IDS 1 2024.docx

1\. Which of the following clinical manifestations of dengue would warrant hospital admission? A. Abdominal pain B. Diarrhea C. Petechial rash D. Vomiting ANSWER:A 2\. A 25/M came in due to a 3-day history of fever, myalgia, back pain, retroorbital pain, headache, and persistent vomiting....

1\. Which of the following clinical manifestations of dengue would warrant hospital admission? A. Abdominal pain B. Diarrhea C. Petechial rash D. Vomiting ANSWER:A 2\. A 25/M came in due to a 3-day history of fever, myalgia, back pain, retroorbital pain, headache, and persistent vomiting. Vital signs at the ER:BP 100/60, HR 115, RR 21. CBC showed hemoglobin 155 g/L, hematocrit 45%,WBC 3.2 x 10 /L, platelet 122 x 10/uL. What is the correct fluid management of this case? A. Oral rehydration solution B. PNSS (1,500 mL + 20 mL/kg for each kg \>20 kg) to run for 24 hours C. PNSS to run at 5 to 7mL/kg/h for the first 2 hours D. PNSS to run at 20 mL/kg over the first 15 minutes then reassess ANSWER: C 3\. Which of the following parameters is NOT a discharge criterion in the management of dengue? A. No fever for 48 hours B. Normal creatinine and liver enzymes C. Increasing trend of platelet count D. Stable hematocrit without intravenous fluids ANSWER: B 4\. A patient was being managed for hypotensive shock from dengue. Initial resuscitation was with 20 mL/kg of crystalloid solution did not improve his blood pressure. A repeat CBC showed a decrease in hematocrit. What is the next step? A. Continue hydration with plain saline solution B. Initiate hydration with colloid solutions C. Transfuse packed red blood cells D. Start vasopressors ANSWER: C 5\. Which of the following statements on the etiology of sepsis is NOT TRUE? A. Among the community-acquired and hospital-acquired infections, pneumonia is the most common source of sepsis. B. Blood cultures are positive in one-half of cases, while many cases are culture negative at all sites. C. Staphylococcus aureus and Streptococcus pneumoniae are the most common gram-positive isolates, while Escherichia coli, Klebsiella species, and Pseudomonas aeruginosa are the most common gram-negative isolates. D. The incidence of sepsis is highest at the extremes of age, higher in males than in females, and higher in blacks than in whites. ANSWER: B 6\. A 60 year old male was brought to the ER for dyspnea. He had a 3-dayhistory of cough and fever. Vital signs were BP 80/50 HR 120 RR 24 T 38.3C O2 at 95% at room air. Physical examination revealed GCS 15, in mild respiratory distress, and crackles on the right lung area mid to base. Initial work up revealed leukocytosis on CBC, infiltrates on the right mid lung fields and serum lactate of 2.2 mmol/L. What is the initial management for this patient? A. Start IV crystalloid fluid at 30mL/kg B. Start Norepinephrine drip C. Load empiric broad-spectrum IV antibiotics within 1 hour D. Obtain appropriate samples for microbiologic cultures ANSWER: A 7\. A 58 year old male with diabetes came in for a non-healing wound on the right foot. Initial vital signs were BP 70/50 HR 124 RR 22 Temp 38C. He was encephalopathic, with clear breath sounds, and a wound on the plantar aspect of the right foot with necrotic area and foul-smelling discharge. Intravenous fluid at 30mL/kg was given with no improvement in the BP hence Norepinephrine drip was started. The patient's wife said that the patient is allergic to penicillin. What initial antimicrobial therapy can begiven to the patient? A. Piperacillin-tazobactam or Meropenem B. Levofloxacin or Ciprofloxacin C. Aztreonam plus Vancomycin D. Cefepime plus Vancomycin ANSWER: C 8\. The above case, was on adequate fluid resuscitation and on Norepinephrine. On your monitoring the patient's BP became 90/50. What will be the next vasopressor of choice before titrating Norepinephrine. A. Vasopressin B. Epinephrine C. Dopamine D. Dobutamine ANSWER: A 9\. What supportive care is appropriate for patients with sepsis or septic shock? A. Stress ulcer prophylaxis is routinely given. B. Red blood cell transfusion is recommended only when the hemoglobin concentration decreases to \200 mg/dL. D. Hydrocortisone is suggested in septic shock even if adequate fluids and vasopressor therapy can restore hemodynamic stability. ANSWER: B 10\. What is the most commonly involved site for extrapulmonary tuberculosis? A. Pleura B. Lymph nodes C. Genitourinary tract D. Central nervous system ANSWER: B 11\. Which among the following patients should be treated for latent tuberculosis? A. 50/F living with her son who has bacteriologically confirmed PTB, tuberculin reaction size 10 mm B. 30/F on pre-employment work up with tuberculin reaction size of 10 mm, no other risk factors C. 35/M IV drug user with tuberculin reaction size of 5 mm D. 28/M PLHIV patient, asymptomatic and tuberculin test negative ANSWER: A 12\. In a patient with TB meningitis who was recently diagnosed with HIV, when is the optimal time to begin anti-retroviral treatment following initiation of anti-TB treatment? A. After 2 weeks B. After 4 weeks C. After 6 weeks D. After 8 weeks ANSWER: D 13\. What is the definition of multidrug-resistant TB (MDR-TB)? A. Resistance to more than one first-line anti-TB drug, other than both Isoniazid and Rifampicin B. Resistance to at least both Isoniazid and Rifampicin C. Resistance to INH and Rifampicin + resistance to any fluoroquinolone D. Resistance to all of the 3 second -line drugs ANSWER: B 14\. A 30/M presented in the OPD for diarrhea for 2 days, associated with tenesmus and abdominal pain. He had oral rehydration therapy but his symptoms persisted. Maintaining ORS, what is the next appropriate step for this patient? A. Observe B. Routine fecalysis C. Stool culture D. Antibiotic therapy ANSWER: B 15\. What is the latest key update in the regimen for the treatment of newly diagnosed MDR-TB? A. Bedaquiline, Pretomanid, Levofloxacin, and Moxifloxacin for 26 weeks B. Bedaquiline, Pretomanid, Levofloxacin for 5 months C. 4-6 Bdq (6) LfxCfzPtoHdHEZ/ 5 LfxCfxEZ D. 6 BdqLfxLzdCfz/ 12-14 LzdCfzCs ANSWER: A 16\. What is the correct prophylaxis for leptospirosis in a patient with a small wound on the right foot, sustained after wading through floodwater? A. Doxycycline 100 mg/capsule, 1 capsule single dose B. Doxycycline 100 mg/capsule, 1 capsule OD for 3 to 5 days C. Doxycycline 100 mg/capsule, 2 capsules single dose D. Doxycycline 100 mg/capsule, 2 capsules OD for 3 to 5 days ANSWER: D 17\. A 60/M farmer was brought to the ER for nausea and vomiting. Three days before consult, he developed fever, abdominal pain, tachypneic and calf pain. Intake of paracetamol did not relieve symptoms. His wife reported the absence of urine output for 12 hours. PE findings showed BP 90/70, HR 120, RR 20, T 38.7°C. Tests showed hemoglobin 120; hematocrit 0.45; WBC 14 with neutrophils 80%, lymphocytes 15%; platelet 150; serum creatinine 3.1 mg/dL, K 5.1 meq/L. Chest x-ray noted with infiltrates. According to the latest CPG for leptospirosis, what is the next best step for this patient? A. Hydrate with pNSS 20 cc/kg/hr B. give Methylprednisone C. Give furosemide 40 mg IV D. Initiate dialysis ANSWER: B 18. Which of the following findings indicate severe leptospirosis? A. WBC 11.0 x 10 /L B. Platelet 121 x 10 /mm C. PaO2 of 68 mmHg on O2 at 10 LPM D. Chest X-ray with right upper lobe infiltrates ANSWER: C 19\. Which of the following etiologies present with indolent type ofendocarditis? A. Haemophilus species B. Pneumococci C. Staphylococcus aureus D. Tropheryma whipplei ANSWER: D 20\. A 24/F presents to the emergency room with a 2 month-history of fever. No cough, sore throat, dyspnea, orthopnea, weight loss or dysuria were noted. Sputum AFB was negative. She has no history of hospitalizations, surgeries, nor intravenous drug use. She was deemed hemodynamically stable based on clinical assessment. The attending physician is highly considering infective endocarditis. Which is TRUE of the diagnostic approach for this patient? A. Three 2-bottle blood culture sets should be obtained immediately, at least 1 hour apart. B. Obtaining blood culture sets from different venipuncture sitesshould be done over 48 hours. C. Empiric antibiotics should be immediately started once bloodcultures have been obtained. D. If initial blood cultures remain negative after 48-72 hours, 2 to 3blood culture sets should be obtained. ANSWER: D 21\. A patient sustains a deep, dirty, contaminated wound. What is the mostimportant step to avoid tetanus? A. Anti-tetanus toxin B. Tetanus vaccine C. Antibiotic therapy D. Wound cleaning ANSWER: D 22\. What is the most common clinical manifestation of first episode HSV-1 infection? HPIM 21 A. Recurrent herpes labialis B. Irritability C. Fever D. Pharyngitis ANSWER: C 23\. A patient consulted due to a cat bite on the right hand. There are enlarged lymph nodes on the right axillary area. What will you give this patient? A. Co-amoxiclav B. Cefuroxime C. ciprofloxacin D. azithromycin ANSWER: D 24\. In patient with SSTI and with 1^st^ time Febrile Neutropenia, what is the most appropriate empiric antibiotic therapy. A. Vancomycin + ceftazidime B. Meropenem + Amikacin C. Penicillin + Ciprofloxacin D. Ciprofloxacin ANSWER: A 25\. A diabetic patient presented with fever and right lower extremity pain. Physical exam shows erythema, tenderness, warmth and crepitations on the right leg. The following management is appropriate EXCEPT: A. Immediate surgery referral B. Blood culture C. hyperbaric O2 therapy D. broad spectrum antibiotics ANSWER: C 26\. Prophylactic therapy with recurrent cellulitis A. benzathine Penicillin every 2-4 weeks B. Oral penicillin for 2 weeks C. Clindamycin for 4 weeks D. Ciprofloxacin x 1 dose ANSWER: A 27\. Treatment for recurrent skin abscess will consist of the following EXCEPT: A. Drain the abscess B. Daily Chlorhexidine wash C. Procalcitonin to start antibiotics D. 5-10 days antibiotic regimen ANSWER: C 28\. In which case is typhoid immunization NOT recommended? A. Adult traveling to endemic areas B. Person with intimate exposure to a documented typhoid carrier C. Person exposed in a common-source outbreak D. Laboratory workers routinely exposed to stool or cultures of S.typhi ANSWER: C 29\. Which of the following antibiotics should be given to a patient diagnosed with typhoid fever presenting with severe dehydration due to persistent vomiting? A. Cefotaxime 2 g IV q8h B. Ceftriaxone 2 g IV q24h C. Azithromycin 500 mg IV q24h D. TMP-SMX 800/600 mg tablet, 1 tablet q12h ANSWER: B 30\. When does gastrointestinal bleeding most commonly occur in the course of typhoid fever? A. Day 1-2 of illness B. End of the first week of illness C. 2 week of illness D. 3 to 4 week of illness ANSWER: D