Ad Blocker Detected
Our website is made possible by displaying online advertisements to our visitors. Please consider supporting us by disabling your ad blocker.
Select the ONE answer that is BEST in each case.
A 43-year-old man developed a cough shortly after returning from a 1-month hiking trip in California. While there, he was hiking in the central California valleys. During his trip, he had developed a “flu-like” illness consisting of fever, cough, and muscle pains, which resolved spontaneously. A CXR shows a thin-walled cavity in the right upper lobe, and the sputum reveals fungal elements. Which of the following is the most likely causative organism?
Coccidioidomycosis is the usual cause of pulmonary cavitation resulting from fungal infection. A rarefaction may be demonstrable in a pneumonic lesion within 10 days of onset. In the United States, most cases are acquired in California, Arizona, and western Texas.
See all quizzes of the Infection diseases at here:
|21. A 43-year-old man developed a cough shortly after returning from a 1-month hiking trip in
California. While there, he was hiking in the central California valleys. During his trip, he had developed a “flu-like” illness consisting of fever, cough, and muscle pains, which resolved spontaneously. A CXR shows a thin-walled cavity in the right upper lobe, and the sputum reveals fungal elements. Which of the following is the most likely causative organism?
(B) Cryptococcus neoformans
(C) Candida albicans
|22. An 8-year-old boy from an impoverished innercity area has never been vaccinated appropriately. He develops fever, cough, and coryza. The next day, blue white spots develop on the buccal mucosa. On the third day, an erythematous, nonpruritic maculopapular rash develops on the face and spreads over the entire body. Which of the following is the most likely
(C) otitis media
|23. A 6-year-old boy develops symptoms of cough, fever, and malaise followed by a generalized maculopapular rash that has spread from the head downwards. A clinical diagnosis of measles is made. A few days after the onset of the rash he is drowsy, lethargic, and complaining of headache. A lumbar puncture, electroencephalogram (EEG), and computerized
tomography (CT) of the brain exclude other etiologies and confirm the diagnosis of encephalitis. Which of the following is the most likely delayed neurologic complication of measles virus encephalitis?
(B) pure motor paralysis
(C) autonomic neuropathy
(D) mental retardation or epilepsy
(E) “stocking-glove” peripheral neuropathy
|24. A 27-year-old man presents with diarrhea. He returned 3 weeks ago from a trip to rural South America. Over the past few days, he has gradually developed lower abdominal pain and diarrhea. Now the symptoms are much worse with eight stools a day consisting mostly of mucus and blood. He is afebrile, the abdomen is tender in left lower quadrant, and the remaining examination is normal. His stool is mostly comprised of blood and mucus. Which of the following is the most appropriate initial diagnostic test?
(A) stool culture
(B) stool toxin assay
(C) examination of a dried stool specimen
(D) immunofluorescence of stool specimen
(E) examination of a wet stool specimen
|25. A 4-year-old boy is sent to the emergency room because of clinical suspicion of meningitis. He has been ill for 2 days with fever and lethargy. On examination, he is febrile, the neck is stiff, and papilledema is present. There is no rash, the lungs are clear, and heart sounds normal. Which of the following is the most likely causative organism?
(A) Neisseria meningitidis
(B) Streptococcus pneumoniae
(C) Haemophilus influenzae
(E) Listeria species
|26. Which of the following is a contraindication toreceiving the live rubella vaccine?
(A) children between 1 year old and puberty
(B) infants <1 year old
(C) all adults
(D) pregnant women
(E) all exposed patients
|27. A 24-year-old woman presents with chills and rigors. She looks unwell, and her temperature is 39.4°C, blood pressure 100/60 mm Hg, pulse 110/min, and oxygen saturation 95%. There is a 3/6 pansystolic murmur at the right sternal border, which increases with inspiration. Her arms have multiple tattoos and needle marks from injection drug use. Blood cultures (2/2 sets) are positive for S. aureus, and she is started on appropriate antibiotics. Her renal function is mildly impaired and her urinalysis is positive for protein, and microscopy reveals red cell casts. Which of the following mechanisms is the most likely explanation for her renal abnormalities?
(A) septic emboli
(B) cardiac failure with prerenal azotemia
(C) a high level of circulating immune complexes
(D) fungal disease
(E) inevitable progression to renal failure
|28. A 22-year-old university student complains of fatigue and malaise for the past 2 weeks. She also reports feeling feverish, and recently had a sore throat. Physical examination reveals enlarged tonsils and palpable cervical lymph nodes. There is also tenderness in the right upper
quadrant on deep palpation, and minimal splenomegaly. Laboratory data show hemoglobin 13 g/dL; hematocrit 40%; platelets 340,000/mL; WBC 9400/mL, with 35% segmented neutrophils, 1% eosinophils, and 64% lymphocytes, of which 36% were atypical. A heterophil antibody (sheep cell agglutination) test is positive. Which of the following is the most appropriate initial treatment for this condition?
(B) adequate rest
(E) radiation therapy
|29. A 23-year-old woman presents with a painless chronic vulvar ulcer. She recently arrived to
study in the United States from Southern India. The lesion began as a papule and then ulcerated. It has persisted for several months. Currently, physical examination reveals a painless elevated area of beefy red, friable granulation tissue. She has been sexually active for everal years. Which of the following is the most likely causative organism?
