elderly man with cough

Question 1

a gram negative rod that releases green diffusible pigment in culture is most likely

Answer 1

pseudomonas aeruginosa

Question 2

best treatment for pseudomonas aeruginosa

Answer 2

piperacillin + tazobactam

p is a semisynthetic penicillin
t is a beta-lactamase inhibitor

Question 3

what has been successfully used to increase the immunogenicity of the Streptococcus pneumoniae vaccine in humans?

Answer 3

conjugation of bacterial polysaccharides with an immunogenic protein

Question 4

legionella is tested for by

Answer 4

urine antigen test

Question 5

left shift in WBC

neutrophils or lymphocytes increased

Answer 5

immature neutrophils being released = bacterial

increased lymphocytes = viral

Question 6

gram positive is colored

Answer 6

blue/purple

thicker membrane retains more purple dye

Question 7

strep pneumoniae is

treat with

Answer 7

GRAM + diplococci

fluoroquinolone (moxifloxacin, levofloxacin) or
beta-lactam (amoxicillin), or
cephalosporin for resistant strep pneumo (ceftriaxone)

plus a macrolide (or doxycycline)

Question 8

Z pack

Answer 8

azithromycin as 5 day course

given for walking pneumonia (mycoplasma)

Question 9

ribavirin

Answer 9

used for RSV or HepC

Question 10

Oseltamivir (Tamiflu)

Answer 10

used to treat influenza/flu

Question 11

treat MRSA with

Answer 11

vancomycin

Question 12

What is the most likely cause for patient’s fever?
A. A direct effect of endotoxin on the hypothalamic temperature regulation center
B. An increased blood supply to the hypothalamus caused by vasoactive mediators
C. The generation of pyrogenic complement fragments by macrophage proteases
D. The release of C-reactive protein by the liver
E. The release of TNF, IL-1 and IL-6 by activated macrophages

Answer 12

E

Question 13

Which of the following is the major indication that this patient requires immediate initiation of therapy?
A. Deterioration of his mental status
B. Possible malignant nature of his prostatic enlargement
C. Possible urinary tract infection
D. Signs and symptoms suggestive of bacteremia and likely sepsis
E. Signs and symptoms suggestive of dehydration

Answer 13

D

Question 14

UTI caused by pseudomonas

Answer 14

gram -
oxidase +
grows on mcconkey agar

occurs with catheter/foley use

Question 15

serious complicstion from strep pneumo as cause of mortality?

Answer 15

meningitis

Question 16

influenza B…to prevent outbreak what drug class should be applied?

Answer 16

neuraminidase inhibitor

Question 17

consolidating pneumonia of right lung is most likley

Answer 17

strep pneumoniae

Question 18

usually see mycoplasma in

xray shows

Answer 18

ASYMPTOMATIC WALKKING PNEUMONIA

NO consolidation, maybe diffuse infiltrates

Question 19

klebsiella is associated with

Answer 19

hemoptysis

Question 20

pneumocystis carinii is seen with

Answer 20

HIV

Question 21

antibiotic for strep pneumo — which would be used?

• levofloxacin
• ampicillin
• penicillin
• vancomycin
• SMX-TMP

Answer 21

levofloxacin

a fluoroquinolone!

Question 22

t/f: the decision to remove life support is easier than the decision to put them on it.

Answer 22

FALSE

harder to remove life support

Question 23

treatment for pseudomonas

Answer 23

levofloxacin

Question 24

gentamycin toicity

Answer 24

nephrotoxicity and irreversible ototoxicity

aminoglycosides are TOXIC

Question 25

fluoroquinolones toxicity?

Answer 25

tendonopathy – affects tendons
and
QT prolongation

Question 26

white exudate with cotton wool ball appearrance is candida

found where?

Answer 26

endogenous flora