practice Flashcards
Patient case 1
BD is a 42-year-old female who presents to primary care for a hypertension
management appointment with you.
▪During the visit, the patient shares she has a 3-day history of cough, sore throat, and
headache. You discuss the case with the primary care physician.
▪Rapid testing for influenza and COVID-19 returns negative. The primary care
physician has to see their next patient and asks you to discuss treatment of acute
bronchitis with the patient.
What is the recommended
treatment for this patient?
A. Azithromycin 500mg PO on day 1 and 250mg PO on days 2-5
B. Amoxicillin 500mg PO TID x 5 days
C. Admit to hospital
D. Symptomatic management
D
Patient case 1 continued
The patient explains that last time this happened 2 years ago the provider she saw
prescribed her a Z-pak and she felt so much better. She presses you to prescribe an
antibiotic.
How do you respond?
A. Prescribe Z pak
B. Tell her she is wrong and the antibiotic did nothing
C. Explain that acute bronchitis is typically due to a virus and antibiotic therapy has risk of adverse effects
D. Tell the patient you need to talk further with the provider
C
TP is a 65-year-old male who presents to the emergency department with cough,
fever (101 F), increased yellow sputum production, and headache.
▪Over the past couple of years, patient has had seasons of chronic cough and sputum
production
▪Patient has been prescribed antibiotic therapy 3 times in the last 3 months
⎻ Amoxicillin/clavulanate
⎻ Doxycycline
⎻ Azithromycin
Which bacteria is the patient
at risk for?
A.Strep agalactiae
B. Enterococcus faecalis
C. Bacteroides fragilis
D. Pseudomonas aeruginosa
D
TP is a 65-year-old male who presents to the emergency department with cough,
fever (101 F), increased yellow sputum production, and headache.
▪Over the past couple of years, patient has had seasons of chronic cough and sputum
production
▪Patient has been prescribed antibiotic therapy 3 times in the last 3 months
⎻ Amoxicillin/clavulanate
⎻ Doxycycline
⎻ Azithromycin
What is the recommended treatement for this patient
A. Levofloxacin 500mg PO once daily x 10 days
B. Augmentin 875/125 PO BID x 5 days
C. Cefpodoxime 200mg BID x 5 days
D. Levofloxacin 750mg PO QD x 5 days
D
SL is a 22-year-old female who presents to the urgent care with a 1-day history of
sore throat, pain with swallowing, fever (100.8 F). The provider performs the physical
exam, and it is consistent with acute pharyngitis.
▪Past medical history – none
▪Rapid strep (RADT) – positive
▪Allergies – amoxicillin (10 years ago, diffuse mild rash, occurred with amoxicillin when it was
prescribed when the patient has mononucleosis)
Which organism is the most
common bacterial cause of
acute pharyngitis?
A. Streptococcus agalactiae
B. Streptococcus Pyogenes
C. Streptococcus intermedius
D. Streptococcus dysgalactiae
B
SL is a 22-year-old female who presents to the urgent care with a 1-day history of
sore throat, pain with swallowing, fever (100.8 F). The provider performs the physical
exam, and it is consistent with acute pharyngitis.
▪Past medical history – none
▪Rapid strep (RADT) – positive
▪Allergies – amoxicillin (10 years ago, diffuse mild rash, occurred with amoxicillin when it was
prescribed when the patient has mononucleosis)
What is the best treatment
option for this patient? (select all that apply)
A. Amoxicillin 500mg PO TID x 10 days
B. Cephalexin 500mg PO BID x 10 days
C. Azithromycin 500mg PO on day 1, then 250mg PO on day 2-5
D. clindamycin 300mg PO TID x 5 days
A and B
You receive a call from the ENT specialist nurse practitioner regarding a patient with
recurrent ABRS. After speaking with the nurse practitioner, it sounds likely that this is
truly recurrent bacterial infection.
▪Allergies – none
▪Renal function – normal for age
▪Recent antibiotic use – amoxicillin/clavulanate x 2, levofloxacin, moxifloxacin all within the
last 4 months
▪No culture data
What would you recommend
for this patient?
