IM EOR: Infectious Disease - Diptheria, EBV, HSV, Parasites, Pertussis, Rock Mt Fever, Varicella, Botulism

Characteristics cholera include severe ______________ diarrhea with extreme fluid and electrolyte depletion, vomiting, muscle cramps, prostration, and potential death without replacement of fluids and electrolytes.

"rice water"

"TORCH" is an acronym meaning:

(T)oxoplasmosis, (O)ther Agents (R)ubella (also known as German Measles), (C)ytomegalovirus (H)erpes Simplex.

Antiviral treatment reduces the duration of illness by about___________ and should be specifically considered for high-risk patients

1 day

PPD Rules: Area of induration = raised area (not the red area). Positive if: > ____________ mm. IV drug users Recent immigrants from high-prevalence areas, Residents of high-risk settings (eg, prisons, homeless shelters) Patients with certain disorders (eg, silicosis, renal insufficiency, diabetes, head or neck cancer), and those who have had gastrectomy or jejunoileal bypass surgery.

10 mm

The peak occurrence of Varicella-zoster virus is now in ____ year olds.

10-14 year olds

Opportunistic toxoplasmosis usually occurs in AIDS patients when the CD4+ count is less than _________________ cells/microL.

100

Pediatricians recommend waiting until your baby is at least __________ months before introducing honey

12

The incubation period of Varicella-zoster is generally ___________ days after exposure

14-16 days

PPD Rules: Area of induration = raised area (not the red area). Positive if: > ____________ mm. Patients with no risk factors

15 mm

Continue to treat most patients for _________________ with isoniazid, rifampin, ethambutol, and pyrazinamide...followed by an additional 4 months of just isoniazid and rifampin

2 months

Most patients are free of V. cholerae within ____________ after cessation of diarrhea.

2 weeks

A CD4+ cell count of < _________ cells/mm3 is associated with Pneumocystis pneumonia.

200

Reduce ethambutol and pyrazinamide dosing to three times per week instead of daily in patients with a CrCl of less than _________ mL/min.

30

Continue to treat most patients for 2 months with isoniazid, rifampin, ethambutol, and pyrazinamide...followed by an additional _______________ of just isoniazid and rifampin.

4 months

The incubation period of tetanus is from _________________.

5 days to 15 weeks

At what size induration would a PPD be positive for an HIV patient?

5 mm

PPD Rules: Area of induration = raised area (not the red area). Positive if: > ____________ mm Chest x-ray evidence of past TB, Immunosuppressed because of HIV infection or drugs (eg, TNF-α inhibitors, corticosteroid use equivalent to prednisone 15 mg/day for > 1 mo) Close contacts of patients with infectious TB

5 mm

Everyone > ______________ of age should receive annnual influenza vaccine.

6 months

Amantadine is only used to treat influenza ( A / B)

A

A 34-year-old man comes to your clinic with gradually worsening ascites for the past 6 months. He immigrated from India 6 years ago. He has seen his primary care provider several times but has not responded to antibiotic treatment and does not have elevated liver enzymes. Two months ago, he had a positive PPD test during routine workup. Consistent with this test finding, a chest X-ray shows a lesion in the lungs. The patient was started on a standard four-drug regimen, which he has complied with for the past month. Which of the following should be done to prevent later complications? A. Addition of corticosteroids to the treatment regimen for a few months B. Addition of more antitubercular drugs, due to concerns of growing resistance from this advanced disease D. Monitoring of the patient for cirrhosis. E. Surgical excision of the tubercles in the peritoneum

A (Addition of corticosteroids to the treatment regimen for a few months) (Active infection with Mycobacterium tuberculosis is treated with a standard four-drug therapy of isoniazid, rifampin, pyrazinamide, and ethambutol (INH+RIF+PZA+EMB). Addition of corticosteroids to the treatment regimen of a patient with peritoneal TB may reduce the incidence of late complications)

A 12-year-old boy presents to the emergency room with a small laceration to his right elbow and forearm after falling out of a tree and scraping it on a wooden fence. The patient also has a clean, open wound on the palmar surface of his right hand. Medical history indicates that he received his full diphtheria, tetanus, and pertussis (DTaP) immunizations at 1 year-of-age as well as a booster at age 5. Based on the patient's medical history, administration of which of the following would be the most appropriate next step in the management of this patient? A. Adult tetanus, diptheria and acellular pertussis vaccine (Tdap) B. Pediatric diptheria, tetanus, and acellular pertussis vaccine (DTaP) C. Pediatric diptheria-tetanus toxoid (DT) D. No tetanus prophylaxis is necessary E. Tetanus immunoglobulin (TIG)

A (Adult tetanus, diptheria and acellular pertussis vaccine (Tdap)) (Tetanus is caused by an infection of the bacterium C. tetani, which generally enters the skin through a puncture wound from a contaminated object. Vaccinations are routinely given as part of DTaP at 2, 4, 6, and 15 months, as well as a booster at age 5 years)

A 16-year-old boy is brought to the clinic for a sore throat and fever. He began feeling a dull, 5/10 pain in his throat 2 days ago and had a documented fever today of 101.4°F (38.5°C). He also endorses fatigue and headache, but denies chills, cough, congestion, rhinorrhea, chest pain, ear pain, ulcerations, or gastrointestinal symptoms. He just returned from a hiking trip in the Rocky Mountains 1 week ago and reports taking some old antibiotics he had received for an ear infection when he began feeling sick. A physical examination demonstrates enlarged posterior cervical lymph nodes and a rash on the torso. Which of the following findings would you expect in this patient? A. Agglutination of blood with sheep red blood cells (RBCs) B. Multinucleated giant cells on skin smear C. Positive IgG against Rickettsia rickettsii D. Positive rapid strep test E. Positive VDRL test

A (Agglutination of blood with sheep red blood cells (RBCs))This patient has Epstein-Barr virus (EBV) mononucleosis as demonstrated by his fever, posterior cervical lymphadenopathy, pharyngitis, and presumed amoxicillin rash. Patients with mononucleosis will have a positive monospot test, which results in the agglutination of blood with sheep or horse RBCs.) (EBV is a type of herpesvirus that is transmitted via respiratory secretions. It can result in mononucleosis, known as the kissing disease, and is common in young adults and teenagers. Patients often present with fever, hepatosplenomegaly, pharyngitis, and posterior cervical lymphadenopathy. Taking amoxicillin will result in a characteristic maculopapular skin rash. Peripheral blood smear would demonstrate "atypical lymphocytes," which represents reactive cytotoxic T-cells. Patients are to avoid contact sports until the resolution of the disease due to the risk of splenic rupture)

A 78-year-old woman comes to your clinic because of chronic cough and night sweats for the past 2 months. She recently returned from a trip to India. Her temperature is 38°C (100.4°F), pulse is 88/min, respirations are 19/min, and blood pressure is130/83 mm Hg. Multiple sputum smears are positive for acid-fast bacilli. Which of the following proceedings is most appropriate? A. Airborne precautions B. Contact precautions C. Droplet precautions D. Post-exposure prophylaxis E. Standard precautions

A (Airborne precautions) (Airborne isolation is necessary to contain the infection of patients with active tuberculosis. Patients are typically kept in negative pressure rooms and guests are given N-95 and protective masks)

Which of the following is recommended for treating pinworm infection A. Albendazole B. Praziquantel C. Diethylcarbamazine D. Ivermectin

A (Albendazole) (Albendazole is recommended in treating pinworm infection. Others include mebendazole and pyrantel pamoate)

A 4-year-old girl is brought to her pediatrician because of abdominal cramps and diarrhea for the past two days. The patient's mother noticed that her stools are bloody, contain mucous and are small in volume. She also mentions that 2 other children at her daughter's daycare have similar symptoms. Physical examination shows a young girl in moderate distress with a fever of 39.6°C (103.3°F). Analysis of the patient's stool sample shows polymorphonuclear leukocytes on a methylene blue stain. A complete blood count was obtained and shows 14/mm3 white blood cells. Which of the following is the most appropriate treatment for this patient's condition? A. Azithromycin B. Ciprofloxacin C. Fluid and electrolyte replacement only D. Loperamide, with fluid and electrolyte repletion E. Nafcillin

A (Azithromycin) (Shigella is a gram-negative, facultative anaerobic, nonspore-forming, nonmotile, rod causing the diarrheal disease shigellosis. Azithromycin is the treatment of choice for symptomatic children with culture-proven infection, and in children who have suspected shigellosis and are either immunocompromised or have clinical features suggesting bacteremia)

A 16-year old female is sent to the emergency department from an outside clinic because of fever, fatigue, a sore throat for 2 days. IV antibiotic therapy is initiated for a presumed bacterial infection. Four days later, her physical examination shows an erythematous, maculopapular rash. Petechiae are also noted on the roof of her mouth at the junction between the hard and soft palate. Which of the following cell types is infected in this patients condition? A. B-cells B. Keratinocytes C. Monocytes D. Platelets E. T-cells

A (B-cells) (Infectious mononucleosis is caused by the Epstein-Barr virus which infects B-cells. Ampicillin rash is more common in individuals with underlying infectious mononucleosis, hyperuricemia, or leukemia) (B-cells are infected in infectious mononucleosis. When given to patients with mononucleosis, ampicillin is more likely to trigger a maculopapular rash. Fatigue, fever and pharyngitis are typical findings of infectious mononucleosis. Teenagers are classically more likely to come down with mononucleosis due to the requirement of prolonged physical contact for transmission (it is nicknamed the "Kissing Disease.") (In this case, the patient was given IV ampicillin for a viral illness (infectious mononucleosis caused by Epstein-Barr virus). Her age, viral illness symptoms and the petechiae on the roof of her mouth support this diagnosis. Petechiae on the oral mucosa are not pathognomonic for infectious mononucleosis, but highly suggestive) (Almost 1 in 10 individuals with mononucleosis who are given IV ampicillin develop Ampicillin Rash. The rash is maculopapular and usually appears about 4 days into therapy. It does not usually itch and will usually go away even if treatment is continued) (Ampicillin rash is thought to be to antigen-antibody complex deposition due to generation of IgM and IgG by infectious mononucleosis complexing with ampicillin in the bloodstream)

A 42-year-old woman comes to your clinic because of multiple neuropsychiatric complaints including hallucinations, confusion, neck and joint pain, numbness, and insomnia. She says the onset was about 2 years ago. While discussing her social history, the patient mentions she used to go hiking and often "had to pull ticks off [her] dogs." Which of the following bacteria most likely caused the condition that developed into late stage neurological sequelae? A. Borrelia burgdorferi B. Corynebacterium diphtheriae C. Francisella tularensis D. Rickettsia rickettsii E. Treponema pallidum

A (Borrelia burgdorferi) (Borrelia burgdorferi is a species of bacteriathat is transmitted by Ixodes ticks and causes Lyme disease. Early signsinclude erythema migrans and flu-like symptoms. If left untreated, theinfection can spread to the bloodstream and affect joints, the heart, andbrain) (Lyme disease is caused by a number of bacteria from the genus Borrelia. It is a zoonotic, vector-borne disease transmitted by Ixodes ticks.One of the earliest symptoms of Lyme disease is a characteristic rash around the bite location. The rash may feel hot to the touch, and vary in size,shape, and color, but it will often have a "bull's eye" appearance.Typically 7-14 days following the infected tick bite, the first stage of Lyme disease begins. This includes flu-like symptoms such as fever, chills, swollen lymph nodes, headaches, fatigue, muscle aches, and joint pain) (Neurological complications from dissemination can include numbness, pain, weakness, Bell palsy, visual disturbances, and meningitis symptoms such as fever, stiff neck, and severe headache. Other problems, which may not appear until weeks, months, or years after a tick bite, include decreased concentration, irritability, memory and sleep disorders, and nerve damage in the arms and legs)

A 25-year-old man from Massachusetts comes to the emergency department because of fatigue and presyncope. He was well until about a year ago, which coincided with a camping trip. The trip itself was uneventful except for exposure to poison ivy or some kind of insect bite as he remembers a prominent rash on his leg. He hasn't really felt like himself since then. He endorses bilateral knee pain, cognitive slowing, and chronic fatigue. An electrocardiogram shows a 3rd degree heart block with a PR interval of 300 msec. His laboratory tests show no abnormalities. Blood cultures and serologies are pending. Which of the following is the most appropriate pharmacotherapy? A. Ceftriaxone B. Ciprofloxacin C. Doxycycline D. Penicillin G E. Rifampin

A (Ceftriaxone) (Lyme disease is caused by Borrelia burgdorferi secondary to an Ixodes tick bite. If left untreated, the infection can disseminate, causing advanced symptoms including meningitis, arthritis, and heart block. Past this point, in late stage disease, IV ceftriaxone is the standard treatment for disease with severe cardiac and neurologic abnormalities) (This patient is suffering from late stage Lyme disease. Lyme disease is caused by the spirochete Borrelia burgdorferi, endemic in the northeastern United States, and borne by the Ixodes tick vector. After infection, many patients experience a targetoid rash around the bite site as early as the day after the bite. About a week later, other symptoms emerge including headache and flu-like symptoms (fever, chills, fatigue). Untreated Lyme disease may enter a disseminated phase affecting the brain (meningitis), peripheral nerves, and heart (first degree heart block). Doxycycline is the drug of choice up to the early disseminated infection. However, once the disease progresses to the late stage, months to year post infection, ceftriaxone becomes the drug of choice. Signs and symptoms of late stage disease include a distinctive neurological syndrome, Lyme encephalopathy, which includes fatigue, cognitive slowing and memory problems; spinal radicular pain or distal paresthesias, and more serious endocarditis with progression to second and third degree AV block with PR interval ≥300 msec. Arthritis may inflame the knees and large joints. Moreover, the Infectious Disease Society of America and the American Academy of Neurology both endorse the use of parenteral ceftriaxone when abnormal cerebrospinal fluid findings are present)

A 73-year-old woman comes to the primary care with weakness, fever, malaise and excessive sweating during sleep over the past several weeks. She has back pain and has a non-productive cough. She has a history of PTCA (percutaneous transluminal coronary angioplasty), diabetes mellitus, myocardial infarction, mitral and aortic regurgitation, COPD and congestive heart failure. In addition, she has a history of 20 pack years of smoking. The patient says she cannot eat as she is 'not in the mood'. The patient has difficulty standing. She complains of numbness and muscle weakness bilaterally in her lower limbs. Which of the following options is a possible complication of the patient's spinal pathology? A. Compression of the spinal cord B. Abscess formation C. Decreased platelet levels on blood analysis. D. Haematogenous spread of infection from bone to the lungs causing a pulmonary tuberculosis (TB) infection E. Septic arthritis

A (Compression of the spinal cord) (Pott disease is an extra-pulmonary TB infection of the bones, the most commonly affected being the lower thoracic and upper lumbar vertebrae. This causes collapse of the inter-vertebral disc, resulting in spinal cord compression)

A 21-year old female comes to you with complaint of low grade fever, sore throat, malaise, anorexia, and body rash. Physical examination reveals cervical lymphadenopathy, generalized maculopapular rash, enlarged tonsils, exudative pharyngitis and soft palatal petechiae. Monospot test shows positivity for Heterophile antibody. Which of the following would be helpful in the treatment of this patient? A. Corticosteroids B. Ampicillin C. Amoxicillin D. Acyclovir

A (Corticosteroids) (Management of Infectious mononucleosis is mostly symptomatic. Corticosteroids may be helpful for the tonsillar enlargement)

Concerning the patient who is severely dehydrated from v. cholera, which of the following antibiotics would you use to treat him? A. Doxycycline B. Gentamicin C. Piperacillin/Tazobactam D. Streptomycin

A (Doxycycline) (The diagnosis of the patient is cholera (profuse watery diarrhea with 'rice water' appearance). Doxycycline is one of the drugs that are used to treat cholera. The other options are not used in the treatment of cholera.)

Which of the following regarding EBV infection is not true? A. EBV is also known as Human herpesvirus-6 B. EBV causes infectious mononucleosis C. EBV is largely transmitted by saliva D. EBV can be associated with Guillain-Barré syndrome

A (EBV is also known as Human herpesvirus-6)) (Human herpesvirus-6 is a B cell lymphotropic virus. EBV is also known as Human herpesvirus-4. All other statements are correct.

A 21-year-old female college student comes to the student health clinic because of a sore throat, headache, fatigue, chills and painful swelling on the back of her neck for 5 days. She states that she hasn't been getting much sleep lately and has been very stressed out by her workload. Her temperature is 38.0°C (101°F), pulse is 87/min, respirations are 12/min, and blood pressure is 117/78 mm Hg. Examination shows bilateral, tender, enlarged cervical lymph nodes, and grayish white tonsillar exudate. Pulmonary auscultation shows clear lungs bilaterally, and there is splenomegaly on abdominal exam. Which of the following tests is most likely to confirm the diagnosis? A. Heterophile antibody test B. IgG antibody against Epstein-Barr viral capsid antigen C. LFT's D. Throat swab for culture E. C-reactive protein

A (Heterophile antibody test) (Infectious mononucleosis is caused by the Epstein-Barr virus (EBV). A reactive heterophile antibody test in addition to symptoms of EBV is diagnostic of EBV infection. In patients with a reactive test, no other testing is needed) (Infectious mononucleosis is caused by the Epstein Barr virus (EBV). A reactive heterophile antibody test in addition to symptoms of EBV is diagnostic of EBV infection. In patients with a reactive test, no other testing is needed. The heterophile antibody test is specific in the right clinical scenario, but it is not that sensitive. Especially in early EBV infection, false negative heterophile antibody tests can occur. If patients have symptoms that strongly raise the concern of EBV, repeating the test is reasonable. Remember, other agents can cause an infectious mononucleosis syndrome, such as CMV and toxoplasmosis) (CHER: Cervical lymphadenopathy, headache, exudates on the tonsils, really tired)

An 18-year-old female presents to the office with fever, fatigue and sore throat. Physical examination reveals an erythematous pharynx, cervical lymphadenopathy and splenomegaly. CBC reveals an increased white blood cell count with atypical lymphocytes, normal hemoglobin and hematocrit and normal platelet count. What additional laboratory test will help you make the diagnosis in this patient? A. Heterophile test B. Lymph node biopsy C. Serum antibody screening D. Serum transaminase

A (Heterophile test) (The heterophile test (AKA Monospot) is used for the diagnosis of infectious mononucleosis in children and adults)

A 35-year-old previously healthy man comes to the office because of high-grade fever and productive coughing. The patient is originally from Mississippi and works as a cave cartographer at the Nanih Waiya Cave Conservation. Since his symptoms started, he began taking over-the-counter flu medications but reported minimal relief of symptoms. Physical exam shows the liver edge 4 cm below the right costal border. His temperature is 38.6°C (103.1°F), pulse is 71/min, respirations are 17/min, blood pressure is 120/70 mmHg. A chest radiograph shows a well-defined concentric calcification in the right upper lobe. Which of the following is most likely causal organism responsible for this patient's current condition? A. Histoplasma capsulatum B. Aspergillus fumigatus C. Blastomyces dermatitidis D. Coccidioides immitis E. Mycobacterium tuberculosis

A (Histoplasma capsulatum) (Histoplasmosis is an infection caused by Histoplasma capsulatum, a dimorphic fungus that is characterized by growing inside of macrophages. This fungal infection is characteristically endemic to the Mississippi and Ohio River valleys, and it's commonly found in patients that are exposed to bat or bird droppings (i.e., cave explorers).)

