IMI Exam 5 Latest 2023 with complete solution
1. A 3-year-old female was rushed to the ED after being found minimally responsive and
febrile by parents following a midday nap. The patient was a previously healthy full-term
baby, without complication experienced during the pregnancy or her delivery. She was
breast-fed exclusively and her immunizations were up-to-date. Her parents denied any
trauma or any other abnormal behavior prior to her nap. The patient was ill-appearing
on arrival with labored breathing. Which of the following would be the most appropriate
response?
A. Prescribe a Z-pack and send the family home
B. Monitor the baby's vital signs for the next few hours
C. Order a sepsis work-up
D. Order a toxicology panel
E. Send the baby to radiology for a chest x-ray
C
2. Which category of conditions is most likely to be responsible for the symptoms of a
patient with fever of unknown origin?
A. Neoplastic
B. Rheumatologic
C. Infectious
D. Genetic
E. Neurologic
C
3. Which of the following is an example of an endogenous pyrogen?
A. Lipoteichoic acid
B. Bacterial Toxins
C. Lipopolysaccharide
D. Viral RNA
E. TNF-alpha
E
4. Which of the following is correct regarding normal body temperature?
A. Exhibits a range
B. Independent of site
C. Lower in the rectum than in the axilla
D. Always the same throughout a 24-hour cycle
E. Slightly elevated in senescent individuals
A
1. A sexually active 17-year-old man presents to the local free clinic to check some
small papules that appeared on his penis. The papules are small and white and contain
a central depression in their center. There is no penile discharge, nor is there pain on
urination. Which of the following best describes the infectious agent?
, a. A large and complex virus containing single-stranded linear RNA
b. A double-stranded DNA virus encoding a DNA-dependent RNA polymerase
c. A double-stranded linear DNA virus that integrates into the chromosome
d. a single-stranded DNA virus that replicates in the host cytoplasm
e. A double-stranded circular DNA virus
B
2. Human papilloma virus-related cervical intraepithelial neoplasia can be diagnosed by
the presence of which of the following histologic features?
a. Central, basophilic intranuclear cellular inclusions
b. Cowdry type A intranuclear cellular inclusions
c. Enlarged multinucleated cells
d. Cytoplasmic vacuolization and nuclear enlargement of cells
e. Numerous atypical lymphocytes
D
3. A 35-year-old man with no known past medical history presents for evaluation of a
rash on the cheek and forehead. The rash consists of numerous, small, coalescing skin-
colored papules. He does not have any systemic symptoms and his HIV status is
unknown. Initial testing for HIV reveals a positive HIV-1/2 antigen-antibody HIV test and
a HIV differentiation antibody test that is positive for HIV-1. Follow-up laboratory studies
show a CD4 count of 90 cells/mm3 and an HIV RNA level of 244,000 copies/mL. Which
one of the following is the recommended first-line therapy for this man's rash?
a. valacyclovir
b. valganciclovir
c. ketoconazole 2% cream
d. oral prednisone
e. anti-retroviral therapy
E
1. Your patient complains of an "itching rash" on her abdomen. On examination, you
find that the lesions are red, circular, with a vesiculated border and a healing central
area. You suspect tinea corporis (ringworm) caused by a dermatophyte. Which of the
following is the most appropriate laboratory procedure to confirm the diagnosis?
a. Potassium hydroxide mount of skin scrapings
b. Giemsa stain for multinucleated giant cells
c. Fluorescent-antibody stain of the vesicle fluid
d. Four-fold rise in antibody titer against the organism
e. RT-PCR for fungal DNA
A
2. A 48-year-old male presents with hypopigmented, scaling, and confluent macules on
the chest, upper arm, and neck. Wood’s lamp examination of skin macules displays a
pale yellow to blue-white fluorescence. Examination of KOH mounting of scales from
lesions demonstrates the presence of short, thick hyphae with clusters of large,
spherical budding yeast cells with spaghetti-meatballs appearance. Which of the
following fungi is the most likely cause of this patient’s symptoms?
