IDS Flashcards
(101 cards)
1
Q
According to the current definition, which of the following criteria is NOT essential for a diagnosis of FUO?
a) Fever of ≥38.3°C (≥101°F) on at least two occasions
b) Illness duration of ≥3 weeks
c) No known immunocompromised state
d) Diagnosis uncertain after 1 week of inpatient evaluation
A
Correct Answer: d) Diagnosis uncertain after 1 week of inpatient evaluation
Rationale:
The text explicitly states that the requirement for 1 week of inpatient evaluation has been removed from the current definition of FUO.
2
Q
patient with FUO who presents with urticaria, bone pain, and monoclonal gammopathy
A
Schnitzler syndrome,
3
Q
Meaning of DRESS
More common causes of
A
drug reaction with eosinophilia and systemic symptoms; - is often accompanied by eosinophilia and also by
lymphadenopathy, which can be extensive.
4
Q
Drugs that induce fever:
A
allopurinol
carbamazepine
lamotrigine,
phenytoin,
sulfasalazine,
furosemide,
antimicrobial drugs
(especially
sulfonamides, minocycline, vancomycin, β-lactam antibiotics, and
isoniazid),
some cardiovascular drugs
(e.g., quinidine),
and some
antiretroviral drugs (e.g., nevirapine).
5
Q
A
6
Q
Which species of malaria has the longest intrahepatic phase?
A
d) P. malariae
P. malariae has an intrahepatic phase of 15 days.
7
Q
Which species of malaria is most likely to infect older red blood cells?
A
d) P. malariae
P. malariae preferentially infects older red blood cells.
8
Q
Which species of malaria is known to cause relapses?
A
d) Both P. vivax and P. ovale
Both P. vivax and P. ovale are capable of causing relapses.
9
Q
Which species of malaria has a 48-hour erythrocytic cycle?
A
d) Both P. falciparum and P. vivax
Both P. falciparum and P. vivax have an approximate duration of the erythrocytic cycle of 48 hours.
10
Q
Which species of malaria is characterized by banana-shaped gametocytes?
A
a) P. falciparum
P. falciparum often has banana-shaped gametocytes.
11
Q
Which of the following is NOT considered a major manifestation of severe falciparum malaria?
a) Cerebral malaria
b) Acidemia/acidosis
c) Jaundice
d) Severe normocytic, normochromic anemia
A
Answer: c) Jaundice
Rationale: While jaundice can occur in severe malaria, it is listed as an “Other” manifestation in the table, not a “Major” one.
12
Q
What is the defining characteristic of cerebral malaria?
a) High fever
b) Unarousable coma
c) Seizures
d) Headache
A
Answer: b) Unarousable coma
Rationale: The table specifically states that cerebral malaria is characterized by “unarousable coma/failure to localize or respond appropriately to noxious stimuli; coma persisting for >30 min after generalized convulsion.”
13
Q
Which of the following laboratory findings would support a diagnosis of severe anemia in the context of severe falciparum malaria?
a) Hematocrit of 18%
b) Hemoglobin level of 8 g/dL
c) Platelet count of 50,000/μL
d) White blood cell count of 12,000/μL
A
Answer: a) Hematocrit of 18%
Rationale: The table defines severe anemia as a hematocrit of <15% or hemoglobin level of <5 g/dL
14
Q
What is the threshold for defining hypoglycemia in severe falciparum malaria?
a) Plasma glucose < 40 mg/dL
b) Plasma glucose < 70 mg/dL
c) Plasma glucose < 100 mg/dL
d) Plasma glucose < 150 mg/dL
A
Answer: a) Plasma glucose < 40 mg/dL
15
Q
Which of the following is NOT a criterion for diagnosing acidemia/acidosis in severe falciparum malaria?
a) Arterial pH of <7.25
b) Base deficit >8 meq/L
c) Venous lactate level of >5 mmol/L
d) Respiratory rate >20 breaths/minute
A
Answer: d) Respiratory rate >20 breaths/minute
Rationale: While increased respiratory rate is a common finding in metabolic acidosis (as the body tries to compensate by expelling more CO2), it is not explicitly listed as a diagnostic criterion for acidemia/acidosis in this table.
16
Q
What is the definition of hyperparasitemia in severe falciparum malaria?
a) Parasitemia level of >1%
b) Parasitemia level of >5% in non-immune patients
c) Parasitemia level of >10% in any patient
d) Parasitemia level of >20% in any patient
e) b and c
A
Answer: e) b and c (Parasitemia level of >5% in non-immune patients and >10% in any patient)
Rationale: The table states that hyperparasitemia is defined as a parasitemia level of >5% in non-immune patients and >10% in any patient.
