Multiple Choice Questions (MCQ)

Quiz Categories Click to expand

Category: Q&A Medicine--->Infectious Diseases
Page: 11

Question 51# Print Question

A 52-year-old woman with a history of diabetes mellitus and hypertension presents to the Emergency Department with fevers, chills, and abdominal pain. The symptoms began about 1 week ago and have been getting worse. The abdominal pain is associated with nausea and vomiting, and she has not been able to eat. On examination, her temperature is 38.8°C, blood pressure is 104/68 mmHg, heart rate is 94 beats per minute, and respiratory rate is 16 breaths per minute. Her abdominal examination shows right-sided pain to deep palpation, and she has severe right-sided costovertebral angle tenderness. Her laboratory values are shown below.

  • Leukocyte count   14,200/mm3
  • Bicarbonate   21 mEq/L
  • Creatinine   1.1 mg/dL
  • Glucose   184 mg/dL
  • Erythrocyte sedimentation rate   54 mm/h 
  • Urinalysis    Significant WBCs, WBC casts, protein, and bacteria

A urine culture returns positive for E. coli that is sensitive to ceftriaxone and ciprofloxacin. She is treated with IV ceftriaxone, but after 3 days of treatment she continues to be febrile.

What is the most appropriate next step in management?

A. Renal biopsy
B. CT scan with contrast
C. Continue the current antibiotic
D. Stop ceftriaxone and start ciprofloxacin

Question 52# Print Question

An 83-year-old woman is hospitalized after an ischemic stroke. On day 2 of her hospitalization, she develops dyspnea. Her vitals show a temperature of 37.8°C, blood pressure of 146/90 mmHg, heart rate of 102 beats per minute, respiratory rate of 26 breaths per minute, and oxygen saturation of 89% on room air. There are diffuse bilateral rales on pulmonary auscultation. She is placed on supplemental oxygen, and a chest x-ray is ordered immediately, which shows bilateral infiltrates.

What is the most likely diagnosis?

A. Cheyne–Stokes respiration
B. Aspiration pneumonia
C. Airway obstruction
D. Chemical pneumonitis

Question 53# Print Question

A 30-year-old man presents to his physician with a rash on his left leg. He reports that the rash started as a bug bite and is spreading. He denies any fever, chills, or malaise. His medical history is significant for type 1 diabetes mellitus, and his only medication is insulin. On examination of the left leg, there is a 4-cm area of erythema, swelling, and warmth with indistinct margins. There is no gross purulence.

What antibiotic should this patient receive?

A. Oral cephalexin
B. Oral dicloxacillin
C. Oral clindamycin
D. IV vancomycin

Question 54# Print Question

A 32-year-old man complains of fever, diarrhea, and abdominal pain. He has had intermittent fevers for the past month, with episodes of bloody diarrhea. The abdominal pain started 2 weeks ago, and since that time he has had fewer episodes of diarrhea. He denies any jaundice, pale stools, or IV drug use. The patient emigrated from Mexico 6 months ago, and has been living with his extended family in Arizona. On examination, there is hepatomegaly with tenderness to palpation over the liver. An abdominal ultrasound reveals a welldefined hypoechoic mass.

What is the most likely pathogen responsible for this patient’s symptoms?

A. Entamoeba histolytica
B. Candida albicans
C. Escherichia coli
D. Diphyllobothrium latum
E. Klebsiella pneumoniae

Question 55# Print Question

A 42-year-old man presents to his physician with fever, headache, and rash. Three days ago, he developed fever and a headache, which minimally improved with acetaminophen. This morning he noticed a rash on his wrists and ankles that spread to his torso. He has no past medical history and does not smoke. He recently returned from a camping trip in Virginia 1 week ago. On examination, he is febrile and there are scattered erythematous blanching macules over his arms, legs, and torso.

What should be done next in the management of this patient?

A. Administer doxycycline
B. Administer IV prednisone
C. Confirm the diagnosis with serology
D. Administer Penicillin G
E. Apply topical clobetasol

Category: Q&A Medicine--->Infectious Diseases
Page: 11 of 11