Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Infections and Immunologic Disease--->Cardiovascular Infections
Page: 1

Question 1#Print Question

A 19-year-old male with no past medical history presented to the emergency room with pelvic fracture after being hit by a car. A central line was placed for administering vasopressors and volume resuscitation. Three days later, the patient became febrile, and blood cultures were obtained revealing Staphylococcus aureus. Vancomycin was started, and repeat blood cultures 2 days later are negative. Transthoracic echocardiogram is unremarkable.

Which of the following is the next best step?

a. Transesophageal echocardiogram
b. Antibiotic lock therapy
c. Central line removal
d. Antibiotics for 7 days

Question 2#Print Question

A 74-year-old male with end-stage renal disease (ESRD) and recent pulmonary embolism on apixaban presents to the intensive care unit from dialysis clinic with a 6-day history of fevers and chills. He received hemodialysis through a tunneled central venous catheter. Blood cultures drawn in the emergency room are all positive for gram-positive cocci that are later identified as coagulase-negative Staphylcoccus (CNS). The patient is hemodynamically stable with significant thrombocytopenia to 15 and is methicillin-resistant Staphylococcus aureus (MRSA) negative.

What is the next best step in this patient’s management? 

a. Tunneled dialysis catheter exchange over a guidewire
b. Obtain transthoracic or transesophageal echocardiogram
c. Obtain blood cultures every 48 hours until negative
d. Switch from vancomycin to oxacillin

Question 3#Print Question

A 67-year-old male with an implantable cardioverter defibrillator (ICD) is admitted with urosepsis. Blood cultures reveal methicillinsensitive Staphylococcus aureus, and transesophageal echocardiogram reveals a 1.9 cm mass on the ICD lead with no evidence of endocarditis.

Which of the following is the MOST appropriate management regarding this patient’s ICD and leads?

a. Interventional transvenous lead extraction
b. Interventional transvenous lead extraction and device explantation
c. Consider explant only if continued bacteremia
d. Surgical lead extraction and device explantation

Question 4#Print Question

A 79-year-old female with ESRD presents to the intensive care unit with 7 days of worsening dyspnea on exertion, lower extremity edema, malaise, and chest pain that radiates toward the left shoulder that is worse with inspiration. Vitals are:

  • temperature 38.5°F
  • blood pressure 105/90 mm Hg
  • heart rate 95 beats/min
  • respiratory rate 21/min

Electrocardiogram (EKG) reveals ST elevations in leads I, II, III, aVF, and aVL.

What is the MOST common etiology of this patient’s condition?

a. Viral infection
b. Myocardial infarction
c. Bacterial infection
d. Renal failure

Question 5#Print Question

A 69-year-old female with history of rheumatic mitral stenosis presents to the intensive care unit with 5 days of fevers and night sweats, malaise, and multiple small erythematous lesions on the soles of the feet. The patient develops an escalating pressor requirement, and a bedside echocardiogram reveals severe mitral regurgitation that was not seen a month earlier on a formal echocardiogram.

Which of the following is the MOST likely organism to be isolated from blood cultures?

a. CNS
b. Entercocci
c. Viridins Streptococcus
d. Staphylococcus aureus

Category: Critical Care Medicine-Infections and Immunologic Disease--->Cardiovascular Infections
Page: 1 of 1