Quiz Questions Flashcards
Aggregation of all Quiz questions....
65 yo woman presents with ulcer on sole of her good, below the first MTP joint. Diabetic neuropathy. Unsure how long the ulcer has been there. What is best dx test for osteomyelitis?
- PE, vitals, pressure around the ulcer
- blood cultures, culture pus from ulcer
- labs: CBC, ESR, CRP
- MRI of the foot
- plain films of the foot for bony erosion or periosteal elevation.
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65 yo woman presents with ulcer on sole of her good, below the first MTP joint. Diabetic neuropathy. Unsure how long the ulcer has been there. What is best dx test for osteomyelitis?
- PE, vitals, pressure around the ulcer
- blood cultures, culture pus from ulcer
- labs: CBC, ESR, CRP
-MRI of the foot
-plain films of the foot for bony erosion or periosteal elevation.
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To determine the level of immune compromise in a patient with HIV, which of the following cell types is enumerated in the blood?
a. CD3+ lymphocytes
b. CD4+ T cells
c. CD8+ T cells
d. CD19+ B cells
e. CD20+ B cells
To determine the level of immune compromise in a patient with HIV, which of the following cell types is enumerated in the blood?
a. CD3+ lymphocytes
b. CD4+ T cells
c. CD8+ T cells
d. CD19+ B cells
e. CD20+ B cells
You should wear an N95 mask when visiting the patient in their negative pressure room to prevent the transmission of tuberculosis and which of the following infections?
- Chickenpox
- Influenza
- Pseudomonas aeruginosa
- Streptococcus pneumoniae
- Mycoplasma pneumoniae
chicken pox
also acceptable answers: Pulmonary TB, measles
About ten days after symptoms of a febrile cough illness for which you took azithromycin without a chest x-ray, you start feeling sick again: you develop diarrhea and crampy abdominal pain as well as low grade temperatures. You experience a sense of urgency to defecate which is relieved by bowel movements (tenesmus). Which of the following organisms is MOST LIKELY to blame?
Clostridium difficile
Hepatitis A
Bacillus cereus
Clostridium perfringens
Salmonella spp
About ten days after symptoms of a febrile cough illness for which you took azithromycin without a chest x-ray, you start feeling sick again: you develop diarrhea and crampy abdominal pain as well as low grade temperatures. You experience a sense of urgency to defecate which is relieved by bowel movements (tenesmus). Which of the following organisms is MOST LIKELY to blame?
Clostridium difficile
Hepatitis A
Bacillus cereus
Clostridium perfringens
Salmonella spp
A 32 year-old medical student notices a painless purple spot on his left calf. “I figured I bumped it while riding,” he says. He is an avid mountain biker. He is surprised when the purple mark does not resolve spontaneously, and comes to see you when additional purple marks appear on his nose. Other than genital herpes for which he takes suppressive valacyclovir, he is completely healthy. Physical examination is normal except for the two mentioned spots (photo). This is the classic presentation for which of the following opportunistic pathogens?
a. Pneumocystis jiroveci
b. Toxoplasma gondii
c. Mycobacterium avium complex
d. Human herpesvirus 8
e. Cytomegalovirus
A 32 year-old medical student notices a painless purple spot on his left calf. “I figured I bumped it while riding,” he says. He is an avid mountain biker. He is surprised when the purple mark does not resolve spontaneously, and comes to see you when additional purple marks appear on his nose. Other than genital herpes for which he takes suppressive valacyclovir, he is completely healthy. Physical examination is normal except for the two mentioned spots. This is the classic presentation for which of the following opportunistic pathogens?
a. Pneumocystis jiroveci
b. Toxoplasma gondii
c. Mycobacterium avium complex
d.Human herpesvirus 8
e.Cytomegalovirus
•A young mother brings her 6 year-old son into your office for a sore throat. She asks, “Is this strep throat?” Which of the following is NOT suggestive of streptococcal pharyngitis?
A.Abrupt onset.
B.Fever of 102F.
C.Bright red tonsils with tonsillar exudate.
D.Post-tussive emesis.
E.Enlarged, tender cervical lymph nodes.
•A young mother brings her 6 year-old son into your office for a sore throat. She asks, “Is this strep throat?” Which of the following is NOT suggestive of streptococcal pharyngitis?
A.Abrupt onset.
B.Fever of 102F.
C.Bright red tonsils with tonsillar exudate.
**D.Post-tussive emesis. **
E.Enlarged, tender cervical lymph nodes.
