Infectious Disease 5

A 23-year-old female with a history of HIV infection presents to the emergency room with a history of dyspnea, fever and non-productive cough. On examination she has a respiratory rate of 24 breaths per minute, a pulse rate of 112 beats per minute, and a temperature of 101.2o orally. SaO2 is 90% on room air. Pulmonary examination is normal aside from the tachypnea. A chest x-ray shows diffuse infiltrates, and a CT scan shows “ground glass” infiltrates. Which of the following lab tests is likely to be elevated in this patient?

A 7-year-old female with a history of asthma presents with a history of asthma presents with a history of sores on her tongue for one week. The sores started approximately one week after she started taking inhaled budesonide for better asthma control. They are painful, but not interfering with her ability to eat. On examination there are thick white plaques on her tongue and soft palate. There is bleeding when attempts to scrape the plaques off the tongue. Which of the following is the most appropriate treatment for this patient?

A 38-year-old female with a history of AIDS presents to the emergency room with a complaint of dysphagia and odynophagia for three days. She also reports that she presently has an oral thrush infection for which her primary care provider has been treating her with nystatin troches. On examination there are numerous white plaques on her toungue, soft palate and buccal mucosa. The lesions scrape off, but the underlying tissue is friable and bleeds easily. Which of the following treatments is the most appropriate treatment for this patient?

A 3-year-old female presents with 3 days history of diarrhea. Her symptoms began with sudden onset of fever to 103.4o, headache, abdominal pain and vomiting. As these symptoms resolved she developed bile stained diarrhea which had some blood mixed in with it. Several children in her daycare center have had the same illness. On examination she appears tired, and has a pulse rate of 122 beats per minute. Her abdomen is soft and mildly tender to palpation. There is decreased turgor and delayed capillary refill. Which of the following is the most likely diagnosis?

A 2-month-old infant is brought in to the clinic with a complaint of a severe diaper rash. He is otherwise well. On examination there is a beefy red rash that involves the entire diaper area, including the scrotum and the perineum. The skin folds are not spared. The rash is well demarcated with a scalloped border and satellite pustules. Which of the following is the most likely cause of this rash?

A 4-year-old female is brought to the emergency room with irritability, lethargy and seizures.   Her parents report she has not had any urine output in the past 24 hours. They report that over the past week she has had vomiting for two days which was followed by watery diarrhea which had some blood in it. On examination she is pale, lethargic and has scattered petechiae on her skin. Laboratory evaluation reveals hemolytic anemia, thrombocytopenia and elevated BUN and creatinine.   Which of the following organisms is the most likely cause of this child’s illness?

A 2-week-old female is brought to the emergency room for inconsolable crying and refusal to feed for 24 hours. On examination she is crying, but not producing any tears, and has a bulging anterior fontonelle. A lumbar puncture is performed and the presumptive diagnosis of bacterial meningitis is made based on the results. Which of the following organisms is most likely to be the cause of the meningitis in this infant?

A 36-year-old female diabetic presents with recurrent candida vaginitis. The infections are occurring approximately 1 time every two months. Her diabetes is not well controlled. Pelvic examination is performed and the diagnosis of candidiasis is confirmed. Aside from better glucose control, which of the following treatments is indicated in this patient?

A 7-year-old male is seen in the emergency room and diagnosed with presumptive bacterial meningitis. On examination you note that he has a 4 cm linear abrasion on his left arm. There is significant erythema surrounding the abrasion and prurulent discharge coming from the abrasion. The epitrochlear and axillary lymph nodes on the left side are enlarged and tender. His parents report the abrasion is from a cat scratch. Which of the following is the most likely organism causing the meningitis?

A family of 4 presents to the emergency room with vomiting and diarrhea. They report that their symptoms started after they returned home from a picnic, where they were eating deli meat sandwhiches and potato salad. None of the patients have any fever or abdominal pain, and their examinations are unremarkable. Which of the following is the most likely organism causing their symptoms?

A 13-year-old female is seen in the emergency room for headache, photophobia, and fever for one day. On examination she appears unwell, has a blood pressure of 138/86, a pulse rate of 126 beats per minute, and a temperature of 103.8o. Papilledema is noted on funduscopic examination and there are positive Kernig’s and Brudzinski’s sign. A lumbar puncture is performed and is suggestive of bacterial meningitis. Pending culture results, which of the following treatment regimens should be intiated in this patient?

A 34-year-old female is being evaluated for abnormal liver enzymes. She has a positive IgM antihepatitis B core antigen (antiHBcAg) and a positive Hepatitis B surface antigen (HBsAg). Which of the following are these findings most consistent with?

A 17-year-old male is diagnosed with meningococcal meningitis. Which of the following medications is appropriate for the other members of his household?

A 48-year-old male with a history of AIDS presents with multiple reddish purple nodular lesions on his arms that have been slowly growing over the past several weeks. He now has developed a similar lesion on his hard palate. Which of the following organisms is the underlying cause of these nodules?

