ID Rosh Questions Midterm
Which of the following is the best treatment for uncomplicated falciparum malaria in areas with endemic chloroquine-resistance? Artemether-lumefantrine Chloroquine Doxycycline Primaquine
Artemether-lumefantrine
A 66-year-old woman reports to the emergency department complaining of cough with bloody sputum and pain with inspiration. Her past medical history includes chronic obstructive pulmonary disease and rheumatoid arthritis, for which she takes oral prednisone, methotrexate, and inhaled ipratropium bromide. Vital signs reveal HR 113, BP 105/75, RR 19, and T 101.8°F. Laboratory values demonstrate neutropenia. Chest radiograph reveals an intracavitary mass surrounded by a crescent of air that is determined to be mobile based on altered position with repeat scans. Which of the following is the most likely diagnosis? Aspergillosis Blastomycosis Cryptococcosis Tuberculosis
Aspergillosis
A 4-year-old boy who is unvaccinated presents to the pediatric clinic with worsening cough for two weeks. His mother reports episodes of frequent coughing that are followed by a gasp and posttussive vomiting. On physical examination, there are no signs of respiratory distress. Chest radiograph is normal. Polymerase chain reaction by nasopharyngeal swab is collected and sent to the lab. Which of the following is the recommended treatment while waiting for results? Amoxicillin Azithromycin Dexamethasone Supportive care
Azithromycin
A 25-year-old woman presents to her primary care provider with vaginal discharge following intercourse with a new sexual partner. She is currently pregnant. Which of the following antibiotic regimens is the best empiric treatment of uncomplicated genital infections in this patient caused by chlamydia? Azithromycin 1,000 milligrams given as a single dose Ceftriaxone 500 milligrams administered intramuscularly Doxycycline 100 milligrams given as a week long course Metronidazole 2,000 milligrams given orally
Azithromycin 1,000 milligrams given as a single dose
40-year-old man with untreated acquired immunodeficiency virus presents to the clinic with fever, night sweats, abdominal pain, and weight loss. His CD4 count is 45 cells per microliter. Mycobacterium avium complex is isolated from his blood. What is the best treatment regimen? Azithromycin and ethambutol Azithromycin, ethambutol, and rifampin Clarithromycin and rifampin Isoniazid, rifampin, pyrazinamide, and ethambutol
Azithromycin and ethambutol
Which of the following bacterial pathogens is associated with hot tub folliculitis? A Escherichia coli B Pseudomonas aeruginosa C Staphylococcus aureus D Streptococcus pyogenes
B Pseudomonas aeruginosa
A 21-year-old man is brought in to the emergency room with a one-day history of nausea and vomiting, difficulty swallowing, and double vision. Upon physical exam, he has evidence of extraocular muscle weakness. He has not had any episodes like this before. He explains that he recently started a fruit canning business. Which of the following is the most likely diagnosis? Anthrax Botulism Guillain-Barré syndrome Myasthenia gravis
Botulism
A 25-year-old man presents to the office for low-grade fever, fatigue, chills, sweating, joint pain, and poor appetite for the past month. He works as a farmhand and has close contact with a variety of animals. His physical exam is unremarkable, but a bone marrow culture confirms diagnosis of which zoonotic disease? Brucellosis Cat scratch disease Q fever Tularemia
Brucellosis Brucellosis is the most common zoonotic infection worldwide and is caused by the bacterial genus Brucella. It is transmitted from animals to humans via infected food products, direct contact with infected animals, or inhalation of aerosols. Brucella are found in the reproductive tract of host animals, particularly in farm animals, especially in the milk, urine, and placental fluid. Cat scratch disease (B) is incorrect. Patients with cat scratch disease will also have a history of a scratch or bite from a cat and will have some regional lymphadenopathy. Q fever (C) is commonly transmitted from farm animals but the most common presentation is pneumonia and influenza-like illness and tularemia (D) is transmitted from ticks. Both are zoonotic diseases but are rarely diagnosed via blood cultures due to low yield of bacteria, and isolation of the blood is dangerous to laboratory personnel and is therefore not recommended
