Gastrointestinal infections represent a broad and clinically significant category of diseases, ranging from self-limiting viral gastroenteritis to severe, life-threatening intra-abdominal abscesses and Clostridioides difficile colitis. The pharmacist’s role, as detailed in the Patient Care 4 curriculum, is crucial for selecting appropriate antimicrobial therapy that covers likely pathogens while considering principles of antimicrobial stewardship. This quiz will test your knowledge on the management of these complex infections, from community-acquired diarrhea to complicated intra-abdominal infections, preparing you for challenges in both community and hospital settings.
1. Which of the following is the most significant risk factor for developing Clostridioides difficile infection (CDI)?
- a. A high-fiber diet
- b. Recent travel abroad
- c. Recent antibiotic use
- d. A history of GERD
Answer: c. Recent antibiotic use
2. What is the recommended first-line treatment for an initial, non-severe episode of C. difficile infection?
- a. Oral Metronidazole
- b. IV Vancomycin
- c. Oral Fidaxomicin
- d. Oral Loperamide
Answer: c. Oral Fidaxomicin
3. The cornerstone of management for a complicated intra-abdominal infection, such as an abscess, is:
- a. Oral antibiotic therapy alone.
- b. A 3-day course of IV antibiotics.
- c. Adequate source control (e.g., drainage of the abscess) in addition to antibiotics.
- d. Probiotic therapy.
Answer: c. Adequate source control (e.g., drainage of the abscess) in addition to antibiotics.
4. Intra-abdominal infections are typically polymicrobial. Treatment regimens must provide adequate coverage for Gram-negative enteric organisms and which other class of bacteria?
- a. Atypical bacteria
- b. Gram-positive cocci only
- c. Anaerobic bacteria
- d. Fungi
Answer: c. Anaerobic bacteria
5. Why is oral vancomycin effective for C. difficile infection but not for systemic infections?
- a. It tastes better than IV vancomycin.
- b. It has poor oral bioavailability, so it remains in the gut to act locally on the C. difficile.
- c. It is less expensive than IV vancomycin.
- d. It is more stable in stomach acid.
Answer: b. It has poor oral bioavailability, so it remains in the gut to act locally on the C. difficile.
6. “Management of Gastrointestinal Infections and C. Diff” is a specific learning module in which course?
- a. PHA5784C Patient Care 4
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5784C Patient Care 4
7. A patient with uncomplicated diverticulitis may be managed with:
- a. Immediate surgery.
- b. IV carbapenems for 14 days.
- c. Bowel rest and, in select cases, oral antibiotics covering common GI flora.
- d. A high-fiber diet during the acute attack.
Answer: c. Bowel rest and, in select cases, oral antibiotics covering common GI flora.
8. Which of the following antibiotic regimens would provide appropriate empiric coverage for a community-acquired, complicated intra-abdominal infection?
- a. Vancomycin alone
- b. Azithromycin
- c. Ceftriaxone plus metronidazole
- d. Doxycycline
Answer: c. Ceftriaxone plus metronidazole
9. What is the primary pathogenic mechanism of C. difficile?
- a. Invasion of the intestinal wall.
- b. Production of Toxin A and Toxin B, leading to colitis.
- c. Formation of a biofilm.
- d. Competition for nutrients.
Answer: b. Production of Toxin A and Toxin B, leading to colitis.
10. What is a key counseling point for a patient being treated for C. difficile?
- a. Use alcohol-based hand sanitizer exclusively for hand hygiene.
- b. Take loperamide to control the diarrhea.
- c. The importance of hand washing with soap and water to remove spores.
- d. Share a bathroom with other family members.
Answer: c. The importance of hand washing with soap and water to remove spores.
11. The management of intra-abdominal infections is a specific topic within the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
12. The most common cause of acute infectious gastroenteritis in adults is:
- a. Salmonella
- b. Escherichia coli
- c. Norovirus
- d. Giardia lamblia
Answer: c. Norovirus
13. A patient presents with fever and bloody diarrhea after eating undercooked chicken. Which of the following bacterial pathogens is most likely?
- a. Staphylococcus aureus
- b. Campylobacter or Salmonella
- c. Clostridium perfringens
- d. Bacillus cereus
Answer: b. Campylobacter or Salmonella
14. In which of the following situations should anti-motility agents like loperamide be avoided?
- a. Mild traveler’s diarrhea without fever.
- b. Chemotherapy-induced diarrhea.
- c. A patient with a high fever and bloody stools.
- d. Chronic diarrhea associated with IBS.
Answer: c. A patient with a high fever and bloody stools.
15. Bezlotoxumab is a monoclonal antibody used for:
- a. Treatment of an initial episode of CDI.
- b. Prevention of CDI recurrence.
- c. Treatment of complicated intra-abdominal infections.
- d. Treatment of viral gastroenteritis.
Answer: b. Prevention of CDI recurrence.
