Infectious Dz

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 antibodies with immunofluorescence

Culture Culture cannot be used to diagnose Pneumocystis jiroveci Pneumonia as the organism cannot be grown in vitro.

A 28-year-old man comes to the urgent care clinic because of a rash that has been present for five days. The rash started on his wrists and ankles, then spread to the palms and soles, and finally to his arms, legs and trunk. He also has headache, and general muscle soreness. Two weeks ago he went camping with friends. After returning from his trip, he states he removed one brown tick from his neck 10 days ago. He does not know how long the tick was attached. Temperature is 39°C (102.2°F), pulse rate is 60/min, blood pressure is 116/78 mmHg. Examination of the skin shows a diffuse maculopapular rash on the chest, arms, hands, legs and feet. The face is spared. Which of the following is the most likely diagnosis? A. Babesiosis B. Ehrlichiosis C. Lyme disease D. Rocky mountain spotted fever E. Tularemia

D. RMSF rash started on wrist then spread centrally. positive for tick bite

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 nebulization is not indicated in the management of diphtheria

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. chose this answer b/c histo is very systemic so if there are pulmonary symptoms, there might not even be any sputum to culture

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 Clostridium botuli-NOTNEGATIVE-linum so its positive

Question 1 Chlamydia trachomatis can cause all of the following except: A Trachoma B Lymphogranuloma venereum C Cervicitis D Gastritis

D. gastritis G L G V (genital lympho granuloma vereneum is caused by serovars of chlamydia trachomatis) trachoma = granular conjunctivitis. part of chlamydia triad of CCChlamydiarthritis C for conjunctivitis C for cervicitis

All of the following are AIDS defining illnesses except A Extrapulmonary cryptococcosis B Kaposi's sarcoma C Toxoplasmosis of brain D. Oral hairy leukoplakia

D. oral hairy leukoplakia

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 an enlargement of the cervical nodes, resulting in a bull neck. what is your diagnosis and how would you treat it?

Diphtheria b/c of his grayish-white membrane which is classic for diphtheria treatment: horse anti-toxin, penicillin or erythromycin. removal of membrane may also be necessary Dip-penicillinpositivehorse-thERIa ERI for erythromycin

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

Doxycycline

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

Generalized tetanus

The gold standard diagnostic test for the diagnosis of malaria is A Giemsa-stained thick or thin blood film B Rapid malaria tests C Serologic test D Blood culture

Giemsa-stained thick or thin blood film

A 45-year-old African American man, who is HIV positive, comes to your clinic with skin lesions that have been increasing in size over the last month. Physical examination shows multiple erythematous to violaceous papules on the face and anterior chest. There is no evidence of bleeding or infection, and the lesions are non-tender and non-pruritic. Which of the following is the most likely diagnosis? A. Kaposi sarcoma B. Basal cell carcinoma C. Lichen planus D. Melanoma E. Molluscum contagiosum

HIV positive patient w/ violaceous papules on the face and chest. violaceous papules in HIV is kaposi sacroma cause by human herpes virus 8

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 Mucormycosi

Histoplasmosis

27-year-old woman comes to the office because of perianal itching and irritation for the past two weeks. She has tried application of over-the-counter hemorrhoid creams without relief. She is sexually active, and takes oral contraceptive pills. Physical examination of the perianal area shows multiple soft, moist cauliflowerlike lesions. Which of the following is the most likely causative organism of this A. Haemophilus ducreyi B. Herpes simplex virus C. Human papilloma virus D. Klebsiella granulomatis E. Molluscum contagiosum virus

I think cauliflower lesions are buzzwords for HPV. C. Human papilloma virus Human papillomavirus (HPV) [>100 types] produces epithelial tumors of the skin and mucous membranes. Condylomata acuminata (genital warts) are generally recognized as benign proliferations of the anogenital skin and mucosa resulting from HPV infection. Despite the generally benign nature of these proliferations, certain types of HPV can place patients at a high risk for anogenital cancer. Genital warts are transmitted by sexual contact. Approximately two thirds of individuals who have sexual contact with an infected partner develop genital warts. HPV types 16 and 18 have emerged as the high-risk types of HPV because they are responsible for most high-grade intraepithelial lesions that may progress to carcinomas, particularly those in the anogenital or mucosal category.

