WorksheetsClinical Scenario Worksheet: Infectious Diseases and Neurology
Total questions: 30
Worksheet time: 16mins
ED patient with high fever and a centrifugal rash of deep, firm, umbilicated pustules in the same stage on face and distal limbs. Which immediate steps are appropriate today?
Airborne and contact isolation with restricted room access
Immediate notification of infection prevention and public health
Routine office viral culture in the hospital lab
Reference-lab PCR arranged through public health channels
Broad-spectrum antibiotics as primary therapy
A triage nurse must rapidly distinguish smallpox from varicella in a patient with generalized rash and fever. Which single finding most strongly supports smallpox over varicella?
Lesions in the same stage of development on each body area
Trunk-predominant rash with mixed-stage lesions
Thin-walled 'dew-drop' vesicles on erythematous base
Absence of prodromal high fever
A hospitalized patient with suspected smallpox requires specimen collection under strict protocols. Which request is least consistent with safety and policy?
Coordinate with public health for secure chain-of-custody
Collect in appropriate leak-proof containers with BSL guidance
Send to local routine lab for same-day viral culture
Limit staff exposure and document PPE used
Traveler from an endemic region develops asymmetric flaccid paralysis with reduced reflexes and intact sensation. Which diagnostics best support confirmation now?
Stool RT-PCR and/or viral isolation for poliovirus
Oropharyngeal swab RT-PCR early in illness
CSF lymphocytic pleocytosis as a specific confirmatory test
MRI alone as definitive confirmation
Paired serology when available, interpreted with timing
Suspected bulbar polio presents with dysphagia, weak cough, and pooling secretions. Which single action is the highest priority this hour?
Airway protection and readiness for ventilatory support
Immediate high-dose corticosteroids
Aggressive diuresis to reduce airway edema
Delay interventions pending viral culture
A rehab plan is written for non-bulbar paralytic polio with lower-limb weakness.
Focuses on strengthening lower limbs
Emphasizes speech therapy
Targets upper-limb rehabilitation only
Centers on bulbar muscle recovery
A rehab plan is written for non-bulbar paralytic polio with lower-limb weakness.
Which element is least aligned with evidence-based care?
Early PT with gentle range-of-motion and contracture prevention
Energy conservation with pacing and assistive devices
Prolonged strict bedrest for several weeks
Swallow screening if bulbar signs emerge
A hospitalized patient with encephalitis is tested for rabies; multiple staff had routine contact using gloves and hand hygiene only. Which follow-up is most appropriate?
Standard precautions are adequate; evaluate only mucous membrane exposures
Place entire unit on airborne isolation for 10 days
Monitor all staff for hydrophobia daily
Begin universal PEP for all employees
A family refuses HRIG due to cost but will accept vaccine after a severe bat exposure during sleep. Which counseling point is most accurate today?
HRIG is unnecessary if vaccine is given the same day
HRIG is indicated for previously unvaccinated persons to neutralize virus at the wound
HRIG is only for dog bites, not bats
Vaccine alone provides immediate passive protection
Infant with severe combined immunodeficiency (SCID) awaits HSCT; parents ask about vaccines and precautions. Which single order is least appropriate today?
Live attenuated MMR at 12 months
PJP prophylaxis per protocol
Protective isolation with infection avoidance
Irradiated/CMV-appropriate blood products
Adolescent with chronic granulomatous disease (CGD) has recurrent abscesses by catalase-positive organisms. Which single test best reflects the cellular defect?
Dihydrorhodamine (DHR) flow cytometry for oxidative burst
Serum IgE level
Complement CH50
ANA titer
A nurse sustains a hollow-bore needle-stick from an unknown source patient in the ED. Which single step is most appropriate first?
Initiate HIV PEP promptly per protocol
Wait for source testing before acting
Reassure; risk is negligible with hollow-bore
Test again in 3 months without starting PEP
An outreach session addresses misinformation about casual HIV transmission. Which statement is least accurate?
HIV is not transmitted by shared utensils
Sustained undetectable VL eliminates sexual transmission risk
Mosquitoes commonly transmit HIV in communities
ART is lifelong therapy
First clinic visit after reactive screening test for HIV with plan to start therapy soon.
Which baseline assessments are essential? (Select all that apply.)
. 4th-gen Ag/Ab test with confirmatory assay or NAAT
CD4 count and HIV-1 RNA viral load
Genotypic resistance testing
Screening for HBV/HCV, TB, and STIs; vaccinations review
D-dimer and ferritin as primary staging tools
After starting an integrase-based regimen, the patient feels well at week 4. Which single monitoring step is most appropriate now?
Check HIV-1 RNA viral load at 4–8 weeks
First check at 12 months only
Monitor only when symptoms occur
Stop ART if undetectable now
A suppressed patient on ART for two years asks about follow-up frequency. Which plan best reflects stable care?
Viral load every 3–6 months with adherence review
Monthly CD4 forever regardless of nadir
No labs if the patient feels well
Annual viral load only
The team plans diagnostic confirmation of PCP in a hypoxemic patient. Which single test approach is preferred?
