Practice questions BI 1 : dont come at me if these suck. put them on shuffle for better experience

Question 1

Toxic shock syndrome, food poisening and scalded skin syndrome are all caused by what organism

Answer 1

staphylococcus extotoxin production

Question 2

a patient presents with a cellulitis that has pustules and boils. it is erythemic and has purulent drainage. what organism likely caused this. What are the treatment protocols? what antibiotics would you treat this patient with? consider outpatient and inpatient

Answer 2

staphylococcus.
incisoin and drainage of the wound
If Low risk of MRSA: treat with Keflex or diclox
If high risk of MRSA treat with Clinda or doxy/mino or bactrim.

if inpatient: 1st line IV vanc. could also use clinda, ancef, naf/ox, or linezolid.

Always use pip/tax to cover possible psuedomonas

Question 3

You have a child who is suffering a staph infection. they are at high risk for MRSA what ABX is indicated

Answer 3

Bactrim only

Question 4

A patient presents with a fever of 101.4 onset last night and a BP of 94/58. There is a rash that is worse on her hands and feet that desquamates.
what is the dx.
what is the treatment.

Answer 4

TSS
admission to hospital
supportive measures (antipyretics, fluids, ect. )
debride sources of infection.
start empiric ABX: IV vanc PLUS clinda PLUS 1 of the following: pip/taz, cefepime, a carbapenem.

Question 5

A 6 month old male presents to with widespread bulla over the skin. there is sloughing of the skin. what is the treatment protocol AND what antibiotics will be given? Consider both MSSA and MRSA

Answer 5

Scalded skin syndrome
supportive care. (treat like actual burns)
MSSA: nafcillin/oxacillin
MRSA: IV Vanc.

Question 6

A 27 year old female presents to the ER reporting N/V/D x 3 hours. she reports she ate at a chinese buffet for lunch around 6 hours ago. What is likely the bacterial culprit causing her symptoms. how would you treat her?

Answer 6

bacteria is S. aureus exotoxin.
treatment: nothing (could give iv fluids but this is self limiting and will resolve in 12 hours)

Question 7

If you aquire a staph infection from a hospital setting, is it likely coagulase positive or negative?

Answer 7

negative

Question 8

a patient is suffering from an infection around his indwelling foley catheter. He has aquired it while he is in the hospital. This type of infection is resistant to most medications in what group.

Answer 8

This is a coag negative staph infection

which is resistant to most beta lactams.

Question 9

strep throat, scarlet fever and peritonsillar abscess are all causes of what. What are all of these “causes” caused by? (sorry i know this is worded weird if you have suggestions plz help.)

Answer 9

Strep throat, peritonsillar abscesses and scarlet fever are all the most common causes of pharyngitis.

all of these are caused by GABHS

Question 10

A 8 year old female presents to the office with abrupt onset fever and malaise. PE findings show a beefy red uvula with palatal petechiae. What diagnostic studies do you order and how do you treat her.

Answer 10

order strep test, if positive treat, if negative send out for culture.

ABX treatment is PCN G or PCN VK or amoxicillin. if she is allergic keflex.

Azithromycin is last treatment option

Question 11

60% of all this disease is caused by S. Aureus. you confirm this disease with an x ray. what is the initial and prolonged therapy for this disease

Answer 11

this disease is osteomyelitis
initial treatment (pending C&S) is Vanc + 3/4 gen cephalosporin.
after C&S results:
MSSA: nafcillin or oxacillin or cefazolin
MRSA: Vanc IV

Question 12

A 8 year old female presents with symptoms of a diffuse erythematous rash resembling a sunburn and enlarged red papillae coating her tongue. The rash blanches with pressure and her face is flushed. What organism is causing these symtpoms? How would you treat this patient?

Answer 12

GABHS - producing exotoxin.
this is scarlet fever
treatment: PCN, AMoxicillin
if allergic keflex or omnicef
azithromycin last resort.

Question 13

A patient presents with a rash consisting of thick pustular lesions on the face and body. The lesions are honey colored stuck on appearance. what organisms are the main causes of this patient’s symptoms? How would you treat them? Consider MRSA and MSSA

Answer 13

this is Impetigo
caused by GABHS or S aureus
MSSA: topical mupirocin, Keflex, or dicloxacillin
MRSA: Bactrim, doxycycline, or clindamycin

Question 14

An adult male presents with superficial cellulitis that began on his face. He describes it as extremely painful. It involves the dermal lymph nodes. what organism is causing these symptoms. How would you treat this patient and what about this illness could alter your treatment plan?

Answer 14

this is Erysipelas
Caused by GABHS or S aureus
this treatment plan is dependent on whether there are signs of systemic involvement.

