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 6# Print Question

A 46-year-old woman with newly diagnosed and untreated HIV infection was admitted to the ICU last night with possible pneumocystis pneumonia. Her CD4 count is 42 cells/µL. She is currently intubated and sedated. Since arrival she has had five episodes of bloody loose stools. PCR for C. difficile is negative and stool studies for bacteria and parasites are pending. Colonoscopy performed at bedside reveals areas of friable, erythematous mucosa with submucosal hemorrhage and large, deep ulcerations. Biopsies are sent for definitive diagnosis.

What empiric antimicrobial should you start while awaiting results?

A. Ciprofloxacin
B. Oral vancomycin
C. Ganciclovir
D. Nitazoxanide
E. No need for empiric therapy, await definitive biopsy results

Question 7# Print Question

A 56-year-old man with a recent diagnosis of acute myeloid leukemia was admitted 10 days ago for induction chemotherapy with cytarabine and anthracycline. Over the past 24 hours he has developed worsening abdominal pain and distension along with a fever of 38.8°C and watery diarrhea. CT shows bowel wall thickening of >10 mm in both the small and large intestine.

Which of the following statements is true regarding this patient’s likely diagnosis?

A. Enteral feeding helps to decrease complications
B. Pneumatosis intestinalis may be seen on CT scan
C. Early surgical intervention improves outcomes
D. Antibiotics are not needed at this time
E. None of these statements are true

Question 8# Print Question

A previously healthy 36-year-old woman is brought in by ambulance following a seizure. Her husband reports that she has no history of seizures but had been complaining of diarrhea and vomiting for almost a week. She went out of town to a family reunion 10 days ago and had talked to several other family members who also became ill, some even needed to go to the hospital. On examination the patient is confused with diffuse abdominal tenderness. Vitals are within normal limits. Although in the ED she experiences an episode of grossly bloody diarrhea. Significant laboratory results include:

  • white blood cell count 12,300 cells/µL
  • hemoglobin 7.7 g/dL
  • platelet count 85,000 cells/µL
  • Cr 5.63

Peripheral blood smear shows a large number of schistocytes.

Which of the following statements is true regarding this patient’s disease process?

A. Early antibiotics have been shown to improve outcomes
B. Therapeutic plasma exchange is a mainstay of treatment
C. All patients should receive steroids
D. Criteria for renal replacement therapy is the same as that for other causes of acute kidney injury (AKI)
E. None of the above is true

Question 9# Print Question

A 63-year-old woman with a history of hypertension and dyslipidemia presents to the emergency department with severe right upper quadrant pain. On examination, she is grimacing and agitated with notable jaundice. She is oriented to self only. She has right upper abdominal tenderness, but no peritoneal signs. Vital signs include:

  • temperature 38.5°C
  • heart rate 112 beats/min
  • blood pressure 92/48 mm Hg
  • SpO2 96% on room air

Pertinent laboratory test results include:

  • white blood cell count 13,500 cells/µL with a left shift
  • total bilirubin 4.4 mg/dL
  • alkaline phosphatase 220 IU/L
  • AST 846 IU/L
  • ALT 932 IU/L

Blood cultures are pending. An ultrasound performed at bedside shows biliary dilation.

Appropriate initial management includes which of the following:

A. Admission to the general surgical ward
B. Rehydration with enteral fluids
C. A first generation cephalosporin
D. Urgent endoscopic retrograde cholangiopancreatography (ERCP)
E. Urgent surgery

Question 10# Print Question

A previously healthy 42-year-old man was admitted to the ICU last night with progressive weakness and was intubated early this morning when he became unable to protect his airway. Per his wife, he was in his usual state of health until 2 days ago when he began to complain of weakness, numbness, and pain in his legs. She called an ambulance yesterday when he started having similar symptoms in his arms. On examination he has symmetric weakness in both upper and lower extremities and absence of deep tendon reflexes. CSF studies show a protein level of 110 mg/dL (normal range 15- 45 mg/dL) and a white blood cell count of <5 cells/µL. Further history reveals that the whole family had suffered a diarrheal illness a couple of weeks ago.

What is the most commonly identified infectious precursor to this patient’s syndrome?

A. Giardia lamblia
B. Campylobacter jejuni
C. Salmonella enterica
D. Cytomegalovirus (CMV)
E. Yersinia pestis

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