Xenopsylla cheopis is the vector responsible for which infectious disease? 1 Human Monocytic Ehrlichiosis 2
Human Granulocytic Ehrlichiosis
3
Scrub typhus
4
Epidemic typhus
5
Endemic typhus Q/Q(M)-474269 Report a Problem Xenopsylla cheopis is the vector responsible for which infectious disease? 5 Endemic typhus Xenopsylla cheopis cheopis (rat flea) is the vector of endemic typhus, which is caused by R. typhi. Q/Q(M)-474269 Report a Problem Butcher's warts are caused by which human papilloma virus (HPV) type? 1 7 2
2
3
3
4
5
5
13 Q/Q(M)-474297 Report a Problem Butcher's warts are caused by which human papilloma virus (HPV) type? 1 7 Butcher's warts are caused by HPV type 7. Q/Q(M)-474297 Report a Problem Tricomycosis axillaris is caused by: 1 Burkholderia mallei 2
Proteus species
3
Corynebacterium tenuis
4
Micrococcus sedentarius
5
Corynebacterium minitissimum Q/Q(M)-474539 Report a Problem Tricomycosis axillaris is caused by: 3 Corynebacterium tenuis Corynebacterium Corynebacterium tenuis is the causative organism associated with most cases. Although up to 33% of adults have colonization by this bacterium in the inguinal or axillary regions, factors such as hyperhidrosis predispose predispose to more extensive growth and resultant clinical manifestations. Q/Q(M)-474539 Report a Problem A 43 year-old man with wit h uncontrolled HIV disease presents with yellowish, red papules, draining sinuses and ulcers perianally and periurethrally. Which histopathological or immunohistochemical stain may aid in diagnosis? 1 CD3 2
CD20 1
3
Von Gieson (EVG)
4
Von Kossa
5
Steiner Q/Q(M)-477607 Report a Problem A 43 year-old man with wit h uncontrolled HIV disease presents with yellowish, red papules, draining sinuses and ulcers perianally and periurethrally. Which histopathological or immunohistochemical stain may aid in diagnosis? 4 Von Kossa The most likely diagnosis is malacoplakia. malacoplakia. Malacoplakia, an infection usually attributed to S. aureus, P. aeruginosa, or E. coli is characterized histopathologically histopathologically by Michelis-Gutmann bodies. These are foamy eosinophilic macrophages containing calcified, laminated, intracytoplasmic bodies. They can be highlighted by a calcium stain such as von Kossa. CD3 and CD20 are lymphocy l ymphocyte te markers, von Gieson is an elastic tissue stain, and Steiner stain is used to highlight spirochetes. These would not aid in the diagnosis of malacoplakia. Q/Q(M)-477607 Report a Problem Which of the following is true regarding the Gardasil vaccine? 1 It is a live vaccine 2
It is FDA approved for females aged 18 to 25
3
It protects against HPV 16 and 18 only
4
It can be administered regardless of history of abnormal pap smear
5
It does not protect against genital warts Q/Q(M)-482490 Report a Problem Which of the following is true regarding the Gardasil vaccine? 4 It can be administered regardless of history of abnormal pap smear Gardasil is a quadrivalent vaccine containing HPV types types 6, 11, 16 and 18. It is approved for females ages 9 to 26. Neither HPV testing nor pap smears are necessary before vaccine administration. It is recommended recommended for the t he prevention of cervical, vaginal, and vulvar cancers, as well as for genital warts. Q/Q(M)-482490 Report a Problem Streptococcus Iniae has been shown to cause: 1 Perianal dermatitis in neonates 2
Necrotizing fasciitis
3
Bullous impetigo
4
Hand cellulitis in fish handlers
5
Perineal erysipelas in postpartum women Q/Q(M)-477424 Report a Problem Streptococcus Iniae has been shown to cause: 4 Hand cellulitis in fish handlers Streptococcus iniae has been demonstrated to cause hand cellulitis from puncture wounds sustained form the dorsal fin, fish bone or knife of usually a tilapia. Treatment with PCN is curative. Group A Streptococci are the most common cause of perianal dermatitis. Many different bacteria have been implicated in necrotizing fasciitis. Bullous impetigo is most frequently caused by phage type 71 S. aureus or a related group 2 phage type. Group B streptococcus st reptococcus is most often responsible for perineal 2
erysipelas in postpartum women. Q/Q(M)-477424 Report a Problem The causative organism for Brucellosis is which of the following: 1 Gram positive rod 2
Gram positive cocci
3
Gram negative rod
4
Gram negative cocci
5
Acid fast bacilli Q/Q(M)-477610 Report a Problem The causative organism for Brucellosis is which of the following: 3 Gram negative rod Brucella species which cause Brucellosis are gram negative rods. Brucellosis, aka undulant fever, is characterized by an acute febrile illness with headache and joint pain. CNS and cardiac manifestations can also occur. It is acquired by contact with infected animals or contaminated dairy products. Treatment is with doxycycline and rifampin. Q/Q(M)-477610 Report a Problem What is the vector for this nematodal infection? 1 Water flea (Cyclops) 2
Tsetse fly (Glossine morsitans)
3
Reduviid bug
4
Mango fly (Chrysops)
5
Black fly (Simulium) Q/Q(M)-476850 Report a Problem What is the vector for this nematodal infection? 4 Mango fly (Chrysops) Loiasis is caused by the nematode loa loa. It is transmitted by the mango fly (Chrysops (Chr ysops dimidia or CHrysops silacea). It may manifest with painful, localized subcutaneous subcutaneous nonpitting edema called calabar swellings. Conjunctival migrations are also common. Q/Q(M)-476850 Report a Problem A patient from South America develops a recurrent fever after living in crowded conditions with multiple roommates having known human body louse infestation. A diagnosis of louse-born Relapsing Fever is made. Which of the following is the implicated organism? 1 Borrelia recurrentis 2
Borrelia duttonii
3
Borrelia hermsii
4
Borrelia burgdorferi
5
Streptobacillus moniliformis Q/Q(M)-482686 Report a Problem A patient from South America develops a recurrent fever after living in crowded conditions with multiple roommates having known human body louse infestation. A diagnosis of louse-born Relapsing Fever is made. Which of the following is the implicated organism? 3
1 Borrelia recurrentis Louse-born relapsing fever is caused by Borrelia recurrentis. It is i s seen in Africa Af rica and South America, and is spread by the human body louse (Pediculus humanus). Symptoms include paroxysmal paroxysmal fevers, headache, headache, myalgias, and petechial macules on trunk and extremities. Borrelia burgdorferi causes Lyme disease; Borrelia duttonii and Borrelia hermsii cause tick-born Relapsing Fever; Streptobacillus moniliformis causes Rat-bite fever. Q/Q(M)-482686 Report a Problem Pediculus humanus corporis can transmit: 1 Murine typhus 2
Epidemic typhus
3
Scrub typhus
4
Endemic typhus
5
Oriental typhus Q/Q(M)-479607 Report a Problem Pediculus humanus corporis can transmit: 2 Epidemic typhus The body louse or Pediculus humanus corporis transmits Rickettsia prowasekii the organism responsible for epidemic typhus. Endemic typhus or murine typhus is caused by R. typhi that is transmited by the rat flea/Xenopsylla cheopis. cheopis. Scrub typhus is caused by R. tsutsugamushi and is transmitted by chiggers or trombiculid mite larvae. Q/Q(M)-479607 Report a Problem A 10 year-old with a 3-day history of fever and headache presents to the clinic with multiple erythematous papulopustules papulopustules on his extremities, many of which have central eschars. The most likely diagnosis is: 1 Lyme disease 2
Rickettsialpox
3
Erlichiosis
4
Rocky mountain spotted fever
5
Meningococcemia Q/Q(M)-477181 Report a Problem A 10 year-old with a 3-day history of fever and headache presents to the clinic with multiple erythematous papulopustules papulopustules on his extremities, many of which have central eschars. The most likely diagnosis is: 2 Rickettsialpox Rickettsialpox is an acute febrile illness caused by the t he bacteria Rickettsia akari, a member of the spotted fever group. R. akari is transmitted by the house mouse mite, Liponyssus Liponyssus sangineus. Clinically, patients have an eschar at the inoculation site sit e with a subsequent subsequent papulovesicular rash, fevers, headache, chills, diaphoresis, myalgia, and anorexia. Q/Q(M)-477181 Report a Problem A 4 year-old boy is diagnosed with Staphylococcal Scalded-Skin Syndrome. Syndrome. Vesiculation in this disease is secondary to exfoliative toxins binding what target protein? 1 Plectin 2
Bullous pemphigoid antigen 2 4
3
Bullous Pemphigoid antigen 1
4
Desmoglein 3
5
Desmoglein 1 Q/Q(M)-477602 Report a Problem A 4 year-old boy is diagnosed with Staphylococcal Scalded-Skin Syndrome. Syndrome. Vesiculation in this disease is secondary to exfoliative toxins binding what target protein? 5 Desmoglein 1 Staphylococcus Staphylococcus Scalded-Skin Syndrome (SSSS) is caused by Staphylococcus exfoliative toxins A and B binding desmoglein desmoglein 1. This results in the intraepidermal split split at the granular layer layer seen in this illness. illness. Targeting of desmoglein 3 would result in a suprabasilar split. Targeting of plectin, BPAG1, or BPAG2 would result in a subepidermal split. This is not seen in SSSS. Q/Q(M)-477602 Report a Problem Most common causative organism of the attached picture is 1 Corynebacterium Corynebacterium minutissimum 2
Corynebacterium Corynebacterium tenuis
3
Micrococcus sedentarius
4
Staphylococcus
5
Streptococcus Q/Q(M)-482123 Report a Problem
Most common causative organism of the attached picture is 3 Micrococcus sedentarius The image shows Pitted keratolysis. It is a non-inflammatory bacterial infection caused by microcolonies of Micrococcus sedentarius or Corynebacterium species that produce a specific proteolytic enzyme enzyme which digests the stratum corneum. It It consists of small crater-like depressions depressions in the stratum corneum, and usually appear on the weight-bearing regions of the soles of the feet, but can occur in other non weight-bearing areas as shown in i n image. This was confirmed with shave biopsy of epidermis that is step-sectioned and stained with methenamine methenamine silver as this is found f ound to be more helpful than a punch biopsy. The disease usually goes unnoticed by patients and is most often an incidental finding. Hyperhidrosis and malodor of the skin are very common findings. Micrococcus sedentarius is the causative agent for erythrasma, and Corynebacterium tenius causes trichomycosis Axillaris. Q/Q(M)-482123 Report a Problem A 24 year old male presents with a high hi gh fever, arthralgias, and a rash r ash characterized by nonspecific erythematous macules in a generalized distribution. He was recently cleaning his family\'s famil y\'s barn, and was bitten more than once once by rats and and mice. What is the treatment of choice for this infection? 5
1
Penicillin
2
Erythromycin
3
Clindamycin
4
Ciprofloxacin
5
Amikacin Q/Q(M)-482688 Report a Problem A 24 year old male presents with a high fever, arthralgias, and a rash characterized by nonspecific nonspecific erythematous macules in a generalized distribution. He was recently cleaning his family\'s famil y\'s barn, and was bitten more than once once by rats and and mice. What is the treatment of choice for this infection? 1 Penicillin Rat-bite fever is also called Haverhill Fever. It is caused by Streptobacillus moniliformis and is acquired from infected rodents or by b y touching or eating contaminated food. The signs and symptoms are nonspecific, but the diagnosis can be suspected based on history. Treatment is with penicillin. Q/Q(M)-482688 Report a Problem Which porphyrin is responsible for the fluorescence under Wood's lamp examination of erythrasma? 1
Porphobilinogen
2
Protoporphyrin IX
3
Coproporphyrin III
4
Uroporphobilinogen
5
Coproporphyrinogen Q/Q(M)-476510 Report a Problem
Which porphyrin is responsible for the fluorescence under Wood's lamp examination of erythrasma? 3 Coproporphyrin Coproporphyrin III Erythrasma is caused by corynebacterium corynebacterium minutissimum. The presence of coprophyrinogen III created by the bacteria bacteria is responsible for the characteristic coral-red coral-red fluorescence under under Wood's lamp. lamp. Q/Q(M)-476510 Report a Problem A 62 year-old man presents with tinnitus, facial paralysis, and vesicles of the external ear. What is the most likely diagnosis? 1 Primary Herpes Simplex infection 2
Primary Varicella Infection
3
Herpes Zoster Infection
4
Cytomegalovirus Cytomegalovirus infection
5
Coxsackievirus A16 infection Q/Q(M)-478210 Report a Problem
A 62 year-old man presents with tinnitus, facial paralysis, and vesicles of the external ear. What is the most likely diagnosis? 6
3 Herpes Zoster Infection This patient has Ramsay Hunt Syndrome, herpes zoster infection of the geniculate ganglion. Vesicles can be seen on the tympanic t ympanic membrane and the external ear. Symptoms include ipsilateral facial paralysis, tinnitus, or or other auditory symptoms. symptoms. Treatment is with acyclovir acyclovir and systemic systemic corticosteroids. Q/Q(M)-478210 Report a Problem A 59-year-old male returns from traveling abroad where he ate many fish. Since then he complaints of recurring migratory 1 cm/day erythematous urticarial plaques. Biopsy shows eosinophilic panniculitis. What is the most likely condition? 1 Drancunculiasis 2
Gnathostomiasis
3
Enterobiasis
4
Hookworm
5
Larva currents Q/Q(M)-482310 Report a Problem
A 59-year-old male returns from traveling abroad where he ate many fish. Since then he complaints of recurring migratory 1 cm/day erythematous urticarial plaques. Biopsy shows eosinophilic panniculitis. What is the most likely condition? 2 Gnathostomiasis This patient has gnathostomiasis caused by Gnathostoma dolorosi or spinigerum. It is i s commonly acquired from freshwater fish. It manifests with migratory intermittent erythematous urticarial plaques that recur every 2-6 weeks. The plaques move about 1 cm/day. Histology shows eosinophilic panniculitis. Treatment Treatment is surgical removal removal or albendazole. albendazole. Q/Q(M)-482310 Report a Problem All of the following statements are true of Bacillus anthracis infection except: 1 Spores remain stable for decades 2
20% mortality rate in untreated cutaneous infections
3
Inhalation, GI and cutaneous forms exist
4
Ciprofloxacin and doxycy doxycycline cline are first line treatments
5
All statements are true Q/Q(M)-477209 Report a Problem All of the following statements are true of Bacillus anthracis infection except:
5 All statements are true Anthrax can present in three different clinical forms: cutaneous, inhalational, and gastrointestinal. The cutaneous form appears as a painless vesicle that later forms an eschar (malignant pustule). The cutaneous form has a mortality rate of less than 1% if treated an up to 20% if untreated. Q/Q(M)-477209 Report a Problem A 56 year old homeless man has many waxy concretions on his axilla and groin hairs. Which of the following organisms is the likely cause?
7
1
Corynebacterium Corynebacterium afermentans
2
Corynebacterium Corynebacterium tenius
3
Corynebacterium Corynebacterium diptheriae
4
Micrococcus sedentarius
5
Corynebacterium Corynebacterium minutissimum Q/Q(M)-480170 Report a Problem
A 56 year old homeless man has many waxy concretions on his axilla and groin hairs. Which of the following organisms is the likely cause? 2 Corynebacterium tenius This condition described is trichomycosis axillaris. Despite the �mycosis� in the name, it is i s not fungal in etiology, but caused by C. tenius. Treatment is topical erythromycin or simply s imply shaving the infected hairs. The other listed organisms do not cause this type of infection. Q/Q(M)-480170 Report a Problem What is the most common presentation of mucous membrane involvement of EBV infection? 1 Buccal ulcers with superficial slough 2
Erosions of the gingivae
3
Plication of the tongue
4
Palatal petechiae
5
Oral hairy leukoplakia Q/Q(M)-482590 Report a Problem What is the most common presentation of mucous membrane involvement of EBV infection? 4 Palatal petechiae The most common presentation of intra-oral involvement of EBV infection is pinpoint petechiae of the junction of the hard hard and soft palate. palate. The associated associated eponym is Forchheimer Forchheimer spots. Forchheimer Forchheimer spots are not pathognomonic for EBV infection, as they can be seen in measles, rubella, and scarlet fever. While oral hairy leukoplakia is associated with EBV infection, it is not the most common mucous membrane sign. Q/Q(M)-482590 Report a Problem The treatment of choice of cat-scratch disease is: 1 Erythromycin 2
Ceftriaxone
3
Trimethoprim-sulfamethoxazole
4
Itraconazole
5
Mebendazole Q/Q(M)-477121 Report a Problem The treatment of choice of cat-scratch disease is: 1
Erythromycin 8
Cat-scratch disease is caused by Bartonella henselae, which is spread among cats b y fleas. The hallmark of the disease is unilateral and regional lymphadenopathy. lymphadenopathy. The treatment of choice for cat-scratch disease is erythromycin. Q/Q(M)-477121 Report a Problem A homeless patient with a history of diabetes and alcoholism presents with chronic suppurative nodules with granular bodies on light microscopy. Culture rapidly grows Staphylococcus aureus colonies. What is the clinical term describing this type of infectious lesion? 1 Botryomycosis 2
Scrofuloderma
3
Rhinoscleroma
4
Ecthyma gangrenosum
5
Erysipeloid Q/Q(M)-482687 Report a Problem A homeless patient with a history of diabetes and alcoholism presents with chronic suppurative nodules with granular bodies on light microscopy. Culture rapidly grows Staphylococcus aureus colonies. What is the clinical term describing this type of infectious lesion? 1 Botryomycosis Chronic purulent nodules with granular bodies seen in patients with immunosuppresion, diabetes, and alcoholism is called botryomycosis. Causative organisms include S. aureus, P. aeruginosa, E. coli, and Proteus species. Scrofuloderma is cutaneous extension of underlying Mycobacteria tuberculosis infection. Rhinoscleroma is caused by Klebsiella pneumoniae rhinoscleromatis. Ecthyma gangrenosum gangrenosum is typically seen following Pseudomonas septicemia. Erysipeloid is caused by Erysipelothrix rhusiopathiae. Q/Q(M)-482687 Report a Problem Which of the following HPV types causes a ridged wart? 1 HPV 1 2
HPV 7
3
HPV 11
4
HPV 18
5
HPV 60 Q/Q(M)-482317 Report a Problem Which of the following HPV types causes a ridged wart?
5 HPV 60 HPV 60 infection leads to a particular type of plantar wart called the ridged wart. HPV 1 leads to plantar warts and myrmecia. HPV 7 causes butcher's warts. HPV 11 along with 6 causes anogenital condyloma and giant condyloma of Bucke and Lowenstein (verrucous carcinoma). HPV 18 causes anogenital dysplasia and neoplasms. Q/Q(M)-482317 Report a Problem Calabar swellings are a characteristic feature of which disease? 9
1
Onchocerciasis
2
Eumycetoma
3
Tertiary Syphilis
4
Carrion's Disease
5
Loiasis Q/Q(M)-473917 Report a Problem
Calabar swellings are a characteristic feature of which disease? 5 Loiasis Calabar swellings are characteristic of Loiasis. They are transient, non-tender soft tissue swellings found most commonly around joints. Q/Q(M)-473917 Report a Problem Erythema infectiosum is caused by a: 1 RNA virus 2
Herpes virus
3
Double stranded DNA virus
4
Single stranded DNA virus
5
None of these answers are correct Q/Q(M)-473926 Report a Problem
Erythema infectiosum is caused by a: 4 Single stranded DNA virus Erythema infectiosum is caused by parvovirus B19 which is a single stranded DNA virus. Q/Q(M)-473926 Report a Problem Which of the following is a gram positive rod? 1 Meningococcemia 2
Gonorrhea
3
Glanders
4
Melioidosis
5
Anthrax Q/Q(M)-478742 Report a Problem
Which of the following is a gram positive rod? 5 Anthrax Anthrax is a gram positive, spore-forming rod. Meningococcemia, gonorrhea, gonorrhea, Glanders, and Meloioidosis are all gram negative. Infection with anthrax initially begins after skin onoculation or may follow after ingestion or inhalation of spores. Cutaneous anthrax initially begins as a localized infection and subsequently evolves to toxemia. It appears as a painless papule that ay later become hemorrhagic or nerotic. It produces two exotoxins: edema toxin and lethal toxin. Edema toxin is comprised of edema 10
factor and protective antigen. Lethal toxin is composed of lethal factor and protective antigen. Q/Q(M)-478742 Report a Problem Which of the following are potential forms of perinatally-acquired neonatal herpes disease? disease? 1
Skin, eyes, mouth (SEM)
2
CNS
3
Disseminated
4
None of the above
5
All of the above Q/Q(M)-482574 Report a Problem
Which of the following are potential forms of perinatally-acquired neonatal herpes disease? disease? 5 All of the above Perinatally acquired neonatal herpes disease can present in three different, dif ferent, occasionally overlapping, forms: 1. skin, eyes, and mouth; 2. CNS; and 3. Disseminated, causing encephalitis, encephalitis, hepatitis, pneumonia, and and coagulopathy. coagulopathy. Q/Q(M)-482574 Report a Problem A 16 year old female presents with a sore throat, painful cervical lymphadenopathy, and an enlarged spleen. An empiric trial of amoxicillin leads to the development of a diffuse morbilliform rash. r ash. What is the incubation period of the most likely viral cause of this patient\'s symptoms? 1 3-7 days 2
7-10 days
3
2-3 weeks
4
3-7 weeks
5
6 months Q/Q(M)-482589 Report a Problem
A 16 year old female presents with a sore throat, painful cervical lymphadenopathy, and an enlarged spleen. An empiric trial of amoxicillin leads to the development of a diffuse morbilliform rash. r ash. What is the incubation period of the most likely viral cause of this patient\'s symptoms? 4 3-7 weeks Infectious mononucleosis is characterized by a sore throat, painful lymphadenopathy, lymphadenopathy, fatigue, and splenomegaly. splenomegaly. The formation of a morbilliform rash upon challenge with ampicillin or related antibiotics is a classic finding. The most common virus associated with infectious mononucleosis is Epstein-Barr virus. The incubation period is relatively long, 3-7 weeks. Q/Q(M)-482589 Report a Problem All of the following are potential causes of a false positive RPR except: 1 Systemic Lupus Erythematosus (SLE) 2
Pregnancy
3
Malignant Melanoma 11
4 5
Lepromatous Leprosy Malaria Q/Q(M)-473906 Report a Problem
All of the following are potential causes of a false positive RPR except: 3 Malignant Melanoma Non-treponemal tests tests for syphilis measure measure antibodies against against phospholipids phospholipids released from treponemes treponemes and damaged host cells. False positive non-treponemal tests can occur in the setting of pregnancy, autoimmune diseases, diseases, other spirochete infections, and infectious diseases such as leprosy and malaria. It does not occur in cases of melanoma. Q/Q(M)-473906 Report a Problem Hebra nose deformity is characteristic of infection inf ection with which organism? 1
Klebsiella pneumoniae
2
E. coli
3
Streptococcus Streptococcus pyogenes
4
Haemophilus influenzae
5
Serratia marcesens Q/Q(M)-477608 Report a Problem
Hebra nose deformity is characteristic of infection inf ection with which organism? 1 Klebsiella pneumoniae Hebra nose deformity is seen in Rhinoscleroma which is caused by Klebsiella pneumoniae. Q/Q(M)-477608 Report a Problem A middle-aged female presents with purplish pruritic plaques on her dorsal wrist and whitish plaques on her buccal mucosa. A diagnosis of lichen planus is made. Which type of lichen planus is most strongly associated with Hepatitis C virus infection? 1 Mucosal ulcerative lichen planus 2
Hypertrophic lichen planus
3
Lichen planus pemphigoides
4
Lichen planus of the nails
5
Vulvar lichen planus Q/Q(M)-482598 Report a Problem
A middle-aged female presents with purplish pruritic plaques on her dorsal wrist and whitish plaques on her buccal mucosa. A diagnosis of lichen planus is made. Which type of lichen planus is most strongly associated with Hepatitis C virus infection? 1 Mucosal ulcerative lichen planus Lichen planus presents a wide variety of cutaneous morphologies morphologies that share common histologic findings of a lichenoid lymphocy l ymphocytic tic infiltrate, basal vacuolization, and dyskeratotic keratinocytes. keratinocytes. The form of lichen planus most strongly associated with Hepatitis C virus infection is mucosal ulcerative lichen planus. 12
Q/Q(M)-482598 Report a Problem A 21 year old female with a family history histor y of C8 complement deficiency presents with sparsely sparsely distributed hemorrhagic vesiculopustules vesiculopustules on the palms, soles, and over joints. She has associated fever, chills, arthralgias, and malaise. What is the treatment of choice for disseminated gonococcemia? gonococcemia? 1 Ceftriaxone IV 2
Penicillin IM
3
Piperacillin-tazobactam Piperacillin-tazobactam IV
4
Levofloxacin PO
5
Azithromycin Q/Q(M)-482693 Report a Problem A 21 year old female with a family history histor y of C8 complement deficiency presents with sparsely sparsely distributed hemorrhagic vesiculopustules vesiculopustules on the palms, soles, and over joints. She has associated fever, chills, arthralgias, and malaise. What is the treatment of choice for disseminated gonococcemia? gonococcemia?
