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1.

A nine-year-old boy presents to his GP with a 2-day history of sudden onset itchy rash over
his face, scalp, neck and trunk, On examination, his temperature is 38C and there is a
widespread vesicular rash. What is the most likely infective organism?
A. EpsteinBarr virus
B. Cytomegalovirus
C. Varicella zoster virus (VZV)
D. Staphlococcus aureus
E. Herpes-simplex type 1

2. A 70-year-old man presents to accident and emergency with a 1-day history of a painful rash
across his trunk. He has a past medical history of hypertension and hypercholesterolaemia.
On examination, there is a well-demarcated blistering rash on the right side of his trunk.
What is the most appropriate treatment?
A. Oral acyclovir
B. High dose intravenous acyclovir
C. Topical steroids
D. Paracetamol
E. Amitryptiline

3. A 27-year-old investment banker presents to accident and emergency with a 4-day history of
painful rash on his penis and testicles. He also reports feeling generally run down with a
fever and myalgia. He returned from a trip to New York a week ago. On examination, there is
a painful vesicular rash over his penis and testicles. What is the most appropriate treatment?
A. Oral acyclovir
B. High-dose intravenous acyclovir
C. Oral flucloxacillin
D. Paracetamol
E. Glyceryl trinitrate cream

4. A 22-year-old medical student presents to the GUM clinic with large amounts of yellow-
coloured penile discharge and discomfort on urinating. He has just arrived home from his
summer holiday in Ibiza. What is the most likely diagnosis?
A. Chlamydia
B. Genital herpes
C. Cystitis
D. Gonorrhoea
E. Syphilis

5. A 30-year-old man presents to his GP with a lesion on his penis, which appeared a week ago.
On further questioning, he reports a change in sexual partner 4 weeks ago. He has otherwise
been well. On examination, there is a painless hard ulcer on the shaft of the penis. What is the
most likely diagnosis?
A. Chancroid
B. Genital herpes
C. Chlamydia
D. Primary syphilis
E. Secondary syphilis

6. A 34-year-old man presents to his GP with a painless hard penile ulcer. Venereal Disease
Research Laboratory tests and Treponema pallidum haemagglutination assay confirm the
diagnosis of primary syphilis. What is the most appropriate treatment for this patient?
A. Co-amoxiclav
B. Acyclovir
C. Azithromycin
D. Ciprofloxacin
E. Procaine penicillin

7. A 45-year-old man presents to accident and emergency, having returned from a holiday to
India a week ago. He has subsequently been unwell with nausea and reduced appetite. Over
the past 2 days he has become jaundiced. He mentions that his two brothers with whom he
went on holiday have also become jaundiced in the last 2 days. On examination, he is
apyrexial and there is a palpable liver edge. Liver function tests reveal a raised ALT, AST and
bilirubin. All other blood tests are normal. What is the most likely diagnosis?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Gilberts syndrome
E. Malaria

8. A 40-year-old man presents to accident and emergency having returned from a holiday to
India a week ago. He has subsequently been unwell with nausea and reduced appetite. Over
the past 2 days he has become jaundiced. On examination, he is apyrexial and there is a
palpable liver edge. Liver function tests reveal a raised ALT, AST and bilirubin. A diagnosis
of hepatitis A is suspected. What is the most appropriate treatment?
A. Intravenous hydrocortisone
B. Pegylated interferon alpha plus ribavirin
C. Conservative management
D. Acyclovir
E. Chloroquine

9. A 19-year-old medical student presents to accident and emergency with a 1-week history of
fever, anorexia and a sore throat. On examination, she is pyrexial at 39C and cervical,
axillary and inguinal lymph nodes are palpable. Palatal petechiae are visible within the mouth
and her tonsils appear inflamed. A full blood count reveals a lymphocytosis and a blood film
reveals the presence of atypical lymphocytes. What is the most likely diagnosis?
A. Toxoplasmosis
B. Cytomegalovirus infection
C. Infectious mononucleosis
D. Streptococcal sore throat
E. Influenza

10. A 19-year-old medical student presents to his GP during freshers fortnight. He is


complaining of neck stiffness, headache and sensitivity to light. On examination, a non-
blanching, petechial rash is observed on the trunk. What is the most appropriate immediate
management?
A. Send the patient to accident and emergency immediately
B. Send him home with advice to rest and return if the symptoms worsen
C. Administer 1.2 g of intramuscular benzylpenicillin
D. Give 500 mg of ciprofloxacin
E. Take a full set of blood tests

11. A 19-year-old man presents to his GP with a 4-day history of painful facial swelling, fevers
and lethargy. On examination, there is bilateral swelling of his parotid glands. What is the
most likely diagnosis?
A. Measles
B. Mumps
C. Influenza
D. Infectious mononucleosis
E. Pertussis
12. A 41-year-old teacher presents to her GP with a 5-day history of fevers, headaches, lethargy
and muscle aches. She also mentions that she is developing an expanding red rash on her left
thigh. On further questioning, she mentions that she has been on a school camping trip the
previous week. She is otherwise fit and well. What is the most likely diagnosis?
A. Lyme disease
B. Sarcoidosis
C. Brucellosis
D. Syphilis
E. Erythema abigne

13. A 39-year-old Indian man presents to his GP with a 5-week history of haemoptysis, night
sweats and weight loss. Which of the following investigations can be used to confirm the
diagnosis of tuberculosis?
A. Tuberculin skin testing
B. Blood cultures
C. Chest x-ray
D. ZiehlNielsen sputum staining
E. Computed tomography pulmonary angiogram (CTPA)

