Download Midterm Pharmacotherapy I test

KING FAISAL UNIVERSITY
COLLEGE OF CLINICAL PHARMACY
Therapy 5 Midterm Exam
2003-525
Instructor: Dr. Yasir A. Ibrahim
Student Name:
Student #:
Final Score
1
Mini Case
BG is a 7 years old boy who brought to the ER by his parents with severe GI
symptoms, low-grade fever, non-productive cough, headache, and malaise. On taking
the history of the disease the parents reported that BG was complaining since last
week of GI symptoms and some signs of pharyngitis. Chest X-ray showed a bilateral
infiltration and on physical exam showed rales and low-grade fever. Labs; negative
sputum culture, hemolytic anemia, cold agglutinin titer of 1:10,000, and positive
serological test. BG is admitted and diagnosed as CAP.
Questions 1-2 are based on this case
1. Which of the following organism is most likely responsible
A. S. pneumonia
B. H. influenza
C. M. pneumonia
D. Chlamydia
E. Legionella
2. Empiric antibiotic therapy could be initiated with
A. Ceftriaxone IV
B. Doxycycline IV
C. Azithromycin plus ceftriaxone IV
D. TMP/SMZ IV
E. Amoxicillin IV
3. MA is 58 yo old male, heavy smoker diagnosed with community acquired
pneumonia. The sputum culture was positive for S. Which of the following
statements is true in regard of S. pneumonia resistance
A. Newer Flouroquinolones are active against penicillin resistant
strains
B. Mechanism is through -lactamase enzyme production
C. Intermediate and sensitive strains can be treated with regular
doses of ceftriaxone
D. ErmAM is a macrolide resistance gene that increases the drug
efflux and usually resistant to clindamycin
E. TMP/SMZ resistance usually is uncommon
4. ------------- ------------- is a false positive test occur within 1 week and may last to
longer than 1 year
A. Booster effect
B. Latent TB
C. Active TB
D. PPD test
E. Quantiferon test
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5. BG has been diagnosed with influenza type A which of the following treatment/s
can be use
I.
Amantadine 100 mg po2xd
II.
Zanamivir 10 mg inhaled bid x 5 days
III.
SMZ/TMP (15 mg TMP component/kg/d IV in divided doses)
A. I only
B. II only
C. I and II only
D. II and III only
E. I, II, and III
6. Aminoglycosides as monotherapy for the treatment of community acquired
pneumonia (CAP) should be avoided because:.
I.
Low pH of the lung tissues
II.
Unfavorable tissue for distribution
III.
Lower pH of the lung tissues
A. I only
B. II only
C. I and II only
D. II and III only
E. I, II, and III
7. Which of the following/s BEST describe sinusitis:
A. Acute bacterial sinusitis usually lasts for > 30 days
B. Radiography is first initial evaluation done
C. Acute viral rhinosinusitis is easily distinguished from bacterial
rhinosinusitis within the first week
D. Patient can be treated with Zinc preparations
E. 40 -60% of patients with acute bacterial rhinosinusitis will clear
the infection spontaneously
Mini case
MG is a 45years old male who presented to the clinic with 3-day history of fever,
chills, pleuritic chest pain, malaise and productive cough. In clinic his temperature is
102oF. His chest radiograph shows consolidation in the right lower lobe. MG is
diagnosed with community-acquired pneumonia. Pneumonia severity index (PSI) was
performed on MG and was categorized as class II.
Questions 8-10 are based on this case
8. Which of the following organism would likely be responsible
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A.
B.
C.
D.
E.
