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Examination on “infectious complications of neoplastic disease”
xamination hStiC
on “Infectious
disease”
complications
0
(Polsky B, Armstrong D., AM J INFECT CONTROL 13:199-209,l
~ducat~onel objectives. This multiple-choice examination is designed to test your understanding of the content of the assigned article. After reading the article and taking the examination, enrollees should be able to meet the following educational objectives: 1. Recognize the epidemiologic factors associated with specific opportunistic infections in the immunocompromised patient 2. List, according to the specific host immune defect, the organisms that commonly cause infections in the immunocompromised patient 3. identify the organisms associated with infections related to invasive diagnostic and therapeutic procedures in the immunocompromised patient 4. Recognize that clinical signs and symptoms of infections in immunocompromised patients may be different from those seen in nonimmunocompromised patients 5. Summarize the clinical and diagnostic findings used for the diagnosis of infections in the immunocompromised patient 6. List the laboratory methods that are helpful in the identification of specific pathogens causing infections in immunocompromised patients 7. Select the procedure that provides the most precise diagnosis of infection in the patient with a neoplastic disease 6. Discuss the interventions that have been found to be valuable in improving the outcome of immunocompromised patients
instructions to CE enrollees. Please complete the test without turning to the article. There is only one correct answer to each question. The passing score is 18 correct answers (75%). This examination has been approved for 1 hour of continuing education credit for physicians and others needing Category 1 CME credit; nurses and others who need contact hours will receive 2 hours of credit. The deadline for submitting test answers is April 25, 1986. For CE enrollment information, see the announcement on the page foilowing this test. ntification XAMilNATlON
Number ICI051 QUESTIONS
1. In the immunocompromised patient an infection caused by which of the following organisms would most likely be associated with exposm-e to farm animals? a. Giaudia lamblia
b. Aeromonas hydvophila c. Listeria monocytogenes d. Toxoplasma gondii 2. The most likely source of an outbreak of pulmonary aspergillosis on a renal transplant unit is: a. The ventilation system b. The respiratory therapy equipment c. A nurse with respiratory colonization by
Aspergilltrs
d. Contaminated prepackaged sterile saline 3. The most common opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS) is: a. Disseminated herpes simplex infection b. Pneumocystis carinii pneumonia c. Invasive candidiasis d. Pulmonary aspergillosis 4. Which organism is most likely to cause pneumonia in the neutropenic patient? a. Pneumocystis cavinii
b. Peptostveptococcus c. Klebsiella pneumoniae d. Cytomegalovirus 5. Splenectomized patients
are
at
an
in-
Voiume
13 Number
October,
5
Continuing education
1985
creased risk of infections the following except:
caused by all of
a. Streptococcus pneumoniae emophilus influenzae b. c. sseria meningitidis d. Pseudomonas aeruginosa 6. Which of these is the most likely cause of meningitis in a patient with a normal neuzrophil count whose T cells are suppressed by chemotherapy? a. Cryptococcus neoformans b. Streptococcus pneumoniae
c. Toxoplasma gondii d. Nocardia asteroides 7. There is an increased risk of disseminated disease from atypical mycobacterium in all of the following except: a. Lymphoreticular malignancies one marrow transplants d. Splenectomized patients with Hodgkin’s disease 8. A neutropenic patient with an indwelling central venous catheter is at an increased risk of infection from skin colonization with: a. Corynebacterium sp. b. Nocardia sp. c. Plasmodium sp. d. Bacillus sp. 9. Which of the following procedures is associated with the smallest or least risk of Candida infection in the immunocompromised patient? a. Indwelling bladder catheterization b. Indwelling venous catheterization c. Splenectomy d. Bone marrow aspiration IO. Which of these statements about a neutropenic patient with disseminated candidiasis is correct? a. Blood cultures are useful in establishing a diagnosis b. Antimicrobial therapy should be started after positive identification of the organism 6. Meutropenic patients are frequently colonized with Candida d. The high mortality rate is associated with a poor response to antimicrobial therapy
il.
