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73 Cards in this Set

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A 39-year-old man presents to his physician, because of a worsening headache over the last week. He has also noticed difficulty concentrating. He has a previous history of human immunodeficiency virus (HIV) infection and has not taken highly active antiretroviral therapy (HAART). Physical examination reveals impaired short-term recall, but is otherwise unremarkable. A head computed tomography (CT) scan is performed and is within normal limits. A lumbar puncture is performed and cerebrospinal fluid (CSF) analysis reveals encapsulated yeast on India ink preparation. What is the most likely diagnosis?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Candidiasis
B. Cryptococcosis
C. Cryptosporidiosis
D. Lymphoma
E. Toxoplasmosis
Option B (Cryptococcosis) is correct. Cryptococcosis can present with CNS pulmonary, skin, or widely disseminated forms. CNS involvement as meningitis or meningoencephalitis is the most common. A headache and altered mental status are the typical presentation. Fever, neck stiffness, and focal neurologic defects are less common but still prevalent. Owing to the nonspecific clinical presentation, many patients have head CT or magnetic resonance imagings (MRIs) performed. Diagnosis, however, is with visualization of the encapsulated yeast on India ink stain of CSF followed by cryptococcal antigen testing.

Option A (Candidiasis) is incorrect. Candidiasis of the central nervous system (CNS) is extraordinarily rare and does not present with a thick capsule on India ink preparation.

Option C (Cryptosporidiosis) is incorrect. Caused by Cryptosporidium parvum, this condition causes diarrhea in the human immunodeficiency virus (HIV) patient and can be detected on stool analysis.

Option D (Lymphoma) is incorrect. Lymphoma of the CNS should always be considered in the human immunodeficiency virus (HIV patient presenting with neurologic complaints. CSF shows pleocytosis, along with elevated protein and abnormal lymphocytes. Polymerase chain reaction (PCR) of CSF almost always is positive for Epstein-Barr virus (EBV) DNA.

Option E (Toxoplasmosis) is incorrect. Toxoplasmosis typically presents with multiple ring-enhancing lesions at the corticomedullary junction on CT and MRI.

High-yield Hit 1
Figure 75-8 Cryptococcus neoformans India ink preparation demonstrating the large capsule surrounding budding yeast cells (magnification 1000×).

From Medical Microbiology 5E by Murray et al
Cryptosporidium parvum, in the human immunodeficiency virus (HIV) patient causes what?
diarrhea
Toxoplasmosis typical presentation on CT and MRI. (including location)
multiple ring-enhancing lesions at the corticomedullary junction
A 28-year-old man presents to the physician for his regular health maintenance examination. He has a 2-year history of HIV and has been taking highly active antiretroviral therapy (HAART). At present, he has no complaints. He is severely allergic to sulfa compounds. Laboratory investigation reveals a CD4+ count of 180 μL.

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Acyclovir
B. Amphotericin B
C. Azithromycin
D. Clarithromycin and ethambutol
E. Dapsone
F. Fluconazole
G. Granulocyte colony-stimulating factor
H. Isoniazid
I. Pyrimethamine and sulfadiazine
J. Trimethoprim-sulfamethoxazole
Option E (Dapsone) is correct. Decisions on when to start chemoprophylaxis are based on CD4+ counts primarily, but have been extensively analyzed with regard to a host of other factors, including disease prevalence, associated morbidity and mortality, and cost-effectiveness. The U.S. Public Health Service (USPHS) and the Infectious Diseases Society of America (IDSA) have published guidelines for prophylaxis against opportunistic infections. The standard of care for patients who have a CD4+ count less than 200 or oropharyngeal candidiasis is to start trimethoprim-sulfamethoxazole (TMP-SMX) in an attempt to prevent Pneumocystis carinii pneumonia. In patients who are allergic or severely intolerant to TMP-SMX, dapsone is considered the primary alternative drug.
Indication for pneumocystis carnii prophylaxis in hiv patient
CD4+counts of <200/μL or oropharyngeal candidiasis

