= (ems of35 [lll vhs) (sim) Three days afer returning fram a camaing tp in North Carolina, a man develops a fever af 39.4" C (103° F), hoadacho, and mussle acnos. Two days later ho noteos the rach chown in tha mage around his wriste ard logs. ‘The following day, the rach has spread te his tunk and nis fever has net gatian tater. He dacides te gota the emergency department where he reports having received several tick bites whila on Fis caraping trip. The resident orders a Well-Felix reaction essay, which is positive, Which of the following 's the treatment of choice for this aatient? mega cowtesy of Inages. IED A. Ceftriaxone B.Doweycline C.Gentamicin D. Nystatin E.Penicilin | bone @ mene 7Fle 2] bone Edit vew Favorites Naseem Charterer nee Meare eee aie te eet Taok Hep eae Rom 35 (Lal Lv Eifel | (Sonim) The correct answer is B. This patient presents with Rocky Mourtain sooted fever (RMEF), which is caused by Rickeitsia rckettsi. This small, gram-negative bacterium Iscairied ty ne Amarican dog tek (Bermacenior vanatuis) Inthe easter United Slates, Patients will en present frstwiti headache, fever * 38.9" C/=102"F), and myalgias followed by arash on the paims and soles (or wtists and ankles) that spreads to the trunk The Wel-Felix assay reaction tests for antirckettsial antibodies, ‘which cross-react with Protous antigon. This tect fe usually pesitve for RNGF ard ‘typhus but natford fevar. Tha treatment of chaice for adults with RMSF is doxyeycling; chioramahentcolis alsa used but has more significant adverse effects Ais not correct. Ceshalasporins (ceftriaxone) are nct effective against Rickettsia rickets Cis not correct. Arrincglycosides (gentemicin) are rat effective against Rickettsia rickets Dis not comect, Nystatin is used in the trealmentof fungal infections such as oval candidiasis. Ee not correct, Penicilin ig noteffactve against Ricketsis rieketish Tetracyclines Tetracycline, doxycycline, demecloeyeline. Demectocycline—ADH minocycline antagonist; acts asa Mechanism Bacteriostatc; bind to 30S and preventattachment Diuretic in SIADH of aminoacyL4RNA; limited CNS penetration. Dowycseline is fecally eliminated and can be used in patients with renal failure. Must NOT take with milk, antacids, ce iron-containing @ mterne coo Bois)eno eet te eee i egnr Fle Edt Yew Favorites Tool Hep a [ema eros |[<)[> ville) [sieii=) ‘A 10-year-old boywith sickle cell disease presents to his primary care physician complaining of pain n his chestand letthigh forthe pastweok He hao recanily had overs spiking to 29.1° C 103" F) and chill, The prysician has known the patient for many yeste and walle the chest pain has heen chronic, the pain in hie left thigh is ofracert onset. With a review ofthe patient's recards, the physician discavers that the pain siartad saan afer he was last adrnitted for a sickle cell crisis. On physical examination, the patienthas a fever of 29.0" (1 02.3" F), and his let thigh is warm, enthematous, and edematous. tis also very tender to palpation. The physician is very concemed and wants the poaient to be adrited to the hospital. He orders an Xray and NRI of he lef thigh and craws blood for culturing before he begins entisiotic reatment. What pathogen is mast likely sponsible far the infection in this patient? A. Mycobacterum tubercuosis B. Neisseria gonorrhoeae ©. Pseuriomonas aeruginosa D. Salmonella typhi E. Staplyiocoseus aureus Explanation @ mtene Gea == S aFle Edt Yew J bone Taok Hep = nem or35 |) [> |v Ie lal ee) Explanation | The cortect answer isD. This patientis oresenting with osteomyelitis of isle femur. Classic signs include fever (often exceeding 38.9" C [102° F}}, eythema, and edema, Panis aso. claesic finding, Most olen, there is some form of eternal injury that allows bacteria ‘0 colonize the bone, such a5 an ulear or puncture Fam an intravenous neecle, However, In pallents win sicke cal disease, osteamyeltis anen ecurs Secondary to hone infacion and ean folowa sil esis The Davita ate hematogerously spread fom elsewhere inthe body colonizing te dead bone. hie the majeny ofosieomyalits cazse are cousad hy tephocaccus aureus, in patents ‘with sioho vel disocce the rdsteaininigh pathoyn ic Galmancla typhi Ais not comrect.jMycobactarium tuberculosis is a rare cause of ostenmryelitis As an extrapulmonary marifestation ofthe disease, tuberculosis may be odserved n the vertebral cclurin af immunosuporessed aatents Bis not correct. Weisseria gonorrhoeae is a rate cause of osteomyelitis. tis seen mastoften as a sewally transmitted dsease (STD). In complizated cases it can lead to septic arhriis.In aven rarer cases, the septic arthrtis can be camplicated oy stecinyellis. In 4 sexually ative patent with ahistory of TDs, itis an important pathogen to consider when the presentalion is consistent with osteornyeltis. Cis not correct. Psoucomonas aanuginosa is cemmon cause of ostoorryoilis in petients wih ciabetes mellitus, is moctoftan seen in ciabetis foot uleors and infections, Eis not correct. Staphyococeus aureus Is the mast common cause of astaomyelitis in the general population and is seen at even higher rates in intravenous drug users. However, in patients wth sickle cell disease, Saimonella yohi is more often identified as the causative agent : @ mterne baci)Reon met te tees Re coger eg en OOs Macreee en areas Fie Edt Vow Fairies Tock Hep a (ems or35 [i [> [yell eee (sifeji=) ‘A 45-year-old man who Is HIV-positive is beng treated with highl active entiretrovial therapy. Despite this patient's aggressive modieation ragiman, he has rocanily dovolopod the locians shown in tho image. Treaimont wih which of the following substances would most ikely be effective against this patent's lesions? Image courtesy of Inagis. MD Accelnterferon B p-lterferon ©.yinterteron D.Tacrolimus E.Tamoxifen ej iconTees ee CN eg ee Met theer ee ater re Cee et tet [) Fle Edt Yew Favorites Tool Hep a | items of 35 See ales) [siiei=) Explanation The correct answer is A. The image is of AACA LMEHIFGAth lesions from Kepos's sarcoma, # shin malignancy commonly seen rn mmunasupgressea pallens Kapest’ sarcoma is caused by HHV-B. tere‘ons are oy Talurl kl cells, ed fori leukceyt effect in petients with hepatits B, hepatitis 4 ralignant malanama Bis not comrect, Connective tissue fibroblasts produce B-interfernn, which is used to treat mutiple sclerosis, ithas na rolein beating Kanosis sarcoma Cis not correct. interferon is produced by mphocytes and ectivates turraricidal macrophages It's used for patienis with chronic granulorvatous disease and has no role in treating Kaposi's sarcorra, Dis not comect, Tacrolimus Is an imnmunosuppressive agent used in organ trensalant recipients, thas na effect in treang Kepasi's sarcoma, Eis not corroct. Soloctvo octrayon recaptar radulators euch as tamnaxifon block tho binding of estrogen to estooen receptor positive cells and are rast commonly used totreat breast cancers, Thay nave ro effect in traatng Kaposi's sareama [FIRST AID) Recombinant cytokines and clinical uses \ Clinical uses Aldesleukin (interleukin-2) Renal cell carcinoma, metastatic melanoma Enthropoietin (epoetin Anemias (especially in renal failure) Filgrastim (granuloeste Recovery of bone marrow colony-stimulating factor) dl cone @ mene coo Bois)Fle Edt Yew Favorites Tool Hep suse jitems ot 35 || [fi[s SEL) (si[aiim) ‘A 54-year-old man, well knowin ts hospitsl siafffor repected admissions for uncontrolled diabetes meliius, is brought to tho emorgancydeaarmanthy ambulance. He was found unconscious, hypotersive, anc with vamit on hic shirt. In the emergency department, he is more alert and complains of severe. sbdorrinal pain and shortness ofbreath. In addition ta these classic signs of diabatic ketoacidacis, the patient is febrle and has sinus ‘endemess with erythema inthe paranasal sinus, and a bloody discharge arourd his nose. The patient states that ne nas had double vision for 3 days; examination shows thathe cannot move his efteye in ary direction, The physician promptly treats the patient's diabetic ketpacidosis and segins him an high doses of amphotericin B. This patient most likely has which of the following types of fungal infection? A Agpeigilus tunigatus B. Cryptococcus neoformans CC. Mucor species D. Blastamycesis Histoplasmosis Explanation @ mtene Gea == S aTaok Hep seam nema 735 |[-<[> |v [fH Se) [explanation | The correct answer is C. This patient is exhibiting classic signs af a"Fazan globe" a condition that affacts the crbits af patie at wide angles (90 degrees). Symptoms of Muccr species infection include an allergic reaction and infarction 6f distal tissue due to fungal proliferation in the walls of blooc vessels The disease Is mostly seenin patients with ketoacicoti: diahetes and leukemia, High dases of amahoteticin B are used ta treat mucormycosis. {Als not correct.Asperoilus tumigatus can present wth oranchopulmanaty aspergilusis, lung caviy ssperullornas (fungus balls"), and invasive aspsrallosis, Dib eae lea ocdwy sapiatypr total pancreas lust epee ral A frigoti ero mG i ae Bis not correct.Cryptocaceus neaformans infactian daes nat afen present with any. symrtams in an immunnenmpetent host. However, in an immunncampramised individual, t can present with meninacencephaliis. Cryptococcus is a heavily encapsulated yeast that is net dimorphic. The fungus is found in sol and pigeon droppings. Dis not correct. Slastemycosis can present with tu-ike symptoms, fevers, chi productive cough, myalgia, athraigia, and pleuiitic chest pain. Some petierts wil fell Torecover flarn an acute Infection and rogress to develop chranic pulmonary infection orwidespread disseminated infection Fluconazole or ketoconazole is used for the ‘treatment of local blastemyecsic infections, and ampnatericin 8 is used for the treatment of oycternic infections: Fis not correct, Histoplasmnasis most often ces not lead in any symptomatic presentation. When sympioms are present, they usually present as a Muclie lines ‘with fer, cough, headaches, and myalgias. Histoplesmosis can result in a lung disesse resembling tuberculasis and widespreac disseminated infectan affecting the liver, spleen, edrenal glands, mucosal surfaces and meninges, Histoplasmosis ‘occurs most corrmanly in the Mississippi and Ohio rver valleys, @ mterne 2 iaeno eet te eee i egnr pie ie Fle Edt Yew Favorites Tool Hep i 2104 [ems or 35 |i [vie [tn| ae. (siimia) ‘After