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

Minor wounds

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

Patients with CD4 counts <350 cells/mcL. this is a poorly made question b/c CD4 count of 200 is the starting point for PJP prophylaxis in HIV but the way the question is asked, 200 is less than 350.

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

Pyrimethamine plus sulfadiazine

Which of the following is associated with acute rheumatic fever A Manning criteria B Revised Jones criteria C Ranson criteria D Duke criteria

Revised Jones criteria JONES PEACE j = joints = arthritis (swollen) heart for O = carditis N = nodules (subq) E = erythema marginatum (painless rash) S = Sydenham chorea P = previous RH E = ECG PR prolongation A = arthralgias C = CRP/ESR elevated E = elevated temperature (fever)

a 30-year-old woman presents with 2 weeks of arthralgias, migrating from distal to proximal joints. It began with increased warmth and erythema in her right ankle and left knee. She has a low-grade fever and reports a history of sore throat and swollen glands about 1 month ago. On physical exam she has red skin lesions on the trunk and proximal extremities, and also small, non-tender lumps located over the joints. Antistreptolysin O titer is positive. what is your diagnosis?

Rheuma-mitral-matic Fever

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

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.

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

Shigella 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. basically inflammatory diarrhea will cause positive fecal leukocytes inflammatory diarrhea has the CCEYSS c - campylobacter c - c diff e - e coli 0157 Y - Yersinia (yersen appendiciten) S - salmonella S - shigella

A 9-year old girl is brought to the clinic by her mother on account of fever. She has red skin lesions on the trunk and proximal extremities, and also small, non-tender lumps located over the joints. On further enquiry, she reports a history of sore throat which occurred about 4 weeks ago. Which of the following would you do to support the diagnosis of acute rheumatic fever? Erythrocyte sedimentation rate (ESR) Antinuclear antibodies White blood cell count Anti-streptolysin O titer

The patient described meets 2 major criteria (Subcutaneous nodules and Erythema marginatum) for the diagnosis of rheumatic fever according to revised Jones criteria. An evidence of a preceding Group A beta hemolytic streptococcus infection is additionally required to make the diagnosis. Elevated ASO titer is an evidence.

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.

The patient is suffering from a vibreo cholera infection hinted by the buzz word of rice water stool. Since he is severely dehydrated and he is 6, the most appropriate treatment would be IV hydration

A 70-year-old male is admitted to the ICU with fever, leukocytosis and purulent sputum. Sputum culture shows methicillin-resistant gram-positive cocci in clusters. Which of the following medications should be ordered for this patient? A Vancomycin (Vancocin) B Clindamycin (Cleocin) C Azithromycin (Zithromax) D Aztreonam (Azactam

Vancomycin (Vancocin) drug of choice of MRSA = VANC

A 26-year-old male presents to your clinic with 2 weeks of joint pain. He reports symptoms consistent with a migratory arthritis, but for the past three days he says that the pain and swelling is worse in his left knee. On further questioning he reveals that three weeks ago he had burning upon urination with some milky discharge from his penis, but the symptoms have since resolved. On physical exam the left knee is erythematous, swollen, tender to palpation, and has decreased range of motion. Genitourinary exam is unremarkable. What is the most likely causative organism? a. chlamydia trachomatis b. Neisseria gonorrhoeae c. staph aureus d. salmonella e. clostridium

answer is neisseria gonorrhoeae i was able to pick the correct answer b/c the common presentation of n. gonnorrhoeae is knee arthritis. but chlamydia also has arthritis so i'm not quite sure how to differentiate them. I think chlamydia will present with multisystem complaint so arthritis and conjunctivitis and cervicitis. "can't see, can't pee, can't climb a tree"

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 and etiology and description of the etiology.

botulism caused by the canned food (food-borne) etiology is clostridium botulinum which a gram positive rod clostridium botu-NOT NEGATIVE-Linum

