Physician Assistant Infectious Diseases 4

Question 1

A hiker in North Carolina has fever, headache, and a petechial rash that started on the wrists and ankles and spread to the palms and soles. What is the empiric treatment?

Accepted Answer

Doxycycline

Answer

Suspected Rocky Mountain spotted fever should be treated right away with doxycycline at any age, because delay increases mortality.

Question 2

A patient from Connecticut has fever, leukopenia, thrombocytopenia, and elevated transaminases after a tick bite, with morulae seen in neutrophils. What is the most likely diagnosis?

Accepted Answer

Human granulocytic anaplasmosis

Answer

Anaplasmosis, transmitted by Ixodes ticks, shows morulae in granulocytes along with cytopenias and transaminitis.

Question 3

A patient with new-onset unilateral facial nerve palsy after a summer tick exposure in Wisconsin is diagnosed with early disseminated Lyme disease. What is the recommended oral therapy?

Accepted Answer

Doxycycline for 14-21 days

Answer

Lyme facial palsy is treated with oral doxycycline for 14-21 days.

Question 4

An asplenic patient who recently returned from Nantucket has fever, hemolytic anemia, and intraerythrocytic 'Maltese cross' forms on blood smear. What is the most likely organism?

Accepted Answer

Babesia microti

Answer

Babesiosis is transmitted by Ixodes ticks in the Northeast, and its tetrad 'Maltese cross' forms help distinguish it from malaria.

Question 5

A traveler returning from sub-Saharan Africa has fever and confusion, and a smear shows banana-shaped gametocytes with 8% parasitemia. What is the most appropriate treatment in the US?

Accepted Answer

IV artesunate

Answer

Severe falciparum malaria (altered mentation or parasitemia of 5% or more) needs IV artesunate, which is available in the US.

Physician Assistant Practice Test

Physician Assistant Practice Test

Physician Assistant Infectious Diseases 4