a long cemping trip in the vioods, a 29-year-old man camesto the ptysislan complaining offever and general malaise. His physical examination 'e significant for a well-damarcatad skin losion with a black base. On furor ‘quesiioring, the pationt scys that the lesion developed aver bite sito, Which of the following arganismes is mast likely responsible far this patients disease? A. Brucella melitensis B. Francisella tularensis C.Nocardia asteroisies D. Treponema patiisum E.Trichinella spiralis Explanation @ mene eaehae Fle Edt Yew Favorites Tool Hep aan [items or35|[<)[> [vy p=.) (sis) The cortect answer is B. One of the diseases caused by Francisela tularensisis tleeroglandular tularemia, This disease is characterized by awell-demarcated skin lesion with a black base following a tick or ceery ite or contact with the ody fuios ortur ofan infected tabolt. var tened few Jays, systernic sympioms develop anc the Ioeal righ nodes may become Swollen and galntul Ais not comect.2rucefla species enter the kady aterthe ingestion of contaminated milk products oF following diractcantaxt with centaminated livectock Itie an inracellular bacterium that causas undulating fever, weakness, anc loss of appatio. Cis ot comect.Wocardia asteroides's an acit-fast aerobe found in soll. This organism causes pulmonary infections, orimavly in immunocormpromised individuals, Dis not correct. Treponema pailicm causes syphilis. Primary syphilis hypically presents with a painless chancre, nota lesion ona black base. Eis not conect. A person infected wil Trichinetle spiralis presents with fever, petiowbital and fecial edema, myalgia, and eosinophilia [FIRST AID] Zoonotic bacteria Species Disease Transmission and source Bomelis burgdorferi. Lyme disease Tick bite; Ixodes ticks that live on deer and Bugs From Your Pet mice Undulate and Brucella spp Brucellosis? Dany products, contact with animals Unpastenrized dainy Undalant products give yo dl cone @ mene coo Bois)eno eet te eee i egnr pie ie Fle Edt Yew Favorites Tool Hep ait zs [ems or35 |[<)[> vise (sila) ‘A S6-year-old man comes to the emergency department because of sharp retrosiermal pain thatradiates to his back and arms. He statos that the pain worsens on incpiration, a¢ wall as whon ha live on hie back Physical examination reveals a high-pitched grating sound ct the lower left sternal barder. An ECG confirms the diagnasis. Which ofthe allowing vituses is a carnman cause ofthis condition? A. Coxsackevirus B.Cyamegalovirus ©.EpsteinBaw virus D. Norwalk agent E.Rubella Explanation @ mene eaeUo ete Te au sn Maines en eee Cae eal ott le] Fle Edt Yew Favorites Tool Hep ae [irems or35|[<)[> [vy panes.) (sis) the correct answer Is A, This patents syrpems ate me ypleal presentation rr peticatdtis, which is ilammalion offi bRETaaineMibfene. Te hgtrplched criisg sourdisdeee plistra per a aelncien per corean monot Poet comectistié cel eioecor mon catee sci nect eetuan Teter terri er oe Bis not correct. Cylnmegalovirus can cause retintis, pneumonitis, and. systamic diseases in immunocompromised patients, but otherwise causes heteraphi-neaative ranonucleosis, Cis not correct. Epstein-Barr vitus causes heterophi-posttive monanucleasis with fever, fatgue, lmphadenopathy, and splenomegaly. Dis not comect. Norwalk virus Is nol 2 cause of infectious pertcardits. It usually causes gastrcentertis in schookaged childien and adults, Eis not corroct. Rubolla doos not cause viral poricardtis andie rare in the Unitod States because of extensive vaccination, [FIRST AID) Pericarditis Serous Caused by SLE, rheumatoid arthritis, infection, uremia. Fibrinous Uremia, MI, rheumatic fever. Hemorrhagic TB, malignancy (e.g,, melanoma), Findings: pericarcal pain, friction rub, ECG changes (diffuse ST elevations in all leads), pulsus paradoxus, distant heart sonnds ‘without scarring or lead to chronic adhesive or chronic constrictive dl cone @ mene coo Bois)Fie Edt Vow Fairies Tock Hep a rem7 ors [<)> ville) [sioeli=) ‘A T-yearold gil has numerous vesicles on her face, particularly around her mouth, Over a fewdays, the vesicles tuin into pustules and crust over, ba¢oming flaky and light yellow in colar. Which of the ‘ollowing statements abaut the organism most likely responsible for thie it's infection is correct? A Sabouraud’s agaris required'to culture this bacterium B.Tha hacterium is a facultative intracellular organism, C.The bacterium Is a group 8 &hemolytc organisin D.The bacterium is becitacin-sensitire E.Tha hacterium is protected from host defenses bypratein Nl Explanation @ mene eaeTees ee CN eg ee Met theer ee ater re Cee et tet [) Fle Edt Yew Favorites Tool Hep seus [rem orss [ |v [Hse ) (sila) ‘A T-yearold gil has numerous vesicles on her face, particularly around her mouth, Over a few days, the vesicles tuin infa pustules and crustover, bocorfinig flaliyaind light YollaWii color. Which of the following statements abautthe organism most likely responsible for this it's infection is correct? A Sabouraud’s agaris required'to culture this bacterium B.Tha hacterium is a facultative intracellular organism, C.The bacterium Is a group 8 &hemolytc organisin D.The bacterium is becitacin-sensitire E.Tha hacterium is protected from host defenses bypratein Nl Explanation The conrect answer is D. This yil has impetigo, caused by Streptococcus pyogenes, a gran-posithe croup § f-hemolytc crganism thatis bscitracin-sensitve. This Infection te characterized by an oruption of vaciclos on the faco. Those vosiclos later tuin into pustules with a characteristic honey-colored crust. A distnelly bufous form of Impetign is caused by 8. aureus Ais not correct. Sabouraud's agaris requited to cuture funai, not Streptecoseus pyogenes. Bis not comrect.ifyeabacterium, Brucella, Francisella, Listeria, Yersinia, Legionella, and Saimonesa ate facultative intracellular organisms, aut Streptococcus pyogenes Is not Cis not comect. The bacteriumis a group A P-hemoltic organism. Stepiococeus agalactizo is a group & B-homoiyte organic, Eis not correct. Protein M protects the hacterium from phagacytosis, but t makas the hecterium more sensitive to host defenses due to antibady praduction against protein M. dl cone @ mene coo Bois)eno eet te eee i egnr pie ie Fle Edt Yew Favorites Tool Hep ot na [nema or35 [<)> vise) [sieii=) Vital myocarditis mast often presents as oiventiicular hearffailure in young people who do not nave valvular, thournate, or congonital hoart diceass,Itic charactorized by diffuse myocardial dogoneration and nocrosie with an infammnatary infiltrate, Which af the following is the masttrequant cause ofviral myacarditis in he United States? A. Coxsackevirus B B Hepaiitis 8 ©.Palio D.Rubella E Strepiocnceus Explanation @ mene eaeTees ee CN eg ee Met theer ee ater re Cee et tet [) Fle Edt Yew Favorites Tool Hep see [roms rss [ |v [fH Se) (sila) Vital myocarditis mast often presents as oiventiicular hearffailure in young people who do not nave valvular, theurate, or congenital heart tig charactorized hy ciffuse myocardial doganoration and necrosie with an int ann Pi AS TOT TOUGH COLON EAUGRTOTO RN PDCUTENSTAWTE oe States? A. Coxsackevirus B B Hepaiitis 8 ©.Palio D.Rubella E Stepiocnccus Explanation The corvect answer is A. Corsackievius B is the mest commen cause ofviral myacarciti inthe United Btates. itio a member afthe Enterovirus gioup ofthe Picomaviridae family, Bis not correct. Henattis B is nat a frequent cause ofviralrmyncardtis. thas both acute ard chronic manifestatons that include syreptoms such as fever, malaise, headache, anorexia, vomiting, darkurine, and jaundice Cis not correct. Poliovrus is nct afrequent cause ofviral riyccardits. Its infections are mostly asymptomatic; however, pcliomyelits results from viral damage to anterior hom motor neurons Dis not cowect. Rubella can cross the placenta andis lerstogeric, ican cause congential tubella, eacing to patent ductus arteriosus, pulmonary stenosis, cataracts, microcsphaly, and deathess, Eis not correct. Strentoccecal infections can lead ta rheumatic fevet, an Immunolocie disorder in which antinauies to stertococeal aniigens autoreact with human antigens in the heart and other tissues. dl cone @ mene coo Bois)eno eet te eee i egnr Us Mathes eee ate See aeey [) Fle Edt Yew Favorites Tool Hep cain: 2900 [memo or 35 [ [vpn] Se.) (slim) ‘Oncogenic viruses have diferert mechanisms bywrich they Induce neaplasme. Neoplasia s defined e a cianal proliferation af calls that io uncontrelled and oxcessiva, Whish of he fallawing vitusoe causes neoplasia by primarily destroying celle, anc then subsequanlly stimulating tepeatad regenarstion and subsequent aberrant call growth? A Epstein-dam vius B Hepaiitis Cvirus C.Human T-cell yinphama virus type 1 D.Human immunodeficiency vius E Human papillomavirus Explanation @ mene eaeTees ee CN eg ee Met theer ee ater re Cee et tet [) Fle Edt Yew Favorites Tool Hep ne [neem 9 0195 |) [vise [explanation | The correct answer is B. ath hepatite © and henaitioB infection are associated ‘with an iiereased risk of developing henatncellular carcinoma, The liver Is the organ inthe bedy wit the most regenerative potential. this abiliy is overused, the chance ofan oncogenie mutation oczuring during the receneration of cells is higher, Ais not correct. Epstein-Barr vitus (E8V) is associated with Burkitt's hmphama (a B- Iymphacyte lymphoma) and nasapharyngeel carcnama The (8:14) tenslacation 1S consistently associated with Burkit's ymphoma, butthe transiocation alone is not resnunsible for he neoplasm and fs rot ound in nasoptanyngeal carcinomas, The other factors that determine oncogenesis of EBY remain unclear Cis not correct. Human T-cell Kmphora virus causes adult T-coll|eukemis, and although tha mechanism af cneagenesis remain unclear thare is same evdence that integration into the host genome. at Incations near cellular growth ganes may jay arole. Dis not correct. HIW es. direct oncogenic agent is being intensely researched, but itis already known thatirmune suppression and dysregulatian caused ky KIV infection give rise tolymphamias and Kaposi's sarcoma Els not con ect, Human papillomavirus causes carcinoma (usually cervival hy inactivating tumor suppressor genes such as 3 and Rb. [FIRST AID| Herpesviruses Vins Diseases Route of transmission HSV. Gingivestomatitis, keratoconjunctivitis, Respiratory secretions, Get hemes ina temporal lohe