1 Ceftriaxone IV Gonococcemia Gonococcemia is characterized by sparsely distributed hemorrhagic vesiculopustules on the t he palms, soles, and over joints with associated fever, chills, arthralgias, and malaise. Recurrent cases associated with complement deficiencies (C5-C8). Treatment is with IV ceftriaxone. Q/Q(M)-482693 Report a Problem A patient from India presents with fever, hepatosplenomegaly, and darkening of the skin. Which of the following is a cause of visceral leishmaniasis? 1 L. donovani 2
L. major
3
L. mexicana
4
L. aethiopica
5
L. tropicana Q/Q(M)-482698 Report a Problem
A patient from India presents with fever, hepatosplenomegaly, and darkening of the skin. Which of the following is a cause of visceral leishmaniasis? 1 L. donovani Visceral leishmaniasis is the most severe form of leishmaniasis. Complications can be fatal, and include i nclude pneumonia, tuberculosis, tuberculosis, and dysentery, dysentery, which are are potential opportunistic infections. Visceral Visceral leishmaniasis is most commonly caused by L. donovani and L. infantum. i nfantum. Q/Q(M)-482698 Report a Problem Which of the extracellular enzymes of S. aureus plays a role in toxic shock syndrome (TSS)? 1 Coagulase 2
Penicillinase
3
Enterotoxin 13
4 5
Hemolysin Exfoliatin Q/Q(M)-480152 Report a Problem
Which of the extracellular enzymes of S. aureus plays a role in toxic shock syndrome (TSS)? 3 Enterotoxin In addition to TSST-1 which is present in 50% of non-menstrual cases of TSS, enterotoxins, especially B & C, cause TSS. These enterotoxins are also superantigens, which recognize the V-beta region of the T-cell receptor. Coagulase clots plasma, Penicillinase degrades penicillin, Hemolysin lyses red blood cells and exfoliatin splits the epidermis (antigen is desmoglein 1). Q/Q(M)-480152 Report a Problem A 19 year old sexually active male presents with a painful ulcer on the shaft of his penis. A biopsy specimen stained with Giemsa reveals a "school of fish." Which of the following is the causative organism? 1
Hemophilus ducreyi
2
Treponema pallidum
3
Calymmatobacterium Calymmatobacterium granulomatis
4
Chlamydia trachomatis L1
5
Herpes simplex virus Q/Q(M)-482695 Report a Problem
A 19 year old sexually active male presents with a painful ulcer on the shaft of his penis. A biopsy specimen stained with Giemsa reveals a "school of fish." Which of the following is the causative organism? 1 Hemophilus ducreyi Chancroid is a sexually transmitted disease caused by the bacteria Hemophilus ducreyi. It is one of many organisms that can cause a genital ulcer. Chancroid is characterized by a soft, painful chancre with ragged edges. Giemsa stained sections reveal a "school of fish" configuration which is typical. t ypical. Treatment is with azithromycin, ceftriaxone, ciprofloxacin, or erythromycin. Q/Q(M)-482695 Report a Problem Neisseria gonorrheae gonorrheae would be identified identified with: 1 Sheep�s blood agar 2
Agar supplemented with heme and nicotinamide
3
Chocolate agar with 10% CO2
4
Chocolate agar
5
Darkfield microscopy Q/Q(M)-480160 Report a Problem
Neisseria gonorrheae gonorrheae would be identified identified with: 3 Chocolate agar with 10% CO2 14
Neisseria gonorrheae gonorrheae should be grown on chocolate chocolate agar in 10% 10% CO2. Thayer �Martin, Martin-Lewis or New York City medium also allow for N. gonorrheae growth. Agar supplemented supplemented with heme (xfactor) and nicotinamide (v-factor) is needed for Hemophilus influenzae cultures. Darkfield microscopy is helpful in diagnosing infections with Treponema pallidum (syphilis). Sheep �s blood agar is useful for identifying hemolytic strains of streptococcus and staphylococcus. staphylococcus. Q/Q(M)-480160 Report a Problem Corynebacterium Corynebacterium minuttissimum is responsible for which of the following infections? 1 Majocchi's granuloma 2
Trichomycosis axillaris
3
Erysipelas
4
Malakoplakia
5
Erysipeloid Q/Q(M)-477606 Report a Problem
Corynebacterium Corynebacterium minuttissimum is responsible for which of the following infections? 2 Trichomycosis axillaris Corynebacterium Corynebacterium minutissimum is responsible for causing trichomycosis axillaris, a superficial bacterial overgrowth of axillary hairs characterized by circumferential yellow (most common), red, or black granular concretions. Majocchi's Majocchi's granuloma is a dermatophyte infection. Erysipelas is caused by betahemolytic group A streptococcus. Malakoplakia is usually caused by S. aureus, P. aeruginosa, aeruginosa, or E. coli. Erysipeloid is caused by Erysipelothrix rhusiopathiae. Corynebacterium Corynebacterium is also the causative organism in erythrasma and pitted keratolysis. Q/Q(M)-477606 Report a Problem Which of the following tests is the most sensitive serologic serologic test in primary syphilis? 1
FTA-ABS
2
VDRL
3
ELISA
4
RPR
5
MHA-TP Q/Q(M)-482696 Report a Problem
Which of the following tests is the most sensitive serologic serologic test in primary syphilis? 1 FTA-ABS The fluorescent treponemal antibody absorption test is the most sensitive serologic test in primary syphilis. The ELISA is the test of choice in early primary pri mary and congenital syphilis because because it is the first fir st to become reactive. reactive. However, it is less less sensitive in late primary syphilis because because of reduction of of IgM production. The ELISA is 100% specific. specific. MHA-TP is less sensitive sensitive than FTA-ABS FTA-ABS during primary syphilis. Q/Q(M)-482696 Report a Problem Which of the following are inconsistent with the diagnosis of staphylococcal scalded skin syndrome? 15
1
Epidermal changes are produced by exfoliative toxins of staphlococcus staphlococcus
2
Initial event is usually a localized staph infection
3
Swabs and cultures of fluid filled blisters overwhelmingly grow staph
4
Prognosis is good in children with low mortality when anitbiotics are administered early
5
Cell necrosis does not occur in staphylococcal staphylococcal scalded skin syndrome as it does in T.E.N Q/Q(M)-478752 Report a Problem
Which of the following are inconsistent with the diagnosis of staphylococcal scalded skin syndrome? 3 Swabs and cultures of fluid filled blisters overwhelmingly grow staph Staphylococcal Staphylococcal scalded skin syndrome: Lesions extend far beyond areas of actual staphylococcal infection, by action of the epidermolytic exotoxin elaborated by the staphylococcus in remote sites. Usually the staphylococci are present at a distant focus such as the parynx, nose ear, or conjuctiva. If cultures are taken they should be obtained fromthe mucous membranes because because the skin erythema er ythema and desquamation is due to the distant effects of the exfoliative toxin, unlike the sitaution in bullous impetigo, where S. aureus is present in the lesions. Epidermal changes are produced by exfoliative toxins of Staphylococcus. Inital event is usually a localized Staph infection. Prognosis is good in children with low mortality when anitbiotics are administered earyl. Cell necrosis does not occur in SSS as it does in toxic epidermal necrolysis. Q/Q(M)-478752 Report a Problem What are the three rapid grower mycobacteria and what is the current treatment of choice? 1 leprae, chelonae, abscessus; clarithromcyin 2
Tuberculum, abscessus, abscessus, fortuitum; rifampin
3
Chelonae, asbcessus, asbcessus, fortuitum; clarithromycin
4
Lepra, fortuitum, abscessus; abscessus; minocycline
5
Chelonae, absccessus, absccessus, fortuitum; minocycline Q/Q(M)-482853 Report a Problem
What are the three rapid grower mycobacteria and what is the current treatment of choice? 3 Chelonae, asbcessus, asbcessus, fortuitum; clarithromycin These three are rapid grower mycobac m ycobacteria teria and the treatment t reatment of choice is clarithryomycin. Minocycline can also be used, but it i t considered second line in WHO treatment. Q/Q(M)-482853 Report a Problem The most common bacterial cause of purpura fulminans is: 1 S. aureus 2
P. aeruginosa
3
H. influenzae
4
E. coli
5
Group A streptococcus 16
Q/Q(M)-474535 Report a Problem The most common bacterial cause of purpura fulminans is: 5 Group A streptococcus Group A streptococcus is the leading bacterial cause of purpura fulminans. Q/Q(M)-474535 Report a Problem A patient develops herpes zoster in the V1 distribution. A few days after development of the classic vesicular rash, her family brings her to the emergency room because of new onset seizures. She had been complaining complaining of confusion, headache, headache, fatigue, and loss of appetite appetite prior to the convulsions. convulsions. What is the diagnosis? 1 Syndrome of inappropriate anti-diuretic hormone 2
Ramsay-Hunt syndrome
3
Delayed contralateral hemiparesis
4
Post-zoster neuropathy
5
Intracerebral vasculitis Q/Q(M)-482588 Report a Problem
A patient develops herpes zoster in the V1 distribution. A few days after development of the classic vesicular rash, her family brings her to the emergency room because of new onset seizures. She had been complaining complaining of confusion, headache, headache, fatigue, and loss of appetite appetite prior to the convulsions. convulsions. What is the diagnosis? 1 Syndrome of inappropriate anti-diuretic hormone The question stem describes signs and symptoms of hyponatremia. The syndrome of inappropriate i nappropriate antidiuretic hormone secretion is a known, albeit rare, complication of varicella-zoster virus infection. The other four answer choices are also known complications of varicella-zoster virus infection, but do not cause the disease presentation as described. Q/Q(M)-482588 Report a Problem A 40-year-old male patient from South America with HIV (CD4+ <200) presents with new purple-red papules and and nodules on his face that have been progressively progressively enlarging. A biopsy is performed, performed, showing lobular vascular proliferations with plump endothelial cells on H&E staining. Immunohistochemical staining of skin tissue for human herpes virus 8 (HHV8) is negative. Upon closer inspection of H&Estained sections, faint purple granular interstitial deposits are noted in the dermis. Which of the following tissue stains is most appropriate for further work-up? 1 Fite 2
Chloroacetate esterase
3
Warthin-Starry
4
Giemsa
5
Ziehl-Neelsen Q/Q(M)-482822 Report a Problem
A 40-year-old male patient from South America with HIV (CD4+ <200) presents with new purple-red papules and and nodules on his face that have been progressively progressively enlarging. A biopsy is performed, performed, showing lobular vascular proliferations with plump endothelial cells on H&E staining. Immunohistochemical 17
staining of skin tissue for human herpes virus 8 (HHV8) is negative. Upon closer inspection of H&Estained sections, faint purple granular interstitial deposits are noted in the dermis. Which of the following tissue stains is most appropriate for further work-up? 3 Warthin-Starry Causes of angiomatous papulonodules arising in immunocompromise i mmunocompromisedd patients include Kaposi �s sarcoma, bacillary angiomatosis, and verruga peruana, as well as pyogenic granulomas and cherry angiomas. Bartonella, a gram negative bacillus, appears as faint purple-blue granular dermal deposits on routine H&E-stained sections. These deposits appear black upon Warthin-Starry staining. Prominent endothelial cells may also be seen. Both B. henselae and B. quintana have been implicated in the pathogenesis pathogenesis of bacillary angiomatosus, angiomatosus, while B. bacilliformis bacilliformis is the causative agent in verruga verruga peruana (as well as Bartonellosis). Erythromycin is the first-line treatment for bacillary angiomatosus, while fluoroquinolones are first-line agents for treatment of verruga peruana. Q/Q(M)-482822 Report a Problem A 1 year old female patient is brought in by her mother because of the development of warty growths peri-anally. A clinical clinical examination and biopsy confirms the diagnosis of peri-anal peri-anal warts. In 12 month old patients, what is the most common cause of acquisition of human papilloma virus. 1 Vertical transmission peri-natally 2
Sexual abuse
3
Contact with a wart-containing finger
4
Contact with a fomite
5
Aerosol transmission Q/Q(M)-482612 Report a Problem
A 1 year old female patient is brought in by her mother because of the development of warty growths peri-anally. A clinical clinical examination and biopsy confirms the diagnosis of peri-anal peri-anal warts. In 12 month old patients, what is the most common cause of acquisition of human papilloma virus. 1 Vertical transmission peri-natally In any child with peri-anal warts, the possibility of sexual contact must be excluded. Fortunately, Fortunately, in infants up to 12 months of age, the most common route of acquisition of the human papilloma virus is vertical transmission at the time of delivery. Q/Q(M)-482612 Report a Problem A 67 year old homeless man comes to clinic complaining of a painful lump along his lateral jawline which has been present for many months. He has noticed that it occasionally occasionally drains a purulent material. What is the most likely diagnosis? 1 Actinomyces israelii 2
Nocardia brasilensis
3
Actinomadura madurae
4
Streptomyces somaliensis
5
Mycobacteria tuberculosis Q/Q(M)-482620 Report a Problem 18
A 67 year old homeless man comes to clinic complaining of a painful lump along his lateral jawline which has been present for many months. He has noticed that it occasionally occasionally drains a purulent material. What is the most likely diagnosis? 1 Actinomyces israelii Actinomycosis Actinomycosis is a chronic suppurative infection forming nodules and sinus tracts with an exudate containing sulfur granules. Risk factors include poor oral hygiene, penetrating foreign bodies, and dental procedures. The causative organism organism is Actinomyces Actinomyces israelii, an anaerobic anaerobic gram-positive rod. Q/Q(M)-482620 Report a Problem All of the following are features of scarlet fever f ever except: 1
Pharyngitis
2
Pastia�s lines
3
S. aureus infection
4
Circumoral pallor
5
Sandpaper-like texture Q/Q(M)-477222 Report a Problem
All of the following are features of scarlet fever f ever except: 3 S. aureus infection Scarlet fever is primarily a disease of children with most cases occurring between the ages of 1 and 10 years of age. Streptococcus Str eptococcus pyogenes pyogenes is the causative organism. It produces the streptococcus pyrogenic exotoxin which elicits the cutaneous manifestations by enhancing delayed type t ype hypersensitivity to streptococcal products. products. Clinical findings f indings include fever, sore throat, headache, chills, sandpaper rash on the trunks, strawberry tongue, and Pastia �s lines (linear petechial streaks found in flexural locations). Q/Q(M)-477222 Report a Problem Which human papillomavirus type is associated with giant condylomata of Bushke and Lowenstein (Bushke-Lowenstein (Bushke-Lowenstein tumor)? t umor)? 1 1 2
2
3
6
4
16
5
31 Q/Q(M)-474538 Report a Problem
Which human papillomavirus type is associated with giant condylomata of Bushke and Lowenstein (Bushke-Lowenstein (Bushke-Lowenstein tumor)? t umor)? 3 6 The Bushke-Lowenstein Bushke-Lowenstein tumor is caused by HPV-6 and 11. Q/Q(M)-474538 Report a Problem The treatment of choice for Loiasis is: 1 Ivermectin 19
2
Diethylcarbamazine (DEC)
3
Permethrin
4
Malathion
5
Chloramphenicol Q/Q(M)-473916 Report a Problem
The treatment of choice for Loiasis is: 2 Diethylcarbamazine Diethylcarbamazine (DEC) The recommended treatment for loiasis is Diethylcarbamazine Diethylcarbamazine (DEC). Q/Q(M)-473916 Report a Problem The dominant organism present present on oily regions of the skin is: 1
Gram positive coagulase negative staphylococcus staphylococcus
2
Staphylococcus Staphylococcus aureus
3
Propionibacterium acnes
4
Corynebacterium Corynebacterium spp.
5
Propionibacterium avidum Q/Q(M)-480149 Report a Problem
The dominant organism present present on oily regions of the skin is: 3 Propionibacterium acnes The most common organism on sebaceous regions of human skin is Propionibacterium acnes. This is an aerotolerant, anaerobic gram positive club-shaped diptheroid that lives in the depths of the sebaceous follicle. It has a potent lipase which cleaves sebaceous triglycerides into glycerol and free fatty fatt y acids. The free fatty acids lower the pH and are thought to retard the growth of pathogens such as S. aureus. Other residents of oily regions r egions are: Malassezia furfur, S. epidermidis, Micrococcus luteus and other catalase positive aerobic cocci. S. aureus is a pathogen, and is not considered normal flora of any region of the skin. The other options are found on dry or moist regions of the skin. Q/Q(M)-480149 Report a Problem Orf virus infection is also known as: 1 Ecthyma 2
Ecthyma contagiosum
3
Echtyma gangrenosum
4
Pseudocowpox
5
Milker's nodule Q/Q(M)-478751 Report a Problem
Orf virus infection is also known as: 20
2 Ecthyma contagiosum Orf virus infection is also known as Ecthyma contagiosum. Ecthyma Gangrenosum is caused by Pseudomonas aeruginosa. aeruginosa. Ecthyma is caused by Staphylococcal or streptococcal streptococcal pyoderma. p yoderma. Pseudocowpox Pseudocowpox and Milker's nodule are also known as paravaccinia and caused by udders of infected cows. Q/Q(M)-478751 Report a Problem All of the following are true regarding tularemia except: 1 Caused by the gram negative Francisella tularensis 2
Ticks serve as a reservoir
3
No longer one of the CDC's list of reportable diseases
4
Presents as an acute febrile illness
5
Potential for use as a biologic weapon Q/Q(M)-477375 Report a Problem
All of the following are true regarding tularemia except: 3 No longer one of the CDC's list of reportable diseases Tularemia is a zoonotic disease caused by the gram-negative gram -negative coccobacillus coccobacillus Francisella tularensis. It is transmitted by arthropods (particularly tick bites) or from contact with infected mammals (usually rabbits). It characteristically presents as an acute febrile f ebrile illness with other variable clinical manifestations depending depending on the route of inoculation. Possible symptoms could include an ulcer at the site of inoculation, pharyngitis, ocular lesions, lymphadenopathy, and pneumonia. Diagnosis can be made by culture or a fourfold titer change. Because of its potential use as a biologic agent, tularemia is once again a reportable disease. Q/Q(M)-477375 Report a Problem The most common location of herpes gladiatorum is i s the: 1 Groin 2
Chest
3
Anterior thigh
4
Face
5
Hand Q/Q(M)-473914 Report a Problem The most common location of herpes gladiatorum is i s the: 4 Face The face is the most common location for Herpes Gladiatorum. Q/Q(M)-473914 Report a Problem
21
A 67-year-old man presents with grouped painful vesicles on an erythematous base on his lateral sacrum. He denies any history of herpes simplex type I or II. He is angry with wit h you for suggesting that he may have herpes. What could explain this presentation? presentation? 1 He actually has �shingles� and your diagnosis is incorrect 2
A significant number of people are asymptomatic for HSV infection
3
He is lying
4
He has the early stages of Alzheimer �s disease
5
This presentation represents a primary infection with Epstein Barr Virus, (HHV4) Q/Q(M)-480180 Report a Problem
A 67-year-old man presents with grouped painful vesicles on an erythematous base on his lateral sacrum. He denies any history of herpes simplex type I or II. He is angry with wit h you for suggesting that he may have herpes. What could explain this presentation? presentation? 2 A significant number of people are asymptomatic for HSV infection A significant number of people are asymptomatic for HSV infection but are seropositive for anti-HSV antibodies. Lumbosacral Lumbosacral HSV occurs in about 10% of HSV infections and is more common in older age groups. In some cases, this may be the �first� presentation of HSV that the patient is aware of. Shingles would be a reasonable consideration for the differential diagnosis and a direct immunofluorescence immunofluorescence scraping and viral culture would confirm that this typical presentation of HSV actually is. It is possible that the patient is lying or that he has early Alzheimer �s disease, but less likely. EBV does not present in this manner. Q/Q(M)-480180 Report a Problem A 52 year-old butcher presents with a tender lesion on his left hand as shown. The treatment of choice for this condition is: 1 Penicillin 2
Azithromycin
3
Ciprofloxacin
4
Tetracycline
5
Chloramphenicol Q/Q(M)-474913 Report a Problem
A 52 year-old butcher presents with a tender lesion on his left hand as shown. The treatment of choice for this condition is: 22
1 Penicillin The clinical description and lesion shown in the image suggest a diagnosis of erysipeloid, caused by Erysipelothrix rhusiopathiae. rhusiopathiae. The treatment of choice is penicillin. Q/Q(M)-474913 Report a Problem Which of the following vectors is responsible for transmitting Chagas � disease? 1
Tstse fly
2
Reduviid bug
3
Black fly
4
Mosquito
5
Sandfly Q/Q(M)-474541 Report a Problem
Which of the following vectors is responsible for transmitting Chagas � disease? 2 Reduviid bug The reduviid big is the t he vector of American trypanosomia tr ypanosomiasis sis (Chagas disease). The vector of African trypanosomiasis trypanosomiasis is the tstse fly. Q/Q(M)-474541 Report a Problem Which of the following skin manifestations of M. tuberculosis infection is a tuberculid? 1 Erythema induratum of Bazin 2
Lupus vulgaris
3
Miliary TB
4
Scrofuloderma
5
Tuberculous gumma Q/Q(M)-480176 Report a Problem
Which of the following skin manifestations of M. tuberculosis infection is a tuberculid? 1 Erythema induratum of Bazin A tuberculid is a cutaneous immunologic reaction to tuberculosis elsewhere in the body. By definition, cultures and stains for M. tuberculosis are negative. Erythema induratum of Bazin/Nodular vasculitis present as erythematous erythematous or cyanotic cyanotic nodules on on the posterior calves. calves. 85% of cases cases occur in women. women. The other listed presentations of TB are all due to secondary spread from an established TB infection at another location. In some cases, organisms can be recovered and cultures may be positive. Q/Q(M)-480176 Report a Problem A young male patient presents with a painful ulcer with a ragged edge after a new sexual encounter. What is the treatment of choice? 1
Penicillin
2
Doxycycline 23
3
Azithromycin
4
Ciprofloxacin
5
Cephalexin Q/Q(M)-482859 Report a Problem A young male patient presents with a painful ulcer with a ragged edge after a new sexual encounter. What is the treatment of choice?