16. Which of the following is a major risk factor for developing a complicated intra-abdominal infection?
- a. A history of GERD
- b. A perforated bowel (e.g., from appendicitis or diverticulitis)
- c. Chronic constipation
- d. A high-fat diet
Answer: b. A perforated bowel (e.g., from from appendicitis or diverticulitis)
17. The treatment of appendicitis and diverticulitis is covered in the lecture on intra-abdominal infections.
- a. True
- b. False
Answer: a. True
18. What is the primary treatment for most cases of viral gastroenteritis?
- a. A 5-day course of ciprofloxacin.
- b. Oral vancomycin.
- c. Supportive care with hydration and electrolyte replacement.
- d. Loperamide and diphenoxylate.
Answer: c. Supportive care with hydration and electrolyte replacement.
19. Which of the following antibiotics has a very high association with causing C. difficile infection?
- a. Doxycycline
- b. Clindamycin
- c. Vancomycin
- d. Nitrofurantoin
Answer: b. Clindamycin
20. An active learning session on GI infections is part of the Patient Care 4 course.
- a. True
- b. False
Answer: a. True
21. A patient with fulminant C. difficile infection (characterized by hypotension and ileus) may require which combination therapy?
- a. Oral fidaxomicin plus IV metronidazole.
- b. High-dose oral vancomycin plus IV metronidazole.
- c. Oral metronidazole alone.
- d. IV vancomycin alone.
Answer: b. High-dose oral vancomycin plus IV metronidazole.
22. Which of the following is a common Gram-negative anaerobe found in the gut that must be covered in complicated IAI?
- a. Peptostreptococcus
- b. Bacteroides fragilis
- c. Clostridium perfringens
- d. Escherichia coli
Answer: b. Bacteroides fragilis
23. The pharmacist’s role in managing GI infections includes:
- a. Recommending appropriate antibiotic selection and dosing.
- b. Counseling on the importance of adherence.
- c. Educating patients on supportive care measures.
- d. All of the above.
Answer: d. All of the above.
24. Traveler’s diarrhea is most commonly caused by which pathogen?
- a. Norovirus
- b. Giardia
- c. Enterotoxigenic E. coli (ETEC)
- d. Staphylococcus aureus
Answer: c. Enterotoxigenic E. coli (ETEC)
25. A patient develops watery diarrhea 4 hours after eating at a picnic. The symptoms resolve within 24 hours. This is most likely:
- a. C. difficile infection.
- b. Food poisoning from a pre-formed toxin (e.g., S. aureus or B. cereus).
- c. A viral infection.
- d. Inflammatory bowel disease.
Answer: b. Food poisoning from a pre-formed toxin (e.g., S. aureus or B. cereus).
26. Which of the following is NOT a primary goal of managing a GI infection?
- a. Eradication of the pathogen.
- b. Prevention of fluid and electrolyte loss.
- c. Symptomatic relief.
- d. Inducing constipation for at least 72 hours.
Answer: d. Inducing constipation for at least 72 hours.
27. For community-acquired complicated IAI in a low-risk patient, which single agent provides adequate coverage?
- a. Ceftriaxone
- b. Metronidazole
- c. Ertapenem
- d. Vancomycin
Answer: c. Ertapenem
28. What is a fecal microbiota transplant (FMT) used for?
- a. Treatment of an initial episode of CDI.
- b. Management of recurrent C. difficile infection.
- c. Treatment of traveler’s diarrhea.
- d. Management of appendicitis.
Answer: b. Management of recurrent C. difficile infection.
29. The main reason for the development of recurrent CDI is:
- a. Patient non-adherence.
- b. A new infection from the community.
- c. Failure to eradicate C. difficile spores, which leads to germination and relapse after therapy stops.
- d. A drug interaction.
Answer: c. Failure to eradicate C. difficile spores, which leads to germination and relapse after therapy stops.
30. The “Management of Gastrointestinal Infections” is an active learning session in the Patient Care 4 course.
- a. True
- b. False
Answer: a. True
31. Probiotics have the strongest evidence for preventing which type of GI infection?
- a. Traveler’s diarrhea
- b. C. difficile infection
- c. Antibiotic-associated diarrhea
- d. Norovirus
Answer: c. Antibiotic-associated diarrhea
32. A patient with suspected secondary peritonitis due to a ruptured appendix requires:
- a. Urgent surgical intervention for source control.
- b. A watch-and-wait approach.
- c. Oral antibiotics only.
- d. A clear liquid diet.
Answer: a. Urgent surgical intervention for source control.
33. Which of the following patient populations is at highest risk for severe complications from a GI infection?
- a. A healthy 25-year-old.
- b. An elderly, hospitalized patient with multiple comorbidities.
- c. A college athlete.
- d. A middle-aged adult with no medical problems.
Answer: b. An elderly, hospitalized patient with multiple comorbidities.
34. A key counseling point for a patient traveling to a high-risk area for traveler’s diarrhea is:
- a. To drink the local tap water.
- b. The importance of food and water safety precautions (“boil it, cook it, peel it, or forget it”).
