Lecom B Micro One-Liners 2015

Front 1

1. Nausea, vomiting (onset < 6 hr) after eating cold cuts, or potato salad, or mayonnaise, or custards is caused by

Back 1

Staphylococcus aureus

Front 2

2. Rapid-onset food poisoning mediated by staphylococcal

Back 2

Enterotoxin

Front 3

3. Tx of staphylococcal food poisoning

Back 3

Rehydration

Front 4

4. Nausea and vomiting, +/- diarrhea (onset < 6 hr) after eating reheated rice is caused by

Back 4

Bacillus cereus

Front 5

5. Bacterial spores are resistant to heat due to

Back 5

dipicolinic acid core

Front 6

6. Nausea, vomiting, watery diarrhea w/ rapid (onset >6 hr) after eating reheated meat or gravy is caused by

Back 6

Clostridium perfringens

Front 7

7. Peptic-ulcer dz (PUD) in a patient w/o NSAIDs use is caused by

Back 7

Helicobacter pylori

Front 8

8. Helicobacter pylori attaches to gastric cells inducing

Back 8

inflammation and cytokines

Front 9

9. Abx treatment and H. pylori eradication significantly impact

Back 9

PUD and MALT

Front 10

10. First-line, triple-drug regimen for PUD due to H. pylori is

Back 10

PPI + clarith + amox

Front 11

11. Acute, severe secretory diarrhea, vomiting, severe dehydration, during travel to tropics, is caused by

Back 11

Vibrio cholerae

Front 12

12. Cholera (A-B, subunit) toxin induces secretion of Na and bicarbonate-rich non-inflammatory fluid from

Back 12

Small intestine

Front 13

13. Vibrio cholerae is isolated from stool by culture on

Back 13

thiosulfate-citrate-buffered sucrose (TCBS) agar

Front 14

14. Aerobic, gram negative, comma-shaped bacilli of cholera are microscopically similar to

Back 14

Campylobacter

Front 15

15. Tx to avoid mortality of cholera is

Back 15

Ringer’s lactate with extra K+

Front 16

16. Besides rehydration, treat cholera as soon as vomiting ceases with

Back 16

doxycyline

Front 17

17. Secretory diarrhea, fever and vomiting during travel are caused by

Back 17

Enterotoxic E. coli

Front 18

18. Secretory diarrhea w/ fatty, foul-smelling stools in campers, hikers; also day-care outbreaks is caused by

Back 18

Giardia lamblia

Front 19

19. Following ingestion of 15-25 cysts, excysted trophozoites adhere at brush border of enterocytes and contribute to malabsorption. TOW?

Back 19

Giardiasis

Front 20

20. Dx of giardiasis is confirmed by

Back 20

Stool antigen (+)

Front 21

21. Giardiasis is specifically treated with

Back 21

Metronidazole

Front 22

22. Protracted, secretory diarrhea w/ large fluid loss in AIDS is caused by acid-fast protozoa

Back 22

Cryptosporidium >> Cyclospora > Isospora

Front 23

23. Frank bloody diarrhea, after drinking roadside fruits drinks, is caused by

Back 23

E. coli O157:H7

Front 24

24. Pathogenesis of hemorrhagic enterocolitis caused by E. coli involves

Back 24

Shiga toxin (a cytotoxin)

Front 25

25. Complication of hemorrhagic enterocolitis in children

Back 25

hemolytic uremic syndrome

Front 26

26. Profuse diarrhea, fever, vomiting, and dehydration in infants is caused by

Back 26

Rotavirus

Front 27

27. Mechanism of rotaviral diarrhea involves

Back 27

Villus destruction

Front 28

28. Infantile watery diarrhea and fever are caused by

Back 28

Adenovirus 40,41

Front 29

29. Outbreak of nausea, vomiting, fever in adults is caused by

Back 29

Norovirus

Front 30

30. Cause of nausea/vomiting, abdominal cramps, diarrhea +/- bloody 12-48h after eating eggs or poultry or peanut butter?

Back 30

Non-typhoidal Salmonella

Front 31

31. Abx treatment of uncomplicated acute gastroenteritis due to Salmonella forces condition of

Back 31

carrier (in bile ducts) state

Front 32

32. Abx used only to treat septic phase of salmonella gastroenteritis is

Back 32

ciprofloxacin

Front 33

33. Cause of fevers (>103°), headaches; macular rash on torso (rose spots) abdominal pain and little diarrhea later in a pt with hx of travel (to tropics)?

Back 33

Salmonella typhi

Front 34

34. Cause of diarrhea w/ occult blood, abdominal cramping and fever, 2d after ingestion of poultry-contaminated salad

Back 34

Campylobacter jejuni

Front 35

35. Abx to treat campylobacter enteritis with high fevers in pregnancy, and HIV is

Back 35

Erythromycin

Front 36

36. Cause of dysentery-like illness with fever + abdominal cramps, tenesmus + blood & mucus in children?

Back 36

Shigella sonnei

Front 37

37. Dysentery due to invasive Shigella spp. in elderly is treated with

Back 37

Ciprofloxacin

Front 38

38. Cause of dysentery-like illness (+/- pseudoappendicitis) in the northern region after eating cheese

Back 38

Yersinia enterocolitica

Front 39

39. Cause of dysentery-like illness in a patient w/ hx of broad-spectrum abx use

Back 39

Clostridium difficile

Front 40

40. Clostridium difficile-associated diarrhea (CDAD) is mediated by toxins

Back 40

A (enterotoxin) + B (cytotoxin).

Front 41

41. Lab confirmation of CDAD is based on

Back 41

stool toxins A or B positive

Front 42

42. Besides rehydration and cessation of inciting meds, CDAD is treated with

Back 42

Metronidazole (mild) or oral vancomycin (severe/relapse)

Front 43

43. Health-care associated (nosocomial) spread of Clostridium difficile diarrhea and protracted outbreak is due to

Back 43

Soiling/contact or spores in rooms

Front 44

44. Hx of abdominal pain, tenesmus, stools with mucus + blood in a patient, who recently traveled to tropics; CBC: eosinophilia. TOW?

Back 44

Amebic dysentery

Front 45

45. Stool microscopy to confirm amebic dysentery should reveal characteristic trophozoites of Entamoeba histolytica w/

Back 45

endocytosed RBCs (distinction from luminal ameba)

Front 46

46. Rx of amebic dysentery involves

Back 46

Metronidazole + iodoquinol

Front 47

47. Abscesses in liver or peritonitis in travelers w/ or w/o hx of amebic dysentery is confirmed by

Back 47

Serology for E. histolytica

Front 48

48. A boar hunter develops dysentery after eating meat at campsite; O& P test should reveal a ciliate parasite, known as

Back 48

Balantidium coli

Front 49

49. Most likely cause of chronic abdominal pain, diarrhea; intestinal obstruction; cholangitis; liver abscess, in children

Back 49

Ascaris lumbricides

Front 50

50. Ova & Parasite test using microscopy for oval eggs (with a thick coarse shell) in stool confirms

Back 50

ascariasis

Front 51

51. A child has stomach ache, distended abdomen, poor appetite. Pearl-colored earthworm-like organisms in the stool. Major immune response against this infection?

Back 51

IgE

Front 52

52. DOC of ascariasis is

Back 52

Mebendazole

Front 53

53. Vomiting, cramping, diarrhea, epigastric pain, weight loss in an immigrant from developing country is caused by

Back 53

Strongyloides stercoralis

Front 54

54. DOC of strongyloidosis is

Back 54

Ivermectin

Front 55

55. Pt w/ AIDS (low CD4+ counts) develops pulmonary infiltrates (+eosinophilia) and/or gram negative sepsis. TOW?

Back 55

Invasive strongyloidosis

Front 56

56. Weakness, fatigue, lightheadedness, dyspnea, pruritis; pallor; iron- deficiency anemia; eosinophilia (hx of outdoor activity). TOW?

Back 56

Hookworm (Necator americanas) infection

Front 57

57. Fever, periorbital edema, subconjunctival hemorrhages, muscle weakness, and rash, after eating undercooked pork (Lab: eosinophilia., ↑CPK, ↑LDH &). TOW?

Back 57

Trichinellosis

Front 58

58. Abdominal pain, bloating, altered appetite after ingestion of sushi. CBC: megaloblastic anemia; leukocytosis/eosinophilia. TOW?

Back 58

Diphyllobothriasis (fish tapeworm)

Front 59

59. Dx of tape worm infection is confirmed by

Back 59

Proglottids in stool

Front 60

60. Tape worm infections are treated with broad-spectrum agent

Back 60

Praziquantel

Front 61

61. Cause of fever, lymphadenopathy, hepatosplenomegaly in an immigrant from Africa or Orient; pt recalls wading in stagnant water. RUQ ultrasound (+); CBC: eosinophilia.

Back 61

Schistosoma mansoni (Africa) S. japonicum (Far East)

Front 62

62. Microscopy of stool in chronic stage of schistosomiasis reveals

Back 62

Large eggs with lateral spine.

Front 63

63. Chronic stage of schistosomiasis is treated with

Back 63

Praziquantel

Front 64

64. Patient with acute jaundice is HAV IgM (+); household contact should receive for prophylaxis

Back 64

Inactivated HAV vaccine

Front 65

65. Patient with jaundice for < 1 week has HBsAg (+), Anti-HBc IgM (+). TOW?

Back 65

Acute HBV infection

Front 66

66. Multiple sex partners, IDU, infants born to infected mothers are risk groups for which hepatitis virus

Back 66

HBV

Front 67

67. This is an enveloped, double stranded DNA virus w/ ss-break; transmitted by infective body fluids. TOW?

Back 67

HBV

Front 68

68. This asymptomatic man has hep serology profile of HBsAg (-), Anti-HBs (+), Anti-HBc IgG (+), Anti-HBc IgM (-). TOW?

Back 68

Resolved hepatitis B

Front 69

69. This man has jaundice and is HBsAg (+) > 6 months, Anti-HBs (-), HBeAg (+), Anti-HBc IgG (+), HBV DNA > 20,000 IU/ml. TOW?

Back 69

Chronic active hepatitis B

Front 70

70. This man has jaundice and is HBsAg (+) > 6 months, HBeAg (+) and evidence of necroinflammation. He should receive

Back 70

Peg-IFN 2a + lamivudine(or cidofovir)

Front 71

71. This man has no jaundice, but HBsAg (+) >6 months, Anti-HBs (-), Anti-HBc IgG (+), HBeAg (-), persistently normal ALT. TOW?

Back 71

Inactive HBsAg carrier

Front 72

72. This man, at the time of annual physical exam, reveals Anti-HBs (+) and other markers are (-). TOW?

Back 72

HBV immunized

Front 73

73. Virologic confirmation of chronic jaundice in a HBV-immunized pt w/ IDU or hemodialysis is based on

Back 73

HCV RNA > HCV IgG

Front 74

74. More chronicity of HCV (than HBV) is due to immune-evasive quasispecies generated during replication (in blood) of

Back 74

error-prone HCV RNA virus

Front 75

75. Fulminant hepatitis in a patient, who has multiple sexual partners and is HBsAg (+); HBcIgM (-), can be fatal due to what?

Back 75

HDV superinfection.

Front 76

76. Cause of acute onset of jaundice, nausea, right-upper quadrant pain, hepatomegaly in pregnant women in India

Back 76

HEV

Front 77

77. Fever, arthralgia, carditis, polyarthritis, chorea, erythema marginatum; elevated WBCs or ESR/CRP. Clinical Dx is confirmed by

Back 77

Rising ASO titer

Front 78

78. Type II hypersensitivity due to molecular mimicry in a immunological sequel of streptococcal pharyngitis causes

Back 78

Acute rheumatic fever (ARF)

Front 79

79. ARF is diagnosed and treated with

Back 79

Anti-streptolysin O (ASO) titer and benzathine penG.

Front 80

80. A man with IDU has flu-like symptoms; 1-3 minor peripheral signs: conjunctival hemorrhage, Janeway lesions, Osler nodes, Roth spots, plus vegetation in tricuspid valve. Blood Cx (BCx) should yield

Back 80

S. aureus

Front 81

81. A pt w/ hx of extraction of impacted tooth 3 weeks ago now has subacute (native, mitral-valve) endocardits. BCx should yield

Back 81

Viridans streptococci.

