Stay ConnectedThe Infectious Disease Board Review (IDBR) Course is designed to help physicians prepare for the American Board of Internal Medicine (ABIM) Infectious Disease certification/recertification exam.
This comprehensive review features exam-focused lectures presented by the Nation’s leading infectious disease experts, case-based reviews, online practice exams featuring over 500 ABIM-style and photo-based questions, and additional study guides and primers.
https://www.idbrcourse.org/
Copyright: © John Bennett, MD / Henry Masur, MD
A 47-year-old female grew up in an impoverished farming community in Argentina. She moved to the
United States when she was 16 years of age.
Three years ago, she developed progressive dyspnea on exertion. A cardiac workup revealed a markedly
enlarged heart, ejection fraction of 25%, and no obstruction of the coronary arteries by angiography.
The most likely pathogen causing her cardiac disease, assuming it is due to an infection acquired in
Argentina, is:
A. Leishmania donovani
B. Taenia solium
C. Trypanosoma cruzi
D. Toxoplasma gondii
E. Trichinella spiralis
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A 62-year-old male was seen for low grade fever and weight loss over the past month.
He had undergone aortic valve replacement in 2015 with a bioprosthesis. Transesophageal
echocardiography found no evidence of endocarditis and routine blood cultures were negative.
Mycobacterial blood cultures grew Mycobacterium chimaera.
The patient lived in a rural area, drank well water and had a pond in this back yard with Koi fish.
The most likely source of this Mycobacterial infection is which of the following:
A. Operating room air
B. Bioprosthetic valve
C. Well water
D. Fish pond
E. Intestinal lesion
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A 37-year-old woman from New Jersey undergoes routine HIV testing with the following results:
• HIV 4th generation test: Reactive (antibody positive + p24 antigen negative)
• HIV-1/2 Supplemental Assay: HIV-1 antibody negative, HIV-2 antibody negative
• HIV-1 RNA: <20 copies/ml
What is the most likely interpretation of the results?
A. She is a long-term non-progressor
B. She has acute HIV-1 infection
C. She has acute HIV-2 infection
D. She has a false negative viral test
E. She has a false positive 4th generation test
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A 30-year-old female presents with a new diagnosis of smear-positive pulmonary TB.
She is also found to have a new diagnosis of HIV.
Labs show mild anemia, normal liver enzymes, CD4 cell count=25 cells/uL.
Which is most appropriate approach to therapy:
A. Start HIV treatment immediately, defer TB treatment
B. Start TB treatment immediately, defer HIV treatment until after 6 months of TB treatment
C. Start TB treatment immediately, and start HIV treatment in 8-12 weeks
D. Start TB treatment immediately, and start HIV treatment within 2 weeks
E. Start HIV treatment immediately, and start TB treatment within 2 weeks
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A 40-year-old female is admitted with a 3-week history of daily fever accompanied by a non-pruritic skin
eruption. She was initially seen at a walk-in clinic 5 weeks ago for cough and given a 7-day course of
Augmentin for bronchitis with resolution of respiratory symptoms. In the last 2 weeks she has developed
diffuse arthritis of hands, knees, elbows, and ankles.
Labs include WBC of 7.8 (82% seg, 15% lymph, 3% eos), platelets of 159, alkaline phosphatase of 454, ALT/AST
137/118 and bilirubin 1.9.
CRP is 183.6, rheumatoid factor <10, ANA negative. Ferritin is 8622
CT scan of the abdomen shows hepatosplenomegaly and peri-portal lymphadenopathy.
What is the most likely diagnosis for this patient?
A. Adult-onset Still’s disease
B. DRESS (drug associated rash with eosinophilia and systemic symptoms)
C. SLE (systemic lupus erythematosus)
D. HLH (hemophagocytic lymphohistiocytosis)
E. Acute CMV infection
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A 62-year-old man with a history of hypertension has taken HIV PrEP with tenofovir DF/emtricitabine for 5
years.
His baseline creatinine clearance was 85 cc/min, but this has trended down with his latest creatinine
clearance 55 cc/min (repeated at 60 cc/min).
He is in a monogamous relationship with his partner who has HIV and is taking a bictegravir-based regimen
with HIV RNA <20 for years.
How would you manage his PrEP?
A. Continue tenofovir DF/emtricitabine, follow creatinine clearance monthly
B. Change to tenofovir AF/emtricitabine
C. Change to injectable cabotegravir every other month
D. Stop PrEP
This 52 minute session, called an HIV bootcamp, is taken from the extensive teaching material on the infectious disease board review website, available to persons who subscribe to the Home study course, the live or the virtual course. This lecture by Dr. Gulick is for physicians who need introductory material before progressing to more advanced topics likely to be on certifying or recertifying examinations given by the American Board of Internal Medicine.
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An 80-year-old resident of a nursing home has severe dementia, type 2 diabetes mellitus and a chronic indwelling Foley catheter which is in place to manage his persistent incontinence. He has no remarkable medical history and is quite healthy except for his dementia. He has received antibiotics for presumed urinary tract infection twice in the last year.
The nursing home staff decided to obtain a urinalysis and urine culture: they call you because the urine culture is growing Candida albicans with a colony count of 100,000 cfu/ml. His UA shows 30-40 WBC and 10-20 RBC per HPF, with a 1+ leukocyte esterase.
He is in his usual state of health with no fever, no urinary symptoms that you can elicit from him, and no flank tenderness.
What would you recommend?
A. Observe and do nothing more unless the patient becomes symptomatic
B. Observe but obtain repeat urinalysis and culture in one week
C. Change Foley catheter and give oral fluconazole for 1 week
D. Change Foley catheter and IV caspofungin for 1 week
E. Change the Foley catheter and order Amphotericin B deoxycholate bladder washes daily for 5-7days
©2024 Infectious Disease Board Review, LLC
A 42-year-old male presents with a deformed foot and draining sinuses. The patient is a native of Mexico, where he does manual labor. He noted the onset of persistent swelling 2 years earlier in Mexico after dropping a heavy wooden box on his foot. He received various treatments, but his foot has become more deformed. He is visiting family in the United States and comes to you for advice.
He is afebrile, with normal vital signs. He looks well. His exam is normal except for his left foot, which is swollen and firmly indurated, particularly over the metatarsals, but not very tender. Several draining sinuses are present.
His routine lab work, including CBC, is normal. An x-ray of his foot shows soft tissue defects without bony erosions.
The appropriate approach would be:
A. An empiric course of trimethoprim-sulfamethoxazole
B. An empiric course of amphotericin
C. An empiric course of itraconazole
D. Smear and culture of the sinus discharge before initiating therapy
E. Surgical biopsy and culture of deep tissue
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©2024 Infectious Disease Board Review, LLC
Two hours after eating at a hotel buffet in Hawaii, a 56-year-old man experiences abdominal pain, vomits once, and has one loose stool. Two days later he experiences numbness of his extremities, tongue, and throat.
He finds that cold objects feel hot and hot objects feel cold, and his teeth feel numb and loose. He develops weakness, gait ataxia, and vertigo. He is hospitalized where he has a slow convalescence. Neurological symptoms persist for one month before he is completely well.
What is the likely diagnosis?
A. Ciguatera
B. Scombroid
C. Paralytic Shellfish Poisoning
D. Botulism
E. Staphylococcal food poisoning
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©2024 Infectious Disease Board Review, LLC
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