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27 Cards in this Set
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1. An 8-yr-old girl presents to the emergency room (ER) with high fever, nuchal rigidity, widespread ecchymosis scattered over her body, and clinical evidence of hypovolemic shock. A spinal tap reveals increased neutrophils, increased protein, and reduced glucose level. The patient has diffuse bleeding from all venipuncture and intravenous sites. She dies 24 hrs. later. An autopsy reveals bilateral adrenal hemorrhage and purulent meningitis. Which of the following would be observed in the Grams stain of the CSF collected in ER?
A. Gram-positive diplococcic B. Gram-negative rods C. Gram-positive cocci in clusters D. Gram-negative diplococci E. Gram-positive rods |
D. Gram-negative diplococci
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2. A 3-week-old infant was well on discharge from the hospital 10 days ago and remained so until last night, when he appeared drowsy and flushed. His skin felt hot to touch. On physical examination, the infant was very difficult to arouse, but there were no other positive findings. His temperature was 40 0C. Blood cultures grew Gram positive cocci in chains. The colonies on blood agar had narrow zones of beta hemolysis. Hippurate hydrolysis test was positive. What is the likely agent?
A. Streptococcus agalactiae B. Streptococcus pyogenes C. Enterococcus fecalis D. Staphylococcus aureus (narrow & Hipp test +) |
.A. Streptococcus agalactiae
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3. A five year old boy presents with dysphonia and complain of dysphagia, and difficulty in breathing. On examination, a grayish exudates is seen in the posterior pharynx. Cervical lymphnodes are observed to be observed to be tender and very much enlarged. Which is the likely cause of this condition?
A. Neisseria meningitidis B. Corynebacterium diphtheriae C. Streptococcus pyogenes C. Hemophilus influenzae |
.B. Corynebacterium diphtheriae
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3. A 50-year-old male Asian immigrant complains of fever, night sweats, and weight loss of 6 weeks’ duration. He has coughs productive of bloody sputum. Examination reveals a malnourished man with abnormal bronchial breath sounds. Chest x-ray is remarkable for small cavity with streaky infiltrates in right upper lobe and calcified lung lesion and lymph node. What caused this man’s illness?
A. Klebsiella pneumonia B. Mycoplasma pneumonia C. Mycobacterium tuberculosis D. Legionella pneumophila |
C. Mycobacterium tuberculosis
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4. A 30-yr-old young immigrant from Africa presents with a ragged ulcers on the genetalia, with marked tender swellings. The regional lymph nodes are also enlarged. Gram stained smears of the lesions show cocco-bacillary forms in strands. The organism grows well on blood agar and chocolate agar. A further test shows that it does not require V-factor. The organism is:
A. Hemophilus ducreyi B. Hemophilus inluenzae C. Hemophilus aegypticus D. Treponema pallidum |
.A. Hemophilus ducreyi
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5. An AIDS patient develops a chronic cough. The patient has been running low-grade fever. A chest X-ray film is unremarkable. Sputum demonstrates numerous acid-fast bacilli. The patient’s CD4 T-lymphocyte count is 200 microliter. Which of the following organisms is the likely causative agent?
A. Mycobacterium avium-intracellulare B. Mycobacterium tuberculosis C. Mycobacterium bovis D. Mycobacterium leprae |
.A. Mycobacterium avium-intracellulare
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6. An outbreak of Epidemic louse borne typhus is favored by crowded living conditions with poor hygiene and is especially common in parts of central and northeastern Africa. Which of the following causative organisms is spread by a louse and causes epidemic louse borne typhus?
A. Coxiella burnetii B. Rickettsia rickettsii C. Rickettsia tsutsugamushi D. Rickettsia prowazekii E. Rochalimea quintana |
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7. 7. On August 2, 2000, an 18-year-old man residing in Flagstaff, Arizona, presented with a 2-day history of fever, inguinal pain, and diarrhea. His vital signs were as follows: heart rate, 126 beats per minute; respiratory rate, 20 breaths per minute; blood pressure, 130/81 mm Hg. He had buboes on the arms and left leg, left inguinal lymphadenopathy, for which he received a non-steroidal anti-inflammatory drug (NSAID) and was sent home. The next day, the patient developed fatigue and difficulty breathing and fell unconscious while taking a shower. He was transported to the emergency room (ER) where he died shortly after arrival. On August 10, hemocultures obtained in the ER were reported to be positive for gram-negative coccobacilli resembling safety pins. Fluorescent antibody staining confirmed the diagnosis. Epidemiologic investigation established that the patient most likely became infected through flea-bites. What is causative agent of his disease?
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A. Yersinia pestis
B. Ricketts C. Rickettsia. akari D. R. prowazekii |
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81 mm Hg. He had buboes on the arms and left leg, left inguinal lymphadenopathy, for which he received a non-steroidal anti-inflammatory drug (NSAID) and was sent home. The next day, the patient developed fatigue and difficulty breathing and fell unconscious while taking a shower. He was transported to the emergency room (ER) where he died shortly after arrival. On August 10, hemocultures obtained in the ER were reported to be positive for gram-negative coccobacilli resembling safety pins. Fluorescent antibody staining confirmed the diagnosis. Epidemiologic investigation established that the patient most likely became infected through flea-bites. What is causative agent of his disease?
