Written PP Flashcards
When choosing the proper antibiotic, one must consider:
a. the number of the patients stool per day
b. the site of infection and distribution of the antimicrobials.
c. the length of the infection
d. body temperature
b. the site of infection and distribution of the antimicrobials.
Narrow spectrum antibiotics are recommended in the case of:
a. wide spectrum pathogens.
b. critical clinical spectrum.
c. known mixed infection.
d. isolated pathogens with known sensitivity.
d. isolated pathogens with known sensitivity.
True is about MIC:
a. It shows the minimum bactericidal concentration in mg/L
b. In vitro parameter, which must be exceeded by the concentration of the effective antibiotic at the site of infection.
c. In vivo parameter
d. The effective antibiotic has to achieve a concentration higher then MIC in the whole body.
b. In vitro parameter, which must be exceeded by the concentration of the effective antibiotic at the site of infection.
Poorly penetrated anatomical sites, except for (sign the incorrect answer):
a. central nervous system
b. prostate gland
c. artificial valve in mitral position
d. bone tissue
e. gall bladder
e. gall bladder
Choose the antibiotic, which is safe during pregnancy:
a. ciprofloxacin
b. ceftriaxon
c. trimethoprim sulfomethaxazole
d. clindamycin
e. chloramphenicol
d. clindamycin
contamination is:
a. the access of bacteria, without pathogenic role into the sample taken from microbe test.
b. the coexistence of humans organism with microbes
c. the invasion of pathogens that induces host response
d. the non-infectious systemic inflammatory response syndrome
a. the access of bacteria,without pathogenic role into the sample taken from microbe test.
which disease has the lowest mortality rate?
a. pneumonia
b. osteomyelitis
c. meningitis
d. endocarditis
e. peritonitis
b. osteomyelitis
Combined antibiotic treatment is not necessary:
a. in the case of severe infection with unknown etiology
b. in the case of infectious neutropenic patients
c. in the case of nosocomial pneumonia
d. in the case of simple urinary tract infection
e. in the cade of infections of poorly penetratable anatomical sites.
d. in the case of simple urinary tract infection
Features of community acquired pneumonia (CAP), except for (sign the incorrect answer):
a. The most common pathogen in CAP except for young age (18-40yrs) group is S.pneumoniae.
b. Alcoholism and impaired immunity are risk factors
c. Viral infections has a role only in nosocomial pneumonia
d. The most common pathogens in young adults are M.pneumoniae and C. pneumoniae
e. The “atypical!” pneumonia has lower mortality rate than the “classical” bacterial one.
c. Viral infections has a role only in nosocomial pneumonia
Features of pneumonia caused by S. pneumoniae, except for (sign the incorrect answer):
a. Clinical signs and symptoms of the disease are negligible.
b. Amoxycillin/ciavulanic acid is a proper choice for the treatment in a patient under 65 yrs of age.
c. High mortality rate.
d. Vaccination is an effective option in he most endangered population.
e. The most common type of pneumonia in the population over 65 yrs of age.
a. Clinical signs and symptoms of the disease are negligible.
Features of “atypical” pneumonia are except for (sign the incorrect answer):
a. Mostly young patients are affected
b. High mortality rate
c. Good general condition
d. Clinical signs are gradual onset, dry coughing, lower fever
e. Usually, multinodular infiltration can be seen on X-ray.
b. High mortality rate
The PORT scoring system contains:
a. age + former pneumonia in the patient’s history.
b. age (only in men)+ former pneumonia in the patient’s history + coexisting illnesses.
c. days in Intensive care unit
d. age +coexisting illnesses + the length of antibiotic treatment
e. age + coexisting illnesses + physical examination and laboratory and radiographic findings.
e. age + coexisting illnesses + physical examination and laboratory and radiographic findings.
Possible antibiotic treatment in community acquired pneumonia under 65 yrs of age, without comorbidity, except for (sign the incorrect answer):
a. Amoxycillin/Clavulanic acid
b. Macrolides
c. Cefuroxim
d. Pefloxacin
e. Clarythromycin
d. Pefloxacin
A 78 year old woman was admitted to your hospital, with known diabetes mellitus, hypertension and coronary heart disease. She had fever (38,5 degrees celcius) and complained shaking chill and productive coughing. Physical examination and chest X-ray prove lobar pneumonia. The most probable pathogen is:
a. M. pneumoniae
b. S.pyogenes
c. S. Pneumonia
d. P. aeruginosa
e. C. pneumoniae
c. S. Pneumonia
What type of empiric antibiotic treatment would you recommend in this case:
a. ofloxacin + ampicillin
b. clarythromycin + ceftriaxon
c. amoxycillin/clavulanic acid monotherapy
d. clarythromycin monotherapy
e. imimpenem + moxifloxacin
e. imimpenem + moxifloxacin
(b. clarythromycin + ceftriaxon ??)