Trimethoprim-sulfamethoxazole (TMP-SMX), 1 double-strength tablet (DS) by mouth daily or TMP-SMX, 1 single-strength tablet (SS) by mouth daily
Mycobacterium tuberculosis prophylaxis regimen in hiv patient
Isoniazid 300 mg by mouth plus pyridoxine 50 mg by mouth daily for 9 months, or isoniazid 900 mg by mouth plus pyridoxine 100 mg by mouth twice weekly for 9 months
Pneumocystis carinii prophylaxis in hiv patient
Trimethoprim-sulfamethoxazole (TMP-SMX), 1 double-strength tablet (DS) by mouth daily or TMP-SMX, 1 single-strength tablet (SS) by mouth daily
Isoniazid-resistant TB prophylaxis in hiv pateint
Rifampin 600 mg by mouth daily or rifabutin 300 mg by mouth daily for 4 months
Toxoplasma gondii prophylaxis indication in hiv patient
mmunoglobulin G (IgG) antibody to Toxoplasma and CD4+count of <100/μL

TMP-SMX 1 DS by mouth daily
Toxoplasma gondii prophylaxis in hiv patient
TMP-SMX 1 DS by mouth daily
Mycobacterium avium complex prophylaxis in hiv patient
Azithromycin 1200 mg by mouth weekly or clarithromycin 500 mg by mouth twice daily
Mycobacterium avium complex prophylaxis indication in hiv pateint
CD4+count of <50/μL
A 29-year-old woman who contracted HIV following a needle stick 15 months ago, presents to her primary care physician for her regular health maintenance examination. She has taken highly active antiretroviral therapy (HAART) and all prophylactic drugs appropriate for her previous CD4+ counts. Her lowest CD4+ count was previously 68 μL. Today, her CD4+ count is 32 μL.

End of set

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Acyclovir
B. Amphotericin B
C. Azithromycin
D. Clarithromycin and ethambutol
E. Dapsone
F. Fluconazole
G. Granulocyte colony-stimulating factor
H. Isoniazid
I. Pyrimethamine and sulfadiazine
J. Trimethoprim-sulfamethoxazole
Option C (Azithromycin) is correct. When the CD4 count drops below 50, the patient begins to be at increased risk for Mycobacterium avium complex (MAC), cytomegalovirus and Jakob-Creutzfeldt (JC) virus reactivation causing progressive multifocal leukoencephalopathy. The only routinely recommended prophylactic agent is azithromycin to prevent MAC. Clarithromycin and rifabutin are alternative agents.
alternative prophylactic agents to azithromycin to prevent MAC.
Clarithromycin and rifabutin are alternative agents.
begins with a flulike prodrome of 1 to 3 days, followed by a rash that begins on the wrists and ankles. It then spreads to the palms and soles, followed by the trunk and face.
Rocky Mountain Spotted fever [RMSF])
Rocky Mountain Spotted fever tx
doxycycline
presents in children as a maculopapular rash on the arms that spreads to the face
Erythema infectiosum, also known as fifth disease,
s presents with flulike constitutional symptoms, followed by abdominal pain, arthralgias, and confusion

A. Babesiosis
B. Erythema infectiosum
C. Human granulocytic ehrlichiosis
D. Lyme disease
E. Rocky Mountain Spotted fever
Option C (Human granulocytic ehrlichiosis)
meningitis is classically caused by Neisseria meningitidis. All close contacts should receive prophylactic doses of
rifampin
Fungal meningitis would not be expected in a immunocompetent individual. Cryptococcus and coccidioides may be seen in acquired immune deficiency syndrome (AIDS). Elevated lumbar puncture opening pressure is highly sensitive for

