A patient with prolonged diarrhea undergoes esophagogastroduodenoscopy. Biopsy of the small intestine demonstrates numerous crescent-shaped protozoa adjacent to the epithelial brush border. Which of the following organisms is the most likely pathogen?
A. Entamoeba histolytica
B. Escherichia coli
C. Giardia lamblia
D. Naegleria fowleri
E. Trichomonas vaginalis
Answer
A patient is referred to a neurologist because of ataxia. Neurological examination reveals a loss of proprioception and a wide-based, slapping gate Magnetic resonance imaging reveals degeneration of the dorsal columns and dorsal roots of the spinal cord. Which of the following organisms is most likely to have caused this pattern of damage?
A. Haemophilus influenzae
B. Herpes simplex I
C. Neisseria gonorrhoeae
D. Neisseria meningitidis
E. Treponema pallidum
Answer
A 33-year-old woman presents with fever, vomiting, severe irritative voiding symptoms, and pronounced costovertebral angle tenderness. Laboratory evaluation reveals leukocytosis with a left shift; blood cultures indicate bacteremia. Urinalysis shows pyuria, mild hematuria , and gram-negative bacteria. Which of the following drugs would best treat this patient's infection?
A. Ampicillin and gentamicin
B. Erythromycin
C. Gentamicin and vancomycin
D. Phenazopyridine and nitrofurantoin
E. Tetracycline
Answer
A previously healthy 11-year-old girl develops a gastrointestinal infection with cramping and watery stools. After several days, she begins to pass blood per rectum, and is hospitalized for dehydration. In the hospital, she is noted to have decreasing urine output with rising blood
urea nitrogen (BUN). Total blood count reveals anemia and thrombocytopenia, and the peripheral smear is remarkable for fragmented red cells (schistocytes). Infection with which of the following bacterial genera is most likely responsible for this syndrome?
A. Campylobacter
B. Clostridium
C. Salmonella
D. Shigella
E. Vibrio
Answer
A 75-year-old woman is re-admitted to an hospital with general complaints of fever (39ºC), malaise, anorexia, and flank pain. She had been released from the hospital about three days prior to this re-admission, after gallbladder removal. A Foley catheter had been inserted during her last admission and review of her records showed that she had fever 24 hours after surgery. She was treated with ampicillin. A urine specimen was obtained through the catheter and was found to contain pus cells and granular casts. A urine culture yielded colonies of an oxidase positive organism producing a green diffusible pigment.
The antibiogram shows the isolated strain to be resistant to beta-lactam antibiotics and susceptible to fluoroquinolones, vancomycin, aminoglycosides,and chloramphenicol. Which of the following antibiotics would you prescribe to this patient?
- Chloramphenicol
- Gentamycin
- Levofloxacin
- Piperacillin
- Vancomycin
AnswerTags:
Geriatrics, Antibiotics
A 75-year-old woman is re-admitted to an hospital with general complaints of fever (39ºC), malaise, anorexia, and flank pain. She had been released from the hospital about three days prior to this re-admission, after gallbladder removal. A Foley catheter had been inserted during her last admission and review of her records showed that she had fever 24 hours after surgery. She was treated with ampicillin. A urine specimen was obtained through the catheter and was found to contain pus cells and granular casts. A urine culture yielded colonies of an oxidase positive organism producing a green diffusible pigment.
Which of the following organisms is most likely to be present on this patient's urine?
1. Escherichia coli
2. Klebsiella pneumoniae
3. Proteus mirabilis
4. Pseudomonas aeruginosa
5. Streptococcus viridans
AnswerTags:
Geriatrics, Infection
A 66-year-old male, is seen in the emergency room complaining of chest pain of sudden onset, cough productive of purulent and blood-tinged sputum, and fever, which rose abruptly after he had felt a sharp chill. Lab tests show a normal hematocrit, 20,000 WBC with 65% neutrophils and 10% bands. An X-ray of the thorax shows a consolidating pneumonia of the right middle lobe.
Sputum cultures were negative. What other cultures should have been ordered to confirm this patient’s diagnosis?
- Blood
- Broncho-alveolar lavage
- CSF
- Gastric aspirate
- Urine
AnswerTags:
Geriatrics, Infectious Diseases
A 66-year-old male, is seen in the emergency room complaining of chest pain of sudden onset, cough productive of purulent and blood-tinged sputum, and fever, which rose abruptly after he had felt a sharp chill. Lab tests show a normal hematocrit, 20,000 WBC with 65% neutrophils and 10% bands. An X-ray of the thorax shows a consolidating pneumonia of the right middle lobe.
What would be the antibiotic of choice to start this patient while the cultures are pending?
- Ampicillin
- Levofloxacin
- Penicillin G
- Sulfamethoxazole-trimethoprim
- Vancomycin
AnswerTags:
Geriatrics Quiz, antibiotics
A 66-year-old male, is seen in the emergency room complaining of chest pain of sudden onset, cough productive of purulent and blood-tinged sputum, and fever, which rose abruptly after he had felt a sharp chill. Lab tests show a normal hematocrit, 20,000 WBC with 65% neutrophils and 10% bands. An X-ray of the thorax shows a consolidating pneumonia of the right middle lobe.Which would be the most likely etiologic agent for this patient's pneumonia?
