Internal-Medicine

206 10: Infection
36. A 9-year-old boy has a severe sore throat with
fever and dysphagia. On examination, there
are grayish-white papulovesicular lesions on
an erythematous base that ulcerate. They are
located on the soft palate, anterior pillars of
the tonsils and uvula. There are no lesions on
the gingiva, tongue, or lips. A clinical diagnosis
of herpangina is made. Which of the following
is the most likely causative organism?
(A)
(B)
(C)
(D)
(E)
measles (Morbillivirus)
rubella (rubivirus)
coxsackievirus A
HSV-1
HSV-2
37. A young man has recently been bitten by a
stray dog. He has a penetrating wound to the
right forearm. The dog is nowhere to be found.
In the emergency room, the wound is cleaned
with water and povidone-iodine solution.
Which of the following is the most appropriate
next step in management?
(A) start postexposure prophylaxis
(B) contact the local public health
professional for further advice
(C) treat with oral doxycycline
(D) treat with IV ceftriaxone
(E) start IV acyclovir
38. Which of the following malignancies in the
United States is most likely to contain EBV
deoxyribonucleic acid (DNA) in a non-HIV
patient?
(A)
(B)
(C)
(D)
(E)
gastric cancer
well-differentiated thyroid cancer
anaplastic nasopharyngeal carcinoma
Burkitt’s lymphoma
Hodgkin’s disease
39. A 24-year-old man complains of fatigue,
malaise, fever, and a sore throat. He was previously
well, but now feels tired all the time
and has to rest multiple times a day. Physical
examination shows enlarged tonsils and palpable
anterior and posterior cervical, axillary,
and inguinal lymph nodes. There is also tenderness
in the right upper quadrant with a liver
span of 10 cm. Laboratory data is significant for
a heterophil antibody (sheep cell agglutination)
test that is positive. Which of the following
rare complications can be associated with this
condition?
(A)
(B)
(C)
(D)
(E)
retinitis
esophagitis
splenic rupture
Kaposi sarcoma
hemorrhage
40. A 40-year-old man develops erythema
nodosum, conjunctivitis, and a pleural effusion.
Over several weeks, pulmonary lesions
lead to cavitation and a large, thin-walled
cavity. He was traveling in Arizona before
becoming ill. Sputum samples reveal mature
spherules. Which of the following is the most
likely diagnosis?
(A)
(B)
(C)
(D)
(E)
Streptococcus
coccidioidomycosis
candidiasis
Staphylococcus
Pneumocystis carinii
41. A patient undergoing emergency surgery for
trauma receives 20 blood transfusions during
the operation. Four weeks later, she develops a
syndrome resembling infectious mononucleosis.
Which of the following is the most likely
causative organism?
(A)
(B)
(C)
(D)
(E)
EBV
hepatitis C virus
delayed hemolysis
CMV
serum sickness
42. A 32-year-old woman acutely develops high
fever, hypotension, and rash. This is followed
by vomiting, diarrhea, confusion, and abdominal
pain. In the hospital, evidence of multiorgan
failure develops. Desquamation of the skin
occurs 1 week after the acute illness. On further
history, the illness started 3 days after the onset
of menstruation. Which of the following is the
most likely diagnosis?