Infectious Diseases

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Clostridioides difficile Infection

Fecal microbiota transplantation is noninferior to oral vancomycin for patients with a first episode of Clostridioides difficile infection.

  • True
  • False
Volume 41.2 - Question 25

H. pylori Screening Post Myocardial Infarction

Routine screening for H. pylori during hospitalization for acute myocardial infarction reduces the risk of gastrointestinal bleeding.

  • True
  • False
Volume 41.2 - Question 24

Perinatal HIV Transmission

Starting antiretroviral therapy before pregnancy and sustaining a maternal HIV viral load of <50 copies per mL through birth was associated with zero observed risk of perinatal transmission of HIV.

  • True
  • False
Volume 41.2 - Question 11

Resistant Mycoplasma Pneumoniae in Children

Which one of the following statements about macrolide resistant mycoplasma pneumoniae in children is false?

  • M pneumoniae resistance to macrolide therapy is prevalent in China and Japan.
  • Antibiotics in the tetracycline class are effective.
  • Fluoroquinolones are not indicated.
  • Doxycycline may be used for 21 days or less in children younger than 8 years old when indicated.
Volume 41.2 - Question 9

Antibiotic Use for UTI and Risk of Congenital Malformations

When treating patients with a UTI in the first trimester of pregnancy, trimethoprim-sulfamethoxazole is associated with an increased risk of congenital malformation compared with treatment with a β-Lactam antibiotic.

  • True
  • False
Volume 41.1 - Question 3

Treatment of Early Syphilis

Persons with early syphilis, including persons with HIV infection, can be effectively treated on a single occasion with benzathine penicillin G administered in a single dose of 2.4 million units.

  • True
  • False
Volume 41.1 - Question 1

Otitis Media

A two-year-old child is brought to your office by their parents because of symptoms of upper respiratory tract infection for the past 4 days. They are concerned that their child may have an ear infection. (Acute otitis media).
Volume 40.6 - Question 36

Malaria

Which one of the following statements about malaria is false?

  • Sterilizing immunity occurs with repeated exposure to Plasmodium
  • Pulmonary edema is a clinical presentation of severe malaria in adults.
  • Malaria can occur without exposure to a region where the disease is endemic.
  • Mosquito resistance to insecticides is widespread in sub-Saharan Africa.
Volume 40.6 - Question 15

Treatment of Genital Warts

Which one of the following statements about treatment of genital warts is false?

  • Sinecatechins are a patient-administered treatment option.
  • When performing smoke-generating procedures such as cautery to destroy or remove HPV-associated lesions, measures should be taken to prevent transmission of HPV DNA to the respiratory tracts of the physician.
  • Imiquimod is recommended in pregnancy.
  • Most successfully treated warts do not recur.
Volume 40.6 - Question 12

Genital Warts

Which one of the following statements about genital warts is false?

  • Human papillomavirus types 6 and 11 are responsible for 90% of genital wart cases.
  • About 30% of genital warts cases resolve spontaneously within 4 months.
  • Individuals who currently smoke have an increased risk of developing genital warts.
  • Male circumcision reduces the incidence of genital warts in males.
Volume 40.6 - Question 11

Breast and Chestfeeding in Virally Suppressed HIV

The risk of perinatal HIV transmission from breast- or chestfeeding is very low when a parent with HIV is on antiretroviral therapy and virally suppressed.

  • True
  • False
Volume 40.5 - Question 14

Lenacapavir for HIV Prevention

Which one of the following statements regarding lenacapavir for human immunodeficiency virus preexposure prophylaxis is false?

  • It is a twice-yearly subcutaneous injection.
  • It is efficacious for prevention of HIV infection in a population of cisgender women.
  • It is more efficacious than daily oral emtricitabine–tenofovir disoproxil fumarate in preventing HIV infection.
  • It is associated with a decline from baseline estimated glomerular filtration rate.
Volume 40.5 - Question 13

Recurrent Bacterial Vaginosis

The use of oral and topical antimicrobial therapy for male partners, when their female partner is treated for bacterial vaginosis, results in a significantly lower recurrence rate of bacterial vaginosis over a period of 12 weeks than the recommended practice of treating women only.

  • True
  • False
Volume 40.5 - Question 1

Acute Rhinosinusitis

A 19-year-old patient with a history of allergic rhinitis is at your office because he is suffering facial pain over his sinuses, fever, and purulent nasal discharge with obstruction of the nasal passages for about 5-7 days. You suspect that he has acute rhinosinusitis.
Volume 40.4 - Question 38

Urine Testing for Infection in Older Adults

Which one of the following statements about urine testing to rule out infection in patients older than 65 is false?

  • For patients with indwelling catheters, urine cultures should only be collected from the first void in a newly replaced catheter.
  • Urine dipstick testing is not recommended to diagnose urinary tract infection (UTI) in adults living in long-term care.
  • Treating asymptomatic bacteriuria (ASB) reduces the risk of developing a subsequent UTI.
  • In the absence of urinary signs or symptoms or signs of sepsis, asymptomatic bacteriuria is an unlikely cause of delirium.
Volume 40.4 - Question 21

Cancer and Development of Tuberculosis Disease

Which one of the following statements regarding individuals with cancer and the diagnosis of tuberculosis disease is false?

  • The likelihood of diagnosis is lower for those with haematologic malignancies than for individuals without cancer.
  • Most people will be diagnosed within 6 months of cancer diagnosis.
  • The median time to diagnosis for those with respiratory cancers is less than 2 months.
  • There is approximately a six-fold increase in the risk of diagnosis within 2 years of cancer diagnosis.
Volume 40.4 - Question 20

Human Strongyloides stercoralis Infection

Which one of the following statements about human Strongyloidiasis is false?

  • Strongyloides stercoralis is a soil-transmitted helminth affecting 30-100 million people worldwide.
  • Autoinfection can result in chronic infection lasting up to 5 years after initial exposure.
  • Hyperinfection occurs mainly in patients who are immunocompromised or immunodeficient.
  • Patients undergoing transplantation should be screened for S. stercoralis.
Volume 40.4 - Question 19

Sepsis

Which one of the following statements about sepsis is false?

  • Sepsis is a syndrome of life-threatening acute organ dysfunction due to a dysregulated host response to infection.
  • Candida species is a rare pathogen cultured from blood.
  • Worldwide incidence is highest among children less than 5 years of age.
  • Persistent lymphopenia is associated with an increased risk of death.
Volume 40.4 - Question 9

Respiratory Syncytial Virus Vaccination in Pregnancy

Which one of the following statements about respiratory syncytial virus (RSV) vaccination in pregnancy is false?

  • RSVpreF vaccination in pregnancy protects infants up to 6 months of age.
  • Maternal vaccination decreases infant RSV infections and hospital admissions.
  • Health Canada has authorized RSVpreF vaccination at 32-36 weeks’ gestation.
  • Vaccination in pregnancy is not an alternative to infant RSV immunization.
Volume 40.4 - Question 6

Nirsevimab to Prevent RSV in Infants

Which one of the following statements regarding administering nirsevimab to infants to prevent respiratory syncytial virus (RSV) is false?

  • It has been shown to reduce hospitalizations due to RSV.
  • It is administered as a single dose before or during RSV season.
  • Anaphylactic reactions have been reported.
  • For infants in the first year of life, the dose is weight-based.
Volume 40.4 - Question 5

Respiratory Syncytial Virus

You have been providing prenatal care to a 30 year old woman (G1P0). She attends your office for a routine prenatal visit at 22 weeks. Her estimated date of delivery is in November. At the end of her visit she asks about the new vaccine for protecting her infant from respiratory syncytial virus (RSV).
Volume 40.3 - Question 39

Avian Flu

Which one of the following statements about highly pathogenic avian influenza A(H5N1) virus infections in humans is false?