Induced sputum or BAL with DFA or PCR for Pneumocystis
Blood culture
Single β-D-glucan as definitive
Nasal rapid antigen test
A patient starting TMP-SMX for PCP reports sulfa allergy of unknown severity. Which request is least appropriate before changing therapy?
Clarify allergy history and reaction details
Consider desensitization protocol if benefits outweigh risks
Immediately avoid all TMP-SMX without assessment
Assess alternatives if severe reaction documented
Patient with cough >3 weeks, night sweats, weight loss, and upper-lobe cavitary lesion on CXR is admitted. Which immediate steps are indicated?
Airborne isolation with N95 and negative pressure
Sputum AFB smear, culture, and NAAT with drug susceptibility testing
Start RIPE empirically if clinical suspicion is high
Switch to droplet precautions after 24 hours regardless
Public health notification per policy
A patient begins RIPE therapy for drug-susceptible TB and asks about monitoring. Which single monitoring plan is least appropriate?
Baseline and periodic LFTs during therapy
Vision checks with ethambutol
Monthly sputum cultures until conversion
Stop all drugs immediately for any minor transaminase elevation
A clinic wants a quick-reference list of major RIPE adverse effects. Which combination best captures the key concerns?
Rifampin—orange fluids/CYP induction; Isoniazid—hepatitis/neuropathy; Pyrazinamide—hepatotoxicity/hyperuricemia; Ethambutol—optic neuritis
Rifampin—bradycardia; Isoniazid—photosensitivity; Pyrazinamide—ototoxicity; Ethambutol—alopecia
Rifampin—QT prolongation; Isoniazid—hypothyroidism; Pyrazinamide—myelosuppression; Ethambutol—hemolysis
Rifampin—renal failure only; Isoniazid—constipation; Pyrazinamide—constipation; Ethambutol—dry skin
Advanced HIV patient with floaters and blurred vision has fundus consistent with CMV retinitis. Which actions are priorities now?
Urgent ophthalmology consultation
Start anti-CMV therapy such as ganciclovir/valganciclovir
High-dose steroids before antivirals
Counsel on retinal detachment symptoms and urgent return
ART review and CBC monitoring for neutropenia risk
Immunocompromised patient has chronic painful genital ulcers; HSV is suspected. Which single diagnostic test is most appropriate today?
HSV PCR from lesion swab
Bacterial culture of ulcer base
KOH prep for hyphae
Serum heterophile antibody
A patient with orolabial lesions requests antibiotics and steroids without testing. Which clinician response is least appropriate?
Offer HSV PCR to clarify diagnosis
Start empiric acyclovir if classic recurrent HSV
Prescribe broad-spectrum antibiotics and steroids immediately without indication
Provide analgesia and hydration advice
New intake with HIV is HBsAg positive with detectable HBV DNA; ART not yet started. Which initial treatment principles are correct?
Include tenofovir (TDF or TAF) plus emtricitabine or lamivudine for dual HIV/HBV activity
Avoid stopping HBV-active agents abruptly to prevent flare
Use abacavir/lamivudine alone for both viruses
If tenofovir contraindicated, consider entecavir with a fully suppressive HIV regimen
Defer all vaccination counseling for household contacts
A suppressed patient on TDF/FTC-based ART stops all meds for two weeks and returns jaundiced. Which single next step is most appropriate now?
Obtain LFTs urgently and restart HBV-active ART under clinician supervision
Wait a month to see if symptoms resolve
Switch to abacavir/lamivudine only
Continue without HBV-active drugs to avoid toxicity
Clinic revises its co-infection protocol for new starts. Which policy is least consistent with best practice?
Screen for HBsAg, anti-HBc, and anti-HBs before/at ART start
Counsel patients not to stop HBV-active ART without guidance
Recommend HBV vaccination for non-immune partners/household contacts
Avoid tenofovir in all co-infected patients by default
Healthy adult bitten on the hand by an unknown stray dog 10 hours ago with uncertain animal availability.
Which steps are indicated now? (Select all that apply.)
. Copious irrigation and wound cleansing
Human rabies immune globulin (HRIG) infiltrated around wound; remainder IM
Start rabies vaccine series on day 0 (today)
Await animal observation before any prophylaxis
Primary wound closure before irrigation
Child with recurrent otitis, sinopulmonary infections, and chronic diarrhea has very low IgA with normal T-cell counts.
Which findings and next steps are most consistent with an antibody defect? (Select all that apply.)
Poor response to T-dependent protein vaccines
Predisposition to encapsulated bacteria
Severe opportunistic infections typical of T-cell failure
Consideration of IVIG in severe/refractory patterns
Normal B-cell number with class-switching defects possible
Newly diagnosed HIV patient starts ART and asks about U=U and daily habits.
Which counseling points are accurate? (Select all that apply.)
Sustained undetectable viral load prevents sexual transmission
Adherence is critical to maintain suppression
Stop condoms immediately once the first dose is taken
Continue condoms for STI prevention and until suppression confirmed
Discontinue ART after 6 months if VL undetectable