Choose the true statement:
a. In CAP etiological diagnosis is possible in 80-90% of the cases.
b. Radiology features can be pathogenomic in CAP.
c. The activity against S. pneumoniae among the macrolide derivatives is different, which has a great impact on the treatment of CAP requiring ICU admittance.
d. Beta-lactams are effective against the atypical pathogens.
e. 2.generation fluoroquinolones exhibit poor activity to S. pneumonia, while 3. and 4. generation derivatives are highly active.
e. 2.generation fluoroquinolones exhibit poor activity to S. pneumonia, while 3. and 4. generation derivatives are highly active.
Common nosocomial pathogens, except for (sign the incorrect answer):
a. Staphylococcus aureus
b. Candida spp.
c. Leptospira interrogans
d. Pseudomonas aeruginosa
e. Enterococcus spp.
c. Leptospira interrogans
The most dangerous nosocomial infection with the highest mortality rate is:
a. osteomyelitis
b. pneumonia
c. cystitis acute
d. cholecystitis acuta
e. tonsillitis follicularis
b. pneumonia
A characteristic feature of severe nosocomial pneumonia:
a. two forms can be differentiated: early and late onset
b. no specific risk factors can be indentified
c. 2. and 3. generation cephalosporins should be the therapy of choice without antipseudomonas activity
d. rapid progression, multilobal infilatration or abscess may occur
e. usually anaerobes are involved
d. rapid progression, multilobal infilatration or abscess may occur
Characteristics of catheter sepsis, except for (sign the incorrect answer):
a. the incidence of catheter infections increases with time
b. the eradication of the bacteria is successful in the majority of cases.
c. the value of antibiotic treatment is limited because of the biofilm production of bacteria.
d. the catheters sooner or later should be removed, except for S. epidermidis infection.
e. isolation of identical pathogens from peripheral blood and catheter.
b. the eradication of the bacteria is successful in the majority of cases.
We present the case of 60 year old man with colon cancer and pulmonary metastasis. Due to his condition, he recieved parenteral potassium substituition through a peripheral intravenous catheter. Chemotherapy has not been introduced yet. The iv. line became infected and the patient developed fever. Four blood samples were taken, and one of them became positive with S. Epidermidis (MSSE). The following therapeutic approach is recommended:
a. the catheter should be removed immediately and local desinfection should be performed
b. parenteral vancomycin therapy for 10-14 days
c. admission to the intensive care unit.
d. prophylactic antimycotic and antibacterial treatment
c. admission to the intensive care unit.
Prophylaxis of catheter infections is possible by:
a. routine changes of the catheter
b. desinfection of the sterile catheter before the introduction
c. prophylactic antibiotics
d. use of moisturing creams
e. rigorous adherence to asepsis
e. rigorous adherence to asepsis
A 38 year old woman received high dose steroid and cyclophosphamid therapy due to systemic vasculitis (Churg-Strauss syndrome) through a central venous catheter. She received broad spectrum antibiotics because of suggested pneumonia from the 5th day of treatment. On the 12th day the patient developed hypothermia, oliguria and hypotonia and became leukopenic. The central venous catheter was changed, multiple blood cultures were taken. Both the result of the blood cultures and the culture of the tip of the catheter show candida spp. infection. Treatment options, except for (sign the incorrect answer):
a. parenteral fluconazole
b. the cessation of the immunosuppressive treatment
c. monitoring in the intensive care unit
d. fluid substituition
b. the cessation of the immunosuppressive treatment
Goals of antimicrobial treatment, except for (sign the incorrect answer):
a. clinical cure
b. antipyretic effect
c. shortening the duration of the illness
d. prevention of complications
b. antipyretic effect
The effect of antibiotic treatment depends:
a. only on the minimum inhibitory concentration (MIC) of the durg
b. only on the number of the microbes
c. on the relationship of one of the kinetic parameters and the MIC
d. only on the kinetic parameter (AUC, Cmaz, etc.)
c. on the relationship of one of the kinetic parameters and the MIC
Choose the false statement:
a. Once-daily administration of aminoglycosides is advocated to maximise efficacy and minimise potential drug administration and toxicity.
b. Fluoroquinolones shoulf be administered in the lowest possible concentration to prevent the serious side effects of the treatment.
c. Antibiotics are indicated only in bacterial infections
d. Antibiotic choice should be based on local suceptibility patterns
c. Antibiotics are indicated only in bacterial infections
The definition of sepsis is:
a. non-infectious systemic inflammatory response syndrome.
b. invasion of microbes that provokes a controlled, local inflammatory response.
c. infectious systemic inflammatory response syndrome.
d. the result of direct bacterial damage of tissues
c. infectious systemic inflammatory response syndrome.
