Infectious Disease
Which of the following TB drugs has major side effects such as optic neuritis and peripheral neuropathy? A. Isoniazid B. Rifampin C. Pyrazinamide D. Ethambutol
A. Isoniazid
A 33 year old pregnant female is at your office for her physical. She is inquiring about whether or not she can still get her annual flu shot, as she is a teacher and wants to make sure she is protected from the flu. Which of the following types of vaccines is contraindicated in this patient? A. LAIV4 B. CCIIV4 C. HD-IIV4 D. RIV4
A. LAIV4 this is the live vaccine
Which of the following organisms causes RMSF? A. Rickettsia rickettsii B. Strep pneumo C. N. meningiditis D. Boriella burgdorferi
A. Rickettsia rickettsii
A 52 year old female with a PMH of recently diagnosed mitral valve prolapse presents to your office with complaints of a fever and painful, purple nodules on the tips of her fingers. Her vitals are as follows: HR 76, BP 120/68, Temp 101.3. Pt appears to be fatigued but in no acute distress. PE is significant for a holosystolic murmur heard at the apex of the heart in the left lateral decubitus position. Pt has no allergies to medications. What is the gold standard diagnostic tool for this pt suspected diagnosis? A. TEE B. TTE C. CT D. MRA
A. TEE
A 45 year old male presents to your office with complaints of severe knee pain and swelling. PE shows erythema over the right knee as well as a fever. MRI with contrast confirms the suspected dx of osteomyelitis. Labs show the infectious agent is MRSA. How would you treat this patient? A. Vancomycin B. Cefazolin C. Penicillin D. Ceftriaxone
A. Vancomycin
A 26 year old day-care worker with a PMH of DM presents to your office with complaints of a really itchy rash that started on her chest and has now spreads down her arms and stomach. Her vitals are as follows: Temp 101.1, BP 116/72, HR 68. She says she can't even sleep due to how itchy her rash is. Pt denies any history of chickenpox as a child. When you visualize the rash it is a mostly vesicular rash with some crusting. What is the most likely diagnosis and how would you treat? A. Varicella - Acyclovir B. Herpes Zoster - supportive treatment C. Herpes Zoster - Gabapentin D. Mono - supportive treatment
A. Varicella - Acyclovir
A 65 year old male presents to your office with complaints of a really painful and itchy rash along his rib cage. When you visualize the rash, it is clusters of clear vesicles, but does not cross the midline. He also admits to recent headaches and sensitivity to light. How would you treat this patient? A. acyclovir B. analgesics and topical antipruritics C. doxycycline D. dexamethasone
A. acyclovir
Which of the following need to be monitored for hyperkalemia? A. bactrim B. clindamycin C. pentamidine D. primaquine
A. bactrim
A 26 year old female who recently returned from a mission trip to Africa presents to your office with complaints of dizziness, headache, and weakness. Her vitals are as follows: HR 78, BP 128/69, Temp 101.2. You suspect the patient may have malaria. How would you diagnose? A. blood smear B. artherocentesis C. Indirect fluorescent antibody D. lumbar puncture
A. blood smear
You are consulting a patient who is about to undergo RIPE treatment for TB. When discussing the possible adverse effects of Rifampin, what should you mention? A. body fluids could change to an orange-red color B. they should supplement with vitamin B6 C. they may develop a rash D. they may become color blind
A. body fluids could change to an orange-red color
All of the following are complications of Measles except? A. bronchitis B. otitis media C. pneumonia D. diarrhea
A. bronchitis
A 22 year old male presents to your office with complaints of abdominal pain and bloody diarrhea. Stool culture shows leukocytes and the presence of Shigella spp. How would you treat this patient? A. ciprofloxacin and IV fluids B. amoxicillin and IV fluids C. ceftriaxone and IV fluids D. doxycycline and IV fluids