encephalitis, herpes saliva CHEVrolet Tnbialis (see Color Image 11) CMV Herpes neonatal hempes al contset, pesinatal HSV dl cone @ mene coo Bois)Roo eet te eee Re tiger eg nO Macreee en ete Fle Edt Yew Favorites Tool Hep fa: 2004 | nem 11 of 95 |[- [v4 [ten] Se.) mame ‘A 25-year-old man preserts fo the ahysician with a fever of39.4°C (109° F), @ blood pressure of SO/S5 mm Hg, @ pulse of 100/min, a WBC of 19,000%nm3, and pain and swalling over his right uppor stm. Blood cultures show humerous bastetia, Anycray tlm ofthe shoulder is shown. Which af the fellawing organisms is mos'likaly causing this patient's symptoms? Image courtesy of Inages. MD A. Closticiurn pertengens B Frevotefa metanincaenica ©. Salmonella species D. Sporothix schenck E. Staphylococcus aureus @ mtene Gea == S aFle 2] bone Edit vew Favorites Naseem Charterer nee Meare eee aie te eet Taok Hep Sassi [emt 035 |) Lv IEE j[n SE) (silaiim) The correct answer is, The symatoms offever, ain and swelling ovar a hone, bacteremia, and sepsis suguest a diagnosis of hamatogenaus osteomyelitis Radiolouic studies show softtissue swelling, bore destruction, and periosteal reacton Plain films may be normel 7-10 days into the infection. The organism most commanly causing osteomyelitis is Staphyococcus aureus, As not cotrect.Ciostrisiurn pegringensis the organism resporsitle ‘orthe development ofgas gangrens. This organism |s associated with contaminated wounds Bis not correct. Provotoiia molaninoganicais part cfthe normal oral fora and ic most commonly tesponsible for abscess formation in the mouth, pharynx, brain, and lung, Cis not comrect.Saimonaiia species usually cause osteomyelitis in individuals with sickle cell disease, Staphviococcus aureusis the cause of astecmyeliis in most Individuals Dis not comrect.Sporothrix sohenckii\s a fungus typically seen after a prick with thorn, which azccuns for he nickname, rose garcener’s disease [FIRST AID] Osteomyelitis, Most people—S. eureus. Assume S. aureus ifno other Semnally active —Nejse e information. arthritis more commen, smyelitis ocens in Diabetics and drug addicts—Peeuden Sickle cell—Selmonella Elewted ESR @ mterne coo Bois)eno eet te eee i egnr pie ie Fle Edt Yew Favorites Tool Hep ain: saa (item 12 0F 35 | (<<) [> [v6 )[i0| ses.) (sina ‘A 43-year-old man lining in Mexico preserts fo ¢ clinic complaining of canstipation end stomach pains for several manths. On cardiac examination, the physician diccavore a laterally dicalaced paint afmmaximal imeaet. Radiological studies reveal pulmanary cargesticn, cardiomegaly, ané megacolon. Sadly, tia ahysician can only offer the pstiont symptomatic teatment. What insects the most likely raute aftranemissien for this patients illness? A Anopheles mosquito B.biades tick ©. Reduvid bug D. Senay ETsatse th Explanation @ mene eaeFle Edt Yew Favorites Tool Hep ae neem 12 0195 |[- [>| v Ie a] es) [exstenaion] The correct answer is C. This patientis presenting with Chavas disease, which is, caused by infection with Tiypanosome cruzi Acute symptoms include chagomas (ema datmal granulomas caused bylocal multipistion ofthe pathogen), myacarcitic, and congestive hear failure as a sevare, but rate, complication of myncarctis, Mare chronic syrntams include arhythmias, ciated cardinmyorathy, megacolon, and mesaesonhagus as T. cru infects cardiac tissue anc colonic hetves, Treatment is mainly syrrptomatic. Anather for of infection cccurs when the organism enters the body through the conjunctiva. In that case, eye edems known 2s Romana's sign occurs. Chagas disease is mostly transrnites hy the reduvilé bug in Central and Soutn America Als not comrect. The Anopheles mosquito Is responsible fr tansirission ofthe four Plasmodia species that couse malaria, B is not correct. The beodes fcktranemite Borrotie burgdorfer, the cause of Lyrna disease Dis not correct. The sancifyis responsible for transmission of Leishmania doravani also known as "Kale-Azar" or leishmaniasis, Eis not correct. The tsetse fy carries Trypanosoma brucei gembiense and 7. bruce! rhodesiense, he two causes of affican sleeping sickness, in this disease, patients complain of repeateuiyraling asieep in addition to headaches and izzness. Omer symigloms include recutrent fevers and lymphadenopalty. 7. gruvefrhedesiense causes a much more acule infection, while 7. brucelgambiense causes a more subacute, Indolent, and progressive disease [FIRST AID) Medically important helminths. dl cone @ mene coo Bois)Fle Edt 2] bone vew avertas Tools Heb ip: 2428 {rem 13 01 35 |[ [> vf] ta] SE] fslin|im] ‘A S3-year-old man whowes diagnosed with Hiv infection B years ago presents io his physician wih several purple colored, painiose plaques on his upper back. The micrograph shows the rosult ofa kiopey of one of those losions. Which ofthe following is the aticlogic agent responsible for hase lesions? Image courtesy of Hnages. MD. A Epstein-ar virus B Hepaiitis Cvirus ©. Human Teeth ymphama virus type 1 D.Human hemesvinus 8 E. Human papillomavirus z) TeFle 2] bone Naseem Charterer nee Meare eee aie te eet Taok Hep ne [neem 0195 |<) vise) Explanation The correct answer is D. The image shaws the spindle-shaped tumor cells diagnostic af Karns's sarcoma The lesians classically appear as described inthe ‘question, Human herpeswrus 8, also known as Kannsis sarcoma-associated herpesvirus, is the oncogenic vitus thet infe:ts endothelial and spindle cells, ghino rise to lesions like the one shown here stein-Bar viusis assovialed with Eurkit’s lynphoma and nasogharyngeal sarsinama Bis not comect, Hepallis C virus Is. eesuclated with hepatocellular carcinarna, Cis not correct. Human T-cell krmphorna virus type 1 is assccicted with adult T-cell leukemia, Eis not correct. Human papillamarirus (yes 18 and 18) s associated with cervical and penile/anal carcinoma Herpesviruses Vimis Diseases Route of transmission HSV. Gingivestomatits, keratoconjunetiitis, Respiratory s Get hemes ima temporal lobe encephalitis, herpes saliva CHEV rolet: Iabialis (see Color Image 11) HsV Herpes genitalis, neonatal hempes Sexual contact, perinatal va \Varicellazoster (shingles), encephalitis, Respiratory secretions pneumonia (see Color Image 15) EBV Infections mononucleosis, Burkitt's @ mterne coo Bois)eno eet te eee i egnr pie ie Fle Edt Yew Favorites Tool Hep ee | reem 14 or 35 | | vf) san] Ses.) [sieii=) ‘A 38-year-old man cies inthe emergency department due fo hear failure. On autopsy, an enlarged endflaccld heart Ie abeored, Microccapy of blaod sample taken in tho ornorgency daariment savior that cay shows Nagellatod parasites, & histolagic section ofthe haatt shovis normotile amastigates. Which af the follawing parasites dia this man most Ikely harbor? A. Cryptosporiaium species BErlamoeha histaivica ©. Giarcia farmbia D. Toxoplasma gorai E.Trypanosoma cruzi Explanation @ mene eaeTaok Hep wer 14 0135 [> [VIE | The correct answer is E.Tiyparosoma cruzi infection can cause ayanglionic Mmegacolan and Chagas’ cisease, a condition in which the heartis enlatued and flaccid. 7. crvziistransmitedvia the reduvid bug. Microscopic examination reveals flagellated rypamastigates in the flood anc nonmotle amastgctes in issue culture T.cruzi infection is reated wih nirurlimos. Ais not cotrect.Ciyotosporiciurm oaecies infection presents with severe diacthea in Hiv. positive patients and mild watory diarthea in HIV negative pationts Cxpiosporiaivnis vanemitted via cysts in wator facal-aral transmission) Microscopically, acic-fast staining cysts are found Linfortunately, there is na ‘reatment available for Cryptosporicium infection; however, in heathy patients, crpptosroridiosis is seltresalving Bis not comect.Entamoena histolvtica infectionpresents with bloody diarrhea (Gysenten), abdominal cramps wit tenesmus, and gus inthe stool Itan also cause Tight upper quadrant pain and liver abscesses £. histolytica is transmitted via cysts in ‘water (ecel-oral transmission). On microscopy, on observes amebas win ingested RBCs, Treatment for E, histoytice infection includes metronidazole and iodaquinol Cis not comect.Giaraie debite nfecion presents with bloating, fstulence, foul malig diarrhea, andlight colored fatty stools. G. /ambiisis transmittad via cysts in water (ecabaral transmission). On micrascapy, ane abseries teardrap-chaped trophozoites with a ¥entral sucking disc or cysts. Netionidazole is usedita treat @ lamblia infecton, Dis not comect.Toxoplasme gonailinfectionpresents with brain abscesses in HIV postive patients and with bith detects ifinfecton occurs curing pregnancy (foxoplasmasis Is one af the TORCHES organisms). 7. goncinis transmitted via cysts Inraw meat or cat teces, The denntive stage (sexual stage) occurs in cats Microscopically, acle-tast staining eysts are found, Sulfadiazine and pylirnatharnine fare used to treat oxoplasmosis. @ mterne 2 iaFle Edit vew Favorites sy eee ear segs Warren ere Taok Hep fin: 3008 | nem 15.0195 |[- [v]p4)[tn] Se.) (slim) ‘A 24-yeat-old man presenis to the emergency department with a ‘ever, chills, night sweats, malaise, anc fatigue that otarted 3 daye ago. In the pact day ho hac also aacame chert of kracth. He admits fo using intravonous drugs regularly. At presentation, the patient is shaking and appears pale. Physical ecamination is remarkable for a temperature of 3¢.4* C(103* F), hyponta 9 83% on roam air, jugular venous distenton, bilaterally decreced brest sounds at the bases with duliness to percussion atthe bases, and a gtade II/VI systaic murmur heard best atthe lower let sternal order. The patent states thathe never had anything wrong with his heart before. Which pathogen is mostlikely responsible for this patients condition? A Enterococcus faecaiis B. Haemophilus aptrophilus ©. Staphyiocaccus aureus D. Streptococcus bovis E. Vitidans streptococe! Explanation @ mtene Ea a Baan)Fle Fat Yew Favertes Took He ais neem 5 0195 | [> |v Ie a] es) The correct answer is C. This patientis presentina with a classis case of acute bacterial endocarditis (ABE). Endocarditis is offen characterized ky constitutional symptoms (fever, malaise, chills), new-onset cardiac murmur, ard @ combination of ather signs and syreptoms (eg, Janewaylesions, Osiernodes, and Roth spcts). Acute ‘and subacute endocarditis can be diferentisted based on history, as the acute case wil havea more severe and sucder onset, as inthis patient. Stapnyfococcus aureus Isthe mostcornmon bacterla Isolated in cases orinfectious endocaraits, and Is mast len seen in cases ofintravenous drug use and indwelling catheters. 