Green: Recall

Shifting exam questions 4 sets (done)

Blue: Understanding
Rec all 1 1 1 1

Black: Application
Understa nding 1 1 1 1 1 1 Applica tion 2 1 1 1 1 1 1 1 1 1 TOT AL 3 2 2 2 2 2 3 2 3 2

L6: Infections in the immunocompromised (done) L8: new concepts in the pathogenesis of SIRS (done) R8a: malaria (done; H: 1280-1293) R8b: tuberculosis (done; H: 1006-1038) R10a: infections in cancer & transplant patients (done; H: 533-541; 842-851) R10b: HIV/AIDS (done; H: 1132-1203) R13a: treatment and prophylaxis of bacterial infections (done; H: 851-864) R13b: tetanus (done; H: 898-900) R13c: sexually transmitted diseases (done; H: 821835; 991-992) R13d: syphilis (done; H: 1038-1045) Mario Panaligan

Rec all 4

1 1 Understan ding 8

Application 11 23

MULTIPLE CHOICE: SELECT THE BEST ANSWER. Malaria 1. Pathophysiologic hallmark in acute P. falciparummalaria, brought about by cytoadherence, rosette formationand agglutination: A. Intravascular hemolysis C. Microvascular obstruction B. Splenic filtration D. Renal tubular acidosis 2. Primary cause of severe anemia in patients with acute malaria: A. Intravascular hemolysis C. Hemoglobinuria B. Splenic clearance of RBCs D. Ineffective dyserythropoiesis

3. Which of the following would explain tropical splenomegaly among individuals residing in highly endemic areas? A. Repeated malarial infections C. Increased portal hypertension B. Increased infected RBC clearance D. Concomitant parasitic infection 4. Which would properly describe quartan nephropathy due to P. malariae infections? A. Histologic appearance is usually membranoproliferative. B. The main manifestation is hematuria due to blackwater fever. C. Metabolic acidosis is a frequent complication. D. The condition is poorly responsive to anti-malarial therapy.

Green: Recall

5. Appropriate empiric therapy for patients with malaria presenting with recurrent generalized convulsions: A. Quinine + doxycycline C. Sulfadoxine-pyrimethamine B. Mefloquine + primaquine D. Atovaquone-proguanil 6. Which of the following malaria chemoprophylactic agents can be safely discontinued 1 week after departure from the endemic area? A. Chloroquine C. Doxycycline B. Mefloquine D. Atovaquone-proguanil

Blue: Understanding

Black: Application

7. Which of the following diagnostic tools is the MOST useful among patients suspected to have drug-resistant malaria? A. Thick blood film C. PfHRP2 dipstick test B. Thin blood film D. LDH dipstick test

Tuberculosis 9. Transmissibility of M. tuberculosisto a susceptible individual after exposure is primarily related to the following: A. Cavitary pulmonary disease C. HIV co-infection B. Extrapulmonary tuberculosis D. Healthcare setting 10. Highest risk for active TB disease is seen among which group of patients: A. Diabetics C. HIV infected B. Malnourished D. Transplant recipients

8. A 25 y/o male who just got back from South Africa where he stayed for 2 weeks was rushed to the Emergency Room because of high-grade fever with chills, jaundice and oliguria. He was reported to take doxycycline for chemoprophylaxis. The best antimalarial regimen for this patient is: A. Quinine + doxycycline C. Sulfadoxine-pyrimethamine B. Mefloquine + primaquine D. Atovaquone-proguanil

11. Delayed type hypersensitivity to TB is primarily mediated by which group of inflammatory cells? A. B lymphocytes C. Monocytes B. T lymphocytes D. Macrophages

12. Which of the following properly describes active TB disease? A. Both primary and secondary TB usually affects the upper lung zones. B. Primary TB is common in children up to 4 years old and may be severe and disseminated. C. Primary TB poses a higher risk of transmission compared to secondary TB. D. Pleural effusion is more frequently seen in patients with secondary TB.