17
Q
Which of the following is a characteristic feature of hemoglobinuria in severe falciparum malaria?
a) Associated with G6PD deficiency
b) Typically associated with dark urine due to the presence of blood
c) Usually caused by medications
d) Not associated with effects of oxidant drugs or red blood cell enzyme defects
A
Answer: d) Not associated with effects of oxidant drugs or red blood cell enzyme defects
Rationale: The table specifically states that hemoglobinuria in severe falciparum malaria is “not associated with effects of oxidant drugs and red blood cell enzyme defects (such as G6PD deficiency).”
18
Q
species of malaria associated with development of Burkitt type Lymphoma
A
P. Falciparum
19
Q
What is the first-line treatment for uncomplicated malaria caused by chloroquine-sensitive strains of Plasmodium falciparum?
a) Chloroquine alone
b) Artesunate plus sulfadoxine-pyrimethamine
c) Artesunate plus amodiaquine
d) Artesunate plus mefloquine
A
Answer: b) Artesunate plus sulfadoxine-pyrimethamine
Rationale: The table lists “Artesunate (4 mg/kg qd for 3 days) plus sulfadoxine (25 mg/kg)/pyrimethamine (1.25 mg/kg) as a single dose” as one of the first-line treatment options for uncomplicated P. falciparum malaria.
20
Q
Which medication is used for radical treatment of P. vivax or P. ovale infections to prevent relapses?
a) Chloroquine
b) Primaquine
c) Artesunate
d) Mefloquine
A
Answer: b) Primaquine
Rationale: The table specifically mentions primaquine as the medication used for radical treatment to prevent relapses in P. vivax and P. ovale infections.
21
Q
What is the recommended treatment duration for severe falciparum malaria with artesunate?
a) 3 days
b) 5 days
c) 7 days
d) 10 days
A
Answer: c) 7 days
Rationale: The table states that the recommended treatment for severe falciparum malaria with artesunate is “Artesunate (2.4 mg/kg stat IV followed by 2.4 mg/kg at 12 and 24 h and then daily if necessary, for children weighing <20 kg, give 3 mg/kg per dose)”
1 for 7 days.
22
Q
Which of the following medications can be used as part of the second-line treatment for imported malaria?
a) Chloroquine
b) Primaquine
c) Doxycycline
d) Sulfadoxine-pyrimethamine
A
Answer: c) Doxycycline
Rationale: The table lists doxycycline as one of the options for second-line treatment of imported malaria, typically used in combination with other medications like artesunate or quinine.
23
Q
Which drug is known to have a significant risk of hemolytic anemia in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency?
a) Quinine
b) Chloroquine
c) Primaquine
d) Mefloquine
A
Answer: c) Primaquine
24
Q
Which drug is most likely to cause neuropsychiatric reactions, including convulsions and encephalopathy?
a) Quinine
b) Chloroquine
c) Primaquine
d) Mefloquine
A
Answer: d) Mefloquine
25
Which drug is considered effective against multidrug-resistant P. falciparum malaria, but resistance has emerged in Southeast Asia?
a) Quinine
b) Chloroquine
c) Piperaquine
d) Amodiaquine
Answer: c) Piperaquine
26
Which drug primarily acts on the trophozoite stage of the parasite and has no action on the liver stages?
a) Quinine
b) Chloroquine
c) Primaquine
d) Mefloquine
Answer: a) Quinine
27
Which drug is considered a radical cure for Plasmodium vivax and Plasmodium ovale infections, eliminating both blood and liver stages of the parasite?
a) Quinine
b) Chloroquine
c) Primaquine
d) Mefloquine
Answer: c) Primaquine
Answer: c) Primaquine
28
What is the most effective time to avoid mosquito exposure?
a) Midday
b) Dusk
c) Dawn
d) Dusk to dawn
Answer: d) Dusk to dawn
29
Which of the following is NOT mentioned as a measure to reduce mosquito bites?
a) Using insect repellents with DEET
b) Wearing long-sleeved clothing
c) Using mosquito nets treated with pyrethroids
d) Avoiding areas with high humidity
Answer: d) Avoiding areas with high humidity
30
What is the recommended percentage of DEET in insect repellents?
