Infectious Disease 8

A 33-year-old female presents with a history of a skin lesion on her hand for six weeks. She states that it started out as a laceration when she cut herself on some coral while vacationing in Hawaii. Over the past several weeks, the laceration has healed, however there has been an enlarging skin lesion over the area where was injured. It is not painful or pruritic. On examination there is a 2 cm granulomatous lesion to her left hand. Which of the following organisms is the most likely cause of this skin lesion?

A 56-year-old female presents for a follow up visit. She had been seen 6 weeks previously with erythema migrans. She complains of vague fatigue and joint pain. Lyme antibodies have come back as positive. On examination she is bradycardic, but the exam is otherwise normal. An ECG reveals a second degree AV block which is new when compared to old ECGs. Which of the following treatments is the most appropriate for this patient?

A 23-year-old male presents to a clinic with a complaint of severe vomiting and mild diarrhea. He reports that the vomiting started shortly after he ate some left over fried rice. He denies any abdominal pain or fever. Which of the following is the most likely causative organism?

A 29-year-old male cut his finger on a piece of metal while working on a construction site. He is unsure of his last tetanus shot, but does not remember receiving any immunizations since he was a child. He is sure he had all of his childhood immunizations. He presented to the ED approximately 2 hours after the injury because he was unable to control the bleeding. On examination his hand is very dirty, and there is an irregular laceration to the palmar surface of his left hand. Which of the following is the most appropriate plan regarding tetanus prophylaxis?

A 42-year-old female presents with a complaint of a change in bowel habit for 4 weeks. She reports that she has had diarrhea with large, greasy stools which are very malodorous. She also complains of abdominal cramping and increased flatulence. She has no ill contacts, and states that the symptoms started shortly after she went on a camping trip. Her examination is essentially normal. Cysts are seen on stool microscopy. Which of the following is the most appropriate treatment for this patient?

A 5-year-old male is brought to the clinic with acute onset of painful swollen parotid glands. His mother reports that he was fine last night, but awoke with the swelling this morning. On examination the child appears well, and has a temperature of 100.8o. His right parotid glad is slightly more swollen than the left, but they both are markedly swollen and tender. Which of the following family of viruses is the most likely cause of this child’s symptoms?

A 17-year-old female presents to the emergency room with a complaint of vaginal discharge and right upper quadrant pain radiating to her right shoulder. On examination there is cervical motion tenderness, and the right adnexa is exquisitely tender but there is no palpable mass. There is also right upper quadrant abdominal tenderness to palpation and a hepatic friction rub. Which of the following is the most likely diagnosis?

A 24-year-old male presents to the emergency department with a complaint of mild sore throat, malaise and chest pain. His voice is very hoarse as he tries to give a history to you. On examination he is febrile, but appears well. His posterior oropharynx and tonsils are coated with a thick grayish membrane. Which of the following is the most likely diagnosis of this patient?

A 19-year-old female presents to the clinic with a complaint of a rash for 2 days. She reports that she has been feeling general malaise, fever and arthralgias along with the rash. She reports that the skin lesions initially were red, but now have become black in the center. Her last menstrual period was one week ago. On examination you observe multiple hemorrhagic and necrotic papules on the extensor surfaces of her wrists and hands, and the dorsum of her feet. Which of the following is the most likely diagnosis?

A 5-year-old male is brought to the emergency room with a complaint of 3 days of fever, abdominal pain and diarrhea. His stools are watery and contain lots of mucous. He has no ill contacts and has had no recent travel. He has recently been given a turtle as a pet. Which of the following organisms most likely has caused his illness?

A 19-year-old female is found to have a chlamydia infection at her initial prenatal visit. She successfully took a single dose regimen of antibiotics for treatment. She returns one week later wanting to make sure the infection is gone. How long is the minimal interval from completion of treatment that she should receive a repeat test?

A 36-year-old female presents to the emergency department with a history of sudden onset of diplopia. She reports that for the preceding several hours she had been feeling very week, had a dry mouth, and her voice had had a very nasal quality to it. She reports that she had just returned from a trip to her parent’s farm, and had been eating some home-canned vegetables while she was there. Which of the following is the most likely diagnosis?

A 15-year-old female presents for a request for contraceptive pills. She reports that she has been sexually active with three partners and has not used any contraceptives. You perform a pelvic examination and test for sexually transmitted infections. She is positive for chlamydia, but a routine pregnancy test is also positive. Which of the following treatments should be given to her at this time?

A 6-year-old female is brought to the pediatrician’s office for evaluation of abnormal movements. Her parents report that initially it began as a mild “figidityness” but has progressively gotten worse. Now they report that she often experiences jerky, uncontrollable movements in her right arm. Her teacher has complained about a deterioration in her handwriting, and her parents report that she has become very “moody” since this has all started. Which of the following is the most likely diagnosis?

A one week old female infant presents with a staccato cough and tachypnea. She does not have significant fever. One day prior to the onset of the symptoms she was diagnosed with conjunctivitis. She was estimated to have been born at 38 weeks, via spontaneous vaginal delivery to a 16 year old mother who received no prenatal care. On examination she is tachypneic and has scattered inspiratory rales. A chest x-ray shows scattered patchy infiltrates. CBC shows an elevated white count with eosinophilia. Which of the following organisms is the most likely cause of this infant’s pneumonia?

A 32-year-old male presents to the sexual health clinic with a complaint of a mass in his groin. He reports that it initially started out as a cluster of small ulcerative lesions, which resolved spontaneously, but now he has developed a tender mass in his groin. On examination the skin overlying the left inguinal lymph nodes is erythematous and indurated, and multiple draining sinus tracts have formed.   Which of the following is the most likely diagnosis?

