Most Important Questions Flashcards by Jharna Patel

What do the 4 R’s of radiation pertain to?
1. IMRT
2. brachytherapy
3. fractionation

fractionation

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What is the dose rate of HDR?
1. 40-60 cGy/hr
2. 80-100 cGy/hr
3. 12 Gy/hr
4. 120 Gy/hr

12 Gy/hr

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What dose of radiation is needed to sterilize occult metastatic disease?
1. 30-40 Gy
2. 40-50 Gy
3. 70-80 Gy

40-50 Gy

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What is the dose of radiation required to double the spontaneous germ cell mutation rate?
1. 1 Gy
2. 5 Gy
3. 10 Gy
4. 50 Gy

1 Gy

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What are the total doses of radiation given in vulvar cancer for microscopic and macroscopic disease, respectivley?
1. 20-25 Gy and 40-45 Gy
2. 40-45 Gy and 60 Gy
3. 60-70 Gy and 90 Gy

40-45 Gy for microscopic disease and 60 Gy for macroscopic disease

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What is the total RT dose delivered by EBRT + Brachy for primary treatment of clinical Stage I-II endometrial cancer?
1. 5000 cGy
2. 6000 cGy
3. 7500-8000 cGy

7500-8000 cGy

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To what dose of RT should gross vaginal disease be treated to?
1. 3000-4000 cGy
2. 5000-6000 cGy
3. 6500-8500 cGy

6500-8500 cGy

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How do you treat hemorrhagic cystitis?

hyperbaric O2, pentosan polysulfate (Elmiron), in severe cases cysto with fulguration of bleeding vessels

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What is the definition of pneumbra?

lateral spread as the dose falls from maximal central axis dose to zero

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Match the radiation source with its half-life:
1. 137Cs
2. 192Ir
3. 60Co
4. 226Rad
5. 222Rn

a. 30 years
b. 5.26 years
c. 1,626 years
d. 74.5 days
e. 3.83 days

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What is backscatter?
1. energy that reflects off of the patient and is reflected back to the radiation source
2. energy that is newly generated from incipient energy as it hits target and structures in path of beam of photons
3. energy that bounces off the tumor

energy that is newly generated from incipient energy as it hits target and structures in path of beam of photons.

Cannot account for this in dosimetry calculations although IMRT tries to

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What is the ratio of contribution of the tandem and ovoids to the total dose of brachytherapy?
1. 1:2
2. 2:1
3. 1:1
4. 1:3

1:1 (each tandem is 1/2)

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Benefits of larger ovoids?
1. better dosimetry and uniformity to Point A
2. better dosimetry and uniformity to Point B

better dosimetry and uniformity to Point A

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All of the following impact relative biologic effectiveness except:
1. linear energy transfer
2. oxygen enhancement effect
3. dose per fraction
4. dose rate
5. total dose

oxygen enhancement effect

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What does Bremstelong mean?
1. radiation being transferred to another form of energy
2. braking rays. Electron hits the nucleus of an atom instead of another electron and decelerates and that energy loss results in an xray
3. braking eyes. If radiation beams hit the cornea they can cause permanent blindness

braking rays. Electron hits the nucleus of an atom instead of another electron and decelerates and that energy loss results in an xray

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What does doubling the tandem length do to the dose of radiation?
1. increases the dose to Point B and decreases the dose to the uterine cavity by 28%
2. increases the dose to Point B and increases the dose to the uterine cavity by 28%
3. decreases the dose to Point B and decreases the dose to the uterine cavity by 28%
4. decreases the dose to Point B and increases the dose to the uterine cavity by 28%

increases the dose to Point B and decreases the dose to the uterine cavity by 28%

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What is the maximum acceptable fetal dose during pregnancy?x
1. <1 cGy
2. < 10 cGy
3. < 50 cGy
4. <1 Gy

< 10 cGy

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What is the mechanism in using metronidazole and misonidazole as a radiation sensitizer?

