
R2 MCQ test 1
Quiz by Natapong Manomaiwong
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A 20-year-old MSM came with diffused MP rash on trunk and extremities including palms and soles for 1 week. He had no fever and other PE was unremarkable. He had multiple partners and last SI was 2 weeks ago. He had never been treated for SY before. Serum RPR was non-reactive but TPHA was reactive. What is the best next step that should be performed on this patient?
A 35-year old Chinese man came for a medical examination for work permit. The syphilis test showed TPHA was positive but RPR was non-reactive. He was not aware of any genital ulcer before. He never had a treatment for syphilis and denied recent unprotected sex. FTA-ABS was performed and it was reactive. Which of the following is the most appropriate management?
A 30-year-old man with HIV infection presented with chronic cough for 3 weeks. He has not taken ARV and initial CD4 was 203 cells/mm3. CXR showed both upper lung reticulonodular infiltration, sputum AFB negative, GeneXpert MTB detected and rifampicin resistant gene (rpoB) detected. He had no MDR TB contact and no history of TB diagnosis and treatment. What is the most appropriate management for this patient after phenotypic drug resistant profile was sent?
A 19-year-old asymptomatic HIV infected man with initial CD4 of 250 cells/mm3 received TDF/3TC/DTG for 6 months. He reported a poor compliance because he studied hard and forgot to take pill. Today, his HIV VL is 18000 copies/mL. What is the most appropriate management?
A 25-year-old HIV infected man with history of IVDU, presented with persistent transaminitis. His initial labs before starting ARV were ALT/AST 144/96 IU/mL and CD4 of 94, HBsAg and anti-HCV were negative, anti-HBs positive. 6 months after initiation of TDF/3TC/DTG, follow up ALT/AST were 156/84, CD4 was increased to 196 and HIV VL was suppressed. He refused other medications/herbs. What is the most useful investigation?
A 65-year-old MSM with newly diagnosis of asymptomatic HIV infection without OI consults you for ART. He also had CKD with eGFR of 45 mL/min. His CD4 is 178, HIV VL is 120,000 copies/mL, HLA B*5701 negative and HBsAg positive. What is the appropriate regimen?
A 72-year-old healthy man with no underlying diseases. He presented with AFI 3 days with productive cough. CXR showed patchy infiltration at LUL. Other labs were unremarkable. He was admitted and received Ceftriaxone + Azithromycin. After 3 days, His clinical was improved but hemoculture grew Aspergillus spp. What is the appropriate management?
30 year-old woman with AML s/p CMT resulted in febrile neutropenia for 2 weeks. She developed hemoptysis and CT chest showed multiple pulmonary nodules. Serum galactomannan is positive. Now she received oral voriconazole and her symptoms was stable but still had persistent neutropenia. She developed multiple deep-seated erythematous nodule over extremities and trunks. Hemoculture reported filamentous fungi.
What is the most likely causative pathogen?
Who was appropriate for treatment of asymptomatic bacteriuria?
A 50-year-old man presented with chronic cough with low grade fever and weight loss for 1 month. CXR showed reticulonodular infiltration at RUL, but sputum AFB negative for 3 days. After 2 months of empirical with HRZE, the patient's symptoms and CXR were improved but sputum grew M. abscessus 1 from 3 specimens. What is the proper management ?