Practice Questions BI 2: doin my bestest out here

Question 1

A patients CXR shows infiltrates w cavitation and lucency. what is the bacteria and what does this suggest? how would we treat this outpatient? How would we treat this inpatient?

Answer 1

gram + anaerobic bacteria
suggests necrotizing tissue
outpatient: augmentin or doxycycline
Inpatient: Beta-Lactam PLUS beta-lactam inhibitor
such as Unasyn OR metronidazole PLUS amoxil or PCN G

Question 2

A patients CXR shows air fluid levels within circumscribed infiltrates. what does this suggest? How would we treat this patient?

Answer 2

Suggests a lung Abscess
treatment:
MUST BE ABLE TO PENETRATE LUNG PARENCHYMA
beta-lactam plus beta-lactam inhibitor such as Unasyn
or could use a carbapenem or clindamycin.

Question 3

you are about to have a joint implanted at the dentist. what might the dentist give you for prophylaxis

Answer 3

PCN or amoxicillin

Question 4

your grandfather is having a minor procedure regarding his endocarditis, he cant remember the name of his prophylactic medication. Care to take a guess?

Answer 4

Amoxicillin

Question 5

your uncle tells you hes having colorectal surgery soon (TMI uncle tim). He tells you they put him on prophylactic meds before surgery, what do you assume these meds are?

Answer 5

A carbapenem
OR
Metronidazole PLUS a 3/4 gen cephalosporin or cipro

Question 5

After recieving a pelvic CT it is revealed that your patient has an abscess in his pelvic area. The abscess is G+. What are your oral and IV treatment options?

After a week of treatment your patient continues to worsen. He is now in a severe state of illness. What antibiotic do you use?

Answer 5

Oral: Moxifloxacin
IV: Ertapenem OR Rocephin PLUS metronidazole.

Severe: imipenem.

Question 6

You have a patient who has a suspected G+ anaerobic infection in her throat/neck. What diagnostic studies do you complete to confirm this? what are her treatment options?

Answer 6

gram stain, culture, susceptibility
Clindamycin, augmentin, unasyn

Question 7

A patient presents with complaints of pain, swelling, redness and foul smelling odor coming from her left lower leg. upon PE you observe tissue crepitis to palpation and smell the foul smelling odor. What is the bacteria MOST LIKLEY causing these symptoms? What is her suspected diagnosis? what tests do you do to confirm this diagnosis?How would you treat this patient?

Answer 7

Bacteria: C. Perfringens
Diagnosis: clistridial soft tissue infection
Diagnostic studies: gram stain, culture
Treatment: Debride and drain

pip/taz PLUS clindamycin if strep and clostridium are suspected. if only clostridium is suspected then use PCN and clindamycin

Question 8

A patient presetns with headache, difficulty swallowing and stiffness in her jaw and neck. She later begins to have trouble opening her jaw and is having muscle spasms in her arms and legs. After PE you find a small wound on the bottom of her foot that she said occured about a week ago.
What is the bacteria causing the symptoms?
What is the diagnosis?
What is your treatment PLAN?
what medication should you administer this patient?

Answer 8

Bacteria: C. Tetani
Diagnosis: tetanus
treatment plan: admit to hospital, debride wound
Medications:
1. tetanus immune globulin
2. full series of tetanus vaccine
3. PCN or Metronidazole.

Question 9

A patient presents with N/V and abdominal cramping that progressed to slurred speech, dry mouth blurred vision and drooping eyelids. upon examinationWhat bacteria likely caused these symptoms? What is the Diagnosis? What diagnositic studies must you do to confrim? What is the treatment plan?

Answer 9

Bacteria: C. Botulinum
Diagnosis: botulinism
Diagnostic studies: Culture and toxin assay.
Treatment:
Hospitalization
Trach tube and NG tube may be needed
ANTITOXIN!!!

If wound is root of problem use PCN G or metronidazole.

Question 10

A patient that is currently admitted to the hospital for a wound infection was started on antibiotics 8 days ago. She is now experiencing diarrhea that is frequent and watery and sometimes bloody. she has abdominal cramping and bloating. what is the most likely the bacteria causing her symptoms. what further diagnostic studies must be completed to confirm a diagnosis? what is the daignosis? how would you treat her?

you find later on that this patient is resistant to the treatment being used, what is your next treatment option?

Answer 10

Bacteria: C. Difficile
diagnostic studies: stool sample (look for C diff toxin and fecal leukocytes), sigmoidoscopy may be needed.
Diagnosis: antibiotic associated/pseudomembranous colitis
treatment: fidaxomicin or vancomycin
resistant: fecal transplant

Question 11

After recieving a pelvic CT it is revealed that your patient has an abscess in his pelvic area. The abscess is G-. What are your treatment options?

Answer 11

Pip/taz
carbapenems
Metronidazole PLUS cephalosporin

Question 12

You have a patient who has a suspected G- anaerobic infection in her throat/neck. What diagnostic studies do you complete to confirm this? what are her treatment options?

Answer 12

Diagnostic studies: gram stain and culture
treatment: clinda or metronidazole.

Question 13

A patient presents with symptoms of thin grayish vaginal discharge and complaints of a fishy smell coming from her vagina. upon further examination you find an elevated pH of the vaginal discharge, clue cells on microscopy, and a positive whiff test. What is the most PREVALENT bacterial cause of these symptoms. what is the diagnosis for this patient. what are the treatment options for this patient?