- c. To take prophylactic antibiotics for the entire trip.
- d. To avoid all local food.
Answer: b. The importance of food and water safety precautions (“boil it, cook it, peel it, or forget it”).
35. A “left shift” on a complete blood count (CBC) indicates:
- a. A viral infection.
- b. An increase in immature neutrophils (bands), suggesting an acute bacterial infection.
- c. A low white blood cell count.
- d. Anemia.
Answer: b. An increase in immature neutrophils (bands), suggesting an acute bacterial infection.
36. Piperacillin/tazobactam is a good choice for many healthcare-associated intra-abdominal infections because it covers:
- a. Only Gram-positive organisms.
- b. Only anaerobic organisms.
- c. A broad spectrum of Gram-positives, Gram-negatives (including Pseudomonas), and anaerobes.
- d. Only MRSA.
Answer: c. A broad spectrum of Gram-positives, Gram-negatives (including Pseudomonas), and anaerobes.
37. The duration of therapy for a complicated intra-abdominal infection after adequate source control is typically:
- a. 24 hours
- b. 3 days
- c. 4-7 days
- d. 14-21 days
Answer: c. 4-7 days
38. What is the role of proton pump inhibitors (PPIs) in C. difficile infection?
- a. They are used to treat CDI.
- b. They are considered a risk factor for developing CDI.
- c. They have no interaction with CDI.
- d. They prevent recurrence of CDI.
Answer: b. They are considered a risk factor for developing CDI.
39. A patient being treated for Giardia would most likely receive:
- a. Vancomycin
- b. A fluoroquinolone
- c. Metronidazole
- d. An antiviral agent.
Answer: c. Metronidazole
40. The curriculum includes a reading from DiPiro’s Pharmacotherapy on intra-abdominal infections.
- a. True
- b. False
Answer: a. True
41. The most important initial step in managing any patient with a GI infection and diarrhea is:
- a. Starting an antibiotic.
- b. Obtaining a stool culture.
- c. Assessing the patient’s hydration status.
- d. Administering an anti-motility agent.
Answer: c. Assessing the patient’s hydration status.
42. Which of the following is NOT a common pathogen in a community-acquired intra-abdominal infection?
- a. E. coli
- b. Bacteroides fragilis
- c. Streptococcus species
- d. Pseudomonas aeruginosa
Answer: d. Pseudomonas aeruginosa
43. Fidaxomicin is superior to vancomycin for treating an initial episode of CDI because it has:
- a. A broader spectrum of activity.
- b. A lower rate of CDI recurrence.
- c. IV and PO formulations.
- d. A lower cost.
Answer: b. A lower rate of CDI recurrence.
44. A patient has uncomplicated sigmoid diverticulitis and will be managed as an outpatient. Which oral antibiotic regimen would be appropriate?
- a. Amoxicillin alone
- b. Metronidazole plus ciprofloxacin
- c. Vancomycin
- d. Doxycycline
Answer: b. Metronidazole plus ciprofloxacin
45. What is the primary difference between diverticulosis and diverticulitis?
- a. Diverticulosis is inflammation, while diverticulitis is the presence of pouches.
- b. Diverticulosis is the presence of pouches (diverticula), while diverticulitis is the inflammation of those pouches.
- c. They are the same condition.
- d. Diverticulosis requires surgery, while diverticulitis does not.
Answer: b. Diverticulosis is the presence of pouches (diverticula), while diverticulitis is the inflammation of those pouches.
46. A patient has a healthcare-associated intra-abdominal infection and is at high risk for resistant pathogens. Which of the following provides the broadest coverage?
- a. Ceftriaxone + Metronidazole
- b. Ciprofloxacin + Metronidazole
- c. Piperacillin-tazobactam
- d. Ampicillin/sulbactam
Answer: c. Piperacillin-tazobactam
47. Rehydration therapy is the cornerstone of management for which GI infection?
- a. Cholera
- b. C. difficile
- c. Appendicitis
- d. Diverticulitis
Answer: a. Cholera
48. Why is metronidazole no longer a first-line agent for an initial episode of non-severe CDI?
- a. It is no longer effective.
- b. It has been shown to be inferior to oral vancomycin and fidaxomicin.
- c. It causes too many side effects.
- d. It is too expensive.
Answer: b. It has been shown to be inferior to oral vancomycin and fidaxomicin.
49. An active learning session on GI infections covers C. difficile and intra-abdominal infections.
- a. True
- b. False
Answer: a. True
50. The ultimate goal of managing a patient with a complicated intra-abdominal infection is to:
- a. Provide adequate source control and targeted antimicrobial therapy to resolve the infection and prevent mortality.
- b. Keep the patient on broad-spectrum antibiotics for at least one month.
- c. Avoid surgery at all costs.
- d. Use oral antibiotics for the entire course of therapy.
Answer: a. Provide adequate source control and targeted antimicrobial therapy to resolve the infection and prevent mortality.