Which of the following is a risk factor for Taenia solium infection? A Exposure of an open wound to aquarium water B Ingestion of undercooked beef C Ingestion of undercooked pork D Ixodes tick exposure
C Ingestion of undercooked pork Tapeworms (cestodes) are flat, hermaphroditic worms that can live as parasites in the human gastrointestinal tract. Tapeworms are composed of repetitive chains called proglottids. Each proglottid contains eggs that can be shed to infect other organisms. Taeniasis is a type of tapeworm infection caused by Taenia saginata (beef tapeworm) and Taenia solium (pork tapeworm
A 23-year-old woman presents to the clinic complaining of purulent vaginal discharge for the past three days. She also reports dysuria with increased urinary frequency. Genitourinary exam reveals mucopurulent cervical discharge, cervical friability, and edematous cervical ectopy. Further testing confirms the diagnosis via nucleic acid amplification testing. Which of the following is the most likely diagnosis? Bacterial vaginosis Chlamydial cervicitis Herpes simplex virus infection Trichomoniasis
Chlamydial cervicitis
A 20-year-old woman presents to the clinic with a vesicular lesion on an erythematous base on her vulva. She says that she has these outbreaks about eight times per year and they cause significant distress. Which of the following is the recommended treatment plan? Chronic suppressive treatment Episodic treatment Observation Sexual abstinence
Chronic suppressive treatment
A 35-year-old woman presents to the clinic with fever, gastrointestinal cramping, vomiting, and diarrhea for four days. She is having 11 loose bowel movements per day. Stool cultures reveal nontyphoidal Salmonella infection. Which of the following is the most appropriate antibiotic agent? Amoxicillin Cefazolin Cephalexin Ciprofloxacin
Ciprofloxacin
An 18-year-old boy with a history of recent travel to Mexico presents to the office with a 2-day history of bloody diarrhea, abdominal cramping, and pain with defecation. There is also mucus in the stool. He has also had a fever with chills, as well as decreased appetite. He does not have any nausea or vomiting or any sick contacts. Microscopic examination of the stool reveals a large number of red blood cells and white blood cells. Which of the following is the medication of choice for this patient? Ampicillin Ciprofloxacin Loperamide Mesalamine
Ciprofloxacin Shigellosis
A 64-year-old woman who has been admitted for three days for treatment of aspiration pneumonia complains of profuse, new-onset, foul-smelling diarrhea. Her vitals reveal HR 104, RR 16, BP 112/76, and T 100.5°F. Computed tomography reveals colonic wall thickening, a target sign, and pericolonic fat stranding. What is the most likely diagnosis causing her new symptoms? Celiac disease Clostridioides difficile infection Ischemic colitis Salmonella infection
Clostridioides difficile infection
A patient who was previously healthy presents with acute onset of bilateral blurred vision, dysphagia, and dysarthria, which was preceded by nausea, vomiting, and abdominal pain several hours ago. Over the next two days, she develops symmetrical descending weakness that affects the trunk and upper extremities and begins to show signs of respiratory distress. Physical examination reveals bilateral fixed pupillary dilation and symmetric muscle weakness that does not improve after periods of rest. Which of the following is a known risk factor for this condition? Consumption of food contaminated with Campylobacter jejuni Consumption of improperly canned food Lack of immunization Presence of a thymoma
Consumption of improperly canned food IE botulism toxin
A 25-year-old man presents with acute diarrhea and lower abdominal cramping. Which of the following would be most suggestive of giardiasis as the cause of this patient's symptoms? Contact with reptiles Currant jelly stools Drinking unfiltered water on a recent camping trip Shellfish consumption
