A 4-week-old white male is brought to your office with a 2-week history of increasing dyspnea, cough, and poor feeding. The child appears nontoxic and is afebrile. On examination you note conjunctivitis, and a chest examination reveals tachypnea and crack
B. Chlamydial pneumonia
- usu in infants 3 - 16 wks; pt sick for weeks
- infant nontoxic & afebrile, tachypneic w/ prominent cough
- physical examination: diffuse crackles with few wheezes, and conjunctivitis (50% of cases).
- CXR: hyperinflation and diff
One day after a nurse performs CPR on an emergency-department patient, she learns that the patient had meningococcal meningitis. Which one of the following is the most appropriate chemoprophylaxis for this condition? (check one)
A. Penicillin G benzathine
B. Rifampin, 600 mg q12 x 12 days
- Rifampin has been shown to be 90% effective in eliminating meningococcus from the nasopharynx. - also minocycline and ciprofloxacin
- even high doses of penicillin may not eradicate nasopharyngeal meningococci.
- Mening
A 30-year-old ill-appearing male presents with right hand and arm pain and a rapidly expanding area of redness. On examination he temp is 38.9�C (102.0�F), a pulse rate of 120beats/min, and a blood pressure of 116/74 mm Hg. He also has erythema from the d
D. Immediate surgical consultation for operative debridement
- Severe pain and skin changes outside the realm of cellulitis, including bullae and deeper discoloration, are strong indications of necrotizing fasciitis.
- Antimicrobial therapy is essential b
You are the medical director of a long-term-care facility that has 60 residents. Several patients experience fever, cough, and upper respiratory symptoms. Two of these patients test positive for influenza A (H1N1) virus.
Which one of the following is reco
A. Chemoprophylaxis with appropriate medications for all residents
= two or more laboratory-confirmed cases of influenza A = outbreak in a long-term care facility.
The CDC has specific recommendations for managing an outbreak, which include
chemoprophylax
A 54-year-old male presents to your office with a 10-day history of increasing cough. A physical
examination reveals coarse crackles in the left lower lobe. You make a diagnosis of pneumonia.
The patient's only current medication is simvastatin (Zocor).
W
C. Clarithromycin
- In older adults, coprescription of clarithromycin or erythromycin with a statin that is metabolized by CYP 3A4 (atorvastatin, simvastatin, lovastatin) increases the risk of statin toxicity. The other antibiotics listed do not interact
A 30-year-old female with a history of prolonged QT syndrome presents with severe acute
bacterial sinusitis. Which one of the following antibiotics should be avoided? (check one)
A. Amoxicillin
B. Clarithromycin (Biaxin)
C. Amoxicillin/clavulanate (Augmen
B. Clarithromycin (Biaxin)
- Clarithromycin interferes with the delayed rectifier potassium current, which results in the accumulation of potassium ions in cardiac myocytes and thereby delays cardiac repolarization.
Clarithromycin is
- metabolized by the
The most common identifiable cause of skin and soft-tissue infections presenting to metropolitan emergency departments is: (check one)
A. Staphylococcus epidermidis
B. Streptococcus pneumoniae
C. Pseudomonas aeruginosa
D. methicillin-resistant Staphylococ
D. methicillin-resistant Staphylococcus aureus (MRSA)
- most common identifiable cause of skin and soft-tissue infections among patients presenting to emergency departments in 11 U.S. cities.
A 2-year-old female is brought to the emergency department with a 2-day history of fever and increasing redness on the left forearm. She is otherwise healthy. On examination her temperature is 39.9�C (103.8�F), pulse rate 140 beats/min, and respiratory ra
A. IV vancomycin
- systemic symptoms that suggest a severe underlying infection
- Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) should be considered the cause of this type of infection until definitive cultures are obtained.
