CM Infectious Disease questions

A 5 years old boy who was playing with his 20-year-old brothers turtle 2 days ago. Yesterday he complained to his mother of feeling feverish (39 Degree Celsius - 102.2 F) accompanied by abdominal pain and bloody mucosal diarrhea. What is the most likely cause of his symptoms? a) Gram negative b) Gram positive c) DNA virus d) RNA Virus

a) Gram negative (Salmonellosis)

Gabriel an unvaccinated college student presents to your office with his mom. His mom states that he was ok last night, but today he woke up with sudden onset of pain and swelling to his left testis. You also note 101.2 F and swelling and tenderness to his left side of face. What is your initial dx? A: epididymitis B: mumps C: tonsillitis D: Strep throat E: not enough information given

B: mumps

35-year-old male with who recently came back from South America 6 weeks ago is now presenting with steatorrhea and persistent weight loss. On examination of the patient's feces, he had eggs in his stool and CBC demonstrates microcytic anemia with a hemoglobin of 8.2. What does the patient potentially have? a. Amoebiasis b. Hookworm c. Pneumocystis d. Histoplasmosis e. Cryprococcosis

b. Hookworm

Janey, a 34-year-old female patient, presents to your urgent care clinic with diarrhea x 8 hours. She just returned from Thailand and her diarrhea started on her flight back to California. Upon questioning, you find out she went out with her family to the market and had shrimp and oysters before her returning flight. Her husband and two children also have diarrhea but her diarrhea has been continuous. She describes her stool as "watery and grey with small white dots." Her breathing is rapid and her eyes are sunken in but she denies fever and abdominal pain. What is the most likely causative agent? A) Vibrio Cholerae B) Salmonella C) Clostridium Botulinum D) Entamoeba Histolytica E) Shigella

A) Vibrio Cholerae

A 10 year old male patient presents to the ER after returning home from a trip to Mexico. He has experienced fever (103.5f), abdominal cramps, bloating, diarrhea, and tenesmus for the past 2 days. He reports small amounts of bloody, watery stool passing more than 20 times per day. He has become weak and lethargic in the last few hours. You find polymorphonuclear leukocytes on a methylene blue stain of the stool. He lives in a small house with 8 people but so far, he is the only one sick. After starting rehydration, what is the next step in managing the patient? A. Azithromycin or Bactrim to help prevent spread of the disease. B. Nothing, the disease is self-limited C. Captopril to protect the kidneys from HUS D. Loperamide to stop the fluid loss E. IV potassium to replace the ion loss

A. Azithromycin or Bactrim to help prevent spread of the disease.

J. Davis is a 29 year old HIV+ male presenting with a CD4 count of 40 and complaints of fever, malaise, weight loss, anorexia, diarrhea, and abdominal pain. Culture confirms a diagnosis with Mycobacterium Avium Complex and you initiate treatment with which of the following? A. Clarithromycin + Rifambutin B. Amoxicillin C. Rifampin + INH D. Fluconazole E. Trimethoprim + Sulfamethoxazole

A. Clarithromycin + Rifambutin

35 year old male patient presents to urgent care presenting with fever, bloody diarrhea and flu like symptoms. The patient has a history of AIDs but reports no recent sick contacts, the patient states that he is an avid spelunker (cave exploration) and recently came back from a trail in Mississippi. What diagnosis and treatment combo is the most appropriate for this patient? A. Histoplasmosis, treat with Itraconazole B. Histoplasmosis, treat with Aminoglycoside C. Pneumocystis, treat with Itraconazole D. Blastomycosis, treat with Amphotericin B E. Blastomycosis, treat with Itraconazole

A. Histoplasmosis, treat with Itraconazole

A 23-year-old sexually active male presents to your clinic complaining of pain and discomfort in his genitals. The patient says that a few times a year he develops small, painful bumps on his penis and then they go away. Upon physical exam you note several small blisters along the shaft of his penis. Which laboratory test will confirm your most likely diagnosis? A. PCR B. ELISA C. RPR D. CBC E. Blood Culture