A 28-year-old male presents to the emergency room with a complaint of being sick for 5 days. He states that he had an abrupt onset of fever, chills, myalgias, headache, and diarrhea. Now for the past 48 hours he has developed shortness of breath and a severe productive cough. He reports that he was camping in New Mexico 2 weeks ago. On examination he appears to be in moderate distress. His heart rate is 112 beats per minute, and respiratory rate is 24 breaths per minute. Bibasilar rales are heard on auscultation. A chest x-ray shows pulmonary edema. Which of the following is the most likely diagnosis?

A physician assistant student presents to the emergency room with severe diarrhea which started when he was on a medical mission trip to India. He reports that he has no fever or abdominal pain, but has severe watery gray diarrhea. There is no blood or pus in the stool. On examination he appears unwell, has a heart rate of 118 beats per minute, and a blood pressure of 90/62. His mucous membranes are dry, and capillary refill is delayed. His abdominal examination is unremarkable. Which of the following organisms is the most likely cause of this patient’s illness?

A 16-year-old male presents to the clinic with a complaint of severe dysuria and urethral discharge. His symptoms started 3 days after he had unprotected sexual intercourse with a new partner. Examination of the penis is unremarkable with the exception of prurulent discharge noted at the urethral meatus. Gram stain of the urethra shows numerous polumorphonuclear leukocytes and gram negative intracellular diplococci. Which of the following is the most likely diagnosis of this patient?

A 26-year-old female has just returned from a mission trip to Cambodia. She complains of abrupt onset of diarrhea, fevers headache and malaise for 2 days. The diarrhea started out as very watery, but now it appears as stools mixed with mucous and blood. On examination she is toxic appearing, and has a temperature of 101.2o and a pulse rate of 118. Her abdomen is diffusely tender. Her fecal smear shows erythrocytes and leukocytes. Which of the following is the most likely diagnosis?

A five day old infant is brought in for evaluation of red eyes. She was born via spontaneous vaginal delivery at 40 weeks gestation. On examination there is copious amounts of prurulent discharge and marked erythema and edema of the palpebral conjunctiva. Which of the following organisms is the most likely cause of her conjunctivitis?

A 14-year-old female is diagnosed with streptococcal pharyngitis and given a prescription for penicillin. Three weeks later she returns with a complaint of pain is multiple joints, and swelling and erythema in her right knee. She reports that she had similar swelling in her left wrist last week that resolved spontaneously. On further questioning she reveals that she did not complete the course of antibiotics because she felt better after three days. On examination there is a moderate erythema and an effusion of the right knee. You also observe that there are multiple small nodules on her scalp and over her joints, and a rash consisting of multiple macular, serpiginous lesions on her arms and trunk. Which of the following is the correct terminology for this rash?

A 46-year-female with a past medical history of AIDS has recently been discharged from the hospital following successful treatment of cryptococcal meningitis.   Which of the following medications should be used as prophylaxis for future infections?

A 19-year-old male presents with a history of two weeks of fever, mild cough and mild substernal chest pain. He reports his symptoms started approximately one week after he returned from a trip where he was exploring caves in Mississippi. He reports numerous exposures to both birds and bats while on the trip. On examination he appears very fatigued. His pulse rate is 102 beats per minute, his respirations are 18 breaths per minute, and his SaO2 is 94% on room air. Pulmonary exam reveals diffuse bronchial breath sounds and expiratory crackles. Chest x-ray reveals diffuse pneumonia. Which of the following organisms is the most likely causative organsisms for this illness?

A 54-year-old male with a history of HIV infection is diagnosed with Pneumocystisi jirovecii pneumonia. He has no other medical problems and has no drug allergies. Which of the following is the most appropriate treatment for this illness?

A 23-year-old female presents with a complaint of a rash on her chest and abdomen. She reports that the rash started while she was vacationing in Arizona. The rash is mildly sore, but does not itch. On examination she is morbidly obese, and there is beefy red, macerated skin in the skin folds and in the inframammary folds. There are a few satellite pustules noted. Which of the following is the most likely diagnosis?

A 29-year-old male with a history of HIV infection presents to the emergency department with a complaint of sudden onset of blindness. He reports that he has been feeling unwell for the past several weeks with fever, malaise and headache. He has not seen his physician for management of his HIV in the past 6 months, nor has he taken his antiretrovirals because ha has lost his health insurance. On examination he appears moderately unwell. He is unable to perform the visual acuity test, and many of the cranial nerve tests are difficult to perform due to his vision loss. He has difficulty performing the mental status examination. Kernig’s and Brudzinksi’s tests are both negative. CT scan shows non-specific changes. Which of the following tests of the cerebrospinal fluid is likely to be abnormal in this patient?

A 34-year-old female presents with a complaint of fever, malaise and rash. She reports that she had the fever for 2 days prior to developing the rash. The rash started on her face and trunk as papules which then progressed to vesicles and spread to her arms and legs. On examination she has a temperature of 101.3o, and has a generalized rash with some of the lesions being popular, some vesicular, and some have scabbed over. Which of the following is the most likely diagnosis?

A 54-year-old male with a history of an artificial mitral valve presents with symptoms of bacterial endocarditis. He undergoes surgery for a valve replacement and removal of vegetations. Culture of the vegetations reveals that the organism is candida albicans. Which of the following antifungals should he be treated with for this infection?

Which of the following medications is the appropriate treatment for a three-year-old male who has been diagnosed with hookworms?