What is the number one infectious disease with the highest mortality worldwide?
- Hepatitis B
The number one infectious disease with the highest mortality worldwide is HIV/AIDS. In 2013, there were 35 million people living with HIV globally. In the same year, 1.5 million people died from AIDS-associated illnesses.
Meningococcal meningitis is a bacterial infection that is spread by:
- Droplets of respiratory or throat secretions from carriers.
- Vector-borne transmission.
- Airborne contact within 20 feet.
- Non-contact transmission modes.
1. Droplets of respiratory or throat secretions from carriers.
Meningococcal meningitis is a bacterial infection that is spread by droplets of respiratory or throat secretions from carriers.
Infected mosquitoes can transmit the following diseases:
- Lyme disease, tularemia, and cholera.
- Chikungunya, malaria, and West Nile virus.
- Yersinia pestis, Rocky Mountain Spotted Fever, and echinococcosis.
- Cholera, Yersinia pestis, and tularemia.
2. Chikungunya, malaria, and West Nile virus.
Infected mosquitoes can transmit chikungunya, malaria, and West Nile virus. Only malaria has prevention and treatment medications. Prevention measures include using insect repellent, wearing long-sleeve shirts and pants, and using windows and door screens.
A 22-year-old female tree worker was bitten by a raccoon that had been acting sluggish and frothing at the mouth. Upon arrival at the primary care office, the initial action of the nurse practitioner would be to:
- Send the young woman to the hospital Emergency Room.
- Call the Centers for Disease Control for direction.
- Report this to the local Department of Public Health.
- Wash the wound thoroughly with soap and water.
4. Wash the wound thoroughly with soap and water.
In order to prevent infection and to promote optimal wound healing careful inspection and cleansing of wounds is required. Vaccinations for rabies, as well as tetanus, are also needed.
After cleaning the wound, the nurse practitioner notes that the raccoon bite has pierced the skin. The nurse practitioner realizes that the patient has never had a rabies vaccine and needs to get a rabies vaccination series started no later than:
- 48 hours.
- 72 hours.
- 36 hours.
- 24 hours.
4. 24 hours.
Rabies is transmitted by wild animals, with the bat being the most common vehicle in the United States. Vaccinations can begin after 24 hours post-bite; however, the more quickly a person seeks care the more quickly wound cleansing and the prevention of infections can begin, chiefly by starting the vaccination series. Rabies immune globulin should also be administered.
Rabies vaccination series for those without prior vaccination are given after rabies immunoglobulin on days:
- 0, 3, 7, and 14.
- 0, 5, 12, and 21.
- 0, 1, 5, and 14.
- 0, 3, 14, and 21.
1. 0, 3, 7, and 14.
Rabies vaccinations for those who have received a prior series include one dose immediately, followed by a second dose on day 3. No rabies immune globulin is needed.
Signs and symptoms of measles (rubeola) include:
- Koplik’s spots, high fever, cough.
- Parotitis, low-grade fever, vesicular lesions on the chest.
- High fever, confusion, and pustular lesions on arms and legs.
- Koplik’s spots, headaches, and sore throat.
1. Koplik’s spots, high fever, cough.
Signs and symptoms of measles (rubeola) include Koplik’s spots, high fever, cough. These tiny white spots appear in the mouth 2–3 days after symptoms start.
A 49-year-old male patient presents to the office upon returning from a trip to the Caribbean. His chief complaint is a high fever of 103°F and a headache. Related to his recent travel, the differential diagnosis will include:
- Rocky Mountain Spotted Fever, West Nile virus, meningitis.
- Dengue fever, malaria, and chikungunya.
- Dengue fever, West Nile virus, and variola.
- West Nile virus, bubonic plague, and malaria.
2. Dengue fever, malaria, and chikungunya.
All three of these illnesses are mosquito-borne and present with clinical symptoms of fever and headache, among other signs and symptoms. Recent travel to areas with endemic disease is a key factor to be assessed during the history portion of the exam.
Bartonella henselae infection is most often caused by:
- Dog bites.
