NMS Q&A Family Medicine

chap ter 31Other Infectious Diseasesin Primary CareExamination questions: Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case.1 A 38-year-old woman who has had an intrauterinedevice (IUD) for 15 years without changing it (hadchanged locations of residency several times) hasnoted a virtually painless 6 cm red area over the lowerabdominal area for many weeks. This week the redarea has broken down to exhibit purulent discharge.On pelvic examination, the adnexa are palpably fixed.The pap smear is negative for caner or precancerousfindings. Which among the following is the mostlikely offending entity?(A) Stage 3 carcinoma of the cervix(B) Streptococcus pyogenes(C) Actinomyces israelii(D) Staphylococcus aureus(E) Histoplasma capsulatum2 A 25-year-old man returns from a trip to Lima Peruwith diarrhea that had a sudden onset the day afterarrival in the United States. The stools were grayish,turbid, without fecal odor, and voluminous in fluidvolume. Cramping was minimal, and he was afebrile,but the patient was lightheaded when he stood up bythe second day. Which of the following is clinicallythe most likely?(A) Toxigenic Escherichia coli (bloody diarrhea)(B) Cholera (rice water stools)(C) Travelers diarrhea(D) Shigellosis dysentery (bloody)(E) Typhoid fever3 A 12-hour-old female newborn has begun to exhibitapathy and poor feeding drive. The mother is 16 yearsold, gravida 1, para 1; she is single and has had noprenatal care. Her membranes had ruptured about24 hours before her reporting to the emergencydepartment of the hospital. On examination, thebaby seems to be “floppy.” A complete blood cellcount reveals a leukopenia and absolute neutropeniaof 100/mm 3 mL, thrombocytopenia, and elevated C-reactive protein. Which of the following infections ismost likely to be the cause of this clinical situation?(A) E. coli sepsis(B) Group B streptococcus (GBS)(C) Haemophilus influenzae(D) Listeria monocytogenes(E) Coagulase-negative S. aureus4 A 24-year-old male injection drug user complains ofdry mouth, dysphagia, dysphonia, diplopia, nausea,and vomiting. In the past few hours, he has notedshortness of breath. He is alert and oriented. His temperatureis normal. Breathing appears to be mildlylabored and shallow, but the lung fields are “clear” toauscultation and percussion. Of the following thatare present in the differential diagnosis of thesesymptoms, which one is the most likely?(A) Tetanus(B) Botulism(C) Bowel obstruction(D) Guillain–Barré syndrome(E) Myasthenia gravis5 A 50-year-old diabetic man complains of rapidlydeveloping redness of the right (anatomical) leg overa period of 24 hours. You note a tense edematous areaextending 10 to 12 cm along the mid right calf andsome bulla formation. The man complains of painthat extends several centimeters beyond the area ofvisible inflammation while noting hypesthesia at theviable site. The area is warm to touch and the patientmanifests systemic symptoms consisting of fever(temperature of 100.8 F), diaphoresis, and tachycardia.Which of the following is the most critical diagnostictest at this time?(A) Culture and sensitivity of the bullae(B) Blood culture(C) Complete blood cell count(D) Venogram(E) Surgical exploration and biopsy189