IDS Flashcards
1
Q
Which of the following is the most common site of Pott’s disease in adults?
a. Upper cervical vertebra
b. Upper thoracic vertebra
c. Lower thoracic vertebra
d. Lower lumbar vertebra
A
Lower thoracic vertebra
2
Q
TB culture showed resistance to both isoniazid and rifampicin but no detected resistance to fluoroquinolones and other anti-TB drugs. What do you call this pattern of resistance in TB?
a. Mono-resistant TB
b. Polydrug-resistant TB
c. Multidrug-resistant TB
d. Extensively drug-resistant TB
A
Multidrug-resistant TB
3
Q
Which of the following pleural fluid findings is consistent with pleural TB?
a. Low concentration of adenosine deaminase
b. High glucose concentration
c. Protein concentration <50% of that in serum
d. WBC with lymphocytic predominance
A
WBC with lymphocytic predominance
4
Q
Which of the following is most consistent with genitourinary TB?
a. Urinalysis showing muddy brown cast with proteinuria
b. Urinalysis showing hematuria with dysmorphic RBCs
c. Gram-negative rods in urine culture
d. Ureteral strictures on IV pyelography
A
Ureteral strictures on IV pyelography
5
Q
Which of the following patients most likely has drug-resistant TB (DR-TB)?
a. Acquaintance of a confirmed DR-TB patient presenting with chronic cough
b. Ongoing treatment with anti-Koch’s and was positive for AFB after 3rd month of treatment
c. Patient previously received HRZE but was discontinued after 2 weeks and was lost to follow-up
d. PLHIV with 1 month history of cough and unintentional weight loss
A
Ongoing treatment with anti-Koch’s and was positive for AFB after 3rd month of treatment
6
Q
What is the treatment regimen for new military TB cases in the absence of meningitis or bone and joint involvement?
a. 2HRZE/4HR
b. 2HRZE/10HR
c. 2HRZES/1HRZE/5HRE
d. 2HRZES/1HRZE/9HRE
A
2HRZE/4HR
7
Q
Which of the following is TRUE in the management of tuberculosis among patients with HIV?
a. Isoniazid is contraindicated in HIV-infected individuals receiving protease inhibitors.
b. Rifampin must be given for 9 months for HIV-infected patients diagnosed with latent TB infection.
c. Adverse drug reactions of anti-TB medications may be more pronounced in HIV-infected patients.
d. All HIV-infected TB patients should first be started with antiretroviral therapy and then anti-TB treatment after 8 weeks.
A
Adverse drug reactions of anti-TB medications may be more pronounced in HIV-infected patients.
8
Q
A 26/M consulted you for a 1-month history of unexplained weight loss and night sweats. Physical examination showed palpable cervical lymphadenopathies. Chest X-ray was unremarkable. Biopsy of the lymph node revealed granuloma formation with Langhans giant cells. The patient was started on anti-TB medications. What is the most proper diagnosis for this patient?
a.Presumptive TB
b. Clinically diagnosed TB
c. Bacteriologically confirmed TB
d. Disseminated TB
A
Clinically diagnosed TB
9
Q
A patient was started on HRZE for bacteriologically confirmed PTB. After 2 weeks of treatment, he developed nausea and vomiting, and jaundice. What is the recommended best course of action?
a. Discontinue isoniazid and refer to a specialist
b. Discontinue pyrazinamide and refer to a specialist
c. Discontinue ethambutol and refer to a specialist
d. Discontinue all anti-TB drugs and refer to a specialist
A
Discontinue all anti-TB drugs and refer to a specialist
10
Q
A 45/F presented at the ER due to altered behavior. She had a 1-month history of unintentional weight loss and generalized weakness. Physical examination revealed cachexia, nuchal rigidity, (+) Brudzinski sign. Which of the following medications is indicated for this patient?
a. Cotrimoxazole
b. Dexamethasone
c. Dapsone
d. Valproic acid
A
Dexamethasone
11
Q
A patient taking HRZE developed arthralgia. What is the recommended best course of action?
a. Reassure the patient
b. Give allopurinol and reassess
c. Give NSAID and request for uric acid
d. Stop pyrazinamide and refer to a specialist
A
Give NSAID and request for uric acid
12
Q
A patient was being treated with HRZE for bacteriologically confirmed PTB. After 2 months of intensive phase of therapy, he was lost to follow-up for 6 weeks. Repeat sputum microscopy is still positive for AFB. What is the recommended course of action?
a. Continue treatment and prolong to compensate for missed doses
b. Assign outcome as “treatment failed”
c. Assign outcome as “lost to follow-up”
d. Perform GeneXpert and refer to DR-TB treatment center
A
Continue treatment and prolong to compensate for missed doses
13
Q
What is the principal vector of dengue virus?
a. Anopheles spp.
b. Aedes spp.
c. Culex spp.
d. Mansonia spp.
A
Aedes spp.