Staphylococcus aureus
Streptococcus pneumonia
Pneumocystis carinii
Haeomphilus influenzae
Mycoplasma pneumonia
9. Based on PSI where would MG could be treated
I. Treated as inpatient
II. Treated as outpatient
III. Treated initially as inpatient then discharge and treated as outpatient
A. I only
B. II only
C. I and II only
D. II and III only
E. I, II, and III
10. According to IDSA and ATS guidelines how can you treat MG
A. Azithromycin 500 mg every 24 hours as an inpatient
B. SMZ/TMP (15 mg TMP component/kg/day IV in divided doses)
as an outpatient
C. Levofloxacin 500mg every 24 hours as an outpatient
D. Clindamycin 600 mg every 8 hours as an inpatient
E. Ceftriaxone 2 gm every 24 hours plus Azithromycin 500mg
every as an inpatient
11. ----------- -------------- is/are highly efficient pathogen/s that may precipitate CAP
through inhalation of organism-containing particles or aerosols
I.
S. aureus
II.
M. pneumonia
III.
S. pneumonia
A. I only
B. II only
C. I and II only
D. II and III only
E. I, II, and III
12. Which of the following statements is most ACCURATE regarding TB
A. TB is spread by shaking someone's hand
B. High socioeconomic status
C. PPD is positive if ≤ 5 mm
D. Interferon TB cold is skin test
E. Breast feeding is not contraindicated in women taking first line
agents
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13. GF is 60 years old male living in a nursing home. Recently there had been an
outbreak of influenza and almost everyone in the nursing home suffered. He had it
too for more than 10 days where his condition started to derteriorate and taken to
the hospital and was diagnosed with pneumonia his sputum showed a coagulase
positive G+ve. Which of the following microorganism is responsible for his
disease
A. Staphylococcus aureus
B. Streptococcus pneumonia
C. Pneumocystis carinii
D. Haeomphilus influenzae
E. Mycoplasma pneumonia
14. Which of the following statements is most ACCURATE regarding RSV
A. RSV sign and symptoms in neonates and infants usually
manifested as upper respiratory tract infection
B. Risk factors for sever disease include high socioeconomic status
C. Routine use of RSV IG and Palvizumab as prophylaxis are
advocated during the season to reduce mortality and morbidity
D. Treatment options is mainly supportive and Ribavarin can be
used for high risk groups
E. Treatment options can be achieved by the use of corticosteroids,
β agonists and antibiotics
Mini case
RK is a 35 year old woman who present to the clinic with a 2 weeks history of night
sweats, fatigue, weight loss, and a cough that won't quit. A PPD test was done in
addition to her sputum was taken and was sent home on levofloxacin 750 mg/d orally.
Two days later her PPD measured 20 mm induration and the sputum sample was
positive for AFB. RK never been outside the Kingdom and the incidence of multidrug
resistant tuberculosis is low.
Questions 15-17 are based on this case
15. Which of the following steps is crucial to do
I.
LFT baseline
II.
HIV testing
III.
No need for isolation
A. I only
B. II only
C. I and II only
D. II and III only
E. I, II, and III
16. If you decided to treat RK what is the best treatment would be
A. INH 300 mg/d orally for 6 months
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B. INH, rifampicin, pyrazinamide, and ethambutol for 2 months
followed by INH rifampicin for 4 more months
C. INH and rifampicin for 6 months
D. Continue levofloxacin for 2 weeks
E. Start amoxicillin/clavulanate with levofloxacin
17. The culture returned and the showed resistance against INH which of the
following is true
I.
INH, PZA and EMB for 6 months
II.
RIF, PZA, EMB for a total of 9 months
III.