8. eureusis associated wih ABE rather than subacute endocarditis, and patients aflicied with ABE ofien appear much sicker. The murmur described is consistent with tricuspid regurgitation, 2 sign of ight-cided endocarditis that is clascic farintravenus drug use or incwelling catheter-related cases. Janeway lesions, Osler nodes, ard Rath spots fara mostly seen as a cornalication of laf-sided endincaraitis, in which seniic emboli leave the heart and enter the systemic circulation. in lahi-sided endocarditis, septic emboli to the lungs leading ta bilateral iniltrates are seen more often. This patient is manifesting signs of bilateral infitrates with signs of nynoxta, decreased breath sounds, and cullness to percussion. Als not correct. Enterococcus feecaiis create a picture of subscute endocarditis. The lassie picture is a slow onset of cunstitulonal sympioris with low-prade ‘ever, Enterocooeys infection is not seen as frequently as viidans streptococci, butitis known to colonize damaged heert valves, especially i patients with a past history of rhaumatic ver. Bis not correct. Haemophilus aphrophilus is nartof he HACEK oraup of fastidious vurarr-negative bill that cause 85-10% of cases of bacterial endavarditis that are ‘ict related to intravenaus drug use. These organisms are diffcul to cuture, making diagnoses more complex. Dis not correct. Streptococcus bovis also creates a pleture of subacute bacteria endocarditis with loveprace fever and insidious onset. Itnormally Innatits the Iower gestraintestinal tact and lesions inthe colon, such a8 those that occur in solon cancer, alow the bacteiia access to the bloodstream. Ik most commonly affects the acrticvave @ mterne ae = 27 iu)eno eet te eee i egnr pie ie Fle Edt Yew Favorites Tool Hep cup: 2097 | nem 16 of 95 ||] [vpn] Se.) mame ‘A 19-year-old woman comes to the physician after returning from a vacation in Tennessee with a fever of 33.5" C (103.1°F). She also has a severe haadacho and rod conjunctvae. A caupio of houre after tho oncet of thoso symptoms, a rash appears cn her aalms and soles. Tho prysician diagnesis har with Rocky Mountain spatied fever. Which af the fallewing statements is earract? A Rickettsia rickettsilis a facultative intracellular garasite B Rickettsia sickettsilis the largest bacterium known ©.Celd antibody agglutination is a classic fnding for rickettsial infections D.She should promptly be treated wit doxycycline E.Tha bacterium is spread by the tsetse fy Explanation @ mene eaeTees ee CN eg ee Met theer ee ater re Cee et tet [) Fle Edt Yew Favorites Tool Hep oo item 16 of 35 || | ~ A125] eee s 1 |[= A 19-yeorht RSNA ERUERUSUERARNART ing froma vacation in Ternesace witha ever of 38.90 x (103.19). She alsahas a severs hsadache and red conjunctvae. A counie of hour fer tho onset cf thes: symptoms, a rash appears on her oalms and soles. The physician diagnosis her with Rocky Mountain spotted fever. Which of the following statements is corset? A Rickettsia rickettsils a facultative intracellular paraste Rickettsia sickettsllis the largest bactaiurn knawn ©. Cold antibody agglutination is a classic nding for rickettsial infections D.She should prompty be treated with doxycycline E.The bacteriunt is spread by the tsetse ty Explanation The correct answer is D. Rocky Mountain opotted fever should promply ke vealed (oer befars confirrratary labaratary tact are in) with 2 tovracyeline (euch ac doxycycline} or chloramphenicol, as delay in antibiotic therapy can lead to death Ais not correct. Ricketts rickettsiis an obligate intracellular parasite that replicetes freelyin the cyionlasm, Bis not cotrect.Ricketsie rickettsiis a stall, rod- to caccold-shaped, gram- negative bacterium the siz2 of a large virus, Cis not comect. Cold anthody agglulnation Is used to detect aycoptasrna infection The Weil-Felix eacton can delect a rickettsial Infection due to cress-reactng antigens from Proteus valgaris Eis not correct. ickotisia riokettairhas twe arthropod veciare, the tek Dermacentor anderson) and D. varishils. The tsatsa fy spreads Atican sleaping sickness: dl cone @ mene coo Bois)eno eet te eee i egnr pie ie Fle Edt Yew Favorites Tool Hep ab: 1841 [item 17 6135 | [lI v6) luau] Ses] (sium) ‘A 22-year-old man comes to the ptysician complaining af diffcuty walking up the stairs because he"centcaich his breath” ray lm ofhie chest chows an onlargod hoarl and pulmonary edoma. A physical oxarnination reveals lowor fexcremity edema. The patient's history includas a racentl treated savers upper raspiratoy infection that did nat Fespandta antibiotics. The patient not diabetic, hypertansive, ar dyslinidemic, and all afi is farnily members are healthy. Which of the following is the mast likely cause of this oatent's symptoms? A. Haemophilus infuenzee pe B B Streptococcus preumanize C.Adenavitus D. Coxsackie B virus E.Respiratory syncytial vius Explanation @ mene eaeFle J bone Taok Hep a neem 17 095 | [> v IP al es) Explanation The correct answer isD. The patientis experiencing congesive hearttailure. Given his young age and lack oftisk fectors, a myocardils should be high on the diferent Half af ll viral cases of ryocardils ate caused by coxsackie B. Coxsackie 8, ar Icosshedral member ofthe Picorneviridae femly, can cause a variety of illnesses, including morinsitio, respiratory infoctano, anc opidemic. plouradynia, However, itis importante note thet while coxsackievirus 1s the most common cause, there ara many different agents thatcan cause myocardtis, including other vitusas (eo, adenavitus, Hl), bacteria (e0, Haemenhilus influenzae, Mycoplasma pneumoniae, streptococcal infections), arctozsa (Toxoplasmra end Trypanosoma cruz) and autoimmune ‘actors (Chagas' disease). Ais not correct. Haemophilus influenzae type 8 is 2 rod-shaped arart-neastive bacterium thats responsible for respiratory infectans end meningiis in childhood. it Is cutrertlyrecommended that all children recelve the Hib vaccine, which is emtectiv2 against his stain of bacteria, While ican b= associated wih infections or the heat is (1) not the most common cause of myocerdtis, and (2) bacterium, which would therefore respand to artibiaties Bis not comect.Steptocacous pneumaniae isa gram-positive diplacaccus and the mostcommon cause of lobar pheumania warkiwde While itcan be associated wih infections ofthe heat, tis (1) nat the most comman cause of myocarditis, and (2) a bacterium, which would therefore respond ta antibiotics, Cis not correct. Adencidal-pharyngesl-canjunetival viruses, also known as avenavilus2s, can cause acute upperresplratcry diseases, conjunctivitis, estiaentents, and nemartnagie cysts, While In rate cases it can oe associated ‘with Infections ofthe heart itis nol the most cornmon cause of myocatlls Eis not correct. Respiratery eyncyialvius io # cause of branchits in young children, butiteauses onlyrild dicoaco in adults @ mterne 2 ia 7seno eet te eee i egnr pie ie Fle Edt Yew Favorites Tool Hep fui: 2940 | nem sor 95 |[- [VI p4)[tn] Se.) (slim) ‘A 42-year-old man comesto the plysician because of a 2-day history of alow-arad fever. He also says that he has boon focling weak and tired recently. He saye tnatho went to tho dentictIsct woek, but did not cormplete the cource of prophyactic medication prescribed byhis dector prior tothe dentist sppoirtmant His physical ecamination is unremarkable except for 2 grade IV blawing systolic rrurmuy heard best atthe apex His Iaborataryfindings are significant fora mild anerria, Which ofthe falowing organisms is mostlikely responsible for this man's condition? A. Clostiidium dificil B Stapiviecoceus aureus ©. Staphylococcus epiternidio D. Stteptococcus mutans E. Stepiococcus pneumenize Explanation @ mene eaeTees ee CN eg ee Met theer ee ater re Cee et tet [) Fle Edt Yew Favorites Tool Hep =e [emis or95 | [> vp ese) Explanation The correct answer Is D.Steptecoccus mutans is a vitidans group stiepiocaccus Members of this graup of bacteria are known ta cause subacute bacterial endocarditis. After the bacieria gain ertiyinto the bloodstream, they seed the surface ofa previously damaged hoa valve, The becteria clowly pilo up and caus the slaw development of low-grade fovers, fatigue, anerna, and a new heart murmur. This patient most likely had nis mitral valve damaged by rheurnatic fever, for which his docter prescribed antibiotic prophylaxis before his dental procedure. Als not comrect.Ciostrisiurn oificle causes severe nonbloady dlanhea associated ‘with pseudomeribranes. tis associated wth orevioss antbiotic treatment. k does nct cause bacteremia and, consequently, is virualy unknown as a cause of endacerditis, Bs not cotrect.Staphyiococcus aureus causes acute bacterial endocarditis, which maniies's as acute onset of high ferey, alher Nu-lite syrnptoms, newron set murmut, and petechiae. &. aureusis acommon cause cfight'sided endocaiditis, which is aceosiaied wih intravenous druy aause. Cis not comect. Staphylococcus epicarmicis, a common skin lara, mostcamrranly ‘causes endacartitis nn prosthetic heart valves or right-sided valves in intravenous drug users: Eis not comrect.Streptccoscus pneumonigeis a rare cause of bacterial endacerdiis, inthe pestantbiatic era Gram-positive lab algorithm Gamstan dl cone @ mene coo Bois)Roo eet te eee Re tiger eg nO Macreee en ete Fle Edt Yew Favorites Tool Hep ain: 3080 (item 19 0135 (<<) [> [v6 )[i00] ses.) sila] ‘A 29-year-old man had a severe episode of ight upper quadrant pain with jaundice 2 years ego. Atthat tne his, - acpattata traneaminace level wae 1,200 [UML and hic alanina arninotrancforace level was 1,500 IUL. Ho admitod to having rnulliple sexual partners ane rarely using protection, His physician at attire thought that ne should he tested Tor hepatic B infection, but the patientrefused ane was last to follaw-up. He preserts ta the physician again now, ard is asymptomatic. What serological marker should be used to meke a ciacnosis of chronic non-realicative hepatiis B virus infection? A-HEV DNA BLHEsAg C.1g6 anti HBeAg D.1g6 anteHicy E.Igh antiHBcAg dl cone @ mene Gea == S aTees ee CN eg ee Met theer ee ater re Cee et tet [) Fle Edt Yew Favorites Tool Hep ae [rem 19.0135 |[<)[> [vy P=) es.) (sis) The correct answer is C. Regardless of whethar the virus is actively replicating or not, afler being exposed to herattis & virus the body will produce antibodies ayainst H8cég. During an active phase of disease, tne most dominant antibady wil be IgM ant -HécAg. However, as the patientprogresses ta a chronic state in which the vis Is dormant, the predominant serological marker is 1oG ant-HBcég. Ais not correct. HBV DNAs present only during active vral replication B ig not correct. The HBSAgis the surface antigen ofthe hepatitis Bvial rarkcle. tic produced only when completa vial particles are being pinduced, ie, during active Infection Therefore, the surface antigen would nothe detectable during the chronic dormant phase. Dis not comrect. IgG anti-HCV is a marker for hapalitis C infection, nat hepattis 8 infection. Ets not correct. igh art-HBcAg Is produsee during ect nection. Conversion ta predominantly gS ant-HEcag o:curs as the vitus becomes dormant and ind.caies pprorar chronic infection. [FIRST AID] Hepatitis serologic markers IgM HAVAb IgM antibody to HAY; best test to detect active hepatitis A, HBsAg Antigen found on surface of HBY: continued presence indicates carrier state, HPsAb Antibody to HBsAz; provides immunity to hepatitis B HBeAg, Antigen associated with core of HBY. iocheare HBeAb Antibody to HBeAg; positive during window period. IgM HBcAb isan indicator of dl cone @ mene coo Bois)Roo eet te eee Re tiger eg nO Macreee en ete Fle Edt Yew Favorites Tool Hep [; 3 | __ainares |item 20 0135 (-][D> [vf [ia5e.