A. ciprofloxacin and IV fluids
A 34 year old male patient presents with complaints of new onset headache and difficulty seeing peripherally. You send him out for a CT which shows edema and ring lesions. What is the confirmatory test for the suspected diagnosis? A. detection of organism in blood, body fluids, or histology B. CT or MRI C. artherocentesis D. antibody levels
A. detection of organism in blood, body fluids, or histology
A 24 year old male presents to your office 5 days following a camping trip with his friends. Pt states he has been having a really horrible headache and thinks he has a fever that started 2 days. He also noticed he has a rash that started yesterday on his wrist but he woke up today and now it is on his chest. Labs reveal elevated LFTs and hyponatremia. How would you treat this patient? A. doxycycline PO B. ceftriaxone IV C. amoxicillin PO D. bactrim PO
A. doxycycline
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
Which of the following is a potential complication of leaving Botulism untreated? A. respiratory compromise leading to death B. toxic megacolon C. sepsis leading to death D. infective endocarditis
A. respiratory compromise leading to death
A 21 year old body-builder presents to the ED with severe abdominal pain and abrupt onset of bloody diarrhea. Pt admits that he had 3 raw eggs in his protein shake this morning. How would you initially treat this patient? A. supportive IV fluids B. doxycycline C. ciprofloxacin D. ceftriaxone
A. supportive IV fluids most pt will not get abx unless immunocomp
A 72 year old male with a PMH of COPD presents to your office with complaints of abdominal pain and diarrhea. Pt says the diarrhea being yesterday after he spent the night in the hospital for community acquired pneumonia. Pt can't remember what medication he started taking, but thinks it ends in "floxacin." What is the initial treatment of choice in this patient? A. Fidaxomicin B. metronidazole C. vancomycin D. Fluconazole
A. Fidaxomicin
A 27 year old male with HIV presents to your office with complaints of SOB and a nonproductive cough. He also states he feels like he has been seeing black spots all of the time. CXR shows interstitial infiltrates. Antigen testing shows antigens for CMV. How would you treat this patient? A. gancyclovir IV B. doxycycline PO C. Bactim IV D. Azithromycin PO
A. Gancyclovir IV
A 3 year old boy presents with red sores around his mouth that are easily burst and leave a gold crust around his mouth. You determine that the sores appear to be vesicles. Mom denies any medication allergies for the pt. What is the bug that is most likely causing this infection? A. Group A strep B. S. aureus C. Neisseria Gonorrhoeae D. C. Diff
A. Group A strep was trying to get at non-bullous impetigo
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 and Rifampin C. Observation only D. Repeat PPD and chest x-ray in 3 months
B. Isoniazid and Rifampin
A 25 year old male with HIV from Louisiana presents with complaints of increasing fatigue, unintentional weight loss, headache, and abdominal pain. PE is significant for hepatosplenomegaly. His CD4 count is 145. Stool sample shows Histoplasma capsulatam. How would you treat this patient? A. ART with supportive care B. Itraconazole C. Gancyclvir D. Fluconazole
B. Itraconazole
A patient presents to your office with a known history of a tricuspid valve replacement. PE is significant for a fever as well as Janeway lesions on the bottom of their feet. TEE confirms the growth of vegetation on the tricuspid valve. Blood cultures are positive for coagulase negative Staph lugdunensis. Pt has no allergies to medications. How would you treat this patient? A. vancomycin for 2 weeks + Rifampin and Gentamicin for 6 weeks B. Nafcillin and Rifampin for 6 weeks + Gentamicin for 2 weeks C. Cefazolin x 6 weeks D. Vancomycin x 6 weeks
B. Nafcillin and Rifampin for 6 weeks + Gentamicin for 2 weeks