14. A 23-year-old man presents to accident and emergency with a 1-day history of severe
headache, discomfort when looking at the lights and neck stiffness. There is a non-blanching
rash observed on his trunk. He has recently recovered from chicken pox. On examination he
is pyrexial at 39C. The most likely causative organism is:
A. Streptococcus pneumoniae
B. Listeria monocytogenes
C. Neisseria gonorrheae
D. VZV
E. Neisseria menigitidis

15. A 51-year-old man presents to accident and emergency with a lesion on his forearm. He
mentions that he has spent the past three months travelling around South America and only
returned home 3 days ago. While his lesion has been present for a few weeks he was
reluctant to see a doctor in South America. On examination, there is a 3 3 cm erythematous
ulcer on the left forearm with a raised edge. What is the most likely diagnosis?
A. Leishmaniasis
B. African trypanosomiasis
C. Herpes zoster
D. Schistosomiasis
E. Cryptosporidiosis

16. Which of the following statements is most accurate regarding leishmaniasis?


A. It is transmitted by the anopheles mosquito
B. Leishmania are bacteria
C. Leishmaniaisis is usually a self-limiting condition
D. It is transmitted by the tsetse fly
E. The presence of LeishmanDonovan bodies confirms the disease

17. A 24-year-old man presents to accident and emergency with fevers, lethargy, myalgia and a
cough. He has also developed an itchy rash on his feet. He returned home from a charity trip
to Malawi last month and is worried he might have malaria. On examination, a papular rash
is noted around his feet and there is a palpable liver edge. Initial blood tests show a raised
white cell count with an eosinophilia. What is the most likely diagnosis?
A. Leishmaniasis
B. Schistosomiasis
C. African trypanosomiasis
D. Malaria
E. Influenza

18. A 35-year-old man presents to his GP with diarrhoea, abdominal pain and nausea. He says he
his stools have been pale and he has felt persistently bloated. His symptoms started 6 weeks
ago while on a surfing holiday in Peru. What is the most likely diagnosis?
A. Coeliac disease
B. Enterotoxigenic E. coli gastroenteritis
C. Salmonella
D. Giardia
E. Cryptosporidiosis

19. A 26-year-old Bangladeshi man presents to accident and emergency with a 1-week history of
fever, headache, malaise and dry cough. He returned to the UK 2 weeks ago, having spent his
summer in Bangladesh. On examination, his temperature is 39C and a patchy maculopapular
rash is seen over his trunk. On examination of the abdomen, there is splenomegaly. Blood
tests reveal a low white cell count. What is the most likely diagnosis?
A. Tetanus
B. Malaria
C. Typhoid
D. Cholera
E. Primary syphilis

20. A 32-year-old man presents to accident and emergency with the inability to open his jaw,
starting a few hours earlier. His wife mentions that he has had the flu since returning from a
weekend camping trip. What is the most likely diagnosis?
A. Tetanus
B. Dislocation of the temporomandibular joint
C. Clostridium perfringens infection
D. Influenza
E. Clostridium difficile infection

21. Following a colonic resection, a 72-year-old woman becomes unwell with acute confusion,
pyrexia, tachycardia and hypotension. The patient has had a difficult postoperative period,
which has included an admission to ITU for the management of a chest infection. Blood
cultures are sent and grow methicillin-resistant Staphylococcus aureus (MRSA). The patient
is placed in isolation and barrier nursing is implemented. What is the most appropriate
management of this patient?
A. Manage conservatively
B. Start intravenous vancomycin
C. Start intravenous co-amoxiclav
D. Start intravenous co-amoxiclav and gentamicin
E. Start oral metronidazole

22. A 90-year-old man presents to accident and emergency with a 2-week history of fevers,
lethargy and night sweats. He has recently had crowns fitted at the dentists. He has a past
medical history of hypertension, gout and type 2 diabetes mellitus. On examination his
temperature is 39C, his pulse is 120 bpm and splinter haemorrhages are seen in the nails. On
auscultation of the heart a pansystolic murmur is audible. A diagnosis of endocarditis is
suspected and blood cultures are taken. What organism is most likely to be grown?
A. Staphlococcus aureus
B. Staphlococcus epidermidis
C. Actinobacillus
D. Enterococcus faecalis
E. Streptococcus viridans
23. A 45-year-old man who lives in a homeless shelter presents to accident and emergency with
an itchy rash. The itching is particularly bad at night. On examination, there is a papular rash
between the web spaces of the fingers and toes, the palms of the hands and soles of the feet,
the axilla and on the genitalia. What is the most likely diagnosis?
A. Scabies
B. Shingles
C. Chicken pox
D. Molluscum contagiosum
E. Tinea cruris

24. A 20-year-old man presents to accident and emergency with extreme pain in the right knee.
On examination, his temperature is 38.5C and the knee is hot and swollen. He is unable to
move his knee due to pain. The joint is aspirated and blood cultures are taken. The patient is
admitted and started on intravenous antibiotics. Gram staining of the joint aspirate shows
gram-negative diplococci. What is the most likely responsible organism?
A. Chlamydia trachomatis
B. Neisseriae gonnorrheae
C. Haemophilus influenzae
D. Streptococcus pneumoniae
E. Streptococcus viridans

25. A 74-year-old man presents to accident and emergency with extreme pain in the left knee. On
examination, his temperature is 39C and the knee is swollen and hot. He is unable to move
the joint due to pain. The joint is aspirated and the patient is admitted and started on
intravenous antibiotics. What is the most likely causative organism?
A. Neisseriae gonorrheae
B. Mycobacterium tuberculosis
C. Neisseria meningitidis
D. Staphlococcus aureus
E. Haemophilus influenzae