If no systemic signs then treat outpatient: PCN VK, amoxicillin. if allergic can use dicloxacillin, keflex, clindamycin

if systemic involvement treat inpatient: Vanc, ancef, rocephin, or clinda.

Question 15

A woman who is 9 months pregnant has just gone into labor. previously she tested positive for group B strep. What is the name of the organism that is threatening the mother and child. what is the treatment plan.

Answer 15

The organism is Strep Agalactiae.
Intrapartum prophylaxis is the treatment.
PCN G or Ampicillin Q4h until delivery of baby.

could also use cefazolin or clindamycin or vanc.

Question 16

a 8 year old female presents to the office with otalgia, fever, nausea and irritability. what is the likely diagnosis for this child. what organism is causing the symptoms. what is a good treatment plan. what is given if symptoms persist.

Answer 16

likely Dx is OM
organism is likely strep pneumo, M. cat or H. flu
treatment is ABX and antipyretics.
Amoxicillin is the first line antibiotic.
if persists past 2 weeks, use omnicef or augmentin (these cover atypical H. Flu).

Question 17

rheumatic fever and glomulonephritis are common complications that can arise from what organism

Answer 17

Group A beta hemolytic strep.

Question 18

a patient presents with a history of nasal polyps and current symptoms of nasal congestion and headache for the past 3 weeks. Upon exam, the patients nasal turbinates are swollen and she has tenderness to palpation to her frontal sinuses. what are the possible organisms responsible for this patients symptoms. what is your treatment plan.

Answer 18

this is sinusitis
could be caused by S. Pneumo, H flu, M cat or S aureus.
treatment plan is augementin for 10-14 days. (first line)
if allergic can use clindamycin or doxycycline.

Question 19

a patient presents with a 15 pack year hx of smoking and COPD as well as a temperature of 101.4. they have chills and SOB and also have a cough productive of rust colored sputum. upon PE they have bronchial breath sounds. You decide to treat this patient outpatient. What is the most likely organism to cause these symptoms. How would you treat this patient?

how would you treat this patient if they did not smoke, and did not have COPD?

Answer 19

This is pnuemococcal pneumonia
the likely organism is strep pneumo

since this patient has comorbidities they would be treated with levofloxacin. they could also be treated with augmentin or cephalosporin, PLUS zmax or Doxy)

If they did not have any comorbidities then 1st line would be amoxicillin. if allergic then go to Doxycycline or azithromycin.

Question 20

a patient presents with a 15 pack year hx of smoking and COPD as well as a temperature of 101.4. they have chills and SOB and also have a cough productive of rust colored sputum. upon PE they have crackles in the left lung in the lower lobe. You decide to treat this patient inpatient. What is the most likely organism to cause these symptoms. How would you treat this patient?

Answer 20

This is pnuemococcal pneumonia
the likely organism is strep pneumo

Treatment is levofloxacin
or
macrolide(-thromycin) PLUS a beta lactam (carb, ceph, pen, monobac).

Question 21

If you are unsure whether to treat a patient inpatient or outpatient for pneumococcal pneumonia, what tests could you do?

Answer 21

CURB 65 or Pneumonia severity index (PSI)

Question 22

a patient presents to the office with fever, malaise and a painless black eschar on his left forearm. what diagnostic treatments must you do on this patient. what is your suspected diagnosis. what would the treatment plan be if your suspected diagnosis is confirmed.

Answer 22

Diagnostic treatments: culture/biopsy and gram stain.
suspected diagnosis: Cutaneous bacillus anthracis.
Treatment: Ciprofloxacin for 7-10 days. alternate if allergic is doxy.

Question 23

A patient presents with fever, N/V, and bloody diarhhea. Upon PE you find ulcerations in his oral mucosa. The patient reports he frequently eats rare cooked steaks. what is your suspected diagnosis. what would the treatment plan be if your suspected diagnosis is confirmed.

Answer 23

suspected diagnosis: Ingested bacillus anthracis.
treatment plan: ciprofloxacin for idk how long. alternate drug is doxycycline.

Question 24

A patient presents with a history of flu like symptoms that have worsened and now present as chest pain and severe hypoxemia. His labs are starting to suggest septicemia. the sudden onset of his symptoms suggest what as the bacterial culprit. what further diagnostic studies do you order. what is your treatment plan

Answer 24

nasal swab for pores, CXR, and LP.

bacillus anthracis.

treatment is cipro for up to 60 days. alternate is doxycycline.

Question 25

a patient presents with watery diarrhea and abdominal cramping. she reports this occured 2 hours after eating reheated leftovers that were a few days old. what is the likely culprit that caused these symptoms. what is the treatment plan

Answer 25

culprit - B Cereus
treatment - none, self limiting

Question 26

A pregnant woman presents with high fever and dermatitis. she reports eating alot of raw veggies and dairy despite her OBs warning to avoid these foods. upon PE you notice enlarged lymph nodes and retinitis. what further diagnostic studies must you order. what is your suspected diagnosis. what is the treatment plan if this diagnosis is confirmed.