A 45 year old female presents to the ED with complaints of left knee swelling accompanied by a rash on the same joint. Pt admits to also having some pain in her knuckles and right knee. On PE you appreciate a maculopapular, necrotic rash along the left knee along with swelling. What is the most likely causative agent of the suspected diagnosis? A. S. aurues B. Neisseria Gonorrhoeae C. Streptococcus D. Mycobacterum
B. Neisseria Gonorrhoeae
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. Amantadine (Gocovri) B. Oseltamivir (Tamiflu) C. Rimantadine (Flumadine) D. Baloxavir (Xofluza)
B. Oseltamivir (tamiflu)
A 12 year old boy presents with complaints of a diarrhea and chills. These symptoms started yesterday. His vitals are as follows: Temp 100.5, BP 116/72, HR 74. Mom says that she has been a little delayed in making sure everyone has their flu vaccines this year. How would you treat this patient? A. Acyclovir B. Oseltavimivir C. Valacyclovir D. Ceftriaxone
B. Oseltavimivir
A 42 year old female with a known diagnosis of HIV presents for a routine check-up. When checking her CD4 count and viral load, you note her CD4 count is 145. Which of the following opportunistic infections should she be prophylactically treated for? A. Candidiasis B. PCP C. MAC D. Toxoplasmosis
B. PCP
A 16 year old girl with her mom and brother come to your office because the mom thinks that she and her son have the flu. A rapid antigen test confirms the suspected diagnosis. Mom says they have had these symptoms starting yesterday morning. The 16 year old daughter denies any symptoms. Which of the following cannot be given to prophylactically treat this patient? A. Zanamivir (Relenza) B. Paramivir (repivab) C. Baloxavir (Xofluza) D. Oseltamivir (tamiflu)
B. Paramivir (repivab) not used for prophylaxis
A 36 year old female with a dx of HIV presents with her brother who says he is worried because she has seemed increasingly disorientated and confused lately. He also feels like she hasn't been able to see as well lately. Pt is too disoriented to comply with the PE. MRI reveals brain edema and ring lesions, blood culture shows T. gondii. How would you treat this patient who has no sulfa allergies? A. Dapsone B. Pyrimethamine + Leucovorin + Sulfadiazine C. Pyrimethamine + Leucovorin + Atovaquone D. Atovaquone
B. Pyrimethamine + Leucovorin + Sulfadiazine
A 45 year old male with a known history of IV drug abuse presents to your office with complaints of fatigue, a fever, and petechiae. You perform a TEE and are able to visualize vegetation growing on the tricuspid valve. You perform a blood culture to identify the causative organism. What organism is most likely causing this patients symptoms? A. Streptococci viridans B. S. aureus C. enterococcus D. Kingella
B. S. aureus
How do you prophylactically treat tetanus? A. metronidazole B. Tdap C. Rabies vaccine D. BCG vaccine
B. Tdap
A patient presents with clustered skin vesicles on the left hypochondrial region. There is associated pain, itching and paresthesia. Which of the following drugs is recommended in treating this patient? A. Prednisolone B. Valacyclovir C. Laninamivir D. Lamivudine
B. Valacyclovir
A 55 year old female with HIV was recently diagnosed with TB. Pt was diagnosed 2.5 months ago and is currently in the continuation phase of her treatment. Based on her current phase of treatment and in addition to her current medications following the standard 6 month regimen, what else should this patient be taking? A. Ethambutol and Pyrazinamide B. Vitamin B6 C. calcium supplements D. folic acid
B. Vitamin B6
A 2 year old is brought to the ED by her mom who says that she has been having a lot of snot come out of her nose as well as a cough. Mom describes the cough as sounding like she can't breathe when it happens. On exam you note that the patient has excessive lacrimation from her eyes. What organism is most likely causing this infection? A. S. aureus B. Strep Pyogenes C. Bordatella Pertussis D. Corynebacterium Diptheriae