  • It generally causes mild illness.
  • Duration of illness is short.
  • Evidence of human-to-human A (H5N1) transmission has been identified.
  • Personal protective equipment use among occupationally exposed persons is suboptimal.
Volume 40.3 - Question 22

Corticosteroids in Pneumonia

Corticosteroids are strongly recommended in adults hospitalized with severe bacterial community-acquired pneumonia.

  • True
  • False
Volume 40.3 - Question 21

The Right Test for Febrile Young Infants

Procalcitonin testing is currently the best diagnostic test available to help guide management in febrile young infants.

  • True
  • False
Volume 40.3 - Question 12

Respiratory Syncytial Virus (RSV) Vaccination in Older Adults

Which one of the following statements regarding RSV vaccination in adults is false?

  • One dose of the RSV vaccine offers protection for at least 2 respiratory virus seasons.
  • There is a small associated increase in the incidence of Guillain-Barre syndrome.
  • There are currently no recommendations regarding booster doses.
  • The National Advisory Committee on Immunization recommends RSV vaccination for all adults aged 65 or older.
Volume 40.3 - Question 7

Chlamydia and Gonorrhea

You are starting a new position at a student health centre. In preparation for your first shift, you decide to review the current recommendations for the diagnosis and management of chlamydia and gonorrhea.
Volume 40.21 - Question 1

Female Genitourinary Schistosomiasis

For suspected female genitourinary schistosomiasis, an empiric treatment course of praziquantel in exposed serology-positive women with clinically compatible and unexplained genitourinary signs and symptoms could be beneficial.

  • True
  • False
Volume 40.2 - Question 10

Listeriosis in Pregnancy

Which one of the following statements about Listeriosis in pregnancy is false?

  • Invasive listeriosis (bacteremia or meningitis) in pregnancy leads to major fetal consequences, including fetal loss.
  • Most exposures in pregnancy to listeriosis result in symptoms.
  • Investigations or treatment are not indicated in asymptomatic patients who have ingested possibly contaminated foods.
  • In febrile patients with possible exposure to L. monocytogenes, blood cultures should be immediately drawn and high-dose ampicillin initiated.
Volume 40.1 - Question 13

Tazocin for Sepsis

Among patients with suspected sepsis treated with vancomycin and no clear indication for anti-anaerobic coverage, administration of piperacillin-tazobactam is associated with higher mortality compared with cefepime.

  • True
  • False
Volume 40.1 - Question 4

Mycobacterium Abscessus

Which one of the following statements about Mycobacterium abscessus infection is false?

  • Precautionary concern is warranted for people who seek cosmetic procedures outside Canada.
  • abscessus is resistant to classic anti-tuberculous medication and to most antibiotics.
  • It is difficult to identify on Gram stains and routine cultures.
  • Clarithromycin monotherapy is as efficacious as surgical intervention plus antibiotics for surgical site infections.
Volume 39.6 - Question 29

Sepsis and Physician Gestalt

Physician gestalt is superior to existing screening tools for identifying sepsis in critically ill patients presenting to the emergency department.

  • True
  • False
Volume 39.6 - Question 28

Syphilis-Related Stillbirth

Syphilis-related stillbirths account for more than 10% of all stillbirths at the largest tertiary referral centre in Manitoba.

  • True
  • False
Volume 39.6 - Question 15

Pediatric UTI

A 5-day treatment of acute febrile UTIs in children with oral amoxicillin-clavulanic acid was non-inferior to a 10-day treatment.

  • True
  • False
Volume 39.6 - Question 14

Rapid Tests for Group A Streptococcus

For negative rapid antigen detection tests for group A Streptococcus (GAS) pharyngitis in children, a confirmatory throat culture should be performed to ensure that GAS was not missed.

  • True
  • False
Volume 39.6 - Question 12

Chlamydia and Gonorrhea

You are starting a new position at a student health centre. In preparation for your first shift, you decide to review the current recommendations for the diagnosis and management of chlamydia and gonorrhea.
Volume 39.5 - Question 43

Cardiovascular Disease in HIV

In patients with low to moderate risk of cardiovascular disease receiving antiretroviral therapy for HIV infection, statin therapy lowers the risk of a major adverse cardiovascular event. 

  • True
  • False
Volume 39.5 - Question 25

Cognition and Memory after Covid-19

Larger deficits in cognition and memory occurred in patients who had SARS-CoV-2 infection during the periods in which the original virus or the B.1.1.1.7 variant was predominant than those in later variants. 

  • True
  • False
Volume 39.5 - Question 24

UTI in Children with Respiratory Symptoms

If respiratory symptoms or a known respiratory tract infection are present in a febrile infant younger than 2 months of age, a urinalysis is a necessary part of the workup.

  • True
  • False
Volume 39.5 - Question 5

HIV Prevention

Post-exposure prophylaxis-in-pocket is an HIV prevention strategy targeted to those who have lower frequencies (i.e., 0 to 4) of higher-risk, and typically unanticipated, HIV exposures per year.

  • True
  • False
Volume 39.5 - Question 1

Total Knee Replacement

What percentage of total knee replacements last 25 years?

  • 20%
  • 40%
  • 60%
  • > 80%
Volume 35.61 - Question 27

Treatment of Bone and Joint Infections

For bone and joint infections, switching to oral antibiotics after the first seven days of IV antibiotics is inferior to IV antibiotic treatment for the first six weeks.

  • True
  • False
Volume 35.61 - Question 25

Pharmacological Management of Type 2 Diabetes

A glucagon-like peptide-1 receptor agonist or SGLT2 inhibitor with demonstrated cardiovascular (CV) outcome benefit should be considered as initial add-on therapy for people with pre-existing type 2 diabetes and clinical CV disease who have not achieved target A1C on existing treatment to reduce CV risk.

  • True
  • False
Volume 35.61 - Question 22

Vitamin K Prophylaxis

Which one of the following statements about vitamin K prophylaxis in newborns is false?

  • Early vitamin K deficiency bleeding (VKDB) is commonly associated with maternal medications that inhibit vitamin K activity.
  • Late VKDB rarely occurs in breastfed infants.
  • There is a 50% chance that infants with late VKDB will experience serious intracranial hemorrhage.
  • Infants receiving oral vitamin K should have more than one dose.
Volume 35.61 - Question 18

End of Life Antimicrobial Therapy

In terminally ill patients with an infection and a prognosis that is anticipated to be weeks to months, there is little evidence that antimicrobials provide significant survival benefit.

  • True
  • False
Volume 35.61 - Question 17

Human Papillomavirus Self-Sampling

Mailing human papillomavirus self-sampling kits is more effective in screening hard-to-reach women than reminder letters for Pap test screening.

  • True
  • False
Volume 35.61 - Question 7

Chlorhexidene Decolonization

In nursing homes, universal decolonization with chlorhexidine and nasal iodophor leads to a significantly lower risk of transfer to a hospital due to infection than routine care. 

  • True
  • False
Volume 39.4 - Question 24

Cyclosporiasis

Which one of the following statements about cyclosporiasis is false? 

  • It often occurs in international travelers or those who have ingested fresh produce imported from endemic regions.   
  • Direct person-to-person transmission is likely.   
  • The average incubation period is about seven days after ingestion.   
  • No effective alternative treatment has been identified for patients with a sulfa allergy. 
Volume 39.4 - Question 23

Eye Infections

Which one of the following statements regarding eye infections is false? 

  • Viruses are the main cause of conjunctivitis in adults.   
  • Infection-control measures are essential to prevent epidemic keratoconjunctivitis outbreaks.   
  • Contact lens wear is the most important risk factor for microbial keratitis.   
  • Endogenous endophthalmitis only affects one eye. 
Volume 39.4 - Question 22

Outdoor Cold Air for Croup Symptoms

A 30-minute exposure to outdoor cold air (<10°C), as an adjunct to oral dexamethasone, is beneficial for reducing the intensity of clinical symptoms in children with croup. 

