CLINICAL PHARMACOLOGY REVISION MULTIPLE CHOICE QUESTIONS

Peptic Ulcer Disease

1 : NSAID-induced ulcers differ from H. pylori-associated ulcers in that patients with an NSAID-induced ulcer are more likely to have

a. a duodenal ulcer.

b. more severe upper gastrointestinal bleeding.

c. ulcer-related epigastric pain.

d. gastric cancer.

The correct answer is b

2 : The preferred noninvasive test to confirm H. pylori eradication is a. a stool antigen test.

b. a whole-blood antibody-detection test.

c. a serologic antibody detection test.

d. a urea breath test.

The correct answer is d

3 : The following statements <i>best </i>characterize the current status of <i>H. pylori</i> testing and treating <i>except</i>

a. asymptomatic patients with a documented history of PUD should be tested for <i>H. pylori</i>, and if positive, should receive eradication therapy.

b. symptomatic patients with uninvestigated dyspepsia should be tested for <i>H. pylori</i>, and if positive, should receive eradication therapy.

c. symptomatic patients with an active peptic ulcer should be tested for <i>H. pylori</i>, and if positive, should receive eradication therapy.

d. asymptomatic patients who do not have an active ulcer or a documented history of an ulcer but who were tested for <i>H. pylori</i> and found to be positive should be offered eradication therapy. The correct answer is b:

4 : Antimicrobial resistance to <i>H. pylori</i> is <i>most likely </i>to occur with which of the following agents?

a. Metronidazole and clarithromycin

b. Clarithromycin and tetracycline

c. Metronidazole and amoxicillin

d. Amoxicillin and tetracycline

The correct answer is a

5 : The <i>preferred </i>drug treatment regimen for a penicillin-allergic <i>H. pylori</i>-positive 35-year-old man with epigastric pain and a duodenal ulcer documented by radiography is

a. lansoprazole + metronidazole.

b. ranitidine bismuth citrate + clarithromycin.

c. omeprazole + metronidazole + clarithromycin.

d. bismuth subsalicylate + metronidazole + tetracycline.

The correct answer is c

6 : The <i>most important </i>parameter to monitor to assess ulcer healing in an

<i>H. pylori</i>-positive 25-year-old man who has just completed eradication therapy for his first ulcer is

a. symptom relief 1 to 2 weeks after completion of drug treatment.

b. upper endoscopy on completion of drug treatment.

c. a urea breath test 4 to 6 weeks after completion of drug treatment.

d. a serology antibody detection 4 weeks after completion of drug treatment. The correct answer is a

7 : The <i>preferred H. pylori</i> eradication regimen for a patient with an active ulcer who is admittedly noncompliant is

a. amoxicillin + omeprazole ( 14 days.

b. bismuth subsalicylate + metronidazole + tetracycline + ranitidine ( 7 days.

c. lansoprazole + amoxicillin + clarithromycin ( 10 days.

d. ranitidine bismuth citrate + clarithromycin + metronidazole ( 10 days. The correct answer is c

8 : The <i>most important </i>counseling information to convey to a patient prescribed an <i>H. pylori</i> eradication regimen containing ranitidine bismuth citrate (RBC) is a. RBC may cause ringing in the ears.

b. RBC may cause your urine to turn orange.

c. RBC may cause dry mouth.

d. RBC may cause your stool to turn dark brown or black.

The correct answer is d

9 : The <i>preferred </i>management of a 70-year-old woman with rheumatoid arthritis who is at risk of developing an NSAID-induced ulcer or ulcer-related complication is a. misoprostol 100 µg twice daily.

b. famotidine 40 mg twice daily.

c. pantoprazole 40 mg daily.

d. omeprazole 40 mg twice daily.