Front 82

82. A pt w/ hx of St. Jude bypass 2 months ago has now subacute bacterial endocarditis. BCx should yield

Back 82

Staphylococcus epidermidis

Front 83

83. A pt with AIDS and recent hx of UTI has now subacute, native mitral-valve endocarditis. BCx should yield

Back 83

Enterococcus faecalis (or faecium)

Front 84

84. DOC of acute endocarditis in patient with IDU due to sensitive S.aureus (MSSA)

Back 84

Nafcillin +gentamicin

Front 85

85. DOC of acute endocarditis in patient with IDU due to resistant S. aureus (MRSA).

Back 85

Vancomycin + rifampin

Front 86

86. DOC of subacute, native mitral-valve endocarditits due to viridans streptococci.

Back 86

PenG +/- gentamicin

Front 87

87. DOC of subacute, prosthetic-valve endocarditis due to Staphylococcus epidermidis

Back 87

Vancomycin + gentamicin

Front 88

88. DOC of subacute, native mitral-valve endocardits due to Enterococcus faecalis (or faecium)

Back 88

High-dose ampicillin +gentamicin

Front 89

89. Patient with enterococcal bacteremia fails to respond to vancomycin. MOR of the organism

Back 89

D-Ala-D-Ala is changed to DAla-D-lac

Front 90

90. Hx of catheter-related endocarditis, involving prosthetic or native valves. BCx (+) for budding yeast. Pt does not respond to AmphoB or fluconazole; should receive

Back 90

Caspofungin

Front 91

91. Patient with colon cancer has bacteremia due to

Back 91

Streptococcus bovis

Front 92

92. Cause of febrile, malaise, arthralgia, dyspnea, edema, palpitations. ST/T wave change, heart block, dysrhythmias; CXR: cardiomegaly

Back 92

Coxsackievirus > echovirus >Trypanosoma cruzi (Chagas)

Front 93

93. Cause of runny nose, red throat, and nasal pus

Back 93

Rhinoviruses

Front 94

94. Rhinoviruses and enteroviruses belong to picornavirus family, but the rhinoviruses differ from enteroviruses on

Back 94

Growth at 22oC/noninvasive

Front 95

95. Rhinovirus receptor in the nasal passages and upper tracheobronchial tree is

Back 95

ICAM-1

Front 96

96. Rhinovirus, influenza, parainfluenza, coronavirus, RSV, metapneumovirus, and adenovirus all cause

Back 96

Upper-respiratory infections(URIs)

Front 97

97. Sinusitis, otitis, laryngitis, exacerbations of bronchitis and asthma are mostly secondary to

Back 97

Viral URIs

Front 98

98. In HEENT, Streptococcus pneumoniae, non-typable Haemophilus influenzae, Moraxella catarrhalis all cause

Back 98

Acute otitis media (AOM) & sinusitis

Front 99

99. AOM and sinusitis are empirically treated with amoxicillin + clavulanate. Why use clavulanate?

Back 99

Haemophilus and Moraxella are beta-lactamase producers

Front 100

100. Cause of pharyngeal pain, dysphagia, fever; red throat + purulent exudate that responds to penicillin

Back 100

Streptococcus pyogenes (aka: Group-A Beta-hemolytic Streptococcus = GABHS)

Front 101

101. GABHS is differentiated from GBBHS by what?

Back 101

Bacitracin sensitivity

Front 102

102. Common mode of acquisition of URI due to Streptococcus pyogenes?

Back 102

Infective droplets

Front 103

103. Major virulence factor with anti-phagocytic function of Streptococcus pyogenes

Back 103

M-protein fibrils

Front 104

104. Damage in posterior pharynx and tonsils due to Streptococcus pyogenes is associated with what host response?

Back 104

Pyogenic inflammation

Front 105

105. DOC of acute bacterial pharyngitis in a pt w/ Pen allergy

Back 105

Erythromycin > clindamycin

Front 106

106. Pyogenic complication of streptococcal pharyngitis

Back 106

Tonsillar abscess

Front 107

107. Toxigenic complication of streptococcal pharyngitis

Back 107

Scarlet fever >> TSS (rare)

Front 108

108. Immunologic complication of streptococcal pharyngitis

Back 108

Acute rheumatic fever (ARF)

Front 109

109. Cause of fever, red throat + purulent exudate - pseudomembrane with lymphadenopathy, in a pt w/ questionable immunization

Back 109

Corynebacterium diphtheriae

Front 110

110. Gram/special stain of Corynebacterium diphtheriae should reveal

Back 110

Gram(+) rods in palisade arrangements/metachromatic granules

Front 111

111. Virulence genotype of Corynebacterium diphtheriae is acquired by

Back 111

Transduction (phage mediated transfer of exotoxin gene)

Front 112

112. Isolate on tellurite agar culture of throat swab for a cause of diphtheria is confirmed by

Back 112

Immunodiffusion (ELEK) assay for toxin

Front 113

113. Mechanism of action of exotoxin of Corynebacterium diphtheriae

Back 113

ADP ribosylation of EF-2 (inhibits protein synthesis)

Front 114

114. Damage to pharynx and cardiac myosites due to Corynebacterium diphtheriae is mediated by

Back 114

Cytotoxicity of A-B toxin

Front 115

115. Virologic Dx of URI symptoms, fever; red throat + purulent exudate; hepato-splenomegaly, lymphadenopathy, in a teenager, is confirmed by

Back 115

heterophile antibody (+)

Front 116

116. Host cells preferentially infected by EBV are

Back 116

B cells

Front 117

117. EBV is biologically similar to what class of viruses?

Back 117

herpes viruses

Front 118

118. Host immune system controls the EBV infection, mediated by

Back 118

CD8+ T lymphocytes

Front 119

119. Rash occurs following which antibiotic(s) to treat infectious mononucleosis?

Back 119

amoxicillin

Front 120

120. Burkitt's lymphoma in some African population is a B-cell tumor due to oncogenesis by

Back 120

EBV

Front 121

121. B-cell tumor in the Oriental population that consumes preserved fish, is due to oncogenesis by

Back 121

EBV

Front 122

122. Heterophile-negative infectious mononucleosis syndrome is due to ?

Back 122

CMV

Front 123

123. Gram-positive bacteria that cause acute otitis media (AOM)

Back 123

Streptococcus pneumoniae

Front 124

124. Gram-negative diplococci bacteria that cause AOM

Back 124

Moraxellar catarrhalis

Front 125

125. Gram-negative coccobacilli bacteria that cause AOM

Back 125

Haemophilus influenzae

Front 126

126. > 7 days of nasal obstruction, rhinorrhea; purulent nasal drainage + frontal pain/tenderness is treated with

Back 126

Amoxicillin & Clavulanate

Front 127

127. DOC for acute mastoiditis in a young child is amoxicillin & clavulanate; why?

Back 127

Same etiology as AOM

Front 128

128. Cause of seal-like barking cough + episodic aphonia w/symptoms of URI in a child

Back 128

parainfluenza virus

Front 129

129. Gram-stain-nonreactive organism that causes redness; purulent discharge at lid margin/eye corners, in a newborn

Back 129

Chlamydia trachomitis

Front 130

130. Most common cause of redness; tenderness; hyperpurulent d/c; eye stuck shut in AM, lid edema. Gram stain (+)

Back 130

Staphylococcus aureus

Front 131

131. Cause of pharyngitis, conjunctivitis, fever with rhinitis, and cervical adenitis in a child.

Back 131

Adenovirus

Front 132

132. Cause of burning, gritty feeling in eyes; diffuse conjunctival injection & profuse tearing + preauricular LN.

Back 132

Adenovirus

Front 133

133. Cause of foreign body sensation, lacrimation, photophobia, conjunctival hyperemia, and ulceration

Back 133

HSV-2>>1

Front 134

134. Cause of severe pain and skin lesions in dermatomal pattern involving the ophthalmic division of the trigeminal nerve.

Back 134

VZV

Front 135

135. Cause of painful, swollen, red eyes, with conjunctival hemorrhaging and excessive tearing in an outbreak

Back 135

Enterovirus

Front 136

136. Cause of chorioretinitis in AIDS, but CMV antigen (-)

Back 136

Toxoplasma gondii

Front 137

137. Cause of painful keratitis, chronic corneal ulcers in contact

Back 137

Acanthamoeba spp.

Front 138

138. In an infant w/ ?immunization, 2 wks of paroxysmal coughs, inspiratory whoop + post-tussive emesis. TOW?

Back 138

Bordetella pertussis

Front 139

139. Pertussis toxin inhibits chemotaxis via downregulation of C3a/C5a receptor, resulting in?

Back 139

Lymphocytic leukocytosis in CBC

Front 140

140. Three major virulence factors of whooping cough pathogen?

Back 140

ADP-ribosylating toxin; tracheal cytotoxin; hemolysin

Front 141

141. Cause of fever + drooling, stridor, dyspnea in a child w/?immunization (pt appears septic)

Back 141

Haemophilus influenzae b

Front 142

142. Major virulence factor of Haemophilus influenza associated with pneumonia and meningitis

Back 142

Capsular polysaccharide (antiphagocytic and anti-C3b)

Front 143

143. Since, absent spleen places host at increased risk for invasive H. influenzae infection, pre-exposure prophylaxis prior to elective splenectomy is ?

Back 143

Hib immunization

Front 144

144. Cause of acute exacerbation (cough, purulent sputum) in pt with chronic bronchitis (COPD); CXR: R/O pneumonia; Lab: sputum reveals Gram-negative coccobacilli.

Back 144

Haemophilus influenzae (non capsular types)

Front 145

145. Tx of AECB, caused by an organism that needs NAD + hematin for growth; -lactamase (+), is

Back 145

Ceftriaxone (severe) >. Amoxicillin-clavulanate (mild)

Front 146

146. Most common cause of lower-respiratory infections in neonates (babies < 4 wk)?

Back 146

Streptococcus agalactiae (aka: group B streptococcus)

Front 147

147. Complicated illness in a newborn of a GBS-colonized mother is

Back 147

Sepsis or meningitis

Front 148

148. A mother colonized (recto-vaginally) w/ GBS is at risk for preterm baby or premature membrane rupture. She should receive

Back 148

Ampicillin

Front 149

149. An elderly comes up with an abrupt-onset fever, myalgia, headache, malaise, dry cough, sore throat and rhinitis, in winter. Illness could have been prevented w/ ?

Back 149

annual influenza vaccine

Front 150

150. Annual influenza vaccine protects at-risk subpopulation w/60% immune protection, and is composed of what 3 viruses?

Back 150

A:H1N1 + A:H3N2 + B

Front 151

151. Secondary spread of influenza occurs in a crowded setting (within 6 feet of infected person) via

Back 151

respiratory droplets

Front 152

152. Annual vaccine to prevent influenza is needed due to antigenic drift. This occurs due to what genetic mechanism?

Back 152

Mutation

Front 153

153. Occasionally serious pandemic of influenza occurs due to antigenic shift. This occurs due to what genetic mechanism?

Back 153

Reassortment of 8 genomic segments

Front 154

154. DOC of pts with influenza <48 hours is

Back 154

Oseltamivir

Front 155

155. Bacterial superinfection, causing pneumonia, after influenza occurs in elderly (in LTCF) due to what?

Back 155

S. pneumonia (common) > S. aureus (severe)

Front 156

156. A seriously ill young adult w/ necrotizing pneumonia, poorly responding to vancomycin, should get

Back 156

Linezolid

Front 157

157. Cause of febrile illness + bronchiolitis in an infant; BAL viral culture (+).

Back 157

Respiratory syncytial virus (RSV)

Front 158

158. RSV causes seasonal, nosocomial pneumonia outbreaks in the pediatric units via

Back 158

Contact spread

Front 159

159. Pathophysiology of asthmatic Sx + Sn in bronchioles in high-risk infants due to RSV involves

Back 159

type III hypersensitivity

Front 160

160. Inhaled anti-viral drug used in the sickest infants with bronchiolitis is

Back 160

Ribavirin

Front 161

161. Insidious onset of fever, dry cough, malaise and sore throat in young adults. CBC: anemia; CXR: diffuse infiltrates. TOW?