3 Azithromycin Ulcers in the genital area in sexually active patient generally fall into two groups: painful and painless. Painless ulcers include syphilllis, lymphogra l ymphogranuloma nuloma venereum, and granuloma inguinale. The primary cause of painful erosion or ulcer is H. ducreyi or herpes simplex. An ulcer with a ragged edge that is painful is characteristic characteristic of H. ducreyi. ducreyi. The treatment of choice choice is azithromycin. Q/Q(M)-482859 Report a Problem The vector of Trench Fever is the: 1
Human body louse (Pediculus humanus corporis)
2
Cat flea (Ctenocephalides felis)
3
Sandfly (Phlebotamus perniciosus)
4
Rat flea (Xenopsylla cheopis)
5
Trombiculid mite Q/Q(M)-473909 Report a Problem The vector of Trench Fever is the:
1 Human body louse (Pediculus humanus corporis) The human body louse (Pediculus humanus corporis)is the vector of Trench Tr ench Fever, Epidemic Typhus, and Relapsing Fever. Q/Q(M)-473909 Report a Problem Granuloma Inguinale is caused by: 1 Chlamydia trachomatis types I, II & III 2
Hemophilis ducreyi
3
Calymmatobacterium Calymmatobacterium granulomatis
4
Treponema pertenue
5
Treponema pallidum Q/Q(M)-480173 Report a Problem
Granuloma Inguinale is caused by: 3 Calymmatobacterium Calymmatobacterium granulomatis Granuloma inguinale is caused by an infection of Calymmatobacterium Calymmatobacterium granulomatis. It is a granulomatous skin disease of the genitals caused by sexual transmission. It is i s a gram negative rod that is similar to the Enterobacteriaceae. Enterobacteriaceae. It is a smll, raised papule or subcutaneous nodule that rapidly ulcerates, rarely with lymphadenopathy. It is not self healing and spreads by radial extension. 24
Hemophilis ducreyi is the cause of chancroid, Chlamydia trachomatis causes Lymphogranuloma Lymphogranuloma Venereum, Treponema pertenue pertenue causes Yaws and T. pallidum is the cause of syphilis. Q/Q(M)-480173 Report a Problem Which Rickettsial infection has a negative Weil-Felix test? 1
Rocky Mountain Spotted Fever (R. rickettsii)
2
Mediterranean fever (R. conorii)
3
Epidemic typhus (R. prowazekii)
4
Endemic typhus (R. typhi)
5
Rickettsialpox (R. akari) Q/Q(M)-476497 Report a Problem
Which Rickettsial infection has a negative Weil-Felix test? 5 Rickettsialpox (R. akari) Rickettsia are short, gram-negative rods which are strict intracellular parasites. The bacteria is transmitted via tick which much be attached for more than 6 hours. The Weil-Felix test exploits crossreactivity between the Proteus vulgaris antigen and RIckettsia. Q/Q(M)-476497 Report a Problem A young patient presents to you after participating in a bar brawl a few nights ni ghts before with a painful swollen erythematous right hand. The most likely organism is: 1 Staphylococus Staphyloco cus aureus 2
Eikenella corrodens
3
Pasturella multocida
4
Streptococcus pyogenes
5
Bacteriodes fragilis Q/Q(M)-479611 Report a Problem A young patient presents to you after participating in a bar brawl a few nights ni ghts before with a painful swollen erythematous right hand. The most likely organism is:
2 Eikenella corrodens Eikenella corrodens is a member of normal oral flora, that is commonly the cause of human bite and fist fi st fight infections. Pasturella multocida is a common organism found in dog and cat bites. Staph and Strep could be the right answers for a cellulitis, but with this history are not the correct choices. Baceriodes fragilis is found in normal bowel flora. Q/Q(M)-479611 Report a Problem
What characteristic color is seen on diascopy of this lesion? 1 Apple jelly 2
Blue 25
3
Orange
4
Red
5
Coral red Q/Q(M)-476877 Report a Problem
What characteristic color is seen on diascopy of this lesion? 1 Apple jelly Leishmaniasis recidivans recidivans is a type of Old World leishmaniasis. Clinically, it appears as a red papule covered with white scale. On diascopy, it has a characteristic apple jelly color. Q/Q(M)-476877 Report a Problem Similar lesions were also seen on this infant's face. Treatment of choice is: 1 phototherapy 2
oral steroids
3
acyclovir
4
topical retinoic acid
5
oral erythromycin Q/Q(M)-480500 Report a Problem
Similar lesions were also seen on this infant's face. Treatment of choice is: 26
3 acyclovir This child has eczema herpeticum, a cutaneous infection with HSV which occurs in patients with prepre existing skin disorders such as atopic dermatitis. It begins as clusters of umbilicated umbil icated and hemorrhagic vesicles in areas of abnormal skin. Lesions spread rapidly but can respond quickly to antiviral treatment. Children with underlying AD who come into frequent contact with an individual with orolabial HSV may have recurrent outbreaks of eczema herpeticum. Q/Q(M)-480500 Report a Problem What is the most common cause of erythema multiforme? 1 Herpes simplex virus 2
Mycoplasma pneumonia
3
Amoxicillin
4
Ibuprofen
5
Cytomegalovirus Q/Q(M)-482809 Report a Problem
What is the most common cause of erythema multiforme? 1 Herpes simplex virus The most common cause of erythema multiforme (EM) is herpes simplex virus, which may not be active at the time of the EM eruption. Patients with recurrent EM are typically treated with acyclovir or valacyclovir. valacyclovir. Mycoplasma pneumonia is a cause of EM, but is not the most common. Amoxicillin, ibuprofen, and cytomegalovirus may cause EM, but are not as common. Q/Q(M)-482809 Report a Problem The Jarisch-Herxeimer reaction is most closely associated with the release of which of the following cytokines? 1 IFN-alpha 2
IL-12
3
TNF-alpha
4
IL-4
5
IL-10 Q/Q(M)-474528 Report a Problem
The Jarisch-Herxeimer reaction is most closely associated with the release of which of the following cytokines? 3 TNF-alpha TNF-alpha. The Jarisch-Herxheimer reaction is associated with increased plasma concentrations of TNF-alpha after antibiotic treatment of syphilis. s yphilis. The Jarisch-Herxheimer reaction has also been described following treatment of louse-borne relapsing fever, lyme disease and leptospirosis. l eptospirosis. Q/Q(M)-474528 Report a Problem A woman who handles fish tanks develops a slow-growing cluster of papules on the hand. What temperature (Celsius) is most optimal for this organism's growth? 27
1
25 degrees
2
30 degrees
3
37 degrees
4
40 degrees
5
42 degrees Q/Q(M)-482328 Report a Problem
A woman who handles fish tanks develops a slow-growing cluster of papules on the hand. What temperature (Celsius) is most optimal for this organism's growth? 2 30 degrees This patient most likely has contract Mycobacterium marinum, otherwise known as "fish tank granuloma." On primary isolation M. marinum grows best at 30-33 degrees C in 7-21 days. Unlike Mycobacterium tuberculosis, tuberculosis, most strains of M. marinum will not grow at the usual incubation temperature of 37 degrees C. Dimorphic fungi have both yeast and fungal forms: hyphae morphology at 25 degrees C and yeast phase at 37 degrees C. Q/Q(M)-482328 Report a Problem What is the principal vector of Lyme Disease in the Northeastern U.S.? 1 Ixodes ricinus 2
Soft-bodied ticks (Ornithodoros)
3
Ixodes dammini
4
Ambylomma americanum
5
Dermacentor variabilis Q/Q(M)-473954 Report a Problem
What is the principal vector of Lyme Disease in the Northeastern U.S.? 3 Ixodes dammini The proncipal vector of Lyme Disease in the t he Northeastern U.S. is Ixodes dammini (Ixodes scapularis). Q/Q(M)-473954 Report a Problem A 27 year-old woman who is 30 weeks pregnant presents with erythema er ythema migrans. The treatment of choice for this patient is: 1
Doxycycline
2
Erythromycin
3
Chloramphenicol
4
Clindamycin
5
Amoxicillin Q/Q(M)-473915 Report a Problem
A 27 year-old woman who is 30 weeks pregnant presents with erythema er ythema migrans. The treatment of choice for this patient is: 28
5 Amoxicillin In the setting of pregnancy, pregnancy, amoxicillin is i s the treatment of choice for Lyme Disease since doxycycline is contraindicated. Q/Q(M)-473915 Report a Problem Unilateral palpebral and periorbital edema is characteristic of which whi ch of the following f ollowing infectious diseases? 1 African trypanosomiasis 2
American trypanosomiasis
3
Amebiasis
4
Schistosomiasis
5
Onchocerciasis Q/Q(M)-482840 Report a Problem
Unilateral palpebral and periorbital edema is characteristic of which whi ch of the following f ollowing infectious diseases? 2 American trypanosomiasis American trypanosomiasis (Chagas � disease) is caused by infection with Trypanosoma cruzi via Triatoma arthropod vectors (reduviid bugs) and is prevalent predominantly in Central and South America. Transmission of this protozoal infection may occur following the bite of an infected reduviid bug, who then then defecates on human skin after after feeding, allowing the the metacyclic trypomastigotes trypomastigotes entry into the bite wound. Alternatively, infected feces may gain direct entry through mucosal surfaces, including the conjunctivae. When the latter occurs, characteristic unilateral palpebral and periorbital edema ensues, known as �Romana�s sign.� Entry into the skin may result in a localized plaque of erythema and induration with regional lymphadenopathy, termed a �chagoma. � Other systemic s ystemic complications resulting from chronic infection include cardiac arrhythmias, congestive heart failure, megacolon, and megaesophagus. megaesophagus. Treatment is with nifurtimox or benznidazole. Q/Q(M)-482840 Report a Problem A patient with HIV/AIDS develops disseminated flesh-colored papules papules with central umbilication. A diagnosis of molluscum contagiosum is made. What is the CD4 cell count below which molluscum contagiosum lesions are first seen in HIV H IV patients? 1 100 2
200
3
400
4
800
5
1000 Q/Q(M)-482603 Report a Problem
A patient with HIV/AIDS develops disseminated flesh-colored papules papules with central umbilication. A diagnosis of molluscum contagiosum is made. What is the CD4 cell count below which molluscum contagiosum lesions are first seen in HIV H IV patients? 1 100 HIV/AIDS patients are afflicted with a wide variety of opportunistic pathogens. The spectrum of 29
infectious diseases can be used to predict a patient\'s CD4 helper T cell count. Molluscum contagiosum is usually not seen until a patient\'s CD4 count drops below 100. Q/Q(M)-482603 Report a Problem The Mikulicz is the histologic hallmark of which of the following conditions: 1 Leishmaniasis 2
Granuloma inguinale
3
Rhinoscleroma
4
Rhinosporidiosis
5
Histoplasmosis Q/Q(M)-480168 Report a Problem
The Mikulicz is the histologic hallmark of which of the following conditions: 3 Rhinoscleroma Rhinoscleroma is caused by Klebsiella rhinoscleromatis, a gram negative rod that causes a chronic granulomatous infection of the upper respiratory tract. It is predominantly seen in Mexico, Central and South America. The histologic hallmark is the Mikulicz cell, a large histiocyte that contains the bacteria in its cytoplasm. Rhinosporidiosis is not an intracellular bacteria, but an extracellular fungi caused by Rhinosporidium seeberi mainly seen in India, Sri Lanka and occasionally the southeastern United States. Extremely large endospores are present in tissue. The other listed organisms are intracellular pathogens but do not have the Mikulicz cell as a feature of infection. infection. Q/Q(M)-480168 Report a Problem At what rate of speed does this parasite migrate through the skin? 1
0.1 cm/day
2
1 cm/day
3
2 cm/day
4
10 cm/day
5
100 cm/day Q/Q(M)-476851 Report a Problem
30
At what rate of speed does this parasite migrate through the skin? 3 2 cm/day The infection depicted is larva migrans or creeping eruption which is caused by Ancylostoma braziliense. This nematode is typically typically a hookworm of of cats and dogs. dogs. It migrates at a rate of 2 cm/day. cm/day. Larva currens migrates at a rate of 10 cm/day. Q/Q(M)-476851 Report a Problem All of the following are true regarding smallpox except: 1 Caused by variola virus 2
Transmitted by respiratory secretions
3
Virus is found in skin lesions
4
Vaccination is contraindicated in children under 5
5
Associated with thrombocytopenia thrombocytopenia Q/Q(M)-477358 Report a Problem
All of the following are true regarding smallpox except: 4 Vaccination is contraindicated in children under 5 Smallpox is an acute exanthematous infection caused by the variolae poxvirus. It is i s transmitted primarily by respiratory respiratory secretions as well as more infrequently infrequently skin inoculation and and fomite spread. spread. Following contact, there is an asymptomatic period of 12-13 days. Following the asymptomatic period, patients develop develop a prodrome of fever, fever, headache, headache, back pain and and vomiting for 3 days. days. Then, the characteristic deep seated papules that vesicles appear. These lesions mature into a pustule with a central umbilication. Occasionally, patients may develop a hemorrhagic form of the disease which is associated with thrombocytopenia and poor prognosis. Vaccination is not contraindicated in children under 5. Q/Q(M)-477358 Report a Problem
31
You are in a medical mission in the Peruvian Amazonia and were asked to examine a patient. The patient was concerned concerned about the skin lesions on her abdomen. abdomen. What is the most likely diagnosis in your your differential? 1
Yellow fever
2
Dengue fever
3
Malaria
4
Strongyloidosis
5
Leptospirosis Q/Q(M)-482882 Report a Problem
You are in a medical mission in the Peruvian Amazonia and were asked to examine a patient. The patient was concerned concerned about the skin lesions on her abdomen. abdomen. What is the most likely diagnosis in your your differential? 4 Strongyloidosis Strongyloides stercoralis causes morphologically variable skin lesions. Rarely, a petechial purpuric eruption which resembles multiple thumbprints may initially present over the periumbilical area. Later on it may involve i nvolve the whole abdomen, thighs, legs and arms. The petechial purpuric skin lesions in disseminated strongyloidiasis strongyloidiasis are due to damage to the blood vessels caused by larval migration. Q/Q(M)-482882 Report a Problem A patient on the bone marrow transplant service has a fever, neutropenia, hemorrhagic hemorrhagic bullae and erythematous nodules with dusky gray centers. The organism most likely to be responsible is: 1 Streptococcus pyogenes 2
Mycobacterium tuberculosis
3
Candida albicans
4
Pseudomonas aeruginosa
5
Staphylococcus Staphylococcus aureus Q/Q(M)-477315 Report a Problem
A patient on the bone marrow transplant service has a fever, neutropenia, hemorrhagic hemorrhagic bullae and erythematous nodules with dusky gray centers. The organism most likely to be responsible is: 4 Pseudomonas aeruginosa Ecthyma gangrenosum gangrenosum is an infection of critically ill or immunocompromised immunocompromised individuals by Pseudomonas aeruginosa. aeruginosa. Clinically, patients develop opalescent, opalescent, tense vesicles or pustules surrounded by a narrow pink pink to violaceous halo. The lesions lesions rapidly become become hemorrhagic, then then violaceous and necrotic leaving ulcers. The most common location is on the buttocks and lower extremities. Treatment is with aminoglycosides. aminoglycosides. Q/Q(M)-477315 Report a Problem A 10-year-old boy develops an acute illness and rash along with marked enlargement of the t he posterior cervical lymph nodes. This presentation is most consistent with: 1
West African sleeping sickness 32
2
East African sleeping sickness
3
Chagas disease
4
Schistosomiasis
5
Sparaganosis Q/Q(M)-482313 Report a Problem
A 10-year-old boy develops an acute illness and rash along with marked enlargement of the t he posterior cervical lymph nodes. This presentation is most consistent with: 2 East African sleeping sickness East African sleeping sickness is caused by Trypanosoma rhodisiense and leads to acute illness ill ness with rapid fatal course and pronounced posterior cervical lymphaden l ymphadenopathy opathy (Winterbottom's sign). West African sleeping sickness is more chronic. American trypanosomiasis, or Chagas disease, features unilateral conjunctivitis and edema of the face (Romana's (Ro mana's sign) and heart and gastrointestinal sequelae. Schistomsomiasis causes causes swimmer's itch, while sparaganosis from ingestion of Spirometra leads to painful edematous edematous lumps. Q/Q(M)-482313 Report a Problem Which of the following is a pox virus? 1 Molluscum contagiosum contagiosum 2
Herpes simplex virus
3
Pediculosis capitis
4
Sarcoptes scabei
5
Human immunodeficiency virus Q/Q(M)-482808 Report a Problem
Which of the following is a pox virus? 1 Molluscum contagiosum contagiosum Of the answer choices, molluscum contagiosum is the only pox virus. Pediculosis capitis, the cause of lice, and sarcoptes scabei, the cause of scabies are not viruses. Herpes simplex virus is a herpes virus and HIV is a lentivirus. Q/Q(M)-482808 Report a Problem A patient recently had pharyngitis and now has an eruption of guttate psoriasis. Which of the following tests would be helpful in determining that this patient had a Streptococcal infection? 1 A complete blood count 2
FTA-ABS
3
U1-RNP
4
DNAse B
5
Serum calcium Q/Q(M)-480156 Report a Problem
33
A patient recently had pharyngitis and now has an eruption of guttate psoriasis. Which of the following tests would be helpful in determining that this patient had a Streptococcal infection? 4 DNAse B The DNAse B, hyaluronidase or streptolysin O (ASLO) (AS LO) antibodies in serum can be helpful for confirming streptococcal infection in situations where streptococci cannot be isolated. The FTA-ABS is used for detecting syphilis, and is the only test that is positive in the first 14 days of infection. U1-RNP is an extractable nuclear antibody which is a marker for Mixed Connective Tissue Disease. Q/Q(M)-480156 Report a Problem A 23 year old intravenous drug user presents with the onset of purpura on the legs. Biopsy reveals vasculopathic changes changes with intravascular thrombi seen in superficial dermal vessels. Serum studies for cryoglobulins and Hepatitis C virus are both positive. Patients with HCV and mixed cryoglobulinemia are more likely to develop what malignancy? 1 Non-Hodgkins lymphoma 2
Cutaneous T-cell lymphoma
3
Anaplastic large cell lymphoma
4
Kaposi\'s sarcoma
5
Acute myelocytic leukemia Q/Q(M)-482597 Report a Problem
A 23 year old intravenous drug user presents with the onset of purpura on the legs. Biopsy reveals vasculopathic changes changes with intravascular thrombi seen in superficial dermal vessels. Serum studies for cryoglobulins and Hepatitis C virus are both positive. Patients with HCV and mixed cryoglobulinemia are more likely to develop what malignancy? 1 Non-Hodgkins lymphoma Mixed cryoglobulinemia is characterized by intravascular thrombi and the finding of monoclonal or polyclonal IgG and and IgM cryoglobulins cryoglobulins in the blood. Mixed cryoglobulinemia cryoglobulinemia is commonly associated associated with HCV infection. Patients with HCV-associated mixed cryoglobulinemia cryoglobulinemia are at an increased risk of developing non-Hodgkins lymphoma, approximately 35 times the general population. Q/Q(M)-482597 Report a Problem The diagnosis of leishmaniasis can be confirmed by which of the following techniques? 1 Weil-Felix test 2
Warthin-Starry stain
3
Culture in Sabourad's agar
4
Culture in Novy-MacNeal-Nicolle Novy-MacNeal-Nicolle (NNN) medium
5
Culture in Michel's medium Q/Q(M)-473908 Report a Problem
The diagnosis of leishmaniasis can be confirmed by which of the following techniques? 4 Culture in Novy-MacNeal-Nicolle Novy-MacNeal-Nicolle (NNN) medium Confirmation of infection with Leishmaniasis Leishmaniasis is performed by b y culture in Novy-MacNeal-Nicolle (NNN) medium. Q/Q(M)-473908 Report a Problem 34
A child presents with fever, cutaneous tenderness tenderness and erythema of flexural and periorifacial areas. Within 24 hours the t he erythema progresses to flaccid blisters and erosions. No organisms are cultured and Nikolsky's sign sign is positive. First line therapy includes: 1 IV penicillinase resistant penicillin 2
Aspirin
3
IV IgG
4
PO tetracylcine
5
PO cephalexin Q/Q(M)-481615 Report a Problem
A child presents with fever, cutaneous tenderness tenderness and erythema of flexural and periorifacial areas. Within 24 hours the t he erythema progresses to flaccid blisters and erosions. No organisms are cultured and Nikolsky's sign sign is positive. First line therapy includes: 1 IV penicillinase resistant penicillin First line therapy for SSSS includes IV penicillinase resistant penicillin. Second line therapy is IV macrolide treatment. Third line therapies are cephalosporin and vancomycin. Q/Q(M)-481615 Report a Problem An 18 year old male presents complaining of pruritus, erythema, and edema of the hands and feet. A serum study for parvovirus antibodies is negative. What is the next most common cause of this syndrome? 1 Epstein-Barr virus 2
Measles virus
3
Coxsackie virus
4
Cytomegalovirus
5
Human herpes virus 6 Q/Q(M)-482591 Report a Problem
An 18 year old male presents complaining of pruritus, erythema, and edema of the hands and feet. A serum study for parvovirus antibodies is negative. What is the next most common cause of this syndrome? 1 Epstein-Barr virus Papular-purpuric gloves and socks syndrome is characterized by pruritus, erythema, and edema of the hands and feet, primarily in teenagers and young adults. Parvovirus B19 is classically associated with this eruption. While all of the viruses listed as answer choices have been associated with this syndrome; Epstein-Barr virus is the best answer choice. Q/Q(M)-482591 Report a Problem A patient develops gastroenteritis after a trip to the seacoast. He reports eating raw oysters at his favorite seafood restaurant. Which of the following organisms or ganisms is the most likely l ikely cause of his gastrointestinal problems? 1 Vibrio vulnificus 2
Vibrio parahemolyticus parahemolyticus 35
3
Mycobacterium marinum
4
Erysipelothrix rhusiopathiae
5
Treponema carateum Q/Q(M)-480161 Report a Problem
A patient develops gastroenteritis after a trip to the seacoast. He reports eating raw oysters at his favorite seafood restaurant. Which of the following organisms or ganisms is the most likely l ikely cause of his gastrointestinal problems? 2 Vibrio parahemolyticus parahemolyticus Vibrio parahemolyticus is a cause of gastroenteritis after consuming contaminated seafood or shellfish. V. vulnificus infection occurs in cuts/wounds that contact contaminated seawater or marine organisms. M. marinum occurs after injury in an aquatic environment such as a fish tank or swimming pool. Lesions typically occur on hands, elbows or knees and are characterized by painless inflammatory nodules that may ulcerate and may occur in a sporotrichoid pattern. E. rhusiopathiae infection occurs after injuries in fishermen, butchers or those handling raw meat. Initially there is burning pain at the inoculation site followed by a gradually enlarging purple plaque with well defined margins. T. carateum is the cause of Pinta. Q/Q(M)-480161 Report a Problem Which of the following forms of syphilis is characterized by ham-colored macules on the palms and soles, condyloma lata, and \"moth-eaten\" alopecia? 1 Primary 2
Secondary
3
Latent
4
Tertiary
5
Congenital Q/Q(M)-482694 Report a Problem
Which of the following forms of syphilis is characterized by ham-colored macules on the palms and soles, condyloma lata, and \"moth-eaten\" alopecia? 2 Secondary Secondary syphilis is characterized by ham-colored macules on the palms and soles, condyloma lata, and \"moth-eaten\" alopecia, in addition to mucous patches and split papules. It typically lasts 4-12 4 -12 weeks. Q/Q(M)-482694 Report a Problem Which of the following Rickettsial diseases would be rarely positive on Weil-Felix test? 1
Rocky Mountain Spotted Fever
2
Epidemic Typhus
3
Rickettsial pox
4
Endemic typhus
5
Scrub Typhus Q/Q(M)-480179 Report a Problem 36
Which of the following Rickettsial diseases would be rarely positive on Weil-Felix test? 3 Rickettsial pox Rickettsial pox is diagnosed by clinical suspicion and confirmatory biopsy, the Weil-Felix test is rarely positive. The other other listed Rickettsial diseases diseases will have positive Weil-Felix tests. The Weil-Felix test makes use of the cross-reaction between antigens from the gram-negative Proteus vulgaris species and Rickettsia spp. It is not specific and rising titers in the appropriate clinical presentation is necessary necessary for confirmation. The Proteus antigens OX-K, OX-19 and OX-2 are employed. Q/Q(M)-480179 Report a Problem A 12 year old girl presents complaining of multiple warts on the fingers f ingers that have been recalcitrant to common over-the-counter treatments. What is the clearance rate of untreated common warts in children at 2 years after diagnosis? 1 25-30% 2
50-55%
3
70-75%
4
1%
5
5-10% Q/Q(M)-482608 Report a Problem
A 12 year old girl presents complaining of multiple warts on the fingers f ingers that have been recalcitrant to common over-the-counter treatments. What is the clearance rate of untreated common warts in children at 2 years after diagnosis? 3 70-75% While warts can be very difficult and frustrating to treat, t reat, the spontaneous clearance clearance rate at two years is actually quite high (70-75%). Q/Q(M)-482608 Report a Problem Roseola infantum is caused by which virus? 1 Coxsackie virus A16 2
Human herpes virus 6
3
Parvovirus B19
4
Epstein-Barr virus
5
Pox virus Q/Q(M)-477135 Report a Problem
Roseola infantum is caused by which virus? 2 Human herpes virus 6 Roseola infantum may be cause be either human herpes virus types 6 or 7. It is the sixth of the traditional exanthems of childhood. A diffuse, maculopapular eruption is typically preceded by a prodrome of fever fever and either respiratory or gastrointestinal symptoms. symptoms. The infection usually usually occurs in the spring and the fall and nearly all children are seropositive for the virus by b y the age of 4. Q/Q(M)-477135 Report a Problem 37
A 37-year-old man presents with a red, tender papule on his lateral right hand that subsequently subsequently becomes necrotic necrotic with regional lymphadenopathy lymphadenopathy.. An exanthem is also also present. Which animal was this individual hunting? 1 Rabbits 2
Grouse
3
Squirrels
4
Deer
5
Moose Q/Q(M)-480165 Report a Problem
A 37-year-old man presents with a red, tender papule on his lateral right hand that subsequently subsequently becomes necrotic necrotic with regional lymphadenopathy lymphadenopathy.. An exanthem is also also present. Which animal was this individual hunting? 1 Rabbits The presentation described above is that of Tularemia, caused by Francisella tularensis. The most common form of Tularemia is the ulceroglandular form, which is described above. Infected animals, most commonly rabbits, transmit the organism though occasionally occasionally tick bites or deer flies may be the vector. Squirrels may be the vector of bubonic plague in endemic areas. The other animals would not cause a syndrome as described. Q/Q(M)-480165 Report a Problem Hutchinson�s teeth are a feature of which stage of syphilis? 1
