Infectious Disease Questions

11 y/o M presents with pain and swelling of his right hand. He was bitten by a German Shepherd when feeding him last night, about 12 hours ago. Wound was cleaned with water. Tetanus is up to date, as well as the dog's rabies immunization. He is afebrile and physical exam shows two puncture wounds on the dorsal aspect of his right hand which was swollen, erythematous, warm, and tender. The rest of exam was normal. Given the short latency period, what is the most likely bacteria causing the infection? A. Neisseria B. Staphylococcus C. Bacillus D. Pasteurella

D

88 y/o F reports to urgent care with cc of cat bite on her right index finger. She states she has 5 cats at home that are all up to date on their vaccinations. She reports PMHx of DM, HTN, and depression and pSHx of hysterectomy and splenectomy. You update the patient's tetanus and prescribe her Augmentin 875/125 mg BID for 5 days. All of the following are reasons this patient should be given prophylactic antibiotic therapy EXCEPT: A. The location of the bite B. PMHx of Splenectomy C. PMHx of DM D. PMx of HTN

D

After receiving the chest x-ray, you decide to order additional testing for Kathy. What would be the most appropriate choice of orders for this patient? a.CBC w/differential b.Rapid Influenza A & B test c.Rapid COVID-19 test d.Amylase, Lipase, LFTs, and a Western Blot test e.All of the above are correct f.Only A, B, and C above are correct

F

What pathogen makes up for over 50% of Meningitis cases? A. Enteroviruses B. N. Meningitidis C. Herpes Simplex Virus D. Streptococcal Pneumoniae

A

What pharmacological treatment is indicated for reducing the risk of infection or neonatal disease in pregnant women with primary CMV infection? A. Cytogam B. Doxycycline C. Estrogen D. Cephalosporin E. Lisinopril

A

Which of the following is NOT a symptom of a baby with congenital cytomegalovirus? A. Overweight B. Microcephaly C. Low birth weight D. Body Rash E. Premature birth

A

24 y/o F presents to the ER with right hand laceration after a dog bite. She was walking a dog for Rover when a semi drove by scaring the dog and it jumped up and bit her. Her tetanus and the dog's rabies vaccines are up to date. The laceration requires 4 sutures. What antibiotic is first line to be used prophylactically? A. Amoxicillin B. doxycycline C. Cephalexin D. Azithromycin

A

27 YOF presents to the ER with diarrhea for the past few hours that has not stopped. You complete proper testing and the results come back with confirmation of V. Cholerae. Which symptom listed below would you not expect to see? a. Febrile b. Abdominal pain c. Leg cramping d. Nausea and vomiting e. Borborygmi

A

A 22-year-old male is brought into the ER via EMS for abdominal pain. The patient is cool, pale, and diaphoretic. Vitals are as follows: HR 117 bpm, BP 86/60 mmHg, spO2 98% RA. On physical exam the patient has LUQ tenderness. The patient states he has been sick for 2 weeks with a fever, malaise, sore throat, and swollen nymph nodes in the neck. He states he did not seek medical treatment due to lack of health insurance. What is the providers next best course of action? a. Treat the patient for hypovolemic shock secondary to splenic rupture. b. Prep the patient for an appendectomy. c. Order an ultrasound to rule out cholecystitis. d. Send him home because he doesn't have health insurance.

A

A 25-year-old female presents to ICU via ambulance with a clenched jaw and her back slightly lifted off of the bed. She is unable to talk so a history is gathered via her mother. She denies her daughter has had any prior trauma however a nurse notices a red inflamed puncture wound on the sole of her foot, roughly the size of a nail. What is the most likely toxin causing these symptoms and from what bacteria? A: tetanospasmin- Clostridium tetani B: Clostrospamin- Clostridium tetani C: tetanospasmin- Clostridium tetanus D: Clostrospamin- Clostridium tetanus E: tetanospasmin- Clostridium Botulinum

A

A 29-year-old woman notes the appearance of an expanding ring-like rash on her forearm over the past week. As this subsides, 3 weeks later she develops a stiff neck, left facial droop, and chest pain. Which of the following is most likely to have initiated this woman's sequence of problems? a. The bite of a deer tick b. Mercury poisoning c. Taking a cephalosporin d. Sexual intercourse e. Systemic lupus erythematosus f. Snorting cocaine

A

A 35-year-old man was found down and was delerious and talking incoherently. On examination in the emergency department his temperature is 39.3 C, pulse 110/minute, and blood pressure 70/palpable. He has a heart murmur, palpable spleen tip, and splinter hemorrhages of fingernails. Which of the following laboratory findings is most likely to be present in this man? a. Positive urine screen for opiates b. Elevated anti-streptolysin O (ASO) c. Increased urinary free catecholamines d. Elevated Cocksakie B viral titer e. Rising creatine kinase (CK) in serum

A

A 36-year-old female with a past medical history of HTN, type 2 diabetes, and depression presents with fever, chills, and vomiting. She has a laceration of her left lower calf that she says has been there for the last month. She saw her PCP three weeks ago but was not prescribed antibiotics at that time. She reports increased pain and notes some edema. Skin is discolored, fluid-filled vesicles, gas in tissues upon palpation. Considering the most likely diagnosis, what is the diagnostic method of choice? a. Surgical Exploration and debridement b. CT c. MRI d. Anaerobic culture

