Internal medicine - Infectology

Question 1

INT - 18.1
Serologic test results after Hepatitis B vaccination:
A) HBsAg positive
B) anti-HBs positive
C) anti-HBc positive
D) anti-HCV positive

Answer 1

ANSWER
B) anti-HBs positive
EXPLANATION
Hepatitis B vaccine contains only the surface antigen of Hepatitis B virus. After the vaccine is given, the body makes antibodies against this antigen therefore other test results should not be positive.

Question 2

INT - 18.2
Definition of sepsis:
A) intermittent fever
B) bacteraemia
C) elevated ESR (erythrocyte sedimentation rate) and fever
D) a condition involving organ disfunction due to systemic immune response in which the role of infection can be seen or suspected

Answer 2

ANSWER
D) a condition involving organ disfunction due to systemic immune response in which the role of infection can be seen or suspected
EXPLANATION
Sepsis is the body’s overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure, and death. It is the body’s over active and toxic response to an infection.

Question 3

INT - 18.3
Which of the following statements is true about antibiotic therapy in severe sepsis?
A) definitive antimicrobial therapy based on the results of blood culture and sensitivity test
B) initial empiric therapy with the intent to cover multiple possible pathogens commonly associated with the septic focus
C) combination of at least two bactericidal antibiotics
D) the newest and the most expensive antibiotic should be administered

Answer 3

ANSWER
B) initial empiric therapy with the intent to cover multiple possible pathogens commonly associated with the septic focus
EXPLANATION
If severe sepsis is suspected empiric antibiotic therapy must be started immediately after performing of specimen collection for microbiological testing. Delay in antibiotic treatment increases mortality based on clinical trials.

Question 4

INT - 18.4
The role of Streptococcus pneumoniae should be considered in community acquired pneumonia in which of the following cases?
A) always
B) if the patient underwent splenectomy
C) if the patient has chest pain when breathing and has purulent sputum
D) if there is a lobar consolidation on the chest X-Ray

Answer 4

ANSWER
A) always
EXPLANATION
The role of S. pneumoniae should always be considered in communitiy acquired pneumonia because this is the most common cause at every age in both mild and severe pneumonia. Lack of symptoms and X-ray signs does not exclude S. pneumoniae caused pneumonia.

Question 5

INT - 18.5
A patient has trismus, risus, sardonicus and opisthotonus. What is the most likely diagnosis?
A) plague
B) gas gangrene
C) tetanus
D) rabies

Answer 5

ANSWER
C) tetanus
EXPLANATION
Trismus, risus sardonicus and opisthotonus are the characteristics of tetanus. Neurotoxins of Clostridium tetani increase excitability of the nerves causing muscle spasm and spastic paralysis.

Question 6

INT - 18.6
A 60-year-old patient presents to his primary care provider with headache and severe muscle pain. He has fever, itchy skin, and periorbital oedema. Two weeks ago he ate wild boar (which was cooked rare). His blood tests reveal elevated CK (creatine kinase) and eosinophilia. What is the most likely diagnosis?
A) Salmonellosis
B) Trichinellosis
C) Echinococcosis
D) Dysentery

Answer 6

ANSWER
B) Trichinellosis
EXPLANATION
The clinical signs and symptoms (incubation period, periorbital oedema, muscle pain, itchy skin, fever, diarrhea an eosinophilia) and the history of eating wild boar refer to trichinellosis. In Hungary trichinellosis mainly occur in wild boars but in other areas such as in Transylvania domestic pigs can also be infected.

Question 7

INT - 18.7
A 19-year-old student boy has had sore throat for two weeks. A few days after the first symptoms he became febrile and generalized lymphadenopathy developed. He has lymphocytosis, thrombocytopenia and elevated liver enzymes. He lives in the countryside with a dog and a cat. Insects bite him frequently. What is the most likely diagnosis?
A) Lyme-disease
B) lymphoma
C) infectious mononucleosis
D) cat scratch disease
E) tularaemia

Answer 7

ANSWER
C) infectious mononucleosis
EXPLANATION
Infectious mononucleosis is most common in teenagers associated with sore throat, enlarged lymph nodes, hepatitis and lymphocytosis-monocytosis. Thrombocytopenia also occurs. 90 percent of adults develop infectious mononucleosis during their childhood.