14
Q
Which of the following clinical manifestations of dengue would warrant hospital admission?
a. Abdominal pain
b. Diarrhea
c. Petechial rash
d. Vomiting
A
Abdominal pain
15
Q
A 25/M came in due to a 3-day history of fever, myalgia, back pain, retroorbital pain, headache, and persistent vomiting. Vital signs at the ER: BP 100/60, HR 115, RR 21. CBC showed hemoglobin 155 g/L, hematocrit 45%, WBC 3.2 x 109/L, platelet 122 x 103/uL. What is the correct fluid management of this case?
a. Oral rehydration solution
b. PNSS (1,500 mL + 20 mL/kg for each kg >20 kg) to run for 24 hours
c. PNSS to run at 5 to 7mL/kg/h for the first 2 hours
d. PNSS to run at 20 mL/kg over the first 15 minutes then reassess
A
PNSS to run at 5 to 7mL/kg/h for the first 2 hours
16
Q
Which of the following parameters is NOT a discharge criterion in the management of dengue?
a. No fever for 48 hours
b. Normal creatinine and liver enzymes
c. Increasing trend of platelet count
d. Stable hematocrit without intravenous fluids
A
Normal creatinine and liver enzymes
17
Q
What is the single most important agent of traveler’s diarrhea?
a. Giardia lamblia
b. Entamoeba histolytica
c. Enterotoxigenic Escherichia coli
d. Enteroaggregative Escherichia coli
A
Enterotoxigenic Escherichia coli
18
Q
Stools that contain blood or mucus indicate what pathology?
a. Ulceration of the large bowel
b. Malabsorption
c. Shiga-toxin-producing enterohemorrhagic Escherichia coli
d. Cholera
A
Ulceration of the large bowel
19
Q
A 35/F consulted due to a 3-day history of loose watery stool, non-bloody, non-mucoid, with associated abdominal cramping and occasional vomiting. Fecalysis showed WBC 10-12, RBC 2-4, no parasites or ova seen. Which of the following is the best treatment for this patient?
a. Loperamide
b. Bismuth subsalicylate
c. Azithromycin
d. Saltine crackers
A
Azithromycin
20
Q
What is the most likely causative agent of diarrhea, with associated nausea, and vomiting, occurring 4 hours after eating egg sandwich?
a. Staphylococcus aureus
b. Bacillus cereus
c. Clostridium perfringens
d. Enterotoxigenic Escherichia coli
A
Staphylococcus aureus
21
Q
When does gastrointestinal bleeding most commonly occur in the course of typhoid fever?
a. Day 1-2 of illness
b. End of the first week of illness
c. 2nd week of illness
d. 3rd to 4th week of illness
A
3rd to 4th week of illness
22
Q
In which case is typhoid immunization NOT recommended?
a. Adult traveling to endemic areas
b. Person with intimate exposure to a documented typhoid carrier
c. Person exposed in a common-source outbreak
d. Laboratory workers routinely exposed to stool or cultures of S. typhi
A
Person exposed in a common-source outbreak
23
Q
Which of the following antibiotics should be given to a patient diagnosed with typhoid fever presenting with severe dehydration due to persistent vomiting?
a. Cefotaxime 2 g IV q8h
b. Ceftriaxone 2 g IV q24h
c. Azithromycin 500 mg IV q24h
d. TMP-SMX 800/600 mg tablet, 1 tablet q12h
A
Ceftriaxone 2 g IV q24h
24
Q
A 39/F was brought to the ER due to obtundation. She had a 3-week history of undocumented fever, abdominal pain and diarrhea. Three days PTA, a family member observed that she was picking at bedclothes and imaginary objects. Vital signs showed BP 80/60, HR 116. Which of the following medications should also be given to the patient in addition to antibiotics?
a. Loperamide
b. Bismuth subsalicylate
c. Dexamethasone
d. Praziquantel
A
Dexamethasone
25
What is the incubation period of leptospires?
a. 1 to 4 days
b. 5 to 7 days
c. 7 to 10 days
d. 1 to 30 days
1 to 30 days
26
Which of the following findings indicate severe leptospirosis?
a. WBC 11.0 x 109/L
b. Platelet 121 x 103/mm3
c. PaO2 of 68 mmHg on O2 at 10 LPM
d. Chest X-ray with right upper lobe infiltrates
PaO2 of 68 mmHg on O2 at 10 LPM
27
What is the correct prophylaxis for leptospirosis in a patient with a small wound on the right foot, sustained after wading through floodwater?
a. Doxycycline 100 mg/capsule, 1 capsule single dose
b. Doxycycline 100 mg/capsule, 1 capsule OD for 3 to 5 days
c. Doxycycline 100 mg/capsule, 2 capsules single dose
d. Doxycycline 100 mg/capsule, 2 capsules OD for 3 to 5 days
Doxycycline 100 mg/capsule, 2 capsules OD for 3 to 5 days
28
A 43/F wet market vendor was brought to the ER for difficulty breathing. Five days PTA, she had fever, and myalgia. Two days PTA, she developed jaundice and eventually oliguria. Which of the following is the treatment of choice for this patient?
a. Doxycycline 100 mg PO BID
b. Amoxicillin 500 mg PO TID
c. Ampicillin 500 mg PO TID
d. Penicillin 1.5 M units IV q6h
Penicillin 1.5 M units IV q6h
29
Which of the following are frequent complications of falciparum malaria in pregnant women?
a. Azotemia, hypertension, thrombocytopenia
b. Hyperglycemia, hypoxemia, oliguria
c. Jaundice, renal failure, pulmonary edema
d. Seizures, behavioral changes, blindness
Jaundice, renal failure, pulmonary edema
30
What is the only drug advised as malaria chemoprophylaxis for pregnant women traveling to areas with drug-resistant malaria?
a. Chloroquine
b. Mefloquine
c. Primaquine
d. Atovaquone
Mefloquine
31
Which of the following is a manifestation of severe falciparum malaria?
