Transcript ID QOD review

Infectious Disease and
Immunology QOD review
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
1.
2.
3.
4.
5.
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?
1.
2.
3.
4.
5.
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
1.
2.
3.
4.
5.
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
1.
2.
3.
4.
5.
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 tiredappearing 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
1.
2.
3.
4.
5.
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
1. allergy skin testing to fresh apples probably will
have negative results
2. cooking the apple will not alter its allergenicity
3. her son should avoid eating all fruits
4. her son should avoid milk products
5. 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 3mm 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
1.
2.
3.
4.
5.
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 selfinjectable 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
1.
2.
3.
4.
5.
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
1. group B Streptococcus
2. Klebsiella pneumoniae
3. Listeria monocytogenes
4. methicillin-resistant Staphylococcus aureus
5. 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:
1.
2.
3.
4.
5.
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 trimethoprimsulfamethoxazole (TMP-SMX) prophylaxis. Her
medications also include phenytoin, albuterol via
nebulizer, ipratropium, and ranitidine. Urinalysis
reveals more than 100 white blood cells per highpower field and is positive for leukocyte esterase and
nitrites.
Of the following, the BEST option for oral
empiric therapy pending culture results is
1.
2.
3.
4.
5.
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
1. bronchopleural fistulas are not associated with
increased mortality
2. bronchoscopy may be useful for both diagnosis
and treatment
3. computed tomography scan is of little value in
establishing the diagnosis
4. surgical therapy is rarely successful
5. 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 tiredappearing 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
1.
2.
3.
4.
5.
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
1.
2.
3.
4.
5.
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
1.
2.
3.
4.
5.
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
1.
2.
3.
4.
5.
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:
1.
2.
3.
4.
5.
amoxicillin
azithromycin
cephalexin
clindamycin
metronidazole
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