Internal-Medicine

Questions: 14–24 203
the following is the most likely causative
organism?
body. Which of the following is the most likely
complication?
(A)
Clostridium botulinum toxin
(A)
pneumonia
(B)
staphylococcal toxin
(B)
encephalitis
(C)
salmonellosis
(C)
otitis media
(D)
brucellosis
(D)
bronchitis
(E)
shigellosis
(E)
mastoiditis
20. A previously healthy 19-year-old female university
student develops myalgia, headache,
fever, and malaise. Blood tests reveal lymphocytosis,
with 20% of the lymphocytes being atypical.
She remains tired and unwell for 6 weeks,
but repeated tests for heterophil antibody are
negative. Which of the following is the most
likely diagnosis?
(A)
(B)
(C)
(D)
(E)
Epstein-Barr virus (EBV) infection
primary HIV infection
human herpes virus type 7 (HHV-7)
CMV infection
toxoplasmosis
21. A 43-year-old man developed a cough shortly
after returning from a 1-month hiking trip in
California. While there, he was hiking in the
central California valleys. During his trip, he
had developed a “flu-like” illness consisting of
fever, cough, and muscle pains, which resolved
spontaneously. A CXR shows a thin-walled
cavity in the right upper lobe, and the sputum
reveals fungal elements. Which of the following
is the most likely causative organism?
(A)
(B)
(C)
(D)
(E)
ringworm
Cryptococcus neoformans
Candida albicans
mycobacteria
coccidioidomycosis
22. An 8-year-old boy from an impoverished innercity
area has never been vaccinated appropriately.
He develops fever, cough, and coryza.
The next day, blue white spots develop on the
buccal mucosa. On the third day, an erythematous,
nonpruritic maculopapular rash develops
on the face and spreads over the entire
23. A 6-year-old boy develops symptoms of cough,
fever, and malaise followed by a generalized
maculopapular rash that has spread from the
head downwards. A clinical diagnosis of
measles is made. A few days after the onset of
the rash he is drowsy, lethargic, and complaining
of headache. A lumbar puncture, electroencephalogram
(EEG), and computerized
tomography (CT) of the brain exclude other
etiologies and confirm the diagnosis of
encephalitis. Which of the following is the most
likely delayed neurologic complication of
measles virus encephalitis?
(A)
(B)
(C)
(D)
(E)
meningitis
pure motor paralysis
autonomic neuropathy
mental retardation or epilepsy
“stocking-glove” peripheral neuropathy
24. A 27-year-old man presents with diarrhea. He
returned 3 weeks ago from a trip to rural South
America. Over the past few days, he has gradually
developed lower abdominal pain and
diarrhea. Now the symptoms are much worse
with eight stools a day consisting mostly of
mucus and blood. He is afebrile, the abdomen
is tender in left lower quadrant, and the
remaining examination is normal. His stool is
mostly comprised of blood and mucus. Which
of the following is the most appropriate initial
diagnostic test?
(A)
(B)
(C)
(D)
(E)
stool culture
stool toxin assay
examination of a dried stool specimen
immunofluorescence of stool specimen
examination of a wet stool specimen