a. Single episode of generalized seizure in the last 24 hours
b. Hemoglobin 68 g/L
c. Plasma glucose 76 mg/dL
d. Serum bicarbonate level 12 mmol/L
Serum bicarbonate level 12 mmol/L
32
A 35/M was referred for anemia. He had a history of malaria when he was young, for which treatment with an unrecalled antimalarial drug caused severe anemia. His brother also has a mild form of anemia, which none of his parents have. What medication was most likely given to this patient?
a. Chloroquine
b. Mefloquine
c. Primaquine
d. Atovaquone
Primaquine
33
Which of the following is equivalent to a score of 1 in the qSOFA scoring for sepsis?
a. SBP 100 mmHg
b. Respiratory rate 21 breaths/min
c. Heart rate 110 beats/min
d. Temperature 39°C
SBP 100 mmHg
34
Which of the following is TRUE in the resuscitation of patients with sepsis?
a. Resuscitation with IV colloids at 30 mL/kg should begin within the first 3 hours
b. Vasopressin is the first-choice vasopressor
c. Dobutamine should be used with the intent of reducing vasopressin dose
d. In patients with elevated serum lactate, resuscitation should be guided towards normalizing these levels
In patients with elevated serum lactate, resuscitation should be guided towards normalizing these levels
35
A 58/M with no known comorbidities is brought to the ER for decline in sensorium. He has a 3-day history of undocumented fever, generalized weakness and decreased appetite. Physical examination shows BP 70/50, HR 128, RR 22. He grimaces to pain and does not follow commands. He remains hypotensive after fluid resuscitation. Which of the following antibiotic regimen is most appropriate to start in this case?
a. Ceftriaxone 2 g IV + Azithromycin 500 mg IV
b. Ampicillin-sulbactam 1.5 g IV q6h + Levofloxacin 750 mg IV
c. Piperacillin-tazobactam 4.5 g IV q6h + Levofloxacin 750 mg IV
d. Piperacillin-tazobactam 4.5 g IV q6h + Vancomycin 25 to 30 mg/kg loading dose
Piperacillin-tazobactam 4.5 g IV q6h + Vancomycin 25 to 30 mg/kg loading dose
36
A 58/M with known type 2 diabetes sought ER consult for a 3-day history of a rapidly progressing wound on the right foot. Vital signs at the ER were: BP 80/50, HR 132, RR 24. He was still hypotensive after fluid resuscitation, prompting initiation of Norepinephrine. Which of the following is NOT indicated for this patient?
a. Fluconazole 400 mg IV
b. Hydrocortisone 50 mg IV q6h
c. Omeprazole 40 mg IV
d. Insertion of arterial catheter
Fluconazole 400 mg IV
37
What is the cornerstone of management and control of schistosomiasis?
a. Elimination of intermediate host snails
b. Use of personal protective equipment
c. Improvement of water quality and sanitation facilities
d. Praziquantel treatment of infected people and mass-drug administration programs
Praziquantel treatment of infected people and mass-drug administration programs
38
Which of the following is the standard method to diagnose schistosomiasis?
a. Complete blood count
b. Fecalysis with concentration technique
c. Whole abdominal ultrasound
d. Liver biopsy
Fecalysis with concentration technique
39
Which of the following is associated with poor prognosis in tetanus?
a. Heart rate 128 bpm
b. Temperature 38.2° C
c. Incubation period 8 days
d. Onset of spasm 36 hours from first symptom
Onset of spasm 36 hours from first symptom
40
Which of the following is the preferred antibiotic therapy for tetanus?
a. Penicillin
b. Ampicillin-sulbactam
c. Clindamycin
d. Metronidazole
Metronidazole
41
Which of the following is TRUE in the pathogenesis of rabies?
a. The incubation period is usually 5 to 7 days
b. The virus is known to bind nicotinic acetylcholine receptors on postsynaptic membranes at neuromuscular junctions
c. Astrocytes are prominently affected in rabies
d. The most characteristic pathologic finding are eosinophilic cytoplasmic inclusions called Babes nodules
The virus is known to bind nicotinic acetylcholine receptors on postsynaptic membranes at neuromuscular junctions
42
A 22/M consulted due to a dog bite 5 days ago. On the day of consult, his pet dog who bit him escaped. He previously received 3 doses of preexposure rabies vaccination. What is the next best step in management?
a. Observe
b. Rabies immune globulin (RIG) only
c. Booster vaccine only
d. RIG and booster vaccine
Booster vaccine only
43
Which of the following is TRUE in SARS-CoV infection?
a. Virus may have emerged from bats in the Middle East
b. Humans are infected thru direct or indirect contact with infected dromedary camels
c. Upper respiratory symptoms are very prominent
d. Watery diarrhea may occur
Watery diarrhea may occur
44
An 84/F with known type 2 diabetes was brought to the ER due to difficulty breathing. She had a 2-day history of productive cough, fever, myalgia, which rapidly progressed to difficulty of breathing. Upon probing, she was never vaccinated for COVID-19 due to fear of complications. She was severely tachypneic at the ER, with O2 saturation 85%, prompting endotracheal intubation. Chest X-ray revealed bilateral densities on middle to lower lung fields. RT-PCR was positive for COVID-19. Which of the following medications is indicated for this patient?