RIF, INH, PZA, EMB for 2 months then RIF for a total of 6 months
A. I only
B. II only
C. I and II only
D. II and III only
E. I, II, and III
18. Indication for invasive diagnostic techniques is warranted when:
I. Good response to empiric therapy
II. Suspicious of non-infectious cause
III. Unexplained deterioration after initial improvement
A. I only
B. II only
C. I and II only
D. II and III only
E. I, II, and III
19. The following statements will lead to increase the risk or incidence of otitis media
EXCEPT
A. Day care attendance
B. Carniofacial abnormalities/cleft plat
C. Family history
D. Breast feeding
E. Second hand smoke
20. The following statements are true with regard latent TB EXCEPT
A. Goal is to prevent latent progression into active TB
B. Close contacts should be treated
C. Foreign born persons from low prevalence countries within 1
year should be treated
D. Person working or living in long term care facility should be
treated
E. Homeless persons should be treated
21. Which of the following statements is most ACCURATE regarding RSV
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A. AAP recommend the use of Ribavarin in high risk groups
B. RSV incubation period is usually 4 -6 weeks
C. RSV immune globulin is save in patients with cyanotic
congenital heart disease
D. RSV in neonates manifest as upper respiratory tract infection
E. RSV in older children manifest as lower respiratory tract
infection
22. TK is 32 year old female who is HIV positive and present to the clinic with
typical TB symptoms that is confirmed with AFB. She is receiving ART
including boosted PI, Zidovudine and lamivudine. She lives in area where INH
resistance is widespread. Which of the following is the initial treatment of choice
I. Start INH, RIF, PZA, EMB with no change in her HIV medications
II. Rifabutin, PZA, EMB, and Moxifloxacin with HIV RNA monitored
III. Start INH, RIF, PZA and Moxifloxacin with no change in her HIV
medications
A. I only
B. II only
C. I and II only
D. II and III only
E. I, II, and III
23. A good sputum sample should contain:
A. 5 neutrophils and  15 squamous epithelial cells per low power
field
B. 25 neutrophils and  25squamous epithelial cells per low power
field
C. 25 neutrophils and  10squamous epithelial cells per low power
field
D. 25 neutrophils and  5 squamous epithelial cells per low power
field
E. 5 neutrophils and 25 squamous epithelial cells per low power
field
Mini case
MS is 40 yo male released from prison few weeks ago. He presented to the ED
complaining of cough, fever, and night sweats. He said he has lost 20 Ib over the last
month since his release. His AFB was positive
Questions 24-25 are based on this case
24. Treatment options would be
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A. INH, RIF, PYZ, ETM for 2 months then INH and RIF for 4
months
B. INH, RIF, PYZ, ETM for 6 months
C. INH, PYZ, ETM for 6 months
D. RIF, PYZ, ETM for 6 months
E. RIF, INH, PYZ for 2 months
25. 8 weeks later his spututm was still positive for AFB and his culture was resistant
to INH and RIF. Which of the following is the most accurate treatment
A. D/C INH and RIF add moxifloxacin to PYZ and ETH
B. D/C INH and RIF add moxifloxacin and amikacin to PYZ and
ETH
C. D/C INH and RIF add amikacin and streptomycin to PYZ and
ETH
D. D/C INH and RIF add stretptomycin to PYZ and ETH
E. D/X INH and RIF add Linezolid
Good Luck
8
KING FAISAL UNIVERSITY
COLLEGE OF CLINICAL PHARMACY
Therapy 5 Final Exam
2003-525
Instructor: Dr. Yasir A. Ibrahim
Student Name:
Student #:
Final Score
9
Please choose the BEST ANSWER, a total of 45 questions
1. Which of the following statements is most ACCURATE with regard urinary tract
infections (UTI)
a. Asymptomatic patients with catheter related UTI should be
treated
b. Epididymitis in patients older than 35 yrs usually caused by
gonococcal or chlamydia
c. Relapse in recurrent cystitis defined as infection with new
organism within 14 days of discontinuing UTI antibiotics
d. Tuberculosis associated with false negative leukocyte esterase
and positive culture
e. Female patients who develop UTI is usually considered
uncomplicated unless pregnant
2. RT is a an 85 year old woman who is bedridden and lives in a nursing home. She
is chronically catheterized and her urinary catheter was last change 3 weeks ago.
Today her urine is cloudy and urinanlysis shows many bacteria. RT is
asymptomatic. A urine culture is obtained which one of the following therapies
should be given
a. No therapy and keep the catheter
b. No antibiotic, but the catheter should be changed
c. Oral ciprofloxacin 500 mg bid for 7 days and a new catheter
d. Oral ciprofloxacin 500 mg bid for 14-21 days without changing
the catheter
e. SMZ/TMP DS bid for 7 days and a new catheter
3. Which of the followings is a type of anemia diagnosed by exclusion and
characterized by low iron with normal or increased ferritin level and decreased
TIBC on peripheral smear is normocytic.
a. Anemia of chronic illness
b. Iron deficiency anemia
c. Macorcytic anemia
d. Hemolytic anemia
e. Sickle cell anemia
Mini case
RT is 5 years old boy presented to the ER with temperature of 104o F, altered mental
status, petachiae and Kernig sign on physical exam. There is no history of trauma.
