[PHARMA] MAGALONG - Dyslipidemia, DM, Hypoglycemia

52.Which of the following statements is TRUE regarding plasma elevations of rosuvastatin in Asians? A. It is higher than in Caucasians B. It entails higher dose requirements C. It is similar to the elevations in Caucasians D. It is lower than in Caucasians

A. It is higher than in Caucasians

34.What is the most common side effect of using insulin to treat diabetes mellitus type 2? A. Headaches B. Insulin resistance C. Muscle wasting D. Gastrointestinal adverse effects E. Hypoglycemia

E. Hypoglycemia

53.Which of the following drugs can potentially mask the symptoms of hypoglycemia in a diabetic patient? A. Antipsychotic agents B. Haloperidol C. Quinolones D. Beta blockers

D. Beta blockers

3.If a diabetic patient who has been taking insulin has been hospitalized for a different illness, which of the following management principles is CORRECT? A. Insulin should be stopped if the blood glucose is below 13 mmol/L B. Insulin should be doubled if plasma glucose rises and stays above 13 mmol/L C. Insulin should be decreased appropriately if plasma glucose falls below 13 mmol/L D. Insulin should not be stopped, even if the patient cannot eat

D. Insulin should not be stopped, even if the patient cannot eat

5.In which of the following conditions should insulin be started in a patient with DM Type 2? A. Patient's 2-hour postprandial RBS remain elevated despite combination metformin and GLP-1 agonist B. Patient's HbA1c level is not yet controlled despite 3 oral hypoglycemic agents being taken daily for 3 months C. Patient's FBS is not yet controlled despite 2 oral hypoglycemic agents being taken daily for 2+ months D. Patient's preprandial glucose remains uncontrolled despite maximum dose of metformin given for 6 months

B. Patient's HbA1c level is not yet controlled despite 3 oral hypoglycemic agents being taken daily for 3 months

6.Which of the following non-pharmacologic treatment principles is recommended for diabetic patients? A. Daily vitamin supplementation and chromium supplementation to lower blood glucose B. Meals should have more grains, bread, and vegetables compared to lean meat, low-fat dairy, and butter C. Regular intake of red wine equal to one standard serving (100 mL) for antioxidant benefits D. Removing all sucrose and sucrose-containing food from the diet

B. Meals should have more grains, bread, and vegetables compared to lean meat, low-fat dairy, and butter

19.Which of the following patient characteristics makes it more reasonable to go for a LOWER TARGET level for glucose control compared to most other DM patients? A. Patient with no family history of DM Type 2 B. Patient with only 1 risk factor for CVD C. Patient with 1 year history of DM Type 2 D. Patient with no active CVD

D. Patient with no active CVD

29.If a diabetic patient who has been taking insulin has been hospitalized for a different illness, which of the following management principles is CORRECT? A. Insulin should be stopped if the blood glucose is below 13 mmol/L B. Insulin should doubled if plasma glucose rises and stays above 13 mmol/L C. Insulin should not be stopped, even if the patient cannot eat D. Insulin should be decreased appropriately if plasma glucose falls below 13 mmol/L

C. Insulin should not be stopped, even if the patient cannot eat

30.What is the target organ/tissue of SGLT-2 inhibitors? A. Hepatic tissue B. Pancreas C. Renal tubules D. Intestinal gut wall

C. Renal tubules

31.Headaches and nasopharyngitis are common side effects of which class of OHAs? A. SGLT-2 inhibitors B. Biguanides C. Sulfonylureas D. DPP-4 inhibitors

D. DPP-4 inhibitors

34.What is the most common side effect of using insulin to treat diabetes mellitus type 2? A. Headaches B. Insulin resistance C. Muscle wasting D. Gastrointestinal adverse effects E. Hypoglycemia

E. Hypoglycemia

35.What is the mechanism of metformin as an OHA? A. Inhibits glucose absorption from kidneys B. Increases tissue insulin sensitivity C. Increases insulin secretion D. Inhibits hepatic gluconeogenesis

D. Inhibits hepatic gluconeogenesis

36.Acarbose targets which of the following organs/tissues? A. Renal tubules B. Hepatic tissue C. Intestinal wall tissue D. Pancreatic tissue

C. Intestinal wall tissue

41.What is the usual starting dose for long-acting insulin? A. 0.05 u/kg BW B. 0.01 u/kg BW C. 0.1 u/kg BW D. 0.5 u/kg BW

C. 0.1 u/kg BW

43.Increased serum cholesterol levels can be seen as a side effect with which of the following medications? A. All of the drugs mentioned can cause weight gain B. Rosiglitazone C. Repaglinide D. Glipizide