In the neutropenic patient with meningitis, diagnostic clues may be limited ts: a. Opisthotonos (spasms and hyperextension) b. Neck rigidity c. Subtle mental changes d. Headache 12. Skin lesions are helpful in establishing the diagnosis of infections caused by all of the following organisms except: a. Varicella-zoster virus b. Nocardia asteroides
c. Candida d. Pneumocystis carinii 13. All of the following are useful in predicting the causative organisms of infections in an immunocompromised patient except: a. The patient’s basic neoplastic disease b. Peripheral neutrophil counts current antineoplastic c. The patient’s therapy d. The age of the patient 14. A patient with Hodgkin’s disease is admitted with pneumonia. A chest film reveals a dense pulmonary infiltrate with cavity formation, and a Gram’s stain of a needle-aspirated specimen from the cavity shows gram-positive branching bacilli. The most likely causative agent is: a. Nocardia asteroides b. Histoplasma capsulatum
c. Legionella pneumophila d. Toxoplasma gondii 15. Meningitis is suspected in a neutropenic patient with Hodgkin’s disease who is currently on chemotherapy. An examination of CSF shows pleocytosis, but no organisms are identified on Gram’s stain or india ink preparations, and the cryptococcal antigen test is negative. The most likely presumptive diagnosis is: a. Meningitis due to Listeria monocyto-
genes b. Pneumococcal
brain abscess
c. Nocardia asteroides brain abscess d. Haemophilus infhenzae meningitis 16. Which of these statements about Nocardia asteroides pneumonia in patients with Tlymphocyte defects is incorrect? a. Roentgenograms dense pulmonary
of the lungs infiltrates
reveal
American
Continuing education b. Cavity and abscess formation occur frequently c. Skin lesions may also be present d. Nocardia may be recovered from cultures of transbronchial aspirates within 48 hours of incubation 17. Which of these statements about Candida pneumonia that develops as a consequence of disseminated disease is incorrect? a. The organisms find their way into the bloodstream from the gastrointestinal tract b. Roentgenograms of the lung show multiple bilateral nodules c. Isolation of organisms from the sputum is an indication of pulmonary infection d. Patients may have an elevated arabinatol to creatinine serum ratio 18. A diagnosis of disseminated histoplasmosis is best made by culture of which of the following specimens? a. Skin lesions b. Serum c. Sputum d. Bone marrow aspirate 19. All of the following laboratory tests are diagnostic for Legionella pneumonia except: a. India ink stain on fresh sputum specimens b. Direct fluorescent antibody test of fresh specimens c. Dieterle stain of fixed specimens d. Culture on charcoal yeast extract medium
‘NFECTION
dournal
of
CONTROL
20. Which of these tests is the most specific in the diagnosis of a brain abscess? a. CT scan of the head b. Serologic antibody titers c. Diagnostic brain biopsy d. Cultures of CSF 21. Which diagnostic test is the least helpful in establishing a definitive diagnosis of pulmonary aspergillosis? a. Transbronchial biopsy b. Open lung biopsy c. Serology for specific antibody d. Sputum cultures 22. Which of the following is most useful in improving the outcome of infected neutropenic patients? a. Prophylactic antimicrobial therapy b. Agent-specific antimicrobial therapy c. Leukocyte transfusions d. Immunotherapy 23. Clinical cure of the neutropenic patient with invasive pulmonary aspergillosis is associated with: a. Remission of underlying disease b. Two weeks of therapy wi.th amphoteritin B c. Cessation of chemotherapeutic agents d. Clinical improvement of aspergillosis 24. Amphotericin B is indicated. for all of the following except: a. Disseminated candidiasis b. Aspevgilhs pneumonia c. Cryptococcal meningitis d. Nocardia asteroides pneumonia
NTINUING EDUCATI Now you can earn CE credits by reading the Amefjoa~ Jcwrnai of Infection Control...And it’s as easy as1...2...3! 1. Read the article. 2. Take the test. 3. Mail your completed answer form and enrollment coupon along with your remittance. All-in-One Package A test offering with everything you need for CE credit appears in selected issues of the AmeriGan Journal of Infection Control. The selected article, the test, and all necessary forms are all together in one convenient package. You Decide This self-paced study program lets you make the decisions. You decide which tests to take and when to take them, (You have up to 6 months to complete any one exam. Check the expiration date that appears on each test.) Study at your leisure in the atmosphere of your choice. Performance bedback Two to three weeks after we receive your answer form, Health Education International, you your results and the correct answers. RM: Infectious complications Test ~dentifi~atjon No. lC7051 ~N/Med Tech: 2.0 Contact Hours/O.2 CEU MD: I.6 Category 1 Credit/O.1 CEU Test fnstructions
and Enrollment
Enrollees who have a passing score will receiv certificate. Accreditation The University of C~~jfor~ia~ San Diego School of Medicine designates this continuing medical education activity acceptable for credit hours in Category 1 of the Physician’s Recognition Award of the American Medical Association and for the Ce~if~c~ti~n Program of the California Medical Association. Health Education International, inc., has been granted approval of its total program of continuing educative in nursing by the Western Regional Accrediting Commi~e~ of the American Nurses’ Association. It has also been approved by the California Board of Ragister~d Nursing (Provider Number 04960). Currently, courses approved by the ANA are acceptable for mandatory CE contact hours in California, Colorado, Florida, Kansas, Massachusetts, Minnesota, Nebraska, Nevada, New Mexico, and South Dakota. (Contact your board of registered nursing for states not listed here.) Approval has also been granted by AMTIE.
