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Infectious Disease and Immunology QOD review.
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A family comes to your office for consultation regarding a 3-week trip to India they are planning to take in 3 months. The children, a 9-year-old boy and a 7-month-old girl, are well, and their immunizations are up to date.Of the following, the MOST appropriate prophylaxis to provide in preparation for travel is • chloroquine for both children • hepatitis A vaccination for both children • measles vaccination for the girl • polio vaccination for the boy • typhoid vaccine for both children
A 15-year-old girl presents to the emergency department with right upper quadrant pain for 2 days that is severe enough to keep her out of school. Her appetite is decreased and she has nausea but no vomiting or diarrhea. She has mild discomfort with urination but no vaginal discharge. The only medication she is taking is combined oral contraceptive pills. Her last menstrual period was heavier that usual. Laboratory tests reveal:WBC 7.4x103/mcL (7.4x109/L) with 64% segmented neutrophils and 26% lymphocytes Total bilirubin, 0.4 mg/dL (6.9 mcmol/L) Alanine aminotransferase, 14 units/L Aspartate aminotransferase, 16 units/L Her urine has 7 white blood cells per high-power field. Abdominal ultrasonography reveals a normal liver, spleen, gallbladder, and kidneys.
What is your diagnosis? • cholecystitis • Fitz-Hugh-Curtis syndrome • hepatitis A infection • infectious mononucleosis • pyelonephritis
A 15-year-old girl presents for evaluation of vaginal discharge, mild lower abdominal cramping, and pruritus of her vulvar area that began 3 days ago. She is sexually active with one partner, and her last encounter was several weeks ago. She denies having fever, pain with urination, or other symptoms. On pelvic examination, you observe a copious amount of thin, whitish-yellow vaginal discharge, and her vaginal walls and cervix appear erythematous and inflamed. Her abdomen is soft and nontender, and there is no cervical motion tenderness or adnexal masses. Laboratory evaluation of the vaginal discharge demonstrates a pH of 6.0. Wet mount of the discharge shows a moderate number of white blood cells and a few epithelial cells with a few motile organisms.
Of the following, the MOST appropriate antibiotic for the treatment of this patient is • Albendazole • Clindamycin • Doxycycline • Fluconazole • Metronidazole
A 16-year-old girl comes to your office in August for evaluation of fever, headache with retro-orbital pain, and marked achiness of her joints and muscles. She returned 1 week ago from a church mission trip to El Salvador. A number of other people on the trip were diagnosed with a viral syndrome. Findings on physical examination are normal except for: Temperature 39.1°C Heart rate 104 beats/min Conjunctival injection without discharge, Erythema of the pharynx without exudate , Mild, tender hepatomegaly, Maculopapular rash on the trunk scattered petechiae WBC 3.2x103/mcL (3.2x109/L) Hgb 14.0 mg/dL (140 g/L) Hct 41.8% (0.418) Platelet count, 78x103/mcL (78x109/L) AST 212 units/L ALT 187 units/L Total bilirubin, 0.8 mg/dL (13.7 mcmol/L) BUN 18.0 mg/dL (6.2 mmol/L) Creatinine, 0.8 mg/dL (70.7 mcmol/L)
Of the following, the MOST likely diagnosis is • dengue fever • Epstein-Barr virus infection • hepatitis A infection • malaria • typhoid fever
You are evaluating a 5-year-old boy who has acquired immunodeficiency syndrome and whose recent CD4 percentage is 18%. He presents today with a 5-day history of a temperature to 38.9°C, increased work of breathing, and cough. His mother states that he is normally very active but over the past 2 days has been having a problem catching his breath just walking to the bathroom. Physical examination shows a tired-appearing boy in mild respiratory distress. He has a temperature of 38.4°C, respiratory rate of 28 breaths/min, some mild nasal flaring, moderate intercostal retractions, and scattered crackles at the lung bases bilaterally. Oxygen saturation by pulse oximetry on room air is 88%, and an arterial blood gas reveals a PaO2 of 60 mm Hg. A chest radiograph demonstrates bilateral perihilar infiltrates:
Of the following, the MOST appropriate antimicrobial agent to start is • azithromycin • cefotaxime • clindamycin • trimethoprim-sulfamethoxazole • vancomycin
A 10-year-old boy presents to the clinic complaining of tongue and mouth itching within a few minutes after eating apples. His mother states that he has not experienced these symptoms with other foods, but they occur every time he eats a fresh apple. He denies systemic symptoms, and the oral symptoms resolve within a few minutes. Other than allergic rhinitis in the spring months, he is healthy.