  • True
  • False
Volume 39.4 - Question 11

Giardiasis

Which one of the following statements about giardiasis is false? 

  • The Giardia cyst is susceptible to chlorinated water.   
  • Symptoms usually occur one to two weeks after ingestion of cysts.   
  • Symptoms are self-limited and generally last two to six weeks.    
  • Individuals should avoid dairy for one month after treatment. 
Volume 39.4 - Question 3

Virtual Care for COVID-19

A 67-year-old female has a virtual care visit today because she is worried that she may have been recently infected by COVID-19.
Volume 36.63 - Question 24

Type 2 Diabetes During COVID19

Three months ago, you saw a 69-year-old male with diabetes for his routine follow-up. At that time, his A1C was 7.5% and his blood pressure was normal. You notice that your secretary has left a message near your door: your patient has cancelled his visit today because he is afraid of exposing himself to COVID-19. You decide to call him during your planned visit.
Volume 36.63 - Question 23

Sperm Count and mRNA Vaccines

COVID-19 mRNA vaccines are associated with significant reductions in sperm count in healthy males.

  • True
  • False
Volume 36.63 - Question 22

Tofacitinib in COVID-19 Pneumonia

Treatment with tofacitinib reduces the combined outcome of death or respiratory failure in patients hospitalized with Covid-19 pneumonia who are not receiving non-invasive or invasive ventilation.

  • True
  • False
Volume 36.63 - Question 21

COVID-19 Brain Impacts

Mild cases of COVID-19 may be associated with cognitive deficits months after recovery.

  • True
  • False
Volume 36.63 - Question 19

Saliva Based COVID Testing

Which one of the following statements about saliva PT-PCR test for SARS-CoV-2 infection is false?

  • Saliva sensitivity is highest in samples collected during the first week of infection.
  • The sensitivity is much higher in symptomatic patients
  • Higher viral load is associated with higher odds of a positive test
  • After 10 days of infection a positive RT-PCR result confirms remaining infectivity.
Volume 36.63 - Question 20

Myocarditis with the mRNA COVID-19 Vaccines

The risk of myocarditis and pericarditis following administration of mRNA-based COVID-19 vaccines is higher in males.

  • True
  • False
Volume 36.63 - Question 18

IVM COVID

Compared with the standard of care or placebo, ivermectin reduces mortality in COVID patients.

  • True
  • False
Volume 36.63 - Question 17

COVID-19

Lequel des énoncés suivants sur les séquelles à long terme de la COVID-19 quatre mois après le congé de l’hôpital est faux ?

  • La moitié des patients signalent au moins un symptôme qui n’existait pas avant la COVID-19.
  • Les symptômes cognitifs sont signalés chez quelque 20 % des patients.
  • Les anomalies à la tomodensitométrie des poumons sont courantes.
  • De nouveaux cas de dyspnée sont signalés chez plus de la moitié des patients.
Volume 36.63 - Question 16

Post-COVID Syndrome

Which one of the following statements about outcomes among those discharged following an admission to hospital with covid-19 is false?

  • There is an increased risk of readmission compared with individuals with similar personal and clinical characteristics.
  • Rates of major adverse cardiovascular events are increased compared to a matched control group.
  • Patients older than age 70 have a greater relative risk of death compared to those under 70 years.
  • Rates of new diagnosis of diabetes are increased compared to a matched control group.
Volume 36.63 - Question 15

Transfusion of COVID-19 Convalescent Plasma

Early administration of high-titer convalescent plasma against SARS-CoV-2 to mildly ill infected older adults reduces the progression of Covid-19.

  • True
  • False
Volume 36.63 - Question 14

mRNA Vaccine Allergy

Which one of the following statements about allergic reaction to mRNA vaccine is false?

  • Most anaphylactic reactions occur in persons with a previous history of anaphylaxis.
  • Acute allergic reactions occur in about 2% of recipients.
  • Acute anaphylactic reactions occur in about 2 in 10,000 recipients.
  • The mean time to anaphylaxis onset is at 17 minutes.
Volume 36.63 - Question 13

COVID19 and C Reactive Protein

In hospitalized patients with COVID-19 who received corticosteroid treatment, C-Reactive protein (CRP) responders (≥50% CRP level reduction) had reduced risk of death compared with risk among CRP non-responders.

  • True
  • False
Volume 36.63 - Question 12

Pediatric Inflammatory Multisystem Syndrome and COVID19

Which one of the following statements about Pediatric Inflammatory Multisystem Syndrome temporally associated with COVID-19 is false?

  • Features include prolonged fever, multiorgan dysfunction and laboratory evidence of hyperinflammation.
  • The history of an illness compatible with acute SARS-CoV-2 infection one week prior.
  • Blood vessels are thought to be the primary target of endothelial inflammation triggered by SARS-CoV-2.
  • The immunobiology mirrors that seen in Kawasaki disease.
Volume 36.63 - Question 11

Monoclonal Antibodies for COVID-19

Bamlanivimab, a monoclonal antibody, is authorized for use in patients who require oxygen therapy because of COVID-19.

  • True
  • False
Volume 36.63 - Question 10

ACE Inhibitors and COVID-19

Discontinuing angiotensin-converting enzyme inhibitors for 30-days improves mortality in patients admitted to hospital with mild to moderate COVID-19.

  • True
  • False
Volume 36.63 - Question 9

SARS CoV 2 Among Children

Which one of the following statements about SARS-CoV-2 among children is false?

  • Children can carry very high viral loads even before symptoms develop.
  • Children with multisystem inflammatory syndrome (MIS-C) exhibit high levels of viral load on nasopharyngeal or oropharyngeal viral testing.
  • Symptoms are nonspecific and overlap considerably with non-COVID-19-related illnesses.
  • Only one half of children with acute SARS-CoV-2 infection present with fever.
Volume 36.63 - Question 8

Elevated D-Dimer in COVID-19

Increased D-dimer levels measured on hospital admission are significantly correlated with the severity of COVID-19 pneumonia.

  • True
  • False
Volume 36.63 - Question 7

Alcohol Policies During the COVID-19 Pandemic

During the COVID-19 pandemic, many national governments have, explicitly or implicitly, deemed the supply of alcohol to be essential and some have even argued that doing so prevents cases of alcohol withdrawal swamping hospitals. Which one of the following statements about the impact of alcohol on health systems or patients is false?

  • Alcohol withdrawal admissions pre-pandemic likely accounted for about 5% of alcohol attributable hospitalizations in Canada.
  • Estimates of alcohol-attributable emergency room visits in Canada exceeds by a factor of about seven all the known cases of COVID-19 in the first wave of the pandemic in Canada.
  • Heavy drinking increases risk for severe lung infections (including both viral and bacterial pneumonia).
  • In South Africa during the COVID-19 pandemic, public policies that resulted in reduced alcohol availability resulted in increased acute-care utilization.
Volume 36.63 - Question 6

Management of Postacute COVID19 in Primary Care

Which one of the following statements about post-acute COVID-19 is false?

  • Around 10% of patients who have tested positive for SARS-CoV-2 virus remain unwell beyond three weeks.
  • There are no evidence based treatments for fatigue after COVID-19.
  • Intense cardiovascular exercise must be avoided for three months in all patients after pericarditis.
  • Chest pain is uncommon in post-acute COVID-19.
Volume 36.63 - Question 3

Dexamethasone and COVID19 Mortality

Mortality is decreased in hospitalized patients with COVID-19 who do not require respiratory support and are given dexamethasone.

  • True
  • False
Volume 36.63 - Question 1

Inhaled Budosenide

Inhaled budesonide improves time to recovery, with a chance of also reducing hospital admissions or deaths, in people with COVID-19 in the community who are at higher risk of complications. 