- C
A 65-year-old male present to the urgent care center with a foot ulcer. His past medical history is significant for hypertension, COPD, and diabetes mellitus. He has been hospitalized several times in the past year for COPD exacerbations and a hip fractur
E. Piperacillin/tazobactam (Zosyn) and vancomycin (Vancocin); severe diabetic foot ulcer - with a systemic inflammatory response. This is an indication for intravenous antibiotics.
Piperacillin/tazobactam and vancomycin together will cover the most common
A 19-year-old college wrestler presents with cellulitis of his left arm extending from a small pustule on his hand to the axilla. He appears acutely ill and has a temperature of 38.9�C (102.0�F). His WBC count is 22,000/mm3 (N 4300-10,800). He is admitted
E. vancomycin
Methicillin-resistant Staphylococcus aureus (MRSA) - community-acquired strains have been susceptible to many antibiotics, clindamycin is associated with Clostridium difficile enterocolitis, trimethoprim/sulfamethoxazole is usually
used oral
A 2-year-old female is brought to the emergency department with a 2-day history of fever and increasing redness on the left forearm. She is otherwise healthy. On examination her temperature is 39.9�C (103.8�F), pulse rate 140 beats/min, and respiratory ra
A. IV Vancomycin
- systemic symptoms that suggest a severe underlying infection.
- Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) should be considered the cause
- CA-MRSA can cause aggressive infections in children, especially in
A 3-year-old female is brought to your office with coughing and a tactile fever. Her only other
symptom is mild rhinorrhea. She has a temperature of 38.2�C (100.8�F) and is mildly
tachypneic. Her vital signs are otherwise normal and she appears to be well
A. Amoxicillin
Amoxicillin is the recommended first-line treatment for previously healthy infants and school-age children with mild to moderate community-acquired pneumonia (CAP) (strong recommendation; moderate-quality
evidence).
The most prominent bacte
On examination a 2-year-old child is found to have otalgia, a temperature of 39.0�C (102.2�F), and a bulging, red tympanic membrane. She weighs 17 kg (35 lb).
Which one of the following would be the appropriate dosage of amoxicillin (Amoxil) for this chil
E. 1500 mg/day
For treating acute otitis media in this patient, the current recommended dosage of amoxicillin is 80-90 mg/kg/day.
A 50-year-old male comes to your office for a "doctor's excuse" for days of work he missed last week. He attended a picnic where he and other guests developed nausea and vomiting 2 hours after eating. Within 48 hours, the symptoms had resolved.
The most l
A. Staphylococcal food poisoning
Not botulism
- in home canned foods
- symptoms begin 18-36 hours after ingestion.
Not Clostridium perfringens
- transmitted in feces and water, and symptoms begin 6-24 hours after ingestion
Not Clostridium difficile
- asso
A 52-year-old healthy male presents with a 2�-week history of diarrhea, consisting of 4-6 watery stools daily. He is afebrile and his examination is normal. You recommend symptomatic care. Two days later the laboratory notifies you that Salmonella is grow
E. No treatment
The recommended management for patients who have non-severe Salmonella infection and are otherwise healthy is no treatment.
Patients with high-risk conditions that predispose to bacteremia, and those with severe diarrhea, fever, and system
A 63-year-old female with corticosteroid-dependent COPD has developed pneumonia. Which one of the following pathogens should the antibiotic regimen cover in this patient that would be unlikely in someone with pneumonia and otherwise healthy lungs? (check
E. Pseudomonas aeruginosa
All of the pathogens listed can cause pneumonia in any patient. However, in patients with chronic lung
disease who are taking corticosteroids, pseudomonas is more common than in those with otherwise healthy lungs. The antibiotics
Which one of the following is most appropriate for patients with asplenia? (check one)
A. Lifelong daily antibiotic prophylaxis
B. Antibiotics for any episode of fever
C. An additional dose of Hib vaccine
D. Avoiding live attenuated influenza vaccine
E. W
B. Antibiotics for any episode of fever - PCN PO bid esp. child under 5 & 1-2 yrs in older adults
- Lifelong daily antibiotics may be considered following post-splenectomy sepsis.