A 46-year old resident of Ohio River Valley presents with 2-week history of cough, chest pain, dyspnea, and fever. Chest radiograph shows hilar lymphadenopathy and patchy infiltrates. Which of the following would you have a high index of suspicion for? A. Histoplasmosis B. Tuberculosis C. Coccidioidomycosis D. Mucormycosis

A (Histoplasmosis) (A resident of Ohio River Valley with pulmonary symptoms and radiographic features would most likely have histoplasmosis as it is endemic this area. All other options can presents with similar symptoms, but are not endemic in this region. Coccidioidomycosis is endemic in California's San Joaquin Valley and southern parts of Arizona, Utah, and Nevada)

Which statement about the workup of tetanus is accurate? A. No laboratory tests are specific for the diagnosis of tetanus B. Blood counts and blood chemical findings are the primary laboratory tests indicated in the diagnosis of tetanus C. A lumbar puncture is required for a diagnosis of tetanus D. Imaging studies (eg, CT scan, MRI) of the head and spine are indicated in all patients with suspected tetanus

A (No laboratory tests are specific for the diagnosis of tetanus) (No specific laboratory tests are indicated for determining the diagnosis of tetanus. The diagnosis is clinically based on the presence of trismus, dysphagia, generalized muscular rigidity, spasm, or combinations thereof. Although the laboratory findings are not diagnostically valuable, they may help exclude strychnine poisoning. A lumbar puncture is not necessary for diagnosis. Blood counts and blood chemical findings are unremarkable. Imaging studies of the head and spine reveal no abnormalities)

A 45-year-old woman with HIV infection comes to the office because of fever and headache during the past 10 days. Her husband reports that she has not refilled her medications during the past 3 months for financial reasons. Her last CD4+ T lymphocyte count was 65/mm3. An MRI with contrast of the brain is shown. Which of the following is the most appropriate pharmacotherapy? A. Pyrimethamine and sulfadiazine B. Daptomycin C. Amphotericin B D. Ceftriaxone E. Acyclovir

A (Pyrimethamine and sulfadiazine) (Toxoplasmosis should be treated with pyrimethamine and sulfadiazine; leucovorin is given in conjunction to prevent pyrimethamine-associated hematologic toxicity. Trimethoprim-sulfamethoxazole is the therapy of choice for prophylaxis against toxoplasmosis reactivation)

Which of the following is associated with Negri bodies? A. Rabies B. Mumps C. Measles D. Herpes simplex

A (Rabies) (Negri bodies are round cytoplasmic inclusions seen in neuronal cells of patient with rabies. All others are not associated with Negri bodies)

The most common Shigella species causing bacillary dysentery in the United States is: A. S. sonnei B. S. flexneri C. S. dysenteriae D. S. boydii

A (S. sonnei) (S. sonnei is the leading cause of bacillary dysentery in the United States. All others are not as common)

17-year old presents to you with complaints of bloody diarrhea, abdominal pain, vomiting and headache for the past 4 days. 8 hours prior to onset of symptoms, he ingested 3 raw eggs. Which of the following is most likely responsible for his diarrhea? A. Salmonella B. Staphylococci C. C. perfringens D. Giardia lamblia E. V. Cholera

A (Salmonella)

A 25-year-old man comes to the emergency department with a fever, headache, and watery diarrhea. His abdomen has been hurting since last night. He noticed a small amount of blood in his most recent bowel movement, 2 hours ago. A stool sample is obtained and is positive for a lactose-negative, hydrogen sulfide-producing bacteria. What is the most likely diagnosis? A. Salmonella B. Staphylococci C. C. perfringens D. Giardia lamblia E. V. Cholera

A (Salmonella)

a 21-year-old bodybuilder presents with complaints of diarrhea, cramps, and low-grade fever for 24 hours. He has been training for a competition, eating large amounts of protein, including shakes made with raw eggs. He reports three thick green "pea soup" stools with blood in the commode today. He denies nausea or vomiting and tolerates liquids and solids. Examination reveals a well-muscled man in no apparent distress; lungs and heart unremarkable; abdomen, with mildly hyperactive bowel sounds and no tenderness or organomegaly; no evidence of hemorrhoids or anal fissure, no masses, and no stool present for hemoccult. What is the likely diagnosis? A. Salmonella B. Staphylococci C. C. perfringens D. Giardia lamblia E. V. Cholera

A (Salmonella)

A 43-year-old Caucasian male who spent the past month on a business trip has diarrhea. Two weeks following his return, he began experiencing diarrhea, pain in his abdomen, and a headache. He presents to the hospital and is noted to be febrile with discrete, blanching, rose-colored spots on his back, chest, and abdomen. What is the most likely diagnosis? A. Salmonella B. Staphylococci C. C. perfringens D. Giardia lamblia E. V. Cholera

A (Salmonella) (Salmonella infection presents with bloody diarrhea, abdominal pain, vomiting and headache. Poultry and eggs are the vehicle of infection)

In which of the following conditions will fecal leukocyte test be most likely positive? A. Shigellosis B. Rotavirus infection C. Giardia infection D. Staphylococcus infection

A (Shigellosis) (Leukocytes are seen in fecal samples of patients with colonic inflammation. Causes of this include C. Difficile, Salmonella and several others. All other options are incorrect)

A 16-year-old boy comes to the clinic because of a "pink and patchy" rash on his face and upper body. The rash began five days prior on his upper arms and trunk, and has since spread to his forearms and face. The rash is faint and does not itch. Additional signs and symptoms include exudative pharyngitis and a fever of five days duration. His only medication is amoxicillin, which he started taking yesterday. He has no known allergies to any medications, including amoxicillin, which he has used previously. On physical examination, there is a prominent posterior cervical lymphadenopathy in addition to the rash. Which of the following is the most likely etiology of this patient's rash? A. Viral exanthem B. Hypersensitivity reaction to antibiotic C. Psoriasis D. Seborrheic dermatitis E. Allergic reaction to the antibiotic

A (Viral exanthem) (Epstein-Barr virus causes infectious mononucleosis, which presents classically with posterior cervical lymphadenopathy, pharyngitis, fever, fatigue and sometimes a rash that precedes antibiotic therapy (typically non-pruritic, salmon-colored patches first appearing on the upper arms and trunk). (This is a classic example of Epstein-Barr virus causing infectious mononucleosis. The hallmark of this disease is posterior cervical lymphadenopathy. Additional symptoms include pharyngitis, fever, fatigue and a rash) (There are two types of rashes associated with infectious mononucleosis: a viral exanthem (caused by the virus itself) and a rash due to a hypersensitivity reaction to beta-lactam antibiotic therapy) (The first type of rash is described by this vignette. 10% of patients with infectious mononucleosis present with a rash independent of antibiotic use. The rash usually appears first on the trunk and upper arms and may spread to the face and lower arms. While this rash is typically composed of faint, salmon-colored patches that do not itch, it may in some cases present with another morphology entirely (morbilliform, vesicular, purpuric). Because its appearance may vary and the rash may spread, change locations or disappear early during the illness, this viral exanthem may be mistaken for a hypersensitivity reaction, particularly if the patient begins taking an antibiotic)

An adult patient who is HIV positive receives a PPD. He develops an area of induration that measures 8 mm after 48 hours. Which of the following is the most appropriate interpretation of this test result? A. positive B. negative C. active infection D. falsely negative

A (positive) (A reaction size of greater than or equal to 5 mm in a HIV positive patient is considered a positive tuberculin skin test reaction)

Cryptococcus is caused by fungus Cryptococcus neoformans, common in AIDS and immunocompromised states, is considered an ____________________.

AIDS-defining illness

Isolate hospitalized patients who may have TB (cough for 3 weeks, night sweats, hemoptysis, etc) and send three sputum specimens for ______________________staining and Mycobacterium tuberculosis cultures.

Acid-fast bacilli

Tuberculosis is the most common cause of ___________________ in the developing world.

Addison disease

What is herpes zoster associated with?

Aging Immunosuppression Intrauterine exposure Varicella at <18 month of age

In histoplastomosis there is increased _________________ and positive LDH blood cultures if disseminated.

Alkaline phosphatase

In histoplastomosis there is increased _____________________ and positive LDH blood cultures if disseminated.

Alkaline phosphatase

________________ or cefuroxime are the medications of choice for early localized Lyme disease, when doxycycline is contraindicated such as in pregnant women or children less than 8 years old.

Amoxicillin

Cryptococcosis is treated with ______________ + Flucytosine for 2 weeks followed by Fluconazole for 10 weeks.

Amphotericin B

Disseminated histoplasmosis is treated with _____________________ (drug), like all other systemic mycoses.

Amphotericin B

__________________ is recommended for patients who cannot tolerate or fail itraconazole therapy or in patients with meningitis or severe histoplasmosis.

Amphotericin B

What diagnostic finding should make you think of Cryptococcus?

An India ink stain showing cysts

____________ is the first line treatment for botulism.

Antitoxin

_________________ is the best initial treatment for Clostridium tetani infection.

Antitoxin

______________________ are masses of Aspergillus fumigatus that are commonly seen in lung cavities, especially after tuberculosis.

Aspergillomas

_______________ is a quinone antibiotic used in the prophylaxis and treatment of Pneumocystis jiroveci pneumonia in AIDS patients, along with trimethoprim-sulfamethoxazole and pentamidine.

Atovaquone

_______________ or clarithromycin are the first choice antibiotics for whooping cough (pertussis).

Azithromycin

The Epstein-Barr virus infects (B/T) lymphocytes through their CD21 receptors.

B

A 50-year-old woman comes to the emergency department because of fatigue and hemoptysis. She says for years she has had a chronic cough and is "always tired." However, she has not had a bloody cough until this past month and it has been getting worse. She estimates producing about half a shot glass of blood today. Her temperature is 37.6°C (99.6°F), pulse is 120/min, respirations are 22/min, blood pressure is 120/80 mmHgA chest x-ray is ordered. Which of the following is the most appropriate immediate next step in her management? A. Administer aspirin B. Administer epinephrine injection C. Administer packed red blood cells D. Consult with the infectious disease team and begin antibiotic treatment E. Emergency surgery

B (Administer epinephrine injection) (Hemoptysis secondary to tuberculosis infection can be treated in mild to moderate forms with laser coagulation, epinephrine injection, or embolization of a pulmonary segment)

A 22-year-old man, who is a college student, comes to the emergency department because of difficulty speaking and the inability to swallow for the past 2 hours. He says he recently returned from spending Thanksgiving at his grandparents' house, and yesterday had eaten a family favorite, home-canned asparagus prepared by his grandmother. He woke up this morning with feelings of nausea and had several episodes of vomiting and non-bloody diarrhea. He denies experiencing these symptoms previously and was in his usual state of excellent health before the onset of symptoms. As the interview goes on, he begins to noticeably slur his speech and appears more fatigued than he did upon arrival, but remains lucid. Physical examination shows drooping eyelids and diplopia. Which of the following is the most appropriate treatment? A. Administration of staphyloccocal enterotoxin antiserum B. Administration of trivalent botulinum antitoxin C. Intravenous amphotericin B D. Immunization with staphylococcus aureus enterotoxin toxoid E. Oral ampicillin

B (Administration of trivalent botulinum antitoxin) (Botulism is caused by exposure to the Clostridium botulinum toxin, commonly through the ingestion of improperly canned foods. The syndrome is characterized by a descending flaccid paralysis and can be treated by inoculation with botulinum antitoxin to bring about passive immunity)

A 16-year-old boy, who recently immigrated to the United States from Africa, comes to the clinic because he has had intermittent fevers and headache for the past few weeks. He is human immunodeficiency virus positive and has not been adhering to his antiretroviral regimen. On physical examination, he is afebrile with nuchal rigidity and sensitivity to light. One month ago his CD4 count was 20 cells/uL. A lumbar puncture shows an elevated opening pressure of 220mm H2O. Microscopy shows a spherical cells with a zone of clearance surrounding each one. Which of the following is the best treatment? A. Fluconazole B. Amphotericin B followed by flucytosine and fluconazole C. Corticosteroids D. Extended-course oral tetracycline E. Rifampin with isoniazid

B (Amphotericin B followed by flucytosine and fluconazole) (Cryptococcus neoformans is a fungal infection that causes meningitis in immunocompromised hosts and is treated with amphotericin B. Treatment with amphotericin B may be followed by flucytosine, and is maintained with a regimen of fluconazole)

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

B (Amphotericin B) (Amphotericin B is the drug of choice in the initial treatment of cryptococcal meningitis. It can be used alone in the initial treatment)

A 19-year-old female college student comes to the student health center because of a sore throat and headache for 6 days. She reports that she has been feeling tired and worn-down for the past few weeks, but attributed it to her busy schedule at school. She denies feeling sad or depressed and denies weight loss. Examination shows that she has enlarged posterior chain cervical lymph nodes. Which of the following is most likely on her peripheral blood smear? A. All stages of granulocyte maturation B. Atypical lymphocytes with clumped chromatin and irregular nuclei surrounded by normal RBCs C. Knobs on RBC membranes and intrerythrocyte organisms D. Microcytic, hypochromic red blood cells E. Microspherocytes

B (Atypical lymphocytes with clumped chromatin and irregular nuclei surrounded by normal RBCs) (Infectious mononucleosis, also known as mono, or glandular fever, is an infection commonly caused by the Epstein-Barr virus (EBV). The peripheral blood film will show 50% lymphocytes with at least 10% atypical lymphocytes (large, irregular nuclei)) (Infectious mononucleosis, also known as mono, or glandular fever, is an infection commonly caused by the Epstein-Barr virus (EBV). Most people are infected by the virus as children, when the disease produces little or no symptoms. In young adults, the disease often results in fever, sore throat, large lymph nodes in the neck, and feeling tired. Most people get better in two to four weeks; however, feeling tired may last for months. The liver or spleen may also become swollen) (The most commonly used diagnostic criterion is the presence of 50% lymphocytes with at least 10% atypical lymphocytes (large, irregular nuclei), while the person also has fever, pharyngitis, and swollen lymph nodes. Furthermore, it should be confirmed by a serological test. The atypical lymphocytes resembled monocytes when they were first discovered, thus the term "mononucleosis" was coined. Diagnostic tests are used to confirm infectious mononucleosis, but the disease should be suspected from symptoms prior to the results from haematology)

A female newborn has jaundice and hepatomegaly. She was born by spontaneous vaginal delivery at term following an uncomplicated pregnancy. Physical examination shows chorioretinitis. Laboratory studies show thrombocytopenia. A CT scan of the brain shows enlarged ventricles and intracranial calcifications. Which of the following is most likely to have prevented this patient's condition? A. Completion of recommended vaccines prior to conception B. Avoidance of handling cat litter C. Prenatal genetic diagnosis D. Prophylaxis with acyclovir E. Supplementation with folic acid prior to conception

B (Avoidance of handling cat litter) (Congenital toxoplasmosis presents with the classic triad of chorioretinitis, hydrocephalus, and intracranial calcifications. Since the protozoal infection is commonly contracted through the handling of cat feces, pregnant women should be advised to avoid contact with cat litter to reduce their fetus's risk for congenital infection)

A 6-month-old boy comes to the emergency department because of acute onset constipation, weak suckling, and inactivity for the past 6 hours. The mother says she has been adding honey that she recently purchased at a farmer's market to sweeten her son's baby food over the past few days, but otherwise, there have not been any recent changes in diet or activity. She has checked his temperature several times today, and he has not had a fever. The infant was born at 40 weeks' gestation following an uncomplicated pregnancy and has been otherwise healthy and meeting appropriate milestones. Physical examination shows generalized weakness and an inability to lift up his head while laying with his back facing up. His eyelids appear droopy and, per his mother, he is drooling much more than usual. Which of the following is the most appropriate pharmacotherapy? A. Botulinum toxoid vaccine B. Botulism immune globulin & human-derived botulinum anti-toxin C. Metronidazole D. Penicillin E. Supportive care

B (Botulism immune globulin & human-derived botulinum anti-toxin) (Botulism is a clinically diagnosed paralytic illness caused by neurotoxins produced by Clostridium botulinum. It is common in infants under the age of 1 and commonly presents with hypotonia, feeding difficulties and constipation. Treatment comprises aggressive supportive care and timely administration of antitoxin in confirmed or suspected cases)

Which of the following is not applicable in the diagnosis of Pneumocystis jirovecii Pneumonia? A. Beta-D-glucan levels B. Culture C. PCR of bronchoalveolar lavage D. Monoclonal

B (Culture) (Culture cannot be used to diagnose Pneumocystis jiroveci Pneumonia as the organism cannot be grown in vitro)

Which of the following diphtheria combination vaccines would you give to a child? A. Td B. DTaP C. Tdap D. dtP

B (DTaP) (DTaP is given to children at ages 2 months, 4 months, 6 months, 15-18 months, and 4-6 years. It is not licensed for anyone over the age of 6)

A 50-year-old woman is brought to the emergency department after experiencing a seizure. She has no prior history of seizures or other neurological disorders and denies any recent trauma. She does not receive regular medical care. She has smoked one pack of cigarettes daily for 5 years and has a 15-year history of intravenous drug use. Her temperature is 38.9°C (102°F), pulse is 80/min, respirations are 12/min, and blood pressure is 110/70 mm Hg. An MRI of the brain shows multiple ring enhancing lesions. Which of the following is the most likely finding in this patient? A. Thrombocytopenia B. Decreased CD4:CD8 T-lymphocyte ratio C. Prolonged partial thromboplastin time D. Increased concentration of fetal hemoglobin E. Pancytopenia

B (Decreased CD4:CD8 T-lymphocyte ratio) (Toxoplasmic encephalopathy is most frequently seen in HIV-infected patients with CD4+ T lymphocyte count less than 100/mm3. Extracerebral manifestions, most commonly pulmonary and ophthalmic manifestations like pneumonitis and chorioretinitis, can also be seen in immunocompromised patients. This patient's history of intravenous drug use suggests a possible mode of HIV infection. Since HIV infects CD4+ T cells, these patients will have a decreased CD4:CD8 ratio, typically less than 1)

A 5-year old is brought to you by her mother with complaint of perianal itching which occurs mostly at night. It affects her sleep and makes her restless. Which of the following is the most likely cause of her symptoms? A. Trichuris trichiura B. Enterobius vermicularis C. Paragonimus westermani D. Clonorchis sinensis

B (Enterobius vermicularis (Pinworm))

A 15-year-old high school rugby player presents to your clinic with a sore throat. He reports that he started feeling fatigued along with body aches about a week ago. His vitals and physical are normal except for an exudative pharynx and an enlarged spleen. Monospot test comes back positive and the student is told not to participate in contact sports for a month. What is the most likely causative agent and which immune cell does it affect? A. Cytomegalovirus; T-cells B. Epstein-Barr virus; B-cells C. Group A Streptococcus; Neutrophils D. Streptococcus; Macrophages E. Epstein-Barr virus; T-cells

B (Epstein-Barr virus; B-cells) (An adolescent presenting with sore throat, splenomegaly, and positive monospot test is most likely suffering from infectious mononucleosis. Epstein-Barr virus (EBV) is most frequently found to be the causative agent and the virus targets B-cells in the immune system. Specifically, EBV will enter B-cells by binding to CD21 and acting as a mitogen) (EBV is part of the herpes virus family along with cytomegalovirus, herpes simple virus, and varicella virus, amongst many others. The chief mechanism of infection is via viral replication within B-cell lymphocytes and subsequent T-cell attack of the infected cell (Fig. A). Often seen in adolescents, those with mononucleosis are recommended not to participate in contact sports due to risk of splenic rupture)

In the United States during the current vaccination era, which is the most common form of tetanus? A. Localized tetanus B. Generalized tetanus C. Cephallic tetanus D. Neonatal tetanus

B (Generalized tetanus) (Generalized tetanus is the most commonly found form of tetanus in the United States, accounting for 85%-90% of cases. The extent of the trauma varies from trivial injury to contaminated crush injury. The incubation period is 7-21 days, largely depending on the distance of the injury site from the central nervous system. Localized tetanus involves an extremity with a contaminated wound and is highly variable in severity. It is an unusual form of tetanus, but the prognosis for survival is excellent. Cephalic tetanus may remain localized or may progress to generalized tetanus. It is an unusual form of tetanus with an incubation period of 1-2 days. The prognosis for survival is usually poor. Neonatal tetanus (tetanus neonatorum) occurs primarily in underdeveloped countries)