Toxicological studies were negative. His labs include WBC of 32000 with left shift. RT
goes to day care. An LP was done and showed > 5000 WBC, with > 3000 neutrophils, 5
mg/dl glucose, and 300 mg/dl protein. He has no known allergy.
Questions 4- 7 are based on this case
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4. RT diagnosis is
a.
b.
c.
d.
e.
Viral enchephalitis
RSV
Bacterial meningitis
Otitis media
ADHD
5. Which of the following microorganisms might contribute to RT disease
I. H. influenzae
II. Neiseseria meningitidis
III. E. coli
a. I only
b. II only
c. I and II only
d. II and III only
e. I, II, and III
6. Which of the following embiric treatment is/are accurate for RT disease
I. Ampicillin plus gentamicin
II. Ceftriaxone ± vancomycin plus dexamethasone
III. Ampicillin plus cefotaxime
a. I only
b. II only
c. I and II only
d. II and III only
e. I, II, and III
7. Which of the following statements is most ACCURATE regarding RT case
I. RT should be given steroids
II. All those come in contact with RT should be given prophylaxis with
rifampicin
III. All those come in contact with RT should be given prophylaxis with
ceftriaxone
a. I only
b. II only
c. I and II only
d. II and III only
e. I, II, and III
8. Which of the following microorganism/s is/are associated with atypical
pneumonia;
I. Streptococcus pneumonia
II. Mycoplasma pneumonia
III. Legionella
a. I only
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b.
c.
d.
e.
II only
I and II only
II and III only
I, II, and III
9. A 50 year old male was admitted to the ICU for CAP with a history of COPD.
The intern physician asked you for your recommendation. What is your BEST
treatment option would be.
I. Trimethoprim/Sulfamethoxazole
II. Levofloxacin
III. Piperacillin/tazobactam
a. I only
b. II only
c. I and II only
d. II and III only
e. I, II, and III
Mini case
RE is a 33 year old man who has been HIV since 1999. He has never started on any
HAART before. He presented with enlarge lymph nodes, weight loss, recently his CD4
counts have started to decrease significantly and reached 170. PMHx include depression,
IV drug abuse that he stated he has been clean for the last 4 yrs.
Questions 10-11 are based on this case
10. Given this scenario what would you manage this case
I. Send for genotyping
II. Consider starting Bactrim DS every other day
III. Consider starting Azithromycin 1200 mg weekly
a. I only
b. II only
c. I and II only
d. II and III only
e. I, II, and III
11. If you wanted to start RE on treatment what would be your best option
a. Efavirenz plus emtricitabine/tenofovir
b. Atazanavir/ritonavir plus emtricitabine/tenofovir
c. Lopinavir/ritonavir plus emtricitabine/tenofovir
d. Raltegravir plus emtricitabine/tenofovir
e. Abacavir plus lamiviudine plus zidoviudine
12. PI is a 35 year old woman who present to the clinic with a 2 week history of night
sweats, fatigue, weight loss, and cough won't quit. A PPD test was done and was
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send home on Levofloxacin 750 mg po daily. Two days later her PPD was 20 mm
induration and her sputum was positive for acid fast bacilli. She has no pertinent
medical history and has never left the country before, and she lives in a low
incident area of multidrug resistant tuberculosis. What is the best treatment for PI
a. INH 600 mg daily for 9 months
b. INH, rifampin, pyrazinamide, and ethambutol for 2 months
followed by INH and rifampin for more 4 months
c. INH and rifampin for 6 month
d. Continue on levofloxacin for 15 days
e. Rifampin, pyrazinamide, and ethambutol for 9 months
13. KJ developed AIDS and was diagnosed with P. carinii pneumonia (PCP) what
would be your treatment options
I. SMZ/TMP (15 mg TMP component/kg/day IV in divided doses)
II. Clindamycin plus primaquin
III. Zanamivir
a. I only
b. II only
c. I and II only
d. II and III only
e. I, II, and III
Mini case:
MJ 19 yo male has sustained a high cervical spine injury at C-2 due to a trampoline
accident. His neurological injury is complete at the C-2/C-3 level and he is intubated.
