19/07/2013 12:41:00

1. Blood culture demonstrating tightly coiled thin flexible spirochetes

shaped like umbrella handle? (Umbrella term wont be there)

Leptospiras tightly coiled, fine spirochetes (seen by darkfield microscopy)
Animals are reservoirs ; espec dogs in US. Animals excrete leptospiras into
water. Water contaminated with animal urine.

2. 28 year old women, comes to the office complaining diffuse skin rash
and eruption in her perineal region. Pelvic examination reveals several
fleshy moist lesions on perineum on all external genital area. What can
be the condition?

Ans: C




syphilis- moist lesions are called condyloma lata
Just eruption painful or painful herpes
Non painful something diff syphillis
Genital wart human papilloma virus

3. The child with sickle cell anemia comes to an pediatrician, the mother
is stating the child is always tired and the pediatrician diagnosis as a
viral infection.






Parvovirus B19 cause aplastic anemia

Key words will be sickle cell and single negative stranded DNA genome with
icosahedral capsid symmetry

4. 65 year man, develops vesicular rash, localized to a narrow band on
one side of his chest. What is the condition?














Zoster the occurrence of painful vesicles along the course of a sensory nerve
of the head or trunk is the usual picture

5. Fisherman, develops an inflammatory skin lesion on his hand. The
edge of the lesion is raised, erythematous with discoloration in the
central area. What can be the causative agent?

Erysipeloid caused by Erysipelothrix rhusipathiae (gram positive rod)
Skin infection that occurs on hands of people who handle meat and fish
It is an acute bacterial infection of traumatized skin and other organs

6. The patient presents to the physician bc of pain during defecation.
Accompanied by blood in the stool. Physical examination demonstrates a
large perianal mass, pathological examination of the rectal mass
demonstrates condolyma in which transformation to frank carcinoma
occurred.



















***In homosexual & HPV 16: perianal mass can also be found side note

7. 22 year old lady, complains of inability to close her right eye for the
last two days. On further questioning, she gives a history of attending a
camping trip 4 weeks ago. On examination multiple erythematous
lesions with central clearing is found around her waistline. Neurological
examination shows right side facial nerve palsy. Based on the finding
what is the diagnose?

Borrelia Burgdoferi transmitted by tick bite
In stage 2: cardiac and neurologic involvement predominates (Bells palsy etc)

The min the lesion is around the waistline what is in mind is a vesicular lesion
central clearing is not there herpes it will be painful

If its not painful it is something else
Note the camping

8. Best method to identify chlamydiae pneumoniae (definite method)

through xray which will show patchy infiltrate, persistent nonproductive
cough
- they will have a cough staccato pattern which interferes with sleep

9. 27 year old man comes to the physician because of pain with urination
for 3 days. Physical examination shows no abnormalities except clear
watery urethral discharge. Urine exam 10-20 WBC per but no bacteria.
What is the diagnosis?

Chlamydiae trachomatis types D-K cause genital tract infections
In MEN it is the common cause of NONGONOCOCCAL URETHRITIS which
may lead to epididymitis, prostatitis or proctitis

10. This lesion which is scraped under a dark field microscopy. lesion is
in the genital tract. Positive for spirochetes. Under biopsy specimen,
what is most likely seen? Which of the following?

granulamotous inflammation?
Acute inflammation?
Perivascular inflammation?
Gummatous inflammation?

If it was stage three tertiary stage: gummas will be seen => gummatous
inflammation?

11. The biopsy specimens how multiple abscess with central necrosis.
Surrounded by perpendicularly arranged histocytes












Chlamydiae infect primarily the columnar/transitional epithelial cells of the
mucous membranes or the lungs/urogenital tract

This is the description of chlamydiae cervicitis

12. Biopsy of small bowel, shows PAS positive macrophages within the
laminar propria. Electron microscope of the macrophage shows small
rods shaped structure. What can be the agent?



Ans: E






-tropheryma whipplii ( bacteria responsible for whipples disease-
diarrohea, ab pain and skin pigmentation ( in men)). Similar to presentation in
crohns disease.

