Terms in this set (155)
Moraxella catarrhalis
A 4-year-old girl presents with a cough
and thick green-yellow nasal discharge
for 10 days. She was previously healthy,
takes no medications, and her
immunizations are up to date.
Temperature is 39.0 °C (102.2 °F), blood
pressure 110/70 mm Hg, pulse 90 bpm,
and respiratory rate 18 breaths/min. Her
nasal turbinates are swollen and
erythematous with thick, purulent
discharge. Her lungs are clear on
auscultation. Amoxicillin-clavulanate
results in the complete resolution of
symptoms in 3 days. Which of the
following is the most likely cause of this
patient's infection?
Clavulanate inhibits beta-lactamase produced by bacteria to prevent the
inactivation of amoxicillin
A 5-year-old boy presents with a
worsening cough and thick yellow-green
nasal discharge for the past 2 weeks.
He has no chronic medical conditions
and is not taking any medication. His
immunizations are up to date. Vital signs
are temperature 102.6 °F (39.2 °C),
blood pressure 120/80 mm Hg, heart
rate 92 bpm, and respiratory rate 20
breaths/min. On examination, nasal
turbinates are swollen and
erythematous, and there is a thick
purulent discharge from the nares.
Lungs are clear on auscultation.
Amoxicillin-clavulanate is prescribed for
acute bacterial sinusitis. What is the role
of the clavulanate component?
, Ciprofloxacin
An 8-month-old boy presents with a new
onset of fever, urinary hesitancy, and
frequency for three days. This is his
second episode of similar complaints in
the same month. He has a history of
recurrent urinary tract infections since
his birth. He has a 4-year-old sibling
who is healthy. He has normal growth
and development and achieved his
milestones on time. The urine culture of
catheterized specimens grew >100,000
colony-forming units of Escherichia coli.
The renal ultrasound shows mild
hydronephrosis of the left kidney, and
the voiding cystourethrogram shows
moderate dilatation of the left ureter and
pelvis. The patient is managed with
nitrofurantoin and paracetamol. The
patient is discharged on a prophylactic
antibiotic for his condition. Which of the
following antimicrobial agents is
contraindicated in this patient?
Hypersensitivity to fluticasone/salmeterol inhalation powder formulation
A 10-year-old African American girl with
a history of moderate persistent asthma
is brought into the clinic for continued
shortness of breath and wheezing. She
is currently being treated with a low-
dose steroid and a short-acting beta-
agonist. The child's family reports their
daughter's symptoms are worse at night
or when she is exposed to cold air. The
family listed no known drug allergies but
did indicate a dairy allergy. After further
evaluation of the patient's severe
chronic asthma symptoms, she is
prescribed a low dose of an inhaled
corticosteroid and long-acting beta-2
agonist combination. Before leaving the
clinic, she is administered one dose of
fluticasone propionate/salmeterol
100/50 mcg inhalation powder. Shortly
after administration, she develops chest
tightness and requires oxygen therapy
and albuterol. Which of the following
best explains the girl's sudden
worsening of symptoms?
, Doxycycline
A 12-month old presents to his
pediatrician for a well-child visit. The
exam is mostly normal, except the
pediatrician notes significantly
discolored teeth. The mother insists that
she only allows her child to drink milk
and water. Upon further questioning, the
mother reveals she was on medication
for acne before she knew she was
pregnant. What medication was she
most likely given?
Do not prescribe any form of promethazine
A 16-month-old infant has been brought
to the emergency department for the
past six hours due to persistent
vomiting. The mother states that despite
multiple attempts, her son has not had
any oral intake. He has vomited 8-9
times in the past six hours. The first few
episodes consisted of partially digested
food. The mother also states that her
son passed two watery stools during this
time. Examination shows a lethargic
infant with dry mucus membranes.
Which of the following is most
appropriate regarding the management
of this patient?