  • True
  • False
Volume 38.21 - Question 11

Paxlovid

Which one of the following statements about Paxlovid for treatment of COVID-19 infection is false? 

  • It can reduce rate of hospitalization.   
  • It can reduce the rate of death.   
  • It is contraindicated for use with drugs that are highly dependent on CYP3A for clearance.   
  • It can be started after 5 days of symptom onset.  
Volume 38.21 - Question 7

Rapid Diagnostic Testing (RDTs) for SARS-CoV-2

Which one of the following statements about rapid diagnostic testing (RDTs) for SARS-CoV-2 is false?

  • Nucleic acid amplification tests can remain positive for months after infection.  
  • Antigen-based RDTs can detect infection within 5 to 7 days after symptom onset.  
  • Home-based RDTs are just as accurate when performed by untrained persons.     
  • Testing is generally not useful in the first 48 hours after exposure.
Volume 38.21 - Question 4

COVID Croup

There is compelling evidence to support the hypothesis that the omicron variant causes laryngotracheobronchitis. 

  • True
  • False
Volume 38.21 - Question 1

Corticosteroids and Postherpetic Neuralgia

Administration of corticosteroids during acute herpes zoster infection has been found to decrease the likelihood of postherpetic neuralgia.

  • True
  • False
Volume 39.3 - Question 38

Cryptosporidiosis

Which one of the following statements about cryptosporidiosis is false?

  • Infections generally occur from early to late fall, with outbreaks related to drinking water contamination, animal contact, travel, and use of swimming pools.
  • Patients may have symptoms ranging from mild watery diarrhea to severe enteritis with possible biliary tract and pulmonary involvement.
  • Routine comprehensive ova and parasite stool examinations detect oocysts.
  • Parasitic cure typically happens within a few weeks to months without the need for any specific therapy.
Volume 39.3 - Question 23

Trichinellosis

Which one of the following statements about trichinellosis is false?

  • This infection most often affects adults who have ingested raw or undercooked pork, wild boar, bear, deer, or ground beef.
  • Diagnosis of trichinellosis is confirmed by serum antibody testing which accurately detects the disease in the first three weeks of illness.
  • Antiparasitic treatment is not needed in patients with mild disease.
  • Patients with severe symptoms may benefit from 10 to 15 days of systemic steroids.
Volume 39.3 - Question 22

Post-COVID Condition

Unvaccinated individuals have an almost fourfold higher proportion of post-COVID condition diagnoses compared with those who were vaccinated before infection.

  • True
  • False
Volume 39.3 - Question 21

Corticosteroid Therapy for CAP

Which one of the following statements about the use of adjunctive corticosteroids for the treatment of patients hospitalized with community acquired pneumonia is false?

  • All cause mortality at 30 days is reduced.
  • Incidence of acute respiratory distress syndrome is reduced.
  • Admissions to ICU are reduced.
  • Incidence of hyperglycaemia is increased.
Volume 39.3 - Question 20

Hepatitis C

Which one of the following statements about hepatitis C is false?

  • Most patients with hepatitis C are asymptomatic.
  • Globally, less than 5% of patients with hepatitis C have been diagnosed.
  • Undetectable HCV RNA 12 weeks after treatment is considered a virologic cure.
  • All patients need liver-specific follow-up.
Volume 37.3 - Question 22

UTI Treatment in Men

In afebrile older men with a suspected urinary tract infection (UTI), a 14-day antibiotic course is superior to a 7-day antibiotic course. 

  • True
  • False
Volume 37.3 - Question 17

COVID Booster

A third dose of the mRNA vaccine BNT162b2 (Pfizer-BioNTech) provides an additional 85% protection against detected SARSCoV-2 infection over and above the reduction in the risk conferred by the first 2 doses. 

  • True
  • False
Volume 37.3 - Question 13

Waning immunity after 2 doses of Covid-19 Vaccination

In adults having received two doses of the BNT162b2 mRNA vaccine (Pfizer-BioNTech) Covid-19 vaccine, there is a gradual increase in the risk of infection over time seen in those having received their second dose at least 90 days earlier.

  • True
  • False
Volume 37.3 - Question 12

Acute Otitis Media in Children

Which one of the following statements about acute otitis media in children is false?

  • Streptococcus pneumoniae is the most common bacterial pathogen.
  • Immediate antibiotic treatment should be prescribed for all children < 2 years old.
  • Macrolide should be considered only for patients with a history of serious penicillin allergy.
  • Clindamycin may be effective.
Volume 37.3 - Question 10

COVID Vaccine

The increased risk of venous thromboembolism in the short time interval after a first dose of the ChAdOx1 nCoV-19 vaccine (Astra Zeneca), is much lower than the risk associated with SARS-CoV-2 infection in the same population.

  • True
  • False
Volume 37.3 - Question 4

Bronchiolitis

Which one of the following statements about diagnosis and treatment of bronchiolitis in infants is true?

  • Chest x-rays are indicated for diagnosis.
  • Salbutamol is beneficial.
  • Routine measurement of oxygen saturation is not recommended in well appearing infants.
  • Inhaled corticosteroids are beneficial.
Volume 39.3 - Question 12

Transfusion of Covid-2 Convalescent Plasma

Among patients hospitalized with Covid-19 who were not receiving mechanical ventilation, transfusion of convalescent plasma with higher anti-SARS-CoV-2 IgG antibody levels was associated with a lower risk of death than transfusion of plasma with lower antibody levels. 

  • True
  • False
Volume 36.6 - Question 19

Baricitinib and Remdesivir for Covid-19

Baricitinib plus remdesivir is superior to remdesivir alone in reducing recovery time among Covid-19 patients receiving non-invasive ventilation. 

  • True
  • False
Volume 36.6 - Question 18

Lyme Disease - 2

Which one of the following statements about Lyme disease is false? 

  • Erythema migrans may go unnoticed because it often asymptomatic.     
  • The removed tick should be tested for the presence of B. burgdorferi.   
  • A single dose of doxycycline given within 72 hours of tick removal is recommended as prophylaxis in adults.   
  • Late disease, which usually presents as arthritis, typically of the knee, can develop months to years after initial infection. 
Volume 36.6 - Question 17

Reinfection with SARS-CoV-2

Which one of the following statements about protection against reinfection after initial infection with SARS-CoV-2 is false? 

  • Initial infection confers about 80% protection against reinfection  
  • Risk of reinfection is much higher in individuals aged 65 years and older.  
  • Protection appears to wane after 7 months.  
  • Rates of protection in males and females are similar.
Volume 36.6 - Question 16

Lyme Disease - 1

In patients with suspected Lyme disease who present with erythema migrans, which antibiotic therapy is not considered first-line treatment?  

  • Doxycycline   
  • Amoxicillin   
  • Cefuroxime    
  • Azithromycin  
Volume 36.6 - Question 15

COVID-19 Vaccine for Adolescents

The risk of syncope is higher in adolescents than in adults following COVID-19 vaccination.

  • True
  • False
Volume 36.6 - Question 14

Meningococcal Vaccine

MenQuadfi is the only vaccine available in Canada for use in persons ≥ 56 years old for the prevention of invasive meningococcal disease caused by Neisseria meningitides serogroups A, C, W, and Y.  

  • True
  • False
Volume 36.6 - Question 12

Protection after Covid-19 Vaccination and Previous Infection

Which one of the following statements about protection against SARS-CoV-2 is false?

  • Two doses of BNT162b2 vaccine (Pfizer-BioNTech) are associated with high short-term protection.
  • Infection-acquired immunity wanes after 6 months in those who are unvaccinated.
  • Protection after two doses of Pfizer-BioNTech wanes after six months.
  • Infection-acquired immunity boosted with vaccination remains high more than one year after infection.
Volume 37.6 - Question 35

COVID-19

Which one of the following statements about long-term sequelae of COVID-19 four months after hospital discharge is false? 

