Infectious diseases

Question 1

What Is the negative predictive value of urinalysis?

Answer 1

94%

Question 2

How long post kidney transplant should patients be screened and possibly treated for asymptomatic bacteriuria?

Answer 2

30-60 days

Question 3

Which Urinary pathogen is intrinsically resistant to nitrofurantoin?

Answer 3

Proteus mirabilis

Question 4

What are the criteria for CDI to be rated as non-severe?

Answer 4

WBC < 15,000 cells/microL AND SCr < 1.5 mg/dL

Question 5

Microbiological pathogenesis of pneumonia: what does HAP-SP stand for?

Answer 5

Haemophilus influenzae, Atypicals (Legionella, mycoplasma, chlamydophila), Streptococcus pneumoniae, staph aureus, Pseudomonas aeruginosa

Question 6

Which antibiotic cannot be used to treat pneumonia because it is deactivated by pulmonary surfactant?

Answer 6

Daptomycin

Question 7

Which anti-MRSA agents can be used to treat pneumonia?

Answer 7

Vancomycin or linezolid

Question 8

What is the clinical criteria for stability for systolic BP in pneumonia?

Answer 8

> 90 mm Hg

Question 9

What is the heart rate for criteria for Clinical stability in pneumonia?

Answer 9

< 100 bpm

Question 10

What is the body temperature threshold for clinical stability in pneumonia?

Answer 10

< 100.4 F

Question 11

What level of MRSA prevalence does anti- MRSA coverage not need to be included for HAP treatment?

Answer 11

=< 20%

Question 12

What is the threshold to consider white blood count to be elevated?

Answer 12

11,200 or 11,800, Depending on the lab

Question 13

What percent bands would be considered elevated?

Answer 13

7-8%, depending on the lab

Question 14

What body temperature in Fahrenheit is considered a fever?

Answer 14

100.4 F or greater

Question 15

How do you calculate mortality risk from lactic acid?

Answer 15

Multiply by ten

Question 16

What is CRE?

Answer 16

Carbapenem resistant enterobacterales

Question 17

Which criteria/ tools are best for determining whether to initiate antibiotics?

Answer 17

Loeb criteria

Question 18

Which tool/criteria are best for prospective surveillance?

Answer 18

NHSN criteria

Question 19

What percent sensitivity of isolates should you have an agent for empiric therapy?

Answer 19

80% or more

Question 20

What is the most common pathogen in older adults in UTI?

Answer 20

E. Coli

Question 21

Which antibiotics penetrate prostate fluid?

Answer 21

Carbapenems and fluoroquinolones

Question 22

How long after removal of a catheter is a UTI still considered a catheter associated UTI (CAUTI)?

Answer 22

Up to 48 hours

Question 23

Which components of urinalysis could indicate a possible UTI?

Answer 23

1) Leukocyte esterases - medium or large
2) urinary nitrites- positive
3) pyuria - greater than 10

Question 24

What is the only specific sign or symptom we have/objective measure for pyelonephritis diagnosis?

Answer 24

Costovertebral angle tenderness (CVA) (aggressive palpation of the border of the kidney)

Question 25

31-60 days how do you decide whether to treat UTI Post kidney transplant ?

Answer 25

If you have two consecutive two consecutive urine samples, yielding more than 100,000 CFU of the same pathogen- may consider treatment for 5 days

Question 26

What level of susceptibility to a fluoroquinolone do you need to have to be able to use it for pyelonephritis?

Answer 26

90% or more

Question 27

When is the seven day treatment for pyelonephritis appropriate?

Answer 27

Resolution of symptoms occurs within the first 72 hours of antibiotics

Question 28

For CAUTI, When would be a catheter needs to be changed if a catheter is still needed?

Answer 28

If it has been in place for more than 2 weeks 

Question 29

What threat level does CDC consider Clostridioides difficile to be?

Answer 29

Urgent

Question 30

Which antibiotic cannot be used to treat C. difficile in someone with severe macrolide allergy?

Answer 30

Fidaxomicin

Question 31

What is the most Common pathogen for community acquired pneumonia ?

Answer 31

Viruses

Question 32

what is the most common bacterial pathogen of community acquired pneumonia?