A. PCR

35-year-old HIV positive male patient presents with fever, dry cough, and SOB on exertion. Patient's O2 sat is 90%, PPD test was negative, and Chest X-ray shows interstitial infiltrates bilaterally. Patient's lab is also remarkable for Increased LDH (>2000U/L). It is found that the offending agent is P. Jirovecci. With your diagnosis confirmed, what is the best treatment for this patient? A. Trimethoprim-sulfamethoxazole (Bactrim) + Steroids B. Fluconazole C. Fluoxetine D. Flucytosine E. Flurazepam

A. Trimethoprim-sulfamethoxazole (Bactrim) + Steroids

A 23-year-old marine arrives to your free clinic complaining of a painless ulcer on the mid-shaft of his penis and states it has been present for approximately 2 weeks. The patient admits to unprotected sex a month ago while on vacation. Upon inspection you note raised indurated edges around the ulceration. What stage of syphilis is the patient presenting in? A.) Primary B.) Secondary C.) Tertiary D.) This presentation is consistent with gonorrhea and not syphilis E.) None of the above

A.) Primary

A new patient arrives to your office. They are new to the area and as you read their intake form, you notice that the patient has written they are HIV positive. You enter the room and the patient is complaining of a cough that will not go away. You do a chest x-ray and find a ground glass appearance and you remember that this is most likely Pneumocystis jirovecii. You also remember that this is a sign that the patient's CD4 count is likely below the AIDS threshold. What level do you expect this patient's CD4 count to be below? A. 100 B. 200 C. 300 D. 400 E. 500

B. 200

A 50-year-old female who recently returned from a trip to Thailand to see her extended family presents with a productive cough x 4 weeks. Along with a cough she admits to having fevers, chills, and night sweats. She also states she has lost 10lb over the past few weeks due to a lack of appetite. You suspect TB and ordered a TST. The skin test should be read within ___________ and measurements to the reaction should be based on the ______________ A. 24-48 hr, redness B. 48-72 hr, induration C. 24-48 hr, induration D. 48-72 hr, redness E. 24hr, induration

B. 48-72 hr, induration

A 45-year old man with HIV presents with fever, headache, vomiting, and altered mental state. Physical examination shows neck stiffness, focal neurological deficit. Opening pressure during spinal tap is elevated. Cerebrospinal fluid (CSF) analysis shows reduced glucose, pleocytosis, and elevated protein. Indian ink preparation shows cryptococci. CSF cryptococcal antigen test is positive and CSF culture shows cryptococci. Which of the following is the drug of choice in the initial treatment of this patient? A. Itraconazole B. Amphotericin B C. Flucytosine D. Fluconazole E. None of the above

B. Amphotericin B

A 5 week old infant is brought into clinic by her mother with a cough but she states the child has not had a fever. On physical exam, you note tachypnea and rales and perform a chest XR which shows hyperexpansion. In reviewing the history, you find out that the mother had a premature rupture of membranes and the infant developed conjunctivitis 3 days after delivery. What is your suspected diagnosis and how do you plan to treat? A. Pneumocystis pneumonia; erythromycin B. C. Trachomatis pneumonia; erythromycin C. HIV; Zidovudine D. Gonococcal ophthalmia neonatorum; ceftriaxone E. Tuberculosis; INH, rifampin

B. C. Trachomatis pneumonia; erythromycin

You have a 9-year-old male patient present to your urgent care with fever, sore throat, fatigue, malaise and painful burning in his eye. Vital signs are: Temp 37OC, B/P: 110/75, RR: 20 and SpO2: 98%. On physical exam you note retinitis, unsteadiness on feet and cervical lymphadenopathy. What congenital virus are you immediately suspicious of? A. Congenital Pertussis B. Congenital Cytomegalovirus C. Congenital Arthritis D. Congenital Rubella E. Congenital Peyroines

B. Congenital Cytomegalovirus

An infant is brought into the ER 7 hours after ingesting contaminated honey. You notice the infant appears lethargic, has fixed dilated pupils, and, while appears to be in distress, has an abnormally weak cry. Based on the exposure and presentation, what other common sign would you expect to see with this intoxication? A. Increased muscle tone and stiffness B. Decreased "floppy" muscle tone C. A black necrotic wound on the neck D. Muscle spasms E. A macular rash on extremities that is reported to be spreading centrally