Question 8

INT - 18.8
Tetanus prophylaxis should be administered in which of the following cases?
A) Every type of injury apart from the age and the vaccination status of the patient.
B) Every type of injury if the patient has been vaccinated but the last dose had been given more than 5 years ago
C) Every type of injury if the patient has never been vaccinated.
D) In every case.
E) B+C

Answer 8

ANSWER
E) B+C
EXPLANATION
If the patient has been vaccinated or a booster has been given to him within 5 years, prophylaxis is not needed. If tetanus infection is suspected (contaminated wounds, burns, puncture wounds, etc.) and the patient had been vaccinated for more than 5 years tetanus toxoid should be administered. If tetanus infection is suspected but the patient has never been vaccinated or his vaccination status is unknown tetanus toxoid and immune globulin are both needed.

Question 9

INT - 18.9
Adequate treatment of uncomplicated infectious mononucleosis is:
A) Doxycyclin
B) Ampicillin
C) Steroids
D) Symptomatic
E) Penicillin+ Steroids

Answer 9

ANSWER
D) Symptomatic
EXPLANATION
Infectious mononucleosis caused by a virus therefore antibiotics are not efficient. If ampicillin or amoxicillin are administered non-allergic type rash can develop. In uncomplicated cases symptomatic treatment is enough. If respiratory tract obstruction appear due to enlarged tonsils steroids can be given but there is no evidence about its effectiveness.

Question 10

INT - 18.10
A patient has periodic attacks of sequential chills and fever, dark urine and hepatosplenomegaly. He has a history of returning from the tropics. What is the most likely diagnosis?
A) hepatitis A
B) malaria
C) plague
D) leprosy
E) none of the above

Answer 10

ANSWER
B)malaria
EXPLANATION
The patient’s history and symptoms refer to malaria which is a widespread disease in the tropics. Since the resistance against antimalarial drugs has increased in certain areas, malaria has to be considered even if the patient took prophyilactic drugs.

Question 11

INT - 18.11
Which of the following treatment should be chosen in severe systemic enterococcal infection?
A) penicillin G + amikacin
B) vancomycin + ceftriaxon
C) ciprofloxacin + oxacillin
D) ampicillin + gentamicin
E) high-dose ampicillin

Answer 11

ANSWER
D) ampicillin + gentamicin
EXPLANATION
Ampicillin is the most effective antibiotic agent against enterococcal infections but it can not show bactericidal activity alone. In combination of ampicillin and gentamicin synergy mechanism develops leading to bactericidal activity. Synergy mechanism requires bacterial sensitivity to ampicillin without high resistance to gentamicin.

Question 12

INT - 18.12
Screening and treatment of asymptomatic bacteriuria is required in which one of the following cases?
A) after catheter insertion
B) in diabetic females
C) in pregnant women
D) in patients using intermittent catheter due to transverse cord lesion
E) in patients who have permanent indwelling catheter

Answer 12

ANSWER
C) in pregnant women
EXPLANATION
Asymptomatic bacteriuria has to be screened and treated only if it can lead to such damage which is preventable by antibiotic treatment. Asymptomatic bacteriuria is relatively common in pregnant women, it often leads to pyelonephritis which is dangerous to both the fetus and the mother. Treating asymptomatic bacteriuria during pregnancy can prevent systemic infection therefore screening and treatment are recommended. In the other cases mentioned above systemic infection can not be prevented moreover antibiotic therapy could result in increased bacterial resistance to antibiotics or other side-effects such as Clostridium difficile associated diarrhoea so treatment in these cases is contraindicated.

