Infections Due To Gram Positive Cocci

5 Questions | Total Attempts: 236

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Questions and Answers
  • 1. 
    A 35-year-old man with a history of HIV presents to the emergency department after developing cough with blood-tinged sputum, shortness of breath, and fever for 1 day. He has not had recent exposures or sick contacts. He is on highly active antiretroviral therapy (HAART) and has never had an opportunistic infection. His last CD4 count was greater than 300/μL. On examination, he is febrile (39.1°C [102.4°F]) and tachypneic (26/min). Ronchi and egophony are noted in the right lower lobe. A chest x-ray shows a right lower lobe consolidation.   What is the most likely cause of this patient's current infection?
    • A. 

      Reactivation of a latent disease

    • B. 

      Aspiration of oropharyngeal secretions containing bacteria

    • C. 

      Inhalation of droplets from another person with the infection

    • D. 

      Intravenous (IV) drug use

  • 2. 
    A 19-year-old woman presents to your clinic complaining of fevers and arthritis for 2 weeks. Her symptoms first started with right knee pain and swelling. She then developed bilateral knee pain followed by left elbow pain. On examination, she has a fever, synovitis, and a pericardial friction rub. Her laboratory testing reveals acute renal failure (creatinine 2.4 mg/dL) and an elevated C-reactive protein. An electrocardiogram shows a prolonged PR interval. The patient had a sore throat 3 weeks ago that resolved spontaneously after a few days.   What is the best prophylactic treatment to prevent a recurrence of this patient's symptoms?
    • A. 

      Penicillin p.o. or IM

    • B. 

      Aspirin p.o.

    • C. 

      Azithromycin p.o.

    • D. 

      Prednisone p.o

  • 3. 
    An 85-year-old woman with dementia presents to the emergency department from a nursing home with delirium. She was in her usual state of health until 3 days ago, when her symptoms developed. The staff at the nursing home report that the patient's urine is dark and she is having low-grade fevers. A urinalysis obtained 2 days previously shows leukocyturia and gram-positive cocci in chains. The culture is available today and shows widely sensitive Enterococcus faecalis. On examination, you see a confused elderly woman. Her temperature is 37.9°C (100.2°F). She is wearing malodorous diapers.   What is the most appropriate antibiotic for this patient's infection?
    • A. 

      Vancomycin

    • B. 

      Ciprofloxacin

    • C. 

      Ampicillin

    • D. 

      Linezolid

  • 4. 
    A 40-year-old female presents to the emergency department critically ill. She is 1 day postoperative from a rhinoplasty. In the emergency department, her blood pressure is 90/60 mm Hg, heart rate is 120 beats per minute, respiration is 20 breaths/min, and temperature is 38.3°C (101°F). On examination, the patient is in significant distress and has a nasal packing in place. Her laboratory evaluation reveals a leukocytosis, thrombocytopenia, and acute renal failure.   What is the most appropriate next step in the management of this patient?
    • A. 

      Remove nasal packing and IV vancomycin

    • B. 

      Remove nasal packing and IV ciprofloxacin

    • C. 

      IV vancomycin only

    • D. 

      IV ciprofloxacin only

  • 5. 
    A 40-year-old male with a history of IV drug abuse presents to your clinic with fevers and chills for 1 week. His examination reveals a new holosystolic murmur at the left lower sternal border that increases with inspiration. He is febrile at 38.9°C (102°F). The remainder of the examination is unremarkable. A chest x-ray shows scattered opacities. You plan to admit him for workup and treatment of infective endocarditis.   What duration of IV antibiotics is necessary for this patient's illness?
    • A. 

      4 to 6 weeks

    • B. 

      7 to 10 days

    • C. 

      3 months

    • D. 

      1 year

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