Bacteria
A 67-year-old was admitted with septic shock from left leg cellulitis and hemorrhagic bullae. Blood cultures grew Vibrio vulnificus. He had been harvesting oysters and walking barefoot while fishing. His wife denies alcohol use. What condition predisposes him to this infection?
a) G6PD deficiency
b) Sickle cell disease
c) Hemochromatosis
d) History of prior gastrectomy
c) Hemochromatosis
A 47-year-old man presents for HIV care, not on medication, unaware of his CD4 count or viral load. He is asymptomatic except for purplish raised lesions on his chest, abdomen, and legs. You suspect Kaposi sarcoma and advanced AIDS. Which virus is associated with these lesions?
a) HHV6
b) HHV8
c) HSV1
d) CMV
b) HHV8
A 50-year-old man presents with fever, severe leg pain, and rapidly spreading skin discoloration after cutting his leg while cleaning his backyard pond. He is hypotensive, and physical exam reveals crepitus and necrotic skin. What is the most likely source of infection?
a) Inhalation of contaminated water droplets
b) Ingestion of undercooked seafood
c) Contact with contaminated animal hides
d) Wound contamination with soil
d) Wound contamination with soil
Lab notifies you that the blood cultures on your 87 year-old patients are showing the growth of e.coli that is ESBL producing. Your treatment of choice is
a) Ertapenem
b) Cefepime
c) Ceftriaxone
d) Bactrim
a) Ertapenem
Which cephalosporin has activity against MRSA?
a) Ceftriaxone
b) Cefotetan
c) Ceftaroline
d) Cefepime
c) Ceftaroline
This bacteria causes majority of the cases of endocarditis
a) Staphylococcus aureus
b) Viridans group of streptococci
c) HACEK
d) Enterococcus
a) Staphylococcus aureus
A 38-year-old unvaccinated man returned from Ohio with left ear and jaw pain, followed by neck swelling on both sides and testicular pain with swelling. What is the most likely etiology?
a) Rubeola
b) Mumps
c) Rubella
d) Adenovirus
b) Mumps
A 36-year-old man presents with a week of right inguinal pain and swelling. He denies trauma, fever, or STDs. He lives with his wife, two kittens, and a dog and recalls hiking in Virginia three weeks ago. Cipro and Keflex were ineffective. The exam shows a tender, fluctuant right inguinal mass; no genital lesions. He is febrile but nontoxic. Aspiration culture, HIV, syphilis, chlamydia, and GC tests are negative; CBC and electrolytes are normal. What is the most likely source of infection?
a) Hiking and tick bites
b) Community-acquired MRSA infection
c) His house pets
d) Eating raw sushi in Virginia
c) His house pets
An 87-year-old man returns after treatment for community-acquired pneumonia (Ceftriaxone, then Levofloxacin). He now reports diarrhea, abdominal pain, WBC 18,000, and creatinine 1.9 (baseline 1.4). C. diff toxin PCR is positive. Which one of the following would you recommend?
a) IV Metronidazole
b) Oral vancomycin
c) Oral fidaxomicin
d) Oral Rifaximin
c) Oral fidaxomicin
A 70-year-old man presented with rapid-onset fever, sore throat, and chills. He tested positive for influenza A and was discharged. Three days later, blood cultures grew Streptococcus gallolyticus, and he was called back for admission. Now asymptomatic and irritated, his physical exam and labs are normal. After calming him down, what should you recommend?
a) Transesophageal echocardiogram
b) CT of the abdomen and pelvis
c) Ultrasound of the kidney bladder and ureters
d) Colonoscopy
d) Colonoscopy
Which one of the following bacteria will not grow on a regular culture medium?
a) Staph aureus
b) E. coli
c) Bacteroides
d) Vibrio cholera
e) Bordetella pertussis
e) Bordetella pertussis
A 72-year-old woman with lymphoma on chemotherapy and rituximab presented with 5-6 days of fever and shortness of breath. She was febrile, tachycardic, tachypneic, and hypoxic (88% on room air, corrected to 97% with oxygen). SARS-CoV-2 PCR was positive, and chest X-ray showed bilateral diffuse infiltrates. She was admitted. What treatment do you recommend?