  • Half of patients report at least one symptom that did not exist before COVID-19.   
  • Cognitive symptoms are reported in about 20% of patients.   
  • Computed tomographic lung-scan abnormalities are common.   
  • New-onset dyspnea is reported in more than half of patients. 
Volume 36.5 - Question 39

Esmolol for Sepsis

The use of ultrashort-acting B-blockers in sepsis and septic shock with persistent tachycardia improves mortality.   

  • True
  • False
Volume 36.5 - Question 25

Transfusion of Covid-19 Convalescent Plasma 

Early administration of high-titer convalescent plasma against SARS-CoV-2 to mildly ill infected older adults reduces the progression of Covid-19.  

  • True
  • False
Volume 36.5 - Question 17

Lyme Disease

Which one of the following statements about Lyme disease is false? 

  • Erythema migrans may go unnoticed because it is often asymptomatic.   
  • The removed tick should be tested for the presence of B. burgdorferi.   
  • A single dose of doxycycline given within 72 hours of tick removal is recommended as prophylaxis in adults.   
  • Late disease, which usually presents as arthritis, typically of the knee, can develop months to years after initial infection. 
Volume 36.5 - Question 16

Bartonella Quintana

Which one of the following statements about Bartonella quintana is false? 

  • It is transmitted via the inoculation of infected body lice feces into breaks in the skin.   
  • Seroprevalence for it can exceed 20% among people experiencing homelessness who use intravenous drugs or have a severe alcohol use disorder.   
  • It can cause endocarditis with a 10-12% mortality rate    
  • Trimethoprim-sulfamethoxazole is the treatment of choice for B.quintana infections. 
Volume 36.5 - Question 15

Post-COVID Syndrome

 Which one of the following statements about outcomes among those discharged following an admission to hospital with covid-19 is false? 

  • There is an increased risk of readmission compared with individuals with similar personal and clinical characteristics.   
  • Rates of major adverse cardiovascular events are increased compared to a matched control group.   
  • Patients older than age 70 have a greater relative risk of death compared to those under 70 years.   
  • Rates of new diagnosis of diabetes are increased compared to a matched control group. 
Volume 36.5 - Question 14

COVID-19

In hospitalized patients with COVID-19 who received corticosteroid treatment, C-Reactive protein (CRP) responders (≥50% CRP level reduction) had reduced risk of death compared with risk among CRP non responders. 

  • True
  • False
Volume 36.5 - Question 2

Strongyloides Infection and Immunosuppressant Drugs

Which one of the following statements regarding Strongyloides infection and the use of immunosuppressant drugs is false?

  • Strongyloides can be asymptomatic and remain quiescent for years.
  • All patients at risk of Strongyloides infection should have testing before beginning immunosuppressant drugs.
  • Empiric ivermectin treatment should not be given before test results confirm infection.
  • Short steroid courses can be associated with Strongyloides Hyperinfection Syndrome and death.
Volume 37.6 - Question 20

Paxlovid for Covid-19

Which one of the following statements about Paxlovid in treatment of Covid-19 is false?

  • In non-hospitalized unvaccinated patients with at least one risk factor for severe disease, treatment within 5 days of symptom onset reduces hospitalization or death by almost 90%.
  • It has been shown to be associated with an increase in birth defects if used during pregnancy.
  • It inhibits the 3CL protease associated with the Omicron variant.
  • Paxlovid is not recommended for use in patients with severe renal impairment (eGFR <30ml/minute).
Volume 37.6 - Question 17

Pediatric Inflammatory Multisystem Syndrome and COVID-19

Which one of the following statements about Pediatric Inflammatory Multisystem Syndrome temporally associated with COVID-19 is false? 

  • Features include prolonged fever, multiorgan dysfunction and laboratory evidence of hyperinflammation.   
  • The history of an illness compatible with acute SARS-CoV-2 infection one week prior.   
  • Blood vessels are thought to be the primary target of endothelial inflammation triggered by SARS-CoV-2.   
  • The immunobiology mirrors that seen in Kawasaki disease. 
Volume 36.4 - Question 16

Monoclonal Antibodies for COVID-19 

Bamlanivimab, a monoclonal antibody, is authorized for use in patients who require oxygen therapy because of COVID-19. 

  • True
  • False
Volume 36.4 - Question 15

Norepinephrine in Septic Shock

Comparing early vs. late initiation of norepinephrine in patients with septic shock, each of the following is decreased except: 

  • Short-term mortality   
  • ICU length of stay   
  • Time to achieve target mean arterial pressure   
  • Volume of intravenous fluids within six hours 
Volume 36.4 - Question 14

Trichomoniasis

Which one of the following statements about trichomoniasis is false?

  • It is the most common non-viral sexually transmitted infection.
  • Vaginal infection is often asymptomatic and can last years.
  • Both penile and vaginal infections should be treated with a seven-day course of metronidazole 500 mg twice per day.
  • Persistent infection should be treated with increased dosing of 2 grams of metronidazole for seven days.
Volume 37.6 - Question 16

Therapeutic Anticoagulation with Heparin in Noncritically Ill Patients with COVID-19

In non-critically ill patients with Covid-19, an initial strategy of therapeutic- dose anticoagulation with heparin increases the probability of survival to discharge with reduced use of cardiovascular or respiratory organ support as compared with usual-care thromboprophylaxis.

  • True
  • False
Volume 37.1 - Question 19

Treatment of C. difficile Infections

In patients with an initial C. difficile infection episode, treatment with fidaxomicin reduces the risk of recurrence compared to vancomycin.

  • True
  • False
Volume 37.1 - Question 8

COVID Croup

There is compelling evidence to support the hypothesis that the omicron variant causes laryngotracheobronchitis.

  • True
  • False
Volume 37.6 - Question 3

Oral Moxifloxacin for Appendicitis

For adults with uncomplicated acute appendicitis, treatment with seven days of oral moxifloxacin resulted in treatment success rates greater than 65%.  

  • True
  • False
Volume 36.3 - Question 21

Cytokine Storm

Which one of the following statements about cytokine storm is false? 

  • Nearly all patients are febrile.   
  • Neurologic toxic effects occur early.    
  • Many patients have hypertriglyceridemia.    
  • Patients can develop a stress-related or takosubo-like cardiomyopathy. 
Volume 36.3 - Question 19

HIV and Anal Carcinoma

Patients with HIV who have a history of anogenital warts have an increased risk of developing anal carcinoma.  

  • True
  • False
Volume 36.3 - Question 18

ACE Inhibitors and COVID-19

Discontinuing angiotensin-converting enzyme inhibitors for 30–days improves mortality in patients admitted to hospital with mild to moderate COVID–19. 

  • True
  • False
Volume 36.3 - Question 17

Remdesivir and COVID-19

Remdesivir shortens the time to recovery in adults who are hospitalized with COVID-19 and have evidence of lower respiratory tract infection. 

  • True
  • False
Volume 36.3 - Question 16

Elevated D-Dimer in COVID-19

Increased D-dimer levels measured on hospital admission are significantly correlated with the severity of COVID-19 pneumonia. 

  • True
  • False
Volume 36.3 - Question 15

Hepatitis B in Children

Which one of the following statements about hepatitis B in children is false? 

  • The World Health Organization recommends hepatitis B vaccination at birth.     
  • Third trimester antivirals are recommended for HBsAg positive women with high viral loads to reduce the risk of vertical transmission.   
  • Neonates are less likely to spontaneously clear hepatitis B infections compared to adults.   
  • Vaccinating at birth is associated with waning of immunity in adulthood compared to vaccinating in adolescence. 
Volume 36.3 - Question 14

Alcohol Policies During the COVID-19 Pandemic

During the COVID-19 pandemic, many national governments have, explicitly or implicitly, deemed the supply of alcohol to be essential and some have even argued that doing so prevents cases of alcohol withdrawal swamping hospitals. Which one of the following statements about the impact of alcohol on health systems or patients is false? 