A 5-year-old girl is brought to the pediatrician by her mother because she had development of a nonpruritic rash four hours ago. The mother says that one week ago the patient had an upper respiratory tract infection consisting of fever, sore throat, and cough. Result of a rapid strep test done at that time was negative, and her symptoms have since resolved. Two days ago, the patient had development of a bright red rash on both cheeks resembling a sunburn; that rash has since resolved. Temperature is 37.0°C (98.6°F), pulse rate is 90/min, and blood pressure is 98/62 mmHg. Physical examination shows pink, nonenlarged tonsils. There is no cervical lymphadenopathy. Lungs are clear to auscultation bilaterally. Which of the following additional findings on physical examination is most likely to be noted in this patient? A. A blanchable maculopapular rash on the trunk B. An erythematous maculopapular rash on the face and neck C. A fine, "sandpaper" rash on the abdomen D. A lacy, reticular rash on the extremities E. A vesicular rash on the face, trunk, and extremities

buzzword here is bright red rash on both cheeks. = erythema infectiousum caused by parvovirus b19. this rash comes in stages. first stage is the bright cheeks 2nd the rash spreads 3rd the rash becomes lacy reticular answer: D. a lacy reticular rash on extremities

A 32-year-old man comes to your family medicine clinic with a painless lesion on his penis for the past week. On examination you determine that it is a chancre. Which of the following is the best next step in the treatment of this patient? A. Oral doxycycline B. IM penicillin C. IM ceftriaxone D. Oral clindamycin E. Amoxicillin/clavulanate

buzzword is painless lesion on penis which is a chancre. chancres are hallmark of primary syphilis and treatment for syphilis is penicillin always. correct answer is B. IM penicillin.

Which of the following diseases of childhood is characterized by the sudden onset of high fever, followed several days later by a rash that begins on the trunk, and spreads to the limbs? radio_button_unchecked A. Erythema infectiosum B. Pityriasis rosea C. Roseola D. Rubella E. Toxoplasmosis

c. Roseala key presentation of roseala is the really high fever (resolve abruptly) followed by erythematous (pink) rashes that typically start on the trunk

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

c. esophagitis The clinical patterns of salmonella infection are enteric fever, bacteremia, and acute enterocolitis.

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 ff would NOT hep to confirm the diagnosis of the patient described above a. stool for parasite b. cellophane tape test c. serologic test d. nocturnal examination of the perianal area

c. serologic test serologic tests cannot be used to diagnose pinworm

A 42-year-old man who is HIV positive comes to the emergency department because he has had worsening nonproductive cough, chest discomfort, and shortness of breath with exertion over the past three weeks. The patient does not have hemoptysis, and he has never smoked cigarettes. He has been homeless for the past six months and has not been compliant with antiretroviral therapy. Temperature is 39.0°C (102.2°F), pulse rate is 112/min, respirations are 26/min, and blood pressure is 138/88 mmHg; oxygen saturation is 88% on room air. Physical examination shows rhonchi bilaterally. Cardiac auscultation shows a regular rate without murmurs, gallops, or rubs. Chest x-ray study shows ground-glass opacity in a central location with peripheral sparing. Which of the following CD4+ lymphocyte counts is most likely in this patient? A. <50 cells/mm3 B. <100 but >50 cells/mm3 C. <200 but >100 cells/mm3 D. <500 cells/mm3 E. <1000 cells/mm3

correct answer is C. <200 but >100 cells/mm3 I was between Tb and PJP. TB b/c he has been homeless. TB OI in HIV is w/ CD4 of 200-500. But his labs and symptoms are more consistent w/ PJP: - non-productive cough w/ SOB and his O2 sats are pretty bad at 88%. PJP causes hypoxia. and PJP CD4 count in AIDs is under 100. any fungal/mycotic OI in AIDs (crypto and histo) is with CD4 less than 100.

A 23-year-old pregnant woman comes to the urgent care with sudden onset of fever, chills, and myalgias which began 24 hours ago. She also has a headache, sore throat and has had a non-productive cough. She is currently in her second trimester and has had a normal pregnancy thus far. A nasopharyngeal swab is performed, and culture results are positive for Influenza A. Which of the following is indicated in the treatment of this condition for this patient? a. influenza vaccine b. supportive therapy c. azithromycin d. amantadine e. oseltamivir

correct answer: E. oseltamivir Nuerominidase inhibitors, oseltamivir and zanamivir, are indicated in the treatment of the influenza virus, especially in pregnant patients, very young and old patients, and patients with severe comorbidities. Oseltamivir is given orally, while zanamivir is administered by inhalation. Zanamivir has a relative contraindication in patients with asthma because of the risk of bronchospasm. b. supportive therapy is wrong b/c she presented at 24 hr mark and not beyond the 48 hr mark. oseltamivir is indicated treatment for the flu if the patient presents within 48 hrs of symptoms.