About twenty-four hours after consuming some cold chicken salad at a picnic, you develop nausea, vomiting and profuse diarrhea. It’s hard to know whether you should be sitting or kneeling for most of the 1-2 day illness, after which you improve back to baseline. Which of the following organisms is MOST LIKELY to blame?
Clostridium difficile
Hepatitis A
Bacillus cereus
Clostridium perfringens
Salmonella spp
About twenty-four hours after consuming some cold chicken salad at a picnic, you develop nausea, vomiting and profuse diarrhea. It’s hard to know whether you should be sitting or kneeling for most of the 1-2 day illness, after which you improve back to baseline. Which of the following organisms is MOST LIKELY to blame?
Clostridium difficile
Hepatitis A
Bacillus cereus
Clostridium perfringens
Salmonella spp
Two d ago you took a call from a worried mother who said her 3yo son seems irritable and “keeps itching his behind” On your advice, she applied Scotch tape to the boy’s anus at bedtime last night, and now she brings the evidence to your office. You see little white worms on the tape. Which of the following statements is likely true?
- This is consistent w pinworm (Enterobius vermicularis) and the boy should be treated with mebendazole.
- This is consistent w pinworm (Enterobius vermicularis) and the boy plus his family should be treated with mebendazole.
- This is consistent with strongyloidiasis (strongyloides stercoralis) and the boy should be treated with praziquantel
- This is consistent with strongyloidiasis (strongyloides stercoralis) and the boy plus his mother and maybe other family members should be treated with praziquantel
- This is a classic example of delusions of parasitosis and you should refer the by and his parents to the Division of Children, Youth and Family for a child abuse evaluation
Two d ago you took a call from a worried mother who said her 3yo son seems irritable and “keeps itching his behind” On your advice, she applied Scotch tape to the boy’s anus at bedtime last night, and now she brings the evidence to your office. You see little white worms on the tape. Which of the following statements is likely true?
-This is consistent w pinworm (Enterobius vermicularis) and the boy should be treated with mebendazole.
-This is consistent w pinworm (Enterobius vermicularis) and the boy plus his family should be treated with mebendazole.
- This is consistent with strongyloidiasis (strongyloides stercoralis) and the boy should be treated with praziquantel
- This is consistent with strongyloidiasis (strongyloides stercoralis) and the boy plus his mother and maybe other family members should be treated with praziquantel
- This is a classic example of delusions of parasitosis and you should refer the by and his parents to the Division of Children, Youth and Family for a child abuse evaluation
You suspect acute HIV infection in a commercial sex worker with three weeks of mono-like symptoms. Which of the following tests is most likely to confirm your hunch?
a. HIV enzyme linked immunosorbent assay (ELISA)
b. HIV Western blot
c. HIV viral load by PCR
d. CD4+ count
You suspect acute HIV infection in a commercial sex worker with three weeks of mono-like symptoms. Which of the following tests is most likely to confirm your hunch?
a. HIV enzyme linked immunosorbent assay (ELISA)
b. HIV Western blot
**c.HIV viral load by PCR **
d.CD4+ count
You meet an HIV-infected injection drug user for the first time in clinic so she can establish care in your office. She has no other medical problems, and takes these medications:
abacavir (a nucleotide reverse transcriptiase inhibitor)
efavirenz (a non-nucleotide reverse transcriptase inhibitor)
Physical examination is normal other than track marks. Her labs reveal CD4 count of 100, and an HIV viral load of 4,000 copies. Which of the following BEST describes what is wrong with her medication list?
- She should be taking trimethroprim/sulfamethoxazole as prophylaxis against Pneumocystis pneumonia.
- She should be taking weekly azithromycin as prophylaxis against Mycobacterium avium complex (MAC).
- She should be taking another antiretroviral agent such as lamivudine (a nucleotide reverse transcriptase inhibitor).
- She should be taking trimethroprim/sulfamethoxazole as prophylaxis against Pneumocystis pneumonia and also another antiretroviral agent such as lamivudine (a nucleotide reverse transcriptase inhibitor).
- She should be taking trimethroprim/sulfamethoxazole as prophylaxis against Pneumocystis pneumonia and weekly azithromycin as Mycobacterium avium complex (MAC) prophylaxis as well as another antiretroviral agent such as lamivudine (a nucleotide reverse transcriptase inhibitor).
You meet an HIV-infected injection drug user for the first time in clinic so she can establish care in your office. She has no other medical problems, and takes these medications:
abacavir (a nucleotide reverse transcriptiase inhibitor)
efavirenz (a non-nucleotide reverse transcriptase inhibitor)
Physical examination is normal other than track marks. Her labs reveal CD4 count of 100, and an HIV viral load of 4,000 copies. Which of the following BEST describes what is wrong with her medication list?