B. Rosiglitazone

44.If you are a primary care physician assigned to remote locations, which of the following methods of glucose monitoring is acceptable as the minimum standard of care? A. Capillary blood meters B. Random blood sugar testing C. Colorimetric strips D. Fasting blood sugar testing

C. Colorimetric strips

45.What is the recommended starting dose and regimen for Metformin in DM Type 2 patients? A. 500 mg twice a day B. 1000 mg twice a day C. 1000 mg once a day D. 500 mg once a day

A. 500 mg twice a day

46.Purely non-pharmacologic treatment for newly-diagnosed diabetic patients can be trialed for how long before medication should be started? A. 1 month B. 3 months C. 4 months D. 2 months

B. 3 months

48.Which of the following hormones are released from the gut and stimulates insulin secretion by the pancreas? A. DPP-4 B. GLP-1 C. SGLT-2 D. Amylin

B. GLP-1

53.Which of the following drugs can potentially mask the symptoms of hypoglycemia in a diabetic patient? A. Antipsychotic agents B. Haloperidol C. Quinolones D. Beta blockers

D. Beta blockers

57.What is the most common cause of patients not following their initial metformin regimen? A. Inconvenient daily dosing schedule B. Intolerance to the gastric side effects C. Difficult obtaining the medication D. Drug interactions with their prescribed statin

B. Intolerance to the gastric side effects

59.What is the target organ/tissue of SGLT-2 inhibitors? A. Intestinal gut wall B. Renal tubules C. Pancreas D. Hepatic tissue

B. Renal tubules

2.Which of the following is the drug of choice for lowering LDL-cholesterol but may slightly increase risk for DM? A. Ezetimibe B. Evolocumab C. Statins D. Fenofibrate

C. Statins

4.Which anti-dyslipidemic agent may reduce absorption of fat-soluble vitamins? A. Colesevelam B. Evolocumab C. Rosuvastatin D. Ezetimibe

A. Colesevelam

8.Which anti-dyslipidemic agent has been shown to reduce LDL-cholesterol by up to 71%? A. PCSK9 inhibitors B. Cholesterol absorption inhibitors C. Bile acid sequestrants D. Moderate-intensity statins

A. PCSK9 inhibitors

9.This is an injectable anti-dyslipidemic agent given every 2 to 4 weeks: A. Atorvastatin B. Fenofibrate C. Evolocumab D. Ezetimibe

C. Evolocumab

11.Which of the following conditions may cause dyslipidemia? A. Hypothyroidism B. Intake of beta-2 agonists C. Increased physical activity D. Low-fat diet

A. Hypothyroidism

12.Treatment of statin intolerance includes which of the following principles? A. Increasing the statin dose B. Withholding vitamin D C. Increasing frequency of administration D. Use of non-statin therapies such as ezetimibe

D. Use of non-statin therapies such as ezetimibe

13.Mr. X was taking atorvastatin for dyslipidemia. He also started taking high doses of gemfibrozil upon his neighbor's advice. He started to have severe muscle aches prompting consult. He needs to be evaluated for this rare but life-threatening adverse drug reaction: A. Cerebral hemorrhage B. Gallstones C. Rhabdomyolysis D. Agranulocytosis

C. Rhabdomyolysis

16.What is the mechanism of action of evolocumab? A. Binds bile acids in the gut B. Inhibits PCSK9 C. Inhibits HMG-CoA reductase D. Decreases catabolism of ApoA1

B. Inhibits PCSK9

17.Which of the following is primarily used to treat hypertriglyceridemia? A. Fenofibrate B. Ezetimibe C. Probucol D. Simvastatin

A. Fenofibrate

18.This lipid-altering agent inhibits absorption of cholesterol: A. Probucol B. Atorvastatin C. Ezetimibe D. Gemfibrozil

C. Ezetimibe

21.Which of the following lipid profiles should be targeted for lowering in diabetic patients? A. HDL B. Triglycerides C. LDL D. IDL

C. LDL

24.What is a common adverse effect of HMG-CoA reductase inhibitors? A. Gallstones B. Hypertriglyceridemia C. Cancer D. Elevation in liver transaminases

D. Elevation in liver transaminases

26.If a diabetic patient needs to aggressively lower his lipid parameters, which statin is recommended? A. Lovastatin B. Simvastatin C. Pravastatin D. Atorvastatin

D. Atorvastatin

27.Which of the following is a risk factor for statin-associated muscle symptoms? A. Obesity B. Diabetes C. Male gender D. Age less than 50 years

B. Diabetes

28.Which of the following is primarily used to treat hypertriglyceridemia? A. Ezetimibe B. Probucol C. Simvastatin D. Fenofibrate