26. A 42-year-old man presents to accident and emergency with a 3-week history of shortness of
breath, dry cough, fevers and malaise. He has presented as his exercise tolerance has
deteriorated. He mentions that he has been HIV positive for ten years. On examination, there
are fine crackles throughout both lung fields. Chest x-ray demonstrates bilateral perihilar
interstitial shadowing. What is the most likely causative organism?
A. Pneumocystis jiroveci
B. Herpes simples virus type 1
C. Herpes simplex virus type 2
D. Streptococcus pneumoniae
E. Mycoplasma pneumoniae

27. A 42-year-old man presents to accident and emergency with a 3-week history of retrosternal
discomfort after swallowing. He mentions that he has been unable to keep any food down at
all. He has been HIV positive for ten years. He is admitted and endoscopy shows areas of
ulceration throughout the oesophagus. What is the most likely causative organism?
A. Staphylococcus aureus
B. Crytosporidium parvus
C. Candida albicans
D. Pneumocystis jiroveci
E. Cryptococcus neoformans

28. A 42-year-old man presents to his GP with blotches over his legs. He has been HIV positive
for ten years. On examination, there are multiple purple and brown papules over his legs and
his gums. What is the most likely diagnosis?
A. Malignant melanoma
B. Squamous cell carcinoma
C. Basal cell carcinoma
D. Kaposis sarcoma
E. Toxoplasmosis

29. A 42-year-old man presents to his GP with blotches over his legs. He has been HIV positive
for ten years. On examination, there are multiple purple and brown papules over his legs and
his gums. A diagnosis of Kaposis sarcoma is suspected. What is the most likely causative
organism?
A. Herpes simplex virus type 1
B. Herpes simplex virus type 2
C. Human herpes virus type 3
D. Human herpes virus type 8
E. Pneumocystis jiroveci

30. A 42-year-old man presents to accident and emergency with a 1-day history of headache and
fevers. He presents with his partner who says he has been becoming increasingly confused
and disorientated. On examination, his temperature is 38.5C. On cranial nerve examination
there is a right-sided superior quadrantanopia. An urgent CT scan of the head is organized
which shows multiple ring enhancing lesions. What is the most likely diagnosis?
A. Toxoplasmosis
B. Meningitis
C. Cryptosporidiosis
D. CMV encephalitis
E. Histoplasmosis

31. A 42-year-old man presents to his GP complaining of deterioration in his vision in the right
eye and the presence of floaters. The change in his vision has been causing him to suffer
from headaches. He has been HIV positive for ten years. Fundoscopy reveals haemorrhages
and exudates on the retina. What is the most likely diagnosis?
A. Retinal detachment
B. CMV retinitis
C. Kaposis sarcoma
D. Optic atrophy
E. Diabetic retinopathy

32. The survival of Mycobacteria after ingestion by macrophages is attributed to?


a. Bacterial inhibition of complement activation via the alternative pathway.
b. Bacterial inhibition of phagolysosome formation and interference with endosomal
acidification
c. The poor immunogenicity of the cell wall glycolipids.
d. The bacteriums rapid escape from the endosome into the cytoplasm of infected cells.
e. The bacteriums resistance to oxygen-active radicals released into the phagolysomsome

33. A 21 year newly married woman developed a urinary tract infection (uti). At the time she
sought medical advice, she was febrile and complained of painful urination and flank pain.
Her urine appeared cloudy. Urine culture yields a lactose-fermenting, indole-positive,
Gram-negative bacillus. The infectiveness of the organism responsible for this urinary tract
infection is associated with specific,
a. exotoxins
b. K antigens
c. Metabolic properties
d. P fimbriae
e. Plasmids

34. The role of bacterial capsules as virulence factors is usually related to their ability to interfere
with?
a. Antibody binding
b. B lymphocyte activation
c. Antibacterial penetration of bacterial cells
d. Phagocytosis
e. The release of interferon gamma and other macrophage activating cytokines

35. A mutation in DNA gyrase is likely to result in resistance to which one of the following
antibiotics?
a. Amphotericin B
b. Ciprofloxacin
c. Penicillin
d. Rifampin
e. Streptomycin

36. Resistance of Staphylococcus aureus to methicillin is most often caused by


a. Alternation of the major target for the drug
b. cell membrane impermeability
c. decreased uptake of the antibiotic
d. Inactivation of autolysins
e. Synthesis of a potent Beta Lactamase

37. The molecular basis for the effect of cholera toxin on duodenal mucosal cells is
a. Activation of adenylate Cyclase
b. Inactivation of a G1 protein
c. Increased activity of potassium pumps
d. increased generation of cyclic adenosine monophosphate (cAMP)
e. Ribosylation of a guanosine triphosphate (GTP) binding protein.

38. The synthesis of erythrogenic toxin by specific strains of group A Streptococcus is


determined by a?
a. Bacterial chromosomal gene
b. gene carried by a lysogenic phage
c. Specific virulence plasmid
d. Transport gen
e. Plasmosom
39. Which one of the following factors, released by heating a suspension of sheep erythrocytes,
is required for the growth of Haemophilus Influenzae in chocolate agar?
a. Coagulase
b. Nicotinamide adenine dinucleotide (NAD)
c. Hemoglobin
d. Hemolysin
e. Protein A

40. Concerning HIV infection in pregnancy:


a. pregnancy approximately doubles the rate of progression to AIDS
b. the rate of vertical transmission of HIV is greater than 50%
c. perinatal administration of corticosteroid to the mother reduces vertical transmission
d. breast feeding increases vertical transmission.
e. transmission of HIV to the neonate is confirmed if the neonate is HIV antibody positive

41. Epstein-Barr virus is associated with


a. hairy cell leukaemia
b. AIDS
c. nasopharyngeal carcinoma
d. teratogenesis
e. Adenocarcinoma recti