C. Bordatella Pertussis
Which of the following is NOT a RF for developing TB? A. alcoholics B. prison inmates C. HCV D. immigration
C. HCV
Mom brings her 4 year old son into the ED very worried because he has had a really horrible cough for the past 2 days and it appears to be getting worse. When you hear the cough, it has a bark-like quality to it. On exam you are able to appreciate coryza as well as a low grade fever. What family of viruses does this infection belong to? A. HPIV 3 B. HPIV 4 C. HPIV 1 D. HPIV 2
C. HPIV 1
A 50 year old female presents to the ED after her dog lost control and attacked her and the other dog in the family. Her vet told her to come to the ED due to the assumption that it could be rabies. She denies any previous vaccination. How would you treat? A. d/c and have her return once sx develop to administer treatment B. vaccine on days 0,7,21,28 C. HRIG and vaccine on days 0,3,7,14 D. no HRIG and vaccine on days 0 and 3
C. HRIG and vaccine on days 0,3,7,14
Concerning varicella, which of the following statements is incorrect? A. Classic rash appearance is the "dew drop on a rose petal" B. May be complicated by secondary bacterial skin superinfection C. Incubation period is 5-7 days D. Varicella-zoster vaccine is a live attenuated vaccine
C. Incubation period is 5-7 days it is 11-20 days
A 6 year old boy is brought to the ED with a fever of 104.6. Mom is extremely worried. On exam you are able to appreciate coryza and conjunctivitis. Mom says he has had a cough for the past few days but has seemed fine. What else may you see on exam? A. vesicular, pruritic rash B. parotitis C. Koplik spots D. rhinorrhea
C. Koplik spots
Which of the following is an example of an appropriate ART therapy? A. INSTI + PI with a booster B. NNRTI + PI with a booster C. NNRTI + INSTI D. 2 NRTI's + INSTI
D. 2 NRTI's + INSTI
Which of the following strains of Influenza are known to cause seasonal epidemics? A. Type A B. Type B C. Type C D. A and B
D. A and B
A 28 year old male with a known diagnosis of HIV presents to your office with complaints of worsening dyspnea and a nonproductive cough. His vitals are as follows: HR 122, BP 132/72, Temp 100.5, RR 24. PE is significant for rales diffuse across his lung fields. Labs show elevated LDH. CXR reveals diffuse, bilateral infiltrates that form a type of butterfly pattern. How would you treat this patient? A. atovaquone B. pentamidine C. clindamycin D. Bactrim PO/IV
D. Bactrim PO/IV
A 55 year old female with a PMH of IVDA and penicillin allergy presents to your office with complaints of shortness of breath and a fever (101.2). On exam you note the presence of Janeway lesions, clubbing of the fingers, and Roth spots on the eye exam. You send the pt out for a TEE which comes back positive for infective endocarditis. Lab results show the pathogen is MSSA. How would you treat this patient? A. Vancomycin x 6 weeks B. Nafcillin x 2 weeks C. Vancomycin and Rifampin x 6 weeks + Gentamicin for 2 weeks D. Cefazolin x 6 weeks
D. Cefazolin x 6 weeks
A 15 year old male who recently immigrated from the Dominican Republic presents to your office with a sore throat and fever x 2 days. On exam you are able to appreciate significant cervical lymphadenopathy and a grayish-white membrane in the oropharynx. You have no immunization records from the patient. What is the most likely pathogen causing this infection? A. S. aureus B. Strep Pyogenes C. Bordatella Pertussis D. Corynebacterium Diptheriae
D. Corynebacterium Diptheriae
A 32 year old female with HIV presents with complaints of abdominal cramping associated with watery diarrhea. Her CD4 count is 92. Stool tests reveal a protozoan parasite. What is the most likely diagnosis? A. CMV B. Histoplasmosis C. MAC D. Cryptosporidiosis
D. Cryptosproidiosis
