ID Post-test

27 Questions | Total Attempts: 59

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ID Post-test

 ID Post-test for EM from Rosens Chapters 132-136


Questions and Answers
  • 1. 
    Which of the following is a common tick vector responsible for transmitting the spirochete which causes Lyme disease?
    • A. 

      A. Coxiella burnetii

    • B. 

      B. Dermacentor variabilis

    • C. 

      C. Ixodes scapularis

    • D. 

      D. Borrelia burgdorferi

  • 2. 
    A 32 y/o presented with c/o headache, decreased concentration, left arm weakness. Travel hx includes hiking in Vermont 1 mos earlier. On exam he has meningismus, and Bell’s palsy. Which of the following is most appropriate?
    • A. 

      A. CT, LP, admit

    • B. 

      B. Labs, steroids, admit

    • C. 

      C. CT, LP, IV cefriaxone, admit

    • D. 

      D. CT, LP, Rx doxycycline x30 days, f/u with neuro

  • 3. 
    A research technician working with rats and rabbits in Mississippi, presents to the ED c/o “sore in hand”. On exam you noted “sore” on left hand, a bubo in his axilla, and low grade fever. What is most likely dx?
    • A. 

      A. Ulceroglandular Tularemia

    • B. 

      B. Q fever

    • C. 

      C. Glandular Tularemia

    • D. 

      D. Ehrlichioses

  • 4. 
    An 8 y/o boy presents to the ED with c/o rash to palms and wrists. Mom states that while waiting in triage the rash has now spread to trunk. He has no allergies. Which of the following is not a treatment for RMSF for this boy?
    • A. 

      A. Doxycycline

    • B. 

      B. PCN

    • C. 

      C. Chloramphenicol

  • 5. 
    Three days after a demonstration in downtown Chicago, you get thirty four patients coming in to the ED c/o sudden fever, productive cough during day shift. Chest x-ray reveal hilar lymphadenopathy. You are thinking this could possibly be related to a biological warfare and take all of the following measures except________
    • A. 

      A. Report to the CDC

    • B. 

      B. Admit for bronchoscopy and put them in isolation

    • C. 

      C. Admit, give streptomycin, and call ID

    • D. 

      D. Call pharmacy to alert them of need for ciprofloxacin or doxycycline for prophylaxis

  • 6. 
    All of the following are reportable diseases except_______
    • A. 

      A. Ehrlichioses

    • B. 

      B. Q-fever

    • C. 

      C. Tularemia

    • D. 

      D. Babesiosis

  • 7. 
    Which is the proper way to remove a tick?
    • A. 

      A. Using blunt forceps squeeze the tick off skin, making sure all parts are removed

    • B. 

      B. Remove tick manually and wash hands with soap and water

    • C. 

      C. Using blunt forceps apply gentle upward traction to remove tick

    • D. 

      D. After removal, place in cultured medium and send to lab

    • E. 

      E. Apply alcohol to site followed by betadine

  • 8. 
    Which of the following is not an FDA approved first line agents for treating tuberculosis?
    • A. 

      A. Ethambutol

    • B. 

      B. Isoniazid

    • C. 

      C. Rifabutin

    • D. 

      D. Pyrazinamide

  • 9. 
    A 22 y/o patient recently moved here from Haiti and is now complaining of vision changes described as “mixing up colors”. Which of his following medications may be the culprit?
    • A. 

      A. Pyrazinamide

    • B. 

      B. Streptomycin

    • C. 

      C. Rifampin

    • D. 

      D. Ethambutol

  • 10. 
    A 42 y/o nurse was exposed 4 months ago to someone who had active tuberculosis. She remains asymptomatic, her first PPD was neg, and now presents for a read of her second PPD. PMH includes hx of SLE and is on daily steroids. Her PPD measures 7 mm and CXR is neg. Which of the following is most appropriate?
    • A. 

      A. Tell her to do nothing and repeat test in 3 months

    • B. 

      B. Start INH 5mgs/kg daily

    • C. 

      C. Consider her to have latent disease and check LFT’s

    • D. 

      D. Call ID and admit her to r/o active Tb

  • 11. 
    All of the following are true about Tuberculosis (Tb) except which of the following?
    • A. 

      A. Reactive Tb is more likely to be seen in patients who have SLE, DM, ESRD, UC, IVDA or are on steroids

    • B. 