42. Suppurative lymphadenopathy may be caused by,except :


a. cat scratch fever
b. lymphogranuloma venereum
c. tuberculosis
d. sarcoidosis
e. plague

43. Benzylpenicillin is suitable empirical therapy for bacterial meningitis caused by which of the
following organisms?
a. Escherichia coli
b. Haemophilus infl uenzae
c. Neisseria meningitidis
d. Pseudomonas aeruginosa
e. Staphylococcus aureus

44. An 82 - year - old man developed a fever 6 weeks after a total hip replacement. He had a
history of chronic obstructive lung disease and had been on long term steroid therapy. He
had noticed worsening hip pain on the side of the prosthesis for 2 weeks. Following
admission to hospital he had four sets of blood cultures that were positive for coagulase -
negative staphylococci. What is the most likely explanation for the positive cultures?
a. Endocarditis
b. Lung abscess
c. Prosthetic hip joint infection
d. Nosocomial pneumonia
e. Skin contaminants

45. Which of the following is consistent with bacterial vaginosis?


a. Infl ammation of the posterior vaginal wall on colposcopic examination
b. Presence of clue cells on microscopy
c. Presence of motile parasites ( Trichomonas vaginalis ) in the vaginal secretions
d. Presence of thick, white vaginal discharge
e. Vaginal discharge pH less than 4.0

46. A 45 - year - old woman is admitted to intensive care with life- threatening Staphylococcus
aureus pneumonia. Investigations reveal an underlying viral infection. Which of the most
appropriate diagnosis from the list of options below?
a. Typhoid
b. Malaria
c. Infl uenza A
d. Meningococcal meningitis
e. Osteomyelitis

47. A 40- year - old oil worker was sent urgently to crisis manage a project in West Africa and
had no time to go to the travel clinic for immunisations. On his return he was admitted with a
severe fl u - like illness, headache, constipation and fever. Blood cultures taken on admission
revealed Gram - negative bacilli on Gram stain. Which of the most appropriate diagnosis
from the list of options below?
a. Typhoid
b. Malaria
c. Influenza A
d. Meningococcal meningitis
e. Osteomyelitis

48. A 70 - year - old man with multiple recent hospital admissions, was admitted with fever,
rigors and malaise and his blood cultures have grown Staphylococcus aureus. He has a
documented severe allergy to penicillin and cephalosporins. Which of the most appropriate
antimicrobial therapy?
a. Doxycycline
b. Metronidazole
c. Piperacillin - tazobactam
d. Trimethoprim
e. Vancomycin

49. An 80- year - old woman with dementia, normally resident in a nursing home, was admitted
to hospital with a 5 - day history of profuse watery diarrhoea. She has received several
courses of antibiotics for urinary tract infections in recent months. No other patients have
been affected in her nursing home. Which of the most appropriate antimicrobial therapy?
a. Doxycycline
b. Metronidazole
c. Piperacillin - tazobactam
d. Trimethoprim
e. Vancomycin

50. A 66 - year - old woman with diabetes and hypertension was admitted with a 5 - day history
of fever, cough and rigors. The chest X - ray showed consolidation in the right lower lobe.
After 18 hours culture, two blood culture bottles showed Gram - positive diplococci on
microscopy. Which of the most likely causative organism from the list below?
a. Salmonella typhimurium
b. Staphylococcus aureus
c. Staphylococcus epidermidis
d. Streptococcus pneumoniae
e. Streptococcus pyogenes

51. A previously healthy 65- year - old man gives a 1- week history of fever, vomiting, jaundice,
pale stool, dark urine and right upper quadrant pain. On examination there is tenderness in
the right upper quadrant. After 24 hours of incubation, two blood culture bottles showed
Gram - negative bacilli on Gram stain. Which of the most likely causative organism from the
list below?
a. Enterococcus faecalis
b. Escherichia coli
c. Haemophilus infl uenzae
d. Mycobacterium tuberculosis
e. Neisseria meningitidis

52. A 60 - year - old man with diabetes gives a 3 month history of mid - thoracic back pain,
fever, sweats and weight loss. An X - ray of his thoracic spine shows an abnormality in the
T5 and T6 vertebral bodies. Several blood cultures were taken and, after 48 hours, Gram
stain of four bottles showed Gram - positive cocci in clusters. Which of the most likely
causative organism from the list below?
a. Salmonella typhimurium
b. Staphylococcus aureus
c. Staphylococcus epidermidis
d. Streptococcus pneumoniae
e. Streptococcus pyogenes

53. A 31 - year - old woman is admitted with urinary frequency, dysuria and vomiting. On
examination she was afebrile with normal pulse and blood pressure and no tenderness in the
abdomen or loin. Forty - eight hours later the patient had been discharged home, but the
laboratory phoned to say that one of two blood culture bottles submitted had became positive
and showed Gram - positive cocci in clusters on Gram stain. Which of the most likely
causative organism from the list below?
a. Salmonella typhimurium
b. Staphylococcus aureus
c. Staphylococcus epidermidis
d. Streptococcus pneumoniae
e. Streptococcus pyogenes

54. An agent active against herpes simplex virus. Which the most appropriate antimicrobial
agent from the options below?
a. Teicoplanin
b. Ceftriaxone
c. Aciclovir
d. Amoxicillin
e. Flucloxacillin

55. An antibiotic used in a combined preparation with clavulanic acid. Which the most
appropriate antimicrobial agent from the options below?
a. Teicoplanin
b. Ceftriaxone
c. Aciclovir
d. Amoxicillin
e. Flucloxacillin

56. A suitable agent for the treatment of MRSA Infection. Which the most appropriate
antimicrobial agent from the options below?
a. Teicoplanin
b. Ceftriaxone
c. Aciclovir
d. Amoxicillin
e. Flucloxacillin