Green: Recall

13. In addition to the anti-TB drugs, adjunctive steroid therapy could be given to patients with this form of extrapulmonary TB? A. Pleural C. Meningitis B. Genitourinary D. Skeletal 14. Beneficial effect of adjunctive steroid for TB pericarditis: A. Diminishespericardial effusion B. Intensifies efficacy of anti-tuberculous drugs C. Slows down progression to disseminated disease D. Prevents development of constrictive pericarditis

Blue: Understanding

Black: Application

15. A 54 y/o male with active TB, receiving quadruple anti-TB drugs for 3 weeks, started to experience joint pains. Which drug could be the most likely cause? A. Isoniazid C. Pyrazinamide B. Rifampicin D. Ethambutol

Infections in Cancer/Transplant Patients/Immunosuppressed 17. Seen in neutropenic patients with cancer, this condition is characterized by coalescent red or bluish-red papules or nodules forming sharply boarded plaques associated with swelling and edema commonly affecting the face, neck and arms: A. Erythemanodosum C. Pyodermagangrenosum B. Leukocytoclasticvasculitis D. Sweets syndrome 18. Acceptable oral chemoprophylactic antibiotic for afebrile neutropenic patients with expected to have prolonged neutropenia (> 14 days): A. Ciprofloxacin C. Cefixime B. Co-amoxyclav D. Clindamycin 19. Viral agent causing hemorrhagic cystitis in immunosuppressed patients, specifically bone marrow transplant recipients A. Adenovirus C. Cytomegalovirus B. BK virus D. Herpes simplex type 2

16. A 35 y/o male with persistent cough is diagnosed to have active PTB, with a positive AFB smear (++). He reported having treated 8 years ago, prior to his work abroad. After requesting for Mycobacterial culture and susceptibility tests, you would start him on: A. INH + Rifampicin + PZA B. INH + Rifampicin + PZA + Ethambutol C. INH + Rifampicin + PZA + Ethambutol + Streptomycin D. INH + Rifampicin + PZA + Ethambutol + Streptomycin + Ciprofloxacin

20. Recommended drug to prevent reactivation of varicella zoster infection among transplant recipients: A. Acyclovir C. Foscarnet

Green: Recall

24. Administration of ganciclovir among neutropenic patients with positive CMV antigenemia that is suggestive evidence of CMV infection is called: A. Prophylactic C. Empiric B. Preemptive D. Definitive

23. Low grade fever associated with non-specific signs and leukopenia developing 1 month after kidney transplantation must be investigated for the possibility of a disseminated disease due to: A. Aspergillosis C. Histoplasmosis B. Cytomegalovirus D. Epstein Barr viral infection

22. In managing infections of febrile neutropenic patients: A. Majority of causative agents would be from the hospitals microbial flora B. The associated signs and symptoms can be readily detected C. An increased risk for candidemia is associated with an indwelling intravascular device D. A higher mortality is seenin patients withprofound neutropenia

21. Manifestations of CMV infections in post-transplant recipients: A. Pharyngitis and lymphadenopathy are frequent clinical signs B. Fever and leukopenia are the usual findings C. Splenomegaly is often present D. Candidiasis is a common complication

B. Cidofovir

Blue: Understanding

D. Ganciclovir

Black: Application

25. A 35 y/o post-kidney transplant male was admitted because of fever. He is on his 2nd month of immunosuppressive therapy. No other associated signs and symptoms. His WBC is 3.5 x 109 with 75% neutrophils, 20% lymphocytes, 5% monocytes. Your most likely diagnosis is: A. Epstein Barr viral disease C. Cytomegalovirus disease B. Enteric fever D. Dengue fever 26. A 40 y/o post-kidney transplant female was admitted because of fever and headache, with 1 episode of seizure. Working impression is bacterial meningitis. CSF analysis showed gram-positive coccobacilli. The most likely organism involved is: A. Streptococcus pneumoniae C. Neisseria meningitidis B. Haemophilus influenzae D. Listeriamonocytogenes

27. A 46 y/o post-kidney transplant female was admitted because of fever, headache and vomiting. With the impression of bacterial meningitis, a lumbar puncture was done. CSF analysis showed gram-positive coccobacilli. Based on this, you would give: A. Ampicillin C. Cotrimoxazole B. Ceftriaxone D. Chloramphenicol

Green: Recall

Blue: Understanding

Black: Application

28. For post-transplant patients suspected to have cytomegalovirus disease, the most appropriate pre-emptive treatment is: A. Acyclovir C. Entecavir B. Gancyclovir D. Valacyclovir 29. Appropriate antibiotic for post-splenectomy sepsis: A. Penicillin C. Clindamycin B. Cotrimoxazole D. Ceftriaxone

