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Volume 16, Number 9—September 2010

CME ACTIVITY - Synopsis

Recurrent Granulibacter bethesdensis Infections and Chronic Granulomatous Disease

To obtain credit, you should first read the journal article. After reading the article, you should be able to answer the following, related, multiple-choice questions. To complete the questions and earn continuing medical education (CME) credit, please go to http://cme.medscape.com/viewpublication/30063. Credit cannot be obtained for tests completed on paper, although you may use the worksheet below to keep a record of your answers. You must be a registered user on Medscape.com. If you are not registered on Medscape.com, please click on the New Users: Free Registration link on the left hand side of the website to register. Only one answer is correct for each question. Once you successfully answer all post-test questions you will be able to view and/or print your certificate. For questions regarding the content of this activity, contact the accredited provider, CME@medscape.net. For technical assistance, contact CME@webmd.net. American Medical Association’s Physician’s Recognition Award (AMA PRA) credits are accepted in the US as evidence of participation in CME activities. For further information on this award, please refer to http://www.ama-assn.org/ama/pub/category/2922.html. The AMA has determined that physicians not licensed in the US who participate in this CME activity are eligible for AMA PRA Category 1 Credits™. Through agreements that the AMA has made with agencies in some countries, AMA PRA credit is acceptable as evidence of participation in CME activities. If you are not licensed in the US and want to obtain an AMA PRA CME credit, please complete the questions online, print the certificate and present it to your national medical association.

Recurrent Granulibacter bethesdensis Infections and Chronic Granulomatous Disease

Medscape CME Questions

1. A 35-year-old man presents with a history of X-linked chronic granulomatous disease (CGD) in the hospital. He was admitted after 3 weeks of fever. Physical examination reveals obvious lymphadenopathy. Laboratory evaluation reveals an elevated erythrocyte sedimentation rate, but a Gram stain for organisms on 1 of his lymph nodes is negative.

This patient is most likely infected with which of the following organisms?

A. Group B Streptococcus species

B. Mycoplasma pneumoniae

C. Aspergillus species

D. Campylobacter jejuni

2. Which of the following statements about a possible infection with Granulibacter bethesdensis in this patient is most accurate?

A. This infection is unlikely, given the patient’s duration of fever

B. Lymphadenopathy was present in all cases of infection with G. bethesdensis

C. Infection with G. bethesdensis does not promote an elevation in the erythrocyte sedimentation rate

D. G. bethesdensis was evident on bacterial staining in all cases

3. The patient has a battery of tests and procedures to establish a causative organism for his infection. Which of the following statements about the diagnosis of G. bethesdensis infection is most accurate?

A. G. bethesdensis cultures grew readily, but only on Middlebrook media

B. PCR amplification testing of excised tissue could identify G. bethesdensis

C. All infections with G. bethesdensis could be traced to the same strain

D. There was no evidence of reactivation of latent infection

4. A bacterial culture from your patient is now growing G. bethesdensis. Which of the following statements about his treatment and prognosis is most accurate?

A. Ceftriaxone is a good choice of treatment

B. Macrolide antibiotics are particularly effective for treating G. bethesdensis

C. Disseminated G. bethesdensis infection was uniformly fatal

D. G. bethesdensis responds to only 1 or 2 antibiotics

Activity Evaluation

1. The activity supported the learning objectives.
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2. The material was organized clearly for learning to occur.
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3. The content learned from this activity will impact my practice.
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4. The activity was presented objectively and free of commercial bias.
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