57. A 4- year - old child was admitted with fevers and sore throat which had started 3 days
earlier. He had returned from eastern Europe the previous week and had no history of
childhood immunisation. On examination he appeared pale, listless and unwell with a
tachycardia of 140 beats/min. There was a grey adherent membrane over the tonsils and
pharynx. Which of the most likely causative organism from the options below?
a. Bacteroides melaninogenicus
b. Corynebacterium diphtheriae
c. Coxsackie virus
d. Epstein Barr virus
e. Herpes simplex virus

58. A 19- year - old student developed extensive painful ulceration over the lips and anterior
mouth. Which of the most likely causative organism from the options below?
a. Epstein Barr virus
b. Herpes simplex virus
c. Staphylococcus aureus
d. Streptococcus pyogenes
e. Viridans streptococci.

59. A 22- year - old woman with a history of recurrent tonsillitis was admitted with sore throat
and fever. She had a left - sided peritonsillar swelling and tender left cervical lymph nodes.
Which of the most likely causative organism from the options below?
a. Epstein Barr virus
b. Herpes simplex virus
c. Staphylococcus aureus
d. Streptococcus pyogenes
e. Viridans streptococci

60. A 78 - year - old woman was referred for assessment of fevers that had been ongoing for 6
weeks. She had also been aware of night sweats, left - sided headaches and fatigue.
Following admission she was noted to have daily fevers of > 38 C. Her ESR was raised at
110 mm/h. A chest X - ray and CT scan of the chest/abdomen were normal. Four sets of
blood cultures were negative. Which of the following is the most likely diagnosis?
a. Endocarditis
b. Lymphoma
c. Renal carcinoma
d. Tuberculosis
e. Temporal (giant cell) arteritis

This case for question number 61-64


Mary is a healthy 3 year old child living in Central Texas. She spends 4 days a week at
daycare while her parents work. The daycare calls and she has developed a low grade fever of
101-102. The fever persists for the next 4 days. She also is drowsy and complains that her head
and tummy hurt and she does not want to eat. The parents call the doctor and he recommends
Tylenol and fluids, keep the fever down and her body hydrated. By the fifth day her parents
noticed that Mary has developed a rash on her head and chest that is spreading to her back.
The lesions are 1 to 4 mm in diameter. Marys parents become concerned and bring her to their
primary care physician for a diagnosis.

61. What infectious disease does Mary have?


A. Varicella Zoster Virus (VZV)
B. Herpes Simplek
C. Rubella
D. Syphilis
E. Candida albicansInfection

62. How is this disease transmitted?


A. Sexually
B. infected respiratory tract secretions
C. Food
D. Blood
E. Indirect Contact
63. When should people receive the vaccine?
A. 2 3 months
B. 3 9 months
C. 12 47 months
D. 1 2 years
E. Adult

64. If Mary has been vaccinated how come she still contracted the virus?
A. Should help keep the disease more mild
B. Great enough the fight the virus completely
C. If only receiving the first dose, the disease still can infect the person mild-severe
D. If only receiving the first dose, the disease still with more complication
E. Great enough the fight the virus completely until age 17 years

This case for question number 65-66


A 54 year old businessman who returned from a holiday in India 10 days ago presents at his GP,
complaining that his skin has turned yellow. He has been suffering from abdominal pain, fatigue
and nausea for the past week and has just developed a fever.
65. What is your differential diagnosis?
a. Hepatitis A
b. Hepatitis B
c. Herpes Simpleks
d. Liver
e. Sarcoidosis

66. How would you test for this?


a. Faecal test Hep A virus is excreted in the faeces towards the end of the incubation
period
b. IgM antibodies detectable 3-4 hours after infection
c. IgA antibodies acute illness has passed and the patient now has long-term immunity to
further infection
d. Bronchoscopy
e. HbAsg serum test

This case for question number 67-68


A 35 year old Geordie man attends a sexual health clinic, complaining of dark urine. It is noted
that he is jaundiced and has a fever. He has just returned from one year in Thailand, and jovially
reported having sex with many women. He states he has never used illegal drugs and has not
received any blood transfusions in the past ten years.
67. What is your differential diagnostic?

a. Hepatitis B
b. Hepatitis C
c. Hepatitis A
d. Varicella Zooster
e. RSV

68. How would you diagnose this?


a. Faecal test Hep A virus is excreted in the faeces towards the end of the incubation
period
b. IgM antibodies detectable 3-4 hours after infection
c. IgA antibodies acute illness has passed and the patient now has long-term immunity to
further infection
d. Bronchoscopy
e. HbAsg serum test

69. A 73 year old woman with COPD is admitted to hospital with an acute history of shortness of
breath, cough and fever. She is bringing up green mucus, but no blood. She is a smoker (30
pack years) and has had numerous similar admissions in the past few years.
What is your differential diagnosis?
a. Pneumonia
b. Pneumonitis
c. Pneumothorax
d. Pleuritis
e. Emphyema

70. A 22 year old medical student returns from her elective in Tanzania with a three day history
of alternating fever and chills. She has an intense headache, fatigue and appears generally
very unwell. She missed her vaccination appointment before her elective and therefore did
not take any prophylaxis for infectious diseases during her stay.
What is your differential diagnosis?
a. Malaria
b. Typhoid Fever
c. Scarlet Fever
d. Trypanosomiasis
e. Sarcoidosis

71. Your patient with chronic hepatitis B is determined to be HbeAg-positive. Treatment with
lamivudine is initiated. Which of these is most likely to be the strongest predictor of
treatment response in this patient?
a. Pretreatment serum ALT
b. HBV DNA after 3 months of treatment
c. Duration of treatment
d. Residual viral level after treatment initiation

This case for question 72-73.