a. Molnupiravir
b. Remdesivir
c. Dexamethasone
d. Vitamin C + Zinc
Dexamethasone
45
A 26/M was diagnosed with HIV 8 months ago. He is compliant with his antiretroviral treatment. His latest CD4+ T lymphocyte count is 750/µL and is currently asymptomatic. What is the patient’s Centers for Disease Control (CDC) infection stage?
a. Stage 0
b. Stage 1
c. Stage 2
d. Stage 3
Stage 2
46
Which of the following types of exposure confers the highest risk of HIV transmission?
a. Human bite
b. Needle-sharing during injection drug use
c. Receptive anal intercourse
d. Receptive penile-vaginal intercourse
Receptive anal intercourse
47
Which of the following is NOT a correct step in the management of patients with fever of unknown origin?
a. Exclude manipulation with a thermometer
b. Stop antibiotic treatment and glucocorticoids
c. Repeat cultures when previous cultures are negative
d. Repeat history and physical examination when scintigraphy is normal
Repeat cultures when previous cultures are negative
48
A 45/F came in for a follow-up visit. She had a 3-month history of intermittent fever and fatigue. She has no recent travel or exposure to known infections. She has not been taking any medications. Physical exam remains unremarkable throughout her multiple visits. Results of the serum lab tests are within normal limits. Chest X-ray and ultrasound are likewise normal. Which is the most appropriate next step in management?
a. Repeat history and physical examination
b. Cryoglobulin and fundoscopy
c. FDG-PET
d. Chest and abdominal CT
Cryoglobulin and fundoscopy
49
A 33-year-old nonpregnant female consulted due to dysuria, urinary frequency and hematuria with no fever and no vaginal discharge. What is the BEST management for this patient?
a. Do urinalysis and start empiric antibiotic
b. Start on Ciprofloxacin 500mg BID for 3 days
c. Start on Nitrofurantoin macrocrystals 100mg QID for 5 days
d. Start on Amoxicillin-clavulanate 625mg BID for 7 days
c. Start on Nitrofurantoin macrocrystals 100mg QID for 5 days
50
A 50-year-old male, who recently underwent bladder tumor resection, consulted at the OPD due to hematuria, fever, chills, vomiting, loss of appetite and left flank pain. He denies dysuria and urinary frequency. You decided to admit the patient. Upon admission, he has stable vital signs.
What will be the next best step?
a. Request for urinalysis and urine CS and start on empiric oral antibiotics while waiting for culture results
b. Request for urinalysis and urine CS and start on empiric IV antibiotics
c. Request for urine CS and blood CS and start on empiric IV antibiotics
d. Refer to a urologist, request for KUB imaging and start on empiric antibiotics
b. Request for urinalysis and urine CS and start on empiric IV antibiotics
51
A 50-year-old male, who recently underwent bladder tumor resection, consulted at the OPD due to hematuria, fever, chills, vomiting, loss of appetite and left flank pain. He denies dysuria and urinary frequency. You decided to admit the patient. Upon admission, he has stable vital signs.
What is the cutoff for significant bacteriuria for this patient?
a. 105 CFU/mL
b. 104 CFU/mL
c. 103 CFU/mL
d. 102 CFU/mL
a. 105 CFU/mL
52
A 37-year-old pregnant patient on 28 weeks AOG came to ER due to fever Tmax 38.3C, chills, dysuria and right flank pain. You decided to request for urinalysis and urine GS/CS. What laboratory findings will likely support your diagnosis?
a. ≥5 WBC/LPF on urinalysis and 105 CFU/mL on urine culture
b. ≥5 WBC/HPF on urinalysis and 104 CFU/mL on urine culture
c. ≥5 WBC/LPF on urinalysis and 104 CFU/mL on urine culture
d. ≥5 WBC/HPF on urinalysis and 105 CFU/mL on urine culture
d. ≥5 WBC/HPF on urinalysis and 105 CFU/mL on urine culture
53
A 50-year-old female with type 2 diabetes underwent an executive check-up. She consulted you due to elevated WBC and bacteria on urinalysis. She denies any symptoms. What will you advise her?
a. No treatment is needed and reassure her
b. Request for a urine culture
c. Start on Nitrofurantoin 100mg QID
d. Start on Ciprofloxacin 500mg BID
a. No treatment is needed and reassure her
54
A 30-year-old garbage collector came to ER due to 8-day history of fever, chills, headache, myalgia, nausea, vomiting and calf pain. On physical examination, he has stable vital signs, clear breath sounds, soft nontender abdomen, and an open wound on his right hand.
How will you confirm your diagnosis?
a. Culture and isolation
b. Urine Polymerase Chain Reaction
c. Specific IgM Rapid Diagnostic Test
d. Microagglutination test
d. Microagglutination test
55
What laboratory finding may indicate that this patient has severe leptospirosis?
a. Serum creatinine 3 mg/dL
b. Serum potassium 2.5 mmol/L
c. Chest X-ray showing extensive alveolar infiltrates
d. Hemoglobin level of 10 g/dL on CBC
c. Chest X-ray showing extensive alveolar infiltrates
56
A 44/M known diabetic residing in Navotas City, had a small cut on his right foot, waded in flood during the recent flood. He consulted regarding post exposure prophylaxis. What will you recommend?