- Cat bites.
- Exposure to cat feces.
- Bites from rabid bats.
2. Cat bites.
Bartonella bacteria can cause three illnesses in humans, including cat-scratch fever. Trench fever is caused by B. quintana, and Carrión’s disease is caused by B. bacilliformis.
Signs and symptoms of Bartonella henselae infection include:
- Fever, headache, and swollen lymph nodes.
- Headache, cough, and runny nose.
- Fever, generalized rash, and cough.
- Generalized rash, headache, and pharyngitis.
1. Fever, headache, and swollen lymph nodes.
Signs and symptoms of Bartonella henselae infection include fever, headache, and swollen lymph nodes.
Treatment of mild Bartonella henselae Infection includes:
- Broad spectrum cephalosporins.
- Tetanus vaccination.
- Antipyretics and analgesics as needed.
3. Antipyretics and analgesics as needed.
Treatment of mild Bartonella henselae infection includes antipyretics and analgesics as needed. Moderate infection can be treated with azithromycin 500 mg orally on day one, followed by 250 mg orally daily for 4 days. Endocarditis requires antibiotic treatment and consulting with an infectious disease specialist.
Co-infection with Hepatitis D can occur with persons who are infected with:
- Hepatitis C.
- Hepatitis A.
- Hepatitis E.
- Hepatitis B.
4. Hepatitis B.
Co-infection with hepatitis D can occur with persons who are infected with hepatitis B. Hepatitis D (delta virus) needs hepatitis B virus for replication. It can be acute or chronic.
Prevention of Hepatitis C includes:
- Vaccination of HCV.
- Twin-rix vaccination.
- Handwashing and avoiding contaminated foods.
- Not sharing injection drug paraphernalia.
4. Not sharing injection drug paraphernalia.
Prevention of hepatitis C includes not sharing injection drug paraphernalia. Patient education regarding prevention of hepatitis C includes avoiding exposure to HCV-infected blood. The majority of transmission occurs from intravenous drug injection users who share needles and paraphernalia. Approximately 90% of IV drug users will become HCV infected within the first 5 years of use. Sharing toothbrushes, razors, etc. can transmit HCV due to blood exposure. Rarely is HCV transmitted by monogamous sexual partners, but there is higher risk in those with multiple sex partners and those whose sexual practices can cause the tearing of mucosa and exposure to blood.
A 28-year-old male comes to the clinic with complaints of watery diarrhea. He states he and his wife just returned from their honeymoon vacation deep-sea diving in Central America. An old wound is noted on his right lower leg. This raises suspicion for:
- Infectious mononucleosis.
- Vibrio parahaemolyticus.
3. Vibrio parahaemolyticus.
This strain of Vibrio is not common, but can cause gastrointestinal illness in people, typically self-limiting over 3 days. However, in those with open wounds it can cause infection in the wound. Patients should be evaluated for septicemia, which would require rapid emergency treatment.
A 33-year-old female patient with no significant past medical history arrives in the office with complaints of mild respiratory symptoms of cough, fever, and congestion. It is important for the nurse practitioner to be aware that:
- Patients with respiratory illness require antibacterial treatment most of the time.
- Patients with these symptoms often require inhaled corticosteroids.
- Approximately 90% of respiratory illnesses are viral.
- If the onset is insidious, it is most likely viral.
3. Approximately 90% of respiratory illnesses are viral.
It is important for the nurse practitioner to be aware that approximately 90% of respiratory illnesses are viral. Viral respiratory illnesses typically improve within 7–10 days. If symptoms do not improve, or worsen, evaluation for bacterial infection from the weakened immune system should be initiated.
Due to drug resistance in gonococcal infections, which drug is no longer recommended for use in the United States?
Fluoroquinolones used to be prescribed for gonorrhea; however, due to resistance, the CDC now recommends cephalosporins for treating gonorrhea.
Even though there is an effective vaccine, this childhood infectious disease remains one of the leading causes of death in young children. Which of the following is it?