The correct answer is c

10 : The <i>preferred </i>management of an <i>H. pylori</i>-negative 60-year-old woman with a documented NSAID-induced ulcer is

a. misoprostol 100 µg four times a day.

b. ranitidine 150 mg twice daily.

c. famotidine 20 mg twice daily + sucralfate 1 g four times a day.

d. lansoprazole 30 mg twice daily.

The correct answer is d:

11 : The <i>most important </i>parameter to monitor to assess the effectiveness of misoprostol cotherapy in a 70-year-old woman taking ibuprofen is

a. prothrombin time.

b. absence of blood in the stool.

c. absence of epigastric pain.

d. stool consistency.

The correct answer is b

12 : The <i>most important </i>parameter to monitor in an ulcer patient receiving long-term maintenance therapy with a PPI is

a. fasting serum gastrin concentrations.

b. recurrence of ulcer symptoms.

c. vitamin B₁₂ concentrations.

d. hemoglobin and hematocrit.

The correct answer is b

13 : A 30-year-old woman prescribed misoprostol cotherapy for the prevention of an NSAIDinduced ulcer should be counseled to do all the following <i>except</i>

a. discontinue the NSAID before beginning the misoprostol.

b. use adequate contraceptive measures.

c. have a serum pregnancy test within 2 weeks of starting treatment.

d. avoid magnesium-containing antacids.

The correct answer is a

14 : The <i>most important </i>counseling information to convey to a 40-year-old man taking omeprazole for an NSAID-induced ulcer is

a. take the omeprazole at the same time you take the NSAID.

b. take the omeprazole 15 to 30 minutes before breakfast.

c. take the omeprazole 1 hour before or 2 hours after a meal.

d. take omeprazole at bedtime.

The correct answer is b

15 : Which of the following statement <i>best </i>characterizes the current status of drug therapy in the <i>prevention </i>of stress-related mucosal bleeding?

a. Large randomized, controlled trials confirm that an intravenous proton pump inhibitor is superior to an intravenous H₂-receptor antagonist.

b. Antacids are the drugs of choice because they are effective and least costly.

c. Continuous infusion of an H₂-receptor antagonist provides similar efficacy as intermittent intravenous administration. d. Sucralfate is not effective. The correct answer is c

Depressive Disorders

1 : The preferred treatment option for a 36-year-old woman with psychotic depression is

a. fluoxetine.

b. imipramine plus sertraline.

c. tranylcypromine.

d. imipramine plus risperidone.

e. lithium.

The correct answer is d

2 : Regarding nefazodone, all the following neurochemical or receptor effects are applicable <i>except</i>

a. 5-HT₂ antagonism.

b. 5-HT reuptake inhibition.

c. potent anticholinergic effects.

d. enhanced 5-HT_1A-medicated neurotransmission

The correct answer is c

3 : Which of the following drugs would be <i>preferred </i>in a pregnant patient with major depression?

a. Desipramine

b. Phenelzine

c. Valproic acid

d. Lithium

e. Bupropion The correct answer is a

4 : Which of the following neurotransmitters is(are) believed to play a role in the pathogenesis of major depression?

a. Norephinephrine

b. Serotonin

c. Dopamine

d. a and b

e. a, b, and c

The correct answer is e

5 : According to DSM-IV-TR, criteria of major depression include

a. symptoms present for at least 6 months.

b. an inability to work.

c. an increased focus and ability to concentrate.

d. feelings of inappropriate quilt.

The correct answer is d

6 : When choosing patient-specific antidepressant therapy, which of the following should be considered?

a. Past history of response or intolerance

b. Cost of the medication regimen

c. Concomitant medications

d. All of the above

The correct answer is d

7 : It is believed that individuals experiencing a depressive episode

a. experience changes in the sensitivity of the amine receptor systems.

b. have a deficiency of acetylcholine.

c. have a surplus of serotonin.

d. have a surplus of norepinephrine.

The correct answer is a

8 : Patients treated with MAOIs do <i>not </i>need to be cautioned about a. dietary restrictions.

b. the use of over-the-counter medications.

c. fluid and salt intake.

d. the use of other prescription medications.