Back 161

Mycoplasma pneumoniae

Front 162

162. Dx of walking pneumonia in older children and young adults, while waiting for serology, is supported by

Back 162

cold agglutinin (IgM Ab against RBCs) titer 1:32

Front 163

163. Mycoplasma spp. is an atypical bacterial pathogen and is hard to grow because of fragility due to lack of

Back 163

Cell wall

Front 164

164. Beta-lactam abx is ineffective for Tx of mycoplasma pneumonia because

Back 164

Wall-less bacteria

Front 165

165. A male child with mycoplasma pneumonia now has systemic rash, covering 10% of his body. TOW?

Back 165

erythema multiforme (SJS)

Front 166

166. Cause of upper respiratory Sx, slow onset of cough (laryngitis) >2wks + CXR: patchy infiltrate, viral serology (+)

Back 166

Chlamydophila pneumoniae

Front 167

167. The most common cause of community-acquired pneumonia (CAP) is

Back 167

Streptococcus pneumoniae

Front 168

168. Cause of rapid onset of high fever, cough, & sputum, dyspnea; tachypnea in an elderly; CXR: lobar infiltrate; CBC: pronounced neutrophilic leukocytosis with left shift, is

Back 168

Streptococcus pneumoniae

Front 169

169. Gram-positive diplococci from sputum from a patient with lobar pneumonia yield α-hemolytic colonies and are confirmed by

Back 169

Capsular swelling (Quelling rxn)

Front 170

170. α-hemolytic colonies of Streptococcus pneumoniae is differentiated from viridans streptococci definitively confirmed by

Back 170

Optochin sensitivity

Front 171

171. Population w/ increased incidence of pneumococcal pneumonia is

Back 171

AIDS

Front 172

172. increased incidence of colonization of what organism is seen in very young and elderly, crowding, following viral URI (increased PAF receptors), fall/winter season?

Back 172

Streptococcus pneumoniae

Front 173

173. Streptococcus pneumoniae is transmitted P2P by

Back 173

Respiratory droplets

Front 174

174. Nasopharyngeal mucosal colonization is facilitated by

Back 174

IgA protease

Front 175

175. Streptococcus pneumoniae reaches lungs after nasopharyngeal colonization via

Back 175

aspiration

Front 176

176. Major virulence factor, facilitating invasion and dissemination of Streptococcus pneumoniae is

Back 176

Polysaccharide capsule

Front 177

177. Pneumococcal cell wall peptidoglycans, teichoic acid elicit

Back 177

Inflammation

Front 178

178. Increased Lung cell injury in pneumococcal pneumonia is caused by virulence factor?

Back 178

Pneumolysin (alpha-hemolysin)

Front 179

179. Multiple myeloma, C3 deficiency, asplenia - Hg SS, COPD, diabetes, alcoholism, smokers are risk factors for mortality due to

Back 179

pneumococcal pneumonia

Front 180

180. Hematologic marker for poor prognosis of pneumococcal pneumonia is

Back 180

Leukopenia

Front 181

181. Emipiric DOC of CAP in pts at risk or w/ comorbidity is

Back 181

Azithromycin (or levofloxacin) + ceftriaxone

Front 182

182. Pneumonia due to highly penicillin-resistant Streptococcus pneumoniae (Pen MIC >8) should receive

Back 182

moxifloxacin or vancomycin

Front 183

183. Mechanism of penicillin resistance in Streptococcus pneumoniae is

Back 183

PBP alteration by mutation

Front 184

184. Pt w/ agammaglobulinemia or asplenia or sick-cell anemia or ↓C3 should be vaccinated with

Back 184

Pneumococcal polysaccharide vaccine (PPSV: 23-valent)

Front 185

185. Hx: a patient w/ serious CAD now on a ventilator, acquires bronchopneumonia >72 hrs after hospitalization. TOW?

Back 185

Pseudomonas aeruginosa(VAP)

Front 186

186. Cause of necrotizing pneumonia >72 hrs after hospitalization of complicated viral illness

Back 186

Staphylococcus aureus (assume MRSA)

Front 187

187. Patients that are aspiration prone have hx of

Back 187

dysphagia, decreased consciousness

Front 188

188. Hx of a patient w/ seizure illness has fever, cough evolving over 2-4 wks; CXR infiltrate (+).TOW?

Back 188

Aspiration pneumonia

Front 189

189. Community-acquired respiratory pathogens that cause aspiration pneumonia

Back 189

Streptococcus pneumoniae > Anaerobes

Front 190

190. Hospital-acquired respiratory pathogens that cause aspiration pneumonia

Back 190

Gram-negative bacilli > S. aureus +/- anaerobes

Front 191

191. Clinical Dx of sudden dyspnea +/- cyanosis, fever, wheezing, often ARDS-like picture is

Back 191

acid-related pneumonia

Front 192

192. Bacterial etiology and Tx of aspiration pneumonia are determined by

Back 192

Gram stain (polymicrobic) and culture of sputum

Front 193

193. Empiric DOC of necrotizing pneumonia in a patient with seizure illness

Back 193

clindamycin + levofloxacin

Front 194

194. Targeted Abx for anaerobic aspiration pneumonia is

Back 194

clindamycin

Front 195

195. Pneumonia in homeless/alcoholics; Gram-positive diplococci in sputum Gram smear. TOW?

Back 195

Streptococcus pneumoniae

Front 196

196. Pneumonia in homeless/alcoholics; Gram-negative rods in sputum smear. TOW?

Back 196

Klebsiella pneumoniae

Front 197

197. Cause of pulmonary embolism in a pt with IVDU

Back 197

Staphylococcus aureus

Front 198

198. Common cause of pneumonia in pts with CF

Back 198

Pseudomonas aeruginosa

Front 199

199. Sputum of a patient with hospital-acquired pneumonia yields a Gram-negative rod that is oxidase (+). TOW?

Back 199

Pseudomonas aeruginosa

Front 200

200. Common cause of external otitis due to hot tub use is

Back 200

Pseudomonas aeruginosa

Front 201

201. A patient with diabetes has osteomyelitis after penetrating foot injury. TOW?

Back 201

Pseudomonas aeruginosa

Front 202

202. The most widely used anti-pseudomonal penicillin

Back 202

Piperacillin > imipenem

Front 203

203. The most widely used anti-pseudomonal aminoglycoside

Back 203

Tobramicin > gentamicin

Front 204

204. This pt >50 years, smoking hx, CMI↓ has pneumonia; diarrhea, renal failure. Urine antigen (+) for pathogen. Pt responds to azithromycin. TOW?

Back 204

Legionella penumophila

Front 205

205. Penicillin is ineffective against Legionnaire’s dz because

Back 205

Intracellular organism

Front 206

206. Individuals with defective CMI response has poor prognosis of Legionnaire’s dz because

Back 206

Intracellular organism

Front 207

207. Asymptomatic patient with PPD (+)

Back 207

Latent tuberculosis infection (LTBI)

Front 208

208. Cough > 2 wks, fever, night sweats, weight loss, hemoptysis, SOB; CXR: upper lobe infiltrate. TOW?

Back 208

Active Mycobacterium Tuberculosis infection

Front 209

209. Oral drug regimen of choice for treatment of active TB (aka: 1st line drugs) is

Back 209

INH+RIF+PZA+EMB (oral) + Vit B6

Front 210

210. Pyridoxine is added to 4-drug therapy for TB to prevent

Back 210

neuropathy (due to INH)

Front 211

211. Pt w/ TB fails to respond to 4-drug regimen w/ INH+RIF resistance because

Back 211

Multiply drug-resistant (MDR) TB

Front 212

212. Pt w/ MDR-TB fails to respond to INH +RIF+FQ+an injectable drug (amikacin, capreomycin, or kanamycin) because

Back 212

Extremely-drug resistant (XDR) TB

Front 213

213. Cause of TB-like Dz that does not respond to 1o TB Tx regimen, in a pt. w/ AIDS

Back 213

Mycobacterium avium –intracellulare (aka: MAC)

Front 214

214. Cause of chronic pneumonia in a patient with cancer, receiving cytotoxic chemotherapy; lung-CT: halo/crescent sign (+)?

Back 214

Aspergillus fumigatus

Front 215

215. Microscopic observation of Aspergillus fumigatus in tissue biopsy sections depends on staining by

Back 215

Silver stain

Front 216

216. Hx of chronic pneumonia w/ lung bpsy histopathology (+) for hyphae 2-4µm wide, septate, acute- angle branching. TOW?

Back 216

Aspergillus fumigatus

Front 217

217. Cause of TB-like LRI in a pt with outdoor activity (Giemsa stain of bronchoscopy specimen: (+) for 2-5 μm yeasts) is

Back 217

Histoplasma capsulatum

Front 218

218. Pt with AIDS has blood culture (+) for histoplasmosis. DOC has effects on

Back 218

Ergosterol in fungal cell membrane

Front 219

219. TB-like Dz w/ ulcerative skin lesions. lung bpsy histopathology (+) for large yeast w/ broad-based bud. DOC?

Back 219

Intraconazole

Front 220

220. Hx of acute onset of cough, fever, infiltrate in a black male with CMI↓; histopathology of lung (+) for a large sac of endospores. DOC?

Back 220

Fluconazole (indefinite)

Front 221

221. Pt w/ aspiration pneumonia with cervico-facial lesion should respond to

Back 221

Penicillin G

Front 222

222. Granular specimen from draining fistulae from a pt with LRI on anaerobic culture should yield

Back 222

Actinomyces israelii

Front 223

223. Pt with AIDS or organ transplant has indolent pneumonia, w/ or w/o CNS abscess or granuloma. TOW?

Back 223

Nocardiosis

Front 224

224. Organism w/ characterization of Gram-positive branching, beaded, filamentous rod, weakly acid fast is

Back 224

Nocardia asteroids

Front 225

225. Hx of non-productive cough, fever and dyspnea evolving over 2-4 wks. CXR (+): bilateral interstitial infiltrates, hypoxemia; ↑LDH, CD4 count <200/mm3 in a MSM. TOW?

Back 225

Pneumocystis pneumonia

Front 226

226. DOC of pneumocystis pneumonia (PCP)

Back 226

TMP-SMX

Front 227

227. Pt has urinary urgency, frequency, dysuria; lab: pyuria (+) or nitrite (+). TOW?

Back 227

Cystitis due to E. coli

Front 228

228. Significant UTI is confirmed by semiquantitative MSU culture based on the threshold of

Back 228

> 105 cfu/mL

Front 229

229. Mode of acquisition of uropathogen is

Back 229

Endogenous

Front 230

230. Microbial (structure) factor favoring bacterial persistence /colonization and UTI is

Back 230

bacterial binding via fimbriae

Front 231

231. Factor favoring bacterial persistence/colonization and UTI despite high osmolarity and urea concentrations and low pH is

Back 231

high bacterial growth rates

Front 232

232. Host factor favoring bacterial persistence/colonization and UTI is

Back 232

Urinary stasis

Front 233

233. Bacterial persistence/colonization and UTI despite frequent voiding and high urinary flow is favored by

Back 233

lack of Tamm-Horsfall proteins

Front 234

234. Pyogenic inflammation in complicated UTI due to Gram- negative bacteria is due to

Back 234

Lipopolysaccharide (LPS)

Front 235

235. Empiric DOC to treat community-acquired UTI in adults is

Back 235

ciprofloxacin

Front 236

236. The abx class that inhibits DNA gyrase or topoisomerase IV and blocks with bacterial DNA replication is

Back 236

Fluoroquinolones

Front 237

237. DOC to treat UTI in pregnant women is

Back 237

Nitrofurantoin

Front 238

238. Gram-positive bacteria that cause uncomplicated UTI in sexually active, young women are

Back 238

Staphylococcus saprophyticus

Front 239

239. Differentiation of Staphylococcus saprophyticus from S. epidermidis (both coagulase negative) is based on

Back 239

novobiocin resistance

Front 240

240. In elderly or pt with risks of urinary stasis, fever, chills, flank pain, and CVA tenderness; Lab: pyuria, casts, nitrite+. TOW?

Back 240

Pyelonephritis due to E. coli

Front 241

241a. Clue: GNR; fermenter; encapsulated; intrinsic ampicillin resistance)

Back 241

Klebsiella pneumoniae

Front 242

241b.Clue: GNR; slow fermenter; red pigment; intrinsic drug resistance)

Back 242

Serretia marcescens

Front 243

241c.Clue: GNR; swarming growth [very motile]; slow fermenter; intrinsic drug resistance)

Back 243

Proteus mirabilis

Front 244

241d.Clue: GNR; non fermenter; oxidase+, blue pigment; intrinsic drug resistance)

Back 244

Pseudomonas aeruginosa

Front 245

241e.Clue: GPC in chains; catalase-neg; grows in high salt; penicillin resistance)

Back 245

Enterococcus faecalis

Front 246

242. If a patient with complicated UTI is severely ill or not improving with therapy, do what rapid test next?

Back 246

renal ultrasound (to rule out urinary tract obstruction)

Front 247

243. For a patient with complicated UTI, once culture and sensitivity available, switch to what?

Back 247

Narrow-spectrum abx

Front 248

244. 2 or more of the following: fever (T>38°C) or hypothermia (T< 36°C), tachycardia (HR>90), tachypnea (RR>20), leukocytosis (WBC>12,000 or differential w/ >10% bands). TOW?