The following symptoms can be signs of sepsis, except for (sign the incorrect answer):
a. body temperature below 36.5°C
b. leukopenia
c. hypotension
d. thrombocytopenia
e. none of the choices above
e. none of the choices above
Useful laboratory test in the diagnoses of sepsis:
a. TSH (thyroid stimulating hormone)
b. PTH (parathormone)
c. PCT (procalcitonin)
d. EMA (endomyseal antibody)
e. ANA (antinuclear antibody)
c. PCT (procalcitonin)
- Common pathogens in nosocomial sepsis, except for (sign the incorrect answer):
a. P. aeruginosa
b. S. aureus
c. N. meningitidis
d. E. coli
c. N. meningitidis
Which of the followings would be the proper choice when treating sepsis:
a. Wait with the antibiotic treatment till the result of blood culture
b. Blood cultures should not be used, because they are not cost-effective
c. Offer a combination of bacteriostatic antibiotics
d. Bactericidal antiobiotics should be chosen according to the site of infection and the possible pathogens.
d. Bactericidal antiobiotics should be chosen according to the site of infection and the possible pathogens.
The presence of the following conditions are to be considered as risk factors for sepsis, except for (sign the incorrect answer):
a. alcohol addiction
b. diabetes mellitus
c. chemotherapy
d. long-term steriod treatment
e. oral contraceptives
e. oral contraceptives
Could be the choice of treatment in skin/soft tissue infections:
a. rifaximin
b. nitrofurantoin
c. amoxycillin/clavulanic acid
d. systemic gentamicin
e. oseltamivir
c. amoxycillin/clavulanic acid
Antibiotics effective against MRSA (Methicillin resistant S. aureus):
a. ceftazidim
b. imipenem
c. caspofungin
d. vancomycin
e. amoxycillin/clavulanic acid
d. vancomycin
What are the most common causes of acute bacterial meningitis in patients older than 3 months of age?
a. Streptococcus pyogenes, Listeria monocytogenes
b. Staphylococcus aureus, Staphylococcus epidermidis
c. Neisseria meningitidis, Streptococcus pneumoniae
d. Mycoplasma pneumoniae, Borrelia burgdorferi
c. Neisseria meningitidis, Streptococcus pneumoniae
What is the overall mortality of acute bacterial meningitis?
a. 40%
b. 8%
c. 0,1%
d. 90%
b. 8%
The following statements are true, except one:
a. Headache, fever and vomiting are the three most important signs of acute bacterial meningitis.
b. Age, immunological condition of the patient and preceeding antibiotic treatment may modify the presenting signs and symptoms of acute bacterial meningitis.
c. Clinical signs of meningeal involvemnet (Kernig, Brudzinski) are present in all cases of acute bacterial meningitis.
d. Skin lesions are often seen in patients with meningococcal meningitis.
c. Clinical signs of meningeal involvemnet (Kernig, Brudzinski) are present in all cases of acute bacterial meningitis.
What is the typical cerebrospinal fluid result found in acute bacterial meningitis?
a. markedly elevated protein and cell count, decreased glucose level.
b. markedly elevated protein with normal cell count and glucose level
c. markedly decreased protein with elevated cell count and glucose level
d. normal protein and cell count with elevated glucose level
a. markedly elevated protein and cell count, decreased glucose level.
What is the first choice of antibiotic therapy in acute bacterial meningitis of a patient older than 3 months of age?
a. ampicillin +cefotaxime
b. ampicillin + gentamicine
c. chloramphenicol + meropenem
d. cefotaxime or ceftriaxone
d. cefotaxime or ceftriaxone
The antibiotics below are recommended for the chemoprophylaxis in meningococcal meningitis, except one:
a. Rifampicin
b. Ceftriaxone
c. Doxycycline
d. Ciprofloxacine
c. Doxycycline
Cerebrospinal fluid in encephalitis:
a. may show elevated protein level
b. may show pleiocytosis
c. may be normal
d. may show normal or elevated glucose level
e. all the above findings may be true
e. all the above findings may be true
Which part of the central nervous system is most preferred by the herpes simplex virus beyond the neonatal period?
a. the parietal lobe
b. the temporal lobe
c. the cerebellum
d. the brainstem
e. the spinal cord
b. the temporal lobe
Which is the quickest acute phase reactant:
a. CRP
b. WBC
c. sedimentation rate
a. CRP
When is the PCT test positive?
a. in bacterial infections
b. in viral infections
c. both in bacterial and viral infections
a. in bacterial infections
What is the “ sensitivity” of a test?
a. the proportion of people with the disease who have a positive test for the disease.
b. the proportion of people without the disease who have a negative test for the disease.
a. the proportion of people with the disease who have a positive test for the disease.
