Module 13

Which of the following is a treatment option for a 30-year-old woman with PID and a history of severe hive-form reaction when taking a penicillin or cephalosporin? a. ofloxacin with metronidazole. b. amoxicillin with gentamicin. c. cefixime with vancomycin. d. clindamycin with azithromycin.

a. ofloxacin with metronidazole.

Second-line drug intervention in the presence of anaphylaxis should be: a. oral diphenhydramine. b. nebulized pentamidine. c. nebulized epipnephrine. d. oral prednisone.

a. oral diphenhydramine.

A preferred treatment for trichomoniasis is: a. oral metronidazole. b. clindamycin vaginal cream. c. topical acyclovir. d. oral azithromycin.

a. oral metronidazole.

Common sites of Chlamydia trachomatis infection in women include all of the following except: a. ovaries. b. cervix. c. endometrium. d. urethra.

a. ovaries.

First-line treatment options for primary syphilis include: a. penicillin. b. ciprofloxacin. c. erythromycin. d. ceftriaxone.

a. penicillin.

In gonoccoal infection, which of the following statements is true? a. risk of transmission from an infected woman to a male sexual partner is about 20% to 30% with a single coital act. b. most men have symptomatic infection. c. the incubation period is about 2 to 3 weeks. d. the organism rarely produced beta-lactamase.

a. risk of transmission from an infected woman to a male sexual partner is about 20% to 30% with a single coital act.

A transvaginal ultrasound in the woman with PID will likely show: a. tubal thickening with or without free pelvic fluid. b. cervical thickening. c. endometrial thinning. d. inflammation of the ovaries.

a. tubal thickening with or without free pelvic fluid.

Which of the following best describes the lesions associated with condyloma acuminatum? a. verruciform. b. plaque-like. c. vesicular. d. bulls.

a. verruciform.

Chlamydial infections occur most frequently among women in which age group? a. younger than 25 year. b. 25 to 35 years. c. 40 to 50 years. d. over 60 years.

a. younger than 25 year.

You see a 42-year-old man with uncomplicated urogenital gonorrhea. His medical records indicate a severe allergic reaction to penicillin that includes difficulty breathing and diffuse urticaria. You recommend treatment with: a. oral cefixime b. parenteral evofloxacin c. oral zithromycin plus oral gemifloxacin d. parenteral tigecycline plus oral metronidazole.

c. oral zithromycin plus oral gemifloxacin

Diagnostic testing of a person with primary HSV-2 infection would likely show: a. negative virological and serological test results. b. negative virological test result and positive serological test result. c. positive virological test result and negative serological test result. d. positive virological and serological test results.

c. positive virological test result and negative serological test result.

What is the most effective protection against shingles? a. previous episode of chickenpox as a child. b. prior episode of shingles. c. receipt of varicella-zoster immunization. d. avoiding children and day-care centers.

c. receipt of varicella-zoster immunization.

A pressure ulcer that exhibits full-thickness skin loss with a crater-like appearance can be categorized as: a. stage 1. b. stage 2. c. stage 3. d. stage 4.

c. stage 3.

Treatment options for patients with condyloma acuminatum include all of the following except: a. imiquimod. b. podofilox. c. topical acyclovir. d. cryotherapy.

c. topical acyclovir.

The most common clinical manifestation of systemic anaphylaxis typically is: a. dizziness. b. airway obstruction. c. urticaria. d. GI upset.

c. urticaria.

Which of the following is the best answer regarding anaphylaxis? a. adults usually do not develop new anaphylaxis triggers such as food allergies. b. peanuts are the primary food that can cause severe allergic reaction. c. future anaphylactic reactions will become increasingly more severe. d. trace amounts of an allergen in a food can cause a severe anaphylactic reaction.

d. trace amounts of an allergen in a food can cause a severe anaphylactic reaction.

Which of the following is not a normal finding in a woman during the reproductive years? a. vaginal pH of 4.5 or less. b. Lactobacillus as the predominant vaginal organism. c. thick, white vaginal secretions during the luteal phase. d. vaginal epithelial cells with adherent bacteria.

d. vaginal epithelial cells with adherent bacteria.

During asymptomatic HSV-2 infection, genital shedding of the virus occurs during approximately _____ of days. a. 10%. b. 25%. c. 50%. d. 100%.

a. 10%.

What is the approximate incubation period for Neisseria gonorrhoea? a. 1 to 5 days. b. 7 to 10 days. c. 18 days. d. 28 days.

a. 1 to 5 days.

