Multiple Choice Questions (MCQ)

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Category: Q&A Medicine--->Infectious Diseases
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Question 1# Print Question

A 72-year-old woman is admitted to the hospital for an acute exacerbation of heart failure. She has a history of congestive heart failure (CHF), hypertension, and diabetes. While in the hospital, she is diuresed with IV furosemide and her symptoms improve. However, 3 days later she develops worsening shortness of breath. Her temperature is 38.1°C, blood pressure is 104/68 mmHg, heart rate is 94 beats per minute, respiratory rate is 26 breaths per minute, and oxygen saturation is 92% on room air. A chest x-ray is ordered and is shown in Figure below:

What is the most appropriate empiric treatment?

A. Ceftriaxone and azithromycin
B. Ceftriaxone, levofloxacin, and vancomycin
C. Clindamycin
D. Increase the dose of IV furosemide and administer morphine

Question 2# Print Question

A 29-year-old woman presents to the hospital with fever, headache, and cough. She developed these symptoms 2 days ago, and now also endorses some shortness of breath. She denies any rash, neck stiffness, recent travel, or sick contacts, and she has received all of her immunizations including her annual influenza vaccine. She lives in Connecticut and has several dogs. She is febrile to 38.7°C, but the rest of her examination is unremarkable. Her laboratory values are shown below:

  • Hemoglobin  11.0 g/dL
  • Leukocyte count  2,700/mm3 
  • Platelets  98,000/mm3 
  • Blood urea nitrogen   22 mg/dL
  • Creatinine 1.4 mg/dL 
  • Aspartate aminotransferase 69 U/L
  • Alanine aminotransferase 58 U/L
  • Alkaline phosphatase  110 U/L
  • Lactate dehydrogenase 160 U/L

Which of the following is the most likely causative organism?

A. Borrelia burgdorferi
B. Ehrlichia chaffeensis
C. Influenza A/B
D. Yersinia pestis
E. Rickettsia rickettsii

Question 3# Print Question

A 42-year-old man is brought to the hospital by his wife due to headache and a change in mental status. His wife reports that the symptoms started yesterday and are getting worse. He has experienced migraines previously, but the pain and photophobia are much worse this time. He was not himself and was very confused this morning, so she brought him to the Emergency Department. His temperature is 38.8°C with a normal blood pressure and heart rate. There is moderate neck stiffness on examination with no focal neurologic deficits. A lumbar puncture is performed, and a Gram stain of the cerebrospinal fluid (CSF) shows gram-positive cocci.

What is the most likely pathogen, and what would be expected on CSF analysis? (Note: WBCs are white blood cells.)

A. (A)
B. (B)
C. (C)
D. (D)
E. (E)

Question 4# Print Question

A 26-year-old man presents to his primary care physician complaining of fatigue, headache, and a sore throat for the past week. There is also nausea and diarrhea, but no weight loss, productive cough, or difficulty breathing. He denies any past medical history, does not take any medications, and has no recent sick contacts. He is sexually active with men and women and uses condoms inconsistently; he drinks alcohol heavily on the weekends and admits to previous IV drug use. On examination, his temperature is 39°C and the rest of his vital signs are normal. He has nontender cervical and axillary lymphadenopathy, tonsillar exudates, and mild splenomegaly. There are also several painful, well-demarcated ulcers within his mouth and a mild maculopapular rash over his chest and arms. A rapid strep test and a monospot (heterophile antibody) test are negative; further screening for chlamydia, gonorrhea, syphilis, and HIV is negative.

What is the most likely diagnosis?

A. Hodgkin lymphoma
B. Acute retroviral syndrome
C. Infectious mononucleosis
D. Secondary syphilis

Question 5# Print Question

A 65-year-old man is brought into the Emergency Department by his daughter, who reports that he is fatigued and short of breath. Several days ago he developed a fever with a productive cough, which has now progressed to dyspnea at rest. On examination, the patient’s temperature is 38.6°C, his blood pressure is 74/42 mmHg, his heart rate is 96 beats per minute, his respiratory rate is 24 breaths per minute, and his oxygen saturation is 94% on room air. He is lethargic, his neck veins are flat, and his extremities are warm and moist. There is dullness to percussion and decreased breath sounds over the right lung base. Serum blood work shows an elevated lactate.

What is the correct diagnosis?

A. Cardiogenic shock
B. Pulmonary embolism
C. Septic shock
D. Severe sepsis
E. Anaphylactic reaction

Category: Q&A Medicine--->Infectious Diseases
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