Question 13

INT - 18.13
What is the acceptable efficacy probability of an empiric (combined) antibiotic treatment chosen in severe life-threatening infection?
A) 50%
B) 60%
C) 80%
D) more than 90%

Answer 13

ANSWER
D) more than 90%
EXPLANATION
Based on international consensus empiric antibiotic treatment has to be at least 90% likely to be effective in severe infections.

Question 14

INT - 18.15
How can you diagnose urinary tract infection in a febrile patient who has no other symptoms?
A) urinalysis shows pyuria and bacteriuria
B) urinalysis shows pyuria and urine culture is positive with the presence of uropathogen bacteria at high colony counts
C) permanent catheter using patient
D) the patient has pyuria and elevated CRP

Answer 14

ANSWER
B) urinalysis shows pyuria and urine culture is positive with the presence of uropathogen bacteria at high colony counts
EXPLANATION
In order to diagnose urinary tract infection in a febrile patient, urinalysis and urine culture tests have to be done. Pyuria and positive urine culture tests confirm the diagnosis. In the absence of any changes in diagnostic test results means that you have to looking for other cause of fever.

Question 15

INT - 18.16
A 63-year-old patient had been treated with COPD for 2 weeks at the division of pulmonology where he got antibiotics and steroid bolus. Two days ago profuse diarrhea and fever have been started a few hours after eating chicken soup. Other members of his family (who ate with him) have no symptoms. Which of the following is the most likely cause of his symptoms?
A) salmonellosis

B) Clostridium difficile associated diarrhea

C) campylobacteriosis

D) intestinal tumor

Answer 15

ANSWER
B) Clostridium difficile associated diarrhea
EXPLANATION
Clostridium difficile is the most likely cause of acute diarrhea in patients with a history of hospitalization and antibiotic treatment, especially if other members of their family have no symptoms.

Question 16

INT - 18.17
Which of the following is the most accurate step in diagnosis of Clostridium difficile associated diarrhea?
A) stool sample culture test

B) detection of Clostridium difficile A+B toxins in stool specimens

C) detection of Clostridium difficile antigen and pus in stool

D) history is enough

Answer 16

ANSWER
B) detection of Clostridium difficile A+B toxins in stool specimens
EXPLANATION
Clostridium difficile is naturally present in the guts of some humans therefore stool culture does not confirm the diagnosis. Detection of toxin in diarrheic stool proves pathogenic role of Clostridium difficile. If the toxin is detectable from stool with normal consistency it means carrier state.

Question 17

INT - 18.18
Which of the following antimicrobial agents is recommended for use in methicillin-sensitive Staphylococcus aureus caused severe sepsis?
A) vancomycin

B) flucloxacillin

C) clindamycin

D) gentamycin

E) ceftriaxon

Answer 17

ANSWER
B) flucloxacillin
EXPLANATION
Antistaphylococcal penicillins are the most effective antibiotics against Staphylococcus aureus therefore this group of antibiotics is the best first choice in severe infections. If the patient has penicillin allergy (which has been confirmed) then first generation cephalosporins or glycopeptides could be used.

Question 18

INT - 18.20
Which of the following diagnostic steps is required for the diagnosis of erythema migrans?
A) serology

B) culture

C) clinical features

D) histology

Answer 18

ANSWER
C) clinical features
EXPLANATION
When erythema migrans appears there is no immune response yet therefore serology is useless. Bacteria can be detected from the histological sample but performing a biopsy is not required for the diagnosis but unnecessary, difficult and expensive. The diagnosis is clinical.