a. Doxycycline 200mg one dose
b. Azithromycin 500mg single dose
c. Doxycycline 200mg once daily for 3-5 days
d. Doxycycline 200mg once weekly until end of exposure
c. Doxycycline 200mg once daily for 3-5 days
57
A 39/F came to ER due to 10-day history of fever (TMax 39C), severe headache, fatigue, abdominal pain and diarrhea. VS showed BP 100/60, HR 86bpm, T 38.9C. Which of the following is TRUE of this case?
a. Early findings include salmon-colored, non-blanching maculopapular rashes on the trunk and relative bradycardia
b. Chronic carriers are at increased risk of urinary bladder cancer
c. Gastrointestinal bleeding and intestinal perforation usually occur on the second week of illness
d. Fluoroquinolones are the most effective class of agents for drug-susceptible pathogens
d. Fluoroquinolones are the most effective class of agents for drug-susceptible pathogens
58
What is the optimal antibiotic therapy for the previous patient if the pathogen isolated turns out to be Multidrug Resistant?
a. Ceftriaxone 2gm IV OD
b. High dose Ciprofloxacin 400mg IV every 8 hours
c. Chloramphenicol 25mg/kg TID
d. Trimethoprim-sulfamethoxazole 160/800mg BID
a. Ceftriaxone 2gm IV OD
59
A 29-year-old patient presented to ER due to 4-day history of fever, headache, myalgia and maculopapular rashes. Upon PE, BP is 80/60, HR 108/min, with thready pulse, Temp 38.6C, with spontaneous gum and nose bleeding. She was seen lethargic and slow to response. Both Dengue IgM and IgG were positive. What is the most immediate clinical management for this patient?
a. Administration of platelet concentrate
b. Administration of fresh frozen plasma
c. Administration of crystalloid
d. Administration of colloid
c. Administration of crystalloid
60
A 20/F consulted due to fever, myalgia, headache, retro-orbital pain and rashes. Symptoms started 6 days ago. Dengue IgM and IgG were positive. Which of the following BEST describes the epidemiologic and clinical features of this viral illness?
a. Incubation period is 3-10 days
b. Rashes usually begins on the face and spreads to the trunk and extremities
c. Laboratory findings include leukopenia, thrombocytopenia, and, in many cases, elevations of serum aminotransferase concentrations
d. The vector responsible for infection, A. aegypti mosquitoes, are night biters and typically breed near human habitation, using relatively fresh water from sources such as water jars, vases, discarded containers, coconut husks, and old tires
c. Laboratory findings include leukopenia, thrombocytopenia, and, in many cases, elevations of serum aminotransferase concentrations
61
A 28-year-old female on her 2nd trimester of pregnancy consulted regarding tetanus vaccination during pregnancy. What will you advise her?
a. Tetanus vaccination is contraindicated during pregnancy
b. 2 doses of tetanus toxoid 4 weeks apart
c. 2 doses of tetanus toxoid on third trimester, 6 weeks apart
d. 1 dose of tetanus vaccination now and another dose on or after giving birth
b. 2 doses of tetanus toxoid 4 weeks apart
62
A 20/M, construction worker, with unrecalled vaccination history, was admitted due to fever, trismus, sweating and difficulty swallowing. Your primary consideration is Tetanus infection. Which of the following is TRUE regarding his case?
a. It is caused by aerobic, gram-positive, spore forming rod
b. The toxin enters the vascular system and is transported to the neuromuscular junctions
c. Infection can be seen in patients with no puncture entry wound
d. Clinical manifestations occur only after tetanus toxin reached the postsynaptic inhibitory nerves
c. Infection can be seen in patients with no puncture entry wound
63
A 35-year-old pregnant patient on 28 weeks AOG came to ER due to dog bite on her right foot. The wound was deep and bled spontaneously. Based on DOH AO 2018-0013 on the Guidelines on the management of Rabies Exposures, you should give the following intramuscularly as post-exposure prophylaxis.
a. Rabies vaccine and rabies Ig are contraindicated in pregnancy
b. Rabies vaccine until Day 28; Rabies Ig is contraindicated
c. 1 dose rabies Ig and post rabies vaccine until Day 7
d. 1 dose rabies Ig and post rabies vaccine until Day 28
c. 1 dose rabies Ig and post rabies vaccine until Day 7
64
A 45/M, who was bitten by a dog 2 weeks ago, presented at the ER due to hydrophobia and aerophobia. Primary consideration was rabies infection. Which of the following best describes the pathogenesis of rabies virus in the nervous system?
a. Rabies virus spreads centrifugally along the peripheral nerves via antegrade axonal transport
b. Rabies virus spreads centripetally along the autonomic nerves via antegrade axonal transport
c. Rabies virus spreads centripetally along the autonomic nerves via retrograde axonal transport
d. Rabies virus spreads centripetally along the peripheral nerves via retrograde axonal transport
d. Rabies virus spreads centripetally along the peripheral nerves via retrograde axonal transport
65
A 65-year-old came to your clinic for executive check-up and is asking about vaccination against “pneumonia”. He has no other co-morbid conditions. Based on the PSMID Adult Immunization Guidelines, what will you recommend?
a. PCV-13 now then PPSV-23 a year later
b. PCV-13 now then PPSV-23 4 weeks later
c. PPSV-23 now then PCV-13 a year later
d. PPSV-23 now then PCV-13 4 weeks later
a. PCV-13 now then PPSV-23 a year later
66
A 20-year-old male who received Rabies Ig and rabies vaccine one month ago went to your clinic inquiring on timing of MMR vaccine. What will you advise regarding the interval of vaccination?
a. 4 weeks after rabies Ig
b. 4 months after rabies Ig
c. 6 weeks after rabies Ig
d. 6 months after rabies Ig
b. 4 months after rabies Ig
67
40-year-old male with history of travel from Samar one month ago where he engaged in swimming and recreational activities consulted due to fever, body malaise, myalgia, headache, and abdominal pain. Physical examination showed hepatosplenomegaly and inguinal lymphadenopathy. CBC was done, showing elevated eosinophils.