1. A 3-year-old female was rushed to the ED after being found minimally responsive and
febrile by parents following a midday nap. The patient was a previously healthy full-term
baby, without complication experienced during the pregnancy or her delivery. She was
breast-fed exclusively and her immunizations were up-to-date. Her parents denied any
trauma or any other abnormal behavior prior to her nap. The patient was ill-appearing
on arrival with labored breathing. Which of the following would be the most appropriate
response?
A. Prescribe a Z-pack and send the family home
B. Monitor the baby's vital signs for the next few hours
C. Order a sepsis work-up
D. Order a toxicology panel
E. Send the baby to radiology for a chest x-ray
C
2. Which category of conditions is most likely to be responsible for the symptoms of a
patient with fever of unknown origin?
A. Neoplastic
B. Rheumatologic
C. Infectious
D. Genetic
E. Neurologic
C
3. Which of the following is an example of an endogenous pyrogen?
A. Lipoteichoic acid
B. Bacterial Toxins
C. Lipopolysaccharide
D. Viral RNA
E. TNF-alpha
E
4. Which of the following is correct regarding normal body temperature?
A. Exhibits a range
B. Independent of site
C. Lower in the rectum than in the axilla
D. Always the same throughout a 24-hour cycle
E. Slightly elevated in senescent individuals
A
1. A sexually active 17-year-old man presents to the local free clinic to check some
small papules that appeared on his penis. The papules are small and white and contain
a central depression in their center. There is no penile discharge, nor is there pain on
urination. Which of the following best describes the infectious agent?
, a. A large and complex virus containing single-stranded linear RNA
b. A double-stranded DNA virus encoding a DNA-dependent RNA polymerase
c. A double-stranded linear DNA virus that integrates into the chromosome
d. a single-stranded DNA virus that replicates in the host cytoplasm
e. A double-stranded circular DNA virus
B
2. Human papilloma virus-related cervical intraepithelial neoplasia can be diagnosed by
the presence of which of the following histologic features?
a. Central, basophilic intranuclear cellular inclusions
b. Cowdry type A intranuclear cellular inclusions
c. Enlarged multinucleated cells
d. Cytoplasmic vacuolization and nuclear enlargement of cells
e. Numerous atypical lymphocytes
D
3. A 35-year-old man with no known past medical history presents for evaluation of a
rash on the cheek and forehead. The rash consists of numerous, small, coalescing skin-
colored papules. He does not have any systemic symptoms and his HIV status is
unknown. Initial testing for HIV reveals a positive HIV-1/2 antigen-antibody HIV test and
a HIV differentiation antibody test that is positive for HIV-1. Follow-up laboratory studies
show a CD4 count of 90 cells/mm3 and an HIV RNA level of 244,000 copies/mL. Which
one of the following is the recommended first-line therapy for this man's rash?
a. valacyclovir
b. valganciclovir
c. ketoconazole 2% cream
d. oral prednisone
e. anti-retroviral therapy
E
1. Your patient complains of an "itching rash" on her abdomen. On examination, you
find that the lesions are red, circular, with a vesiculated border and a healing central
area. You suspect tinea corporis (ringworm) caused by a dermatophyte. Which of the
following is the most appropriate laboratory procedure to confirm the diagnosis?
a. Potassium hydroxide mount of skin scrapings
b. Giemsa stain for multinucleated giant cells
c. Fluorescent-antibody stain of the vesicle fluid
d. Four-fold rise in antibody titer against the organism
e. RT-PCR for fungal DNA
A
2. A 48-year-old male presents with hypopigmented, scaling, and confluent macules on
the chest, upper arm, and neck. Wood’s lamp examination of skin macules displays a
pale yellow to blue-white fluorescence. Examination of KOH mounting of scales from
lesions demonstrates the presence of short, thick hyphae with clusters of large,
spherical budding yeast cells with spaghetti-meatballs appearance. Which of the
following fungi is the most likely cause of this patient’s symptoms?