Early congenital
2
Late congenital
3
Primary
4
Secondary
5
Tertiary Q/Q(M)-474236 Report a Problem
Hutchinson�s teeth are a feature of which stage of syphilis? 2 Late congenital Hutchinson�s teeth (widely-spaced, peg-shaped upper incisors) are a seen in Late Congenital Syphilis (> 2 years of age). Q/Q(M)-474236 Report a Problem The mechanism of action of this virulence factor of Bacillus anthracis is via increasing the activity of tumor necrosis factor alpha: 1 Lethal toxin 2
Edema toxin
3
Polyglutamate acid capsule
4
All of the above answers are correct 38
5
None of the above answers are correct Q/Q(M)-477605 Report a Problem
The mechanism of action of this virulence factor of Bacillus anthracis is via increasing the activity of tumor necrosis factor alpha: 1 Lethal toxin Bacillus anthracis is responsible for causing Anthrax. Anthrax of the skin is characterized by a painless edematous nodule which rapidly degenerates into an eschar. B. anthracis has 3 virulence factors: a polyglutamate acid acid capsule which which inhibits phagocytosis phagocytosis of the bacteria, edema edema toxin (edema factor and protective factor) which which results in edema secondary to induction of cAMP pathway, pathway, and lethal toxin (lethal factor and protective factor) which leads to shock and death via increasing TNFalpha activity. Q/Q(M)-477605 Report a Problem Which of the following statements best describes the pathogenesis of scrofuloderma? 1 Hematogenous Hematogenous spread of M. tuberculosis from a distant site of infection 2
Autoinoculation of M. tuberculosis from advanced pulmonary tuberculosis
3
Contiguous spread from an underlying focus of tuberculous lymphadenitis
4
Primary incoculation of M. tuberculosis in a sensitized host
5
An cutaneous manifestation of military tuberculosis Q/Q(M)-474530 Report a Problem
Which of the following statements best describes the pathogenesis of scrofuloderma? 3 Contiguous spread from an underlying focus of tuberculous lymphadenitis Scrofuloderma is the result of contiguous spread onto skin from an underlying focus of tuberculous infection. This typically occurs in a sensitized host with low immunity. Q/Q(M)-474530 Report a Problem Scrofuloderma is most commonly associated with an underlying infection of what organ system? 1 Lymph nodes 2
Spine
3
Lungs
4
Gastrointestinal tract
5
No underlying systemic disease Q/Q(M)-482065 Report a Problem
39
Scrofuloderma is most commonly associated with an underlying infection of what organ system? 1 Lymph nodes Scrofuloderma is a tuberculous or nontuberculous mycobacterial infection affecting children and young adults, representing direct extension of tuberculosis into the skin from underlying structures such as lymph nodes, bone, or lung. It most commonly presents as a neck abscess secondary to a tuberculosis infection of the cervical lymph nodes. It is manifested by the development of painless subcutaneous swellings that evolve into cold abscesses, multiple ulcers, and draining sinus tracts. The diagnosis is based on positive positive Mantoux test/PPD test, histologic features features of caseating caseating granulomatous granulomatous inflammation, culture, and favorable response to anti-tuberculosis therapy. Q/Q(M)-482065 Report a Problem Which virus is most commonly associated associated with oral hairy leukoplakia? 1 Pox virus 2
Herpes virus
3
Epstein-Barr virus
4
Human papilloma virus
5
Parvovirus Q/Q(M)-477142 Report a Problem
Which virus is most commonly associated associated with oral hairy leukoplakia? 3 Epstein-Barr virus Oral hairy leukoplakia is an oral mucosal infection most often caused by the Epstein-Barr virus, which occurs in immunocompromised patients. Clinically, thick, white plaques are noted on the lateral sides of the tongue, often fissured. Q/Q(M)-477142 Report a Problem Measles is caused by a: 1 Paramyxovirus 2
Togavirus
3
Picornavirus
4
Rhabdovirus
5
Adenovirus Q/Q(M)-473928 Report a Problem
Measles is caused by a: 40
1 Paramyxovirus The measles virus is an RNA virus belonging to the Paramyxovirus family. Q/Q(M)-473928 Report a Problem A 45 year old female is admitted to the t he hospital because of symmetric, large ecchymotic ecchymotic areas with irregular borders on the extremities, extr emities, ears, and nose. Laboratory testing reveals the patient has disseminated intravascular intravascular coagulation. Which of the following is the most common underlying infection associated with this condition? 1 Group A streptococcus 2
Meningococcus
3
Staphylococcus
4
Pseudomonas
5
Mycobacterium Q/Q(M)-482690 Report a Problem
A 45 year old female is admitted to the t he hospital because of symmetric, large ecchymotic ecchymotic areas with irregular borders on the extremities, extr emities, ears, and nose. Laboratory testing reveals the patient has disseminated intravascular intravascular coagulation. Which of the following is the most common underlying infection associated with this condition? 1 Group A streptococcus Purpura fulminans is an oftentimes dramatic presentation of large ecchymotic areas of the skin, favoring acral sites including the extremities, ears, and nose. The underlying pathophysiology is hemorrhagic infarction of the skin due to disseminated intravascular coagulation. Group A streptococcal infection is the leading underlying infection associated with this condition. Q/Q(M)-482690 Report a Problem What is the most common cause of focal epithelial hyperplasia? h yperplasia? 1
Ebstein Bar virus(EBV)
2
Pachyonychia Pachyonychia Congenita
3
human immunodeficiency virus(HIV)
4
human papilloma virus(HPV)
5
Dyskeratosis Congenita Q/Q(M)-477635 Report a Problem
What is the most common cause of focal epithelial hyperplasia? h yperplasia? 4 human papilloma virus(HPV) Focal epithelia hyperplasia, also known as Heck's disease, is caused by HPV types t ypes 13, 32 and 57. It is most commonly found on the lower lip but also on the buccal mucosa, gums and tongue. It is mainly a disease of native Americans and Greenlander Eskimos. EBV causes an oral hairy leukoplakia l eukoplakia in patients with AIDS. Pachyonychia Congenita patients commonly develop a benign oral leukoplakia, while Dykeratosis Congenita patients develop a premalignant oral leukoplakia. Q/Q(M)-477635 Report a Problem A patient presents with this t his anesthestic plaque. Which cytokines are upregulated in this disease? 41
1
IL-2
2
IL-4
3
IL-5
4
IL-10
5
All of these cytokines are upregulated Q/Q(M)-476864 Report a Problem
A patient presents with this t his anesthestic plaque. Which cytokines are upregulated in this disease? 1 IL-2 Leprosy is caused by infections to Mycobac M ycobacterium terium leprae. It is i s a acid fast f ast bacilli. In tuberculoid leprosy, Th1 cytokines (IL-2, IFN-gamma) are upregulated. Clinically, patients have few, well-circumscribed anesthetic plaques. Q/Q(M)-476864 Report a Problem Which of the following is the vector for Dengue fever? 1 Phlebotomus papatasii 2
Culex mosquito
3
Aedes aegypti
4
Lutzomyia verrucarum
5
Xenopsylla cheopis Q/Q(M)-478209 Report a Problem
Which of the following is the vector for Dengue fever? 3 Aedes aegypti Dengue fever also known as "break-bone" fever is characterized by sudden high fever, backache, retro42
orbital pain, bone/joint pain, weakness, and malaise. It is caused by an arbovirus (RNA virus) which is transmitted by Aedes aegypti, a species of mosquito. Q/Q(M)-478209 Report a Problem A 37 year old male with a history of HIV/AIDS presents complaining of the new onset of purplish nodules of the feet and lower legs. He lost his insurance eight months ago and has been unable to afford the HAART therapy that he was prescribed. HHV-8 is found in the semen of what percent of men with this disease? 1 5% 2
20%
3
35%
4
50%
5
65% Q/Q(M)-482592 Report a Problem
A 37 year old male with a history of HIV/AIDS presents complaining of the new onset of purplish nodules of the feet and lower legs. He lost his insurance eight months ago and has been unable to afford the HAART therapy that he was prescribed. HHV-8 is found in the semen of what percent of men with this disease? 2 20% Kaposi\'s sarcoma is a vascular neoplasm seen most commonly on the lower extremities, back, and genitaliae. In the United States, this disease is most commonly seen in patients with AIDS. Kaposi\'s sarcoma has been linked to infection with HHV-8. 20% of men with Kaposi\'s sarcoma will have detectable HHV-8 in their semen. Q/Q(M)-482592 Report a Problem Where do you see Gamma-Favre bodies? 1 Granuloma inguinale 2
Lymphogranuloma Lymphogranuloma venereum (LGV)
3
Syphilis
4
Chancroid
5
Herpes virus Q/Q(M)-477444 Report a Problem
Where do you see Gamma-Favre bodies? 2 Lymphogranuloma Lymphogranuloma venereum (LGV) LGV is a sexually transmitted disease that is characterized by suppurative inguinal adenitis with matted lymph nodes, inguinal bubo with secondary ulceration, and constitutional symptoms. It is caused by Chlamydia trachomatis serotypes L1, L2, and L3. First line li ne treatment is doxycycline 100mg bid for 3 weeks as well as treating the sexual partners. Gamma-Favre bodies are found in histiocytes in LGV. Q/Q(M)-477444 Report a Problem What is the following is the best choice for treatment tr eatment of herpes zoster? 1 Ganciclovir 43
2
Foscarnet
3
Valacyclovir
4
Gabapentin
5
Cidofovir Q/Q(M)-482817 Report a Problem
What is the following is the best choice for treatment tr eatment of herpes zoster? 3 Valacyclovir First line treatment of herpes zoster (shingles) is with valacyclovir, acyclovir, acyclovir, or famciclovir. Gabapentin may be used for post-herpetic neuralgia. Cidofovir and ganciclovir are treatment options for cytomegalovirus. cytomegalovirus. Foscarnet is used to treat acyclovir resistant herpes simplex infections. Q/Q(M)-482817 Report a Problem A patient with primary syphilis is treated with Benzathine penicillin G. Soon after treatment, he develops fever, headache, myalgias, myalgias, and elevated white blood cell count, consistent with the JarischJ arischHerxheimer Reaction. This reaction is primarily mediated through which inflammatory cytokine? 1 TNF-alpha 2
IFN-gamma
3
IL-6
4
EGFR
5
IL-10 Q/Q(M)-482697 Report a Problem
A patient with primary syphilis is treated with Benzathine penicillin G. Soon after treatment, he develops fever, headache, myalgias, myalgias, and elevated white blood cell count, consistent with the JarischJ arischHerxheimer Reaction. This reaction is primarily mediated through which inflammatory cytokine? 1 TNF-alpha The Jarisch-Herxheimer Reaction is characterized by fever, f ever, headache, lymphadenopathy, lymphadenopathy, myalgias, and elevated white blood cell count. It is caused by the release of inflammatory cytokines, particularly TNFalpha, due to phagocytosis of spirochetes following antibiotic administration. Q/Q(M)-482697 Report a Problem Acrodermatitis chronica atrophicans is caused by: 1 Borrelia burgdorferi 2
Borrelia burgdorferi senso stricto
3
Borrelia garinii
4
Borrelia afzelii
5
Unknown Q/Q(M)-477428 Report a Problem
Acrodermatitis chronica atrophicans is caused by: 4 Borrelia afzelii 44
Acrodermatitis chronica atrophicans, atrophicans, also known as primary diffuse atrophy, is characterized by the appearance on the extremities of diffuse reddish or bluish red, paper-thin skin allowing the blood vessels to easily be seen beneath the skin. It is caused by Borrelia afzelii and is tick transmitted by Ixodes ricinus. It is seen almost exclusively in Europe. Q/Q(M)-477428 Report a Problem Sun exposure has been associated with the development of what type t ype of warts? 1 Flat warts 2
Myrmecial warts
3
Common warts
4
Butcher\'s warts
5
Condyloma accuminatum Q/Q(M)-482609 Report a Problem
Sun exposure has been associated with the development of what type t ype of warts? 1 Flat warts Warts are common cutaneous lesions caused by the various human papilloma virus subtypes. Flat warts are commonly caused by HPV subtypes 3, 10, 28, and 41. Sun exposure has been implicated as a potential factor in the formation of flat warts. Q/Q(M)-482609 Report a Problem A 34 year old woman complains of recurrent painful blisters on her lower lip. These occur 4 times per year, and are preceded by painful sensations for a day before the blisters appear. What is the most common trigger of recurrent orolabial herpes simplex virus infection? 1 UVB radiation 2
UVA radiation
3
Visible light radiation
4
Emotional stress
5
Medication use, including opioids Q/Q(M)-482619 Report a Problem A 34 year old woman complains of recurrent painful blisters on her lower lip. These occur 4 times per year, and are preceded by painful sensations for a day before the blisters appear. What is the most common trigger of recurrent orolabial herpes simplex virus infection?
1 UVB radiation Recurrent orolabial herpes simplex virus infection is a very common problem. In many cases, the cause of the recurrences is idiopathic. Identifiable triggers include light exposure and emotional stress, among others. UVB is the most commonly implicated factor. Q/Q(M)-482619 Report a Problem Woolsorter �s disease is caused by: 1 Erysipelothrix rhusiopathiae 2
Listeria monocytogenes monocytogenes 45
3
Corynebacterium Corynebacterium minutissimum
4
Corynebacterium Corynebacterium tenius
5
Bacillus anthracis Q/Q(M)-480167 Report a Problem
Woolsorter �s disease is caused by: 5 Bacillus anthracis Anthrax, also know as woolsorter �s disease or malignant pustule is caused by Bacillus anthracis, a gram positive rod. It is primarily caused by contact with infected wild or domestic animals or their products (such (such as wool). This organism organism has 3 clinical clinical forms: inhalation, gastrointestinal gastrointestinal and cutaneous. cutaneous. The primary lesion is a �malignant pustule� which begins as a painless papule that evolves into a hemorrhagic bulla. Ultimately, a black eschar forms. The lack of pain is helpful in distinguishing between anthrax anthrax and other infections infections of the skin which which are painful, such such as ecthyma. ecthyma. The other listed organisms are not causes of this disease. Q/Q(M)-480167 Report a Problem What named nerve is involved in the formation of Hutchinson's sign (vesicles at the nasal tip) in herpes zoster? 1 Ophthalmic nerve 2
V2 (maxillary)
3
Nasociliary
4
Infratrochlear nerve
5
Labial nerve Q/Q(M)-482583 Report a Problem
What named nerve is involved in the formation of Hutchinson's sign (vesicles at the nasal tip) in herpes zoster? 3 Nasociliary Hutchinson's Hutchinson's sign is defined by vesicles at the nasal tip in a patient with facial herpes zoster. It is caused by VZV invovlement invovlement of the nasociliary nasociliary nerve. Patients suffering suffering with this sign should be screened screened for ophthalmologic herpes zoster invovlement. Q/Q(M)-482583 Report a Problem Herpes-associated Herpes-associated erythema mutliforme is most commonly associated with which HLA type? 1 HLA B27 2
HLA DR2
3
HLA DR3
4
HLA B15
5
HLA B8 Q/Q(M)-477429 Report a Problem
Herpes-associated Herpes-associated erythema mutliforme is most commonly associated with which HLA type? 46
4 HLA B15 Recurrent erythema multiforme (EM minor) is usually caused by recurrent herpes simplex, most commonly HSV-1 orolabial disease. This is more correctly now called herpes-associated erythema multiforme(HAEM) and has been more commonly associated with people with HLA type B15. Q/Q(M)-477429 Report a Problem The patient in this photograph has claw hands, hypoesthesia of the distal extremities, madarosis and leonine facies. What type of leprosy l eprosy does she have? 1 A. Lepromatous leprosy 2
Tuberculoid leprosy
3
Borderline leprosy
4
Erythema nodosum leprosum
5
Lucio phenomenon Q/Q(M)-482071 Report a Problem
The patient in this photograph has claw hands, hypoesthesia of the distal extremities, madarosis and leonine facies. What type of leprosy l eprosy does she have? 1 A. Lepromatous leprosy Hansen'™s disease (aka Leprosy) is a chronic granulomatous disease princi pally pally affecting the skin and peripheral nervous nervous system, caused caused by Mycobacterium Mycobacterium leprae. The areas most commonly commonly affected are are the superficial peripheral nerves, skin, mucous membranes of the upper respiratory tract, anterior chamber of the eyes, and testes. These areas tend to be cool parts of the body. Tissue damage depends on the degree to which cell-mediated immunity is expressed, the type and extent of bacillary spread and multiplication, the appearance of tissue-damaging ti ssue-damaging immunologic complications (ie, lepra reactions), and the development of nerve damage and its sequelae. Q/Q(M)-482071 Report a Problem What is the causative agent of this parasitic eruption which also causes patchy pulmonary infiltrate and eosinophilia? 1 Dracunculiasis 2
Gnathostomiasis
3
Larva currens
4
Larva migrans
5
Filariasis Q/Q(M)-476852 Report a Problem 47
What is the causative agent of this parasitic eruption which also causes patchy pulmonary infiltrate and eosinophilia? 4 Larva migrans Larva migrans is caused by Ancylostoma braziliense, a hookworm of cats and dogs. It also associated with Loeffler's syndrome, patchy infiltrate of the t he lungs with eosinophilia. Treatment for this parasitic infection is ivermectin or albendazole. albendazole. Q/Q(M)-476852 Report a Problem Foamy macrophages containing Klebsiella pneumoniae are called: 1 Virchow cells 2
Hansemann's cells
3
Mikulicz's cells
4
Michaelis-Gutman cells
5
Russell cells Q/Q(M)-477425 Report a Problem
Foamy macrophages containing Klebsiella pneumoniae are called: 3 Mikulicz's cells Mikulicz�s cells are foamy macrophages found in Rhinoscleroma � a chronic, inflammatory, granulomatous disease disease of the upper respiratory tract. Virchow cells are found in Hansen�s disease. Hansemann cells and Michaelis-Gutman bodies are found in Malakoplakia. Q/Q(M)-477425 Report a Problem Which of the following is not a tick born disease? 1
Lyme disease
2
Tularemia
3
Rocky Mountain spotted fever
4
Yaws
5
Ehrlichiosis Q/Q(M)-478753 Report a Problem 48
Which of the following is not a tick born disease? 4 Yaws Ticks are capable of transmitting:Lyme disease-Borrelia burgdorferi, a tickborne spirochete. TularmiaFrancisella tularensis, bite of a tick. ti ck. Rocky Mountain spotted fever-Rickettsia rickettsii, tick typhus. Yaws-Treponema Yaws-Treponema Palladium, subspecies pertunue-transmitted nonsexually, by contact with infectious lesions. Ehrlichiosis-Ehrlichia chaffeensis, tickborne Q/Q(M)-478753 Report a Problem A 35 year old male has had frequent sex with prostitutes. He presents complaining of the rapid onset of a new rash on his legs. A review of symptoms is otherwise unremarkable. Examination reveals palpable purpura and tender nodules of the the lower legs. Biopsy reveals vasculitis vasculitis of small- and medium-sized medium-sized vessels. What percentage percentage of patients with this disease are found to be infected with Hepatitis B virus? 1 7-8% 2
20%
3
35%
4
1%
5
50% Q/Q(M)-482596 Report a Problem
A 35 year old male has had frequent sex with prostitutes. He presents complaining of the rapid onset of a new rash on his legs. A review of symptoms is otherwise unremarkable. Examination reveals palpable purpura and tender nodules of the lower legs. Biopsy reveals vasculitis vasculitis of small- and medium-sized vessels. What percentage percentage of patients with this disease are found to be infected with Hepatitis B virus? 1 7-8% Polyarteritis nodosa is characterized by the onset onset of painful nodules on the lower extremities. It can be limited to the skin (cutaneous PAN), or can involve a wide variety of organ systems (systemic PAN). Approximately 7-8% of cases of polyarteritis nodosa cases are associated with Hepatitis B virus infection. Q/Q(M)-482596 Report a Problem Which of the following factors is most important in the skin providing protection against infectious agents? 1 The mechanical barrier of intact skin 2
The resident flora present on intact skin
3
The relative dryness of intact skin
4
The cornified cell envelope
5
The presence of immunoglobulins on intact skin Q/Q(M)-480150 Report a Problem Which of the following factors is most important in the skin providing protection against infectious agents? 1 The mechanical barrier of intact skin The most important determinant of the skin �s protection against infectious agents is the mechanical barrier of intact skin. The dryness of the skin is also important important in retarding infection. infection. The resident flora 49
may help prevent colonization by pathogenic organisms, but is not the most important factor. Immunoglobulins are present on intact skin in miniscule amounts. The cornified cell envelope is not a major determinant of infection prevention. Q/Q(M)-480150 Report a Problem Nonmenstrual cases cases of the staphylococcal staphylococcal toxic shock shock syndrome are mediated by which which of the following toxins? 1 Enterotoxins B and C 2
Exfoliative toxins A and B
3
Edema toxin
4
Epidermolytic toxins A and B
5
Pyrogenic exotoxins A, B, C Q/Q(M)-474534 Report a Problem
Nonmenstrual cases cases of the staphylococcal staphylococcal toxic shock shock syndrome are mediated by which which of the following toxins? 1 Enterotoxins B and C Toxic shock syndrome (TSS) is mediated by Enterotoxins B and C (50% of nonmenstrual cases) and TSS toxin 1 (TSST-1), which is the leading cause of menstrual cases. Q/Q(M)-474534 Report a Problem What laboratory finding is commonly seen in children with measles virus infection? 1
Lymphopenia
2
Thrombocytopenia
3
Polycythemia
4
Anemia
5
Lymphocytosis Q/Q(M)-482607 Report a Problem What laboratory finding is commonly seen in children with measles virus infection? 1 Lymphopenia Children who are actively infected with the measles virus are commonly found to have lymphopenia. While an abnormality of any of the blood cell lines is possible during viral infections, in the case of measles infections, lymphopenia is most common. Q/Q(M)-482607 Report a Problem
A 48 year-old woman presents to the Emergency Room with a 2 day history of fever and a well demarcated erythematous plaque on her right cheek. What is the treatment of choice? 1 Prednisone 2
Intravenous penicillin
3
Cephelexin 50
4 5
Fluconazole Potent topical corticosteroid Q/Q(M)-477603 Report a Problem
A 48 year-old woman presents to the Emergency Room with a 2 day history of fever and a well demarcated erythematous plaque on her right cheek. What is the treatment of choice? 2 Intravenous penicillin The most likely diagnosis is Erysipelas which is caused by beta-hemolytic group A streptococcus. The treatment of choice is intravenous penicillin. Q/Q(M)-477603 Report a Problem The leading infectious cause of deafness and mental retardation in the U.S. is: 1 Congenital Rubella 2
Congenital varicella
3
Congenital Cytomegalovirus (CMV)
4
Congenital syphilis
5
Congenital herpes simplex Q/Q(M)-473920 Report a Problem
The leading infectious cause of deafness and mental retardation in the U.S. is: 3 Congenital Cytomegalovirus (CMV) Congenital CMV is the leading infectious cause of deafness and mental retardation in the U.S. Q/Q(M)-473920 Report a Problem Which of the following is a characteristic of papilloma viruses? 1 enveloped viruses 2
single stranded RNA viruses
3
replicate independent of the host cell
4
controlled by host antibody regulated response
5
can cause a condition that manifests with stridor and hoarseness hoarseness in children Q/Q(M)-482552 Report a Problem
Which of the following is a characteristic of papilloma viruses? 5 can cause a condition that manifests with stridor and hoarseness hoarseness in children Papilloma viruses are non-enveloped,double stranded DNA viruses. Cell mediated responses are primarily responsible for controlling papillomavirus papillomavirus infections. Unlike viruses such as as HSV, HPV does does not have enzymes required for replication of viral DNA, and is entirely dependent on the host cellular machinery. Recurrent respiratory papillomatosis can be caused by HPV-6 and 11, with verrucous lesions of the airways. It can occur as a juvenile or adult-onset form and present with hoarseness in children. Unlike viruses such as HSV, HPV does not enzymes required for replication of viral DNA, and is entirely dependent on the host cellular machinery for these functions. Q/Q(M)-482552 Report a Problem 51
A patient with atopic dermatitis presents with frequent flares of dermatitis. They have multiple lichenified plaques, some with serum crust. Which of the following organisms is most likely colonizing these areas? 1
Aerobic diphtheroids
2
Gram positive coagulase negative cocci
3
Staphylococcus Staphylococcus epidermidis
4
Staphylococcus Staphylococcus aureus
5
Propionibacterium avidum Q/Q(M)-480148 Report a Problem
A patient with atopic dermatitis presents with frequent flares of dermatitis. They have multiple lichenified plaques, some with serum crust. Which of the following organisms is most likely colonizing these areas? 4 Staphylococcus Staphylococcus aureus S. aureus rapidly becomes a member of the cutaneous flora in locations where there t here is serum or plasma on the skin. Often patients with atopic dermatitis will have colonization of this organism in lesions and may benefit from topical or oral antibiotics. P. avidum and aerobic diphtheroids are present in moist regions of the skin. Gram positive coagulase negative cocci cocci are the dominant organism in the dry regions of the body. S. epidermidis is most commonly found in oily body regions. Q/Q(M)-480148 Report a Problem Which antibiotic is best to treat this condition caused by Bartonella hensalae. 1 Erythromycin 2
Ceftriaxone
3
Clindamycin
4
Trimethoprim/sulfamethoxasole
5
Fluconazole Q/Q(M)-476525 Report a Problem
Which antibiotic is best to treat this condition caused by Bartonella hensalae. 1 Erythromycin Bartonella hensalae is the causative agent of bacillary angiomatosis. The differential di fferential diagnosis of bacillary angiomatosis angiomatosis may include include pyogenic granulomas granulomas and Kaposi's Kaposi's sarcoma. The The treatment of choice choice is erythromycin. Q/Q(M)-476525 Report a Problem 52
Which anatomic locations are most commonly involved in herpes gladiatorum? 1 Lateral neck, lateral face, forearm 2
Tips of fingers
3
Feet
4
Upper thighs and buttocks
5
Scalp Q/Q(M)-482572 Report a Problem
Which anatomic locations are most commonly involved in herpes gladiatorum? 1 Lateral neck, lateral face, forearm Herpes gladiatorum is most commonly seen on the lateral neck, lateral face, and forearm, areas which most commonly contact a competing wrestler or the wrestling mat. Q/Q(M)-482572 Report a Problem What is the annual risk of developing herpes zoster in an HIV infected patient? 1 3% per month 2
10% per month
3
3% per year
4
10% per year
5
25% per year Q/Q(M)-482580 Report a Problem What is the annual risk of developing herpes zoster in an HIV infected patient?