of neoplastic disease Cut out this page
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13.0a
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No.(s)
order payable to Health of $9.00 must be atto be processed.
q b
Address
I have
12.Ca
q e
Name
License
address:
11770 Bernard0 Plaza Court San Diego, California 92129
Information
Choose the correct answer to each question and mark the corresponding box on the answer form. Use a pencil, not a pen. Fill in the enrollment information at the bottom of the answer form. 1.0a q b
and
Health Education International, Inc.
and State(s) a check
Security
(-
1
No. Zip
of Licensure or money
order
for $9.00.
Expires
April
25,
1986
/
on “Infectious
disease”
complications
0
(Polsky B, Armstrong D., AM J INFECT CONTROL 13:199-209,l
~ducat~onel objectives. This multiple-choice examination is designed to test your understanding of the content of the assigned article. After reading the article and taking the examination, enrollees should be able to meet the following educational objectives: 1. Recognize the epidemiologic factors associated with specific opportunistic infections in the immunocompromised patient 2. List, according to the specific host immune defect, the organisms that commonly cause infections in the immunocompromised patient 3. identify the organisms associated with infections related to invasive diagnostic and therapeutic procedures in the immunocompromised patient 4. Recognize that clinical signs and symptoms of infections in immunocompromised patients may be different from those seen in nonimmunocompromised patients 5. Summarize the clinical and diagnostic findings used for the diagnosis of infections in the immunocompromised patient 6. List the laboratory methods that are helpful in the identification of specific pathogens causing infections in immunocompromised patients 7. Select the procedure that provides the most precise diagnosis of infection in the patient with a neoplastic disease 6. Discuss the interventions that have been found to be valuable in improving the outcome of immunocompromised patients
instructions to CE enrollees. Please complete the test without turning to the article. There is only one correct answer to each question. The passing score is 18 correct answers (75%). This examination has been approved for 1 hour of continuing education credit for physicians and others needing Category 1 CME credit; nurses and others who need contact hours will receive 2 hours of credit. The deadline for submitting test answers is April 25, 1986. For CE enrollment information, see the announcement on the page foilowing this test. ntification XAMilNATlON
Number ICI051 QUESTIONS
1. In the immunocompromised patient an infection caused by which of the following organisms would most likely be associated with exposm-e to farm animals? a. Giaudia lamblia
b. Aeromonas hydvophila c. Listeria monocytogenes d. Toxoplasma gondii 2. The most likely source of an outbreak of pulmonary aspergillosis on a renal transplant unit is: a. The ventilation system b. The respiratory therapy equipment c. A nurse with respiratory colonization by
Aspergilltrs
d. Contaminated prepackaged sterile saline 3. The most common opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS) is: a. Disseminated herpes simplex infection b. Pneumocystis carinii pneumonia c. Invasive candidiasis d. Pulmonary aspergillosis 4. Which organism is most likely to cause pneumonia in the neutropenic patient? a. Pneumocystis cavinii
b. Peptostveptococcus c. Klebsiella pneumoniae d. Cytomegalovirus 5. Splenectomized patients
are
at
an
in-
Voiume
13 Number
October,
5
Continuing education
1985
creased risk of infections the following except:
caused by all of
a. Streptococcus pneumoniae emophilus influenzae b. c. sseria meningitidis d. Pseudomonas aeruginosa 6. Which of these is the most likely cause of meningitis in a patient with a normal neuzrophil count whose T cells are suppressed by chemotherapy? a. Cryptococcus neoformans b. Streptococcus pneumoniae