The drug undergoes radiation-induced redox reaction in absence of oxygen – thus are more toxic to hypoxic than aerated cells. It stablizes DNA breaks caused by radiation and makes them unrepairable.

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What is the mechanism in using bleomycin, procarbazine, steptonigrin, dactinomycin, vincristine as a radiation sensitizer

reduces the shoulder region of radiation survival curve by inhibiting repair of sublethal injury.

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How do you manage a RV fistula 3cm from introitus in a radiated patient? The patient developed an RV fistula 3 cm from the introitus after radiation treatment and got a diverting colostomy for 3 months. What was the best surgical approach for correction of the RV fistula?
1. endorectal advancement flap
2. fistulectomy with Martius flap
3. laparotomy with fistula repair and omental flap
4. laparotomy with fistula repair and reversal of colostomy

fistulectomy with Martius flap

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how do you manage a non-healing vulvar ulcer s/p radiation?
1. Debridement
2. hyperbaric oxygen
3. resection with primary closure

hyperbaric oxygen

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What is the mechanism of action of aminoglycosides?
1. Bind to the 30S ribosomal subunit and inhibits protein synthesis
2. Binds to the 50S ribosomal subunit and inhibits DNA synthesis
3. Targets the cell wall and interferes with addition of new cell wall units
4. Targets DNA synthesis by Inhibit DNA gyrase and topoisomerase IV

Binds to the 30S ribosomal subunit and inhibits protein synthesis

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Which of the following is NOT part of the antibacterial specrtum of the aminoglycosides?
1. gram negative bacilli
2. pseudomonas
3. staphlococcus
4. enterobacter

staphlococcus

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What percentage of patients treated with aminoglycosides will experience some degree of renal dysfunction?
1. 5%
2. 10%
3. 20%
4. 40%

0.2

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True or false: ototoxicity associated with aminoglycosides is dose related

True or false: at high doses cephalosporins can block acetylcholine release at presynaptic neurons and therefore should be avoided in myasthenia gravis

FALSE- this is true of aminoglycosides NOT cephalosporins

Which of the following is a side effect of amphoteracin? 1. rigors 2. nephrotoxicity 3. chills 4. nausea 5. fever 6. all of the above

Which of the following is NOT part of the antibacterial specrtum of the fluconazole? 1. Candida 2. Coccidioidomycosis 3. Cryptococcosis 4. all of the above all part of the antibacterial spectrum of fluconazole 5. none of the above are part of the antibacterial spectrum of fluconazole

all of the above all part of the antibacterial spectrum of fluconazole

True or false: fluconazole can cause significant liver dysfunction.

true. Watch liver enzymes closely.

With which of the following drugs can fluconazole interact? 1. erythromycin 2. warfarin 3. phenytoin 4. all of the above

all of the above. 1. erythromycin- cardiotoxicity 2. warfarin - potentiates effect 3. phenytoin- potentiates effect

What type of drug is aztreonam? 1. quinolone 2. beta lactam 3. cephalosporin 4. antifungal

beta lactam

Which of the following is part of the spectum of antibiotic use of aztreonam? 1. gram negatives 2. pseudomonas 3. gram positives 4. gram negatives and pseudomonas 5. gram positives and pseudomonas

gram negatives and pseudomonas

What is a benefit of using aztreonam over using aminoglycosides? 1. less hepatotoxicity 2. less nephrotoxicity 3. less nausea 4. less cost

less nephrotoxicity

What is the mechanism of action of cephalosporins? 1. Bind to the 30S ribosomal subunit and inhibits protein synthesis 2. Inhibits cell wall cross linking 3. Binds to the 50S ribosomal subunit 4. Targets DNA synthesis by Inhibit DNA gyrase and topoisomerase IV

Inhibits cell wall cross linking. Mnemonic: cefWALLsporins

What is the mechanism of clearance of cephalosporins? 1. hepatic 2. renal 3. feces 4. biliary

renal- all except ceftriaxone

Which of the following is NOT true regarding the coverage of 1st generation cephalosporins? 1. good gram + coverage 2. limited gram - coverage 3. moderate anaerobic coverage 4. no pseudomonas coverage

moderate anaerobic coverage- 1st generation cephalosporins have NO anaerobic coverage