3 3% per year The annual risk of developing herpes zoster in an HIV infected individual, regardless of the CD-4 count, is approximately 3%. Q/Q(M)-482580 Report a Problem The treatment of choice for acyclovir-resistant herpes simplex virus infection is: 1
Valcyclovir
2
Famciclovir
3
Indinivir
4
Saquinivir
5
Foscarnet Q/Q(M)-474295 Report a Problem
The treatment of choice for acyclovir-resistant herpes simplex virus infection is: 5 Foscarnet Foscarnet directly inhibits viral DNA polymerase pol ymerase (without requiring phosphorylation by TK) and is therefore effective in acyclovir-resistant HSV infections. Cidofovir can also be used. 53
Q/Q(M)-474295 Report a Problem A 48 year-old man develops headache, myalgias, and high fever 5 days after a hunting trip. On examination he has a tender ulcer with raised margins and an eschar on his index finger, as well as tender axillary lymphadenopathy. lymphadenopathy. The most likely diagnosis is: 1
Anthrax
2
Orf
3
Glanders
4
Tularemia
5
Erysipeloid Q/Q(M)-474536 Report a Problem
A 48 year-old man develops headache, myalgias, and high fever 5 days after a hunting trip. On examination he has a tender ulcer with raised margins and an eschar on his index finger, as well as tender axillary lymphadenopathy. lymphadenopathy. The most likely diagnosis is: 4 Tularemia Tularemia, which is caused by Francisella tularensis, occurs after exposure to infected animals, including, rabbits, foxes, and squirrels. The clinical description is that of the ulceroglandular form, which is the most common presentation. Q/Q(M)-474536 Report a Problem Milker �s nodule is caused by infection with which of the following viruses? 1 Human herpesvirus-6 (HHV-6) 2
Human herpesvirus-8 (HHV-8)
3
Paravaccinia virus
4
Vaccinia virus
5
Orf virus Q/Q(M)-474237 Report a Problem
Milker �s nodule is caused by infection with which of the following viruses? 3 Paravaccinia virus Milker �s nodule is caused by paravaccinia virus, a poxvirus of the genus Parapoxvirus. It is transmitted to humans from infected cows. Q/Q(M)-474237 Report a Problem Which of the following is the treatment of choice for the disease caused by Bartonella bacilliformis and spread by the Lutzomyia sandfly? 1 Chloramphenicol 2
Erythromycin
3
Doxycyline
4
Minocycline 54
5
Azithromycin Q/Q(M)-482685 Report a Problem
Which of the following is the treatment of choice for the disease caused by Bartonella bacilliformis and spread by the Lutzomyia sandfly? 1 Chloramphenicol Oroya Fever (Carrion\'s Disease) is caused by Bartonella bacilliformis. The Lutzomyia sandly is the vector. While Bartonella infections respond to multiple classes of antibiotics, including tetracyclines and macrolides, Oroya Fever has a high frequency of superinfection with Salmonella. Therefore, chloramphenicol chloramphenicol is the treatment of choice. Q/Q(M)-482685 Report a Problem A patient presents with fever, irritability and a scarlatiniform erythema with accentuation in the flexural areas. Nikolsky positive blisters develop within 48 hours. Which of the following would predict the best outcome? 1
Frequent NSAID use
2
Normal renal function
3
Normal immune system
4
Age < 5 years old
5
Age > 18 years old Q/Q(M)-480153 Report a Problem
A patient presents with fever, irritability and a scarlatiniform erythema with accentuation in the flexural areas. Nikolsky positive blisters develop within 48 hours. Which of the following would predict the best outcome? 4 Age < 5 years old Staphylococcal Staphylococcal scalded skin syndrome is described in the question. This is predominantly a disease of young children, < 5 years old. The mortality is low in children, but in adults it exceeds 50% due to sepsis and electrolyte and fluid imbalance. NSAID use may predispose patients to a poorer outcome. Normal renal function function and immune system system are helpful, but but do not predict the best best outcome. Q/Q(M)-480153 Report a Problem Tick-borne Relapsing Fever is caused by: b y: 1 B. burgdorferi 2
B. recurrentis
3
B. duttonii
4
B. henselae
5
B. bacilliformis Q/Q(M)-473913 Report a Problem Tick-borne Relapsing Fever is caused by: b y:
3
B. duttonii 55
Relapsing Fever can be either Louse-borne or Tick-borne. Tick-borne Relapsing Fever is caused by B. duttonii, while Louse-borne Relapsing Fever is caused by B. recurrentis. r ecurrentis. Q/Q(M)-473913 Report a Problem Through which cellular protein does molluscum contagiosum evade host immunity? 1 IL-18 binding protein 2
Beta-4 integrin
3
T cell receptor
4
MHC II
5
Toll-like receptor 7 Q/Q(M)-482605 Report a Problem
Through which cellular protein does molluscum contagiosum evade host immunity? 1 IL-18 binding protein Molluscum contagiosum virus, like other viral and bacterial pathogens, attempts to exploit the host immune system to avoid destruction. In this case, molluscum contagiosum virus usesIL-18 binding protein, which blocks blocks the host helper helper T (Th1) response response by reducing local IFN-gamma production. production. Q/Q(M)-482605 Report a Problem
Exanthem Subitum is caused by which of the following? 1 Group A Steptococcus 2
Coxsackie virus
3
Human Herpes Virus-6 (HHV-6)
4
Parvovirus B19
5
Epstein-Barr Virus Q/Q(M)-473919 Report a Problem
Exanthem Subitum is caused by which of the following? 3 Human Herpes Virus-6 (HHV-6) Exanthem Subitum (Roseola Infantum, Sixth Disease) is caused by human herpesvirus 6, and 7 (HHV-6, HHV-7). Q/Q(M)-473919 Report a Problem A 29-year-old woman presents with multiple crateriform pits on the soles of her feet following a month m onth of hiking on the Appalachian Trail. She wants a complete skin exam and wonders about her feet. Which of the following do you plan to do next for her foot problem. 1
These pits are a variant of normal
2
You explain that she has a hereditary syndrome that causes these pits
3
You explain that this is a superficial bacterial infection and will resolve with topical therapy 56
4 5
You ask for a skin biopsy You use a Wood�s lamp to confirm your diagnosis Q/Q(M)-480169 Report a Problem
A 29-year-old woman presents with multiple crateriform pits on the soles of her feet following a month m onth of hiking on the Appalachian Trail. She wants a complete skin exam and wonders about her feet. Which of the following do you plan to do next for her foot problem. 3 You explain that this is a superficial bacterial infection and will resolve with topical therapy Multiple crateriform pits on the feet following suboptimal hygiene most likely is pitted keratolysis caused by Micrococcus sedentarius. Treatment is topical erythromycin, clindamycin or benzoyl peroxide. This is not not Gorlin�s syndrome (Basal Cell Nevus syndrome). While these pits are common, it is not a variant of normal. A skin biopsy could confirm the diagnosis, but is not necessary. A Wood �s lamp would not be particularly helpful. Some believe that Corynebacterium spp. also cause this condition, but that is still theory and not proven. Q/Q(M)-480169 Report a Problem A 12 month old boy has the sudden onset of a fever of 40 degrees Celsius. When the fever breaks spontaneously spontaneously in three days, an erythematous, morbilliform rash arises on the t he trunk and spreads to the arms and legs. The rash is not itchy, and lasts 1-2 days. What is the most likely viral cause of this syndrome? 1
HHV-6
2
Measles virus
3
Rubella virus
4
Coxsackie virus
5
Cytomegalovirus Q/Q(M)-482595 Report a Problem
A 12 month old boy has the sudden onset of a fever of 40 degrees Celsius. When the fever breaks spontaneously spontaneously in three days, an erythematous, morbilliform rash arises on the t he trunk and spreads to the arms and legs. The rash is not itchy, and lasts 1-2 days. What is the most likely viral cause of this syndrome? 1 HHV-6 Roseola infantum is also known as exanthem subitum or sixth disease. It is seen in infants ages 6-36 months, and is characterized by the signs and symptoms as described. The syndrome is caused by Human Herpes Virus 6. Q/Q(M)-482595 Report a Problem A 35 year-old woman who works in the animal product industry presents with a painless hemorrhagic bulla. A diagnosis diagnosis of anthrax is suspected. suspected. Gram Gram stain of the vesicle fluid should reveal reveal which of the following? 1
Guarnieri bodies
2
Gram-negative cocci
3
Gram-negative bacilli 57
4 5
Gram-positive cocci Gram-positive bacilli Q/Q(M)-474914 Report a Problem
A 35 year-old woman who works in the animal product industry presents with a painless hemorrhagic bulla. A diagnosis diagnosis of anthrax is suspected. suspected. Gram Gram stain of the vesicle fluid should reveal reveal which of the following? 5 Gram-positive bacilli Anthrax is caused by Bacillus anthracis, which is a gram-positive spore-forming rod. Q/Q(M)-474914 Report a Problem A 35 year-old woman presents with a painful vaginal erosion and tender left-sided inguinal lymphadenopathy. lymphadenopathy. Gram stain reveals clusters of coccobacilli in a �school of fish� pattern. What is the most likely diagnosis? 1 Primary syphilis 2
Lymphogranuloma Lymphogranuloma venereum
3
Granuloma inguinale
4
Chancroid
5
Secondary syphilis Q/Q(M)-474272 Report a Problem
A 35 year-old woman presents with a painful vaginal erosion and tender left-sided inguinal lymphadenopathy. lymphadenopathy. Gram stain reveals clusters of coccobacilli in a �school of fish� pattern. What is the most likely diagnosis? 4 Chancroid Chancroid classically presents with a soft, tender chancre with ragged edges and unilateral, tender inguinal adenopathy (bubo). A �school of fish� pattern on Gram or Giemsa stain is diagnostic. Q/Q(M)-474272 Report a Problem A 28 year old sexually active female presents to clinic complaining of new growths of her labia majora. Examination reveals condyloma acuminatum, and biopsy with immunohistochemistry immunohistochemistry confirms the diagnosis of human papilloma virus infection. Condyloma accuminatum is most commonly caused by what HPV type? 1 6 and 11 2
16 and 18
3
1 and 3
4
31 and 33
5
48 and 60 Q/Q(M)-482611 Report a Problem
A 28 year old sexually active female presents to clinic complaining of new growths of her labia majora. Examination reveals condyloma acuminatum, and biopsy with immunohistochemistry immunohistochemistry confirms the 58
diagnosis of human papilloma virus infection. Condyloma accuminatum is most commonly caused by what HPV type? 1 6 and 11 While many subtypes of HPV are associated with genital warts, 6 and 11 are the most common. In general, potentially oncogenic oncogenic HPV subtypes such as 16 and 18 cause sessile genital warts. Q/Q(M)-482611 Report a Problem What is the most common single nerve involved with herpes zoster? 1 Facial nerve 2
Trigeminal nerve
3
Spinal nerve C7
4
Spinal nerve T4
5
Spinal nerve T10 Q/Q(M)-482581 Report a Problem
What is the most common single nerve involved with herpes zoster? 2 Trigeminal nerve While herpes zoster can be seen in the dermatome of any cranial or spinal nerve, the most common single nerve involved is the trigeminal nerve. Q/Q(M)-482581 Report a Problem Epithelioma cuniculatum is an HPV-associated verrucous carcinoma involving the: 1 Oral mucosa 2
Scalp
3
Sole
4
Penis
5
Trunk Q/Q(M)-473924 Report a Problem
Epithelioma cuniculatum is an HPV-associated verrucous carcinoma involving the: 3 Sole Epithelioma cuniculatum is a form of verrucous carcinoma involving the sole. Q/Q(M)-473924 Report a Problem A 27 year-old HIV positive presents with this pruritic eruption? What is the characteristic cell type found on histopathology? histopathology? 1 Neutrophil 2
Plasma Cell
3
Basophils
4
Eosinophil 59
5
Lymphocyte Q/Q(M)-476876 Report a Problem
A 27 year-old HIV positive presents with this pruritic eruption? What is the characteristic cell type found on histopathology? histopathology? 4 Eosinophil Eosinophilic pustular folliculitis is a pruritic disorder that may be seen in HIV positive patients. Typically, the CD4 count is < 300. In patients with HIV, pruritus tends to improve i mprove after institution of anti-retroviral therapy. Q/Q(M)-476876 Report a Problem Xenopsylla cheopis transmits: 1 Epidemic typhus 2
Murine typhus
3
Rickettsia prowazekii
4
Scrub typhus
5
Rickettsia akari Q/Q(M)-479608 Report a Problem
Xenopsylla cheopis transmits: 2 Murine typhus Xenopsylla cheopis along with Ctenocephalides Ctenocephalides felis are fleas that transmit R. typhi, the organism responsible for murine or endemic typhus. t yphus. The body louse or Pediculus humanus corporis transmits Rickettsia prowasekii the organism responsible for epidemic typhus. Scrub typhus is caused by R. tsutsugamushi tsutsugamushi and is transmitted by chiggers or trombiculid mite larvae. Q/Q(M)-479608 Report a Problem A 23 year old Peace Corp volunteer returns from Africa with an extensive undermined, non-healing ulceration on the right lower leg. Which of the following infections is the most likely cause of this presentation? 1 M. marinum 2
M. kansasii
3
M. chelonei
4
M. ulcerans
5
Leishmania donovani 60
Q/Q(M)-480177 Report a Problem A 23 year old Peace Corp volunteer returns from Africa with an extensive undermined, non-healing ulceration on the right lower leg. Which of the following infections is the most likely cause of this presentation? 4 M. ulcerans The most likely cause of a non-healing ulceration in someone who has been in a tropical location is M. ulcerans. M. marinum causes inflammatory nodules following injury in an aquatic environment. M. chelonei is a rapidly growing organism most commonly found in soil, water, dust and animals which presents as single/multiple erythematous erythematous SC nodules on on an extremity or or following a surgical procedure. procedure. M. kansasii rarely causes skin lesions. L. donovani is a causse of visceral leishmaniasis in India and Kenya (kala-azar). Q/Q(M)-480177 Report a Problem A patient is suspected to have contracted rabies after a dog bite. The best site for diagnostic biopsy would be: 1 Neck 2
Acral area
3
Site of bite
4
Buccal mucosa
5
Buttocks Q/Q(M)-482316 Report a Problem
A patient is suspected to have contracted rabies after a dog bite. The best site for diagnostic biopsy would be: 1 Neck The best site for diagnosis of rabies is a biopsy from the t he neck. This virus has an incubation period of 5 days to 1 year and demonstrates retrograde axoplasmic flow until it reaches the spinal cord. It subsequently subsequently undergoes centrifugal spread along the peripheral nerves to the skin, intestine, and into the salivary glands where it is shed. Q/Q(M)-482316 Report a Problem The treatment of choice for Oroya Fever is: 1 Penicillin 2
Doxycycline
3
Erythromycin
4
Minocycline
5
Chloramphenicol Q/Q(M)-473910 Report a Problem
The treatment of choice for Oroya Fever is: 5 Chloramphenicol The treatment of choice for Oroya Fever is chloramphenicol because of frequent superinfection with Salmonella. 61
Q/Q(M)-473910 Report a Problem An otherwise healthy six-day-old boy is brought into clinic by his mother with the complaint of tiny thin-roofed vesicles with a rim of inflammation and a few lesions covered with a �honey-colored� crust. Which organism is the most likely cause in this newborn? 1 Listeria monocytogenes 2
Group B streptococcus
3
Group D streptococcus
4
Staphylococcus Staphylococcus Aureus
5
Lancefield type O organisms Q/Q(M)-480158 Report a Problem
An otherwise healthy six-day-old boy is brought into clinic by his mother with the complaint of tiny thin-roofed vesicles with a rim of inflammation and a few lesions covered with a �honey-colored� crust. Which organism is the most likely cause in this newborn? 2 Group B streptococcus Group B streptococcus is S. agalactae, commonly isolated from normal vaginal mucosa. In neonates, impetigo caused by group B streptococci may develop. Listeria monocytogenes is a small, gram-positive organism that may present as petechial, papular or pustular eruptions in acutely ill infants, usually those that were meconium stained at birth. The usual cause of ecthyma is Group A streptococcus, though other organisms can occasionally cause similar cutaneous infections. Group D streptococcus/Lancefield type O organisms are enterococci. S. aureus can secondarily infect a lesion of ecthyma but is not the usual cause of this condition. Q/Q(M)-480158 Report a Problem A 25-year old man with wit h a history of a healed genital ulcer develops a diffuse papulosquamous papulosquamous eruption resembling pityriasis rosea. What is the most likely time lapse between the appearance of the genital lesion and the appearance of this eruption? 1 3-12 weeks 2
1-2 weeks
3
3-5 months
4
6-12 months
5
1-2 years Q/Q(M)-482229 Report a Problem
A 25-year old man with wit h a history of a healed genital ulcer develops a diffuse papulosquamous papulosquamous eruption resembling pityriasis rosea. What is the most likely time lapse between the appearance of the genital lesion and the appearance of this eruption? 1 3-12 weeks The lesions of secondary syphilis are often diffusely distributed due to spirochetemia. Papulosquamous lesions are characteristic, and the presence of constitutional symptoms such as fever, fatigue, headaches, and bone pain may help distinguish secondary syphilis from pityriasis rosea. Other lesions of secondary syphilis include â˜moth-eatenâ™ alopecia, mucous patches, split papules, and condyloma lata. The mucocutaneous mucocutaneous manifestations of secondary syphilis typically occur 3-12 weeks after the appearance of the chancre and last 4-12 weeks. 62
Q/Q(M)-482229 Report a Problem Herpangina is caused by which of the following? 1 Group A coxsackievirus coxsackievirus 2
Epstein Barr Virus
3
Parvovirus B19
4
Human Herpesvirus 6 (HHV-6)
5
Human Herpesvirus 6 (HHV-7) Q/Q(M)-473921 Report a Problem
Herpangina is caused by which of the following? 1 Group A coxsackievirus coxsackievirus Herpangina is caused by Group A coxsackievirus. Q/Q(M)-473921 Report a Problem A 69 year old man who had recently returned from a boating trip in the Atlantic developed pain with hemorrhagic bullae of his right leg. He had substained a cut on his right leg prior to leaving for the trip, tr ip, but swam in the water water anyway. Which Which of the following treatments treatments should be started? started? 1 Doxycycline 2
Erythromycin
3
Penicillin
4
Rifampin
5
Dapsone Q/Q(M)-482551 Report a Problem
A 69 year old man who had recently returned from a boating trip in the Atlantic developed pain with hemorrhagic bullae of his right leg. He had substained a cut on his right leg prior to leaving for the trip, but swam in the water water anyway. Which Which of the following treatments should be started? started? 1 Doxycycline The case presentation describes an infection with Vibrio vulnificus, a Gram-negative rod, which may lead to a rapidly rapidl y expanding cellulitis, with hemorrhagic bullae and necrosis, and life-threatening life-t hreatening septicemia. This infection mainly occurs along the Atlantic seacoast. It may be acquired after ingesting raw oysters or other seafood. Alternatively, localized skin infection may result after exposure of an open wound to seawater. Doxycycline together with ceftazidime is the treatment of choice. In patients with preexisting hepatic hepatic dysfunction or immunocompromise and and whose wounds wounds are exposed exposed to or acquired acquired in saltwater, prophylactic antibiotic coverage with doxycycline, 100 mg every 12 h, and cleansing with 0.025% sodium hypochlorite solution may prevent progressive infection. Q/Q(M)-482551 Report a Problem What is the first-line recommended therapy for orf? 1 Penicillin 2
Erythromycin
3
Doxycycline 63
4 5
Bactrim No therapy is needed since the condition is self-resolving Q/Q(M)-482200 Report a Problem
What is the first-line recommended therapy for orf? 5 No therapy is needed since the condition is self-resolving No therapy is needed, since orf is usually a benign, benign, self-resolving infection. Orf is caused by a parapoxvirus, often often associated with sheep and and goats. The infection infection undergoes 6 different stages of evolution: the papular, target, acute, regenerative, papillomatous, and regressive stages. Q/Q(M)-482200 Report a Problem Blueberry Muffin Baby can be a feature of all of the t he following EXCEPT: 1 TORCH 2
Klippel-Trenaunay-Weber Klippel-Trenaunay-Weber syndrome
3
Hemolytic disease of the newborn
4
Rhabdomyosarcoma
5
Langerhans � cell histiocytosis Q/Q(M)-473933 Report a Problem
Blueberry Muffin Baby can be a feature of all of the t he following EXCEPT: 2 Klippel-Trenaunay-Weber Klippel-Trenaunay-Weber syndrome Blueberry muffin lesions can be seen in the setting of prenatal infections (e.g. TORCH), severe anemia (e.g. Hemolytic Disease of the newborn) and neoplastic diseases (e.g. rhabdomyosarcoma). rhabdomyosarcoma). It is not associated with the Klippel-Trenaunay-Weber Klippel-Trenaunay-Weber syndrome. Q/Q(M)-473933 Report a Problem A 36 year-old homeless man presents with a tender suppurative nodule on the mandible. "Sulfur granules" are present on microscopy. The most likely diagnosis is: 1 Actinomycetoma 2
Actinomycosis
3
Anthrax
4
Acne Conglobata
5
Aspergillosis Q/Q(M)-481612 Report a Problem
A 36 year-old homeless man presents with a tender suppurative nodule on the mandible. "Sulfur granules" are present on microscopy. The most likely diagnosis is: 2 Actinomycosis The presentation of a suppurative nodule discharging sulfur granules on the jawline of a patient with poor oral hygeine hygeine is characteristic characteristic of actinomycosis - caused caused by the anaerobic anaerobic gram-positive rod, Actinomyces israelii. This differs from Actinomycetoma, which is a slowly progressive subcutaneous infection characterized by tumefaction, draining sinuses, and an exudate containing grains on microscopy. Unlike Eumycetomas - caused by fungi - Actinomycetoma A ctinomycetomass are bacterial infections. The 64
foot is the most common location, followed by the thoracic area. Q/Q(M)-481612 Report a Problem What is the most common subtype of molluscum contagiosum virus infection seen in HIV patients? 1 MCV-1 2
MCV-2
3
MCV-3
4
MCV-4
5
MCV-5 Q/Q(M)-482602 Report a Problem
What is the most common subtype of molluscum contagiosum virus infection seen in HIV patients? 2 MCV-2 The most common subtype of molluscum contagiosum virus is MCV-1. In HIV patients, however, MCV-2 is more common. Q/Q(M)-482602 Report a Problem Most common causative agent agent for the lesion l esion shown in this 5-year old child is 1 Staphylococcus Staphylococcus aureus 2
group A β-hemolytic streptococci
3
Pseuomonas
4
kleibsiella
5
H.influenza Q/Q(M)-482119 Report a Problem
Most common causative agent agent for the lesion l esion shown in this 5-year old child is 1 Staphylococcus Staphylococcus aureus The picture shown is Impetigo, which is a common, contagious superficial skin infection caused most commonly by staphylococci. Although seen in all age groups, the disease is most common in infants and children. Lesions may involve any body surface but occur most frequently on the exposed parts of the t he body, especially especially the face, hands, hands, neck, and extremities. There are two classic forms of impetigo, bullous and nonbullous. Nonbullous impetigo accounts for more than 70% of cases. Historically was caused primarily by group A β-hemolytic β-hemolytic streptococci streptococci (GABHS), but now appears appears to be most most commonly caused by S. aureus. Anaerobic organisms may also be recovered from lesions of nonbullous impetigo. (Reference: Brook I, Frazier EH, Yeager JK. Microbiology of nonbullous impetigo. Pediatr Dermatol 1997;14(3):192-195.) 65
Q/Q(M)-482119 Report a Problem A patient had a severe febrile illness with hemolytic anemia and now has exophytic nodules on the trunk, extremities and face. Which of the following organisms is the cause? 1 Bartonella henselae 2
Bartonella quintana
3
Bartonella bacilliformis
4
Rickettsia rickettsii
5
Rickettsia akari Q/Q(M)-480163 Report a Problem
A patient had a severe febrile illness with hemolytic anemia and now has exophytic nodules on the trunk, extremities and face. Which of the following organisms is the cause? 3 Bartonella bacilliformis The first stage of this condition is known as Carrion �s disease, which can be fatal. It was in Dr. Carrion, who self inoculated himself to prove that the cause of verruga peruana (the second stage described above) above) was the same as that of the first stage. The cause of both Carrion �s disease and verruga peruana is Bartonella bacilliformis. B. henselae is the t he cause of Cat Scratch disease while B. quintana causes Trench Fever. Rickettsia rickettsii is the cause of Rocky Mountain Spotted Fever and Rickettsia akari causes Rickettsial pox. Q/Q(M)-480163 Report a Problem An 18-year old man presents to the Dermatology Clinic with a nontender penile erosion that has been present for 2 weeks. weeks. An indurated indurated border and nontender nontender bilateral inguinal inguinal lymphadenopathy lymphadenopathy are also noted. What is the most likely diagnosis? 1 Primary syphilis 2
Chancroid
3
Herpes simplex
4
Lymphogranuloma Lymphogranuloma venereum
5
HIV Q/Q(M)-474235 Report a Problem An 18-year old man presents to the Dermatology Clinic with a nontender penile erosion that has been present for 2 weeks. weeks. An indurated indurated border and nontender nontender bilateral inguinal inguinal lymphadenopathy lymphadenopathy are also noted. What is the most likely diagnosis? 1 Primary syphilis A painless chancre with an indurated border is characteristic of primary syphilis. Associated painless lymphadenopathy lymphadenopathy ("buboes") is also a common feature. Q/Q(M)-474235 Report a Problem A patient with AIDS develops umbilicated papules consistent with molluscum contagiosum. What anatomic sites are favored for molluscum papules in patients with HIV? 1 Face and genitalia 2
Head and neck
3
Abdomen and back 66
4
Upper and lower extremities
5
Chest and shoulders Q/Q(M)-482604 Report a Problem A patient with AIDS develops umbilicated papules consistent with molluscum contagiosum. What anatomic sites are favored for molluscum papules in patients with HIV? 1 Face and genitalia Molluscum contagiosum is a common opportunistic infection of HIV patients. Lesions can be seen anywhere, but the most common locations are on the face and genitalia. Q/Q(M)-482604 Report a Problem A patient with a chronic nose-bleed is treated with nasal packing. The packing is accidentally left in place, and he develops Toxic Toxic Shock Syndrome. Syndrome. What is the implicated implicated toxin? 1 Enterotoxin B 2
Toxic Shock Syndrome toxin 1
3
Exfoliative Toxin A
4
Edema toxin
5
Lethal factor Q/Q(M)-482689 Report a Problem A patient with a chronic nose-bleed is treated with nasal packing. The packing is accidentally left in place, and he develops Toxic Toxic Shock Syndrome. Syndrome. What is the implicated implicated toxin? 1 Enterotoxin B Toxic Shock Syndrome is characterized by fever, hypotension, and a generalized scarlatiniform eruption followed by desquamation. Menstrual-associated TSS is generally driven by Staphylococcus aureus, which released Toxic Shock Syndrome toxin 1. In nonmenstrual cases, cases, however, Enterotoxins B and C are more commonly implicated, although TSST-1 has also been associated. Exfoliative toxins A and B are involved in bullous impetigo, and edema toxin and lethal factor are involved in Bacillus anthracis infections. Q/Q(M)-482689 Report a Problem Congenital Varicella Syndrome occurs after maternal varicella infection during which stage of pregnancy? pregnancy? 1 First 20 weeks 2