All of the following are caused by Streptococcus Pyogenes except? A. impetigo B. Otitis media C. Rheumatic Fever D. Diptheria
D. Diptheria
A patient undergoing known TB treatment begins to complain of a having difficulty seeing and not really being able to see colors anymore. What drug is most likely causing these symptoms? A. Isoniazid B. Rifampin C. Pyrazinamide D. Ethambutol
D. Ethambutol
Which of the following is not a major side effect of ART therapy? A. lipodystrophy B. hyperlipidemia C. diabetes D. hypercholesterolemia
D. Hypercholesterolemia
A 30 year old female presents to your office with complaints of joint pain for the last 2 weeks. Pt states that the pain is mostly in her hips and knees. Pt admits to having a sore throat 2-3 weeks ago, but she didn't receive treatment. On PE, you do not appreciate any swelling of tenderness to the touch, however there are a few lumps along her knees and you are able to visualize a macule rash on her trunk. Labs are significant for leukocytosis and elevated ESR and CRP. Antistreptoysin O titer is positive. Assuming this patient has no allergies to medications, what is the first like treatment for this patient? A. Ceftriaxone B. clindamycin C. bactrim D. penicllin
D. Penicillin
A 24 year old male with a history of IV drug abuse presents to your office with complaints of weight loss and a productive cough. His HIV test is negative. You decide to perform a PPD. 48 hours later he returns to have it read and it is positive with a result of 12 mm. CXR reveals patchy infiltrates in the upper lobes. What treatment regimen should he expect to begin? A. 3 months of INH and Rifampin B. INH monotherapy x 6 months C. 3 months of rifampin monotherapy D. RIPE regimen x 6-9 months
D. RIPE regimen x 6-9 months
A 45 year old male who hunts in his free time presents to the ED with fever, agitation, hyper-salivation, and muscle twitching. His wife states she has been trying to get him to drink water but he is unable to swallow. His wife states that one week ago he had general weakness and a headache after he had gone hunting, but he didn't receive treatment. What is the most likely diagnosis? A. Botulism B. Tetanus C. Lyme Disease D. Rabies
D. Rabies
A 6 year old girl presents to your office with mom who states that she was complaining of a sore throat a few days ago, but now she has some form of rash. PE shows small papular elevations along her neck. You go to perform a throat exam and notice that her tongue has many small red spots all over it. What bug most likely is causing her condition? A. S. aureus B. Neisseria Gonorrhoeae C. Clostridium Dificile D. Streptococcus Pyogenes
D. Streptococcus Pyogenes
A 64 year old female presents to the ED with complaints of significant knee pain. On exam you are able to appreciate significant swelling as well as a fever. How would you diagnose this patient to determine the course of treatment? A. CT with contrast B. X-ray C. MRI D. arthrocentesis
D. arthrocentesis
What is the most common complication seen in kids with Varicella? A. pneumonia B. post-herpetic neuralgia C. otitis media D. bacterial skin infection
D. bacterial skin infection
At what phase of the Varicella rash is the infection determined to be no longer contagious? A. macule B. papule C. vesicles D. crusting
D. crusting
Which of the following is not a way of getting tetanus? A. burns B. crush injuries C. dirt D. fermented foods
D. fermented foods
All 4 of the main TB drugs can cause cause? A. renal failure B. neuropathy C. hemolytic anemia D. hepatotoxicity
D. hepatotoxicity
All of the following are adverse effects of amphotericin B except? A. nephrotoxicity B hypokalemia C. fever/chils D. hypermagnesemia
D. hypermagnesemia
HPIV-3 is associated with all of the following infections except? A bronchiolitis B. bronchitis C. pneumonia D. sinusitis
D. sinusitis
True or False: viral load is mostly useful prior to starting ART therapy as it establishes threshold for initiation.