Vital signs are P 62, BP of 82/44 RR 18 with BSA of 1.5M2. He has been given 4 L of
NS and his BP has not responded. A PAC was established in MJ and the following
parameters were recorded, CO 4 L/min, PCWP 14 mmHg, SVR 600 dynes/cm5.
Questions 14-16 are based on this case
14. MJ calculated CI is
a. 2.6
b. 6
c. 8.7
d. 3.5
e. 4
15. MJ MAP is
a.
b.
c.
d.
e.
60
56.6
69.3
82
72
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16. The drug of his shock is
a. Epinephrine
b. Norepinephrine
c. Dopamine
d. Dobutamine
e. Vasopressin
17. Goal of therapy in sepsis include all the following EXCEPT
a. Timely diagnosis and identification of the pathogen
b. Rapid elimination of the source of infection
c. Use appropriate antibiotic based on the culture results
d. Interruption of the pathogenic sequence leading to septic shock
e. Avoidance of organ failure
18. Which is NOT TRUE about dobutamine
a. Induces catecholamine release
b. Indicated in cardiac decompensation secondoray to decreased
cardiac contractility
c. It is contraindicated in patients with idiopathic hypertrophic
subaortic stenosis
d. When given with tricyclic antidepressants significant increase in
blood pressure may occur
e. Has a drug drug interaction with bretylium
Mini case:
LG is a 48 year old woman with a history of mitral valve prolapse. She presents to her
physician's office with malaise and low grade fever. Her physician notes that here
murmur is louder than normal and orders blood cultures and an echocardiogram. A large
vegetations is observed on LG's mitral valve, and her blood cultures are growing
Enterococcus faecalis (susceptible to all antibiotics).
Questions 19-20 are based on this case
19. Based on this presentation LG can be diagnosed with
I. Septic shock
II. Definite endocarditis
III. Cardigogenic shock
a. I only
b. II only
c. I and II only
d. II and III only
e. I, II, and III
20. The best treatment for LG would be
I. Penicillin G plus gentamicin for 4-6 weeks
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II. Dobutamine
III. Norepinephrine
a. I only
b. II only
c. I and II only
d. II and III only
e. I, II, and III
21. Which of the following is/are the Most Common bacterial microoraganisms
associated with HAP, VAP and HCAP:
I. Pseudomonas aeruginosa
II. Acinetobacter spp.
III. Coagulase negative Staph aureus
a. I only
b. II only
c. I and II only
d. II and III only
e. I, II, and III
Mini case:
QB is a 25 year old woman who present to ER with a 2 day history of dysuria, frequency
and urgency. She has no significant medical history, and the only drug she takes is oral
contraceptives.
Questions 22-23 are based on this case
22. QB is best diagnosed with
I. Complicated UTI
II. Uncomplicated UTI
III. Epididymitis
a. I only
b. II only
c. I and II only
d. II and III only
e. I, II, and III
23. QB treatment should compose of
I. TMP/SMZ 5 days
II. Levofloxacin 5 days
III. Mechanical contraceptive
a. I only
b. II only
c. I and II only
d. II and III only
e. I, II, and III
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24. MR is a 24 yo man with a history of IV drug abuse. He is currently admitted with
10 day history of malaise and intermittent fevers. He has no history of
endocarditis nor artificial valves. On physical exam was noted to have a new
murmur. A vegetation is observed on the tricuspid valve on echocardiography.