D. Fenofibrate

38.If a diabetic patient needs to aggressively lower his lipid parameters, which statin is recommended? A. Lovastatin B. Atorvastatin C. Simvastatin D. Pravastatin

B. Atorvastatin

39.Which of the following are considered high-intensity statins? A. Atorvastatin 40 mg B. Pravastatin 40 mg C. Simvastatin 40 mg D. Lovastatin 40 mg

A. Atorvastatin 40 mg

40.Which of the following is a risk factor for statin-associated muscle symptoms? A. Male gender B. Obesity C. Age less than 50 years D. Diabetes

D. Diabetes

42.This drug class in combination with statins has been shown to reduce CV events in a subgroup of patients with low HDL and high TG: A. Bile acid sequestrants B. Probucol C. Fibrates D. Niacin

C. Fibrates

55.Which anti-dyslipidemic agent must be used with caution in patients with cholelithiasis? A. PCSK9 inhibitors B. Fish oil C. Fibrates D. Statins

C. Fibrates

58.Which anti-dyslipidemic agent is well-known to induce skin flushing? A. Atorvastatin B. Niacin C. Alirocumab D. Gemfibrozil

B. Niacin

60.A 59-year-old male was given a lipid-altering agent. Both his LDL and HDL levels went down. Which of the following is the most likely agent? A. Rosuvastatin B. Probucol C. Fenofibrate D. Niacin

B. Probucol

A 29-year-old woman presents with dysuria, frequency, and urgency. BP is 120/80 mmHg, CR is 84 bpm, RR is 16 cpm, and temperature is 36.8°C. The resident orders Nitrofurantoin 100 mg BID. Why is Nitrofurantoin appropriate?
A. Excellent renal parenchymal penetration
B. Excellent prostate penetration
C. Broad anti-pseudomonal activity
D. High urinary concentration and effectiveness for uncomplicated cystitis

D. High urinary concentration and effectiveness for uncomplicated cystitis

A 26-year-old woman presents with fever, flank pain, nausea, vomiting, and CVA tenderness. BP is 112/68 mmHg, CR is 118 bpm, RR is 24 cpm, and temperature is 39.2°C. Which antibiotic is LEAST appropriate?
A. Levofloxacin 750 mg daily
B. Cefixime
C. Cefuroxime
D. Nitrofurantoin 100 mg BID

D. Nitrofurantoin 100 mg BID

A 75-year-old man with chronic Foley catheterization develops septic shock. BP is 78/48 mmHg, CR is 140 bpm, RR is 34 cpm, temperature is 40°C, WBC count is 25,000/mm³, and creatinine is 3.1 mg/dL. Which is the BEST initial management?
A. Nitrofurantoin 100 mg BID
B. Fosfomycin 3 g single dose
C. Outpatient Levofloxacin 750 mg daily
D. Replace catheter, obtain cultures, admit to hospital, and start broad-spectrum IV antibiotics

D. Replace catheter, obtain cultures, admit to hospital, and start broad-spectrum IV antibiotics

A 23-year-old woman presents with dysuria, urgency, and frequency. She has no fever, flank pain, nausea, vomiting, or CVA tenderness. BP is 120/80 mmHg, CR is 76 bpm, RR is 16 cpm, and temperature is 36.7°C. Which diagnostic test is REQUIRED before starting treatment?
A. CT scan
B. Urine culture
C. Renal ultrasound
D. None

empiric treatment may be started for uncomplicated cystitis

D. None

empiric treatment may be started for uncomplicated cystitis

A 32-year-old woman presents with dysuria and frequency. BP is 118/72 mmHg, CR is 80 bpm, RR is 16 cpm, and temperature is 36.8°C. Urinalysis shows pyuria. The intern prescribes Meropenem 1 g IV q8h. Which statement is MOST correct?
A. Appropriate because pyuria is present
B. Appropriate because resistance rates are increasing
C. Appropriate because all UTIs require IV antibiotics
D. Inappropriate because uncomplicated cystitis should be treated with narrow-spectrum oral therapy

D. Inappropriate because uncomplicated cystitis should be treated with narrow-spectrum oral therapy

A 78-year-old man with a history of ischemic stroke 2 years ago is brought to the emergency department because of fever and productive cough for 3 days. His daughter reports that he frequently coughs while eating and has difficulty swallowing liquids. On examination, BP is 120/70 mmHg, CR is 112 bpm, RR is 28 cpm, temperature is 38.8°C, and oxygen saturation is 93% on room air. Chest radiograph demonstrates a right lower lobe infiltrate. Which is the MOST appropriate empiric antibiotic regimen?
A. Amoxicillin 1 g PO TID
B. Ceftriaxone 2 g IV daily
C. Azithromycin 500 mg IV daily
D. Ceftriaxone 2 g IV daily + Clindamycin 600 mg IV q8h