A 6-year-old Russian boy who recently immigrated to the United States presents to your office with fever and dyspnea. On examination of the oropharynx, you note a grayish-white pseudomembrane and uneven elevation of the soft palate. The patient displays marked enlargement of the cervical lymph nodes. Which of the following describes the organism responsible for this patient's disease? A. Yeast with pseudohyphae B. Gram-positive bacteria producing exotoxin that acts via ADP ribosylation C. Gram-positive cocci with hyaluronic acid capsule D. Gram-negative encapsulated bacteria producing IgA protease E. Gram-negative bacteria producing exotoxin that inactivates elongation factor 2

B (Gram-positive bacteria producing exotoxin that acts via ADP ribosylation) (The patient described in the question stem suffers from diphtheria, caused by Corynebacterium diphtheriae. C. diphtheriae is a gram-positive organism that produces an exotoxin that inactivates elongation factor 2 (EF-2) via ADP ribosylation) (Diphtheria presents with pseudomembranous pharyngitis (a grayish-white membrane) and lymphadenopathy. The membrane can extend into the larynx and cause obstruction. Recurrent laryngeal nerve palsy is also common, resulting in the palate paralysis described in the question stem. Systemic sequelae of C. diphtheriae infection include cardiac and neurologic damage)

A 33 year-old HIV-positive woman develops an 8mm area of induration following the administration of a purified protein derivative (PPD) test. Her chest radiograph shows no evidence of active tuberculosis (TB) infection. Which of the following is the most appropriate clinical intervention? A. Four-drug regimen for 4 months B. Isoniazid with Rifampin C. Observation only D. Repeat PPD and chest radiograph in 3 months

B (Isoniazid with Rifampin)

The treatment of choice for mild-moderate histoplasmosis is A. Amphotericin B B. Itraconazole C. Methylprednisolone D. Ketoconazole

B (Itraconazole) (Itraconazole is the treatment of choice for mild-moderate histoplasmosis with an overall response rate of approximately 80%. It can also be used in severe disease after amphotericin B has been used for about 2 weeks)

Which is currently the most common source of infection that leads to tetanus? A. Chronic skin ulcers B. Minor wounds C. Corneal abrasions D. Intranasal inhalation

B (Minor wounds) (The source of infection usually is a wound (approximately 65% of cases), which often is minor (eg, from wood or metal splinters or thorns). Frequently, no initial medical treatment is sought. Chronic skin ulcers are the source in approximately 5% of cases. In the remainder of cases, no obvious source can be identified. Tetanus can also develop as a complication of chronic conditions such as abscesses and gangrene. It may infect tissue damaged by burns, frostbite, middle ear infections, dental or surgical procedures, abortion, childbirth, and intravenous or subcutaneous drug use. Possible sources not usually associated with tetanus include intranasal and other foreign bodies and corneal abrasions)

An 85-year-old nursing home resident presents with abrupt onset of cough, sore throat, headache, myalgias, and malaise. On examination the patient's temperature is 102 degrees F; the rest of the exam is unremarkable. Nasal smear is positive for Influenza B. Which of the following is the treatment of choice in this patient? A. Amantadine (Symmetrel) B. Oseltamivir (Tamiflu) C. Acyclovir (Zovirax) D. Nevirapine (Viramune)

B (Oseltamivir (Tamiflu)) (Oseltamivir is used to treat both influenza A and B.)

Which of the following is not an indication for Pneumocystis jiroveci Pneumonia prophylaxis in HIV infected adult patients? A. Patients with oral candidiasis. B. Patients with CD4 counts <350 cells/mcL. C. Patients with history of Pneumocystis pneumonia. D. Patients with unexplained fever exceeding 100oF for more than 2 weeks.

B (Patients with CD4 counts <350 cells/mcL) (CD4 counts <200 cells/mcL and not < 350 cells/mcL is an indication for prophylaxis. All other options are indications for Pneumocystis jiroveci Pneumonia prophylaxis in HIV infected adult patients)

A 45 year old man with a PMH of HIV comes to the emergency room with complaints of difficulty breathing, weight loss, and low grade fevers. Labs are remarkable for a CD4 count of 152. A chest x-ray shows bilateral diffuse interstitial infiltrates. Bronchoalveolar lavage demonstrates PCP pneumonia. The patient's allergy history is notable for a sulfa allergy. Which of the following is the next best therapy? A. TMP-SMX B. Pentamidine C. Doxycycline D. Amphotericin B E. Itraconazole

B (Pentamidine) (Pneumocystis pneumonia is caused by P. jirovecii. Pentamidine is recommended for those patients that cannot tolerate TMP-SMX due to allergy)

A 29-year-old man with a CD4 count of 190/mm3 presents with a dry cough, fever for 2 weeks and shortness of breath, worsened when climbing stairs. His laboratory workup revealed a lactate dehydrogenase (LDH) concentration of 540 U/L. His blood pressure is 125/86 mm Hg. Chest X-ray shows no abnormalities. Which of the following is the most likely cause of the patient's problems? A. Escherichia coli B. Pneumocystis jirovecii C. Congestive heart failure D. Septic shock E. Streptococcus pneumoniae

B (Pneumocystis jirovecii) (Pneumocystis pneumonia (PCP) is caused by Pneumocystis jirovecii, a fungus. PCP is generally seen in the setting of immunocompromised patients with depressed CD4 counts (<200/mm3))

A 45-year old man with AIDS presents to you with fever, headache, altered mental state, and left hemiparesis. MRI of the brain shows ring enhancing lesions and surrounding edema. The treatment of choice is A. Co-trimoxazole B. Pyrimethamine plus sulfadiazine C. External ventricular drain D. Spiramycin

B (Pyrimethamine plus sulfadiazine) (Toxoplasmosis occurs commonly in the immunocompromised (AIDS) and presents with symptoms of encephalitis etc. Brain imaging CT Scan/MRI) usually shows multiple ring enhancing lesions. Pyrimethamine plus sulfadiazine is the standard therapy for the treatment of toxoplasmosis)

A patient is brought to the emergency on account of pain, numbness, and intense itching at a wound site on his leg which he obtained from a Raccoon bite about 6 weeks ago. There is also associated hydrophobia, aerophobia, fever, and headache. Which is the most likely diagnosis? A. Tetanus B. Rabies C. Measles D. Mumps

B (Rabies) (Symptoms mentioned above occur in the prodromal period of Rabies. Rabies occurs following bite from infected raccoons, dog, bats etc)

A 40-year-old man comes to the emergency department because of a 5-day history of fever, diplopia, slurred speech, myoclonic jerks, and hypersalivation. His temperature is 39.0°C (102.0°F), pulse is 103/min, respirations are 19/min, and blood pressure is 195/100 mm Hg. He was bitten by a racoon 4 months ago. Laboratory studies show an elevated ESR. A CT scan of the brain is unremarkable and an EEG shows diffuse abnormalities consistent with metabolic encephalopathy. Samples of the patient's saliva and skin are sent for polymerase chain reaction (PCR) and direct fluorescent antibody. Which of the following is the most likely diagnosis? A. Tetanus B. Rabies C. Measles D. Mumps E. Toxoplasmosis

B (Rabies) (The rabies virus is an RNA virus which belongs to Rhabdoviridae family. It is a neurotropic virus which is responsible for the disease rabies. Rabies causes inflammation of the brain (encephalitis) and is characterized by hypersalivation, fever, seizures, hallucinations, and hydrophobia (a primary symptom of rabies). The virus is transmitted by the saliva of infected animals like dogs, bats, and raccoons among others. This case is a classic presentation of infection by the rabies virus. The virus is enveloped with negative single-stranded RNA. It replicates inside the cytoplasm inside Negri bodies (eosinophilic inclusion bodies found inside nerve cells) which are used as a definite histological proof of rabies. Diagnosis is usually made upon the basis of symptoms and confirmed by reverse transcriptase polymerase chain reaction (RT PCR) and direct fluorescent antibody. The disease is usually fatal once neurological symptoms start)

A 24-month-old boy is brought to the emergency department by concerned parents because of an unexplainable episode of unresponsiveness, stiffening and shaking throughout his body that lasted around 30 seconds an hour before. The parents also state that when changing his diaper this morning prior to dropping him off at daycare they noticed large, watery stool with blood and mucus. On physical examination the patient appears fatigued and in moderate distress, with a temperature of 39.9°C (103.8ºF). Lumbar puncture shows no abnormalities. Which of the following is the most likely diagnosis? A. Campylobacter B. Shigella C. Benign (childhood) epilepsy with centrotemporal spikes (BECTS) D. Heterotopic grey matter E. Infantile spasms

B (Shigella) (Shigellosis, a diarrheal infection caused by the Shigella spp, can present with seizure as the chief complaint. Other signs and symptoms include fever and bloody diarrhea with mucous)

Which of the following statements about cholera is incorrect? A. It is caused by Vibrio cholerae B. The best preventative measure is vaccination C. Spread is by fecal-oral route D. Can occur as an epidemic

B (The best preventative measure is vaccination) (The best preventative measures are good hygiene and improved sanitation. Vaccination has limited efficacy in preventing cholera. All other statements are correct)

Which of the following statements is incorrect concerning Rocky Mountain spotted fever A. It's a tick-borne illness B. The characteristic rash initially involves the trunk, arms, and legs, spreading outwardly to the wrists and ankles C. Indirect immunofluorescent antibody test confirms the diagnosis D. May present with seizures

B (The characteristic rash initially involves the trunk, arms, and legs, spreading outwardly to the wrists and ankles) (The characteristic rash initially involves the wrists and ankles, spreading centrally to the arms, legs, and trunk)

A 19-year-old man comes to the clinic because of backache and stiffness. He has been having night sweats and has a fever upon arrival. He is a heavy smoker and was in a road traffic accident 6 months previously in which he fractured his collar bone. On imaging he is found to have demineralization of lumbar spine vertebrae with degeneration of the disc space. Which of the following is the most appropriate treatment option? A. Treat with a four-drug regimen for at least six to nine months and may be maintained for as long as twelve months. B. Treat with a four-drug regimen for at least two months and two drugs for four months which may be maintained for up to twelve months. C. Treat with a single drug for at least nine months, but may be maintained for up to twelve months. D. Treat with a six-drug regimen for at least nine months and antibiotic treatment may be maintained for as long as twelve months. E. Treat with a two-drug regimen for at least four months and may be maintained for up to two months.

B (Treat with a four-drug regimen for at least two months and two drugs for four months which may be maintained for up to twelve months.) (Pott disease is an extra-pulmonary tuberculosis manifestation in the spinal vertebrae, requiring four-drug regimen for two months, followed by two drugs for four more months. The total treatment time is increased with more advanced disease)

Which of the following serologic tests confirms the diagnosis of Lyme disease? A. ELISA B. Western immunoblot assay C. Indirect immunofluorescence D. None of the above

B (Western immunoblot assay) (Western immunoblot assay is the confirmatory serologic test for lyme disease. It is done after a positive or equivocal ELISA)

A 62 year-old female is admitted to a nursing home during an outbreak of influenza. In review of her records, you note that she did not receive the flu vaccine this year. Which of the following is the most appropriate drug of choice for influenza prophylaxis in this patient? A. Ciprofloxacin (Cipro) B. Zanamivir (Relenza) C. Clarithromycin (Biaxin) D. Alpha-2b interferon (Avonex)

B (Zanamivir (Relenza) (Either zanamivir or oseltamivir are indicated for prophylactic use against influenza A or B)

A 6 year old boy is brought to the emergency by his mother on account of frequent passage of non bloody watery stool, vomiting, and lethargy for the past 2 days. He passes stool in your presence and you notice it to be rice water stool. Physical examination reveals he's severely dehydrated. Which of the following is the most important in the immediate management of this patient? A. Antibiotic B. Intravenous rehydration C. Oral rehydration D. Report to the appropriate public health authority.

B. (Intravenous rehydration) (The patient is severely dehydrated; therefore he requires immediate intravenous rehydration to prevent hypovolemic shock and to maintain circulation)

What are the categories for superficial cutaneous infections?

Bacterial Fungal Viral

The following is common in which type of infection? CRP increased

Bacterial Infection

The following is common in which type of infection? ESR increased

Bacterial Infection

The following is common in which type of infection? Leukocytosis

Bacterial Infection

The following is common in which type of infection? Neutropenia

Bacterial Infection

The following is common in which type of infection? Purpura

Bacterial Infection

The following is common in which type of infection? Shift to the left (Increased bands)

Bacterial Infection

A "shift to the left" (increased number of immature neutrophils) occurs in which type of infection?

Bacterial infection

What type of cutaneous infection is impetigo?

Bacterial infection

Prophylaxis against toxoplasmosis for all HIV patients with CD4 count < 100 with _________________.

Bactrim

Prophylaxis with daily _________________ for high-risk patients with a CD4 < 200 or with a history of PJP infection.

Bactrim

Name three things that should make you think of Histoplasmosis

Bats, bat caves, and the Mississippi and Ohio River Valleys

_________________ is the spirochete that causes Lyme disease.

Borrelia burgdorferi

__________________ is a bacterium that may cause cranial nerve VII palsy.

Borrelia burgdorferi

The following is common in which type of infection? Petechiae

Both Viral and Bacterial Infections

A 1-year-old infant boy is brought to the emergency department because of a 2-day history of poor feeding and constipation. His medical history is noncontributory. Upon further interrogation, the mother claims that she recently started sweetening his meals with honey. Physical exam shows generalized muscle weakness. His temperature is 36.5°C (97.6°F), pulse is 70/min, respirations are 16/min, blood pressure is 120/80 mmHg. What is the most likely diagnosis?

Botulism

A 45-year-old female who ate grandma Becky's famous canned tomatoes yesterday now presents with dry mouth, blurred or double vision, drooping eyelids, slurred speech, and difficulty swallowing. Loss of pupillary light reflex along with symmetric descending weakness and flaccid paralysis without sensory deficits. What is the most likely diagnosis?

Botulism

What condition: Presents with sudden onset of diplopia, dry mouth, dysphagia, dysphonia and muscle weakness leading to respiratory paralysis

Botulism

A 41-year-old woman comes to the hospital because of uncontrollable fits of coughing, and trouble breathing over the past week. Due to the recent Ebola scare, she is quickly quarantined from other patients and put in a special room. She has a cough productive of clear sputum and denies night sweats. Her temperature is 37°C (98.6°F), pulse is 70/min, and respirations are 20/min. Pulse oximetry shows oxygen saturation of 95% on room air. The rest of the physical examination is normal except for minimal rales at the posterior and inferior lung margins. Which of the following is the most appropriate step for acute management? A. Administering a fluoroquinolone B. Administering a macrolide C. Administering albuterol and antitussives D. Offering oxygen therapy E. Performing a sputum gram stain

C (Administering albuterol and antitussives) (Acute bronchitis in adults is of viral origin and should not be treated with antibiotics. Management can be reassurance or symptomatic treatment with bronchodilators or antitussives)

Which of the following statements concerning bacillary dysentery is incorrect: A. Can be effectively treated with ciprofloxacin B. Reactive arthritis is a possible complication. C. Blood culture grows the causative organism in >80% of cases. D. The diarrheal stool is often mixed with blood and mucus

C (Blood culture grows the causative organism in >80% of cases) (Blood culture grows the causative organism in <5% of cases. All other statements are correct)

A 22-year-old man presents to his student clinic with a temperature of 40°C (104°F), pulse 90/min, respirations 18/min, and blood pressure 130/80 mm Hg. He has been feeling extremely tired for the past two weeks. Physical examination shows exudative tonsillitis. The patient was prescribed amoxicillin yesterday, but has seen no improvements, and developed a new maculopapular rash on his trunk. Further physical examination shows posterior cervical lymphadenopathy and splenomegaly. Which of the following findings would you most likely find on a peripheral blood smear? A. B cell crowding B. CD4+ T cell death C. CD8+ T cell enlargement D. Hypersegmented neutrophils E. Schistocytes

C (CD8+ T cell enlargement) (Peripheral blood smear in mononucleosis is characterized by reactive lymphocytosis of atypical cytotoxic T lymphocytes) (This patient displays classic signs and symptoms of mononucleosis (mono): he is a young adult with fever and sore throat. Exudative pharyngitis is a nonspecific finding in mono, and may be misdiagnosed as a bacterial infection, e.g. Streptococcus spp. However, β-lactam incorrectly given to patients with mono causes a characteristic maculopapular rash on extensor surfaces by an unknown mechanism. Lymphadenopathy is a common finding in mono, especially in the posterior cervical lymph nodes and axillae. Mono is most commonly caused by Epstein-Barr virus (EBV), or cytomegalovirus (CMV). The virus infects B lymphocytes through the cell surface receptor CD21. In response, there is reactive lymphocytosis. The absolute increase is predominantly in CD8+ T lymphocytes. The atypical lymphocytes are also known as Downey cells, peaking during the second or third week of illness and persisting for a few months. They are enlarged, with pale blue cytoplasm and a basophilic rim indented by surrounding RBC)

The definitive host of Toxoplasma gondii is: A. Man B. Pig C. Cat D. Mouse

C (Cat)

A 62 year-old homeless patient presents complaining of fever, weight loss, anorexia, night sweats and a chronic cough that recently became productive of purulent sputum that is blood streaked. On physical examination, the patient appears chronically ill and malnourished. Which of the following chest x-ray findings supports your suspected diagnosis? A. Hyperinflation and flat diaphragms B. Interstitial fibrosis and pleural thickening C. Cavitary lesions involving the upper lobes D. "Eggshell" calcification of hilar lymph nodes

C (Cavitary lesions involving the upper lobes) ( This patient most likely has tuberculosis. A chest x-ray finding of cavitary lesions involving the upper lobes would support this suspected diagnosis)

A recent Haitian immigrant presents to the clinic for an employment physical examination before starting work at a local hospital. The patient has a history of receiving bacilli Calmette-Guerin (BCG) vaccination. Screening for tuberculosis for this employee should include which of the following tests? A. Sputum induction B. PPD skin test C. Chest x-ray D. No screening needed

C (Chest x-ray) (Chest x-ray is the test of choice in patients where the PPD test is not indicated or in high-risk individuals)

Cryptococcal infection is most UNLIKELY to occur in which of the following? A. Patients with Hodgkin lymphoma. B. Patients with HIV infection. C. Chronic pyelonephritis D. Patients undergoing corticosteroid therapy.