A. Levofloxacin 750mg PO once daily x 7 days
B. Clindamycin 300mg PO TID + Ciprofloxacin 500mg PO BID x 7 days
C. Augmentin 875/125mg PO BID + Doxycycline 100mg PO BID x 7 days
D. Cefpodoxime 200mg PO BID + Levofloxacin 750mg PO once daily x 7 days
C
q
LN is a 26-year-old female who presents to urgent care for a 2-day onset of dysuria,
increased urinary frequency, increased urinary urgency, and suprapubic pain.
▪No pertinent past medical history
▪No history of previous UTI
▪Sexually active with 1 partner (uses condoms)
▪Home medications: Oral contraceptive
▪Urinalysis
▪WBC: 25-50 cells/hpf
▪WBC esterase: Positive
▪Nitrites: Positive
▪Bacteria: Moderate
Local E. coliSusceptibility Rate
Ampicillin 56%
Amoxicillin/clavulanate 88%
Cefazolin 92%
Ceftriaxone 93%
Ciprofloxacin 79%
SMX/TMP 78%
Nitrofurantoin 97%
Which antibiotic would you
look at to determine Cefpodoxime susceptibility?
A. Ampicillin
B. Amoxicillin/clavulanate
C. Cefazolin
D. Ceftriaxone
E. Nitrofurantoin
C
LN is a 26-year-old female who presents to urgent care for a 2-day onset of dysuria,
increased urinary frequency, increased urinary urgency, and suprapubic pain.
▪No pertinent past medical history
▪No history of previous UTI
▪Sexually active with 1 partner (uses condoms)
▪Home medications: Oral contraceptive
▪Urinalysis
▪WBC: 25-50 cells/hpf
▪WBC esterase: Positive
▪Nitrites: Positive
▪Bacteria: Moderate
How would you classify LN’s
UTI?
A. Uncomplicated
B. Complicated
C. Catheter associated
A
LN is a 26-year-old female who presents to urgent care for a 2-day onset of dysuria,
increased urinary frequency, increased urinary urgency, and suprapubic pain.
▪No pertinent past medical history
▪No history of previous UTI
▪Sexually active with 1 partner (uses condoms)
▪Home medications: Oral contraceptive
▪Urinalysis
▪WBC: 25-50 cells/hpf
▪WBC esterase: Positive
▪Nitrites: Positive
▪Bacteria: Moderate
Local E. coli
Susceptibility Rate
Ampicillin 56%
Amoxicillin/clavulanate 88%
Cefazolin 92%
Ceftriaxone 93%
Ciprofloxacin 79%
SMX/TMP 78%
Nitrofurantoin 97%
What would you recommend
for treatment?
A. SMX/TMP 1 DS PO BID x 3 days
B. Ciprofloxacin 250mg PO BID x 3 days
C. Cefidinir 300mg PO BID x 5 days
D. Cephalexin 500mg PO TID x 5 days
D
AB is a 55-year-old male who presents to the emergency department for a
3-day onset of dysuria, urinary incontinence, fever (101 F), and altered
mental status. Patient is admitted to the general medical unit.
▪PMH: HTN, T2DM
▪History of 3 UTIs in the past year, both due to E. coli
▪Home medications: Metformin, semaglutide, lisinopril
▪Allergies: Sulfa drugs (hives)
▪Urinalysis
▪WBC: >100 cells/hpf
▪WBC esterase: Positive
▪Nitrites: Positive
▪Bacteria: Many
How would you classify AB’s UTI?
A. Uncomplicated
B. Complicated
C. Catheter associated
B
q
B is a 55-year-old male who presents to the emergency department for a
3-day onset of dysuria, urinary incontinence, fever (101 F), and altered
mental status. Patient is admitted to the general medical unit.
▪Pertinent lab values
▪WBC 16,000 cells/mL
▪Hgb 13.8 g/dL
▪Plt 210,000/mm3
▪Na 139 mmol/L
▪K 4.2 mmol/L
▪Cl 103 mmol/L
▪CO2 22 mmol/L
▪BUN 11 mg/dL
▪SCr 1.1 mg/dL
Local E. coli
Susceptibility Rate
Ampicillin 56%
Amoxicillin/clavulanate 88%
Cefazolin 92%
Ceftriaxone 93%
Ciprofloxacin 79%
SMX/TMP 78%
Nitrofurantoin 97%
Gentamicin 92%
What would you
recommend for
empiric IV treatment?