Answer 26

suspected diagnosis: listeriosis
diagnostic studies: Blood culture, CSF sample.
treatment ampicillin AND gentamicin.
once patient is transferred to outpatient can transfer over to amoxicillin.

Question 27

A patient presents with symptoms of sore throat, fever and malaise. Upon PE you find a gray membrane is covering the tonsils and pharynx.
if this condition is not treated, what will occur.
what is the bacteria responsible for these symptoms?
what further diagnostic studies will you obtian?
how would you treat this patient?

Answer 27

this is pharyngeal diphtheria

the bacteria causing it is corynebacterium diphtheriae.

confirming diagnostic studies: culture.

If left untreated this patient will begin to enter toxemia and prostration (super lethargy) and could eventually spread to CNS, heart and kidneys.

treatment:
MUST OBTAIN ANTITOXIN FROM CDC
ABX: PCN or erythromycin.
contacts should be treated with erythromycin!!

Question 28

A patient presents with Fever, HA and photophobia. upon PE you find a postive kernigs and brudinski sign. what further diagnostic studies should you order. what is the treatment protocol for the suspected diagnosis.

Answer 28

Meningococcal meningitis

Diagnostic studies: Gram stain, LP, Blood culture.

treatment: if it is a susceptible strain use PCN G and use rocephin to cover all other causative agents.

treat all close contacts of meningitis.

Question 29

a patient presents with a skin rash and pain in the pelvic area. Upon PE you find cervicitis and a yellow-green purulent discharging from the cervix. What is the bacteria causing these symptoms. what further diagnostic studies should be done. what is the treatment protocol for the suspected disease

Answer 29

the bacteria is N. Gonorrhea
diagnostic studies: gram stain + culture.
treatment: single dose of rocephin.

MUST BE REPORTED TO HEALTH DEPARTMENT

Question 30

a patient presents with fever and pain to her eyes after not taking out her contacts for multiple days in a row. after PE you find she has corneal ulcers. what is oral OR inhaled treatment options for this patient and what organism is causing her syjmptoms.

Answer 30

psuedomonas.
oral treatment options: cipro and levofloxacin.
inhaled treatment is tobramycin

Question 31

A patient in the ICU recently developed pneumonia. the most likely culprit that caused this to occur is what. what are the IV options to treat this illness.

Answer 31

psuedomonas.
IV treatment options: pip/taz, ceftazidime, cefepime, meropenem, aztreonam.

Question 32

an 8 year old female presents with a history of 1 week of sneezing and coughing (allergy-like symptoms) that has now progressed to forceful worsening coughing fits that result in her gasping for air. what is the bacteria that is likely causing this patients symptoms? How will this disease progress? What diagnostic studies must you obtain to confirm this? What would the treatment be for this patient.

Answer 32

Bordetella pertussis - whooping cough

Stages:
catarrhal stage: similar to allergies (cough, sneezing, coryza)
paroxysmal stage: forceful worsening coughing fits with whooping and gasping for air
Convalescent stage: diminishing symptoms, lingering cough.

diagnostic studies: nasopharyngeal cultures
treatment: azithromycin or bactrim (if started in catarrhal stage it may stop the progression of the disease.

Question 33

A patient presents with a cough that is non productive of sputum. she has a high fever and pleuritic chest pain. The Chest Xray shows focal patchy infiltrates in the lungs. What is the bacteria causing her symptoms. How would you treat her?

Answer 33

Diagnosis: legionnaires disease
treatment: macrolide, fluoroquinolone.

Question 34

A patient presents with severe SOB and Chest pain as well as a cough productive of red, currant-jelly sputum. What diagnostic studies do you order? What is her suspected diagnosis? If confirmed, how would you treat this diagnosis?

Answer 34

Diagnostic studies: Sputum culture, CXR
diagnosis: klebsiella pnuemonia
Treatment: empiric treatment with respiratory fluoroquinolone (levofloxacin, moxifloxin, or gemifloxacin) or a carbapenem.

Question 35

A patient presents after returning from a trip to mexico yesterday. She has nausea, vomiting, fever and frequent loose stools with associated abdominal cramping. What is the diagnosis? How would you treat her?

Answer 35

Diagnosis: E. Coli - travelers diarrhea.
treatment: IV fluids. usually self resolves, if not then can use antidiarrheals, pepto bismol and cipro.

