Review Test

1.A 13-day-old male infant presents with a fever (temperature up to 100.6°F [38.1°C]), mild irritability, and diminished appetite. His parents report no change in the number of wet diapers. Which of the following statements regarding this patient’s management or prognosis is correct?

A.Careful observation at home is appropriate because of the relatively low fever and normal urine output.

B.The risk of bacteremia in this patient is approximately 25%.

C.Intramuscular ceftriaxone and close home monitoring are appropriate after evaluation with a complete blood count, blood culture, urinalysis, and urine culture.

D.Irrespective of the results of initial laboratory testing, management should include intravenous antibiotics and hospitalization.

E.Bacteria likely to cause fever in this patient include Streptococcus pneumoniae and

Haemophilus influenzae type b.

2.A 10-month-old female infant with up-to-date immunizations presents with a fever (temperature up to 103.5°F [39.7°C]) for the past 3 days. She was previously healthy. Her parents report no symptoms other than the fever. On examination, she is well hydrated and appears nontoxic, and no focus of infection is identified. Which of the following is the next appropriate management step?

A.Complete blood count (CBC) and blood culture, and empiric oral antibiotics to cover likely causes of bacteremia

B.Urine culture and urinalysis, and if suggestive of a urinary tract infection, empiric antibiotics to cover likely urinary pathogens

C.No laboratory studies are indicated because the patient appears nontoxic.

D.Hospitalization and empiric intravenous cefotaxime

E.CBC, blood culture, urinalysis, urine culture, lumbar puncture, and chest radiograph; intramuscular ceftriaxone should be given because of the high risk of bacteremia.

3.A 2-year-old girl presents with fever. On examination, she has exudative pharyngitis, enlarged posterior cervical lymph nodes, and splenomegaly. Which of the following statements regarding her evaluation and management is correct?

A.Amoxicillin should be prescribed after performing a throat culture for suspected “strep throat.”

B.Monospot testing is highly sensitive and is the best test to make a diagnosis in this case.

C.Human immunodeficiency virus is the most likely cause of this infection.

D.Amoxicillin may result in a pruritic rash in this patient.

E.The patient should be administered corticosteroids that will lead to rapid improvement and resumption of full activity.

4.A 6-year-old girl is sent home from summer camp with a temperature of 101.3°F (38.5°C), stiff neck, photophobia, and headache. Lumbar puncture in the emergency department reveals the following results: white blood count 380 cells/mm3, with 65% polymorphonuclear cells and 35% lymphocytes; normal protein and glucose; and negative Gram stain. Which of the following pathogens is the most likely cause of her meningitis?

A.Neisseria meningitidis

B.Streptococcus pneumoniae

C.Enterovirus

D.Borrelia burgdorferi

E.Mycobacterium tuberculosis

5.A previously healthy 18-month-old girl is admitted to the hospital with fever (temperature up

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to 102.8°F [39.3°C]), vomiting, and lethargy. She was well until 2 days ago, when she was diagnosed with a viral upper respiratory infection. Lumbar puncture to evaluate the cerebrospinal fluid shows the following results: white blood cells 3050 cells/mm3, with 98% polymorphonuclear cells; very low glucose; and elevated protein. Gram stain shows Grampositive diplococci. Initial management should include which of the following?

A.Vancomycin and third-generation cephalosporin

B.Third-generation cephalosporin alone

C.Ampicillin and third-generation cephalosporin

D.Third-generation cephalosporin and acyclovir

E.Third-generation cephalosporin and corticosteroids

6.A 25-year-old woman is pregnant with her first child. The woman has human immunodeficiency virus (HIV) infection that was diagnosed 2 years before this pregnancy. Which of the following has been shown to increase her risk of transmitting HIV to her infant?

A.Treatment with highly active antiretroviral therapy during pregnancy and before delivery

B.Exclusive bottle formula feeding

C.Prolonged rupture of membranes

D.Birth by cesarean section

E.Orally administered zidovudine given to the infant after birth

7.An 8-year-old girl presents with sore throat, fever, and a rough sandpaper-like rash over her trunk and extremities. A throat culture is positive for group A β-hemolytic streptococcus. Treatment of her infection with antibiotics will prevent which of the following complications?

A.Reactive arthritis

B.Rheumatic fever

C.Poststreptococcal glomerulonephritis

D.Guillain–Barré syndrome

8.A 1-year-old girl presents with weight loss and a 2-week history of large, bulky, nonbloody, foul-smelling stools. She has been attending day care and recently received amoxicillin for an ear infection. Which of the following is the most likely cause of her diarrhea?