- risk for Haemophilus influenzae type b infection is not increased in aspl
Which one of the following is an indication for a second dose of pneumococcal polysaccharide
vaccine in children? (check one)
A. A cerebrospinal fluid leak
B. Cyanotic congenital heart disease
C. Type 1 diabetes mellitus
D. Sickle cell disease
E. Chronic
A. A cerebrospinal fluid leak
Individuals with sickle cell disease, those with anatomic or functional asplenia, immunocompromised persons with renal failure or leukemia, and HIV-infected persons should receive polysaccharide vaccine on this same schedule
A 30-year-old female is referred to you by a local optometrist after she was treated several times
for anterior uveitis. You are concerned about an associated systemic disease. She feels well otherwise, and denies back or joint pain, rash, cough, or fever
C. Syphilis
Many patients with uveitis have an associated systemic disease. Some medications may cause secondary uveitis, and conditions such as ocular lymphoma and bloodborne infection may masquerade as primary uveitis.
In North America, the most common
A 30-year-old female presents with dysuria and flank pain. She reports a fever of 102�F
yesterday morning. She has not taken any antipyretics since that time, and today her temperature
is 36.7�C (98.1�F). She has a pulse rate of 93 beats/min, a respirator
B. Ciprofloxacin (Cipro)
Acute pyelonephritis (renal pelvis and kidney)
- most often seen in young women
- most commonly caused by Escherichia coli.
- Outpatient oral fluoroquinolone e.g. ciprofloxacin is usually the first-line therapy
- If the community
A 22-year-old female with a 2-week history of paroxysmal cough is found to have pertussis
confirmed by a polymerase chain reaction test and a nasal swab culture. Which one of the
following is the antibiotic of choice for this patient? (check one)
A. Amoxi
B. Azithromycin (Zithromax) - treatment and prophylaxis of pertussis;
- 6 wks from onset for peds under 1 y/o, 3 wks for all others
- Trimethoprim/sulfamethoxazole is an alternative in cases of allergy or intolerance to macrolides.
A 14-year-old male presents to your office with a high fever that began suddenly. He has a
diffuse petechial rash and some nuchal rigidity on examination. A lumbar puncture is performed,
and gram-negative diplococci are found. You admit him to the hospita
C. Chemoprophylaxis for family members and very close contacts only
The risk for secondary disease among close contacts is highest during the first few days after the onset of illness in the index patient, mandating immediate chemoprophylaxis of those exp
A 25-year-old male daycare worker presents with a 3-week history of bloating and foul-smelling
stools. On examination the patient has mild, diffuse abdominal tenderness and increased bowel
sounds.
Which one of the following is the most likely cause of thi
D. Giardia lamblia
Giardia: daycare - metronidazole
C. diff: hospital - metronidazole
E. coli (enterotoxigenic)/Norovirus: traveler's diarrhea - cipro
Campylobacter: food + bloody diarrhea - cipro
A 74-year-old male presents with a 4-day history of diarrhea that he had initially thought was "a 24-hour virus." He states that the onset of his illness included nausea, one episode of vomiting, and profuse diarrhea. He has felt feverish and has been hav
C. Campylobacter jejuni
- most common causes of bacterial foodborne illnesses,affect 1 million Americans annually
- Undercooked or improperly handled chicken
- infection generally isolated and sporadic, occurs more frequently at the extremes of age, affec
A 25-year-old male presents with a 3-day history of cough, chills, and fever. The patient was previously healthy and has no chronic medical problems. He has no known drug allergies. On examination he is alert and oriented, and has a temperature of 38.4�C
B. Outpatient treatment with Levofloxacin
or combined cefuroxime (Ceftin) + macrolide (azithromycin or clarithromycin)
Mild symptom: azithromycin
Comorbidities or Resistance: Levofloxacin
Severe e.g. tachypnic, tachycardiac: IP ceftriaxone or azithromycin
A 26-year-old pet groomer sustained a dog bite to her left hand 2 hours ago. On examination a
4-cm � 2.5-cm laceration is noted on the thenar eminence of her palm. Although the wound
shows some gaping there is minimal active bleeding. No neurovascular inj
C. A bite involving the hand
high risk include
- bite on an extremity with underlying venous and/or lymphatic compromise
- bite involving the hand
- bite near or in a prosthetic joint,
- cat bites, crush injuries, delayed presentation, puncture wounds,
-
You see a 27-year-old male with autosomal dominant polycystic kidney disease. He has no other
medical problems and his renal function has always been normal on annual testing. Today the
patient reports his blood pressure at home has been 142-150/84-90 mm
D. Lisinopril (Prinivil, Zestril)
You see a 4-year-old male in your office for evaluation of persisting fever, rash, and red eyes.