B. Decreased "floppy" muscle tone

Robert, a 45y/o M decided to treat himself to a nice steak dinner. Although this seemed like a good idea, things took a turn for the worse when Robert was served and ate a steak that was severely undercooked. Later that night Robert developed a fever and headache, as well as increased fatigue and generalized body aches. After Robert arrived at the clinic and told you this story, and your physical exam revealed cervical adenopathy you inform him that he likely has toxoplasmosis which is caused by what organism? And what is commonly used for diagnosis? A. Borrelia Burgdorferi / FOBT B. Toxoplasma Gondii / Serologic Testing C. Shigella Bacteria / Serologic Testing D. Plasmodium / Chest X-Ray E. A type of helminth / Clinical Diagnosis

B. Toxoplasma Gondii / Serologic Testing

Mr. Warner presents to your clinic complaining of arthralgias, fever, and an abnormal rash that started about 10 days ago. Mr. Warner states he recently returned from visiting his family in Connecticut, where they went on multiple hikes to enjoy beautiful views. Upon physical exam, you notice multiple erythematous annular lesions with central clearing. What will confirm your diagnosis? A. Asking the patient if he recalls being bitten by a tick B. Western immunoblot assay C. Arthrocentesis D. Dark-field microscopy of swab from lesion

B. Western immunoblot assay

During your outpatient pediatric rotation you are asked by your supervising physician to check out a 6 year old that is brought to the clinic for a chief complaint of "My bum is really scratchy". He denies any recent changes in bowel habits, but his mother said he is still working on washing his hands regularly. Especially after recess and playing soccer with his friends. You suspect an Enterobiasis infection. How do you proceed with confirming your diagnosis? A) Blood culture B) Skin scrape with KOH C) Early AM Scotch tape test with microscopic evaluation D) None, this is a clinical diagnosis

C) Early AM Scotch tape test with microscopic evaluation

A 16-month old girl is brought in to the pediatric clinic by her mother, with complaints of a light pink rash across the child's chest and back. Her mother tells you that for the past 3 days, the child has had a high fever (T max 103.1) but has otherwise been playful and acting normally. On exam today, the child is easily-consolable and afebrile with a maculopapular pink rash across the trunk and a few small red papules on the soft palate. What is the treatment of choice for this child? A) Acyclovir x 5 days B) Amoxicillin x 10 days C) Reassurance and supportive care D) Low-potency topical corticosteroid E) OTC Dipenhydramine

C) Reassurance and supportive care

While on your Mexico missions' trip, you encounter an 18-year-old male farm laborer with 1-week progressive worsening diarrhea with bloody mucoid stools and lower abdominal pain. He states that he has been going through cycles of feeling hot and cold since yesterday. You think you notice a small mass with liver palpation, but you do not have access to an ultrasound to confirm. Stool sample came back positive for Entamoeba histolytica cysts. You decide to treat the patient with: A) luminal amebicide B) Metronidazole or tinidazole C) luminal amebicide followed by metronidazole or tinidazole D) Metronidazole, tetracycline, bismuth, and omeprazole E) Symptomatic only. This will clear itself.

C) luminal amebicide followed by metronidazole or tinidazole

A 46-year-old male farmer presents with chief complaint of neck stiffness and trouble swallowing for the past 3 days. When taking his history, he denied recent illness, travel, or history of IV drug use. He is unsure if all of his immunizations are up to date. He reports that about a week ago, he suffered a puncture wound while working on his tractor, but he did not think anything of it until 2 days later when there was increased pain and tingling around the site of the wound. Today, he is also complaining of jaw stiffness and muscle spasms in his face. On physical exam, you notice muscle spasm with mild stimulation, increased DTRs, and fever. What is the most likely causative agent and diagnosis considering the patient's history and physical exam? A. Clostridium botulinum, Botulism B. Borrelia Burgdorferi, Lyme Disease C. Clostridium tetani, Tetanus D. Streptococcal pneumoniae, Bacterial Meningitis

