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MID SSN 2012 Practice Questions [Part 2 of 6] - Qiurio

MID SSN 2012 Practice Questions [Part 2 of 6]

A collection of practice questions covering infectious disease and parasitology (MID course) written by SSN instructors in 2012. There are 6 parts to this collection.







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Difficulty Analysis

Question Difficulty

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Question 1
A 75 y/o bed bound man presents to the emergency room with fever and altered consciousness. His vital signs are temp 101, HR 105, BP 95/54, RR 22. His exam is significant for increased somnolence, decreased breath sounds and crackles bilaterally. Blood and urine culture shows many E Coli. How would you classify patient’s clinical status?
A. Systemic inflammatory response
B. Septic shock
C. Severe sepsis
D. Transient bacteremia

Explanation

Question 2
What bacterial factor leads to this patient’s immune system activation?
A. Endotoxin
B. Teichoic Acid
C. Superantigen
D. Bacterial flagella

Explanation

Question 3
Which of the following is an appropriate treatment for this patient?
A. Activated protein C
B. Normal saline bolus
C. Steroids
D. IV Vancomycin

Explanation

Question 4
How does endothelial cell release of NO lead to sepsis pathology?
A. Decrease cardiac output
B. Activation of the coagulation cascade
C. Increase release of TNF, IL-1
D. Vasodilation

Explanation

Question 5
A 19 yo woman who recently became sexually active presents the clinic complaining of dysuria, urgency, and a sense of bladder fullness. She has never had these symptoms before. The clinician suspects an uncomplicated UTI and sends her home with a 3-day course of Bactrim (trimethoprim-sulfamethoxazole). She returns 3 months later with identical symptoms. What is the most likely cause of her new symptoms?
A. Bacterial strain resistant to antibiotics
B. Inappropriately short course of antibiotic therapy
C. Noncompliance with prescribed treatment regimen
D. Infection with an organism not covered by the prescribed antibiotic
E. New infection unrelated to the prior infection

Explanation

Question 6
Which of the following is the most likely causative organism for the above patient’s infection?
A. Pseudomonas aeruginosa
B. Staphylococcus epidermidis
C. Staphylococcus saprophyticus
D. Candida albicans
E. Mixed commensal flora

Explanation

Question 7
For which of the following patients would you be most likely to order additional testing beyond urine cultures?
A. A 28 yo sexually active woman with several UTIs over the past year
B. A 40 yo woman with pyelonephritis who remains febrile despite appropriate IV antibiotics
C. A 22 yo man diagnosed with a UTI after engaging in anal intercourse
D. A 4-month-old uncircumcised boy

Explanation

Question 8
A 25 yo woman comes to clinic complaining of dysuria. She denies any other symptoms. She has engaged in unprotected sex with multiple partners over the past several months. Which of the following should be included in her evaluation?
A. Urine culture to determine antibiotic sensitivities and effectively treat her UTI
B. Abdominal and pelvic CT
C. Cervical cultures for gonorrhea and chlamydia
D. Blood cultures to determine source of infection

Explanation

Question 9
A 12 yo boy attending a school picnic eats his weight in hot dogs, hamburgers, macaroni salad, and egg salad. About 3 hours later, he suddenly develops nausea, vomiting and non-bloody diarrhea. Several classmates (who ate more reasonable portions) are also ill. Which of the following is the most likely cause of the boy’s illness?
A. Shigella
B. aureus
C. Campylobacter
D. Yersinia
E. Rotavirus

Explanation

Question 10
What is the cause of his symptoms?
A. Ingestion of spores which germinated and produced toxin
B. Ingestion of bacteria which led to infection
C. Heat stable toxin
D. Heat labile toxin
E. Allergic reaction

Explanation

Question 11
A 4 yo girl who attends daycare develops fever, cramping abdominal pain, and diarrhea that becomes bloody. The child appears uncomfortable but only mildly ill, but her mother calls the pediatrician and requests a prescription for some antibiotics. What should the doctor do?
A. Phone in a prescription to the family’s pharmacy to avoid angering the mother
B. Explain that the diarrhea is likely self-limiting and should be treated with oral rehydration, but recommend that the mother bring her child and a stool sample in for evaluation
C. Ask the mother to bring the child to the ER for IV fluids and antibiotics to prevent severe complications such as anemia or renal failure
D. Reassure the mother that diarrhea is often not infectious and thus does not require any treatment or precautions to prevent spread to other daycare attendees