Maria and her mother traveled to Latin America to visit her grandparents who she had not
seen in several years. Upon getting there, her grandparents took them out to eat at a local
restaurant. Two weeks later after returning home Maria began feeling ill with stomach cramping
and loose stools. Her symptoms became worse and she developed a fever, bloody stools, felt
weak, and she complained of severe stomach pain. Her mother took her to get examined by a
local physician who ran several tests including a complete blood count which showed she was
anemic and microscopic stool studies that revealed this trophozoite:
72. What is the disease and etiologic agent?
a. Amebiasis and Entamoeba histolytica
b. Amebiasis and Balantidium Coli
c. Amebiasis and Entamoeba Coli
d. Amebiasis and Entamoeba Hartmani
e. Amebiasis and Iodomoeba butschii

73. How is the disease transmitted?


a. Sexually transmitted
b. Person to person by indirect contact
c. Ingestion of mature cysts in focally contaminated food, water, or hands.
d. Spread via mucose membrane, saliva, urine, and blood.
e. Make contact with the susceptible individuals respiratory tract, via blood the mature cyst
spread and be absorbed in the intestinal.

74. What is the treatment for this disease?


a. Metronidazole 750-800mg taken three times daily for 5-10 days
b. Tinidazole 10 grams daily
c. Paromomycin 50 mg/kg per day, divided into three doses per day for seven days.
d. Ketoconazol 1 x 200 400 mg /hari
e. Itrakonazol 1 x 100-200 mg/hari
This case for question 75-76.
A girl aged 11 years old from Mengwi came with her mother to Sanglah General Hospital
with the chief complaint of discomfort of full body itchiness since two weeks ago. According to
her mother, this itchiness started from her fingers first which widespread in more numbers and
different sizes to her wrist, armpits and back within the time frame of one week. She also
complained of itchiness in her lower extremities, which mainly appeared in between her toes and
knees. The girl experienced such for the first time and had never consulted to a doctor before
assuming it would disappear by itself.
Furthermore, she said that the itchiness worsens at night and her sleep was ruined by intense
pruritus for the past two weeks. In these two weeks, the complaint did not reduce or subside. It
intensified until her daily routine was affected. History of pyrexia was denied. Her mother
applied a traditional cream to the affected area but the symptoms did not show any improvement.
According to the girl, currently both her brothers are experiencing the same complaint.
Apparently, she has a history of sharing the same room and bed with both her brothers. On
physical examination the girl appeared to be compos mentis with GCS of E4V5M6. Her vital
signs appeared to be normal with blood pressure 110/70 mmHg, respiratory rate of 18 times per
minute, pulse rate of 72 times per minute, and axillary temperature of 36.3 degree Celcius. The
girl appeared well nourished with a body mass index of 20.0.
According to the dermatological findings, the itchiness was limited bilaterally between the
fingers, wrist, palm, armpit, back and chest. The efflorescence was multiple erythematous
papules, round shaped with well defined borders, discrete presentation measuring from 0.1 to 0.2
cm in diameter, with no scales. The papules also appear in multiple spherical vesicles with a size
range measuring from 0.3 to 0.5 cm in diameter with erosion that has already healed and crusted.
There were also few serpiginous papules that appears whitish to greyish colour and has a
threadlike elevated line on her right hand.
From the physical examination, there were no fine scales found at the skin lesions or hyper
pigmentation of the skin.
Figure 1. Papules located at Figure 2.
patients finger webs I
75. What is the likely cause of the girl on that clinical case ?

a. Pediculosis

b. Scabies

c. Dermatophytosis

d. Pityriasis Vesicolor

e. Cutaneous Larva Migrans

76. What is the treatment for this case?


a. Scabimite scream 30 gram to be applied on her whole body
b. Interhistin scream 30 gram to be applied on her whole body
c. Tetrakloroetilen 100-400 mg/ kg per day, divided into three doses per day for seven days
d. Isoniazid and Riphampicin 30 mg/ kg per day
e. Tinidazole 10 grams daily

77. A 56- year - old man undergoes coronary artery bypass grafting after a myocardial infarction.
He develops a temperature of 102.3F a few days after surgery. On physical examination, the
sternotomy wound margins are erythematous, and a purulent discharge is noted. Cultures
obtained at the time of sternal wound dbridement grow Pseudomonas aeruginosa.
Intravenous (IV) therapy is begun with tobramycin and piperacillin; the fever resolves over
next few days. A week later, the patient has rigors and a temperature as high as 102F. The
sternal wound is healing well, and repeat wound culture is negative for organisms. The
subclavian triple lumen venous catheter site appears normal. One of 3 sets of blood cultures
is positive for yeast. Which of the following is the most appropriate next step in the treatment
of this patient?
a. Remove the triple lumen catheter and observe
b. Insert a new catheter over the guidewire and with hold antifungal therapy
c. Remove the triple lumen catheter and initiate treatment with fluconazole
d. Repeat the blood cultures, since the yeast in the blood is likely to be a contaminant

Questions below refer to the following case.

