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30 Cards in this Set
- Front
- Back
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All of the following refer to cases of uncomplicated urinary tract infections, except:
A. pyelonephritis in an otherwise healthy young woman B. cystitis in a paralyzed young man with a spinal injury C. cystitis in a young healthy man D. a post-menopausal woman with cystitis E. a young healthy woman with cystitis |
B. cystitis in a paralyzed young man with a spinal injury.
The difference between complicated and uncomplicated UTIs is that once an uncomplicated UTI is treated, there is an expectation that the disease will resolve whereas a complicated UTI may have recurrences or long-term consequences - frequently due to an underlying predisposing condition. QCCP2, Urinary tract infection |
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Which of the following situations may require treatment?
A. pregnant woman with asymptomatic bacteriuria B. patients with asymptomatic bacteriuria during cystoscopy C. pediatric patient with hypospadias and asymptomatic bacteriuria D. A & B E. A, B, C |
E. A, B, C.
For the most part asymptomatic bacteriuria does not require treatment. It is defined as >103CFU/mL in a voided urine specimen (actually, two consecutive samples in a woman due to the high contamination rate) without the symptoms of cystitis (frequency, urgency, dysuria, etc). QCCP2, UTI |
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Which of the following tests for urinary tract infections has the highest specificity?
A. microscopic hematuria B. urine dipstick positive for hemoglobin C. microscopic detection of pyuria D. urine dipstick positive for nitrite E. urine dipstick positive for leukocyte esteras |
D. urine dipstick positive for nitrite.
All of the tests presented have fairly high sensitivity, but only the presence of nitrite is somewhat specific. Since the nitrite test requires the presence of bacteria capable of reducing nitrate to nitrite any bug unable to do so will not be detected, eg, enterococci. The most sensitive and specific surrogate to detect UTI is a combination of leukocyte esterase and nitrite. QCCP2, Lab approach |
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According to the Infectious Disease Society of America (IDSA) what bacterial concentration should be considered the minimum for the diagnosis of cystitis?
A. >101 CFU/mL B. >102 CFU/mL C. >103 CFU/mL D. >104 CFU/mL E. >105 CFU/mL |
C. >103 CFU/mL.
It may appear nitpicky, but the traditional teaching has always been >105 CFU/mL based on studies that showed bacterial levels that high were strongly correlated with pyelonephritis. More recent studies have shown lower levels of bacteriuria may be associated with disease and require treatment. pyelonephritis. More recent studies have shown lower levels of bacteriuria may be associated with disease and require treatment. QCCP2, Laboratory approach |
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All of the following organisms are causes of culture negative urinary tract infections, except:
A. Ureaplasma urealyticum B. Corynebacterium D2 C. Chlamydia spp D. Mycoplasma hominis E. all of the above are causes of culture-negative UTIs |
B. C D2.
Corynebacterium is a common cause of hospital-acquired UTI and is capable of being cultured, unlike the other organisms, which are common causes of culture-negative UTI. QCCP2, Specific agents |
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Which of the following organisms is most commonly associated with hemorrhagic cystitis in bone marrow transplant patients?
A. BK virus B. CMV C. HSV D. adenovirus E. E. coli |
D. adenovirus.
Adenovirus, especially serotype 11 is associated with the hemorrhagic cystitis that can be seen in immunosuppressed patients, especially those post-bone marrow transplant. QCCP2, Specific agents |
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What is the most common cause of infectious diarrhea in an otherwise healthy patient?
A. Hepatitis A B. norovirus C. E. coli D. D. Salmonella E. Clostridium spp |
B. norovirus.
Viruses account for the vast majority of cases of infectious diarrhea, especially the members of the norovirus family. Bacterial causes are responsible for 10% of the cases with E. coli accounting for the majority of those cases. QCCP2, Infectious diarrhea |
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Which of the following organisms should be at the top of the differential diagnosis of bloody diarrhea without fecal neutrophils?