Back 248

SIRS

Front 249

245. SIRS + infection (e.g., positive blood culture) is

Back 249

Sepsis

Front 250

246. Sepsis + organ failure, decreased perfusion (lactic acidosis, oliguria, altered mental status) or low BP. TOW?

Back 250

Severe Sepsis

Front 251

247. Severe sepsis + hypotension despite fluids + lactic acidosis, oliguria, altered mental status.

Back 251

Septic Shock

Front 252

248. Septic shock due to Gram-negative bacteria (e.g., E. coli, Klebsiella spp., or Pseudomonas aeruginosa) is

Back 252

Endotoxic Shock

Front 253

249. Endotoxin that mounts pro-inflammatory cytokines, responsible for endotoxic shock, is

Back 253

Lipid A of LPS

Front 254

250. Genital chancre begins as a papule, ulcerates to form a single, painless, clean-based ulcer. TOW?

Back 254

1o syphilis

Front 255

251. Cause of genital chancre, begining as a papule, ulcerating to form a single, painless, clean-based ulcer.

Back 255

Treponema pallidum

Front 256

252. A pen-allergy, non-pregnant, female pt w/ fever, copper penny macular lesions on the palms or soles; RPR(+) should be treated with

Back 256

Doxycycline

Front 257

253. Management choice of tabes dorsalis (10-20yrs), iritis, uveitis, or Argyll-Robertson pupils of pen-allergy in a pregnant woman w/ pen allergy; RPR(+) is

Back 257

Desensitization

Front 258

254. Hx of painful clustered vesicles with an erythematous base; urinary retention in a promiscuous woman. TOW?

Back 258

HSV-2 >> 1

Front 259

255. Giemsa stain of fluid from a herpetic lesion should reveal

Back 259

Multinucleated giant cells

Front 260

256. Patient with genital herpes does not respond to acyclovir because pt is infected with

Back 260

thymidine kinase deficient HSV

Front 261

257. A pregnant woman with 1o symptomatic HSV-2 infection is at risk of her baby developing

Back 261

neonatal (congenital) herpes

Front 262

258. Cause of painful genital ulcers; purulent, grey base; painful inguinal adenitis, in a man with multiple sexual partners is

Back 262

Haemophilus ducreyi

Front 263

259. Fastidious organism in the infiltrate of the penile ulcer, co- localized with neutrophils and fibrin, in a pt w/ chancroid is

Back 263

Haemophilus ducreyi

Front 264

260. All sex partners of pt with chancroid, regardless of symptoms, should be examined and treated with

Back 264

Azythromycin > ceftriaxone

Front 265

261. New episode of purulent or mucopurulent endocervical exudate visible in the endocervical canal or on endocervical swab. Friability and bleeding may be noted after gentle passage of swab though cervical os. Test for:

Back 265

Chlamydia trachomatis and Neisseria gonorrhoeae

Front 266

262. New episode of purulent or mucopurulent endocervical exudate visible in the endocervical canal or on endocervical swab. Friability and bleeding may be noted after gentle passage of swab though cervical os. Test is

Back 266

Nucleic acid amplification tests (NAAT)

Front 267

263. Most common cause of mucopurulent endocervical exudate (Gram stain non revealing) in a sexually promiscuous woman

Back 267

Chlamydia trachomatis D-K

Front 268

264. Chlamydia trachomatis is an intracellular parasite which lacks

Back 268

Muramic acid (cell wall)

Front 269

265. Dx of mucopurulent urethral discharge, dysuria, penile pruritis is based on

Back 269

NAAT of urethral specimen or urine (+)

Front 270

266. DOC of most frequent cause of nongonococcal urethritis

Back 270

Azythromycin > doxycycline

Front 271

267. Cause of rare genital ulcers, inguinal lymphadenopathy [cytology(-) for multi-nucleated giant cells; RPR (-)] in men is

Back 271

Chlamydia trachomatis L1-L3

Front 272

268. Hx of systemic Sx/Sn w/ cervical motion tenderness in a woman with turbo-ovarian abscess. TOW?

Back 272

PID

Front 273

269. Cause of mucopurulent urethritis, dysuria, penile pruritis [Smear (+):Gram-negative diplococci co-populated w/ PMNs] is

Back 273

Neisseria gonorrhoeae

Front 274

270. Deficiency in serum factors in a female pt w/ frequent gonorrhea and DGIs is

Back 274

C6-C9

Front 275

271. Immune evasion of Neisseria gonorrhoeae in frequent mucosal infection is due to

Back 275

Antigenic variation of pili.

Front 276

272. Auxotrophic strains of N. gonorrhoeae with serum (complements) resistance are likely to cause

Back 276

Septic arthritis (aka: DGI)

Front 277

273. Most frequent complication of gonococcal (GC) infection in men

Back 277

Epididymitis

Front 278

274. Cause of bull headed clap, urethral stricture, prostatitis is

Back 278

Neisseria gonorrhoeae

Front 279

275. Urethritis is treated with ceftriaxone + azythromycin because

Back 279

Concurrent GC + Chlamydia

Front 280

276. Intra-amniotic infection syndrome, following rupture of membranes, without histological (neutrophilic inflammation of chorion, necrosis, micro-abscess formation, amnion basement membrane thickening) or microbiological confirmation, etiology is usually

Back 280

polymicrobial (2 or more)

Front 281

277. Intra-amniotic infection syndrome, following rupture of membranes, without histological (neutrophilic inflammation of chorion, necrosis, micro-abscess formation, amnion basement membrane thickening) or microbiological confirmation, Frequently recovered isolates from pre-term infant placentas (chorioamnionitis):

Back 281

Ureaplasma urealyticum, Gardnerella vaginalis.

Front 282

278. Along with gentamicin, a standard component of treatment for chorioamnionitis is

Back 282

Ampicillin

Front 283

279. Acute onset of intermenstrual bleeding in a non-pregnant woman, recent onset dyspareunia, lower abdominal pain or distension: crampy, fever, pain with bowel movements or constipation. Confirm by tests of

Back 283

Gram stain and culture of fluid from surgery (acute endometritis)

Front 284

280. Diagnosis of chronic endometritis is made by endometrial biopsy with histologic diagnosis based upon

Back 284

plasma cells, lymphocytes in endometrial infiltrate

Front 285

281. An older woman with PID and tubo-ovarian abscess receives ceftriaxone, azythromycin, and metronidazole because

Back 285

Polymicrobic (endogenous) infection

Front 286

282. Cause of anogenital warts w/ histology (+): koilocytes is

Back 286

HPV 6 and 11

Front 287

283. Cause of atypical squamous cells of undetermined significance (ASCUS) on pap smear w/ no clinical signs of infection is

Back 287

HPV 16 and 18

Front 288

284. Cause of koilocytotic cells and possible progression to squamous cell carcinoma

Back 288

HPV 16 and 18

Front 289

285. Next step to identify viral cause of ASCUS on pap smear w/ and further management in a woman of age > 29 years is

Back 289

Colposcopy > HPV DNA in bpsy

Front 290

286. Wet prep of vaginal discharge from a pt w/ vaginal pruritis; ectocervical erythema (strawberry cervix) should reveal

Back 290

motile tissue flagellate

Front 291

287. Clinical syndrome form replacement of normal peroxide- producing Lactobacillus spp. in the vagina with high concentrations of anaerobic bacterial (e.g., Mobiluncus sp and Prevotellasp), G. vaginalis, and Mycoplasma hominis is

Back 291

Bacterial vaginosis (BV)

Front 292

288. Gardnerella and/or Mobiluncus morphotypes in BV are seen with few or absent of

Back 292

Lactobacilli

Front 293

289. Gram stain of vaginal discharge w/ fishy odor from a pt w/ vaginal pruritis but no erythema and normal cervix (in BV) should reveal

Back 293

SECs stippled with Gram- variable organisms.

Front 294

290. DOC of bacterial vaginosis is

Back 294

metronidazole

Front 295

291. Wet prep of curdy discharge (no odor), adhering to vaginal walls, from a pregnant woman w/ recent UTI, who now has severe vaginal pruritis; vulvovaginal area - erythematous should reveal

Back 295

budding yeasts with pseudohyphae

Front 296

292. Normal commensal of skin, GI & GU tracts; endogenous overgrowth of budding yeast, capable of >10 diseases. TOW?

Back 296

Candida albicans

Front 297

293. Mechanism of action of a po DOC of vulvovaginal candidiasis is

Back 297

blocks C14 alpha-lanosterol demethylase

Front 298

294. Hx of flu-like illness, lymphadenopathy, maculopapular rash in a bisexual man. Lab: lymphopenia and transaminase elevations; monospot/all serology (-). TOW?

Back 298

Acute retroviral syndrome

Front 299

295. Time from infection (acquisition) to acute seroconversion detected by HIV serology (ELISA/ WBlot) is

Back 299

6-12 weeks.

Front 300

296. Hx of mononucleosis-like illness and lymphadenopathy in a man who has sex man. Serology (-). What is HIV viral load?

Back 300

>10,000 copies/ml

Front 301

297. Host-cell receptor for HIV-1 infection

Back 301

CD4

Front 302

298. Homozygous for deletions in what gene renders resistance to infection and some protection against progression.

Back 302

CCR5

Front 303

299. Host cells that trap HIV and mediate the efficient transinfection of CD4+ T cells are

Back 303

Dendritic cells

Front 304

300. A man, who practices sex with another man, has antibodies to HIV (ELISA and WB) but asymptomatic. TOW?

Back 304

Clinical latency

Front 305

301. What happens to HIV-1 virus when acute retroviral syndrome progresses to clinical latency?

Back 305

Virus continues to replicate low level.

Front 306

302. A man who practices sex with another man, is now HIV-1 serology (+) and has dual symptomatic infections/cancer (any two from below). Expected CD4+ count is? i. Candidiasis, esophageal, bronchi, trachea, or lungs ii. Cervical cancer, invasive iii. Coccidioidomycosis, extrapulmonary iv. Cryptococcosis, extrapulmonary v. Cryptosporidiosis, chronic intestinal vi. Cytomegalovirus retinitis (with vision loss) vii. Encephalopathy, HIV-related viii. Herpes simplex - Chronic ulcers ix. Histoplasmosis, disseminated or extrapulmonary x. Isosporiasis, chronic intestinal (duration >1 mo) xi. Kaposi sarcoma xii. Lymphoma, Burkitt xiii. Lymphoma, primary, of the brain xiv. Mycobacterium avium complex or Mycobacterium kansasii infection, extrapulmonary xv. Mycobacterium tuberculosis infection, any site (pulmonary or extrapulmonary) xvi. Pneumocystis pneumonia xvii. Progressive multifocal leukoencephalopathy xviii. Wasting syndrome due to HIV infection

Back 306

CD4+ < 200/microL

Front 307

303. A man with HIV infection has chronic diarrhea, oral thrush + toxoplasma encephalitis. Most likely CD4+ count is

Back 307

< 50 cells/microL.

Front 308

304. Most common cause of HIV- associated peripheral skin or mucosal ulcers

Back 308

HSV-1 (>> Histo > CMV > VZV > Syphilis)

Front 309

305. Most common cause of HIV- associated nodules (neoplasia)?

Back 309

HHV-8 (aka KSHV)

Front 310

306. Hx of fatigue, nausea, abdominal pain, diarrhea, fever, chills, night sweats, dry persistent cough w/ SOB and weight loss in a man with AIDS. Lab: PPD (-); blood culture (+) for AFB. TOW?

Back 310

Mycobacterium avium- intracellulare (MAI) complex (aka: MAC)

Front 311

307. Common cause of retinitis, viral pneumonitis or esophagitis in AIDS

Back 311

CMV

Front 312

308. Cases of CMV disease occur with immunosuppression level

Back 312

CD4< 50

Front 313

309. cytopathology of CMV infected tissue is characterized by large cells with

Back 313

nuclear (Cowdry owl’s eye) and cytoplasmic inclusions

Front 314

310. Hx of progressive CNS dz in a pt w/ AIDS: hemiparesis, visual, ataxia, aphasia, cranial nerves, sensory. Head MRI: ring- enhancing lesions. Toxo antibody (-). TOW?

