Unit 2 Board Questions
How is Epstein-Barr virus mononucleosis distinguished clinically from cytomegalovirus mononucleosis?
Tonsillitis, enlarged cervical lymph nodes, and splenomegaly are more common in Epstein-Barr virus mononucleosis. Fever and systemic symptoms are more common in cytomegalovirus mononucleosis.
A 43-year-old woman presents to her primary care physician with complaints of bilateral wrist and hand pain for the last two months. Her symptoms are the worst when she wakes up and improve throughout the day or when she takes ibuprofen. She denies recent injury, recent illnesses, or rash. Given her presentation, you suspect rheumatoid arthritis. Which of the following combinations provides the most specific diagnostic findings for this condition? A Anti-citrullinated peptide/protein antibody and rheumatoid factor B Antinuclear antibody and rheumatoid factor C Antinuclear antibody and X-ray D C-reactive protein and erythrocyte sedimentation rate
A Anti-citrullinated peptide/protein antibody and rheumatoid factor There is no definitive test for RA, but in the context of inflammatory arthritis lasting over six weeks and involving three or more joints, once other diseases with similar clinical presentations like acute viral polyarthritis, polyarticular gout, psoriatic arthritis, and systemic lupus erythematosus are excluded, positive rheumatoid factor (RF) or anti-citrullinated peptide/protein (anti-CCP) antibody are most diagnostic. Alone, each will be positive for only half of RA patients; when both are positive, the specificity is further increased.
A 5-year-old boy presents to the office for the second time this month for a nosebleed that has lasted for more than 15 minutes at home despite applying direct pressure to the nostrils. His mother states that he is constantly picking his nose. Physical examination reveals blood coming from the left nostril, but the bleeding site is not visualized. Which of the following is the best next step in treatment for his condition? A Application of a topical decongestant B Cautery with silver nitrate C Nasal packing D Refer to an otolaryngologist
A Application of a topical decongestant Topical cocaine or a topical decongestant (e.g., phenylephrine, oxymetazoline) applied with a topical anesthetic (e.g., lidocaine) can also be used for vasoconstriction.
A 25-year-old woman presents to her primary care provider with vaginal discharge following intercourse with a new sexual partner. Which of the following antibiotic regimens is the best empiric treatment of uncomplicated genital infections caused by chlamydia? A Azithromycin 1,000 milligrams given as a single dose B Ceftriaxone 250 milligrams administered intramuscularly C Doxycycline 100 milligrams given as a single dose D Metronidazole 2,000 milligrams given orally
A Azithromycin 1,000 milligrams given as a single dose Chlamydia is the most common bacterial sexually transmitted disease in the United States. Risk factors include age less than 25 years, new or multiple sex partners, and recent known exposure to chlamydia. Chlamydia most commonly affects the cervix in women and the urethra in men. It is asymptomatic in 90% of women. The preferred antibiotic treatment method is observing the patient take a single 1 gram oral dose of azithromycin. Azithromycin is preferred over doxycycline because it can be given as a single dose (leading to increased compliance) and can be used during pregnancy.
A 40-year-old man with acquired immunodeficiency virus presents to the clinic with fever, night sweats, abdominal pain, and weight loss. His CD4 count is 45 cells per microliter. Mycobacterium avium complex is isolated from his blood. What is the best treatment regimen? A Azithromycin and ethambutol B Azithromycin, ethambutol, and rifampin C Clarithromycin and rifampin D Isoniazid, rifampin, pyrazinamide, and ethambutol
A Azithromycin and ethambutol Mycobacterium avium complex refers to infections caused by one of two nontuberculous mycobacterial species: Mycobacterium avium or Mycobacterium intracellulare. The treatment of Mycobacterium avium complex infection includes combination therapy with a macrolide (azithromycin is preferred) and ethambutol.
Which of the following animals is most commonly associated with rabies transmission in the United States? A Bat B Dog C Fox D Rat
A Bat Rabies is a viral disease caused by several different species of neurotropic viruses in the Rhabdoviridae family and Lyssavirus genus.