(B) Gram-positive coccus
(C) intracellular Gram-negative bacteria
(D) chronic viral infection
|30. A 20-year-old woman presents with headache, fever, and neck stiffness. On examination, her blood pressure is 100/70 mm Hg, pulse 100/min, temperature 38.6°C, and the neck is stiff and painful to flex and extend. The ears, throat, and sinuses are normal, there are no focal neurologic signs, and the remaining examination is normal. There are no reported similar cases in the community. Which of the following is the most likely source of her infection?
(A) an infected heart valve
|31. A 44-year-old renal transplant patient develops severe cough and shortness of breath on exertion. On examination, he appears dyspneic, respirations 24/min, pulse 110/min, and oxygen saturation 88%. His lungs are clear on auscultation and heart sounds are normal. CXR shows bilateral diffuse perihilar infiltrates. Bronchoscopy and bronchial brushings show clusters of cysts that stain with methenamine silver. Which of the following is the most appropriate next step in management?
(A) amphotericin B
|32. A34-year-old man presents with diarrhea 3 weeks after returning from a trip to rural South America. Over the past few days, he has gradually developed lower abdominal pain and diarrhea. Now the symptoms are much worse with eight stools a day consisting mostly of mucus and blood. He is afebrile, the abdomen is tender in left lower quadrant, and the remaining examination is normal. His stool is mostly comprised of blood and mucus, and stools tests show trophozoites of Entamoeba histolytica. Which of the following is the most likely site of extraintestinal involvement?
(E) cerebral cortex
|33. A 20-year-old woman complains of headache and discomfort in both sides of her jaw. Physical examination reveals enlarged parotid glands that are slightly tender on palpation. There is reddening of the orifice of Stensen’s duct on intra oral examination; her temperature is 38.3°C, and the pulse rate is 80/min. Laboratory data show hemoglobin 14 g/dL; hematocrit 40%; WBC 11000/mL, with 33% segmented neutrophils, 7% monocytes, and 60% lymphocytes. Which of the following diagnostic tests will help to confirm the diagnosis of epidemic parotitis?
(A) single blood sample for a specific immunoglobulin G (IgG)
(B) blood cell count
(C) blood culture
(D) single blood test for a specific immunoglobulin M (IgM)
(E) serum amylase
|34. Three hours after a church social, eight people develop severe diarrhea. Other symptoms included nausea, vomiting, and abdominal cramps. Food served included chicken salad and cream-filled pastries. All affected individuals had the chicken salad. Which of the following is the most likely causative organism?
(A) staphylococcal enterotoxin
(B) C. botulinum
(C) Clostridium perfringens
(D) Salmonella species
(E) ptomaine poisoning
|35. A young woman complains of hair loss, loss of hair luster, and intense scalp irritation. Examination reveals patches of hair loss with tiny little black dots where the hair shaft has broken off. A Wood’s light examination is positive. Which of the following is the most likely diagnosis?
(A) seborrheic dermatitis
(B) Aspergillus infection
(C) Trichophyton infection
(E) excess androgen levels
|36. A 9-year-old boy has a severe sore throat with fever and dysphagia. On examination, there
are grayish-white papulovesicular lesions on an erythematous base that ulcerate. They are located on the soft palate, anterior pillars of the tonsils and uvula. There are no lesions on the gingiva, tongue, or lips. A clinical diagnosis of herpangina is made. Which of the following is the most likely causative organism?
(A) measles (Morbillivirus)
(B) rubella (rubivirus)
(C) coxsackievirus A
|37. A young man has recently been bitten by a stray dog. He has a penetrating wound to the right forearm. The dog is nowhere to be found. In the emergency room, the wound is cleaned with water and povidone-iodine solution. Which of the following is the most appropriate next step in management?
(A) start postexposure prophylaxis
(B) contact the local public health professional for further advice
(C) treat with oral doxycycline
(D) treat with IV ceftriaxone
(E) start IV acyclovir
|38. Which of the following malignancies in the United States is most likely to contain EBV
deoxyribonucleic acid (DNA) in a non-HIV patient?
(A) gastric cancer
(B) well-differentiated thyroid cancer
(C) anaplastic nasopharyngeal carcinoma
(D) Burkitt’s lymphoma
(E) Hodgkin’s disease
|39. A 24-year-old man complains of fatigue, malaise, fever, and a sore throat. He was previously well, but now feels tired all the time and has to rest multiple times a day. Physical examination shows enlarged tonsils and palpable anterior and posterior cervical, axillary, and inguinal lymph nodes. There is also tenderness in the right upper quadrant with a liver span of 10 cm. Laboratory data is significant for a heterophil antibody (sheep cell agglutination) test that is positive. Which of the following rare complications can be associated with this condition?
(C) splenic rupture
(D) Kaposi sarcoma
|40. A 40-year-old man develops erythema nodosum, conjunctivitis, and a pleural effusion. Over several weeks, pulmonary lesions lead to cavitation and a large, thin-walled cavity. He was traveling in Arizona before becoming ill. Sputum samples reveal mature spherules. Which of the following is the most likely diagnosis?
(E) Pneumocystis carinii