Third trimester
3
5 days before and 2 days after delivery
4
20-24 weeks
5
None of these answers are correct Q/Q(M)-473936 Report a Problem Congenital Varicella Syndrome occurs after maternal varicella infection during which stage of pregnancy? pregnancy? 1 First 20 weeks Congenital Varicella Syndrome occurs after maternal varicella-zoster virus infection early in pregnancy (up to 20 weeks gestation). Q/Q(M)-473936 Report a Problem Heck �s disease is associated with which of the following types t ypes of human papillomavirus? 67
1
1
2
3
3
7
4
6/11
5
13/32 Q/Q(M)-480162 Report a Problem Heck �s disease is associated with which of the following types t ypes of human papillomavirus? 5 13/32 Heck �s disease (focal epithelial hyperplasia) is caused by HPV 13 and 32 infections. These lesions are multiple circumscribed papules on the oral mucosa that may resemble oral condyloma. They are not prepre cancerous. HPV-1 is associated with plantar wars, while HPV-3 is associated with flat warts. HPV-7 cause � butcher �s warts� and are believed to be acquired from handling meat, poultry and fish. Q/Q(M)-480162 Report a Problem Which subtype of the human papilloma virus is most likely to have caused this infection? 1 HPV, type 1 2
HPV, type 2
3
HPV, type 3
4
HPV, type 5
5
HPV, type 6 Q/Q(M)-476853 Report a Problem Which subtype of the human papilloma virus is most likely to have caused this infection? 5 HPV, type 6
The human papilloma virus is a member of the Papovavirus family, a double-stranded DNA virus. HPV, type t ype 6 has been implicated in giant conduloma of Buschke and Lowenstein and anogenital condyloma. Q/Q(M)-476853 Report a Problem A rabbit farmer presents with fevers, myalgia, and a rash. A serum study reveals antibodies to Francisella tularensis. Which of the following is the most common form of tularemia? 1 Ulceroglandular 2
Chancriform
3
Oculoglandular
4
Typhoidal
5
Meningeal 68
Q/Q(M)-482691 Report a Problem A rabbit farmer presents with fevers, myalgia, and a rash. A serum study reveals antibodies to Francisella tularensis. Which of the following is the most common form of tularemia? 1 Ulceroglandular Tularemia represents a wide range of clinical syndromes caused by Francisella tularensis. The bacterium is most commonly acquired through contact with infected i nfected animals, including rabbits. There are a wide variety of variants, with the t he ulceroglandular form being most common. Ulceroglandular tularemia is characterized by a chancre-like ulcer with raised borders and regional lymphadenopathy, lymphadenopathy, most commonly on the finger or hand. Treatment is with streptomycin. Q/Q(M)-482691 Report a Problem Coxsackievirus A16 is implicated in the pathogenesis of which of the following dieases? 1 Exanthem subitum 2
Fifth disease
3
Papular purpuric �gloves and socks � syndrome
4
Erythema infectiousum
5
Hand-Foot-and-Mouth Hand-Foot-and-Mouth disease Q/Q(M)-474545 Report a Problem Coxsackievirus A16 is implicated in the pathogenesis of which of the following dieases? 5 Hand-Foot-and-Mouth Hand-Foot-and-Mouth disease Hand-Foot-and-Mouth Hand-Foot-and-Mouth disease is caused by coxsackievirus A16. Group A coxsackievirus infection is also associated with herpangina. Q/Q(M)-474545 Report a Problem Streptobacillus moniliformis is the causative organism of which infectious disease? 1 Rat-bite fever (Haverhill fever) 2
Scrub typhus
3
Tularemia
4
Glanders
5
Cat scratch disease Q/Q(M)-474262 Report a Problem Streptobacillus moniliformis is the causative organism of which infectious disease? 1 Rat-bite fever (Haverhill fever) Rat-bite fever (Haverhill fever) is caused by Streptobacillus moniliformis. Q/Q(M)-474262 Report a Problem A patient is given a single dose of dimethylcarbamazine and soon develop edema, itching, fever, arthralgias, and exacerbation of pruritus. He most likely has which underlying condition? 1 Onchocerciasis 2
Loiasis
3
Filariasis
4
Gnothostomiasis
5
Trichinosis Q/Q(M)-482312 Report a Problem 69
A patient is given a single dose of dimethylcarbamazine and soon develop edema, itching, fever, arthralgias, and exacerbation of pruritus. He most likely has which underlying condition? 1 Onchocerciasis This patient developed an acute reaction to dimethylcarbamazine indicating a Mazzotti reaction. This reaction is seen with wit h onchocerciasis. Appropriate treatment for onchocerciasis, caused caused by Onchocerca volvulus, is ivermectin. These patients may demonstrate pruritus, dermatitis, leopard skin, onchocercomas onchocercomas (nodules with microfilariae) and blindness. Q/Q(M)-482312 Report a Problem Which of the following is not a DNA virus? 1 Herpesvirus 2
Poxvirus
3
Parvovirus
4
Paramyxovirus
5
Adenovirus Q/Q(M)-482571 Report a Problem Which of the following is not a DNA virus? 4 Paramyxovirus Paramyxovirus is a single-stranded RNA virus. All other listed choices are DNA-based viruses. Q/Q(M)-482571 Report a Problem Dracunculiasis is typically acquired from: 1 Soil 2
Salt water
3
Drinking water
4
Chiggers
5
Black flies Q/Q(M)-474540 Report a Problem Dracunculiasis is typically acquired from: 3 Drinking water Dracunculiasis, which is caused by Dracunculus medinensis, is acquired by ingestion of copepodinfested water. Q/Q(M)-474540 Report a Problem The causative organism in Whitmore disease is which of the following? 1 Streptobacillus moniliformis 2
Vibrio vulnificus
3
Klebsiella pneumoniae
4
Pseudomonas aeruginosa
5
Burkholderia pseudomallei Q/Q(M)-477611 Report a Problem The causative organism in Whitmore disease is which of the following? 5 Burkholderia pseudomallei 70
Whitmore disease also known as Meloidosis is characterized by pulmonary disease, septicemia, and miliary abscesses. It is caused by Burkholderia pseudomallei. Q/Q(M)-477611 Report a Problem Carrion's disease is characterized by fevers, headaches headaches and arthralgias art hralgias and is accompanied accompanied by severe hemolytic anemia. Superinfection with which organism is the most frequent cause of death? 1 Bartonella bacilliformis 2
Bartonella henselae
3
Bartonella Quintana
4
Salmonella
5
Shigella Q/Q(M)-478757 Report a Problem Carrion's disease is characterized by fevers, headaches headaches and arthralgias art hralgias and is accompanied accompanied by severe hemolytic anemia. Superinfection with which organism is the most frequent cause of death? 4 Salmonella Carrion's disease (Oroya fever) is characterized by fevers, headaches and arthralgias and is accompanied by severe hemolytic anemia. Superinfection Superinfection with Salmonella Salmonella is the most frequent frequent cause of death. death. Protection from sandfly bites is all-important. Q/Q(M)-478757 Report a Problem Which of the following is the causative organism of cat-scratch disease? 1 B. quintana 2
B. henselae
3
B. bacilliformis
4
B. duttonii
5
B. burgdorferi Q/Q(M)-474544 Report a Problem Which of the following is the causative organism of cat-scratch disease? 2 B. henselae B. henselae is the cause of cat-scratch disease. Humans are infected by a cat bite or scratch, while the cat flea is responsible for cat to cat transmission. Q/Q(M)-474544 Report a Problem Most common causative agent for the lesion l esion shown in image for this 34-year old immunocompetent man is 1 Staphaylococcus Staphaylococcus aureus 2
Group A Beta hemolytic streptococcus streptococcus
3
Pseudomonas aeruginosa
4
Klebsiella
71
5
Proteus Q/Q(M)-482118 Report a Problem Most common causative agent for the lesion l esion shown in image for this 34-year old immunocompetent man is 2 Group A Beta hemolytic streptococcus streptococcus Ecthyma is a deep or ulcerative type of pyoderma commonly seen on the lower extremities and buttocks and caused most often by GABHS, in addition to staphyloccous aureus which also can be involved in the infection. Ecthyma can present as small punched-out ulcers or a deep spreading ulcerative process. The disorder begins in the same manner as impetigo, often following infected insect bites or minor trauma, but penetrates through the epidermis to produce a shallow ulcer. The initial lesion is a vesiculopustule with an erythematous base and firmly adherent crust. Removal of the crust reveals a lesion deeper than that seen in impetigo, with an underlying saucer-shaped ulcer and raised margin. The lesions are painful and heal slowly over a few weeks, often with scar formation. Ecthyma gangrenosum is a cutaneous finding that may be seen in patients with Pseudomonas aeruginosa bacteremia. bacteremia. Most of the affected individuals have an underlying immunodeficiency (either congenital or acquired) or a history of cancer chemotherapy. Neutropenia may be a risk factor for ecthyma gangrenosum Q/Q(M)-482118 Report a Problem Botryomycosis is: 1 A fungal infection caused by M. canis 2
A bacterial infection commonly associated with Clostridium botulinum
3
A bacterial infection commonly associated with Staphylococcus Staphylococcus aureus
4
A fungal infection caused by T. tonsurans
5
An acute, disseminated infection involving the genitourinary system Q/Q(M)-478759 Report a Problem Botryomycosis is: 3 A bacterial infection commonly associated with Staphylococcus Staphylococcus aureus Botryomycosis is an uncommon, chronic, idonlent disorder characterized by nodular, crusted, purulent lesions. Sinuses that discharge sulfur granules are present. These heal with atrophic scars. The granules yield most commonly Staphylococcus aureus on culture, although cases caused by Pseudomonas aeruginosa, E. coli, Proteus, Bacteroides, and Streptococcus have been reported Q/Q(M)-478759 Report a Problem Which of the following organisms is spread by non-sexual person-to-person contact? 1 Treponema carateum 2
Chlamydia trachomatis types I, II & III
3
Hemophilis ducreyi
4
Calymmatobacterium Calymmatobacterium granulomatis 72
5
Treponema pallidum Q/Q(M)-480174 Report a Problem Which of the following organisms is spread by non-sexual person-to-person contact? 1 Treponema carateum Treponema carateum is the cause of Pinta which is primarily transmitted tr ansmitted by direct contact. Occasional insect vectors have also been implicated, but sexual contact is not the primary cause of spread. The other options (C. trachomatis, H. ducreyi, C. granulomatis and T. pallidum) are all venereal diseases. diseases. Q/Q(M)-480174 Report a Problem Which of the following manifestations of syphilis would you expect to be present 2-6 months after the individual was exposed? 1 Osteitis 2
Aortitis
3
Tabes dorsalis
4
Condylomata lata
5
Pseudochancre redux Q/Q(M)-480172 Report a Problem
Which of the following manifestations of syphilis would you expect to be present 2-6 months after the individual was exposed? 4 Condylomata lata All of the listed options except condylomata lata are manifestations of tertiary syphilis, which does not manifest for years after the initial infection. Secondary syphilis presents 2-6 months following infection. Condylomata lata are moist, flat and smooth. Do not confuse them with wit h Condyloma accuminatum which are usually dry, cauliflower-like projections on the genitalia. Q/Q(M)-480172 Report a Problem A patient with known chronic Hepatitis C virus infection presents with hyperkeratotic plaques of the bilateral feet. Biopsy reveals psoriasiform psoriasiform changes with superficial superficial epidermal necrosis. necrosis. Diet supplementation with what mineral has been shown to improve the appearance and symptoms of this cutaneous finding? 1 Zinc 2
Biotin
3
Magnesium
4
Calcium
5
Chromium Q/Q(M)-482599 Report a Problem
A patient with known chronic Hepatitis C virus infection presents with hyperkeratotic plaques of the bilateral feet. Biopsy reveals psoriasiform psoriasiform changes with superficial superficial epidermal necrosis. necrosis. Diet supplementation with what mineral has been shown to improve the appearance and symptoms of this cutaneous finding? 73
1 Zinc Necrolytic acral erythema erythema is characterized characterized by hyperkeratotic hyperkeratotic well-defined plaques plaques on the lower extremities, seen occasionally in patients with hepatitis C virus infection. Treatment consists primarily of treating the underlying infection. Diet supplementation with zinc has been shown to improve necrolytic acral erythema, even in the presence of normal serum zinc levels. Q/Q(M)-482599 Report a Problem A 43 year-old man presents with suppurative nodules and sinus tracts over the mandible. He also is noted to have poor oral hygiene. What is the most likely causative organism? 1
Bartonella Henselae
2
Nocardia brasilensis
3
Streptococcus somaliensis
4
Actinomyces israelii
5
Staphylococcus Staphylococcus aureus Q/Q(M)-478207 Report a Problem
A 43 year-old man presents with suppurative nodules and sinus tracts over the mandible. He also is noted to have poor oral hygiene. What is the most likely causative organism? 4 Actinomyces israelii Actinomyces israelii is an anaerobic gram-positive rod which causes chronic suppurative nodules and sinus tracts with an exudate containing sulfur granules. It most commonly effects the cervicofacial area, especially near the mandible. The abdomen and thoracic areas can also be affected. The source of infection is endogenous and patients with poor oral hygiene, penetrating foreign bodies, and recent dental procedures are at increased risk. Treatment of choice is penicillin. Q/Q(M)-478207 Report a Problem The most common extracutaneous complications of varicella zoster virus is: 1
Lymphoreticular
2
Musculoskeletal
3
Cardiovascular
4
Central nervous system
5
Genitourinary Q/Q(M)-481898 Report a Problem
The most common extracutaneous complications of varicella zoster virus is: 4 Central nervous system Zoster usually resolves without sequelae in children and young adults with intact immune systems. However, the pain, cutaneous eruption and complications of zoster become more severe with increasing age and immune compromise. Complications of zoster include post-herpetic neuralgia (PHN), secondary 74
bacterial infection, scarring, ophthalmic zoster, Ramsay-Hunt Ramsay-Hunt syndrome, meningoencephalitis, meningoencephalitis, motor motor paralysis, pneumonitis pneumonitis and hepatitis. hepatitis. Reference: Stalkup Stalkup JR et al. Human Herpesviruses. Herpesviruses. In: Bolognia JL, Jorizzo JL, Rapini RP, eds. Dermatology. New York: Mosby, 2003:1243. Q/Q(M)-481898 Report a Problem Which exotoxin(s) are involved in mediating the effects of Bacillus anthracis - the causative organism for anthrax? 1 Exotoxin B 2
Edema Toxin
3
Alpha toxin
4
Lethal Toxin
5
Edema Toxin and Lethal Toxin Q/Q(M)-473951 Report a Problem
Which exotoxin(s) are involved in mediating the effects of Bacillus anthracis - the causative organism for anthrax? 5 Edema Toxin and Lethal Toxin B. anthracis has 2 exotoxins: edema toxin and lethal toxin, each comprised of a pair of noncovalently linked proteins: � Edema toxin = Edema Factor (EF) + Protective Antigen (PA) � Lethal toxin = Lethal Factor (LF) + PA � EF causes gelatinous edema of anthrax skin lesions by inducing an increase in cyclic adenosine monophosphate (cAMP) levels � LF causes shock and death in disseminated anthrax via the release of tumor necrosis factor-alpha (TNF-a)and interleukin-1b (IL-1b) � PA is responsible for entry of exotoxins into the cell by receptor-mediated endocytosis. Q/Q(M)-473951 Report a Problem Name the syndrome syndrome defined by gonorrhea with perihepatitis perihepatitis and liver adhesions. adhesions. 1
Lhermitte-Duclos Syndrome
2
Turcot Syndrome
3
Fitz-Hugh-Curtis Syndrome
4
Leser-Trelat Syndrome
5
Clutton's Syndrome Q/Q(M)-482484 Report a Problem
Name the syndrome syndrome defined by gonorrhea with perihepatitis perihepatitis and liver adhesions. adhesions. 3 Fitz-Hugh-Curtis Syndrome Gonorrhea, caused by a gram negative intracellular diplococcus, often presents cutaneously with hemorrhagic vesiculopustules vesiculopustules of the distal extremities. Septic arthritis is also an important presentation of gonococcemia, most commonly involving the knee. Q/Q(M)-482484 Report a Problem
75
Which of the following is true regarding lymphogran l ymphogranuloma uloma venereum? 1 The primary stage presents as a painful herpetiform ulcer. 2
Proctocolitis can be seen in the late stages of this disease.
3
It is caused by Chlamydia psittaci.
4
Buboes should be incised and drained.
5
Transmission does not occur via skin-to-skin contact. Q/Q(M)-482504 Report a Problem
Which of the following is true regarding lymphogran l ymphogranuloma uloma venereum? 2 Proctocolitis can be seen in the late stages of this disease. Lymphogranuloma Lymphogranuloma venereum presents as a painless ulcer and is caused by b y Chlamydia trachomatis serotypes L1, L2, L3. While buboes can be aspirated, they should not be incised and drained. Transmission occurs through sexual contact, but can occur via skin-to-skin contact. Complications of late stage disease include proctocolitis, perirectal abscesses, rectovaginal rectovaginal fistulas, and anal fistulas. Q/Q(M)-482504 Report a Problem Pediculus humanus var. corporis (human body louse) is the vector in which of the following diseases: 1
Endemic typhus (R. typhus)
2
Epidemic typhus (R. prowazekii)
3
Q fever (C. burnetii)
4
Rickettsialpox (R. akari)
5
Rocky Mountain Spotted Fever (R. rickettsii) Q/Q(M)-478208 Report a Problem
Pediculus humanus var. corporis (human body louse) is the vector in which of the following diseases: 2 Epidemic typhus (R. prowazekii) The human body louse is the implicated Trench fever, epidemic typhus, and relapsing fever. Trench fever usually affects alcoholic men and is manifested by fevers. Treatment is with ceftriaxone, erythromycin, or doxycycline. Epidemic typhus is manifested by fevers, chills, malaise, and a pink macular eruption beginning in the axilla and trunk. Treatment is with tetracycline or chloramphenicol. Relapsing fever is manifested by paroxysmal fevers, headache, lymphocytoma, and erythematous/petechial erythematous/petechial macules on trunk/extremities. Treatment is with doxycycline. doxycycline. Q/Q(M)-478208 Report a Problem
Treatment of severe nodulocystic acne with which of the following vitamin derivatives may completely arrest the disease process through decreasing P. acnes? 1 Vitamin D 2
Vitamin A 76
3
Vitamin K
4
Vitamin E
5
Vitamin B3 Q/Q(M)-480159 Report a Problem Treatment of severe nodulocystic acne with which of the following vitamin derivatives may completely arrest the disease process through decreasing P. acnes?
2 Vitamin A 13-cis-retinoic acid (isotretinoin/Accutane) is a derivative of vitamin A. It has several mechanisms of action in acne. It rapidly suppresses sebum production, causing a decrease in P. acnes populations. It also decreases follicular plugging by an uncertain mechanism. Vitamins D, K and E are fat soluble vitamins, but are not able to completely arrest the disease process in acne. Vitamin B3 is niacin and is associated with a diet of exclusively of corn, millet or sorghum. Other sources: carcinoid, Hartnup disease, parasites, GI disorders, IV nutrition, and psychiatric disease. Findings include the 3 D �s: Diarrhea, Dementia, Dermatitis. Q/Q(M)-480159 Report a Problem Which of the following diseases is caused by a virus? 1
Rocky Mountain spotted fever
2
Human monicytic ehrlichiosis
3
Colorado tick fever
4
Boutonneuse spotted fever
5
Q fever Q/Q(M)-478900 Report a Problem
Which of the following diseases is caused by a virus? 3 Colorado tick fever Rocky Mountain spotted fever is caused by Rickettsia rickettsii. Human monicytic ehrlichiosis is caused by Ehrlichia chaffeensis. chaffeensis. Colorado tick fever is caused caused by Reoviiridae. Boutonneuse Boutonneuse fever fever is caused by Rickettsia conorii. Q fever is caused by Coxiella burnetti. Q/Q(M)-478900 Report a Problem The usual culture medium for mycobacteria is: 1 Chocolate agar in 10% CO2 2
Lowenstein-Jensen
3
New York City
4
Sheep�s blood agar
5
Agar supplemented with heme and nicotinamide Q/Q(M)-480175 Report a Problem 77
The usual culture medium for mycobacteria is: 2 Lowenstein-Jensen The Lowenstein-Jensen medium is used to t o culture mycobacteria most commonly. Neisseria gonorrheae is be grown on chocolate agar in 10% CO2. Thayer �Martin, Martin-Lewis or New York City medium also allow for N. gonorrheae growth. Agar supplemented with heme (x-factor) and nicotinamide (vfactor) is needed for Hemophilus influenzae cultures. Sheep�s blood agar is useful for identifying hemolytic strains of streptococcus str eptococcus and staphylococcus. staphylococcus. Q/Q(M)-480175 Report a Problem A male patient experiences painful vesicles on the palate, tongue, and ipsilateral eardrum. Additionally, he complains of vertigo and difficulty difficult y with speaking and eating. Involvement of what anatomic structure is responsible for this constellation of symptoms? 1
Geniculate ganglion
2
Dorsal root ganglion
3
Hippocampus
4
Basal portion of pons
5
Hypoglossal Hypoglossal nerve Q/Q(M)-482585 Report a Problem
A male patient experiences painful vesicles on the palate, tongue, and ipsilateral eardrum. Additionally, he complains of vertigo and difficulty difficult y with speaking and eating. Involvement of what anatomic structure is responsible for this constellation of symptoms? 1 Geniculate ganglion The question stem describes Ramsay-Hunt syndrome, which is characterized by unilateral vesicles on palate, tongue, tongue, earlobe, and eardrum, eardrum, in association association with neurologic symptoms including vertigo, difficulty speaking, difficulty eating, hearing loss, and facial droop. The syndrome is caused by varicella-virus infection of the geniculate ganglion. Q/Q(M)-482585 Report a Problem High doses of which of the following antiviral agents has been associated with thrombotic thrombocytopenic thrombocytopenic purpura in immunosuppressed patients? 1
Valcyclovir
2
Acyclovir
3
Foscarnet
4
Famciclovir
5
Cidofovir Q/Q(M)-473922 Report a Problem
78
High doses of which of the following antiviral agents has been associated with thrombotic thrombocytopenic thrombocytopenic purpura in immunosuppressed patients? 1 Valcyclovir Thrombotic thrombocytopenic thrombocytopenic purpura has been reported with high doses of valcyclovir in immunosuppressed immunosuppressed patients. Q/Q(M)-473922 Report a Problem How long is the life cycle for the mite that causes this infestation? 1 1 day 2
1 week
3
1 month
4
6 months
5
1 year Q/Q(M)-476874 Report a Problem
How long is the life cycle for the mite that causes this infestation? 3 1 month Scabies is caused by the mite Sarcoptes scabiei scabiei var. hominis. The life cycle of the mite is 30 days. A female mite will lay 60-90 eggs during her life. Q/Q(M)-476874 Report a Problem Each of the following is true regarding leishmaniasis except: 1 Arthropod vector is the sand fly 2
Mazzotti�s test is diagnostic
3
Pentavalent antimony used for visceral disease
4
Cutaneous disease is the most common form 79
5
Espundia seen mucocutaneous mucocuta neous disease Q/Q(M)-477344 Report a Problem
Each of the following is true regarding leishmaniasis except: 2 Mazzotti�s test is diagnostic Leishmaniasis is a parasitic infection born by a sandfly vector. No treatment is i s necessary for cutaneous leishmaniasis, pentavalent pentavalent antimony for visceral leishmaniasis. le ishmaniasis. Mazzotti reaction is used to test for onchocerciasis onchocerciasis in which a single dose of dimethycarbamazine is given for reaction. Q/Q(M)-477344 Report a Problem Bacillary angiomatosis is caused by which of the following organisms? 1
B. quintana
2
B. henselae
3
B. bacilliformis
4
B. quintana and B. henselae
5
All of these answers are correct Q/Q(M)-473953 Report a Problem
Bacillary angiomatosis is caused by which of the following organisms? 4 B. quintana and B. henselae B. quintana or B. henselae are both causative organisms for bacillary angiomatosis. Q/Q(M)-473953 Report a Problem A 42 year-old woman presents with a large, vegetating ulcer involving her left labia majora and groin for over 1 year. A Giemsa �s stained touch preparation reveals bipolar, safety pin-shaped intracytoplasmic inclusions. What is the most likely diagnosis? 1
Lymphogranuloma Lymphogranuloma venereum
2
Granuloma Inguinale
3
Chancroid
4
Primary herpes simplex
5
Gonorrhea Q/Q(M)-474273 Report a Problem
A 42 year-old woman presents with a large, vegetating ulcer involving her left labia majora and groin for over 1 year. A Giemsa �s stained touch preparation reveals bipolar, safety pin-shaped intracytoplasmic inclusions. What is the most likely diagnosis? 2 Granuloma Inguinale Bipolar, safety pin-shaped intracytoplasmic inclusions on Giemsa stain - known as Donovan bodies - are 80
diagnostic of granuloma inguinale. Q/Q(M)-474273 Report a Problem A pool worker develops these painful erythematous er ythematous nodules nodules with ulceration on his fingers and then his arms. The antibiotic of choice to treat this infection is: 1 Penicillin 2
Ceftriaxone
3
Minocycline
4
Trimethoprim-sulfamethoxasole
5
Dapsone Q/Q(M)-476665 Report a Problem
A pool worker develops these painful erythematous er ythematous nodules nodules with ulceration on his fingers and then his arms. The antibiotic of choice to treat this infection is: 3 Minocycline Sporotrichoid spread may be seen in cutaneous leishmaniasis, actinomycosis, atypical mycobacterial infections, deep fungal infection, and melanoma. Mycobacterium marinum is associated with skin injury followed by exposure to contaminated water, usually from an aquarium, lake, or pool. The treatment of choice for M. marinum infections i nfections is minocycline. Q/Q(M)-476665 Report a Problem A 52-year old male develops a brownish-red plaque on his forehead. The lesion has an "apple jelly" color on diascopy, and the patient has a positive PPD skin test. What is the most likely li kely mechanism mechanism of disease in this patient? 1 Spread from a distant site 2
Exogenous re-infection
3
Primary inoculation
4
Contiguous spread to skin from underlying infection
5
Id reaction Q/Q(M)-482275 Report a Problem
A 52-year old male develops a brownish-red plaque on his forehead. The lesion has an "apple jelly" 81
color on diascopy, and the patient has a positive PPD skin test. What is the most likely li kely mechanism mechanism of disease in this patient? 1 Spread from a distant site This patient has lupus vulgaris, a pauci-bacillary manifestation of tuberculosis infection. Lesions occur in sensitized patients with a moderate to high immune response and are due to hematogenous, lymphatic, or contiguous spread from a distant site of infection. Lesions typically occur on the head and neck. "Apple jelly" color on diascopy is described in lupus vulgaris, but can also be seen in cutaneous lesions of sarcoidosis. Q/Q(M)-482275 Report a Problem The vector of New World Leishmaniasis is the: 1
Phlebotomus sandfly
2
Lutzomyia sandfly
3
Tsteste fly
4
Deer fly (Chrysops spp.)