- She should be taking trimethroprim/sulfamethoxazole as prophylaxis against Pneumocystis pneumonia.
- She should be taking weekly azithromycin as prophylaxis against Mycobacterium avium complex (MAC).
- She should be taking another antiretroviral agent such as lamivudine (a nucleotide reverse transcriptase inhibitor).
-She should be taking trimethroprim/sulfamethoxazole as prophylaxis against Pneumocystis pneumonia and also another antiretroviral agent such as lamivudine (a nucleotide reverse transcriptase inhibitor).
-She should be taking trimethroprim/sulfamethoxazole as prophylaxis against Pneumocystis pneumonia and weekly azithromycin as Mycobacterium avium complex (MAC) prophylaxis as well as another antiretroviral agent such as lamivudine (a nucleotide reverse transcriptase inhibitor).
The treatment of furuncles and carbuncles typically involves which of these?
A. Ice packs
B. Steroid treatment
C. Systemic antibiotics for all patients
D. Drainage of large lesions
The treatment of furuncles and carbuncles typically involves which of these?
A. Ice packs
B. Steroid treatment
C. Systemic antibiotics for all patients
D. Drainage of large lesions (What’s “large”? greater than 1 cm)
Which of the following is the MOST SENSITIVE and SPECIFIC imaging modality for the diagnosis of osteomyelitis?
A. Plain radiography
B. Computed tomography
C. Ultrasonography
D. MRI
Which of the following is the MOST SENSITIVE and SPECIFIC imaging modality for the diagnosis of osteomyelitis?
A. Plain radiography
B. Computed tomography
C. Ultrasonography
D. MRI
The daycare calls to let you know your three-year-old otherwise healthy child has to come home because he has developed vomiting and profuse diarrhea. He has a low grade temperature, and doesn’t want to play very much, but is otherwise well with stable vitals per the school nurse. The nurse mentions that three other kids were sent home recently, but “they were both back and doing great after a couple of days at home.” Which of the following is the BEST characterization of the pathophysiology of the likely pathogen?
Viral damage to brush border causes impaired absorption of water and nutrients.
Non-inflammatory bacterial toxin causes cyclic AMP upregulation in enterocytes.
Bacterial cytotoxin can cause bloody diarrhea and hemolytic uremic syndrome.
Intracellular bacterial pathogen passes through intestines into macrophages and causes disseminated infection.
Invasion of colonic epithelial cells causing superficial ulcerations and colitis.
The daycare calls to let you know your three-year-old otherwise healthy child has to come home because he has developed vomiting and profuse diarrhea. He has a low grade temperature, and doesn’t want to play very much, but is otherwise well with stable vitals per the school nurse. The nurse mentions that three other kids were sent home recently, but “they were both back and doing great after a couple of days at home.” Which of the following is the BEST characterization of the pathophysiology of the likely pathogen?
Viral damage to brush border causes impaired absorption of water and nutrients.
Non-inflammatory bacterial toxin causes cyclic AMP upregulation in enterocytes.
Bacterial cytotoxin can cause bloody diarrhea and hemolytic uremic syndrome.
Intracellular bacterial pathogen passes through intestines into macrophages and causes disseminated infection.
Invasion of colonic epithelial cells causing superficial ulcerations and colitis.
A 26 yo medical student develops acute fever, muscle aches, and exhaustion about 1 w after returning from a 3 m medical rotation in Gabon. She is otherwise healthy, has taken no medicines for “years” and has lived only in the US and Gabon but has traveled widely throughout Africa and Asia as well as Europe. On examination she is febrile, but stable with normal oxygen saturations. Her exam is normal. CBC shows new anemia with hemoglobin of 6 g/dL and mild thrombocytopenia to 120,000. The lab reports parasite forms on peripheral smear, shown in picture. Which of the following is true about this condition?
- Symptoms of this human infection range from none to lethal cerebral edema
- Hypnozoites lodged in liver venules cause congestive hepatitis
- Supportive care is the only treatment for this viral infection
- Cerebral inflammation can arise weeks to years after infection
- Drug resistance to this parasite is most prevalent in North America
A 26 yo medical student develops acute fever, muscle aches, and exhaustion about 1 w after returning from a 3 m medical rotation in Gabon. She is otherwise healthy, has taken no medicines for “years” and has lived only in the US and Gabon but has traveled widely throughout Africa and Asia as well as Europe. On examination she is febrile, but stable with normal oxygen saturations. Her exam is normal. CBC shows new anemia with hemoglobin of 6 g/dL and mild thrombocytopenia to 120,000. The lab reports parasite forms on peripheral smear, shown in picture. Which of the following is true about this condition?