Drinking unfiltered water on a recent camping trip
A 33-year-old woman presents to the ED for a 2-day history of headache, photophobia, and neck stiffness. Her medical history is significant for human immunodeficiency virus. While interviewing the patient, she is unable to tell you where she is and appears confused. A lumbar puncture is performed, and an India ink stain of the cerebrospinal fluid reveals encapsulated yeast. Which of the following is the most likely diagnosis? Coccidioidomycosis Cryptococcal meningitis Lyme meningitis Toxoplasmosis
Cryptococcal meningitis
Which of the following is the most common anthrax syndrome? Cutaneous Gastrointestinal Inhalation Meningitis
Cutaneous
A Brazilian man presents to his local clinic complaining of a solitary, painless, ulcerated lesion on his right forearm. He states the lesion began as a small pink papule that progressed to a nodule and then to the ulceration now present. The ulceration has an indurated border without surrounding erythema and is covered by a thick, white-yellow fibrinous material. A full-thickness punch biopsy of the indurated border is stained with Giemsa stain, which reveals an oval organism with rod-shaped kinetoplast. Which of the following is the most likely diagnosis? Basal cell carcinoma Chancroid Cutaneous leishmaniasis Leprosy
Cutaneous leishmaniasis
Which of the following physical exam findings is most likely to be found in a patient diagnosed with foodborne botulism? Descending muscle weakness Fixed bilateral miosis Temperature of 101°F Urinary incontinence
Descending muscle weakness
A 30-year-old man presents to a clinic along the Amazon River in Brazil. He complains of epigastric abdominal pain, nausea, vomiting, and diarrhea. Stool studies confirm a hookworm infection. Which of the following species most likely caused this infection? Ancylostoma duodenale Diphyllobothrium latum Necator americanus Taenia solium
Necator americanus (causes hook worm)
A 20-year-old man presents to the emergency department with a cutaneous abscess and surrounding cellulitis. Which of the following antibiotics provides coverage against methicillin-resistant Staphylococcus aureus infection? Cephalexin Dicloxacillin Doxycycline Piperacillin-tazobactam
Doxycycline
Which of the following is the drug of choice in the treatment of acute Q fever? Ciprofloxacin Doxycycline Hydroxychloroquine Trimethoprim/sulfamethoxazole
Doxycycline
Which of the following is a risk factor for histoplasmosis? Exposure to cats Exposure to soil contaminated with bird and bat droppings Recent antibiotic use Residence in the southwestern part of the United States
Exposure to soil contaminated with bird and bat droppings
A woman presents to the clinic with vaginal itching and white curd-like discharge. Potassium hydroxide preparation shows budding yeast and pseudohyphae. Which of the following is the most appropriate treatment? Azithromycin Ceftriaxone Fluconazole Metronidazole
Fluconazole tx for vaginal candidiasis
A 20-year-old man presents to the clinic with acute diarrhea and foul-smelling stools for the past two days. Other symptoms include bloating, abdominal cramping, and flatulence. He states that 10 days ago he was camping and drank water directly from the stream. What is the most likely diagnosis? Crohn disease Giardiasis Lactose intolerance Traveler's diarrhea
Giardiasis
A 25-year-old man presents to the clinic with dysuria and urethral discharge. He is diagnosed with urethritis due to a sexually transmitted disease. He is correctly treated with 500 milligrams of ceftriaxone. Which of the following describes the causative organism? Difficult to Gram stain Gram positive Gram-negative diplococcus Protozoan parasite
Gram-negative diplococcus Ie gonorrhea
A 50-year-old man presents to the clinic to be screened for tuberculosis. He has no typical symptoms of pulmonary tuberculosis, such as fever, night sweats, chills, and hemoptysis. Which of the following risk factors causes a tuberculin skin test to be considered positive at 5 millimeters? History of intravenous drug use disorder Housing instability or being without housing Human immunodeficiency virus infection Immigration from an endemic area