False CD4 count does this viral load is most important to monitor effectiveness of therapy after initiation of ART
A 33 year old female with HIV presents with complaints of loss of peripheral vision and diarrhea. Pt admits to having recent sexual interactions with someone. PCR is positive for CMV. What would you expect her CD4 count to be? A. > 200 B. < 150 C. < 50 D. > 100
C. < 50
A patient with a known diagnosis of HIV presents for a routine check-up. Her CD4 count is 46. She had already been prophylactically taking Bactrim for PCP and Toxoplasmosis, what should be added? A. Flucystosine B. Dapsone C. Azithromycin D. Ethambutol
C. Azithromycin
Which of the following is used to diagnose Rocky Mountain Spotted Fever? A. CT with contrast B. artherocentesis C. Indirect fluorescent antibody D. lumbar puncture
C. indirect fluorescent antibody
Which of the following is not a risk factor for developing a C. Diff infection? A. > 65 B. recent abx use C. not being vaccinated D. H2 blocker usage
C. not being vaccinated
Which of the following tests can often detect the presence of HIV the fastest but is expensive and not routinely used? A. antibody test B. combination test C. nucleic acid test
C. nucleic acid test
Which of the following is not a complication of Shigella? A. hemolytic-uremic syndrome B. arthritis C. respiratory failure D. seizures
C. respiratory failure
How long can it take for the body to make detectable antibodies for the antibody HIV test? A. 3-12 weeks B. 2-6 weeks C. 7-28 days D. 1-5 weeks
A. 3-12 weeks
A 48 year old female with HIV presents to your office with complaints of night sweats and diarrhea. Her CD4 count is 38, viral load is 122,000. You perform a blood culture and it shows mycobacterium avium. How would you treat this patient? A. Azithromycin and Ethambutol B. Rifabutin C. Levofloxacin D. Liposomal Amphotericin B
A. Azithromycin and Ethambutol or clarithyomycin and ethambutol
Which of the following is an adverse effect of Pyrimethamine? A. BM Suppression B. sulfa hypersensitivity reaction C. hyperkalemia D. diarrhea
A. BM suppression
How long can it take for the body to make detectable antigen/antibody levels to be measured by the combination HIV test? A. 3-12 weeks B. 2-6 weeks C. 7-28 days D. 1-5 weeks
B. 2-6 weeks
The Herpes Zoster vaccine is recommended for what age group? A. 9-14 year olds B. > 50 C. < 50 D. 27-46
B. > 50
A patient with a known diagnosis of HIV presents to your office for a routine check-up. Her CD4 count is currently at 88. What should she be prophylactically taking? A. Leucovorin B. Bactrim C. Pyrimethamine D. Fluconazole
B. Bactrim
What should you monitor in a patient taking gancyclovir? A. LFTs B. CBC C. CMP D. renal fx
B. CBC
A 68 year old male presents to your office with complaints of left knee pain and a fever. CT with contrast shows what appears to be a septic joint. Artherocentesis reveals the organism to be a gram negative organism. How would you treat this patient? A. ceftriaxone B. Cefepime C. Vancomycin D. Nafcillin
B. Cefepime
A 9 month old baby is brought to the ED by her mom who states that she has been acting really fussy for the past few days and has not been eating well. Then, she went to wake her baby up this morning and she now seems to have no ability to hold her weight up. Mom says she also has been crawling all over the place and can't do it at all anymore. Mom denies any significant PMH in her or the baby. Upon further investigation, you discover that they introduced honey into her diet 3 days ago. What organism is most likely causing these symptoms? A. Bordatella Pertussis B. Clostridium Botulinium C. Clostridium Tetani D. Corynebacterium Diptheriae
B. Clostridium Botulinium
All of the following are prophylactically treated for in an HIV patient except? A. MAC B. Cryptococcal meningitis C. PCP D. Toxoplasmosis
B. Cryptococcal Meningitis
A 45 year old female with a known diagnosis of HIV presents to your office with complaints of painless white plaques in her mouth. You are able to visualize white plaque-like lesions on the soft palate that are able to be scraped off. How would you treat this patient? A. Bactrim B. Fluconazole C. Pentamidine D. Amphotericin B
B. Fluconazole
