Each question below contains five suggested responses. Choose the one best response to each question.
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1 | |
A 30-year-old male patient complains of fever and sore throat for several days. The patient presents to you today with additional complaints of hoarseness, difficulty breathing, and drooling. On examination, the patient is febrile and has inspiratory stridor. Which of the following is the best course of action? |
| | A) | Begin outpatient treatment with ampicillin |
| | B) | Culture throat for b-hemolytic streptococci |
| | C) | Admit to intensive care unit and obtain otolaryngology consultation |
| | D) | Schedule for chest x-ray |
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2 | |
A 70-year-old patient with long-standing type 2 diabetes mellitus presents with complaints of pain in the left ear with purulent drainage. On physical exam, the patient is afebrile. The pinna of the left ear is tender, and the external auditory canal is swollen and edematous. The peripheral white blood cell count is normal. The organism most likely to grow from the purulent drainage is |
| | A) | Pseudomonas aeruginosa |
| | B) | Staphylococcus aureus |
| | C) | Candida albicans |
| | D) | Haemophilus influenzae |
| | E) | Moraxella catarrhalis |
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3 | |
You are a physician in charge of the patients who reside in a nursing home. Several of the patients have developed influenza-like symptoms, and the community is in the midst of an influenza A outbreak. None of the nursing home residents have received the influenza vaccine. What course of action is most appropriate? |
| | A) | Give the influenza vaccine to all residents who do not have a contraindication to the vaccine (i.e., allergy to eggs) |
| | B) | Give the influenza vaccine to all residents who do not have a contraindication to the vaccine; also give amantadine for 2 weeks |
| | C) | Give amantadine alone to all residents |
| | D) | Do not give any prophylactic regimen |
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4 | |
An elderly male develops fever 3 days after cholecystectomy. He becomes short of breath, and chest x-ray shows a new right lower lobe infiltrate. Sputum Gram stain shows gram-positive cocci in clumps, and preliminary culture results suggest staphylococci. The initial antibiotic of choice is |
| | A) | Penicillinase-resistant penicillin such as nafcillin |
| | B) | Vancomycin |
| | C) | Antibiotic therapy should be based on the incidence of methicillin-resistant staphylococci in that hospital |
| | D) | Quinolones have become the drug of choice for pneumonia |
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5 | |
A 30-year-old male with sickle cell anemia is admitted with cough, rusty sputum, and a single shaking chill. Physical examination reveals increased tactile fremitus and bronchial breath sounds in the left posterior chest. The patient is able to expectorate a purulent sample. Which of the following best describes the role of sputum Gram stain and culture? |
| | A) | Sputum Gram stain and culture lack the sensitivity and specificity to be of value in this setting |
| | B) | If the sample is a good one, sputum culture is useful in determining the antibiotic sensitivity pattern of the organism, particularly Streptococcus pneumoniae |
| | C) | Empirical use of antibiotics for pneumonia has made specific diagnosis unnecessary |
| | D) | There is no characteristic Gram stain in a patient with pneumococcal pneumonia |
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6 | |
A 30-year-old man who has spent 5 of the last 10 years in prison in New York City is referred from the prison because of hemoptysis. He has a history of tuberculosis diagnosed 3 years ago and took isoniazid and rifampin for about a month. A cavitary lesion is seen on chest x-ray. The physician should do all the following except |
| | A) | Obtain sputum for acid-fast bacilli (AFB) stain, culture, and sensitivity |
| | B) | Start supervised isoniazid and rifampin administration |
| | C) | Start a supervised multiple drug combination to treat multidrug-resistant tuberculosis |
| | D) | Place the patient in respiratory isolation |
| | E) | Perform routine screening of inmates and staff for tuberculosis |
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7 | |
A recent outbreak of severe diarrhea is currently being investigated. Several children developed bloody diarrhea, and one remains hospitalized with acute renal failure. A preliminary investigation has determined that all the affected children ate at the same restaurant. The food they consumed was most likely to be |
| | A) | Pork chops |
| | B) | Hamburger |
| | C) | Gefilte fish |
| | D) | Sushi |
| | E) | Soft-boiled eggs |
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8 | |
A 40-year-old female nurse was admitted to the hospital because of fever to 103-F. Despite a thorough workup in the hospital for over 3 weeks, no etiology has been found, and she continues to have temperature spikes greater than 102-F. The least likely diagnosis in this patient is |
| | A) | Occult bacterial infection |
| | B) | Influenza |
| | C) | Lymphoma |
| | D) | Adult Still's disease |
| | E) | Factitious fever |
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9 | |
In a patient who has mitral valve insufficiency, which procedure does not require prophylactic antibiotic therapy? |
| | A) | Cardiac catheterization |
| | B) | Prostatectomy |
| | C) | Cystoscopy |
| | D) | Tonsillectomy |
| | E) | Periodontal surgery |
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10 | |
Rabies, an acute viral disease of the mammalian central nervous system, is transmitted by infective secretions, usually saliva. Which of the following statements about this disease is correct? |
| | A) | The disease is caused by a reovirus that elicits both complement-fixing and hemagglutinating antibodies useful in the diagnosis of the disease |
| | B) | The incubation period is variable, and, although 10 days is the most common elapsed time between infection and symptoms, some cases remain asymptomatic for 30 days |
| | C) | Only 30% of infected patients will survive |
| | D) | In the United States, the skunk and the raccoon have been important recent sources of human disease |
| | E) | Wild animals that have bitten and are suspected of being rabid should be killed and their brains examined for virus particles by electron microscopy |
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11 | |
A previously healthy 25-year-old music teacher develops fever and a rash over her face and chest. The rash is itchy and on exam involves multiple papules and vesicles in varying stages of development. One week later she complains of cough and is found to have an infiltrate on x-ray. The most likely etiology of the infection is |
| | A) | Streptococcus pneumoniae |
| | B) | Mycoplasma pneumoniae |
| | C) | Pneumocystis carinii |
| | D) | Varicella virus |
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12 | |
A 25-year-old male from East Tennessee had been ill for 5 days with fever, chills, and headache when he noted a rash that developed on his palms and soles. In addition to macular lesions, petechiae are noted on the wrists and ankles. The patient has spent the summer camping. The most important fact to be determined in the history is |
| | A) | Exposure to contaminated springwater |
| | B) | Exposure to raw pork |
| | C) | Exposure to ticks |
| | D) | Exposure to prostitutes |
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13 | |
A 19-year-old male has a history of athlete's foot but is otherwise healthy when he develops the sudden onset of fever and pain in the right foot and leg. On physical exam, the foot and leg are fiery red with a well-defined indurated margin that appears to be rapidly advancing. There is tender inguinal lymphadenopathy. The most likely organism to cause this infection is |
| | A) | Staphylococcus epidermidis |
| | B) | Tinea pedis |
| | C) | Streptococcus pyogenes |
| | D) | Mixed anaerobic infection |
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14 | |
An 18-year-old male has been seen in clinic for urethral discharge. He is treated with ceftriaxone, but the discharge has not resolved and the culture has returned as no growth. The most likely etiologic agent to cause this infection is |
| | A) | Ceftriaxone-resistant gonococci |
| | B) | Chlamydia psittaci |
| | C) | Chlamydia trachomatis |
| | D) | Herpes simplex |
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