Skin and Soft Tissue Infections
A cirrhotic patient presents with sepsis and hemorrhagic bullae after eating raw oysters. Which organism is most likely responsible?
A. Mycobacterium marinum
B. Vibrio vulnificus
C. Capnocytophaga canimorsus
D. Pseudomonas aeruginosa
B. Vibrio vulnificus
Which of the following is the most commonly identified bacterial cause of community-acquired pneumonia across all age groups?
A. Moraxella catarrhalis
B. Mycoplasma pneumoniae
C. Streptococcus pneumoniae
D. Chlamydophila pneumoniae
C. Streptococcus pneumoniae
A patient with HIV has a CD4 count of 290/μL and is newly diagnosed with esophageal candidiasis. What does this finding most likely indicate?
A. ART failure
B. Need for PCP prophylaxis
C. AIDS-defining illness
D. IRIS
C. AIDS-defining illness
Which of the following is an appropriate empiric therapy for uncomplicated cystitis in a nonpregnant woman?
A. 10 days of ampicillin
B. 7 days of ciprofloxacin
C. 3 days of trimethoprim-sulfamethoxazole
D. Daily nitrofurantoin for 2 weeks
C. 3 days of trimethoprim-sulfamethoxazole
A patient presents with diarrhea after a picnic. Multiple others are also affected. The stools are described as bloody and culture grows gram-negative rods. Which organism is most likely?
A. Clostridium perfringens
B. Norovirus
C. Shigella
D. Giardia
C. Shigella
A 48-year-old man presents with a bright red, swollen lesion on his cheek. The area is sharply demarcated, tender, and slightly raised with a clear border. What is the most likely diagnosis?
A. Cellulitis
B. Impetigo
C. Herpes zoster
D. Erysipelas
D. Erysipelas
Which of the following scenarios warrants extending CAP antibiotic therapy beyond 5 days?
A. Resolution of fever but persistent crackles on auscultation
B. Inpatient with confirmed influenza and CAP
C. Ongoing fevers and cavitary lung lesions
D. Elderly patient treated with doxycycline
C. Ongoing fevers and cavitary lung lesions
Which vaccination is indicated at diagnosis for all HIV patients ≥19 years old regardless of CD4 count?
A. Meningococcal vaccine
B. Recombinant zoster vaccine
C. MMR vaccine
D. BCG vaccine
B. Recombinant zoster vaccine
What is the preferred empiric treatment for nonpurulent cellulitis with systemic signs of infection?
A. Topical clindamycin
B. Oral cephalexin
C. IV cefazolin
D. Oral TMP-SMX
C. IV cefazolin
Which of the following infections requires droplet precautions in the hospital?
A. Neisseria meningitidis meningitis
B. Tuberculosis
C. MRSA wound infection
D. Clostridioides difficile colitis
A. Neisseria meningitidis meningitis
A dog bite leads to sepsis in a patient with a history of splenectomy. What organism should you suspect?
A. Pasteurella multocida
B. Capnocytophaga canimorsus
C. Eikenella corrodens
D. Streptococcus pyogenes
B. Capnocytophaga canimorsus
A 72-year-old woman with a history of COPD presents with cough, fever, and dyspnea. Chest x-ray confirms a left lower lobe infiltrate. Which of the following organisms is most likely responsible for her community-acquired pneumonia?
A. Streptococcus pyogenes
B. Haemophilus influenzae
C. Staphyloccocus aureus
D. Legionella pneumophila
B. Haemophilus influenzae
A patient has a CD4 count of 45/μL and is not yet on ART. What prophylaxis should be started to prevent Mycobacterium avium complex?
A. Isoniazid
B. Rifampin
C. Azithromycin
D. Dapsone
C. Azithromycin
A 54-year-old man presents with rapidly progressing erythema, swelling, severe pain out of proportion to exam, and purple bullae on the lower leg. Imaging confirms myonecrosis. Which of the following antibiotic regimens is most appropriate to initiate alongside urgent surgical debridement?