C. Clostridium tetani, Tetanus

A 10-year-old girl comes into your clinic with her mother complaining of a sore throat and a fever. The mother, who is very vocal about telling you how against vaccines she is, says she has tried all her healing oils and sage, but the fever and sore throat are getting worse. Upon inspection of the girls' throat, you note what looks like a pseudomembrane in the back of her throat. Which of the following is the most appropriate treatment for this young girl? A. Double the amount of oils and surround the house with sage B. Tetracycline C. Erythromycin plus an antitoxin D. Supportive care, as her problem is most likely viral E. None of the above

C. Erythromycin plus an antitoxin

17-year-old male presents with 5-day history of fever, sore throat, malaise, and myalgias. Vital signs are significant for a temperature of 101.2 F. On physical exam, the patient has bilateral posterior cervical lymphadenopathy, splenomegaly, and hepatomegaly. Labs show leukocytosis and atypical lymphocytes. Heterophile antibody test is positive. What is the first line treatment for this patient? A. Amoxicillin B. Penicillin C. Supportive D. Ceftriaxone E. Corticosteroids

C. Supportive

The patient in question 1 required treatment, what is the treatment of choice? A.) Doxycycline bid x 10 - 21 days B.) Rocephin 250 g IM C.) Penicillin G benzathine 2.4 million units x 1 dose D.) 1 g Azithromycin PO E.) None of the options above apply.

C.) Penicillin G benzathine 2.4 million units x 1 dose

A 22-year-old female presents to your office complaining of intermittent fevers. She recently returned from a semester abroad in Africa. She has had fevers a few days on and off for the last 2 weeks. She also feels fatigued and weak. On exam, patient has scleral icterus and splenomegaly. What is the test of choice to diagnose the most likely condition? A) serum IgM antibodies B) blood cultures C) biopsy of the spleen D) Giemsa thick and thin smear E) Hgb electrophoresis

D) Giemsa thick and thin smear

A 31-year old female presents to the clinic with complaints of numerous flesh colored growths on her vulva and groin area. She is sexually active with multiple male partners, but denies any past history of STI. She denies any change in vaginal discharge, pruritis, dysuria, pain, or burning. She uses an IUD for birth control and expresses that her most recent partner infrequently used condoms. On physical exam you note reveals multiple large flesh colored pedunculated papules on the vulva and inguinal region and medial thigh. She endorsed being up to date on childhood immunizations but was not sure of receiving the Gardasil vaccine. What microorganism are you most suspicious of causing these symptoms? A) HIV B) Neisseria gonorrhea C) Chlamydia trachomatis D) HPV E) HSV

D) HPV

Jon Lannister, 24-year-old male, presents to your clinic for painful urination that began 1 week ago. While obtaining a thorough history, you learn that he has a 3 year history of unprotected insertive anal sex with 4 different male partners over the past 2 years. His most recent sexual encounter was 7 days prior to the onset of his current complaint. Upon further questioning, you learn that he has noticed purulent yellowish discharge from his urethral meatus over the past 3 days. As a competent PA, you order a culture of the discharge, which shows gram negative diplococci in polymorphonuclear leukocytes. Recognizing the STI you are dealing with, you give the patient a 250mg IM injection of Ceftriaxone. You also decide to write him a prescription for 7 days of Doxycycline to cover another STI that frequently occurs with your primary STI. What is your primary diagnosis based on the above presentation? A. HPV B. Herpes Simplex 1 C. Chlamydia D. Gonorrhea E. Syphilis

D. Gonorrhea

A 24 year old male was diagnosed with HIV 6 months ago after a hospital stay for pneumonia. After initiating the proper therapy the patient comes in for a follow up at the infectious disease office in which you work. Which diagnostic test can be used to determine the patient's response to his current therapy? A. ELISA B. Western blot test C. Rapid HIV test D. HIV RNA viral load

