PA easy coin med exam 2
A 36-year-old nurse states she will be traveling to Honduras for a medical mission and wants to ensure that she has adequate protection against hepatitis B. What laboratory value is consistent with immunity against hepatitis B from prior immunization?
+anti-HBs
A 55-year-old generally healthy male returns from a vacation to Mexico with a 5-day history of nausea, vomiting, fever of 100.5°F, and vague RUQ abdominal discomfort. Which of the following physical examination findings would be most consistent with your suspected diagnosis? what is diagnosis
acute hep a jaundice
Which of the following is the drug of choice for treating herpes simplex virus (HSV) types 1 and 2?
acyclovir
An adult male, not previously vaccinated for rabies, presents to the emergency department after being bitten by an aggressive stray dog. The dog was captured, and declared "probably rabid" by a local veterinarian. whats the treatment
administer human rabies immune globulin and human diploid cell rabies vaccine
33-year-old man with HIV infection is brought in by his partner for evaluation of altered mental status. The partner has noticed waxing and waning periods of confusion throughout the day, difficulty in performing tasks such as balancing a checkbook, and deterioration of handwriting. The patient reports no fever or headache. What is the most likely diagnosis?
aids dementia complex
Which drug exerts its action by inhibiting cell wall synthesis?
all penicillins (including amoxicillin), cephalosporins,
A 28-year-old woman who is HIV positive presents with substernal discomfort and painful swallowing for the past week. Her physical examination is unremarkable, but on endoscopy she has extensive adherent yellowish plaques on the esophageal mucosa. What is the most likely diagnosis?
candidal esophagitis
A 3-day-old infant 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?
ceftriaxone
An 8-year-old boy began vomiting earlier in the day and complained of "feeling terrible." His mother says he has slept most of the day and is hot to the touch, although she has not taken his temperature. He is also complaining of a sore throat and that his neck is sore. On examination, his temperature is 103F and he appears unwell. His pharynx is beefy red, the tonsils are enlarged, and covered with a thick exudates. His anterior cervical nodes are tender and markedly enlarged. What additional physical finding is most consistent with this presentation?
circumoral pallor
A 25-year-old gravida 1 woman who is HIV positive arrives at the hospital in early labor. Membranes are intact and the cervix is 50% effaced and 3 to 4 cm dilated. Fetal heart rate is 150 beats/min. Which of the following procedures is contraindicated during labor?
fetal scalp electrodes
A patient with no history of treatment for primary syphilis presents with symptoms and signs consistent with secondary syphilis. The most common sign of secondary syphilis is
generalized maculopapular rash
virus is rodent-borne and the cause of hemorrhagic fever and a pulmonary syndrome, which begins with a fever and may rapidly progress to shock and adult respiratory distress syndrome
hantavirus
A 72-year-old male presents to you for a routine physical exam. He complains of increasing abdominal distention, weight loss, and night sweats over the past 2 months. He admits to having a blood transfusion as a young adult. His labs include +anti-HCV and HCV RNA. Which of the following is the most likely explanation for his history and laboratory findings?
hepatocellular carcinoma
The organism shown in Figure 8-1 usually enters the body from infected soil through a break in the skin of the feet. It then is carried to the lungs, travels to the mouth, and is swallowed. Once in the gastrointestinal (GI) tract, it attaches to the wall and induces bleeding, leading to an iron deficiency anemia. Associated GI symptoms are uncommon. Additional symptoms include swelling and intense itching at the site in which the larva penetrates the skin.
hookworms
A 16-year-old girl presents to the office complaining of a very sore throat, swollen lymph nodes, fever, and general malaise. Her examination reveals a temperature of 102.2°F, enlarged exudative tonsils, tender cervical lymphadenopathy, and borderline enlarged spleen. Rapid strep screen is negative. Which of the following laboratory findings best supports the most likely diagnosis?
increased atypical lymphocytes on white blood cell differential
A 29-year-old man who is taking combination antiretroviral therapy develops severe right-sided flank pain and dysuria. He is also nauseated, which he attributes to the severity of the pain. He is unable to sit still and paces about the examination room. Dipstick urine is remarkable for 3+ hematuria. Which of the following drugs is most likely to be responsible for this clinical picture?
