AMBOSS INTERNAL MEDICINE EXAM TESTBANK LATEST
2024-2025 COMPLETE 700 REAL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (CORRECT
VERIFIED SOLUTIONS) LATEST UPDATED VERSION
|ALREADY GRADED A+
(may not appear until late in disease course)
Diagnosis
Mother: typically clinical diagnosis
Fetus: The ultrasound may show CNS abnormalities.
Newborn (and mother) Standard: viral culture of HSV from skin lesions,
conjunctiva, oro/nasopharynx, or rectumAlternative: PCR for HSV DNA
(CSF, blood)
Treatment
Newborn and mother: IV acyclovir or valaciclovir
Additionally in newborns: supportive therapy of fluid/electrolyte
imbalances, SIRS, septic shock, seizures, secondary infections, etc.
Prevention
Antiviral therapy (acyclovir) beginning at 36 weeks of gestation for
individuals w
Neutropenic fever
,Neutropenic fever is an oncologic emergency common in patients
receiving chemotherapy. A decrease in a patient's absolute neutrophil
count (ANC) can lead to potentially life-threatening infections, and the
risk of serious infection is directly associated with the extent and
duration of neutropenia. Because the immune response is impaired in
neutropenia, symptoms can be mild and even a low-grade temperature
(38°C) should be considered a fever. Initial workup should consist of
peripheral and, if applicable, central line blood cultures; further
investigation is guided by localization of clinical signs. Empiric
antibiotic therapy should be started within the first hour of onset to
minimize mortality risk. Treatment should be adjusted as soon as further
findings are available.
Neutropenia: ANC < 500/μL OR expected to decrease to < 500/μL
within 48 hours
Fever: single oral temperature ≥ 38.3°C (101°F) OR ≥ 38°C (100.4°F)
for at least 1 hour
Laboratory studies
CBC with differential
Blood cultures x 2 sets (at least)
Culture from any suspected site of infection
,Urinalysis with reflex urine culture
BMP
LFTs
Serum lactate
Blood glucose
ESR/CRP
Procalcitonin
Type and screen
Coagulation studies (e.g., INR, PTT)
Imaging [1]
CXR for patients with respiratory symptoms
, Further imaging (e.g., CT) should be guided by history and clinical
findings.
Common bacterial pathogens in neutropenic fever
Gram-positiveCoagulase-negative staphylococciStaphylococcus aureus,
including MRSAViridans group streptococciStreptococcus
pneumoniaeStreptococcus pyogenes
Gram-negativeEscherichia coliKlebsiella speciesEnterobacter
speciesPseudomonas aeruginosaCitrobacter speciesAcinetobacter
speciesStenotrophomonas maltophilia
Treatment
Empiric antibiotic therapy should be initiated immediately after two sets
of blood cultures have been obtained
Low-risk patients who can tolerate oral intake and have a caregiver,
telephone, and access to transportation may be treated with oral
antibiotics on an outpatient basis.
2024-2025 COMPLETE 700 REAL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (CORRECT
VERIFIED SOLUTIONS) LATEST UPDATED VERSION
|ALREADY GRADED A+
(may not appear until late in disease course)
Diagnosis
Mother: typically clinical diagnosis
Fetus: The ultrasound may show CNS abnormalities.
Newborn (and mother) Standard: viral culture of HSV from skin lesions,
conjunctiva, oro/nasopharynx, or rectumAlternative: PCR for HSV DNA
(CSF, blood)
Treatment
Newborn and mother: IV acyclovir or valaciclovir
Additionally in newborns: supportive therapy of fluid/electrolyte
imbalances, SIRS, septic shock, seizures, secondary infections, etc.
Prevention
Antiviral therapy (acyclovir) beginning at 36 weeks of gestation for
individuals w
Neutropenic fever
,Neutropenic fever is an oncologic emergency common in patients
receiving chemotherapy. A decrease in a patient's absolute neutrophil
count (ANC) can lead to potentially life-threatening infections, and the
risk of serious infection is directly associated with the extent and
duration of neutropenia. Because the immune response is impaired in
neutropenia, symptoms can be mild and even a low-grade temperature
(38°C) should be considered a fever. Initial workup should consist of
peripheral and, if applicable, central line blood cultures; further
investigation is guided by localization of clinical signs. Empiric
antibiotic therapy should be started within the first hour of onset to
minimize mortality risk. Treatment should be adjusted as soon as further
findings are available.
Neutropenia: ANC < 500/μL OR expected to decrease to < 500/μL
within 48 hours
Fever: single oral temperature ≥ 38.3°C (101°F) OR ≥ 38°C (100.4°F)
for at least 1 hour
Laboratory studies
CBC with differential
Blood cultures x 2 sets (at least)
Culture from any suspected site of infection
,Urinalysis with reflex urine culture
BMP
LFTs
Serum lactate
Blood glucose
ESR/CRP
Procalcitonin
Type and screen
Coagulation studies (e.g., INR, PTT)
Imaging [1]
CXR for patients with respiratory symptoms
, Further imaging (e.g., CT) should be guided by history and clinical
findings.
Common bacterial pathogens in neutropenic fever
Gram-positiveCoagulase-negative staphylococciStaphylococcus aureus,
including MRSAViridans group streptococciStreptococcus
pneumoniaeStreptococcus pyogenes
Gram-negativeEscherichia coliKlebsiella speciesEnterobacter
speciesPseudomonas aeruginosaCitrobacter speciesAcinetobacter
speciesStenotrophomonas maltophilia
Treatment
Empiric antibiotic therapy should be initiated immediately after two sets
of blood cultures have been obtained
Low-risk patients who can tolerate oral intake and have a caregiver,
telephone, and access to transportation may be treated with oral
antibiotics on an outpatient basis.