-Symptoms of this human infection range from none to lethal cerebral edema
- Hypnozoites lodged in liver venules cause congestive hepatitis
- Supportive care is the only treatment for this viral infection
- Cerebral inflammation can arise weeks to years after infection
- Drug resistance to this parasite is most prevalent in North America
•You are seeing a lot of patients with influenza in your family practice clinic this year, and recently learned from the CDC that a new type of influenza is circulating nationwide. In contrast to last year’s H9N1 now the CDC says circulating influenza virus type is H7N1. What PHRASE is used to describe the emergence of a “new virus” from major changes in the hemaglutinin (H) and/or neuraminidase (N) viral proteins?
A.Antigenic shift.
B.Antigenic drift.
C.Antigenic variation.
D.Antigenic mutation.
E.Antigenic speciation.
•You are seeing a lot of patients with influenza in your family practice clinic this year, and recently learned from the CDC that a new type of influenza is circulating nationwide. In contrast to last year’s H9N1 now the CDC says circulating influenza virus type is H7N1. What PHRASE is used to describe the emergence of a “new virus” from major changes in the hemaglutinin (H) and/or neuraminidase (N) viral proteins?
**A.Antigenic shift. **
B.Antigenic drift.
C.Antigenic variation.
D.Antigenic mutation.
E.Antigenic speciation.
A 23 year-old injection drug user presents with cough, dyspnea, and fever to 102 degrees F. He has chronic hepatitis C but no other known medical problems. He takes no medications. Physical examination otherwise reveals bilateral crackles, respiratory distress with a room air oxygen saturation of 72%, and cachexia. His white count is decreased, and an HIV serology comes back positive whereas a serum cryptococcal antigen is negative. A chest x-ray reveals hazy bilateral infiltrates. This is the classic presentation for which of the following opportunistic pathogens?
a. Pneumocystis jiroveci
b. Toxoplasma gondii
c. Mycobacterium avium complex
d. Human herpesvirus 8
e. Cytomegalovirus
A 23 year-old injection drug user presents with cough, dyspnea, and fever to 102 degrees F. He has chronic hepatitis C but no other known medical problems. He takes no medications. Physical examination otherwise reveals bilateral crackles, respiratory distress with a room air oxygen saturation of 72%, and cachexia. His white count is decreased, and an HIV serology comes back positive whereas a serum cryptococcal antigen is negative. A chest x-ray reveals hazy bilateral infiltrates. This is the classic presentation for which of the following opportunistic pathogens?
**a.Pneumocystis jiroveci **
b. Toxoplasma gondii
c. Mycobacterium avium complex
d. Human herpesvirus 8
e. Cytomegalovirus
The next inpatient you see on the wards has a fever, a new heart murmur, and painful Osler’s nodes on the right hand. A transesophageal echocardiogram shows a mobile echodensity on the aortic valve that is 0.3 cm in diameter. Which of the following findings would make you call the cardiothoracic surgeon to replace the patient’s aortic valve?
High grade fever and leukocytosis
The presence of a mobile echodensity that is greater than 0.5 cm in diameter
A new stroke attributed to septic emboli
Unquenched bacteremia nine days after starting treatment
Growth of viridans streptococci in the initial blood cultures
The next inpatient you see on the wards has a fever, a new heart murmur, and painful Osler’s nodes on the right hand. A transesophageal echocardiogram shows a mobile echodensity on the aortic valve that is 0.3 cm in diameter. Which of the following findings would make you call the cardiothoracic surgeon to replace the patient’s aortic valve?
High grade fever and leukocytosis
The presence of a mobile echodensity that is greater than 0.5 cm in diameter
A new stroke attributed to septic emboli
Unquenched bacteremia nine days after starting treatment
Growth of viridans streptococci in the initial blood cultures
The oral live attenuated typhoid vaccine provides five years of 75% protection from typhoid infection. In the United States, this is commonly given to people who travel to endemic areas. To which of the following people going to an endemic area should your travel clinic NOT give this vaccine?
- A 28-year-old with irritable bowel syndrome whose soccer team is traveling to India for an invitational tournament.
- A 65-year-old presidential candidate with undisclosed multiple sclerosis who is visiting the West Bank for peace talks.