30. Environmental precautionary measures applicable when handling febrile neutropenic patients: A. Single, isolated room with airborne precautions B. Personnel to always wear masks, gowns and gloves when seeing the patient C. Avoidance of salads, fruits and vegetables, yogurts and raw nuts D. Mandatory vaccination against food-borne illnesses for all healthcare personnel taking care of the patient 31. Among high-risk febrile neutropenics, when fever recurs on the 5th day, which of the following could be the initial appropriate intervention? A. Immediately start an antifungal drug B. Shift antibiotics to another broad-spectrum antimicrobial agents C. Repeat microbiologic examinations, including fungal cultures D. Observe because fever recurrence could be due to the main underlying problem

32. A 44 y/o female, diagnosed with Hodgkins disease, had her 4th course of chemotherapy, coming in because of fever for 3 days. She started having fever 10 days after her last chemotherapy, with no cough, difficulty of breathing, dysuria and LBM. On PE, there is a noted erythema near the porta-cath site. Her WBC is 2,000 with 85% neutrophils; creatinine is 1.8 mg%, ALT and AST are within normal limits. After getting 2 sets of blood cultures, you would start her on: A. Ceftazidime + vancomyin C. Meropenem + linezolid B. Meropenem + Vancomycin D. Ceftazidime + Clindamycin

33. A 20 y/o female, diagnosed to have non-Hodgkins lymphoma, was admitted because of fever for 1 day. She had her 1st cycle of chemotherapy a week prior to onset of fever. No other associated signs or symptoms. Based on this, you would start her on the following antibiotic regimen: A. Oral co-amoxyclav + ciprofloxacin C. IV piperacillin-tazobactam B. IV ceftazidime D. IV imipenem 34. Appropriate approach to afebrile neutropenic patients presenting with acute onset of abdominal pain:

Green: Recall

HIV / AIDS 37. Regarding the clinical course of HIV infection: A. Death is often due to the HIV infection itself. B. Opportunistic infections usually appear when CD4 counts are 500 cells/uL. C. Acute retroviral syndrome occurs w/in 3-6 weeks after primary infection. D. Viral load is low during the clinical latency period. 38. Bacterial pneumonia in HIV is frequently due what organism? A. Acinetobacter baumanii C. Pseudomonas aeruginosa B. Pneumocystisjiroveci D. Streptococcus pneumoniae

36. A documented catheter-related bloodstream infection due to this organism can be safely managed by antibiotic therapy alone without removing the catheter: A. Pseudomonas aeruginosa C. Staphylococcus aureus B. Coagulase-negativeStaphylococcus D. Candida spp.

35. Among febrile neutropenic patients, what is the most important laboratory parameter in monitoring treatment response? A. Serum creatinine C. Quantitative platelet count B. Prothrombin time D. Absolute neutrophil count

A. Must be categorized as high risk for complications and mortality B. Anaerobes are usually the frequent etiologic cause C. Imaging tests could be done, only when microbiologic examinations are negative D. Vancomycin is recommended for the empiric therapeutic regimen

Blue: Understanding

Black: Application

39. Most frequent secondary CNS infection causing seizures among AIDS patients: A. Cryptococcosis C. Toxoplasmosis B. Herpes simplex virus D. Tuberculosis 40. Recommended secondary chemoprophylactic drug for HIV patients after successful treatment of cryptococcal meningitis with amphotericin B: A. Fluconazole C. Posaconazole B. Itraconazole D. Voriconazole 41. Etiologic cause of chronic diarrhea among AIDS patients that can be treated effectively with cotrimoxazole: A. Cryptosporidium C. Isospora belli B. Enterocytozoon D. Toxoplasma

Green: Recall

42. Antimicrobial therapy for AIDS patients with mild Pneumocystis pneumonia, who are allergic to cotrimoxazole: A. Itraconazole C. Sulfadoxine-pyrimethamine B. Clindamycin + primaquine D. Fluconazole + dapsone

Blue: Understanding

Black: Application

43. A 24 y/o HIV patient came in because of bloody diarrhea associated with crampy abdominal pain and fever. He is maintained on ARV therapy for 8 months with the last CD4 count of 385 (done 2 months ago), stopped intake of cotrimoxazole that time. He reported intake of combined Chinese and Thai food prior to the onset of diarrhea. After requesting for blood and stool CS, you would give: A. Amoxicillin C. Chloramphenicol B. Cotrimoxazole D. Erythromycin 44. A 23 y/o male HIV-AIDS patient who is concurrently receiving ARV and antiTB therapy for 2 weeks suddenly develops fever and lymphadenitis. No other remarkable PE findings. What would you do? A. Stop both ARV and anti-TB drugs C. Stop anti-TB drugs B. Stop ARV D. Supportive therapy