A. Ampicillin alone
B. Ciprofloxacin IV
C. Ampicillin + Gentamicin
C
AB receives 2 days of IV ampicillin and IV gentamicin. His fever resolves
and his labs return to normal values. A urine culture was obtained upon
admission and the results return. (select all that apply)
What is your
recommendation?
A. Amoxicillin 500mg PO TID x 5 days
B.Ciprofloxacin 500mg PO BID x 5 days
C. Cefadroxil 1000mg PO BID x 5 days
D.Cephalexin 500mg PO QID x 5 days
all options are possible
AB receives 2 days of IV ampicillin and IV gentamicin. His fever resolves
and his labs return to normal values. A urine culture was obtained upon
admission and the results return.
▪You recommend cefadroxil 1000 mg PO BID x 5 days
▪The provider states that they are very concerned because the patient
came in and looked “very sick”. They state cefadroxil is a narrow spectrum
antibiotic and they are not sure if it is appropriate. They typically like to
use ciprofloxacin in these cases.
▪How would you respond?
A. Agree with the provider. It sounds reasonable
B. Politely discuss that BL are appropriate options when selected and dosed appropriately. additionally, the isolate is susceptible
C. Become enraged
D. Check the time. Its 4:01pm go home
B
JB is a 73-year-old male presenting to the hospital with a 2-week onset of right foot
pain, swelling, erythema, and purulent drainage. Patient has deep wound on right
heel
▪Below-knee amputation is performed
What is the appropriate
antibiotic duration?
A. 2-5 days
B. 7-14 days
C. 2-4 weeks
D. 3 months
A
JB is a 73-year-old male presenting to the hospital with a 2-week onset of right foot
pain, swelling, erythema, and purulent drainage. Patient has deep wound on right
heel
▪Past medical history
▪T2DM
▪HTN
▪Home medications
▪Metformin 1000 mg PO BID
▪Semaglutide 2 mg SC once weekly
▪Insulin degludec 20 units SC once daily
▪Lisinopril 20 mg PO once daily
47
▪X-ray of the right foot is performed
▪Findings concerning for osteomyelitis of the
right calcaneus
▪Laboratory findings
⎻ WBC: 13,000 cells/mL
⎻ CRP: 43 mg/dL
⎻ ESR: 120 mm/hr
Podiatry and ID is consulted – both recommend below-knee amputation
Which of the following would
be an acceptable empiric
regimen while the patient is
awaiting amputation? (select all that apply)
A. Ampicillin/Sulbactam 3g IV Q6H
B. Piperacillin/tazobactam 3.375 g IV Q6H + vancomycin
C. Ceftriaxone 2g IV Q24H + Metronidazole 500mg PO Q12H + Linezolid 600mg PO Q12H
D. Meropenem 1 g IV Q8H + Vancomycin
ALL
JB is a 32-year-old male presenting to the hospital with a 3-week onset of right knee
pain, swelling, and erythema. He also reports daily fever and general malaise.
▪Synovial fluid culture results with MSSA
▪Blood culture results with MSSA
▪Transesophageal echocardiogram (TEE) does not show endocarditis
▪The ID physician recommends 6 weeks of IV antibiotic treatment
Patient preferences – provider unwilling to allow patient to discharge with central
line without constant observation
▪Patient unwilling to go to a facility for IV antibiotic treatment
▪Patient’s insurance will cover all options
CANT PUT A CENTRAL LINE IN PATIENT
Which of the following
would be an acceptable
pathogen-directed
regimen?
A. Vancomycin 1.5 g IV Q12H
B. Daptomycin 6-12 mg/kg IV Q24H
C. Amoxicillin 1000mg PO TID
D. Dalbavancin 1500mg IV on day 1 and day 8
D
B is a 32-year-old male presenting to the hospital with a 3-week onset of right knee
pain, swelling, and erythema. He also reports daily fever and general malaise.