Which of the following is NOT true regarding the coverage of 2nd generation cephalosporins? 1. more gram - coverage than 1st generation cephalosporins 2. less gram + coverage than 1st generation cephalosporins 3. moderate pseudomonas coverage 4. activity against enteric anaerobes

moderate pseudomonal coverage- 2nd generation cephalosporins have NO Pseudomonal coverage

Which of the following is NOT true regarding the coverage of 3nd generation cephalosporins? 1. more gram - coverage than 2st generation cephalosporins 2. less gram + coverage than 2st generation cephalosporins 3. some have pseudomonas coverage 4. all of the above are true

All of the above are true. Especially especially ceftazidime has Pseudomonal coverage.

Which of the following is NOT true regarding 4th generation cephalosporins? 1. Good gram negative coverage 2. Good Pseudomonal coverage 3. Some grame + coverage 4. all of the above are true

All of the above are true. Example of 4th gen cephalosporin is cefipime.

What type of drug is imipenem? 1. quinolone 2. beta lactam 3. cephalosporin 4. antifungal

beta lactam. Carbapenem.

Which of the following is NOT sensitive to imipenem? 1. MSSA 2. Enterobacter 3. Pseudomonas 4. Klebsiella 5. Staph epi 6. MRSA 7. Enterococcus 8. E Coli 9. Proteus 10. anaerobes

MRSA. Imipenem has the broadest coverage of all. Covers G+, G-, an anaerobes.

What is a serious side effect associated with imipenem? 1. hemolytic anemia 2. seizures 3. neutropenia 4. tachycardia

seizures. In 3% of patients.

What is the mechanism of action of penicillin? 1. inhibits cell wall cross-linking 2. Binds to the 50S ribosomal subunit 3. Targets DNA synthesis by Inhibit DNA gyrase and topoisomerase IV 4. reactive intermediates cause DNA damage

inhibits cell wall cross-linking

What is Penicillin G used for? 1. streptococcus A 2. pneumococcal pneumonia 3. E coli 4. Serratia 5. streptococcus A and pneumococcal pneumonia

streptococcus A and pneumococcal pneumonia

True or false: penicillinase resistant penicillins such as nafcillin, methacillin and oxacillin were initially useful in treating staph infections but now resistance is developing.

Which of the following extended-spectrum penicillins also covers Pseudomonas? 1. piperacillin- tazo 2. Ticarcillin 3. piparcillin 4. ticarcillin-calvulanate 5. all of the above

All of the above. Pip-tazo= zosyn. Ticarcillin-clav= timentin

Which of the following penicillins does NOT cover anaerobes? 1. piperacillin- tazo 2. Ampicillin-sulbactam 3. ticarcillin-calvulanate 4. piparcillin 5. Amoxicillin- calvulanate 6. ticarcillin 7. nafcillin

Nafcillin. Pip-tazo= zosyn. Ticarcillin-clav= timentin. Ampicillin-sulbactam= unasyn, Amoxicillin- calvulanate= augmentin

What is the mechanism of action of quinolones? 1. inhibits cell wall cross-linking 2. Binds to the 50S ribosomal subunit 3. Targets DNA synthesis by inhibiting DNA gyrase and topoisomerase IV 4. reactive intermediates cause DNA damage

Targets DNA synthesis by inhibiting DNA gyrase and topoisomerase IV

Which of the following is NOT true regarding the spectrum of quinolones? 1. covers gram negatives 2. covers anaerobes 3. covers Pseudomonas 4. covers staph

covers anaerobes. This is NOT true. Quinolones have NO anaerobic coverage

What is the mechanism of action of vancomycin? 1. Targets the cell wall and interferes with addition of new cell wall units 2. Binds to the 50S ribosomal subunit 3. Targets DNA synthesis by inhibiting DNA gyrase and topoisomerase IV 4. reactive intermediates cause DNA damage

Targets the cell wall and interferes with addition of new cell wall units

Which of the following is NOT included in vancomycin's spectrum of activity? 1. all gram positives 2. C. Difficile 3. staph 4. strep 5. enterococcus 6. E coli

E coli. Vancomycin has no gram negative coverage.