Blood culture was positive for MRSA. Which of the following is the best therapy
for MR
a. Vanocmycin for 2 weeks
b. Vancomycin for 2 weeks plus gentamicin for 3-5 days
c. Vancomycin for 6 weeks
d. Vancomycin plus gentamicin both for 6 weeks
e. Vancomycin plus rifampin both for 6 weeks
25. Which of the following best described as an acute skin infection that involves the
deep dermis and subcutaneous fat and characterized by poor defined margins and
happens as a result of minor trauma, abrasions, ulcers or surgery.
a. Cellulitis
b. Erysipelas
c. Necrotizing fasciitis
d. Leishmaniasis
e. Diabetic foot infection
26. Which of the followings is/are the risk factors for developing antibiotic resistance
I. Prior antimicrobial use
II. Prolonged hospitalization
III. Underdosage of antibiotics
a. I only
b. II only
c. I and II only
d. II and III only
e. I, II, and III
27. When treating a patient with TB which of the following points should be
addressed during counseling the patient with regard the drug use
I. If the patient complained of blurred vision might be contributed to
Pyrazinamide and its optic neuritis side effect
II. Alcohol consumption might increase INHl liver toxicity
III. Rifampicin might lead to orange discoloration of body fluids
a. I only
b. II only
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c. I and II only
d. II and III only
e. I, II, and III
28. RK, a 47 yo immigrant presented to ED with severe abdominal pain, while taking
the history he mentioned he had many episodes of amebiasis that he was not
compliant with taking the medication for it. After a comprehensive investigation
was found to have liver amebiasis. What would be the best treatment option for
RK.
a. Paromomycin
b. Emetine
c. Chloroquine phosphate
d. Tinidazole
e. Diloxanide furoate
29. Which of the following occur during or after an influenza infection
I. Resolution with antiviral drugs
II. Bacterial superinfection
III. Reliable protective immunity against influenza in the next seasons
a. I only
b. II only
c. I and II only
d. II and III only
e. I, II, and III
Mini case:
VN is 56 yo woman who came to the primary care clinic for an evaluation of a tender and
painful inflamed area on her left leg. She has noticed increasing pain and swelling over
the past 2 days. She was playing with her grandson over the weekend and tripped and fell
down scrapping her leg. She has a medical history of hypertension for which is taking
HCTZ 25 mg daily and NKA. .
Questions 30-31 are based on this case
30. Which of the following is most likely cause of her cellulitis
a. Pseudomonas aeruginosa
b. Streptococcus pyogenes
c. Klepsiella pneumonia
d. Enterococcus faecalis
e. Enterococcus faecium
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31. Which one of the following is the best treatment option
a. Naficillin
b. Bactrim
c. Ciprofloxacin
d. Vancomycin
e. Erythromycin
32. Severe sepsis is composed of
I. SIRS
II. Organ dysfunction
III. Hypotension not responding to fluid resuscitation
a. I only
b. II only
c. I and II only
d. II and III only
e. I, II, and III
33. OA was diagnosed with open angle glaucoma with IOP of 30 mmHg, vertical cup
disk ration of 0.8 and visual field defects. Which of the following drugs would
you recommend as first line treatment
a. Topical beta blockers
b. Latanoprost
c. Oral CAI
d. Carbachol
e. Argon laser
Mini case:
TR is a personnel who works with the WHO, his sector that he covers include, Iraq, |Iran,
SA, Afghanistan, and Kuwait. He has been visiting remote places in those countries for
the last 1.5 years. Recently he noticed scattered dry type of ulcers with a size ranging
from 1-2 cms with no exudates and painless around exposed pats of his body.