5
Simulium black fly Q/Q(M)-473907 Report a Problem
The vector of New World Leishmaniasis is the: 2 Lutzomyia sandfly The sandfly belonging to the genus Lutzomyia is the vector of New World Leishmaniasis. Sandflies of the genus Phlebotomus are the vectors of Old World Leishmaniasis. Q/Q(M)-473907 Report a Problem Of the choices listed, which antiobiotic is the best to treat a 7-year 7 -year old child with erythema migrans? 1 Doxycycline 2
Amoxicillin
3
Azithromycin
4
Tetracycline
5
Rifampin Q/Q(M)-476702 Report a Problem
Of the choices listed, which antiobiotic is the best to treat a 7-year 7 -year old child with erythema migrans? 2 Amoxicillin Doxycycline is the usual treatment for erythema migrans in adults in the absence of neurologic or cardiovascular cardiovascular complications. In children less than 8, all tetracyclines are relatively contraindicated because of they can cause cause tooth discoloration. discoloration. Therefore amoxicillin amoxicillin should be used used as the first line therapy for children less than 8. Note: Changes have been made to the treatment of RMSF. Children of any age should be treated with doxycycline for that disease. 82
Q/Q(M)-476702 Report a Problem Verruga peruana is transmitted by: 1
Tick
2
Blackfly
3
Sandfly
4
Fecal oral contact
5
Fecal fecal contact Q/Q(M)-477426 Report a Problem
Verruga peruana is transmitted by: 3 Sandfly Verruga peruana, a disease endemic to Peru and a few neighboring countries, is caused by Bartonella bacilliformis. It is transmitted by the sandfly, Lutzomyia Lutzomyia verrucarum. It It is preceded by an acute febrile stage called Oroyo fever or Carrion �s disease. The treatment of choice is chloramphenicol. Q/Q(M)-477426 Report a Problem A patient with HIV/AIDS presents complaining of an asymptomatic patch on the tongue. t ongue. Examination reveals a white patch with a corrugated surface on the lateral tongue. What percentage of HIV patients will have this finding? 1 5% 2
20%
3
33%
4
50%
5
67% Q/Q(M)-482594 Report a Problem
A patient with HIV/AIDS presents complaining of an asymptomatic patch on the tongue. t ongue. Examination reveals a white patch with a corrugated surface on the lateral tongue. What percentage of HIV patients will have this finding? 3 33% Oral hairy leukoplakia is characterized by a white patch with a corrugated surface on the side of the tongue. It is generally asymptomatic. Oral hairy leukoplakia is seen most commonly in patients with defective cell-mediated immunity, in particular HIV infection. Oral hairy leukoplakia is associated with EBV opportunisitc infection, among other viruses. viruses. 33% of patients with HIV will have oral hairy leukoplakia. Q/Q(M)-482594 Report a Problem A 40-year-old male with HIV (CD4 <200) presents with asymptomatic, slowly enlarging yellow-pink papules and and nodules localized to his perianal skin. skin. A skin biopsy is performed, which which reveals foamy 83
dermal interstitial histiocytes with characteristic basophilic laminated inclusion bodies. The latter are noted to stain positively with von Kossa, Perls, and PAS stains. The most likely diagnosis is: 1
eruptive xanthomas
2
malakoplakia
3
hidradenitits suppurtiva
4
granuloma inguinale
5
chancroid Q/Q(M)-482835 Report a Problem
A 40-year-old male with HIV (CD4 <200) presents with asymptomatic, slowly enlarging yellow-pink papules and and nodules localized to his perianal skin. skin. A skin biopsy is performed, which which reveals foamy dermal interstitial histiocytes with characteristic basophilic laminated inclusion bodies. The latter are noted to stain positively with von Kossa, Perls, and PAS stains. The most likely diagnosis is: 2 malakoplakia Malakoplakia is a multi-organ inflammatory granulomatous disease that most frequently arises in the setting of immunosuppression. Common sites of involvement include the genitourinary, lung, lymph nodes and bone. Cutaneous involvement is rare, and typically presents as asymptomatic papules, nodules, or plaques. Lesions may have associated erosions or ulcerations, and sinus tracts may be seen. While skin lesions are non-specific, histopathology reveals foamy dermal histiocytes known as von Hansemann cells which contain basophilic granular inclusions. The latter are known as MichaelisGutmann bodies and are considered pathognomonic pathognomonic for malakoplakia. Michaelis-Gutmann bodies are comprised of calcium, iron, and phosphate salts, and hence stain positively positivel y with von Kossa, Perls, and PAS, respectively. The pathophysiology of malakoplakia is thought to arise from an acquired defect in macrophage activation in response to bacterial infection, most commonly. E. coli. Treatment for cutaneous lesions is surgical excision, although recurrence is not uncommon. Q/Q(M)-482835 Report a Problem What is the characteristic body on histopathology for this disease? 1 Cowdry Type A 2
Cowdry Type B
3
Henderson-Patterson
4
Guarnieri
5
Dutcher Q/Q(M)-476866 Report a Problem
84
What is the characteristic body on histopathology for this disease? 1 Cowdry Type A Herpes simlex virus is characterized by Cowdry type t ype A bodies on histopathology. They appear as sharply demarcated eosinophilic structures separated separated by a clear halo from a basophilic rim of the infected cell's marginated nuclear chromatin. Cowdry B bodies may be seen in polio infections. Q/Q(M)-476866 Report a Problem A child presents with fever, cutaneous tenderness tenderness and erythema of flexural and periorifacial areas. Within 24 hours the t he erythema progresses to flaccid blisters and erosions. No organisms are cultured and Nikolsky's sign sign is positive. What What is the most likely diagnosis: diagnosis: 1 Staph scalded skin syndrome 2
Bullous impetigo
3
Fogo selvagem
4
Pemphigus
5
Pemphigoid Q/Q(M)-481614 Report a Problem
A child presents with fever, cutaneous tenderness tenderness and erythema of flexural and periorifacial areas. Within 24 hours the t he erythema progresses to flaccid blisters and erosions. No organisms are cultured and Nikolsky's sign sign is positive. What What is the most likely diagnosis: diagnosis: 1 Staph scalded skin syndrome Staph scaled skin syndrome is caused by exfoliative toxins A and B (ET-A and ET-B) produced by S. aureus (phage group II, types 71 and 55 most common). Histopathology of the skin shows superficial intraepidermal splitting without epidermal necrosis with very few f ew inflammatory cells. Desmoglein 1 is the specific receptor for exfoliative toxin A cleavage. Desmoglein 1 is the antigen targeted in Fogo selvagem, the vector for which is the black fly. Bullous impetigo is caused by Staph and is a subgranular blister with bacteria and and neutrophils on histopahtology. histopahtology. Pemphigoid Pemphigoid and pemphigus pemphigus would be be less likely in a child. Q/Q(M)-481614 Report a Problem Which of the following is the vector responsible for the transmission of Verruga Peruana? 1 Lutzomyia verrucarum 2
Tsetse fly 85
3
Ctenocephalides Ctenocephalides felis
4
Pediculus humanus corporis
5
Simulium slossonae Q/Q(M)-473942 Report a Problem
Which of the following is the vector responsible for the transmission of Verruga Peruana? 1 Lutzomyia verrucarum Verruga Peruana is caused by infection with B. bacilliformis, which is transmitted by the sandfly, Lutzomyia verrucarum. Q/Q(M)-473942 Report a Problem Contagious pustular dermatitis (Orf) is caused by a: 1 Herpesvirus 2
Poxvirus
3
Gram-positive spore-forming rod
4
Paramyxovirus
5
Papovavirus Q/Q(M)-474529 Report a Problem
Contagious pustular dermatitis (Orf) is caused by a: 2 Poxvirus Orf is caused by orf virus (OV), a poxvirus of the genus Parapoxvirus. Q/Q(M)-474529 Report a Problem Herpes simplex virus infection and this condition has been linked to which HLA type? 1
HLA Cw6
2
HLA B15
3
HLA B27
4
HLA B51
5
HLA DR3 Q/Q(M)-476753 Report a Problem
86
Herpes simplex virus infection and this condition has been linked to which HLA type? 2 HLA B15 HSV related erythema multiforme has been associated with an increased frequency of HLA-B15. Q/Q(M)-476753 Report a Problem A 23 year old female patient is found to have genital warts. A referral to an gynecologist reveals that she has cervical dysplasia. What viral proteins does HPV use to induce neoplasia? 1 E6 and E7 2
E1 and E2
3
L1 and L2
4
E8 and L1
5
E3 and E4 Q/Q(M)-482610 Report a Problem
A 23 year old female patient is found to have genital warts. A referral to an gynecologist reveals that she has cervical dysplasia. What viral proteins does HPV use to induce neoplasia? 1 E6 and E7 Certain HPV subtypes have been shown to induce neoplasia, including cervical cancer. There are many high-risk subtypes, including 16, 18, 31, and 33. The HPV early genes E6 and E7 bind the tumor suppressors p53 and retinoblastoma protein, respectively, inactivating them and initiating oncogenesis. Q/Q(M)-482610 Report a Problem
87
A 28 year-old man presents with fever, chills, arthralgias and the cutaneous lesions shown. The most likely diagnosis is: 1
Purpura fulminans
2
Rickettsialpox
3
Anthrax
4
Gonoccemia
5
Primary herpes simplex infection Q/Q(M)-474912 Report a Problem
A 28 year-old man presents with fever, chills, arthralgias and the cutaneous lesions shown. The most likely diagnosis is: 4 Gonoccemia The image shows sparsely distributed hemorrhagic vesiculopustules with erythematous bases on an acral surface. These features are characteristic of gonococcemia. Q/Q(M)-474912 Report a Problem What percentage of patients undergoing stem cell transplantation for leukemia will develop herpes zoster within the first year? 1 5% 2
30%
3
50%
4
70%
5
90% Q/Q(M)-482586 Report a Problem
What percentage of patients undergoing stem cell transplantation for leukemia will develop herpes zoster within the first year?
88
4 70% The risk of developing herpes zoster following stem cell transplantation for leukemia is quite high, approaching 70% in some studies. Q/Q(M)-482586 Report a Problem A patient presents with multiple multi ple asensate patches on the abdomen. A diagnosis of leprosy is made. Which of the following regimens is the WHO recommendation r ecommendation for treatment of paucibacillary leprosy? 1
Dapsone and rifampin
2
Dapsone and clofazimine
3
Clofazimine and rifampin
4
Minocycline and rifampin
5
Minocycline and clofazmine Q/Q(M)-482692 Report a Problem
A patient presents with multiple multi ple asensate patches on the abdomen. A diagnosis of leprosy is made. Which of the following regimens is the WHO recommendation r ecommendation for treatment of paucibacillary leprosy? 1 Dapsone and rifampin Paucibacillary leprosy is characterized by three or fewer anesthetic and anhidrotic lesions. This form of leprosy develops when the body mounts a Th1 cytokine c ytokine profile leading to rare bacilli found in the lesions. The WHO recommends treatment of paucibacillary leprosy with dapsone 100 mg daily for 6 months and rifampin 600 mg monthly for 6 months. Q/Q(M)-482692 Report a Problem
Guarneri bodies are associated with: 1 Measles 2
Orf
3
CMV
4
Smallpox
5
Anthrax Q/Q(M)-474531 Report a Problem
Guarneri bodies are associated with: 4 Smallpox Guarnieri�s bodies are cytoplasmic eosinophillic inclusions found on light microscopy. Q/Q(M)-474531 Report a Problem
89
Winterbottom�s sign is a characteristic feature of which of the following diseases? 1 Leishmaniasis 2
Onchocerciasis
3
Loaiasis
4
African Trypanosomiasis Trypanosomiasis
5
Strongyloidiasis Q/Q(M)-474543 Report a Problem
Winterbottom�s sign is a characteristic feature of which of the following diseases? 4 African Trypanosomiasis Winterbottom�s sign (posterior cervical lymphadenopathy) is a clinical feature f eature of African trypanosomiasis. trypanosomiasis. Roma�a�s sign (eyelid edema and conjunctivitis at site of incoculation) is a diagnostic finding in American trypanosomiasis (Chagas� disease). Q/Q(M)-474543 Report a Problem The usual cause ecthyma is: 1 Group A streptococcus 2
Group B streptococcus
3
Group D streptococcus
4
Staphylococcus Staphylococcus Aureus
5
Lancefield type O organisms Q/Q(M)-480157 Report a Problem
The usual cause ecthyma is: 1 Group A streptococcus The usual cause of ecthyma is Group A streptococcus, though other organisms can occasionally cause similar cutaneous infections. Group B streptococcus is S. agalactae, agalactae, commonly isolated from normal vaginal mucosa. Infections can be problematic for neonates, but not a frequent cause of ecthyma. Group D streptococcus/Lancefield streptococcus/Lancefield type O organisms or ganisms are enterococci. S. aureus can secondarily infect a lesion of ecthyma but is not the usual cause of this condition. Q/Q(M)-480157 Report a Problem What is the most important predictor of materal-fetal transmission t ransmission of HSV-2? 1
Use of pre-natal antiviral medications
2
Length of delivery
3
Nature of maternal infection
4
Nutrition status of the mother
5
Use of peri-natal monitoring equipment. 90
Q/Q(M)-482575 Report a Problem What is the most important predictor of materal-fetal transmission t ransmission of HSV-2? 3 Nature of maternal infection The nature of the maternal infection (primary versus recurrent) is the most important predictor of maternal-fetal transmission of HSV-2. In mothers with a primary infection, the risk of transmission tr ansmission is 25-50%. In mothers experiencing a recurrent infection, the risk is 2-5% Q/Q(M)-482575 Report a Problem What rare hematologic disorder can accompany varicella-zoster virus infection? 1
Thrombocytopenia
2
Neutropenia
3
Lymphopenia
4
Lymphocytosis
5
Anemia Q/Q(M)-482578 Report a Problem
What rare hematologic disorder can accompany varicella-zoster virus infection? 1 Thrombocytopenia Symptomatic thrombocytopenia, thrombocytopenia, while rare, has been associated with acute varicella-zoster virus infection. Q/Q(M)-482578 Report a Problem A laboratory worker undergoes injection of vaccinia virus for vaccination against smallpox. What type of reaction is needed to ensure adequate development development of immunity? 1 Vesicle or ulcer surrounded by 4 cm of erythema 2
Lichenoid plaque
3
Development Development of vesicles at site separate from injection
4
Targetoid plaque
5
Systemic flu-like reaction with fever and myalgia Q/Q(M)-482601 Report a Problem
A laboratory worker undergoes injection of vaccinia virus for vaccination against smallpox. What type of reaction is needed to ensure adequate development development of immunity? 1 Vesicle or ulcer surrounded by 4 cm of erythema Vaccinia virus is used to vaccinate high-risk individuals against smallpox virus. Development of a vesicle or ulcer with 4 cm of surrounding erythema is a reaction considered considered to have a high rate of adequate immunization. 91
Q/Q(M)-482601 Report a Problem A 25 year old woman who is 13 weeks pregnant is exposed to cytomegalovirus (CMV). Three weeks later, she develops infectious mononucleosis mononucleosis symptoms. What percentage of neonates with congenital CMV infection are asymptomatic? 1
10%
2
25%
3
50%
4
75%
5
90% Q/Q(M)-482593 Report a Problem
A 25 year old woman who is 13 weeks pregnant is exposed to cytomegalovirus (CMV). Three weeks later, she develops infectious mononucleosis mononucleosis symptoms. What percentage of neonates with congenital CMV infection are asymptomatic? 5 90% Symptoms of congenital CMV infection include low birth weight, microcephaly, seizures, petechial rash, and hepatosplenomeg hepatosplenomegaly. aly. Fortunately, the vast majority (90%) of congenital CMV infections i nfections are asymptomatic. Q/Q(M)-482593 Report a Problem A goatherder develops this painless pustule that subsequently forms a black eschar. What causes the edema to form in this lesion? 1
Increased levels of cAMP
2
Release of TNF-alpha
3
Release of IL-1beta
4
Inhibition of phagocytosis phagocytosis
5
C1 esterase inhibitor Q/Q(M)-476661 Report a Problem
92
A goatherder develops this painless pustule that subsequently forms a black eschar. What causes the edema to form in this lesion? 1 Increased levels of cAMP Anthrax is caused by Bacillus anthracis, a gram positive spore-forming rod. Anthrax is primarily seen in individuals who are in contact with wild or domestic animals. Recent cases have been linked li nked with bioterrorism. B. anthracis anthracis produces edema toxin and lethal lethal toxin. Edema toxin toxin is comprised of edema factor and protective antigen. Edema factor is a calmodulin dependent adenyl adenyl cyclase. The increased cAMP induces the gelatinous edema of anthrax skin lesions. Q/Q(M)-476661 Report a Problem The causative organism of epidemic typhus is: 1 Francisella tularensis 2
R. prowazekii
3
R. akari
4
R. typhi
5
Salmonella typhi Q/Q(M)-474245 Report a Problem
The causative organism of epidemic typhus is: 2 R. prowazekii Epidemic typhus is caused by infection with R. prowazekii. Q/Q(M)-474245 Report a Problem The usual culture medium for Mycobacterium leprae is: 1
Chocolate agar in 10% CO2
2
Lowenstein-Jensen
3
It cannot be cultured
4
Sheep�s blood agar
5
Agar supplemented with heme and nicotinamide Q/Q(M)-480178 Report a Problem
The usual culture medium for Mycobacterium leprae is: 3 It cannot be cultured M. leprae cannot be grown in media or cell culture. It has been grown in mice footpads and in armadillos. Humans are the only natural host. It is endemic in the tropics and found worldwide. The Lowenstein-Jensen Lowenstein-Jensen medium is used to culture mycobacteria most commonly. Neisseria gonorrheae is grown on chocolate agar in 10% CO2. Agar supplemented with heme (x-factor) and nicotinamide (vfactor) is needed for Hemophilus influenzae cultures. Sheep�s blood agar is useful for identifying hemolytic strains of streptococcus str eptococcus and staphylococcus. staphylococcus. Q/Q(M)-480178 Report a Problem 93
A 25-year old male from Egypt complains of slowly enlarging chronic growths on his external nares that are causing nasal obstruction. Biopsy reveals Mikulicz cells on histopathology. Which of t he following medications would be most appropriate for treatment of these lesions? 1
Ciprofloxacin
2
Penicillin
3
Erythromycin
4
Trimethoprim-Sulfamethoxazole
5
Imipenem Q/Q(M)-482274 Report a Problem
A 25-year old male from Egypt complains of slowly enlarging chronic growths on his external nares that are causing nasal obstruction. Biopsy reveals Mikulicz cells on histopathology. Which of the following medications would be most appropriate for treatment of these lesions? 1 Ciprofloxacin This patient has rhinoscleroma, a chronic granulomatous infection of the nose and upper respiratory tract by Klebsiella pneumoniae pneumoniae rhinoscleromatis. rhinoscleromatis. The disease disease is endemic endemic in Africa, Southeast Southeast Asia, Mexico, Central and South America, and Central and Eastern Europe and is rarely reported in the United States. Presentation may vary from rhinitis to diffuse airway obstruction. Mikulicz cells are foamy, vacuolated macrophages seen in rhinoscleroma. Antibacterial therapeutic choices include ciprofloxacin, tetracycline, and rifampin. Surgical treatment may be required for obstructive lesions. Q/Q(M)-482274 Report a Problem In addition to Kaposi �s sarcoma, HHV-8 infection is also the causative agent in: 1
Pityriasis rosea
2
Angiosarcoma
3
Primary effusion lymphoma
4
Bacillary angiomatosis
5
Pyogenic granuloma Q/Q(M)-477224 Report a Problem
In addition to Kaposi �s sarcoma, HHV-8 infection is also the causative agent in: 3 Primary effusion lymphoma Human herpes virus 8 is a double stranded DNA virus. It is thought to be pathogenic p athogenic in Kaposi �s sarcoma, primary effusion lymphoma, and Castleman �s disease. Primary effusion lymphoma is a rare B-cell lymphoma seen predominantly in patients with AIDS. A IDS. Q/Q(M)-477224 Report a Problem The main deterrent to staphylococcal staphylococcal infection of the skin is: 1
Complement 94
2
Neutrophils
3
Macrophages
4
Immunoglobulin
5
CD8+ T-cell mediated immunity Q/Q(M)-480151 Report a Problem
The main deterrent to staphylococcal staphylococcal infection of the skin is: 2 Neutrophils The main deterrent to staphylococcal infection is the neutrophils. These contain bactericidal chemicals and proteins such as myeloperoxidase-H202-halide, myeloperoxidase-H202-halide, lysozyem, serine proteases, defensins and bacterial permeability increasing increasing peptide. Complement Complement serves as an effective opsonin opsonin for phagocytosis phagocytosis by circulating neutrophils and macrophages. Immunoglobulin response hastens phagocytosis but is not absolutely required. Cytotoxic T-cells do not play a major role in controlling S. aureus infections. Q/Q(M)-480151 Report a Problem Epidermodysplasia Epidermodysplasia verruciformis is caused by which human papilloma virus (HPV) types? t ypes? 1
6 and 11
2
16 and 18
3
5, 8, and 9
4
3 and 10
5
13 and 32 Q/Q(M)-474296 Report a Problem
Epidermodysplasia Epidermodysplasia verruciformis is caused by which human papilloma virus (HPV) types? t ypes? 3 5, 8, and 9 Epidermodysplasia Epidermodysplasia verruciformis is caused by HPV types 5, 8, 9, 12, 14, 15, 17, 19-26. Q/Q(M)-474296 Report a Problem A 24 year-old man from f rom New York City Cit y develops fever, chills, malaise, and a severe headache. His apartment has a mouse problem. On examination, multiple, discrete papulovesicles papulovesicles and a single eschar are found. What is the most likely diagnosis? 1
Ehrlichiosis
2
Rickettsialpox
3
Q Fever
4
Meningococcemia
5
Rocky Mountain Spotted Fever Q/Q(M)-474271 Report a Problem 95
A 24 year-old man from f rom New York City Cit y develops fever, chills, malaise, and a severe headache. His apartment has a mouse problem. On examination, multiple, discrete papulovesicles papulovesicles and a single eschar are found. What is the most likely diagnosis? 2 Rickettsialpox The clinical description is that of rickettsialpox, which is caused by R. akari and spread by liponyssoides sanguineus - the house mouse mite. Q/Q(M)-474271 Report a Problem Which of the following is the causative organism of Tularemia? 1 Burkholderia mallei 2
Streptobacillus moniliformis
3
Francisella tularensis
4
Orientia tsutsugamushi
5
Klebsiella pneumoniae Q/Q(M)-474268 Report a Problem
Which of the following is the causative organism of Tularemia? 3 Francisella tularensis Tularemia is caused by infection with Francisella tularensis - most commonly acquired after contact with infected rabbits (e.g. hunters). Q/Q(M)-474268 Report a Problem Which of the following is the vector of lymphatic l ymphatic filariasis caused by Wuchereria Wuchereria bancrofti? 1 Black fly 2
Tsteste fly
3
Mosquito
4
Deerfly
5
Botfly Q/Q(M)-474542 Report a Problem
Which of the following is the vector of lymphatic l ymphatic filariasis caused by Wuchereria Wuchereria bancrofti? 3 Mosquito Lymphatic filariasis is spread by mosquitoes belonging to genera Aedes, Anopheles, Anopheles, Culex, or Mansonia. Q/Q(M)-474542 Report a Problem What is the classic CXR finding of a patient with inhalational anthrax? 96
1
Alveolar infiltrates
2
Increased interstitial markings
3
Pleural effusions
4
Widened mediastinum
5
Normal x-ray Q/Q(M)-477506 Report a Problem
What is the definition of disseminated herpes zoster? 1 Involvement of two or more defined dermatomes 2
Symmetric bilateral involvement
3
Involvement of one cranial and one spinal nerve.