A 2-year-old boy is brought in to your clinic by his mother with a rash that appeared one day ago. The rash began on his abdomen but has now spread over his entire body. History reveals that 4 days ago, the patient has a high fever which could only be temporarily reduced with acetaminophen and ibuprofen. Physical examination reveals a maculopapular, blanching rash that is widespread across trunk, face, and extremities. He also has mild rhinorrhea. His physical examination is otherwise negative. Which of the following is the most likely diagnosis? a. fifth disease b. hand foot mouth dz c. molluscum contagiosum d. roseola infantum e. rubeola

d. roseola infantum abrupt onset high fever followed by erythema on abdomen (pink) is characteristic of roseola infatum cause by human herpes 5 and 6

Which of the following diseases of childhood is characterized by a rash that begins on the face, and spreads to the trunk and limbs? a. infectious mononucleosis b. pityriasis rosea c. roseola d. rubella e. scarlet fever

d. rubella ger-rubella-man for german measles

At what CD4 cell count in an HIV positive patient should you worry about infection with Pneumocystis jirovecci ? a. less than 1000 b. less than 500 c. less than 300 d. less than 250 e. less than 200

e. less than 200 at CD4 of less than 200 for HIV/AIDs, you start prophylaxis w/ bactrim

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 the 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

her presentation of inflammatory diarrhea plus her Hx as a prison inmate = shigellosis. shiga sheilla shigella nega

a 33-year-old female 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 causative agent?

her recent travel to a remote area where she was uncertain of the water quality plus her drop in BP due to extreme dehydration leads to the diagnosis of Vibreo Cholera. the diarrhea caused by cholera is severe osmotic diarrhea

a 21-year-old male who three days after returning from a camping trip has developed fever, chills, myalgias, and headache. He then developed a rash on the wrists, ankles, palms, soles, and forearms that rapidly extended to the neck, axillae, buttocks, and trunk. What is your diagnosis?

rash started on wrist and ankles and moved centrally to the trunk plus history of returning from camping (exposure to outdoors) = rocky ricky mountain spotted fever

An 18-year-old woman (gravida 1, para 1) who is at 14 weeks' gestation comes to the women's health clinic for follow-up of a reactive rapid plasma reagin screening test. The patient has no history of sexually transmitted infections and says that she does not have any symptoms. She only has had one male sexual partner in her life. Which of the following is the most appropriate next step in evaluation? A. Darkfield microscopy of vaginal secretions to confirm the diagnosis B. Fluorescent treponemal antibody absorption to confirm the diagnosis C. Reassurance that the initial screen was falsely positive due to pregnancy D. Repeat screening with rapid plasma regain to confirm the diagnosis E. Treponemal and nontreponemal tests to confirm the diagnosis

reactive RPR or VDRL should be confirmed with FTA-ABS so correct answer is B.

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.

review salmonella

a 43-year-old Caucasian male who spent the past month on a business trip in the Caribbean. 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.

review salmonella

nfection with which of the following organisms is most likely to be associated with the consumption of undercooked poultry? A. Clostridium botulinum B. Escherichia coli C. Pseudomonas aeruginosa D. Salmonella heidelberg E. Staphylococcus aureus

salmonella is associated w/ poultry, particularly eggs and dairy.

a 23-year-old PA student with a 3-day history of bloody diarrhea, abdominal pain, and fever. She reports having passed liquid stools up to nine times that day. She started noticing blood earlier this morning. There is no history of recent travel or sick contacts but she reports eating grilled chicken during a recent study group. Stool microscopy revealed numerous WBCs and RBCs in the stool. A sample was cultured on Skirrow agar and incubated in a gas mixture with 5% oxygen. what is the most likely diagnosis and how would you treat it?

she has inflammatory diarrhea and her only clue as to what she ate is grilled chicken. Campylobacter is acquired from ingestion of poultry meat. so this girl has a campylobacter jejuni infection and if her symptoms do not resolve, ABX of choice are floroquinolones (cipro) or azithromycin