The correct answer is c

9 : Antidepressant plasma level monitoring has been found to be clinically useful in which of the following situations?

a. Any patient on an antidepressant

b. <b> </b>Patients receiving MAOIs

c. Patients on nortriptyline

d. Patients receiving paroxetine

The correct answer is c

10 : Which of the following statements regarding major depression is <i>not </i>true?

a. Approximately 70 percent of patients with major depression respond to treatment.

b. The disorder is twice as prevalent in males.

c. Electroshock therapy (ECT) therapy is effective for all subtypes of major depression.

d. Patients with atypical depression have been found to respond well to MAOIs. The correct answer is b

11 : Bupropion, an aminoketone antidepressant, has which of the following neurochemical or receptor effects?

a. 5-HT₂ antagonism

b. Central presynaptic &alpha;₂-adrenergic antagonism

c. Dopamine reuptake blockade

d. Norepinephrine reuptake blockade

The correct answer is c

12 : Which of the following statements regarding the use of antidepressants in the pediatric population is <i>true</i>?

a. Multiple double-blind, placebo-controlled trials have demonstrated the efficacy of the SSRIs.

b. Baseline ECGs are recommended when TCAs are used to manage depression in adolescents.

c. The TCAs are FDA-approved for this indication.

d. The dosing range for SSRIs is markedly different in adults compared with adolescents.

The correct answer is b

13 : Treatment options in a patient who has failed an initial trial of either a TCA or an

SSRI include all the following <i>except</i>

a. initiation of a structurally unrelated antidepressant agent.

b. augmentation of the current regimen.

c. concurrent use of two different classes of antidepressant agents.

d. initiation of therapy with an antipsychotic agent.

The correct answer is d

14 : Regarding drug costs for antidepressant therapy, which of the following statements is <i>true</i>?

a. The use of SSRIs has been found to be economically advantageous compared with the TCAs when all treatment costs are considered.

b. The use of paroxetine has been found to be economically advantageous when compared with citalopram and nefazodone.

c. Drug costs account for 5 to10 percent of the total costs.

d. Drug costs account for 30 percent of the direct costs of depression. The correct answer is a

15 : Regarding ECT, the following statements are <i>true</i> <i>except</i>

a. ECT is a safe and effective treatment for major depression.

b. A rapid therapeutic response has been observed (10 to 14 days).

c. Maintenance therapy following the initial course is not required.

d. Adverse effects include cognitive dysfunction and headache

The correct answer is c

Antimicrobial

1 : Which of the following is <i>true </i>regarding obtaining and interpreting microbiologic results?

a. The Gram stain is performed on all culture material to reliably identify the infecting organism.

b. The initiation of antimicrobial therapy after obtaining cultures may interfere with microbiologic results.

c. Ideally, blood cultures should be drawn from two peripheral sites approximately 1 hour apart.

d. Abcesses and cellulitic areas require culturing due to the high likelihood of contamination.

The correct answer is c

2 : Which of the following should be used in combination with the urine culture to help confirm the presence of urinary tract infection? a. Organism susceptibility data

b. Urinanalysis

c. Patient's renal function

d. Patient's systemic red blood cell count

The correct answer is b

3 : Which of the following antimicrobial therapies is <i>appropriate </i>for broad gramnegative coverage for a patient with a history of anaphylaxis reaction to penicillin? a. Rifampin

b. Any third-generation cephalosporin

c. Vancomycin

d. A monobactam

The correct answer is d

4 : Selection of presumptive antimicrobial therapy is based on all the following

<i>except</i>

a. local susceptibility data.

b. national susceptibility data.

c. patient host factors.

d. drug factors.