a) 5-10%
b) 10-35%
c) 35-50%
d) 50-75%
Answer: b) 10-35%
Answer: b) 10-35%
31
Chemoprophylaxis for Resistant P.Falciparum:
atovaquone-proganil, doxycycline pr mefloquine
32
Chemoprophylaxis mainly for P. vivax
Primaquine
33
Anti-relapse therapy for P vivax and P ovale:
Primaquine
34
According to the table, a 21 year-old with an HIV infection would be classified as having Stage 3 if their CD4+ T lymphocyte count is below:
a) 200 cells/µL
b) 500 cells/µL
c) 1000 cells/µL
d) 1500 cells/µL
Answer: a) 200 cells/µL
35
HIV is an RNA virus whose hallmark is _________. The
replication cycle of HIV begins with the high-affinity binding via
surface-exposed residues within the _______ to its receptor on
the host cell surface, __________.
the reverse transcription of its
genomic RNA to DNA by the enzyme reverse transcriptase.
gp120 protein
the CD4 molecule
36
The two major co-receptors for HIV-1 :
CCR5 and CXCR4.
37
HIV-1 binds to
its target cell via the _______, leading to a conformational change in the
_________ that allows it to bind to the co-receptor _________. The virus then firmly attaches to the host cell membrane in a coiledspring fashion via the newly exposed_______ .
CD4 molecule
gp120 molecule
CCR5 (for R5-using
viruses).
gp41 molecule
38
Most common mode of HIV transmission:
Type of sexual practice with Highest risk of transmission:
Heterosexual
Receptive Anal intercourse
39
HIV:
long-term non-progressors if: they had been infected with HIV for a
long period (___ years), their CD4+ T-cell counts were in the normal
range, their plasma viremia remained relatively low (undetectable to
several thousand copies of HIV RNA/ml plasma), and they remained
clinically stable over years without receiving ART
others move on to require ART eventually and the remaining 1% that remains to have low viral load are called_________
≥10
Elite controllers
40
Accessory receptor that likely plays an important role in the transmission
of HIV at mucosal surfaces such as the genital tract and gut and
contributes somewhat to the pathogenesis of HIV disease.
Integrin α4β7
41
antibodies to HIV generally appear in the circulation for how many weeks
following infection?
3–12 weeks
42
Case:
A 28-year-old male presents to a clinic in Cebu City, Philippines with a history of unprotected sexual intercourse with multiple partners. He reports fatigue, weight loss, and persistent fever for the past month. You suspect HIV infection.
Question:
Based on the provided algorithm, what is the next step in the diagnostic workup for this patient?
Answer Options:
a) Perform an HIV-1/HIV-2 Western Blot assay
b) Begin antiretroviral therapy immediately
c) Order an HIV-1/HIV-2 EIA screening test
d) Repeat the HIV-1/HIV-2 EIA in 4-6 weeks
Correct Answer: c) Order an HIV-1/HIV-2 EIA screening test
43
Let's assume the initial HIV-1/HIV-2 EIA screening test comes back positive. What is the next step in the diagnostic workup according to the algorithm?
Answer Options:
a) Repeat the HIV-1/HIV-2 EIA immediately
b) Begin antiretroviral therapy
c) Perform an HIV-1 Western Blot assay
d) Refer the patient to a specialist for further evaluation
a) Repeat the HIV-1/HIV-2 EIA immediately
44
If the initial HIV-1/HIV-2 EIA screening test is positive, but the subsequent HIV-1 Western Blot assay is indeterminate, what is the next recommended step according to the algorithm?
Answer Options:
a) Repeat the HIV-1/HIV-2 EIA immediately
b) Repeat the HIV-1 Western Blot assay immediately
c) Repeat the test in 4-6 weeks
d) Begin antiretroviral therapy
Correct Answer: c) Repeat the test in 4-6 weeks
45
If the initial HIV-1/HIV-2 EIA screening test is positive, and the subsequent HIV-1 Western Blot assay is negative, what is the next recommended step according to the algorithm?
Answer Options:
a) HIV-2 EIA
b) Repeat the HIV-1 Western Blot assay immediately
c) Repeat the test in 4-6 weeks
d) Begin antiretroviral therapy
a) HIV-2 EIA
46
If the initial HIV-1/HIV-2 EIA screening test is positive, and the subsequent HIV-1 Western Blot assay is negative, and the HIV 2 EIA came back negative, what is the next recommended step according to the algorithm?
Answer Options:
a) Go ahead with HIV-2 Western Blot assay
b) Repeat the HIV-1 Western Blot assay immediately in 4-6 weeks
c) Re-test in 3-6 months if clinically indicated
d) Begin antiretroviral therapy
c) Re-test in 3-6 months if clinically indicated
47
A 30-year-old female presents to a clinic in Cebu City with complaints of fatigue, fever, and night sweats for the past month. She reports having unprotected sexual intercourse with a new partner recently.
Follow-up Question 1:
Based on the algorithm, what is the initial diagnostic test that should be performed on this patient?