What toxicity has been associated with Vancomycin? 1. infusion reaction from histamine release 2. ototoxicity 3. nephrotoxicity 4. all of the above

all of the above

What is the mechanism of action of metronidazole? 1. Targets the cell wall and interferes with addition of new cell wall units 2. Binds to the 50S ribosomal subunit 3. Targets DNA synthesis by inhibiting DNA gyrase and topoisomerase IV 4. In the anaerobic electron transport system, the nitro groups is reduced andreactive intermediates cause DNA damage and strand break

In the anaerobic electron transport system, the nitro groups is reduced andreactive intermediates cause DNA damage and strand break

Which of the following is included in the spectrum of activity of metronidazole? 1. anaerobic bacteria 2. Streptococcus 3. Staphalococcus 4. Enterococcus 5. all of the above

anaerobic bateria ONLY

What is the mechanism of action of the macrolides? 1. Target the cell wall and interferes with addition of new cell wall units 2. Block protein synthesis by binding to 50S ribosomal subunits 3. Target DNA synthesis by inhibiting DNA gyrase and topoisomerase IV 4. In the anaerobic electron transport system, the nitro groups is reduced andreactive intermediates cause DNA damage and strand break

Block protein synthesis by binding to 50S ribosomal subunits

Which of the following is NOT included in the spectrum of activity of erythromycin, clarithromycin, and azithromycin? 1. Legionella 2. mycoplasma 3. MSSA 4. E Coli 5. Actinomycin

E coli. These drugs cover G+, mycoplasma, and legionella.

What is the general spectrum covered by Clindamycin? 1. anaerobes and G+ 2. G+ and G- 3. G- and anaerobes 4. only anaerobes

Anaerobes and G+. Clinda also covers Pseudomonas.

What is the mechanism of action of trimethoprim/sulfamathoxazole? 1. Target the cell wall and interferes with addition of new cell wall units 2. Competitively inhibit enzymes involved in 2 steps of folic acid biosynthesis 3. Target DNA synthesis by inhibiting DNA gyrase and topoisomerase IV 4. In the anaerobic electron transport system, the nitro groups is reduced andreactive intermediates cause DNA damage and strand break

Competitively inhibit enzymes involved in 2 steps of folic acid biosynthesis

What is true about the spectrum of activity of trimethoprim/sulfamethoxazole? 1. modest activity against strep 2. gram negative coverage 3. no anaerobic activity 4. activity against staph 5. all of the above are true

all of the above are true

Match the type of necrotizing fasciitis with the organisms that cause it: 1. Type I necrotizing fasciitis 2. Type II necrotizing fasciitis a. group A streptococcus or other beta-hemolytic streptococcus often in combination with staph aureus B. anaerobic and aerobic bacteria

Type I necrotizing fasciitis- anaerobic and aerobic bacteria Type II necrotizing fasciitis- group A strepto coccus or other beta-hemolytic streptococcus often in combination with staph aureus

Which of the following is NOT a risk factor for type I necrotizing fasciitis 1. diabetes 2. peripheral vascular disease 3. recent surgery 4. immune compromise 5. chronic UTI

chronic UTI

Fournier's gangrene is what type of necrotizing fasciitis: 1. Type I 2. Type II

Type I

Which of the following is NOT an acceptable antibiotic regimen for necrotizing fasciitis: 1. pip-tazo + clindamycin+vancomycin 2. meropeneum + clindamycin + linazolid 3. ertapeneum + clindamycin + vancomycin 4. cefriaxone + clindamycin

ceftriaxone + clindamycin. Need broader coverage including MRSA coverage (which vanco, linazolid, and daptomycin provide). Must broadly cover gram negatives, gram positives and anaerobes. Clindamycin is added for its antitoxin effects against toxin-elaborating strains of streptococci and staphylococci.