A

A 45-year-old man has had increasing abdominal discomfort with abdominal enlargement for the past two years. On physical examination, the spleen can be felt below the left costal margin. There is no fluid wave. An abdominal CT scan reveals massive (estimated 3000 gm size) splenomegaly. Which of the following underlying conditions is he most likely to have? a. Myelofibrosis b. Sickle cell anemia c. Portal hypertension d. Infectious mononucleosis e. Hemochromatosis

A

A 45yo F was driven to the ER by a family member after patient was found disoriented and had a high fever. She's squinting, sensitive to the light around her and says her head is killing her. Patient has normal vitals except for a 101.1 temperature. You perform Kernig's test and find it positive. She is not at a high risk for cerebral herniation, so a lumbar puncture is performed. What is the first line antibiotic given to empirically treat while awaiting blood culture and CSF results? A. Ceftriaxone B. A fluoroquinolone C. Bactrim D. You wouldn't, you should wait until culture results are available to see if it was bacterial or viral

A

A 50-year-old male patient presents with fatigue, headache, and erythema migrans. You subsequently diagnose him with early stage Lymes disease and prescribe him Doxycycline. How long should this patient be treated with the Doxycycline for? A. 14 days B. 7 days C. 15 days D. 21 days E. 5 days

A

After receiving an immunization for diphtheria, tetanus, and pertussis, a patient develops swelling and tenderness at the injection site, a low-grade fever, and malaise. The PA informs the patient's parents that: A. This is a mild reaction, and teaches them how to manage it. B. The reaction is severe enough that they should bring the patient to an emergency department. C. This is an appropriate reaction, and instructs them to do nothing. D. They should delay future immunizations until the patient sees an allergist. E. None of the above

A

Plasmodia organisms lack which of the following structures? A. peptidoglycan cell walls B. Flagella, as that is primarily a bacterial structure C. 40S and 60S ribosomes D. None of the above; Plasmodia is not considered eukaryotic or prokaryotic

A

The mother of a 5-year-old girl realizes that her child has spent all of Saturday in bed. The girl is listless and not arousable, so her mother takes the child to the emergency room. The examining physician notes a temperature of 38.8 C and nuchal rigidity. A lumbar puncture yields slightly cloudy CSF with a protein of 61 mg/dL and glucose 19 mg/dL (serum glucose 83 mg/dL). A culture of CSF is most likely to yield which of the following organisms? a. Hemophilus infuenzae b. Cryptococcus neoformans c. Aspergillus fumigatus d. Mycobacterium tuberculosis e. Cytomegalovirus

A

True or False, The closer the animal bite from a rabid animal is to the head, the shorter is the incubation period. A. True B. False

A

True or false. There is no established treatment for rabies. A. True B. False

A

What is the most common pathogen that causes Lymes disease in the US? A. B. burgdorferi B. B. afzeliii C. B. bavariensis D. B. lusitaniae E. B. mayoniii

A

Which species and sex of moquito is respobsible for nearly all mosquito borne illnesses? A. Female Aedes aegypti B. Both Aedes aegypti male and female mosquitoes transmit illnesses C. Aedes vexans females D. Male Aedes albopictus E. Female Aedes toxicoplasmodia

A

A 69 year old male comes to the office for his annual exam. His medical history includes hypertension, diabetes, smoking, and obesity. He is retired and lives a sedentary lifestyle. He has not had any immunizations within the past 5 years. Which of the following vaccinations would you recommend for him today? MA a.Fluzone High-Dose b.Comirnaty (Pfizer COVID-19) c.SmallPox d.Human Papillomavirus e.MMR

A, B

34 YOM presents to ER with complaints of chronic diarrhea and rice water stool that is described as "liquid grayish" in appearance that started 6 hours ago. He recently returned from a health care trip to Haiti after the recent earthquake. He claims that all of the water that he drank was filtered, but he did eat fruit without first cleaning it. What is the most likely diagnosis? a. Irritable Bowel Syndrome b. Vibrio Cholerae c. Giardia Lambia d. Non-typhoidal Salmonella enteric e. Lactose Intolerance

B

A 07 YOM presents to the ER complaining of nausea and neck stiffness. Vital signs on the patient are as follows: BP 108/70, P 98 SpO2 95% RR 20 T 101.8F. While obtaining a history from the patients you learn the child has been confused, and is also unvaccinated. Knowing that many preventable diseases by vaccination can lead to meningitis, you decide to elicit which test on physical exam to help in your differential of meningitis? A. CVA Tenderness B. Brudzinski's Sign C. Babinski Sign D. Percussion of the lungs

B

A 21-year-old man has had increasing malaise over the past three weeks. On physical examination his vital signs show T 39.2 C, P 105/minute, R 29/minute, and BP 80/40 mm Hg. The physician auscultates a loud systolic cardiac murmur. His lungs on auscultation have bibasilar crackles. Needle tracks are seen in his left antecubital fossa. He has splinter hemorrhages noted on fingernails, as well as painful erythematous nodules on palmar surfaces. A tender spleen tip is palpable. A chest radiograph shows pronounced pulmonary edema. Which of the following laboratory test findings is most likely to be present in this patient's peripheral blood? a. Creatine kinase-MB of 8% with a total CK 389 U/L b. Positive blood culture for Pseudomonas aeruginosa c. Total serum cholesterol of 374 mg/dL d. Blood urea nitrogen of of 118 mg/dL e. Antinuclear antibody titer of 1:512

