Infectious Diseases Module 4

An 83-year-old male patient with a history of advanced chronic obstructive pulmonary disease (COPD) and poorly controlled diabetes mellitus presents to the emergency department with severe community-acquired pneumonia. He is febrile, tachypneic, and has a productive cough with purulent sputum.

His chest X-ray shows bilateral infiltrates. He was recently hospitalized two months ago for an exacerbation of COPD and was treated with intravenous antibiotics.

During that hospitalization, Pseudomonas aeruginosa was isolated from his sputum culture.

Considering his clinical history, what is the strongest individual risk factor for his current respiratory infection with Pseudomonas aeruginosa?

Recent hospitalization and exposure to parenteral antibiotics with prior isolation of Pseudomonas in the sputum.

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History of poorly controlled diabetes mellitus

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Advanced Chronic obstructive pulmonary disease (COPD)

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Advanced age

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The color and volume of sputum production.

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What is the most common organism that causes hospital acquired urinary tract infection?

E. coli

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P. aeruginosa

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klebsiella species

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enterobacter species

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A. baumannii

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Which of the following is the most common hospital acquired infection?

urinary tract infection

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pneumonia

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cellulitis

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meningitis

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encephalitis

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Which of the following is the most common life-threatening hospital acquired infection?

hospital acquired pneumonia

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urosepsis

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meningitis

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encephalitis

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cellulitis

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Which of the following exposure poses the highest risk of HIV transmission?

Receptive anal intercourse

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Use of contaminated injecting equipment

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Occupational needlestick injury

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Receptive vaginal intercourse

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Insertive anal intercourse

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Which of the following is the most common cause of recurrent bacterial meningitis?

Head trauma

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craniotomy

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internal ventricular catheters

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external ventricular catheters

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external lumbar catheters

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Which of the following characteristics is not considered a risk factor for the development of human papillomavirus (HPV)–related cancer?

HPV infection type 8

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HPV infection type 18

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Multiple partners

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Tobaccco smoking

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HIV co-infection

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An 18-year-old had became sexually active in the last 2 years. During the past 6 months, she has had two sexual partners who intermittently used condoms for contraception.

She has not received the human papillomavirus vaccination.

She is relatively asymptomatic and physical examination is unremarkable.

Given her recent sexual contact, which of the following infections should this patient be tested for?

Chlamydia, gonorrhea, and HIV

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Chlamydia and HIV

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Chlamydia, gonorrhea, hepatitis B virus, and HIV

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Chlamydia, gonorrhea, and hepatitis B virus

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HIV and hepatitis B virus

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Fidaxomicin is capable of eradicating which type of bacteria?

Clostridium difficile

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Clostridium perfringens

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Escherichia coli

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Stenotrophomonas

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Enterobacter cloacae

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All of the following statements are true regarding HIV-2 except?

More virulent

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Mostly in western central africa

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Lower viral load

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Lower rates of vertical transmission

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Slower progression

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Which of the following antibiotic is least useful in the treatment against Methicillin Resistant Staphylocccus aureus (MRSA)?

cefepime

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daptomycin

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tigecycyline

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ceftaroline

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pristinomycin

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Which of the following features would be highly suggestive of an acute HIV-1 infection?

Painful mucocutaneous ulcers

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Fever

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Lymphadenopathy

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Sore throat

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Rash

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A 25 year old renal transplant patient on mycophenolate and sirolimus visits your practice to get some advice on pre-travel vaccination.

Which of the following vaccines are contraindicated?

Bacillus Calmette-Guérin (BCG)

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Hepatitis A

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Injectable typhoid

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Rabies

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Diphteria

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A 16 year old girl recently had unprotected sex with a man known to be HIV positive.

Which of the following tests is most helpful in establishing whether she has been infected with HIV?

HIV DNA

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HIV RNA viral load

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p24 antigen

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HIV antibody

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p17 antigen

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Which of the following dental procedure does not require endocarditis prophylaxis?

intracanal endodontic procedures

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dental extraction

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subgingival scaling

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avulsed teeth replantation

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root planing

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Which of the following Aedes mosquito is a known vector for the Zika virus?

Aedes aegypti

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Aedes albopictus

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Aedes australis

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Aedes vexans

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Aedes polynesiensis

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Which of the following is the strongest single predictive marker of disease progression at all stages of HIV?

CD38 expression by CD8 cells

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CD4 count

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HIV viral load

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Soluble TNF-R

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Presence of CCR5 delta 32

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The following statements are true regarding this rash, except?

The rash is characteristically non-pruritic

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The incubation period is usually between 3-17 days

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Lesions typically develop simultaneously and evolve together on any given part of the body

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Sexual contact history is crucial

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Tecovirimat may be a useful treatment

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Which of the following statement is incorrect regarding Candida auris?