- Erythema infectiosum
Rubeola (measles) can have severe complications, including pneumonia, seizures, mental retardation, and death, but is preventable with vaccination.
A 23-year-old male patients presents with complaints of "bumps" on his penis. Upon examination, raised lesions, which appear to be genital warts, are noted and a sample is sent for testing that returns positive for HPV. Treatment options include which of the following?
- Valcyclovir 500 mg bid for 5 days
- Imiquimod 3.75% to affected area once a day at bedtime for 8 weeks
- Corticosteroid cream 1% bid after showers for 2 weeks
- Azithromycin 1 gm orally once
2. Imiquimod 3.75% to affected area once a day at bedtime for 8 weeks
Anogenital warts can spontaneously disappear within one year. Other treatment options include imiquimod, podofilox, sinecatechins, or cryotherapy, surgical removal, and TCA or BCA solutions.
Treatment for a positive Chlamydial infection is:
- Valcyclovir 500 mg bid for 5 days.
- Imiquimod 3.75% to affected area once a day at bedtime for 8 weeks.
- Corticosteroid cream 1% bid after showers for 2 weeks.
- Azithromycin 1 gm orally once.
4. Azithromycin 1 gm orally once.
Chlamydia is most common in persons 24 years of age and younger, and is the most common reportable STD. Other treatment options include doxycycline 100 mg orally twice a day for one week, and levofloxacin 500 mg orally once a day for one week, among other options, as noted in the STD Guidelines recommended by the CDC.
Upon visualizing a wet mount for a patient complaining of greenish-colored vaginal discharge, trichomonads with 3 to 6 flagella are noted. Treatment for this patient will include:
- Valcyclovir 500 mg orally bid for 5 days.
- Imiquimod 3.75% to affected area once a day at bedtime for 8 weeks.
- Metronidazole 2 gm orally once.
- Doxycycline 100 mg orally bid for 7 days.
3. Metronidazole 2 gm orally once.
Trichamoniasis is the most common non-viral STD in the United States. Metronizadole can also be given 500 mg orally twice a day for one week. Tinadazole 2 gm orally once is another option.
While infections are the most common cause of fever of unknown origin (FUO) in children, what are the most common causes of FUO in older persons?
- Neoplasms and connective tissue disorders
- Endocarditis and HIV
- Connective tissue disorders and hepatitis
- Long-term corticosteroid use and COPD
1. Neoplasms and connective tissue disorders
In adults, FUO is defined as a temperature over 38.3°C off and on for over three weeks duration, which has not been adequately diagnosed as an inpatient. Fevers associated with weight loss or other serious signs and symptoms suggest more dire illness, including cancers, HIV, and rheumatic and connective tissue diseases.
Persons who have varicella are advised that they may return to school or work:
- Seventy-two hours after blisters have erupted.
- Once they no longer have a fever.
- After 24 hours, as long as they keep the blisters covered tightly.
- After all the blisters have scabbed over.
4. After all the blisters have scabbed over.
Persons who have varicella are advised that they may return to school or work after all the blisters have scabbed over because they are still considered contagious until this happens.
Which patient should be started on opportunistic infection Pneumocystis jiroveci pneumonia prophylaxis?
- A 52-year-old male with an HIV viral load of 60,000 copies and a CD4 absolute count of 364
- A 22-year-old female with an HIV viral load of 325,000 copies and a CD4 absolute count of 325
- A 44-year-old female with an HIV viral load of 1,230 copies and a CD4 absolute count of 185
- An 18-year-old male with an HIV viral load that is undetectable and a CD4 absolute count of 255
3. A 44-year-old female with an HIV viral load of 1,230 copies and a CD4 absolute count of 185
HIV+ patients whose CD4 cell count falls below 200 cells/mm3 need to start on Bactrim (TMP-SMX) or an alternative (dapsone, Mepron).
A 24-year-old female patient asks the nurse practitioner about herpes infections since her new boyfriend told her he might have been exposed to it in a previous relationship. Which of the following statements is not accurate and therefore should not be the nurse practitioner’s response?