How will you confirm the diagnosis?
a. Stool PCR test
b. Serology
c. Blood culture
d. Detection of eggs in stool
d. Detection of eggs in stool
68
40-year-old male with history of travel from Samar one month ago where he engaged in swimming and recreational activities consulted due to fever, body malaise, myalgia, headache, and abdominal pain. Physical examination showed hepatosplenomegaly and inguinal lymphadenopathy. CBC was done, showing elevated eosinophils.
What is the treatment of choice for this patient?
a. Albendazole
b. Praziquantel
c. Ivermectin
d. Diethylcarbamazine
b. Praziquantel
69
A 40-year-old male with history of travel from Samar one month ago where he engaged in swimming and recreational activities consulted due to fever, body malaise, myalgia, headache, and abdominal pain. Physical examination showed hepatosplenomegaly and inguinal lymphadenopathy. CBC was done, showing elevated eosinophils.
The patient asks you on how he got infected. What will you tell him regarding its mode of transmission?
a. Ingestion of metacercariae in freshwater fish
b. Ingestion of metacercariae in crayfish or crabs
c. Skin penetration by cercariae released from snails
d. Ingestion of eggs from soil
c. Skin penetration by cercariae released from snails
70
A 45-year-old female with history of travel to Sudan consulted due to fever spikes, chills and rigors occurring every 2 days, associated with headache, fatigue and myalgia. Peripheral blood smear was done showing infected young RBCs with black pigment.
What is the likely organism involved?
a. Plasmodium falciparum
b. Plasmodium vivax
c. Plasmodium ovale
d. Plasmodium malariae
a. Plasmodium falciparum
71
A 45-year-old female with history of travel to Sudan consulted due to fever spikes, chills and rigors occurring every 2 days, associated with headache, fatigue and myalgia. Peripheral blood smear was done showing infected young RBCs with black pigment.
What is the recommended treatment if her illness remains to be uncomplicated?
a. Mefloquine
b. Primaquine
c. Artemether-lumefantrine
d. Quinidine
c. Artemether-lumefantrine
72
A 77/M, smoker, known with Hypertension and Type 2 DM presented at the ER due to fever, cough, nasal congestion, body malaise and anorexia. His latest HbA1c one month ago was at 6.8%. At the ER, oxygen saturation is 95%, CBG of 120 mg/dL. Initial Chest X-ray done showed cleared lungs. RT-PCR for SARS-COV2 yielded positive results.
What will be the next management?
a. Send home and advise isolation
b. Admit to COVID-19 ward and give supportive care
c. Send to quarantine facility
d. Start empiric antibiotics
b. Admit to COVID-19 ward and give supportive care
73
A 40/F with RHD was admitted due to fever, shortness of breath and easy fatigability. A TTE was done, showing an oscillating mass on the mitral valve. Blood Culture showed growth of methicillin-sensitive S. aureus (MSSA). What is the best course of treatment?
a. Cefazolin x 4 weeks
b. Ampicillin plus Gentamicin x 4 weeks
c. Vancomycin plus Gentamicin plus Rifampin x 4 weeks
d. Ceftriaxone x 4 weeks
a. Cefazolin x 4 weeks
74
A 20/M, injecting drug user was referred to you due to 2-week history of intermittent fever, palpitations, chest pain and headache. On physical examination, he is febrile with temperature of 38.8C. You also noted conjunctival hemorrhage and a grade 3/6 murmur on the parasternal area. Blood culture was done showing growth of MRSA. 2D Echo was done showing vegetation on the tricuspid valve. Which of the following findings will give you a definite diagnosis of infective endocarditis?
a. Fever, (+) Blood culture, conjunctival hemorrhage
b. Vegetation on 2D Echo, injecting drug user, (+) Blood culture
c. Fever, Injecting Drug user, vegetation on 2D Echo
d. Fever, conjunctival hemorrhage, injecting drug user
b. Vegetation on 2D Echo, injecting drug user, (+) Blood culture
75
An 80/M known with severe aortic stenosis underwent valve replacement surgery. 8 months after, he developed intermittent fever, shortness of breath, easy fatigability, bipedal edema and a new onset 3/6 systolic murmur. What is the most likely etiologic agent?
a. viridans Strep
b. S. aureus
c. Cardiobacterium hominis
d. Coagulase-negative staphylococci
d. Coagulase-negative staphylococci
76
A 20/F with history of congenital heart disease underwent repair of ASD when she was a child, with no complications. She consulted for prophylaxis prior to dental tooth extraction. What will you advise her?
a. No need for prophylaxis
b. Take Amoxicillin 2g 1 hour prior to dental procedure
c. Take Clindamycin 600mg 1 hour prior to dental procedure
d. Ceftriaxone 1gm IM prior to dental procedure
a. No need for prophylaxis
77
A 22/M developed high grade fever and body malaise, with dry persistent cough, coryza and conjunctivitis. On PE, you noted bluish white lesions on the buccal mucosa; rashes apparently started on the ears, neck then back, spreading to trunks and arms.
