Questions, Answers, and Explanations Infectious Diseases Blueprint

Question 1 1. Your patient is a 44 year old male that presents with a new diagnosis of AIDS. He is in your office for counseling regarding vaccinations. Which of the following are true regarding immunizations in patients with AIDS. A. Live virus vaccines may be given B. Live bacterial vaccines may be given C. Tetanus should not be given D. Antibody response may be variable

Answer 1 1. Answer D is the correct answer. Antibody responses in vaccines in patients with HIV may not be predictable. Live viruses should be avoided in these patients. CD4 counts should be monitored closely.

Question 2 2. Which of the following signs and symptoms are not associated with botulism? A. Flaccid facial expression B. Blurry vision C. Cranial nerve palsy D. Ascending paralysis

Answer 2 2. Choice D is the correct answer. Descending paralysis not ascending paralysis is not associated with botulism. Botulism also can have cranial nerve palsies, flaccid facial expression, and blurry vision. Other clinical features include slow heart rate, normal blood pressure, and no sensory deficits. Treatment is penicillin G or flagyl IV.

Question 3 3. Your patient is a 34 year old female with an HIV positive lab test. All of the following illness would be considered an AIDS defining illness except? A. Invasive vaginal cancer B. Esophageal candidiasis C. CMV Retinitis D. Cryptococcus

Answer 3 3. Choice A is the correct answer. Invasive cervical cancer not vaginal cancer is an AIDS defining illness. Other AIDS defining illness with a positive HIV test include: esophageal candidiasis, CMV, cryptococcus, P. Carinii, Kaposi sarcoma, HIV associated dementia, toxoplasmosis, immunoblastic lymphoma, chronic cryptosporidiosis, Burkitt Lymphoma, disseminated histoplasmosis, and chronic herpes simplex

Question 4 4. Your patient is a 35 year old male diagnosed with malaria. You are considering putting him chloroquine. Which of the following strains are most likely to be chloroquine resistant? A. Ovale B. Vivax C. Malariae D. P. Falciparum

Answer 4 4. Choice D is the correct answer. Plasmodium Falciparum is the most virulent of all the strains of malaria, most likely to cause death, and most likely to be chloroquine resistant.

Question 5 5. Which of the following diseases is the most common opportunistic infection with AIDS? A. Pneumocystis Pneumonia B. CMV pneumonitis C. CMV retinitis D. Mycobacterium Tuberculosis

Answer 5 5. Choice A is the correct answer. Pneumocystis Carinii Pneumonia is the most common opportunistic infection with AIDS patients.

Question 6 6. Your are working up a patient suspected of Rheumatic Fever. All of the following are considered major criteria Acute Rheumatic Fever except: A. Migratory Arthritis B. Erythema Marginatum C. Subcutaneous Nodules D. Elevated CRP or Sed Rate

Answer 6 6. Choice D is the correct answer. The Jones Criteria for diagnosis of ARF major criteria include: Migratory arthritis (large joints), carditis or valvulitis, CNS involvement (Sydenham Chorea), Erythema Marginatum, and subcutaneous nodules. Minor criteria include: fever, prolonged PR interval, elevated CRP or ESR, and arthralgias. To make a diagnosis you need one major criteria and two minor criteria.

Question 7 7. Your patient is a 7 year old male that presents with appears to be a tick bite on his right thigh. His parents report him being in a wooded area that is known for ticks. He has a circular rash around the site. Which of the following is the best treatment plan? A. Amoxicillin B. Clindamycin C. Bactrim DS D. Doxycycline

Answer 7 7. Choice A is the correct answer. Amoxicillin, cefuroxime, and doxycycline are equally effective in treating Lyme disease. Doxycycline is incorrect because it should not be given to patients that are less than 8 years of age. Clindamycin and Bactrim DS have not shown to be effective against Lyme disease.