Medicine
Infectious Disease
Which feature is most concerning for necrotizing fasciitis rather than uncomplicated cellulitis?
A. Mild stable erythema for several days
B. Localized itching only
C. Severe pain out of proportion with rapidly progressive systemic toxicity
D. Small bruise after minor trauma
Correct Answer: C
Pain out of proportion, rapid spread, bullae, crepitus or shock are red flags for necrotizing infection.
Medicine
Infectious Disease
Which complication or major adverse outcome is particularly associated with Nonpurulent cellulitis?
A. Urosepsis
B. Necrotizing soft-tissue infection
C. Hemoptysis
D. Opportunistic infection with advanced immunosuppression
Correct Answer: B
Rapid progression, systemic toxicity and pain out of proportion suggest a deeper necrotizing process.
Medicine
Infectious Disease
A patient is diagnosed with Nonpurulent cellulitis. Which is the most appropriate management principle?
A. Use antimicrobial therapy targeting likely skin flora and address the portal of entry
B. Start prompt age- and risk-appropriate empiric intravenous antibiotics with adjunctive dexamethasone when indicated
C. Give appropriate antimicrobial therapy based on severity, local resistance and patient risk; admit if unstable or unable to tolerate oral therapy
D. Use a guideline-based multidrug antituberculous regimen under appropriate public-health supervision
Correct Answer: A
Typical nonpurulent cellulitis treatment targets streptococci and other likely organisms based on local guidance and severity.
Medicine
Infectious Disease
In a patient with suspected Nonpurulent cellulitis, which investigation or diagnostic approach is most appropriate at this stage?
A. HBV serology, HBV DNA, liver assessment and evaluation for coinfections
B. Blood cultures and lumbar puncture when safe, without delaying empiric therapy in a critically ill patient
C. Urinalysis and urine culture
D. Clinical diagnosis in uncomplicated cases; imaging is reserved for suspected abscess, deep infection or alternative diagnoses
Correct Answer: D
Routine cultures or imaging are often unnecessary in uncomplicated cellulitis.
Medicine
Infectious Disease
A patient has acute unilateral erythema, warmth, tenderness and swelling of the lower leg without a drainable abscess. What is the most likely diagnosis?
A. Falciparum malaria
B. Chronic hepatitis B infection
C. Nonpurulent cellulitis
D. Acute bacterial meningitis
Correct Answer: C
Diffuse inflammatory skin changes without a collection are typical of cellulitis.
Medicine
Infectious Disease
Which finding should raise concern for an obstructed infected urinary system requiring urgent urologic drainage?
A. Simple cystitis without fever
B. Pyelonephritis with hydronephrosis and sepsis
C. Asymptomatic bacteriuria in a healthy nonpregnant adult
D. Isolated microscopic hematuria after exercise
Correct Answer: B
Infection behind an obstructed collecting system is a source-control emergency.
Medicine
Infectious Disease
Which complication or major adverse outcome is particularly associated with Acute pyelonephritis?
A. Urosepsis
B. Opportunistic infection with advanced immunosuppression
C. Toxic megacolon
D. Cerebral malaria
Correct Answer: A
Ascending urinary infection can cause bacteremia and septic shock.
Medicine
Infectious Disease
A patient is diagnosed with Acute pyelonephritis. Which is the most appropriate management principle?
A. Use a guideline-based multidrug antituberculous regimen under appropriate public-health supervision
B. Start effective combination antiretroviral therapy and address opportunistic-infection prevention and treatment
C. Stop unnecessary precipitating antibiotics and use recommended C. difficile-directed therapy based on severity and recurrence
D. Give appropriate antimicrobial therapy based on severity, local resistance and patient risk; admit if unstable or unable to tolerate oral therapy
Correct Answer: D
Treatment intensity depends on sepsis, pregnancy, obstruction, comorbidity and oral tolerance.
Medicine
Infectious Disease
In a patient with suspected Acute pyelonephritis, which investigation or diagnostic approach is most appropriate at this stage?
A. Clinical diagnosis in uncomplicated cases; imaging is reserved for suspected abscess, deep infection or alternative diagnoses
B. Microbiologic testing of respiratory specimens with rapid molecular testing and culture
C. Urinalysis and urine culture
D. Laboratory HIV antigen/antibody testing with confirmatory testing according to the diagnostic algorithm
Correct Answer: C
Urine culture confirms the pathogen and guides antibiotic selection, especially in systemic infection.
Medicine
Infectious Disease
A patient has fever, flank pain, costovertebral-angle tenderness and urinary symptoms. What is the most likely diagnosis?
A. Acute bacterial meningitis
B. Acute pyelonephritis
C. Nonpurulent cellulitis
D. Pulmonary tuberculosis
Correct Answer: B
Systemic illness plus flank pain and urinary features is typical of upper urinary tract infection.
Medicine
Infectious Disease
Which clinical situation is a reason to consider brain imaging before lumbar puncture?
A. Focal neurologic deficit or signs suggesting raised intracranial pressure
B. Mild sore throat only
C. Uncomplicated cystitis
D. Stable ankle sprain
Correct Answer: A
Selected patients need imaging first because lumbar puncture may be unsafe when significant mass effect or raised intracranial pressure is suspected.
Medicine
Infectious Disease
Which complication or major adverse outcome is particularly associated with Acute bacterial meningitis?
A. Cerebral malaria
B. Cirrhosis and hepatocellular carcinoma
C. Urosepsis
D. Sensorineural hearing loss
Correct Answer: D
Neurologic sequelae including hearing impairment can follow bacterial meningitis.
Medicine
Infectious Disease
A patient is diagnosed with Acute bacterial meningitis. Which is the most appropriate management principle?
A. Stop unnecessary precipitating antibiotics and use recommended C. difficile-directed therapy based on severity and recurrence
B. Use species- and severity-appropriate antimalarial therapy; severe malaria requires urgent parenteral treatment
C. Start prompt age- and risk-appropriate empiric intravenous antibiotics with adjunctive dexamethasone when indicated
D. Use specialist-guided antiviral therapy for patients meeting treatment criteria and perform appropriate liver-cancer surveillance in at-risk groups
Correct Answer: C
Bacterial meningitis is time-critical; empiric therapy should cover likely pathogens and be refined when results return.
Medicine
Infectious Disease
In a patient with suspected Acute bacterial meningitis, which investigation or diagnostic approach is most appropriate at this stage?
A. Laboratory HIV antigen/antibody testing with confirmatory testing according to the diagnostic algorithm
B. Blood cultures and lumbar puncture when safe, without delaying empiric therapy in a critically ill patient
C. Stool testing using an accepted C. difficile diagnostic algorithm in a patient with clinically significant diarrhea
D. Urgent malaria testing with thick and thin blood films or validated rapid testing, repeated if initial testing is negative but suspicion remains
Correct Answer: B
CSF analysis is diagnostic, but antibiotics must not be delayed when meningitis is strongly suspected.
Medicine
Infectious Disease
A patient has fever, severe headache, neck stiffness and altered mental status. What is the most likely diagnosis?
A. Acute bacterial meningitis
B. Pulmonary tuberculosis
C. Human immunodeficiency virus (HIV) infection
D. Clostridioides difficile infection
Correct Answer: A
Fever, meningism and encephalopathy should be treated as possible acute bacterial meningitis.