      B. Leading cause of pericarditis in HIV patients is Tb

    • C. 

      C. Tuberculin skin test is an inexpensive reliable test for detecting active Tb

    • D. 

      D. Complications from Tb include pneumothorax, airway Tb, massive hemoptysis, endobronchial spread and empyema

    • E. 

      E. In the immunocompromised elderly, FTT and cough can be presenting symptoms for Tb

  • 12. 
    A patient with hx of HIV presents with c/o back pain and stiffness. On exam he has point tenderness over L3-4, decreased ROM, and erythema, warmth and small drainage from skin over vertebrae area. He is on bactrim for “chronic cough”. CT reveals “cold” abscess and skipped lesions. Which of the following is not true?
    • A. 

      A. He likely has Pott’s disease and needs isolation and admission

    • B. 

      B. A complication may be spinal cord compression

    • C. 

      C. Irrigate wound, start antibiotics and anti-Tb meds, admit

    • D. 

      D. He possibly had Tb undiagnosed or incomplete treatment in the past

  • 13. 
    A 57 y/o undomicile male with hx of an “old” fracture and diabetes, presents to the ED c/o pain to left leg x3 weeks. He admits to fever/chills the last 5 days and has been placing some “vaseline” to old ulcer at the site. Exam revelas warm, erythematous anterior leg, + tenderness, and he is tachycardic. Which is the most appropriate sequence of care?
    • A. 

      A. Labs→ CT→ admit

    • B. 

      B. Labs→blood cultures→ antibiotics and admit

    • C. 

      C. Ortho consult→ labs→admit

    • D. 

      D. Labs→blood cultures→ antibiotics→ CT or MRI→ admit

  • 14. 
    Why are long bones and vertebral bodies more susceptible to hematogenous osteomyelitis? 
    • A. 

      A. These bones are more prone to trauma

    • B. 

      B. They contain slow-moving or valveless venous systems and longitudinal and horizontal anastamoses

    • C. 

      C. Bacteria have an increased affinity for the matrix and surface proteins of these bones

    • D. 

      D. IgG and phagocytosis is impaired, and blood supply is enhanced with many tributaries

  • 15. 
    All of the following are true except_____
    • A. 

      A. Bone biopsy or culture are the gold standards for confirming diagnosis of osteomyelitis

    • B. 

      B. ESR is more precise than CRP when following response to antibiotics for osteomyelitis

    • C. 

      C. Most common cause of osteomyelitis in sickle cell patients is Salmonella

    • D. 

      D. Usually hematogenous spread of septic arthritis is caused by a single strain of bacterium vs osteomyelitis in a diabetic foot

    • E. 

      A. Early x-ray findings include soft tissue edema, alteration of fat in surfaces and fascial planes, periosteal reaction

  • 16. 
    Which of the following combinations of antibiotics would be appropriate for treatment on suspected osteomyelitis in the ED? 
    • A. 

      A. Nafcillin, ceftriaxone, vancomycin, penicillin

    • B. 

      B. Ceftriaxone, oxacillin, vancomycin, rifampin

    • C. 

      C. Ceftriaxone, ancef

    • D. 

      D. None of the above

  • 17. 
    A 2 y/o presents to ED with c/o pain to thigh x1 day, mom states no hx of trauma and child is refusing to walk. On exam he has temp 100.6, holds his leg in slight flexion, and decrease ROM to hip secondary to severe pain. What is the most likely diagnosis?
    • A. 

      A. Reactive arthritis

    • B. 

      B. Lyme arthritis

    • C. 

      C. Septic arthritis

    • D. 

      D. Legg-Calve-Perthes disease

  • 18. 
    A 21 y/o presents with a rash to palms, and c/o joint pain to ankle, knee, and elbow. One month ago he was in Daytona Florida for spring break. Denies any insect bites. All of the following are correct except_____?
    • A. 

      A. diagnosis can be obtained by culture of mucosal surfaces

    • B. 

      B. administer ceftriaxone IV and admit

    • C. 

      C. diagnosis can be made with culture of synovial fluid

    • D. 

      D. Rx doxycycline, motrin and refer to rheumatology

  • 19. 
    A 54 y/o male s/p knee replacement 2 weeks ago, now presents to ED with c/o constant pain, fever. On exam he is tender, limited ROM, and has an effusion. Which of the following is most appropriate?
    • A. 