A. Cryptococcus
B. Haemophilus Influenzae type B (HIB)
C. Neisseria meningitidis
D. Streptococcus agalactiae
E. Streptococcus pneumoniae
Option A cryptococcal meningitis.
formerly the leading cause of meningitis among children
It is a rare cause of meningitis.
A. Cryptococcus
B. Haemophilus Influenzae type B (HIB)
C. Neisseria meningitidis
D. Streptococcus agalactiae
E. Streptococcus pneumoniae
Option B (Haemophilus Influenzae type B (HIB)
the leading cause of meningitis in neonates and is not seen in adults.
A. Cryptococcus
B. Haemophilus Influenzae type B (HIB)
C. Neisseria meningitidis
D. Streptococcus agalactiae
E. Streptococcus pneumoniae
ption D (Streptococcus agalactiae)
the leading cause of bacterial meningitis in adults, especially the elderly and asplenic patients.
A. Cryptococcus
B. Haemophilus Influenzae type B (HIB)
C. Neisseria meningitidis
D. Streptococcus agalactiae
E. Streptococcus pneumoniae
Option E (Streptococcus pneumoniae)
However, among special populations (e.g., students, prisons, military). Neisseria meningitidis is more likely.
Meningitis of neonates is most often caused by (2)
E. coli and group B streptococci.
the most common cause of meningitis in children
Neisseria meningitidis
Neisseria meningitidis gram stain
Gram-negative diplococci
Neisseria meningitidis oxidase and catalase
Oxidase and catalase positive
A 17-year-old boy has experienced a penile discharge and painful, burning urination for the last 2 days. He has had nine female sex partners in the last 12 months and irregularly uses barrier contraception. A urethral smear reveals 7 white blood cells (WBCs) per oil-immersion field and no bacteria. What is the most likely cause of these findings?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Chlamydia trachomatis
B. Herpes simplex virus
C. Human papilloma virus
D. Molluscipoxvirus
E. Neisseria gonorrhoeae
F. Treponema pallidum
G. Trichomonas vaginalis
Option A (Chlamydia trachomatis) is correct. This patient has a mucopurulent discharge with more than 5 WBC/high-powered field (hpf), confirming the presence of urethritis. No bacteria were identified, suggesting that this is most likely a case of nongonococcal urethritis. Of the causes of nongonococcal urethritis, Chlamydia trachomatis is felt to be the most common, thought to cause between 25% and 50% of cases.

Option B (Herpes simplex virus) is incorrect. Herpes simplex virus presents with multiple, painful shallow ulcerations with vesicles that is often preceded by localized tingling and burning.

Option C (Human papilloma virus) is incorrect. Human papilloma virus causes genital warts, which presents with hyperkeratotic, verrucous papules.

Option D (Molluscipoxvirus) is incorrect. This is the cause of molluscum contagiosum, which present as pearly white, umbilicated papules.

Option E (Neisseria gonorrhoeae) is incorrect. This is the cause of gonorrhea, and the organism is usually (but not always) identified as gram-negative intracellular diplococci.

Option F (Treponema pallidum) is incorrect. This is the etiologic agent of syphilis. In primary syphilis, there is a painless chancre.

