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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
c. Surgical debridement with IV antibiotic
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 scan of the head reveals a
localized ring-enhancing lesion in the left hemisphere. The best
diagnostic step in this patient is:
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 presents to your clinic


with a 3 month history of increasing shortness of breath, productive
cough with yellowish sputum and weight loss with night sweats.
Attacks of hemoptysis are also noted. the best initial step in diagnosis
should be:
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 scan
showed a lesion in the left temporal lobe. LP revealed elevated
lymphocytes count, elevated protein, normal glucose and negative
gram stain. Xanthochromia was also noted on a background of
elevated red blood cell count. The next best action in this patient
should be:
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 scan
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