Question 19

INT - 18.22
Which of the following prophylaxis is recommended for patients underwent splenectomy?
A) pneumococcal, meningococcal and Haemophilus influenzae type b vaccines

B) crystalline penicillin for 2 weeks

C) pneumococcal vaccine

D) amoxicillin therapy for years

Answer 19

ANSWER
A) pneumococcal, meningococcal and Haemophilus influenzae type b vaccines
EXPLANATION
Splenectomized patients are at risk for uncontrolled severe infection caused by encapsulated bacteria because spleen has an important role to eliminate them. Vaccination against S. pneumoniae, N. meningitidis and H. influenzae b would be the best choice. Although according to international and Hungarian recommendations H. influenzae b vaccine doesn’t have to be taken due to its low prevalence in adults. Pneumococcal and meningococcal vaccines should be administered a few weeks before an elective splenectomy. If emergency splenectomy is inevitable vaccination has to be performed at least two weeks after the operation.

Question 20

INT - 18.23
Which of the following antibiotics has no efficacy against Pseudomonas?
A) piperacillin/tazobactam

B) ciprofloxacin

C) ceftazidime

D) ceftriaxone

E) colistin

Answer 20

ANSWER
D) ceftriaxone
EXPLANATION
Ceftriaxone has no antipseudomonal activity.

Question 21

INT - 18.24
Which of the following laboratory tests is the most specific for sepsis?
A) white blood cell differential count

B) complete blood count

C) erythrocyte sedimentation rate

D) CRP

E) PCT

Answer 21

ANSWER
E) PCT
EXPLANATION
Procalcitonin (PCT) is the most specific lab test for sepsis and it is routinely used lately.

Question 22

INT - 18.25
Which of the following bacteria is the most common cause of toxic shock syndrome?
A) Streptococcus agalactiae

B) Streptococcus pyogenes

C) Streptococcus bovis

D) Group C and group G Streptococci

E) Streptococcus pneumoniae

Answer 22

ANSWER
B) Streptococcus pyogenes
EXPLANATION
Streptococcal toxic shock syndrome is caused by Streptococcus pyogenes which is able to produce toxins act as superantigens leading to invasive disease.

Question 23

INT - 18.26
Tuberculous meningitis is suspected. What is the most appropriate initial step in management?
A) making decision based on culture

B) administer antituberculous drugs immediately

C) there is nothing to do because TB meningitis does not exist

D) symptomatic treatment can be enough

Answer 23

ANSWER
B) administer antituberculous drugs immediately
EXPLANATION
Culture time of Mycobacterium tuberculosis is very long therefore if tuberculous meningitis is suspected, antituberculotic drugs must be administered immediately (right after collecting sample for culture). Since the disease has high mortality rate, delay in treatment jeopardizes treatment success

Question 24

INT - 18.27
Which of the following conditions is not a risk factor of community acquired pneumonia?
A) patient more than 65 years old

B) hypertension

C) diabetes mellitus

D) uraemia

E) long-term steroid treatment

Answer 24

ANSWER
B) hypertension
EXPLANATION
Based on statistics hypertension is not a risk factor for community acquired pneumonia (CAP). There is no connection between hypertension and outcome of CAP either.

Question 25

INT - 18.28
Which of the following bacteria is the most common cause of purulent meningitis?
A) E. coli

B) Haemophilus influenzae

C) Streptococcus pneumoniae

D) Listeria monocytogenes

Answer 25

ANSWER
C) Streptococcus pneumoniae
EXPLANATION
Streptococcus pneumoniae is the most common cause of bacterial meningitis in developped countries. Statistical database is well known since the disease is reportable.

Question 26

INT - 18.29
Which of the following signs is one of the major criteria of infective endocarditis?
A) fever

B) positive blood culture

C) murmur

D) erythrocyte sedimentation rate

E) skin signs

Answer 26

ANSWER
B) positive blood culture
EXPLANATION
Diagnosis of infective endocarditis is based on Duke criteria. Major criteria include positive blood culture for typical infective endocarditis organisms, and echocardiogram with typical signs of endocarditis.