A thirty-eight year old Caucasian man with advanced AIDS. One year ago he presented with
signs of HIV dementia and wasting syndrome. At that time, his CD4 count was less than fifty.
Since the initial AIDS diagnosis, he has been routinely evaluated in Stanford's Positive Care
Clinic. Eosinophilic folliculitis and Candida stomatitis are his only documented opportunistic
infections. His outpatient medications prior to admission included anti-retroviral D4T,
itraconazole for eosinophilic folliculitis treatment and Candida prophylaxis, acyclovir for HSV
prophylaxis, monthly pentamidine for Pneumocystis carinii prophylaxis, marinol for treatment of
HIV wasting syndrome and pepcid for peptic ulcer disease.
On the day of admission, the patient presented of a worsening sore throat, odynophagia,
trouble swallowing his oral secretions, difficulty breathing, decreased appetite, and a fever of
1020F for three days. On exam, the patient was in significant distress sitting upright, drooling,
with some use of accessory muscles of respiration. Due to swelling and upward/posterior
displacement of his tongue, the patient was limited to one word, garbled responses to questions.
Recorded vital signs were T 39 C, HR 100, R 24, BP 130/80, and 97% saturation on room air.
Tender, bilateral submandibular swelling greater on the right than the left was noted. Fluctuance
was insignificant. Sublingual swelling was indicated by upward displacement of the tongue. No
cervical, supraclavicular, infraclavicular, pre/posterior auricular or axillary Iymphadenopathy
was detected. Examination of the oropharynx was hindered by marked trismus of 25 mm. The
right tonsil had a yellow-white exudate and was erythematous. The left tonsil was clear. A large
area (estimated 3 x 3 cm) of the right soft palate was swollen. Due to the potential of rapid
airway compromise and the need for better visualization of the oropharynx, the Otolaryngology-
Head, Neck & Throat team evaluated the patient immediately in the emergency department. This
examination confirmed the findings previously described and further noted normal vocal cords, a
fully patent airway, right arytenoid fold swelling, and slight fullness of the right lateral
pharyngeal wall. Importantly, no supraglottitis or epiglottitis were seen.
A CT scan of the neck and sinuses demonstrated significant bilateral peripharyngeal,
retropharyngeal, and paravertebral space soft tissue inflammatory change with edema. Right
sicled spaces were more involved than left. Swelling distorted and compressed the oropharynx.
The left common and external jugular veins were thrombosed. Finally, there was CT evidence of
chronic sinusitis.

78. What is your diagnose base on the case?


a. Scabies
b. Pertussis
c. Meningitis
d. Ludwigs Angina
e. TORCH infection
79. Which of these treatments is the most appropriate initial regimen for most patients with
nodular/bronchiectatic Mycobacterium avium complex (MAC) lung disease?
a. Azithromycin (AZM) 500 mg 3 times weekly
b. Clarithromycin 1000 mg daily
c. AZM 500 mg, ethambutol 25 mg/kg, and rifampin 600 mg 3 times weekly
d. AZM 500 mg, ethambutol 25 mg/kg, and rifampin 600 mg daily

80. A 35-year-old man presents to his primary care physicians office with complaints of nasal
stuffiness with yellow nasal drainage, watery eyes, nonproductive cough, sore throat, and
muscle aches for 7 days duration. He requests a course of antibiotics. The patient describes
mild right facial discomfort for which acetaminophen has provided no relief. He has no
toothache. Medical history is significant only for hyper- tension. The patient is married and
has been working as a sales manager in a department store for the past 3 years. He and his
wife each smoke two packs of cigarettes per week. He takes no medications other than the
acetaminophen and atenolol for the hypertension. On physical examination the patient
appears healthy. His blood pressure is 146/92 mm Hg and temperature is 37.1C. His
conjunctivae are injected. He has minimal maxillary sinus tenderness on the right, and
bilateral yellow nasal discharge. On transillumination he has normal light transmission
through both maxillary sinuses. His oropharynx appears mildly erythematous and is without
exudate. His external ear canals are with- out edema or erythema. The tympanic membranes
are neither bulging nor retracted; the ear landmarks are easily identifiable. He has no
lymphadenopathy. What are the most likely causes of this patients symptoms?
a. Acute Rhinosinusitis
b. Avian Influenza
c. Hay fever with hypersensitivity
d. Rhinitis diphteriae
e. Acute Influenza Type A

81. Which of these is the first choice for Sarcoptes scabiei infection?
a. Ivermectin oral tablet
b. Lindane lotion
c. Malathion lotion
d. Permethrin cream

82. Which of these is the most common method of transmission for Chagas disease?
a. Triatomine insect bite
b. Blood transfusion or organ transplantation
c. Ingestion of contaminated food or drink
d. Mother-to-infant transmission

83. A 16 year old male presents with sore throat, fever, and cervical lymphadenopathy. A throat
culture is done which is positive for group A streptococcus. Treatment is initiated with
penicillin. He returns two days later with worsened symptoms, despite taking the medicine.
Which of the following is the most appropriate step to do next?
a. Switch to azithromycin.
b. Obtain a CBC and Monospot.
c. Check anti-VCA, anti-EA, and anti-EBNA titers against EBV.
d. Assume the patient has infectious mononucleosis and start acyclovir and prednisone.

84. Which of the following statements about EBV infection is TRUE?


a. The syndrome of infectious mononucleosis results from primary infection with the virus.
b. Infection usually occurs via contact with the blood of an affected person.
c. About 25% of older adults show serologic evidence of prior infection.
d. Splenic rupture is a frequent complication in EBV-associated infectious mononucleosis.