A 25-year-old man recently diagnosed with human immunodeficiency virus (HIV) presents to the office with a white patch along the right side of his tongue for the past week. The patch is nontender and adherent. He is diagnosed with oral hairy leukoplakia. Which of the following tests would definitively confirm this diagnosis? A Biopsy to confirm histologic appearance and presence of Epstein-Barr within the epithelial cells of the lesions B Biopsy to reveal squamous cell carcinoma C Clinical examination is sufficient to definitively diagnose this condition D Presence of hyphae, pseudohyphae, or budding yeast cells on wet mount
A Biopsy to confirm histologic appearance and presence of Epstein-Barr within the epithelial cells of the lesions Oral hairy leukoplakia is a disease of the mucosa commonly associated with Epstein-Barr virus and occurs mostly in people with human immunodeficiency virus (HIV) infection, although it can occur in some patients who are immunocompromised (e.g., organ transplant patients, chronic steroid users and patients on chemotherapy).
A 70-year-old man presents with a gradual onset of dyspnea on exertion and a nonproductive cough. He reports a 30 pack-year history. He is otherwise healthy. Laboratory studies are normal at this time. Chest radiography reveals reticular opacities in the lower lung. High resolution computed tomography shows subpleural honeycombing. Which of the following physical examination findings is most likely to be present in this patient? A Clubbing B Fever C Janeway lesions D Osler nodes
A Clubbing (Idiopathic pulmonary fibrosis, also known as usual interstitial pneumonia)
A 25-year-old man with cystic fibrosis presents to the clinic with a cough producing copious amounts of purulent sputum. Examination reveals digital clubbing and crackles at the lung bases. You suspect bronchiectasis. Which of the following radiographic findings is most consistent with bronchiectasis? A Dilated and thickened bronchi B Hyperinflation and flattening of the diaphragm C Linear streaking at the lung bases D Peribronchial and perivascular markings
A Dilated and thickened bronchi. Bronchiectasis is a pulmonary disorder characterized by permanent dilation and destruction of the large bronchial walls which leads to chronic and recurrent infections.
A 13-year-old boy presents to his pediatrician with a two-week history of high fevers and a two-month history joint pain. He complains of wrist and ankle pain in the mornings and when he has fevers. Initially he just had joint pain but has now had fevers daily for two weeks, as high as 104°F. He also has a pink rash that goes away when the fever subsides. When afebrile, he behaves like his usual self; he is still attending school and engaging in sports. His fever and symptoms do respond to ibuprofen, but his mother is concerned because the fevers have been going on for so long. Which of the following is the most likely diagnosis? A Juvenile idiopathic arthritis B Malignancy C Reactive arthritis D Septic arthritis
A Juvenile Idiopathic Arthritis Juvenile idiopathic arthritis (JIA), formerly known as juvenile rheumatoid arthritis (JRA), is an illness in children less than 16 years old that is characterized by fever, arthritis, and rash.
A 56-year-old woman presents to the emergency department with cough and dyspnea. Vital signs are T 101.4°F, HR 128, BP 90/55 mm Hg, RR 28, and oxygen saturation of 94% on room air. Chest radiograph shows a pulmonary consolidation. Lactic acid is 4.5 millimoles per liter. Which of the following is the best management of this patient? A Administer broad-spectrum antibiotics and 30 milliliters per kilogram of colloid fluids B Administer broad-spectrum antibiotics and 30 milliliters per kilogram of crystalloid fluids C Administer broad-spectrum antibiotics and 60 milliliters per kilogram of crystalloid fluids D Administer narrow-spectrum antibiotics and 60 milliliters per kilogram of colloid fluids
B Administer broad-spectrum antibiotics and 30 milliliters per kilogram of crystalloid fluids
Which of the following is a first-line pharmacologic treatment for fibromyalgia? A Acetaminophen B Amitriptyline C Exercise D Ibuprofen
B Amitriptyline (Elavil) Initial pharmacologic therapy consists of certain antidepressants and anticonvulsants, including amitriptyline, duloxetine, milnacipran, and pregabalin.
