Board Review
Choosing Wisely
Kids and Teens
Pearls
100
A 52-year-old female presents with a 5-day history of nasal congestion, facial pressure, heavy nasal discharge, and decreased sense of smell. She has not had a fever and says her symptoms have not started to improve. She is mildly tender over both maxillary sinuses.
Even though you have reassured her that this is most likely a viral illness, she would like antibiotics because she is going on vacation in 2 days and she wants to be better for her trip.
Which one of the following strategies has been shown to improve the acceptance of symptomatic care only and reduce the use of antibiotics in this situation?
A) Using medical terminology for the condition, such as acute bronchitis or acute tracheitis
B) Providing a “pocket” prescription with advice to fill it after a defined period without improvement
C) Ordering sinus radiographs
D) Referral to a specialist
What is B) Providing a "pocket" prescription?
100
Antibiotics should only be prescribed for mild-moderate acute sinusitis lasting at least this long
What is 10 days?
100
The percentage of antibiotic prescriptions in children thought to be unnecessary.
What is 50%?
100
Up to 10% of the US population is listed as allergic to this antibiotic
What is penicillin?
200
A healthy 30-year-old male presents to your office with a 2-cm abscess on his leg. There is no surrounding erythema and he is afebrile. You incise and drain the abscess. Which one of the following would be the most appropriate management for this patient?
A) Observation only
B) Amoxicillin/clavulanate (Augmentin)
C) Cephalexin (Keflex)
D) Clindamycin (Cleocin)
E) Trimethoprim/sulfamethoxazole (Bactrim)
What is A) Observation only?
200
This is an unacceptable indication for foley catheter placement in the hospital.
What is intake/output monitoring?
What is incontinence?
What is convenience?
200
Which one of the following topical antibiotics used in the treatment of acne vulgaris is not known to increase bacterial resistance?
A) Benzoyl peroxide
B) Clindamycin (Cleocin)
C) Dapsone (Aczone)
D) Erythromycin
E) Metronidazole
What is A) Benzoyl peroxide ?
200
Of those who are listed allergic to penicillin, this is the estimated percentage of patients who actually are.
What is 10%?
300
An 86-year-old female is in the emergency department with community-acquired pneumonia confirmed on a chest radiograph. Physical findings include a temperature of 38.4°C (101.1°F), a pulse rate of 101 beats/min, a blood pressure of 101/50 mm Hg, an oxygen saturation of 90% on room air, and a respiratory rate of 32/min. The patient is awake, alert, and oriented times three. The physical examination is otherwise unremarkable except for coarse breath sounds in the left lung base. Laboratory findings include a BUN level of 14 mg/dL (N 8–25), a serum creatinine level of 0.7 mg/dL (N 0.6–1.5), a blood glucose level of 144 mg/dL, and a WBC count of 15,000/mm3 (N 4300–10,800). Which one of the following would be most appropriate?
A) Discharge to home and treatment with azithromycin (Zithromax)
B) Discharge to home and treatment with amoxicillin/clavulanate (Augmentin)
C) Discharge to home and treatment with amoxicillin/clavulanate plus azithromycin
D) Hospital admission and treatment with amoxicillin/clavulanate
E) Hospital admission and treatment with ceftriaxone (Rocephin) plus azithromycin
What is E) Hospital admission and treatment with ceftriaxone (Rocephin) plus azithromycin?
300
Asymptomatic bacteriuria in older adults should be treated with...
What is nothing?
300
A 4-year-old female is brought to your office after a recent camping excursion and presents with a large number of mosquito bites. She has developed a number of areas of honey-colored crusting lesions you diagnose as nonbullous impetigo. Which one of the following oral medications is preferred for this patient?
A) Cephalexin (Keflex)
B) Doxycycline
C) Erythromycin
D) Penicillin VK
E) Trimethoprim/sulfamethoxazole (Bactrim)
A. Cephalexin
300
A 55 year old man was found in a v fib cardiac arrest. He was treated 3 days ago by his PCP for community acquired pneumonia. This antibiotic is likely implicated.
What is azithromycin?
400
A 27-year-old male calls and reports that he has an elevated temperature of 101.5°F(38.6°C). He underwent a surgical splenectomy following an automobile accident 5 months ago. He has no allergies and is otherwise healthy.
Which one of the following would be the most appropriate recommendation for this patient?
A) Temperature monitoring with follow-up if it exceeds 39.0°C (102.2°F)
B) Antipyretics to maintain a temperature <39.0°C (102.2°F)
C) Oral antibiotics, with follow-up if the elevated temperature persists
D) Urgent parenteral antibiotic therapy
What is D) Urgent parenteral antibiotic therapy?
400
What is stasis dermatitis?
400
This imaging study should be ordered on children with suspected bronchiolitis.
What is no imaging study?
400
This is the best way to prevent spread of infection.
What is handwashing?
500
A healthy 50-year-old male consults you about preparations for a business trip to India. He will be traveling in rural areas at times and has read that he should have antibiotics with him in case of traveler’s diarrhea. Which one of the following would be best for you to prescribe?
A) Trimethoprim/sulfamethoxazole (Bactrim)
B) Azithromycin (Zithromax)
C) Ciprofloxacin (Cipro)
D) Rifampin (Rifadin)
E) Doxycycline
What is B) Azithromycin (Zithromax)?
500
A 30 year old ICU nurse has been taking care of several patients with c diff. she is concerned abiut the possibility of infection but is asymptomatic. Which one of the following is the most appropriate recommendation for this nurse?
A. No testing and no treatment.
B. Testing for toxin.
C. Testing for antigen
D. empiric treatment with metronidazole.
E. Probiotics.
What is A. No testing and treatment?
500
Parents of children ages 2-12 with non-severe symptoms acute otitis media should routinely be given this option for treatment.
What is observation?