B

A 25-year-old male has been bothered by multiple painful oral lesions, sore throat, and cervical lymphadenopathy for the past 5 days. He complains of feeling malaise with accompanying headaches for the past 2 days. Upon examination, pharyngeal edema, tonsillar exudate, and multiple ulcerative lesions throughout the mouth were noted. His temperature is 38.1 C. He states that 6 days ago he had sexual intercourse with a new partner. A sputum gram stain shows normal flora. Which of the following is the most likely diagnosis? A. SLE B. HSV-1 C. Rheumatic Fever D. Influenza A E. Strep Throat

B

A 28 yo male was bitten by a tick 5 days ago while on a hike. He has a fever, malaise, myalgia, rash, bleeding, and confusion. He has a temperature of 38.3 C. Due to the high sensitivity, his provider wants to perform serologic testing to see if he has been infected with R. rickettsia. Assuming he was infected 5 days ago, when would be the appropriate time to test for elevated antibodies? A. 0-3 days B. 9-16 days C. 12-18 days D. 4-7 days

B

A 30-year-old G2 P1 woman delivers a stillborn male infant at 28 weeks gestation. Her previous pregnancy resulted in a normal term birth. At autopsy, the cerebrum of the fetus demonstrates extensive diffuse periventricular areas of necrosis. Infection in utero with which of the following organisms is most likely to have caused these findings? a. Taenia solium b. Cytomegalovirus c. Poliovirus d. Candida albicans e. Treponema pallidum f. Group B streptococcus

B

A 30-year-old man has had a progressively worsening productive cough for one month. On physical examination, a few small non-tender lymph nodes are palpable in the axillae, and the tip of the spleen is palpable. Laboratory studies show Hgb 10.2 g/dl, Hct 31.1%, MCV 90 fL, WBC count 67,000/microliter, and platelet count 36,000/microliter. Microscopic examination of his peripheral blood smear shows many blasts with Auer rods. Which of the following is the most likely diagnosis? a. Leukemoid reaction b. Acute myelogenous leukemia c. Chronic lymphocytic leukemia d. Acute lymphoblastic leukemia e. Leukoerythroblastosis

B

A 33-year-old HIV-positive woman has had increasing inability to think clearly, with forgetfulness, over the past 3 weeks. She now has trouble doing everyday tasks. She has no history of seizures, headaches, nausea, vomiting, fever, chills or diarrhea. On examination she is oriented to time, place and date. She is indifferent to her surroundings. She is unable to perform calculations and has difficulty in word finding. She is afebrile. MR imaging of the brain shows an irregular ring-enhancing lesion in the white matter of the left frontal lobe. Her CD4 count is 90/microliter. Which of the following is the most likely diagnosis? a. Infarction b. Toxoplasmosis c. Contusion d. Astrocytoma e. Cysticercosis

B

A 35 yo woman presents to the office with fever, malaise, headache, nausea, and vomiting, onset 3 days ago. She is 5 months pregnant. The patient reports that her symptoms started a few days following getting bitten by a tick while gardening. You suspect RMSF. What first-line treatment is recommended? A. Chloramphenicol B. Doxycycline C. Amoxicillin D. Cefuroxime

B

A 40 y/o male presents to the ED complains of fever, weakness, malaise, and GI distress (N/V) for the past 2 days. Previously healthy male, no significant medical history, not on any prescription medications, NKDA. He states that the symptoms have been worsening over the past 8 hours, and now he presents with temperature of 103F and chills. Pt denies exposure to sick people, eating spoiled food/drinking dirty water, but states he traveled to Dominican Republic (a known malaria endemic region) 3 weeks ago. Which test should you request to confirm your suspicion of malaria? A. CBC B. Blood smear (Giemsa stain) C. Urinalysis D. Chest X-ray

B

A 45 year old man comes in to the clinic with complaints of sore throat, dysphagia, and malaise. He states symptoms started yesterday and have been getting progressively worse. He has a low grade fever but all other vitals are normal. Upon inspection of his pharynx you notice a thin grayish-white membrane on his tonsils and throat that is strongly adhered to the tissue. What is the most likely cause of his symptoms? A. Acute tonsillitis B. Diphtheria C. Leukoplakia D. Strep throat E. Oral thrush

B

A 53-year-old previously healthy man has had a rapid decline in mental function over the past 4 months. On physical examination he exhibits profound dementia along with myoclonus. He is afebrile. A cerebral electroencephalogram shows periodic biphasic synchronous sharp-wave complexes that are superimposed upon a slow background rhythm. He dies from bronchopneumonia. At autopsy, his brain appears grossly normal, but a spongiform encephalopathy is seen microscopically in a section of the cerebral cortex (which was put in concentrated formic acid for 1 hour prior to processing). Which of the following is the most likely diagnosis? a. Alzheimer disease b. Creutzfeldt-Jakob disease c. HIV encephalopathy d. Herpes viral encephalitis e. Lead poisoning f. Leigh disease g. Progressive multifocal leukoencephalopathy h. Rabies