In a discussion with his father you learn that the child has had temperatures in the 99�F-102�F
range for 6 days, along with what the father describes as "pin
B. Transthoracic echocardiography - Kawasaki disease
Diagnostic criteria include fever for at least 5 days and at least 4 of the 5 principal clinical features:
� changes of the oral cavity and lips
� polymorphous rash
� bilateral nonpurulent conjunctiviti
A 30-year-old female at 36 weeks gestation has a positive culture for group B Streptococcus. Her past medical history is significant for the development of a nonurticarial rash in response to penicillin.
Which one of the following is most appropriate for
E. Cefazolin
Best for GBS
A 52-year-old male presents with a swollen and tender area anterior to the left ear and extending to below the left angle of the mandible. One week ago he had a Nissen fundoplication for intractable GERD. This was complicated by difficulty swallowing and
A. Amoxicillin/clavulanate (Augmentin) - acute parotitis
- commonly caused by dehydration and can be diagnosed clinically
- Empiric treatment is directed toward gram-positive and anaerobic organisms
- most common pathogen being Staph, often penicillin res
Which one of the following, especially in homeless people, is a vector for Bartonella quintana, which causes trench fever, an influenza-like syndrome with relapsing fever? (check one)
A. Fleas
B. Maggots
C. Bedbugs
D. Scabies
E. Lice
E. Lice
This disease got its name in World War I, when soldiers in the trenches were often infested with body lice. This is a serious disease that can be treated with antibiotics.
A 65-year-old female develops gram-negative septicemia from a urinary tract infection. Despite the use of fluid resuscitation she remains hypotensive, with a mean arterial pressure of 50 mm Hg. Which one of the following would be the most appropriate trea
D. Norepi (Levophed) - sepsis
- vasopressors are indicated when fluid resuscitation does not restore organ perfusion and blood pressure.
- Norepinephrine and dopamine currently are the preferred pressor agents
- Norepinephrine appears to be more effective
A previously healthy 59-year-old male is brought to the emergency department by his wife, who
describes symptoms of confusion and ataxia. She also says that he has had a fever and cough for
the past 2 weeks. On examination he has a temperature of 39.0�C (
D. Aggressive fluid resuscitation
SIRS
- fever >38.5�C
- heart rate >90 beats/min
- respiratory rate >20/min
- WBC count >12,000/mm3)
also meets severe sepsis criteria
- positive chest radiograph
- evidence of organ hypoperfusion (mental status changes)
-
23-year-old healthy male is sexually active with other men and does not use condoms. He is
interested in reducing his risk of contracting HIV by using a daily oral antiretroviral medication.
Which one of the following laboratory tests should be done no mo
B. Antibody testing for HIV - has to do it b/f pre-exposure prophylaxis (PrEP)
- via serum or fingerstick
- emtricitabine/tenofovir is not good enough for HIV infection & cause resistance
- other testing: Cr clearance, HBV antibody, STD screening, pregnan
Which one of the following potential bioterrorism agents requires treatment with 60 days of
continuous antibiotics? (check one)
A. Anthrax
B. Botulism
C. Pneumonic plague
D. Smallpox
E. Tularemia
A. Anthrax
- only anthrax needs 60 days tx (60 days incubation)
- oral fluoroquinolones and doxycycline.