- A 12-year-old boy with mild autistic spectrum disorder who is traveling to Thailand with his family.
- A 38-year-old pregnant infectious diseases doctor who will work with the DarDar research program in Tanzania.
A 38-year-old pregnant infectious diseases doctor who will work with the DarDar research program in Tanzania.
live-attenuated vaccines are contraindicated in pregnancy and immunodeficient persons. (just FYI - Jullet wasn’t allowed to get the yellow-fever vaccine prior to backpacking in SEA because it is a live-attenuated vaccine!)
You are seeing a patient with cough, fever and mild dyspnea in your office. She admits to drinking twelve beers daily, sometimes to the point of blackouts, but otherwise she carries no medical diagnoses. Physical examination reveals T 102, normal vital signs, poor dentition and acne rosacea plus loud wet-sounding crackles in the right lower lung. A chest x-ray confirms an infiltrate without cavitation in the right middle lobe. Which of the following antibiotic regimens would be BEST for this patient?
Vancomycin plus piperacillin/tazobactam
Trimethroprim-sulfamethoxazole plus clindamycin
Ceftriaxone plus azithromycin plus vancomycin
Levofloxacin plus metronidazole
Vancomycin plus piperacillin/tazobactam plus metronidazole
You are seeing a patient with cough, fever and mild dyspnea in your office. She admits to drinking twelve beers daily, sometimes to the point of blackouts, but otherwise she carries no medical diagnoses. Physical examination reveals T 102, normal vital signs, poor dentition and acne rosacea plus loud wet-sounding crackles in the right lower lung. A chest x-ray confirms an infiltrate without cavitation in the right middle lobe. Which of the following antibiotic regimens would be BEST for this patient?
Vancomycin plus piperacillin/tazobactam
Trimethroprim-sulfamethoxazole plus clindamycin
Ceftriaxone plus azithromycin plus vancomycin
Levofloxacin plus metronidazole
Vancomycin plus piperacillin/tazobactam plus metronidazole
In those unusual cases when the infectious source of sepsis is not completely obvious, it is helpful to know which sources of infection are most likely and thus worthy of additional diagnostic work up. Which of the following is the MOST COMMON cause of sepsis?
- Pneumonia
- Urinary tract infection
- Primary bloodstream infection
- Intraabdominal abscess
- Skin and soft tissue infection
pneumonia
You are running a community health clinic in which you see a college student and avid hiker who has had 4 weeks of loose stools. “It’s like water Doc.” Otherwise he feels fine. He is healthy otherwise. A routine stool culture reveals nothing. Which of the following pathogens is the likely culprit?
- Trichomonas
- Cryptosporidium parvum
- Ascaris lumbricoides
- Giardia Lamblia
- Schistsoma mansonii
You are running a community health clinic in which you see a college student and avid hiker who has had 4 weeks of loose stools. “It’s like water Doc.” Otherwise he feels fine. He is healthy otherwise. A routine stool culture reveals nothing. Which of the following pathogens is the likely culprit?
- Trichomonas
- *-Cryptosporidium parvum**
- Ascaris lumbricoides
- Giardia Lamblia
- Schistsoma mansonii
Which oc these bugs is the most common cause of vertebral osteomyelitis?
A. Escherichia coli
B. Streptococcus pyogenes
C. Pasteurella multocida
D. Staphylococcus aureus
Which oc these bugs is the most common cause of vertebral osteomyelitis?
A. Escherichia coli
B. Streptococcus pyogenes
C. Pasteurella multocida
D. Staphylococcus aureus
You draw two sets of blood cultures in a patient hospitalized for a GI bleed and who subsequently developed a fever while you are on call. At that point you notice the patient has no indwelling catheter, and no prosthetic joints or other man-made body parts. Three days later, at which point the patient is feeling well and afebrile and nearly ready for discharge, you learn one of the bottles has grown coagulase negative staphylococci. Which of the following is an adequate justification for your decision to disregard this finding as culture contaminant?
GI bleeding is almost never caused by coagulase negative staphylococci.
You can always disregard a blood culture result if only some of the bottles are positive.
The finding of coagulase negative staphylococci on a blood culture is always a culture contaminant.
The patient lacks clinical risk factors that would make coagulase negative staphylococcal bacteremia a likely condition.
The fact that the patient is feeling better off of antibiotics excludes bacteremia from the realm of possibility.