a) Remdesivir
b) Molnupiravir
c) Nirmatrelvir/ritonavir
d) Remdesivir plus decadron
e) NO treatment; she is out of the window period of treatment, just supportive care
d) Remdesivir plus decadron
A 67-year-old woman is admitted with severe diarrhea. Stool studies show Shiga toxin-producing E. coli. She recently returned from Orlando, where she ate at multiple restaurants, visited a zoo, and took a Disney cruise. What is the potential source of her infection?
a) Eating green, leafy vegetables from the salad bar
b) Partially cooked hamburgers
c) Going to the zoo
d) Drinking, freshly squeezed juice from a vendor
a) Eating green, leafy vegetables from the salad bar
Your patient was diagnosed with Nocardia pneumonia, What is the treatment of choice?
a) Bactrim
b) Bactrim plus amikacin
c) Piperacillin/tazobactam
d) Levoflaxacin plus metronidazole
b) Bactrim plus amikacin
Which fluoroquinolone has activity against MRSA?
a) Ciprofloxacin
b) Moxifloxacin
c) Trovafloxacin
d) Delafloxacin
d) Delafloxacin
A 35-year-old man presented 24 hours after a fist fight with fever and a warm, tender wound on his second knuckle. Cultures showed gram-positive cocci in chains and tiny gram-negative rods, labeled as mixed skin flora. ID requested further isolation and workup. What are they looking for?
a) Viridans streptococci
b) Eikenella corrodens
c) Peptostreptococcus
d) Staph aureus
e) Fusobacterium necrophorum
b) Eikenella corrodens
A 35-year-old man with a history of liver transplant (4 months ago) for NASH presents with 3 days of fever, abdominal pain, and bloody diarrhea. FOBT positive. He is on mycophenolate, prednisone, and tacrolimus. Exam shows a distended, tender abdomen. Which of the following viruses is the most likely cause of the patient's illness?
a) CMV
b) EBV
c) HSV2
d) BK virus
a) CMV
A 26-year-old is admitted with fever, sepsis, and shortness of breath. WBC is 18,000, chest X-ray shows multiple nodules, and needle tracks are noted despite his denial of drug use. Blood cultures grew Eikenella corrodens. He was started on piperacillin/vancomycin. What is the most likely source of infection?
a) Exposure from a water cooling system
b) Wound contamination with urine and feces
c) Injection of contaminated water or food
d) Using toilet paper to dilute the opiate
e) Priming the needle before injection
e) Priming the needle before injection
A 72-year-old man presents with fever, rigors, and worsening dyspnea. He is febrile, mildly hypotensive, and has a loud murmur. Blood cultures show gram-positive cocci in clusters; identification is pending. He is on piperacillin/tazobactam and vancomycin. While awaiting results, you should?
a) Continue current regimen
b) Discontinue Piperacillin-tazobactam and continue Vancomycin
c) Continue Vancomycin, add Nafcillin
d) Continue Vancomycin, add gentamycin
b) Discontinue Piperacillin-tazobactam and continue Vancomycin
This cephalosporin has anaerobic activity
a) Cefuroxime
b) Ceftaroline
c) Ceftriaxone
d) Cefotetan
d) Cefotetan
A 22-year-old woman was advised to seek care after her aunt, with whom she lives, was diagnosed with active TB. Her initial IGRA was negative but turned positive after 8 weeks. She is asymptomatic with a normal chest X-ray. You recommend?
a) No treatment she’s totally fine
b) Six months of Levofloxacin
c) Four months of daily Rifampin
d) Two months of Rifampin and Pyrazinamide
e) Start treatment with Rifampin, INH, Ethambutol and Pyrazinamide
c) Four months of daily rifampin
A 24-year-old woman from Minnesota presents in winter with a 3-day history of headache, fever, stiff neck, and photophobia. Vitals are normal except for a temperature of 38°C. Head CT with contrast is normal. CSF suggests 50 RBC, normal glucose protein, and 2 WBC . Which of the following is the most likely diagnosis?
