapy
Follow-up testing usually is necessary; culture regardless if the patient is symptomatic or not at the end of therapy
GABHS carriers do NOT need antimicrobial therapy due to the very low risk of spreading GABHS pharyngitis or developing suppurative (or nonsuppurative) complications
In pneumonia, which of these factors constitute clinical evidence of infectious origin? Select all that apply.
Fever/Chills
Productive cough
Pleuritic chest pain
Dyspnea/Decline in oxygenation
Septic presentation
Of the following bacteria, which of them would be detectable via an urinary antigen test? Select all that apply.
Streptococcus pneumoniae
Legionella pneumophila
Mycoplasma pneumoniae
Haemophilus influenzae
Chlamydiae pneumoniae
CAP is defined as "pneumonia that develops in the outpatient setting OR _____ of hospital admission."
< 48 hours
> 48 hours
< 24 hours
> 24 hours
None of the answers are correct
Which of the following statements are true regarding CAP diagnostic criteria (assuming exam conditions)? Select all that apply.
A score of 4 for CURB-65 indicates that a patient should be treated in-patient (ICU).
Assigning a patient to a PSI Risk Class II indicates that a patient should be treated outpatient.
Assigning a patient to a PSI Risk Class V indicates that a patient should be treated in-patient (ICU)
Assigning a patient to a PSI Risk Class IV indicates that a patient should be treated in-patient
In order to specify if a patient must go to the ICU or not following a PSI Risk Class assignment, you must also use the modified ATS Criteria/
Which of the following Modified ATS Criteria would you need just ONE of to send a patient assigned to either PSI Class IV or V to the ICU (i.e., which of these are major criterion)? Select all that apply.
Invasive mechanical ventilation
Uremia (BUN level 45 mg/dL)
Hypothermia (core temperature = 35 deg. Celsius)
Hypotension requiring aggressive fluid resuscitation (i.e., hypovolemic shock)
Septic shock requiring vasopressors
Which of the following Modified ATS Criteria would you need just THREE or more to send a patient assigned to either PSI Class IV or V to the ICU (i.e., which of these are major criterion)? Select all that apply.
Invasive mechanical ventilation
Uremia (BUN level 45 mg/dL)
Hypothermia (core temperature = 35 deg. Celsius)
Hypotension requiring aggressive fluid resuscitation (i.e., hypovolemic shock)
Septic shock requiring vasopressors
Which of these are acceptable forms of supportive care for CAP patients?
Water restrictions (< 1 L/daily)
Fever control
Humidified oxygen (for hypoxemia)
Mechanical ventilation if necessary
Loop Diuretics
Which of the following statements are true regarding the use of antibiotics in outpatient CAP therapy? Select all that apply.
For outpatient therapy to be viable, a CAP patient must have no comorbidities or risk factors for MRSA or P. aeruginosa
An example of a risk factor is a history of respiratory isolates of either MRSA or P. aeruginosa
Amoxil is recommended because it is very efficacious against atypical pathogens such as Chlamydiae pneumoniae
Macrolides cover atypical pathogens such as Legionella pneumophila, but they must only be used if local pneumococcal resistance is > 25%
Doxycycline can be used as an alternative to either amoxicillin or the macrolides and is dosed as follows: 100 mg PO BID
Which of the following statements are true regarding outpatient antibiotic treatment of CAP patients with comorbidities? Select all that apply.
An example of a comorbidity in a CAP patient is Stage IV CKD
An acceptable monotherapy option for CAP patients with comorbidities is Cipro 500 mg PO BID
An acceptable combination therapy is Augmentin 2000/125 mg PO BID and Doxycycline 100 mg PO BID
Do not use levofloxacin or moxifloxacin as fluoroquinolone monotherapy in CAP patients
An acceptable combination therapy is Augmentin 500/125 mg PO TID and Vancocin 125 mg PO BID
Which of the following statements are true regarding inpatient, NON-ICU antibiotic treatment of CAP patients? Select all that apply.
If a patient has been recently hospitalized, recently had antibiotic therapy, AND there are locally validated risk factors for P. aeruginosa, cultures can be obtained from them but antipseudomonal coverage must only begin if the culture results are positive.
If a patient has a prior respiratory isolation of MRSA, anti-MRSA coverage must be added; no cultures or nasal PCR testing is required, although it is strongly encouraged.
An acceptable combination therapy is Unasyn 1500/3000 mg IV Q6H and Biaxin 500 mg PO BID
An acceptable fluoroquinolone monotherapy is Levaquin 750 mg IV QD
An acceptable combination therapy is Augmentin 500/125 mg PO TID and Cleocin 300 mg PO BID
Which of the following statements are true regarding inpatient, ICU antibiotic treatment of CAP patients? Select all that apply.
If a patient has been recently hospitalized, recently had antibiotic therapy, AND there are locally validated risk factors for P. aeruginosa, cultures can be obtained from them but antipseudomonal coverage must only begin if the culture results are positive.
If a patient has a prior respiratory isolation of MRSA, anti-MRSA coverage must be added; also obtain cultures/nasal PCR to allow de-escalation or confirm the need for further therapy.
An acceptable combination therapy is Unasyn 1500/3000 mg IV Q6H and Biaxin 500 mg PO BID
An acceptable fluoroquinolone monotherapy is Levaquin 750 mg IV QD
An acceptable combination therapy is Augmentin 500/125 mg PO TID and Cleocin 300 mg PO BID
Which of the following are criteria for clinical stability (i.e., signs of clinical improvement) in CAP patients undergoing antibiotic therapy? Select all that apply.