Human immunodeficiency virus infection
Which of the following tests can identify human immunodeficiency virus infection earliest? Human immunodeficiency virus enzyme-linked immunosorbent assay Human immunodeficiency virus rapid antibody test Human immunodeficiency virus viral load Western blot
Human immunodeficiency virus viral load
Which of the following is the most common sexually transmitted infection? Chlamydia Gonorrhea Herpes simplex virus Human papillomavirus
Human papillomavirus
Which diagnostic study can help with the diagnosis of meningoencephalitis due to Cryptococcus species? India ink staining Potassium hydroxide preparation Rapid plasma reagin Tzanck smear
India ink staining
A 48-year-old man who does not have housing and has a history of chronic infection with human immunodeficiency virus presents with fever, dyspnea, nonproductive cough, and weakness during usual activities. You suspect Pneumocystis pneumonia. Which of the following laboratory results would you expect to see? Alveolar-arterial oxygen gradient of 15 mm Hg CD4 count of 400 cells/microL Lactate dehydrogenase level of 400 U/L Negative 1-3-beta-D-glucan level
Lactate dehydrogenase level of 400 U/L
A 30-year-old woman presents to the clinic complaining of vaginal discharge and dyspareunia. Vaginal swabs are obtained, and wet mount microscopy shows motile trichomonads. Which of the following is the best pharmacologic treatment? Azithromycin 1,000 milligrams administered orally once Ceftriaxone 250 milligrams administered intramuscularly once Doxycycline 100 milligrams administered orally twice daily for 10 days Metronidazole 2,000 milligrams administered orally once
Metronidazole 2,000 milligrams administered orally once
An 18-year-old man presents to the office for complaints of purulent discharge from his penis and painful urination for about one week. Today, he started complaining of joint pain and fever. On physical exam, his right knee is swollen and warm to the touch with loss of range of motion. He had unprotected intercourse with several men in the past few weeks and has a history of prior sexually transmitted infections. A specimen is obtained, and a culture is ordered. Which of the following organisms is most likely to be identified on a culture? Chlamydia trachomatis Haemophilus ducreyi Neisseria gonorrhoeae Treponema pallidum
Neisseria gonorrhoeae
A 20-year-old man presents with a painless ulcer on his penis. He has a reactive rapid plasma reagin. Which of the following is the best treatment for the most likely diagnosis? Acyclovir Ceftriaxone Doxycycline Penicillin G
Penicillin G
A patient presents with a CD4 count of 150 cells/microL secondary to a previously undiagnosed infection with human immunodeficiency virus. In addition to starting antiretroviral therapy, you decide to prescribe trimethoprim-sulfamethoxazole as primary prophylaxis. Which of the following opportunistic infections are you attempting to prevent? Disseminated Mycobacterium avium complex Pneumocystis jirovecii pneumonia Toxoplasmosis Tuberculosis
Pneumocystis jirovecii pneumonia
Which of the following is a contraindication to live-attenuated vaccinations? Egg allergy Human immunodeficiency virus infection without severe immunosuppression Pregnancy Viral upper respiratory infection
Pregnancy
A 7-year-old boy presents to the pediatric clinic with his mother who states he has had perianal itching at night. Pinworm paddle testing confirms the suspected diagnosis. Which of the following is the best treatment? Fluconazole Metronidazole Pyrantel pamoate Topical permethrin
Pyrantel pamoate Fluconazole (A) is an antifungal medication that is often used in the treatment of vulvovaginal candidiasis, which presents with vaginal itching and burning. Antifungals are not used to treat helminthic infections. Metronidazole (B) is an antimicrobial medication used to treat numerous infections, including trichomoniasis, giardiasis, bacterial vaginosis, and Clostridioides difficile infection. It is not used to treat helminthic infections. Topical permethrin (D) is used to treat scabies.