The correct answer is b

5 : Which of the following is <i>false </i>regarding host and drug factors influencing antimicrobial regimen selection?

a. Pharmacodynamic properties of all antimicrobial drugs have been well studied and should be employed in decision making.

b. Immunocompromised patients are predisposed to infections with organisms different from what would normally be expected.

c. Antimicrobial drug cost should be considered after all other host and drug factors.

d. Renal and liver function should be evaluated for all patients receiving

antimicrobial drug therapy.

The correct answer is a

6 : Which of the following antimicrobial drug combinations requires absolute avoidance of concomitant usage?

a. Quinolones and antacids

b. Amphotericin and aminoglycoside

c. Metronidazole and alcohol

d. Ciprofloxacin and theophylline

The correct answer is c

7 : Synergistic combination antimicrobial therapy appears to produce better clinical response in severe infections involving all the following <i>except</i>

a. <i>Escherchia coli.</i>

b. <i>Pseudomonas aeruginosa.</i>

c. <i>Enteroccocus </i>spp.

d. Patients with persistent neutropenia

The correct answer is a

8 : Evidence of good therapeutic response to antimicrobial drug therapy includes

a. increasing white blood cell count.

b. decreasing appetite.

c. achieving therapeutic serum drug concentrations.

d. decreasing patient physical complaints

The correct answer is d

9 : Which of the following is a possible reason for antimicrobial failure?

a. Patient experienced drug toxicity

b. Use of nonsynergistic antimicrobial drug combination therapy

c. Surgical drainage of the infected site

d. Development of antimicrobial drug resistance

The correct answer is d

10 : The hospital antibiotic formulary

a. is usually determined by the director of pharmacy.

b. results in increased resistance rates.

c. is switched every year depending on drug cost.

d. encourages familiarity with core antimicrobials.

The correct answer is d

11 : Antibiotic switching

a. is a common pratice.

b. has been well-studied.

c. is employed to prevent or reduce antimicrobial drug resistance.

d. involves a change from the intravenous to the oral route of administration.

The correct answer is c

12 : Which of the following is <i>not </i>considered a "drug of choice" for the organism indicated?

a. Methicillin-sensitive <i>Staphylococcus aureus</i>: nafcillin

b. <i>Entercoccus faecium</i>: ampicillin and gentamicin

c. <i>Pseudomonas aeruginosa</i>: piperacillin and aminoglycoside

d. <i>Enterobacter </i>spp.: imipenem

The correct answer is b

CNS

1 : By definition, meningitis is an infection of the

a. pia mater.

b. brain tissue.

c. subarachnoid space.

d. dura mater.

The correct answer is c

2 : Because of the unidirectional flow of CSF, _______________ administration of antimicrobial agents is <i>not</i> preferred.

a. intrathecal

b. intracisternal

c. intraarticular

d. intraventricular

The correct answer is c

3 : All the following are capsulated microorganisms <i>except</i>

a. <i>Streptococcus pneumoniae.</i>

b. <i>Listeria monocytogenes.</i>

c. <i>Neisseria meningitidis.</i>

d. <i>Hemophilus influenzae.</i>

The correct answer is b

4 : The most important laboratory tests needed to diagnose bacterial meningitis are

a. Gram stain and aerobic culture.

b. CBC with differential.

c. enzyme immunoassay (EIA) and polymerase chain reaction (PCR).

d. MRI or head CT scan.

The correct answer is a

5 : Penicillin resistance has been seen in

a. <i>Streptococcus pneumoniae.</i>

b. <i>Neisseria meningitides.</i>

c. <i>Hemophilus influenzae.</i>

d. all the above.

The correct answer is d

6 : The pneumococcal vaccine that can be used for patients over 65 years of age is known as

a. Prevnar.

b. the 23-serotype pneumococcal vaccine.

c. a and b.

d. none of the above.

The correct answer is b

7 : Appropriate initial (empirical) therapy for <i>H. influenzae</i> meningitis (pending antibiotic susceptibility data) includes

a. vancomycin alone.

b. ampicillin alone.

c. ampicillin plus cefotaxime.

d. ampicillin plus vancomycin.