| SII 10 ‘A 33-year-old woman develops an enfhemetous, finely punctate, blanchable rash. The rash frst devsloas on her i trunkand mack. Within 3 day, t progracces to hor extrarities but spares tho face. Tha rach ie warea in tho eroases of A her aullae and groin. On physical examination, the physician notes a strawbarry-colored tongue, a baef-red 12 fropharymx, ard paleness around the mouth, Which of the following is the rast likely diagnosis? 18 i 15 16 x 10 19 20 = Explanation 2 8 m4 26 26 e 28 28 30 A Bacterial meningitis B Rubella ©. Scanet fever D.Sttepiocaccal phanngtis E.Tode shock syndrome 32 3 mu 36 Block End|* dl cone @ mene Gea == S aFle Edt Yew Favorites Tool Hep esas Ren 206135 [el Lv Eile Se (Sonim) 13 The correct answer is C. Scarlet fever is caused by Streptoececus pyogenes and is characterized ty a hpical sandpaper rash, strawbarry tongue, beefy-red pharynx and 14 circumaral pallor. As the rash heals, the skin peels off in fine scales, 15 a Als not correct. The signs of meninoitis are fever, headache, photophobia, auch 7 Hicidly, snd possibly seizures. This pallent does rotnave these symplorns, 10 Bis not comect. Rubela presents wih a prodrome of malaise and subaccipita ie lymphadenopathy. A maculopapular rach dovalope fit on the face and than generalizes and racolvasin 3-5 days. The patients rash is nat consistentwith 20 diagnas's of nibella x Pa Dis not correct. Inflammation, sxudates, fever, and fender cervical yh nodes characterize pharyngitis. While scarlel fever may cametimes camplicata cases of = primary Streptococcus pyogenes phaiynuitis, pharyngitis does not anpearto be a m4 prominent feeture o'this paricular presentetion, 2 Els not con ect.Stephyiococcus aureus anu Steptococcus pyogenestoxte shu! 26 syidiomes are characterized by abrupt onsel of local or difuse pain, fever, contusion, at and signs of saftissue in‘ection, The foiner is sometimes cout nat exclusively) 2 associated wih women using typoraasorbabla tampons during moncos, Adifluce 2 enthema that subsequently desquamates 25 the patient recovers maybe prasentin 29 10% af patients. It daes nat involve the symptoms described in the question. 30 3 # Streptococcus Causes PHaryngitis gives you pyogenes 1, Pyogenic—pharyngitis cellulitis, impetigo theumatic"PHever" and (group A Toxigenic—scarlet fever, toxieshock syndrome _glomeruloneP Hits. Block End * || A-hemolvtic Imminnhrie—thenmatic fever act No “thenm’ for SPECClation 36 dl cone @ mene coo Bois)Fle Edt Yew Favorites 8 40 4 2 18 i 15 16 at 10 19 20 x 2 8 m4 26 26 S 28 28 30 32 3 mu 36 2] bone USMLERx :: Your prescription to USMLE Success - Microsoft Internet Explorer Taok Hep an: 2044 [item 21/6135 |[ [D>] P=) uan] es] (sina 'A-79-year-old man develors a flu-like ilness 10 days after « trio to upstate New York. On physical examination, he hes. Iymphadonapathy and a ciccular, nenprurtio, esthemataus, rmacularrach on his laf arm. Ona red spatis particularly big and has a clear area in tha cantar. Which ofthe following statements is correct? A.A diagnosis oflate stage Lima disease is best made based on clinical presentation B. Entthema multforme isthe characteristic rash of Lyra diseace C. Lyme disease Is vest realed with @ nuoroquinclone D.The reservoir af Bonetia turgetcrfer'is the white-footed mouse E.Tha late stane, stage 3, of Lyme disease is characterzed by acute, aseptic meninatis, Explanation Block End|* @ mtene Ea a Baan)Fle 2] bone Edit vew Naseem Charterer nee Meare eee aie te eet Favorites Tools Hep 3 mu 36 Block End|* es Remar 36 [el [weil Se) (Sonim) The cortect answer is D. The whitz-footad mouse is the main reservoir of Borrelia burgdorfen The bacterium is spread ta hurnans by the fxodestick. Lyrne diszase has thiee charactensic stages. Stage 1 Is characterized by erythema chronicum migran's (ECW), enhralglas, andnonsaecine munike symptoms. Stage 21s marked ay te appearance of mulligle small ECM rashes, as well as cardiac and neurologic Inohement, Stage involves artis, usually ofthe large joints, and chronic, progressive cential nervous eysiem disease, Ais not correct. Eatly, localized Lyme is more reliably diagnased clinically (ie, on the basis of tik exnosure and rast) due to the delay in the deveinnment af antinodies Serologic tests for Lime are, however, paiticulerly helpful in evaluating patents for the later stages of Lyme disease Bis not correct. Enthems chronicurn migransis the characterise rash of Lyme disease It's circular, macularrash with a clear certer that sareads out over time. Cis not comect, Lyme disease can be treated witi eoxycycline or any antibiotic ram, the penicillin farvily Eis not comroct. Stago 2, not stago 3, of Lyme disoaco Ic chataciorized by nourclogic insoherent, including aseptic menincitis ard cranial naurepathies, such as Balls nalsy [FIRST AID) Lyme disease Gaused by Bonelia burgdorfen, which is transmitted 3 stages of Lyme diease by the tick hrodes Stage 1—erythema Classic symptom is erythema chronicum migrars, chronicum migrans, an expanding “bull's eye” red rash with central fluke symptoms @ mterne coo Bois)Roo eet te eee Re tiger eg nO Macreee en ete Fle Edt Yew Favorites Tool Hep [ss | e180 |item 22 oF 35 [-][D> [v/|[f=j[ia5 e| Bae 10 ‘The ascociation setwesn auioimmune diseases and the expression of certain cytokines hes prompled several - ij advances in pharmacotherapy. Which of the following is an accurate staternent regarcing tho drug tharapy of autoimmune ciseasa? 2 8 A.Adalimumab, a smthetic TNF-a analog, is indicated for mild rheumstatd arthitis, a disease associated ‘with an overexaression of TNF-o B.Anakinra, a manaclanal antitody againstthe interlaukin-1 receptor, is indicated for rheumatoid arth, a disease associated with an overexressicn of endogencus interleukin-1-recentor antagonist i 15 ff ©. Etanercept, a fusion protein of a TNF-« recestor and igCt1, I Indisated for theumatoid arihrtio, a at disease accostated wih en ovorexgrossion of TNF-2 19 D.Infibdmas, a monocional antioody against TNF-a, is indicated for systemic lupus erythematosus, a 49 uisease associated wih an underexpression of TNF-a 20 E.Infiximad, a synthete TNF- analog, is indicated for mmeumnatoid arthritis, @ disease associated wth an x overexpression of TNF-a 2 8 u Explanation 26 26 e 28 28 30 32 3 mu 36 Block End|* dl cone @ mene Gea == S aFle Edt Yew J bone Favorites Tools Hep 26 26 e 28 28 30 32 3 mu 36 Block End|* a neem 22 0195 | [>| v IP [a] es) Explanation The correct answer is C. ailof ihe facts in this statement are correct, Tumor ne:rasis Tactora (THF-0) s ¢ potent intammatry cytokine roundin ne‘eased amounts in the Serumn and synovial Nuld of people with meumetold arthis, TNF-« also promotes ine felease of olher pro-infammatory cytokines. Furthermore, rakes jogcal sense thal one would treat rheumatoid atthitis wth etanercept, a drug that can bind the excess TINF-1t and romoxo itvis an Ig@-mediatod immune responce. Ais not comrect, adalimumab binds and inhibits tumor necrasis factor-a (TNF-0); Ris sometimes prescribed far moderate ta severe cases of rheumatoid arthriis. tis not 2 synthetic TNF-a analog. Bis not comrect. Anakinra is a synthetic interleukin-1-reveptot artacorist, nat a manoclonal antibody. Rheumatoid arthrtis is associated with an under-expression ofendogenous interleukin-1-receptor antaganist (a, it causes an ecess of available Inlerleukin-l receptors), and thus some cases can be treated with anakinta, a synthetic interleukin-1-teceptar antagonist Dis not correct. Systomic lupus enthomatosus is ascociatod with an nderexprascion of umarnecrosis factor-a (TNF-«), buithis answer choice can be ruled aut by (1) knowing thatinfiximab is @ manaclonal antibody against TNF-a, and Q) realizing that ane would rot test an underexoression of TNF-a with an. antibody avainst TNF-a. Eis not correct. infiimab is @ monoclonal antibody against tumor necrosis factor (TNF-a), nota synthatic TNF-a analog. But inflidmab is indicated forthe treatment of Theumaioic artis, since tis a moncclanal antibody against TNF-t, which is overexpressed in meumatole arnt, @ mterne baci)Roo eet te eee Re tiger eg nO Macreee en ete Fle Edt Yew Favorites Tool Hep [; 3 | anos |item 25 0135 ([-][D> [v/||f[ia5e.| (su) 10 ‘A §5-year-old man cames to his physician with a tender, swollen, and erythematous left nee, He has limited range of ‘ation in hic log. On acpiratian of the synovial fd frem his knee, tho fluid io faundto be yollow ard cloudy and hac ak 150,000 neutrophilsirnn#. Gram stain afthe aspirate shawe gram-rositive cece’ in clusters. The organism mos’ 12 likely responsible far this patiants syroptarns balangs ta which genus? 