D. Ceftriaxone 2 g IV daily + Clindamycin 600 mg IV q8h

A 75-year-old woman with residual hemiparesis from a previous stroke develops fever, productive cough, and foul-smelling sputum. Chest radiography reveals right lower lobe consolidation. The resident starts Ceftriaxone 2 g IV daily. What is the BEST reason to add Clindamycin?
A. To provide MRSA coverage
B. To provide Pseudomonas coverage
C. To provide atypical coverage
D. To provide anaerobic coverage for aspiration pneumonia

D. To provide anaerobic coverage for aspiration pneumonia

A surgery resident asks why Clindamycin is routinely added to Vancomycin and Piperacillin-Tazobactam in suspected necrotizing fasciitis. Which statement is MOST accurate?
A. Clindamycin provides superior Gram-negative coverage.
B. Clindamycin prevents nephrotoxicity.
C. Clindamycin covers Pseudomonas aeruginosa.
D. Clindamycin inhibits bacterial ribosomes and decreases toxin production.

D. Clindamycin inhibits bacterial ribosomes and decreases toxin production

A patient with diabetic foot infection is receiving Piperacillin-Tazobactam and Vancomycin. During rounds, a consultant notices extensive foul-smelling tissue necrosis and adds Clindamycin. What additional pathogen group is Clindamycin primarily targeting?
A. MRSA
B. Pseudomonas
C. ESBL-producing organisms
D. Anaerobes

D. Anaerobes

A 79-year-old man with previous cerebrovascular accident is brought to the ICU because of respiratory distress. His family reports recurrent choking episodes during meals. On examination, BP is 86/54 mmHg, CR is 136 bpm, RR is 38 cpm, temperature is 39.6°C, and oxygen saturation is 84% on room air. Chest radiography demonstrates bilateral dependent infiltrates. Which regimen is MOST appropriate?
A. Amoxicillin 1 g PO TID
B. Cefuroxime 500 mg PO BID
C. Ceftriaxone 2 g IV daily + Clindamycin 600 mg IV q8h
D. Nitrofurantoin 100 mg BID

C. Ceftriaxone 2 g IV daily + Clindamycin 600 mg IV q8h

A 68-year-old woman with an indwelling Foley catheter for 12 days develops fever of 39°C. BP is 118/70 mmHg, CR 118 bpm, RR 22 cpm. The resident plans to obtain a urine specimen before starting antibiotics. Which is the MOST appropriate method?
A. Collect urine from the drainage bag
B. Collect urine from the distal catheter tubing
C. Midstream clean-catch specimen
D. Replace the catheter and obtain urine from the sampling port of the newly placed catheter

D. Replace the catheter and obtain urine from the sampling port of the newly placed catheter

A 79-year-old diabetic man has had an indwelling Foley catheter for 2 weeks. He develops fever, rigors, altered mental status, and hypotension. Vital signs reveal BP 82/50 mmHg, CR 136 bpm, RR 32 cpm, temperature 39.5°C, and oxygen saturation 92%. WBC count is 24,000/mm³. Creatinine is 2.8 mg/dL. Which of the following is the BEST initial management?
A. Nitrofurantoin 100 mg PO BID
B. Fosfomycin 3 g single dose
C. Ciprofloxacin 500 mg PO BID
D. Hospital admission, catheter replacement, cultures, and broad-spectrum IV antibiotics

D. Hospital admission, catheter replacement, cultures, and broad-spectrum IV antibiotics

A 30-year-old woman presents with dysuria and frequency for 3 days. Over the last 24 hours she developed fever of 39°C, chills, nausea, and right flank pain. BP is 112/70 mmHg, CR 118 bpm, RR 22 cpm. Which feature MOST strongly suggests pyelonephritis rather than uncomplicated cystitis?
A. Dysuria
B. Frequency
C. Urgency
D. Flank pain with fever and systemic symptoms

D. Flank pain with fever and systemic symptoms

A 76-year-old man presents with fever, dysuria, and decreased urine output. BP is 104/60 mmHg, CR 118 bpm, RR 24 cpm, temperature 38.9°C. Ultrasound reveals bilateral hydronephrosis and a 2.5-cm ureteropelvic junction stone. WBC count is 17,000/mm³. Which statement is MOST correct?
A. This is uncomplicated cystitis
B. Nitrofurantoin is preferred
C. Fosfomycin is preferred
D. This is a complicated UTI because of urinary tract obstruction

D. This is a complicated UTI because of urinary tract obstruction

A 25-year-old nonpregnant woman presents with dysuria, urgency, and frequency. She has no fever, flank pain, or systemic symptoms. Which antibiotic is LEAST appropriate?
A. Nitrofurantoin 100 mg PO BID
B. Fosfomycin 3 g single dose
C. Meropenem 1 g IV q8h
D. Appropriate oral therapy without admission

