Infectious disease Questions 2
Infectious disease
25. You are a physician in charge of the patients who reside in a nursing home. Several of the patients have developed influenza-like symptoms, and the community is in the midst of an influenza A outbreak. None of the nursing home residents have received the influenza vaccine. What course of action is most appropriate?
a. Give the influenza vaccine to all residents who do not have a contraindication
to the vaccine (i.e., allergy to eggs)
b. Give the influenza vaccine to all residents who do not have a contraindication
to the vaccine; also give amantadine for 2 weeks
c. Give amantadine alone to all residents
d. Do not give any prophylactic regimen
26. An elderly male develops fever 3 days after cholecystectomy. He
becomes short of breath, and chest x-ray shows a new right lower lobe
infiltrate. Sputum Gram stain shows gram-positive cocci in clumps, and
preliminary culture results suggest staphylococci. The initial antibiotic of
choice is
a. Penicillinase-resistant penicillin such as nafcillin
b. Vancomycin
c. Antibiotic therapy should be based on the incidence of methicillin-resistant
staphylococci in that hospital
d. Quinolones have become the drug of choice for pneumonia
27. A 30-year-old male with sickle cell anemia is admitted with cough,
rusty sputum, and a single shaking chill. Physical examination reveals
increased tactile fremitus and bronchial breath sounds in the left posterior
chest. The patient is able to expectorate a purulent sample. Which of the
following best describes the role of sputum Gram stain and culture?
a. Sputum Gram stain and culture lack the sensitivity and specificity to be of value
in this setting
b. If the sample is a good one, sputum culture is useful in determining the anti-
biotic sensitivity pattern of the organism, particularly Streptococcus pneumoniae
c. Empirical use of antibiotics for pneumonia has made specific diagnosis unnec-
essary
d. There is no characteristic Gram stain in a patient with pneumococcal pneumonia
28. A 30-year-old man who has spent 5 of the last 10 years in prison in New York City is referred from the prison because of hemoptysis. He has a history of tuberculosis diagnosed 3 years ago and took isoniazid and rifampin for about a month. A cavitary lesion is seen on chest x-ray. The physician should do all the following except
a. Obtain sputum for acid-fast bacilli (AFB) stain, culture, and sensitivity
b. Start supervised isoniazid and rifampin administration
c. Start a supervised multiple drug combination to treat multidrug-resistant
tuberculosis
d. Place the patient in respiratory isolation
e. Perform routine screening of inmates and staff for tuberculosis
29. A recent outbreak of severe diarrhea is currently being investigated. Several children developed bloody diarrhea, and one remains hospitalized with acute renal failure. A preliminary investigation has determined that all the affected children ate at the same restaurant. The food they consumed was most likely to be
a. Pork chops
b. Hamburger
c. Gefilte fish
d. Sushi
e. Soft-boiled eggs
30. A 40-year-old female nurse was admitted to the hospital because of fever to 103°F. Despite a thorough workup in the hospital for over 3 weeks, no etiology has been found, and she continues to have temperature spikes greater than 102°F. The least likely diagnosis in this patient is
a. Occult bacterial infection
b. Influenza
c. Lymphoma
d. Adult Still’s disease
e. Factitious fever
31. In a patient who has mitral valve insufficiency, which procedure does not require prophylactic antibiotic therapy?
a. Cardiac catheterization
b. Prostatectomy
c. Cystoscopy
d. Tonsillectomy
e. Periodontal surgery
32. Rabies, an acute viral disease of the mammalian central nervous system, is transmitted by infective secretions, usually saliva. Which of the following statements about this disease is correct?
a. The disease is caused by a reovirus that elicits both complement-fixing and
hemagglutinating antibodies useful in the diagnosis of the disease
b. The incubation period is variable, and, although 10 days is the most common
elapsed time between infection and symptoms, some cases remain asympto-
matic for 30 days
c. Only 30% of infected patients will survive
d. In the United States, the skunk and the raccoon have been important recent
sources of human disease
e. Wild animals that have bitten and are suspected of being rabid should be killed
and their brains examined for virus particles by electron microscopy
Items 33-36
Match each clinical description with the appropriate infectious agent.
a. Herpes simplex virus
b. Epstein-Barr virus
c. Parvovirus B19
d. Staphylococcus aureus
e. Neisseria meningitidis
33. Slapped-cheek rash
34. Desquamation of skin on hands and feet
35. Petechiae on trunk
36. Diffuse rash after administration of ampicillin Items 37-41
Match the following diseases with their appropriate signs or associations.
a. Koplik spots
b. Agammaglobulinemia
c. A vesicular and pustular eruption that begins when the patient is afebrile
d. Acute cerebellar ataxia
e. Pancreatitis
37. Mumps (CHOOSE 1 SIGN)
38. Chickenpox (CHOOSE 1 SIGN)
39. Smallpox (CHOOSE 1 SIGN)
40. Echovirus infection (CHOOSE 1 SIGN)
41. Measles (CHOOSE 1 SIGN)
Items 42-46
Match the clinical illness with the appropriate opportunistic pathogen in patients with AIDS.