Option G (Trichomonas vaginalis) is incorrect. Trichomonas vaginalis is increasing being recognized as a cause of urethritis, particular in parts of Africa. However, this is a less common cause of nongonococcal urethritis compared to chlamydia.
present as pearly white, umbilicated papules.
A. Chlamydia trachomatis
B. Herpes simplex virus
C. Human papilloma virus
D. Molluscipoxvirus
E. Neisseria gonorrhoeae
F. Treponema pallidum
G. Trichomonas vaginalis
Option D (Molluscipoxvirus)
multiple, painful shallow ulcerations with vesicles that is often preceded by localized tingling and burning.
A. Chlamydia trachomatis
B. Herpes simplex virus
C. Human papilloma virus
D. Molluscipoxvirus
E. Neisseria gonorrhoeae
F. Treponema pallidum
G. Trichomonas vaginalis
Option B (Herpes simplex virus)
A 35-year-old man presents to the emergency department with right-sided weakness for the last several days. The weakness has been progressively worsening over this time. He has a history of human immunodeficiency virus (HIV) infection and has elected not to receive therapy. A head computed tomography (CT) scan is performed and reveals three parenchymal lesions that are spherical and ring-enhancing. Appropriate anti-infective therapy is begun. Two weeks later, the patient returns with right sided hemiparesis and no change on CT. What is the most appropriate next step in the management of this patient?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Addition of clindamycin to current anti-infective therapy
B. Addition of oral steroids to current anti-infective therapy
C. Brain biopsy
D. Cerebrospinal fluid analysis with DNA amplification for Toxoplasma gondii
E. Serology for antitoxoplasma antibodies
Option C (Brain biopsy) is correct. This patient has multiple ring enhancing lesions on CT, which is highly suggestive of toxoplasmosis. However, a significant percentage may be attributed to central nervous system (CNS) lymphoma. If there is failure to respond to therapy, then brain biopsy is indicated to diagnose lymphoma. A trial of therapy is used in a patient not taking prophylaxis when imaging reveals classic signs and serology for antitoxoplasma antibodies is positive. Brain biopsy is avoided if possible, because of the associated morbidity and mortality.
A 35-year-old man presents to the emergency department with right-sided weakness for the last several days. The weakness has been progressively worsening over this time. He has a history of human immunodeficiency virus (HIV) infection and has elected not to receive therapy. A head computed tomography (CT) scan is performed and reveals three parenchymal lesions that are spherical and ring-enhancing. Appropriate anti-infective therapy is begun.
there is a significant midline shift or evidence of raised intracranial pressure. What is the most appropriate next step in the management of this patient?
A. Addition of clindamycin to current anti-infective therapy
B. Addition of oral steroids to current anti-infective therapy
C. Brain biopsy
D. Cerebrospinal fluid analysis with DNA amplification for Toxoplasma gondii
E. Serology for antitoxoplasma antibodies
Option B (Addition of oral steroids to current anti-infective therapy)
A 56-year-old male presents complaining of diarrhea. He was discharged from the otolaryngology service of a nearby hospital 2 days ago. He was admitted for 5 days for the treatment of a peritonsillar abscess. He has been on antibiotics for a total of 7 days now and is having some tenesmus but otherwise no abdominal pain. He has had Clostridium difficile colitis in the past, and notes that the usual treatment of metronidazole (Flagyl) did not clear up his infection. Vital signs are normal and he is afebrile. His abdomen is soft on exam, and his abdominal x-ray does not show colonic dilatation and is otherwise normal. What antibiotic would be appropriate treatment for this patient?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Ampicillin/sulbactam
B. Ciprofloxacin
C. Piperacillin/tazobactam
D. Rifampin
E. Vancomycin
Option E (Vancomycin) is correct. Vancomycin is the treatment of choice for thoseC. difficile infections not responsive to metronidazole. Although this man does not appear toxic, he needs admission secondary to the need for this intravenous treatment.
The antibiotic is used to cover skin and soft tissues infections.
A. Ampicillin/sulbactam
B. Ciprofloxacin
C. Piperacillin/tazobactam
D. Rifampin
E. Vancomycin
A. Ampicillin/sulbactam
is used to treat urinary tract infections and can be used in combination with metronidazole (Flagyl) in diverticulitis.
A. Ampicillin/sulbactam
B. Ciprofloxacin
C. Piperacillin/tazobactam
D. Rifampin
E. Vancomycin
B. Ciprofloxacin
can be used as a broad spectrum antibiotic with pseudomonas coverage
A. Ampicillin/sulbactam
B. Ciprofloxacin
C. Piperacillin/tazobactam
D. Rifampin
E. Vancomycin
C. Piperacillin/tazobactam
can be used in tuberculosis or methicillin resistant Staphylococcus aureus,
A. Ampicillin/sulbactam