You draw two sets of blood cultures in a patient hospitalized for a GI bleed and who subsequently developed a fever while you are on call. At that point you notice the patient has no indwelling catheter, and no prosthetic joints or other man-made body parts. Three days later, at which point the patient is feeling well and afebrile and nearly ready for discharge, you learn one of the bottles has grown coagulase negative staphylococci. Which of the following is an adequate justification for your decision to disregard this finding as culture contaminant?
GI bleeding is almost never caused by coagulase negative staphylococci.
You can always disregard a blood culture result if only some of the bottles are positive.
The finding of coagulase negative staphylococci on a blood culture is always a culture contaminant.
The patient lacks clinical risk factors that would make coagulase negative staphylococcal bacteremia a likely condition.
The fact that the patient is feeling better off of antibiotics excludes bacteremia from the realm of possibility.
Which of the following syndromes is MOST CONSISTENT with the typical presentation of viral encephalitis?
- A 34-year-old injection drug user presents with fever, headache and weakness of the left arm
- An 16-year-old high school girl presents with fever, headache, a petechial rash and sepsis
- A 22-year-old Appalachian trail hiker presents with fever, confusion and seizure
- A 21-year-old otherwise healthy woman from Massachusetts presents with fever, headache, normal vitals, and myalgias in the summer
- A 68-year-old dancer with AIDS presents with ataxia and personality changes
Which of the following syndromes is MOST CONSISTENT with the typical presentation of viral encephalitis?
- A 34-year-old injection drug user presents with fever, headache and weakness of the left arm
- An 16-year-old high school girl presents with fever, headache, a petechial rash and sepsis
-A 22-year-old Appalachian trail hiker presents with fever, confusion and seizure
- A 21-year-old otherwise healthy woman from Massachusetts presents with fever, headache, normal vitals, and myalgias in the summer
- A 68-year-old dancer with AIDS presents with ataxia and personality changes
An alcoholic hiker from New England presents to the emergency room with profound fatigue and fevers. His evaluation there reveals marked new anemia, with red cell schistocytes on his smear. Some red cells contain ring forms. He has never traveled internationally. Which of the following parasites is likely to blame?
- Toxoplasma
- Schistosoma
- Ascaris
- Babesia
- Trichomonas
An alcoholic hiker from New England presents to the emergency room with profound fatigue and fevers. His evaluation there reveals marked new anemia, with red cell schistocytes on his smear. Some red cells contain ring forms. He has never traveled internationally. Which of the following parasites is likely to blame?
-Toxoplasma
- Schistosoma
- Ascaris
-Babesia
-Trichomonas
•A 23 year-old sexually active recent college graduate develops dysuria. His urinalysis shows pyuria but so far nothing has grown in urine culture. Which of the following is true?
A.You should look for congenital abnormalities of the genitourinary tract before treating.
B.A three-day course of trimethoprim-sulfamethoxazole should cover the most likely pathogens.
C.A three-day course of azithromycin should cover the most likely pathogens.
D.You should look for MRSA in culture before treating.
E.You should look for Chlamydia and other sexually transmitted infections before treating.
•A 23 year-old sexually active recent college graduate develops dysuria. His urinalysis shows pyuria but so far nothing has grown in urine culture. Which of the following is true?
A.You should look for congenital abnormalities of the genitourinary tract before treating.
B.A three-day course of trimethoprim-sulfamethoxazole should cover the most likely pathogens.
C.A three-day course of azithromycin should cover the most likely pathogens.
D.You should look for MRSA in culture before treating.
**E.You should look for Chlamydia and other sexually transmitted infections before treating. **
You see a WWII veteran with a long history of episodic abdominal pain and diarrhea. A month ago he was started on a trial of steroids for a reason that is not clear. He now presents with fever and hypotension and a productive cough. Your careful history reveals that he served in the Philippines and has visited there several times over the years. A blood culture grows a gram-negative rod and a sputum exam reveals microscopic worm larvae. The worms are most likely:
- An incidental finding, probably pinworm (Enterobius)
- Ascaris lumbricoides, because it is the most common worm infection worldwide
- Strongyliodes stercoralis in its hyperinfection phase
- Visceral larva migrans (Toxocara) from his pet dog
- Schistosoma japonicum reactivated by the steroids
You see a WWII veteran with a long history of episodic abdominal pain and diarrhea. A month ago he was started on a trial of steroids for a reason that is not clear. He now presents with fever and hypotension and a productive cough. Your careful history reveals that he served in the Philippines and has visited there several times over the years. A blood culture grows a gram-negative rod and a sputum exam reveals microscopic worm larvae. The worms are most likely:
- An incidental finding, probably pinworm (Enterobius)
- Ascaris lumbricoides, because it is the most common worm infection worldwide
-Strongyliodes stercoralis in its hyperinfection phase
- Visceral larva migrans (Toxocara) from his pet dog
- Schistosoma japonicum reactivated by the steroids
You have been treating a 62-year-old lawyer for the past several weeks with ciprofloxacin for biopsy-proven lumbar vertebral osteomyelitis from Escherichia coli. Other than some benign prostatic hypertrophy, and high blood pressure, he is a healthy guy who enjoys golfing with his friends on the weekends. Which of the following is an accurate explanation of the pathophysiology of this disease?