      A. Perform an ultrasound guided joint aspiration, send synovial fluid to lab, and admit

    • B. 

      B. Labs, antibiotics, analgesics and admit

    • C. 

      C. Call ortho consult, analgesics

    • D. 

      D. Labs, x-ray, and admit

  • 20. 
    Which of the following would you expect in Staphlococcal Scalded Skin Syndrome and not in Toxic Epidermal Necrolysis
    • A. 

      A. Mucous membrane involvement

    • B. 

      B. Negative Nilkolsky

    • C. 

      C. Improvement after treatment with Bactrim

    • D. 

      D. Bullae, vesicles and loss of superficial epidermis

  • 21. 
    A 27 y/o female presents with "sunburn-like" rash, nausea, vomiting, myalgias. On exam she has a fever, is dehydrated and her creatine is three times normal. What is the most likely diagnosis?
    • A. 

      A. RMSF

    • B. 

      B. necrotizing fasciitis

    • C. 

      C. myositis

    • D. 

      D. STSS (Staphlococcal Toxic Shock Syndrome)

  • 22. 
    Patient with hx of HTN and ESRD presents with c/o 2 superficial abscesses to right axilla x3 days. No fever, trauma, or IVDA. Which may be true about his condition?
    • A. 

      A. This disease can lead to Squamous cell carcinoma

    • B. 

      B. Incision and debridment

    • C. 

      C. Antibiotics and surgical referral for obliteration of apocrine glands

    • D. 

      D. Care includes I & D, antibiotics, send gram stain, and culture

  • 23. 
    Which of the following is True?
    • A. 

      A. The clotting cascade gets activated and give rise to a positive d-dimer

    • B. 

      B. As in all types of shock, in septic shock one sees severe and long-lasting drops in vasopressin

    • C. 

      C. In early stages of shock, one may see increased CO and increased ejection fraction

    • D. 

      D. phenylephrine is alpha 1 & beta 2 agonist and does not affect cardiac output

    • E. 

      E. dopanime is agent of choice for someone in septic shock and with myocardial dysfunction

  • 24. 
    An 83 y/o nursing home patient presents to ED with AMS, Bp 86/47, RR 24, HR 112, saturation 89%. Lethargic, moves all extremeties to command, foley draining cloudy urine, rhonchi throughout. All of the following would be incorrect in early goal directed therapy except_______
    • A. 

      A. start renal dose dopamine before starting inotropic agent

    • B. 

      B. intubate then give IVF resuscitation to a CVP of 8-12mm/Hg

    • C. 

      C. if hypotensive after adequate IVF, start dopamine or norepinephrine

    • D. 

      D. hypoxemia is most definitively from a primary lung infection

  • 25. 
    You have just intubated your patient who is in septic shock. Your goals in the ED include all of the following except______
    • A. 

      A. Fluid resucitate followed by pressors to maintain a CVP 12-16, and a MAP 60-90mmHg

    • B. 

      B. Try to identify infectious cause to tailor antibiotics and surgical intervention if needed

    • C. 

      C. Ensure oxygen carrying capacity, transfusing blood if needed

    • D. 

      D. Vent settings should include peep, and high tidal volume to ensure adequate oxygenation

  • 26. 
    In which patients would steroids be most indicated?
    • A. 

      A. all ICU patients

    • B. 

      B. patient with hx of SLE

    • C. 

      C. patient with refractory hypotension

    • D. 

      D. those not responding to corticotropin stimulation test and in adrenal suppression

  • 27. 
    A 62 y/o woman with hx of breast CA and DM presents to Ed with c/o thigh pain. Exam is unremarkable. However patient continues to say that pain is “severe” and “deep”. Nurse makes you aware of temp 100.8 and when you go to re-examine patient, you note erytheatous patches and no relief of pain after morphine. Which of the following is most appropriate?
    • A. 

      A. discharge with NSAIDS, , ice packs and dermatology referral

    • B. 

      B. x-ray, analgesics and admit to OBS

    • C. 

      C. labs, x-ray, IVF, antibiotics, stat surgery consult and admit

    • D. 

      D. psych consult, acetaminophen with codeine, and dermatology referral