  • Alcohol withdrawal admissions pre-pandemic likely accounted for about 5% of alcohol attributable hospitalizations in Canada.   
  • Estimates of alcohol-attributable emergency room visits in Canada exceeds by a factor of about seven all the known cases of COVID-19 in the first wave of the pandemic in Canada.    
  • Heavy drinking increases risk for severe lung infections (including both viral and bacterial pneumonia).   
  • In South Africa during the COVID-19 pandemic, public policies that resulted in reduced alcohol availability resulted in increased acute-care utilization.  
Volume 36.3 - Question 11

Nirsevimab and Respiratory Syncytial Virus

In healthy preterm infants, a single injection of nirsevimab results in fewer medically attended RSV-associated lower respiratory tract infections throughout the respiratory syncytial virus season. 

  • True
  • False
Volume 36.2 - Question 26

Acute Cardiovascular Events and Influenza

Diabetic patients hospitalized with influenza have a > 10% risk of experiencing an acute cardiovascular event. 

  • True
  • False
Volume 36.2 - Question 18

SARS-CoV-2 Among Children

Which one of the following statements about SARS-CoV-2 among children is false? 

  • Children can carry very high viral loads even before symptoms develop.   
  • Children with multisystem inflammatory syndrome (MIS-C) exhibit high levels of viral load on nasopharyngeal or oropharyngeal viral testing.   
  • Symptoms are nonspecific and overlap considerably with non-COVID-19-related illnesses.   
  • Only one half of children with acute SARS-CoV-2 infection present with fever. 
Volume 36.2 - Question 17

Persistent Night Sweats

Following a Mediterranean diet is associated with a decrease in night sweats.  

  • True
  • False
Volume 36.2 - Question 16

The Approach to the Febrile Infant

Parents bring their 16-day old infant to your emergency room, stating the child has had a fever of 39C rectally. The child appears well. You wish to use the American Academy of Pediatrics (AAP) guidelines to tailor your approach.
Volume 37.2 - Question 33

Abscess Management

Which one of the following statements about the management of a cutaneous abscess in the emergency department is false?

  • Irrigation has been shown to be of benefit.
  • Needle aspiration is inferior to incision and drainage.
  • The loop drainage technique is an alternate approach to traditional incision and drainage.
  • In settings with high prevalence of MRSA, the addition of a cephalosporin does not reduce the incidence of treatment failures after incision and drainage.
Volume 37.2 - Question 29

Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19

In critically ill patients with Covid-19, an initial strategy of therapeutic-dose anticoagulant results in a greater probability of survival to hospital discharge with a greater number of days free of cardiovascular or respiratory organ support than does usual-care pharmacologic thromboprophylaxis.

  • True
  • False
Volume 37.2 - Question 23

Cytomegalovirus Infection in Pregnancy

Which one of the following statements about Cytomegalovirus (CMV) infection in pregnancy is false?

  • Pregnant patients with a mononucleosis-like illness should be investigated for CMV infection.
  • The most common neurological sequelae of Congenital CMV (cCMV) is sensorineural hearing loss.
  • Risk of long-term sequelae for the infant is directly proportional to the gestational age at which cCMV is acquired.
  • Risk of CMV transmission to the fetus increases proportionally with the gestational age at which the mother is infected.
Volume 37.2 - Question 7

Multisystem Inflammatory Syndrome in Children

Which one of the following statements about multisystem inflammatory syndrome in children is false?

  • Testing for evidence of COVID-19 is not needed for case definition.
  • Gastrointestinal symptoms are common.
  • Neurocognitive symptoms may include headache and altered mental status.
  • Cardiogenic shock can occur.
Volume 37.2 - Question 6

Septic Arthritis

A 60-year-old woman in your practice has a medical history of rheumatoid arthritis and diabetes. Her medications include an anti-tumor necrosis factor biologic. She presents with an acutely painful, warm, swollen knee and you are concerned about septic arthritis.
Volume 37.4 - Question 45

Multiple Sclerosis and Epstein-Barr Virus

The risk of Multiple sclerosis is significantly increased after infection with Epstein-Barr Virus.

  • True
  • False
Volume 37.4 - Question 20

Fluvoxamine in COVID-19

In unvaccinated adults with COVID-19 infection and risk factors for disease progression, treatment with fluvoxamine reduces the risk of hospitalization compared with placebo.

  • True
  • False
Volume 37.4 - Question 17

Point of Care Ultrasound in Diagnosis of Skin and Soft Tissue Abscess

Point of care ultrasound used to differentiate between cellulitis and abscess has been shown to lead to a correct change in management in greater than 10% of cases of skin and soft tissue infections in the emergency department. 

  • True
  • False
Volume 36.1 - Question 18

Dexamethasone and COVID-19 Mortality

Mortality is decreased in hospitalized patients with COVID-19 who do not require respiratory support and are given dexamethasone.  

  • True
  • False
Volume 36.1 - Question 17

COVID-19 and Fertility

Compared with unvaccinated females, women who received at least one dose of COVID-19 vaccine before a given menstrual cycle had a lower probability of conceiving during that cycle.

  • True
  • False
Volume 37.4 - Question 8

COVID-19 and Diabetes

There is an increased risk for newly diagnosed diabetes >30 days after acute infection with SARS-CoV-2 among persons aged <18 years.

  • True
  • False
Volume 37.4 - Question 7

COVID-19 and Multisystem Inflammatory Syndrome in Children

Which one of the following statements about children with COVID-19 and multisystem inflammatory syndrome (MIS-C) is false? 

  • Most children with SARS-CoV-2 infection have mild COVID-19 that does not lead to medical intervention. 
  • The majority of patients admitted with MIS-C test positive for SARS-CoV-2. 
  • The gastrointestinal system is the organ system most commonly involved. 
  • Among patients with MIS-C and recorded COVID-19 symptoms, MIS-C symptom onset usually occurs within three days of COVID-19 symptom onset. 
Volume 36.1 - Question 15

Management of Post-acute COVID-19 in Primary care

Which one of the following statements about post-acute COVID-19 is false?  

  •  Around 10% of patients who have tested positive for SARS-CoV-2 virus remain unwell beyond three weeks. 
  • There are no evidence based treatments for fatigue after COVID-19.  
  • Intense cardiovascular exercise must be avoided for three months in all patients after pericarditis.  
  • Chest pain is uncommon in post-acute COVID-19.  
Volume 36.1 - Question 14

Serological Testing in SARS-CoV-2

 Which one of the following statements about serological testing for SARS-CoV-2 infection is false?  

  • Health Canada’s recommended target specificity of 98% or higher would result in a positive test having a highly predictive value in most Canadian populations.   
  • Antibody levels may not correlate with disease immunity. 
  • Case definitions for multisystem inflammatory syndrome in children due to SARS-CoV-2 include the use of serology results. 
  • Serological testing is not currently recommended on an individual level to guide the use of personal protective equipment. 
Volume 36.1 - Question 13

COVID-19 Symptoms in Nursing Home Residents

Patients dying of COVID-19 in nursing homes have lower symptom prevalence than those dying in hospital. 

  • True
  • False
Volume 36.1 - Question 11

Inhaled Budosenide

Inhaled budesonide improves time to recovery, with a chance of also reducing hospital admissions or deaths, in people with COVID-19 in the community who are at higher risk of complications.

  • True
  • False
Volume 37.4 - Question 3

SARS-CoV-2 in Human Breast Milk

Pasteurization of donated human milk is effective in inactivating SARS-CoV-2. 

