Multiple Choice Questions (MCQ)

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Category: Q&A Medicine--->Infectious Diseases
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Question 6# Print Question

A 79-year-old woman presents to the Emergency Department from a nursing home with severe diarrhea and dehydration. The symptoms started yesterday and are associated with fever and abdominal pain. She has had approximately 15 nonbloody, watery bowel movements since then and has been getting weaker. Upon further questioning of the nursing home staff, she had pneumonia 1 week ago and is finishing treatment. Her other medical problems include hypothyroidism, hypertension, and coronary artery disease. Her temperature is 39.8°C, blood pressure is 96/64 mmHg, heart rate is 92 beats per minute, and respiratory rate is 18 breaths per minute. Initial screening laboratory values show a leukocyte count of 22,300/mm3 , a hemoglobin of 13.8 g/dL, and a platelet count of 480,000/mm3 . Further diagnostic workup is pending.

What is the most appropriate next step in management?

A. Decrease the patient’s dose of levothyroxine
B. Immediate laparotomy
C. Oral metronidazole alone
D. IV vancomycin alone
E. Oral vancomycin and IV metronidazole

Question 7# Print Question

A 32-year-old man is brought into the Emergency Department after he had a seizure. He has no history of a seizure disorder and there was no preceding trauma, new medications, or illicit drugs. On examination, his temperature is 38.9°C, blood pressure is 118/70 mmHg, heart rate is 90 beats per minute, and respiratory rate is 12 breaths per minute. He is lethargic and has a horizontal gaze palsy affecting the left eye. Appropriate laboratory values are sent, and a lumbar puncture and MRI (Figure below) are performed. The CSF studies show a large number of RBCs in each tube.

Which of the following therapies is most likely to be active against this condition?

A. Dexamethasone
B. Vancomycin
C. Amphotericin B
D. Acyclovir
E. Ceftriaxone

Question 8# Print Question

A 60-year-old man with a history of hypertension and chronic obstructive pulmonary disease (COPD) presents to the Emergency Department complaining of fever and a productive cough. The symptoms started yesterday and have been progressive. He now also has vomiting, diarrhea, headache, and muscle and joint pain. His current medications include inhaled albuterol and ipratropium, hydrochlorothiazide, and lisinopril. He has a 30 pack-year smoking history and drinks alcohol moderately. He recently returned from a business trip, where he stayed in several hotels and ate all of his meals within these hotels. On examination, his temperature is 39.2°C with a heart rate of 110 beats per minute and a respiratory rate of 26 breaths per minute. Pulmonary examination reveals dullness to percussion in the left lower lobe with rales and bronchial breath sounds on auscultation. His laboratory values are shown below.

  • Hemoglobin   13.9 g/dL
  • Leukocyte count   15,000/mm3
  • Platelets   130,000/mm3 
  • Sodium   128 mEq/L
  • Potassium   3.5 mEq/L
  • Chloride   95 mEq/L
  • Bicarbonate  22 mEq/L
  • Blood urea nitrogen   32 mg/dL
  • Creatinine   1.3 mg/dL
  • Aspartate aminotransferase   54 U/L
  • Alanine aminotransferase   62 U/L
  • Alkaline phosphatase    53 U/L

A urine dipstick shows 1+ protein and 1+ blood.

Which of the following is the most likely causative organism? 

A. Streptococcus pneumoniae
B. Legionella pneumophila
C. Klebsiella pneumoniae
D. Pseudomonas aeruginosa
E. Mycoplasma pneumoniae

Question 9# Print Question

A 46-year-old HIV-positive man is doing poorly on his antiretroviral regimen. He undergoes HIV genotyping and begins a new treatment regimen. Several days later, he follows up for routine blood work and reports feeling well with no adverse reactions. Blood work reveals a creatinine of 1.6 mg/dL (baseline 1.0 mg/dL), and a urinalysis shows hematuria, pyuria, and crystalluria.

Which of the following medications is most likely responsible?

A. Tenofovir
B. Abacavir
C. Indinavir
D. Efavirenz
E. Maraviroc

Question 10# Print Question

A 48-year-old man presents to the Emergency Department with fevers, headache, fatigue, and yellowing of his skin and eyes. The constitutional symptoms began 3 days ago, and he thought it was the flu. This morning, his girlfriend noticed that his eyes appeared yellow. He has a history of hypertension and Graves disease, which are both stable. The patient lives in rural New York and is a nature photographer. He has no pets and does not smoke. Initial laboratory values are significant for a hemoglobin of 9.6 mg/dL, a serum leukocyte count of 14,500/mm3 , and a serum lactate dehydrogenase of 210 U/L. His peripheral blood smear is shown in Figure below.

Which of the following is the most likely diagnosis?

A. Plasmodium falciparum
B. Strongyloides stercoralis
C. Clonorchis sinensis
D. Echinococcus granulosus
E. Babesia microti

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