Metronidazole
A 16-year-old female is being treated for
insulin dependent diabetes mellitus and
develops a perineal abscess. It is foul
smelling and you suspect an anaerobic
infection. Which of the following
antibiotics has anaerobic activity?
Hypoglycemia
A 16-year-old female presents to the
emergency department after
intentionally ingesting 30 metoprolol
succinate 100-milligram pills. This was
done in a suicide attempt approximately
1 hour prior to arrival. She told her
parents after the ingestion, and they
brought her to the emergency
department. The patient currently has no
complaints. Which metabolic
derangement could occur with this type
of ingestion?
, Hypokalemia
A 16-year-old girl presents with a
decreased level of consciousness and
abdominal pain. Her mother says that
she vomited twice before coming to the
hospital. She has no known medical
history, and this is the first time to have
these symptoms. Her family history is
significant for diabetes in her mother
and 2 uncles. Her glucose level is 574
mg/dL, creatinine 0.8 mg/dL, potassium
3.7 mEq/L, sodium 137 mEq/L, and
white blood count 12700/microL. Her
urine dipstick shows glucose 4+ and
ketones 3+. She is given normal saline.
She is also given an infusion of the next
appropriate medication. Which of the
following side effects is most likely to
occur with this infusion?
Maculopapular rash
A 16-year-old male presents with a fever
and sore throat. On physical
examination, there are multiple swollen
lymph nodes in his neck, and
hepatosplenomegaly is noted. A
monospot test is positive. The patient is
advised to stop contact sports for a year,
and treatment with amoxicillin is
initiated. Which of the following is the
patient at high risk of developing due to
his current medication?
Ethosuximide
A 16-year-old presents for staring spells
that occur several times a day. Each
episode lasts only a few seconds and
occurs at random times of the day. The
patient continues regular activity after
the event and is not confused. The
patient is otherwise healthy with no
recent trauma or infections. The patient
is not on any medications. EEG reveals
a 3-Hz spike and waveform. Which of
the following is the first-line treatment for
this patient?
Moraxella catarrhalis
A 4-year-old girl presents with a cough
and thick green-yellow nasal discharge
for 10 days. She was previously healthy,
takes no medications, and her
immunizations are up to date.
Temperature is 39.0 °C (102.2 °F), blood
pressure 110/70 mm Hg, pulse 90 bpm,
and respiratory rate 18 breaths/min. Her
nasal turbinates are swollen and
erythematous with thick, purulent
discharge. Her lungs are clear on
auscultation. Amoxicillin-clavulanate
results in the complete resolution of
symptoms in 3 days. Which of the
following is the most likely cause of this
patient's infection?
Clavulanate inhibits beta-lactamase produced by bacteria to prevent the
inactivation of amoxicillin
A 5-year-old boy presents with a
worsening cough and thick yellow-green
nasal discharge for the past 2 weeks.
He has no chronic medical conditions
and is not taking any medication. His
immunizations are up to date. Vital signs
are temperature 102.6 °F (39.2 °C),
blood pressure 120/80 mm Hg, heart
rate 92 bpm, and respiratory rate 20
breaths/min. On examination, nasal
turbinates are swollen and
erythematous, and there is a thick
purulent discharge from the nares.
Lungs are clear on auscultation.
Amoxicillin-clavulanate is prescribed for
acute bacterial sinusitis. What is the role
of the clavulanate component?
, Ciprofloxacin
An 8-month-old boy presents with a new
onset of fever, urinary hesitancy, and
frequency for three days. This is his
second episode of similar complaints in
the same month. He has a history of
recurrent urinary tract infections since
his birth. He has a 4-year-old sibling
who is healthy. He has normal growth
and development and achieved his
milestones on time. The urine culture of
catheterized specimens grew >100,000
colony-forming units of Escherichia coli.