Answer Options:
a) HIV-1 Western Blot assay
b) HIV-1 RNA (viral load) test
c) HIV-1/HIV-2 Antigen/Antibody Combination Immunoassay
d) CD4+ T-cell count
Correct Answer: c) HIV-1/HIV-2 Antigen/Antibody Combination Immunoassay
Rationale:
The algorithm clearly indicates that the initial screening test for HIV infection is the HIV-1/HIV-2 Antigen/Antibody Combination Immunoassay.
48
Let's assume the initial HIV-1/HIV-2 Antigen/Antibody Combination Immunoassay result is positive. What is the next step in the diagnostic workup?
Answer Options:
a) Repeat the HIV-1/HIV-2 Antigen/Antibody Combination Immunoassay
b) Proceed directly to antiretroviral therapy
c) Perform an HIV-1/HIV-2 antibody differentiation immunoassay
d) Order a CD4+ T-cell count
Correct Answer: c) Perform an HIV-1/HIV-2 antibody differentiation immunoassay
49
The HIV-1/HIV-2 antibody differentiation immunoassay came back indeterminate, what will you test?
HIV 1 NAT
50
Level of CD4 to start prophy for PCP?
Recommended DRUG prophylaxis for PCP?
What are the alternatives?
When to Stop?
<200/ OROPHARYNGEAL CANDIDIASIS/PRIOR BOUT OF PCP
TMP SMX 1 DS QD PO
Dapsone/
Dapsone+Pyrimethamine+Leucovorin
Pentamidine/
Atovaquone/
>200 CD4 for 3 months or more
51
Level of CD4 to start prophy for MAC?
Recommended DRUG prophylaxis for MAC?
Alternatives?
When to Stop?
<50
Azithromycin 1200 mg weekly
Clarithromycin 500 mg BID PO
Rifabutin
Once ART is initiated
52
Level of CD4 to start prophy for T.gondii ?
Recommended DRUG prophylaxis for T.gondii?
Alternatives?
When to Stop?
<100 and TOXO IgG Ab +
TMP-SMX DS TAB QD PO
TMP-SMX 1 DS 3X WEEKLY/
TMP-SMX, 1 SS PO DAILY/
Dapsone+Pyrimethamine+Leucovorin
Atovaquone+Pyrimethamine+Leucovorin/
>200 IN 3 MONTHS OR MORE
53
IF WITH PRIOR TOXOPLASMA ENCEPHALITIS + CD4 <200?
SULFADIAZINE + PYRIMETHAMINE+ LEUCOVORIN
TMPSMX 1 DS BID
54
THE FOLLOWING ARE RECOMMENDED VACCINATION FOR HIV EXCEPT:
A. MMR
B. INLFUENZA
C. HEPATITIS A AND B
D. PNEUMOCOCCAL
E. HPV
A
55
SCHEDULE FOR PNEUMOCOCCAL VACCINATION?
PCV 13 1 DOSE THEN FOLLOWED BY PPSV 23 AFTER 8 WEEKS OR MORE IF CD4 >200
RE IMMUNIZE IF WITH CD4 <100
56
Which of the following hemodynamic changes is characteristic of distributive shock?
A. Increased CVP, increased cardiac output, decreased systemic vascular resistance
B. Decreased CVP, decreased cardiac output, increased systemic vascular resistance
C. Decreased CVP, increased cardiac output, decreased systemic vascular resistance
D. Increased CVP, decreased cardiac output, increased systemic vascular resistance
Answer: C
57
In cardiogenic shock, how do central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) typically change?
A. Both CVP and PCWP are increased
B. Both CVP and PCWP are decreased
C. CVP is increased, but PCWP is decreased
D. CVP is decreased, but PCWP is increased
Answer: A
58
T or F
“Sepsis-3” clinical criteria for sepsis include
(1) a suspected
infection
(2) acute organ dysfunction
defined as an increase by
2 or more points from baseline (if known) on the sequential
(or sepsis-related) organ failure assessment (SOFA) score
True
59
According to the 2016 (Sepsis-3) criteria, which of the following is required to diagnose septic shock?
A. Persistent hypotension despite vasopressor therapy and serum lactate >2.0 mmol/L
B. Documented infection plus ≥2 SIRS criteria
C. Documented infection and an increase in SOFA score of ≥4 points
D. Fever >38°C and leukocytosis >12,000/μL
Answer: A
60
Which of the following is a distinguishing feature of sepsis as per the 2016 (Sepsis-3) criteria?
