Infectious Disease MCQ
1- 22 year old male presents to the ER with a 1 day history of erosions of the lips, conjuctivitis and blistering rash. He has a temperature of 37.9 and no other systemic complaints. He is currently on a course of Cotrimoxazole Full dose twice daily PO for an episode of otitis media diagnosed 3 days ago. The best initial step in the management of this patient is:
a. Prescribe a course of topical steroids
b. Change antibiotic, preferably to a cephalosporin and send home
c. Admit to hospital, monitor fluid status and stop antibiotic
d. Refer to Dermatology for further investigation
e. Reduce the dose of his antibiotic
2- A 40 year old diabetic male presents with an acute onset of redness in the hands and forearm with streaks extending up towards the axilla. There is local pain and crepitus. Temp 40, pulse 110 and BP 95/65. WBC is elevated. The most likely causative offending organism is:
a. Group A streptococcus
b. Staph. epidermidis
c. Viridans Streptoccocus
d. Group D strep
e. Group B strep.
3- In the above patient, the most appropriate approach for therapy is:
a. IV antibiotic only
b. Oral Antibiotic only
d. Observation
e. Surgical Drainage with IV antibiotic
4- A 69 year old man presents to the ER with diarrhea, confusion and delirium in conjunction with pneumonia. Which of the following organisms is the most likely pathogen:
a. Legionella pneumophila
b. Francisella Tularemia
c. Mycoplasma Pneumonia
d. Hemophilus pneumonia
e. Klebsiella Pneumonia
5- All of the following are complications of otitis media EXCEPT:
a. Perforation of Tympanic membrane
b. Mastoiditis
c. Sinusitis
d. Conductive hearing loss
e. Chronic middle ear effusion
6- A patient with Agammaglobulinemia is at most risk of infection with which of the following:
a. Candida Albicans
b. Strep Pneumonia
c. Bronchopulmonary aspergillosis
d. Pneumocystis cariini pneumpnia
e. Dissiminated herpes simplex
7- Recognized complications of bacterial meningitis include all of the following EXCEPT:
a. SIDH
b. Hearing loss
c. Hemiparesis
d. Seizures
e. Intraventricular Haemorrhage
8- 23 year old pregnant lady with a known allergy to Penicillin presents in the first trimester with VDRL positive test, FTA ABS is positive as well. What is the most appropriate pharmacotherapy:
a. Cefalexin
b. Doxycycline
c. Penicillin
d. Vancomycin
e. No treatment is required at this time
9- A young male patient presents with non productive cough, chills, and fever. He has type 1 diabetes. A chest Xray shows diffuse interstitial infiltrate bilaterally, the most probable infecting organism in this patient is:
a. Strep. Pneumonia
b. Klebsiella pneumonia
c. Mycoplasma Pneumonia
d. Legionella pneumophilla
e. Pneumocystis Carinii
10- A 26 year old female with a known allergy to penicillin requires antibiotic treatment for an episode of sinusitis. Her previous allergic reaction consisted of rash only that resolved upon discontinuation of treatment. The best choice of antibiotic for her current infection should be:
a. A cephalosporin
b. A macrolide
c. Vancomycin
d. Amoxicillin
e. An Aminoglycoside
11- 22 year old male who is currently receiving treatment for acute sinusitis develops neck stiffness and sever headache with N and V. Kernigs and prudzinski signs are positive. CSF exam shows low glucose with elevated protein and elevated lymphocyte and neutrophil count. Gram stain is negative. To confirm the diagnosis, the best next step would be:
a. CSF VDRL
b. CSF culture
c. CSF latex agglutination test
d. CSF ZN stain
e. Blood Culture
12- A 50 year old diabetic presents with 2 days history of fever, headache, neck stiffness, photophobia plus N and V. physical exam reveals positive Prudsinski and Kernig signs with mild weakness of left upper extremity and papilledema. The next best step in diagnosis is:
a. Lumbar puncture
b. Blood Culture
c. CT scan of head
d. MRI of Brain
e. Chest Xray
13- An important pathogen that should be accounted for in the above patient is:
a. Neisseria Meningitidis
b. Listeria moncytogenes
c. Heamophillus influenza
d. Strep. Pneumonia
e. Yersinia Pestis