A. norovirus B. enterohemorrhagic E. coli C. Entamoeba D. Vibrio E. Campylobacter |
B. enterohemorrhagic E .
E. coli O157:H7, or enterohemorrhagic E. coli (EHEC), should be considered in the presentation of bloody diarrhea without neutrophils. The presence of neutrophils with bloody diarrhea suggests other causes, such as Clostridium difficile, Salmonella, Campylobacter, and Shigella. QCCP2, Infectious diarrhea, Differential diagnosis |
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All of the following symptoms are associated with hemolytic uremic syndrome, except:
A. mental status changes B. microangiopathic hemolytic anemia C. renal failure D. thrombocytopenia E. fever |
A. mental status changes.
The hemolytic uremic syndrome associated with E. coli O157:H7 bears many similarities to the thrombotic thrombocytopenic purpura due to decreased amounts of ADAMTS-13 protein. The major difference in the clinical presentation between HUS and TTP is that patients with TTP will exhibit neurological symptoms, which usually ADAMTS-13 protein. The major difference in the clinical presentation between HUS and TTP is that patients with TTP will exhibit neurological symptoms, which usually manifest as mental status changes. QCCP2, Infectious diarrhea - specific agents |
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All of the following patients are at an elevated risk of salmonellosis, except:
A. an otherwise healthy 6-month-old baby B. a 24-year-old HIV(+) man C. a 93-year-old otherwise healthy woman D. an otherwise healthy 33-year-old man E. a 62-year-old man with a prosthetic hip |
D. an otherwise healthy 33-year-old man.
A number of groups are at an increased risk of Salmonella bacteremia, the primary cause of morbidity in patients infected with Salmonella. These include the immunocompromised (choice B), the very young (choice A), the very old (choice C), and those with permanent prosthetic devices (choice E). QCCP2, Infectious diarrhea - specific agents |
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Which of the following is the most common cause of Guillain-Barre syndrome?
A. Campylobacter jejuni B. Helicobacter pylori C. Clostridium difficile D. Escherichia coli E. Clostridium perfringens |
A. C .
Overall, the majority of cases of GBS (~70%) have either no identifiable cause or are due to a multitude of different organisms. C. jejuni accounts for the largest percentage of cases due to a single identifiable organism. QCCP2, Infectious diarrhea - specific agents |
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Which of the following HLA haplotypes is associated with the enteropathic arthritis of Campylobacter jejuni?
A. HLA-A4 B. HLA-B7 C. HLA-B27 D. HLA-DR4 E. HLA-DP7 |
C. HLA-B27.
The reactive arthropathy, or Reiter syndrome ("Can't see [uveitis], can't pee [urethritis], can't climb a tree [arthritis]"), is seen predominantly in patients expressing the HLA-B27 allele. QCCP2, Infectious diarrhea - specific agents |
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Which of the following serotypes of Vibrio cholerae are responsible for the majority of cases of epidemic cholera?
A. O1 B. O139 C. O233 D. A & B E. A, B, C |
D. A & B.
While O1 and O139 cause epidemic cholera (voluminous rice water stools), other non-O1, non-O139 strains can cause self-limited colitis or, less commonly, wound infections. Most cases of cholera are due to the consumption of contaminated shellfish or rice. QCCP2, Specific agents - Vibrio |
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Which of the following Vibrio species is the most common cause of food-borne diarrhea in Japan?
A. V. cholerae B. V. parahemolyticus C. V. vulnificus D. V. enterocolitica E. V. perfringens |
B. V .
Both V. parahaemolyticus and V. vulnificus are associated with exposure to contaminated seafood or seawater. A common history of eating seafood or getting cut while either swimming in the sea or cleaning a fish tank is often seen. V. parahaemolyticus is much more common than V. vulnificus. QCCP2, Specific agents |
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Which of the following plasmids is associated with pathogenicity in Yersinia enterocolitica and can be detected with DNA-based assays?
A. pYE B. pYV C. pYP D. pmecA E. pYR5 |
B. pYV.
This may be more detail than many people want about Yersinia enterocolitica, but it is an easy subject for a test question. Another important fact about Yersinia is that, like Campylobacter, infections can be seen in a higher percentage of patients expressing the HLA-B27 allele and the associated reactive arthropathy. QCCP2, Infectious diarrhea - specific agents |
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Which of the following routine tests for Entamoeba histolytica has the highest sensitivity and specificity?
