INTEGRATED MEDICINE

Dr Sam

• An 18-month-old male is seen on an outpatient basis for fever, runny nose, and sore throat. Two days later, he is brought to the emergency department with persistent fever, brassy cough and di1ticultc breathing.

• Physical examination reveals stridor. Which of the following pathogens is most likely responsible for this patient’s condition?

• A.Rhinovirus• B. Paramyxovirus• C. Togavirus• D. Parvovirus• E. Calicivirus

• A 32-year-old male presents to his physician complaining of diarrhea,

• flatulence, foul-smelling stools, and abdominal cramping. He recently returned

• home from a hiking trip. A smear of his stool sample is shown below:

• Which of the following is the drug of choice for this condition?

• A. Ciprofloxacin• B. Metronidazole• C. Mebendazole• D. Albendazole• E. Loperamide• F. Clindamycin• G. Erythromycin

• Cytomegalovirus (CMV) is isolated from the urine sample of a 26-year-old male. Which of the following manifestations of CMV disease is most commonly seen in immunocompetent adults?

• A. Vesicular skin rash• B. Mononucleosis• C. Viral pneumonia• D. Retinitis• E. Hepatitis• F. Esophageal ulcer

• An 8-year-old male is brought to the ER with a two day history of fever, abdominal pain and diarrhea. Careful history taking reveals that the patient’s pet puppy had diarrhea one week ago. Aside from the present episode, the patient has no significant past medical history and all of his vaccinations are up-to-date. His stool is negative for ova and parasites. Which of the following is the most likely cause of this patient’s symptoms?

• A. Staphylococcus aureus• B. Shigella• C. Campylobacter• D. Bacillus cereus• E. Vibrio parahemolyticus• F. Giardia lamblia

• A 78-year-old nursing home resident develops high fevers, chest pain and cough productive of rusty sputum. Sputum microscopy reveals numerous lancetshaped Gram positive cocci in pairs. The patient dies despite aggressive hydration and antibiotic treatment. A vaccine containing which of the following might have prevented this outcome?

• A. Recombinant surface protein• B. Capsular polysaccharide• C. Live attenuated bacteria• D. Killed bacteria• E. Inactivated toxin• F. Synthetic oligopeptides

• A 6-year-old male is brought to the pediatric emergency room with fever and sore throat. The parents tell you that the child has not received any immunizations. Physical exam reveals a grey pharyngeal exudate and Gram stain shows scant Gram positive organisms. Which of the following culture types would facilitate the growth of this organism?

• A. MacConkey agar• B. Thayer-Martin VON medium• C. Blood agar containing bile and hypertonic saline• D. Cysteine-tellurite agar• E. Bordet-Gengou medium

• A 7-year-old child with a history of recurrent granulomatous skin infections and a prior episode of Aspergillus pneumonia undergoes a partial hepatectomy to treat a poorly draining liver abscess. The patient is thought to have a mutation of a structural component of a neutrophil oxidase. This child also has an increased vulnerability to infections caused by:

• A. Pseudomonas cepacia• B. Mycobacterium tuberculosis• C. Cryptococcus neoformans• D. Herpes simplex type 1• E. Streptococcus pyogenes• F. Giardia lamblia• G. Corynebacterium diphtheriae

• Bacteria are injected into the skin of several healthy volunteers as part of an experiment. Over several weeks, the bacteria migrate slowly through the skin from the site of injection outward. On physical examination, each patient develops a flat red skin lesion with a central clearing. Which of the following bacteria was most likely injected?

• A. Mycobacterium scrofulaceum• B. Treponema pallidum• C. Leptospira interrogans• D. Borrelia burgdorferi• E. Rickettsia rickettsiae• F. Bartonella henselae

• A 7-year-old Caucasian boy is brought to your office with blisters on his face. Some of the blisters have broken and are covered with golden yellow crusts.

• Exudate microscopy reveals Gram-positive cocci in chains. Which of the following would be a component of the clinical syndrome that may follow such an infection?

• A. Joint pain and eve redness• B. Fatigue and heart murmurs• C. Face puffiness and dark urine• D. Bilateral facial nerve palsy• E. Abdominal pain and jaundice

• A toxic substance produced by C. perfringens induces massive hemolysis and tissue necrosis when injected into mice. The lethal effect observed in the experiment correlates with the substance’s ability to split..

• A. Collagen• B. Hyaluronic acid• C. Phospholipids• D. Carbohydrates• E. Plasminogen

• A 34-year-old immigrant from Africa has patchy areas of skin anesthesia and hypopigmentation on his upper extremities. Nerve biopsy evaluated under light microscopy shows many bacteria invading Schwann cells. This patient’s disease is most likely caused by:

• A. Borrelia burgdorferi• B. Treponema pallidium• C. Corynebacteria diphtheriae• D. Mycobacteria leprae• E. Campylobacter fetus

• A 74-year-old previously healthy Caucasian male comes to his physician’s office complaining of abrupt on set fever, headache, myalgias, malaise, cough and throat pain. His two granddaughters missed several days of school because of similar symptoms. Examination demonstrates mild hyperemia of the throat without any exudate, and the patient is sent home on conservative management. Five days later, he is admitted to the hospital with progressive dyspnea, chest pain, and productive cough. Which of the following pathogens is most likely to be isolated from this patient’s sputum?

• A. Listeria monocytogenes• B. Klebsiella pneumoniae• C. Staphylococcus aureus• D. Nontuberculous mycobacteria• E. Cytomegalovirus

• A 22-year-old male ingests a solution containing 13C-labeled urea. He is then asked to blow into a tube, and the labeled carbon is detected in his breath samples. This test is most likely part of the evaluation for which of the following conditions?

• A. Bronchiectasis• B. Pulmonary fibrosis• C. Congenital heart disease• D. Chronic hepatitis• E. Duodenal ulcer• F. Acute pancreatitis• G. Chronic diarrhea

• A 3-month old infant is irritable, feeds poorly and frequently vomits. His current weight is at the 45th percentile and his head circumference as at the 96th percentile. Funduscopy reveals white-yellow chorioretinal lesions in both eyes.

• Head CT shows enlarged ventricles and scattered intracranial calcifications. Which of the following is the most likely cause of this patient’s condition?

• A. Chromosomal abnormality• B. Single gene disease• C. In-utero infection• D. Intrapartum infection• E. Postpartum infection

• Several students returning from a cave exploration trip to the eastern United States develop fever, cough and malaise. Pulmonary infiltrates and hilar adenopathy are apparent on chest x-rays. Lung tissue specimens would most likely show:

• A. Multinucleated spherules• B. Ovoid cells within macrophages• C. Budding yeast with a thick capsule• D. Pseudohyphae and blastoconidia• E. Septate hyphae with dichotomous branching