Answer 32

Streptococcus pneumoniae

Question 33

When is Anaerobic coverage needed for pneumonia treatment?

Answer 33

Radiographic evidence of consolidation/empyema

Question 34

When are blood cultures and sputum culture recommended for pneumonia?

Answer 34

Severe disease, or when suspecting MRSA or Pseudomonas

Question 35

pneumonia is Severe when three minor criteria are present. What are the criteria Re:, respiratory rate, body, temperature, and blood pressure?

Answer 35

1) RR 30 breaths, per minute or more 2) core Temperature < 36 C (96.8 F) 3) hypotension requiring fluid resuscitation

Question 36

Pneumonia is severe when 3 minor criteria are present. What lab results are minor criteria?

Answer 36

1) uremia (BUN >= 20 mg/dL) 2) leukopenia (WBC < 4,000 cells/microL) 3) thrombocytopenia (PLT < 100,000/microL)

Question 37

Pneumonia is severe when 3 minor criteria are present. What are the minor criteria (miscellaneous)?

Answer 37

Confusion, multilobar infiltrates, Pa O2/Fi O2 =< 250

Question 38

Which tool is the best mortality / prognosis predictor in pneumonia?

Answer 38

PSI/PORT (Pneumonia Severity Index/ Patient Outcomes Research Team)

Question 39

PSI/PORT (Pneumonia Severity Index/ Patient Outcomes Research Team)= 130 points, What is the mortality rate?

Answer 39

9.3%

Question 40

PSI/PORT (Pneumonia Severity Index/ Patient Outcomes Research Team)= 131 points, What is the mortality rate?

Answer 40

27%

Question 41

Which Two groups of antimicrobial should be used to treat pneumonia without MRSA or Pseudomonas risk factors? (Except for outpatient without comorbidities)

Answer 41

Beta-lactam + macrolide

Question 42

Which agent can be used to treat pneumonia in an outpatient without comorbidities? (2 choices)

Answer 42

Amoxicillin, doxycycline

Question 43

What is the treatment duration required for pneumonia in a stable patient without MRSA or Pseudomonas?

Answer 43

5 days minimum

Question 44

What are the 7 criteria for clinical stability ?

Answer 44

Temp < 100.4 F HR < 100 bpm RR < 24/min SBP > 90 mmHg Normal mental status Ability to maintain oral intake SpO2 > 90%

Question 45

How many clinical instability criteria must be present before extending treatment for pneumonia to seven days?

Answer 45

2

Question 46

Hospital acquired pneumonia: patient who is not high risk of mortality and has had no IV antibiotics in the previous 90 days with an MRSA prevalence under 20%. Which organism Must be covered?

Answer 46

Pseudomonas

Question 47

HAP- pseudomonas regimens (4)

Answer 47

Pip-tax 4.5 gm q6h Cefipime 2 g q8h (neurotoxicity risk) Levofloxacin 750 mg q24h Meropenem 1g q8h

Question 48

HAP - MRSA coverage regimens (2)

Answer 48

Vancomycin 15 mg/kg q8-12h (AUC 400, or trough 15-20 mcg/mL) Linezolid 600 mg q12h

Question 49

HAP -When is double anti- Pseudomonal coverage needed? (3)

Answer 49

1) Septic shock w vent d/t pneumonia 2) Structural lung disease 3) No agent w susceptibility 90% or more

Question 50

Which meningitis vaccine is contraindicated in a patient w prior severe allergy to tetanus toxoid?

Answer 50

MenQuadfi (MenACWY-TT)

Question 51

Which Pneumonia vaccines are contraindicated in patients with severe reaction to diphtheria/Tdap?

Answer 51

PCV15, PCV20

Question 52

Allergy to egg- other than hives (eg anaphylaxis) - can the patient receive flu vaccination?

Answer 52

Administer in any inpatient or outpatient setting by HCP who can recognize and manage severe allergic reaction

Question 53

Patient XY received two shingrix doses four weeks apart. Does he need any more doses?

Answer 53

Yes -2

Question 54

Which pneumococcal serotypes have highest risk of morbidity and mortality? (2)

Answer 54

22F, 33F