18 i 15 16 x 10 19 20 = Explanation 2 8 m4 26 26 e 28 28 30 A. Babesia B Bacillus ©. Clstitur D. Pasteurella E. Staphylococcus 32 3 mu 36 Block End|* dl cone @ mene Gea == S aFle Edt Yew Favorites Tool Hep seo rem 25 0135 |[-<)[ |v fH Se) [sili] Explanation The correct answer is E. This man is suffering from septic arthriis, commonly characterized by a ewallan, tondor, and oythoratous joint. Tho organiem mast, commonly responsible for this infection is Sianhyiococcus aureus. The infection results fam the invasion ofthe bacteria info the synovial fluc). The diagnosis of sertic arhrtis requires the aspiration of the synovial fic, which appears yellow and turbid ‘with a predominance ofneutranbils. When Staphyiococcusis the causative agent, Gram stain and culture ofthe synowal uid show cram-positive cacc’ in clusters, Ais not correct, Septic arhriis is most commonly caused by Stephyfococcus aureus, ‘which Is notin te 82besia genus. Organisms within he Babesia genus are prctazaa and cause such iinesses as babesiosis, Bis not correct. Septic arhriis is most commonly caused by Stephy ‘Which io notin the Bacillus genus. Orrgariome witin the Baciis gen postive rode causing such ilnessae as anthrax. Cis not correct. Septic arhrtis is mast commonly caused by Stephviococcus aureus, ‘which is notin the Ciostricium genus, Organisms witiin the Ciostricium genus are joram-pesitve rods resporsible for such illness as tetanus and botulism, Dis not correct. Septic arhnriis is most commonly caused by Stephylococcus aureus, ‘which is not in the Pasteuresia genus. Organisms withinthe Pasteuretie genus are encapsulated, grarrnegative rods thal cause wound Infections assuciated with cal and dog bit [FIRST AID] Staphylococcus Protein A (virulence factor) binds Fey, inhibiting TSST is asuperantige dl cone @ mene coo Bois)Roo eet te eee Re tiger eg nO Macreee en ete Fle Edt Yew Favorites Tool Hep — (item 24 0135 ||| vf \[i5 SEL [si{r]im| ‘A 19-year-old woman preserts to the emergency department with malaise and a diffuse redrash over mostcther = body axcopi tho palms af harhande and the soles of hor fost. Physical axamination is romarkaalo for fover, tachycardia, elavsted respiratory rate, and orthastatic hypotension. No obvious signs of infection are found. The pafient reports that this is the second day at harmanstrual cycle. She denies alcahol use, diug use, ar recent exoosure te febrile individuals. The petient is immediately started on intravenous antibiotes and gradually mmoroves. Which ofthe follawing is the most likely causative agentin his patient’ condition? A. Clostridium pertringens enterotcxin B. Rickettsia rickets ©. Staphylococcus surous exotoxin D. Treponerna pettiourn E. Disseminated Steptyiccoecus aureus infection dl cone @ mene Gea == S aFle Edt Yew J bone Favorites 26 26 e 28 28 30 32 3 mu 36 Taok Hep weam24 0195 [<< [> [v= [too [eI The correct answer is C. Sacterialviral superantigens are proteins that bind'to the major histacompatiility comalex (MHC) class | molecule outside of the peptide -binding graave. They also bind to the V-B domain ofcertain T-ceil receptor (TCR) subsets, thus leading io tne ‘nonsgecine” activation of certain T-\ymahooyle subsets, Depending onthe superantigen, anywhere fiom 2%-20% of ali Tiymphacytes can be activated, Stazhylococcua aureus toxic ohack ayndrame toxn 1 (TSET-1) is ane of those cuporantigans, andit can additionally cross-link class Il molecules, leading to ddenditic cell and macrophage activatinn indapencent af tha MHC-TCR crass-linking, The massive T-lymphocyte activation leads to supraphysiologic production o cytokines, including interleukin (L)-1, tumor necrosis f 16, 1-12, and inlerferon-y Itis these cytokines that are most responsible forthe clinical symptoms ‘floc shock syndrome. Thus, the mostlikely cause ofthe menstruating female's, symptoms is a toxin released from S. auleus TSST-1 and not the bacterium tselt Als not correct. While Ciosticium pertingens enterotoxin s also a superartigen, plysical exarinetion revealed no signs of cuteneaus infections, and thus this, pathogen is less likely to be the causative agent. Aduilionally, the patient's symptoms Improved following Staphylococcus aureus antbiotic treatment, Bis not correct. In Rocky Mountain spotted fever, the fashis offen a prosenting symetom, butthis rash offen includes the palms and soles Dis not correct. in syphilis, the rash is often a presenting symptom, but this rash offen incluces the palms and soles. Eis not comrect. The clinical vignetie is most likely indicative of toxic shock syndrome, a result of 3 circulating staprylozoceal toxn and nat te oactenum itset.n fact, blood cullules ar most oten negative, I th's patients case, vaginal cullures may be positive for 8. aureus and may have been taken. Pe MIL FIRST SIDI @ mterne baci)Roo eet te eee Re tiger eg nO Macreee en ete Fle Edt Yew Favorites Tool Hep [; 3 | __a-sres |item 25 0135 ([-<][D> [v/||f[i25| | SII 10 ‘A 22-year-old man visits his college medical center comolaining of furlixe symptoms tat have persisted for about a i ‘wook Ho reports low. grade fovors, night sweats, 3 painful sore throat, headaches, and increasing fatiguo. Ho usod 10 A exercise § days awaek but ic no longer able to because af a "lack af aneray” Physical exarnination reveals eniargad 2 cervical Wmph nades and a spleen thet is pzlnable 2 inches below the leffcastal margin. Whatis the shucture afthe 13 virus that has infected this patient? 14 A. Linear, double-stranded, DNA virus with an envelope i i i ” 2 7 F 7 2 : B. Linear, double-stranded, DNA vitus without an enveloae ©. Lineer, double-stranded, RNA vitus with an enveloge D. Pattally circular, double-stranded, DNA vrus with an envelone E. Segmented, liner, single-stranded, negative-polarity, RNA virus with an envelope 32 3 mu 36 Block End|* dl cone @ mene Gea == S aFle Edt Yew Favorites Tool Hep jae rem 25 0135 |<) |v fH Se) [sili] [explanation | The cortect answer is A. The cvasion ce afinfacton ‘with Ensteinebaeviis (EBV), including He. Iymphacenapathy, and splenamedaly. EBV is a member ofthe herpes viral fernity with linear double-stranded, enveigned ONA. Hermes viruses are unique in hat itis the only virus that obtains its envelope via budding from the nuclear membrane. Bis not correct. Linear, dauble-stranded DNA withaut an envelope descriaes the adenaviluss. This virus Is mostly known for ccnjuncivits or "aink eye. itean also cause respiratory trect infections, hemnormagie cystilis, and gastruerierts Cis not correct. The only double-stranded RNA viuces known to infect humans are the reoviruces. Thoce includes coltvirus, which eaueae Colorads tick fever, and rofavirus, which causes gastinentertis. Rotavirus infectoinis the principal cause of falal diathea in children throughout the wntld. Colorado tick fevers transmitted via ticks caried br rodents and is found mast commonly it Dis not correct. Partially circular, double-stranded DNAwith en envelope describes the hepsdnaviruses. The man infectious pathagen in this family s hepatits 8 vius, Its main modes of transmission are blood and sexusl contact. This patient does net presentiwitn signs of hepatitis, Eis not conect. The aithonpoviruses are characterized by segmented, sinle stranded PNA with negative polariy and an envelope. The arincipal disease caused bythoce virusao '¢ influonza. Although thio pationt daoe hava fu-like oymptams, Iymphacenapathy and splonamegaly are not characteristic ofthe fu [FIRST AID| DNA viruses Viral Family | Favelope | DNA Strchite Medical Tmpartance Block End * z dl cone @ mene coo Bois)eno eet te eee i egnr pie ie Fle Edt Yew Favorites Tool Hep fb: 2048 | mem 26 or 95 |[- [vIf4)[txn] Se.) mame ‘A T-yearold girl with a vrel upper respiratory infection is broughtio the emergency departmentwith severe confusion, abdominal pain, vomiting, and ohydration. Hor broathing is dogo and rapid with afruty odor. The child's motior ates that she has heen crinking large quantitiae of water snd has had an increased appatte. An arterial bioad gas study shawe the fllowing resulis: pH: 7.25 Po2:90 mm Ho Peo: 30 mm Ho HoO3-: 18 me Based on the probable diagnosis, when ofthe tollowing Is the enlle's most ukey HLA tyae’ AHA BLHLA-BZT C.HLA-DQ2 and-Dos D.HLA-DR2 and-DR3 E.HLADR3 end-DR4 Explanation 2] bone @ mene eaeFle 2] bone Edit vew Naseem Charterer nee Meare eee aie te eet Favorites Tools Hep Block End|* eon [em 26 035 |) Lv IE )[n SEI (silaiim) The correct answer is E. This patientis in ketoacidesis due fo uncontrolled type 4 diabetoe molliue. The strase caused bythe viral uppor respiratory infostion Ikoly Increased her insulin raquirernants, ereciniating fatoreakdawn and ketoganesie. These are often the presenting avents of previously undiagnosed tyne | dahetes mellitus the patienthas a suaclnical disease thai becomes @clinical disease n the setting of an acut2 comortid illness, Signs snd symptoms of xetaacidasis include raid deep breathing (Kussmau’s respirations), nausealvamting, elsdorninal pain, hyperthermia, psychasis/cementia, ard deliydration.A fully odor to the breath hom the ketone oodies is commonly present, Lats demonstrate hynerglycernia, increased ketone levels, leukocytasis, anda metabolic acidosis. Type 1 diabetes melitus is associated wih HLADR3 and -DR&. Ais not cotrect. HLA-Ad is. essaciated with hemochramatosis, B ie not comect. HL8-£27 is associated wih a number af inflammatory conettions, including paoriacis, anlylasing spandyliis, Reiter's syndreme, and inflarnmnatory bowel disease Cis not comect. HLA-LQ2 and-DO8 are associated wih celiac disease Dis not comrect. HLA-0R2 and-DR3 are associated wih lupus, One ofthe most important complications of ype I diabetes. Uaully due toan T in ketoacidosis insulin requirements from an f in sires (eg, infection), Excess fat breakdown and 7 Lelogeness froin the fin fee faty acid, which are then, made into ketone bodies Signsymptoms —__Kussmaul respirations (rpi/eep breathing), hyperthermia, nauseafvomiting, abdominal bain, psvchovislenientia, dehydration, Fruity breath odor (due to exheled acetone @ mterne coo Bois)Roo eet te eee Re tiger eg nO Macreee en ete Fle Edt Yew Favorites Tool Hep [ps | __ eaten |item 27 ot 35 (-][ D> [v/|f=[i25|e.| (sin) 10 ‘A 20-year-old man presents tothe physician with a nontenderindurated mass over his mandible. He has had this, i mace for 4 menthe and decicedto same to the prycieian hocause tho mace ctarted te onze a thick yallow exudate. A Yellow cranulas are sean on microscopic examination of the discharge. Which of the following organisms is 12 responsible far this man's lesion? 