Smallpox (variola virus)
- smallpox vaccine and two compounds currently in development.
Pneumonic (Yersinia pestis)
- 10-day course of an aminoglycosi
A pet reptile is most likely to transmit which one of the following to human contacts? (check one)
A. Hantavirus
B. Psittacosis (Chlamydophila psittaci)
C. Plague (Yersinia pestis)
D. Pasteurella multocida
E. Salmonella
E. Salmonella
Pasteurella multocida: dog or cat bites.
Yersinia pestis (plague): rodents or their fleas.
Hantavirus: rodents, and
psittacosis: bird species.
A 28-year-old male has had bright red blood in his semen with his last three ejaculations. He is
sexually active. He considers himself in good health, takes no medications, has no other
symptoms to suggest a coagulopathy, and has no other genitourinary sy
C. A urine probe for Neisseria gonorrhoeae and Chlamydia trachomatis
Which one of the following has been shown to be effective for Lyme disease prophylaxis after
removal of an engorged deer tick? (check one)
A. Amoxicillin
B. Ceftriaxone (Rocephin)
C. Cefuroxime axetil (Ceftin)
D. Doxycycline
E. Clarithromycin (Biaxin)
D. Doxycycline
An appendectomy and cholecystectomy were performed in the past, and the patient has since been free of gastrointestinal disease.
On physical examination his blood pressure is 100/80 mm Hg, pulse 100 beats/min and regular, and temperature 37.0�C (98.6�F).
C. C. diff colitis
-
semiformed stool
rather than watery, fecal leukocytes (not seen in viral gastroenteritis or sprue), and a hospital stay greater than 2 weeks.
- used to be associated with antibiotic use; now no abx is needed
- primary sources for infe
A 75-year-old male develops a mild Clostridium difficile infection and is treated with 10 days of metronidazole (Flagyl), 500 mg orally 3 times daily. The diarrhea recurs 10 days after he completes the course of treatment.
Which one of the following would
A. Repeat the course of metronidazole
For mild recurrent C. diff, repeating the course of the original agent is appropriate (SOR B).
Multiple recurrences or severe disease warrants the use of both agents.
About a month after returning from the Middle East, an American soldier develops a papule on his forearm that subsequently ulcerates to form a shallow annular lesion with a raised margin. The lesion shows no signs of healing 3 months after it first appear
A. leishmaniasis
The indolent course of the sore described favors the diagnosis of cutaneous leishmaniasis.
Neither malaria nor schistosomiasis produces these sores.
The chancres of syphilis and trypanosomiasis are more fleeting in duration.
Which one of the following organisms is NOT killed by alcohol-based hand disinfectants? (check one)
A. Methicillin-resistant Staphylococcus aureus (MRSA)
B. Methicillin-sensitive Staphylococcus aureus
C. Pseudomonas aeruginosa
D. Klebsiella pneumoniae
E.
E. C. diff
Sporulating organisms such as Clostridium difficile are not killed by alcohol products.
One week after returning from a Caribbean vacation, a 43-year-old female presents to a walk-in clinic with a complaint of redness and itching on the sole of her foot
She recalls experiencing a stinging sensation in the same area while she was wading in th
C. hookworm - characteristic serpiginous, red larva tracts
- When third-stage hookworm larvae, most commonly of the species infecting dogs and cats, penetrate the skin and migrate through the dermis, they create the tracks .
- most often in tropical and s
The pruritic lesions on the arm shown in Figure 6 are typical of: (check one)
A. poison ivy dermatitis
B. brown recluse spider bites
C. bedbug bites
D. Hymenoptera stings
E. molluscum contagiosum
C. bedbug bites
Which one of the following is an appropriate rationale for antibiotic treatment of Bordetella pertussis infections? (check one)
A. It delays progression from the catarrhal stage to the paroxysmal stage
B. It reduces the severity of symptoms
C. It reduces
D. It reduces the risk of transmission to others
- effective for eradicating bacterial infection but not for reducing the duration or severity of the disease.