  • True
  • False
Volume 36.1 - Question 9

Compression Stockings and Prevention of Cellulitis

In patients with leg edema and recurrent cellulitis, compression therapy, results in a lower incidence of recurrence of cellulitis. 

  • True
  • False
Volume 36.1 - Question 2

Rapid diagnostic testing (RDTs) for SARS-CoV-2

Which one of the following statements about rapid diagnostic testing (RDTs) for SARS-CoV-2 is false?

  • Nucleic acid amplification tests can remain positive for months after infection.
  • Antigen-based RDTs can detect infection within 5 to 7 days after symptom onset.
  • Home-based RDTs are just as accurate when performed by untrained persons.
  • Testing is generally not useful in the first 48 hours after exposure.
Volume 37.4 - Question 1

Pre-Exposure Prophylaxis for HIV

A 32-year-old male presents to your office for a “check-up.” At the visit, he mentions that he has just returned from a trip to “P-town” and would like to have some STI testing. As you discuss further with him, he explains that Provincetown, Massachusetts is a popular location for gay men to visit, and while there, he had a couple of new sexual partners. At your visit today, he also mentions that he met a few people using “PrEP,” and is wondering whether he, too, should be on it. 
Volume 38.1 - Question 39

Gonorrhea

Which one of the following statements about gonorrhea is false? 

  • Chlamydia trachomatis infection is present in 10-30% of patients with gonorrhea. 
  • A single 800 mg dose of oral cefixime can be used to treat uncomplicated urogenital infection. 
  • Test of cure is not recommended after treatment in patients with pharyngeal gonorrhea. 
  • Rescreening is recommended 3-6 months after completing treatment.  
Volume 38.1 - Question 15

Monkeypox Infection in Pregnancy

Which one of the following about monkeypox infection and pregnancy is false? 

  • It is not known whether pregnant people are more susceptible to the infection.
  • It can be confused with pruritic urticarial papules and plaques of pregnancy. 
  • Adverse pregnancy outcomes have been reported after infection. 
  • Post-exposure prophylaxis with attenuated vaccine is contraindicated in pregnancy.
Volume 38.1 - Question 14

Monkeypox Infection

Which one of the following statements about monkeypox infection is false? 

  • The Congo Basin clade is associated with more severe illness.   
  • In the current outbreak, the lesions seldom occur in mucosal areas 
  • For diagnostic testing, multiple samples from different skin lesions should be collected. 
  • Patients are contagious until the scabs have crusted over and fallen off and a fresh layer of intact skin has formed underneath. 
Volume 38.1 - Question 13

Hidradenitis Suppurativa

A 25-year-old woman presents to your clinic with a recent fever and tender swelling and redness in her axilla. She reports she has experienced this a few times in the past associated with purulent drainage that resolved on its own. You suspect hidradenitis suppurativa (HS).
Volume 38.2 - Question 34

Monkeypox

Post-exposure prophylaxis with monkeypox vaccination for recently exposed persons is recommended.

  • True
  • False
Volume 38.2 - Question 27

HIV Pre-Exposure Prophylaxis

Your next patient is 28 years old and new to your family practice. He has no known medical problems and considers himself healthy. During your visit, he confirms that he has sex with other men (MSM).   You question the patient’s HIV risk and after careful assessment, you consider that pre-exposure prophylaxis (PrEP) is indicated. The patient has never heard of PrEP and is unsure if it could be useful.
Volume 37.5 - Question 41

Chlamydia

Which one of the following statements about chlamydial infections is false?

  • A single dose of oral azithromycin is less effective than doxycycline for rectal infection.
  • The regimen of choice for treatment of oropharyngeal and urogenital infection is 7 days of oral doxycycline.
  • Test of cure is required for non-pregnant patients.
  • All patients should be tested for reinfection 3-6 months after completing treatment.
Volume 38.2 - Question 8

Post-COVID Conditions

Which one of the following statements about post-COVID conditions among adult COVID-19 survivors is false?

  • Neurocognitive symptoms have been reported to persist for up to 1 year after acute infection and might persist longer.
  • One in five COVID-19 survivors aged 18–64 years experienced at least one incident condition that might be attributable to previous COVID-19.
  • The risk ratio (RR) for cardiac dysrhythmia was significantly lower among patients aged 18–64 years compared with those aged ≥65 years.
  • Independent of age group, the highest RRs were for acute pulmonary embolism and respiratory symptoms.
Volume 38.2 - Question 7

Treatment of Epididymitis

For acute epididymitis in sexually active men not at risk for infection with enteric organisms, empiric treatment with a single dose of ceftriaxone plus oral doxycycline for 10 days is recommended.

  • True
  • False
Volume 38.2 - Question 6

Membrane Sweeping at Term

Performing a membrane sweep in pregnant patients who are positive for group B streptococci has been shown to result in an increased risk of negative outcomes.

  • True
  • False
Volume 38.2 - Question 2

Prone Positioning of Patients with COVID-19

For hospitalized ward patients with COVID-19 and moderate hypoxemia, encouraging prone positioning reduces the risk of worsening respiratory failure.

  • True
  • False
Volume 37.5 - Question 25

COVID-19 and Thromboembolic Disease

Incidence rates for pulmonary embolism are significantly increased up to 110 days after COVID-19 infection.

  • True
  • False
Volume 37.5 - Question 20

Community-Acquired Bacterial Meningitis

Which one of the following statements about community-acquired bacterial meningitis in patients of 80 years and older is false?

  • Diabetes is a common pre-disposing condition.
  • More than 70% of patients had the triad of fever, neck stiffness and altered consciousness.
  • Streptococcus pneumoniae is the most common causative organism.
  • Atypical causative pathogens should be considered when starting empirical antimicrobial therapy in this age group.
Volume 37.5 - Question 18

Influenza Antiviral Treatment and Length of Stay

In children with laboratory-confirmed influenza and high-risk medical conditions not admitted to the ICU, antiviral therapy was associated with significantly shorter hospitalizations if started In the first 2 days from symptom onset.

  • True
  • False
Volume 37.5 - Question 9

Post-Covid POTS

 A 45-year-old female presents with a 4-month history of palpitations, shortness of breath, chest pain and fatigue. She tells you it started after an infection with COVID-19. Prior to this she was completely healthy, and she doesn’t take any regular medication. She has done lots of reading about post-COVID syndrome and believes she has postural orthostatic tachycardia syndrome (POTS). 
Volume 39.1 - Question 40

Infectious Mononucleosis

A 19-year-old female university student athlete is at your office today because she has fever, sore throat, headache, abdominal pain, and fatigue. You discover that she has tonsillar exudate, anterior cervical lymphadenopathy, posterior cervical lymphadenopathy, and splenomegaly during your physical examination. You perform a rapid antigen test to rule out streptococcal tonsillitis, which is negative. You suspect this patient has infectious mononucleosis.
Volume 38.3 - Question 39

Spontaneous Bacterial Peritonitis

Which one of the following statements about spontaneous bacterial peritonitis in patients with cirrhosis is false?

  • Diagnosis should be confirmed by culture of ascitic fluid prior to starting antibiotics.
  • Administration of albumin is recommended to reduce risk of death.
  • Patients often present with decompensation of their cirrhosis.
  • Mortality rates remain high even with appropriate antibiotic treatment.
Volume 38.3 - Question 37

Dyspnea in Long Covid  

In patients with COVID-19 who received mechanical ventilation and who have persistent dyspnea, dyspnea scores improve more with exercise training rehabilitation therapy than with standard physiotherapy. 

  • True
  • False
Volume 39.1 - Question 26

Acne Management

When treating acne vulgaris with oral antibiotics, combination therapy with topical benzoyl peroxide is recommended. 