Treatment and prophylaxis of bacterial infections 45. Most frequent mechanism of bacterial resistance to beta-lactam antibiotics: A. Alteration of penicillin-binding protein B. Decreased outer membrane permeability C. Efflux pumps D. Enzyme inactivation

47. Duration of treatment for chronic prostatitis: A. 1 week B. 2 weeks

46. Sites of infections which are difficult to treat because of poor capillary penetration and low antibiotic levels: A. Brain and vitreous humor C. Lungs and bone B. Gall bladder and valvular vegetation D. Prostate and urine C. 3 weeks D. 4 weeks

48. Class of antibiotics which has poor activity in treating abscesses: A. Aminoglycosides C. Fluoroquinolones B. Beta-lactam drugs D. Lincosamides

49. The combination of these antibiotics has a recognized antagonistic activity against a specific organism: A. Oxacillin + gentamicin against Staphylococcus spp. B. Penicillin + streptomycin against Enterococcus fecalis C. Penicillin + doxycycline against Streptococcus pneumoniae D. Trimetophrim + sulfamethoxazole against Salmonella enteritidis

Green: Recall

50. Prior to the initiation of empiric antibiotic therapy, which one is the first important task to do: A. Recognizing the site of infection B. Getting specimens for culture C. Obtaining microbiologic specimens for culture and sensitivity D. Knowing antibiotic allergies

Blue: Understanding

Black: Application

51. Pharmacodynamic parameter on antibiotic killing that correlates the highest concentration of the antibiotic at the onset, being 4x above the minimum inhibitory concentration: A. t> MIC C. AUC/MIC B. C max /MIC D. MBC/MIC 52. Combination antibiotic therapy is necessary against the following organisms: A. Methicillin-resistant S. aureus C. Escherichia coli B. Haemophilus influenzae D. Enterococcus fecalis

53. A 55 diabetic female started experiencing pain on her left leg, which progressed eventually involving the left thigh. This was associated with fever, and multiple bullae, slight swelling, and redness, with limitation of movement of the knee joint due to pain. On PE, her BP is 90/50 mmHg; HR is 120/min; RR is 26/min and Temperature is 38.9oC; there are several bullae on the left leg, some necrotic areas particularly on the lower leg near the ankle, withcrepitation. After requesting for blood C/S, you would start this patient on: A. Ampicillin-sulbactam + clindamycin B. Ampicillin-sulbactam + ciprofloxacin C. Piperacillin-tazobactam + ciproxacin D. Piperacillin-tazobactam + ciproxacin + Clindamycin 54. Which is the most appropriate empiric antibiotic for acute uncomplicated pyelonephritis in pregnant patients? A. Amoxicillin C. Cotrimoxazole B. Ceftriaxone D. Erythromycin

55. Appropriate antibiotic therapy for patients with endocarditis due to methicillin-susceptible S. aureus? A. Ampicillin 3 gm IV q6 hours B. Clindamycin 900 mg IV q 8 hours C. Oxacillin 2 gm IV 14 hours D. Penicillin 4 M units q4 hours

56. Administration of this antibiotic should be avoided in COPD patients receiving theophyline: A. Amoxicillin C. Cotrimoxazole B. Ceftriaxone D. Erythromycin

Green: Recall

Blue: Understanding

Black: Application

Tetanus 57. Initial goals of therapy for tetanus include: A. Neutralization of bound toxins B. Provide preventive prophylaxis C. C. Control spasms D. Prevent thromboembolism

58. The following characterizes the manifestations of generalized tetanus: A. The first manifestation is usually lockjaw B. Stiffness involving the extremities usually follows dysphagia C. Arched back frequently occurs early D. Facial contraction produces proptosis, grimace and sneer 59. Preferred antibiotic for tetanus: A. Clindamycin B. Metronidazole C. Penicillin D. Tetracycline

60. Diagnosis of tetanus is usually based on: A. Positive tissue culture growing C. tetani B. Serum antitoxin levels > 0.01 unit/ml C. EMG showing continuous discharge of motor units D. Clinical findings

61. To control the consequent autonomic dysfunction due to tetanus, which one is the most appropriate antihypertensive agent: A. Diltiazem C. Esmolol B. Metoprolol D. Nifedipine

63. Which one is correct in providing adequate respiratory support for patients with generalized tetanus: A. Avoid high doses of benzodiazepines B. Give sufficient oxygen supplement immediately C. Provide proton pump inhibitor to increase gastric pH D. Early intubation or tracheostomy