Question 27

INT - 18.30
Terminal ileitis and mesenteric adenitis mimicking acute appendicitis can be seen in which of the following diseases?
A) abdominal typhus

B) campylobacteriosis

C) E.coli associated gastroenteritis

D) yersiniosis

Answer 27

ANSWER
D) yersiniosis
EXPLANATION
Appendicitis-like symptoms are most often found in yersiniosis although similar signs can be seen in the other diseases as well

Question 28

INT - 18.32
Which of the following conditions can be a manifestation of Lyme-disease?
A) erythema chronicum

B) carditis

C) arthritis

D) neurological signs

E) all of the above

Answer 28

ANSWER
E) all of the above
EXPLANATION
Erythema chronicum, carditis, arthritis and neurological signs can all occur in Lyme-disease

Question 29

INT - 18.33
Which of the following statements is true if PCT decreases during treatment?
A) antibiotic therapy is adequate

B) lack of PCT production results from multiple organ failure

C) PCT is stored in the cells as a result of antibiotic therapy

D) supportive steroid therapy stops the production of PCT

Answer 29

ANSWER
A) antibiotic therapy is adequate
EXPLANATION
Procalcitonin is an indicator of severe infection and predictor of antibiotic choices. PCT produced inside every tissue thus there is no connection between multiple organ failure/steroid therapy and serum levels of PCT.

Question 30

INT - 18.34
Which of the following statements is false about the transmission of tularemia?
A) can be acquired by tick or horse-fly bite

B) may be spread through microtrauma during meat preparation

C) fecal-oral transmission from person to person

D) can be transmitted through inhalation of contaminated dust

Answer 30

ANSWER
C) fecal-oral transmission from person to person
EXPLANATION
Tularemia is a zoonotic disease and it can not be transferred from person to person. The disease can be transmitted to humans by handling infected animals, inhalation of contaminated dust, or via bites by infected vectors.

Question 31

INT - 18.35
Which of the following statements is true about empiric antibiotic treatment for severe nosocomial Gram-negative bacterial infections?
A) combination of antibiotics is needed

B) it is important to know the local flora and antibiotic resistance rates

C) antibiotic treatment should last for 10 days

Answer 31

ANSWER
B) it is important to know the local flora and antibiotic resistance rates
EXPLANATION
The most important thing about empiric antibiotic treatment for nosocomial infections is knowing the local flora and antibiotic resistance rates. There is a big difference between the different hospitals

Question 32

INT - 18.37
Is it necessary to collect blood cultures when FUO is suspected?
A) it is not, because the most common cause of FUO is cancer

B) it is not, because viral infections are more common than bacterial infections

C) yes it is, because endocarditis is one of the most common causes of FUO

D) yes it is, because rickettsiosis and mycoplasma endocarditis can be detected by blood cultures

Answer 32

ANSWER
C) yes it is, because endocarditis is one of the most common causes of FUO
EXPLANATION
15-35% of FUOs result from infections of which endocarditis is the most common cause. Blood cultures are almost always positive in infective endocarditis. Blood cultures should always be collected from a patient with fever.

Question 33

INT - 18.38
Which of the following diagnostic tests should be performed in Staphylococcus aureus bacteremia?
A) chest X-ray

B) blood cultures if the patient is febrile despite of treatment

C) abdominal ultrasound

D) echocardiography

E) all of the above

Answer 33

ANSWER
E) all of the above
EXPLANATION
Invasion of Staphylococcus aureus results from its virulence factors. Entry of the bacteria into the bloodstream can lead to metastatic abscess formation and infective endocarditis within a short time. All diagnostic steps mentioned in the test question are required in order to confirm or exclude metastasis and infective endocarditis. Treatment depends on the results of these tests.

Question 34

INT - 18.39
Early recognition of herpes simplex encephalitis is critical, because it can be cured with acyclovir and early administration of acyclovir decreases mortality.
A) true

B) false

Answer 34

ANSWER
A) true
EXPLANATION
True. It can be cured if treatment begins early enough

Question 35

INT - 18.42
Patients suffering diabetes mellitus are susceptible for Staphylococcus aureus caused infections.
A) true

B) false

Answer 35

ANSWER
A) true
EXPLANATION
It is true. Staphylococcus aureus colonization on the skin and on the mucous membranes is more common in diabetic patients which - along with immune dysfunction - leads to more frequent and more severe skin- and soft tissue infections, or sepsis.