13. Sexually active 20 year old women, complains of vaginal discharge
that has a fishy odor. Gram stain of the vaginal stain shows bacterial
organism. Whiff test is positive.

Gardernella vaginalis: malodorous vaginal discharge and clue cells (vaginal
epithelial cells covered in bacteria)
- pungent fishy odor

14. clenched fist injury ________ pathogen?

Eikenella corrodens- also associated with endocarditis in drug abusers

15. The history of tick bite is noted. Rickettsia fever is suspected, what is
the definite diagnostic method available for rickettsial fever diagnosis?

Side note: Not will flakes test (older test) what is the current one?

Based mainly on serological analysis rather than isolation of organism
Specifically of the serological tests: the INDIRECT immunofluorescence and
ELISA tests are most often used.

16. 38 year old male hunter, comes with a fever chills headache.
Peripheral blood smear shows intracellular inclusions in monocytes.
What is the diagnosis?

Ehrlichia chaffeensis member of rickettsia family
CAUSES human monocytic ehrlichiosis (HME)
Transmitted by a dog tick
EC primarily infects mononuclear leukocytes and forms a characteristic
morulae (inclusion body that resembles mulberry) in the cytoplasm

17. This 45 year old lady comes with fever, chills, non productive cough
and her main occupation is collecting birds. shes got parrots at home.





Chlamydia psittaci infects the lungs mainly
Causes psittacosis (pneumonia) in humans and orinthosis in birds
Caused by inhalation of bird feces and is diagnosed by a serological test

Human psittacosis is not communicable*

18. This man is 35 yrs old comes to ER, with a rash fever, vomiting and
abdominal pain. The rash started on the trunk and spread to palm and
soles. History a week ago he went for hunting and pulled a deeply
embedded tick off his trunk after he got home. What is the diagnosis.

Which one is common in US. Don't go with the desc of the rash.

The description of the rash fits with Louse borne epidemic typhus => R.
Prowazakii strain ; this usually occurs in individuals in war setting or poverty
found in DEVELOPING countries not the United States

HOWEVER IF WE DON'T GO WITH THE DESCRIPTION OF THE RASH and
see the most common in US it would be Rocky mountain spotted fever
Occurs in 95% of the cases

19. Regarding host defense method against viral infection which one is the
following? Best one in the description?

Neutralizing
antibody.
What type of
antibody you
should know.

20. over the course of summer, several patients presents to the hospital
in north western united states with fever, chills, headache and other
viral symptoms. After several investigations, spirochetes was observed
in the PBS
and the next adding point is all the patients are outdoor activities like
camping, fishing and hiking in the mountain areas and what is the most
likely etiological agent?

Borrelia Burgdorferi tick bite

21. A naked protein similar in amino acid sequence to normal human
protein which has no nucleic acid. But causes human infection. Know the
name
Prions

22. 2 mutants of polio virus, one mutated at gene x another mutated at
gene y has been isolated if a cell is infected with each mutant alone , no
virus is produced. If a cell is produced with both mutants. What is the
method and the outcome.

The method is complementation. The outcome will be VIRAL PROGENY will be
formed (still with mutated DNA) this is the case if they both are defective in
different genes.

23. The purified genome of certain RNA virus, can enter and elicit the
production of progeny virus. Regarding this virus which one of the
following statement is most accurate.

What type of virus is this? Positive sense RNA. It acts as mRNA

24. Hepatitis A virus is resistant to solvent such as chlorophorme and
20% diether, while HIV is sensitive to such solvents. This resistance is
best explained by which part of the virus?
Hep A is an RNA nucleocapsid Virus while HIV is an RNA enveloped virus.

