W10-T.IAI QUESTION 1 The most important component of treatment of a perforated appendix is: A. Using the best antimicrobial regimen B. A surgical procedure, including drainage and repair Selected this answer at 2024-10-22 9:37 AM (UTC-7) C. Aggressive IV fluid therapy D. Enteral nutrition supplementation QUESTION 2 (a) is generally caused by a single organism, (b) in patients undergoing chronic ambulatory peritoneal dialysis (CAPD) or (c) in patient with cirrhosis. A. (a) Primary peritonitis (b) E. coli - (c) S. aureus Selected this answer at 2024-10-22 9:39 AM (UTC-7 B. (a) Secondary peritonitis (b) E. coli (c) 5. aureus C. (a) Primary peritonitis - (a) S. aureus - (c) E. coli Selected this answer at 2024-10-22 9:37 AM (UTC-7) D. (a) Secondary peritonitis (b) S. aureus (c) E. coli Right answer: C QUESTION 3 (a) is usually caused by a mixture of bacteria, including enteric (b) and anaerobes, which enhance the pathogenic potential of the bacteria. A. (a) Primary peritonitis (b) Gram positive cocci B. (a) Primary peritonitis (b) Gram negative bacilli C. (a) Secondary peritonitis -(a) Gram positive cocci D. (a) Secondary peritonitis - (b) Gram negative bacilli Selected this answer at 2024-10-22 9:38 AM (UTC-7) APP- QUESTION 1 A S9-year-old woman with history of cirrhosis secondary to alcohol abuse is admitted from an outside hospital for altered mental status and concern for hepatic encephalopathy. The patient lives at home, and the day before admission, the patient told her spouse that her stomach was hurting. The spouse expresses concern that the patient was not receiving lactulose for the past 1.5 weeks and missed her recent liver clinic appointment. The patient was initially admitted for less than 24 hours to an outside hospital and received unknown antibiotics before transfer to the current hospital. On exam, the patient is drowsy and not very responsive to questions. Patient appears jaundiced and is complaining of abdominal pain. No nausea, vomiting, or shortness of breath is observed. Home medications: Folic acid 1 mg orally every day, Lactulose 10 g orally twice a day, Magnesium oxide 400 mg orally twice a day, Pantoprazole 40 mg orally every day, Potassium chloride 20 mEq orally twice a day, Hydrochlorothiazide 25 mg orally every day, Spironolactone 25 mg orally every day ALL: NKDA Pertinent Labs: Total bilirubin 11.5 mg/dL (197 µmol/L), Direct bilirubin 3.9 mg/dl (67 µmol/L), Alkaline phosphatase 68 U/L (1.13 ukat/L), AST/ALT 65/27 U/L (1.08/0.45 ukat/L), Albumin 2.3 g/dl (23 g/L), Creatinine 0.7 mg/dl (62 µmol/L), WBC 14.8×109/L (14,800/µl), Hemoglobin 8.9 g/dL (89 g/L: 5.52 mmol/L), Platelets 92 x 109/L (92,000/ µL), INR 3.2 No significant culture history Vitals: Pulse 106 BPM, Respiratory rate 24 BPM, BP 145/65 mm lig, O2 Saturation 96% (0.96) on room air, Tmax 38°C Diagnostic paracentesis on admission: Ascites fluid cell count/differential; Color: Yellow, cloudy; WBC: 8,080 cells/µl (8.08 109/L); RBC: 5,280 cells/µl. 15.28 109/L); Neutrophil: 74% (0.74); Gram stain: negative 1. Case1, How do you classify this patient's infection? A. Cholecystitis B. Cholangitis C. Spontaneous bacterial peritonitis D. Secondary bacterial peritonitis QUESTION 2 Case1, What laboratory data and patient symptoms support the diagnosis above? Select all that apply. A. h/o Liver cirrhosis B. fever C. abdominal pain D. ascitic fluid with PMN 250 cells/mcl E. negative gram stain of ascitic fluid QUESTION 3 Case1, What is the most common pathogen that could cause this syndrome? A. Bacteroides fragilis B. Candida albicans C. E. coli D. Pseudomonas aeruginosa E. Staphylococcus aureus QUESTION 4 Case1, what empiric therapy is the best to initiate? A. Cefepime B. Cefepime + metronidazole C. Ceftriaxone D. Ceftriaxone + metronidazole E. Meropenem QUESTION 5 Case1, Which is the best drug for prophylaxis after treatment? A. Ceftriaxone 1gram IV daily B. Vancomycin 125 mg PO BID C. Ciprofloxacin 500 mg PO qday D. Linezolid 600 mg PO BID QUESTION 6 The most reasonable initial intraperitoneal empiric antimicrobial therapy for a 46-year-old male patient with peritoneal dialysis associated peritonitis and a history of immediate hypersensitivity reaction (reaction occurred within the last year) to penicillin is: A. Cefazolin plus ceftazidime (LD 500 mg/L, MO 125 mg/l, for each Cefepime (LD 500 mg/L, MD 125 mg/L 8. C Vancomycin (LD 1,000 mg/L, MD 25 mg/L) plus tobramycin (LD 8 mg/L, MD 4 mg/ D. Metronidazole (LD 250 mg/L, MO 50 mg/L) APP2-

Peritonitis Treatment and Causes

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