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1.
Questions 1 through 5 pertain to the following case:

AC is a 65-year-old white woman who was recently admitted to the hospital for a heart-valve replacement. She received a cephalosporin prophylactically in the hospital and was discharged with an additional 14-day course. AC is overweight and has type 2 diabetes and hypertension that is controlled with medication. She routinely takes a proton pump inhibitor, “the purple pill” (esomeprazole magnesium 40 mg), each morning to prevent gastric reflux.

A week after discharge AC started experiencing abdominal cramping, diarrhea, loose stools up to 5 times daily, fever, and “feeling poorly.” She tried some OTC medications to control the diarrhea with no success. She presents to her primary care provider (PCP) to seek treatment and describes the diarrhea as “unlike anything she has had before.” The PCP suspects that the patient has acquired a Clostridioides difficile infection (CDI) based on the patient’s risk factors, and this is confirmed by laboratory tests.

Which of the following medications should the PCP discontinue?

A. Esomeprazole B. Antidiabetic therapy C. Cephalosporin D. Antihypertensive therapy

2. The clinical presentation of CDI in this patient is an initial, nonsevere episode. All of the following are symptoms of an initial, nonsevere episode except:

A. Crampy abdominal pain B. Watery diarrhea, 3 or more times daily for several day C. Watery diarrhea up to 15 times daily D. Fever

3. According to the 2017 clinical practice guidelines for Clostridioides difficile infection, which of the following regimens would be recommended for this initial, nonsevere episode in AC?

A. Fidaxomicin 200 mg orally twice daily for 10 days B. Rifaximin 550 mg orally twice daily for 10 days C. Metronidazole 500 mg orally 4 times daily for 10 days D. Alternatives A and C are both correct choices

4. Protocols for preventing transmission of Clostridioides difficile should include which of the following actions?

A. All surfaces should be wiped down with 70% isopropyl alcohol. B. All surfaces should be disinfected with a chlorine-based product or sporicidal. C. All surfaces should be cleaned with hot, soapy water. D. All surfaces should be steam-cleaned.

5. The best treatment option to resolve the patient's recurring infection is

A. A fecal microbiota transplantation B. Probiotic therapy C. A single intravenous infusion of beziotoxumab 10 mg/kg over 60 minutes D. Intravenous metronidazole 500 mg every 8 hours for 10 days

6. Questions 6 through 7 pertain to the following case:
JM is a 5-year-old Hispanic boy with recently diagnosed leukemia (weight, 27 kg) who just finished his first 5-day course of chemotherapy as an inpatient in a pediatric hospital. A couple of days after discharge, JM started experiencing up to 10 episodes of loose stools per day, abdominal cramping, fever, malaise, loss of appetite, and weight loss. He has never experienced gastrointestinal issues prior to his chemotherapy. His oncologist confirmed Clostridioides difficile infection with testing.
What testing should be done to confirm the CDI?

A. Nucleic acid amplification test (NAAT) alone B. Cell culture cytotoxicity neutralization assay (CCNA) C. Toxigenic culture (TC) D. Glutamate dehydrogenate (GDH)

7. The patient is diagnosed with an initial, severe/fulminant episode of CDI. Which of the following is the best treatment option for JM?

A. Metronidazole 200 mg intravenously every 6 hours for 10 days. B. Rifaximin 200 mg by mouth three times daily for 20 days. C. Vancomycin 270 mg by mouth four times daily for 10 days D. Fecal microbiota transplantation

8. Which of the following statements about metronidazole benzoate powder is FALSE?

A. Metronidazole benzoate powder tastes very bitter. B. The weight of metronidazole benzoate powder is adjusted by 1.6 to be equivalent to the amount of metronidazole base in commercial tablets. C. Metronidazole benzoate powder is palatable with little or no taste. D. Metronidazole benzoate powder is an active pharmaceutical ingredient.

9. Which of the following options is NOT an appropriate action for decreasing the likelihood of infection with fecal microbiota transplantation?

A. File an emergency IND with the FDA for the fecal microbiota transplantation B. Obtain an FMT Capsule DE Microbiota Preparation for oral administration C. Provide the patient with instruction on preparation and administration of an FMT mixture using a family member as the donor D. Obtain FMT Upper Delivery Microbiota Preparation for administration via nasoenteric/gastric tube or esophagogastroduodenoscopy

10. Which of the following statement is/are accurate about donating fecal matter for FMT at donor sites?

A. Fewer than 3% of donors pass the rigorous screening process. B. Once a donor is approved, donations may be received for up to 60 days. C. Donors must repeat the screening process every 60 days. D. All of the above alternatives are correct.