The correct answer is c

8 : The microorganism specific to meningitis cases in newborns is

a. <i>Streptococcus</i> group B.

b. <i>Listeria monocytogenes.</i>

c. <i>Hemophilus Influenzae.</i>

d. all the above.

The correct answer is b

9 : Which of the following lists of medications achieves therapeutic concentrations in the CNS with or without inflammation?

a. Pipercillin, imipenem, acyclovir

b. Aminoglycosides, ketoconazole, itraconazole

c. Chloramphenicol, metronidazole, trimethoprim

d. Ciprofloxacin, nafcillin, penicillin

The correct answer is c

10 : Tuberculous meningitis is often identified by

a. cellular bacterial Gram stain.

b. negative purified protein derivative (PPD).

c. paralysis of nerve VI.

d. stress test.

The correct answer is c

11 : The <i>most common </i>form of fungal meningitis in the United States is

a. <i>Cryptococcus neoformans.</i>

b. <i>Candida albicans.</i>

c. <i>Torulopsis glabrata.</i>

d. <i>Aspergillus </i>spp.

The correct answer is a

12 : The most common CNS complication associated with AIDS is

a. tuberculous meningitis.

b. HIV encephalitis.

c. <i>C. neoformans </i>meningitis.

d. Alzheimer's.

The correct answer is b

13 : The use of dexamethasone in meningitis has been questioned due to the

a. corticosteroid's tendency to worsen inflammation.

b. possible decrease in drug penetration into the CNS.

c. corticosteroid's effects on lipid profile.

d. cost of corticosteroids.

The correct answer is b

14 : Close contacts of meningitis patients should receive prophylaxis in cases of

a. <i>Neisseria meningitides.</i>

b. <i>Listeria monocytogenes.</i>

c. <i>Staphylococcus aureus.</i>

d. <i>Streptococcus pneumoniae.</i>

The correct answer is a

15 : Multi-drug-resistant <i>S. pneumoniae</i> may force clinicians to resort to such agents as

a. aztreonam.

b. erythromycin.

c. tacrolimus.

d. linezolid.

The correct answer is d

1) Which of the following is the most probable reason females will experience at least one urinary tract infection (UTI) in their lifetime?

A. Increase bacteria in their GI tract

B. Their tendency to take baths more often than males

C. Their anatomical predisposition

D. Increased use of antibiotics in their younger years

2) Which of the following organisms is the most predominant organism causing uncomplicated cystitis?

A. Pseudomonas aeruginosa

B. Escherichia coli

C. Enterococcus faecalis

D. Staphylococcus saprophyticus

3) Which of the following patients is most likely to have an uncomplicated cystitis infection?

A. A 40-year-old female with diabetes

B. A 65-year-old healthy male

C. A 22-year-old healthy female

D. A 10-year-old female with a history of vesicoureteral reflux

4) Organisms can most often gain entry into the urinary tract via all of these pathways except:

A. Hematogenous spread

B. Lymphatic spread

C. Ascending route into bladder

D. Translocation from intestines

5) Which of the following would be the most common predisposing factor for the development of recurrent UTIs in an otherwise healthy 28-year-old female?

A. Sexual intercourse

B. Irritable bowel syndrome

C. Birth control pills

D. Type of toilet paper used

6) Altered mental status, change in eating habits, or GI symptoms as opposed to typical manifestations of UTIs are frequently seen in which patient population?

A. Children

B. Elderly

C. Pregnant females

D. Males

7) Which of the following methods of urine collection is the least likely to be contaminated?

A. Midstream catch

B. Urine catch using the first 20 to 30 mL of urine flow

C. Catheterization

D. Suprapubic bladder aspiration

8) Which of the following results is considered a significant number of bacteria for the diagnosis of a UTI?