What lab test is often elevated in necrotizing fasciitis? 1. Troponin 2. CPK 3. ferritin 4. Alkaline phosphatase

CPK

Which organisms are most commonly associated with necrotizing myositis (aka myonecrosis): 1. MRSA and clostridium 2. Group A strep and MRSA 3. mixed anaerobes and Group A strep 4. Clostridium and Group A strep

Clostridium and Group A strep

Which of the following antibiotics should be used in treating necrotizing myositis? 1. penicillin + clindamycin 2. fluoroquinolone + clindamycin 3. penicillin + metronidazole 4. Ampicillin/sulbactam

penicillin + clindamycin

Which of the following antibiotics has the best anaerobic coverage? 1. ceftriaxone 2. ciprofloxacin 3. imipenem 4. nafcillin

imipenem

True or false: Penicillin covers clostridium perfringes

What is amikacin especially good for treating? 1. Vancomycin-resistant MRSA 2. Clostridial infections 3. Resistant Pseudomonal infectiosn 4. Vancomycin-resistant enterococcus

Resistant Pseudomonal infections

Which of the following drugs does NOT have reliable coverage against Pseudomonas? 1. ticarcillin 2. ceftazadime 3. imipenem 4. meropenem 5. ticarcillin-clavulanate 6. cefipime 7. piperacillin-tazobactam 8. ertapenem 9. ceftobiprole 10. pipercillin 11. aztreonam 12. ciprofloxacin

ertapenem

Who is most likely to have a wound infection? 1. diabetic 2. chronic steriod user 3. obese patient 4. patient who underwent a bowel resection

??? I guess diabetic what do you think?

Which of the following organism-specific factors related to infections in patients with diabetes are true? 1. glucose- inducible proteins promote adhesion of C. albicans to buccal or vaginal epithelium. This adhesion, in turn, impairs phagocytosis, giving the organism an advantage over the host. 2. . Ketone reductases produced by Rhizopus species allows Rhizopus spp. to thrive in high glucose, acidic conditions typically present in diabetic patients with ketoacidosis 3. Both 1 and 2 are true 4. Neither 1 nor 2 are true

Both 1 and 2 are true

?treatment of aerobacter -

Are they talking about enterobacter aerogenes? This is synonomous with aerobacter aerogenes. They say that answer is gentamicin but I read that aminoglycoside resistance is high and treatment of choice is carbepenems.

What is the best antibiotic treatment for clostridium dificile? 1. vancomycin 2. ciprofloxacin 3. metronidazole 4. clindamycin

metronidazole

What antibiotic should be used in the treatment of a neutropenic patient with concern for line-sepsis? 1. clindamycin 2. vancomycin 3. piperacillin-tazobactam 4. cefipime

vancomycin

In a young patient who is 12 hours postoperative with fever, tachycardia, tachypnea, and appears ill, what pathogen do you expect is responsible for this picture? 1. MRSA septicemia 2. E Coli septicemia 3. beta-hemolytic strep septicemia 4. Pseudomonal septicemia

beta-hemolytic strep septicemia

Place these pathogens in order from most common to least common cause of septicemia: 1. candida 2. coagulase negative staph 3. gram negative enteric pathogens 4. strep 5. enterococcus 6. anaerobes

gram negative enteric pathogens> coagulase negative staph> enterococcus> strep> anaerobes> candida

Which of the following antibiotic does NOT potentiate the anticoagulant effect of warfarin? 1. clarithromycin 2. metronidazole 3. erythromycin 4. trimethoprim-sulfamethoxazole 5. ciprofloxacin 6. ampicillin

ampicillin

The anticoagulant activity of Coumadin is depressed if the patient? 1. is taking narcotics 2. is taking atropine 3. is a diabetic 4. phenytoin

phenytoin. Based on micromedex there is no interaction between warfarin and atropine or narcotics. Severe diabetes can cause increase in INR not decrease.

