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Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Infections and Immunologic Disease--->Gastrointestinal and Intra-abdominal Infections
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Question 1#Print Question

A 38-year-old man who recently returned from visiting his family in the Philippines presents to the emergency department with 1 week of fatigue, low-grade fever, abdominal pain, and jaundice. Laboratory results include:

  • serum alanine transaminase (ALT) 2,850 U/L
  • total bilirubin 7.6 mg/dL
  • international normalized ratio (INR) of 3.6

Serology comes back as:

  • HBsAg negative
  • anti-HBs positive
  • anti-HBc IgG positive
  • anti-HBc IgM negative

The serology results are most consistent with which of the following?

a. Acute hepatitis B infection
b. Chronic hepatitis B infection
c. Immunity to hepatitis B from prior infection
d. Immunity to hepatitis B from vaccination
e. None of the above


Question 2#Print Question

A 68-year-old woman has been in the ICU for 5 days receiving ceftazidime for Pseudomonas aeruginosa meningitis following surgical removal of a meningioma. This morning on rounds her nurse mentions that the patient had three loose stools overnight. Laboratory results show that the patient’s white blood cell count jumped from 7,600 to 16,500 cells/µL. Serum creatinine has also increased from 1.2 to 1.9 mg/dL. Nucleic acid amplification test and stool toxin test are both positive for Clostridium difficile.

What is the recommended management?

a. Metronidazole 500 mg PO three times daily for 10 days
b. Vancomycin 125 mg PO four times daily or fidaxomicin 200 mg PO twice daily for 10 days
c. Repeat testing for C. difficile toxin at 14 days
d. Both A and C
e. Both B and C


Question 3#Print Question

A 45-year-old man with a history of alcoholic cirrhosis and poor medication compliance is dropped off in the emergency department by a friend. He is:

  • afebrile
  • blood pressure 108/56 mm Hg
  • heart rate 89 beats/min
  • oxygen saturation 96% on room air

On examination he is sleepy but rouses to voice. He cannot remember how he got to the hospital and gets irritated with repeated questions. He has asterixis and hyperactive reflexes. His abdomen is moderately distended but not tense or painful. In addition to admitting the patient and starting medical management of his decompensated cirrhosis, what is the best approach to working up and treating a possible infection?

a. No antibiotics needed at this time, and await results of blood and urine cultures
b. Send blood and urine cultures, start empiric broad-spectrum antibiotic coverage, and narrow or discontinue based on culture data
c. Send blood and urine cultures, start empiric broad spectrum antibiotic coverage, and perform diagnostic paracentesis as soon as convenient
d. Perform diagnostic paracentesis and send blood and urine cultures, and decide whether to start empiric antibiotics based on ascitic fluid cell count or culture results
e. Perform diagnostic paracentesis and send blood and urine cultures, and decide whether to start empiric antibiotics based on ascitic fluid gram stain or culture results


Question 4#Print Question

A previously healthy 63-year-old woman presents to the emergency department with 24 hours of severe abdominal pain, nausea, and vomiting. Vital signs include:

  • temperature 38.8°C
  • heart rate 108 beats/min
  • blood pressure 86/42 mm Hg
  • oxygen saturation 93% on room air

On examination, she is in moderate distress with diffuse epigastric pain and diminished bowel sounds. Laboratory results include:

  • white blood cell count 18,500 cells/µL
  • creatinine 2.1 mg/dL
  • lipase 320 U/L (normal range 7-60 U/L)
  • total bilirubin 2.8 mg/dL
  • spartate aminotransferase (AST) 96 U/L
  • alanine aminotransferase (ALT) 89 U/L
  • alkaline phosphatase 256 U/L

What is the recommended management?

a. Start aggressive intravenous fluid repletion, and obtain an abdominal ultrasound, early enteral feeding
b. Avoid aggressive fluid repletion, and obtain an abdominal ultrasound, early parenteral feeding
c. Start aggressive intravenous fluid repletion, and obtain an abdominal ultrasound, early parenteral feeding
d. Avoid aggressive fluid repletion, early enteral feeding
e. Start aggressive intravenous fluid repletion, and broad spectrum empiric antibiotics, early enteral feeding


Question 5#Print Question

A previously healthy 24-year-old man presents to the emergency department with severe right lower quadrant pain, anorexia, and nausea. Vital signs include:

  • heart rate 126 beats/min
  • blood pressure 86/43 mm Hg
  • SpO2 99% on room air
  • temperature 38.7°C

Physical examination is significant for exquisite right lower quadrant tenderness with rebound and guarding. Laboratory test results reveal a white blood cell count of 19,000 cells/µL with a left shift. CT with contrast shows appendiceal wall thickening, periappendiceal fat stranding, and a focal defect in the enhancing wall of the appendix.

In addition to IV fluids, what are the next best steps in management?

a. Start antibiotics with narrower-spectrum, gram-negative, and anaerobic coverage such as ceftriaxone plus metronidazole, urgent surgery
b. Start antibiotics with broad coverage such as cefepime plus metronidazole, urgent surgery
c. Start antibiotics with narrower-spectrum gram-negative and anaerobic coverage such as ceftriaxone plus metronidazole, surgery within 24 hours
d. Start antibiotics with broad coverage such as cefepime plus metronidazole, surgery within 24 hours
e. Start antibiotics with broad coverage such as cefepime plus metronidazole, no surgery unless the patient does not improve with antibiotics and fluids




Category: Critical Care Medicine-Infections and Immunologic Disease--->Gastrointestinal and Intra-abdominal Infections
Page: 1 of 2