Question 36

INT - 18.43
Pulmonary symptoms of ascariasis are associated with urticaria, eosinophilia and angioneurotic edema.
A) true

B) false

Answer 36

ANSWER
A) true
EXPLANATION
Pulmonary manifestation of Ascaris lumbricoides infection involves invasion of the parasite. Concomitant symptoms are urticaria, eosinophilia and angiedema resulting from hypersensitivity reaction provoked by the parasite.

Question 37

INT - 18.45
The most common cause of acute exacerbation of COPD is Haemophilus influenzae because of its persistent colonization on the respiratory mucosa.
A) true

B) false

Answer 37

ANSWER
A) true
EXPLANATION
Haemophilus influenzae shows high affinity for the respiratory mucosa so it frequently colonizes the respiratory tract. It can be detected from the bronchi with low colony counts in patients with COPD. When acute exacerbation develops (usually after a viral infection or a physical harm) the bacteria multiply leading to symptoms of acute inflammation.

Question 38

INT - 18.46
Ceftriaxone is effective against penicillin resistant S. pneumoniae in most cases because resistance mechanism is based on beta-lactamase production.
A) both the statement and the explanation are true and a causal relationship exists between them

B) both the statement and the explanation are true but there is no causal relationship between them

C) the statement is true, but the explanation is false

D) the statement is false, but the explanation itself is true

E) both the statement and the explanation are false

Answer 38

ANSWER
C) the statement is true, but the explanation is false
EXPLANATION
Resistance to penicillins results from changes in penicillin-binding proteins located in the bacterial cell wall. Other beta-lactam antibiotics can bind to these proteins at different rates therefore third generation cephalosporins like ceftriaxone and cefotaxime are highly effective against S. pneumoniae.

Question 39

INT - 18.47
Antibiotic prophylaxis in Lyme disease is not needed because the side-effects of prophylactic antibiotics have greater risk than the chance of developing Lyme disease.
A) both the statement and the explanation are true and a causal relationship exists between them

B) both the statement and the explanation are true but there is no causal relationship between them

C) the statement is true, but the explanation is false

D) the statement is false, but the explanation itself is true

E) both the statement and the explanation are false

Answer 39

ANSWER
A) both the statement and the explanation are true and a causal relationship exists between them
EXPLANATION
Prophylactic antibiotics against Lyme disease are not recommended because there is a bigger risk of suffering from side-effects than the chance of developing the disease. Although if Lyme disease appears, antibiotic treatment has to be started as soon as possible in order to prevent further complications. Adequate preventing methods are using repellents and removing tick properly.

Question 40

INT - 18.48
Antibiotics should be avoided in salmonella gastroenteritis because antibiotic treatment may prolong the duration of fecal excretion results in higher resistance and more severe infection.
A) both the statement and the explanation are true and a causal relationship exists between them

B) both the statement and the explanation are true but there is no causal relationship between them

C) the statement is true, but the explanation is false

D) the statement is false, but the explanation itself is true

E) both the statement and the explanation are false

Answer 40

ANSWER
A) both the statement and the explanation are true and a causal relationship exists between them
EXPLANATION
Antibiotic treatment causes higher resistance and prolonged fecal excretion of the bacteria therefore it should be avoided in nonfebrile patients who are not at high risk for invasive disease.