B. Ciprofloxacin
C. Piperacillin/tazobactam
D. Rifampin
E. Vancomycin
D. Rifampin
first-trimester pregnant woman presents complaining of diarrhea. He was discharged from the otolaryngology service of a nearby hospital 2 days ago. He was admitted for 5 days for the treatment of a peritonsillar abscess. He has been on antibiotics for a total of 7 days now and is having some tenesmus but otherwise no abdominal pain. What antibiotic would be appropriate treatment for this patient?
A. Ampicillin/sulbactam
B. Ciprofloxacin
C. Piperacillin/tazobactam
D. Rifampin
E. Vancomycin
E. Vancomycin
resents with intensely pruritic and grouped papules and vesicles most commonly on extensor surfaces. The lesions are often bilaterally symmetrical
A. Dermatitis herpetiformis
B. Herpes zoster
C. Lichen planus
D. Psoriasis
E. Tinea corporis
Option A (Dermatitis herpetiformis)
presents with the six Ps: pruritic, purple, polygonal papules located in the periphery and on the penis.
A. Dermatitis herpetiformis
B. Herpes zoster
C. Lichen planus
D. Psoriasis
E. Tinea corporis
Option C (Lichen planus)
Lichen planus presents with the six Ps:
pruritic, purple, polygonal papules located in the periphery and on the penis.
presents with well-defined, erythematous plaques covered with silvery white scales. Most common affected sites are extensor surfaces, scalp, and pressure areas.
A. Dermatitis herpetiformis
B. Herpes zoster
C. Lichen planus
D. Psoriasis
E. Tinea corporis
D. Psoriasis
presents as a pruritic round plaque with scales and an erythematous border with central clearing.
A. Dermatitis herpetiformis
B. Herpes zoster
C. Lichen planus
D. Psoriasis
E. Tinea corporis
Option E (Tinea corporis). Also known as ringworm, this is a fungal infection of the epidermal keratin.
potent liver toxin found in rancid nuts.
Aflatoxin
It is an enteroinvasive organism and may cause hemolytic-uremic syndrome, bloody diarrhea and in the young and elderly, death. The infection lasts 5 to 10 days and includes nausea and vomiting. Raw meat, contaminated vegetables, unpasteurized milk, and apple cider are all potential sources for infection.
A. Aflatoxin
B. Bacillus cereus
C. Escherichia coli
D. Salmonella
E. Vibrio vulnificus
C. Escherichia coli
is a pathogen that is found is shellfish. Patients with liver failure and hemochromatosis are especially susceptible to infection.
A. Aflatoxin
B. Bacillus cereus
C. Escherichia coli
D. Salmonella
E. Vibrio vulnificus
E. Vibrio vulnificus
Giardia infection. Which of the following is the indicated treatment?
A. Diloxanide furanoate
B. Doxycycline
C. Mebendazole
D. Metronidazole
E. Sulfamethoxazole and trimethoprim
Option D (Metronidazole) is correct. The figure shows Giardia intestinalis on the mucosa of the small intestine. This is the correct treatment for the infection.
antihelminthic directed toward larval and egg stages.
A. Diloxanide furanoate
B. Doxycycline
C. Mebendazole
D. Metronidazole
E. Sulfamethoxazole and trimethoprim
A. Diloxanide furanoate
Gastrointestinal whipworm infections among other helminthic infections are treated with this drug
A. Diloxanide furanoate
B. Doxycycline
C. Mebendazole
D. Metronidazole
E. Sulfamethoxazole and trimethoprim
Option C (Mebendazole)
Isosporidium may be treated with this regimen.
A. Diloxanide furanoate
B. Doxycycline
C. Mebendazole
D. Metronidazole
E. Sulfamethoxazole and trimethoprim
Option E (Sulfamethoxazole and trimethoprim)
A 29-year-old man is brought into the emergency room because of a 1-week history of fevers, chills, rigors, and night sweats. He has a history of intravenous (IV) heroin use and last injected heroin earlier today. An echocardiogram reveals valvular vegetations. A chest X-ray shows several nodular densities that are bilaterally distributed throughout the entire lung fields. Cardiac auscultation will most likely reveal what finding?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Crescendo-decrescendo systolic murmur best heard over the upper right parasternal region that radiates into the neck
B. High-pitched pansystolic murmur best heard over the apex that radiates to the axilla
C. Rumbling diastolic decrescendo murmur best heard over the apex
D. Soft pansystolic murmur that increases in intensity with inspiration
E. Three-part, high-pitched scratchy sound heard in systole and diastole on sitting forward and in end-expiration
Option D (Soft pansystolic murmur that increases in intensity with inspiration) is correct. This patient has infective endocarditis with evidence of multiple pulmonary septic emboli. He is also an IV drug user, which makes the most likely cause Staphylococcus aureus involving the tricuspid valve. A key finding is the presence of pulmonary septic emboli that strongly suggests the presence of right-sided infective endocarditis (IE). In many cases of IV drug user (IVDU)–associated IE, the murmur of tricuspid regurgitation is barely audible. Right-sided murmurs increase in intensity on inspiration.