(Jen didn’t get the answer choices….ECHO cut off)
You have been treating a 62-year-old lawyer for the past several weeks with ciprofloxacin for biopsy-proven lumbar vertebral osteomyelitis from Escherichia coli. Other than some benign prostatic hypertrophy, and high blood pressure, he is a healthy guy who enjoys golfing with his friends on the weekends. Which of the following is an accurate explanation of the pathophysiology of this disease?
He likely developed bacteremia from a urinary infection resulting from his benign prostatic hyperplasia, which in turn led to hematogenous seeding of his vertebrae.
(sorry, Jen didn’t get the rest of the answer choices…. ECHO cut off)
An AIDS patient with a CD4 count under 100 is admitted to the neurology ward with left sided weakness ascribed to what the radiologist called a ‘ring-enhancing lesion’ in his right motor cortex. He is afebrile, hemodynamically stable and blood cultures show nothing. Which of the following parasites is the most likely cause of this syndrome?
- Toxoplasma
- Schistosoma
- Ascaris
- Babesia
- Trichomonas
An AIDS patient with a CD4 count under 100 is admitted to the neurology ward with left sided weakness ascribed to what the radiologist called a ‘ring-enhancing lesion’ in his right motor cortex. He is afebrile, hemodynamically stable and blood cultures show nothing. Which of the following parasites is the most likely cause of this syndrome?
-Toxoplasma
- Schistosoma
- Ascaris
- Babesia
- Trichomonas
About four hours after consuming some reheated fried rice from the local Chinese restaurant, you develop nausea and vomiting that is miserable but lasts only two hours. Which of the following organisms is MOST LIKELY to blame?
- Clostridium difficile
- Hepatitis A
- Bacillus cereus
- Clostridium perfringens
- Salmonella spp
About four hours after consuming some reheated fried rice from the local Chinese restaurant, you develop nausea and vomiting that is miserable but lasts only two hours. Which of the following organisms is MOST LIKELY to blame?
- Clostridium difficile
- Hepatitis A
3. Bacillus cereus
- Clostridium perfringens
- Salmonella spp
You meet a 42 yo fisherman who emigrated to the US from Guinea Bissau where he worked in the same trade. To date your workup has revealed cirrhosis, portal hypertension, and esophageal varices. Which of the following is true about the parasitic infection causing his liver disease?
- This is consistent with visceral larva migrans (Toxocara spp) and the man should be treated with mebendazole
- This is consistent w pinworm (Enterobius vermicularis) and the man plus his daughter and maybe other family members should be treated with mebendazole.
- This is consistent with schistosomiasis (Schistosoma spp) and the man should be treated with praziquantel
- This is consistent with schistosomiasis (Schistosoma spp) and the man plus his daughter and maybe other family members should be treated with praziquantel
- This is a classic example of migratory Ascaris (Ascaris lumbricoides) but no therapy is indicated because the worms are already dead.
You meet a 42 yo fisherman who emigrated to the US from Guinea Bissau where he worked in the same trade. To date your workup has revealed cirrhosis, portal hypertension, and esophageal varices. Which of the following is true about the parasitic infection causing his liver disease?
- This is consistent with visceral larva migrans (Toxocara spp) and the man should be greated with mebendazole
- This is consistent w pinworm (Enterobius vermicularis) and the man plus his daughter and maybe other family members should be treated with mebendazole.
-This is consistent with schistosomiasis (Schistosoma spp) and the man should be treated with praziquantel
- This is consistent with schistosomiasis (Schistosoma spp) and the man plus his daughter and maybe other family members should be treated with praziquantel
- This is a classic example of migratory Ascaris (Ascaris lumbricoides) but no therapy is indicated because the worms are already dead.
An 18 year-old college student returned from a summer internship in Tanzania two days ago, and now is seeing you in the ER with a high fever, shaking chills and muscle aches. She is otherwise healthy, and takes no medications. She asks, “could this relate to the fact I didn’t take my malaria prophylaxis?” You have ordered a parasite smear of her blood. In the meantime, which of the following lab patterns would be most suggestive of severe malaria from Plasmodium falciparum?