A 6 year old boy presents to the office's annual flu shot clinic. His PMH is significant for a tonsillectomy, egg allergy, and seasonal asthma. He has a PRN Albuterol inhaler, but that is the only current medications that he is on. Which of the following vaccines is contraindicated in this patient? A. RIV4 B. IIV4 C. LAIV4 D. CCIIV4
B. IIV4
A 5 year old boy presents to your office with mom who says that she was bathing him the other day and noticed a rash on his back. She did not think much of it until he started saying he felt really itchy. He has also had a fever for the last 24 hours. When you visualize the rash you see a vesicular rash along his back and arms. The boy has no additional health issues and the fever is quite mild. How would you treat this patient? A. acyclovir B. analgesics and topical antipruritics C. doxycycline D. dexamethasone
B. analgesics and topical antipruritics
All of the following are AE of Pentamidine except? A. infusion related sx B. anemia C. pancreatitis D. elevated LFTs
B. anemia
How would you prophylactically treat a patient who is traveling to a region of high malaria spread? A. chloroquine B. Atovaquone-Progranil C. rifampin D. penicillin
B. atovaquone-progranil
A 35 year old woman who recently immigrated from India presents to your office to receive a PPD for work. She says she was required to get one because she was from India. You perform the PPD and she returns 48 hours later with a 11 mm positive result. You send her for a CXR which is clear. What is the next best step? A. false positive - retest her in 3 months B. begin treatment for latent TB C. initiate RIPE therapy D. send her for a repeat CXR
B. begin treatment for latent TB
You are treating a patient with a penicillin allergy for Pharyngitis. Which of the following is another medication that you can give? A. doxycycline B. clindamycin + Bactrim C. nafcillin D. gentamicin
B. clindamycin + bactrim
A 25 year old male pt presents to your office with complaints of fever and unintentional weight loss. Pt admits to also having night sweats. You suspect the patient may have HIV as he admits that he has had unprotected sex a lot within the past month. Pt states he feels like he hasn't been feeling like himself for 3 weeks. You run labs and detect the presence of HIV antibody using the antibody test. CD4 count is 562, viral load is mild. What is your next step? A. monitor the pt for when his CD4 drops below 500 to start treating B. initiate ART therapy C. prophylactically treat the patient for PCP and MAC D. retest the patient for HIV as you think it could be a false positive
B. initiate ART therapy
A 23 year old female who is in vet school presents for her physical and vaccinations required for school. Other than the routine exam and vaccines to administer, what else would you recommend? A. nothing, she is not considered high risk B. rabies vaccine on days 0,7,21,28 C. rabies HRIG and vaccine on days 0,3,7,14 D. no HRIG and vaccine on days 0 and 3
B. rabies vaccine on days 0,7,21,28
A 10 year old boy presents to your office with complaints of a sore throat and a fever. PE is significant for swollen cervical LN. Pt denies cough. How would you diagnose this patient? A. clinically B. throat culture C. nasal swab D. CD4 count
B. throat culture
If it turns out that a patient with bacterial meningitis was infected by Listeria, what drug regimen would be indicated for someone > 50? A. Vancomycin and ceftriaxone B. vancomycin + ampicillin + cefotaxime C. ampicillin and vancomycin D. vancomycin and meropenem
B. vancomycin + ampicillin + cefotaxime
A 18 year old male presents to the ED with his roommates who say that he has just seemed off for the past 2 days. Pt admits to a severe headache and stiff neck. Vital signs are as follows: HR 88, BP 128/74, Temp 102.2. On exam the pt appears to be confused and sensitive to light. Labs reveal elevated WBC. You decide to perform an LP because the blood culture is inconclusive and the patient appears to be deteriorating. Results show elevated protein, low glucose. How would you treat this patient? A. ampicillin and ceftriaxone B. vancomycin and ceftriaxone C. vancomycin and cefepime D. penicillin
B. vancomycin and ceftriaxone
A 38 year old male with HIV presents to the ED with his sister. His sister says that he had been complaining of a headache and a stiff neck for the past week but just today he started acting really confused and disoriented. Labs reveal a CD4 count of 32 and a cryptococcal antigen titer of 3:67. How would you treat this patient? A. Fluconazole x 3 weeks B. Azithromycin and Ethambutol x 6 weeks C. Liposomal amphotericin B + Flucystosine x 2 weeks D. Doxycycline x 1 mo