patient has infective endocarditis with evidence of multiple pulmonary septic emboli. He is also an IV drug user, which makes the most likely cause
Staphylococcus aureus involving the tricuspid valve.
Left/Right-sided murmurs increase in intensity on inspiration.
Right-sided murmurs increase in intensity on inspiration.
the murmur of aortic stenosis
. Crescendo-decrescendo systolic murmur best heard over the upper right parasternal region that radiates into the neck
B. High-pitched pansystolic murmur best heard over the apex that radiates to the axilla
C. Rumbling diastolic decrescendo murmur best heard over the apex
D. Soft pansystolic murmur that increases in intensity with inspiration
E. Three-part, high-pitched scratchy sound heard in systole and diastole on sitting forward and in end-expiration
Option A (Crescendo-decrescendo systolic murmur best heard over the upper right parasternal region that radiates into the neck)
mitral regurgitation
A. Crescendo-decrescendo systolic murmur best heard over the upper right parasternal region that radiates into the neck
B. High-pitched pansystolic murmur best heard over the apex that radiates to the axilla
C. Rumbling diastolic decrescendo murmur best heard over the apex
D. Soft pansystolic murmur that increases in intensity with inspiration
E. Three-part, high-pitched scratchy sound heard in systole and diastole on sitting forward and in end-expiration
B. High-pitched pansystolic murmur best heard over the apex that radiates to the axilla
the most common of all murmurs heard in infective endocarditis.
A. Crescendo-decrescendo systolic murmur best heard over the upper right parasternal region that radiates into the neck
B. High-pitched pansystolic murmur best heard over the apex that radiates to the axilla
C. Rumbling diastolic decrescendo murmur best heard over the apex
D. Soft pansystolic murmur that increases in intensity with inspiration
E. Three-part, high-pitched scratchy sound heard in systole and diastole on sitting forward and in end-expiration
ption B (High-pitched pansystolic murmur best heard over the apex that radiates to the axilla) This is the description of mitral regurgitation a
mitral stenosis
A. Crescendo-decrescendo systolic murmur best heard over the upper right parasternal region that radiates into the neck
B. High-pitched pansystolic murmur best heard over the apex that radiates to the axilla
C. Rumbling diastolic decrescendo murmur best heard over the apex
D. Soft pansystolic murmur that increases in intensity with inspiration
E. Three-part, high-pitched scratchy sound heard in systole and diastole on sitting forward and in end-expiration
Option C (Rumbling diastolic decrescendo murmur best heard over the apex)
the sound heard in pericarditis \A. Crescendo-decrescendo systolic murmur best heard over the upper right parasternal region that radiates into the neck
B. High-pitched pansystolic murmur best heard over the apex that radiates to the axilla
C. Rumbling diastolic decrescendo murmur best heard over the apex
D. Soft pansystolic murmur that increases in intensity with inspiration
E. Three-part, high-pitched scratchy sound heard in systole and diastole on sitting forward and in end-expiration
Option E (Three-part, high-pitched scratchy sound heard in systole and diastole on sitting forward and in end-expiration)
the pericardial friction rube. The three components are
atrial systole, ventricular systole, and early diastolic ventricular filling.
A 21-year-old woman is seen in the clinic complaining of pain with urination. She has no other complaints. Her symptoms started 3 weeks ago; she has been to the clinic twice since, and each time urine cultures were negative. Her condition has not improved with antibiotic therapy with sulfonamides and then quinolones. Physical examination is normal. Which of the following organisms is most likely responsible for the patient’s symptoms?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Chlamydia trachomatis
B. Escherichia coli
C. Herpes simplex virus
D. Staphylococcus aureus
E. Trichomonas vaginalis
Option A (Chlamydia trachomatis) is correct. C. trachomatis urethritis accounts for 5% to 20% of cases of dysuria, and its presence may be especially likely when urine cultures are sterile. If clinical symptomatology and urinalysis point to a urinary tract infection, cultures are sterile, and standard antibiotic regimens effective against most urinary pathogens fail, consider chlamydia.
accounts for 70% to 90% of community-acquired urinary tract infections (UTIs) in women.
E. coli
A 31-year-old female presents to the public health clinic after discovering a lesion on her labia majora. She is unsure how long it has been there, and apart from being able to feel it, the lesion is otherwise asymptomatic. Her previous medical history is unremarkable and she is currently sexually active with one male partner. Examination demonstrates a single, 9-mm, exophytic, flesh-color lesion with a jagged, cauliflower-like appearance on the right labia majora.