A 68-year-old male presents for evaluation of a painful rash on the right side of his chest for one day. He reports a burning sensation in the area prior to the onset of the rash. On examination you see vesicles on an erythematous base occurring in the distribution of the T7 dermatome on the right side. Which of the following treatments would be the most appropriate for the treatment for this patient at this time?

A six year old female is brought to the walk in clinic for evaluation of a rash on her face. She is otherwise well. On examination there are erythematous lesions to the nasolabial folds and perioral area which are covered with a honey-colored crust. There are no lesions elsewhere. The prevalence of community acquired methicillin resistant staphylococcus aureus (CA-MRSA) in the area is low. Which of the following treatments would be the most appropriate for this patient?

A 33-year-old female presents with a swelling on her right hand. She reports that it started out as a small papule while she was deployed in Iraq, and she thought it was an insect bite. Over time it has become enlarged. It is not painful, and she feels otherwise fine. On examination there is a 3 cm indurated, dry plaque on her right hand, which has a few satellite papules. There is epitrochlear and axillary lymphadenopathy. Which of the following is the most likely diagnosis?

A 34-year-old female who is 32 weeks pregnant presents with a complaint of fever, myalgias, arthralgias, backache and headache, within 48 hours of presentation she goes into labor and delivers her baby. On further questioning she reveals that she had been eating some soft cheese and deli meats at a party one week prior to her illness. Which of the following bacteria is most likely the cause of her illness?

A 14-year-old female who is currently undergoing treatment for acute lymphocytic leukemia has developed nasal congestion, facial pain, and bloody nasal discharge. Endoscopic examination of the nasal cavity reveals dusky and necrotic tissue. Which of the following is the most likely diagnosis?

A 58-year-old male with a history of chronic alcoholism presents with fever, cough and dyspnea. His cough is productive with thick, bloody, jelly-like sputum. Examination reveals inspiratory crackles over the right middle lung field. Chest x-ray shows consolidation and a cavitary lesion in the right middle lobe. Which of the following organisms is most likely the cause of his symptoms?

A mother brings her 8 month old infant in to the clinic with a complaint of high fevers for three days. She denies any other symptoms. On examination the child appears very well and is playful with you despite having a temperature of 103.9o. A complete physical examination and urinalysis are done and no source of the fever is found. You send her home with fever control measures and a follow up appointment for the next day. The next day, the child is afebrile, but has a generalized pink maculopapular rash. Which of the following is the most likely diagnosis?

A 54-year-old male presents with a painful lesion on his hand that has been present for one week. It began as a small papule, but has become vesicular in nature. He denies any insect bites or exposures to any new products. He works as a rug importer. On examination there is a large hemorrhagic bulla with on the dorsum of his right hand, with surrounding erythema and edema. Which of the following is the most likely diagnosis?

A 42-year-old male presents with a rash following a trip to a spa. The lesions are slightly tender and nonpruritic. He is otherwise well. On examination he has erythematous papules and pustules from the neck down. The lesions are all located over a hair follicle. Which of the following is the most likely causative organism of this rash?

A 24-year-old male with a history of HIV presents for routine evaluation. His CD4 count is 46L. Which of the following medications should be initiated as prophylaxis for mycobacterium avium complex infection?

A 19-year-old male presents to the emergency room with an acutely swollen, erythematous right knee. He reports that prior to the onset of these symptoms he had pain in multiple joints. On examination he is febrile and has an erythematous right knee with a large effusion. Aspiration of the joint yields prurulent fluid, but gram staining is inconclusive. Which of the following is the most likely organism causing his symptoms?

An 88-year-old female is brought to the emergency room because of headache, fever, and confusion. She has recently returned from a trip to Florida. Lumbar puncture is performed and shows lymphocytosis. MRI shows increased signal intensity in the parenchyma of the brain. Which of the following is the most likely cause of her symptoms?

A husband, wife and their 8-year-old child present to their primary care clinician for treatment of scabies. The mother of the family is currently 24 weeks pregnant. Which of the following scabies treatments is cannot be used to treat the mother?

A 23-year-old female presents with sudden onset of fever, headache, and nausea. She reports that her symptoms started 3 days after returning from a hunting trip in Colorado. On examination she appears to be unwell, has a temperature of 102.4o and a pulse rate of 118. There is an ulcerative lesion over her medial malleolus and there are tender, enlarged inguinal lymph nodes. Which of the following is the most likely diagnosis?

You are counseling a patient on overseas travel. He is traveling to an area where multidrug resistant malaria is prevalent. Which of the following medications should be used as chemoprophylaxis?

You are seeing a 23-year-old patient who is HIV positive. He has a friend who was recently diagnosed with cytomegalovirus (CMV) retinitis and wants to know if he should be receiving prophylaxis for this. What advice should you give him?