Questions 34-35 are based on this case
34. Based on this presentation what is BEST diagnosis of his condition would be
a. Localized cutaneous leishmaniasis caused by L. tropica
b. Localized cutaneous leishmaniasis caused by L. aethipica
c. Localized cutaneous leishmaniasis caused by L. infantum
d. Localized cutaneous leishmaniasis caused by L. chagasi
e. Localized cutaneous leishmaniasis caused by L. braziliensis
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35. Given this case what would be BEST describes the treatment
a. Pentostam can be used for the treatment given for 10 days orally
b. Amphotericin is the first line for treatment of cutaneous
leishmaniasis
c. Pentamidine isethionate can be given orally and associated with
many side effects including acute renal failure
d. Glucantime is given for 20-28 days and the resolution may take
up to 2 years for TR
e. Miltefosine is a phospocohline analogue that must be given IM
or IV because is it poorly absorbed from the GI
36. Which of the following statements is most ACCURATE with regard HIV
a. HIV transmission decreases with increased sexual partners
b. Western blot is the first test we use to check HIV
c. RNA testing can be used to diagnose acute HIV infection
d. Postpartum transmission in not possible through breastfeeding
e. ELISA assay has low sensitivity and specifity
37. All the following drugs may induce or potentiate increased intraocular pressure in
open angel glaucoma EXCEPT
a. Opthalmic corticosteroids
b. Systemic corticosteroids
c. Fenoldopam
d. Carbonic anhydrase
e. Cimetidine
38. Which of the following statements is TRUE with regard sickle cell clinical
presentation
a. Sicke cell trait carrier rarely experience pain unless provoked by
heavy exercise and usually have normal Hgb level
b. Sickle cell HgbC usually have sever hematuria and common
vaso-occlusive crises
c. Sickle cell β-thalassemia have rare crises due to no production of
HgbA
d. Sickle cell α thalassemia severity similar to sickle trait carrier
due to production of HgbA
e. Sickle cell anemia is due to iron deficiency and characterized by
acute pain crises
Mini case:
ED is 25 yo young man with a history of Sickle Cell disease, recently has many visits to
the ER with chief complain of severe chest pain, this episode he has a history of fever,
cough and SOB
Questions 39-40 are based on this case
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39. What would be your approach to treat ED
I. Give antipyretics/analgesics but not narcotics
II. O2 supplementation
III. Hgb transfusion
a. I only
b. II only
c. I and II only
d. II and III only
e. I, II, and III
40. Which of the following constitute an ideal treatment plan for ED
I. Routine vaccination against flu and pneumococcal
II. Folic acid
III. Hydroxy urea
a. I only
b. II only
c. I and II only
d. II and III only
e. I, II, and III
41. When dealing with UTI which of the following pathogens might not be associate
with the disease
a. E. coli
b. Proteous mirabilis
c. S. pneumonia
d. Klebsiella
e. Pseudomonas
42. Despite your plan ED did not follow and this time was admitted to the ER with
altered mental status and from the history from the family it was noticed that he
was complaining of severe headache and he started to limp. Given this scenario
what would be the appropriate approach
I. Should be assessed for VTE
II. Supportive care
III. Long term transfusion
a. I only
b. II only
c. I and II only
d. II and III only
e. I, II, and III
43. ED condition after recovering from the previous episode he started to deteriorate
further with a rapid fall in Hgb concentration and rise in reticulocyte count with
splenomegaly. What is the next treatment option for ED.
I. Vaccination
II. Splenectomy
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III. Nothing since he is going to recover after this episode
a. I only
b. II only
c. I and II only
d. II and III only
e. I, II, and III
44. Which of the following statements is NOT TRUE regarding amebiasis
a. All E. histolytica infections should be treated, even in the
absence of symptoms
b. Goal of treating intestinal amebiasis is to eradicated both the
trophozoites and cysts
c. Cholorquine is effective only for intestinal amebiasis
d. Tissue amebicide acts on trophozoites only eg metronidazole
e. Luminal amebicides acts only in the bowel lumen with minimal
systemic absorption e.g. diloxanide furoate
45. ST recently returned from a trip to an endemic area of falciparum resistant
malaria, 2 weeks later he presented to the ER with high fever, severe headache,
nausea and vomiting. A blood smear showed P. falciparum. Which of the
following is your best treatment option.
a. Chloroquine phosphate IV
b. Mefloquine oral
c. IV quinine plus tetracycline
d. Primaquine orally
e. Artemisinin single agent
BEST OF LUCK
21
KING FAISAL UNIVERSITY
COLLEGE OF CLINICAL PHARMACY
Therapy 5 Lab Final Exam
2003-525
Instructor: Dr. Yasir A. Ibrahim
Student Name:
Student #:
Final Score
22
The exam consists of a total of 3 Questions with a total of 15 marks.