62. A 24 y/o male was brought to the emergency room because of lacerations, multiple wounds on the left leg, including an avulsed nail of the 2nd digit. He reported having a booster shot for tetanus 4 years ago. What would you do in terms of anti-tetanus management? A. Administer tetanus Ig only B. Give both tetanus Ig and tetanus toxoid C. Inject one dose of tetanus toxoid as a booster shot D. Advise him to receive a booster shot 6 years later

Green: Recall

Sexually transmitted infections 65. First line drug for N. gonorrhea infection: A. Amoxicillin B. Cefixime

64. Effective preventive measure to prevent neonatal tetanus: A. Give tetanus Ig only after birth B. Administer tetanus toxoid and Ig immediately after birth C. Maternal vaccination during pregnancy D. Prophylactic ampicillin administration prior to delivery

Blue: Understanding

Black: Application

66. Recommended drug for non-gonococcalurethritis: A. Amoxicillin C. Ciprofloxacin B. Cefixime D. Azithromycin

C. Ciprofloxacin D. Azithromycin

67. Presence of clue cells on vaginal discharge by microscopy is indicative of what vulvovaginal infection: A. Bacterial vaginosis C. Genital herpes B. Candidiasis D. Trichomoniasis

68. The presence of white, adherent plaques on speculum examination is suggestive of what vulvovaginal infection: A. Bacterial vaginosis C. Genital herpes B. Candidiasis D. Trichomoniasis 69. For male patients presenting with mucopurulent discharge, a negative finding of gram-negative intracellular diplococci warrants the following: A. Combined treatment using ciprofloxacin and metronidazole B. Administercefixime and doxycycline C. Monotherapy with azithromycin D. Discharge culture for non-gonococcal organisms 70. The following features characterize bacterial vaginosis: A. Profuse yellowish discharge B. Vulvaginal pain and ulcers C. Malodorous whitish discharge coating the vaginal mucosa D. Metronidazole treatment of partners markedly reduce its recurrence

71. The following features characterize trichomoniasis: A. Strawberry cervix B. Vulvaginal pain and ulcers C. Malodorous whitish discharge coating the vaginal mucosa D. Metronidazole treatment of asymptomatic partners provides no benefit

Green: Recall

72. Appropriate antibiotic therapy for patients suspected to have pelvic inflammatory disease (PID), should have coverage against the following: A. Non-gonococcalorganisms B. Gonococci and Chlamydia C. Gonococci, Chlamydia and anaerobes D. Gonococci, Chlamydia, Candida and anaerobes

Blue: Understanding

Black: Application

74. A 35 y/o female started to have malodorous vaginal discharge a day prior to consult. PE revealed grayish homogenous discharge, with clue cells on microscopy. You would give: A. Cefixime 400 mg single dose B. Ciprofloxacin 500 mg 2x a day for 10 days C. Doxycycline 100 mg 2x a day for 7 days D. Metronidazole 500 mg 2x a day for 7 days 75. A 40 y/o female comes to you because of malodorous vaginal discharge and vulvar itching. She has a sexually active husband, who has apparently developed urethritis 2 weeks ago. PE revealed yellowish discharge, with erythematousvulvovaginal area. Her cervix was also noted to be inflamed, with mucopurulent discharge. Considerations for this patient should include: A. Bacterial vaginosis and cervicitis B. Trichomoniasis and cervicitis C. Trichomoniasis and candidiasis D. Trichomoniasis only 76. A 20 y/o male consulted you because of urethral discharge. His last unprotected sexual contact was 6 days prior to consult. PE revealed mucupurulent discharge upon milking of the urethra, with no inquinallymphadenopathy. You would give: A. Cefixime 400 mg single dose B. Doxycycline 100 mg BID for 7 days C. Azithromycin 1 gm single dose D. Cefixime 400 mg single dose plus Azithromycin 1 gm single dose

73. A 28 y/o sexually active male sought consult with you for a history of dysuria w/o frequency of urination, and unilateral pain on the right scrotal sac of 4 days duration. PE reveals absence of penile lesions or discharge; however, the patients right scrotum is enlarged and tender to palpation. What is the likely etiologic cause? A. Neisseria gonorrhea C. Mycoplasmagenitalium B. Chlamydia trachomatis D. Ureaplasmaurealyticum

SYPHILIS 77. Characterized by a solitary, indurated and non-painful genital ulcer with regular and undermined edges: A. Chancre C. Granulomainquinale