85. Which syndrome has NOT been found to be associated with EBV?
a. Nasopharyngeal carcinoma
b. Oral hairy leukoplakia
c. Aplastic anemia
d. Kaposi's sarcoma

86. A 3-year-old girl is brought to your office by her mother Because she has a fever and
complains that her ear hurts. She has no significant medical history. The child is not pleased
to be in the physician's office and has been crying. Explains Her mother that she developed a
"cold" about three days ago with sniffles. Her temperature is 37.8 C (100 F), and the rest
of the physical examination is completed with some difficulty. The only slight abnormalities
are Redness of the throat, a nose full of thick green mucus, and injected tympanic
membranes.
What is your diagnose following in the case?
a. Otitis Media
b. Acute laryngotracheobronchiolitis
c. Croup
d. Pharyngitis
e. Tonsilitis with bronchitis

87. A two years old boy reported to the hospital with the complaint of difficulty in eating since a
day. History revealed the presence of fever since a day. The patient had developed fever
suddenly the previous night without any symptoms of flu. After 12 hours his mother had
noticed two papules; one in the palm and one in the foot. Following that he developed a
severe ache in legs and difficulty to eat. The patient experienced a severe itching over the
papules. Informed consent was obtained from the parent as a part of the routine protocol
before the clinical examination. On examination, the patient was febrile and had a body
temperature of 101.4F. Many papules were noted on the palm and foot. 2-3 papules were
present over the trunk region and knee as well. Intraoral examination revealed multiple
reddish macules, measuring approximately 2mm in diameter in the roof of the hard palate.
No other lesions were present intraorally. The patient was advised to consume plenty of
fluids and was prescribed paracetamol syrup to control fever, topical local anesthetic for
intraoral application, antihistamine syrup to reduce itching and calamine lotion for topical
application. After two days, most of the papules had turned into fluid filled blisters and few
blisters were present around the mouth. However, palatal lesions had subsided improving the
patients ability to take food. Vesicles started forming crustations in a week and the skin
returned to normal in a month.
Papules on hands Papules and Healing lesions
and feet on the blisters on the on hand and foot
first day. hand, foot and on the 15th day.

What is your diagnose base on the case?

a. Hand-Foot-Mouth Disease

b. Erytema marginatum

c. Polyscitemia

d. Arthropod-borne viruses related disease

e. Rhinitis alergica with Leptospirosis

88. Which of these is the microbiological classification of the etiologic agent of toxoplasmosis?
a. Ameba
b. Fungus
c. Protozoan
d. Roundworm

89. A 43 year old lady was seen in clinic with progressive leg weakness. At the age of 9 weeks
she had an illness causing weakness of both legs which kept her in hospital until the age of 6.
A diagnosis of poliomyelitis was made at this stage and she had several foot and ankle
operations. She had used callipers as a child and young adult, but had walked well and
excelled at swimming. At the age of 36, she complained of right arm dysfunction with pain.
Subsequent to this she had increasing weakness of her right arm and leg with some falls. This
progressed slowly and severely limited her mobility to a few yards with crutches. Over the
course of a few years she had progres- sive left leg weakness and the need for a wheelchair.
More recently she developed some left sided hand parasthesiae in the mornings. Cranial
nerve examination was normal. She had no upper limb wasting. There was some weakness of
the right triceps. Right triceps and supinator reflexes were absent, but the remainder were
preserved. In the lower limbs, there was global weakness of the legs with bilateral wasting
(more pronounced on the right and more distal than proximal). She was areflexic in the lower
limbs with flexor plantars. There were no abnormal sensory findings and proprioception was
normal.
What is the diagnose about this case?
a. Post-polio syndrome
b. Intestinal nematodes
c. Hemipharesis dextra
d. Marfan syndrome
e. Plegia

90. Which of these mosquito species is most likely to cause severe malarial disease?

a. Plasmodium falciparum
b. Plasmodium malariae
c. Plasmodium ovale
d. Plasmodium vivax

91. For an infectious disease to develop in a host, the organism must initially:
a. Survive phagocytosis
b. Be in the log phase of multiplication
c. Penetrate the skin or mucous membrane barrier
d. Be present in the host for 7 to 10 days
e. Release endotoxin

92. Each of the following parasite is transmitted by mosquitoes, except:


a. Leishmania donovani
b. Wuchereria Bancrofti
c. Plasmodium vivax
d. Plasmodium falciparum
e. Plasmodium ovale

93. In malaria, the form of plasmodia that is transmitted from mosquito to human is the?
a. Sporozoite
b. Gametocyte
c. Merozoite
d. Hypnozoite
e. Nucleus

94. A 35 year old man was in South East Asia on holiday backpacking alone. He has returned 5
days ago, having been there for a month. His temperature is 38 C and he has a swollen ankle
and elbow joint. He also complains of purulent penile discharge. Which of the following
conditions/infections is likely?

a. Staphylococcus Aureus
b. Treponema pallidum
c. Neisseria gonorrhoeae
d. Chlamydia trachomatis
e. Influenza Virus

95. An 70-year-old gentleman from an Aged Care Hostel has been noted by the staff to by
frequently scratching his hands. On reviewing him you notice the above Red Papules in the
webbed spaces. What do they likely represent?

A. HPV infection
B. Scabies
C. Contact Dermatitis
D. Eczema
E. Herpes Zoster

96. A distinguishing characteristic of the herpesviruses is that:


a. They are cell-associated viruses.
b. They are enveloped RNA.
c. Human beings are the only known reservoir of
infection.
d. Both a and c
e. both b and c

97. Factors that influence the development of an infectious disease include all the following,
except the:
a. Immune status of the individual
b. Incidence of an organism in the population
c. Pathogenicity of the agent
d. Sole presence of the agent or microorganism
e. Both b and d

98. Affected by immune responses such as immunoglobulin, complement, and antibody-


dependent cell-mediated cytotoxicity. Type of infectious disease to the most appropriate
description above is :
a. Bacterial disease
b. Viral disease
c. Parasitic disease
d. Allergic disease
e. Both a and b

99. The detection of _________ can be of diagnostic significance during the first exposure of a
patient to an infectious agent.
a. IgM
b. IgG
c. IgA
d. IgD
e. IgE

100. Aspergillosis is:


a. An opportunistic organism
b. Caused by a parasite
c. A cause of skin infections
d. A relatively mild disease
e. Caused by a virus