Internal-Medicine

Questions: 72–81 213
statements concerning the epidemiology of
S. pneumoniae is correct?
(A)
(B)
(C)
(D)
(E)
most children are nasopharyngeal
carriers
most adults are nasopharyngeal carriers
bacteremia is not common in people
over 55
in adults, bacteremia is most common in
midwinter
bacteremia always occurs with
pneumonia
78. A 62-year-old woman presents with fever,
cough, sputum production, and pleuritic chest
pain. CXR reveals a right middle lobe infiltrate,
and she is started on antibiotics for the treatment
of pneumonia. Her sputum Gram stain is
positive for S. pneumoniae. Which of the following
immunologic mechanisms is the most
specific host defense against pneumococcal
infection?
(A) intact splenic function
(B) intact complement function
(C) IgG antibody directed against capsular
antigens
(D) alveolar macrophages
(E) liver macrophages
79. A 5-year-old boy presents with ear pain and
fever. The left eardrum is inflamed with a small
perforation in it and pus is seen in the external
canal. A swab of the area grows S. pneumoniae.
Which of the following is the most likely mechanism
for S. pneumoniae to cause otitis media?
(A)
(B)
(C)
(D)
(E)
hematogenous spread
direct extension from the nasopharynx
direct inoculation on the ear
spread through lymphatic tissue
associated dental disease
80. A 31-year-old woman presents with symptoms
of vulvar itching and burning made worse by
urinating. She has no fever or frequency, but
has noticed a recent whitish vaginal discharge.
Clinical examination reveals vulvar erythema,
edema, and fissures. On speculum examination,
there is a white discharge with small white
plaques loosely adherent to the vaginal wall.
Which of the following treatments is appropriate
for her asymptomatic male sexual partner?
(A)
(B)
(C)
(D)
(E)
azole cream to the penis
oral fluconazole
standard urethritis investigation
no investigation or treatment
azithromycin plus cefixime
81. A 29-year-old man is seen in the office after
returning from a hiking trip in Colorado. He
complains of feeling unwell and reports symptoms
of fever, myalgia, headache, and nausea.
Two days ago, he noticed a rash on his wrists
and ankles that has now spread to his body. He
recalls having had numerous insect bites
during his trip. On examination, his blood pressure
is 90/60 mm Hg, pulse 100/min, and respirations
20/min. There are multiple 1–5 mm
macules on his body and some of them have a
hemorrhagic center consistent with a petechia.
His neck is supple and fundi are normal. The
heart sounds are normal, lungs clear, and legs
are edematous. Cranial nerve, motor and sensory
examination is normal. A clinical diagnosis
of RMSF is made and he is started on
appropriate therapy. Which of the following is
the most common type of central nervous
system (CNS) presentation in this condition?
(A)
(B)
(C)
(D)
(E)
hemiplegia
cranial nerve abnormalities
paraplegia
encephalitis
ataxia