A 24-year-old woman presents to your clinic for her yearly examination. She is sexually active with her new boyfriend of two months, and uses oral contraceptives for birth control. On examination, vitals signs are normal, and yellow mucopurulent discharge is seen at the cervical os. There is no cervical motion tenderness or adnexal tenderness. A cervical specimen is sent for C. trachomatis and N. gonorrhoeae, but results will not return for several days. Which of the following is the best initial recommended treatment for this patient's suspected condition? A. Azithromycin 1gm PO once B. Azithromycin 1gm PO once and ceftriaxone C. Ceftriaxone 250mg IM once D. Ciprofloxacin 500mg PO as a single dose E. Doxycycline 100mg PO twice daily for 14 days

she has yellow mucopurulent discharge on her cervical os and this is indicative of chlamydia or gonorrhea infection. You always treat for both anyway so ceftriaxione for N. gonorrhoeae and Azithromycin for chlamydia correct answer is B.

A 30-year-old healthcare worker comes to the emergency department because he has had headache, fever, shaking chills, and a cough for the past 24 hours. He returned from a medical mission trip to Haiti two weeks ago. He has not had vomiting, diarrhea, or skin rash. Temperature is 39.0°C (102.2°F), pulse rate is 85/min, and blood pressure is 120/82 mmHg. Physical examination of the abdomen shows splenomegaly. Preliminary laboratory studies show atypical lymphocytes, decreased platelet count, and elevated lactate dehydrogenase level. Which of the following is the most appropriate next step in diagnosis? A. Blood smear microscopy B. Enzyme-linked immunosorbent assay C. Serum-based reverse transcriptase D. Stool culture E. Urine-based RT-PCR

symptoms are related to malaria: the fever, chills, cough, headache, plus the splenomegaly. the way to diagnose malaria is giemsa stain/write stain for blood smear. this is mainstay of malaria diagnosis.

Which of the following is recommended in the treatment of ascariasis? A. Albendazole B Ivermectin C Triclabendazole D Praziquantel

A. Albendazole

Each of the following vaccines is routinely administered to children in the United States EXCEPT: a. BCG vaccine (for tb) b. hep A c. hep B D. influenza E. polio

A. Bacillus Calmette-Guérin vaccine Bacillus Calmette-Guérin (BCG) vaccine is a vaccine primarily used against tuberculosis. In countries where tuberculosis is common, one dose is recommended in healthy babies as close to the time of birth as possible. However, BCG is not generally recommended for use in the United States because of the low risk of infection with Mycobacterium tuberculosis, the variable effectiveness of the vaccine against adult pulmonary TB, and the vaccine's potential interference with tuberculin skin test reactivity.

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 anything greater than 5 in HIV is positive

Which of the following is recommended in the treatment of Chlamydia trachomatis infection? A Amikacin B Itraconazole C Azithromycin D Metronidazole

Azithromycin

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 is the correct answer b/c the RMSF rash starts on wrist and ankles and moves centrally to the trunk

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

B. Itraconazole

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

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

Cat

Patient will present as → a 21-year-old male complaining of pain on urination and a watery discharge from his penis. Gram stain of the discharge is negative for bacteria but shows many neutrophils. When questioned about his social history, he says that he uses condoms most of the time but occasionally has unprotected sex. The patient responds to treatment with azithromycin. What organism was the most likely causative agent?

Chlamydia trachomatis chlamydia is hard to culture so gold standard for diagnosis is NAAT

A 23-year-old woman presents with pelvic discomfort and vaginal discharge for the past 3 days. She finished her period last week. She is taking oral contraceptives as directed. Her medical history is significant for a therapeutic abortion with no other hospitalizations or pregnancies. She has had three sexual partners in the past 6 weeks and does not use condoms. Her latest partner reported that he was treated recently for gonorrhea. On examination, she has a mucopurulent discharge with "strawberry" cervix on speculum examination with no cervical motion tenderness on bimanual examination. After collecting the appropriate specimens, which of the following is the best therapeutic option for this patient? A Oral ofloxacin 400 mg once plus oral metronidazole 500 mg twice daily for 7 days B Oral fluconazole 150 mg once C Oral metronidazole 2 g once D IM ceftriaxone 250 mg plus oral doxycycline 100 mg twice daily for 7 days

D IM ceftriaxone 250 mg plus oral doxycycline 100 mg twice daily for 7 days

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

Enterobius vermicularis

A 22-year-old female presents to the ED complaining of right knee pain, fever, and chills. Examination reveals a swollen and reddened knee joint that is tender and warm to touch. Patient has limited ROM of the knee. What is the most likely bacteria causing the infection in this scenario? A Group B streptococci B Haemophilus influenzae C Neisseria gonorrhoeae D Staphylococcus aureus E Streptococcus pyogenes

Neisseria gonorrhoeae TDP = tenosynovitis, dermatitis, polyarthritis N. gonorrhoeaa particulary likes the kee.