Green: Recall

78. Characteristic features of primary syphilis: A. Initial genital lesion is a painless papule B. Genital ulcers are frequently multiple, with ragged edges C. Chancres, resulting from the initial papules, are frequently painful D. Bilateral inguinal lymphadenopathy is unusual

B. Chancroid

Blue: Understanding

D. Herpes

Black: Application

80. Characteristic features of tertiary syphilis: A. Symptomatic neurosyphilis B. Cluttons joints and Hutchinsons teeth C. Aortitis and saccularaneursym D. Mucous patches affecting the genital and oral mucosa

79. Characteristic features of secondary syphilis: A. Disseminated maculopapular lesions sparing the palms and soles B. Moist pink or grayish white plaques present in the genital area C. Rapid weight loss and persistent fever D. Generalized lymphadenopathy

82. A 25 y/o asymptomatic male is referred to you because of a reactive VDRL. He reported not having any sexually transmitted infection in the past. What advice would you give? A. Have a repeat VDRL test after 6 months B. Request for a quantitative VDRL C. Verify the result and request for TPPA D. Workup for a connective tissue disease

81. A 54 y/o married businessman consults you because of maculopapular lesions on his trunk, lower extremities, and palms associated with malaise.He disclosed that he had as many sexual partners as he had business trips and some of those sexual encounters were unprotected. Based on your assessment, wou would give him the following: A. Benzathine penicillin G 2.4 M units IM single dose B. Benzathine penicillin G 2.4 M units IM per week x 3 doses C. Ceftriaxone 125 mg IM single dose D. Doxycycline 100 mg/tab 1 tab BID

83. Appropriate interventions for secondary syphilis in pregnant patients allergic to penicillin: A. Ceftriaxone 1 gm IM q weekly for 3 doses B. Doxycycline 100 mg BID for 2 weeks C. Azithromycin 500 mg OD for 1 week D. Benzathine penicillin G 2.4 M units IM after desensitization

Green: Recall

SIRS/SEPSIS 85. Acute phase procoagulant response of an individual during infection: A. Augmented synthesis of antioxidants B. Iron and zinc sequestration C. Increasedproduction of complement factors D. Decreased synthesis of protein C and anti-thrombin III 86. The following characterizes the vasoconstrictive phase of septic shock: A. Decreased systemic vascular resistance and increased cardiac output B. Decreased cardiac output and elevated systemic vascular resistance C. Decreased cardiac output and systemic vascular resistance D. Elevated cardiac output and systemic vascular resistance 87. Which of the following factors directly triggers the cascade of events leading to microcirculatory dysfunction in sepsis? A. Vascular endothelial injury C. Coagulopathy B. Complement activation D. Cytopathic hypoxia

84. Appropriate management for Herxheimer reaction: A. Prednisone 1 mg/kg day B. Low dose hydrocortisone

Blue: Understanding syphilis

C. Loratidine 10 mg OD D. Supportive therapy

patients

developing

Black: Application Jarisch-

88. Recommended inotropic agent for septic patients with underlying heart disease: A. Norepinephrine C. Dobutamine B. Dopamine D. Vasopressin

90. At present, the recommended blood glucose level that should be maintained among septic patients is less than: A. 110 mg/dl C. 180 mg/dl B. 150 mg/dl D. 200 mg/dl 91. During the first 6 hours of managing patients with severe sepsis or septic shock, the most appropriate intervention is: A. Fluid resuscitation using either crystalloids or colloids B. Inotropic support along with fluid infusion C. Administration of supplemental bicarbonate to correct acidosis

89. A 45 y/o female comes to you because of fever for 5 days and cough for 3 days. No other comorbid problem is elicited. On physical examination, he is febrile with a temperature of 38.9oC, heart rate is 104/min, respiratory rate of 24/min and BP of 130/80. Based on the above data, the patient has: A. SIRS C. Severe sepsis B. Sepsis D. Infection without SIRS

Green: Recall

92. Regarding blood product administration in patients with severe sepsis: A. Red blood cell transfusion is indicated when the hemoglobin level is below 10 g/dl. B. Regardless of the quantitative count, platelet transfusion is necessary when there is excessive bleeding. C. Antithrombin therapy is recommended to prevent disseminated intravascular coagulation. D. The use of fresh frozen plasma is discouraged to correct laboratory clotting abnormalities.

D. Immediate administration of empiric antibiotics

Blue: Understanding

Black: Application