1/10
A 38-year-old male intravenous drug user hospitalized for high-grade fever, fatigue and dyspnea dies in the intensive care unit(ICU). His lung autopsy findings are shown on the slide below.
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- Mycotic aortic aneurysm
- Tricuspid valve endocarditis
- Severe small airway obstruction
- Miliary tuberculosis
- Venous thromboembolism
2/10
Transient bacteremia is demonstrated in a healthy 22-Year-old male after a dental procedure.The Gram-positive bacteria isolated from the blood synthesize dextrans from sucrose. Which of the following would be the most likely adherence site for these bacteria?
- Endothelial surface glycoproteins
- Subendothelial collagen
- Subendothelial glycosaminoglycans
- Circulating heparins
- Fibrin-platelet aggregates
3/10
A 23-year-old man comes to the physician due to a 2-month history of fatigue, malaise, and abdominal discomfort. He is found to have tender hepatomegaly with elevated liver function tests. The patient has never been vaccinated against hepatitis. He has had no raw or uncooked foods recently and recalls no ill contacts.There is no history of blood transfusion. The patient is a graduate student who immigrated to the United States 2 years ago and has not traveled outside the country since. He smokes 2 packs of cigarettes a day and consumes 1 or 2 bottles of beer on weekends. The patient does not use illicit drugs. He has had several episodes of unprotected sex with different female partners within the past year. Which of the following is most likely to be present in this patient?
- HAV in the stool
- Serum anti-HAV lgM
- Serum anti-HBsAg lgG
- Serum HBsAg
- Hepatitis C virus RNA viral load in blood
4/10
A 24-year-old woman comes to the physician due to persistent white plaques on her tongue as well as recurrent episodes of genital itching and vaginal discharge. She has also had unintentional weight loss and diarrhea recently. The patient's past medical history is unremarkable ;her vaccinations are up to date and she recalls no recurrent or prolonged illnesses as a child. She smokes a pack of cigarettes daily and drinks alcohol socially, She has experimented with recreational drugs in the past but not recently. The patient has had several male sexual partners in the last 3 years and uses condoms inconsistently. Her temperature is 38.8 C (98.2 F) and BMI is 18 kg/m2. Examination shows generalized lymphadenopathy and white plaques in the oropharynx that can be easily scraped off with a tongue depressor. Vaginal wet mount with potassium hydroxide shows budding yeast with pseudohyphae. The patient is at greatest risk of developing a malignant B-lymphocyte proliferation associated with which of the following?
- BK virus
- Epstein-Barr virus
- Helicobacter pylori
- Hepatitis B virus
- Human T lymphotropic virus
5/10
Monoclonal antibodies against complement receptor CD21 on the surface of B-lymphocytes could prevent infection with which of the following viruses?
- Parvovirus B19
- Human imunodeficiency virus
- Epstein-Barr virus
- Cytomegaiovirus
- Adenovirus
6/10
A 31-year-old man comes to the emergency department with a 2-week history of fever, night sweats,and productive cough. He has also had a 5-kg (11 -lb) weight loss. He has no other medical problems. The patient is a software engineer who moved to the United States from Uzbekistan 15 years ago. He takes no medications and has no known drug allergies. His temperature is 38.3 C (101 F), blood pressure is 110/80mm Hg, pulse is 94/min, and respirations are 18/min. He weighs 60 kg (132.3 Ib). Pulse oximetry shows 94% on room air. Chest-x ray reveals a cavitary lesion on the right. Sputum culture is obtained. When exposed to drug A, isolates of the pathogen growing in culture quickly become less resistant to decoloration with an acid-alcohol agent and stop proliferating. Which of the following is drug A most likely to be?
- Ciprofloxacin
- Isoniazid
- Rifampin
- Streptomycin
- Vancomycin
7/10
A 29-year-old woman comes to the hospital due to fever and skin rash. She returned from a trip to Brazil,10 days ago. Her symptoms started 5 days ago with a headache, retro-orbital pain, high-grade fever, and joint and muscle pains. She has also had an episode of epistaxis.Today,she noticed a skin rash all over her body. Examination shows a diffuse maculopapular rash and scattered petechiae.Laboratory study results show thrombocytopenia. Her boyfriend traveled to Brazil with her and is asymptomatic.Which of the following diseases has a similar mode of transmission to that causing this patient's symptoms?
- Chikungunya fever
- Lymphogranuloma venereum
- Meningococcal meningitis
- Pulmonary tuberculosis
- Rocky Mountain spotted fever
- Typhoid fever
8/10
A 21-year-old man is brought to the emergency department in a stuporous condition.He returned from a family visit to Mexico 2 weeks ago. One week ago, the patient began developing high-grade fever, headaches, severe myalgias, and joint pains. He had similar symptoms following a trip to Mexico 5 years ago, but at that time the symptoms did not progress and instead resolved spontaneously within a few days. Temperature is 38.3 C (101 F), blood pressure is 80/50 mm Hg, and pulse is 128/min. Examination shows a diffuse maculopapular rash, multiple purpuric lesions, and hepatomegaly. Laboratory studies show marked thrombocytopenia, leukopenia, and elevated liver aminotransferases. Which of the following is the most likely mechanism for this patient's current severe illness?
- Antigenic drift in the virus
- Blunted T-lymphocyte response
- Infection with a different viral serotype
- Larger viral inoculation dose
- Viral superinfection
9/10
A group of researchers is attempting to determine the asymptomatic carrier rates of certain bacterial pathogens in various age groups. They sample and culture pharyngeal exudates from individuals of different ages. Healthy volunteers who have no significant medical history, take no medication,and have been free of upper respiratory tract illnesses for the past 6 weeks are recruited. A pharyngeal exudate sample from a woman in the 20-25-year-old group is placed on a selective medium containing vancomycin, colistin, nystatin and trimethoprim. This medium favors growth of which of the following bacteria?
- Escherichia coli
- Streptococcus pyogenes
- Streptococcus pneumoniae
- Klebsiella pneumoniae
- Neisseria gonorrhoeae
- Corynebacterium diphtheriae
10/10
A 24-year-old woman comes to the emergency department with severe pain and swelling in her right knee and left elbow and wrist. Her temperature is 37.1 C (98.8 F), blood pressure is 124/76 mm Hg, and heart rate is 94/min. Oropharyngeal examination is unremarkable. There is no heart murmur. No skin lesions are present. There is right knee swelling and tenderness as well as tenderness to palpation of the left elbow and wrist joints. Joint aspiration of the right knee is performed, and microscopic analysis reveals an opaque exudate with high neutrophil content and intracellular organisms. Which of the following would have most likely prevented this patient's symptoms?
- Abstinence from intravenous drug use
- Consistent condom use
- Methotrexate therapy
- Proper sore throat treatment
- Timely vaccination
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