The Metro Education Challenge - Sample Questions
1. A 23 y/o male presents with a 2 week history of a rash on his left arm. He works in a pet shop cleaning cages and tanks, as well as handling small animals. Recently he handled a sick cat who subsequently died. Pex revealed multiple ulcerated nodules from his wrist to mid arm in mostly a medial distribution.
Gram stain revealed only occasional wbc’s but no organisms. Aerobic and anaerobic culture was negative. A biopsy was performed and a diagnosis was made. Which of the following therapies is most likely to have been effective? a. itraconazole
b. minocycline and rifampin
c. trimethoprim/sulfamethoxazole
d. systemic glucocorticoid therapy 2. A 33 y/o male traveled to Acapulco 6 weeks ago with his fraternity brothers. They drank all available beverages and visited the local brothels on two occasions. He swam in the local pool as well as the ocean daily and believes he was bitten by multiple non-visualized insects. Approximately 4 weeks ago, which was 2 weeks after leaving Acapulco, he noted the onset of a serpiginous rash on his left leg which slowly moved caudally. Subsequently, he experienced watery diarrhea and one week ago presented to the ER with a headache, fever of 102 F and right sided weakness. His CBC showed WBC of 15K with 54S, 12B, and 22 eos. A CSF evaluation revealed WBC of 220 cells with 65% polys and17% eos. The most likely diagnosis is: a. Angiostrongylus cantonensis
b. Baylisascaris procyonis
c. Coccidioidomycosis
d. Gnathostoma spinigerum 3. A 74-year-old woman with advanced Alzheimer’s disease is admitted from a nursing home with a fever of 103 degrees F, a BP of 65/palpable, peripheral cyanosis, and grossly purulent urine. Ceftriaxone is begun in the emergency room. The patient requires levophed and extensive fluid resuscitation. At 24 hours, the microbiology lab reports gram negative rods growing in the aerobic bottles, and are found to be non-lactose fermenters. You are asked to consult on the antibiotic regimen and you recommend: a. continue ceftriaxone
b. add flagy to ceftriaxone
c. add tobramycin and metronidazole to ceftriaxone
d. discontinue ceftriaxone and begin tobramycin and cefepime 4. A 5 y/o child present to the pediatrician’s office with complaints of blood streaked stools rectal pain. PEx reveals a rectal prolapse. Stool samples are sent to the lab for evaluation. Routine culture is negative for pathogens, but the lab calls the next day with an answer. Which of the following are most likely to have been found by the lab? 
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