  • True
  • False
Volume 39.1 - Question 25

Long Covid-19 Symptoms

Which one of the following Long Covid symptoms is least likely to be present in the late (180-360 days) time period after mild infection?

  • Cough
  • Dyspnea
  • Palpitations
  • Cognitive impairment
Volume 38.3 - Question 21

Long COVID

Among individuals who have been hospitalized with SARS-CoV-2, the estimated mean Long COVID symptom duration is 9 months.

  • True
  • False
Volume 38.3 - Question 20

Prescribing for Common Complications of Spinal Injury

Antibiotics should be offered for routine prophylaxis (e.g., when changing indwelling catheters) in patients with recurrent urinary tract infection and spinal cord injury.

  • True
  • False
Volume 38.4 - Question 15

Long COVID Treatment

Which one of the following statements about the treatment of long COVID is false?

  • An individualized, symptom-guided, phased return to activity program is recommended for patients with fatigue or postexertional malaise.
  • Patients with ongoing cough and dyspnea may benefit from breathing exercises that focus on optimal body position and posture.
  • The recommended treatment for dysautonomia includes dietary and behavior modifications such as ensuring fluid and salt repletion and wearing compression garments.
  • Methylphenidate has strong evidence for use to treat fatigue.
Volume 38.4 - Question 13

Long COVID Diagnosis

Autonomic dysfunction (dysautonomia) such as postural orthostatic tachycardia syndrome commonly occurs in long COVID.

  • True
  • False
Volume 38.4 - Question 12

Long-COVID Epidemiology

Epstein-Barr viremia is a risk factor for long COVID.

  • True
  • False
Volume 38.4 - Question 11

Ear-Piercing Complications

Which one of the following statements about ear-piercing complications in children and adolescents is false?

  • In one study, 65% reported local infection after ear-piercing.
  • It has been associated with endocarditis.
  • It is one of the commonest causes of keloids in children 2 to 19 years of age.
  • Trans-cartilaginous piercing infections are most commonly caused by Staphylococcus aureus.
Volume 38.4 - Question 10

Febrile Neutropenia

Which one of the following statements about the management of febrile neutropenia is false?

  • Granulocyte colony–stimulating factors are not typically recommended in the treatment of febrile neutropenia.
  • Routine rectal examination to rule out mucositis is advised.
  • About 20% to 30% of patients with febrile neutropenia will have an identifiable infectious cause.
  • Low risk patients may be treated with oral antibiotics.
Volume 38.3 - Question 14

Prone Positioning in Hypoxemic Patients with COVID-19

In non-intubated adults with hypoxemic respiratory failure due to covid-19, awake prone positioning compared with usual care results in which one of the following significantly improved outcomes?

  • Mortality
  • Risk of endotracheal intubation
  • Hospital length of stay
  • Ventilator-free days
Volume 38.3 - Question 13

Antibiotics for Otitis Media

Harms and benefits are evenly balanced for antibiotic treatment of a child with acute otitis media.

  • True
  • False
Volume 38.3 - Question 12

Sequelae Associated with SARS-CoV-2 Reinfection

Which one of the following statements regarding SARS-CoV-2 reinfection is false?

  • Compared to those with no reinfection, those with reinfection exhibit an increased risk of all-cause mortality.
  • Compared to those with no reinfection, those with reinfection have an increased risk of gastrointestinal sequelae.
  • There is no increased risk of hospitalization following reinfection in those who have received two or more vaccinations before they are reinfected.
  • The risks of adverse outcomes increase in a graded fashion as the number of reinfections increases.
Volume 38.4 - Question 5

Bacterial Meningitis

Which one of the following statements about bacterial meningitis is false?

  • Streptococcus pneumoniae causes most cases in people older than 16 years.
  • The classic triad of fever, stiff neck, and a change in mental status occurs in more than half of patients.
  • The diagnostic accuracy of Kernig’s sign is poor.
  • Less than 10% of adults presenting with meningitis have bacterial meningitis.
Volume 38.3 - Question 1

Community Acquired Pneumonia

Which one of the following statements about community-acquired pneumonia is false?

  • Death at one year occurs in about 30% of all hospitalized patients.
  • In viral pneumonia, procalcitonin levels are typically high.
  • Testing for viruses should be considered for most patients.
  • Doxycycline is a recommended first-line therapy in healthy patients under 65 years old.
Volume 39.2 - Question 40

Suppurative Sialadenitis

Which one of the following statements about acute suppurative sialadenitis is false?

  • It most commonly affects men aged 50 to 70..
  • It most commonly involves the submandibular gland.
  • Salivary stasis is one of the main precipitating factors.
  • The first line outpatient antibiotic treatment is amoxicillin/clavulanate
Volume 39.2 - Question 22

Chlamydia and Gonorrhea

Which one of the following statements about chlamydia and gonorrhea is false?

  • From 2010 to 2019, reported cases of gonorrhea in Canada increased by more than 100%.
  • Patient-collected swabs are equivalent to provider-collected swabs.
  • The Canadian Task Force on Preventive Health Care recommends annual opportunistic screening for chlamydia and gonorrhea in all sexually active people younger than 30 years.
  • Compared with urine testing, vaginal swab detects fewer infections.
Volume 39.2 - Question 20

Vaccines for Prevention of RSV Disease

Vaccination for prevention of respiratory syncytial virus (RSV) reduces the incidence of RSV-associated lower respiratory tract disease in adults ≥ 60 years old. 

  • True
  • False
Volume 39.1 - Question 7

Latent Tuberculosis

Rifamycin-based regimens are preferred therapy for latent tuberculosis because of higher adherence rates than isoniazid regimens.

  • True
  • False
Volume 38.6 - Question 21

Group A Streptococcal Pharyngitis

Which one of the following statements about Group A Streptococcal (GAS) pharyngitis is false?

  • It is the most common cause of acute pharyngitis.
  • In children and adolescents, throat culture is recommended when a rapid antigen test is negative and GAS pharyngitis is suspected.
  • When clindamycin is used in patients with severe penicillin allergy, there is a >20% GAS may be resistant to clindamycin.
  • Tetracyclines are not recommended for treatment.
Volume 38.6 - Question 20

Community-Acquired Pneumonia

Which one of the following statements about community-acquired pneumonia (CAP) is false?

  • Pneumococcal vaccination has substantially reduced the incidence of CAP caused by  pneumoniae.
  • High dose amoxicillin or doxycycline is the recommended treatment of CAP in most cases.
  • Macrolides can prolong the QT interval.
  • Shorter courses of antibiotic treatment (5-7 days) are less efficacious than long courses (8-10 days).
Volume 38.6 - Question 19

RSV and Childhood Asthma

Among healthy children born at term, not being infected with RSV in the first year of life was associated with a substantially reduced risk of developing childhood asthma.

  • True
  • False
Volume 38.6 - Question 3

Sinusitis

Which one of the following statements about sinusitis is false?

  • Bacterial sinusitis in otherwise healthy adults often improves without antibiotic therapy.
  • Amoxicillin/clavulanate is the antibiotic of choice for the treatment of bacterial sinusitis in adults and children.
  • Doxycycline is an option for adults with a penicillin allergy.
  • Trimethoprim/sulfamethoxazole is a recommended treatment.
Volume 38.5 - Question 35

Metformin to Prevent Long COVID

Adults with SARS-CoV-2 infection who take metformin for 2 weeks are less likely than those who take placebo to later report a diagnosis of long COVID.

  • True
  • False
Volume 38.5 - Question 12

Postexposure Doxycycline to Reduce STIs

Doxycycline postexposure prophylaxis taken within 72 hours after condomless sex decreases incident gonorrhea, chlamydia, and early syphilis among men who have sex with men and transgender women who have had bacterial STI in the previous year.

  • True
  • False
Volume 38.5 - Question 10

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