14- the best emperic antibiotic regimen for this patient should be:
a. Ceftraixone alone
b. Ceftraixone + Ampicillin
c. Ampicillin + Gentamicin
d. Ciprofloxacin
e. Augmentin
15- An HIV negative man is brought to the hospital because of a seizure with focal neurologic defecits. A CT
a. Lumbar puncture
b. Blood Culture
c. Biopsy
d. MRI
e. Diagnostic Emperic antibiotic therapy
16- A 25 year old woman comes to your office complaining of headache with fever and facial pain for 4 days. On examination, you find maxillary tenderness and a discoloured nasal discharge. There is decrease translumination of the maxillary sinus on the left. The next step in management should be:
a. Oral Amoxicillin
b. Sinus Xray
c. Sinus drainage and culture
d. CT scan
e. Pseudoephedrine
17- 63 year old man is in your office complaining of a 3 day history of couph productive of yellowish sputum. He has 20 pack year history of smoking. O/E, he has clear lungs with no abnormal findings other than a temp. of 38. His chest Xrays are normal. The most probable diagnosis is:
a. Viral pneumonia
b. Bacterial Pneumonia
c. Bacterial Bronchitis
d. Sinusitis
e. Chronic Bronchitis
18- the best treatment for the above patient is:
a. Oral Amoxicillin
b. Augmentin
c. IM Gentamicin
d. Metronidazole
e. Acyclovir
19- A 25 year old with seizure disorder had his last seizure episode 7 days ago. Presents now with increasing cough and shortness of breath for 3 days and fever of one day duration with a fowl smelling sputum. Crackles were heard on auscultation. Chest Xray shows right lower lobe infiltrate of the lung, the most likely pathogen is:
a. a gram positive aerobe
b. a gram negative aerobe
c. an anaerobe
d. mycoplasma
e. an Acid fast bacillus
20- A 44 year old male alcoholic presents with a 4 day history of fever, chest pain and cough productive of red jelly like sputum. Xray shows a left lobe infiltrate. The most probable diagnosis in this patient is:
a. Streptococcus pneumonia
b. Klebsiela pneumonia
c. Mycoplasma Pneumonia
d. Anerobic pneumonia
e. Coxiella pneumonia
21- a 31 year old HIV positive male presents with a 3 day history of shortness of breath, chest pain and non productive cough. His CD4 count is 180. Chest Xray shows a ground glass appearance. His PO2 is 65 and A-a Gradient is 30. The most appropriate therapy for this patient is:
a. IV ceftraixone
b. Oral Penicillin
c. Trimethoprim/Sulfamethoxazole
d. TMP/SMZ plus steroids
e. Dapsone
f. Ocacillin
22- 42 year old immigrant from Vietnam
a. Chest Xray
b. Sputum staining
c. Sputum Culture
d. PPD skin test
e. ABG
23- Pleural Biopsy specimen taken from the above patient will most likely show:
a. Non Caseating granulomas
b. Caseating granulomas
c. Non specific inflammatory changes
d. Normal Appearance
e. Hyaline degeneration
24- 3 hours after eating in a restaurant, a patient presents with diarrhea and N & V. The most likely pathogen in the above patient is:
a. Salmonella
b. Vibreo parahemolyticus
c. shigella
d. Campylobacter
e. Staph aureus
25- A 22 year old male homosexual presents with a 1 month history of painless red nodules in the inguinal area. Further examination reveals scarring lesions around the anus in the buttock area. Wright stain reveals Donovan bodies. The diagnosis is:
a. Chancroid
b. Lymphgranuloma Venerum
c. Granuloma inguinale
d. Genital warts
e. Syphilis
26- a 32 year old male homosexual presents to the ER with a 1 day history of Fever and Chills. Examination reveals a temp of 40, Pulse of 130, BP 100/70. multiple needle marks are seen on his arms. Splinter hemorrhages are also seen. Auscultation revealed a 3/6 murmur. The murmur will most probably represent:
a. Mitral Regurgitation
b. Tricuspid Regurgitation
c. Aortic Regurgitation
d. Mitral Stenosis
e. Pulmonary regurgitation
27- the most likely organism in the above patient is:
a. Strep Viridans
b. Staph. Epidermidis
c. Staph Aureus
d. Streptococcus mutans
e. A HACEK member (see end of questions list)
28- After a recent camping trip, a 30 year old female develops rash on her right lower extremity. the rash was associated with flue like symptoms and disappeared spontaneously. Three weeks later, the patient suddenly develops paralysis of the left half of her face. The most likely offending organism in the above patient is:
