1. In hematologic malignancy patients, the most common cause of invasive fungal infection is:
A. Candida spp.
B. Cryptococcus spp.
C. Aspergillus spp.
D. Fusarium spp.
2. Which of the following pre-chemo factors confers the highest risk for proven/probable mold infections?
A. House renovation
B. Higher body weight
C. High exposure job
D. Performance status greater than or equal to 2.
3. You are evaluating the appropriateness of prophylactic antifungal use at your institution. Among the following hematologic/malignancy patients, which patient type, in which time period post transplant (in days) would have the highest risk for an IFI?
A. An autotransplant patient, day 80, with a prior IFI
B. An allotransplant patient, related donor, day 65, prior IFI
C. An allotransplant patient, unrelated donor, day 65, no prior IFI
D. An allotransplant patient, cord blood transplant, day 20, prior IFI
4. Regarding the impact of mold-active prophylaxis in allogeneic HSCT patients
A. Itraconazole is considered an effective, mold-active prophylaxis agent
B. In the Ullmann study, posaconazole was more effective than fluconazole in preventing IFI-related deaths in patients with severe GvHD
C. Prophylaxis is most beneficial in auto stem cell transplants for patients with mucositis
D. Among HSCT patients, prophylaxis is most effective in related donor transplants
5. Regarding blood culture vs non-culture based diagnostics for fungal infections, which is an advantage of culture?
A. Higher sensitivity with blood culture in the hematology population
B. Less time consuming
C. Enables susceptibility testing
D. All fungal species grow well in culture and at the same rate
6. Which of the following nonculture-based diagnostics can be used as a point-of-care test at the bedside for bronchoalveolar lavage (BAL) specimens?
A. Galactomannan
B. Lateral flow assay
C. PCR
D. Beta-D-Glucan
7. You care for a range of patients who are at risk for invasive fungal infections, including invasive aspergillosis. You are asked to help work on some standard orders for use of the galactomannan (GM) test. In which of the following patient types would you indicate that the test is likely to have the highest sensitivity and utility?
A. Solid organ transplant patient with neutropenia
B. Neutropenic patient with a hematologic malignancy
C. ICU patient
D. HIV-infected patient
8. In a patient with suspected invasive aspergillosis based on radiologic findings and respiratory symptoms, BAL galactomannan index values above what cutoff value would you consider highly suggestive of IA?
A. 0.25
B. 1.0
C. 1.5
D. 2.0
9. Which of the following is true about trial data for isavuconazole versus voriconazole?
A. Voriconazole was found statistically more effective than isavuconazole for prophylaxis in HSCT patients in terms of all-cause mortality
B. isavuconazole was found statistically more effective for treatment of invasive Aspergillus in terms of all-cause mortality
C. Isavuconazole was associated with the lower rate of adverse drug reactions versus voriconazole
D. Isavuconazole was found statistically more effective for treatment of invasive Aspergillosis in terms of overall response rate
10. Which of the following is true about amphotericin B formulations as used for IFD in the setting of hematologic malignancies?
A. Voriconazole was found to have similar efficacy as amphotericin B for invasive aspergillosis
B. Liposomal AmB was found ineffective for IA in the AmBiLoad trial
C. Liposomal AmB is considered a reasonable choice for patients with breakthrough infections after azole prophylaxis
D. Liposomal AmB is unlikely to be tolerated in patients who are intolerant of azoles
11. Which of the following is true about the use of echinocandins for prophylaxis in newly diagnosed AML patients?
A. Echinocandins have the broadest spectrum of action among antifungals and are therefore appropriate for prophylaxis against both yeasts and various invasive molds
B. Drug interactions with cancer therapeutics are much more likely with echinocandins than with azoles
C. Echinocandins can be easily transitioned from IV to oral therapy in the outpatient setting
D. The Gomes study provided a signal suggesting that breakthrough infections are higher in echinocandin-prophylaxed vs mold-active azole-prophylaxed patients, although additional study is needed to corroborate the results from this single center study
12. Which of the following adverse events has been associated with voriconazole?
A. Hallucinations
B. Increased skin cancer risk
C. Bone pain
D. All of the above
13. For an adult HSCT patient without any recognizable absorption issues, you prescribe posaconazole delayed release tablets for prophylaxis. After the initial loading dose, what is the dose of the oral tablets?
A. 300 mq 12 h x 2 doses/day
B. 300 mg QD
C. 200 mg 12 h x 3 doses/day
D. 200 mg 12 h x 2 doses/day
14. When considering the use of isavuconazole in a hematologic malignancy patient, which of the following pharmacologic considerations/strategies is relevant?
A. Follow the guidelines available regarding therapeutic dose monitoring
B. Expect a similar adverse event profile as voriconazole
C. The long terminal half-life allows once daily dosing after the loading dose
D. Consider an alternative oral step down therapy, since isavuconazole is only available in the IV formulation
15. For an adult patient with ALL who is receiving dose-intense multi-agent multi-cycle chemotherapy, how would you counsel him about his risk for IFIs as well as potential prophylaxis regimens?
A. He is at substantial risk for IFI
B. ALL regimens containing vincristine are unlikely to have drug interactions with azoles
C. He is likely to experience a very high risk for fungal infections in the consolidation cycle
D. Amphotericin B would be an inappropriate option for this condition
16. In the Marr study of combination antifungal therapy for invasive aspergillosis, voriconazole plus anidulafungin (as compared with voriconazole alone):
A. Provided an overall benefit in the intent-to-treat population
B. Provided the greatest benefit in patients with low disease burden [serum galactomannan (GM) <0.5]
C. Provided the greatest benefit in patients with moderate disease burden (serum GM between 0.5-1.5)
D. Provided the greatest benefit in patients with high disease burden (serum GM >1.5)
17. Which of the following is true about targeted therapy in the management of invasive aspergillosis?
A. Amphotericin B is equally effective as voriconazole in IA according to the Herbrecht study
B. Isavuconazole has been found equally effective as posaconazole in this setting
C. Currently, combination therapy is considered an option for salvage therapy
D. Echinocandins are the preferred first-line regimen in this setting
18. In a patient who has received posaconazole as prophylaxis and who appears to have a breakthrough mold infection, which of the following would be the preferred therapy?
A. Voriconazole
B. Fluconazole
C. Liposomal amphotericin B
D. An echinocandin
