PANCE Infectious Disease 3

Question 1

A 35-year-old patient with HIV (CD4 count 150 cells/µL) presents with painless white plaques on the lateral tongue that cannot be scraped off. What is the most likely diagnosis?

Accepted Answer

Oral hairy leukoplakia

Answer

Oral candidiasis (thrush)

Answer

Aphthous ulcers

Answer

Lichen planus

Question 2

A 25-year-old woman presents with fever, bilateral joint pain (wrists, knees), skin lesions (pustules on erythematous base), and tenosynovitis of the right hand. Cervical cultures are positive. What is the most appropriate treatment?

Accepted Answer

Ceftriaxone 1 g IV/IM daily × 7 days

Answer

Doxycycline 100 mg PO BID × 7 days

Answer

Azithromycin 1 g PO single dose

Answer

Penicillin V 500 mg PO QID × 10 days

Question 3

A 45-year-old patient who received a renal transplant 6 months ago presents with fever, dyspnea, and non-productive cough. CT chest shows bilateral ground-glass opacities. BAL with Gomori methenamine silver stain reveals cysts. What is the treatment?

Accepted Answer

Trimethoprim-sulfamethoxazole

Answer

Fluconazole

Answer

Amphotericin B

Answer

Caspofungin

Question 4

A 28-year-old male presents with a painless scrotal swelling. Urethral culture is positive for an intracellular gram-negative diplococci. He also complains of urethral discharge. Which is the recommended dual therapy per current CDC guidelines?

Accepted Answer

Ceftriaxone 500 mg IM + doxycycline 100 mg PO BID × 7 days

Answer

Ceftriaxone 250 mg IM + azithromycin 1 g PO

Answer

Ciprofloxacin 500 mg PO + doxycycline 100 mg PO BID × 7 days

Answer

Penicillin G 4.8 million units IM + probenecid

Question 5

A 70-year-old woman presents with confusion, fever, and flank pain. Urinalysis shows pyuria and bacteriuria. Blood cultures are positive. She has a penicillin allergy (rash). Which antibiotic is most appropriate for gram-negative bacteremia?

Accepted Answer

Ciprofloxacin 400 mg IV

Answer

Ampicillin-sulbactam IV

Answer

Clindamycin 900 mg IV

Answer

Vancomycin 15 mg/kg IV

Question 6

A patient exposed to a bat in their bedroom is brought to the ED. The bat was not captured for testing. The patient has no visible bite marks but was asleep. What is the appropriate management?

Accepted Answer

Administer rabies immune globulin at wound site plus initiate rabies PEP vaccine series

Answer

Reassure and discharge — no treatment needed without confirmed bite

Answer

Administer rabies vaccine series only (4 doses)

Answer

Culture wound site and start prophylactic amoxicillin-clavulanate

Question 7

A 55-year-old diabetic presents with fever, crepitus, and rapidly spreading necrosis of the scrotum and perineum. CT shows subcutaneous gas. What is the immediate management priority?

Accepted Answer

Emergent surgical debridement plus broad-spectrum IV antibiotics

Answer

Start IV vancomycin and piperacillin-tazobactam and observe for 24 hours

Answer

Hyperbaric oxygen therapy as definitive treatment

Answer

Culture the wound and start targeted antibiotic monotherapy