indinavir
A 4-year-old boy presents with 5 days of fever, conjunctivitis, strawberry tongue, red lips, and injected throat. He has large, swollen, slightly tender lymph nodes in his neck and a peeling rash in the palms and soles. The most likely cause is
kawasaki disease
Koplik spots are a differentiating diagnostic feature of which of the following viral exanthems?
measles
Which of the following childhood exanthems is characterized by a 10-day incubation period followed by 3 days of fever, runny nose, and conjunctivitis giving way to a maculopapular rash starting on the head, progressing to the trunk, and accompanied by white spots on the buccal mucosa?
measles
Following a gunshot wound to the lower abdomen, a 29-year-old man is hospitalized and treated with clindamycin for a potential anaerobic infection. After 3 days of clindamycin therapy, while recuperating in the hospital, he develops severe diarrhea, dehydration, and lower abdominal cramping. A stool culture is ordered and later discovered to contain Clostridium difficile. After discontinuing the clindamycin, which of the following would be the most appropriate treatment?
metronidizole
A 7-year-old girl is brought in by her mom for evaluation of a rash. She has had a fever for a few days and woke up this morning looking like she had been slapped on both cheeks. Other than supportive care, which instruction below represents the best patient education for this patient?
resume normal activity as energy level improves
A mother brings her 11-month-old son to you for a fever and rash. He had four days of fever worsening each day until last night when it measured 104.5°F taken orally before being given acetaminophen. When he awoke this morning, his fever was 100.4°F but he had developed a maculopapular rash to his trunk and extremities that blanches. Which of the following is the probable etiology
roseolla ( measles)
the two major risk factors for human immunodeficiency virus (HIV) infection in American women are intravenous drug use and which of the following?
sexual contact with infected male
The organism responsible for most cases of peritonitis in patients on peritoneal dialysis is
staph. a
Which of the following types of renal calculi is associated with an infectious cause?
struvite
A 35-year-old patient with AIDS has had unintended weight loss of nearly 30 lb over the past 6 months. This loss has been primarily in muscle mass. He has little appetite, but no nausea, diarrhea, or evidence of oral candidiasis. He reports interest in resuming his former weight-training regimen. Which of the following is the most appropriate pharmacologic agent to help him gain muscle mass
testosterone enathrate
Which drug can potentially lead to oropharyngeal candidiasis, and which agent can be used to treat this type of infection?
triamcinolone; fluconazole
A 33-year-old woman presents with an itchy vaginal discharge for the past 2 days. She has been healthy other than a recent sinus infection for which she took a 10-day course of amoxicillin. Her husband is her only sexual partner and he has no symptoms. On examination, the vulva is noted to be slightly erythematous and swollen with some evidence of excoriation. Discharge is white and clumpy. what is diagnosis and first-line therapy is
vulvovaginal candidiasis. fluconazole 150 mg i po × 1 day
A 6-year-old child with leukemia presents with a very painful vesicular rash as seen in Figure 8-2. This is the only dermatologic manifestation but is accompanied by fever and malaise. His medical history is significant for the leukemia, tonsillectomy, and adenoidectomy at age 3 and chicken pox 4 months later. He has had all his other childhood immunizations. The most likely diagnosis in this case is
zoster
Which of the following patients, without laboratory evidence of HIV, meets the Centers for Disease Control and Prevention case definition for acquired immunodeficiency syndrome (AIDS)?
32-year-old man with Kaposi sarcoma
A 28-year-old man has a positive HIV ELISA and Western Blot but has never had an opportunistic infection. Of the following laboratory parameters, which, if present, is consistent with a diagnosis of AIDS in this man
CD4 lymphocyte count of 175/mL
Which of the following tests should an HIV-positive pregnant woman undergo in each trimester of pregnancy?
CD4+ lymphocyte count
A 17-year-old female patient presents to your family practice office complaining of a persistent sore throat for the past 2 weeks duration. She is extremely fatigued, and she tells you that her boyfriend has had similar symptoms for about a week. Her vital signs are a blood pressure of 116/72 mm Hg, pulse 88 beats/min, respirations of 16 beats/min, and temperature of 101.1˚F taken orally. Her white blood cell count (WBC) reveals 14,800 mcL with more than 10% atypical lymphocytes. On physical examination you find significant yellowish-grey pharyngeal exudate, cervical lymphadenopathy as well as an enlarged spleen. Her rapid strep is negative. What should be your treatment of this patient
Draw a Monospot test and treat the patient supportively pending the results, insuring that they avoid contact sports until a definitive diagnosis has been made.