C. Meropenem 1 g IV q8h

A 23-year-old woman presents with dysuria, urgency, and frequency. She is afebrile with BP 118/78 mmHg, CR 80 bpm, RR 16 cpm. Urinalysis reveals pyuria. Urine culture has not yet been obtained. What is the MOST appropriate next step?
A. Obtain CT scan before treatment
B. Admit for IV antibiotics
C. Wait for urine culture before treatment
D. Treat empirically for acute uncomplicated cystitis without waiting for culture

D. Treat empirically for acute uncomplicated cystitis without waiting for culture

A 22-year-old nursing student consults because of painful urination for 2 days. She reports urinary frequency and urgency but denies fever, chills, nausea, vomiting, flank pain, or vaginal discharge. Her BP is 110/70 mmHg, CR is 78 bpm, RR is 16 cpm, and temperature is 36.7°C. Urinalysis reveals pyuria and positive leukocyte esterase. Which is the BEST treatment?
A. Fosfomycin 3 g single dose
B. Levofloxacin 750 mg PO daily × 5 days
C. Ceftriaxone 2 g IV daily
D. Nitrofurantoin 100 mg PO BID × 5 days

D. Nitrofurantoin 100 mg PO BID × 5 days

A 25-year-old woman presents with dysuria and urinary frequency for 2 days. During the last 12 hours, she developed fever, chills, nausea, and right flank pain. BP is 110/70 mmHg, CR is 116 bpm, RR is 22 cpm, and temperature is 39°C. Costovertebral angle tenderness is present. What is the BEST empiric treatment?
A. Nitrofurantoin 100 mg BID × 5 days
B. Fosfomycin 3 g single dose
C. Levofloxacin 750 mg PO daily × 5 days
D. Amoxicillin 1 g TID

C. Levofloxacin 750 mg PO daily × 5 days

A 30-year-old pregnant woman at 26 weeks gestation is noted to have >100,000 CFU/mL E. coli on urine culture obtained during routine prenatal screening. She denies dysuria, urgency, frequency, fever, chills, flank pain, and suprapubic discomfort. Her BP is 110/70 mmHg, CR is 84 bpm, RR is 18 cpm, and temperature is 36.8°C. What is the MOST appropriate management?
A. No treatment needed
B. Repeat urine culture after delivery
C. Start treatment only if symptoms develop
D. Treat asymptomatic bacteriuria because pregnancy is an indication

D. Treat asymptomatic bacteriuria because pregnancy is an indication

A 70-year-old woman undergoes an executive check-up. Urinalysis reveals bacteriuria. Urine culture subsequently grows 150,000 CFU/mL E. coli. She denies urinary symptoms. Her BP is 130/80 mmHg, CR is 72 bpm, RR is 16 cpm, and temperature is 36.5°C. What is the BEST management?
A. Nitrofurantoin 100 mg BID
B. Fosfomycin 3 g single dose
C. Ciprofloxacin 500 mg BID
D. No antibiotic treatment

D. No antibiotic treatment indicated

A 68-year-old man with benign prostatic hyperplasia presents with fever, dysuria, urinary hesitancy, and weak urinary stream. BP is 118/70 mmHg, CR is 110 bpm, RR is 22 cpm, and temperature is 38.6°C. Ultrasound demonstrates a post-void residual volume of 250 mL. What is the MOST accurate diagnosis?
A. Acute uncomplicated cystitis
B. Acute uncomplicated pyelonephritis
C. Asymptomatic bacteriuria
D. Complicated UTI

D. Complicated UTI

A 71-year-old diabetic man presents with fever, chills, flank pain, nausea, and vomiting. BP is 88/54 mmHg, CR is 132 bpm, RR is 30 cpm, temperature is 39.8°C, and HbA1c is 11.2%. CT scan reveals a 2-cm obstructing ureteral stone with hydronephrosis. Which is the BEST empiric antibiotic?
A. Nitrofurantoin 100 mg BID
B. Fosfomycin 3 g single dose
C. Co-amoxiclav 625 mg TID
D. Meropenem 1 g IV q8h

D. Meropenem 1 g IV q8h

A 74-year-old woman has had an indwelling Foley catheter for 10 days following hip surgery. She develops fever and suprapubic tenderness. BP is 120/70 mmHg, CR is 108 bpm, RR is 20 cpm, and temperature is 38.7°C. Urinalysis reveals pyuria. Which finding MOST strongly supports CAUTI?
A. Positive nitrite test
B. Positive leukocyte esterase
C. Pyuria
D. Presence of catheter plus compatible symptoms and no other source of infection