A 64-year-old woman who has been admitted for three days for treatment of aspiration pneumonia complains of profuse, new-onset, foul-smelling diarrhea. Her vitals reveal HR 104, RR 16, BP 112/76, and T 100.5°F. Computed tomography reveals colonic wall thickening, a target sign, and pericolonic fat stranding. What is the most likely diagnosis causing her new symptoms? A Celiac disease B Clostridioides difficile infection C Ischemic colitis D Salmonella infection
B Clostridioides difficile infection Clostridioides difficile is an anaerobic gram-positive, spore-forming, toxin-producing bacillus that colonizes the colon via fecal-oral transmission. With antibiotic therapy, normal gut flora is suppressed and C. difficile opportunistically overgrows, causing antibiotic-associated colitis.
A 58-year-old man presents to the clinic complaining of a productive cough, fever, and chills for three days. He has a past medical history of alcohol abuse, tobacco use (20 pack-year history), and hypertension. Which of the following additional history or physical findings would most closely correlate with a diagnosis of community-acquired pneumonia caused by Klebsiella pneumoniae infection? A Bibasilar crackles B Currant jelly sputum C Exposure to contaminated water D Recent travel to Asia
B Currant jelly sputum Community-acquired pneumonia refers to pulmonary infection acquired outside of the hospital setting. Common causes of community-acquired pneumonia include viral infection and infection with Streptococcus pneumonia, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. Features of Klebsiella pneumoniae pulmonary infection are similar to those of other causes of community-acquired pneumonia and include fever, chills, tachycardia, dyspnea, pleuritic chest pain, and productive cough. A history of currant jelly sputum is associated with Klebsiella pneumoniae infection.
Which of the following is a risk factor for pulmonary infection with Histoplasmosis capsulatum? A Changing cat litter while pregnant B Exploring caves in the Ohio River Valley C Farming in Arizona D Tending pigeons in the Pacific Northwest
B Exploring caves in the Ohio River Valley Histoplasmosis capsulatum is a fungus that is endemic to certain parts of the United States, including the Ohio River Valley. The fungus proliferates in moist soil and is more common in areas with high concentrations of bats and chickens.
What is the most important step in preventing influenza infection according to the Centers for Disease Control? A Avoiding sick contacts B Getting the annual influenza vaccination C Practicing good hand washing technique D Taking antiviral medications
B Getting the annual influenza vaccination Influenza is a highly contagious infection caused by different strains of influenza viruses which are a part of the orthomyxovirus family. It has peak activity in the fall and winter months and has a high mortality rate especially in infants and the elderly population. Prevention of the disease is key to managing outbreaks, with annual vaccines being the most important step in protecting against flu viruses according to the Centers for Disease Control (CDC).
A 58-year-old man presents to the emergency department complaining of shortness of breath, cough, fever, nausea, and diarrhea for three days. He recently installed a hot tub in his home and has been using it quite frequently. Physical exam reveals a soft, mildly tender abdomen, bilateral crackles on chest auscultation, and a pulse oxygen saturation of 91%. Abnormal laboratory values include leukocytosis, hyponatremia, and elevated liver enzymes. Which of the following causes of atypical pneumonia correlates most closely with this patient's clinical picture? A Klebsiella pneumoniae B Legionella pneumoniae C Mycoplasma pneumoniae D Pseudomonas aeruginosa
B Legionella pneumoniae Legionella pneumoniae is a gram-negative, aerobic organism responsible for both nosocomial and community-acquired pneumonia. The bacteria are present in water and soil, and infection occurs via contaminated aerosolized particles. Although the bacteria are ubiquitous in the environment, most human infections occur as a result of contaminated water from man-made sources, such as pools, hot tubs, air conditioning units, and drinking water.
A 78-year-old woman with a previous history of left-sided stroke and dysphagia presents to the clinic complaining of weeks of productive cough, fever, malodorous sputum, and weight loss. Chest X-ray reveals a solitary pulmonary infiltrate in the right lower lung with a central cavitation and a visible air-fluid level. Which of the following represents the most likely diagnosis? A Aspirated foreign body B Lung abscess C Lung cancer D Sarcoidosis
B Lung abscess Lung abscess is a microbial infection of the lung causing localized destruction of the lung parenchyma. Aspiration is the main cause of lung abscess, therefore, the major risk factors are those that increase the likelihood of aspiration, such as neurologic or neuromuscular disease, and states of decreased consciousness, including alcohol abuse.