A 30-year-old woman presents without symptoms but states that her male partner has dysuria without penile discharge. Examination reveals a friable cervix covered with thick yellow discharge. This description is most consistent with an infection caused by: a. Chlamydia trachomatis. b. Neisseria gonorrhoeae. c. HPV. d. Trichomonas vaginalis.

a. Chlamydia trachomatis.

Which of the following plays an essential role in type 1 hypersenstivity? a. IgE. b. IgA. c. IgG. d. IgF.

a. IgE.

Sequelae of genital HPV infection in a man can include: a. anorectal carcinoma. b. low sperm count. c. paraphimosis. d. Reiter syndrome.

a. anorectal carcinoma.

Which of the following is recommended by the CDC for as single-dose therapy for uncomplicated urethritis caused by N. gonorrhoeae when an oral product is the most appropriate option? a. cefixime. b. metronidazole. c. TMP-SMX. d. amoxicillin.

a. cefixime.

The preferred treatment for uncomplicated gonococcal proctitis is: a. ceftriaxone 250 mg IM as a single dose plus a single dose of azithromycin 1 g PO. b. oral erythromycin 500 mg BID for 7 days. c. oral norfloxacin 400 mg BID with metronidazole 500 mg BID for 3 days. d. azithromycin 1 g PO as a single dose plus single dose of injectable doxycycline 100 mg.

a. ceftriaxone 250 mg IM as a single dose plus a single dose of azithromycin 1 g PO.

Which of the following agents is active against N. gonorrhoeae? a. ceftriaxone. b. metronidazole. c. ketoconazole. d. amoxicillin.

a. ceftriaxone.

Which of the following is the best treatment option for cellulitis when risk of infection with a methicillin-resistant pathogen is considered low? a. dicloxacillin. b. amoxicillin. c. metronidazole. d. trimethoprim-sulfamethoxazole.

a. dicloxacillin.

How is the varicella virus most commonly transmitted? a. droplet transmission. b. contact with inanimate reservoirs. c. contact transmission. d. water-borne transmission.

a. droplet transmission.

Which of the following is representative of the presentation of secondary syphilis? a. generalized rash. b. chancre. c. pupillary alterations. d. aortic regurgitation.

a. generalized rash.

In the person with HSV-2 infection, the virus can spread via contact which of the following methods? Select all that apply. a. genital secretions. b. oral secretions. c. intact skin.

a. genital secretions. b. oral secretions. c. intact skin.

A 38-year-old woman with advanced HIV disease presents with a chief complaint of a painful, itchy rash over her trunk. Exam reveals linear vesicular lesions that do not cross the midline and are distributed over the posterior thorax. This presentation is most consistent with: a. herpes zoster. b. dermatitis herpetiformis. c. molluscum contagiosum. d. impetigo.

a. herpes zoster.

A Tzanch smear that is positive for giant multinucleated cells was taken from a lesion caused by: a. herpesvirus. b. S. aureus. c. streptococci. d. allergic reaction.

a. herpesvirus.

Treatment options of postherpetic neuralgia include all of the following except: a. injectable methylprednisolone. b. oral pregabalin. c. oral nortriptyline. d. topical lidocaine.

a. injectable methylprednisolone.

Which of the following statements is most accurate regarding cellulitis? a. insect bites, abrasion, or other skin trauma can be the origin of cellulitis. b. cellulitis most often occurs on the chest and abdomen. c. necrosis is a common compilation of cellulitis. d. cellulitis often occurs spontaneously without any identifiable skin wound.

a. insect bites, abrasion, or other skin trauma can be the origin of cellulitis.

The time to highest blood concentration (Cmax) of epinephrine is shorter when the medication is given: a. intramuscularly in the vastus lateralis. b. subcutaneously in the abdominal wall. c. intramuscularly in the deltoid. d. intramuscularly into the gluteus.

a. intramuscularly in the vastus lateralis.

How long after contact does the onset of clinical manifestations of syphilis typically occur? a. less than 1 week. b. 1 to 3 weeks. c. 2 to 4 weeks. d. 4 to 6 weeks.

c. 2 to 4 weeks.

About _______ of patients with genital warts have spontaneous regression of lesions? a. 10%. b. 25%. c. 50%. d. 75%.

c. 50%.

The incubation period for C. trachomatis is approximately: a. 24 hours. b. 3 days. c. 7 to 14 days. d. 24 days.

c. 7 to 14 days.