D. Presence of catheter plus compatible symptoms and no other source of infection

A 65-year-old man has an indwelling Foley catheter. He develops fever of 39°C. BP is 118/76 mmHg, CR is 112 bpm, RR is 24 cpm. A urine specimen is needed before antibiotics are started. Which is the BEST method?
A. Obtain urine from collection bag
B. Obtain urine from distal tubing
C. Midstream clean-catch specimen
D. Replace catheter and obtain urine from sampling port

D. Replace catheter and obtain urine from sampling port

A 63-year-old diabetic man with HbA1c of 10.5% presents with fever, dysuria, flank pain, and vomiting. BP is 90/60 mmHg, CR is 128 bpm, RR is 30 cpm, and temperature is 39.5°C. Which factor is the STRONGEST indication for hospital admission?
A. Dysuria
B. Positive urinalysis
C. Fever
D. Severe illness with signs of sepsis

D. Severe illness with signs of sepsis

A 25-year-old nonpregnant woman presents with a 2-day history of dysuria, urinary frequency, and urgency. She denies fever, chills, flank pain, nausea, vomiting, or vaginal discharge. Her blood pressure is 120/80 mmHg, cardiac rate is 88 beats/min, respiratory rate is 16 breaths/min, and temperature is 36.9°C. Which of the following is the most appropriate treatment?
A. Ciprofloxacin 500 mg PO BID for 7 days
B. Levofloxacin 750 mg PO daily for 5 days
C. Nitrofurantoin 100 mg PO BID for 5 days
D. Meropenem 1 g IV q8h

C. Nitrofurantoin 100 mg PO BID for 5 days

A 27-year-old woman presents with a 3-day history of fever, chills, dysuria, nausea, and left flank pain. On examination, her blood pressure is 110/70 mmHg, cardiac rate is 118 beats/min, respiratory rate is 24 breaths/min, temperature is 39.2°C, and there is marked left costovertebral angle tenderness. Which of the following is the most appropriate empiric treatment?
A. Nitrofurantoin 100 mg PO BID for 5 days
B. Fosfomycin 3 g single dose
C. Levofloxacin 750 mg PO daily for 5 days
D. Amoxicillin 500 mg PO TID

C. Levofloxacin 750 mg PO daily for 5 days

A 79-year-old man presents with fever, dysuria, urinary hesitancy, and suprapubic discomfort. His blood pressure is 90/60 mmHg, cardiac rate is 130 beats/min, respiratory rate is 32 breaths/min, and temperature is 39.5°C. Ultrasound reveals significant bladder outlet obstruction due to benign prostatic hyperplasia with a post-void residual volume of 300 mL. Which of the following is the most appropriate empiric treatment?
A. Nitrofurantoin 100 mg PO BID
B. Fosfomycin 3 g single dose
C. Co-amoxiclav 625 mg PO TID
D. Meropenem 1 g IV q8h

D. Meropenem 1 g IV q8h

A 69-year-old woman who has been hospitalized for 10 days develops fever, suprapubic pain, and cloudy urine. She has had an indwelling Foley catheter since admission. Her blood pressure is 115/70 mmHg, cardiac rate is 112 beats/min, respiratory rate is 24 breaths/min, and temperature is 38.7°C. Laboratory studies reveal leukocytosis. Which of the following is the most likely diagnosis?
A. Acute uncomplicated cystitis
B. Acute uncomplicated pyelonephritis
C. Asymptomatic bacteriuria
D. Catheter-associated urinary tract infection (CAUTI)

D. Catheter-associated urinary tract infection (CAUTI)

A 24-year-old sexually active woman presents with a 2-day history of dysuria, urinary frequency, urgency, and nocturia. She denies flank pain, fever, chills, nausea, vomiting, or vaginal discharge. On examination, BP is 118/76 mmHg, CR is 82 bpm, RR is 16 cpm, and temperature is 36.8°C. Urinalysis shows 15-20 WBC/HPF and positive leukocyte esterase. Which is the MOST appropriate treatment?
A. Levofloxacin 750 mg PO daily × 5 days
B. Ceftriaxone 2 g IV daily
C. Nitrofurantoin 100 mg PO BID × 5 days
D. Meropenem 1 g IV q8h

C. Nitrofurantoin 100 mg PO BID × 5 days

A 28-year-old G2P1 woman at 18 weeks AOG presents for routine prenatal consultation. She denies dysuria, frequency, urgency, fever, chills, flank pain, or suprapubic pain. Vital signs are BP 110/70 mmHg, CR 78 bpm, RR 16 cpm, and temperature 36.7°C. Urine culture obtained during prenatal screening reveals 150,000 CFU/mL of E. coli. What is the MOST appropriate management?
A. No treatment because she has no symptoms
B. Repeat urine culture after delivery
C. Start Nitrofurantoin only if symptoms develop
D. Treat asymptomatic bacteriuria because pregnancy is an indication for treatment