Question 41

INT - 18.49
Aminoglycosides must be administered once a day because the once-daily dosing of aminoglycosides is associated with higher peak concentration, higher efficacy, and less toxicity due to complete excretion within 24 hours.
A) both the statement and the explanation are true and a causal relationship exists between them

B) both the statement and the explanation are true but there is no causal relationship between them

C) the statement is true, but the explanation is false

D) the statement is false, but the explanation itself is true

E) both the statement and the explanation are false

Answer 41

ANSWER
A) both the statement and the explanation are true and a causal relationship exists between them
EXPLANATION
Based on clinical trials about pharmacokinetics and pharmacodynamics of aminoglycosides, efficacy depends on the peak concentration. Once-daily dosing leads to higher peak concentration and less toxicity.

Question 42

INT - 18.50
The incubation period of Lyssa virus infection depends on how far the virus entry is from the brain because the virus travels along the axons at a rate of 1-2cm/day to enter into the central nervous system.
A) both the statement and the explanation are true and a causal relationship exists between them

B) both the statement and the explanation are true but there is no causal relationship between them

C) the statement is true, but the explanation is false

D) the statement is false, but the explanation itself is true

E) both the statement and the explanation are false

Answer 42

ANSWER
A) both the statement and the explanation are true and a causal relationship exists between them
EXPLANATION
The more far the injury is from the brain, the longer the incubation period is. This is because the virus travels along the axones to the central nervous system.

Question 43

INT - 18.51
Macrolides are recommended in urinary tract infections in pregnant women, because macrolides can be administered in pregnancy.
A) both the statement and the explanation are true and a causal relationship exists between them

B) both the statement and the explanation are true but there is no causal relationship between them

C) the statement is true, but the explanation is false

D) the statement is false, but the explanation itself is true

E) both the statement and the explanation are false

Answer 43

ANSWER
D) the statement is false, but the explanation itself is true
EXPLANATION
Macrolides can be administered in pregnancy but these antibiotics are ineffective in urinary tract infections. If urine culture shows macrolide sensitive bacteria (e.g. S. agalactiae), macrolides can be given as a second choice although their efficacy in urinary infections has not been proven due to their metabolism in the liver

Question 44

INT - 18.53
Empiric antibiotic therapy in aspiration pneumonia should cover anaerobes, because typical pathogens origin from the oral flora where there is a significant number of anaerobes.
A) both the statement and the explanation are true and a causal relationship exists between them

B) both the statement and the explanation are true but there is no causal relationship between them

C) the statement is true, but the explanation is false

D) the statement is false, but the explanation itself is true

E) both the statement and the explanation are false

Answer 44

ANSWER
A) both the statement and the explanation are true and a causal relationship exists between them
EXPLANATION
Aspiration pneumonia is a polymicrobial disease caused by bacteria that resides in the oral flora. Role of anaerobes always has to be considered.

Question 45

INT - 18.54
Treatment for leptospirosis has to be started within 48 hours, because antibiotics are often ineffective during leptospiremia.
A) both the statement and the explanation are true and a causal relationship exists between them

B) both the statement and the explanation are true but there is no causal relationship between them

C) the statement is true, but the explanation is false

D) the statement is false, but the explanation itself is true

E) both the statement and the explanation are false

Answer 45

ANSWER
C) the statement is true, but the explanation is false
EXPLANATION
Antibiotic treatment has to be started as soon as possible because it can prevent the development of multiorgan manifestations. Leptospiremia presents at the onset of the disease. When second phase develops with multiorgan damage, bacteria can not be detected anymore therefore antibiotics are ineffective in this stage.

Question 46

INT-18.55-18.57
A 20-year-old woman presents to her primary care provider with the following symptoms. Match each clinical presentation with one diagnosis!
A) stomatitis

B) epidemic parotitis

C) infectious mononucleosis

INT - 18.55 - fever, tonsillopharyngitis, cervical lymphadenopathy, hepatosplenomegaly, right shift in white blood cell count

INT - 18.56 - sharing drinks, mucosal hyperemia, sore throat, painful chewing, swollen cervical lymph glands

INT - 18.57 - lethargy, headache, fever, asymmetric facial swelling, dysphagia, painful chewing, meningeal irritation signs

