Internal Medicine Exam Infectious Disease Management 5

Question 1

A 42-year-old man with HIV (CD4 50 cells/μL, not on ART) develops progressive dyspnea. Chest CT shows bilateral ground-glass opacities. LDH is elevated. Which prophylaxis failure does this presentation most likely represent?

Accepted Answer

Pneumocystis jirovecii pneumonia (PCP) prophylaxis failure

Answer

Bilateral ground-glass opacities with elevated LDH in a severely immunocompromised HIV patient is classic for PCP; prophylaxis with TMP-SMX is indicated when CD4 <200 cells/μL.

Question 2

A patient is being treated for PCP with TMP-SMX. She has room air PaO2 of 62 mmHg. What adjunctive therapy should be added within 72 hours of starting antibiotics?

Accepted Answer

Systemic corticosteroids (prednisone)

Answer

Adjunctive corticosteroids reduce mortality in moderate-to-severe PCP (PaO2 <70 mmHg or A-a gradient >35 mmHg) by blunting the inflammatory response triggered when organisms are killed.

Question 3

A 25-year-old woman presents with high fever, headache, and a non-blanching petechial rash evolving to purpura. CSF shows gram-negative diplococci. What empiric treatment should be administered IMMEDIATELY?

Accepted Answer

Ceftriaxone 2 g IV immediately

Answer

Meningococcal meningitis/septicemia requires immediate ceftriaxone without delay; dexamethasone adjunctively reduces meningitis complications.

Question 4

A 48-year-old man develops fever and flank pain 10 days after a kidney transplant. Urinalysis shows pyuria. Urine culture grows Escherichia coli (ESBL-producing). What is the preferred treatment?

Accepted Answer

Meropenem or ertapenem

Answer

ESBL-producing Enterobacteriaceae are resistant to most cephalosporins and require carbapenems as the definitive treatment for serious infections in immunocompromised hosts.

Question 5

Which of the following is the MOST important measure to prevent catheter-associated urinary tract infections (CAUTIs) in hospitalized patients?

Accepted Answer

Prompt removal of urinary catheters when no longer needed

Answer

The most effective CAUTI prevention strategy is daily reassessment and prompt catheter removal, as infection risk increases with each catheter-day.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Infectious Disease Management 5