Back 314

JC virus

Front 315

311. Definitive indication for initial HAART is CD4+ count?

Back 315

350/mm3.

Front 316

312. Objective of ARV Tx is to reduce viremia to what level of genomic RNA/mL

Back 316

< 50 copies RNA/mL.

Front 317

313. Initial regimen of anti-retroviral therapy is

Back 317

Emtricitabine + Tenofovir + Efavirenz

Front 318

314. Abacavir, emtricitabine, lamivudine, zidovudine, tenofovir belong to what class of antiretrovirals?

Back 318

NRTIs

Front 319

315. Efavirenz, nevirapine belong to what class of antiretrovirals?

Back 319

NNRTIs

Front 320

316. Atazanavir, Lopinavir, Saquinavir belong to what class of antiretrovirals?

Back 320

Protease inhibitors

Front 321

317. This drug binds to gp41 and prevents conformational change required for viral fusion and entry into cells.

Back 321

enfuvirtide

Front 322

318. This drug inhibits integrase, responsible for insertion of HIV proviral DNA into the host genome.

Back 322

raltegravir

Front 323

319. A man has AIDS and CD4 <200cells/μL or thrush. Antibacterial prophylaxis needed besides HAART is

Back 323

TMP-SMX (for PCP)

Front 324

320. A man has AIDS and CD4 <100 + pos toxo IgG. Chemoprophylaxis needed besides HAART is

Back 324

TMP-SMX (for Toxoplasma encephalitis)

Front 325

321. A man has AIDS and CD4 <100 + PPD >5mm induration. Antibacterial prophylaxis needed besides HAART is

Back 325

INH + pyridoxine

Front 326

322. A man has AIDS and CD4 <50. Antibacterial prophylaxis needed besides HAART is

Back 326

azithromycin (for MAC)

Front 327

323. Hx of fever, a pustule at a cat scratch site, adenopathy, hepatosplenomegaly in a pt w/ AIDS. Warthin-Starry stain tissue (+). TOW (clue: bacillary angiomatosis)?

Back 327

Bartonella henselae

Front 328

324. Leading causes of congenital infections are

Back 328

ToRCH3eS-List To = Toxoplasma gondii R = Rubella C = CMV H = HSV-2 H = HIV H = HBV S = Syphilis List = Listeria monocytogenes

Front 329

325. Cause of severe CNS sequelae, chorioretinitis, systemic disease in a neonate (mom at pregnancy had mono-like illness after eating undercooked beef or pork or exposure to oöcysts in cat feces) is

Back 329

Toxoplasma gondii

Front 330

326. Drug for pregnant woman in first trimester to prevent transmission of Toxoplasma gondii if mother seroconverts is

Back 330

Spiramycin

Front 331

327. Hx of deafness, cataracts, heart defects, or microcephaly in a child (of a seronegative, caregiver mom, exposed to Blueberry muffin baby in 1st trimester). TOW?

Back 331

congenital rubella syndrome (CRS)

Front 332

328. Dx of CRS usually with positive anti-rubella antibody type?

Back 332

IgM

Front 333

329. Microcephaly, seizures, sensorineural hearing loss, feeding difficulties, petechial rash, hepatosplenomegaly, or jaundice in a neonate. PCR of any body fluid should yield

Back 333

CMV

Front 334

330. After primary infection, CMV, characterized as enveloped dsDNA betaherpesvirus; establishes

Back 334

lifelong latency

Front 335

331. Hepatosplenomegaly, neurologic abnormalities, frequent infections in a neonate w/ low CD4+ counts. Woman before birthing should have received

Back 335

Nevirapine

Front 336

332. Cause of vesicular skin lesions + conjunctivitis in a child (asymptomatic at birth)

Back 336

HSV-2

Front 337

333. Hx of cutaneous lesions, hepatosplenomegaly, jaundice, saddle nose, and saber shins. Hutchinson teeth, + CN VIII deafness in a neonate (mom is a prostitute). TOW?

Back 337

3o syphilis

Front 338

334. Neonatal septicemia or meningitis (mom had flu-like Sx and ate imported cheese during pregnancy). TOW?

Back 338

Listeria monocytogenes

Front 339

335. What are the SIX red rashes of childhood (acute, febrile exanthema illnesses)?

Back 339

Measles, Rubella, Scarlet fever, Chicken pox, parvovirus B19, HHV-6

Front 340

335a. (Clue1: maculopapular rash; off-white lesions on buccal mucosa, MMRV vaccine prevents)

Back 340

Measles

Front 341

335b. (Clue2: maculopapular rash starting on face moving to foot; MMRV prevents)

Back 341

Rubella

Front 342

335c. (Clue3: scarlatina rash post pharyngitis)

Back 342

Scarlet fever (GAS)

Front 343

335d. (Clue4: vesicular rash, moderate pain)

Back 343

Chicken pox (VZV)

Front 344

335e. (Clue5: maculopapular slapped face appearance in a young child)

Back 344

Parvovirus B19

Front 345

335f. (Clue6: maculopapular rash and systemic Dz in immunocompromised pt)

Back 345

HHV-6

Front 346

336. Worldwide rubella infection, with only human reservoirs known this infectious agent is a

Back 346

RNA togavirus

Front 347

337. >95% seropositive after MMRV if >12mos age and lifelong protection against rubella is conferred with?

Back 347

Single dose

Front 348

338. Cause of single or multiple scaly and/or crusted patches and/or plaques, affecting the scalp or beard area +/- inflammation.

Back 348

Dermatophytes

Front 349

339. KOH prep of scales from the scalp and plucked hairs from cutaneous mycoses may reveal?

Back 349

hyphae and spores

Front 350

340. Most common cause of cutaneous mycoses

Back 350

Trichophyton spp.

Front 351

341. Common cause of cutaneous mycosis with animal contact

Back 351

Microsporum spp.

Front 352

342. Oral DOC of cutaneous mycoses

Back 352

itraconazole

Front 353

343. Topical DOC of cutaneous mycoses

Back 353

terbinafine

Front 354

344. Dz w/ subcutaenous lesions w/ slow spread by lymphatic system producing nodules in a gardener, or from rose-thorn injury.

Back 354

Sporotrichosis

Front 355

345. Cause of subcutaenous lesions w/ slow spread by lymphatic system producing nodules in a gardener, or from rose-thorn injury.

Back 355

Sporothrix schenckii

Front 356

346. Dimorphic fungus that grows at 37°C as cigar-shaped yeast, and produces septate hyphae and conidia (in daisy arrangement) at 25°C is

Back 356

Sporothrix schenckii

Front 357

347. DOC of sporotrchosis

Back 357

itraconazole.

Front 358

348. Cause of deeper and wider lesions with interconnecting subcutaneous abscesses arising from infection of several neighboring hair follicles, in young children.

Back 358

Staphylococcus aureus (Curbuncle)

Front 359

349. Cause of superficial pustules progressing to erosions covered by honey-colored crusts, surrounded by erythematous halo, in young children.

Back 359

Staphylococcus aureus >> Streptococcus pyogenes (non- bullous impetigo)

Front 360

350. Dz characterized by bullae and denuded areas after the blisters rupture, covered by thin, varnish-like light brown crusts; regional lymphadenopathy, in children. DOC if lab: gram stain and culture of pus or base of the lesions yields GPC in chains. DOC if lab: gram stain and culture of pus or base of the lesions yields GPC in clusters.

Back 360

Bullous impetigo/ Chains=Penicillin G/ Clusters=Nafcillin

Front 361

351. mecA (SCC) genes which encode PBP2a, w/ low affinity for β-lactams; confers resistance in Staphylococcus aureus against what?

Back 361

Nafcillin

Front 362

352. Cause of spreading (butterfly-wing) erythema on the face that responds to empirical penicillin.

Back 362

Streptococcus pyogenes (Erysipelas)

Front 363

353. Cause of severe pain on his knee w/ site of injury is tender and erythematous. Blood culture may yield?

Back 363

Streptococcus pyogenes. (Cellulitis)

Front 364

354. What is the microbial factor that promotes degradation of C3b by binding to factor H, the serum β globulin factor

Back 364

M protein

Front 365

355a. Causes of cellulitis Clue1: cat/dog bite. What?

Back 365

Pasteurella multocida / Capnocytophaga canimorous

Front 366

355b. Causes of cellulitis Clue2: Salt water exposure. What?

Back 366

Vibrio vulnificus

Front 367

355c. Causes of cellulitis Clue3: Fresh water exposure. What?

Back 367

Aeromonas hydrophila

Front 368

355d. Causes of cellulitis Clue4: Neutropenia. What?

Back 368

Pseudomonas aeruginosa

Front 369

355e. Causes of cellulitis Clue5: Human bite. What?

Back 369

Eikenella corrodens

Front 370

356. Most likely cause of fever/chills/ night sweats, localizing pain/tenderness or swelling/erythema (lab: ↑ESR, ↑CRP; ↑WBC w/ left shift. Radiology: periosteal elevation.) is

Back 370

Staphylococcus aureus (Osteomyelitis)

Front 371

357. Major antiphagocytic virulence factor of drug-resistant organism that causes osteomyelitis is

Back 371

protein A

Front 372

358. Major neutrophil-damaging virulence factor of drug- resistant organism that causes osteomyelitis is

Back 372

Penton-Valentine leukocydin

Front 373

359. Cause of vertebral, sternoclavicular or pelvic bone infections (in pt w/ IVDU) or osteochondritis of foot (following penetrating injuries through tennis shoes)?

Back 373

Pseudomonas aeruginosa

Front 374

360. Cause of osteomyelitis in pt w/ underlying sickle cell Dz; blood culture +)?

Back 374

Salmonella typhimurium

Front 375

361. Cause of chronic, vertebral osteomyelitis (blood culture negative)?

Back 375

Mycobacterium tuberculosis

Front 376

362. Cause of osteomyelitis in pt. w/ hx of cat bites; GNSR; fastidious growth of wound culture?

Back 376

Pasteurella multocida

Front 377

363a. Cause of fever, chills, malaise, joint pain, swelling. PE: tenderness, erythema, heat, swelling, decreased ROM. CBC: leukocytosis w/ neutrophils predominating; joint aspirate: no crystals. Clue1: sexually active; BLCx (-); responds to ceftriaxone Think of other pathogens (BLCx negative):

Back 377

Sceptic Neisseria gonorrhoeae

Front 378

363b. Cause of fever, chills, malaise, joint pain, swelling. PE: tenderness, erythema, heat, swelling, decreased ROM. CBC: leukocytosis w/ neutrophils predominating; joint aspirate: no crystals. Clue2: Rheumatoid arthritis?

Back 378

Sceptic S. aureus

Front 379

363c. Cause of fever, chills, malaise, joint pain, swelling. PE: tenderness, erythema, heat, swelling, decreased ROM. CBC: leukocytosis w/ neutrophils predominating; joint aspirate: no crystals. Clue3: IVDU?

Back 379

Sceptic S. aureus, P. aeruginosa

Front 380

363d. Cause of fever, chills, malaise, joint pain, swelling. PE: tenderness, erythema, heat, swelling, decreased ROM. CBC: leukocytosis w/ neutrophils predominating; joint aspirate: no crystals.Clue4: Unpasteurized dairy products

Back 380

Sceptic Brucella spp.

Front 381

363e. Cause of fever, chills, malaise, joint pain, swelling. PE: tenderness, erythema, heat, swelling, decreased ROM. CBC: leukocytosis w/ neutrophils predominating; joint aspirate: no crystals.Clue5: Diabetes

Back 381

Sceptic S. agalactiae (GBS)

Front 382

364a. Dz is characterized by arthritis in up to 6 joints (especially knees, feet), low back pain/stiffness, irritable eyes w/ or w/o redness, conjunctivitis, iritis, malaise. Clue1: sexually acquired

Back 382

reactive arthritis C. trachomatis, N. gonorrhoeae

Front 383

364a. Dz is characterized by arthritis in up to 6 joints (especially knees, feet), low back pain/stiffness, irritable eyes w/ or w/o redness, conjunctivitis, iritis, malaise. Clue2: non-sexually acquired

Back 383

Reactive arthritis Campylobacter, Salmonella

Front 384

365. Cause of bacteremia in neutopenic pts with central line or pts with prosthetic devices and catheters; blood culture (+)

Back 384

Staphylococcus epidermidis

Front 385

366. Cause of intraabdominal abscess w/ putrid pus; anaerobic bacteremia in pt with trauma or solid GI tumor?

Back 385

Bacteroides fragilis.