A.Elevated hemoglobin, elevated platelets, and elevated creatinine.
B.Elevated hemoglobin, decreased platelets, and decreased creatinine.
C.Decreased hemoglobin, elevated platelets, and elevated creatinine.
D.Decreased hemoglobin, decreased platelets, and elevated creatinine.
E.Decreased hemoglobin, decreased platelets, and decreased creatinine.
An 18 year-old college student returned from a summer internship in Tanzania two days ago, and now is seeing you in the ER with a high fever, shaking chills and muscle aches. She is otherwise healthy, and takes no medications. She asks, “could this relate to the fact I didn’t take my malaria prophylaxis?” You have ordered a parasite smear of her blood. In the meantime, which of the following lab patterns would be most suggestive of severe malaria from Plasmodium falciparum?
A.Elevated hemoglobin, elevated platelets, and elevated creatinine.
B.Elevated hemoglobin, decreased platelets, and decreased creatinine.
C.Decreased hemoglobin, elevated platelets, and elevated creatinine.
D.Decreased hemoglobin, decreased platelets, and elevated creatinine.
E.Decreased hemoglobin, decreased platelets, and decreased creatinine.
A 41 year-old lawyer presents with right sided blindness. She says about two weeks ago she started experiencing “blind spots” on that side which progressed to “total haze” and now complete loss of vision. Otherwise she feels completely fine: no fevers or other symptoms. “I was just too busy to see a doctor.” She has no past medical history, and takes no medications. Physical examination is completely normal except for cotton wool spots obscuring the retinal arteries and the edges of the optic disc. This is the classic presentation for which of the following opportunistic pathogens?
a. Pneumocystis jiroveci
b. Toxoplasma gondii
c. Mycobacterium avium complex
d. Human herpesvirus 8
e. Cytomegalovirus
A 41 year-old lawyer presents with right sided blindness. She says about two weeks ago she started experiencing “blind spots” on that side which progressed to “total haze” and now complete loss of vision. Otherwise she feels completely fine: no fevers or other symptoms. “I was just too busy to see a doctor.” She has no past medical history, and takes no medications. Physical examination is completely normal except for cotton wool spots obscuring the retinal arteries and the edges of the optic disc. This is the classic presentation for which of the following opportunistic pathogens?
a. Pneumocystis jiroveci
b. Toxoplasma gondii
c. Mycobacterium avium complex
d. Human herpesvirus 8
e.Cytomegalovirus
Yesterday you notified Joe, a 25 year-old man who has sex with men, that he has HIV infection. He feels well, has no past medical history, and has a normal physical examination. The HIV serology was obtained during routine screening. After he spent a few hours on Google looking up HIV and its complications, Joe has a list of questions for you, including, “When do you think we should start meds, doc?” Joe’s CD4 count is 90. You plan to start prophylactic antibiotics today and then next week you’ll begin antiretroviral therapy.
What prophylactic antibiotics would you recommend for Joe?
a. Trimethoprim/sulfamethoxazole alone
b. Azithromycin alone
c. Valganciclovir alone
d. Trimethoprim/sulfamethoxazole plus azithromycin
e. Trimethoprim/sulfamethoxazole plus valcanciclovir
•Yesterday you notified Joe, a 25 year-old man who has sex with men, that he has HIV infection. He feels well, has no past medical history, and has a normal physical examination. The HIV serology was obtained during routine screening. After he spent a few hours on Google looking up HIV and its complications, Joe has a list of questions for you, including, “When do you think we should start meds, doc?” Joe’s CD4 count is 90. You plan to start prophylactic antibiotics today and then next week you’ll begin antiretroviral therapy.
What prophylactic antibiotics would you recommend for Joe?
a.Trimethoprim/sulfamethoxazole alone
b. Azithromycin alone
c. Valganciclovir alone
d. Trimethoprim/sulfamethoxazole plus azithromycin
e. Trimethoprim/sulfamethoxazole plus valcanciclovir
Ova and parasite testing reveals the organism pictured below in the stool of a 45-year-old teetotaler with cirrhosis of the liver and a gastrointestinal bleed from esophageal varices. Which of the following parasites is the MOST LIKELY culprit?
Strongyloides stercoralis
Schistosoma japonicum
Ascaris lumbricoides
Babesia microti
Cryptosporidium parvum
Schistosoma japonicum
(this is actually a picture of schistosoma haematobium!!)