Approximately what percentage of sexually active adults has a serological evidence of human herpesvirus 2 (HHV-2 or herpes simplex type 2)? a. 5. b. 15. c. 25. d. 40.

b. 15.

Which HPV types are most likely to cause condyloma acuminatum? a. 1, 2, and 3. b. 6 and 11. c. 16 and 19. d. 22 and 24.

b. 6 and 11.

Maria is a 28-year-old healthy woman who is 6 weeks pregnant. Her routine prenatal laboratory testing reveals she is not immune to varicella. She voices her intent to breastfeed her infant for at least 6 months. Which of the following represents the best advice for Maria? a. she should receive VZV vaccine once she is in her second trimester of pregnancy. b. Maria should be advised to receive two doses of VZV vaccine after giving birth. c. once Maria is no longer breastfeeding, she should receive one dose of VZV vaccine. d. a dose of VZIG should be administered now.

b. Maria should be advised to receive two doses of VZV vaccine after giving birth.

For which of the following patients should an NP order varicella antibody titers? a. a 14-year-old with an uncertain immunization history. b. a healthcare worker who reports having had varicella as a child. c. a 22-year-old woman who received two varicella immunization 6 weeks apart. d. a 72-year-old old with shingles.

b. a healthcare worker who reports having had varicella as a child.

Your priority in caring for Tom, the aforementioned patient, is to: a. administer a rapidly acting oral antihistamine. b. administer parenteral epinephrine. c. initiate vasopressor therapy. d. administer a parenteral systemic corticosteroid.

b. administer parenteral epinephrine.

Treatment of vulvovaginitis caused by Candida albicans includes: a. metronidazole gel. b. clotrimazole cream. c. hydrocortisone ointment. d. clindamycin cream.

b. clotrimazole cream.

When caring for an adult with an outbreak of shingles, you advise that: a. there is no known treatment for this condition. b. during outbreaks, the chickenpox (varicella) virus is shed. c. although they are acutely painful, the lesions heal well without scarring or lingering discomfort. d. this condition commonly strikes young and old alike.

b. during outbreaks, the chickenpox (varicella) virus is shed.

Women with PID typically present with all of the following except: a. dysuria. b. leukopenia. c. cervical motion tenderness. d. abdominal pain.

b. leukopenia.

The use of a systemic corticosteroid in the treatment of anaphylaxis is primarily helpful for: a. treatment of the most acute symptoms. b. minimization of a protracted allergic response. c. prevention of future episodes. d. reducing the risk of fatality associated with the event.

b. minimization of a protracted allergic response.

Which of the following statements is true of gonococcal infection? a. the risk of transmission from an infected woman to a male sexual partner is about 80%. b. most men have asymptomatic infection. c. the incubation period is about 2 to 3 weeks. d. the organism rarely produces beta-lactamase.

b. most men have asymptomatic infection.

Complications of pressure ulcers include all of the following except: a. squamous cell carcinoma. b. osteoporosis. c. bone and joint infections. d. cellulitis.

b. osteoporosis.

Risk factors for the development of postherpetic neuralgia include: a. age younger than 50 years at the time of the outbreak. b. severe prodromal symptoms. c. lumbar location of lesions. d. low volume of lesions.

b. severe prodromal symptoms.

An annual screening for C. trachomatis infection is recommended for: a. all sexually active women. b. sexually active women 25 years of age and younger. c. sexually active women who have had 2 or more partners in the past 12 months. d. sexually active men 25 years of age and younger.

b. sexually active women 25 years of age and younger.

A 24-year-old woman presents with a 1-week history of thin, green-yellow vaginal discharge with perivaginal irritation. Physical exam findings include vaginal erythema with petechial hemorrhages on the cervix, numerous white blood cells, and motile organisms on microscopic examination. These findings most likely represent: a. motile sperm with irritative vaginitis. b. trichomoniasis. c. bacterial vaginosis. d. condyloma acuminatum.

b. trichomoniasis.

Shingles most commonly involve the dermatomes of the: a. legs and pubic area. b. face. c. upper arms and shoulders. d. thorax

d. thorax

which HPV types are most likely to cause anorectal carcinoma? a. 1 and 3 b. 6 and 11 c. 16 and 18 d. 72 and 81

c. 16 and 18

What percentage of sexually active adults has serological evidence of human herpes virus 2 (HHV-2 or herpes simplex type 2)? a. 4.8%. b. 14.5% c. 18.9%. d. 35.6%.

c. 18.9%.