1. A combination of anaerobes
2. Klebsiella pneumoniae
3. Mycoplasma pneumoniae
4. Pneumocystis carinii
5. Streptococcus pneumoniae
AnswerTags:
Geriatric Quiz, Pneumonia
An 80 year-old man who attends a Senior Day Care facility develops malaise, low grade fever, diffuse aches, and a dry cough. His physician diagnoses Influenza B. To prevent an outbreak, employees and other seniors at his Day Care facility should receive a drug of which of the following classes?
A. DNA polymerase inhibitor
B. neuraminidase inhibitor
D. reverse transcriptase inhibitor
Answer
Tags:
Geriatrics Quiz
Which of the following clinical manifestations of
Streptococcus pneumoniae is most frequently involved as a cause of morbidity and mortality in an older adult?
- Endocarditis
- Meningitis
- Otitis media
- Pneumonia
- Septic shock
AnswerTags:
Geriatrics Quiz
A 75-year-old widow living in a rural area comes to your office because she has had several colds last winter and is worried about her ability to fight disease. In discussing possible beneficial immunizations, which one of the following vaccines would be of least benefit for this patient?
1. Anthrax
2. Influenza
3. Pneumococcal
4. Tetanus
Answer
The slide reproduces a nutrient agar plate seeded with an aerobic Gram negative rod which produces a green diffusible pigment recovered from the urine of a 78 year old man with advanced prostatic carcinoma in whom a Foley catheter was placed to relieve obstruction. Of the following antibiotics, which one would be more likely effective in this patient?
A. Doxycycline
B. Ceftriaxone
C. Sulfamethoxazole-trimethoprim
D. Metronidazole
E. Piperacillin/Tazobactam
Answer
Tags:
Geriatrics Quiz
A 33-year-old woman presents with fever, vomiting, severe irritative voiding symptoms, and pronounced costovertebral angle tenderness. Laboratory evaluation reveals leukocytosis with a left shift; blood cultures indicate bacteremia. Urinalysis shows pyuria, mild hematuria, and gram-negative bacteria. Which of the following drugs would best treat this patient's infection?
A. Ampicillin and gentamicin
B. Erythromycin
C. Gentamicin and vancomycin
D. Phenazopyridine and nitrofurantoin
E. Tetracycline
AnswerTags:
MCQ, Infectious diseases, Urinary Tract Infection, UTI
Regarding chlamydial Infection all are true Except
A. typically causes a vaginitis.
B. is symptomatic in the majority of women.
C. is the commonest cause of chronic prostatitis.
D. if discovered in pregnancy is best left untreated until after delivery.
E. urethritis is typically associated with a dysuria combined with a negative midstream urine culture.
Answer
Tags: MCQ, Infection, STD, Chlamydia
A 25-year-old male has a dental infection associated with facial swelling and lymphadenopathy. Which one of the following is the most appropriate antibiotic?
A) Cephalexin (Keflex)
B) Tetracycline
C) Penicillin
D) Ciprofloxacin (Cipro)
E) Azithromycin (Zithromax)
Answer
Your community recently experienced an outbreak of infectious diarrheal illness due to the protozoan Cryptosporidium, a chlorine-resistant organism. A reporter from the local newspaper asks you if there are other chlorine-resistant fecal organisms that could contaminate public drinking water.
You would tell the reporter that such organisms include:
A) Escherichia coli.
B) Vibrio cholerae.
C) Campylobacter jejuni.
D) Giardia lamblia.
E) Rotavirus.
Answer
A worried mother calls to tell you that when she went in to check on her crying 6-month-old infant after his nap she noticed a bat in the room. She contacted animal control and an officer captured the bat. The mother wants to know what to do next.
Which one of the following is the best advice?
A) Arrange to have the bat tested for rabies; initiate postexposure prophylaxis for the child only if positive.
B) Initiate postexposure prophylaxis for the child while testing the bat for rabies; discontinue the shots if negative.
C) Initiate postexposure prophylaxis for the child and dispose of the bat.
D) Examine the child for bites or scratches; reassure the mother if none is found, and dispose of the bat.
E) Tell the mother not to worry because bats do not carry rabies.
Answer
A 4-year-old white male has radiographically proven osteomyelitis following a cat bite to the finger. A Gram stain reveals pleomorphic gram-negative rods.
The most likely diagnosis would be:
A) Bartonella henselae.
B) Francisella tularensis.
C) Pasteurella multocida.
D) Haemophilus influenzae.
E) Bacteroides fragilis.
Answer
A 17-year-old white male comes to your office worried about Lyme disease. He recently returned from a camp in the Upper Peninsula of Michigan where he went hiking in the woods. He recalls no tick bite, but about 1 week after returning home he developed a low-grade fever, myalgias, and fatigue. He has had these symptoms for 1 week when he comes in to see you. A physical examination is completely normal.
The single most important diagnostic clue in establishing the diagnosis of Lyme disease is:
A) new-onset bundle-branch block.
B) nuchal rigidity compatible with meningitis.
C) high, spiking fevers.
D) erythema migrans.
E) acute arthritis of a large joint.
Answer