a. Ricketttsia Rickettsi
b. oxiella Burnetti
c. Borrellia Burgdorferi
d. Toga Virus
e. Herpes Zoster virus
29- if not treated, possible complications in the above patient include all of the following EXCEPT:
a. Arthritis
b. Heart Block
c. Arrhythmias
d. Meningitis
e. Glomeulonephritis
30- Best modality of treatment for the patient above is:
a. IV Ceftraixone
b. Oral Doxycycline
c. Erythromycin
d. Metronidazole
e. Vancomycin
31- A 33 year old physician had a needle stick injury while trying to draw blood from an HIV positive patient. He presents to the ER highly anxious and requests immediate help. The needle was contaminated with the patients blood and had certainly penetrated the doctor’s skin. The best course of action at this time is:
a. Perform An Elisa test
b. Perform a PCR test
c. Prescribe AZT for one month
d. Prescribe Triple anti-retroviral therapy for 1 month
e. Repeat HIV test on patient
32- 33 year old female presents with a seizure. No Papilleodema was noted. her family states that she has had a headache and decreased level of consciousness for the last 24 hours. A CT
a. IV acyclovir
b. IV imperic antibiotic
c. Wait for CSF culture results, continue to control seizures
d. Surgical drainage of abscess
e. Hyperventilation with IV mannitol
33- 55 year old diabetic presents with a 5 day history of sever earache, headache and discharge from the left ear. Examination reveals high fever with severe tenderness over the left temporal bone with swelling and erythema of the left auricle. A sticky yellowish discharge is noted. conductive hearing loss is elicited. The best initial diagnostic test for this patient is:
a. Skull Xray
b. Head CT
c. Culture of discharge
d. Gram stain of discharge
e. Blood culture
34- The most common causative organism in the above patient is:
a. Staph Aureus
b. Pseudomonas Aeroginosa
c. Strep Pneumonia
d. Candida Albicans
e. Actinomyces Israeli
35- a 10 year male with sickle cell anemia is brought to your office by his mother with fever and a severe redness of the face with a lacy rash on the proximal extremities and upper chest. On examination, he appears to have been slapped on both cheeks with some lesions on forehead. There is spaing of the circumoral area. The child is restless but stable. The most probable diagnosis is:
a. Roseola
b. Infectious mononeoclosis
c. Scarlet fever
d. Erythema Infectiosum
e. Coxscakie A virus
36- a very serious complication that could very possibly arise in the above patient is:
a. Sepsis
b. Encephalitis
c. Worsening of Anemia
d. Septic arthritis
e. Hypoglycemic coma
37- 62 year old female is being treated in the hospital for severe bacterial pneumonia. Her previous medical history and symptomatology were unknown at the time of admission. Initial blood laboratory tests confirmed gram positive bacteremia. Culture was done before emperic therapy was started. The patient continued to improve on her levofloxacin treatment. Culture results were obtained 3 days later and showed Streptococcus Bovis bacteremia. Which of the following statements is correct:
a. The bacteremia is consistent with her diagnosis of pneumonia
b. There is a high possibility that this patient has a malignancy
c. A new drug has to be added to her regimen to cover for Strep. Bovis
d. The patient has to be investigated for bacterial endocarditis
e. The blood cultures have to be repeated since Strep. Bovis is highly suggestive of specimen contamination
NB/ (The acronym HACEK refers to a grouping of gram-negative bacilli; Haemophilus species (H parainfluenzae, H aphrophilus, and H paraphrophilus), Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella species. These organisms share an enhanced capacity to produce endocardial infections)
Answers
1-C 2-A 3-C 4-A 5-C 6-B 7-E 8-C 9-C 10-A 11-C 12-C 13-B 14-B 15-C 16-A 17-C 18-A 19-C 20-B 21-D 22-A 23-B 24-E 25-C 26-B 27-C 28-C 29-E 30-B 31-D 32-A 33-B 34-B 35-D 36-C 37-B
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