Which of the following medications used to treat rheumatoid arthritis has been shown to alter the disease course and improve radiographic outcomes? A Ibuprofen B Methotrexate C Naproxen D Prednisone
B Methotrexate Methotrexate, a disease-modifying antirheumatic drug, is considered the first-line drug of this class used to treat rheumatoid arthritis. While the nonsteroidal anti-inflammatory drugs and disease-modifying antirheumatic drugs have been shown to improve the symptoms of rheumatoid arthritis, only the disease-modifying antirheumatic drug class has been shown to alter the disease course and improve radiographic outcomes. Methotrexate is generally well tolerated in these patients and produces beneficial effects in two to six weeks. Methotrexate should be taken with folic acid supplementation due to its mechanism of inhibiting dihydrofolate reductase and serving as a folate antagonist. During the first few weeks that the patient is started on methotrexate, nonsteroidal anti-inflammatory drugs and corticosteroids may be given to control symptoms and reduce disease activity until the methotrexate takes effect.
A 45-year-old man with a history of renal transplantation presents to the emergency department with fever, headache, and confusion. Lumbar puncture for cerebrospinal fluid analysis is performed for suspected meningitis. Which of the following diagnostic tests would be best to confirm the diagnosis of cytomegalovirus? A Complete blood count with differential B Polymerase chain reaction C Shell vial viral culture D Traditional viral culture
B Polymerase chain reaction Since the patient in this vignette is immunocompromised (history of solid-organ transplant) and has symptoms and signs of meningitis, polymerase chain reaction is the best test to confirm cytomegalovirus infection.
A 40-year-old woman presents to the clinic with pain and morning stiffness in her fingers and toes. She describes the morning stiffness as lasting more than 30 minutes but says it improves throughout the day. On physical examination, you note a "sausage appearance" of her fingers and toes along with joint line tenderness and effusion of the distal interphalangeal joints. You also note onycholysis and nail pitting. There is an erythematous, thick plaque with silvery scale noted around her umbilicus. Laboratory results reveal an elevated erythrocyte sedimentation rate and uric acid levels, however, rheumatoid factor and anti-cyclic citrullinated peptide antibodies are absent. The synovial fluid examination does not show any monosodium urate crystals. Radiography of the fingers and toes shows a "pencil-in-cup" deformity. Which of the following is the most likely diagnosis? A Gout B Psoriatic arthritis C Reactive arthritis D Rheumatoid arthritis
B Psoriatic arthritis Psoriatic arthritis is seronegative inflammatory arthritis that follows psoriasis in more than 80% of cases. The morning stiffness usually lasts more than 30 minutes and improves with activity. Nail pitting and "sausage-like" appearance of the digits are also good clinical indicators of the disease.
A 10-month-old boy presents to the emergency department with a widespread maculopapular rash. His mother states he had a fever for three days that suddenly resolved prior to the development of the rash. Which of the following infectious exanthems is the most likely cause? A Erythema infectiosum B Roseola infantum C Rubella D Rubeola
B Roseola infantum Roseola infantum is an illness of young children that has a peak prevalence between 7 and 13 months of age. It occurs throughout the year, and most cases occur sporadically without known exposure. Roseola infantum is caused by human herpesvirus 6. Roseola infantum classically begins with three to five days of fever (that may exceed 104°F) that resolves abruptly and is followed by the development of a rash.