A. Suspected or documented infection plus ≥2 systemic inflammatory response syndrome (SIRS) criteria
B. A life-threatening organ dysfunction with an acute increase in ≥2 SOFA points
C. Persistent arterial hypotension despite fluid resuscitation
D. Signs of infection, oliguria, and hyperlactatemia
B
61
Components of SOFA score except:
a. RR
b. BP
c. WBC count
d. Creatinine
C
62
What is the recommended initial fluid resuscitation for patients with sepsis or septic shock?
A. 20 mL/kg of IV colloids within the first 3 hours
B. 30 mL/kg of IV crystalloids within the first 3 hours
C. 10 mL/kg of saline within the first 6 hours
D. 30 mL/kg of IV blood products immediately
B
63
Which of the following vasopressors is recommended as the first choice in septic shock management?
A. Dopamine
B. Vasopressin
C. Dobutamine
D. Norepinephrine
D
64
In which situation is a red blood cell transfusion recommended in patients with sepsis or septic shock?
A. When serum lactate levels are elevated
B. When hemoglobin drops below 7.0 g/dL without acute myocardial infarction or severe hypoxemia
C. When the target mean arterial pressure is not achieved
D. When evidence of hypoperfusion persists despite adequate fluid loading
B
65
within how many hours should empiric antibiotics be given once sepsis is suspected?
a. 1
b. 2
c. 3
d. 4
A
For every 1-h delay among septic
patients, a 3−7% increase in the odds of in-hospital death is
reported. Thus, international clinical practice guidelines recommend
the administration of appropriate broad-spectrum antibiotics within 1
h of recognition of sepsis or septic shock
66
In a patient with neutropenia (<500 neutrophils/µL) and suspected central line-associated bloodstream infection, which of the following antibiotic regimens would be appropriate?
a) Cefepime 2 g q8h
b) Cefepime 2 g q8h + vancomycin
c) Meropenem 1 g q8h
d) Meropenem 1 g q8h + vancomycin
Answer: b) Cefepime 2 g q8h + vancomycin
67
A patient with a history of splenectomy presents with fever and suspected pneumonia. Which of the following antibiotics would be the most appropriate initial treatment?
a) Ceftriaxone 2 g q24h
b) Cefepime 2 g q8h
c) Meropenem 1 g q8h
d) Vancomycin 1 g q24h
Answer: a) Ceftriaxone 2 g q24h
68
Which of the following is NOT a component of the management bundle for severe sepsis and septic shock?
a) Measurement of serum lactate levels
b) Administration of intravenous fluids
c) Initiation of broad-spectrum antibiotics
d) Immediate surgical intervention
Answer: d) Immediate surgical intervention
69
True regarding de-escalation of care in sepsis:, except
a. The deescalation of initial broad-spectrum therapy, which observational
evidence indicates is safe, may reduce the emergence of resistant
organisms as well as potential drug toxicity and costs.
B. Current guidelines recommend combination antimicrobial therapy only for neutropenic sepsis and sepsis caused
by Pseudomonas.
C. Procalcitonin should be monitored as studies consistently show that its use has a mortality benefit
D. There is no consensus on antibiotic
de-escalation criteria.
C
70
true or false:
a. Among those with suspected dengue
infections, we recommend the use of dengue NS1 rapid diagnostic tests.
b. Dengue NS1 RDT is most useful in the
following situations:
* individuals presenting within 5 days of
symptom onset
c. Patients with no previous history of
dengue infection
A. True
b. False
c. true
71
Among patients with suspected dengue
infection who present more than 5 days from
onset of symptoms, we recommend the use of
rapid diagnostic test with Dengue IgM/IgG
antibodies.
truie
72
Dengue:
CBC monitoring may be discontinued when
the patient is in the recovery phase (e.g.
increasing platelet count trend, 48 hours
afebrile, adequate urine output, and improved sense of well-being/appetite).
True
73
Among patients with confirmed or probable
dengue fever, we recommend against the use
of acid suppressants for the prevention of
gastrointestinal bleeding or abdominal pain.
True
74
Among patients with confirmed dengue
infection, we suggest giving papaya (Carica
papaya) leaf extract or juice preparations as a
supplement to standard therapy.
True
75
Among individuals at risk for dengue infection,
we suggest against the DEET repellents for
the prevention of dengue.
False
Among individuals at risk for dengue infection,
we suggest against the use of plant-based
non-DEET extracts over DEET repellents for
the prevention of dengue.
76
WHO case definitions of dengue infection/spectrum
severe dengue except;
a. Fluid accumulation with distress
b. AST > 3x upper limit
c. Severe bleeding
d. Hypotension
B. >1000
77
Infectious Diarrhea CPG
The change in stool consistency is more important to consider than the
change in stool frequency in assessing if a patient has diarrhea.