Question 36

C. Jejuni produces inflammatory, sometimes bloody diarrhea. how would you treat this?

Answer 36

Cipro single dose
or
azithromycin

Question 37

A patient presents with abrupt onset of diarrhea with blood and mucus in the stool. She has associated tenesmus, fever, and malaise. A stool culture shows WBC in the stools. What is the likely bacteria causing her symptoms and how would you treat her?

Answer 37

diagnosis: shigellosis
Treatment: usually self limiting, but if persistent use cipro first line. if cant use cipro then use bactrim.

Question 38

A patient presents with acute onset of diarrhea that is liquid, gray and described as “rice water stool.” What further diagnostic studies must you order to confirm diagnosis. what is your suspected diagnosis. how would you treat this.

Answer 38

diagnosis: vibrio cholerae
diagnostic studies: stool culture MUST GET SUSCEPTIBILITY TESTING before ABX treatment.
Treatment: tetra/doxy, bactrim, azithromycin, cipro

Question 39

a patient presents with diarrhea that is watery with associated tenesmus and abdominal cramping. You also notice upon PE that she has cellulitis. what is he likely diagnosis and how would you treat her

Answer 39

diagnosis: non-cholerae vibrio infection
treatment: doxycycline. cipro.

Question 40

a patient presents with a 7 day history of HA, cough, nausea and vomiting. She now presents with bloody “pea soup” diarrhea and rose spots on her skin. what is her likley diagnosis. what is the bacteria causing these symptoms? How would you treat her?

Answer 40

diagnosis: typhoid fever
bacteria: salmonella
treatment: cipro/levo, rocephin, azithromycin

Question 41

A a patient presents with fever, bloody diarrhea, nausea, vomiting and crampy abdominal pain. He reports he would like to be treated quickly, as he must pick his pet turtle up from daycare in an hour. What is the likely diagnosis for this patient? what bacteria causes this? how would you treat him?

a week later his symptoms are worse and he is extremely dehydrated. He is now in the “severe spectrum of this illness” how would you treat it now?

Answer 41

Diagnosis: enterocolitis
Bacteria: salmonella
treatment: supportive, no antibiotics unless severe.
severe: cipro, rocephin, azithromycin, bactrim.

Question 42

A patients urine culture concludes that she has a UTI. what type of bacteria most commonly causes this illness. what do you treat her with?

Answer 42

Bacteria: gram negative rods
treatment: bactrim, nitrofurantoin, fosfomycin, cephalosporins, cipro

Question 43

what is used to treat pyelonephritis

Answer 43

cipro
levo
rocephin for one dose PLUS bactrim or augmentin or omnicef

Question 44

a patient presents with symptoms of sudden onset high fever, malaise, prostration and a productive cough of blood-tinged sputum. Upon PE you find axillary lymphadenitis. what is the likely diagnosis of this patient. what bacteria caused these symptoms? How do you treat them?

Answer 44

Diagnosis: the black death/bubonic plague
bacteria: yersinia pestis (G-)
treatment: streptomycin for 10 days or gentamicin for 10 days or doxy for 10 days or a fluoroquinolone.

prophylactically treat any contacts.

Question 45

a patient presents after being bitten by her pet rabbit. she now has fever, HA and an eschar ulcer on her left hand where her rabbit bit her. Upon PE she has regional lymphadenopathy. what is the likely diagnosis for this patient? what is the treatment?

Answer 45

diagnosis: tularemia
treatment: streptomycin, gentamicin, doxy, flouroquinolones

Question 46

define fever of unknown origin

Answer 46

*over 38.3 degrees celcius or 101.9 F on several occasions taken with an oral thermometer
*greater tha 3 weeks duration
*failure to make dx despite at least 1 week of inpatient investigation

Question 47

What are the criteria for SIRS

Answer 47

Two or more of the following:

fever over 38C (100.4) or under 36C (96.8)
heart rate over 90BPM
Resp rate over 20 BPM
abnormal WBC levels

Question 48

what is the main difference between bacteremia and septicemia

Answer 48

bacteremia is simply the presence of bacteria in the blood. septicemia is the presence AND multiplication of bacteria in the blood.

Question 49

what are the 8 risk factors for sepsis (Im sorry i didnt know how else to put this into these cards lol, suggestions are welcome)

Answer 49

Bacteremias
Previous hospitalization
Genetics

Advanced age
CAP
ICU admission
DM
Immunosuppression
Cancer
(BPG ACIDIC)

Question 50

A patient who resides in the ICU with previous diagnoses of DM, bacteremia and CAP now presentes with a BP of 88/46, heart rate of 112 bpm, and RR of 27 bpm. his skin is warm and flushed and he has AMS and absent bowel sounds. What is likely this patients diagnosis. What are your treatment options.

Answer 50

septicemia.
treatment: multiple empiric antibiotics, IV fluids, and vasopressors.