A 35-year-old woman presents to the office complaining that over the past several months her fingertips have been visibly getting pale and numb, especially in cold weather. After they are warmed, her affected fingers become bright red with painful numbness and tingling throughout. She also notes that the skin on both hands has become dry and feels tight, especially on the palmar surfaces. A blood test is positive for antinuclear antibodies and anticentromere antibodies. Which of the following is the most likely diagnosis? A Multiple sclerosis B Scleroderma C Sjogren's syndrome D Systemic lupus erythematosus
B Scleroderma Scleroderma or systemic sclerosis is a rare disease characterized by fibrosis of the skin and internal organs. There are two forms of scleroderma: limited (more common) and diffuse. Limited scleroderma is also called CREST syndrome (calcinosis cutis, Raynaud phenomenon, esophageal motility disorder, sclerodactyly, and telangiectasias), and fibrosis of the skin is limited to the face and hands. Laboratory findings may reveal positive antinuclear antibody tests, positive anti-topoisomerase (anti-Scl-70) antibodies which are associated with diffuse disease and higher risk of interstitial lung disease, positive anticentromere antibodies (highly specific for limited scleroderma), and anti-RNA polymerase III antibodies which are associated with rapidly developing skin disease and increased risk of scleroderma renal crisis.
What systemic condition should be suspected in a patient with recurrent oral ulcers as well as skin lesions, uveitis, and genital sores?
Behcet syndrome
A 2-year-old boy presents to the emergency department with a barking cough and respiratory distress. There is a high-pitched sound heard on inspiration. Intercostal retractions are also visible on exam. He is diagnosed with croup. Vital signs are T 99.6°F, HR 130, RR 40, and oxygen saturation is 94% on room air. What is the best initial treatment? A Azithromycin B Dexamethasone C Dexamethasone and nebulized epinephrine D Nebulized epinephrine
C Dexamethasone and nebulized epinephrine Moderate or severe croup is indicated by stridor at rest and other signs of respiratory distress, such as retractions or hypoxemia. The recommended initial treatment for moderate or severe croup is nebulized epinephrine and a single dose of dexamethasone.
An 82-year-old man was admitted to the ICU 14 days ago for an acute coronary event. His clinical course required that he be ventilated. He has now developed hypoxia, fever, and pulmonary infiltrates. Which of the following antimicrobials represents the best treatment plan for this patient's nosocomial pneumonia? A Azithromycin and levofloxacin B Ceftriaxone C Imipenem, gentamicin, and vancomycin D Piperacillin-tazobactam
C Imipenem, gentamicin, and vancomycin Nosocomial pneumonia refers to pulmonary infection acquired over 48 hours after intubation or hospital admission. The microbes associated with nosocomial pneumonia differ slightly from those found in the community. Common pathogens in nosocomial pneumonia include Staphylococcus, Streptococcus, Pseudomonas, Escherichia coli, Enterobacter, Acinetobacter, and Klebsiella pneumoniae. Patients with nosocomial pneumonia should receive empiric treatment as quickly as possible to prevent morbidity and mortality. Treatment for patients with risk factors for multidrug-resistant nosocomial pneumonia is with a three-drug regimen, which includes an agent with activity against gram-negative bacilli (such as imipenem), an aminoglycoside, and an agent with activity against methicillin-resistant Staphylococcus aureus (such as vancomycin).
A 48-year-old homeless man with a history of chronic infection with human immunodeficiency virus presents with fever, dyspnea, nonproductive cough, and weakness during usual activities. You suspect Pneumocystis pneumonia. Which of the following laboratory results would you expect to see? A Alveolar-arterial oxygen gradient of 15 mm Hg B CD4 count of 400 cells/microL C Lactate dehydrogenase level of 400 U/L D Negative 1-3-beta-D-glucan level
C Lactate dehydrogenase level of 400 U/L Pneumocystis jirovecii pneumonia is the most common opportunistic respiratory infection in human immunodeficiency virus-infected patients and is an acquired immunodeficiency syndrome-defining illness. In this case, an important laboratory clue in diagnosis would be a lactate dehydrogenase level of 400 U/L. An elevated serum lactate dehydrogenase level is present in 90% of human immunodeficiency virus-infected patients with Pneumocystis pneumonia, and as such, serum lactate dehydrogenase is a very sensitive diagnostic tool.
