CMPP ID Latest Update -

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A 2 year old female presents to the office with a fever and irritability with poor feeding.You suspect staphylococcal scalded skin syndrome. Which of the following would you expect to see on physical exam?

• Blisters on the skin surface and mucous membranes
• Child is energetic and paying attention
• Pressure on lesions to rupture leaving denuded skin underneath

D. There are no specific signs in this patient - CORRECT ANSWER: C. Pressure on

lesions to rupture leaving denuded skin underneath ---- Nikolsky's sign

This is because of an exfoliative toxin.Will see blisters to exfoliation that spares the mucous membranes.Patients can present with lethargy

A 2 year old girl presents to the office with a sore throat, abdominal pain, and nausea and vomiting. Her rapid strep test comes back positive. Her mother mentions that she has a penicillin allergy. What medication do you give her?

• cephalexin
• azithromycin
• metronidazole

D. amoxicillin - CORRECT ANSWER: B. azithromycin

but first line for GAS is PCN VK or amoxicillin

A 22 year old female presents to the office with nausea, vomiting, and diarrhea for 1 day. She states she had Chinese takeout last night and thoroughly enjoyed the house special fried rice combo. What is the most likely pathogen?

• staph aureus
• salmonella enterica
• bacillus cereus

D. clostridium perfringens - CORRECT ANSWER: C. bacillus cereus

heat resistant organism found in uncooked rice

tx: self-limited no diagnostic test needed

A 23 year old female presents to the office complaining of non-specific flu-like symptoms. Her blood pressure is 110/75 and her temperature is 100.9. She states her period started 3 days ago and she uses tampons while on her period. Which of the following would you not expect to see on?

• desquamation of the skin
• rash that spares the palms and soles 1 / 4

• abdominal pain

D. vomiting and diarrhea - CORRECT ANSWER: B. rash that spares the palms and

soles

The initial rash involves the palms and soles.

Treat with supportive care and can use clindamycin because it reduces toxin production

A 25 year old female presents to the office with an infection that starts in her hair follicles and spreads to adjoining tissue. Your culture of the purulent material comes back as MRSA. What is not an indicated treatment?

• Bactrim
• Doxycycline
• Ceftriaxone

D. Clindamycin - CORRECT ANSWER: C. Ceftriaxone

if it was only MSSA you can give PCN V, amoxicillin, Keflex, or cefadroxil

A 30 year old female who is 12 weeks pregnant presents to the office with fever, diarrhea, and a headache. She states she went to a picnic with a charcuterie board and ate lots of soft cheeses and lunch meats. What treatment is indicated?

• supportive care
• ampicillin
• doxycyclin

D. vancomycin - CORRECT ANSWER: B. ampicillin

first line for listeria monocytogenes.if PCN allergy use bactrim if neonate use ampillin plus gentamycin

A 30 year old woman presents to the office with severe, achy RUQ pain that radiates to the right arm and shoulder. She has a temperature of 101.2 and mentions that her partner tested positive for gonorrhea/chlamydia a month ago, but she did not think it was necessary for her to be treated. What now is her most likely diagnosis?

• gonorrhea
• choledocholithiasis
• appendicitis

D. fitz hugh curtis syndrome - CORRECT ANSWER: D. fitz hugh curtis syndrome

this is a perihepatitis that is a complication from PID Can cause perihepatic lesions secondary to capsular inflammation of the liver

A 31 year old female presents to the office complaining of a change in vaginal odor that she recognizes after intercourse and grey colored vaginal discharge. What type of cells can be seen from a vaginal culture?

• Bite cells 2 / 4

• Clue cells
• Whiff cells

D. Thomas cells - CORRECT ANSWER: B. Clue cells

gardnerella vaginalis treat with metronidazole or clindamycin

A 40 year old male presents to the office complaining of pain while urinating and itching in his genitals. He states he noticed white discharge under the foreskin and it has been hard to retract. What medication would you give him?

• topical azole
• amphotericin b
• itraconazole

D. terbinafine - CORRECT ANSWER: A. topical azole

cadidiasis topical azole - clotrimazole OR miconazole or oral fluconazole

A 50 year old female presents to the office with diplopia, facial paralysis, dry mouth, constipation, and sore throat. She is complaining of her arms feeling limp and now her legs are beginning to feel the same way. She is afebrile and A&O x 3. She tells you that she is passionate about cooking and cans her own foods. What is your next step in her treatment?

• wound debridement
• hospitalization for observation
• supportive care

D. IV vancomycin STAT - CORRECT ANSWER: B. hospitalization for observation

clostridium botulinum commonly from home preserved foods Must be hospitalized due to descending flaccid paralysis which progresses to respiratory failure Can also administer anti-toxin if available No wound debridement because this specific case was food borne, but would debride if needed

A 55 year old male presents to the office with severe flank pain, dysuria, frequency, and urgency. You suspet a struvite stone. What is the indicated treatment?

• start doxycylcine
• stone removal, then doxycycline
• stone removal, then ceftriaxone

D. stone removal, then nitrofurantoin - CORRECT ANSWER: C. stone removal, then

ceftriaxone

proteus is not susceptible to tetracylcines, nitrofurantoin, and ampicillin 3 / 4

A 55 year old man with a temperature of 101.5 and complaining of a headache comes into the office. Upon physical exam he appears confused and has a stiff neck. He has a negative Brudinzinski's sign. What else would you expect to see on physical exam?

• hypertensive
• tachycardia
• resting tremor

D. CN palsies - CORRECT ANSWER: D. CN palsies - commonly 3 and 6

Meningitis will also present with bradycardia, hypotension, and patient appears toxic

A 68 year old male presents to the office stating that he had severe pain in his arm yesterday along with a fever and chills. Today his skin appears dusky and mottled and he reports less pain. What is the next step in his treatment?

• administer vancomycin
• give Bactroban topically
• surgical exploration

D. administer PCN G - CORRECT ANSWER: C. surgical exploration

necrotizing fasciitis needs early surgical exploration.Relief of pain is due to destruction of cutaneous nerves.ABX can be started in addition to surgery.

A 7 year old boy comes into the office after his mother removed a tick from him yesterday. They went on a hike a few days ago and the mother states she removed the tick 2 days after the hike. The county they live in has and infectivity rate of 25%. Is the

patient eligible for prophylactic treatment? - CORRECT ANSWER: No

doxy is contraindicated due to the patients age

criteria:

tick on for more than 36 hours prophylaxis can be started within 72 hours local infectivity rate greater than 20% doxy is not contraindicated

A child comes in to the office with honey colored crusts on their face. What is the treatment of choice?

• Keflex
• amoxicillin
• clindamycin

D. augmentin - CORRECT ANSWER: A. Keflex

Keflex is the oral abx of choice.Can also treat with Bactroban topically

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