Internal Medicine Infectious Disease Management Questions and Answers

Question 1

A 65-year-old male with diabetes presents to the emergency department with fever, confusion, and a blood pressure of 85/50 mmHg.
He is diagnosed with septic shock from a urinary source.
After an initial 30 mL/kg crystalloid fluid bolus, his mean arterial pressure (MAP) remains 55 mmHg.
According to the Surviving Sepsis Campaign guidelines, what is the most appropriate next step?

Accepted Answer

Initiate a norepinephrine infusion.

Answer

Administer an additional 1-liter fluid bolus before considering other therapies.

Answer

Add vasopressin to the current regimen.

Answer

Obtain a central venous oxygen saturation (ScvO2) measurement to guide resuscitation.

Question 2

A 45-year-old female with no significant comorbidities and no recent antibiotic use is diagnosed with outpatient community-acquired pneumonia (CAP), confirmed by chest X-ray. According to the most recent IDSA/ATS guidelines, which of the following is a recommended first-line empiric antibiotic regimen for this patient?

Accepted Answer

Doxycycline

Answer

Levofloxacin

Answer

Azithromycin monotherapy

Answer

Amoxicillin-clavulanate

Question 3

A 72-year-old man is diagnosed with his first episode of non-severe *Clostridioides difficile* infection (CDI). According to the most recent IDSA/SHEA guidelines, which of the following is the preferred first-line treatment?

Accepted Answer

Oral Fidaxomicin for 10 days

Answer

Oral Metronidazole for 14 days

Answer

Oral Vancomycin for 10 days

Answer

Fecal Microbiota Transplantation (FMT)

Question 4

A 35-year-old asymptomatic healthcare worker undergoes routine annual screening and has a positive Interferon-Gamma Release Assay (IGRA) test. A subsequent chest X-ray is normal. What is the most appropriate next step in the management of this patient?

Accepted Answer

Offer a recommended treatment regimen for latent TB infection (LTBI).

Answer

Reassure the patient that this is likely a false positive and repeat the test in 6 months.

Answer

Obtain three morning sputum samples for AFB smear and culture.

Answer

Start a four-drug regimen for active tuberculosis.

Question 5

A 28-year-old surgical resident sustains a deep needlestick injury from a hollow-bore needle used on a patient with a known high HIV viral load and no documented drug resistance. According to current CDC guidelines, what is the most appropriate regimen for post-exposure prophylaxis (PEP) that should be initiated as soon as possible?

Accepted Answer

A three-drug regimen with tenofovir, emtricitabine, and an integrase inhibitor (e.g., raltegravir or dolutegravir) for 28 days.

Answer

Zidovudine (AZT) monotherapy for 28 days.

Answer

A two-drug regimen with tenofovir and emtricitabine for 28 days.

Answer

No prophylaxis is needed if the resident's baseline rapid HIV test is negative.

Question 6

A 68-year-old male from a nursing home with a long-term indwelling urinary catheter presents with fever and flank pain. He was treated with levofloxacin for a UTI two months ago. He is admitted for pyelonephritis. Which of the following is the most appropriate empiric intravenous antibiotic while awaiting urine culture results?

Accepted Answer

Piperacillin-tazobactam

Answer

Ceftriaxone

Answer

Ciprofloxacin

Answer

Ampicillin-sulbactam