Please Explain and Rationalize your answers.
1- (8 marks)
CC: DA is a 17 year old previously healthy boy who presents to a local ER with fever
and altered mental status.
PMHx:
DA is a new university student living in the barracks, has had a 2 day history of
intermittent fever and painful headache unrelieved by extra-strength acetaminophen
tablets. This morning DA complained of increasing lethargy and slept much of the
remaining day. Six hours prior to admission, DA was difficult to arouse and had three
documented episodes of vomiting
FHx:
Non contributory
MHx:
DA has a 3 year history of intermittent AFib, associated with Wolff-Parkinson-white
syndrome, which has improved on procainamide, which has not fully suppressed the
arrhythmia.
Procainamide 750 mg po q 6h
Allergies
NKDA
SHx:
Son of a single mother, just accepted to the university where he moved and stayed in the
barracks, non-smoker or alcohol drinker.
PE:
GEN
VS
HEENT
NECK
COR
CHEST
ABD
GU
RECT
EXT
NEURO
Male disoriented to person, place, and thing, in mild respiratory distress
BP 135/72, HR 95 and regular, RR 30, T40.5, Wt 62.5 kg (Usual Wt 65),
Ht 170 cm
Head was without trauma, ears clear, PERRLA, normal vessels without
papilledema, normal dentition
Decreased mobility, positive Brudzinski's sign
NL heart sounds, RRR
Rales could heard on the right side, decreased breath sounds and dullness
to percussion: right greater than left
WNL
WNL
WNL
WNL
Lethargic, not oriented to person, place or thing, reflexes were 3+
throughout and symmetrical, motor was intact
23
Result of lab test:
Na 145
K4
Cl 105
HCO3 24
BUN 18
Scr 0.9
HCT 46
Hgb 14.8
WBC 16.5
Plt 285
Mg 2.1
Alb 4.5
Glucose 90
CSF: WBC 1.8, 90% PMN
Glu: 30
Protein: 125
Gram stain: Positive diplococcic
ABG: pH 7.48, pCO2 35, PO2 90, HCO3 24, O2 Sat 90%
24
2- DA was admitted to the ICU where was intubated and was on treatment, 3 days later
his condition started to deteriorate and his ventilator parameters were altered, he has a
lot of yellowish secretions. His labs showed a sudden increase in WBC despite initial
decline in WBC to reach 23,000, BP is 70/40 that is not responding to fluid
resuscitation.
Explain with rationalizing your answer for the followings (3 marks)
a. Based on this presentation what do you think is the reason for DA
deterioration?
b. What is the name of his current diagnosis?
c. How can you treat this new condition?
25
3- 42 yo male, 72 kg, BSA 1.8 M2, admitted to the ER with severe chest pain not
relieved by 3 NTG, EKG was consistent with AMI, 10-115 PVCs were noticed on the
monitor with some coupled. BP 90/40, P 90, RR 30. At the ER 4 mg of MS IV< 40
mg furosemide IV x 1, O2 at 2 L/min lidocaine total of 150 mg bolus, now at 2
mg/min. PVC now about 3/min. Patient stable for now.
An Arterial line and S-G catheter was placed, data as follows:
BP 84/45, P 90, RR 20, CO 2.9, PCWP 24
ABGs on 50% FIO2
pH 7.2, , pO2 50, pCO2 50, HCO3 22
Skin is cold and clammy, pt. is confused and drowsy
CXR suggests pulmonary edema
Urine output 10 ml over last 30 mi
Explain with rationalizing your answer for the followings (4 marks)
a. What is your diagnosis for this condition?
b. How would you approach this case?
c. What is the treatment options for this case would be explaining your
rational for it?
GOOD LUCK
26