The renal ultrasound shows mild
hydronephrosis of the left kidney, and
the voiding cystourethrogram shows
moderate dilatation of the left ureter and
pelvis. The patient is managed with
nitrofurantoin and paracetamol. The
patient is discharged on a prophylactic
antibiotic for his condition. Which of the
following antimicrobial agents is
contraindicated in this patient?
Hypersensitivity to fluticasone/salmeterol inhalation powder formulation
A 10-year-old African American girl with
a history of moderate persistent asthma
is brought into the clinic for continued
shortness of breath and wheezing. She
is currently being treated with a low-
dose steroid and a short-acting beta-
agonist. The child's family reports their
daughter's symptoms are worse at night
or when she is exposed to cold air. The
family listed no known drug allergies but
did indicate a dairy allergy. After further
evaluation of the patient's severe
chronic asthma symptoms, she is
prescribed a low dose of an inhaled
corticosteroid and long-acting beta-2
agonist combination. Before leaving the
clinic, she is administered one dose of
fluticasone propionate/salmeterol
100/50 mcg inhalation powder. Shortly
after administration, she develops chest
tightness and requires oxygen therapy
and albuterol. Which of the following
best explains the girl's sudden
worsening of symptoms?
, Doxycycline
A 12-month old presents to his
pediatrician for a well-child visit. The
exam is mostly normal, except the
pediatrician notes significantly
discolored teeth. The mother insists that
she only allows her child to drink milk
and water. Upon further questioning, the
mother reveals she was on medication
for acne before she knew she was
pregnant. What medication was she
most likely given?
Do not prescribe any form of promethazine
A 16-month-old infant has been brought
to the emergency department for the
past six hours due to persistent
vomiting. The mother states that despite
multiple attempts, her son has not had
any oral intake. He has vomited 8-9
times in the past six hours. The first few
episodes consisted of partially digested
food. The mother also states that her
son passed two watery stools during this
time. Examination shows a lethargic
infant with dry mucus membranes.
Which of the following is most
appropriate regarding the management
of this patient?
Metronidazole
A 16-year-old female is being treated for
insulin dependent diabetes mellitus and
develops a perineal abscess. It is foul
smelling and you suspect an anaerobic
infection. Which of the following
antibiotics has anaerobic activity?
Hypoglycemia
A 16-year-old female presents to the
emergency department after
intentionally ingesting 30 metoprolol
succinate 100-milligram pills. This was
done in a suicide attempt approximately
1 hour prior to arrival. She told her
parents after the ingestion, and they
brought her to the emergency
department. The patient currently has no
complaints. Which metabolic
derangement could occur with this type
of ingestion?
, Hypokalemia
A 16-year-old girl presents with a
decreased level of consciousness and
abdominal pain. Her mother says that
she vomited twice before coming to the
hospital. She has no known medical
history, and this is the first time to have
these symptoms. Her family history is
significant for diabetes in her mother
and 2 uncles. Her glucose level is 574
mg/dL, creatinine 0.8 mg/dL, potassium
3.7 mEq/L, sodium 137 mEq/L, and
white blood count 12700/microL. Her
urine dipstick shows glucose 4+ and
ketones 3+. She is given normal saline.
She is also given an infusion of the next
appropriate medication. Which of the
following side effects is most likely to
occur with this infusion?
Maculopapular rash
A 16-year-old male presents with a fever
and sore throat. On physical
examination, there are multiple swollen
lymph nodes in his neck, and
hepatosplenomegaly is noted. A
monospot test is positive. The patient is
advised to stop contact sports for a year,
and treatment with amoxicillin is
initiated. Which of the following is the
patient at high risk of developing due to
his current medication?
Ethosuximide
A 16-year-old presents for staring spells
that occur several times a day. Each
episode lasts only a few seconds and
occurs at random times of the day. The
patient continues regular activity after
the event and is not confused. The
patient is otherwise healthy with no
recent trauma or infections. The patient
is not on any medications. EEG reveals
a 3-Hz spike and waveform. Which of
the following is the first-line treatment for
this patient?
