MCQ Book Questions

Q60282. A 40-year-old immigrant from Brazil presents with a 2-month history of fever, weight loss, and prominent mus- cle pain. She reports a “strange feeling around her heart.” Physical examination shows tachycardia and an irregular heart beat. Laboratory studies reveal marked peripheral eosinophilia. The patient dies 2 days later of an arrhythmia. A photomicrograph of the heart at autopsy is shown. Which of the following pathogens is the most likely cause of car- diac arrest?

Q60283. A 45-year-old man presents with chest pain, fever, productive cough, and rust-colored sputum. The patient was diagnosed with tuberculosis in his early 20s. A chest X-ray shows mul- tiple, nodular infi ltrates and cavitary lesions. A lung biopsy reveals necrotizing infl ammation and vascular thrombi with branching fungal hyphae. Which of the following is the most likely diagnosis?

Q60284. A 42-year-old man presents with a 1-week history of myalgia, low-grade fever, and swelling of the left calf. The patient reports recently attending a fi reman’s pig-roast. Laboratory data show elevated serum levels of creatine kinase. Examina- tion of a muscle biopsy in this patient would most likely reveal an infi ltrate of which of the following cell types?

Q60285. A 32-year-old immigrant from Vietnam presents with a 4-year history of progressive loss of eyebrows; patchy hypopigmenta- tion of skin; coarse facial features; and multiple, fi rm subcu- taneous nodules. Acid-fast organisms are seen on skin biopsy. Which of the following is the most likely etiology of this patient’s condition?

Q60286. A 16-year-old girl presents with fever and swollen lymph nodes. Physical examination reveals painful lymphadenopathy in her left axilla. The girl remembers that she was scratched by her cat 3 weeks ago. A silver stain of a lymph node biopsy is shown in the image. Which of the following is the most likely cause of lymphadenopathy in this patient?

Q60287. A 12-year-old farm boy from Mexico complains of generalized weakness and abdominal pain. Physical examination shows pallor and pitting edema of the lower extremities. A CBC reveals severe microcytic, hypochromic anemia (hemoglobin = 8.2 g/dL). Which of the following pathogens is the most likely cause of anemia in this patient?

Q60288. A 28-year-old drug abuser presents with high fever, chills, productive cough, hemoptysis, and right-sided chest pain. Physical examination shows the stigmata of intravenous drug abuse, as well as splenomegaly and pleuritis. Auscultation reveals a systolic ejection murmur over the tricuspid area. Which of the following is the most likely etiology of this pat- ent’s valvular heart disease?

Q60289. A 50-year-old woman presents with sudden-onset, crampy abdominal pain and watery diarrhea. She also complains of low-grade fever with chills, nausea, and vomiting. She ate partially cooked eggs 24 hours prior to the onset of these symptoms. Which of the following pathogens is most likely responsible for this patient’s gastrointestinal disorder?

Q60290. A 30-year-old man presents with inguinal swelling and pain- less penile and perianal ulcers. He admits to having unpro- tected sexual intercourse with multiple partners. A silver stain of a biopsy from a skin lesion (shown in the image) reveals organisms clustered in large macrophages. Which of the fol- lowing is the most likely diagnosis?

Q60291. An Egyptian fi sherman develops lower abdominal pain and pain on urination, and reports seeing blood in his urine. Which of the following parasites is the most likely cause of urinary symptoms in this patient?

Q60292. A 34-year-old man with history of diabetes mellitus presents with a fever of 3 days duration and a painful, swollen fi nger (shown in the image). Physical examination reveals erythema and edema affecting the fourth digit. Which of the following is the most likely etiology of this lesion?

Q60293. A 22-year-old student living in a college dormitory presents with a 4-week history of a nonproductive cough and previous low-grade fever. An X-ray fi lm of the chest shows patchy con- solidation of the right lower lobe, with evidence of interstitial involvement. Which of the following is the most likely etiol- ogy of this patient’s pulmonary infection?

Q60294. A 47-year-old woman receiving chemotherapy for leukemia complains of headache, cough, and dyspnea. An X-ray fi lm of the chest shows nodular pulmonary infi ltrates and thin-walled cavities. A mucicarmine stain of a lung biopsy discloses bud- ding yeast surrounded by a mucin-rich capsule. Which of the following is the most likely pathogen?

Q60295. A 65-year-old man with a history of Hodgkin lymphoma develops a painful erythematous rash with a band-like distri- bution over the left side of his chest, which becomes vesicular over the next several days. Biopsy of lesional skin is shown in the image. Which of the following is the most likely etiology of this patient’s rash?

Q60296. A 23-year-old woman presents with low-grade fever and multiple, painful, vesicular lesions on the vulva. A Pap smear shows multinucleated giant cells with intranuclear inclusions. Which of the following pathogens is the most likely cause of this patient’s genital lesions?

Q60297. The patient described in Question 47 asks you about the pos- sibility of future outbreaks and the risks of sexual transmis- sion. In addressing her concerns, you might consider that the virus is harbored in a latent form in which of the following anatomic locations?

Q60298. A 6-year-old girl presents with intense perianal itching, espe- cially at night. Physical examination reveals perianal excoria- tion. An adhesive tape test is positive for worms. Which of the following is the most likely parasite in this patient?

Q60299. A 29-year-old woman (gravida III, para II) delivers a premature infant at 28 weeks of gestation. At birth, the neonate shows signs of profound anemia and generalized edema (hydrops fetalis). The disease is most likely caused by an intrauterine infection with which of the following TORCH agents?

Q60300. A 36-year-old woman presents with a 2-day history of fever, myalgias, headache, and watery diarrhea (5 to 10 per day) that contains some blood. A stool smear shows leukocytes and Gram-negative curved bacilli. The patient reports drink- ing raw milk 7 days ago. Which of the following microorgan- isms is the most likely cause of this woman’s gastrointestinal disorder?

Q60301. A 45-year-old construction worker suffers a penetrating wound of the left leg, which is cleaned and sutured. Three days later, the patient presents with sudden onset of severe pain at the site of injury. Physical examination shows dark- ening of the surrounding skin, hemorrhage, and cutaneous necrosis. The wound shows a thick serosanguinous discharge with gas bubbles and a fragrant odor. Which of the following is the most likely etiology of this patient’s wound infection?