C (Chronic pyelonephritis) (Chronic pyelonephritis does not predispose to cryptococcal infection. Cryptococcosis is an opportunistic systemic mycosis associated with many immunosuppressed states. Chronic Pyelonephritis does not cause immunosuppression. All other options are immunosuppressed states)

A 73-year-old woman comes to the primary care with weakness, fever, malaise and excessive sweating during sleep over the past several weeks. She has back pain and has a non-productive cough. She has a history of PTCA (percutaneous transluminal coronary angioplasty), diabetes mellitus, myocardial infarction, mitral and aortic regurgitation, COPD and congestive heart failure. In addition, she has a history of 20 pack years of smoking. The patient says she cannot eat as she is 'not in the mood'. The patient has difficulty standing. She complains of numbness and muscle weakness bilaterally in her lower limbs. Which of the following options is a possible complication of the patient's spinal pathology? A. Septic arthritis B. Decreased platelet levels on blood analysis. C. Compression of the spinal cord D. Abscess formation

C (Compression of the spinal cord) (Pott disease is an extra-pulmonary TB infection of the bones, the most commonly affected being the lower thoracic and upper lumbar vertebrae. This causes collapse of the inter-vertebral disc, resulting in spinal cord compression)

Which of the following is recommended in treating Rocky Mountain spotted fever? A. Clarithromycin B. Itraconazole C. Doxycycline D. Metronidazole

C (Doxycycline)

Which of the following is not a type of salmonella infection: A. Enteric fever B. Bacteremia C. Esophagitis D. Acute enterocolitis

C (Esophagitis)

A 42-year-old woman comes to your clinic because of a persistent cough for the past 2 months. She is visiting from Jamaica. Her past medical history is significant for rheumatoid arthritis. A chest X-ray is ordered. Which of the following drugs was she most likely taking for her rheumatoid arthritis? A. Aspirin B. Azathioprine C. Etanercept D. Indomethacin E. Methylprednisolone

C (Etanercept) (TNF antagonists place patients at an increased risk of infections. This includes reactivation of Mycobacterium tuberculosis which is particularly concerning because both TNF and M. tuberculosis interact closely with macrophages. Patients should be screened for tuberculosis prior to being started on TNF antagonists)

A 16-year-old boy comes to the clinic because of a "red and bumpy" rash on his arms, back and chest. The rash has persisted for 36 hours and is intensely itchy. The patient says that he has been recovering from "a cold" over the past two weeks. Apart from the rash, he complains of a mild sore throat and some fatigue. When asked about his medications, he says he recently finished a 10-day course of amoxicillin. A heterophile antibody test is administered and returns positive. Which of the following is the most likely etiology of this patient's rash? A. Psoriasis B. Allergic reaction to antibiotic C. Hypersensitivity reaction to the antibiotic D. Viral exanthem E. Seborrheic Dermatitis

C (Hypersensitivity reaction to the antibiotic) (Beta-lactam antibiotic (ampicillin, amoxicillin, cephalosporins) use during a bout of infectious mononucleosis, a result of Epstein-Barr virus, can trigger a rash caused by a temporary hypersensitivity mechanism. These rashes are typically intensely pruritic, morbilliform rashes that appears on extensor surfaces and pressure points 7-10 days after antibiotic therapy) (This is a classic example of Epstein-Barr virus causing infectious mononucleosis. Symptoms include posterior cervical lymphadenopathy, pharyngitis, fever, fatigue and a rash. Diagnosis of infectious mononucleosis is confirmed by a positive heterophile antibody test (Monospot). (There are two types of rashes associated with infectious mononucleosis: a viral exanthem (caused by the virus itself in 10% of cases) and a rash due to a hypersensitivity reaction to beta-lactam antibiotic therapy) (This vignette describes the second type of rash, which occurs in 90% of patients with infectious mononucleosis who are treated with certain beta-lactam antibiotics (ampicillin, amoxicillin, cephalosporins). Hypersensitivity to beta-lactams is thought to be induced by active Epstein-Barr virus infection by an unknown mechanism. The resulting hypersensitivity (ampicillin) rash typically appears 7-10 days after antibiotic therapy is initiated in cases where infectious mononucleosis is mistaken for streptococcal pharyngitis. This rash is usually morbilliform, widespread and very pruritic. In contrast to the viral exanthem, ampicillin rashes do not occur until after antibiotic therapy is initiated and tend to persist for longer)

Ingestion of the spores of C. botulinum, with subsequent spore germination, multiplication, and production of botulinum toxin in the large intestine results in A. Inhalational botulism B. Wound botulism C. Infant botulism D. Food-borne botulism

C (Infant botulism) (Infant botulism results from Ingestion of the spores of C. botulinum, with subsequent spore germination, multiplication, and production of botulinum toxin in the large intestine)

An 18-year-old man presents to the urgent care clinic. He has recently immigrated and has been experiencing back pain for a few weeks. He slipped on ice and had a minor fall onto his backside around the time that the pain began, but he does not believe it was severe enough to have caused serious damage. The pain radiates from the lower back to the gluteal muscles, back of the upper thigh, posterior lower limb, and feet. He has fever (38.5oC) and has noticed recent weight loss. What is the most likely explanation for this condition? A. Mycobacterium tuberculosis co-infection with HIV B. Herniated disc and Pott's fracture of the ankle as a result of the fall C. Infection of lower thoracic and upper lumbar vertebrae D. Infection of the cervical spine E. Residual trauma from the fall

C (Infection of lower thoracic and upper lumbar vertebrae) (Pott disease describes a Mycobacterium tuberculosis infection of the spine, most commonly in the lower thoracic or lumbar region. Imaging will show decreased vertebral height, as well as irregularity of the vertebral margin)

A 25-year-old woman comes to your clinic because of low-grade fever and malaise for 3 days. She is a self-described hiking enthusiast, and recently had a short weekend camping trip in Maryland 10 days ago. Physical examination shows an expanding erythematous patch with a clear ring on the upper right arm, and there is regional lymphadenopathy observed. Which of the following may occur if this patient's condition is left untreated? A. Alopecia B. Infertility C. Inflammatory arthritis D. Subacute sclerosing panencephalitis E. Galactorrhea

C (Inflammatory arthritis)

A 45-year-old Hispanic woman comes to the office because of a 1-month history of cough and mild weight loss. When asked about her background information, the patient mentions that she recently immigrated to the US from Mexico. Upon further questioning, the patient mentions that she has to change the sheets at night because of her severe sweating. Physical examination is non-contributory. Her temperature is 38.6°C (101.48°F), pulse is 102/min, respirations are 17/min, blood pressure is 110/80 mmHg. Chest radiography shows a calcified, right perihilar cavitation and bilateral diffuse nodular opacities. Tuberculin test is positive (10mm). Which of the following is most likely seen in a biopsy specimen in this patient? A. Langerhans cells B. Basophils C. Macrophages D. Eosinophils E. Neutrophils

C (Macrophages) (Chronic inflammation is characterized by persistent destruction and repair. The presence of mononuclear cells (i.e.,macrophages, giant cells) is a characteristic biopsy finding in patients with a calcified tuberculous caseating granuloma)

Which of the following would you use to treat tetanus? A. Azithromycin B. Ciprofloxacin C. Metronidazole D. Fluconazole

C (Metronidazole) (Metronidazole is the drug of choice in the treatment of tetanus. Penicillin can also be used. All others are not used in treating tetanus)

An HIV patient you diagnosed of having Pneumocystis jiroveci Pneumonia is found to be sensitive to Bactrim. Which of the following is NOT an alternative treatment choice? A. Pentamidine B. Atovaquone C. Moxifloxacin D. Dapsone/trimethoprim

C (Moxifloxacin) (Moxifloxacin is not used in treating Pneumocystis jiroveci Pneumonia)

A 50-year-old man comes to the office because of two weeks of fevers that he has measured to be as high as 100°F (38.8°C). He has had an occasional dry cough and chest pain during inspiration. Yesterday, there were some streaks of blood in his cough, which prompted him to come in for evaluation. He had not had any rhinorrea or sore throat. He works as a prison guard and smokes half a pack of cigarettes per day. He has a history of diabetes mellitus for which he takes metformin, and was last checked one year ago. Which of the following is the most likely diagnosis? A. Bronchiectasis B. Sarcoidosis C. Mycobacterium tuberculosis infection D. Klebsiella pneumoniae infection

C (Mycobacterium tuberculosis infection) (Mycobacterium tuberculosis is an aerobic bacillus. Mycolic acid in its cell wall gives the surface a waxy coating that is best stained with acid fast dyes. Primary TB, reactivation TB, and tuberculoma are some of the clinical manifestations)

An 11 year-old boy comes to your clinic because of severe headache, mild neck stiffness, unilateral facial palsy, and a severe radicular pain in his left lower limb. He was bitten on his left leg by a tick 4 weeks ago. A "Bulls-Eye" lesion appeared 3 weeks ago. His pain does not appear to have a mechanical precipitant and he describes it as a burning, excruciating pain on his left leg that "does not let [him] sleep." A lumbar puncture is performed. The CSF results include lymphocytic pleocytosis (160 cells/μL and moderately elevated protein concentration (250 mg/dL). Glucose concentration shows no abnormalities. Which of the following is the most likely diagnosis? A. Charcot-Marie-Tooth disease B. Multiple sclerosis C. Neuroborreliosis D. Neurosarcoidosis E. Rocky Mountain spotted fever

C (Neuroborreliosis) (Lyme disease is caused by Borrelia burgdorferi via vector Ixodes tick bites. Mnemonics: BAKE a Lyme pie: Bell Palsy Arthritis Kardiac block (3rd degree) Erythema migrans LIME Lymphocytic meningitis Ixodes Motor (Bell) Palsy Erythema migrans Main explanation Neuroborreliosis is a disease caused by Borrelia burgdorferi. The term is sometimes used interchangeably with Lyme disease, but neuroborreliosis refers to infection by Borrelia burgdorferi that specifically includes neurologic manifestations. This distinction is important because nervous system involvement only occurs in disseminated Lyme disease. The vectors of Lyme disease are ticks of the genus Ixodes. Lyme disease has a higher prevalence in temperate climates of Europe and North America. Symptoms of early Lyme disease include the characteristic rash, headaches, and vague flu-like symptoms. Erythema migrans is the first recognizable manifestation of infection; after a tick bite it usually appears within 10 days. The skin lesion may look like a target lesion with central clearing of the erythema ("bullseye rash"). After 1 to 12 weeks, manifestations of infection and inflammation of the central or peripheral nervous systems occur in some patients. The triad of early neurologic Lyme disease is: Lymphocytic meningitis Cranial neuropathy (particularly facial palsy) Radiculoneuritis (motor or sensory or both)

A 9-month-old boy is brought to the clinic by his mother because of a three-day history of poor feeding. She reports that his suckling and swallowing seem weaker than usual and he has not had a bowel movement in this time. She feeds him home-processed vegetables from their garden. Medical history shows that his immunizations are up-to-date. Physical examination shows decreased muscle tone, abdominal distention, and labored breathing. When the skin is poked with a sharp edge on both proximal and distal body parts, the infant reacts each time, but the whimper is minimal. With the infant on the examination table, his mother is asked to slowly walk away across the room. The physician watches the infant's eyes, and though they remain pointed in his mother's direction, his pupils do not dilate as she gets further away. Which of the following is the most likely etiology? A. Autoimmune antibodies targeting the post-synaptic acetylcholine receptor B. Lead ingestion resulting in toxic plasma level C. Neurotoxin preventing the release of acetylcholine from presynaptic nerve terminals D. Point mutation resulting in defective muscular protein E. Virus resulting in necrosis of anterior horn cells

C (Neurotoxin preventing the release of acetylcholine from presynaptic nerve terminals) (Infant botulism is caused by ingested spores of the bacterium Clostridium botulinum. After germination, they produce botulinum toxin which prevents acetylcholine release from presynaptic nerve terminals, thus affecting somatic and autonomic neuromuscular junctions alike)

A 24-year-old woman comes to the office because she forgot to take appropriate precautions while volunteering at a hospital and interacting with an HIV-positive patient being treated for active infection with Mycobacterium tuberculosis. Her past medical history is noncontributory and she is a healthy medical student. Physical examination shows the patient is anxious with no other abnormalities. A PPD is placed. Two days later, she calls, saying her arm has 6 mm of induration around the injection site, and she is horrified because she remembers that the patient had initially presented with only 5 mm of induration. Which of the following most accurately describes the criteria for tuberculin positivity in this student? A. PPD+ if induration ≥10 mm B. PPD+ if induration ≥15 mm C. PPD+ if induration ≥5 mm D. PPD+ if induration >= 20mm

C (PPD+ if induration ≥5 mm) (The purified protein derivative (PPD, Mantoux) test is used to screen for tuberculosis. In patients who are immunocompromised or are in recent contact with active tuberculosis, a positive result is an area of induration ≥5 mm. Further testing is required for a diagnosis)

A 31-year-old man presents to the emergency department with the complaint of increasing shortness of breath for the past three days, especially when climbing stairs or walking for a few minutes. He reports having fevers, chills, night sweats, and a non-productive cough. A chest radiograph demonstrates bilateral interstitial infiltrates. Laboratory studies reveal that the patient is HIV-positive and has a CD4 count of 150/mm3. Additionally, the patient's oxygen saturation is decreased to 92% on 3L of O2. Which of the following is the most likely causative organism of this acute illness? A. Cytomegalovirus B. Streptococcus pneumoniae C. Pneumocystis jiroveci D. Tuberculosis E. Histoplasmosis

C (Pneumocystis jiroveci) (Pneumocystis pneumonia is caused by Pneumocystis jirovecii. This form of pneumonia is often seen in patients with AIDS (CD4 <200/mm3).)

A 38-year-old man comes to the clinic because of a 1-day history of dyspnea, fever, and a non-productive cough. His past medical history is notable for HIV, for which he has been noncompliant with his medications. His CD4 count was last taken a month ago and was 183/mm3. He denies past or present smoking. Chest radiograph is obtained and is shown below. Which of the following is the patient's most likely diagnosis? A. Bronchiectasis B. Emphysema C. Pneumocystis pneumonia (PCP) D. Tuberculosis E. Viral pneumonitis

C (Pneumocystis pneumonia (PCP)) (Pneumocystis pneumonia is a form of pneumonia caused by Pneumocystis jirovecii. Suspect PCP in immunocompromised patients who have a CD4 count of <200/mm3. The main finding on X-ray is diffuse bilateral interstitial infiltrates)

Which of the following is associated with typhoid fever? A. Koplik spot B. Osler's nodes C. Rose spots D. Janeway lesions

C (Rose spots) (Rose spots are pink, blanchable, slightly raised macules that occur on the chest and abdomen of people with typhoid fever. It commonly appears during the second week of the disease)

You are managing a 21-year old male for tetanus. He has never been vaccinated against tetanus. How would you administer tetanus toxoid? A. Single dose of DTaP. B. Series of 3 vaccinations (DTaP) 6 weeks apart. C. Series of 3 vaccinations (Td) with the first two doses 4-6 weeks apart, and the third dose 6-12 months later. D. Series of 3 vaccinations (DT/Tdap) with the first two doses 2 weeks apart, and the third dose 4 weeks later.

C (Series of 3 vaccinations (Td) with the first two doses 4-6 weeks apart, and the third dose 6-12 months later) (For persons aged 19 years and older who have never been vaccinated against tetanus, a series of 3 vaccinations (Td) should be given with the first two doses 4-6 weeks apart, and the third dose 6-12 months later. Substitute a one-time dose of Tdap for one of the doses in the series. All others are inappropriate treatment options)

Which of the following would not help to confirm the diagnosis of a patient with pinworms? A. Stool for parasites B. Cellophane-tape test C. Serologic test D. Nocturnal examination of the perianal area

C (Serologic test)

A 4-year-old girl is brought to the office because of diarrhea for 12 hours. Her mother states that she came home from daycare and developed fever, abdominal pain, and diarrhea containing flecks of bright-red blood and pus. The girl did not ingest any food at daycare, and her diet has been unchanged in the last week. A stool specimen is collected and sent to the lab. Which of the following is the most likely causative organism based on clinical findings? A. Campylobacter jejuni B. Enterotoxigenic Escherichia coli C. Shigella dysenteriae D. Vibrio cholera E. Yersinia enterocolitica

C (Shigella dysenteriae) (Shigella dysenteriae is a non-motile gram-negative rod. Humans are the only hosts for Shigella, and it usually causes bloody diarrhea. Transmission is by fecal-oral and hand-to-hand routes)

Which is true regarding the treatment of tetanus? A. Penicillin G is the drug of choice for elimination of toxin production B. Current recommendations suggest excising 4 cm of normal viable-appearing tissue around wound margins suspected of causing the infection C. Tracheostomy should be performed in patients requiring intubation for more than 10 days D. Wound debridement is indicated in all cases

C (Tracheostomy should be performed in patients requiring intubation for more than 10 days) (The goals of treatment should include stopping the production of toxin and its neutralization, airway management, and control of muscle spasm and dysautonomia. Prophylactic intubation should be seriously considered in all patients with moderate to severe clinical manifestations. Intubation and ventilation are required in 67% of patients. Attempting endotracheal intubation may induce severe reflex laryngospasm; preparations must be made for emergency surgical airway control. Rapid-sequence intubation techniques (eg, with succinylcholine) are recommended to avoid this complication. Tracheostomy should be performed in patients requiring intubation for more than 10 days. Tracheostomy has also been recommended after onset of the first generalized seizure. Antimicrobials are used to decrease the number of vegetative forms of Clostridium tetani (the toxin source) in the wound. For years, penicillin G was used widely for this purpose, but it is not currently the drug of choice. Metronidazole (eg, 0.5 g every 6 hours) has comparable or better antimicrobial activity, and penicillin is a known antagonist of gamma-aminobutyric acid (GABA), as is tetanus toxin. Metronidazole is also associated with lower mortality. Human immune tetanus globulin is administered to neutralize the toxin. In many cases, the wound responsible for tetanus is clear at presentation, in which case surgical debridement offers no significant benefit. If debridement is indicated, it should be undertaken only after the patient has been stabilized. The current recommendation is to excise at least 2 cm of normal viable-appearing tissue around the wound margins)

A 22-year-old male presents to the emergency department with a gunshot wound to the abdomen. The bullet did not puncture the patient's bowel but did lacerate the spleen. The patient was given a splenectomy and then transferred to the intensive care unit. However, the next day, the patient developed a rigid abdomen and then began clenching his fists and arching his back. Which of the following would be the next best step in the management of this patient? A. Mechanical ventilation B. Surgery to treat an acute surgical abdomen C. Wound debridement D. Broad spectrum antibiotics

C (Wound debridement) (Tetanus is an injection characterized by muscle spasms that is caused by exposure to the bacterium C. tetani, often through a contaminated wound. The first step in management is wound debridement and administration of tetanus immune globulin)

A 26-year-old pregnant woman comes to the clinic for her first visit at 8 week gestation. She does not report any current concerns. It is the month of October and the influenza vaccine for this year is available. Based on the woman's current condition, why should the patient receive or not receive the influenza vaccine at this visit? A. No, this patient should not receive the influenza vaccine at this visit because both forms of the influenza vaccine (live attenuated and inactivated) are contraindicated during pregnancy. B. No, because both forms of the influenza vaccine (live attenuated and inactivated) are contraindicated during the first trimester of pregnancy. C. Yes, this patient should receive the inactivated influenza vaccine at this visit. D. Yes, this patient should receive the live attenuated influenza vaccine at this visit. E. Yes, but this patient should receive the inactivated influenza vaccine at the visit during her third trimester.

C (Yes, this patient should receive the inactivated influenza vaccine at this visit) (It is safe to receive the inactivated influenza vaccine at any point during pregnancy and is indicated for pregnant women during the flu season. This is in contrast to the live attenuated vaccine, which is contraindicated during pregnancy)

On a _____ for mononucleosis atypical lymphocytes will often constitute >10% of total leukocyte count.

CBC

Epstein Barr virus attacks the __________ receptor on the B-cell.

CD21

Infectious mononucleosis is an Epstein-Barr virus infection that results in a lymphocytic leukocytosis comprised of reactive ______________.

CD8+ T cell

The ________ response caused by infectious mononucleosis, leads to generalized lymphadenopathy, splenomegaly, and high WBC count with atypical lymphocytes.

CD8+ T-cell

Diagnosis of cyrptococcus is made with _________ and serum serology.

CSF

If PPD is + order a ______________.

CXR

________________ is/are the usual method of transmission of Clostridium botulinum toxin.

Canned foods

On biopsy pts with TB will have ________________________.

Caseating granulomas

________________ necrosis is seen in Histoplasma capsulatum.

Caseous

_____________________ with granulomas is the pattern of necrosis characteristically seen in tuberculosis.

Caseous necrosis

What stage of pertussis is characterized by congestion, rhinorrhea, low-grade fever, sneezing, lacrimation, and conjunctival suffusion?

Catarrhal stage

What are the stages of pertussis?

Catarrhal stage (1-2 weeks) Paroxysmal cough stage (1-6 weeks) Convalescence (Weeks to months)

Amoxicillin or _______________ are the medications of choice for early localized Lyme disease, when doxycycline is contraindicated such as in pregnant women or children less than 8 years old.

Cefuroxime

A 33-year-old female presents with watery, nonbloody diarrhea and abdominal cramps for the past 2 days. She also reports a low-grade fever. She returned from a medical mission trip to South America yesterday. While on the trip she spent time in a remote area and is uncertain of the quality of the water she drank. She also ate shrimp one night for dinner. On examination, the stools are liquid with flecks of mucus. Physical exam reveals sunken eyes, dry mucous membranes and decreased skin turgor. The patient is afebrile. Blood pressure is 90/60 mmHg. What is the most likely diagnosis?