D. Treat asymptomatic bacteriuria because pregnancy is an indication for treatment

A 65-year-old woman with well-controlled hypertension presents for an annual physical examination. She denies urinary symptoms. BP is 130/80 mmHg, CR 76 bpm, RR 16 cpm, and temperature 36.6°C. Routine urinalysis shows bacteriuria, and urine culture grows 120,000 CFU/mL E. coli. What is the MOST appropriate management?
A. Nitrofurantoin 100 mg BID × 5 days
B. Fosfomycin 3 g single dose
C. Ciprofloxacin 500 mg BID × 7 days
D. No antibiotic treatment indicated

D. No antibiotic treatment indicated

A 72-year-old man has been admitted for ischemic stroke and has had a Foley catheter for 8 days. He develops fever, suprapubic pain, and worsening confusion. Vital signs show BP 108/68 mmHg, CR 112 bpm, RR 24 cpm, temperature 38.8°C, and oxygen saturation 97% on room air. CBC shows WBC 18,000/mm³. Urinalysis demonstrates pyuria and bacteriuria. Which of the following findings MOST strongly supports the diagnosis of catheter-associated UTI?
A. Positive urine dipstick alone
B. Pyuria alone
C. Indwelling urinary catheter plus compatible symptoms and no alternative source of infection
D. Positive leukocyte esterase

C. Indwelling urinary catheter plus compatible symptoms and no alternative source of infection

According to the AGS Beers Criteria, why should indomethacin generally be avoided in older adults?
A. Causes severe hypoglycemia
B. Causes serotonin syndrome
C. Causes hypothyroidism
D. Has a higher risk of CNS adverse effects, gastrointestinal bleeding, and acute kidney injury compared with other NSAIDs

D. Has a higher risk of CNS adverse effects, gastrointestinal bleeding, and acute kidney injury compared with other NSAIDs

An 84-year-old woman with severe osteoarthritis takes naproxen daily. She was recently started on prednisone for polymyalgia rheumatica. Her medication list also includes pantoprazole. According to the AGS Beers Criteria, which is the MOST appropriate management?
A. Discontinue naproxen
B. Discontinue prednisone
C. Continue pantoprazole because concomitant NSAID and corticosteroid use increases GI bleeding risk
D. Discontinue pantoprazole because PPIs should always be avoided in older adults

C. Continue pantoprazole because concomitant NSAID and corticosteroid use increases GI bleeding risk

Which of the following medications should be used cautiously in older adults because prolonged use may cause tardive dyskinesia?
A. Famotidine
B. Ondansetron
C. Pantoprazole
D. Metoclopramide

D. Metoclopramide

Which of the following BEST describes the purpose of the START criteria?
A. Detect drug-drug interactions
B. Detect renal dosing errors
C. Identify prescribing omissions
D. Identify anticholinergic medications

C. Identify prescribing omissions

Which of the following BEST describes the STOPP criteria?
A. Detect medications omitted from treatment
B. Detect patient noncompliance
C. Identify potentially inappropriate medications
D. Detect medication allergies

C. Identify potentially inappropriate medications

Which of the following is a major goal of the AGS Beers Criteria?
A. Increase medication use
B. Increase specialist referrals
C. Reduce polypharmacy and adverse drug reactions
D. Increase prescription rates

C. Reduce polypharmacy and adverse drug reactions

What is the primary clinical value of measuring frailty in older adults?
A. Determining eligibility for hospitalization
B. Predicting medication adherence
C. Identifying patients requiring intensive disease control
D. Shifting the focus from individual diseases toward holistic patient-centered care

D. Shifting the focus from individual diseases toward holistic patient-centered care

A 67-year-old man comes to the emergency department because of a 4-day history of productive cough, fever, and right-sided pleuritic chest pain. He has a history of type 2 diabetes mellitus controlled with oral medications. On examination, he is alert and oriented. His blood pressure is 120/80 mmHg, cardiac rate is 112 beats/min, respiratory rate is 24 breaths/min, temperature is 38.5°C, and oxygen saturation is 96% on room air. His HbA1c is 6.8%. Crackles are heard over the right lower lung field, and chest radiography shows a right lower lobe infiltrate. What is the most appropriate empiric antibiotic regimen?
A. Amoxicillin 1 g PO TID
B. Ceftriaxone 2 g IV daily + Azithromycin 500 mg IV daily
C. Co-amoxiclav 875/125 mg PO BID + Azithromycin 500 mg PO daily
D. Piperacillin-Tazobactam 4.5 g IV q6h