A 32-year old woman comes to your clinic complaining of passage of white vaginal discharge with associated itching, dyspareunia and dysuria. Examination findings include erythematous labia and vagina, thick curd-like discharge. Vaginal pH is 4.0, and 10% KOH wet preparation shows yeast cells and hyphae. Which of the following is the appropriate treatment for her condition? A Oral fluconazole B Oral metronidazole C Oral doxycycline D Oral Acyclovir

Oral fluconazole

Factors that indicate a poor prognosis in cryptococcal meningitis include all of the following except A Pleocytosis B Increased intracranial pressure C Decreased mental status D Initial high antigen titer CSF

Pleocytosis

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

S. sonnei

A 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

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

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

Sudden cardiac death

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

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

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

a. Pharyngeal pseudomembrane

Which of the following is not a major criterion for diagnosing acute rheumatic fever? Polyarthralgia B Sydenham's Chorea C Migratory polyarthritis D Erythema marginatum

answer: Polyarthralgia JONES PEACE major j = joints = arthritis (swollen) heart for O = carditis N = nodules (subq) E = erythema marginatum (painless rash) S = Sydenham chorea minor P = previous RH E = ECG PR prolongation A = arthralgias C = CRP/ESR elevated E = elevated temperature (fever)

A 3-day-old neonate has bilateral copious, yellow-green eye discharge and conjunctival inflammation. A Gram stain of this discharge reveals gram-negative intracellular diplococci. Which of the following antibiotics is the drug of choice for this infection? A Acyclovir (Zovirax) B Ceftriaxone (Rocephin) C Cephalexin (Keflex) D Erythromycin (Ilotycin) E Gentamicin (Garamycin)

b. ceftriaxone I just know this by now. gram negative diplo is n. gonorrhea

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

botulism presentation are the Ds diplopia droopy eyes dilated pupils dry mouth dysarthria dysphagia so the answer here is A. paresthesia

a 19-year-old sexually active woman presents to your office with complaints of yellow vaginal discharge and intermittent postcoital vaginal bleeding for 1 week. She otherwise feels well. On examination, there is purulent discharge visible in the endocervical canal. After you collect vaginal fluid for a wet prep and cervical samples for gonorrhea and chlamydia cultures, you note bleeding at the cervical os. On bimanual examination, the patient complains of tenderness on cervical palpation but denies uterine or adnexal tenderness. Wet prep reveals vaginal pH 4; negative whiff; 20 white blood cells (WBCs) per high-power field; and no clue cells, trichomonads, or pseudohyphae.

need to review trich and BV

A 16-year-old girl is brought to the clinic by her mother because of recurrent rheumatic fever. This is the third time this year that she has had similar symptoms, with each prior episode yielding a positive diagnosis. Which of the following is the most appropriate treatment of this patient's recurrent condition? A. Administration of low dose oral amoxicillin daily B. Intramuscular administration of ceftriaxone at the onset of symptoms with each episode In the setting of true penicillin allergy, the recommended alternative drug is oral erythromycin. C. Low-dose aspirin therapy D. Low dose corticosteroid therapy E. Monthly injections of benzathine penicillin

patient has RH and TOC for RH is penicillin. so answer is E.