Usually colonizes the skin rather than gut.

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Resistant to multiple anti-fungals.

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As of 2022, there has been widespread of candida auris around the world.

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Can be detected via rectal swab

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Can persist on surfaces in healthcare settings, such as medical equipment for weeks to months.

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Which of the following ART has been implicated in the development of lipodystrophy (buffalo hump) in HIV patients.

Ritonavir

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Delavirdine

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Efavirenz

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Nevirapine

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Etravirine

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Which of the following statements about rezafungin is false?

Rezafungin is not suitable for outpatient echinocandin therapy

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Rezafungin has activity against a wide range of fungal pathogens, including Candida species and Aspergillus species

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Rezafungin is administered as a once weekly infusion

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Rezafungin works by inhibiting the synthesis of a component called β-(1,3)-D-glucan in the cell walls of certain pathogenic fungi.

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A 38-year-old male presents to the clinic with a 6-month history of progressive dyspnea, non-productive cough, and intermittent low-grade fevers. He reports significant weight loss over the same period but denies any recent travel, sick contacts, or known exposures to tuberculosis. His past medical history is unremarkable, and he has no known history of immunodeficiency in the family. He does not smoke and has no history of intravenous drug use.

On examination, the patient appears cachectic. Vital signs reveal a low-grade fever and mild tachypnea. Pulmonary auscultation identifies diffuse crackles bilaterally, but no wheezes or rhonchi. The rest of the physical examination is unremarkable.

Laboratory tests show a normal complete blood count with differential.

His flow cytometry reveals a CD4+ T-lymphocyte count of 180 cells/µL (normal range: 500-1500 cells/µL).

HIV testing, including antigen/antibody combination assays and HIV RNA viral load, is negative. Additional workup for other causes of lymphocytopenia, such as HTLV, SLE, and sarcoidosis, is also negative.

Chest radiography shows diffuse interstitial infiltrates, and high-resolution CT of the chest reveals a pattern suggestive of Pneumocystis jirovecii pneumonia (PJP).

Which of the following statement is incorrect regarding the above condition?

The disease is progressive and have a poorer prognosis compared to HIV related CD4 lymphocytopenia

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Individuals with ICL may not exhibit any noticeable symptoms or recurrent infections initially.

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The diagnosis is based on the persistent, unexplained decrease in CD4+ T cell counts and the presence of opportunistic infections

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Intravenous immunoglobulin (IVIG) therapy may have a role in boosting the immune system

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Statins has been recommended as primary prophylaxis against cardiovascular disease in HIV patients over 40 years of age with elevated LDL level and a 10-year atherosclerotic cardiovascular disease (ASCVD) score of above 7.5 percent.

However, all statins are metabolized to some degree by the CYP3A4 system. Therefore, for a HIV person who is on a protease inhibitor, which statin should he or she avoid?

Simvastatin

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Pitavastatin

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Pravastatin

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Fluvastatin

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A 25 year old mother has a 6 year old son and both of them are HIV positive.

She is currently pregnant and asks you what the chances of her baby developing HIV, if she takes her ART during pregnancy?

<1%

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10%

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20%

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30%

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90%

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The following are associated with increased risk of HIV transmission except?

Circumcision

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Untreated chancroid

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High plasma viral load

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Use of microbicide

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In a HIV patient, all of the following complications may only develop once the CD4 count drops to less than 200, except?

Herpes Zoster

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Oral candidiasis

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Hairy leukoplakia

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Cryptosporidiosis

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Toxoplasmosis

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What is the effect of being Heterozygous for CCR5 Delta 32 allele in the development of HIV and AIDS?

Slower disease progression to AIDS

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Faster disease progression to AIDS

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Highly protective against HIV infection

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Absolute protection against HIV infection

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No effect.

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A patient with HIV on ART for 10 years with stable CD4 count and undetectable viral load asks if he could stop taking ART.

What should you advice?

Continue taking ART lifelong

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Stop for now.But restart when CD4 <350.

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Give PCP prophylaxis

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Commence lipid lowering medication

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Refer for viral resistance testing

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A patient with HIV treated with Ritonavir (protease inhibitor) develops lipodystrophy. He is treated with oral lovastatin as part of management of his lipodystrophy.

Which complication could potentially arise from this treatment?

Rhabdomyolysis

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Anaphylactic reaction

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Normalization of serum lipid.

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Worsening of serum lipid

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No adverse reaction.

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What is the primary indication for the use of lefamulin?

Treatment of urinary tract infections

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Treatment of community-acquired pneumonia

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Treatment of skin and soft tissue infections

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Treatment of hospital-acquired pneumonia

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Treatment of chronic obstructive pulmonary disease (COPD)

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Infectious Diseases Module 4

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