- The eradication of infection is important for disease control because it reduces infectivity
-
A 24-year-old female presents to your clinic with a 5-day history of fever to 103�F. She has no localizing symptoms or overt physical findings. Initial testing shows an elevated WBC count with a disproportionate number of reactive lymphocytes.
Which one o
D. Viral infection
- ?-Blockers do diminish the effectiveness of inhaled ?-agonists, but this effect is not severe enough to contraindicate using these drugs together.
A 4-year-old white male is brought to your office because he has had a low-grade fever and decreased oral intake over the past few days. On examination you note shallow oral ulcerations confined to the posterior pharynx. Which one of the following is the
A. Herpangina - febrile disease caused by coxsackieviruses and echoviruses.
- Vesicles and subsequent ulcers develop in the posterior pharyngeal area (SOR C).
Herpes infection
- causes a gingivostomatitis that involves the anterior mouth.
Mononucleosis
-
A 63-year-old male with type 2 diabetes mellitus is seen in the emergency department for an acute, superficial, previously untreated infected great toe. Along with Staphylococcus aureus, which one of the following is the most common pathogen in this situa
B. Streptococcus
The most common pathogens in previously untreated acute superficial foot infections in diabetic patients are aerobic gram-positive Staphylococcus aureus and ?-hemolytic streptococci (groups A, B, and others). Previously treated and deep i
Which one of the following is true concerning Norwalk virus? (check one)
A. Outbreaks occur mostly in settings with large numbers of children, such as schools and day-care centers
B. Viral shedding continues long after the acute illness
C. The virus does
B. Viral shedding continues long after the acute illness
- Outbreaks occurs at all settings and all ages esp. elderly & immunocompromised
- Viral shedding b/f and after illness
- Virus persists on environmental surfaces and can tolerate a broad range of t
A 2-month-old female is brought to your office with tachypnea and a staccato cough. She is
afebrile. A chest radiograph shows hyperinflation and bilateral infiltrates, and a CBC reveals
eosinophilia.
Which one of the following is the most likely etiologic
A. Chlamydia trachomatis
- 1-3 months after birth
- tachypnea, a staccato cough, and no fever (SOR
A).
- Radiographs often show hyperinflation and infiltrates, and a CBC will reveal eosinophilia.
A hospitalized patient is being treated with vancomycin for an infection due to methicillin-resistant Staphylococcus aureus (MRSA). Which one of the following is most important to monitor? (check one)
A. Hepatic function
B. Trough serum levels
C. Peak ser
B. Trough serum levels - best predictor of vancomycin efficacy
- should be over 10 mg/L to prevent development of bacterial resistance
Which one of the following is the most common cause of recurrent and persistent acute otitis media in children? (check one)
A. Haemophilus influenzae
B. Moraxella catarrhalis
C. Penicillin-resistant Streptococcus pneumoniae
D. Pseudomonas aeruginosa
E. St
C. Penicillin-resistant Streptococcus pneumoniae
Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common bacteria
Hantavirus pulmonary syndrome results from exposure to the excreta of: (check one)
A. migratory fowl
B. bats
C. parrots
D. mice
E. turtles
D. mice
Hantavirus pulmonary syndrome results from exposure to rodent droppings, mainly the deer mouse in the southwestern U.S
A 16-year-old afebrile, otherwise healthy female presents with a 4-day history of right ear pain. She says she has spent a fair amount of time swimming recently. Traction on the pinna causes pain. The erythema and inflammation is limited to the ear canal
D. Cipro 0.3%/dexamethasone 0.1% (Ciprodex) topical
Acute otitis externa is treated with topical antibiotics. Although no preparation has been shown to be most effective, a fluoroquinolone does not create a risk of ototoxicity if the tympanic membrane is
A 20-month-old male presents with a history of a fever up to 38.5�C (101.3�F), pulling at both ears, drainage from his right ear, and a poor appetite following several days of nasal congestion. This is his first episode of acute illness, and he has no his
C. amoxicillin
This patient has acute bilateral otitis media, with presumed tympanic membrane perforation, and qualifies by any criterion for treatment with antibiotics. Amoxicillin, 80-90 mg/kg/day, should be the first-line antibiotic for most children w
A 47-year-old male is preparing for a 3-day trip to central Mexico to present the keynote address for an international law symposium. He asks you for an antibiotic to be taken prophylactically to prevent bacterial diarrhea.