The zoster vaccine is: a. an inactivated/killed virus vaccine. b. a conjugate vaccine containing a virus-like partial (VLP). c. a live, attenuated vaccine. d. an inactivated toxin vaccine.

c. a live, attenuated vaccine.

Of the following medications, which is least likely to be implicated as a trigger for anaphylaxis? a. ibuprofen. b. amoxicillin. c. acetaminophen. d. aspirin.

c. acetaminophen.

Complications of gonococcal and chlamydial genitourinary infection in women include all of the following except: a. PID. b. tubal scarring. c. acute pyelonephritis. d. acute peritoneal inflammation.

c. acute pyelonephritis.

Tom is a 19-year-old man who presents with sudden onset of edema of the lips and face and a sensation of "throat tightness and shortness of breath" after a bee sting. Physical examination reveals inspiratory and expiratory wheezing. Blood pressure is 78/44 mm Hg, heart rate is 102 bpm, and respiratory rate is 24/min. His clinical presentation is most consistent with the diagnosis of: a. urticaria. b. angioedema. c. anaphylaxis. d. reactive airway disease.

c. anaphylaxis.

What percentage of anogenital and cervical cancers can be attributed to HPV infection? a. less than 30%. b. at least 50%. c. at least 70%. d. 95% or greater.

c. at least 70%.

Which of the following agents is most active against C. trachomatis? a. amoxicillin. b. metronidazole. c. azithromycin. d. ceftriaxone.

c. azithromycin.

Which of the following is a treatment option for a 28-year-old woman with PID who has no history of medication allergy and has undergone a bilateral tubal ligation? a. ofloxacin with metronidazole. b. gentamicin with cefpodoxime. c. ceftriaxone with doxycycline. d. clindamycin with azithromycin.

c. ceftriaxone with doxycycline.

A 62-year-old woman presents 2 days after noticing a "bug bite" on her left forearm. Exam reveals a warm, red edematous area with sharply demarcated borders. The patient is otherwise healthy with no fever. This most likely represents: a. contact dermatitis. b. an allergic reaction. c. cellulitis. d. erysipelas.

c. cellulitis.

Appropriate treatment of a stage 1 pressure ulcer can include all of the following except: a. ensuring proper nutrition and hydration of the patient. b. regular repositioning of the patient. c. debridement of non-vital skin. d. special padding for vulnerable skin areas.

c. debridement of non-vital skin.

Syphilis is most contagious at which of the following times? a. before onset of signs and symptoms. b. during the primary stage. c. during the secondary stage. d. during the tertiary stage.

c. during the secondary stage.

Expected lab findings for the woman with PID include all of the following except: a. elevated ESR. b. elevated CRP. c. elevated creatinine clearance. d. leukocytosis.

c. elevated creatinine clearance.

Treatment options for HSV-2 genital infection include: a. ribavirin. b. indinavir. c. famciclovir. d. cyclosporine.

c. famciclovir.

Which of the following is not representative of the presentation of primary syphilis? a. a painless ulcer. b. localized lymphadenopathy. c. flu-like symptoms. d. a spontaneously-healing lesion.

c. flu-like symptoms.

Neisseria gonorrheae are best described as: a. gram-positive cocci. b. gram-positive rods. c. gram-negative diplococci. d. gram-negative bacilli.

c. gram-negative diplococci.

The most common causative organisms in cellulitis are: a. E. coli and H. influenzae. b. Bacteroides species and other anaerobes. c. group A beta-hemolytic streptococci and Staphylococcus aureus. d. pathogenic viruses.

c. group A beta-hemolytic streptococci and Staphylococcus aureus.

Recommended comprehensive STI testing includes testing for all of the following except: a. hepatitis B. b. syphilis. c. hepatitis A. d. HIV.

c. hepatitis A.

Physical examination of a 19-year-old woman with a 3-day history of vaginal itch reveals moderate perineal excoriation, vaginal erythema, and white, clumping discharge. Expected microscopic exam findings include: a. a pH greater than 6. b. an increased number of lactobacilli. c. hyphae. d. an abundance of white blood cells.

c. hyphae.

A 22-year-old woman complains of pelvic pain. Physical exam reveals cervical motion tenderness and uterine tenderness. Which of the following would further support a diagnosis of PID? a. temp less than 100 F. b. absence of WBCs in vaginal fluid. c. mucopurulent vaginal discharge. d. lab documentation of cervical infection with E. coli.

c. mucopurulent vaginal discharge.