4
More than 20 vesicles outside of the primarily affected dermatome
5
Involvement of the trunk and at least one extremity. Q/Q(M)-482582 Report a Problem
What is the definition of disseminated herpes zoster? 4 More than 20 vesicles outside of the primarily affected dermatome The definition of dissemianted herpes zoster is at least 20 vesicles seen outside of the primarily affected dermatome. The other option choices are distractors. Q/Q(M)-482582 Report a Problem An HIV infected male, presents with a two-week history of a painless 2 cm ulcer on the t he penile shaft, with associated inguinal lymphadenopathy. lymphadenopathy. What is the best treatment? 1 Valacyclovir 2
Benzathine penicillin G
3
Ceftriaxone
4
Doxycycline
5
Azithromycin Q/Q(M)-482813 Report a Problem
An HIV infected male, presents with a two-week history of a painless 2 cm ulcer on the t he penile shaft, with associated inguinal lymphadenopathy. lymphadenopathy. What is the best treatment? 2 Benzathine penicillin G A painless ulcer in an HIV patient is most likely l ikely a syphilitic chancre. The treatment of choice is benzathine penicillin penicillin G in patients without without a penicillin allergy. allergy. Alternative agents in allergic patients include doxycycline, tetracycline, erythromycin, and ceftriaxone. Valacyclovir would be the treatment of choice for genital herpes, which is typically painful. Azithromycin in a single 1 g oral dose is 97
effective for chancroid, which is painful. Q/Q(M)-482813 Report a Problem What is the first line l ine treatment of streptococcal toxic shock syndrome? syndrome? 1 Penicillin 2
Ciprofloxacin
3
Clindamycin
4
Doxycycline
5
Vancomycin Q/Q(M)-482852 Report a Problem
What is the first line l ine treatment of streptococcal toxic shock syndrome? syndrome? 3 Clindamycin Clindamycin is considered 1st line treatment of streptococcal toxic shock syndrome, as it inhibits secretion of the exotoxin. Q/Q(M)-482852 Report a Problem
Which of the following mycobacterial organisms is classified as a photochromogen? 1 M. Kansasii 2
M. grodonae
3
M. fortuitum
4
M. ulcerans
5
M. tuberculosis Q/Q(M)-477652 Report a Problem
Which of the following mycobacterial organisms is classified as a photochromogen? 1 M. Kansasii M. Kansasii, M. marinum, and M. simiae are photochromogens. They form pigment when exposed to light. Q/Q(M)-477652 Report a Problem A 4 year old girl experiences systemic symptoms including fever, fatigue, headache, and vomiting. An associated exanthem exanthem consists of a non-pruritic eruption including the formation of blisters on the palms and soles and an intra-oral ulcer. Hand-foot-mouth syndrome is diagnosed. What nail finding can be seen approximately 1 month after infection with Coxsackie virus and other Enteroviruses? 1 Onychomadesis 2
Onycholysis 98
3
Trachyonychia
4
Terry\'s nails
5
Paronychia Q/Q(M)-482606 Report a Problem
A 4 year old girl experiences systemic symptoms including fever, fatigue, headache, and vomiting. An associated exanthem exanthem consists of a non-pruritic eruption including the formation of blisters on the t he palms and soles and an intra-oral ulcer. Hand-foot-mouth syndrome is diagnosed. What nail finding can be seen approximately 1 month after infection with Coxsackie virus and other Enteroviruses? 1 Onychomadesis Although rare, onychomadesis has been associated with enteroviral infections, including hand-footmouth syndrome due to Coxsackie virus. Onychomadesis is an idiopathic shedding of the nails beginning at at the proximal end. It may be due to temporary temporary arrest of the matrix during the infection. In most cases, the nails return normally. Q/Q(M)-482606 Report a Problem Each of the following species may be involved in necrotizing fasciitis except: 1 Pseudomonas 2
Clostridium
3
Streptococcus
4
Mycobacterium
5
Bacteroides Q/Q(M)-477223 Report a Problem
Each of the following species may be involved in necrotizing fasciitis except: 4 Mycobacterium Necrotizing fasciitis fasciitis is a rapidly advancing advancing acute necrotizing necrotizing infection that may may follow trauma, surgery, or occur spontaneously. It is associated with systemic s ystemic toxicity and high mortality rate. Clinically, Cli nically, erythema, edema, and edema progresses to dusky cyanosis, blistering and necrosis. Many virulent bacteria have been culturesd including Pseudomonas, Pseudomonas, Bacteroides, Bacteroides, streptococci, staphylococcus, staphylococcus, enterococci, and clostridium. Both aerobic and anaerobic cultures should be taken. Mycobacterium is not associated with necrotizing fasciitis. Q/Q(M)-477223 Report a Problem WHO recommendations for the treatment of multibacillary leprosy include all of the following EXCEPT: 1
Dapsone
2
Clofazimine
3
Clarithromycin
4
Rifampin 99
5
All of these answers are recommended for the treatment of multibacillary leprosy. Q/Q(M)-473937 Report a Problem
WHO recommendations for the treatment of multibacillary leprosy include all of the following EXCEPT: 3 Clarithromycin Clarithromycin is not part of the WHO recommendations recommendations for the treatment of multibacillary leprosy. Q/Q(M)-473937 Report a Problem Which human papillo viurs (HPV) type t ype is implicated in papillomatosis cutis carcinoides di Gottron? 1 7 2
11
3
18
4
57
5
60 Q/Q(M)-477636 Report a Problem
Which human papillo viurs (HPV) type t ype is implicated in papillomatosis cutis carcinoides di Gottron? 2 11 Papillomatosis cutis carcinoides di Gottron, also know as Gottron's tumor, is a verrucous carcinoma of the skin. In 1948, Ackerman first described verrucous carcinoma carcinoma (VC), a low-grade tumor that generally is considered a clinicopathologic variant of squamous cell carcinoma. Verrucous carcinomas are caused by HPV types 6 and 11. When they occur on on the feet they are called called epithelioma caniculatum. caniculatum. When they occur on the genitals they are refered to as Buschke-Lowenstein Buschke-Lowenstein tumors. When they occur in the mouth they are called Ackerman's tumors or oral florid papillomatosis. Q/Q(M)-477636 Report a Problem Which of the following tests is the most sensitive serologic serologic test in primary syphilis? 1
FTA-ABS
2
VDRL
3
ELISA
4
RPR
5
MHA-TP Q/Q(M)-482696 Report a Problem
Which of the following tests is the most sensitive serologic serologic test in primary syphilis? 1 FTA-ABS The fluorescent treponemal antibody absorption test is the most sensitive serologic test in primary 100
syphilis. The ELISA is the test of choice in early primary and congenital syphilis because it is the first to become reactive. reactive. However, it is less less sensitive in late primary syphilis because because of reduction of of IgM production. The ELISA is 100% specific. specific. MHA-TP is less sensitive sensitive than FTA-ABS FTA-ABS during primary syphilis. Q/Q(M)-482696 Report a Problem
The treatment of choice of the tropical infectious disease shown is: 1 Ivermectin 2
Permethrin
3
Diethylcarbamazine
4
Pentavalent antimony
5
Mebendazole Q/Q(M)-476070 Report a Problem
The treatment of choice of the tropical infectious disease shown is: 4 Pentavalent antimony The ulcerated nodule shown here is characteristic of cutaneous leishmaniasis leishmaniasis (CL). Leishmaniasis is treated with pentavalent antimony. Q/Q(M)-476070 Report a Problem
A patient on the bone marrow transplant service has a fever, neutropenia, hemorrhagic hemorrhagic bullae and erythematous nodules with dusky gray centers. The organism most likely to be responsible is: 1 Streptococcus pyogenes 2
Mycobacterium tuberculosis
3
Candida albicans
4
Pseudomonas aeruginosa
5
Staphylococcus Staphylococcus aureus Q/Q(M)-477315 Report a Problem
A patient on the bone marrow transplant service has a fever, neutropenia, hemorrhagic hemorrhagic bullae and erythematous nodules with dusky gray centers. The organism most likely to be responsible is: 4 Pseudomonas aeruginosa 101
Ecthyma gangrenosum gangrenosum is an infection of critically ill or immunocompromised immunocompromised individuals by Pseudomonas aeruginosa. aeruginosa. Clinically, patients develop opalescent, opalescent, tense vesicles or pustules surrounded by a narrow pink pink to violaceous halo. The lesions lesions rapidly become become hemorrhagic, then then violaceous and necrotic leaving ulcers. The most common location is on the buttocks and lower extremities. Treatment is with aminoglycosides. aminoglycosides. Q/Q(M)-477315 Report a Problem An otherwise healthy six-day-old boy is brought into clinic by his mother with the complaint of tiny ti ny thin-roofed vesicles with a rim of inflammation and a few lesions covered with a �honey-colored� crust. Which organism is the most likely cause in this newborn? 2 Group B streptococcus Group B streptococcus is S. agalactae, commonly isolated from normal vaginal mucosa. In neonates, impetigo caused by group B streptococci may develop. Listeria monocytogenes is a small, gram-positive organism that may present as petechial, papular or pustular eruptions in acutely ill infants, usually those that were meconium stained at birth. The usual cause of ecthyma is Group A streptococcus, though other organisms can occasionally cause similar cutaneous infections. Group D streptococcus/Lancefield type O organisms are enterococci. S. aureus can secondarily infect a lesion of ecthyma but is not the usual cause of this condition. Q/Q(M)-480158 Report a Problem A 10 year-old girl presents to the dermatology clinic with a pruritic eruption on her trunk after swimming at a beach in Florida. Of note, the lesions are limited to skin that was covered by her bathing suit. The most likely diagnosis is: 1 Seabather?s eruption 2
Swimmer?s itch
3
Cercarial dermatitis
4
Swimming pool granuloma
5
Cutaneous larva migrans Q/Q(M)-474532 Report a Problem
A 10 year-old girl presents to the dermatology clinic with a pruritic eruption on her trunk after swimming at a beach in Florida. Of note, the lesions are limited to skin that was covered by her bathing suit. The most likely diagnosis is: 1 Seabather?s eruption Seabather?s eruption characteristically characteristically involves areas covered by swimwear, as a result of coelenterate larvae becoming trapped underneath bathing suits. The causative organisms are larval forms of Edwardsiella lineata (sea anemone) and Linuche unquiculata (thimble jellyfish). Q/Q(M)-474532 Report a Problem For which of the following smallpox vaccination complications is the administration of vaccine immune globulin indicated? 1 Post-vaccinal encephalitis 102
2
Erythema multiforme
3
Eczema vaccinatum
4
Vaccinia keratitis
5
Mild generalized vaccinia Q/Q(M)-477373 Report a Problem
For which of the following smallpox vaccination complications is the administration of vaccine immune globulin indicated? 3 Eczema vaccinatum Vaccinia immune globulin can be administered to treat some of the complications associated with vaccinia vaccination. Vaccinia immune globulin is indicated for inadvertent inoculation with extensive involvement or ocular implantations, im plantations, eczema vaccinatum, generalized vaccinia (severe or recurrent), and progressive vaccinia. vaccinia. It is not recommended recommended for inadvertent inadvertent inoculation with mild reaction, reaction, generalized vaccinia (mild or limited), post-vaccination encephalitis, encephalitis, and isolated vaccinia keratitis. Q/Q(M)-477373 Report a Problem A 35 year old male has had frequent sex with prostitutes. He presents complaining of the rapid onset of a new rash on his legs. A review of symptoms is otherwise unremarkable. Examination reveals palpable purpura and tender nodules of the the lower legs. Biopsy reveals vasculitis vasculitis of small- and medium-sized medium-sized vessels. What percentage percentage of patients with this disease are found to be infected with Hepatitis B virus? 1 7-8% Polyarteritis nodosa is characterized by the onset onset of painful nodules on the lower extremities. It can be limited to the skin (cutaneous PAN), or can involve a wide variety of organ systems (systemic PAN). Approximately 7-8% of cases of polyarteritis nodosa cases are associated with Hepatitis B virus infection. Q/Q(M)-482596 Report a Problem A 48-year-old Latin American female with a diagnosis of leprosy develops bullous lesions that appear rapidly and ulcerate, especially below the knee. This most m ost likely represents: 1
Reversal reaction
2
Upgrading reaction
3
Erythema nodosum leprosum
4
Lucio's phenomenon
5
Lofgren's syndrome Q/Q(M)-482352 Report a Problem
A 48-year-old Latin American female with a diagnosis of leprosy develops bullous lesions that appear rapidly and ulcerate, especially below the knee. This most m ost likely represents: 4 Lucio's phenomenon This patient has a type t ype III reactional state to leprosy called Lucio's phenomenon. It mostly occurs in 103
people of Latin Latin American descent descent and is characterized characterized by rapidly ulcerating and bullous lesions usually usually on the legs. It has a high mortality mortalit y rate. A type I reaction, or a reversal/upgrading reaction, can occur after treatment and are associated with a change in cell-mediated immunity and result in accelerated destruction of bacilli. This is manifested as inflammation of existing lesions with no systemic symptoms. A type II reaction, or erythema nodosum leprosum, represents an immune complex deposition and features widespread erythematous nodules with systemic features. Lofgren's is associated with sarcoidosis. Q/Q(M)-482352 Report a Problem One of your colleagues returned from a vacation to India with fever, vomiting, pleural effusions, ascites and conjunctival petechiae. She also has a diffuse macular rash with notable areas of sparing that your attending refers to as �white islands in a sea of red �. What is your diagnosis? 1 Leishmania 2
Dengue hemorrhagic fever
3
Malaria
4
Typhoid
5
Leptospirosis Q/Q(M)-477139 Report a Problem
One of your colleagues returned from a vacation to India with fever, vomiting, pleural effusions, ascites and conjunctival petechiae. She also has a diffuse macular rash with notable areas of sparing that your attending refers to as �white islands in a sea of red �. What is your diagnosis? 2 Dengue hemorrhagic fever Dengue fever is caused by an Arbovirus and transmitted tr ansmitted by the mosquito, Aedes aegypti and may cause Dengue Shock Syndrome and Dengue Hemorrhagic Fever. The infection starts with sudden onset of high fever, backache, retroorbital pain, bone and joint pain, depression and malaise. The disease is also called "break-bone fever." One to seven days after onset of fever, rash presents characteristically starting on the dorsum and hands and feet f eet spreading to limbs and torso. The eruption may become confluent with small, round islands of sparing, the so called "white islands in a sea of red." Treatment is generally supportive as no antivirals are effective. Q/Q(M)-477139 Report a Problem The vector of Trench Fever is the: 1 Human body louse (Pediculus humanus corporis) 2
Cat flea (Ctenocephalides felis)
3
Sandfly (Phlebotamus perniciosus)
4
Rat flea (Xenopsylla cheopis)
5
Trombiculid mite Q/Q(M)-473909 Report a Problem
The vector of Trench Fever is the: 104
1 Human body louse (Pediculus humanus corporis) The human body louse (Pediculus humanus corporis)is the vector of Trench Fever, Epidemic Typhus, and Relapsing Fever. Q/Q(M)-473909 Report a Problem Which of the following are inconsistent with the diagnosis of staphylococcal scalded skin syndrome? 1 Epidermal changes are produced by exfoliative toxins of staphlococcus staphlococcus 2
Initial event is usually a localized staph infection
3
Swabs and cultures of fluid filled blisters overwhelmingly grow staph
4
Prognosis is good in children with low mortality when anitbiotics are administered early
5
Cell necrosis does not occur in staphylococcal staphylococcal scalded skin syndrome as it does in T.E.N Q/Q(M)-478752 Report a Problem
Which of the following are inconsistent with the diagnosis of staphylococcal scalded skin syndrome? 3 Swabs and cultures of fluid filled blisters overwhelmingly grow staph Staphylococcal Staphylococcal scalded skin syndrome: Lesions extend far beyond areas of actual staphylococcal infection, by action of the epidermolytic exotoxin elaborated by the staphylococcus in remote sites. Usually the staphylococci are present at a distant focus such as the parynx, nose ear, or conjuctiva. If cultures are taken they should be obtained fromthe mucous membranes because because the skin erythema er ythema and desquamation is due to the distant effects of the exfoliative toxin, unlike the sitaution in bullous impetigo, where S. aureus is present in the lesions. Epidermal changes are produced by exfoliative toxins of Staphylococcus. Inital event is usually a localized Staph infection. Prognosis is good in children with low mortality when anitbiotics are administered earyl. Cell necrosis does not occur in SSS as it does in toxic epidermal necrolysis. Q/Q(M)-478752 Report a Problem A patient with HIV/AIDS presents with vesicles in a disseminated distribution. A biopsy is performed. Which histologic finding favors infection with varicella-zoster virus over herpes simplex virus? 1
Pseudoepitheliomatous Pseudoepitheliomatous hyperplasia
2
Margination of keratinocyte nuclei
3
Multinucleated cells
4
Superficial dermal leukocytoclastic vasculitis
5
Molding of nuclei Q/Q(M)-482587 Report a Problem
A patient with HIV/AIDS presents with vesicles in a disseminated distribution. A biopsy is performed. Which histologic finding favors infection with varicella-zoster virus over herpes simplex virus? 4 Superficial dermal leukocytoclastic vasculitis Herpes simplex virus and disseminated varicella-zoster virus infection can be difficult to distinguish 105
clinically and histologically. These viruses share the histologic findings of margination of nuclei, multinucleated cells, and nuclear molding. The presence of leukocytoclastic vasculitis favors a diagnosis of disseminated varicella-zoster virus. Q/Q(M)-482587 Report a Problem Which of the extracellular enzymes of S. aureus plays a role in toxic shock syndrome (TSS)? 1 Coagulase 2
Penicillinase
3
Enterotoxin
4
Hemolysin
5
Exfoliatin Q/Q(M)-480152 Report a Problem
Which of the extracellular enzymes of S. aureus plays a role in toxic shock syndrome (TSS)? 3 Enterotoxin In addition to TSST-1 which is present in 50% of non-menstrual cases of TSS, enterotoxins, especially B & C, cause TSS. These enterotoxins are also superantigens, which recognize the V-beta region of the T-cell receptor. Coagulase clots plasma, Penicillinase degrades penicillin, Hemolysin lyses red blood cells and exfoliatin splits the epidermis (antigen is desmoglein 1). Q/Q(M)-480152 Report a Problem What is the risk of transmission t ransmission of HSV from active cervical lesions when a C-section is performed? 1
1%
2
8%
3
17%
4
31%
5
43% Q/Q(M)-482576 Report a Problem
What is the risk of transmission t ransmission of HSV from active cervical lesions when a C-section is performed? 1 1% When a C-section is performed in the setting of active cervical lesions of HSV, the risk of maternal-fetal transmission is decreased decreased to 1%. If a child were delivered vaginally in such a setting, the risk of transmission is approximately 8%. Q/Q(M)-482576 Report a Problem A 16 year old female presents with a sore throat, painful cervical lymphadenopathy, and an enlarged spleen. An empiric trial of amoxicillin leads to the development of a diffuse morbilliform rash. r ash. What is the incubation period of the most likely viral cause of this patient\'s symptoms? 106
1
3-7 days
2
7-10 days
3
2-3 weeks
4
3-7 weeks
5
6 months Q/Q(M)-482589 Report a Problem
A 16 year old female presents with a sore throat, painful cervical lymphadenopathy, and an enlarged spleen. An empiric trial of amoxicillin leads to the development of a diffuse morbilliform rash. r ash. What is the incubation period of the most likely viral cause of this patient\'s symptoms? 4 3-7 weeks Infectious mononucleosis is characterized by a sore throat, painful lymphadenopathy, lymphadenopathy, fatigue, and splenomegaly. splenomegaly. The formation of a morbilliform rash upon challenge with ampicillin or related antibiotics is a classic finding. The most common virus associated with infectious mononucleosis is Epstein-Barr virus. The incubation period is relatively long, 3-7 weeks. Q/Q(M)-482589 Report a Problem A 10-year-old boy develops an acute illness and rash along with marked enlargement of the t he posterior cervical lymph nodes. This presentation is most consistent with: 1 West African sleeping sickness 2
East African sleeping sickness
3
Chagas disease
4
Schistosomiasis
5
Sparaganosis Q/Q(M)-482313 Report a Problem
A 10-year-old boy develops an acute illness and rash along with marked enlargement of the t he posterior cervical lymph nodes. This presentation is most consistent with: 2 East African sleeping sickness East African sleeping sickness is caused by Trypanosoma rhodisiense and leads to acute illness with rapid fatal course and pronounced posterior cervical lymphaden l ymphadenopathy opathy (Winterbottom's sign). West African sleeping sickness is more chronic. American trypanoso tr ypanosomiasis, miasis, or Chagas disease, features unilateral conjunctivitis and edema of the face (Romana's sign) and heart and gastrointestinal sequelae. Schistomsomiasis causes causes swimmer's itch, while sparaganosis from ingestion of Spirometra leads to painful edematous edematous lumps. Q/Q(M)-482313 Report a Problem A 24 year-old man from f rom New York City Cit y develops fever, chills, malaise, and a severe headache. His apartment has a mouse problem. On examination, multiple, discrete papulovesicles papulovesicles and a single eschar are found. What is the most likely diagnosis? 107
1
Ehrlichiosis
2
Rickettsialpox
3
Q Fever
4
Meningococcemia
5
Rocky Mountain Spotted Fever Q/Q(M)-474271 Report a Problem
A 24 year-old man from f rom New York City Cit y develops fever, chills, malaise, and a severe headache. His apartment has a mouse problem. On examination, multiple, discrete papulovesicles papulovesicles and a single eschar are found. What is the most likely diagnosis? 2 Rickettsialpox The clinical description is that of rickettsialpox, which is caused by R. akari and spread by liponyssoides sanguineus - the house mouse mite. Q/Q(M)-474271 Report a Problem What is the most common site of infection from Streptococcu St reptococcuss Iniae? 1 Lower leg 2
Face
3
Hand
4
Foot
5
Nails Q/Q(M)-477612 Report a Problem
What is the most common site of infection from Streptococcu St reptococcuss Iniae? 3 Hand Streptococcus iniae most commonly causes bacteremic cellulitis of the hand in persons who have recently handled fresh fish. S. iniae is a fish pathogen that causes sporadic infection in tilapia, yellowtail, rainbow trout, and coho salmon. Treatment of choice is with penicillin antibiotics. Q/Q(M)-477612 Report a Problem A 32 year-old woman presents with meningitis and palpable purpura. A diagnosis of meningococcemia is confirmed via culture of cerebrospinal fluid. Which complement components are most likely to be deficient in this patient? 1 C1 2
C2
3
C3
4
C4
5
C5 108
Q/Q(M)-477609 Report a Problem A 32 year-old woman presents with meningitis and palpable purpura. A diagnosis of meningococcemia is confirmed via culture of cerebrospinal fluid. Which complement components are most likely to be deficient in this patient? 5 C5 Patients with meningococcemia meningococcemia often demonstrate deficiencies of late complement components C5-9. Q/Q(M)-477609 Report a Problem A 24 year old male presents with a high fever, arthralgias, and a rash characterized by nonspecific nonspecific erythematous macules in a generalized distribution. He was recently cleaning his family\'s famil y\'s barn, and was bitten more than once once by rats and and mice. What is the treatment of choice for this infection? 1
Penicillin
2
Erythromycin
3
Clindamycin
4
Ciprofloxacin
5
Amikacin Q/Q(M)-482688 Report a Problem
A 24 year old male presents with a high fever, arthralgias, and a rash characterized by nonspecific nonspecific erythematous macules in a generalized distribution. He was recently cleaning his family\'s f amily\'s barn, and was bitten more than once once by rats and and mice. What is the treatment of choice for this infection? 1 Penicillin Rat-bite fever is also called Haverhill Fever. It is caused by Streptobacillus moniliformis and is acquired from infected rodents or by b y touching or eating contaminated food. The signs and symptoms are nonspecific, but the diagnosis can be suspected based on history. Treatment is with penicillin. Q/Q(M)-482688 Report a Problem A patient presents with painful vesicles in a dermatomal distribution on his forehead and on the tip of his nose. She is sent by her ophthalmologist who diagnostic ophthalmic zoster. Which nerve branch is involved? 1 Ophthalmic 2
Nasal
3
Infraorbital
4
Supraorbital
5
Temporal Q/Q(M)-480181 Report a Problem
109
A patient presents with painful vesicles in a dermatomal distribution on his forehead and on the tip of his nose. She is sent by her ophthalmologist who diagnostic ophthalmic zoster. Which nerve branch is involved? 1 Ophthalmic The ophthalmic branch of the trigeminal t rigeminal branch is involved in ophthalmic zoster. This presentation accounts for 10-15% of all cases of VZV. The other nerve branches listed are not involved in ophthalmic zoster. Q/Q(M)-480181 Report a Problem A 20-month old child develops a high fever followed 2 days later by a sudden eruption of rose pink macules and papules with white halos as the fever subsides. What is the most likely diagnosis? 1 Measles 2
Rubella
3
Scarlet fever
4
Exanthem Subitum
5
Erythema infectiosum Q/Q(M)-474238 Report a Problem
A 20-month old child develops a high fever followed 2 days later by a sudden eruption of rose pink macules and papules with white halos as the fever subsides. What is the most likely diagnosis? 4 Exanthem Subitum The cutaneous features of Exanthem Subitum (Roseola infantum, Sixth Disease)as described described in the question develop as the fever subsides. While the other diagnoses are part of the differential diagnosis of "fever and rash" in children, only roseola infantum has this characteristic clinical course. Q/Q(M)-474238 Report a Problem What is the treatment for syphillis in a penacillin allergic patient? 1 Penicillin 2
Doxcycyline
3
Rifampiin
4
Clindamycin
5
Ceftriaxone Q/Q(M)-476872 Report a Problem
What is the treatment for syphillis in a penacillin allergic patient? 2 Doxcycyline Secondary syphillis is caused by the spirochete, T. pallidum. Penicillin is the treatment of choice for secondary syphillis. In penicillin allergic individuals, doxycyline may be used. Q/Q(M)-476872 Report a Problem 110
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