Front 386

367. A woman with obstetric infection has fever > 102oF, SBP <90; diffuse sunburn-like rash or desquamation of palms and soles; multisystem Sx/Sns; vomiting, and diarrhea; BLCx (-). TOW?

Back 386

Staphylococcal Toxic shock Syndrome

Front 387

368. What is the toxin associated with staphylococcal toxic shock syndrome?

Back 387

TSST-1 (a superantigen)

Front 388

369. Cause of severe, watery diarrhea in a woman with toxic shock syndrome?

Back 388

Enterotoxin (coregulated with TSST-1)

Front 389

370. Cause of toxic shock syndrome, which responds to vancomycin and clindamycin?

Back 389

MRSA

Front 390

371. Hx of fever > 38.9oC, SBP < 90 ; diffuse sunburn-like rash or desquamation of palms and soles, in a man w/ necrotizing fasciitis or myositis; multisystem involvement; BLCx (+). TOW?

Back 390

Streptococcal toxic shock syndrome

Front 391

372. What is the toxin associated with streptococcal toxic shock syndrome?

Back 391

SpeA (superantigen)

Front 392

373. DOC for streptococcal toxic shock syndrome

Back 392

PenG + clindamycin

Front 393

374. Hx of fever, chills, and hypotension. Blood culture yields a GNR, oxidase (-), lactose fermenting organism on MacConkey agar. Immunological mediators of sepsis.

Back 393

IL-1 and TNF

Front 394

375. DOC for a neutropenic pt w/ line-associated infection w/ immune suppression (hematologic malignancy, organ or hematopoietic stem cell transplantation, chemotherapy); w/ positive blood cultures and Beta-D-glucan antigenemia?

Back 394

Caspofungin

Front 395

376. DOC for a line-associated infection in a pt w/ GI tumor; lab: positive blood cultures and Beta-D-glucan antigenemia?

Back 395

Fluconazole

Front 396

377. Without prophylaxis with valganciclovir, D+/R- solid organ txp pts will develop

Back 396

CMV disease

Front 397

378. Cause of mononucleosis-like dz with fever, myalgia/ arthralgia w/ lab: leukopenia, LFT abnls, in a pt w/ solid organ transplant?

Back 397

CMV

Front 398

379. Lung biopsy reveals large cells with nuclear inclusions (Cowdry owl's eyes inclusion bodies) in a pt with AIDS and interstitial pneumonia. TOW?

Back 398

CMV

Front 399

380. DOC for CMV antigenemia in a febrile pt with solid organ transplant?

Back 399

valganciclovir

Front 400

381. Cause of hematuria, hemorrhagic cystitis, or ureteric stenosis, or interstitial nephritis in a severly immunocompromised pt?

Back 400

BK Virus

Front 401

382. What is the most common cause of bacteremia associated w/ foreign device (prostheses, intravenous cathether, or central lines) in co-morbid, hospitalized pts?

Back 401

Staphylococcus epidermidis

Front 402

383. What is the cause of infections associated w/ ventilator support of respiration in co-morbid pts in the ICU?

Back 402

Pseudomonas aeruginosa

Front 403

384. DOC for a pt w/ travel hx (back from the tropics), who has flu-like symptoms; splenomegaly; lab: CBC: anemia, thrombocytopenia, hypoglycemia. Blood smear: enlarged RBCs and Schuffner dots.

Back 403

mefloquine + primaquine

Front 404

385. Which drug is contraindicated in specific Tx of liver form of malaria in pts w/ G6PD deficiency?

Back 404

Primaquine

Front 405

386. DOC for a pt w/ travel hx (back from the tropics), who has flu-like symptoms (fever > 103o F), seizure, hyperparasitemia (>2.5% of RBC), pulmonary edema, or renal failure, or severe anemia?

Back 405

Quinidine and doxycycline.

Front 406

387. Cause of malaria-like illness in an immunosuppressed pt w/o travel hx; lab: blood smear has cross-over rings in the RBCs?

Back 406

Babesia spp.

Front 407

388. A pt from S. America has a week-long fever, anorexia, lymphadenopathy, mild hepatosplenomegaly, and myocarditis; a nodular lesion on the arm; blood smear should reveal

Back 407

Trypanosoma cruzi

Front 408

389. Cause of a chronic-stage systemic dz w/ cardiomyopathy, megaesophagus, megacolon, and weight loss in a pt from S. America, who does not respond to nifurtimox.

Back 408

Trypanosoma cruzi

Front 409

390. Cause of protracted fever and Crohn’s, celiac dz, ocular problems, and lymphadenopathy; duodenal biopsy demonstrating foamy macrophages in lamina propria?

Back 409

Tropheryma whipplei

Front 410

391. Painless papule (on arms, face, or chest), then vesicles/bullae, then black eschar + edema evolving over 3-5d is

Back 410

Cutaneous anthrax

Front 411

392. Unique features of cutaneous anthrax include edema, lack of pain and bullous fluid that lacks

Back 411

PMNs

Front 412

393. Cutaneous anthrax can be treated in 7-10 days with

Back 412

Ciprofloxacin

Front 413

394. Fever, chills, sweats, GI sx, cough, malaise, chest pain (3-4d); CXR: wide mediastinum and bloody pleural effusion is

Back 413

Inhalation anthrax

Front 414

395. CT scan in inhalation anthrax may show hyperdense mediastinal nodes and

Back 414

pulmonary edema

Front 415

396. Cultures of blood and respiratory specimens from in inhalation anthrax should yield

Back 415

Bacillus anthracis

Front 416

397. DOC of Inhalation anthrax is

Back 416

Ciprofloxacin or levofloxacin> doxycycline

Front 417

398. Need to treat inhalation anthrax 60 days because

Back 417

Spores persist in lungs

Front 418

399. 60 d total course recommended for any presentation anthrax to avoid

Back 418

relapse or breakthrough of incubation of spores

Front 419

400. Post-exposure prophylaxis to prevent inhalation anthrax also requires

Back 419

Cipro for 60 days

Front 420

401. Exposure (time & place to environment) + papule progressing to black eschar on exposed area in 3-4d +/- local edema, often intensely pruritic is

Back 420

Cutaneous anthrax

Front 421

402. Ciprofloxacin, levofloxacin and doxycycline are equivalent to treat cutaneous anthrax. All other abx are

Back 421

less effective

Front 422

403. In the event of an index case of anthrax (although infection is not P2P communicable), notify public health authorities and local

Back 422

infection control

Front 423

404. Infection control of all types of anthrax (based on non- communicability of the pathogen) warrants only

Back 423

Standard precautions

Front 424

405. Species of Clostridium that causes afebrile, systemic toxic diseases in infants (honey), and in adults foodborne (meat, canned vegetables), wound (injected), iatrogenic (cosmetic) is

Back 424

C. botulinum

Front 425

406. Differential diagnosis of botulism-like symptom/signs should include Myasthenia gravis, Stroke, Chemical Intoxications, Lambert-Eaton Dz, and

Back 425

Guillian-Barré

Front 426

407. Clostridia produces human pathogenic

Back 426

neurotoxins types A, B, E, F and G

Front 427

408. Many pts w/ flaccid paralysis in the same geography without common food source may be

Back 427

Bioterrorism-associated botulism

Front 428

409. CSF examination in botulism is

Back 428

Normal profile (no pleocytosis)

Front 429

410. Post lab confirmation of food botulism, while waiting for antitoxin may give

Back 429

activated charcoal

Front 430

411. Infection control of all types of botulism (based on non- communicability of the pathogen or toxins) warrants only

Back 430

Standard precautions

Front 431

412. Aerobic slender gram-negative rod, which causes glanders in horses, associated with bioterrorism is

Back 431

Burkholderia mallei

Front 432

413. Acute glanders caused by Burkholderia mallei may produce a localized infection with ulceration following inoculation in the skin; lymphadenopathy; lung infections may present as pneumonia. Acute bloodstream infections can be

Back 432

rapidly fatal.

Front 433

414. If Burkholderia mallei isolated suspect bioterrorism; Quarantine pt & give antibiotics:

Back 433

TMP-SMX or Imipenem

Front 434

415. Multiple cases of glanders: must consider

Back 434

bioterrorism.

Front 435

416. Patients with glanders should be isolated, respiratory precautions. B. mallei spread by

Back 435

aerosol.

Front 436

417. In the DDx of bioterrorism-related pneumonia + pleuritis + hilar adenopathy, include anthrax, plague and

Back 436

tularemia

Front 437

418. Small, pleomorphic, aerobic Gram-neg rod that causes 1) bite/abrasion (acquired from tick exposure or contact with rabbits) → nodule/ulcer → node → sepsis, or 2) inhalation (bioterrorism) → acute fever, dry cough. CXR: infiltrates + hilar adenopathy, is

Back 437

Francisella turlarensis

Front 438

419. DOC of tularemia is

Back 438

streptomycin

Front 439

420. For tularemia, if bioterrorism suspected, notify

Back 439

local public health

Front 440

421. Pathogen Francisella turlarensis does not have a person-to- person mode of transmission. Infection control does not require:

Back 440

Isolation

Front 441

422. Acute fever, myalgias, remorrhagic rash, conjunctivitis, pharyngitis, headache, diarrhea, and thrombocytopenia in bioterrorism indicates

Back 441

Viral hemorrhagic fever (e.g., Ebola, Marburg)

Front 442

423. For Lassa, Marburg, and Ebola, person-to-person transmission based infection control (respiratory) precautions and other measures must include:

Back 442

Patient isolation

Front 443

424. Endemic plague in the South West USA is acquired by bite of rodent flea carrying

Back 443

Yersinia pestis

Front 444

425. Aerobic, Gram-neg bipolar rod, which causes painful lymphadenitis (bubonic), fever, chills, headache (after exposure to rodents, rabbits or fleas) is

Back 444

Yersinia pestis

Front 445

426. Three forms of plague: bubonic (lymph nodes), pneumonic and the third:

Back 445

septicemic

Front 446

427. DOC of plague is

Back 446

Doxycycline

Front 447

428. Pneumonic plague can be transmitted

Back 447

from person-person

Front 448

429. Sudden fever ≥ 102°F , homogeneous vesiculo-pustular rash (unlike common viral exanthems) in multiple pts (in time and place) is

Back 448

Small pox, caused by variolla major virus

Front 449

430. Sudden fever ≥ 102°F , homogeneous vesiculo-pustular rash in multiple pts (in time and place) is, main diagnostic differential is

Back 449

Varicella or zoster

Front 450

431. For small pox associated bioterrorism, person-to-person transmission based infection control warrants isolation measures and

Back 450

respiratory precautions

Front 451

432. No person-to-person transmission are observed (other than standard precautions) for the bioterrorism agents:

Back 451

Anthrax, botulism (noncommunicable)

Front 452

433a. Fever, headache, neck stiffness, and altered mental status; Kernig's/Brudzinski's sign, rash; CSF: WBC > 2000 or PMNs > 1200; glucose < 34, protein > 220 CSF gram stain of the most likely pathogen of ABM in a 6 mos-6yr old (or adults > 50 years) should reveal

Back 452

Gram-positive diplococci

Front 453

433b. Fever, headache, neck stiffness, and altered mental status; Kernig's/Brudzinski's sign, rash; CSF: WBC > 2000 or PMNs > 1200; glucose < 34, protein > 220 CSF gram stain of the most likely pathogen of ABM in an older child or young adult should reveal

Back 453

Gram-negative diplococci

Front 454

434. Most common cause of sepsis/meningitis in newborns/neonates?

Back 454

Streptococcus agalactiae

Front 455

435. Cause of fever, headache, photophobia, nausea/vomiting, rash, diarrhea, meningeal signs, in older children in the summer months; CSF with 10-<1,000 WBC typical, mostly monos, moderately elevated protein?