18 i 15 16 x 10 19 20 = Explanation 2 8 m4 26 26 e 28 28 30 A Actinomyces israetii BNecardia asteraides ©. Prevetelta melaninogenica D. Staptyiococcus aureus E.Trchinella spraiis 32 3 mu 36 Block End|* dl cone @ mene Gea == S aUo ete Te au sn Maines en eee Cae eal ott le] Fle Edt Yew Favorites Tool Hep a= | item 27 of 35 Milles) [siieii=) ‘A 20-year-old men preserts ‘olthe shjsicianwith a hontenderinéurated mass over his mandible. He has had this mage for mentho ond decidedto same to the ptysician bocauso tno ted to 0020 a fhickyolow oxudato YYollow aranulae are seen on microscopic examination ofthe dlocharge. Which of the folowing organisme is responsible fortis man's lesion? 13 i 15 16 A Actinomyces israetii BNecardia asteraides ©. Prevetelta melaninogenica D. Staptyiococcus aureus E.Trichinella spwaiis 10 19 20 = Explanation 2 % The correct answer is A. The infection caused by Actinonaycee iaraetityricelly a prosonts a6 a chroric, slowly progiossing macs that oveniually ovoWos into a draining x sinus tract Characteristic sulfur granules ate seen in the thick yellow exudate 26 26 Bis not correct. Novardiasis is caused by Nocardia asteroids. This cisease begins yy asa respiratory infection followed by abscess and sinus tractformation. The organism coes notoroduce sultur granules butis often acid-fast, 28 29 Cis not comrect.Prevotetie melaninogenicais part cf the normal oral ora and is 5, mostcommonly responsible for aascess formation in the mouth, pharynx, rain, andl lung. Itdoes not produce sultr grenuies, 2 Dis not correct. Staphylococcus aureusccan alsa cause abscesses in various body 8 Javatione but is nat secociated with the pracenee of sullur granules. 4 Eis not correct. & persan in‘ected wih Trichinalla spiratis presents wih fever, 36 periorbital and fecial edema, mvalaia, and eosinophilia Block End|* dl cone @ mene coo Bois)Fle 2] bone Edit vew Favorites 8 40 it 2 18 i 15 16 x 10 19 20 x 2 8 m4 26 26 e 28 28 30 32 3 mu 36 Meee Taok Hep ae 10-2178 | mem 28 or 95 |[- [vpn] 2&2.) (siimia) ‘A 45-year-old man comes to the physician beceuse af a fever af 39.6° C (103.2°F) thai developed suddenly the previous night. On physical examination, the physician notes a new-onset murmur aleng wih whilo spcte on tho retina. The appearance ofhis hands is shown in the image. Which ofthe following organisms Is most likely responsible far this patient's syraptorns? Image courtesy of Inages. MD A Neissaria meningitices B. Staphylococcus aureus ©. Staphylococcus epidermiai. D. Stieptococcus pneumoniae E. Stepiococcus viridans Explanation Block End|* @ mtene Chia)Fle 2] bone Naseem Charterer nee Meare eee aie te eet Edt Yew Favorites Tools Hep 13 i 15 16 ‘if 10 19 20 x 2 8 m4 26 26 e 28 28 30 32 3 mu 36 Block End|* ae [eem2s 095 |[-< [> v Ie al ese) Explanation The correct answer is B. Staphylococcus aureus causes acuta bacterial encacartltis, ‘which presents with an acute onset ofhigh tever, cther Tu-like symptoms, new-onset, ‘murmur, petechiae, Roth's spots (white spots on the retin rormed by microemboln, Janeway lesions (psinless macules on the pais of soles), Oslers nodes (strall, painful nodules on the pads ofthe fingers or toes), and nai-bed (subungual) hemorthages. The kacieria can attack healtyy vakes and resultin yegetatons that are much larger than those of subacute bactarial endocardis. Ais not comrect.Wveisseria meningiicis is not an etiologic agent cf bacterial endocarditis Cis not correct. Staphylococcus epicermiais mast commonly causes endocarcitis on prostetc heart valves or right-sided valves in intravenus drug users, Ds not correct. streptococcus peumoniae, particularlyin he postantibictc era, Is a much rarer cause ofhacterial erdocarditis, When it does occur, 5. pneymnoniae endocarditis s tically a secuela of pneumacoccal aneumaria Eis not comroct.Stroptecoscus viricans causes subavute bactorial endocarditis This disease presents with small vegetations an previcusly damaged valves The onset of symptoms is mare gradual, 45 competed to acute bacterial endocarditis. [FIRST AID) Staphylococcus Protein A (virulence factor) binds FelgG, inhibiting TSST isa superantigen that aureus complement fisation and phagocytosis, binds to MHC Hand Causes i ell receptor, resulting in 1. Inflammatory dsease—skin infections, organ polyclonal I-cell activation @ mterne baci)Roo eet te eee Re tiger eg nO Macreee en ete Fle Edt Yew Favorites Tool Hep [ps | a asso |item 29 ot 35 ([-][ D> [v/||f [i258] (sin) 10 ‘A 16-year-old hoywith sickle cell disease has complained of a weak rightles for the past 10 deys. He is unable to put i auch weight on i, On physical examination, the arga over the right tbia is founda 20 ewallen ang onthamatous A ‘The organism responsible for this patient's infection most likely has which ofthe following features thatmakes it 2 partcularlypathogenicy 18 i 15 16 x 10 19 20 = Explanation 2 8 m4 26 26 e 28 28 30 A Capsule B Flegella ©.Lack of cell wall D.Myealic acies E.Pil 32 3 mu 36 Block End|* dl cone @ mene Gea == S aFle Edt Yew J bone Favorites Tools Hep Block End|* we 29095 (> [vf [tl] ) The correct answer is A. Since sickle cell disease leads ta autcsplenactorry, ¢ condition inwhich Mbrosis results from repeated infarcts ofthe solesn due to acherence of sickled red tlood cells. The spleen is unable to perform ts normel functions, such as sequestering capsulated organisms, Since the spleen is the major defende’ againstthese oiganisms, patients without splenic function are susceptible to Infection by encapsulated organ'sms such es Staphylococcus aureus and Seltronelie tyohi The symploins suggest thal he buy fas asteomyelits orthe tbl, and the most important determinant af virulence in sickle cell patients with osteamyeliis is the presence ofa capsule. 8. sureusis the most common cause of ‘octocmyeliic in all roupe, but Salmonella actoomyalitis has a rarbeular accociaton ‘with sictle cell disease, and itis this assaciation that is aftan tected an tha USMLE Step 1 examination Bis not correct. The flagellum of Salmonella is indeed a vinulense facior that acts as an antigen that can be varied (antigenic variation or switching). However, itis not the presence ofthe flagellum that makes Salmonella more pathogenic in sickle cell patients C is not comect.sfycopiasna species are bacteria that lack cellwell and that most bflen cause pneumania (M. pneumoniae) or nonganacoccal urethritis (also Ureaplaams weelytcun), Dis not correct. Mycolic acids are foundin the outer cell membrane ofrnycosacteria Myeobacteria cancause esteomyaitc, but autasrleneciamy does nat pariculary rut sickle cell oatents at a higher risk Eis not correct. Piliare structures an sore bacteria that aid in adhesion host cells. @ mterne baci)Fie Edt Vow Fairies Tock Hep oO [eema0 or 35 [|v IE al ene) (siieji=) 10 ‘A 43:year-old homaseual man has ADS. His viral load wes well cantralled on highly active artiretroviral therapy a i (HAART) for 5 yosrs, but recontlyit has loon ricing. He comosto the prysietan bocause of ekin lasions, as shawn in A the image. Which of the following organisms most likely caused this lesion? 2 18 « i 15 16 x 10 19 20 x 2 A. Proumosyetis carini 8 B.cyomegalovirus m4 C.Hepatitis B 26 D Herpes simplax virus ype 26 e 28 28 30 Explanation nage cowtesy of ages. MD E.Human heipesviius 8 32 3 mu 36 Block End|* ej iconFle 2] bone Edit vew Naseem Charterer nee Meare eee aie te eet Favorites Tools Hep Block End|* ee | item 30 of 35 See ales) [siiei=) The correct answer isE. Human hersesvirus 8 (HHV-8) has recently been disccveredto be the causative agent of Kaposi's sarcoma ttis contracted through sexual contact, and tls Incidence is mach higher in the ommasexual community. Ais not correct. Pneumocystis carinlis an opaattunistic infection seen primariy in AIDS patients. t usually presents 2s s pneumenia and is conaled by provicing prophyecc antibiotles ta patierts aner thelr T-cell coun drops below zsuirnm3. Bis not correct. Cyiomegalovirus causes manorucleasis, pneumenia, and birth defects ranemitted congenitally, tic one of the viral causes of arth defecto, ToRCHeS is the mnaronic for this (Toxoplasmosis, Rudela, Cyfamegalovirus, Herpesaly, Syphilis) Cis not correct. Heoattis Bis a sexually tensmitec and blood-aome disease of he livar.it does not present with skn lesians. Dis not correct. Herpes simplexvrus tyge 1 is the cause af the common cold sore. It presents rast often inthe oral and perioral areas, athough itcan also intectthe genitals [FIRST AID] viruses Virus Associated cancer TINA Adult T-cell leukemia HBV, HCV Hepatocellular carcinoma EBV Burkit’s lymphoma, nasopharyngeal carcinoma HPV Cervical carcinoma (16, 18}, penilefanal HHVS (Kaposi's Kaposi's sarcoma, bedy cavity fluid Becell @ mterne coo Bois)Roo eet te eee Re tiger eg nO Macreee en ete Fle Edt Yew Favorites Tool Hep tip: 2677 | nemst or 95 |[- [vpn] Se.) (slim) ‘A 55-year-old man with a history ofviral hepatitis presents to his orimary care physician with complaints of early alialy, 2 10-Ib woight lose ovar 3 months, upper abcorrinal pain, and yollowing of hie ayes. Workup rovasie a macs Innis liver. Past infection wity which of the following vial hepatitidas is mostlikelyo resultin this patient's current presentation? r ; i i i > Ps - : : Z : A Hepaitis A B Hepaitis ©. Hepatitis D.Hepattis E-Hepaiitis 32 3 mu 36 Block End|* dl cone @ mene Gea == S aUo ete Te au sn Maines en eee Cae eal ott le] Fle Edt Yew Favorites Tool Hep ais rams or 35 [9 [> [IP jfn] | s\n jim) #-B&-year-ofd man witha history oral Repatits presents o hie oriman care onysician Witt Commolamt= ofeerly ~~~ inal pain, and yellowing ofhis eyes. Warkup reveals a mass in is iver, Past infection wit which ofthe following virl hapatides is mostlikely'o resultin this patients current presentation? 13 AHepailis A 14 B.Hepatitis 8 oe C. Hepatitis C i D. Hepatitis D : E.Hepatitis & 10 19 20 a E 2 ss The correct answer is C. This patient presents with classic symptoms of hepatocellular carcinoma, Approximately 10%-30% of people infected with hepatitis C 4 ‘will develon.cirhosis cf the Iver. Approximately 1%-6% of hese patients develog 25 hepatocellular carcinoma, Hepatitis Cis transmitted via olood or oload trensiusions a and, rarely, by sexual contact. 