Which of the following diseases is NOT associated with decreased INR in patients on warfarin? 1. hypertension 2. edema 3. hereditary coumarin resistance 4. hyperlipidemia 5. hypothyroidism 6. nephrotic syndrome

Hypertension

Which of the following drugs does NOT cause a decrease in INR in patients on warfarin? 1. phenytoin 2. nafcillin 3. carbamazapine 4 barbituates 5. rifampin 6. cimetidine 7. griseofulvan

cimetidine. This causes INCREASED risk of bleeding with warfarin.

What is the best antibiotic to treat klebsiella pna sepsis 7 days after hospitalization? 1. ceftazadime 2. imepenem 3. gentamicin 4. other multi agent regimens

Empirical combination antimicrobial therapy should include an antipseudomonal cephalosporin (e.g., ceftazidime), antipseudomonal carbapenem (e.g., imipenem), or beta-lactam-beta-lactamase inhibitor (e.g., piperacillin-tazobactam), plus an antipseudomonal fluoroquinolone (e.g., ciprofloxacin) or aminoglycoside (e.g. tobramycin) plus vancomycin or linezolid (for MRSA).

-- Renally cleared antibiotics (flagyl, levoquin, ceftazadime, aztreonam, others)

abx who DON't require renal dosing: ceftriaxone, clinda, second gen pcns, doxycycline, erythro, flagyl

What is the best way to reduce nephrotoxicity of nephroxic antibiotics? 1. dose reduction 2. good hydration 3. eliminate other nephrotoxic drugs 4. all of the above

all of the above

1. What is the most likely means of acquiring clostridium diffile? 1. no hand washing btween patients 2. sharing bathrooms 3. single dose of prophylactic antibiotics

no hand washing btween patients

What is the most sensitive/specific test for c.diff? 1. stool toxin culture (toxigenic culture) 2. PCR 3. Antigen detection by latex agglutination 4. Enzyme immunoassay

stool toxin culture (toxigenic culture) is most sensitive and specific but takes more time.

What is the best antibiotic to treat neutropenic fever? 1. cefepime 2. imipenem 3. zosyn 4. all of the above

All of the above are good choices. cefepime, imipenem or zosyn (all cover pseudomonas) NO vanc unless line infection

Which antibiotic does NOT require renal dosing? 1. Cefazolin 2. flagyl

flagyl

If you have a patient with a wound infection with raised borders and lymphangitis what organism is likely the cause? 1. MRSA 2. enterobacter 3. Group A strep (Erysipelas) 4. anearobes

Group A strep (Erysipelas)

If you have a patient with a Pseudomonas UTI, which antibiotic should you NOT use to treat this? 1. ceftazadime 2. amoxicillin 3. piperacillin-tazobactam 4. ciprofloxacin

amoxicillin

Which of the following is NOT an appropriate treatment for neutropenic fever? 1. Imipenem 2. Zosyn 3. Ceftazadime 4. Ceftriaxone 5. Aztrenonam

ceftriaxone

What is the most common CT finding in C. Diff colitis? 1. "thumbprinting" 2. thickening of bowel wall 3. perforation

thickening of bowel wall. "thumbprinting" and perforation can also be seen but less commonly.

What is the best antibiotic for klebsiella infection? 1. ceftazidine 2. imipenem and clindamycin 3. vanc and gentamicin

ceftazidine?? Ceftaz, imipenem and gent have activity against klebsiella. Clinda and vanco don’t. Other antibiotics with activity against klebsiella third-generation cephalosporins (eg, cefotaxime, ceftriaxone), carbapenems (eg, imipenem/cilastatin), aminoglycosides (eg, gentamicin, amikacin), and quinolones.

Which of the following antibiotics is NOT renally cleared? 1. flagyl 2. levoquin 3. ceftazadime 4. aztreonam

flagyl. Other antibiotics that do NOT require dose adjustment for renal failure include: ceftriaxone, clinda, second gen pcns, doxycycline, erythro, flagyl

Most Important Questions Flashcards

(94 cards)