A. colonic ulcer biopsy B. stool culture C. stool microscopy D. stool EIA E. stool PCR |
D. stool EIA.
Neither culture nor PCR are routinely performed in cases of suspected Entamoeba histolytica. Biopsy and stool microscopy are limited by both the paucity of organisms and the possible presence of related non-pathogenic Entamoeba species, such as E. dispar. Enzyme-linked immunoassay has the highest sensitivity and specificity. QCCP2, Infectious diarrhea, specific agents |
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Which of the following agents is the most common cause of pediatric viral gastroenteritis?
A. adenovirus, serotypes 40 and 41 B. Norwalk virus C. coronavirus D. astrovirus E. rotavirus |
E. rotavirus.
While Norwalk virus is a common cause of viral gastroenteritis in all age groups, pediatric patients are most often infected with rotavirus. Norwalk virus is the most common cause of adult viral gastroenteritis and is often responsible for the diarrheal outbreaks on cruise ships, resorts, or nursing homes. Norwalk viruses are spread by food and person-to-person contact. QCCP2, Infectious diarrhea, specific agents |
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Which of the following tests can act as a substitute for microscopic leukocyte detection?
A. stool nitrite B. stool leukocyte esterase C. stool culture D. peripheral blood smear E. stool lactoferrin |
E. stool lactoferrin.
Stool microscopy is a laborious process utilized to detect the presence of leukocytes as well as ova and parasites. Instead of searching for leukocytes, one can perform assays that detect the production of a protein produced by neutrophilic lactoferrin. QCCP2, Infectious diarrhea, specific agents |
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Which of the following agents is a very common cause of community-acquired pneumonia but is rare in cases of pneumonia in elderly persons living in nursing homes?
A. Streptococcus pneumoniae B. Mycoplasma pneumoniae C. Haemophilus influenzae D. Klebsiella pneumoniae E. Serratia marascesens |
B.Mycoplasma pneumoniae
Atypical causes of community-acquired pneumonia, such as Mycoplasma pneumoniae and Chlamydia pneumoniae, are much less often a cause of pneumonia in the nursing home. S. pneumoniae tops the list, followed by Haemophilus influenzae, but also other causes, such as aspirated oral flora (aerobic gram-negative bacilli and anaerobes), are common causes of pneumonia in the communally-living elderly. QCCP2, Pneumonia, differential diagnosis |
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Which of the following people is at the greatest risk of coccidiomycosis?
A. a Missouri cattle rancher B. a homeless alcoholic C. a Wyoming rabbit rancher D. a Central Valley California migrant worker E. a pregnant woman with several housecats |
D. a Central Valley California migrant worker.
Valley fever, or San Joaquin fever, are caused by Coccidioides immitis, which is seen in high, dusty deserts, such as those found in S.E. California, Arizona, and New Mexico. Sandstorms are responsible for spreading the spores. QCCP2, T3.1, Risk factors for agents of pneumonia |
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Which of the following organisms is a more common cause of pneumonia in patients with cystic fibrosis than in patients without cystic fibrosis?
A. Legionella pneumophila B. Pseudomonas aeruginosa C. Coccidioides immitis D. Coxiella burnetti E. Moraxella catarrhalis |
B.Pseudomonas aeruginosa
Pseudomonas (both P. aeruginosa and P. cepaciae), Burkholderia, and Stenotrophomonas, all gram-negative, lactose non-fermenting organisms - as well as Staphylococcus aureus - are often seen as causes of pneumonia in patients with cystic fibrosis. QCCP2, T3.1 |
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All of the following are acceptable diagnostic tools for pneumococcal pneumonia, except:
A. sputum culture B. bronchoscopic biopsy C. bronchoalveolar lavage D. blood culture E. all of the above are acceptable |
A. sputum culture.
A very high percentage (up to 10%) of normal healthy adults are colonized with Streptococcus pneumoniae, leading to a very high false positive rate. Bacteremia occurs at a very high rate with Pneumococcus, making blood culture a viable tool to diagnose pneumonia. In addition, a urine antigen that tests similar to the one utilized for the diagnosis of Legionella has a potential use in the future. QCCP2, Pneumonia, specific agents |
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Which of the following risk factors increase the risk of Haemophilus influenzae pneumonia?