Which of the following medications used to treat tuberculosis causes orange discoloration of body fluids? Ethambutol Isoniazid Pyrazinamide Rifampin
Rifampin
A 32-year-old woman presents to the urgent care clinic complaining of sudden onset diarrhea and fever for the last two days. She describes the diarrhea as "pea soup" and reports associated abdominal cramping, nausea, and vomiting. Vital signs indicate a fever and bradycardia. She reports no changes in her diet, except the recent addition of eggs from her neighbor's chickens. Which of the following is the most likely cause of her gastroenteritis? Escherichia coli infection Norovirus infection Salmonella infection Shigella infection
Salmonella infection
A 25-year-old man presents to the clinic in June after returning from Kenya six weeks ago. Over the past two days, he has had a sudden onset of fever, chills, myalgias, arthralgias, headache, abdominal pain, dry cough, and urticaria. He reports swimming in fresh water while traveling. Serologic studies detect antigens of a blood fluke infection. What is the most likely diagnosis? Enteric fever Influenza Malaria Schistosomiasis
Schistosomiasis
A 43-year-old woman presents to the emergency department with fever, chills, and night sweats for the past nine days. On exam, she has bilateral and nontender cervical lymphadenopathy. She works at an animal shelter and frequently cleans out cat litter boxes. Which of the following diagnostic studies is indicated to make a presumptive diagnosis of toxoplasmosis? Brain biopsy Polymerase chain reaction Serologic studies for immunoglobulin G Serologic studies for immunoglobulin M
Serologic studies for immunoglobulin M Brain biopsy (A) is sometimes performed in patients with toxoplasma encephalitis, which most commonly occurs in HIV patients with a CD4 count below 100 cells per microliter. It is the definitive diagnostic test for toxoplasma encephalitis. However, it is not always performed due to the morbidity and mortality associated with obtaining a brain biopsy. Brain biopsy has no role in the diagnosis of acute toxoplasmosis in immunocompetent patients. Polymerase chain reaction (B) is not the preferred diagnostic study due to the low sensitivity in immunocompetent patients. However, polymerase chain reaction of cerebrospinal fluid is very specific for toxoplasma encephalitis. Serologic studies for immunoglobulin G (C) are typically not positive until symptoms have been present for at least two weeks. In this vignette, the patient has symptoms for nine days.
A 33-year-old man presents to the clinic with fever, crampy abdominal pain, small and frequent bloody stools, and tenesmus. He is nontender to palpation during exam, and he reports no vomiting. He also has not had any recent international travel. Which of the following is the most likely diagnosis? Appendicitis Enteric fever Pancreatitis Shigella gastroenteritis
Shigella gastroenteritis
Which of the following is the best diagnostic study to confirm the diagnosis of Clostridioides difficile infection? CT of the abdomen and pelvis Enzyme immunoassay for Clostridioides difficile glutamate dehydrogenase antigen Plain abdominal radiograph Stool nucleic acid amplification testing
Stool nucleic acid amplification testing or smelling... lol
A 22-year-old woman presents to the clinic with a high fever, chills, a skin ulceration on her right thigh and painful inguinal lymphadenopathy for two days. She recently went camping and states that she removed a tick from the same leg before the symptoms began. Which of the following is the drug of choice to treat her condition? Ciprofloxacin Gentamicin Streptomycin Tetracycline
Streptomycin Tularemia is an infectious disease caused by Francisella tularensis, an aerobic, gram-negative bacillus. Ciprofloxacin (A) is also an effective drug but is not the initial drug of choice. Gentamicin (B) is an effective second-line drug but is not the initial drug of choice. Tetracycline (D) has been shown to be effective but is also associated with disease relapse
Which of the following is a finding of tertiary syphilis? Chancre Diffuse lymphadenopathy Generalized rash Tabes dorsalis
Tabes dorsalis (slow degeneration of the nerve cells and nerve fibers that carry sensory information to the brain) Late neurosyphilis (part of tertiary syphilis) involves the brain and spinal cord parenchyma and presents with general paresis or tabes dorsalis.