A 62-year-old woman comes to the clinic because she has a rash on her upper abdomen that she noticed yesterday. Two days ago, she says she began experiencing shooting pain and tingling in the same area. Temperature is 37.0°C (98.6°F), pulse rate is 82/min, and blood pressure is 116/78 mmHg. Examination of the skin shows grouped vesicles starting to the left of the umbilicus and wrapping upwards around the side of the torso in a dermatomal distribution. There are no vesicles seen on the right abdomen or back. Which of the following is the most likely diagnosis? A. Dermatitis herpetiformis B. Herpes gladiatorum C. Herpes zoster D. Impetigo E. Molluscum contagiosum

positive for pain and parethesias that preceded rash eruption and rash follow dermatomal pattern and the rash is described as group vesicles answer is C. herpes zoster

A 35-year-old international relief worker presents to the emergency department 24-hours after returning from a refugee camp in a war-torn part of the world. She is complaining of abdominal cramps, profuse "rice water" diarrhea, and is worried that her bowel movements are mostly liquid. She reports extreme thirst, but is able to tolerate oral fluids. Her vital signs show tachycardia and postural hypotension, but physical exam is otherwise unremarkable. What is the most LIKELY diagnosis? A. H. pylori B. Cholera C. Enteric Fever D. Salmonella Gastroenteritis E. Escherichia coli

rice water is buzzword for cholera also note the severe dehydration which is how cholera kills you. cholerICE water diarrhea correct answer is B. cholera

Which one of the following Rickettsial pathogens is responsible for Rocky Mountain spotted fever? A Rickettsia felis B Rickettsia conorii C Rickettsia prowazekii D Rickettsia rickettsii

rocky ricky mountain spotted fever is caused by rickettsia rickettsii

An HIV infected patient with persistent generalized lymphadenopathy is at what clinical stage? a. Stage 1 B Stage 2 C Stage 3 D Stage 4

stage 1

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 the causative agent

the child is suffering from pin worms also known as enterobius vermicularis

Which of the following patients is at the highest risk for acquiring a methicillin-resistant Staphylococcus aureus (MRSA) infection? 3-year-old in daycare 27-year-old inmate with no significant past medical history 31-year-old female healthcare worker 50-year-old male with a 40 pack-year smoking history

27-year-old inmate with no significant past medical history Methicillin-resistant Staphylococcus aureus (MRSA) is present in more than 50% of cases of cellulitis in which a pathogen has been isolated. Although MRSA can affect healthy people, patients who are immunocompromised, those with chronic illnesses (such as end-stage renal disease and diabetes), inmates and athletes are affected at higher rates than the general population.

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

3 types/ presentation of botulism: food,wound,baby through honey correct answer 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. ==> ingesting spores contained in the honey. once ingested the spores germinate and multiply and produce the toxin. it is not food-borne botulism b/c in food borne botulism, there are PRE-formed toxins contained in improperly prepared or preserved food.

A 52-year-old man who is HIV positive is brought to the emergency department by his partner because he has had confusion and vomiting for the past 12 hours. He has had a headache for the past week as well as a nonproductive cough and intermittent shortness of breath for the past two weeks. The patient has not had night sweats, hemoptysis, or diarrhea. Temperature is 38.5°C (101.3°F), pulse rate is 85/min, and blood pressure is 114/86 mmHg; oxygen saturation is 90%. Physical examination shows rales in the lower lobes bilaterally. Nuchal rigidity is absent. Vision examination shows no abnormalities. No focal neurologic deficits are identified. Mini-Mental State Examination score is 17/30. CD4+ lymphocyte count is 60 cells/μL. Lumbar puncture shows budding encapsulated oval yeast with India ink staining. Which of the following is the most likely diagnosis? a. cryptococcus b. cryptosporidiosis c. cytomegalovirus d. histoplasmosis e. toxoplasmosis

A. Cryptococcosis HIV-positive patients are at increased risk of cryptococcosis when their CD4+ lymphocyte count is 100 cells/μL or less. Cryptococcus is the most common cause of fungal meningitis. Clinical findings may be subtle and nonspecific; a lumbar puncture should be performed on all patients with suspected cryptococcosis even in the absence of neurologic symptoms. Pulmonary involvement is also common and may be subtle in nature as well. both toxo and crypto OI occur at CD4 less than 100 for AIDS/HIV. the only way I was able to sort between the two was with the key words of india ink staining and encapsulated yeast

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 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. Concerning the patient described above, which of the following antibiotics would you use to treat him? A Doxycycline B Gentamicin C Piperacillin/Tazobactam D Streptomycin

A. doxycycline cipro also would be a good treatment

In which of the following helminthic infections will stool for occult blood be most likely positive? A. Hookworm disease B Ascariasis C T. saginata infection D None of the above

A. hookworm remember hookworm can cause iron deficiency anemia Hookworms attach to the intestinal mucosa and suck blood leading to the presence of red blood cells in stool. All other options do not give rise to blood in stool.