B

A 60-year-old male with a past medical history of type 2 diabetes and neuropathy of lower extremities presents with edema and erythema to the left foot. Patient reports maceration between toe. He reports a foul smell coming from foot that he began to notice yesterday. BP 94/60 mmHg, HR 110bpm, 38.4℃. On a physical exam, pale skin noted around the wound, gas present upon palpation, and brown, serous discharge present. Culture of the exudate shows gram positive rods. What is the most likely causative agent? a. S. Aureus b. C. perfringens c. C. trachomatis d. E. faecalis

B

A 64-year-old man has noted the presence of several lumps on the right side of his neck for the past 5 months. On physical examination he has firm, non-tender, movable lymph nodes palpable in right posterior cervical region. He does not have splenomegaly or hepatomegaly. Laboratory studies show Hgb 11.3 g/dL, Hct 40%, MCV 88 fL, platelet count 256,000/microliter, and WBC count 7230/microliter. A cervical lymph node biopsy is performed and on microscopic examination shows numerous crowded follicles of small, monomorphic lymphocytes. Which of the following is the most likely diagnosis? a. Chronic lymphocytic leukemia b. Poorly differentiated lymphocytic lymphoma c. Infectious mononucleosis d. Hodgkin lymphoma, lymphocyte predominance type e. Reactive hyperplasia

B

A 66-year-old female patient presents to the ED with the chief complaint of blurred vision. After talking to the patient, the patient's speech is also slurred and complains of muscle weakness and dysphagia. Upon physical exam the patient has drooping eyelids and hypotonia. Patient denies any recent travel and states that she loves gardening and canning her vegetables. What is the best treatment for this patient based on her history and symptoms? A: Flagyl B: Antitoxin C: Amoxicillin D: Intravenous Immunoglobulin E: Hydrocortisone

B

A 68-year-old man has had malaise for over a year. On physical examination, there are no abnormal findings. A CBC shows: Hgb 10.5 g/dL, Hct 31.5%, MCV 85 fL, platelet count 211,000/microliter, and WBC count 6980/microliter. A bone marrow biopsy is performed and microscopic examination shows that maturation is occuring in all cell lines and there are no abnormal cells seen. Stainable iron in the bone marrow is increased. He has a total serum iron of 130 microgm/dL and total iron binding capacity (TIBC) of 230 microgm/dL. Which of the following underlying diseases is he most likely to have? a. Diverticulosis b. Hepatitis C infection c. Systemic lupus erythematosus d. Atrophic gastritis e. Fanconi anemia

B

A 69-year-old woman with a 10 kg weight loss over the past 6 months now has developed painless jaundice over the past 2 weeks. On physical examination she is afebrile. An abdominal CT scan shows a large mass involving the head of the pancreas, along with widespread nodules in the liver. Nodules are seen in both lungs by chest radiograph. Which of the following cardiac lesions is she most likely to develop? a. Dilated cardiomyopathy b. Non-bacterial thrombotic endocarditis c. Acute fibrinous pericarditis d. Endocardial fibrosis e. Acute myocardial infarction

B

A 70-year-old man has had increasing difficulty with movement, starting with his feet and ascending to involve legs, trunk, and now arms, over the past 10 days. On physical examination there are variable sensory changes noted. He is afebrile. He does not lose consciousness and remains mentally alert. He becomes ventilator dependent a week after the onset of this illness. A lumbar puncture is performed and the CSF demonstrates a protein of 86 mg/dL, glucose 63 mg/dL (serum 89 mg/dL), and only 3 mononuclear cells/microliter. He gradually recovers over the ensuing 4 weeks. Which of the following conditions most likely preceded the onset of this man's illness? a. Exposure to a toxin b. Recent viral infection c. Severe hypotension d. Bacterial septicemia e. Radiation therapy

B

A daycare teacher comes into the clinic complaining of an itchy perianal area and abdominal pain. She says that it is worse in the evenings and better in the mornings. Due to the itching, he is also having a hard time sleeping. She denies fever, and N/V/D. She said that he bathes every morning and night and washes her hands regularly throughout the day, as her job can be quite messy. Upon examination, the anus is erythematous, excoriated, and has normal sphincter tone. What diagnostic test should you perform, given the likely cause of the symptoms? A. CBC B. Paddle or Tape test C. Colonoscopy D. Skin biopsy E. Stool sample

B

An umbilical cord is cut during an in the field delivery. The mother has not received any vaccinations but is otherwise healthy. The infant becomes stiff and spasms follow. The doctors miraculously catch the tetanus in time and the infant lives. What form of tetanus is this considered? A: generalized B: neonatal C: localized D: cephalic E: this is not considered tetanus

B

Onset of respiratory diphtheria is gradual and begins after an incubation period of: A. 1 day B. 2-5 days C. 6-14 days D. 10-20 days E. 4-6 weeks

B

Two rowdy toddlers were engaged in a serious food fight while the teacher's head was turned. After flinging a meatball at the face of the initial offender, the child retaliated by shoving her used fork into the arm of the other child. The child proceeded to scream until the teacher came over. Due to the volume of blood leaving the child, the teacher called 911 in a panic. After taking the child to the ER and treating the wound, the provider wanted to prescribe medication for the child. What should be prescribed? A. Clindomycin 150mg PO q6h B. Amoxicillin + Clavulanate 875mg/175mg PO b.i.d C. Metronidazole 500mg PO q6h D. Levofloxacin (Fluoroquinolone) 250mg PO qd

B

What is the mode of transmission for HSV? A. Respiratory Droplets B. Sexual Contact C. Shared Needle Use D. Airborne E. X-linked recessive disease

B

Which is the incorrect statement regarding rabies active immunization: A. Purified inactivated rabies vaccine is given IM at the deltoid area B. Pregnancy is a contraindication for rabies immunization. C. The rabies vaccine is given at a dose of 1mL on days 0, 3, 7 and 14. D. Local reactions (eg pain, erythema, edema) over the injection site are indications to discontinue giving the vaccine. E. The current rabies vaccines available for PEP are highly immunogenic and remarkably safe compared to previous vaccines.