▪Past medical history
▪Active IV drug use
▪Home medications
▪None
▪CT of the right knee is performed
▪Findings concerning for septic arthritis
43
▪Laboratory findings
⎻ WBC: 25,000 cells/mL
⎻ CRP: 43 mg/dL
▪Vital signs
⎻ Febrile (102 F)
⎻ Hemodynamically stable
▪Arthrocentesis is performed
▪PMN count: 77,000 cells/mm3
▪Low synovial glucose (35 mg/dL)
▪Elevated synovial protein (4.8 g/dL)
▪Blood cultures obtained
Is the arthrocentesis
result consistent with
septic arthritis?
A. Yes
B. No
C. Im tired
A
JB is a 67-year-old male presenting to the hospital with a 3-week onset of back pain
with worsening severity and periodic fevers.
▪Biopsy cultures result with MRSA
▪The ID physician recommends patient complete 8 weeks of IV antibiotic treatment
▪Patient preferences
▪Lives alone, unable to self-administer IV antibiotic at home
▪Only able to come to infusion center once per day
▪Insurance coverage not available for high-cost drugs
Which of the following
would be an acceptable
pathogen-directed
regimen?
A.Vancomycin 1 g IV Q12H
B. Daptomycin 8-12mg/kg/ IV Q24H
C. Recommend discontinuation of antibiotic treatment
D. Ceftaroline 1800mg IV Q24H (continuous Infusion)
B
JB is a 67-year-old male presenting to the hospital with a 3-week onset of back pain
with worsening severity and periodic fevers.
▪Past medical history
▪HTN
▪Afib
▪T2DM
▪Home medications
▪Lisinopril 40 mg PO once daily
▪Pantoprazole 40 mg PO once daily
▪Metformin 1000 mg PO BID
▪Apixaban 5 mg PO BID
40
▪MRI of the spine is performed
⎻ L2-L3 vertebral osteomyelitis
▪Laboratory findings
⎻ WBC: 16,000 cells/mL
⎻ CRP: 35 mg/dL
▪Vital signs
⎻ Afebrile
⎻ Hemodynamically stable
Antibiotics are held and interventional radiology is consulted for biopsy
▪Biopsy is performed and antibiotic treatment is being initiated
Which of the following would be an
acceptable empiric regimen?
A. Cefepime 1 g IV Q8H and ciprofloxacin 400mg IV Q12H
B. Ceftriaxone 2 g IV Q24H and vancomycin (dose based on PK eval)
C. Linezolid 600mg Q12H and amoxicillin 1000 mg PO Q8H
D. Meropenem 1 g IV Q8H
B
ST is a 64-year-old female who presents to the urgent care with sudden onset of fever, chills, dyspnea, and cough with increased sputum production. Chest x-ray shows right lower lobe consolidation and is diagnosed with CAP.
PMH: T2DM, HTN, DLD, OSA
Vitals:
HR: 96
BP: 136/78
Temp: 38.1°C
RR: 24
O₂ sat: 90%
Labs:
WBC: 13.8
SCr: 1.64
BUN: 28
Previous EKG – QTc: 548
ST reports having taken an oral antibiotic (Omnicef) for an ear infection a little less than 3 months ago, which resolved.
Question:
What would be the most appropriate regimen for outpatient therapy for this patient?
A. Moxifloxacin 400 mg PO daily
B. Ceftriaxone 1 gm IV daily + doxycycline 100 mg PO BID
C. Cefpodoxime 200 mg PO BID + doxycycline 100 mg PO BID
D. Amoxicillin/clavulanate 875/125 mg PO BID + azithromycin 500 mg PO daily
CJ is a 58-year-old male who presents to the emergency department with sudden onset of fever, chills, dyspnea, cough with sputum production, and noted confusion. Chest x-ray shows left lower lobe consolidation and is diagnosed with CAP.
CJ was previously admitted 2.5 months ago for diverticulitis and received 5 days of piperacillin/tazobactam.
PMH: HTN, ulcerative colitis, T2DM, asthma
Vitals:
HR: 94
BP: 88/64
Temp: 103.1°F
RR: 32
O₂ sat: 86%
Labs:
WBC: 18.6
SCr: 1.3
BUN: 34
CJ was admitted to the progressive care unit for further management.
Question:
What would be the most appropriate regimen for this patient?
A. Lin