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

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

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

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.

Which of the following is not considered a risk factor for candidiasis? A Uncontrolled diabetes mellitus B Malnutrition C HIV infection D Antiviral drugs

Antiviral drugs do not predispose to candidiasis, but broad-spectrum antibiotics do. All other options are correct.

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

B. DTap I remember b/c D is before T in the alphabet so its given to children at 2, 4, 6, 15-18, and 4-6 years old and NOT anyone over. adults would get Tdap b/c T comes after D in the alphabet

A 24-year-old woman comes to the clinic for a Pap smear and requests sexually transmitted infection screening. She has had three partners in the past year and does not always use condoms. The patient says she had a painless bump on her vulva one month ago that has since resolved; she has no history of discharge. Physical examination shows no abnormalities. Result of rapid plasma reagin (RPR) test is positive. Which of the following additional studies is most likely to confirm the diagnosis? radio_button_unchecked A. Bacterial culture B. Fluorescent treponemal antibody absorption (FTA-ABS) C. Nucleic-acid amplification test (NAAT) D. Tzank smear The RPR test is a screening test for syphilis that should be confirmed by FTA-ABS test. The Tzank smear is a test for herpes simplex virus. E. Venereal disease research laboratory (VDRL) test

B. Fluorescent treponemal antibody absorption (FTA-ABS) diagnosis of syphilis requires positive/reactive RPR or VDRL confirmed by FTA-ABS

A 45-year-old woman is noted to have four yeast infections in 1 year. Appropriate management of this patient should be A Continued observation and treatment only if symptomatic B Further evaluation for hypothyroidism C Blood test to look for the presence of diabetes and HIV infection D Prophylactic therapy with weekly metronidazole E Examination for endometrial structural abnormalities

Blood test to look for the presence of diabetes and HIV infection

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.

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. answered via process of elimination cipro is usually the treatment for inflammatory diarrhea reactive arthritis is a common theme and stool is often mixed with blood

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 cavitary lesions = classic for TB

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 also BCG reacts w/ PPD so anyone who received the BCG vaccine is screened for TB w/ an x-ray

A 39-year-old woman who is HIV positive is admitted to the hospital for treatment of bacteremia from a cutaneous abscess. She has been on antiretroviral therapy on and off for two years, but has not experienced any AIDS defining illness. Laboratory studies on admission show a CD4 count of 178 cells/mm3 (normal = 500-1600 cells/mm3). Prophylactic medication for which of the following conditions is most appropriate at this time? A. Mycobacterium avium-intracellulare complex infection B. Oral candidiasis C. Pneumocystis jiroveci pneumonia D. Toxoplasma gondii encephalitis E. Varicella zoster encephalitis

C. Pneumocystis jiroveci pneumonia prophylaxis is done w/ bactrim

Which of the following is a fungus found in soil, and bird or bat guano? A. Candida albicans B. Cryptococcus neoformans C. Histoplasma capsulatum D. Malassezia furfur E. Pneumocystis jirovecii

C. histoplasma capsulatum histoplasma is found in the soil and also associated with bats

Which of the following cancers is found predominantly in HIV-positive patients? A. Breast B. Glioblastoma C. kaposi sarcoma d. pancreas e. prostate

C. kaposi sarcoma

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

C. metronidazole penicillin can also be used tetanus-sporesoilseetetanINHIBI-GABA-tory is a gram positive rody treat with metronidi or penicilli

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. moxifoxacin all the others alternative treatments to Bactrim for PJP. I also picked moxifloxacin bc it sounds like a quinolone and PJP is fungal. Beside Bactrim, other abx should not work for it.

Which of the following is responsible for an irregular, erythematous, cracking skin lesion with satellite papules and pustules located axilla and inframammary regions of your patient? A Herpes simplex B Candida albicans C Malassezia furfur D Trichophyton rubrum

Candida albicans candida albicans = satellite lesions

The leading cause of infertility in females in the United States is A Chlamydial infection B Gonorrhea C Ureaplasma urealyticum infection D Gardnerella vaginalis infection

Chlamydial infection