Bloody diarrhea is a specific sign for Shigella, Campylobacter, rotavirus and norovirus
Routine stool examination is not indicated in acute watery diarrhea, except in cases where parasitism is suspected or in the presence of bloody diarrhea.
true
true
true
78
Stool cultures are indicated only for severe cases (significant dehydration, high fever,
persistent vomiting, severe abdominal pain, dysenteric stool); high risk of transmission of
enteric pathogens (food handlers); high risk of complications; and for epidemiologic
purposes (when there is suspicion of an outbreak that is enteric in origin). Stool culture should be requested within 3 days of symptom onset and before administration of
antibiotics to ensure that its yield is highest.
true
79
Which of the following blood tests may be useful in distinguishing bacterial from non-bacterial? viral acute infectious diarrhea?
a. Calprotectin
b. Lactoferrin
c. CRP
d. Prolactin
A
BAsed on CPG
80
A 55-year-old male presents to the emergency department with a 2-day history of vomiting and diarrhea. He is noted to have sunken eyes, dry oral mucosa, and a respiratory rate of 24 breaths per minute. His blood pressure is 100/60 mmHg, and his pulse is 110 beats per minute. Based on the table, which of the following best describes his level of dehydration?
A) Mild dehydration
B) Moderate dehydration
C) Severe dehydration
D) No dehydration
Rationale for Question 1:
Correct Answer: B) Moderate dehydration
Explanation: The patient exhibits multiple signs consistent with moderate dehydration: sunken eyes, dry oral mucosa, increased respiratory rate (24), orthostatic hypotension (blood pressure 100/60 with likely postural changes), and increased pulse rate (110). While he doesn't have all the signs of severe dehydration (like coma or shock), he clearly surpasses the criteria for mild dehydration.
81
A patient with moderate dehydration is being assessed. According to the table, which of the following urine output values (ml/kg/hr) would be most consistent with this classification?
A) <0.5
B) ≥0.5
C) ≥1.0
D) Normal urine output is not a reliable indicator of dehydration severity.
Rationale for Question 2:
Correct Answer: A
Explanation: The table indicates that in moderate and severe dehydration, the urine output is typically <0.5 ml/kg/hr.
82
Which of the following clinical manifestations is NOT typically associated with moderate dehydration in adults according to the table?
A) Thirst
B) Fatigue
C) Moist oral mucosa
D) orthostatic hypotension
Rationale for Question 3:
Correct Answer: C) Moist oral mucosa
Explanation: Mild dehydration is characterized by potential thirst and fatigue (+/-), but the oral mucosa tends to remain moist. In moderate to severe dehydration, the oral mucosa becomes dry.
82
Most clinicians initiate treatment
when the bicarbonate level is very low (HCO3 _______) and the pH is _____ since symptoms such
as myocardial depression, decreased catecholamine efficacy, and arrhythmias are usually noted at
these levels.
<10 meq/L
<7.10
83
This is another possible complication of diarrhea which is best explained by microvascular injury
caused by Shiga-toxin-producing organisms such as Shigella dysenteriae and Shiga-toxin-producing
E. coli (STEC serotype O157:H7)
Hemolytic URemic Syndrome
84
1,000 to 2,000 ml of PLRS within the first hour is recommended for severe dehydration and 500 to 1000 ml for the first 2 hours in moderate dehydration
True
85
Patients with moderate dehydration should be given 500-1,000 mL of IV fluids within 1-2 hours. For
patients with severe dehydration, 1-2 liters of IV fluids should be given within 1 hour. Once
hemodynamic stability has been restored, fluids to replace ongoing losses in addition to maintenance
IV fluid of at least 25-30 mL/kg/day should be given.
True
86
Case: A 36-year old man was rushed to the ER due to worsening dyspnea, accompanied by intermittent undocumented febrile episodes of 2 weeks duration, productive cough with yellowish sputum, 2-pillow orthopnea, and bipedal edema. He is a known case of Heart failure with preserved ejection fraction from uncorrected ASD but has good baseline functional capacity and good compliance with medications. He denies any vices. On physical examination, he was hemodynamically stable but febrile at 38.0C. He had anicteric sclerae, elevated JVP, no CLADs, bibasal rales, Gr 3/6 soft, midsystolic murmur best heard at the 3-4th LPSB, a soft, nontender abdomen with no signs of hepatosplenomegaly, and Grade 1 bipedal edema reaching the ankles. Based on the Modified Duke Criteria, which of the following findings will establish the diagnosis of definite infective endocarditis?
a.