A. Ceftriaxone and azithromycin
B. Clindamycin and vancomycin
C. Piperacillin-tazobactam alone
D. Vancomycin plus piperacillin-tazobactam and clindamycin
D. Vancomycin plus piperacillin-tazobactam and clindamycin
A patient is started on RIPE therapy for active pulmonary TB. After 2 months, symptoms resolve. What is the minimum total treatment duration for this patient?
A. 2 months
B. 4 months
C. 6 months
D. 9 months
C. 6 months
A 68-year-old man presents with severe leg pain, erythema, and purple bullae. What is the best next step in management after IV antibiotics?
A. Order MRI of the extremity
B. Consult Infectious Disease
C. Start clindamycin and observe
D. Incision and drainage
A. Order MRI of the extremity
Which of the following patients should receive both urine pneumococcal and Legionella antigen testing?
A. A patient with CAP who is stable and being treated as an outpatient
B. A hospitalized patient with suspected aspiration pneumonia
C. A patient admitted for CAP with a recent history of travel to an area with Legionella outbreak
D. Any patient admitted to the ICU with CAP
D. Any patient admitted to the ICU with CAP
Which of the following HIV screening strategies is most appropriate for universal screening in adults?
A. Annual rapid antibody test
B. Western blot only in high-risk groups
C. Fourth-generation antigen/antibody combination immunoassay
D. CD4 count and viral load testing
C. Fourth-generation antigen/antibody combination immunoassay
Which of the following is an acceptable treatment regimen for latent TB infection in a patient without HIV?
A. 6 months of rifampin only
B. 3 months of isoniazid plus rifapentine once weekly
C. 9 months of isoniazid plus pyrazinamide
D. 2 months of isoniazid plus ethambutol
B. 3 months of isoniazid plus rifapentine once weekly
Which of the following is true regarding pyelonephritis follow-up?
A. Routine follow-up urine cultures are recommended for all patients
B. Follow-up urine cultures are recommended only in pregnant women
C. All patients should have a post-treatment CT scan
D. Blood cultures must be repeated in all patients at 72 hours
B. Follow-up urine cultures are recommended only in pregnant women
A 35-year-old patient presents with several acute, tender, well-demarcated, papular lesions on the thigh with prior history of similar infections. There are no systemic symptoms. What is the most appropriate initial step in management?
A. Empiric oral antibiotics with MRSA coverage
B. Surgical excision of all lesions
C. Incision and drainage with culture
D. Observation with warm compresses only
C. Incision and drainage with culture
Which finding would most strongly support empiric therapy for MRSA in a patient with prior history of incarceration and purulent sputum production?
A. Cavitary lung lesion on imaging
B. WBC >12,000
C. Age >65
D. Recent history of swimming in Golf of Mexico
A. Cavitary lung lesion on imaging
A 29-year-old man recently started ART and anti-TB therapy for late-stage HIV and TB. He returns 4 weeks later with fever and tender cervical lymphadenopathy. What is the most appropriate management?
A. Stop ART and treat TB
B. Treat lymphadenitis surgically
C. Add prednisone and stop TB therapy
D. Continue ART and antituberculous therapy
D. Continue ART and antituberculous therapy
A patient is admitted with CAP and has structural lung disease and a history of Pseudomonas infection. Which is the best empiric regimen?
A. Piperacillin-tazobactam plus levofloxacin
B. Ceftriaxone plus azithromycin
C. Amoxicillin alone
D. Vancomycin plus cefuroxime
A. Piperacillin-tazobactam plus levofloxacin
A patient with newly diagnosed HIV presents with painful vision loss and floaters. Fundoscopic exam reveals fluffy, white, hemorrhagic retinal lesions. What is the most likely diagnosis?
A. CMV retinitis
B. Retinal detachment
C. Candida endophthalmitis
D. Toxoplasmosis
A. CMV retinitis