Of the following, you are MOST likely to advise his mother that • allergy skin testing to fresh apples probably will have negative results • cooking the apple will not alter its allergenicity • her son should avoid eating all fruits • her son should avoid milk products • her son's symptoms are related to his allergic rhinitis
You are evaluating a 2-year-old girl who was adopted from an orphanage in Eastern Europe. She has had a pruritic rash since she was brought to the United States 3 weeks ago. According to the mother, the rash is so pruritic that the girl must wear socks on her hands at night to prevent her from scratching. Physical examination demonstrates multiple 2- to 3-mm erythematous papules and vesicles around her waist, in her inguinal folds, on her neck, and on the palms and soles (Item Q13). No other focal findings are evident on physical examination.
Of the following, the MOST appropriate agent with which to treat this patient is • acyclovir orally • hydrocortisone topically • hydroxyzine orally • permethrin topically • prednisone orally
The parents of a 10-year-old boy who has a peanut and tree nut food allergy ask your advice on the treatment of food allergy reactions at school. They describe a scenario that occurred last year when their son started itching diffusely and having difficulty breathing during lunchtime after inadvertently eating some of his friend's chocolate candy bar that contained peanuts. At his current school, the child is allowed to carry his own self-injectable epinephrine. His current weight is 90 lb (41 kg).
Of the following, the BEST advice for the child, if a similar situation occurs, is to • have the school call emergency services (911), who should evaluate and administer epinephrine if needed • have the school nurse observe the child for 10 to 15 minutes while calling his parents • immediately administer 0.15 mg of self-injectable epinephrine • immediately administer 0.30 mg of self-injectable epinephrine • take an oral antihistamine immediately
A 12-year-old boy who has acute lymphoblastic leukemia (ALL) is undergoing reinduction chemotherapy and has an indwelling Broviac catheter. He has received multiple courses of antibiotics for episodes of fever and neutropenia. He recently completed a 6-week course of vancomycin for persistent coagulase-negative staphylococcal bacteremia. He is admitted to the hospital with a temperature of 39.5°C and a white blood cell count of 0.2x103/mcL (0.2x109/L) (0% neutrophils). Blood culture grows gram-positive cocci that are resistant to vancomycin.
Of the following, the MOST likely pathogen on the blood culture is • group B Streptococcus • Klebsiellapneumoniae • Listeria monocytogenes • methicillin-resistant Staphylococcus aureus • vancomycin-resistant Enterococcus
You are speaking to a group of medical students about antifungal agents, their potential uses, and the potential adverse effects associated with their use.Of the following, the MOST common adverse effect of ketoconazole is: • arrhythmias • headache • nausea • rash • seizures
A 7 year-old-girl presents to your office with a 1-day history of a temperature of 38.9°C. Notable findings from her past medical history include static encephalopathy, seizure disorder, and recurrent urinary tract infections. She is receiving intermittent straight catheterization and trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis. Her medications also include phenytoin, albuterol via nebulizer, ipratropium, and ranitidine. Urinalysis reveals more than 100 white blood cells per high-power field and is positive for leukocyte esterase and nitrites.