B

Which is the incorrect statement: A. Negri bodies are pathognomonic of rabies. B. Rabies can be detected in the serum. C. Direct fluorescent antibody test (DFA) is the gold standard in diagnosing rabies. D. Rabies virus are found in neurons. E. The RT-PCR Amplification test is highly sensitive and specific for rabie

B

Which of the following is NOT a characteristic of diphtheria in an infected person? A. Fever and chills B. Difficulty urinating C. Bull-neck appearance D. Fatigue E. Pseudomembrane in the back of the throat

B

Which patient population is at greatest risk for the dangerous symptoms of toxoplasmosis? a. A 2-year-old with a broken arm b. A pregnant woman c. Patients of south Asian decent d. Pets like dogs, rabbits, and hamsters e. An 85-year-old man who recently had a hip replacement

B

You are asked to round on a patient admitted to the hospital 3 days ago for cough and shortness of breath. Her chart shows her current medications include: Acetaminophen 500mg PO PRN for pain, and Remdesivir 100mg IV QD. Her x-rays are shown below. Without looking further into her chart for an admitting diagnosis, based on the information you currently have what illness do you think this patient is suffering from? a.Cytomegalovirus b.COVID-19 c.Diphtheria d.RMSF e.Meningitis

B

A 15-year-old female has a chief complaint of excessive fatigue, fever, and a sore throat for one week. Her physical exam reveals tonsillar exudate and posterior cervical lymphadenopathy. Splenomegaly is felt upon palpation. What is her most likely diagnosis? a. Strep throat b. COVID-19 c. Infectious mononucleosis d. Upper respiratory infection e. Influenza

C

A 25-year-old male presents to your clinic with complaints of a rash that has developed over the week. He states he was camping last weekend and is an avid hiker. Upon inspection, you notice an erythematous, bull's eye shaped rash on his back. Your first suspicion is: A. Poison ivy B. Mosquito bite C. Lymes disease D. Contact dermatitis E. A bad reaction to new lotion he was trying

C

A 25-year-old previously healthy woman has had worsening fatigue with dyspnea, palpitations, and fever over the past week. On physical examination her vital signs show T 38.9 C, P 103/minute, R 30/minute, and BP 95/65 mm Hg. Her heart rate is slightly irregular. An ECG shows diffuse ST-T segment changes. A chest x-ray shows mild cardiomegaly. An echocardiogram shows slight mitral and tricuspid regurgitation but no valvular vegetations. Laboratory studies show a troponin I of 12 ng/mL. She recovers over the next two weeks with no apparent sequelae. Which of the following laboratory test findings best explains the underlying etiology for these events? a. Anti-streptolysin O titer of 1:512 b. Total serum cholesterol of 537 mg/dL c. Coxsackie B serologic titer of 1:160 d. Blood culture positive for Streptococcus, viridans group e. ANCA titer of 1:80

C

A 26 y/o F nurse was bitten on the ventral aspect of her right hand by a patient in the ER during the night shift today. She cleaned the wound with soap and water, stopped the bleeding, and covered it with a bandage. Two days later she noticed increasing pain, swelling, and limited range of motion with flexion of her fingers. During her next shift, she showed you her wound. The wound was erythematous and warm to touch. When asked if she was prescribed anything for the wound she replied with Clindamycin 150 mg PO q6h. What is likely the aggravating agent. A.Streptococci B.Pneumococci C. Eikenella D. Staphylococci

C

A 27 YOF patient presents to the ER with fever, headache, photophobia, altered mental status, and nuchal rigidity. On physical exam, you find a positive Kernig's Sign, and no rashes to the patients skin. You decide to order blood cultures and CSF studies on suspicion of meningitis. Blood culture results come back negative, CSF results show slightly elevated total WBC count that is predominantly made of lymphocytes. What is the most likely pathogen causing the patients illness? A. Herpes Simplex Virus 1 B. Syphilis C. Coxsackievirus D. Malaria

C

A 27 year old pregnant female presents with jaundice, fatigue, N/V, and headache. She appears in distress and complains of strong, throbbing pain beneath her ribs on the right side of her abdomen. She returned from a month long trip to South America, where she was completing research on local insects. You strongly suspect a mosquito-borne illness, and you test for malaria using Gold Standard blood smear that tests positive for Plasmodium gametocytes. She is in her first trimester of pregnancy and tells you to save the baby at all costs. Her condition is rapidly declining. What do you prescribe? A. Clindamycin 100 mg/kg BD, for 7 days B. Wait until she gives birth and prescribe chloroquine, 300mg IM for 4 months post-partum C. Treat aggressively with 2.4 mg IV aretsunsate. Repeat at 12 and 24 hours and once daily as necessary D. Treat conservatively with clindamycin 10 mg/kg until she reaches her second trimester, then consider IV artesunate if still showing symptoms

