Naplex Q's

Question 1

definition that describes a patient with septic shock

Answer 1

an infection with persistent hypotension despite fluid resuscitation.

Question 2

Septic shock is defined

Answer 2

as sepsis with persistent hypotension despite fluid resuscitation. The American College of Chest Physicians and the Society of Critical Care Medicine developed definitions related to sepsis. Physiologic parameters categorize patients as having bacteremia, infection, systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, and multiple-organ dysfunction syndrome (MODS).

Question 3

Bacteremia (or fungemia

Answer 3

is the presence of viable bacteria (or fungi) within the bloodstream.

Question 4

Systemic inflammatory response syndrome (SIRS) is defined

Answer 4

as a systemic inflammatory response to a variety of clinical insults that can be either infectious or non-infectious.

Question 5

Severe sepsis

Answer 5

is sepsis associated with organ dysfunction

Question 6

hospital-acquired pneumonia duration of ABX?

Answer 6

7 or 8 days is the recommendation duration of therapy for most patients with hospital-acquired pneumonia. especially if responded clinically

Question 7

Albumin is recommended for fluid resuscitation of

Answer 7

severe sepsis and septic shock when patients require substantial amounts of crystalloids. Given the patients past medical history of heart failure and his current exacerbation, administration of albumin would be recommended.

Question 8

brand name of linezolid

Answer 8

Zyvox

Question 9

Pneumonia common pathogen

Answer 9

Streptococcus pneumoniae is a gram-positive coccus that is a common bacterial cause of lower respiratory tract infections. It is frequently resistant to macrolides and azalides such as the azithromycin that he received.

Question 10

Short-course therapy (3 days) is appropriate for which patient group UTI

Answer 10

The Infectious Disease Society of America (IDSA) recommends 3-day therapy for treatment of uncomplicated lower tract infections in women.

Question 11

Acute bacterial prostatitis is treated for

Answer 11

4 weeks to reduce the risk of developing chronic prostatitis.

Question 12

hemodynamic properties of norepinephrine

Answer 12

Potent α-adrenergic activity with less potent β-adrenergic agonist properties

Norepinephrine is an endogenous catecholamine with potent α1 and less potent β1 adrenergic activity which primarily is utilized to increase systemic vascular resistance and blood pressure. Compared to dopamine, norepinephrine is more potent in terms of vasopressor activity and is less arrhythmogenic

Question 13

YU is a 41-year-old woman admitted to the intensive care unit with possible sepsis secondary to pneumonia. Her vital signs are temperature 38.1°C, heart rate 80 beats/min, and a respiratory rate 16 breaths/min. She also has a white blood cell count of 15,500 cells/mm3. Based on this information, does YU have sepsis?

Answer 13

YU has sepsis because of the infection source (pulmonary), and meets two SIRS criteria (elevated temperature and leukocytosis).

Question 14

The diagnostic criterion for which of the following opportunistic infections is seropositive for immunoglobulin G (IgG)?

Answer 14

Diagnosis of Toxoplasmosis can be made by seropositivity for IgG

Question 15

Adamantanes have activity against which influenza types?

Answer 15

Answer a is correct. Adamantanes (rimantadine and amantadine) have activity against influenza A, however, over the past few influenza seasons, resistance to the adamantanes has significantly increased.

Question 16

AA is a patient with hypotension secondary to sepsis. Past medical history is significant for heart failure with active fluid overload, hypertension, diabetes, previous myocardial infarction, and dyslipidemia. Medications include lisinopril, spironolactone, glipizide, metoprolol succinate, simvastatin, and a baby aspirin. Labs were within normal limits except for a SCr of 1.9 mg/dL, glucose 180 mg/dL, and potassium of 5.6 mEq/L. Select the appropriate early goal resuscitation colloid therapy for this patient.

Answer 16

Five percent albumin is a colloid resuscitation fluid used for patients at risk for fluid overload. Colloids are large molecules that do not pass across diffusional barriers as readily as crystalloids. Colloid fluids infused into the vascular space have a greater tendency to stay put and enhance the plasma volume than do crystalloid fluids. The plasma expansion with albumin is nearly twice that produced by an equivalent volume of isotonic saline (500 mL versus 275 mL, respectively). This is the principal benefit of colloid fluid resuscitation: more effective resuscitation of plasma volume than that produced by crystalloid fluids.

Question 17

Select the best answer that represents part of the normal (endogenous) flora of the lower respiratory tract.

Answer 17

The lower respiratory tract is normally sterile. Other areas that are normally sterile include the cerebrospinal fluid and urine.

Question 18

parenteral cephalosporin that is often administered intramuscularly for acute otitis media.

Answer 18

Ceftriaxone is a third generation cephalosporin that is available only as a parenteral formulation. Ceftriaxone is used intramuscularly

Question 19

When the 13-day-old former 35-week gestational age baby is examined at the pediatric hospital, she is also noted to have some lesions. The team has just sent cultures of the lesions as well as herpes simplex virus (HSV) PCR of the CSF. Which of the following is an appropriate pharmacologic approach in this patient

Answer 19

IV acyclovir should be added as soon as possible as empiric therapy for HSV encephalitis while awaiting the results of diagnostic studies. The earlier treatment is started, the lower the risk of death or serious sequelae.

Question 20

BD is a 44-year-old male with severe alcoholism who is intubated due to hypoxia from community-acquired pneumonia complicated by severe sepsis. Which of the following sedation regimens if given via continuous infusion may induce a metabolic acidosis?

Answer 20

Ativan contains propylene glycol in its diluent which can result in an osmolar gap metabolic acidosis when given in high doses as a continuous infusion. High doses of benzodiazepines are often given in alcoholic patients in alcohol withdrawal in order to prevent symptoms such as delirium tremens.

Question 21

BC is a 40-year-old woman, with hypertension and drug allergies to penicillins (angioedema, hives) and sulfa drugs (rash), who presents to urgent care with a dry and intensely red lesion about 5 cm by 5 cm in size, with well-demarcated and raised borders on her right lower extremity. She describes having pain and a burning sensation. What is the most likely type of SSTI that BC is presenting with?

Answer 21

The clinical presentation is most consistent with erysipelas, an SSTI that affects the epidermis and lymphatics.

Question 22

KJ is an 87-kg man receiving a norepinephrine infusion (4 mg/250 mL) at 2 μg/kg/min for management of his septic shock. At what rate (mL/h) should the infusion be administered?

Answer 22

Infusion concentration = 4 mg/250 mL = 0.016 mg/mL = 16 μg/mL

2 μg/kg/min × 87 kg = 174 μg/min × 60 min/1 h = 10,440 μg/h 10,440 μg/x mL = 16 μg/1 mL X = 652.5 mL