Explanation

Question 12
After leaving my boyfriend home alone for several days while I attended residency interviews, I came home to find that he had been feeling unwell and had been experiencing some nausea, vomiting, and diarrhea. When left to his own devices, his dinner usually consists of rice cooked in our rice cooker or leftover rice if he didn’t finish it the day before. How might he have prevented his gastrointestinal distress while I was away?
A. Warming the leftover rice in the microwave before eating it, taking care not to heat it to a very high temperature
B. Tightly covering the leftover rice before leaving it on the counter overnight
C. Putting the leftover rice in the refrigerator immediately after serving himself the first night
D. Allowing the rice to cool completely on the counter before placing it in the refrigerator
E. Putting a little less sriracha on his leftover rice than he usually does

Explanation

Question 13
A 45 yo woman comes to the physician with a 2-day history of abdominal cramps and bloody diarrhea. She has just returned from a vacation in Thailand, where she enjoyed many local dishes. She is not in severe distress, but she has a low-grade fever. Stool exam shows many PMNs, and culture reveals aerobic non-motile GNRs. What is the most likely cause of her diarrhea?
A. coli
B. Vibrio cholera
C. Yersinia
D. Shigella dysenteriae
E. Salmonella typhi

Explanation

Question 14
A 32 yo man comes to the physician complaining of several episodes daily of loose watery stools that started 2 days ago while on the plane home from a trip to Mexico. He reports that he took every precaution during his trip to avoid contaminated food and water, but he admits that he may have paid less attention as the trip neared its end. What is true about the likely causative organism for his diarrhea?
A. It is a member of the same species as strains that have been implicated in illnesses resulting from poorly-cooked ground beef
B. It often causes epidemics following disasters such as earthquakes or wars
C. It usually only affects immunocompromised individuals, so his physician should strongly advise an HIV test
D. Infection requires only a very small inoculum
E. It elaborates a neurotoxin that is actually likely to activate the vomiting center and cause emesis in addition to bloody diarrhea

Explanation

Question 15
A 75 year old woman presents with two days of watery diarrhea, stomach cramps, and a mild fever (100.9 F). Today, she noticed blood in her stool. She was recently hospitalized for a lung abscess and treated with levofloxacin. What is the cause for her symptoms?
A. enterotoxin causing hemorrhagic necrosis and fluid secretion
B. cell wall fragments, causing inflammation
C. lipopolysaccharide causing inflammation
D. neurotoxin causing GABA blockade
E. neurotoxin blocking acetylcholine release

Explanation

Question 16
Culture from a patient shows the following:



What is the recommended treatment?
A. metronidazole, IVIG, and vaccination with toxoid
B. penicillin
C. surgery and penicillin
D. doxycycline

Explanation

Question 17
Which of the following is not true?
A. Freezing does not kill spore-forming bacteria
B. Some anaerobes are able to tolerate oxygen
C. Some anaerobic bacteria protect hosts from other bacteria
D. Acne is caused by a gram (+) anaerobe
E. Botulism results from excessive GABA release

Explanation

Question 18
A new parent comes to the primary care clinic complaining of a sore throat. You obtain a throat swab and find normal bacterial flora, but a monospot test is positive (patient has mononucleosis). What might have grown on the throat culture?
A. Actinomyces israelii
B. Clostridium difficile
C. Clostridium perfringens
D. Streptococcus pyogenes

Explanation

Question 19
Your patient on the general surgery service is diagnosed with an abdominal abscess after appendiceal rupture. Your attending asks the most likely bacterial organism. You respond…
A. by covertly checking your smart phone
B. “Clostridium difficile”
C. “Escherichia Coli”
D. “Bacteroides fragilis”

Explanation

Question 20
A 21-year-old college student comes into the emergency room complaining of a severe headache. You notice petechiae on his arms. Which of the following would most likely be isolated from a lumbar tap?
A. high WBC count (80% PMNs) / low glucose / high protein
B. high WBC count (80% PMNs)/ low glucose / normal protein
C. “one angry poly” (100% PMN) / normal glucose / normal protein
D. very high WBC count (50% PMNs) / low glucose / high protein

Explanation

Notes

Remember BUN/Cr is for kidney function

Discussion

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