An infant is born to an HIV-positive mother who received three-drug treatment during pregnancy. Which of the following, if positive, indicates HIV infection in the infant?
HIV ELISA and Western Blot at 24 months of age
A 12-year-old boy presents to the urgent care center complaining of burning pain in his lower extremities with weakness. On examination, the clinician notes symmetric weakness with severely decreased active range of motion of the lower extremities. In addition, there is decreased position and vibratory sensation in the distal portions bilaterally. Upon further questioning, the patient admits to being diagnosed with mononucleosis 2 weeks ago. Which of the following is the most likely diagnosis?
GBS
A 9-year-old male child presents with a painful rash of his upper extremity. His mom states it started 4 days ago and seems like it is spreading. Physical examination demonstrates a vesicular rash across the right upper arm and chest but does not cross the midline. What is patient presenting with and what prescription would be most appropriate for this patient at today's visit?
Herpes Zoster oral acyclovir
patient presents complaining of a painful rash on his lips.
Herpes simplex type 1
Septic arthritis in adults younger than 30 years is usually caused by
N. Gonorrhea
2-year-old girl has developed a "barking" cough and a low-grade fever. She has some runny nose and her voice is somewhat raspy and hoarse. When approached by the PA, she becomes somewhat upset and exhibits mild inspiratory stridor. She appears otherwise well and has no drooling or dyspnea. What is the most likely etiology of this child's illness?
Parainfluenza virus *croup
A 55-year-old man with a history of chronic renal failure, 6 months status post renal transplant, presents with chest pain, productive cough, and low-grade fever. He reports generalized malaise as well. Current medications include only those related to the transplant. He has no known allergies. Examination reveals a temperature of 102°F, unremarkable HEENT (head, ears, eyes, nose, throat), and few crackles anteriorly in the upper right lung field. Chest X-ray reveals a solitary nodule in the right upper lobe. The most likely etiology for his symptoms is
cryptococcosis
While seeing a 12-week-old baby girl for her well-child checkup, it is noticed that she has tearing from her left eye. There is a small reddened area that is swollen and she cries when it is touched. The swollen area is just below the medial inferior eyelid. There is also constant tearing from this same eye. Her mother says it just started about 2 days ago and is getting worse. What is the most likely cause of this problem?
dacryocystitis
Which of the following viral exanthems includes a fever followed by a diffuse maculopapular rash that spares the face and resolves in about 2 days
erythema subitum
What treatment is first-line therapy for sputum culture-positive Legionnaire's pneumonia in an immunocompetent patient?
erythromycin
A 25-year-old man presents for evaluation of diarrhea. He is generally healthy and reports he finished a 4-day hike about 2 weeks ago. He does mention that he ran out of water on day 3 and did not have a filter with him. Today he reports that he does not feel too badly but he has had 24 hours of abdominal bloating, increased flatulence, and loose stools. He denies melena or hematochezia. His physical examination is unremarkable but stool ova and parasite examination reveal ova and trophozoites. The most appropriate antimicrobial agent for this patient is
metronidozale
Following a gunshot wound to the lower abdomen, a 29-year-old man is hospitalized and treated with clindamycin for a potential anaerobic infection. After 3 days of clindamycin therapy, while recuperating in the hospital, he develops severe diarrhea, dehydration, and lower abdominal cramping. A stool culture is ordered and later discovered to contain Clostridium difficile. After discontinuing the clindamycin, which of the following would be the most appropriate treatment
metronidozole
The majority of cases of halitosis in young children can be traced to which of the following causes?
nasal foreign bodies
A generally healthy, 20-year-old male complains of malaise, mild flank discomfort, and cola-colored urine for the past 24 hours. He denies any history of kidney stones. He does admit to having a sore throat and fever about a week ago that has since resolved. His BP is 160/94 P-92 and T is 97.2˚F. His urinalysis is positive for protein, RBCs, leukocytes, and RBC casts. His BUN (blood urea nitrogen) and CR are also elevated.
post-streptococcus glomerulonephritis
A 28-year-old male is concerned because he has a friend who was diagnosed with chronic hepatitis C and wants to know if he is at risk for this disease as well. Which of the following answers elicited in your history would make you the most suspicious
previous IVDA
what sexual practice poses the greatest risk of HIV transmission when practiced with an infected partner but without the use of a reliable barrier method of prophylaxis?
receiving anal intercourse