Suppressive therapy reduces the frequency of genital herpes recurrences by: a. 5-10%. b. 20-25%. c. 40-50%. d. 70-80%.

d. 70-80%.

The most likely causative pathogen in a 23-year-old woman with PID most likely indicates the presence of: a. uterine fibroids. b. an ectopic pregnancy. c. ovarian malignancy. d. a tubo-ovarian abscess.

d. a tube-ovarian abscess.

Routine anal Papanicolaou (Pap) tests can be considered for all of the following patient populations except: a. men with HIV. b. men who have sex with men (MSM). c. women with a history of anogenital HPV infection. d. all males under age 25 years.

d. all males under age 25 years.

Which of the following statements is correct about the varicella vaccine? a. it contains killed varicella-zoster virus (VZV). b. the use of the vaccine is associated with an increase in reported cases of shingles. c. varicella vaccine should be offered to adults who were U.S. born prior to 1980 and report a childhood history of chickenpox. d. although highly protective against invasive varicella disease, mild cases of chickenpox have been reported in immunized individuals.

d. although highly protective against invasive varicella disease, mild cases of chickenpox have been reported in immunized individuals.

Treatment options for venous stasis ulcers in the lower extremities include: a. cleansing with hydrogen peroxide. b. applying Burow solution. c. prescribing a systemic corticosteroid. d. applying a moisture-retaining dressing.

d. applying a moisture-retaining dressing.

A recommended treatment for rectal gonorrhea is: a. oral amoxicillin. b. oral azithromycin. c. oral ciprofloxacin. d. ceftriaxone injection.

d. ceftriaxone injection.

Increased risks for fatal reactions from anaphylaxis include all of the following except: a. personal history of asthma. b. delay in administering epinephrine c. age in the teen years. d. delay in administering antihistamines.

d. delay in administering antihistamines.

Which of the following include characteristics of a friable cervix? a. presence of a dull pain, particularly prior to menses. b. a constant burning sensation. c. presence of multiple polyps. d. easily irritated and prone to bleeding, especially following intercourse.

d. easily irritated and prone to bleeding, especially following intercourse.

Analgesia options for a patient with shingles can include all of the following except: a. topical lidocaine gel 5% with oral acetaminophen b. Burow's solution with a high-potency oral NSAID c. Burow's solution with an oral opioid d. fentanyl transdermal patch and a topical medium-potency corticosteroid on the affected area

d. fentanyl transdermal patch and a topical medium-potency corticosteroid on the affected area

Which of the following is found in tertiary syphilis? a. arthralgia. b. lymphadenopathy. c. maculopapular lesions involving the palms and soles. d. gumma.

d. gumma.

Women with bacterial vaginosis typically present with: a. vulvitis. b. pruritus. c. dysuria. d. malodorous discharge.

d. malodorous discharge.

Treatment options for bacterial vaginosis include all of the following except: a. oral metronidazole. b. clindamycin cream. c. oral clindamycin. d. oral azithromycin.

d. oral azithromycin.

A woman who has been advised to receive varicella-zoster immune globulin (VZIG) asks about its risks. You respond that IG is a: a. synthetic product that is well tolerated. b. pooled blood product that often transmits infectious disease. c. blood product obtained from a single donor. d. pooled blood product with an excellent safety profile.

d. pooled blood product with an excellent safety profile.

The anticipated result of debridement as part of the treatment of venous stasis ulcers includes all of the following except: a. enhanced tissue granulation. b. encouragement of re-epithelialization. c. reduction of bacterial burden. d. prevention of peripheral arterial disease.

d. prevention of peripheral arterial disease.

All of the following are likely reported in a man with an initial episode of genital HSV-2 infection except: a. painful ulcer. b. inguinal lymphadenopathy. c. fever and body aches. d. pustular lesions.

d. pustular lesions.

All of the following are likely reported in a woman with an initial episode of genital HSV-2 infection except: a. painful ulcer. b. inguinal lymphadenopathy. c. thin vaginal discharge. d. pustular lesions.

d. pustular lesions.

A person with latex allergy also often has a cross-allergy to all of the following except: a. banana. b. avocado. c. kiwi. d. romaine lettuce.

d. romaine lettuce.

Which of the following is most consistent with a woman with PID? a. temp 99.6 F; WBC 8,000. b. temp 101.4 F; WBC 6,000. c. temp 99 F; WBC 14,000. d. temp 101.5 F; WBC 16,000

d. temp 101.5 F; WBC 16,000