End of set


Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Acyclovir
B. Benzathine penicillin
C. Ceftriaxone
D. Clindamycin and gentamicin
E. Doxycycline
F. Erythromycin
G. Famciclovir
H. Ganciclovir
I. Lamivudine
J. Lindane
K. Metronidazole
L. Permethrin
M. Podophyllin
N. Valacyclovir
Option M (Podophyllin) is correct. This patient has genital warts, caused by the human papilloma virus (HPV). This is a diagnosis typically made clinically without laboratory investigation. Cauliflower-like exophytic lesions are a classic description of genital warts. Although in this case they were asymptomatic, lesions can be pruritic or painful. The standard form of therapy has been application of podophyllin resin, which is a mitotic poison. There are a variety of therapies for genital warts, including cryotherapy, topical 5-fluorouracil, and trichloroacetic acid.
presents with a flu-like illness, petechiae, hepatosplenomegaly, and jaundice.
A. Babesia microti
B. Bartonella henselae
C. Borrelia burgdorferi
D. Rickettsia rickettsii
E. Treponema pallidum
A. Babesia microti
the causative organism of Cat Scratch disease
Bartonella henselae
Cat Scratch disease classically presents with
regional lymphadenopathy within 2 weeks of exposure to cats. There may also be a pustule or papule at the site of trauma. Fever is present in a minority of cases.
the cause of Rocky Mountain spotted fever (RMSF)
Rickettsia rickettsii)
A 37-year-old woman presents to the physician, because of burning on urination, increased urinary frequency, and urinary urgency. She denies any discharges. She has been previously well and does not take any regular medications. She is married and had one sexual partner for the last 17 years. On examination, she is afebrile, the abdomen is soft and nontender and there is no costovertebral angle tenderness. What is the most appropriate next step in the management of this patient?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Kidney, ureters, bladder (KUB) X-ray
B. Penicillin
C. Renal and bladder ultrasound
D. Trimethoprim-sulfamethoxazole (TMP-SMX)
E. Urine culture
Option D (Trimethoprim-sulfamethoxazole [TMP-SMX]) is correct. The combination of urgency, frequency, and dysuria are highly suggestive of a urinary tract infection (UTI) in women. Treatment is empiric and is usually with TMP-SMX, unless the patient has a sulfa allergy
in women The combination of urgency, frequency, and dysuria are highly suggestive of a
urinary tract infection (UTI)
urinary tract infection (UTI) in women. Treatment is empiric and is usually with
TMP-SMX, unless the patient has a sulfa allergy.
What is the treatment for Acute uncomplicated cystitis:
Trimethoprim/sulfamethoxazole, trimethoprim, a fluoroquinolone, cefpodoxime proxetil for 3 days, or nitrofurantoin for 7 days.
Cystitis in men: tx
Treat for 7 days instead of 3 days, preferably with a fluoroquinolone (which has the best prostatic penetration) or trimethoprim/sulfamethoxazole.
Acute prostatitis: Tx
Treat for 4-6 weeks guided by cultures. For empiric treatment and for gram-negative rods, use a fluoroquinolone or trimethoprim/sulfamethoxazole. For enterococci, use ampicillin or amoxicillin. Gram-positive cocci in clusters (Staphylococcus aureus or S. epidermidis) are treated with a cephalosporin or penicillinase-resistant penicillin (e.g., dicloxacillin), and methicillin-resistant S. aureus requires vancomycin. If obstruction develops, suprapubic catheterization is recommended, not Foley catheterization.
Chronic prostatitis tx
Administer fluoroquinolones or trimethoprim/sulfamethoxazole for 6-12 weeks. Consider C. trachomatis when routine urine and prostatic secretion cultures are negative.