A. >105 bacteria/HPF

B. 30,000 bacteria

C. >105 bacteria/mL (>108/L)

D. 107 bacteria/mL (1010/L)

9) A urine dipstick comes back positive for nitrite, leukocyte esterase, protein, and blood in the urine. Which of the results is most indicative of a UTI?

A. Nitrite positive

B. Leukocyte esterase positive

C. Positive protein

D. Positive blood

10) Based off of the 2010 IDSA Guidelines, which of the following regimens would be the most appropriate treatment for uncomplicated UTIs?

A. Nitrofurantoin 100 mg orally two times/day for 5 days

B. Ciprofloxacin 500 mg orally two times/day for 3 days

C. Amoxicillin 500 mg orally four times/day for 3 days

D. Trimethoprim–sulfamethoxazole double strength, one tablet orally, one dose

11) Which of the following regimens would be the most appropriate treatment for a seriously ill patient with acute pyelonephritis?

A. Trimethoprim–sulfamethoxazole double strength, one tablet orally two times/day for 3 days

B. Ciprofloxacin 500 mg orally two times/day for 3 days

C. Levofloxacin 500 mg orally, one dose

D. Cipofloxacin 400 mg IV two times/day for 3 days, followed by 500 mg orally two times/day for 11 days

12) Which of the following statements is most correct regarding recurrent UTIs?

A. The recurrence is mostly likely due to a relapse from the previous infection

B. If possible, catheterize the patient and instill antibiotics for optimum treatment in men

C. One-half of a single-strength trimethoprim–sulfamethoxazole tablet may be used on a daily basis

D. Men are immune to UTI recurrence due to the immune effects of prostatic fluid

13) The course of antibiotic therapy for acute prostatitis is:

A. 2 to 4 weeks

B. 1 day

C. 3 days

D. 7 to 10 days

14) Which of the following therapies should be reserved for patients with suspected pyelonephritis or resistant infections?

A. Amoxicillin

B. Levofloxacin

C. Trimethoprim–sulfamethoxazole

D. Nitrofurantoin

15) Which of the following regimens would be the treatment of choice in a female patient with uncomplicated cystitis in a geographical area with greater than 20% resistance to trimethoprim– sulfamethoxazole?

Lower Respiratory Tract Infections

1 : In the absence of a complicating bacterial infection, which of the following is the <i>most appropriate </i>approach to treating acute bronchitis?

a. Prescribing broad-spectrum antibiotics

b. Routinely recommending over-the-counter cough and cold preparations.

c. Providing symptomatic and supportive care

d. Discouraging hydration and bed rest

The correct answer is c

2 : In the treatment of acute exacerbations of chronic bronchitis, which of the following is <i>true </i>regarding treatment with ampicillin?

a. Highly effective against penicillinase-producing bacteria

b. Low incidence of gastrointestinal side effects

c. Decreased compliance concerns due to recommended once-daily dosing d. None of the above

e. All of the above

The correct answer is d

3 : Which of the following is the <i>most common </i>cause of bronchiolitis?

a. Respiratory syncytial virus

b. Parainfluenza virus

c. <i>Mycoplasma</i>

d. Adenovirus

e. <i>Streptococcus</i>

The correct answer is a

4 : Which of the following statements is(are) <i>true </i>regarding ribavirin?

a. Administered via aerosol generator.

b. In vitro antiviral activity is limited to respiratory syncytial viruses.

c. Due to questionable efficacy, its use is often limited to a subset of severely ill patients.

d. a, b, and c

e. a and c only

The correct answer is e

5 : Community acquired pneumonia is <i>most commonly </i>associated with

a. <i>Staphylococcus.</i>

b. <i>Listeria.</i>

c. <i>Legionella.</i>

d. <i>Pneumococcus.</i>

e. <i>Pseudomonas.</i>

The correct answer is d

6 : Which of the following would be the <i>most appropriate </i>choice as empirical therapy for nosocomial pneumonia?