Back 455

Aseptic meningitis (enteroviruses)

Front 456

436. Cause of aseptic meningitis in men with exposure to rodents?

Back 456

Leptospira interrogans

Front 457

437. Cause of aseptic meningitis with hx of tick bite and erythema migrans?

Back 457

Borrelia burgdorferi

Front 458

438. Cause of aseptic meningitis with hx of sex with multiple partners; CSF PCR(+):

Back 458

HSV-2 > 1

Front 459

439. Cause of fever, headache, photophobia, meningismus, in pts w/ solid organ transplant, malignancy, corticosteroid use. CSF glucose < 2/3 serum glucose, elevated protein, WBC > 5 with PMNs

Back 459

Listeria monocyotgenes

Front 460

440. How does Listeria monocytogenes differ from other - hemolytic bacteria

Back 460

Gram-positive rods; tumbling motility

Front 461

441. Cause of chronic meningoencephalitis in a pt, who uses infliximab or native from endemic region; PE: papilledema. CXR (+). Lab: elevated monocytes on differential, low CSF glucose?

Back 461

Mycobacterium tuberculosis

Front 462

442. Test to confirm subacute mengoencephalitis in a, immunocompromised pt (CD4 <100); vesicular skin lesions [CSF profile: protein 30-150mg/dl, monos 10-100]?

Back 462

CSF India ink

Front 463

443. Cause of meningoencephalitis after a hx of respiratory illness after travel to SW USA?

Back 463

Coccidioides immitis

Front 464

444. Test to confirm CNS pathology with fever, cognitive deficits, focal neurologic signs, seizures; temporal lobe involvement on MRI. Lab: no papilledema, CT (no brain lesion)?

Back 464

CSF PCR (+)

Front 465

445. Cause of fever, cognitive deficits, focal neurologic signs, seizures, abnormal mental status with ataxia, hemi-paresis, in a pt w/ AIDS?

Back 465

JC virus > HHV-6

Front 466

446. Cause of fever, cognitive deficits, focal neurologic signs, seizures or abnormal mental status with ataxia in an adult during outdoor activity?

Back 466

West-Nile virus > SLE

Front 467

447. Hx of fever, cognitive deficits, focal neurologic signs, seizures, in a pt w/ AIDS (CD4 < 50). MRI: multifocal (ringenhancing) lesions in basal ganglia. Rule out?

Back 467

Toxoplasma encephalitis (TE)

Front 468

448. HIV-infected Pt with TE should receive (for life)

Back 468

pyrimethamine + leucovorin + sulfadiazine

Front 469

449. Folinic acid (leucovorin) prevents bone marrow suppressive effect of

Back 469

Pyrimethamine

Front 470

450. Cause of confusion, stiff neck, irritability over wks to months, in immunocompromised pts; CT/MRI = multifocal lesions in midbrain, brain stem, & cerebellum; wet mount CSF = motile macrophage-like organisms

Back 470

Acanthamoeba spp. (GAE)

Front 471

451. Cause of severe headache and other meningeal signs, fever, vomiting, and focal neurologic deficits, frequently progressing to coma, in a healthy boy (summer diving activity)?

Back 471

Naegleria fowleri (PAM)

Front 472

452. Cause of seizures, chronic headache, symptomatic hydrocephalus, in immigrants; pt. successfully responds to praziquantel + anti-convulsant drug?

Back 472

Taenia solium (neurocysticercosis)

Front 473

453. Pt from Africa had fever, lymphadenopathy, chancre, and pruritus weeks ago; now has headaches, somnolence, neuro Sns; slowly responds to pentamidine isothionate or suramin. TOW?

Back 473

Sleeping sickness caused by Trypanosoma brucei

Front 474

454. Hx of rigidity, muscle spasm, and autonomic dysfunction. Trismus due to masseter spasm in an infant w/ umbilical stump infection. Neurotoxin interferes w/

Back 474

GABA and glycine

Front 475

455. Hx of afebrile illness w/ diplopia, dysarthria, dysphoria, dysphagia, in a pt w/ IDU skin poppers with black tar heroin. Neurotoxin blocks the release of

Back 475

Acetylcholine

Front 476

456. Immediate treatment of a male infant w/ constipation, a weak cry, and drooling, hypotonea and cranial neuropathy, after ingestion of home-processed honey.

Back 476

Equine immune globulin (infant botulism)

Front 477

457. Ingestion of a raw potato delivers a new vaccine protein to elicit an immune response. The immune structure to interact with the vaccine protein?

Back 477

Lamina propria mucosae

Front 478

458. Inflammation and the resulting increase in vascular permeability permit leakage into damaged or infected sites are effected by

Back 478

Phagocytic cells and acute phase proteins

Front 479

459. The serum of a pt, who has IgG and IgM deficiency, appears to fix complement in an assay for tetanus antibodies. What is the explanation?

Back 479

Activation of the alternate pathway

Front 480

460. A 3-year-old boy with genetic C3 deficiency has recurrent ear and lung infections due to pyogenic bacteria. Deficiency of what?

Back 480

B lymphocytes

Front 481

461. A very young child, w/ recurrent infections due to Staphylococcus aureus, now has numerous granulomas. TOW?

Back 481

Chronic granulomatous dz

Front 482

462. Treatment with which protease enzyme causes decrease in avidity of IgG w/o changing the specificity of the antibody?

Back 482

Papain

Front 483

463. Cells activated by both γ-IFN and CD40 are

Back 483

Macrophages

Front 484

464. High-dose chemo has caused severe bone marrow suppression in a pt with hematologic malignancy. Reversal is plausible with what?

Back 484

GCSF

Front 485

465. Function of the T-lymphocyte receptor (CD3) complex of transmembrane proteins?

Back 485

Signal transduction

Front 486

466. The MHC class I pathway presents an antigen directly to what?

Back 486

CD8+ T lymphocytes

Front 487

467. HSV infection can block the transfer of antigenic peptides from the cytoplasm to the ER of the infected cells. As a result of this, action of what cell type is compromised?

Back 487

CD8+ T cells

Front 488

468. Infection of the thyroid gland can induce the expression of MHC II molecules. Which cell types would initiate an autoimmune response, leading to Hashimoto’s thyroiditis?

Back 488

CD4+ T cells.

Front 489

469. PPD skin test (+) in a pt , who was vaccinated against turberculosis in his native country, reflects response of what cell type?

Back 489

CD4+ T lymphocytes (Th1 response  γ-IFN)

Front 490

470. A man with hx of MI is given a morphine injection for a new episode of chest pain; 10 mins later, he has itching and urticaria. Mechanism of this reaction?

Back 490

mediators from sensitized mast cells

Front 491

471. Loss of skin pigments, sense of touch, inability to feel objects and pain in a pt from Africa, whose skin scraping contains AFBs, is caused by

Back 491

Th1-mediated DTH reactions

Front 492

472. A man with polycystic kidney dz, who receives a renal transplant and cyclosporine, develops a high temp and swelling and tenderness in the grafted kidney. TOW?

Back 492

Immunity to the donor MHC antigens.

Front 493

473. A man who now has progressive stupor and laryngeal spasms for 3 days after pt was being attacked by a wild bat in a cave a month ago should have received

Back 493

Inactivated rabies virus vaccine

Front 494

474. Alternative and lectin pathways of complements activated

Back 494

bacterial surfaces

Front 495

475. Classic complement pathway is activated by antibody- antigen complexes involving antibody class type

Back 495

IgM >> IgG

Front 496

476. Chemotactic and anaphylotoxic complements are

Back 496

C3a, C5a

Front 497

477. successful opsonization of all non-encapsulated bacteria are by complement

Back 497

C3b

Front 498

478. Defect or deficiency of which complements predisposes individuals to infections caused by Neisseria spp., the causative agents of gonorrhea and meningitis

Back 498

C6-C9

Front 499

479. Antimicrobial (immune) response important for intracellular bacterial infections involves cell type

Back 499

Th1 CD4 T cells

Front 500

480. Immune response important for viral infections involves cell type

Back 500

CD8 cytolytic T cells

Front 501

481. Major antibody in secretions and plays a significant role in first-line defense at the mucosal level is

Back 501

IgA

Front 502

482. Main antibody in the initial primary immune response and allows good complement activation is

Back 502

IgM

Front 503

483. Fc region of this immunoglobulin binds to eosinophils, basophils and mast cells and is significant mediator of allergic (hypersensitivity) reactions

Back 503

IgE

Front 504

484. What on macrophages enables them to sense that the material is microbial in origin, and must therefore be eliminated quickly?

Back 504

Toll-like receptor

Front 505

485. These oxygen-dependent enzymes: NADPH oxidase, superoxide dismutase, and myeloperoxidase are involved in killing of what?

Back 505

Gram-positive bacteria

Front 506

486. These oxygen-independent enzymes/proteins: lysosome, lactoferrin, defensins and other cationic proteins are involved in killing of what?

Back 506

Gram-negative bacteria

Front 507

487. Infections persist, because m activation is defective, leading to chronic stimulation of CD4+ T cells in what dz?

Back 507

Chronic granulomatous Dz

Front 508

488. Defective respiratory burst, predisposing chronic bacterial infection is associated with deficiency of what?

Back 508

Glucose-6-phosphate dehydrogenase (G6PD)

Front 509

489. All nucleated cells express MHC I antigens

Back 509

HLA-A, B, C

Front 510

490. Antigen-presenting cells express MHC II antigens

Back 510

HLA-DP, DQ, DR

Front 511

491. Lymphocyte proliferation (T, B) and NK → cytotoxicity are undertaken by what cytokine?

Back 511

IL-2

Front 512

492. B-cell activation, IgE and IgG4 switch, ↓ TH1 cells/ M (phi), ↓ IFN-gamma, TH0 → TH2 are all undertaken by what cytokine?

Back 512

IL-4

Front 513

493. M activation; elevated expression of MHC and FcRs molecules on B cells, IgG2 class switching, increased IL-4 and TH2 are all undertaken by what cytokine?

Back 513

IFN gamma

Front 514

494. The Th1 response, driven primarily by IFN-gamma leads to the activation of

Back 514

macrophages

Front 515

495. The Th2 response, driven primarily by IL-4 and IL-5, leads to the production of IgE and IgG4 and to the activation of

Back 515

Mast cells and eosinophils

Front 516

496. Variable T and B cells in DiGeroge’s syndrome is associated with

Back 516

Thymic aplasia

Front 517

497. No B cells and immunoglobulins in X-linked agammaglobulinemia (Bruton’s) is associated with

Back 517

Loss of Btk tyrosine kinase

Front 518

498. Lack of anti-polysaccharide antibody and impaired T-cell activation causing Wiskott-Aldrich syndrome is associated with

Back 518

X-linked-defective WASP gene

Front 519

499. Inability to control B cell growth in X-linked lympho- proliferative syndrome is associated with

Back 519

SH2D1A mutant

Front 520

500. Glomerulonephritis, pulmonary hemorrhage in Goodpasture’s syndrome is caused by what autoantigen?

Back 520

basement membrane collagen type IV

Front 521

501. Hyperthyroidism in Grave’s Dz is caused by what autoantigen?

Back 521

Thyroid-stimulating hormone

Front 522

502. Progressive muscle weakness in Myasthenia gravis is caused by what autoantigen?

Back 522

Acetyl choline receptor

Front 523

503. Brain degeneration, paralysis in Multiple sclerosis (MS) is caused by what autoantigen?

Back 523

Myelin basic protein, proteolipid protein

Front 524

504. Localized allergies (e.g., drug allergy, asthma, hay fever) and anaphylaxis (food, drug) w/ systemic inflammation throughout circulation are associated with reaction?

Back 524

Type I hypersensitivity

Front 525

505. Autoimmune hemolytic anemia: Ab’s produced vs RBC membrane Ag’s, mismatched blood (transfusion rxn), and allergies to antibiotics (e.g., penicillins, sulfa drugs) are associated with reaction?

Back 525

Type II hypersensitivity

Front 526

506. Grave’s Disease, Myasthenia Gravis, Goodpasture’s syndrome are all associated with reaction?

Back 526

Type II hypersensitivity

Front 527

507. Post-streptococcal glomerulonephritis, serum sickness to horse diphtheria anti-toxin, systemic lupus erythematosis (SLE), and rheumatoid arthritis are all associated with reaction?

Back 527

Type III hypersensitivity

Front 528

508. Poison ivy, erythematous induration in tuberculin skin test, and transplantation/graft rejection are all associated with reaction?