Most likely diagnosis is:
a. Measles
b. German Measles
c. Hand Foot and Mouth disease
d. Varicella Infection
a. Measles
78
A 22/M developed high grade fever and body malaise, with dry persistent cough, coryza and conjunctivitis. On PE, you noted bluish white lesions on the buccal mucosa; rashes apparently started on the ears, neck then back, spreading to trunks and arms.
Which of the following vitamin is an effective treatment shown to reduce morbidity and mortality in this case?
a. Vitamin E
b. Vitamin D
c. Vitamin C
d. Vitamin A
d. Vitamin A
79
A 53/M consulted due to right trunk pain along the distribution of T6-T8 dermatome, with no other symptoms. He has unrecalled history of varicella infection. You are still considering herpes-zoster infection. In how many days are rashes expected to appear from onset of pain?
a. in 24 hours
b. in 1-2 days
c. in 2-3 days
d. in 3-5 days
c. in 2-3 days
80
A 40/M farmer admitted at the Orthopedic unit was referred to you due to fever, severe right leg pain and hypotension. He sustained a right leg fracture due to vehicular accident and underwent ORIF. On physical examination, he is in severe pain, and you noted a foul-smelling serosanguineous wound discharge. The right leg also appeared mottled, with brawny color, edematous and with bullous lesions. What is the likely diagnosis?
a. Pyomyositis
b. Clostridial Myonecrosis
c. Acute Osteomyelitis
d. Necrotizing Fasciitis
b. Clostridial Myonecrosis
81
A 58/M diabetic, construction worker presented at the ER due to fever, chills, left foot wound with swelling and foul-smelling wound discharge. He accidentally stepped on a nail 1 week ago. On PE, you noted blackish discoloration on the left foot. Blood CS was obtained, showing Gram positive cocci in chains. What is the most appropriate antibiotic therapy for this patient?
a. Ampicillin-sulbactam 1.5gm every 6 hours
b. Vancomycin 1gm IV every 12 hours
c. Clindamycin 600mg IV every 6 hours plus Penicillin G 4 million units IV every 4 hours
d. Ampicillin 2g IV every 4 hours plus Clindamycin 600mg IV every 6 hours plus
Ciprofloxacin 400mg IV every 6 hours
c. Clindamycin 600mg IV every 6 hours plus Penicillin G 4 million units IV every 4 hours
82
An 83/F consulted due to sudden onset painful red swelling of the left nasolabial fold with well-defined margins; with bullae formation on the 2nd day. What is the appropriate treatment?
a. IV Clindamycin
b. IV Oxacillin
c. IV Penicillin
d. IV Vancomycin
c. IV Penicillin
83
A 75/F was rushed to the ER due to 1 day history of severe right knee pain, swelling, with limited range of motion, accompanied by fever and chills. She denies any history of trauma on the right knee. On physical examination, right knee joint is swollen, warm to touch, with limited ROM. Arthrocentesis and synovial fluid analysis were done.
Which of the following is an expected finding?
a. Synovial fluid cell count of <180/uL with mononuclear predominance
b. Synovial fluid cell count of 20,000/uL, with 60% neutrophils, 40% lymphocytes
c. Synovial fluid cell count of 150,000/uL with neutrophilic predominance
d. Synovial fluid cell count 30,000/uL with lymphocytic predominance
c. Synovial fluid cell count of 150,000/uL with neutrophilic predominance
84
A 75/F was rushed to the ER due to 1 day history of severe right knee pain, swelling, with limited range of motion, accompanied by fever and chills. She denies any history of trauma on the right knee. On physical examination, right knee joint is swollen, warm to touch, with limited ROM. Arthrocentesis and synovial fluid analysis were done.
What is the LEAST likely etiologic agent involved in this case?
a. Streptococcus pneumoniae
b. Staphylococcus aureus
c. Mycobacterium tuberculosis
d. Gram-negative bacilli
c. Mycobacterium tuberculosis
85
A 22-year-old commercial sex worker with history of untreated gonorrhea had 10-day history of intermittent fever, chills, and joint pains involving her right elbow, right wrist, left knee and left ankle. Arthrocentesis and synovial fluid aspirate gram stain were done revealing a gram negative intracellular monococci and diplococci. Which of the following is TRUE of this case?
a. Men are at greater risk of acquiring gonococcal arthritis
b. True gonococcal septic arthritis is less common than disseminated gonococcal infection (DGI) and always follows DGI
c. Gonococcal septic arthritis usually involves multiple joints such as hip, ankle, knee or wrist d. Blood cultures are almost always positive in most cases of gonococcal septic arthritis
b. True gonococcal septic arthritis is less common than disseminated gonococcal infection (DGI) and always follows DGI
86
A 45/M, chronic alcoholic with cirrhosis consulted due to 2-day history of fever, generalized abdominal pain, body malaise, fatigue and nausea. On physical examination, there is ascites and tenderness on all abdominal quadrants
Which of the following is TRUE of his case?
a. The most common manifestation is abdominal pain
b. It is most commonly associated with single organism
c. An abdominal CT scan can help in establishing diagnosis
d. Empiric treatment includes anaerobic coverage
b. It is most commonly associated with single organism
87
A 45/M, chronic alcoholic with cirrhosis consulted due to 2-day history of fever, generalized abdominal pain, body malaise, fatigue and nausea. On physical examination, there is ascites and tenderness on all abdominal quadrants
What prophylactic regimen can you give in this patient given that he has normal renal function?