D. HIV RNA viral load

It was mid-February and Carrie was so excited for a day off work. She'd been working 10 days straight and was exhausted. Sadly though, when she woke up the next morning, she did not feel well. Her legs, chest, and back hurt, she had a fever, chills, headache, dry/unproductive cough, and after sleeping all night, still felt fatigued. She works at a medical biohazard facility and oddly, the power went out several days ago, but she kept working even without ventilation. Remembering all this, she decided to go see her doctor. Based on her s/s, what treatment did her doctor prescribe? A. Azithromycin B. Immediate referral to the ER C. Ribavirin D. Oseltamivir E. Supportive care

D. Oseltamivir (influenza)

A mother comes into your primary care office with her 2 yr. old daughter complaining of a fever and a rash on her face. She explains to you that it has been there for 2-4 days now and almost seems like she was "slapped" on the cheek. Upon physical exam you also notice a rash on her upper extremities which spares the palms and soles. How do you proceed to treat? A.Zanamivir B.Azithromycin C.Prednisone D.Supportive, anti-inflammatories

D.Supportive, anti-inflammatories

Billy, a 4 yo healthy child went over to a friend's house, Bob for a play date. His friend unfortunately was sick and was very itchy. Bob recognized that his friend had small red (vesicular) crusty lesions all over his body and was very flushed. He notified Bob's mother and Billy's mother came to get him immediately. It turned out that Billy was never vaccinated so he was likely to get the same lesions and itchiness. What disease is Billy likely to get and what is the treatment? a) Varicella-zoster, supportive care b) Psoriasis, steroids c) Varicella-zoster, antivirals d) Cellulitis, Bactrim e) None of the above

a) Varicella-zoster, supportive care

It's 5:29pm and you're on your last patient of your OB/gyn rotation. Your 16 y/o Pt was recently diagnosed with HIV and now presents with white oral plaques and vaginal discharge (cottage cheese like), with severe burning and vulvar pruritus. How do you diagnose and treat her current symptoms and what does she have? a. Magnesium hydroxide smear of mouth, Clue cells on smear; Tx her Trichomoniasis with Metronidazole. b. KOH smear of mouth, Hyphae yeast on vaginal smear; Tx her Candidiasis orally w/Nystatin & vagina w/Fluconazole. c. Clinical Dx of mouth and vagina (no testing); Tx her underlying cause with antivirals d. Positive Whiff test of mouth and vagina; Tx her Bacterial Vaginitis w/Metronidazole for both symptoms e. KOH smear of mouth, Hyphae yeast on smear; Tx her Cytolytic Vaginitis w/ Sodium Bicarb douche and sitz bath

b. KOH smear of mouth, Hyphae yeast on vaginal smear; Tx her Candidiasis orally w/Nystatin & vagina w/Fluconazole.

Mr. Warner presents to your clinic complaining of arthlagias, fever, and an abnormal rash that started about 10 days ago. Mr. Warner states he recently returned from visiting his family in Connecticut, where they went on multiple hikes to enjoy beautiful views. Upon physical exam, you notice multiple erythematous annular lesions with central clearing. What will confirm your diagnosis? a. Asking the patient if he recalls being bit by a tick b. Western immunoblot assay c. Arthrocentesis d. Dark-field microscopy of swab from lesi

b. Western immunoblot assay

Patient is a 19 y/o male who presents to the clinic for rash to bilateral extremities for 3 days. He recently returned from a camping trip 5 days ago, and initially experienced fever, chills, fatigue, headache, nausea, and vomiting. He then noticed a rash to his palms, soles, wrists, and ankles, which have been spreading proximally. On physical exam, you note a blanchable, erythematous macular rash that has a centripetal pattern of spread. What would be the most appropriate treatment? a. Anti-toxin b. Debridement c. Doxycycline d. Ketoconazole e. None of the above

c. Doxycycline

A 14-year-old female presents to clinic with a complaint of a rash for 3 days that seemed to spread quite rapidly but is starting to go away, a low-grade fever, and cough. She is also having some joint pain. During physical exam, you notice posterior cervical lymphadenopathy and a pink, light red maculopapular rash on face and extremities. How would you treat this condition? a. Ciprofloxacin b. Amphotericin B c. NSAIDS and Supportive care d. Amoxicillin e. None of the above

c. NSAIDS and Supportive care