25. 29 year old female, diagnosed with AIDS has been suffering from
progressive blurring of vision in her right eye on fundoscopy
examination .a small white opaque lesion is noted. On the retina of her
right eye.
What is the diagnosis and treatment?
Diagnosis: Cytomegalovirus causes retinitis in AIDS patients
Treatment:
1. Ganciclovir (cytovene) is moderately effective in cytomegalo virus
retinitis and pneumonia in patients with AIDS
2. Cidofovir is also a useful treatment


26. This viral particle isolated from nasal exudate of ten year old boy has
shown to lose infectivity once exposed to ether. It can be concluded that
the viral particles are most likely?

-
enveloped


27. 24 year old man presents with fever, rash, mild headache and sore
throat. He denies HIV risk factors although he is sexually active. On
examination diffuse erythematous maculopapular rashes present over
most of his body. Generalized lymphadenopathy is appreciated. If this
man is not treated what is the outcome?


Has Syphilis caused by
trepenoma Pallidum
He is in the 2
nd
stage
After the 2
nd
stage:
VDRL (Venereal disease
research laboratory) will be
negative after treatment (Non
specific test) gives you an
indication of the progress of
treatment

TPH (trepenoma pallidum haemoagglutinin) will remain positive for life after
treatment (specific test) does NOT give you indication of progress of
treatment

28. syphilis q as well but pat is diff
When the patients serum is added to mixture of cardiolipin, lethicin and
cholesterol extensive flocculation is observed. The next step in
management of his condition would require evaluation for?

Reagin ab forms which is a mixture IgG and IgM. This is a non specific
serological test.

Cold agglutinin ( IgM)

He is already positive keep in mind

29. Ribavirin is a drug of choice of dash infection?
Know the clinical interpretation of that. One clue is there, age of the
patient know this.

Ribavirin aerosol is used clinically to treat pneumonitis caused by respiratory
syncytial virus in infants and to treat severe influenza B infections.

Also in combination with alpha interferon for treatment of Hepatitis C

30. in the lab, the virologist was studying the properties of HIV. She
infected the same single cell with HIV and rabies virus. Some of the
progeny viron were able to infect dog cells within which she found HIV
specific RNA. Which one of the following describes the best description
for the progeny viron?
Phenotypic mixing. The progeny viruses (pseudotypes) consist of the
nucleocapsid of one virus (HIV) and the envelope of another (Rabies).

31. The minute in vitro infection is there, what is the virus?
Vacinnia Virus

32. A new born is born in utero with an envelope virus containing double
stranded DNA. Brain calcification are detected on CT scan. Which of the
following virus can do such things?



Cytomegalovirus

33. Flu vaccine, 65 year old women. Refuses to be vaccinated against
influenza virus because she was vaccinated the previous year. What
changes in the virus necessitate annual vaccination?

Similar Q,
ANS: B
Ressortment ( genetic recombination b/w RNA viruses)

Antigenic drift- minor antigenic changes. No need for new vaccines.
Antigenic shift- major antigenic changes. New virus, therefore new vaccine
needed.

34. Parvo B19 (answer) don't know the question
Hydrops fetails, lacy diffuse rash and slapped cheek. Damages endotheial cells
of B.vessels.
Only single stranded DNA virus



35. Healthy 16 year old boy seen by physician for umbilicated flesh
colored papules on his face. Which family it belongs too?















Pearl on skin. Molluscum contagiosum. Family: POX VIRUS
Pink popular wart like benign tumor.
Cup-shaped crater with a white core.
Transmitted by close personal contact

36. The patient here 8 year old boy, low grade fever and
keratoconjunctivitis following a swimming camp*

Ans: A
Adenovirus causes pink eye
Key word: swimming

37. Eradication of small pox was achieved by which one of the following?
No carriers in small pox, not only live attenuated.

The disease was eradicated by global use of the vaccine, which contains live,
attenuated vaccinia virus.

The success of the vaccine is dependent upon five critical factors:
(1) smallpox virus has a single, stable serotype;
(2) there is no animal reservoir, and humans are the only hosts;
(3) the antibody response is prompt; therefore, exposed persons can be
protected;
(4) the disease is easily recognized clinically; therefore, exposed persons can
be immunized promptly; and
(5) there is no carrier state or subclinical infection
19/07/2013 12:41:00