a. Amoxicillin

b. Clindamycin

c. Piperacillin/tazobactam

d. Erythromycin

The correct answer is c

7 : Which of the following pathogens should be <i>highly considered </i>when prescribing empirical antimicrobial therapy to a newborn?

a. <i>Mycoplasma</i>

b. Group A <i>Streptococcus</i>

c. Group B <i>Streptococcus</i>

d. <i>Pseudomonas</i>

The correct answer is c

8 : Which of the following may reduce the severity and duration of influenza if administered early in the course of the infection?

a. Zanamivir

b. Oseltamivir

c. Palivizumab

d. a and b

e. a and c

The correct answer is d

9 : Which of the following would be the <i>most appropriate </i>therapy for the treatment of <i>Mycoplasma </i>pneumonia in a patient with compliance issues and currently receiving theophylline?

a. Erythromycin

b. Azithromycin

c. Clindamycin

d. Clarithromycin

The correct answer is b

10 : Which of the following would be the preferred antimicrobial agents in the treatment of aspiration pneumonia in a hospitalized patient?

a. Clindamycin and gentamicin

b. Gentamicin and oxacillin

c. Tobramycin and oxacillin

d. Tobramycin and erythromycin

The correct answer is a

11 : Patients diagnosed with bronchiolitis routinely should be prescribed which of the following?

a. Albuterol

b. Ipratropium

c. Methylprednisolone

d. All of the above

e. None of the above

The correct answer is e

12 : Which of the following concerning viral pneumonias is <i>correct</i>?

a. With the exception of immunocompromised patients, viruses are a major cause of pneumonia in adult patients.

b. Influenza virus type B is the most common isolate in the adult population.

c. RSV, parainfluenza, and adenoviruses are common causes of pneumonia in children. d. All of the above

e. a and b only

The correct answer is c

13 : Which of the following is <i>true </i>regarding nosocomial pneumonias?

a. <i>Staphylococcus aureus </i>and gram-negative bacilli are rarely associated with nosocomial pneumonia.

b. Broad-spectrum antibiotics should be withheld until microbiological cultures are available.

c. Diagnosis is often difficult due to underlying lung pathology of intensively ill patients. d. All of the above

e. a and b only.

The correct answer is c

14 : Which of the following are potential pulmonary complications among immunocompromised patients?

a. <i>Pneumocystis carinii</i>

b. <i>Mycobacterium tuberculosis</i>

c. <i>Mycobacterium avium </i>complex

d. All of the above

e. a and c only

The correct answer is d

15 : Acute tracheobronchitis is <i>most commonly </i>associated with which of the following pathogens?

a. <i>Pseudomonas</i>

b. <i>Klebsiella</i>

c. A virus

d. <i>Hemophilus influenzae</i>

The correct answer is c

Upper Respiratory Tract Infections

1 : Which of the following is <i>not </i>a risk factor for otitis media?

a. Season

b. Cleft palate

c. Breastfeeding

d. Attendance at day care

e. Smoking The correct answer is c

2 : Which of the following is the predominant pathogen associated with recurrent acute otitis media?

a. <i>Hemophilus influenzae</i>

b. <i>Chlamydia trachomatis</i>

c. <i>Moraxella catarrhalis</i>

d. <i>Staphylococcus aureus</i>

e. <i>Streptococcus pneumoniae</i>

The correct answer is e

3 : According to the Centers for Disease Control (CDC), which of the following constitutes the first line of treatment of an initial episode of uncomplicated acute otitis media?

a. Amoxicillin 90 mg/kg per day

b. Amoxicillin 40 mg/kg per day

c. Cefixime 8 mg/kg per day

d. Clarithromycin 15 mg/kg per day

e. Ceftibuten 9 mg/kg per day

The correct answer is b

4 : All the following regarding group A <i>Streptococcus </i>(GAS) pharyngitis are <i>true except</i>

a. the peak incidence is between 4 and 14 years of age.

b. it is responsible for 70 percent of pharyngitis in children.

c. it can predispose to rheumatic fever.

d. the symptoms appear 1 to 5 days following exposure to the microorganism.

e. symptoms can be difficult to differentiate from those of viral pharyngitis.