C

A 30-year-old man gives a history of a sore throat with fever followed by 6 weeks of malaise. On physical examination he has mildly tender generalized lymphadenopathy. A cervical lymph node biopsy is performed and on microscopic examination shows a diffuse polyclonal hyperplasia. Which of the following is the most likely diagnosis? a. Lymphocytic lymphoma b. Hodgkin lymphoma c. Infectious mononucleosis d. Human immunodeficiency virus e. infection f. Brucellosis

C

A 52 yo female presents with nausea and vomiting, fever, and a headache for 3 days. Her temperature is 38.1 C. Serologic testing shows elevated levels of IgG and IgM antibodies. A 3 mm skin biopsy is suspicious of R. rickettsia. What electrolyte would you expect to be low? A. magnesium B. potassium C. sodium D. chloride

C

A 85-year-old male with a past medical history of diabetes and BPH. Patient lives in SNF and has chronic use of a foley catheter. He presents to the ED with AMS, edema and erythema of his scrotum. He reports severe pain and fever. His BP is 92/58 mmHg and HR is 110 bpm. On physical exam, tissue appears necrotic and brown discharge present. Culture of the exudate shows gram positive rods. What is the most likely diagnosis? a. Epididymitis b. UTI c. Fournier's gangrene d. Testicular torsion

C

A father brings in his 7-year-old son to the clinic for a yearly checkup. He told the provider that he has recently been very itchy in the perianal area, not sleeping as well as he used to and has started to grind his teeth. While listening to the father talk, the provider notices that the 7-year-old is biting his nails. The father says that they have been trying to break this habit without much luck. Given what the father has said, the age of the patient, and what was witnessed in the clinic, the provider should suspect which of the following causative agents: A. Candidiasis B. Ringworm C. Pinworms D. Perianal strep E. Eczema

C

A newborn child is born prematurely with microcephaly, and red macular rash all over his body. Providers are concerned that this is a congenital pathology. Based on the likely diagnosis what diagnostic lab is performed to check for this? a. Urine Test b.Blood Test C. PCR Test D. Antibody Test E. Fasting Glucose Test

C

A young mother brings in her 10-month-old son to the pediatricians' office with the chief complaint of constipation. The mother believes her son is in pain because he also has a weaker, different sounding cry and does not show as much facial expressions anymore. The mother did state that her son has recently been teething, so she has tried some at home remedies to relieve his pain. She states these remedies include Tylenol, honey, and teething chew toys. She states that these symptoms have appeared even after trying the remedies. What is most likely the cause of her son's symptoms? A: Clostridium tetani B: Teething C: Clostridium Botulinum D: Campylobacter jejuni E: Respiratory syncytial virus

C

Cytomegalovirus is a disease that is caused by: A. Gram + bacteria B. Rna Virus C. DNA virus D. prion E. Gram - Bacteria

C

Genital Herpes is most commonly caused by? A. Herpes Simplex Virus 1 B. Varicella-Zoster Virus C. Herpes Simplex Virus 2 D. Cytomegalovirus E. Candida Albicans

C

The following patients, if exposed to CMV, are most likely to show symptoms of CMV except for: A. Organ transplant patient B. Newborn babies C. Healthy individuals D. HIV patient E. Immunocompromised PA student

C

The recommended dose for rabies immune globulin is: A. 1ml/kg B. 4ml/kg C. 20 IU/kg D. 40 IU/kg E. 20mL/kg

C

Upon contracting HSV-2, which of the following pathologies are you more susceptible to? A. Herpes Zoster Virus B. HPV C. HIV D. Chlamydia E. Hepatitis

C

What is the first step in the treatment of V. Cholerae? a. Antibiotic therapy b. NPO and prep for surgery c. Aggressive volume repletion d. Watchful waiting e. Send home and tell them to come back if it gets worse

C

What is the most common clinical presentation of a Toxoplasmosis infection in adults? a. Unilateral, symmetrical, tender cervical adenopathy b. Polymyositis c. Bilateral, symmetrical, nontender cervical adenopathy d. Hepatosplenomegaly e. Encephalitis

C

Which of the following is the offending organism of RMSF? A. Borrelia burgdorferi B. Babesia microti C. Rickettsia rickettsii D. Francisella tularensis

C

Which statement is incorrect about rabies? A. Rabies is a rapidly, progressive cute infectious disease of the central nervous system. B. The rabies virus is a bullet-shaped single stranded RNA virus from the family Rhabdoviridae, genus Lyssavirus. C. In the US, rabies transmission is mostly from dog bites. D. Rabies is transmitted usually through an animal bite, rarely through aerosol exposure and corneal transplantation. E. Mammals are the animal reservoirs.

