A 75-year-old woman is re-admitted to an hospital with general complaints of fever (39ºC), malaise, anorexia, and flank pain. She had been released from the hospital about three days prior to this re-admission, after gallbladder removal. A Foley catheter had been inserted during her last admission and review of her records showed that she had fever 24 hours after surgery. She was treated with ampicillin. A urine specimen was obtained through the catheter and was found to contain pus cells and granular casts. A urine culture yielded colonies of an oxidase positive organism producing a green diffusible pigment.

The antibiogram shows the isolated strain to be resistant to beta-lactam antibiotics and susceptible to fluoroquinolones, vancomycin, aminoglycosides,and chloramphenicol. Which of the following antibiotics would you prescribe to this patient?

1. Chloramphenicol
2. Gentamycin
3. Levofloxacin
4. Piperacillin
5. Vancomycin

Answer

Tags: Geriatrics, Antibiotics

A 75-year-old woman is re-admitted to an hospital with general complaints of fever (39ºC), malaise, anorexia, and flank pain. She had been released from the hospital about three days prior to this re-admission, after gallbladder removal. A Foley catheter had been inserted during her last admission and review of her records showed that she had fever 24 hours after surgery. She was treated with ampicillin. A urine specimen was obtained through the catheter and was found to contain pus cells and granular casts. A urine culture yielded colonies of an oxidase positive organism producing a green diffusible pigment.

Which of the following organisms is most likely to be present on this patient's urine?

1. Escherichia coli
2. Klebsiella pneumoniae
3. Proteus mirabilis
4. Pseudomonas aeruginosa
5. Streptococcus viridans

Answer

Tags: Geriatrics, Infection

A 66-year-old male, is seen in the emergency room complaining of chest pain of sudden onset, cough productive of purulent and blood-tinged sputum, and fever, which rose abruptly after he had felt a sharp chill. Lab tests show a normal hematocrit, 20,000 WBC with 65% neutrophils and 10% bands. An X-ray of the thorax shows a consolidating pneumonia of the right middle lobe.

Sputum cultures were negative. What other cultures should have been ordered to confirm this patient’s diagnosis?

1. Blood
2. Broncho-alveolar lavage
3. CSF
4. Gastric aspirate
5. Urine

Answer

Tags: Geriatrics, Infectious Diseases

A 66-year-old male, is seen in the emergency room complaining of chest pain of sudden onset, cough productive of purulent and blood-tinged sputum, and fever, which rose abruptly after he had felt a sharp chill. Lab tests show a normal hematocrit, 20,000 WBC with 65% neutrophils and 10% bands. An X-ray of the thorax shows a consolidating pneumonia of the right middle lobe.

What would be the antibiotic of choice to start this patient while the cultures are pending?

1. Ampicillin
2. Levofloxacin
3. Penicillin G
4. Sulfamethoxazole-trimethoprim
5. Vancomycin

Answer

Tags: Geriatrics Quiz, antibiotics

A 66-year-old male, is seen in the emergency room complaining of chest pain of sudden onset, cough productive of purulent and blood-tinged sputum, and fever, which rose abruptly after he had felt a sharp chill. Lab tests show a normal hematocrit, 20,000 WBC with 65% neutrophils and 10% bands. An X-ray of the thorax shows a consolidating pneumonia of the right middle lobe.Which would be the most likely etiologic agent for this patient's pneumonia?

1. A combination of anaerobes
2. Klebsiella pneumoniae
3. Mycoplasma pneumoniae
4. Pneumocystis carinii
5. Streptococcus pneumoniae

Answer

Tags: Geriatric Quiz, Pneumonia

An 80 year-old man who attends a Senior Day Care facility develops malaise, low grade fever, diffuse aches, and a dry cough. His physician diagnoses Influenza B. To prevent an outbreak, employees and other seniors at his Day Care facility should receive a drug of which of the following classes?

A. DNA polymerase inhibitor

B. neuraminidase inhibitor

C. protease inhibitor

D. reverse transcriptase inhibitor

Answer

Tags: Geriatrics Quiz

Which of the following clinical manifestations of Streptococcus pneumoniae is most frequently involved as a cause of morbidity and mortality in an older adult?

1. Endocarditis
2. Meningitis
3. Otitis media
4. Pneumonia
5. Septic shock

Answer

Tags: Geriatrics Quiz

A 75-year-old widow living in a rural area comes to your office because she has had several colds last winter and is worried about her ability to fight disease. In discussing possible beneficial immunizations, which one of the following vaccines would be of least benefit for this patient?

1. Anthrax
2. Influenza
3. Pneumococcal
4. Tetanus


Answer