A. Yersinia pestis B. Rickettsia rickettsii C. Rickettsia. akari D. R. prowazekii |
.A. Brucella melitiensis
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8. A previously healthy, 50-yr-old daily farmer is admitted to the hospital. Two months prior to admission, he developed swollen lymph nodes and myalgia. Approximately one week prior, he began having daily fevers, chills, and night sweats. Blood cultures were positive for a Gram negative bacterium after prolonged incubation. Histological examination of a liver biopsy showed non-caseating granulomatous lesions. Which of the following organism is the likely cause?
A. Brucella melitiensis B. Brucella canis C. Brucella ovis D. Salmonella typhi E. Mycobacterium tuberculosis |
.A. Brucella melitiensis
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9. A 40-yr-old man presents to the emergency department because of diplopia and dysphagia that developed after he consumed homemade strawberry jam. While in the emergency department, he develops general weakness and requires intubation due to sudden respiratory muscle paralysis. Which of the following pathogens is most likely to be responsible for the patient’s condition?
A. Staphylococcus aureus B. Clostridium perfringens C. Clostridium botulinum D. Clostridium tetanus E. Bacillus cereus |
.C. Clostridium botulinum
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10. A burn patient developed a wound infection, and a bacteriological culture of the site indicates a Gram negative rod that was oxidase positive and produced a bluish green pigment. The organism is resistant to several antibiotics but is susceptible to ticarcillin, piperacillin and tobramycin. The organism is most likely to be:
A. Escherichia coli B. Klebsiella pneumonia C. Psudomonas aeruginosia D. Aeromonas hydrophila E. Serratia marcescens |
.C. Psudomonas aeruginosia
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11. A 45-yr-old man has an 8-months history of progressive weakness, weight loss of 13 kg, along with intermittent fever, and chronic productive cough, yellowish sputum occasionally streaked with blood. Microscopic examination of sputum demonstrates acid-fast bacilli. Cultures of the sputum on Lowenstein-Jensen medium and Middle Brook agar yield Mycobacterium tuberculosis. Which of the following treatment regimens is most suitable for initial therapy?
A. Isoniazid and rifampin B. Isoniazid, rifampin, pyrazinamide, and ethambutol C. Sulfamethoxazoletrimethoprim and streptomycin D. Rifampin and streptomycin |
.B. Isoniazid, rifampin, pyrazinamide, and ethambutol
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12. A medical student was bitten by infected ticks. In a week, he developed a high fever, headache, muscular aches, nausea, and splenomegaly. Five days later his symptoms subsided. However, 1 week later all his previous symptoms returned. During the next 9 days he went through a recovery and another relapse followed by a final recovery. Which of the following is the most likely etiological agent?
A. Borrelia sp B. Leptospira interrogans C. Treponema carateum D. Treponema pertenue |
.A. Borrelia sp
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13. Ten days after deer hunting in a wooded area, 35-yr-old man developed fever of 39 0C with headache and malaise. Over the subsequent 24 hours, he developed nausea, vomiting, abdominal pain, and diarrhea. On day 4, he developed a rash, initially around the wrists and ankles, which then progressively evolved, involving the arms, trunk, palms and soles. Initially the rash was macular, but it quickly progressed into maculopapules, some with central petechiae. The history of the case and symptoms are suggestive of which of the following diseases?
A. Rocky mountain spotted fever B. Lyme disease C. Scrub typhus D. Epidemic typhus |
.A. Rocky mountain spotted fever
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14. A 20-yr-old male come to your clinic and presents for evaluation of a new genital lesion. He returned from spring break last week and noticed a painless ulcer on his scrotum. He admits to several instances of unprotected sexual intercourse. On physical examination you noticed a well demarcated, 2 cm painless lesion could be called chancre with a raised border on the scrotum. You clinically diagnosed the case and asked him to provide the contact details of his sexual partners as it is required by law to report to health department. What is your diagnosis?
A. Syphilis B. Chlamydia C. Genital herpes D. All of above E. None of above’ . |
.A. Syphilis
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15. A 27-yr-old medical resident was admitted to the hospital because of sudden onset of fever and headache. Two weeks earlier he had vacationed in rural Oregon, where he had frequently gone swimming an irrigation canal that bordered a cow pasture. Blood tests done shortly after admission indicated renal function abnormality and elevated bilirubin and other live function tests. Routine blood, urine and CSF cultures were negative. Which is the most likely provisional diagnosis?