HR < 120 BPM
RR < 24 breaths/min
Systolic BP > 100 mmHg
Temperature < 37.8 deg. Celsius
Normal mental status
Given the following statements regarding your patient, select the correct number and appropriate types of agents to treat your patient. You may use the algorithm included as a reference.
- Patient develops pneumonia 56 hours following hospitalization
- Patient does NOT need ventilatory support, is NOT in a state of septic shock, and has NOT had IV antibiotics within 90 days
- There are > 20% MRSA in hospital S. aureus isolates
- The patient has structural lung disease
3 agents; 1 is anti-MRSA; 2 are antipseudomonals and each from different classes
3 agents; 1 is antipseudomonal and 2 are anti-MRSA and each from different classes
3 agents; 1 is anti-MRSA and 2 are antipseudomonal
2 agents; 2 antipseudomonals with one having activity against MSSA
2 agents; 1 is anti-MRSA and 1 is an antipseudomonal
Given the following statements regarding your patient, select the correct number and appropriate types of agents to treat your patient. You may use the algorithm included as a reference.
- Patient develops pneumonia 56 hours following intubation
- Patient required acute RRT prior to VAP
- There are > 10% MRSA in hospital S. aureus isolates
- The patient has structural lung disease
3 agents; 1 is anti-MRSA; 2 are antipseudomonals and each from different classes
3 agents; 1 is antipseudomonal and 2 are anti-MRSA and each from different classes
3 agents; 1 is anti-MRSA and 2 are antipseudomonal
2 agents; 2 antipseudomonals with one having activity against MSSA
2 agents; 1 is anti-MRSA and 1 is an antipseudomonal
Given the following statements regarding your patient, select the correct number and appropriate types of agents to treat your patient. You may use the algorithm included as a reference.
- Patient develops pneumonia 56 hours following hospitalization
- Patient did NOT require ventilatory support, was NOT in a state of septic shock, and did NOT receive IV antibiotics within the past 90 days
- There are > 20% MRSA in hospital S. aureus isolates
- The patient does NOT have structural lung disease, there is < 1% pseudomonal resistance to antipseudomonal agents being considered, and there is NO abundance of GNB on gram stain
3 agents; 1 is anti-MRSA; 2 are antipseudomonals and each from different classes
3 agents; 1 is antipseudomonal and 2 are anti-MRSA and each from different classes
3 agents; 1 is anti-MRSA and 2 are antipseudomonal
2 agents; 2 antipseudomonals with one having activity against MSSA
2 agents; 1 is anti-MRSA and 1 is an antipseudomonal
Which of the following statements are FALSE regarding agent selection for initial empiric therapy for HAP patients? Select all that apply.
Invanz is an acceptable carbapenem for use in patients who have faced ESBL-producing pathogens in the past.
If there is a risk of patient mortality OR if the patient has received IV antibiotics in the past 90 days, you may select 2 beta lactams in the same class (e.g. Cefepime 2000 mg IV Q8H and Ceftazidime 2000 mg IV Q8H for anti-pseudomonal coverage) AND vancomycin 15 mg/kg IV Q8-12H (for MRSA coverage).
If there is a risk of patient mortality OR if the patient has received IV antibiotics in the past 90 days, you may select a single aminoglycoside (e.g. Amikacin 15-20 mg/kg IV QD for anti-pseudomonal coverage) AND vancomycin 15 mg/kg IV Q8-12H (for MRSA coverage)
If there is NOT a high risk of patient mortality BUT has factors that increase the likelihood of MRSA, you may select Zosyn 4500 mg IV Q6H AND Linezolid 600 mg IV BID (Vancomycin MIC > 2)
Use Linezolid 600 mg IV Q12H instead if Vancomycin MIC > 2
Which of the following statements is true regarding the monitoring and treatment duration of HAP/VAP therapy? Select all that apply
A normal chest X-ray for a HAP/VAP patient indicates stability
In general, the duration of treatment is 7 days, but you must also account for the patient's clinical response to therapy!
De-escalation of antibiotic therapy is dependent upon C&S reports
Pseudomonal pneumoniae may warrant longer durations especially in patients with heightened mortalities due to comorbidities (e.g. cystic fibrosis)
If an antibiogram is unavailable at your institution, select agents that can cover gram-negative cocci and MRSA.
Which of the following are true statements concerning antibiotic therapy in bronchitis (assume test conditions, not real practice)? Select all that apply.
It is highly encouraged to recommend Augmentin or Amoxil to patients suffering from acute bronchitis due to their benefits in reducing symptoms.
Consider antibiotic usage in COPD exacerbation especially if a patient has an increase in purulent sputum AND dyspnea
If a COPD patient is 50 y.o., FEV1 > 50% predicted, has < 2 exacerbations yearly, and has perfect cardiovascular health, they can be classified as having uncomplicated COPD and may receive macrolides as antibiotic therapy.
All complicated COPD patients receive the same therapy recommendations: sputum must be obtained from the patient for Gram stain and culture, and the patient must be started on ciprofloxacin
A 70 y.o. COPD patient can be immediately classified as a complicated COPD patient. They must then be screened for potential increased risk of pseudomonal infection in order to determine the proper course of therapy.
