Infectious Diseases Tropical and Travel Medicine: Review Questions Varsha Moudgal, MD Dr. Moudgal is an assistant professor, Wayne State University, Detroit, MI. Choose the single best answer for each question.
	1. A 37-year-old man presents to the clinic with a 1-week history of intermittent high-grade fevers, malaise, and fatigue. The symptoms started about 2 weeks after he returned from a vacation at Martha’s Vineyard. On examination, he appears pale and ill. His spleen is palpable at 2 cm below the costal margin. Results of laboratory studies reveal a leukocyte count of 7.5 × 103/mL, a hemoglobin level of 8 g/dL, a platelet count of 75 × 103/mL, and a low haptoglobin level. What is this patient’s most likely diagnosis? Babesiosis Bartonellosis Lyme disease Malaria Viral illness Click here to compare your answer. 2. A 39-year-old soldier is referred to your clinic by his primary care physician for treatment of an ulcer that developed in Iraq 1 month ago on his right cheek. The ulcer is about 3 cm in diameter and is slightly pruritic but not painful. The ulcer has well-defined, raised borders and has a central bed of granulation tissue; it did not resolve with a course of cephalexin. A biopsy reveals amastigotes in tissue. What is the next course of treatment for this patient? Ciprofloxacin Linezolid Metronidazole Pentavalent antimony Vancomycin Click here to compare your answer. 3. A 72-year-old Indian man was recently diagnosed with glioblastoma multiforme. While being treated with high-dose dexamethasone, he develops abdominal pain, nausea, vomiting, and worsening shortness of breath. His respiratory symptoms rapidly worsen, leading to intubation. Chest radiograph reveals bilateral diffuse interstitial infiltrates. A bronchoalveolar lavage (BAL) is performed, and an urgent call from the laboratory states that worm larvae are seen in the BAL fluid. What is the most likely cause of this patient’s symptoms? IAscariasis Dracunculiasis Hookworm Strongyloidiasis Tapeworm Click here to compare your answer.		4. All of the following statements regarding malaria are correct EXCEPT Quinidine and doxycycline are the treatment of first choice for falciparum malaria in adults in the United States Widespread quinine resistance is a significant problem in African countries Plasmodium vivax is associated with persistent liver stages that lead to relapse if not appropriately treated Chloroquine resistance among P. falciparum is now widespread in many countries Duffy antigen negativity is protective against P. vivax Click here to compare your answer. 5. A 33-year-old HIV-positive woman with a recent CD4 count of 350 cells/mm3 is admitted to the hospital with a 1-week history of progressively worsening shortness of breath, fever, and cough. On examination, the physician notes tender red nodules on her shins. The patient recently returned from a trip to Arizona, where her sister is building a new home. Chest radiograph reveals bilateral diffuse pulmonary infiltrates. What is this patient’s most likely diagnosis? Blastomycosis Coccidioidomycosis Congestive heart failure Pneumococcal pneumonia Pneumocystis jiroveci pneumonia Click here to compare your answer.
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