A. corticosteroid use B. antibiotic use C. chronic obstructive pulmonary disease D. A & B E. A, B, C |
E. A, B, C.
Haemophilus influenzae causes a severe pneumonia seen most often in patients with COPD, especially those with more chronic bronchitis than emphysema and those who are treated with antibiotics or steroids QCCP2, Pneumonia, specific agents |
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Which of the following electrolyte abnormalities is associated with Legionella pneumophila infection?
A. hypoglycemia B. hyperkalemia C. hyponatremia D. hyperchloremia E. hypomagnesemia |
C. hyponatremia.
Patients with Legionnaire disease develop very severe illness with very high fever, mental status changes and hyponatremia. Diagnosis can be made with culture, but a rapid urinary antigen test is also available. QCCP2, Pneumonia, specific agents |
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Which of the following features is associated with pseudomonal pneumonia?
A. chronic carriage B. severe necrotizing pneumonia C. empyema formation D. A & B E. A, B, C |
D. A & B.
It is important to note that Pseudomonas often leads to a chronic state with frequent re-infections, even with treatment. Also, the pneumonia associated with Pseudomonas is severe, with necrosis and an acute respiratory distress syndrome presentation. QCCP2, Pneumonia, specific agents |
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What is the most common way to diagnose Chlamydia pneumoniae pneumonia?
A. urine antigen test B. bronchoalveolar lavage and culture C. bronchoalveolar lavage and microscopy D. serology E. transbronchial biopsy |
D. serology.
While culture is the gold standard, it is difficult to obtain appropriate specimens, so culture is not often performed. Serology is the most often used means to diagnose C. pneumoniae, with either a 4-fold increase in IgG or an IgM titer >1:16. QCCP2, Pneumonia, specific agents |
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Hanta, or Sin Nombre, virus is a bunyavirus found in the four corners area of the U.S. (Arizona, New Mexico, Nevada, Colorado). What is the vector?
A. deer mouse B. Norwegian rat C. domestic canine D. human E. Ixodes tick |
A. deer mouse.
Peromyscus maniculatus, or the deer mouse, spreads the virus in its infected feces. People living in close contact with animals are at a particularly high risk. Infected individuals experience a flu-like prodrome with thrombocytopenia, followed by additional peripheral blood findings, such as increased immunoblastic lymphocytes (>10%). Finally, patients develop ARDS where more than 1/3 of patients don't survive. QCCP2, Viral pneumonia |
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Which type of virus causes severe acute respiratory syndrome?
A. paramyxovirus B. enterovirus C. rhinovirus D. coronavirus E. calicivirus |
D. coronavirus.
SARS is a severe respiratory disease spread from human to human and caused by a coronavirus (SARS-CoV). After a 1-2 week incubation, patients develop acute respiratory distress syndrome. QCCP2, Viral pneumonia |
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Which criterion is most helpful in formulating the differential diagnosis of infective endocarditis?
A. patient age B. status of underlying valve C. patient gender D. medication list E. exposure history |
B. status of underlying valve.
The differential diagnosis of organisms that cause infective endocarditis can be divided according to valve status: the organisms that infect normal valves are different from those that infect abnormal native valves and those that infect prosthetic valves. QCCP2, Infective endocarditis, differential diagnosis |
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What is the most common agent causing normal native valve endocarditis?
A. S. milleri B. S. pneumoniae C. viridans Streptococcus D. S. aureus E. S. epidermis |
D. S .
The most common cause of normal native valve endocarditis is S. aureus, which leads to a severe and destructive infection. Other potential causes of normal native valve endocarditis can include S. milleri and enterococci. Abnormal native valves are usually victim to less severe, subacute endocarditis, caused by viridans Strep or the HACEK organisms. Prosthetic valves are most commonly infected by Staphylococcus epidermidis. QCCP2, Infectious endocarditis, differential diagnosis |
