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

The Surviving Sepsis Campaign guidelines recommend initiating vasopressors if hypotension persists after initial fluid resuscitation to maintain a MAP of ≥65 mmHg. Norepinephrine is the first-line vasopressor of choice. While further fluid administration may be considered, vasopressor therapy should not be delayed in patients with persistent shock. Vasopressin is typically added as a second-line agent if the patient is refractory to norepinephrine. Routine monitoring of ScvO2 is no longer a primary resuscitation target.

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

For healthy outpatients with CAP and no risk factors for resistant pathogens, the IDSA/ATS guidelines recommend monotherapy with amoxicillin, doxycycline, or a macrolide (only if local pneumococcal resistance is <25%). Due to widespread macrolide resistance, doxycycline and amoxicillin are often preferred. Levofloxacin is a respiratory fluoroquinolone, which is typically reserved for patients with comorbidities or recent antibiotic use. Amoxicillin-clavulanate is broader than necessary for this patient and is typically recommended in combination with another agent for patients with comorbidities.

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

The 2021 IDSA/SHEA guidelines suggest fidaxomicin as the preferred agent over oral vancomycin for an initial episode of CDI, based on evidence showing lower rates of recurrence. Oral vancomycin is considered an acceptable alternative. Metronidazole is no longer recommended as a first-line agent for initial episodes due to inferior efficacy. FMT is generally reserved for patients with multiple recurrent infections.

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

A positive IGRA in the context of a normal chest X-ray is diagnostic for latent TB infection (LTBI). For individuals like healthcare workers who are at increased risk of exposure, treatment for LTBI is recommended to prevent progression to active disease. Sputum samples and active TB treatment are only indicated if active disease is suspected based on symptoms or radiographic findings. Assuming a false positive is not appropriate without further evaluation.

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

For a high-risk occupational exposure to HIV (e.g., deep injury, hollow-bore needle, high viral load source), a three-drug PEP regimen is the standard of care. The preferred regimen for adults typically includes two nucleoside reverse transcriptase inhibitors (like tenofovir and emtricitabine) plus an integrase inhibitor (like raltegravir or dolutegravir). Two-drug regimens are no longer preferred for most exposures, and monotherapy is outdated. PEP should be initiated as soon as possible, ideally within 2 hours of exposure, and should not be delayed pending the results of the healthcare worker's baseline tests.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Infectious Disease Management Questions and Answers