c. Toxoplasma gondii d. Nocardia asteroides 7. There is an increased risk of disseminated disease from atypical mycobacterium in all of the following except: a. Lymphoreticular malignancies one marrow transplants d. Splenectomized patients with Hodgkin’s disease 8. A neutropenic patient with an indwelling central venous catheter is at an increased risk of infection from skin colonization with: a. Corynebacterium sp. b. Nocardia sp. c. Plasmodium sp. d. Bacillus sp. 9. Which of the following procedures is associated with the smallest or least risk of Candida infection in the immunocompromised patient? a. Indwelling bladder catheterization b. Indwelling venous catheterization c. Splenectomy d. Bone marrow aspiration IO. Which of these statements about a neutropenic patient with disseminated candidiasis is correct? a. Blood cultures are useful in establishing a diagnosis b. Antimicrobial therapy should be started after positive identification of the organism 6. Meutropenic patients are frequently colonized with Candida d. The high mortality rate is associated with a poor response to antimicrobial therapy
il.
In the neutropenic patient with meningitis, diagnostic clues may be limited ts: a. Opisthotonos (spasms and hyperextension) b. Neck rigidity c. Subtle mental changes d. Headache 12. Skin lesions are helpful in establishing the diagnosis of infections caused by all of the following organisms except: a. Varicella-zoster virus b. Nocardia asteroides
c. Candida d. Pneumocystis carinii 13. All of the following are useful in predicting the causative organisms of infections in an immunocompromised patient except: a. The patient’s basic neoplastic disease b. Peripheral neutrophil counts current antineoplastic c. The patient’s therapy d. The age of the patient 14. A patient with Hodgkin’s disease is admitted with pneumonia. A chest film reveals a dense pulmonary infiltrate with cavity formation, and a Gram’s stain of a needle-aspirated specimen from the cavity shows gram-positive branching bacilli. The most likely causative agent is: a. Nocardia asteroides b. Histoplasma capsulatum
c. Legionella pneumophila d. Toxoplasma gondii 15. Meningitis is suspected in a neutropenic patient with Hodgkin’s disease who is currently on chemotherapy. An examination of CSF shows pleocytosis, but no organisms are identified on Gram’s stain or india ink preparations, and the cryptococcal antigen test is negative. The most likely presumptive diagnosis is: a. Meningitis due to Listeria monocyto-
genes b. Pneumococcal
brain abscess
c. Nocardia asteroides brain abscess d. Haemophilus infhenzae meningitis 16. Which of these statements about Nocardia asteroides pneumonia in patients with Tlymphocyte defects is incorrect? a. Roentgenograms dense pulmonary
of the lungs infiltrates
reveal
American
Continuing education b. Cavity and abscess formation occur frequently c. Skin lesions may also be present d. Nocardia may be recovered from cultures of transbronchial aspirates within 48 hours of incubation 17. Which of these statements about Candida pneumonia that develops as a consequence of disseminated disease is incorrect? a. The organisms find their way into the bloodstream from the gastrointestinal tract b. Roentgenograms of the lung show multiple bilateral nodules c. Isolation of organisms from the sputum is an indication of pulmonary infection d. Patients may have an elevated arabinatol to creatinine serum ratio 18. A diagnosis of disseminated histoplasmosis is best made by culture of which of the following specimens? a. Skin lesions b. Serum c. Sputum d. Bone marrow aspirate 19. All of the following laboratory tests are diagnostic for Legionella pneumonia except: a. India ink stain on fresh sputum specimens b. Direct fluorescent antibody test of fresh specimens c. Dieterle stain of fixed specimens d. Culture on charcoal yeast extract medium
‘NFECTION
dournal
of
CONTROL