Cholera

A 34-year-old Caucasian man is brought to the emergency department by his girlfriend after losing consciousness. Medical history is relevant to recent travel to South America. Upon medical interrogation, the girlfriend claims that he started feeling sick a couple of hours after eating ceviche. He started with frequent episodes of voluminous and watery diarrhea. Physical exam shows dry mouth and swollen tongue, sunken eyes, and shriveled and dry skin. His temperature is 36.5°C (97.6°F), pulse is 70/min, respirations are 16/min, blood pressure is 120/80 mmHg. What is the most likely diagnosis?

Cholera

_________________ is an acute infectious disease of the small bowel caused by Vibrio cholerae a gram-negative, oxidase positive, comma-shaped bacteria which secretes a toxin that causes a life-threatening, rice water diarrhea.

Cholera

_______________ is an inflammation of the choroid and retina that is commonly seen in cases of congenital toxoplasmosis.

Chorioretinitis

Botulism is caused by a neurotoxin elaborated by _______________________________.

Clostridium botulinum

Floppy baby syndrome is caused by____________________ (bacterium) spores.

Clostridium botulinum

Tetanus results from a toxin produced by the anaerobic bacteria _____________________.

Clostridium tetani

_________________ causes a disease of spastic paralysis that presents with risus sardonicus and trismus.

Clostridium tetani

Susceptible individuals to the Varicella-zoster virus are infected via the:

Conjunctiva Respiratory tract

A 49 year-old HIV positive male with a CD4 count of 9, he lives alone, drinks daily, he presents to the hospital with a headache, neck stiffness, and confusion. A lumbar puncture (LP) shows that his intracranial pressure is very high (45 cm). An India ink stain shows cysts. What is the most likely diagnosis?

Cryptococcosis

A 35-year-old man, who is human immunodeficiency virus positive, comes to the emergency department because of one week of fever, malaise, and headache. He also reports having some neck stiffness over the past two days. His temperature is 39.1°C (102.4°F) and he has a stable pulse and blood pressure. He has no focal neurological deficits, but is very uncomfortable when a pen light is shined in his eye to examine his pupils. What is the most likely diagnosis?

Cryptococcus

A 56-year-old Hispanic man comes to the office complaining of recurrent headaches, fever, and vision disturbances. His medical history is relevant to positive HIV. Physical exam shows a malnourished appearance, neck rigidity, and a positive Brudziński sign. A lumbar puncture is obtained and cultured. The microorganism grows in Sabouraud agar and has a microscopic appearance of an encapsulated yeast with narrow-based budding. What is the most likely diagnosis?

Cryptococcus

Pneumonia due to ___________________ may be present as a cough with little sputum and pleuritic chest pain.

Cryptococcus

_________________ is the most common cause of fungal meningitis. May present with altered mental status changes, headache or meningismus

Cryptococcus

__________________ is caused by budding yeast found in soil contaminated with pigeon/bird droppings.

Cryptococcus

_______________ remains the gold standard for diagnosis of histoplasmosis but requires a lengthy incubation period.

Culture

The secondary viremia of the Varicella-zoster, results in a:

Cutaneous infection with typical vesicular rash

________________ is a herpesvirus that causes infectious mononucleosis with a negative monospot test.

Cytomegalovirus

All of the following statements concerning botulism are true except A. Ingestion of honey is a risk factor for infant botulism. B. Presents as symmetric descending flaccid paralysis. C. Illness of food borne botulism usually begins 18-36 hrs after ingestion of the contaminated food. D. Botulism is an anaerobic gram-negative rod.

D (Botulism is an anaerobic gram-negative rod.) (Botulism is an anaerobic gram-positive rod. All other options are correct statements)

A 6-year-old male who recently immigrated to the United States from Asia is admitted to the hospital with dyspnea. Physical exam reveals a gray pseudomembrane in the patient's oropharynx along with lymphadenopathy. The patient develops myocarditis and expires on hospital day 5. Which of the following would have prevented this patient's presentation and decline? A. Increased CD4+ T cell count B. Secretory IgA against viral proteins C. Increased IgM preventing bacterial invasion D. Circulating IgG against AB exotoxin E. Improved IgE release from mast cells

D (Circulating IgG against AB exotoxin) (This patient most likely died from diphtheria, an infection caused by Corynebacterium diphtheriae. Diphtheria can be prevented with administration of the diphtheria-pertussis-tetanus (DPT or DTaP) vaccine, which stimulates the production of circulating IgG antibodies against the diphtheria AB exotoxin) (Diphtheria presents with pseudomembranous pharyngitis (a grayish-white membrane) and lymphadenopathy. The membrane can extend into the larynx and cause obstruction, explaining this patient's dyspnea. Recurrent laryngeal nerve palsy is also common, resulting in palate paralysis. Systemic sequelae of C. diphtheriae infection include cardiac and neurologic damage due to the actions of the AB exotoxin. In particular, the toxin inhibits beta-oxidation of fatty acids in the myocardium, leading to myocarditis)

A 56-year-old woman who immigrated from China 3 years ago comes to the emergency department because of substantial hemoptysis. Initial work up includes a chest x-ray which shows several cavitary lesions in the upper lung fields bilaterally. Further testing confirms a diagnosis of tuberculosis. Proper airborne precautions are initiated and the patient is placed in isolation. Which of the following is the most appropriate initial treatment, assuming the TB strain is not multi-drug resistant? A. Administration of isoniazid B. Administration of rifampicin and isoniazid C. Combination therapy with rifampicin, isoniazid and ethambutol D. Combination therapy with rifampicin, isoniazid, ethambutol and pyrazinamide

D (Combination therapy with rifampicin, isoniazid, ethambutol and pyrazinamide)

A 7-year-old boy is brought to the emergency department by his mother because he has a rash on his arms and legs. In addition the patient complains of a headache and nausea. The mother notes that the rash has progressively gotten worse since her son returned home from Boy Scout camp in North Carolina about 2 days ago. Physical examination of the patient shows a tired, febrile young male with a maculopapular rash over all four extremities involving the palms and soles. The remainder of the examination is unremarkable. Which of the following is the best step in the medical management of this patient's condition? A. Admit for intravenous ceftriaxone B. Admit for intravenous vancomycin and gentamicin C. Discharge on oral amoxicillin, with close follow-up D. Discharge on oral doxycycline, with close follow-up E. Give IM ceftriaxone and discharge

D (Discharge on oral doxycycline, with close follow-up) (Rocky Mountain spotted fever (RMSF) is a tick-borne febrile illness characterized by a maculopapular rash starting on the extremities, involving the soles and palms, and progressing to the trunk. Doxycycline is the agent of choice for treatment of RMSF in children because of the potentially deadly consequences of untreated disease) (The best answer here is to discharge the patient on doxycycline with close follow-up. The child in this question most likely has Rocky Mounted Spotted Fever (RMSF), a tick-borne illness caused by the gram-negative intracellular coccobacillus bacteria Rickettsia rickettsii. It is characterized by a rash starting on the extremities, including the palms of the hands and soles of the feet, and progressing to include the trunk but sparing the head. Other symptoms characteristic of RMSF include fever, headache, myalgia, gastrointestinal and central nervous system involvement. Once RMSF is diagnosed, the first line of treatment is the administration of doxycycline, a bacteriostatic tetracycline. While generally doxycycline is contraindicated in children < 8 years old, cases of Rocky Mountain Spotted Fever are the exception to this rule because of the severe risk of complications and mortality associated with this disease. Mild cases without signs of systemic involvement can be treated on an outpatient basis; however, these patients need close follow-up)

A 25-year-old comes to the emergency department because of shortness of breath and fever for the past week. He also notes a persistent dry cough and recent unintentional weight loss. Physical examination shows mild tachypnea, and tachycardia to 110/min. Oxygen saturation is 94% on room air. A chest X-ray shows bilateral diffuse interstitial infiltrates without focal consolidation. Giemsa stain of induced sputum shows cysts in aggregate. Which of the following diagnostic tests is the next best step in the care of this patient? A. Blood culture B. Broncheoalveolar lavage C. CT Chest D. HIV testing E. Lung biopsy

D (HIV testing) (Pneumocystis jirovecii infection occurs in severely immunocompromised hosts (CD4+ cell counts <200) and usually manifests as a pneumonia characterized by interstitial infiltrates on chest x-ray. Giemsa staining of induced sputum may show aggregated cysts characteristic of this yeast-like fungal organism)

A 36-year-old Hispanic woman comes to the primary care clinic with chronic back pain. She has had asthma since childhood and has a prosthetic leg. She also has hypogammaglobulinemia. She has recently returned from volunteering in South Africa. Chest x-ray shows evidence of past granulomatous disease, and an x-ray of the spine shows loss of definition of the bony margin. she is started on a four-drug regime which she must maintain for at least six to nine months. Which of the following is most relevant for this patient? A. In order to prevent the infection from reoccurring she may require a six drug regime to be maintained for 18 months B. In order to prevent the infection from reoccurring she may require additional surgery for her prosthetic leg C. In order to prevent the infection from reoccurring she may require life long physiotherapy D. In order to prevent the infection from reoccurring she may require life-long drug therapy

D (In order to prevent the infection from reoccurring she may require life-long drug therapy) (The patient's immunodeficiency places her at increased risk of relapse of her spinal tuberculosis (Pott's disease), so she may require life-long drug therapy)

A 24-year-old woman comes to the emergency department because of progressive bilateral muscle weakness. She had first noticed blurry vision and dry mouth a day ago, which was followed by nausea and vomiting later in the day. She had initially attributed her symptoms to a mild case of food poisoning because she was returning from a visit to a farm, where she had eaten homemade canned beans and unpasteurized cheese. Physical examination shows bilateral muscle weakness of the face and limbs as well as reduced deep tendon reflexes. Which of the following pathologic processes best explains the patient's symptoms? A. Cell-to-cell spread of intracellular bacteria by actin polymerization B. Destruction of cell membranes by lecithinase activity C. Impairment of protein synthesis by inhibition of translocation D. Inhibition of acetylcholine release by protease activity E. Polyclonal activation of T cells by superantigen

D (Inhibition of acetylcholine release by protease activity) (Botulism, caused by ingestion of preformed toxin typically associated with home-canned food, produces flaccid paralysis by inhibition of acetylcholine release at the neuromuscular junction)

The classic triad of congenital toxoplasmosis includes all of the following except A. Intracranial calcification B. Chorioretinitis C. Hydrocephalus D. Microcephaly

D (Microcephaly)

Which of the following provides definitive diagnosis of rabies? A. MRI B. Blood culture C. PCR of saliva sample D. None of the above

D (None of the above) ( PCR of a saliva sample can detect viral RNA. It is diagnostic)

Clinical features of botulism include all of the following except A. Paresthesia B.Dysphagia C. Diplopia D. Fixed/dilated pupils

D (Paresthesia)

A 17 year-old boy comes to the emergency department because of dehydration. For the past day, he has experienced severe spasms in his throat when trying to drink. He reports being bitten on the left upper arm by a dog in the local park one month ago. During the previous week he experienced several episodes of fever, weakness, fatigue, insomnia and headache. He has also experienced some dysphagia in the past two days, but onset of his spasms was very sudden. Physical examination shows a facial grimace and hyperextension of the neck. Which of the following is the most likely diagnosis? A. Central nervous system vasculitis B. Cephalic tetanus C. Herpes simplex virus type 1 encephalitis D. Rabies encephalitis E. Rasmussen encephalitis

D (Rabies encephalitis)

A 25-year-old woman comes to the emergency department complaining of weakness for the past three days. She reports fever, malaise, a non-productive cough, and muscle soreness. Physical examination shows a temperature of 38.5o C (101.3o F), an SpO2 of 100%, and appears tired but otherwise well. She has no focal weakness, and her lung auscultation is normal. A chest x-ray is negative for an acute process. Rapid flu testing is positive for influenza A, and nasal wash cultures are pending. Which of the following is the best treatment for this patient? A. Amantadine B. Amoxicillin C. Oseltamivir D. Reassure and discharge E. Tetravalent flu vaccination

D (Reassure and discharge) (Patients with a mild case of influenza infection, without major vital sign derangements and tolerating oral intake, may be discharged home safely. The administration of osteltamivir is only advised for patients reporting the onset of symptoms less than 48 hours prior to presentation)

A 12-year-old previously healthy boy is brought to the emergency department by his mother because of nausea, vomiting, fever, non-bloody diarrhea and cramping abdominal pain for the past 24 hours. His mother states that he woke up the day before with a fever of 38.6°C (101.6°F) and has been having 5-6 loose stools per day ever since. She also mentions that he was helping her cook chicken cutlets two days ago. Physical examination shows a dehydrated male in moderate distress, and abdominal examination shows diffuse tenderness to palpation without rebound. Stool culture grows gram-negative, lactose-negative rod that form translucent colonies on MacConkey agar. Which of the following is the best course of treatment? A. Amoxicillin B. Ciprofloxacin C. Piperacillin-tazobactam D. Replace fluids and electrolytes E. Trimethoprim-sulfamethoxazole (TMP-SMX)

D (Replace fluids and electrolytes) (Salmonella is a gram negative motile rod causing a variety of illnesses, including typhoidal and non-typhoidal salmonellosis. Non-typhoidal salmonellosis (gastroenteritis) is self limiting, and in immunocompetent patients treatment is supportive only, no antibiotics are needed)

Which of the following is not a measure taken in the management of a patient with diphtheria? A. Patient isolation B. Diphtheria antitoxin therapy C. Penicillin therapy D. Salbutamol nebulization

D (Salbutamol nebulization)

A 65-year-old man comes to the emergency department because of fever, chills, and a blood tinged productive cough for 2 weeks. He says he is homeless, drinks a pint of vodka per day, and has smoked a pack of cigarettes per day for the past 19 years. His temperature is 38.3°C (101°F), pulse is 100/min, and blood pressure is 141/80 mm Hg. Chest X-ray reveals small lung nodules in the right upper and left upper lobes. A lung biopsy is obtained (depicted below). Which of the following is the most likely diagnosis? A. Chronic bronchitis B. Lobar pneumonia C. Sarcoidosis D. Secondary tuberculosis

D (Secondary tuberculosis) (Secondary tuberculosis is characterised by caseating granulomas in the upper lobes of the lungs. Clinical features include fever, night sweats, weight loss and cough with blood sputum)

A 15-year-old male comes to the office because of a sore throat and fever for two days. He says his throat started hurting several days ago and he has been experiencing increased fatigue. His medical history is noncontributory, and he has no allergies. His temperature is 38.5°C (101.3°F), pulse is 87/min, respirations are 18/min, and blood pressure is 117/78 mm Hg. Physical examination shows a erythematous posterior pharynx, tonsillar edema with exudates, palatal petechiae, and several enlarged posterior cervical lymph nodes. Rapid group A beta-hemolytic streptococci screen and Monospot tests are performed in the office and both are negative. The patient begins course of amoxicillin, but calls the next day saying that he has developed a diffuse rash. Of the following potential complications associated with this patients condition, which most commonly results in death? A. Interstitial nephritis B. Myocarditis C. Pneumonia D. Splenic rupture E. Upper airway obstruction

D (Splenic rupture) (Infectious mononucleosis is caused by Epstein-Barr virus. Deaths are rare in patients with infectious mononucleosis but may be due to splenic rupture, bacterial super infections, upper airway obstruction, or central nervous system complications) (The most likely diagnosis is infectious mononucleosis. The most specific symptoms include fever, lymphadenopathy, palatal petechiae, and splenomegaly accompanied by at least 50% lymphocytes and at least 10% atypical lymphocytes seen on peripheral smear. The monospot test detects heterophile antibodies seen with Epstein-Barr virus (EBV) infection that react to antigens (horse red blood cells).) (In the first week of infection, this test may result in false negatives for up to 25% of the cases. Measurement of specific IgM and IgG antibodies can be detected with serologic testing. Another sign that mononucleosis is the correct diagnosis in this case is the adverse reaction seen as a rash after taking an antibiotic that was previously tolerated. Many patients with infectious mononucleosis who are given amoxicillin or ampicillin may develop a morbilliform rash.) (Treatment is mostly supportive as anti-viral treatment has been shown to be ineffective. Deaths are rare in patients with infectious mononucleosis but may be due to splenic rupture, bacterial super infections, upper airway obstruction, or central nervous system complications.)

Which of the following regarding histoplasmosis is not true? A. It's caused by Histoplasma capsulatum. B. Transmission is mainly by inhalation of the spores. C. The primary reservoir of H. capsulatum is soil enriched by bird and bat droppings. D. Sputum culture is almost always positive in acute pulmonary histoplasmosis

D (Sputum culture is almost always positive in acute pulmonary histoplasmosis) (Sputum culture is rarely positive in acute pulmonary histoplasmosis. All other statements are correct)

Which is the leading cause of death associated with tetanus? A. Asphyxia from tetanic spasms B. Pulmonary embolism C. Hypoxic injury and aspiration pneumonia D. Sudden cardiac death

D (Sudden cardiac death) (Before 1954, asphyxia from tetanic spasms was the usual cause of death in patients with tetanus. However, with the advent of neuromuscular blockers, mechanical ventilation, and pharmacologic control of spasms, sudden cardiac death has become the leading cause of death. Sudden cardiac death has been attributed to excessive catecholamine production or the direct action of tetanospasmin or tetanolysin on the myocardium)

A 45-year-old woman comes to the office because of a 5-day history of fever, headache, and confusion. She was diagnosed with HIV infection 5 years ago, and her last CD4+ T lymphocyte count was 72/mm3. She lives at home with 3 dogs and 2 cats. An MRI with contrast of the brain shows multiple ring-enhancing lesions. Which of the following is the most likely diagnosis? A. HIV encephalopathy B. Progressive multifocal leukoencephalopathy C. Glioblastoma multiforme D. Toxoplasmic encephalitis E. Cryptococcal meningitis

D (Toxoplasmic encephalitis)

A 10-year-old Asian-American boy comes to your office because of fever, sore throat, and cough for the past week. His past medical history is noncontributory. He denies any cold symptoms, rhinnorhea, diarrhea, or changes in appetite. His mother says he has lost weight since his last visit 6 months ago for immunizations and a well-child visit. Previously, his weight was at the 35th percentile; now he is at the 20th percentile. Physical examination shows the patient is afebrile, breathing comfortably, with no nasal discharge. Posterior oropharynx shows no abnormalities. He has moderate non-tender cervical lymphadenopathy bilaterally. No murmurs, rubs, or gallops are heard on auscultation of the heart. Diminished breath sounds on the right are heard on auscultation of the lungs. A chest x-ray is ordered. Which of the following is the most appropriate next step in management? A. Bartonella serology B. Lymph node biopsy C. Rapid strep throat test D. Tuberculin skin test E. Viral panel nasal swab

D (Tuberculin skin test) (Tuberculosis can present in young patient with fever, weight loss, cervical lymphadenopathy, and lower respiratory tract symptoms. The first step in differentiating this from other respiratory diseases is a tuberculin skin test)

A patient should be tested for tuberculosis prior to being treated with: A. etanercept (Enbrel). B. cyclosporine (Neoral). C. methotrexate (Rheumatrex). D. prednisone (Deltasone)

D (prednisone (Deltasone)) (Etanercept is an anti-cytokine agent used in the treatment of rheumatoid arthritis and has as a side effect the potential for serious infections. One of these side effects includes reactivation of dormant tuberculosis)

Which of the following is the most appropriate therapeutic agent for acute influenza? A. azithromycin (Zithromax) B. acyclovir (Zovirax) C. tetracycline (Sumycin) D. zanamivir (Relenza)

D (zanamivir (Relenza))

A 25-year-old woman comes to the emergency department because of worsening fatigue, lightheadedness, shortness of breath, and chest pain for the past 3 days. She reports seeing her family doctor 2 weeks ago for a fever and rash. She was prescribed antibiotics but stopped the course 1 week early after symptoms subsided. Physical examination shows mild left knee edema and a 6 cm blue-red circular rash with 1 cm of central clearing on the right posterior thigh and lower-left abdomen. Which of the following findings is most expected with this presentation? A. Atrial fibrillation B. Diffuse ST elevation over several leads C. Long QT changes D. Third degree heart block E. Ventricular fibrillation

D. Third degree heart block (Lyme carditis often causes atrioventricular blocks and occurs several days to months after a Ixodes tick bite. It occurs in approximately 1% of Lyme disease cases, and can be fatal if untreated) (This patient likely has Lyme disease, an infection caused by the Ixodes tick-borne bacteria Borrelia burgdorferi. This bacterium causes the characteristic erythema migrans. While it can take many forms and colors, this rash is often described as a "bull's eye," or a circular rash with central clearing. In later presentations, the bacteria can cause erythema migrans at multiple sites of the body which indicates dissemination of infection) (The presenting symptoms of fatigue, lightheadedness, shortness of breath, and chest pain are all consistent with a heart block due to Lyme carditis. This involves direct invasion of the bacteria into the heart which interferes with the normal cardiac conduction circuits. The most common manifestation of such interference is an atrioventricular block)

The Epstein-Barr virus is a (DNA/RNA) virus belonging to the herpesvirus family.