What is the “ specificity” of a test?
a. the proportion of people without the disease who have a negative test for the disease.
b. the proportion of people with the disease who have a positive test for the disease.
a. the proportion of people without the disease who have a negative test for the disease.
what is the main reason for cultures?
a. to have a correct diagnosis
b. to get informations on resistance
c. to monitor the effectivity of the treatment
b. to get informations on resistance
Which of the following situations are potentially life-threatening?
a. Meningococcaemia
b. Toxic shock syndrome
c. Necrotising fasciitis
d. All of the above
d. All of the above
In which infection are vesicles characteristic?
a. Chickenpox
b. Exanthema subitum
c. Rubella
a. chickenpox
In which infection do we see Koplik sign?
a. Measels
b. Megaloerythema
c. Rubella
a. Measles
What is the pathogen for scarlet fever?
a. Pneumococcus
b. Streptococcus pyogenes
c. Haemophylus influenzae
b. Streptococcus pyogenes
Which infections are vaccine preventable?
a. Rubella
b. Chickenpox
c. Measels
d. All of the above
d. All of the above
What is the main bacterial pathogen in tonsillopharyngitis?
a. pneumococcus
b. haemophylus influenzae
c. streptococcus pyogenes
c. streptococcus pyogenes
What is the main pathogen in acute otitis media?
a. pneumococcus
b. haemophylus influenzae
c. streptococcus pyogenes
a. Pneumococcus
Which antimicrobial has the highest cc. in the middle ear fluid?
a. Ceftriaxone
b. Clarithromycine
c. Azithromycine
a. Ceftriaxone
What is the main pathogen in acute bacterial rhinosinusitis?
a. Pneumococcus
b. Haemophilus influenzae
c. Streptococcus pyogenes
a. Pneumococcus
The recommended duration of fluoroquinolones treatment in acute uncomplicated cystitis?
a) 3 days
b) 5 days
c) 10 days
a) 3 days
Choose the true statement:
a. Diabetes mellitus, malignancies, COPD and chronic renal failure increases the risk of community acquired pneumonia
b. In CAP requiring hospitilsation (Group III.) Amoxycillin/Clavulanic acid, macrolide or doxycyclin monotherapy is the choice of treatment.
c. S. pneumoniae and L. pneumophilia can not cause CAP requiring ICU admittance.
d. Every patient diagnosed with CAP must be treated with 3. or 4 generation fluoroquinolons, because these are the most effective drugs in CAP.
a. Diabetes mellitus, malignancies, COPF and chronic renal failure increases the risk of community acquired pneumonia
Risk factors of nosocomial pneumonia are, except for (sign the incorrect answer):
a. aspiration
b. mechanical ventillation
c. parenteral nutrition
d. polypectomy via enteral endoscopy
e. stress ulcer prophylaxis
d. polypectomy via enteral endoscopy
What is the mechanism of penicillin resistance in pneumococci?
a. Beta-lactamase production
b. alteration in the penicillin binding protein
c. Phas activity
b. alteration in the penicillin binding protein
The following examinations have abnormal results in most cases of herpes simplex encephalitis beyond the neonatal age, except one:
a. Brain MRI
b. Cerebrospinal fluid (CSF) PCR for HSV DNA
c. immunofluorescent assays of serum and CSF for HSV specific antibodies
d. viral culture of the CSF
e. electroencephalogram (EEG)
d. viral culture of the CSF
The most frequent pathogen in acute uncomplicated cystitis?
a) E. coli
b) P. aeruginosa
c) Candida albicans
a) E.coli
The first dose of the presumably effective antibiotic should be given in severe sepsis or septic shock within:
a) 1 hour
b) 1 days
c) 2 days
a) 1 hour
The surgical (secondary) peritonitis is due to the synergistic effects of:
a) several aerobes
b) several anaerobes
c) several aerobes and anaerobes
a) several aerobes