Which one of the following woul
B. Rifaximin
- prophylaxis for those on critical short trips for which even a short period of diarrhea might cause undue hardship.
- Rifaximin, a nonabsorbable antibiotic, has been shown to reduce the risk for traveler's diarrhea by 77%.
- Trimethoprim/su
A healthy 24-year-old male presents with a sore throat of 2 days' duration. He reports mild congestion and a dry cough. On examination, his temperature is 37.2�C (99.0�F). His pharynx is red without exudates, and there are no anterior cervical nodes. His
A. Analgesics and supportive care
streptococcal pharyngitis w/ Centor criteria.
1. tonsillar exudates
2. tender anterior cervical lymphadenopathy
3. absence of cough
4. history of fever.
- three or four of these criteria has a positive predictive value of
A 24-year-old male presents with a fever of 38.9�C (102.0�F), generalized body aches, a sore throat, and a cough. His symptoms started 24 hours ago. He is otherwise healthy. You suspect novel influenza A H1N1 infection, as there have been numerous cases i
A. Oseltamivir (Tamiflu)
- H1N1 virus is almost always susceptible to neuraminidase inhibitors (oseltamivir and zanamivir) and resistant to the adamantanes (amantadine and rimantadine).
- Zanamivir should not be used in patients with COPD, asthma, or resp
Three members of the same family present with a high fever and cough that began abruptly yesterday. All three report having fevers over 40� C (104� F), painful coughs, moderate sore throats, and prostration. They have loss of appetite, but no vomiting or
B. Influenza-like illness
- has a very abrupt onset, and a fever with a nonproductive cough is almost always present. Unconfirmed cases are referred to as influenza-like illness (ILI) or suspected influenza. Patients with confirmed cases tend to say they
A 55-year-old hospitalized white male with a history of rheumatic aortic and mitral valve disease has a 3-day history of fever, back pain, and myalgias. No definite focus of infection is found on your initial examination. His WBC count is 24,000/mm3(N 430
E. vancomycin and gentamicin - endocarditis caused by a gram-positive coccus.
- Until sensitivities of the organism are known, treatment should include intravenous antibiotic coverage for Enterococcus, Strep, and methicillin-sensitive and methicillin-resi
A 20-year-old male presents with a complaint of pain in his right testis. The onset of pain has been gradual and has been associated with dysuria and urinary frequency. The patient has no medical problems and is sexually active. On examination he has some
C. Ceftriaxone (Rocephin) and doxycycline -
epididymitis.
- In males 14-35 years of age
- the most common causes are Neisseria gonorrhoeae and Chlamydia trachomatis.
- treatment is ceftriaxone, 250 mg intramuscularly, and doxycycline, 100 mg twice daily f
An asymptomatic 32-year-old male requests screening for sexually transmitted diseases. A nucleic acid amplification test is performed on a urine sample, and the results are positive for gonorrhea and negative for Chlamydia. The patient has no known drug a
A. Ceftriaxone (Rocephin) 250 mg intramuscularly
- also, azithromycin, 1 g orally, because of the high incidence of coinfection with Chlamydia, even if testing is negative, and to decrease the risk for cephalosporin resistance.
- 125-mg regimen is no long
A 19-year-old college student comes to your office with her mother. The mother reports that her daughter has frequently been observed engaging in binge eating followed by induced vomiting. She has also admitted to using laxatives to prevent weight gain.
