infectious disease rosh UPDATED ACTUAL Questions and CORRECT
Answers
1. A 12-year-old girl with no significant medical history echo
presents to her pediatrician complaining of two weeks
of joint pain. Initially, the pain started at the same acute rheumatic fever
time as a fever, first in her knees, then her ankles, and
now she feels like her elbows are bothering her as
well. Ibuprofen helps a great deal, but the pain is still
present after the medication wears off. Her only recent
illness was strep throat which was treated with amox-
icillin. On physical exam, mild erythema and swelling
around her elbows is appreciated and her lower ex-
tremities appear normal but are painful to move. The
rest of her physical exam is also normal, including ear,
nose and throat, cardiac, and skin exams. Which of the
following is the most appropriate diagnostic test?
2. You see a 15-month-old girl in the clinic for a well child administer oseltamivir
visit. She likes to listen to her parents read bedtime
stories to her. She can show you what she wants by
pointing and pulling on things. She can also speak
two words. You hand her a crayon, which she grabbed
onto and started scribbling. She is also walking well.
The mother is concerned because yesterday she was
exposed to her four-year-old cousin who was febrile
and later confirmed to have influenza B. Which of the
following is the next best step?
3. A 42-year-old man with no significant medical history discharge without prophy-
and no known allergies presents to the emergency laxis
department with concerns of a tick bite that occurred
earlier this morning, about 8 hours ago. The patient mt must have all of crite-
reports that he was on a hike with his family in upstate ria:
,New York when he noticed the tick on his left calf. His - attached tick identified as
, vital signs are a HR of 89 bpm, RR of 19/min, oxygen deer tick
saturation on room air of 99%, BP of 132/88 mm Hg, - attached for >= 36 hours
T of 97.8°F, and BMI of 29.6 kg/m2. On physical exam, -<72 hrs from tick re-
there is an attached tick to his left calf that is then re- moval
moved. There is no surrounding erythema or warmth - local rate of infection with
to the affected area on exam. Which of the following b. burgdorferi is >= 20%
is the most appropriate management for this patient's - doxy no contraindicated
condition? (pt pregnant or lactating)
4. A 33-year-old wrestler presents with a worsening skin bactrim for MRSA infec-
infection. He was seen in the ED two days prior and had tions
an incision and drainage of an abscess on his left arm.
The drainage has decreased but now he has an area
of erythema that has expanded around his original ab-
scess and a second purulent lesion on his leg. Which of
the following is the most appropriate antibiotic choice?
5. Which of the following patients should be started on 40 yo M w/o housing w/
isoniazid therapy with a normal chest radiograph? 10mm PPD reaction
6. A 58-year-old man presents to the ED with complaints malaria
of severe fever and chills, a diffuse headache, ab-
dominal cramping, nausea and vomiting, and general
weakness with lethargy. He returned from a lengthy
business trip to Central America six days ago and has
been experiencing such symptoms every three days.
He notes that he had some generalized irregular fever
while in Central America but did not seek help at that
time. His blood pressure is 148/72 mm Hg, respiratory
rate 24/min, heart rate 122 bpm, oxygen saturation
of 96% on 2 L nasal cannula, and temperature 40.6°C.
On exam, you note scleral icterus. Physical exam is
Answers
1. A 12-year-old girl with no significant medical history echo
presents to her pediatrician complaining of two weeks
of joint pain. Initially, the pain started at the same acute rheumatic fever
time as a fever, first in her knees, then her ankles, and
now she feels like her elbows are bothering her as
well. Ibuprofen helps a great deal, but the pain is still
present after the medication wears off. Her only recent
illness was strep throat which was treated with amox-
icillin. On physical exam, mild erythema and swelling
around her elbows is appreciated and her lower ex-
tremities appear normal but are painful to move. The
rest of her physical exam is also normal, including ear,
nose and throat, cardiac, and skin exams. Which of the
following is the most appropriate diagnostic test?
2. You see a 15-month-old girl in the clinic for a well child administer oseltamivir
visit. She likes to listen to her parents read bedtime
stories to her. She can show you what she wants by
pointing and pulling on things. She can also speak
two words. You hand her a crayon, which she grabbed
onto and started scribbling. She is also walking well.
The mother is concerned because yesterday she was
exposed to her four-year-old cousin who was febrile
and later confirmed to have influenza B. Which of the
following is the next best step?
3. A 42-year-old man with no significant medical history discharge without prophy-
and no known allergies presents to the emergency laxis
department with concerns of a tick bite that occurred
earlier this morning, about 8 hours ago. The patient mt must have all of crite-
reports that he was on a hike with his family in upstate ria:
,New York when he noticed the tick on his left calf. His - attached tick identified as
, vital signs are a HR of 89 bpm, RR of 19/min, oxygen deer tick
saturation on room air of 99%, BP of 132/88 mm Hg, - attached for >= 36 hours
T of 97.8°F, and BMI of 29.6 kg/m2. On physical exam, -<72 hrs from tick re-
there is an attached tick to his left calf that is then re- moval
moved. There is no surrounding erythema or warmth - local rate of infection with
to the affected area on exam. Which of the following b. burgdorferi is >= 20%
is the most appropriate management for this patient's - doxy no contraindicated
condition? (pt pregnant or lactating)
4. A 33-year-old wrestler presents with a worsening skin bactrim for MRSA infec-
infection. He was seen in the ED two days prior and had tions
an incision and drainage of an abscess on his left arm.
The drainage has decreased but now he has an area
of erythema that has expanded around his original ab-
scess and a second purulent lesion on his leg. Which of
the following is the most appropriate antibiotic choice?
5. Which of the following patients should be started on 40 yo M w/o housing w/
isoniazid therapy with a normal chest radiograph? 10mm PPD reaction
6. A 58-year-old man presents to the ED with complaints malaria
of severe fever and chills, a diffuse headache, ab-
dominal cramping, nausea and vomiting, and general
weakness with lethargy. He returned from a lengthy
business trip to Central America six days ago and has
been experiencing such symptoms every three days.
He notes that he had some generalized irregular fever
while in Central America but did not seek help at that
time. His blood pressure is 148/72 mm Hg, respiratory
rate 24/min, heart rate 122 bpm, oxygen saturation
of 96% on 2 L nasal cannula, and temperature 40.6°C.
On exam, you note scleral icterus. Physical exam is