A. Viral hepatitis B. Leptospirosis C. Liver abscess due to Entamoeba histolytica D. Malaria |
.B. Leptospirosis
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16. A college student went on a Connecticut camping trip. He is not seeking medical treatment for an expanding skin rash on his arm. The physician notes an annular, red rash with clear area in the center. The student complains of fever, headache, arthralgias, and stiffness of neck. He does not remember being bitten by an insect but he did find ticks in his sleeping bag. He was treated with doxycycline and fully recovered. He was checked thoroughly for cardiac and CNS problems. Which organism is causing this clinical case?
A. Rickettsia rickettsii B. Coxiella burnetii C. Borrelia burgdorferi D. Treponema pertenue |
.C. Borrelia burgdorferi
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17. A 45-yr-old woman presents with a 4 months history of productive cough, weight loss, and fever. Chest X-ray shows bilateral cavitary disease suggestive of tuberculosis. Sputum culture grows an acid bacillus that is a photochromogen (produces an orange pigment when exposed to light). The organism is most likely to be:
A. Mycobacterium tuberculosis B. Mycobacterium kansasi C. Mycobacterium inracellullare D. Mycobacterium fortuicum’ . |
.B. Mycobacterium kansasi
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18. A 38-yr-old mother brings her one year old child to your clinic. The child presents with a fulminating obstructive laryngo-tracheitis with epiglottitis, appearing cherry requiring tracheostomy or intubation as a life-saving procedure. What is the likely agent of the infant’s ailment?
A. Streptococcus pyyognees B. Streptococcus pneumonia C. Hemophilus inluenzae D. Hemophilus aegypticus’ . |
.C. Hemophilus inluenzae
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19. Four university students ate a mean that included undercooked chicken. Within 3 days, they developed headache, myalgia, fever, abdominal pain and diarrhea. Stool cultures grew Campylobacter jejuni. Which of the following culture conditions was most likely used for recovering the organism?
A. Salmonella-Shigella selective medium incubated at 370C in ambient aie B. MacConkey agar incubated at 370C in 5% O2 and 10% CO2 C. TCBS medium incubated at 370C in 5% O2 and 10% CO2 D. A medium containing vancomycin, polymyxin B, and trimethoprim incubated at 420C in 5% O2 and 10% CO2’ . |
.D. A medium containing vancomycin, polymyxin B, and trimethoprim incubated at 420C in 5% O2 and 10% CO2’ ./
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20. A 35-yr-old alcoholic man presents with severe multilobar pneumonia. He requires intubation and mechanical ventilation. A Gram stain of his sputum reveals Gram negative rods that appear to have a capsule. The organism forms pinkish mucoid colonies on MacConkey agar. It is non-motile and positive for lysine decarboxylase. What is the organism most like to be responsible for man’s illness?
A. Enterobacter aerogenes B. Escherichai coli C. Klebsiella pneumoniae D. Serratia marcescens’ . |
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21. . A patient from Washington DC presents to the emergency room with bloody diarrhea for the last 12 hrs. He has not recently travelled out of the area. Which one of the following is unlikely to be the cause of the patient’s diarrhea?
A. Salmonella typhimurium B. Campyobacter jejuni C. Vibrio cholerae D. Shigells sonnei’ . |
.A. Salmonella typhimurium
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22. Humans become infected with Legionella pneumophila by:
A. Drinking water contaminated with Legionella pneumophila B. Kissing a person who is a carrier of L. pneumophila C. Breathing aresols from an environmental source contaminated with Legionella pneumophila D. Consuming under-cooked pork’ 23. An outbreak of Epidemic louse borne typhus is favored by crowded living conditions with poor hygiene and is especially common in parts of central and northeastern Africa. Which of the following causative organisms is spread by a louse and causes epidemic louse borne typhus? A. Coxiella burneti B. Rickettsia rickettsii C. Rickettsia tsutsugamushi D. Rickettsia prowazekii ‘. |
.C. Breathing aresols from an environmental source contaminated with Legionella pneumophila
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23. An outbreak of Epidemic louse borne typhus is favored by crowded living conditions with poor hygiene and is especially common in parts of central and northeastern Africa. Which of the following causative organisms is spread by a louse and causes epidemic louse borne typhus?
A. Coxiella burneti B. Rickettsia rickettsii C. Rickettsia tsutsugamushi D. Rickettsia prowazekii |
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24. A 20-yr-od sexually active college girl goes to the college health center with complaints of dysuria, frequency and urgency on urination for 24 hrs. On urinalysis, many polymorphonuclear leucocytes are seen. The most likely organism likely to be responsible for these symptoms is:
A. Staphylcooccous aures B. Lactobacillus species C. Escherichia coli D. Gardenella vaginalis E. Trichomonas vaginalis’ . |
.C. Escherichia coli
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25. A 57-yr-old woman with a history of urinary tract infection comes to the emergency room with burning sensation on urination, and also frequent urination and sense of urgency to urinate. She mentions that her urine smells like ammonia. The cause of her urinary tract infection is likely to be:
A. Enterobacter aerogenes B. Escherichai coli C. Proteus mirabilis D. Serratia marcescens’ . |
.C. Proteus mirabilis
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