The correct answer is b

5 : In a 36-year-old patient presenting with a sore throat, fever of 102°F, swollen anterior cervical nodes, and a cough, what would be the chance of having a streptococcal infection?

a. 2-3 percent

b. 3-7 percent

c. 8-16 percent

d. 19-34 percent

e. 41-61 percent

The correct answer is c

6 : In a 45-year-old patient presenting with a sore throat, fever of 100ºF, swollen anterior cervical nodes, no cough, and tonsillar exudates, the suggested actions would be

a. no throat culture or antibiotic required.

b. perform a throat culture, and treat with an antibiotic if culture is positive.

c. perform a throat culture, and treat with an antibiotic on clinical grounds.

d. do not perform a throat culture, and treat with an antibiotic on clinical grounds. e. none of the above.

The correct answer is b

7 : Symptoms and signs of acute sinusitis include all the following <i>except</i>

a. maxillary toothache.

b. facial fullness.

c. purulent nasal secretions.

d. epistaxis.

e. fever.

The correct answer is d

8 : All the following statements regarding the treatment of uncomplicated acute bacterial sinusitis are <i>true except</i>

a. duration of antibiotic treatment is 21 to 28 days.

b. standard-dose amoxicillin is considered first-line treatment.

c. TMP-SMX is considered first-line treatment in penicillin-allergic individuals.

d. cephalexin is a second-line treatment.

e. levofloxacin offers excellent coverage against major pathogens.

The correct answer is a

9 : Which of the following is <i>not </i>a typical sign of epiglottitis?

a. Respiratory distress

b. Dysphagia

c. Dysphonia

d. Dystonia

e. Drooling

The correct answer is d

10 : The management of epiglottitis includes all the following <i>except</i>

a. administer humidified oxygen.

b. administer dexamethasone.

c. maintain in a sitting position.

d. administer cefuroxime.

e. perform a throat examination.

The correct answer is e

11 : Clinical features of viral croup (laryngotracheitis) include all the following <i>except</i>

a. fever is high.

b. it occurs mainly in children between 6 months to 3 years of age.

c. it occurs at the beginning of night.

d. a barking cough is present.

e. a loud stridor is present.

The correct answer is a

12 : Treatment of moderate viral croup (laryngotracheitis) includes all the following

<i>except</i>

a. 40 % oxygen.

b. racemic epinephrine.

c. amoxicillin 40 mg/kg per day.

d. cold humidified air.

e. dexamethasone 0.6 mg/kg.

The correct answer is c

13 : D. J. is a 6-year-old, otherwise healthy boy that presents to the emergency department on a winter evening. He has a fever of 102ºF. He is in moderate respiratory distress; a loud stridor and barking cough can be heard. His father mentions that his son has not felt well and has had a fever for the past 2 days. Laboratory analysis shows a leukocytosis. D. J. most likely has

a. bacterial laryngotracheitis.

b. viral laryngotracheitis.

c. epiglottitis.

d. otitis media.

e. sinusitis.

The correct answer is a

14 : The management of D. J. should include all the following <i>except</i> a. humidified oxygen.

b. dexamethasone.

c. gentamicin.

d. cefuroxime.

e. racemic epinephrine.

The correct answer is c

15 : Regarding the use of corticosteroids in croup, all the following are <i>true except</i>

a. inhaled budesonide and dexamethasone offer comparable efficacy.

b. dexamethasone and budesonide improve respiratory status.

c. children receiving corticosteroids require less epinephrone treatments.

d. a dose-effect relationship has been noted with dexamethasone.

e. dexamethasone and budesonide relieve symptoms as early as 12 hours after treatment.

The correct answer is e