a. Pneumocystis carinii
b. Toxoplasma gondii
c. Cryptosporidium
d. Cytomegalovirus
e. Salmonella
42. Pneumonia (CHOOSE 1 PATHOGEN)
43. Retinitis (CHOOSE 1 PATHOGEN)
44. Seizures (CHOOSE 1 PATHOGEN)
45. Bacteremia (CHOOSE 1 PATHOGEN)
46. Diarrhea diagnosed by direct examination of stool (CHOOSE 1
PATHOGEN)
Items 47-51
For each of the sexually transmitted diseases, select the treatment of choice.
a. Penicillin
b. Doxycycline
c. Ceftriaxone plus doxycycline
d. Metronidazole
e. Acyclovir
47. Presumed gonococcal urethritis (SELECT 1 TREATMENT)
48. Nongonococcal urethritis (SELECT 1 TREATMENT)
49. Severe primary genital herpes (SELECT 1 TREATMENT)
50. Trichomoniasis (SELECT 1 TREATMENT)
51. Syphilis (SELECT 1 TREATMENT)
Items 52-55
Identify the antimicrobial agent associated with the adverse effects listed below.
a. Gentamicin
b. Imipenem
c. Tetracycline
d. Clindamycin
52. Photosensitivity (CHOOSE 1 AGENT)
53. Acute tubular necrosis (CHOOSE 1 AGENT)
54. Progressive weakness in a patient with myasthenia gravis (CHOOSE 1 AGENT)
55. Seizures (CHOOSE 1 AGENT)
56. A previously healthy 25-year-old music teacher develops fever and a rash over her face and chest. The rash is itchy and on exam involves multiple papules and vesicles in varying stages of development. One week later she complains of cough and is found to have an infiltrate on x-ray. The most likely etiology of the infection is
a. Streptococcus pneumoniae
b. Mycoplasma pneumoniae
c. Pneumocystis carinii
d. Varicella virus
Items 57-58
57. A 22-year-old male complains of fever and shortness of breath. There is no pleuritic chest pain or rigors and no sputum production. A chest x-ray shows diffuse perihilar infiltrates. The patient worsens while on erythromycin. A silver methenamine stain shows cystlike structures. Which of the following is correct?
a. Definitive diagnosis can be made by serology
b. The organism will grow after 48 h
c. History will likely provide important clues to the diagnosis
d. Cavitary disease is likely to develop
a. Give the influenza vaccine to all residents who do not have a contraindication
to the vaccine (i.e., allergy to eggs)
b. Give the influenza vaccine to all residents who do not have a contraindication
to the vaccine; also give amantadine for 2 weeks
c. Give amantadine alone to all residents
d. Do not give any prophylactic regimen
26. An elderly male develops fever 3 days after cholecystectomy. He
becomes short of breath, and chest x-ray shows a new right lower lobe
infiltrate. Sputum Gram stain shows gram-positive cocci in clumps, and
preliminary culture results suggest staphylococci. The initial antibiotic of
choice is
a. Penicillinase-resistant penicillin such as nafcillin
b. Vancomycin
c. Antibiotic therapy should be based on the incidence of methicillin-resistant
staphylococci in that hospital
d. Quinolones have become the drug of choice for pneumonia
27. A 30-year-old male with sickle cell anemia is admitted with cough,
rusty sputum, and a single shaking chill. Physical examination reveals
increased tactile fremitus and bronchial breath sounds in the left posterior
chest. The patient is able to expectorate a purulent sample. Which of the
following best describes the role of sputum Gram stain and culture?
a. Sputum Gram stain and culture lack the sensitivity and specificity to be of value
in this setting
b. If the sample is a good one, sputum culture is useful in determining the anti-
biotic sensitivity pattern of the organism, particularly Streptococcus pneumoniae
c. Empirical use of antibiotics for pneumonia has made specific diagnosis unnec-
essary
d. There is no characteristic Gram stain in a patient with pneumococcal pneumonia
28. A 30-year-old man who has spent 5 of the last 10 years in prison in New York City is referred from the prison because of hemoptysis. He has a history of tuberculosis diagnosed 3 years ago and took isoniazid and rifampin for about a month. A cavitary lesion is seen on chest x-ray. The physician should do all the following except
a. Obtain sputum for acid-fast bacilli (AFB) stain, culture, and sensitivity
b. Start supervised isoniazid and rifampin administration
c. Start a supervised multiple drug combination to treat multidrug-resistant
tuberculosis
d. Place the patient in respiratory isolation
e. Perform routine screening of inmates and staff for tuberculosis
29. A recent outbreak of severe diarrhea is currently being investigated. Several children developed bloody diarrhea, and one remains hospitalized with acute renal failure. A preliminary investigation has determined that all the affected children ate at the same restaurant. The food they consumed was most likely to be
a. Pork chops
b. Hamburger
c. Gefilte fish
d. Sushi
e. Soft-boiled eggs
30. A 40-year-old female nurse was admitted to the hospital because of fever to 103°F. Despite a thorough workup in the hospital for over 3 weeks, no etiology has been found, and she continues to have temperature spikes greater than 102°F. The least likely diagnosis in this patient is