Answer 46

ANSWER
INT - 18.55 - fever, tonsillopharyngitis, cervical lymphadenopathy, hepatosplenomegaly, right shift in white blood cell count- C)

INT - 18.56 - sharing drinks, mucosal hyperemia, sore throat, painful chewing, swollen cervical lymph glands- A)

INT - 18.57 - lethargy, headache, fever, asymmetric facial swelling, dysphagia, painful chewing, meningeal irritation signs - B)

Question 47

INT-18.58-18.63
A patient has pneumonia confirmed by chest X-ray. Match each clinical presentation with one or more pathogen(s)!
A) Mycoplasma pneumoniae

B) Streptococcus pneumoniae

C) Influenza virus

D) Legionella spp.

INT - 18.58 - severe headache, sore throat, and earache

INT - 18.59 - diarrhea, and hyponatraemia

INT - 18.60 - sore throat, muscle pain, joint pain, WBC count: 3,6 G/L, CRP: 2mg/l

INT - 18.61 - shivering, chest pain when breathing, leukocytosis, elevated CRP, and PCT

INT - 18.62 - erythema multiforme

INT - 18.63 - splenectomy 1 month ago

Answer 47

ANSWER
INT - 18.58 - severe headache, sore throat, and earache- A)

INT - 18.59 - diarrhea, and hyponatraemia- D)

INT - 18.60 - sore throat, muscle pain, joint pain, WBC count: 3,6 G/L, CRP: 2mg/l - C)

INT - 18.61 - shivering, chest pain when breathing, leukocytosis, elevated CRP, and PCT- B) D)

INT - 18.62 - erythema multiforme- A)

INT - 18.63 - splenectomy 1 month ago- B)

Question 48

INT-18.64-18.66
Match each clinical presentation with the most likely pathogen!
A) adenovirus

B) Norwalk-virus

C) rotavirus

INT - 18.64 - A disease mainly occurs in infants and toddlers characterized by fever, vomiting and watery diarrhea. It peaks in fall/winter, it is highly contagious and can lead to dehydration.

INT - 18.65 - A mild disease in adults associated with diarrhea, headache, abdominal and muscle pain.

INT - 18.66 - A mild disease involving fever, upper respiratory symptoms, vomiting and diarrhea. Most commonly affects toddlers and it is often followed by lactose intolerance.

Answer 48

ANSWER
INT - 18.64 - A disease mainly occurs in infants and toddlers characterized by fever, vomiting and watery diarrhea. It peaks in fall/winter, it is highly contagious and can lead to dehydration.- C)

INT - 18.65 - A mild disease in adults associated with diarrhea, headache, abdominal and muscle pain.- B)

INT - 18.66 - A mild disease involving fever, upper respiratory symptoms, vomiting and diarrhea. Most commonly affects toddlers and it is often followed by lactose intolerance -A)

Question 49

INT-18.67-18.71
Match each of the following bacteria with the most likely effective antibiotic treatment!
A) imipenem/cilastatin

B) penicillin

C) ceftriaxone

D) vancomycin

E) ampicillin

INT - 18.67 - MRSA

INT - 18.68 - Enterococcus faecalis

INT - 18.69 - Streptococcus pyogenes

INT - 18.70 - Streptococcus pneumoniae

INT - 18.71 - ESBL-producing E.coli

Answer 49

ANSWER
INT - 18.67 - MRSA- D)

INT - 18.68 - Enterococcus faecalis- E)

INT - 18.69 - Streptococcus pyogenes- B)

INT - 18.70 - Streptococcus pneumoniae- C)

INT - 18.71 - ESBL-producing E.coli- A)

Question 50

INT- 18.31
Which of the following diseases is associated with hydrophobia?
A) plague
B) tetanus
C) rabies
D) all of the above
E) none of the above

Answer 50

ANSWER
C) rabies
EXPLANATION
Hydrophobia or aquaphobia means fear of water. This is the historic name for rabies because symptoms of encephalitis can be triggered by liquids.