Of the following, the BEST option for oral empiric therapy pending culture results is • amoxicillin • azithromycin • ciprofloxacin • nitrofurantoin • trimethoprim-sulfamethoxazole
You have been treating a 5-year-old boy in the pediatric intensive care unit who has been receiving mechanical ventilation for 10 days due to pneumonia caused by Staphylococcus aureus. He required chest tube placement for an empyema. Over the past 3 days, he has developed a persistent air leak, and you are concerned that he may have developed a bronchopleural fistula.
In discussions with his parents, a TRUE statement regarding bronchopleural fistulas is that • bronchopleural fistulas are not associated with increased mortality • bronchoscopy may be useful for both diagnosis and treatment • computed tomography scan is of little value in establishing the diagnosis • surgical therapy is rarely successful • they are likely to heal spontaneously within 12 to 24 hours
You are evaluating a 4-year-old boy for a 3-day history of temperature to 40.0°C, diarrhea, abdominal pain, and listlessness. His mother states that they returned 1 week ago from Pakistan, where the family spent 1 month visiting relatives in both urban and rural areas. The child received no prophylactic travel vaccines or medications prior to the trip. On physical examination, the tired-appearing boy has a temperature of 39.5°C; diffuse, moderate abdominal tenderness; and a spleen that is palpable 2 cm below the left costal margin. A complete blood count shows a peripheral white blood cell count of 14.0x103/mcL (14.0x109/L), hemoglobin of 12 mg/dL (120 g/L), and platelet count of 350x103/mcL (350x109/L).
Of the following, the MOST likely pathogen causing this patient's symptoms is • Entamoeba histolytica • hepatitis A virus • hepatitis B virus • Plasmodium falciparum • Salmonella typhi
You are evaluating a 6-year-old girl who has acquired immune deficiency syndrome, failure to thrive, and chronic profuse diarrhea. Her diarrhea has worsened progressively over the past 3 months. She has had intermittent temperatures to 38.6°C and anorexia. Her family is very poorly compliant with her medications. Her viral load is greater than 500,000 copies, and her CD4 count is 20 cells/mm3. On physical examination, the very thin girl, who weighs 12 kg (<5th percentile), has oral thrush and generalized lymphadenopathy.
Of the following, the MOST likely pathogen causing this patient's illness is • Cryptosporidium • cytomegalovirus • Mycobacterium avium complex • Mycobacterium tuberculosis complex • Salmonella
A 14-year-old girl presents to your emergency department for evaluation of a 3-week history of progressive episodes of coughing spasms. She reports several episodes of posttussive vomiting and difficulty sleeping at night. She denies night sweats or weight loss and says she was previously well. She does not take any medications.
Of the following, the MOST important additional information to obtain is a history of • gastroesophageal reflux disease • international travel over the past year • pet or animal exposures • spelunking trips in the last 6 months • vaccinations received since 11 years of age
You are evaluating a 2-year-old boy who has a 10-hour history of a temperature to 40.0°C and progressively worsening diarrhea. Yesterday he attended a birthday party that was held in a petting zoo, but he has no other history of ill contacts or unusual exposures. His mother states that he has had eight watery bowel movements with mucus and streaks of blood in the last 10 hours. On physical examination, the little boy is irritable and has a temperature of 39.5°C. His mucous membranes are slightly tacky, and his abdomen is diffusely tender to palpation. The rest of the physical examination findings are within normal limits. Laboratory data include a peripheral white blood cell count of 16.0x103/mcL (16.0x109/L), with 65% neutrophils, 9% band forms, and 26% lymphocytes. Microscopic examination of stool shows fecal leukocytes, mucus, and blood.
Of the following, the MOST likely etiologic agent for this patient's condition is • Campylobacter • Escherichia coli • Salmonella • Shigella • Yersinia enterocolitica
A 5-year-old boy develops fever, abdominal pain, diarrhea, and malaise 5 days after drinking fresh cow's milk on a school field trip. His stool culture is positive for Campylobacter jejuni.Of the following, the MOST appropriate treatment for this child is administration of: • amoxicillin • azithromycin • cephalexin • clindamycin • metronidazole