A.Entamoeba histolytica

B.Enterotoxigenic Escherichia coli

C.Clostridium difficile

D.Giardia lamblia

E.Norwalk virus

9.A 19-year-old boy, a college sophomore, presents with high fever, headache, cough, conjunctivitis, and a diffuse macular rash over his trunk and face. He is unsure of his immunization status. You suspect measles infection. Which of the following is correct regarding this diagnosis?

A.Vitamin A may improve his outcome.

B.Koplik spots would likely be present on examination of his mouth.

C.Mortality is most commonly caused by measles encephalitis.

D.Diagnosis is based on culture and direct fluorescent antigen testing.

E.Corticosteroids will decrease symptoms and improve outcome.

The response options for statements 10–14 are the same. You will be required to select one answer for each statement in the set.

A.Malaria Plasmodium species

B.Toxoplasma gondii

C.Giardia lamblia

D.Entamoeba histolytica

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E.Coccidioides immitis

F.Cryptococcus neoformans

G.Aspergillus fumigatus

H.Candida albicans

For each clinical description, select the most likely cause.

1.At birth, a term infant is noted to have hydrocephalus and intracranial calcifications on computed tomography of the head. Eye examination reveals bilateral chorioretinitis.

2.A 5-year-old boy is admitted with a fever of unknown origin. An abdominal computed tomographic scan reveals a large hepatic abscess.

3.A 12-year-old girl with cystic fibrosis has an exacerbation of her disease and presents with wheezing, pulmonary infiltrates, and eosinophilia.

4.A 16-year-old boy is admitted to the hospital for a workup of cyclical fevers after a trip to India. His illness began with flulike symptoms.

5.An 18-month-old girl and three of her day care classmates present with 2 weeks of watery diarrhea and some weight loss.

6.A 2-year-old boy has a positive tuberculin skin test that measures 12 mm. It was placed during a routine well-child care visit. He is well, without fever, chills, cough, weight loss, or night sweats. No known tuberculosis contacts are identified. Which of the following statements regarding this patient’s management is correct?

A.A chest radiograph should be ordered because the tuberculin test is positive.

B.He should be placed into respiratory isolation immediately because he is likely to spread tuberculosis to others.

C.Isoniazid is not indicated because this tuberculin skin test is negative.

D.Triple drug therapy for tuberculosis should be started immediately.

E.Gastric aspirates should be ordered.

The response options for statements 16–20 are the same. You will be required to select one answer for each statement in the set.

A.Salmonella species

B.Shigella sonnei

C.Yersinia enterocolitica

D.Clostridium difficile

E.Campylobacter jejuni

F.Vibrio cholerae

G.Enterotoxigenic Escherichia coli

H.E. coli 0157:H7

Match the clinical description with the likely causative organism.

1.While visiting Monterey, Mexico, a 16-year-old boy develops watery, nonbloody diarrhea, without fever.

2.A 3-year-old boy presents with an acute onset of high fevers, bloody diarrhea, and a generalized tonic-clonic seizure. The stool Wright stain reveals sheets of white blood cells.

3.An 8-year-old girl presents with a 1-week history of diarrhea and low-grade fever. The family reports that they have recently acquired a pet turtle.

4.A 10-year-old boy is admitted to the hospital and taken directly to the operating room for suspected acute appendicitis. Surgeons discover a normal appendix but enlarged mesenteric lymph nodes.

5.A group of travelers to Bangladesh suddenly develop massive, watery, nonbloody diarrhea

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that results in severe dehydration and electrolyte imbalance.

The response options for statements 21–24 are the same. You will be required to select one answer for each statement in the set.

A.Buccal cellulitis

B.Impetigo

C.Necrotizing fasciitis

D.Erysipelas

E.Staphylococcal scalded skin syndrome

F.Toxic shock syndrome

Match the clinical description with the likely diagnosis.

1.A 9-month-old girl with mild facial eczema has fever and a facial skin rash. The skin lesion is weepy with a honey-colored crust.

2.An unvaccinated 4-month-old boy has a blue color to his cheeks and a positive blood culture for Haemophilus influenzae type b.

3.An infant boy has fever, an erythematous skin rash, and a positive Nikolsky sign.

4.A 7-year-old girl develops fever and a rapidly expanding tender skin rash with a welldemarcated border.

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