Answer 13

most likely bacterial cause: gardnerella
Diagnosis: bacterial vaginosis
treatment:
metronidazole oral
metronidazole vaginal
clinda oral
clinda vaginal
tinidazole oral

Question 14

A patient presents with a cough that is not productive of sputum. she is also complaining of a sore throat and ear pain. She has no fever or chills. Upon PE you find bullous myringitis and her chest is clear to auscultation. What is the likely bacterial cause to these symptoms? What are some diagnostic studies that you may want to order? How would you treat this patient?

Answer 14

Bacterial Cause: M. Pneumo or C. Pneumo (treated and present the same)
Diagnosis: “walking pneumonia”
diagnostic studies: confirmed with NP swab, could do CXR (no lobar consolidation, patchy infiltrates present) or labs but may be inconclusive.
treatment: Empiric antibiotic treatment - azithromycin 1st line

macrolides, fluoroquinolones, doxycycline can be used.

Question 15

A patient presents to your office reporting HA, Chills, fever, sore throat and a non productive cough x 3 days. upon PE you find chest is clear to auscultation and bullous myringitis. The patient reports hed like to leave soon, as his pet birds day care closes within an hour. What is the bacteria that is likely causing his disease? what is his diagnosis? what is the treatment plan?

Answer 15

bacteria: chlamydia psittaci
Diagnosis: Psittacosis
Treatment: tetracycline or erythromycin

Question 16

A patient presents with pelvic pain and pain with urination. She also reports redness and itchiness of her eyes. Upon PE you find her cervix to be red, inflamed and friable with mucopurulent discharge. What diagnostic tests would you want to obtain? what is your suspected diagnosis? How do you treat her?

What possible complications could arise from this diagnosis?

Answer 16

Diagnostic tests: Culture, no gram stain. (no cell wall)
diagnosis: chlamydia trachomatis
treatment: Azithromycin, doxycycline. If patient is asymptomatic, still need to treat.

Complications: Pregnancy complications PROM, infertility, transmission to a newborn, perihepatitis.

Question 17

A patient presents with testicular pain and swollen testicles as well as reports of pain with urination. Upon PE you find mucoid/watery discharge. What is a diagnostic test that you could do to further diagnose your patient. What is your suspected diagnosis? How would you treat that diagnosis?

if you are unable to differentiate this diagnosis from another common presenting diagnosis, what would you treat this patient with?

Answer 17

Diagnostic studies: culutre, no gram stain (no cell wall)
Diagnosis: chlamydia trachomatis
Treatment: azithromycin or doxycycline.

If unable to differentiate between chlamydia or gonorrhea, then give azithromycin and 1 dose of rocephin.

Question 18

A patient presents for a routine visit to her OBGYN office and upon routine exam you find an ulcer on her labia. She reports she did not know it was there and says it is painless. What diagnostic studies should you do? What is the bacteria that you think may be causing her symptoms? What is the diagnosis? How would you treat this patient?

Answer 18

Diagnostic studies: culture of ulcer, non-treponemal antibody tests
Bacteria: treponema Pallidum
Diagnosis: syphilis
Treatment: PCN G. in bicillin form MUST REPORT AND TREAT PARTNER.

Question 19

A patient presents with HA, fatigue and malaise. upon PE you find a flat “bulls eye” lesion on her back. What diagnostic studies do you order? What is the bacteria that you assume is causing her symptoms? what is the diagnosis? How do you treat her?

Answer 19

Diagnostic studies: serologic tests including ELISA and western blot test
Bacteria: borrelia burgdorferi (ticks BORR into skin)
Diagnosis: lyme disease
treatment: Doxycycline

Question 20

A patient presents and they are in stage 2 of lyme disease. what types of symptoms would you likley see in this patient? How long after infection would the patient be in this stage?

Answer 20

worsening flu like sympotms.
skin lesions and rashes.
bacteremia
neurologic or cardiac manifestations (less than 15% of patients)

this stage begins within days to weeks of infection

Question 21

A patient presents and they are in stage 3 of lyme disease. what types of symptoms would you likley see in this patient?How long after infection would the patient be in this stage?

Answer 21

Musculoskeletal manifestations such as arthritis
neurologic manifestations (palsy/meningitis)
skin rashes and lesions.

occurs months to years after infection.

Question 22

Stuart after drinking water out of a cup contaminated with urine of a rat (yum), a patient later develops liver and kidney disease. What is the bacterial culprit and diagnosis? what is the diagnostic confirmatory study? what is the treatment?

this is so vague lol im sorry

Answer 22

bacteria: leptospira
Diagnosis: leprospirosis
diagnostic study: serologic testing
Treatment: doxycycline.

Question 23

A patient presents after a 5 day hiking trip and reports symptoms of fever, chills, HA, N/V, myalgias and insomnia x 2 days. He was not worried initially but now he has developed a rash on his wrists and ankles. What diagnostic studies should you order on this patient? What is the bacterial culprit causing these symptoms? what is the diagnosis? how do you treat him?

Answer 23

Bacteria: rickettsia
Diagnosis: rocky mountain spotted fever
diagnostic studies: serologic:
treatment: doxy ONLY. no substitutions!!! fatal unless treated w doxy. must be started within 5 days of symptoms.