Two separate positive blood cultures yielding Staphylococcus hominis, presence of subungual hemorrhage, and painful, red, raised lesions found on the hands and feet
b.
Two separate positive blood cultures of S. viridans, and echocardiogram finding of mild mitral valve regurgitation
c.
Negative repeated blood cultures, echocardiography findings of an oscillating intracardiac mass on the posterior leaflet of mitral valve
d.
Two separate positive blood cultures yielding E. faecium, presence of painful, red, raised lesions found on the hands and feet, and subungual hemorrhage
D
87
A 22-year-old previously healthy female admitted under OBGYN service was urgently referred to you for co-management. On history, 1 week prior, at 12 weeks AOG, she took abortifacients she bought at a public market, after which spontaneous passage of products of conception was observed. Shortly after, she had hypogastric pain associated with lightheadedness, anorexia and generalized weakness. She denied fevers, dysuria, or any foul-smelling vaginal discharge. On assessment, she was awake but disoriented to place and time, had palpatory BP, hypothermia at 35C, HR of 125 bpm and O2 sats of 92%, pink palpebral conjunctivae, fine bibasal crackles, cool extremities with thready pulses, pink nailbeds, and Gr 1 bipedal edema. IE revealed open cervical os and a palpable uterus. Which of the following is the most appropriate empiric antibiotic treatment in her case?
a.
Cefoxitin 2g IV q6 plus Metronidazole 500 mg IV q6-8 hours
b.
Clindamycin 600-900 mg IV every 8 hours plus ciprofloxacin 400 mg IV q6-q8
c.
Penicillin G 4 million units IV q4 plus Clindamycin 600- 900 mg IV
d.
Vancomycin 1g IV every 12 hours plus metronidazole 500mg IV every 6 hours plus ciprofloxacin 400 mg IV every 6-8 hours
C
gas gangrene of the uterus
88
Poncet’s disease is associated with what condition?
a.
Disseminated gonococcal infection
b.
Mycobacterial arthritis
c.
Lyme arthritis
d.
Syphilitic arthritis
D
89
A 38-year-old male seafarer, married, sought consult at your clinic due to dysuria and urethral discharge. He denied any genital sores or rash on other parts of his body that has been sexually exposed. He admitted to a history of recent unprotected sexual contact with a female sex worker while he was overseas. He had no previous known STI’s. Which will establish the presence of urethritis?
a.
Absence of purulent or mucopurulent discharge even after performing proximal-to-distal milking of the urethra
b.
A first morning urine specimen showing 5 leukocytes per high-power field
c.
A gram stain smear of an anterior urethral specimen revealing 2 neutrophils per 1000x field with no organisms
d.
A first-catch urine specimen with a negative leukocyte esterase test
C
90
A 58 year old diabetic male sought consult at the clinic due to ~4 week history of urinary frequency, dysuria and perineal pain. He denied fevers, anorexia, or nausea/vomiting. He initially sought consult at the local health center and was prescribed a 2-week course of antibiotics, which only had minimal relief of symptoms. He had a urinalysis done after antibiotic treatment, which had findings of WBC 4-6/hpf, few epithelial cells, and few bacteria. What is the next best step in management?
a.
Request for urine and blood cultures then start fluoroquinolones as empiric treatment to complete 4-6 weeks
b.
Request for a KUB with prostate ultrasound and close follow up once with results
c.
Advise intake of cranberry juice for UTI prophylaxis
d.
Consider urology consult
D
91
Which is correct regarding treatment of Varicella zoster?
a.
Valacyclovir, a prodrug of acyclovir, accelerates healing and resolution of zoster-associated pain more promptly than acyclovir.
b.
Treatment for zoster ophthalmicus include the initial use of IV corticosteroids and atropine
c.
In patients with lymphoproliferative malignancies, the dose of acyclovir should be 800mg given orally five times daily for 7-10 days
d.
For low-risk immunocompromised hosts, oral therapy with acyclovir appears beneficial
A
92
Which is a known manifestation of acquired rubella?
a.
Hepatosplenomegaly
b.
Interstitial pneumonitis
c.
Occipital lymphadenopathy during the second week of exposure
d.
Rash as the first sign of illness among adults
B
93
A 28 year old male, person living with human immunodeficiency virus, consulted the clinic due to malaise. He complained of 3-day history of undocumented febrile episodes accompanied by nonproductive cough and coryza. He is on antiretroviral therapy, with last known CD4 count 150 cells/mm3 3 months prior. Which physical examination finding will lead to the most likely diagnosis?
a.
Erythematous macules behind the ears, neck and hairline, progressing to involve the face, trunk and arms
b.
