1. A 59-year-old white man with a history of AML receives a matched unrelated SCT. Medications included tacrolimus, acyclovir, trimethoprim/sulfamethoxazole, and fluconazole.During his posttransplant period, he develops a range of GI and neurologic symptoms that was not relieved with commonly used medications. Symptoms continued to worsen along with a new rash suggestive of skin GvHD. A flexible sigmoidoscopy/EGD demonstrated moderate GvHD in the stomach and duodenum. Prednisone 2 mg/kg was initiated. Which agent should the patient receive now for antifungal prophylaxis?
A. Isavuconazole
B. Posaconazole
C. Liposomal amphotericin B
D. Fluconazole
2. In the pre-engraftment period of HSCT, the primary fungal infection to be concerned about is:
A. Aspergillosis
B. Mucormycosis
C. Invasive candidiasis
D. Cryptococcal meningitis
3. If an institution has high rates of mold infection, which of the following would be the best option for antifungal prophylaxis for HSCT?
A. Fluconazole
B. Caspofungin
C. Micafugin
D. Voriconazole
4. Which of the following is true of mold-active azole therapy for prophylaxis?
A. Has fewer drug-drug interactions than echinocandin-based therapy
B. Requires frequent monitoring of galactomannan
C. Is generally more toxic than echinocandin-based therapy
D. On a global level, does not require therapeutic dose monitoring
5. Which of these antifungals has been shown to shorten the QT interval?
A. Isavuconazole
B. Liposomal amphotericin B
C. Posaconazole
D. Voriconazole
6. Regarding the development of GvHD in HSCT patients:
A. Typically occurs with any immunosuppressive therapy
B. Is an indication for the use of posaconazole prophylaxis
C. Is associated with skin rash but not gastrointestinal side effects
D. Preferentially increases the likelihood of invasive candidiasis infection
7. Regarding drug-drug interactions in the prophylaxis setting:
A. Vincristine can interact with azoles
B. Echinocandins are generally less prone to drug-drug interactions
C. Drug-drug interaction rates vary with different types of azoles
D. All of the above
8. A 56-year-old man who had received a bilateral lung transplant with primary CMV mismatch for pulmonary fibrosis is on mycophenolate 500 mg q12 hrs, prednisone 20 mg qd, and tacrolimus 2 mg qd. After developing fever and an infiltrate, he has been treated for proven Aspergillus fumigatus IPA with voriconazole 300 mg twice daily. He is also on azithromycin 500 mg once daily. He was recently readmitted with shortness of breath, dyspnea, and reaccumulation of pleural fluid. What would be the best option to evaluate or reevaluate this patient?
A. Serum galactomannan
B. Bronchoscopy with BAL and send for fungal, AFB, and viral staining
C. Serum Fungitell assay
D. Fungal blood cultures
9. Which of the following is consistent with the IDSA guidelines for IPA?
A. Voriconazole: salvage therapy only
B. Isavuconazole: salvage therapy only
C. Posaconazole: primary therapy
D. Liposomal amphotericin B: alternative primary therapy
10. In a patient with IPA who has failed voriconazole (despite adequate drug levels and lack of azole resistance), which of the following would be the best option for salvage therapy?
A. Posaconazole
B. Fluconazole
C. Itraconazole
D. Liposomal amphotericin B
11. Regarding azole resistance in IPA:
A. It is more common in the United States vs Europe
B. The mutations in the United States are generally different from those in Europe
C. It can be exacerbated by long duration of therapy in patients with high fungal load
D. It is typically managed by a switch to a more potent azole
12. In diagnosing IPA in non-neutropenic patients
A. Bronchoscopy with BAL is helpful
B. Fungal blood cultures frequently yield molds
C. The beta-D-glucan test is well established in this setting
D. Galactomannan is better established for this population than neutropenic patients
13. For a patient with an Aspergillus spp empyema
A. Source control is easily managed surgically
B. Resistance can develop easily
C. The mortality rate is similar to that of the more typical IPA presentation
D. All of the above
14. In the setting of nonresponse to voriconazole, which of the following can be helpful?
A. Therapeutic drug monitoring
B. Evaluation of potential drug-drug interactions
C. A switch to another class of antifungal agent
D. All of the above
15. Which of the following has the widest spectrum for mold prophylaxis?
A. Fluconazole
B. Posaconazole
C. Itraconazole
D. Micafungin
16. What empiric antimicrobials would you use in this case? [CASE STUDY]
A. Meropenem, daptomcyin, and fluconazole
B. Cefepime and metronidazole
C. Meropenem, vancomycin, and micafungin
D. Ampicillin-sulbactam and vancomycin
E. No empiric treatment is warranted
17. Candida auris :
A. It is frequently misidentified as C haemulonii
B. It can only be identified based on culture, not MALDI-TOF
C. The first-line therapy recommendation is liposomal amphotericin B
D. Is slow to develop secondary resistance to echinocandins
18. Which of the following pathogens is commonly associated with complicated intra-abdominal infections?
A. Anaerobes
B. Multidrug resistant Gram-negative bacteria
C. Non-albicans Candida
D. All of the above
19. The combination of an azole and echinocandin has been most extensively studied for the indication of
A. Antifungal prophylaxis in SOT
B. IPA
C. Antifungal prophylaxis in HSCT
D. Candida auris
20. For a patient with C auris who fails micafungin therapy, the appropriate second-line therapy is:
A. Posaconazole
B. 5-FC
C. Liposomal amphotericin B
D. Voriconazole