A 68-year-old man presents to the clinic for a routine annual exam. He has had complete prior immunization against tetanus, diphtheria, and pertussis. Which form of the tetanus vaccine should be provided to him as a booster? Diphtheria and tetanus (DT) Diphtheria and tetanus toxoids and whole cell pertussis (DTwP) Diphtheria, tetanus, and acellular pertussis (DTaP) Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap)
Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap)
A 40-year-old woman presents to the clinic with acute diarrhea after camping in the wilderness for the past two weeks. She says that she drank pond water that was not filtered or boiled. She also complains of fatigue, malaise, and abdominal bloating. Nucleic acid amplification testing reveals giardiasis as the cause of her symptoms. Which of the following is the best treatment? Albendazole Azithromycin Ciprofloxacin Tinidazole
Tinidazole Individuals ≥3 years old — tinidazole Individuals between 1 and 3 years old — nitazoxanide Individuals <12 months old —metronidazole
A pregnant 34-year-old woman presents to the clinic for evaluation of vaginal itching and white, thick discharge which has been present for the past week. Physical exam reveals white, curd-like discharge and vulvovaginal erythema. Wet mount preparation of the discharge indicates vulvovaginal candidiasis. Which of the following is the most appropriate treatment? Expectant management Oral amphotericin B Oral fluconazole Topical clotrimazole
Topical clotrimazole
Which organism is the most common cause of central nervous system infection in patients with acquired immunodeficiency syndrome who are not receiving appropriate prophylaxis? Cryptococcus neoformans Cytomegalovirus Histoplasma capsulatum Toxoplasma gondii
Toxoplasma gondii
A 23-year-old woman presents to the gynecology clinic complaining of foul-smelling vaginal discharge for the past week. She reports pruritus, lower abdominal pain, and burning but denies vulvovaginal erythema or tenderness. Genitourinary exam reveals green, frothy, malodorous discharge and an erythematous cervix with punctate hemorrhages. Which of the following is the most likely diagnosis? Bacterial vaginosis Chlamydia Trichomoniasis Vulvovaginal candidiasis
Trichomoniasis
A 30-year-old man with a history of human immunodeficiency virus presents to the clinic with fever, cough, and dyspnea on exertion. His last CD4 count was 100 cells per microliter. Chest X-ray shows bilateral diffuse interstitial infiltrates. Polymerase chain reaction of respiratory fluids obtained by bronchoalveolar lavage confirms the diagnosis of Pneumocystis jirovecii pneumonia. Which of the following is the recommended antimicrobial treatment? Aerosolized pentamidine Dapsone Fluconazole Trimethoprim-sulfamethoxazole
Trimethoprim-sulfamethoxazole
A 32-year-old woman with a history of AIDS is admitted to the intensive care unit for respiratory failure. Chest radiography reveals bilateral interstitial infiltrates. Cystic forms are identified in respiratory secretions. Which of the following is the most appropriate initial antimicrobial therapy for this patient? Azithromycin Doxycycline Prednisone Trimethoprim-sulfamethoxazole
Trimethoprim-sulfamethoxazole
An animal enthusiast who takes care of rabbits is diagnosed with an infection. Laboratory studies reveal aerobic, slow-growing, gram-negative coccobacilli. Which of the following is the most likely diagnosis? Histoplasmosis Lyme disease Q fever Tularemia
Tularemia
A 21-year-old woman presents to urgent care for a two-day history of vaginal discomfort and abnormal discharge. She was recently seen in the urgent care two weeks ago for a sinus infection, for which she was treated with amoxicillin. On exam, there are minimal excoriations on the labia, and a white, curd-like discharge is noted in the vaginal vault. Which of the following tests would confirm the suspected diagnosis? Biopsy of vulva tissue Nucleic acid amplification Urinalysis Wet prep
Wet prep