C

Your patient is a 19 year old male who presents to your office with a low fever, pharyngitis, and malaise. On physical exam you notice soft palate petechiae and cervical lymphadenopathy. His monospot test is positive. What is your course of treatment? a. Prescribe a 10 day course of ampicillin b. Prescribe an antiviral like acyclovir c. Advise the patient to stay hydrated and take NSAIDs to reduce fever and pain d. Admit to the hospital for observation

C

A 10-year-old boy presents to the emergency room with c/o fever, headache, and adenopathy. The patient is not in too much distress as he begins to tell you about his new kitten he got for his birthday. Upon physical exam, you notice many scratches from this new kitten. As the NLO of Dr. Urban's classes, you know that scratches from kittens can cause a bacterial infection by Bartonella henselae bacteria. However, an essential physical exam finding leads you to believe this is a toxoplasmosis infection. What clinical presentation is that? a. Unilateral, symmetrical, tender cervical adenopathy b. Tender lymph nodes with erythema overlying the skin c. Tender regional lymphadenopathy involving a single node d. Bilateral, symmetrical, non-tender cervical adenopathy e. No enlarged cervical lymph nodes

D

A 22-year-old man has recently emigrated from Mexico City. He has the sudden onset of a seizure disorder while working as a chef in a restaurant. On physical examination he is afebrile. No papilledema is noted. MR imaging of the brain reveals a 2 cm rounded cyst in the right temporal lobe cortex and another 1.5 cm cyst in the subarachnoid space over the left parietal lobe. Both lesions are non-enhancing. A lumbar puncture yields colorless CSF under normal pressure. The CSF protein and glucose are normal, and there are 5 WBCs/microliter (4 monos, 1 PMN). Which of the following conditions most likely to cause these findings? a. Metastatic adenocarcinoma b. HIV encephalopathy c. Left atrial mural thrombosis d. Cysticercosis e. Hypertension

D

A 33-year-old pregnant patient presents with fatigue, joint pain, erythema migrans, and a headache. What would be your first line treatment for this patient? A. Azithromycin B. Doxycycline C. Erythromycin D. Amoxicillin E. Penicillin

D

A 45-year-old female with a past medical history of diabetes, HTN, and depression recently underwent surgical debridement for gangrene present on her right great toe. She has been cleared to go home under the care of her daughter. Her daughter is a nurse and will be assisting with her wound care. Which of the following are appropriate steps in management of her wound? a. Keep the area clean with soap and water b. Keep area dry and change bandage when saturated c. Check the skin for increased redness, swelling, and purulence d. All of the above

D

A 60-year-old male with a past medical history of type 2 diabetes and neuropathy of lower extremities presents with edema and erythema to the left foot. Patient reports maceration between his 2nd and 3rd toes. He reports a foul smell coming from foot that he began to notice yesterday. BP 94/60 mmHg, HR 110bpm, 38.4℃. On a physical exam, pale skin noted around the wound, gas present upon palpation, and brown, serous discharge present. Culture of the exudate shows gram positive rods. Considering the most likely diagnosis, what broad spectrum antibiotics would you use? a. Penicillin + Ceftriaxone + Clindamycin b. Ceftriaxone + Vancomycin c. Azithromycin + Daptomycin d. Penicillin + Vancomycin + Clindamycin

D

A pregnant woman lives in a house with her 5-year-old child who has contracted Enterobius vermicularis (pinworms). You know that the whole household needs treatment. What medication should you prescribe the mother? A. Albendazole B. Mebendazole C. Piperazine D. Pyrantel pamoate E. Ivermectin

D

Antibiotic treatment options for diphtheria include: A. Erythromycin B. Rifampin C. Penicillin D. A and C E. All of the above

D

The deadliest parasite that is responsible for causes of malaria in humans is: A. Toxoplasma B. Cryptosporidia C. Isospora D. Plasmodium falciparum

D

The usual incubation period of rabies is : A. 1-7 days B. 7-14 days C. 2-4 days D. 20-90 days E. 1-2 months

D

What grouping below includes the triad of signs commonly seen in patients presenting with meningitis? A. Fever, Headache, Pneumonia B. Fever, Altered Mental Status, Fatigue C. Nuchal Rigidity, Photophobia, Nausea D. Fever, Nuchal Rigidity, Altered Mental Status

D

What serogroup of V. Cholerae are we worried about as health care professionals? a. O1 b. O214 c. O139 d. A and C e. All of the above

D

Which diagnostic technique for R. rickettsia has 100% specificity? A. Serologic testing B. Polymerase chain reaction C. DNA testing of blood D. Skin biopsy

D

Which of these statements regarding the prevention of HSV transmission is true? A. The best method of reducing the spread of genital herpes is condom use. B. Suppressive treatment will reduce outbreaks by 90% and viral shedding by 95%. C. Suppressive treatment has not been effective in reducing transmission of HSV. D. There is not a guaranteed method of prevention of transmission of HSV. E. HSV can only be spread during an active outbreak

D

Which testing is not diagnostic for toxoplasmosis? a. ELISA b. DNA amplification by PCR c. Lymph node biopsy d. Heterophile antibody test e. Serologic testing

D

You are working in an OB/Gyn clinic where your patient is at 28-year-old women who is 12 weeks pregnant. She admits this will be her first child, though she has many fur babies at home and loves to volunteer at the local humane society. Which of the following is NOT an important counseling point for the prevention of Toxoplasmosis in your patient? a. Fruits & vegetables should be washed thoroughly before eating b. Meats should be cooked all the way through prior to consumption c. Your patient should avoid changing her cat's litter box, or wear gloves and possibly even a mask if she must do it herself d. Your patient has little risk of becoming infected by toxoplasmosis during her time at the humane society thanks to the required vaccination for cats e. Your patient should avoid drinking water from rivers, streams, lakes, etc. as toxoplasmosis can be spread from unclean drinking water.

