Internal Medicine Exam Infectious Disease Management 4

Question 1

A 50-year-old immunocompromised patient develops fever, pleuritic chest pain, and a pulmonary infiltrate with a halo sign on CT chest. Galactomannan is positive. What is first-line treatment?

Accepted Answer

Voriconazole

Answer

Voriconazole is first-line therapy for invasive pulmonary aspergillosis, demonstrating superior survival over amphotericin B in landmark trials.

Question 2

A patient with severe sepsis is started on empiric broad-spectrum antibiotics. Blood cultures later grow Pseudomonas aeruginosa sensitive to piperacillin-tazobactam. At 72 hours the patient is clinically improving. What is the appropriate antibiotic de-escalation?

Accepted Answer

Narrow to piperacillin-tazobactam alone

Answer

Antibiotic stewardship mandates de-escalation to the narrowest effective agent once culture and sensitivity data are available, reducing resistance and adverse effects.

Question 3

A 28-year-old pregnant woman at 36 weeks is found to have group B Streptococcus (GBS) on vaginal-rectal screening. She is penicillin-allergic with a history of urticaria only (not anaphylaxis). What is the appropriate intrapartum prophylaxis?

Accepted Answer

Cefazolin IV

Answer

For GBS-positive patients with low-risk penicillin allergy (urticaria, not anaphylaxis), cefazolin is safe and preferred for intrapartum prophylaxis.

Question 4

A 60-year-old man with diabetes develops unilateral facial pain, periorbital swelling, and black eschar on the nasal turbinate. CT shows bony destruction of the sinuses. What is the most appropriate treatment?

Accepted Answer

Liposomal amphotericin B plus urgent surgical debridement

Answer

Rhinocerebral mucormycosis requires immediate liposomal amphotericin B combined with aggressive surgical debridement; delay is associated with rapid mortality.

Question 5

A hospitalized patient develops fever 5 days after a central venous catheter insertion. Blood cultures from the line and periphery both grow Candida albicans. What is the FIRST management step?

Accepted Answer

Remove the central venous catheter and start echinocandin therapy

Answer

Candidemia requires prompt catheter removal (source control) and initiation of an echinocandin, which is preferred over fluconazole for empiric treatment pending species identification.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Infectious Disease Management 4