a) Enterovirus
b) HSV1
c) HSV2
d) West Nile virus
c) HSV2
A 40-year-old man presents with fever, malaise, and a black eschar on his arm after handling animal hides at his job in a tannery. Blood cultures grow Bacillus anthracis. What is the most likely source of infection?
a) Inhalation of contaminated dust from livestock
b) Direct contact with contaminated animal products c) Inhalation of spores from bird droppings
d) Consumption of undercooked beef
e) Exposure to contaminated freshwater
b) Direct contact with contaminated animal products
An 89-year-old woman is admitted with fever, chills, night sweats, dysuria, and lower abdominal pain. She has leukocytosis, blood cultures positive for Enterococcus faecalis, and mixed flora in urine culture. Echocardiogram shows mitral valve vegetation. What is your preferred antibiotic regimen?
a) Ampicillin for two weeks
b) Ampicillin plus gentamicin for four weeks
c) Ampicillin plus ceftriaxone for six weeks
d) Daptomycin for eight weeks
c) Ampicillin plus ceftriaxone for six weeks
52-year-old male was recently treated with H Pylori infection with triple antibiotic therapy. Now he comes to your office and wants to know if his infection has resolved completely. You recommend:
a) No need for testing; he was appropriately treated
b) Order a stool H. pylori antigen test eight weeks after treatment.
c) Perform a urea breath test three weeks after treatment
d) Repeat endoscopy and biopsy and rapid urease
b) Order a stool H. pylori antigen test eight weeks after treatment
A 60-year-old woman with a renal transplant on chronic immunosuppression presents with 4 weeks of cough, weakness, fatigue, and low-grade fever. She is febrile with normal WBC. Chest CT shows left lower lobe consolidation. Bronchoscopy was performed, and Gram stain shows gram-positive filamentous rods, possibly acid-fast. What is the most likely diagnosis?
a) Cryptococcus neoformams
b) Cutibacterium acnes
c) Nocardia asteroides
d) Actinomyces Israeli
c) Nocardia asteroides
A 65-year-old woman is evaluated in the emergency department with shingles invloving more than 2 dermatomes. Medical history is notable for breast cancer; she is receiving chemotherapy. Which of the following transmission-based precautions should be initiated?
a) Airborne precautions
b) Airborne and contact precautions
c) Contact precautions
d) Contact and droplet precautions
Droplet precautions
b) Airborne and contact precautions
A 42-year-old woman presents with fever, muscle aches, and jaundice after returning from a whitewater rafting trip in Hawaii. She also reports red eyes and mild confusion. What is the most likely source of infection?
a) Inhalation of contaminated dust
b) Contact with water contaminated by animal urine c) Ingestion of contaminated shellfish
d) Contact with bird droppings
e) Inhalation of spores from soil
b) Contact with water contaminated by animal urine
78-year-old gentleman with COPD hypertension and CAD was admitted to the hospital. He developed respiratory failure and was intubated admitted to intensive care unit. Tracheal aspirate cultures are showing the growth of stenotrophomonas maltophilia. Treatment of choice is
a) Cefepime and vancomycin
b) Piperacillin/ tazobactam
c) Meropenem
d) Trimethoprim/sulfametaxozole
d) Trimethoprim/sulfametaxozole
A 33-year-old man was bitten on the leg by a skunk while hiking. In the ER, he had multiple puncture wounds, received a rabies vaccine, and the wound was cleaned. He has no prior rabies vaccination. What is recommended?
a) Rabies immunoglobulin at the bite site
b) Intramuscular rabies immunoglobulin in deltoid
c) Intramuscular rabies immunoglobulin in buttocks
d) He's getting vaccinated no need for immunoglobulin
a) Rabies immunoglobulin at the bite site