Internal-Medicine

214 10: Infection
82. Three individuals living on the same floor in a
university dormitory residence develop symptoms
and signs of pneumonia. The diagnosis is
confirmed by CXR, and sputum samples are
positive for S. pneumoniae. In an outbreak,
which of the following conditions most likely
predisposed these three individuals to developing
pneumococcal pneumonia?
(A)
(B)
(C)
(D)
(E)
immotile cilia syndrome
previous viral infection
asthma
cigarette-induced chronic lung disease
allergies
83. A 78-year-old woman with a prior stroke is not
feeling well. Her appetite is poor, and today her
family noticed that she is confused so they sent
her to the emergency room. She reports no
cough, fever, or sputum production but her
CXR reveals a left lower lobe infiltrate. Blood
cultures are drawn, and she is started on antibiotics.
The next day the cultures are positive for
S. pneumoniae sensitive to penicillin. Which of
the following is the most likely complication of
pneumococcal pneumonia?
(A)
(B)
(C)
(D)
(E)
peritonitis
empyema
pericarditis
endocarditis
osteomyelitis
84. A 23-year-old woman presents with cough,
malaise, and fever. She reports minimal whitish
sputum production and now has chest soreness
from coughing so much. She has no other
past medical history and no risk factors for
HIV. On examination, her temperature is
38.3°C, pharynx is normal, and lungs are clear.
CXR reveals diffuse bilateral infiltrates.
Mycoplasma pneumonia is considered in the
possible differential diagnosis of her pneumonia.
Which other symptom besides cough is
also prominent in patients with mycoplasma
pneumonia?
(A)
(B)
(C)
sputum
shortness of breath
headache
(D)
(E)
shaking chills
pleuritic chest pain
85 A 24-year-old woman has new symptoms of
fever, headache, myalgia, and macular rash.
She recently went on a camping trip with
friends to the South-Central United States. She
endured many “bug bites” during the trip but
does not specifically recall any tick bites. The
rash consists of macules 3 mm in size on her
hands and feet. A clinical diagnosis of RMSF is
made and she is started on treatment. Serology
is drawn to confirm the diagnosis. Which of
the following is the most likely causative
organism?
(A)
(B)
(C)
(D)
(E)
Gram-positive bacterium
Gram-negative bacterium
virus
type of rickettsia
type of chlamydia
DIRECTIONS (Questions 86 through 105): Each
set of matching questions in this section consists
of a list of lettered options followed by several
numbered items. For each numbered item, select
the appropriate lettered option(s). Each lettered
option may be selected once, more than once, or
not at all. EACH ITEM WILL STATE THE NUM-
BER OF OPTIONS TO SELECT. CHOOSE
EXACTLY THIS NUMBER.
Questions 86 through 90
(A)
(B)
(C)
(D)
(E)
beta-lactams (penicillins and
cephalosporins)
vancomycin
erythromycin
sulfonamides and trimethoprim
ciprofloxacin
For each mechanism of antibiotic action, select the
most likely drug.
86. Major cellular target is interference with cell
metabolism (SELECT ONE)
87. Work by inhibiting DNA synthesis (SELECT
ONE)