DNA

Varicella-zoster virus is a double stranded (RNA / DNA) virus that is a member of the herpesvirus family.

DNA

What are immunocompromised individuals with Varicella-zoster at risk of:

Death from pneumonia and/or encephalitis

Rickettsia rickettsii infection is transmitted via bite of the ______________.

Dermacentor tick

A 14-year-old male, who recently immigrated with his parents from the Dominican Republic, presents with a 2 day history of fever, malaise, and sore throat. Immunization records are unavailable. On physical exam, temperature is 102°F (38.9°C). A friable grayish white membrane is seen in the oropharynx that bleeds if scraped. There is enlargement of the cervical nodes, resulting in a bull neck. What is the most likely diagnosis?

Diphtheria

Complications may include myocarditis, inflammation of nerves, kidney problems, and bleeding problems due to low blood platelets.

Diphtheria

Symptoms may include a fever, sore throat, and in severe cases a grey or white patch in the throat and lymphadenopathy around the neck. What is the most likely diagnosis?

Diphtheria

_________________ is an infection that presents with a grayish-white pseudomembranous pharyngitis, lymphadenopathy, myocarditis, and arrhythmias.

Diphtheria

__________________needs to be considered in patients with nonspecific findings of pharyngitis, cervical adenopathy, and low-grade fever if they also have systemic toxicity plus hoarseness, palatal paralysis, or stridor.

Diphtheria

How does transmission of Varicella-zoster occur?

Direct contact Droplet Air

Transmission of rabies is via:

Dogs Raccoons Skunks Bats Fox Coyote.

_________________ is a drug that accumulates intracellularly, and is the treatment of choice for the initial symptoms of Lyme disease.

Doxycycline

Depending on results of susceptibility testing, the following antibiotics can be used to treat cholera:

Doxycycline Azithromycin Furazolidone Trimethoprim/sulfamethoxazole (TMP/SMX), or Ciprofloxacin

A 57-year-old woman comes to the clinic because of persistent coughing productive of blood-tinged sputum. She has had night sweats and chills for the past week. She is a nurse working on the infectious disease unit of the hospital. Her temperature is 37.5°C (99.5°F), pulse is 82/min, respirations are 18/min, and blood pressure is 120/80 mm Hg. A blood sample is drawn for quantiferon testing. Chest x-ray shows right hilar lymphadenopathy. Which of the following is most likely present in the affected lymph nodes of the lung? A. Fibrinoid necrosis B. Liquefactive necrosis C. Gangrenous necrosis D. Coagulative necrosis E. Caseous necrosis

E (Caseous necrosis) (Caseous necrosis is a type of unprogrammed cell death resulting in a soft, white foci of dead tissue. It is characteristic in tuberculotic lymph nodes)

A month-old infant is brought to the office because of a 1-week history of jaundice and petechial rash. Pregnancy was uncomplicated except for a mild flu-like illness during the second trimester. Laboratory examination shows anemia. A CT scan of the head shows hydrocephalus and intracranial calcifications scattered throughout the cortex. The infant is at greatest risk for which of the following complications? A. Sensorineural deafness B. Keratoconjunctivitis C. Cataracts D. Frontal bossing E. Chorioretinitis

E (Chorioretinitis) (Congenital toxoplasmosis presents with the classic triad of chorioretinitis, hydrocephalus, and intracranial calcifications. While many infants are asymptomatic at birth, long-term sequelae may include mental retardation, learning disabilities, and vision loss)

A 6-year-old boy is brought to his pediatrician's office because of 2 weeks of coughing and progressive fatigue. The boy's medical history is notable for asthma diagnosed at 4 years of age. He is up-to-date on all vaccinations. He and his parents live in an old home along the Ohio river. His temperature is 38°C (100.4°F); pulse is 72/min; respirations are 20/min, and blood pressure is 95/63 mm Hg. Pulmonary examination is notable for a focus of decreased breath sounds over the right superior lung fields. A chest X-ray is obtained and demonstrates a cavitary lung lesion at the right lung apex with diffuse perihilar lymphadenopathy. Which of the following is the most likely diagnosis in this patient? A. Asbestosis B. Gram-positive bacterial pneumonia C. Small-cell lung carcinoma D. Acute asthma exacerbation E. Histoplasmosis

E (Histoplasmosis) (Histoplasmosis is a fungus endemic to the Ohio and Mississippi river valleys. Suspect histoplasmosis in patients with respiratory symptoms and a cavitary lung lesion)

A 14-year-old male presents to his pediatrician complaining of a sore throat. His mother reports that he developed a fever two days ago that was immediately followed by a sore throat. He denies cough or rhinorrhea. His past medical history is notable for poorly controlled asthma and he currently takes albuterol and budesonide. Of note, the child immigrated to America from Vietnam three months ago. His temperature is 101.6°F (38.7°C), blood pressure is 130/85 mmHg, pulse is 110/min, and respirations are 18/min. Physical examination reveals a malnourished adolescent who is small for his age. Grayish-white plaques are seen on the back of his throat. No hepatosplenomegaly is noted. Without appropriate treatment, this patient is at greatest risk for which of the following? A. Erythema infectiosum B. Splenic rupture C. Scalded skin syndrome D. Rheumatic fever E. Myocarditis

E (Myocarditis) (The patient in this vignette presents with fever and pseudomembranous pharyngitis suggestive of diphtheria. Diphtheria toxin inhibits beta-oxidation of fatty acids in the myocardium, leading to eventual myocarditis and cardiomyopathy.) (In this patient with a sore throat who is possibly unvaccinated due to recent immigration, the differential diagnosis should include mononucleosis, viral pharyngitis, bacterial pharyngitis, and oropharyngeal candidiasis. The presence of greyish-white pharyngeal pseudomembranous plaques on physical exam is consistent with diphtheria. Diphtheria is caused by infection with Corynebacterium diphtheria, a gram-positive bacillus. It is rarely seen in the USA due to the widespread adoption of the Tetanus-Diphtheria-Pertussis (Tdap) vaccine. Signs of cardiac involvement (e.g., arrhythmias, heart failure) may appear 7-14 days after the pharyngeal symptoms. Diphtheria produces an exotoxin that inhibits ribosome function via ADP ribosylation of elongation factor 2 (EF-2), a protein that is necessary for peptide elongation. This exotoxin acts systemically but shows preference for the myocardium)

A male newborn has microcephaly, jaundice, and hepatomegaly. He was born at term following an uncomplicated pregnancy and delivery. Three days later, physical examination shows chorioretinitis. A CT scan of the brain shows hydrocephalus and intracranial calcifications. Which of the following interventions during pregnancy would have most likely prevented this patient's condition? A. Acyclovir B. Induction of labor C. Varicella-zoster immune globulin D. Warfarin E. Pyrimethamine and sulfadiazine

E (Pyrimethamine and sulfadiazine) (Toxoplasmosis is a protozoal infection that can cause multiple congenital abnormalities in fetuses infected in utero, including the classic triad of chorioretinitis, hydrocephalus, and intracranial calcifications. In the United States, treatment for cases diagnosed prior to birth include pyrimethamine and sulfadiazine for known fetal infection)

A 25-year-old previously healthy man comes to the office because of a 2-day history of high-grade fever, coughing, and headaches. The patient is originally from North Carolina and works as a summer guard at the Stone Mountain State Park. Since his symptoms started, he started taking over-the-counter flu medications, to which he reports a poor relief of symptoms. Physical exam shows a confluent petechial rash around the wrists, ankles, that extends to some parts of the trunk. His temperature is 38.6°C (103.1°F), pulse is 81/min, respirations are 16/min, blood pressure is 110/70 mmHg, oximetry on room air shows an oxygen saturation of 96%. Which of the following is most likely causal organism responsible for this patient's current condition? A. Rickettsia typhi B. Coxsackievirus type A C. Ehrlichia chaffeensis D. Streptococcus pyogenes E. Rickettsia rickettsii

E (Rickettsia rickettsii) (Rocky Mountain spotted fever is a tick-borne disease that is caused by the bacteria Rickettsia rickettsii. The transmission is caused by the Dermacentor (i.e., dog tick) that is usually acquired because of outdoor exposure in mountainous areas around the East Coast) (The patient in the vignette is experiencing Rocky Mountain spotted fever, a tick-borne disease that is caused by the bacteria Rickettsia rickettsii. This organism is a Gram-negative bacteria, that is non-spore forming, and non-motile. The transmission is caused by the Dermacentor (i.e., dog tick) that is usually acquired because of outdoor exposure in mountainous areas around the East Coast i.e., North Carolina) (Patients often present with "influenza-like symptoms" such as headaches, fever, coughing, malaise, as well as, a petechial rash over the ankles, wrists, and trunk. If left untreated, patients may progress to develop myocarditis, acute renal failure, or death. For board exam purposes, the diagnosis is most classically established with a Weil-Felix test, which is a cross reaction of rickettsial antigens with OX strains of proteus vulgaris) (Nowadays, besides starting empirical antibiotic therapy, other helpful studies to establish the diagnosis can include a serological indirect fluorescent antibody (ITA) test. The first-line treatment is with doxycycline. Prevention should be encouraged in high-risk patients, with tick bite protection)

A 23-year-old prison inmate was brought in from the detention clinic with a 3-day history of crampy abdominal pain and diarrhea. Patient reports the stools were small volume and bloody. On examination his abdomen is tender, he has decreased skin turgor, and temperature was found to be 101.5°F (38.6°C). Stool microscopy reveals numerous RBCs and WBCs and a stool culture was ordered. What is the most likely diagnosis? A. Escherichia coli B. Proteus mirabilis C. Pseudomonas aeruginosa D. Salmonella enteritidis E. Shigella dysentariae

E (Shigella dysentariae)

A 20-year-old woman comes to the emergency department with a fever, headache, and watery diarrhea. The patient's stomach has been hurting since last night and she has noticed a small amount of blood in her most recent bowel movement. She went on a picnic with her boyfriend two days ago where they ate peanut butter sandwiches, chips, and had a couple of soft drinks. A stool sample is obtained and is positive for a lactose-negative, hydrogen sulfide-producing bacteria. Which of the following is the most likely infectious agent causing these symptoms? A. Escherichia coli B. Proteus mirabilis C. Pseudomonas aeruginosa D. Salmonella enteritidis E. Shigella dysentariae

E (Shigella dysentariae) (Salmonella typhimurium are lactose-negative bacteria on MacConkey agar that produce hydrogen sulfide in culture. Non-typhi salmonella manifests as watery or bloody diarrhea and can be acquired from almost any type of food, including peanut butter)

A 22-year-old female comes to the emergency department because of fever, headache and watery diarrhea for 12 hours. She says her stomach has been hurting since last night, and that she noticed a small amount of blood in her most recent bowel movement. She states she went on a picnic with her boyfriend 2 days ago. They ate sandwiches, chips, and consumed soft drinks. A stool sample is obtained and cultured using MacConkey agar. The colonies show non-lactose fermenting, non-hydrogen sulfide-producing bacteria. Which of the following organisms is the most likely to cause such clinical symptoms? A. Escherichia Coli B. Leptospira interrogans C. Listeria monocytogenes D. Salmonella enteritidis E. Shigella dysenteriae

E (Shigella dysenteriae) (Shigella dysenteriae is lactose-negative, oxidase-negative, Gram-negative rod that does not produce hydrogen sulfide gas. It propels itself between cells by actin polymerization. Symptoms include severe abdominal cramping, high fevers, vomiting, tenesmus, urgency, fecal incontinence, blood stained stools, loss of appetite and large volumes of watery diarrhea)

A 7-year-old boy is brought to the emergency department with fever, headache and generalized muscle pains, particularly in his calves, for the past 3 days. He also complains of mild abdominal pain and nausea. His mother cannot remember anything unusual in the past couple of weeks, but when probed she recalls removing an attached tick from his leg last week. On examination he appears toxic and there is a rosy, blanching maculopapular rash on both his upper and lower extremities bilaterally, including the palms and soles. His mother states that she first noticed the rash yesterday over his wrists and ankles, and it has spread. Based on the patient's symptoms, which of the following is the best approach to managing his condition? A. Obtain blood cultures and start regimen of ceftriaxone B. Order Borrelia titers and start on doxycycline C. Order rickettsial antibody titers; initiate analgesics and antipyretics while awaiting results D. Start regimen of chloramphenicol E. Start regimen of doxycycline

E (Start regimen of doxycycline) (Rocky Mountain spotted fever (RMSF) is a tick-borne febrile illness characterized by a blanching maculopapular rash beginning on the wrists/ankles, later spreading to the extremities and the trunk. Involvement of palms and soles is pathognomonic. RMSF is treated with doxycycline within 4 days of disease onset) (Rocky Mountain Spotted Fever (RMSF) is a tick-borne infectious disease caused by Rickettsia rickettsii that most frequently occurs in children ages 5-9 years of age, and the incubation period is between 2 and 14 days after the tick bite. Symptoms are nonspecific at onset and include fever, headache, and myalgia. Abdominal symptoms and mental confusion are also possible. The rash occurs about 2-3 days after symptom onset, and begins as a blanching maculopapular rash on the wrists/ankles, later spreading to the extremities and then the whole body.Involvement of palms & soles is pathognomonic. Since rickettsial infection causes a small vessel vasculitis, this rash can progress into apetechial/purpuric rash, but this classical appearance can be delayed up to 6days, therefore it is crucial to have a high degree of suspicion of RMSF in any person with a history of a tick bite regardless of presence of a petechial rash, so that treatment can be initiated. The treatment of choice in both children and adults is doxycycline, which is most effective when administered within 4 days of disease onset. Although using tetracyclines in children under 8 years old bears the risk of developing tooth discoloration, this side effect is dose dependent.In addition, RMSF can be a life-threatening illness, and the benefit of using tetracycline far outweighs the risk)

A 13-year-old boy is brought to the emergency department because of acute onset of a severe headache, along with fever and nausea for the past 24 hours. He does not have a significant past medical history and has not had any sick contacts. His parents say that they all went on a camping trip to the Adirondack Mountains a week ago, and that he started complaining that he was not feeling well 2 days after they returned. Physical examination of the patient shows a well developed boy in moderate distress and a petechial rash on the soles of his feet and palms of his hands. Based on the patient's presentation, which of the following is the most appropriate pharmaceutical treatment? A. Azithromycin B. Aztreonam C. Ciprofloxacin D. Penicillin E. Tetracycline

E (Tetracycline) (Rocky Mountain spotted fever (RMSF) is a Dermacentor tick-borne illness caused by Rickettsia rickettsii and characterized by headache, fever, and a petechial rash of the palms of the hands and soles of the feet. The treatment of choice is doxycycline (a tetracycline), a bacteriostatic protein synthesis inhibitor) (This patient in this question is suffering from Rocky Mountain Spotted Fever (RMSF). The causative agent is the obligate intracellular Gram-negative Rickettsia rickettsii, an organism endemic in the southeastern and south-central United States and uses the Dermacentor tick as its primary vector. People with RMSF usually present a week after a tick bite with the clinical triad of fever, headache, and rash, and RMSF should be high on the differential if they have a history of potential tick exposure, travel to endemic area or presentation in the spring or fall. The rash is described as a blanching erythematous rash of the arms and wrists including the palms and soles, with progression to generalized distribution and petechial characterization over time. Other symptoms include myalgias as well as central nervous system and gastrointestinal symptoms. It is also important to remember that rashes on the palms and soles are characteristic of only a few conditions: RMSF, secondary syphilis, coxsackievirus, and adverse drug reactions. Diagnosis depends on clinical presentation and epidemiological criteria, because lab findings are typically nonspecific. Once diagnosis is confirmed, the treatment of choice is tetracycline (specifically doxycycline), a bacteriostatic protein synthesis inhibitor. The only alternative is chloramphenicol, although it is less effective)

A 1-day-old neonate has jaundice and hepatomegaly. He was born at term following an uncomplicated delivery. His mother reports that pregnancy was uncomplicated despite sporadic prenatal care. Physical examination shows chorioretinitis. A CT scan of the brain shows hydrocephalus and intracranial calcifications. The most likely explanation for these findings is in utero infection with which of the following? A. Rubella virus B. Cytomegalovirus C. Herpes simplex virus D. Varicella-zoster virus E. Toxoplasma gondii

E (Toxoplasma gondii) (Congenital toxoplasmosis presents with a classic triad of chorioretinitis, hydrocephalus, and intracranial calcifications. Toxoplasmosis is a protozoal infection transmitted via the fecal-oral route and commonly contracted through the handling of cat litter)

A 36-year-old man comes to the emergency room complaining of a mass on the right side of his neck which has been growing over the past 3 months. He has also experienced a heavy cough for the same period of time. On examination, the mass is fluctuant, non-tender, and cold to touch. His temperature is 38.7°C (101.6°F), pulse is 83/min, respirations are 18/min, and blood pressure is 110/72mmHg. His past medical history includes HIV, for which he is on anti-viral treatment. Fine-needle aspiration of the cervical mass allows for staining, which shows acid-fast bacilli and granulomatous cells with caseous necrosis. Which of the following is the most likely cause of his cervical mass? A. Branchial cleft cyst B. Grave's disease C. Nasopharyngeal carcinoma D. Papillary thyroid cancer E. Tuberculous lymphadenitis

E (Tuberculous lymphadenitis) (Tuberculous lymphadenitis is the most common manifestation of extra-pulmonary tuberculosis (TB). TB reactivation typically occurs in those who are immunosuppressed, such as patients with diabetes, HIV, or on immunosuppressive therapy. The presence of acid-fast bacilli on staining confirms the presence of Mycobacterium tuberculosis, and warrants immediate treatment with combination therapy)

Toxoplasmosis triad

Encephalitis Chorioretinitis Intracranial calcifications *in AIDS patients with a CD4 < 100

Gastroenteritis (also known as Salmonella Typhimurium, _________________, and Newport): results from improperly handled food that has been contaminated by animal or human fecal material. It can also be acquired via the fecal-oral route, either from other humans or farm or pet animals.

Enteritidis

What is the most likely diagnosis for the following symptoms: Persistent perianal itching leads to insomnia and restlessness.

Enterobius vermicularis (Pinworm)

__________________ commonly presents as nocturnal perianal pruritus. Persistent perianal itching leads to insomnia and restlessness.

Enterobius vermicularis (Pinworm)

a 4-year-old is brought to the office by his mother because the daycare teachers noticed he is unusually restless at school. The mother also noticed that he has not been sleeping well lately and has started wetting the bed at night. The child is alert and cooperative but scratches his buttocks while you are interviewing. Cellophane tape applied to the perianal area reveals football-shaped ova under the microscope. What is the most likely diagnosis?

Enterobius vermicularis (Pinworm)

A _________________________ for a pt with toxoplasmosis would be positive for anti-toxoplasma IgG and IgM.

Enzyme-linked immunoassay (ELISA)

What CBC finding is associated with allergic disease but can occur in infections caused by tissue invasive multicellular parasites (hookworm)?