a. Occult bacterial infection
b. Influenza
c. Lymphoma
d. Adult Still’s disease
e. Factitious fever
31. In a patient who has mitral valve insufficiency, which procedure does not require prophylactic antibiotic therapy?
a. Cardiac catheterization
b. Prostatectomy
c. Cystoscopy
d. Tonsillectomy
e. Periodontal surgery
32. Rabies, an acute viral disease of the mammalian central nervous system, is transmitted by infective secretions, usually saliva. Which of the following statements about this disease is correct?
a. The disease is caused by a reovirus that elicits both complement-fixing and
hemagglutinating antibodies useful in the diagnosis of the disease
b. The incubation period is variable, and, although 10 days is the most common
elapsed time between infection and symptoms, some cases remain asympto-
matic for 30 days
c. Only 30% of infected patients will survive
d. In the United States, the skunk and the raccoon have been important recent
sources of human disease
e. Wild animals that have bitten and are suspected of being rabid should be killed
and their brains examined for virus particles by electron microscopy
Items 33-36
Match each clinical description with the appropriate infectious agent.
a. Herpes simplex virus
b. Epstein-Barr virus
c. Parvovirus B19
d. Staphylococcus aureus
e. Neisseria meningitidis
33. Slapped-cheek rash
34. Desquamation of skin on hands and feet
35. Petechiae on trunk
36. Diffuse rash after administration of ampicillin Items 37-41
Match the following diseases with their appropriate signs or associations.
a. Koplik spots
b. Agammaglobulinemia
c. A vesicular and pustular eruption that begins when the patient is afebrile
d. Acute cerebellar ataxia
e. Pancreatitis
37. Mumps (CHOOSE 1 SIGN)
38. Chickenpox (CHOOSE 1 SIGN)
39. Smallpox (CHOOSE 1 SIGN)
40. Echovirus infection (CHOOSE 1 SIGN)
41. Measles (CHOOSE 1 SIGN)
Items 42-46
Match the clinical illness with the appropriate opportunistic pathogen in patients with AIDS.
a. Pneumocystis carinii
b. Toxoplasma gondii
c. Cryptosporidium
d. Cytomegalovirus
e. Salmonella
42. Pneumonia (CHOOSE 1 PATHOGEN)
43. Retinitis (CHOOSE 1 PATHOGEN)
44. Seizures (CHOOSE 1 PATHOGEN)
45. Bacteremia (CHOOSE 1 PATHOGEN)
46. Diarrhea diagnosed by direct examination of stool (CHOOSE 1
PATHOGEN)
Items 47-51
For each of the sexually transmitted diseases, select the treatment of choice.
a. Penicillin
b. Doxycycline
c. Ceftriaxone plus doxycycline
d. Metronidazole
e. Acyclovir
47. Presumed gonococcal urethritis (SELECT 1 TREATMENT)
48. Nongonococcal urethritis (SELECT 1 TREATMENT)
49. Severe primary genital herpes (SELECT 1 TREATMENT)
50. Trichomoniasis (SELECT 1 TREATMENT)
51. Syphilis (SELECT 1 TREATMENT)
Items 52-55
Identify the antimicrobial agent associated with the adverse effects listed below.
a. Gentamicin
b. Imipenem
c. Tetracycline
d. Clindamycin
52. Photosensitivity (CHOOSE 1 AGENT)
53. Acute tubular necrosis (CHOOSE 1 AGENT)
54. Progressive weakness in a patient with myasthenia gravis (CHOOSE 1 AGENT)
55. Seizures (CHOOSE 1 AGENT)
56. A previously healthy 25-year-old music teacher develops fever and a rash over her face and chest. The rash is itchy and on exam involves multiple papules and vesicles in varying stages of development. One week later she complains of cough and is found to have an infiltrate on x-ray. The most likely etiology of the infection is
a. Streptococcus pneumoniae
b. Mycoplasma pneumoniae
c. Pneumocystis carinii
d. Varicella virus
Items 57-58
57. A 22-year-old male complains of fever and shortness of breath. There is no pleuritic chest pain or rigors and no sputum production. A chest x-ray shows diffuse perihilar infiltrates. The patient worsens while on erythromycin. A silver methenamine stain shows cystlike structures. Which of the following is correct?
a. Definitive diagnosis can be made by serology
b. The organism will grow after 48 h
c. History will likely provide important clues to the diagnosis
d. Cavitary disease is likely to develop