A 17-year-old boy presents to the clinic complaining of chronic cough and hemoptysis. He has never smoked. He states that, along with the respiratory symptoms, he has also been experiencing flushing, abdominal cramps, and diarrhea. On chest X-ray and subsequent CT scan, several small, noncavitary lung nodules are noted. Which of the following is the most likely diagnosis? A Disseminated tuberculosis B Hepatocellular carcinoma with lung metastases C Primary carcinoid lung tumor D Sarcoidosis with systemic involvement
C Primary carcinoid lung tumor Lung carcinoid tumors are tumors of the lung parenchyma that are neuroendocrine in origin and often secretory. The appearance of lung carcinoid tumors is sporadic, and they are the most common lung neoplasm in children, typically presenting in late adolescence. The most common signs and symptoms associated with lung carcinoid tumor are cough, hemoptysis, wheezing, and recurrent pneumonia.
A 10-year-old boy presents to the office with painful sores in his mouth for the past three days. He has not had any fever, recent upper respiratory infection, or oral trauma. He has had several episodes of mouth sores in the past year. Which of the following is the best initial treatment for aphthous ulcers? A Oral B12 supplementation B Oral corticosteroids C Topical corticosteroids D Topical tetracycline
C Topical corticosteroids Aphthous ulcers, also known as canker sores or ulcerative stomatitis, are a common condition characterized by painful ulcerations of the mouth.
A 35-year-old woman presents to the clinic with fever, gastrointestinal cramping, vomiting, and diarrhea for four days. She is having 11 loose bowel movements per day. Stool cultures reveal nontyphoidal Salmonella infection. Which of the following is the most appropriate antibiotic agent? A Amoxicillin B Cefazolin C Cephalexin D Ciprofloxacin
D Ciprofloxacin Replacement of fluids and electrolytes is the main therapy. Patients with severe disease can be treated with antimicrobials, most often fluoroquinolones, such as ciprofloxacin. Severe disease may be characterized by one or more of the following: at least 10 loose stools per day, persistent fever, or need for hospitalization.
A 75-year-old man with HIV presents to the office with multiple round, reddish macules on the inside of his mouth that are not painful. He is diagnosed with Kaposi sarcoma. Which of the following is a risk factor for developing this condition? A Cigarette smoking B Cytomegalovirus (human herpesvirus-5) infection C Highly active antiretroviral therapy D Human herpesvirus-8 infection
D Human herpesvirus-8 infection Kaposi sarcoma is a type of cancer that is categorized into four types: epidemic (AIDS-related), iatrogenic (immunosuppressant therapy related), endemic (African), and classic. Most Kaposi sarcoma lesions contain human herpesvirus 8 (HHV-8), which suggests that this DNA virus has a causative role in the development of the disease.
Which of the following is the most common sexually transmitted infection? A Chlamydia B Gonorrhea C Herpes simplex virus D Human papillomavirus
D Human papillomavirus
Which abnormal breathing pattern is most often found in diabetic ketoacidosis? A Agonal respirations B Cheyne-Stokes respirations C Hypopnea D Kussmaul respirations
D Kussmaul respirations
Which of the following pharmacologic therapies is generally a first-line treatment for osteoarthritis? A Acetaminophen B Hyaluronic acid C Hydrocodone D Naproxen
D Naproxen Naproxen is a first-line pharmacologic treatment for osteoarthritis. Osteoarthritis is the most common form of joint disease and is due to degeneration of the joints with minimal inflammation. Risk factors for osteoarthritis include advanced age, female sex, family history, obesity, repetitive use, and prior injury to the joint.
A 55-year-old woman presents with increasing weakness in her muscles that began in her legs and then progressed to her shoulders and neck for the past six months. Her physical exam reveals proximal muscle weakness of her hips, shoulders, and neck, which are non-tender to palpation. A blood test reveals an elevated creatine kinase and an elevated antinuclear antibody. A muscle biopsy is ordered to confirm diagnosis. Which of the following is the most likely diagnosis? A Cushing syndrome B Hypothyroidism C Polymyalgia rheumatica D Polymyositis
D Polymyositis Polymyositis is a systemic disease that is primarily characterized by muscle weakness. Patients will present classically with progressive bilateral proximal muscle weakness over the course of weeks to months. The muscles involved typically include the muscles in the neck and upper and lower extremities.