Eosinophilia

Atypical lymphocytes are classically seen in _______________.

Epstein-Barr virus

Chinese patients affected with________________ are at increased risk for nasopharyngeal carcinoma.

Epstein-Barr virus

The most common etiology of infectious mononucleosis is ___________________.

Epstein-Barr virus

There is an increased risk of (organ) splenic rupture in patients with ______________ infection.

Epstein-Barr virus

_________________ causing infectious mononucleosis primarily infects oropharynx, liver, and B cells.

Epstein-Barr virus

Sickle cell patients are at high-risk of developing aplastic crises with _____________________________

Erythema Infectiosum (Fifth Disease)

The side effects of ______________ are Optic neuritis and red-green blindness.

Ethambutol

_______________ is an anti-tuberculous drug that can sometimes cause optic neuropathy.

Ethambutol

________________nerve palsy is associated with Lyme disease.

Facial (cranial nerve VII)

What type of bacteria is Bordetella pertussis?

Fastidious gram-negative bacteria

Cryptococcosis is treated with Amphotericin B + Flucytosine for 2 weeks followed by _____________ for 10 weeks.

Fluconazole

Prophylaxis for cryptococcus if CD4 < 100 is with _________________.

Fluconazole

_________________ can be given to immunocompromised patients to prophylactically suppress cryptococcal meningitis.

Fluconazole

Cryptococcosis is treated with Amphotericin B + ________________ for 2 weeks followed by Fluconazole for 10 weeks.

Flucytosine

What type of cutaneous infection is Candidiasis?

Fungal infection

What type of cutaneous infection is Tinea capitiis/corporis (ringworm)?

Fungal infection

The serologic diagnosis of toxoplasmosis in immunocompromised patients is based on the presence of immunoglobulin (M/G) antibodies.

G

_________ and glycine are the major two inhibitory neurotransmitters, the release of which is blocked in tetanus.

GABA

Calcified lymph + lesions

Ghon complex

Hilar lymphadenopathy in addition to a peripheral granulomatous lesion due to Mycobacterium tuberculosis infection in the mid to lower lung segments is referred to as a ____________________.

Ghon complex

On CXR pts with TB will have cavitary lesions, infiltrates, and __________________ in the apex of lungs.

Ghon complex

Herpes Simplex -1 infection that involves the gingivae and the vermillion border of the lips

Gingivostomatitis

The side effect of Pyrazinamide is Hyperuricemia (_______________).

Gout

What are the screening tests can be used in the evaluation of sick child suspected of having an infectious disease?

Gram stain Cultures CBC Urinalysis Lumbar puncture

The influenza vaccination should be avoided in people who have developed _______________ within 6 wk of previous influenza vaccination.

Guillain-Barré syndrome

Post-exposure prophylaxis for rabies is the _______________ given on day 0, 3, 7 and 14 + rabies immune globulin 1/2 injected into the wound and 1/2 given IM.

HDCV (rabies vaccine) + Rabies immune globulin

______________ individuals may mount a reactive arthritis with shigella infection because of temporary disaccharidase deficiency.

HLA-B27

Staphylococcus, Streptococcus, and _______________ are the commonest species causing bacterial superinfection in patients with the flu.

Haemophilus

Rifampin, Isoniazid, Pyrazinamide, Ethambutol. All are __________________ so you need to get baseline labs

Hepatotoxic

What can occur after inoculation of the virus at any mucocutaneous site?

Herpes Simplex-1

Which herpes virus is common in children and classically causes gingivostomatitis?

Herpes Simplex-1

Which herpes virus may cause approximately 30% of genital herpes?

Herpes Simplex-1

Which herpes virus classically infects the genitalia as a sexually transmitted infection?

Herpes Simplex-2

Herpes Simplex-1 infection that is limited to the vermillion border of the mouth involving the skin and mucous membranes.

Herpes labialis

A 24-year-old male presents with a cough and mild shortness of breath for three days. The cough is occasionally productive of yellowish mucus. He reports a low-grade fever with this episode but says that he has otherwise been healthy. He has spent the last month working in bat caves in the Ohio and Mississippi River Valleys. He denies tobacco or alcohol use. Laboratory findings reveal worsening pancytopenia and liver function. A chest radiograph demonstrates diffuse, fine, nodular interstitial prominence and superior mediastinal widening. On admission, a computed tomography (CT) scan of the chest revealed diffuse miliary pulmonary infiltrates without mediastinal mass or lymphadenopathy. What is the most likely diagnosis?

Histoplasmosis

What condition: Highest risk is with a CD4 < 100. Patients develop fever and multiorgan failure; fulminant disease, septic shock, and death are common. Asymptomatic in most cases - flu-like symptoms. May cause pulmonary infections/pneumonia.

Histoplasmosis

___________________ (fungus) may mimic tuberculosis in presentation.

Histoplasmosis

___________________ is a dimorphic fungus endemic to the Mississippi and Ohio river valleys.

Histoplasmosis

___________________ is an opportunistic fungus that is known to cause systemic disease in HIV patients that involves low-grade fevers, cough, hepatosplenomegaly and tongue ulceration.

Histoplasmosis

______________ is/are the usual method of transmission of Clostridium botulinum spores.

Honey

____________________ is a consequence of toxoplasmosis, which presents as an accumulation of cerebrospinal fluid in the brain.

Hydrocephalus

_______________ (inability to swallow water) is a classic symptom of rabies. Pharyngeal spasms, aerophobia (fear of drafts of fresh air) and hyperactivity.

Hydrophobia

_____________________ neutralizes toxin of tetanus.

Hyperimmune human globulin

The side effect of Pyrazinamide is _________________(Gout).

Hyperuricemia

What is the treatment for Herpes-Simplex 1 in infants, persons with eczema, and persons with immunodeficiency that are at increased risk for severe and disseminated HSV disease?

IV acyclovir

The monospot test used for screening of infectious mononucleosis detects (IgG/IgM) antibodies that cross-react with horse or sheep red blood cells (heterophile antibodies).

IgM

What condition do you suspect with the following signs and symptoms: A single erythematous papulo-vesicle that progresses to one or many honey-colored, crusted lesions Appears on the face, around the nares and mouth, and on the extremities Fever is uncommon

Impetigo

_____________ is a dark stain is used to visualize Cryptococcus neoformans.

India ink

A 5-year-old girl presents with sudden onset of fever, chills, malaise, sore throat, headache, and coryza. The child is also complaining of myalgia, especially in her back and legs. On physical exam, the patient appears lethargic, has a temperature of 102.5 F, and palpable cervical lymph nodes. Breath sounds are distant with faint end-expiratory wheezes. What is the most likely diagnosis?

Influenza

___________________ is a viral respiratory infection caused by orthomyxovirus resulting in fever, coryza, cough, headache, and malaise

Influenza

If CXR negative for Latent TB treat with ______________________ for 9 months.

Isoniazid

Prophylaxis for household members of a pt with TB is ___________________ for 1 year.

Isoniazid

The recommended treatment for Histoplasmosis is _________________orally for weeks to months.

Itraconazole

The vector for Borrelia burgdorferi is ________________, also known as the deer tick.

Ixodes scapularis

In histoplastomosis there is increased Alkaline phosphatase and positive _________ blood cultures if disseminated.

LDH

______________ will be elevated in Pneumocystis jirovecii

LDH

__________________ is a specific diagnostic test used to detect the polysaccharide capsular antigen of Cryptococcus neoformans.

Latex agglutination test

What will you see in a CBC initially in bacterial AND Viral infections?

Leukocytosis

_______________ or bronchioalveolar lavage is used to diagnose Pneumocystis jiroveci pneumonia.

Lung biopsy

A 19-year-old previously healthy man comes to the office because of a recent onset fatigue, nasal congestion, and joint pain. The patient is originally from Massachusetts and currently works as summer camp counselor. Since his symptoms started, he started taking over-the-counter flu medications, to which he reports poor relief of symptoms. Physical exam shows a target-shaped rash in his chest. Upon further interrogation, the patient does not recall recent tick bites. His temperature is 38.3°C (102.6°F). What is the most likely diagnosis?

Lyme Disease

Initial symptoms of ________________ include erythema chronicum migrans and flu-like symptoms.

Lyme disease

Later symptoms of _______________ include migratory polyarthritis, AV nodal block, and neurological symptoms such as encephalopathy, facial nerve palsy, and/or polyneuropathy.

Lyme disease

_____________ (drug class) are the antibiotics of choice for Bordetella pertussis active infection and for post-exposure prophylaxis.

Macrolides

_________________ or penicillin is given to all patients to eradicate tetanus toxin-producing organisms.

Metronidazole

___________________ tuberculosis is a complication of advanced tuberculosis that is defined as millet-like seeding of tuberculosis bacilli in the lung and other internal organs, as seen on radiography.

Miliary

What is recommended treatment for impetigo?

Mupirocin Oral anti-staphylococcal antibiotics

Where does the Varicella-zoster virus replicate?

Nasopharynx Upper respiratory tract

_________________ are eosinophilic inclusion bodies in the cytoplasm of hippocampal nerve cells

Negri bodies

___________________ are considered pathognomonic for rabies and are found in the brain of dead animals.

Negri bodies

What is the treatment of Varicella-zoster?

Non-aspirin anti-pyretics Cool baths Careful hygiene *Routine administrations of Acyclovir is NOT recommended* for otherwise healthy children

The side effects of Ethambutol (EMB) are ________________ and red-green blindness.

Optic neuritis

What is the recommended treatment for extensive or disseminated lesions, bullous impetigo, lesions around the eyes?

Oral antibiotics

The neuraminidase inhibitors _________________, zanamivir (Relenza), and peramivir treat A + B strains of influenza.

Oseltamivir (Tamiflu)

____________ is used for rapid detection of the toxigenic strain of diptheria.

PCR

How are the vesicles of herpes characterized?

Painful lesions that begin as erythematous papules quickly progress to grouped (differentiates from varicella) 2-4 mm fluid filled vesicles on an erythematous base

Development of complications such as pneumonia, seizures, and encephalopathy can occur in the ___________ stage of pertussis.

Paroxysmal stage

The _______________stage of pertussis is characterized by fits of coughing and inspiratory "whoop", and posttussive vomiting.

Paroxysmal stage

Vigorous, prolonged coughing marks the onset of the ____________ stage of pertussis.

Paroxysmal stage

If allergic to Bactrim treat Pneumocystis jirovecii with ___________________.

Pentamidine

The neuraminidase inhibitors oseltamivir (Tamiflu), zanamivir (Relenza), and ____________ treat A + B strains of influenza.

Peramivir

A 3-year-old boy is brought to the office because he has been *coughing for the past 3 weeks.* His mother states that *cough seems to come in bouts lasting several minutes.* The coughing is sometimes severe enough to cause him to vomit. *About 6 weeks ago, she reports that he had a very mild cold that went away on its own, and that this new cough seemed to happen spontaneously.* He has a *fever* of 100.4. His *oropharynx is erythematous* but does not have any frank lesions or exudates. A chest X-ray is obtained and is also normal. What is the most likely diagnosis?

Pertussis

A pt presents with a *low fever* and a *minor upper respiratory infection* with a *nonspecific cough* that had an *insidious* onset. What do you suspect?

Pertussis

Diphtheria vaccine is usually combined at least with tetanus and ____________ vaccines.

Pertussis

The following describes the pathogenesis of what pathogen? Attachment to cilia of ciliated epithelial cells in respiratory tract Pertussis antigens allow evasion of host defenses (lymphocytosis but impaired chemotaxis) Local tissue damage in respiratory tract Systemic disease may be toxin mediated

Pertussis

What disease? Accounts for up to 7% of cough illnesses per year in adults Disease often milder in infants and children Adults often source of infection for children

Pertussis

What disease? Incubation period 5-10 days (up to 21 days) Insidious onset, similar to minor upper respiratory infection with nonspecific cough Fever usually minimal throughout course

Pertussis

Antigenic and biologically active components of Bordetella pertussis....

Pertussis toxin (PT) Filamentous hemagglutinin (FHA) Agglutinogens Adenylate cyclase Pertactin Tracheal cytotoxin

Which of the following findings on physical examination is typical of diphtheria? A. Pharyngeal pseudomembrane B. Sister Mary Joseph nodule C. Janeway lesions D. Forschheimer spots

Pharyngeal pseudomembrane

What is the initial test for respiratory infections?

Plain Radiograph

(Pathogen) ____________________ pneumonia presents as diffuse, bilateral ground-glass opacities on chest X-ray or CT.

Pneumocystis jiroveci

A 32-year-old man with a two-week history of fever and dry, nonproductive cough. For the past five days, he has been having shortness of breath. There is no history of pleuritic chest pain or rigors. Past medical history is significant for HIV. His temperature is 100.4°F (38°C), pulse is 92/min, O2 saturation is 92%, respirations are 18/min, and blood pressure is 120/70 mmHg. Purified protein derivative (PPD) is negative. CD4 cell count is 190. Chest exam reveals bibasal crackles. Chest radiograph shows interstitial infiltrates bilaterally. The patient's condition worsens on levofloxacin. What is the most likely diagnosis?

Pneumocystis jirovecii

TMP-SMX and dapsone can be used for (fungus) ____________________ prophylaxis.

Pneumocystis jirovecii

____________________ is the most common opportunistic infection in patients with HIV especially if CD4 count < 200.

Pneumocystis jirovecii

__________________is a ubiquitous yeast-like fungus (doesn't respond to antifungals) transmitted by aerosol route and causes NO disease in immunocompetent patients.

Pneumocystis jirovecii

What complications can occur due to pertussis?

Pneumonia Seizures Encephalopathy Hospitalization Death

Vertebral osteomyelitis associated with Mycobacterium tuberculosis bacteria is called ____________________.

Pott's disease

____________ and eggs are the vehicle of infection for salmonella.

Poultry

(Primary/Reactivated) Mycobacterium tuberculosis infection affects the middle to lower lung segments.

Primary

_______________ wounds are most susceptible to tetanus infection.

Puncture

The side effect of ________________ is Hyperuricemia (Gout).

Pyrazinamide

________________ is an anti-tuberculous drug that can cause hyperuricemia and thus increase the chance for gout in susceptible patients.

Pyrazinamide

_________________ is an agent that is co-administered with isoniazid to decrease the chance of a peripheral neuropathy or sideroblastic anemia developing.

Pyridoxine

The most effective regimen in immunocompetent patients against toxoplasmosis is _______________________.

Pyrimethamine + Sulfadiazine

A 46-year-old male who presents to the ED with dysphagia, hypersalivation, agitation, and generalized muscle twitching. The patient's wife says that she has been trying to get him to drink water but he can't seem to swallow. Past medical history revealed patient had right arm pain and paraesthesia one week prior which had failed to resolve. Further questioning revealed the patient had been bitten by a racoon about three months ago while hiking in the woods. He didn't seek medical attention. CT scan and lumbar puncture were unremarkable. Nuchal biopsy was carried out and samples of the patient's saliva and serum sent for DFA and PCR. What is the most likely diagnosis?

Rabies

Cytoplasmic inclusions known as Negri bodies are commonly found in Purkinje cells of cerebellum and in hippocampal neurons in ___________ infections.

Rabies

__________________ is a rapidly progressive CNS infection caused by a ribonucleic acid (RNA) rhabdovirus affecting mammals, including humans.

Rabies

What is herpes zoster?

Reactivation of varicella zoster virus

The primary viremia of the Varicella-zoster virus infects the:

Regional lymph nodes Liver Spleen

The rash characteristic of ______________ spreads from (pattern) wrists and ankles to trunk, palms, and soles.

Rickettsia rickettsii

______________ is the causative agent of Rocky Mountain spotted fever.

Rickettsia rickettsii

_________________ is preferred over rifampicin in the treatment of tuberculosis in AIDS patients.

Rifabutin

The anti-tuberculous drug _________________ can cause a benign red-orange discoloration of body fluids like tears and urine.

Rifampicin

The side effects of ________________ include orange body fluids and hepatitis.

Rifampin

Active TB treatment incluedes quad therapy (RIPE):

Rifampin, Isoniazid, Pyrazinamide, Ethambutol

A CT of the brain of a pt with toxoplasmosis shows ____________________.

Ring enhancing lesions

What is the classic CT finding in patients with Toxoplasmosis?

Ring enhancing lesions

_____________ infection presents with bloody diarrhea, abdominal pain, vomiting and headache. Poultry and eggs are the vehicle of infection.

Salmonella

What is the most common complication of varicella-zoster?

Secondary infection of skin lesions

What condition: Illness starts abruptly with diarrhea, lower abdominal cramps, and tenesmus accompanied by fever, chills, anorexia, headache, and malaise. Stools are loose and mixed with blood and mucus. The abdomen is tender and dehydration is common.

Shigellosis

_____________________ is an infection caused by the gram-negative bacteria and results in watery diarrhea or dysentery (the frequent and often painful passage of small amounts of stool that contains blood, pus, and mucus).

Shigellosis

______________________ is a common cause of bacterial diarrhea worldwide.

Shigellosis

________________ patients are at high-risk of developing aplastic crises with Erythema Infectiosum (Fifth Disease)

Sickle cell

______________ drugs treat symptoms (e.g. diazepam) of tetanus.

Spasmolytic

(Stage: 1/2/3) __________ Borrelia burgdorferi infection is characterized by a bull's eye rash.

Stage 1

(Stage: 1/2/3) Borrelia burgdorferi infection is characterized by bilateral bells palsy and heart block.

Stage 2

Atrioventricular block occurs in _____________(stage) two of Lyme disease.

Stage 2

(Stage: 1/2/3) ________ Borrelia burgdorferi infection can be characterized by peripheral polyneuropathy, encephalopathy, and/or migratory polyarthritis.

Stage 3

Non bullous or crusted impetigo is most often caused by:

Staph aureus

__________________ is a second-line anti-tuberculous drug that can cause ototoxicity and nephrotoxicity.

Streptomycin

_______________ is the antibiotic of choice for shigella, although ciprofloxacin or a fluoroquinolone may be substituted.

TMP-SMX

_________________________ refers to infection of a developing fetus or newborn by any of a group of infectious agents.

TORCH Syndrome

What is the booster vaccine for Bordetella pertussis given to patients older than 11 years of age?

Tdap

Bordetella pertussis is prevented by the _________vaccines.

Tdap or DTaP

_______________ is the toxin responsible for the characteristic spastic paralysis of tetanus.

Tetanospasmin

A 45-year-old homeless injection drug user with fever, painful muscle spasms in his arms and legs, and difficulty eating because of painful spasms in his jaw muscles. Examination of his feet reveals shoes with holes in the soles and a small, puncture-type wound on the bottom of the right foot. It is surrounded by erythema and somewhat tender to touch. What is the most likely diagnosis?

Tetanus

What condition: Pain and tingling at the site of inoculation is followed by spasticity of the muscles nearby. Jaw and neck stiffness, dysphagia, and irritability are common. Hyperreflexia and muscle spasms develop, especially in the jaw (trismus) and face.

Tetanus

What condition: Painful tonic convulsions, spasm of the glottis and respiratory muscles, and asphyxia develop if the patient is untreated.

Tetanus

Describe the treatment of tetanus

Tetanus immune globulin Tetanus toxoid Penicillin

This sticky test is used to diagnose pinworm:

The Scotch tape test

______________________are at particular risk for tetanus.

The elderly, migrant workers, newborns, and injection drug users

Treatment of pinworms is with albendazole or mebendazole. ________________ should be treated because pinworms are so contagious.

The entire family

What is the recommended treatment for tinia (ringworm)?

Topical antifungal therapy for 4-6 weeks and 2 weeks after resolution Oral therapy recommended for tinea capitis

The diagnosis of botulism is made by _____________.

Toxin assays

_____________________ is a parasitic protozoa that causes the disease toxoplasmosis.

Toxoplasma gondii

(Parasitic infection) _____________ can be contracted through cysts in meat, oocysts in cat feces, and by transplacental infection.