Back 528

Type IV hypersensitivity

Front 529

509. Periodic acid Schiff (PAS) stain targeted at glycogen and mucopolysaccharides is used to diagnose

Back 529

Whipple’s disease

Front 530

510. For microscopic visualization, mycobacteria with highlipid-content cell wall requires

Back 530

Acid-fast stain

Front 531

511. Acid-fast bacteria (aka: mycobacteria) are visualized by microscopy using

Back 531

Ziehl-Neelsen stain

Front 532

512. Non-stainable bacteria that are considered atypical and intracellular may be detected by microscopy using

Back 532

Giemsa stain

Front 533

513. Rickettsia and chlamydia do not stain with Gram stain because they are

Back 533

Strictly intracellular

Front 534

514. Special culture medium required to grow Haemophilus influenzae is

Back 534

Chocolate agar w/ X (hematin) and V (NAD) factors

Front 535

515. Special culture medium required to grow Bordetella pertussis is

Back 535

Bordet-Gengou (potato) agar

Front 536

516. Special culture medium required to grow Corynebacterium diphtheriae is

Back 536

Tellurite or Loeffler’s agar

Front 537

517. Special culture medium required to grow Neisseria gonorrhoeae is

Back 537

Thayer-Martin (agar) media

Front 538

518. Special culture medium required to grow Mycoplasma pneumoniae is

Back 538

Eaton’s agar

Front 539

519. Special culture medium required to grow Mycobacterium tuberculosis is

Back 539

Lowenstein-Jensen agar

Front 540

520. Special culture medium required to grow Legionella pneumophila is

Back 540

Buffered charcoal-yeast- extract (BCYE) agar with iron and cysteine

Front 541

521. Growth/differential medium required to grow and differentiate Escherichia coli from non-sterile body fluid/tissue is

Back 541

MacConkey agar

Front 542

522. Growth/differential medium required to grow and differentiate Staphylococcus aureus from non-sterile body fluid/tissue (e.g., skin, abscesses) is

Back 542

Mannitol-salt agar

Front 543

523. Nutrient rich medium required to support growth of fastidious organisms (e.g., Streptococus pneumoniae, Neisseria meningitidis) from the sterile body fluid/tissue is

Back 543

Chocolate agar

Front 544

524. Special culture medium required to grow moulds or yeasts from a presumed fungal infection is

Back 544

Sabouraud’s dextrose agar

Front 545

525. Thee anaerobes, such as ABC (Actinomyces, Bacteroides, and Clostridium) organisms do not grow in presence of oxygen because they lack

Back 545

Catalase and superoxide dismutase

Front 546

526. The encapsulated bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Klebsiella pneumoniae, Streptococcus agalactae) are all virulent by virtue of the property of resistance to

Back 546

Phagocytosis

Front 547

527. Edema factor and lethal factor carried by protective antigen are associated with

Back 547

Bacillus anthracis

Front 548

528. A-B subunit toxin (plasmid encoded): ADP ribosylating activity is associated with

Back 548

Bordetella pertussis

Front 549

529. Neurotoxin toxin (prophage carrier) that caused flaccid paralysis is associated with

Back 549

Clostridium botulinum

Front 550

530. Enterotoxin A and cytotoxin B are syngerstically active in

Back 550

Clostridium difficile

Front 551

531. Phospholipase C and enterotoxin are non-synergistically (in different diseases) associated with various subspecies of

Back 551

Clostridium perfringens

Front 552

532. Peripheral neuro toxin causing spastic paralysis (carried in plasmid) is associated with

Back 552

Clostridium tetani

Front 553

533. A-B subunit toxin (carried in bacteriophage) causing inhibition of protein synthesis in target cells is associated with

Back 553

Corynebacterium diphtheriae

Front 554

534. Heat-labile toxin (LT, carried/coded in plasmid), heat-stable toxin (ST, also carried/coded in plasmid), and Shiga-like toxin (carried/coded in bacteriophage) are non-synergistically associated with various toxic strains of

Back 554

Escherichia coli

Front 555

535. Exotoxin A is associated with a pyocyanin-producing Gram-negative bacterial species:

Back 555

Pseudomonas aeruginosa

Front 556

536. Shiga toxin, an enterotoxin is associated with

Back 556

Shigella dysenteriae

Front 557

537. TSST-1, exfoliating toxin (carried in plasmid), alpha toxin

Back 557

Staphylococcus aureus

Front 558

538. Pyrogenic exotoxin SpeA, SpeC (carried in bacteriophage) and hemolysins O & S (general cytotoxins) are associated with

Back 558

Streptococcus pyogenes (know also: M proteins surface virulence factor)

Front 559

539. Gram-positive Cocci in pairs and chains are:

Back 559

o Streptococcus (Lancetshaped:Streptococcus pneumoniae) o Enterococcus o Peptostreptococcus (anaerobe)

Front 560

540. Gram-positive Cocci in Clusters are:

Back 560

o Bacillus (large; aerobe) o Clostridium (Box carshaped:Clostridium perfringens) o Corynebacterium (palisading; aerobe) o Propionibacterium (pleomorphic; anaerobe) o Listeria (small) o Nocardia (branching, filamentous, aerobe) o Actinomyces (branching, filamentous, anaerobe)

Front 561

541. Gram-negative Cocci are

Back 561

o Neisseria (diplococci: kidney bean-shaped) o Moraxella catarrhalis (diplococci) o Veillonella (anaerobe)

Front 562

542. Gram-negative Rods are

Back 562

o Enterobacteriaceae (E.coli, Klebsiella, Salmonella; Safety pinshaped: Yersinia pestis) o Pseudomonas o Bacteroides (anaerobe) o Fusobacterium (anaerobe) o Haemophilus (pleomorphic) o Brucella (coccobacillus) o Vibrio (curved) o Campylobacter (Seagull appearance) o Helicobacter (curved)

Front 563

543. Facultative intracellular bacteria are non-susceptible to β-lactam antibiotics and are commonly known species of :

Back 563

Brucella, Francisella, Legionella, Mycobacterium, Yersinia

Front 564

544. Non-envelope, icosahedral, smallest virus with linear single-stranded (ss-) DNA is

Back 564

parvovirus B19

Front 565

545. Non-envelope, icosahedral virus with circular double stranded (ds-) DNA (super-coiled) is

Back 565

papilloma viruses; JC, BK viruses

Front 566

546. Enveloped, icosahedral virus with incomplete, circular dsDNA is

Back 566

hepatitis B virus

Front 567

547. Enveloped, icosahedral virus with linear, ds-DNA is

Back 567

herpes viruses (e.g., HSV 1,2; VZV; CMV; EBV; HHV-6; HHV-8 (KSHV))

Front 568

548. Enveloped (Donut-shaped), largest virus with helical, linear, ds-DNA is

Back 568

smallpox

Front 569

549. Non-enveloped, icosahedral virus with linear, positivepolarity, ss-RNA is

Back 569

polioviruses; rhinoviruses; echoviruses; coxsackieviruses; enteroviruses; HAV

Front 570

550. Non-enveloped, icosahedral ('Star of David') virus with linear, positive-polarity, ss-RNA is

Back 570

noroviruses

Front 571

551. Enveloped, icosahedral virus with linear, positive-polarity, ss-RNA is

Back 571

HCV; dengue virus; yellow fever virus; West Nile virus; Japanese encephalitis virus

Front 572

552. Enveloped, icosahedral virus with linear, positive-polarity, ss-RNA is

Back 572

rubella virus; Eastern equine encephalitis (EEE) and WEE viruses

Front 573

553. Non-enveloped (Rota or wheel-shaped) icosahedral virus with linear ds-RNA (10 segments) is

Back 573

rotaviruses

Front 574

554. Enveloped, helical virus with linear, negative polarity, ssRNA (8 segments) is

Back 574

influenza viruses types A, B, and C

Front 575

555. Enveloped, icosahedral virus with linear, positive-polarity, ss-RNA (diploid) is

Back 575

HIV-1 and 2; HTLV-1 and 2

Front 576

556. Enveloped, helical virus with linear, negative-polarity ssRNA (3 segments) is

Back 576

Hantaan (Sin Nombre) virus

Front 577

557. Enveloped (crown-shaped virus), helical virus with linear, positive-polarity, ss-RNA is

Back 577

SARS Corona virus type 4

Front 578

558. Enveloped (bullet-shaped virus), helical virus with linear, negative-polarity, ss-RNA is

Back 578

rabies virus

Front 579

559. Enveloped, complex virus with linear, negative-polarity, ssRNA is

Back 579

Marburg and Ebola viruses

Front 580

560. Enveloped (largest RNA viruses), helical virus with linear, negative-polarity, ss-RNA is

Back 580

Paraifluenza viruses, Mumps, Measles, RSV

Front 581

561. Outbreaks of Acinetobacter infections typically occur in intensive care units and healthcare settings housing:

Back 581

Very ill patients

Front 582

562. People with certain health conditions, like weakened immune systems or chronic lung diseases (particularly cystic fibrosis), may be more susceptible to infections with

Back 582

Burkholderia cepacia.

Front 583

563. Burkholderia cepacia bacteria are often resistant to

Back 583

common antibiotics

Front 584

564. Diarrhea and fever are the most common symptoms of

Back 584

Clostridium difficile infection

Front 585

565. The most important risk for getting Clostridium difficile infection in health-care settings is overuse of

Back 585

antibiotics

Front 586

566. A family of Gram-negative bacteria that are difficult to treat health care-associated infections because they have high levels of resistance to antibiotics.

Back 586

Carbapenem-resistant Enterobacteriaceae (CRE)

Front 587

567. Carbapenem-resistant Enterobacteriaceae are

Back 587

Klebsiella species and Escherichia coli

Front 588

568. Gram-negative bacteria cause pneumonia, bloodstream infections, wound or surgical site infections, and meningitis in

Back 588

healthcare settings

Front 589

569. In medical facilities, MRSA causes life-threatening bloodstream infections, pneumonia and

Back 589

surgical site infections

Front 590

570. Community-acquired CA-MRSA isolates contain the virulence factor Panton-Valentine leukocidin (PVL) and carry

Back 590

staphylococcal cassette chromosome (SCC) mec genes

Front 591

571. Patients colonized (nare) with MRSA, in health-care settings are advised to use chlorohexidine, gluconate scrub, povidone iodine, and

Back 591

mupirocin ointment for 5 days

Front 592

572. Products that are used to remove soil, dirt, dust, organic matter, and germs (like bacteria, viruses, and fungi) are

Back 592

Cleaners or detergents

Front 593

573. Cleaners or detergents work by washing the surface to lift dirt and organisms off

Back 593

surfaces (so they can be rinsed away with water)

Front 594

574. Products used to reduce organisms from surfaces but not totally get rid of them (considered safe) are

Back 594

Sanitizers

Front 595

577. Chemical products that destroy or inactivate germs and prevent them from growing (also used after cleaning for surfaces that have visible blood or drainage from infected skin) are

Back 595

Disinfectants

Front 596

578. Disinfectants are regulated by the

Back 596

Environmental Protection Agency (EPA)

Front 597

579.Pruritus is the most common symptom of head lice infestation and is caused by an allergic reaction to bites by

Back 597

Pediculus humanus capitis

Front 598

580.Lice infestations (pediculosis and pthiriasis) are spread most commonly by

Back 598

close person-to-person contact

Front 599

581.The life cycle of the head louse has three stages:

Back 599

egg,nymph, and adult

Front 600

582. Nits, heads lice eggs, are laid by the adult female and are cemented

Back 600

at the base of the hair shaft nearest the scalp

Front 601

583.The egg hatches to release a nymph. The nit shell then becomes a more visible dull yellow and remains attached to the

Back 601

hair shaft

Front 602

584. Nymphs mature after three molts and become adults about

Back 602

7 days after hatching

Front 603

585. The adult louse is tan to grayish-white, about the size of a sesame seed, and has legs numbering:

Back 603

6 (each with claws)

Front 604

586.Treatment for head lice is recommended for persons diagnosed with

Back 604

an active infestation

Front 605

587.Apply lice medicine, also called pediculicide, using prescription medication(s):

Back 605

Benzyl alcohol, 5% or ivermectin, 0.5% or malation, 0.5% or spinosad 0.9%

Front 606

588.Body lice infestations (pediculosis) are spread most commonly by close person-to-person contact but are generally limited to persons who live under conditions of

Back 606

crowding and poor hygiene

Front 607

589.The only treatment needed for body lice infestations is

Back 607

Improved hygiene and regular changes of clean clothes

Front 608

589.The only treatment needed for body lice infestations is

Back 608

Improved hygiene and regular changes of clean clothes