a. Metronidazole 500 mg 3x/day
b. Ciprofloxacin 250 mg 2x/day
c. Metronidazole 500 mg weekly
d. Ciprofloxacin 500 mg weekly
d. Ciprofloxacin 500 mg weekly
88
A 55/M diabetic with history of nephrolithiasis consulted due to progressive and worsening right flank pain of 3 months duration, now associated with fever, chills, nausea and vomiting. Diagnostics were done including urine CS, blood CS and KUB imaging. Ultrasound showed subcapsular abscess in the right kidney. What is the most likely organism involved?
a. E. coli
b. S. aureus
c. Anaerobes
d. Mixed flora
a. E. coli
89
A 40/F consulted due to numbness of her fingers and toes. She also claimed that she has nonpruritic hypopigmented lesions on her right arm which started 1 year ago. On physical examination, there is decreased sensation at the tips of her fingers and toes. You also noted dry scaling skin with several symmetrically distributed skin nodules and plaques on the extremities, back, face, with decreased sensation. There is also loss of the outer two-thirds of both eyebrows and pendulous earlobes. Your primary consideration is Leprosy.
Which spectrum of leprosy is she presenting?
a. Tuberculoid leprosy
b. Lepromatous leprosy
c. Borderline tuberculoid
d. Mid borderline
b. Lepromatous leprosy
90
A 40/F consulted due to numbness of her fingers and toes. She also claimed that she has nonpruritic hypopigmented lesions on her right arm which started 1 year ago. On physical examination, there is decreased sensation at the tips of her fingers and toes. You also noted dry scaling skin with several symmetrically distributed skin nodules and plaques on the extremities, back, face, with decreased sensation. There is also loss of the outer two-thirds of both eyebrows and pendulous earlobes. Your primary consideration is Leprosy.
What is the WHO recommended treatment regimen for her?
a. Dapsone 100 mg/day for 5 years
b. Dapsone 100 mg/day (unsupervised) plus Rifampin 600 mg/month (supervised) for 6 months
c. Dapsone 100 mg/day plus Clofazimine 50 mg/day (unsupervised); and Rifampin 600 mg plus clofazimine 300 mg monthly (supervised) for 1–2 years
d. Rifampin 600 mg/day for 3 years plus Dapsone 100 mg/day indefinitely
c. Dapsone 100 mg/day plus Clofazimine 50 mg/day (unsupervised); and Rifampin 600 mg plus clofazimine 300 mg monthly (supervised) for 1–2 years
91
A 40/F consulted due to numbness of her fingers and toes. She also claimed that she has nonpruritic hypopigmented lesions on her right arm which started 1 year ago. On physical examination, there is decreased sensation at the tips of her fingers and toes. You also noted dry scaling skin with several symmetrically distributed skin nodules and plaques on the extremities, back, face, with decreased sensation. There is also loss of the outer two-thirds of both eyebrows and pendulous earlobes. Your primary consideration is Leprosy.
After months of treatment, she complained of red-black skin discoloration. What drug is the most likely culprit? a. Dapsone
b. Clofazimine
c. Rifampin
d. Look for other causes
b. Clofazimine
92
A 51/M consulted due to 1-month history of fever with temperatures ranging from 38.4 to 38.6C on four occasions. You plan to work-up the patient on FUO.
Which of the following is NOT part of obligatory tests in management of FUO?
a. Procalcitonin
b. IGRA
c. ESR
d. LDH
a. Procalcitonin
93
A 51/M consulted due to 1-month history of fever with temperatures ranging from 38.4 to 38.6C on four occasions. You plan to work-up the patient on FUO.
He had his obligatory tests done with normal results. What is your next best step?
a. Request for chest and abdominal CT scan
b. Request for autoimmune panel
c. Request for tumor markers
d. Review medication history
d. Review medication history
94
A 30/M volunteered to participate in a COVID-19 vaccine clinical trial. As part of the trial’s screening process, he underwent HIV screening test, which turned out positive. He is inquiring which of the following modes of transmission has the highest risk of acquiring HIV infection?
a. Needle sharing during injecting drug use
b. Receptive oral intercourse
c. Unprotected insertive penile-vaginal intercourse
d. Unprotected receptive anal intercourse
d. Unprotected receptive anal intercourse
95
A 31/M, diagnosed with HIV, noncompliant with ART, was admitted due to 2-week history of anorexia, non bloody diarrhea and abdominal pain. Fecalysis and stool culture are negative. He underwent endoscopy, showing multiple mucosal ulcerations; biopsy of the lesions revealed intranuclear and cytoplasmic inclusion bodies. What is the best management for this case?
a. Start on Valacyclovir
b. Give Foscarnet for 7 days
c. Refer to Ophthalmology
d. Repeat stool culture
c. Refer to Ophthalmology
96
A 24-year-old, newly-diagnosed with HIV infection, inquired about prophylaxis for opportunistic infections. He has unremarkable past medical history and denies any symptoms. Physical exam was also unremarkable. You requested for chest x-ray, which showed normal results. CD4+ T cell count was 180/uL. You should give:
a. Azithromycin
b. Co-trimoxazole
c. Itraconazole
d. Valganciclovir
b. Co-trimoxazole