- As long as your partner wears a condom, you do not have to worry about getting genital herpes.
- You and your partner can be tested for herpes type 1 and type 2 to check if you have been infected, since it could be asymptomatic.
- There is no cure for herpes infections.
- Genital herpes can be type 1 and/or type 2.
1. As long as your partner wears a condom, you do not have to worry about getting genital herpes.
Because shedding of HSV can occur outside of the area that condoms cover, they may not be 100% effective.
While working in the northeast, a 62-year-old gardener comes to the clinic with complaints of right knee pain and inflammation for a few weeks. Which of the following responses is the best choice to be included in the differential diagnosis?
- Multiple sclerosis
- Ankylosing spondylitis
- Lyme disease
3. Lyme disease
This outdoor worker is at high risk for tick bites. Complications from untreated Lyme disease includes joint swelling, effusions, and arthritic symptoms.
Patients should be encouraged to do which of the following to keep from becoming infected with West Nile Virus?
- Wear high socks and sturdy shoes when walking in the woods.
- Avoid contact with wild rabbits and deer.
- Apply permethrin onto exposed skin multiple times per day.
- Use insect repellants and empty outdoor water containers.
4. Use insect repellants and empty outdoor water containers.
Using these techniques can aid in reducing infection from mosquito-borne diseases.
"Chandelier’s sign" is associated with which condition?
- Inflammatory knee pain due to Lyme disease
- Cervical motion tenderness due to pelvic inflammatory disease
- A meningeal inflammation sign apparent during neurological examinations of arthritis
- Optic nerve damage found upon assessment of cranial nerve II
2. Cervical motion tenderness due to pelvic inflammatory disease
During the pelvic examination, severe discomfort causes the patient to reach up toward the ceiling (where chandeliers hang).
A patient with a penicillin allergy who needs antibiotics for an infection may safely be given any of the following EXCEPT:
Cross hypersensitivity can occur when using beta lactam antibiotics. Up to 10% can occur, in particular, with first-generation cephalosporins.
The nurse practitioner is on-call for the office and speaks by phone to an adult who complains of 48 hours of acute diarrhea consisting of 10 non-bloody loose stools per day. The patient states she has no fever but is asking for antibiotics. She denies any chronic medical diseases and takes no current daily medications. Which of the following is the best initial treatment plan for this patient?
- Encourage fluids, starches, and loperamide 4 mg initially, then 2 mg after each loose stool (not to exceed 16 mg per day)
- Flagyl 500 mg by mouth twice a day for 7 days, encourage hydration with electrolyte enhanced water drinks
- Ciprofloxacin 500 mg by mouth twice a day for 5 days, hydration, loperamide 2 mg (one tablet) every 4 hours (not to exceed 16 mg per day)
- Probiotics, hydration intravenously, triple antibiotic treatment for suspected parasite infection
1. Encourage fluids, starches, and loperamide 4 mg initially, then 2 mg after each loose stool (not to exceed 16 mg per day)
The best initial treatment plan for this patient is to encourage fluids, starches, and loperamide 4 mg initially, then 2 mg after each loose stool (not to exceed 16 mg per day).
A new patient tells the nurse practitioner that he has had a very bad allergy to peanuts in the past and carries an EpiPen wherever he goes. The nurse practitioner educates the patient by reinforcing the need to carry the EpiPen and that anaphylaxis is caused by:
- Chemicals released into the body system by mast cells and basophils.
- Mediators from IgG cells that are released into the blood stream.
- Histamines released into the alveoli by immunoglobulin M.
- Chemicals released into the major organs by eosinophils.
1. Chemicals released into the body system by mast cells and basophils.
Anaphylaxis is an acute, potentially life-threatening hypersensitivity reaction with the sudden onset of rapidly progressive urticaria and respiratory distress. Signs and symptoms occur between 5–30 minutes after contact with the allergen. Rashes, hives, pruritus, swelling of lips, throat, chest tightness, and a feeling of doom occur, and can be fatal. Treatment with epinephrine and transport to the emergency department is required.