C. Liposomal amphotericin B + Flucystosine this is the induction therapy --> consolidation therapy: fluconazole at least 8 weeks --> maintenance therapy is long term po fluconazole
A 48 year old female presents to the ED with complaints of a severe headache, vomiting, and a really abnormal rash. The rash looks like pink pin pricks. Labs show elevated WBC, LP shows elevated protein and low glucose. What organism is most likely causing this infection? A. HSV B. Strep pneumo C. N. meningiditis D. Boriella burgdorferi
C. N. meningiditis
How would you treat an HIV patient who has moderate/severe PCP with a known sulfa allergy? A. Bactrim IV B. Atovaquone C. Pentamidine IV D. Dapsone PO
C. Pentamidine IV
A 45 year old male presents to the ED with symptoms of jaw pain and difficulty swallowing. He says his jaw will randomly just lock up. Pt admits that he is a construction worker and he stabbed himself with a rusty nail the other day. Which of the following is correct regarding the most likely diagnosis and the corresponding organism? A. Pertussis - Bordatella Pertussis B. Tetanus - Clostridium Botulinium C. Tetanus - Clostridium Tetani D. Botulism - Corynebacterium Diptheriae
C. Tetanus - Clostridium Tetani
A 75 year old woman with a PMH of a spinal fusion presents to your office with complaints of spinal pain. On exam you are able to appreciate swelling and erythema over the lumbar vertebrae. Her vitals are as follows: BP 128/70, Temp 100.6, HR 87. You run labs and are able to appreciate leukocytosis. It is determined that the infecting organism is coagulase negative staph epidermis. How would you treat this patient? A. Vancomycin B. Ceftriaxone C. Vancomycin + Gentamycin + Rifampin D. Nafcillin + Gentamycin
C. Vancomycin + Gentamycin + Rifampin
A 32 year old pregnant female presents to your office with complaints of a fever, headache, and localized rash on her calf. Pt says it started out as what looked like a red pimple but now looks like a bullseye. Pt states she has a dog and plays with him in the woods all the time. What is the preferred treatment for this patient? A. doxycycline PO B. ceftriaxone IV C. amoxicillin PO D. bactrim PO
C. amoxicillin PO amoxicillin in pregnancy
A 52 year old homeless man presents to the ED with complaints of coughing up blood. His vitals are as follows: HR 88, BP 135/82, Temp 101.3. PE is significant for rales in upper lung lobes bilaterally along with dullness to percussion. Labs reveal the pt is anemic with low albumin levels. Upon further investigation, you discover that he spent some time in a homeless shelter about 1 month ago. Which of the following chest x-ray findings would be consistent with your suspected diagnosis? A. hyperinflation and flat diaphragms B. interstitial fibrosis and pleural thickening C. cavitary lesions in the upper lobes D. "eggshell" calcifications of hilar LN
C. cavitary lesions in the upper lobes
You are checking in on your patient with active TB and undergoing the intensive phase of RIPE therapy. You want to ensure that they have been actually adhering to their medications. What is one way you could test this? A. CD4 count B. LFT's C. check their urine D. check their CBC
C. check their urine to see if it has turned an orange-red color
Which of the following needs to be completed prior to starting an HIV patient on Rifabutin? A. MRI B. CT C. chest x-ray D. weight loss
C. chest x-ray
A 28 year old male presents to your office after traveling to Nigeria with complaints of a cyclical fever and overall weakness. Blood smears reveal the presence of Plasmodium malariae. How would you treat this patient? A. atovaquone B. doxycycline C. chloroquine D. ceftriaxone
C. chloroquine
A 34 year old female presents to the ED with complaints of profuse watery diarrhea. Pt denies any blood in her diarrhea. Pt states she had shrimp for dinner last night and thought it tasted a little funky. Stool sample reveals the presence of vibrio cholerae. How would you treat this patient? A. ciprofloxacin B. ceftriaxone C. doxycyline D. ampicillin
C. doxycyline or azithro or tetracyclinen
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 E. TB blood test (IGRA)
E. TB blood test (IGRA)