Toxoplasmosis

A 35-year-old male is brought to the emergency department by his male partner due to chronic headache and confusion. The patient is HIV positive, and his CD4+ count one month ago was 73 cells/μL. He has not been adherent to his antiretroviral and prophylactic therapy. An MRI of the head is shown here and demonstrates ring enhancing lesions and surrounding edema. Enzyme linked immunoassay (ELISA) is positive for anti-toxoplasma IgG antibodies. What is the most likely diagnosis?

Toxoplasmosis

A pregnant woman and cat litter should make you think of what diagnosis?

Toxoplasmosis

Congenital ______________ is part of ToRCH syndrome.

Toxoplasmosis

Congenital _____________________ is a central nervous system protozoal infection that presents with a classic triad of chorioretinitis, hydrocephalus and intracranial calcifications.

Toxoplasmosis

What condition: Triad of encephalitis + chorioretinitis + intracranial calcifications in AIDS patients with a CD4 < 100

Toxoplasmosis

___________________ is the reason we tell pregnant mothers not to change cat litter.

Toxoplasmosis

_____________________ is the most common central nervous system protozoal infection that presents with brain abscesses in patients with AIDS.

Toxoplasmosis

______________________ is a folate synthesis inhibiting antibiotic that is used as a treatment and prophylaxis for Pneumocytis jirovecii pneumonia.

Trimethoprim-sulfamethoxazole

A 24-year-old inner city social worker presents to the office with a 3-week history of fatigue, anorexia, a 10-lb weight loss, low-grade fever, and intermittent night sweats. He has a nonproductive cough that has recently become somewhat productive with bloody sputum. A chest X-ray and CT scan were performed, revealing cavities near the apex of his lungs. What is the most likely diagnosis?

Tuberculosis

A hilar lymphadenopathy with a peripheral granulomatous lesion in the middle or lower lung lobes which can calcify is diagnostic of primary ______________________.

Tuberculosis

Certain organisms that thrive in high oxygen concentrations, flourish in the lung apex, such as _________________.

Tuberculosis

Pulmonary __________________ is an infectious condition with symptoms including fever, night sweats, weight loss, cough (nonproductive or productive), and hemoptysis.

Tuberculosis

What condition: Classic findings include fever, night sweats, anorexia, and weight loss

Tuberculosis

_______________ is the most common cause of Addison disease in the developing world.

Tuberculosis

_________________ is the main cause of constrictive pericarditis in the developing world.

Tuberculosis

Enteric fever (also known as salmonella _____________ ): a flu-like bacterial infection characterized by fever, GI symptoms, and headache. Transmitted via the consumption of fecally contaminated food or water.

Typhioid

What condition: GI symptoms may be marked constipation or "pea soup diarrhea" Rose spots may be present (2-3 mm papule on trunk usually) More common in the developing world (usually immigration cases)

Typhoid

What is the treatment for Herpes Simplex-1?

Valacyclovir or famcyclovir

What disease? Incubation period 14-16 days (range 10-21 days) Mild prodrome for 1-2 days Generally appear first on head; most concentrated on trunk Successive crops (2-4 days) of pruritic vesicles Different stages of healing

Varicella Zoster

What virus: Prodrome of fever, malaise and anorexia Rash of small red papules that progress rapidly to non-umbilicated, oval, "teardrop" vesicles on an erythematous base Vesicular fluid progress from clear to cloudy, crust and heal. New crops appear for 3-4 days usually beginning on the trunk followed by the head, face and extremities Pruritus is universal and severe

Varicella-zoster virus

Leukocytosis gradually becomes mononuclear in which type of infection?

Viral infection

What type of cutaneous infection is Herpes simplex virus (HSV-1)?

Viral infection

What type of cutaneous infection is Molluscum Contagiosum?

Viral infection

Pt's on INH should take supplemental __________________ daily to prevent neuropathy.

Vitamin B6 (Pyridoxine)

The neuraminidase inhibitors oseltamivir (Tamiflu), _______________, and peramivir treat A + B strains of influenza.

Zanamivir (Relenza)

What is the recurrence of latent HZV and can be transmitted by direct contact?

Zoster

In patients with AIDS, Toxoplasma gondii can reactivate and form brain _________________ that are seen as ring-enhancing lesions on MRI.

abscesses

The tetanus toxoid vaccine confers (active/passive) immunity.

active

In mononucleosis a maculopapular rash develops in 80% of patients treated with ______________.

ampicillin

Clostridium tetani is an (aerobe/anaerobe) , and is thus difficult to culture.

anaerobe

A Enzyme-linked immunoassay (ELISA) for a pt with toxoplasmosis would be positive for ________________________

anti-toxoplasma IgG and IgM.

After potential exposure to the rabies virus, unvaccinated patients are vaccinated and given preformed ____________.

antibodies

On CXR pts with TB will have cavitary lesions, infiltrates, and Ghon complexes in the _____________ of lungs.

apex

Sickle cell patients are at high-risk of developing ___________ with Erythema Infectiosum (Fifth Disease)

aplastic crisis

Avoid FluMist in patients with ______________.

asthma

Electromyography shows characteristic _________ response to rapid repetitive stimulation in most cases of botulism.

augmented

The preferred antibiotic treatment for salmonella is ceftriaxone and sometimes a fluoroquinolone or ________________.

azithromycin

Blood cultures are sensitive and specific for:

bacteremia

Miliary tuberculosis refers to clinical disease resulting from ___________________ of Mycobacterium tuberculosis and is characterized by the presence of small, firm white nodules resembling millet seeds.

bacteremia

CXR in primary influenza pneumonia will show __________________.

bilateral diffuse infiltrates

Patients with cholera will be chronic ___________ tract carriers.

biliary

Toxoplasmosis can be spread by eating undercooked food that contains cysts, exposure to cat feces, and rarely through _____________________.

blood transfusions

Salmonella infection presents with (watery / bloody) diarrhea, abdominal pain, vomiting and headache.

bloody

Lung biopsy or __________________ is used to diagnose Pneumocystis jiroveci pneumonia.

bronchial alveolar lavage

Diptheria toxin is an exotoxin from Corynebacterium diphtheriae that causes pharyngitis with pseudomembranes in the throat and severe lymphadenopathy ("_____________").

bull neck

Toxoplasmosis can be spread by eating undercooked food that contains cysts, exposure to ________________, and rarely through blood transfusions.

cat feces

The preferred antibiotic treatment for salmonella is ______________ and sometimes a fluoroquinolone or azithromycin.

ceftriaxone

Administration of activated _____________ may be helpful in some cases of botulism.

charcoal

In the US, shigellosis predominantly affects ______________ and is often spread in areas with crowded conditions (like day care centers).

children

The cholera toxin produced by Vibrio cholerae overactivates cyclic AMP leading to high volume diarrhea with ___________ and water loss.

chloride

Vibrio cholerae causes a watery diarrhea that is rich in ______________________.

chloride

TMP-SMX is the antibiotic of choice for shigella, although __________________ or a fluoroquinolone may be substituted.

ciprofloxacin

Infectious mononucleosis is a viral infection associated with (warm / cold) autoimmune hemolytic anemia.

cold

Transmission of shigella is via direct person-to-person contact and ____________________________.

contaminated foods and water

Exogenous ____________________ can cause reactivation of tuberculosis and candidiasis (blocks IL-2 production).

corticosteroids

In suspected cases of salmonella _______________ should be obtained.

cultures of blood, stool, and urine

Toxoplasmosis can be spread by eating undercooked food that contains __________________, exposure to cat feces, and rarely through blood transfusions.

cysts

TMP-SMX and _____________ can be used for (fungus) Pneumocystis jirovecii prophylaxis.

dapsone

CSF for cryptococcus shows variable pleocytosis (predominantly lymphocytes), increased opening pressure, increased protein, and (increased / decreased) glucose.

decreased

Congenital toxoplasmosis is associated with the presence of (elevated/decreased) platelet count.

decreased

The rash of Rickettsia rickettsii is a(n) (immediate/delayed) manifestation of infection.

delayed

Spasmolytic drugs treat symptoms (e.g. _______________ ) of tetanus.

diazepam

Chest x-ray for Pneumocystis jirovecii characteristically shows ______________________.

diffuse, bilateral perihilar infiltrates

Drugs to stop diarrhea (such as __________________ or loperamide) may prolong the infection and should not be used for shigella.

diphenoxylate

Rapid _______________ testing for cholera is available for public health use in areas with limited access to laboratory testing

dipstick

Transmission of shigella is via ______________________ and contaminated foods and water.

direct person-to-person contact

HLA-B27 individuals may mount a reactive arthritis with shigella infection because of temporary _________________ deficiency.

disaccharidase

Histoplasma (does / does not) show person-to-person transmission.

does not

The herpesviruses, including the Epstein-Barr virus, are all (single/double) stranded DNA viruses.

double

The most common mode of transmission for V. colerae is undercooked shellfish and ______________________.

drinking contaminated water

The influenza vaccination should be avoided in people who have a severe ______________ allergy.

egg

Poultry and _____________ are the vehicle of infection for salmonella.

eggs

Start _______________________ in those likely to have TB...such as a symptomatic patient with TB exposure.

empiric treatment

Once intravascular volume is restored (rehydration phase) in pts with cholera, amounts for replacement of continuing losses should ________________ measured stool volume (maintenance phase).

equal

Histoplasmosis can cause ___________________, a skin disease presenting with painful inflammatory lesions on the anterior shins.

erythema nodosum

The treatment of diptheria is the diphtheria antitoxin + _____________ or penicillin x 2 weeks.

erythromycin

Diphtheria is an infection that is caused by an (exotoxin/endotoxin).

exotoxin

Rabies is generally considered to be _________________ once symptoms develop.

fatal

Mycobacterium tuberculosis is a mycobacterial species that thrives in high oxygen environments, flourishes in the apex of the lung, and presents with __________________________.

fever, night sweats, hemoptysis, and weight loss

Clostridium botulinum causes a (spastic/flaccid) paralysis.

flaccid

The treatment for cholera is ________________, mild cases can be treated with standard oral replacement formulas

fluid replacement

TMP-SMX is the antibiotic of choice for shigella, although ciprofloxacin or a ________________ may be substituted.

fluoroquinolone

The preferred antibiotic treatment for salmonella is ceftriaxone and sometimes a ______________or azithromycin.

fluoroquinolone

Pyrimethamine is typically administered in conjunction with sulfadiazine and ___________ acid as a treatment for toxoplasmosis.

folinic

The diagnosis of pinworms is done with the "scotch tape test' in the early morning. One can see ____________ under microscopy.

football-shaped ova

Pneumocystis pneumonia has "_______________" opacities on chest X-ray.

ground-glass

The side effects of Rifampin include orange body fluids and _____________________.

hepatitis

A new ____________________ (A to G) now replaces the older trivalent antitoxin for botulism.

heptavalent equine antitoxin

Epstein-Barr virus belongs to the _____________family of viruses.

herpesvirus

Varicella-zoster virus is a double stranded DNA virus that is a member of the _____________family.

herpesvirus

Epstein-Barr virus infection can cause ___________ to appear in the blood.

heterophile antibodies

Calcifications can be seen in the _____________ region on the chest x-ray of a patient with histoplasmosis.

hilar

The Ghon complex of tuberculosis is a combination of _______________________ and a Ghon focus on chest X-ray.

hilar lymphadenopathy

Botulism is associated with _________ and ____________ in infants

home-canned food products and honey

A CBC of a patient with with salmonella will show (increased / decreased) WBC and low platelets.

increased

CSF for cryptococcus shows variable pleocytosis (predominantly lymphocytes), (increased / decreased) opening pressure, increased protein, and decreased glucose.

increased

CSF for cryptococcus shows variable pleocytosis (predominantly lymphocytes), increased opening pressure, (increased / decreased) protein, and decreased glucose.

increased

Sigmoidoscopy of a pt with shigella will reveal __________________, punctate lesions, or ulcers.

inflamed engorged mucosa

Cryptococcus is transmitted through ____________ and causes illness in patients with cellular immune deficiency, such as HIV, cancer, or long-term corticosteroid therapy.

inhalation

Cryptococcus neoformans infection is acquired via _________________ , and it spreads to the meninges hematogenously.

inhalation

Amoxicillin (is / is not) effective against shigella.

is not

The rabies vaccine ( is / is not) 100% preventative against rabies.

is not

A side effect of __________________ is peripheral neuropathy.

isoniazid

The botulinum toxin is heat (labile/stable) and causes a flaccid paralysis.

labile

When is the peak seasonal infection for the Varicella-zoster virus?

late winter and spring

In shigella stool is positive for ___________________ and red blood cells.

leukocytes

The Epstein-Barr virus has a (linear/circular) DNA structure.

linear

Drugs to stop diarrhea (such as diphenoxylate or _____________________) may prolong the infection and should not be used for shigella.

loperamide

A CBC of a patient with with salmonella will show increased WBC and (high / low) platelets.

low

The Ghon focus of tuberculosis usually involves the middle or (upper/lower) lobe of the lung.

lower

CSF for cryptococcus shows variable pleocytosis (predominantly _______________ ), increased opening pressure, increased protein, and decreased glucose.

lymphocytes

Mycobacterium tuberculosis proliferates within (immune cell type) _______________________.

macrophages

Bed rest, sedation, and ___________________ often are necessary to control tetanic spasms.

mechanical ventilation

Cryptococcus neoformans infection is acquired via inhalation, and it spreads to the _________________ hematogenously.

meninges

Cryptococcus is a fungus that can cause _______________ or pneumonia.

meningoencephalitis

Infectious _________________ is a complication of Epstein-Barr virus infection that presents with fever, hepatosplenomegaly, pharyngitis and lymphadenopathy.

mononucleosis

___________ is a viral illness characterized by a classic triad of fever + lymphadenopathy + pharyngitis.

mononucleosis

A "________" (mononucleosis rapid slide agglutination test for heterophile antibodies) is used to diagnosis Epstein-Barr Virus

monospot

The ______________ for infectious mononucleosis usually turns positive within one week after infection.

monospot test

Toxoplasmosis in HIV patients usually presents with (single/multiple) ring-enhancing lesions on brain MRI.

multiple

Infectious mononucleosis is associated with __________________ especially in Asian adults.

nasopharyngeal carcinoma

Ultimate recovery from botulism depends on the regeneration of ____________________, which may take weeks or months.

nerve endings

Botulism is caused by a _____________________ elaborated by Clostridium botulinum.

neurotoxin

The rabies virus uses the _____________ receptor to enter target cells.

nicotinic acetylcholine

Borrelia burgdorferi is typically acquired in the (geographic region) United States.

northeast

Giving _______________ and high volume oral fluids is the most effective treatment for cholera.

oral rehydration salts

The side effects of Rifampin include _____________________ and hepatitis.

orange body fluids

Metronidazole or ________________ is given to all patients to eradicate tetanus toxin-producing organisms.

penicillin

Use of (drug class) _____________ for infectious mononucleosis can cause a characteristic maculopapular rash.

penicillin

A side effect of isoniazid is ______________________.

peripheral neuropathy

Cryptococcus neoformans is found in soil and __________________ droppings.

pigeon

CSF for cryptococcus shows variable _____________ (predominantly lymphocytes), increased opening pressure, increased protein, and decreased glucose.

pleocytosis

Cryptococcus is a fungus that can cause meningoencephalitis or __________________.

pneumonia

Histoplasmosis can cause ___________ (disease), like all other systemic mycoses.

pneumonia

Clostridium tetani is a gram (positive/negative) bacillus.

positive

Vibrio cholerae is an oxidase (positive/negative) , comma shaped organism that grows in alkaline media.

positive

A Ghon focus on chest X-ray is a feature of (primary/secondary) tuberculosis.

primary

Symptoms of diphtheria are either nonspecific skin infections or _________________ followed by myocardial and neural tissue damage secondary to the exotoxin.

pseudomembranous pharyngitis

Sigmoidoscopy of a pt with shigella will reveal inflamed engorged mucosa, __________________, or ulcers.

punctate lesions

HLA-B27 individuals may mount a _______________ with shigella infection because of temporary disaccharidase deficiency.

reactive arthritis

In shigella stool is positive for leukocytes and ____________________.

red blood cells

The side effects of Ethambutol (EMB) are Optic neuritis and ___________________.

red-green blindness

The greatest threat to life in botulism is _________________ and its complications.

respiratory impairment

The rabies virus travels to the central nervous system by migrating in a (anterograde/retrograde) fashion, via dynein motors, up to nerve axons.

retrograde

Rabies virus is a ______________ that causes formation of Negri bodies in the cerebellar Purkinje cells and hippocampal pyramidal cells.

rhabdovirus

Rabies is a rapidly progressive CNS infection caused by a ribonucleic acid __________________ affecting mammals, including humans.

ribonucleic acid rhabdovirus

The tetanus toxin makes muscles become _____________________.

rigid and contract involuntarily (spasm)

Epstein-Barr virus is transmitted by _______________, that is why infectious mononucleosis is also known as "kissing disease".

saliva

A fibrocaseous cavitary lesion on chest X-ray is seen in (primary/secondary) tuberculosis.

secondary

Caseating granulomas and Langhans giant cells are found in (primary/secondary) tuberculosis.

secondary

Diagnosis of cyrptococcus is made with CSF and serum __________________.

serology

A diagnosis of botulism is confirmed by demonstrating C. botulinum toxin in ________________ or by isolating the organism from the stool.

serum or stool

It is thought that _______________ may disrupt phagolysosomes and impair macrophages, increasing susceptibility to (infection) tuberculosis.

silicosis

Cryptococcal encephalitis, which may occur in AIDS patients, has a classic _______________ appearance on brain MRI.

soap bubble

A patient with infectious mononucleosis must avoid contact sports until resolution due to risk of _________________.

splenic rupture

In children, ingestion of (spores/toxins) in honey is the usual cause of botulism.

spores

Pneumocystis jirovecii is treated with trimethoprim-sulfamethoxazole and _________________.

steroids

Botulinum toxin prevents the release of (stimulatory/inhibitory) signals at the neuromuscular junction.

stimulatory

Diagnosis of cholera is confirmed by ___________________ plus subsequent serotyping.

stool culture

Once intravascular volume is restored (rehydration phase) in pts with cholera, amounts for replacement of continuing losses should equal measured _______________ (maintenance phase).

stool volume

Treatment of mononucleusis is ______________, and antibiotics are not helpful in treating this viral infection. Analgesics, increased fluid intake, and rest will help to relieve some of the symptoms. Warm salt water gargles can help with the sore throat. The symptoms of the infection may last for several weeks. A patient will not contract mononucleosis again after the initial exposure to the Epstein-Barr virus.

supportive

Tetanus results from a ___________ produced by the anaerobic bacteria Clostridium tetani.

toxin

In adults, ingestion of (spores/toxins) in canned goods is the usual cause of botulism.

toxins

A ___________ vaccine can prevent diphtheria.

toxoid

Pneumocystis jirovecii is treated with ___________________________ and steroids.

trimethoprim-sulfamethoxazole

Histoplasma is commonly transmitted by bird or bat (animal) droppings, and should always be borne in mind in spelunkers presenting with _________________-like symptoms.

tuberculosis

Reactivated Mycobacterium tuberculosis infection is classically due to use of (drug class) ______________________.

tumor necrosis factor alpha inhibitors

Patients with active TB will need ____________ negative AFB smears and cultures in a row negative for therapy cessation

two

Sigmoidoscopy of a pt with shigella will reveal inflamed engorged mucosa, punctate lesions, or _____________.

ulcers

The most common mode of transmission for V. colerae is ____________________ and drinking contaminated water.

undercooked shellfish

Definitive diagnosis of infectious mononucleosis is made by serologic testing for the Epstein-Barr virus ___________ antigen.

viral capsid

Patients with respiratory impairment due to botulism should be hospitalized and closely monitored with serial measurements of ____________________.

vital capacity

Vibrio cholerae causes a (watery/bloody) ______________ diarrhea that is rich in chloride.

watery

The rash associated with Rocky Mountain spotted fever typically starts at the _______________.

wrists and ankles