D

Your patient is a 20 year old female complaining of a sore throat, decreased appetite, and swollen cervical lymph nodes. She has an elevated WBC, elevated LFTs, and a positive heterophile antibody test. After confirming Eptsein-Barr Virus, what is your advice to the patient? a. Avoid contact sports for at least 4 weeks to decrease the risk of splenic rupture. b. Avoid intimate contact and sharing beverages with others as saliva can be infectious for 6 months or longer. c. Gargle with warm saline 3-4 times a day to relieve throat discomfort. d. All of the above is good advice

D

A 20-year-old man has recently been inducted into the army. Several weeks into basic training, he experiences a severe headache for an entire day. He had been healthy prior to this, noting only a mild sore throat the prior day. He goes to the base physician, who records vital signs of T 39.2 C, P 90/minute, RR 19/minute, and BP 110/70 mm Hg. A lumbar puncture is performed and examination of the cerebrospinal fluid shows 2 RBC's/microliter, 34,000 WBC's/microliter, glucose of 20 mg/dl (serum 75 mg/dL), and CSF protein of 105 mg/dL. Which of the following additional laboratory tests on the CSF would be the most helpful in reaching a diagnosis in this case? a. Cryptococcal antigen b. Acid fast stain c. India ink stain d. Serology for Herpes simplex e. Gram stain f. VDRL

E

A 31-year-old female patient presents to the ER with complaints of cough, headache, nausea, and vomiting. She denies any recent travel out of the country but does claim to have been in Nashville two weeks ago for a friend's bachelorette party. Upon review of systems the patient denies having any congestion but does state she has difficulty smelling. You order a COVID-19 Rapid test which comes back positive. If you ordered a chest x-ray for this patient, what would you expect to see? a.Pulmonary infiltrates b.Lung consolidation c.Ground-glass opacities d.Lower zone distribution e.All of the above could be indicative of COVID-19

E

A 45 year old male arrives to the ER with jaw spasms. A PA performs a thorough history and reports he stepped on a rusty nail 2 days prior. He is vaccinated but not up to date with all of his vaccines. What overall treatment (s) are you going to give this patient? A: tetanus antitoxin B: antibiotic C: narotic D: muscle relaxant E: A, B and D

E

A 50-year-old man has noted increasing swelling of his lower legs along with shortness of breath for 5 months. On physical examination he is afebrile, but diffuse crackles are heard over the lung bases. His heart rate is 80/minute and regular, with no murmurs, rubs, or gallops. A chest radiograph reveals an increased size to the right heart border, along with bilateral pleural effusions. Laboratory studies show a serum troponin I of <0.4 ng/mL. Which of the following conditions is he most likely to have? a. Alcoholic cardiomyopathy b. Viral myocarditis c. Bicuspid aortic valve d. Constrictive pericarditis e. Pulmonary interstitial fibrosis

E

According to the CDC, rabies is mostly found in: A. raccoon B. bats C. skunks D. Foxes E. All of the above

E

An 11-year-old male patient complains of a severe throat for a week. The patient's mother states that multiple boys from his wrestling team are also ill. He has a fever of 102.1 F and white tonsillar exudate. The patient has an a positive heterophile antibody test and is positive for group A beta-hemolytic streptococcus pharyngitis. What is the best course of treatment? a. Advise the patient to take NSAIDs b. Prescribe a 10 day course of penicillin c. Prescribe a 10 day course of amoxicillin d. Prescribe a 10 day course of ampicillin e. Both A and B

E

Kathy Stevens, an awake and alert 68-year-old female comes into the ER complaining of shortness of breath and generalized weakness. She is responding to questions appropriately at Triage. Before being examined by her Physician Assistant, her vitals were reported as 100/68 mmHg, 101.3F, 89% O2 on RA, 110 bpm, and 22 RR. She received a chest x-ray that showed bilateral patchy infiltrates. What is the next step in the treatment plan for this patient? a. Discharge the patient home with a broad-spectrum Cephalosporin Abx b.Order a Chest CT to r/o ground-glass opacities c.Call in a consultation with General Surgery to evaluate the patient for tracheal collapse d.Perform an emergency Cricothyrotomy to establish an airway for ventilation and oxygenation e. Admit the patient to the hospitalist and order a consult with Infectious Disease

E

What is the best way to diagnose whether or not your patient has V. Cholerae? a. Molecular test b. Rapid test c. Measuring the degree of volume depletion from the patient d. CBC and check WBC e. Stool culture

E

Which of the following diagnostic tests would you expect to be elevated in a patient with Lymes disease? A. ESR B. Creatine Phosphokinase C. AST/ALT D. A and C E. All of the above

E

You are on a medical mission trip to assist a local clinic in the south region of Nigeria. A 29 y/o female is brought to the clinic by her family. She is febrile and has altered level of consciousness. Suspecting acute malaria infection, you perform a Gemsa stain blood smear test, which comes back positive with > 11% parasite load. What is the initial treatment that should be initiated promptly? A. IV quinine B. Hydroxychloroquine C. Artemether-lumefantrine (Coartem) D. Metfloquine E. IV artesunate

E