20. Which of these tests is the most specific in the diagnosis of a brain abscess? a. CT scan of the head b. Serologic antibody titers c. Diagnostic brain biopsy d. Cultures of CSF 21. Which diagnostic test is the least helpful in establishing a definitive diagnosis of pulmonary aspergillosis? a. Transbronchial biopsy b. Open lung biopsy c. Serology for specific antibody d. Sputum cultures 22. Which of the following is most useful in improving the outcome of infected neutropenic patients? a. Prophylactic antimicrobial therapy b. Agent-specific antimicrobial therapy c. Leukocyte transfusions d. Immunotherapy 23. Clinical cure of the neutropenic patient with invasive pulmonary aspergillosis is associated with: a. Remission of underlying disease b. Two weeks of therapy wi.th amphoteritin B c. Cessation of chemotherapeutic agents d. Clinical improvement of aspergillosis 24. Amphotericin B is indicated. for all of the following except: a. Disseminated candidiasis b. Aspevgilhs pneumonia c. Cryptococcal meningitis d. Nocardia asteroides pneumonia
NTINUING EDUCATI Now you can earn CE credits by reading the Amefjoa~ Jcwrnai of Infection Control...And it’s as easy as1...2...3! 1. Read the article. 2. Take the test. 3. Mail your completed answer form and enrollment coupon along with your remittance. All-in-One Package A test offering with everything you need for CE credit appears in selected issues of the AmeriGan Journal of Infection Control. The selected article, the test, and all necessary forms are all together in one convenient package. You Decide This self-paced study program lets you make the decisions. You decide which tests to take and when to take them, (You have up to 6 months to complete any one exam. Check the expiration date that appears on each test.) Study at your leisure in the atmosphere of your choice. Performance bedback Two to three weeks after we receive your answer form, Health Education International, you your results and the correct answers. RM: Infectious complications Test ~dentifi~atjon No. lC7051 ~N/Med Tech: 2.0 Contact Hours/O.2 CEU MD: I.6 Category 1 Credit/O.1 CEU Test fnstructions
and Enrollment
Enrollees who have a passing score will receiv certificate. Accreditation The University of C~~jfor~ia~ San Diego School of Medicine designates this continuing medical education activity acceptable for credit hours in Category 1 of the Physician’s Recognition Award of the American Medical Association and for the Ce~if~c~ti~n Program of the California Medical Association. Health Education International, inc., has been granted approval of its total program of continuing educative in nursing by the Western Regional Accrediting Commi~e~ of the American Nurses’ Association. It has also been approved by the California Board of Ragister~d Nursing (Provider Number 04960). Currently, courses approved by the ANA are acceptable for mandatory CE contact hours in California, Colorado, Florida, Kansas, Massachusetts, Minnesota, Nebraska, Nevada, New Mexico, and South Dakota. (Contact your board of registered nursing for states not listed here.) Approval has also been granted by AMTIE.
of neoplastic disease Cut out this page
2.m Cib
3.Oa
4.Cla
5.0a
q b
6.0a
q b
q e
16,Oa Ob
17.Ca Db
3e
Cle
Please
check
De 16.0a
q b
q e
q b
19.0a Lib
q e 20.0a
7.0a Ob
:: Cle
q e 21.0a
q b
it to the following
Be sure to include a check or money Education International, Inc. Payment tached to this page for your examination 8.Cla 13b
9.0a
iQ.Ela
q b
q b
::
UC Ud
q e
q e
UC
q e
send
22.0a
q d Ue 23.0a
24.0a
25.0a
11.0a IIlb DC q d 26.0a
I&Da Ob oc C?d
q b
UC
q d q e 27.Ua
@e
15.Lla i;b oc r2d
Oe
28.Ja
29.0a
iTe 30.Cla Cb
Ue
one:
0 Med Tech
0 Nurse
0 Physician
0 Other
(Please
Specify)
Social State
City
enclosed
13.0a
q b
Phone
No.(s)
order payable to Health of $9.00 must be atto be processed.
q b
Address
I have
12.Ca
q e
Name
License
address:
11770 Bernard0 Plaza Court San Diego, California 92129
Information
Choose the correct answer to each question and mark the corresponding box on the answer form. Use a pencil, not a pen. Fill in the enrollment information at the bottom of the answer form. 1.0a q b
and
Health Education International, Inc.
and State(s) a check
Security
(-
1
No. Zip
of Licensure or money
order
for $9.00.
Expires
April
25,
1986
/