W
A. Hypokalemia
no explanation
An 8-year-old white male presents with a 4-day history of erythematous cheeks, giving him a "slapped-cheek" appearance. Examination of the extremities reveals a mildly pruritic, reticulated, erythematous, maculopapular rash (see Figure 1). He is afebrile
A. human parvovirus
A previously healthy 29-year-old pediatric nurse has a 3-day history of malaise, arthralgias, and a nonpruritic rash. The rash is a faint, maculopapular, irregular, reticulate exanthem that covers her thighs and the inner aspects of her upper arms. Symmet
C. Parvovirus B19
- erythema infectiosum or fifth disease,
- common cause of an exanthematous rash and arthritis in younger women.
- esp. in health-care workers who have frequent contact with children.
The preferred antibiotic treatment for community-acquired pneumonia in a young adult in the ambulatory setting is: (check one)
A. trimethoprim/sulfamethoxazole (Bactrim, Septra)
B. cephalexin (Keflex)
C. azithromycin (Zithromax)
D. penicillin V
E. ciprofl
C. Azithromycin (Zithromax)
- covers the
atypical organism Mycoplasma pneumoniae
, most common causes of community-acquired pneumonia.
- Certain fluoroquinolones such as levofloxacin also cover atypical causes, but ciprofloxacin does not
- The other antib
Which one of the following drugs would be the most appropriate empiric therapy for nursing home-acquired pneumonia in a patient with no other underlying disease? (check one)
A. Cefazolin
B. Erythromycin
C. Ampicillin
D. Tobramycin (Nebcin)
E. Levofloxacin
E. Levofloxacin (Levaquin)
The major concern with regard to pneumonia in the nursing-home setting is the increased frequency of oropharyngeal colonization by gram-negative organisms.
In the absence of collectible or diagnostic sputum Gram's stains or cult
A 7-year-old Hispanic female has a 3-day history of a fever of 40.0�C (104.0�F), muscle aches, vomiting, anorexia, and headache. Over the past 12 hours she has developed a painless maculopapular rash that includes her palms and soles but spares her face,
D. Rocky Mountain spotted fever (RMSF) (SOR C) - tick-borne.
- mostly found in the South Atlantic and south central states.
- the summer and with exposure to tall vegetation (e.g., while camping, hiking, or gardening)
- clinical dx: fever, hypotension, ra
A 20-year-old female presents with a sudden onset of fever, chills, and headache of 2 days duration, and now has a pink blanching rash. The rash covers most of her body, including the palms of her hands and the soles of her feet, but not including her fac
A. Doxycycline, 100 mg bid - rickettsial illness (in the United States this would most likely be Rocky Mountain Spotted Fever):
- outdoor activity, the sudden onset of fever, chills, and rash on the palms of the hands and the soles of the feet.
A 26-year-old gravida 1 para 0 presents for a prenatal examination. She has two cats and expresses concern about toxoplasmosis.
Which one of the following would be most appropriate for this patient?
(check one)
A. Recommend that she avoid directly handlin
A. recommend that she avoid direct handling of litter box
- the American College of Obstetrics and Gynecology does not recommend routine screening except in patients who are known to be HIV positive
- However, because the infection is thought to be passed
A 35-year-old male with a toothache presents to a local clinic for uninsured patients. On examination you find a decayed left lower molar that is tender when tapped lightly, and surrounding gingival inflammation and tenderness. There is no obvious mandibu
C. Clindamycin - periodontitis of the tooth's roots with cellulitis, complicated by an apical abscess.
-
anaerobic oral bacteria
.
- Penicillin VK, amoxicillin or amoxicillin/clavulanate is preferred for antibiotic treatment
- Pt is allergic to penicillin
A 70-year-old female with type 2 diabetes mellitus is admitted to the hospital with a 4-week history of fever, anorexia, and weight loss. Two blood cultures are positive for Streptococcus bovis. In addition to being treated for the infection, she should b
E. Colorectal cancer