C. Co-amoxiclav 875/125 mg PO BID + Azithromycin 500 mg PO daily

A 74-year-old woman is brought to the emergency room because of progressive cough, fever, and shortness of breath. On examination, she appears confused and disoriented. Her blood pressure is 100/60 mmHg, cardiac rate is 128 beats/min, respiratory rate is 34 breaths/min, temperature is 39°C, and oxygen saturation is 89% on room air. Chest radiography reveals bilateral patchy infiltrates. She has no known history of chronic lung disease. Which of the following is the most appropriate empiric antibiotic regimen?
A. Amoxicillin 1 g PO TID
B. Co-amoxiclav 875/125 mg PO BID
C. Ceftriaxone 2 g IV daily + Azithromycin 500 mg IV daily
D. Nitrofurantoin 100 mg PO BID

C. Ceftriaxone 2 g IV daily + Azithromycin 500 mg IV daily

A 70-year-old man with severe chronic obstructive pulmonary disease and bronchiectasis presents with fever, worsening dyspnea, and productive cough. He was previously admitted for a Pseudomonas aeruginosa respiratory infection. On examination, he appears toxic. His blood pressure is 85/55 mmHg, cardiac rate is 140 beats/min, respiratory rate is 38 breaths/min, temperature is 39.6°C, and oxygen saturation is 84% on room air. Chest radiography demonstrates multilobar pneumonia. Which of the following is the most appropriate empiric antibiotic regimen?
A. Ceftriaxone 2 g IV daily + Azithromycin 500 mg IV daily
B. Co-amoxiclav 875/125 mg PO BID
C. Piperacillin-Tazobactam 4.5 g IV q6h + Azithromycin 500 mg IV daily
D. Amoxicillin 1 g PO TID

C. Piperacillin-Tazobactam 4.5 g IV q6h + Azithromycin 500 mg IV daily

A 62-year-old man with poorly controlled diabetes mellitus presents with a painful ulcer on the plantar aspect of his foot. He reports increasing redness and mild purulent drainage over the past week. His blood pressure is 130/80 mmHg, cardiac rate is 96 beats/min, respiratory rate is 18 breaths/min, and temperature is 37.9°C. Laboratory evaluation reveals an HbA1c of 10.2%. Physical examination demonstrates a 2-cm ulcer with surrounding erythema but no signs of systemic toxicity. What is the most appropriate empiric treatment?
A. Clindamycin 300 mg PO QID
B. Piperacillin-Tazobactam 4.5 g IV q6h + Vancomycin
C. Meropenem 1 g IV q8h
D. Ceftriaxone 2 g IV daily

A. Clindamycin 300 mg PO QID

A 66-year-old man with long-standing diabetes mellitus presents with fever, progressive foot swelling, foul-smelling discharge, and increasing pain. On examination, his blood pressure is 90/60 mmHg, cardiac rate is 126 beats/min, respiratory rate is 30 breaths/min, and temperature is 39.5°C. His HbA1c is 12.5%. The foot demonstrates extensive cellulitis, purulent drainage, and areas of tissue necrosis. What is the most appropriate empiric antibiotic regimen?
A. Clindamycin 300 mg PO QID
B. Levofloxacin 750 mg PO daily
C. Cefalexin 500 mg PO QID
D. Piperacillin-Tazobactam 4.5 g IV q6–8h + Vancomycin 15–20 mg/kg IV q8–12h

D. Piperacillin-Tazobactam 4.5 g IV q6–8h + Vancomycin 15–20 mg/kg IV q8–12h

A 58-year-old diabetic man is brought to the emergency department because of severe right leg pain that began suddenly 12 hours ago. He describes the pain as 10/10 in intensity and far worse than expected from the appearance of the skin lesion. On examination, his blood pressure is 80/50 mmHg, cardiac rate is 142 beats/min, respiratory rate is 34 breaths/min, temperature is 39.8°C, and HbA1c is 11.7%. The affected leg demonstrates hemorrhagic bullae, dusky skin discoloration, and palpable crepitus. Plain radiography reveals gas within the soft tissues. Which of the following is the most appropriate empiric antibiotic regimen?
A. Ceftriaxone 2 g IV daily
B. Vancomycin 15 mg/kg IV q12h
C. Meropenem 1 g IV q8h
D. Piperacillin-Tazobactam 4.5 g IV q8h + Vancomycin 15–20 mg/kg IV q8–12h + Clindamycin 600–900 mg IV q8h

D. Piperacillin-Tazobactam 4.5 g IV q8h + Vancomycin 15–20 mg/kg IV q8–12h + Clindamycin 600–900 mg IV q8h