A 75-year-old woman presents to the emergency department with complaints of severe headache, jaw claudication, and visual changes. Temporal artery biopsy results are positive for giant cell arteritis. Which of the following is the most appropriate therapy? A Hydrocodone B Methotrexate C Naproxen D Prednisone
D Prednisone High-dose, systemic corticosteroids, such as prednisone, are the foundation of therapy, and patients will generally remain on steroid treatment for at least two years after diagnosis. Methotrexate (B) is sometimes used in the treatment of GCA when there are contraindications to the use of corticosteroids, but it is not considered first-line therapy.
Which of the following clinical findings is characteristic of Rocky Mountain spotted fever? A Bull's eye lesion B Rash on the first day of illness C Rash preceding fever and headache D Rash that spreads proximally
D Rash that spreads proximally Rash occurs in 90% of cases but typically develops between the third and fifth day of illness and is often absent at initial clinical presentation. The rash is classically an erythematous blanchable rash with macules that eventually become petechiae. It begins distally (ankles and wrists) and spreads centrally. Rash that appears on the palms and soles is also characteristic, but this is often a later finding.
An 8-year-old boy presents for his annual physical with complaints of night-time cough and intermittent wheezing. Which of the following diagnostic studies would confirm a diagnosis of asthma? A Arterial blood gas B Bronchoscopy C Chest radiograph D Spirometry
D Spirometry
Which of the following is a finding of tertiary syphilis? A Chancre B Diffuse lymphadenopathy C Generalized rash D Tabes dorsalis
D Tabes dorsalis Late syphilis (tertiary syphilis) occurs in approximately 25-40% of patients with untreated syphilis. Tertiary syphilis may occur one to 30 years after primary syphilis, and it is not necessary for individuals to have experienced symptoms of primary or secondary syphilis prior to developing tertiary syphilis. The presentations include major complications involving the central nervous system, cardiovascular structures, or skin and bones. Late neurosyphilis (part of tertiary syphilis) involves the brain and spinal cord parenchyma and presents with general paresis or tabes dorsalis. Tabes dorsalis is a disease of the posterior column of the spinal cord and the dorsal roots.
Which organism is the most common cause of central nervous system infection in patients with acquired immunodeficiency syndrome who are not receiving appropriate prophylaxis? A Cryptococcus neoformans B Cytomegalovirus C Histoplasma capsulatum D Toxoplasma gondii
D Toxoplasma gondii Toxoplasmosis is an acquired immunodeficiency syndrome-defining illness and is caused by an intracellular protozoan parasite called Toxoplasma gondii.
A 30-year-old man with a history of human immunodeficiency virus presents to the clinic with fever, cough, and dyspnea on exertion. His last CD4 count was 100 cells per microliter. Chest X-ray shows bilateral diffuse interstitial infiltrates. Polymerase chain reaction of respiratory fluids obtained by bronchoalveolar lavage confirms the diagnosis of Pneumocystis jirovecii pneumonia. Which of the following is the recommended antimicrobial treatment? A Aerosolized pentamidine B Dapsone C Fluconazole D Trimethoprim-sulfamethoxazole
D Trimethoprim-sulfamethoxazole Pneumocystis jirovecii pneumonia is a fungus and is one of the most common opportunistic infections in human immunodeficiency virus-infected individuals. Trimethoprim-sulfamethoxazole is the recommended antimicrobial agent. It is given intravenously in severe cases and orally in mild or moderate cases. The treatment duration of trimethoprim-sulfamethoxazole is 21 days.
What medication is used for bronchoprovocation testing?
Methacholine
What are human immunodeficiency virus-infected patients with Pneumocystis pneumonia commonly co-infected with at the time of presentation?
Oral thrush.
What is another name for Clostridioides difficile colitis that is demonstrated by purulent inflammation of the inner lining of the bowel?
Pseudomembranous colitis
What clinical features can help distinguish a drug allergy from roseola infantum in infants who present with a fever and were treated with antibiotics?
The duration of the rash is longer in drug allergies, and the rash associated with a drug allergy is more likely to be pruritic.
What is the treatment for Rocky Mountain spotted fever in pregnant patients?
Treatment is ALWAYS doxycycline, even in children and pregnant women