2 Als not cotrect. Hepattis Ais tiansmnitted wa he fecal-oral route and causes an 28 acute self-limited gastrointestinal infection, at Bis not correct. Hopattic Bic barernitted via blaod and cowual 30 cause chronic hepalitis. tis alsa linked to hepatocellular carcincrna, but much less x fen than nepatiis © & Dis not comrect. Hepattis Dis transmitted via oload and sexual contact. His a 3 dependentvirus thal requites hepatitis B confection in order tb be transrnitted to the 34 human hast el Ets not correct, Hepatitis |s transmnied va the ecaloral route ard has been linked Block End * || tu alas In pregnantwornen dl cone @ mene coo Bois)Roo eet te eee Re tiger eg nO Macreee en ete Fle Edt Yew Favorites Tool Hep [; 3 | ai zeae |item 32 0135 [-][D> [vf j[i25e| [sin] 10 ‘A 47-year-old woman fiom the Niddle East presents with general malaise and weighiloss. On physical examination, i the woman i found ta have hepatomegaly and splenomegaly. Blood samples are taken and show moderate anemia, A Macrophages containing amastgotes ar2 seen on histologic analysis. Which of the following parasites dees the 12 ‘wornan most ikely harbor? 18 i 15 16 x 10 19 20 = Explanation 2 8 m4 26 26 e 28 28 30 A. Babesia species B.Giaraia lamblia ©.Lelatmenie eanovani D. Plasmodium ovele E.Trchornones vaginalis 32 3 mu 36 Block End|* dl cone @ mene Gea == S aFle Edt Yew Favorites Tool Hep seas rem s2 0135 |[-<) [> |v fH Se) [sili] [expianation | The correct answer is C.Leishrmania donovani infection preserts wilh hepatomegaly and splenomegaly, malaise, anemia, and weightloss. L conovantis tansmitted via the sancfly. Microscopically, macrophages containing amastigotes are observed. Sodium ti edito treat L donovani infaction, Ais not correct. Babesia species infection preserts with a malariacike syndrome. Babesiosis is transmitted bythe Ixodes tick On mictastogic examinaton, ane abserves no red olaod cel pigment and the Maltese cross-appearing parasite Quinine is used to teat babesiosis, Bis not comrect.Giardia fambila invectionpresents wth bloating, latulence, foul -smaliing dlarthea, ane light colored tatty stools. G. ammbsia is trensmited Mia cysts in vale) (feva-oral ransmission). On microscopy, one obsenes teardiop-shaned trephozcites with a vaniral sucking disc or cyst, Metronidazole is used treat 2, Jambiiaintection, Dis not correct. Plasrnactium ovate infection has a 48-hour cyclic fever A unique feature of bath the P ovate and P. vivax organisms is that hey can form hynnazoites 26 that can remain cormant in the iver for long periads of time, anlyta resurface later. 2° ||| ets not comeet.7richomonas vaginatsis the cause ofvavints. Synploms af 8 vaginitis include a fouFsmeliing greenish discharge, itching, ane burning, T. vaginalis 28 istransmitted sewally. On microscopic wet mourt, cne finds traphczotes. 2H Metronicazole is used tp teat 7. vaginas inrection, 30 > | Gu) = ‘Medically important protozoa 4 38 | Organism Disease | Transmission Diagnosis | Treatment Block End|* dl cone @ mene coo Bois)Roo eet te eee Re tiger eg nO Macreee en ete Fle Edt Yew Favorites Tool Hep [7 3 | i zeos /item 35 ot 35 (-][D> [v/||fj[i25e| [sins] 10 ‘A 50-year-old man who recently returned from a trip to SoutieastAsia comes to the piysician with exquisitaly tender ‘and enlarged yah nades. He also coralsins offever, chills, and ganoral weaknacs, On prysioal exarnination, the : physician notes eschars and purpura on his right arm over the area where, according to the patient, alea had biten 12 hii 5 dys ago, Which af thefollawing oiganisms is mest likely responsible for this patient's symptoms? 18 i 15 16 x 10 19 20 = Explanation 2 8 m4 26 26 e 28 28 30 A. Babesia microti B. Bacillus anthracis ©. Lelatimenie ebnovani D.Trehinetia sprais E. Yersinia pestis 32 3 mu 36 Block End|* dl cone @ mene Gea == S aUo ete Te au sn Maines en eee Cae eal ott le] Fle Edt Yew Favorites Tool Hep en | item 33 of 35 SP Miiélales) (sium) ‘A 50-year-old man who recently returned from a trp to SoutieastAsia comes to the paysician with exquisitaly tender ‘and enlarged yah nades. He also comalsins offever, chillo, and ganoral weaknacs, On prysioal exarnination, the physician notes eechars and purpura an his right arm over the area whare, accarding ta the patient, alea had bitten him 5 dys aga, Which af the follawing oiganisms is mest likely responsible for this patient's symptoms? 13 i 15 16 if D.Trehinetia sprais 6 E. Yersinia pestis A. Babesia microti B. Bacillus anthracis ©. Lelatimenie ebnovani 19 20 = Explanation 2 % The correct answer is E. Yersinia pestiais he organism resporsitle forthe plague, Be also knewn as the Black Death. The Eaciarium can ko cproac bytleac. The ciceaso x develops ater 2-€ days af incubation and is charseterized by te presence of 26 euisitely ‘ender mph nodes called buboas 26 e 28 29 Bis not comrect. Bacillus anthraciscan cause cutaneous anthrax, which Is 5, characterized oy a painiess ulcerwith a black sao, at Cis not couect.seishmania conovanits transmitied thraugh the bile of @ sendy 2 and causes visceral leishmaniasis. This disease is characterized ky abdaminal pain 8 and cictanton, anaroxia, woight lose, and fever, 4 Dis not correct. 4 parcon infeciedwith Trichinelia spiratis aresents with fover, 36 periorbital and fecial edema, myalgia, and eosinophilia Alls not correct. abesia mieroi is transmitted to hurnans through the ile ofatick It causes a sickness similar to malaria with syrnptoms offever and anemia, Block End|* dl cone @ mene coo Bois)Roo eet te eee Re tiger eg nO Macreee en ete Fle Edt Yew Favorites Tool Hep [ps | a aoze |item 34 ot 35 (D> [v/||f=[i25e.| SII 10 ‘Ahelthy S-year-old boy sustains a deep puncture wourd in his Ie heel while playing in a junkyard. Hie father brings ij him to tho emnargancy department 2 days later whan ha notices thathic ccn appears quits il. On physical examination, the area around the puncture wound is warm, swollen, and extramelytender. A purulent discharge is 2 coming fom the wounc, The patent has a ternnerature of 207° ¢ (103.4"F), A Grams stain afthis discharge is most 13 likelvta shew which of re fallawing results? 14 AAcid-fast bacili i i i ” 2 7 F 7 2 : B.Coaqulase-negatve, gram-positive cocci in clusters ©. Ceagulese-positive, grarr-positive cozctin clusters D.Ondese pesitve, gram-negative baci E.Oxdase-negative, gram-negative bacill 32 3 mu 36 Block End|* dl cone @ mene Gea == S aFle 2] bone Edit vew Favorites Tools Hep Block End|* ee reemas 0195 |) [>| v Ie al es) [Explanation | Tho correct answer is C. This child most ikely has acute pyogenic osiaarnyalits This none infection is mare Ikey in children because the bloed supply ofthe eciptysis is separate tom that af the metaphysis, which is nct the case in adults and young infants. However, Staphyiococcus aureus is the predominant orgarism in ostecmyeliis regarcless of age. 8, aureus is a gram-positive caccus thatgrews in clusters and produces the erzyme coagulase. is worth neting that while puncture ‘wounds often necome infected with Ciosiridurn tetani, tne patient wauld present with tefany, particularly of his terparalis and masseter muscles (leading to the common name or. tetaniinfection. lockjavy. Ais not comrect. Acid-fast bacill such as Mycobacterium tuberculosis are found in patients with tuberculosis. Infection ofthe bone by tuberculasis is knowin as Pot's ddisesee, but ts usual presertation is veriabval osteomyelitis, Bis not comrect. Staphylococcus epidermicisis a coagulase-neyatve, gram-positive corcus that grows in clusters, It san be a cause ofosteornveltis buts most often associated wih prosthetic replacement Dis not correct. Pscucioronas aeruginesais an oxidase-cositve, gram-negative becillus, Pseudomonas asteormeltis is most often associated with inavenous drug use. Eis not comect.S2imoneiia species are oxidase-neative, granmneuative bscil Selroneile octeamyeltis is often associated with patients who have aickle cell disease, Staphylococcus Protein A (virulence factor) binds FelgG, inhibiting ‘TSST isa superantigen that aureus complement fisation and phagocytosis. Causes 1 IPadders binds to MHC Hand cell receptor, resulting in nobrclnnat Teall @ mterne baci)Roo eet te eee Re tiger eg nO Macreee en ete Fle Edt Yew Favorites Tool Hep [ps | et |item 35 0135 (D> [v/||f= [i258] (sins) 10 ‘A major prablem in hospitals is the risk ef needle sticks and the accidentsl transrrission ofhepaiftie C, hepatitis B, i and HIV to hoslth caro porconnal. Although differant circumetancos can make tho likolihood of infection higher oF A Jawer, its well known thatthe chance of infection taremrigsion fram a needla is net the came for aach ofthese 12 diseases. Fram greatest chance af infection taleast,which ofthe fellowing is the order af infection among these 13 three diseases? 14 ALHIY, hepatiis B, henatits C de B Hepatitis B HIV, nepatts C ff ©. Hepatitis B, hepatitis C, HV ’ D.Hepattis C, HV, hepattis B e E.Hepaiiis C, hepatitis B HV ” 2 7 F 7 2 : 3 : Block End|* dl cone @ mene Gea == S aTees ee CN eg ee Met theer ee ater re Cee et tet [) Fle Edt Yew Favorites Tool Hep — [nemas or | [> [vel esse) Explanailon The correct answer is A. One has upto 4 20% chance of being infected with hepatitis B Faccidertaly stuck, vercus a 1.9%-0.45% change of boing infected vith Hv if aecidentally stuck Bis not correct. One has only 3 0.3%-0.45% chance ofbeina infected wit HIV t accidentally stuck, versus a 10% chance of infection f stuck with a hepatitis C- infected needle Cis not correct. The COC reports thet ifstuck ay an infected needle, there is up toa 30% chance of cantracting hepatitis B, while there is on¥y a 10% chance of contracting hepatitis ©. OSHA reports that ihe chence ot actually becoming Infected wih HIY i'you are accidentally sluck with a needle used onan HIV palientis between 0.9% and 0.45%, Dis not correct. One hasa 10% chance ofaeing infected with hepatitis C it accidentally stick, versus upta a 30% chance of infection stick with a hana infected needle Eis not correct. One has a 10% chance of being infected with hepatitis Cif accidentally stuck, versus upto a 30% chance of infection f stuck with a needle conteminatedwith hepatiis B HAV RNApicornavins) istransmitted primarily Hep A: Asymptomatic transmission by fecal-oral route, Short incubation (3 weeks (woully), Acute, Alone (n No carriers corriers;naked sRNA) HBV (DNA hepadnavinus) is transmitted primatily Hep B: Blood born by parenteral, sexual, and matemal-fetal routes, Block End|* Long incubation (3 months). Carriers, Reverse dl cone @ mene coo Bois)