Bluish white dots~1 mm in the buccal mucosa surrounded by erythema
c.
Changes in sensorium
d.
Conjunctivitis
B
94
Which is considered as a risk factor of shock from severe dengue?
a.
Black race
b.
Female sex
c.
Infection after 12 years of age
d.
A dengue virus 4 infection followed by dengue virus 2 infection
B
95
A previously well 65 year old female, homemaker, consulted your clinic due to 3 months’ history of low grade febrile episodes and easy fatigability. She has no known comorbids and does not take any medications or even nutritional supplements. She had no recent travel history. Physical examination, including a baseline fundoscopy and palpation of temporal arteries, was unremarkable. She had sought consult prior and underwent baseline laboratory examination, which revealed mild normocytic, normochromic anemia (Hgb 10.2 g/L), CRP of 40 mg/L and ESR of 88 mm/hr. Metabolic panel was only pertinent of mild hypoalbuminemia. Results of other obligatory tests were normal. What is the next best step in management?
a.
Request for a bone marrow biopsy and culture
b.
Request for FDG PET/CT
c.
Request for a chest and abdominal CT scan
d.
Request for a temporal artery biopsy
B
96
What is the best biochemical test for poor prognosis in severe falciparum malaria?
Elevated Plasma Lactate levels
97
32 yr old male was rushed to the ER due to decrease in sensorium. He had a 2-week history of on and off undocumented febrile episodes with irregular patterns, body malaise, and fatigue. He denied cough/colds, dysuria or BM changes. He self-medicated with Paracetamol but had little relief of symptoms. Around 2 days prior, he had onset of postural dizziness, nausea and vomiting, making him bed bound. 1 hour prior, he was found to be unarousable, prompting consult at the ER. His ancillary history revealed that he had no comorbidities, no known vices, and works as a scuba diving instructor with frequent travels to Palawan. On assessment at the triage, he was GCS 8, with an RR of 30 with subcostal retractions, with BP of 80/50 and temperature of 36.3C. A spot CBG showed hypoglycemia at 35 mg/dL. Regional PE showed icteric sclerae, flat neck veins, occasional bibasal crackles, tachycardia with no murmurs, a soft nondistended abdomen and thready pulses with no bipedal edema. Neuro PE showed briskly reactive pupils with intact corneal reflexes, no facial asymmetry and intact gag. The limbs are normotonic with hyperreflexia on all extremities. Babinski and clonus are absent. Brudzinki and Kernig signs are negative. Which finding is true for his case?
a.
A thick blood smear would show infected erythrocytes, enlarged and oval with tufted ends
b.
A positive PfHRP2-based rapid diagnostic test is confirmatory
c.
A poor prognosis is indicated by > 50% of parasites with visible pigment in peripheral blood smear
d.
In peripheral blood smear, there is slight lymphocytosis accompanied by eosinopenia during acute infection
b
98
38 year old female was admitted due to a 7-day history high grade fevers, rashes and abdominal pain. Pertinent physical examination findings were faint, salmon-colored, blanching maculopapular rash on the trunk and chest and LUQ tenderness with obliterated Traube’s space. Which of the following tests will have the highest diagnostic sensitivity?
a.
Bone marrow culture
b.
Serologic testing
c.
Blood culture
d.
Duodenal string test
D
99
A 34 year old woman who has asplenia from a history of splenectomy due to abdominal trauma from a vehicular accident came to your clinic for vaccination. She inquired on the vaccines she can safely receive without additional risks for complications. Pertinent in her past medical history is a severe allergy to gelatin. Which of the following vaccinations is NOT recommended for her?
a.
Serogroup B meningococcal
b.
Varicella
c.
HPV vaccine
d.
Live attenuated influenza nasal spray
B
Answer: B. Varciella
Source: HPIM 21st edition, p Ch. 123, p 985 Table 123-3
Allergic reaction to latex:
Serogroup B meningococcal, Hepatitis A
Allergic reaction to gelatin or neomycin: MMR, Varicella, Zoster
Allergic reaction to yeast:
HPV, Hepatitis B
The correct answer is: Varicella
100
A 38 year old woman originally from Samar came to the clinic with a chief complaint of painless hematuria that started around 4 weeks prior. She noted eventual low back pains and onset of dyspareunia. She sought consult and initially treated as UTI, given a 7-day course of antibiotics with little relief of symptoms. Which of the following diagnostic tests has the highest sensitivity ?
a.
Detection of egg with lateral knob in stool
b.
A positive urine CAA ELISA
c.
Detection of egg with terminal spine in papsmear
d.
PCR based detection of parasite DNA in urine
D
